Tá áthas orm bheith páirteach anocht sa díospóireacht tábhachtach seo faoi sheirbhísí fiaclóireachta ár dtíre. I am very pleased to come in here tonight to participate in this important debate. I have listened with great interest to the Opposition speakers last night and again tonight. Listening to them you would think there was no dental service at all as they have painted a very black picture indeed. We are well aware that there are problems. Indeed why else would the Minister have established the working group to review the delivery of dental services last year. There are nevertheless many positive aspects to the health board dental services at present.
There are about a third of a million attendances by children at the health board dental clinics every year. Until recently the different health boards had different methods for selecting children for treatment. Some boards used a school-based system, where they visited the schools on a rotational basis and screened all the children before setting up a course of treatment for those who had caries or other problems. Other health boards target specific classes and screen all the children in those classes.
One health board has relied on selfreferral by patients. This last approach has been less than satisfactory, because it is widely believed that some children never visit the dentist because the parents may not put dental treatment high on the priority list for whatever reason — lack of knowledge of its importance, bad family circumstances or otherwise. It was in the light of this problem that the working group recommended a standardised approach, based on the targeting of specific classes. The working group recommended that first and sixth classes should be the target classes but on reflection it became obvious that in most instances second class would be more appropriate because at that age the first molars would have grown. As a result of this recommendation, the health boards have now adopted this approach to the delivery of dental services for children. The Eastern Health Board which had the self-referral method is piloting the new approach in three community care areas.
In this health board area it will of course be necessary to re-educate the parents to come to accept that this new approach is more advantageous to the population at large and that their children will be examined and treated at the appropriate times rather than on demand.
Some health boards have already introduced fissure sealant programmes. The application of fissure sealants to the molars reduces the incidence of dental decay in those teeth and as these are the teeth most prone to decay the application of the sealants can help to keep the mouth decay free. We are hopeful that more health boards will introduce fissure sealant programmes to the routine treatment programme of the second class children.
In targeting the sixth class group, the health board dental service can ensure that each child is made dentally fit before he leaves the care of the public dental service.
I cannot talk about children's dental services without referring to the tremendous improvement in the dental health of our children which was noted in the national survey of children's dental health. The survey found that there was a significant decrease in the incidence of dental caries in all our children. However, that decrease was most significant in the children who had been lifetime residents of fluoridated areas.
That brings me to another great success story of the health board dental service — the water fluoridation programme which celebrates its silver anniversary this year — 25 years which have seen this country as a European pioneer of the addition of fluorides to the public piped water supplies.
This major contribution to oral health was not introduced without a considerable amount of opposition, which some Deputies may remember. But it is clear that those who were far-sighted enough and determined enough to push ahead with its introduction have been fully vindicated.
To listen to the Opposition here last night, you would get the impression that the water fluoridation programme was a shambles. Nothing could be further from the truth. About 65 per cent of the population are served by water supplies which are fluoridated. I must emphasise that it is not possible to fluoridate every water supply and, as I speak, every water supply which is suitable for fluoridation has had a fluoridation plant installed. Some supplies are too small. We consider it viable to fluoridate supplies which serve a population of over 1,000 persons. Some supplies have a number of water sources, which make the installation of fluoridation plant impossible. However as every small supply or group of water supplies is replaced by a new regional water scheme, the water fluoridation plant is installed, bringing the benefits of fluoridation to an increasing number of people.
As the Minister pointed out yesterday, we have made an additional £200,000 available this year to the health boards for projects in connection with the water fluoridation programme. The health boards were asked for their own proposals in this regard. In some cases they wanted to fund new schemes, in other cases they found it necessary to purchase stand-by plant — new pumps to serve in the event of pump failure. At this moment the health boards are engaged in the purchase and installation of this new equipment. In drawing up their plans for the present year, they were also asked for their needs for the coming few years and thus we have been able to draw together the material to enable us to put together a strategic plan for the further development of the water fluoridation programme in the future.
In talking about the water fluoridation programme, I feel compelled to refer to the improvements in the results returned by the health boards in recent years. In 1988, over 80 per cent of tests taken showed fluoride levels of at least 0.7 parts per million. Four years previously only 67 per cent of tests reached this broadly acceptable fluoride level.
In many areas where the water supplies are unsuitable for fluoridation for the reasons I have already instanced, the health boards have introduced and maintain fluoride mouth-rinsing programmes. These target in on school children and are usually administered in the classroom setting. When the new grade of dental hygienist is introduced to the health board dental service there will be scope for a further extension of the mouth-rinsing programmes, which must be administered under close supervision.
Much has been said here about the orthondontic service. The Opposition have put forward a figure of 24,000 awaiting treatment. The most recent figure is that there are 12,250 children awaiting orthodontic treatment. Of course, the fact that such a number of children are still on the waiting lists is far from satisfactory. Many of these children are awaiting the most expensive fixed appliance therapy. Again there is an on-going orthodontic programme in all health boards.
All dentists can fit the basic removable orthodontic appliances, which can be used to treat the more basic orthodontic conditions.
It is when we come to the more complicated treatments using the fixed appliance that the services of a consultant orthodontist are required to advise on, oversee and on some occasions actually carry out the treatment. The House is well aware of the difficulties which have been experienced in attracting consultant orthodontists to the health board dental service. The high rewards available in private practice are well known. Because of these problems we have decided to reexamine the conditions attached to the post before we re-advertise them.
You will also be aware that the one consultant orthodontist in the health board service is involved in the provision of a training programme for a number of health board dentists who will reach specialist level. There are two trainee consultant orthodontists in the Dublin dental school and it is known that there are eight Irish trainees in higher training pathways in orthodontics in the United Kingdom at present. It is understood that many of these are interested in returning to Ireland in the future. Thus the long-term availability of highly qualified orthodontists looks very promising. Rather than the gloomy picture painted by the Opposition spokespersons, I want to emphasise that the problems are recognised, the solutions — the long-term solutions — have been determined and we are now taking decisive action.
The Minister has already told the House that the Government have made £300,000 available to the health boards to enable the treatment of 500 top priority cases to begin immediately. These cases will supplement the cases already underway in the health boards. Indeed it may well be that the Opposition are unaware that about 5,000 children conclude courses of orthodontic treatment provided by the health boards each year. A full course of treatment can take as much as two years and thus there are many thousands of children under treatment at any one time. This fact, too, I want to emphasise.
The Minister and I are, of course, confident that, in the future, as recruitment problems are solved there will be a great improvement in the level of the orthodontic service, which the health boards can provide. In the meantime, we are confident that the health boards will continue to use the guidelines, issued by the Department of Health to ensure that priority in the provision of treatment is granted to those children, who have the most serious handicapping conditions.
We are aware that there have in recent times been some problems in relation to the highly sophisticated orthodontic treatment required by children who have been born with a cleft lip and palate and we are actively reviewing this service at present.
The dental hospitals also make a major contribution to the health board dental services. The two hospitals, in Dublin and Cork, provide routine treatment for adults and children as part of the training programme for undergraduate dentists. Specialist services are provided for particularly difficult cases. Each year about 28,000 patient visits are made to Cork Dental Hospital and about 75,000 patient visits are made to the Dublin Dental Hospital.
Therefore, in excess of 100,000 people are treated at these two dental hospitals each year in the public sector. At this point I wish to pay special tribute to the directors and staff of these two dental hospitals. I saw at first hand recently the tremendous work being done in the Dublin Dental Hospital, in the public sector, with regard to education, research and science and AIDS patients. We can be proud of the tremendous cadre of professional staff who work in these two hospitals.
In addition, the senior lecturer consultants in Dublin are involved in the training of health board dentists in orthodontics. Special arrangements are also provided for the treatment of AIDS patients, haemophiliacs, and other special categories. The Cork Dental Hospital provides a special clinic for the treatment of the handicapped who require special conditions for their dental treatment.
Following the enactment of the Dentists Act, 1985, the dental council was introduced to replace the dental board. The council has more far-reaching powers than the old board. It also has a wider membership. The council regulates the dental profession. It also has powers to create classes of dental auxiliary and to specify the training required by persons seeking registration.
The council began its deliberations on the creation of grades of auxiliary dental workers by looking at the grade of dental hygienist. A hygienist can carry out a number of procedures such as the scaling and polishing of teeth, the provision of education in dental hygiene, the application of fissure sealants, the administration of fluoride mouth rinsing programmes and other services. In some countries the hygienist can also administer fillings.
It will be a matter for the dental council under the Act to specify the tasks which is considers appropriate for the dental hygienists to fulfil in Ireland. The Opposition last night asserted that the newly registered dental hygienists would be confined to the private dental sector. This is not our policy.