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An effective dental health scheme needs more than funds for fillings

By Mark Schifter - posted Thursday, 5 February 2004

The indigent and socially disadvantaged in Australia today are not determined by their state of dress or even where they live, but by their poor oral health, often exemplified by lack of teeth. This is why Labor's announcement of a national dental scheme, previously known as the Commonwealth Dental Health Program, urgently needs to be addressed.

As with the previous scheme under the Keating government, directing money into fillings and dentures will not fundamentally affect dental health in Australia. Once a tooth is replaced or repaired it needs ongoing regular maintenance. To be effective, any national dental scheme must be directed to long-term goals beyond the electoral cycle.

An oral health national strategy would entail that money is not simply flung at repairing and replacing teeth, but would address the major cause of oral health dysfunction - tooth loss. In children and young adults tooth loss is primarily due to dental decay, but in adults, it is due to gum and periodontal disease, and the lack of a workforce to provide oral health care. What needs to be done?


First, money must be spent on a national fluoridation scheme to provide longer-term amelioration of the rates of dental decay. Water fluoridation is a proven and effective public health measure that benefits not only children, but our increasingly aged population, who lose teeth from decay of their root surfaces, which is difficult to repair.

Fluoridation should be part of a cohesive national policy, not subject to the whim of local government authorities which determine in which regions it is available.

Second, money needs to be provided for unfunded preventive practices, including dental-office-based fluoridation, diet assessment and education, cleaning and scaling.

Third, fundamental reform of the oral health sector is needed. Projections show that there will be a shortage of 200-300 dentists in NSW by 2010. To train a dentist entails a five-year university course that is frightfully expensive - given the need for access to appropriate costly labs, models and patient simulators, and ongoing expenses in infrastructure, materials and chairside support and assistance. With progressive financial shortfalls in the university and health sectors, the training of dentists is, and will be, compromised.

Another problem is that there are no prescribed internship or pre-registration vocational training for dentists, as there is for doctors. In a world of ever-increasing technological and biomedical advances, and increasing litigation, it would be sensible to extend the training of dentists by providing financial support for a two-year "dental intern" program as has been successfully undertaken in Britain. This would allow the immediate creation of an extensive oral health workforce in public hospitals and dental clinics and available to the most needy, as well as ensuring the availability of dentists in rural and regional areas.

Again unlike medicine, there are few if any salaried or funded specialty training postings. For the poor, socially disadvantaged or geographically distant, there is little if any access to specialist services such as orthodontics, oral surgery, and periodontics. Salaried, specialty training positions, with a requirement of one to two years' "return of service" in a public facility, would ensure access for the indigent. With appropriate infrastructure in place, such trainees could be rotated to rural and regional centres.


Yet there is a group even worse off than the poor - patients termed "special needs" or "medically compromised". These are patients who, because of their medical, physical or mental state, cannot be treated by general dental practitioners in the private or the public setting, and require treatment to undertaken within the safety and resources of hospitals.

This group - which includes the severely immuno-suppressed, such as organ and bone marrow transplant recipients, patients who require replacement heart valves, and those needing radiotherapy treatment to the head and neck - need medically necessary dental care.

One practical long-term solution is an extension of Medicare to fund, concurrently with the patient's medical treatment, this medically necessary dental care. For example, specialist treatment such as orthodontics is provided to cleft palate patients, via Medicare.

No single issue so much defines the advantages that the haves have over the have-nots than the access to oral health services that so many of us take so much for granted. An immediate injection of money is needed for the disastrously long waiting lists for basic dental services, for the relief of pain and the repair and replacement of teeth.

However, just throwing money at the problem will provide little if any short-term gain. In fact, it may be harmful if unrealistic expectations are created and left unmet when, with the next change of government, policy sees the money dry up.

The next federal dental scheme needs to do more than just give money for fillings. Money, as well as leadership for a policy of true reform of the dental sector, is what is required to bring about a longer-term benefit and improved outcomes in oral health for all. Let us hope Labor and the Liberals are listening.

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Article edited by Marita Eisler.
If you'd like to be a volunteer editor too, click here.

This article was first published in The Sydney Morning Herald on 29 January 2004.

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About the Author

Dr Mark Schifter is the senior specialist in oral medicine at the Westmead Centre for Oral Health, and national president of the Oral Medicine Society of Australia and New Zealand. These are his personal views.

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