Adults' dental treatment in 2001-2013 in Finnish public dental service.

BACKGROUND: All adults over 17 years of age have access to the Public Dental Service after the Finnish Dental Care Reform in 2001-2002. This study aimed to survey the treatment needs and treatment measures provided for adult patients and changes in these during the period 2001-2013. METHODS: Sing each person's unique identifier, demographic data on dental visits during the period 2001-2013 were collected from municipal databases in five PDS-units covering 320,000 inhabitants. The numbers of visitors, those in need of basic periodontal or caries treatment (CPI > 2 and D + d > 0) were calculated for three age groups. Treatment provided was also calculated in 13 treatment categories. Trend analyses were performed to study changes during the study period. RESULTS: Restorative treatments (968,772; 23.6%), examinations (658,394; 16.1%), radiographs taken (529,875; 12.9%) anaesthesia used (521,169; 12.7%) and emergency treatments (348,229; 8.5%) made up 73.8% of all treatment measures during the entire study period. Periodontal treatment (7.8%) and caries prevention (3.9%) made up a small part of the care provided and prosthetics and treatment of TMJ disorders were extremely uncommon (fewer than 1%). Treatments related to caries (restorative treatment, examinations, endodontics, emergencies, anaesthesia and radiographs) made up 60.4% of the dental personnel's treatment time. During the study period, statistically significant increasing trends were found for radiographs (p < 0.001***), anaesthesia (p = 0.003**) and total number of treatments (p = 0.009**). There was a slight decreasing trend in treatment need among the youngest adults (18-39 years; p = 0.033*). CONCLUSION: Compared with the results of national epidemiological studies, insufficient periodontal treatment is provided and prosthetic treatment is almost totally neglected in the PDS. Rather, adults' dental treatment concentrates on treatment of caries. The unmet needs may be due to tradition, inadequate treatment processes or a lack of resources or failed salary incentives.

Children and adolescents´ dental treatment in 2001-2013 in the Finnish public dental service.

BACKGROUND: The Public Dental Service (PDS) in Finland has catered for the overwhelming majority of the young for more than 50 years. They have had examinations, preventive measures and all other necessary treatment free of charge. This study aimed to survey the treatment needs and treatment measures provided for children and adolescents and changes in these during the period 2001-2013. METHODS: Using each person's unique identifier, data on patients (< 18 years), their oral health (CPI > 2, D + d > 0) and treatment received in the period 2001-2013 were collected retrospectively from municipal databases in five PDS-units covering 320,000 inhabitants. The National Institute for Health and Welfare gave ethical approval. Permission to use local data was received from the Directors in the PDS units. Treatment measures were grouped into 14 categories and patients into three age categories (0-6 years, 7-13 years and 14-17 years). Trend analysis was used to test changes over time. RESULTS: About 40,000 children and adolescents visited the PDS each year and 2,488,805 treatment measures were provided for them during the entire study period. The proportion of those in need of treatment decreased from 44.4 to 33.2% during the study period. The most common treatment categories were examinations (613,753, 24.7%), orthodontics (499,033, 20.1%), preventive measures (372,473, 15.0%) and restorative treatment (355,325, 14.3%); these made up 74% of all treatment measures. During the study period, statistically highly significant (p < 0.001***) increasing trends were found for examinations, anaesthesia and the total number of treatment measures, and a significant (p < 0.001***) decreasing trend in restorative treatment were found for all the young. More preventive treatment measures were provided for those not in need of treatment compared with those in need of treatment. CONCLUSION: Although children's oral health had improved and restorative treatment provided had decreased, the total number of treatment measures increased. Healthy children received frequent examinations and high numbers of preventive treatment measures. Targeting treatment according to needs was not satisfactory.

Community-based preventive activities in the Public Dental Service in Norway.

OBJECTIVES: The purpose of this study was to describe community-based preventive interventions undertaken by the dental team outside the dental clinics in Norway, from the dental hygienists' and the dentists' perspective, with the main focus on target groups and existing guidelines and routines for these activities. A secondary aim was to identify the personnel responsible for developing the local guidelines and the knowledge sources for the guidelines. METHODS: With the assistance of the Chief Dental Officers in 15 Public Dental Service (PDS) regions, questionnaires were emailed to the local clinics (n = 421). In each, the most experienced dental hygienist and dentist were asked to respond; 215 dentists and 166 and dental hygienists responded (60%). RESULTS: Almost 40% of the respondents reported that their clinic had guidelines on community-based activities conducted outside the clinics. Dental hygienists and local chief dentists were responsible for planning them. The main target groups were young children and the dependent elderly; the majority of the activities were carried out at child welfare centres and for personnel at nursing homes or for home care nurses. CONCLUSION: At the regional and local level, a more strategic and coordinated approach to the provision of community-based activities is needed, including assessment of oral health needs among population groups. Continuous documentation and evaluation of results are necessary for optimal use of available resources and to facilitate an evidence-based approach.

The professional role of a dental hygienist in Finland - educators' views.

OBJECTIVES: To assess the role and envisioned professional identity of the dental hygienist in the eyes of their educators at the Finnish training institutes and to determine the need for any changes and improvements. METHODS: A cross-sectional explorative study used as its main method interviews conducted in 2012-2013 among educators of dental hygienists in Finland. Leading representatives of dental hygienist training at all vocational health institutes, dental schools and centres of health education were asked to participate in the study. The interviews consisted of two parts: a self-administered questionnaire and a semi-structured interview. The qualitative data were analysed with thematic analysis. The inductive theoretical approach served to categorize the data based on emergent themes and patterns. RESULTS: The educators held a general respect and appreciation for the dental hygienist profession. They felt that dental hygienists' skills ought to see more use in orthodontics and in preventive care than is customary today, including in tobacco prevention and smoking cessation as well as in dietary instruction among adults. The traditional role of the dental hygienist and the evolving scope of dental practice seemed mismatched. Concern about the lack of clarity regarding the division of labour in clinical practice was expressed. The respondents were convinced of that the division of labour in the public sector differs from that in the private sector. CONCLUSION: The educators thought that the role of the dental hygienist and the evolving scope of dental practice were partly mismatched. A reassessment of stakeholder involvement in the development of training curricula is urgently needed.

Treatment provided in the Public Dental Service in Finland in 2009.

OBJECTIVES: To analyse treatment measures provided in the Public Dental Service (PDS) and to discuss the therapy given against treatment needs as expressed in the national clinical epidemiological studies. METHODS: In 2009, the Chief Dentists of the PDS units collected data from their local registers on patients and treatment provided. Data were obtained from 166 PDS units (86%). Treatment patterns were compared between age groups, provider groups and geographical areas using chi-square tests. RESULTS: Altogether 8.9 million treatments were provided for 1.7 million patients. Examinations, restorative treatment and anaesthesia accounted for 61.3% of all treatments. Preventive measures (8.4%) and periodontal treatment (6.3%) were small proportions of the total. Prosthetic treatment was uncommon (0.5%). Working age adults received half of all treatments (53.2%), the young a third (36.4%) and the elderly 10.4%. Dental hygienists or dental assistants provided 29.7% of all treatment for children and adolescents, 11.1% for adults and 14.1% for the elderly. CONCLUSION: Relatively healthy children had plenty of examinations and preventive measures, and adults had mostly restorative care when their needs were more periodontal and prosthetic care, indicating that treatment given was not fully in line with needs.

Longitudinal register study of attendance frequencies in public and private dental services in Finland.

OBJECTIVE: The Public Dental Service (PDS) in Finland was recently opened to all adults. According to annual statistics, 75% of children and 51% of adults made dental attendances in 2008. This study aimed to survey the frequency of dental attendance across three years and compared attendance frequencies between age groups and treatment sectors. METHODS: Data from municipal databases and the reimbursement register of the Social Insurance Institution were collected on all who had attended the PDS (733,000) or the private sector (473,000) in 2008 and they were retrospectively followed from 2008 to 2006. RESULTS: Most children had attended the PDS in each year (57.4%) or in two of the three years (32.2%). Most working aged (57.3%) and elderly (69.1%) were annual attenders in the private sector. In addition, 27.1% of the former and 19.8% of the latter had attended in two of the three years. Attending in one year only was unusual. In the PDS, adult annual attendance was uncommon (31.9%), and adult attenders were fairly evenly distributed over the three categories, attending in one, two or all three years. CONCLUSIONS: Annual or biannual attendances seemed to be the norm among children in the PDS and adults in the private sector. Adults in the PDS showed irregular attendance patterns probably partly due to scarcity of resources for recall patients in the PDS.

Industry structures in private dental markets in Finland.

OBJECTIVE: To use industrial organisation and organisational ecology research methods to survey industry structures and performance in the markets for private dental services and the effect of competition. DESIGN: Data on practice characteristics, performance, and perceived competition were collected from full-time private dentists (n = 1,121) using a questionnaire. The response rate was 59.6%. Cluster analysis was used to identify practice type based on service differentiation and process integration variables formulated from the questionnaire. RESULTS: Four strategic groups were identified in the Finnish markets: Solo practices formed one distinct group and group practices were classified into three clusters Integrated practices, Small practices, and Loosely integrated practices. Statistically significant differences were found in performance and perceived competitiveness between the groups. Integrated practices with the highest level of process integration and service differentiation performed better than solo and small practices. Moreover, loosely integrated and small practices outperformed solo practises. Competitive intensity was highest among small practices which had a low level of service differentiation and was above average among solo practises. CONCLUSIONS: Private dental care providers that had differentiated their services from public services and that had a high number of integrated service production processes enjoyed higher performance and less competitive pressures than those who had not.

Pricing and competition in the private dental market in Finland.

OBJECTIVE: To investigate how the prices were set in private dental care, which factors determined prices and whether the recent National Dental Care Reform had increased competition in the dental care market in Finland. DESIGN: A questionnaire to all full time private dentists (n = 1,121) in the ten largest cities. Characteristics of the practice, prices charged, price setting, perceived competition and expectations for the practices were requested. The response rate was 59.6%. Correlation analysis (Pearson's) was used to study relationships between the prices of different treatment items. Linear regression analysis was used to study determinants of the price of a one surface filling. RESULTS: Most dentists' fee schedules were based on the price of a one surface filling and updated annually. Changes in practice costs calculated by the dentists' professional association and information on average prices charged on dental treatments in the country influenced pricing. High price levels were associated with specialisation, working in a group practice, working close to many other practices or in a town with a dental school. Less than half of the respondents had faced competition in dental services and price competition was insignificant. CONCLUSIONS: Price setting followed traditional patterns and private markets in dental services were not found to be very competitive.

Evaluation of a dental outreach teaching programme.

Dental health care is largely based on primary care. It is therefore logical to train students in external dental clinics in addition to university facilities. Consequently, the new dental curriculum at The University of Tromsø in Northern Norway has implemented outreach teaching and training as an extensive part of their curriculum. The overall opinion is that the external training has been very valuable both regarding volume and diversity of treatment experiences and has contributed substantially to the clinical maturity of the students. Educating the tutors is considered to be an essential part of the programme.

Heavy consumption of dental services among Finnish adults.

OBJECTIVE: To compare treatment of heavy and low users of dental services among adults in the Public Dental Service (PDS) in one of the biggest cities in Finland and to identify reasons for heavy use and to suggest improvements to care provision. METHOD: All adults who attended the PDS in Espoo (pop. 227,500) in 2004 were allocated to a group (n = 3,173) who had made six or more dental visits and a comparison group (n = 22,820) who had three or fewer dental visits. The data were obtained from the patient register of the PDS. A sample of 320 patients was randomly selected from each group. Information on age, gender, number and types of visits, oral health status, treatment provided and fees paid was collected from treatment records. RESULTS: 10.5% of the adults were found to be heavy users and their treatment made up 31.6% of all adult dental visits. The proportion of men was greater among heavy users and the heavy users were on average 6.6 years older than the low users. The mean total treatment time for heavy users was 5.5 hours and 2.0 hours for low users. Heavy users had more untreated and treated caries and more periodontal pockets than low users. Restorative, endodontic and prosthetic treatment needs characterised the heavy user group, while the low users most often received restorative and periodontal treatment only. CONCLUSIONS: Our study indicates that complicated treatment needs of heavy users and lack of experience among the caregivers in dealing with them resulted in high numbers of dental visits for individual patients. The PDS should offer appropriate continuing education for its oral health care teams and organize a referral system offering specialist care for difficult endodontic, periodontal and prosthetic treatments.

Changes in dentist and dental hygienist numbers in the European Union and economic area.

AIM: To investigate the extent to which changes in the numbers of dental hygienists and dentists have occurred in the Member States of the European Union and Economic Area (EU/EEA) during the last ten years and discuss the changes in relation to the possibilities of sharing tasks between the two groups. METHODS: Numbers for active dentists, registered hygienists and EU/EEA member state populations in 2007 were taken from the website of the Council of European Chief Dental Officers (CECDO) (www.cecdo.org) and from CECDO records for the EU/EEA member states in 1998 and for the new EU member states (who joined in 2004 and 2007) in 2000. From these data, population: active dentists, population: registered dental hygienist and active dentists: registered dental hygienist ratios were calculated together with percentage changes in the number of dentists and dental hygienists by member state, between 1998 and 2007 for the old and between 2000 and 2007 for the new EU member states. RESULTS: In 2007, there were a total of 343,922 active dentists and 30,963 registered dental hygienists in the 30 EU/EEA member states plus Switzerland. The mean population to dentist ratio was about 1500:1 and the mean population to dental hygienist ratio (in the 25 states where dental hygienists were registered) was 13,454:1. During the study period, the population of the EU/EEA plus Switzerland increased by less that 3%, the number of dentists increased by 13% and the number dental hygienists by 42%. The overall ratio of active dentists: dental hygienists changed from 18:1 to 11:1. In six of the 30 member states plus Switzerland the population to dental hygienist ratio was between 2000:1 and 6000:1 and the dentist: dental hygienist ratio less than 1:3. CONCLUSIONS: Although, most member states educate dental hygienists and their numbers in the EU/EEA during the last 10 years have risen more than the dentist numbers, there are still only a handful countries where the hygienist numbers are great enough to make a significant difference to the delivery of oral health care.

Heavy use of dental services among Finnish children and adolescents.

AIM: Our aim was to identify the heavy use of dental services among children and adolescents in the Public Dental Service (PDS) of one of the biggest cities in Finland, and compare oral health and treatments provided for heavy and low users. METHODS: All patients under 18 years of age having had 6 or more dental visits (n. 2,285) in 2004 and a comparison group of those having had 3 or fewer visits (n. 27,957) were selected from the patient register of the PDS of the city of Espoo. A sample of 245 patients was randomly selected from each group and information on age, sex, dental status, number and types of visits and treatments provided was collected from their treatment records. RESULTS: Seven percent of the children and adolescents who had visited the PDS in 2004 were heavy users according to the definition used. Their visits accounted for 26.3% of all dental visits of children and adolescents. The heavy users were classified as basic care heavy users and orthodontic heavy users. The mean treatment time for the basic care heavy users was 3 hours and 50 minutes, and for orthodontic heavy users 3 hours and 23 minutes; it was 40 minutes for the low users. Heavy users were on average 1.8 years older than low users. The basic care heavy users had more treated and untreated caries (mean DMFT/dmft = 4.0 and D/d = 2.4) than the low users (DMFT/dmft = 0.95 and D/d = 0.4). Of the low users, 43.6% had a healthy periodontium (CPI = 0) compared with 27.4% of the basic care heavy users and with 30.8% of the orthodontic heavy users. The most frequently provided treatments for heavy users were orthodontic care and fillings by dentists and for low users preventive measures and examinations. Most of the heavy users (66.4%) received less complicated orthodontic treatment given by a dentist compared with only 7.9% of the low users. Despite the low users' significantly better oral status compared with basic care heavy users there were only minor differences in the type of preventive measures provided for the two groups. The orthodontic heavy users received fewer preventive measures than low users. CONCLUSION: Our study revealed two main reasons for heavy use of dental services: high numbers of orthodontic treatments provided by dentists and high numbers of decayed teeth in a small number of children. To increase productivity, orthodontic care should be provided more efficiently and preventive care needs to be targeted more carefully.

Education in and the practice of dental public health in the United kingdom and Finland.

This paper describes and compares the education in and practice of dental public health in Finland and the United Kingdom. A brief introduction describes the populations of the two countries in terms of their geography, mean per capita, Gross Domestic Product (GDP), life expectancy, recent oral epidemiological data, oral health needs and the dental workforce. This is followed by a description of education in Dental Public Health in each country at undergraduate, postgraduate and continuing levels. The practice of Dental Public Health is then outlined. In both countries it includes: leadership and management of health organisations, teaching, training, research, advising and evaluating. A discussion follows. It considers the need for the provision of Dental Public Health at a time of changing oral health need and gives examples of problems that have arisen when such advice has not been sought or has been ignored. Finally, the paper considers how education in Dental Public Health could be developed to provide more flexible training whilst ensuring that the quality of knowledge and skills of specialists is maintained or improved.

Working profiles of dental hygienists in public and private practice in Finland and Norway.

AIM: The aim was to compare the working profiles of Finnish and Norwegian dental hygienists in public and private practice. To this end, we compared the procedures performed, the type of patients and the time devoted to different tasks. SUBJECTS AND METHODS: A questionnaire survey was originally conducted among a representative sample of dental hygienists in Finland (n = 595) and all authorized dental hygienists in Norway (n = 1,138) in 2004. The questionnaires collected data on the dental hygienists' age, gender, year of graduation, working experience, work sector (private or public), working time spent on different activities and patient groups. The questionnaire also assessed how frequently the dental hygienists performed 25 different treatment measures. RESULTS: The Norwegian dental hygienists spent 45.4% of their clinical time on check-ups, whereas the Finns spent 49.9% of their time scaling. Dental hygienists in Finland and Norway working in the public sector spent 42.9% and 74.6% of their working time dealing with children and youth respectively. CONCLUSIONS: The working profiles of dental hygienists in Finland and Norway were quite similar, although differences in distribution by activities, type of patients and treatment measures do exist. The main activity of the dental hygienists was clinical work. The most commonly practised clinical activity among Finnish dental hygienists was scaling, and among Norwegians, check-ups. Public dental hygienists in both countries dealt mainly with children and youths. Oral hygiene instruction was the most commonly reported treatment measure among both Finns and Norwegians.

Is there a need for a common framework of dental specialties in Europe?

This paper aims to promote discussion about dental specialties and post-graduate dental education in the European Union (EU). Previously, dental educators have concentrated their efforts of seeking Pan-EU convergence in undergraduate dental education. However, the impact of the enlargement of the EU, the new European Commission (EC) Directive of professional training and the Bologna Process all impact on post-graduate (specialist) just as much as on undergraduate dental education. The provisions of the new EC directive mean that, unlike new medical specialties, new Pan-EU dental specialties cannot be created purely because they exist in two-fifths of EU Member States. At present, some EU Member States recognise eight or more dental specialties, whereas others recognise none. It is suggested that changing needs and demands of patients, which reflect a general improvement in oral health, increased wealth and an aging population will place increasing demands on dentistry to provide more complex care and treatment and that the current undergraduate curriculum cannot be expanded to provide suitable training to meet these needs and demands. There is thus a need to expand dental specialist training in all EU Member States, to agree common standards for specialist education and to officially recognise a wider range of Pan-EU dental specialties. The paper concludes that in order to achieve these goals, there is a need of a better collaboration between competent authorities, including governments, universities, dental associations and the various Pan-European Scientific Specialist Organizations.

The healthcare system and the provision of oral healthcare in European Union member states. Part 9: Sweden.

Equally accessible and affordable dental services for all population groups have been a political goal in Sweden for almost a century. All political parties have shared the idea that a person's social background should not have consequences for his or her dental status. Strategic tools to achieve this ambitious goal have been the wide use of publicly provided oral healthcare services, covering even sparsely populated areas, focusing on preventive care and significant subsidies for necessary treatments. Besides free care for children and young adults, oral healthcare is reimbursed from public funds. The public subsidy was particularly generous in 1975-1999 when a 'full clearance' of adults' dentitions was undertaken both by the public and private providers under fixed prices and high reimbursement levels for all treatment measures. Today, preventive oral healthcare for the elderly is given higher priority as most Swedes have been able to keep their natural teeth.

The healthcare system and the provision of oral healthcare in European Union member states. Part 8: Italy.

In Italy healthcare is provided for all Italian citizens and residents and it is delivered mainly by public providers, with some private or private-public entities. Italy's public healthcare system - the Servizio Sanitario Nazionale (SSN) - is organised by the Ministry of Health and administered on a devolved regional basis. It is financed by general taxation that provides universal coverage, largely free of charge at the point of service. The central government establishes the basic national health benefits package, which must be uniformly provided throughout the country, through services guaranteed under the NHS provision called LEA - (Livelli Essenziali di Assistenza [Essential Level of Assistance]) and allocates national funds to the regions. The regions, through their regional health departments, are responsible for organising, administering and delivering primary, secondary and tertiary healthcare services as well as preventive and health promotion services. Regions are allowed a large degree of autonomy in how they perform this role and regarding decisions about the local structure of the system. Complementary and supplementary private health insurance is also available. However, as in most other Mediterranean European countries, in Italy oral healthcare is mainly provided under private arrangements. The public healthcare system provides only 5-8% of oral healthcare services and this percentage varies from region to region. Oral healthcare is included in the Legislation on Essential levels of care (LEAs) for specific populations such as children, vulnerable people (medically compromised and those on low income) and individuals who need oral healthcare in some urgent/emergency cases. For other people, oral healthcare is generally not covered. Apart from the national benefits package, regions may also carry out their own initiatives autonomously, but must finance these themselves. The number of dentists working in Italy has grown rapidly in the last few years. In December 2014, there were 59,324 practicing dentists with a ratio of one dentist every 1025 inhabitants, about 90,000 dental chair-side assistants, about 26,000 dental technicians and about 4000 dental hygienists. To enrol in an Italian dental school a student must pass a competitive national entrance examination after obtaining a high school leaving certificate. For entry in the 2015-2016 cycle, there were 792 places for dentistry. In comparison with dental schools in other EU member states, the number of dental students per school is low with an average of 20 students per year, per school and a range of 10 to 60. The aims of this paper are to give a brief description of the organisation of healthcare in Italy, to outline the system for the provision of oral healthcare in Italy and to explain and discuss the latest changes.

The healthcare system and the provision of oral healthcare in European Union member states. Part 7: Republic of Ireland.

The Irish oral healthcare system is a hybrid model with a public/private mix of service provision, predominantly organised on the basis of fee-per-item remuneration. The system is structured around three long standing publicly funded schemes: the Public Dental Service (PDS) for all children and adults with special needs and provided by salaried dentists, the Dental Treatment Services Scheme (DTSS) for low income adults, and the Dental Treatment Benefit Scheme (DTBS) for insured persons, the latter two both provided by private independent dental practitioners. Ireland introduced systemic water fluoridation in 1963 and currently 73% of the population has access to fluoridated water. Ireland currently has a dentist density ratio of 6.1 dentists per 10,000 inhabitants and on average, 43% of the population (30% for those aged 70+ years) visit a dentist annually. In 2014, 83% of expenditure on oral healthcare was from out-of-pocket payments by patients, with less than 1% of overall government expenditure on healthcare allotted to oral healthcare. After the economic downturn of 2008 and the severe recession that followed in Ireland, substantial cutbacks in government expenditure resulted in extensive cuts to the public sector supply of dental services and to the extent of cover provided by the publicly funded schemes. The Department of Health has recognised the major post recessionary challenges facing the Irish health system, not least, significantly reduced budgets and capacity deficits, and acknowledges the need for change in Ireland's health service. In 2014, a three-year project commenced at the Department of Health, to develop a new national oral health policy for Ireland.

The healthcare system and the provision of oral healthcare in European Union member states: Part 5: Romania.

Romania is one of the newest member states of the European Union (EU). It has 13 dental schools, 14,841 dentists and 2,935 dental technicians providing oral health care for a population, at 31 December 2014, of 21.3 million. The shift from a communist system to a democratic or capitalist society has contributed to an enormous change in the proportion of public and private sector oral health services. The lack of public funds during the post-communist years has contributed to a dependency on private oral healthcare rather than the government financed public provision. Affordability and social awareness have together established a mixed economy for oral health care costs and oral healthcare is growing slowly compared with other developed EU member states. At the same time, there has been overproduction of new dentists (currently 1500 graduate annually). This has led to un and under-employment and emigration of dentists to other EU member states. This paper explains the current oral healthcare system in Romania and changes in recent years.

The healthcare system and the provision of oral healthcare in European Union Member States. Part 6: Poland.

Poland is one of the largest European countries in terms of area and population. The country's economic situation does not allow for the allocation of sufficient public funds for healthcare in general and oral healthcare in particular. The health policy of the state focuses primarily on prophylaxis and treatment of diseases, directly threatening the health and lives of the inhabitants. Currently, expenditure on oral health accounts for only 2.7% of the public funds allocated to healthcare. In this context, providing oral care financed from public funds at an appropriate level constitutes a challenge for state institutions, centres providing medical and dental services and private practices. Despite difficult financial conditions in Poland, therapeutic and prophylactic programmes are implemented, aimed at improving the oral health of the society, especially children and adolescents, pregnant women and patients with disabilities or developmental disorders such as cleft palate. In Poland, apart from the oral care system financed by the state, there is also an extremely well developed system of private practices and clinics providing clinical services on a commercial basis. In 2014, oral services, financed by the state, were utilised by about 30% of the population of children and youths aged 0-18 years (2,212,792 patients) and about 15% of the adult population (5,026,383 patients). Training of Polish dentists is conducted in ten state-owned universities, from which 700 graduate each year. Dentists work mainly in private practices or medical centres, some of which provide services guaranteed by the public insurer - the National Health Fund. The other dentists find employment in state clinics, hospitals, and universities and their associated clinics. In Poland dentistry is a predominantly female profession and 75% of the just over 40,000 Polish dentists are female. Accession of Poland to the European Union meant that some Polish dentists have taken up employment abroad. It is estimated that the most common destination is the United Kingdom (UK), where 803 Polish dentists were registered, according to the General Dental Council in 2015.