Dáil debates

Thursday, 19 January 2023

Public Dental Services: Motion [Private Members]


5:05 pm

Photo of Michael LowryMichael Lowry (Tipperary, Independent)

As the Minister is aware, good dental health is paramount to good overall health. The connection between periodontal disease and a myriad of serious health conditions has long been medically proven. Without proper preventative dental care, people can become more susceptible to cardiovascular disease, kidney disease, cancer, respiratory infections and even dementia due to the circulation of various bacteria in the body. Yet, despite this knowledge and the constant emphasis on preventative healthcare, we continue to risk the health of 37% of people in Ireland. We risk their health because they receive their dental care through the medical card system. We threaten their health because of the dismal level of dental care that a medical card allows them to receive. Medical cardholders are entitled to one free dental examination in each calendar year. They can have as many extractions as they require, but only two dental fillings are free in a 12-month period. Just one first-stage root canal treatment is available annually for teeth, but only if that is at the front of the mouth. As medical cardholders, people are entitled to an upper and lower denture every five years. In fact, in some cases, dentures will not be approved by the HSE if it deems there is no clinical necessity.

This is the full extent of the entitlements of medical cardholders. It is the barest of minimums. If a dentist determines that a medical cardholder needs further fillings to save his or her teeth, the medical cardholder is prevented from having this work unless he or she can fund it independently. Dental care is expensive. Therefore, many, if not all, choose to have their teeth extracted when fillings would be appropriate, as they cannot afford costly dental work. They choose that option because extractions are free.

We threaten the health of people even further because up to 80% of those who have a medical card have enormous difficulties when trying to access dental care. There are currently fewer than 650 dentists remaining in the medical card scheme in Ireland to serve 37% of the population. The number has hit a ten-year low. These figures show that the current situation is untenable, and it becomes more untenable with every passing year. Countrywide, private dental practices that were contracted to provide services have turned their backs on the dental treatment services scheme. This is not because they do not want to treat medical cardholders. The reality is that it is not viable for them as business people to do so.

Modern dental practices employ nurses, hygienists and office staff and have substantial overhead costs. They must be fairly reimbursed for their work. They must protect their businesses. In almost all cases, community healthcare dentists are at full capacity. They are simply unable to take on new patients and have no choice but to turn people away. In my constituency of Tipperary, hundreds of patients, young and old, are denied access to dental treatment. It goes against the ethos of medical practitioners to deny people with a medical card, including children, disabled people and elderly patients the proper care they need, yet this is what is happening every day in Tipperary and across the country.

As is the case with almost all health professionals in this country, there is a serious shortage of dentists at the present time. Those who are practising cannot run and staff a business by working for the reduced rate of pay they receive for treating people in the medical card scheme. Despite their best efforts, community dentists are overwhelmed. The availability of licensed dentists per capitain this country has not increased since 2005. The number of new Irish-trained dentists entering the Dental Council of Ireland has not changed in 25 years. Therefore, Ireland has become reliant on overseas-trained dentists with almost half of our current dentists receiving their training in other countries.

Ironically, dentistry remains among the top choices on CAO applications every year. However, because there is such a limited number of training places available, even those who achieved the highest possible number of points in their leaving certificate fail to secure admission. The Irish Dental Association has been calling for significant investment in the UCC and TCD dental schools to enable Ireland to train more dentists, dental nurses and dental hygienists. The call goes unheard, despite the dental crisis we have been witnessing in recent years. A dental school at UCC was due to commence development in 2019 but, as yet, nothing has happened. Many students who wished to study dentistry left Ireland to study abroad and have not returned once qualified. Emigration of our healthcare workers and, indeed, our potential medical professionals is a significant part of the crisis in our health system. Unless constructive action is taken, the slippery slope will continue to get steeper. The dental service is falling apart. Thousands of patients are neglected. The system is broken. We need radical action to rescue dental services.


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