The report of the President of Stomatological Association of Russia professor V.K. Leontyeva

"About the results of activity of the StAR for the accounting period"
(2000-2003)

In an initial part of the report I would like to touch upon a number of the quantitative data describing our Association.

The Russian Dental Association consists of 79 regional Associations the majority from which are the legal persons. With the account, that there are only 89 territories in Russia and some of them practically have no stomatologists (for example, Ust-Koryaksky National District) we with satisfaction can ascertain, that practically all theRussian Federation is submitted in our Association by the members - territorial Dental Association. It testifies about high authority of the Association, about it’s importance and role.

In the structure of the Association there are more than 20.000 persons. Unfortunately, it is difficult to name the exact figure, as not all the territories know exact quantity of the members, not all the members of the associations are not affirmed in appropriate way registered that is serious lack of our job, which should be overcome.

In the structure of the StAR 12 sections are created and function. These are the sections of orthodontology, maxillofacial surgery, endodontology, aesthetic stomatology, pathology, dental mecanics, private stomatology, preventive maintenance, of children's stomatology, paradontology, implantology, main doctors. Creation of these sections testifies high professional activity of the stomatologists-professionals, about the following step in development of the Association, which will be developed and supported. Especially successfully function the section of orthodontology, children's stomatology, implantology, paradontology, endodontology, aesthetic stomatology, preventive maintenance.

The certificate of their activity is such important fact as realization of championships of professional skills. They are annually organized on aesthetic in stomatology, tooth engineering, implantology, anesthesiology.

These championships turn out into holidays of professional skill and stimulate our colleagues on perfection of the trade.

Some words about the device of the StAR. It is submitted by management of the congress led by Z.P. Grigorevskoy. This group organizes and spends congresses and conferences of the StAR.

Administrative group led by O.G. Avraamovoy. This group conducts a number of the programs of the StAR, carries out scientific and test researches, works according to the orders received by the StAR from various firms and companies.

Government consisting of the President, Vice-presidents, a responsible secretary and a number emplioyees - M.V. Dunaeva, V.I. Kozlova, I.I. Brodezkogo, A.A. Hohlova, chief accountant, V.I. Polyeva, A.A. Loginova, L.N. Maksimovskoy, V.L. Kovalskogo carry out the decisions of the council of the StAR, a numberof the programs of the StAR, prepare congresses and conferences.

I want to inform about high activity and large job being fulfilled by the Vice-presidents of the StAR. The professor A.V. Zimbalistov conducted the scientific program of the StAR, the program of championships on orthopedical stomatology and tooth engineering and a numberof the current questions of the StAR. Professor L.E. Leonova has organized a numberof conferences of the StAR, carried out a numberof the assignments of Advice and Congress of the StAR, organized a numberof regional conferences of the StAR. V.D. Vagner worked with regions and was responcible for the regional programs of the Association, for the problems of organization and management, the realization of a numberof conferences and seminars and was won by the large authority as the expert. The professor Y.M. Maksimovsky is the initiator and realizator of a numberof new ideas and programs in the Association connected with new technologies in stomatology, licensing, a numberof the scientific programs, degree and postdiploma education.

The responsible secretary except of his direct functions was responcible for the regional and information programs of the StAR and fulfilled his dutes excellently.

Now we annually hold 3 All-Russia conferences, about 20 regional conferences and we support many other regional measures. It is possible to say with confidence, that the regional programs of the StAR have become our main and most serious achievement for the past period.

At last, some words about the Programs of the StAR. All of them are carried out by staff of the StAR and it’s employees without the state grant. The preventive Program of the StAR has captured more than 2 mln.of children. The program of sponsorship allows to spend our exhibitions, congresses, conferences, championships, information measures successfully.

StAR for the first time in the country began competent insurance of professional risks the stomatologists of our country for the first time have learned, what it is and for what it is for.

"Marks of approval of the StAR" allow to choose the best stomatological goods for the population and experts reliably.

The scientific programs of the StAR decide large problems of organization, management and preventive maintenance in stomatology, to prepare the necessary documents.

Professional championships of the StAR, unique in public health services, have allowed to lift healthy interest to professionalism in our speciality and to reveal hundreds of talents. Awording Program of the StAR allows to mark the best stomatologists of the country in among of their colleagues at a high objective level.

At last, informational Program of the StAR has allowed to lift on a new level an exchange of dental mechanics, technologies, dialogue, training etc. major aspects of a speciality.

Further we shall expand these programs to involve in them the increasing number of the colleagues.

Now let me pass to the next part of our report.

Building of the market relations in Russia was marked by new serious and deep changes in the speciality. Let me analyse them and report to your attention.

I. On a background of proceeding crisis in social sphere and public health services of the country the situation and ways of reforming of stomatological service was rather precisely defined. Stomatology is one of few sections of public health services, in which for the last years the real steps on reforming of the speciality, adaptation of it to conditions of the market are made, where the additional sources of financing are found, the modern technologies of preventive maintenance and treatment are introduced, the intensive training and conversion training of the staff is carried out and are solved a number of problems.

What have the market relations given and what have they taken away from stomatology (fig. 2)?
We consider, that now our speciality basically is ready to perception of any variants of development. In a basis of the further development of stomatology in a direction of actionoring there can be two decisions:

1. Acceptance by the Government of Russia and the Ministry of public health services decision about a state, joint-stock or private way of development of our speciality.
2. Delegating of the decision of this problem to the regions depending on a condition of the budget and other local conditions.

The basic changes in stomatology of Russia during transition to the market relations
Positive, Negative
1. Development of different forms of stomatological help
2. Introduction of new technologies
3. Improvement of quality of stomatological help
4. Expansion of sources of financing
5. Need in high-quality treatment and experts
6. Improvement of of image stomatologists in public health services and in a society
7. Improvement of the rights of the patient
8. Improvement of individual preventive maintenance
9. Increase of the responsibility of stomatologists
10. Free choice of products for stomatology
11. Increasing of a role of public organizations and self-management
12. Sharp development of computer science
13. Rapid development of implantology, orthodontology, endodontology
14. Strengthening the responsibility of stomatologists:
1. Deficiency of budget financing
2. Deterioration of the help to children, destruction of a children stomatology
3. Reduction of social protection of the patient
4. Reduction of availability of stomatological help
5. Deterioration of school of stomatology
6. Irresponsibility of the owner for the condition of his property
7. Destruction of material base of the state stomatological establishments.

The analysis of a today's situation shows, that the decision about actionizing and privatization of stomatology at a level of the country as a whole will be hardly accepted. The acceptance of the decision on improvement of budget or insurance development of stomatology is improbable also. Our conversation in the Ministry of Public Health of Russia on this problem has shown, that the Ministry in conditions of absence of an interdiction on actiononzing of medical establishments is not going neither to stimulate, nor to interfere with this process, if the special decision of Government will not be accepted. Thus the process of actionizing of municipal stomatology will depend on regional authority.

Really, the analysis of the tendencies of development of stomatology in Russia shows, that in many regions a problem of actionizing and privatization of stomatological establishments is seriously examined now. Kaliningrad, Novosibirsk, Pskov, Tyumen etc.). In details this problem will be mentioned on a symposium in the report of V.D. Vagner.

The experience collelted in Russia and in Kazakhstan shows, that privatization of stomatological the establishments cannot be considered as the general boon neither for the population, nor for stomatologists, as well as gradual development of public sector without increasing of the state budget. Most likely, the process probable of actioniring stomatological sector of public health services can become the compelled measure of state or regional authority because of the deficiency of budget financing.

The boon is the reception of complete independence of the establishment at the process of actionizing. But in conditions of the worn out equipment not enough prepared staff, bad condition of buildings and infrastructure, the survival of such actionizing polyclinic is possible only at presence of the State Order on stomatological help, greatest efforts of collectives, attraction of investors or the collective of the polyclinic to reequipment of establishment, reasonable price politics.

For the all actionized of polyclinics, which today exist safely, these conditions were necessary for their survival and development.

If to consider other circuit of the further development of the state stomatological establishment, it has in two aspects.

The safe variant consists in reception of the help of the budget for reequipment of the polyclinics, their development, training of the staff. This variant, unfortunately, is accessible to few polyclinics, it is optimum, though it does not guarantee an obstacle to development of shadow sector. The similar way of development is convenient for further actionizing.

Less safe, but more probable, way of development of the state stomatological polyclinics consists in job of these establishments in the conditions of deficiency of the budget and insurance maintenance, rough development of “shadow” sector, the system of collecting wear out buildings and - sad ending of such establishments. Such way of development is more probable for stomatological polyclinics in the regions, where not enough attention is given to stomatological help, in those establishments, which are supervised by the elderly and old main doctors who have been not adapted to the market relations, in those establishments, where the development does not exist and the hope for development is absent. Unfortunately, there is a lot of such stomatological establishments and majority of them have no prospects. An exit for them is the change of management, search of the investors, complete changing of politics of the establishment.

It is necessary to note, that on various forums, including sessions of the Board of Public Health Services of Russia, it was repeatedly marked, that stomatology is one of the most successfully developing sections of public health services in conditions of market economy.

It is promoted by high political, economic, social and professional activity of the members of stomatological of corporation ifself. Collected by them capital as the orders of P.H.S. № 50, 312, 259, 289 etc., organization and job of the Russian Dental Association, development of training and computer science, contract with P.H.S. of the Russian Federation, wide contacts of the experts at all levels - all this promotes development of stomatology in the country (fig. 3).

THE ORDERS OF THE MINISTRY OF PUBLIC HEALTH SERVICES OF RUSSIA ON SECTION "STOMATOLOGY", PREPARED AND ISSUED In 1992-2002.
1. Order PH of the Russian Federation "About the organization of job the stomatological establishments in new economic conditions of managing" from 06.08.96 № 312

2. Order PH of the Russian Federation "About perfection of the system of the account of work of the doctors of stomatological structure" from 02.10.97 № 289

3. Order PH of the Russian Federation "About the statement of the plan of measures on preparation of realization of reform of stomatological of a service" from 02.07.99 № 259.

4. Order PH of the Russian Federation "About the statement of the Instruction on account of standard units of labour input of job of the doctors - stomatologists and dentists" from 15.11.01г. № 408

5. Order PH of the Russian Federation " About introduction of a speciality " Stomatology "preventive" from 06.02.01г. № 33

6. The changes into "the Methodical recommendations for the order of formation and economic substantiation of the territorial programs of state guarantees of rendering to the citizens of the Russian Federation of free-of-charge medical aid "as the new qualifier basic of stomatological of treating-diagnostic measures and technologies expressed in standard units of labour input (CPL) - the Decision of Government of Russian Federation from 24.07.01 №550

The preparation of the three orders is going on:
1. "About introduction in the nomenclature of specialities and medical posts of stomatological service of the doctor - stomatologist of general practice"

2. "Rules on protection of work in the establishments of stomatological structure"

3. "About the statement of the primary registration of documentation in medical establishments ".

II. It is possible to ascertain, that stomatology as one of most socially important medical specialities, has not only successfully survived, but also receives the further development.

It is shown in the following:
1. In all the stomatological establishments of the country in the various forms the new methods of organization, management, economy, technology, training etc. are introduced
2. For the last 5-7 years on all the sections of the speciality the new technologies of treatment and preventive maintenance are introduced, training the staff, analysis of out-of-date methods are carried out.
3. Efficiency of using and application of computer science in stomatology has sharply increased. In the country and tens of magazines, newspapers, sites in the Internet are created and issued, annually we have three large All-Russia measures, about 20 regional conferences, 3 large exhibitions, championships of professional skill, the professional National Academy of stomatology etc. are created.
4. The largest in the country voluntary public organization – the Stomatological association of Russia is created successfully functioning and actively protecting and reflecting interests of stomatologists.
5. High social and professional activity of stomatologists, good connections and the mutually advantageous relations with administration, management of regions help to successful development of the speciality.

III. In stomatology, much wider (in tens times), than in any other medical speciality, alternative to the state the market of stomatological of services in the most various forms was developed - paid services, private laboratories, treat-preventive enterprises, individual private enterprises, the rent of workplaces etc. Now this new created market gets the civilized forms. The significant quantily of stomatological of clinics such as "Elites", "Comfort" are created, they completely satisfy the population in this kind of stomatological help. In many cities of the country perfect private stomatological clinics which have won trust and a recognition of the patients exists, they carry out the help to the population at the highest level.

In the country the deficiency of the qualified experts has appeared, they are highly estimated, valued, well known in the country. Especially it would be desirable to note such private clinics as "Omdent" (Omsk), "Megastom", "Professorial", "Club - 32", "Representation", "Stells-Stom" (Moscow), "Biodent" (Ekaterinburg), Stomatological holding "Era" (Voronezh), "Medi" (St.-Petersburg), "Denta" (Novosibirsk), "Smile" (Kemerovo), " Stomatological Centre (Angarsk), children's stomatological polyclinic (Tyumen). The perfect doctors and chiefs of private clinics - Rogatnev V.P., Pyrkov S.T., Novikov V.S., Sobolev S.M., Zaharov A.V., Mchedlidze T.SH., Tretyakov S.P., Sorokoumov G.L., V.V. Trofimov, L.S. Ivanova, G.V. Drobot etc. At the support of the StAR were held a number of congresses of private stomatologists of Russia, which have passed successfully. The serious attempt of overcoming of the certain mistrust between private stomatologists and StAR was made of them. Therefore I want to declare from this high tribune once again exists, that for the StAR no state, no private, no departmental stomatology exists, for the StAR there are only experts of stomatological structure, the members of our corporation irrespective of place, kind of the property and kind of clinic, in which they work. The association is to protect and to reflect interests of stomatological trade, our corporation before the person of a community, state, country, we do it and we shall do it.

It is necessary to note unsufficient activity of the section of private stomatologists. Just on this congress they submit the Charter of the section, but we for a long time were ready to open for them the bill or subbill in the bank, we are ready to support any measures, which they will count necessary to carry out. I consider, that in the section should be large democracity, activity and the level of management should be extended.

It is necessary to note significant volume of public sector in our country. In Moscow more than 1000 private stomatological clinics and studies are now registered, hundreds of them are available in large cities - Nizhni Novgorod, St.-Petersburg, Ekaterinburg, Perm, Rostov. They distract on themselves millions of patients, removing thus loading from the budget and improving conditions of job of state clinics. The positive role is played by them in creating the atmosphere of a competition that appreciably promotes improvement of quality of treatment of the population. But, it is necessary to mention both negative phenomena in this connection. Quite often occurrence of the "underground" doctors of stomatology, having no license on the activity engaged in frank hack-work, deceiting the patients that induce “a shadow” on the whole professional corporation. Are frequent stomatologists, which open private studies, but are not capable for qualitative effective medical job because of lack of experience, knowledge, training. The purpose of our professional corporation is to interfere into such situations to not give or to remove the licenses from these bad - experts, but it is necessary to do it on the base of the law. One of our major purposes is preservation, maintenance and development of image of our speciality, and the above-stated cases directly work against us.

IV. The steady, reliable and convenient order was established in maintenance of stomatology by materials, medicines, tools, equipment for stomatology. Basically, the normally functioning market system of maintenance of stomatology by products, necessary for activity is created. On stomatological market a number of highly professional firms and companies which have won trust of stomatologists reliably function. These firms as "Stomadent", "Circle", "Stomatorg", "Procter & Hambl", "Ajdek", "Amfodent", "Ekradent", "Megastom" etc. A number of factories which produce stomatological products are created and successfully work. They are "Stomadent", "Rainbow - Russia", "Averon", "Vladmiva", "Mikron", "Stomel", "Biont", "the Neva cosmetics". The rough development of trade in stomatology and industry (120 new enterprises are created) has allowed them to be united into Association "Stomatological industry", which is headed by I.S. Bochkovsky. We welcomed the creation of the Association according to the purpose and tasks close to ours and we are ready to work together and we wish it great successes.

However the unpleasant tendencies in this sector have begun in the previous two years.

First, the Association did not mange to win authority neither in stomatological industry, nor among stomatologists.

Secondly, among the most powerful and rich companies delivering the goods for stomatology, the tendency of intervention into internal businesses of StAR has begun.

In particular, at preparation of this congress a numberof the chiefs of the private trading companies have afforded obvious intervention into the businesses of the StAR - they visited the chiefs of large HIGH SCHOOLS, professors, members of RAHS, rendered pressure on them personnel problems of management of the StAR, they offered money for supporting of their offers. They finance the publications in the editions, controlled by them, they aspire to create the structures parallel to the StAR. What is this done for? I consider, that the purpose is one - those tasks and actions, which are carried out by the StAR, do not correspond, and sometimes contradict the purposes of these businessmen from stomatology. They consider, that it is possible to buy everything for money. The part of press, and some perfect editions are also financed by these people. Nothing bad would be in it, if they did not try with the help of such actions not only to interfere with businesses of the StAR, but also to try to subordinate it to their purposes and tasks. Such attempts should receive and they do receive worthy resistance, and we shall not allow to stay in a rank led by such kind of businessmen. Fortunately, we have a large group of the enterprises closely cooperating with the StAR and stomatologists. They are sincerely interested in development of our speciality and do(much) for this purpose. Our joint job gives perfect results, and such job will develop. As to a number of monopolists with high ambitions, StAR will find worthy measures of their suppression, will help their worthy competitors to enter stomatological market of Russia and to cooperate closely with the StAR. In this connection we call all the companies serving stomatological market of Russia, to strengthen contacts with the StAR.

It is especially important now, as the time of drawing up and statement of the standards of rendering stomatological help began. In these standards the recommendations for the equipment and materials will be given which are expedient for using in stomatological practice and on this section we would like to have close contact with firms for drawing up an objective opinion about quality of their production for inclusion them into the standards of M.P.H. of Russia and the StAR.

Thus, a rough development of trade and industrial activity in the area of stomatology, that has allowed has happened in Russia to reduce the break in technologies, which are now used in the West and in Russia, to remove completely need in "the Medtechnics", in the system of the applications and to establish the market relations in maintenance of stomatology by materials and equipment. It is the large merit, first of all, of stomatological specialists of the country, the StAR also of a large group of the enthusiasts, among which it would be desirable to name V.I. Kozlova, F.A. Erusalimov, I.A. Rozhkova, T.SH. Mchelidse, U.P. Smirnov, S.P.Chyev, N.V. Shykin, A.A. Kholodnnyak, P.V. Dobrovolskogo, a collective of the department of materials of CSRIS, N.H. Shakirov and many others.

V. There were positive shifts in training of personnel of stomatological structure, during the last years though in whole this problem is the most difficult, conservative and poorly adapted to conditions of the market.

The positive shifts in the system of stomatological training are connected with development and acceptance of the concept about stomatological education submitted by Moscow State medical-stomatological university (МSMS Y). The essence of it is, that the preparation of stomatologists of general practice as basic central figure with high education let out by stomatological faculties of the country is offered. It means, that all the stomatological faculties should let out only stomatologists of general practice with passage of appropriate additional courses, then they should work during 3 years according to the given speciality, combining in one person the function of therapeutist, surgeon, orthopedist, children's stomatologist. The reception of narrow specialization is possible only by passage of clinical courses. The reception of the sanctions on other kinds of jobs, their quantily will depend on abilities, desire, passage of the appropriate training, but thus he (without passaging additional courses) does not become the narrow expert, but only receives the right on the appropriate kind of activity.

According to this concept the set and release of the dentists should be stopped. Their niche on the average stomatological education on a speciality " stomatology preventive " will borrow " hygienist stomatological ". This speciality and everything, necessary for this purpose, including the documents we have already received.

The realization of this concept in life will require very serious changes both in system of education, and in the nomenclature of the stomatological staff in the structure of stomatological polyclinics. Such reform is necessary, as it follows the interests of our speciality, it puts it on a level, clear and accepted in all the western world. However these transformations cannot be begun immediately. They need to be prepared, to enter gradually and, as a whole, such reform can occupy 20 years so that the early decisions could not bring harm to the speciality and quality of stomatological help to the population. Many difficulties will be called out with training, preparation of workplaces, definition of functional duties and introduction into wide stomatological practice of a post " hygienist- stomatological ". Even one list of workplaces, where he can work, is great enough to understand an opportunity and necessity of its wide using in stomatology. He should be able to work independently (within the limits of the competence) in children's preschool and school establishments, in studies of preventive maintenance and hygiene, in a room of the healthy child. Together with a stomatologist he can work in medical studies, on the system of several armchairs t one stomatologist etc.

What is the destiny of the speciality "dentist" in Russia? Opinion of the professionals is unequivocal and steady - this speciality should leave stomatology. Basically, having supported the concept of development of stomatological education of МSHSU, for this has expressed its meaning to МPH of Russia. However this problem is so difficult, and its roots go down into the history of Russian stomatology, that it is possible to solve it
simply and quickly. On our sight, the decision of it should consist of the following stages (fig. 4):
1. To forbid to open new dental surgery branches in medical colleges - immediately;
2. To forbid new admitting of the dentists into medical colleges - within 1-2 years;
3. To open correspondence branches in 2-3 stomatological faculties of the country (as it was in 60 years) for 2-3 years, for the dentist wishing to receive high education was able to do it;
4. To stimulate conversion training of the dentists on hygienists stomatological (positive experience already is present);
5. To give possibility to work quietly on the places for all dentists having the appropriate diplomas, up to pension age according to the received speciality.
6. To change the system of preparation of the dentists to hygienists stomatological.

However a number of the facts connected, basically, with decentralization and easing of authority as a whole do not allow to realize such plan just now.

It is necessary to note, that the collective of the МSМHSU led by the academician Yshuk N. D., the collective of Tver Medical Academy led by the professor Davydov B. N., the main stomatologist of the Ministry of public health of the Russian Federation,the StAR in May of this year have prepared under the arrangement with the MPH the Board of it, on which all the problems connected with overcoming of mistakes in the nomenclature of the experts of stomatological structure (about maxillofacial surgery, stomatologist-surgeon, dentist), about preparation and introduction into the nomenclature and practical public health services the stomatologist of general practice, a statement of the concept of preparation of the experts of stomatological structure, introduction of a post of a stomatologist of general practice in stomatological establishment, the statement of a Rule about stomatologist of general practice etc. All the questions were prepared, but we do not know why this Board was not held and it is not clear, when it will be hold. By the way, from the decision of these problems depends both preparation of stomatologists in Russia, and a number of the important practical questions of stomatology.

The serious problems still exist in the popstdiploma education. First of all they are connected with bad material base of the faculties of improvement of stomatologists, poor financing, with absence of their own bases etc. Considerable role plays the lack of money resources for business trips of the experts for training. Therefore the existing local bases of the postdiploma education are mainly used now and they often do not give satisfactory training.

The large brake in development of postdiploma in stomatology is the stiffened specifications of hours, courses, plans, they do not coexist to real life. They are based on the orders of 70-80 years, when there were no market relations. All these documents demand reconsideration, but it is really very difficult to begin this work, as the system is very bureaucratic and hard for reforming. The large role, not always positive, plays the greatest lobby of faculties and HIGH SCHOOLS giving postdiploma education, which do not want any changes of the situation and do not work at it.

That is why various courses of improvement of qualification, including private have received wide circulation. They achieve the license for teaching activity and conduct such activity, often on the basis of perfect private clinics, but essential lack of such rates is the absence of the skilled teachers.

The exit from the created situation we see in radical changing of the postdiploma in stomatology with translation of it on independence and self-financing, with introduction into it some paid services, individual training, opening the new faculties (book keeping, management, economy, narrow specialization, technology of R-logia etc.),collecting system of hours of improvement and many other things.

For assistance in solving of this problem the National Academy Of stomatology was founded. One of its purposes was rendering real assistance of improvement of postdiploma education in Russia. For this purpose the necessity of close interaction of this educational organization with official system of postdiploma in Russia - with institutes, faculties, faculties of postdiploma education was meant.It was also meant, that the developed and advanced network of congresses, conferences, symposiums of the StARl will give necessary hours of the postdiploma preparation, which then under the arrangement with postdiploma sections of High SCHOOLS will be represented there, where there will be a finishing phase of preparation with giving the official document.

It was also mentioned (research by Y. I. Chetntsov), that the postdiploma education on 90 % requires expansion, 70 % of stomatologists act for the short cycles of postdiploma preparation, that is why collecting cycles are optimum in this respect. It is not a secret, that the similar niche in the postdiploma education has called occurrence of multiple private courses and even whole institutes and academies, and it was completely normally recognized by stomatologists.

Unfortunately, our offer was understood not correctly, both by some members of the StAR, and as a result of it the chiefs official postdiploma of education yet do not accept this system. But we shall not depart from our offer. We are ready to discuss this problem, to find the common decisions in the interests of our speciality, the StAR and also official postdiploma. All participants of this process should understand – the old system of stomatological postdiploma is insolvent, it is necessary to search for alternatives and criterion here can be not lobby of official postdiploma, but interests of practical stomatology.

VI. The submitted data allow with a high degree of reliability to approve, that for the last 5-7 years in Russian stomatology there was a qualitative technological revolution, in the basis of which lays appearing in the country and intensive development of new materials, tools, equipment, medicinal means and on their basis - new technologies of preventive maintenance and treatment.

The introduction of new technologies into our speciality has 2 different situations with their using. Practically the majority of the experts are acquainted with them, know about their presence, are able to use them and to apply an overwhelming part of the experts. However real opportunities of their application are different in different clinics, territories, private and state sectors of stomatology. It is natural, that using of new technologies requires the information, training, conditions, financing, high level of preparation in the speciality etc. Really all these factors are present only in private sector and in an insignificant part of the state stomatological establishments. That is why we have the situation, when many stomatological establishments, stomatologists, administrations of the clinics are ready to wide application of new technologies, but the deficiency of budget and insurance financing does not allow to buy and constantly use effective technologies. In many cases the exit is in offering of paid services on the basis of the order of the Ministry of public health № 312 (1996), searching of additional sources of financing etc. However really looking at the problem, we see that the most part of the population still receives stomatological help on the basis of out-of-date technologies, materials and equipment, as its significant part is not capable to pay paid services. At the same time, the progress of stomatological treatment is so obvious and great, that the development and gradual introduction of new technologies in all the stomatological establishments occurs according to rules of technical progress and it cannot be stopped. Probably, by integration of a number of the factors - gradual increasing of budget financing, improvement of well-being of the population, gradual making cheaper the cost of new technologies, increasing introduction of them into wide stomatological practice will exist. As positive examples of wide introduction of new technologies into stomatological practice, I want to name a number of actions - application of new anesthetics and kinds of anasthesy, using of tools, gloves, masks for single using etc., using of composite materials for sealing, achievement of aesthetic stomatology, expansion of metalceramics and metalloplastics prosthesis, expansion of application of locking fastenings, rapid improvement of endodontical treatment etc.

It is necessary to mention and serious technological backlog on a numberof problems. Here, first of all, it is necessary to mention about forgetting of preventive maintenance at realization of treatment of the patients. It is shown both by low figures of treatment on addressing to doctors, and by absence of preventive procedures at the reference to various stomatologists. At the same time in this quota the huge reserve of preventive maintenance in stomatology exists(more than 140 mln.visitings per one year).

In orthopedical stomatology articulators are practically not used, which application allows to improve quality of prosthesis. Catastrophic situation with paradontology in the country, exists basically, because of suspense organizational problems of the speciality, weak preparation of the doctors on paradontology, unsufficient qualitative and quantitative preparation of the experts of this section. The preparation, training and equipping of the branches of implantology - the most progressive unit of orthopedical treatment should rapidly increase.

Out-patient surgery develops poorly. The reserves of rendering of effective stomatological help here are very great. The expansion of toothkeeping operations, treatment of roots of teeth, preservation and increasing of the height of the aiveolar branch etc. are especially important.

The unsufficient attention is given to the diseases of temporal-lowerjaw joint, especially to preventive maintenance of these illnesses.

Still considerably lags behind domestic stomatological material-conducting, though lately many serious steps here are made. Here it is necessary to involve the highly skilled scientific staff from a military-industrial complex, academic science.

VII. During the last years the active development of science in stomatology was restored. The annual serious growth of the number of prepared doctors and candidates of science on stomatology is obvious. The basic centres of science of preparation of the scientific staff and the sciences in the country are Moscow (CSIIS and МSHSY), St.-Petersburg, Omsk, Ekaterinburg, Samara. During the last years the number of scientific researches on organization and management of stomatological help, on development and introduction of new technologies of preventive maintenance and treatment, on generalization of clinical experience on various sections of stomatology has increased.

At the same time, considerably, it is possible to say, the quantity of researches on fundamental bases of stomatology - on chemistry, biochemistry, physiology, pharmacy, phatphysiology, phatanatomy, material-conducting, etc.has rapidly decreased. The backlog on these sections is very dangerous to the future of our speciality, as the successes in fundamental sections guarantee the future of preventive maintenance, treatment, inventions, discoveries, advanced technologies. It is very dangerous also that disappearance of domestic schools in the field of fundamental bases of stomatology, material-conducting threaten us. Those few experts, which are still available on the given section, are of pension age, there is nobody to replace them, they have very low salary, also have no support neither from the state, nor from the society. The steps for revival of fundamental stomatology in the conditions, when the state is unable to support it, should make stomatological faculties, enterprises, producing stomatological production, and first of all they are our main HIGH SCHOOLS - МSHSY CSIIS. If not to liquidate this backlog now, it can become insuperable. The unpleasant fact also is, that RАC has revealed the infringements about assignment of a rank "professor". 7 professors, including one on stomatology – A.S.Tishin from Rostov are deprived of it.

VIII. I want to make a stress also on some complex, difficult, negative problems and tendencies in our speciality.

First, it is unsolved questions with the future of development of stomatology in the country. Creation of large public sector, it’s intensive development, occurrence of a competition between state and not state sectors, small sizes of payment for work, difficulties in children stomatology and many other problems require knowledge of the strategic purpose - what stomatology is necessary to the state, what will be a development of public health services, whether the privatization in public health services will be admitted, or not, what will be it’s mechanism, how will be assisted children and socially unprotected groups of the population? The public health services and stomatology, in particular, require the answer to these questions, the long-term planning of development of the speciality, attraction in it the additional capitals, creation of interest for the experts in development of stomatological establishments and enterprises is impossible without them. These and other questions for a long time stay on the schedule of the day, are asked from various tribunes, excite the population and the specialists of public health services, are put at Pirogov congresses and at Duma sittings, but already during more than ten years there is no precise politics and economy in this question. I think that the Government of Russia underestimates all gravity of absence of precise strategy in the development of public health services. On our mind, this factor is one of the main political, economic, psychological, personal reasons constraining development of public health services. Look at the monstrously swelled bureaucratic staff of management of public health services. Even at the time of Soviet power there was nothing similar. And you see they should be engaged by something, should earn money and considerable ones. How is it possible? Only according to the “law”: "not to let", "to coordinate", "to forbid", to monopolize. I am sure, that effective functioning of public health services having this monstrous insatiable bureaucratic staff of management is impossible and also any strategy of development of public health services should be inevitably connected with strengthening of the rights of medical establishments and enterprises, mechanism of their effective protection from a strong-willed management of higher instances, both active reduction of quantity and rights of the staff of management. In this respect the concept of self-management of medical establishments sounded at the previous Pirogov congress, has the certain attractiveness, but it should get the legislative rights.

Secondly, the major problem in public health services still remains a significant deficiency of budget financing. It is so great, that does not allow the system of public health services as a whole to function effectively, though in separate regions (Moscow, Kemerovo, Perm, Ekaterinburg, Tyumen) it is solved quite well and allows to function and to develop public health services and stomatology. As always, in many respects financing of public health services and it’s condition, and of stomatology in particular, depends on the person - the person of the regional chief, chiefs of public health services, main stomatologists, main doctors. In many cases thank to their efforts it becomes possible to achieve an acceptable level of financing of stomatology, unfortunately, such picture is not typical. In the majority of regions stomatological establishment successfully function only using various sources of financing - budget means, means of FOMI, paid services. Thus in the most number of cases the basic part of means comes from paid services - 40-80 %, and that allows stomatological establishments to function normally. These means are adressed to increasing the salary of the employees, on purchasing of high-quality materials and tools, equipment, repair of premices, other purposes.

Thus, the management due to the financial means received from paid services, has managed:
1.To survive in the conditions of huge deficiency of budget financing.
2.To save the premises and buildings belonging to the state, which has not allocated any means for maintenance of the property in a satisfactory condition.
3.To improve material maintenance of polyclinics, to update the equipment, materials.
4.To introduce new technologies of preventive maintenance and treatment, to train the experts.
5.To increase the salary of the employees of stomatological establishments.
6. The part of means was spent for free-of-charge reception of children and other groups of the population, which required treatment with application of higher technologies.

With the account, that all this was executed at the expense of own means, earned by collectives of polyclinics, which could be spent for absolutely other purposes, the job of the main doctors and stomatologists on paid services can be estimated as performing by them the civil debt through maintenance of stomatology, savings of it from disintegration and crash, when the state was unable to fulfill the obligations on preservation and maintenance of the property, belonging to it, as stomatological establishments. Now one more document -a letter of the Main adviser of a tax service of Russia V.V. Gusev from June 17, 2003 has appeared.

According to it, the money given by FOMI for treatment and preventive maintenance, are not target, in this connection they are exposed to the taxation. The situation concerns both FOМI itself, and the establishments using the means of FОМI. In Moscow some inspections already are trying to realize this document. It turns out, that some people try to plunder poor public health services also even more.

According to our initiative a number of outstanding lawyers have analysed this document and have found it illegal. The conclusion on it and how to behave, concerning it in the relations with tax inspection on the given problem you can take in the StAR, it will also be placed in a site of the StAR. I also would like to say, that for prevention of the similar phenomena we should more widely use court and judicial decisions. Don’t be afraid of it. If you do not want to do it yourself- charge it to the staff of the StAR, but the financing is necessary.

In the last section of the report I would like to touch upon some prospects of development of our speciality, badly used opportunities, the reserves, professional and public activity of stomatologists.

First of all I would like to say about the problems of personal activity of the chiefs of stomatological service and stomatological establishments of the country.

What is increasing of activity of the chiefs of the service of all ranks?
1. Establishment of good relations with the management of the region, with the local chiefs of public health services and public.
2. Creation of authority among stomatologists of the region, understanding their needs, improving the conditions of job, growth of salary, opportunities for rest.
3. Constant informing about all the news in stomatology, about the decisions of the Ministry of Public Health of Russia, the StAR, about advanced experience of job, new trends and tendencies in the speciality.
4. Skilful, not only on the basis of personal sympathies and relations, selection of the staff in the region, educating of the staff.
5.Admitting progressive transformations in the speciality, introduction of the new organizational and stomatological technologies in practice, training of the experts, purchasing of the equipment, promoting professional growth.
6. Business and public activity, holding conferences, participation in congresses, symposiums, invitations of the experts, attraction of stomatologists to participation in congresses, organization of subscription on stomatological editions.

Among you, our colleagues, there are many stomatologists-chiefs responsible for fulfilling these requirements. I mean G. M. Ziborova, S.А.ЗZlotnicov, V.I.Polyev, М.V.Dynayev, L.М.Rаbinovich, Y.I.Маksimovsky, G.I.Lohmotko,Т.А.Gulyaeva, А.V.ЦTsymbalistov, А.I.Bоgatov, G.S.Ivanova, V.V.Trofimov. Unfortunately, among our colleagues – the chiefs there are those, who put their personal interests above service, they work for development of the speciality, it’s image a little. Stomatologists in their regions do not know about activities of the StAR, about it’s measures, they do not promote active work of the Association, not attentively concern to the growth and selection of the staff.

It is necessary to all the chiefs of the service to read much, to be engaged, to attend thematic seminars, to study all new documents. Some of the chiefs find an opportunity to accept on job a lawyer, an economist, a manager or to work with them according to the contract. A number of the chiefs in nowadays conditions aspire to receive the second, the third education. All these measures substantially allow to adapt better the service, the establishment, the personnel for new administrative, political, legal, economic conditions of job in stomatology. Very important is adequate understanding of the problems of the professional responsibility, professional riscs, psychology of job with the patients in new conditions.

I suppose, that within the new three-years period the new President already on the basis of the documents, developed by us, will begin activities on checking of the work of separate Associations, their efficiency, their interaction with the stomatologists and other problems.

Very serious problems stand in connection with the nomenclature of the staff and their preparation. It is necessary, at last to solve the problem with the maxillofacial surgeon, surgeon - stomatologist, with preparation and introduction in the nomenclature of posts of stomatologists of general practice, with the introduction of the medical experience for the workers of private stomatological establishments and a number of other problems. However the basic task is the drawing up and acceptance of the long-term, deep, serious Program of assistance to the population, to our patients. We seldom speak about this problem, but it does not disappear, and in the conditions of the market - requires daily attention and working at it.

In conclusion with a pain in heart it would be desirable to mention the image of our speciality, as it is perceived till now by overwhelming part of the population.

1. The population of the country and the stomatologists have reconciled with continuous stomatological illnesses and consider them as inevitable evil.
2. The population of the country still connects stomatology and stomatological treatment with troubles and pain as inevitable elements of stomatological treatment.
3. At the population of the country was brought up and continues to be brought up the perverted image of stomatologists as an expert, which though he is necessary for preservation of health, but visiting him is always connected with troubles of economic, psychological, pain and personal character.
4. The usual philosophy of the relations of stomatologists with the patients suits no more than 20-25 % of the last. About 40 % do not visit stomatologists in general, and about 40 % - only at emergency.
5. The usual relations of stomatologists with children are especially unpleasant. The negative relation of the children to stomatoiogists often results for them as a catastrophic condition of teeth for the whole life.

Now situation is changing, but very slowly.

The significant part of fault stated above lays on stomatologists:
1.Unsufficient sanitary - hygienic training and education of the patients. Stomatologists are engaged in it very little.
2.Often there is no psychological approach to the person of the patient and its motivation on preventive maintenance and treatment is unsufficient:
a) The dialogue of stomatologist with the patient is extremely narrowed and on 70-80 % consists of 5-10 standard phrases;
b) stomatologists very seldom explain the patient essence and reason of his disease, preventive maintenance and treatment and opportunity of choice, do not ask the consent to realization of treatment or manipulations, do not speak about variants or alternative methods of treatment and preventive maintenance, and as a result - there is not enough motivating of the patient on treatment, use an arsenal of anesthesiology unsufficiently, quite often neglect not only sensations, but also the personality of the patient, that in many cases inevitably conducts discontent of the patients, conflicts, complaints etc.

There is no philosophy of our speciality allowing the population to perceive correctly, to estimate and to concern to the person and the job of stomatologists, to stomatological diseases, to the role of tooth-jaw system in their life and health, that in a result conducts catastrophic consequences. Neglecting of stomatological preventive maintenance and treatment conducts to infringement of choice and reception of food, feeding as a whole, aesthetics of the face, normal dialogue, well-being in life and infringement of quality of life of our patients. The population does not understand and does not know, how much the quality of it’s life depends on a condition of tooth-jaw system, primitively perceives the role of stomatologists, stomatological treatment and preventive maintenance in their life, incorrectly concerns to treatment of teeth, their removal and prothesis. Stomatologists and the speciality as a whole do not apply necessary efforts to creating among the population the correct image of a stomatologist and attitude to their tooth-jaw system, do not expect consequences of it’s infringement.

Thus, the relations which exist today between the stomatologists and the population create at a significant part of the population the deformed representation about stomatology, make an image of a stomatologist unfriendly, a part of inevitable evil in the life, do not motivate the patients on preventive maintenance and treatment, do not perceive the infringements of tooth-jaw system as actual deterioration of quality of their life.

A long-term scientifically proved program on this problem is necessary for the work with population. Our country never had such program, and it’s creation demands huge work. But, at the same time, its creation and the performance will result that those 80 % of the population, which according to the personal motives do not want to contact to our speciality, will leave gradually “a shadow” and for us the problem of the patient will disappear. This task now is the most important in stomatology and for it’s decision is necessary to regret neither time, nor forces and it’s fulfilling depends on each of us. The radical reorganization of our philosophy is necessary for this purpose, and then the philosophy of our patients will change also.

At the head of the new approach there can be the following principles:
1. We for the patients, instead of they for us.
2. There are no bad patients.
3. Teeth of the patients - our teeth.
4. The patient should be fond of stomatologists.
5. Children -is future of our stomatologists.
6. It is necessary to talk to the patient. He should understand and accept the purposes of the stomatologist.
7. The patient should understand, that the loss of teeth is an infringement of all basic aspects of his life in qualitatively worse direction
8. Stomatologists should live and work adequately, and the patient should understand it.

In conclusion, let me thank you for the trust, rendered by you, within 3 years to have honour to represent the interests of our speciality, sorry for mistakes in job or not fulfilled tasks, for insults and disappointments brought to you.

09.09.2003.
Moscow