As she works on updating Ireland’s national Oral Health Policy, Dr Dympna Kavanagh, Ireland’s Chief Dental Officer, has a message for the dental profession – ‘get involved and make it your own’

There’s no doubt Dr Dympna Kavanagh is a busy woman. When you only have two days a week to devote to your role as Ireland’s Chief Dental Officer (CDO), you have to make every moment count – and that’s exactly what Dr Kavanagh is trying to do.

When Ireland’s Dental magazine sat down with Dr Kavanagh in her office in the Department of Health Building in central Dublin, she was in a flurry of activity, preparing for the next stage in the development of the new national Oral Health Policy, which as CDO she is leading.

It is a three-year project to review the previous policy, which dates back over 20 years, and was key to Dr Kavanagh taking on the CDO role.

“I had been working within the operational side of the Health Service Executive (HSE), and one of the real frustrations for all of us was that we were dealing with an Oral Health Policy which was from 1994,” she said. “There is still a lot which is valuable from that policy, but obviously it needs to be refreshed and updated. So we wanted to have a chance to look at the policy again, and from that perspective, there has been an energy and eagerness from everyone who wants to develop it.”

The project includes a study of needs assessment, which will inform how new oral health services should be provided. The second part is a review of resources. Thirdly, there is an extensive consultation under way with relevant stakeholders, including the public, on new ways of delivering oral health services.

To support the policy and ensure it is informed by evidence, the Oral Health Policy Academic Reference Group has been established. The group will build on the core strengths of academics across several oral health and other relevant disciplines, and will help to determine the quality and relevance of existing data and requirements for further work.

“The Academic Reference Group is predominantly made up from the dental community,” said Dr Kavanagh. “They’ve given up a huge amount of their time, and all of their expertise and experience. The amount of work and input and energy they have put in has been phenomenal.

“We already have 70 stakeholders from all of the different dental organisations and from institutions across the dental community. Now, the Academic Reference Group is taking the opportunity to air all of the work it has completed in the last year, and share it among its peers and colleagues and say listen, we want to hear your comments.

“It also provides an opportunity for the stakeholders themselves to come fresh to the table and put forward any new ideas. It’s our first dip into the water to go out to the stakeholders to get their views and feelings and get that input, as well as the hardcore evidence from the population.”

Dr Kavanagh’s background in developing policy has given her an understanding that it is critical to take a long-term view rather than a rapid, quick-fix approach. Earlier in her career, she worked across five strategic health authorities in London, which included developing promotion and prevention oral health policies for deprived communities in the east end of the city.

“I got a very good background in dental public health working across these five different health authorities in London, and was able to develop policies to commission different models of health services and care,” she said.

“It’s important in developing policy to concentrate on long-term results. Your involvement from the start can feel slow and frustrating, but what you are developing has to be sustainable.

“It’s also really important that we can continue to measure the health of the public, so that health needs are built into the contract. Every time you go to see a dentist, they are looking in your mouth, they are looking at what is going on in your life, and they are picking up all of that information – but we don’t get access to it.

“We want to have an opportunity to harness all of that information so that we can inform the Oral Health Policy for the future, and understand more specifically what the problems are in Galway, or what the problems are in Kerry.

“There are a variety of ways of gathering that information but to be able to respond much faster to the needs of the population, it has to be built into the system. And that has to be ongoing so that you can respond to cutbacks, you can respond to changes in health, much faster. That’s the challenge for us in dentistry, to find a different way of thinking about it.”

From Dr Kavanagh’s point of view, that emphasis on hard facts should ensure that the Oral Health Policy is guided by data, rather than any form of anecdotal evidence.

“Hard facts are what influence policy and convince ministers,” she said. “If we can say there have been changes in the health of the elderly or in different groups, then that helps us to focus.

“We know, for example, from The Irish Longitudinal Study on Ageing (TILDA) that there is early evidence people are holding onto a lot more teeth, and we have clinical research which supports that. That’s why we’re supporting TILDA,

we want it to be continuous so that we know what the evidence is and see what impact changes of policy can have on the health of the population.”

Dr Kavanagh does not deny that dentistry in Ireland has been through a difficult period, with cuts in state support to the Dental Treatment Services Scheme (DTSS) and Pay Related Social Insurance (PRSI) dental schemes.

“Ireland has gone through very tough times, but I hope that there is a sense of green shoots there and a positive sense that people are coming together again,” she said. “Funding is increasing year on year, even if that’s not the sense out there. The good part is that we have held onto our state schemes, because other state schemes just didn’t survive. The bad news is we didn’t maintain the money, but at least we have a core to work with and we’re not going to lose it. Now what’s really important is that we move forward and onwards with the policy.”

Ultimately, though, the final part of developing the Oral Health Policy is in the public consultation, to understand people’s perceptions and ensure that any developments will be understood and taken up by the general public.

“You could create the perfect system, but if people don’t come to the door, because there’s something about it they don’t like, then they won’t come,” said Dr Kavanagh. “Even in a time of depression, what was really concerning was that people were not turning up for dental treatment, even those who receive it for free.

“Maybe they didn’t understand enough about the system, and they were scared that they would be charged. So it’s really important to understand from the public’s point of view what brings them in across the door, and what makes them stay and come again. We need to engage with the public in a very focused way in that regard.”

With that, Dr Kavanagh is off to her next appointment, leaving only long enough for one final message to the profession in Ireland.

“This policy is not about what the Department of Health thinks, or about the HSE, or the Government,” she said. “What is really important is that it is informed from the practice, and the only way that will happen is by practitioners getting involved, and by them letting us know how they feel. We need to hear your responses about how we’re going to move forward, so you can make it your own. The future sustainability for the profession is what is most important.”

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Career in the spotlight

Dr Kavanagh qualified from University College Cork Dental School with a PhD in Preventive Dentistry. She completed her Fellowship in Dental Public Health at Guy’s Hospital and King’s College Hospital in London, and then worked across five strategic health authorities in dental public health.

Dr Kavanagh returned to Ireland in 2001 to take up a post with Mid-Western Health Board in general management. She returned to dentistry in the post of principal dental surgeon for the Limerick/North Tipperary area in 2003. She has also worked in HSE Corporate for the Quality and Risk section of the former Primary, Community and Continuing Care Directorate. She was appointed Oral Health Lead for the HSE in Ireland in 2010, and became Chief Dental Officer in 2013.

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Oral health policy academic reference group

Prof Denis O’Mullane (chair) – emeritus professor of preventive dentistry at UCC and former chief dental officer from 1978 to 1982.

Prof Brian O’Connell(vice chair) – professor of restorative dentistry and director of postgraduate prosthodontics at Trinity College, Dublin.

Prof Margaret Barry –professor of health promotion at NUI, Galway.

Dr Alison Dougall – consultant and Assistant Professor in Special Care Dentistry at DDUH.

Dr Jacinta McLoughlin – professor in public dental health and director of undergraduate teaching and learning, Trinity College Dublin.

Ms Kathryn Neville – manager for medicine and health at UCC.

Prof David Madden – professor of economics at University College Dublin.