Article: “Dentistry is evolving at the speed of a space shuttle”

Äripäev TU+, 10 August 2018

Dental care services are expensive in Estonia, but the whole undertaking is no less expensive for the owner of the clinic who has committed to providing high-quality and fast treatment services. The founder and manager of Lumen Dental Clinic, Dr. Merike Immato speaks honestly and openly about what it means to be both the head of a modern and deep-rooted dental clinic and a specialist whose head, hands and heart have to work together.

Merike Immato,
dentist and manager of Lumen Dental Clinic

Firstly, it means saying YES to all professional challenges. It requires a lot of time, dedication, courage and results orientation. “Life means movement. That is a fact. How can we think that a doctor should now move towards improving their skills or the clinic towards new developments? They go hand in hand. If there is equipment and medical products that enable development and create value, then there must be doctors who know to use it,” she expresses.

Of course, being open to new opportunities and the desire to move with the times will also mean investments and rigid calculations. “Excluding manpower, the construction of a clinic, including equipment, will cost at least half a million euros,” says Dr. Immato. “And that will not come from the taxpayers’ pocket.”

Dr. Immato, who has built a modern clinic, says that a diploma in dentistry is just a prerequisite for holding the title of a doctor, but the decision to become an expert must be made separately. “With the diploma, you are given a huge amount of credit, the credit of trust, the maintenance of which is a great honour and obligation. The notion that your mission is to serve the patient should be clear to you before you even start studying medicine.”

Both failures and successes are part of the experience, so do not get discouraged. “Every day we must exceed our own expectations in order to really apply the theoretical knowledge,” she believes. “Since dentistry is a handicraft that requires the help of technology, your knowledge will never be complete, it is an endless journey that takes you out of your comfort zone and makes you face your fears.”

One day dentistry
Dr Immato is most pleased with the introduction of digital dental technology which they have been practising at Lumen Dental Clinic for close to six years, being one of the first in this field in Estonia. With use, they have gained a lot of experience which is extremely valuable. Patients do not have to suffer and wait weeks for the restoration of one tooth, with Cerec CAD/CAM technology, it is possible to get a new tooth in just one day.

However, according to the manager of the dental clinic, unique and expensive equipment should never be introduced just to gain a competitive advantage, it should be done because of your own inner curiosity – only then it will start to create real value. Dr. Immato can safely say that the introduction of digital technology has not only paid off in economic terms but also in terms of treatment processes. Development and progress is what really matters! And patients can also value this.

As important as state-of-the-art medical and diagnostic devices are, the establishment of mutual trust with the patient is just as important and begins with sincere care for the patient, professional attitude towards work and the ability to practise these in your daily work. Dr. Immato clarifies what she means by this: confidence in decision-making, calculated analysis, watertight treatment plans, offering alternative solutions, listening skills, empathy, understanding and acknowledging the patient.

At the same time, it is important to remain concrete, non-judgmental of the patient’s decision, and friendly but not too familiar. If you take too much of the patient’s wishes into account and ignore your own opinion as a doctor as to what the best treatment is, it will quickly come back to bite you. Difficult, isn’t it?

What makes dental care so expensive?
When asked what Dr. Immato thinks about the common belief that dentists are making huge profits off the backs of patients, she says the following: “Every service is as expensive as its provision. We should be extremely grateful and glad that our dentistry is world-class, high-quality, and fast. Treatment options and solutions cannot be so stuck in the stone age that the dentist is ashamed to be a dentist.”

According to Dr. Immato, what makes dental care so expensive for both the clinic and the patient is the fact that dentistry develops at the speed of a space shuttle. “Without modern medical and diagnostic devices, without sterilisation equipment, without the tools and opportunities to raise patient awareness, it is not possible to talk about a modern treatment centre. We cannot and should not!” she says, adding that only then we can get a result that is excellent, offers satisfaction and is long-lasting.

A dental clinic that offers high-quality service has an endless set of quality requirements that must be followed in their daily work. No mistakes or concessions can be made.  To name just a few: the treatment must comply with all the standards in every sense (sterility, quality, methods, solutions, four-handed dentistry, the acquisition of new knowledge and skills, etc.); the premises must comply with certain rules (dimensions) and be covered with a layer of radiation protection, e.g. the 3D X-ray room has specific requirements; the purity of water must be ensured, as appliances that require water are very sensitive; ventilation and air circulation in different rooms is very important, especially in the sterilisation room and compressor room; there are also numerous prerequisites for data storage, etc.

In addition, all kinds of permits and licences, and documents for covered loans and leases for the purchase of the clinic and equipment, rent paid and utilities should be available. The staff should also be remunerated according to everyone’s contribution and skills. State taxes also must be paid, taking into account that payroll constitutes a very big part of the company’s turnover.

Modern means of communication, such as patient programmes along with SMS notifications for the patient are all expenses for the company. And for accounting to be in order, that service must be outsourced. The company website needs constant updating so that it is relevant and useful. Another luxury – we are available to patients until late in the evening.

In conclusion, it is important to minimise mistakes and maximise creating value.

Doctors must have a sense of their mission

According to Dr. Immato, a whole series of lectures is needed to answer what skills a very good dentist needs in addition to professional training. She immediately says that she does not want to be an employer of a lazy doctor with low motivation. “Manual dexterity skills can be learned, but personal skills cannot.”

According to her, a good doctor has a special kind of determination, patience, a sense of reality and a need to give. A good doctor is a hard-working, forward-looking person. They are constantly learning and developing their manual dexterity and information competency. They have a spark in their eye and know that life-long learning is important to keep gaining knowledge – both professional and everyday.

A good doctor also values the team, the work of colleagues and manage their ego. They analyse their mistakes and can lead others and themselves. They are ethical as a person and as an expert. They can be straightforward but caring at the same time. They know how to determine the actual current situation and offer solutions. Most importantly – a good doctor is a person with a sense of mission!

Estonians’ awareness of oral hygiene varies
There is nothing too good that we can say about the awareness of oral hygiene of Estonians, as the knowledge varies greatly. “I appreciate people with a high level of awareness and who take responsibility for their health; however, there are people who think that they know everything; there are people who only trust what they read in online forums; and there are people who still do not care about oral health at all,” Dr. Immato considers.

But broadly speaking, she says: “As awareness increases, so does the demand for services and results.” That is why she believes that any increase in awareness is very welcome because it will also force medical institutions to leave their comfort zone. “Awareness is a luxury that you cannot buy or swallow without first having an open mind,” she points out.

With 31 years of experience in dentistry, Dr. Immato mentions three dental and oral diseases that are now more widespread than they used to be. For example, children who already have teeth have developed caries due to long-term breastfeeding. Breastfeeding has become like a safety blanket for children.

The use of chewing tobacco causes oral mucosal diseases. She also mentions increased tooth wear which may be due to stressors or changes in the characteristics of food products.