Issue 1 / 18 January 2016

THE workforce needed to improve oral health in the bush is raring to go, but the small business model of dentistry makes solutions hard to implement, according to leading experts. 
New research, published today in the MJA, reveals how rural GPs feel about the provision of oral health services in their communities. Marc Tennant, Winthrop professor at the University of Western Australia and director of the International Research Collaborative – Oral Health and Equity, said that there has been a near doubling of the number of dental schools across the country, with many based in rural areas. 
As a result, Australia now has a growing resource of graduates “that can be deployed to get the right solution to the right place”, Professor Tennant told MJA InSight
Solutions are stymied, however, by the private fee-for-service structure underpinning Australian dental practice, which stops some rural patients from seeking dental care. Developing answers to this problem “is going to require more brains, not just more money”, he said. 
The MJA study was based on face-to-face interviews with 30 GPs from rural Queensland, Tasmania and South Australia, conducted in 2013 and 2014. 
The authors found that GPs saw patients with a range of oral health problems, including toothache, abscesses and trauma, and observed poor oral health in their communities. 
Most GPs provided prescriptions for antibiotics and short-term pain relief, and advised patients to see a dentist. However, some acknowledged that they were not confident when dealing with oral health problems. 
According to the GPs, rural patients might not see a dentist when advised to do so because their symptoms had subsided, oral health was regarded as a low priority, or the costs of travelling to and seeing a dentist discouraged them. 
The study participants recommended building the capacity of GPs to better care for patients with oral health problems, and establishing more effective communication and referral pathways between GPs and dentists. 
They also said there should be a greater focus on preventive dental care, and delivering dental services in more flexible and consistent ways that better meet the needs of the community.
The president of the Australian College of Rural and Remote Medicine (ACRRM), Professor Lucie Walters, told MJA InSight that the research highlighted the significant gaps in the delivery of health care services in the bush. 
“Rural doctors have a broad scope of practice, however we do rely on a multidisciplinary team, including dentists, to care for the health of rural and remote people.”
Professor Tennant said that while the issue of oral health in the bush remained a lingering problem in Australia, substantial efforts have been made in recent years to address this. Programs have been developed to attract dentists to move to the bush, and city-based dental schools are now putting the spotlight on dentistry in rural communities.   
At the end of the day, however, rural GPs are still going to face oral health issues due to the “direct out-of-pocket cost of dental care,” he said. 
Dr Ian Kamerman, a rural GP at Northwest Health in NSW and former president of the Rural Doctors Association of Australia, agreed, telling MJA InSight that the problem of oral health in the bush was becoming less about the size of the workforce and more about pricing. 
“There has been an explosion in dental graduates who are now flooding rural areas — along with corporate-style dental practices.”
Professor Tennant said that now was the time for policymakers to take action and restructure this small business model of dentistry to make services more accessible. 
Until this change happens, there are initiatives in place to support GPs in providing dental care, Dr Kamerman said.
“Dr Tony Skapetis, who is a staff specialist at Westmead dental hospital, has provided many educational programs to rural doctors to upskill them for emergency dental management. These include dental repairs to fractured teeth, as well as dental blocks.”
ACRRM also trains its rural GPs in a curriculum that includes oral care, as well as running dental emergency workshops at the annual Rural Medicine Australia conference, Professor Walters said. 
Professor Tennant said that there were other clear opportunities to improve service access. In particular, that the development of modern telehealth systems would “enhance the opportunity for real-time input when cases come to the GP/ED’s door”.
“Even more importantly, the ability of medical practitioners to make contact with dental practitioners and seek help as needed has not been at the forefront of system reform so far.”

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