The family of a teenager who was told he needed braces following orthodontic assessment in Dublin have told Gript of their disbelief after being informed there would be a four-and-a-half year wait for braces under HSE orthodontic care.
Around a third of children require orthodontic treatment, according to the HSE, with the treatment often involving using braces to straighten crooked, crowded or protruding teeth, to close gaps between teeth, or to correct bite. Treatment usually lasts from 18 months to 2 years, with visits to the orthodontist scheduled every 6 to 8 weeks.
While private treatment is widely available, fees for private orthodontic treatment usually start from around €3,500 but can be much higher, according to the HSE.
After being told that their child qualified for HSE orthodontic care, the family say they were delighted – however, their hopes were instantly dashed when the orthodontist told them their son would have to be placed on a waiting list which had a waiting time of four and a half years. The family say they will now have to go private, as they did for another one of their children, which they estimate will cost in or around €4,500.
Speaking to us, the father of the child said by the time his teenage son would receive treatment under the HSE, he would be an adult.
“Four and a half years – it’s a long time. He’s thirteen. So it was maybe his second time getting looked at by the dental service over the course of his life – and the dentist said he would possibly need orthodontic work, so they referred him to an orthodontist in Dublin.
“That was all fine, and a week or two later, we went to the appointment. They told us, ‘Look, it’ll all be covered, it’s not a problem’ – so I said that’s great. Both myself and my wife work but that was still a great relief.
“The dentist said, ‘If the extraction doesn’t sort it, he will probably need orthodontic work, but the waiting list is four-and-a-half years.’
“He’s thirteen at the minute, so he’ll be eighteen by the time they look at him. I was in shock, I thought he was joking.”
The Dublin dad described an “awkward silence” descending upon the orthodontist’s office when he was told of the lengthy waiting time.
“The nurse was there as well, and she was just kind of looking at the floor. They’re probably telling people this day in, day out. We feel there seriously needs to be action here.”
Figures released back in December 2021 revealed that more than 13,200 children across the State were waiting for urgent orthodontic treatment. The information was relayed in response to a question by Deputy David Cullinane, with the HSE saying at the time that demand for services exceeded capacity.
To make matters worse for the parent who spoke to Gript, a couple of weeks after the appointment, the family received a letter telling them that the orthodontic treatment couldn’t be provided by the HSE at all.
“They said this was because of the waiting lists, and because they can’t get the staff. Effectively, they were saying the care was covered, but they couldn’t get anyone to do it.”
“I went into them, and I asked what was happening, because they said the treatment could be covered – but the orthodontist apologised and said, ‘Look, we don’t have the staff to do it.’ I asked if I got the treatment for my son privately would I be reimbursed, but the orthodontist said no. It just seems like a very Irish solution to the problem,” he added.
The parent said that the reality at present is that a lot of families are struggling at present in Ireland, adding, “I’m sure I’m just one among many others – I’m sure other people are being told the same thing.”
‘THE COUNTRY JUST ISN’T BEING RUN VERY WELL’
However, the dad told Gript that “it just seems ridiculous” – adding that the family were informed they would effectively be forced to go private just days after An Taoiseach Leo Varadkar announced, during COP28, that the Irish government would begin allocating €225 million annually, starting from next year, to tackle climate change, with a portion of the money being allocated to countries abroad “most affected” by climate change.
“I just thought, could you not spend some of that on vital services here, like ensuring people have access to dentists?” the parent said. “I suppose our experience is symptomatic of a bigger issue. In short, the country just isn’t being run very well at all at the moment, and I think there are a lot of people who are very disillusioned.”
After having paid thousands for his daughter’s braces recently, the parent said although he is willing to invest the money in orthodontic care for his son, it just seems like an additional “unnecessary and unexpected” expense, which he says “makes no sense”.
“To be quoting a waiting list of four and a half years is beyond ridiculous,” he said. He also said that “the government is advertising asylum to people from countries around the world, even where there is no war, while we can’t even provide basic services and healthcare for the people living here paying taxes – it makes no sense. There’s something slightly ridiculous about it all.”
“Surely,” he added, “There has to be some kind of benefit to being a citizen of this country, and you’d like to think you’d be given some sort of priority.”
“I think we have to start with fixing the problems facing the normal people in this country. We can’t fix the entire world. Surely we should start at home first. A lot of people are struggling, and there’s no debate about that.
“We hear that we are one of the richest countries in the world, but I honestly wonder about that. Maybe on paper, but in real terms, a lot of people are just barely getting by. I am sure we are just one of many families who are facing unnecessary, large bills.
He said receiving a letter saying the treatment couldn’t be done at all was “probably a matter of course,” adding that his son, who needed a tooth extracted, was also not able to have this done at his original dentist’s surgery.
“When we were told by the dentist they wouldn’t be able to extract the tooth, after around two months, I honestly felt as if our time had been wasted. We were told there was no staff to do the job. You just wonder, ‘What’s going on here?’ You’re taking time off from work to go to these appointments, and it just feels like a box-ticking exercise. That seems to be utterly irrelevant to these dentists, as they know that they’re not going to provide the treatment.”
“We will just have to go and pay for it ourselves. That’s the bottom line. It would be something if you could claim the money back, but there doesn’t seem to be any way of doing that according to the professionals. I just feel this is part of the bigger picture regarding how things are being done at the moment. I honestly was shocked by the situation,” he added.
80% OF DENTAL CARE EXPENDITURE ‘OUT OF POCKET’
The issue of a shortage of dentists and dental staff, and long waiting times, have previously been raised in the Oireachtas. In July, a Joint Committee on Health debate heard that oral health was not being prioritised in terms of promotion, funding or service delivery on a national level. Fintan Hourihan, Chief Executive of the Irish Dental Association (IDA), told the committee, which discussed the IDA’s strategic workforce plan, that according to the CSO, 80% of expenditure on dental care in Ireland is out-of-pocket expenditure.
Mr Hourihan said this was indicative of two things: that State assistance towards the cost of dental care is “extremely limited compared with other health conditions.”
“More worrying,” he said, “It shows that good oral health is strongly linked to socioeconomic status, with oral diseases and conditions disproportionately affecting poor and vulnerable members of society across the life cycle.”
Mr Hourihan went on to reference “chronic delays” in delivering the school screening programme, and that staffing and resourcing in the dental sector was fast becoming an even greater issue for patients in accessing dental care. He referred to research carried out by the Irish Dental Association in September 2021 which showed “in the starkest terms” that the majority of vacancies in the dental sector had not been filled.
“At that time, two thirds of practices that tried to recruit dentists in the previous 12 months could not fill the vacancy and neither could half of practices that attempted to recruit nurses or hygienists,” Mr Hourihan said.
“Two thirds of dentists said the staffing shortage was having an impact on patient access to dental care in their practice and two thirds said their capacity to treat emergency appointments had reduced in the past year,” he added.
Mr Hourihan also said that in April of 2023, one in four dentists said they were not currently in a position to take on new private adult patients – while four in five dentists reported not having the capacity to take on any new patients, including children.
He said that the situation is “as stark, if not more so,” in the public sector, where the HSE is obliged to provide care for children and an orthodontic service. Here, he said, recruitment and resourcing challenges stemmed from policy decisions which Mr Hourihan said reflected “the very low priority attached by the Department of Health and the HSE to the provision of dentistry.”
CHILDREN NOT BEING SEEN BY DENTIST UNTIL ’16 OR 17′
“The Minister for Health himself told us recently that the State has had a blind spot when it comes to dentistry and oral health,” he continued.
“Our question to the committee today is what will it take for the State to open its eyes to the scale and urgency of the crisis that it consistently chooses to ignore in order that dental health is finally recognised as an integral part of general health. My colleagues will tell the committee in real terms that they cannot recruit enough dentists.
“They will say that their patients cannot get appointments quickly enough. I have no doubt that each member has come to today’s meeting with stories from their own constituencies and communities about how difficult people are finding it to access care.”
In November, Sinn Féin TD Brian Stanley spoke of how dental services in Laois and Offaly had become “chronic.” Mr Stanley told the Dail how there was “no follow-up being done,” as he referenced the schools scheme, under which children were not being seen in primary school. The TD said that children were not being seen until third year in secondary school, “if they are lucky,” adding that it is “often fifth year” before they visit a dentist.
“Children of 16 and 17 years of age are only being seen now. That is a problem because they may need extractions. Losing teeth is not preventative action,” he said. The TD said that while efforts “have been made” to recruit, it is difficult to recruit dentists in Ireland.
“They are being recruited abroad. We are training them but not employing them. Young graduate dentists need to see there are opportunities and a career path. We need to fix this by having a public dental system. I am not being ideological about this. I am only being practical. We cannot rely on the model we have,” he added.