A dental system in decay, with urgent reform required.
The Senate Select Committee into dental care has said it is time to put the mouth back into the body, and increase funding to allow people to access dental care.
A Senate Committee inquiry into dental services has handed down a report highlighting a system in decay and has made a series of recommendations necessary to ensure that Australians are able to access dental care in a timely and affordable manner.
The committee received 168 submissions, heard from 84 witnesses over 4 hearings and had a staggering 17,592 public responses to a survey. Some of the responses and testimony were quite harrowing:
‘I have come to the heartbreaking realisation that I cannot afford this treatment. My front tooth will eventually fall out, and as the disease progresses, I will lose the rest of my teeth with it.’
‘The pain in my mouth affects my general wellbeing and the lack of regular, basic dental care takes away dignity and self-respect as well as inability to enjoy food properly.’
‘We found that 118,943 people in rural and remote areas did not have access to general dental services within a 60-minute drive.’
‘She has been in a lot of pain and has been on the waitlist to receive treatment via general anaesthetic by public dental health services for over a year.’
The committee heard that there were many barriers to accessing care, including high costs, trauma and fear, long waiting times and inaccessible services, with gaps including a lack of special needs dentists, limited mobile services, very few Aboriginal dentists and sparse services in regional areas. Poor oral health has significant impacts, including pain and suffering, shame and low self-esteem, poor nutrition and poor general health.
Poor oral health remains one of the strongest indicators of disadvantage in Australia, and the impacts are wide reaching. Oral diseases including dental caries (tooth decay) and periodontal (gum) disease are amongst the most prevalent diseases affecting Australians. There is an urgent need for action to improve access to dental care to improve oral health outcomes.
Around 50% of the population do not visit the dentist on a regular basis, and cost is one of the major barriers to access care. Government funding for dental care across Australia is manifestly inadequate, and amongst the lowest compared with comparable countries. This lack of funding is one of the key contributing factors resulting in long waiting times for public dental services and poor oral health linked to social disadvantage. Whereas governments fund 80% of hospital expenditure and 79% of medical care, they contribute only 21% to total dental expenditure (with a large portion subsidising private health insurance), so it is not surprising that the safety net for dental care is not meeting the needs of millions in the community.
Regional and Rural Australia
The lack of oral health workforce in regional and rural Australia creates a major barrier for accessing dental care, with more than three times the number of dentists per 100,000 people in major cities compared with remote areas. Much of the growth in the workforce over the past 20 years has been concentrated in these major cities, exacerbating these access issues. That is why there are a series of recommendations to address this workforce maldistribution, including incentives to work in regional and remote Australia and implementing a subsidy for students from rural backgrounds to study dentistry and oral health.
Economic and Social Disadvantage
Cost continues to be a major barrier to accessing dental care, with an underfunded public dental system unable to cope with the demands placed on it. People skip or delay care because routine dentistry is unaffordable, and there is clear evidence that the cost of dental care affects people with lower incomes more than those with higher incomes. Waiting times for public dental care are unacceptably long – over 2 years in parts of Australia – and this leads to a cycle of despair as oral health deteriorates whilst waiting. Until the government increases funding for dental services to similar levels as the rest of health, many Australians will continue to suffer poor oral health outcomes.
Aboriginal and Torres Strait Islanders
Aboriginal and Torres Strait Islanders experience a disproportionate level of poor oral health compared with other Australians. With around half living in regional and remote areas, many lack access to even basic oral health care delivered in a culturally appropriate manner. There is a need to work more closely with Aboriginal community controlled health providers to improve outcomes.
Disabled People
Some of the most harrowing testimony related to disabled people, who experience poorer oral health and have more unmet treatment needs than non-disabled people, with significant barriers in accessing care. There is a shortage of specialist dentists to provide care to disabled people and limited funding for patients to access care, particularly when that requires sedation or general anaesthetic services. The NDIS is also failing to provide the support services necessary to assist in improving oral health.
Older Australians
The population is ageing, and soon around 20% of Australians will be aged 65+ years. Older people are keeping more of their teeth, but this means they continue to experience dental problems – particularly tooth decay and gum disease – as they age. The Aged Care Royal Commission highlighted significant neglect of oral health in residential aged care, and that is why the report has a number of recommendations for older Australians, including importantly the establishment of a Senior Dental Benefits Scheme as a matter of priority.
Solutions Based Approach
Although the situation appears dire, there are solutions for a government committed to improving oral health. A strong focus on health promotion and the integration of oral health into primary health care is essential. There is a need to expand the oral health workforce into areas of need, particularly in regional and remotes areas, Aboriginal health, supporting disabled people and those living in residential aged care. Funding for service provision needs to follow the workforce into these areas, with work to increase the utilisation of the Child Dental Benefits Schedule as well as implementing a Senior Dental Benefits Scheme as key steps on the path to universal dental care. It is important that this is done in a planned and phased manner, to allow for the workforce to grow and adapt to a new system. It also means that care will be provided where it is need most – targeted to those population groups that experience the greatest disadvantage. One key recommendation is the establishment of a Chief Dental Officer to provide much needed leadership and oversight.
It is imperative that the Albanese government carefully considers the recommendations of this report. They have three months in which to table a response sets forth a plan to increases access to dental care in a sustainable and equitable manner.
The report has highlighted the system is in decay, and we all know what happens when decay is left untreated …
Further reading:
Last week: If you missed, last week, you can go back and read about the launch of the Mindful Smiles Hub, a new online mental health and wellbeing resource for all members of the dental team.