Dental policy, planning and programs seem to be stuck in the past and need to refocus on current and future needs, say researchers from the International Research Collaborative – Oral Health and Equity at The University of Western Australia.
Dental efforts must focus on the poor and marginalised
Marc Tennant, Kate Dyson and Estie Kruger write:
The dental health of Australians as a whole has improved meteorically in the last 50 years. In the 1960s, decay was an epidemic, which left almost no child untouched. An average 12 year old had over 10 decayed teeth.
Today, decay is an insignificant problem for most 12 year olds – half of them have no decay at all and only a small minority have high levels of the disease (around 5% have more than 5 teeth affected by decay). This situation could have been only a pipe dream 50 years ago.
But have we completely seen off the serious dental decay problems of our past? For many Australians, the answer is yes.
However, some are left still dreaming about a better oral health future. Overwhelmingly, it is severely disadvantaged and marginalised Australians whom as a group, continue to suffer severe tooth decay at levels akin to those of 50 years ago.
One in three Aboriginal children in remote WA still has to endure toothache, and poor Australians are 30 times more likely to end up in hospital as a result of severely infected teeth than are wealthy Australians.
We need our public policy machinery to keep up with current times in which decay is now heavily sequestered among disadvantaged people. Is the policy focus sufficiently aligned to where the highest needs are – remote areas, poor rural and urban areas, aged care and other marginalised groups?
What, for instance, can be the justification for continuing to fund non means tested school dental programs in contemporary times where decay is insignificant in most children’s lives?
Moreover, why would these programs remain untargeted in circumstances where they are struggling to provide effective care for the relative few disadvantaged children whose needs are greatest? Is it time to call stumps on this untargeted approach, which is really a legacy of yesteryears disease pattern?
What reasonable justification could there have been for the establishment of the grossly under-focused Chronic Diseases Dental Scheme?
So loosely targeted, this recent Medicare scheme exceeded its $300 million budget to become a monstrous $1.2 billion liability that provided large amounts of un means tested high-end services amid very loose eligibility specifications. This money has been spent without any measures or evidence of health improvement outcomes. Australians should surely be able to expect more.
Workforce numbers can be something of a national fixation in Australian dentistry, especially in times of feast or famine. Australia is emerging from a time of severe dental workforce shortage during a period of world economic contraction. This current situation of economically driven reduced demand for private dental services is exacerbating the sense of workforce over-supply experienced in some capital cities.
There is a danger that the ricochet effects from a temporary strong supply in some quarters may result in inappropriate supply reductions. This risk is elevated in our dental environment, which tends to under appreciate the frailties of workforce predications.
Unforseen issues such as generational shift in work-life balance attitudes will continue to blunt the precision in workforce modelling and at best these models can only be considered a rough indicator of need.
History and has clearly shown us that it is the poor and marginalised, ironically those suffering the greatest rates of disease, who lose out if we get it wrong in our workforce planning.
Australia must focus its attention on targeted initiatives for those who still have substantial need. A number of targeted systems addressing the dental health of marginalised communities have been found successful in Australia and other countries.
Systems that rest on modern young practitioners’ views of work are going to be essential. For example, the next generation of dentists have very different attitudes to parenting responsibilities with males taking a more active role and more time off expected.
This, coupled with innovative new ways of getting care to the isolated and marginalised, is going to be the major solution to the next wave of problems facing public dental health in Australia. For example, taking advantage of modern fly-in-fly-out models and effective use of tele-health has been shown to be successful.
Extending the old ways into the future will fail.
The complex challenges of addressing health in marginalised communities is the problem for 21st century dentistry in Australia. We have to stay focused on reducing the gap between rich and poor.
• Marc Tennant, Kate Dyson and Estie Kruger are from the International Research Collaborative – Oral Health and Equity, Department of Anatomy, Physiology and Human Biology, The University of Western Australia