Peter Brooks and Mike Morgan write:
Data released recently by the Australian Institute of Health and Welfare show the number of dentists has increased by 24% in the five years to 2011. There are now around 12,700 dentists in Australia, with 80% working in the private sector.
Fearing an over-supply of dentists, the Australian Dental Association (ADA) has called for a cap on the number of dental schools and graduates. The ADA expects 580 local students to graduate this year, up from 250 a year in the early to mid-2000s. Given that around 200 foreign-trained dentists are expected to arrive in Australia this year, the ADA wants the number of university places capped at 460 a year.
But do we really have an over-supply of dentists in Australia? If you live in metropolitan areas and can afford private dental care, the answer might be yes. But it’s a very different story for rural Australia and low-income families.
Who is missing out on dental care?
Dental disease is high among Australian children, with around half having a history of dental decay. But the disease is not distributed evenly across all children. Those from disadvantaged families or who live in rural non-fluoridated communities have a far higher rate of disease than children from wealthier families living in urban fluoridated communities.
Australia’s aged population is also missing out on appropriate dental care. The many thousands of residents of nursing homes around the country often lack access to the basic dental services which are so important for them to maintain adequate nutrition.
Poor oral health is also associated with an increase in a raft of other diseases such as heart disease, arthritis and stroke. Oral disease and most of these systemic diseases have similar risk factors – poor diet, obesity, smoking, for example. Modifying the risk factors for oral disease may well reduce the crippling burden of other conditions in the community.
But nearly half a million Australians are currently on waiting lists for care in public dental facilities. Most will be requiring some form of tooth restoration or even tooth extraction.
Small steps towards equity
The Commonwealth government’s Dental Health Reform Package, announced in August, will provide subsidised dental care for children and additional services for low-income adults. Clearly there will be a need for more dental health practitioners to work in the public system to provide the necessary services.
The reform package also includes a grant scheme to encourage dental practitioners to relocate to rural or regional localities where there are limited or no services provided.
New dental programs have often been set up in association with rural campuses (Charles Sturt University, for example), with the expectation that at least some of the graduates will practice in currently under-served regions of Australia. This model of rural training has certainly been successful for medicine.
Access to services in rural areas could also be enhanced with better use of telehealth/teledentistry services – digital technologies to deliver health care, consultations and education.
Do we need to see a dentist?
With such substantial gaps in dental care, it’s logical to ask whether everyone who has an oral health problem or needs a dental check-up requires a dentist to provide this care.
Dental therapists, dental hygienists and oral health therapists currently provide significant amounts of oral health care, particularly in the area of treating and preventing tooth decay, and gum disease. This model of care has a long history in both this country and overseas and is proving effective, particularly when the model ensures that such providers work closely with dentists as part of a dental care team.
Dental hygienist and therapist programs have increased significantly in Australian universities, with the number of graduates expected to reach 330 by 2015. These dental professionals could be used effectively in rural centres working with dentists in regional centres, in schools and, of course, in nursing homes.
With so many Australians still missing out on dental care, restricting the number of practitioners does not make sense. Rather, we need to aim for a more equitable system, where quality dental services are accessible to those who really do need them.
It’s unclear what impact the Commonwealth’s dental package will have on access to care. But while we wait to find out, we need to take a close look at our current system. Should we continue – and can we afford – to support an uncapped fee-for-service system which provides an excellent standard of care for those who can pay but long waiting times (or little care) for those who are under financial stress, live in rural areas or are unable to care for themselves?
** Peter Brooks is Director of the Australian Health Workforce Institute at the University of Melbourne.
** Mike Morgan is Professor, Colgate Chair of Population Oral Health at the Melbourne Dental School and Program Leader, Oral Health CRC at the University of Melbourne. Mike has received funding from NHMRC. He is Director of the Australian Dental Council, Board member of VicHealth, Principal Oral Health Advisor, Dental Health Services Victoria and a member of the Australian Dental Association.