July 2017

The Medicine

A pain in the tooth

By Karen Hitchcock
What happened to Australia’s publicly funded dental system?

We spend a lot of time in queues. People will wait in line for a seat at a momentarily hip ramen joint, to secure a trickle of government assistance or some discount Louis Vuitton. All day every day they’re waiting for treatment outside hospitals’ emergency departments. We trade in our time and comfort for the things we need or really want. The older and richer you are, the less time you will squander anticipating your turn.

In primary school I spent an inordinate amount of time queuing for things I didn’t want: vaccinations, nit inspections, a check-up in the dental van.

The Commonwealth-funded van would visit our school a few times each year. A short-tempered trainee dentist and his female assistant ran it, and there’d be one kid mouth-open in the recliner and another kid ready in a seat to the side. I copped a lot of pain in that van. One time the dentist wouldn’t believe that his giant needle had failed to numb the tooth he was drilling, and yelled at me to stop edging down the seat as I tried to escape. I experienced the most memorable pain while waiting for them to treat my classmate Patrick. He was only up there for a few minutes before the assistant asked him the colour of his toothbrush. Patrick said it was yellow. The assistant sneered, “Is that so? We’re surprised you can even remember. You do realise that your breath smells so bad the dentist has had to put on a mask?”

The van staff made no effort to disguise their hatred of this job. They were wheeled out to the freeway suburbs, time pressured, physically cramped, preposterously young, completely unsupervised and without a single parent to thank them. But they had to learn on someone. Might as well be on those who had no other way to pay except with a bit of suffering. Turns out we were lucky. Born a couple of decades earlier and I may have had the lot extracted and replaced with a set of “low-maintenance”, “germ-free” dentures. If not for free, then perhaps as a 21st birthday present or “dental dowry” (reassurance that a future wife’s teeth wouldn’t send you bankrupt). At the time of my contact with that shakily benevolent van, 60% of men and 71% of women over the age of 65 in Australia were edentulous. That is, they were completely toothless.

Compared to the current state of publicly funded dental services in Australia, the dental van sounds as luxurious as cut-price Louis Vuitton. If you are poor you can still get free dental treatment, but you’ll wait up to seven years. We may have been mildly tortured and occasionally humiliated, but that dental van prevented a lot of future trouble.

People rarely get all their teeth removed anymore, and when they do it’s generally at their own request. When you’re in a queue that’s seven years long and have a sore tooth, a request for “definitive” treatment is hardly surprising. Only 14% of Australian dentists work in the public system. I’ve never met any of them but I completely understand if they’re in a permanent bad mood. The exclusion of dental care from Medicare was supported by dental associations worried that government funding would bring with it government control. What profession would choose that over the riches available in the free market?

Both of my daughters had braces fitted last year. One had extremely prominent front teeth caused by a vigorous thumb-sucking habit. The other had a minor overlapping of her two front teeth. They saw the orthodontist – a man with gleaming white offices, terrifically attractive assistants and exquisite shoes – and he recommended the braces and three-year payment plan. The braces hurt them for a few days and thereafter caused no major issues. But this week they came home from their check-up with their little cheeks swollen up like a chipmunk’s. Their teeth were so straight by now I’d half expected him to declare further bracing unnecessary. Instead, he’d inserted sets of fat medieval-looking springs: a scheduled part of the treatment I’d apparently forgotten. The girls authoritatively told me the springs were necessary to “correct their overbites”. They noticed my sceptical look and told me – wide-eyed – that if they didn’t get the minor abnormality fixed they might need “jaw surgery” later on. Then they refused dinner and miserably took to bed.

I remembered the horror of being a young girl too intensely to have insisted my daughters learn to live with buck teeth. Dental malformation has become a potent signifier of poverty and a long list of other unjustifiable assumptions that I’m sorry about but not prepared to use my own children to protest. But to move an entire jaw forward, to inflict that kind of pain on a couple of 12-year-olds who looked perfectly fine? I needed evidence that the intervention would prevent a serious long-term health problem. So, guilt-stricken and conflicted, I spent a night among the dentistry journals. The sceptical look on my face found no reason to remove itself. There is virtually no evidence that “malocclusion” affects the health of the “masticatory apparatus” unless the overbite is “traumatic”, the incisors self-mutilating or the teeth wildly impacted. The studies even fail to prove any emotional ill effects of dental irregularity.

Our primary school suffering saved our teeth and provided a generation of dentists with intensive training. My daughters’ pain was serving nothing more than a fairytale of bite perfection. In a country where dentistry costs big dollars, children are lucky if their parents can pay. When it comes to orthodontics, parents should question exactly what it is they’re buying into.

Karen Hitchcock

Karen Hitchcock is a doctor and writer. She is the author of a collection of short fiction, Little White Slips, and the Quarterly Essay Dear Life: On Caring for the Elderly.

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