2026-01-22

5. Deputy David Cullinane asked the Minister for Health the steps she will take to address the major shortfalls in school dental screening and extreme waiting times for orthodontic care; and if she will make a statement on the matter. [5084/26]

What steps will the Minister take to address the major shortfalls in school dental screening and the extreme waiting times for orthodontic care, and will she make a statement on same?

I will first concentrate on the wider challenges regarding oral healthcare. There is a significant challenge that continues to affect the delivery of school-based dental programmes. In the period to November 2025, over 138,000 new patients were assessed, including 90,000 under targeted programmes in respect of school and special care programmes, but in many cases screening is delayed, meaning some children do not receive an assessment until they have already entered secondary school, except in emergencies. While the HSE follows up to ensure those children are seen, the situation is simply not good enough. I am not happy with it. The situation stems from long-standing workforce pressures and a totally outdated, episodic model of care that is not aligned with the prevention-focused approach we want. The response to this is multifaceted and requires some short-term interventions and meaningful strategic reform. The HSE is funded to recruit an additional 15 oral health staff this year targeted at service areas experiencing the greatest delays. Good progress is being made in recruitment. We have recruitment campaigns completed for eight of them and three campaigns are currently active. Looking ahead, we need to think about how we use the wider dental workforce. I met with the Irish Dental Hygienists' Association last year. Hygienists are a fantastic group of people. They advocate for more direct access to patients. I believe they can play a much bigger role in preventive and periodontal care. I have instructed my Department to accelerate the necessary consideration of this matter. It must be safe and of course add value for patients. Legislative change will be required and the regulator will need to establish the necessary conditions and supports to make sure that it is done safely. That is an important part of how we use our workforce at the top of their expertise, and use every qualified professional resource. In the medium-to-long-term the national oral health policy sets out a comprehensive vision for strategic reform, including new children's oral health services supported by age-appropriate packages of care. I regularly hear this cannot be achieved due to capacity constraints. The proportion of children that is already being seen in private dental practice and families paying out of their own pockets to do so is not acceptable.

I raised this question numerous times through parliamentary questions and at the Committee of Public Accounts and the health committee, among others, last week. There was no school screening in Monaghan in 2024-25. That is just not good enough. I get a lot of emails and other contacts in this regard. There is no orthodontist in the north-east region at all. There used to be one in the Monaghan area. People are now being asked to travel to Dundalk, which is not acceptable. I do not even know if that orthodontist is still in operation. Could the Minister focus on the workforce plan and introduce targeted measures in that regard? It is completely acceptable if people are off on maternity leave but it must be projected that it will happen each year. She mentioned that she is recruiting in 15 areas. I hope Monaghan is one of those areas.

I am in complete agreement that this simply has to improve. While the services are there, looking at the wider workforce generally in relation to dental care, if we separate it out from orthodontics, how we use the workforce has come up a number of times. We train dentists at quite a considerable cost to the State. We do that because we want dentists to be available to do dental work, both in private practice and for the State. We want children to have screening. I do not want to deviate too much but I have been consistently concerned by one issue. This has been acknowledged by the Irish Dental Association and ADI, which is the group training dentists. The issue relates to the number of dentists who are being trained in Irish State-funded facilities and the drift towards cosmetic dentistry, the scale of practice in injectables, Botox and other things being done by dentists. At a two-day conference of the dental association last May, one full day was dedicated to injectables. I want to train dentists to do dentistry on children.

I have to agree with the Minister. Children should be our priority here. As we know, early intervention is key. I have heard of cases, again in Monaghan, where a child of seven years of age had to get seven extractions done. There was no screening. That could have eliminated them. They could have put a wee filling in and helped with that process. Will the Minister make it a top priority that children are screened? It develops good habits and good oral hygiene for their lives. Therefore, I would make it a priority. On the dental training, perhaps there should be a recruitment drive to ensure that people are going back to college to study dentistry and that we make it a priority.

We have made some good progress on the training. The RCSI has opened a new community train-and-treat facility in Sandyford and has just started building one in Connolly Hospital as well. We are making some good progress there. On screening, the seven-year-old child mentioned by Deputy Bennett needed much earlier screening, which could have been provided by a dental hygienist. The actual dental work that might be needed has to be done by a dentist. When we are trying to identify problems at an early age, we need prevention, screening, cleaning and good habits; all of the things the Deputy has talked about. We are not using our workforce well enough at the moment. I want to see the role of dental hygienists amplified. They should be given better opportunities to do programmes in schools and to have more direct access to patients. We have to look at every lever. We will train more dentists but when we do so I would like to see a commitment to public service. We have increased the fees generally for HSE-funded dentistry, by between 40% and 60% in some instances. On average, we have increased them by 40% for doing certain procedures and we still cannot encourage dentists to come, at the scale that we want, into that practice, potentially because of the allure of more lucrative products.