Manual of Dental Practice 2014 Spain: Council of European Dentists
Manual of Dental Practice 2014 Spain: Council of European Dentists
Manual of Dental Practice 2014 Spain: Council of European Dentists
Edition 5
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Spain
*****
Authors:
with
Ms Emma Barnes
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EU Manual of Dental Practice 2014
Edition 5
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The revised EU Manual of Dental Practice (Edition 5) was commissioned by the Council of European Dentists1 in April 2013. The work has
been undertaken by Cardiff University, Wales, United Kingdom. Although the unit had editorial control over the content, most of the
changes were suggested and validated by the member associations of the Council.
Dr Anthony Kravitz graduated in dentistry from the University of Manchester, England, in 1966. Following a short period working in a
hospital he has worked in general dental practice ever since. From 1988 to 1994 he chaired the British Dental Association’s Dental
Auxiliaries’ Committee and from 1997 until 2003, was the chief negotiator for the UK’s NHS general practitioners, when head of the
relevant BDA committee. From 1996 until 2003 he was chairman of the Ethics and Quality Assurance Working Group of the then EU
Dental Liaison Committee.
He gained a Master’s degree from the University of Wales in 2005 and subsequently was awarded Fellowships at both the Faculty of
General Dental Practice and the Faculty of Dental Surgery, at the Royal College of Surgeons of England.
He is an Honorary Research Fellow at the Cardiff University, Wales and his research interests include healthcare systems and the use of
dental auxiliaries. He is also co-chair of the General Dental Council’s disciplinary body, the Fitness to Practise Panel.
Anthony was co-author (with Professor Elizabeth Treasure) of the third and fourth editions of the EU Manual of Dental Practice (2004 and
2009)
President of the BDA from May 2004 until May 2005, he was awarded an honour (OBE) by Her Majesty The Queen in 2002.
Professor Alison Bullock: After gaining a PhD in 1988, Alison taught for a year before taking up a research post at the School of
Education, University of Birmingham in 1990. She was promoted to Reader in Medical and Dental Education in 2005 and served as co-
Director of Research for three years from October 2005.
She took up her current post as Professor and Director of the Cardiff Unit for Research and Evaluation in Medical and Dental Education
(CUREMeDE) at Cardiff University in 2009. With a focus on the education and development of health professionals, her research interests
include: knowledge transfer and exchange; continuing professional development and impact on practice; workplace based learning.
She was President of the Education Research Group of the International Association of Dental Research (IADR) 2010-12.
Professor Jonathan Cowpe graduated in dentistry from the University of Manchester in 1975. Following training in Oral Surgery he was
appointed Senior Lecturer/Consultant in Oral Surgery at Dundee Dental School in 1985. He gained his PhD, on the application of
quantitative cyto-pathological techniques to the early diagnosis of oral malignancy, in 1984. He was appointed Senior Lecturer at the
University of Wales College of Medicine in 1992 and then to the Chair in Oral Surgery at Bristol Dental School in 1996. He was Head of
Bristol Dental School from 2001 to 20004.
He was Dean of the Faculty of Dental Surgery at the Royal College of Surgeons in Edinburgh from 2005 to 2008 and is Chair of the Joint
Committee for Postgraduate Training in Dentistry (JCPTD). He has been Director of Dental Postgraduate Education in Wales since 2009.
His particular interest now lies in the field of dental education. He was Co-ordinator for an EU six partner, 2-year project, DentCPD,
providing a dental CPD inventory, including core topics, CPD delivery guidelines, an e-learning module and guidelines (2010-12).
Ms Emma Barnes: After completing a degree in psychology and sociology, Emma taught psychology and research methods for health
and social care vocational courses, and later, to first year undergraduates. Following her MSc in Qualitative Research Methods she started
her research career as a Research Assistant in the Graduate School of Education at the University of Bristol, before moving to Cardiff
University in 2006, working firstly in the Department of Child Health and then the Department of Psychological Medicine and Clinical
Neurosciences.
In 2010 Emma joined Cardiff Unit for Research and Evaluation in Medical and Dental Education (CUREMeDE) as a Research Associate.
Working in close collaboration with the Wales Deanery, (School of Postgraduate Medical and Dental Education), her work focuses on
topics around continuing professional development for medical and dental health professionals, and knowledge transfer and exchange.
1 CED Brussels Office, Avenue de la Renaissance 1, B - 1000 Brussels, Tel: +32 - 2 736 34 29, Fax: +32 - 2 732 54 07
2 The authors may be contacted at [email protected]
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Spain
Date of last revision: 1st January 2014 Specialist care is very limited and clinical auxiliaries are limited to
hygienists.
Continuing education for dentists is not mandatory, and is administered
mainly by the dental association – the Consejo General de Colegios
Oficiales de odontólogos y estomatólogos de España.
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Oral healthcare
Almost all oral healthcare in Spain is provided by private The level of the premiums depends on the procedures covered
practitioners and patients usually pay the total cost. and takes no account of the risk of poor health.
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Education, Training and Registration
Undergraduate Training Vocational Training (VT)
There is no post-qualification vocational training in Spain.
Year of data: 2012 Registration
Number of public schools 12
The law defines the specific acts a dentist may perform as: ‘The
Number of private schools 5 treatment of diseases of the whole mouth’ (law 10/86, RD
Student intake (approximate) 1,400 1594/1994).
Number of graduates 1,379 To practise as a dentist a dentist must hold a degree awarded
Percentage female 67% by a recognised Spanish University, or a diploma from a
European Union country which is recognised by the Ministerio
Length of course 5 yrs de Educacion y Cultura.
There is a register of dentists held by the Consejo General in
Madrid. The list is revised every day and there is a fee for
To enter dental school students have first to pass a state inclusion which varies because each regional Colegio charges
school-leaving examination. its own fee according to local expenses. It varies, under a
liberal system between €18 and €50 monthly. An incoming
Dental schools are part of the universities, and not necessarily dentist must register regionally.
part of medical faculties.
Language requirements
Standards of care are not controlled in the private sector and
Dentists from other member states of the EU are not subject to
the clinical facilities are limited. Dental schools have no health
any linguistic tests.
service responsibilities and students gain clinical practice within
Docente University Clinics. Further Postgraduate and Specialist Training
The responsibility for quality assurance of the courses in the Continuing education
schools is undertaken by the Ministry of Education.
An extended system of evaluation of the continuing education
systems is being developed, after encouragement by the
Qualification and Vocational Training
government but it was not compulsory in 2013.
The qualifications on graduation are as follows:
The current system of continuing education is organised by the
Licenciado en Odontología (1986 onwards ) Consejo General and local Colegios de Odontólogos y
Médico Especialista en Estomatología (1948 to 2001) Estomatólogos. Some companies and particular initiatives offer
and other historical categories: Odontólogo (1901 to programmes on continuing education, of different degrees of
1948) quality and control.
Specialist Training
Until 2001, it was possible to train as a stomatologist, in Spain;
There is no specialist training in Spain (but see Working in
this involved a period of dental training by qualified medical
Hospitals).
practitioners, followed by further training as a dentist. No more
have been trained since then.
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Workforce
Dentists
Until 1986, to be a dentist a qualification in medicine was first
required – with dental training following, producing a Year of data: 2013
“stomatologist”. Since then dentists could qualify with an EU Hygienists 13,200
recognised degree, and from 2001 no more stomatologists
have been trained. In 2008 less than one third of the dentists Technicians 11,135
practising in Spain are stomatologists. Denturists 0
Assistants 37,000
Year of data: 2012 Therapists 0
Total Registered 31,261 Other 0
In active practice* 29,000
Dentist to population ratio** 1,623 All figures estimated
Percentage female 52% Dental Hygienists
Qualified overseas* 6,300 Hygienists must hold a registerable qualification. Their
education and training is provided over 2 years by private or
public schools of Formacion Professional and certificates of
* estimated
proficiency are granted by the Ministry of Education and
** in active practice only
Culture.
Many dentists in private practice also work part-time in other
Hygienists are allowed to carry out prophylaxis and oral health
spheres.
education, but only under the prescription of a dentist who must
be present in the building while they are working. The
The dental association believes that Spain has an excess of
employing dentist is responsible for their work. Until 1998 there
supply over need in 2013.
was an unknown number of non-titled dental hygienists.
However, in 1996 the Government started a validation process
Movement of dentists across borders
which finished in 1998 for dental hygienists who had accredited
a minimum number of years of experience in dental practices,
There is also a tradition of accepting dentists trained in “third
and then passed an examination process. This resulted in a
world” countries, usually South America, but the numbers
rapid increase in the number of “recorded” hygienists (there is
entering Spain have reduced. The entry examinations for these
no registration) from 1,000 to over 13,000.
dentists have become progressively more difficult. The dental
association reported that 70 to 100 a year were still passing the
Hygienists are almost exclusively employed in private practice.
entrance examination in 2013. These dentists may not be able
The public dental service has created positions for this group,
to work freely in other countries in the EU.
although some are employed on preventive programmes, on
temporary contracts.
There are no figures for the movement of dentists out of Spain.
Dental Technicians
Specialists
There is a qualification for Dental Technicians which is obtained
No specialties, as defined in the EU Dental Directives, are
after training and education at schools of Formacion
formally recognised. There are a number of Stomatologists and
Professional, over a 2-year period. Voluntary registers are kept
Maxillo-facial Surgeons who are specialists in Maxillo-facial
by the regional associations for the craft, but there is no
surgery according to the EU Medical Directives.
national mandatory requirement and some regional ‘colegios’
are being established. However, in some regions it is
There are an increasing number of practitioners who are
compulsory and the numbers of such are growing.
limiting their practice to a given speciality, mainly orthodontics,
periodontics, endodontics and oral surgery. Some Spanish
Dental technicians may only work in commercial laboratories. In
universities offer postgraduate courses in different specialist
2013 the Supreme Court announced a judgement that dental
areas; however they lack official professional validity.
technicians are health care professionals, but cannot take part
Auxiliaries in clinical acts performed on patients, being the taking of dental
impressions and recordings – these being reserved exclusively
Other than dental chairside nurses or receptionists, who are to dentists.
trained by dental practitioners directly, there are two main types
of dental auxiliary. They are: Dental Assistants (Nurses)
Dental assistants work at the chairside. There is no formal
Dental hygienists training or qualification.
Dental technicians
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Practice in Spain
titles used are Odontólogo de área and Odontólogo de cupo.
Year of data: 2012 No formal postgraduate training is required for these posts but
attendance for continuing education is assessed on a points
General (private) practice 28,839 basis, when evaluating applicants. As in the hospital dental
Public dental service 1,300 service there are no grades but every third year, a dentist
University 864 receives a ‘Trienio’ which raises his salary.
Hospital 350 The regional authorities have introduced a capitation system for
Armed Forces 340 children of 6 to 14 years old. Private practitioners are eligible to
accept patients from these schemes.
General Practice as a proportion is 99%
Patients attending the public dental service pay nothing for their
care. The number of procedures undertaken is recorded for
Many dentists in private practice also work part-time in other statistical purposes and complaints are investigated through a
spheres, hence the imbalance in the numbers above. medical system. Where these are upheld a warning may be
recorded on the dentists file, but he may only be prevented
Working in Private (General) Practice from practising in the service by judicial sentence following
malpractice.
Dentists who practise outside hospitals, universities or the
public dental service are referred to as private practitioners. Working in Hospitals
Approximately 92% of the profession work in this way and are Most hospitals are owned by the state, but a few have been
largely in single-handed practice. established by the large insurance companies. In the latter
private practitioners may rent facilities and charge patients on a
Most dentists in private practice are self-employed and earn fee per item basis. Normally however, dentists are employed
their living through charging fees for treatments. Generally as Odontologists who provide routine dentistry and minor oral
such private practitioners accept only private fee-paying surgery, or medically qualified Stomatologists, who supplement
patients. the work of Odontologists with Temporo-Mandibular Joint
Fee scales therapy, and Oral Medicine or Maxillo-Facial Surgeons. In each
case these are titles and not definitive grades.
There is no prescribed fee scale and the laws controlling free
competition restrict the possibility of set fees, but regional There is no formal postgraduate training requirement for
dental associations provide recommended fees for different Odontologists and Stomatologists, but if applicants hold an oral
treatments. Local “Colegios” (regional dental organisations) set surgery qualification they are evaluated preferentially. Maxillo-
recommended fees but they cannot be enforced as mandation Facial Surgeons must have completed a formal five year
is against Spanish law. training programme in an accredited hospital as set out in the
EU medical Directives. No career structure exists for these
Joining or establishing a practice appointments but pay, which is revised every three years,
reflects experience. Posts are filled by national competition but
Newly qualified practitioners normally work as assistants and autonomous regions can apply their own rules.
are paid a proportion (30-50%) of their gross earnings. A few of
Working in Universities and Dental Faculties
these eventually become partners but more usually they open
their own practices. Although there are no workforce
Both full-time and part-time staff are employed and the latter
restrictions, there are agreed minimum conditions for a new
also routinely work in private practice. Full-time staff may also
clinic. These include sterilisation and prevention of cross
practise outside their school when they have completed their
infection, radiological protection, adequate waiting rooms and
university schedule if they have full ‘dedication’. However this
toilets, fire precautions and emergency lighting and insurance.
group can also opt for exclusive ‘dedication’ which denies them
Existing practices may also be purchased together with
outside work but allows intra-mural practice.
goodwill and it is acceptable to inform patients when this
occurs. No state assistance is available for practice purchase, The following grades have been established for faculty staff:-
or establishing a new practice, but some banks have special
agreements with the Colegios, for loans. Associate Professor (Profesor Asociado)
- part-time faculty member
Premises may be rented or owned. They would usually be Assistant Professor (Profesor Ayudante)
sited in houses or offices only. - contracted full-time and pursuing an academic career
Profesor Titular - full-time professor
A dentist on average will look after 664 patients on a regular Chairman (Catedratico) - highest academic rank, with
basis. the same obligations and duties as a full-time
professor
Working in Public Clinics
A public dental service exists as described above and limited To be eligible for a full professorship, a faculty member must
care is available to all sections of the population. Less than 5% obtain a doctorate after a five year training programme in
of registered dentists work in the service but although the research methodology, a research project and the production of
number employed by Insalud is stable, the number of those a thesis which must be defended. Professors are usually
working in the regions is rising, for example in Andalusia. The appointed to a predetermined subject by a panel of their peers
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after national competition. Appointees must also have had at The agency reviews publications and if a candidate passes this
least three years of teaching experience. process, a salary increment is awarded.
Teaching standards are not formally monitored but some Working in the Armed Forces
universities have their own evaluation systems using student
questionnaires. The quantity and quality of an individual’s Many dentists serve full-time in the Armed Forces but is not
research is voluntarily monitored by a National Agency for recorded how many are female.
Evaluation which also awards research grants.
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Professional Matters
Electronic commerce is not extensively implanted among
Professional association dentists but some companies of dental supplies operate in this
There is a single federal organisation, the Consejo General de mode. However, dentists may have their own websites under
Colegios Oficiales de odontólogos y estomatólogos de España the Codigo and the ethical code. Spain has adopted the CED
which has a Council (Consejo General) of which the Presidents ethical code on these matters.
of each of the 19 regional Colegios are members.
Indemnity Insurance
Number Year Source Liability insurance is compulsory for dentists and is provided by
Consejo General de Colegios 31,260 2013 Colegios private general insurance companies. It provides cover for
de Odontólogos y Estomatólogos de España financial liabilities of not less than €300k, up to €600k and
premiums do not vary for different types of dentists (nb. a
general dental practitioner pays between €150 and €240
Membership is mandatory, so the figures represent 100% of annually).
dentists in Spain. The central organisation has a full-time office
based in Madrid. The regional organisations are best contacted The premiums do cover a Spanish dentist who is working
through this office (see later). overseas.
There are no specific contractual requirements between Health and Safety at Work
practitioners working in the same practice other than private
contracts agreed by individual dentists. A dentist’s employees Inoculations, such as Hepatitis B are not compulsory for the
however are protected by the national and European laws on workforce, although they are recommended.
maternity benefits, occupational health, the payment of social
security benefits and health and safety. Ionising Radiation
There are many regulations relating to the facilities, dosage,
Fitness to Practise/Disciplinary Matters sanitary controls. To direct a radiograph formal training must
have been undertaken, with a licence at the end of this.
If a patient wishes to complain about a dentist in general
practice, this may be to either the Regional Colegio or However, continuing training is not mandatory.
Municipal Consumer Offices in the Town Halls or directly to the
courts. Complaints to the former are considered by a Hazardous waste
Deontologic committee, which has only dental members.
These committees may arbitrate, issue a private or public Since 1986 it has been mandatory to fit amalgam separators to
warning, suspend a dentist or, in severe cases, refer to the all newly equipped premises or newly installed units. This
courts for removal from the Register. requirement extends to putting in older units in new premises.
However, there may be differences in the autonomous regions
Dentists have a right of appeal to the Consejo General and towards compliance.
patients to the legal system. All criminal acts against patients
are considered by the courts. Regulations for Health and Safety
Data Protection
For Administered by
There is a strict compulsory protocol of clinical data collection Ionising radiation State Government
and storage, for patient protection and all dental offices had to
be adapted to conform by 2007. Electrical installations Regional Government
Waste disposal Regional Government
Advertising
Medical devices Regional Government
Since 2003, there has been a Codigo de publicidad about Infection control Regional Government
advertising in dentistry, accepted by the Tribunal of
Competence Defence, which has applicability to all dentists.
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Financial Matters
€300,000. Each Autonomous Community has to approve its
Retirement pensions and Healthcare own scale of rates. In general, the rates are 12% to 21%.
For the majority of the Spanish population general health care Investment income, such as dividends and interest arising from
is free, paid for out of a General State Budget - from taxation bank deposits, any gains on sales of shares, and so on, are
92%, and 8% from the Social Security contributions of taxed at a rate of 21% for amounts up to €6,000, 25% for
employers and employees. income between €6,000 and €24,000 and 27% for amounts
exceeding €24,000.
There are two types of contributory schemes in the Spanish
social security system: a general scheme applicable to all VAT
employed persons who are not covered by special schemes The standard VAT rate is 21% (since Sept 2012). There is a
such as one for the self-employed. There is also a Non- reduced rate of 10% (from Sept 2012) for: passenger transport;
contributory system for persons who face a specific situation of hotel and restaurant services; and others. There is also a 4%
need, and whose income is below a certain legally prescribed VAT rate for: food and drink; goods from chemists; construction
level. work; and some newspapers.
Social security payments (autónomos) for a dentist in private No medical procedures, including laboratory prostheses attract
practice are approximately €300 a month. Many dentists will VAT. The VAT rates are 10% on dental equipment and 21% on
also take out private health insurance plans.ublic pensions are materials.
paid as a percentage of up to 85% of average salary, up to a
maximum of €1,502 a month, and assume a minimum of 15 Various Financial Comparators
working years. Many supplement their public pension with
private pension plans.
Madrid 2003 2012
The compulsory retirement age in Spain is 70 (65 for some Zurich = 100
professions), but it can be done on a voluntary base from 65 Prices (including rent) 67.5 60.1
years onwards. Dentists may continue to work in private
Wage levels (net) 39.2 43.5
practice beyond normal retirement age.
Domestic Purchasing Power at PPP 55.4 60.6
Taxes
Income taxes are progressively increased from 12.75% of Source: UBS August 2003 & November 2012
taxable income after allowances, to 30.5% on incomes over
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Dental Schools
2013 Number of Annual
Undergrads Graduates
Private
Madrid: El Sabio 1,829 312
Madrid: Europea 811 201
Catalunya 287 57
Valencia 449 96
San Pablo CEU, Madrid 241 48
3,617 714
Public
Madrid 347 95
Barcelona 404 96
Valencia 298 55
Granada 391 71
Vizcaya 199 44
La Coruna 220 41
Sevilla 279 61
Murcia 195 45
Oviedo 140 34
Salamanca 155 36
Madrid Rey Juan Carlos 246 61
Huesca 121 26
2,995 665
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Public Dental Schools:
Madrid Barcelona Madrid
Facultad de Odontología Facultad de Barcelona
Ciudad Universitaria Ciudad Sanitaria de Bellvitge Universidad Rey Juan Carlos
Universidad Compultense - 28040 “Principe de España” C/ Tulipán s/n 28933 (Móstoles)
Madrid Feixa Llarga, s/n Madrid
Tel: +34 91.394 19 15 08907 - Hospitalet de Llobregat, Tel: +34 91.665.50.60
Fax: +34 91.394.19.10 Barcelona Fax: +34 91.614.71.20
Email: [email protected] Tel: +34 93 335 88 99 Email: [email protected]
Website: Fax: +34 93 403 59 27 Website: www.urjc.es
www.ucm.es/info/odonto/ Email: [email protected] Dentists graduating each year: 61
Dentists graduating each year: 95 Website: Number of students: 246
Number of students: 347 http://www.ub.es/fodont/
Dentists graduating each year: 96
Number of students: 404
Valencia Granada Huesca
Facultad de Valencia Facultad de Odontologia de Facultad de Ciencias de la Salud y del
C/Gascó Oliag Granada Deporte
1 - 46010 Valencia Campo Universitario de Cartuja s/n C/ Plaza Universidad, 3. 22002-Huesca
Tel: +34 96 386 41 75 18071 Granada Tel: +34 97 4239393
Fax: +34 96 386 41 44 Tel: +34 958 24 38 12 Fax: +34 97 4239392
Email: [email protected] Fax: +34 958 24 37 95 Email: [email protected]
Website: www.uv.es Email [email protected] Website: www.unizar.es/facuhu/
Dentists graduating each year: 55 Website: Dentists graduating each year: 26
Number of students: 298 http://www.ugr.es/~odonto/ Number of students: 121
Dentists graduating each year: 71
Number of students: 391
Vizcaya (Bilbao) Santiago de Compostela Oviedo
Facultad de Vizcaya Facultad de Medicina de Facultad de Medicina.
Universidad del País Vasco Santiago de Compostela Clínica Universitaria de
Facultad de Medicina y Entrerios, s/n1 Odontología.
Odontología 15705 Santiago de Compostela C/ Catedrático José Serrano,
Sarriena s/n (La Coruña) s/n , 33006 Oviedo
48940 Lejona (Vizcaya) Tel: +34 981 562 026 Tel: +34 98 510 36 47
Tel: +34 94 464 77 00 Fax: +34 981.582.642 Fax: +34 98.510.35.33
Fax: Email [email protected] Email:
Email: [email protected] Website: Website: www.uniovi.es
Website: www.lg.ehu.es http://www.usc.es/coies/ Dentists graduating each year: 34
Dentists graduating each year: 44 Dentists graduating each year: Number of students: 140
Number of students: 199 41
Number of students: 220
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