- Many people are avoiding preventative care and early treatment because they can’t afford dental care, resulting in more serious oral and general health problems — with more extreme treatment and higher costs later on.
- The public dental health system is failing the people who need it most, with the Federal and state governments blaming each other for the crisis.
Nothing to smile about
A recent study of thousands of Australians representing all walks of life found that:
- 30% of adults reported avoiding dental care due to its cost.
- One quarter had untreated decay, and more than 20% had moderate to severe gum disease.
- Almost one in five had avoided certain foods because of problems with teeth, mouth or dentures.
- Just over half of Australian adults visited a dentist at least once a year.
So, the overall state of dental care in Australia isn’t looking too flash. And it could get worse: it’s been estimated that by 2010 Australia will have a shortage of 1500 dentists and other oral health professionals — equivalent to 3.8 million dental visits.
Please note: this information was current as of June 2007 but is still a useful guide today.
High cost of dental care
When the cost of a check-up, a couple of x-rays, a clean and scale and a fluoride application costs over $200 on average, perhaps it’s little wonder people think twice about such preventative measures.
And from there the costs blow out: throw in another $100+ for each filling needed, or $400 for root canal treatment if it’s gone that far, and you start to understand the current affordability crisis. We’ve tabulated the costs of some common dental procedures to help you work out if you could get a better deal.
A significant minority of Australians is forced to go without regular dental care, perhaps requiring extractions or expensive remedial treatment some time down the track. At worst, people are being hospitalised with life-threatening illnesses. This shouldn’t be happening in a wealthy country such as ours.
Who’s to blame?
Responsibility for public dental healthcare has traditionally lain with the state and territory governments.
- In 1994 the Keating government introduced the short-lived Commonwealth Dental Health Program, worth $100 million a year in its heyday (1995/96). This was additional to state funding. While the federal funding was less than a third of total public funding, it dramatically helped reduce waiting times for dental care, shifted treatment from extractions (a last resort) to fillings, and increased attendance.
- The Howard government abolished the program at the end of 1996. The effects were immediate and devastating. Waiting lists and waiting times have blown out, there’s been a shift to emergency dental care, such as extractions, and increased costs as dental problems get worse while waiting.
- The Federal Government says dentistry falls under the jurisdiction of the states, and it’s up to the states to pick up the funding shortfall. Only Queensland has done this. (Despite this, Queenslanders have the worst teeth in the nation — due to a lack of fluoridated water.)
Others argue that because the mouth is part of the body, dental care is part of healthcare — a federal responsibility. And with increasing evidence of the links between poor oral health and heart disease, premature births and severe problems leading to hospitalisation, it’s difficult to argue for their segregation. See Flow on effects of poor dental care, below, for more information.
Federal funding for private dental care
The Federal Government hasn’t completely abandoned taxpayer funding for dental care, forking out hundreds of millions of dollars a year to people with private health insurance. The 30% tax rebate for people with ancillary cover was calculated at $438 million for the 2005/06 financial year for the dental care component of the extras cover rebate.
Approximately 42% of the population benefit from the private health insurance rebate, and while people from all income groups have the insurance, the more you earn, the more likely you are to have it. So it’s the relatively wealthy who benefit most from this form of government dental funding. Consider also that a lot of private insurance dollars are spent on what’s essentially cosmetic dentistry: for example, where healthy, functional teeth are straightened up with braces for a nicer smile.
Having private dental cover does confer some benefit for teeth:
- People with dental cover are more likely to visit the dentist for a check-up (rather than a specific problem) and to visit the dentist at least once a year.
- Many companies actively promote preventative dental healthcare for members, with free or low-cost check-ups and cleaning — see the private dental cover table for what the major insurers offer.
- The study noted above showed people without dental cover had fewer teeth, a higher prevalence and severity of untreated crown and root decay, and higher prevalence of gum disease. However, these differences may not be due only to having the cover — it might also be due to characteristics of the kind of people who take out such cover.
Public dental care
At the lower end of the income spectrum:
- Five million health concession cardholders are entitled to public dental care, many of whom have problems accessing services.
- At the moment there are 650,000 people on waiting lists for public dental care.
- The average waiting time for public dental care is 27 months.
- People on low incomes visit dentists less often than the more affluent, are more likely to have teeth extracted than filled, and are less likely to get preventative care.
- People with particularly poor dental health and who are least likely to visit the dentist are low-income adults, people living in remote and rural communities, indigenous people, nursing home residents, people with disabilities, young adults on income support payments, and single-parent households.
- The cost of dental care doesn’t only affect the poor, with 23% of adults not eligible for public dental care reporting delaying or avoiding treatment because of the cost.
Little action on endorsed national plan
A comprehensive National Oral Health Plan was endorsed by state and federal health ministers in July 2004. The plan acknowledged the disparity across socio-economic groups with respect to oral health, and sought to address this through equitable and efficient allocation of resources. But three years on, little progress has been made.
CHOICE is a member of the National Oral Health Alliance, an advocacy group comprising various community and welfare organisations, and dental and other health professionals. The Alliance has called on the Federal Government to renew its commitment to oral healthcare for disadvantaged adults by taking responsibility for covering the minimum costs of their basic dental care. The states and territories are also expected to uphold their responsibilities under the National Oral Health Plan, including oral health promotion, expansion of water fluoridation, and planning and development of high-quality and accessible adult oral health services.
Specific recommendations for Commonwealth action include:
- Funding preventative and early-intervention treatment for eligible adults: this entails a comprehensive oral health check (including clean, scale and x-rays) or the cost of a basic course of treatment (such as fillings or treatment for acute gum infection) every two years.
- Expanding eligibility for publicly funded dental healthcare to include those who aren’t currently eligible, but who are unable to afford dental care.
- Ensuring the National Oral Health Plan is properly implemented.
- Funding the training of additional oral health professionals in universities.
Seeing the budget surplus of billions, members of the National Oral Health Alliance took their concerns to Canberra earlier this year, lobbying MPs and senators for increased expenditure on dental health. No funding was allocated in the latest budget to increase the affordability of preventative dental care for people on low incomes, although there was more funding for people with chronic conditions and complex care needs to receive dental care. There were also initiatives to increase dental training opportunities and clinical placements in rural and regional areas, and three scholarships per year to encourage indigenous people to study dental health.
Flow on effects of poor dental care
There’s increasing evidence of the links between poor oral health and cardiovascular disease, diabetes, poor nutrition (when you’re limited to eating certain foods) and oral cancer. It’s also connected with premature births.
Every year there are tens of thousands of hospital admissions for problems arising from a lack of preventative dental care. Sometimes it’s because people require a general anaesthetic to have several teeth extracted. More alarmingly, there are many cases of life-threatening infections where dental infection has spread to the eye or brain, or into the neck or chest cavity. Medicare foots the bill for this.
Finally there are psychological and social impacts resulting from appearance issues and problems speaking, such as loss of self-esteem, difficulties obtaining employment and becoming socially isolated.
The cost of providing dental care to those at the lower end of the income spectrum is high: starting at $160 million for the first year, rising to approximately $800 million per year after five years. That’s about $280 per eligible person every two years.
But the costs of neglect are also high, not only in terms of quality of life for the individuals concerned, but also for a health system left to pick up the pieces when the problems become severe or even life-threatening.
People with private health insurance ancillary cover are already benefiting from government dental subsidies, and we’d like to see that largesse extended to all Australians, particularly those most in need.