Irish Dental Association
Executive Summary
During the COVID-19 pandemic, Ireland’s dental sector faced significant challenges due to a lack of preparedness, leadership, and recognition within national emergency planning. Oral healthcare, vital to public health, was largely excluded from early communication and decision-making structures. Dentists were forced to make independent risk assessments and restrict services in the absence of acceptable national guidance, contributing to delays in care and worsening oral health outcomes.
The purpose of our submission is to reflect the views and real experience of the membership of the Association and to highlight deficiencies in the approach taken by those charged with leading and managing the response to the Covid-19 lockdown, especially within the Department of Health and associated health agencies. We have detailed several recommendations at the end of each section in this submission which takes a thematic approach to considering the Covid experience as it related to the provision of dental care.
The political, administrative and scientific leadership within the Department of Health lost, or at the very least, failed to secure the confidence of the dental profession. This was exacerbated after the Chief Dental Officer (CDO) issued guidance on March 20th, 2020, that the profession considered inappropriate and inconsistent with international advice. The inherently unclear and ill-defined nature of the Chief Dental Officer’s role, coupled with a failure to meet professional expectations and international standards, significantly undermined its capacity to provide the necessary leadership and guidance for the dental sector during the pandemic. By contrast, the Irish Dental Association (IDA) emerged as a key communicator, collaborating with health bodies and international counterparts to support effective infection control protocols. These efforts enabled Ireland’s dental practices to reopen earlier than in many other countries and maintain very low levels of in-practice transmission.
The pandemic highlighted systemic weaknesses, including the lack of a comprehensive dentist contact database, inconsistent personal protective equipment (PPE) supply, and absence of state support for dental practitioners. Unlike medical colleagues and others, dentists received no financial or operational assistance, resulting in increased costs, anxiety, and disillusionment. Promises of PPE and VAT relief were broken, undermining trust in the Department of Health, its Minister and officials.
Meanwhile, opportunistic marketing of unproven technologies added to financial pressures. Despite these challenges, dental professionals upheld patient safety and public confidence through adherence to scientifically sound protocols.
Educational and professional development were also disrupted, with reduced clinical exposure and a shift toward remote learning.
Recommendations include recognising dentistry as an essential service, embedding leadership in public health structures, reassessing the CDO’s role (a precise definition of the Chief Dental Officer’s role would significantly benefit the incumbent by clarifying their responsibilities, empowering them to provide clear leadership and guidance, and helping to rebuild trust with the dental profession. This clarity would enable better integration of oral healthcare into national emergency planning and provide a framework for accountability and necessary support, ultimately preventing the issues experienced during the COVID-19 pandemic), establishing centralised and evidence-based communication, and ensuring financial and mental health support for dental teams. A strengthened register of practising dentists is also needed for effective coordination.
The IDA calls for future collaboration models that prioritise consensus and transparency, ensuring the dental sector is fully integrated and supported in any future public health crisis.
Introduction
Oral healthcare plays a vital role in maintaining overall health and well-being. Poor oral health can lead to a range of issues that affect general health, including cardiovascular diseases, diabetes, respiratory infections, and even mental health issues such as depression and anxiety. The mouth-body connection is well documented, and untreated dental problems such as gum disease or tooth decay can cause or exacerbate other serious medical conditions. For children, untreated oral issues can result in developmental challenges, poor nutrition, and even poor academic performance due to the pain and discomfort of dental diseases (International Journal of Health Services, 2020).
Dental professionals are not just involved in treating teeth—they are an integral part of the public health system, providing education on disease prevention and promoting overall wellness. This means that disruptions in dental care, especially in times of crisis like the COVID-19 pandemic, can lead to wider public health challenges including the non-detection of oral cancers (Irish Times, 2020).
The outbreak of COVID-19 led to unprecedented challenges in global healthcare delivery. The Irish dental sector was no exception. Elective procedures and preventative treatments were put on hold. The backlog of appointments contributed to deteriorating oral health, as many patients postponed or missed crucial examinations and treatments such as cleanings, fillings, and other restorative procedures. The long-term effects of these delays were expected to manifest in more severe dental issues, leading to higher treatment costs and prolonged suffering for patients (British Dental Journal, 2020).
In keeping with the IDA’s commitment to contribute positively to Ireland’s COVID-19 Evaluation, this paper aims to explore the key issues encountered by the dental sector during the pandemic, analyse the lessons learned, and provide recommendations for the future.
World Health Organization (WHO) Pandemic Phase 6 (Pandemic Period)
The Irish Dental Practice landscape
The WHO declared the novel coronavirus (SARS-CoV- 2) a global pandemic on the 11th March 2020. On the 16th – 19th March 2020, the Irish Dental Association (IDA) surveyed its members on the impact of the viral infection (COVID-19) on their dental practices. The key findings included:
83% had made changes in practice opening hours or access due to the COVID-19 crisis.
Of these, 18% had closed the practice temporarily and 52% had confined the practice to emergency treatment only.
For the minority of practices who had not yet made changes, 88% expected to make changes by the end of the week (20th March). Nearly all of these expected to either limit practice to emergency treatment only or close their practice for a period of time.
Threequarters (76%) expected their practice income to drop by over 70% in the medium to long term. Half (52%) expected income to drop by 90% – 100%.
Most (60%) did not expect to receive commercial insurance compensation for loss of income.
Regarding access to appropriate, prescribed personal protective equipment (PPE), 5% did not have access to gowns and 30% did not have access to masks.
(IDA 2020)
Communication
Communication is a critical factor in crisis management. Communication skills and facilitation came sharply into focus for dental teams in the first weeks of March 2020. The first cases of SARS-CoV- 2 infection (COVID-19), in Ireland, had been identified while we watched in fear and horror at the images and reports coming from Northern Italy. Information on the progression and management of the disease was coordinated between the Department of Health, the Health Protection Surveillance Centre (HPSC) and the Health Services Executive (HSE). Little of the early information addressed dental team concerns.
The nature of dental procedures, which inherently involves close contact and potential exposure to aerosols, complicated dentists’ response. Dentists are experts in risk assessment in relation to patient care. Dentists were knowledgeable and mindful of international advice to colleagues in combating the disease.
In the absence of national guidance, they adopted that advice. Some dental practitioners closed their practice on assessment of their personal circumstances and their assessment of the risk to their staff, to their patients and community and to themselves. By the 16th March 2020, many dental practices had confined their practice to emergency-only, following the example of the Cork and Dublin dental hospitals and later the advice from the National Oral Health Office (NOHO) regarding HSE Dental and Orthodontic Services. Dentists are expected by the Dental Council to provide emergency cover. At the time, the Dental Council was very concerned for patients whose dentists had closed their practices and could not be contacted.
A void in clinical leadership for dentistry became a critical issue that arose early and persisted through the lockdown. The exclusion of dentally qualified experts on the National Public Health Emergency Team (NPHET) was a notable omission.
The office of the Irish Dental Association which is the representative body for dental practitioners in Ireland, was inundated with requests for guidance as the initial March 20th 2020 guidance from the Chief Dental Officer (CDO), upon the advice of the HPSC, that “there is currently no need for change in practice” was rejected by the broad profession as it was out of step with international advice, the need for research into the disease and, indeed, the reality on the ground (CDO, 2020). It also contradicted the guidance given by NOHO to public service dentists. Subsequently, 300 dentists signed an open letter in which they deemed the CDO’s advice to be “extremely worrying.” (Irish Times 2020). Unfortunately, the same advice was re-affirmed a week later by the CDO’s office. We contend that at that time, the CDO lost the trust of the profession.
The role of the CDO in the pandemic was unclear compared to that of the Chief Medical Officer (CMO) and Deputy CMOs who gained public confidence and, on whose guidance the medical profession and the public came to rely. The expectation of the dental profession was that the CDO would take a similar leadership role to her medical counterparts but there has never been a clear explanation as to the role and responsibilities attaching to their role. Unacceptably, the CDO became the focus of ire and grievous personal vitriol on social media, and we do not condone such an approach. This outcome can be traced back to the Department of Health’s apparent ambition for the position, which fell short of the profession’s expectations and the lack of clear definition of the role of the CDO as well as confusion about the interaction and demarcation between the office of the CDO, the Dental Council, NPHET and the HPSC.
The Dental Council advises that every patient must be assessed on an individual basis. Most dentists considered the early safety protocols to be equivocal and unacceptable resulting in continuing restricted primary dental care practice.
The notion that ‘we are all in this together’ was an effective soundbite in March 2020 but many dentists felt profoundly let down by the Department of Health at that time. The IDA decided to take the initiative and contacted Professor Martin Cormican in his role in the HPSC. Professor Cormican acknowledged, on RTE’s Liveline (20th March 2020), that dentistry was an essential service and yet it remained outside the loop in communications amongst consultative and decision-making bodies.
Professor Cormican agreed to provide guidance on infection prevention and control in a dental setting. The HPSC’s initial guidance to dentistry, on 3rd April 2020, was published following the establishment of a consultative process where the IDA and NOHO were invited to give their inputs. The initial guidance that AGPs should be minimised rather than avoided created strain in the profession as it again contradicted the worldwide advice to avoid APGs. As a result, there was no noteworthy reopening of dental services. The consultative process survived and strengthened so when guidance was given prior to the 18th May 2020, Phase 1 of the Roadmap for Reopening Society and Business, the profession, with reassurance from the IDA, was satisfied that the guidance was of the highest standard. In fact, it was a world leader as it was scientifically sound, accessible and equitable. Interestingly, it was considerably less stringent than that imposed by the two dental schools and hospitals and elsewhere when they reopened. The HPSC guidance was regularly updated reflecting the changing nature of the pandemic and our understanding of it.
On the 8th April 2020, the Dental Council communicated its guidance: “Aerosol-generating procedures should only be undertaken with an appropriate level of personal protection equipment (PPE), which includes a respirator mask to a minimum standard of FFP2.” At the time, even standard PPE was scarce or unavailable and in very high demand across all healthcare. The required standard of facemask was much debated with little scientific evidence. The Dental Council dropped this recommendation, via Facebook, after 18th May 2020. The HPSC then advised that Standard Precautions were appropriate to infection prevention and control.
The lack of a database with postal or email addresses for practising dentists was a serious impediment to communicating with dentists and dental team members. Dentists were in the main reliant on regular communications from the Irish Dental Association, even though significant numbers of dentists are not members.
Between 16th March – 17th May 2020, many dental practices provided emergency only treatment based on a three-pronged approach (Advice/Medication/Emergency Treatment) following assessment, which was generally by telephone. This time witnessed increased use of tele-dentistry. Tele-dentistry provided an innovative solution to maintain some form of dental care during the pandemic, especially for consultations and post-treatment follow-ups (Telemedicine and e-Health Journal, 2020; Frontiers in Public Health, 2021). As a new technology, remote communication required its own guidance. This was primarily provided by our professional indemnity agents. At present, the Dental Council’s 2022 ethical advice is that direct, face-to-face patient consultations must remain normal practice. Remote consultations must only be used in emergency situations or exceptional circumstances.
The Dental Council was not the only body to communicate through social media during the pandemic. Societally, social media was widely used and abused in the dissemination of information, advice and opinions. It was a portal for the good, the bad and the ugly.
The pandemic placed significant mental health pressure on dental professionals, who had to navigate the challenges of working in high-risk environments while managing fears about their own health, that of their families and the health of their patients in a world of often contradictory information. In the initial weeks, the absence of clinical and governance leadership and defined communication channels, coupled with the misinformation and misplaced advice and opinions on social media, heightened anxiety and stress resulting in the undesirable limitation of dental services.
Summary:
A wide variety of bodies provided advice throughout the pandemic. The Department of Health was ill-prepared but not alone in that regard. However, in the first weeks of the pandemic, it repeatedly failed dentistry because, historically, it assumed we function like our medical colleagues. The delivery of primary oral healthcare is very different. The office of the CDO was laid bare in comparison to her medical colleagues.
In the absence of national guidance, dentists carried out and acted upon assessment of the risks the virus presented to their team, patients and community. The initial failure to recognise dentistry as an essential service created barriers to guidance and appropriate support, ultimately, delaying the reopening of primary care settings.
The IDA established communication channels at organisational and personal levels. Those efforts were important in maintaining relationships, developing trust and confidence. The guidance that ensued provided a pathway in which reopening dental practices that May put dentistry in Ireland at the forefront internationally while reducing stress and counteracting misinformation. Unfortunately, these communication channels were short-lived and if there was a pandemic in the morning dentistry would start from ground zero.
The shifting and different sources of guidance for dentists led to confusion and inconsistency in the application of protocols. Many dental professionals reported difficulties in keeping up with the evolving guidance. Social media reached a limited audience. Overall, social media was often unhelpful and sometimes corrosive.
IDA endeavoured to ensure all its communications were based on the best scientific evidence available to dentists worldwide.
Communication Recommendations:
The WHO’s strategy for universal healthcare, especially oral healthcare, provides for strong leadership, the establishment of partnerships and public health planning. The IDA has presented practical recommendations for the development of leadership structures, which would embed dentistry in the appropriate public clinical administration. Thus far, the Department of Health have shown little interest in developing appropriate structures despite proclaiming its support for the WHO’s objectives.
The role and obligations of key players must be reassessed and the appraisal communicated clearly to the dental profession:
CDO – the role must meet expectations and international standards; a precise definition of the Chief Dental Officer’s role would significantly benefit the incumbent by clarifying their responsibilities, empowering them to provide clear leadership and guidance, and helping to rebuild trust with the dental profession. This clarity would enable better integration of oral healthcare into national emergency planning and provide a framework for accountability and necessary support, ultimately preventing the issues experienced during the COVID-19 pandemic,
Dental Council – its relationship with the CDO and agencies such as the HSE and HPSC needs examination for reasons of transparency and assurance.
Consideration should be given to the development of limited source communication of evidence-driven guidelines covering all aspects of dental practice, especially in times of a crises.
The Irish Dental Association should have a significant role in communications. It is an obvious conduit for the dissemination of evidence across the profession.
Policy makers should rethink reimbursement structures for innovations in emergencies, including tele-dentistry, to ensure it is financially sustainable for both patients and providers. The revised infrastructure should provide clarity on indemnity in the context.
Coordination
It the midst of a national crisis it is very difficult to efficiently coordinate communications and actions in the absence of existing strong, established leadership relationships. The arrival of the pandemic was ‘a rabbit caught in the headlights’ moment for many bodies, state and private. The failure of the Department of Health to understand the players to whom it had a responsibility and its ensuing failure to communicate, coordinate guidance or support caused unnecessary stress and anxiety to dental teams and their patients.
Many services appeared overwhelmed. The vaccination programme came to dentists’ attention for at least two reasons. Numerous dentists offered to help in the vaccination centres and most never received a reply. The lack of contact details was also a significant issue when the campaign to prioritise the immunisation of dentists commenced. The Irish Dental Association was obliged to spend huge amounts of time contacting regional immunisation coordinators to ensure that dentists were notified and enabled to receive immunisation vaccines.
Independent dental practice has to be run as a business to survive. Despite the promise of help, the lending institutions were unaccommodating and reportedly cavalier in their approach to requests for help from dentists. Although most of the financial institutions were largely in public ownership, there was no oversight from Government that these institutions responded in a helpful manner to requests to restructure mortgages, loans or overdrafts in the fallow months of the pandemic, especially March – July 2020. Limited support provided by the National COVID-19 Income Support Scheme in March 2020 and the rates waiver/rebate scheme was welcomed.
The closure of practices and reduced patient volume during COVID-19 resulted in substantial financial strain for those in independent practice due to the loss of income, with fixed operational costs continuing despite the lack of patient visits. The financial pressures also led to increased stress and burnout among dental professionals. The fear of infection, combined with financial uncertainty and the emotional toll of navigating an evolving crisis, led to a deterioration in overall mental well-being. (British Dental Journal, 2021; Irish Dental Association Report, 2020; The Lancet Psychiatry, 2021; Journal of the American Dental Association, 2021). This was at a time when medical services were limited. Indeed, dentists, who were open and accessible, were often called upon to deal with problems that their patients would normally present to their medical GPs particularly in the months after 18th May 2020.
Summary:
The lack of preparation and the inability to coordinate services severely affected the ability of dentists to respond to the pandemic in the early months creating anxiety and financial stress. The lending institutions were fundamentally uncooperative.
Offers by dentists to help in other aspects of the management of the pandemic had a limited response. The lack of a database with contact details of dentists working in Ireland was troublesome especially in ensuring the rollout of the phased vaccine programme to all essential oral healthcare workers
Coordination Recommendations:
It is imperative that the Department of Health learn from the pandemic and dentistry is recognised and addressed as an essential service.
The proposed upgrade of the Register of Dentists must be prioritised to provide an accurate register of all working dentists (and in emergency circumstances their contact details) enabling appropriate communication into the future.
Financial aid and relief packages should be specifically tailored to the dental sector in future crises. Measures like subsidies, emergency loans, or tax relief could help ease the burden on practices, particularly small or independent ones that are highly vulnerable during crises (British Dental Journal, 2021).
In future crises, mental health support should be a priority for healthcare workers, including dental professionals. This includes offering access to counselling services, creating peer support networks, and implementing policies to manage workloads and reduce stress. Ensuring the mental health of dental professionals is vital not only for their well-being but for the continued provision of care and patient safety.
Continuity
Independent dental services in Ireland, on and after the 18th May 2020, were outliers in world terms opening up ahead of most other countries and working with standard precautions for infection prevention and control with no restrictions on the type of dental treatment being undertaken for patients who had been appropriately risk assessed. Dental services remained open through all future lockdowns. There is no doubt that being at the forefront caused further stress and work for dental teams. Infection prevention control measures now went from the street to the chair. Once agreed, the evolving advice from the HPSC on infection control protocols compared very well to other national guidance, including the UK National Health Services, where confusion and inconsistencies have been highlighted (Journal of Dentistry, 2021; Dental Tribune International, 2021).
A positive by-product of the advice on infection prevention control measures, Standard Precautions, was that Irish dentistry avoided dumping thousands and thousands of tonnes of costly and unnecessary plastic PPE waste into the environment during the pandemic.
HPSC data provided to the Irish Dental Association shows that the incidence of COVID-19 outbreaks, attributable to dental practices, was remarkably low relative to many other settings, demonstrating the huge commitment of dentists to infection control, a priority for dentists in normal circumstances, which proved invaluable in a lockdown.
The cost of running dental practices increased during the pandemic. Reduced footfall and social distancing measures reduced the number of patients attending in any given day. In addition, all practices were bombarded with marketing for ‘virus killers’ of every imaginable sort. New technologies in air filtration and UV sterilisation units were regularly installed by practices in an attempt to maximise the safety of all who entered the practice. However, many of these technologies lacked robust scientific backing regarding their efficacy, particularly in reducing the transmission of airborne pathogens (Journal of Dental Research, 2020).
Acquiring PPE, an acronym that entered the general lexicon, was challenging and costly as the supply chain was stretched. The cost of PPE items increased three and four-fold overnight. Often, the established dental trade struggled to satisfy demand as opportunistic entrepreneurs accessed PPE sources. This pressure on the supply chain also raised quality control issues.
The Government decided to provide PPE free of charge to nursing homes, to all medical doctors and pharmacists as they requested. Given the significant exposure of dentists to possible infection and the proximity of dentists and dental nurses to the oral cavity, the IDA was disappointed that the same support was not extended to dentists. The Association lobbied all the political parties on this issue and in correspondence dated June 4th 2000, the then Minister for Health, Mr Simon Harris TD, pledged to the Irish Dental Association that “the HSE has confirmed to me this week that it has completed a demand modelling process and this will be validated in the coming days. They expect that, subject to necessary approvals, they will be in a position to commence issuing PPE to dental practices in the next 7 days. I have written to the Minister for Finance in support of your request for a zero-rating of VAT on PPE for dentists.” Neither promise was delivered by the Government. No explanation was ever provided to dentists or to the Association for these broken promises.
The IDA made repeated representations on this issue, highlighting that it estimated that with massive demand and significant price gouging by suppliers, dentists were facing an estimated €14 – €16 per cost of appointment in procuring PPE by their own efforts. In correspondence released to the IDA subsequently under Freedom of Information legislation, the HSE estimated that the annual cost of providing PPE to dentists in the private sector (excluding fully private dentists and specialists / limited practice dentists) could amount to over €66m (HSE 2020), suggesting a total cost in private dentistry of over €75m. The fact that no support was provided to dentists obviously means that they were obliged to bear costs of over €66m simply to acquire PPE to care for and treat their patients. Unlike their medical equivalents in general practice, dentists receive absolutely no support towards their running costs. The appropriate supports provided to doctors during the lockdown and the failure to provide any supports to dentists represented a double insult to dentists and has caused a long-lasting distrust in the state’s leadership amongst dentists.
The 2020 report of the HSE Primary Care Reimbursement Service shows that payments of €183m were made to doctors in general practice in the form of allowances, locum, nursing and other practice support payments in addition to annual and study leave payments. Fees paid by the HSE to reimburse medical GPs for care provided to medical card patients increased from €429m in 2019 to €605m in 2020. By contrast no payments in the form or grants or allowances were paid to dentists in general practice and the level of fees paid by the HSE to reimburse dentists for providing care to the same cohort of patients (medical card holders) fell from €56m in 2019 to €41m in 2020. So, although dentists’ income had dropped remarkably and they incurred significant extra costs in providing such care, the Department of Health and the HSE chose to provide no assistance to the dental profession at its time of great need.
It is reasonable to say that the catalyst for the withdrawal of dentists from the medical card scheme, Dental Treatment Services Scheme (DTSS), emanates from the Department’s response to dental concerns over costs associated with delivery of the scheme, or more accurately, the lack of response. Briefing Notes, prepared by the Department, in advance of meetings with the Association reflect the Department’s unwillingness to address issues specific to the delivery of dental care through state schemes (Department of Health 2020). From the outset, the Association warned the Department of the inevitable outcome for those under their care (Irish Times, 2020).
Dental education, at every level, was disrupted by the pandemic with protracted closure of educational facilities. This resulted in challenges to pedagogy and most importantly, clinical exposure in undergraduate and postgraduate programmes which the Schools were required to address. The disruption will have affected the education of at least five years of student programmes in each School and the effects, including the remedial work done to compensate for the disruption, will have to be assessed over many years. Continuing professional development made widespread use of webinars and podcasts, media that have remained popular with dentists to the detriment of in-person meetings. This has implications for future CPD delivery, networking and wellbeing.
The HSE Public Dental Service (PDS) which provides care to children and special care patients primarily, faced additional challenges in that the majority of staff (clinical and non-clinical support staff) were redeployed from dental services to work in other services such as Covid assessment centres, test centres, vaccination centres, to work with the National Ambulance Services and other admin support roles. These redeployments happened very suddenly and early in the pandemic, were sustained and in most cases, dental staff were the last to be returned to their normal roles and responsibilities. This had the impact of placing enormous pressure on the PDS to try to delivery essential services to patients during the pandemic, and the long-term redeployments mean that it will never be possible to deliver care to those patients that were on waiting lists at that time. Clinical staff were redeployed for too long. In addition, in many cases highly skilled dentists were redeployed to admin duties simply due to their abilities to manage non-clinical tasks effectively. This was inappropriate and not the best use of skilled clinical staff.
Many Principal Dental Surgeons were redeployed to Covid services leaving their dental areas without management at a time of crisis. To counteract this many continued their dental service duties in addition to being redeployed to full time Covid services. This was a great personal strain on these staff members. This came at a time when they were trying to support and guide DTSS contractors through delivering emergency care to medical card patients and trying to ensure that essential services were maintained for these HSE patients. Daily these contractors were contacting Principal Dental Surgeons for advice on how to manage clinical situations in the absence of guidance and PPE.
HSE dentists were critical to Covid services- their expertise was invaluable in providing insight and coordination in setting up and operating clinical Covid services e.g. their expertise in basis infection prevention and control.
As with private dentists, without the leadership and communications from the IDA in conjunction with the NOHO, the PDS would have been without leadership and guidance from the HSE on how to manage the pandemic situation.
General anaesthetic services were halted as were all elective surgeries. However, dentists in HSE Public Dental Services had to fight harder for emergency access as their patients were from “the Community” and not hospital patients, per se. Dentists in the HSE have acknowledged their gratitude to Oral Surgery Specialists in private practice who assisted in the emergency management of some challenging cases when we had no access to GA in the hospitals.
HSE dentists had to fight to resume elective lists and in some areas these lists have never resumed with knock-on effects on waiting lists and patients. Indeed, in some regions the hospitals wouldn’t even swab the dental patients being admitted for day-case procedures and farcically HSE dental services had to make their own swabbing arrangements to ensure the hard-won theatre access wasn’t wasted.
Summary:
In Ireland, dental services reopened in advance of many countries to the credit of everyone involved from the guidance providers, the IDA, the dental trade and most of all, the dental teams for whom this was understandably an anxious time. Regrettably, it was also a time where opportunities to undermine the good will and professionalism of dental teams were exploited. The Minister for Health, his department and its officers provoked disbelief and anger amongst the dental profession, which continues to have significant consequences in the delivery of services. The attitude evident destroyed the little trust that dentists had in the Department of Health and its desire or ability to provide oral healthcare services.
Continuity Recommendations:
Accountability: Promises made must be promises kept.
Transparency and fairness must underpin support for all essential workers.
Robust supply chains for essential PPE must be maintained during times of crisis to prevent shortages (Journal of Dental Sciences, 2021).
The environmental impact of pandemic measures, especially waste PPE, must be considered in decision-making.
Future adoption of new technologies in the dental sector should be based on solid scientific evidence and peer-reviewed research.
Greater contingency planning is required regarding the maintenance of care provided by the HSE Public Dental Service and especially in regard to the redeployment of skilled dentists, both in terms of the impact on care delivery and on the well-being of both those redeployed and those left to attempt to maintain care delivery.
Collaboration
“Coming together is a beginning. Keeping together is progress. Working together is success.” Henry Ford will never know how prescient his observation on collaboration proved to be for dental teams in the pandemic.
The IDA knew it did not have the authority to independently offer guidance and advice despite the absence of leadership within the Department of Health. But leadership was required. The IDA collaborated with or, at least, reached out to many bodies, some at home, some abroad.
The principle of collaboration adopted across the IDA was ‘consensus for the advancement of the common good’. It is easier said than done but it was regularly achieved across the many invitational collectives.
The Association’s repeated attempts to work with the Department of Health most often fell on deaf ears. This has long been the Department’s working practice with dentists and the beginning of the pandemic brought no change. Multiple suggestions and requests, including the nationwide establishment of emergency treatment centres (Irish Times 2020), were put on the long finger or ignored.
The collaboration of the IDA with Professor Cormican and our colleagues in the NOHO, Drs Joseph Greene and Niamh Galvin, was a turning point in gaining the confidence of dentists and their teams. It worked on a number of levels including the honest nature of the collaboration, the pooling of knowledge and the ability to adapt to changing circumstances. The collaboration had the confidence of the IDA and its numerous committees. The IDA’s communications with its membership reflected the strength of collaborations while ensuring a wide audience, both of which were important to the reopening of dental practices across the country. The general reopening of practices was an important optic to the public in their concerns around infection prevention and control. This successful venture was a prime example of leadership through collaboration.
The Association wishes to acknowledge the strong support provided by Professor Martin Cormican and his team. His willingness for the HPSC to provide dental specific guidance in consultation with dentists was a game changer. Likewise, we commend the work undertaken by Drs Joseph Greene and Niamh Galvin in the HSE NOHO and their close collaboration in particular with Dr Eamon Croke, the IDA’s nominated point of contact with the HPSC.
Similarly, we wish to acknowledge the leadership shown by Mr David Walsh in the HSE and his colleagues who convened an online consultative forum with representatives of trade unions, including the Irish Dental Association, to discuss and find solutions to the many practical problems which arose in regard to clinical guidance, the vaccination programme, supports for frontline staff and industrial relations issues which arose.
The Irish Dental Association was fortunate to collaborate in an online forum with the chief executives of the American Dental Association, the Australian Dental Association, the British Dental Association, the Canadian Dental Association and the New Zealand Dental Association, which proved very helpful in gathering information on guidance, research and responses in similar jurisdictions. Likewise, the Association availed of contacts through the Council of European Dentists.
In so many ways, all these collaborations would have been less than they were without the collaboration of members of the IDA, across its committees, especially the Quality and Patient Safety Committee and the Executive Team. This was the net that drew in the information, sorted it and released it to the profession. Despite regular negative criticism and the long hours involved, the work continued guiding the profession throughout the pandemic. The success of the collaborations is borne out by the calming of social media, the reopening of dental services in advance of our neighbours, near and far, and public safety in the dental setting.
Summary:
In a crisis, no one person or body has all the answers. Collaboration pools available knowledge, skills and consensus. The IDA constantly interacted with a wide range of people and organisations in providing leadership and reassurance in a dearth of both from Government bodies. The leadership of the IDA was central to establishing, maintaining and communicating the upshot of the many collaborations. The Association demonstrated commitment, flexibility and expertise in all collaborations.
Collaboration Recommendations:
In preparing for future pandemics, collaborations based on commitment, cooperation and consensus are key to outcomes for the common good.
Potential Crisis Collaborations should be explored and recognised in preparation for future events.
The Irish Dental Association, immersed as it is in the dental profession, has a meaningful contribution to make to collaborations in future pandemics.
Conclusion
In conclusion, the COVID-19 pandemic underscored the importance of preparedness, flexibility, and rapid response within the dental sector. Moving forward, it is essential that lessons learned are applied to enhance the resilience and sustainability of the sector, ensuring that oral healthcare remains accessible to all, even during crises. Supporting mental health, ensuring financial security for professionals, and fostering technological innovation are key components for future success. Furthermore, recognising dentistry’s vital role in public health will ensure that equitable access to dental care is prioritised in times of crisis. The severe disruptions and profound loss of trust experienced during the COVID-19 pandemic must serve as an undeniable catalyst for fundamental reform. Without immediate, decisive action to implement these vital recommendations, the Irish dental sector and, critically, the nation’s oral health, will remain vulnerable to future crises. – another suggestion for emphasis
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