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Emergency dental

You'll most likely need a private health insurance extras policy if you want cover for dental emergencies.

Extras cover is the only way most people will get cover for emergency dental work because the public health system only covers certain groups like children, seniors and low-income families, and, in some rare cases, emergency treatment in a normal (i.e. non-dental) hospital.

With a private extras policy, your insurer will pay up to 80% of your treatment cost, plus you'll have access to other benefits like regular dental check-ups, natural therapies and more.

What is emergency dental?

Emergency dental care refers to any dental treatment that requires immediate attention. It can include medical emergencies like trauma to the face and jaw, but it doesn't always have to be a medical emergency. For example, broken dentures can be considered an emergency since some people require them to be able to eat.

Common examples of dental emergencies include the following:

  • Having a tooth knocked out due to head/face trauma
  • Chipping, cracking or breaking a tooth (for example by biting on a cherry pit)
  • Bleeding gums
  • Broken jaw
  • Extreme pain
  • Broken dentures

Does Medicare cover emergency dental?

It is very rare for Medicare to cover dental treatments including emergency care. There are only three situations in which Medicare will cover you:

  • If it's part of another treatment. You will be covered for the initial treatment if your emergency dental work is part of another Medicare-approved surgery, for example, if you break your jaw and need teeth extracted before doctors can fix the jaw. However, you won't be covered for follow-up dental treatments.
  • If you're under 18 and disadvantaged. Certain children are eligible for up to $1,000 in dental benefits over one consecutive two-year period, but only if they are receiving other benefits meant for disadvantaged children like the Family Tax Benefit A. This is called the Child Dental Benefit Schedule.
  • You are treated in the emergency room. If you go to the emergency room of a public hospital, Medicare will cover any treatment they provide even if your dental issue is not part of a larger health concern (e.g. a broken jaw). For example, if your tooth is in extreme pain, you can be treated for the pain in an emergency room and have it fully covered.

Can you get emergency dental care through your state's public health system?

Most states also have public dental benefits, but they usually prioritise certain groups like children, the elderly, the homeless and low-income families. If you are eligible for emergency dental benefits through your state, you will most likely have to visit a public dental facility and may have to join a queue if your condition is not life-threatening.

Here are the benefits available in each state:

In NSW, emergency dental care is free for the following people:

  • All children under 18.
  • Any adult with a valid Centrelink Concession Card (plus anyone else listed on the card).

You must also have a valid Medicare Card and get your treatment at a NSW public dental clinic.

The following groups are eligible for free emergency dental care in a VIC community health centre or public dental hospital:

  • All children up to the age of 12.
  • Children up to 18 who are eligible for the Child Dental Benefit Schedule, are in out-of-home care provided by the Department of Human Services or in custodial care.
  • Children up to 17 who have a valid concession card or are the dependant of someone with a concession card.
  • Refugees, asylum seekers, Indigenous Australians, Torres Strait Islanders and mental health patients.

Adults who have a valid Health Care or Pensioner Concession Card will receive emergency dental care in a community health centre or public dental hospital for $28.50. Everyone else can use the public facilities, but you'll be charged rates that are similar to what you'd find in a private facility.

The following groups can receive free publicly funded emergency dental treatment in QLD:

  • All children between age 4 and year 10 of secondary school.
  • Children outside of that range who have a concession card or are dependants of a concession card holder.
  • Children in the custody of the Director-General, Department of Communities or Child Safety and Disability Services.
  • Adults with a Pensioner Concession Card from the Department of Veterans' Affairs or Centrelink, a Health Care Card, a Commonwealth Seniors Health Card or a QLD Seniors Card.

You must be a QLD resident and you must receive your treatment in a public dental facility.

The following groups are eligible for publicly funded emergency treatment in WA:

  • All children 4 and under.
  • Children 5-16 who are in school.
  • People 17+ who hold a Health Care or Pension Concession Card.

You must receive your treatment in a public dental facility. If you live in a rural community and don't have access to a private clinic, you can use a public clinic but you will have to pay full price for treatment.

If you belong to one of the following groups, you are eligible for publicly funded dental treatment in SA:

  • Dental treatment is free for all babies and children not yet in school as well as school-aged children under 18 who have a Health Care Card, are members of the School Card Scheme or are dependants of someone with a Pensioner Concession Card.
  • All other children under 18 are eligible for dental treatment if they pay a small fee.
  • Adults with a Pensioner Concession Card or a Health Care Card are eligible for dental treatment if they pay a small fee.
  • Adult Indigenous Australians and Torres Strait Islanders with a Pensioner Concession Card or a Health Care Card are eligible for free emergency dental treatment.

You must have your treatment in a public facility.

The following groups are eligible for publicly funded dental treatment in TAS:

  • All children up to 18 years of age will receive free treatment.
  • Adults with a Health Care or Pensioner Concession Card will receive treatment for a small fee.

You must visit a public dental facility to be eligible.

Does private health insurance cover emergency dental?

Unless you are one of the very few people who are eligible for public assistance, private health insurance is the best way to get cover for emergency dental treatment. Private insurers cover dental work as part of their extras policies (as opposed to hospital policies).

Here's what to look out for when choosing an extras policy:

  • You'll want the right level of cover. Many basic policies will cover tooth removals, but usually nothing more complicated than that. Most other emergency procedures like root canals, complex fillings and crowns will be considered major dental treatment, which is usually only covered under a comprehensive policy.
  • You need to consider waiting periods. When you first take out a new extras policy, you'll usually have a waiting period of anywhere from 2-12 months depending on whether you need basic treatment like a tooth removal or major treatment like a root canal. Sometimes insurers will waive your waiting periods for basic treatments as a way to win your business, so it doesn't hurt to ask.

Your insurer will pay a percentage of your treatment cost up to your yearly benefit limit. The percentage they'll pay varies from insurer to insurer, but will usually be anywhere from 60-80%.

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What to do if you experience a dental emergency?

If you think you need emergency dental work, the first things you need to do are get yourself out of immediate danger and take steps to minimise long-term damage to your teeth, gums and jaw.

Here's what you need to do:

  • Call an ambulance. If your dental emergency involves head trauma or continuous bleeding, call an ambulance.
  • Save your tooth. If you lost a tooth, wash it with milk and try to place it back in the socket – holding it by the crown, not the root. If you can't replace it, or if it's just a tooth fragment, place it into some milk or wrap it in a wet towel and take it to the dentist.
  • Save your crown or filling. If you lost a crown or filling, rinse it in warm water and take it to the dentist.
  • Ice your jaw. If you think you have a broken jaw, you can minimise swelling by icing it down with a cold pack or some ice wrapped up in a towel.
  • Rinse your mouth. If you are out of immediate danger, rinse your mouth with warm water to remove debris and prevent infection.
  • Do not take aspirin. Aspirin thins the blood and can cause excessive bleeding. Wait to see your dentist before taking anything for pain.
  • See a dentist. After you have taken care of all immediate concerns, you should go straight to your dentist or the nearest one. Many dentists will leave space open for emergencies, and they may be able to get you in immediately depending on how severe your condition is.

How to find a dental hospital

If your emergency is so severe that you need an ambulance, there is a good chance they will take you directly to a dental hospital, which is better equipped than a family dentist to handle surgeries and other complex treatments.

If you don't need an ambulance, you should see your family dentist who will be able to take care of some emergency procedures and refer you to a dental hospital if necessary.

If you're eligible for emergency dental treatment through your state's public health system, you may need to be treated in an authorised community health centre (in place of the family dentist) or the local public dental hospital (in place of a private dental hospital). So if you can, mention to your dentist or ambulance driver that you'd rather be treated in a public facility.

How do the costs work?

If you use a public dental facility for your emergency dental treatment, your costs will differ based on what state you are in and your eligibility threshold in that state. If you are eligible for publicly funded emergency dental treatment in your state, it could be free or you could end up paying a small fee.

If you are not eligible for public benefits in your state (most adults and a large proportion of children in each state), you will most likely need to visit a private clinic for your treatment.

A private clinic can charge you whatever they want for your treatments. If your private health insurance covers your emergency dental treatment, it will pay a percentage of your costs up to your benefit limit.

The following table shows how much you would pay for a hypothetical root canal and how it would affect your benefit limits, based on an insurance policy that covers 70% of your treatment costs and has a $1,000 benefit limit.

You may be able to do these calculations yourself for your actual treatments. Just ask your dentist to itemise your treatment costs upfront so you'll have the figures to work with. Keep in mind that they won't always be able to predict exactly what you will need without seeing your teeth first.

Your treatment costs

The cost of your root canalThe amount your insurance paysThe amount you pay
$600$600 x 70% = $420$600 x 30% = $180

Your benefit limits before and after the treatment

Your dental benefit limit before your root canalThe amount your insurance paid toward your root canalYour new dental benefit limit
$1,000$420$1,000 - $420 = $580

Do any dental hospitals do bulk billing for emergency dental?

Bulk billing is only available when a Medicare-approved treatment is involved. That means the only time bulk billing occurs is when a child is treated under the Medicare Child Dental Benefits Schedule (CDBS). Some private and public dentists and dental hospitals will bulk bill for services under the CDBS to help disadvantaged children avoid out-of-pocket costs.

Picture: Unsplash

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