Most cases of emergency medical treatment for deep neck infections at Royal Darwin Hospital could have been avoided with early dental treatment, according to a recent study.

The research, spearheaded by Dr Mahiban Thomas, a head and neck surgeon and also Chair of the NT Regional Committee of the Royal Australasian College of Surgeons (RACS), put the spotlight on the lack of funding for dental services in the Northern Territory (NT) Health system.

Dr Thomas said, “Most of the infections that we see could have been treated as simple dental infections at one point in time, but by the time they get to us they have become life threatening. For example, a patient might not be able to breathe properly.

“Surprisingly head and neck infections occur in typically younger patients with a median age under 30, and more likely in males. These problems are far more common in people that overuse alcohol or tobacco, and Aboriginal and Torres Strait Islander patients were significantly overrepresented in our numbers.”

Aside from the lack of funding, Dr Thomas also believes that misappropriation of the budget, is partly to blame for the incidents of life-threatening dental infections.

“In our (5 month) study we calculated that the cost of treating these patients in hospital was almost $390,000, which would equate to approximately $935,000 over a one-year period. If we spent this money on clinical dentists instead we could halve these costs and relieve pressure on hospital beds.”

“In the NT unless you have a health card or a pension card you are reliant on private dental cover, which is a significant barrier to those who can’t afford it. Most other jurisdictions have greater public access to dental services, for example there are dental schools where patients can get care for free or for very little. Unfortunately we don’t have anything like that here” Dr Thomas said.

He also thought that changing the strategy and investing in senior dentists can help in the long run.

“It makes sense for the NT government to change its strategy and to invest in senior dentists within the hospital system who will help to work with these clients, and to defuse the situation before it goes too far. Ultimately this will save money, save bed spaces, and reduce the surgical workload allowing us to focus our attention on other areas of need.”

Dr Nomikos Rakkas, President of Australian Dental Association NT Branch (ADANT) has this to say:

“The first simple point I would like to make it that there is an oversupply of dentists Australia wide. This has been building for some time now and the Northern Territory is no exception. We have far more dentists being trained in Australia than is needed and this is projected to worsen over the years ahead.

As a result many private dentists across Australia are actually struggling for work and this again is no different in the Northern Territory.

So my point of clarity is simply that there is no dental shortage in terms of workforce supply numbers in Australia or the Northern Territory and that a rumored dentist shortage is NOT the cause of increased emergency care admissions due to dental disease. There was a recent article in the NT News on this same topic and we were horrified as the article suggested this problem was linked to a dental shortage in the NT.

No doubt there is a lack of services in rural and remote areas but there are economic constraints with operating a dental clinic in rural and remote locations including facilities, equipment and servicing etc. The generic contrast I like to make is the difference between a GP practicing and needing simply a laptop, stethoscope, briefcase, etc (like a mobile GP) in a rural location. In contrast to a dentist who needs to operate with a dental nurse, dental chair (requires air and water services), drills, x rays, computer software, sterilization equipment and processing areas, complex dental equipment and materials which expire and need complex storage conditions. Not to mention requirements for servicing and certification of the dental chairs and x ray equipment etc, which needs to be done by FIFO workers in these locations at significant costs. So it is often the very high costs of operating a dental facility and having a sufficient patient base in the clinic to make it economically feasible that restricts the supply of dental services to rural and remote areas. This is why there is a shortage of dental services in these areas. NOT because there is a lack of a dental workforce. This is applicable both from the standpoint of private practice feasibility and from a public funding perspective. In contrast, the economics of operating a dental practice is also why the greatest oversupply of dentists are located in urban areas. This is no different for Darwin in the NT which has an oversupply of dental providers.

On the other hand, due to a current dentist oversupply there is a huge capacity for private dental practitioners and clinics to work collaboratively and support the Northern Territory public dental system to help provide timely care for patients in need at an early stage to help prevent these problems. Solutions such as a private dental outsourcing models and an emergency after hours private dental roster at the hospital have been solutions ADANT has advocated for and we are actively working towards make these a reality.

There is no secret that the challenge lies in providing appropriate and timely dental services to the underprivileged and those who live rural and remote. These can be challenging, very costly and difficult environments to provide dental services to. This is a great limiting factor to the capacity of dental funding to service areas adequately. ADANT would always support the move for more dental funding to help service these areas and we support the excellent yet extremely challenging job being done by dental health services in the NT in this area with the limited funding and resources they have available.

My last point is that ADANT agrees that the public hospital system deals with significant number of life threatening or severe infections which could have been cheaply and easily prevented through early intervention by a dentist. Certainly, emergency medical treatment in most cases could have been avoided had dental treatment been earlier. However there are many factors that contribute to the avoidance of dental treatment (which leads to these emergency medical situations). But a shortage of dentists is not one of them.

From a broad perspective there area a range of factors that contribute to patients not seeking early dental care including:

• Access and distribution of services to rural and remote locations
• Public dental waiting lists and eligibility
• Public perception/willingness to visit the dentists
• Lack of culture or apathy towards oral health
• Economic cost limitations to access private care
• Overseas dentistry/poor quality dentistry complicating their presentations
• Poor dental/oral hygiene education in the community
• Appalling rebate clarity, provider choice, flexibility and service coverage of private health insurers”

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