Call for dentists to train in orthodontic referrals

Waiting lists: A Galway consultant has developed a course to train dentists in how to properly assess children who are eligible for treatment in the public orthodontic service and to reduce inappropriate referrals.

The public waiting lists for orthodontic treatment may have fallen over the past few years, but the service is still being flooded with inappropriate referrals which clog up the list and cause long delays.

However, Niall McGuinness, consultant orthodontist for HSE West, believes the system could become more efficient if dentists underwent his training programme - only children eligible for treatment would then be referred to the public system.

Many children wait up to two years to be assessed by a public orthodontist, only to have their expectations shattered when they are told they are not eligible for treatment.

His one-day course is based on the 1985 Department of Health guidelines for assessing children's eligibility for orthodontic treatment.

Mr McGuinness and his colleagues have been calling on the Government to update these guidelines for years, but he says there does not seem to be any willingness to move on the issue.

A subcommittee of the joint Oireachtas Committee on Health and Children has now recommended that the current Department of Health guidelines for assessing children's eligibility for orthodontic treatment should be immediately changed to make the system fairer.

Under the current guidelines, there are three categories of assessment. Category A includes children with congenital abnormalities such as cleft lip and palate which may require surgery. Category B includes those with skeletal discrepancies between the sizes of their jaws and category C consists of children with severe overcrowding and crooked teeth.

The biggest problem, Mr McGuinness said, was with category C because it was a vague category which could include most of the population of schoolgoing children in the country.

"The Health Act 1970 states that every child who attends a national school is entitled to free dental, medical and ophthalmic care up to the age of 12. In theory, this includes orthodontic treatment, but the resources are not there to treat everybody," he said.

Each participant on the course developed by Mr McGuinness gets a stock of disposable rulers specially designed to measure teeth to see if they are eligible for treatment and a wall chart to remind them of the criteria for assessment.

He said the Index of Treatment Need had been used in the UK and the US to assess patients for the past 20 years and he had developed a version based on the Irish guidelines.

"Up to recently only 20 per cent of the patients being referred to me were appropriate. I had to tell the other 80 per cent sorry, you're not eligible for treatment. This is devastating for parents and children who have waited up to a year and a half to be assessed."

So far, Mr McGuinness has give courses in Galway, Roscommon and the northeast and he plans to hold one in the midlands soon.