Children are waiting for up to 18 months for appointments, some may 'never be treated'. Many children are denied important orthodontic services they are entitled to, writes Theresa Judge
Ian O'Dowling is unequivocal: the current state of orthodontic services is "a shambles" and has been getting worse over the past five years, with many children being denied treatment they are entitled to.
He should know. A consultant orthodontist, Dr O'Dowling has been appointed to a new review group the Health Service Executive (HSE) has established to examine orthodontic services.
The review group has been set up in the context of widespread criticism of the service being offered to children. Many parents are left with no option but to try to raise very large sums of money to pay for private treatment.
One orthodontist working in the Irish public system after coming from the UK said: "For the poor, the reality is: these children are never treated."
O'Dowling describes as "a nonsense" the management of a system that allowed both dental schools in the State, in Cork and Dublin, to lose their recognition to train orthodontists. The Cork dental school lost its recognition in 1996, while Dublin temporarily lost it last September after a consultant teaching on the course left the school.
O'Dowling says he believes the dental schools had shown "a lack of commitment" to the training of orthodontists and one of his aims in taking a position on the review group is "to put pressure on the dental schools to train orthodontists for the public health service".
He is also critical of the fact that the State currently pays huge amounts - up to £25,000 sterling (€28,733) per year per student - to train Irish orthodontists in the UK.
"This is not a solution at all. Their contracts are not legally binding, they cannot be forced to come back to work in Ireland. These are Irish people who were working in England, they were not working in the Irish system when they were selected to do this training," O'Dowling says. The training should be provided to people currently working in the Irish system, he says.
According to the latest HSE figures for the end of June 2005, 9,331 children were awaiting assessment for orthodontic treatment and a further 11,146 were awaiting treatment after assessment. There were 23,216 children receiving treatment.
The HSE says since 2002, there has been "a reduction in most regions in both numbers waiting for assessment and waiting times for assessment".
However, O'Dowling says it is "very difficult to give an accurate picture" of the numbers of children who need treatment because patients classified as category C - which includes severely overcrowded or crooked teeth - have been taken off waiting lists and told they are not eligible for treatment.
A report by the joint Oireachtas Committee on Health and Children in 2005 said children classified as category C should be treated, in addition to category A, where surgery is needed and category B, where there is a jaw anomaly.
O'Dowling says category C problems are often the "most disfiguring". He says he still holds the view he expressed to the Oireachtas committee that some health authorities are "lying" to families, wrongly telling them their children are not eligible for treatment in an attempt to shorten waiting lists.
The HSE statement said that in one region, Dublin/Mid-Leinster, the waiting times for assessment for Category B patients had been reduced to 12 months from five years at the end of 2002 and that urgent category A cases were assessed within three months.
Dr Antonia Hewson, the principal dental surgeon in Co Mayo, says she feels she is "banging her head off a wall" trying to get children treated because of the way these classifications can be interpreted. Children who have very severe problems are not getting treated and this is causing them considerable trauma.
She says it is wrong to dismiss treatment for such problems as cosmetic. "In this day and age, is it a sin to want to have your child's teeth straightened? I don't think people should be made to feel embarrassed for asking for treatment. One woman broke down and cried with relief when we told her we could treat her child here," she says.
In her 30 years of experience, she has found parents are generally very good at recognising the difference between a child who has a minor problem and those who need orthodontic treatment, she says.
The main tasks of the new review group are to review recommendations made in two Oireachtas committee reports, in 2002 and 2005; "to examine recommendations within the operational remit of the HSE and establish their status"; to "conduct an analysis of the HSE's existing orthodontic delivery structure and capacity and, based on that analysis, to make recommendations"; and these are to be costed and a timeframe for implementation proposed.
HSE chief executive Prof Brendan Drumm, who set up the review group, said last month it was unacceptable that children were waiting up to 18 months for orthodontic appointments, but that it would take up to six years before a full cohort of trained orthodontists was available in the public sector.
O'Dowling, who is based in Cork, says progress is being made up to 2000, but since then, it has become "a minefield" and children are now waiting up to four years for treatment.
Up to 1999, a number of consultant orthodontists based in the regions had set up programmes to train people to work as orthodontists in the public system and qualifications from these programmes were recognised by the Royal College of Surgeons in London.
However, a change in Irish regulations concerning recognition of UK qualifications meant these programmes were forced to close and there is much anger among consultant orthodontists who maintain that attempts to improve the public system were hampered. The Oireachtas committee recommended that these training programmes be "reinstated immediately".
The chairman of the new review group, Huge Kane, declined to be interviewed.
A HSE statement said the review would "consider how best to offer a unified, standard and uniform orthodontic services throughout the country" and that it would examine all areas of orthodontics, including training for orthodontists and eligibility guidelines.
O'Dowling says that while there have been "reports upon reports upon reports" on orthodontics delivered to the Department of Health over many years, he hopes the review group's recommendations will be implemented.
"I am hopeful because the difference on this occasion is that the review has been established by the HSE, which also has to provide the service, so the recommendations will be more pertinent to the HSE," he says. In the past, the Department of Health "hadn't the interest or the commitment" to implement recommendations, he says.
The review group will meet for the first time at the end of this month and is due to have its final meeting in June.