Professor Leo Stassen:

They are all good questions and I hope I can answer some of them. On the HPV vaccination, much has been written in the newspapers and discussed around the Government about cervical cancer and the problems it has created for women, in general, but also the serious problems it has created for how medicine and surgery deal with it. The HPV vaccination has been shown to be significantly protective. It has been shown to be useful and has been given to many girls for many years, but it should also be given to boys.

It is, without a doubt, one of the most lifesaving things that could be produced. If it had been introduced at such a level in the past, which it would not have been, we would not be where we are now with these court cases and the threats to cervical screening.

With regard to the input, I treat an awful lot of mouth cancers. I treat more than 100 cases of mouth cancers each year. There has been a significant increase in the amount of mouth cancer, in particular oropharyngeal, which is directly related to HPV. This is placing significant stress on our system of providing care for mouth cancer patients. How it reflects in dentistry is important because many cases of mouth cancer are picked up by dentists as well as by pharmacists and doctors and they often end up with us. Many of them require radiotherapy and they need screening by a dentist prior to having radiotherapy. We heard Professor Lynch speak about this. They need screening after their radiotherapy in the context of dental care. The HPV vaccine is an absolute no-brainer and I hope the committee will push it as strongly as it can for girls and boys.

We then come to enamel hypoplasia but we are really speaking about caries, infection and other problems in young children that require antibiotics. Antibiotics are not the treatment for caries. Prevention is how it should be managed, followed by early detection, protecting and saving the teeth. A tooth that develops an abscess and requires an extraction is a failure of a health system and of dentistry. I agree completely that antibiotics are not the treatment; the treatment is prevention. If a patient has an abscess, the treatment is probably root canal, if possible, in the older population and, for a child, extraction of the tooth but we cannot actually provide this. This needs to be addressed. Enamel hypoplasia is a very small part of the story. Caries is the big problem.

Fluoride was mentioned, as was sugar. What we do know is if we want to have in place a good programme to prevent tooth decay we require fluoride, decreased sugar by whatever means in the diet and tooth brushing. We can teach children through proper systems to brush their teeth. We are working on trying to decrease the amount of sugar people take. As president, I will be pushing for a lot of support for this. We need to inform people on how children get sugar because mothers and fathers do not know. People who train them for sport give them a sugar treat at the end of training, which is absolutely the wrong thing to do. They should get an apple or even a toothbrush but they should not get a sugar treat.

Fluoride has been shown by all of the research available at present, and research needs to continue, to be the most practical, cost-effective and safe way to help manage caries. Unfortunately, in the strategy put to us, it is seen as everything and it is not. Many places do not have fluoride. Children older than two need topical fluoride, fissure sealants and varnishes. They are not part of the national oral strategy. If we cannot prevent decay developing in younger people, we will have a serious problem. If fluoride is pushed, we will also push tooth-brushing and reduced sugar of any type. I guarantee that all of the research so far shows the application of fluoride to be safe at the levels recommended by Europe.

Dental technicians were mentioned. The problem is educating the public on what is a dental technician. People working on the high street as what we call denturists or dental technicians have no training in examining a mouth, head or neck, which a dentist does. They have no experience of what mouth cancer looks like and, as I have stated, I see more than 100 cases of this per year. They are dangerous. Many of them who provide treatment to patients are assaulting those patients and it should be taken up by the Garda as assault.