BILLS - Dental Benefits Amendment Bill 2021 - Second Reading

I rise today to speak on the Dental Benefits Amendment Bill 2021. Before I deliver my speech, I should admit my biases: I am the son of a dentist and the brother of a dentist. Some of the earliest memories I have of my father are sitting at the foot of the dental chair in his surgery while he operated on his patients, drilling teeth and pulling teeth. I look back now—I was very young—and I wonder how some of those patients would have felt having a little two- or three-year-old boy sitting at their feet while their tooth was being pulled out. I have always had a very strong interest in dental care, and I was always interested in what my father was doing.

I also am the proud co-chair of Parliamentary Friends of the Dental Industry, together with the member for Lyne, David Gillespie. I work inside and outside the parliament with this group to make sure that the needs and wants of the dental industry are provided to the wider parliament. My brother Andrew Freelander is an extremely good dentist who specialises in some of the newer dental treatments such as titanium implants, removing the need for dentures in many people. I continue to, through him, have a strong interest in all things dental.

I also remember the arguments that were had—and people don't really remember this—when Gough Whitlam introduced Medibank and then when Bob Hawke introduced Medicare. There was a strong push to have dental treatment included in the Medibank system and later in the Medicare system. In many ways it's very sad that we didn't do that, because there is increasing evidence that good dental care is a very strong promoter of good health care, and the association between poor dental care and chronic illness is well recognised. It's always been my belief that health matters are above politics, and I found my membership of the Parliamentary Friends of the Dental Industry, along with David Gillespie, a very good way to promote the importance of dental and oral health and its association with good wider health care. I've worked as a paediatrician, as you know, for many years and during that time I've come to recognise the importance of good paediatric dental care. One of the great tragedies of Australian health care is that I can actually tell a parent's income by looking in their children's mouth and seeing their dental care. That just should not happen in a developed country like Australia.

The Child Dental Benefits Schedule was introduced in 2008 to provide children between the ages of two and 17 access to financial benefits for dental care. Labor introduced this reform, and it's provided over $2.3 billion in benefits to Australian children. That $2.3 billion would have been multiplied many times in overall health care over the time of that scheme. We know that children who develop good oral hygiene and good dental care in the preschool age group have better overall health. There is some evidence that they also have better overall development than their peers who don't get good dental and oral care. Over three million children have avoided the pain and the physical and mental health impacts from poor dental health care over the time of the scheme. They've also benefited by there being less of a financial burden on their families, so it's been a very, very good scheme.

The amendment bill we're debating today lowers the age of eligibility from two years to zero years. People may well wonder how important that is, because many people believe that children's teeth don't develop until they're six to 12 months old and that their primary teeth aren't all that important because they're replaced by their secondary teeth. But that's not true. Some children are born with teeth. About one in 2,000 children have what are called natal teeth; they're born with a tooth, or sometimes more than one. That can be part of their primary dentition, or it can be a third set of teeth. Being born with natal teeth can often cause problems—for example, with breastfeeding—and very often these teeth need to be removed in infancy. There are also a number of conditions in which teeth development is impacted during the development of the fetus. There's a relatively common condition, called ectodermal dysplasia, where children don't ever develop teeth, and that can cause problems with their jaw development, with their oral health and with their feeding and swallowing. There are conditions that do require dental involvement very early on, even just after birth. Some children have cleft palates or similar abnormalities and have dental abnormalities associated with those, and so they need treatment long before they reach two years of age. So it's actually a very good thing that we're extending the age to from birth onwards. This will be a great relief to parents who have children with some of these conditions, which are often associated with other forms of disability. It will relieve some of the burden on them that they would otherwise bear.

Of course, one of the problems that we have in Australia, particularly in outer metropolitan electorates like mine, is a lack of dentists. We suffer from quite a significant shortage of dentists in Australia, and, in the public dental system, such as at the dental hospital at Westmead or the Sydney Dental Hospital, waiting lists for treatment are measured not in weeks or months but in years.

I am a believer in establishing another dental school in New South Wales. There's only one at Sydney university, which actually has the same number of people enrolled to study dentistry as in the 1940s, so there is a very low number of dentists being trained in Australia. We need to really increase the number of dentists to improve the access to dental care, particularly for disadvantaged people and disadvantaged families. I think an unfair disadvantage is often put on children whose parents can't afford access to dental care, and this scheme is very important in promoting that. Another thing that we should be looking at as a country is training more dentists so people get better access to dental care.

This is very similar, in my electorate, to the shortage of general practitioners. Many people are using our public hospital system because they can't get access to a general practitioner. I've petitioned the health minister on many, many occasions about the changes the government's made to the area-of-need classification for general practitioners which is inhibiting recruitment of general practitioners to work in outer metropolitan areas, like Campbelltown or Macarthur and others around the country. I know Emma McBride, the member for Dobell, has been facing the same problem on the Central Coast—and this is true for many disadvantaged electorates around the country. I've petitioned the health minister about this on numerous occasions. The response has been deafening in its silence, and it's another area where the government appears not to want to provide adequate health care for disadvantaged people.

The lack of dentists is a similar thing. However, this scheme will at least help relieve some of the burden on people who have children with oral and dental problems in the first couple of years of life. We know that, with proper dental care, the lives of these children can be made so much better and so much healthier. Believe it or not, there's a very strong association with good dental care and good cardiac health. Looking after someone's dental health as an infant can have huge impacts on the health system over 50, 60, 70, 80 years, so this is actually a very good thing that we're doing. It also raises the importance, in the public and political eye, of dental care and its importance over a lifetime, not just early on. Bad dental hygiene leads to dental caries or decay in primary teeth, which then causes ongoing problems with jaw development, with eating, with swallowing, with nutrition and with development of the secondary teeth. It can cause a whole range of abnormalities later on in life. It's also very good to get children used to seeing dentists at a very early age and encouraging good dental care and promoting the importance of good dental care. As a paediatrician I see children who don't own a toothbrush. Anything we can do to improve awareness of and engagement with dental care is very important in those kids, and for their kids on an ongoing basis.

This amendment will help Australian families and their children but it will also help, as I've said, education and it will help in getting rid of the stigma carried by people who have poor dental care and poor dental hygiene. I've had people, for example, who've had difficulty getting work because, when they go for a job interview, they have very poor dental care and they feel that inhibits their ability to obtain work. Anything we can do to help that is important.

I've been trying to promote, in this parliament and other places, a program called the first thousand days, which looks at child health from preconception, right through the first two years of life. If we look at the first thousand days, it's a way of providing health care that provides a benefit to that child throughout their lives. The most important time in providing health care and the most important time in promoting health in a child for the rest of their lives is that first thousand days. Part of that is attendance to dental hygiene, and that includes being careful about nutrition and health during pregnancy. We know that there are lots of impacts of poor nutrition on the growth of a baby, and one of those impacts can include poor teeth development, because your teeth develop long before you're born. If we can improve awareness of dental hygiene and dental care in young children, that also includes improving knowledge of the importance of good pregnancy care, for good child health care.

Getting health professionals used to being aware of dental hygiene and dental care is also very important. Many, many people here in Australia aren't aware of the importance of child dental care—this includes many doctors, because they aren't able to refer many children for dental care because of the costs involved. That is another benefit of this policy. It's not infrequent as a paediatrician to have to treat children with dental abscesses and poor oral hygiene because of their lack of access to dentists. That's certainly true in some communities that I've had to deal with over many years.

I think we need to be looking at this as a holistic health policy. I think to have other members in the House talking about this has been very important. I'm glad it has bipartisan support. I do think it's imperative that the government looks further in terms of providing dental care. As I've said, I've always been a supporter of the involvement of dental care in the Medicare system; that's something I would actively support. I realise there are significant costs involved, but dental care is just so important for overall health care that it's something, as a parliament, we should be embracing.

I support this bill. I think it's a really good start to improving child health care and I commend the bill and the amendment to the House.