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.

At that point, it means “you may need an extraction, you may need a partial denture or have gum disease problems and the State will ultimately pay a multiple of what it would have paid 12 months earlier and, more importantly, the oral health of the patient suffers as a consequence. What the State is saying is, it is happy to pay for extractions.” says Hourihan.

The dental industry in Ireland has declined from an estimated 10,000 dentists, hygienists and nurses employed around the country by an estimated 1,500, as practices adjust to the harsh new realities.

Many young dentists emigrate to other English-speaking countries and, unlike GPs, dentists get no support to run or maintain their surgeries.

But is the decline of the dental industry in Ireland not attributable to high prices?

“Certainly there is that perception,” Hourihan admits. “But there are reasons why it is far more expensive to run a practice here as compared with Britain or the rest of Europe.”

He points out that, recently, dentists have achieved price transparency by a code of practice that means they must display their prices for treatments.

Also, they have developed a dental complaints resolutions system so that if anything goes wrong, at least there is a way to get redress.

The economics of travelling abroad are also changing, so the dentists’ moves to strengthen their relationship with their customers may be a timely strategy.

But if the dentists could get the relevant ministers in the chair, what would they say to them?

“We haven’t had a change in oral health strategy since 1994. There hasn’t been a chief dental health officer in 10 years,” says Hourihan.

A chief dental officer would be an important step to give the minister independent professional advice.

What is needed now is a radical rethink of the way dental health is designed and delivered.

“It makes far more sense to prioritise oral health prevention and promotion measures rather than funding a system which is essentially a recognition of a failure on the part of the State to support those who most need it,” says Hourihan.

He points out that people from lower income groups traditionally have more profound oral health problems, so these cuts affect them more than those who can reach into their pocket and pull out a nice crisp note.

“The damage was done in the last government, but there hasn’t been any positive action by this one. This type of slash-and-burn approach is counter-productive,” argues Hourihan. “And it’s not serving patients well.”

He points out that it is 50 years since universal fluoridation of the water supply was initiated in Ireland, widely considered to be a great dental initiative.

“It’s a terrible shame that at this stage we are now going back to 1950s dentistry because of a very myopic view of dental care by successive administrations.”

Hourihan is not being coy when he points out that “any kind of improvement would be of huge benefit to a huge number of people and politically that must be attractive as well”.

In the meantime, the message is to keep flossing every day.