Letter from the Editor: We've had Medicare for 50 years, but where's the dental care?

Have you been to the dentist lately? If you haven’t, you’re not alone, according to the latest national report on dental health in Australia.

There are any number of reasons people put off going to the dentist, but the physical and mental health risks of delaying a visit for too long can be life-threatening.

The Australian Institute of Health and Welfare’s (AIHW) oral health and dental care report found that in 2022–23, more than 87,000 hospitalisations for dental conditions could have been avoided if patients had been treated earlier.

About one in three Australians aged 15 and over have untreated tooth decay, while about 30 per cent of adults have gum disease.

“Poor oral health can lead to the development of bad breath and problems with eating, communicating and sleeping,” the report says.

“But it can also have a more widespread effect on the body and is associated with a number of chronic conditions including cardiovascular disease, stroke, and diabetes.”

Frighteningly, the highest rate of potentially preventable hospitalisations was among children aged five to nine years old.

Consumers Health Forum of Australia CEO Dr Elizabeth Deveny was staggered by that figure – “what sort of country have we become where that is ok?”.

She said the health sector had known about the dire problem Australians have in accessing and affording dental treatment for some time.

“Yet every time it is discussed the same problems, namely the cost to implement a truly universal scheme, and solutions, starting out small investing in greatest need first, are put on the table.

“This only results in more Australians delaying or deciding to not get the care they need when they need it.”

And she’s dead right. The same AIWH report 10 years ago found that Australians’ dental health had not improved in recent years. Back then there had been a rise in the average number of children’s baby teeth affected by decay and an increase in the number of adults reporting adverse oral impacts.

That begs the question – why the bloody hell has nothing been done about it?

The AIHW report revealed one in five Australians say the cost of dental visits was why they had delayed or avoided treatment.

Public dental care is available but good luck with that – it has strict limits on who can access it and waitlists can be ridiculously long.

“Our public dental system is so bad, has been so neglected for so long, that we have adults in some parts of the country waiting 500 or 600 days to get in on the public dental system. This clearly isn’t a universal system which provides for all,” Dr Deveny added.

Choice looked at the cost issue last year and found, based on Australian Dental Association data from 2022, the average cost of a periodic check-up including an examination, scale and clean and a fluoride treatment was around $219.

But Choice also found there was a huge variation in cost between dentists, ranging from $162 to $309.

“Dentists are free to set their own fees. There are no standard fees for services provided by dentists or other dental professionals in Australia,” Choice said.

So next question – why doesn’t Medicare cover dental services? When Gough Whitlam’s government introduced Medibank (which later became Medicare) back in 1974, dental care wasn’t included. Many argue that was down to the cost and the politics – the government had faced a difficult time getting doctors to accept Medicare, without taking on the dental lobby as well.

The argument today is still about cost – in the billions to introduce such a scheme – and the issue continues to divide politicians, dentists and health experts.

In 2023, a Senate inquiry into the provision of dental services in Australia recommended the Australian government work with states and territories “to achieve universal access to dental and oral health care … under Medicare or a similar scheme … over time, in stages”.

Health Minister Mark Butler has indicated there are no plans to include dental in Medicare in the near term.

Fair enough, but the government should be sitting down now and talking with those politicians, dentists and health experts who have put forward a myriad of sensible and affordable alternatives for many, many years.

And it can’t just be a talk fest – our nation has gone way beyond talking and needs action. The problem is not going to go away by itself.

The solutions will no doubt be costly, but when poor oral health results in hospitalisations and surgery, surely they must be worth the pain.