Mr. Fintan Hourihan:

I am happy to do that. We have three different patient scenarios. I did not include them in our submission but I am happy to send that information to the committee. One of the scenarios addressed the exact question posed by Deputy Donnelly. These scenarios are based on real experiences but I am using different names. Let us take the example of four year old Millie and her eight year old brother. They live at home with their father who works full-time in financial services. He drops them to the crèche at 8 a.m. The staff there bring Millie and her brother to school and both of the children are collected by their dad from the crèche at 6.30 p.m. They go home, have dinner and then go to bed. Millie's mother no longer resides in the family home as the parents separated due to her mother's mental health issues. Millie's dad manages to organise the day-to-day schedule during school term by cooking and supervising. He states that tooth brushing does not always happen. The children sometimes stay with their mother or at the home of their grandmother.

Millie mentions to her dad that she has a sore tooth, but it is not until her face is slightly swollen and the crèche staff remind him that her dad organises a dental appointment. As things stand, he takes time from school to bring Millie to the emergency dentist at the HSE. It is noticed there that Millie has a reasonably high rate of decay in her baby teeth and has an abscess in one of her molars. In that situation, the HSE staff would refer Millie to a general anaesthetic extraction service, having managed the symptoms with an antibiotic. Her social circumstances are noted on the dental records and she is registered as having a reasonably high risk of future decay. The HSE staff record that Millie and her brother will need to have a good reminder system in place. The children are placed on recall to enable support to be given to them and Millie and her brother will be targeted at intervals throughout their school years. They will also have continuous access to emergency care. The HSE staff will arrange with the children's dad to liaise with the crèche staff to bring Millie for dental appointments to enable her to continue her dental care.

As outlined in this new policy, in a future version of this same scenario, while Millie will have access to care bundles, it is uncertain how support will be given to her dad to remind him of the importance of the child's dental health. It is unclear if the children can be registered as being at risk due to the mother's mental health issues. It is also unclear how any symptoms can be managed while Millie waits for her general anaesthetic extraction appointment. In this new scenario, after Millie has her tooth taken out, her dad may wait until she has another toothache before bringing her to the dentist again. Millie relies on her dad to recognise the early signs of dental decay, and it is uncertain if there is any safety net for children within the new proposed structures. It is also uncertain how the new arrangements will interact with Tusla, the child and family agency.

The system in place identifies, manages and arranges treatment and referral where necessary. It also allows what presents to be recorded and a plan to be set out for the future. That is how the public service is set up. The difficulty is that the public service has been run down, with an insufficient number of dentists in place. With the best will in the world, those resources are not available in general practice and those systems of recording information, arranging care and treatment and referrals and follow-up are not in place. We have no confidence that what is outlined in this strategy document suggests that is something that can be provided in the near future.