I welcome the Minister of State and thank her so much for coming in. I am going to talk about dental care, particularly in schools. Access to dental care is in crisis and staffing has become a very serious issue, with staff shortages the main concern for dentists and dental staff. In 2024, 65% of dentists were unable to recruit candidates for dentist positions. A quarter of dentists said they were not taking on any new private adult patients and a third stated they were not taking on any new child patients.

My concern here, however, is about children. I can still remember the day so vividly when the dentist came into my school when I was six years old in 1981 and taught me how to brush my teeth and we got a lovely little colouring book. In 1981, I had access to a dentist in school but in 2026, my children, aged ten and 11, have never seen a dentist in school. Apparently, children should be having check-ups in second, fourth and sixth classes, but they are not having the first of these until fourth year in secondary school. Dentists are saying they are being forced to choose between which children they believe are in most pain and which to treat first. Analysis from the Irish Dental Association shows we need an extra 500 dentists across the private and public sectors immediately. Ireland currently trains fewer dentists per capita than most OECD countries.

A lady contacted my office. Her daughter was seen in May 2024 and put on the priority list for braces. She was told the dentist was working off the 2021 priority list. Her daughter will be 18 in December. A procedure will now have to be done for her daughter whereby she will have to be put under anaesthetic, even though she qualified for braces two years ago. In the public dental service, the lack of dentists has led to a situation where fewer than half of the children who should have been seen as part of the dental school programme have been seen. Children in parts of the country are facing a ten-year backlog.

I am in the very lucky position where I have been able to bring my own kids to a private dentist, but my kids were diagnosed with molar incisor hypomineralisation, MIH, two years ago, an enamel defect affecting the first permanent molars and incisors. The enamel is softer than normal, leading to discolouration, increased sensitivity and the potential for chipping and decay. Enamel is the outer, strong part of your teeth, and if it is not there, your teeth are not good. MIH affects approximately one in eight children in Ireland. Early detection is crucial to prevent further tooth damage and reduce the need for extensive restorative work. The defective enamel can lead to rapid tooth decay or crumbling. It is typically identified when children are aged around six or seven.

MIH-affected teeth are often harder to numb, which means dentistry for these patients can be challenging and may require specialised care. As we can appreciate, it really is unpleasant. As a mammy, it is horrible to bring your kids into the dentist for these treatments. Now that my children have been diagnosed with this condition, I cannot believe the number of other children I know who have it. When I explain it to parents, they often fear that their kids might also have it. White spots on the front of the teeth are a clear sign of it.

My kids have had fissure seals and crowns. They have both had four teeth removed in hospital in their very young years. The cause of the condition is not entirely known. We have been researching it in Ireland over the last 20 years, but it can be due to a baby having a low birth weight, having been a C-section baby or having taken a lot of antibiotics in his or her first two years. I dread to think how many kids are suffering from this condition in Ireland and do not even know because a public dentist has not come to their school and they cannot afford to go to a private dentist.

Our dental schools do not have the basic capacity to educate and train enough dental practitioners to meet population demands. Only half of the students who graduate here each year stay, given that most of them are international students, as the Minister of State knows. We need more investment in our colleges, and I very much welcome the opening of the dental education centre last year. We need specific training in other aspects of dentistry and we need to change the work permit rules for dentists and dental nurses. If we do not do this, I dread to think what will happen to our children's teeth in the future.

I have heard the Minister, Jennifer Carroll MacNeill, mention the need for prevention screening, cleaning and good habits. I have also heard her say our workforce is not working well enough and that dentists are moving into cosmetic treatments such as injectables and Botox treatments. How can we perhaps use our dental hygienists more? How can we get early screening and get dentists into our schools? How can we convince enough dentists to commit to public dentistry?

The bright light here is that I really trust the Minister of State and the Minister, Jennifer Carroll MacNeill. I know they know what is going on. Highlighting this situation will ensure there is more pressure, more talk and more discussion about the situation, and I hope we can get the investment in it.

I thank the Senator for articulating a pressing issue. It is a question I have answered many times in the Seanad and the Dáil. I am taking this matter on behalf of the Minister for Health.

I am grateful to her for the opportunity to address the issue of access to oral healthcare services for children, including orthodontic treatment.

The HSE oral healthcare service aims to provide an oral examination and necessary treatment for children at ages approximating to second and sixth class and, in some cases, fourth class. Emergency care is provided for children of all ages up to 16 and for those with complex and additional needs. The HSE provides orthodontic treatment to patients with the most severe and complex treatment needs.

The Minister is aware that there are currently backlogs in the HSE’s child oral health examination programme, which has meant that the sixth-class groups are being prioritised. As the Senator said, it used to be second class, fourth class and sixth class I recall all my children getting the fissure seals, which make such a difference when they are heading into their teenage years. The Government is committed to addressing the immediate difficulties patients are experiencing in accessing oral healthcare services. The Senator asked an awful lot of questions at the end and they are the driving questions we have at the moment regarding why some dentists do not take public patients. We are losing people when they are trained. They decide to work abroad. People who come here for excellent training go back to their home countries. It was interesting when I met the Belgian minister for health in Brussels, I think it was in 2023. It was during a St. Patrick's day visit. At that time we were just coming out of the Covid-19 pandemic. I recall asking the Minister what his most pressing concern was at the time and he said it was the lack of dentists in Belgium. We have population growth here. In 2015, we had 900,000 children in the country; now we have 1.2 million. It is so important. Everyone knows that there is nothing worse than a toothache. This situation is challenging.

Last year, over 146,000 new patients were assessed in the public dental service, including approximately 100,000 under targeted programmes in schools and special care programmes with over 46,000 others attending for emergencies.

The Minister acknowledges that the current system, which was developed in the 1990s in response to the identified oral healthcare needs at that time, must be modernised and aligned with current needs. The national oral health policy sets out the vision for oral healthcare services in Ireland and has two key goals: first, to provide the supports to enable every individual to achieve their personal best oral health; and, second, to reduce oral health inequalities across the population.

The Senator raised MIH, which she has lived experience of and knows a lot more about than I do. It is a specific pattern of enamel defects in adult teeth. While there is no definitive cause, it is thought that the defects are due to issues arising at the time of development of these specific teeth. The impact for the patient can be wide-ranging, with some experiencing very little impact on the incisors, but a common presentation is sensitivity in the molars.

Depending on the enamel area impacted, management of these teeth can be challenging. Enamel is designed to protect the inner layers of the tooth including the nerve tissue, with MIH patients often experiencing sensitivity to hot and cold due to these enamel defects. The treatment ranges from preventive management through fluoride applications right through to managed extractions at an appropriate age range. These children may present as emergencies from associated sensitivity.

I thank the Minister of State. I appreciate emergency care is provided to children up to 16 years of age but we should not be letting them get to the emergency care situation. The teeth of primary schoolchildren who cannot afford to go to a private dentist are not going to be good. I feel really privileged that I could afford to go to a dentist, but if my children had to wait until sixth class, they would have no back teeth. There would be no enamel. They would be so uncomfortable and it would be emergency procedure after emergency procedure. Parents do not want to see their kids going through that because they do not want them turned off dentists and do not want them going through that pain.

It is so important we get to the primary school age. If I take my own county of Meath, which seems to have been particularly hit, in quarter 4 of 2017, 9,400 children were seen in their school, but in quarter 4 of 2023, only 2,378 were seen. That is three quarters down in nine years. Counties Longford and Westmeath had a population of 142,000 people according to census 2022. They have 31 dentists contracted under the dental treatment services scheme, DTSS, but in Meath we only have 17 for a population of 240,000. Nationally we have a major problem but in County Meath we absolutely need a focus on public dentistry.

There is nothing the Senator is saying that I disagree with. The Government invests annually in oral healthcare with a figure of €240 million this year alone. Over €20 million has been allocated to waiting list initiatives for contracted orthodontic care, resulting in more than 5,200 removals from waiting lists since 2020. This includes a dedicated orthodontic surgery programme that has delivered treatment for an additional 206 patients to date. This funding will continue in 2026 with a further €2.85 million being provided.

I understand exactly where the Senator is coming from. It was part of primary school for all of us to get oral hygiene care. I appreciate that for some families it might be a step too far if they have an issue. However, children will be looked after if they have an emergency. The Senator's point is well made that we should not allow them to get to the point of emergencies. The Minister for Health has a meeting this week on dentists. I saw it in her diary. She is putting a focus on this at the moment to see if we can get some sort of solution to provide more care to those that need it sooner than we are doing at the moment.