Central Victorians are being forced to wait years for public dental care, meaning simple dental problems such as tooth decay can lead to tooth extractions.
It’s a problem which is not only causing pain to patients.
It may also be costing thousands, as patients are forced into emergency departments for problems which could have been easily prevented.
Public Dental Health patients in Victoria wait an average of 19.7 months for treatment.
In Bendigo the situation is better. Average wait times at the Bendigo Health Dental Service clinic are just nine months.
In the electorates of Ripon and Macedon however, these blow out to 30.1 months, and 15.7 months respectively.
Patients at Maryborough District Health Service wait an average of 22.7 months for general treatment, 39.6 for dentures.
At the Hepburn Health Service in Daylesford, patients’ average waiting time is 15.7 months, or 8.1 for dentures.
Doctor Marietta Taylor is a dentist at the Bendigo Health Dental Services in Bendigo.
She attributes Bendigo’s low wait times to a major effort from Bendigo Health over the past few years.
Long wait times in areas such as Maryborough and Daylesford are the result of inadequate and unreliable funding, Dr Taylor said. Low salaries for public dentists also means it can also be difficult to attract dentists to rural areas.
“We just can’t service the eligible population because we’re funded so poorly,” Dr Taylor said.
“The public dental service is in a bad way. We need the support of the State and Federal governments, and we haven’t had it for a long time.
“Statewide the situation is dire, you can wait 12 to 14 months.”
Long waits for dental treatments can have a detrimental effect on patients’ dental health, Dr Taylor said.
Easily treatable conditions such as tooth dec
“I have been called to ICU on more than one occasion to extract teeth for a person who has gotten a life threatening infection because of abscessed teeth,” she said.
Living with untreated dental conditions can be detrimental to people’s ability to live a normal life.
“It has a massive impact on people’s quality of life,” Dr Taylor said.
We just can’t service the eligible population because we’re funded so poorly. Doctor Marietta Taylor
LaTrobe University’s head of Dentistry and Oral Health Professor Mark Gussy said broader social inequity arises when people can’t access care.
Not only do long-untreated dental problems cause patients pain, it can have far-reaching consequences for people’s lives.
For instance, missing teeth can reduce self-esteem, social-interaction, and even make people less likely to get a bank loan.
Dr Taylor said dental disease is a problem which may be invisible to many who haven’t experienced it, as it disproportionately affects poorer groups of people.
It’s the most disadvantaged groups in Australian society that she sees coming through her clinic, those with low literacy, those on welfare and those with poor mental health.
“The problem with dental disease is there’s a tiny amount of disease in our wealthier sections of communities, but there’s a massive amount of disease in our communities,” Dr Taylor said.
“It’s our most vulnerable in our communities that are the ones that are the most at risk of dental disease.”
It’s those eligible for public dental treatment who need the most treatment, and often receive the least.
Professor Gussy said it was often high risk patients who were waiting long periods of time for treatment.
He described this as “the inverse care law”, saying those who could afford to pay for private dental care, often had higher incomes, and were at a lower risk of dental disease.
“The group of people who are eligible for public health are at higher risk,” Professor Gussy said.
“They have low income, they have other health issues, they have problems accessing resources like toothpaste and other oral products.”
Treatment costs are significantly higher when easily treatable dental problems are left to fester according to Dr Taylor.
Not funding public dental care adequately means healthcare is delivered in an “inefficient” way.
Dr Taylor said this meant more money was spent in emergency departments, ICU, diabetes control, and any area where medical staff saw the consequences of poor dental health.
A 2016 Auditor General’s report into access to public dental services in Victoria called for change to break the cycle of poor oral health among those eligible for public healthcare.
The report said the state’s current model of treatment was less cost effective than a preventative approach to dental care.
The report stated that while 41 percent of Victorians were eligible for public dental services, only one in four of those accessed them.
Professor Gussy said not only was funding insufficient, but public dental waiting lists were not managed to best deliver treatment to those who need it.
Those with dental problems needing urgent treatment are not prioritised over those with lower urgency needs.
“People put their name on a list, and they just wait on that list until their name comes up, so the more people that are on the list the longer that wait is,” Professor Gussy said.
“There’s this false believe that the only way to be fair is to treat everyone equally and they just need to wait in line, regardless of their needs.”
Parents pay for private
Bendigo dentists are concerned that many parents don’t know that they can claim the Child Dental Benefits Schedule at private dental clinics.
Bendigo Health Dental Service saw 8,022 children in 2017-18, including those at its Outreach screening programs delivered in schools and early learning centres.
The scheme allows parents to claim their children’s dental care up to a cap of $1,000 over two years both through the public or private dental systems.
Picture: SHUTTERSTOCK.
Waiting times at the Bendigo Health Dental Service are among the lowest in Victoria, at nine months.
Arnold Street Dental practitioner Dr David O’Malley said he sees a good bit of confusion among parents who don’t realise they can claim their child’s treatment at a private practise under the schedule.
Dr O’Malley said he believed that it would be better if the public system could be freed up for the people who really need it.
“The public system’s busy enough as it is,” Dr O’Malley said.
“There seems to be some confusion there that people can come to their own service first.”
He said easing the burden of costs on parents meant children were likely to come in more frequently for check-ups.
This meant common dental problems such as tooth decay could be caught earlier, easing both the financial and health burden of the disease.
Dr O’Malley said another benefit of the schedule was that affordable and regular trips to the dentist meant children weren’t treated for a build up of problems, making them more confident in the chair.
“It makes the trip to the dentist not a scary thing, that it’s often perceived as,” Dr O’Malley said.
“If you wait until what you’re going into is a load of dental treatment or extractions or fillings, then it’s not a nice thing.”
A 2015 audit of the Child Dental Benefit Schedule found that while the program had been delivered largely effectively, only around 30 percent of eligible children claimed benefits in 2014 and 2015.
The Australian National Audit Office recommended that the Department of Health evaluate the effectiveness of its communications, and assess why the program had a low uptake.
Oral health therapist at Bendigo Family Dental Care and Bendigo Health Sophie McKenna said she thinks there is some lack of knowledge among parents about the dental benefits schedule.
Ms McKenna said dental treatment was particularly important for school aged children, as a high number have untreated tooth decay.
She said she has seen a rise in the number of children with dental problems such as tooth decay over the past ten years, due to sugar in food and drinks.
“For so many people dental is something that when it comes to costing is first to go, or seen as a bit of a luxury,” Ms McKenna said.
“This funding allows people to be seen publicly or privately at a dentist of their choice.
“It’s really important for children because if they’re able to be seen early and having dental treatment early then we can avoid having treatment later.”
Would you work in Victoria for $20,000 less?
Salaries for dentists working in the public system are as much as $36,000 less per year than those in other states, which may be making it hard for clinics in regional areas to find experienced dentists.
When Bendigo Health Dental Services dentist Marietta Taylor began to work in the public system, in five days a week she earned thirty percent of what she had earned working three days at a private clinic.
Dr Taylor said that low salaries discouraged dentists from remaining in the public health system, and that higher salaries in other states meant graduate dentists where unlikely to stay in Victoria.
Recruiting experienced dentists is a particular problem for regional areas, such as Maryborough.
“What it means is that we end up with a high proportion of new graduate dentists,” Dr Taylor said.
“So we end up with a high proportion of inexperienced dentists who require mentoring and support, and it… means that publicly a very limited number of experienced dentists to go around.
“Often dentists go into public practise because they have a bit of a passion for it, they like helping people, but how much of a quality of life are you going to sacrifice to work public?”
In Victoria new graduate dentists can earn $65,094 per year, over $36,000 less than their highest paid counterparts in South Australia, who earn $101,745. NSW graduate dentists are the next lowest paid, earning nearly $20,000 more on average than Victorian graduates at $85,009.
Dentists with three years experience in Victoria can earn $85,389 per year.
This is again over $36,000 less than their highest paid contemporaries, this time in Western Australia, who can earn $121,528. By this time Queensland dentists are the next lowest paid, earning $106,614.
The Australian Dental Association has called for public dentists and dental specialists to be paid enough to retain “the best and brightest”.
In an issues paper on the public dental sector the ADA called for a common pay scale for dentists, regardless of where they work.
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