IMAGINE a health system in which one particular body part was carved out of medical training and normal care arrangements, with treatment provided only to those who could afford to pay for it.
The eye perhaps. The skin. Or the heart.
We’d think such a system ridiculous, and it would be; yet, that is arguably what has happened with oral care.
The world’s first university dental school is said to have been established at the University of Maryland in 1840 by two largely self-trained dental practitioners, one of whom was also a medical doctor.
The two dentists, the story has it, had earlier approached the university’s medical school with a request for dental instruction to be added to the curriculum.
The schism between medicine and dentistry may have had its origins right there.
According to a version of the story recounted in health journalist Mary Otto’s book, Teeth, the doctors rebuffed the dentists’ overture in a letter saying “the subject of dentistry was of little consequence”.
The Baltimore dentists went their own way and so it has been ever since.
Dentistry’s separate status has led to it being seen as an optional extra – literally so in private health insurance policies – rather than an essential part of the health care system.
Inevitably, the resulting health burdens fall disproportionately on those who can least afford to pay.
A report from the Grattan Institute last week brought into stark relief the inadequate and inequitable provision of dental care in this country.
It’s hard to imagine anybody on a multiyear waiting list for public dental care in 21st century Australia would see the subject as being “of little consequence”.
Around two million Australians who needed dental care in the past year delayed or did not get it at all because of the cost, the Grattan report found. A quarter of Australian adults had to avoid some foods because of the condition of their teeth and for low income adults, it was more like one in three.
It may be outside the scope of the report, but it’s also true that good teeth are a highly visible marker of social status in our society, further entrenching disadvantage for those who can’t afford proper care.
If two people come in for a job interview, one with a row of ragged stumps in their mouth, the other with a gleaming smile, which one is more likely to get an offer?
The Grattan report argues the federal government needs to take responsibility for ensuring all Australian have access to dental care by moving towards a Medicare-style universal primary dental scheme.
“There’s no compelling medical, economic, or legal reason to treat the mouth so differently from the rest of the body,” the authors say.
Full implementation of such a scheme would cost about $5.6 billion a year, they estimate, suggesting the scheme would need to be phased in over a decade.
It’s true the dental profession might not be entirely supportive of such a proposal. After all, a universal public scheme would likely exert downward pressure on fees.
Public health policy, though, should not be determined by vested interests but by the interests of, well, public health.
Barriers to accessing preventive dental care, and prompt treatment when problems arise, contribute to worse outcomes and higher costs down the track.
Untreated dental conditions can even be fatal, as in the tragic case of 12-year-old Maryland boy, Deamonte Driver, who died in 2007 after the infection from an untreated tooth abscess spread to his brain.
A more integrated health system could deliver benefits beyond healthier teeth.
It’s been suggested, for example, that periodontitis might be a warning sign for type 2 diabetes, meaning dentists with a solid grounding in systemic health could play a role in early diagnosis of that condition.
It’s interesting to wonder how different things might have been if those 19th century medical men in Baltimore had been more open-minded about their dental colleagues.
Jane McCredie is a Sydney-based health and science writer.
The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.