Paddy Burke (Fine Gael)
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I welcome the Minister of State, Deputy Ann Phelan, to the House.

Kathryn Reilly (Sinn Fein)
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I welcome the Minister of State to the House. A plethora of issues and challenges for young people's health, such as the obesity crisis, are emerging these days. Dental health is just as much an essential issue when it comes to ensuring the future well-being of our citizens. As we all know, dental complications can lead to serious illness and disease. If the Government is serious about children and their health, it must ensure that dangers are minimised, not just for patient health but also for the savings this could bring to the cost of dental services provision in the longer term if problems are detected and dealt with at an earlier stage.

The State provides free dental services to persons under 16 years of age. Parents should be able to expect their children's teeth to be examined in second, fourth and sixth class. However, with delays in dentist visits, many children may not be seen until they are 11 or 12 years of age. By that stage, the priority will be orthodontic work. Seeing a dentist for the first time at 12 years of age or so could be too late to stop major problems with decay and gum disease. It is tantamount to closing the door after the horse has bolted. Reductions in staff and funding have led to cutbacks in the service in recent years. In my county, Cavan, this has been an issue of grave concern to many families. The local council has raised the issue with the HSE on several occasions. Collectively, counties Cavan and Monaghan are three to five years behind other counties in terms of dentists visiting primary schools. This is unacceptable.

Even though there are supposed to be screening programmes and services for persons under 16 years of age, the reality is that this is not happening. The plight of children and young adults with dental disease is being exacerbated by this failure of the HSE to meet its obligations to children to provide primary school dental services. The failure to provide timely screening and treatment of simple problems or early onset of dental disease causes severe deterioration which then requires more complex remedial treatments. The State services often cannot provide these and many families simply cannot afford them, particularly given current economic circumstances. This is the reality.

From previous ministerial responses to this issue when raised by other Deputies and Senators, I understand that a three-year project is under way to develop a new national oral health policy. It has been acknowledged that despite the introduction of the 1994 dental health action plan, inequalities remain in the population's oral health. The vulnerability of some groups linked to low income or disabilities is of particular concern. The severe delays in dentists visiting primary schools are having a very detrimental effect on children's oral health in their formative years. Why are there such delays and problems with dentists visiting primary schools and what is being done to address this?

Ann Phelan (Carlow-Kilkenny, Labour)
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I thank the Senator for raising this important issue. I am taking this matter on behalf of my colleague, the Minister for Health, Deputy Leo Varadkar. Dental services for children up to 16 years of age and persons of all ages with special needs are provided by the public dental service of the HSE. These services are provided through its dental clinics throughout the country. All HSE dental clinics ensure emergency care for children up to 16 years of age, treatment for special needs patients and screening of children aged 11 to 13 years. This includes referral for orthodontic services where necessary. Other services, including screening of children aged six to eight years, are provided where possible.

Following the successful recruitment of a general dental surgeon in October 2014 and a dental nurse in November 2014, the HSE public dental service is now able to operate across all locations in Cavan and Monaghan. There were particular difficulties in Virginia, County Cavan, and in Monaghan, but these have recently been addressed. The dental clinic at Castleblayney was decommissioned several years ago as part of network area reforms. This coincided with a reduction in dental surgeons employed across the Cavan and Monaghan area between the end of 2006 and 2010, including the loss of a dental surgeon at Castleblayney. Retirements, including the early retirement of the dental surgeon in Ballybay in 2011, added to the pressures on the service. Despite these severe difficulties, a level of dental service was maintained and provided at Ballybay and Carrickmacross into 2014. A new dental team was recruited and routine dental services resumed at Carrickmacross in October 2014. With a dental nurse member of the new dental team assuming duties in November 2014, routine services at Ballybay are once again being provided. The service, which is based in the dental clinic in the health centre in Ballybay, caters for the Ballybay and Castleblayney areas, for a number of national schools and also provides emergency care to eligible adolescents aged up to 16 years of age attending secondary schools in Ballybay and Castleblayney. To date the service has been following up on recall-review appointments and providing emergency care. Service frequency is two to three days a week, Monday to Wednesday, inclusive.

The service has arrears to deal with concerning children aged 11 to 13 who were in sixth class in the school year 2013-2014.

Accordingly, screening is being completed in Carrickmacross, County Monaghan, and arrangements are being made to commence screening of such children in Virginia, County Cavan. It should be noted that the HSE public dental service in the Cavan-Monaghan area is not merely a school dental service as the service remit includes dental paediatric specialist care in Cavan General Hospital and Monaghan hospital, for children with special needs who are medically compromised. It also includes a dental general anaesthetic service at Cavan General Hospital for routine paediatric extraction cases, paediatric services and adult special care, oral health promotion service and care for adults with special needs.

I wish to assure the Senator that the HSE is committed to continuing to address the service challenges in providing these important primary care services in Cavan and Monaghan.

Kathryn Reilly (Sinn Fein)
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The Minister of State is replying on behalf of her colleague, the Minister for Health, Deputy Varadkar. I ask that she brings to the attention of the Minister my queries about the arrears for children aged 11 to 13 years in Virginia County Cavan and the time line for the commencement of screening.

Ann Phelan (Carlow-Kilkenny, Labour)
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I assure the Senator that I will convey her concerns to the Minister. I take her point that perhaps a stitch in time saves nine. The earlier the intervention the greater the outcome.