Caroline Robins (right) is a dentist and owner of Kiwi Dental in Carlow town. She is also the incoming President of the Irish Dental Association 2022.
Married to Anthony, they have two daughters and a suckler-to-beef farm outside Tullow, Co Carlow. Caroline has been in Ireland for 22 years and hails from a sheep farm in New Zealand.
As a dentist, the catch-up with dental procedures after the lockdowns is Caroline’s biggest headache at the moment.
“Due to COVID, appointments have been lengthened to ensure an adequate turnaround time between patients and to lessen foot fall in the waiting area,” she says. “This lessens the overall volume of patients in a day, so I therefore don’t see the usual number of patients a day. Consequently, I am now booking into October. Generally, with a shortage of dentists in the country at present, getting an appointment can be crazy hard.”
Broken teeth due to stress
But what are the main problems Caroline is seeing post-lockdown?
“After the first lockdown, it was broken tooth after broken tooth,” she says. “It was probably that people were snacking more – because they were at home – or people were clenching due to stress. Then we started to see pain in jaws, the muscles around the jaws and people were describing headaches as well. Stress is a prime cause of tension in the mouth which results in clenching.
“Clinically, I was seeing people with horizontal lines running along the inside of their cheeks which is a sure sign they were clenching teeth at night. I made quite a few night splints. Considering what was going on – the working from home, the restrictions, home schooling, closures of some industries – stress was in every aspect of society.”
Cleaning an issue
Lockdowns also led to some people not being as careful as before about cleaning their teeth, she adds.
“Hygiene started to fall with people who were previously pretty tidy, so they were turning up with not such a clean mouth.
“I think, in part, working from home, snacking more frequently and a little less routine, so to speak, contributed to this.”
HSE school check-ups
Because the HSE has been unable to provide 2nd, 4th and 6th class dental screening for primary school children, private dentists are seeing a lot of children with tooth decay.
“This had been an issue pre-COVID anyway,” she says. “The HSE had reduced the number of public service dentists by over 20% and the number of children eligible for the service had increased by over 20%, so the service was under-resourced.
“When COVID hit, many public health dentists were redeployed to undertake swabbing and contact tracing, lessening the available numbers again. The HSE still doesn’t have enough resources. As a consequence, children are not being screened as they should be. This isn’t the HSE dentists’ fault. They have been left to provide a service with little or no personnel available to them.”
Dental bondings, braces and whitening have become more popular since COVID-19 began, too.
“Certainly, we are seeing a lot of people coming in for cosmetic procedures since they have been sitting in front of the screen, video conferencing, looking back at themselves instead of the usual looking at someone else when you are having a conversation,” she says.
“Braces are very popular as well, especially because masks are being worn and they can be hidden away for a lot of the day.”
Caroline encourages people to start with treatments that don’t require invasive destruction of one’s teeth, however.
“Whitening especially is a lovely non-invasive way to freshen your smile.”
Caroline remembers her experience of the first lockdown and the challenges that presented.
“I work in private practice and, initially, dental practices were limited as to what they could provide. From March to May 2020 it was emergency only. Some practices closed altogether over this period and some didn’t. We provided an emergency service on an as needed basis.
“Basically, we provided pain relief for those who needed it. We took out a lot of teeth and undertook first stage root canals. We were not allowed to place any fillings as the worry was that drills caused AGPS (aerosol generating procedures). As the virus was said to be spread by aerosols, sneezing and coughing, the concern was that these procedures would be extremely risky. However, once we reopened in May we were deemed an essential service and could provide all services. We had extensive guidelines from the HPSC (Health Protection Surveillance Centre) as to recommended precautions to take and the level of PPE we should be wearing.”
But was it difficult to cope?
“In a word, yes,” she says. “There was so much uncertainty. No one knew anything for absolute and the information and news footage at that time – coming from Italy, especially – was really scary. There were days I asked myself, ‘What are you doing?’ I am in my late 40s and, while healthy, you just never knew. On the other hand, I couldn’t, in good conscience, let my patients be in pain and in need of emergency treatment, so I elected to provide this level of care through the March to May Period. From May we returned to full service.”
Mini operating theatres
While all patients will now be asked COVID-19-related questions and have their temperature taken on entry, dental surgeries have always been very clinical settings.
“To be fair, the set up in the dental surgery hasn’t changed that much,” Caroline says. “We always wore gloves, masks and scrubs. Dental surgeries are often described as mini-operating theatres. The level of cleaning and sterilisation after each patient happened anyway, even before COVID, so we were at least on that front already up to the mark with what was needed.
“It was testament to the profession, I think – how many patients came back in their droves once lockdown was lifted – as they all felt safe in the dental setting.”
How often should we have dental checks?
Regular check-ups and regular cleaning, by a dental hygienist, twice a year, will pay dividends, Caroline insists.
“Nothing you do at home in relation to cleaning products and gadgets will make one ounce of difference if you first don’t have a healthy clean foundation,” she explains. “Always get your teeth checked and cleaned. It’s just like your farm vehicles’ DOE. It has to be done!”
Illnesses a dentist can spot
Going to a dentist regularly can also do more than keep your smile bright.
Dentists are always looking out for signs of abnormalities which could indicate other issues related to your overall health.
“Delayed healing can be seen in someone with diabetes,” she says, “Frequent ulceration may suggest a deficiency in iron or B12, for example, or highlight another cause – such as blood loss due to an ulcer or a tumour. We can often pick up if someone has undiagnosed reflux or an eating disorder, too, by how their teeth look.”
The big one, however, is oral cancer.
“We are always looking for ulcers, red lesions, white lesions, lumps and bumps. I would encourage anyone who may have had an ulcer that is persisting for more than three weeks to go to their dentist and have it looked at.”
Farmers and their teeth
“Farmers, traditionally, would be emergency presenters as the need arises – reactive rather than proactive,” Caroline says.
“I have those that smile politely at me when I suggest the hygienist and a cleaning twice a year – something I would highly recommend – and I have others that embrace it and are great regular attendees.
“For farmers, you have to think of the appointment times as well – dairy farmers can attend between 11-2. The older age group are emergency attendees and often have their appointments made by their wives! Home care would be basic but diet would be OK – three meals a day – so you often see grime, so to speak, and not drastic tooth decay. I’d probably see more gum disease as they are a little ad hoc with cleaning routines. It can be hit and miss.”
She finds that the younger generation of farmers are better at looking after their teeth.
“They attend regularly. Their parents would have bought them as children and many are doing a job off the farm as well as farming and are definitely more dentally aware.”
Living on the land
Although the pandemic has been tough, frightening and exhausting, Caroline is grateful that she was able to continue working and have a job to go to.
“I am so conscious that so many have had their lives turned upside down by this pandemic with loss of job/industry closure,” she says. “Living on the land over the first lockdown was a saviour.
To be able to walk everyday around the farm with the dogs to clear the head and talk myself back into the game when I fretted about the safety or sanity of what we were doing at the very beginning was a priceless gift.”
Don’t forget that self-employed people with the required PRSI contributions are entitled to a free annual dental examination and a subsidised cleaning once a year under the Treatment Benefit Scheme.
Under this scheme, the Department pays the full cost of an oral examination once a calendar year.
A payment of €42 towards either a scale and polish or – if clinically necessary – periodontal treatment, is also available once a calendar year. If the cost of either cleaning or periodontal treatment is more than €42, you must pay the balance – capped at €15 for a scale and polish. There is no cap on the balance charged for periodontal treatment.
Treatment is provided by private dentists who are on the Department of Employment Affairs and Social Protection’s panel. Lists of dentists on the panel are available on welfare.ie
The Irish Dental Association has a ‘find a dentist’ facility on its website, dentist.ie. Caroline Robin’s dental practice website is Kiwidental.ie