In principle, the scope of necessary dental services should be determined by requirements for consultation and comprehensive examinations, followed by decisions on what diagnoses are of dental and public health importance (including both preventive and treatment services for those diagnoses), as well as established standards of care. However, there is considerable debate within the dental profession on these areas and what constitutes ‘necessary care’.
The approach taken by the Council has been to classify dental services into three broad tiers: diagnosis and preventive; routine; and elective. The areas of service which might be included against each tier are noted in Table 7.1 below.
Upon examining the three tiers, it is the Council’s view that an essential dental care schedule should include diagnostic and preventive as well as routine services. This approach allows for a focus on oral health prevention and early intervention. These are the bulk of existing services, with diagnostic, preventive and routine services accounting for approximately 90 per cent of all dental services. However, only approximately two thirds to three quarters of the total costs of dental services are due to these two tiers.
However, some patients may require more complex high end dental care which is not categorised as diagnostic, preventive or routine. In this case, we believe that any program using a primary dental care schedule would need to have a mechanism where by patients could access a category of complex care items in exceptional circumstances.
Importantly, the inclusion or exclusion of specific tiers of services should be guided by the philosophy behind a dental program – for example, the philosophy might be to emphasise preventive clinical services, diagnose dental diseases early and encourage prompt low level interventions to address disease and restore function in the most cost–effective manner.
Table 7.1 Scope of dental services—diagnostic and preventive, routine and elective services.
Tiers of service | Areas of service | % of current services | % of current costs |
---|---|---|---|
Diagnostic and preventive | Consultations | 1.7 | 0.7 |
Diagnostic and preventive | Dental examinations | 18.2 | 6.7 |
Diagnostic and preventive | Radiographs | 13.1 | 3.9 |
Diagnostic and preventive | Scaling/cleaning | 11.6 | 8.0 |
Diagnostic and preventive | Specific preventive services, including fluoride treatments | 6.3 | 1.9 |
Routine | Consultations | 0.1 | 0.1 |
Routine | Services associated with dental caries − Restorations and endodontics (some) | 34.9 | 37.6 |
Routine | Services associated with periodontal disease − Periodontics (some) | 0.5 | 0.4 |
Routine | Services associated with replacement of lost teeth − Partial and complete dentures (some) | 2.7 | 6.5 |
Routine and diagnostic | Sub–total | 89.1 | 65.8 |
Elective | Crowns and Inlays | 2.5 | 19.8 |
Elective | Bridgework | 0.2 | 0.9 |
Elective | Implants | 0.1 | 0.8 |
Elective | Orthodontics | 1.0 | 0.4 |
Elective | Cosmetic dentistry including restorations placed without a diagnosis of caries and issues like tooth whitening | 1.2 | 1.7 |
Elective | Laser dentistry | 0 | 0 |
Elective | Other | 5.9 | 10.6 |
Elective | Sub–total | 10.9 | 34.2 |
Source: Spencer, AJ & Harford, J 2008, Improving oral health and dental care for Australians, discussion paper commissioned by the National Health and Hospitals Reform Commission, ARCPOH, based on LSDPA 2003/04; DVA Fee Schedule of Dental Services for Dentists and Dental Specialists. Note: totals will not add due to rounding.
Using the academic and practical clinical expertise of Council members, a schedule of diagnostic, preventive and routine dental services has been developed by the Council (see Table 7.2 below).
However, depending on the specific reform options the Government chooses to implement, this schedule may need to be further refined. Such follow–on analysis would cover also cover the high–end services that should be provided under exceptional circumstances.
Top of pageTable 7.2 Schedule of dental services.
Service Type | Description | Item Number |
---|---|---|
Examination Diagnostic Services | Comprehensive oral examination | 011 |
Examination Diagnostic Services | Periodic oral examination | 012 |
Examination Diagnostic Services | Oral examination – limited | 013 |
Examination Diagnostic Services | Consultation | 014 |
Extended Consultation Diagnostic Services | Consultation – extended (30 minutes or more) | 015 |
Referral Consultation Diagnostic Services | Consultation by referral | 016 |
Letter of referral Diagnostic Services | Letter of referral | 019 |
Radiograph Diagnostic Services | Intraoral periapical or bitewing radiograph – per exposure | 022 |
Radiograph Diagnostic Services | Intraoral radiograph – occlusal, maxillary, mandibular – per exposure | 025 |
Radiograph Diagnostic Services | Panoramic radiograph – per exposure | 037 |
Examination Diagnostic Services | Biopsy of tissue | 051 |
Preventive and Prophylactic Services | Removal of plaque and/or stain | 111 |
Preventive and Prophylactic Services | Recontouring restorations | 113 |
Preventive and Prophylactic Services | Removal of calculus – first visit | 114 |
Preventive and Prophylactic Services | Removal of calculus – subsequent visit | 115 |
Preventive and Prophylactic Services | Topical application of remineralizing and/or cariostatic agents, one treatment | 121 |
Preventive and Prophylactic Services | Concentrated remineralizing and/or cariostatic agent, application – single tooth | 123 |
Preventive and Prophylactic Services | Dietary advice | 131 |
Preventive and Prophylactic Services | Oral hygiene instruction | 141 |
Preventive and Prophylactic Services | Fissure sealing – per tooth | 161 |
Periodontics | Treatment of acute periodontal infection – per visit | 213 |
Periodontics | Root planing and subgingival curettage – per tooth | 222 |
Extraction Oral Surgery | Removal of a tooth or part(s) thereof | 311 |
Extraction Oral Surgery | Sectional removal of a tooth | 314 |
Extraction Oral Surgery | Surgical removal of a tooth or tooth fragment not requiring removal of bone or tooth division | 322 |
Extraction Oral Surgery | Surgical removal of a tooth or tooth fragment requiring removal of bone | 323 |
Extraction Oral Surgery | Surgical removal of a tooth or tooth fragment requiring both removal of bone and tooth division | 324 |
Emergency Surgery Oral Surgery | Repositioning of displaced tooth/teeth – per tooth | 384 |
Extraction Oral Surgery | Splinting of displaced tooth/teeth – per tooth | 386 |
Extraction Oral Surgery | Replantation and splinting of a tooth | 387 |
Extraction Oral Surgery | Drainage of abscess | 392 |
Endodontics | Direct pulp capping | 411 |
Endodontics | Pulpotomy | 414 |
Endodontics | Complete chemo–mechanical preparation of root canal – one canal | 415 |
Endodontics | Complete chemo–mechanical preparation of root canal – each additional canal | 416 |
Endodontics | Root canal obturation – one canal | 417 |
Endodontics | Root canal obturation – each additional canal | 418 |
Endodontics | Extirpation of pulp or debridement of root canal(s) – emergency or palliative | 419 |
Endodontics | Resorbable root canal filling – primary tooth | 421 |
Endodontics | Additional visit for irrigation and/or dressing of the root canal system – per tooth | 455 |
Endodontics | Interim therapeutic root filling – per tooth | 458 |
Restoration Restorative Services | Metallic restoration – one surface – direct | 511 |
Restoration Restorative Services | Metallic restoration – two surfaces – direct | 512 |
Restoration Restorative Services | Metallic restoration – three surfaces – direct | 513 |
Restoration Restorative Services | Metallic restoration – four surfaces – direct | 514 |
Restoration Restorative Services | Metallic restoration – five surfaces – direct | 515 |
Restoration Restorative Services | Adhesive restoration – one surface – anterior tooth – direct | 521 |
Restoration Restorative Services | Adhesive restoration – two surfaces – anterior tooth – direct | 522 |
Restoration Restorative Services | Adhesive restoration – three surfaces – anterior tooth – direct | 523 |
Restoration Restorative Services | Adhesive restoration – four surfaces – anterior tooth – direct | 524 |
Restoration Restorative Services | Adhesive restoration – five surfaces – anterior tooth – direct | 525 |
Restoration Restorative Services | Adhesive restoration – one surface – posterior tooth – direct | 531 |
Restoration Restorative Services | Adhesive restoration – two surfaces – posterior tooth – direct | 532 |
Restoration Restorative Services | Adhesive restoration – three surfaces – posterior tooth – direct | 533 |
Restoration Restorative Services | Adhesive restoration – four surfaces – posterior tooth – direct | 534 |
Restoration Restorative Services | Adhesive restoration – five surfaces – posterior tooth – direct | 535 |
Restoration Restorative Services | Provisional (Intermediate/temporary) restoration | 572 |
Restoration Restorative Services | Metal band | 574 |
Restoration Restorative Services | Pin retention – per pin | 575 |
Restoration Restorative Services | Metallic crown – direct | 576 |
Restoration Restorative Services | Cusp capping – per cusp | 577 |
Restoration Restorative Services | Restoration of an incisal corner – per corner | 578 |
Restoration Restorative Services | Bonding of tooth fragment | 579 |
Recementing Restorative Services | Recementing of inlay/onlay | 596 |
Restoration Restorative Services | Post – direct | 597 |
Restoration Prosthodontics | Preliminary restoration for crown – direct | 627 |
Recementing Prosthodontics | Recementing crown or veneer | 651 |
Recementing Prosthodontics | Recementing bridge or splint – per abutment | 652 |
Other restorative Prosthodontics | Removal of bridge or splint | 656 |
New denture Prosthodontics | Complete maxillary denture | 711 |
New denture Prosthodontics | Complete mandibular denture | 712 |
New denture Prosthodontics | Complete maxillary and mandibular dentures | 719 |
New denture Prosthodontics | Partial maxillary denture – resin base | 721 |
New denture Prosthodontics | Partial mandibular denture – resin base | 722 |
New denture Prosthodontics | Partial maxillary denture – cast metal framework | 727 |
New denture Prosthodontics | Partial mandibular denture – cast metal framework | 728 |
Other denture Prosthodontics | Provision for casting | 730 |
New denture Prosthodontics | Retainer – per tooth | 731 |
New denture Prosthodontics | Occlusal rest – per rest | 732 |
New denture Prosthodontics | Tooth/teeth (partial denture) | 733 |
New denture Prosthodontics | Immediate tooth replacement – per tooth | 736 |
New denture Prosthodontics | Metal backing – per backing | 739 |
Denture ease Prosthodontics | Adjustment of a denture | 741 |
Denture reline Prosthodontics | Relining – complete denture – processed | 743 |
Denture reline Prosthodontics | Relining – partial denture – processed | 744 |
Denture reline Prosthodontics | Reline complete denture direct | 751 |
Denture repair Prosthodontics | Reattaching pre–existing tooth or clasp to denture | 761 |
Denture repair Prosthodontics | Replacing/adding clasp to denture – per clasp | 762 |
Denture repair Prosthodontics | Repairing broken base of a complete denture | 763 |
Denture repair Prosthodontics | Repairing broken base of a partial denture | 764 |
Denture repair Prosthodontics | Replacing tooth on denture – per tooth | 765 |
Denture repair Prosthodontics | Adding tooth to partial denture to replace an extracted or decoronated tooth –per tooth | 768 |
Denture repair Prosthodontics | Repair or addition to metal casting | 769 |
Denture repair Prosthodontics | Impression – dental appliance repair/modification | 776 |
Denture repair Prosthodontics | Identification (ie labelling denture) | 777 |
Miscellaneous General Services | Palliative care | 911 |
Miscellaneous General Services | Provision of medication/medicament | 927 |
Miscellaneous General Services | Splinting and stabilization – direct – per tooth | 981 |
Miscellaneous General Services | Post–operative care not otherwise included | 986 |