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Dentistry in Sweden


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Contents:

Government and healthcare in Sweden

Oral healthcare

Education, Training and Registration

Workforce

Practice in Sweden

Professional Matters

Financial Matters

Other Useful Information


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Sweden has a population of 8.94 million,

with about 85% of inhabitants livingin the southern half of the country. Ithas a constitutional monarchy with aparliamentary system of government,but as Head of State the King only has aceremonial function.

The Swedish Parliament, the Riksdag,consists of 349 members. These members

are chosen in 29 different constituenciesand therefore represent the entire country.At present (2003) seven political partiesare represented in the Riksdag. Together,members belonging to the same partyform a party group.

The parties and their mandates: The SocialDemocratic Party 144, The Moderate Party55, The Liberal Party 48, The Christian

Democrats 33, The Centre Party 22, TheLeft Party 30, The Green Party 17.

Many aspects of government, includinghealthcare, are delegated to the countyor municipality level (289 municipalities2001). Both the counties and municipalitieshave elected councils which may levytaxes. Liberal immigration policies have

given Sweden a multicultural population,with immigration accounting for 39% ofthe gross population growth.

Social expenditure accounts for some 40%of Swedens Gross Domestic Product.The proportion of GNP spent on generalhealthcare, including dentistry, in 2002was 8%. The county government has apredetermined global budget every year.

Government and healthcare in Sweden


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In Sweden most healthcare is providedthrough a national social insurance system,which also provides sick pay, child benets,disability allowances and pensions. The

national insurance system operates as agovernment agency (the National SocialInsurance Board or Riksfrskringsverket),through local Social Insurance Ofces(Frskringskassan). Everyone who isresident in Sweden is registered with asocial insurance ofce when they reachthe age of 16. The expansion of healthcarein the 1950s and 1960s concentratedespecially on secondary care, so thatSweden now has a high proportion ofspecialist and hospital-based services.Public expectations of health servicesare high. In total, around 85 % (2001) ofhealthcare costs including dentistry, arefunded by government.

For the majority of the Swedish populationgeneral health care is paid for throughgeneral taxation, plus a small fee (20 in2003) for each visit to a doctor.

In Sweden oral healthcare is the

responsibility of county government,although counties are not required toprovide the services themselves. 8% oftotal governmental spending on healthcareis spent on dentistry.

Almost all oral healthcare is provided inone of two ways. Firstly, there is a PublicDental Service (NDS) which provides free

dental care to children up to the age of 19.

Oral healthcare in Sweden


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These dental services are mainly deliveredin local clinics which are managed by thecounties. Children and their parents canchoose to attend either the NDS or privatepractitioners. Secondly, adults and elderlypeople who are not entitled to free carefrom the Public Dental Service can getsubsidised dental care from the NDS ordentists in private practice.

The framework in 2003 is (this nationalinsurance scheme was introduced in 1999):

Basic dental care, such as prevention,llings and emergency treatment ispartially paid for by a xed subsidy.For those between the ages of

20 and 29 this covers the initial examination as well.

There is free pricing with a xed

subsidy. The dentists in private practice settle their prices themselves The counties settle the prices for all the clinics within the county.

There are no subsidies for amalgam llings.

For those with long-term illness,

certain diseases or special needs, get a subsidy by means of a xed sum fordental care.

There are cost limits for both prosthetic and orthodontic treatment. In 2003 the limit was set at 600

over this limit the dental care is subsidized by a xed sum.

People older than 65 have a 100 %


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subsidy for dental prosthetic treatment, on costs of more than 850 (2003), excluding the costs for the

materials.

Prior approval for some treatments isnecessary.In 2000 (the latest gures available) thetotal cost for dental care was approximately1.54 billion. Patients fees were 0.9 billionof this sum, so the taxpayers share was 0.6billion. Of this, 0.2 billion was providedthrough the national insurance scheme.

It is easier to access NDS-care in the bigcities than in the country. During a one-yearperiod (2001) 64.6% of men and 70.1% ofwomen in the ages from 16 to 84, accesseddentistry. In a 2-year period, approximately82% of the adult population access

dentistry. A re-examination is normallycarried out every one or two years.

Quality of CareThere is a Dental Act which states thatall Swedish citizens are entitled to goodquality dental care. The standards aremonitored by the Regional Departments ofthe National Board of Health and Welfare

(Socialstyrelsen). The authority has issueda regulation imposing the dental servicesto work with quality questions. The dentalservice also works using a system called LexMaria, where all incidents that have causedor could have caused serious injury, are tobe reported.


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Education, Training and Registration

Primary dental

qualicationThere are 4 dental schools, all Stateowned and nanced. The schools are allpart of the Faculties of Medicine of therespective universities. To enter dentalschool, students must have completedsecondary education. There is no entranceexamination. See dental schools.

On completion of studies studentsare awarded a degree, known asTandlkarexamen.

Quality assurance for the dental schoolsis provided by the National Agency forHigher Education.

Post-Qualication VocationalTrainingThere is no post-qualication vocationaltraining in Sweden.

RegistrationIn order to practise as a dentist in Sweden,a qualied dentist must have a licenceawarded by the National Board of Healthand Welfare unit for Qualication andEducation. This body keeps a register ofdentists. For the address of the unit clickhere

The main degrees which may be includedin the register are: the licence, and a

diploma of specialisation. There is a fee of45.60, to receive the licence.


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The Social Insurance Ofce (Frskrings-kassan) also keeps a register of practitionerswho are afliated to the national socialinsurance scheme, and dentists mustbe on this register before they can claimsocial insurance subsidies. Registering forafliation with the national social insurancescheme only requires the production of arecognised degree certicate or diploma.

There are no formal linguistic tests in orderto register, although dentists are expectedto speak and understand Swedish.However, an employer has the right todemand knowledge in Swedish as thecase book must be written in Swedish asa patient has the right to understand whatis written in it.

Further Postgraduate andSpecialist Training

Continuing education

Continuing education is optional. TheSwedish Dental Association is responsiblefor the continuing education and promotesit to the dentists (for the address clickhere).

Specialist Training

Training for the specialities lasts 3 years,after 2 years in general practice. It takesplace in university clinics or recognisedpostgraduate institutions approved by theSwedish Board of National Health andWelfare. The capacity of specialist training

is about 180 places - 150 are currently used


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(2003). The major part of this training ispaid for by the Counties, directly througheducation on request or indirectly throughthe co-ordinated County grant. Before

2009, 30% of specialists are due to retireand it is anticipated that there will be ashortage in some disciplines.There is training in 8 main specialties:

Orthodontics Oral and Maxillo-facial Surgery Endodontics Paediatric Dentistry Periodontology Prosthodontics Radiology Stomatognathic physiology

The number of specialist training postsis limited. The systems for remunerationvary.

Dentists

In 2002, 222 persons obtained a dentistslicence in Sweden - 81 of these graduatedas a dentist in another country thanSweden. There were 6,007 male and

5,108 female dentists under the age of 65(retirement age) registered in Sweden.

Workforce

Total Registered 14 043

In active practice 7 594

General (private) practice 3 313

Public dental service 3 761

University 300Hospital 220


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54% of those who are active are men and46% are women. But, the number of activedentists is decreasing.

Retirement is increasing due to thedispersion of age. In the mid 1990s theGovernment reduced undergraduatenumbers by 40 %. Additionally, emigrationis higher than the immigration of dentists.During the period 1993-2001 the net lossof dentists was 722. Most of the emigratedSwedish dentists have moved to the UnitedKingdom and Norway. The trend of a

greater movement in and out of Sweden ispredicted to last.

For the moment, the loss of retired dentistsis balanced by the newly-qualied, so thereduction of the active workforce is onlyfrom this emigration.

Specialists

In 2003 there were approximately 1,450dentists in the eight recognised dental

specialties (this works out as a ratio of 1/8

Numbers (2003) Total Over 65

Orthodontics 430 120

Oral & MF Surgery 251 83

Endodontics 68 17

Paediatric dentistry 171 54

Periodontology 202 52Prosthodontics 198 51

Radiology 70 15

Stomatognathic

physiology 51 6


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specialists to generalists). 1,080 were underthe age of 65.Patients are referred by a dentist to thespecialist. Most specialists work in thePublic Dental Service or the universities. Asmall number work in private practice, butmany of these are approaching retirementage. There are many associations andsocieties for specialists - a list of theseis available from the Swedish DentalAssociation.

AuxiliariesThe system of use of dental auxiliaries iswell developed in Sweden and much oralhealth care is carried out by them. Apartfrom (chairside) dental nurses, there are

three types of dental auxiliary: Dental hygienists Dental technicians Orthodontic Auxiliaries

Dental Hygienists

To train as a hygienist requires an academicentry of 2 A levels, and then 2-3 years ofundergraduate academic education, in oralhealth science, at one of several UniversityColleges in Sweden. Oral health scienceis multidisciplinary and composed ofmedical/odontological and behavioural

sciences.

Numbers (2003) Total

Hygienists 2 900

Technicians 1 348

Orthodontic Auxiliaries Unknown


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After qualication all hygienists are licensedby the National Board of Health andWelfare. They have to have a registerablequalication and may work independently.Their duties may include diagnosis ofcaries and periodontal disease, and theymay provide temporary llings and localanaesthesia (mandibular and inltration).

Most dental hygienists work in locationswhere dentists work, with 600 employedin private practice and 2,100 in the public

dental health sector and 200 are privatepractitioners. They take legal responsibilityfor their work and charge fees to patients,which may vary from what dentists charge.They are required to obtain professionalindemnity insurance.

Their earnings would be about24,000 per year (in 2000).

Dental Technicians

To train as a dental technician requires anacademic entry of 2 A levels, and then3 years of lectures and practical trainingat a dental school. After qualicationtechnicians are licensed by the NationalBoard of Health and Welfare, but they do

not have to have a registerable qualicationto work. Their duties include the productionof xed and removable prosthetic andorthodontic appliances. They may not dealdirectly with the public.

The number of active dental techniciansamounted to 1,348 in 2001. Of these,226 were employed by the Counties and

1,122 worked in private practice. This is


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a decrease of more than 60% since 1990.In the period 2000 to 2003 an average of45 dental technicians have been qualiedeach year.

Typically they would earn about 21,000per year (in 2000).

There are no reports of (illegal) denturistsin Sweden.

Orthodontic Auxiliaries

Orthodontic operating auxiliaries traininglasts one year and takes place whereorthodontists are trained. This enablesthem to carry out specied procedures, butthey must work under the direction of anorthodontist.

There is no available data on numbers forthis group.

Dental Nurses

More than 8,000 dental nurses areemployed by the Counties. The totalnumber of dental nurses is estimated as14,000 in 2003. About 3,100 will reachretirement age within a period of ten years.

An addition of newly-qualied dentalnurses is not expected as formal educationfor dental nurses did not exist in 2003.


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Practice in Sweden

Working in General (Private)PracticeIn Sweden, dentists who practice on theirown or as small groups, outside hospitals orschools, and who provide a broad range ofgeneral treatments are said to be in privatepractice. There are about 3,300 dentistswho work in this way. This represents 45 %of all dentists registered and practising. InSweden, the term general practice refers todental practitioners who are not specialistsand who work outside hospitals.

Dentists in private practice are self-employed and are remunerated mainly bycharging fees for treatments, supplementedby social security subsidies. The mostcommon way of remunerating a dentistis to pay a fee for each treatment (item ofservice). If the treatment is one includedin the NDS the dentist gets reimbursed bythe dental insurance. Very few dentists (lessthan 1%) accept only private fee-payingpatients.

Joining or establishing a practice

There are no rules which limit the numberof dentists or other staff who may work ina single practice. Most newly qualifyingdentists who enter practice do so asassociates in a group practice. There isno state assistance for establishing a newpractice and generally practitioners takeout commercial loans from a bank.


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The dental practice can be housed in anypremises and there are no constraintson the opening of new practices. Theresponsible practitioner has to make certainenvironmental adjustments to the premises,such as installing an amalgam-separator.

No standard contractual arrangements areprescribed for dental practitioners workingin the same practice. They may be employeesof a principal dentist, in partnership oremployed under a lease arrangement. Thislease arrangement is the renting of a room,equipment and sometimes staff from thedentist-owner. Such dentists have theirown patients and pay either a monthly rentor a percentage of their income.

Dentists would normally have about 1,500patients on their list.

The controls for monitoring of the standardof care are the same as already describedabove. It is estimated that more than 80 % ofthe adult population visits a dentist at leastonce every two years.

Working in the Public DentalService

There is a public dental service withresponsibility for free services to children upto 19 years of age. Apart from children, theservice also provides dental care for adults asstated earlier. The Public Dental Service isfunded by the Counties. It broadly providesthe same types of treatment for whichnational insurance subsidies are available.For adults the same system of national

insurance reimbursements and fee-scalesapply as in private practice.


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The service employs about 4,000 dentists,approximately 700 as specialists. (Thespecialists receive patients from dentistsin private practice, as well as from dentistsin the Public Dental Service.) Besides thedental degree, the only formal qualicationrequired to work in the public dentalservice is for specialists, who should havereceived recognised additional training.

The monitoring of dentists in the Public

Dental Service is the same as that fordentists in private practice, except whereservices are provided free of charge.

The provision of domiciliary (home) care isnot very common in Sweden, and is usuallyprovided by public health dentists.

Working in Hospitals

In Sweden dentists work in hospitals assalaried employees of the counties. Thereare usually no restrictions on seeingpatients outside the hospital. Dentistsworking in hospitals are employed ashospital dentists who provide conventionaldental treatment to disabled or medicallycompromised patients. Dental treatmentunder general sedation and/or nitrousoxygen is also available but the sedation/anaesthesia cannot be performed by adentist. For this, formal postgraduatetraining is required.

Any complaints are handled by thePublic Dental Service or the MedicalResponsibility Board (HSAN).


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Hospital dentists earn about 43 000 peryear.

Working in Universities andDental FacultiesIn Sweden about 300 dentists workin universities and dental faculties, asemployees of the university. They areallowed to combine their work in thedental faculty with part-time employmentelsewhere and, with the permission of theuniversity, may work in private practiceoutside the faculty. Academic titles withina Swedish dental faculty are: professor(responsible for education and research),associate professor (teaching), andassistant professor (teaching). There areno formal age or training requirements, butmost promotions are made on the basis of

scientic research experience.The time of a typical full-time facultymember of staff is spent 50% onteaching, 15% on their own patients, 25%administration and 10% research. Thecomplaints procedures are as describedabove.


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Professional associationsThe Swedish Dental Association (SDA)has four member associations:

the Swedish Association of Private Dental Practitioners, the Swedish Association of

Public Dental Ofcers, the Swedish Association of

Dental Teachers and the Swedish Association ofDental Students.

Through the membership in one of theseassociations, the dentist automaticallygets a membership in the SDA as well.More than 95 % of all active dentists inSweden are members of the SDA.

The SDA has through a membershipin the Swedish Confederation ofProfessional Associations (SACO) closelinks to other professional organisationsin Sweden.

For more information about theSwedish Dental Association.

EthicsThe SDA has formulated a number ofethical guidelines for the members. Theguidelines are imbedded in the rulesof the SDA and are formulated by theAssociations highest decision-makingbody. The Swedish Association of Private

Dental Practitioners has formulated anethical code for their members.

Professional Matters


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As far as the relationship of the dentist withtheir employees and with other dentists isconcerned, there are no specic contractualrequirements between practitionersworking in the same practice; howevera dentists employees are protected bythe national and European laws on equalemployment opportunities, maternitybenets, occupational health, minimumvacations and health and safety.

Standards and monitoring

If a patient complains, and the dentistcannot resolve the matter directly, thereare two processes through which the issuesmay be considered. Local Boards for PrivatePractice (composed of dentists) and LocalBoards for Public Dental Services (mayconsist of people from another professionthan dentistry) is one way, and the Medical

Responsibility Board (HSAN), on behalf ofthe National Board of Health and Welfareis the other.

In the Medical Responsibility Boardmembership may comprise politiciansand jurists. The person who submits thereport concerning dental matters is alwaysa dentist. The Medical Responsibility Board

(HSAN) is the only authority that canapply sanctions. There are 4 alternativesanctions: an admonition, a caution, tokeep the licence for a trial period or thelicence is suspended. The most commonreason why a dentist loses his licence isillness - less common is crime and lack ofskill.

An appeal against a decision made by


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the Medical Responsibility Board (HSAN)can be made to the County Court inStockholm.

Advertising

Advertising is regulated by law. A dentistcannot compare him/herself with otherdentists nor say he/she is better thansomebody else. Only basic informationmay be given in an advertisement.Advertising should be reliable, impartial

and accurate.Dentists are allowed to promote theirpractices through websites but they arerequired to respect the legislation on DataProtection and Electronic Commerce.

Liability insurance is compulsory fordentists. For dentists working in the

Public Dental Service there is a nationalscheme. Insurance for private practitionersis provided by The Swedish Associationof Private Dental Practitioners and by theproducers cooperative Praktikertjnst, forthe dentists joined to Praktikertjnst. (ThePraktikertjnst group is a private providerof healthcare, schools and welfare, withthe owners themselves healthcare

practitioners). The liability insurance forthe private practitioners provides nancialsupport for the cost of further medicaland dental treatment, compensation forloss of income, damages for pain andsuffering, physical disability and injury andother inconveniences. A private dentalpractitioner currently pays in average 220(2003) each year for this cover.


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Corporate Dentistry

Dentists are able to form limited liabilitycompanies. Non-dentists may fully orpartly own these companies.

Health and Safety at Work

Inoculations are not compulsory forthe workforce, but there is a generalrecommendation to undertakeinoculations, such as Hep B.

For Administered by

Ionising radiation Swedish Radiation

Protection Authority,

SE-171 16 Stockholm

Electrical The county authorities

installations

Infection control The National Board of

Health and Welfare,

SE-106 30 Stockholm

Medical devices Medical Products

Agency, P.O.Box 26,

SE-751 03 Uppsala

Waste disposal Swedish Environmental

Protection Agency,

Blekholmsterassen 36,

SE-106 48 Stockholm

Regulations for Health and Safety


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Dentist Incomes:

The income ranges dentists would haveexpected to earn in 2002 (monthly):

Retirement pensions andHealthcarePeople born before 1937 receive asupplementary payment according tothe old rules, and those born between

1938 to1953 receive part of the pensionaccording to the new and part accordingto the old system. Anyone born after 1954will receive pensions according to the newsystem only. The new pension system willbase payments on lifetime income andindividuals contribute 18.5% of their pay.

The normal retirement age is between 65

and 67. A dentist is allowed to practice

Financial Matters

2002(in Euros)

Generalist 2,940 2,750-3,130 3,380 3,330-3,740

Head of Clinic - - 4,340 3,080

Hospital dentist - - 3,630 3,190-4,070

Specialist(and not

Head of Clinic) - - 4,400 3,960-4,950

Dentist 25years old or2 years afterqualica-

tion (range ofincome)

Dentist 25years old or2 years afterqualication

(avergare)

Dentist45 yearsold or 20years after

qualication(average)

Dentist 45years oldor 20 yearsafter quali-

cation (rangeof income)


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dentistry until the age of 70.There is also a disability pension (againfrom the Frskringskassan) for thoseunable to work due to chronic illness or

disability.

TaxesNational income tax:

The highest rate of income tax is about58 % on earnings over about 46,155 peryear.

VAT/sales tax

VAT is 25% of the value of some typesof goods, including dental equipment,instruments and materials. There arealso reduced rates of 12% (on publictransportation, hotels and provisionsetc.) and 6% (on newspapers and cinema

tickets).


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Other Useful Information

Main national associations andinformation centres:

Swedish Dental AssociationPO Box 1217S-111 82 StockholmPhone: +46 8 666 15 00Fax: +46 8 662 58 42

E-mail: [email protected]: www.tandlakarforbundet.se

The Swedish Association of Private DentalPractionersPO Box 1217S-111 82 StockholmPhone: +46 8 555 446 00Fax: +46 8 555 446 66E-mail: [email protected]: www.ptl.se

Association of Public Health Dentists inSwedenPO Box 1217S-111 82 StockholmPhone: +46 8 545 159 80Fax: +46 8 660 34 34E-mail: [email protected]: www.stf-tt.org

The Swedish Association of Dental Teachers

Karolinska Institutet, Anders BolinPhone: +46 8 728 81 54

The Swedish Association of Dental StudentsPhone: +46 8 666 15 00


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Publications:

Tandlkartidningen

(Journal of the Swedish Dental Association)andSwedish Dental Journal(the scientic journal of the SDA), both at:PO Box 1217S-111 82 Stockholm, SwedenTel: +46 8 666 15 00Fax: +46 8 666 15 95E-mail:[email protected]

Competent authority:

The National Board of Health and WelfareRlambsvgen 3S-106 30 Stockholm

Phone: +46 8 555 53 000Fax: +46 8 555 53252E-mail: [email protected]: www.sos.se


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Dental schools:

HuddingeKarolinska InstitutetOdontologiska InstitutionenBox 4064S-141 04 HuddingePhone: +46 8 728 64 60Fax: +46 8 760 815 05

GteborgGteborg University

Odontologiska fakultetenMedicinaregatan 12A, vn 8Odontologen, GteborgPhone: +46 31 773 3033Fax: +46 31 773 32 07E-mail: [email protected]: www.sahlgrenska.gu.se

MalmTandvrdshgskolanS-205 06 MalmPhone: +46 40 665 8461Fax: +46 40 925 359

UmeTandlkarhgskolanS-901 87 UmePhone: +46 90 785 60 00Fax: +46 90 770 580

E-mail: [email protected]: www.umu.se/odont


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We protect and developthe professional interests

of dentistsThe Swedish Dental Association is theorganisation for the dental profession.Together with the four nationalassociations, the Swedish Association ofPrivate Dental Practitioners, the SwedishAssociation of Public Dental Ofcers, theSwedish Association of Odontological

Teachers and the Association of DentalStudents, we offer dentists and dentalstudents professional and trade-unionservices.

Our task is to protect and develop ourmembers professional interests. Wedo this in close co-operation with thenational associations, which look after the

The organisation for the dentalprofession


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interests of their members from a tradeunion or business perspective.

The Swedish DentalAssociation offersits members:

monitoring and active inuencing ofdentists professional areas of interest

continuing education, courses and theAnnual Dental Congress

Tandlkartidningen (the Swedish-language journal of the Swedish Dental

Association) and the Swedish DentalJournal

membership service and collegialsupport

Swedish Dental Association


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PO Box 1217 . SE-111 82 Stockholm, Sweden . Tel +46 8 666 15 00Fax +46 8 662 58 42 . e-mail: [email protected]: www.tandlakarforbundet.se

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