Call for an end to medical/dental divide

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Doctors-in-meetingDental and medical practitioners must work together more closely to tackle the growing divide in Australian dental health, according to an article in the current Medical Journal of Australia. The article, written by Dr Lesley Russell, a Visiting Fellow at the Australian Primary Health Care Research Institute in Canberra, says ending the dental–medical divide is essential for efficient health care expenditure and improved health outcomes.

“Oral diseases can ravage the rest of the body and physical illnesses and trauma affect oral health,” Dr Russell writes. “Moreover, the risk factors for oral disease and dental decay — high sugar diets, poor hygiene, smoking and excessive alcohol consumption — are also risk factors for heart disease and cancers. Yet medicine and dentistry remain distinct practices that have never been treated the same way by the health care system, health insurance funds, public health professionals, policymakers and the public.”

Dr Russell points to a recent report from the Australian Institute of Health and Welfare highlights that Australians’ dental health has not improved in recent years. “There has 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. Nearly half of all children aged 12 years had decay in their permanent teeth, over one-third of adults had untreated decay, over 50% of people aged 65 years and over had gum disease and over 20% of this age group had complete tooth loss.”

“First, it is time to make dental and medical professionals partners in delivering health care services and to include the mouth as part of the body. At the very least this should entail some shared training, recognition that dental services are an integral part of primary care, inclusion of dental information on personally controlled electronic health records, and professional courtesies around patient referrals. Primary care doctors, nurses and allied health professionals need training and skills in oral health screening, providing oral hygiene advice and emergency pain management. Specialists need to consider the dental implications of their patients’ diagnoses and treatments. And dental professionals need to advise patients’ doctors about infections and other oral health problems. In particular, they have a key role in screening for cancerous and precancerous lesions.”

Dr Russell also wrote that, in the absence of a universal dental care system, a possible replacement would be “for an investment in a “Dental Health Service Corps” made up of dentists and dental staff, doctors, nurses, community and Aboriginal health workers and public health professionals to take oral health services and education where they are needed.”

Dr Russell’s assessment of the role of private health insurers—which is also of interest to groups like the ADA—is for those groups to “consider their role in providing better dental care with reduced costs. The caps on current services mean that even an annual check-up can leave the patient out of pocket.”

“In the absence of universal dental care, the best-value investments for governments are in three broad areas: fluoridation, preventive services for children, and preventive and treatment services for the poor and those with special needs. This will require dental services that are more accessible, especially to those living outside metropolitan areas, and more affordable,” Dr Russell wrote.

For more, go to https://www.mja.com.au/journal/2014/201/11/closing-dental-divide

 

 

3 COMMENTS

  1. If a rural/remote patient has diabetes, hypertension, poor renal function, asthma and a BMI > 35 she is sick. If she also has gingivitis, huge painful caries and recurrent dental abscesses she is sicker.
    Her teeth cannot be extracted in a rural area because of rules about anaesthetics in obese people.
    Is she eligible for PATS? No! She is classified as dental, not medical.
    Not only is this medically and dentally illogical bureaucratic non-sense, it also puts the State and Commonwealth mantra of ‘Close the Gap’ between Aboriginal and caucasian health in its real perspective.

  2. It is well and good to look at population exposure to fluoride, but we should not see it as the panacea for all… Life style and dietary choices must be addressed in the same context as fluoride… But how to influence individuals is the trick! Large corporations / food companies who make millions out of “sugar” need to be included in the medico/dental discussion about the options and the changes required to address the major caries / periodontal( let’s not forget the impact of sugar .. Via diabetes / sequella effect on periodontal health) and General health of our society.
    Change takes time but perseverance, communication and education is crucial for long
    term better health outcomes…think globally… Act locally .

  3. I applaud Dr Lesley Russell for bringing attention to an area of great concern to me for years. A person with a swollen face from an abscessed tooth needs to find money to see a dentist but a slacker faking a ‘sickie’ gets Bulk Billed by his GP and and then a full day’s pay in Sickness Benefits is added to a Company’s running costs without the Worker present to off-set the cost. Something is terribly wrong there!!! Knock out a tooth and you need to pay but kick your toe and it is free. Again, this is so wrong!!! The Dental/Medical divide is so crazy in this country that a Dentist cannot receive a Medicare fee for doing his profession but a Medico can treat dental problems with no dental registration and then charge Medicare for the service. I kid you not. That is a fact in this country. A Medico can walk into your Dental Practice and attempt unregistered dentistry and be paid for it by Medicare but you try removing an appendix as a Dentist in a Medical Practice. You may be arrested. So, is there any divide between our professions? Of course there is. It is also not just about money. In summary, Dentists should [at least] be paid for basic dental services. It is now common knowledge that as people age, and lose their teeth through neglect and inadequate dental education and experience, they look for softer foods to eat using the teeth they have retained, or the dentures they have collected in lieu of their teeth, over the years. Softer foods are often full of sugar and fat and these foods lead to diabetes, heart disease and stroke, and now can be linked to ‘diabetes 3’ [Alzheimer’s Disease]. We need better teeth to eat a healthier diet so as to live a longer life. Well done Dr Russell.

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