The NobleDentist Blog

This is an article by Brad Norington that was recently published in The Australian – Australia.

THE Rudd Government’s drive to create uniform minimum employment standards across the health industry will push up costs and reduce opening hours, according to dentists.

In an impassioned plea to the Australian Industrial Relations Commission, the dental industry claims the Government’s push to simplify employment standards is also at odds with a Labor plan for improving oral health.

Workplace Relations Minister Julia Gillard has set a strict timetable for hundreds of awards that set minimum conditions across industry to be vastly simplified by January.

But the Australian Dental Association, representing more than 90 per cent of private practice dentists, wants its industry to continue under separate conditions. Barrister Arthur Moses SC told the AIRC in Sydney that private dental practice was an identifiable, distinct industry sector with a job classification structure, rates of pay, penalty rates and allowances.

But an exposure draft for a proposed new health professionals industry award that is in line with Ms Gillard’s plan for modernising awards says rates for dental assistants would be equal to assistants at medical centres, physiotherapy clinics and medical imaging practices.

Mr Moses said the proposed minimum adult wage of $637 a week for dental assistants entering the industry at level four was significantly higher—with the exception of Queensland—than the existing rate.

He said proposed penalty rates for Saturday also exceeded the current rate applying around Australia, except for in Queensland.

A number of allowances proposed under the new award also do not currently apply for the dental industry.

According to the ADA, the Health and Hospitals Reform Commission believes the cost of dental care has already created problems for disadvantaged people gaining access to care.

Hundreds of different awards are to be compressed into about a dozen broad industry and occupational groups.

Many employers in the retail, hospitality and services industries claim the AIRC will be forced to lift minimum standards in different states to uneconomical levels in order to create a single set of award pay and penalty rates.

Ms Gillard is committed to a simpler award system and is showing no signs at this stage of allowing exemptions.

This is an article by Mike Sexton from the 7.30 Report – ABC News Online – Australia.

A growing number of Australians are losing their teeth due to a failure of preventative dentistry. Gladys Facal was left with no choice but to have all her teeth removed and now faces the challenge of living and eating without them. Ms Facal is the classic end product of a system where 650,000 adults wait an average of two years to see a public dentist. The 7.30 Report looks at a bold policy proposal called Denticare which aims to stop the decline in oral health.

Every day Gladys Facal meticulously chops up vegetables and puts them through a blender.

“I have to do it very often because it’s the only way I can get my nutrition and to eat properly,” the 55-year-old says.

The dire state of Ms Facal’s dental health has left her with no other option. She has had all her teeth extracted over the past few years because of their poor condition, and dentures have caused painful ulcers in her gums.

“My gums were starting to bleed, starting to get so red, and my teeth were getting sore as well.” she recalls.

The only treatment option left for Ms Facal is to have false teeth implants costing more than $50,000; an amount the part-time cleaner can’t afford.

The physical and emotional scars suffered by Ms Facal due to the removal of her teeth have been enormous.

“I feel really terrible, I don’t want to go public places, I didn’t even want to go back to work. My boss had to come in and say ‘Go back to work please, we need you’. I was so ashamed of myself.”

For the first time since the early 1980s, when Medicare was being created, there is open discussion about a national dental health care system.

The Federal Government’s Health and Hospitals Reform Commission is looking at the long-term health needs of the nation and has identified dental services as a priority area.

Among the six reforms proposed by the Commission is Denticare – a $4 billion a year scheme that would be paid for by a three-quarters of 1 per cent increase in the Medicare Levy.

The money collected would be used to pay for people’s private dental insurance.

Professor John Spencer from the University of Adelaide has studied the industry for more than two decades and says many middle and low income earners base their visits to a dentist on what they can afford.

“What is important about the Denticare proposal [is] even though it sounds the same it is a private dentistry, private insurance solution to the issue of affordability of privately delivered dental care.

“It’s not a Medicare solution.”

He believes the appeal of Denticare is that people will be likely to visit the dentist more often, rather than waiting for emergencies, if their dental insurance is covered.

“If the services are routine diagnostics, preventative, restorative and dentures, then all will be covered under the plans and people will be able to seek services with very little direct cost to them.”

However not everyone is in favour of the Denticare proposal.

Neil Hewson is the president of the Australian Dental Association, which represents 90 per cent of dentists.

“Denticare is a broad scheme to cover the whole population and so for us, one of the major faults is that it is collecting money from the public and not distributing it entirely to the people in need,” he said.

“It is diluting it to the most in need by distributing it to the whole population.”

He describes the Denticare proposal as nonsensical, preferring instead to see the Government directly fund extra clinics and services for those on public waiting lists.

“We need a strong public system. Where it is impractical to have that, private networks should be used to supplement the system. So you have a vouchers system, and that does work very effectively, where the private sector helps the public sector out to achieve its goals”.

Denticare is only one of 116 proposed medical reforms contained in the National Health and Hospitals Reform Commission’s interim report.

Submissions closed this week and a final plan will be delivered to Canberra mid-year.

This article was recently published in the Lithgow Mercury – Lithgow, New South Wales, Australia.

A pilot program launched in Lithgow two months ago that aims to identify tooth decay in children five years old and younger is proving to be an outstanding success.

The Lift their Lip program, developed by Sydney West Oral Health Service and funded by Western Child Health Network, sees specially trained nurses of Lithgow Hospital emergency department conduct brief dental checks and identify signs of dental decay in presenting children.

The program is an expansion of one launched at Mt Druitt Hospital last March.

The Lift their Lip program will be introduced to Auburn Hospital in April.

The Lift their Lip program, at all pilot sites, will be evaluated after July this year with a view for it to be introduced across all Sydney West Area Health hospitals.

Sydney West Area Health Service Oral Health Promotion Manager Bronwyn Johnson said since the launch of the Lithgow program eight of the 44 children checked so far had been identified as having, or at risk of having, dental disease.

“Early Childhood Caries (ECC), which affects infants and young children, is a severe and rapidly progressing form of tooth decay,” Ms Johnson said.

“There is a growing body of data showing an increase in dental decay among young children.

“A child dental health survey carried out last year in NSW showed that 40 per cent of children aged five to six have evidence of tooth decay.”

Ms Johnson said the children identified with signs of dental decay were referred to Lithgow Public Dental Clinic or parents could take their child to their own private dentist.

All parents of children who were checked by the nurses were given a `Lift their Lip’ brochure showing the signs of tooth decay.

The brochure offered tips for keeping their children’s teeth healthy while encouraging them to look at their child’s teeth at regular intervals.

“Attendance at public dental clinics usually occurs when ECC is at an advanced stage and can only be treated under general anaesthetic,’’ Ms Johnson said.

“By educating Lithgow parents of the early signs of tooth decay, treatment can be sought before this happens.

“We recognise that early intervention and prevention are driving factors in delivering improvements in oral health in the community and the nurses at Lithgow Hospital emergency department have been extremely keen in implementing this pilot project.’’

SOME tips from the Lithgow program staff for healthy teeth in small children:

Stop the bottle at about 12 months of age (put your baby to bed without a bottle)

Start drinking from a cup at about six months of age (boil tap water until 12 months of age)

Start brushing when your child gets their first tooth (use low fluoride toothpaste 18 months of age)

This article was recently published in the Bendigo Advertiser – Bendigo,Victoria, Australia.

STATE health minister Daniel Andrews will today open La Trobe University’s new $1.9 million dental and oral health clinic laboratories.
The new State Government-funded facilities include a 30-chair simulation laboratory and 32-chair general purpose laboratory, giving dental and oral health students access to the latest technology.

The new labs are in addition to the existing 32-chair oral health laboratory that was completed in 2006.

The new laboratories include audiovisual systems that are fully integrated with teaching stations and allow lecturers to deliver material to students in any of the laboratories or to any combination of laboratories.

One simulation laboratory also allows students to access teaching material on individual computers.

La Trobe University’s regional pro vice-chancellor Professor Hal Swerissen said the new laboratories demonstrated the university’s aim to strengthen its regional presence.

“La Trobe University is committed to enhancing its well established reputation in providing health science courses that help to promote the recruitment of health professionals in rural and regional locations,” he said.

“The Bendigo dental school will have regional clinics in places such as Albury-Wodonga, Mildura and Melton.

“We know that people who study in regional locations tend to stay in country areas when they qualify.”

Head of the School of Dentistry and Oral Health, Professor Peter Wilson said the new facilities set the benchmark for dental and oral health education.

“I believe La Trobe University now has one of the best facilities of its kind in the world; it is an outstanding showcase of a cutting-edge facility, designed like a modern museum,” he said.

This is an article by Adam Cresswell that recently appeared in The Australian – Australia.

DENTAL experts are divided over a government plan to train a staff member from each of Australia’s 2830 aged-care homes in dental hygiene, with some describing it as ineffectual and others as a step in the right direction.

The plan, unveiled last weekend by Ageing Minister Justine Elliot, aims to improve the sometimes woeful state of oral health in elderly residents by ensuring the nearly 3000 staff members are trained by next year.

After their training, they will return to their workplaces and teach other health workers how to help maintain the teeth of nursing home residents.

Announcing the plan, Ms Elliot said one of the factors driving a greater demand for dental care in aged-care homes was the fact that more elderly residents had teeth to look after, as opposed to dentures.

She cited Australian Dental Association research that forecast 80 per cent of residents would still have at least some of their natural teeth in 10 years, up from 56per cent in 1989.

In 1979, only 40 per cent of residents had natural teeth.

But while there are more teeth, they are often in poor shape.

Many residents grew up before fluoridation of drinking water, and their dental health is often poor.

“Unfortunately, many of the older Australians in aged-care homes cannot communicate their discomfort and are unable to look after their own dental health,” Mrs Elliot said.

“The key to improving dental care is to educate aged-care workers on how to assist with residents’ oral and dental health.”

However, some dental experts say the plan falls far short of what is required, pointing to its modest price tag—$3 million over two years.

Hans Zoellner, chairman of the Association for the Promotion of Oral Health and head of oral pathology and oral medicine at the University of Sydney, said the plan “has to be put in the basket of token gestures, really”.

“What these patients need is not well-intentioned amateurs having a go,” Associate Professor Zoellner said.

“They need fully trained dental hygienists and dentists to work as teams, coming into nursing homes to deliver dental care.

“Anyone who thinks you just have to show someone how to brush their teeth is (making) a very glib response … a lot of these patients have dementia and it can be quite hard even to get them to open their mouths.”

Associate Professor Zoellner said many if not most nursing home residents would qualify for dental care under the “Enhanced Primary Care” Medicare-based dental scheme introduced by the Coalition, which the present Government had been trying to close down.

“Why not encourage the nursing homes to use the Enhanced Primary Care Medicare program to pay for the services by hygienists and dentists?” he asked.

“The problem is at this time hygienists don’t have provider numbers (needed to qualify for Medicare rebates), but they could adjust the program and give hygienists the provider numbers.”

However, the Australian Dental Association was more supportive of the scheme.

Its president, Melbourne dentist Neil Hewson, said it was a “good idea” and neither the Government nor anyone else was suggesting it was the answer to all the problems affecting elderly people’s dental health.

“It’s just training them so they can keep residents’ teeth clean when they are not capable of doing it themselves—it’s not cleaning in the sense of scaling,” Dr Hewson said. “We wouldn’t say this is a definitive, complete solution to the dental-health problems in residential care.

“But given that federal governments for a long period of time haven’t done anything, it’s a good first step.”

Under the program, there will be a nationally consistent approach to dental assessments done by aged-care assessment teams.

The separate staff training package, to be provided later this year, will teach aged-care workers to provide standard protective oral hygiene, showing residents how to brush their teeth and look after their gums to reduce decay and ulcers.

They will also teach workers how to clean dentures, show residents how they can cope with a dry mouth—a condition caused by some common drugs, that can in turn promote tooth decay—and various techniques for assisting tooth brushing in patients with dementia.

The training programs will be partially shaped by the results from a trial project running in seven aged-care homes in South Australia, NSW and Victoria.

This article was recently published by Australian Ageing Agenda – Sydney, NSW, Australia.

The whistleblower dentist who spoke out about oral neglect in residential aged care last December says the government’s new dental plan for nursing homes is flawed.

In a statement Dr Clive Rogers from the School of Dentistry at the University of Western Australia welcomed the Rudd Government’s action in this area but said its plan would not address the problem sufficiently.

Dr Rogers is concerned that there is no requirement that the standardised oral review for the aged care assessment team (ACAT) process be performed by a qualified dentist.

“The oral and dental care status and care plan needs of the elderly, when they move into institutionalised residential care, is one of the most complex in dental practice,” he said.

“These elderly [people] deserve to be assessed by a dentist, and not a non-dentally qualified health worker…”

Dr Rogers also believes that the plan to provide dental hygiene training to a representative form every aged care home in Australia by 2010 will produce superficial results.

He estimates carers would require 24 hours of formal training over a period of six weeks to gain the necessary level of knowledge and skills to provide dental care in the aged care setting.

He also says several educators will need to be identified in each state to deliver the training.

“There are no ‘quick fixes’ to solve these significant health concerns,” Dr Rogers said.

“A better solution is one that will lead to an effective and long-term resolution.”

Dr Rogers also questioned the idea that staff champions could educate other aged care workers in oral maintenance.

“It is unrealistic and unsatisfactory to expect inexperienced and superficially trained carers to be able to adequately train other staff back at their RACF to deliver adequate oral and dental hygiene to their residents,” he said.

However the Australian Dental Association has welcomed the plan, describing it is an important new direction in aged care policy.

“The measures proposed are a significant step in the right direction for the aged,” said the association’s president, Dr Neil Hewson.

“When implemented they will bring about a much improved dental health status for this group.

“To have staff better educated to attend to residents’ oral hygiene and screen for problems will assist in allowing early intervention by dentists.”

This is an article by Mark Metherell that was recently published in Kalgoorlie Golden Mail – Kalgoorlie, Western Australia, Australia.

MEDICARE Australia is investigating allegations that doctors, dentists and patients are colluding to rort the Medicare dental scheme.

The dentistry program, which can finance up to $4250 worth of dental work, is believed to have become a big earner for some dentists.

The Medicare inquiries are believed to be focusing on doctors who are referring to dentists patients who do not have the medical problems necessary to justify Medicare cover for the dental work.

By early this year, 94,673 patients in NSW had benefited from Medicare dentistry, with many receiving dentures and crowns that previously they could not afford.

The Herald has been told that Medicare has identified “compliance concerns” with the scheme, introduced by the Howard government but targeted for removal by the Rudd Government.

Potential rorts have been identified as a result of Medicare’s risk assessments, reports by the public to Medicare fraud tip-off line and complaints by state law enforcement agencies.

Medicare, which can scan its computer databank to identify suspect claims, is targeting dentists who have wrongly claimed upfront for future services, claims made by patients who do not fit the eligibility requirements, and collusion by doctors, dentists and patients.

Under the scheme, patients cannot be reimbursed by Medicare for the dental work until the referring doctor has notified Medicare that a care plan has been prepared.

The Senate has twice blocked Government moves to abandon dental Medicare, which costs about $250 million a year and rising.

The Senate impasse has meant that the Government has refused to introduce its Commonwealth dental scheme, which was promised to provide 1 million services over three years to people on long public dentistry waiting lists.

The Health Minister, Nicola Roxon, said the current arrangements meant millionaires could get dental treatment under Medicare if they had a medical condition, while many pensioners who could not afford private dentists had to wait years for treatment at a public clinic.

Associate Professor Hans Zoellner, who has campaigned to retain dental Medicare, said that while it was “very likely” that some dentists and doctors were doing the wrong thing, he believed most of the treatments so far provided were warranted.

Professor Zoellner, of Sydney University’s dental school, is chairman of the Association for the Promotion of Oral Health. From his analysis of the dental services financed by Medicare, the average “is getting the sort of care you would expect for someone with a big backlog of untreated disease”.

He had checked claims by critics of dental Medicare that the scheme was generating excessive crown and bridgework and was being squandered on cosmetic dentistry.

“Overall, data indicate a reasonable use of public Medicare funds for delivery of dental services … The high incidence of treatments for pain, extractions or other surgical procedures supports this interpretation.

“No sensible patient presents for extraction or other surgical procedure without clear clinical need.”

He said the requirement for people to have a chronic disease in order to benefit from Medicare was a flaw.

Everybody, “whether they have a chronic disease or not”, should be able to get the treatment they need.

This is an article by Danielle Cronin that was recently published in The Canberra Times – Australia.

The Federal Government’s health-reform commission suggests the nation should adopt a universal dental scheme funded through a 0.75per cent increase in the Medicare levy.

‘’Denticare Australia’’ and a national takeover of the health system are among proposals offered in the National Health and Hospitals Reform Commission’s interim report to the Government.

Commission chairwoman Dr Christine Bennett issued the report which includes 116 recommendations yesterday at the National Press Club.

‘’Let’s stop bragging about having the best health system, it’s time to start bragging about having the best wellness system,’’ she said.

Health Minister Nicola Roxon said the report contained some radical and ambitious recommendations.

‘’I asked the commission to plan ahead, to lift themselves beyond the day-to-day politics and practical considerations that I have to manage. They have done that,’’ Ms Roxon said.Dr Bennett said Denticare Australia would ‘’give every Australian universal access to preventive and restorative dental care and dentures regardless of people’s ability to pay’‘.

Opposition health spokesman Peter Dutton said it would impose ‘’billions of dollars in extra taxes’’ on Australians.

But Ms Roxon said the commission had identified a pressure point in the health system. ‘’They’ve put forward a fairly radical proposal … but we are interested in the community’s response to this issue,’’ she said.

The commission is due to deliver its final report in June the same timetable that Prime Minister Kevin Rudd set for states and territories to improve public hospital services or face a federal takeover.

In its report, the commission canvassed three options on who should ‘’run’’ the health system.

A federal takeover was involved in two of the options, including one that required the ‘’greatest departure from existing approaches, with all the attendant risks inherent in such a fundamental change’‘, Dr Bennett said.

‘’It would establish a community-wide social health insurance scheme, with people choosing from competing health plans that will purchase health care from public, private and not-for-profit providers,’’ she said.

‘’These health plans would be required to cover a mandatory set of services, including hospital, medical, dental, pharmaceutical, allied health and aged care.’’ Health groups have delivered a mixed verdict on the interim report, that sets four directions for the health system taking responsibility, connecting care, facing inequalities and driving quality performance. Dr Bennett said these were designed to ‘’serve the health needs of the nation five, 10, 20 years into the future’‘.

A National Health Promotion and Prevention Agency should be set-up to pursue ‘’Healthy Australia 2020 Goals’‘, such as reducing obesity levels, binge drinking and road trauma. Primary and secondary students should be taught ‘’health literacy’‘.

‘’We propose opportunities such as universal home visits, school nurses, better targeted special care to families at risk and more coordinated intensive care for children with disabilities and major health problems,’’ Dr Bennett said.

One-stop health clinics and personal electronic health records were also among the proposals, which Australian General Practice Network chief executive David Butt believed would spark a ‘’power shift’’ from acute to primary care to improve the health and well-being of the nation.

Accommodation bonds for aged care and a new National Aboriginal and Torres Strait Islander Health Authority to purchase services were also recommended.

‘’[And] where doctors are scarce, such as in remote and rural areas, appropriately credentialled nurse practitioners and other registered health professionals should be able to order diagnostic tests and make specialist referrals that are covered by Medicare,’’ Dr Bennett said. ‘’The same should apply to [Pharmaceutical Benefits Scheme] cover for prescriptions.’’

The commission believed public hospitals should be required to meet new targets to provide timely access to services.

The Australian Medical Association saw ‘’no value to the community … in pursuing some of the tired policies of budget-holding and restrictions on patient choice and rationing that have failed patients in the United Kingdom’‘.

This is an article that was recently published on the ABC News website – Australia.

An advocacy group says the Federal Government should include dental services in Medicare rather than creating a new and separate scheme.

The interim report from the National Health and Hospitals Reform Commission (NHHRC) suggests setting up a universal dental services scheme called Denticare, which would be funded by an increase in the Medicare levy.

The Government says nothing will be ruled in or out before the commission’s final report is presented in June.

But Hans Zoellner from the Association for the Promotion of Oral Health says the Denticare scheme would not work in its current form.

“The current Denticare proposal isn’t as strong as it could be,” he said.

“The most simple solution is to simply put dentistry in Medicare. Medicare is a system that works. It’s been shown to work for dentistry for people with chronic diseases over this past year and it will work for the whole community.”

Mr Zoellner says the Denticare scheme would create a two-tier system for dental care as it currently stands.

“One where federal money is filtered through private health insurers to pay for private dental services, and if you can’t provide private health insurance, Denticare, as currently proposed, would simply give the money to the private system so you can join the waiting list,” he said.

Opposition health spokesman Peter Dutton says the Government should immediately rule out the Denticare plan.

“We need to make sure that the Government puts in place a sustainable and affordable system, but this is a massive tax increase that the Government is proposing and the Rudd Government needs to come out and say whether or not they support the proposal for a 50 per cent increase in the Medicare levy tax,” he said.

“It’s a significant increase and they should be stating their position very clearly so that the Australian people can understand whether or not the Rudd Government is going to impose a new tax.”

The Queensland president of the Dental Association Dr Greg Moore says he does not like the idea.

“The money needs to be directed in a more clever way than a universal dental scheme,” he said.

“It is not going to solve the problems of access to general treatment itself and it’s not going to solve the problems of misdistribution of the dental workforce.”

Dr Moore says similar schemes have failed overseas.

“The dental profession would greatly welcome an injection of money into the dental health field but this is not the right way to do it,” he said.

“We need to gain better access to the bureaucrats and the health planners who have this money to spend in the spirit of cooperation to find the best way of providing services to the population.”

This is an article that was recently published in The Age – Australia.

Taxpayers would be charged a higher Medicare levy to fund a universal dental scheme under a radical proposal by the federal government’s health reform body.

Accommodation bonds for high-care nursing home residents was another idea floated by the National Health and Hospitals Reform Commission in its interim report, released on Monday.

Commission chairman Dr Christine Bennett told the National Press Club in Canberra that about 670,000 adults were on public dental care waiting lists, with an average waiting time of 27 months.

The commission has recommended a 0.75 per cent increase in the Medicare levy to pay for a scheme, called Denticare Australia, which would replace existing premiums paid for private dental insurance.

“(Denticare) would give every Australian universal access to preventative and restorative dental care and dentures, regardless of a person’s ability to pay,” Dr Bennett said.

Health Minister Nicola Roxon said the government was committed to long-term health reform, despite a looming recession.

“They (the commission) have put forward a fairly radical proposal, obviously the way of delivering the services, and a tax, an extra levy attached to it, it is a fairly ambitious proposal,” she said of Denticare.

“But we are interested in the community’s response to this issue. I think people do feel that something new is needed in dental care.”

Australian Dental Association president Neil Hewson said targeted funding was a better approach than a universal scheme.

“Denticare, as is suggested by the commission, is not necessary and would be fiscally irresponsible and unlikely to deliver quality dental care,” he said.

Dr Bennett said Australia’s aged-care system needed to be overhauled to respond to changing consumer expectations.

“We recognise that providers will need to be able to raise revenues to invest in expanded places and offer greater choice,” she said.

“We therefore suggest that accommodation bonds, and other alternative approaches for payment, be explored.”

A spokesman for Ms Roxon said the government was not currently considering introducing bonds in high-care.

The commission called for the Commonwealth to take over responsibility for primary care, that is services provided outside of hospitals by professionals such as GPs and physiotherapists.

But it stopped short of recommending a takeover of state hospitals, instead putting three options forward for discussion.

Under the first model, responsibility for the nation’s health system would continue to be shared by the Commonwealth and the states, while the second model advocates a federal takeover of the system, with services delivered by regional health authorities.

The third and most radical option is a socialisation of the system, whereby the Commonwealth would be responsible for health-care and establish a compulsory social health insurance scheme.

Ms Roxon described the third option as radical, while Australian Medical Association president Rosanna Capolingua said it seemed to be similar to the model in the United States where private health insurers controlled the system.

“What happens there is that when you have something wrong with you that doesn’t fit into the plan then there is no one to look after you,” Dr Capolingua said.

The health minister repeated the government’s threat to hold a referendum on whether or not Canberra should assume control of public hospitals if the states don’t lift their game by the middle of the year.

But despite that deadline being just four months away, Ms Roxon again refused to reveal exactly what the trigger point for such action would be.