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| Year : 2009 | Volume
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| Issue : 4 | Page : 518-519 |
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| Some aspects of dental care in Russia |
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Sergei V Jargin
Department of Therapeutic Stomatology, Peoples' Friendship University of Russia, Clementovski per 6-82, 115 184, Moscow, Russia
Click here for correspondence address and email
| Date of Web Publication | 29-Jan-2010 |
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How to cite this article:
Jargin SV. Some aspects of dental care in Russia. Indian J Dent Res 2009;20:518-9 |
Sir,
The concept of minimally invasive dentistry includes early detection of carious lesions, individual caries risk assessment, minimally invasive interventions with a modified surgical approach and smaller tooth preparations. The purpose of minimally invasive dentistry is preservation, as far as possible, of natural tooth structure. [1] This concept is new for Russia. During Soviet time, necessity and possibility to spare dental tissue were undervalued. The motto of Soviet health care was priority of prophylaxis, which was realized by more or less regular medical checkups at schools, factories and institutions. [2] The attitude to these checkups was often rather formal. As for dental care, initial and sometimes questionable carious lesions were treated by dry cutting, often with dull rotary instruments, with excessive removal of dental tissues. Exploration with a probe was habitually performed with the application of excessive force. Together with poor quality of filling materials, it caused acceleration of the restoration/re-restoration cycle [3] and rapid enlargement of the cavities: the fillings failed, the cavities were further enlarged, which eventually led to fractures and extractions. As for endodontic therapy, it can be seen in today's radiograms that quality of root canal treatment was often inadequate, and sometimes only traces of filling material are visible in the roots. Quality of treatment was additionally impaired by limited availability of effective anaesthesia. Endodontic treatment was usually performed without local anaesthesia, after arsenic trioxide devitalization of dental pulp.
One of the problems of Russian dentistry and medicine in general has been limited access to foreign literature. [4] Overview of Russian literature from the last two decades showed that the concept of minimally invasive dentistry has remained largely unknown, and the traditional approach to the caries treatment ("extension for prevention") has never been seriously questioned. Assessment of caries activity for the purpose of treatment individualization is rarely discussed in literature, and the proposed criteria of caries risk (number of cavities and devitalized teeth) [5] are questionable because the partially iatrogenic nature of these lesions cannot be excluded. It is a well-known fact in Russia, confirmed also by everyday experience that accelerated restoration cycle can cause more rapid tooth destruction than caries. The term 'minimally-invasive dentistry' appears only in singular Russian-language publications from the recent years. Such articles are devoid of comprehensive analysis of literature and are largely aimed at promotion of certain products. [6]
Large-scale privatization of dentistry, started in the 1990s, gave rise to new problems. Some private practitioners avoid the conservative therapy of advanced lesions and manipulate their patients towards extractions and prosthetics. Conservative treatment is sometimes plainly denied. Theoretically, all Russian citizens have a right to free medical insurance, which covers the dental treatment (prosthetics not included). However, some dentists at the free polyclinics also receive private patients, the border between a state polyclinic and a private practice being thus effaced. The best way to improvement of dental care should be propagation, in dentistry, of the same ethical principles as in medicine in general: "dentistry for the patient" instead of the "dentistry for the dentist". [7] Besides, economical re-routing of dental practices is needed, so that they could survive using more extensively preventive and minimally-invasive methods. [8]
 References | |  |
| 1. | Murdoch-Kinch CA, McLean ME. Minimally invasive dentistry. J Am Dent Assoc 2003;134:87-95.  [PUBMED] [FULLTEXT] |
| 2. | Avraamova OG, Leont′ev VK. The prospects for the development of prophylactic dental programs in Russia (a historical and situational analysis) Stomatologiia (Mosk) 1998;77:11-8. |
| 3. | White JM, Eakle WS. Rationale and treatment approach in minimally invasive dentistry. J Am Dent Assoc 2000;131 Suppl:13S-9. [PUBMED] [FULLTEXT] |
| 4. | Jargin SV. Limited Access to Foreign Medical Literature in Russia. CILIP Health Libraries Group Newsletter, 25(4) Dec. Available from: http://www.cilip.org.uk/specialinterestgroups/bysubject/health/newsletter/ [cited on 2009 Dec 3]. |
| 5. | Maksimova OP, Rybnikova EP, Petlev SA. Back to the medical approach to the treatment of dental caries (in Russian). Klinicheskaya stomatologiia 2004;1:10-3. |
| 6. | Rzhanov EA. Minimally-invasive treatment of dental caries (in Russian). Klinicheskaya stomatologiia 2005;1:24-7. |
| 7. | Hochman RM. Minimally invasive dentistry. J Am Dent Assoc 2006;137:296. [PUBMED] [FULLTEXT] |
| 8. | Ericson D. The concept of minimally invasive dentistry. Dent Update 2007;34:9-10. [PUBMED] |
Correspondence Address:
Sergei V Jargin
Department of Therapeutic Stomatology, Peoples' Friendship University of Russia, Clementovski per 6-82, 115 184, Moscow
Russia
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0970-9290.59435
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