Redesigning rural health to improve dental outcomes

Inequalities in access to essential dental care is a critical issue in Australia. The 2019 Grattan Institute Filling the gap report found that two million Australians put off seeing the dentist every year because of the cost, despite regular check-ups being crucial to maintaining oral health. Currently about 90,000 adults in New South Wales (NSW) alone are on the public dental waiting lists for treatment, with patients often having to wait months for treatment.

Indigenous patients, socially disadvantaged people and those with special healthcare needs were highlighted in the National Oral Health Plan 2015–2024 (NOHP) for experiencing the greatest barriers to accessing oral health treatment.

Poor oral health can have huge impacts. As well as being costly and time-consuming to resolve, it is associated with a range of serious chronic conditions including heart disease and diabetes. Tooth loss can affect oral function, appearance and psychosocial function, all of which negatively impact a person’s quality of life.

Regional and remote Australians were also among the NOHP priority populations – and with good reason. Regional and remote residents have poorer oral health than those living in major cities, with oral health status generally declining as remoteness increases. Multiple contributory factors include a lack of availability of dental and oral health practitioners, geographical location, treatment cost, and patient preferences and attitudes toward dentistry and oral health.

A lack of effective policy and health system commitment towards oral health in rural regions is problematic, resulting in significant disparities experienced by those living in regional, rural and remote communities.

As a regionally based dentist for most of my 40-year dentistry career, I’ve seen first-hand the serious and debilitating effects a lack of regular access to dental treatment can have on patients’ teeth. That’s why I was eager for the Australian Dental Association New South Wales (ADA NSW), the peak body for dentists in NSW and the Australian Capital Territory, to prioritise this issue in 2022, as part of our overall effort to improve oral health accessibility for all Australians.

There are several initiatives which would, if implemented, improve oral health outcomes for regional patients. ADA NSW outlined some of these in our recent submission and subsequent in-person evidence to the ongoing ‘Health outcomes and access to health and hospital services in rural, regional and remote New South Wales’ inquiry. These include transforming the current Oral Health Fee for Service Scheme (OHFFSS), which provides a dollar amount allowing eligible patients to seek specific dental treatment in the private sector. Redesigning the OHFFSS funding within rural and regional areas, to provide greater support for eligible patients to access private practitioners in a public–private partnership model, must be considered.

Our recommendations also included providing more incentives – including allowances for dental and oral health graduates to live and work in rural, regional and remote NSW – and more funding for the use of technology to help overcome barriers of remoteness. Other proposals by ADA NSW included ongoing, targeted student recruitment and retention strategies such as allocating a targeted percentage of places in dental and oral health training programs in NSW to students from Indigenous and regional backgrounds. These strategies would increase access to preventive, diagnostic and oral health treatment for rural residents.

Implementing these recommendations will require a substantial and coordinated approach involving government and non-government healthcare organisations and educational institutions – not to mention adequate funding, education and training. This is necessary, however, to ensure all Australians can access timely and affordable dental treatment when they need it, wherever they live.