Bud­get missed teenage den­tal needs

The Weekend Australian - Travel - - Health - WEN­DELL EVANS

THE La­bor Gov­ern­ment pledged on Tues­day night to in­tro­duce a so-called pre­ven­tive den­tal plan for teens, but the long-awaited bud­get de­tails re­vealed a dis­ap­point­ing pack­age — $150 per el­i­gi­ble teen per year for a so-called pre­ven­tive check, in­clud­ing an oral ex­am­i­na­tion, scale and clean, and x-rays where re­quired.

But un­for­tu­nately, the teen den­tal plan will not fund the fur­ther ap­point­ments to ei­ther treat es­tab­lished dis­ease or pre­vent fu­ture prob­lems. With­out fund­ing for flu­o­ride treat­ment, fis­sure sealants, fill­ings and fol­low-up ses­sions, there will be lim­ited ben­e­fit to young pa­tients.

This is par­tic­u­larly dis­ap­point­ing as dur­ing the elec­tion cam­paign La­bor promised $510m for a teen den­tal pro­gram, but only $346m was de­liv­ered.

Still, it is good to learn that La­bor will in­tro­duce a teen den­tal health pro­gram and more so be­cause it is touted as pre­ven­tive. This is im­por­tant for sev­eral rea­sons.

At the be­gin­ning of the teen years the last of the de­cid­u­ous teeth are lost and teens get 12 new per­ma­nent teeth. Later, at the end of the teen years, the fi­nal four wis­dom teeth be­gin to ar­rive.

All of th­ese new teeth are of the most vul­ner­a­ble type — they have fis­sures on their bit­ing sur­faces that can­not be cleaned ad­e­quately and there­fore are in need of pro­tec­tion, for in­stance, with sealants.

In ad­di­tion, since it’s not pos­si­ble to brush in the spa­ces be­tween teeth, so-called hid­den de­cay’’ may de­velop at th­ese sites, es­pe­cially at the back of the mouth. This is why it is nec­es­sary for den­tal prac­ti­tion­ers to use x-rays to see’’ be­tween the teeth.

Th­ese sites also are in need of pro­tec­tion, es­pe­cially dur­ing the teen years when risk of de­cay is great­est be­cause the tooth min­eral (enamel) on the sur­faces of new teeth is im­ma­ture.

Flu­o­ride from drink­ing wa­ter and from tooth­paste has three com­ple­men­tary func­tions: it speeds up the enamel mat­u­ra­tion process, re­duces the risk of dem­iner­al­i­sa­tion (de­cay), and strongly en­hances nat­u­ral re­pair (rem­iner­al­i­sa­tion) of early de­cay.

It should be re­alised, how­ever, that some chil­dren are more at risk of de­cay than oth­ers and their teeth need ad­di­tional, pro­fes­sion­ally ap­plied, flu­o­ride var­nish to bol­ster enamel mat­u­ra­tion and the nat­u­ral re­pair of early de­cay. In sum­mary, teens’ new per­ma­nent teeth — which must last for a life­time — are vul­ner­a­ble to de­cay.

‘‘

But the good news is that, to a very great ex­tent, this risk can be re­duced, the early signs of de­cay can be stopped, and tooth enamel can be rem­iner­alised if — and this is the point — teens could have ac­cess to a well-de­signed pre­ven­tive den­tal health pro­gram.

But what was an­nounced this week is not a pre­ven­tive scheme. Be­sides, a one-size-fits-all plan is not an ef­fi­cient use of re­sources; much would be wasted.

If a scheme is to be la­belled as pre­ven­tive’’, it must con­tain spe­cific pre­ven­tive el­e­ments.

As well, it’s been shown that a scale and clean — the cen­tre point of the teen pro­gram — even if car­ried out three times yearly, con­trib­utes ab­so­lutely noth­ing to dis­ease pre­ven­tion.

And what does x-rays as re­quired’’ mean? All teens need x-rays to iden­tify signs of hid­den de­cay. This im­por­tant in­for­ma­tion is needed for risk clas­si­fi­ca­tion pur­poses as well as to iden­tify treat­ment needs.

But treat­ment is not part ap­par­ently.

A proper pre­ven­tive plan should pro­vide for spe­cific ev­i­dence-based pre­ven­tive mea­sures ac­cord­ing to risk. All teens should be coached on sev­eral oc­ca­sions to achieve a high stan­dard of oral hy­giene us­ing a tooth­brush and flu­o­ri­dated tooth­paste in or­der to re­duce the risk of both tooth de­cay and gum (pe­ri­odon­tal) dis­ease.

In ad­di­tion, for those at greater risk of de­cay — as as­sessed on the ba­sis of a den­tal check-up and x-rays when signs of early de­cay may be re­vealed — sealants may need to be ap­plied to the fis­sured bit­ing sur­faces of some teeth and flu­o­ride var­nish may need to be ap­plied to sur­faces of other teeth.

For those at risk of gum dis­ease, also de­ter­mined dur­ing a den­tal check-up, more in­ten­sive pre­ven­tive tooth clean­ing strate­gies along the gum mar­gins will need to be put in place. Only a plan that con­tains th­ese el­e­ments can be cat­e­gorised as pre­ven­tive. A check-up, by it­self, is a waste of time, money, and ef­fort and can­not pos­si­bly yield any ben­e­fits what­so­ever.

of the

plan, Wen­dell Evans is as­so­ci­ate pro­fes­sor, Com­mu­nity Oral Health and Epi­demi­ol­ogy, Fac­ulty of Den­tistry, The Univer­sity of Syd­ney

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