Russian Dentistry 2010... Responsibility and Consequences

 

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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 33^rd 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
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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.
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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!

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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 33^rd 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

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!

russian dentistry, gingivitis, paradontist, periodontist, pay dental clinic, government regional clinic, ortopantomogram, Yrjo Paatero, radiograph, xray, dental surgeon, dental treatment antibiotics, ADA treatment guidelines, endocarditis, dental fountains, baheely foot covers, waiting room magazines

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My Weak Teeth and Russian Dentistry

Most Russian dentists have good training, excellent equipment, and make way more money than doctors. As with medical doctors, most are women. In the early years after my arrival, I would go to a government clinic where many patients received treatment in one room. Once I was enrolled in the Russian medical insurance plan, I could get free treatment if I was willing to wait for hours.

Its easier and quicker to go to one of the new платна, pronounced platna, pay clinics. I am very happy with Oksana, my dentist, and Victoria, my hygienist for they are skillful, gentle and kind.  The new dental clinics also have a set up that is unique to Russia.

Mud, rack and ruin...

It is a typical Russian business attitude to not worry much about the exterior appearance of a building in which they work, nor how it looks when approached by a customer. My dentist is in a structure that looks like a bomb hit it on one side, has a field of mud leading to the door, and advertises a late night bar on the third floor. It's exterior is worn and grungy.

Бхилы Mandatory!

You must put blue plastic covers... pronounced ba-heel-y... on your shoes in the reception area. This practice keeps the floor clean... especially important in wet sandy St Petersburg.

My kingdom for a tooth!

After seeing a recent photo, I realized I needed a tooth cleaning. Larissa said that her daughter's dentist only charges 70 rubles a tooth, a sensible yet surprising way to calculate the bill! We called my dental office and the receptionist quoted 80 rubles. The question remained... how many teeth are we talking about?

I counted 20 teeth in the mirror, Larissa said 19. In fact, each tooth was 100 rubles because the office added 20 rubles a tooth for a cosmetic protective coating... but my hygienist Victoria, said she would only count the upper teeth in the bill... such a deal... 20 teeth for the price of 11!

Maybe I could save money if she only cleaned the lower part of my top teeth. As long as I limited myself to a conservative smile the visible teeth would look good.

I pictured myself walking around to other dental offices... there are many... and asking, "What's your best price for cleaning each tooth?" or, "How much will you charge for cleaning and coating just this one tooth?"

When my hygienist finished the cleaning and was putting away items, I grabbed a little mirror which was lying on the shelf next to me. It had been upside down and all I saw was black... I said in Russian Oh my God! What's happened to my teeth? She really enjoyed that kidding and her laugh was music to my ears, and teeth.

Unit pricing, but not in the supermarkets where we need it!

This mentality is consistent with other pricing in St Petersburg. It's possible to buy one or two cigarettes from a kiosk, or one battery from a pack of three at a prorated amount. You learn quickly that prices are quoted for one item even when you point to a package of three.

All I want is water!

I have been treated in six Russian dental offices over the past ten years, one of them in Brooklyn. None of them had a working fountain or cuspidor for the patient.

The cuspidor is often wrapped in plastic or has a dish on top of the drain. You are supposed to spit into the plastic or dish. Often you only get a drink of water if you ask.

I stopped in at two other dental offices the other day and asked to see their dental chairs and equipment. They thought the request strange and were concerned that I put on бахилы. The first dentist turned a few valves, one of which required lifting a panel in the floor, and on the second attempt, got the water running in the cuspidor, even though it was wrapped in plastic at first. The other used the dish method. Dentists and patients in St Petersburg don't expect a running fountain for the patient, and don't think it necessary. Perhaps clinic owners don't want to pay for the initial plumbing or for the daily water use.

Sell your skill as a commodity!

Dental offices have the latest equipment, and do tooth coating, which made my old teeth look young again! But they seem unconvinced that making the client a little more comfortable with a clear walkway and working fountain would help grow their business.

Practice-enhancing ideas such as appointment cards... my next appointment was just scribbled on the back of the bill... referral requests, and little gifts for children would be good. How about a cheerful waiting room with magazines and music? Diplomas should be displayed.

Medicine still isn't viewed as a marketable business even if платна, and Russians often do not like to make the first move in social interchanges. The Russian idea of pride and their unwillingness to be outgoing hurts their business. Only once did a dental secretary call me in St Petersburg to say that it was time for my six month check up. What lost opportunities!

If I were younger, a dental clinic would be a good investment. I enjoy marketing, and feel I could help any quality dental business quickly have a loyal client base. Then the profitable clinic could be sold, and the money reinvested in a larger one with good potential.

So, going to the dentist in St Petersburg is a little strange. You and I just have to get around our own cultural hangups and be willing to speak up when it may help improve things. Remember, it can be just as safe to get your teeth fixed in Russia as in America, and you'll save some money as well!