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Dáil Éireann debate -
Tuesday, 27 Nov 1984

Vol. 354 No. 4

Dentists Bill, 1984 [Seanad]: Second Stage (Resumed).

Question again proposed: "That the Bill be now read a Second Time."

Last week I referred to the fact that the new board will comprise 19 members and a refreshing factor was that the consumers will be represented. I appeal to the Minister to consider including a member from the auxiliary dental workers group. I know the Minister has the right to nominate four members and that he may include one of this group in his nomination but there is no guarantee of this. I urge the Minister to reconsider the composition of the board and to include a member of the auxiliary dental workers group. This would have a number of advantages.

As I said last week, dental hygiene has become a major factor in the practice of dentistry today, with the emphasis on preserving teeth rather than extracting them, as was the practice heretofore and I am very glad the modern dentist recognises this. While there is a section in the Bill dealing with auxiliary dental workers there is no specific reference to dental hygiene and this is a major drawback in the Bill. Many of the dentists to whom I spoke concerning this Bill told me this is one area where we in Ireland are lacking. This is not through any fault of Fianna Fáil, if the Chair will forgive me for being partisan for a moment. Our Leader, Deputy Haughey, when he was Minister for Health provided free tooth brushes for school-going children but unfortunately through ignorance at that time he was ridiculed in certain quarters. His farsightedness and vision are only being recognised today. The Minister should reconsider the whole question of dental hygienists and provide for their recognition and training in the service as a matter of urgency.

Many fears were expressed by dentists concerning the dental technicians, or to be more specific the whole area of denturists. I am glad this has been satisfactorily resolved in the Bill. However, a deputation of technicians earlier this week made a request that a grandfather clause be included in the Bill which would guarantee some rights to those technicians who have been in practice for a number of years. Deputy Keating referred to this matter also. It has been done in the past in other Bills and I see no reason why we cannot do it again.

At the moment we have about 1,000 dentists and about 200 dental technicians. The WHO state there should be at least two dentists to every technician. This suggests we may have a shortage of technicians or a surplus of dentists. If this is so, then it is likely they could provide the services that could be provided by technicians. With reference to the grandfather clause and the other requirements I mentioned last week, the Irish Association for Dental Prosthesis make the point that they have no desire to extract teeth, to fill them, to become involved in crowning or in bridging work or to get involved in the area of orthodontics. All they want is to take impressions and to manufacture and fit dentures direct to the public. I ask the Minister to look at this matter again and perhaps a satisfactory solution may be arrived at.

At the moment through no fault of their own technicians do not have the training to provide anything other than a dentures service. If they are to provide a proper service and to be of benefit and assistance to dentists they will need proper education and training. If the Minister is serious about this matter he must be prepared to provide money for the training and education of these people. At the moment the more sophisticated auxiliary services are provided from abroad, from England in particular. That is wrong. We should be in a position to have these facilities here. The majority of our technicians have no experience in the treatment of conditions such as cleft palates, facial prosthesis following cancers and many other ailments. They have no experience or training in the area of oral pathology. There are about 120 conditions from the simple koplik spots suggesting measles to the more sinister mole representing a malignant melanoma. Dentists contend that at the moment only they have the experience to recognise and treat these conditions. That may be so but we must provide training for auxiliary dental workers so that they too can recognise these conditions and refer them for treatment and correction.

Another area that must be considered is that of orthodontics and oral surgery. There is an attempt in the Department to provide these services but unfortunately, either through lack of funding or properly trained personnel, the services are very slow in getting off the ground. We will have a major problem in 1985 because these facilities and services are very expensive but if the Minister is serious about these matters funds will have to be made available. Otherwise this will be but another example of pious platitudes, talking about what must be done but doing nothing about it. I appeal to the Minister to make the funds available if he is really serious about this problem.

In comparison with most other countries the percentage we spend on dental care is about 2 per cent of total expenditure on health care. This compares with 11 per cent in Austria, 8 per cent in Denmark, 7 per cent in Norway and 5 per cent in the United Kingdom. If we are going to provide the services necessary for those people whom we are committed to help we will have to provide the necessary funds. Otherwise all of this will be a load of rubbish. At the moment we are committed to cater for 1.5 million people, if we take into account pre-school children, primary school children, adolescents and adults who have medical cards. Because of lack of funds fewer than half of those people are receiving the treatment to which they are entitled and which they require. We have a duty and responsibility to cater for them.

I welcome the Bill, as do the members of my party. I shall have more to say on this matter on Committee Stage.

It seems the hand of dentists lies heavily across this Bill, far too heavily in my opinion. The situation appears to be that the protection of the position of auxiliary dental workers and also the provision of a service for the public at a price that some of them can afford has not been covered adequately in the Bill. From information given to me it appears that the auxiliaries and the denturists who have provided a substantial service to the people for many years have been by-passed. I am told that in the discussion period leading to the formation of this Bill the denturists and their association were not even consulted. They were not called in for discussions and this Bill has been brought in over their heads which will have the effect, if passed in its present form, of copperfastening a monopoly in the hands of the dentists' profession.

It is quite clear from reading the Bill that the new Dental Council to be set up will have a built-in majority of members of the dental profession and they will be in a position to control the situation absolutely. They will be able to control the question of who will practise denturism and dental hygiene as well as the question of who will practise dentistry. This is a matter which goes to the root of the financial set up of the dental profession. The provision of dentures is the most lucrative side of the dental profession and they would be given under this Bill a monopoly to secure their financial position entirely within their own control.

I would have thought that in setting up a monopoly of this nature great care would have been necessary to safeguard other interested parties, firstly those denturists who have been in practice for many years and have achieved a great degree of knowledge and expertise and, secondly, the members of the public who have been provided with this service and the opportunity of obtaining dentures for themselves and their wives at a reasonable cost which they can afford. A large proportion of married women are not covered for dentures under our social services scheme. Pregnant women, whose teeth are particularly at risk, have to pay dentists' prices if they are to be furnished with this most essential and basic need.

I understand there are approximately 250 denturists in practice here. This is not something that arose today or yesterday. It goes back for half a century and more during which they have been providing a fine service to the public. No doubt there are black sheep among them as there are in every profession and trade, but I have no reason to suppose that their degree of professionalism is any less than that of the dentists. There are black sheep among the medical, dental and, be it said, among the legal profession.

In this Bill we are going to tackle people who have been practising for ten, 20 or maybe 30 years earning their livelihood and performing a service. The enactment of this legislation will turn these people into criminals and the practice of their profession will warrant a fine of £1,000 and 12 months imprisonment. That is ludicrous. Technically speaking, until now the practice of denturism has been an offence and there have been a few cases of prosecutions in the District Court brought about through the agent provocateur method initiated by the Dental Board. The district justices are very practical people and know the conditions under which people live and what the realities are. They have given their verdict on these prosecutions and on the challenge to the practice of the denturists. They have indicated their views by imposing token or nominal fines only.

That is the verdict of the district justices on these agent provocateur prosecutions which have been brought on rare occasions. I do not know whether a prosecution under the new legislation would in any way alter the opinion of the district justices. I do not know what the existing penalty is but only a trifling amount has been imposed until now. The fact that the penalty is extended here does not make it likely that the district justices will increase the penalties they impose. Why should they? There is an increase from £100 to £1,000 plus 12 months imprisonment. I know of no case under the existing legislation where the maximum penalty was imposed. The usual is £5 or some other nominal sum. I find reprehensible the whole concept of the agent provocateur prosecutions. There may be difficulties in securing convictions in any other way but one could not be unduly proud of the practice of the Dental Board in setting up a person to trap these people in the practice of their profession.

Some sectors of the dental profession have indicated their views on denturists. There have been suggestions about the role these people should play in the scheme of things. In selling them into the hands of the dentists one must surely look at the stated intentions of the dentists vis-à-vis the denturists and dental hygienists. At the annual general meeting of the Irish Dental Association in Killarney the general secretary stated:

Our view is that any auxiliary should be introduced only after a study is undertaken with regard to the necessity, the viability and the long-term effectiveness of such an auxiliary, who should complement the work of the dentist and not be seen as an alternative to the dentist.

That, one may assume, is the stated view of the dental profession. The general secretary presumably would cut off these people who have been earning their living in good faith while an examination was carried out as to their necessity, viability and long-term effectiveness. These matters would have to be examined before these 250 people would be allowed to continue. That is an entirely untenable proposition.

I have no doubt that there is a clear and definite role for the professions of denturists and dental hygienists in our scheme of health services. It may well be that we must look at the nature of the training that should be provided for them. If the Bill was aimed at setting out the parameters of the training that would be required, the number of years, the kind of training schools, tests and examinations that would be required, that would have been a major step forward.

In my view a separate school should be provided, under AnCO or one of the other agencies, or in association with the Dental Hospital or whatever. We should have provided for a separate school in which to train them in a proper manner. The control of this, in my view, should be not in the hands of the dentists. They may control the dental profession but this is a distinct category and there should be a separate denturists and hygienists council which would organise the scope of the training and the examinations and select the technicians who would train in the schools. Of course dental professors and extern lecturers and so on would be involved in this as a necessary and logical purpose of the arrangements. However, to place such arrangements under the control of the very group to whose financial interest it is contrary is an entirely untenable proposition.

Is it that there are more than enough dentists in the State to cope with all the dental work in a broad sense? Is it that there are dentists going begging without work to do of a more specialised nature that they are qualified for? The figures available show otherwise. The World Health Organisation have indicated that to operate a reasonably adequate dental service requires one dentist for every 2,000 of the population — that is the WHO norm. Our ratio is one dentist to every 3,500 people. If the WHO norm were to be accepted it would mean that we have approximately only half the number of dentists we require. That being so, there is an enormous scope available for dental hygienists and denturists to deal with children's teeth and matters of that nature without the necessity of having a dentist. Taking impressions of the mouths of adults which is being done already by denturists could be adequately undertaken by them in the future.

I am aware that there is provision in the Bill for the Minister to direct a scheme to be set up by which a register of denturists would be provided. This would determine the training and qualifications necessary to put those people on the register. That is fine as far as it goes, but it does not meet the basic objection I have to that provision in the Bill because, although the Bill at present gives the Minister power to direct the Dental Council to make a scheme, it does not give him the power to direct them what scheme to make, or the parameters of the scheme, the position being that if he directs them to make a scheme they could, and in my view might well bring in a scheme that would be so harsh and so difficult as effectively to rule out any reasonable working possibilities for auxiliary dental workers and could have the effect of removing from practice people who have been doing this work for decades. It would be an entirely unacceptable position in my view.

Possibly some arrangement can be made through which denturists would have some association with the dentists to cover the possibility referred to by Deputy Ormonde, through which a prescription from a dentist would be required to ensure that there would be an inspection by a dentist, at least as an interim measure until the extent of a training scheme for denturists could be developed that would enable them to have the training that would be desirable and that would enable them on examining a mouth to see if there were conditions in it that would require more specialised investigation by the medical profession or somebody else.

All in all, this Bill in my view gives too much control to the dentists. I am afraid it goes overboard in that direction by loading the Dental Council with members of the dental profession with no provision for membership by any auxiliary organisation. The Bill places complete control of the denturists in the hands of the dentists which is in conflict with them from the financial point of view. That is untenable.

I am grateful for the opportunity to speak on this measure which is designed to provide for the establishment of a Dental Council which shall provide for the registration and control of persons engaged in the practice of dentistry and the persons engaged in such practice and to provide for the repeal of the Dentists Act, 1928, and the Dentists (Amendment) Act, 1983, and to provide for other matters connected therewith. It is right that we should amend the Acts referred to and provide for proper control, education and proficiency in the profession of dentistry and all associated with it. My main concern is that we do not have enough dentists to meet our needs. We have approximately only one dentist for every 3,500 persons. This lack is particularly evident in health boards who have very long waiting lists for dental people and whose priority is to properly look after the needs of children. Many adults and especially older people must also wait interminably for dental treatment.

I understand the primary reasons for the long waiting lists and the inordinate delays involved are the embargo on recruitment to the public service and the row which has been going on for some years past between the Minister and his Department and the health boards in respect of fees for dentists. It is nothing less than a tragedy that the ad hoc arrangement between our health boards and the dentists in the private sector has broken down. That arrangement was invaluable. When local clinics under the aegis of health boards were unable to cope with the work load, medical card holders could be transferred for treatment to dentists in the private area. This facility was much availed of.

Since the breakdown in the negotiations between the dentists' organisation and the health boards, we have had a colossal increase in the number of people awaiting dental treatment. It is a national scandal that on the one hand we have an embargo on recruitment to the public service, which includes the health boards, and a breakdown in the negotiations between the health boards and the private dentists on the other hand. The unfortunate patient suffers, the long-suffering patient. I want to impress upon the Minister the urgency and the importance of finalising the negotiations and getting back to the ad hoc arrangement whereby medical card holders could go to private dentists for treatment. This arrangement must be restored as a matter of great urgency.

I know of no good grounds for applying the embargo on recruitment rigorously in this area. It is intrinsically wrong that people should have to suffer for so long before securing an essential service of this kind because of problems of this nature. The Minister should face up to them. The health boards should be enabled to recruit the necessary staff. The dental profession ought to acknowledge their obligation to the public at large and come to a speedy settlement with the Department of Health. Money alone should not be the criterion. They have an obligation to their profession to serve the public in the first instance.

In the main it is the medical card holder, a member of the most underprivileged section of our community, who is suffering most of all under these handicaps. At least people with social welfare insurance may go to the dentist of their choice. They have some prospect of getting treatment. The medical card holder must wait the longest and seemingly no one cares about that person. When the Minister is replying I look forward to hearing a statement from him that he is concerned about the problem of the arrears of work accruing in the health board areas, the need to secure the services of the private dentists and, if necessary, to provide the additional people required to service this area.

I share the sentiments expressed by my colleague Deputy Taylor concerning the auxiliary dental service. I am concerned about the position of the auxiliary as he is called, the dental hygienist, the dental mechanic and the dental technician. I would welcome an explanation from the Minister as to how he differentiates between the various categories referred to in this Bill. I am concerned primarily about the position of the dental mechanics or technicians. Some of these people are resident in my constituency. They are highly qualified people. Many of them come from family firms, so to speak. Their fathers and their grandfathers have been engaged in this craft, this profession, for years. They are highly qualified and they have been providing dentures for the general public and the dentists in the area down through the years.

Their craftsmanship and expertise are acknowledged by all concerned. It is disconcerting in the extreme to realise that they are not provided for in this proposed Bill. Despite the number of years they have been operating successfully it seems that they are now expected to go back to school, as it were, to learn their trade. Is this the position? If so, it is preposterous to suggest that a dental mechanic or technician of proven skill and ability, and with long service to the public and to the profession, should be asked to go back to school before he will be registered by this new board.

One must appreciate that in the main these people are self-employed. They may not be insured under the Social Welfare Acts. They have to provide for their own retirement. It is a preposterous suggestion that they should be asked to abandon their way of life for a period of time and to neglect their wives, families and homes and go back to school or college and go through the motions of proving to somebody that they are skilled dental technicians. This is an area which has to be cleared up effectively.

I should like to see enshrined in the Bill proper conditions of employment, salary scales, superannuation. We should provide a grant-aid for educational pursuits for all those engaged in the profession. The position of the dentists' surgery assistants has to be provided for. There must be some 900 of these in this State and they must not be forgotten. The role of the dental hygienist must be regarded as of vital importance and an adjunct to any dentist in carrying out tests, cleaning and polishing teeth. In the instruction of patients in the matter of preventive care and dental hygiene, of health and education generally, the role of the dental hygienist is of paramount importance.

I should like to see appropriate scholarships provided so as to enable young people to engage in this profession. Quite recently a young lady who wished to be a dental hygienist had to go to England to be suitably trained. No scholarship or State aid of any kind was available to her here. That is a shame. I should like to see this Bill improved to cover that kind of situation.

I hope that the Minister's mind is not closed when it comes to providing for recognition for the dental mechanic or technician to whom many of us have adverted in this House. These categories are recognised in many other countries. There is no reason why they should not be recognised here. Denmark, Australia, the USA and many other countries recognise the intrinsic work of the dental mechanic and they are provided for in legislation and given an appropriate place on the boards governing dental treatment in the countries to which I refer.

It is not good enough to say that the auxiliaries, dental mechanics and others referred to here would be catered for adequately under certain committees which may be established under this Bill. That is not adequate for the situation. They are, as I said, highly experienced technicians, master craftsmen who are properly trained and fully appreciated by the profession in which they work. It seems that any who have served, for, say, seven years as technicians or craftsmen should be recognised under this Bill and an appropriate amendment must be made along those lines. It would be the height of injustice to exclude them from this Bill or to show total disdain and disregard for their services to the dental profession and their long years of experience. This would be patently unjust. The suggestion that they should go back again to school is an affront and an insult to these categories of workers. That is a provision that is quite understandable in respect of future requirements, future training, future standards that should apply, but it must not be invoked against the existing technicians, of whom there are upwards of 300 in this country, three of whom I know in my constituency. If their workmanship is acceptable to the public and the dental profession it should surely be acceptable to the Minister and his Department. For those of us who have read the Bill and are familiar with the people in question and the work they perform, their honour and their integrity, it is a matter of astonishment that these categories are not being properly provided for under this Bill. It was not done in the Seanad, but it must be done in this House.

I observe, too, that there is no place for these auxiliary workers, these technicians on the board. The Minister has the power to nominate some persons to that board and I am lending my support to the many other Deputies who have told the Minister that when it comes to appointing the people whom he has the right to appoint he must not forget the technicians. They must have an honourable place on this board. They must not be subordinate to the dentists or to any of the vested interests in the profession. They have a right to be heard and a right to their proper place in the profession and this must be conceded under this Bill.

The unfairness and disregard of these technicians has been acknowledged in recent years, especially by the Restrictive Practices Commission, who came down very definitely on the side of the technicians. The Minister has had some regard to this decision, but the essential features of the recommendation have been ignored. A monopoly has been existent in this matter for a long number of years. The Restrictive Practices Commission have said so. They have made recommendations and the Minister has a bounden obligation to have regard to the salient features of that report.

While the Restrictive Practices Commission recommend that any penal prohibition such as a £100 fine should be abolished, I observe that the Minister for Health, without giving any real justification, has increased that fine to £1,000 and has actually provided for a 12 month's jail sentence for anyone who deviates from the regulations laid down under this Bill.

Technicians welcome the opportunity to be acknowledged and legalised under this Bill. They want to play their proper role. They are entitled to their proper status. I am pleading for them in this House on that basis. I express the hope that suitable amendments will be made to this Bill. One of the amendments that I should like to see made is in respect of the position of the technicians. Any of these who have served for seven years should be recognised and registered. They should be given representation on the board. Up to now the Minister has not been inclined to do that. He did not respond to the request in that regard in the Seanad. However, I hope he will realise the justification for such a provision and make the necessary amendment while the Bill is going through this House.

I welcome the various salient features of the Bill. It is only right that a profession such as the dental profession be structured properly, be efficient and be operating to the highest standards possible.

I shall conclude by adverting again to the great need for more dentists. We must have more dentists if we are to be able to provide the necessary dental treatment for our people and especially for the poorer sections. I appeal to the Minister to bring about an end to the infernal row that has been going on with the dental profession for far too long. This dispute is all about money and it is in total disregard of those thousands of people who are waiting for treatment.

Because of it many in the older age groups will go to their eternal reward, not only without natural teeth but without dentures.

I appeal to the Minister also to have regard to his responsibility in the area of social welfare and to extend dental treatment to the wives and families of insured persons. It is not good enough that that aspect of dental treatment be confined to the one member of the family who happens to be insured under the social welfare code. We must have regard to the family unit and extend the services to spouses and children.

I welcome the Bill, which comes to us from the Seanad where it was debated extensively. One of the points that emerged frequently during that debate was that the first dental board were established in 1928, that is 56 years ago. After such a long time it is appropriate that we should be setting up a new Dental Council to take account of changes in our society. One of the great hopes for the future in terms of dental care is that people should be able to retain their natural teeth instead of having to wear dentures, particularly badly fitting ones, as is so often the case now. One of the memories of my childhood was that so many people in middle age had only few teeth in their heads, and if they were lucky, had dentures.

We have moved a long way since then. The main improvements have come about by way of the flouridation of water and of increasing emphasis on dental care.

I would be very concerned about people living in remote rural areas particularly, first, because of water in those areas not containing flouride and, secondly, because of the inadequacy of community dental services. As has been pointed out, there are not enough dentists or auxiliary dental workers to allow equal opportunity of access to dental services. Those in the more remote areas are likely to be discriminated against to an even greater extent than are those in the more populated urban areas, though even in those urban areas there are long waiting lists for dental treatment, some of which is very urgent.

The other group who have been the greatest victims of the lack of dental care have been women in the home, women who give up the opportunity of economic independence and of making their own social welfare contributions. I speak not only of those who are wives and mothers and who work in the home but also of another group who are among the least acknowledged in terms of the amount of valuable work they do. I refer to those who stay at home to look after parents or other elderly relatives. These women often have very little economic support and are not able to pay the high fees charged by dentists. When we are talking about broadening and updating the dental council, we might realise the scandal it is that so many women do not have access to dental care even by way of the social welfare contributions of their husbands. Regarding those single women to whom I have referred, the State should credit them with social welfare contributions by way of acknowledging the contribution they make by looking after their elderly parents or other relatives at home. In that way they would be eligible in their own right for dental treatment.

Some time ago a former Minister for Health commissioned a survey in regard to dental health and it was no surprise to many of us to learn from that survey that mothers had the greatest incidence of tooth decay of any other group. During pregnancy and then as nursing mothers women are at high risk in terms of dental care. In addition, as is well known, mothers put themselves last in the family in terms of priority for dental or any other care. When it is a case of either buying a child a pair of shoes or paying a visit to the dentist for herself a mother always comes last. We have taken advantage of that kind of self-sacrifice and generosity to the detriment of women. If we want to acknowledge the value of the work of women in the house and of parenting, we had better put our money where our mouth is and redress this grave discrimination hopefully in the next budget.

This Bill attempts to establish a register to ensure the training and so on of dentists. What we should be considering is how effectively we can use the resources we have. We do not have a high enough standard of dental care in the sense that we cannot look after everybody from childhood to elderly adulthood. Dentists undergo a long and costly training. Often poor families are not able to afford or allow their children to take up dentistry on account of the high cost of training. It also costs the taxpayer a lot of money. If we had the right kind of flexibility and acknowledgement of the skills of the members of each of the structures within dental care, we could more effectively use the investment we are making in the training of dentists at present. There is a big problem in that when young men and women are trained as dentists they find there is no job here for them.

We should look at investing more money through health boards in two ways. One is by giving an attractive salary for dentists to work through community care and with the health boards. At present dentists generally seek to work in totally private practice or else they emigrate. That is a huge loss to the country. Not only do we lose the money we spent on training them but we lose their talent. Health boards might consider subsidising students in their own areas and guarantee them employment with an attractive salary.

That has been done in certain health board areas.

It could be done on a wider scale. There is also the question of dentists being able to work permanently on a part time basis. We have problems regarding part time workers because they are not assured of full remuneration on a part time basis and so on. Dentists are often over burdened with work and that is because they attempt to carry out all the treatment themselves. There are other groups of people who with proper training could take over some of the work of dentists. A register could be set up of people with the proper expertise and experience. For instance, mention has already been made of auxiliary dental workers. I will not repeat what Deputies Taylor and Treacy have said. Denturists who have been practising here for many years have expertise and experience which cannot be overlooked or devalued. We all agree that a longer term of training for denturists would be acceptable. We must, however, take account of those who have been operating on a level which has been acceptable to dentists and to the public. I will not labour that point because it has already been made and I am sure that we will come back to it on Committee Stage.

There is another group, and we have not taken their role very seriously. I have had several discussions with them. I refer to dental assistants. They are usually women. They are a support service to the dentist. They usually prepare the instruments and help with regard to the welfare of the patient particularly after dental treatment. Through their work they have become quite expert in the area of dental hygiene and dental care. I know that many of them would like a defined training structure to be set up so that they can move on from the limbo in which they find themselves now, in which they are not recognised or well paid, into an area where they would be trained as dental hygienists. As Deputy Treacy said, anyone who wishes to do that now has to go abroad to be trained. Surely training could be given immediately to people who wish to avail of it. They already have the expertise and experience though it is not recognised. A structure of dental hygienists could be set up which would relieve a lot of the day to day work of dentists and allow them do the work for which they were trained.

Such people could be employed to go to schools, particularly to primary schools, and give a course on dental hygiene and detect teeth which are in need of treatment before they get to a stage where that treatment becomes costly. In terms of cost benefit alone this is something we should be thinking about for sheer efficiency. We would also instil in young people a health programme which may mean we could cut down drastically on the need for dental care. If we concentrate on ensuring that the council when it is set up would have these as its first tasks, then we would be addressing problems which should have been addressed a long time ago.

We are talking about a Dental Council and I ask, as other Deputies will ask, that we will have different levels of expertise and training — denturists, dental workers, dental technicians, hygienists and so on — represented on that council and that the council will be seen as representing the entire area of dental care and not just the area of the expertise of the dentists themselves. Therefore on Committee Stage I hope to come back to that kind of representation on the Dental Council. It is important that we have consumer representation on the council, that the people getting the service would have some input into how it is working.

Lastly, I hope that on the Dental Council and the various committees set up under it the dentists will not set themselves up as an expert or elite group. I would worry in case dental care would be concentrated in separate areas. I recognise the high expertise in orthodontic treatment, but it would be a pity and could end up being incredibly costly if only certain dentists were trained to operate in the area of orthodontic treatment, bridge building and so on. I know it is expert and that not everybody would have the talent or the wish to operate in that field, but if only a small number of dentists are doing this there would not be sufficient access on a national scale for people needing such care, it might become expensive and elitist and only people with a large amount of money could afford to avail of it.

I conclude with a heartfelt cry that the whole area of orthodontics would be contemplated at an early stage. This area concentrates very much on structural difficulties that can affect not alone the teeth and appearance but also speech and confidence. It would worry all Deputies if that very expert, exclusive area become so restricted that people on low incomes or medical cards would need to be in a very bad way before they would be accepted for this treatment and, therefore, grow up suffering from the psychological effects of needing it, believing it to be completely outside their range. We must face the fact that at the moment as a nation we have not really offered equality of opportunity and access to all the people of the nation that would ensure that all have the same standard of oral hygiene and dental care.

I welcome the setting up of this council and I hope that it will include the representation that I and other Deputies seek. Above all, I ask that the resources be made available for the effective use of the talent and expertise already available. We should ensure that no person, living no matter where in Ireland, irrespective of age or circumstances—and I am thinking of the discriminatory position of women in the home in this regard — would be left without the fullest, best and most expert dental care needed, not as a matter of privilege but as a matter of right.

I want to make a brief contribution. The Minister in his Second Stage speech asked that the House would not comment on the services available to the public. I will try to observe that request but it is difficult to comment on certain sections of the Bill without touching on it. For instance, the section which allows for consumer representation on the new dentists' board seems to be very much needed, and I recall proposing this in the 1983 legislation when that was going through the House. Married women in particular should be represented on this dental board. The way married women are treated is nothing short of a scandal; and if the argument is that sufficient funds are not available to admit all the housewives, surely husbands and wives could take it on a rotation basis. At least 50 per cent of the treatment could go to the housewives, or some system could be worked out. As things stand many mothers of young children who are struggling to make ends meet are very concerned about dental hygiene and are not in a position to pay for what to them is very expensive dental work. Their husbands in many cases because of their stamps are entitled to claim for themselves in this. If it is proposed to include in this Bill representation for consumers, then I suggest that the sort of consumer we are talking about is the housewife. Absolute injustice is being perpetrated against the housewife and this has been the case for a considerable time. If we must argue that extension of the benefit would be too expensive, then let us find a solution. Perhaps either husband or wife could opt to avail of the scheme, both could opt for 50 per cent of the cost, or 50 per cent of the State cost in this area would go to the housewives and 50 per cent to the married men. It is unfair that the present situation should continue. I hope that the Minister would include housewives in order that voice would be given to the injustices which many housewives quite justifiably feel.

I would like to comment on dental technicians and their right to manufacture dentures without the involvement of a dentist. It seems that this would be quite justified. We seem to have a great propensity for involving doctors in the supplying of non-medical contraceptives and so on. Dentures have been made by dental technicians for many years and in most cases there is no reason whatsoever why the dentist need be involved. I agree with the report of the Restrictive Practices Commission. I tend to accept that there should be freedom in this area but I am prepared to accept the Government's decision on the second recommendation in the commission's report that it should be confined to denturists and to where living tissue is not involved. In such areas generally where there is no medical involvement there is no need to involve either a doctor or a dentist. I agree also with the second suggestion and I look forward to that being incorporated in the Bill.

I should like to express my concern at the lack of availability in the Eastern Health Board area of orthodontists to treat children. Many children have problems with the growth of teeth and need special treatment under the care of an orthodontist. However, there is a long waiting list for such treatment. As far as I am aware there is a vacancy for an orthodontist in the Eastern Health Board area. The dental structure of many children will be destroyed for the rest of their lives because they cannot get attention from an orthodontist. It is all very well for those who can afford to go privately to an orthodontist to have the teeth of their children beautified but many children of working class and middle class homes will not get such treatment because the parents of such children cannot afford that treatment. In fact, they cannot make ends meet. It is wrong that something that may affect the lives of those children later is not treated. It is possible that because they cannot get that treatment they will have dental problems for the rest of their lives.

I hope that in the proposed examination and regulation of the dental profession it is not forgotten that the whole purpose of this procedure is to ensure that dentistry is available for the people in a regulated way. We are fooling ourselves if we think that by setting up boards to set standards we will be dealing with the problem when there is no follow up and no standards are being observed in regard to the teeth of many children of lower income families.

In giving the board a role in the regulation of the profession of dentistry the Minister should ask them to look at regular intervals at the programme of fluoridation. There was a protracted debate on that topic almost 20 years ago but there has not been much discussion on it since. It would be a useful exercise for the new board to monitor fluoridation on a regular basis to ensure that the policy being pursued is the correct one. The fact that a decision was made 20 years ago after a long court case does not mean that we should accept that it was the right one for all time. We must ensure that those who are professionally competent to review the whole question of dental hygiene have as part of their terms of reference the ability to examine the entire area of dental health including the question of water fluoridation to ensure that the levels are correct and that the policy being pursued is correct. The board should be given that type of independence and authority. I welcome the Bill and I hope it will have a speedy passage through the House. I hope the Minister will be able to facilitate the many housewives on whose behalf I spoke some months ago. I am delighted that there will be consumer representation and I appeal to the Minister to ensure that the consumer is a housewife.

I welcome the introduction of this Bill and I agree that the changing trends in dentistry over recent years necessitates this type of legislation. The main thrust of the Bill is the setting up of a Dental Council to replace the Dental Board and to run parallel with the recently appointed Medical Council. It appears that it will be the duty of the Dental Council to regulate under and post-graduate education and to provide for recognition and registration of dental specialists and auxiliary dentists. The Bill is useful. The concept of control of a profession by the profession is good provided it is balanced by adequate community participation and that there is a process that facilitates citizens in making and getting due process in relation to serious complaints that may arise from time to time.

I note with satisfaction that the council will consist of 19 members as distinct from the nine members on the existing board. The increased role of the council in the education and training of dentists is welcome also. As a member of the Eastern Health Board I am aware of the huge demands being made on the dental service by young people. It is regrettable that the Minister has not seen fit to appoint a dentist who is employed by a health board to the council. The Eastern Health Board employ the largest number of dentists but because we do not have dental hygienists we are obliged to ask fully trained dentists to carry out duties that should be carried out by auxiliaries. That is a waste of time and expensive expertise. I suggest that a representation of two out of the 19 members of the council is hardly adequate to reflect the public interest especially when one considers the heavy public cost in education and the big number of dentists employed by the health boards. The Minister said that it will be his duty to nominate four members to the council and I appeal to him to include in that number a dentist to represent health board interests. The two to be appointed to represent the interests of the public should be elected representatives who at the end of the day must account for their actions to the electorate.

I agree that the primary function of the Dental Council is to regulate the profession and not deliver a dental service. That is understandable but it would be unreasonable to suggest that there will be a balanced representation if there is not some representation of the auxiliary dental workers. It could be argued that one person among 19 will not make much of an impact but it would be better than not having any representative at all on the council.

As we are all aware, before the 1928 Act dental technicians were permitted to supply dentures direct to the public. That Act unjustly took that right from them. When this, and other facts, were presented to the Restrictive Practices Commission inquiry in 1982 the commission recommended that non-dentists should be permitted to provide dentures to persons over 18 years so long as this work did not involve work on living tissue. It is important that we take note of that recommendation. It should also be noted that a dental technician must spend four years in full time training while a dental student spends only 13 per cent of his training time learning the same skills. That begs the question: who is better equipped to provide dentures, a dentist or a dental technician?

The commission also considered the law in relation to dental technicians who have obtained a recognised technical qualification at advanced level and who have undergone a period of clinical training. The commission considered the possibility of such people being considered competent to provide dentures direct to the public. The subject of denturism has been well debated and there are very few who have any doubt about the advisability of making allowances for this indentifiable category of people who have been providing a very valuable service.

The commission suggested that if denturism were to be introduced to Ireland it should be under the regulations which the Minister for Health may make from time to time adding that such a flexible formula leaves open the possibility of a separate form of qualification being designed for existing illegal practitioners. When introducing the Dentists Bill in 1984 the Minister for Health indicated that he would adopt the recommendations of the Restrictive Practices Commission. I believe the Minister will do us all a service if he adheres to that commitment. This Bill says the Minister will allow at a later date future incumbents of the office of the Minister for Health, to make provision for such a category. That is not good enough.

The commission suggested that regulations in regard to dentists should be made by the Minister for Health, but in this Bill the Minister has left these regulations to the Dental Council, the membership of which is comprised largely of dentists. One does not have to stretch one's imagination too far to see that they will not be too anxious to do away with a lucrative business. I had a very interesting experience in this area earlier this year. I took an 83 year old man who had broken his dentures to the representative of the Eastern Health Board and was told it would take ten days to make the dentures at a cost of £240. Because this man could not wait so long I took him to a dental technician. He provided the service within two days at a cost of £40. Since the Minister is so anxious to make economies it behoves him to take a long hard look at what is happening in this area. If we could save £200 on a set of dentures by going to a dental technician, it would not be reasonable to believe that the Dental Council will be anxious to let the dental auxiliaries become involved in this area.

In Dublin city we have been very fortunate in the service provided by the dentists and technicians. It would be a retrograde step if the Minister introduced this Bill but neglected the wellbeing of the people who provide this auxiliary service by putting their livelihood in jeopardy. I am sure that is not the Minister's intention but I ask him to reconsider this matter, to put one of these people on the board and give those providing this auxiliary service a proper standing under this Bill.

This Bill proposes to establish a fitness to practise committee but it does not give a member of the public who may have a complaint the right to be heard by the committee or the council. The evidence to the council from the committee can only be presented by persons with the imprimatur of the fitness to practise committee and only when a decision to hold an inquiry is made has the citizen the right to be heard. That is not good enough. Here we have a council made up entirely of dentists, and not unnaturally they will have a bias to protect their own. A person with a just complaint but without the resources to employ counsel will be left at the mercy of the fitness to practise committee as to whether they will be heard. That is a serious matter and I ask the Minister to look at it. To date the Medical Council have not fulfilled the role in relation to the medical profession which was suggested in the legislation passed here. To my knowledge that legislation has not made it any easier for the public to have their complaints heard. They are still handicapped by the rigid constraints of the profession. We do not want that to happen again in the Dentists Bill.

A great deal of what I wanted to say has already been said and I will not repeat it. I ask the Minister to consider the appointment of dental auxiliaries, the recognition of denturists involved in the profession and to look at the protection the public need. He should also consider appointing public representatives to this board. In recent times the Minister appointed two people to represent the public on hospital and other boards, and I ask him in this instance to consider appointing a person who has a mandate from the people to represent them. I have no doubt that the Minister will take note of all that is said by every speaker and I look forward to the Committee Stage.

Unfortunately, I have not been able to hear all the speeches which have been made so far, except for Deputy Taylor, Deputy Ormonde and the latter part of Deputy Glenn's speech. They referred to some of the points I wanted to make dealing with dental technicians and dental surgery assistants which this Bill does not adequately cater for.

On the face of it the Bill does not seem to do what the Minister claims, that is, updating the 1928 Act and being very progressive. The definitions section says that:

"practice of dentistry" means the performance of any operation and the giving of any treatment, advice, opinion or attendance which is usually performed or given by a dentist and includes the performance of any operation or the giving of any treatment, advice or attendance on or to any person preparatory to, for the purpose of or in connection with, the fitting, insertion, or fixing of artificial teeth.

That is how the practice of dentistry is described in the Bill. It goes on to establish a council of dentists whose members will be appointed by the Minister and all except two can be dentists. Two people are to be consumers and this could include dentists as they get treatment for their teeth also, but let us assume that they are two lay people. The ministerial appointments could be a dentist, as on the last council, and people from the training area could be professors, etc., in dentistry colleges and they probably will be. There will be seven elected dentists so there could be 17 dentists on this council and two lay people.

They are making all the decisions and will have power under the Bill in regard to the practice of dentistry which is explained as I outlined it. Everything is covered, even the question of advice. Dental hygienists and anything regarding the fixing, fitting and insertion of artificial teeth is covered in the practice of dentistry. Anybody who does not conform to the council's rules and regulations can be fined £1,000 or imprisoned for 12 months. This is an extraordinary insertion in the Bill for those who practise dentistry in the broader sense but who are not dentists.

It is estimated that there are about 200 dental technicians who are very experienced and provide artificial teeth just as opticians supply glasses. One does not have to go to a medical doctor to get glasses and the examination of eyes is far more important than supplying artificial teeth. The Medical Council do not attempt to control every area of medicine, including opticians, but the dentists are given overall control. Radiographers, midwives, physiotherapists and opticians are not covered by the Medical Council. In the field of dentistry there are dental technicians, dental nurses, surgery assistants, etc., but they do not have these titles in this country. In many cases they are simply described as clerks or receptionists but they are graded in other countries. There are dental surgery assistants, dental health education nurses, dental hygienists and therapists, etc., but the dentists here simply employ a receptionist straight from school to do little bits and pieces and eventually she is doing many of the things which in Britain would be done by a dental surgery assistant with a particular grade and salary. They are exposed to mercury and X-rays. They are not educated in regard to these matters and have no idea of the dangers or toxicity of the materials. They are totally untrained but they are still called receptionists or clerks and paid a pittance.

Does the Minister really think that a dental board consisting entirely of dentists or totally controlled by dentists will alter the conditions of employment for their receptionists or clerks? They will not give them a title although the Minister gives them power to do so under section 8 of the Bill. The dentists have fought for 50 years to control practices in their profession. Prior to the 1928 Act dental technicians were allowed to operate and the dentists lobbied for the 1928 Act to make that practice illegal. This Bill ensures that only dentists can decide who will do what and they must be employed by them. They will make all the decisions in regard to dental practice.

Does the Minister think that this is a progressive Bill which radically changes the 1928 Act? The dental council should deal with professionally trained dentists. I do not have to describe what a dentist is but in the Bill it could mean only dentists and not dental auxiliary workers. That description is the first thing the Minister should alter. He should set up a dental council for dentists. The other area can be controlled by the Minister in the same way as areas of medicine are controlled or decontrolled as the Restrictive Practices Commission recommended. They gave two alternatives, one was that there should be no restriction on the supply of dentures direct to persons of 18 years of age and over provided it did not involve work done on living tissue. The second alternative was that the 1928 Dentists Act should be amended to provide that the general prohibition on the carrying on of dentistry by a non-dentist should not apply to the provision of dentures by a denturist to a person of 18 years of age or over provided that it did not involve work done on living tissue. The commission came down in favour of the first recommendation.

The Minister said that the Bill has been drafted in such a way as to permit the implementation of the principle of the second alternative of the Restrictive Practices Commission. In other words the new Dental Council can do this if they so wish. After 50 years of restrictive practices in the dental trade, which is the most notorious in the country, does anybody think that they will alter the situation? The Minister will have to have the guts to alter it himself and prevent dentists from having control of dental assistants. That is the major point I want to make on the Bill and many speakers have mentioned particular cases but there are others, such as dental nurses in the Eastern Health Board who, when they work for dentists, are only clerks.

If the Minister wants to alter the 1928 Act now is the time for him to do so. Now is the time to remove the monopoly from dentists in the whole area of trade and in matters relating to dental practice. On Committee Stage I shall ask the Minister to take certain action. The major item will be alteration of his description of the practice of dentistry as relating to the Dental Council where they will deal only with qualified dentists. Alterations will have to be made in sections 49, 50 and 51. These deal with the practice of dentistry and provide for a fine of £1,000 or 12 months imprisonment.

I welcome this Bill. It is one we have been waiting for for a long time and I should like to pay tribute to those responsible for introducing it to this House. The Minister deserves praise for this reforming Bill. In the Seanad he was not adverse to accepting worthwhile amendments and the Bill before this House has been fined down considerably. I should like to praise in particular Deputy O'Brien for his work following the report of the joint commission that had been set up by Deputy Haughey.

The Bill before us will deal with the situation existing in the late eighties. The establishment of the new and broader Dental Council is a step forward even though it does not meet all the criteria of Deputies. Deputy Glenn wanted public representatives to be on the board. The Minister might look again at the whole question of membership and the numbers.

The dental profession must have an element of control on a council that will be responsible for the behaviour of dentists in their practice but also for the preparation and education of dentists. Sufficient attention has not been given to the matter of oral hygiene. Speakers in this debate have referred to the lack of dentists when one considers the large numbers of people who require their services. Some Members have said there are just enough dentists to look after two-thirds of the children who require dental care. In that regard the use of resources must be questioned. Since 1977 approximately £2,000 million has been given to the health boards. They have recruited many staff and in some sections they are over-manned. The health boards should ensure that children are cared for adequately.

The Minister has set up a Dental Council that will direct the education of those who want to become dentists. Account should also be taken of those people who run health boards. In some areas the health boards have not been able to give adequate cover in respect of dental services. In addition to the 500,000 children requiring dental care, some 600,000 adults are eligible and there are also the elderly and the old. The service given to this section in respect of oral hygiene is very limited and the lack of this service can have a severe effect on the personality of the individual concerned.

Other speakers have referred to the matter of orthodontics. Children whose teeth need attention in this regard must be looked after at an early age. Parents are often reluctant to continue sending their children to different clinics if they consider that the officer in charge is not prepared to do the necessary extensive work. However, the younger dentists are more adventurous. I urge the new council to have regard to the most up-to-date practices in orthodontics and in dental care generally. In the Mid-Western Health Board area the number of young dentists setting up practice is an indication of the confidence they have in the economy of the area. I hear nothing but praise for these people and as a profession they can hold their heads high. Deputies receive many complaints about malpractices in other professions but I have not heard any such complaint about dentists.

However, there is a conflict between what has been known up to now as dental mechanics and the practice of dentistry exclusively by dentists. The dental mechanic was hired by the dentist. In this Bill the Minister makes reference to auxiliary dental workers. He is recognising the skills of these people and that is a progressive move. Some other speakers said that the Minister has not gone far enough but in matters dealing with health I wonder if the Minister would have been responsible if he had given wide powers to auxiliary dental workers? I do not think the general public would accept it. They would expect that the highest standards would prevail. Dental mechanics are excluded from the provisions of this Bill. These people are already in practice and they have been giving a service for many years. I ask the Minister to consider their position following the passage of this Bill. In my county there are three auxiliary dental officers. They have been practising for some time and have worked in association with groups of dentists. They have done their work well. Under the new Bill they have the chance to work for the dentists but there is also the possibility that they might want to establish on their own. I wonder whether they are being restricted under this Bill in so doing.

I congratulate the Minister on this Bill. When he decided to bring it forward he recognised the work that had been done by the commission and by the former Minister of State at the Department of Health, Deputy Fergus O'Brien. I support the Bill.

I thank all the Members who have contributed to the debate on the Dentists Bill. The Bill was initiated in Seanad Éireann and it received a fairly thorough going over in that House before it came into the Dáil. Many amendments to the Bill were tabled in the Seanad and quite a number of them are now incorporated in the Bill. As a result the Bill as it now stands is largely non-controversial and this is reflected in the tone of the debate which it has generated in this House. There have been no demands to have the Bill altered drastically but some questions have been asked and clarification has been sought on a number of points. I will try to deal with those points to the satisfaction of Deputies.

Deputy O'Hanlon asked why the Bill does not specify a particular time period within which the Dental Council must be established following the passing of the Bill. As he himself pointed out, the provisions for establishment of the Dental Council contained in the Bill follow the normal practice — the Medical Practitioners Act, 1978, and the new Nurses Bill have similar provisions in relation to the establishment of the regulatory bodies set up under them. As the Deputy pointed out, there are many factors which could result in a specific target date for the establishment of the Dental Council not being achieved. However, it just happens that without its being written into the Bill there is a target date to be met for the establishment of the new Dental Council. Deputy O'Hanlon will be aware that the Dental Board had its term of office extended by two years in order to maintain continuity of office between the Dental Board and Dental Council. One of those years has already gone by so that it is not necessary to set a date for the new Dental Council to come into existence because the two year extension expires in 1985.

On the question of representation for auxiliary dental workers on the new Dental Council, the Minister has already indicated that there is nothing to prevent him from including a representative of auxiliary dental workers among his four nominees to the new council. There have been a number of suggestions from Deputies as to whom should or should not be included. The Minister would need more than four nominees to satisfy all the Deputies who have spoken. Deputy Ormonde spoke about this problem. Deputy G. Mitchell said that housewives should be represented because of the problems they encounter in not being covered for dental services. Deputy Alice Glenn indicated that there should be a public representative on the council.

Deputy O'Hanlon queried the power of the Minister to alter by regulations the composition of the Dental Council. He said he did not see why the Minister should have the power to alter something which the Houses of the Oireachtas, following full consideration, had agreed to. It is important that there should be provision in the Bill for altering the composition of the council because circumstances can change quite rapidly, particularly in this day and age. What may appear to be perfectly reasonable in 1984 could within a very short time become totally inappropriate to meet the conditions then prevailing. On the question of the Minister's powers to vary the composition of the Dental Council, there are adequate safeguards in the Bill. Under section 9(3) it will be noted that regulations made by the Minister to vary the composition of the council must be laid before each House of the Oireachtas and resolutions approving them must be passed by each House.

On the question of the function in dental education of the Postgraduate Medical and Dental Board when the new Dental Council assumes responsibility for the postgraduate education of dentists, this is something that was raised and dealt with in some depth in Seanad Éireann when the Bill was at Report Stage in that House. Basically the Dental Council will have responsibility for setting standards for postgraduate education in dentistry while the Postgraduate Medical and Dental Board will promote and co-ordinate the putting into effect of those standards. As well as education towards the attaining of higher qualifications, postgraduate education also embraces the continuing education of dentists so that they may maintain their competence. This is an area also in which the Postgraduate Board will continue to have their separate function.

On the question of reciprocal arrangements between this country and countries abroad for the recognition of dental qualifications and their acceptance for registration purposes, there is provision for such reciprocation under the 1928 Dentists Act. However, no formal reciprocal arrangements were in fact ever entered into. Deputy O'Hanlon mentioned Australia specifically. Australian dentists have always had access to the British Dental Register by virtue of Australia's Commonwealth status and, consequently, under the 1928 Act they would have had access to registration here. On the other hand Irish dentists, though not having a similar entitlement to registration in Australia, generally have no problem in getting on the register there. However, the different states that make up Australia each have their own registers and conditions can vary between one state and another.

Deputy O'Hanlon queried the need for section 25 (f) which permits the council to charge a fee for the issue of a certificate of registration to a dentist. I am not entirely sure what the Deputy is querying here — the necessity for issuing such a certificate at all or whether a fee should be charged for its issue. Section 26 (3) sets out that a certificate of registration be issued to each registered dentist. Section 26 (4) lays down that the certificate must be displayed by the dentist at the place where he practices dentistry. This is considered to be a necessary provision and it would obviously have no meaning if the issue of a certificate was not mandatory in the first place.

It was the fee I queried.

On the question of fees charged by the council — and this is something which Deputy Keating raised also — it should be noted that the Dental Council, like all regulatory bodies of this sort, is intended to be self-funding. Its main source of income will be fees charged to dentists for registration services. The Minister has indicated that if after a period of, say, two or three years operation it became clear that the council had funding difficulties, then the question of some grant-in-aid money for the council could be considered. However, as things stand, no allowance has been made for the provision of Exchequer funds for this purpose. The Minister for Finance would of course have to be consulted in such an event.

On the question of notification of the erasure of a dentist's name from the register to the dentist's employer, if he is an employee, as well as to the Minister, this is unnecessary and would not be altogether practicable in many instances. The Dental Council will not have up-to-the-minute information on the employment of all the dentists on the register and dentists do tend to move about quite a bit, particularly in the earlier part of their careers. In any event the erasure of a dentist's name from the register in a country such as ours would scarcely go unnoticed by those connected with the profession.

Deputy O'Hanlon asked if it would be possible under the new legislation to establish a class of dental auxiliary workers who could extract teeth. The short answer to that question is yes. The Dental Council, with the consent of the Minister, may establish classes of auxiliary dental workers who may undertake such class of dental work as shall be specified by the council. The council shall determine the type of dental work these auxiliaries may undertake and the conditions in which it may be undertaken.

Deputy O'Hanlon was wondering if the Bill as drafted will permit the fitting of dentures by non-dentists since it involves work on gums which he regards as living tissue and would therefore be excluded under section 54 (3). This is a matter which has been gone into in some depth and the Minister is satisfied, following legal advice on the matter, that the fitting of false teeth does not actually involve working on the gums, which are of course living tissue.

Deputies O'Hanlon, N. Treacy and others touched on the dental services themselves and spoke about the manpower problem which we have in the public dental service, particularly in their own constituencies. The problem in Deputy O'Hanlon's area is that dentists cannot be enticed into taking up full-time posts with the health board. Perhaps the recently announced pay award for dentists in the health board service will help to solve that problem in Deputy O'Hanlon's constituency as well as in other areas where a similar problem exists.

The problem in Dublin is somewhat different. No doubt additional dentists could be recruited into the health board service if the number of dentist posts could be increased. However, the embargo on the creation of additional posts in the public service prevents any increase in dental manpower at present. The situation in Lucan, which Deputy O'Hanlon referred to specifically, and about which Deputy Durkan spoke to me, should show an improvement now that the health board have increased the number of clinic days in the local dental surgery from two per week to three per week.

I agree with Deputies that preventive care offers the best prospects in the long term. The value of the fluoridation of our water supplies is already pretty well established but it is expected to be proven beyond doubt when results of the national survey of children's dental health carried out earlier this year are available.

Deputy Keating expressed his concern on the question of regulation of professions generally and, in relation to this particular Bill, at the number of instances in which functions of the Dental Council will be subject to the approval of the Minister. He said that the tendency in some countries is towards de-regulation of professions. I am aware of developments in some other countries to make some of the regulations governing certain professions less restrictive — for instance the restrictions on advertising have been relaxed in some instances. However, I am not aware of any instances of the total de-regulation of a profession and certainly not dentistry. I think the Deputy will find upon looking into the specific provisions of the Bill that in all instances when the approval of the Minister is required there is a reason for it. It may be for the protection of the public, members of the dental profession or perhaps auxiliary dental workers. In fact there was one amendment carried on Report Stage in Seanad Éireann, following representations to the Minister from the Dental Board, which deleted the requirement for the Dental Council to have the approval of the Minister in the matter of how they would dispose of any surplus funds they might have.

I am aware that in certain areas, particularly in relation to the disciplinary powers of the council, the wording of the Bill appears cumbersome, and is repetitive in relation to different types of offences. However, I can assure Deputy Keating that the format is absolutely necessary if the powers of the council, in relation to discipline are not to be successfully challenged on constitutional grounds. It is necessary that the provisions should stand up in law if the Bill is to provide adequate protection for the general public and for members of the profession. The Bill provides in so far as possible for the profession of dentistry being self-regulatory but State involvement of necessity arises in certain areas.

Deputy Keating said that some professional associations have a reputation for protecting their members rather than giving any degree of satisfaction to members of the public who make complaints against them. In the case of the dental profession I would imagine — though I am not aware of any such incidents personally — that there must have been occasions where members of the public felt that their complaints to the Dental Board about individual dentists did not result in any positive response. What the general public in all probability did not know was that under the 1928 Act the only disciplinary power open to the Dental Board was erasure of a dentist's name from the register. Obviously the great majority of complaints, even if upheld, would not warrant this drastic measure and what happened, therefore, was that no action could be taken by the board and the complainant had to be informed accordingly.

This new Bill will rectify the situation by providing also for a number of lesser penalties than erasure from the register. The new Dental Council with their additional disciplinary powers will be in a position to demonstrate to the public that they are as willing to protect their interests as they are those of the members of the profession and I have no doubt that they will not hesitate to do so.

On the question of enforcement of the provisions of the Bill, Deputy Keating said that this could be difficult. I am afraid I do not share his pessimism. The enforcing authority in nearly all instances, backed up by the necessary legislative provisions, will be the Dental Council. The Dental Board were quite successful in enforcing the provisions of the 1928 Act and in those areas where enforcement might have appeared to be lax this was due to the inadequacy of the legislation rather than any reluctance on the part of the board to carry out their statutory functions. I have no doubt that the Dental Council will be quite effective in enforcing the provisions of this legislation.

Though there is specific provision for only two representatives of consumer interests on the Dental Council the Minister will have four nominees and there would be nothing to prevent him increasing the consumer representation if he thought fit.

I dealt with this a little earlier and referred to the various expressions of opinion by Deputies in regard to who should and who should not be members of the council. Deputy Glenn was in favour of having public representatives on the council because of their public accountability. I am sure that when the Minister will be making appointments he will take all these expressions into consideration.

Deputy Keating said it might be desirable to have some form of rolling membership of the council rather than have a complete change of membership every five years. While on the face of it this would appear to be the case, what is likely to happen is that on every new council there will be a number of members of the outgoing council. This is possible by virtue of the fact that members may serve for two periods of office.

Deputy Keating mentioned the desirability of communication between the council and the public by way of regular reports. In fact, there was an amendment to the Bill in Seanad Éireann as a result of which the council will be obliged to publish an annual report.

Deputy Taylor and others thought it was necessary to clarify the situation in relation to the position of dental mechanics. Deputy Keating mentioned a figure of some 250 dental mechanics whose livelihoods may be put in jeopardy due to the powers of the new Dental Council. This is not the case. The great majority of dental mechanics have nothing to fear. It is only the small number who are operating illegally at present in supplying dentures direct to the public who fear the increased penalties contained in the Bill for the illegal practice of dentistry.

The penalties in existence at present have not been updated over the years and are totally inadequate. Incidentally, these penalties are not aimed specifically at any particular group. It is perfectly understandable that there should be penalties for the illegal practice of dentistry. The fitting and insertion of artifical teeth is within the definition of the practice of dentistry. There is provision in the Bill for the establishment of a class of auxiliary dental workers who will be fully qualified and competent to supply dentures direct to persons of 18 years of age and over provided it does not involve work on living tissue.

It is true that the Restrictive Practices Commission came up with a recommendation that the supply of dentures to persons of 18 years of age and over should be subject to no restrictions whatsoever. Dental mechanics would have had no more right to supply dentures under this recommendation than any other members of the public. The fact of the matter is that the Government decided that to create a free-for-all situation in relation to the supply of dentures would not be in the interests of the general public. Instead they opted for the implementation of the alternative option put forward by the Restrictive Practices Commission which was for the introduction of trained denturists. This is provided for in the Bill.

The Dental Council will determine the training and qualifications for entry to this new class of auxiliary workers. The council could, perhaps, make some concessions to those who are practising illegally at present and have been doing so for a number of years, but it is extremely unlikely that all those who are working as dental mechanics at present will be given automatic entry to the new class. The council will have to satisfy itself as to the competency of all persons who are permitted to supply dentures direct to the public.

A number of other matters were raised. Deputy Mac Giolla was of the opinion that the Bill did not mean very much and that the new council will have no teeth by virtue of the fact that it will be totally controlled by dentists. That is not so. Section 55 states:

The Minister may, by order, in any case where he considers the establishment of a particular class of auxiliary dental worker to be desirable, direct the Council to exercise the powers vested in it under section 53 of this Act to make a scheme for the establishment of such a class and, in any case where the Minister considers it desirable, he may, by order, direct the Council to make a scheme for the establishment of a particular class for a limited period in order that the value to the public of the existence of that class may be judged and the Council shall comply with any such direction.

Section 15 states:

If the Council fails, neglects or refuses to perform any function assigned to it under this Act, the Minister may, by order, direct the Council to discharge that function and for that purpose to do such other matters or things ancillary or incidental thereto as may be specified in the order.

In actual fact the Minister can discharge the council. Deputies suggested that it was necessary to establish some class of dental hygienists. It is most likely that this will be done by the council.

Deputy Taylor referred to the poor ratio of dentists to the population. Various figures for other countries were quoted. I should like to clarify one matter. There is no international recognised ratio of dentists to the population. The ratio of dentists to the population in an area would depend on the health status of the population which would, in turn, depend on a number of factors such as whether the water supply was flouridated, the type of diet followed and the level of oral hygiene practised by the people in the area.

I want to thank Deputies for their contributions. If they are not totally satisfied with my reply or with the Bill they will have an opportunity on Committee Stage to put down amendments.

Question put and agreed to.
Committee Stage ordered for Wednesday, 5 December 1984.