New funding for dental treatment, welcome news for parents! (By Dr Tijana Fisher)

Wednesday, September 19, 2012 : Catherine-Anne Walsh

It may be a bit of 'old news' today, but the media were certainly abuzz about the government announcement a couple of weeks ago, promising a serious increase in funding of dental services. On August 29th, the office of the Hon Tanya Plibersek, Minister for Health and The Greens issued a media release announcing a $4b package, over six years, which is aimed at improving access to dental care for children, disadvantaged adults and remote communities. In a nutshell, the package will offer subsidised care to children under the age of 17 (by introducing the Child Dental Benefits Schedule), add much needed funding to the public dental facilities and incentivise improvement of private (and public) dental infrastructure in rural and remote areas. This new Dental Health Reform will also render obsolete the current Enhanced Primary Care (Medicare funded dental treatment for chronic disease sufferers). In fact, this scheme is now closed and all treatment commenced before September 8th 2012 will need to be completed by December 1st 2012 to receive the funding.

Dentistry hadn't been in the news this much, well...never and the politicians filled dental clinics all across the country for some snaps with kids in dental chairs. The announcement was welcomed by the Australian Dental Association, the Public Health Association of Australia and many dentists, myself included, across the country. So, how has the benefit of a couple of weeks post-announcement affected my sentiment about it?

What's great about the new announcement:

The best part about this announcement, in my view, was that the Child Dental Benefits Schedule is the biggest part of the package, weighing in at $2.7b. This will replace the former Medicare Teen Dental Plan and give all the families who are entitled to Family Tax Benefit A a $1000 allowance over two years for each child's basic dental care at a private dental practice. This allowance will go a long way in getting children to the dentist and educating them about oral health and prevention! It will be up to us dentists to take this opportunity seriously and use all our resources to motivate these youngsters to learn and keep up some good habits!

What's not so great:

The government is attempting to create an artificial, bureaucratic divide between "basic" and "high end" treatment. By their definition, "basic" treatment, also defined as "essential" treatment consists of check ups, x-rays, fillings and extractions, while "high end" treatment (and they stop short of calling it "unnecessary") consists of root canal treatment, crowns, bridges and orthodontic items.

I take issue with this. The decision whether to save a child's tooth (with root canal treatment and a crown) or remove it should be left to the family and the treating dentist to decide, not to some arbitrary rule. Surely, imposing barriers to treatment which may save a tooth by dismissing it as "high end" or elective, makes it difficult for these families to choose any other option but to allow their children's teeth to be removed prematurely (for free), even if  there was a way to save them (for a fee). I believe that it somewhat defeats a purpose of this package to say to these disadvantaged families: "we'll pay for your children's treatment, but we decide what treatment that will be". I believe this further highlights inequality in health between the wealthy and the not so wealthy. Why not allow the beneficiaries to have whatever treatment is necessary? Dental treatment is only ever performed  with the patient's or young patient's carer's consent. I don't believe that any family will allow a dentist to use up the whole $1000 allowance on treating one or two teeth while their child's other teeth deteriorate and decay. If a child only needs one tooth treated, it should be treated properly, by any means necessary. If a child needs their whole mouth treated, then it is obvious that to fit within the budget, more basic treatment, spread across the many teeth, will be more appropriate. The government should not have copied the private health funds' tactics in this. The government is not a private corporation. Their role is to look after the interests of the disadvantaged, not to preserve as much of the funds they offered as possible, which is what private health insurance companies do.

There is also no mention in the recent announcement nor on the government website, whether the new funding will be applicable to Oral Health Therapists treating children. During the EPC scheme, dental hygienists were not allowed to treat these patients- a huge flaw in the scheme, just one of many. It will be very unfortunate if Oral Health Therapists (and Dental Therapists, aka School Dental Nurses) are excluded from this scheme as they are specifically trained in prevention, education and health promotion and treatment of children.

What is uncertain:

It is not yet clear just how the additional funds will improve access to dental care for adults. As I understand it, the funds are going to the public sector and are meant to help with the facilities and staffing. What exactly will the State Governments do with these funds is yet to be seen.

So, where do we stand now?

Regardless of how the new dental scheme plays out in real life, it will not commence until January 2014. Until then, government, dentists and families need to take oral health issues seriously and work harder on education, prevention and early and minimal intervention, to create a strong framework for good health outcomes for our children.

To find out more about the new dental funding reforms, go to the Department of Health and Aging's website .

By Dr Tijana Fisher