Pedro Ruiz of Madrid, a 29-year-old unemployed plumber, has been putting off dental surgery to fix his crooked teeth.
“I don’t want to spend in one visit to a dentist what it takes me 10 days to earn,” said Ruiz.
In the midst of Europe’s worst financial crisis in a generation, countless other patients are making similar decisions across the continent, doing without everything from checkups to tooth implants as unemployment has surged and governments have reined in health spending. Many are putting their health at risk.
Though no hard Europe-wide data on dental spending exists, the cutbacks by governments and individuals mean oral cancers and other illnesses won’t be spotted earlier, when they’re more easily treatable, said Kamini Shah, honorary secretary at the British Association for the Study of Community Dentistry.
“The mouth is a mirror to the rest of the body,” said Shah.
The effects of the financial crisis on dental care are also evident for companies that supply equipment. Shares of the world’s biggest makers of dental implants, Nobel Biocare Holding AG and Straumann Holding AG, have plunged 90 percent and 67 percent, respectively, from their peaks in 2007.
Declining sales in Europe is “the new normal,” said Ingeborg Oie, an analyst with Jefferies International Ltd.
“If Europe continues to plod along this trajectory then we’re not going to be out of this for a few years,” she said.
In Spain, which has the highest unemployment rate among countries using the euro at 24.8 percent, patients are choosing cheaper, removable dentures costing a few hundred euros instead of permanent implants that can cost thousands of euros, Manuel “Alfonso” Villa, president of the Spanish Dental Association said in a telephone interview from his clinic in Gijon, northern Spain.
“People are very scared about spending,” he said. “We’ve noticed a significant slowdown since 2009, but 2011 and this year have been disastrous.” Patients are delaying procedures “unless it hurts too much,” he said.
Ruiz, the Spanish plumber, earned 2,500 euros ($3,070) a month before losing his job in January. He just finished a temporary job that paid him 1,200 euros and decided to bank it rather than spend it on his teeth because “it’s not a life-or-death matter.”
Research has shown longer-term effects from poor dental care. Chronic gum disease may leave the mouth more susceptible to head and neck cancers, while persistent plaque may increase the risk of dying early from cancer, according to studies this year. Earlier research indicated people with severe periodontal disease may be at increased risk for developing diabetes, and infections around the teeth may be a signal of heart disease.
Irish government spending on dental care has been reduced by 100 million euros a year since 2010, just as the number of people depending on state-funded care grew to cover two-thirds of the population, according to the Irish Dental Association.
Low-income residents who hold a medical card can get two cavities filled per year, but no more, even if it’s an emergency, which has patients “choosing which tooth they like better,” Maurice Quirke, a dentist for 23 years in New Ross, County Wexford, said by telephone.
Medical-card holders receive one dental examination a year, according to the association. Twice-annual cleanings, extended gum cleanings and X-rays are no longer covered, though unlimited extractions are provided.
“A lot of patients are putting off treatment that they need,” said Quirke, owner of Quirke Dental Surgeons. “We’re seeing a lot more advanced gum disease, toothaches and emergency situations, and lot more extractions, than three or four years ago.”
Patients on government insurance now must pay for cleanings, fillings and x-rays. Those on private insurance in Ireland, where unemployment stands at 14.8 percent, are delaying crowns and veneers, said Fintan Hourihan, chief executive of the Irish Dental Association, in a phone interview. Those procedures generally aren’t covered by insurance.
Between 2009 and 2011, the number of fillings for medical-card patients declined 44 percent and dentures were down 28 percent, while extractions increased 11 percent, the association said. “The state has decimated spending on dental care,” Hourihan said.
Paradoxically, the cutbacks have benefited Smiles Dental, a chain of practices in Ireland and Northern Ireland, said Emmet O’Neill, chief executive of the Dublin-based company. Smiles slashed prices 30 percent to navigate the downturn and saw business increase by 50 percent, he said.
“There’s a huge element of the Irish population that are effectively getting their teeth pulled because they can’t afford basic care,” he said.
Smiles has recruited some dentists whose business has dried up. Paul O’Dwyer, 39, shuttered his dental practice in the rural village of Newport in County Tipperary two years ago after he began losing patients.
“I thought, would I weather the storm and would patients return and start paying out of pocket or would I grab the bull by the horns and shut the practice down?” he said by phone. “I chose the last option.” O’Dwyer said he has “significant” debt from the practice that he ran for 10 years and it may take him another decade to pay it off.
Some patients are learning the hard way the wisdom of the adage that cheap is expensive. Carmen Martinez, 46, of Madrid, chose a temporary denture to replace three infected teeth that were pulled, at a total cost of 400 euros. That way, she figured, she’d avoid the expense of shelling out 1,200 euros per tooth for permanent dental implants.
“I first thought I had saved a lot, but within weeks I realized I was totally wrong,” she said. “It was very unpleasant and uncomfortable and finally I had to get the implants.”