DENTISTS ARE CONTINUING to drop out of the State’s medical card scheme, leaving older people and those in low-income households without access to basic oral healthcare.

Speaking to The Journal, Fintan Hourihan, CEO of the Irish Dental Association, said in the last number of years there has been “an exodus of significant proportions” from the scheme due to the low level of fees paid by the State and frustrations with how the scheme is operated. 

According to the HSE, the number of dentists holding Dental Treatment Services Scheme (DTSS) contracts is now 1,082. However figures from the start of this year show just 660 dentists across the country were actively treating medical card patients.

The number of dentists holding DTSS contracts has fallen from 1,660 in 2017.

“What that means is that the eligible number of patients has remained the same but the number of dentists available to provide the care has halved,” Hourihan said.

“The consequence of that is that it’s more difficult for people to get an appointment to see a dentist.

When patients are told their dentist is no longer on the scheme they should be advised to contact the HSE to direct them to someone else local in the scheme but if you take even a medium sized town there might previously have been six dentists in the scheme in the locality and now there are only two or three and they’re facing having to potentially double the number of medical card patients they see.

“They can’t possibly manage that so there are waiting lists, people have to travel further and we know that many people only call to make an appointment when there is a problem and they are already in pain.”

The HSE said there have been reports of “deficits in DTSS contractor capacity” in many parts of the country, and within each region there are areas that have been more impacted than others.

It said it is aware that some medical card holders have experienced difficulties in accessing dental treatment under the scheme and when it is informed the matter is followed up by local community services who seek to assist medical card holders.

‘You can’t blame the dentists’

Pensioner Tom Fennelly recently received a letter from his dentist informing him that the surgery would no longer be participating in the scheme going forward.

He said does not believe any other local dentists where he lives in County Dublin are on the scheme and while he is not in immediate need of dental work, he has in recent years relied on his medical card for dental services.

“Two years ago I went with my card, I needed three fillings but I was only entitled to two under the scheme,” he said. “I got two, one of them fell out a few weeks later and the dentist couldn’t replace it under the scheme because I was only entitled to two.”

He said he had to wait a year to get the filling replaced.

“There’s not one dentist around here that will take the medical card and you can’t blame the dentists, they’re not being paid enough,” he said. “It’s not their fault, it’s the system.”

Fintan Hourihan said dentists have, for years, raised issues about the way in which the scheme operated, both in terms of the fees and the type or amount of dental work covered. 

“Up until recently the HSE would have said you can’t offer white fillings in posterior teeth, you could only offer the silver ones, you’re limited to two fillings per year even if the person needs more and they only pay for the use of certain technologies,” he explained.

Dentists have always seen this an an interference in their treatment of patients. Usually you examine a patient, you set out a treatment plan and proceed on that basis, but if you can only do half of what you think they need that’s not satisfactory for the dentist or the patient.

He said the fees paid by the State for services under the scheme are not covering the full costs for dentists and many no longer see it as operationally viable. Additional costs incurred during the Covid-19 pandemic without adequate government support have also added to frustrations, he said.

To address the crisis, the government recently approved new measures to provide for expanded dental health care for medical card holders and increased fees for dental contractors under the scheme, in the hope that more dentists will see more medical card patients. The expansion of services included the reintroduction of a scale and polish for all medical card holders one a year. 

The combination of these measures represents an additional investment of €26 million in the scheme this year compared to 2021. 

In a statement to The Journal, the Department of Health acknowledged that “a significant number of contracted dentists chose to opt out of the Dental Treatment Services Scheme (DTSS), citing various reasons, including the range of treatments available, and the viability of fees payable under the scheme”.

“To address those concerns, the Minister has given a commitment to substantial reform of oral health provision in accordance with the National Oral Health Policy, Smile agus Sláinte, which was published in 2019,” it said.

“Improving and enabling easy access for the public to oral healthcare services is a key component of that policy.

Under the policy, it is proposed that oral healthcare packages will be provided for medical card holders over 16 years. The packages will be provided in a local primary care setting by oral healthcare practitioners contracted by the HSE. HSE community oral healthcare services will provide additional high-support care as required.

The recent expansion of the scheme and increased fees were designed to address the immediate problem experienced by medical card holders who are trying to access the service.

The changes to the scheme came into effect from the beginning of May and the department said they are designed to secure services for medical card holders pending a more substantive reform of dental services.

Significant changes to the provision of services for children are also planned under the proposed reform, the department said.