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COTA Australia: Focusing on dental health is crucial for us all

Good oral health is important for people of every age, but for many Australians – including many older Australians – access to the affordable dental support they need is out of reach.

Having a good standard of oral health is fundamental to a person’s health and wellbeing. It’s critical to supporting our ability to eat, communicate and socialise.


As we get older, the stakes get higher. The risks of poor oral health in young people can be substantial, but as we age the risks increase significantly. Evidence shows that poor dental health increases the risk of diabetes, heart disease and chronic malnutrition in older people, as well as embarrassment and social isolation.


The link between poor oral health and poor general health and quality of life is incredibly strong. However, despite all the evidence, dental care in Australia currently receives little public funding.


COTA Australia has long advocated for – as a first and urgent step – the introduction of a Senior Dental Benefits Program to ensure that everyone, no matter their financial situation, can get access to the dental care they need.


The impact of age on our oral health

The recent Intergenerational Report released by the Federal Government showed that the number of Australians aged over 65 is expected to double in the next 40 years. Those aged over 85 are expected to triple.


The fact that we’re living longer and healthier is a good thing and something we’ve known for a long time. It’s a tribute to medicine, to science, and something we’ve essentially strived for for centuries.


However, an ageing population obviously comes with its challenges, and from an oral health perspective, one of those is looking at how we shift our dental system from a deficit system that focuses on treatment to one that is more focused on stopping problems before they occur.


The Council on the Ageing (COTA) has found that older Australians report a number of key reasons why they don’t get timely oral health treatment, including:


  • the high out-of-pocket costs

  • lack of provision of oral health services outside of metropolitan areas, and

  • structural barriers due to public dental services largely existing in a silo with little integration with the broader health system, or between the public and private dental sectors.

Given the serious potential consequences of not getting adequate dental health treatment, this is incredibly concerning.


Untreated oral health can:

  • contribute to unnecessary pain and distress

  • contribute to social isolation

  • possibly shorten life expectancy

  • contribute to the purchasing of over-the-counter or online medications to alleviate pain and distress. Although likely to provide temporary relief, the underlying issue is left untreated, placing a person’s overall health at risk.

  • contribute to the development of preventable physical, psychological and emotional health issues. For instance: malnutrition, which can affect weight and muscle loss, skin integrity and increase the risk of pressure injuries and falls

  • endocarditis

  • cardiovascular disease

  • pneumonia

  • diabetes

  • osteoporosis

  • Alzheimer’s disease

  • Sjogren’s syndrome (dry mouth).

There is also significant evidence, substantiated by Australian and international research, that shows poor oral health increases an older person’s risk for loneliness and social isolation. The findings of the Royal Commission into Aged Care Quality and Safety strengthened this understanding.


The hip pocket cost

The lack of public funding for dental services means that dental care is mostly paid for by private health insurance, often with out-of-pocket costs, or fully by the person receiving the treatment.


The cost of accessing private dental services varies significantly, but any Australian who has visited the dentist will be able to tell you that the out-of-pocket expense can be substantial – prohibitively so for many people.


In fact, COTA Australia estimates that there are approximately 2.5 million Australians who miss out on dental care primarily due to cost.


While there are public dental clinics, most dental care in Australia is provided in the private sector, with approximately 85 per cent of dentists working exclusively in private practice.


Those who do access public dental clinics can find themselves waiting for over two years for treatment, and this treatment is limited to the provision of ‘essential treatments’ such as emergency dental care and selected general dental treatments like tooth extractions or fillings.


Addressing the prohibitive cost of dental care for those at extreme risk – which includes all older people – needs to be a priority.


The importance of dental care for every age and generation

Including dental in our healthcare system is the kind of prevention-focused policy we need to see from our governments.


Making sure older Australians get access to the quality, affordable dental care they need will keep us healthier for longer – decreasing the burden on our public healthcare system and freeing it up for those who need it most.


Improving older people’s access to dental health services won’t just lead to improved outcomes for older Australians, but for every Australian. Making our broader health system more efficient will keep older people active in the community for longer, which is good on every measure – socially and fiscally.


The tragedy of the current policy stance is that oral health conditions are largely preventable or can be remedied if treated in their early stages. Not addressing them early adds a significant, potentially preventable cost to an already stretched public health system.


The increased risks of largely preventable hospitalisations add considerable financial strain to an already stretched public health system. For instance, in 2019–20, it was found that about 67,000 hospitalisations for dental conditions may have been prevented with earlier treatment.


We also see the impact at a GP level, with an estimated 750,000 GP consultations each year for dental problems, with the most common treatment being prescriptions for pain relief medication and antibiotics.


Taxpayers easily pay $30 million per year for these consultations, plus the cost associated with subsidising any prescribed drugs. Other estimates of the cost of GP consultations for dental conditions have been of higher magnitude. At least some of this cost could be avoided if fewer Australians faced financial barriers to dental care.

Australia has no comprehensive national oral health data source, largely due to the fact that much of our dental work is done within private practices, which in itself is concerning. However, all the evidence points to the importance of ensuring Australians get access to the dental care they need and deserve.


The crucial next step: Senior Dental Benefits Program

Australia’s Medicare system is the envy of many countries throughout the world, but the short-sighted policy separation of a person’s oral health from overall health and wellbeing makes no sense.


Prior to the May 2022 Federal Election, the current Australian Government publicly stated its support for providing Australians with better access to dental support, and COTA Australia, with the support of many other organisations, is continuing to put pressure on the Federal Government to honour its commitment.


The risks of continuing on the current trajectory are too great, and the benefits of shifting to a system that rightly sees dental health as an extension of our general health and wellbeing are also too great to be ignored.


Of course, any large-scale change needs to be measured, which is why as a first step COTA Australia recommends the introduction of a Senior Dental Benefits Program – similar to the program currently in place for children – that would allow an immediate focus on at-risk older people, including those in aged care.


As we live longer, the importance of preventative health becomes even more critical – for our quality of life, our healthcare system and for the budget. It’s important for every Australian that we get this right.


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