Goodbye, Soviet dentistry: Russians take tooth care seriously

MOSCOW – Yekaterina Tkalenko brushes her teeth three or four times a day – especially after tea or coffee – has them professionally cleaned twice a year and carries floss as if it were as vital as an inhaler. She recently spent nearly $1,000 to have her teeth whitened.

“When I look at a person, no matter who it is, the first thing I look at is his or her teeth and their smile,” said the 34-year-old Muscovite, who works in the tourist industry. “When I see good teeth, I think this person has more chances in life, and he’ll be more successful than a person who has bad teeth.”

In a nation where, a generation ago, a trip to the dentist happened only when a tooth hurt, families shared toothbrushes, and dental floss was but a curiosity, oral hygiene is the new vogue. And good teeth – or at least straight, white ones – are as important a part of one’s image in wealthy cities such as Moscow as the proper shade of lipstick or the perfect pair of heels.

Soviet-era teeth were notoriously bad. In 1991, the average 35-year-old had 12 to 14 cavities, fillings or missing teeth, said Vladimir Sadovsky, vice president of the Russian Dental Association (not counting wisdom teeth, adults have 28).

Toothpaste meant whatever was available. Toothbrushes had hard bristles that cut the gums, sometimes doing more harm than good. Dental technologies were years behind those of the West; the 17-year-old who was crowned Miss U.S.S.R. in 1990 flew to Philadelphia the same year to have the gap in her teeth closed and a few cavities filled.

But the domestic oral hygiene market has exploded in recent years. Private dental clinics in central Moscow, which have new equipment far surpassing the quality in still-underfunded municipal clinics, are practically around every corner. Pharmacy shelves are stocked not just with the latest blends of imported Colgate and Aquafresh, but yogurt-based paste and paste in flavors like Jazz of Lemon Mint. There are also anti-plaque rinses, fresheners, round flosses, flat flosses, whitening strips, whitening gels and whitening plates, among other things.

According to industry estimates, sales of oral hygiene products in Russia have nearly doubled since 2000. From 2005 to last year, Russians boosted spending in the sector by an estimated $170 million, to $1.43 billion, according to the online newsletter Cosmetics in Russia, citing statistics from Euromonitor International. More people are willing to purchase high-end items, including electric toothbrushes and Rembrandt toothpaste, which can cost as much as $14 a tube. Tkalenko, a self-described oral hygiene addict, uses another foreign brand that goes for $19.

“Now the population is well aware of one fact: If you want to be successful, say, in business, you have to have a healthy smile,” said Andrei Akulovich, a dentist in Saint Petersburg who is editor of the newspaper Stomatologiya Sevognya, or Dentistry Today.

In the 1980s, he said, federal statistics showed that one-quarter of households in Russia had only one toothbrush. And even now, amid the tooth obsession sweeping some cities, the average per capita spending on toothpaste – per year – is the equivalent of $3.80. That still means a lot of tooth decay.

Still, it’s not unusual for women, and even some men, to keep floss with them. And, in large part because of an education campaign in schools, the importance of good oral hygiene is being drilled in at a young age: In a recent art contest in which children illustrated their view of the Russian president, a 9-year-old girl drew a pajama- and slipper-clad Vladimir Putin brushing his teeth in front of the mirror (alongside a toilet made of gold).

Fluoride in the water still is viewed with skepticism here; one Moscow dentist said it causes people’s teeth to turn brown, and a major water supplier stopped selling it last year because, the company said, clients could get enough “from food” and “in the air.” Still, the Russian government has funded the fluoridation of milk in some municipalities, and with good result. In the southern city of Voronezh, the average 12-year-old had nearly four cavities in 1994, the year the fluoridation campaign began, said Sadovsky. By 2004, the number of cavities was one-and-a-half.

In the United States, by contrast, nearly 60 percent of those from 6 to 19 years of age have never had a cavity in their permanent teeth.

“In 1991, they didn’t know what a dental hygienist was. They didn’t know what dental floss was,” said Giovanni Favero, an American dentist who trained Russians in the early days after the collapse of the Soviet Union and founded the American-Russian Dental Center in central Moscow, where he has worked for 12 years. “Dentists never told a patient to come if it didn’t hurt. Now the general population has learned there’s a different way.”

Favero, 69, became acquainted with Russian dentistry in the early ’90s when he saw Russian exchange students at his practice in California. One student, who had recently been to a dentist in Russia, came complaining of a toothache. He had 21 cavities, Favero said, still with a measure of disbelief.

Favero has seen it all in Russian mouths. An X-ray image once showed a patient’s broken tooth had been reattached with something that looked suspiciously like a paperclip. More recently, he removed two teeth that gave new meaning to the word loose; they were barely hanging by the roots. In jest, Svetlana Chekalina, a dental assistant at the clinic who has lovely teeth herself, suggested he pull them out by hand.

Favero and other dentists say the dental craze, which like much here is largely a thing of the well-to-do, is not all for the good. Many clinics are owned and operated not by dentists but businessmen who care far more about a healthy bottom line than they do healthy teeth and gums.

Favero knows of one dentist who did 29 implants on a patient who needed half as many. The American Dental Center, which lures expatriate clients both with its name and its ads on the front page of the English-language Moscow Times, once told a patient who was impeccable about her oral hygiene that she had 14 cavities – even though she had none.

“Your smile is a business card,” said Antonina Shevtsova, a dentist at Masterdent, the largest dental chain, which has opened 30 clinics in the Russian capital since 1996.

Most patients at her clinic, which has a trendy vertical fish tank adorning the waiting room (without fish) and computer screens and keyboards in the examination rooms, wish to have their old fillings or crowns replaced with new, better-quality ones. Some want implants. Every second patient asks for whitening. Most popular are veneers, thin caps of porcelain that fit over a tooth – like a fake fingernail – and can cover up stains or chips. They run about $570 a tooth.

Akulovich, of Dentistry Today, cautioned against all the whitening, especially that done at home, which can damage gums. He wants Russian teeth to become not just whiter but healthier.

“White teeth,” he said, “don’t necessarily mean healthy teeth.”