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A CALL for doctors to become more involved in oral health has had a lukewarm response from doctors and dentists, who say Medicare-funded dentistry is the only real solution to the nation’s burden of dental disease.
In an article published in the MJA, Dr Lesley Russell, a senior research fellow at the Australian Primary Health Care Research Institute at the Australian National University, called for shared training and closer communication between doctors and dentists, saying “it is time to end the dental–medical divide”. (1)
In the absence of regular dental checks “dental problems quickly become medical problems”, she wrote, citing figures showing there were over 63 000 potentially preventable hospitalisations for dental conditions in 2011‒2012.
Dr Russell said primary care workers needed training and skills in oral health screening, providing oral hygiene advice and emergency pain management, while specialists needed to consider the dental implications of their patients’ diagnoses and treatments.
Dentists needed to advise patients’ doctors about infections and other oral health problems and screen for cancerous and precancerous lesions, she said.
Dr Russell also called for public health promotion activities explaining poor oral hygiene could cause “sickness, disability and even death”, a greater focus on oral health among disadvantaged groups and people on certain medication regimens, private health insurers to reduce dental out-of-pocket costs, and an outreach “dental health service corps” to service areas of need.
She stopped short of calling for dental care to be covered by Medicare, despite arguing its current exclusion was “increasingly hard to rationalise on health grounds”.
“Implementing my proposals … depends more on changes in cultures and focus than increased resources”, she wrote.
Professor Hans Zoellner, head of the discipline of oral pathology at the University of Sydney, who has been a vocal advocate for universal dental care, agreed that dentistry needed to be brought into medical health structures.
However, Professor Zoellner told MJA InSight the big issue was “getting more dental patients actually treated”, which was unlikely to be substantially addressed through Dr Russell’s proposals.
“I am convinced that the only long-term solution must include proper and complete inclusion of dentistry in Medicare”, he said. “Anything that falls short of that will simply fall short of achieving meaningful progress.”
Professor Zoellner said GPs already provided frequent pain relief for dental patients, because many patients in dental pain could not afford to see a dentist.
The call for GPs to be involved in oral health screening was a waste of time and money, as “dentistry is primarily a surgical art, and requires dental training to do properly”, he said.
Screening was “best performed by appropriately trained dentists and hygienists supported with appropriate lighting, suction and radiographic equipment, mirror and necessary probes”.
Professor Zoellner said he was disappointed Dr Russell made no mention of the Medicare Chronic Disease Dental Scheme, which provided Medicare-supported dentistry to more than one million Australians over 5 years, before it was axed by the previous Labor government in 2012 over claims of rorting. (2)
However, Professor Zoellner said there was no statistical evidence of widespread rorting, and that problems could have been overcome through a pre-approval process for the more expensive procedures, the development of standards for diagnosis and treatment planning, and more streamlined administration.
Dr Frank Jones, president of the Royal Australian College of General Practitioners, said while there was “always room for improvement”, GPs already had “good collaborative interactions with their colleagues in dentistry”.
He told MJA InSight he routinely referred patients to the dentist before prescribing oral bisphosphonates to assess the risk for osteonecrosis of the jaw, while dentists occasionally contacted him for advice on antibiotics in patients at risk of endocarditis.
Oral health was already part of GP training, he said, and was included in the RACGP Guidelines for Preventative Activities in General Practice. (3)
Dr Jones said it was “regrettable” that the government had ended the Medicare Chronic Disease Dental Scheme. “There’s a fundamental funding issue that needs to be addressed to look after the dental health of patients who are disadvantaged”, he said.
Professor Nicky Kilpatrick, of the Royal Australian College of Dental Surgeons, told MJA InSight there were many examples of interdisciplinary collaboration on oral health, including in maternal and child health, aged care and palliative care. However, most happened “in isolation in response to local personal interest or funding opportunities”.
Professor Kilpatrick said the college supported “a coordinated national approach to planning and implementing inter-sectorial oral health” programs, adding this should be underpinned by a rigorous evaluation strategy.
1. MJA 2014; 201: 641-642
2. ABC News 2012; Dental scheme rorts in Government's sights, 15 February
3. RACGP: Guidelines for preventive activities in general practice 8th edition
(Photo: LajosRepasi / iStock)
Despite the cogency of principled reasons against any compulsory medication, flouridation should be compulsory, as should the vital immunisations.
Dentists, lke many doctors, simply charge too much for the majority of people. Medicare is not the answer to this high cost. There are other alternatives, well-described in the relevant literature, but they never get a look-in.
Though Professor Zoellner is clearly well meaning and targed funding is certaily needed to improve or health several of his opinions are simply incorrect and outdated.
Dentistry is not “primarily a surgical art” It is the treatment of cronic diseases namely caries and peridontal dsease. They are listed as such by AIHW and have been regarded as such by researchers ad progressive cinicians for over twenty years. Cavities and the surgical(drilling) treatment of those is equivalent to the treatment of secondary outcomes of other chronic diseases such as osteoporosis or diabetes.
D Russells argument is valid and pertinent. In fact caries risk assessmnts for early cildhood nurses and doctors alread exist and are roughly as preditive a those for diabetes and osteoporosis. The NSW “Liift the Lip ” programme has nurses examining for pre-caviation caries somthing which is rare when production based and surical philosophies are use.
The Medicare Chronic Disease Dental Scheme was poorly targeted and wasteful. Drilling more teeth is not a long term solution. There is great scope for improved medical management of the the primary diseases caries and periodontal diseases and their risk assessment by medical practice. Medicatin induced Xerosomia alone is a huge and growing issue in Dental Care.
Dr Russells proposal is timely and shows great insight into the non surgical mangement of Dental disease and oral healths role in general health and also as an early marker for later developing lifestyle mediated chronic diseases.
Prevention of dental disease starts with Fluoridation of the water supply. Contentious I know but no scientific arguement against one of the most successful Public health measures ever.
Medicare inclusion for dental care will not make patients attend their dentist on a regular basis. There is a great need “out there” to educate both the public and medical/dental practitioners that, by the time a patient has toothache, the problem is potentially serious (thus regular check ups) and antibiotics are not the treatment for an abscessed tooth. Removal of the cause (ie the tooth or the pulp) asap is the correct treatment.