The dental medical card scheme is in a state of crisis currently. It was confirmed to me in a reply to a parliamentary question that in the period from September 2020 to September 2021, there have been 33 resignations of dental surgeon contractors from the dental treatment services scheme in my constituency of Laois-Offaly alone. This crisis is mirrored in every single region and county right across this State.

In discussions I had with the Irish Dental Association on Monday, it was confirmed to me that there are only 750 dentists actively treating medical card patients. This is less than half the number of contracts held by dentists up to two years ago. This translates to just one dentist per 2,000 medical card patients. It is extremely worrying. The scheme is entirely unfit for purpose. It is under-resourced and restrictive to the point where patients cannot access the care they need in their local communities. It supports the extraction of teeth, rather than preventative treatments to save teeth. An entirely new scheme is required. That is coming from the people themselves, the dentists who are at the coalface.

There are now also enormous and serious concerns regarding access to dental care for children. Over the past decade, there has been a 30% decline in the number of dentists in the public dental service, despite a 23% increase in the number of eligible under-16s due for assessments. Understaffing of the school screening system means that the number of children being seen for targeted checkups is a fraction of what it should be. It also is alarming that the Irish Dental Association says that its members have been repeatedly denied meaningful engagement with the Department of Health, whether through representation in the development of policy, or constructive engagement in its preparation.

We have been promised reform of the Dentists Act 1985 for more than a decade. The Government needs to give this urgent priority. Will the Department of Health respond positively in the near future to the Irish Dental Association's request, communicated two months ago to the Department, for the appointment of an independent chair and confirmation of a framework for negotiations equivalent to that agreed with the Irish Medical Organisation seven years ago? Will the Taoiseach accept that the current crisis is widening the divide in oral health status according to income levels, thereby prohibiting general dentists from following through on their wish to provide access to essential and routine dental care for all of the community?

I thank the Deputy for raising a very important issue. I acknowledge there are significant challenges in fully implementing the dental treatment services scheme, DTSS, which provides dental care, free of charge, to medical card holders aged 16 and over. These services are provided by independent dental practitioners who have a contract with the Health Service Executive. I know the Deputy has spoken eloquently and has been in touch with the Irish Dental Association, IDA. The Irish Dental Association is discussing that contract and the dental treatment services scheme with the Department of Health and the HSE. The Deputy has suggested, following the lobbying of the Irish Dental Association, that an independent chair should be appointed for those talks. The reality is that there are industrial relations and contractual dimensions to this which we cannot lose sight of. That said, additional funding was provided in the budget, of €10 million more than the €56 million base for the existing level of services, so there is now €66 million for the operation of the scheme. The national oral health policy, Smile agus Sláinte, has been developed in consultation with all involved, and was published in 2019. The Minister at that stage meant with representatives of the Irish Dental Association in late November 2020. It was followed by discussions with officials. They have been engaging constantly with the IDA with a view to contractual engagement.

This is about a contract and we need to go into it with our eyes wide open. At the same time, there has been a reduction by more than 200 private dentists holding a DTSS contract to provide dental care to medical card holders. Approximately 1,200 contracted dentists continue to provide oral healthcare to medical card holders under the DTSS. As the Deputy said, recent figures show that there have been about 85 resignations from the DTSS so far this year. Some 81 new contracts have been issued. We are aware that more dentists, particularly recent graduates, have been joining established dental practices. Since they usually, at the outset, provide services under the contract of the practice owner, they are not included in the figures of dental contractors. The salaried public dental services will provide emergency and routine care to children under the age of 16. We want to get these issues resolved. I will again engage with the Minister for Health and the HSE about the ongoing discussions. I am mindful that with matters of this kind, we have to give space for those discussions to continue to get a resolution that is fair to everybody.

I thank the Taoiseach for his response. We have to remember that reform of the Dentists Act 1985 has been promised for the last decade. There are difficulties at play. From speaking with the dentists, there is a lot of frustration which would indicate that there has not been meaningful dialogue with the Department. That concerns me because these issues should have been ironed out long ago and the matter should have been resolved to make sure that people have access to dental treatment. The core issue is that people do not have enough access and that there have been 33 resignations in Laois-Offaly alone. I stress that there needs to be some commitment from the Department to the appointment of an independent chair and confirmation of a framework for negotiations equivalent to that agreed with the Irish Medical Organisation seven years ago. Will the Taoiseach request that the Minister for Health publish the report commissioned by the HSE on orthodontic care and treatment, as an important first step in debating how best to tackle these persistent difficulties that have led to having so few dentists and to 33 resignations in Laois-Offaly?

I thank the Deputy. I will talk to the Minister for Health about the publication of the report on orthodontic care. These are negotiations and discussions that involve contractors seeking a better contract, which will involve additional resources from the taxpayer to provide care for those who have medical cards. We want to provide free dental care for those with medical cards. As always, with contractual negotiations, there are two sides to every story. I am informed that officials in the Department of Health and HSE are in discussions - I will double-check that with the Minister and officials - with the Irish Dental Association on matters concerning the dental treatment services scheme. All matters raised by the Irish Dental Association are under discussion. I will revert to the Minister with the Deputy's views.