Australia and Canada are hemispheres apart, but the two countries have much in common. Both are Commonwealth nations with publicly funded universal health care systems that largely exclude dental care.
As a result, many citizens rely on private insurance, often through employers. Similar shares of the populations don’t have any coverage at all. About 24 per cent of Australia’s adults aged 18 and over didn’t have dental insurance in 2021. In the same year, about 32.4 per cent of Canadians aged 12 and older didn’t have dental insurance, requiring them to pay out of pocket for dental care.
One key difference is that Australia’s policy makers have tracked the state of oral health more regularly.
Canada’s federal government collected oral health data at a national level in 2007-08 and 2022-24, returning to the issue after stopping in the 1970s.
“We know of previous governments who made an explicit decision to reduce data collection because they didn’t want to have data to inform their decisions.” Paul Allison.
But since the 1980s Australia has tracked its DMFT (Decayed, Missing and Filled Teeth index) score as a national oral health metric in line with global standards set by the World Health Organization (WHO). The country’s surveys measured the state of oral health in 1987-88, 1996, 2004-06, 2012-14 and 2017-18, giving researchers the data to track changes in dental care across different age groups. In 2014-16, the survey focused solely on children.
Does such data affect public policy changes?
“To what extent [do] politicians use data to make decisions? That’s an honest debate,” says Prof. Paul Allison of McGill University’s Faculty of Dentistry and lead investigator for Canada’s latest oral health survey. “There are some politicians who genuinely use data analysis to try and inform their decisions. There are some who are not interested at all.”
Not using data can itself be a political choice.
“We know of previous governments who made an explicit decision to reduce data collection because they didn’t want to have data to inform their decisions,” he adds.
Does data drive policy?
Australia began collecting DMFT scores for children as early as the 1960s. And countries with active DMFT indexing, such as Japan, saw childhood cavities hit a record low in fiscal 2024.
Associate Prof. Estie Kruger, from the School of Allied Health at the University of Western Australia and director of the International Research Collaborative – Health and Equity, says DMFT data has influenced policies in Australia, using school dental services as an example.
“We’ve got very well-trained dental health therapists here in Australia, so you don’t always need to see a dentist,” Kruger says, referring to one change in care. For Kruger, these dental therapists are crucial, particularly in lower socio-economic areas where they educate children about the effects of diet and sugar on oral health.
The country’s Child Dental Benefits Schedule (CDBS) was also introduced in 2014, providing eligible children up to 17 years old with up to $1,132 over two years for essential dental services, including checkups, X-rays, fillings and extractions.
“There are limits to how much money can be spent, but these policies are introduced because of the evidence we have from national oral health surveys,” Kruger says.
“Every time there’s an election, people push for universal dental care, and political parties make promises: ‘If you vote for us, we’re going to start universal dental care.” Estie Kruger.
Lots of data — but limits to coverage
But there are still limits to the money that will be invested.
“Every time there’s an election, people push for universal dental care, and political parties make promises: ‘If you vote for us, we’re going to start universal dental care,’” Kruger says.
“I think when it comes to implementation, they crunch the numbers and see that it’s very expensive. We also need enough workforce capacity in a country with almost 27 million people and an aging population—16.2 per cent were over the age of 65 in 2021.”
Even the targeted policies for children leave gaps in the system.
“Orthodontic treatment, for example, is simply unaffordable unless you have private insurance,” Kruger says of Australia’s experience. “If a child has significant orthodontic issues, they might receive treatment at a dental school within a tertiary hospital, but access is limited. For many families, if they can’t afford it, getting orthodontic care is nearly impossible. While dentists consider it important, it’s not always viewed as an emergency, which affects access to treatment.”
Data about the need is clearly just part of the equation.
This is part two of our two-story series. Part 1: Canada rekindles oral health data surveys to track trends: ‘It was serendipity’
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