Dental and Orthodontic Services: Motion [Private Members]

Deputy David Cullinane

I move:

That Dáil Éireann:

notes that:

— there are more than 11,000 people, mainly children, on waiting lists for dental and orthodontic treatment with the Health Service Executive (HSE), including for braces and for dental surgery under general anaesthetic, and that more than 8,000 of them are waiting over a year for an appointment;

— half of primary school children are leaving school without ever having received a screening appointment, with average waiting times of four years for an appointment, and upwards of four and a half years in some areas such as Waterford City;

— access to dental care for medical card patients through the Dental Treatment Services Scheme (DTSS) has become severely limited, with less than half of dentists signed onto the scheme; and

further notes:

— the Joint Committee on Health report entitled "Report on Dental Services in the Healthcare System" published April 2026; and

— considers that the National Oral Health Policy Smile agus Sláinte fails to prioritise the development of public dental services;

calls on the Government to:

— publish an action plan targeting an urgent reduction in years-long waiting lists for dental and orthodontic care so that children get the preventive and corrective treatment that they need, when they need it;

— invest in public dental services which will prioritise school screening and medical card holders, including the development of a public-only dentist contract;

— modernise the DTSS and integrate this with the GP Visit Card to widen access to preventative primary care services on the basis of need, and not the ability to pay;

— revise Smile agus Sláinte to include the development of public dental services and publish a timebound implementation plan;

— establish a multi-disciplinary working group on the development of a public model of dental and oral health service provision;

— develop a strategic workforce plan for dentistry, including an increase in training places across all dental care professions;

— allow direct access to dental hygienists and dental nurses for appropriate care within their scope of practice without a referral from a dentist following the development of the necessary regulatory guidelines and oversight, and engage with professional societies on this;

— introduce a new Dental Act to update the out-dated legal framework of the 1985 Act, in line with the recommendations of the Dental Council of Ireland, which should also place new entitlements to access dental care services on a statutory footing; and

— improve the collection and publication of data on special care patients, which includes patients with intellectual disabilities, to ensure transparency and accountability for waiting lists in this area and ensure timely access to care under general anaesthetic for these patients who need it.

The public dental service in this State is absolutely shocking and clearly is not working. I have dealt with this now for a long number of years. I have tabled parliamentary questions. We have raised it in the Oireachtas Committee on Health.

We have had the Irish Dental Association in along with the HSE and the Department. I have written countless letters on behalf of constituents not just in Waterford but across the State whose children are waiting years on orthodontic and dental waiting lists for braces and treatment. Some of those children are in pain and yet are waiting so long for access to a dentist and an orthodontist. The HSE and the Department went as far as apologising to parents in letters, which I have received, and indeed at the Oireachtas Joint Committee on Health because they are simply not giving children the care they need. We have 11,000 children waiting for braces and tens of thousands of children waiting for access to an orthodontist. They are on an assessment list, they have not been assessed or they are waiting to see a dentist for all sorts of different reasons. The public system clearly is not working and is clearly failing patients.

To add insult to injury, despite a scheme the Government put in place, and which we should all value, encourage and support, to ensure children get proper screening in schools - the Government policy being that each primary school child would get two screenings over their journey in primary school - the majority of children are not getting those screenings. Some get one screening but very few, if any, get both. Again, it is a symptom of a system that is not working.

The public dental treatment service scheme has collapsed. Dentists have walked away from it because they do not think it is working. A number of dentists, including one from Deputy Doherty's constituency in Donegal, have contacted me to say that they get paid for extractions and can have an unlimited number of extractions under the current scheme but can only do two fillings. Yet in a lot of cases, fillings are actually the answer. If that is happening, that is, again, shocking. That scheme has collapsed for some time and only about 800 dentists out of about 2,200 private dentists are operating that scheme so, obviously, there is no confidence in it on the part of dentists.

An alternative needs to be put in place. I put forward alternative proposals and solutions to the Government on this time and again, including in a very substantial policy document I did in this area but also in similar debates in the Dáil and elsewhere. We need to train more dentists. The reality is that a significant amount of international training takes place in our training colleges and dental schools. I have no problem with an element of that but when it gets to a point where more or as many international students come to be trained and we are not training as many domestic dentists as we need, who will actually stay here, work in the public system and treat patients, that is a problem. The first thing we have to do is to make sure we have enough dental training schools and enough training places and we clearly do not. We need to encourage more dentists and more orthodontists to come into the public system.

I have been dealing with parents for the past number of years and I have to say what they tell me when I deal with them is that their children are on waiting lists that are going nowhere. When one looks at the breakdown of how long children are waiting, one can see that there children who are deemed to be grade four or five - the most urgent cases - waiting five, six, seven and in some cases, eight years for treatment. How is that acceptable? How has that been allowed to happen? It is worse in some parts of the country. The Minister of State comes from the south east as do I. It is one of the worst performing areas. We have been raising this time and again with the Minister, the previous Minister, the HSE and the Department but every time we raise it, we are told there will be a new strategy and an updated plan and new measures will be put in place but it is not happening and it is not working. The facts speak for themselves. A total of 11,000 children are on waiting lists for braces of which 40% are waiting over two years; some of them are waiting as long as six, seven or even eight years; children in pain are waiting for treatment; and children with disabilities, who also have additional needs for dentistry, are often waiting. We have dealt with those issues on the floor of the Dáil. The screening system has collapsed and is not working, which is not good for children.

The public system for medical card patients has not been working for some time. I have to be honest. I do not know if it is ideological coming from this Government but there is no will on the part of the Government to fix it. It has been a problem for years and public patients and medical card holders are simply told to "Go whistle somewhere, do what you like, go private, we cannot do anything for you". That is all I hear from the Government on this and it is not good enough. All of those problems need to be fixed, which is why we put forward not just this motion but the alternatives involving more training places, hiring more public orthodontists and dentists and fixing the problems with the dental treatment service scheme.

Deputy Pearse Doherty

I commend Deputy Cullinane on his work and advocacy on this and the proposals he has brought forward in this Private Members' motion. There is no doubt that dental care is no longer simply under pressure. It is in crisis. That is clear for everybody to see. Across the State, there are 11,000 people - mainly children - waiting on dental and orthodontic treatment while thousands of others are waiting far too long for routine dental care. That is why we are calling for urgent action. In counties like my own county of Donegal, the issue has been felt. It is really serious there. There 420 people in the north west - mainly children - on the HSE waiting list for dental and orthodontic treatment. This for braces, dental surgery and other types of interventions. Nearly one quarter of these people are waiting for over a year. That is disgraceful. The number of dentists participating in the dental treatment services scheme in Donegal and elsewhere has fallen in recent years.

Over recent weeks, I have been contacted by dentists in the Irish Dental Association who outlined the growing crisis facing patients in Donegal. They have told me that there is a significant and ongoing withdrawal of dentists from the medical card scheme. Everybody living in the county can tell you that. Long-established clinics are no longer accepting new medical card patients while others have withdrawn from the scheme altogether or have had to reduce the services they provide and there has been no response from Government. In rural counties like Donegal, this means that people are travelling significant distances simply to access basic dental care and some cannot get an appointment at all. One dentist in Donegal even told me that the system is designed to force dentists to go private. He also explained that on many occasions, dentists like him are being asked to extract teeth for free in emergencies and are constantly under pressure to provide fillings for free because people cannot get free care.

All of this exposes a system that is simply no longer working and it is having a real impact on older people, families with younger children and those living in isolated rural communities. Access to care increasingly depends not just on need but on where people live and whether they can afford to pay privately. The Government should be listening to those on the front line. Instead of allowing the system to continue to collapse and deteriorate, it needs to work with the profession to restore access and ensure that nobody is left without essential care.

Deputy Pa Daly

When one hears about the waste of Government money and about the people all around the State, but particularly the people to whom I listen in Kerry, who cannot access dental services, it makes one even angrier. Over the past couple of weeks, I have been speaking to people about this. One person told me her 19-year-old son has never been seen, another person said their children aged eight and 15 had never been seen while another told me of three children aged 17, 13 and ten who were never called. They speak of a chaotic dental service that is going backwards and that has been neglected and underfunded with no vision. Another person to whom I spoke said, and this is a common theme, their child had never been seen all the way through primary school and they were forced to pay thousands of euro for proper dental treatment.

We put down a parliamentary question on it and discovered the number of people in Kerry who are waiting because the medical card system has completely collapsed. In the Killarney and east Kerry area, 600 second class children are waiting to be seen. In Tralee in west Kerry, 912 are waiting to be seen. In sixth class, 466 in the Killarney area and 788 in the Tralee area are waiting to be seen and that is not to mention people in other parts of the county. While the Government is wasting money on one hand, there are children who are literally in agony waiting for dental services.

Across the State, we can see that there are 11,000 people on waiting lists. Half of children leave school without ever having received an appointment. In Kerry, the figure is way more than that because there is practically no chance of getting seen by a dentist if you have a medical card. Private dentists will tell you that it is not worth their while and that they actually lose money if they participate in the medical card scheme. This has been going on for years but the Government is sitting on its hands and is doing nothing about it. We need proper investment in public dental services, proper school screening, proper medical card services and a workforce plan for dentistry to get more people into the public service just to meet the needs of children who are going through the system and are not being seen. We also need direct access to hygienists and dental nurses to stop the agony of children across the county.

Deputy Matt Carthy

Sinn Féin has brought forward this motion because the Government simply refused to understand that dental care is an essential part of healthcare. Across the State, particularly in counties like Cavan and Monaghan, families are being failed by a dental service that is stretched beyond capacity. State-wide, as colleagues have outlined, thousands of people, mostly children, are waiting for dental or orthodontic treatment, with a significant proportion waiting well over a year. Many children are leaving primary school without ever receiving the dental screening to which they are entitled.

All of these numbers represent real children and families. In my constituency, parents contact me in utter desperation and frustration because their children are waiting years for orthodontic treatment. People feel they must contact local politicians because their child needs braces or other healthcare. This is the scenario that Fianna Fáil and Fine Gael have allowed to develop. Many people stretch themselves to access private treatment. A whole cohort of others just cannot afford that option and feel they are letting down their children. In fact, it is the Government that is letting them down. There are staffing issues in Monaghan, with vacancies in the local dental service for dental hygienists, general surgeons and dental nurses. All of those vacancies have been in place for a prolonged period. Then there is the situation at Dundalk hospital for the children who are referred there. We might as well tell them they will not receive the orthopaedic care they need.

This cannot stand. We need urgent action to reduce orthodontic and dental waiting lists. We need investment in public dental services, a dedicated public-only dental contract and workforce planning. We must ensure dental places in our universities are being utilised by those we can encourage to work in the domestic system, rather than being sold to international students to make up for the shortfall in Government funding for the third level sector. We need a dental treatment service that actually works for the people it is supposed to serve.

Deputy Darren O'Rourke

I thank Deputy Cullinane for bringing forward this important motion. We need action on this issue. A number of parents in my constituency of Meath East have written to me. I was told about a 12-year-old in Dunshaughlin who has never been called to the HSE dentist. One wrote: "My daughter is 11 and has not been called for any HSE dental services at all." A parent wrote about a son, who is 12 this year, who has never been called. Another parent wrote:

My son is 12, nearly 13, just about to finish in primary school and has never been called to be seen by a HSE dentist. Obviously, I have gone private and paid myself but it is a totally different experience to my daughter, who is 12 years older and got all her checks through the HSE. I called about four years ago to see why he still hasn't been called and they said that due to Covid, everything was delayed. It's an absolute joke.

A parent wrote to me: "My daughter is 13 and has never been called to see a HSE dentist and is starting secondary school in September." Another parent told me of a daughter who is 15 and had her first HSE check-up eight weeks ago. That is the pattern not just across my constituency but across the State.

The figures provided by Deputy Cullinane comparing waiting lists in quarter 1 of 2026 with quarter 1 of 2021 are absolutely stark. The number of orthodontic patients at grade 5 waiting more than 48 months, or four years, significantly increased between 2021 and this year from 180 to 250. We can only imagine the pain those children are suffering. The overall numbers waiting have more than doubled from 734 to 1,565. These are the most severe cases representing those most in need. The waiting lists are absolutely obscene. Will the Minister of State please do something about them?

Deputy Rose Conway-Walsh

I acknowledge the hard work done by my colleague Deputy Cullinane in this area. He has presented all the proposals and solutions to fix what is happening in dental services. Dental care is a critical part of the health and well-being of any human being but it is not treated as such by the Government, which has failed to address the critical shortage in this area of healthcare provision. Between 2019 and 2025, the number of dentists in Mayo providing care under the dental treatment services scheme fell from just 31 to 22. How can there be dentists available when the Government fails to invest in public services? All of those dental practices are full to capacity. The evidence is clear that we must introduce a public-only dentist contract in order to reduce waiting lists, ensure children have timely access to preventative and corrective care and prioritise school screening and medical card holders. Patients should have direct access to hygienists and dental nurses within their scope of practice to reduce the waiting lists.

A mother from Mayo contacted me about her seven-year-old son who had to attend a private dentist because he could not access public treatment. She was told he would need to be referred to Dublin because he needed two surgeries. Those surgeries would normally be done in Galway but the service was full to capacity. The treatment, she was told, would cost €4,000. That is completely unaffordable for the vast majority of parents. Another child is 12 years old and has never been seen by a dentist through school. One mother told me her child has been waiting three years for braces. Another mum described the ordeal of her autistic deaf son who needed urgent dental care. He had to be hospitalised before being sent to Oranmore Dental Care, then to the Hermitage Clinic and then to Dundrum. The whole experience was very traumatising for the child and it ended up costing €6,000. That is just nuts.

We need an action plan to improve dental care delivery and drastically reduce the waiting lists. We need a strategic workforce plan to address the skills shortages. The solutions are set out in the motion and the Minister needs to implement them. I am aware of an elderly woman for whom a dentist could not be found anywhere to provide the critical care she needed. The horrific cases that are coming forward must be dealt with. I am really tired of bringing up this subject and nothing being done.

Deputy Joanna Byrne

Week in and out, my constituency office is inundated with people trying to access dental and orthodontic services. The population in Drogheda and south Louth is growing faster now than it ever has before but vital services are not by any stretch keeping up with the population growth. In fact, they are getting worse under the Minister's watch. The number of dentists working under the dental treatment services scheme in Louth dropped between 2019 and 2025. There is huge population growth but the level of service provision is declining.

The number of children waiting for dental treatment under the primary school dental checks scheme can only be described as scandalous. One parent told me her daughter has been on the list for braces since fifth class. She is 20 now and has never received the public care she needed. That is a nine-year wait and it beggars belief. Half of primary school children are leaving school without ever having received a screening appointment. Consultant orthodontic vacancies have been unfilled since 2024 in Louth. The total number on school dental screening waiting lists in the county continues to increase year on year. A total of 2,800 children were waiting to be seen and 718 were waiting for orthodontic treatment at the end of 2025.

Although this is detrimental to the children in question, it is not just children who are affected. Miriam, a widow in her late 70s with a full medical card, needed to have her dentures replaced as they were too large for her mouth. She was in pain and could not eat properly. Facing exorbitant waiting times, she had to borrow money to the tune of thousands of euro to get the care she needed. Another constituent needed extensive dental work as a direct consequence of domestic violence. She was told that advanced restorative treatment is not provided to medical card holders and that no assistance is available to help meet the costs of private care.

Parliamentary question responses provided to me in recent months have stated that the capacity of the service is based on available resources. There are limitations to clinical capacity, we are told. Data shows ongoing service pressures, reduced staff levels and declining levels of oral health assessments. This is not news to anyone trying to access services or to those providing services. It surely cannot be news to the Government. This has not happened by accident. Rather, it is a direct result of underinvestment, failure to plan and a hands-off approach by successive Ministers. The Government's inaction on dental services leaves those languishing on waiting lists either in pain or in significant debt. Either way, they have been completely failed. The cost of the Minister's neglect of this issue will be felt for decades. Action is long overdue on the dental care crisis in this country.

Minister of State at the Department of Health (Deputy Jennifer Murnane O'Connor)

I thank the Members for this very important motion and for giving me the opportunity to discuss dentistry services and to provide an update on the developments in the sector and the oral health action plan. The Government allocates over €240 million to the provision of public oral healthcare services every year across the Department of Health and the Department of Social Protection. This ongoing investment shows our commitment to delivering services, progressing reforms and addressing the challenges we know exist in dentistry services. We fully acknowledge that more needs to be done. The Minister for Health wants to do much more to improve oral healthcare services and to address access issues. The Minister welcomed the Joint Committee on Health’s recent report on dental services and understands the frustration families and individuals are experiencing with the current services. In my own clinics I see this daily. The current position on public dental services is not good enough. Too many people cannot get timely care. We have to do two things, namely, take practical steps now to improve access and deliver lasting reform in the long term. The model of services we operate is largely from the 1990s, and it must be modernised. While that reform is progressing, we are determined to ease the pressure people are facing now. In practical terms, that means improving access through the public system, especially for children and adult medical card holders. The Department and the HSE are currently finalising a two-year action plan - and this is where a lot of work has been done - that aims to deliver meaningful impact in the short term while also making progress on the structural reforms outlined in the national oral health policy.

The salaried HSE oral healthcare service provides dental care to several groups of patients. In the January to April period this year, it provided care to over 56,000 adults and children. This includes over 16,000 emergency appointments to eligible patients, on a same-day or next-day basis. Those with additional needs who cannot receive care in a general dental practice may need special care services provided by the HSE. The HSE provides these patients with an oral health examination and where necessary, their treatment is provided using additional supports. This service provides care to many children and adults who would not otherwise have access to oral healthcare services.

Regarding access to public oral healthcare services for children, there are access issues in respect of the current model of service provided by the HSE. This service aims to offer the first of three appointments to children while they are in second class, or seven years old. Due to capacity challenges, the HSE needed to prioritise patient groups, to ensure emergency care remains available for all eligible HSE patients. Within the three childhood appointments, the sixth-class appointment is prioritised by the HSE. This is to ensure that children receive preventative treatment on their permanent molars and, for those children who require it, a referral for an orthodontics assessment. Some €4 million in additional funding has been provided to support the HSE to complete recruitment of 15 additional whole-time equivalents across dentists and dental nurses. The public oral healthcare services provided by the State includes orthodontic treatment. I know the Deputy spoke about how many are on the waiting list. The HSE provides orthodontic treatment to those who have the greatest level of clinical need and have been assessed and referred for treatment before their 16th birthday.

It is positive to note that 5,500 grade 4 patients have been removed from orthodontic waiting lists since the introduction of the waiting list action plan in 2020. This includes 392 patients so far in 2026. A further €2.85 million has been invested this year to support continued measures to reduce orthodontics waiting lists. However, despite additional capacity provided via private contractors under the waiting list action plan, waiting lists remain high due to staffing and recruitment challenges. I know Deputies are aware of this. The action plan seeks to address this and improve the current orthodontic waiting lists.

I am aware there are challenges in the provision of dental services under general anaesthetic. I know this is not acceptable for those who are on these waiting lists. This is why the action plan will consider initiatives such as using the emerging availability of capacity that the new surgical hubs will enable. This will help reduce the current waiting times for general anaesthetic access for both children and adults. An important part of this work will be to improve the collection and availability of data, in particular for our special care patients, which includes those with intellectual disabilities. We want to ensure timely access to care under general anaesthetic for those who most need it.

I want to turn to the dental treatment services scheme, DTSS. Last year the State provided care to over 300,000 medical card holders over the age of 16 under the scheme. In order to address contractor concerns regarding the DTSS, a range of measures came into effect in May 2022 to introduce and reintroduce elements of preventative care. The Minister for Health also increased the fees paid to dentists for most treatment items by from 40% to 60%. These measures are having an impact, with access to care continuing to increase each year since they were introduced.

In 2025, over 241,000 additional treatments were provided under the DTSS, with an extra 50,000 patients treated, when compared with 2022. Activity has continued to increase further into this year. Initial data from the first half of this year indicates that more than 4,000 additional patients have been treated, compared with the same period in 2025. These are important signs of progress and improved access, however, we have much more to do and I do understand the frustration. Reform of the DTSS is one of the actions in the action plan that my Department and the Minister have committed to. We look forward to working with relevant stakeholders in progressing this reform. A key enabler of successful reform and improvement of oral health services is ensuring that we have enough appropriately-trained oral healthcare professionals. In particular, we need to maximise the contribution of our hygienists, dental nurses and other oral healthcare professionals to provide the modernised, prevention-focused care we are developing. This requires changes to our educational and legislative frameworks which is acknowledged in the oral health action plan. We also need to consider educational models which enable students to experience providing care in a community setting, within our most vulnerable communities, equipping them with the experience and confidence needed to serve the entire population following graduation.

I am delighted to note that we currently have more dentists on the Dental Council of Ireland's register than ever before, with 3,962 as of June 2026. There has been a steady increase in the number of registered dentists. In 2019, there were 3,100 and therefore we have seen an increase of over 28% since the national oral health policy was published. There is also a need to increase the number of dental hygienists and other oral healthcare professionals. The Department of Health has commenced work on a draft strategic workforce plan for dentistry and oral health. This plan recognises and highlights the challenges in terms of data gaps in the dentistry sector. To address the gaps in data, the Department has designed an oral healthcare workforce census framework. The workforce census is intended to gather information, including the proportion of registered oral healthcare professionals who are practising in their registered profession, the services they provide, and the skills they have. The roll-out of the workforce census is expected to be a key action in the new dental action plan. The census data will provide information to support the development of the sector and to support workforce planning.

The Government is committed to ensuring our healthcare services are supported by a steady and sustainable pipeline of highly skilled graduates and one of the programme for Government commitments is to increase the number of healthcare college places, including for dentistry. We have achieved a lot in this area through collaboration with the Department of Further and Higher Education, Research, Innovation and Science and the Higher Education Authority, HEA. This work has led to the commencement of a new bachelor of dentistry degree programme in the Royal College of Surgeons in Ireland, RCSI, in September 2025. The RCSI model trains dental students in a community-based model of dental education. The RCSI has taken in 21 Irish and EU students in 2025 and has secured an agreement with the HEA to expand its intake of Irish and EU students to 35 places by 2027. This will significantly increase the number of dental training places available and will enhance the workforce capacity.

We know that more must be done in this area which is why we have engaged with Cork University Dental School and Hospital at University College Cork, UCC, and the Dublin Dental University Hospital at Trinity College Dublin regarding the expansion of dentistry training places. These engagements are ongoing, with a view to developing potential options to facilitate further expansions.

In terms of improving access to services and supporting reform, the Department of Health is progressing policy to introduce direct access for dental hygienists in Ireland.

This will allow dental hygienists to provide appropriate elements. I am sorry I did not have time to finish this statement.

An Ceann Comhairle

You will be back in.

Deputy Jennifer Murnane O'Connor

I do understand the challenges that are there. I see them daily. With our new action plan, going forward, we want to make those changes. We are not opposing the motion.

Deputy Louise O'Reilly

I commend my colleague, an Teachta David Cullinane, for bringing forward this motion, for his work on this issue and for the well-crafted solutions he has brought to the floor of the Dáil.

I strongly encourage the Minister of State to engage with the solutions and proposals brought here this evening by Sinn Féin because it is very clear that what the Government is doing is not working. There are over 1,500 kids in north Dublin on waiting lists for orthodontic treatment having been assessed as grade 5. Grade 5 means they are already in pain. They have had the assessment and they need the treatment but they cannot get it. It is not hard to see what is needed. The Minister of State did not need ten minutes to tell us what is needed. We know what is needed. We need investment in our kids' dental health. The Government needs to treat it like healthcare because that is what it is.

I do not know if the waiting lists I deal with in my constituency office day in, day out result from indifference, incompetence or both but the parents who contact me day in, day out are at the end of their rope. Of course, because this is Fianna Fáil and Fine Gael, the private sector has moved right into this space. We now see that people can go to a private provider that did not provide dental care for kids previously but does so now. There is a price list on their website. It costs €77 for a filling and €40 for an assessment. That is €120. If parents do not have it, and plenty of them do not, does the Minister of State know what they can do? Buy now and pay later. That is getting important healthcare for children on the drip, on the never-never, on the buy now, pay later. They are getting themselves into debt. The private provider has brochures and leaflets it hands out. The incompetence of this Government has opened up that space for it.

Deputy Seán Crowe

Access to timely, effective and affordable dental care is one of the most important guarantees of a good quality of life. Persistent pain from an abscess or tooth decay is one of the most unpleasant and debilitating things a child or adult can go through. A modern healthcare system should make it a top priority. Instead, the Government parties have long abandoned affordable dental services. It is almost entirely privatised now, as my colleague has said, with the number of dentists directly employed by the HSE dwindling every year.

This means more than half of children do not get a dental screening in primary school. This is just a basic check-up and we cannot even provide that. This Government does not even know how many dentists are practising in Ireland or how many dental clinics there are. It is completely detached from a vital aspect of healthcare provision in Ireland. The national oral health policy was published in 2019. We still do not have an implementation plan for that policy.

Access to dental care for people with a medical card has collapsed, as other speakers have said. More than half the dentists have withdrawn from the medical card scheme, leaving thousands of patients without the care that they need and are entitled to.

Successive Ministers for Health promised that a breakthrough to fix the scheme was imminent, but it is ordinary people in need of urgent care who are suffering. We must invest in a public dental scheme that will prioritise school screening and medical card holders, including the development of a public-only dentist contract. We must modernise the medical card scheme to guarantee access to care on the basis of need and not on the ability to pay.

Deputy Sorca Clarke

The Minister of State mentioned access issues nine individual times in her opening address. I am going to tell her what these so-called access issues really involve. A mother told me she had spent three weeks trying to contact the school-age dental team and when she finally got through this morning she was told nothing could be done, not even in an emergency, until that child's school was called, despite the case being referred to as "urgent" by a private dentist. The mother of a young girl with autism spectrum disorder, hypoplastic teeth and a severe 8.5 mm overjet was provided with documentation indicating that the girl would qualify under national criteria while simultaneously being told that she did not qualify under the modified regional criteria. Parents should not have to navigate contradictory and inconsistent rules to get dental care for their child.

The last aspect I will bring to the Minister of State's attention are medical card patients. They are really struggling. A constituent told me she had no option but to have a tooth extracted because she simply did not have the cash to stretch as far as a filling. They are what the Minister of State is calling "access issues". They are not access issues. That is an abject failure of this scheme.

The Minister of State cannot continue to ignore a shortage of dentists while failing to adequately address workforce planning. Sinn Féin has consistently called for more training places, a workforce strategy that retains graduates here and investment directly into our public dental service, rather than continuing to rely on crisis management.

It is an absolute shame that this Government stands over a system where half of primary school children leave school without ever having received a screening appointment. At the health committee we heard of children who, when they were finally called for that screening programme, drove themselves to their dental appointment. Where is that in the Government's two-year action plan? Is that going to be covered by the initiatives the Government will consider in surgical hubs that do not yet exist? That is why change is needed and needed now.

Deputy Natasha Newsome Drennan

I commend my colleague, Deputy Cullinane, for his work on this motion. The numbers speak for themselves. Over 11,000 people, the vast majority of them children, are left suffering on dental treatment waiting lists across the country. The State is failing them, plain and simple, yet what do we see from Fianna Fáil and Fine Gael? The same attempt to normalise these shocking delays, just as they have done with the disastrous waiting list for the children seeking an assessment of need. These waiting lists are not just numbers; they are children left suffering. I have spoken to so many parents drowning in stress, feeling that their only option is to go private at crippling personal cost just to get adequate care for their child. All the while, those in the private sector continue to line their pockets off the back of the Government's incompetency.

This Government needs to accept a hard truth: the current system is outdated, chronically under-resourced and simply not fit for purpose. A child should be able to see a dentist when they need one, rather than having to wait until six years down the line. A family that contacted my office were told their child would be waiting six agonising years for dental treatment. With a bit of help, they finally got a notice in March to say he was on the priority list but just last week they were told the funding had run out. His booking was cancelled. They were told the patients on the list from January and half of those from February would be seen. How the money can run out that early in the year is beyond me. This family are absolutely devastated. God knows how long he is going to be on the list. This child does not smile anymore. This is not just about his physical health; this is about children's mental health also. A child should be able to smile.

Deputy Cathy Bennett

The Government has utterly failed in terms of dental services. It has especially failed every child, with more than 11,000 children waiting years to get braces and half of all children not getting their scheduled dental check-ups through the school dental scheme. The Government is especially failing children in my county of Monaghan, where, as of October last year, not a single child in the 2024-25 cohort had received their dental checkup. Not a single child out of 832. How do Fianna Fáil and Fine Gael account for this failure? When I submit questions to the Minister for Health, the excuse provided is that it is down to staff vacancies arising from maternity leave and retirement. If the Minister and senior HSE management are unable to implement adequate workforce planning to account for women having children or people retiring, that calls into question basic competencies.

Equally, at one point last year when I asked the Minister about access to orthodontic treatment for people from Monaghan, she told me that service was under-resourced, with three vacant orthodontic posts.

This is utterly unacceptable and I commend the Sinn Féin spokesperson on health, Deputy David Cullinane, on bring forward these very detailed proposals, which outline the solutions that seem to be needed for this ever-worsening crisis. I appeal to all Members of this House to endorse this plan because this is what the children of our nation deserve - not excuses that they will not receive the healthcare that is their right simply because a dentist has retired or is off having a baby. We need a workforce plan and complete reform of our access to dental care.

Deputy Pádraig Rice

I welcome this debate and thank Sinn Féin for putting forward the motion. It is a really welcome debate and it follows on from the work done by the joint Oireachtas committee and the report we published on this matter.

I sometimes wonder if I live in a different country when I hear some speeches from Ministers talking about the money they have invested and that their ongoing investment shows their commitment to delivering services, progressing reforms and addressing challenges. From what we have heard tonight, none of that is happening. The Government is not showing commitment to services, progressing reforms and addressing challenges. The evidence sadly speaks for itself and it is not the rosy picture that is presented by the Minister of State, unfortunately.

There is a long history here of dysfunction when it comes to oral health policy in the State. Successive Governments have utterly neglected public dental services. The first clear statement of the State's aims and objectives for dental services was first published in 1994. That was called the dental health action plan. That plan led to the development of the dental treatment service scheme for medical card holders but it would take a quarter of a century for another dental policy to be published. In 2007, the then Minister for Health, the former Deputy Mary Harney, announced the development of a new oral health policy and although a draft plan was presented to the Minister in 2009, it was never published.

In the years between 2001 and 2017, aside from one mention of community water fluoridation, oral health did not feature in any of the national healthcare policy documents. That only changed with the publication of Sláintecare. Then, in 2019, a new oral health policy was finally published, Smile agus Sláinte, 25 years after Ireland's first and only dental policy plan had been published. What we see over the period and the history of the State is neglect of this area and a failure to plan and put policies in place. Even sometimes when policies are formed, there is a failure to implement, prioritise, publish and resource them. It is not just the current Government that is failing on this; there is a track record of failure from successive Governments that have led us to the state we are in today.

On Smile agus Sláinte, in 2019 the oral health policy did not set out a roadmap for the practical delivery of its vision. It was developed without proper consultation with dentists and allied healthcare professionals. In 2024, the former president of the Irish Dental Association, IDA, Dr. Eamon Croke, said that the 2019 policy "was launched from behind a veil of secrecy". While Dr. Croke said that the IDA may share and support many of the 2019 plans and their aspirations, the Department of Health had yet to articulate how its vision would be enacted, a situation that prevails to this day.

In January of this year, the Department of Health told the health committee that a three-year implementation plan to progress phase 1 of the 2019 plan was in development. This is now seven years after the plan was put in place that we were still waiting for the implementation plan. The implementation has been described as imminent since 2024. We are led to believe that this implementation plan will finally be published this year. However, in January, the Minister said it was at an advanced stage, while in April, she said her goal was to publish it in the coming weeks. It is now the end of June and we still do not have that implementation plan for a policy that was published seven years ago - back in 2019. If that does not tell you how much of a priority this issue is for the Government, I do not know what will. In the Minister of State's speech this evening, she said it is currently being finalised. I would ask the Minister of State, in her closing address, to give us a solid timeline. We have been told for many months that it was coming to the end. We would like to know exactly when the Minister intends to publish that. We have been waiting, as I said, since 2019 for this. I do not think it is unreasonable to give the Dáil a final date on when that implementation plan will be published.

On the Oireachtas health committee's report, which was published previously, this followed engagement with stakeholders. The health committee published its report on dental services back in April. This report included 19 recommendations, with the first three all relating to implementation of that 2019 plan. We found there had been no noticeable improvement in dental services since 2019. There was no noticeable improvement over a seven-year period. There had been no progress, according to the report produced across the parties, including Government members of the joint committee.

In fact, the situation has gotten worse and not better. Children are leaving primary school without being screened. The medical card scheme is haemorrhaging dentists. The laws governing dentistry are over 40 years old and they are putting the public at risk. The Dental Council of Ireland has been calling for a new Act and additional powers since 2008. It urgently needs powers to investigate, enter and inspect dental practices. Here are just some examples of instances in which it has not got the powers to act. There was an unregistered person convicted of sexual assault practicing as a dentist. There was an unregistered dentist offered dental treatments, including X-rays, from the sitting room of an apartment in central Dublin. Three unregistered dentists were operating pop-up clinics in Munster and Connacht. These are the kinds of patient safety issues we have here - people convicted of sexual assault practicing of dentists; clinics in apartments across the State; and unregistered dentists. We need regulatory reform that is supported by both the regulator and the regulated.

In regard to children's dental services, children should be screened three times before leaving primary school but some children are not being seen until transition year. If that is not a failing on behalf of the State, I do not know what is. This is because of understaffing and under-resourcing of the school screening programme. Check-up targets have been missed on a massive scale. In 2023, only half of the eligible population of children were screened. Half of the children who were entitled to this completely missed the screening. This is really important screening to check on children and it just being missed. They are being completely failed and neglected and it is utterly unacceptable.

We urgently need the strategic workforce plan, as recommended by the health committee. We need to know what the capacity requirements of a school screening programme are if it is to deliver a service that actually works for people. At present, the Department simply does not know how many public dentists are needed. All we know is that we do not have enough, and that the number of public dentists delivering the dental scheme has dropped by 30 since 2012. We are seeing a fall in the number. Despite what the Minister of State may talk about, investment in services and the number of dentists working in the public dental scheme is dropping. We need to make public dentistry an attractive option for dentists. That includes the development of new and attractive public dental contracts to support the public model. Outsourcing children's dental services to the private market is not the answer. Scaling up the public service is. That should be a priority and it should be a matter of real concern to the Minister of State that we have children in the State who are entitled to these screenings who are missing them. It being half of the eligible population, it is really utterly unacceptable.

The concerns we have do not just extend to children; they also extend to adults on the medical card and medical card patients. Under the medical card scheme, private dentists are contracted by the HSE to provide services to medical card patients but this scheme is haemorrhaging dentists and medical card patients are paying the price. In 2015, there were around 1,600 dentists participating in the scheme but, by last year, that had halved to 800. The scheme is no longer fit for purpose and the health committee, in our report, called on the Minister to enter immediate talks with the Irish Dental Association to replace it with a new scheme, one that allows dentists to provide medical card patients with the best care and not just emergency care. It is unacceptable in the current scheme that the number of fillings per year is limited but the number of extractions is not. As a result, people are having teeth removed when they could have had fillings and prevention. This is not the proactive, preventative type of care that should be provided in our public dental scheme. This scheme is a relic of the 1990s. It is no longer fit for purpose. We need modernisation and mere modification will not be enough. The scheme must be completely modernised.

In the health committee's dental report, we also called for the development of a strategic workforce plan not just for dentists but for allied dental healthcare professionals. We also recommended that the roles of those dental health professionals should be expanded, allowing direct access without the need for referral. In the context of the national oral health policy's aims to move from an outdated curative care model to a prevention first model, direct access from dental hygienists is particularly important. The Minister of State has already said that work is under way to develop a policy paper on direct access for dental hygienists. This needs to be accelerated. Unnecessary barriers to direct access must be removed. Allowing direct access for dental hygienists will increase capacity, enable earlier interventions, reduce waiting times and allow dentists to focus on more complex and high-need care.

This is already in place in the UK. A 2023 UK General Dental Council evaluation paper found no evidence of patient safety concerns associated with direct access to dental hygienists and therapist practices when their defined scope and appropriate referral pathways are in place. I met with the Irish Dental Hygienists Association earlier this year and it did excellent work in putting forward a case for direct access. Patients should have the option of accessing care from dental hygienists without needing to see a dentist first. Advancing this practical and evidence-based reform should not be put on the long finger any longer. It is a key reform and it will help dentists, patients and the public at large.

The Government is not doing enough here. It is not investing enough. The issue is not being prioritised. The reforms to the dental Act that are needed have not been progressed. I say this all the time when we have statements the House; we could be progressing reforms to legislation, including the dental Act. I have real concerns about the school screening programme and the number of children who are being absolutely failed, are not getting the appointments they need and are being completely neglected. We heard at the health committee that in some cases, people are driving themselves to their first screening when they should have been screened in primary school. It is not good enough. It is utterly unacceptable. I urge the Minister of State and the Minister to get a grasp on this issue.

For our part, the health committee has set out a series of recommendations. We have laid out clearly exactly what needs to be done step by step. I urge the Minister of State to engage with that report and the recommendations and progress the reforms needed because people deserve access to good quality public dental care. The least people should get in this Republic is access to good quality healthcare, particularly children, medical card holders and others who have been failed and failed by successive governments. The time for reform is now. I urge the Minister of State to listen to what we are saying and prioritise this issue because together, by working with the health committee and the recommendations we put forward, we can make real progress on this issue. However, it needs to become more of a priority for the Minister of State, her Department, her officials and the Minister.

An Ceann Comhairle

I call Deputy Marie Sherlock, who is sharing with Deputy Kenny. Deputy Sherlock has ten minutes.

Deputy Marie Sherlock

I very much welcome the opportunity to speak on this motion and I thank Sinn Féin for introducing it this evening. The Labour Party will very much be supporting this motion. The Government has effectively watched our public community dental services collapse over the last decade. It is very clear that oral healthcare is very much the poor relation of the health service. It is almost a year to the day since we had a debate in this Chamber last year, with a motion then sponsored by Deputy Stanley. It is clear that almost little or nothing has happened since then. We are seven years on since the smile agus sláinte national strategy on dental care was published, yet we have seen a deterioration and disregard for public dental services in this country.

One of the critical things we know about dental care is that prevention is as important as treatment. We know the one organisation that was set up 40 years ago to promote oral health awareness, the Dental Health Foundation, lost a massive chunk of its funding a number of years ago. We have to ask serious questions about the seriousness and intent of the Department of Health with regard to oral healthcare in this country. We know that so many people out there are now having to go abroad for cosmetic dental surgeries to make up for years of neglect by the public dental system. The size of your wallet should not determine your health, yet, in oral healthcare in particular, it absolutely is the case. People are no longer just afraid of the dentist's chair. They are terrified of the cost of visiting the dentist. We know that children in particular are not getting the dental care they need.

Along with anybody else who was contributing to the debate last year, we looked at the drop in the number of public dentists and those participating in the dental treatment scheme. It is devastating to see and was reflected in the cross-party report that Deputy Rice spoke about. It was from the Oireachtas health committee and was published a number of months ago. It very clearly set out what needs to happen. We have seen little or no response from the Department of Health since then. Earlier this year, the Irish Dental Association told our committee that more than half of dentists had withdrawn from the medical card scheme, leaving thousands of patients without the free care they are entitled to. If that were to happen within GP care, there would be absolute uproar and alarm - rightly so. Yet, we are not seeing that same level of attention or care for our public health service.

The reality is that as of April this year, there are just 232 whole-time equivalent dentists across the public health service. In 2009, there were 330. It is scandalous that we have seen such a decline. I know from talking to public dentists on the ground there are enormous challenges with regard to trying to get additional dentists recruited into the system. Business cases sit there for months on end. That is absolutely unacceptable if we are to take public dental care seriously. The reality is that those on medical cards and those who struggle to afford to see a dentist are the ones who are most disadvantaged by this. They are the ones suffering from real inequality. People are genuinely delayed for months, just to save the money needed to get basic treatment.

With regard to children, the number of children participating in targeted programmes and scheduled appointments within community dental services has significantly dropped. We know that across all CHO areas, the number of children in first and second class, or fifth and sixth class and other targeted groups, attending scheduled appointments has dropped dramatically over the past five years. Tens of thousands of children are leaving primary school without any basic checks. Last year, I relayed a story in this Chamber of a public dentist telling me that she had patients, who were no longer children because they were driving a car, driving themselves to an appointment they were supposed to get in sixth class but they were in fifth or sixth year by the time that appointment came through. That is absolutely unacceptable and the costs we are storing up for our health service further down the line because of those delays to care is frankly outrageous. We know there was a 30% drop in the number of children attending these scheduled assessments between 2019 and 2024. The reality is there is a bit of a ticking time bomb here. If we do not put the money in early to the preventative aspect of our dental healthcare system, we will end up with a health system that has much greater costs further down the line. Surely, the ambition and aim of all of us here should be to ensure we are looking after people's health as opposed to ill-health further down the line.

I very much welcome in particular the reference to general anaesthetic services in this motion because the reality is there are hundreds of children across this country who need general anaesthetic to receive dental care. Many are waiting over a year. There are children and special care adults left in excruciating pain with simply nowhere to go. We know people have to travel very long distances. In the south west, 310 people with additional needs are waiting more than a year for general anaesthetic. In some parts of the country, like my own area of Dublin north city and west, there is no special care service for children at all. We know children have to travel to either Louth or Kildare to get general anaesthetic if that becomes available and, of course, they are in the queue with everybody else from that area.

The reality with the dental treatment services scheme, DTSS, is that we have seen a drastic reduction in the willingness of dentists to participate in it over the last number of years. We must have a serious conversation with dentists about that. It is not good enough to just wave our arms in the air and say there are dentists going into cosmetic surgery and they should stay in dentistry. We need to have a serious conversation about the number of dentists who are currently in the private system and the number who would be willing to get involved with the dental treatment services scheme if the conditions were right. This is not about a free pass for dentists. This is about a serious negotiation. The other aspect of it that is critically important is what is actually available within the DTSS. It is frankly bizarre if you have had two fillings and require a third one in a particular year, you have to wait a further year but there is no limit on the number of extractions done. That is from the dark ages and we have to change how the dental treatment services scheme is designed.

It is also critically important to say the recruitment of dentists needs to be significantly looked at. We know there has not been any significant expansion or investment into our dental schools in decades. Barely half of the 70 dentists who graduate in Ireland each year opt to practise here in the long term. We know we need to add dental nurses and hygienists to critical skills lists. The other key issue for me is that notion of an apprenticeship scheme for dentists. I remember 20 years ago, which was a time dentists were coming out of college around the same time as myself.

Dentists were able to do part-time work with the HSE and part-time with a private practice. It was excellent training for that year after they graduated. Many dentists stayed in the private system but continued to provide that public care through the DTSS. Unfortunately, that system fell away in the intervening years and we do not have that nature of apprenticeship now within our dental services in this country. That needs to be restored. The plea is that we will not be standing here again this time next year talking about the same issues. We need to make sure the right investment goes into dental services and, in particular, there needs to be an absolute focus on prevention so that we are not storing up greater issues for our health service further down the line.

Deputy Eoghan Kenny

On this very important motion by Sinn Féin, I raise the significant issue of the dental treatment service scheme. Last year in the Dáil, I, along with my colleague, Deputy Sherlock, spoke about this scheme and about how it is simply not working. I refer to the number of people who come to constituency offices right across this country who tell us they are medical card holders but they cannot get access to a dentist in their locality. It is just not acceptable that a medical card holder in this country cannot get access to basic services like dentistry. The people who often take the blame for this are the dentists themselves. I spoke to a dentist practising in my home town of Mallow today who told me she saw a medical card holder, a patient of hers, last week. The cost of the dental treatment was €333. She received €109 from the HSE through the service scheme. Why, if I was a dentist, would I stay in that scheme? I would not because I am not covering the basic costs. Dentists themselves also have to live. We are failing two cohorts of people here. We are failing the very dentists we have in this country who are doing their best to provide the care needed in the country, and we are also failing those who have medical cards who very much need the dentistry care.

I worked previously for former Deputy Seán Sherlock who was a TD for 17 years, and year on year he would tell me about the significant issues being faced right across the constituencies by those who cannot access dentistry. If a constituent comes to me seeking my support in accessing a dentist who will take them on as a medical card holder, I have to ring around - and I do it because they are constituents of mine - different dentists across the county to ask them if they will take on a medical card holder. In the north Lee catchment area, which covers my constituency of Cork North-Central, 66 dentists have left the dental treatments service scheme in the past five years while just over 20 have joined the scheme. Give or take, about 40 dentists have left that scheme. That should speak wonders to those who are in charge of our health service. It should speak wonders to the HSE in relation to the system itself and the scheme being provided. It is simply not working and it is unacceptable for us, as politicians, to stand in this House and to speak about it year after year, from Dáil term to Dáil term, without actually fixing the problem.

We have a system that is not working. We must change it for the benefit of the people across this country who rely on this care and for the very dentists who provide it. It is a system that is not working and we must change it. It is as simple as that. We must provide effective dentistry care in this country for everybody. There is a socioeconomic issue here as well. People who are on medical cards may be those who are less well-off than those who can pay the all-out cost of dentistry care. There is a socioeconomic problem here as well. It is vulnerable people who are being left behind. We need to fix this dental treatment service scheme because it is not working.

Deputy Seamus Healy

Tipperary town, in my constituency, with a population of over 5,000 people and serving a further 10,000 in mid-Tipperary and east Limerick in its hinterland, has no dentist accepting public patients, medical card holders. That is absolutely and totally unacceptable. It is proof positive that the dental and oral health service in this country is totally in disarray and is failing patients very badly. In 2024, the number of dentists operating the dental treatment services scheme was 810. That was down from 1,452 in 2012; a drop of 642. Currently, the number in the scheme is believed to be less than 600. The very small number of dentists employed by the HSE in the public dental service is also reducing by 30, with 65 unfilled posts as of early this year.

The year 2019 saw the Smile agus Sláinte plan for the dental service. That was a strategy that was supposed to move the outdated curative care emphasis to a preventative care and health promotion model. However, seven years later, in 2026 there is no implementation of that plan. There is no plan; it is still apparently under consideration. The service has deteriorated since.

Of the 208,000 eligible school children, only 104,000 were screened - 50% - and that figure itself was down by 31,000 on the 2017 figure. Between 2009 and 2023, there was an €800 million cut in the funding for dental care for PRSI and medical card patients. Under that dental treatment services scheme, there was a drop of 94,000 in treatments between 2012 and 2024. That was down from 395,000 in 2012 to 301,000 in 2024.

As other speakers said, there is a two-year waiting list for patients in pain but requiring general anaesthetics. That is totally unacceptable. Of course, there is also the six-year wait for orthodontic treatment. Parents are being forced into private orthodontic treatment costing literally thousands of euro, sometimes as high as €6,000, €7,000 or €8,000, or their children must suffer on. Orthodontic treatment, as we know, is time sensitive and should be available when necessary. Middle-income and low-income families suffer most due to the lack of the public orthodontic service.

Even in the private service, dentists tell us that 25% are not accepting new adult patients and 33% are not accepting new child private patients. The ratio of dentists to patients in this country is one to 2,160, therefore we are at the lowest quartile of OECD in that regard.

The dental services is in chaos. What we need is a fully-funded resourced and staffed public dental service, and that should be established as a matter of priority. That requires a determined focused and multifaceted strategy to retain the existing dentists and to recruit additional dentists into the public dental service. To do that, a significant number of additional training places for dental professionals at third level must be put in place. Currently, there are only 70 dentists qualifying each year. That will increase in the next academic cycle to 87 due to the new dental school at the Royal College of Surgeons in Ireland. However, because of the fact that these colleges use fees from overseas students, 44% of students in them are from overseas, so it is almost certain that up to half of the students will never practice in Ireland. We should also remove dental nurses, dental technicians and hygienists from the ineligible list for employment permits and add them to the critical skills list. That would allow recruitment from areas outside the EU. Direct access to dental nurses, hygienists and technicians should be introduced in a similar way that pharmacists can now prescribe in limited regulated circumstances.

The legislation in this area is well over 40 years old. It is absolutely outdated and requires urgent updating. I support this motion and compliment Deputy Cullinane and Sinn Féin on bringing it forward.

Deputy Brian Stanley

I welcome the fact that these proposals are before the Dáil tonight. Only a few short weeks ago, I brought similar proposals to the floor of the Dáil and to Deputy Micheál Martin and set out a lot of what is in this motion. However, it is good that we are here and that parties are getting behind this.

I have raised these issues with successive Ministers for Health: James O'Reilly, Leo Varadkar, Deputy Simon Harris, Stephen Donnelly and the current Minister. We have had four governments in that time. It is a major failure on the part of a relatively wealthy state that we do not have a good public dental system. We have actually gone backwards. In the case of Laois, the figures show that matters have deteriorated. Students should be getting their first examination in third or fourth class in primary school, just as the Minister of State probably got in Graiguecullen and as I got in Laois. Prevention is key. However, they are now not getting that first examination until third, fourth or fifth year in secondary school. That is according to the HSE. There are 6,600 waiting for their first examination and 800 of these are overdue by six years, according to figures I recently got from the HSE. Some 1,500 are overdue by five years. If prevention is key, untold damage is being done.

I will raise the position of children and adults with special needs. This is a really serious issue. Those who can only have dental treatment under general anaesthetic are really being neglected. I have dealt with a number of cases where people have waited years for hospital access. In one case, not 100 miles from the Minister of State's own house in Laois, a boy has been waiting six years for treatment under general anaesthetic. This child is non-verbal and has serious inflammatory disease. He is in constant pain. This is medical neglect and it is not good enough. After repeated representations, he finally received dental treatment in a hospital recently. He had extractions but the teeth that remain are in very poor condition. The family tell me there is advanced decay and infection. I am informed that he will lose those teeth but the child cannot have dentures. This is very regrettable.

The school dental scheme has to be the foundation of a public dental scheme. We have to catch people when they are young. When this fails, as it is clearly failing in Laois, the whole system fails. How it is failing in other parts of the country has been outlined but the Taoiseach has agreed with me that Laois is a black spot. He also gave me a commitment to take this up with the Minister for Health. I would like to see that followed through on.

The dental treatment services scheme is 95% non-existent. There is just one dentist from Carlow providing this service in a community centre in Killeshin on the Laois-Carlow border. It is impossible for 95% of medical card patients to get treatment under the DTSS, the scheme that is supposed to cater for them. No dentist will do it. No dentist will take on new patients. The PRSI-based scheme, the dental treatment benefit scheme, only provides workers and families with a cleaning and an examination. It does not cover treatment. The Irish Dental Association estimates that we need at least 500 additional public dentists immediately because, as has been outlined here, we actually have fewer public dentists now than we had five years ago. According to the Irish Dental Association, we need an extra 500 if we are to make a start in providing dental care.

The fact is that, as a State, we have failed. Successive governments have failed to put a public dental system in place. Those with special needs have been failed, as have those with medical cards. Workers and families making use of the dental treatment benefit scheme have been failed. Crucially, there has been a failure to provide a proper school dental scheme. All of this shows that we are way behind and have a great deal of work to do. We are supposed to arrive at the full implementation of Sláintecare and a public health system within 18 months but, of course, we are nowhere near that. This should form part of that. I acknowledge that extra dental training places have been put in place but it is key that these students are recruited as public dentists and then retained.

There is work to be done. The Government needs to prioritise this with the HSE. We are putting money into the dental system. We probably need to increase that funding. I always argue for money to go into front-line services as much as is possible and for bureaucracy and the top layers to be reduced to make sure money is not wasted before it can be used to provide services. It is time for a major shake-up of how dental services are delivered. Other countries can do it. We should do it. We clearly need action and an action plan. We need to prioritise the areas I have outlined: the public dental scheme, the schools scheme, and children and adults with special needs, particularly those who are non-verbal and need to have treatment under general anaesthetic. Other countries can do it. Other countries did it years ago. We should do it. It needs political will. It is part of Sláintecare. We should get to work on it now and waste no opportunity. As I said, I have raised this issue with five or possibly even six Ministers across four governments but we are still not there. We have ground to make up. As an Opposition TD, I would certainly support Government in this. We need to do it.

Deputy Richard O'Donoghue

Where has the Government gone wrong on dental and orthodontic services? I was here when this was being raised seven years ago. Where has the Government gone wrong? Why has it not learned and why has it not listened? There are 11,000 on waiting lists, most of whom are children. Some 8,000 have been waiting to see a dentist for longer than two years. Where has the Government gone wrong? All my colleagues here have said the very same things. They have said it is absolutely disgusting and a disgrace that people cannot get to see a dentist. Children are supposed to have at least three visits to a dentist before they leave primary school but they do not get to see a dentist at all.

How do we fix this? As we told the Government a couple of years ago, fixing it is very simple. You build a team. You try to retain the next generation within the country. You train them and get them into practices where they have regular hours. So many people are waiting for services that the dental surgeries are staying open and people are working longer hours. Dentists coming into these practices do not want to stay there because the hours are too long and they can get better hours in other areas. They may leave the country. We have to build a team and encourage that team to stay here working in practices, even local practices, to help people. The same thing happened with SouthDoc, Shannondoc and our doctors' surgeries. The same thing is happening all the time but the Government is ignoring it. The small practices cannot keep going. You see doctors retiring and nobody taking on their surgeries. The same thing is now happening in dentistry.

The Government still has not listened. I have been here listening to this for seven years now. It is the same thing over and over again. We are promised it will be sorted this year, next year or the year after. As this goes on, children and adults are left suffering. I guarantee that if the Minister of State himself had an issue with his teeth, he would not wait. He would go private because he is in a financial position to do so. A lot of people in this country are not in that position. They are watching their children suffer because the Government did not listen and did not build a team to ensure we would have dentistry into the future.

Deputy Michael Collins

If you want to understand the true state of a nation's healthcare system, do not just look at its emergency rooms or its hospital beds. Look at its smiles. Look at the teeth of its children, the stress lines of its working class and the growing bills on the kitchen tables of ordinary families. In 2026, Ireland is celebrated globally for economic prosperity, technological innovation and a soaring population but beneath that shiny surface lies a painful systematic reality.

Dental and orthodontic services in Ireland are in state of absolute crisis. There has been a 4% decline in the number of dentists employed by the HSE in the past seven years. There has been a 31% decrease in the number of dental surgeons employed by the HSE since 2005 despite population growth of 32%. There are 27% fewer whole-time equivalent dentists now compared with 2019 and 25.3% fewer dental nurse whole-time equivalents than there were in 2019, with 7.7% of those in the Cork-Kerry region. The crisis hits no one harder than our children. Our target primary school screening programme, once the jewel of preventative care, is broken.

Recent data reveals that over 100,000 eligible schoolchildren were completely denied dental screenings because the number of public HSE dentists per capita has steadily fallen, leaving dozens of vital roles permanently vacant. Only about half of our students are getting checked when they should. What happens when children clear that hurdle and need structural help? They enter the punishing labyrinth of HSE orthodontic waiting lists. Right now, more than 11,000 people, mostly children, are stranded on waiting lists for braces and jaw surgeries in some regions. Families face a six-year wait for public orthodontics. I ask the Minister of State to think about that. A child identified with a severe agonising bite deformity at age 11 might not see a specialist until they are nearly an adult.

The data from the Irish Dental Association also shows 979 children waiting in HSE South West, of whom 438 have been on the list for over a year, 277 waiting in the HSE Dublin and South East region, of whom 172 have been on the list for over 12 months, and 81 on the HSE Mid West list who have been waiting over 12 months for a general anaesthetic. Too many children are leaving primary school without ever having had a dental screening. In 2023, fewer than 104,000 children were screened out of an eligible cohort of 208,000. What we are witnessing today is what professional bodies, such as the Irish Dental Association, have rightly called a poor law service, a regression to an outdated, unequal system where decent, timely oral care has effectively become a luxury for those who can pay and a lottery of charity for those who cannot. The foundation of our public oral health network is crumbling for years. The dental treatment service scheme was meant to guard the most vulnerable, namely, our medical card holders. That scheme has fundamentally collapsed. Private practitioners are withdrawing from State schemes in droves because they are forced to operate under austerity era rules dating back to the financial crisis.

Deputy Paul Lawless

Families are contacting me regularly about dental care. The level of frustration and desperation is shocking. The truth is that in many parts of the country people cannot access their dentist. In parts of the country people with a medical card will not find a dentist. That is how bad the dental service scheme is.

In relation to the school screening programme, according to the Government, every child is entitled to see a dentist before they leave primary school. However, the vast majority will never see a dentist and get their teeth examined under that programme. The system is in such chaos and has such bottlenecks that thousands of students will continue to leave the school system without ever seeing a dentist. That is absolutely wrong. There are so many families in Ireland who simply cannot afford to go private. These children are suffering and that suffering will go on into adulthood because their teeth will no longer be baby teeth. That is the truth of it.

We need to look at the dental Act. At present, there are bottlenecks in the system. For example, a dental hygienist cannot be seen until a dentist refers a patient to the public system. The fact that someone cannot access a dentist means that, therefore, they cannot access a dental hygienist. That is a bottleneck that needs to be addressed.

Workplace planning is important. This Government is not planning for the future when it comes to dental care, as with many other services in this country. I submitted a parliamentary question to the Minister for further education. The data I received was alarming. It showed that 40% of students studying dentistry in Ireland are from outside of the EU. That is extraordinary. We are training so few dentists in the country, yet 40% are from outside of the EU. The remaining 60% are a combination of Irish, British and EU students. This Government is not even capturing that data. This is really important. We need to understand how many Irish students are in the system. At a time when dental care is in crisis and the Irish Dental Association has said we are currently about 500 dentists short, the solution to this problem is that the Government gives a significant number of the limited places to students from outside of the EU, the vast majority of whom will not be retained in the Irish system. This crisis is going to go on and on.

I have listened to Deputies from around the House outline how many years we are into this crisis. A crisis is temporary. This is now complete and utter gross mismanagement of the system. We need to address workplace planning in the system, expand the places and protect those places for Irish students.

Deputy Paul Nicholas Gogarty

I am not the first to say it, but more than 11,000 children are on HSE dental and orthodontist waiting lists. Over 8,000 have been waiting more than a year. Half of all primary school children now finish school without ever receiving even a screening appointment. In some areas, the waiting time is four and a half years. This is not acceptable. In CHO 7, which covers Lucan, Palmerstown, Clondalkin, Saggart, Rathcoole, Citywest, Newcastle, Brittas and Adamstown, it is one of the bottlenecks. The Irish Dental Association told the Committee on Health that dental services are in severe shortage, with multi-year delays for school screenings, and there are chronic vacancies that it was the HSE's job to fill, but it did not do so.

The dental treatment service scheme has collapsed in many places, including my constituency. Participation fell from 1,600 dentists to 600. Different parliamentary question replies have confirmed that some areas have had periods in which no dentists were available. At the same time, we have rapidly growing areas in my constituency, including Adamstown strategic development zone, SDZ, and Clonburris SDZ. It is one of Ireland's fastest growing urban areas, with tens of thousands of new homes and new residents. There has been no corresponding increase in public dental staff, if only to keep up with the low levels we already had.

Again, I am repeating points that others who spoke before me made. Of the children needing dental surgery under general anaesthetic, 3,500 are waiting nationally, of whom 40% have been waiting more than a year. As others noted, there are solutions. It is about training more people who are going work here. If we have to recruit internationally, we have to do it properly and effectively. HSE campaigns, for whatever reason, whether it is pay, the number of adverts or the targeting of people, have been largely unsuccessful, with many posts remaining unfilled and some regions receiving no applicants. This does not only apply to dental services, but it is relevant to this debate. There are persistent vacancies year on year, but we have not run a serious recruitment strategy.

We need more tied scholarships that would assist people doing these courses, while getting them to work in the public sector for a period of time. We need more large-scale recruitment campaigns to beat the Australians at their own game and expanded training places. Again, we need to tie this to people who will work in this country. That is what we should be doing because we are in a crisis.

Deputy Mattie McGrath

I commend Sinn Féin on bringing this motion forward. It is a shocking and alarming situation. The old saying is "Mol an óige agus tiocfaidh sí" - praise the young and they will come. How can they come forward? The dental service is in crisis. In my constituency of Tipperary, we now face the shocking reality that Tipperary town, one of our major county towns, no longer has a dentist providing a service to public patients. This is not acceptable. The Government has repeatedly ignored warnings and pleas for changes to the dental medical card scheme. I have raised my concerns many times in the House and repeatedly with various Ministers for Health, yet we continue to see a complete failure to act. The Government has ignored the cost of dental inflation and expects private dentists to absorb the cost. That cannot happen and it simply will not happen. Anybody in business knows that, for very good reason, it cannot happen. The dentists cannot afford to do it.

The HSE pays a maximum of €109.96 for up to three repairs.

The laboratory fees alone for that work can range between €120 and €150. It is simple maths - it will not save your business if you do that. Before a dentist even factors in their own time, staff or overheads, they are already operating at a loss. These are substantial issues, which the HSE just will not listen to or engage with. A dentist is expected to absorb that and continue to treat public patients. It cannot happen - dentists are disappearing from the system and you cannot blame them.

Dentists simply cannot continue like this. As a result, many have a made the decision to withdraw from the scheme entirely. Others are limiting their services to basic pain relief only. A small minority of dentists are still trying to provide care under the scheme but they are at their wits' end. They are carrying the burden of an underfunded system without the support they need or deserve. It is just not acceptable. When you see a problem, you should try to fix it because this is getting worse year by year. Figures have been quoted on the thousands of children waiting. Children need treatment when they go into their teens or late teens. It is a big issue for them, especially young girls. We talk about mental health but these issues, when children need assistance with their teeth, should be sorted out.

I pay a full and special tribute to Dr. Daniel O'Connell, a Clonmel dentist working on the Quay. For nearly 40 years, he has served this community with professionalism and dedication. He has been sounding the alarm on this issue for years but, like so many others, his voice has not been listened to. Now, entire communities are left without public dental care. He has been warning about this but nobody was listening. I salute him and his staff, the dental technicians and receptionists. You could not find a finer practice.

The situation is untenable. The Government must urgently review reimbursement rates, engage meaningfully with the professionals and take immediate action to restore confidence in the public system. I received an email this evening from a mother about her son. It would bring tears to a stone. He was referred for attention. She asked if we can do anything. The son, whose first name is Noah, was approved by the HSE for publicly funded orthodontic treatment, his orthodontic issues being assessed as severe enough to qualify. When this was originally approved the parents were told Noah would be at least 18 before he was called for the treatment. Imagine that. Having discussed this with his orthodontist, who advised that 18 would be way too late for treatment to be effective, they made a difficult decision to begin private treatment at the end of February. On 5 March, the mother received a call from the orthodontic department of the HSE in Waterford, who informed her that the boy would move forward and receive funding beginning in November 2026. She explained that he had started treatment with a private orthodontist based in County Cork, the parents would be willing to remove him from that service and remove the wire that had been put in if Noah went back onto the public system. She was told that would not be a problem but, hey presto, it would be November 2026. On that basis, the wires were removed in anticipation of his public treatment but, sadly, on 12 June, two weeks ago, the parents received a further call informing them that the national oral health office had withdrawn the offer of funding and the boy, along with about 200 other children, would no longer be entitled to the treatment and would be placed back at the end of the waiting list. What kind of incompetence and disgraceful treatment is that to give a young boy who needs that treatment, was forced to go private, started treatment, got a call that it could be done publicly and later withdrew from that, having been told he would be get treatment in the public system-----

An Cathaoirleach Gníomhach (Deputy Sorca Clarke)

Thank you, Deputy.

Deputy Mattie McGrath

-----and then the money was pulled again. It is a body blow. It is disgusting and someone should be held accountable.

An Cathaoirleach Gníomhach (Deputy Sorca Clarke)

Deputy, your time is up. I call Deputy Danny Healy-Rae.

Deputy Danny Healy-Rae

I thank Sinn Féin for bringing this serious and important motion to the Chamber this evening. I have encountered many people looking for orthodontic treatment for their children as well as elderly people looking to get seen by a dentist when they only have a medical card. More than 2,000 people, mostly children, are waiting for dental and orthodontic treatment in the south-west region, Cork and Kerry. Deputy Michael Collins came at it from his side. Children are waiting for braces for more than two years. We all know if they do not get the braces when they need them, children can outgrow the possibility of the braces ever working or having the desired effect. I dealt with a number of young girls who lost confidence and would not leave their rooms. They barely go to school and after school they have no interaction with their friends. They do not go out in the evenings, at 16 or 17 years old. They felt they did not look right and they should look better. They were waiting for this treatment but they did not get it.

I do not know if the Minister of State is listening to me but he would want to listen to me about this. Maybe he will listen to other Deputies. We all have the same story. There is something wrong. Children are not getting the treatment they should get at 12, 13 or 14 years of age. When they go beyond that, they are gone beyond the time the braces and the work would have any genuine effect on their problems.

Not all parents can afford to pay for dental care. It is extremely costly and a lot of parents cannot afford it. This has life-long adverse effects on children. I cannot find any dentist in Kerry who accepts the medical card. It does not work because the medical card does not cover the cost. Is the Government giving enough to the HSE? Are we, as taxpayers, giving enough to the HSE to pay dentists properly? They cannot all be wrong. We have great dentists in Kerry, including Killarney, but they say it does not pay them and they have to put on more staff to cover public patients but the money they get to do it does not cover them. That question needs to be addressed. Does the HSE have the money? Is it going elsewhere with it like it is doing with a lot of other things? That question needs to be answered.

Many elderly people have to travel outside the county. I found two dentists - I believe they are both elderly - who would take patients and have taken the patients from Kerry. It is some distance from Kerry but I cannot say where it is because they would be overpowered with people coming to them and maybe then, they would not treat my patients. This is terrible. John Reilly, the publican across the road from us, was a great man to summarise things. Any of us know children have trouble with teeth coming but he used to say, they are trouble coming and trouble going, that is the story with teeth. People have a lot of pain. When a person is in pain and a tooth needs to be extracted, if they have a medical card and do not have the funds to pay for an extraction themselves, surely we should be able to do that for them. Any person in pain, whatever pain it is, it hurts them and drives them crazy. A toothache would drive you insane, out of your mind with pain when it goes on for days and days. I ask the Government to do something about funding the dentists properly to ensure these people can get treatment locally rather than travelling outside the county of Kerry. The Minister of State knows the effort to travel outside the county of Kerry and if you live in a place like Dingle or Cahersiveen, you have to travel two hours before you get to the county boundary to go to Limerick or Cork.

It is not right. We have great dentists in Kerry - very good, professional people - but they cannot afford to do teeth extractions, not to mind fillings, for what they are being reimbursed by the HSE. What is the HSE doing with the funding? Is the Minister giving the HSE enough funding? This is what we need to ask. If we are, then what is the HSE doing with it because it is not giving it to the dentists? There needs to be a re-evaluation. Every dentist cannot be wrong. They all have the same story - it is not paying them to do it. We are not coming in here and making this up. I am telling the Minister of State the God's gospel truth. Every day and every week, we have people in our office looking to see can they get a tooth pulled, but they cannot find a dentist who will take the medical card. That is the gospel truth. I am asking the Minister of State, for God's sake, to do something about it because it is time he did.

Minister of State at the Department of Finance (Deputy Robert Troy)

I thank all Deputies across the House for their contributions to the debate. I will not disagree with many of the arguments they made. While some progress has been made recently, it is absolutely fair to say that the current level of access to dental and orthodontic services is not where it needs to be. It needs to be improved. I know this from the various contributions that have been made tonight, having taken this debate on behalf of the Government, and from my engagement with constituents. It is important to recognise the challenges that many individuals and families are facing, whether they involve delays in accessing dental care, lengthy waiting lists for orthodontic treatment or difficulties accessing general anaesthetic. These issues are simply not good enough.

As has been acknowledged, meaningful reform is needed to address these long-standing issues. Work is under way in this regard. The Department of Health is working in conjunction with the HSE to develop a focused two-year national oral health action plan to improve access to oral healthcare services, while long-term reform is under way. Completion of the action plan, which is at an advanced stage, will also be informed, insofar as possible, by the recommendations made by the Oireachtas Joint Committee on Health in its report on dental services. The action plan will respond to sustained service pressures, workforce constraints and growing waiting lists, particularly for children, people with additional needs and other vulnerable members of our community.

The plan contains ten key action areas for implementation, including addressing waiting lists for the child dental programme and orthodontic services; a review of the dental treatment service scheme; support for recruitment, education and training for dental service positions; and support for innovation and new models of service. In the coming weeks, the Department expects to meet with the Irish Dental Association to further consult on the plan, with a view to finalising and publishing it shortly thereafter. Engagement is critically important but the publication and implementation of this plan are a priority and cannot come quick enough. I think we can all agree on this. The implementation of the plan will be overseen by an implementation oversight group jointly chaired by the Department of Health and the HSE. The Department and the HSE will continue to engage with key stakeholders to inform the delivery of the plan.

I acknowledge that the current school-based appointment service for children in second, fourth and sixth class is inadequate. Delays in early intervention can result in children needing more extensive treatment in later life. The action plan will address this by reducing the appointment backlog, with an initial focus on children in sixth class. While this is an important step, it is not a substitute for a service that provides early preventative oral health care for all children. This reform will be essential to improving oral healthcare services and is aligned with our national oral health policy, Smile agus Sláinte.

The success of the action plan will be enabled through addressing workforce constraints. Without a significant number of trained oral healthcare professionals, we cannot deliver the service to the level that is required. While it is encouraging that the number of dentists has increased by over 28% since 2019, this is simply not good enough. We still need more dentists, as well as dental hygienists and dental nurses, to provide the oral healthcare services that the public needs, deserves and requires. At the same time, we must maximise the role of dental hygienists, dental nurses and other dental healthcare professionals, including through the introduction of direct access, where appropriate, to enhance the capacity of our workforce. In collaboration with the Dental Council of Ireland, the scopes of practice of oral healthcare professionals, including dental hygienists, are being examined by the Department of Health to ensure each oral healthcare professional can work to the top of their licence, which is aligned with Sláintecare. Workforce reform must also be supported by a modern legislative framework. Updating the Dentists Act 1985 and introducing statutory continuous professional development are important steps in ensuring our oral healthcare services are fit for purpose and capable of meeting future demands. These reforms will help to support ongoing professional development across the dental sector.

I assure the Deputies that the Minister for Health will continue the ongoing work to address both the access issues that are affecting current healthcare services and to progress work on the implementation of the oral health action plan, which sets out a body of transformational reforms. These challenges are significant but we aim to address them across a multi-year programme of work. The first phase over the next two years will have a specific focus on short-term improvements to core services aimed at improving access and reducing waiting times. At the same time, this plan will support strategic planning and progressing the necessary structural reform required to build an oral healthcare service that provides care to people, with the right care in the right place at the right time. Along with the Minister of State at the Department of Health, Deputy Murnane O'Connor, I again thank the Deputies across the House for their contributions and reiterate the Government's commitment to improving our oral healthcare services.

Deputy Dessie Ellis

Early childhood dental examinations are important because they identify problems before they become serious. Early assessments of a child's teeth, jaws and bite can detect developmental issues that can reduce the need for more extensive treatment at a later age. Early check-ups can detect other health concerns and dentists may note the signs of conditions that can affect the child's overall health, such as nutritional deficiencies, oral infections and so on. Preventative dental care and early treatment is more cost-effective and less invasive than treating advanced dental disease. Early dental examinations ensure healthy oral development and establish good dental habits into adulthood. However, children can often face years before orthodontic treatment begins. This can be a result of staff shortages as the HSE has recruitment and staff retention problems. This has impacted school dental screening programmes and caused significant delays in routine dental assessments for children.

The long waits for specialist orthodontic treatment and the fact that orthodontic treatment is not covered by a medical card have meant that parents and adults have turned to private care. The cost of private orthodontic treatment can be prohibitive and treatments can cost several thousand euro. Children requiring moderate orthodontic treatment will not qualify for free care as the HSE will only fund treatments for children with severe orthodontic problems based on strict clinical criteria.

There are significant backlogs in targeted check-ups in the school dental screening service. This is a result of the many children reaching secondary school before receiving dental assessments. There are also fewer dentists participating in State-funded schemes. Among the measures the Government plans could implement is to put in place a plan to reduce waiting times for dental care and to increase resources for the school screening programme. Our dental healthcare is a system beset by workforce shortages, underfunded State schemes and outdated legislation.

Deputy Fionntán Ó Súilleabháin

Once again there is a crisis for families and primary school children in Counties Wicklow and Wexford and across the State. From Bunclody right up to An Bhearn Dearg, from Rathdrum to Kilmuckridge, children are waiting not months but years to have their teeth checked and attended to. My background is in primary school teaching and half of children at primary school level are not receiving dental screening appointments, something that was standard 50 years ago when this country was supposed to have been poor.

More than 11,000, mostly children, are waiting on dental treatment, with over 8,000 for more than a year. Some 40% of children are on a waiting list two years for braces. In counties Wicklow and Wexford, almost 900 young people are waiting between three and four years for orthodontic treatment. It gets worse. Following a parliamentary question I submitted last year, in 2025, the HSE admitted that the public dental service was still only targeting children who were in second or sixth class in 2019. That means many children in counties Wicklow and Wexford have simply been left behind, and could be in their leaving certificate cycle before being seen by a dentist, instead of having been seen in sixth class in primary school. This is unbelievable in a super-wealthy country in 2026. Meanwhile, the number of dentists available locally under the dental treatment services scheme has collapsed by 50% in County Wexford and 25% in County Wicklow over the past seven years. That is not an accident; it is a failure of planning, investment and political will.

Let us be clear about what needs to happen. The Minister of State needs to publish a real action plan to cut the waiting lists fast, modernise the DTSS, restart school screening immediately, integrate this with the GP visit card, invest properly in public dental services, expand access to dental nurses and hygienists and introduce a dental Act. I ask him to vote for our motion to bring about these changes.

Deputy Johnny Mythen

This motion calls for major reform of dental care in Ireland because the current system is systematically broken. The HSE dental lists are evidence of this, with 11,000 people, most of whom are children, waiting for an appointment. Some 8,000 are waiting more than a year, while 40% of children are waiting more than two years. In fact, we had a well-known and reported case in my own county of Wexford, where a pensioner, Mr. Hayes, pulled out his own teeth because he was in excruciating pain and had tried in vain to get an appointment at several dental practices. This is totally unacceptable in a wealthy, modern country.

Only one third of dentists are providing public dental treatment services, and only one tenth of dentists work for the HSE. This is causing major financial hardship for working families and people with disabilities, especially those who require an anaesthetic. This type of treatment costs a small fortune. Many families have to borrow from their local credit union for dental treatment. This is wrong. The recommendations of the Dental Council of Ireland should be implemented and a new dental Act should replace the outdated 1985 Act. A workforce plan must be implemented and more places must be made available for our young trainee dentists. Sinn Féin is also calling for a digitalisation of data for special care patients and patients with intellectual disabilities to ensure transparency and accountability.

We have an ageing population. It is not rocket science. It is a global fact that people will have problems with their teeth and oral health as they grow older. This is why we in Sinn Féin are calling for a total overhaul of our current dental system, which is completely out of date, and a legal framework for dental practices. Every man, woman and child should have access to a dentist if they need one. A major reform of our dental care system must happen because the current one is creating a two-tier operation that is only serving those who can afford it and those who have expensive medical insurance, while the majority of citizens are left to wait for years for treatment. This is wrong and something must change.

Deputy Ruairí Ó Murchú

The Minister of State has accepted that dental care, especially orthodontic care in this State, particularly that provided by the public system, is not fit-for-purpose in any way, shape or form. I do not know how many times we have all been in here talking about the DTSS. The fact is a person is incredibly lucky on a medical card if he or she can find a dentist and avail of it, but we have all seen that even in those cases, a person may be offered an extraction at times instead of a filling, on the basis of how not fit-for-purpose the system is.

I do not know how long we are going to continue talking about this. It would make an awful lot of sense if rather than saying great strides are being made, the Minister of State was saying great strides have been made and the Government has delivered a system that works for the people. It is as simple as that.

Regarding orthodontic care and Louth County Hospital, in one of my recent parliamentary questions, I asked for an update and the response was:

At this time, the Department is under-resourced, with a vacant consultant orthodontist post. There is a 1.0 whole-time equivalent for the Louth-Meath region, and 1.2 whole-time equivalent vacant specialist orthodontist post in Dundalk clinic.

The specialist orthodontist position has been vacant since January 2024. In August 2024, a recruitment campaign was halted due to the pay and numbers strategy, leaving only one valid vacancy to fill. The latest update I received on this is the post has been readvertised. It does not matter about the closing date, we need to see somebody in position. I could say the same about the specialist orthodontist 0.2 WTE post which has been vacant since March 2025 and, again, “readvertised lately.” We need to see that filled. The consultant orthodontist post has been vacant since late December 2022. This is not working at all. I also have a letter from a company saying it offers cross-Border orthodontic health care for patients. It states that the contract that was offered to it has failed miserably and it cannot even offer a private, short-term solution.

Deputy David Cullinane

I thank all of the speakers for their contributions. It has to be said, among Government and Opposition Members, including the Ministers, there is a recognition that we have a real problem, and that children and adults, but particularly children, are waiting too long. The problem is that this is not the first debate we have had on this issue. It is not the first time that issues and problems with dental and orthodontic wait times have been raised in this Dáil.

I mentioned that the Joint Oireachtas Committee on Health had a number of sessions on this and published a report. I have been talking about this issue for the best part of ten years or more. I recall dealing with this issue when I was a member of Waterford City and County Council, many years ago. There is no part of the country about which it can be said a top class service is being provided but there are parts of the country where it is really bad, and the south east and Waterford is unfortunately one of the worst-performing. The Minister of State talked about the system relying on private contractors, and it is, but no public system should depend on private contractors. The problem is that we simply do not have enough dentists and orthodontists working in the public system. That is a reality. When the Government says it cannot hire or find them or get them into the public system, that is what workforce planning is about. The Government starts a plan and examines why something is the case, deals with those challenges, overcomes them and puts in place a strategy to enable us to train more dentists and orthodontists, recruit more and have them in the public system, but it is not happening, and because it is not happening, we are not treating children in schools or doing the screening. Children with disabilities are waiting too long for treatment and the vast majority of children waiting for braces or urgent care are waiting far too long.

It is simply not good enough. We have put forward solutions in this motion. This motion is not being opposed by Government but what I want to see is not just the Government not opposing it, but actually engaging with the solutions we have put on the table. Let us improve this service so that we are not here in a year or a number of years having the same circular debate with more children unfortunately waiting for care.

Question put and declared carried.

Dáil Éireann debate - Tuesday, 23 Jun 2026

Dental and Orthodontic Services: Motion [Private Members]

Dáil Éireann debate -
Tuesday, 23 Jun 2026