Dr. Alison Dougall:

On where people with disabilities are seen, some 643,000 people self-report with a disability, so the answer is that they are seen everywhere. Approximately 13,000 people require complex care at some time. Access to services is ad hoc. A large number of patients are particularly at risk. A relatively small number of people are specifically trained to treat such patients, which is an issue. Access to general anaesthesia is also ad hoc. There are some pockets of brilliance and excellence, but in many other areas there is nothing. Some people must travel a great distance to a dental hospital or across borders to access treatment. The dental hospital is not an acute setting as it does not have general anaesthesia facilities. General anaesthesia is provided throughout the country but it is severely limited and many people with disabilities have their treatment options severely limited by poor access to it. For example, extraction-only services may be offered or, within the general anaesthesia setting, the patient is not offered root canal, even to save a front tooth. It is well recognised that there are no well-defined care pathways and not enough people trained to provide the required care. That needs to be addressed in the policy and there will undoubtedly be a need for more people to be trained in this area.

On training at undergraduate level, evidence has shown that we can train people in general practice to do the bulk of the work, but undergraduate is not the time to work on complex patients because students are honing their basic dental skills. The mentoring of graduates following qualification is extremely important. Special care dentistry is a specialty. We offer three-year specialist training on an international basis. Most Irish graduates travel overseas for training in this area because of its cost in Ireland. Unlike orthodontics or periodontics, in regard to which people can thereafter go into general practice to earn a living, it is currently difficult to self-fund a expensive course of treatment.

On succession planning, I am a consultant but there is no formal recognition for a consultant training pathway to, for example, replace me when I retire in ten years. The provision of training across the board in this area is a priority and it has been recognised as such. It is possible to achieve very good levels of care for people with disabilities, as evidenced by the literature. It will be a challenge, but we know it is possible and the evidence shows that the training is available in Ireland. We have the methodology and curricula to train our undergraduates, postgraduates and practising dentists to give them the skills to prevent the need for extensive treatment. We always seek to avoid general anaesthesia being necessary. Prevention works very well for people with disabilities. We need general anaesthesia to be available and people to be trained to provide sedation, which opens up bigger options of care than general anaesthesia, but we mainly wish to prevent the necessity of sedation or general anaesthesia by having good, well orientated preventative services in primary care.