Dental Care Should Be Included in the Basic Package: Doctors of the World and FNV Call for Change

Tomorrow, Wednesday 14 June, the two parties will hand over the ‘Black Book Oral Care’ to the House of Representatives in The Hague. It contains testimonials from people who avoid dental care because of the high costs. “In this way we show that there is a major national problem that requires a large-scale and structural solution,” says Hendrik Verschuur, chairman of the Dokters van de Wereld aid organization.

Since 2006, oral care for adults is no longer reimbursed due to rising healthcare costs. “At the dentist, market forces in healthcare and the purchasing power crisis, which we as FNV are both concerned with, come together,” says Kitty Jong, vice-chairman of FNV.

A survey among 28,000 FNV members in September last year showed that 18 percent of the respondents went to the doctor and dentist less. A recent survey among 5,000 FNV members shows that healthcare costs are a financial problem for nearly 65 percent of the respondents. 17 percent indicated that the health problems are made worse by avoidance; this is even 26 percent for dental problems. “And these are mainly working people. Perhaps you can already say that healthcare is inaccessible to low incomes and some groups.”

The parties argue that including dental care in the basic package is cheaper than continuing the current dental care policy. “Neglected oral care can lead to physical and mental complaints, the healthcare costs of which are reimbursed by the healthcare system.”

Jong outlines that having dental problems affects your position in society. “When you are often in pain, it has negative effects on your life. Moreover, rotten teeth do not help with finding and keeping a job. We know that if adults don’t go to the dentist, eventually their children won’t either.” According to her, it is necessary to look at where the social benefits end up. “With the removal of oral care from the basic package, we did not look at what it costs society in terms of negative effects. The problems never reach the people who can afford them.”

Minister Ernst Kuipers of Health set at the end of 2022 answers to parliamentary questions about the increase in the number of people who avoid the dentist for financial reasons, that he has no plans to include dental care in the basic package.

In a mobile treatment unit, which will be placed near the House of Representatives in The Hague on Wednesday, the Voorburg dentist Mahdi Khalilzada will treat patients for whom dental care has become too expensive. Free. Dental care is not a luxury, but a basic right. Why, as an insured person, can you go to a doctor with an earache, but not with a toothache?”

The dentist has experience with it. Four Sundays a year, during Ramadan, he helps free of charge people for whom dental care has become too expensive. His project ‘Honest Smile’ has now been running for three years – and he sees it getting busier. “My practice is in Voorburg, but I see people who come from Brabant or Flevoland. I see people who have been functioning for months only with pain relief, because of the toothache. I see rotten molars, so that a person in their 30s could only eat if it was cut into very small pieces.”

He sees in practice how, as he puts it, we are ‘lagging behind’. “If you can’t chew, it has a major impact on your gastrointestinal system. If you have a lot of tartar, it means that you ingest an extra amount of bacteria that live in your mouth. And so the healthcare costs are getting higher and higher and the costs for treatment are only increasing.”

Wouter Vriesman, a dentist in Amsterdam since 1985, also sees ‘oral care avoidance’ increasing. His practice Welldent Mokum is located exactly on the border between the Amsterdam East and Watergraafsmeer districts. “You immediately see the difference there: people from East avoid the dentist more often than from the more affluent Watergraafsmeer.”

He sees reduced insurance policies and people who simply come less. “They used to go to the dental hygienist three times a year, now twice, or not. They say ‘I’ll call’ but don’t. People are more critical of treatment plans. Or we see that the children from a family go – dental care is free up to the age of 18 – but the parents do not.”

He also sees that people avoid preventive measures; they watch wait until they get pain and only then go to the dentist. “But if you eventually end up at the weekend outpatient clinic, it is much more expensive.”

Vriesman tries to think along with his customers where he can. “There are treatments that can be spread over several years, for example. But sometimes you have to protect people against themselves and that is simply not possible.” Occasionally he also helps people financially, he says. “Then a new customer arrives, and an overview photo has to be taken of the teeth. And then I think: we leave out the costs, that device has already been purchased anyway. But that is not possible with many; fillings, for example, also cost me a lot of money.”

If oral care becomes part of the basic package, that would make a big difference, the two argue. More stable oral health, says Khalilzada. And more emphasis on preventive care, says Vriesman. “Simply cleaning the teeth well ultimately prevents a lot of suffering.”

In May 2022, the Patient Federation of the Netherlands concluded on the basis of its own research that almost one in ten people had not had oral care in the past two years. The federation therefore includes all necessary care in the basic package, says spokesperson Tijmen Hendriksen. “We do not say in advance that dental care should be included in the package across the entire width. But it would be good if regular dental care would come, so that you avoid complicated and expensive procedures.”