State support for dental treatment, through PRSI and medical card schemes, has fallen from a high of almost €150 million in 2009 to less than €75 million last year.
Data also shows, from 2009 to 2015, the number of extractions of teeth among medical card patients increased, while cleanings and fillings fell. And, according to a study at St James’s hospital in Dublin, there was a 38 per cent increase in patients admitted for severe infections caused by dental decay, after the State dental supports were cut.
Following the economic collapse in 2009, entitlements to treatment, under the PRSI Dental Treatment Benefit Scheme, were severely cut. Workers had been entitled to a free check-up and cleaning, as well as subsidised gum cleaning, fillings, extractions, root canal treatments, X-rays and denture work. After the 2009 budget, only the free examination was retained and workers were required to pay for the cost of all other treatments.
In 2010, the medical card Dental Treatment Services Scheme was also cut back. Entitlements to cleaning, gum cleaning and X-rays were suspended, root canal treatment could only be performed on an emergency basis and only on front teeth, denture work was only allowed on an emergency basis and people could only have two fillings per year. But extractions, the cheapest of dental pain remedies, could still be performed on an unlimited basis.
Since then, data on medical card dental patients shows extractions have increased by 15 per cent, from more than 108,000 in 2009 to almost 124,600 in 2016. And surgical extractions have increased by 40 per cent, from just over 37,200 to more than 52,000.
Prevent gum disease
The number of fillings carried out for medical card patients dropped by 37 per cent, from more than 604,000 to almost 380,000. And cleaning, which is essential to help prevent gum disease, fell by 96 per cent, from 255,000 treatments in 2009 to almost 10,100 in 2016.
Spending on the PRSI scheme fell from €55.7 million in 2009 to €10.5 million in 2016. It is expected to increase to €15.4 million this year because benefits under the scheme were extended to self-employed people for the first time, but none of the old dental treatments have been reinstated.
There is no information available on what treatments workers are now paying for, but according to data from the Central Statistics Office, households have dramatically decreased their spending on dental treatment, from an average of €197 in 2010 to €84.53 in 2015.
Results from a study, published in 2015, which looked at patients admitted to St James’s Hospital in Dublin with serious dentofacial infections caused by decayed teeth, showed a 38 per cent increase in numbers after the changes to State supplement schemes.
The authors identified “a worrying trend of patients accessing the emergency department” and requiring more serious treatment, with average stays in hospital of 5.5 days. The authors concluded that increased resources should be made available to support access to dental care.
The study has continued at the hospital and chief executive of the Irish Dental Association Fintan Hourihan says early indications are the results have been exacerbated with time. He said dentists are very concerned about the effect of the cutbacks on the nation's dental health and are seeing a "significant impact".
The cuts affected the “preventative element”, he said.
“If you are not preventing problems, you are treating them soon afterwards,” he said.
Slow pace
He raised concerns about "the slow pace" of the new national oral health policy being developed by the Department of Health under the leadership of Dr Dympna Kavanagh, the country's chief dental officer. It is due to be completed this year.
“I don’t see why there couldn’t be, on an interim basis, some measures taken to try to offset the costs people are incurring and hopefully encourage greater attendance ahead of any oral health policy,” Mr Hourihan said.
As part of the Programme for Government, pledges were made on dental health. These included a dental health package for the under 6s and the extension of PRSI treatment benefits to cover the cost of some routine dental treatments. The Government also promised a “preventive dental health package” for medical card holders.
But it is unlikely that changes will be made to the schemes before the new oral health policy has been developed.
Speaking to The Irish Times, Dr Kavanagh said the project includes research into the dental health of the nation through studies including The Irish Longitudinal Study on Ageing (Tilda), the Healthy Ireland survey and other methods. A public consultation process will take place in September.
Dr Kavanagh said she is aiming to publish the policy by the end of the year, but if the full picture is not available by then, they would wait for it.
“We are working as hard as we can to get that out,” she said.
