An expert group of dentists has warned of huge logistical, administrative and legal problems resulting from the HSE's shock decision last month to end free routine dental care for 1.5 million medical card patients.

The experts say medical card patients are currently in the dark about what their future entitlements will be.

And documentation released to Fine Gael health spokesman Dr James Reilly also shows that recommendations from the lead principal dental surgeons to the HSE on ways of living within a reduced budget for the free dental scheme this year were ignored when the HSE announced the cutbacks in a circular on April 26.

In this circular, the HSE annunced that medical card patients would in future only be entitled to emergency dental care for relief of pain or infection. Routine treatments such as fillings will no longer available under the medical card scheme.

The HSE said in order to live within a reduced €63 million budget for the scheme for 2010, medical card patients would only get emergency dental care with a focus on the relief of pain or infection, and additional care would only be considered in exceptional or high-risk cases.

The lead principal dental surgeons, who are tasked with advising the HSE on the free dental scheme, have now warned the HSE of significant management, governance and legal issues surrounding the cuts in the scheme.

The experts, among other issues, have pointed out:

* That there is no commencement date given for the changes, causing significant confusion among dentists and dental staff.

* That no notice period has been given to patients or dental contractors in the scheme and medical cardholders have still received no information from the HSE about their reduced entitlements.

* That no advice has been given with regard to the entitlements of patients whose treatment is in progress at present.

* That principal dental surgeons were not informed of the impending cuts before contracting dentists were, thus affording no time for local management to prepare.

*That no operating procedures for how the cuts will be administered have been produced.

The dental experts have pointed out that the lack of a lead-in time for the new scheme has meant that patients who might already have made appointments to see dentists will now turn up to be told they have no entitlement to treatment.

The experts also point that no information has been given about what constitutes "approved emergency circumstances" for free dental care under the new arrangements.

They say as it stands , there is nothing to prevent dentists in the same practice from "churning" patients for multiple "emergency" courses of a treatment.

The dental experts say the scheme has "exposed the HSE as an organisation that appears to care little for its employees, contractors or its patients."

They add that the way the dental cutbacks have been implemented "has done nothing to enhance the reputation of the HSE as a well-managed organisation."

The lead principal dental surgeons have also warned the HSE that inevitably, there will be legal challenges by dentists to the implementation of the revised scheme.

They also point out that advice sought from them by the HSE on how planned savings could be implemented were were ignored when the cutbacks were announced.

The lead dentists also claim that in the lead-in to the cuts, a letter drafted for a senior HSE official to the Department of Health did not  reflect their advice, exposed the HSE to "professional ridicule" from dental contractors, and contradicted HSE policy in areas such as antibiotic use.

Dr Reilly expressed concern that the advice of the dental experts was ignored in framing the implementation of Budget cuts to the dental scheme.

"What is the point of the HSE having experts at its disposal if it is going to take no notice of what they have to say?"

He pointed out that medical card patients can no longer get dentures, routine scaling, fillings or extractions.

Dr Reilly added that the position of Hepatitis C sufferers, who had been entitled to free dental care, is unclear.

The new cutbacks affect medical card patient care provided by private dental contractors.

According to the Irish Dental Association, dental services for medical card patients are still avalable from public health clinics. However, until now, these have mainly been availed of by children under 16 and special needs patients.

The Association says these clinics, along with the dental hospitals, may now be inundated with medical card patients who can no longer avail of routine services from private dentists and would not be able to cope with the extra demand.

A spokesman for the Association also told irishhealth.com that there is considerable concern on how the cutbacks will affect vulnerable groups, and a number of support groups had expressed concern about the cuts.

The Association has described the cuts as unsafe, unworkable and unethical, hitting the most vulnerable in society.