Few smiles for dental plan

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)