Rural Australia Has A Huge Dental Hole To Fill – Why Is It So Deep?
Not just in Australia, and not simply confined to rural life. Given the seemingly endless research, reports, studies and investigations into the long-term health impacts of the inability to adequately care for your oral health, its view now is so much like watching 1968’s underground film The Longest Most Meaningless Movie in the World. How many choc-tops you could reasonably get through in its 48-hour duration almost qualifies as a fair question to submit to the Senate Committee.
Out of interest, a search for ‘dental health’ on the Parliament of Australia site throws up 124,000 results. In one way that’s impressive; that there are that number of 10-page or more documents focused on some aspect of that topic. At the same time, there’s the jolting realisation of ego justification and a crap load of disjointed talking that’s essentially resulted in not very much.
Just like the movie.
It consists entirely of commercials, outtakes, undeveloped footage, imagery in reverse, upside down and much of it without sound. There’s a half-hour loop of a 45-second clip that’s designed to do nothing but fatigue and stupefy the audience. That it also contains newsreels, stock footage and castoff material makes it an apt comparison to a national question that has been formed, reworked and repeated thousands of times with no discernible result.
It brings to mind noted late American film critic Roger Ebert (late in that he died; not that he tardily arrived at the cinema). When the four-hour movies Dances with Wolves and JFK were released, he said that filmgoers deciding on a ticket generally processed it in much the same way as, “contemplating an evening in the dentist’s chair.”
Were it oh so simple to spend four hours in a dentist’s chair for the inflation-adjusted price of $15.76. That’s an idea that certainly earns its place in Hollywood’s dream factory.
Although Japan has pretty much made it a reality.
By law, dental health is included as a general health service with more than half the cost subsidised by the National Diet. (Being the government. Not curry rice.) It too is a system of parliamentary democracy; and there’s a seven decade-strong relationship between the two countries built on strategic, economic and deepened cultural ties. You’d think we’d want to adopt that from Japan more than sushi, Toyotas and Wagyu beef.
Instead, Australia proudly stands alongside the many other countries that repeatedly and protractedly shove the public matter of oral health to the too-hard-to-chew-on side of the plate. While a history of dental service deficit and decline is permanently on the menu, multibillion-dollar budget blowouts and failed grants are washed down with a slurp from regular top-ups from a cup that already runneth over, with inflated salaries, questionable expenses, and the dregs of incompetence nobody ever seems to get to the bottom of.
It’s a layman’s perspective, undoubtedly; from someone with either the dumb luck or divine intervention of being born in one of the best nations in the world. Still, it’s a common one given the pervading mass cynicism borne of decades of politeratti primping and petty politics over good policy.
Long ago in 1989, when the Berlin Wall fell, and the sublime sanity of a million peaceful protestors in Tiananmen Square was met with a psychotic brutality that shattered souls and stunned the world, Japan’s health system was in its infancy. Yet hand-in-hand, the Ministry of Health and Welfare and the Japanese Dental Association promoted the ‘8020 (eighty-twenty) Campaign’. Its aim was to help citizens retain at least 20 of their natural teeth by the time they reached 80 years of age.
What brilliance. What foresight. What a beautifully simple concept. What a generously social, social contract.
It was based on all the supporting evidence (yes, even way back then) that to retain adequate chewing function for nutritional intake, and to experience a socially satisfying and communally connected life requires a minimum of 20 natural teeth. That adolescence brings us 32, it’s not such a hard ask; and so crucial to enviable happiness and quality of life.
Meanwhile in Australia, improvements in the oral health of Australian children halted during the mid 1990s; after which cavities have continued to increase. Minorities carry the majority of this caries experience. The disparity’s apparent with 30% of 12-year-olds with the most cavities averaging almost two-and-a-half decayed, missing and filled teeth. Statistically, for a Japanese kid of the same age the answer is 0.2.
These issues of an hugely inequitable system have been known for decade upon decade. The barriers to reform remain solidly in place with a misty blur of white noise promises prettying it up every now and then.
In the land of the cherry blossom and blossoming oral health, a 2016 national survey reported the 8020 Campaign a success. More than 50% of 80-year-olds plus have retained 20 or more teeth. It has the Japanese Society of Oral Health proposing a new goal of “28 Teeth for Lifetime”.
With the 2023 development of a tooth regrowth drug in Osaka, it’s a winning combination.
Japan’s sagacious attitude to oral care means that almost all restorative, prosthetic and surgical treatments are subsidised. The same fees are applied throughout the country. Services are provided by private practitioners under local government contracts. Even if the Japanese love crooked teeth as a sign of impish youthfulness, everyone has access to dental care for relatively little cost.
Unlike Down Under, where the government contribution to oral health is low by international standards, no less. It’s around half the average for countries in the OECD. Of 38 members, only 8 countries report a lower proportion of public funding for dental services. That’s disgusting. Which is really hard to say when your teeth are falling out. When it comes to oral health care Australia has a two-tiered system. Around half its citizens have adequate access to services and acceptable dental health – the other half do not.
As great a system Japan has, it faces future challenges, as does Australia – but it’s not starting all tongue-tied with an already decayed system. Its universal dental scheme and Australia’s clearly mental one, have similar boxes to tick: developing tele-dental systems for remote areas; establishing emergency oral healthcare services (during times of disaster for Japan); decreasing expenditure (a catch cry for Oz); and dealing with regional shortages of dentists.
A recent Senate enquiry found a “disproportionate number of people” have no choice but to travel an hour or more to access dental care. (Specific numbers are secret, clearly. Or too humiliating.) In regional, rural and remote Australia, one-in-three people have no available dentist “half the time”.
There are 7 million people living in those areas. That’s 26% of the population. Maybe if “half the time” were changed to “half time” money would arrive in festooned buses.
Only 5% of practitioners work in the public system, and they deliver 15% of dental services. There’s a shortage of specialists, particularly those trained in treating patients with complex needs. Currently, there are no special care dentists in the ACT, Tasmania or the Northern Territory.
In more good news, the Royal Flying Doctor Service (RFDS) has for the past eleven years had a mobile dental truck to service remote areas. That it’s been the only option for isolated towns since 2013 is telling, and not the story we’d like to hear. It gets better – on its first visit to a remote Queensland town with only 300 inhabitants, its initial schedule of two weeks had be extended to three.
Mostly, it’s a dental drill of fillings and extractions. So much for prevention. A lot of patients have minimal teeth, or no teeth at all. There are people in their 30s needing full or partial dentures.
I don’t know if there are any ministers dropping that in a glass beside their bed every night. At this point it has to be said there’s more chance of it being ice into a couple of shots of Glenfiddich.
Sounding the QI klaxon alarm and pointing flashing neon arrows at the hole in acceptable oral care for rural Australians is much like bewailing torn linen on the Titanic. It’s simply another symptom of a dental health system in long-term, rotting decay. Until it’s replicates and dedicates to international policies proven to actually work instead of pretending to be the 51st state, and is funded like it’s a sport, the conga line of inefficient and bloated governments will continue achieving nothing but social shackling and intergenerational poor health outcomes.
Fifty-one years have passed since Gough Whitlam gave us Medibank – non-means tested, tax funded universal health insurance programme that ensured free treatment at public hospitals, and subsidised private ones. Dental wasn’t on board, but there was hope. Prior to losing his pants in a seedy Memphis hotel, Fraser reduced it. There began the long history of the Coalition undoing both it, and its successor Medicare by stealth.
The reality is there will likely never be a funded, functioning dental health scheme in Australia. We’ve been watching that long, meaningless movie for five decades. The popcorn’s stale, and half of us are dribbling.
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