Seán Kyne (Fine Gael)

I welcome the Minister of State. According to the Irish Dental Association, diseases of the mouth and oral cavity have a significant impact in terms of pain, suffering, impairment of function and reduced quality of life. To a large extent, oral diseases are entirely preventable. When they occur, however, the damage is not reversible and they can be among the most expensive to treat. That sums up the reason dental and oral health is hugely important.

Looking at some of the statistics, according to the Department of Health, there are 2,420 dentists in Ireland for a population in excess of 5.1 million. That is 47 dentists per 100,000 or one dentist per 2,128 of the population. This is among the lowest in and in the bottom quartile of the OECD.

How can this be solved? College places and training provide a solution. Our colleague, Deputy Colm Burke, presented this solution to our parliamentary party last week. The number of places in our universities is still quite low.Investment and accommodation are needed. If that is the case, then provision needs to be made for both in the upcoming capital plan.

On places in Trinity and UCC, we do not have sufficient numbers. We have a lot of international students coming, which is fine, but that is not to say that they always stay in this country and practise here. Therein lies the crux of the problem. No funding has been forthcoming and nor has a plan to follow on from the Higher Education Authority's announcement in 2023 regarding initial undergraduate dental places. We need to see increases. The number of final year students in TCD in 2023 was 46, with 25 EU students and 21 non-EU students. In UCC, there were 61 final-year students, with 25 EU students and 36 non-EU students. It is fine if all those students stay here and practise. If they do not, therein lies part of the issue. This needs to be rectified.

One of the commitments in the current policy, the national screening programme for children, is for children to have three dental appointments before the age of 12. These are to happen in second, fourth and sixth class. As my colleague Senator Nelson Murray told us from her lived experience, that in not happening in Meath. It is also not happening across the country. This is a requirement. It is a commitment on the part of the Government. This is a national policy, and we need to provide those appointments. Obviously, training more dentists in our colleges will allow for the position to be improved upon. In the interim, as I asked the then Minister, Stephen Donnelly, last year, could a scheme for recently retired dentists be looked at? Such dentists may not want to practise but they may be happy, and are obviously qualified and trained, to visit schools and carry out assessments. This would be less onerous but just as important. They would be able to pick up developmental issues in children at an early age. This would fulfil the commitments in the Smile agus Sláinte programme, which is Government policy on this matter. That could be done quickly and have immediate results. There might be issues in relation to pensions and pay but these could be sorted out. It would be a positive step in the area of oral healthcare for children.

I have also raised on numerous occasions the closure of a practice. A practice may close because the practitioner passes away, leaves the country suddenly or is suspended. I have experience of this in Oranmore. The matter is on the record and has been looked at. Basically, parents are forking out huge sums for orthodontic care and then a practice suddenly closes and they have to go elsewhere. As it transpired in the case of the Oranmore practice, this was not easy. There were delays. They forked out this money but they also had to pay the new orthodontist to complete the work. Despite the fact that an orthodontic practice may be fully insured, there is no recourse to get money back or at least there is a delay in doing so. I have spoken to the Minister, Deputy Peter Burke, and am calling for the establishment of a working group involving the Department of Enterprise, Tourism and Employment, the Competition and Consumer Protection Commission, the Dental Council and the Departments of Finance and Health to figure out what can be done in these emergency situations to ensure that parents are not left out of pocket. That is what insurance is for. That is what a dental practice or orthodontist has insurance for. It is to protect themselves and to ensure that the consumers have cover. I am calling for the setting up of such a working group. I have engaged with Ministers on the matter. It is important that representatives from all the entities to which I refer sit around a table and sort this out, particularly as parents out of pocket, and the time delays involved in trying to get someone else who might be quite busy to try to fit in the children of those parents.

Let us look at the total number of dentists on the DTSS. Back in 2012, there were 1,452 on the scheme. The most recent information shows that the number is down to just over 800. That is a huge drop. The population of the country is not dropping; it is increasing. The demand for dental services is there. The number of medical card patients seen by dentists on the DTSS is also dropping, from over 394,000 in 2012 to 283,000 in 2023. That is a significant drop of more than 100,000 and it is replicated across the board. The number of dentists contracted to the school dental screening service has decreased by 30 since 2012, down from 283 whole-time equivalents to 253. That is reflective of the longer waiting lists and despite the fact that there are still backlogs. Just over 104,000 children were seen by dentists under the school dental screening service in 2023, a drop of 31,000 on 2017. Something is wrong in terms of these services, which we have in the past taken for granted. It is reflected in a poorer service and a poorer delivery for children and patients under the DTSS. The crux of the issue, as far as I can see, is the numbers of dentists or else the complexity of the scheme means dentists do not want to be involved with it, issues with reimbursement or whatever. It is not getting the level of attention that is needed. That is what we are calling for today in raising this matter.

Returning to the issue of places, it is hugely important. If we are not training enough and not even offering enough places to Irish students who might see this as a worthy and noble career, then we are going nowhere. We need to open this up and make it attractive for Irish students to go through their education in dental practice in Trinity or UCC and then remain in this country and set up a practice or work in an existing practice. I also include dental hygienists in that. There is an issue there as well which needs to be sorted. Our colleague Deputy Colm Burke has raised that matter. If we look at the number of undergraduate places, Irish student places in Trinity and UCC have not increased in 25 years. That says it all. In all aspects of life, there should be an increase in the supply of specialists to serve a growing population. That goes without saying, and it should happen across all occupations. There is a clear need for extra investment in dental services and to look at the additional accommodation needed in UCC and Trinity.

Overall, I am afraid the picture is not as rosy as it could be. I commend all the work done by our dentists, dental hygienists and orthodontists. While I commend Government investment in the DTSS, more needs to be done. The Minister and the Department need to come to terms with this. We need to look at the Dentists Act 1985 as a priority and at the recommendations of the Irish Dental Council.