Regular checkups are important and France has an excellent and cheap dental service but it is best to know the rules.
Finding a good dentist is likely to be a priority, sooner or later, for all newcomers to France. The next step will be negotiating around the complex rules on how the cost of treatment is reimbursed.
If you are a temporary visitor, you may be able to get work done under the European Health Insurance Card (EHIC) scheme, although this will need to be considered urgent to be reimbursed. You can then apply for the refund from the local French health state health insurance body (CPAM) either in France, or from home.
However, for residents, dental work is dealt with using the Carte Vitale in the same way as going to the doctor - you hand it over and, after paying for the work done, you get a set amount reimbursed by the state, and more if you have a “top-up” private insurance scheme (mutuelle).
One Riviera dentist said: “Financially I think you get a better deal than you do in the UK and it’s easier to find someone, and these days a lot more French dentists are speaking English. However, only a standard set of procedures are reimbursed. You should ask if there are alternatives that you can pay for outside the state reimbursement scheme and if you are not sure then get a second opinion from another dentist before you get work done.”
The dentist went on to say asking friends for a recommendation was the best way to pick a dentist.
Experts from the Conseil de l’Ordre des Chirurgiens-Dentistes des Alpes-Maritimes - a professional body for French Riviera dentists - said there was no official way to find a fluent English-speaking dentist, although they said many spoke enough for the basic requirements of carrying out their work. Compiling such a list could be seen as a form of advertising, they said, which is strictly prohibited for French dentists and a number of other professionals.
Although you will find dentists in the yellow pages, they cannot advertise in such a way as to suggest they are better than someone else, and there are even rules limiting them to a simple style of plaque outside their door. The French government believes the best way for a professional to make a name for themselves is by word of mouth.
In dentistry, there is no equivalent to the “médecin traitant” system for doctors, where you get cheaper treatment if you register with one general practitioner instead of picking and choosing each time you have a health problem. The only thing to look for, when choosing a dentist, is whether or not they are conventionné, meaning they work within the rules of the usual French social security system. In fact, the Conseil de l’Ordre experts said, probably no more than a couple of hundred French dentists fall outside this system, and most of them look after clients like wealthy celebrities at Parisian clinics. To be sure, simply ask the dentist of your choice when you make contact .
The social security system may still reimburse part of payments to these dentistes non-conventionnés but it will be a very small percentage. The Conseil de l’Ordre says there are essentially three kinds of dental treatment in terms of cost and state reimbursements.
Certain common procedures are listed under something called the “nomenclature” and there are two kinds. The first have a state-fixed price which cannot be altered by the dentist (tarif bloqué) of which 70% can be reimbursed afterwards through the Carte Vitale system and the rest will be “topped up” by your mutuelle.
The second kind have a state-set minimum price but dentists are able to charge more if they want (these are in the nomenclature but do not have a tarif bloqué). For these, the state only reimburses 70% of the set minimum price. You should note that a so-called “100%” mutuelle will only reimburse you the remaining 30% of the state-set minimum price in this case, not the full amount you may have paid the dentist, which could be many times more, depending on the treatment type and the clinic.
The most expensive and comprehensive mutuelles will help you to get more money back - potentially the full amount. For example, a 200% mutuelle will top you up so you end up getting back, in total (state refund plus mutuelle), up to twice the state-set minimum price of the treatment concerned (up to the price you paid, if it comes within this amount). If your treatment cost more than this, in order to get a full refund of the money you paid you may need a 300% or 400% mutuelle and so on.
The Conseil recommends checking the small print to find out what your mutuelle offers, as the deals vary.
There is a third kind of dental treatment which has no state price and no state reimbursement, although some mutuelles may help. The fees for these are at a “tarif libre” (free tariff).
To take some examples of the first kind of treatment - if you have your teeth ‘scaled’ to remove plaque, if it takes no more than two sessions, the sessions will cost €29 each and these will be reimbursed at 70%. An examination (consultation in French) is fixed at €21. Fillings have several fixed prices from about €30 - €60 depending on how large they are.
Traditional grey fillings and white fillings cost the same, however if you want white ones you have to discuss this with your dentist, who has the right to refuse.
The second kind of procedure includes all dental prostheses. For example, a crown has a state-fixed price of €107.50, but you may well be asked to pay considerably more.
This involves an agreement between the patient and dentist, called an entente directe. It is a legal requirement for the dentist to write out a document (un devis) showing the agreed price, which the patient and dentist sign.
This also applies to orthodontic work which, to be eligible for a state refund, must be started before the patient is 16.
Dentures also come under this second category, with different prices depending on how complex they are.
Anything considered cosmetic is at a tarif libre - it is said to be outside the nomenclature. Mutuellle coverage will vary according to your policy. These treatments include polishing and whitening as well as veneers, which are rarely used by French dentists who consider them outdated and of mainly cosmetic effect.
Importantly, work on the gums, not teeth, is outside the nomenclature.
Special arrangements exist for children - at six, nine and 15 households are sent a form by the CPAM offering a free dental visit. This does not have to be paid for - the social security system pays the dentist directly. This is a preventative measure.
If the child then needs treatment, this is paid for and reimbursed at 100%. In other cases, when a child is taken to the dentist, the same rules apply as for adults.