The cornerstone of unity

LEGAL ACTIONS 
The first European legal case against the tobacco companies began in Finland in 1988. The plaintiff was 
pensioner Pentti Aho, who started smoking in 1941 at the age of 16. 
The product liability suit against Oy Rettig Ab and Suomen Tupakka 
– BAT Nordic Oy was based on the right 
to receive compensation because the companies had manufactured and sold a product that is hazardous to 
human health. The companies had also concealed the health hazards caused by their products, prevented 
outsiders from warning their clients, and had actively lied to consumers about the health effects of their use. 
The Finnish product liability case was dismissed by the City Court, the Court of Appeal, and the Supreme 
Court. 
Legal actions against Philip Morris and British American Tobacco were filed in March 2005. The case focused 
on light cigarettes. The plaintiffs claim that Amer Oy (subsidiary company of Philip Morris) and Suomen Tupakka 
– BAT Nordic Oy had aimed to create addiction by manufacturing cigarettes and have, without exception, denied 
and concealed the fact that their products might cause addiction in their marketing since the 1950s. In October 
2008 Helsinki City Court dismissed the case, and so did the Court of Appeal in 2010.
Mervi Hara 
– Executive director, Finland´s ASH 

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60 A CENTURY OF FINNISH DENTAL CARE
In terms of its achievements in dental care, Finland has been a model country according to many international 
experts. At the beginning of this millennium, oral healthcare experienced more changes affecting the whole 
population than ever before. The statutory care guarantee that entered into force in 2005 classifies oral 
healthcare as administratively equal to general healthcare.
Finnish dental care has in principle gone through three different development phases. The first phase, during 
the first half of the last century, was bloody and violent. It was characterised by symptom-based dental care. 
Dental problems were solved when they appeared 
– and mainly with dental forceps. With its school dentist 
system, Finland entered the era of corrective dental care. Dentists tried to fill cavities when they appeared, but 
this system soon proved to be impossible because the cavities couldn’t be filled as fast as they appeared! The 
era of preventive and systematic dental care gradually began in the 1970s due to the Primary Healthcare Act. 
Nowadays, when the combined effects of diseases of the rest of the body and of the mouth and their importance 
are understood better than before, one can say that Finnish dental care has entered the era of oral medicine. 
Today’s organisation of oral healthcare services as part of general healthcare is part of this historic transition to 
the new era.
The road has been long. When the Health Insurance Act came into force in 1964, it didn’t cover dental care. 
Almost the same thing nearly happened with the Primary Healthcare Act. Public healthcare was at first provided 
for children and young people, which has produced excellent results. The Primary Healthcare Act entered into 
force in 1972 and entitled everyone under the age of 17 to systematic and free health centre dental care. 
Everyone under the age of 18 is still entitled to free health centre dental care.
When the Primary Healthcare Act came into force, 12-year-olds had an average of nearly 7 teeth with cavities. 
Now that figure is down to 1.1, which is one of the lowest in Europe. This was achieved through a combination of 
school dental care, health education programmes, fluoride rinses, and systematic use of xylitol. Most children 
now enjoy healthy teeth and mouths. A small number of children with manydental problems have however 
become a challenge, and they keep dentists and other healthcare professionals busy.
Over the years, the right to receive state-subsidized health centre dental care has been extended to all adults. 
In addition, dental care subsidized by the public health insurance is provided by private dentists, who are found 
mostly in larger towns and make up almost half of the entire profession. The amount of healthy and well taken 
care of teeth of young adults is increasing. Dental problems, however, easily become more common after the 
end of free dental care, especially in the case of those young people who then stop going to the dentist. Adults 
clearly have fewer cavities than before. Gum diseases are still a great challenge for oral healthcare; they are 
found in more than half the population.
There is clearly less toothlessness. It is most common among retired people; less than one percent of people 
under the age of 55 are toothless. Today people no longer lose all their teeth during the course of their life as 
was common with many people born during the first half of the last century.
Good modern care requires high technology, special materials, and highly trained staff. A Finnish dentist can 
nowadays use an optical scanner to transfer a digital image of a tooth to a computer-controlled milling machine 
that quickly produces a filling or a crown. The national online service Terveysportti used by healthcare 
professionals and its international counterpart Dental Mammoth continually provide all Finnish oral healthcare 
professionals with clinical decision-making support and up-to-date information. The efforts of dentists should 
indeed be focused on diagnosis and treatment of demanding oral diseases. Today’s oral hygienists are experts 
in oral health promotion methods and are able to assess oral health conditions and carry out dental screening. 
They are versed in radiological imaging methods, the prevention of cavities and gum diseases, and initial 
treatment, in addition to many other tasks. They are now in great demand. 
Population ageing brings big challenges. More and more senior citizens with teeth that are multi-medicated 
and have many diseases need dental care. It is necessary to be able to carry out treatments in homes or care 
facilities, which requires mobile healthcare professionals and equipment. Oral hygiene should be part of senior 
citizens’ general hygiene, which someone else has to take care of if necessary. The mouth is a source of many 

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pleasures, feelings, and expressions. Ageing does not diminish or end the basic needs connected with the 
mouth.
Oral health is understood better than before to be essential for good general health and a good quality of life. 
The general risk factors for oral health are connected with peo
ple’s habits. Many of them, such as nutrition and 
hygiene habits and smoking, are also general risk factors for cardiovascular diseases, diabetes, various tumours, 
and other public health problems. Because these risk factors are connected with people’s habits, it is essential to 
influence them. The problem of oral diseases cannot be solved only through dentist’s appointments – they need 
to be controlled in everyday life and by citizens themselves. The causes of and preventive measures for the 
main diseases of the mouth, cavities and gum diseases, are well known, and these diseases can be prevented 
– 
if we want to.
Heikki Murtomaa 
– professor emeritus of
oral public health at the University of Helsinki