New approaches needed to fill gaps in rural dental care

Dental disadvantage by postcode remains a significant barrier to improving oral health outcomes in Australia. This year’s updated Australian Institute of Health and Welfare Oral Health and Dental Care in Australia report illustrated that people in regional and remote areas of Australia have poorer oral health, such as suffering higher rates of untreated tooth decay, than those living in major cities and oral health status generally declines as remoteness increases. People in rural areas have access to fewer dental practitioners than their city counterparts which, coupled with longer travel times and limited transport options to services, affects the oral health care they receive. People living in remote and very remote areas are also more likely to smoke and drink at risky levels. They have reduced access to fluoridated drinking water and face increased costs of healthy food choices and oral hygiene products. With oral health key to overall good wellbeing and poor oral health contributing to serious chronic conditions such as Type 2 diabetes, this disparity has serious implications for Australians’ overall health.

Exacerbating this situation is the difficulty in attracting dental professionals to work in rural areas. Current literature has identified the trend of excess dental professional employment in metropolitan areas, with a lower supply in rural and remote areas despite the need for dental treatment in those areas. Anecdotal evidence has shown how establishing dentistry and oral health therapy and hygiene courses such as those run by Charles Sturt University in rural areas of NSW has not – as yet – improved the situation.  

Data from the NSW Health Oral Health Report has also illustrated that about 85 per cent of oral health services are provided by the private sector. Lack of accessible and affordable public service is another area where rural Australians, together with those from low socio-economic backgrounds, are missing out on treatment.

What has been shown is that further research must focus on workforce planning to address the oral health disparity in Australia. It would be in the public interest to encourage more dental graduates to work in the public sector, which with improved Australian Government funding could be attained. Further research is, however, also required into the effectiveness of clinical, mentorship or funding programs which could improve the situation. While workforce planning policies could hence be directed at prompting universities to increase rural student intake and increase clinical teaching at rural-based clinics, we need to investigate if further incentives such as financial grants and assistance would work.

In addition, however, I would argue that we must consider more innovative solutions to improve Australia’s oral health outcomes. A 20 per cent tax on sugar sweetened beverages, similar to those successfully implemented in other countries and flagged by the ADA NSW’s position statement on this issue, should be considered by the Federal Government as a means to improve dietary habits and oral health, among other positive outcomes. Monies generated could fund marketing programs for better oral health awareness and education. Fluoridating Australia’s entire water supply would ensure all Australians have access to a safe and cost-effective means for preserving oral health, regardless of their socio-economic status. More effective promotion of schemes such as the under-utilised Child Dental Benefits Schedule would ensure all Australian children have access to Medicare-funded dental treatment.

Furthermore, future research is needed to explore how, with a greater emphasis on the importance of oral health to overall health, we can improve overall health outcomes for rural Australians. Putting the mouth at the centre of health care in Australia could have numerous benefits to the community, including decreasing hospital admissions and lost working days, and generally better overall health outcomes.

I believe it is possible to create an equitable oral health workforce that ensures fair and accessible treatment for all Australians. Further research in this area, however, must be combined with devising and implementing new approaches to securing better oral health outcomes for rural Australians.