Dr. Dympna Kavanagh:

On the point made about water fluoridation, like Ireland, Israel had mandatory water fluoridation and it was pulled out. It tried to replace it with toothpaste and other programmes outlined by Dr. McLoughlin. For all those reasons, the level of decay has increased phenomenally. The only area in Israel that has maintained its oral health rates is a place in which water is naturally fluoridated. Now that water fluoridation has been taken away, it is impossible to put it back in. It is really important that we protect water fluoridation as there are stark and dramatic outcomes, as we see in Israel.

The point made about the workforce is very important, especially because we have put in place the World Health Organization, WHO, safety net surveillance network. On focusing on children only, the WHO is very clear that we must consider five year olds, 12 year olds, adolescents from 15 to 19 years of age and 35 to 45 year olds, the prime ages for childbearing, and then move to 60 and 70 year olds. The overarching safety net monitoring and surveillance service has been recognised by the WHO since the early 2000s and all European countries are moving in this direction exactly for the reasons outlined by the Deputy to make sure people in the workforce are encouraged and formally nudged to tell them that their oral health is not okay, as they need to be signposted to the dentist and assured on where they are going.

The view from other countries, particularly the Dutch models, is that there is much more flexibility when the message is sent to the profession in communities that dentists are providing care because they can afford to be more flexible, work on a Saturday, or late if they so chose because it is up to them to get their patients into the clinic. A core part of oral health policy is to establish a dental home as early as possible because the first two years are crucial, not just for children but also their parents because the effect is twofold. When they bring in their child, it nudges them. There is a lot of evidence to support this. We can be absolutely certain that certain socio-economic groups have access to services. One of the key points in the policy is to say it is a universal approach, but it must be overlaid with a targeted approach. That comes through in the oral health promotion programmes and services, but at no point do we say universal access stands on its own. We are absolutely aware of the vulnerable and people with disabilities. That is why we have put in place the WHO safety net surveillance network to ensure we can pick up those in the vulnerable groups.