Community dentistry and rebuilding a damaged smile

A note on this article

An earlier version of this page described the treatment of an identified individual, including their personal circumstances and their comments about the result.

Testimonials are not permitted in advertising a regulated health service under the National Law, and publishing the health information and personal history of an identified patient is not appropriate regardless of consent given years ago. That material has been removed.

What remains is the part that is genuinely useful: the community work, and what rebuilding a badly damaged dentition actually involves.

Community work

Giving back to the community matters to Smile Solutions. See Supporting Charities.

The practice donates dental services each year to people experiencing homelessness, through an initiative called Magpies Nest, administered by the Salvation Army.

This is worth naming plainly because dental care sits outside Medicare for most adults, which makes it one of the first things to become unaffordable and one of the last to be addressed. For someone without stable housing, untreated dental disease is both a source of chronic pain and a barrier to employment — which is why pro bono dental work has a reach beyond the mouth.

That last point is not just an assertion. The World Health Organization sets out what untreated decay does to a person, and the list is not confined to teeth: “physical symptoms such [as] pain, discomfort or chronic systemic infection; functional limitations such as challenges eating, speaking, breathing or sleeping; and detrimental impacts on emotional, mental and social well-being.” On the employment question specifically, the WHO is direct: “For adults, dental caries is associated with absence from work, and may negatively affect employment opportunities and reduce productivity.”

The WHO also describes the pattern that makes charitable work necessary rather than merely generous: where treatment is out of reach, “teeth affected by caries are often extracted (pulled out) when they cause pain or infection”, and “prevention and treatment for dental caries is usually not part of national health benefit packages”, which “often leads to catastrophic costs and significant financial burden for families and communities.” Extraction becomes the default not because it is the right treatment but because it is the affordable one — and each tooth lost that way makes the eventual rebuild larger.

The scale of the underlying problem in Australia is substantial. Writing in an Australian Dental Association publication, Professor Lisa Jamieson put the economic cost this way: “Dental caries imposes a large cost on the Australian economy. That cost is estimated to be up to $1 billion per year”, adding that “children who are in socially vulnerable situations are also more likely to be hospitalised for dental conditions that could have been prevented.”

For eligible children there is a public scheme — see Child Dental Benefit Schedule.

Rebuilding a severely damaged dentition

Some patients present after years of chronic dental pain, infection, and teeth broken down beyond ordinary repair — sometimes following trauma, sometimes following long periods where care was not accessible. See Complex Dentistry and Fix My Teeth.

Written in general terms, here is what treatment of that kind involves.

The consequences being treated

Chronic dental pain affects a person’s whole outlook, not only their mouth. It changes what they can eat, whether they smile in company, and how they feel about being seen. See Tooth Pain & Ache.

And the pattern compounds. Damage leads to pain, pain leads to avoidance, avoidance leads to more damage — which is why these cases are rarely the result of neglect alone. Where the avoidance is fear rather than access, see Dental Anxiety and Sleep Dentistry.

Infection is not only a local problem. Diabetes Victoria notes that “in extreme cases, untreated oral infections can result in hospitalisation” — which is part of why the first phase below deals with infection before anything else, and why pain that is escalating should be seen rather than endured. See Emergency Dentistry.

The two-phase approach

Phase one: remove the teeth that cannot be saved — those with infections and abscesses. Infection is dealt with first, before any restorative work, because restorations placed over active infection fail. See What is a tooth abscess?, Can a dental abscess affect your general health? and Emergency Dentistry.

Phase two: restore all the salvageable teeth. In a case of this kind that may be done with white resin fillings, which restore function and appearance without the cost and chair time of ceramic work — an appropriate choice where the priority is getting a mouth healthy and functional. See Tooth Fillings and Composite Bonding.

The clinical principle throughout: save what can be saved. A natural tooth restored is preferable to a natural tooth replaced. Where a tooth is saveable through its root, see Root Canal and Endodontists; where teeth have been lost, Bridges, implants or dentures, Dentures and Dental Implants.

Gum health is assessed alongside — it is the most common reason teeth are lost in the first place. The scale of it is easy to underestimate: a review in Diabetologia records that severe periodontitis, the form that threatens whether a tooth can be kept, affects 10 to 15 per cent of adults in most populations studied, while moderate periodontitis affects 40 to 60 per cent. See Bleeding Gums, What is periodontal disease? and Periodontists.

Time and cost

Treatment of this scale typically runs to around two months of weekly appointments.

Indicative cost at the time of writing: in the order of $8,000, with both cosmetic dentists and registered specialists involved. See General Dentistry and Specialist Care.

That figure is not a quote, and it is more than a decade old — see the Price Guide for current fees. It is included because people in this position often assume the cost is unreachable and stop before asking — and the actual number, and the payment options against it, are worth establishing rather than guessing.

Two things from the Australian Dental Association’s Dental Fees Survey 2022 are worth knowing before you read any published figure, including that one. First, fees vary widely between practitioners and between states — the ADA found “considerable variation in the fees charged within and between states”, so a number from one practice is not a national rate. Second, where specialists are involved the range is wide: among the specialists who responded, the mean hourly rate was $921 and the median $800, ranging between $450 and $1,500 per hour. The ADA attaches its own warning to that figure — the specialist response rate was low, and it says the specialist results “should be interpreted with considerable caution.” We quote it with that caution attached, because a rehabilitation of this kind is priced by the hours it takes.

The practical consequence is that only a written, itemised quote for your own mouth means anything. See Understanding your treatment for what that quote should set out.

Payment plan options are available. Where a plan is advertised as interest free, that describes the plan term only — a deposit may be required, an establishment fee and ongoing account fees may apply, and charges can apply if the balance is not cleared within the agreed period. The applicable terms depend on the provider and the amount financed, and are set out in writing before you commit — ask what the deposit and the establishment fee are, in dollars, and what the total will be by the end. Payment Plans.

Staging the work also spreads it: urgent infection and pain first, restorations next, anything cosmetic last.

Why it matters

A healthy smile helps people feel confident in social and work settings.

Functional, healthy teeth support overall wellbeing, physically and emotionally — the ability to eat properly, to speak without self-consciousness, and to be free of chronic pain. The WHO puts the same point from the other direction, describing oral disease as “a major health burden ... causing pain, discomfort, difficulties in eating and sleeping, tooth loss and reduction in quality of life.”

If your teeth are in a state you find embarrassing, that is a reason to be seen, not a reason to stay away. Practices that treat these cases see them regularly, and the first appointment is a conversation rather than a judgement. See Contact Us and Second Opinions & Corrective Dentistry.

Once the mouth is healthy, keeping it that way is the cheaper half — Dental Cleans & Hygienists and How do I prevent dental decay?.

Common questions

Once the work is finished, is it finished?

No, and anyone who tells you otherwise is selling something. A rebuild of this kind ends one problem and begins a maintenance relationship. The NHMRC states the underlying point plainly in its public information on tooth decay: “Once a tooth is filled, it becomes structurally weaker and will almost certainly require further treatment in the future.” That is not an argument against filling teeth — it is an argument for understanding what you have bought. Restorations are repairs, they have finite lives, and the mouth they sit in keeps changing.

What determines how long the work lasts is mostly what happens after it. The same disease that caused the damage is still in the mouth unless the things that drove it change — diet, plaque removal, dry mouth, and above all gum health. The Diabetologia figures quoted above are the reason: moderate periodontitis affects 40 to 60 per cent of adults, and it is the leading route by which restored teeth are eventually lost anyway.

Practical resolution: at the end of treatment, ask for three specific things in writing — which restorations are expected to need review soonest and why, what your recall interval should be and on what basis, and what would count as an early warning sign to call about rather than wait out. Budget for maintenance as part of the plan rather than as a surprise. See Dental Cleans & Hygienists and What is periodontal disease?.

Can a tooth infection really make me seriously ill, or is that just said to make me book?

It is not a scare line, and the sources are government ones rather than dental marketing. Healthdirect, the national health information service, states that if a tooth abscess is not treated “the infection can spread beyond your tooth and jaw”, and lists the serious complications as “trouble breathing — swelling in your neck or mouth can block your airway”, “sepsis — a serious infection that spreads through your whole body”, and “long-term problems — such as facial scarring, difficulty opening your jaw, vision loss or brain injury”. It also states that “rarely, dental abscesses can become life-threatening” — rarely being the operative word, and the reason for it being that most infections are treated before they get there.

The Australian burden is larger than most people expect. Published Australian figures put it this way: “in Australia, approximately 37% of all adult dental emergency visits to public hospital emergency departments are due to dental infections”, and describe dental infection as “the leading dental-related cause of potentially preventable hospitalisations” in this country.

The signs that mean today, not next week: swelling that is spreading into the neck or under the jaw, difficulty swallowing or opening the mouth, any change to your voice or your breathing, a fever with the swelling, or swelling closing an eye. Those are emergency department signs, not dental appointment signs — a swelling that is affecting the airway is treated as an emergency. Anything less dramatic but persistent — a tooth that throbs, a gum boil that drains and refills, pain that wakes you — is a dentist this week. See Emergency Dentistry and What is a tooth abscess?.

Is there any help paying for it if I have very little?

Be told the honest structure of it rather than a reassurance. As this page says, most adult dental care sits outside Medicare, and that is the central fact. What exists around it:

• For children, the Child Dental Benefits Schedule. Services Australia's own wording: “You can claim up to $1,158 for each eligible child over 2 consecutive calendar years”, with the cap “indexed yearly on 1 January”. Eligibility depends on the child's age and on the family receiving a qualifying payment, and it is assessed each calendar year. It pays nothing toward treatment in hospital or under general anaesthetic. See Child Dental Benefit Schedule.
• For adults, public dental services exist in Victoria for people holding an eligible concession card, and the ADA has publicly called for “more funding for public dental services” and for dental care to be included in chronic disease management plans — which tells you something about the demand relative to capacity. Waiting times are set by the service, not by any private practice, so ask the public service directly rather than assume.
• In private practice, the levers are staging and payment plans rather than discounts: urgent infection and pain first, restorations next, cosmetic work last or never. The payment plan terms above are the ones to interrogate.

The one thing not to do is wait for the money before asking the question. A written, itemised plan costs nothing to obtain, and it converts an unbounded fear into a number that can be staged. If the number is still out of reach, say so plainly at the appointment — the sequence can usually be rearranged around what is urgent.

Wouldn't it be cheaper to just have them all taken out?

Sometimes the arithmetic does point that way, and a good practitioner will say so — but the comparison people make in their heads is usually the wrong one. The cost of extractions is not the end of the cost; it is the beginning of the cost of replacing them, which can run for the rest of a life. Replacement teeth, in any form, have their own fees, their own maintenance and their own eventual remaking. That is why this page's clinical principle is to save what can be saved, and why the WHO's observation quoted above matters: extraction becomes the default where treatment is unaffordable, not because it is the correct treatment.

Where the balance genuinely tips is when teeth are not restorable, when advanced periodontal disease means restorations would be built on failing foundations, or when a person's circumstances make a long staged rehabilitation unrealistic. Those are clinical and practical judgements about your mouth and your life, not a general rule.

Practical resolution: ask for both pathways costed in writing — restore what is restorable, against extract and replace — including the replacement work and its expected maintenance, not just the extractions. Then ask which teeth are genuinely unrestorable and why, tooth by tooth. If the two plans come from the same conversation, you can compare them honestly; if the answer feels rushed, a second opinion is a normal thing to seek and not an insult to anyone.

Practical details

Written by Dr Madeleine Hoopmann.

Smile Solutions, Level 1, 220 Collins Street, Manchester Unity Building, Melbourne VIC 3000. Phone 13 13 96, or theteam@smilesolutions.com.au. Monday–Friday 8.00am–6.00pm, Saturday 8.30am–1.30pm, Sunday by appointment.

Specialist registration can be verified on the AHPRA register, or by calling 1300 419 495; the clinicians are listed on Our Team.

Published 2 December 2014; revised to remove identifying patient information and testimonial content. Costs and donation figures are as at the original date of publication and are indicative only. Treatment need, duration and cost vary considerably between individuals. Quotations and figures attributed to the World Health Organization, the Australian Dental Association, Diabetes Victoria, the NHMRC, Healthdirect, Services Australia and Diabetologia are those publishers’ own, as at the dates of the documents cited, and describe populations rather than any individual. General information only; it does not replace advice from your treating practitioner. Payment plan terms are set by the credit provider and change; confirm current terms directly before you commit. Medicare and Child Dental Benefits Schedule rules are set by government and change; confirm current entitlements with Services Australia.

Smile Solutions trades under ABN 28 193 514 103.