The Solution? A Universal Dental Care System
Reducing oral health issues calls for a reform of dental care systems to shift the focus from invasive dental treatment, which has failed to combat the global challenge of oral diseases, to minimal invasive treatment and oral diseases prevention.
World Health Organisation
We need a dental health care system that:
- Provides for everyone
- Is free at point of access
- Is safe for all involved
- Promotes health, instead of treating disease
- Uses techniques, materials and equipment that are minimally invasive when possible and up to date with best evidence
- Is sustainable for our environment
For our current population of 4.9 million people (and 1.8 million in Northern Ireland) there is a need for more comprehensive dental care. At present, there are around 2,000 dentists and an estimated 10,000 people employed by dental practices in Ireland. The government has a duty of care to provide dental care under Section 67 of the Health Act, 1970. It is not feasible to continue to contract out this care to private practices.
A two-tier health system does not provide for everyone’s general health. Oral health is no different. Our oral health is linked to our quality of life, our overall health, our ability to digest food, our speech and our appearance. No one should be left behind. To give everyone access to high quality and safe dental care, we must remove the barrier of cost to the patient.
Dentistry cannot continue in the same way it did before COVID-19. Huge changes need to be made in how people are scheduled, in PPE and how care is provided. These must be done with the input of dental healthcare workers and patients, the Irish Dental Association, the Irish Dental Council, the Irish Medical Association and Council.
For the health and wellbeing of our population, we need dental care to be provided in a comprehensive way for everyone. Oral health care should be provided as part of a National Health Service. Children should be seen as early as needed, and certainly before their first birthday. Prevention should be the most important aspect, and given the time and funding needed for us to be able to succeed in protecting health, rather than trying to ‘fix’ disease once it begins. Oral health in older populations and Nursing Homes needs to be prioritised as our elderly loved ones are keeping teeth longer than they would have in the past. We need to develop systems for delivering Teledentistry to allow dental healthcare workers to diagnose and provide people with advice in a safe environment and to improve access for all kinds of people.
Everyone should have access at the point of care to dental care that enhances health.
- Xrays and Photographs
- Prevention consultations
- Nightguards and Sportguards
- Gum treatments: Scale and Polish and Root Debridement
- Fissure sealants
- Fluoride varnish
- Restorations (Fillings) utilising minimally invasive techniques to reduce aerosols
- Incision and drainage of abscesses
- Extractions: simple and surgical
- Endodontics (Root canals)
- Orthodontics (Straightening)
Cosmetic treatments such as whitening and aesthetic work, and expensive procedures such as Implants, Crowns and Bridges and complex Orthodontics may not be possible at the beginning, until an increased staff force was available, but could be added in as funding increases.
Dental therapists are registered dental professionals who carry out most types of dental treatment direct to patients or under the prescription of a dentist. They provide most kinds of dental care, except for dentures, crowns or bridges, endodontics or orthodontics, or extraction of adult teeth. They currently work in UK, but there is no option for them in Ireland. They could be a valuable asset to a Universal Dental Care system.
Dental Hygienists are already an important part of the dental team in Ireland. Many of the closest connections between dental and overall health are due to health of the gums (periodontium). We must ensure continued support of the Irish Dental Hygienist’s Association.
Ireland already trains CDTs. They often work as self-employed contractors through private practice or employees in dental hospitals. They make dentures to give directly to the patient, without requiring a dentist to be an intermediate.
Dental technicians without the clinical qualification cannot see the patient directly to make records by impression etc. They require a dentist to send these impressions and records to them. This adds another layer of costs.