The NobleDentist Blog

NobleDentist will continue to run as per normal during the festive season.

The office will be closed on the public holidays including Christmas Day, Boxing day, and New Years day. Memberships will still be processed and posted to you outside of these times. So, turnaround times will be the same as usual – join before 4pm Brisbane time and your membership will be posted to you that day.

The NobleDentist team has enjoyed immensely assisting so many members in 2009. And we look forward to doing so for many years to come. For now, we simply wanted to wish all of you a joyous and safe festive season from the NobleDentist team.

Merry Christmas & Happy New Year!

This is an article by Louise Hall that was recently published in The Sydney Morning Herald – Australia.

WAITING times for public dental services could become even longer as a Senate impasse shows no sign of ending.

The Health Minister, Nicola Roxon, has refused to release $290 million in funding promised to the states and territories to provide one million public dental services, until the Senate agrees to axe her predecessor’s popular but expensive Medicare dental scheme.

State dental bureaucrats are fuming as urgently needed reforms are now on hold, despite Ms Roxon signing off on each state’s proposal months ago.

The acting chief dental officer for NSW Health, Peter Hill, said commitments for staffing and planning have been made in anticipation of the $91 million allocated to his department under Labor’s Commonwealth Dental Health Program. The money was targeted at the most needy patients, including indigenous Australians, preschool children and pensioners, as well as attacking chronic waiting lists.

Dr Hill called on Ms Roxon to release some of the funding so programs such as additional dental chairs in high-need areas and a pediatric dental registrar position at the Children’s Hospital at Westmead could begin.

The head of South Australia’s dental service, Martin Dooland, said many clinics around the country already have had to cancel non-emergency dental care, leading to a blow-out in existing lengthy waiting lists. An estimated 500,000 Australians are waiting for public dental care.

“To have the rug pulled out from underneath us is extremely damaging to the morale of public dental staff and disappointing for concession card holders who were about to get reasonable access to dental treatment for the first time in a long time,” he said.

Health groups including the Australian Health and Hospital Association have been lobbying Opposition and cross-bench Senators, urging them to agree to a compromise where a pared-back Medicare dental program runs alongside the Commonwealth scheme.

Dr Hill said NSW Health is writing to all patients on its waiting list encouraging them to make use of the Medicare dental scheme, which provides $4250 in private dental work for the chronically ill with poor oral health, until a solution is found.

The Australian Dental Association’s policy officer, Bernard Rupasinghe, said the NSW Government spent less per capita on public dentistry than its counterparts, with $21.65 designated for this financial year, compared to $46.56 in Tasmania and $35.46 in Queensland.

This is an article by Adam Creswell that was recently published in The Australian – Australia.

THE threatened Medicare dental scheme may win a permanent reprieve if senators back a compromise that would allow it to continue in scaled-back form alongside a federal Government-proposed replacement program.

The Australian Healthcare and Hospitals Association, representing public health facilities nationally, plans to hold meetings with balance-of-power senators next week to seek support for its proposal aimed at smashing a six-month deadlock on the issue.

Under the plans, the Medicare dental scheme—the current version of which was introduced in the last weeks of the Howard Government—would no longer cover certain high-cost procedures such as crowns and bridges, reining in its cost by an estimated $100 million per year.

The AHHA says this would be enough to pay for the planned Commonwealth Dental Health Program, which was promised in the May budget as a replacement for the current scheme but which has been stymied by the Senate’s refusal to approve the scrapping of the Medicare-based program.

Dental and health advocates have been increasingly critical of the Government’s plans to scrap the Medicare scheme, which was little used shortly after its introduction but which has since grown rapidly and has now delivered over 1 million services to almost 80,000 patients.

The Medicare-based scheme is open to patients with a chronic health condition which a GP certifies is worsened by their dental problems. It allows them to claim $2150 in rebates for private dental treatment. The proposed Commonwealth Dental Health Program would instead pay $290 million over three years directly to the states and territories to treat more of the 650,000 people on public dental waiting lists.

However, critics say the CDHP relies on understaffed public dental systems that are already swamped by patients, and would need to use vouchers entitling patients to private treatment—which costs up to four times as much as in the public system.

The Medicare scheme, meanwhile, has been hit by claims that it is underwriting an unusually high rate of crowns and bridges, and has been criticised by the government on the grounds that, being an open-access Medicare program, it does not preferentially direct its funding to the least well-off or those with the most pressing health needs.

Cydde Miller, policy and networks manager for the AHHA, said the association had already held “encouraging” meetings with Liberal senators to brief them on the plan, which had also been put to Federal Health Minister Nicola Roxon. “I think we are very hopeful because they see it as a reasonable solution to the problem,” Miller said. Next week the AHHA will meet Family First leader Steve Fielding and independent Senator Nick Xenophon to ask for their support.

However, Hans Zoellner, chairman of the Association for the Promotion of Oral Health and a strong critic of the Government’s plans, says that far from being “cosmetic” as the Government was trying to imply, crowns in a range of situations are the only option to save a tooth from extraction. In these cases if a crown was denied and the tooth removed, something else would still need to be fitted.

Zoellner concedes there are more crowns and bridges being given to patients under the Medicare scheme than would be normally expected, but says the AHHA has exaggerated the scale of this problem and the true rate is not outrageous.

He says a better way of preventing unnecessary high-cost procedures would be to require treatment plans where crowns and bridges are proposed to be submitted for pre-approval by independent dental experts on behalf of the federal health department.

The Government’s dental plans have also come under attack from a West Australian oral health consultant and former dentist, Patrick Shanahan, who told Weekend Health that public dental clinics in Western Australia were “already closing” due to the workforce shortage.

Shanahan says the federal Government’s Teen Dental Plan, which will pay $150 for eligible young people to have an annual examination and some fluoride treatment, would further increase public dental waiting lists because it provided next to no money for any treatment the examinations found to be necessary.

While Shanahan supported Zoellner’s proposal for an approvals process, he said the frail aged and young disabled, in particular, were missing out.

Shanahan has lobbied the Government and independent senators to promote his own view of how to fix the problem—integrating dental health services much more closely with mainstream medicine to ensure those with dental problems serious enough to jeopardise their overall health received effective and prompt treatment.

However, the Government is resisting the compromise moves. Minister Roxon has said the Government remained “absolutely determined to deliver on our election commitment” of funding the CDHP from savings generated by discontinuing the Medicare scheme. “The most needy in our community are missing out on care and that’s why we need to introduce the CDHP,” she said.

This is a transcript from the Lateline (ABC) program that aired recently.

Reporter: Suzanne Smith

Senior lecturer in geriatric dentistry at the University of Western Australia Dr Clive Rodgers says nursing homes across Australia are seriously neglecting the dental health of their patients.

The ABC warns the graphic images of medical conditions in this report may be distressing to some viewers.

Transcript
TONY JONES, PRESENTER: Tonight Lateline reveals the hidden suffering of elderly Australians across the country – victims of aged care homes that are letting them literally rot away, at least when it comes to their dental health.

A senior dentist has told the ABC the state of dental care in many nursing homes is appalling, and in some cases tantamount to abuse and neglect.

Dr Clive Rogers says nursing homes are passing accreditation tests even when their residents’ mouths and teeth are so ravaged they risk serious illness or premature death.

Lateline’s Suzanne Smith has this special report. And a warning, the graphic images of medical conditions may be distressing to some viewers.

DR CLIVE ROGERS, SENIOR LECTURER, UNIVERSITY OF WESTERN AUSTRALIA: I’ve just come to have a look at your mouth, is that OK?

SUZANNE SMITH, REPORTER: Clive Rogers is doing his rounds at a nursing home in Perth; a routine he has done for the last 12 years.

He is getting ready to examine a woman with dementia.

DR CLIVE ROGERS: There’s quite a lot of gear I’ve got here to get so it won’t be very long.

Let’s have a little bit of light.

This is a fairly classic mouth. What we’re looking at here is… there’s massive amounts of food debris and plaque, which is very old.

And just down in the front here… and there’s large lesions and some of them are small, relatively, occupying maybe one tenth.

Some have occupied 30 per cent of the tooth; some have just completely eaten through the top of the tooth above the gum.

SUZANNE SMITH: As Dr Rogers examines further, he is not shocked by what he sees; for him it is a typical mouth of a nursing home patient.

DR CLIVE ROGERS: This is a fairly typical mouth of what I see. I see actually worse than this sometimes; I see better than this.

In this mouth I’m predicting that there’s five abscesses. Though I have on one particular chap seen 19 tooth roots, and it appeared that nearly half of them were actively draining pus into the mouth.

SUZANNE SMITH: Dr Rogers says untreated dental abscesses could become septic and lead to major infection.

But what most disturbs him is that some patients are obviously in pain.

DR CLIVE ROGERS: The thing that disturbs me most is seeing someone who is in pain. Yes, having pus draining into their mouth, abscesses, they disturb me.

The whole aspect of the neglect and the whole aspect that this is not widely known amongst the population, Australia at large, that mouths that I see, these terrible mouths, exist everywhere all over Australia.

SUZANNE SMITH: So concerned by what he saw, Dr Rogers has put together a library of photos to show the extent of the problem.

He has also conducted his own national survey of 18 visiting dentists who all have experienced working in nursing homes across all states and territories.

DR CLIVE ROGERS: Out of those 18 people, 89 per cent of them said that they didn’t believe that the standard was being met.

I will go in and I will look at the in house dental reports, and some reports done by other government bodies. I will totally disagree with what’s been written down.

SUZANNE SMITH: He is concerned accreditation authorities are ignoring the Government’s legislated standards that require nursing homes to ensure daily maintenance of oral and dental hygiene.

DR CLIVE ROGERS: All the nursing homes I see should not be passing their accreditation. And from the survey that I did, that seems to be the consensus around Australia.

SUZANNE SMITH: Of great concern too is the link between dental health and general health. Periodontal disease can lead to cardiovascular illness.

Untreated caries and dental abscesses can in some cases lead to pneumonia, especially if patients inhale stagnant food or puss from infections.

Dr Rogers says some of the neglect could be considered a form of abuse.

DR CLIVE ROGERS: Neglect as a form of abuse, yes, I have to say it is, especially when the problem is recognised or seen, and then nothing is done about it.

SUZANNE SMITH: Dr Rogers lodged complaints with the accreditation authorities and the Commonwealth Department of Health and Ageing, who have rejected his claims.

Minister For Ageing, Justine Elliot, has asked Dr Rogers to send his complaints to her directly.

JUSTINE ELLIOT, MINISTER FOR AGEING: I would encourage him to put forward complaints and issues he has to the complaints investigation scheme or to forward them to me personally, because, as I say, anyone raises any issues in relation to any matter to do with the nursing homes, whether it’s about health, safety and wellbeing, these will be investigated.

SUZANNE SMITH: Minister Elliot announced a strengthening of 44 legislated standards that govern nursing homes.

SUZANNE SMITH: I’m also getting all of those standards assessed. And since I’ve become minister I’ve looked at ways of strengthening our age care standards and accreditation agency, strengthening their standards as well.

SUZANNE SMITH: Dr Rogers says immediate action needs to be taken to ensure the daily care of oral and dental health in your nursing homes.

Suzanne Smith, Lateline.

This is a transcript from a 7.30 Report (ABC) that aired recently.

Reporter: Peter McCutcheon

After many years of refusing to toe the line on the issue of water fluoridation, Queensland Premier Anna Bligh has pushed ahead with a water fluoridation program. The program got underway in south-east Queensland this month.

Transcript
KERRY O’BRIEN, PRESENTER: Queensland has never minded setting its own course compared to the rest of the country; daylight savings is a case in point. Perhaps Barnaby Joyce too in some ways.

Water Fluoridation is another.

Despite his huge parliamentary majority even Peter Beattie, as Premier, baulked at introducing this public health measure in Queensland.

But his successor Anna Bligh has ignored the critics and pushed ahead with a fluoridation program in south-east Queensland this month.

But with an election not too far off, will she pay a political price?

Peter McCutcheon reports.

ANNA BLIGH, QUEENSLAND PREMIER: Our kids have the worst teeth in the country and we need to stop that.

PETER MCCUTCHEON, REPORTER: Why do you think fluoride generates so much passion?

DR JOHN RYAN: Well, why are people against poisons?

PETER MCCUTCHEON: 40 years on the great fluoride debate is still raging in Queensland.

It’s the latest in a series of issues that has tested the political nerve of the Bligh Government, coming hot on the heels of sudden policy backdowns on water recycling and the construction of a major dam.

DR JOHN RYAN: Recycled water looks like it was done and dusted a couple of weeks ago, so we haven’t given up.

PAUL WILLIAMS, POLITICAL ANALYST, GRIFFITH UNIVERSITY: It seems to be that discovering a bit of momentum for being a lightning rod for all sorts of anti-government feelings.

PETER MCCUTCHEON: Water fluoridation was rolled out across most of the United States and the decade following World War II.

There was some opposition at the time with claims it would even be part of a Communist plot.

DR ROBERT MCCRAY, DENTAL SURGEON: I think people love to distrust Government; It’s a common theme.

And unfortunately in this regard it’s something that’s been tied in with fluoridation ever since it began in 1945.

PETER MCCUTCHEON: But while most of Australia embraced water fluoridation in the 1960s and early ‘70s, Queensland missed out, with the one exception of Townsville.

DR JOHN RYAN, PROFESSIONALS AGAINST WATER FLUORIDATION: Queenslanders have always been a bit different. There was a Conservative Government for 22 years who was from a rural background.

I think the farmers often have an instinctive sort of a thing about nature and they don’t like playing with poisons.

PETER MCCUTCHEON: Brisbane GP and complementary medicine practitioner John Ryan has been at the forefront of the fight against water fluoridation.

He and his supporters challenged two assertions widely accepted by the scientific mainstream; that fluoridation is safe and that it reduces dental decay.

DR JOHN RYAN: In the most favourable studies supporting fluoride for efficacy, it’s a difference of a half a tooth per mouth, and there’s 32 teeth in the mouth

DR ROBERT MCCRAY: If we even took half a tooth difference over 4 million Queenslanders, we’ve got 4 million cavities are going to be stopped in a very short space of time.

PETER MCCUTCHEON: Dr Robert McCray is a Brisbane dentist and fluoride spokesman for the Queensland Dental Association.

DR ROBERT MCCRAY: What you get with water fluoridation is more bang for your buck.

You’ve simply got something that’s very simple; something that can be done quite cost effectively but which produces more benefit than any other single action that can take place.

PETER MCCUTCHEON: But what about the safety of introducing fluoride at just under one part per million to the party supply?

Well, the case against fluoride rests heavily on the 2006 review by the US National Research Council.

MERILYN HAINES, QUEENSLANDERS FOR SAFE WATER: There’s lots of research out there linking it to adverse affects. There’s dental fluorosis, there’s thyroid problems.

It’s stored in the bones for start. Just about all the fluoride that’s stored in your body is stored in bones and it makes bones more brittle.

PETER MCCUTCHEON: But the Australian authority on water quality, the National Health and Medical Research Council, says this is misleading.

The US report specifically looked at fluoride levels considerably higher than those present in Australian drink water.

PROFESSOR JOHN SPENCER, DENTAL EXPERT, NHMRC: It is not a report that is directly commenting on the safety of water fluoridation either for most citizens in the United States or particularly for people in Australia.

DR ROBERT MCCRAY: We’re not looking at an experiment to see what will happen; we know what will happen, and we’re just bringing this into mainstream public health policy.

PETER MCCUTCHEON: If fluoride is the poison that you say, why don’t we see the evidence here in Australia…

DR JOHN RYAN: We’ve gone down this road Peter…

PETER MCCUTCHEON: That Queensland is so much better?

DR JOHN RYAN: Well, they don’t look; they will not look. There’s no research done. So it’s no use saying there’s no evidence when they’re not looking for it.

(excerpt from Queensland Government advertisement).

ACTOR: Look around this room, there’s one thing here that can reduce dental decay by up to 40 per cent.

PETER MCCUTCHEON: Although the Queensland Government has backing of the scientific mainstream, it still feels the need to run an extensive public relations campaign.

ACTOR: Fluoridated water. From December 2008 south-east Queenslanders will have it on tap.

(end of excerpt).

PAUL WILLIAMS: It’s not really a case of bringing the Bligh Government down singlehandedly but it is an issue that could act as a lightning rod and attract a whole range of dissent.

PETER MCCUTCHEON: Political analyst Paul Williams says the Queensland Premier’s stocks appear to have dropped in the past few weeks, with backdowns on the water permanent water recycling and delays to the construction of the Traveston Crossing damn.

And controversy over fluoridation is the last thing she needs. After all, it’s an area where her predecessor Peter Beattie feared to tread.

PAUL WILLIAMS: There was a whole range of issues that the former Premier didn’t want to raise, daylight savings was another classic one, for fear of raising or generating or galvanising opposition to his Government.

PETER MCCUTCHEON: The Bligh Government is hoping anti-fluoride gatherings like this one in the Premier’s own electorate last month can be politically isolated.

But the anti-fluoride campaign is taking heart from recent policy back flips and good old fashioned Queensland spirit.

DR JOHN RYAN: They don’t like being pushed around; they don’t like being patronised; they don’t being bullied and their representatives, which are us, they try to continually bully and marginalise us.

DR ROBERT MCCRAY: This is something that really has very strong support across many national and international health organisations.

There’s certainly very little debate in the scientific community about the validity of water fluoridation as a public health measure and its effectiveness as a public health measure.

KERRY O’BRIEN: Peter McCutcheon with that report.

This is an article by Sarah Elks that was recently published in The Australian- Australia.

WHEN southeast Queenslanders turn on their taps in the new year, most will be drinking fluoridated water for the first time – 40 years after the rest of Australia.

Currently, fewer than 5 per cent of Queenslanders drink fluoridated water – it was introduced in Townsville in 1964 – by far the lowest of any state or territory. And Queenslanders have the worst teeth in the nation.

Premier Anna Bligh took the bold decision in December last year, soon after taking over from Peter Beattie and following years of inaction by previous state governments. Until then, it was left to local councils to add fluoride to water supplies.

“I know it’s controversial out there, but I think it’s something that will leave a very long legacy for better dental health for our children,” Ms Bligh said in an interview in September.

The $35 million program will give 95 per cent of Queenslanders access to fluoridated water by 2012. Five major water treatment plants in southeast Queensland are being equipped to add fluoride powder, at a rate of 0.6-0.8 milligrams per litre, to the region’s drinking water.

Devices in the fluoridation units constantly measure the final concentration of fluoride in the water.

If there is any variation from the set dose, the device automatically shuts down the system. The treated water will then go into reservoirs before it is reticulated to residents’ homes.

Over the next four years, the rest of the state will gradually go through the same process.

For health professionals, the move can’t come soon enough.

Queensland’s Chief Health Officer, Jeannette Young, said the delay in adding fluoride to the state’s drinking water had left Queenslanders with terrible teeth.

“Unfortunately, our dental health is appalling in this state, despite our Government spending the most per head of population on oral healthcare,” Dr Young told The Australian.

She said fluoridation should bring a 40 per cent improvement in the oral health of Queenslanders.

“I personally think fluoridation is one of the top public health decision of the past 100 years,” Dr Young said.

The Australian Dental Association in Queensland has campaigned since 1953 for the move.

Its president, John Wills, said the reluctance of some Queenslanders to fluoridate began with sheep farmers, who tapped into bore water.

“In certain areas of Queensland, there’s a very high fluoride level in the bore water which caused skeletal problems in the sheep,” Dr Wills said. “They made the extrapolation that all fluoride was dangerous and have resisted it ever since.”

In the 27 years since the beginning of the HIV/AIDS epidemic in the United States, that which was once an unavoidable death sentence has largely become a chronic condition when properly managed with medication. However, both the manifestation of the virus as AIDS as well as the retroviral therapy used to keep HIV in check can take a heavy toll on a patient, including one’s oral health and quality of life.

(Media-Newswire.com) – In the 27 years since the beginning of the HIV/AIDS epidemic in the United States, that which was once an unavoidable death sentence has largely become a chronic condition when properly managed with medication.

However, both the manifestation of the virus as AIDS as well as the retroviral therapy used to keep HIV in check can take a heavy toll on a patient, including one’s oral health and quality of life.

Two recently published USC School of Dentistry studies examine data from the Women’s Interagency HIV Study, a cohort made up of hundreds of HIV-positive and at-risk women at six sites throughout the U.S., to discern how the disease affects American women.

While AIDS itself can increase the chance of mouth lesions, infections and other oral maladies, a common treatment method can have negative oral side effects, according to data collected from the cohort.

Protease inhibitor-based highly active antiretroviral therapy ( HAART ), a treatment used to suppress HIV replication and preserve patient immunity, is a significant risk factor for decreased salivary gland function, explained Mahvash Navazesh, School of Dentistry Diagnostic Sciences Division chair in “Effect of HAART on Salivary Gland Function in the Women’s Interagency HIV Study.” The study was published Nov. 11 in Oral Diseases.

The impact of low salivary flow is much more than just the discomfort of a dry mouth, Navazesh said. With less saliva to wash away cariogenic food and moisten soft tissues, dry mouth can accelerate tooth decay and make irritated tissue more susceptible to infection.

“Saliva plays an important role in maintaining the health of the oral cavity,” she said.

In the study “Oral Health-Related Quality of Life Among HIV-Infected and At-risk Women,” principal investigator and School of Dentistry associate dean of Community Health Programs Roseann Mulligan and her team evaluated not just the oral health of hundreds of cohort participants, but they also examined the psychosocial and emotional impact that the disease’s effects on oral health can have.

“Women participating in this study are minorities, poor, less educated and either HIV-infected or at risk of infection; they are vulnerable women in our society,” said Hazem Seirawan, the study’s second author and research assistant professor at the School of Dentistry.

Participants were evaluated physically and asked questions on several subjects, including functional limitation, discomfort and pain as well as psychological and social discomfort and disability related to their oral health.

On average, HIV-infected women had 10 percent lower oral health-related quality of life compared to non-infected women, Mulligan said. However, after adjusting for significant clinical and behavioral oral health factors, including drug use, the difference in quality of life was much less prominent.

“The study identifies many specific factors where dental professionals can intervene and help both HIV-positive and at-risk patients have better oral health-related quality of life,” Mulligan said.

Simply having access to more follow-up care can help greatly, Seirawan added.

“It seems that follow-up visits, when women came for their semiannual check-up, were significant in reducing the difference in oral health-related quality of life between the two groups of women,” he said.

The study appeared Sept. 8 in Community Dentistry and Oral Epidemiology.

This is an article by Louise Hall that was recently published in The Sydney Morning Herald – NSW, Australia.

WAITING times for public dental services could become even longer as a Senate impasse shows no sign of ending.

The Health Minister, Nicola Roxon, has refused to release $290 million in funding promised to the states and territories to provide one million public dental services, until the Senate agrees to axe her predecessor’s popular but expensive Medicare dental scheme.

State dental bureaucrats are fuming as urgently needed reforms are now on hold, despite Ms Roxon signing off on each state’s proposal months ago.

The acting chief dental officer for NSW Health, Peter Hill, said commitments for staffing and planning have been made in anticipation of the $91 million allocated to his department under Labor’s Commonwealth Dental Health Program. The money was targeted at the most needy patients, including indigenous Australians, preschool children and pensioners, as well as attacking chronic waiting lists.

Dr Hill called on Ms Roxon to release some of the funding so programs such as additional dental chairs in high-need areas and a pediatric dental registrar position at the Children’s Hospital at Westmead could begin.

The head of South Australia’s dental service, Martin Dooland, said many clinics around the country already have had to cancel non-emergency dental care, leading to a blow-out in existing lengthy waiting lists. An estimated 500,000 Australians are waiting for public dental care.

“To have the rug pulled out from underneath us is extremely damaging to the morale of public dental staff and disappointing for concession card holders who were about to get reasonable access to dental treatment for the first time in a long time,” he said.

Health groups including the Australian Health and Hospital Association have been lobbying Opposition and cross-bench Senators, urging them to agree to a compromise where a pared-back Medicare dental program runs alongside the Commonwealth scheme.

Dr Hill said NSW Health is writing to all patients on its waiting list encouraging them to make use of the Medicare dental scheme, which provides $4250 in private dental work for the chronically ill with poor oral health, until a solution is found.

The Australian Dental Association’s policy officer, Bernard Rupasinghe, said the NSW Government spent less per capita on public dentistry than its counterparts, with $21.65 designated for this financial year, compared to $46.56 in Tasmania and $35.46 in Queensland.

This is an article by Tony Rogers that was recently published in the Adelaide Independent Weekly – Adelaide, South Australia, Australia.

There is still a fear factor when it comes to maintaining dental health, and it exists on several levels – personal, community and government.

There’s a fear of going to the dentist, a fear of the cost of treatment, a fear of handing over public money for dental research and, seemingly, a fear of any government wanting to do something to fix the dental health system and the oral health of Australians.

Dental health is not “sexy”, which is why it’s so hard to get research funding. This problem isn’t confined to Australia; it’s a world-wide issue.

Scientific and medical research is generally very expensive, and dental research is no exception. This is especially true when you look at the most recent developments in gene and protein research, which aim to unravel the basis of dental disease: why and how it occurs, and how we can prevent it.

On a personal level, patients are afraid of pain from dental treatment, but this fear is largely unfounded. There have been major advances in dentistry in recent decades and pain can now be controlled very well in most procedures.

Dentistry might be uncomfortable but usually it doesn’t hurt – except perhaps in the hip-pocket nerve. Many people can’t afford private dental treatment and the wait in the public system is too long. Too often, this leads to unnecessary tooth loss.

Why does oral health have such an image problem? Having healthy teeth is vitally important aesthetically (we don’t look good without them), and for our overall quality of life (we can’t chew properly without them).

Research is also showing that oral disease may be linked to a number of systemic diseases, including heart disease.

On the subject of “bad bacteria”, those most closely linked to dental decay are the “mutans streptococci”. Almost all of us have them in our mouths but their numbers can be kept below potentially dangerous levels by reducing our “in-between-meals” intake of sugars – and, in particular, sucrose (cane sugar). Sugar substitutes, such as the “alcohol sugars” sorbitol and xylitol, are useful weapons in the “anti-decay” fight and are commonly used in “sugar-free” sweets.

Xylitol is interesting because although mutans streptococci can take it up, they can’t use it as an energy source. They are forced to “spit it out”, and because this requires energy, they “fall behind” and can be overgrown by the many other types of bacteria that make up dental plaque. This is a neat example of “ecological imbalance”, literally, on a small scale.

Thanks to research, we know how we can harness such ecological imbalance to prevent tooth decay. This is the same principle that has led to the use of yoghurts to control intestinal pathogens. But how can we address that other imbalance – the poor public image of oral health? To be honest, someone needs to take charge.

The Federal Government and private health funds have the opportunity to show leadership on this. They should, in collaboration with the dental profession, provide a free dental health check-up and professional prophylaxis (tooth clean) for every person, at least annually. Could you imagine what the impact of that would be on the oral health of Australians?

At the very least, a free check-up should help to identify oral health problems at an early stage. Currently, a professional prophylaxis costs about $100,which is only partly covered by a healthfund rebate. But it’s an important preventive measure and something that everyone should have done at least once a year.

If the Government and health funds provided one free check-up and tooth-clean annually, it might encourage people to value dental health, to change their mindset about dental care and to seek the services of dental health professionals.

A potentially beneficial side-effect, for both government and private health funds, is that the overall costs for dental treatment would be reduced due to early detection of potential problems. In turn, we might see an increase in rebates for certain dental procedures.

We need to see some initiative from public and private funding to do something that really benefits the community, acts as a genuine preventive measure, and raises awareness of the importance of dental health in a way this country has never seen before.

Maybe, once we’ve been able to achieve this and get people really thinking about dental health, we’ll start to see it being taken more seriously as an area of research, giving Australia yet another opportunity to shine on the global research front.

Associate Professor Tony Rogers is Honorary Visiting Research Fellow in the School of Dentistry, University of Adelaide, and is editor of the book Molecular Oral Microbiology (Caister Academic Press, 2008).

This is an article by Louise Hall that was recently published in the Sydney Morning Herald – NSW, Australia.

DENTISTS and their patients are abusing Medicare Dental to get unnecessary, excess or aesthetic work done on their teeth while the neediest patients miss out, health groups say.

The scheme, introduced in the dying days of the Howard government, was designed to provide up to $4250 in private dental work such as extractions, fillings, and dentures for the chronically ill with poor oral health who could not afford to pay.

But some dentists admit a significant proportion is being spent on treatment that improves appearance, such as crowns, implants, bridges, straightening and capping teeth, but has little or no effect on the patient’s overall health.

One Sydney dentist who did not wish to be named told the Herald some “greedy” dentists were encouraging their patients to take advantage of the largely unregulated handout.

“Patients who are technically eligible because they have a chronic illness come in with their referral and then request aesthetic work, and because there’s no auditing or monitoring of what procedures are done, dentists are churning it out and getting a few thousand dollars a day out of the scheme.”

The Australian Healthcare and Hospitals Association and the National Rural Health Alliance said their analysis of Medicare data showed up to 40 per cent of the funding had been spent on excessively invasive or unnecessary procedures, or crowns and implants that had a more aesthetic function, or for which there were cheaper alternatives.

“We’ve found dentists are offering their patients expensive work like crowns or bridges when they could use a cheaper method and treat nine or 10 people for the same cost and an equal medical outcome,” said the association’s policy manager, Cydde Miller.

An unexpectedly high uptake of the taxpayer-funded scheme has caused a cost blowout that threatens to undermine the Rudd Government’s budget unless it can persuade the Senate to axe the program.

More than 1.73 million services have been performed at a cost of $192 million in the first 12 months, which is more than one-third of the original allocation for the entire four-year program.

But its intended target – indigenous people, the disadvantaged and those in rural and remote areas with complex health needs – have largely missed out, the health groups say.

Almost 75 per cent of procedures were in NSW, with smaller states virtually missing out. Ms Miller said NSW metropolitan dentists tended to be corporatised and well-informed about the benefits their patients could take advantage of.

The Minister for Health, Nicola Roxon, said Labor’s promised Commonwealth Dental Health Program, providing $290 million over three years to states and territories to clear public dental waiting lists, was on hold as the Government could not afford to fund both schemes.

“Under the current program, pensioners suffering from a simple toothache can’t get help – but if those pensioners were multimillionaires instead, with chronic diseases, they would have no trouble,” she said.

The president of the Australian Dental Association, John Matthews, said the scheme should be restricted to the financially disadvantaged. All work should have to get prior approval, similar to the process used by the Department of Veterans Affairs to filter out cosmetic or exorbitant work.