The Eschmann commissioned series looking at dental practices around the world reaches Denmark
Dr Svend Ulrich Jensen is the principal of a dental clinic in Hundested, in Denmark. He describes some of the daily challenges he faces in his practice and the protocols in place to ensure patient safety.
My clinic is situated approximately 60km from Copenhagen in the northern part of Zealand. This region is in East Denmark and is surrounded by water on three sides, which leads out to the fjords. Hundested is a typical provincial town with around 10,000 inhabitants.
When I first came to the practice in 1983 there were very few patients, but I now treat approximately 1,800. The clinic opens at 8.30am each weekday but we also open on a Saturday once a month because many of our patients work away from the local area.
I work as a full-time dentist and there is also a part-time dentist, a dental nurse and a trainee dentist employed at the clinic. I work around 37 hours a week, which is average for any professional person in Denmark. At the clinic, we offer implant treatment in collaboration with dental surgeon, Henrik Ehlers-Hansen, who has extensive experience with this type of treatment. Henrik visits the clinic once a month to perform operations, but other procedures such as restorations, crowns or follow-up treatments are carried out by the regular dental team.
I spend most of my time attending to patients, but there is also the increasing burden of administrative jobs to complete. I’m required to meet the growing demand for documentation including patient journals – each patient journal must include all the treatment suggestions we have discussed, their choice of treatment and then their acceptance to ensure appropriate consent. In addition, every patient journal must clearly document the details of all treatment undertaken, along with any preventative work performed.
The Danish Health and Medicines Authority monitors and assesses this information and gathers statistics based on a dentist’s work to ensure high standards. Occasionally we are also required to carry out questionnaires asking our patients to rate their experience, the hygiene standards, and the cleanliness of the clinic.
During the 1970’s Denmark had one of the highest rates of dental caries in Europe, but government subsidies and targeted oral health promotions and preventative programmes are believed to have turned that around. Denmark now has one of Europe’s lowest rates for decayed, missing, or filled teeth, particularly for young people and adolescents. One of the most impressive programmes is focused on babies, offering advice to new parents on how to care for their children’s teeth so that effective oral health routines are established right from the very start.
In Denmark, the health care system subsidises dental costs; patients under the age of 18 receive free dental care including orthodontics; patients between 18 and 25 years old are required to pay 35% of dental fees and if the patient is over 25 years of age, they pay 60% of the costs. Fees are payable when the patient leaves the clinic and the cost already includes the subsidy. Some people take out additional insurance to help lower these expenses particularly if a lot of treatment is anticipated.
We place a significant amount of attention on hygiene standards and the prevention of cross contamination. Generally, we find that patients are very aware of their rights, the law, regulations, and procedures that we are required to implement to ensure their safety. In fact, if the law or regulations change or alter in any way, patients will often ask us how we intend to follow the new procedures.
The entire dental team is required to work to strict infection control protocols and every dentist must follow and show evidence of the clinical instructions laid down by the Danish Health Authorities.
Our guidelines on infection control and the sterilisation of equipment are specific and divided into three main steps:
1. Collecting used equipment. Instruments are disinfected in boiling water that contains detergent for 30 minutes.
2. After this the instruments are sterilised in a vacuum autoclave.
3. Handpieces tools are cleaned, sterilised and lubricated in a DAC autoclave.
The decontamination process takes place on three separate surfaces to optimise hygiene standards and it must be carried out in the same way every time. It is also my responsibility as the owner to ensure that every member of the dental team is fully compliant with all regulations.
Standards of dental care are extremely high in Denmark and I find my job very rewarding. There are still many people that avoid the dentist because they feel anxious when they hear the dentist drill or become nervous due to the smell of the dental clinic. Our speciality at the clinic is to look after dental phobic patients very carefully and make sure they feel completely comfortable before we carry out any clinical assessments or treatments.