Back when he was minister for health, Charles Haughey distributed a toothbrush and paste to every schoolchild in the State. Political stroke or not, this is about the last time children's dental health has figured in public debate.
Parents used to have a reasonable expectation that their children would be seen by a public dentist in 2nd, 4th and 6th class. Any problems picked up would be referred on, though there have always been long waiting lists for orthodontic treatment.
All that has changed in recent years, but without any formal public announcement being made. Now children get seen only if the HSE’s public dental service has the resources to see them. Service provision varies hugely from area to area, from school to school and from child to child within a family. Worse, parents are rarely informed that their children won’t be seen at a particular age; if they were, those that could afford it could presumably make their own arrangements privately.
The international scientific advice is that children see a dentist before their first birthday, and every six to 12 months thereafter, according to Kirsten Fitzgerald, consultant paediatric surgeon at Our Lady's Hospital in Crumlin. Early preventive work is cost-effective in the long run, she says.
The danger in coming late to examine a child’s teeth is that decay becomes established in the soft tissue, according to Dr Fitzgerald, and that can lead to infection, pain and further dental problems with knock-on effects for sleep, appetite and mood. Later on, it is the parent who feels the pain – financially – when expensive remedial work becomes necessary.
Children are eligible but not legally entitled to free dental services up to the age of 16 years. However, there are no clear guidelines on what treatment should be provided and no national plan.
The last time the state of Irish children’s teeth was measured was in 2002, when a report found that half of all five-year-olds had holes in their teeth and 87 per cent had untreated decay. There is no reason to believe things have got any better since, and plenty of grounds for assuming they are worse. One reason is that there are fewer dentists in the public services; numbers dropped 20 per cent between 2009 and 2013, from 399 to 322.
Meanwhile, the orthodontic waiting list continues to be a source of political embarrassment; currently, 17,000 children are on the list and 900 have languished there for more than four years.
The new guidance seen by The Irish Times represents a further hardening of the policy of prioritisation, to the detriment of younger children, but may help to reduce the orthodontic backlog.
"It means that, for the first time, children will not be seen until they are 12-13 and even then the priority will be orthodontics," says Fintan Hourihan, chief executive of the Irish Dental Association. "It's too late by then. And even if you have rampant decay, you'll just go on a waiting list."