The NobleDentist Blog

This article by Natasha Rudra was recently published in The Canberra Times – Australian Capital Territory, Australia.

Four out of five Australian children visit the dentist regularly but one-third of young children have fillings in their teeth, a new health report says.

The research also found the proportion of children who cannot afford to see a dentist has dropped.

The Australian Institute of Health and Welfare will publish the report, Trends in Access to Dental Care among Australian Children, today.

Researchers surveyed more than 45,000 adults and children between 1994 and 2005 about access to and the cost of dental care.

They found the percentage of children who visited the dentist every year for a check-up increased between 1996 and 2005.

In 2005, 78 per cent of under-12s and 81 per cent of adolescents went to the dentist for a routine check rather than to fix a problem.

But children from families without private dental insurance were more likely to visit the dentist only if they had a problem.

When children did visit the dentist and needed treatment, they were most likely to have a filling.

About 30 per cent of children aged five to 11 and a quarter of 12 to 17-year-olds had a filling.

About 8 per cent of children in the younger age group had had a tooth pulled by a dentist.

But there was a sharp drop in the percentage of children who had had their teeth professionally scaled and cleaned.

Only 52 per cent of children aged 12 to 17 years received a scale and clean in 2005, down from 65 per cent in 1994.

Among five to 11-year-olds, the figure was only 34 per cent in 2005, down from nearly 50 per cent.

Institute researcher Professor John Spencer said that between 2002 and 2005 there was a sharp rise in the number of younger children who saw a private dentist.

Professor Spencer said 53 per cent of children aged five to 11 saw a private-practice dentist in 2005, up from 40 per cent in 2002.

The change reflected a decline in the use of the state and territory-run School Dental Service.

But the school schemes helped children who were least able to afford dental care.

This is an article by Morgan O’Brien that was recently published in The Gladstone Observer – Queensland, Australia.

DENTISTS are this week urging people to become more pro-active with their dental health by having regular check-ups to prevent the onset of future problems.

With the help of the Dental Health Week awareness campaign, local dentists are taking the opportunity to encourage members of the public to take their oral health just as seriously as their overall health.

There are some people who have adopted the time-old attitude of “If it ain’t broke, don’t fix it”, but Cheryl Petrie from Optima Dental Care said this attitude was outdated.

“Sadly, people see oral health as something that doesn’t actually affect the rest of their body,” she said.

Some see a trip to the dentist as an unnecessary or unaffordable exercise, but dentists are trying to change that mentality.

“They say they can’t afford to go to the dentist, but it’s like getting your car serviced regularly, it’s just something you need to do,” Ms Petrie said.

She said she could not understand why people are prepared to pay up to $200 to get their hair done or $100 to buy a new pair of joggers, but are happy to let their regular six-monthly preventative care check-ups fall by the way-side.

“Particularly if they’re covered by a health fund, it’s a false economy not to visit,” she said.

The experts say by continually putting off treatment, you may actually incur a bigger cost in the long-run.

“If you can prevent early decay from happening, it’s a lot better and cheaper,” she said.

“We find when people do come in it’s usually a more traumatic and more expensive experience than it needs to be if they’d taken a little bit of care.”

This is an article by Jay Fletcher that wa published recently in The Green Left Weekly – Australia.

If the rhetoric of the National Health and Hospitals Reform Commission’s report on Australia’s health system is taken at face value, health care in Australia will get an impressive overhaul courtesy of the federal government.

Released on July 28, A healthier future for all Australians marks “the biggest shakeup since Medicare”, SBS News said on July 27. Prime Minister Kevin Rudd said it was “a major report with major implications for the nation”. The report said: “We need to re-design health services around people.”

Yet the main thrust of the report is a determined push on competition, user-pays health care and a bigger role for the private sector.

The commission put the state-based health system in its crosshairs. It proposed the creation of “competing health plans” that would force state governments to compete with private insurers, overseen and funded by the federal government.

In a blatant swing towards greater privatisation of health care, the commission proposed the government introduce federally subsidised “health plans” for a range of basic health services.

This would enable private health funds to compete directly against the chronically underfunded and overstretched public health system to provide services covered by Medicare. Unsurprisingly, private health funds have welcomed the proposal heartily.
The federal government set up the commission in February 2008 to review the nation’s health system.

The report recognised the crisis in healthcare across Australia. The report found “hospitals are under severe pressure, directly influencing their ability to provide safe, high quality, accessible and timely care to all patients”.

It offered five priorities for the health system. These included: address the appalling health situation of Indigenous people, improve care for people with mental illness, more support for people living in remote areas, and improve access to dental care. “Timely access to quality care in public hospitals”, was the fifth priority.

Despite these “priorities”, the report has been criticised by health professionals for a failure to move beyond mere rhetoric and generalities.

The report recommended the formation of a new national authority for Aboriginal and Torres Strait Islander health funding and services. However, the National Aboriginal Community Controlled Health Organisation (NACCHO) chairperson Mick Adams criticised the plan for being “barely developed” in a July 27 statement.

“There’s no detail on how the $58 million Health Authority might work to ensure Aboriginal people’s role in setting the priorities to improve our health for example”, Adams said.

The Rural Doctors Association of Australia said that a lack of clear proposals for improving remote health — supposedly another priority — is a gaping omission. “Rural Australia is already suffering from a shortage of 17,000 health professionals”, said the association’s Dr Nola Mayfield on July 27.

“The crucial element missing from the report is any recommendation for substantial new initiatives to get more doctors and other healthcare professionals to the bush”, she said.
Private healthcare in Australia is already considerably expensive. It is heavily subsidised by the government. The Doctors Reform Society said the changes proposed in the report would mean private healthcare would expand. Market-based competition instead of universal access will be encouraged.

Doctors Reform Society President Dr Tim Woodruff said the report had some “excellent ideas” but was still “ultimately about entrenching those vested interests, about a long term vision for health care as a commodity to be subject to competition and the market”, according to the Crikey.com health blog Croakey.

The report also proposed a 0.75% rise in the Medicare levy to pay for a national dental scheme to cover basic dental services — Denticare.

Oral health is a critical part of overall health. Yet many Australians lack access to affordable dental health services. In 2006, the Australian Dental Journal estimated 35% of people do not have access to proper dental care. Eighty-five percent of dentists are private practitioners.

Woodruff welcomed the proposal to make dental care a universal entitlement. However, he pointed out: “The Denticare proposal is at odds with the Commission’s comment that ‘we want to translate universal entitlement into universal access’. Denticare will encourage dentists to stay in areas of relative affluence, supported by taxes.

“Those without teeth unfortunate enough to have limited mobility and live in poorer areas will remain toothless,” said Woodruff.

“Denticare also guarantees that those who have the money for private insurance can get faster access. That’s choice before equity. It should be the opposite.”

The Denticare proposal would not provide genuine universal coverage. People would be able to “choose” between private dental care or the public system. The government would pay for about 85% of private dental services, leaving the patient to cover the shortfall.

Greens Senator Bob Brown criticised the Denticare plan on July 27 for its heavy reliance “on subsidised private health insurance. Getting good dental care should be like Medicare — available to all regardless of wealth or privilege.”

On July 28, Rudd spoke at length about the “guiding principles” of the government’s plan for healthcare. The emphasis, he said, was a system that “focused on people”, is concerned with prevention, minimises waiting times and provides better access, quality and safety.

However, the report’s key recommendations will not achieve any of these things. Health reform, in the eyes of the government, is code for neoliberal, market-inspired changes that increase the power and profits of private companies.

Health campaigner and policy advisor Fiona Armstrong summed up many of the problems with the report on Croakey on July 28.

“Not content with the current status quo of a two-tier system in hospital care, the commission has recommend[ed] we extend this to all health care and, in a highly risky first step towards managed care system, proposes a greatly increased role for the private sector and private health insurers,” she said.

“This report should make the poor, the disadvantaged, the truly sick, and anyone with an sense of fairness very afraid for what lies ahead.”

A better health outcome is not the goal here. If that were the case we would have seen proposals for a dramatic expansion of Medicare, the end of government subsidies to private health insurance and a health care system based on free, equal and timely access for all.

This article was published recently in The Age.

Fear of the dentist, a visit’s impact on the hip pocket or lack of time sees many Australians put off an annual dental check.

A MBF Healthwatch survey shows more than half (57 per cent) of respondents had not visited the dentist for a preventative checkup in the past year.

“Our survey shows that adults generally think they only need to see a dentist when they have a problem,” says Bupa Australia Chief Medical Officer, Dr Christine Bennett.

More than 1,200 people were surveyed this month, and common reasons for avoiding the dentist were going only when there’s a problem (43 per cent) or not being able to afford it (also 43 per cent).

Other reasons included lack of time and fear.

Dr Bennett says the results were disappointing as poor oral health could have a major impact on general health and wellbeing.

“Oral health impacts many aspects of our everyday life – eating, drinking, speaking, kissing and smiling to mention a few.”

This is an article by Kelsey Munro that was recently published in The Sydney Morning Herald – Sydney, New South Wales, Australia.

YOU may not want to see your dentist all that often but it would be worse if you couldn’t see one at all.

More than 650,000 Australians are on dental waiting lists, with an average waiting time of 27 months, according to latest figures.

Now, in an effort to tackle what has been called a silent epidemic of poor oral health, dentists are volunteering their time and skills to treat people in need as part of a new program.

Healthy Smiles for Life aims to provide more than $100,000 worth of free treatment this year to patients most in need, from simple cleans to braces and more involved orthodontic treatments.

Program co-ordinator Katherine Barbeler said more than 220 dentists have volunteered nationally, with more signing up each day.

“We’ve had one dentist offer $5000 worth of orthodontics over two years, and a dentist in Brisbane has committed to 48 appointments over the next two months,” she said.

The patients are found through charities including the Salvation Army, Youth off the Streets, Barnardos and the Benevolent Society.

Epping dentist Beng Lee participated as a volunteer in the successful pilot program Bright Smiles, which targeted disadvantaged children. He has also signed up for the new program. Recently he treated Matthew*, a six-year-old living with his mother in a women’s refuge, who had serious tooth decay.

“He was initially nervous, but he coped very well,” Dr Lee said. “He was a happy boy and even happier when he left us.”

Dr Lee treated Matthew in two free sessions, worth about $250 each.

“He was a changed patient and the gratitude came from his heart,” Dr Lee said. “He actually made up a thank-you poster … with lots of stickers and a thank-you note. It was very heart-warming.”

Matthew called Dr Lee a “cool monster” in his note. Dr Lee will now treat Matthew’s mother.

This is an article by Geraldine Mitchell that was recently published in The Melbourne Herald Sun – Melbourne, Victoria, Australia.

MORE than 108,000 Victorians wanting to get their teeth checked in the public system are languishing on waiting lists.

New figures show a further 10,000 people joined the queue for dental check-ups or dentures in the six months to December last year.

Ballarat is the worst place in Victoria for access to general public dental care.

The government figures, provided to the Opposition, show patients can wait a whopping 51 months to see a dentist in the regional city.

That’s followed by Rosebud with 36 months, Wangaratta 35 months, and Broadmeadows 33 months.

Opposition health spokeswoman Helen Shardey said patients were now being forced to wait even longer at 30 Victorian centres for general dental care.

“This is totally unacceptable and means that Victorians are often being forced to wait more than two years for general dental care and in some cases up to four years,” she said.

“These shocking figures reveal that 108,327 people are waiting for general dental care while a further 15,230 Victorians are waiting for dentures.”

The figures also show Southern Health has almost 12,000 patients waiting for treatment, while the Isis Primary Care centre in Brimbank has more than 6000 on its waiting list.

Ms Shardey said the figures proved the system was strained.

“Just like our hospitals that are buckling under the pressure of increased demand, Victorian dental health services simply cannot cope and the Brumby Government has no real plans to reduce dental waiting times or reduce the number of dental emergencies, which account for more than half of all treatments,” she said.

“Dental patients must be seen in a timely manner and leaving them languishing on waiting lists for months contributes to the need for more complex treatment.”

The Government hit back, accusing the Opposition of “opposing things” rather than coming up with solutions.

“Since 1999 we have invested more than $1 billion into oral health; in stark contrast, the Opposition is blocking a Commonwealth Dental Health Program that would mean an additional 258,000 dental treatments for Victorian families,” said spokeswoman Peta James.

This is an article by Adam Cresswell that was recently published in The Australian – Sydney, New South Wales, Australia.

THE proposed $3.7 billion plan for a universal dental health scheme is facing mounting opposition amid fears it could fuel rampant fee inflation or spark a boycott by dentists.

Dental experts from opposite sides of the healthcare debate have united to condemn the plan, and even some private insurers—who would receive hundreds of millions of taxpayers dollars through the scheme—have joined the condemnation.

The planned Denticare scheme, one of the key elements of the National Health and Hospitals Reform Commission final report delivered this week, had been one of the commission’s most popular ideas when first unveiled in an interim report in February. But the health fund NIB, the fifth-largest private health insurer with a 7 per cent market share, yesterday said it was flatly against the scheme’s introduction. NIB managing director Mark Fitzgibbon said while it was “crucial” to give disadvantaged Australians better dental care, the fund was “totally opposed” to Denticare.

“Instead, governments should allow the existing private health insurance mechanism to connect the disadvantaged with dentists by direct subsidy of premiums,” Mr Fitzgibbon said. “A duplicate funding mechanism will merely increase administrative costs.”

NIB’s intervention is unlikely to make it any easier for the federal government to sell the scheme to the public, who are expected to need some convincing it is worth paying 0.75 percentage points more in tax, through an increased Medicare levy.

If Denticare were approved, every Australian would be entitled to subsidised dental care, with patients able to opt either for treatment in the totally free public system or alternatively under a private plan.

Patients choosing the private route would have premiums paid on their behalf by Denticare, and would then be able to see a private dentist as most do now. Although private patients would still pay a gap out of their own pockets, these gaps would be much smaller than now, with 85 per cent of the fee being covered.

Denticare has already come under fire from opposite sides of the dentistry profession, with professional groups such as the Australian Dental Association on the one hand and reform advocates on the other both condemning the scheme, albeit for different reasons.

The ADA says there is no need for universal dental coverage as the wealthy can afford to look after themselves, and any scheme should be limited to the neediest patients.

Others, such as Hans Zoellner, chairman of the Association for the Promotion of Oral Health and head of oral pathology and oral medicine at Sydney University, said Denticare did not go far enough and would not help people with poor oral health by refusing to cover necessary treatments.

Associate Professor Zoellner yesterday added another concern that Denticare would fuel fee inflation by promising to pay 85per cent of private dentists’ charges. “If you just pay 85 per cent of whatever the dentist charges … fees will be completely uncontrollable. The other possibility is if they say: ‘We will tell you what you can charge, and refund 85 per cent of that’, then some practices will close down and others will refuse to become involved. If the result is that the only way people can access subsidised dental care is through the public system, then the public system will collapse.”

Professor Zoellner called for Denticare to be scrapped and replaced by a phased expansion of Medicare to cover a much more comprehensive range of dental services, rather than the limited selection of basic treatments envisaged under Denticare.

He said not only would this be fairer—by avoiding the two-tier Denticare proposal—it would also expose dentistry to Medicare’s inherent competitive pressures that had successfully reined in doctors’ fee increases for more than 20 years.

The Shortcomings of Dental Insurance

Australians will drive many miles to visit a dentist as long as the price is right. It’s no secret that a visit to the dentist can be very expensive. There are insurance plans available but the premiums are too expensive and constantly rising.

Dental insurance imposes restrictions such as waiting periods, annual limits, pre-existing condition exclusions, and treatment exclusions particularly for cosmetic dentistry. Dental insurance also only covers usually less than half of the expense of dental services – so, effectively you have to pay hefty monthly premiums plus potentially hundreds and even thousands of dollars in dental fees for out-of-pocket expenses for the treatment.

(Note: Treatment such as root canal treatment, wisdom teeth extractions, dental veneers, dental crowns, dental bridges, and dental implants are very costly.)

Unfortunately the net result of this situation is that many people fail to get adequate and regular dental care. This can lead to the need for even more expensive dental services and/or eventual loss of teeth over time. Children who don’t see a dentist regularly can lose their baby teeth due to tooth decay or malformed teeth that must be pulled leading to a whole new set of problems related to the permanent teeth.

An Even Worse Scenario

Even worse than the inadequacies of dental insurance is the expense for those people without dental insurance. For these people dental expenses may be much greater as they will receive no rebate whatsoever.

Fortunately, there is an excellent alternative.

Cost Savings Drive Dental Care

People in Australia are fortunate that there is an alternative to traditional dental insurance. There is a non-insurance dental cover they can join that has a very low membership fee and provides access to exceptional participating dentists who will charge mush less for the same services provided to people without membership. This makes dental care affordable and available to most people.

As a result, many Australians find themselves driving many miles to visit a dentist knowing they will save a lot of money in dental fees. When dental services become affordable, people are more inclined to access them regularly. Following are some of the other reasons people will drive so far to find an affordable dentist.

• Lives in a rural area where there is no local dentist


• Needs family dental services available for parents and children


• Must locate a dentist that offers weekend appointments


• Needs emergency dental service that is not offered locally


• Requires ability to make appointments with short lead times


• Seeks reasonable dental fees to obtain regular dental care


• Seeks reasonable dental fees to afford cosmetic dentistry


• Seeks an exceptional dentist who may also specialise in the type of dental services needed


• Seeks affordable dentist now because there is a waiting period, annual limit, pre-existing condition exclusion, or treatment exclusion on their dental insurance policy

On a dental membership plan, it is possible to literally save thousands of dollars in dental expenses. It only makes sense to drive many miles to the dentist when it’s possible to realise these kinds of savings. This is especially true when the children need essential dental care or someone has an urgent and painful dental problem.

This is an article by Ari Sharp that was recently published in The Sydney Morning Herald – Sydney, New South, Australia.

THE proposed multibillion-dollar plan for a steep rise in the Medicare levy to provide every Australian with dental care has been given the thumbs down by a dentists’ group.

In its final report to the Federal Government, released yesterday, the National Health and Hospitals Reform Commission called for a $3.6 billion-a-year Denticare Australia scheme that would offer universal access to preventive and restorative dental care and dentures.

The plan would be funded by an 0.75 percentage point increase in the Medicare levy, leading to an extra tax bill of $450 for those earning $60,000 a year and pushing the basic Medicare levy up to 2.25 per cent of income. The Denticare scheme was the only element of the health blueprint, whose recommendations total up to $9.3 billion a year, that had a specific funding proposal linked to it.

The Prime Minister, Kevin Rudd, yesterday refused to commit to the scheme, even though, unlike many of the other recommendations of the Commission, there are no concerns the scheme may fall foul of the constitution.

The proposal, which would provide some relief for the more than 650,000 people currently on dental public health waiting lists, would allow people to choose between private and public dental health plans, both of which will be funded by the scheme.

Speaking at the release of the commission’s report in Canberra yesterday, the Health Minister, Nicola Roxon, said that the state of teeth was a significant indicator of income differences in Australia. ‘‘Dental health is becoming an indicator of wealth or poverty,’’ she said.

It was a sentiment shared by Mr Rudd who said that his contact with people had left him distressed at the poor state of dental health.

‘‘We’ve actually got to lift our game here,’’ he said.

The Opposition Leader, Malcolm Turnbull, said he would take a wait-and-see approach to the plan, but noted a Medicare levy increase was not Coalition policy.

The recommendation drew opposition from the Australian Dental Association, which said it demonstrated a ‘‘lack of appreciation of dentistry’’. It argued the Denticare scheme would deliver limited services such as teeth cleaning, extractions, fillings and dentures, but neglected more invasive procedures.

‘‘It is not good enough to say that provision of basic services to all will fix dental care delivery,’’ the association president, Neil Hewson, said.

He said the universal access rules will prevent funding from being directed to those most in need.

It was a position backed by the academic Hans Zoellner from the Association for the Promotion of Oral Health, who argued it would force ‘‘stupid clinical decisions’’.

‘‘Depending on your root canal anatomy, Denticare would either provide full service to save a lower front tooth, or alternatively offer nothing but extraction.’’

The Greens called for the Government to embrace the Denticare plan, saying it was ‘‘long overdue’’, but raised fears it would not live up to its promise.

‘‘We are concerned what is being proposed is not a universal dental scheme based on the Medicare model – it relies heavily on subsidised private health insurance,’’ the Greens leader, Bob Brown, said.

In 2007 the previous government expanded Medicare for the 2 million people with chronic diseases to be eligible for a rebate of up to $2125 for dental services.

Alongside the Denticare scheme, the commission also recommended a one-year internship scheme prior to full registration for dental health professionals, as well as an expansion of preschool and school dental programs.

This article by Hans Zoellner was recently published in The Australian – Sydney, New South Wales, Australia.

AUSTRALIANS have good equity in health, but not for diseases of the mouth. Although it is worrying that dental disease worsens diabetes, heart disease and stroke, it is shocking that at least 30,000 Australians are hospitalised yearly for preventable dental infection.

Almost half the population cannot afford private dentistry, while the public system, with less than 10 per cent of the nation’s dentists, cannot cope with demand. People suffering dental infection but unable to afford a dentist get prescriptions for antibiotics via Medicare from doctors, and this drives the emergence of increasingly antibiotic-resistant bacteria that later threaten the community.

The Association for the Promotion of Oral Health argues that inclusion of dentistry in dental Medicare would address these problems. Importantly, since November 2007 dental Medicare has been available for up to 10per cent of Australians and apart from some teething problems has worked well.

The present dental Medicare program was established in the dying days of the Howard government within the Enhanced Primary Care scheme for people with chronic diseases such as diabetes. To access the scheme, patients need a care plan from their doctor, which acts as a referral to a dentist to deliver treatment for which Medicare rebates of up to $4250 can be claimed every two years.

More than 150,000 people have been treated and our most recent analysis demonstrates the clear public need. The average dental Medicare patient has one treatment for pain or surgical procedure and also usually has an extraction. Most people receive two to three fillings, while about 80 per cent of patients also have denture services. About 14per cent of dental Medicare patients have had root canal therapies to save teeth. These statistics demonstrate sensible use of the dental Medicare service for people with a backlog of untreated dental disease.

Unfortunately, further dental Medicare statistics suggest over-servicing for crown and bridgework, and a need for government regulation of the scheme.

We are concerned that 16 per cent of dental Medicare patients have had bridges and 46per cent have had crowns separate to bridgework. It is important that any crown and bridgework be clinically appropriate, and we would be surprised if most of these treatments were clinically justified or appropriate. Frustratingly, we have long advised government that regulation is needed.
Federal Hansard records that the reason regulation has not been introduced is that the Rudd government intends to axe dental Medicare and apparently considers the effort of regulation unnecessary. Astonishingly, the government has issued letters incorrectly advising patients using dental Medicare that the scheme is closed and has further refused to advertise the present entitlement of chronically ill people for dental service.

The only reason dental Medicare still exists is that the Coalition, the Australian Greens, Family First and independent Nick Xenophon voted against the government in the Senate and refused to axe dental Medicare for replacement by an ill-considered government alternative termed the Commonwealth Dental Health Program.

More than $350million has been spent on dental Medicare since November 2007, exceeding the $100m a year proposed for the CDHP. Notably, the CDHP would deliver just $15 for each public dental patient to each state each year to support public dental services.

In this way, the government wishes to replace $2125 for each patient of dental Medicare to see any private dentist, with only $15 a patient to join the state public dental waiting list. Nationally, about 500,000 people are waiting for state public dental service, so it is clear that states can’t cope with present or any increased demand. The CDHP would not be a fair swap for dental Medicare.
States have highly variable public dental funding, with NSW, for example, spending about $64 for each public patient, compared with $138 in the ACT or $108 in Queensland.

Because of this, if the $15 a patient CDHP money were distributed, NSW and Victorian public dental patients would be rated by federal government as deserving about half the public dental funding as similar Queenslanders and ACT residents. The Senate represents state interests and it is hardly surprising senators could not justify axing dental Medicare in support of the government’s proposal.

To address overservicing, some have suggested simply removing crowns and bridges from the dental Medicare schedule.

But this would fail to provide such treatment when really needed and would punish the public for the government’s failure to enact appropriate regulation.
We suggest regulation of dental Medicare by a system in which any dentist wishing to do crown or bridgework would first provide a treatment plan to Medicare for approval.

A similar approach has worked well in the Department of Veterans Affairs, which provides comprehensive dental care for returned soldiers. Also, we see that it makes sense for dental Medicare to include those people who have dental problems needing antibiotics or who are hospitalised with dental infection.

With time, we believe dental Medicare should become available to all Australians.
Finally, we suggest any federal funds supporting state public dental services should be contingent on the states first increasing their own funding to an agreed minimum national level.

We believe dental Medicare is important for the health of the nation and hope the government can be brought to share our view.

Hans Zoellner chairs the Association for the Promotion of Oral Health and heads oral pathology and oral medicine at Sydney University’s faculty of dentistry.