GP support for changes that would help end ‘cycle of poverty’

Barriers to dental care for vulnerable patients and communities need to be removed, according to a new RACGP submission to an ongoing Senate Inquiry.
 
The Select Committee into the Provision of and Access to Dental Services in Australia is due to present an interim report by 20 June and has sought feedback about people’s lived experiences with that part of the healthcare system.
 
While dental care is not commonly undertaken by GPs, the RACGP submission nonetheless points out that the health of all Australians depends on having a well-funded and skilled primary care sector, which includes oral health.
 
‘Poor dental care can lead to poor nutrition, cardiovascular disease and affect a person’s wellbeing, e.g. the ability to get a job and preserving their self-esteem,’ the submission states.
 
‘Significant financial barriers to accessing dental care remain in Australia. Socioeconomically vulnerable patients are at higher risk of oral disease and people on low incomes are more likely to delay dental visits and less likely to receive appropriate dental care.
 
‘Further support [should] be provided for more public dental health services to be made available so vulnerable patients and communities have access to affordable dental care.’
 
The fact most dental care in Australia is only available via private services poses a ‘significant barrier’, the RACGP contends, while the common requirement for patients to make a co-payment also makes it unaffordable for many.
 
As a result, an increasing number of people from disadvantaged populations present at general practices with oral health issues, for which GPs can only provide ‘limited support’.
 
Dr Liz Sturgiss, Chair of RACGP Specific Interest Deprivation and Poverty, told newsGP the submission accurately highlights the lack of access to dental care for vulnerable people, as well as the associated health impacts.
 
‘Poor dentition has wide ranging effects on health – from inability to chew and therefore inadequate nutrition, to impact on wellbeing and mental health,’ she said.
 
‘People with poor dentition [also] have more trouble accessing employment due to stigma. It’s a cycle of poverty that is difficult to get out of.’
 
The RACGP identifies prevention as the most cost-effective way to reduce the burden of oral disease, and said GPs are well placed to identify those at risk of dental decay and periodontal issues.
 
However, there are other factors in addition to cost affecting people’s ability to access care, with a lack of services in rural and remote areas said to be particularly problematic.
 
‘The services that are available can be limited, with more complex procedures requiring referral to public dental services … often with long waiting lists and long-distance travel,’ the submission states.
 
‘This is a bigger issue in rural and remote settings, but it is also an issue in metropolitan areas. The limited access to public dental services, for both children and adults, will also impact on the treatment offered.
 
‘For example, people are only offered tooth extraction compared to a private dentist whose service would offer tooth-saving procedures that take more time.’
 
It is a point supported by Dr Sturgiss, who said people need to have severe pain to be able to access emergency services.
 
‘There is very little availability of public dental services,’ she said. ‘Waiting times for non-emergency work runs into many months and usually patients have to provide a co-payment.’
 
Aside from removing barriers to dental care, the college says oral health can also be improved by ensuring fluoridated water is accessible across the country, particularly in rural and regional areas.
 
‘The use of fluoride in water, or topically, reduces dental decay in children,’ the RACGP submission states.
 
‘More than 90% of the population in Western Australia, South Australia, Victoria, New South Wales and Tasmania … have access to fluoridated water. In comparison, 76% and 78% of the population in Queensland and the Northern Territory, respectively, have access to fluoridation.
 
‘The majority of those with no or limited access reside in rural and regional areas.’
 
Meanwhile, in regions where access to dental services is poor, the college believes Government should ensure health professionals can access appropriate training to deliver preventive care.
 
‘There is often little to no preventive dental care provided in rural and remote areas due to lack of resources,’ the RACGP says.
 
‘In service poor areas, timing can be critical when addressing trauma presentations and delays to care can have significant impact on the prognosis of oral hard and soft tissues.
 
‘As a consequence, GPs working in rural and remote communities have a greater need to maintain their skills and knowledge in dental care.’
 
The Committee’s full report is expected to be handed down on 28 November.
 
RACGP oral health resources  

• Emergency dental for rural GPs webinar
• Management of dental trauma by GPs

dental care deprivation and poverty oral health socioeconomic determinants of health