I thank the committee for its invitation to appear before it. First, I will introduce my colleagues. June Nunn is professor of special care dentistry and head of our department of public and child dental health which has responsibility for orthodontics. Dr. Paul Dowling is a senior lecturer and consultant in orthodontics. As Professor Nunn is involved in organising the healthy smiles programme for the Special Olympics, she will have to leave early. Dr. Dowling has interrupted his teaching of specialist orthodontics this morning to attend the meeting and will also have to leave before 11 a.m.
In relation to accreditation systems, it is important to state the accreditation system for the training of orthodontists is the responsibility of the Dental Council. Without accreditation we would be unable to attract applicants to our specialist courses. When we met the committee in December 2001, we set out the range of programmes we provide at undergraduate and postgraduate level, each of which requires accreditation. I have provided the committee with a table featuring the courses, their duration, number of students, qualifications and accreditation bodies. In addition, courses which carry with them a degree from the University of Dublin or Trinity College have in each year external examiners to assure their equality, equity and accountability.
Orthodontic accreditation is the responsibility of the Dental Council as the regulatory body with responsibility for the registration of specialists in orthodontics. The council appointed the Irish committee for specialist training in dentistry as the body in the State it recognises for the purposes of granting evidence of satisfactory completion of specialist training in accordance with EU directives and the guidelines of the EU advisory committee on the training of dental practitioners. The submission to this committee by the council last November set out the statutory position. I understand 71 people are currently registered on the specialist orthodontic register.
The process of accreditation as it impacts on the Dublin Dental School and Hospital is that the Irish committee for specialist training in dentistry must approve the training programme we deliver. The committee was appointed by the Dental Council in 1999 and carried out a review of our programme in May 2002. This was wide ranging and assessed not only the academic content of the programme but also our facilities, the level of clinical supervision, supports etc. It is a process with which we are familiar as it mirrors the arrangements in the United Kingdom for postgraduate training, on which we relied from 1989 when we first started training orthodontic specialists until the recent establishment of the Irish specialist register.
Most of our specialist and consultant training programmes are recognised by the specialist advisory committees of the United Kingdom. This is an important element in ensuring we attract good quality applicants and our courses are regarded as comparable with those in other countries. The Irish committee for specialist training in dentistry approved our training programme in 2002 and will revisit the hospital in 2004. Its approval permits us to train 12 specialists and up to two consultant trainees in orthodontics. We advertised a consultant training programme last year but failed to attract any suitable applicants. This reflects the difficulty in attracting people into orthodontic consultant training on these islands which will undoubtedly present difficulties for training at all levels.
When we last met the committee in December 2001, we had ten postgraduates in specialist training, four of whom graduated in July 2002, while the other six are due to graduate in July next year. With the approval of the Irish committee for specialist training in dentistry, we took on a further six postgraduate trainees in October 2002 who would be expected to graduate in July 2005. We have, therefore, 12 postgraduates in training. We are not planning an intake of trainees in 2003. The next intake is planned for 2004, subject to the approval of the Irish committee for specialist training in dentistry.
Given current constraints on supervision, space and support staff, we expect to graduate 28 people as specialists in orthodontics between now and 2010. We indicated when we last met the committee that we could increase the numbers in training to 18 at any one time with a further consultant appointment, additional facilitates and greater nursing, radiographic and administrative support. We have had discussions with the Department of Health and Children in this regard.
The Dental School and Hospital has only two consultant orthodontists, Dr. Paul Dowling and Dr. Therese Garvey. I publicly pay tribute to their hard work, commitment and dedication to public service. The committee will appreciate that specialist training in orthodontics is just one part of their consultant role. They also have teaching responsibilities for dental students, dental hygienists and dental nurses and a treatment load involving complex, multidisciplinary patient care. In addition, they must continue with their research interests.
Recently, the press has featured a considerable amount of comment about consultant contracts. It is important to draw to the committee's attention the difference between the dental academic consultant contract and the medical consultant contract. Our consultants work exclusively in the public service and are not permitted to accept VHI or private fee income. They may, however, opt to reduce their commitment to public service - 39 hours per week - to undertake a maximum of just three hours work in the private sector, for which their salaries must be reduced. Our staff are, therefore, fully committed to the hospital and delivery of service to the public. At present, students at undergraduate level in their fourth and fifth clinical years treat orthodontic patients on a weekly basis. This is a more extensive clinical training in orthodontics than is found in most dental schools and is in accordance with the Dental Council guidelines.
The Dental School and Hospital understand the concerns of the committee in respect of orthodontics and welcomes the report from the committee. We are conscious of the public demand for more extensive services and we are endeavouring to facilitate that demand through our training programmes in orthodontics. We are training more orthodontic specialists than most European dental schools and we are doing so with fewer orthodontic consultants than other schools.
It is, however, incumbent on a dental school to look at orthodontics in the context of oral and dental health and not as an isolated area. As a school and hospital we have a responsibility to train 300 students at undergraduate level in dental science, dental hygiene, dental technology and dental nursing. We have nearly 100 postgraduates in training for diploma, membership, specialist or consultant training programmes. We are providing a further 300 dentists and dental nurses with continuing education lectures and courses.
In terms of our delivery of clinical care to patients, we provide some 14,000 treatment episodes in orthodontics each year out of a total of 100,000. Orthodontics is not a dental disease. Most of the care we deliver is to address disease rather than malocclusion. The demand for orthodontic treatment includes a significant amount of perceived need for treatment which is not a health need. In particular, we are concerned to ensure that care is delivered to those areas of dentistry which have not had the same degree of attention as orthodontics but which encompass patients who have disabilities and who are seriously medically compromised. We find it difficult to get access to operating theatres to treat persons with intellectual and physical disability. We are struggling to deliver pre-operative care to oral cancer patients. We are only now able to address the needs of hundreds of patients with missing and defective teeth as a result of genetic defects. We have one consultant in each of these areas of real need where dental disease contributes to their disadvantage.
We welcome the joint committee's interest and concern to expand orthodontic services. We would also welcome the opportunity at a future time to present to the committee our deeper concerns about the inadequate provisions made for the more vulnerable sections of our community.