Victor Boyhan (Independent)
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I welcome the Minister of State, Deputy O’Donnell, to the Chamber. I call Senator Byrne to speak. She has 16 minutes in total.

Maria Byrne (Fine Gael)
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I will divide my time with Senators Kyne and Nelson Murray.

Victor Boyhan (Independent)
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Is that agreed? Agreed.

Maria Byrne (Fine Gael)
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I move:

That Seanad Éireann:

acknowledges: - the publication in 2019 of Smile agus Sláinte - National Oral Health Policy;

- that the Dental Treatment Services Scheme provides access to dental treatment for adult medical card holders;

- that taxpayers may be able to claim tax relief on specialist dental treatment;

- that under the Treatment Benefit Scheme taxpayers may qualify for dental benefit;

- that the Dentists Act 1985 establishes the Dental Council as the regulator of the dental profession in Ireland; and notes: - that the national screening programme for children commits to 3 dental appointments before the age of 12 in second, fourth and sixth classes;

- the establishment of new dentistry programmes, including a new Bachelor of Dental Surgery at the Royal College of Surgeons in Ireland, commencing in 2025;

- that the National Oral Health Policy contains a range of strategic workforce planning actions to increase national workforce capacity;

- the particular challenges for patients of dental and orthodontist practices where the practitioner dies, leaves the country suddenly or is suspended;

- the issues raised by the Dental Council in its 2021 submission to the Department of Health, titled – Submission regarding Legislative Change in Dental Regulation;

- that smoking increases the risk of gum disease, tooth loss and oral cancer; and calls on the Government to: - update the Dentists Act 1985;

- increase the number of training places in dentistry and dental hygiene in Trinity College Dublin and University College Cork;

- implement the Smile agus Sláinte - National Oral Health Policy;

- expand orthodontic treatment for children and implement an enhanced dental package for children under the National Oral Health Policy;

- introduce a mobile dentistry unit for nursing home residents and those with mobility issues;

- consider, in the interim, the hiring of recently retired dentists for school check-ups and screenings, to cover schools where regular scheduled checks are not happening; and

- work with the Department of Enterprise, Tourism and Employment, the Competition and Consumer Protection Commission, the Dental Council and the Department of Finance on finding a resolution regarding customers who are left in limbo financially, where an insured dental or orthodontist practice closes suddenly.

I compliment my colleague, Senator Kyne, and the Fine Gael group on putting together this motion. There are two or three key things I wish to raise with the Minister of State, Deputy O'Donnell, whom I welcome to the Chamber. A number of children did not receive their treatment last year, with some being on waiting lists for two or more years. It is unacceptable. Dentists actually have to choose which children they believe are the worst or have issues. The number of places available is another issue. We need to increase and expand the number of places on offer in the higher education institutes. While some 60 dentists come out of UCC, it is not enough. There are approximately 45 dentists per 100,000 head of population. It is time to expand those services and for the Government to invest in oral health.

I will hand over to my colleague, Senator Nelson Murray.

Linda Nelson Murray (Fine Gael)
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I am delighted to stand and speak on this motion today. I welcome the motion by my colleagues. While I knew there was a huge problem with dentistry in Ireland, I had no clue how severe it was until I began my research. Analysis from the Irish Dental Association shows that we need an extra 500-----

Victor Boyhan (Independent)
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Will the Senator formally second the motion?

Linda Nelson Murray (Fine Gael)
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I second the motion. The analysis from the Irish Dental Association shows that we need an extra 500 dentists across the private and public sector immediately. The number of dentists with a dental treatment services scheme, DTSS, contract is down 642 nationally in 12 years. A total of 7,711 children were seen by dentists in the school dental screening service in Meath in quarter 4 of 2017, compared with just more than 1,000 in quarter 4 of 2023. Those are baffling figures. In the public dental service, the lack of dentists has led to a situation where less than half of the children who should be seen under the dental school programme have been seen. Some children in parts of the country are facing a ten-year backlog.

To take my children as an example, they are aged nine and a half and ten and a half and have never seen a dentist through the school programme. I am in the lucky position that I was able to bring them to a private dentist. I welcome the proposal on taxpayers being able to claim tax relief on specialist dental treatment. In the past year and a half, we have now discovered that both my children have molar and incisor hypomineralisation, MIH. This is a developmental enamel defect affecting the first permeant molars and incisors. It is characterised by enamel that is softer than normal, leading to discoloration. A lot of people would see that there are these white dots on their children's teeth. It leads to the potential for chipping and decay. Early detection and management of MIH are crucial to prevent tooth damage and reduce the need for extensive restorative work. Now that my children have this condition, when speaking to parents, I cannot believe the number of children who also have it.

I was lucky I could bring my kids to a dentist. I started going when they were three and as I said, this condition was picked one year and a half ago. My children have had fissure seals and crowns and they both have had four teeth removed in hospital in their younger years. While the cause of this condition is not entirely known, it can be from genetics, low birth rate, C-section babies or babies who took a lot of antibiotics in their first two years. I dread to think how many children are suffering with this condition and they do not know because they cannot get to a dentist or the public dentist has not visited the school. I am sure there are many kids with this condition who are not seen until sixth class, which in many situations is too late for their teeth.

Our dental schools do not have the basic capacity to educate and train enough dental partitioners to meet population needs. Only half of the 90 students who graduate each year stay, as most of them are international students who go home. We need more investment in our colleges and specific training in other aspects of dentistry. We need to change the work permit rules for dentists and dental nurses. If we do not do this, I dread to think what will happen to our children's teeth in the future. I ask the Minister of State to take particular note of that condition I mentioned. It is molar and incisor hypomineralisation, shortened to MIH. It has really only been discovered in the past 20 years in Ireland and it is really impacting children's teeth. We need to look at it.

Kieran O'Donnell (Limerick City, Fine Gael)
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I will send a note to the Minister.

Victor Boyhan (Independent)
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Before I call Senator Kyne, I welcome the students from Gorey Educate Together Secondary School who are guests of Senator Imelda Goldsboro. I also warmly welcome Deputy Michael Cahill from Kerry and his guests, who are in the Distinguished Visitors Gallery.

Seán Kyne (Fine Gael)
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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.

Victor Boyhan (Independent)
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I thank Senator Kyne scheme for setting out his stall. Before we go on, I welcome Deputy Richard O'Donoghue and his guests, Mary Angela Downes and friends, who travelled here from Limerick. I hope they have a most enjoyable day in the Oireachtas.

Joe Conway (Independent)
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This motion is very timely in that it address the géarghá mór i stádas na fiaclóireachta atá sa tír seo. There is a big crisis in dental care across the country. As a former primary school principal, even when I was in the classroom, I noted year on year a deterioration in the level of service that children got from the school dental service. At this stage, many children go through primary school and do not get to visit a dentist at all or are not seen at all. On my travels, I have noticed that the state of the dental hardware, namely teeth, of teenagers, young adults and people entering their 30s who have been recipients of dental care in Ireland is oftentimes pretty shocking in comparison with that of their European counterparts. That is the state of the nation from a dental point of view and from the perspective of young people. Forget about the older cohorts because, basically, the state of their teeth is basically just care on the tear that has been done during their lives.On the young people who are remediable, the impact of the Irish dental profession and the Irish dental service is lamentable. We just have to look at the smiles. Often, we will see youngsters in Ireland hiding their smiles because they are so embarrassed about the array of their teeth that they do not want to do the most human and natural thing to a young person, which is to display their personality and jollity through the openness of their smiles. What they have in their mouths is a crowded misalignment of their teeth. This is not down to anything they do, but down to a very poor lack of care.

We are addressing a problem here today, but if the Minister of State and his colleagues will forgive me - it is very good that we have this motion here - I must ask if there is not a tad of the burglar ringing the gardaí here. The Minister of State's party has been in government for 14 years and his colleagues are bringing forward this motion today. I think this is perhaps a little rich because it shows to me that somewhere along the line there is a dismal lack of planning. We all saw this problem years and years ago, but it is 14 years later that we are standing up and calling out the fact that somebody has been asleep at the wheel on this problem. What I want to decry is that we have this system that deals with our children and their health and, as the old cliché goes, the dogs in the street are barking out that there is a problem. Nobody, however, seems to get their act together until it becomes dismally critical before they begin to address it. This is a horrible state of affairs.

I spoke here last week about balanced regional development. I talked about the way the South East Technological University, SETU, is being effectively discriminated against because of a lack of funding. That university would love to have a dental faculty and it would offer to host it. Given the standard of living in the south east, God help us down there, we would be able to offer to host that faculty much more cheaply than the centres of excellence we already have. As for the young graduates who might come out of such a faculty, be it in Cork, Dublin or Waterford, I refer to us being able to incentivise Irish kids - I know there are implications in relation to the EU and the equality of student opportunities - to go in and take dentistry as a noble and very remunerative profession, which it is and we all know it is because most of us have to pay for our dentistry and we know what it costs. We could incentivise the profession by locking the graduates who come out of dentistry into a commitment to the State for five or ten years or whatever could be negotiable. Then we would not have this talent drain we see afflicting the medical and dental professions. It is just pure common sense. If we train our own dentists, then surely to God we should get the benefit of training them. I think this is self-evident.

Our spokespeople have talked about a baffling problem, ten-year backlogs and some children never being seen. I absolutely echo that as someone who was working with kids all my life. It is an analysis that is almost impossible to make because it is so neglectful. I refer not alone to dental hygiene but also the implications for heart problems later in life. This is, essentially, at the nub of human health. Depending on what league table you are looking at, whether it is from the World Bank or other organisations, we are either the third or fourth most wealthy nation in the world per capita. If we cannot afford our children basic and good healthcare, then we are failing our children and our future generations.

Teresa Costello (Fianna Fail)
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I am happy to support this extremely important motion calling on the Government to take strong, proactive steps to reform and modernise dental services in Ireland. I lend my support to the call for the Dentists Act 1985 to be updated. The legislation is now four decades old and no longer reflects the realities of a modern dental profession. We need a framework that supports high standards of care, ensures accountability and gives regulators the tools they need to protect patients and support practitioners. Updating this Act is long overdue. Furthermore, the Dentists Act 1985 established the Dental Council of Ireland, which plays a vital role in regulating the dental profession and protecting the public. However, it is now clear this legislation needs modernisation to reflect today's clinical standards, workforce needs and patient expectations.

If we are serious about improving access to oral healthcare, we must increase the number of training places in dentistry and dental hygiene courses in Trinity College Dublin and University College Cork. A sustainable workforce is at the core of any functioning healthcare system. The demand for dentists is growing yet capacity to train them remains constrained. Investment in this area is not just necessary; it is urgent. I also welcome the establishment of the new dentistry programmes, including the upcoming bachelor of dental surgery at the Royal College of Surgeons in Ireland in 2025. This expansion is a necessary response to workforce shortages and will support the next generation of dental professionals. I welcome the renewed commitment to the Smile agus Sláinte national oral health policy. This policy has the potential to transform how we deliver dental care by shifting the focus to prevention, early intervention and access in the community. Implementing this policy fully must be a priority. The national oral health policy also outlines strategic workforce planning actions and these must be fully resourced and supported to ensure adequate capacity across the country.

In particular, I welcome the call to expand orthodontic treatment for children and to enhance the dental package for younger patients under the national oral health policy. Families are facing long waiting lists, high costs and patchy access to public services. We can and must do better for our children. A solid focus on the dental health of our children will help to eliminate costly and painful dental issues later in life. Equally, I support the proposal to introduce mobile dental units for residents in nursing homes and others with limited mobility. No one should be denied basic oral healthcare because of where they live or their ability to travel. This is a practical and compassionate solution to a real gap in services. In the interim, hiring recently retired dentists for school checkups and screenings is a smart and sensible step. Many schools, particularly those outside the major urban centres, are missing out on routine dental checks. This is a way to maintain standards and reach children who may be at risk of going unseen.

We also cannot ignore the experiences of patients left financially vulnerable when dental or orthodontic practices close suddenly. This motion rightly calls on the Government to work across Departments and agencies, including with the Dental Council of Ireland and the Competition and Consumer Protection Commission, to develop safeguards. Patients need to be protected, especially when they have paid in advance for treatments they may never receive. Patients cannot be left financially exposed and clinically unsupported. In supporting this motion, I acknowledge the important steps taken by the State in laying the groundwork for dental reform. The publication of the Smile agus Sláinte national oral health policy in 2019 marked a turning point in how we view and deliver oral healthcare in Ireland. It prioritised prevention, early intervention and equity of access, especially for vulnerable groups. Its implementation now is a must.

I also acknowledge the role of the dental treatment services scheme, which provides essential access to dental care for adult medical card holders. This scheme is a crucial safety net for low-income patients and its continued enhancement must remain a policy priority. I also highlight that taxpayers may claim relief on specialist dental treatments and that many workers and self-employed individuals are eligible for dental benefit under the treatment benefit scheme. These schemes help to ease the financial burden and increase access to essential dental care, but more is required. We should not ignore the impact of smoking on oral health, increasing the risk of gum disease, tooth loss and oral cancer. Public health initiatives must continue to link oral health with wider lifestyle and well-being supports. In closing, I thank the proposers of this motion for bringing attention to this vital issue. Oral health is not a luxury, but a key part of our overall health and well-being. The proposals outlined today are measured, sensible, achievable and very necessary.

Victor Boyhan (Independent)
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Our next two Senators are sharing time. Is that agreed? Agreed.

Nicole Ryan (Sinn Fein)
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Last year, more than 100,000 children missed out on the basic dental health screenings they were entitled to. These screenings are meant to happen in second, fourth and sixth classes, which are critical development stages. Delaying them means missing signs of disease, delaying intervention and preventing suffering. At the same time, the number of dentists serving medical card holders has drastically been slashed.

When it comes to children with additional needs, the system is even more broken. The HSE does not collect data on special care patients. Many of them are waiting two years or longer for treatment under general anaesthetic. Take the case of Tiernan Power Murphy, a six-year-old autistic boy who was in severe dental pain. He needed to have three teeth removed. His family were told they could be waiting ten years for dental care, and their only option was to pay €2,500.

There is also the story of a constituent of mine, a young woman who has been a patient at Cork dental hospital for more than ten years due to an unusual case of supernumerary teeth. Because of the Covid pandemic, she was not able to be seen. When she did get her X-ray, it was found she has an extremely rare case of tooth resorption affecting four to five of her teeth, which can fall out at any time, and the cost of that is €10,000. What kind of State allows that?

This is not isolated, as we have heard. Families across the country are being forced to go private or go without, based not on clinical need but their ability to pay. Meanwhile, the Government’s oral health policy, Smile agus Sláinte, is gathering dust, promised reforms to dental treatment services are delayed, the dentists Bill is missing and a dental school in UCC to tackle workforce shortages is paused. Oral health is healthcare, pain is pain, and neglect is neglect. That is the Minister of State’s responsibility. Our children deserve better, and our families deserve even more.

Pauline Tully (Sinn Fein)
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Our public dental service is basically not functioning, or functioning to a very low standard. In 2006, there were 330 dentists working within the public dental service. Last year, there were 253. Considering that the population has increased by about 1 million, it tells the story that children are not getting the check-ups they should be getting throughout primary school. They should be getting three check-ups, in second, fourth and sixth class, but many are not getting any or only getting one, or it could be into secondary school. It is in primary school that they need to learn the preventative measures to ensure they do not develop tooth decay and gum disease.

Some 104,000 children - 50% - missed out on a dental appointment in 2023. I do not have the figures for 2024, but it was something similar in 2022 as well. It is due to insufficient staff. There are 22 posts unfilled at the moment. The Irish Dental Association has been calling on the Government to rebuild the dental service and to immediately recruit 120 dentists. If we were to look at it and assess it properly, we would probably need even more dentists than that. I would say we need more than 400 dentists to address the concerns of the population as it stands.

The HSE recruitment moratorium has affected dentists more so than any other grade. There has been a 23% decrease in the number of dentists recruited. The numbers of doctors, nurses, etc., have increased, even though we still need more in the system. The number has actually decreased for the dental service. Numerous posts have disappeared under the pay and numbers strategy.

Regarding medical card services for adults, in 2009 the budget being spent on this was €86.8 million. It is €20 million less than it was a number of years ago. Due to our population increase and the increase in the costs of all these services, it stands to reason that people are not getting the service they deserve. Fewer people are being seen. Approximately 50% of the dentists on that scheme have pulled out. That is partly to do with funding but many would say it is to do with the contract and the bureaucracy involved in the contracts. Even if the money was increased, many would not go back in under that contract. We are seeing many people with medical cards unable to access dental care because they cannot afford to pay for it privately.

There are thousands waiting on orthodontic services. Most are of them are children, but some of them are adults who were not seen as children. They have become adults and still require the service but have not been able to access it due to years-long waiting lists. As my colleague mentioned, people who require general anaesthetic for dental surgery are waiting possibly years. It is again down to a lack of trained personnel to provide this service.

Autistic children have sensory issues around having their teeth seen to by a dentist, so we need a number of specialised dentists who can address that. Recently, a constituent contacted me about a young man of around 30 years of age whose teeth are in a shocking state of disrepair. He is autistic and has not gone to a dentist because he cannot stand anything being put into his mouth. His teeth are now so bad that he will require implants, which will cost a huge amount of money he does not have. She was talking to me about how we get support for this young man to get his teeth seen to. It was causing him such distress that he was suicidal because of the state of his teeth.

There are many issues here that need to be dealt with. There is nothing in the motion I disagree with. We just need to see it implemented.

Victor Boyhan (Independent)
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I only have two more Senators on the list. If any other Senators wish to speak, they might pop up here and let me know. Senators O'Donovan and Boyle wish to contribute. We will come back about the timing in a few moments but I have taken their names.

Cathal Byrne (Fine Gael)
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I thank the Minister of State for attending the Chamber to hear this important motion introduced by my Fine Gael party colleagues. It is refreshing, having listened to many of the contributions that have been made across the Chamber, that there is cross-party unity on this issue that is important for so many people across the country.

At the outset, I will speak on the need for mobile dentistry units to be introduced specifically to deal with patients in nursing homes and those with mobility issues. This issue was highlighted to me while canvassing during the last general election. The point was made that the HSE does not currently provide a scheme, mechanism or programme for mobile dentistry units. It is not currently possible for people who have mobility issues and are not able to attend at a dental clinic or surgery, or those who are permanently living in a nursing home or residential institution, to avail of dentistry surgeries through the public system. Instead, they are dependent on having either private medical health insurance or a private provider giving up their own time and making mobile dentistry clinics available to them. When one considers the priorities under the Sláintecare model, which is to deliver timely surgeries and treatments at the best place, that currently does not exist. This motion is calling for that, and I am grateful to my colleagues in Fine Gael for accepting it to be included in this motion. One of the key principles under Sláintecare is the principle of equitable access to healthcare, and introducing a mobile dentistry unit would help with that.

I am struck by the fact that in 2017 it was the now Tánaiste and then Minister for Health, Simon Harris, who introduced the changes to PRSI to allow for free scale and polish services both for PAYE taxpayers and those who are self-employed. That was introduced to help to ensure there is equal access to dentistry services for adults.

When it comes to children, as has been highlighted by my colleagues, school-going children should have three dentist appointments. The HSE should set out a similar key target for people in nursing homes or residential institutions, or those who have mobility access issues, so they have the opportunity to avail of dentistry services and check-ups over the years. I would like the officials in the Department and the HSE to look at a pilot programme in this area.If we are to see this rolled out, we need a pilot programme in order that we can learn from what works and what does not. I am aware, as are many of my colleagues, of the issues relating to access to dentistry places and the training of and number of dentists and dental hygienists. However, there is an option for a pilot in this area that should be explored further.

I welcome the contributions from across the House in support of this motion. I want to put my full weight behind it.

Eileen Lynch (Fine Gael)
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Cuirim fáilte roimh an Aire Stáit. Gabhaim buíochas leis as a bheith sa Teach linn inniu.

I rise to support this important motion which calls attention to the future of oral healthcare in Ireland and the steps we must take to ensure that access is fair, services are reliable and regulation is fit for purpose. As has already been mentioned by my colleagues, the Government published Smile agus Sláinte in 2019, our first ever national oral health policy. This was a landmark moment in public dental care. As has been noted, however, as we move through 2025, progress has been incredibly slow and uneven and has practically stalled in many regions.

In terms of access, under the dental treatment services scheme, adult medical card holders are supposed to receive routine care. In reality, a growing number of dentists are withdrawing from the scheme, citing underfunding, bureaucracy and unsustainable working conditions, points that have been strongly articulated by the Irish Dental Association. It has warned that without urgent reform, access will continue to erode, particularly for vulnerable groups. In rural areas such as west and north Cork, Kerry and parts of Waterford, medical card patients face a waiting time of more than 18 months. These are communities where private alternatives are few and far between. This creates not just healthcare inequality, but a regional imbalance that undermines the Government's commitment to regional equality in access to primary care services. Furthermore, while tax relief and the treatment benefit scheme help offset some costs for working adults, these supports do not reach those who need it the most, namely the unemployed, older people and families with children that are in lower income brackets.

On the matter of children's dental services, Smile agus Sláinte promises three school dental appointments for children before the age of 12. As has been mentioned, implementation has been wildly inconsistent. In some counties, particularly in the south, HSE dental teams are so under-resourced that many children get one check-up, if any. While I welcome the announcement of the new bachelor of dental surgery course at the Royal College of Surgeons in Ireland that is due to commence this year, we need to go further. The Irish Dental Association and public health experts have warned that our dental workforce is ageing, and many practices are closing or scaling back.

The programme for Government contains a commitment in respect of increasing the number of health and social care training places. That must include expanding dental education at Trinity College and UCC. These universities already have the infrastructure and are well placed to serve the east and the south, including under-served regions. UCC in particular can anchor recruitment for Munster and surrounding counties. It is incredibly disappointing that funding has been withdrawn from the planned new dental school in UCC. That the project has essentially been shelved. This decision needs to be reconsidered and reversed. A total of €55 million is needed to deliver the project, which was originally planned to be delivered and completed in 2023. Quite simply, the solution is that more college places need to be made available. Every year, there is huge interest among students in studying dentistry. We need to make more places available to them. However, we must also address the short-term shortages.

The motion suggests engaging recently retired dentists to help with school screenings. This is a practical interim solution that would make a real difference in areas where school dental checks are not happening. The number of dentists employed to deliver school dental screenings has decreased by 30 since 2012. There has also been a massive reduction in the number of those receiving the service in recent years. While 104,000 students were seen in 2023, this was a drop of 31,000 on the figure for 2017. That is a massive drop in the short space of six years.

The closure of dental and orthodontic practices has left many patients not only in pain and lacking services but also out of pocket. Families have spent thousands on orthodontic treatment plans, only for clinics to subsequently shut down without warning. In these cases, patients can be left financially stranded. That is not acceptable. In its 2021 submission, the Dental Council called for stronger legislative tools to manage these events. This motion echoes that call on the Government to work with regulators and the Department of Finance to protect consumers and establish fair resolution mechanisms. In addition, I want to highlight a silent and often forgotten group, namely nursing home residents and those with mobility challenges. Oral health is often the first casualty of reduced mobility, leading to pain, poor nutrition and an overall worsening of general health. Action to address the call to introduce mobile dentistry units is long overdue. That call deserves cross-party support.

To echo my colleagues' comments, we need to modernise our dental legislation. The Dentists Act is now 40 years old. It is outdated, vague on practice closures and silent on technological change. The Dental Council has repeatedly sought its reform. We need to take action now. This motion is not just about teeth; it is about access, equity, regulation and common decency in how we care for our people. We cannot forget parts of the country. The next generation cannot be left without care. Our dental professionals deserve policies that match their commitment to public health. We need to implement Smile agus Sláinte in full and update our laws to protect consumers and build a fair, modern, regional and reliable dental system for all.

Noel O'Donovan (Fine Gael)
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I will be brief. A lot of valid points have been made, and I do not want to repeat what has already been said. I thank the Minister of State for being in the House for this debate.

When talking about dentistry, certain words come to mind. When we go to dentists, we are all reminded of proper dental hygiene and brushing our teeth in the morning and evening. Some of us may well be guilty of not following through on that. This is how I see the issue of dentistry. People have become a bit complacent. This is not an issue that is discussed in the Houses very often. That is where we need change. I pay tribute to my Fine Gael colleagues for raising the matter in the House and to the former Minister of State, Deputy Colm Burke, for his presentation at a recent parliamentary party meeting. The statistics are staggering with regard to the number of available dentists and the drop in services for school dentistry. It is clear we have an issue.

As my colleague Senator Lynch said, it is not about system failures; this is about access and equality in our health service. In the area where I come from in west Cork, there are severe needs on the peninsulas outside the big towns and the city. I pay tribute to local councillor Caroline Cronin, who has been raising this issue with Cork County Council. It is good to see a follow-through here and that it is being raised at a national level. Some of the statistics are really serious, such as the number of children being seen dropping by 30,000 to 104,000 in 2023 compared with the 2017 figures. That is quite serious.

This is not just about calling out the issue and raising the problems that exist. The solutions are there. The development of new dental school in UCC is needed. The project needs €55 million. That is a lot of money, but it is not a great deal in terms of overall goal of getting more dentists into the system. We need to see movement on that. I welcome talk of mobile dental clinics is welcome too. It is about thinking outside the box.

I ask the Minister of State to take practical solutions from what has been discussed today, such as allowing retired dentists back into the school system. That is a really plausible option and solution. The retired dentists would not carry out major operations or services, but would analyse and assess. As the old saying goes, "prevention is better than a cure". That is what we need here. This system needs tinkering with. Looking at the State as a whole, we have issues in so many different sectors. Our population is growing and growing, and our services need to grow too. I ask the Minister of State to take this issue seriously.

Manus Boyle (Fine Gael)
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Many of the issues have been addressed by my colleagues. I thank the Fine Gael Party for pushing for this motion to be taken today. We definitely need more college places, more dentists, more dental nurses and more dental hygienists. A wee girl in Donegal applied three times to UCC to get onto a dental hygiene panel but was turned down because only ten places were available. Only ten places were available at Trinity College too. We need to set up more courses for the young people who want to study dentistry.This girl is talking about going to England to do the course. Her family are devastated because she is the heart and soul of the family. She will be away for three years, but if she stayed in Ireland to do the course, she would be able to be home at the weekends.

Taking retired dentists back into the schools would be great. I firmly believe that if we teach children how to do it when they are young, they will follow through in life. It is like gardaí going into schools to talk about seatbelts. If I got in the car without putting on my seatbelt, my wee daughter would be the first one to reprimand me.

I would love to support Senator Byrne’s proposal for a mobile dentistry unit, especially for people in nursing homes. The Minister of State has responsibility for older people. I do not have to tell him but since we joined the Seanad in March, I have dealt with two people in nursing homes who were trying to access dentistry after their dentures broke but who were finding it very hard to get anyone in. These people carried this country for years. The least they deserve is a visit from the dentist twice or three times a year to make sure their teeth are okay. We do not want them feeling any more pain.

Kieran O'Donnell (Limerick City, Fine Gael)
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I thank the Senators for their contributions, and particularly the Fine Gael Senators for tabling the motion and providing us the opportunity to discuss dental services and outline the Government’s priority to fundamentally reform these services over the coming years. I am taking this debate on behalf of Minister for Health, Deputy Carroll MacNeill. She is not opposing the motion.

Before I begin with my formal speech, many of the issues Senators have raised have a common theme. Many are identified in the new programme for Government, which refers to increasing the number of college places, with one of the faculties being dentistry. Under the programme, the Government will: implement Smile agus Sláinte; hire more public dentists; agree a new dental treatment service scheme for medical card holders, which is the dental treatment services scheme, DTSS, and something that many of the Senators have referenced; expand access to the orthodontic scheme for children and strengthen the school dental programme; update the Dentists Act 1985, an issue that has been raised a lot in today’s debate; and recognise and regulate more dental specialties.

I recognise what many of the Senators have said about older people in nursing homes. This is something I will take up with the Minister and officials. The mobile service, which was raised by many Members, is very important.

Senator Byrne spoke about increasing the number of college places. The overarching theme was to have more young people seen for orthodontic treatment. Senator Nelson Murray spoke about student places as well as work permits. Senator Kyne, the leader of the Fine Gael group, spoke about oral health and referenced our colleague, Deputy Colm Burke’s proposals in this area.

A theme that arose was that of retired dentists and the question of whether they had a role to play - Senator Kyne mentioned this, as did many others - in examinations as opposed to clinical practice. Am I correct in that interpretation?

I take Senator Conway’s point that we need more dentists in both the public and private systems. That is in the programme for Government. Senator Costello spoke of the need to update the 1995 Act and the DTSS. Senator Ryan referred to increasing the numbers being seen, as did Senator Tully. Senator Byrne made specific reference to the mobile dentistry scheme and that the service should be fair and reliable. Senator O’Donovan referred to the mobile service and the Health Act. Senator Boyle made a telling point on nursing homes and dental care for older people.

The Government allocates over €230 million to the provision of oral healthcare every year. This shows our commitment to delivering oral healthcare services. All the points raised by the Senators will be brought back to the Minister and the officials. A senior official from the Department is attending this debate, which I felt was important.

Improvements in access to care and in reducing waiting times over recent years have been supported by significant additional investment. This includes an additional €15 million in recurring funding between 2022 and 2024 to progress the national oral health policy. A further €17 million in non-recurring funding has been invested to improve access and respond to waiting lists. A range of measures have been put in place since 2022 within the DTSS for adult medical card holders. This introduced and reintroduced elements of preventive care. The Minister for Health also increased the fees paid to contractors for most treatment items by 40% to 60%. Fees paid to dentists for DTSS care are now aligned with other European countries that provide comparable public dental care, noting that many European countries, especially in the southern and eastern regions, do not have any scheme in place for adults that is free at point of access.

Our measures are having an impact, with access to care increasing in 2022 and increasing further again into 2024. The range of treatments provided includes scale and polish, fillings and extractions. Comparing 2022 to 2024, these measures have had an impact on activity and expenditure. The fees paid to contractors increased from €49 million in 2022 to €69 million in 2024. Over 300,000 patients received care in 2024, which was an increase of 44,000 on 2022. In terms of the volume of care received, over 222,000 additional treatments were provided in 2024 versus 2022.

However, we must acknowledge that challenges still exist. People, especially children, are waiting too long for care. Our oral health service, notwithstanding the commitment and dedication of all front-line oral healthcare workers, is not aligned with WHO standards. Through implementation of the national oral health policy, the Minister for Health, Jennifer Carroll MacNeill, wants to do more to improve oral healthcare services and to address the access issues that are still there.

In 2019, the national oral health policy, Smile Agus Sláinte, was published. This Government policy 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 transform oral healthcare services in Ireland, with prevention and promotion are an integral part of all service provision. Smile agus Sláinte was informed by and aligned with other relevant Government health policies, including the primary healthcare approach, Sláintecare, our overall framework for better healthcare in Ireland, and Healthy Ireland.

The two goals of the policy are: to achieve personal best oral health across the life course from birth to old age; and to reduce oral health inequalities across the population. The current model of oral healthcare services does not adequately provide for those who need additional support to access oral healthcare, including those living in residential settings and those accessing services under the umbrella of inclusion health. The Government has provided €2 million in budget 2025 to enable the HSE to progress initial scoping work to better understand the oral healthcare needs of people living in residential settings so that the HSE can then design the oral healthcare services that best meet their needs. This may include mobile units. Senators have referred to those, so this is a positive.

For children, the HSE is progressing with the design of comprehensive and prevention-focused oral healthcare packages, starting with children aged from birth to seven years. This aims to support children to attend a local dentist from birth, representing a significant expansion of care compared to the current model, which centres on three examination appointments, starting at the age of seven.This will ensure a greater emphasis on prevention, and earlier intervention for children, where intervention is needed.

Senator Lynch made reference to fair, reliable and consistent care. I note what she said about UCC as well. We recognise that much work is still to be done here, including the design of an operating service model, the development of a contractual framework with the dentist representatives and supporting legislation. For adult medical card holders, the HSE is committed to the design and development of packages of expanded preventative care. As we work systematically through the implementation of the policy, we will walk through a public conversation on what kind of oral healthcare is needed in Ireland, within the framework set out within the policy, which is in turn based on international evidence. This requires substantial change in dental training and education, and an enhanced role for a wider range of dental professionals, including nurses and hygienists, in the dental team providing oral healthcare. Both are provided for within the programme for Government, which refers to an increased number of college places and to an expanded role for other dental professionals.

Progress on the reform envisaged in the policy has been slower than the Minister would have liked. It has been by the pandemic, among other things. However, to support a focused and structured implementation of the policy, the Department of Health and the HSE are developing an implementation plan for the 2025-27 phase of its roll-out. This plan is currently being finalised for publication.

The public oral healthcare services provided by the State include orthodontic treatment. There has been particular focus on supporting patients to access these services. A total of €17 million in non-recurring funding was provided between 2022 and 2024 to address orthodontic service backlogs. Some 511 patients were removed from the grade 4 orthodontic treatment list through this funding in 2024. In addition, a new orthognathic jaw surgery waiting list commenced in September 2023. These are complex surgeries which can require a lengthy hospital stay. Some 77 patients received this type of surgery in 2024. A further €2.85 million is being invested this year to support the continuation of measures to reduce orthodontic waiting lists.

The Minister for Health is committed to reviewing the legislation underpinning the regulation of oral healthcare professionals, the Dentists Act 1985. A priority for 2025 is the development of new provisions to amend the 1985 Act in areas which have been identified as prime concerns by the Dental Council and to proceed with these where appropriate. This will include enabling provisions for the Dental Council to develop a statutory scheme of continuous professional development, CPD, and competence assurance for registered dentists, in line with that provided for other regulated health professions. This long-overdue intervention will make CPD a mandatory requirement. We must acknowledge that the entire regulatory framework requires reform. In parallel to these interim reforms, work is commencing on a fundamental review of the Dentists Act 1985 with the ultimate aim of developing a new, modern, fit-for-purpose regulation, which aligns with the reform envisaged in the oral health policy.

I note there are now more dentists than ever registered in Ireland. There are 3,888 dentists on the Dental Council register as of June 2025. This reflects ongoing upward trends in the number of registered dentists in the State, and compares favourably with the number in April 2019, when Smile agus Sláinte was published, which as 3,100. This is an increase of over 25%.

The Government is firmly committed to ensuring that our healthcare system is supported by a steady and sustainable pipeline of highly skilled graduates, including in critical areas such as oral health and dentistry. Ensuring adequate capacity to train future dentists is part of our broader commitment to workforce planning that supports the health and well-being of our population. This is a recurrent theme with nearly all of today's contributors.

The Minister for Further and Higher Education, Research, Innovation and Science has remit over providing more funding for dentistry places through the Higher Education Authority. The Department of Health supports any expansion in the oral healthcare workforce. The Government provided €2 million in budget 2025 to support 15 additional new whole-time equivalent posts, specifically to improve staffing levels within the HSE community dental service. It is acknowledged that there are issues with the school screening programme and many Senators raised that here today. It is envisaged that funding allocated in budget 2025 for an additional 15 dental staff will go towards alleviating this as an interim measure. The focus is on continuing to build and maintain a sustainable workforce.

The National Oral Health Policy envisages major transformation of oral health services, requiring a greater role for dental contractors in providing a wider range of care through a model that focuses on primary care. It also requires a much enhanced and reoriented public dental service which will, among other things, play a key role in providing services to patient categories that are often underserved, including people with disabilities, people living in residential services and people requiring more complex oral health interventions. In building the necessary capacity to meet the current and future oral health needs of our population, we must also look to other members of the dental team to ensure they are supported to work to the top of their expertise. We will explore the opportunities for new and expanded roles within the traditional dental teams, providing opportunities for a wider scope of capacity and more opportunity for dental professionals to provide more care and a greater variety of care.

We all recognise and are sympathetic to any situation where patients are impacted financially following a sudden closure of a dental or orthodontic practice. This is something Senator Kyne referred to. Consumer law is primarily the responsibility for the Department of Enterprise, Tourism and Employment. The Minister for Health is committed to working with and supporting further consideration of safeguards or other opportunities to enhance consumer protection. The Competition and Consumer Protection Commission is the statutory body responsible for promoting compliance with, and enforcing, competition and consumer protection law in Ireland and is best placed to advise on such matters.

I thank the Fine Gael Senators for bringing forward this motion and the other Senators who have contributed. I assure the Senators that the Minister for Health, Deputy Carroll MacNeill, will continue the ongoing work being delivered by her Department to fundamentally reform the oral healthcare sector through the implementation of the National Oral Health Policy.

Seán Kyne (Fine Gael)
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I thank the Minister of State for that response and his engagement on this matter. Indeed, I thank all Senators for their contributions during the course of this debate. I think the role of Senators, including Government Senators and backbenchers, is not just to clap each other on the back and say we are all wonderful, but to be critical, to bring up flaws, shortcomings and shortfalls and to respond to the needs of our constituents and people who bring matters to our attention. We have done that in this debate. I say that in response to Senator Conway, who rightly spoke about Fine Gael being in government for 14 years but should bear in mind that the Opposition is well able to bring forward debates it wishes to have on dentistry or anything else. We brought forward this positive motion, which outlines what we have done, what needs to be done and what is committed to under the programme for Government. That is welcome.

I welcome the Minister of State 's commitment to looking at those practices that have closed because that is a cohort of people who overnight can be left facing severe financial penalties. It is important that is looked at. The Minister of State said that there are currently 3,888 dentists on the Dental Council's register but data from the Department of Health shows that there are 2,420 dentists. I am not sure if all of the dentists on the Dental Council's register are practising or what the reason is for that disparity. Certainly the figures we have show that there is a shortfall in relation to this. I welcome the commitments in relation to the Dentists Act 1985, but the Minister of State has been in various Government Departments and I have been as well, and we know that sometimes these things can be on lists for a long time. The Minister for Health has to actively push for this to be part of the legislative programme, has to go through all the consultations, has to get the heads of a Bill published, has to go through pre-legislative scrutiny and has to get a Bill drafted and published. I will continue to push her and the Government on that.

I wish to respond to what was said about people, especially children, waiting too long for care. There was a suggestion that we are aligned to World Health Organization standards. That should not be the case. That is just being honest. We can do better and we have to do better for the children of our country. My colleague Senator Nelson Murray spoke of her experience with her own children. That is the reality. I hope that this problem is not centred on certain parts of the country, such as disadvantaged areas, and that we do not have a postcode lottery in relation to this. All children are deserving of these vital check-ups. The longer they are left untreated, the more problems are stored up for themselves, for their families and for the HSE and dental services into the future.

I again thank the Minister of State and all of the Senators for their contributions. It was a good debate and it is an important issue. I know the Minister of State will continue to engage with his Department officials, whom he brought along today, and they will bring these issues back to the Minister, Deputy Carroll MacNeill, as well.