Seanad Éireann - Volume 103 - 14 March, 1984
Dentists Bill, 1984: Second Stage.
Question proposed: “That the Bill be now read a Second Time.”
Minister for Health (Mr. B. Desmond) Barry Desmond
Minister for Health (Mr. B. Desmond): The Dentists Act, 1928, is the legislation that governs the registration and control of persons practising dentistry and the maintenance of standards of dental education and training in this country. There has been only one minor amendment to the legislation since its enactment. That was in November last when it was found necessary to extend the term of office of the Dental Board, established under the 1928 Act, so as to keep it in office until this new legislation was passed.
The 1928 Act has, therefore, remained virtually unaltered over the years. Legislation, no matter how well thought out and drafted, cannot be expected to provide for every eventuality, especially in times of rapid change, and so with the  passage of time and in particular in the past few years, it became evident that alterations were required to the provisions of the 1928 Act. Some of these alterations could be termed necessary while others were of a desirable rather than of an essential nature.
A series of amendments to the 1928 Act perhaps could have effected the necessary changes but it was thought preferable to bring in an entirely new Dentists Act and to incorporate in it the best of modern thinking in relation to the practice of dentistry.
This Bill, therefore, is designed to bring the laws governing dentistry up to date and, in so far as possible, to provide for future developments in the profession. It is being put forward as a comprehensive measure, repealing the existing legislation, but at the same time re-enacting where necessary the provisions of the old Act. In many ways the proposed legislation is parallel to the legislation governing the medical profession contained in the Medical Practitioners Act, 1978 but it contains also certain provisions which are peculiar to dentistry.
The Bill provides for the dissolution of the Dental Board set up under the 1928 Act and its replacement by a new body to be known as the Dental Council. Over the years the Dental Board has served the general public and the dental profession well. The esteem in which Irish dentistry is held today throughout the world is due in no small measure to the dedication and efficiency of the many individuals who have served as members of the Dental Board over the years.
I would like to take this opportunity to extend my sincere thanks to all of them. Special thanks are due to the current membership of the Dental Board who were willing when called upon to serve for an extended period beyond the normal term of office of board members in order to facilitate the smooth transition from Dental Board to Dental Council arising from the provisions of the new legislation.
In drafting any legislation it is necessary to consult with all those who will be affected in one way or another by its  provisions and with those who might have an input into the legislation. I can assure the House that this has been done in the case of the Dentists Bill and that every shade of opinion has been sought and listened to. We are indeed fortunate in this country in that in almost every sphere individuals exist who are dedicated to the promotion of excellence.
The dental profession is no exception and in the course of consultations on this new Bill discussions were held with those who are committed to promoting the profession and the practice of dentistry and who are anxious to maintain and improve standards of education and training, and indeed the code of behaviour which governs the members of the profession. In formulating the proposals contained in this Bill, due regard was had to all opinions put forward by those consulted.
The purpose of the new Dentists Bill is to update and improve the legislation governing dentistry in this country. One of the fundamentals of the regulation of any profession is the recognition and registration of those who by virtue of their education and training are regarded as competent to practise it. The benefit which the general public derives from statutory registration is that it enables them to recognise the qualified practitioner, thus protecting them from those who are unqualified.
The registered practitioner on the other hand, through statutory registration, enjoys the benefit of public recognition of his status and the consequent practical advantages which this bestows. Statutory registration is, therefore, to the mutual benefit and advantage of the general public and the practitioner.
There are eight main parts in the Bill and I propose to deal with the principal provisions of each part in sequence.
Part 1 of the Bill provides for interpretation, by defining certain words and phrases which occur throughout the Bill. It also provides for the fixing of commencement days for the bringing into operation of certain provisions of the Bill. It provides, too, for the repeal of the existing legislation governing the dental profession; that is to say, the Dentists  Act, 1928 and the Dentists (Amendment) Act, 1983 — the latter being the Act through which the term of office of the present Dental Board was extended to facilitate the introduction of this new legislation.
The first major change in the existing provisions is contained in Part II. This provides for the dissolution of the Dental Board and its replacement by the new Dental Council. This is not merely a changing of the name of the statutory body for the regulation and registration of the dental profession.
First of all, the new council will have 19 members whereas the Dental Board has only nine. However, it is the make-up of the membership of the new council and its powers, rather than the number of its members that is significant. The role of the Dental Council in the education and training of dentists is reflected in the representation given to educational interests. The council will have four members appointed by the undergraduate educational institutions and one member by postgraduate interests and it will also have a nominee of the Minister for Education. The number of representatives of the practising profession, elected by their colleagues, will be increased from five to seven and while this will not give them a majority on the council as they have on the present board, it will nevertheless ensure that the practising profession will form the biggest single group on the council. Two members of the new council will be nominated by the Medical Council which has three representatives on the Dental Board at present. The reduced Medical Council representation reflects the increased independence and responsibility of the Dental Council in the matter of the education and training of dentists. The remaining four places on the council will be filled by my nominees and at least two of these must be non-dentists who will represent the general public as consumers of dental services. This is in line with the provisions of the Medical Practitioners Act, 1978 which gives similar representation on the Medical Council to consumers of medical services.
 The Dental Council will have the authority to set up various committees to carry out specific functions of the council, and the Bill provides in particular that three such committees shall be set up to act for the council in matters relating to its education and training functions, its functions in relation to the fitness of members of the profession to practise dentistry and its functions in relation to auxiliary dental workers.
The remainder of Part II of the Bill deals with the mechanics for the setting up and the staffing of the Dental Council, the make-up of membership of the three specific committees of the council and the various powers of the council, including the charging of registration fees.
Part III of the Bill deals with the registration of dentists. In addition to the establishment and maintenance of the basic register of dental practitioners there is provision for the future establishment of a register of dental specialists, should the council consider it desirable. The provisions relating to the establishment of the basic register follow the pattern of the existing legislation except that specific provision is made for the registration of nationals of member states of the European Economic Community who possess the necessary qualifications. Under directives of the EEC which came into effect here in January 1980 we here in Ireland are obliged to recognise certain qualifications in dentistry issued by other member states of the EEC and vice versa. There is also an obligation under these directives to permit the holders of the recognised qualifications to practise dentistry anywhere in the EEC. One of the directives relates to the setting and maintaining of minimum standards of education and training in dentistry within the EEC.
An agreement concluded in 1927 between this country and the United Kingdom and incorporated in the 1928 Dentists Act provides for the mutual recognition of dental qualifications awarded in these islands and could be said to have foreshadowed the provisions of the relatively recent EEC directives.
Registers of dental specialists, such as orthodontists and oral surgeons, exist in  France and Germany and such registration is about to be introduced in the Netherlands. It exists also in many countries outside the EEC, for instance in the USA and in Canada. The registration of specialists is of benefit to the public in enabling them to identify those who are qualified and who specialise in particular aspects of dentistry. It also enables the public to clarify whether a practitioner possesses the qualifications he purports to possess. Although the provisions in the Bill do not compel the Dental Council to set up a register of dental specialists now, they give the council the facility for registering specialists at some future date if it should consider it desirable to do so.
Part IV deals with the education and training of dentists. It spells out the duties of the council in relation to undergraduate and postgraduate education. The council will have to satisfy itself as to the suitability of the education provided by the two dental schools in the State, that is to say Trinity College, Dublin and University College, Cork, and as to the standards of education and clinical experience required for basic qualifications in dentistry.
The council will also be required to satisfy itself as to the standards of postgraduate education and training in the State. Part IV also outlines the duties of the council in relation to compliance with EEC directives regarding minimum requirements for qualifications in dentistry in member states. It also outlines the Council's responsibilities in relation to qualifications in specialised dentistry. Our standards in dental education and training are highly regarded abroad and I feel sure that the objectives of the Dental Council will be to establish and maintain standards that are higher than those stipulated by the EEC as minimum requirements. The educational role of the council is far more responsible than that exercised by the Dental Board at present and in general the new Bill makes provisions which will assign to the council powers in relation to undergraduate dental education that are vested in the Medical Council at present.
This move to make the dental profession  self-governing is long awaited and will, I know, be welcomed, not only by the dentists, but also by the undergraduate educational interests and indeed by the medical profession. The education and training functions of the Dental Council will be performed by the Education and Training Committee which I referred to earlier.
Part V of the Bill extends greatly the powers of the council in relation to the discipline of members of the profession for professional misconduct or general unfitness to practise. While, fortunately, it is only very rarely that it is necessary to have recourse to disciplinary action in regard to any member of the dental profession, it is essential in the interests of the public and of the profession itself to have adequate and suitable machinery available whenever it is necessary to have recourse to such action. The statutory powers of the Dental Board at present provide only for the erasure of a dentist's name from the register. Recognising the fact that circumstances may arise where some disciplinary action may be called for but that the penalty of erasure would not be always warranted, provision is also made in the Bill for lesser penalties.
Section 39 empowers the council to suspend a dentist's registration; section 40 gives the council power to attach conditions to a dentist's continuing registration and section 41 contains provisions enabling the council to admonish, to advise or to censure a dentist in relation to his or her professional conduct.
In relation to Part V as a whole, it was necessary to ensure that its provisions would not be in conflict with the Constitution. Difficulties have arisen over the years in relation to the constitutionality of the powers of registration councils and other bodies dealing with the regulation of certain professions and there have been some instances where these powers have been found to be in conflict with the Constitution. The provisions of Part V of the Bill, therefore, have been very carefully drafted to ensure that there can be no such conflict in so far as the discipline of the dental profession is concerned. What is proposed is that every disciplinary decision of the council will be subject  to the approval of the High Court either on appeal by the dentist concerned or by way of application to the court by the council in the event of no appeal being made.
There is also a provision which enables the council to take action against a dentist because of his unfitness to practise by reason of physical or mental disability. Again, the judicial safeguards have been built into this section.
Part VI defines the practice of dentistry and describes those who are entitled to practise dentistry in the State. The 1928 legislation could be regarded as somewhat defective in that it made no specific provision for the practice of dentistry by students of medical and dental schools. The new Bill contains provision for the practice of dentistry by these students, under the supervision of a registered dentist. The Bill also provides that the general prohibition on the practice of dentistry by non-dentists does not apply in the case of auxiliary dental workers, subject to certain provisions outlined in Part VII. The penalties for offences under this part of the Bill have been updated, as indeed have all others throughout the Bill, and these could serve as deterrents to those who at present might be prepared to run the risk of prosecution in the knowledge that the maximum penalties that can be imposed for the illegal practice of dentistry are relatively trivial in this day and age.
Under Part VII there is provision for the recognition and registration of classes of auxiliary dental workers. It gives the Dental Council the power, subject to my approval, to determine the nature of the dental work that a dental auxiliary may be allowed to undertake and to stipulate the circumstances and conditions under which such work might be undertaken. We already have dental mechanics and dental surgery assistants working in this country though neither class of dental auxiliary can be registered under existing provisions. There are certain classes of auxiliary dental workers in other countries who perform various dental procedures which under the existing 1928 legislation are illegal here. For instance,  dental hygienists are a class of dental auxiliary that exist in some countries and which I would like to see introduced here under the new provisions. Hygienists, as well as carrying out clinical tasks such as cleaning and polishing teeth, perform a very useful service in instructing patients in preventive care measures such as oral hygiene and in dental health education in general. The dental profession would have no objection to and in fact would welcome the introduction of dental hygienists here. In the public sector they could make a significant contribution to the dental care of school children since, apart from the valuable service they would provide themselves, their use would permit health board dentists to concentrate on the delivery of clinical work rather than have them spend valuable time on oral hygiene instruction, etc.
I intend also to establish under the new legislation a class of auxiliary dental workers whose education and training would make them competent to supply dentures direct to persons of 18 years of age or over. They would not, of course, be permitted to perform any work on living tissue. The idea of such a class of dental auxiliary workers is not new and they already exist in many countries abroad. For instance, such a class has existed in Denmark for many years. The introduction of such a class of dental auxiliary here was one of the alternatives suggested by the Restrictive Practices Commission following the public inquiry which they carried out in 1982 into the legal restriction to registered dentists of the supply of dentures to the public. The commission made it clear in their report that they were not at all in favour of dentures being supplied to the public by unqualified persons but they were against the retention of the existing legislative provisions which they regarded as restrictive.
The establishment of a qualified class of auxiliary dental workers who are competent to supply dentures to the public direct will to some extent remove the monopoly enjoyed by dentists in providing this service at present. However, it is well known that for many years certain dental mechanics have been dealing with  the public direct, which, in the case of the supply of dentures, constitutes the illegal practice of dentistry within the meaning of the 1928 Act. As indicated earlier, the penalties for offences under the existing legislation did not prove to be an effective deterrent and this will now be rectified. The provisions of the new legislation, therefore, far from constituting a relaxing of the restrictions on the practice of dentistry, should in fact result in greater safeguards for the public from the activities of illegal operators. Only qualified persons will be permitted to practice dentistry and those who are in breach of these provisions will be liable to incur stiff penalties. I would hope that preliminary moves towards the establishment of this new class of dental auxiliary would be initiated as soon as this legislation is passed. This would involve discussions with all concerned leading to agreement on standards and on education and training programmes for the new class of auxiliary.
Although there is no specific provision in the membership of the Dental Council for auxiliary dental workers, any class of auxiliary established by the council would have a representative on the committee of the council dealing with auxiliary dental workers. This is provided for also in section 13 of Part II of the Bill.
As well as providing for the establishment by the council of certain classes of auxiliary dental workers, Part VII also gives the Minister the authority, if he thinks fit, to direct the council to establish a particular class of dental auxiliary either on a permanent basis or for an experimental period, in order that the value to the public of the particular class of auxiliary may be assessed.
Part VIII contains various miscellaneous provisions including authority for the making of regulations by the Minister for Health to give effect to any of the provisions of the Bill. It also provides, under section 65, for the continuing in force for the time being of the agreement I referred to earlier between this country and the United Kingdom for the mutual recognition of dental qualifications awarded in these islands. This agreement has served its purpose well over the years  but it is no longer relevant in the light of the mutual recognition of dental qualifications and rights of nationals of member states of the EEC to practice dentistry in the other member states. This agreement will, therefore, be terminated as soon as practicable following the enactment of this legislation and discussions are already in progress with the United Kingdom authorities towards this end.
There are two Schedules attached to the Bill, one of which lists the primary qualifications in dentistry issued in the State at present. The other Schedule contains details of the rules regarding membership and meetings of the new Dental Council. It covers such items as tenure of office of members, resignations and termination of membership, casual vacancies, quorum, proceedings at meetings, etc., all of which are on the lines of the normal rules governing bodies of this type.
Before concluding I would like to place on the records of the House my appreciation of the role played by the dental profession in our society. They have given long and dedicated service to the community and I know that this will continue to be the case in the future. I would like in particular to thank all those members of the profession who have given and continue to give their services voluntarily in serving on various committees, boards and working parties. Their contributions help to maintain the high standards in dentistry which we in this country are so lucky to possess.
The general description which I have given of this Bill will, I hope, demonstrate that it is non-controversial and that its only aims are the advancement of standards of the practice of dentistry and the safeguarding of the general public. The introduction of the Bill is long awaited by the dental profession itself and I am sure that the profession will be in agreement with its general provisions and would wish for its enactment at the earliest possible date. In that regard I welcome the statement issued on 8 March by Mr. Donal Atkins, General Secretary of the Irish Dental Association, commenting on the Bill and generally welcoming its introduction. I welcome his  agreement and the agreement of the association that the general direction of the Bill will provide for the protection of dental patients and the community as a whole from harmful practice by unqualified personnel. Further, I welcome the indication from the association that the composition of the proposed Dental Council appears to reflect the public interest as well as that of the profession and that they will be given sufficient powers to safeguard that public interest.
I noted that the association were reassured and pleased by the fact that the Bill makes provision for the establishment of schemes whereby properly qualified, registered and supervised dental auxiliary workers, such as dental hygienists who will be concerned with the prevention of dental disease, may be permitted to practise under the supervision of dentists.
Therefore, I hope that this Bill will have a speedy passage, and I look forward to the co-operation of the House in making this possible. I want to thank Senator Jim Dooge for initiating the Bill in the first instance in Seanad Éireann, and its passage through this House is the first step.
Mr. Fallon Mr. Fallon
Mr. Fallon: The Dental Board who have been referred to by the Minister as we all know have been a statutory body set up under the Dentists Act, 1928, over 50 years ago. As the Minister rightly said, they have served the profession well. Up to then the profession was in a chaotic situation. Indeed in this House the then Minister for Health referred to unlicensed persons from whom the public should be protected. Obviously in those days there were wholesale massive abuses of the profession and it was right and proper that corrective action should have been taken. Since 1928 — as the Minister said, we had a short Bill here some months ago — the practice of dentistry has come a long way. The profession has served the public very well, as we all acknowledge, and this fact has been totally acknowledged in the Minister's address here this evening.
Over the past 56 years the Dental Board have acted as a very important  watchdog for the profession. They have not been afraid to act against a member of the profession if they felt it necessary. Generally as a collective group they have a very real sense of pride and responsibility for maintaining the integrity and competence of their profession as a whole. In their area of specialist skill we are getting a fairly specialised service.
This Bill does many things. For example, the right of the State to intervene in certain professions if it considers that the public need protection, cannot but be agreed upon, particularly in the area of health, life and so on. It is right that in this highly skilled area also that the State should have some input, and the council that the Minister sets up should consist of people who understand the profession. Members of the public are sometimes good judges of the quality of service but in skilled specialist service, as in this case, perhaps their judgment would not be totally correct. For that reason the 19 members of the council provided for in section 9 of the Bill have been fairly well considered. My calculation is that of the 19 members, 14 have a medical-dental background and obviously would understand medical problems facing the council. One is representing the general public and here the Minister is probably thinking of fees and charges generally. Certainly the consumer has a right to have a voice on this council and so too has the Minister for Education. I throw out for discussion a possible amendment to provide that this council should have a direct link with the Irish National Teachers Organisation. Perhaps the Minister for Education will decide in her wisdom to nominate somebody from that area because it is an area of importance.
At primary school level the question of brushing and care of the teeth is vital for the children and if at that stage hygiene and all other relative matters are explained to them that training will stay with them for the rest of their lives. The Minister should think about this because, apart from that aspect, it is generally accepted that the school dental scheme is a very serious matter of contention which I, as a public representative, and I am  sure the Minister also, have found many times to be a very real problem.
Of course the question of orthodontics at that level is surely a national disgrace. I have known of delays of five, six and seven years before a child is looked at after his name appears on the list for treatment, and by that time it may well be too late to do anything about the problem. Indeed, in ordinary dental treatment too there is quite a backlog. This whole area should be examined thoroughly with a view to corrective action. That is why I am keen that somebody from the INTO should be a member of the board. If need be why not have a 20-member board? I hope the Minister will consider my suggestion.
Section 34 deals with the area of education and training, and standards of knowledge and experience required in dentistry in this country. It is well known that people who aspire to a professional qualification must have obtained a sufficiently high standard in their leaving certificate and the points necessary for entry into dentistry studies are equal or very close to what are required for medical students. Subsequent examinations ensure great competency on the part of the people who qualify, and not alone that but the profession imposes what is almost a duty on its members to continue to improve their standards. Through the years they have continued to improve their own education, thus continuing to provide service for the people which has been of a very high degree of professionalism.
The three sections dealing with auxiliary dental workers need very close examination and perhaps will be examined in greater detail on Committee Stage. What does the Minister mean in section 56 by directing “the Council to make a scheme” and “an experimental period”? In so far as the training of these people is concerned any work that they carry out must be under the direction of a registered dentist after the dentist has first examined the patient and outlined the course of treatment. How will the public react to this? It must be remembered that the work that these people will be engaged in is and has been part and  parcel of the work of the dentist who has had many long years of careful training. The medical profession will certainly have to have a very large input into this whole area. That profession are very conscious, and rightly so, of the preventive aspects of medicine. So too, dentists now tend towards preventive treatment. Scaling and general gum treatment play an important role in the whole dental field.
Section 38 of the Bill deals with “Inquiry by Fitness to Practise Committee into the conduct of a registered dentist”. The dentists of Ireland would welcome this section, the aim of which is to extend disciplinary powers in relation to the practise of dentistry and to ensure that these powers are compatible with the provisions of the Constitution. The present power of the Dental Board in this regard deals only with the erasure of a dentist's name from the register. I would generally welcome the provision for broader powers to be given to the Dental Council whereby a dentist can be suspended from the dentists' register for professional misconduct, as can happen from time to time with so many people practising. It is also right that the Bill provides the right of the dentist in question to apply to the High Court for cancellation of the council's decision. That is to be welcomed also because dentists, like all of us, are human beings and unfitness to practise in that profession, as indeed in any profession, due to change in physical or mental ability, can occur at any time. The changes in this area appear to be practical and fair and they protect the general public, the profession and the rights of the suspended dentist.
It is generally believed that the training of technicians in this country is totally inadequate and I understand that the scheme administered by AnCO has not been at all satisfactory. The council should investigate and tackle this problem. The technicians would require a full-time course in a dental school or college of technology. It is interesting to compare our training system with what pertains in Denmark where the training of denturists consists of a period of five years, that is two years of technical training, two years of clinical training and a  year of supervised clinical practice, a total of five years in all compared to our training period of six months which is inadequate. People who are trained should have priority over those who have not the same competence and degree of training. A person with, say, six months of training should not be allowed to set himself up as suitable to treat the public. We have some excellent dental mechanics in this country. They should be protected and overnight technicians should not be allowed to spring up all over the place.
I referred earlier to preventive dentistry and to the gums. It can be said that the gum is the very foundation of the whole dental set-up and dentures can cause real problems if the operation is not properly executed. We speak of foreign bodies in our mouths but in that sense one could say that a denture is a foreign body. I think that gums and all the supporting tissues would be at risk with the provision of dentures by persons not trained in oral physiology. All of this area must be totally understood. Therefore, years of training must be given to the person concerned. The general comment I make is that the financing of the work of the water fluoridation scheme should be extended. Money spent in this area is well worth while. I am told of a scheme in the Monaghan-Cavan area where money could not be sought from either the Department or from the county council for fluoridation. This is a disgrace. Hopefully it will not be allowed to continue. The worth while effect of fluoridation is obvious everywhere. It must be allowed to advance with its very obvious benefits. Fluoridation has clearly improved the dental health of people.
The dental treatment of physically and mentally handicapped people, disabled people and people in various institutions is something that should be examined. Hopefully nobody will be neglected in this area. Overall, I would hope that there must be something in this Bill for everybody. In particular, there must be something in it for the public because we have to consider the implications for the dental health of the public primarily. I  give my wholehearted support and a general welcome to the Bill.
There are areas we will talk further about on Committee Stage. At this point in time, I would say that it is a Bill to which I give general welcome and I support the principles enshrined in it.
Mr. Kennedy Mr. Kennedy
Mr. Kennedy: Is mian liomsa ar dtús fáilte a chur roimh Bille na bhFiaclóirí agus is mian liomsa freisin comhgháirdeas a dhéanamh leis an Aire Sláinte agus leis an Rialtas as ucht an Bille seo a thabhairt os comhair an tSeanaid.
First of all, I would like to express a very broad welcome for this comprehensive Bill, the first such Bill introduced in this country in 66 years. In doing so, I would like to pay tribute to the Minister for Health and Social Welfare, Deputy Barry Desmond, and to the Government. In particular, I would like to pay tribute to Deputy Fergus O'Brien, Minister of State, who during his time as Minister of State at the Department of Health had a particular interest in this matter. We are seeing some of the fruit and results of his hard endeavours in that regard.
I would also like to take this opportunity to express our grateful appreciation to the joint working party for their dedicated work in this regard. This is a very comprehensive Bill consisting of eight parts, 68 sections and some Schedules. I would like to compliment the Government in bringing this Bill before the Seanad within 15 months of their being elected to office.
I join with Senator Fallon in welcoming the proposals in Part II of the Bill, sections 9 to 25, for the establishment of a Dental Council to replace the existing Dental Board. The council will consist of 19 representatives as opposed to nine on the board at the moment. The council will be broadly representative of the various interests and there will be at least two representatives of the consumer interest.
I agree with Senator Fallon that the Minister should give very serious consideration to having representation from the Irish National Teachers Organisation. I believe teachers, especially primary  teachers, have a vital role to play in the whole area of dental education. I would like to welcome the provisions in Part V of the Bill in regard to fitness to practice in respect of which the new Dental Council will have much wider powers than heretofore. Under existing legislation the only disciplinary measure open to the Dental Board is the erasure of a dentist's name from the register. This has obvious drawbacks. There are bound to be occasions when some form of disciplinary measure is called for but where the nature of the offence would not warrant so drastic a measure as the removal of the dentist's name from the register. In that context, therefore, I welcome the provisions in sections 39, 40 and 41 in relation to the professional conduct of a dentist.
Section 29 provides for the recognition and registration of dental specialists. While that may be desirable in the context of EEC legislation and so on, the informed dental profession believe that the paramount need at this moment and in the years ahead is primary health care supported by the consultants, some of whom were recently appointed to the health boards. I would like to congratulate the Government for their decision to appoint consultants to advise health boards. I have no doubt the Minister will see that every health board in the country will have such a consultant on its staff.
I welcome the proposal under section 54 which will enable the Dental Council to recognise and register certain classes of auxiliaries. This will be a decided boon to the underdeveloped health board dental service and also in regard to the vital area of job creation for suitably qualified people. However, there are reservations among the dental profession, and they are well-informed reservations, regarding sections 55(1), 55(2) and also section 56. I hope that we will have the opportunity of discussing these sections when we come to Committee Stage. I also hope the Minister will be amenable to meeting the various interests in regard to these sections.
Those of us who are members of health boards and who are elected public representatives  will agree that the existing dental service is totally unsatisfactory and inadequate. I think a few statistics in this regard are pertinent. Sixty per cent of children in the eight to nine year age group have dental decay which is untreated and 37 per cent in the 13 to 14 year age group have dental decay which is untreated. These facts speak for themselves. The question of the population-dentist ratio needs to be looked at. According to world health standards, it is three times what it should be.
The joint working party emphasised the importance of giving priority to the preventive aspects of dental care. They stressed that the establishment of an improved dental service in this country in the absence of a preventive philosophy is unlikely to bring about an improvement in the overall dental health of a community. The World Health Organisation has this to say on this topic. I quote as follows:
Given the high incidence of dental caries today, no country, no matter how wealthy, can train a sufficient number of dentists and finance the service required to give an adequate treatment to the whole population. The only solution is to reduce the incidence through preventive measures.
Therefore, it is very important that the whole philosophy of the Bill should be an emphasis on preventive treatment.
The joint working party also stress that the drinking of fluoridated water to a level of one part per million is well established as the most effective and efficient measure available on a community basis in the fight against dental caries. A reduction of over 50 per cent in the incidence of disease is recorded among children using fluoridated piped water supplies. Again the joint working party are anxious that effective fluoridation of piped water supplies should be utilised to the fullest extent. I would like to put on record my support for their proposal for the setting up of a national monitoring agency designed to ensure that we can have effective fluoridation of water supplies where necessary.
The working party also indicate that  other measures need to be examined in regard to this area. They point out that fluoride toothpaste, for example, gives a reduction of 20 per cent to 25 per cent in dental caries. Other examinations are currently being carried out in regard to milk and the EEC subsidy. I hope this will play a role for those children who do not have access to fluoridated water supplies. Dental health education is of paramount importance. Dental hygiene, as Senator Fallon mentioned, has a very important role to play in the whole area of oral hygiene, in diet control and other measures in our schools. For that reason, therefore, I support his suggestion that the INTO should have a representative on the Dental Council.
Provision must be made for the special groups, for example, the mentally handicapped and the physically handicapped. Dental treatment can pose special hazards for the institutionalised handicapped patients, for Down's Syndrome patients and for patients suffering from various blood disorders. Therefore, I welcome the decision of the Minister and the Government in regard to the appointment of senior dental officers in this discipline. It is important that provision be made for nursing mothers also.
I would ask the Minister to consider seriously — it has been said on a number of occasions in this House and in the other House — the question of the insured worker. Some provision will have to be made for the wife and dependants of the insured worker in regard to the provision of dental and other services. I would also suggest to the Minister that the whole question of third-party funding of dental care needs to be examined. In this regard I would suggest to the Minister that an examination should be carried out by his Department with regard to the Danish experience. Consideration should be given to the work of Professor Norman Butler who is currently President of the Irish Dental Association. We are enormously indebted to Professor Butler for the stimulating suggestions which he has made in recent addresses and for his work in this matter. I have today received representations on behalf  of what are called dental mechanics or technicians. As a group they are concerned in regard to the provisions in the Bill relating to their role. As Senator Fallon said, there are some such who are excellent people but we also know there is another side to the coin. I am sure the Minister will be amenable to having appropriate discussions with these people.
It is true to say that the remit of the health boards in regard to dental care over the past number of years is not being met — it is being grossly under-provided. Pre-school children, as we are aware, receive little or no treatment. Medical card holders are similarly ill-served. The service provided for primary school children is grossly inadequate. If the spirit of the Bill is to be realised these matters will have to be looked at very seriously.
The introduction of the Bill, the first such major comprehensive Bill since 1928, is long overdue. I would like to commend all concerned with the provision of dental care, both those who work in the health boards and those working in the private sector for the unstinting service which they have given the community. With adequate consultation between all concerned an appropriate Bill can go through both Houses and eventually become an Act and thereby serve the community better in the future.
Mr. Lynch Mr. Lynch
Mr. Lynch: Very briefly, I welcome the Bill which has my approval. I understand the Bill has the full approval of the Dental Association. I note from the Minister's speech that this will bring the entire administration of the service as operative at present under the control of one new body. Certainly this is a step in the right direction. All aspects of the service will be under the control of the new body, from post-graduate level to training level and dental care. It is also worthy of note that the Bill will bring control of dentistry into line with EEC regulations.
I would like to ask the Minister a few brief questions. Is he satisfied that there are sufficient trainee dentists to meet the needs of the scheme, not just to have the scheme administered but to have it done  as we would like to have it administered. I speak specifically of rural areas where Senator Kennedy correctly stated there is a backlog. For an on-going service, which it should be for dental care, the number of dentists in rural areas is not sufficient especially for the school going population. We all recognise that that is the most important area at treatment level. In the orthodontal treatment service as everybody is aware, there is a long waiting list. I am aware that it is a very expensive area. While health boards are limited in their resources, especially with regard to finance for orthodontal care, there is a growing problem in that service.
The scheme is not financially attractive enough for the recruitment of dentists. That is where the major problem lies. I would urge the Minister to see if something could be done to make the scheme attractive enough so that when health boards advertise for dentists in an area they will not find that young people who have been educated, mostly by the State and trained in dentistry, have emigrated to practise in some other country. Several suggestions have been made that especially at local health committee level there should be some regulation stipulating, especially in the dentist's field and perhaps in the GP's field also, that students who qualify be requested to give service for a number of years in their own country. Meanwhile there is a major problem. The problem is simply that health boards are not offering a decent and attractive salary to dentists to join the scheme as administered by the health boards. I would especially like the Minister to look into that aspect of the matter.
Mr. Ferris Mr. Ferris
Mr. Ferris: I want to welcome the Minister and his opening remarks on this Bill. The origin of this Bill goes back to 1976 under a previous Labour Party Minister, Mr. Brendan Corish, when I think for the first time people involved in health boards began to look at the whole area of dentistry, what the existing role of the Dental Board was, what was needed to be done in the whole area to revolutionise the practice of dentistry. Indeed, I want  to put on record my appreciation of the Minister, Deputy Desmond, who is with us today, on his ability to listen to the various submissions we made to him before the Bill was finally drafted and brought into the Seanad today. I think that period of consultation and the recognition that this was a whole new area has been justified by the warm welcome that has been generally given to the Bill by the dentists' association.
The board shows a new concept and I am pleased to see an adequate representation, not alone of the profession that have given a lifetime to the service of dentristry but also for the first time it takes into consideration the role of the consumer. In this particular area the role of the consumer is vitally important from two points of view; first of all, to ensure that the consumer gets a fair service competently provided at a reasonable cost, but also to ensure that when they submit themselves as patients to dental clinics they can do so in the knowledge that qualified people are there to look after them and only an adequately trained and qualified person can be responsible for dealing with the live tissue. I am glad that the Minister actually used that terminology in his opening speech. At very early stages any problems within the mouth — mouth ulcers or mouth cancer or whatever other major problem can arise can only be dealt with confidently by people who are trained and educated and fully qualified to do so.
That does not take away for one moment from the very useful role that can be performed and will, I hope, be performed, under this new council in the area of auxiliary dental workers or hygienists, or whatever we would like to call them. I am pleased that these will be working under the direction and supervision of the dental profession because the public will need to be reassured that when they submit themselves in this area they can have the confidence that they always had in the past, particularly with the dental profession. I do not think the dental profession can ever be accused, unlike some other professions in this and other countries, of having a vested interest in this legislation. All the submissions  that were made to us were made along the lines of protecting the health and the future of people, particularly schoolchildren, young children and adults who had neglected themselves because of a lack of hygiene or a lack of knowledge of the appropriate hygiene that they should have adopted.
I wish this new board well when it is full initiated. We may have questions to ask the Minister on Committee Stage. For instance, in section 51 it says specifically that a person who is not a registered dentist shall not take or use the title of a dentist or dental surgeon or dental practitioner and a person who is not a registered dentist shall not take or use any title or description which implies that he is a registered dentist. We are changing to the council instead of the board. That is an area where we have to be extremely careful to ensure that people do not purport to be something that they are not or to do what they are not trained to do. If that happens certainly the interest of the consumer would not be protected.
I am glad to see that that section gives that protection and also ensures that adequate fines are available to act as a deterrent to people who, as Senator Fallon stated, spring up overnight and purport to be providing a service which, on the surface, seems to be good value, but when we take the risks involved into consideration, could be the worst value for money that the consumer could have.
Section 54 states that:
The Council may, with the consent of the Minister, make a scheme for establishing classes of auxilliary dental workers who may undertake such class or classes of dental work as may be specified by the council, notwithstanding that the doing of such work would constitute the practice of dentistry within the meaning of this Act.
This is a section that I would like the Minister on Committee Stage to elaborate on so that there can be no doubt in anybody's mind whether they are people who will become auxiliary dental workers or indeed the existing dental profession  or the council dealing with both of them as to what this section means.
I would like also an explanation from the Minister in respect of section 56, under which, if he considers that the council do not perform their functions under this section, he would have the right to ask them to establish the particular auxiliary dental service. Although I have no objection in principle to the section giving the Minister the right to do that I would hope that he would trust this new council to perform the functions which are given to them by the Houses of the Oireachtas and that they would perform them with due regard for all the consequences. I hope the Minister will never find it necessary to implement section 56, because there is a general feeling amongst the profession and, indeed, among those of us who are involved in health boards and know the inadequacies of the service that we on the health boards provide that something had to be done within this area. I have no doubt that the council will do it and I have no doubt whatsoever that the dental profession involved in the new council will have a major input in ensuring that that section is carried out to the letter of the law.
I would like to pay tribute to dentists. I know very many of them in my constituency and many of them at health board level. Not alone are they experts and contributors to the normal day-to-day policy-making functions of health boards, but they have always shown a dedication to their own calling and to their duties under extreme pressure. The Minister is aware that up to now, because of the limited number of dentists qualified in this country, they have always seemed to be working round the clock, keeping appointments and then suddenly having to face urgent situations in cases of extreme pain. In spite of all that, they have managed to give this tremendous service. They also provide facilities at their own expense and make very expensive equipment available to the public at unsociable hours in many areas. That is well known. It is only right that we should put it on the record of the House today.
They operate in the private sector in a private capacity. Within their private surgery  hours, they also facilitate people who qualify under the Social Welfare Acts and I would like to thank them for that. I know that their compensation for that service has not always been as good as I would have liked it to have been. There have been delays because people give a wrong social insurance number or present themselves for emergency dental treatment, being, according to themselves, covered under insurance contributions. The dentist kindly obliges and by the time the number is submitted he discovers that there were not sufficient contributions to qualify for payment. In spite of that, the dentists still react professionally to the demands of society.
I join with my colleague, Senator Kennedy, in trying to ensure that this area of cover for social welfare contributors would be extended to the dependants of the insured contributor. It would be a policy of both the Minister's party and my own to try to extend this particular facility at some stage so that people who pay quite a large share of PRSI and PAYE contributions may, if at all possible, have their families covered at some future extension when our economic situation has improved to the degree that both the Minister and I would like.
I would like also to thank the dentists who have functioned under the medical cardholders system. There are quite a few dentists throughout the country who have given such a service — limited though it may be. Some boards operate quite a good scheme. Unfortunately in recent years sufficient money was not available in the health allocations to have this medical cardholder dental service continued. That was a pity, because the area in which you would probably find most neglect is that of the medical cardholder bracket. Because some of these people do not have the contributions to qualify for the social welfare section of the dentistry services, they may neglect themselves and not present themselves in time to ensure that proper dental treatment can be given.
Acting Chairman (Mr. Browne) Acting Chairman (Mr. Browne)
Acting Chairman (Mr. Browne): Caithfidh mé cur isteach ort. We have  to finish at 4 p.m. Item 3 has been ordered to be resumed at 4 o'clock.
Seanad Éireann 103 Dentists Bill, 1984: Second Stage.