Brian Stanley (Laois, Independent)
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I move:

That Dáil Éireann:

notes that: — the School dental programme for children is not providing adequate and timely treatment for primary and secondary school students;

— children are not seen for their first screening examination in second, or even fourth or sixth class in primary schools and in many areas, they are receiving their first examination in fourth year in secondary school;

— in Co. Laois, based on Health Service Executive (HSE) figures of 6,433 are waiting on their first exam invitation, and that is being provided seven years late;

— in 2017, 135,662 pupils were screened and treated, and this dropped to 101,112 in 2023, and in the same period in Co. Laois and Co. Offaly it reduced from 4,300 to 181;

— the Dental Treatment Services Scheme (DTSS) for adults with medical cards is not available in many areas, in Co. Laois for example just one dental practice currently takes clients under this scheme;

— the budget for the scheme in the current year is €73 million, a reduction of €6 million from 2010;

— the HSE emergency dental service is almost impossible to access;

— the Treatment Benefit Scheme based on Pay Related Social Insurance (PRSI), only provides for examination and polishing which puts lower- and middle-income families at a disadvantage; and

— children or people with special needs, that require anaesthesia cannot access treatment due to a lack of staff in hospitals, and there is a two-year waiting list; and calls on the Government to: — publish the promised dental services plan;

— provide for a significant increase in Dental School places in University College Cork and Trinity College Dublin, and provide additional funding for this;

— facilitate the re-introduction of a structured mentorship programme to allow new graduates to gain work experience;

— authorise the HSE to step up recruitment for dentists to work in the School dental programme, and in public dental services;

— introduce a dynamic advertising and recruitment campaign for the DTSS, to encourage dental practices to take medical card patients in all parts of the State;

— expand the range of services available under the PRSI based Treatment Benefit Scheme;

— ensure the HSE improve and expand hospital services and capacity for children and adults who have special needs, and require treatment under general anaesthetic; and

— provide for a significant increase in the forthcoming budget for dental services.

The public dental health service is in crisis and there is also a shortage of dentists in the private sector. This is due to a lack of planning and the schemes not properly being resourced. Dental and oral health have not been made the priority they need to be. For a relatively wealthy First World country, we have a Third World dental health system.

Untreated tooth decay is one of the most common health conditions, according to the Global Burden of Disease Report 2019. Conditions such as stomach ulcers, gum disease, heart conditions and a range of other physical health issues are caused by poor oral health. The workforce crisis in dentistry has been well publicised in recent years. This has not happened all of a sudden; it has crept up over several years. Action on this by successive Governments and the HSE has been way too slow and at nowhere near the pace required to have a substantial impact. In recent years, insufficient attention and resources have been put in to prevention through education and public awareness campaigns. The cure comes too late, often and most likely in the form of multiple extractions and fillings.

I want to address the main public schemes, namely, the school dental scheme, the dental treatment services scheme, the treatment benefit scheme and orthodontics, for which there is a six-year waiting list for treatment. The school dental scheme is not providing timely and adequate treatment for primary and secondary school pupils. Children are not being seen for their first examination in second, fourth and sixth class, as they should be. In many cases, they receive their first examination well into secondary school. In Laois, children are four years into secondary school when they are first seen. In Offaly, it is not much better, at three years. This is an absolute scandal in public health. In the case of Laois, according to HSE figures, 6,433 pupils are waiting on their first examination. As I said, for most of those pupils this will come six or seven years too late, and they will then have to wait for treatment. In 2017, 135,662 pupils were screened and treated. This figure dropped to 101,112 in 2023. We are going backwards. I am not too sure what happened but these are figures I got from the HSE. In Laois, the number of pupils screened and treated reduced from 4,300 in 2017 to 181 in 2023. Those are interesting figures.

The dental treatment services scheme for adults on medical cards is not available in many areas. For example, for people in Laois, only one dental practice currently takes clients under the scheme and it is based on the edge of Carlow town. The budget for the current scheme is €73 million this year.

That is a reduction of €6 million on the allocation in 2010. There has been a reduction of almost 50% in the number of dental practices taking clients under the scheme. The HSE's emergency dental health service is almost impossible to access. The treatment benefit scheme for workers and retired workers, which is based on PRSI, only provides for examinations and cleaning. This puts low- and middle-income families at a disadvantage. I refer here to ordinary workers and their families who get no fillings or extractions under the scheme. Overall, 83% of dental treatment is funded by means of out-of-pocket payments.

Children with special needs and adults who require anaesthesia to access treatment suffer from a lack of services. There is a two-year waiting list in hospitals for such treatment. I have had representations at my constituency office about this. Patients often present with serious levels of tooth decay and oral health issues. That needs to be fixed. In the Dublin and midlands health region, there are 654 children and 102 adults on waiting lists for hospital treatment. That matter requires urgent attention.

The Irish Dental Association has highlighted the fact that 500 additional dentists are needed immediately to address the crisis in private practice and the public system. Given the rising population and the high number of dentists who will reach retirement in the coming years, this needs a particular focus on the part of and action from Government. To underline the scale of the crisis, the overall number of dentists working in both public and private practice has dropped by 23% in the past 15 years. Less than 10% of dentists are working in the public service. It is estimated that 120 additional dentists are needed just to maintain the very basic level of service we have at present. In 2023, 320 dentists were working in the public service. By 2025, according to the HSE, that had dropped to 294. In the context of private practice, the Irish Dental Association has found that due to workload, one quarter of dental practices are not taking on new adult clients and more than one third will not take on new children. This is not because they do not want to do so; they cannot do it due to their workload. While the effects of this are felt across society, low- and middle-income households are hit the hardest. Between 2009 and 2023, there was a cut of €800 million in funding for the PRSI scheme and the treatment benefit scheme, or medical card scheme, to which I referred earlier. This has meant that workers on low and middle incomes have suffered hugely negative outcomes. Unfortunately, dental health and dental treatment are often put on the back burner by families out of economic necessity. We all know how important it is that dental health is tackled early, namely when children are in second class in primary school. We also need to bring forward the promised scheme for children under seven. The €800 million cut in funding for those two public schemes over a 14-year period has had a significant effect.

I urge the Government to publish the long-promised new plan for dental services. I acknowledge that a new dental school was opened in Sandymount last week. The Minister for Health told me about it the other day. While I acknowledge that development, more needs to be done. We need to bring forward a plan for our dental health services, and a scheme for children under seven must be given priority. There must also be a significant increase in the number of dental school places in universities, particularly UCC and TCD, and additional funding for this. We need to facilitate the reintroduction of a structured mentorship programme to allow new graduates to gain work experience. I am sure the Minister of State understands the importance of that. We need to authorise the HSE to step up recruitment for dentists to work in the school dental scheme and public dental services. We need to sort out the delay between the point at which dentists are recruited and told they have a position and when they start work. The information I have, if it is correct, is that such delays can be for six months or more, which is too long. Officials need to take this on board and take it up with the HSE directly because what is happening is that in the interim, those recruited either emigrate or get another job. That means that we do not have them in the public system where they are needed.

We need to introduce a very dynamic advertising and recruitment campaign for the dental treatment services scheme. Extra funding was provided for that. The rates being paid have been increased, but we need to encourage more dental practices to take on medical card patients in all parts of the State. I have been highlighting this issue since former Deputies Varadkar and James Reilly served as Minister for Health. It needs to be sorted out. The situation across the country is bad, but there is a really big hole in the service in Laois and Offaly is not much better. We need to expand the range of services available under the treatment benefit scheme. Workers are working hard and paying their taxes - PAYE, USC and PRSI - which are gone out of their wages before they get them. They do not mind paying their taxes but they need to see services for that money. If people could see good services, they would not mind paying their taxes and levies. We need to ensure that the HSE improves and expands hospital services and capacity for those children and adults with special needs who require treatment. I have outlined the numbers waiting in just one area, and that needs to be tackled. There is a particular need there because such patients have to be under anaesthetic before they can be treated.

We are coming up to budget time. The Government is being lobbied left, right and centre. I see lobbyists going in and out of here every day. They are coming to us, as Opposition Deputies, as well. This is not just about oral health. Oral health affects all health. The Government needs to provide a significant increase in funding. The one message I want to leave with the Minister of State, having chaired the Committee of Public Accounts for four and a half years, is that we need clear tracking of the budget going into dental services. If we just throw money at it, we will not get the outcomes we want. There needs to be clear tracking of the budget going in and the outcomes and services being provided, and that needs to correspond to increases in the budget.

Roderic O'Gorman (Dublin West, Green Party)
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I thank Deputy Stanley for tabling this important motion, thus giving us the opportunity to place a particular focus on oral health and oral healthcare in the Dáil during the final week of this term. I am really pleased to have the opportunity to speak on the motion. We all how the importance of oral health. It affects everything including how we eat and speak. It can even affect our self-confidence, but, for far too long, it has been considered and treated as an optional extra in our health system. Dental healthcare is too costly and too hard to access for far too many and this has to change.

One of the biggest challenges in our system is the shortage of dentists. The dental treatment service scheme, which provides dental care for most medical card holders, has seen the number of participating dentists fall by 50% over the past decade. There were about 1,600 dentists practising previously. That number is now down to 810, and only 600 of those are actively providing dental care.

Community dentists are the backbone of accessible oral healthcare in our communities. They provide essential preventative and treatment services directly within communities, especially to those who need it most. They really help to reduce pressure on our hospitals and wider emergency services. It is for this reason that I really welcome the initiative by the Royal College of Surgeons in Ireland, RCSI, and its recent establishment of a brand new bachelor of dental services degree. It will be the first community-based undergraduate dental degree course delivered in Ireland. In order to advance the education of students on this new programme, work by the RCSI and the HSE on a new dental education centre at Connolly Hospital Blanchardstown has commenced. This new centre is set to open in September of 2027 and will provide state-of-the-art facilities for training dental students while also delivering local care in the community. It is expected to support over 375 dental students annually and provide approximately 30,000 treatments in the community.

What has really piqued my interest in that this is the pilot programme under which supervised dental students will provide free dental care to local residents. That is going to help to improve access to care for those who face barriers, particularly financial ones. It is going to give students valuable practical experience and will be a major boost for oral healthcare in Dublin 15, an area I represent. As well as giving that immediate benefit to residents in Dublin 15, we will now have a new stream of trained dentists emerging from third level every year whose entire training has been about serving the community. We will have a brand-new type of dentist, and that is something we should really welcome.

Oral healthcare is healthcare. We need to treat it that way. It is about fairness and making sure that no child or older person feels left behind because of cost or a lack of access. The work under way shows what can be delivered when we have ambition that is backed with action. The Government must show that same ambition at national level to back our dentists, serve our communities and treat oral health as the essential element it is. This means fixing the dental treatment service and giving medical card holders the same level of access to dentists as everybody else. It means investing in prevention and early intervention in order that we do not have to rely on emergency care and emergency situations to pick up the pieces. We are getting this right in some pockets of the country but that is not enough. We have to build on that success and ensure there is access to dental care in every part of the country.

Paul Murphy (Dublin South West, Solidarity)
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I thank Deputy Stanley for bringing forward this motion. It is striking that oral health is not much discussed in this House. This reflects a neglect that exists within our State whereby we know that oral health is so important for overall health and well-being but it is neglected and seriously under-resourced in our public health system. If your teeth and gums are healthy, you are less likely to suffer from heart disease, cancer, chronic respiratory diseases and diabetes. Dental care is a key part of preventative healthcare that can keep everyone healthier for longer and lower costs for the HSE. At least it should be. Unfortunately, in Ireland it has been treated as a luxury only accessible to those with the ability to pay to see a private dentist. Scandalously, that goes for children as well as adults. Public dental care is extremely limited. There are long waiting lists. Fewer private dentists accept medical cards. Children are meant to be seen in first or second class but often this does not happen until secondary school.

A mother of a child with additional needs recently contacted me in relation to this. She says they are currently paying a private orthodontist to help with their daughter's teeth because she urgently needs early intervention treatment and they cannot wait for the HSE. When the mother called the HSE, she was told that it could not help and that the child would not be seen in sixth class because the backlog is so big. She was also told that it would wait to see her for the first time in second year, most likely. If the family waits for this, their daughter will most likely need more intensive treatment and other treatments that would not be needed if she was seen when required. The mother tells me the HSE is currently only seeing kids for dental problems that are causing pain, so basically when it is too late. She says that all the waiting times are very frightening and the kids have been failed so badly right now, and that she just has to stand back and watch her daughter be failed in the context of multiple issues. She finds it absolutely heartbreaking that she cannot do anything else to help her. If this is not a common story, elements of it are definitely things I hear again and again. I refer, for example, to the complaint that people do not get prioritised in the public system until they are experiencing pain, that is, when it is too late. Kids have to wait to be seen and are then forced to go private, if their parents can afford to do so. In many cases, parents get loans in order to go private.

The cause of all this unnecessary suffering is deliberate underfunding and understaffing of our public dental service by successive Fianna Fáil and Fine Gael Governments. They have pursued a policy of privatisation by stealth. Public dental care in this country was never great, but it was decimated after the financial crash as a result of austerity cuts. That policy of starving the public system of resources continues today through the HSE pay and numbers strategy, which guarantees that there are never enough dental workers to staff the system properly. There are also nowhere near enough dental training places. In addition, inflexible working conditions force dentists to either go into private practice or emigrate. We still do not have any dental therapists. A dental therapist qualification is midway between those of dentist and dental hygienist. Dental therapists exist in many other countries and could help fill in the gaps here. The solution is to fund public dental services properly and to train and recruit hundreds of new public dentists and dental therapists. Public dental care should be available to all, free of charge, as part of a universal single-tier national health service. There should be no limits on care as proposed under Sláintecare, which has still not been implemented.

No one is going to the dentist for the craic, obviously. The right-wing argument that free healthcare will encourage overuse is even more wrong for dentistry than for other forms of healthcare. Free dental care - free healthcare - would encourage people to go early to ensure prevention rather than seeking a cure later. We know that prevention is always better than cure. Even from the point of view of cents and euros, it makes sense. Regular, free dental examinations, with treatment from an early age preventing more serious problems later, make obvious good sense. The only argument against it is an ideological preference for privatisation and private profit. For Fianna Fáil and Fine Gael, these will always take precedence over public health. We need a renewed mass movement for universal free public healthcare, including free oral healthcare. A left government is needed for this change to happen, together with the mass movement to which I refer.

Mary Butler (Waterford, Fianna Fail)
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I thank Deputy Stanley and his colleagues for tabling this motion and giving us the opportunity to discuss oral healthcare services. The motion is timely, given that the Minister for Health has only last week officially opened the RCSI's new dental education centre in Sandyford. The motion, which the Government is not opposing, provides a chance to update the Dáil on developments in the sector and to outline the Government’s priorities to fundamentally reform dental services. As Deputy Murphy said, it is really important that we are talking about dental treatment services and oral hygiene.

To be clear, this Government allocates over €230 million to the provision of public oral healthcare services every year across the Departments of Health and Social Protection. This ongoing investment shows our commitment to delivering real change in important areas and to addressing the challenges that we acknowledge exist in the provision of oral healthcare services. Improvements in access to care and in addressing waiting lists over recent years have been supported by significant additional investment. This included an additional €15 million in recurring HSE funding between 2022 and 2024 to support progression of the national oral health policy. A further €17 million in one-off HSE funding was provided between 2022 and 2024 to improve access and respond to waiting lists. This investment demonstrates the increased focus placed on improving oral healthcare services.

At the same time, we acknowledge much more needs to be done. The Minister for Health wants to do much more to improve oral healthcare services and to address the access issues that are still there. This will be achieved through the implementation of the national oral health policy. This year, a further €2 million is being invested to support implementation. This will increase to €4 million next year. It will support recruitment of additional dentists and dental nurses into the HSE. A further €2.85 million is also supporting continuation of successful orthodontic waiting list initiatives.

The salaried HSE oral healthcare service provides dental care to several groups of patients. Last year it provided care to over 156,000 adults and children. This includes almost 50,000 emergency appointments to eligible patients, on a same-day or next-day basis. Those with additional needs, who cannot receive care in a general dental practice, may need special care services provided by the HSE. The HSE provides these patients with oral health examinations. Where necessary, their treatment is provided using additional supports. This service provides care to many children and adults who would not otherwise have access to oral healthcare services.

Regarding access to public oral healthcare services for children, there are access issues in respect of the current model of service provided by the HSE. This service aims to offer the first of three appointments to children while they are in second class - at approximately seven years of age. Due to the impact of the pandemic on the operation of its dental clinics, the HSE has had to prioritise patient groups in order to ensure emergency care remains available for all eligible patients. Within the three childhood appointments, the sixth class appointment is prioritised by the HSE. This is to ensure that children receive preventative fissure sealants on their permanent molars and, for those who require it, referrals for orthodontic assessment.

It is important to note that the number of examination appointments being provided by the HSE to its target group is increasing. In 2022, 99,000 such appointments were provided. Last year, this increased to almost 107,000 appointments, including almost 15,000 appointments for children on the second class list. I acknowledge that, previously, it was second, fourth and sixth class. Sixth class is now being prioritised.

On recruitment, the RCSI proposal was really welcome, and the Minister opened the RCSI Dental Education Centre last week. The Royal College of Surgeons in Ireland will commence its new bachelor of dental surgery in September 2025. This will train students in a community-based model of dental education, significantly increasing the number of dentistry training places available nationally and expanding access to dental services. This was what Deputy O'Gorman spoke about just some minutes ago.

The new RCSI bachelor of dental surgery programme will provide for between 25 and 26 students, 20 of whom will be EU students from 2025 onwards. The RCSI will provide these 20 EU places from September and would like to be in a position, with Government support, to increase the number to 35 the following year. Over time, this will expand domestic graduate output by approximately 25% and will contribute to workforce sustainability. Overall, the RCSI has indicated it will produce 75 graduate dentists when fully operational. Within the model, the RCSI proposes to establish dental education centres that would be community based dental clinics to train students. This is really welcome. These centres are planned to be located in areas of deprivation where there is a pronounced need for greater access to community dental care and there is a dearth of both HSE infrastructure and private dentists participating in the dental treatment services scheme. The RCSI will train the dentists in their facility in Sandyford and the Connolly education centre. The RCSI also plans to train dentists in an outreach primary care centre in Ashtown, north Dublin. This is really welcome.

Last year, the State provided care to 300,000 medical card holders over the age of 16 through the dental treatment service scheme, DTSS. In order to address contractor concerns regarding the DTSS, a range of measures came into effect in May 2022. The Minister for Health also increased the fees paid to dentists for most treatment items by 40% to 60%. These measures are having an impact with access to care continuing to increase each year since they were introduced. In 2024, more than 227,000 additional treatments were provided under the DTSS, supporting more than 44,000 extra patients. Activity has continued to increase further into this year. Preliminary data from the first half of the year indicates almost 3,000 patients have been additionally treated compared to the same period in 2024.

The Department of Social Protection administers the treatment benefit scheme funded by PRSI contributions to the Social Insurance Fund. The scheme provides a financial contribution towards certain dental, optical and medical appliance services for eligible social insurance contributors. In all, more than 2.7 million contributors are eligible for services provided under this scheme. These treatments are also available to their dependent spouses or partners, if applicable. Under the dental scheme, the full cost of one oral examination per calendar year is covered. The scheme also provides a payment of €42 towards the cost of one scale and polish with the patient paying the remainder, capped at €15. Furthermore, it provides a payment of €42 towards periodontal treatment with the balance payable by the patient. All the above payments are available to eligible contributors once every calendar year.

Activity within the dental element of the scheme is increasing in both claim volumes and associated costs. In 2023, €63.7 million was spent on 1.6 million claims, while €75 million was spent on 1.7 million claims last year. The Department of Social Protection keeps schemes under regular review to ensure they meet their objectives. Any changes to the treatments available under the scheme would have to be considered in a policy and budgetary context.

There are also important measures making a real difference for patients today. In tandem, we are driving fundamental reform of our healthcare services for the future. The Government’s national oral health policy, Smile agus Sláinte, aims to radically transform our current oral healthcare service, recognising that we need an entirely new approach to oral healthcare to meet the needs of our population into the future. The policy provides a framework to comprehensively reform oral healthcare services, supported by accompanying reforms to legislation, strategic workforce planning and education and training. Implementation of this policy is a programme for Government commitment. To support a focused and structured implementation process, the Department of Health and the HSE are currently finalising, following the targeted external consultation, a three-year implementation plan for the first phase to guide an acceleration of reform. The Deputy asked about this when he spoke and my understanding is that this plan is currently with the HSE for further observations. Mr. Bernard Gloster, the chief executive, is part of the management team that will be signing off on it. That is where it currently stands at the moment. The plan is with the HSE and we hope to expedite it as quickly as possible to support a focused and structured implementation process. The plan will provide a multi-annual framework for policy implementation and will help to inform the necessary budgetary considerations.

I did not get to conclude my written speech because I wanted to include the piece about the RCSI, but there is a copy of it that the Deputies have all received.

Charles Ward (Donegal, 100% Redress Party)
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I thank my colleague, Deputy Stanley, for tabling this motion, which I fully support. Dental care is completely inaccessible, especially for people in rural areas. In Donegal, children are lucky if they have seen a dentist once by the time they are finished school. Many of them have not seen one at all. I know this from experience, as I have four children. Maybe one has seen a dentist but the rest have not, unless we go privately. The Irish Dental Association has outlined that just half of the children targeted for school dental screening were screened in 2022. Of those who are seen, many are seen late, with almost a ten-year backlog in accessing services in parts of the country.

It is very common for children in Donegal to receive their first appointments when they are nearly finished primary school or well into secondary school. The HSE threshold for children and teenagers to avail of essential dental treatment like extractions or orthodontic work is far too high. Many children in Donegal are forced to go across the Border to access essential dental treatment. This is not for cosmetic procedures; this is for essential treatments. The application process can be complex and confusing, with many constituents feeling misled or unclear about the eligibility requirements. Some of the requirements to ensure reimbursement are unnecessary and, frankly, ridiculous. When people go into the North to visit a dentist, they have to purchase an item from a shop in the North so as to have a receipt to show they are actually in the county of Derry or Tyrone. That receipt would then be proof instead of the dentist actually filling in the paper. Dentists do not take that. People must have the receipt. Some of the requirements to ensure reimbursement and some of the things people have had to do are bizarre.

Many people are unaware of these requirements, believing the application and confirmation from the clinic would be enough. This is not the case, and many people are misled and some are out of pocket for significant amounts of money. The Ombudsman himself, Ger Deering, has criticised the HSE for an unreasonable, inflexible approach to administrating the scheme. It funds treatment abroad for healthcare that the State is either unable to provide or unable to provide in a timely manner in Ireland. In his report, entitled "In Sickness and in Debt", the Ombudsman found that some patients faced a fight to be reimbursed for the legitimate costs they had incurred for necessary treatment they had received abroad. Many people were forced to borrow money, and some fell into debt as a result. In other cases, approval to have treatment abroad was unreasonably refused or delayed. This is completely unacceptable and it is clear that the application process needs to be far more accessible and the scheme needs to be flexible.

We also need to address the severe lack of dentists. This is what is causing such a backlog. Last year, there was only one dentist per 2,500 eligible medical card patients in Ireland. One in six patients on private dental care waiting lists is waiting over three months for an elective appointment, while half of patients are being forced to wait longer than three months for specialised care. The Irish Dental Association has outlined issues regarding staffing across the sector, which is limiting capacity and patient access. Our overreliance on non-EU students at our dental schools is growing, so we need to increase the number of places available to undergraduates in the country. We need to start taking necessary steps to address this.

I agree with this motion.

We need to provide a significant increase in dental school places in University College Cork, UCC, and Trinity College Dublin, but we also need to expand significantly beyond Dublin and Cork. It is clear that we need to establish a new dental school, and this should be established in the north west. I do not believe we can properly address issues in the public or private dental sectors, particularly in rural areas, without establishing a dental school in the north west. The Atlantic Technological University is steadily growing. It is developing its campus. There are new courses going on all the time. The university should be supported in establishing a dental school to address the staff shortages and clinic closures we are seeing across the country.

The HSE needs to step up its recruitment. There are dentists in County Donegal and beyond who would work and who would help. The Government needs to ensure significant investment to make sure this is addressed in this upcoming budget. Oral health has often been left behind in health budgets despite the fact that so many oral health issues are preventable. Early intervention is available to ensure issues are caught in time. However, like everything else, the Government sits on its hands and allows issues to grow and fester until we have a full-on crisis. It is time we break this vicious cycle.

Ruth Coppinger (Dublin West, Solidarity)
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Why are teeth a luxury item in Ireland? Why are they considered an accessory? Everything about our dental system implies that. On one hand, one in six adults over the age of 54 in this country has no natural teeth. The figure for Japan is 15%. It is just completely different. We have a historic and systemic unequal dental system whereby if people are rich and able to pay, they can keep their teeth and keep them straight and white, and if they are poor, they cannot. Then, we have so many more people who have VHI, which does not cover, for example, periodontal treatment at all and yet the way most people lose their teeth is from gum disease. It does not cover orthodontics. Every parent in this country knows that when their child reaches a certain age, they will be coughing up four grand for braces. Why is that? Teeth and gums are essential for a person's overall health. They are also essential for people's self-esteem and that is important as well.

This idea that people should go to Turkey and get a loan or save up the money to restore their teeth is not generally done. Maybe celebrities do it, but for most people, it is to get implants to keep their teeth so they can actually smile and so that they do not feel self-conscious. Most important, however, it is related to people's cardiac health. A person I know who is waiting for a heart transplant had to get all of his teeth removed recently because it would be too injurious to his prospects not to do so.

Why do we have a dental system where very few elite people can qualify and provide care under the private system and then there is hardly anybody in the public health system? It really is shocking. I welcome this motion. We need much more discussion on this topic. I welcome the fact it has been tabled.

A person might pay tax in this country, and this is where the injustice of the tax system comes in. On paper, we have a so-called egalitarian tax system, but in practise, we get nothing for it. I went to France some years ago and had a dental problem and I got treated immediately in the public system for €50. I would be waiting so long in Ireland for that, and it would probably cost thousands of euro.

According to the HSE, there are 7,000 children in Ireland waiting for urgent dental care, and 1,100 children have been waiting more than four years. In 2003, 104,000 children missed out on school dentistry checks at which problems can be picked up early. In 2024, 2,000 children were facing a waiting list of over four years for orthodontic treatment. We know most people do not even bother putting their child on the public list. They just save money or get a loan or whatever, and that goes into the hands of private providers.

The prices for dentistry have increased dramatically in the past five years by 20%. It has led to what the Irish Dental Association has called a divide between rich and poor on affording care for their teeth. For dentistry that requires a general anaesthetic for children with disabilities or anxiety, the waiting list is even longer; it is well over two years. The Economic and Social Research Institute, ESRI, noted that the majority of dental care is private and paid out of pocket. The fact is this is being put down by professional associations in the area to a lack of investment in public dental services.

We need massive investment to create a public dental system. We also need to recruit and to open up the recruitment system. For example, we have a situation at the moment where only UCC and Trinity College Dublin provide places. My understanding is that a number of places are for international students so that the colleges can avail of increased fees. The problem with that is that it means those people may not stay and work in the public system. We need to open dentistry up, not just to those who achieve 625 points, which is massively unattainable for most people, and make it something that ordinary young people can get into.

Teeth are not luxury item. They are not an accessory. They are absolutely essential for people's health, and it is time that Ireland started recognising that fact.

Aidan Farrelly (Kildare North, Social Democrats)
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We will move to the Sinn Féin members, starting with Deputy Gould.

Thomas Gould (Cork North-Central, Sinn Fein)
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I will just give the Minister of State some figures. Before Covid-19, in the first quarter of 2019, 5,175 children got dental screenings in Cork city. In the first quarter of this year, it was 4,938. There were fewer children seen in the first quarter of 2025 than there were in the first quarter of 2019. We must factor in that during the Covid years, screening went below 2,500.

There is a crisis now in dental care for children in this State and there seems to be no plan to deal with it. In an area I represent in Cork city, Mayfield, the Government closed Harrington Square and the centre at the COPE Foundation where dental services were provided. Now children in that part of the city, in Ballyphehane, the Glen, Mayfield and Glanmire, must travel to the other side of the city to get services. How can that be right? This is something the Government has done for the last number of years. It has stripped services out of the north side of Cork city, whether it is dental services or doctors. We are waiting for primary care centres. There is no primary care centre in Glanmire, Mayfield or Blarney. What we have now are waiting lists for children to be seen.

We are talking about dental services here. There is a two-tier system in this State where if people have money, their children will get the care they need and if they do not have money, they go on a waiting list for years. I have spoken to parents whose children were so long on the system waiting to get treatment that they became adults. How can that be right? Then once they become adults, they are not entitled to the care and they have to go on a different list. Enough is enough; children deserve and need proper dental screening and proper dental care.

Louis O'Hara (Galway East, Sinn Fein)
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Access to dental services is fundamental to a person's overall health. A person's income or means should not be a factor as to whether he or she can access the dental services he or she requires. However, we have seen a total collapse in the school screening programme, while adults with a medical card find it increasingly difficult to access care under the dental treatment services scheme, DTSS. Over the past number of years, we have seen the number of dentists who are participating in this scheme reduce, and people in need of dental services are forced to travel increasing distances for appointments. In my constituency of Galway East, there are just five dental practises to provide dental services to medical card holders. Not all of these will take on new patients.

I recently hosted a group from the Brothers of Charity and Galway Advocacy Council in Leinster House and their experience of the DTSS is grim. To quote one of the advocacy council members:

Medical card holders in Galway simply cannot get dental appointments. Every time we ring, we are told we can go on a waiting list. However, we have yet to find anyone who has come off the waiting list. Not getting appointments is leading to a deterioration of people's teeth, gums and general well-being. We want services in our locality. At the minute, we are travelling miles to get an appointment and many of us cannot drive.

The current situation is disgraceful. The Government is punishing ordinary families who cannot afford private healthcare as a result of incompetence and mismanagement.

Access to care needs to be on the basis of need, not ability to pay. We need to recruit and retain more dentists and, crucially, ensure greater participation in the DTSS so medical card holders can access care in a timely manner.

Seán Crowe (Dublin South West, Sinn Fein)
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I agree with other speakers in that successive Governments have left dental services for public patients to collapse in the State. The dental services scheme for medical card holders has been in a state of chaos for years. In the term of the previous Dáil, the then Minister, Stephen Donnelly, assured us at a meeting of the health committee that a breakthrough on dentists was imminent and that services would be restored for all medical card holders. That was clearly not the case. Hundreds of thousands are left without access to dental treatment they simply cannot afford to obtain privately.

Dental care is another aspect of the healthcare sector that we have seen privatised by stealth. Residential care services and eye and hearing services are other examples of services that the State is steadily scaling back, relying on the private sector to pick up the slack. In disability services, we expect charities to do likewise. We must initiate a widespread recruitment plan for public dentists and sort out the DTSS so medical card holders can gain access to treatment. It is simply unacceptable to leave hundreds of thousands of people without access to dental care. This is an area of health in which it is guaranteed that a person will get worse without care. Having a dental issue can have a debilitating effect on quality of life. We cannot even give schoolchildren one check-up to ensure their teeth are developing properly.

It is pointless to talk about how we are spending more and more on health every year when there are fundamental services degrading over time. A dental service plan has been long promised. It must be published and discussed in this House and the health committee so we can get back on track and give people care at the level they deserve.

When I was chair of the health committee, we visited Daisy Hill Hospital. It has a free theatre for a number of days per week. It is ideal for dental surgery in the Border area. The Minister might consider that proposal.

Johnny Mythen (Wexford, Sinn Fein)
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I thank the Independent and Parties Technical Group for tabling this motion. Access to the DTSS has worsened every year under the Government's watch. Since 2020, I have raised this issue here, along with many other Deputies from across the country. Data in 2020 showed us the extent of the serious and erroneous condition of dental services. Thousands of people are left in pain, some for over a year. Children with special needs and disabilities who need immediate dental treatment have to wait for months for an appointment. Included are many of those who require treatment under anaesthetic. Each of the four main towns in my county – Enniscorthy, Wexford, New Ross and Gorey – faces these unacceptable conditions daily.

There are 104,000 children on a waiting list for school dental screening out of an eligible 208,000. This is forcing parents to go private, costing them an arm and a leg, which they cannot really afford. Of the 810 dentists signed up to the DTSS, only 600 are active. Seven thousand children have been waiting for over a year for orthodontic treatment and more than 2,000 have been waiting for over two years. How is this being allowed to continue? How can anyone justify this or attempt to say things are okay? It is now time to publish the promised dental services plan. People need to be able to access the HSE emergency dental service when needed. However, this is not happening. That statement alone is an indictment of the lack of support and inability of future planning for orthodontic services that has left our citizens with a broken system and a totally inadequate DTSS, where 50% of dentists over the past ten years have rejected the scheme.

It is now time to fix the problem, not just stumble from year to year having the same debates and discussing the same motions. It is not fair to the thousands of families who are being screwed for the last cents in their pockets because of the inability of the Government to plan, take hold of the real problem and give the people of the country the dental service they deserve and are entitled to.

Mairéad Farrell (Galway West, Sinn Fein)
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This is an issue we have been discussing for many years. In my home county, Galway, not a single dental practice is taking on new patients with medical cards. This is an issue I have been raising for some time. Consistently over recent years, people in dire straits have come to me, whether for themselves or their children, to try to gain access to medical care. A child in absolute agony might be told there is no dentist who can take him or her but that he or she can be put on a list with a waiting period of several months or a year. Anybody who has ever experienced a toothache will realise it is not something a child can live with day in, day out. It is not a good enough response.

I have reached out to the HSE on this and the response was that people should look in other counties. That is not feasible or practical. The response is not an answer to the question. I am sure that if the people concerned asked about services in other counties, they would find it very difficult to find a dentist who would give the medical care with a medical card. Really and truly, what we need now is a plan.

Another dental issue I was contacted about concerns a woman who flagged with me that her young son, who has had significant dental issues throughout his primary schooling, will not be seen within the school system until he is in sixth class. The family has already incurred many dental expenses for which it has had to save. Again, that is not good enough. When it comes to dental care, or any form of healthcare, treatment for an immediate need should not be based on what money you have in your back pocket to fork out for it. The reality is that everybody, including every child, deserves dental treatment when they need it. Therefore, we need to see a plan put in place to ensure people from across Galway and other counties have access to dental care when they need it.

Conor McGuinness (Waterford, Sinn Fein)
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Over 200,000 children were eligible for school dental screenings last year but only half were actually seen. The other half, amounting to more than 100,000, were left behind. It is not an isolated failing; it is part of a wider collapse in public dental services – a collapse that is hitting families hard, especially those without the means to pay privately. Even medical card holders are struggling to find a dentist, let alone get an appointment.

In Waterford, the picture is especially stark. Staffing for children's dental and orthodontic care has halved since 2022, according to figures released to me in response to a parliamentary question. These are not abstract figures; they reflect the reason children are waiting in pain. The Minister, other representatives in Waterford and I have met some of the families and helped them to gain access to care, but families should not have to go on radio or to their local TD to get very basic care for their children. The statistics point to why children are left waiting in pain and are missing school. When they can get to school, they cannot concentrate. They are losing out on parts of their education and suffering avoidable health problems that get worse while this issue is not addressed.

Half of all children due school dental checks last year were not seen. In Waterford, the situation is much worse. The staff number has halved since 2022. We are without a senior dentist in Waterford and there is no full-time orthodontist in place. Children are waiting in pain while services collapse around them. The Government's failure to act on this is hurting families and it needs to end.

We know how critical second-, fourth- and sixth-class screenings are for early detection. When children are missed, small problems become major. In regions like the south east, which now has the second highest number awaiting orthodontic care, the crisis is only deepening. The number of dentists providing care to medical card patients has fallen by 200 in just eight years. In Dungarvan in particular, but also in other parts of County Waterford, it is next to impossible for a medical card holder to get a dentist, much less an appointment. The service is being hollowed out and the HSE has admitted it cannot manage the preventative care backlog. When will the Government act? When will recruitment bans be lifted and proper funding be delivered to restore services in Waterford and across the rest of the State? When will the contract be agreed with dentists so medical card patients can get access to much-needed dental care services?

Donna McGettigan (Clare, Sinn Fein)
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The lack of dentists and orthodontists across the State is a long-running problem that I raised when I became a councillor in Clare County Council and have since raised in the Dáil since my having become a TD. Not only has there been no progress in this time but things have gone from bad to worse, despite the lip service paid to the problem by the Government. There was a 46% reduction in investment in dental treatment service schemes between 2017 and 2021 and a devastating 50% reduction in the number of dentists practising in the scheme in the past decade. These figures have been available to the Government and they should have acted as a wake-up call, but they have fallen on fell on deaf ears, it seems.

On the basis of the most recent figures I have received, eight dentists are still practising under the DTSS in Clare. I first sounded the alarm bell when the number had reduced to 17, so the situation is beyond alarming now. There are no orthodontists in Clare. Patients are referred to St. Camillus Hospital, Limerick, and languish on the waiting list there. Recently, a constituent of mine was told her daughter would have to wait from three to four years to have braces fitted. By then, she would have started college. That girl was in pain and her mother was at her wits' end, and since there was no hope in sight for them, they ended up going private. I had contacted the Department about this. This is just one example of many.

In response to the number of constituents coming to me who are unable to find a dentist, I phoned around in Clare and discovered none of the practising dentists was taking on new patients with medical cards. That is another of the Government's failures. Another is chronic overcrowding at University Hospital Limerick, which is also impacting on this problem.

Some dental patients require anaesthesia for extractions, and when the hospital is forced by overcrowding to enact surge capacity protocols, it cancels day procedures, including dental extractions. There are no dental anaesthesiologists in Ennis hospital. Failure to treat dental problems promptly can have serious long-term impacts on a person's health. Tooth infections can cause sinus infections, which can be serious. They can also lead to bacteria in the blood and can increase the chances that a tooth that could have been treated ends up being extracted.

Rose Conway-Walsh (Mayo, Sinn Fein)
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If there was ever an example of a do-nothing Government, it is when it comes to dental care. I want to read out a letter from somebody in County Mayo:

I’m writing to you as a desperate mother from Mayo. For the past five years, my family has been unable to access any dental care through the medical card in our area.

No one is accepting new patients, and despite endless phone calls, pleading, and searching, we’ve hit a brick wall over and over again.

My 23-year-old daughter is on a disability payment and has been in constant dental pain.

She has many cracked teeth, cavities and a likely infection, and she is getting to the point where she may not be able to eat soon.

She’s trying every day to find someone who will see her, but there is just no one available.

She is only 23 and deserves so much better than this.

My husband is also suffering.

He was told he needed dentures and was referred to get all his teeth removed first but no one in the county will do it.

He was even sent to the north for treatment, but they couldn’t help him and he had to come back [to Mayo] untreated. He’s now left in limbo, unable to eat properly, in pain, and with no idea [of] where to turn.

Our family is at the end of our rope.

We feel ignored, abandoned, and forgotten by a [Government and a] system that is supposed to care for its people. This has become an emergency.

We don’t have the money to go private, and yet the public system is impossible to access.

That about sums it up. I do not know how many times last year I spoke on dental services and the lack of them in County Mayo. We were referred to the HSE and back again, and when there was nothing there, back again. For heaven's sake, will the Government please do something? I thank the Deputies who brought forward this motion. What is outlined in it is what the Government needs to do. It has been outlined over and over again. Can the dental care system please be fixed? It is a basic human right.

Cathy Bennett (Cavan-Monaghan, Sinn Fein)
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I thank the Independent and Parties Technical Group for bringing forward this motion on this very important matter. This Government is utterly failing in terms of dental services. The Minister's role is to provide a framework in which services can reliably and efficiently be delivered and to adequately fund these services. As I see it, the Minister is utterly failing. Of the 200,000 schoolchildren eligible for dental screening appointments, only half received what they were entitled to. Blaming the pandemic might have flown in its aftermath, but at some point the Minister must accept that her job is to address this backlog and not to make excuses for it.

Despite the increase in population, the Irish Dental Association tells us we have 23% fewer public dentists than we had 15 years ago. What have Fianna Fáil and Fine Gael done that they have overseen the collapse in the school screening programme? At the same time, they have fostered an environment that has seen the number of dentists participating in the scheme to provide care to medical card holders decrease by 50% in just eight years, despite warnings from across this House. In County Monaghan, for example, as of May 2024, nearly 40% of whole-time-equivalent hours for dentistry positions were vacant. Last month, the one consultant orthodontist post in the region was also vacant, as were both specialist orthodontist posts. This is utterly scandalous and stands as another testament to the failure of Fianna Fáil and Fine Gael in terms of dental services in counties like Monaghan. When will the promised dental services plan be brought forward to address the situation? The truth is that free dental services for children up to the age of 16 do not exist.

Louise O'Reilly (Dublin Fingal West, Sinn Fein)
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There are 7,000 kids who have been waiting for dental treatment for more than a year. It is a damning figure and one the Government should be rightly ashamed of it. I am sure the Minister of State is ashamed of it. She might not put it on the record, but I am sure she looks at those figures and feels some shame. Despite the veneer of a public system, the vast majority of dental care is carried out in the private sector. We have heard from people who have been forced to go to the private sector and forced to take out loans just for something very basic in a civilised country. We should not really have to come in here to beg the Minister of State for dental services for kids, but this is the situation the Government has brought us to and the reason we are here this morning. I thank the Deputies who brought forward this motion.

The impact of the Government's failure to provide even basic checkups is felt by kids right through into secondary school and into adulthood. Added to the pressure to go to the private sector and to get a loan, what do people do if they are in bits with their teeth, in pain all night and cannot access the public system? God knows, people cannot get anywhere near it. They cannot wait a year and a half with a toothache. Dentists now have in their waiting rooms - and I saw this last week - signs saying buy now, pay later. There was a brochure with a lovely big picture featuring a lovely woman with a big smile on her face, as if buying now and paying later would give you the toothy smile of your dreams. Every person I spoke to in that dentist's waiting room was someone in pain and on a low income who was getting into short-term debt they could not simply for the privilege of not having a toothache. The figures speak for themselves.

Aidan Farrelly (Kildare North, Social Democrats)
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I thank Deputy O'Reilly.

Louise O'Reilly (Dublin Fingal West, Sinn Fein)
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The inaction of this Government has caused tens of thousands of children to miss out on basic dental care. The impact of this is felt throughout their lives.

Aidan Farrelly (Kildare North, Social Democrats)
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The time is up now, Deputy.

Louise O'Reilly (Dublin Fingal West, Sinn Fein)
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Now, they are getting themselves not just into long-term debt but also into short-term debt.

Aidan Farrelly (Kildare North, Social Democrats)
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The House might join me in welcoming our Young Scientist and Technology Exhibition winners in the Public Gallery: Ciara Murphy, Saoirse Murphy and Laoise Murphy and their parents. We wish them well in making their presentation to the health committee at 12.30 p.m.

Marie Sherlock (Dublin Central, Labour)
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I extend a sincere welcome to the Young Scientist winners. I sincerely thank Deputy Stanley for his motion. The reality is that public dental services in this country are on the brink of collapse. We know there has been an almost 40% drop in the number of dentists participating in the dental treatment services scheme over just five years. The number of directly employed HSE dentists has fallen by about one third since 2009. When we think back to those awful years post the recession, there has been no investment by the HSE since to increase the number of dentists working directly within the organisation. We know in places like Laois–Offaly that school assessments have had to be suspended. In other parts of the country, sixth-class assessments are now being conducted when the children are in sixth year of secondary school. As one dentist said to me yesterday, some of her children are now driving themselves to their appointments. That is outrageous. The critical point here is that with all these facts and figures, we have a very clear picture and it is that the public dental services are being allowed to whittle away in favour of the private provision of dental care, leaving those on low incomes and with limited means in a desperate situation.

Let us start with the public dental service. We have just 249 dentists covering the entire country, down from 330 in 2009. It is scandalous that this has been allowed to happen. As I said, this has a very real impact, particularly on low-income persons and people dependent on the medical card or with particular dental circumstances who cannot access private services. There was a time when the school assessments used to happen in second class, fourth class and sixth class. There were even senior infant assessments in some parts of the country. Now, in many parts of the country assessments are limited to sixth class, or will be in the coming months.

Of course, by the time those children get picked up, the result is that there are very high levels of decay and increased levels of extractions. The extremely important orthodontic checks are not being picked up because the dentist is the first point of contact and screening with regard to the need for an orthodontic check, especially when children are coming up to their teenage years. This is leading to much more complex and expensive care being needed as those children go into adulthood.

Not only have pay and numbers had an extraordinarily devastating impact on dental employment within the HSE over the past number of years, it is also the case that the recruitment process, where it does exist across some of the health regions, is painfully slow. One principal officer told me yesterday that it took 14 months for his role to be filled. It is not just about dentists; it is also about nurses. Another dentist working within the HSE has told me that he cannot provide clinics because he does not have the nurses available. A business case must be prepared to try to recruit a dentist. They will be lucky if that recruitment process commences by Christmas. This is completely unacceptable. It is perhaps the silent aspect of the motion before us. While we are talking about dentists, it is also about dental nurses. They are a critical part of the infrastructure because no dentist can function unless they have a dental nurse by their side.

The key devastating part of all of this is some of our most vulnerable children are those who are being hit hardest. Children with additional needs or special needs who require care under general anaesthetic are obliged to wait two years or more for that care. Kids in Kildare have to travel to Dundalk in order to be treated under general anaesthetic. Kids in Waterford have to go to Cork for such treatment. I am aware that in one part of the country adults requiring specialised care involving general anaesthetic have to wait five years for treatment. That is absolutely unacceptable.

We have to get serious about recruitment to the HSE. We also have to get serious about the dental treatment services scheme and the number of dentists who are no longer participating. There has been a drop of 38.4% in just five years. The number participating is down to 833 according to the responses received by my office to parliamentary questions I submitted. If we saw this level of drop in GP numbers in this country, it would be a national scandal. Yet, because it is dentists, we are not seeing the same reaction. We need much greater ambition and direction on the part of the Ministers of State, Deputies Butler and O'Donnell, to ensure that dental services are properly resourced.

The other big part of the jigsaw is recruitment. In reality, if you are a dental student graduating in this country, botox anaesthetics is a very lucrative path to go down. We know that some dentists are going down that path. For others, staying within private practice is certainly a much more exciting prospect because of the range of services they get to provide. There is a real issue where dentists with a number of years' service go into the public system because the range of services they provide is arguably more limited. We need to look at the schemes that existed in the past. The vocational trainee scheme, for example, was in place 20 years ago. There used to be five places across the Republic whereby a dental graduate would effectively work under the mentorship of a private dentist and within the HSE for a 12-month period. This provided fantastic training before they went out into private practice or public practice. That scheme has been gone by the wayside for many years. It needs to be reintroduced.

There is another reality within our dental schools and in the context of the profile of students within those schools. A large number of those graduating from our dental schools are not staying in this country. They are going abroad. From talking to some dentists, I understand that 20 years ago the majority of students were Irish born and from the Middle East. We are now seeing a large number of students from Canada and other parts of the world coming here, availing of world-class training, paying for it, obviously, and then leaving very quickly after graduating. This is a serious issue. The State is spending significant amounts of money on that training. Obviously, those students who are coming have to pay but there have to be real questions about the third level institutions providing dental training and about what are we doing to ensure that we retain those dentists into the future.

The system of PRSI benefits was enormously popular prior to being cut back in 2009. It was enormously popular for people in being able to go to their dentist and avail of a range of services paid for through their PRSI. That has been scaled back dramatically. People can now only avail of a very limited number of services. Ultimately, if one needs any sort of proper work done, one must go private. It is high time that we ensured an expansion of the range of benefits afforded to people by means of their PRSI. Oral care and dental care are hugely important for our population's health, and the State is doing far too little to support those involved in providing them. A crucial point is that for far too long people feared the procedures carried out by dentists; now they fear the length of time they have to wait to try to access dental procedures. That is unacceptable. If we saw the same drop in the numbers in GPs that we are seeing in HSE dentists, and those participating in the DTSS, then we would not be here in the Chamber debating with these small numbers. We would be having a much larger national conversation. We need this Government to take dental services and how they are resourced much more seriously and ensure that many of the things called for in Deputy Stanley's motion are implemented.

Liam Quaide (Cork East, Social Democrats)
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I thank Deputy Stanley for bringing forward the motion. It presents us with another opportunity to discuss the crisis in dental care. The Social Democrats tabled a similar motion in May of last year. Unfortunately, the challenges facing dental care in Ireland remain and urgent action on the part of the Government is still required. One significant issue relates to the number of dentists within the HSE and the numbers currently being trained to deal with unmet patient need. Patients are being left to sit on waiting lists up to two years for procedures involving general anaesthetic and six years for orthodontics, while the Government is failing to provide adequate funding to increase the number of dentists being trained.

I am sure many of the same numbers from the Irish Dental Association will be mentioned time and again during the debate, but I would just like to point out some salient trends. Half of all eligible children are being denied access to their dental screening appointments due to shortages of dentists within the HSE. This means that 104,000 children are missing out on their scheduled check-ups. The number of HSE dentists has declined by nearly one quarter over the past 20 years. We have seen a 31% reduction in the number of children being seen by HSE dentists in the past five years alone. It is not just children who are being affected by shortages in the number of dentists. One in six of all patients is left waiting more than three months for a routine appointment.

If we are to address these ongoing issues around the number of dentists within the system, we must address the funding and capacity issues relating to the education and training system. The two dental schools in this country are run by Trinity College Dublin and University College Cork. Neither has received significant funding in recent years to either update or expand their facilities or increase the number of trainees they have in order to keep up with patient demand. The dean of the school in Cork has described its current building as "frail" and said that its continued use is "untenable without significant investment". He pointed out that it has a leaky roof and other issues that come with buildings of a certain age. He has highlighted the need to update and even replace much of the dental equipment being used currently within the school.

As in so many areas, this Government is not getting the basics right with dental service provision. There had been plans to expand and relocate the Cork University Dental School and Hospital but these now appear to have been dropped, seemingly due to a lack of funding from Government. The school, which is located on the Cork University Hospital campus was granted planning permission back in 2019 for a five-storey building in Curraheen. The new building was designed and the project went to tender. The Tánaiste visited the site and turned the sod but the development appears to have effectively been shelved.

Continued underinvestment in our dental schools has contributed to the insufficient number of dental graduates coming into the system each year and to a growing disparity between need and number of dentists required to meet that need. I appeal to the Government to address this specific issue that is contributing to our crisis in dental care services and to provide the necessary funding for a new dental school and hospital building in Cork.

Rory Hearne (Dublin North-West, Social Democrats)
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I thank Deputy Stanley for tabling this motion on what is a very important issue. The public dental care service has declined significantly in recent decades. It is incredible how the idea of access to dental care is considered a luxury rather than a public service that should be universally available on the basis of need. It should not be about whether people can afford to pay. It is an incredible indictment of how we have developed our public services that areas such as dental care are not seen as core to the public health system.

The Government can argue about the funding it has put in - and it will speak about that - but the reality for people is that trying to access dental care in the public system, including for an emergency, is extremely difficult. One of my children needed a tooth out. People who need a tooth out are told it will take a certain amount of time. As a result, they have no choice but to go private. The cost of private dental care is astronomical. This is another part of the quasi-privatisation or outsourcing in our public services. It is deeply disappointing.

The Social Democrats believe in a public universal health system under which people have access to dental care as a human right and a basic human need. Dental care is interconnected with so many aspects of our lives. The problems have been outlined, including underfunding, under-resourcing and understaffing.

I want to speak about children and dental care. Since 2023, more than 100,000 children nationally have been missing dental checkups annually. Two thirds of posts advertised remain unfilled as the staffing crisis worsens. A total of 65% of dentists have said that staff shortages impact on the care of their patients and their capacity to deal with emergency appointments. Delays in visits result in escalating need. Delayed intervention requires more intensive and emergency care, particularly for children. It is no different to early years intervention for additional needs in education. Dental intervention in children is key to preventing the much more expensive and traumatic procedures that must happen if we do not have proper preventative care and intervention.

Dental care is an extreme financial burden on families. Children are suffering as a result of the lack of dental care. As I have said, oral healthcare is not a luxury; it is necessity. The current model of access denies children this necessary care. Dental health and general health are not two separate things; they are intertwined. Unfortunately, as a result of the cost-of living-crisis, people have far less disposable income. The Irish League of Credit Union's annual back-to-school survey has found that one in three parents will get into debt to cover back-to-school costs. Along with covering rising rents and the rising cost of food, families have to consider whether they can afford to go to the dentist. What does this mean? It is an incredible decision when we think about it. Families have to decide whether or not they can bring their child to the dentist. They will put off this care. The child might be in pain but they put it off because they cannot afford it that week. Then it ends up being a much worse situation. Parents have to choose between food and going to the dentist. It is wrong that children should bear the cost and pain of inadequate public dental healthcare.

As recently as 2023, 104,000 eligible schoolchildren were denied screening appointments by the HSE's dental service due to a shortage of public-only dentists employed by the executive. The Irish Dental Association has voiced serious concerns regarding access to dental care for children. There are two-year waiting lists for treatments requiring general anaesthetic, as my colleague Deputy Quaide outlined, with decisions having to be made on which children have the greatest need. This is a sanitised way of saying dentists are being forced to choose which children are in the most pain in order to treat them first.

In my constituency of Dublin North-West, the number of dentists contracted to the dental treatment service scheme in January 2024 was a shocking 31. Almost 20,000 children in Dublin North-West are being treated by 31 dentists. It is a simple and sad fact that these children will not receive the oral and dental care they need and deserve. Figures released by the HSE in February indicate that 6,289 children were registered as new patients for scheduled assessments Dublin North-West. This cohort is to be assessed by 31 dentists and is in addition to their current patients. Acute need for dental care impacts on vulnerable children and children with additional needs. Children with autism or special needs face extremely long waiting times as they often need more specialist care and there is no staffing capacity for it.

It is clear that chronic underfunding, historic under-resourcing and, I would argue, a lack of commitment to a public dental care system and model, have resulted in this crisis. It has to be addressed. Children cannot be allowed to languish on waiting lists without access to appropriate healthcare or to suffer the pain and indignity of poor access to the dental care that should be available as a human right and a public need. It is the least we should be doing in a republic that is committed to cherishing all children of the nation equally.

Michael Collins (Cork South-West, Independent Ireland Party)
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I thank Deputy Stanley and his group for tabling this very important motion, particularly in view of the crisis we have in dental care throughout the country. In the past 12 months alone, Cork has lost 58 dentists who were providing treatment to medical card holders. This is almost one quarter of all dentists who are part of the dental treatment service scheme. These include 22 dentists in the south Lee area, 25 in the north Lee area, eight in west Cork and two in north Cork. These are not just numbers; they are people and families left without access to basic dental care.

The figures speak for themselves, with a 23.57% drop in the number of dentists participating in the dental treatment service scheme in only one year. We are met with nothing but a mass exodus from the scheme, which is no longer fit for purpose. One Cork dentist described the system as being like banging your head against a brick wall. Who could blame dentists? The scheme is outdated. It was designed in 1994 and it has failed to evolve in order to adapt to modern dental practices. Dentists are restricted to providing only two fillings per year, but they can perform an unlimited number of extractions. That is not healthcare; it is damage control. The HSE has admitted that access to routine care is now somewhat restricted and that the focus has shifted to emergency care. Emergency care is not a substitute for prevention. It is not a substitute for dignity. Dentists are burning out and patients are being left behind. The system is collapsing under the weight of its own neglect.

I call on the Minister for Health and the Government to act now. Reform the dental treatment service scheme, restore clinical autonomy, invest in prevention and, above all, ensure that every person in Cork and throughout Ireland can access the dental care to which they are entitled with their medical cards. We cannot allow this crisis to deepen. The people of Cork deserve better, our dentists deserve better and our healthcare system must do better.

The waiting time to see a HSE dentist for a routine visit for a child is five years. The urgent waiting time is more than two years. All children in west Cork, from Mizen Head and Castletownbere to Kinsale, are being referred to see dentists in Clonakilty or at St. Finbarr's Hospital campus in Cork city. There is no service west of Clonakilty. It is questionable that children who should be seen urgently are being put on a routine list. There are children in west Cork who have been put on the routine list at 14 years of age and are never seen as children because by the time they come to be seen they are aged over 18. They are then in the adult dental service and go onto another waiting list.

When I was growing up, there was a dental service in every town and village. In the name of God, what has gone wrong in this country? We take one step forward and two, three or four steps back. A mile or two down the road, we were able to meet our dentist on a weekly basis when we had problems. There was no issue. Now we have to travel 40 or 50 miles and we still cannot get to see a dentist.

If you cannot afford it, "To hell with you", you just lie in pain.

I brought up this issue a couple of weeks ago. I attended a public meeting at Oranmore, County Galway, with Deputy Michael Fitzmaurice and Councillor Declan Kelly. I met parents whose children had been scammed by a local orthodontist and neglected by the Dental Council of Ireland. These parents paid large sums upfront in 2022 for their children's dental treatment only to find out they were being deceived. Some children were left with misaligned jaws and others with braces but no treatment plan. Some had to remove their braces themselves or with the help of others over the phone. One girl had a wire sticking into her mouth, which her boyfriend eventually cut with a clippers. These parents have faced significant challenges as a result of the previous Government, the dental council and the former Minister for Health with no solutions or support available. The Dental Council of Ireland is supposed to investigate the fitness of registered dentists to practise based on allegations of professional misconduct or unfitness due to physical or mental disability. According to the parents of these children, however, the dental council has done absolutely nothing to help them. These parents and children have been left more than €2 million out of pocket. Let us imagine €2 million paid by parents who are hard-working people in Oranmore. It was sad to hear the stories at that public meeting. Out of respect, I travelled there to listen to their stories because Councillor Declan Kelly asked me to. They have had no satisfaction from the dental council.

We are living in a very tough time for some people out there. They are the ordinary folk, not the extraordinary folk. These people deserve answers. To be left €2 million out of pocket as these people were, tells parents they may not be able to send a child any further in education because of the amount of money that was wasted. It was initially paid up to get a proper dental service and they ended up getting no service. In the worst-case scenario, some of them already have a service that has been left unattended.

John McGuinness (Carlow-Kilkenny, Fianna Fail)
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I acknowledge the presence of Patrick O'Dea from Dromin in the Public Gallery. He is a colleague and friend of Deputy O'Donoghue and has travelled here from Spain. I hope he enjoys the proceedings.

Richard O'Donoghue (Limerick County, Independent Ireland Party)
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I welcome Patrick. It is great to see a fellow Dromin man in the Gallery.

The year 1968 is memorable to the Minister of State because his father was one of the members who set up St. Joseph's Foundation. It was set up to help vulnerable children and adults. It is still running and is a massive service that covers north Cork and south Limerick. Maybe it is time that history repeats itself. He could be the Minister of State who can deliver for young children in this country by reintroducing dentists into our areas and encouraging dentists through a work-life balance that will welcome them to Ireland, where they will be able to get affordable housing. They would be able to have a work-life balance when they come here and we would have the dentists as we had years ago. Maybe it needs something like what the Minister of State's father did in 1968, which everyone is grateful for. We need something like that now.

We need to reintroduce, number one, training and the offer of free college places. Other countries are doing it. They are sending people here to be trained. They go back to their own countries where they have to work for two years because they were given their training for free. Why can we not do that here? Why can we not get the front-line services by getting people to their college courses and giving them the training for free? We could ask them in return that they spend two or three years here for having their training done. Would that not encourage people who would love to be a dentist in this country but cannot afford to be one, if we now back them?

It is the same thing with our doctors and nurses. Other countries are doing it. I spoke to a doctor yesterday. Of the people she was in college with, four from her class were being paid to come here from other countries to train to be a doctor. It was in their contract that they had to return to their own country to do two years there because they had got their placements and college for free. Maybe it is time we did this to encourage people. It has gone on for decades. It affects young children and adults throughout the country. Children are going through the whole of primary school who are not getting their dentistry done. Maybe it is time to look for a change.

Ken O'Flynn (Cork North-Central, Independent Ireland Party)
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I have now been seven months in this House. This is another important debate that is going on in this House, but let us have a look at the benches. There is not one member of Fine Gael or Fianna Fáil on the backbenches. Not even the senior Minister bothered to turn up. Instead, we are left with the Minister of State. With all due respect to him, and I appreciate him coming to the House, we do not have the senior Minister here. Instead, we have the Minister of State for housing and older people, when we are talking about a dental issue. We are talking about one of the most important issues in this country, that of oral hygiene and oral health, and not one of those Ministers have turned up. Where is the Minister for Health? She is too busy looking for the Tánaiste's job rather than doing her own job. That is the reality of it. I am sitting here and looking at this continuously. Nobody is showing up for debates. Nobody is interested in what is going on in the country.

I met with a family in Cork the other day. They had to pay €1,900 because the dental hospital turned them away as it was a weekend. They were lucky enough to be able to get credit and money from the credit union. It was €1,900, despite having a medical card. I meet parents every day of the week whose children are on six-year waiting lists for orthodontist services. Most of them have gone off those lists because what happens when they hit 16, 17 or 18 years of age, and still have not seen a dentist or orthodontist, is they go into the adult cases. No wonder people are flying to Turkey to get their mouths reset. It is because they have no other opportunity. They do not see dentists or are two years waiting to see a dentist. There is not one dentist in my hometown of Mallow who will take a medical card. There is not one dentist in Mallow who will take DTSS patients. That is the reality of it. People are going away from it.

The Minister of State knows as well as I do that with the stroke of a pen he could fix this problem. To fix that problem, the same deal given to GPs needs to be given to dentists because this is a serious matter of oral hygiene for the entire country. We are not looking after people at all, whether children, men or women. It is impossible to get a dentist appointment. It is an absolute disgrace.

Danny Healy-Rae (Kerry, Independent)
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I am glad to get this opportunity. I thank Deputy Brian Stanley for tabling the motion on this very important and serious matter to give us all the chance to say a few words on it. We know the scenario in County Kerry is very drastic. Practically no dentist will take a patient on a medical card to remove or extract a tooth or to deal with that patient at all. Gladly, when people were in very dire circumstances, we found places for them in another county. That is a poor reflection. Some of these people are on a State pension. They worked all their lives, and contributed their stamps and all that, but their medical card is not taken. They have a medical card. The dentists say to me they have no agreement with the State and are not being properly compensated for carrying out the work. They do not undertake the work then. They are very busy anyway. For the people who paid their stamps, what is pay related social insurance, PRSI, for? It does not cover dental services anymore. At least, dentists are saying it does not cover it.

There are then young people. I have dealt with many cases of girls and boys, who are coming up to their group cert or leaving cert, who become shy because their mouths are wrong and they need extractions, straightening and a whole lot of work. The longer that goes on and their mouths become firm, it is way more difficult and a much bigger job. It is easier to do that type of work when the children are aged 13 or 14. I know of one girl whose mother was so concerned about her. She would not leave her room, she was missing days in school and she would not go out in the evening. Her mother was constantly worried about her. It took about two years to get that little girl seen. She is a lovely girl and is doing very well now, but we had a battle to get her seen. There have been many other cases.

When we were going to primary school ourselves, the dentist called to the school and undertook whatever was to be done. The dentist talked to the parents and we got sorted out. However, that is not the case any more. This is a new Government but the same system pertained all through the last Government. Many of the Ministers and members of the Government are the same. I urge the Minister of State to look at this very serious matter to see if it can be improved. That must happen because it is just not fair. It is a health issue when a person's teeth go wrong, given that so many other things go wrong as a result. When there is an oral health problem, it causes adverse issues and other parts of the body not to work right. On top of that, there is the pain of it. There was a publican across the road from ourselves, John Reilly, who used to say about teeth that they were trouble coming and they were trouble going. There is a lot of trouble with the system now.

We are grateful to Brian Stanley for recognising the issue, identifying the problem and bringing it forward here today. The main point is that dentists are not taking the medical card. We must bring people who are in a bad way outside the county. I ask the Minister of State to look at Kerry especially for this very reason. Some bits of a service are happening in Cork. Deputy Flynn says there are no dentists taking the medical card in Mallow, but there are other parts of Cork where they do. Nothing is happening in Kerry. That is the honest truth of it. Dentists are upset about it. They do not want to be refusing people. The Government must sort it out. It is about money. People are paying into the scheme.

Barry Heneghan (Dublin Bay North, Independent)
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Gabhaim buíochas le Deputy Stanley chun an motion seo a chur thuas. This motion reflects a shared understanding. The Minister of State has heard multiple Members across this House speak about public dental services, in particular for children, that are under significant pressures. Young parents are in urgent need of our support.

I urge the Minister of State not to oppose the motion. When I was knocking on doors across my constituency, one of the things I heard most often during the election campaign in areas like Clontarf, Raheny, Donaghmede, Clongriffin and Darndale was that many people across Dublin Bay North were under stress due to their children not being seen as part of the school dental screening programme. In some cases, children are in fourth or fifth class or even in secondary school before they have a public dental check up. These are not just isolated cases. I know the Minister of State is aware that it is a national problem.

In 2023, more than 208,000 children were eligible for school dental screenings, yet fewer than half that number were seen. This means that more than 100,000 children were not assessed. This represents a 31% drop in screening since 2019. Even as the population of children has continued to rise, the Irish Dental Association has made it clear that this is not sustainable and the gap is growing.

As the Minister of State is well aware, staffing is at the core of this problem. I welcome the contributions of other Members. We have heard there are 241 full-time equivalent public dentists working in the system, but that is simply not enough to meet the need. We all know the solution, which requires more recruitment and training. That is the case across the board with most of the issues relating to public services that we raise in this Chamber. We must increase the number of dental training places.

I welcome the opening last week of the RCSI's purpose-built education centre in Sandyford and the centre under construction at Connolly Hospital Blanchardstown. However, these alone will not solve the crisis. We must create a structured and supportive pathway for dental graduates entering public services. I call for the creation of a national membership scheme for new dental graduates. This would pair new dentists with experienced HSE clinicians. I have friends who are dentists and I spoke to them before today's debate. They said it would be a good idea. They also said it would give them a stronger pipeline into the public system. We cannot build dental services without making public dentistry a supported and attractive career path. A lot of my friends who studied dentistry have emigrated. That is a truth that we must consider.

For children who require more complex care, including those needing general anaesthetic, the current waiting time is up to two years. That is the real issue we have on the ground. This is not just an access issue; it is due to a pure neglect of dental services, which places enormous pressure on families.

I wish to briefly mention the dental treatment services scheme. We all know it was designed to ensure access for adults with medical cards, but no dentists are participating in it in many counties. That leaves vulnerable people without any dental care at all. A person's economic status should not determine whether he or she can receive dental care. The scheme must be reviewed, fees must be modernised and dentists must be brought back into the system.

I appreciate that progress is being made and that planning is under way. I thank the Minister of State and other Ministers for their engagement to date when I have spoken to them about struggling constituents who have reached out to me. The reality is that dental care is not a luxury. It is essential to a child's health, development and well-being. Every child deserves to thrive in every aspect of life. Every child should smile without pain and grow up with dignity and proper care. I believe we have the right vision but we need it to be delivered. I look forward to hearing the Minister of State's contribution. Words are not enough.

Kieran O'Donnell (Limerick City, Fine Gael)
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I thank Deputies across the House for their contribution to the debate. I also thank Deputy Stanley for bringing forward the motion.

As the Minister of State, Deputy Butler, announced, the Minister for Health and the Government are not opposing the motion, which provides a chance to update the Dáil on developments in this sector and to outline the Government's priority to fundamentally reform dental services.

As the Minister of State noted, there was €4.85 million in additional HSE funding this year, building on an additional €15 million in core HSE funding from 2022 to 2024 and a further additional €17 million in one-off HSE funding in the same period, which is supporting the ongoing work to reduce waiting lists and address access to services through policy implementation. Further, expenditure on the dental element of the PRSI-based treatment benefit scheme administered by the Department of Social Protection increased by more than €11 million in 2024 compared to 2023, bringing it to €75.4 million. A total of 1.7 million dental claims were processed under the scheme in 2024.

I assure Members that the Minister for Health, Deputy Carroll MacNeill, and her Department appreciate the difficulties experienced by people seeking to access oral healthcare and we will continue our ongoing work to address this. We are easing current access issues through a range of measures, which include a 40% to 60% increase in payment for treatments under the dental treatment services scheme and additional staffing for the HSE oral healthcare service. Ultimately, implementation of the national oral health policy will achieve the substantive service reforms that are required to ensure that patients can access the care they need, as set out in international best evidence and practice. Collectively, these reforms will examine the scope of oral healthcare in Ireland to ensure a focus on basic and essential oral healthcare, provided in a reoriented community-based model of care so that our most vulnerable can access the care they need. The State has a responsibility to do this. In turn, we recognise that the oral healthcare sector must be enabled and supported to provide this evidence-based care through an appropriate framework of professional regulation, education and training and strategic workforce planning, as well as modernised contractual arrangements.

The national oral health policy, Smile agus Sláinte, sets out the vision for the future of oral healthcare services in Ireland. The policy was informed by considerable evidence inputs, including the support of an oral health policy academic reference group, consultations with key stakeholders, considerable feedback from a number of consultations with front-line workers, including dentists and auxiliary dental workers, and a comprehensive qualitative research project.

This policy constitutes a body of very wide-ranging and transformative reforms. The implementation plan for the 2025 to 2027 phase is being finalised by the Department of Health and the HSE. The lengthy phase of policy development was fully cognisant of two policies in particular, which have provided the framework for the vision of transformative change that Smile agus Sláinte sets out.

Smile agus Sláinte is based on technical concepts that the World Health Organization has endorsed for several decades, including the emphasis on preventative care, the provision of care in a primary, rather than acute, setting, and the integration of oral healthcare into general healthcare. Accordingly, Smile agus Sláinte reflects the ethos, practices and intentions of the WHO’s global oral health resolution, strategy and action plan.

Smile agus Sláinte also applies the Sláintecare vision of enabling patients to access the right oral healthcare in the right place at the right time, based on best international evidence and practice. The designing and development of oral healthcare packages for adults and children that is under way within the HSE represents a significant expansion of preventative care. The delivery of these packages by local dental practices under contract to the HSE will allow patients and families to attend a local practice of their own choosing for continuity of care and to prevent problems before they arise. This will also allow dental practices to build enduring relationships with their patients.

The Sláintecare approach also means that people should have sufficient access to care from birth and across the full life course to prevent problems before they arise. This is why starting with our zero– to two-year-olds, who can currently only access emergency care, is a priority.

The HSE oral healthcare service will continue to play a core role in oral healthcare provision. The changes envisaged will increase the capacity of the HSE service to reorient and develop oral health promotion programmes. There will also be greater capacity to provide care to those more vulnerable groups in our community, including adults and children with additional needs, and adults living in residential settings. This a considerable change, based on the evidence identified. The Government will work with the sector to support these developments.

A key enabler of this transition towards the Sláintecare ethos is ensuring that we have a sufficient number of appropriately trained oral healthcare professionals. We need to consider educational models that enable students to experience care provision in community settings, including within our most vulnerable communities. We currently have more dentists on the Dental Council’s register than ever before, with 3,888 as of July 2025. There has been a steady increase in the number of registered dentists since April 2019, when Smile agus Sláinte was published, from 3,100 - an increase of more than 25% - but many more are needed.

The Department of Health is committed to the development of an oral healthcare workforce plan, as set out in the national oral health policy. This workforce plan will consider how dental professionals can best support the new model of oral healthcare services and how they, in turn, can be supported with career pathways that support staff retention. We will progress consideration of the role of the wider dental team and expand the scope of practice of oral health professionals where appropriate. This will support increased capacity and access and give patients greater choice.

To support this work, the Department is finalising the design of the first oral healthcare workforce census skills assessment. The workforce census will gather information, including the proportion of registered oral healthcare professionals who are practising in their registered profession, the services they provide and the skills they have. The census data will provide information to support the development of the sector and support workforce planning by identifying the skills that oral healthcare professionals need to provide the new model of service set out in the policy.

This Government is firmly committed to ensuring our healthcare services are supported by a steady, sustainable pipeline of highly skilled graduates, and one of the programme for Government commitments is to increase the number of healthcare college places, including in dentistry. The RCSI will commence a new bachelor of dental surgery this September, which will train students in a community-based model of dental education, significantly increasing the number of dentistry training places available nationally and expanding access to dental services. Last week, the Minister for Health officially opened the new Dental Education Centre in Sandyford. This is the first of three proposed facilities that the RCSI is developing to facilitate the delivery of its new bachelor of dental surgery. This new programme will significantly increase the number of dentistry places available in Ireland and provide 20 new dentistry places per annum for EU-EEA students from 2025 onwards. It will also have a focus on delivering a primary care-oriented model, in line with policy.

The Government remains committed to supporting oral healthcare and dental education. By enhancing our future workforce, we are taking important steps to ensuring that our national oral health policy, which supports greater access to care across the life course, is implemented.

The Minister for Health will continue the ongoing work to address the access issues that are affecting current healthcare services and will progress work on implementation of the national oral health policy, which sets out a body of transformational reforms. Along with the Minister of State, Deputy Butler, I thank Deputies across the House once again for their contributions and reiterate the Government's commitment to improving our oral healthcare services. I also thank Deputy Brian Stanley for tabling this motion.

John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Before calling Deputy Stanley, I acknowledge the visitors in the Public Gallery. They are all very welcome. It is good to see so many here. I also acknowledge the presence of Councillor Pat Fitzpatrick, former president of the AILG, who is attending with family and friends. Indeed, some have come from America. They are all very welcome.

Brian Stanley (Laois, Independent)
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I join with the Leas-Cheann Comhairle in welcoming the visitors to the Gallery. I welcome Fintan Hourihan from the Irish Dental Association, as well as Pat Fitzpatrick. As a councillor, I met Pat Fitzpatrick a few times in his former role.

We are all elected here to be the voice of the people - Teachtaí Dála, Dáil delegates. Not to take any cheap shot, but the Government benches have been empty throughout this debate. Not one member of Government, apart from the Ministers of State, spoke. Maybe they do not see there is any problem in dental health, but I find that remarkable. Maybe they are not hearing it from constituents. We have had a range of speakers from across the Opposition benches, from Kerry to Donegal, from Dublin across to Galway, and everywhere else in between. The problems and some suggestions have been outlined, and that is welcome. I welcome the fact the Minister of State is not opposing it. I know he and the Minister of State, Deputy Butler, are sincere in what they are doing. In his closing remarks, he framed it in the context of Sláintecare, and we have to set it in that context. That means we must start providing the proper dental health services that are available to everybody.

It is like many other problems, including housing. There is no one thing that will fix any of it. There are a number of parts, and a number of them are being focused in on, in fairness, and were identified by Deputies. I also tried to do it in the motion and in the proposals I tabled.

The Minister of State, Deputy Butler, mentioned the overall budget of €230 million. That is the case, but we cannot have budgets without tracking the outcomes. Outcomes have to match any increase in budget. That needs to be clear and I am saying that as an Opposition TD. Throwing money at something will not solve it on its own.

People going abroad has been mentioned. There is even a term now I heard recently, namely, “Turkey teeth”. We have seen good and bad examples of people coming back with treatment. However, if they are going there, it is a failure.

What brought this to my attention a number of years ago, and I have raised it since joining the House – it is my 15th year here – is that an acquaintance of mine wound up nearly dying in hospital because of poor dental health. Poison got into his system. He was a fine hardy fellow and it almost killed him. It really underlined the problem for me.

I raise another issue. I watched my granddaughter go through primary school. As far as I can remember, I saw the dentist in third class – it is a few years ago now – in the dispensary in Mountrath. Everybody else also saw the dentist at that time. Here we are now, and she did not see the dentist in primary school. She came out of primary school. She and her pals - I know the kids she was going around with at the time - are now near the end of their teens. They went through secondary school and almost came out the other end without seeing the dentist. They saw the dentist in the past year. That was their first examination. It brought it all into sharp focus for me.

Under section 67 of the Health Act 1970, the HSE must provide dental treatment and appliances for those on medical cards.

We must increase the number of places. Some 65% of dentists have been unable to recruit additional people. There has been no progress on the new dental school at UCC since the then Minister, Simon Harris, turned the sod in 2019. My understanding is the funding is being withdrawn.

Only 10% of dentists work in the public dental health services. Even private dentists are saying that figure needs to be doubled. We need to double the percentage to have a representative number in the public dental system. It is like the GP situation. Not all dentists can afford to open a private practice or want to open a private practice because they would have to run a small business and there are a lot of costs associated with that. Women, because of the reality of the world we live in, need to work a 35- or 40-hour week while also having other responsibilities trying to manage their families and everything like that. They want to work a nine-to-five job, and a lot of men do, too. Men are now taking on a greater role in parenting children. We must try to get more people into the public system and the private system.

The shortcomings and the limited number of services available under the dental treatment benefit scheme have been outlined very graphically. Portugal, as I understand it, has a voucher scheme. I do not want to make this look cheap, but the voucher scheme would allow people to access the services they or their dental surgeons consider they need under the dental treatment benefit scheme. It is something the Minister of State may consider. I mentioned the six-year waiting list for orthodontic services. Nothing happens during school term in primary. Nothing happens during secondary. They then come out the other end and it is all over at that stage. The opportunity is gone, and that is really disappointing.

I will read a short letter, which is one of many letters I get. This came from somebody working in the public dental services who wanted to outline to me some staffing issues:

There have been jobs advertised and no dentist have applied. There are currently two full time dentists covering all of Laois. They are currently doing late evenings or try get through the list.

I acknowledge here the efforts of one particular HSE manager, Joe Ruane, in getting that in place. I want to acknowledge that because there are people trying to change things. I welcome that fact and I recognise the efforts of those people working late in the evening to try to do that, shorten the list and get on top of this. The letter writer goes on to say:

There are very few dentists qualifying in Ireland as college spaces are limited and non-Irish Nationals tend to go back [to their home countries] once qualified. Maybe you could speak on the dental hospitals in Dublin and Cork and maybe they could come up with a scheme that once you qualified you have to practice in Ireland for a year [or, as some Deputies have mentioned, two years]. I know two years ago 43 dentists qualified in Dublin and only 10 stayed in the Country.

I will finish there and will not read the rest of it. That to me brings home the problem we are facing. The overall dependence on foreign students has been mentioned. I have nothing against foreigners. They are welcome, particularly those who are working in our public health system, but governments of other countries are paying them to come here to train. The funding from that is supporting the dental schools. This is something I have put a lot of work into looking at over the years. In the past few months, I have decided to give this a particular focus while I am in the Dáil representing Laois during this term. We cannot have a situation where the dental schools are depending on foreign students. The spaces are taken up. We are not educating and training enough dentists to work in either the public or private systems here. We need to get on top of this.

As has already been outlined, dental care is not a luxury. We need a fix. I outlined the new dental plan, the timeline for which the Minister of State, Deputy Butler, referred to when she spoke earlier. That needs to happen a lot quicker. We also need that scheme for the under-sevens. The Minister of State knows what needs to be done in the dental schools in TCD and UCC in terms of additional funding. The structured mentorship programme and its different forms have been spoken about. It needs to be brought on stream so that people can gain work experience.

On HSE recruitment, I think it was Deputy Sherlock who mentioned a 14-month wait for one person between being told that person would be taken on and actually starting the job. People will go elsewhere. They are not going to hang around. They cannot hang around because they have to bring in money to live in an expensive economy and country.

There is also still something wrong with recruitment for the DTSS. I acknowledge the 40% increase in payments, but the scheme is not being taken up. There needs to be a dynamic advertisement and recruitment campaign for the DTSS. The services under the treatment benefit scheme need to be expanded. The voucher system also needs to be looked at as one option. I do not know all the ins and outs of it, but it certainly should be considered.

For those people with special needs, I plead with the Minister of State, because I have come across some terrible cases where people have had to have treatment under anaesthetic because they are autistic or have some other condition. That needs to be fixed in the hospitals providing those services. I have seen awful situations.

I welcome this opportunity. I know the Government is not opposing the motion and I welcome that, but let us not just go out of here this morning and nothing then happens. Let us use some of the suggestions put this morning. They are being put forward genuinely from Kerry to Donegal and Galway to Dublin. I am telling the Minister of State that the situation is really serious in Laois. It needs a fix and I plead with the Minister of State to fix this issue.