RÓISÍN TREACY took a look through the past volumes of the Journal in the library of the Dublin Dental University Hospital.
This issue is the first of the sixtieth volume of the Journal of the Irish Dental Association, a landmark achievement for any publication. The idea for the Journal arose in the 1940s, when the Irish Dental Association (IDA) wished to improve communication with its members. Poor road conditions and public transport services meant that often members in rural Ireland could not travel to their general meetings. The Journal was seen as an opportunity for dentists to share their experiences, in order to give an interchange of views on problems concerning the profession.
It also allowed dentists to share any unusual cases they may have come across in their practice, which could benefit their colleagues in the IDA.
Past issues of the Journal also provide an incomparable documentation of changes in the profession over the last seven decades.
The Journal began in earnest in January of 1946 as a monthly publication, under the presidency of Dr J.B. Moorhead. Its publication was widely welcomed, particularly by dentists living in rural Ireland, who had little or no access to news from the IDA up until this point.
At the time, the dental profession was marred by problems. One of the biggest challenges was the necessity to raise the status of the profession, which was held in poor regard at the time. An early issue encouraged dentists to “strive to attain the highest standard of dentistry. Be it the most expensive form of restoration, or the most moderate, he or she should never deviate from the highest idea, and give their best”.
With World War II having only ended the previous year, many Irish dentists were involved in the Army Dental Service in the 1940s. The salary received by these dental surgeons had fallen considerably between 1938 and 1946. The Journal reported that the terms and conditions offered to young dentists in the Irish army were “a disgrace to any army in any country”. Through the publication, the IDA urged all young graduates to boycott the Army Dental Service. By their November issue in 1946, the IDA had received a promise from the Minister for Defence, Oscar Traynor, that the Government would put new, improved conditions of pay and promotion for army dental surgeons in place.
The National Health Insurance Society (NHIS) Scheme also proved to be a huge bone of contention in the 1940s, as dentists complained that the scheme was inequitable. In an article, dental surgeon Dr J. McCloskey criticised the scheme for not supplying a reasonable fee for the various dental treatments required: “To say the least of it, the attitude of the Society [NHIS], to my mind at any rate, is most unfair. When one considers the benefits to health derived from dental treatment, it causes one to pause and think. What are the benefits that arise as a consequence of such treatment?”
“Insured members are more healthy, there is less loss of time to an employer through illness, with a subsequent improvement to the industry of the state… Yet the NHIS quibble about granting decent fees to the dentists for performing this wonderful work.”
With the 1950s came a change of focus in the dental profession. The onus began to move from dental treatment to preventive dentistry, which had not held much of the spotlight up until this point.
The Journal itself went through extensive change during the early 1950s. In 1952, it became a bi-monthly publication, coming out six times a year, instead of 12 times as it had for the previous five years.
In 1953, the editor Dr S. MacNeill announced his retirement due to illness. The publication did not last long without him, and by mid-1954, it had ceased publication.
After 12 months without any type of medium to communicate with its members, the IDA established the Irish Dental Review, a quarterly journal, which would incorporate the same principles as the Journal.
The editorial board was made up of 13 people, several of whom had been involved in the original publication. The Irish Dental Review continued for 10 years, until in January 1965, the Journal returned.
During the life of the Irish Dental Review, fluoridation became a recurring subject. Studies on the fluoridation of water in the United States were fielding positive results in terms of reducing the number of caries in residents. One report said: “Fluoridation is an awkward-sounding word, but in places where it has been introduced, dental decay has been cut down by about two-thirds among young people. The whole idea is to start protecting the children’s teeth when they are young”.
As the 1950s wore on, dentists increased their call for fluoridated water to be introduced in Ireland. In 1956, the Irish Government agreed to introduce the scheme, and it finally came into effect in 1964.
The 1960s and ’70s
The promotion of preventive dentistry continued in the 1960s. A 1966 issue of the Journal contained a feature from Chief of the Dental Corps in the US army, Dr Joseph L. Bernier, which gave advice on the importance of preventive dentistry. In this article he said: “Among the greatest difficulties experienced in attempting to promote preventive practice, of the type and to the extent now possible, have been those of revising deep-seated attitudes and of over-coming skepticism of members of the profession conscientiously committed to the concepts of repair and cure”.
By 1970, Dr Walter C. Allwright was editor of the Journal. A number of studies had been carried out on how the fluoridation scheme was progressing in Ireland, with the Naas-Athy six-year molar fluoridation study at the forefront. The study was carried out by F.M. O’Carroll, B.
Flanigan and J. Kehoe, and intended to track and report any benefits shown in first permanent molar teeth due to the fluoridation of water supplies. During the course of the study, the following results were observed: “It is rather evident that fluoridation exerts its most striking benefits in instances where amelogenesis is in progress. The age seven group were exposed to fluorine at two years of age, which was prior to completion of amelogenesis”.
However, although people were already reaping the benefits of fluoridation, problems began to arise with the scheme. In 1974, the availability of fluoride supplies became an issue, which took the Department of Health two years to rectify. Dentists were also unhappy with fluorine concentrations, with many tests showing that the levels in water were too low. In a report published in the Journal in 1976, a call was made for the establishment of an official agency to monitor and direct the fluoridation of piped water supplies in the country.
Fluoridation remained a hotly discussed topic in the Journal throughout the rest of the 20th century, and even to this day.
Under the editorship of Dr Seamus O’Hickey, in the 1980s, the Journal began to make a move towards more technical content such as case studies, and it also grew in size significantly.
The Social Welfare Dental Benefit Scheme was causing the most concern in the dentistry profession in 1980. The IDA felt that the fees being paid to dentists under the scheme were too low. In 1974, the limits for eligibility for social welfare benefits were removed, meaning all employees were now entitled to the scheme. As a result, an entirely new category of patients was created. The IDA demanded that the Department of Health reform the scheme. The Government eventually gave in to two of their requests. These were: the introduction of a fee for examination and general consultation; and changes in the scale of fees for extraction.
Alterations were later made to the Public Dental Service, which in a letter to the Journal in 1990, Dr Dermot Healy said amounted to “one of the most serious challenges” to face the dental profession to date.
The challenge to which he was referring, was the introduction of a scheme of relative value units to measure dental clinical output. Dr Healy criticised this change, saying: “The scheme fails to take into account the quality of care being provided. It ignores health promotion and prevention. It will encourage referral to secondary care. It fails to recognise the fact that for many of our patients, it is their first attendance at a dental surgery. Thus, there are many incentives and disincentives within the scheme, which would not be conducive to the delivery of a caring and effective Public Dental Service”.
The 1990s and 2000s
The role of the dental hygienist in Ireland did not emerge until the ’90s, when the Dental Council recommended to the Minister for Health that dental hygienists be allowed to train and be registered in Ireland. An editorial in a 1990 edition of the Journal was entitled “The dental hygienist – friend or foe?”, which highlighted how many members of the profession were distrustful of dental hygienists at the time. However, the editorial wrote in favour of the position of the dental hygienists, saying: “Rather than seeing them [dental hygienists] as some kind of alien threat, we should see them rather as allies in our work, and see how best they can fulfill a useful role in dentistry, while at the same time, ensuring that this role is well defined and adhered to at all times”.
By 2000, the role of the dental hygienist became more widely accepted in the dental profession. The Journal ran a piece in its July/August issue, which described the employment of a dental hygienist as a means of increasing productivity. The feature, written by Dr Denise MacCarthy from the School of Dental Science in Trinity College, outlined the instructions of the Dental Council for employing a dental hygienist, and what work they could or could not carry out.
The Journal today
While much has changed and improved since the first edition of the Journal was published in 1946, the profession still faces many challenges in 2014. The poor economic climate in Ireland over the past six years has seen a drop in the number of people visiting the dentist for their annual examination. The PRSI Dental Scheme was also hit with huge cuts, with the 2009 Budget curtailing the benefits available to workers under the scheme, while the Medical Card Dental Scheme was capped at the 2008 level in the Budget for 2010. The IDA has been vigorously campaigning for the restoration of the scheme ever since.
Despite the litany of challenges that still face the profession today, the Journal has proven, throughout its 60 volumes, to be a fundamental resource to IDA members. The contribution of case reviews and papers from members across the profession has provided a vital reference for dentists to widen their knowledge. The news and editorial sections have allowed all members to be kept up to date about any matters of interest within the Association. With the support of members, the Journal hopes to continue to provide this valuable outlet for dentists, long into the future.
60 volumes – 68 years
The Journal commenced publication in 1946. While it is possible that a predecessor may have existed in the Association (there is some reference to one in 1946 editions), no record of such a publication exists. The Journal ceased publishing in 1954, before reappearing in 1955 under the guise of the Irish Dental Review. The Review continued for 10 years, until in 1965, it styled itself once again as the Journal of the Irish Dental Association. The volume numbers began with the Irish Dental Review in 1955; hence 2014 is Volume 60. However, the Journal will mark 70 years of publication in 2016.