Ireland’s dental scheme for medical card holders is “in a state of crisis” and will continue to deteriorate without urgent reform, the Oireachtas health committee will hear today.
The Irish Dental Association (IDA) will warn that access to care under the Dental Treatment Services Scheme (DTSS) has collapsed, leaving many medical card holders unable to secure routine dental treatment.
In his opening statement, IDA chief executive Fintan Hourihan will say participation by dentists has fallen dramatically. Fewer than 600 dentists now operate under the scheme, compared with 1,452 in 2012 and 1,664 in 2016.
At the same time, demand has grown. The number of adults eligible for medical cards increased from 1.48 million in 2009 to 1.61 million in 2023. However, treatment volumes have dropped sharply, from almost 1.6 million procedures in 2009 to just over 970,000 in 2023.
“This decline is certain to continue without meaningful reform,” Mr Hourihan will say.
He attributes the exodus of dentists to State-imposed restrictions on treatments and materials, heavy administrative burdens, delays caused by HSE approval requirements, and fees that fail to cover the cost of care.
Although fees have increased in recent years, Mr Hourihan will argue the scheme remains largely limited to emergency care and extractions, with few preventive options. He will warn that this approach deepens inequality and ultimately increases long-term costs for the State.
The IDA has proposed a voucher-based system and interim measures such as evening clinics in HSE facilities. However, Mr Hourihan will note that formal negotiations on a replacement scheme ended in 2008.
The association will also highlight a growing workforce shortage. It estimates that at least 500 additional dentists are needed across the public and private sectors. While welcoming the opening of the new RCSI dental school, Mr Hourihan will point out that Ireland’s two existing dental schools in Cork and Dublin produce about 90 graduates a year, with around half coming from outside the EEA and typically returning home after graduation.
He will also raise concerns about delays to a planned new dental school in Cork, which was due to be completed in 2023. The IDA believes non-EEA student places should be capped at 20%, but says this would require additional State funding to compensate dental schools.
In addition, the IDA will call for the restoration of school dental services. Mr Hourihan will say the HSE school screening programme has deteriorated significantly, despite a long-standing policy of screening children at three stages of primary school.
In 2023, fewer than 104,000 children were screened, down from 152,000 in 2018, even though the eligible population is around 200,000. Screening rates vary widely, from as low as 19% in Limerick to 87% in Tipperary.
The consequences, he will warn, include higher rates of tooth decay, more extractions, and delays in orthodontic care.
