Dr. Nikolai Sharkov: "Leadership is Change, Not a Position"

Dr. Nikolai Sharkov is one of the most established names in dental medicine both in Bulgaria and internationally. Born in Sofia in 1956, he grew up in Burgas, where he graduated with honors from the “Geo Milev” English Language School. He studied dentistry at the Medical University of Sofia. He holds specialties in Pediatric and General Dental Medicine, as well as a Master’s degree in Business Administration with a specialization in healthcare management. Since 1989, he has been a lecturer in the Department of Pediatric Dental Medicine at MU – Sofia. For over two decades, he has actively participated in the leadership of the Bulgarian Dental Association, where he has successively held the positions of Vice President, Secretary General, and President.

His international activity within the World Dental Federation (FDI) began as early as 2003 in Sydney, Australia. In 2021, he was elected Treasurer, and in 2023, President-elect of the organization. Thus, Dr. Sharkov becomes the first Bulgarian to lead the FDI – the leading global voice of the dental community. Furthermore, he is one of the five directors on the board of the Council of European Dentists (CED).

1. Personal Path and Motivation – Leadership Through Reforms, Not Positions

Dr. Sharkov: I have always believed that true leadership is proven by the changes achieved, not by titles. I lead by personal example and reforms, motivated by the desire to facilitate my colleagues and improve patient access to quality treatment. A leadership position means nothing without positive changes.

2. Specific Reforms You Would Propose Given Political Will Dr. Sharkov: Given political will, I propose: First, at least 5% of the NHIF budget for dental medicine – to expand services (especially for the elderly and vulnerable). Second, continued targeted funding for pediatric dental prevention. Third, reform of specializations – more funding and facilities to retain young personnel. Fourth, mandatory continuing education. Fifth, reducing added sugar by at least 5%. Finally, better integration of oral health into general healthcare – through digitalization, artificial intelligence, and participation in all health strategies.

3. Balance Between Technology and the Human Factor in Dental Medicine

Dr. Sharkov: Technologies (digital scanners, 3D printers, etc.) increase precision, but the human factor is irreplaceable. The experienced physician makes the diagnosis, takes the decisions, and communicates with empathy. We strive for balance: we implement technologies, but we also invest in the training of our colleagues. Equipment should complement, not replace, expertise and humanity.

4. The Difference Between Rhetoric and Real Change Under System Survival Conditions

Dr. Sharkov: There is often a discrepancy between promises and reality. For example, it took 21 years to secure the right to dentures through the health insurance fund for completely edentulous patients – a basic standard achieved with a huge delay. In words, everyone supports a sustainable system, but in practice, dental medicine is underfunded and neglected. Dental practitioners (DPs) invest in their practices themselves without support. Real change requires action: better funding, administrative relief, and protection of labor rights – to transition from survival to development.

5. Problems with Reactive Funding and the NHIF

Dr. Sharkov: Funding is predominantly reactive. The NHIF budget for dental medicine is “patched up” without considering real needs and inflation, leading to chronic underfunding. Money is only found during an acute crisis. A proactive model is needed: long-term planning, price indexation, and sufficient resources for oral health goals.

6. Assessment of Current Funding Through the National Framework Agreement (NFA) for Dental Health

Dr. Sharkov: Funding under the NFA is far below needs and unfairly distributed. Twenty years ago, approximately 550 million BGN per year was needed just for maintenance; today the amount is many times larger. Currently, about 416.5 million BGN is allocated, which covers only the meager current package (with rapidly depleting limits for adults). Often, dental practitioners work at a loss. Current funding does not provide sustainable care. At least a 30% increase in the budget is necessary to expand the package for adults – this is what the BDA will insist on.

7. Additional Funding Mechanisms – Funds and Programs

Dr. Sharkov: We need funding outside the NHIF. Opportunities include: State-funded national programs (such as the National Program for Prevention of Oral Diseases in Children – which must continue and expand). European funds (Horizon Europe for research, Erasmus+ for education) pertaining to dental medicine faculties. Voluntary supplementary health insurance (but not at the expense of the NHIF budget, as suggested years ago) for dental services. The combination of public funds, national programs, and European funding would provide stability. The BDA must initiate and coordinate these efforts.

8. Necessity of a Prevention Strategy and Educational Campaigns

Dr. Sharkov: Prevention is key – investing in prevention saves enormous costs later. A national prevention strategy is needed, supported by educational campaigns independent of the NHIF. A culture of oral hygiene should be nurtured starting from kindergartens. The existing Ministry of Health program for the prevention of oral diseases in children is a good foundation – it must continue. Many people visit a dental practitioner only when in pain, which leads to late detection and complications. Therefore, we plan more awareness initiatives – through media and the community. A high-level national strategy is needed, uniting dental practitioners, pediatricians, endocrinologists, schools, authorities, and society. Only then can we break the vicious cycle of “treating consequences.”

9. The Global State of Oral Health and Bulgaria’s Place in This Picture

Dr. Sharkov: Globally, oral health is unsatisfactory – nearly half of the population has an oral disease (WHO, 2022). Bulgaria faces challenges: services are at a European level (well-trained specialists, modern equipment), but the oral health indicators of the population are not good – caries and periodontal disease are more prevalent compared to Scandinavian countries. Bulgaria ranks second in Europe after Sweden in the number of dental practitioners per capita. The issue is to use this resource effectively to improve health outcomes through prevention and increasing health literacy.

10. Why Governments Do Not Perceive Oral Health as Part of General Health

Dr. Sharkov: Historically, oral health has been viewed as separate and secondary. Oral diseases are rarely directly life-threatening, which is why they are underestimated. There is also a misconception that teeth are a matter of comfort rather than health. In reality, poor oral health affects the entire body – infections can cause cardiac, joint, and diabetic complications. The WHO emphasizes that oral health is an inseparable part of general health. The challenge is for this paradigm to be adopted. Inertia and competition for resources (directed toward hospital care and medications) neglect the “silent epidemic.” Our task is to inform policymakers that investing in oral health saves costs for other diseases. There is a gradual change, but work remains.

11. Environmental Practices in Dental Medicine – Will and Reality

Dr. Sharkov: There is no lack of will for environmental sustainability. More and more colleagues are looking for ways to reduce waste and recycle. The FDI has published a manual on reducing the carbon footprint. The sector has a responsibility to be sustainable. The gap with reality comes from obstacles: financial (expensive equipment) and infrastructural (lack of recycling systems). Some colleagues in small practices are concerned about additional costs. Therefore, we must act gradually: increasing awareness with easy first steps (digital records, conservation, waste separation). Industry organizations and the state should provide incentives through guidelines and relief. The younger generation is enthusiastic. The trend toward “green” dentistry will intensify.

12. Digitalization and How to Prevent Unequal Access

Dr. Sharkov: Digitalization brings benefits but risks increasing inequality if only large clinics have access to technologies (e-records, telemedicine, CAD/CAM, AI). The process must be fair. Regarding the National Health Information System, the BDA insisted on participating to ensure the specifics of dental medicine were considered and that colleagues were not burdened. For expensive technologies (3D X-rays, scanners, CAD/CAM), incentives and programs are needed for small practices (collective purchases, leasing, EU projects). Knowledge exchange is also important – more experienced colleagues should train others. Digitalization should improve quality and access everywhere. This requires strategic thinking and solidarity.

13. Ethics, Economics, and Staff Attrition – Is Sustainability Possible?

Dr. Sharkov: The balance is delicate against the backdrop of young talent leaving for abroad (dozens annually). We have more than enough dental practitioners, but their labor here is not valued – many face financial difficulties at the start (large investments with uncertain returns). Economic challenges tempt compromises, but high professional ethics are non-negotiable – there can be no concessions in quality or integrity. Sustainability requires the system to overcome shocks without eroding trust. To retain personnel, more opportunities for development, specialization, and support for young dental practitioners are needed. The BDA works for economic stability, more specialization spots, and adherence to the code of ethics. Patient trust also improves the economy. In conclusion, sustainability is achievable with care for people and principles.

14. What is Missing in the Public Debate on Healthcare

Dr. Sharkov: In the debate, there is almost no mention of oral health and prevention. The focus is on hospitals, emergency care, and drug prices. Caries in children, edentulous elderly, or oral health care are rarely discussed. This lack of attention leads to low priority in resource allocation. We must purposefully include dental health. There is also a lack of understanding that oral health affects general health – we must communicate this clearly. Prevention is hardly spoken of. The debate concentrates on the shortage of money instead of effective use and organizational reforms. In summary, a long-term, holistic conversation where dental health takes its place is missing. An appeal to media and politicians: include dental medicine and prevention – this directly affects quality of life. (“There is no health without oral health” – WHO).

15. The FDI MOOC Program /World Dental Federation/ – How Bulgarian Dental Practitioners Can Get Involved

Dr. Sharkov: The FDI has launched the first large-scale Massive Open Online Course (MOOC) on sustainability in dental medicine. The goal is to provide knowledge and skills for more sustainable practices. I recommend it to Bulgarian colleagues – joining is easy: registration on the FDI website. The course is available in several languages and covers modules on waste management, carbon footprint reduction, and social and economic sustainability. Everyone learns at their own pace. Bulgarian dental practitioners can join individually, but we would like to organize broader participation as a professional body. The course connects you with a global community – a chance to exchange experience. As President-elect of the FDI, promoting such opportunities in Bulgaria is a priority. My advice: take advantage of it.

16. Opportunities for Participation in Erasmus+ and Horizon Europe

Dr. Sharkov: Erasmus+ allows students, lecturers, and professionals to exchange good practices and training abroad. Our faculties traditionally participate. Horizon Europe (a research and innovation program) offers opportunities for projects in dental medicine – new biomaterials, public health, digital solutions. The Bulgarian scientific community has the potential to win such projects. Participation brings funding, knowledge, and prestige, and contributes to the improvement of dental health in our country. Faculty leaderships will continue to seek these opportunities.

17. International Platforms for Young Dental Practitioners

Dr. Sharkov: There are platforms for the youth: forums like FDI Young Dentists, a working group in the ERO (European Regional Organization of the FDI). The BDA collaborates with the International Association of Dental Students (IADS) and the European Dental Students’ Association (EDSA). Many of today’s successful colleagues were active in them as students. I encourage them to continue participating – for example, in the structures of the BDA, which has partnerships with other national associations. The BDA provides a stage for young people at its congresses (youth sections) and provides foreign lecturers. Access to international platforms is easy online. The BDA can help with contacts and guidance. Advice to the young: Do not limit yourselves to the university – connect with colleagues from abroad, learn, and share. This is how you and Bulgarian dental medicine develop.