Children in need of orthodontic treatment in the Mid Western Health Board region are experiencing long delays for assessment and treatment, with no guarantee they will be offered treatment at all or if they are, that they will be treated within an appropriate timeframe.
That's according to an independent review of the service which found it has declined for several reasons in recent years.
It states there are 2,432 patients awaiting assessment and 642 patients waiting for treatment at present.
"Patients referred for treatment are uncertain as to whether they will receive treatment or how long they will have to wait. If they do receive treatment the start of this treatment will not be at the optimum age and in particular this makes it impossible for the patients to benefit from the use of functional appliances. In order to be reasonably successful functional appliances must be fitted during the time of optimum growth," the report states.
The health board's director of public health, Dr Kevin Kelleher, confirmed an urgent meeting has been sought with the Department of Health to discuss the contents of the report. The meeting is due to take place next week.
Carried out by Dr David Spary, a consultant orthodontist working with the NHS in Britain, the report points out that the orthodontic service in the mid-west started in 1985 and developed rapidly until 1998, when 2,500 patients were undergoing treatment. The service was developed by consultant orthodontist Mr Ted McNamara who was training dentists in orthodontics until approval for the training was withdrawn.
"It was felt that the dental hospitals were making unreasonable demands. It is equally possible that there was simply a conflict of personalities or a misunderstanding," the report said.
However it said the quality of treatment and training which had been provided was of a high standard. "Unfortunately since 1999 the level of treatment has dropped. This seems to have been related to the withdrawal of approval of the training programme," the report said. With approval for training withdrawn, the unit had less staff and could treat fewer patients.
Dr Spary criticised the way in which children in need of orthodontic treatment are categorised in the Republic. When patients are assessed they are, under Department of Health guidelines, put into either of three categories according to their perceived need. The categories are A, B and C. "It is largely a subjective assessment and it is quite likely that no two orthodontists would grade patients in the same way.
"The referring dentists do not seem to understand the grading system hence the need for a separate assessment appointment where the orthodontist assesses whether the patient is eligible for treatment," the report said.
It recommended the system be replaced by a grading system currently in use in the UK which could be modified for use in the Republic.
It also recommended the restoration of the Limerick orthodontic training programme which would be linked to the Cork dental hospital, and the appointment of another orthodontic specialist. Furthermore, it would be desirable if private practitioners were also involved in the training, Dr Spary said.
"Conflicts exist between orthodontists in Ireland which are damaging the profession," he concluded.