Community Contribution winner in the Australian Business Awards

The problem

The Salvation Army in Melbourne has had more than 300 homeless people on its accommodation waiting list — people sleeping rough on the streets, or in unsafe rooming houses, almost every night across the city.

The Magpie Nest Housing Project was created through a partnership between The Salvation Army, the Collingwood Football Club Foundation, and the Victorian Government’s Homelessness Innovation Action Plan.

It aims to provide:

• Good-quality, safe accommodation
• Reduced rents
• Wrap-around case management
• Links to health services, employment and training assistance

The goal is to make a real difference in the lives of people experiencing homelessness.

The design principle behind that list matters. Housing on its own has a poor record of holding. A tenancy offered without case management, health access and a path to work tends to fail for the same reasons the previous one did. Magpie Nest bundles the accommodation with the support — and dental care was identified as one of the supports that was missing. The practice’s other community commitments are listed on supporting charities.

How the involvement began

Smile Solutions had a long relationship with The Salvation Army, donating to its Christmas Appeal annually. Wanting to do more, the practice approached the Salvos to ask how it could contribute further.

The answer identified a specific problem: poor oral health was hindering homeless people trying to get their lives back on track — particularly when it came to employment.

Major Brendan Nottle, a Salvation Army social worker who had recently been named Melburnian of the Year for his work strengthening Melbourne’s social fabric, suggested that association with Magpie Nest would be the most effective contribution.

That is the part worth pausing on. The charity was asked what it needed rather than told what would be given — and the answer was not the obvious one. A dental practice offering help would ordinarily assume the useful thing to give is money, or a general offer of care to whoever turns up. What the Salvos identified instead was a targeted need inside an existing programme, attached to case management that could actually get people to appointments. That distinction is most of the difference between a donation that helps and one that is administratively impossible to use.

Why dental care, specifically

This is the argument that makes the programme make sense.

A healthy smile matters to self-confidence, and for people trying to regain control of their lives, damaged or degraded teeth are one more hurdle.

Typically, people with serious dental problems are self-conscious. They avoid smiling, and cover their mouths when they speak.

And their appearance can be confronting to others — which can stop prospective employers from giving them a chance.

That last sentence describes the mechanism precisely. Visible dental damage functions as a barrier to employment, in a way that is unfair, largely unspoken, and entirely real. Someone who will not open their mouth in an interview is not competing on equal terms.

But appearance is only the visible half. Untreated dental disease is also a health problem and a pain problem:

• Untreated decay and periodontal disease cause chronic pain, which disrupts sleep, concentration and mood — and makes every other part of stabilising a life harder. See tooth pain.
• Missing or painful teeth restrict what a person can eat, pushing the diet towards soft, processed, often high-sugar food, which in turn accelerates the decay — see how does sugar affect your dental health? and replacement options for missing teeth.
• Dental infection can become a medical emergency. A spreading facial infection from an untreated tooth is a hospital presentation, not a cosmetic matter — see what is a tooth abscess? and can a dental abscess affect your general health?
• Dental pain is a common reason for emergency-department attendance where a person has no other access point — an expensive route that usually provides antibiotics and analgesia rather than treatment of the cause. On that specific point, see I have a toothache. Should I see my GP for antibiotics?

Why it accumulates

There is a structural reason dental problems concentrate among people who are already struggling: dental care sits outside Medicare for most adults. Unlike a visit to a GP, routine dental treatment is not covered by the national scheme.

The alternatives available are narrower than most people assume:

• Public dental services in Victoria are available to concession-card holders and certain other eligible groups, delivered through community dental agencies and Dental Health Services Victoria. General-care waiting lists have historically run to long periods, though emergency care is prioritised.
• The Child Dental Benefits Schedule provides a capped benefit for basic dental services for eligible children — it does not extend to adults. See Child Dental Benefit Schedule and how the schedule operates.
• Private health insurance with extras cover requires premiums, usually waiting periods, and still leaves a gap payment.

So dental care is among the first things to become unaffordable, and among the last to be addressed. It is frequently the untreated problem left standing in a life that has otherwise begun to stabilise — and the one that is most visible to an interviewer.

The contribution

Since 2014, we have pledged an annual donation of up to $100,000 in dental services to Magpie Nest.

This has enabled people who could not otherwise access or afford dental care to receive the treatment they needed.

It was in recognition of that collaboration that we were named a winner of the Australian Business Award for Community Contribution in 2017. The practice’s other awards in that programme are recorded in a third consecutive Australian Business Award for Service Excellence and Smile Solutions wins on service excellence.

What the figure means

“Up to $100,000 in dental services” is a commitment of treatment, not a cash transfer, and it is a ceiling rather than a guaranteed spend. It is valued at the practice’s fees for the work provided — see the price guide. The people treated are referred through Magpie Nest and The Salvation Army, whose case workers identify who is in the programme and who would benefit.

How to read this page

This is a corporate and community page. It is not clinical information, and it is not an offer of treatment.

Several things follow, and they are worth stating plainly:

• There is no public application process for this programme. Places are identified by The Salvation Army and the Magpie Nest project, not by Smile Solutions, and not by request from the general public. Contacting the practice will not get a person onto it.
• A business award is a business award. The Australian Business Awards are an entrant-nominated programme assessing organisational practice. It is recognition of a community partnership — not a clinical assessment, a quality rating of dental treatment, or an endorsement by a health regulator. See how to read a business award.
• If you need dental care and cannot afford it, the routes that exist are the public ones: contact your nearest community dental agency about eligibility, or in Victoria the Royal Dental Hospital of Melbourne for emergency assessment. Facial swelling, difficulty swallowing or breathing, or fever with dental pain is a medical emergency — present to an emergency department or call 000. See what is considered a dental emergency? and emergency dentistry.
• Nothing on this page describes what treatment any individual would receive, at Smile Solutions or anywhere else. That depends on examination — see understanding your treatment.

On paying for private treatment

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. A credit arrangement is not a substitute for the public system if you are eligible for it.

Common questions

I cannot afford a dentist. Can I just get antibiotics for a bad tooth instead?

Antibiotics do not treat the cause, and the evidence on this is unusually clear-cut. A Cochrane review of systemic antibiotics for symptomatic apical periodontitis and acute apical abscess in adults summarises the guideline position: "clinical guidelines recommend that the first-line treatment for these conditions should be removal of the source of inflammation or infection by local operative measures, and that systemic antibiotics are currently only recommended for situations where there is evidence of spreading infection (cellulitis, lymph node involvement, diffuse swelling) or systemic involvement (fever, malaise)".

The gap in the evidence is the part worth knowing. The same review reports: "we found no studies that compared the effects of systemic antibiotics with a matched placebo delivered without a surgical intervention for symptomatic apical periodontitis or acute apical abscess in adults" — that is, there is no randomised evidence at all that antibiotics on their own, without the tooth being treated, resolve these conditions. The review also notes that "there is evidence that dentists frequently prescribe antibiotics in the absence of these signs", and that the concern about doing so is "that this could contribute to the development of antibiotic-resistant bacteria".

What that means in practice: a course of antibiotics may buy a few days and settle a spreading infection, and in the circumstances above it is the right thing to have — but the tooth still has to be dealt with, and the problem returns if it is not. Any prescribing decision belongs to the practitioner seeing you.

And the exception that overrides everything: spreading swelling into the neck or floor of the mouth, difficulty swallowing or breathing, a change in your voice, or fever with facial swelling is an emergency department presentation, not a wait-and-see. See I have a toothache. Should I see my GP for antibiotics? and what is considered a dental emergency?

Do bad teeth really cost someone a job, or is that a convenient story for a charity page?

It is the World Health Organization's own finding, stated without hedging. On the employment question specifically the WHO says: "for adults, dental caries is associated with absence from work, and may negatively affect employment opportunities and reduce productivity". On children it makes the parallel point that dental caries "often leads to absence from school".

The WHO also describes the wider consequences of leaving decay untreated, and the list is not confined to appearance: "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".

So there are two separate mechanisms, and both are real. One is visible — how a person is read across a table. The other is not visible at all: chronic pain, disturbed sleep and restricted eating are a poor foundation for holding down work, and they are present long before anything shows.

Why treat this as a public health problem rather than a matter for charity?

Because the scale is beyond what donated care can reach, and the published numbers make that plain. The WHO records dental caries as "the most common noncommunicable disease (NCD) worldwide, affecting 2.5 billion people", and puts the direct cost across its member states at "US$ 387 billion or a global average of about US$ 50 per capita in 2019" — about "4.8% of global direct health expenditures" — with productivity losses on top of that estimated at around US$ 323 billion.

In Australia the access gap shows up in the same way every time it is measured. A submission to the Senate inquiry into out-of-pocket medical costs cited an Australian Institute of Health and Welfare survey finding that "nearly a third of people aged 5 or older (32%) avoided or delayed visiting a dentist due to cost", and argued for a recommended national dental fee schedule on the grounds that its absence contributes to the cost of care. The Australian Dental Association, from a different direction, has called for dental care to be included in chronic disease management plans and for "more funding for public dental services".

The honest framing of a page like this one, then: a donated-services programme is worth doing and it is not a solution. It reaches the people a case worker can get to an appointment. The 32 per cent are a policy problem.

If dental care is out of reach right now, what is actually worth doing?

The prevention that works costs very little, and it is the same advice regardless of income.

• Brush with a fluoride toothpaste. The WHO identifies "inadequate exposure to fluoride and a lack of removal of plaque by toothbrushing with fluoride toothpaste containing 1000-1500 ppm concentration" as part of what allows decay to develop. Standard adult toothpaste in Australia sits in that range; check the tube.
• Spit, do not rinse. Rinsing with water straight after brushing washes away the fluoride before it has done its work. Research on fluoride mouthrinses found that "the inclusion of 100 ppm fluoride in a mouth rinse compensated for the loss of" the fluoride otherwise washed away — which is the same point from the other side: a plain water rinse removes the benefit.
• Cut the free sugars, and the frequency more than the amount. The Australian Dental Association's diet policy states that "the form, frequency, timing and total amount of sugar intake are significant in the initiation of the caries process" and recommends limiting intake to "no more than 6 teaspoons (24 grams of free sugar (5% of total energy intake) per day". Sipping a sweet drink across an afternoon does more damage than drinking it at once.
• Water, not soft drink. The ADA notes that "the combination of sugar and food acid can be particularly destructive", and the WHO recommends that "children under 2 years of age should not consume any sugar-sweetened beverages".
• Do not wait for pain to decide the timing. Decay is usually painless while it is cheap to fix. See how do I prevent dental decay? and the stages of dental decay.

None of this replaces treatment for a tooth that is already damaged — but it is what keeps the next one from joining it, and it is available to anyone with a toothbrush and a tap.

Related reading

Supporting Charities · Our Awards · Emergency Dentistry · What is considered a dental emergency? · How does tooth decay develop? · What is gum disease? · How do I prevent dental decay? · How often should I go to the dentist? · General dentistry

Practical details

Smile Solutions, Level 1, 220 Collins Street, Manchester Unity Building, Melbourne VIC 3000 — see how to find us. Phone 13 13 96, or theteam@smilesolutions.com.au; full details on the contact page. Monday–Friday 8.00am–6.00pm, Saturday 8.30am–1.30pm, Sunday by appointment.

Published 17 August 2017. Figures, roles, award year and programme arrangements are as described at that date and may have changed since. Waiting-list numbers, public dental eligibility criteria and government schemes change over time; check current details with the relevant service rather than relying on this page. Payment plan terms are set by the credit provider and change; confirm current terms directly before you commit. Quotations and figures attributed to the World Health Organization, the Australian Dental Association, the Cochrane Library, the Australian Institute of Health and Welfare and submissions to Parliament are those publishers’ own, as at the dates of the documents cited.

General information only — this page describes a community partnership and an award. It is not clinical information, not a diagnosis, not a treatment plan, not a quote, and not an offer of free or subsidised treatment. It does not replace advice from your treating practitioner.

Smile Solutions trades under ABN 28 193 514 103.