Professor Hans Zoellner talks on Public Dental Policy

Interview with Professor Hans Zoellner

Associate Professor Hans Zoellner is the Head of Discipline of Oral Pathology at the Faculty of Dentistry.

What aims do you have in regards to dental health in Australia?

Professor Hans Zoellner: Okay, well look we say that there is a real problem for dental health; if you are able to access services in Australia you care is very good but if you are unable to access the services because the costs are simply beyond you or there aren't any practitioners in your area as you are in the country then really your service is non-existent and dental health is pretty much absent for a lot of people. Services in Australia and dental care in Australia is either very good or absent. What we want to do is bring dental into the health care system in a way that all the rest of medical areas are, have the benefits of dental internships so the public dental system can be properly built up or start to provide services in rural areas and also to bring in for example, Medicare- so there are proper funding arrangements in place, for dental services unlike the situation we have now.


Recently there has been reports of huge waiting lists in regards to dental, how do you plan to combat this?

Professor Hans Zoellner: When people talk about the waiting list they are talking about the waiting list for the public dental service. Now, depending on upon where you live, getting towards 40 to 50% of the population are eligible for public dental services, so that is half of the population. If you did an interview with the population 40 to 50% of the population would say that they couldn't afford basic dental services. Those people could enter the public sector, but you have almost half the population trying to be seen by a public services dentist, and less than 10% of the nations dentists work in the public sector. 10% of the dentists are trying to see half of the population of Australia. Obviously, there is an endless waiting list; the current waiting list is estimated to be half a million people long, the truth is most people are eligible for public dental care but know there is no use joining the waiting list because they will never be seen. So it is potential double that size.


So do these people chose not to see a dentist or pay for dental services?

Professor Hans Zoellner: That's right they just don't go and see a dentist, what happens is they then end up with pain and a tooth ache and they eventually have to be seen in some type of emergency situation, then they sometimes do get into the public section as an emergency to get their teeth pulled out or they have to scrape the money in from somewhere for an emergency private dental service. It is actually a real mess. We don't tolerate that in medicine. If you have a dental infection, infection of the mouth or dental decay - they are the most common infections in man-kind. It's bizarre that if I have an infection on my thigh- it is probably not going to cause a life threatening infection and kill me, but none the less I can have the full benefit of Medicare and the whole public system to gain care for that infection. But if I have exactly the same, an infection of the mouth from a tooth there is no Medicare cover there. You have to do without. The public system- is too long. It is a terrible mismatch for what is available for health care of the whole body, compared with the mouth.

What we want to do is to have Medicare and we want there to be funding and training arrangements that we know work really well for the rest of the body. We just want to be apart of the system. We know that Medicare will work well for dentistry because 10% of the population since November 2007 are in fact eligible for really comprehensive dental under Medicare, that is through the Advanced Primary Care Program- for people with chronic diseases such as diabetes or heart disease, these people can get $2125 worth of Medicare rebates per year, to treat their dental problems. The scheme is working pretty well, except that the Government is trying to shut it down and is not advertised. The scheme does need regulating. We want the Government to see that and introduce regulations and make sure the scheme is expanding to deliver services to all the people that need it.


Do you find that Australians do no have regular dental check ups, to the extent that they have medical check ups?

Professor Hans Zoellner: Yes, they don't because the funding isn't the same. You could go to a doctor and your Medicare rebate would cover that.


Do you think if the system was improve more people would go to the dentist for regular check ups?

Professor Hans Zoellner: Definitely!


What is the most common dental issue for Australians?

Professor Hans Zoellner: The most common dental problem is dental decay and the soft-tissue infection as a result of that decay. 20% of people have experienced dental pain, pain that has required pain-killers or meant that the sufferer was unable to eat or sleep in the last 12 months. Dental pain is a really common problem and most people simply put up with the pain because they can't afford to get treated.

Between 30-50,000 people are hospitalised every year in regards to a preventable dental infection. That is a lot of people, amongst those we estimate around about a 1,000 people are in hospital because without treatment it may kill them unless they have heavy duty medical treatment. This is outrageous as it is a preventable infection- they could have had this fixed via the dentist prior to it getting to a serious, life treating state. If dentistry was funded in the same way that medical was funded, through Medicare, then frankly you wouldn't have all those people visiting the hospital. You will always have some people who choose not to attend, but the great majority of people would seek treatment before it got to that stage.

It is bizarre that for some reason dentistry has been cut out of Medicare. The message we want to get out there is we want dentistry to be apart of the health care system- it actually works well for the rest of the medical bodies in Australia.

Medicare is already established and is very successful- use that for dentistry.


It has been said that dentist are prescribing inappropriate, expensive dental work, how will a new system ensure this doesn't happen?

Professor Hans Zoellner: Some dentist are doing the wrong thing, yes, they are over-prescribing crowns and bridges- we think that is very bad, not only is it a waste of money, what I really care about is people are getting treatment that is not right for them. So, you need the government to step in here and provide a regulation for crown and bridge work - so that everybody can only get constructed treatments when they are really clinically needed, not because they are expensive and dentist want to make a bit of extra cash.