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Wednesday, 10 October 2012
Page: 11986


Mr WYATT (Hasluck) (17:11): I rise today to talk on the proposed Dental Benefits Amendment Bill 2012. It was quite illuminating listening to the member for Fraser. I can now understand why the member for Eden-Monaro, who has a promotional position based on the proposition that if you have a good set of teeth you have a good opportunity of a higher position and the income that goes with it. I am not sure, with your smile, Mr Deputy Speaker, whether you fit the same category! Based on that logic, you are better off taking your teeth out and having dentures because they would look white and clean!

The DEPUTY SPEAKER ( Mr Windsor ): Order! That could be a reflection on the chair!

Mr WYATT: No, it is not a reflection on the chair; it's just that your smile is like one of those Cheshire Cat smiles, Chair!

Can I start by making reference to the second reading speech by the minister, from which I will cite a couple of key sentences, because I want to build on that. There is $225 million for dental capital and workforce measures aimed to provide expanded services for people living in outer metropolitan, regional, rural and remote areas—interesting concepts.

This bill will establish a Child Dental Benefits Schedule for children from the age of two until they turn 18. Then the states and territories would also be able to provide services, as they currently do under the Medicare Teen Dental Plan for services provided by dentists and para-dental professionals, such as oral health therapists and dental hygienists.

Let me come to that notion of workforce. One of the major challenges that I hear constantly from the committees I am involved with is the lack of workforce, the lack of preparedness for those workforces to be part of rural and regional Australia. But often the referrals come back into capital cities, so that increases the cost of access. It also is about those factors that impact on families in terms of socioeconomic status, access to oral health services and also our dietary behaviours—which are always interesting. With the number of kids you see drinking Coca Cola but who never swill their mouths out with water, it is natural that they would end up with poor oral health in their early years. So, to that extent, the changes that are mooted being delayed for as long as they are, have consequential outcomes: if those services do not exist currently, for a period of up to 19 months, then we are creating a tremendous problem by ceasing funding in this area.

I have serious concerns about the rural and regional areas of Australia that have limited access to the type of funding that is required to provide the oral health services that they need.

It was also interesting that in her speech the minister said:

As part of the dental package, the Gillard government is providing $1.3 billion to states and territories under a national partnership agreement to expand public dental health services for low-income adults, including pensioners and concession card holders and those with special needs.

But when I read back through the speech I found something that the minister referred to fascinating.

In fact, she did not contact me herself; her neighbour contacted me and said that she could not go with her son on his first day because she did not have any teeth and she was too embarrassed and did not want to humiliate her son by turning up with her teeth having been extracted … bad teeth can exclude you not just from getting a job and not just from economic participation but also from social participation …

There is merit in what the minister presented. But it is no basis for ceasing funding for the Chronic Disease Dental Scheme.

I will now refer to the World Oral Health Report, entitled Continuous improvement for oral health in the 21st century, the approach of the WHO global oral health program. Comments in here are consistent with those of the Surgeon-General of the United States. The report says:

The interrelationship between oral and general health is proven by evidence. Severe periodontal disease, for example, is associated with diabetes The strong correlation between several oral diseases and noncommunicable chronic diseases is primarily a result of the common risk factors. Many general disease conditions also have oral manifestations that increase the risk of oral disease which, in turn, is a risk factor for a number of general health conditions.

Further on, the report continues:

A core group of modifiable risk factors are common to many chronic diseases and injuries. The four most prominent noncommunicable diseases (NCDs)—cardiovascular diseases, diabetes, cancer and chronic obstructive pulmonary diseases—share common risk factors with oral diseases, preventable risk factors that are related to lifestyle.

Hence my reference to the food factor. The report continues:

Moreover, control of oral disease depends on availability and accessibility of oral health systems but reduction of risks to disease is only possible if services are oriented towards primary health care and prevention.

The report later states:

If left untreated even for a short period of time, oral diseases can have adverse consequences. Oral infection can kill. It has been considered a risk factor in a number of general health conditions. The systemic spread of bacteria can cause, or seriously aggravate, infections throughout the body, particularly in individuals with suppressed immune systems. People with cardiovascular disease and diabetes are particularly vulnerable. Studies have suggested that oral diseases (e.g. dental caries and periodontal disease) are associated with other NCDs, and interrelationship which merits further investigation.

An Australian publication says:

Periodontal disease (affecting the gums) is caused by bacterial infection associated with poor oral hygiene, infrequent dental visits, age, smoking, low education and income levels, and certain medical conditions, especially diabetes. Current research is strengthening the association between periodontal disease and pre-term, low birthweight babies; cardiovascular disease; and rheumatoid arthritis. Poor oral health may exacerbate other chronic diseases. There are possible associations between early childhood caries and otitis media and blood borne diseases and infective endocarditis (associated with rheumatic heart disease).

It then goes on to explain the processes of poor oral health and the association with chronic diseases and then says:

They have difficulty eating (which might adversely affect their nutritional levels), and they may have low self-esteem from the appearance of their decayed teeth. Poor dental health can also cause impaired speech and language development.

One of the issues is that delayed access to treatment exacerbates chronic health conditions. My father-in-law over a period of time has had cardiovascular health problems. He has an artificial valve. When he has treatments his teeth are the first thing that his specialist looks at. If his teeth show any sign of poor conditioning or there is bacteria associated with the mouth, the gums or the teeth, they then undertake appropriate medical treatment. That is covered under the current Medicare program. Now that we have this gap, I wonder what will happen with that process? People will still have to have oral and gum treatment and probably the extraction or treatment of teeth before they can continue with surgery or other complex treatment associated with their particular health problem. If we have that gap in the provision of the NBS item, then I have some serious concerns about the some 400,000 adults who currently access dental health schemes.

The group that worries me more than any other are those who do not have the capacity to pay what is required by dentists for the treatment that they will need prior to their treatment in hospital. If that is the case, they are more likely to take the risk and delay treatments. If that is the case, then that will compound their health problems. On a DRG mix—which is the cost of hospitalisation and the services provided—that becomes an increased cost to the healthcare system and to the drawdown for both the state and the Commonwealth in the provision of hospital treatment because of the factors associated with oral health, gum diseases and tooth decay.

The other thing that is more insidious is raised in something that was put out recently—in September 2012—by the Australian Dental Association. That publication says:

There has been an increasing prevalence of 'dental tourism' where the strong Australian dollar is not only drawing Australians towards overseas travel, but also some travellers are undertaking dental procedures overseas in the hope they will 'save' money'.

…   …   …

Some packages offer 'prepackaged' accommodation, sightseeing tours and activities to 'facilitate the recuperation' of consumers after receiving their dental treatment.

They go on to say:

Teeth are for life. Obtaining dental treatment overseas can be incredibly risky to both your dental health and general health.

They also talk about something even more important:

Australia has recently recorded cases of a new superbug 'NDM-1', the most resistant to antibiotics yet seen to be on the rise in the UK. Like in the UK, the growing number of patients jetting out for 'medical tourism' has been blamed for the increasingly impervious bacteria arriving here in Australia.

If we have this gap in the provision of dental health care under a measure implemented by the Howard government and in particular Tony Abbott when he was health minister, that has serious implications for the health and wellbeing of many Australians, who may seek to go elsewhere, combining a holiday overseas with dental treatment that is much more risky and much more likely to cause some unintended consequences, such as antibiotic resistant bacteria getting into Australia. It is important that the minister reconsiders her decision in the context of this bill.

I do not have a problem personally with the need to provide comprehensive dental health care to children who experience levels of poverty and social disadvantage.

I do not have a problem with the fact that there is a reform factor being considered within the context of the bill, but I do have an issue with the fact that it is a bill that allows for a significant program to be put on hold, that was accessed by children in the context I just talked about, being delayed for such a lengthy period. We are putting at risk the lives of Australians in this process. It would be more important that this is not a budget measure for a saving but a budget measure to increase access to those who have a need for chronic disease dental health services, because that is one of the factors that will reduce the burden of ill health or, ultimately, in some cases, save a life instead of putting it at risk.

I certainly encourage the government to consider the delay in the expenditure: if you are proposing to change it in the way that you are then do not cease the funding, because the lives of individuals are far more valuable than a political expediency that takes us into the realm of the deprivation of services that are much needed. I encourage the minister in particular to look at some of her own documents from the Department of Health and Ageing and some of the research that goes to those critical issues of continuity of care, from the mouth to the blood system. I have seen Indigenous Australians and elder Australians die from septicaemia and oral health related diseases because they could not access the services or did not have them. My significant concern is for those in rural and regional Australia.