Dentists say Medical Card Scheme is unfit for purpose

(22 Apr 2016)

The Irish Dental Association has described the medical card scheme as being wholly unfit for purpose and called for it to be replaced as soon as possible.

The IDA said the dental profession has no confidence in the operation of the Dental Treatment Services Scheme (DTSS) by the HSE because it has manifestly failed the patients it was designed to serve.

According to a new report as of Dec 31st 2015, the number of patients eligible for dental care under the Scheme stood at 1,734,853 representing 37% of the population. This is an increase of 256,293 or 17% since December 2009.

However despite the fact that the number of eligible patients has increased significantly, the number of treatments has actually fallen by 20%.

This is due to unilateral cuts to the Scheme which the HSE imposed in 2010 without informing or consulting with patients, contractor dentists or the Irish Dental Association.

The cuts mean it is essentially an emergency care only scheme with patients only entitled to an annual exam, two fillings and unlimited extractions.

The amount of cleanings has fallen by 97% and the number of protracted periodontal treatments (for gum disease) has fallen by 80%, while the number of fillings has also fallen by over 33%. On the other hand surgical extractions have increased by 53% and routine extractions have increased by over 14%.

Prolonged use of antibiotics

As a consequence of the cuts to preventive treatments there has been an increase in the number of medical card patients forced to use antibiotics for prolonged periods.

Nine out of ten dentists have had to prescribe multiple antibiotics for medical card patients on these waiting lists. The average number of repeat prescriptions issued for antibiotics was three per patient, with some dentists having to issue five antibiotic prescriptions to a single patient.

There has also been a 38% increase in the number of people with severe dental infections requiring hospital admissions since the cuts were made.

The irony here of course is that the HSE has mounted several campaigns urging people not to use antibiotics unless absolutely necessary.

Dentists’ anger

The CEO of the IDA Fintan Hourihan said it was not possible to overstate the anger and concern for patients felt by members. As a consequence the Association cannot continue to endorse the Scheme. He noted that two thirds of dentists said they had changed the way they are practising dentistry due to the way the medical card scheme operates.

Comments by dentists included the following;

I am more or less just doing extractions now
A patient presented with a number of decayed teeth, all sore. I was not able to treat them all and had to choose two
There is an inability to provide the correct treatment
Emergency patch up jobs only for DTSS patients, no comprehensive care, this is very damaging to long-term health
It is horrendously stressful trying to explain to patients routinely that you cannot provide the basic care that they require

‘The medical card scheme pre 2010 was not perfect, but it was effective in treating a wide range of patients in a cost efficient way. Now the gross inadequacy of funding and rising demand means it simply cannot cope. The failure of the HSE to approve treatments deemed necessary, to prioritise preventive treatments and to heed dentists concerns regarding the impact on patients have taken their toll on patients and dentists’ Hourihan said.

‘Given our members complete dissatisfaction with the administration of the Scheme and the high number of treatments provided by dentists that remain unpaid it’s not surprising that 8 out of 10 dentists favour a complete renegotiation of the Scheme’ he said.

Proposed new scheme

‘The HSE has effectively overseen the introduction of dental apartheid for medical card patients. That is why we are calling for the introduction of a new state funded dental scheme where the medical card and PRSI schemes would be merged and one universal scheme would prevail for the benefit of both medical card and PRSI eligible patients over 16.


10,000 children under 15 are being hospitalised every year for dental extractions under general anaesthetic

(15 Oct 2015)

Figures are up to five times higher than UK

IDA says figures are an indictment of slash and burn oral health policy

Waiting times for young children with chronic dental infections are now up to 12 months

Shocking new figures indicate that up to 10,000 children under the age of 15 are being hospitalised for dental extractions under general anaesthetic every year in Ireland.

The Irish Dental Association has described the revelations as a national disgrace and an indictment of the slash and burn policy of the previous and current government to oral health policy.

The IDA, which has compiled the figures, says the rate of hospitalisations here could be up to five times higher than in the UK.

The President of the IDA Anne Twomey said thousands of young children with chronic dental infection, many of whom require multiple extractions are waiting up to twelve months for treatment.

Dr Twomey, who is opening the IDA’s annual seminar for dentists working in the HSE, in Carlow, this morning (Thurs 15th Oct), said the figures were off the scale.

“Why are thousands of our young people undergoing the trauma of hospitalisation for multiple dental extractions? Ninety five per cent of these cases would have been avoidable if they had been detected and treated earlier. The reason they weren’t is because of Government cuts to family dental supports since 2010, the constant undermining of what had been a highly effective schools screening service and the fact that too many of our young people have a poor diet containing too much sugar” she said.

Five years ago when these cuts were introduced the IDA said they would cause unnecessary pain and suffering. It also said the true cost of the cutbacks would be a multiple of the very modest savings made on these once cost efficient and effective schemes.

Dr Twomey said the second question which needed to be addressed was why are young people with serious infections being forced to wait between 6 and 12 months for treatment. She urged the HSE to act before a tragedy occurred.

“The closure of the walk-in clinic in St James’s Hospital in Dublin means waiting lists for general anaesthetic services in Dublin, Wicklow and Kildare are 12 months. Waiting periods around the country are typically six to nine months. We know there are currently over 3,000 children awaiting general anaesthetic services and some of these have been waiting up to a year. The issue is compounded by the fact that dental cases are not included on hospital priority lists, and this results in theatre slots for dental cases being cancelled on a regular basis in favour of other paediatric cases.”

 “So for example if  a child is waiting longer than six months to have an ear, nose or throat operation the hospital is penalised, but this doesn’t happen for dental patients. We are hearing stories of children having to be admitted for IV antibiotics for oral infection. Our concern is that general anaesthetic services for dentistry will not become a priority until a child has a serious outcome from dental infection. If a terrible situation like that is to be avoided the HSE needs to put dental cases on priority lists and put the appropriate number of staff in place. I have no doubt that several motions calling for such action will be passed overwhelmingly at this annual seminar” Dr Twomey concluded.



The importance of bringing your baby to the dentist


Parents are advised to bring their child for their first visit to the dentist when the first tooth erupts or by 12 months of age.

"Most parents believe it is fine to wait for a visit until a child is in primary school or has his or her first toothache," said Dr Rose-Marie Daly, a consultant in paediatric dentistry in Tralee, Co Kerry.

"At that stage, we look for early signs of disease and factors such as risky feeding practices, fluoride use and habits that can affect the development of the teeth such as soothers. This is evidence-based, not a belief. By the age of three years, almost 30pc will have decay experience.

"Typically in small children, they get severe and aggressive dental disease. We look at dietary habits, the quality of teeth and saliva, fluoride exposure and bacterial plaque on the teeth, and any developmental defects in teeth which increase the risk of decay."

"I also clean the teeth and apply fluoride to prevent decay at that stage although no all dentists do."

Dr Daly said: "If you are looking at prevention measures, these are done on a risk assessment basis. Calculating a child's risk of decay can involve the shape of the tooth, enamel, saliva and the child's eating habits.

"Hygiene for young children's teeth is a skill that parents often need help with," said Dr Daly.

"Children who have dried fruit and biscuits for lunch are more likely to have cavities. Cheese and unsweetened dairy help neutralise acid in the mouth and fruit, only in moderation, is good."

www.independent.ie, Jan. 2015


Dentists welcome findings of new

review on fluoridation


02 Jun 2015

The Irish Dental Association has welcomed the findings of a new review which has found there is no definitive evidence that community water fluoridation has negative health effects.

The in-depth review was carried out by the Health Research Board, the lead agency in Ireland supporting and funding health research.

The HRB said that having examined the research available and excluding dental health it had found no definitive evidence that community water fluoridation is associated with positive or negative systemic health effects.

The President of the Irish Dental Association, Dr Anne Twomey, said the Association would study the findings carefully.

“The review found no definitive evidence to link fluoridation to increased bone fractures, reduced IQ, cancer, heart disease, kidney disorders, Down Syndrome or increased mortality from all causes. In relation to an alleged link to bone cancer, it said the literature pointed to “mixed” effects and no link had been proven.”

“The HRB review follows fifteen major peer-reviewed studies of fluoridation undertaken across the world by recognised academic authorities in the past twenty years. None of these major reviews has concluded that community water fluoridation poses a known risk to general health or has suggested halting water fluoridation.“

“These, and other reviews which dealt solely with oral health, show a significant benefit to dental health and through this to general health” Dr Twomey concluded.




New HSE Service Plan = Same Old Dental Cutbacks


Dentists have denounced the HSE’s service plan for 2015 as a devastating blow after it was confirmed that almost four million adult patients are now facing a sixth successive year of cuts to dental treatments worth €100m annually.


The Chief Executive of the Irish Dental Association Fintan Hourihan, said dentists were shocked that there was no provision to increase funds towards the costs of dental care treatment for medical card holders in 2015.


Commenting on the publication of the HSE service plan for 2015, Mr Hourihan said;

“Since 2010, adults covered by the dental scheme for HSE medical card holders and those covered by the Department of Social Protection’s PRSI dental scheme have seen ongoing annual cuts in state supports of over €100m each and every year. It is therefore incomprehensible that there is no additional funding for medical card patients in the first service plan for seven years to provide a net increase in spending.”


“The result of this continued deterioration in assistance for patients has been characterised by a huge decline in patients attending for preventive care and treatment which in turn has caused a massive rise in extractions (up over 33% since 2009), the greater provision of dentures and the rising incidence of tooth decay and gum disease.”


“The legacy of these years of systematic dental neglect by the state will be reaped for many years to come. It is long past time for the HSE and the Department of Health to prioritise support for patients requiring dental care and treatment. Today is not only a missed opportunity but a devastating blow to all those advocating for urgent action and funding for oral health.”


“The €1m provided for orthodontic waiting lists is a paltry sum for a huge problem but the fact remains that those with unmet or diagnosed dental need represents a huge multiple of those requiring orthodontic care and treatment” Mr Hourihan concluded.


(Irish Dental Association, Nov. 2014)

Dental Care in Ireland

Oral health is of vital importance to the well-being and general health of every individual.  Diseases of the mouth and oral cavity have a significant impact in terms of pain, suffering, impairment of function and reduced quality of life.

There are approximately 2,000 dentists practising in Ireland, in Private Practice, HSE Dental Service, the army and hospitals.

There are two state schemes under which patients may receive state subsidised dental treatment.

PRSI Dental Scheme 

FreeCheck Up at your local dental surgery Thumbnail0

The Dental Treatment Benefit Scheme is available to insured workers and retired people who have the required number of PRSI contributions. Under this scheme, the Department of Social Protection pays the full cost of an oral examination once a year. The examination is provided by private dentists who are on a Department of Social Protection's panel. Most dentists are on the panel so you should not have any difficulty finding one. You can find a dentist in your area who participates in the Scheme in ourFind-A-Dentist section. The dentist or the Department will have the application forms. These forms require details such as your Personal Public Service Number (PPSN). If you are a dependent spouse or civil partner, you should give the PPSN of the insured person. The Treatment Benefit Section of the Department of Social Protection manages the Scheme Locall: 1890 400 400. Further information on the scheme is available here.

Medical Card Dental Scheme

The HSE manages the dental scheme for medical card holders. This scheme is available to medical card holders who are 16 years of age or over.

Under the scheme private dentists who have an agreement with the HSE can carry out free dental treatment for you. You can search for a dentist who participates in the scheme in our Find-a-Dentist section.

The HSE introduced changes to the Scheme in April 2010. Under the new measures the range of treatments available are being prioritised in accordance with their clinical necessity and priority. Services for high-risk patients (including those with special needs), and those requiring exceptional care, continue to be available.The remaining care provision is subject to prior approval, which will be required from a clinician in the HSE, who will prioritise:

  • High risk and exceptional patients
  • Those requiring emergency care
  • Patients who are considered to have a greater clinical urgency and/or necessity in receiving care.

The Irish Dental Association advises patients to check with your local dentist who can check what treatment is available to you. 

May 2014

New dental health survey shows 80% of Irish adults believe their gums are healthy however 80% of Irish people have some form of gum disease.

(03 Jan 2014)

New dental health survey shows most Irish adults believe their teeth and gums are healthy and look good.


  • 776,000 say they are visiting the dentist less often
  • 58% say they only consider visiting the dentist in an emergency situation
  • 46% say they are spending less on dental health
  • 41% say they rarely if ever think of visiting the dentist

Four out of five Irish people believe their teeth and gums are healthy and look good according to a new dental health survey.

However the survey also found 23% of people are visiting the dentist less often since 2010 while 58% of those surveyed said they would only consider visiting the dentist in an emergency situation.

According to the survey of 750 adults, which was carried out by Behaviour and Attitudes on behalf of the Irish Dental Association, 46% of Irish people are spending less on dental health while 41% rarely if ever think of visiting the dentist.

The Chief Executive of the IDA, Fintan Hourihan said the survey shows the impact the recession is having on dental health and a disconnect between what people think and how they act.

“One in four Irish people are attending the dentist less often. In population terms, this equates to 760,000 adults. It’s clear this is having a hugely negative impact on the dental health of the population. While over 80% believe their gums are healthy, according to the most recent national health survey, 80% of Irish people have some form of gum disease.

While 94% of respondents said they thought dental health is important almost 60% said they would only attend a dentist when they really need to or in an emergency. Financial pressures are definitely a factor here but so also is the lack of information from the HSE. The survey shows that only half of Irish adults are aware of their State dental entitlement of a free check up and only 1 in 3 have availed of it“ Mr Hourihan said.

Mr Hourihan said the survey showed the need to reach out to non-attenders and a restoration of the benefits which were previously available under the Medical Card and PRSI schemes.

“According to the survey, people who attend their dentist annually are much more likely to be middle class females under 44 years. Frequency of dental visits shows a strong age pattern, declining sharply from 45 years onwards. The Department of Health needs to reach out to the people who are not attending and encourage them to do so. The cost of preventative treatment will be much less than the cost of the current neglect” Mr Hourihan warned.

The survey also found that Irish people prefer to consistently visit the same practice and/or health practitioner. On average, Irish people visit the same dentist for over 11 years.

It also found that dentists continue to enjoy the confidence of the general public with over 95% of respondents saying they trust the care they receive from them and 94% saying they trust their advice.

3 out of 4 people here do not avail of free check ups

(18 Apr 2013)


3 out of 4 people here do not avail of free check ups

European study of 7 countries shows Irish adults worst for attending routine dental examinations

Dentists say new voucher system would be cost effective way of arresting decline in dental health

New figures from the Irish Dental Association show that 75% of people who are entitled to a free dental examination do not avail of the service.

The Irish Dental Association said cutbacks to the two main dental health schemes and ongoing confusion over people’s entitlements have led to an alarming deterioration in the dental health of the population. It said the HSE’s failure to explain to people what their entitlements were, amounted to a dereliction of duty.

The IDA pointed out that a study on perceptions of dental health in seven European countries* found that Ireland had the lowest number of adults attending the dentist for routine examinations. Ireland also had the highest number of patients citing cost as a factor preventing attendance at the dentist.

The Chief Executive of the Irish Dental Association, Fintan Hourihantold delegates at the IDA’s annual conference in Galway, that the short-sightedness of withdrawing several modest benefits from three million patients was already becoming apparent.


These simple preventive treatments were key to maintaining good dental health for the general population. In their absence dentists are seeing a huge increase in dental decay and gum disease. Other problems which may be caused or made worse by poor dental health include heart disease, strokes, diabetes, premature and low birth weight babies and respiratory disease.

By slashing the PRSI and Medical Card schemes, by halving tax reliefs for orthodontic and other dental treatments and by reducing the number of dentists and nurses in the public service by 20% over the last two years - leading to longer and longer waiting lists – this Government and its predecessor has created a dental health time bomb which will have huge repercussions for the population as a whole in coming years” Hourihan said.


The IDA believes that if the Government was to take a number of timely and cost effective measures – including the introduction of a voucher system for the annual oral examination - it could arrest the shocking decline in the dental health of the nation. It says the Government should;

-       Introduce a voucher system for annual oral examination

-       Gradually restore benefits to Medical Card and PRSI schemes

-       Restore marginal rate of tax relief

-       End the embargo on recruitment of dentists by the HSE

-       Appoint a Chief Dental Officer (Vacant for the last 20 years)


Everyone would have an entitlement to a voucher and would physically receive one. We think it would be seen as a service they have paid for in the case of PRSI employees and one to which they are entitled by medical card holders. If people had an actual voucher they might be more inclined to avail of the service and this could save them painful and costly treatment down the line as well as leading to higher detection rates for oral cancer at an early stage.

It would also be easier to administer from the State’s point of view and again more cost effective. This system has worked well in Sweden, Australia, Canada and several US states. We need urgent action. The voucher system would be a good starting point and that’s what we need right now” Hourihan concluded.

An estimated 100,000 Irish people suffer from sleep 


An expert on the disorder told delegates at the annual conference of the Irish Dental Association that 90% of those who suffer from sleep apnoea are undiagnosed. 

Sleep apnoea occurs when the airway collapses and there is a cessation of airflow for 10 seconds. If this happens constantly during the night every night it prevents the person getting the deep sleep required to function normally. 

Symptoms of apnoea include:

  • inappropriate fatigue
  • choking episodes during sleep
  • excessive napping
  • bruxism or tooth grinding
  • irritability, anxiety and poor mental functioning
  • hypertension  

    Dr Michael McWeeney, Consultant Respiratory Physician in the Galway Clinic and the Bon Secours Hospital says the prevalence of the condition is rising in tandem with our increasing awareness.  

    Overall we believe the condition affects between 2.5 and 4% of the population but because most people who suffer from it remain undiagnosed that figure may be a little on the conservative side. We are in an obesity epidemic and that increases the severity of apnoea. Poor muscle tone and alcohol consumption also increase the risk substantially. What we really want to do is raise awareness of the condition not just among the general population but also among health providers such as doctors and dentists. 

    Thirty per cent of men snore while the figure for women is around 10%. Snoring on its own is not the issue as not everyone who snores has apnoea. However if a person who snores suffers from constant fatigue despite adequate sleep they should visit a doctor or specialist with knowledge of the condition to get a diagnosis” Dr McWeeney said. 


Dentists welcome new rules for tooth whitening & mouthguards and issue top tip guide for better dental health in 2013

The Irish Dental Association, has welcomed the introduction of new rules on tooth whitening and mouthguards which it says will offer greater dental protection to the public in 2013.

Late last year a new European Council Directive came into force which strictly regulates the use and sale of hydrogen peroxide – the chemical used in tooth whitening. Under the Directive tooth whitening can only be carried out by a dentist.

From the 1st of January 2013 it is compulsory for juvenile gaelic footballers to wear mouthguards in football games and training.

The President of the Association, Dr Andrew Bolas said he hoped that GAA coaches all round the country enforced the new rules from the start. 

“I frequently get called into Sligo General Hospital to treat the results of sports related injuries. Some injuries to teeth from a clash of heads or a stray elbow can be quite horrific, with teeth broken, displaced or completely knocked out” he said. 

Dr Bolas said that whilst off the shelf mouthguards provide some protection and are certainly better than no mouthguard, care should be taken when fitting to ensure a good tight fit around the front teeth. 

“It is well worthwhile talking to your dentist about the best options. While customised mouthguards are more expensive initially they could well prove much cheaper than the treatment needed to repair or replace traumatised teeth” Dr Bolas said.

All the top tips and further information relating to dental health are available at www.dentist.ie



1.     Ensure that children who play contact sports have a well fitted mouthguard which offers maximum protection and fits tightly around the front teeth;

2.     For consistent cleaning, brush your teeth and gums at the same time every day, e.g. after breakfast and before going to bed. Supervise children under seven. Only use the recommended amount of toothpaste and ensure all teeth and gums are cleaned thoroughly;

3.     Make a special effort to quit smoking. Smoking is a major cause of preventable death and oral problems include bad breath, stained teeth, tooth loss and oral cancer. Your dentist can advise;

4.     Change your toothbrush every three months and make sure to floss at least once a day;

5.     Take time to read the sugar content of your food and drink and reduce intake of high sugar content foods. Keep snacks between meals to low-sugar or sugar-free foods;

6.     Remember there is a relationship between oral health and general health and ask your dentist if a visit to your medical practitioner is appropriate;

7.     Make a resolution to visit your dentist regularly so that small problems can be resolved before they become bigger, more complicated and expensive;

8.     If you decide to whiten your teeth, contact your dentist as s/he can ensure safe and professional teeth whitening under the care of a qualified dental practitioner;

9.     Arrange preventative fissure sealants for children reaching the age of six or seven as directed by your dentist. Follow up at six or twelve months intervals;

10.   If you notice ulcers or lumps in your mouth or neck persisting for more than a week, arrange to have an oral cancer screening appointment with your dentist.



New Regulations for Tooth Whitening


Rogers Dental welcomes the new regulations from The Dental Council and The Irish Medicines Board regarding the use of tooth whitening products.


The new regulations state how and where this treatment should be carried out. Dentists are the only individuals qualified to carry out this treatment and each patient much be assessed initially to ensure they are suitable for the procedure.

They also allow for the use of 16.62% carbamide peroxide (maximum 17%) which is the tooth whitening gel used here at the practice.

Statutory Instrument 396 of 2012 came into effect on the 31st October 2012. You can find out more information at www.dentalcouncil.ie.




GAA Guidelines


Rogers Dental is happy to endorse the decision by the GAA to make it compulsory for players to wear mouthguards in football games and training. This is a policy that we have long supported.

The GAA Congress passed a motion making it mandatory for juvenile players up to minor grade to wear mouth guards from the start of 2013. The rule will come into effect for senior players from the start of 2014. 


The Irish Dental Association believes the gumshield rule should also apply to hurling and it is hopeful the GAA will introduce a similar measure for that sport in the near future.


To show our support for this important decision we are offering a reduction on all custom made mouthguards.

Mouthguards now €50