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Nation's oral health at risk as children not seeing a dentist until their teens

Health Minister Stephen Donnelly said not everyone is getting the high-quality dental care they deserve.

THE ORAL HEALTH of the nation is at risk due to a severe shortage of dentists working in Ireland, according to Fintan Hourihan, CEO of the Irish Dental Association. 

Speaking to The Journal, Hourihan said that in many parts of the country children are not being seen by a dentist until they enter secondary school.

“That’s just incomprehensible. It is so important for children to see the dentist as early as possible.

“If the first time some children are seeing the dentist is when they enter secondary school, it’s it’s simply way too late. There’s damage being done, those poor oral health habits have been formed and need to be addressed at an early stage,” he said.

If there are not enough dentists working in Ireland, then the health of the nation will suffer, said Hourihan. 

His comments come as Health Minister Stephen Donnelly told the Dáil that a new, sustainable, long-term scheme is needed “that makes sure that everybody, whether on a medical card or not, can get access to affordable, high-quality oral healthcare when they need it”.

“Unfortunately, at the moment, that simply is not the case for too many people,” he acknowledged. 

The Oireachtas Public Accounts Committee (PAC) was also told yesterday the percentage of members of the public who didn’t receive an appointment was north of 50%. 

Severe shortage of dentists

“When the oral health of the nation suffers, the people who suffer most are usually the people who have the greatest oral health need and the least amount of income to afford dental care. So the entire oral health of the nation is going to suffer.

“There’ll be a disproportionate or worsening of oral health in lower income groups, and that’s what what dentists are reporting to us all the time,” said Hourihan.

Sinn Féin’s health spokesperson David Cullinane told the health minister that in many parts of the country people who have medical cards cannot get access to dental treatment simply because the scheme has collapsed. 

Hourihan agreed that the medical card scheme operated by Department of Health has collapsed.

He said the issue of some children not being seen until they are teenagers has “been a problem which has been highlighted over many years” by the dental association and by dentists.

“The Health Department and the HSE has been made more aware of it. And now, very belatedly, they seem to be waking up to it,” he told The Journal.

“Dentists now reaching a stage where they tell us they thought they had seen it all but they are seeing significant deterioration in the oral health of the nation,” he added. 

Why are there a shortage of dentists?

Hourihan said there is a serious shortage of dentists for a number of reasons.

The two dental schools in Cork and Dublin are not training enough dentists that will remain in Ireland.

In more recent times, about 200 new dentists would be added to the register each year, with 70 Irish registered dentists from the Dublin and Cork dental schools.

“The problem is that the two schools are grossly under resourced.”

In order to make up for the shortfall in funding, Hourihan said the dental schools have been forced to take in students from overseas who pay significantly more in fees than Irish students.

“What that means is there are fewer places for graduates from Irish secondary level schools,” he said.

As many of the dental students from abroad come from Canada or the far East, they tend to return home once they have completed their studies. 

There is also a greater incidence of dental students providing facial aesthetics, such as botox, fillers, anti-wrinkle injections and not partaking in the typical dentistry industry, he acknowledged. Dentists that carry out such non-surgical procedures are regulated by the Irish Dental Council, while other businesses in the beauty industry that offer such services are not regulated. 

A vocational training scheme similar to the one medical doctors undertake, where they spend a year as interns and they move around between the public and the private specialties, was also in place for dentists a number of years ago, explained Hourihan.

However, it was abolished in 2010.

‘Retrograde step’

Hourihan said the dental association has been saying for the last decade that the decision to abolish the vocational training scheme “was a very retrograde step”.

“There are very obvious things that could be done to make the public service more attractive, but in terms of dentistry overall, the problem ultimately is the population and demand for dentistry is increasing on the one hand, while the supply of dentists is unable to keep up,” he said.

Even within the private sector, some customers are waiting months for appointments, added Hourihan.

He added: 

“The HSE and the Department of Health have been told this for many years and have ignored it until it has now reached a critical stage. So it’s not for the want of having been  told there’s a problem.” 

Secretary General of the Department of Health Robert Watt was also asked about the deteriorating dental provisions in the country during a sitting of the PAC. 

The chair of the committee said: “I saw a dentist at eight or nine years of age. My grandchild is 16 and still hasn’t seen a school dentist.” 

Watt said the department had consultations with the Irish Dental Association and health minister on 12 April where “substantial increase” including the reintroduction of the scale and polish and an increase in fees was agreed from 1 May.

“But there is clearly a problem and the problem is it is a shortage of dentists, more generally, and we have been in discussions about how can we increase the number of dentists and train more dentists.

The issue of salary has not been discussed with dentists, he added, but said “I think it’s certainly worthy of consideration”.

“Clearly, we’d have to think about that and how could we make the salaries attractive, how could we ensure that that people who could have a career in dentistry could choose the public system over the alternatives,” said Watt.

A spokesperson for the Irish Dental Council said the number of Irish qualified dentists registered every year has remained relatively unchanged in recent years and that 3,300 dentists are on the register today, which is as high as it has ever been. 

However, when asked if all dentists on the register are practicing or have a dental surgery in Ireland, the spokesperson said “it would seem that the shorter-term solution would be to look at the existing register – which list those dentists who are legally entitled to practice now – and see what impediments are stopping them practicing”.  

“This would seem to be a good starting point given the numbers on the register are their highest and the numbers seeking registration is strong,” they added.

They said that dental education is a five-year full-time programme, which is expensive and that schools are also at or close to the maximum numbers they can safely train annually. 

“It will take a significant length of time for changes to the education model, either in terms short-term funding or increased student capacity to filter through to more graduate dentists,” they added.
They acknowledged that there are issues in how dental education is funded that require consideration, but said these will not address the immediate problem of the shortage of dentists. 

Student places 

A spokesperson from the Department of Further Education said there is no quota placed on dental courses by the department and therefore the places offered are a matter for the higher education institutions, in line with their autonomy.

“However due to the high level of practical work involved there are material constraints on the number of students that can be accepted onto dentistry courses,” they said.

The statement said the Further Education department officials are continuing to engage with the Department of Health and other relevant stakeholders “to ensure that we can continue to deliver graduates with the skills necessary to support our healthcare system and support the strategic workforce planning by the health sector”.

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