When 26-year-old Harindra Herath finished her dental studies, she wanted to work where she grew up, but knew it would not be easy.
"I find that a lot of young people here want all their teeth taken out and have dentures made, which is not the way to go," Dr Herath said.
The main reason patients make the request is to save on dental costs, but Dr Herath, who works in Hobart's northern suburbs, said some intergenerational attitudes to teeth also played a role.
"Unfortunately, it is a cycle that we do notice a lot in the northern suburbs; their parents have had full dentures, their grandparents have full dentures, so unfortunately young people do think it's the norm."
In Tasmania, dental problems are the most common reason for preventable hospital admissions.
Those admissions are often the very young.
"Which is really sad and a lot of patients require general anaesthetics because they are so young, they can't tolerate treatment in the chair," Dr Herath said.
Sixty teeth removed from five children under five
Ioan Jones, the clinical director of Oral Health Services in Tasmania, lamented the number of young children from Hobart's northern suburbs being operated on for something that is almost entirely avoidable.
"We don't want to be doing it, we want to be preventing disease, we don't want to be getting to that. It's intense and burdensome for a clinician, for the family and not only that, the impact on the child," Dr Jones said.
He recalled a particularly grim hospital day.
"Again you see that cycle where all the siblings [in the one family] have had general anaesthetics, had most of their teeth taken out, and sometimes they're as young as two or three years old," Dr Herath said.
Jane had all her teeth removed at 36
Fourteen years ago, aged 36, Jane Bridges woke with a large swelling in her cheek and was rushed to hospital.
Before the day was over, all her teeth had been removed.
Facing the world without teeth has been a struggle.
"I've sort of grown into it and I'm a little less self-conscious," Ms Bridges said.
"But there are some times if I'm at the shops or somewhere and all of a sudden I will think, 'Oh sugar, I hope they can't tell I've got no teeth.'
Ms Bridges has been trying to find paid work for eight years and often gets to the interview stage.
She said she would always be left guessing during the interview whether people realised she had no teeth.
"Do they know? Can they tell? Is that why I'm not getting to the next stage?" she said.
Massive public waiting lists
Appointments at Oral Health Tasmania are free for under 18s and $45 for adults with a healthcare card or pensioner concession card.
As of July, there were 17,838 people waiting for an appointment and last financial year the average wait-time was two years.
In an emergency, people are usually seen within two days.
Mary-Anne Evans, who runs the Bucaan Community House at Chigwell, where Ms Bridges volunteers, said the $45 co-payment was counter-productive.
"Especially when they started putting people into collection for not paying that fee," Ms Evans said.
"People just stopped going because they knew they weren't going to be able to afford it in a timely fashion and they knew they were going to end up in collection, and that affects everything.
Even if they do choose to contact Oral Health, Ms Evans said a small dental problem could often develop into a crisis while they wait to be seen.
"They'll be put on a waiting list, and they might have to wait two to three years before they see someone and in that time their health can decline, especially if it's an infection and they could end up in hospital."
The $5 billion burden
The Glenorchy Local Government Area in Hobart's north is in the grip of an oral health crisis, a picture replicated throughout most lower socio-economic parts of Australia.
As well as the huge impact on human health, tooth decay costs the country billions of dollars every year.
Dr Jones is passionate about improving oral health but said meaningful change would only happen when the community realised its importance.
"If we can improve oral health we will actually help improve systemic health as well," he said.
If dental problems are not fixed, they can lead to cardiovascular disease, lung conditions, adverse pregnancy outcomes, stroke and diabetes, he said.
"We know that if we improve oral health, improve the condition of somebody's mouth, we can get better glycemic control, we can improve their diabetic health," he said.
The Australian Institute of Health and Welfare counted the economic cost of dental decay in Australia for the 2018/2019 financial year — it was $5.1 billion.
"I'm somebody who should know about the cost of disease but even that took my breath away to see the economic size of the burden," he said.
Improvements depend on education and equity
Ms Evans said better promotion of dental care in her community would help but it needed to factor in the stress dominating so many people's lives.
"People don't like hearing that they're not doing something right, it's not a great thing to hear constantly," she said.
At Claremont College, 17- and 18-year-olds have been learning about inequities that exist in accessing health care.
Libby Alderton is in grade 12 and throughout her childhood she had a lot of dental work done.
The often traumatic experiences have made her want to be a dental assistant to help others.
"I was really stressed and nervous when I used to sit in the dental chair and I think if I can help someone get over their fear, that's a good thing," she said.
Grade 12 student Will Medwin said most people his age would not know it was free to go to the public dentist for under 18s.
"I guess [it's a] fault of my own I haven't been in a few years, but there's not a lot of community push to go to the dentist and you don't see lots of health promotions promoting the dentist," he said.
Grade 11 student Kate Forrest-Magill said understanding the importance of dental health depended on where you lived.
"Because there might be education levels higher in a higher socio-economic area and so obviously if a parent knows that the child's going to have to go to the dentist, they're going to take their child to the dentist and that will be passed onto the child for the future," she said.
Thousands more appointments on offer
The number of publicly funded and staffed dental chairs in Hobart's northern suburbs will soon rise to seven, up from three.
The state government is trying to reduce waiting times by committing $5 million to create thousands of extra appointments in the next 18 months.
A recruitment drive is also underway to deal with a shortage of dentists and assistants in the state.
"We're encouraging people to come into the industry, you can make a real difference on peoples' lives as part of a healthcare team," Dr Jones said.
