ORTHODONTIC treatment to correct misaligned teeth has improved greatly over the past two decades. New developments including memory wire and “invisible” tooth brackets have made brace-wearing that little bit less difficult for patients.
But, in the past few years, access to orthodontics has become much more difficult. Within the public system, only children with the most severe problems, such as a combination of crooked teeth, bad bite and jaw disharmony, are eligible for free treatment.
But many parents are unaware of that and their children can spend years waiting for public assessment only to be told they are ineligible.
The public service moratorium and cutbacks to funding have exacerbated the problems, resulting in children who should be treated at 12 not being dealt with until they are almost adults.
Services on the north side of Dublin seem to be the most badly affected, with children referred to the HSE’s Mill House clinic in Ashtown waiting up to four and a half years.
The wait for children referred to orthodontic services in Navan can reach four years. Those referred to the orthodontic clinic at St Colmcille’s, Loughlinstown, face delays of up to three years and at St James’s Hospital orthodontic unit in Dublin 8, children wait for up to two and a half years for treatment.
There has also been a drop in the number of children attending for private orthodontic treatment. Dentists are attributing the reduction to financial pressures on families and a cut in tax relief on orthodontic treatment from 41 per cent to 20 per cent.
So why is orthodontic treatment so important for children? And what are the consequences if treatment is not carried out at the right time?
Dr Claire O'Sullivan of Dublin Orthodontist in Glasnevin,who also works for the HSE in Dublin, says timely orthodontic treatment for children is essential.
If children are treated while they are still growing, functional appliances can be used to modify the growth and positioning of the upper and lower dental arches.
This can be followed by fixed appliances, commonly known as “train tracks”, to move the teeth.
“In an ideal world children should get their appliances aged 11 or 12 and be finished most of their treatment by 14 or 15,” she says.
But if a child has stopped growing, functional appliances cannot be used, and some children who could have been treated more simply end up having surgery to correct their problems.
In some cases, it is impossible to achieve a successful result if a child has stopped growing, O’Sullivan says.
Even when later orthodontic treatment is successful, some children have to face a few difficult teenage years, self-consciously waiting to have their teeth fixed.
Some children may be bullied because of how they look, but for most it is a self-esteem issue, O’Sullivan says.
For example, one of her patients is 13 years of age and has gaps between her front teeth. She won’t go out because she is so self-conscious.
But her case is not considered severe enough to qualify for free public treatment. She cannot afford to be treated privately.
In her private practice, O’Sullivan says many parents complain of the long wait to be assessed, only to find their child’s problems are not severe enough for public treatment.
They tell her if they had known when their children were 11 or 12 that they would not qualify, they would have found a way to raise the money for private treatment.
“If every child was assessed at 11 and treated if necessary, these problems would be averted,” O’Sullivan says.
In the long run, early treatment would also save money, she says.
Most children’s treatment costs between €4,000 and €5,000 when carried out at the right time, but if left until later and surgery is required, the bill to the State can be about €30,000.
The problems are exacerbated by delays in carrying out routine dental checks in primary school children in some parts of the State.
“Children are not getting seen at 2nd, 4th and 6th class as they should, so they are not getting picked up as needing orthodontic treatment,” O’Sullivan says.
We had made great advances in dental health in Ireland, she says, but now we are going backwards to the 1960s.
In a statement to The Irish Times, a spokeswoman for the HSE says there are plans to move from "waiting lists to targeted waiting times for key areas of performance", which "should allow parents to be informed of expected treatment plans".
The HSE is considering prioritising complex cases in a pooled regional waiting list and giving additional training to practitioners, so that they “appropriately” refer children for treatment.
“In order to address current difficulties, orthodontic services may need to be rebalanced according to patient need,” the spokeswoman says.
Fintan Hourihan, chief executive of the Irish Dental Association, says members are very concerned about the many thousands of patients waiting for an assessment examination or who have been prescribed an orthodontic treatment plan and are waiting for it to be carried out.
Hourihan has written to Minister for Health James Reilly calling for National Treatment Purchase Fund money to be diverted to public orthodontics.
He has suggested marginal tax relief for private orthodontic treatment should be reinstated and also that “the anomaly” that means those without an income are unable to claim tax relief for orthodontic treatments should be investigated.
“A voucher system would be of considerable benefit in addressing public waiting lists given the profile of patients awaiting assessment or treatment,” he says.
The association is also calling on the HSE to carry out a comprehensive audit of the dental services currently available.
* This article was originally published on November 22nd, 2011. It was corrected on January 3rd, 2012. The name of Dublin Orthodontic in Glasnevin was originally incorrect.
