Minister’s new oral health plan may be last chance to fix our dental crisis
Latest figures show that over 104,000 children are not receiving the oral health checks they are entitled to every year, a situation that is both unacceptable and entirely avoidable. File photo
Minister for health Jennifer Carroll MacNeill intends to publish a three-year plan shortly which will herald the initial roll-out of the 2019 national oral health policy known as Smile agus Sláinte. This may be the last chance to fix our dental crisis.
We can only hope that lessons have been learned since 2019, when a plan was launched without any proper or real consultation with Irish dentists.
The first the Irish Dental Association heard of the plan to introduce a new State-funded scheme for children to be seen in private practice was when we read the published oral health strategy report on the eve of our annual conference in April 2019.
We made our disquiet known at the time, and we hope that has been heard. The association is willing to play its part either in co-designing a new policy or acting as a trusted adviser to a policy for which the profession has so far been treated as an observer.
We have extensively engaged with the Department of Health, HSE and wider Oireachtas to advance our own set of constructive proposals since 2019. We strongly believe that accessibility to care for lower-income families is essential in a just, dignified and health-focused society.
With the publication of the Smile agus Sláinte Implementation Plan imminent, we welcome the fact that there is now a recognition that access to care for children and vulnerable adults is a problem which demands action. Our concerns are more about the ‘how’ of what is being suggested to address these issues. We fear current plans take no account of the capacity problems facing Irish dentistry.
Latest figures show that over 104,000 children are not receiving the oral health checks they are entitled to every year, a situation that is both unacceptable and entirely avoidable. The true deficit here comes from a systematic underfunding of public dental services by consecutive governments.
There has been a €800 million cut in spending on dental care for PRSI and Medical Card patients between 2009 and 2023 — representing a lost decade in dental care for the most vulnerable in our society. As it stands, there is an acute shortage of dentists in both private and public dental services across the country.
Many of our members are simply not equipped to deal with a huge influx of children, as much as they would like to offer them the care they need. For many who have medical cards, it can already be extremely difficult to secure an appointment.
Our most recent data shows that 90% of private general dental practitioners have stated that they would not partake in a proposed new scheme to treat children in private clinics. The capacity simply does not exist.
Staffing shortages alongside a lack of paediatric expertise and experience mean that public services still remain the best potential pathway to treatment.
It is our view that an appropriately resourced, restored public dental system is best placed to provide targeted, free oral healthcare to children from birth to the end of primary school education, allowing space for intervention from dental practices for complex cases. Private primary dental settings will remain the main centres for life-course oral healthcare provision.
In the day-to-day political debate, dentistry is often implied to be a luxury, rather than a core pillar of lifetime health outcomes — as most of our European neighbours have come to realise in the design of their national health strategies.
We cannot have good health without good oral health.
Poor oral health can have a domino effect into chronic conditions such as heart disease, stroke, diabetes and respiratory problems.
The cost to patients, particularly to those who could not afford preventative care in the first place, can be astronomical in both monetary and health terms.
We have published seven major policy papers since 2018, all with concrete, costed and evidence-based proposals that would ensure a top-class level of care across Ireland. Our public dental system used to be the envy of much of the Western world, it has sharply declined over the past 15 years.
The good news is that a prevention-focused model of oral healthcare can drastically reduce cost and health burdens over the lifetime of a patient. The pain, resulting financial outlay and inconvenience of dental issues can be avoided entirely if the public is given an affordable, accessible and understandable route to regular dental check-ups.
To this end, we believe that reforms to the Med 2 tax relief scheme, as outlined in our Budget 2026 submission, to extend tax relief to additional treatments, are necessary. Currently, only a narrow range of procedures qualify, excluding much of the preventative care that could stop problems before they escalate.
Reforming Med 2 to include rehabilitative and preventative treatments such as fillings and dentures, alongside the restoration of public dental services for children, would drastically expand access across society and incentivise people to seek timely care.
It would also provide a real alternative whilst public services are being rebuilt.
In the Programme for Government, there are six important core commitments made with regards to dental services. One of them is to hire more public dentists, the other is to “expand access to the orthodontic scheme for children and strengthen the School Dental Programme.”
While this express commitment to our key issues is welcome, we have yet to see substantive follow-through on these two pledges that meet the challenges our patients are facing.
Our economy is in a very strong position, despite recent disruptions in global trade dynamics. We have had several consecutive record health budgets. There is strong evidence of political will among government and stakeholders to transform oral healthcare in Ireland.
Yet, there is no guarantee that the government will keep its promise over the next four years. We are under no illusions about the scale of the task ahead.
We believe we are at a real turning point in rightfully putting oral health at the centre of general health and securing its rightful place at the top of the agenda in Irish healthcare policy. We also believe that a failure to follow through and engage collaboratively with the dental sector will have severe long-term public health consequences.
That need not be the case. In a time of abundant opportunity, we stand ready and willing to assist the Government in implementing an effective national oral healthcare strategy. But we as a profession do need to be substantively engaged.
We want a national policy that works for low-income families, that delivers value for money to the State and the taxpayer alike, that allows for sustainable private dental practice and one that ultimately leads to a healthier Ireland. Now is the time to deliver it.
- Fintan Hourihan is CEO of the Irish Dental Association
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