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Only the Government can fix the problems in dental care

04 September, 2006

Over the last few weeks, we have published two Q&As with Hans Zoellner, a dental lecturer at Sydney University, and the Chair of the Association for the Promotion of Oral Health. He told about the growing problems facing the dental industry and how they can be overcome.

In this final Q&A, Zoellner explains exactly what the Government needs to do to improve the dental industry.

How more difficult is it to treat people’s teeth these days?

There are more teeth in each person’s head these days. Those days have gone when people used to reach the age of 65 and wear dentures because they didn’t have their teeth anymore. Most people have got most of their teeth into old age now. But they are not in very good condition. People think that fluoride stops decay. It’s true that it reduces the amount of decay but a background rate of tooth decay still gets through. As a result, one tooth in 10 still gets decay. But when you consider that there are a lot more teeth in the community now, then that background rate of decay goes up. In the same way, people have now got teeth that can attract other dental diseases very easily, so people are getting into old age with sun decay and old fillings. This means that the actual amount of work has increased perversely because of the success of fluoridation. Although the preventative treatment is actually working, there is a cost involved - you actually increase the amount of work that has to be delivered long term.

Has the Government failed to understand these problems?

They have failed to understand in the past. And it would also be fair to say that there wasn’t a strong enough voice advocating and debating this issue before. There are people who have spent their lifetime documenting the disaster, and there is a study that demonstrates that there is a doubling in the amount of untreated decaying teeth across all age groups over a 25-year period. Six years later, this doubled again.

How much money needs to be brought in by the Government to fix the problems?

That’s a hard one to answer at a national level. What I can say is that we did a detailed costing in NSW and that was done with the assistance of the state Government. We met Morris Lemma last year when he was the Minister for Health in NSW, before he became Premier. We went to him with basically a 10-point plan. We said: “Here are 10 things you could do at the state level at least that would make a real difference.” He said: “That’s great, I’ll give you the assistance of my staff, and you go out and work out a costing for how much it will be to fix up.” And we worked out that it was surprisingly inexpensive to really start to improve things, at least in this state, in regards to just the public sector. But certainly, the public sector could be substantially improved for a staggered investment starting off at just  $48 million dollars in the first year, rising to $116 million dollars in the 5th year.

So we worked out a five-year implementation strategy that involved staggered increases in funding that would pay for internships; launch joined initiatives between the hospitals and the University system; recruit specialist services and provide specialist training;  and improve salaries in the public system to attract dentists and keep them in the system. This costing not only involves paying for dentists, but also paradental professionals, therapists, hygienists, registrar appointments. It would also improve the physical infrastructure to make it possible to treat patients. So we worked out that it would be ridiculously cheap. I can only guess that maybe if you multiply it by three you will also get the  cost needed to fix the industry across the nation. At a rough estimate, if the money can be spent carefully and wisely in these targeted areas then you will really start to fix the problem.

Is the Government going to implement the strategy?

Well, we have had some success at the state level again. The Minister has announced the introduction of internships, registrar appointments, rural scholarships, improved fluoridation and the introduction of the dental team model for services. The thing that we are just a little bit disappointed with is that although the Minister of NSW  has made public announcements about these innovations, and we strongly support them, he hasn’t actually put the money into it that is needed to make it work. And we are in discussions with his office and parliamentary colleagues to try to get the necessary commitment from his ministry to make sure it happens.

At the moment it’s just rhetoric, and without money it’s just nonsense, so he must be thinking that he can just get rid of us. In truth, I think he is just trying to shut us up. Without the money the changes are not going to happen. We’re hoping he’ll change his mind, and that the Lemma government will now come up with the funds.

At the state level, the Coalition party (the opposition) has fundamentally picked up most of our recommendations, including the important one about increasing salaries. This is essential in regards to being able to attract and maintain dental staff in the public sector. And indeed, they have made these policies the lead of their election campaign for the up and coming year. So at the state level, we can certainly see that there’s improvement. We think that a brisk political debate has developed at state parliament, which will get us the necessary advancements. We hope anyway. If it doesn’t then it will be a disaster for the people of NSW.

But at the national level, we are hoping that many of the things that can be done at a national level will start to be discussed by the opposition and the Government too. We are very optimistic, but we are impatient too, because there’s not a day to lose on this. We have to be prepared for the retiring baby boomer population that’s going to be here in 10 years. It’s going to happen very soon. For us to be prepared for them, we need to be acting now, getting the public system in place and coping with all those retirees who won’t be able to afford to go to private dentists. There won’t be any available anyway. If you try to find a private dentist in the country now, it is very hard to do so. For instance, if you look in South Western Sydney, it is difficult to find one because there are only 32 dentists for 100,000 people in that area. There’s no time to waste and we’re very impatient. We’re trying to make it clear to all levels of Government that they need to act now.

Did last year’s NSW dental enquiry cover all these issues?

Yes, it did, and we were very pleased with that. Our group was instrumental in initiating the NSW dental enquiry. We certainly put in a lot of energy into it and we were very pleased with the outcome. The general recommendations were very sound, although there were a couple of recommendations that we didn’t agree with. But on the whole, we felt that it was a very good and balanced enquiry. The thing that we have to remember is that the history of enquiry reports is not a happy one. The 1998 senate enquiry into public dental services has been all but ignored. With the exception of a couple of minor things, the enquiry has not been acted upon yet.

We are pretty determined about preventing the dental enquiry in NSW from suffering the same fate. We want to put as much pressure on the Government as we can by saying: “Don’t forget that it’s there.” They have to respond by September with a formal response and we are waiting with bated breath for the results. We’re agitating as much as possible in the background to make sure they come up with a decent response to this enquiry.