Office of the Public AdvocateThe Office of the Public Advocate (OPA) welcomes the opportunity to respond to the Senate Select Committee Inquiry into the Provision of and Access to Dental Services in Australia.
OPA is a Victorian statutory authority that works to safeguard the rights, interests and dignity of people with disability. OPA also coordinates the Community Visitors Program consisting of independent volunteers who are empowered by law to visit Victorian accommodation facilities for people with disability or mental illness at any time unannounced. They report on issues and concerns relating to service provision and whether residents are being provided with support services to achieve and maintain a high quality of life.
OPA is aware of issues and barriers faced by people with disability in accessing dental services in Victoria which are relevant to a, b and g of the terms of reference.
Article 25 of the United Nations Convention on the Rights of Persons with Disabilities recognises that people with disability have the right to enjoyment of the highest attainable standard of health without discrimination on the basis of disability.1
OPA is currently undertaking a project with a human-rights approach called Healthy discussions that aims to support health practitioners throughout Victoria to improve their communication with, and understanding of, people with disability. The heart of the project is the voice of people with disability.2 OPA’s Healthy Discussions project coordinator recently met with volunteers from the Community Visitors Program to consider the issue of lack of access to timely and appropriate dental care for people with disability. The Community Visitors Program had identified over 50 dental care issues in the period 2021-23. Community Visitors have reported on dental care issues in their annual reports to Parliament.
Community Visitors reported residents having difficulty obtaining timely and adequate dental care. In one instance, where there was more than a two-year wait to attend a special needs dental clinic, local private options were explored. In another case,
routine dental checks were problematic as they required the person to undergo a general anaesthetic.3
- female resident of an SRS displaying serious assaultive behaviours was urgently relocated… The resident was admitted to hospital for a psychiatric review, remaining there for eight weeks. While there, her serious dental pain, which may have contributed to her behaviour, resulted in extraction of nine 4
OPA is aware:
- that while there are specialist services for people with disability, these can be costly and unaffordable for individuals living on a Disability Support Pension
- that while mobile dentists are available to people living in specialist disability accommodation (SDA) and supported residential services (SRS), these services may not be available to respond in a timely way to the range of dental care needs that individuals may have at different times throughout their lives
- that people with disability who are reliant on mobility aids such as wheelchairs or walking frames can face barriers in physically accessing dental care
- there may be times when people with disability exhibit behaviours due to them being in a great deal of pain and discomfort due to a tooth abscess or infection and that these behaviours can be misunderstood
- of reports of long delays in accessing specific services such as the dental hospital and special needs dentist and lack of community dental clinics which are
In relation to the adequacy and availability of public dental services in regional Australia, Community Visitors have shared observations that people with disability living in rural and regional Victoria do not have regular access to community and specialist services that meet their dental needs. For example, a Community Visitor reported that a resident in an SDA property waited an extended period of time for an appointment at the dental hospital in Melbourne. The resident was unable to physically transfer into a dental chair and therefore found it difficult to access a community dental care service. The resident was suffering dental discomfort for approximately six months due to lack of appropriate dental care options in their geographical location.
For improved oral health outcomes in Australia for people with disability:
- community dental care clinics need to be accessible for people with disability
- dental health plans that enable access to regular dental care services each year for people with disability are important
- there should be collaboration of mainstream dental care services and disability support providers
- there should be improved education of dentists and oral hygienists on the needs of people with
Access to a range of quality dental care services is vital for people with disability to maintain their health and wellbeing to enable them to pursue their goals and aspirations.
1 Article 25 states that: …
In particular, States Parties shall:
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Provide persons with disabilities with the same range, quality and standard of free or affordable health care and programmes as provided to other persons, including in the area of sexual and reproductive health and population-based public health programmes;
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Provide those health services needed by persons with disabilities specifically because of their disabilities, including early identification and intervention as appropriate, and services designed to minimize and prevent further disabilities, including among children and older persons;
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Provide these health services as close as possible to people's own communities, including in rural areas…
2 A video developed as part of the project 'HealthCARE Conversations'
3 Office of the Public Advocate, Community Visitors Annual Report 2020-21 (Report, 2021) 27.
4 Office of the Public Advocate, Community Visitors Annual Report 2018-19 (Report, 2019) 38.
