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00:00:01
The Mouth is Part of the Body
0 Plays2 seconds ago
Julie and Dr. Aidan are joined by A/Prof Matt Hopcraft to talk all things oral health.
Should our teeth be as white as we think? Why isn't dental in Medicare? Why are people scared of dentists? Learn all this and more.
Follow Matt's work at Dental as Anything and his campaign to Give Medicare Teeth.
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Transcript
Introduction and Episode Focus
00:00:01
Speaker
Good morning, everyone, and welcome to another episode. I am so privileged today to be here with my wonderful co-host, Julie McCrossin. Julie, bring us in. What are we going to be talking about and what special guests do we have on the show with us today? Look, we're going to be talking oral health. We're going to be talking teeth. We're going to help you to have teeth for the whole of your life, ah which is a goal in itself.
00:00:22
Speaker
And it's just to have someone who is as passionate about teeth as you and I are, Aidan. Love it. Absolutely love it. Look, I'm really excited to just get cracking.
00:00:33
Speaker
Julie, who do we have um on
Guest Introduction: Matt Hopcraft
00:00:35
Speaker
the podcast? This might sting with us today. We have Associate Professor Matt Hopcraft. He is from Melbourne Dental School. He's a dentist. He's a public health advocate.
00:00:44
Speaker
He's worked with all sorts of patients, including in the army for a period of time where you genuinely see a cross-section of the Australian population. And he also has his own podcast advocating good oral health. And I have followed him for years and I'm so glad we're going to talk to him.
00:01:05
Speaker
Unreal. Look, Matt, everyone always asks me about, Aidan, why'd you get into medicine?
Journey to Dentistry
00:01:09
Speaker
So I have a question for you, Matt. Why teeth? It's a really good one. And thanks for the lovely introduction too, Julie. It's great to actually be talking to you face to face after, i think, following each other for such a long time and advocating for really similar things.
00:01:22
Speaker
I grew up in regional Victoria and in a small town, and I was really interested as a relatively young kid in health. And I wanted to be a doctor originally. And I spent some time doing work experience in a doctor's clinic and at the hospital.
00:01:37
Speaker
And it was really, really fascinating. I really liked that idea of being able to help other people. um And then i was at my dentist for my regular checkup. I was probably in about year 10 or year 11.
00:01:50
Speaker
And he asked me, what do you want to do And I said, I'm going to be a doctor. And he said, you're an idiot. You should be a you should be a dentist. It's much more. he He said the hours are better. No on call.
00:02:01
Speaker
And I thought and didn' never really thought about it, but it's health. And you think about this, the really broad spectrum of health out there. So I went down and I did... work experience with him.
00:02:11
Speaker
And I think to sit chairside with him and see the impact that he was having on his patients in this local community, um really transforming lives. And I was really hooked. And I liked the idea of working with my hands, helping people.
00:02:28
Speaker
And so, yeah, from that moment on, I ditched the, I want to be a doctor and became an, I want to be a dentist advocate. I love that. If you had like ah a one-liner for anyone who's thinking of getting into dentistry as a young person, what would you tell them?
00:02:42
Speaker
I'd probably steal that one line from Nike and say, just do it. But I think for anyone, it's find out something that you're really passionate about. and and follow that path as best you can. i also I'm a big advocate, I think, for people really trying new opportunities. And I think a lot of people really get stuck down a particular path. And I think through my career, I've sort of opened doors and walked through them. And sometimes it works and sometimes it doesn't, but trying things.
00:03:09
Speaker
um And definitely, I think for me, that that work experience opportunity, that that opportunity to see up close what people actually do, I think is really important. And I think for a lot of us,
00:03:20
Speaker
our experiences in health, for example, are not the same as what a lot of people experience in health. And up until that stage, my experience with health was pretty narrow. My experience with dentistry was pretty narrow. And so I think you have ah an idea in your head about what some of these jobs do, but not until you sit down and follow someone around. so I think for anyone out there who's listening, who's passionate about a career somewhere, you know go and go and follow someone around for a little bit.
00:03:50
Speaker
Unreal. Matt, thank you
Fluoride in Water: Benefits and Concerns
00:03:51
Speaker
so much. My first question is, I'm in healthcare care day in, day out, and with RFK Jr.'s sort of presence in the US and ah the horror of the public health nightmare going on over there, slowly encroaching onto our shores, people are becoming more and more skeptical about things that we used to take for granted.
00:04:10
Speaker
And one of the questions I'm starting to hear murmurs of is fluoride and fluoride in the water. And is it good for me? Is it going to give me brain damage? do I need to protect my baby from it? Now, as a health professional, I'm a hundred percent pro fluoride.
00:04:25
Speaker
The more fluoride, the better. I have it in my toothpaste. I have it in my water, but I actually don't know what the exact details are. And I'd love you to just give us a bit of an insight into why we should be so grateful to have fluoride in our water.
00:04:38
Speaker
Yeah, that's a really good question, Aidan. And I share that concern. you know Last year when there was talk about you know a Trump presidency and RFK becoming the health secretary, he was very strong back then about removing fluoride from water. I think Utah has just voted to remove fluoride from water over there. and And it's a real concern. And it goes to this issue of a loss of trust in institutions, in health professionals. And that's something that's been simmering along for a long time. But on the issue of water fluoridation, I think that the CDC nominated it as one of the top 10 most important public health measures of the last century, up there with reducing tobacco use and seatbelts and a number of other things. It's been so instrumental in
00:05:22
Speaker
helping to reduce tooth decay and and particularly reducing inequities in health. And one of our big things, I think, health broadly is inequity and disadvantage. And we see so many diseases that are concentrated that have a much higher burden in disadvantaged population groups. And whether that's based on education or income or language or background, all sorts of things, we always tend to see these diseases clustering much more in those areas of disadvantage.
00:05:50
Speaker
And the real advantage of water fluoridation, you know it's free, it comes out of the tap, everyone drinks it, and so it it helps to reduce that inequity.
Public Health and Water Fluoridation
00:06:00
Speaker
There have been concerns about the health impacts of fluoride pretty much since it started. And there's conspiracy theories, it's a communist plot, it's mind control, it's been in in movies.
00:06:12
Speaker
But the evidence just keeps coming back time and time again. The NHMRC did a big review um about seven or eight years ago now. No no evidence of cancers, thyroid problems, bone issues.
00:06:24
Speaker
The latest sort of battleground is now around cognitive decline and IQ. And there's a number of really poorly done studies in parts of the world where water fluoridation occurs naturally and at quite high levels.
00:06:37
Speaker
that seems to suggest maybe there's a risk. But at the levels that we use it here in in Australia, at about one part per million or less, no evidence of harm. There was a study in Queensland just recently and you know looked at, or actually all of Australia, but run out of the University of Queensland. Again, showed no difference in ah IQ levels between kids with access to fluoridated water or not.
00:06:59
Speaker
So Matt, what I'm hearing is We know has a massive benefit on the population. We know that there's absolutely no harm. There's a net positive good. And I guess when I'm hearing things like health inequity, what ah you and I see actually is young kids who come in with mouth diseases, painful teeth. They can't eat properly. They can't chew properly. They get less nutrition.
00:07:19
Speaker
They get exposed to bacteria in their mouth, which then seeds into their gums, which causes horrible ear, nose and throat diseases. They get heart disease. Those are all the real world like smack bang in front of me, wow, these people are really suffering and sick. It all comes back to oral health.
00:07:34
Speaker
I just wanted to say the CDC is the Centre for Disease Control in the United States. The NHMRC is a National Research and Medic. Help me, Aidan, what does it stand for? The National Health and our Medical Research Council in Australia. It's our peak research authority that looks after medical research in Australia.
00:07:52
Speaker
Exactly. So i think we should, let's talk in language so people can understand, explain that these are the critical sources of the evidence that we need. And I think the Centre for Disease Control is one of the many agencies under threat at the moment.
00:08:06
Speaker
But you described you're seeing children coming in with very poor teeth. And when we were talking about fluoride, my dad was a dentist and then an orthodontist. Okay. hear talk about what they do later. I remember he said after fluoride came in, he stopped seeing um teeth at the front of the mouth of children that need to be filled. He literally saw the benefit in the mouths of the children. And I think that's such an important...
00:08:32
Speaker
ah a visual message of the positive impact of fluoride. but And yet, Ayn is talking about seeing children without it. and like So my question, Matt, is this. You mentioned you come from a rural area and I know you're interested in the mental deserts. I think you're giving a paper on it in Tasmania later in the year.
00:08:51
Speaker
but There are areas of Australia where the water is not fluoridated. It may be because they're using tank water. In Adelaide, I'm living in Adelaide these days, a lot of people buy their water because they don't find the Adelaide water potable, I think is the right word. It's not nice to drink. It's got a bit of a smell.
00:09:11
Speaker
Others swear by it. But there's many parts of Australia where people are buying water. What's the practical implication, particularly for our kids? Yeah, it's a really interesting one, Julie. So about 90% of the population would have access to fluoridated drinking water um and about 10% don't. But in somewhere like Queensland, where they we talked about Utah before and in America, removing fluoridation, Cook County in far North Queensland voted at the start of this year to remove fluoride from their water as well. Now, relatively small population, I think Cook Town, about 3,000 people.
00:09:47
Speaker
But Queensland now has dropped to about 70% of the population with access to fluoridated water. And it tends to be regional areas that don't have access. Here in where I live in Victoria, it's about 90%, but the 10% that don't are living predominantly in regional areas. So there's this huge kind of geographic issue. And then as you say, this trend towards bottled water, I think is a really significant one. I think we've seen um that probably play out with rising levels of tooth decay. One in three kids in Australia now has tooth decay by the age of five to six in their baby teeth.
00:10:23
Speaker
And a lot of people say, well, they're just baby teeth. You know, they fall out. But tooth decay in baby teeth is a really strong predictor of tooth decay in adult teeth. So by the age of 12 to 14, around about 40% of our kids have tooth decay in their adult teeth.
00:10:38
Speaker
And then it causes those problems that Aidan's talking about, people presenting to hospitals, to GPs.
Preventable Oral Health Issues
00:10:44
Speaker
Poor oral health, the leading cause of preventable hospitalisation in Australia, of all the causes, it's the leading cause of preventable hospitalisation. Adults, older people are ending up in hospitals, clogging up but your hospital system, Aidan, when you know you need to be doing other important work for people because they've got a dental problem that we're not solving. So it's a really big issue.
00:11:07
Speaker
yeah In a second, Aidan, I'd love us to turn to the question of what are the general health problems that are made worse by having oral health problems.
00:11:18
Speaker
But just before I do, I always like to put solutions in as well as problems. If I could just quickly say as ah a grandmother living in Adelaide in a family that can afford dental care, and I always say people who think there's no class distinctions or differences in Australia, just have a look at people's teeth and see if you can hold on to that.
00:11:37
Speaker
But I'm seeing good work here, Matt, and I wonder if you could talk about the work of paediatric dentists. I'll just give it a s snapshot. I've gone along to dental hygienists actually here in Adelaide where there's a massive use of dental hygienists. I might get you to explain what they are and how they work in partnership with the general dentists.
00:11:56
Speaker
But these ah these were women who brought in at my little tiny grandchildren, both under three, got them to sit in adjacent seats. They had toys, they had conversations, they had techniques to get them to open their mouth and cope with things being poked in them.
00:12:12
Speaker
And I thought, wow, this is preventative care at its very best. It's preparing them to accept dentistry, which I'm afraid some adults, cost aside, some adults are afraid of dentists. So just innovations in getting kids to accept dental care.
00:12:30
Speaker
Yeah. And starting early is so important. And yeah we know that that fear, anxiety, phobia is a real problem in adults. And a lot of that in adults now stems from their experiences as children.
00:12:43
Speaker
And so you know we recommend that you should be taking your child to the dentist pretty much as soon as that first tooth starts to come through, which is ah around about the age of six months to a year. And it's not about really...
00:12:55
Speaker
seeing what's going on with those teeth, because the likelihood is very little is going on with those teeth. It's all about getting those kids used to the idea that this is just a normal part of life. And you imagine the problem that occurs if you wait until that child's five or six and their first experience at the dentist is because they've got tooth decay, because they need to then have a needle, they need to have a tooth filled or a tooth extracted or multiple teeth.
00:13:19
Speaker
then that becomes a really distressing occurrence for that child. So yeah, that that sort of focus on getting kids in early, getting them used to the idea of going, I think is really important. And anyone who works with kids knows how challenging it is, but how rewarding it can be as well. And like, they're really special people who do that work to make the life of those kids much more comfortable.
00:13:42
Speaker
I just want our dental hygienists and are there different practices in terms of their inclusion in care in different parts of Australia? Yeah. Yeah. So we can probably have a deep dive into a lot of history. And I'm a really big kind of history buff because I think we we forget so much of our history, but we can understand where we are now if we do understand our history a little bit better. So in in dentistry, most people think about dentists as being the people who provide the care. And in the hospital equivalent, we think about doctors as being the people who provide the care, but doctors are supported by this whole team of people
00:14:15
Speaker
and whether it's nurses and physiotherapists and pharmacists, other sorts of people. So in dentistry, we have dentists, but in the 1960s, when we had this really huge problem with tooth decay, which we're kind of seeing again, New Zealand invented a category of dental practitioner called the school dental nurse. And so they were trained to work specifically with kids and solve some of the problems that they were seeing in New Zealand. and So Australia adopted that model of school dental nurses and we had school dental vans. And for those of us in this call who are old enough to remember, and I'm looking at you and I, Julie, probably spent a little bit of time sitting in a school dental van being treated by a school dental nurse.
00:14:55
Speaker
We changed the terminology to dental therapist at a point in time. And so dental therapists were a group of people who were effectively trained to do dentistry for kids up to generally high school age children.
00:15:08
Speaker
America and other parts of the world had a different kind of model and they had the dental hygienist, which tended to focus more on prevention and gum disease and adults. And so we had hygienists in Australia as well.
00:15:20
Speaker
And then for us, we went down a really interesting path of merging those two together. So we've now got a group called oral health therapists that are trained to do both of the things that a dental therapist and a dental hygienist do.
00:15:33
Speaker
And most of the dental schools around Australia now focus on training oral health therapists so that the hygienist as a, I guess, a practitioner group is pretty much not being trained anymore. But people in that oral health therapy category or registration group will practice with adults, will practice with kids, will practice in orthodontic practices in a range of different areas. So it's about ah expanding the oral health team to focus on particular areas of need.
00:15:59
Speaker
but but Look, I'll throw back. I wanted to get that in because I'm so aware that cost of private dentistry, and I know you're interested in the system itself, Aiden, but cost is such a big thing. And what I've discovered here, which I hadn't experienced in New South Wales, is I go to this cleaning lady who does all different sorts of things to help. me I think of her as the cleaning lady, and that's diminishing her skills, I'm sure. But is there a way forward to help people who have struggled to afford private dentistry?
00:16:29
Speaker
to have this multidisciplinary approach expanded. That's one of the things that's in my mind, but over to you, Ed. Yeah, thanks, Julie. So, Matt, I'm sure I'm not in the minority here.
00:16:41
Speaker
I guess I'll relate a story i recently had. I'm a junior doctor and um I happen to be working in the emergency department recently, and so I cannot tell you how many patients come in with dental abscesses, so infections that sort of at the root of their tooth gum disease, really terrible infections of their mouth, which are oral ah hygiene and dental related. And I was sitting there with one of the emergency specialists and we were chatting for a few minutes. i looked at him, i said, I think we really screwed up when we partitioned teeth away from the rest of medicine.
00:17:14
Speaker
Because I felt really powerless to do much. I can give painkillers, I can give antibiotics, but I can't do what we call source control, which is actually fixing the problem. I can just put a few band-aids over it. We know that antibiotics aren't going to fix an infection if that infection is walled off and it's difficult for the antibiotics to penetrate the scar tissue and get into that infection, which is essentially, for our listeners, what an abscess is.
Dental Care and Medicare Exclusion
00:17:39
Speaker
You need someone to go in there and cut out the infected bit, which is scarred off and walled off from the rest of the body. So I often feel really frustrated that I'm unable to help patients more. And it's so difficult for some of these patients to get in to see a dentist. Matt, what's gone wrong?
00:17:55
Speaker
the It's the million dollar, probably the billion dollar question. um When Medicare was first started as Medibank back in the 1970s, there was talk that maybe dentistry should be included.
00:18:09
Speaker
um And for a range of reasons, it wasn't, and it sort of lost in the depths of time, the mists of time, but whether it was the dental profession pushing back against the idea. i know that Gough Whitlam had a big struggle on his hands to get the doctors over the line, concerns about cost, all sorts of things, but dentistry was excluded and it's allowed dentistry to morph into this highly privatized business.
00:18:34
Speaker
85% of dental practitioners work in the private sector on a fee-for-service basis, plus or minus funding from private health insurance, which is still essentially coming out of the individual's pockets, where the governments, state and federal fund about 80% of medical care and 90% of public hospital care, 90% of pharmaceutical care.
00:18:55
Speaker
They fund about 20% of dental care. And of that, about 40% of that is actually private health insurance rebates that tend to go to middle-class people to support them, which is not an unimportant thing.
00:19:08
Speaker
But when we've got somewhere like 35% of the population who have a healthcare care or concession card or on government payments who are eligible to access our public dental services, but the waiting lists are two years long because they're chronically underfunded, then we have the problem that you describe.
00:19:26
Speaker
And patients who know that they can go and see a doctor or go to a hospital where that care is funded, and they think, unfortunately, that... painkillers and antibiotics will fix the problem when we know that it won't.
00:19:39
Speaker
That's the path they're forced down. So i'm I'm spending as much of my waking hours at the moment in the lead up to this election campaigning to give Medicare teeth. We've got to put the mouth back into the body and say, if you have a patient that has an abscess on their arm or has a fall and breaks a leg, they can front up to the hospital, they can front up to the GP, and they know that regardless of their postcode, regardless of their income or their circumstances,
00:20:06
Speaker
they're going to get the best quality care. and If a person falls over and breaks their front tooth or if they get an abscess in their gums, then ah if they're fortunate enough to be able to afford private care, they'll get in and have that treated.
00:20:22
Speaker
and If they aren't fortunate enough and are relying on public care, then they might have to wait for months or years for that care to occur. and Then we know what happens when they wait for too long. Those problems get worse. They exacerbate all of these problems.
00:20:35
Speaker
So we really need to be funding dental care much better than we currently do.
Advocacy for Dental Health in Medicare
00:20:40
Speaker
Could I share a moment from an interview I did on ABC Radio National where I used to work for years and it's just haunted me.
00:20:48
Speaker
And it was a story about a group of dentists from Thailand who were doing a charity trip as a group to northwest Tasmania. to do dental care. and It was part of the faith, of a Buddhist faith, that they go to different disadvantaged parts of the world and do dental care. and It was Northwest Tasmania.
00:21:08
Speaker
Because I had grown up with a dentist, I had some insight into what this might mean. My father had worked in public dentistry as well as private dentistry, but I said, what's the most ah the kind of dental work you're doing? and i Can you guess, Matt? i don't It's probably obvious to everyone, they just do extractions. extractions They just do extractions and it's weepable.
00:21:28
Speaker
ah I guess my question, if I could ask you, Aidan, before we move to another topic is, if you're seeing that emergency and if all doctors, you're a junior doctor, rotate through emergency, why don't doctors speak up more for the inclusion of the mouth in Medicare?
00:21:45
Speaker
Maybe they do, Matt, and I just don't hear their voices, but you're on the front line there, Aidan, and you're seeing what's going on. a great question, Julie. I think we do, but it's hard when there's so many pressing issues and sometimes our voice doesn't even get heard on some of the most pressing ones. Obviously, there's the public health sector doctor strike going on at the moment in New South Wales because there's significant underfunding compared to most other states in New South Wales, so public doctors.
00:22:15
Speaker
I think there's so many competing issues at the moment that sometimes our advocacy of our colleagues and our patients just gets drowned out. But it's a good reminder that we do need to make a bit more noise, a lot more noise about it.
00:22:28
Speaker
We need to use our mouths to put the mouth back in the body, Matt. I love that. Put the mouth back in the body. That's what we have to do. but And it's a good question, Julia. And we I spend a lot of time trying to build networks with people all over the place. And the Medical Association has run a really good campaign for a long time about removing sugary drinks or reducing...
00:22:47
Speaker
over reliance on sugary drinks. And that's something that's really important in the medical space because of links to obesity and type two diabetes and so on. But it's also really important for us in oral health with the links, obviously, to tooth decay as well. We try and do these things, but Aidan's right too. Doctors primarily have to be fighting for the things that are really important for them in health.
00:23:06
Speaker
i My argument, I guess, is there's a cost issue here. We're we're clogging up with these preventable hospitalizations. We estimate that costs something like $1.6 billion dollars a year. So if we even if we reduce that by half and we save $800 million dollars a year by getting people out of hospitals,
00:23:25
Speaker
think about what doctors can do to help people are in need for all of those other problems. So we're helping people's oral health, we're improving their quality of life, and we're freeing up our healthcare system to do other things. So there's a really good economic argument that we can all prosecute as well.
00:23:39
Speaker
That's such an important point. If I've learned about health advocacy as a former cancer patient and just a patient, is understanding more of the significance of health economics and good data when you're advocating with Treasury, it whether it's state or federal level, because I just ask you something. you know we We get a sense from Aidan of what he sees of a cross-section of the general public in emergency, but when you worked in the army, what did you see about the mouths of Australians?
00:24:06
Speaker
Because a lot of people join the army to get an education and I wonder if they can also get their health done because a lot of prisoners get their dental care done in prison, not out in the community because they're the most disadvantaged population.
00:24:20
Speaker
But what did you see in the army? And look, I certainly would wouldn't recommend going to prison just to get your teeth fixed. it's It's interesting and it goes back to our discussion on water fluoridation. And in fact, your point, Julie, about your dad seeing that really vast difference in in kids oral health when water fluoridation came in. So when I first started working in the army, I got posted to Wagga Wagga in regional New South Wales, and it was the army recruit training center. So we had army recruits coming from all over Australia.
00:24:48
Speaker
And our job was to essentially do a dental checkup for everyone. And it was partly to see what their oral health was like, make sure that we could get them ready for their next phase of training and get them dentally fit. And there's an ah interesting history piece there, because if you go back to World War we had so many troops who had such poor oral health that they couldn't eat the rations. And we didn't send dentists over in World War I. And we didn't have a dental corps until World War II. And we didn't learn the mistakes from World War I. So we still had all of the problems in World War II, where all of these troops were not able to fight.
00:25:18
Speaker
because they didn't have good oral health. They couldn't eat the rations. They became sick. So there's ah there's a really good reason that we do that in the military. And so we had all of these people coming in from all over Australia.
00:25:31
Speaker
And I was a fresh graduate out of Dandor School. and And somewhere in the back of my head had this little bit of information floating around about how good water fluoridation was. And at that time, most of Queensland wasn't fluoridated.
00:25:42
Speaker
Certainly Brisbane wasn't fluoridated. Sydney and Melbourne had been fluoridated for a long time. And we could tell where the buses came in from. So the bus had land from Sydney, the bus had roll in from Melbourne.
00:25:53
Speaker
And the oral health of these, I call them kids, but they were 17 to 25 predominantly young recruits. um was pretty good. And then the bus would roll down from Queensland and we would see tooth decay everywhere. and was so obvious that it was quite remarkable.
00:26:08
Speaker
um And that sort of prompted me to get into doing some research. And we published a whole lot of papers that showed that the difference was about 25% in the amount of tooth decay in the non-fluoridated people, mostly from Queensland, but from regional parts all around Australia.
00:26:23
Speaker
But yeah, you know a really big cross-section of oral health across the community. ah I'd like to turn, Aiden, if I may, to some of the practical tips and then come back to the systemic issues of how we're going to help Australians. But, you know, I guess I'd love to hear from you, Matt, for people who aren't regular at going to the dentist, but who want and who perhaps are struggling financially. We are right in the middle of this turbulent time financially.
00:26:49
Speaker
um What are the fundamental good habits that we need ah to have that will give us the best chance of having to go to the dentist maybe just once a year, twice a year? You tell us what's the minimum that you think is safe.
00:27:03
Speaker
What would be your three or four key habits to try and develop and and get your kids to develop? Yeah, and there really is only a couple that are the really important ones. I think for me, the number one thing is reduce the amount of sugar that you consume. And what we know is that so many more of our foods these days are are becoming loaded with sugar. And we tend to focus a lot on sugary drinks, a can of Coke that has 10 teaspoons of sugar in it.
00:27:27
Speaker
We inherently know that's bad. But you look at the breakfast cereal that you're having for breakfast in the morning or that you're feeding your kids in the morning. And some of those are 25, 30% sugar.
00:27:39
Speaker
They're not food. They're desserts that we're feeding our kids for breakfast. um The evidence tells us that if we can reduce our sugar consumption to below about 10 teaspoons, 10 to 12 teaspoons a day, then that's really going to help our health overall.
00:27:54
Speaker
If we can get it below six teaspoons a day, then that's going to really improve our oral health. Six teaspoons isn't a lot, but if you go and have a look at the food that you're eating, you'll find that you get to six teaspoons pretty quickly with some of the food that's out there. For me, i think that there's this really big intersection and I'm really passionate about food, but there's this really big intersection between what we eat and our health. And so reducing sugar is the number one thing. Can I just ask you one question that comes up again and again is if I brush my teeth and they bleed,
00:28:28
Speaker
what What should I do? If I could just jump in on that, because I think most people are very ignorant about gum disease and bleeding. Yeah. And so the other thing, obviously, reduce sugar, brush your teeth. um Our mouths are full of bacteria, full of bugs, and we can't get rid of them. That's just the the way that our mouth is.
00:28:45
Speaker
What we want to do is reduce the amount there. So if you don't brush your teeth for a day, those bugs all just multiply and multiply exponentially and they build up. And you know what it's like if you've gone out At night, you don't brush your teeth before you go to bed. You wake up in the morning and your teeth feel a little bit furry and fuzzy.
00:29:02
Speaker
And if you keep not brushing them well, those bacteria continue to grow. And they cause an infection, a little infection of the gum. And when the gum becomes infected, it becomes much more likely to bleed. Like any infection, you cut your hand and it becomes a little bit infected, it's much more likely to bleed.
00:29:19
Speaker
And so what a lot of people do is think, oh, my gums are bleeding. I'd better not do anything. So if you've got a cut on your hand and it's not healing well, you don't sit there and poke it all the time and think that's going to make it better. And and so people tend to not brush their gums when they're bleeding, thinking that'll make them get better.
00:29:36
Speaker
And in fact, the treatment for it is to brush them more, is to remove all of that bacteria, and then that'll allow the gums to heal up. So I guess when someone comes in with a cut on their hand, what I tell them is you have to wash it and then keep it clean and dry.
00:29:50
Speaker
But you have to keep washing it every day, multiple times a day, because your hands get dirty. But you have to keep washing it even if it bleeds a bit. and then put a dressing on it, keep it clean and dry. So same principle applies to gums is what you're saying. Yeah, essentially. it's you want You want to try and remove the thing that's causing it to bleed in the first place. And this goes back to these basic principles of prevention.
00:30:09
Speaker
What's the thing that's caused the problem? It's the plaque buildup. It's the bacteria that's on there. If we remove that, then the bleeding will stop. So that's brushing teeth. How important is flossing? How many times a day am I supposed to be flossing? Am I supposed to be carrying around tooth floss with me and flossing after every meal? I see some people who are like...
00:30:26
Speaker
addicted to flossing and then i'm yeah I forget to do every now and again. and So if you think about it, again, plaque is going to build up. Those bugs are going to build up on the bit where the tooth and the gum meet because it's that uneven surface that attracts where the plaque is going to be.
00:30:40
Speaker
And one of those areas is between the teeth where the toothbrush doesn't fit. So if you don't floss, if you don't do something to get in between there, then that's where you're most likely to have some plaque continue to build up.
00:30:52
Speaker
The more that you do it, the better. I think at least once a day is fine. And like all habits, it's something that once you get into the habit of doing, you do it more regularly. Julie's there showing me that, yes, you can use a toothpick or a little brush that goes in between.
00:31:06
Speaker
and There's a lot of different ways that you can do that. What about those water irrigation, the high-pressure water sputter, burster things? Yeah, and they they do the job as well. They can be a little bit messy. Some people love them, some people don't. my My general rule on a lot of these things, and as electric toothbrushes, do they do a better job? I use an electric toothbrush and I do it because my teeth feel cleaner. and there's So there's a positive reinforcement there. My teeth feel cleaner, therefore I'm going to do it more. But the reality is that you can clean very effectively with a manual toothbrush, a water pick will do it, floss will do it.
00:31:37
Speaker
little brushes in between, find the tool that works for you um and keep using that because that's the tool that works for you. Can I just come back to gum disease? Because you go to certain parts of Australia and if people smile, they've lost some teeth.
00:31:51
Speaker
And I ah come from a family with a genetic predisposition to gum disease. So that bleeding, if not dealt with, that cleaning, if not done well, for some parts of the population can lead to extractions and not everybody can afford the expensive dental work that can fill the gap. So can you just give us the key facts about gum disease?
00:32:10
Speaker
Yeah, so gum disease is that extension of the bleeding gums. We call bleeding gums gingivitis. It's the early reversible signs of inflammation of the gum. But if it's allowed to continue, so if you don't get on top of it, then it starts to eventually sort of erode away where the gum attaches to the tooth and to the bone, and then it eventually starts to erode away the bone.
00:32:30
Speaker
So then the teeth become loose and then we get to a stage if that is allowed to progress where yeah teeth are eventually lost, they have to be extracted. it's It's very strongly linked to age. Older people tend to have, and that's just a time in the game, I guess, but much higher prevalence. So something around 50 to 60% of older adults with gum disease.
00:32:50
Speaker
There's really strong associations with tobacco smoking. So tobacco actually makes it much, much worse. There's also really strong links with diabetes. So poor diabetic control makes it much harder to look after gum disease.
00:33:05
Speaker
And uncontrolled gum disease makes it much harder for people with diabetes to maintain their diabetic control. We know that with type 2 diabetes increasing in adult populations, that dealing with both of those problems together is really important.
00:33:20
Speaker
ah Could you just tell us the links to other issues like cardiovascular health or any other health issues that can arise if you don't look after your oral health?
Oral Health and Systemic Health Connections
00:33:29
Speaker
Yeah, and it's really interesting and somewhat contentious area because there's a school of thought that says we should just be advocating for oral health because in and of itself, oral health is so important. Your ability to smile and self-esteem and but live pain-free. Yeah.
00:33:44
Speaker
And that some of the links to to other diseases are, I guess the science is still emerging in some of them. But what we do know, so we've talked about the diabetes one, cardiovascular disease, heart disease is is one too. So that inflamed gum puts toxins into our bloodstream that can then go around and cause inflammation that can cause heart disease.
00:34:05
Speaker
There's emerging evidence now that really talks about links with dementia as well. And we know that dementia is increasing in prevalence and that's a really significant problem. um Low birth weight or preterm birth is another one where there are growing links as well. but You think about inflammation is a problem in our body and any source of inflammation can cause problems in other parts of our body. And it goes back to the mouth is part of the body, right? It's not this isolated little area where something is happening over there that doesn't affect the rest of our body.
00:34:34
Speaker
What did we say when we were kids? The knee bones connected to the you know, whatever bone that I didn't do anatomy below the head and neck. So, you know you kind of have to forgive me there, but like like overdori it's all connected, right? It's not surprising that problems in our mouth are going to cause problems elsewhere in our body.
00:34:50
Speaker
So Matt, you and I know this, we now all know this and our listeners will be well aware of how important oral health is, but it's 10 PM at nine and I've had a massive day and I'm coming home and I'm going to be honest with you. I'm not going to take an extra five minutes to take care of my mouth to ward off a future of maybe reducing dementia or improving my cardiovascular health. And I shouldn't admit that as a doctor, we're all human and it's late at night.
00:35:14
Speaker
But if you tell me that my teeth are going to look whiter if I do this or that, that's a real motivation because that's a social impetus that's very easy for me to act on and connect. And there's a lot of taboo now around people having yellow teeth.
00:35:27
Speaker
I guess my first question is, are our teeth supposed to be this white or are we setting like artificial beauty standards for teeth? Back when I was ah a dental student 30 years ago, it was all about how Hollywood was ruining the perception of what our teeth look like and the Hollywood smile.
00:35:44
Speaker
And now it's social media that's doing that. It's still Hollywood, but clearly now it's moved out of the realm of actors in movies and TV shows. And it's anyone who is an influencer on any kind of social media platform.
00:35:57
Speaker
Our teeth are naturally not white, not as white as an A4 sheet of paper. um Some people like their teeth to look much lighter. And there are a lot of things that people can do to do that tooth whitening that is mostly risk-free but can have some risks associated with it.
00:36:15
Speaker
It gets us into this really interesting area I think about oral health, because it starts to get us into this sort of idea of self-esteem and the psychosocial aspects of health. So we often spend so much time, I think, in health talking about disease and health is about being disease free when health is about much more than that. It's about a ah state of optimum wellbeing as well.
00:36:38
Speaker
And we know that our mouth is a really important part of our identity, of who we are. Julie said before, you can see that in in people around the community. Poor old health is probably the strongest indicator of disadvantage.
00:36:52
Speaker
And you can tell someone's social status by their smile or perhaps they're not smile because they're self-conscious about it. It impacts on people's ability to find employment or to engage in other activities in society, education for kids. You think about that five-year-old old or six-year-old kid who's fronting up to the hospital and having five or six teeth taken out and then having to go to school.
00:37:16
Speaker
And how does that impact on that child's interactions with peers and on their learning? We've gone a long way from tooth whitening, but it's that idea that for people, their self-worth, their identity, their self-esteem is very much tied up in the way that they look.
00:37:29
Speaker
I just want to help you, Aidan, because I want to motivate you when you get home and you're really tired from your time at the hospital to do something with your teeth and think about chissing. you know what um Let me put it into a question.
00:37:43
Speaker
ah Matt, why is it that some people who really bad breath don't know? ah I'm not sure that I know the answer to that question. Interesting. though, isn't it? Has anybody noticed that?
00:37:54
Speaker
Yeah, yeah. Definitely some people are are not aware of that at all. And maybe it's just because they've been living with it for so long that they're unaware. and I have a mouthwash. If we could just come to mouthwash, you can, again, it's cost, you can pay more.
00:38:06
Speaker
And there are quality mouthwashers, often they are sold by dentists that have fluoride in them. There are other ways to get the fluoride if you're in one of these places that doesn't have fluoride. I want to get back to equity. But before we do, Aidan, do you have another issue?
00:38:21
Speaker
So I'm interested to know, you said most teeth widening strategies that people can act get access to are actually fairly low risk. That's really good to know. I guess my other question is, what is something completely wacky that you've currently seen as a trend out there on social media that we should not be doing?
00:38:38
Speaker
I've seen the oil pulling thing. Yeah, oil pulling. up with that? Oil pulling is a weird one. So there's there's that sort of group of people who don't believe in in things like fluoride. Fluoride toothpaste is bad for you. It's harmful.
00:38:50
Speaker
And so they use it like a coconut oil or something and they swish it around their mouth. Probably it's quite neutral. It might be effective in a somewhat antibacterial way. um But the amount of time that you have to spend doing that to get maybe a marginal benefit is a bit counterproductive. These people are doing it for 20 minutes.
00:39:09
Speaker
Brushing with charcoal ist is another one I think that's probably in in a really wacky kind of sense and wacky and dangerous because charcoal can be quite abrasive. And yes, it will remove stains. Yes, it will make your teeth probably a little bit cleaner, but it does that by actually eroding the surface layer away.
00:39:25
Speaker
And then that becomes problematic. It's amazing you talk about charcoal because I have actually read quite a few cases now of people who've swallowed activated charcoal thinking it's going to improve their health and it's neutralized medications they're taking, including birth control.
00:39:39
Speaker
So now it's predominantly some other medications, but there are actually some serious side effects to these seemingly natural, non-harmful organic remedies.
00:39:50
Speaker
Certainly, we know activated charcoal is what we use to absorb a lot of the toxins. When people come in with poisonings to hospital, sometimes we will give them activated charcoal because some medications can be sucked up by it.
00:40:02
Speaker
And so that can actually neutralize a whole bunch of medications. It can stop you absorbing nutrition properly from the foods you're eating. It sucks everything up into it. And I'm interested to hear that it also causes sort of abrasion to the teeth. And is it dentin that it wears away?
00:40:15
Speaker
will wear away the enamel. So the enamel, the outer layer of our teeth, is the hardest surface in the human body, much harder than anything else that we've got. um But it's not resistant to to wear and you can wear it away with toothbrush, you can wear it away with abrasive toothpaste and certainly charcoal will do that as well.
00:40:31
Speaker
And then once you get to the dentine, which is underneath, which is the bit that's a little bit darker, so the enamel is the really white part of the tooth. The dentine underneath is a little bit yellower. um And as you start to wear away that that enamel, more of the discolour or the the yellowish dentine starts to show through. So that actually makes the teeth seem a little bit more discoloured. So people start brushing even more, wear away even more of the enamel. But if you get to the dentine, that will wear away really quickly.
00:40:58
Speaker
Can I just come in with another practical thing before we go to your steps for equity so that people can get access to dental care? But that's dry mouth and how some medications can cause dry mouth. Because I'm the 70-year-old on this program and I've got this young doctor with me.
00:41:15
Speaker
Why is it important when we have functional saliva? And if you're on medication that makes it dry, what can you do to prevent the damage to your teeth? Yeah, saliva saliva is such an underrated part of our human body and certainly from an oral health perspective. So effectively, it it does a couple of things. It helps to wash away the food. It helps us to digest food and to eat and swallow properly. So anyone with a dry mouth knows that it's really difficult to eat and swallow and function and talk.
00:41:41
Speaker
So it has that sort of function. um But from an oral disease point of view, every time you eat something that's got some sugars in it, the bacteria that are inherently in your mouth produce acid.
00:41:52
Speaker
And that's the acid that then dissolves away the tooth and potentially causes tooth decay. So the more often that you eat, the more times that you've got this acid sitting on your tooth surface eroding it away.
00:42:04
Speaker
And that's why the amount of times that we eat, the frequency is really important. But what the saliva does is after you've finished eating, it washes away that acid. And then the saliva is full of all of the minerals that the teeth are made up of and helps to actually remineralize the tooth, build it back together again.
Role of Saliva in Oral Health
00:42:20
Speaker
So I think of that tooth enamel like this big block of lattice blocks and little bits are coming out all of the time with the acid and then little bits are coming back in again with the saliva.
00:42:30
Speaker
And if we don't have a lot of saliva, we don't have good quality saliva, and we're eating too much, too frequently sugary foods, the bits going out start to outweigh the bits that are being put back in.
00:42:42
Speaker
And that's when a cavity forms. That's when a hole forms in the tooth. So saliva is really important. A lot of medications, like you say, anything that starts with an anti, anti-histamines, anti-hypertensives, anti-somethings are probably anti-saliva as well.
00:42:56
Speaker
Head and neck cancer is another area where we see radiation therapy that effectively kills salivary glands and people with head and neck cancer often experience really significant problems as well.
00:43:09
Speaker
If I could just say, because our audience, I think, know that I've had a head and neck cancer, an oral cancer down in the throat and had radiation. Radiation oncologists and their teams put a huge amount of effort into trying to spare the salivary glands for exactly the reason.
00:43:25
Speaker
But if I could move us to equity and use an example from my oral cancer experience, Before we have radiation aid, and I don't know if you've done this in your doctor studies yet, we get a dental assessment because of this danger to our salivary glands.
00:43:40
Speaker
And if a patient who needs to have radiation to the jaw area does have a poor level of oral health, does not have a history of going to the dentist,
00:43:51
Speaker
ah Often the decision is made that that is a prediction of their likelihood of looking after their teeth after treatment. And so any teeth that are in trouble need to be removed, extracted, before they start the radiation treatment.
00:44:07
Speaker
Because for reasons I won't go into now, it's very dangerous to have an extraction after you've had radiation, you're meant to avoid them for the rest of your life. And it is still not uncommon here in Australia right now for people to have eight, nine, 10 teeth extracted prior to radiation or even what's called Full mouth clearances.
00:44:27
Speaker
I just use that expression again because I remember when I was told it, I almost had a panic reaction. Full mouth clearances. um and And what I've seen sitting in those cancer treatment areas is that people from poorer backgrounds often lose all their teeth before they're treated for radiation.
00:44:45
Speaker
And they can't necessarily afford to have the dental work later to put in... false teeth, if I could put it that way. So my mouth is almost a ton. It's about $30,000 to $40,000 is my mouth.
00:44:57
Speaker
I simply put the price on it. Private dentistry with a bit back from my medical fund. And that's an elite capacity. So Matt, what do we need to do? Whoever wins the election,
00:45:10
Speaker
so that people get dental care. Yeah, look, I'm saying we need to give Medicare teeth because Medicare currently doesn't have teeth. And I think your kind of story there, Julie, really highlights the problem.
00:45:21
Speaker
You've got a health condition. Up to a certain point, a health system looks after you. And then there's a little bit where they say, sorry, you're on your own. And then afterwards, they continue to look after you. So, you know, you'll have post-radiation care, you'll have post-cancer treatment care, and they'll look after you for the rest of your life to make sure that you're fit well, except for that little bit that's happening in your mouth, which is a consequence of some of the treatment that's been provided for you by the government. It's crazy.
00:45:47
Speaker
That is exactly right. And there's a group called Head and Neck Cancer Australia who are lobbying all parties who understand exactly what Matt has just said. It's a result of our treatment and we should get help and we don't.
00:46:00
Speaker
So there's people are on self-food aid for the rest of their lives because they can't afford dental care to eat again. Look, it just comes back to this issue that the mouth is part of the body. The same principle applies for all patients who are undergoing organ transplantation.
00:46:15
Speaker
We will not transplant patients with new organs and suppress their immune system for life without having a dentist completely go through every nook and cranny in their mouth looking for those infections because they are so immunosuppressed.
00:46:27
Speaker
their immune system is completely the volumes turns down totally so that it doesn't attack the new organs and at the same time the mouth is literally the portal to the rest of the body and if you get even a little bit of an infection in your mouth and that moves into your deeper sort of gum tissues and you don't have a functioning immune system that infection can go rip roaring through your body in health particularly in hospital the thing we most worry about is that it causes an infection in the bloodstream which ends up attacking your heart.
00:46:58
Speaker
And we call that endocarditis. Endo meaning the inside, card meaning heart and itis meaning inflammation. And these patients get an infective endocarditis where they get these moldy growths on their heart valves and it destroys their heart tissue. And they end up with the most horrendous heart diseases and valve failures. And oftentimes people end up dying because they had a mouth infection, which spread.
00:47:24
Speaker
So Matt, what has to happen and and where do you see the hope, because you've advocated for a long time, to gradually afford to put the mouth back into the body and into Medicare?
Campaigning for Dental Care Reform
00:47:36
Speaker
Yeah, I swing wildly between being an optimist and a pessimist on these sorts of things. But we've got an election that that I think gives us a really good opportunity. we've got So on the one hand, we've got the Greens who have been advocating for a long time to put dental into Medicare. And the Greens in Labor years ago created the Child Dental Benefits Schedule. So that put dental into Medicare for about 50% of kids, a really important, valuable scheme.
00:48:00
Speaker
We've got a really good opportunity to build on that. There's a lot of independents and crossbenchers, I think, who are supporting this idea because it's an equity issue, because it's something that they passionately believe in.
00:48:11
Speaker
People in the dental profession are continuing to advocate for this. But my my call to people out there listening is, you know, our politicians do things because people tell them that it's important. And they don't do things because doctors and dentists, people in the industry tell them. They do things because the voters tell them that this is important.
00:48:29
Speaker
And if voters are telling them that putting dentistry into Medicare is an important issue, then they will do that. And I'm saying, I guess, vote people in who are going to take it seriously. So I'd be encouraging everyone to be contacting their local MPs, the candidates who are running in their election.
00:48:46
Speaker
I don't know whether I'm allowed to to plug something that I'm doing or not, but I've set up a website called Give Medicare Teeth, www.givemedicareteeth.com. It's got all of the resources there. You can find your electorate. You've got all of the candidates and email them, jump on social media. And it's that thing, if we make noise about it, then people will listen. But I think we've got a really good opportunity here to do this.
00:49:08
Speaker
And you've got dental as anything. Can you explain that to for people with a passion for this? Oh, look, I like talking about dentistry and I think it's something that we don't talk about enough. And so I fell into this idea of just putting my thoughts out there. So dental as anything is just my little...
00:49:25
Speaker
passion project, I guess, of podcasts, talking to interesting people, writing stuff that I think is really important and interesting, not only for the dental profession, but for a broader audience as well. Yeah, if anyone's interested, you can find me at Dental Is Anything doing pretty much anything to do with dental.
00:49:42
Speaker
Aidan, I'd love to hear the paper that Matt's going to give at a conference in Tasmania. So what's your dream about what is a dental desert? but health yeah What's your dream if we come back in 10 years? What's Northwest Tasmania going to look like? Yeah, sadly the conference is in Hobart, not in Northwest Tassie, but it'd be nice if it was up there. Maybe I'll have a little detour. Dental deserts are this idea that that's been popping up ah a little bit in the public health literature lately. ah You're trying to identify areas where there's just a lack of services.
00:50:12
Speaker
um and so i looked at this ah by local government areas around Australia. so There's about 570 local government areas all across Australia and defined it really crudely as just a local government area that doesn't have any dentists. and There are 216 local government areas ah with no dentists at all, albeit you know only with about 700,000 people. so The number of people in those areas is quite small, but a lot of them have population sizes of 5,000 people, 10,000 people.
00:50:43
Speaker
And then if you expand it out a little bit, we've got about 60 dentists per 100,000 people in Australia as an average across the country. um There are something like maybe 30 LGAs where there's less than 25 dentists per 100,000 people, and that's covering about a million people. So there's at least 2 million people who have really poor access to dentists.
00:51:08
Speaker
When we look at the trend over the last 10 years, the number of dentists is growing in inner city areas, but it's not growing as fast the further away from ah an inner city area that you go from a capital city.
00:51:19
Speaker
And then there's this really strong social gradient. So there's many more dentists per 100,000 in areas of high socioeconomic advantage and fewer in areas of more socioeconomic disadvantage.
00:51:32
Speaker
And that gap's been widening over the last 10 years as well. So it's been almost the same in the low socioeconomic areas, but in the higher socioeconomic areas, what we're seeing is that gap actually widening.
00:51:44
Speaker
So what would I like to see in 10 years' time? I think if we had... um More dentistry in Medicare, so an adult dental benefits scheme, means tested to start with, because we don't have the workforce to look after everyone at the moment, but something that targets to areas most at need.
00:52:00
Speaker
Using that as a bit of a tool to help perhaps encourage practitioners to work in some of these areas of need, so Northwest Tasmania areas of regional disadvantage or a socioeconomic disadvantage.
00:52:12
Speaker
and giving people much more of an opportunity to access dental care when and where they need it for the health problems that they are experiencing. Unreal.
00:52:23
Speaker
Matt, I think putting the teeth back in Medicare has to be the one-liner from today. Speaking of putting the teeth back into things, I understand you've recently been competing on a national level and in a slightly different forum.
00:52:36
Speaker
I love that competing at a national level makes it sound like I'm some sort of athlete Nothing could be further from the truth. Yes, i'm i'm I'm back. So for a lot of people who do know me, 10 years ago, i was on a little TV show that some people might have watched called MasterChef, which combined my passion for food and cooking and advocacy around healthy eating.
00:52:58
Speaker
And I did all right. I finished sixth and surprised a lot of people. And this year, they've got the Back to Win crew, so they've brought back contestants from previous years, and I'm back to have another crack and see if I can't do a little bit better this time.
00:53:12
Speaker
Unreal. I'm very excited to to watch you. Can I ask a quick one? What is your favorite dish and why? i I love cooking pasta and I love cooking pasta, A, because it's fun. I like making homemade pasta. And so the process I find quite kind of therapeutic and relaxing.
00:53:29
Speaker
And I don't know too many people who don't love pasta in some way, shape or form. So it's a really great dish to cook for anyone and everyone. Unreal. Well, we've just loved talking to you, Matt. Thank you so much for coming onto This Might Sting, where we try to diagnose nonsense and prescribe truth.
00:53:46
Speaker
And we've just learned so much about the mouth and it's linked to the rest of health. So, you know, just a big thank you. Thank you. It's been a pleasure.
00:53:55
Speaker
Matt, thank you again. That's all from us today at This Might Sting. I'm Aidan Barron and Julia McCrossin, my inevitable and phenomenal co-host, signing off for today. Have a great one and stay healthy.