DHS Annual Report 2004/05 - Dental Outcomes

The Department of Human Services recently published its Annual Report for 2004/05, containing a number of dental references - notably on pages 15, 17, 58 and 116.

The summary of major "outputs" and "deliverables" appears on page 116, and includes the following key points:

• There were a total of 785,938 dental service units provided within the community, school, preschool and specialist service areas
• the ratio of emergency to general treatment was 55:45 (above the budgetted target of 49:51)
• the waiting time for restorative dental care as at 30 June was 28 months (compared with a target of 22 months)
• the waiting time for dentures was 28 months (compared with a target of 24 months)
• the total output cost for dental services (as distinct from system development and resourcing) was $104.4m for the 2004/05 year

Dental Tourism Warning

The Age newspaper today carries a story about dental tourism "Keep Smiling", in which a sidebar item headed "Cheaper Work at what risk?", notes warnings by ADA Inc. CEO Robert Boyd-Boland about infection control, variable work quality and problems in following up treatment failure outside Australia's regulated environment.

"System in Decay" Feature Story

Following up their editorial and articles earlier in the week, The Australian today published a large feature story on public dental waiting lists and the need for policy reform. (See also posts dated 24 and 25 October).

The story highlights ADA Inc. CEO Robert Boyd-Boland's call for the introduction of a new federal dental scheme, similar to the Commonwealth Dental Health Program (CDHP) which operated during the mid 1990's, in the following terms:

"The CDHP significantly reduced waiting times and waiting lists. Estimates put the growth in waiting lists between 20 per cent and 55 per cent in the 12 months to 24 months after the CDHP ended. Since then there has been no discernible, unified plan in place to provide delivery of dental care."

Minister's speech on the new Bill

Health Minister Bronwyn Pike's Second Reading speech regarding the Health Professions Registration Bill, delivered in the Legislative Assembly late on Thursday 27 October, has now been published in Hansard.

Health Professions Registration Bill available

Further to this morning's posting advising of the introduction of the Health Professions Registration Bill into the Victorian Parliament, the Second Reading stage was reached late today and so the Bill is now available online.

Members who subscribe to the ADAVB Alert! service are being sent a brief outline of some key changes following a (very) partial analysis, and attendance by Branch representatives at a Departmental briefing this evening. Further commentary will follow.

Information Sheets on the proposed legislation have been published by the Department of Human Services.

Changes to Medicare allied health and dental care initiative

The Federal Government is introducing administrative changes to the Medicare allied health and dental care initiative.

From next Tuesday - November 1 - signed copies of Enhanced Primary Care program referral forms for allied health and dental care services will no longer be required to accompany Medicare claims.

Copies of the initiative's fact sheets, referral forms and frequently asked questions are available from the Department of Health and Ageing website: www.health.gov.au/strengtheningmedicare

Information is also available from Medicare on 132 150.

Health Professions Registration Bill introduced

The Hon. Cheryl Garbutt, representing the Minister for Health, The Hon Bronwyn Pike, introduced the Health Professions Registration Bill into the Legislative Assembly yesterday, and the Second Reading is scheduled to occur later today (after which a copy of the text will become available).

The First Reading noted that the purpose of the Bill is "to protect the public by providing for the registration of health practitioners and for a common system of investigations into the professional conduct, professional performance and ability to practise of registered health practitioners, to repeal various acts relating to the registration of health practitioners and for other purposes. "

ADAVB representatives are attending a briefing on this legislation this evening and further information will be the subject of an Alert and additional Blog postings subsequently.

Opposition warning re Vic health standards

The Victorian Shadow Minister for Health, The Hon David Davis has warned that the proposed Health Practitioners Registration Act "could result in reduced health care quality and standards in Victoria".

In a media release issued on 25 October, Mr Davis said, "We need checks and balances in place to ensure that in the rush to deal with doctor and nurse shortages, especially in the country, dangerous practitioners are not allowed to practice."

He also urged the Premier to put the legislation out "for public comment for at least two months to enable patients, health practitioners and the community to examine and comment on it".

The Bill is expected to be introduced into the Victorian Parliament this week.

NSW Health Survey - Oral Health Results

The Report of the New South Wales Health Survey for 2004 has just been published, including a section on Oral Health. The report highlights information about:

• retention of natural teeth
• toothache and other oral health problems
• frequency of visits to dental professionals and
• dental providers used.

"Of those who reported an oral health problem, 30.7 per cent did not see a dentist for the problem. Of those who did see a dentist, the most common treatments were dental fillings (25.3 per cent), tooth extractions (12.9 per cent), or simply a check up (12.0 per cent)."

Enhanced Medicare fails to deliver

In a follow up to yesterday's story about dental waiting lists in The Australian, today's edition reports that the Enhanced Primary Care (Medicare) scheme, intended to provide dental care for up to 23,000 medically compromised patients each year, has actually only funded care for 3,150 people.

This story is accompanied by an Editorial (no link available) condemning the federal - state confusion over funding responsibility for public dental care.

Dental waiting lists increase

A report in The Australian today notes that 20,000 people each year are added to the waiting lists for public dental care, and that there are now over 650,000 people in the queue.

Victoria's waiting list grew from 143,000 in 1997 to 197,810 in 2004/05. Figures in the most recent Dental Health Services Victoria Annual Report indicate that waiting times have begun to improve, and triage systems being used now ensure that emergency treatment is usually provided within 24 hours.

European Workshop on Tobacco Use Prevention

The 1st European workshop on Tobacco Prevention and Cessation for Oral Health Professionals took place in Switzerland from 8-11 October 2005.

The workshop objectives were to:-

• Review the present paradigms and current concepts of tobacco cessation in dental offices.
• Introduce motivational interviewing into the dental profession.
• Update recent recommendations for both the education of tobacco cessation supported by nicotine substitutes and the organization of dental practice settings.
• Discuss research questions and appropriate study designs that will generate comparable results in education, stop smoking rates and improvement in oral health.
• Review public health approaches in tobacco control and identify the potential role of the dental profession in these activities.
• Communicate outcomes of the workshop elaborations with dental, dental hygienist's schools and oral health care companies.
• Establish a network for quality control.

The proceedings of the workshop and resources to support smoking cessation counselling and training will be available soon. Click here to visit the organisers' website for information about the initiative.

Land Tax on Trusts - Update

Victorian Treasurer John Brumby today issued a Media Release advising that the State Government is proceeding with their proposed new arrangements to impose Land Tax on Trusts, which we expect will impact on a number of dental practices. While the draft legislation apparently contains some changes compared with the arrangements originally flagged, there is still likely to be a need for practices holding land through a trust to obtain accounting and/or legal advice.

The Shadow Treasurer, Robert Clark has also issued a Media Release, criticising the Bill and highlighting confusion around the due dates for completion of State Revenue Office requirements.

Wangaratta clinic still seeking a dentist

According to a story in the Wangaratta Chronicle (19/10) Dental Health Services Victoria (DHSV) has not received any applications for the vacant dentist’s position at the Wangaratta Community Dental Clinic. The article quotes DHSV spokesperson Anne Stanford, who said:

"Wangaratta is one of the top priorities in the state ... but we are still searching and as far as I know we haven’t had any applications at this stage."

DHSV hopes to assign a travelling team comprising a dentist and a dental therapist to commence work in the area soon.

Ms Stanford also said that public patients with urgent treatment needs were being provided with vouchers to have their work undertaken by a private dentist and that some were reimbursed for travelling to a Melbourne clinic.

Queensland to means test health services

According to a media release issued by Queensland Premier Peter Beattie on 19 October, the Queensland Government will "examine the introduction of means testing and co-payments for non-urgent surgery, the spectacle subsidy scheme, dentistry for adults and specialist outpatient services for non-concession card holders".

Today's edition of the Financial Review notes criticism of this decision by the federal health Minister, Tony Abbott and others.

Public dental patients in Victoria have been required to make co-payments for some years.

NSW dental waiting lists

There are at least 215,500 people waiting for public dental care in NSW, according to the Shadow Health Minister Mrs Jillian Skinner. This included 650 children waiting for a general anaesthetic for dental treatment at a Sydney hospital. She told the NSW Parliament yesterday that there was a crisis in public sector oral health services.

In a media release, Mrs Skinner said a leaked Government paper claimed that there were only seven public sector dentists per 100,000 eligible patients compared to the OECD average of 56.

According to Mrs Skinner, NSW spends the least per head on dental treatment of all States and Territories at $31 per person a year. This compares with $61 in Queensland, $51 in the NT and SA, $49 in the ACT, $46 in Tasmania, $42 in Victoria, $40 in WA with a national average of $48.

NSW Fluoridation Study

Following up a posting from 7 October, the latest edition of the Australian and New Zealand Journal of Public Health contains the report on the ARCPOH study of fluoridation in NSW.

The study compares caries within Area Health Services (AHSs) rather than comparing caries in disparate geographical locations where other factors – such as diet, poverty, age profile, access to care, etc – may confound the results.

The abstract for this paper concludes: "Water fluoridation was found to be related to significantly reduced caries experience in the majority of AHSs where comparisons could be made, and to benefit all socio-economic strata of the community ... Water fluoridation should be extended to those areas of NSW that are yet to benefit from this successful caries preventive public health initiative. "

The contents and abstracts of the Australian and New Zealand Journal of Public Health can be viewed here.

Queensland to fund Fluoridation

According to today's Financial Review, the Queensland government intends to offer local councils money to fluoridate their water "as part of a plan to fix the state’s health system and bring children’s dental care in line with other states".

The plan is expected to cost about $6 million and responds to a recommendation from consultant Peter Forster in his review into Queensland’s health bureaucracy. This was noted in the story posted on 3 October (see Blog Archive).

Queensland Premier Peter Beattie was previously opposed to water fluoridation but has admitted that Mr Forster’s report forced him to see the situation differently "I’ll admit I was the obstacle to this because frankly I thought local government should have done it", Mr Beattie said.

The Financial Review story also notes that only five Queensland communities - Townsville, Mareeba, Morandah, Dalby and Bamaga - currently have fluoridated water.

Prominent US academic calls for professional rethink

Bruce S. Graham, DDS, FACD, Dean of the College of Dentistry at University of Illinois at Chicago, believes that the business side of dentistry is "endangering the integrity of the profession and demeaning dentistry in the eyes of the public".

Prof. Graham presented the Convocation Address to the American College of Dentists (30 September, 2004, Orlando Florida), which challenged Fellows of the College and members of the dental profession generally, to reassess the extent to which business interests have compromised professional motivations and behaviours in dentistry.

The address was entitled "Is Dentistry a Business or a Profession?", and is reproduced in the October 2005 edition of the Canadian Journal, Oral Health and Dental Practice Management.

AMA urges Government to release draft legislation

Dr Mark Yates, President of AMA Victoria, is reported in The Age today (News p4) as calling on the State Government to make public a draft of the health practitioner board legislation, which will also affect dentists, nurses, physiotherapists, pharmacists and other registered health care providers. Dr Yates expressed particular concern that the planned changes would reduce the number of doctors on the Medical Practitioners Board by one third, and increase the nmber of community representatives by the same amount - and that this would undermine the safety of health care.

According to the The Age, "the legislation is expected to go to Cabinet in a week and to Parliament in early November". ADAVB Alert! subscribers will note that this adjusts by a week or so, the expected timeline for progress of this legislation.

Amoxycillin may damage infants' teeth

According to data published in the Archives of Paediatric and Adolescent Medicine (Arch Pediatr Adolesc Med. 2005;159:943-948) use of amoxycillin in patients aged between three and six months doubled the risk of fluorosis on incisor teeth at nine years.

The Abstract for this article notes:

"After adjusting for fluoride intake and otitis media, the risk of fluorosis on the maxillary central incisors from amoxicillin use during 3 to 6 months ... was still statistically significant."

American Dietetic Association reaffirms fluoride support

Another ADA, namely the American Dietetic Association has reaffirmed that fluoride is an important element for all mineralized tissues in the body. In the October 2005 edition of their Journal, (J Am Diet Assoc. 2005 Oct;105(10):1620-1628) they have published a position paper which notes that "appropriate fluoride exposure and usage is beneficial to bone and tooth integrity and, as such, has an important, positive impact on oral health as well as general health throughout life."

Only the abstract for the article is available at no charge, but this goes on to state:
"Fluoride is an important element in the mineralization of bone and teeth. The proper use of topical and systemic fluoride has resulted in major reductions in dental caries (tooth decay) and its associated disability. The Centers for Disease Control and Prevention have named fluoridation of water as one of the 10 most important public health measures of the 20th century. Nearly 100 national and international organizations recognize the public health benefits of community water fluoridation for preventing dental caries. However, by the year 2000, over one third of the US population (over 100 million people) were still without this critical public health measure. Fluoride also plays a role in bone health. However, the use of high doses of fluoride for prevention of osteoporosis is considered experimental at this point. Dietetics professionals should routinely monitor and promote the use of systemic and topical fluorides, especially in children and adolescents. The American Dietetic Association strongly reaffirms its endorsement of the appropriate use of systemic and topical fluorides, including water fluoridation, at appropriate levels as an important public health measure throughout the life span."

Report on Victorian Public Dental Services

The Victorian Minister for Human Services, The Hon. Bronwyn Pike, today released 'Your Hospitals: A six-monthly report on Victoria's public hospitals'.

On page 34 of this publication a number of graphs and statistics regarding public dental services are highlighted, including the following figures (as at June 2005):

• Funding for dental health services increased by $50 million or 67 percent from 1999-2000.
• In 2004-05 there were 425,193 visits to community dental clinics. There were 27,079 or 7 percent more visits to community dental clinics in 2004-05 compared to 2003-04.
• For the first time since the Commonwealth Dental Health Program ceased in 1996, the average time to treatment for people needing care has decreased. From June 2004 to June 2005, the average time to treatment for dentures decreased from 34 months to 28 months (18 percent), while the average time to treatment for restorative dental care fell from 29 months to 28 months (3.4 percent).

WHO Bulletin focuses on Oral Health

The September 2005 edition of the World Health Organisation's (WHO) Bulletin is dedicated to oral health. Articles on oral health promotion, fluorides, tobacco, aged care, links between oral and general health, and various other oral health topics are addressed.

The full text of this Bulletin can be accessed from the WHO website.

SA funds further cut to dental waiting times

The Rann Government has provided an extra $3m to further reduce dental waiting times for public patients in South Australia. These waiting time have already been cut from an average 49 months in 2002 to 29 months as at June 2005.

View the media release here.

WorkChoices - Government Information

Members interested in further information about the Federal Government's new industrial relations legislation can visit the website dedicated to this reform here.

Please note that the changes are subject to legislation being passed in the Parliament, and will not take effect for some time yet.

AmDA's Best Management Practices for Amalgam Waste

The American Dental Association (AmDA) recently updated their best practice guidelines (7 pages) on handling amalgam wastes. These guidelines offer suggested measures, especially recycling, to help protect the environment and protect operator health and safety.

To review these guidelines, click here.

Note: A sharp eyed member has pointed out that these guidelines do not comment on storage of amalgam waste under used fixer. Refer to the ADAVB Systematic Operating Procedures (SOP) 2005, Chapter 5, page 14, for local best practice. The online version of the SOP can be referenced on the Branch website under Member Services/Infection Control.

Fluoride theory is watertight

A study of more than 250,000 children has found that almost 70 per cent of children living in non-fluoridated areas had more dental decay. Researcher Jason Armfield, of the Australian Centre for Population Oral Health at the University of Adelaide, said the study shows that water fluoridation significantly reduces the occurrence of dental decay in school children.

Horsham to be Fluoridated

Drinking water in Horsham is to be fluoridated, according to a media release issued yesterday by Victoria's Chief Health Officer, Dr Robert Hall.

"As a result of approaches by the Community Oral Health Group GWMWater's customers received information about water fluoridation from the Department. Residents were also encouraged to seek further information from their dentist, GP or pharmacist or through a special toll free information line", he said.

All members have been provided with literature to assist them in their discussions of this matter with patients and other community members. For further information and copies of 'Water fluoridation - Information for health professionals', telephone 1800-651-723.

To review the release, click here.

Dentists welcome at National Conference

The ADAVB and the Australian Veterinary Association (Victorian Division) are assisting AMA Victoria to conduct the 4th National Doctors’ Health Conference in Melbourne, on 3 - 5 November 2005. The conference will play a vital role in stimulating awareness and new ideas in the approach to the treatment and prevention of ill-health in health professionals.

Our own CEO, Garry Pearson, is presenting a paper entitled "Slips, Trips and Needlesticks: Updating Dentists' Health Issues", and also chairing a workshop on the action required to better address dentist health issues.

Join with colleagues from other health professions to consider how we can create professional communities in which health care is given a preventive priority.

The total conference program promises to be thought-provoking and topical with international keynote speakers, discussion groups, presentations, and supporting trade displays.

To review the conference program and register, click here.

Queensland Review Supports Fluoridation

According to the Queensland Health System Review (Forster Review):

"Queenslanders have the lowest standard of oral health in Australia. Public oral health services are unable to meet demand, particularly adult services where treatment is directed to health care card holders and for emergencies. School dental services should be continued whilst service models for adults should be reviewed including informed public debate about the benefits of water fluoridation, targeting eligibility criteria, increasing involvement of private oral health practitioners through flexible local arrangements and developing alternative workforce roles."

This independent review of Queensland Health’s administrative, workforce and performance management systems was announced by the Queensland Government on 26 April 2005. The Forster Review was established in the context of public disquiet about the quality and safety of public hospital services, particularly arising from the circumstances surrounding the appointment and practice of Dr Jayant Patel at Bundaberg Hospital.

An Executive Summary, and a full copy of the final report, is available here.

Dentist avoids jail term via appeal

The result of an appeal to the Supreme Court by Dr George Varnavides, against a VCAT ruling, is reported here.