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11 JUNE 2020

This week the Government announced that it is extending the National Partnership Agreement on Adult Public Dental Service to support the states and territories in delivering public dental services. The $107.8 million one-year extension to the National Partnership Agreement will provide services of around 180,000 additional public dental patients across Australia.

The COAG Health Council estimated that:

“Current funding for public oral health services allows for treatment of only about 20% of the eligible group, leaving some 80% without public treatment. Some seek care in the private sector, generally for relief of pain, which means that they receive only limited and compromised oral health care; some do not access any care.”

Tooth decay is the most common chronic health condition in the country. More than one-quarter of tooth decay in Australia is untreated, causing pain and discomfort. It sometimes leads to more complex dental work, including the dreaded root canal therapy.

Figure 1Australia's Oral Health Tracker 2018

In Australia, oral and dental care is provided by private and public dental services in the community, and in public and private hospitals, to both admitted and non-admitted patients. Alongside these services, publicly funded oral and dental health services play a role in helping eligible Australians who might find it difficult to access dental health care in the private sector to receive such care, either free of charge or at a subsidised cost. Public dental programs are operated by states and territories, with eligibility for services and the organisation of services varying greatly across the jurisdictions.

Despite strong public sentiment to improve access to affordable dental services, this remains an area of public health policy that is outside the ‘universal health’ promise of Medicare. Most consumers continue to bear the out of pocket costs for dental services. Not surprisingly, in 2014–15, about 1 in 2 Australians had seen a dentist or dental professional in the last 12 months.

For those who can’t afford care in the private sector, waiting in pain is an unfortunate reality, which leaves them which much worse health outcomes. Despite its significant impact on ongoing health outcomes, dentistry is poorly integrated with other areas of health care. Alarmingly, one in ten preventable hospital admissions are due to dental conditions, such as untreated tooth decay which needs to be treated with a general anaesthetic.

Chronic pain has an emotional, psychological, and physical impact on people’s lives and can result in but is not limited to lack of proper diet, poor sleeping habits, and poor personal and oral hygiene – all factors which can exacerbate dental health.  The chronic pain situation becomes a “catch-22” for the individual, with each circumstance presenting a dilemma because of mutually conflicting or dependent conditions.  It is also clear that disadvantaged families go on to have greater rates of tooth decay as adults.

General dentists and dental specialists treat patients with pain on a daily basis. Orofacial pain is recognised as a chronic form of pain related to the face and/or oral cavity caused by diseases or disorders of regional structures, by dysfunction of the nervous system, or through referral from distant sources. This form of pain often mimics dental pain disorders of the orofacial region. Treatment of orofacial pain is a specialty in dentistry in many parts of the world and an emerging area of specialisation in others.

Overall, pain in the mouth is a serious health concern. If it is not directly related to trauma, then it is usually a sign of late stage disease which needs to be attended to urgently. To avoid the high costs and pain associated with late stage disease, it is highly recommended that people attend regular dental checkups when early stage disease can be treated effectively. Unfortunately, the current state of public dental health access means that many people simply cannot afford to have their oral pain resolved.

Many prominent health policy strategists advocate for expanding access to dental care for pensioners and health care card-holders which would eliminate the waiting lists for existing public dental services, address a key inequity in health care, and set the stage for the big reform: a universal dental scheme for Australia. It is hard to see how the current economic circumstances will support this. 

Poor oral health is clearly a problem for our community and in particular for people on lower incomes who avoid seeking timely treatment because of the cost. But for the individual living with poor oral health, the impact goes beyond pain and discomfort.

With a year’s extension of the public dental health scheme, many more Australians will be able to access dental care access ensuring they do not continue to live with unacceptable levels of oral pain.  This is good news if only temporary relief.

Carol Bennett,
Painaustralia CEO