Hundreds of children left without orthodontic treatment, HSE report finds

Attempts made to recall 16 patients 20 years after records pointed to permanent dental damage

Hundreds of children in the greater Dublin area were left without orthodontic treatment, sometimes for years, due to “unacceptable” delays in care, according to a HSE report.

Sixteen of the most concerning cases were recalled for follow-up treatment after their records indicated they may have suffered permanent adverse effects.

However, this was over 20 years after their orthodontic service had been interrupted and six of them could not be traced, the report says.

The report dated April 2022 relates to a look-back review of orthodontic services in Dublin Mid-Leinster in the period 1999-2002. In 2012, a whistleblower, orthodontic consultant Ted McNamara, alleged children were being damaged by the service through interruptions in care and governance issues.

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Some children had braces left in longer than intended, damaging the surface of their teeth, while others who suffered wire protruding into their gums had to get false teeth, Dr McNamara alleged.

After two UK experts concluded in 2015 that patients were being harmed, the HSE began re-examining the files from that period.

According to the new HSE report, it is clear many young patients and their parents had “poor experiences” with the orthodontic service and for some treatment was prolonged for a number of years beyond the original timeframe.

“It was clear that the frustration, disappointment and dissatisfaction with the service recorded in the orthodontic records over 20 years ago continue to resonate with the patients and their families today,” the review team notes.

“On behalf of the HSE, we apologise to patients and families who were let down by our orthodontic services and experienced interruption in their care. While those events cannot be reversed, the HSE is fully committed to providing an honest record of what happened and in doing so it can avoid a recurrence of similar events in the future.”

The audit looked at 7,634 patient charts and found 487 had evidence of interruption of care for six months or more. The review team concluded 471 of these cases required no further investigation.

Of the 16 patients identified for recall, 10 were found to have experienced a range of clinical outcomes, including treatment not being started or not completed, to treatment completed within the service or privately.

In the records, parents voiced dissatisfaction and frustration at the response from the service.

“Many families opted out of the system and sought treatment elsewhere. The review team acknowledge that many others could not or did not know how to access alternative care,” the HSE report states.

“It was evident from some charts that the request by patients to have their appliances removed was due to frustration in the length of time the treatment was taking.”

The report says that in most cases where treatment was interrupted, satisfactory outcomes were achieved when it was restarted and completed.

But it describes the impact of delays and interruptions on patients as “negative and serious”.

Many children had complex dental issues that affected their appearance, and spoke of the prolonged negative effects of not starting treatment on their sense of wellbeing during their teenage years.

“Some recounted their experience of being bullied, having low self-esteem and a lack of confidence in their appearance.”

The HSE has previously refused to release under the Freedom of Information Act the 2015 report by UK experts on the matter.

Paul Cullen

Paul Cullen

Paul Cullen is Health Editor of The Irish Times