Professor Brian O'Connell:

I have been a practising dentist for 35 years. I am a consultant in dentistry and dean of the dental school in Trinity College. I am accompanied by my colleagues, Dr. Jacinta McLoughlin, a specialist in dental public health, and Dr. Alison Dougall, a consultant who treats patients with serious illnesses and disabilities. We are here on behalf of the reference group whose chairman, Professor O'Mullane, has submitted a letter that addresses a number of specific points raised about the group’s work.

The reference group was established to help provide the Department of Health with the best independent evidence that could be used to improve oral health in Ireland. It is a broad group with a range of backgrounds and disciplines relevant to policy development. Like all dental professionals, and indeed members of the public, we are acutely aware of the shortcomings of current dental services in Ireland. There remains huge inequality in oral health, especially among vulnerable groups and those living in rural areas. We see parents of children with disabilities who are often desperate to access appropriate care. Far too many young children turn up at hospitals needing emergency extractions, and those who are frail, living with dementia or in residential care often find their oral health completely neglected. The training pathways needed to sustain oral health services have not been developed or, in some cases, have been dismantled.

The committee should also know that most dental disease is preventable. Dental decay and gum disease, which are the main reasons for tooth loss, pain and infection, are two of the most common diseases worldwide but preventing these diseases, and oral cancer, is possible to a large degree with simple primary care measures.

The reference group proposed principles that might frame an oral health policy. Members will have seen some of these in the final Smile agus Sláinte document. There is the common risk factor approach, which recognises that some of the same factors are involved in oral and other diseases, so controlling these risk factors can have a big impact on health. For example, high sugar intake is the main cause of tooth decay but is also implicated in obesity and type 2 diabetes. Reducing sugar intake should, therefore, be the business of the whole primary health care team, including dentists. Importantly, the provision of a service such as dental treatment must be surrounded by broader public health policies to make a real difference. The life course approach means that individuals need access to different services throughout life and depending on their circumstances. However, at all ages our population should have a home in a dental practice setting that is focused on prevention and empowering them to maintain their oral health and independence. As part of Sláintecare, oral health care must be available to all who need it, regardless of income, location and disability. These are just a few examples of policy recommendations that have been included in Smile agus Sláinte, which will be crucial to transform oral health in Ireland. The principles are not only well established in Government policy, but are also contained in recommendations from internationally recognised professional bodies.

Those of us who want to provide appropriate care for patients know that an oral health policy will accomplish nothing without determined and sustained implementation. Continuing with current services will not improve the oral health of the population and will exacerbate inequalities. Available evidence is strongly supportive of change. It is vital to build confidence in the public and in dental professionals that we will be supported in our roles. Most of the population can be readily treated in a practice setting and a strong primary care system reduces the need for more complex interventions. Nonetheless, primary care providers cannot be asked to take responsibility for patients unless they know there is access to backup and specialist care when needed, as outlined in the policy’s advanced centres of care. It is also essential that we monitor progress as we proceed, to make sure we are achieving the goals of the policy for all people. The evaluation and research parts of the policy are critical to a successful outcome, as emphasised already in the Healthy Ireland framework. All of these issues have been recognised in Smile agus Sláinte and we welcome the publication of priority actions to be addressed in the coming years.

We would like to highlight the need to develop a workforce that is fit to deliver the best oral health care across disciplines to the greatest number of people, as stated clearly in Sláintecare and described in the oral health policy. Smile agus Sláinte proposes a review of dental education and the development of primary care leadership throughout the dental schools and, I hope, the HSE to ensure that dentists will be central pillars of the primary health care team. This may include extending education in a mentored environment to encompass broad community experience, inter-professional teamwork and general practice skills. The oral health policy provides for ongoing access to retraining through a skills match programme, so the dental team can keep abreast of changes in the population, disease patterns and technology. In order to support patients and practitioners, specialist and academic training must be put back on a firmer footing within the established medical model. As the policy has stated, it is also time to look at the scope of practice of the whole dental team so the population has the greatest possible access to good quality care.

My colleagues and I have the privilege of working not only with students but all members of the dental team at all stages of their careers. I assure the committee that in this country we have a talented and dedicated workforce whose skills are recognised everywhere. I am confident they are capable of meeting any challenge they embrace.