Budget missed teenage dental needs
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.
plan, Wendell Evans is associate professor, Community Oral Health and Epidemiology, Faculty of Dentistry, The University of Sydney