30 April 2010

Russian Dentistry 2010... Responsibility and Consequences

Click My Weak Teeth and Russian Dentistry to see our other post on this topic.  You will see this post again... just scroll down to find the previous one on the same page.

The Coat of Arms of St Petersburg Russia, found on every dental and medical clinic in the city.


A sudden infection...

I awoke Saturday with a gum infection below the front teeth. The tissue had receded, hurt some, and looked bad. We are leaving
St Pon May 7 for rural Tverskaya Oblast, where it would be unlikely they would be equipped to deal with what could be a bad infection.

Larissa first suggested I see the paradontist, also called periodontist, at the government clinic, but I insisted my стомотололог, pronounced stomotololog, meaning dentist at Сафир, Saphire Dental could cure my infection.

The receptionist said she remembered me and said to come in at 6 PM that evening. I noticed in 2000 the long hours offices and stores are open, even on weekends.

My Saturday night...

Saphire is a платна, pronounced platna, meaning pay clinic, is open every day 10 AM to 9 PM. The dentist on duty, Margarita, cleaned the infected area and instructed us to buy a mouth rinse, хлортекспдин, сhlortekspedine, made in St Petersburg, and Metrogyl Denta cream, made in Mumbai, India.

Oropantomogram anyone?

She also told us to go to 33rd Tooth... six offfices, walk-ins welcome!... to get an ortopantomogram, a curved xray or radiograph of my teeth. They have equipment from Planmeca Oy, Finland. Yrjö Paatero invented this system more than 50 years ago. My radiograph showed little detail, and needlessly included all my teeth.

Everyone is smiley and pleasant as the people understand that they don't get paid without customers.The operator evinced a motherly attitude, worried that I didn't have an отчество, a middle name. I agreed that it's a problem, and commiserated by saying кошмар, koschmar!

Xray fatigue...

In America I spent a lot of time in the dental chair in the '90s. What I found tiresome, although necessary for thorough dental treatment, was the amount of xrays dentists insisted on. There were before-and-after xray shots, some for the insurance companies, some to protect from malpractice suits, some to diagnosis and develop a treatment strategy... all with the requisite heavy lead blanket.

Escaping xray folderole...

In Russia I found no such xray folderole. The dentist pokes the teeth and gums, asks a few questions, and starts. No worry about rampaging hidden tooth rot. No possibility of an overdose of radiation. It seems Saphire clinic doesn't even have an xray machine.

I see Oxcana Dimitrivna.

On Monday after xrays we stopped by Saphire to see Okcana.  She asked that I buy another cream, Холисал, Holysal, made by Jelfa in Poland, to be used with the Metrogyl cream, and to see her for possible surgery on Thursday. She said she is qualified as a dental surgeon along with her basic five year dental education.

My old brain lets me down...

It was only early Wednesday that I realized that Oxana did not have my chart to refer to, and that she and I didn't discuss a need for antibiotics.

The new standards...

Even with the new American Dental Association restrictive guidelines, antibiotics are indicated for post heart surgery patients if there is a mouth infection as a way to prevent endocarditis.

Sometimes things are too casual...

Doctors and dentists are casual about double checking records and ordering antibiotics because they have little worry about malpractice suits in Russia.

Responsibility and consequences...

Especially in Russia ten two letter words say it well... If it is to be, it is up to me! I must be doubly alert, whether walking past open manholes or receiving medical treatment. There is less responsibility professionally and on the street because there are fewer or no consequences if something goes wrong.1 and 2
1 It isn't unusual for a driver to kill a pedestrian or another driver and not be ticketed or sued. Russia is the Wild West of Eastern Europe, which makes it a jazzy place to live, but not a particularly safe one. As a result of all this, it's also the Land of Low Expectations.
2 Russia's Culture of Accountability, PRI's The World, http://www.theworld.org/2009/12/09/russias-culture-of-accountability/

I need stricter, more qualified, dentistry!

There still are government clinics where you can get treatment for free if you can wait such times as a two month wait to see the paradontist.  Free or pay there is bureaucracy.

You can find good dentists at the clinics if you understand how to deal with the system. It's an irony that doctors and dentists that work for a government clinic are held to higher standards and accountability than what is found in the new for-profit clinics which have little regulation.

In my first few years in St Petersburg I went to Regional Dental Clinic #33 for simple work, paying a small amount as a non-resident. But this visit required a bus ride, and often, long waits. After a while I looked for a closer dental office and found Saphire, a short walk through our courtyard.

This week I realized that I needed to see someone who used charts and followed guidelines... a professional. 

I reminded Larissa that she had originally suggested a paradontist at Clinic 33 as able to deal with any dental situation. We decided to go there Wednesday afternoon.

A sea change in treatment...

There are two lines to get your chart at the clinic, one for free treatment, the other for платна, platna, pay treatment. Platna didn't start until 530 for the paradontist, but we were told we might see her by around 4 PM. It turned into an hour and a half wait, but it was worth it, as this dentist was on top of the situation.

She saw that there were signs of bacterial endocarditis³... paleness, blue lips... and suggested putting me in the hospital, but we said we would see a cardiologist the next day as an outpatient. We were sent for a снимок, sneemok, an xray shot, as the large one requested by Saphire was illegible and inappropriate. On our return to the Paradontist Office, she wrote several items to buy and actions to take to stop any infection.

³ Baterial endocarditis is found in the dirtiest place in the body, the mouth.  It gets in the blood stream, then in 
a heart valve, which provides a welcoming habitat for this bacteria.  Those of us with normal hearts usually easily resist this scourge, but those with defects and surgeries are open to life-threatening infections.
This paradontist, Anna Urevna, is a soft, relatively young, blonde woman. She seemed genuinely concerned for my welfare. She asked me to come back next Tuesday to check on my progress.

Making sure that the ticker is OK...

The next day we were off to the Cardiac Clinic to make sure my heart hadn't been affected by the infection. After an EKG, a doctor new to us, Tatiana Anatolevna, took a very thorough medical history and expressed interest in changing some of my medications. First she scheduled me for an echo cardiogram Friday.

Some side observations about fountains, baheely, magazines

It's ironic that although Russian dentistry is advanced they still do not connect or turn on the fountain attached to the chair. A plastic bag covers the area to rinse, and you are asked to spit into this flimsy cover.

But, I have grown to like what are pronounced 'baheely', blue plastic elasticized shoe covers, that all patients must wear when receiving medical treatment. They keep out the dirt, add to the sanitation, and keep you humble! As one gets older they become a challenge to separate, much like the plastic bags in supermarkets, and can be difficult to put on and take off.

Things are changing in St Petersburg! Magazines, neatly stacked (but untouched) are now available in the waiting rooms of some dental clinics

Now I'm better, and more reflective...

What started as a simple gum infection is now responding to antibiotics. 

My favorite dentist 1. didn't consult my chart 2. didn't give me  advice to start an antibiotic, and 3. didn't refer me to someone more qualified to deal with my problem. 

But most of the responsibility rests with me... with my age and education I should not have been asleep at the switch. I plan to see Okcana when I need simple dental work as she is a good dentist in most situations... and I like her kind, gentle and pleasant attitude!
I have gained an excellent paradontist. She has high experience, education, and is very engaged in her career. As a bonus, I have a second cardiologist that is energetic, young, and interested in improving my situation.

Russia surprises all the time, good and bad. This unevenness makes it interesting, but also at times precarious!

How are prices in Russia 2010?

30 Apr 2010 +/-29.13 rubles = 1 dollar
  • Rinse Сhlortekspedine bottle........rubles 0.40    $ .36  
  • Dental cream  ..........................................96.90     3.33 
  • Холисал cream .....................................133.20     4.57 
  • Jeelak Forte 100ml microflora..............208.90    7.17
  • Cefran CT 500mg 10 tab antibiotic......266.95    9.16 
  • Etronedazol 250mg 20 tab antibiotic........7.12      .24 
  • Askorutin 50mg 50 tab..............................28.02      .96
  • Xray 33rd Tooth.......................................550.00 18.88
  • Xray gov dental clinic.............................150.00     5.15
  • EKG..........................................................250.00    8.58
  • Echo cardiogram..................................1400.00   48.06
  • Margarita, Saphire Pay Dental..............200.00     6.87
  • Parodontist Anna Urevna Clinic #33.....275.00    9.44
  • Cardiologist Almazova GovCardio.......700.00   24.03

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Let us know what you think! 

~Was I mainly at fault in forgetting about needing antibiotics for my condition, or was Okcana?

~The government wants to see more private clinics and less government involvement.  Is this a good idea?

~Everything here seems very inconsistent.  Could you live in such a society?  Maybe you do!

To read comments, or to comment, click the title or 30.4.10.  Then scroll down and click Post a Comment.  We love to hear from you!

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  1. I have been reading your blogs, skipping around and am amazed and fascinated! As odd as this might sound, America isn't any better organized really when it comes to treating anything out of the ordinary. I fully believe it is up to us the patient to take charge of our whole need, and speak up when/if we feel have a special need, like your heart and gum infection. Love your writing!

  2. American Russia ObservationsThursday, August 26, 2010

    Thanks Widow Lady for your perceptive comment. Yes, most professionals are in a scholarly rut of protocols and are not scientific enough to really think and examine each case.

    Americans probably are the most Speak Up people in the world. Russians suffer from what they call stick nia itza... hesitation and shyness.

    My cardiologist asked my wife, 'Why does he ask questions about the medicines I prescribe... Doesn't he trust me?'

    Rarely is treatment explained to a patient. Questions are often considered criticism.

    Please continue commenting when you see something you want to add.
    I really like your enthusiasm.


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