Brace yourself . . . this could hurt your wallet

There hasn’t been a change in oral health strategy since 1994. A radical rethink of the way dental health is designed and delivered is now needed

IN CONTRAST to your family dentist, Government cutbacks don’t drill down with precision into problem areas. They’re more swingeing than that.

In the good old days of Bord Snip Nua, three budgets ago, without warning or justification and amidst a slate of cutbacks, State support for dental care was virtually eliminated.

The service was not charity, it was insurance, paid for five years in advance with workers’ PRSI taken directly from their pay. The service has disappeared, even if the PRSI charges designed to pay for the service have not.

Dental services were not used to provide exotic treatments such as a free Hollywood smile. They tended to be used for the basics of dental care – examination, cleaning, X-rays, fillings and treatments.

For more salubrious care like bridgework, crowns or implants, at least you can still claim it back against tax. Now, there’s a funding gap for the most basic treatments that is not covered anywhere.

The only thing your PRSI is now paying for is a cursory oral hygiene check.

“Cursory” because, according to dentist Dr Martin Vaughan, “you cannot do a comprehensive examination in most people without doing a proper cleaning and sometimes taking X-rays as well at the same time”.

In his practice in Phibsboro in Dublin, has Vaughan had fewer people coming through his door in the past three years?

“Certainly. People are strapped for cash. They have massive extra taxes and expenses and they hadn’t budgeted for private dental care, because they never had to.”

Many of the patients at his practice are in receipt of social welfare. Some of his patients have been coming to him since he became established in 1993 when, without warning, on the first day of 2010 their benefits were stopped and they could no longer afford treatment.

“They had a fair and equitable subsidised dental insurance scheme that had been in place for 60 years that they had paid in advance,” he says. To reduce the service would be understandable in the circumstances. But “to wipe out people’s total dental health insurance is radical,” he says, “mind blowing.”

Ordinary people have been disenfranchised of the insurance benefits they’d already paid for, as he sees it.

In the meantime, Vaughan has dropped his prices while trying to remain viable.

“So people who can afford it come when they can, people who can’t afford it come when there’s a crisis,” says Vaughan.

And, according to the Irish Dental Association (IDA), a representative body for dentists, the crisis is deepening.

“Since 2009, the number of fillings has fallen by 44 per cent, the numbers of scale and polish (cleaning) 98 per cent, X-rays are down 98 per cent, dentures down 28 per cent,” reveals Fintan Hourihan, chief executive of the IDA. “But meanwhile, extractions are up 10 per cent.”

The PRSI and medical card dental schemes once played a valuable role in prioritising prevention. “It is no longer that type of scheme,” says Hourihan. Now they will only guarantee to pay for two fillings per year.

“Clearly, this is very unsatisfactory from the dentist’s and the patient’s point of view.”

Because of the way the scheme is structured, the State is willing to support emergency treatment so people who can’t afford the necessary preventative care are storing up their problems for later, until it becomes an emergency.