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Dental treatment: Putting your money where your mouth is

"A YOUNG farmer came to me to have his teeth cleaned, and I looked into his mouth and saw something on the side of his cheek."

Wicklow dentist Dr James Turner says: "I didn't like the look of it, so I sent him to a specialist. He had early stage dysplasia -- a cancer in his mouth -- which is completely curable, if it's caught in time.

"The man has three young kids."

But the changes in dental treatment for medical cardholders mean that many people won't be going for routine teeth cleaning. It's no longer covered for anyone over 16 on a medical card.

If you've lost your job and you're trying to support your family on the dole, and you're looking at that €50 note, what are you going to choose to spend it on? Getting your teeth cleaned, or buying food for your kids?

A fortnight ago, anyone with a full medical card had access to a range of dental care: examination, cleaning, fillings, extractions, dentures and front tooth root treatments.

But last week the HSE decided that these people could only attend a dentist if they have an emergency -- and then they can have one tooth out, or one filling.

"The mouth is the mirror of your body," says James. "When we look in the mouth as dentists . . . we have to examine for all manner of conditions and the risks they present."

There is a known link between bacteria in the mouth and cardiovascular disease -- heart attacks and strokes.

And expectant mothers who have periodontitis -- a gum disease -- are in danger of having underweight or overweight babies.

"Complications of diabetes will present in the mouth," says James. "Therefore, dentists can be the first people to refer a patient to a GP or a specialist." Osteoporosis is also obvious in your mouth. So is bulimia. "Sometimes we get young people -- girls mostly -- who show a striking pattern of erosion on the insides of their teeth where they force themselves to be sick," James says. "The acid in the vomit wears away the enamel."

And there are gum diseases. "If people have swollen or bleeding gums, that affects their physical health, because they can't eat properly, and their mental health, because they're dealing with long-term pain."

James has been in private practice for eight years, and has already saved three patients with early stage cancer.

But he's heard the stories of older dentists, about the bad old days when people could only afford emergency treatment: "People in lines in their waiting rooms, with swollen faces, lots of kids in terrible condition with lots of pain, and they spent most of their days just extracting and trying to deal with emergency care."

This changed with the introduction of preventative dentistry. "Since 1994, people's dental health has improved immeasurably -- the Government has got great bang for its buck.

"We were winning the battle," he says. "We're picking up approximately three oral cancers every week in Ireland. By not allowing people these visits, all these oral cancers -- the third biggest killer in the cancer ranking -- will not be caught until a late stage."