The NobleDentist Blog

This is an article by Des Houghton that was published recently in The Courier Mail – Queensland, Australia.

THE number of Queenslanders on public dental waiting lists has soared past 106,000 with some patients waiting seven years for treatment.

The revelations come at a time when the State Government has been caught out blocking the recruitment of dentists to cut costs at public clinics.

In one case a man allegedly waited three years for a check-up, and was then told he had been placed on another three-year waiting list for dentures.

And a Queensland Health dentist said a patient in Brisbane had been waiting for treatment since 2002.

Thousands of patients routinely wait a month to see a dentist with aching teeth so painful they are unable to sleep. And thousands of elderly people are forced to eat baby food while they wait months, even years, for dentures or repairs to broken dentures.

Secret department figures leaked to opposition health spokesman Mark McArdle show scores of unfilled vacancies across the state for dentists and other oral-health professionals.

There were vacancies in Brisbane’s Metro South district, Cairns, Mackay, the Darling Downs and the Sunshine Coast.

Another document headed Critical Oral Health Vacancy Report warned of unfilled vacancies “which have caused, or will cause closure of services”.

Queensland Health acknowledges the crisis in a website warning to patients: “Many areas of Queensland are currently experiencing long waiting times for general dental treatment. In some regions the waiting time is over three years.”

Mr McArdle said Queensland Health’s 520 public dental clinics – made up of 191 community clinics, 189 school dental vans, 121 fixed school clinics and 12 self-drive dental vans – were operating under crisis conditions and barely able to keep up with emergencies.

“It’s a disgrace,” he said. “A dental health crisis is sweeping the state. And now we have evidence Queensland Health is so incapable of managing the system it can’t even fill vacancies.”

The tables show there are more than 168 vacancies across Queensland for dentists, dental specialists, therapists, technicians and others.

Greg Moore, president of the Queensland branch of the Australian Dental Association, agreed many clinics were understaffed.

“Health districts are under pressure to keep numbers down,” Dr Moore said. “A good way to make hospital budgets look better is to employ fewer people.”

He said some Queensland Health dental clinics were being forced to shut on certain days because of staff shortfalls.

Dr Moore said a colleague at a state clinic complained to the association that some patients were suffering for years without treatment.

He wrote: “The waiting lists in most areas and the difficulty attracting dentists are the real killers. While most clinics can see emergency patients from trauma to mild concerns about bleeding gums within a couple of days, that’s usually only patch-up dentistry.”

One of the best-performing clinics on Brisbane’s northside had a waiting list of only two years.

“That’s one of the shortest waiting lists in Queensland,” Dr Moore said. “And if patients need a partial denture, they go on a general waiting list for their operative. When that’s done they go on a separate waiting list for their partial denture, and that could be another couple of years.

“If the patient is missing upper anteriors they’ll be prioritised but they’ll often still be waiting for weeks or months.”

One district went three years without a general anaesthetist.

A dentist said: “After a struggle, we got some general anaesthetic back last year, but it’s in one of the part-time theatres, not the main operating theatre.

“That means that the anaesthetists will only see patients who don’t have severe medical conditions or airway problems.

“We still have one seriously disabled patient who’s been waiting for a general anaesthetist since 2002, and many from 2004, 2005 and 2006.”

Health Minister Paul Lucas said in an answer to a question in Parliament that public dental clinics gave priority to patients seeking emergency dental care.

He said emergencies involving trauma, swelling, or uncontrolled bleeding were generally seen within 24 hours, while urgent cases with patients experiencing pain had a recommended waiting time of less than five days.

Mr Lucas said 1,011,238 patients were treated in dental clinics across Queensland between April 2008 and March this year.

Dr Moore said waiting lists would remain long until Queensland Health employed more dentists at clinics.

“Only 15 per cent of dentists work in the state system,” he said. “There is one-third of the state’s population eligible for care at a Queensland Health community clinic or in a school clinic. Do the sums. It means 15 per cent of Queensland’s dentists are looking after 33 per cent of the state’s population.”

He said there were some positive signs. James Cook University and Griffith University now had medical schools.

There would be a turning point in 2013 when 150 new dentists graduated. By then, the advantages of water fluoridation would have been realised with 20 per cent fewer cavities in children’s teeth.

As well the Federal Government has committed $104 million for the Oral Health Centre at the University of Queensland’s Royal Brisbane Hospital campus.

It is being billed as potentially Australia’s largest and most advanced tertiary oral health facility, combining research, education, training and specialist expertise in patient care.

Professor Laurie Walsh, head of the University of Queensland school of dentistry, said dentists in the public system spent one-third of their time dealing with day-to-day emergencies.

This is an article by Siobhain Ryan that was published recently in The Australian – Australia.

(Article from: Dow Jones Newswires )

POOR Australians are resorting to do-it-yourself dentistry, including filing their own teeth and attempting their own extractions, because of lengthy queues for public dental services.

Graham Long, pastor and chief executive of the Wayside Chapel in Sydney, says he sees “black, ulcerated mouths’’ every day in his job.

“It’s a dentist’s nightmare,’’ he says. “I just don’t know how they live with it. I’ve seen people do dentistry on themselves. I’ve seen people pull out their own teeth. I’ve seen people file the ends of their teeth because they’ve got a jagged tooth slicing up the side of the mouth.’’

Most dental work in Australia is paid for privately, but public services exist for concession card holders and other groups deemed needy by local health authorities.

Some qualify for immediate or emergency care, with the rest referred to non-urgent waiting lists for general or denture care.

An Australian Institute of Health and Welfare study of dental patients in NSW and South Australia published in June, however, has found that even non-urgent cases suffer pain or discomfort, with 49 per cent declaring themselves uncomfortable eating any food and 45 per cent reporting toothaches in the previous four weeks.

Yet they still face waits of up to four years for treatment, the report reveals.

Australian Dental Prosthetists Association vice-president Bruce Menzies says the queue is longer still, up to five years, in his home state Queensland.

At his private clinic he sees the results of those delays in patients with worn and ill-fitting dentures, unable to chew food properly, who eventually abandon the public dental waiting lists.

“People have tried to fix their dentures with super glue, which is not really good for their health, either,’’ Menzies says.

Australian Dental Association chief executive Robert Boyd-Boland says the reports of people resorting to self-help dentistry reflect the lack of access to public dental services.

“It does happen, there’s no hiding from that,’’ he says. “It’s just indicative of the extremely low priority that dental health is given by some of the state governments.’’

Eligibility and waiting times for adult public dental services vary from state to state, but overall funding has fallen since the Howard government scrapped the commonwealth dental health program more than a decade ago.

Ahead of the 2007 federal election, Kevin Rudd promised $290 million for a replacement scheme. But he made the commitment contingent on saving an even greater amount by ending Medicare rebates for private dental services for the chronically ill, a trade-off rejected by the Senate twice last year. A spokeswoman for federal Health Minister Nicola Roxon acknowledges that “access to dental services is a problem’‘.

She says the government is offering teenagers free dental check-ups, and blames the opposition for blocking the roll-out of a million extra services under the planned commonwealth dental health program.

But Prue Power, executive director of the Australian Healthcare and Hospitals Association, which represents public health services, says the sector has lost patience with the buck-passing over the election pledge. More than a year has passed since the Senate defeat but the matter has yet to return to parliament for negotiation.

“It is not acceptable for low income earners and pensioners to continue to miss out due to the inflexibility of the government and the Senate to reach agreement on implementing the best solution possible,’’ Power says.

Martin Dooland, executive director of the SA Dental Service, says taxpayers will save money if the promised funding is put towards public dental checks to prevent decay and reduce emergency presentations.

“It’s just negligence that has led to this major health problem for lower income earners,’’ he says. “It’s so inefficient and such an awful way of providing health care.’’

Roxon’s National Health and Hospital Reform Commission also wants to see change, having made dental care one of its top priorities.

Nearly one-third of all Australian adults avoid or delay visiting the dentist because of costs and, of those who do seek treatment, more than 650,000 are on public dental waiting lists, its final report notes.

The commission has backed a universal “Denticare’’ scheme, funded through a 0.75per cent rise in the Medicare levy, to help address the multi-billion-dollar problem. The government has opted for six months’ consultation on the proposal, with Roxon and Rudd warning when the report was first released that teeth were becoming an indicator of wealth or poverty.

Dooland says, however, the socio-economic divide in oral health already is well entrenched, with pensioners twice as likely as their better-off peers to be toothless.

Power says the needy cannot afford to wait the years it will take to introduce Denticare, regardless of the scheme’s merits.

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

DENTISTS have called for the booming unregulated teeth-whitening industry to be shut down amid fears that staff in shopping malls, beauty parlours and tanning salons are performing the potentially dangerous treatment without proper training.

Dental groups say the procedure should be carried out only in a clinic and the proliferation of cheap, ‘’instant’’ teeth bleaching options poses a serious safety risk to clients.

The Cosmetic Physicians Society estimates there has been a rise of up to 500 per cent in the number of beauty therapists offering whitening services in the past two years.

The Australian Dental Association wants the law changed so only dentists can conduct whitening procedures – which involve strong chemicals that can cause damage to the gums and teeth, burning and mouth ulcers and increased sensitivity.

But the non-dental sector says it is operating safely and dentists are only complaining because the increased competition is encroaching on a lucrative part of their business.

The push for regulation comes as the Dental Practice Board of Victoria awaits a verdict on legal action it has taken against a beauty therapist who allegedly injured a client through teeth bleaching.

If successful, the case – which was heard at Heidelberg Magistrates Court in March – could set a precedent that would effectively shut down the non-dental teeth-whitening industry.

The board has received about 20 complaints from people who suffered oral health complications after teeth bleaching in the past two years. None of the cases involve dentists.

The booming industry is attracting male and female customers aged from 16 to the 70s as an increasingly image-conscious public buys into the Hollywood obsession for gleaming, white teeth. In the US, it is an $US11 billion ($A13 billion) industry. Local figures were not available.

While dentists can charge up to $1600, bleaching is being advertised from as little as $139 in settings as varied as department stores, pharmacies and in-home mobile services. The whitening effects can last up to two years in non-smokers.

Many tanning salons are offering the service, following a loss of profits due to public concern over the safety of solariums.

But a spokesman for the Dental Practice Board of Victoria said teeth whitening outside dental clinics posed hygiene and training concerns. He said that under the Health Professional Registration Act dentistry was defined as the ‘’performance of any invasive or irreversible procedures on the natural teeth’’ and that bleaching fitted this definition.

‘’Dentists have to comply with quite strict codes of practice around infection control and have their practices up to a certain standard. But the infection control practices of these people who are not registered and are not controlled, we would say could be a potential danger,’’ the spokesman said.

The Cosmetic Physicians Society backs the Dental Association’s view that only dentists have adequate dental training to diagnose oral health problems, such as gum disease or tooth decay, which increase the health risks of bleaching.

The most common chemical used in bleaching is hydrogen peroxide – considered hazardous in concentrations of 5 per cent or more. ‘’With the chemical there is also the possibility of damage to gums, it can burn … There are various concentrations of this stuff and we say that the concentrations used by these bleaching clinics is potentially dangerous,’’ the Dental Practice Board spokesman said.

Gavin Harrison, managing director of Pro Teeth Whitening – believed to be the biggest teeth bleaching company in Australia, offered in 34 pharmacies nationwide – said the company’s system was safer than those used by some dentists, who also sell take-home treatments that leave the client unsupervised.

Mr Harrison said that while the treatment was often administered by a specially trained beauty consultant or retail assistant, the on-duty pharmacist was also trained and was on hand to answer questions.

The Pro White method uses a cold blue light to accelerate the effects of the whitening gel and promises to make teeth two to six shades whiter in 20 minutes. Mr Harrison said it was safer than older ‘’zoom’’ whitening systems that used ultraviolet or infrared lights that could burn clients.

‘’With the dentists’ system they usually use three 15-minute treatments consecutively. We could do the same thing and get exactly the same results as them but we don’t … because we care about the trauma for the gums.

‘’What we do has absolutely less side effects because we do one 20-minute treatment. The chemical is about the same or lower concentration than what dentists do,’’ Mr Harrison said.

He said the company had received no complaints since its launch in Australia six months ago.

‘’When people are not happy about their teeth, then they’ll keep their mouth closed and not smile and they’ll come across as not confident … [Whitening] really does make a big difference to the attitude of the person.’’

This is an article by Kelly Burke (Consumer Affairs Reporter) that was recently published in The Sydney Morning Herald – Australia.

INCREASING numbers of unsuspecting Australians are having their mouths filled with cheap dental prosthetics from unregulated overseas laboratories, some of which are believed to contain toxic heavy metals.

Lead, nickel, cadmium and beryllium were being added to ceramic-covered prosthetics by manufacturers in many Asian countries, said the president of the Oral Health Professionals Association’s College of Dental Technicians, Robert Boshier.

Dentists could legally import cut-price prosthetics such as crowns, bridges and dentures because the Therapeutic Goods Administration did not regulate imported custom-made dental products. Yet the use of such heavy metals in Australian-made equivalents was banned due to their carcinogenic properties.

Mr Boshier said no longitudinal studies had been done on adverse effects from imported dental products suspected of containing dangerous metals and there was no mandatory reporting of cases.

‘’But we’ve certainly had some adverse patient outcomes,’’ he said. ‘’Use of inappropriate metals in prosthetic devices can lead to chemical reactions within the mouth which can damage the vital tooth. There can be severe pain, headaches, infections, even the loss of the tooth.’’

Dentists struggling to maintain profits during the downturn are increasingly turning to cheap imports. A single crown costing a patient about $1300 can be manufactured in China for about $25, then sold to the dentist for between $100 and $250.

While importing custom-made dental devices is legal, the Herald has been told of dentists buying other products – from amalgam for fillings to specialised instruments – on foreign websites and bypassing mandatory TGA scrutiny.

The Herald is aware of one NSW dentist who holds seminars to teach other dentists how to boost profits by buying materials online from China.

According to meeting minutes obtained by the Herald, the NSW chapter of the Australian Dental Industry Association, which represents dental technicians, has voted to form a team to tackle the problem.

But the national president of the Australian Dental Association, Neil Hewson, has disputed the technicians’ claims that the practice is widespread.

Dr Hewson conceded the association had been aware of some dentists engaged in illegal importation in the past.

‘’We’ve put out statements, we’ve advised in newsletters saying you can’t legally import … They must obey the law.’’

But the executive officer of the dental equipment suppliers’ association, Duncan Campbell, said commercial dental publications regularly carried advertisements from foreign dental supply companies.

‘’We’re concerned about patient safety. These products are not going through the TGA’s safety checks,’’ Mr Campbell said.

A spokesman for the TGA said it had worked closely with dentists and technicians for many years, and regularly updated the industry on its obligations to work within the administration’s regulations on imports.

‘’When the TGA becomes aware of instances of the possible illegal supply of therapeutic goods it actively pursues the matter.’’

Correction

An earlier version of this story said Duncan Campbell was the executive officer of the technicians’ association and that the dentists’ industry publication, Australian Dental Journal, regularly carried advertisements from foreign dental supply companies. It should have said commercial dental publications regularly carried advertising for foreign dental supply companies. The Australian Dental Journal carries no such advertising.

This article recently appeared in The Sydney Morning Herald and The Brisbane Times – Australia.

Geoffrey Molyneux, 1926-2009

ONE day in London in the early 1950s, Geoff Molyneux, a young Australian trainee dental surgeon, was called upon to give an injection to June Kerr, another young Australian. She was so impressed by his painless technique that they were married in 1954.

Molyneux went on to enjoy both a long marriage and a distinguished career as a dentist, oral and maxillofacial surgeon and academic.

Geoffrey Stuart Molyneux, who has died aged 83, was born in Sydney, the only son of Roy Molyneux, an accountant, and his wife, Rita May Welch. He went to Marcellin College, Randwick, then the University of Sydney.

After graduating with a bachelor of dental surgery in 1949, he practised for a year in Sydney then, as did so many young dentists at that time, went overseas.

He became a dental surgeon in London in 1951 and attended lectures at the Royal College of Surgeons, leading to the primary examination for the fellowship of dental surgery. After two years’ more work and study he completed the fellowship and worked in Hammersmith.

Back in Sydney after five years, Molyneux took the job as graduate assistant to the director of the Institute of Dental Research and was soon appointed clinical pathologist at the Sydney Dental Hospital.

In 1958 he also began lecturing in the department of histology and embryology at University of Sydney and became a senior research officer at the Institute of Dental Research, Sydney.

In 1962 he was appointed senior lecturer in anatomy in the University of NSW.

He moved to the University of Tasmania as reader in anatomy in 1967 and took the chair of anatomy at the University of Queensland in 1971. He remained there until he retired in 1991 as emeritus professor and never wavered from his determination to make the department a centre of excellence for professional and science teaching and research.

He spent a sabbatical year as visiting professor in anatomy at Harvard, and six months as visiting senior scientist in the CSIRO laboratories of animal physiology at Prospect.

Although the main area of Molyneux’s research was the arteriovenous anastomoses (the microscopic blood vessels that connect the arterial and venous systems) and their role in the regulation of body temperature, his interests extended to oral pathology, bacteriology, experimental surgery, zoology, neuroanatomy and the function of the temporomandibular joint (the jaw joint). Results of his work were published in 14 scientific journals, and he was author or co-author of eight book chapters.

Molyneux served as the honorary secretary and treasurer of the Australian chapter of the International Association for Dental Research and was a member of the council of the Dental Health Education and Research Foundation.

At the University of Sydney he was on the research foundation and was chairman of the research committee of the Dental Health Foundation.

He was also president of the Royal Society of Queensland, president of the Microscopical Society of Australia, president of the Anatomical Society of Australia and New Zealand, and a member of the executive of the Australia and New Zealand Microcirculation Society.

After he retired, the Molyneuxs toured Australia then moved to Hobart. Molyneux enjoyed reading and woodwork for as long as he was able but his desire to build a boat and get back to sailing was frustrated by health problems.

Geoff Molyneux is survived by June and their children Tony, Damian, Suzanne and Virginia. Another daughter, Michele, predeceased him.