Number of dentists registered in the UK in 2007: 661 in 2008: 652 in 2009: 625 in 2010: 684 in 2011: 721
The total number of dentists registered in 2011 was 2,646, and 41 per cent were female (5).
General healthcare is administered largely by the Health Service Executive (HSE). Health sector reform plans envisage the replacement of the HSE over the next two years by smaller regional or functional units with the Department of Health taking a more direct role in the planning of service A significant proportion of healthcare is privately funded, and the private sector is subsidised through tax allowances for health insurance premiums. Dental health care for almost all adults is provided mainly by general dental practitioners. There is also a public dental service for children up to the age of sixteen; patients who cannot afford private dentistry; patients with special needs and/or patients with restricted access to dental services (5). The public dental service is organized at local level in 17 administrative areas of the HSE, each of which is managed by a Principal Dental Surgeon (PDS). In 2012, a national dental office was established under the direction of a dentist (National Clinical Oral Health Lead), who will advise the Department of Health and will effectively take over the role of a Chief Dental Officer for Ireland.
For treatments funded by the State, the standard of dental care is mainly monitored by the funding body. A Dental Inspectorate has been established in 2012 as part of the dental services reform and will be largely responsible for quality assurance of all publicly funded dental schemes. The quality of dentistry in the public dental service is assured through dentists working under the direction of the PDS, working with the Inspectorate. Complaints regarding publicly funded schemes are currently made via the HSE complaints officers or the local PDS. Complaints regarding private dentists can be made to the Irish Dental Council.
Vaccination against hepatitis B is highly recommended for general dental practitioners and is required for those who work in a hospital (5).
All dentists must acquire a license from the RPII (Radiological Protection Institute of Ireland) in order to take radiographs on their premises (5)
Continuing education specifically related to ionising radiation is not a compulsory requirement (5)
There is no mandatory post-qualification vocational training scheme in Ireland. However, a voluntary scheme has been in operation for some years. No Foundation Training Programme currently exists (5).
The principal regulating body is the Irish Dental Council (IDC). Ultimately, the IDC also has a statutory responsibility to promote high standards of professional education and to ensure high standards of professional conduct and ethics amongst dentists (5).
There are registers for dentists, dental hygienists, clinical dental technicians and a voluntary list for dental nurses. There is no register for dental technicians.
Summary of relevant points
1. Regulatory Mechanisms
The principal regulating body is the Irish Dental Council, and the following must register:
Graduates in dentistry from a university in Ireland
Nationals of EEA Member States graduated within the EEA with a dental degree/diploma.
Nationals of EEA Member States who qualify for registration under the provisions of the Directive 2001/19/EC
Ultimately, the IDC has a statutory responsibility to promote high standards of professional education and to ensure high standards of professional conduct and ethics amongst dentists.
All dentists in Ireland are required to work under a code of professional behaviour and dental ethics, as stipulated by the Dental Council of Ireland. The code defines relationships and behaviour between dentists, contracts with patients, consent and confidentiality, continuing professional development, advertising and the quality of treatment delivered. This includes a duty to provide emergency care for patients outside of normal surgery hours
Vaccination against hepatitis B is strongly recommended for general dental practitioners and hospital dentists, but is not a legal requirement (5).
Liability insurance is provided for HSE public dental surgeons and is compulsory for general dental practitioners participating in either the Department of Social and Family Affairs or the Department of Health and Children Schemes. It is not compulsory for other dentists, but strongly recommended.
Corporate Bodies are precluded by law from engaging in the practice of dentistry.
There is no mandatory post-qualification vocational training but a 12 month voluntary scheme has been in operation for some years. No system for foundation training exists.
There are two dental specialties in Ireland: oral surgery and orthodontics (5). Other dental specialties such as paediatric dentistry, periodontology and endodontics, are not formally recognised. However, where practitioners have undertaken further training in these specialties, they can limit their practices to these specialities.
3. Support Systems
Professional representation is via the Irish Dental Union and the IMPACT trade union for public employees.
4. The Dental Team
There is no register for dental technicians. Training is consists of a four year apprenticeship programme, or a three year course at the Dublin Dental Hospital/Trinity College, leading to a Diploma in Dental Technology. All work must be undertaken under the prescription of a dentist.
Dental Hygienists may only practice under the prescription of a dentist, where the dentist will have prescribed the treatment plan and will be responsible for treatment. There are two hygienist education programmes, each of two year’s duration, which both lead to a Diploma. A BA degree programme adapted to European Credit Transfer System (ECTS) is pending.
Dental nurses undergo formal training in one of the dental schools after leaving secondary school with a Leaving Certificate. They obtain a recognised qualification. Others are trained ‘on the job’, and may or may obtain a formal qualification through night school.
Qualified dental nurses and hygienists can train to provide radiography services but there is no validation of this training. Dental nurses who have registered with the Dental Council can take radiographs as long as they have attended a course which has been approved by the Dental Council.
Clinical Dental Technicians have been legal in Ireland since 2009.
Dental therapists and orthodontic therapists are not yet recognized.
5. Dental care delivery
Dental health care for almost all adults is provided mainly by general dental practitioners, who are mostly self-employed and earn their living partly through fees from patients, and partly from government subsidised treatment schemes.
For general dental practitioners, care is mostly charged on a fee per item basis, but there are two ways in which patients are eligible for state subsidised treatment and the total cost of treatment is calculated differently under each. These are (5):
Department of Social and Family Affairs Dental Treatment Benefit Scheme (DTBS)
Insured employees and their spouses may receive wholly or partly subsidised dental care for a limited range of treatments.
Department of Health and Children Dental Treatment Services Scheme (DTSS)
The service is for those over 16 yrs of age who have “low income”, including those over 70 years of age. Patients are referred to as Medical Card Holders (MCH). It is essentially a basic oral health care system which covers examination, scaling, fillings, extractions and root treatments, periodontal and removable prosthetic treatment. The service is provided free of charge.
The public dental service is operated by the HSE, and is known as the Health Board Dental Service (HBDS) (14). Public dental surgeons (HSE employees) are responsible for providing treatment to children under 16 years of age (pre-school and primary school children, but also to others who are institutionalised, medically compromised or otherwise limited in their ability to access a general dental practitioner), adult medical card holders and patients with special needs (5).
There are very few private insurance schemes to cover dental care costs. A limited number of dental procedures are covered by private health insurance, related mostly to in-patient oral surgery.
6. Quality assurance mechanisms
CPD is not mandatory
There is an extensive system for the delivery of continuing education, through courses provided by the Postgraduate Medical and Dental Board, the Dental Schools, the Royal College of Surgeons, the Irish Dental Association, and various societies.
Following graduation, no further training or continuing education in ionising radiation is legally required for dentists.
Any person can apply to the Dental Council for an inquiry into the fitness of a registered dentist to practice dentistry on the grounds of:
Alleged professional misconduct
Alleged unfitness to practice because of physical or mental disability
For treatments where some or all of the cost is shared with the state, the standard of dental care is mainly monitored by the funding body.
The quality of dentistry in the public dental service is assured through dentists working within teams which are led by experienced senior dentists. The complaints procedures are the same as those for dentists working in other situations. In addition, Health Boards have their own complaints handling procedures (4). For Private dentistry, not covered under either of the State Schemes, the only other control on the quality of care is through patient complaints. In the first instances complaints are normally addressed to the dentist directly. A complaint may be made to the Irish Dental Council. If the complaint or misunderstanding cannot be resolve, it might become necessary to instigate civil litigation.
Key Points to Consider When Inducting or Supporting a Dentist Qualified in Ireland
Dentists qualified in Ireland:
May have limited experience of UK clinical governance requirements (e.g. clinical audit);
May not have undertaken vocational training in Ireland;
Will not have undertaken foundation training in Ireland;
May have little experience of working within the wider team of dental care professionals;
May not appreciate that professional indemnity is compulsory in the UK;
May not appreciate that amalgam separators are mandatory in the UK;
May not be vaccinated against hepatitis B.
Country : Italy Population : 60,626,400 (2011)
Number of registered dentists: 58,065 (2011)
Number of dentists in active practice: 48,000 (2007)
Number qualified overseas: 1,172 (2011)
Number of dentists registered in the UK in 2007: 116 in 2008: 148 in 2009: 158 in 2010: 182 in 2011: 192
Background The number of dentists registered in 2011 was 58,065 and 27 per cent were female. There is reported unemployment amongst dentists in Italy, especially in Southern Italy due to a supply-demand imbalance (5).
In principal, until 2009, a comprehensive oral healthcare system existed within the National Health Service (NHS). Implants are the only treatment interventions that are not formally included within the NHS. However, in reality, the dental services provided will vary according to local health priorities, and there are thus significant differences within and between regions. In many areas, only emergency dental treatment is provided. Thus, in reality, publicly provided dental treatment comprises principally of extractions and, sometimes, restorations. It is due to this under-provision of treatment that dentistry is considered a private sector service. However, in the last few years, there has been evidence of an increase in the provision of public dental services, in the form of new models for delivery, and of joint public/private financing especially in Lombardia, Piemonte, Veneto, Emilia and Romagna (5). The government is also looking to prioritise vulnerable groups, including the socio-economically disadvantaged members of the population, the elderly with systemic diseases and high-risk children. Regional insurance schemes are also being planned. These will cover any additional dental care not delivered by the public dental services (16).
There is no formalised direct monitoring of the quality of care in either the public or private sector, other than by patient complaints. However, both public and private practices are “regulated” by District Health Service Inspectors. Vaccination against hepatitis B is not mandatory, but it is expected. Radiation protection is regulated by law. The competent person is always the dentist (5).
In 2002, continuing dental education (CPE became a mandatory requirement. Continuing education and training in radiation protection must be undertaken every 5 years (5).
Since September 2009, the dental degree has increased in length to six years, and ends with the award of a Masters degree.
Glossary of Terms
A medical specialty that relates to the mouth and its diseases, originally practiced by medical doctors. Historically it was a medical specialty.
Summary of relevant points
1. Regulatory Mechanisms
In order to register as a dentist in Italy, an applicant requires a degree or a diploma in dentistry recognised by the Ministry of Health (Foreign Affairs) and must be a citizen from an EU or other appropriate country.
The registration list is held by the Federazione Ordini dei Medici Chirurghi e degli Odontoiatri - the competent authority for dentistry (5). Registration is annual, and the fee varies as it is dictated by each provincial branch medical/dental board.
This national body manages the registration and ethics of all dental practitioners (5).
Professional liability insurance is not compulsory for dentists, but insurance is generally provided by private general insurance companies, or the dentists themselves.
Dentists can legally incorporate and form companies where the only partners are dentists. Non - dentists can be members of these professional companies, but clinical matters must be the responsibility of a Dental Director.
Clinical waste is stored for a month at the practice before being disposed of by a sanitary waste company. Spent X-ray chemicals and amalgam are generally disposed of once a year. Amalgam separators are not compulsory by law.
2. Education and Training
In 2008, there were 34 dental schools, with an annual intake of 800 students
The primary degrees included in the register are:
University degree in dentistry and dental prosthesis with a degree to practice dentistry and dental prosthesis.
or (until January 1984) University degree in medicine and surgery accompanied by specialisation in the dental sector with a degree to practice medicine and surgery.
From January 2003, only a university degree in dentistry is required to register as a dentist.
There is no post qualification vocational training in Italy, nor a foundation training programme.
In Italy two specialties, orthodontics and oral surgery, are formally recognised currently. In the future, paediatric dentistry and general dentistry may also be added to this list,(5)
3. Support Systems
There are two main national dental associations, the Associazione Nazionale Dentisti Italiani (ANDI) and the Associazione Italiana Odontoiatri (AIO). Both associations represent the full range of dental professionals: private practitioners, state employed dentists, university teachers and dental specialists.
4. The Dental Team
Chair-side assistants are generally trained by their employer. However, a training and education programme exists, and in some regions a certificate of completion is issued (5).
A formalised education pathway exists for dental hygienists and technicians.
Since 2003, there has been an increase in opportunities for dental hygienists to practice, without direct supervision by a dentist. Their duty of responsibility (defined by Decree in 1999) includes oral hygiene instruction, scaling and dietary advice, but not the administration of local anaesthesia. Dental hygienists can work autonomously, but must work to the prescription of a dentist
5. Dental care delivery
In 2008, the range of dental services delivered within the National Health Service was redefined to include (5):
Dental health care programmes specifically for those between the age of 0-14 years
Dental and prosthetic care to specific “vulnerable patients. “
For the general population, including those who are not defined as protected groups, the following treatment is guaranteed (5):
Dental examinations following diagnosis of neoplastic pathologies of the oral cavity.
Immediate treatment of dental emergencies - treatment of severe infection, bleeding, pain, and pulpotomy
Access to private dentistry is not a problem but access to the public dental sector is limited, with under-provision of services (even when the treatment is guaranteed) or waiting lists.
The Public Dental Service exists in most regions as the only alternative to private practice. It thus provides the only government funded primary care service. In theory, all members of society are eligible to attend the service, but in reality it is largely the lower and middle class, who cannot afford private care, who will use this service. The Public Dental Services are organised and delivered by local health authorities and vary greatly throughout the country. Publicly provided dental treatment comprises mainly of extractions and, on occasion, restorations. Emergency treatment of oro-facial trauma is also delivered. In most regions, orthodontic or prosthetic treatment is not normally covered by the public system. It is due to this under provision of service that dentistry is considered a private sector service
There are a few private healthcare insurance plans available, but they generally exclude routine dental care. Most, however, include hospital-based oral surgery on an “item of care basis”. There are no private dental care plans.
6. Quality assurance mechanisms
There is no formalised direct monitoring in either the public or private sector, other than by patient complaints. However, both public and private practices are “regulated” by District Health Service (ASL) Inspectors.
In private practice complaints are directed to the appropriate ethical committee, but in the Public Service they are first investigated by a clinical officer who theoretically has the power to suspend or dismiss the dentist concerned.
Each ethical body exercises disciplinary powers and patients are able to complain directly to them about the care that they have received. Both the patient and the dentist can be legally represented during any hearings. This system is applicable in both the private and public sector.
Continuing professional development for dentists has been mandatory since 2002. The Italian Ministry of Health stipulates that dentists must undertake 150 units of CPE within a three-year period (2008-10), including a minimum of 30, and a maximum of 70 units each year. Continuing education and training in radiation protection must be undertaken every five years (5).
Key Points to Consider When Inducting or Supporting a Dentist Qualified in Italy