Appendix K - Schedule of Dental Services

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.

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.

Table 7.2 Schedule of dental services.