Unlocking access to preventive oral care in Ireland
Donna Paton explores the role of dental hygienists in improving oral health across Ireland and how this is changing.
Historically, dental hygienists in Ireland have operated under indirect-access models, requiring patient referrals from dentists. The IDHA has been holding discussions with the Department of Health and other stakeholders about improving access and efficiency in preventive oral care for patients, often referred to as ‘direct access’.
The political momentum is already shifting. As evidenced at the opening address of the IDHA’s Annual Scientific Conference in Cork last November, minister of state Jennifer Carroll MacNeill has expressed a strong interest in reform, signalling that the government is increasingly aware that the status quo is unsustainable and, a transition from a ‘supervision’ model to ‘direct access’, empowering dental hygienists to address significant public health backlogs, including 105,000 children awaiting screenings, by providing preventative care and increasing overall dental team efficiency.
Since November last year, the IDHA, along with our newly appointed lobbyist, Mr Sorley McCaughey, has been actively engaged, focusing on lobbying ministers and strongly anticipating the introduction of a bill before the Dáil to amend the Dental Act, enabling direct access for dental hygienists.
Direct access for dental hygienists
Direct access allows dental hygienists to provide preventive oral health services to patients without requiring a prior examination or prescription from a dentist. This model enhances patient accessibility to preventive care and routine treatments. Dental hygienists would have a referral pathway if they recognised dental disease or had concerns about the patient. The dental hygienist can choose whether to treat a patient under direct access or to continue working ‘under the supervision of the dentist’.
Enhanced patient care, improved workflow and efficiency
In Ireland, the backlog of oral screening for school children, the elderly, vulnerable populations in care homes, and access to the Dental Treatment Services Scheme providers (DTSS) present a significant public health challenge. Addressing this issue requires innovative approaches to improve efficiency and expand access to essential dental services. One such approach is empowering dental hygienists to provide direct access and screen patients.
In Ireland, where resource constraints and workforce shortages often stall comprehensive health programs, allowing dental hygienists to see the public directly would make work more efficient. This would increase the capacity for screenings and preventive treatments, ensuring more individuals benefit from the early detection needed to stop the progression of dental disease. In turn, this will also reduce the burden on dentists, enabling them to focus on complex procedures and treatments that require their specialised skills.
The division of responsibilities optimises the use of available resources, shortens appointment times, and enhances overall practice productivity. Consequently, patients benefit from quicker service and more comprehensive care.
Professional development and motivation
The introduction of compulsory continuing professional development (CPD) would ensure consistent upskilling, maintain clinical excellence, and align dental hygienists more closely with best practice expectations across the profession. Furthermore, supporting greater professional autonomy for dental hygienists would not only recognise their clinical competence but also foster a stronger sense of responsibility, ownership, and career progression. This combination of structured CPD and increased autonomy has the potential to significantly enhance motivation, encourage lifelong learning, and ultimately improve patient outcomes within the dental team.
Advancing oral health reform in Ireland
Considering the current oral health crisis in Ireland – evidenced by significant service backlogs affecting over 105,000 children and a critically limited public workforce of approximately 40 dental hygienists within the HSE – there is an urgent need for decisive, system-wide reform. In alignment with the World Health Organisation’s Global Oral Health Action Plan 2023-2030, Ireland must transition from a predominantly treatment-focused model to a prevention-driven, equitable, and sustainable oral healthcare system.
A central pillar of this reform must be the expansion and modernisation of the dental workforce. The introduction of direct access for dental hygienists is a critical, evidence-based solution that would enable patients to receive preventive care, screening, and periodontal treatment without prior examination by a dentist. This approach aligns with WHO recommendations to optimise workforce capacity through innovative models of care. Empowering dental hygienists in this way would immediately improve access, reduce waiting lists, and allow dentists to focus on more complex treatment needs.
A renewed focus on prevention and early intervention is imperative. This would include expanding school-based oral health programmes, community-led education initiatives, and promoting evidence-based preventive measures, such as the use of fluoride. Dental hygienists should play a leading role in delivering these services across community and primary care settings.
Additionally, oral health must be fully integrated into broader healthcare strategies, recognising its links to systemic conditions such as diabetes and cardiovascular disease. Embedding oral health professionals within primary care teams will support early detection, reduce inequalities, and improve population health outcomes.
Finally, robust governance structures must be established to ensure accountability and progress. This includes developing measurable national targets, improving data collection on oral health outcomes, and establishing transparent reporting mechanisms aligned with WHO’s 2030 objectives.
A collaborative vision for Irish oral healthcare
The resolution of Ireland’s dental crisis does not lie in professional competition, but in a robust, integrated partnership between dentists and dental hygienists. For too long, the restrictive ‘supervision’ clause of the 1985 Act has acted as a barrier to efficient care, rather than a safeguard for patient safety. It is time for the profession to collectively recognise that direct access is not a threat to the traditional dental team, but a vital evolution that benefits practitioners and the nation alike.
In conclusion, addressing Ireland’s oral health crisis requires bold leadership and a commitment to reform. By embracing preventive care, expanding the role of dental hygienists through direct access, investing in workforce development, and aligning with international best practice, Ireland can deliver a modern, equitable, and effective oral healthcare system for all.
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