The newest signal of Greece’s decay: kids’s enamel

Greek children now have some of the worst dental health in Europe. It is a measure of the country’s economic depression, and could be storing up more problems for the future


IOANNINA, Greece – It was the primary time in weeks Anthoula Papazoi had cooked meat. She had stewed the reduce of beef, donated by a good friend, on a low flame all morning. However now the casserole sat untouched, as Papazoi fretted about her 13-year-old daughter Nikoleta’s tooth.

– lengthy black hair, electric-blue nail polish – emerged from the bed room in shorts and a tank prime. She had slept a lot of the day and was late for an appointment for an extended overdue root canal process on a backside entrance tooth.

“Do now we have painkillers?” she requested, rummaging by way of a kitchen cupboard. “I’m going loopy.”

“No, we don’t. Go prepare for the dentist,” Papazoi mentioned.

“Do now we have milk?” Nikoleta requested.

She pulled at a chunk of masking tape that held closed the fridge door, reached in and grabbed a carton of milk. In a tall white mug she blended the milk with chocolate powder and 5 spoonfuls of sugar, after which slumped right into a chair.

“Rise up and go,” her mom ordered.

In few locations are the injuries of Greece’s financial melancholy extra evident than within the mouths of the nation’s kids. By most indicators of dental well being, Greece is likely one of the unhealthiest locations in Europe. The variety of Greeks 16 years or older reporting unmet dental care wants was 10.6 p.c in 2013, in line with Europe’s statistical company Eurostat. That compares to a European Union common of seven.9 p.c.

Dental issues are notably acute amongst kids, in line with a current survey by the Hellenic Dental Federation, a supervisory physique. And the monetary disaster has made issues worse. Within the decade as much as 2014, 60 p.c of all dental issues in 15-year-olds have been left untreated for a minimum of a 12 months, up from 44 p.c within the earlier decade. Virtually all of the five-year-olds surveyed – 86.eight p.c – suffered dental issues that had not been handled, the survey discovered.

“Enamel are sadly thought-about a luxurious,” mentioned Niki Diamanti, a dentist who works at Hatzikosta Hospital, one among two public hospitals within the northwestern city of Ioannina. “If, 5 years in the past, individuals went to the dentist annually, now they go each 5 years.”


In Greece’s case, the scenario is outstanding as a result of the dental issues aren’t primarily brought on by modifications in every day oral hygiene, consultants say. Quite, kids are creating tooth illnesses for causes associated to the nation’s six-year financial melancholy.

First, cash woes have led to fewer dentist visits. Disposable incomes in Greece have shrunk by about 30 p.c since 2009. Greater than 1.2 million Greeks – one in 4 working-age individuals – are unemployed. Forty p.c of youngsters dwell in poverty, in line with the U.N kids’s company UNICEF, greater than in locations equivalent to Chile, Turkey and Mexico.

As effectively, the publicly funded system of free or low-cost medical care that hundreds of thousands of Greeks relied on for many years has shrunk, largely due to public spending cuts demanded in trade for the 326 billion euros in monetary assist Greece has obtained since 2010. Per capita well being spending fell 9 p.c a 12 months between 2009 and 2012.

The consequence: Greater than eight p.c of Greeks skipped dentist visits in 2013 as a result of it was too costly, effectively above the 5.1 p.c European common, in line with Eurostat.

The monetary disaster has additionally pushed a surge within the consumption of low cost, high-sugar meals, dentists say. After dipping for a few years, gross sales of sugary snacks at supermarkets picked up once more in 2013, in line with Euromonitor, a shopper items analysis group.


Greece’s unhealthy enamel could also be storing up issues for the longer term. Research around the globe have recognized hyperlinks between unhealthy oral well being and continual diseases equivalent to cardiovascular illnesses, the world’s primary killer. Extreme gum illness is related to diabetes and coronary artery illness, in line with a number of medical research. Scientists are nonetheless debating whether or not dental issues trigger different well being circumstances, or are merely related to them.

Medical doctors and scientists have lengthy related dental well being with financial improvement, largely as a result of good enamel are correlated with entry to schooling. Ache from dental illnesses retains kids in lots of creating international locations from their research, in line with the World Well being Organisation.

Paula Vassallo, chair of a European foyer group that promotes oral well being, mentioned kids struggling tooth ache usually sleep and eat poorly, which may damage how effectively they do at college.Kids with tooth ache can undergo malnutrition and low ranges of vitamin D, she mentioned.

“Should you’re in ache like that you could’t sleep, you possibly can’t eat effectively, you possibly can’t communicate, you possibly can’t carry out,” says Vassallo, whose Platform for Higher Oral Well being in Europe receives funding from dental care companies. “The impact on Greece goes to be enormous, not simply when it comes to the financial influence, but in addition the well being, high quality of life and employability of individuals.”

Within the Papazoi household, it’s not solely Nikoleta who has suffered. Anthoula Papazoi’s eldest daughter, Elli, 16, was rushed to hospital final 12 months due to ache from a pus-filled tooth, solely to be turned away as a result of there was no dentist on name. Papazoi’s eldest baby, Christoforos, 17, had a tooth stuffed lately. And Anastasis, 5, barely averted a root canal earlier this 12 months.

Papazoi, who runs a small enterprise hiring out cleaners and nurses, stopped contributing to social safety three years in the past when she might not afford to. That meant the 44-year-old joined an estimated 2.5 million Greeks with out entry to public well being care. She now owes 900 euros to 4 totally different dentists.

The household’s struggles could be seen within the contents of their fridge. 5 years in the past, it was stocked with cheese, meat and greens. In the present day: celery, a little bit of shredded pumpkin and home-churned butter Papazoi’s dad and mom ship from their village. The household weight loss plan is excessive in carbohydrates and sugar. Most days they eat rice, pasta, or often lentils.

“I at all times used to purchase fruit however now you possibly can’t purchase fruit. It’s too costly,” mentioned Papazoi. “I’d by no means think about I’d attain this level: working round from day to nighttime and never even having the ability to present the fundamentals for my kids.”


Diamanti, the dentist, sees comparable struggles virtually day by day. The 42-year-old studied in Athens and in Britain, earlier than transferring to Ioannina in 2010 after she married an area.

By that point, the town of 112,000 close to the border with Albania was reeling from Greece’s financial downturn. The capital of a mountainous northwest area, Ioannina has a big scholar inhabitants and produces feta cheese and spring water. However it’s poor. Per capita output in 2012 was simply 12,000 euros, down from 15,000 in 2008 and a 3rd decrease than that of Greece as an entire, in line with the most recent knowledge.

The downturn has damage native individuals’s enamel. The prefecture across the metropolis has the worst charge of five-year-olds with caries, or extreme tooth decay, in Greece, in line with the Hellenic Dental Federation survey.

“Folks have surrendered, psychologically. They not care about their well being, together with oral well being,” mentioned Yorgos Papazaharis, head of the regional unit’s dental affiliation.

In consequence, he mentioned, dentists are struggling to maintain their practices alive. He estimates that the price of dental care within the area has dropped 35 p.c over the previous six years. Many dentists now deal with sufferers free of charge.

On the identical time, Worth Added Tax on medical provides equivalent to cotton wool or gauze has risen from 9 p.c to 13 p.c in the course of the disaster. VAT on different provides utilized by dentists is as excessive as 23 p.c because of Greece’s bailout commitments.


Successive governments have tried to paper over the cracks. Final 12 months, as an example, the Greek authorities gave uninsured residents free pharmaceuticals and free care, together with dental therapy, in public hospitals. And this April, the federal government of leftist Prime Minister Alexis Tsipras scrapped the 5-euro price to entry public hospitals. However the nation’s worldwide collectors have ordered the federal government to reinstate the price or give you one other strategy to make up the misplaced income.

As a result of so many individuals discover non-public care unaffordable Diamanti says she now typically sees as many as 20 sufferers in sooner or later. At non-public practices it prices 30 to 50 euros for a filling, 150 euros for root canal therapy, and 200 euros for a crown. For Greeks with nationwide medical health insurance, therapy in a public hospital prices a lot much less. However solely two of 199 dentists in Ioannina take such sufferers, that means appointments can take months to safe. Many individuals be a part of the lengthy traces at hospital emergency rooms, or wait till a rotting tooth must be pulled, Diamanti mentioned.

Sitting behind her desk, she rubs her aching fingers and wrists. One of many causes for unhealthy enamel is cultural, she mentioned. “Folks in Epirus develop up with the concept candy issues make us really feel higher. They put honey on kids’s dummies (pacifiers).”

Now lots of her sufferers can’t afford fruit and greens, she mentioned, in order that they flip to processed meals. “It’s the sugar. Sugar is the meals of the poor.”



In her kitchen, casserole on the range, Anthoula Papazoi particulars her well being issues. A sturdy girl with auburn hair and neatly trimmed fingernails, she has a respiratory illness that’s set off by cigarette smoke, sturdy perfumes or the scent of meals. She struggles to make it up the steps to her two-bedroom flat in a neighbourhood of low-rise buildings.

Papazoi’s small enterprise often earns her between 30 and 60 euros a month; some months she makes nothing. The state pays her a profit. Final 12 months, a household with 4 kids or extra acquired three,900 euros a 12 months, although that quantity has now been reduce to 2,400 euros. Papazoi says she paid greater than half of final 12 months’s profit again in taxes. The remainder goes in direction of the 200 euros month-to-month lease for her 70 square-metre residence. Papazoi says her month-to-month bills can attain about 1,000 euros. She has disconnected her house cellphone and owes a whole bunch of euros in unpaid water and electrical energy payments.

Earlier than Papazoi divorced, her household was financially comfy. She labored in the course of the day, shopped within the late afternoon and cooked meals at night time. There was at all times sufficient meals and garments, she mentioned, and the youngsters acquired new sneakers once they wanted them.

Now the hallway of her residence doubles as an workplace, with overflowing bookcases, unpacked cartons and a desk stacked with columns of papers and folders. The paint has begun to chip off the mustard-coloured partitions of the lounge, which is dotted with vases of plastic flowers. Papazoi mentioned her ex-husband, who couldn’t be contacted for this text, doesn’t assist with prices.

Her two women share a room, which is overflowing with bins and garments. Anastasis and his older brother Christoforos sleep on a bunk mattress of their mom’s room.

Papazoi bakes her personal bread with flour that kinfolk ship. Although her kids crave milk, she will be able to not often afford it. She makes up for the misplaced calcium with yogurt. For breakfast, she typically splurges on chocolate croissants.

Angelos Priovolos, who has labored on the enamel of three Papazoi kids, mentioned the household’s issues have been typical. Folks have stopped going for check-ups for concern their dentist will discover issues they will’t afford to repair.

That occurred final 12 months when Elli started complaining of ache in a again tooth that had full of pus. At first, her mom informed her to attempt to ignore it. She gave her daughter paracetamol and anti inflammatory medicine. When she ran out, Papazoi informed Elli to swish tsipouro, a Greek brandy, in her mouth.

The nights turned insufferable. Papazoi and Elli quarreled. That woke Nikoleta. Exhausted, each women would sleep their summer time days away.

One afternoon, when Elli’s ache turned an excessive amount of to bear, Papazoi informed Christoforos to take his sister to the hospital. However the kids have been turned away as a result of there was no dentist on name, she mentioned.


“She (Elli) phoned and started screaming at me, saying, ‘Are you kidding me? Why did you ship me right here?’” recalled Papazoi. Determined, she despatched her daughter to Priovolos, a personal dentist, who offered fundamental therapy. Later, after the swelling had subsided, Elli had the tooth stuffed.

This summer time it was Nikoleta’s flip. At some point in August, the roof of her mouth and a part of her throat started swelling from her contaminated tooth. Papazoi didn’t trouble with hospital however took Nikoleta to a personal specialist who opened up the tooth and drained the pus. Value: 200 euros, plus additional to take away a cyst that had shaped on one other tooth. Priovolos mentioned such cysts are often present in individuals over 60.

On the night of Nikoleta’s subsequent appointment, because the household awaited her return, Papazoi chopped pears despatched by her mom and positioned them on a plate on the kitchen desk. Anastasis grabbed a yogurt dessert with chocolate flakes from the fridge.

“You by no means purchase what we wish,” joked Elli as she walked into the kitchen, ignoring the pears.

The casserole sat, chilly. Papazoi’s cell phone rang. It was the dentist. She listened after which hung up. “One other 100 euros,” she mentioned, leaving the room.