Oral care is one of the great gaps in Spanish public health. It represents one of the largest health expenses of the Spanish (along with medicines) and the public budget only covers 1%, compared to 30% on average in the European Union, according to a study by the World Health Organization (WHO). ) published last year. The Government has approved this week a plan to alleviate this problem with new coverage that may benefit, according to its calculations, seven million people. The funding, 44 million euros from the general state budget, is still far from what is needed to catch up with the rest of the EU.
The Minister of Health, Carolina Darias, explained after the Interterritorial Council of the National Health System (CISNS) on Wednesday that the plan aims to increase common services that until now were not provided by public health, “with a fundamentally preventive”. Prioritizes children and adolescents up to 14 years old, pregnant women, people with disabilities and cancer patients in the cervicofacial area.
“We believe that it is a very powerful plan, which will allow us to intervene preventively in matters such as highly concentrated fluoride varnishes, pit and fissure dryers that prevent the appearance of cavities, mouth cleaning or fillings in the permanent dentition”, he said. Darias, who has described the plan as “the largest expansion of the portfolio of the National Health System”.
Until now, the public system covers treatment for all acute processes (infections or inflammations, trauma, wounds, injuries), oral advice, pharmacological treatment of oral pathology that requires it, extractions and check-ups to detect potentially carcinogenic lesions. . And there is a wide variety of additional benefits depending on the autonomous community, or even the municipality.
When this plan begins to be implemented, the service for the groups it benefits will also include regular check-ups, cleanings and x-rays, if necessary. Pregnant women should make at least one dental visit, “preferably during the first trimester of pregnancy.” Children up to 14 years of age will be provided with check-ups to determine the risk of caries, something that will be promoted in the first two years of life to establish the frequency of visits to the dentist.
This is something that the General Council of Dentists of Spain (CGDE) considers key. Its president, Óscar Castro, considers that any progress is important, even if the budget does not seem very high (less than one euro per citizen). “What is spent on prevention in the world of health is 20 times less than what is involved in treatment. If we educate people in prevention, then we will have healthy adults. This will especially favor that social echelon, that of the most disadvantaged people, who have a worse mouth than those who enjoy a better social condition. The social status of a person should not condition their oral health, ”he says.
One of the problems in implementing this plan, in Castro’s opinion, is the number of professionals who work in public health: some 3,000 dentists: “Any service that expands has to have resources, not only material, but also human. In public health there are few dentists. If you want to increase benefits, you have to increase templates”.
The plan will go live at the end of this year. Before December 31, all communities must have implemented care for pregnant women, people with disabilities and children and adolescents aged 6 to 14 years. The next step, before June 30, 2023, children from 0 to 5 years old and cancer patients will be incorporated.
Including oral health in public care is an international challenge. At the end of May, the WHO approved a strategy aimed at “integrating oral health programs into broader coordinated public health initiatives, including oral health in Primary Care or addressing oral health from all stages of life, including children. prenatal programs for infants, children, adolescents, working adults, or older adults.”
Spain still has a long way to go. In the adult population, periodic check-ups are not included, nor is one of the biggest expenses among the elderly: prostheses. Since 2015, the National Health System has covered implants for people who have lost teeth due to cancer treatment and people with congenital malformations. All other dental services must be paid for in full or through private insurance.
The report published by the WHO in 2021 pointed out that among health expenses, the richest households dedicate a greater part of the direct expense to dental care, while the poorest allocate it to medicines. This indicates, according to the document, that these families prioritize spending on drugs over dental care, “which highlights the high inequality.” “Even small payments can cause financial hardship for poor people and those who have to pay for long-term treatment,” says the report.
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