H E A LT H

Denture dilemmas
Since 2008, dentures can be provided directly to consumers by clinical dental technicians.
However, it seems there are many providers operating in the market who do not have the
adequate clinical qualifications. Consumer Choice investigates.
Most of us would prefer not to reach a worker the ‘clinical dental technician’ or model where consumers had to visit the
stage in our lives where we have missing CDT has been introduced by the Dental dentist for all their dental needs. Allowing
teeth and keeping our mouth and teeth Council. While changes are intended to for greater competition in dental services
healthy is key to preventing oral health benefit the consumer, issues affecting was intended to benefit consumers
problems such as tooth loss. Where consumer health protection have also resulting in more competitive prices.
tooth loss does occur getting dentures arisen. Some progress has been made and
fitted is a common solution. We’ve put since 2008 a new clinical profession was
together some tips for consumers who A new class of dental worker created. Consumers who need dentures
may be considering getting dentures and In 2007 the Competition Authority can be treated directly by a qualified AT A GLANCE
advice on denture care for those who published a report on dentists which clinical dental technician. Previously these
have them already (see denture care). highlighted that consumers had to go professionals would have supplied
Consumer Choice also updates through their dentist to get dentures and dentures to dentists. Dentures can still be Professional
consumers on changes in how dentures did not have the option of going directly sourced through the dentist, who would practice.
are provided in Ireland. Now consumers to a qualified clinical dental technician. order dentures to a specific prescription
Unregulated
no longer have to go to their dentist if The Competition Authority called for for the patient from a dental technician providers.
they need dentures or have to get their urgent reform of the dental sector and the dentist would then treat the
old ones repaired. A new grade of dental suggesting it was based on an outdated patient. c Our investigation.

HEALTH MAY 2011 consumer choice 125

Useful contacts

Advertising Standards advertising of denture services: our investigation

Authority of Ireland
IPC House
35-39 Shelbourne Road
Dublin 4
Ireland
tel (01) 6608766
fax (01) 6608113
email info@asai.ie
www.asai.ie

The Dental Council

57 Merrion Square
Dublin 2
tel (01) 676 2069
fax (01) 6762076
email
info@dentalcouncil.ie
www.dentalcouncil.ie

The supply of dentures, dental repairs and maintenance are advertised by many service providers. However there are currently
only 15 clinical dental technicians on the Dental Council’s register, who would be appropriately qualified to treat consumers
directly who are in need of denture services. We looked at how services are advertised in the Dublin area.
We looked at the ‘dental repairs’ section of the Dublin area Golden Pages 2010/11 edition and found a list of 38 ads for
such services. Of these, only five were on the Dental Council’s register. These are the only clinical dental technicians on the
register with an address in the Dublin area. All of the registered clinical dental technicians clearly stated they were clinical
dental technicians, showing the letters CDT after their name indicating their level of qualification.
Almost half of the ads did not list the name of the proprietor or give an indication of their qualifications. They didn’t often
claim to be a dental technician, but advertised themselves as for example a denture clinic, lab, specialist or studio. Services
offered included new dentures, duplicates/remakes, repairs, adjustments and cleaning.
If these providers don’t treat consumers directly, and are just advertising their services to dentists who need to order
dentures for a patient, then there is no breach in the law. However it is unclear from the ads who the target customer is. None
specified they were advertising to dentists and not the general consumer.
To begin to assess if they do provide services direct to consumers we called a number of those offering denture services
that we didn’t find on the Dental Council’s register. Posing as a relative of a consumer who wanted to get a new denture
made, we asked if it was possible for them to make and provide a denture to replace some missing teeth, or did the patient
need to go to the dentist for this. Out of the eight we got a response from, all except one said they could provide this service.
A number also said that they didn’t accept medical cards. The CAI has alerted the Dental Council of our findings and called for
an investigation.
Last year the Dental Council raised three complaints with the Advertising Standards Authority of Ireland (ASAI, see Useful
contacts) relating to ads in the 2010/11 Golden Pages. Advertisers who were not on the Dental Council register were
advertising the fitting and repair of dentures, which only a registered dentist or clinical dental technician is permitted to do. All
three complaints were upheld and the ASAI complaints committee deemed that future advertisements should refer to the
services being available to dental surgeons only. Two of the advertisers stated in response to the ASAI’s queries their services
were aimed at dentists and not the general consumer. One of these advertisers was included in the sample we contacted.
When asked if they could provide dentures to our relative, they said they could.
The same ads are still featured in the Golden Pages and when Consumer Choice contacted them about the issue they
declined to comment. The representative organisation for clinical dental technicians, the Clinical Dental Technicians
Association of Ireland (CDTAI, see Useful websites) told Consumer Choice “The Dental Council and Golden Pages should
endeavour to ensure that only qualified and regulated professionals are entitled to advertise clinical services. Dental
technicians and dental laboratories should only advertise in the dental laboratory section.” Alongside ads for dental repairs in
the Golden Pages, the CDTAI gives a number of tips for consumers when choosing denture treatment.

126 consumer choice MAY 2011 HEALTH

c Professional practice
While the change was intended to
benefit consumers giving them more
choice another issue has arisen. Not all
denture providers operating in Ireland
have the same level of qualification, and
it’s not easy for consumers to identify
which professionals have adequate
qualifications to provide dentures. We
assessed a sample of promotion
information consumers must evaluate
when choosing where to get dentures
(see advertising of denture services: our
investigation).
Dental technicians and clinical dental
technicians both make dentures, but
clinical dental technicians have specific
training, above that of a dental
technician, and can provide dentures
direct to the public. The Dental Council
(see Useful contacts) regulates the dental
sector in Ireland, defines the scope of
practice of dental healthcare
professionals and describes the tasks
dental technicians and clinical dental
technicians are legally entitled to carry
out. It clearly states that dental
technicians do not carry out or provide
treatment directly to the public, perform
clinical procedures or fit any appliances.
The Dental Council’s ‘Scope of Practice’
document published last year stated:
“these are skills reserved for dentists and
clinical dental technicians.”
Clinical dental technicians are
technically trained to make, fit, repair
and maintain dentures, including
advising patients about their dentures.
They also have clinical training meaning
they can assess mouth tissue and will
refer patients to dentist if they identify
issues that would need a dentist’s
attention. They can also work on dental
implants that have already been fitted by
a dentist. They are part of a dental team
and if explained in terms of a hierarchy,
the dentist is at the top and other clinical
dental care professionals, such as clinical
dental technicians and dental hygienists
also provide dental services that support
the dentist’s work.
Register
The Competition Authority also
highlighted in its report that there was
no register for clinical dental technicians
in Ireland, meaning that consumers had
no means of verifying a denture
provider’s qualifications. The Dental
Council now maintains a register of
clinical dental technicians, which was
opened in 2008.
Useful websites
denture care Irish Dental Association
• Provision of dentures It looks impressive if someone has a list of qualifications after their www.dentist.ie
name, but they must be the correct qualifications and at the relevant standard to provide a
Clinical Dental
service – nobody wants a doctor of philosophy prescribing medicines. If you don’t go to the
Technicians
dentist for dentures, only clinical dental technicians with approved qualifications are on the
Association of Ireland
Dental Council register and are qualified to provide dentures direct to consumers. Look for
www.cdtai.ie
CDT after the service provider’s name and check that they are on the Dental Council’s
register. Dental Health
• Night time Remove dentures at night to allow your mouth to rest. Keep them in safe place. Foundation
They can also be soaked overnight in water or a specially designed solution. www.dentalhealth.ie
• Cleaning Like our teeth, dentures should be cleaned twice a day. This will help avoid
discolouration and the build up of plaque. It is best to use denture cleaning products, such as
creams or tablets that can be dissolved to make a solution, or clean with soap and warm
water. Don’t use hot water as this can damage dentures. Toothpaste can be abrasive and is
not recommended to clean dentures with. A soft toothbrush can also help to clean them.
• Denture check-up Because dentures are supported by the jaw bones and gums, these can
change over time meaning the denture fits less comfortably over time. According to the
Dental Health Foundation (see Useful websites) dentures should be checked at least every
five years.
• Duration The last National Oral Health Survey found 48% of older adults who wore dentures
were wearing dentures that were too old (at least ten years). The mouth can change shape
as you age which can mean older dentures don’t fit as well as they used to. If your dentures
have begun to feel uncomfortable or move while you eat or speak, consult a clinical dental
technicians or your dentist.
• Fit When you get new dentures it can take a few weeks for them to adjust to your mouth
and feel comfortable to wear. After this they should feel comfortable and shouldn’t slip or
move while you’re eating.
• Quick fix If dentures crack, fixing them with denture repair kits should only be a temporary
measure. According to the Dental Health Foundation, denture repair kits can be useful in an
emergency, but broken dentures are best mended properly as soon as you can.
“Consumers have been left exposed to
unregulated providers of dental services
which potentially compromises their
oral health.”
If consumers choose not to go through technician is considered to be, the Dental
their dentist when getting dentures, they Council has to set standards of training
can contact the Dental Council to check and qualifications necessary for those to
if the professional providing their be included in the register who are
dentures is on the register. Professionals deemed to be qualified to treat patient’s
who treat patients directly should be dental needs. Those on the clinical dental
registered and this indicates they are technician register have successfully
properly qualified to provide dentures completed a course that has been
direct to consumers. approved by the Dental Council. All those
The Dental Council is also in the on the Irish register have a Diploma in
process of establishing an online search Clinical Dental Technology from the
facility. Consumers will soon be able to Royal College of Surgeons of England.
check online if clinical dental technicians
or other dental professionals are Not on the register
registered, such as dentists, dental If a denture maker is treating patients
hygienists and dental nurses. directly and is not on the Dental
Council’s register this is an illegal practice
Qualifications under the Dentists Act 1985. The
Under the Dentists Act 1985, when a new consumer has no guarantee that the
class of auxiliary dental worker is provider has adequate training if they are
established, which the clinical dental not registered. If consumers have concerns
HEALTH MAY 2011 consumer choice 127
 brushing up on your oral health
• Effective brushing Brush twice a day for at least two minutes. Don’t brush too hard
as this can damage tooth enamel. Also be methodical about your brushing, starting at
one side of the mouth and moving to the other, paying attention to brushing the
surface of each one of your teeth.
• Replacing your brush Bacteria can build up on toothbrushes. Their bristles can bend
and wear with use so consumers should regularly replace their brush.
Recommendations vary on how often you should replace your brush, but most seem
to suggest every three or four months is adequate.
• Floss away It’s recommended you floss after you brush and do so at least once a
day, but preferably twice. This means the parts of your teeth your brush can’t get to
are cleaned. People can dislike flossing because it can be difficult to get in between
tight spaces in teeth. If you’re not a fan, dental tape that’s flat can be easier to get in
between teeth or use small ‘inter-dental’ brushes.
• Mouth rinse Using mouthwash can help prevent plaque build up by reducing the
number of plaque bacteria living in the mouth.
• Spot the signs Regular check-ups at the dentist are essential to good oral health and
if you spot any signs like consistent bad breath or bleeding gums also pay the dentist
a visit.
• Healthy gums, healthy teeth Gum disease is common and the signs include
swelling, redness and bleeding gums. It is easily prevented with good oral care
practices. In severe cases if left untreated it can lead to loosening or loss of teeth.
• Diet and lifestyle Oral health will be supported by what’s good for our general health,
especially limiting intake of alcohol, sugary food or drinks and stopping smoking.

about how they have been treated by an
unregulated provider, or feel misled by a
denture services ad, they should make an
official complaint to the Dental Council.
It holds the powers to prosecute those
providing denture services illegally.
Unregulated providers
Regulated health services and
professional providers of health services
will have professional indemnity
insurance which covers the healthcare
provider for claims made against them if
they breach the duty of care to patients.
Under the Dental Council’s Code of
Ethics for clinical dental technicians they
Report by have an obligation to patients to hold
Aisling Murtagh cc professional indemnity insurance against
accidents and malpractice court cases.
Unregistered providers have no such
obligation to have this insurance, which
makes redress difficult if something goes
wrong. The Code of Ethics also outlines
a range of other duties to patients and is
underpinned by the general principle
that clinical dental technicians are
motivated by the aims of maintaining
the honour and integrity of the
profession and of cooperating with the
dentist in safeguarding the health,
especially the oral health, of patients and
promoting the welfare of the community.
Consumers who have been treated by
a provider they subsequently find out is
unregistered, and have a problem with
their treatment have the right to a
refund. They should also report the
maintained.
The last National Oral Health Policy
was published in 1994. The IDA has also
called on the new Government to
prioritise dental health pointing out,
among other issues, that there has been
no Chief Dental Officer in the
Department of Health for almost a
decade. The IDA states the absence of a
Chief Dental Officer is having a
detrimental effect on the development of
oral health policy in Ireland and has
contributed to the emergence of many
unsuitable ad hoc arrangements in oral
health services.
The case of denture provision certainly
supports the IDA’s claim. At present in
Ireland, there seems to be a system of
unregulated dental technicians operating

choice comment incident to the Dental Council.
Standards of denture care
While greater competition in the dental sector is said to be At the time the Competition Authority
positive for consumers encouraging more competitive prices, report made its recommendations, the
this also has to be matched with the maintenance of high Irish Dental Association (IDA) raised a
standards of care in the provision of dental services. The number of issues in relation to patient
creation of the new class of dental worker, the clinical dental protection and the creation of the
technician, has opened up the field for competition; however clinical dental technician as an oral
competition among properly qualified clinical dental health profession. The IDA said that
technicians is low. Rather a competitive space has opened up while the move to broaden dental
between denture providers who have not gained the relevant technician’s areas of practice was
qualifications to treat consumers directly and clinical dental welcome, any changes should be
technicians who have. This means consumers have been left matched with appropriate technical
exposed to unregulated providers of dental services which qualifications and training to ensure
potentially compromises their oral health. patient safety and standards are
alongside regulated clinical dental
technicians (see advertising of denture
services: our investigation). Such a system
compromises quality of service, leaving
consumers without adequate protection
in a crucial area of consumer health, in
an area where research in Ireland has
shown issues exist. The last National
Oral Health Survey found problems
surrounding provision and quality of
dentures. Partial dentures were found to
have adverse effects on the surrounding
tissues in over 33% of people wearing
them. Furthermore, 41% of older denture
wearers were not satisfied with their
upper and/or lower denture.

128 consumer choice MAY 2011 HEALTH