Recent statistics have revealed that there have been over 2,000 grievances against dental practitioners over a four-year span, with the majority stemming from issues with one specific dentist.
The Dental Council has reported that it is normal for them to receive up to 150 patient concerns per annum. Astonishingly, in the 2022-2023 period, they were bombarded with over 1,500 communications such as phone calls and emails regarding one dental practitioner, Anne Hahessy from Oranmore, Co Galway. Hahessy has since committed, before the High Court, to abstain from dental practice while the council investigates the numerous complaints that emerged after many patients were left with no crucial orthodontic treatments.
David O’Flynn, the registrar of the Dental Council confirmed that each year, the council predominantly receives complaints regarding the quality of treatment that patients received. Irrespective of the influx of complaints, the much-needed reforms to the regulation of dentistry have not made progress.
The regulation of dentistry in Ireland is unique among other health professions as the hearings determining a dentist’s fitness to practice are conducted privately. Only the severest allegations are investigated, typically relating to professional malpractice, which refers to a significant deviation from expected standards. These allegations must be backed by evidence beyond a reasonable doubt, similar to criminal cases.
Dentists make up the majority of the Dental Council with 12 out of 19 members. O’Flynn noted that the council has not published an annual report since 2018 due to resource constraints.
In its 2021 submission to the Minister for Health, the council highlighted a “substantial risk to public safety” caused by legislative gaps. The council’s submission expressed that the lack of regulation has resulted in patient safety not being guaranteed, with some patients experiencing harm as a result. The council pleaded for more authority to intervene and brought to light issues such as dentists who had been disbarred in other countries setting up practices in Ireland, the presence of unregistered dentists, and significant failures in maintaining patient safety standards.
From 2020 onwards, there have been a total of 38 requests for investigation into dental practitioners; 26 of these were lodged by patients, nine instigated by the council and three initiated by fellow professionals.
Decisions were made by the council to investigate 22 from these cases, while 15 were ruled out due to lack of substantial evidence pointing at professional misconduct. One case remains unresolved.
The High Court has settled five cases involving three dentists, meanwhile, 17 investigations continue to be underway. The concluded cases led to one dentist voluntarily agreeing to deregister, while another is awaiting council sanction. No actions were directed towards the third dentist.
Mr O’Flynn reported that the Department of Health has engaged in “productive conversations” around future legislative amendments. These modifications under deliberation would necessitate dentists presenting their registration certification upon request and participation in compulsory professional competency programmes.
Under existing law, the council doesn’t hold authority to verify a dentist’s registration or enforce continuous professional development, Mr O’Flynn clarified. “While there is a moral imperative at play, there isn’t a legal requirement.”
When questioned about the delays in hearing investigations, Mr O’Flynn acknowledged that allegations often take up to nine months for the council to thoroughly investigate. Owing to the “health aspect”, the investigation period can be prolonged to maintain due diligence.
The department, which appointed a chief dental officer in 2017, assured its intention to reexamine the Dentists Act of 1985.
“The minister held discussions with the council in January to review the executive powers at their disposal under the Act, and the possible progression of provisional amendments. A number of in-depth discussions around legislative matters have taken place between the department and council, with more expected in the future,” the department stated.
Furthermore, careful consideration will be given to align appropriate fitness to practise with other significant aspects of the Act corresponding with other health regulatory Acts.
One patient, Patricia*, who sought investigation into her unfavourable experience with a dentist, insists that there is effectively no regulation of the profession. The issues began in 2019, after a routine checkup stemming from discomfort in a crown led to a root canal treatment. Patricia began to experience severe pain, which she described it as “more agonising than childbirth”, following the procedure.
Patricia recounted her harrowing experience of intense facial and jaw pain, blurred vision, and frequent fainting spells, all stemming from what was supposed to be a routine dental procedure. Despite receiving antibiotics from her dentist eight times, the agony lingered on. She then embarked on a medical journey that included consultations with an additional eight dental professionals and doctors, a fortnight stay in hospital, painkillers, and two nerve blocks.
The debilitating pain incapacitated her to such an extent that it brought her business operations to a halt. Patricia lamented that an uneventful dental procedure had led to a life-altering permanent injury that would demand constant treatment and medication throughout her life. As a result, she initiated legal proceedings against the offending dentist, and a significant settlement was reached out of court, although the dentist did not acknowledge any responsibility.
Simultaneously, she engaged her lawyers to report the dentist’s reluctance to release her X-ray scans for over a year to the Dental Council. The X-ray records were eventually produced following the council’s interference, even though Patricia insinuated that they were incomplete. The investigation by the council was concluded and they declined to recommence it.
David O’Connor, the Dental Council Registrar, clarified to Patricia that the council looked into allegations of professional misconduct instead of attending to grievances in their conventional sense. He elaborated that the standard to prove allegations surpasses any reasonable doubt, which permits for shortcomings in dental practice standards that may not qualify as professional misconduct. The council only assesses the provability of an allegation and doesn’t get involved in patient inquiries.
Lastly, Patricia pointed out that the implicated dentist was currently under other legal battles. She conveyed her realization that both the Act and the council appeared to be powerless, describing it metaphorically as a ‘cardboard mock-up’ of regulation with a facade but devoid of substance. This understanding, she confessed, was a result of her distressing encounter with a dental procedure gone awry.
It is commonly believed that the Dental Council is responsible for ensuring the safety of dental patients. An effective regulatory organization equally supports its profession and patients. It is capable of identifying and intervening when practitioners aren’t meeting standards. It aids such practitioners in rectifying their mistakes. It conducts unbiased investigations into treatment failures to gain knowledge and enhance practice. If treatment does not go as planned, it assists patients by linking them with specialists to rectify the mistaken treatment. Additionally, it provides a solution for patients who have suffered harm.
However, the Dental Council does not perform any of these duties.
A dentist’s case was brought to closure after he claimed to have provided all the evidence in his capacity, stated Mr O’Connor.
*not her real name.