Dental health crisis: Children forced to wait years for treatment
For the first time in 25 years, we have a new national oral health policy, Smile agus Sláinte.
The Government says it will provide the groundwork to transform oral health services over the next eight years.
This includes changing the way public dental healthcare is currently delivered to children.
At the moment, children are offered free dental check ups and associated treatments, to coincide with key developmental stages, through the school dental programme.
The proposal in the new policy is to put eight oral health packages in place that children can avail of up to the age of 16.
The Irish Dental Association (IDA) says it won’t work, that relying on busy parents to take their kids to a dentist of their choosing in not a workable plan.
But an examination of the existing school dental programme shows it isn’t working very well either.
Ostensibly, it is targeting kids in second, fourth and sixth class, but the reality is fourth class pupils are largely excluded and in some parts of the country, such as Cork, the programme is largely confined to sixth class.
The IDA says increasing numbers of children are only being offered examination and dental care for the first time at sixth class.
Those children identified as in need of orthodontic work can also face long waits, particularly where that work must be done under general anaesthetic. In Co Kerry, there are 120 children on a two-year waiting list for treatment under general anaesthetic
In the Mid-West, for routine cases in need of orthodontic services, the waiting time on average is 3.5 to four years. There are 1,728 children on the waiting list in the Mid-West, with dental problems ranging from significant to severe.
Children with special care needs are also kept waiting. There are 48 such children in Cork/Kerry on a waiting list who require routine dental care under general anaesthetic with a waiting time of 20 weeks.
Whether or not Smile agus Sláinte is the way forward, our school dental programme is in dire need of an overhaul.
Our analysis today sets out the waiting lists, staff vacancies and schoolchildren that are missing out on screening in each of the nine community health organisations around Ireland.
Cork, Kerry (CHO 4)
There has been no change in policy in relation to the screening service targeting children in second and sixth class. While there may unfortunately be times when it is not possible to see all children during the academic year, those children will be offered appointments as soon as possible. This means their appointment will take place either during their school holidays or during the next academic year.
There are no screenings in 4th class due to resources.
In terms of specialist referral, the main requirement is children requiring extractions under general anaesthesia. There are currently 120 children on the waiting list and approximately 60 per year are treated at UHK so the current waiting time is two years. A service improvement plan has been drawn up and discussions are ongoing with UHK management to improve the level of service in 2020.
With regard to waiting lists for specialist treatment, both routine and urgent cases are referred onward for the appropriate care.
There are currently 320 children on the waiting list for general anaesthetic in Cork, resulting in a waiting time of 10 months. Acute urgent cases are prioritised and are seen within one to two weeks.
There are 48 children in Cork/ Kerry on a waiting list who require routine dental care under general anaesthetic with a waiting time of 20 weeks.
A small number of children requiring specialist referral are referred to Cork University Dental School and Hospital. They are usually seen promptly.
Senior dental surgeon x 3wte (whole-time equivalents)
General dental surgeon x 2wte
Dental nurses x 3wte
Waterford/ Wexford/Carlow/ Kilkenny/South Tipperary (CHO 5)
Children are called for appointment in first/ second, fourth and sixth classes. However, it has not been possible to see children in fourth class for the past number of years.
At present, a cohort of children in Waterford/ Wexford for the period 2017-2018 from second and sixth classes are currently awaiting dental examination and treatment.
Unfortunately, no children in the 2018-2019 period second and sixth classes have been offered dental examination and treatment to date.
In Carlow/ Kilkenny, it has not been possible to offer dental examination and treatment to fourth class at all for several years. Children from the 2018-2019 cohort of second and sixth classes are still being called to appointments while no child from the 2019-2020 period has been seen other than in the emergency clinics.
Children requiring specialist treatment are referred to Cork Dental School and Hospital or to OLCH, Crumlin or Temple Street. Waiting lists for these services are retained in the respective/relevant hospital.
Emergency dental treatment is provided to all children up to the eve of their 16th birthday.
There are currently vacancies within the service under the following areas:
Senior administrative dental surgeons
Senior dental surgeons (paediatric).
Senior dental surgeon special needs
Senior dental surgeons
General dental surgeons
Dental nurse
Clare, Limerick, North Tipperary/East Limerick (CHO 3)
A schools dental screening service is offered, targeting children in first/second class and sixth class.
Emergency dental services are available to all eligible patients (children under 16 and certain eligible adults).
For routine and preventative care, priority is given to medically compromised children and adults with special needs.
There are currently 87 patients awaiting assessment with the Orthodontic Service, Mid West Community Healthcare.
As patients are seen for assessment at quarterly intervals, all of these patients will be offered an appointment for assessment in Q4 (last three months of the year).
Waiting time for orthodontic assessment: All patients seen for assessment within six months of referral — 75% of patients are seen within three months of referral.
There are currently 1,728 patients on our treatment waiting list of which 942 are Grade 5 (severe dental health problems) 786 Grade 4 (substantial irregularities that require treatment for dental health purposes)
Within orthodontic services, urgent cases with evidence of pathology are prioritised for treatment.
For routine cases, the waiting time on average is 3.5 to four years.
There are currently no vacancies in our oral health services
Galway/ Mayo/Roscommon (CHO 2)
Appointments are offered to sixth class in CHO2 to start with, then moving to second class but unlikely to see fourth class in all areas due to vacancies.
Yes we have a waiting list for orthodontics and general anaesthetic — children 17 (12 -28 weeks) — adults 13(12–18 weeks)
We are currently seeing routine cases in sixth class only and urgent cases as emergencies
Vacancies as follows:-
Galway: 2 dentists and 1 dental nurse
Roscommon: 1 dentist, 1 dental
hygienist and 2 dental nurses
Mayo: 1 dentist and 1 dental nurse.
Total: 9
Longford/ Westmeath/ Laois/ Offaly (CHO 8)
Children are categorised into priority groups.
Priority 1: Children aged 12-16 are being offered screening, referral and intervention in all four counties
Priority 2: Children aged 6-8 are offered screening, referral and intervention in Longford and Westmeath only
Priority 3: In all four counties, children aged 9-11 are not being offered screening, referral or intervention
There is a waiting list to receive dental treatment under general anaesthetic. The wait can be from a month to 18 months and there are approximately 250 children awaiting treatment.
Urgent cases i.e. relief of pain, emergencies are seen on the day at the local clinic.
Scheduled appointments (routine cases) are provided for the children in the priority group.
Currently there is one vacancy for a dental surgeon in Co Laois and there is a campaign launched to fill this post.
The HSE Louth Meath Service strives to offer dental care to children in target classes each year. For the past two years, we have had to reduce the number of target classes from three (1st/4th/6th) to two classes (1st/6th) and we will initially target only 6th class in 2019-20, until the recruitment is completed (see below).
The main waiting list for specialist treatment is the orthodontic waiting list.
We also provide care in hospital settings for children who require dental treatment under general anaesthesia. The current waiting list for dental extractions under general anaesthesia for school children is seven months.
If this question refers to the HSE Dental Service as a whole we see both. If it is in relation to treatment under general anaesthesia, children are prioritised depending on the urgency of their need.
National derogation has been received for six posts, three to be filled from an existing panel and three more to go through the complete recruitment process.
Those to be filled from panel include senior dental nurse special care; dental nurse Ashbourne; dental nurse Navan
Those yet to go through recruitment include senior dental surgeon special needs Co Louth; general dental surgeon Dunboyne Co Meath, and general dental surgeon Navan, Co Meath.
Dublin South, Kildare and West Wicklow (CHO 7)
In Dublin South City/ Dublin West children in second and sixth classes are offered appointments under the school dental programme. In DSC to date fourth classes have been offered appointments. This is unlikely to happen this year due to reduced staffing.
In Dublin South West/Kildare West Wicklow children in second and sixth classes are offered examinations under the school dental programme. Until approximately five years ago, all were also offered examinations in fourth classes also but this stopped due to reduced staffing.
Waiting lists are not maintained for other specialist services, all such patients are referred to the Dublin Dental Hospital and in some cases the patients may be waiting a year for an appointment or increasingly being refused entry onto a waiting list due to the length of the lists.
Services for dental emergencies are offered in dental clinics, Monday to Friday.
Dental teams are not fully staffed and overall since 2008 there has been a reduction in staffing of circa 30% (posts lost due to previous staffing embargoes and not approved for replacement).
In DSC/DW current vacancies include 3.6 WTE general dental surgeons, I.0 WTE dental hygienist due to maternity leave and 1.2 senior dental surgeon special needs post. Other vacancies are filled by agency staff pending recruitment.
In addition there are 3.0 WTE general dental surgeons and 1.6 WTE dental nurses on leave.
Total DSC/DW: 10.4
Donegal/Sligo/Leitrim (CHO 1)
All children in first/second/fourth and sixth class are offered a dental appointment and follow-up treatment is provided if required.
Emergency dental care for relief of dental pain, dental infection or dental trauma is otherwise available to all children and eligible adolescents.
The service operates as a public dental service, and not merely a school-based service. Those requiring emergency dental care are seen immediately on the day of contacting the service.
There is no waiting list for children waiting for emergency dental treatment.
In Donegal Dental Services children requiring specialist input are referred to Dublin Dental Hospital, Temple Street Children’s Hospital or Our Lady’s Hospital, Crumlin. The service does not have a waiting list for children requiring specialist dental input.
Treatment under general anaesthetic is provided at Letterkenny University Hospital. The waiting list time for treatment under general anaesthetic is circa six months. The service fast-tracks those most in need.
In Sligo/Leitrim Dental Services, 36 children are on a waiting list for oral surgery under general anaesthetic, with a wait time of 3 months.
Urgent cases are seen within six weeks, routine cases within 12 months.
The Cavan Monaghan dental service caters for those with special needs, who are medically compromised and provides care under general anaesthesia and relative analgesia. Waiting times for extraction under general anaesthesia is currently 8- 12 weeks.
Waiting time for dental care under relative analgesia* is eight weeks. The service also provides non-complex/ minor oral surgery for which the waiting period is four weeks.
*Pain relief, without putting you to sleep
Dental services see both. Emergency dental care is triaged according to presenting conditions.
There are currently seven vacancies in CHO 1 made up of senior administrative dental surgeons, surgeons and dental nurses.
Dublin North City & County (CHO 9)
In Dublin North City 6th, 2nd and 4th classes are seen in all clinics.
In Dublin North County 6th classes are being seen in all clinics, 2nd classes are also being seen but this is running behind in many clinics. No 4th classes are being seen currently.
6th class are the first to be prioritised firstly because this will be their last assessment and secondly to detect orthodontic anomalies that could cause issues if not picked up; 2nd are the next class as it is their first assessment with the service and 4th class are the last. However, missing 4th class means that there could be a higher treatment need in 6th class as well as not assessing potential orthodontic issues earlier.
Due to staffing issues and a growing population, Dublin North has been unable to examine 4th class for the last 2 years. Balbriggan has been cited as the fasted growing population in Ireland. This has an obvious impact on the service.
We have limited access to specialist services. We refer to Crumlin and Temple Street for paediatrics special care general anaesthetic cases. We do not hold these waiting lists.
Dublin North City & County Dental Service offer a same day emergency service across the area, so all urgent emergency cases are seen.
In Dublin North County in the schools’ dental programme no cases are being seen in the 4th class group.
Throughout DNCC only a limited service is available for routine special care children and adults as there is a vacancy in the senior special care post in both DNCity and DNCounty.
Children waiting for assessment are part of the schools programme and also special care adults and children who would normally be seen at least once annually.
Dental Service LHO Dublin North City vacancies:
1 x general dental surgeon
1 x senior dental surgeon
2 x dental nurses
Dental service LHO Dublin North vacancies:
0.6 wte general dental surgeon
1 x Senior dental surgeon administration
2 x dentists
Wicklow, Dun Laoghaire, Dublin South East (CHO 6)
Dental care is offered to children in second class (if resources allow) and sixth class.
The waiting list for orthodontic specialist treatment is managed by Orthodontic Services; Some patients are referred to Dublin Dental University Hospital for specialist treatment; waiting lists are managed by DDUH.
Dental nurses 2.6 WTE at present
General dental surgeons 1.0 WTE
Senior dental surgeon special needs 1.0 WTE
Total: 4.6
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