Grindingly slow progress on inquiry into orthodontic damage

Waiting lists and patchy services testify to dire state of public dentistry for children

Almost 20,000 children are on the orthodontic waiting list, including almost 8,000 who have been waiting for over two years. Photograph:  John Giles/PA

Almost 20,000 children are on the orthodontic waiting list, including almost 8,000 who have been waiting for over two years. Photograph: John Giles/PA

 

It has taken almost two decades for the health service to investigate the allegations made by a whistleblower about damage to children’s teeth in its orthodontic services. Even by the often snail’s-pace standards of public health investigations this is a long time – and still the process is far from complete.

Three years ago, the Health Service Executive – which didn’t even exist when these allegations were first made – told The Irish Times a review into them was being finalised; now it says it is auditing thousands of files on foot of the review and this work is “nearing completion”.

It is hard to avoid the conclusion that someone, somewhere, would prefer if the results of investigations into these claims never came to light.

The affair highlights the deplorable state of public dentistry, especially for children, one that is borne out by continuing long waiting lists and patchy service provision. At present, about 84,000 children are waiting for a public dental assessment. Almost 20,000 children are on the orthodontic waiting list, including almost 8,000 who have been waiting for over two years. Children are supposed to get three routine screenings while in primary school; in practice, they are lucky if they get one.

Expense of braces

This is unacceptable. Childhood and adolescence are critical times for children’s teeth; corrections need to be made promptly before it is too late. Better-off families may – just – be able to afford braces and other expensive orthodontic treatments for their children but others can’t.

Perhaps because dentistry is the Cinderella of the public health system, receiving little attention, these problems have been allowed to persist.

But the system has also been slow to change, and seems resistant to investigation. The remit of the Health Information and Quality Authority does not run to dentistry. It took years of pressure from Ted McNamara, the consultant orthodontist who made the original allegation of children’s teeth being damaged in 2000, before action was taken.

Some of the patients affected may have to be recalled well over a decade after their orthodontic work was performed, the HSE has indicated. Photograph: iStock
Childhood and adolescence are critical times for children’s teeth; corrections need to be made promptly before it is too late. File photograph: iStock

Finally, former HSE chief executive Cathal Magee put in place a process to review the complaints. In 2014, two UK professors were brought in to help with the review. Their report was completed in 2015.

Unpublished report

We still don’t know whether the allegations will be borne out. It is understood the British authors of the review are unhappy that it has not been published. And now, in an indication of the potential seriousness of the situation, the HSE says it is auditing thousands of patient files from the period and may recall some of them if this is justified.

The review isn’t the only document in this area to be delayed. It is 25 years since the last national oral health policy was published, and five years since the Department of Health started work on a new one. That policy is due to be published imminently, perhaps as soon as Wednesday.

Leaks suggest it will be long on promises of free dental care for children, rolled out progressively by age group over the coming years. Hard reality suggests it will have to be backed up by real change – in resourcing, governance and structural reforms within the profession – if anything is to improve.