How did you come to work in special care dentistry?
I graduated from Trinity in 2008. I worked in private practice in Dublin but then the crash hit and I went to Australia for a couple of years. I worked in community health services attached to a psychiatric hospital there, and that was where I started getting interested in special care dentistry. I wanted to do more training, so I came back to the Dublin Dental Hospital and did a three-year doctorate in special care dentistry. I then moved to Cork and joined the HSE, and I’ve been there since. I run a weekly general anaesthetic list and a sedation list. I’ve also established a service for patients with inherited bleeding conditions, attached to the Haematology Department at Cork University Hospital.
What are the particular challenges in special care dentistry in Ireland?
In special care dentistry in Ireland, there’s always room for improvement. In some areas we have really good services, and in other areas services are limited and outcomes have not been good. We know that patients with disabilities have poorer oral health so there are always more resources needed, more trained staff, more targeted care. Waiting lists for treatment under general anaesthesia can be a challenge. For a lot of people with special needs, general anaesthetic is something they will always need for their dental treatment. In addition, a lot of younger patients now expect more from services. In the past a lot of general anaesthetic services were just extractions; now, people want to keep their teeth, so we’re doing more advanced treatments, and trying to hold onto patients’ teeth. This leads to an ongoing struggle with waiting times. Limited access to intravenous sedation nationally also increases this problem. I think Covid has probably set a lot of that back as well. A lot of staff were redeployed, and I couldn’t criticise that initially, but as time goes on you start to be more critical because you won’t have any dental services running. Dentistry is not optional; it’s a quality of life issue, and it’s frustrating that special care gets so little attention from Government.
How important is community care for patients with special needs?
All of our research shows that most people that come under the special care umbrella, whether it’s people with specific bleeding disorders, or people with intellectual disabilities, or dental phobia, want to be treated in the community. They don’t want to have to go to hospital. The mainstay of special care is in community services, whether in general practice or in the HSE community dental service. However, for this cohort the medical card has not been fit for purpose for a long time. If someone has additional needs the main thing you need to give them is time, and if you’re being paid a very minimal fee you don’t have that time.
What do you think are the implications of the oral health policy on your work?
It’s very positive where it’s saying the community is the home for care, but with clear pathways for people to move into HSE services or specialist services. When we look at other countries that have good special care systems, that is how it works. However, the issue is how do we get there without huge investment of funds and training? When I look at what it could achieve for patients with disabilities, I think the policy is very positive. I have often said special care is the easy thing to implement; it’s about training more specialists, getting very clear pathways, having that support and training. A lot of it is already there; a lot of GDPs and HSE dentists see these patients all the time, they just need more support and pathways.
What would you like to see the IDA doing for special care dentistry?
dentistry? For special care dentistry a lot of it is training and exposure and mentoring. I am involved in the Irish Society for Disability and Oral Health where we do a lot of that kind of training, but generally, while there would be some general dentists there, it would be more HSE dentists who are seeing these patients every day. I really think there’s huge scope for small clinical training for general dentists who aren’t looking to become a specialist or see special care patients all the time, but are seeing them in their practices and just want to get better at that. That’s where the IDA comes in because they do training really well, and even a small amount of training reduces stress on dentists.