Wednesday, 2 February 2005
I welcome the Minister of State, Deputy Brian Lenihan to the House. The purpose of this Adjournment matter is to request the Minister for Health and Children to look favourably on a request for the establishment of a regional consultant post in restorative dentistry in the Limerick-mid-western region. On a part-time basis this service has been provided at the Mid-Western Health Board orthodontic unit in St. Camillus's Hospital Limerick since 1997 and has involved the provision of restorative dental treatment to those categories of patients requiring a multi-disciplinary approach or optimum oral rehabilitation, patients with clefts of the lip and palate and patients with hypodontia or congenitally missing teeth. Treatment has been provided from this region for patients with oral cancer and treatment has also been provided for patients referred from the community dental service who require specialist restorative treatment, such as central trauma cases and difficult complete denture cases.
Prior to the establishment of this service most patients were referred to either Cork or Dublin. The establishment of a regional consultative post in restorative dentistry would ensure that the benefit of specialised restorative care would be available and accessible to patients in the mid-western region and in Limerick. I pay tribute to the service provided in St. Camillus's Hospital over the years and I ask the Minister to look favourably on this request.
Brian Lenihan Jnr (Minister of State, Department of Education and Science; Minister of State, Department of Justice, Equality and Law Reform; Minister of State, Department of Health and Children; Dublin West, Fianna Fail)
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I thank Senator Brennan for bringing this matter before the House on the Adjournment and I will convey his concerns to the Tánaiste and Minister for Health and Children, Deputy Harney, on whose behalf I make this reply. I thank the Senator for giving me the opportunity to put the position on record regarding restorative dentistry.
As the Senator is aware, the Health Act 2004 provided for the Health Service Executive, which was established on 1 January 2005. Under the Act, the executive has the responsibility to manage and deliver, or arrange to be delivered on its behalf, health and personal social services. Clearly, this includes the delivery of restorative dentistry services. Nonetheless, I am happy to set out the situation regarding the development of policy in this area and to convey the information provided by the chief officer for the executive's mid-western area on the specific question raised by the Senator.
Restorative dentistry is an over-arching term which includes such mono-specialties as periodontics — the treatment of gum disease; endodontics — the treatment of abscesses in teeth; operative dentistry — restoration of diseased or broken teeth; and prostodontics — the provision of dentures, crowns, bridges and implants. Therefore, consultants in restorative dentistry have a very wide brief and are mainly involved in complex care which is not appropriate for general practice. In particular, they work in multi-disciplinary teams in the treatment of the most complex medical and dental conditions such as congenital abnormalities and trauma. However, many cases can be treated by private practitioners with specific expertise. A review of oral and dental specialisation in Ireland commissioned by the Department of Health and Children and carried out by Professor Stanley Gelbier of the division of dental public health and oral health services of King's College, London, was presented to the Minister for Health and Children in 2002.
On the area of restorative dentistry, Professor Gelbier noted that previous reports, including a 1979 report of a joint working party established by the Department and a 1989 Eastern Health Board report, had considered the provision of restorative dentistry and concluded that the specialty should continue to be provided within the dental hospital setting. For his part, Professor Gelbier noted that private practitioners were involved in the provision of much of the treatment needed in relation to restorative dentistry.
With regard to the future delivery of restorative dentistry, Professor Gelbier recommended that those with an expertise in the mono-specialties should continue to work mostly in private, or high street, practices while consultants in restorative dentistry should be based in the dental hospitals. It should be noted that the professor also raised the possibility of a further supra-regional consultant in Galway or another appropriate site, if it could be shown that the local providers required tertiary support outside of the dental hospitals.
At present, the provision for complex and specialised restorative dentistry needs are based in two dental schools in Dublin and Cork. In Dublin the restorative dentistry department consists of three professors and four consultants in restorative dentistry. A further consultant is appointed to St. James's Hospital and linked to the Dublin Dental School. In Cork the restorative dentistry department consists of one professor and three consultants in restorative dentistry. I am informed by the chief officer of the mid western area of the Health Service Executive that restorative dentistry services in the Limerick-mid west area are provided through the employment of a dentist with relevant expertise on a sessional basis. This usually involves one to two sessions per week. Where necessary, the Mid-Western Health Board also has the facility to refer more complex cases to either the Cork or Dublin Dental School and Hospital.
I am further informed that some consideration had been given by the then Mid-Western Health Board to the question of appointing a regional consultant in restorative dentistry, and that such a possibility was signalled in its 2001 service plan. However, I am informed that it was decided to await developments at national level, in particular the completion of the Gelbier report and a report by Comhairle na nOspidéal on the related discipline of oral and maxillofacial surgery. The latter report has recently been finalised.
As I indicated, the Health Service Executive has the responsibility to manage and deliver, or arrange to be delivered on its behalf, restorative dental services. The executive will now consider the implications of these reports in the context of setting priorities within available resources on an ongoing basis.