Many people, sick to the back teeth of high dental costs, are going outside the State for their dental work, but a new report could force Irish dentists to cap their prices, writes Conor Pope.
'What do you think I'm running, a restaurant?" asked one dentist peevishly when it was recently suggested that he might consider putting a price list outside his practice to help prospective patients make informed choices about whether or not to avail of his services.
This reluctance to be upfront about pricing is not uncommon in a profession where patients' mouths are often treated like a car engine in the hands of a shady mechanic; they get tinkered with for a few minutes before it is explained, patronisingly, that the problem will cost a ludicrously expensive sum, seemingly plucked from the air, to make right.
That could change if the recommendations contained in a Competition Authority report into the dental healthcare sector are adopted by the Department of Health and the profession. The long-anticipated document, published earlier this week, said an outdated system of regulation had stifled competition and driven up dental costs. It described the absence of price lists in and outside surgeries as anachronistic and called for dentists to be allowed to advertise their services and - crucially - their prices.
It found that the requirement for patients to visit a dentist for all their dental services was out of step with international best practice and called for a profession of advanced dental hygienist to be created. It was also critical of the absence of regular checks on the standard of dental services offered in the State and pointed out that that there were insufficient dentists and orthodontists to meet demand, which had driven up costs to the consumer.
According to the Authority, the cost of a visit to the dentist has increased 171 per cent since 1990 compared with 69 per cent for general inflation and 147 per cent for health costs. "Consumers are paying too much for dental services in Ireland. This is not surprising given the rules that are currently in place," said Competition Authority chairman Bill Prasifka. "Consumers are in the dark when it comes to shopping around."
Consistently high prices have seen growing numbers taking their dental business elsewhere, mostly to Northern Ireland, where prices are routinely around 30 per cent cheaper, but also further afield to central and eastern Europe, where savings of up to 70 per cent can be made on predominantly cosmetic treatments such as porcelain crowns and implants.
The internet is now littered with flash-looking websites advertising complex dental treatments at prices which would make dentists closer to home weep. Even the Golden Pages is at it. There are so many smiley happy people with perfect teeth beaming out of the full page dentists' ads in the directory that someone unfamiliar with the inside of a dental surgery could be forgiven for thinking they were joyous places where beautiful smiles were created painlessly by kind-looking men with steady hands and no interest in money.
All these toothsome grins are only advertising dental practices outside of this jurisdiction, as it's illegal for an Irish dentist to advertise at all. "Why shouldn't dentists advertise and compete on the same terms as any other business?" Prasifka asks.
In response to the report, the Irish Dental Association warned against applying a strict economic approach to healthcare issues. "While we will endorse any responsible proposals to encourage competitiveness within the profession, we must ensure that any changes do not prioritise competitiveness over professionalism," said the association's chief executive Ciara Murphy. She added that changes to the work of hygienists and technicians "should be matched with appropriate technical qualifications and training to ensure patient safety and standards are maintained".
Standards and safety are the twin barrels Irish dentists use to take potshots at advocates of overseas dental tourism. They speak darkly about clinical standards and equipment not being on a par with Ireland and point to the risks associated with having extensive treatments carried out far from home by strangers who don't speak your language and offer little by way of comfort should things go wrong.
Shane MacNally's experience of overseas dentistry could scarcely be further from this bleak assessment. He brought his seven-year-old son to get a filling done at a public clinic at home earlier this year but was less than pleased with the result.
It had to be done twice and both times the procedure lasted little more than two minutes. Unfortunately, the filling didn't last much longer before coming loose.
On holiday in Bulgaria six weeks ago, his son developed a toothache and MacNally's hotel arranged for them to visit a dentist in a nearby town. "The surgery was very high spec, more so than anything I've ever seen in Ireland," he says. "All the equipment used came out of sterile packages - and I was looking very closely, as the last thing I wanted was for my son to contract Hepatitis C."
His son was given an X-ray on the troublesome tooth, a diagnosis was made and anti-inflammatory drugs were prescribed. The dentist also performed an extraction and refilled the tooth which had caused the Irish dentist such difficulty. "A filling which took minutes in Ireland was worked on for more than half an hour in Bulgaria and it really is a much better job," says MacNally. "I feel confident saying that, because I was actually watching what the dentist was doing as opposed to sitting in the chair wondering what was going on," All told, the bill came to just under €100 - at home, the work, if done privately, would have, he says, cost twice as much.
While MacNally was an (acci)dental tourist, growing numbers of Irish people travel abroad with the sole purpose of having their teeth fixed. German clinics advertise on Dublin buses and arrange airport pick-ups in Porsches while, further east, patients' hotels and airport transfers are all taken care of by dentists eager for Irish business.
Dentalux is an umbrella group representing a number of dental clinics in Budapest; a spokesman told The Irish Timesthat business was booming, with hundreds of Irish people travelling to the Hungarian capital annually in search of better value. "You'll save between 60 and 70 per cent on the Irish prices," he promises.
He admits that dental tourism for emergency work such as fillings, extractions or one-off root canal procedures and crowns doesn't make financial or logistical sense; however, where multiple crowns are fitted, thousands of euro can be saved.
"The dentists we have working at the clinics are the most highly trained and professional people," he says. "Budapest has a highly developed medical system and all the equipment that is being used and the methods that are being used are right up to date."
But he's unlikely to say anything different and the question that went unanswered is, what happens if something goes wrong? While dental practices across the world claim to offer guarantees, Irish dentists say patients in reality have very little comeback if things go pear-shaped.
"People who talk up dental tourism don't have to deal with the consequences of some of these trips like we do," one dentist told The Irish Times earlier this week. "How do you know these dentists are qualified? Insured? Some people are going away to be treated and they come back without ever having even found out the name of the dentist who treated them."
This week's report from the Competition Authority isn't the first time it has called for reform of the dental profession, and cynical consumers might be forgiven for thinking that it is once more just whispering into the wind and nothing will change.
The timing of its publication could scarcely be better, however, coming as it does so soon after the publication of the Oral Health Care Strategy by the Minister for Health, Mary Harney, last month. The Competition Authority is optimistic its recommendations will inform any new legislation which will emerge from the minister's strategy, although little by way of change is expected until the latter half of next year.
"There's never been a better time to reform the dental health profession and this report and its recommendations can play a major role in that reform," a Competition Authority spokesman told The Irish Times yesterday. Those with fragile teeth will hope his optimism is not misplaced.