“I prefer the patient that trusts us for our quality, that’s what Spain deserves”

February 22, 2016

Dr. Pablo Avilés learned the profession from his father, also a dentist. He used to go to his office since he was a little boy and has been absorbing knowledge since then. He began to study in Madrid and trained in the family's dental office every summer. He started doing the cleanings and that experience helped him a lot. Both he and his father have always liked bricolage and this profession has some similarities with it.

Why did you choose to study dentistry?

It is true that my father advised me to study this Degree and, luckily, I came to like the chosen option. There is a risk that you realize at the end that this profession is not for you, nor what you expected, as it happens to many people.

How many years have you been in the profession?

Fifteen years.

Do you have public and private practice?

Only private.

Why private health?

Public is more for doctors. In public health there's not odontology, there used to be in the past but it only covered extractions.

What do you think of private medicine in Andalusia and Malaga in particular?

This period of crisis has caused a lot of harm to the odonatological sector, not because of the disappearance of clinics but just for the opposite. Entrepreneurs, not dentists, began to open clinics just for business, and because of that an advertising war began. This has also been a consequence of the massive influx of graduates. Universities are offering more places every time and as a result there are between 1,000 and 2,000 new dentists every year in Spain. The great number of professionals just graduated from University who accept lower salaries as well as the entrepreneurs’ interest to start business without having the right knowledge and skill has offered lower prices to society but worst quality at the same time, because the entrepreneurs want to earn money but they don't know this profession well enough to make a quality-price valuation, which can only be carried out by a qualified dentist. And besides, the entrepreneur gets into the diagnoses without a proper knowledge. At long-term we will see where this war price leads because the patient, in most cases, doesn't know how to differentiate the quality from one treatment to another, and price is his only a guide. For example, an implant can be made manually or by means of technology, in which case the quality increases, but the price gets multiplied per three. On the other hand, the crisis also had a positive side, as it has incentivized graduate's preparation. As they couldn't find a job, lots of young professionals have invested their time in keeping on with their formation with Masters and specialties, and, though they might not have practical experience, there are currently lots of young dentists with a lot of theoretical knowledge.

Is there a fight to win the customer?

I don’t enter into the patient acquisition struggle. In our company, Clínica Avilés y Román, we work with quality and that is reflected on our number of patients. We can't be explaining every detail about why a treatment here costs double than in another clinic, we must have these prices in order to maintain our quality standards.  We are lucky that the crisis has not affected us as much as to the traditional professionals.

How would you define the dentist profession?

Among the health sciences, odontology is well-considered and paid, and we don't play with people's lives, what relieves stress at work. There is a lot of competition though, but you still can make a good living. What is true is that this profession is given to the war of prices.

What has been your biggest professional achievement up to date? What are the pioneer techniques the market is currently offering and which ones are you using in your medical practice?

In 2006, I brought a computer-guided surgical technique, so I only had to do minimal incisions. I was the first person to bring it to Andalusia, and, after acquiring a lot of experience, I threw myself into explaining it to other professionals. It is currently used only in very specific cases.

Minimally invasive surgery is a simulator that makes a surgical template to be placed inside the patient's mouth as you have seen on the computer's software before. It is a very precise surgery that avoids cuts in the patient's gums and possible infections.

On the other hand, to avoid months of waiting with a bone graft, zygomatic or transzygomatic implants are used. They are larger than usual and they are anchored to the inner side of the cheek. Larger implants, if there is maxillary bone, in the inner side of the cheek with four anchors can be placed it in the same instant. That was a revolution, it is a technique called dental surgery of zygomatic more than thirty years old, invented by the Swedish doctor Branemark, the father of the modern implantology, but here in Málaga it wasn't used until we brought it.

We could also talk about the prosthesis machine that we've got in our clinic, the only one in Andalusia, and one of the three in the whole country.  It is a titanium and cobalt chromium milling center, subsidized by the Junta de Andalucía.

The metallic structures that go inside the prosthesis had always been made with manual techniques with wax followed by a plaster phase. It is a process with contractions and expansions, which leads to not having an exact fix. In the field of implantology everything must be perfectly tight, so ideally they should be made of titanium. The innovation that this milling machine offers is maximum precision. What it does is the structure’s milling creating a bespoke piece from a titanium block. With this machine the piece is first computer-designed and then it comes up in a block with a perfect adjustment.

What are the most common cases?

Caries, which is one of the most prevalent non-contagious diseases of the world.

And the most complicated?

There aren’t many, they are mainly a question of aesthetics. As we the facial structure or the bite can’t be changed in odontology, these cases have to be transferred to a maxillofacial surgeon. That kind of intervention is one of the most complicated, but it is made by one of our associated maxillofacial surgeons in our case.

Is there a difference between adult and child odontology?

There are three types of treatments for children: the first one consists on keeping his/her child tooth. In the past it used to be removed, but nowadays we are keeping and treating it so it can be used as a guide for the definitive one and avoid little malformations.  In the second place, if the nerve has not been affected a dental filling can be made.  if it has been affected,  a pulpotomy, which is like and endodontic, but for child teeth, is indicated. In the third place, if the tooth had to be removed, a space maintainer would be placed. In the case of a definitive tooth it has to be kept at all cost through different techniques. Adults, on their side, are treated of caries or for aesthetical maintenance.

What do you think of the current situation of private medicine in Andalusia and in Málaga specifically?

I can’t give a first-hand opinion, only by hearsay from other colleagues. As a patient, I only use private health.

And what do you think of Málaga Health Foundation’s idea of attracting foreign patients to Costa del Sol with our medical excellence?

Convincing foreigners that they are going to receive a better treatment here than in their own country is possible in the case of a Moroccan, but a French or an English would come only for the price. They mainly arrive through word of mouth.

What’s your opinion on health tourism?

I started treating foreign patients a long time ago, English in particular. It was much cheaper for them to be treated here.  In no way it was that the quality was worse in England, it was just a matter of money because it implied saving thousands of Pounds. On the other hand the patients I had from Morocco came looking for better quality and service than those they would have in their own country. To sum up, there are two types of health tourism. I have never liked the kind of tourist that comes here attracted by better prices, I prefer the patient that trusts us for our quality and that’s what Spain deserves.