Dympna Kavanagh: The local dentist will now be the centre of oral care

Henceforth, families will choose a private practice, and this will be the ‘dental home’ at which they will receive state-funded care, says Dympna Kavanagh

Ireland’s dental health is in the top one third in the EU and, per capita, we spend a high amount on dental health, so why do we have concerns about access to care?

Currently, the HSE Public Dental Service focuses mainly on providing care for children in second, fourth, and sixth classes. It also provides care for people of all ages who have special needs.

Orthodontic braces are provided for the children with greatest need. All children have access to emergency care. Adults with medical cards can access limited dental care.

Since the 1970s, fluoridated water and toothpaste, fissure sealants, and better diet have improved dental health.

In the 1980s, eight out of ten 12-year-olds had several decayed teeth. At that time, half of older people had no teeth. Now, most 12-years-olds have few cavities and teeth are retained into old age.

Yet, not everyone has benefitted. Many, including people with disabilities, people in residential facilities, the homeless, and refugees have difficulty accessing care.

Oral health quality of life, which includes how a person can perform functions such as eating, talking and smiling, declines with age and is worse in poverty.

Smile agus Sláinte, a new policy approach to dental care, was launched by the ministers for health and social protection in April 2019.

It has two goals: to help every person to reach their personal best oral health and to ensure no-one is unable to access care. It includes 41 actions to be delivered over the next eight years.

In the future, most care will be provided by local dental practices: we call this the ‘dental home.’ People can choose their dentist and a family (from children to grandparents) can access state-funded care in the same place.

Waiting lists for children’s dental care (up to the age of 16) will be tackled by the introduction of eight oral healthcare packages, rather than the three visits currently provided to this age group.

Adults with medical cards will also have access to preventive dental care throughout their lives, as well as routine treatment and complex care.

Under Smile agus Sláinte, free oral healthcare for children aged under six will be introduced in late 2020.

This will allow the HSE service, over time, to refocus. It will deliver health promotion programmes and provide dental services to those whose care cannot be provided at their local dentist, such as people in residential care.

The oral health promotion programmes will focus on integrating oral and general health. The right advice for general health is also right for good oral health. HSE dental services will provide preventive care to vulnerable and excluded communities.

Treatment that requires advanced skills and services not available from local and HSE dentists will be provided in advanced oral healthcare centres, for example in hospitals.

But what about orthodontics? Smile agus Sláinte supports the provision of care, where possible, in local dental practices. Dental practices provide a greater range of care than ever before.

Even when people are referred to community or hospital services, their local dentist, or ‘dental home’, will continue to support their care.

For the first time, Ireland will have a population oral health programme throughout life. The logic will be: Inspect and Protect.

Inviting the population at key stages for these check-ups will ensure that Smile agus Sláinte stays on track. This programme will give a reminder or a nudge to people at key ages (three times up to 16 years) to attend a dentist.

Further state dental check-ups will be provided into old age. This will compare a person’s oral health to that of their peers. This supports the ethos of Smile agus Sláinte that ‘no-one is to be left behind’.

But can we afford this change? The estimated cost of preventive packages is at least €80m. Routine and complex care will be budgeted separately. The long-term dividends are an early best start to reduce emergency care, general anaesthetics, and expensive care and treatment.

Smile agus Sláinte is a big change for the public, but also for the profession. Education of dentists will be reviewed. Over half of our dental professionals are hygienists, dental nurses, clinical dental technicians, orthodontic therapists, and dental technicians.

Enabling access to more dental professionals will give more choice to the public. There will be greater diversity of work for dentists and dental professionals and a synergy with other health professionals, such as doctors and pharmacists. The Smile agus Sláinte approach shows better health outcomes across all age groups in other EU countries and reduces inequalities between rich and poor. Such an approach is endorsed by the World Health Organisation and the United Nations. Our highly skilled profession is well-placed to this support this change.

Dr Dympna Kavanagh, chief dental officer, Department of Health