Only one in five medical card holders visit the dentist every year, with elderly people the least likely to seek an appointment resulting in poor diet and nutrition according to a new report to be published today.
The report by UCC health economist Dr Noel Woods concludes that while General Medical Service (GMS) patients are not abusing the medical card system, they are not valuing their oral health.
Based on the database of the Dental Treatment Services Scheme, Dr Woods found that the 16 to 24 age group go to the dentist more often and receive more services than they might actually require. He reasoned that dental care services such as teeth whitening had introduced a cosmetics element to the area and contributed to young people perceiving dental care as an aesthetic, cosmetic and clinical necessity.
In areas served by numerous dentists and where competition for customers is more intense, Dr Woods discovered that medical card holders tend to receive more treatments per visit than average.
His report suggests that since dentists can claim a fee every time they see a medical card holder, there is the possibility that dentists are recommending follow-up visits and additional procedures, and therefore exploiting the incentive. "A few dentists may be responding to the financial incentives and acting economically rather than clinically," he said.
While stressing that he did not prove any irregularities during his analysis but simply revealed a trend, Dr Woods believes, however, that the current dental delivery system which provides incentives to providers with no probity checks is open for exploitation.
In recognition of the "underutilisation" of the medical card system for free dental services, particularly among the elderly, Dr Woods recommended that day care centres and nursing homes should provide dental check ups in addition to the services they already offer.
He contended that ill-fitting dentures can affect an older person's ability to eat, and their diet and nutrition.
"Elderly people attending daycare centres have no access to dental care despite the presence of chiropodists, GPs and nurses.
"These places are the ideal location for visits to the dentist . . . without the service, poor dental health can impact on an elderly person's quality of life," he says.
Dr Woods reasoned that the system whereby health board salaried dentists attend primary and post-primary schools and assess pupils, should be extended to include nursing homes and daycare centres.
In addition, increased information on dental care needs to be available in GP practise, with GPs advising and informing patients of the need to attend the dentist. The cost of dental services for medical card holders, which is around €50 million every year, may also need to be addressed due to the possibility that some €5 million could be "over provision."
"That's a drop in the ocean, alongside the overall healthcare budget. But it's still €5 million. And everything that is irregular and especially any medical treatment that is not needed is unethical," said Dr Woods.
Earlier this year, new probity checks allowing for regular random checks on dentists were introduced in Ireland in an agreement with the Irish Dental Association.