Dental decay is the most common chronic disease of childhood. Recent research by Behaviours and Attitudes has shown that the majority of parents feel it is suitable to wait until children are in primary school before scheduling the first dental visit. The problem with this approach is that many children will already have developed significant dental problems before school going age. Up to 50% of 5 year olds have decay experience in Ireland. Untreated dental disease in young children leads to pain, infection and poor quality of life. Children’s general health is also affected by chronic infection. Dental decay is amongst the most common reasons for general anaesthetic in Ireland and the UK.
Unfortunately delaying the first dental visit means that many children attend the dentist for the first time with pain and dental problems. Dental disease is preventable but starting visits early is essential to good dental health and positive dental behaviours. Children who attend the dentist with pain are more likely to have stressful experiences and in turn are more likely to become nervous dental patients as adults.
State funded dental care has been grossly neglected in recent years. The moratorium on recruitment within the Public Dental Service has meant that staff numbers are insufficient to meet the needs of the population. Children are entitled to emergency dental care up to the age of 16 years. Children are entitled to treatment of decay in permanent teeth through the school screening programs. Often children are not called by the school service until they are in second class or even later. Even if treatment is provided, routine check-ups are not included in the entitlements that children have. There may be 3-4 years between screening visits and this is a long time in the course of a child’s dental development where a lot of change can occur.
It is a positive thing that children have the entitlement to emergency dental treatment until the age of 16 and that there is a school screening program. It is however important that parents understand that this is not a complete system of care. Children require dental check-ups and professional cleaning every 6-9 months. The public service is not sufficient to depend upon for children’s routine dental needs.
The Irish Dental Association recommends that dental visits should start by 12 months or as soon as the first tooth develops. This is to ensure parents receive appropriate advice on fluoride use, habits, cleaning, teething and anticipatory guidance on the prevention of dental disease. Currently this is not one of the entitlements provided for by the Public Dental Service. Therefore parents need to arrange this privately through their own dentist. It is important not to wait for an appointment to arrive in the post.
Due to funding constraints, many Public Dental Clinics are forced to prioritise adult teeth and therefore when there is a problem with a primary tooth, the only option available is to remove the tooth. Parents need to be aware that in the majority of cases if they wish to have their child’s decayed primary teeth fixed, they need to attend privately. The same applies when a primary tooth is extracted and a space maintainer would be beneficial to prevent closure of space and potential risk of crowding in the adult teeth. This is not an entitlement in the Public Dental Service.
The point of this article is not to in any denigrate the Public Dental Service which faces huge challenges in meeting the needs of the population under very difficult circumstances. The key message for parents is that children are not entitled to important early dental visits or routine preventive care outside of the school screening service. It is easy to assume that children will be called on time and this is a problem for Irish children’s’ dental health.