Strengthening the Profession, Serving the Public: Reflections on a Presidential Year in Irish Dentistry

When I reflect on my year as President of the Irish Dental Association, I find myself returning to one simple idea: a strong dental profession is fundamental to good patient care.

That has been the thread running through almost everything I have tried to achieve during my presidency. Of course, the Irish Dental Association has a responsibility to represent dentists and to advocate for a profession that is properly resourced, appropriately regulated and sustainable. But I have never regarded that responsibility as separate from the public interest. Quite the opposite. If we want patients to receive timely, safe and high-quality care, we need a profession that is strong, supported and confident enough to deliver it.

That has been the basis of my advocacy over the past year.

Moving dentistry to the centre of healthcare

For too long, dentistry has been treated as something of an adjunct to healthcare policy rather than an integral part of it. Yet oral health affects our ability to eat, speak, sleep, work and socialise, while poor oral health can have profound consequences for general health and quality of life.

One of the priorities of my presidency was therefore to ensure that dentistry was heard much more clearly in the national healthcare conversation. Through engagement with Government, the Department of Health, the HSE, the Oireachtas and the national media, we have worked to demonstrate that the problems facing dentistry are not simply professional issues. They are public-health issues.

The collapse in access to State-funded dental care, the pressures on the HSE dental service, workforce shortages and unacceptable waiting times are ultimately experienced by patients. A waiting list is not merely a statistic: it is a child waiting for treatment, an older person struggling with oral pain, or a family unable to find a dentist willing to provide care under the Medical Card scheme.

That human dimension has always been important to me.

Reforming a system that is no longer working

The Dental Treatment Services Scheme is perhaps the clearest example of why fundamental reform is needed.

For years, the number of dentists participating in the scheme has declined while the number of people depending on publicly funded dental care has increased. It is tempting to frame this simply as a disagreement between dentists and Government over remuneration. I believe that does both sides a disservice.

The more fundamental question is whether the system itself is capable of delivering the care that the State has promised its citizens.

Our advocacy has therefore been about creating a sustainable model rather than simply trying to preserve an increasingly dysfunctional one. We have argued for appropriate funding, clinical autonomy, reduced bureaucracy and, importantly, greater use of the capacity that already exists within general dental practice.

I do not believe that public and private dentistry should be viewed as opposing camps. They are components of the same healthcare system, and the challenge is to design a model in which public investment can effectively utilise the expertise, infrastructure and capacity of general practice for the benefit of patients.

That is why our engagement around Smile agus Sláinte has been both supportive and critical. We want reform to succeed, but responsible advocacy means being willing to say when a proposal is unlikely to work in practice. Constructive engagement should never mean unquestioning agreement.

Children must come first

The issue that has perhaps concerned me most during the year has been access to dental care for children.

The deterioration in the HSE school dental service should concern all of us. When children miss screening or wait excessive periods for treatment, we lose one of the most effective opportunities we have to identify disease early and prevent more serious problems developing.

Behind every waiting-list figure is a child and a family.

That is why I have consistently argued that children's dentistry should be regarded as a core public-health responsibility. Prevention is one of the great strengths of dentistry, and early intervention can prevent pain, infection, extraction and complex treatment later in life. We should be investing in systems that identify problems early, rather than allowing those problems to become more difficult and more expensive to treat.

The same principle applies to older people, people with disabilities and other vulnerable groups. Oral health is part of dignity and quality of life. It should not depend upon whether someone happens to have the financial means to purchase private care.

The workforce is the foundation

The workforce crisis sits underneath almost every other challenge facing Irish dentistry.

There is little point developing ambitious oral-health policies if there are insufficient dentists and dental team members to deliver them. Equally, it is not reasonable simply to expect the existing workforce to work harder to compensate for years of inadequate planning.

During my presidency, the IDA has therefore put workforce planning firmly at the centre of the national debate. We have advocated for a National Workforce Plan, increased dental-school capacity, improved workforce data, recruitment and retention measures, appropriate integration of internationally trained dentists, and greater investment in the infrastructure required to educate future generations.

But workforce planning must mean more than producing additional graduates. We have to consider where dentists will work, how we retain them, how we support practices, how we develop the wider dental team and how we make Ireland an attractive place in which to build a professional career.

That is why I have also been particularly keen to promote structured mentoring. A newly qualified dentist should not have to navigate the complexities of clinical practice, regulation, professional responsibility and career development alone. An experienced dentist should have the opportunity to pass on knowledge, while younger colleagues bring new perspectives and ideas.

A strong profession is an intergenerational profession.

Strengthening the whole profession

That principle has influenced our wider work within the Association.

Dentistry is not delivered by dentists alone. Dental nurses, hygienists, specialists, academics, HSE dentists, students and young dentists all contribute to the quality of care that patients receive. We have therefore worked to broaden representation, including the development of stronger structures for specialists and academics, greater engagement with dental nurses and the development of a Dental Nurse Network.

We have also worked hard to bring students and younger dentists closer to the centre of the Association. The development of the Student Forum and the greater involvement of younger colleagues in Council and Association activities are important because the IDA cannot simply represent the profession as it exists today. It has to help shape the profession that will exist twenty and thirty years from now.

This is also the thinking behind the One Profession Charter ideal. Dentistry will always contain different views and different professional interests, and that is healthy. But disagreement should not become division. Whether we work in general practice, the HSE, academia or specialist practice, whether we are established clinicians or just beginning our careers, we share a fundamental responsibility to our patients.

Our collective voice is stronger when we recognise that.

Professionalism means responsibility

Another significant achievement has been the progress towards statutory Continuing Professional Development.

I have always regarded CPD as much more than a regulatory obligation. When a patient sits in a dental chair, they are placing an extraordinary degree of trust in their dentist. That trust carries a responsibility to maintain competence, keep up with developments and continue learning throughout a professional career.

Government approval of proposals to introduce statutory CPD is therefore an important step forward, but regulation must be accompanied by support. The IDA has continued to invest in its own education programme, developing six educational streams through the IDA CPD Forum and strengthening the opportunities available to members.

The same philosophy applies to patient complaints and dispute resolution. The Dental Complaints Resolution Service demonstrates that supporting dentists and protecting patients are not mutually exclusive. Good communication, clear expectations and a willingness to listen are fundamental components of good healthcare.

An Association that listens

Some of the most important work of the year has happened away from the national headlines.

The IDA Roadshow has allowed us to engage directly with members around the country, including the return of significant regional engagement in the North West. I have always believed that leadership cannot be conducted solely from Dublin. The challenges facing a dentist in a rural practice may differ considerably from those facing a large urban practice, just as the concerns of a young associate may differ from those of an established practice owner.

All of those voices matter.

We have also continued to modernise the Association itself, including the development of our CPD offering, the redevelopment of the Journal of the Irish Dental Association and work towards a future National Congress for the profession.

A professional association can only advocate effectively if it is itself strong, representative and relevant.

Advocacy with a purpose

There have been many different issues during this presidential year: Medical Card dentistry, children's services, workforce planning, dental education, Smile agus Sláinte, CPD, dental tourism, nicotine, professional representation and patient protection.

On the surface, they may appear unrelated.

To me, they are connected by one principle: Care.

Care for the child who is waiting for treatment. Care for the older person who cannot access the care they need. Care for the dentist struggling to recruit a team. Care for the young graduate trying to build a future. Care for the dental nurse whose contribution deserves greater recognition. Care for the profession that has a responsibility to maintain the highest standards. And care for a public that deserves an effective and accessible oral-health service.

That is why I have never believed that advocating strongly for dentists is incompatible with advocating for patients.

A dentist who is exhausted, unsupported and unable to recruit cannot provide the service that patients deserve. A practice that is not sustainable cannot continue to provide care. A profession that cannot attract and retain people cannot meet the country's future needs.

Strengthening the profession is therefore not an act of self-interest. It is an act of public service.

A relay, not a finish line

As I hand the chain of office to Dr Bridget Harrington Barry, I am conscious that a presidency is temporary. The Association is much bigger than any individual President, and the progress achieved this year belongs to Council, committees, members, staff and all those who have given their time and expertise to the work of the IDA.

I have simply had the privilege of carrying the chain for a year.

I leave the presidency proud that we have not simply described the problems facing Irish dentistry, but have tried to articulate what a better future could look like: a sustainable workforce, properly funded public dental services, meaningful access to care, greater investment in education, stronger professional standards, a more united profession and a healthcare system in which oral health is finally recognised as an essential part of overall health.

There is still an enormous amount to do. The Medical Card system needs fundamental reform. Children continue to face unacceptable barriers to care. Workforce shortages remain acute, and the implementation of Smile agus Sláinte will require ambition, investment and careful attention to what can actually be delivered on the ground.

But I believe the conversation has changed.

Dentistry is being taken more seriously as a national healthcare issue. The profession is becoming more confident in articulating its own vision. And the IDA is increasingly demonstrating that it can be both a powerful advocate for its members and a responsible voice for patients.

Ultimately, that is what I have tried to achieve during my year as President.

Not simply to defend a profession, but to strengthen it.

Not simply to criticise a system, but to help build a better one.

And not simply to speak for dentists, but to ensure that the voice of dentistry is heard on behalf of the patients and communities we serve.

Because the strongest profession is not the one that asks what it can receive from society. It is the one that is strong enough, confident enough and united enough to give society the very best care it can provide.