Dr Patrick Shanahan, a Perth Catholic, has for decades worked on
national dentistry policy for the government and the industry itself. In
an exclusive column for The Record, he says the Federal Government’s
current health reforms are woefully inadequate, leaving those on the
fringes of society without access to basic dental care which is linked
to general health problems in the community.
It is widely accepted that oral health is critical to general health but less so with health care outcomes. Medical research has strongly connected harmful bacteria from untreated dental conditions in high medical risk patients with serious medical complications. These can be prevented by promptly identifying and treating ‘medically necessary dental care’. Dental care for medical reasons is not the same as dental care for dental reasons. The principal objective of medically necessary dental care is to remove the bacterial risk before it impacts on medical treatment.
It is primary health care and non-elective.
This is a very good example of what I am talking about.
Recently, a patient here in Perth presented at a public dental clinic for an urgent dental extraction that was going to cost $35 which he didn’t have, so no dental extraction. Shortly afterwards he was admitted to hospital with pericarditis (inflammation of the heart lining) caused by bacteria from the infected tooth. The hospital treatment cost $18,000. That was medically necessary dental care that could have been funded under Medicare dental, but wasn’t.
In health care, ignoring the risk of infection from the mouth in high medical risk patients is really going to cost heaps more than preventing it happening.
Rigorous studies in the US and Japan have demonstrated this.
In the US, complications following heart valve replacement surgery caused by harmful dental bacteria added $100 million (10 percent) to the treatment costs. They found treating the bacterial risk before surgery would cost only $16 million, a saving of $84 million. The US Congress adopted Medicare dental legislation in 1998. It stated exactly what would be funded by Medicare, and not what is being funded here under Medicare dental in Australia now.
Japan has many in aged care because of their very large aged population. Pneumonia is very common in aged care, frequently caused by harmful bacteria from the mouth entering the lungs. It costs $15,000 plus to treat pneumonia.
In Japan, a large nursing home study found that simply implementing preventative antibacterial oral care daily at minimal cost reduced the number of cases of pneumonia. A very important finding was the risk of pneumonia was just as high in those without teeth or dentures as it was with those who had teeth or dentures. These preventative strategies are not practised here.
GPs treat high medical risk patients all the time and know most have serious oral and dental problems but nothing is done about it. The patients most affected cannot afford private dentists and public dental services don’t address this.
As you can see, the health system is picking up the tab for all this but attempts to change this have been rejected at a time when everyone is calling for more money and more hospital beds. GPs are treading water and the health system is burning money.
The principal objective of primary care is to deliver better health care outcomes, keep people out of hospital and save money.
This was the reason behind Medicare dental introduced in 2004 but it was little used because no-one knew what to do. It was amended in 2007 and since then it has gone ‘gang busters’ because it is now delivering dental, but not health care, outcomes.
The most sensible thing to do would be to amend the legislation and ensure the funds were spent for health care reasons, and to establish pilot projects that demonstrate how they can best work. Both these options have been rejected.
While we cannot amend the legislation, we can establish pilot projects, and that’s what we are doing right now.
We are working on two demonstration projects at present to fine tune this, one at Romilly House, a mental health facility in Claremont, the other the Swan Medical Group in Midland, the largest medical practice in WA. This will also include St Vincent’s, a Catholic Homes aged care facility.
Romilly House is serviced by a dedicated GP and Cottesloe dentist. They will both bulk bill so there will be no gap as the patients cannot afford it.
Besides dental treatment there will be an emphasis on prevention and delivering social benefits restoring quality of life and dignity to the residents, not just health care. This will involve the whole facility, not just the residents, GP and the dentist. This is what should be happening.
At the Swan Medical Group, we have very strong GP support but we don’t have any Midland dentists. We want to make sure that this works well for dentists and not compromise their practices. We want to bulk bill to avoid the gap which most of the patients cannot afford to pay.
Ideally, the programme should operate locally through local general practice to be efficient and cost effective.
It is unlikely an opportunity like this will present again. If we can demonstrate the benefits, this initiative will spread across Australia and deliver immeasurable benefits to the nation now and in the future. If you support this initiative, please write to your local State and Federal Member to express your support and for them to get behind it.
Dr Patrick Shanahan has 25 years’ experience in the field, including establishing centres for indigenous Australians.
He can be contacted by email on patricks@iinet.net.au or phone (08)0385 2565.