Irish dental directive raises concerns

Dentists in Ireland's public health clinics have been ordered not to place fillings in carious primary teeth of otherwise healthy children, according to an article in Irish Health. A memo issued by a senior dental manager at Health Service Executive (HSE), Ireland's public healthcare provider, ordered the new policy in an apparent effort to cut costs.

But Dental Protection (DPL), a community watchdog group composed of dentists and lawyers, is raising concerns about the HSE's directive.

"DPL is concerned when any dentist finds themselves in a situation where they cannot adequately treat their patients due to a lack of resources," DPL said in a press release. "Our concern is that this particular policy statement could create an ethical dilemma for dentists; since acting in the best interests of their patients could prove to be contrary to HSE's instruction."

DPL advised against leaving primary teeth caries unrestored, citing potential danger such as abscess, infection, and unnecessary pain and suffering experienced by young patients. Legal concerns were also outlined.

"Not providing treatment for patients nor making them aware of other options, this could result in complaints to or claims by patients against the HSE," DPL said. "This in turn could compromise the dentist's professional position, possibly resulting in disciplinary action."

After the publicity, the HSE has made an effort to assuage concerns about conflicts of interest that could arise as a result of the directive. In an e-mail to, DPL wrote, "The Department concerned has clarified that there is more flexibility within the system than might have been originally suggested and that currently resources do allow the filling of deciduous teeth."

According to a recent newsletter published by DPL, dentists have been "instructed not to provide routine deciduous fillings" unless the case is "exceptional" and "prompted by an obvious gain for the patient."

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