It is extremely regrettable that the analysis of dental costs by Professor Stephen Kinsella in the Irish Independent (September 4th 2012) serves to offer a very misleading impression of dental care in Ireland. Mr. Kinsella acknowledges that dental prices are falling and the effect of state cuts in the medical card and PRSI schemes has been to pass on extra costs to citizens as well as to exacerbate the divide between those who can afford to pay and the rest. However, the article fails to properly ascribe culpability for the state of emergency in which dentistry finds itself right now.

As an economist, Mr. Kinsella will understand that dentists have to ensure that their costs are covered and in ensuring they seek a fair price for their service this is their primary consideration. However, unlike medical care, dental practices are offered no supports from the state. So, whereas the state spends €3.6billion annually building, staffing and equipping hospital medicine within the HSE and offers individual doctors in general practice extensive grants and allowances to maintain and develop their surgeries, no such assistance is provided for dental care. Ever wonder how much medical costs for patients would be if the state withdrew its supports for hospitals and general practice? The same question could also be asked in regard to university fees also.

Given that dentists have to rely entirely on generating attendance and income to cover costs (and most of these costs are fixed or state controlled), it is no surprise in these difficult times that with falling attendances dental practices are closing and we estimate there have been 1,500 redundancies in the sector in the past couple of years. Again this won’t be noticed in the same way as the closure of a high profile multinational but the effects are just as real. Equally, entire classes of dental graduates are forced to emigrate for the lack of viable opportunities (and not because of any professional control on numbers which simply does not exist). Yet evidence also shows that dentists are continuing to reduce or freeze their fees in a highly open and competitive market.

Against such a background, the dental profession has not sought to curse the darkness or to exact some form of retribution. Instead, the profession has sought to enhance confidence in the high quality of care the profession continues to provide. In the last couple of years, the profession has introduced transparent display of fees, has introduced a new dental complaints resolution system, has developed a major public awareness campaign in regard to mouth cancer and has developed a range of other important initiatives to assist and support patients at practice level and nationally. All of these initiatives have been arranged in spite of rather than with the support of the state .

By contrast the HSE and Department of Social Protection are continuing with their policy of withdrawing €100m annually in price supports to patients previously entitled to dental treatments under the medical card and PRSI schemes. These cuts continue in spite of the fact that more than eight out of ten citizens remain entitled to dental benefits and promises by this Government to reverse these cuts. In fact, the HSE has still not notified medical card holders of their dental entitlements since these were unilaterally slashed in April 2010.

Incidentally, it is the state also which has been the cause of the delay in introducing all the outstanding reforms recommended by the Competition Authority and mentioned by Mr. Kinsella. New legislation for the dental profession has long being sought by dentists but again it is the state which is dragging its heels.

For all these reasons it is regrettable that Mr. Kinsella fails to explain the dental ‘market’ in its full sense and overlooks the absence of any state supports for dentistry alone amongst health services provided. The impression may be left with readers that the current crisis is somehow the fault of the dental profession when in fact dentists have shown remarkable innovation in seeking to promote the highest standards of care in the interests of their patients and have sought to maintain competitive prices in the face of unrelenting and unprecedented pressures and an indifferent Government.