Sleep apnoea affects 1.3 million Australians, including one in four men above the age of 40.

Its symptoms, like excessive sleepiness, headaches, high blood pressure and mood changes, have a significant impact on daily life.

A simple dental device could help — but, as it stands, only a handful of those affected are offered it.

Up to 90 per cent of those with sleep apnoea are prescribed CPAP (continuous positive airway pressure) therapy, but Flinders University sleep expert Danny Eckert says a mouthguard, a less invasive option, has similar health benefits.

“Yet … only a minority are ever prescribed it,” Professor Eckert tells ABC RN’s Saturday Extra.

Up to 90 per cent of those with sleep apnoea will be offered CPAP therapy. (Getty: No Limit Pictures)

This raises the obvious question: why?

The answer lies in the historical divide between medicine and dentistry, and a lack of understanding about the relationship between general and oral health.

‘The mouth is part of the body’

A mouthguard (or oral splint) must be inserted by a dental professional, whereas a CPAP machine can be prescribed by a general practitioner or sleep physician.

Medicare doesn’t cover dentistry, which can make getting a splint fitted expensive for an individual.

Indeed, three in 10 Australians avoid or delay seeking dental care because of its cost.

But Professor Eckert says investing in dental health makes economic sense.

“Treating obstructive sleep apnoea with an oral appliance would be cost beneficial to the healthcare system,” he argues.

Professor Danny Eckert says an oral splint has been shown to have similar health benefits to CPAP therapy. (Unsplash: Ozkan Guner)

He explains that four out of 10 Australians have inadequate sleep, which is “conservatively” estimated to cost the Australian community $66 billion a year.

But the historic separation between dentistry and medicine — both in Australia and globally — makes the situation difficult to change, although there have been attempts to bridge the divide.

In The United States in 1840, an application was made to include dentistry as part of the University of Maryland’s medical school, but was rejected on the basis that it was too expensive. 

This led to the establishment of the Baltimore College of Dentistry, enshrining dentistry as a separate profession. 

Scott Davis, vice president of the Australian Dental Association, says that while such divisions may no longer exist in academia, they have persisted economically.

“If you look at the university system now, in many schools dentistry is part of the faculty of medicine,” he says.

“It is recognised at an academic level that the body is the body, and the mouth is part of the body.”

But Dr Davis says government funding is yet to catch up in Australia, as demonstrated by dental care’s exclusion from Medicare.

“It all comes down to Treasury having more power than the Health Department, I suspect.”

Lack of dental funding adds to chronic disease burden

Good oral health is not just beneficial to sleep apnoea sufferers. It also has a range of general health benefits that are poorly understood.

As Dr Davis puts it, the two biggest dental problems facing Australians are dental decay and periodontal (gum) disease, with the latter having the “biggest impact on our systemic health”.

“We know that untreated [gum] disease contributes to heart disease, diabetes, rheumatoid arthritis, chronic kidney disease, dementia and more,” he says.

He wants to see the community better educated on the importance of preventative oral health for overall well-being.

“Prevention is not particularly difficult,” Dr Davis says.

“But we need money for advertising and government to take a positive step in this and really talk to doctors and dentists about how we get the message out to the community.”

The campaign to include dentistry in Medicare

The Australian Greens have long campaigned to get dental care included in Medicare.

In 2012, they successfully negotiated a $2.7 billion scheme with the Gillard Labor government to secure childrens access to subsidised dental care.

Greens Senator Jordon Steele-John is currently chairing a Senate inquiry into the provision of and access to dental care in Australia. The Greens also want to invest $77.6 billion over the next decade to make dental care free to anyone who is eligible for Medicare.

Greens Senator Jordon Steele-John is chairing a Senate inquiry into the affordability of dental care. (ABC News: Armin Azad)

“In the current [economic] climate that’s obviously not affordable,” Dr Davis argues.

By contrast, the ADA has proposed a senior persons’ dental benefit scheme, which they have costed at $100 million a year.

Dr Davis says $100 million would cover dental care for older people living in aged care facilities, as well as those on pensions.

The low figure would be made possible by “a strong approach to prevention” and the existing low fee schedule, set by the government.

“It would help with a serious backlog of care, but we can’t even get that across,” he says.

“Dentists want to participate, even if the rebates are poor, because we really feel this disadvantaged group needs better oral health.”

Difficulties starting a conversation

Dr Davis, however, claims that the ADA has been unable to get an audience with Federal Health Minister Mark Butler to discuss the issue.

“During dental health week … all our federal executive and senior staff flew to Canberra to meet with figures in the Senate … and the health minister couldn’t even find time to speak to us,” he says.

“When we said, ‘We really want to sit down and have a discussion about oral health because it’s important,’ he said, ‘Oh I’ll look into that’, which I suspect is code for no.”

In response, a spokesperson for the Department of Health said that both Mark Butler and Assistant Minister for Health and Aged Care Ged Kearney were in attendance at the ADA’s launch of New Oral Health Messages for Australia — A National Consensus Statement during Dental Health Week.

A Department of Health spokesman said both the Health Minister and Assistant Minister, Ged Kearney, attended dental health week. (ABC News: Scott Jewell)

The spokesperson added that long-term dental policy reform is a “priority” for the department.

But while dentistry remains excluded from Medicare, Dr Davis argues that everyday Australians are bearing the costs.

“[The lack of funding] has led some people to think that oral health isn’t an important component for our general health,” he says.

“I fear that people have neglected their oral health, not realising how big an impact it can have on so many chronic diseases.”

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