By Associate Professor Roisin McGrath (MPH 2011, PhD 2019, GCertUniTeach 2021)
Australia’s dental care system delivers world-class outcomes – if you can afford it. But, for too many people, basic dental care is out of reach. The good news is we don’t need to start from scratch to get better results. We can learn from what works globally and adapt it to our local context to build a more sustainable, inclusive framework for dental care.
Early prevention for nursery and primary school children in Scotland
The earlier we reach children with preventive care, the more likely they are to avoid costly and complex dental issues later in life.
Scotland’s Childsmile program has become a global benchmark for prevention and early intervention in oral health. Running since 2011, the initiative centres around supervised toothbrushing in all nurseries and targets primary schools in areas with the highest levels of need. By delivering toothbrushes and fluoride toothpaste directly to children and ensuring they are used via supervised toothbrushing Childsmile reaches families who may not have the resources, routines or knowledge to support oral hygiene at home. In some cases, it’s the first time a child has had their own toothbrush.
In Australia, such initiatives tend to focus on outreach through school dental services or mobile dental vans, which provide preventive care and treatment in communities with limited access to dental clinics. Evidence shows an eight per cent rise in attendance among low-income groups and some improvement in access, but overall population oral health outcomes remain marginal. The contrasting effectiveness of Childsmile is attributed to persistent oral health education, population-wide reach, and systematic evaluation.
Keeping seniors chewing and thriving in Japan
Japan offers one of the most comprehensive systems for senior dental care, built on universal health coverage, proactive public health initiatives and a focus on maintaining oral function. Research shows that adequate chewing and swallowing ability is strongly linked to better nutrition, frailty prevention and quality of life in older adults. Since 1989, the nation’s 8020 campaign has encouraged people to maintain at least 20 of their natural adult teeth by the age of 80.
National policy now supports regular oral function assessments at ages 40, 50, 60, 70 and 75+. Dental care for seniors in Japan is increasingly delivered through community-based integrated care, where dentists and dental hygienists work with aged care teams to assess, prevent oral disease and rehabilitate oral function. This model blends clinical outreach, in-home visits and inter-professional collaboration to support healthy, independent aging. As a result, Japan has among the world’s highest rates of retained natural teeth at age 80. Around 50 per cent of elderly adults retain at least 20 teeth, a fivefold increase since the program began.
In contrast, Australia lags well behind Japan, with studies showing only about 46 per cent of adults aged 75+ retain 20 or more natural teeth – one-third the rate seen in Japan. The major factors that explain differences in elderly tooth retention between Japan and Australia include health system structure, funding models, preventive program reach, socioeconomic disparities and cultural attitudes toward oral health.
Cutting down sugar and saving teeth in the UK
Around the world, fiscal policy is proving to be a powerful tool in preventing oral disease. A high-impact example is the UK’s Soft Drinks Industry Levy – or "sugar tax." Introduced in 2018, the tiered tax applies higher charges to drinks with greater sugar content, pushing manufacturers to reformulate their products.
We should be considering government interventions like taxes, advertising restrictions or even school canteen bans.
And it’s working! After the tax was introduced, the average sugar content of soft drinks dropped by 43 per cent, and recent research shows this change has translated into meaningful health outcomes. Both children and adults are now consuming less sugar overall, and hospital admissions for childhood tooth extractions due to decay have reduced. The biggest improvements are in children under 10, across a wide range of communities regardless of socioeconomic background.
It’s a compelling example for Australia, where sugar-sweetened beverages are one of the largest sources of added sugar in our diet: heavily marketed, widely available and often cheaper than healthier options. We should be considering government interventions like taxes, advertising restrictions or even school canteen bans.
Steps towards universal dental care in Europe
Last year, responding to evidence that oral health has a significant influence on overall health outcomes, the World Health Organization called for all countries to fully integrate oral health into universal health coverage by 2030. Research comparing outcomes across European countries shows that universal systems are effective at prioritising prevention, improving equity and – critically for Australia – gathering better data. Universal dental care ensures a broad base of data is collected across the entire population, providing a comprehensive picture of dental health trends, service gaps and treatment effectiveness.
For example, Germany uses a combination of national surveys, routine data analyses from health insurance companies, and ongoing epidemiological projects to gather data for improving dental health outcomes. This data informs public health initiatives, policy adjustments and preventive measures like fluoridation and oral health education interventions.
In Denmark, which provides free dental care to all children and adolescents, a national oral health registry collects child oral health data, allowing for monitoring and evaluation.
In contrast, countries like Australia, Spain, Ireland and the Netherlands have more limited or targeted programs and rely heavily on private sector delivery. These countries experience wider disparities in oral health outcomes and higher rates of untreated disease.
Key takeaways for Australia
Australia has much to learn from these examples. While our current system delivers world-class care to those who can afford it, it leaves too many behind – especially children in disadvantaged communities, older adults, and people in rural and regional areas. With 80 percent of dental care delivered in the private sector (60 percent paid directly by individuals and 20 percent through private health insurance) and limited national data collection, we lack the visibility, coordination and accountability needed to drive real system improvement.
The answer involves more than funding – it requires a shift in mindset. We need to treat oral health as essential to overall health, embed preventive care into schools and aged care settings and explore policy levers like sugar taxes that shift behaviour at a population level.
Integrating oral health into a proportionate universal health care model would be ideal. This would ease the financial burden on individuals, support earlier intervention and promote more equitable health outcomes.
But even if we do not go down this route, we must invest in comprehensive, nationally coordinated oral health data collection. Otherwise, Australia will not have the insights needed to design smarter policies, uncover inequities, understand what works and ensure accountability across both public and private providers – or be able to compare and contrast learnings from across the globe.
The future of oral and dental care is being written now – and you can be part of it. Support ground-breaking oral health and dental research at the Faculty of Medicine, Dentistry and Health Sciences.