Limited access to special needs dentists regularly leaves vulnerable patients in pain, says surgeon

In January, the Irish Examiner reported there were just nine senior public dentist roles across Cork and Kerry.

Vulnerable patients, including autistic children, are regularly being “left in pain” due to limited access to special needs dentists, the Irish Society for Disability and Oral Health (ISDH) president has warned.

“It’s just so unfair, they’re the most vulnerable people in our society and they’re being left in the cold, in pain with no access to treatment," Dr Gillian Smith said.

Many people with disabilities need general anaesthetic for dental care. 

A senior dental surgeon in a special needs job may also work with frail, elderly patients or people with mental health conditions. 

These patients “really have no voice”, Dr Smith said, pointing to long waiting lists nationally.

“If you’ve a child who struggles to even sit in a chair for an examination, you’re not going to be able to do treatment for them (without anaesthetic),” she said.

You can’t put a drill into the mouth of someone who’s moving about or trying to fight you off. That’s dangerous, you’re going to injure someone. 

Dr Smith is a dentist in the private sector in Bray. Many of her patients are on public waiting lists or facing long delays. General anaesthetic can only be offered in hospitals. She can offer intravenous sedation but this is not suitable for all patients.

“In Ireland you can only do that from 12 years of age up,” she said. She can do an assessment for some people using this approach.

“Then I will say ‘they might need teeth out or fillings but I can’t do that’. They need a general anaesthetic so they can appeal to the HSE to get on a waiting list to do that treatment,” she said.

Dr Smith welcomed increased political focus on disability care recently. However, she added: “Sitting around a table with a minister doesn’t necessarily mean action, I would say we haven’t seen anything different on the ground.” 

One key problem is how dental posts are structured.

“There are some special care dentists within the HSE who are superb and run amazing services but the problem is there’s no recognition of the speciality within the HSE,” she said.

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In contrast, British dentists trained in special needs care are eligible for consultant status. “The only place you can get a consultant post in Ireland is within the dental hospitals,” she said, referring to Cork and Dublin.

The ISDH has called for “more concrete referral pathways, a structured consultant-led system within the HSE”, she said.

This would address a significant pay gap and also mean easier access to hospital theatres.

In January, the Irish Examiner reported there were just nine senior public dentist roles across Cork and Kerry.