Ireland’s chronic shortage of dentists
Prof. Albert Leung, Dean of the Faculty of Dentistry at the Royal College of Surgeons in Ireland, noted Association President Dr Caroline Robins’ comments on the shortage of dentists in Ireland in our last edition and says that this problem must be addressed urgently.
Maintaining a high standard of oral health is vital for the well-being and general health of our patients. For many, dental diseases are very unpleasant, symptomatic, demoralising and expensive to treat, yet most of these conditions can be avoided with timely access to high-quality dentistry and appropriate preventive dental care. As dental care professionals, we know that good dental healthcare provision is also essential for our general health because dentists can help with the early detection of a number of serious diseases and conditions. We also know that well-maintained hard and soft oral tissues inspire confidence for our patients. Access to dental care in Ireland and manpower in dentistry are two major challenges that go hand in hand. There is a major shortage of dentists practising in Ireland, and waiting lists for child and adult dental care are ever increasing. Furthermore, around 80% of medical card holders find it difficult to access dental care, and many dentists have turned away from the medical card scheme (DTSS), which has become non-viable. For many patients, this means that preventable conditions become irreversible, with adverse effects on their oral and general health and quality of life.
Addressing the shortage
We must immediately address the chronic shortage of dentists in Ireland. Ireland has 44 dentists for every 100,000 people. Germany and Italy each have almost double that number. France has 65 and the UK has 53. It is no wonder that Irish residents, particularly those with medical cards, find it hard to access the dental care they need and deserve.
Fundamentally, we are not graduating a sufficient number of dentists each year. Ireland educates fewer dentists per capita than most other OECD countries and we are not catching up. The availability of licensed dentists per capita in Ireland has not increased since 2005, while it has grown by approximately 20% in other OECD countries. The number of Irish-trained dentists entering the Dental Council of Ireland (DCI) register has been relatively static over the past 25 years, and many dentists on the register are not actually practising or are practising dentistry part-time.
As a consequence, the system has become increasingly reliant on overseas-trained dentists; 45% of dentists on the current register who qualified in the past 10 years were trained overseas. A reliance on overseas dentists exposes us to greater international competition for talent, greater risk if the international pipeline is reduced because of factors such as Brexit or Covid-19, and challenges in staffing practices, particularly in more deprived and rural communities. It can also contribute to a brain drain, which would negatively impact poorer countries, compounding health inequalities elsewhere.
At the same time, we know that we have lots of bright young people who would like a career in dentistry. Last year, over 460 students set dentistry as their first CAO preference. With about 60-65 places available nationally, only some of those with maximum possible Leaving Cert scores of 625 points received places. The challenge is a lack of domestic training places. We need a step change in the provision of dental education in Ireland – potentially by enabling more institutions to offer dentistry courses. The way we educate dentists must also change. There has been much development in recent years of primary care-based clinical training of dentists in community settings. More clinical training should take place close to where patients live. This way, dental students would experience a far more realistic and integrated approach to patient care. It would target the dental workforce to where the patients are, offering patient care and reducing waiting lists, while training dental professionals in a well-supported setting closely related to the clinical environment where they will go on to practise. It also has potential to enable the State to support an expansion in dentistry graduates at a lower cost. This approach has been adopted in other jurisdictions where they have seen an increase in the number of dentists opting to work in areas of greatest public need after they have qualified.
The population in Ireland is growing and ageing, meaning that demand for dental care will increase at a time when we are graduating fewer dentists than we need. The younger generation will continue to require quality preventive dental care despite an overall improvement in public dental health over the last few decades. Lack of access to dental care is a longstanding challenge and it’s time for an urgent new solution.
Prof. Albert Leung,
Dean of the Faculty of Dentistry
at the Royal College of Surgeons