Dental ‘tourists’ leaving Republic in search of cheaper care

A "dental divide" has opened between North and South in Ireland, with the differences in prices and services upsetting some patients in the Republic.

Checks show that prices for dental treatment are often highest in Dublin and sometimes only slightly cheaper further afield in the Republic. Even so, there is good value to be found.

However, there is often a big drop in price when people travel to the North for dental work and occasionally an additional saving to be made for trekking to eastern Europe. But it's not that simple, as any hard-working dentist in the Republic – and especially Border counties – will quickly point out. There is more to it than price, they say.

Uneven playing pitch
The Irish Times has spoken to dentists both sides of the Border and they all refer to the playing field being far from even.

Government supports and lower costs favour Northern Ireland dentists, many of whom are keen to attract value-conscious patients from the South. Most dental practices are effectively private clinics within the National Health system and therefore have to care for a large patient list – roughly 1,000 per dental surgeon. Many offer evening appointments, some weekend services, and provide cover for emergency care at local hospitals.

Newry has a number of dental practices, many of which target patients south of the Border. Some practices suffered as recession hit the Republic.

Séamus O'Hagan, a partner at O'Hagan and Murray Dental Surgeons in the centre of Newry, is well-tuned to cross-Border traffic. His practice handles about 15 such cases a day. "We find most people come for root canal therapy. If there's [a treatment] with a big price disparity – root canals, crown and bridge work – they come North. They also come for cosmetic treatments such as coloured fillings or tooth-whitening."

O'Hagan can carry out this work at €178-€400 as opposed to prices beginning at €300 in nearby Dundalk and sometimes significantly more at Dublin practices.

There is no need to advertise, he says, and the practice does not pay for online ads. Word of mouth referrals seem to attract a considerable level of business. “Maybe a patient comes once for a crown, then they find that they’re happy with everything and they tend to come again or just once a year for a check-up.”

Crown work in Newry typically costs €400. While such prices can be found in the Republic too, rates are often higher – sometimes much higher – with top-flight clinics charging four-figure sums.

Disparity in prices
O'Hagan denies his partnership sets its prices with the Dublin market in mind, but he knows from those who travel to see him that the price disparity is sometimes very wide indeed. Like many others in practice in Newry, he is well used to dealing in euro, helping to fill out Med2 forms for tax relief in the Republic and managing the treatment schedule into time-efficient appointments for people travelling far.

However, the recession has hit North-bound traffic. Exchange rates and austerity across both parts of Ireland have hit demand for expensive and optional cosmetic treatments. Several dentists said the number of “dental tourists” had declined and some of the most glaring price differentials had been “squashed”.

Tom Rodgers, a Northern-born and trained dentist who used to work in a busy Belfast practice, set up his own single-handed clinic in Blackrock, Co Louth, five years ago. His prices compare well to O'Hagan's – just 15 miles away – with many rates, but not all, on a par with his Newry colleague. However, unlike O'Hagan, he has more costs to bear and laments the lack of support for practices in the Republic.

He receives no State funding and claims that had he remained in Belfast he could have been entitled to up to €40,000 in annual grants, allowances and other supports including leave, sickness cover and, crucially for him, pension entitlements. Northern state subsidies for routine dental care, especially for young, pregnant women and mothers all of whom receive free treatment, guarantee base-level incomes.

The experience in the South, he says, has been one of State withdrawal from the funding of basic care. Medical card holders are entitled to one check-up, two fillings and extractions per year – but that is all. PRSI contributors receive a free check-up but nothing else.

“I got zero help [from the State] when I started here,” he says. “The only way I got anything was by going in and talking to the bank. They loaned me the money and I’m still paying it off.”

Exchange rate fluctuations
For a young dentist branching out with his own single-handed practice, he has endured what he calls a "perfect storm" during 2008-2010. Wages, property prices and equipment costs were all at their highest, he says, and he invested heavily. Since then he has suffered recession, wildly fluctuating exchange rates against sterling and a drop-off in demand by people who cannot afford even badly needed care.

That goes some way to explaining why dental treatment can cost so much in the Republic. Practices in Dublin, where property costs are much higher than in north Louth, suffer accordingly. For all that, his practice is now thriving thanks to hard work and keen pricing.

“The perception on there being a huge North/South price difference is, I feel, wrong,” he says. “Practices in places like Dundalk compare favourably to Newry but there is a tendency to compare with prices in Dublin which would generally be higher than Dundalk. A dentist in Ballsbridge will have much higher running costs than me and will have to set his fees accordingly.”

With a NHS background in Northern Ireland, Rodgers is critical of state dental provision in the Republic.

Toothcare time bomb
"My main problem down here is that the Government has relinquished responsibility for looking after dental health. They've cut PRSI to nothing and cut the medical card – and that's really the cohort of people who can't afford a dentist. You need to be seeing them regularly and if they can't come in here it's a disaster. In terms of dental healthcare here in the Republic, there is definitely a ticking time bomb.

“Forgetting about the dentists, the big problem in the South is for patients – especially medical card patients. It’s depressing. I can’t treat them for free. It’s the Government’s responsibility to ensure proper dental healthcare is provided for those who can’t afford it themselves. That’s how I see it.”