Economic crisis and waiting lists block dental care for EU citizens

Anche per le visite per prevenzione o per la pulizia dei denti professionale, la quota di persone rilevata nel Meridione (16,1%) è la metà di quella del Nord (30,7%), mentre è doppia rispetto al Nord la percentuale di coloro che non sono mai stati da un dentista. A guardare con attenzione e preoccupazione la situazione è la Federconsumatori, l’associazione che si occupa della difesa dei diritti dei consumatori. «L’ultimo report dell’Istat rivela un dato allarmante: il 12% degli italiani rinuncia alle cure dentali per motivi economici. La percentuale sale vertiginosamente al Sud, dove il 61% delle famiglie non si rivolge al dentista per lo stesso motivo, contro il 26% del Nord - fa sapere l’organizzazione presieduta da Michele Carrus, con un documento -. Segno evidente che il diritto alla salute e l’accesso alle cure sono sempre più a rischio nel nostro Paese, con l’aggravante dell’inaccettabile disparità e squilibrio tra Nord e Sud».

Then the figures: 'In Italy, dental care can be very expensive for families: considering hygiene (2 sessions a year per person), orthodontic braces, and caries treatment, a family can spend €3,550,' Federconsumatori emphasises. 'Expenses that weigh almost entirely on the shoulders of citizens: public assistance is extremely limited and does not guarantee fair access to prevention and the necessary treatments. This has dramatic consequences on the health of the population, especially the youngest: in the last 12 months, in fact, over 72 per cent of children have not been visited by a dentist. A worrying figure, which underlines how the absence of prevention policies can compromise the future health of the new generations'.

Then there is another aspect linked to high costs: dental tourism. "A trend that," Federconsumatori emphasises, "while on the one hand allows for immediate savings, on the other exposes patients to risks linked to quality standards that are often uncontrollable and to the difficulty of managing any post-surgery complications. From the organisation an appeal for dentistry to be "fully and adequately integrated into the National Health Service, guaranteeing fair and uniform access to dental care for all citizens". "We can no longer put it off," Federconsumatori concludes, "dental health is not just an aesthetic factor, but has a profound effect on the general wellbeing of the body, from the muscular-skeletal system to the prevention of cardiovascular and metabolic diseases.

In Austria, dental care is organised through the Österreichische Gesundheitskasse (ÖGK), the national health insurance fund, which concludes contracts with contracted dentists, supported by private practitioners and their own dental health centres. The insurance covers basic care and some standard prostheses, but excludes services considered 'extra', such as fixed prostheses or dental hygiene, which are paid for entirely by the patient.

For younger people, up to the age of 18, access to orthodontic treatment is facilitated: in some cases the entire cost or a large part of it is covered by the health fund. For adults, on the other hand, the burden of costs remains almost entirely private.

A central issue, however, is the availability of affiliated dentists. Over the past ten years, their number has dropped significantly: from 2,602 in 2014 to 2,377 in 2024. The wave of retirements, working conditions perceived as unattractive, and the shortage of dental graduates are all having an impact. This generates vacancies and jeopardises the ubiquity of care. Institutions are attempting to reverse this trend with economic incentives, less bureaucracy, and a reduction in workloads.

Alongside these dynamics, the issue of social exclusion remains strong. For more than 15 years, the Neunerhaus organisation has been offering free dental care to the homeless and uninsured, reaching some 15,000 beneficiaries. As director Daniela Unterholzner emphasises, oral health is not just a health factor, but directly affects dignity and the possibility of social reintegration, especially for those seeking work or housing.

In France, dental treatment is generally reimbursed by the national health system, with the exception of some cosmetic treatments. Costs for citizens are therefore lower than in Italy. However, it is not so much the price of treatment that affects real accessibility, but the distribution of professionals on the territory.

According to government figures, 60 per cent of French municipalities do not have enough dentists: a phenomenon known as 'déserts médicaux'. The shortage mainly affects rural areas and small towns, while the large cities remain relatively covered. The average density is 339 doctors per 100,000 inhabitants, but there are strong territorial imbalances: departments such as Indre, Eure or Ain have less than half the national average, while areas such as Paris or the Hautes-Alpes exceed this figure by a factor of five.

The problem does not only concern dentists: a Crédoc survey in 2025 reveals that 44% of French people perceive that they live in areas with a shortage of doctors, and in rural areas the figure rises to one in two. Waiting times to get an appointment have doubled in the last five years, exacerbating the difficulty of access, especially for specialist visits. Even in the metropolises, some neighbourhoods remain without an offer, forcing citizens to move elsewhere or to give up altogether.

The Czech system provides, in theory, for full coverage of basic dental care: preventive examinations, tartar removal, extractions and standard fillings should be free of charge for citizens through health insurance. In practice, however, these services are almost only available in hospitals or from older dentists nearing retirement.

In private practices, which have become more widespread over the last twenty years, patients face surcharges of between EUR 20 and EUR 100 per service, justified by more modern equipment or additional services. In fact, only emergencies or basic check-ups remain accessible free of charge, while everything else is chargeable.

The result is a strong social and geographical divide. In rural areas, even in private clinics, waiting times can be weeks. The law only requires that there is a dentist reachable within 35 km, but does not stipulate how many people he or she must serve, which means that a single practice may have to cover entire communities. Some municipalities offer free flats to attract dentists, but with little success. In contrast, in wealthier cities, the supply is ample and private practices compete to win new patients.

Those who belong to the weakest groups, however, often forego treatment altogether. NGOs and voluntary associations intervene only minimally, with only a few initiatives dedicated to the homeless in the big cities. On the political level, the debate remains deadlocked: the centre-right government does not want to expand public spending, while the populist oppositions promise radical solutions, but without turning them into concrete reforms.

*This article is part of the European collaborative journalism project "Pulse"