Cinderella of public health braces itself for a cultural shift
New plans are in place to target the long waiting lists for orthodontic treatment
Stacey McNulty before her treatment.
Stacey McNulty after her treatment. Stacey is one of the success stories of public health orthodontic services.
Jason Sheridan after his treatment.
Jason Sheridan before his treatment.
Dympna Kavanagh, Chief Dental officer at the Department of Health in Limerick. Photograph: Brian Gavin/Press 22
The public health orthodontic service has been hit hard by the recruitment embargo in the health service.
In some areas children requiring orthodontic intervention, and even surgery, are being placed on waiting lists that have no end. There are no dates given for the commencement of treatment, or even for a consultation appointment with an orthodontist.
This is certainly the case in the area the HSE calls Dublin North East (DNE), which covers not only the northern half of the Dublin area but also counties Meath, Louth, Cavan and Monaghan.
In letters sent to parents of children in the Dublin area who have been identified as having orthodontic needs, which have been seen by The Irish Times , managers state, “I am therefore unable to advise you of how long X will remain on our waiting list before being offered a treatment place. Please note that at this point, we have children in X’s category awaiting treatment since January 2008 . . .”
The general impression given by this letter was not improved by the fact that although the child concerned had an identifiably female Christian name she was referred to at the outset as “your son, X”.
The parents of this child acknowledge her case is not of the highest medical priority. Nevertheless she is a teenager with a prominent jaw and overcrowded teeth.
In fact, this teenager has been recommended for surgical realignment of her jaw.
In preparation for that operation, braces must be worn for several years, but she has not yet been given a date, or even a year, in which the operation might take place, or in which the fitting of braces might begin.
Her mother would like the opportunity to talk over the treatment options for her daughter. She is worried at the prospect of an operation and would like to discuss an alternative to surgery. “But there’s no prospect of an appointment to do that,” she told The Irish Times .
It is generally accepted that the DNE region, with its burgeoning young population and lower income levels, is at the sharp end of the problems facing the public orthodontic services.
Last autumn the Orthodontic Society of Ireland pointed out that children in that area can wait up to four years for treatment and bemoaned the fact that more orthodontists are not employed by the public service.
DNE has one consultant and eight specialist orthodontists working full-time, with a ninth working part-time. But the whole system is struggling, with varying degrees of success.
“Not too bad,” said one orthodontist working outside Dublin. Another said she was sick of the negative picture of the service being painted, while positive patient outcomes were ignored.
“We have a good manager who does her best. Parents should not be panicked by waiting times,” this orthodontist said.
Willing to travel
As well as juggling the waiting lists, staff can sometimes use less busy, outlying surgeries in their area if patients are willing to travel. DNE, for example, refers Dublin patients to its surgeries in Navan and Dundalk.
Patients can be referred to the private sector for some procedures and patients can be referred to hospitals and dentists in Northern Ireland; this is already happening in the Sligo area.
It’s hard to measure the orthodontic problem using any tools other than the number of specialists – or lack of same – and the length of waiting lists.
For example, according to HSE South, in the Cork and Kerry area which, for many years, was a black spot, it has two consultant orthodontists, four and a half specialists and a connection to dental post-graduates at University College Cork dental school.
All staffing levels are under pressure.
According to the statement from HSE South, its orthodontic services receive 200 referrals a month. Waiting times for treatment extend from three and a half to seven and a half years. Areas, such as DNE in which initial assessment is fast, have more children on their lists.
And with the system of grading patients’ needs, it is the less compromised who are a long time on the list.
Dympna Kavanagh, who was appointed chief dental officer at the Department of Health last year, wants to look at the whole dental system a little differently.
She is more worried about adults than she is about children. Some years ago a colleague was asked to supply a denture for the corpse of an old lady, for the purposes of her funeral. The old lady had to die before she got any dental care.