First, what should happen – in theory. Your child should be assessed routinely by a public health dentist when they reach second class in school and subsequently called for (free) treatment if they need it.

Another check-up is supposed to happen when they are in 4th class and another in 6th class.

In between times, all children under 16 years of age are entitled to attend for emergency treatment at their local HSE Dental Clinic, if necessary.

Many of the routine assessments and check-ups are being missed out on, however, according to Dr Caroline Robins, the Carlow and farm-based dentist who is now president of the Irish Dental Association.

“What has unfortunately happened,” she says, “is that the HSE dentist workforce fell by 24% between 2006 and 2021 while the number of children in the assessment age demographic needing the system [the under-16s] has increased by over 20%.”

That means that the provision of community dentistry in Ireland was a cause for concern before the emergence of COVID-19, but now the resourcing levels have become a full-blown crisis.

“A lot of dentists were redeployed to do PCR testing and some haven’t come back,” she adds. “During COVID, an emergency service was available but screenings couldn’t happen because dentist numbers weren’t there to do that. The impact of all this is that some children are often 12 years of age and in 6th class by the time they are seen by a dentist under the school screening programme. This has a huge impact in terms of missed tooth decay and early intervention/prevention. It also means that children who need orthodontic assessment are not being referred in a timely manner.”

She reiterates that the school system, when working well, is excellent.

“It is fantastic and would catch everybody if it was properly staffed. It’s just constrained by the HSE’s ability to offer the service. They just don’t have the physical number of dentists to be doing what they want to be doing and they are not back to full capacity after the pandemic yet.”

So what can parents do in the meantime to keep their children’s teeth healthy?

1 Go early

For most parents, taking their children to a private dentist from a very young age is the wise option, she states.

“Dental disease is preventative and lots of parents are now more aware of this. Tooth decay doesn’t have to happen. It’s all about getting children to the dentist early.”

She advocates taking them there at the age of one or two.

“It’s about trying to make it a good positive experience so that they get used to seeing the dentist because God forbid if something happened - a small trauma [accident], for example. Kids at preschool often fall and knock teeth and it would be difficult if their first presentation [at a dental surgery] was in an emergency situation. That’s why we strongly recommend that parents bring their children to the dentist in pre-school years. We try to make the check-up fun and they get a sticker and it doesn’t cost the earth.”

For dentists these early visits are also an opportunity to advise parents, she adds.

“We talk to them about cleaning their child’s teeth and give them dietary advice like what foods are damaging for teeth. It’s all about catching things early, which means that if there is a problem it’s an easy fix. Many families come every six months but once a year is generally fine.”

2 Watch sugar consumption

Parents should become skilled at reading food labels and understanding nutritional values, she believes.

“Sometimes parents don’t know how to read these labels. To find out how many teaspoons of sugar there are in a product, for example, you look at the carbohydrate value on the back of the pack and where it says ‘of which are sugars’, look at that value and divide it by four. That’ll tell you how many teaspoons of sugar are in that product. Don’t forget that sugar has several names also – glucose, fructose, corn syrup…”

With fizzy drinks she advises looking at the ‘per 100 mls’ figure.

“One well-known fizzy drink manufacturers are very clever though [in the way they present the information]. In a 500ml bottle you have to multiply that [per 100ml] figure by five. That works out at 12 teaspoons of sugar per 500ml.”

Other products can have a lot of hidden sugar also, she states.

“Ingredients are ordered on the label according to the amount of the ingredient in the product. This means that the ingredient that makes up the most of the product’s total weight will appear first, followed by the next, and so on. For tomato ketchup, for example, sugar is the second or third ingredient – tomatoes, vinegar, sugar, salt…”

Looking after your child’s teeth is also about limited snacking during the day.

“When it comes down to it, parents have to take responsibility for the amount of sugar their child consumes,” she says.

3 Be ‘well’ aware of fluoride

“If you have your own well on a farm, there won’t be fluoride in the water, so from the age of two parents should be using adult strength toothpaste on children. The toothpaste doesn’t have to be expensive but look for the 1450 ppm stannous fluoride statement on it. It’s the magic number. The ‘child 6-12 years’ toothpastes have that amount. It’s about the number, not the brand. Adult toothpaste may be too minty for children. Fluoride strengthens the enamel, makes it hard and resistant to tooth decay.”

Caroline Robins sees more tooth decay in children from rural backgrounds compared to urban backgrounds, she says.

“That’s because they are not getting the fluoride in the town supply, in drinking water, in cooking. I’ve seen sad consequences of children who have not had fluoride toothpaste. Everyone to their own [some people disagree with fluoridation] but no one likes having dental work done. It’s not easy doing dentistry on small children. It’s scary and noisy for them and they don’t understand what’s going on so it’s fraught. This is all avoidable. It’s back to the fact of attending early, it’s about prevention. Bringing your child to the dentist as early as you can is the single best thing that anyone can do.”

She also points out that decay can be spread from parent to child.

“Tasting food to make sure food is cool can mean transferring bacteria into your child’s mouth, which puts them at higher risk of dental decay. These are all little habits that we don’t think about.”

4 Brush technique

Children need help brushing their teeth for as long as they need help tying their own shoe laces, she believes.

“That can often be until they are eight years of age as their co-ordination won’t be well enough developed until then. Often young children don’t want help, of course, so I suggest to patients to do as I did - leave them to do their teeth cleaning in the bathroom, then get their toothbrush and put a smear across it again - the tiniest amount – and then get them to lie on the bed and look up at you. The vision and access you get that way is so much easier than looking down. A little wet facecloth with a smear of toothpaste on it would work as well.”

She points out that rinsing isn’t necessary and that the spit reflex doesn’t develop until five years of age - and that mouthwash is not advised for children.

5 Sip water not juice

Dr Robins is advising that parents send their children to school with bottles of water rather than juice.

“I used to go to schools to give talks and found that many children were sipping juice all day. It’s better to give them water. Sipping [juice that contains sugar] all day isn’t good.”

Orthodontic treatment

The HSE provides free orthodontic treatment for children who have the most severe orthodontic problems. The criteria used to decide whether a child qualifies is based on an international grading system called the Index of Orthodontic Treatment Need.

HSE dental surgeons can advise on eligibility and refer you to the local HSE orthodontic unit for assessment if appropriate. The types of orthodontic problems that qualify under the guidelines include front teeth that are buried and fail to emerge, multiple missing teeth, very prominent front teeth or severe problems with the bite or jaw development.

Waiting lists are an issue at present, however, with 13,294 patients currently waiting for treatment and 5,076 of those waiting for more than three years.

Dental Insurance

Private dental appointments for children must be paid for, but private medical insurance (dental) can be taken out e.g. VHI Dental and DeCare Dental and HSF.

These are dedicated dental insurance companies. The Hospital Saturday Fund (HSF) family plan will reimburse expenditure on dental (and optical) care within the limits of the policy you chose. You pay up front and get reimbursed within five working days.

See for information about dental cover.

Tax relief can’t be claimed back, at present, on routine examinations or emergency dental work. The Irish Dental Association is lobbying currently for an increase in the number of claimable procedures.

“One frequent misconception is that check-ups and fillings can be claimed on Revenue’s Med 2 form,” says Caroline Robins, president of the association.

“We often have parents looking for receipts for these at the year end but Med 2 doesn’t cover these.”

Note: The Irish Dental Association is the main representative body for general dental practitioners, dental specialists and HSE dental surgeons.

More info

For more information related to caring for your teeth through all the age groups, see

Did you know that

  • Barely half of Irish children brush their teeth more than once a day.
  • Fruit juices contain sugar and water and are no better for your teeth than fizzy drinks.
  • The electric toothbrush was first introduced in 1939.
  • Two-thirds of Irish people who brush their teeth twice a day still have visible plaque deposits.
  • You should replace your toothbrush every three-four months.
  • In the 15th century the Chinese made toothbrushes from the neck hairs of a Siberian wild boar.