Mr. Fintan Hourihan:

With regard to orthodontic treatment in the north east, I can only guess that the issue is related directly to the lack of dental staff. As the Deputy will be well aware, there has been a severe shortage of dentists in Cavan-Monaghan, of all places, irrespective of whether children require general or orthodontic treatment. I can only guess that this is reflected in the waiting list.

I will ask my colleague, Dr. Bolas, to respond to queries on the threshold and the criteria for orthodontic care.

With regard to clinical dental technicians, ours is not the regulatory body. The Dental Council is a separate entity so we do not have a role in regulating the profession. However, as an association, we fully support the registration of clinical dental technicians. We fully support the fact that they are engaged by the HSE and others. We, too, are concerned about technicians who do not have the necessary formal training. It is acquired at the expense of the individuals concerned, who must travel to Canada and elsewhere to obtain it. We share concerns that the system is not properly regulated. We hope there will be regulation and that increased enforcement powers will be given to the Dental Council as part of the new dental legislation, on which we expect consultation to begin very shortly.

With regard to the administration of the DTSS, we felt we could have spent a lot of time talking about the matter. General practitioners are experiencing considerable difficulties. Circumstances vary widely throughout the country. Essentially, this reflects the lack of resources in the public service to handle the correspondence from dentists. It also reflects the fact that there is now a budget ceiling for care provided to medical card patients. The HSE officials are told they can spend only so much so they must spend time exercising discretion in dealing with requests for care and treatment. The service is now an emergency service, essentially, and consequently some time is spent on deciding what constitutes an emergency. Deputy Healy asked whether there is a general definition in this regard. I am not sure that there is. A dentist may comment on that.

With regard to Deputy Mitchell O'Connor's comments on the voucher system, such a system has been introduced in other countries. Very often, people feel that if something is available free of charge, it is not availed of. Currently, under the medical card system and the PRSI arrangement, eight out of ten adults are entitled to a free checkup, yet fewer than a quarter actually avail of it. If people had an actual voucher, they might be more inclined to avail of the service. It would be easier to administer from the State's point of view and would be more cost-effective. It would not necessarily mean more expenditure, but we feel the current system, under which people have entitlements that they are not choosing to avail of, is not doing their-----