Introduction by Croakey: As we wait to see if the federal election campaign will bring meaningful gains for long awaited oral healthcare reform, a researcher has proposed a technological solution to help improve affordable access to care.
Shariq Ali Khan, a PhD candidate in oral health literacy and oral health seeking behaviour at Federation University Australia, says a comprehensive mobile app may offer oral health promotion and overcome some barriers to access.
In the fourth of a series of essays published by Croakey from the 2024 National Public Health Student Think Tank Competition, he calls for the National Health and Medical Research Council and Federal Department of Health and Aged Care to develop the app in partnership with state chapters of the Australian Dental Association.
Students participating in the competition were invited to address the following prompt: Considering the need for an inclusive public health system in Australia, propose an innovative strategy to amplify marginalised voices to address the public health challenges of today.
Shariq Ali Khan writes:
A simple but comprehensive ‘mobile application’ that includes easy, authentic and reliable access to dentists and dental specialists, and provides real-time relevant information for improving oral hygiene could create a positive impact for the dental needs of priority populations.
With many Australians experiencing poor oral health, multi-faceted mobile technologies such as this have the potential to improve access to oral healthcare.
Many smartphone applications have been created globally and in Australia to help people manage their oral healthcare.
However, there is still a gap for oral health promotion and accessibility apps for priority populations, including people living in rural and remote areas, Aboriginal and Torres Strait Islander people, new migrants from different cultural backgrounds, refugees, women and children experiencing domestic violence, people with disability or the ones with special needs, and older people to connect with dentists.
Priority populations face significant barriers in receiving dental care for many reasons including affordability, access and knowledge of available services. A mobile app is one tool or solution that may help, but complex and wider issues also need addressing.
The Australian Department of Health and Aged Care published in July last year its response to Senate Select Committee’s report regarding the provision and access to Dental Services in Australia. The report called dental services “a system in decay” and proposed 35 recommendations.
These include an emphasis on expanding coverage of the Child Dental Benefit Scheme (CDBS) (number 22), universal dental coverage under Medicare or similar scheme (number 35), and a suggestion for seed funding to be provided for a national oral health promotion and advocacy body (number 10).
A mobile application for oral healthcare is in alignment with the above-mentioned recommendations from the Senate Inquiry, as it offers a pathway for improving access to CDBS, overall dental healthcare and oral health promotion interventions. The digital nature of the app will be able to provide real-time feedback and data to improve the oral health delivery system on the go.
Improving affordability
In Australia, affordability is the major barrier for people visiting the dentist regularly, for which a public-funded Child Dental Benefit Scheme (CDBS) scheme runs under Medicare to provide dental services to all children under 18 years of age.
Last year, Tan Nguyen, oral health therapist and PhD Candidate at Monash Public Health and Preventive Medicine, and Dr Sneha Sethi, dentist and research fellow from the Indigenous Oral Health Unit, Australian Research Centre for Population Oral Health at The University of Adelaide, called for the Federal Government to fund Medicare like the Child Dental Benefit Scheme, to include the adult population as well.
They proposed a cost estimate including the entire population to be around $6.1-9.2 billion in 2025, that would grow up to $7.6-11.3 billion by 2030.
‘Dental for schools’ programs provide checkups for children at schools and many other non-profit organisations work to improve the oral health of Australian population. While there are many public dental clinics across the country providing subsidised or free emergency dental services to the eligible patients, waitlists can be long in many cases.
In addition, tele-dentistry has been used in the context of schools, rural communities as well as the general public – some organisations provide this service to general public too.
Mobile applications in dentistry
An accessible mobile app could overcome some of the barriers to accessing affordable oral healthcare. Versions of digital technology in oral health have been used in Australia and internationally.
For example, Australian e-Health Research Centre (AEHRC) developed a mobile app and a web-portal in 2019 to 2021 as a research project with Queensland Government to collect dental images of from oral cavities of school children. Trained teachers can upload images of children’s teeth through a smartphone, and the images can be accessed by dental experts to screen for dental caries and other problems.
They predicted that the cost of setting up and running the app and portal is $1 million and if staff are hired along with other expenses – then the cost would go up to $50 million.
This is compared with $135-241 million for conventional screening in school dental programs. However, at present it has had limited adaptability as a research project in few schools of Queensland with no current statistics available and hasn’t been able to replace the conventional mobile dental screening program across Australia.
A scoping review, by Dr Maurizio Pascadopoli from University of Pavia and colleagues, identified some major uses of mobile applications in dentistry globally which include:
- helping children or older people manage oral hygiene
- helping dentists manage patients’ records and suggesting treatment options using AI
- apps supporting tele-dentistry and sharing images of patients’ records.
There are numerous offline and cloud-based platforms providing solutions to the dental clinics for complete practice management. Non-conventional and new technology players in the market are working on metaverse and integrating machine learning models in dental education and professional growth of dental community.
Globally, tele-dentistry has been developing as a trend especially in the last few years. It has been used in the fields of oral medicine, supporting diagnostic capabilities of dentists, and outreach dental consultation to remote and difficult to access areas.
Tele-dentistry mostly refers to an online or videoconferencing between a dentist and the patient. It offers limited contact with a dentist suggesting a possible diagnosis and treatment plan, as well as prescribing suitable medications.
Features of proposed mobile application
A detailed mobile app could provide multiple features and benefits in oral healthcare that aren’t available for video-consultation only.
I recommend that a mobile application for oral healthcare should offer multiple features including:
- A GPS-enabled map, showing the locations and details of all dental clinics in the vicinity of the user. The app would give details of the community clinics, free-of-cost dentists, and speciality-based dental clinics.
- The user would be able to share the dental problem or query in a ‘chat with a dentist’ section, and the available resource would answer their questions via chat box or through an email thread.
- The user would also be able to share images / videos of their teeth and oral cavity for the dentists to diagnose the problem.
- Videoconferencing would be possible by booking an appointment with a dentist, where they can discuss the problem of the patient and would be able to see the problem virtually.
- The dentists can make referral to specialists from the app as well, and the specialists can look at the images / videos of the referred patients to segregate the ones with high priority. This can also help in reducing the waiting times to see a specialist.
- Mid-level dental practitioners like dental therapists can also play a crucial role in screening for dental problems. That will increase the number of technical workforce and would relieve the burden on dentists and specialists, as well as cost-saving from expensive workforce.
- The three-tier system starting from mid-level dental practitioners to dentists and then specialists can make the system highly efficient in terms of saving time and efforts of professionals, thus utilising them more efficiently.
- Through the app, dentists would be able to prescribe the medicines to the patients, which the patient can get from pharmacy by showing the QR code in the app.
- Tailored oral health promotion lectures, brochures and educational pictures / videos will be available in the app for the users to improve their knowledge, oral health habits and oral hygiene routine.
- Online modules, games, puzzles, and other interactive items would be available in the app to keep the interest of every age group. The educational content would be accessible as levels are crossed, to ensure that more educated or interested people also get their interest alive as they engage more with the app.
- The basic version of the app would be free for all, while the app can be provided as additional service with private health insurances as well.
- The app should be available in multiple languages to be inclusive for populations from different cultures, and the content should be simple to comprehend, so that people of all ages and educational level can understand it well.
- The mobile app can also carve out a pathway to integrate dental and medical records of the population as well.
Call for action
This project could be executed by National Health and Medical Research Council (NHMRC) and Federal Government (Department of Health and Aged Care).
I recommend that the NHMRC and Department of Health and Aged Care partner with state-wise chapters of the Australian Dental Association to recruit dentists, oral health therapists, specialists and other dental professionals for the project.
Additionally:
- The current web-portal and mobile app by CSIRO can be used as a live template to create a universal model for public.
- The Department of Health and Aged Care should ensure relevant marketing and advertisement of the service to the priority populations to ensure utilisation by them.
- Utilising this app in conjunction with Medicare funding would save money as ‘screening and routing’ would be done remotely, direct contact with health systems would be reduced, and each patient would be routed to the specific professional through the app.
The Australian Government should include the utilisation of digital tools to enhance the accessibility of dental services in the ‘National Oral Health Plan for 2025-2036’.
All oral health-related organisations, support groups, non-profit organisations and stakeholders should advocate and work collectively to make this mobile app a universal utility for Australian population.
In addition to supporting the use of digital technologies such as the proposed application to improve oral healthcare in Australia, the Department of Health and Aged Care should fund Medicare under the recommendations of the Senate Select Committee’s report to cover for dental treatments for Australians.
Just like the Child Dental Benefit Scheme, some essential treatments should be available for free to the eligible families, or at subsidised rates for the ineligible families.
About the author
Shariq Ali Khan is pursuing a PhD in Public Health at Institute of Health and Wellbeing (IHW), Federation University Australia. His PhD project is based on oral health literacy and oral health seeking behaviour among Islamic Boarding Schools’ children in Pakistan. He has completed a Bachelor of Dental Surgery (BDS) and Masters Philosophy in Public Health.
He is working as a Sessional Lecturer at Federation University, as an Intern at Council of Academic Public Health Institutions Australia (CAPHIA), as a member of Academic Board, President of Federation University Postgraduate Association (FUPA), and he is also an active member of Child and Youth Health, Health Promotion and Oral Health Special Interest Groups (SIGs) in Public Health Association Australia (PHAA). He also has a long-standing experience of teaching in a medical college and is skilful in utilising digital tools in academia as well as research.
He is a passionate clinician and early career public health researcher. He is committed to community welfare and has been affiliated with multiple NGOs working on local and global projects. He also provides free dental services to the underprivileged children of his country. His areas of interest are oral health literacy and health promotion.
Connect with Shariq on: X, LinkedIn, Facebook, and email.
Bookmark this link to follow the 2024 Think Tank series, and see Croakey’s archive of articles on oral healthcare.