HRG Public Statement :: Poor oral health in Australia is a costly chronic problem that is getting worse. Current strategies do not address the problem.

Posted 2 years ago by convenor

 

 

Download the Word Document – HRG Statement on Oral Health- 2023-09-16

Draft Press/Public statement

Poor oral health in Australia is a costly chronic problem that is getting worse. Current strategies do not address the problem.

The Sydney-based “Health Reform Group” (HRG), drawing members from across the health professions and consumers, meets regularly to champion needed healthcare reform in Australia. The HRG, stimulated by recent distressing data, again advocates for timely access to evidence-based dental care for all Australians.

Most people will claim that they use their teeth three times a day when eating. Some will remember their snacking habits and adjust to five times a day. Few will remember that everyone needs their teeth to speak properly, and even fewer think teeth are crucial for our ability to smile, smell, taste and swallow. We need our teeth to convey a range of emotions through facial expressions, for which teeth are essential. On top of this, all people want to do these activities with confidence and without pain, discomfort and disease. Just as the mouth is connected to our body, so too oral health is essential for good overall health.

For decades health professionals have been arguing that it is illogical and costly to regard the protection of oral health any differently than the protection of our hearts and lungs. Poor oral health leads not only to toothache but results in social and physical costs to individuals who suffer from the stigma of poor dentition, ranging from problems in securing employment to missing school and work, and downstream impacts on other chronic diseases, like cardiovascular diseases, asthma, arthritis and metabolic diseases, like diabetes1.

According to the Australian Institute of Health and Welfare, Australians aged 15 and over have an average of 11.2 decayed, missing or filled teeth, and 1 in 25 have no natural teeth2. In NSW, over 20% of adults (15+ years) have avoided eating certain foods because of problems with their teeth, mouth or dentures over the last 12 months2. Over a quarter of Australian adults reported they felt uncomfortable about the appearance of their teeth, mouth or dentures in the previous 12 months2. These numbers contrast starkly to the available care—less than half (44%) of Australian adults with teeth had a regular dental provider whom they visit for an annual check-up, an appalling statistic compared to other developed countries (US: 64%; England: 61%; Canada: 86%). About one-third of the Australian population is eligible for public dental services, but in practice, there is only sufficient capacity to provide services for about 20% of eligible people, resulting in multi-year public dental waiting lists.

One in four children aged 5–10 have untreated tooth decay in their primary teeth2. An alarmingly high number of young children are hospitalised owing to preventable dental conditions: in 2021, we had 150,000 hospital stays requiring general anaesthesia for procedures related to dental conditions2. In Victoria, dental conditions are the highest single cause of preventable hospitalisations for children under ten. Dental caries is 5th highest disease burden among 5-14-year-olds3. Kids are suffering in Australia!

Dental care in Australia is a policy anomaly; for some reason, the mouth is treated very differently than other parts of the body. About 59% of dental costs are met directly from patients’ pockets, compared to 11% for medical primary care and 12% for prescriptions. Overall, $11.1 billion was spent on dental services in 2020–21 ($432 per capita)2.

Dental caries is a preventable disease! While water fluoridation has been recognised as one of the most effective public health measures in preventing dental caries, it is still not universal in Australia4.

In 2021, we had 82,000 potentially preventable hospitalisations due to dental conditions2. The AIHW estimates that, in 2015, oral disorders were responsible for 4.5% of the non-fatal burden of disease in Australia2.

There are a number of State and Federally funded programs supporting dental health. However, the Productivity Commission stated that the majority of dental services presently funded in Australia have never been scrutinised methodically for effectiveness, cost-effectiveness, value or health equity. Instead, the system focuses on high-volume services where patients receive care that is not always focused on achieving better health outcomes. Patients are less likely to receive preventive services in public dental services as the current funding arrangement is predominantly treatment-focused5.

If we want to address the silent epidemic of oral disease, we need to know the extent of the problem and then track measures that reflect oral health improvements across communities. Thus, as for the rest of healthcare, we must integrate the existing dental care information health information technology ecosystem so that, with patient consent, it encourages the routine sharing of reliable information at the individual tooth level across private health insurers, public dental services and private dental services. As in medical general practice, mandating interoperability with My Health Record and integrating all dental electronic records with hospital EMRs should be included in all state and national oral health strategic plans.

The HRG insists that oral health should be a foundational component of health and physical and mental well-being; we, as a society, need to address this issue. If oral health reflects the physiological, social and psychological attributes essential to the quality of life, then denying it to large portions of our population does not align with Australia’s egalitarian aspirations and values.

Immediate actions are needed!

The Commonwealth Child Dental Benefits Scheme (CDBS) helps eligible children to receive dental treatment with up to $1,052 for each child over 2 consecutive calendar years, full costing would be around $1.5b (3 million kids x $526 per year). The scheme covers children who live in low- and middle-income households – those that receive Family Tax Benefit Part A or another Commonwealth payment. The CDBS is under-utilized—less than 40% of eligible children participate.

Let’s fully fund the CDBS an use the funds to improve the oral health of Australians by extending the CDBS to other vulnerable groups: Aboriginal and Torres Strait Islander peoples have more than a two-fold prevalence of dental caries. Residents in aged care facilities go days and sometimes weeks without anyone cleaning their teeth, while Medicare pays for cutting toenails and hair in aged care facilities but not for oral healthcare. People who live with disabilities lack access to sufficient dental care, with only a few places in the country that provide care to patients with special needs. We call for an immediate:

  • Increase access to dental care by allowing billing for suitable services by oral health therapists, dental therapists, dental hygienists, and dental students under supervision, i.e. non-dentists.
  • Increase to the billing cap (and possibly fee for some services) for children with special needs (including Aboriginal and Torres Strait Islanders) when provided by designated service providers.
  • Retention of the limits on types of service, but access for all children 0-18 whose families don’t have private health insurance.
  • Repair of the administrative systems to make it easier for clients and providers.
  • Establishment of capitation for services like Aboriginal Community Controlled Health Organisations as this means they can employ oral health professionals with greater budget certainty. 
  • Refinement of the eligibility to exclude children covered by PHI (to avoid double dipping) and change private health insurance so that family dental insurance cannot exclude children.

Implement Australia-wide Universal Prevention
Water fluoridation in Australia is still not universal, particularly in some of the country’s most disadvantaged communities. Water fluoridation is recognised as an effective prevention approach, so nationwide implementation needs to be immediately prioritised.

We need preventive oral healthcare for all, starting with implementing robust programs for vulnerable groups, such as children, people with physical and mental disabilities that impact their self-care capacity, high-level residential aged care, highest-level community care packages, and Aboriginal and Torres Strait Islanders.

Where they don’t exist, we must commence school oral health screening and service to all schools. A public education campaign needs to include information, among other aspects, about the preventive power of sealants, the importance of healthy eating and the need to care for baby teeth.

 

Fundamental change is required

We have an uneven oral healthcare delivery system where a few lucky patients receive evidence-based and person-centred care. At the same time, others receive too much or no care.

We, the members of the HRG, envision a time when all Australians will receive timely evidence-based dental healthcare, not because they are affluent or live in a metropolitan area but rather as part of Universal Health Coverage. We align with the resolution of the 148th session of the World Health Organization (WHO) Executive Board (2021) that calls on member states to integrate oral health within their national policies and, as part of general health, to reorient the traditional curative approach and move toward a preventive and health promotion approach to oral health, develop surveillance and monitoring systems, map and track fluoride in drinking water, and reduce risk factors for oral diseases and strengthen oral health care as part of universal health coverage.

Full access to oral healthcare supports the best possible care for all Australians—“all” meaning here across

  • all socio-economic groups,
  • all age groups
  • all encounter types, including preventive, acute, chronic and monitoring well-being,
  • all settings, including in hospitals under general anaesthesia and in traditional ambulatory care settings, and
  • all geographical areas of Australia.

How do we move such a vision from impossible to imperative to inevitable?

The HRG asks all levels of government and consumers to support the establishment of a National Dental Commission, under the leadership of a permanently appointed Commonwealth Chief Oral Health Officer, to steer the implementation of this imperative as an urgent priority.

 

References:

  1. Global oral health status report: towards universal health coverage for oral health by 2030. World Health Organization (2022). Geneva
  2. Oral health and dental care in Australia. Web report. Australian Institute of Health and Welfare (2023). Canberra. https://www.aihw.gov.au/getmedia/54eca525-8a32-4ec4-96cb-f3c8aa551f8c/Oral-health-and-dental-care-in-Australia.pdf?inline=true
  3. Australian Burden of Disease Study 2022. Australian Institute of Health and Welfare (2022). Canberra.
  4. Health effects of water fluoridation. NHMRC (2023). https://www.nhmrc.gov.au/fluoridation
  5. Nguyen, T.M., Bridge, G., Hall, M. et al. Is value-based healthcare a strategy to achieve universal health coverage that includes oral health? An Australian case study. Journal of Public Health Policy 44, 310–324 (2023). https://doi.org/10.1057/s41271-023-00414-9