Colm Burke TD, Fine Gael’s spokesperson on health, recently posed questions to Stephen Donnelly, Ireland’s Minister for Health, and Simon Harris, the Minister for Further and Higher Education, on a range of issues affecting the country’s oral health.

He first addressed the current shortage of dentists across the public service and private sector. According to the Irish dental Association’s report Providing Dental Care in Ireland: A Workforce Crisis, at least 500 more dentists are needed to meet the demands of a rising population and to replace those who are retiring.

Mr Donnelly responded: “I have met with Minster Harris and have requested significant increases in the number of dentists we train to address dental workforce capacity issues. The Higher Education Authority (HEA) is undertaking a process to identify a set of options for Government from higher education institutions interested in building capacity in Dentistry, among other areas.

“Aligned with Departmental policy regarding self-sufficiency, and to address the current imbalance of domestic students versus non-EU students, dental schools need to have a 75:25 ratio of domestic versus non-EU students. Superimposed on this rebalancing, there needs to be an additional 10 to 20 per cent on the number of college places made available to dental students in the longer term.

“The HEA has requested both current dental schools to submit proposals to expand capacity and it also sought proposals for new dental schools. We await the outcome of the HEA process and welcome the opportunities to expand capacity. 

“The Dental Council has introduced a registration process regarding refugee and temporary dentists who are currently living in Ireland and wish to practise here. The Dental Council has advised that it is doing everything it can to expedite the registration of all such dentists to enable them to contribute to our workforce. The council has reported an increase in the numbers of dentists registering since 2016; from 2,949 then to 3,492 on the register now.”

Mr Burke asked about broadening the range of dental specialities in Ireland – currently there are only two recognised by the Dental Council, orthodontics and oral surgery – to include others, such paediatric and special needs dentistry. Similarly, he questioned the scope of work carried out by auxiliary dental workers, such as technicians, and whether it could be expanded to take pressure off dentists. Another area of concern was how undergraduate education programmes could better support Smile Agus Sláinte, the country’s oral health policy.

“Smile agus Sláinte, sets out a new model of oral healthcare delivery,” said Mr Donnelly. “[The policy] focuses on a primary oral healthcare approach that will enable greater access to care by examining the training, roles and regulation of dental health professionals. There will be a particular focus on improved oral healthcare services for all vulnerable groups, including people in nursing and residential homes.

“Undergraduate dental education will need to be realigned with the policy by placing primary oral healthcare at its centre. The primary oral healthcare approach represents a significant change which requires an education system, both at undergraduate and graduate level, to ensure that the profession can respond to the oral healthcare needs of the whole population. In addition, ensuring that a sufficient breadth of skills is maintained in the profession will enable it to be flexible and responsive as the population’s oral health needs change.

“In line with the Sláintecare implementation plan and the primary oral healthcare approach, a focused programme, led by the Dental Council, will be required in order to reassess auxiliary dental workers’ scope of practice. This programme will consider enabling the public to have direct access to additional auxiliary dental workers, where possible.

“Currently, once provision of oral healthcare services directly to a patient is involved, oral healthcare professionals generally fall into the compulsory registration category. Any potential risks to the public of implementing a triage system have to be considered and regulated accordingly. Nonetheless, such a system would ensure improved access for the public overall.”

Questioned further on the detail of Smile Agus Sláinte, Mr Donnelly said that delivery of the policy would involve three strands: health and oral health promotion and protection programmes, oral healthcare service provision and evaluation of oral health in the population through a clinical surveillance programme.

“There will be a particular focus on improved oral healthcare services for all vulnerable groups, including people in nursing and residential homes,” he said. “Oral health surveillance will be an adjunct to, and, where possible, part of, routine visits to local dentists at key targeted ages for the whole population. The development of appropriate advice on toothpaste use and progress on preventive packages and outlining of measures to support the phase-down of amalgam are among the priority actions of the policy.

“The HSE will drive reform in the delivery of oral healthcare services, including developing a national oral health evaluation programme and any associated information campaigns that may be required.

“My department is working with the HSE to ensure the establishment of focused structures to drive implementation of the policy, including an oversight structure. It is also developing a cross-Governmental oversight structure which will produce the overall policy implementation plan and ensure that involved Departments and agencies are accountable for their progress under the plan.

“I recognise that the HSE Public Dental Service needs to be staffed appropriately in order to provide the care it is tasked to provide. The Department will support and resource the HSE to gradually reorient to provide the functions that the National Oral Health Policy ascribes to the HSE Public Dental Service, as implementation of the National Oral Health Policy proceeds over its eight-year implementation period.”

The health minister also addressed the issue of the Dentists Act which, though it was updated in 2020, was introduced in 1985. “While [it] has served the public and the profession well, I am aware that it needs to be updated to align with other healthcare profession regulatory legislation. It is intended to update the legislation in order to support the reforms to oral healthcare services and to the oral healthcare profession outlined Smile Agus Sláinte. 

“The process of developing legislation will involve consultation with the public and stakeholders. The protection of the public and ensuring high professional standards will remain the central focus of the new legislation. New legislation must also progress in the context of and in support of the fundamental reforms of dental services envisaged in the national policy over the coming years – it cannot standalone.”

Mr Colm asked about progress on the building of a new dental school and hospital in Curraheen, County Cork. Before the pandemic, University College Cork (UCC) was granted permission to build a multi-million euro facility in the western suburbs of Cork city. It will provide dental health services, clinical teaching spaces for dental students along with education and support facilities, research laboratories and innovation spaces.

“UCC submitted their project to the HEA Higher Education Authority for consideration under the higher education capacity building process,” said Mr Harris.

“This process was developed to identify opportunities in the higher education system to build capacity in dentistry, pharmacy, medicine, nursing, and veterinary medicine programmes. The HEA have recently submitted their recommendations to me. I will now consider the recommendations and consult with colleagues across government on the opportunities for expansion identified and associated funding priorities.”

Fine Gael’s health spokesperson also the education minister what was being done to increase places in the dental schools at UCC and Trinity College Dublin, in particular dental hygienists – of whom only around 25 graduate each year from the two schools – and dental nurses.

Mr Harris said: “The matter of health workforce planning and ensuring an appropriate pipeline of qualified healthcare workers within Ireland, including all suitably qualified dental professionals, is a major priority for my department. I have just recently received recommendations from the HEA.

“As I am still reviewing the submission, it is not possible to say how many further places may be delivered at this time, or in what specific areas these places may be made available. The Minister for Health and I will consider opportunities for new programme provision alongside options for current programme expansion to determine a final list of options.

“My department and the Department of Health will be engaging closely on this matter to consider these options, having regard to workforce plans and projected demand for graduates.”