Dental Bill

Extract from Hansard

Legislative Council
5 April 2001

Sandra Kanck
Deputy Leader Australian Democrats
Member of the Legislative Council

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The Hon. SANDRA KANCK: The Australian Democrats support the second reading of this bill. Dentists, dental prosthetists, hygienists, therapists and dental students will all come under the ambit of this act. After a number of attempts over a number of years, dental prosthetists, known previously as clinical dental technicians, will be allowed to fit partial dentures. I have previously supported bills introduced by the Hon. Mr Holloway and the Hon. Mr Redford to allow this to happen.

The advent of competition policy has forced the government's hand on this issue. I must observe that every now and then-and it is only now and then-competition policy actually causes something sensible to happen. However, it is only on rare occasions. This group of dental professionals has fought long and hard to be recognised in this way, and it is pleasing to see this in the bill.

The bill gives the parliament the opportunity to focus on the problems within our dental health system. The issue of dental health, which had slipped off the political and media agenda, has reappeared due to the introduction of this bill, the latest report from the Australian Institute of Health and Welfare and the fact that we are now in an election year.

It is no secret that dental health in South Australia has deteriorated, with almost 100 000 people currently waiting for treatment. Of these, 90 000 are waiting for fillings, extractions and general checkups, and the remaining 10 000 are waiting for dentures. Not only are many people waiting but the time they are waiting is unacceptably high-in some cases, up to four years for general dental care.

The impact of the federal government's decision to scrap the Commonwealth Dental Scheme has been obvious. This was recently highlighted by the release last month of a report prepared by the Australian Institute of Health and Welfare, which showed the differences in dental health and access to dental care between 1994-96 and 1999. Alarmingly, those who had government concession cards had experienced an increase in extraction of teeth and a decrease in fillings, and the cost of treatment was a significant factor in deterring people from seeking more timely and less drastic measures.

Access to appropriate dental services proves to be closely related to income. The Commonwealth Dental Health Program was introduced in 1994 to address social inequities in oral health as well as ensuring access to dental care for all Australians. It was a welcome program, and South Australians received approximately $10 million of federal funding for the scheme.

There is no doubt that it was effective and achieved its aims, which included increasing the provision of emergency care for people experiencing pain, improved dental outcomes and increased access to basic dental care. With the scrapping of the scheme, the South Australian government has not been able to keep up with demand, even for emergency treatment, and the provision of routine dental treatment has been severely restricted.

The scrapping of the scheme has affected the general physical health of those South Australians who cannot afford private dental treatment. There has been a high social and emotional cost for some of these people. I have been told, for instance, of cases where severe halitosis, due to untreated gum disease, has affected self-esteem and reduced chances of employment.

The scrapping of the program made no real economic sense. Long waiting lists have only compounded and exacerbated dental problems, which could have been more efficiently and cost effectively provided with early intervention. While the state government lamented the loss of the program, blaming the federal Liberal government for poor dental outcomes for South Australians, other states have opted either to replace the program or to deal with the funding shortfall.

Queensland continued the program with state funds, while Western Australia introduced a means tested system and Victoria and Tasmania introduced a system of co-payments. For more than three years this state government did nothing to address the scrapping of the scheme, and only recently has the government introduced a system of co- payments to begin to address the long waiting lists. This is a step in the right direction but, at this rate, it will take 100 years to clear the waiting list of 100 000 people.

As the bill has come at a time of crisis, there is a certain attraction to use it as a quick fix solution to our current problems, without taking into account the long-term view and direction of dental care for South Australia. I am referring, in particular, to the issue of therapists being able to treat adults, which is possibly the most contentious part of the bill in its current form. According to the opposition, if therapists were allowed to treat adults, this would reduce costs and improve accessibility to dental care. At this point in my research on the issue, I do not have the evidence or data to prove this.

Tasmania is the only state in Australia at the moment to have enabling legislation which makes a trial possible to look at the cost and effectiveness of therapists treating adults. Therapists would have to work under the supervision of a dentist and would not be able to diagnose patients. A number of questions arise from this. Would this make the treatment cheaper for the patient? Would we be doubling up on services if the therapist found a problem which could only be treated by a dentist, therefore, making another appointment with a dentist necessary? Would we be creating a two tiered dental health system, with those who could afford dental care seeing dentists and those who had less money using dental therapists?

There is no doubt that, in some cases, dentists are carrying out some relatively simple work that could possibly be carried out by therapists under supervision. This could lead dentists to concentrate on more complex cases and give them time to see more patients to prescribe appropriate treatment. That could be a useful mechanism to overcome some of the waiting list problems.

While we focus on restorative treatment to tackle the blow out in waiting lists, we should not be distracted from the urgent need of addressing primary care. Dental disease is preventable and, therefore, primary dental health care should be the focus of government policy. I would be interested to hear if the government has any plans to use this new act to deal with these problems, and how it plans to do it.

Over time, industrial issues have clouded some of the arguments regarding the registration of all dental practitioners. It is sometimes difficult to separate issues of vested interests-such as power and status and, ultimately, pay-from issues of community dental health. But it is our role, as parliamentarians, to assess the arguments and weigh them up against any vested interests. The parliament is duty bound to ensure that the changes in this legislation benefit the dental health care of all South Australians.

Many changes will be needed to address the current problems in our dental health system in South Australia. A Bachelor of Oral Health degree is due to be introduced next year, which could change the roles of therapists and hygienists. It is conceivable that, in the next five to 10 years, we will have only one type of dental auxiliary, who will combine the skills of both therapists and hygienists, which seems to be a most logical use of resources.

Dental care of elderly people in nursing homes must also be addressed. People entering nursing homes now still have their own teeth, which was not the case 20 years ago. As a consequence, there is a need for preventive maintenance. An Adelaide study has shown that provision of dental services in nursing homes is at a low level, and there has been little interest from dentists to treat patients. There are few dental hygienists working in nursing homes and little education provided by professionals to nursing home staff. Dental inspections found a high prevalence of tooth loss and cavities amongst nursing home residents.

Other issues in the bill which I am still investigating include changes to the Dental Board, the membership of which is to be increased to 13. There is some contention about the number of dentists as opposed to the number of consumers represented. But, overall, the composition of the board appears to be a positive step forward in its representation of all areas of dental health care. There are a number of complex questions that I am endeavouring to answer before we move into the committee stage of the bill, and I have appointments with a number of groups and people in the next few weeks to assist me in obtaining the answers. But, overall, I welcome the changes to the existing act as a positive step forward in the provision of dental services in South Australia.