SPANISH OBSERVATORY FOR ORAL HEALTH First quarter 2015

The aim is to take the pulse, in a permanent way, to oral health and dental profession in Spain The methodology is quantitative, selecting a group of "sentinel dentists" who are interviewed online (CAWI) with a semi-structured questionnaire model. In this way, we can have a picture of the current situation with quarterly data for each wave and an evolutionary analysis comparing the different phases. The survey has been conducted between April 14 and May 8, in a sample of 150 dentists scattered across the country, with a sampling error of 8%.

Context  The Spanish Observatory of Oral Health will be carried out in four waves, on the following estimated dates:  The data which will be presented here corresponds to the first wave, and refers to March 2015 and to the comparison of the last quarter of 2014 with the first quarter of 2015.

MAIN OBJECTIVE SPECIFIC OBJECTIVES  Identify the strong points in order to strengthen them.  Identify the aspects to be improved in order to correct them.  Conduct a synchronous analysis assessing the current situation.  Conduct a diachronic analysis by comparing the different times of measurement. Objectives of the research  The main objective of the Spanish Observatory of Oral Health is to analyze, on an ongoing basis, the state of oral health and of the dental profession in Spain.

Method Universe of analyse Technical aspects n Interview online (CAWI) through a semi-structured questionnaire model n All Spanish dentists in active professional practice Type of study n Quantitative, selecting a group of 150 “sentinel dentists” Frequency n Quarterly Sampling error  A sample of 150 dentists scattered across the country, with a sampling error of 8% Level of analyse n National Date of survey n The survey has been conducted between April 14 and May 8

RESULTS Professional Practice Patients and treatments Quarter comparison Conclusions

Professional Practice 120 hours/month 200 patients The Spanish dentists work 120 hours per month attending an average of 200 patients

76% 13% 11% The Spanish dentists devote 76% of their time to clinical activities, 13% to administrative work and 11% to other activities (mainly additional training courses) Professional Practice

Patients and treatments Age of patients Sex of patients

Clinical work time 60% of the clinical work time is devoted to Curative Care while the other 40% is used for Preventive Care or Routine Check-ups. Spanish dentists spend 3.5 times more to treat than to prevent. Patients and treatments

Of all Curative Care provided by the Spanish dentists, on average, one third of the treatments are focused on Restorative Care. Implantology has been the least demanded treatment with no more than 7% of the total. Patients and treatments

In relation to the level of professional satisfaction, 9 out of 10 dentists are satisfied with the quality of care given to patients during the first quarter of 2015 Patients and treatments Dentists’ perceived satisfaction with the quality of care given to patients SCALE 1-5 ( 1= VERY INSATISFIED; 5= VERY SATISFIED) VERY INSATISFED 2% INSATISFIED 5% NEUTRAL 7% SATISFIED 66% VERY SATISFIED 19% 7% 85% N.A 1%

HOW HIGH DO YOU THINK THE IMPACT OF THE ECONOMIC CRISIS HAS BEEN WHEN DOING AND/OR RECOMMENDING TO PATIENTS DIFFERENT TREATMENT OPTIONS? (1= No impact; 5= Very high impact) 65% 11% 65% of the dentists agree with the fact that the economic crisis has had a great impact on their patients. Patients and treatments

Quarter comparison COMPARED WITH THE LAST QUARTER OF 2014, HOW DO YOU THINK THE NUMBER OF PATIENTS HAS EVOLVED? 4th Q st Q 2015

4th Q st Q 2015 TREATMENTS EVOLUTION EVOLUTION OF THE DIFFERENT TREATMENTS BETWEEN LAST 2014 QUARTER AND NOW (1 st QUARTER 2015) Quarter comparison Orthodontics Restorations Extractions Scalling Check-ups Endodontics Removable prosthesis Periodontics Implants Fixed prothesis Prothesis over implant Oral surgery (3 rd molars) Bleaching Esthetics treatments Analyzing the evolution of the types of treatments with regard to the last quarter of 2014, dentists state that there has been a significant decrease in aesthetic treatments (up to 29%) and a slight increase in basic treatments such as restorations, orthodontics, cleaning and extractions (around 6-8% increase).

4th Q st Q 2015 COMPARED WITH THE LAST QUARTER OF 2014, HOW DO YOU THINK YOUR INCOME HAS EVOLVED SINCE THEN? Quarter comparison

Conclusions The economic crisis: a determining factor The economic crisis stands as a determining factor when it comes to providing the ideal treatments, having also an effect on the quality: 65% of dentists state that the crisis has quite affected the adequacy of procedures, and 37% of them remarks that it has had a high negative effect on quality. Satisfaction with the treatments provided Still, 5 out of 6 dentists are very or quite satisfied with the care provided to the patients who have visited their clinics, while 7% express dissatisfaction with it. Increase in the number of patients during the 1 st quarter of 2015 With reference to the number of visitors to the dental clinics, the perception is positive in the first three months of 2015 in comparison to the last three months of 2014: more than half (52%) of participants in the study believes that there has been no difference between the two periods, while the proportion of those who believe that the number of patients has increased is 8 percent points higher than those expressing the opposite.

Conclusions Patients go to the dentist for Curative Care Almost 46% of the dentists’ total working time in March 2015 was focused on treating some kind of disease or illness. By contrast, only 12.7% of total working time was aimed at preventive care. Fewer treatments aimed at aesthetics Discomfort in the profession The dentists participating in the study express the need of a greater control in the professional practice (intrusion, deceiving advertising, unfair competition) and of a human resources planning (numerus clausus, excess of dentists, etc). Between last quarter of 2014 and first quarter of 2015 the treatments which have been diminished (29%) have been those related to aesthetics, such as veneers and tooth whitening, while the techniques applied to oral maintenance such as orthodontics, fillings, simple extractions and tooth cleaning have increased slightly (6-8%).