When dentists first had to display their awards in 2011, it was seen as a milestone for patients.
It followed continued criticism of a lack of transparency when a series of price surveys compared dental costs in the Republic and Northern Ireland.
Some NHS subsidized dentists in Belfast attracted so many customers that they offered transport when patients crossed the border on the ‘pain train’.
A Irish independent research on dental prices shows widespread variation, with gaps not only appearing between city and city, but also between surgeries that are relatively close together, with a filling costing €70 in Dundrum, Dublin, and €170 in Blackrock, a few miles away.
So, is this evidence of competition? And why such large variations?
Overheads such as property prices and rent are higher in the cities and must be added to operating expenses.
But other hidden factors can influence prices. One of these is recruiting and retaining dentists and dental hygienists. They are in short supply, so if a practice owner wants to keep them, they need to be competitive when it comes to pay.
Those costs can be passed on to the patient, but dentists argue it means service is improved with more patient access to timely appointments.
The advent of larger, corporate-owned chains has also changed the landscape. These have economies of scale that are not open to the smaller family businesses.
Covid-19 has also affected some practices more than others.
During the darkest days, when so many people feared infection, they avoided doctors and dentists. Not only was there a decrease in the habit, but dentists had to reduce their number of patients by a third.
By July 2020, 16 percent of dentists had resumed less than 50 percent of their practice.
Still, most said they worked the same hours because of social distancing and infection control measures. Dentists have long pointed to the extra costs of personal protective equipment, which in a three-dental practice amounted to about €14 per appointment.
A number of dentists have hired additional staff to manage cleaning and infection control between patients. Some have been able to absorb these costs more than others.
Most have said that their daily operating expenses have risen since the pandemic, while at the peak they saw revenues fall.
Some clinics and surgeries also offer more advanced treatments than others, and expectations from the public – especially younger age groups – have increased.
In addition, at the last count, only 1,082 private dentists were contracted for the HSE to provide care to medical card holders, by 1,482 by May 2020. Dentists insist it is not economically viable.
This year, the Minister of Health has announced an additional €10 million Stephen Donnelly to reintroduce a scale and polish for medical card holders from May 1, and a broader assessment has been promised.
Dentists say the current medical schedule is so restrictive in what they can offer patients that it creates a two-tier system that is ethically difficult for them to get over.
State payments provide a guaranteed buffer, so if there were a better medical card system, it could have the knock-on effect that benefits private patients.
Michael Kilcoyne, president of the Consumers Association of Ireland, who for many years was the facilitator with the Dental Complaints Resolution Service, said some issues related to costs were related to the patient not being well informed about any increased payments. that arose after work began on their treatment.
Each patient should be given a treatment plan in advance, stating what they will pay, Mr Kilcoyne added.
The dental board regulates the profession, but unlike the medical board that oversees physicians, it maintains an obscure profile that is not good for dentists or the public.
While it does not play a role in prices, in times of a cost of living crisis it should be more consumer-oriented about dentists’ obligations, which will make people more vigilant if price is a priority.