Katie Allen (Higgins, Liberal Party) Share this | Hansard source

I rise to speak on the Dental Benefits Amendment Bill 2021. Oral health is fundamental to overall health, wellbeing and quality of life. A healthy mouth enables people to eat, speak and socialise without pain, discomfort or embarrassment. The impact of oral disease on people's everyday lives is subtle and pervasive, influencing the way we eat, the way we work, the way we sleep and, indeed, our social interactions. The prevalence and recurrence of these impacts constitutes a sil ent epidemic if left untreated.

Dental diseases lead to pain, discomfort and tooth loss and can lead to difficulties with chewing, swallowing and speech. Poor oral health can lead to problems with nutrition and general health and disruptions to sleep and productivity , and can be a barrier to full participation in society, including the ability to gain employment. Indeed, the national study of adult oral health indicates that, of the Australian population, 24 per cent avoid ed food due to dental problems—that's one in four people—20 pe r cent experienced regular tooth ache, 35 per cent were uncomfortable about their dental appearance and 24 per cent rated their oral health as fair or poor. There are also links between poor oral health ; g eneral diseases, including type 2 diabetes ; and cardiovascular health.

Most importantly, dental health is cumulative in nature, and poor oral health in childhood is a predictor of poor oral health throughout life. It's the great inequity of health care. Therefore, it's critical to ensure that young children have access to preventive dental care from an early age to give them the best possible chance of good oral health for life. That is why I welcome the bill being debated here today.

This bill amends the Dental Benefits Act 2008 to remove the lower eligibility age restriction of two years so that all children under 18 can access the scheme. I know from friends, colleagues and constituents how much they have enjoyed using the dental benefits scheme for their children, and I really welcome this extension to the under-2 age group.

The amendment is based on the Report of the fourth review of the Dental Benefits Act 2008 and has been developed in consultation with stakeholders. The review committee included the Commonwealth Chief Medical Officer, representatives of the Australian Dental Association, Consumers Health Forum of Australia, private dental practitioners, dental advisers to the Department of Veterans' Affairs and the Department of Health, as well as Oral Health Services Tasmania. Stakeholders that were consulted, including state and territory dental health services, Services Australia, the federal government Indigenous health division and academic dental professionals, all agreed that, if parents promote and practise good oral hygiene with their children from a young age, this will help in the prevention of more serious dental decay as their children grow up. It's a fact that is widely understood by parents, experts and the community. Any parent who has tried to clean their kids' teeth when they're very young will understand how difficult that can be, pragmatically.

Before the passage of this bill, eligible children aged between two and 17 years are currently entitled to access up to $1,300 in benefits for basic dental services, with benefits capped over two consecutive calendar years. This bill removes the minimum age of eligibility so that children under two years of age can access this scheme. Services that receive a benefit under the program include examinations, X-rays, cleaning, fissure sealing, filling, root canals, extractions and partial dentures where necessary. Services can be provided in a public or private setting, but benefits are not available for orthodontic or cosmetic dental work.

One in three Australian children experience tooth decay by the age of five or six years, and tooth decay is the leading cause of preventable hospitalisation in Australian children. Most people don't realise this. It is actually quite extraordinary. As a paediatrician, I worked with Professor Nicky Kilpatrick on a number of oral health initiatives, particularly for orofacial granulomatosis, which is an oral expression of Crohn's disease. I know how difficult management of oral health is in young children.

There are three key things that parents can do to look after their children's oral health. One of the most important ones is to reduce the amount of added sugar that they consume. They need to help their children to brush their teeth twice daily, with fluoride toothpaste, to clean between the teeth—essentially, to floss—and to attend their dentist for regular dental check-ups. We know that sugar in food and drink is a major contributor to tooth decay today. Children aged two to three years of age, on average, eat nine teaspoons of added sugar per day, and teenagers eat even more. They eat 20 teaspoons of added sugar per day. The World Health Organization recommends reducing added sugar consumption to fewer than six teaspoons per day to minimise the risk of tooth decay but also to avoid obesity and type 2 diabetes. WHO is clear: oral hygiene measures are important in preventing tooth decay and gum disease through the regular removal of plaque bacteria that cause disease.

Guidelines also tell us that fluoride in toothpaste helps to strengthen teeth to prevent tooth decay from starting and also helps to repair the early signs of damage to teeth. This is also why water fluoridation and drinking tap water are important. Don't just drink water from a bottle. Make sure you drink tap water. We are lucky in Australia that most of our water is fluoridated. I'm of the age when, growing up in country Victoria/New South Wales, in Albury-Wodonga, our water was not fluoridated, and we had to take daily fluoride tablets as children.

Because of high-sugar diets, dental disease still does occur—even though we have excellent rates of fluoridation in Australia—particularly for those who use fruit juices early in life. Having worked in developing countries, I can tell you that fruit juice decay is simply awful and incredibly dangerous. Even when I worked in the United States, people in disadvantaged communities would give fruit juice in bottles to their toddlers, and these toddlers would come into hospital with completely black teeth. Unfortunately parents did not know that sugar on the teeth of children is a solvent and can actually rot their teeth. And fruit juice is not what people think. It has a lot of added sugar; it's just not declared in a way that you would think.

Tooth decay in children progresses rapidly from an early lesion that can be reversed to a large cavity that might require extraction or, worse, result in a nasty tooth abscess. Regular dental check-ups, particularly in high-risk children, are important for early detection of disease and to ensure that appropriate prevention strategies and modifications to risky behaviour can be implemented. The Australian Dental Association recommend that a child's first dental visit should occur when the first tooth erupts, which is usually around six months of age, or by one year of age. Tooth decay in Australia has a strong social gradient, with a higher burden of disease amongst children whose parents are from vulnerable population groups, including Aboriginal and Torres Strait Islanders, people from a non-English speaking background, people from regional and rural areas and people from a low household income or educational background.

The Medicare Child Dental Benefits Schedule provides vital funding to ensure that these vulnerable children are able to access the necessary health care to help prevent and treat dental disease. However, the current eligibility requirements have until now prevented children under the age of two from accessing the scheme. It is estimated that around 20 per cent of children already experience tooth decay by the age of two years and many of those require irreversible treatment, often under general anaesthetic. This treatment is traumatic for the child and their parents, and can continue to longer-term issues of fear and anxiety, which can impact on future dental visiting patterns and create a risk of ongoing dental problems. I know because, as a child, I had a serious and significant dental phobia, which meant I avoided going to the dentist for many years—until I developed a tooth abscess and quickly got over my dental phobia because the pain was worse than the fear of going to the dentist. So I know how hard it is. But that's because, in the old days, there wasn't fluoridation and we had many more visits to the dentist. And we are now seeing much better dental health care.

If this bill is passed, it will enable vulnerable children to visit the dentist from an early age and avoid more complex treatment and hospitalisation for care and, hopefully, avoid dental phobia in the future. Unfortunately, only 56 per cent of children aged five to six years have visited the dentist before the age of five, and this decreases to 46 per cent for children from low-income families. Financial cost is a major barrier to accessing dental care for many families, and the Child Dental Benefits Schedule provides an important mechanism to address this. As we heard from the previous speaker, this bill will support 45,000 families to access dental services each year. It's something all of us in the House should be proud of, because this is about children's future.

A recent study investigated the impact of COVID-19, however, and we know that dental services have taken a real hit because people have been locked down and unable to access dental health care. This is something I would like to comment on in the last few minutes that I have. In Victoria there were 881,000 fewer dental services provided in 2020 than in 2019—a reduction of 27 per cent. There was also a great decline in preventive and diagnostic services. Dental practices in my home state of Victoria in particular have gone through six periods of restriction of their ability to provide dental services since the pandemic began. For nearly six of the last 18 months, patients were restricted to mostly urgent or emergency dental care only. The COVID pandemic has had a significant impact on the provision of dental services—in particular, to children from low socio-economic backgrounds, who already experience higher levels of dental disease and disadvantage in accessing dental care.

To those listening: please don't delay your dental health check-up. Your teeth are some of your most important health assets. That is why I support the amendment and that is why it is so important. I commend the bill to the House.

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