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Oral Health DRS Conference 2005
Oral Health DRS Conference 2005
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School of Dentistry=
and
Slide 2
"Outline"=
"Oral diseases=
in
Australia"
"Current oral =
health
trends in..."
"Current oral =
health
trends in..."
"Current oral =
health
trends in..."
"Current oral =
health
trends in..."
"Current oral =
health
trends in..."
"Current oral =
health
trends in..."
The major causes of
morbidity and mortality [WHO]
Important “Oral” Di=
seases
Slide 13
Slide 14
Slide 15
Slide 16
Slide 17
Slide 18
"Prevention of=
Oral
Diseases"
"Interactions
between oral and"
"Interactions
between oral and"
"Public Fundin=
g"
"Public Fundin=
g"
"Public Fundin=
g"
"Funding for O=
ral
Health Services"
"Funding for O=
ral
Health Services"
"Funding for O=
ral
Health Services"
"Funding for O=
ral
Health Services"
Slide 29
"Funding for O=
ral
Health Services"
"Funding for O=
ral
Health Services"
"Funding for O=
ral
Health Services"
Slide 33
"Cost of Poor =
Oral
Health"
"Access to oral
health care"
"Waiting Times=
"
"Eligible Pati=
ents
for Public Dental..."
"Dental Inflat=
ion"
"Demographics&=
quot;
"Demographics&=
quot;
Slide 41
"Workforce to
promote oral health"
"Workforce to
promote oral health"
Slide 44
"Workforce to
promote oral health"
"Workforce to
promote oral health"
"Migration&quo=
t;
"Suggestions to
Workforce Shortages"
"Teach oral he=
alth
to ALL..."
"Suggestions f=
or
Workforce Changes to..."
"Suggestions f=
or
Workforce Changes to..."
"Suggestions f=
or
Workforce Changes to..."
Integration of Geri=
atric
Oral Health into the General Health System
"Project One -
Community Living..."
"Project One -
Community Living..."
"Project One -
Community Living..."
"Griffith
University- Auatralia’s first new..."
"Community Res=
earch
Placement"
"Community Res=
earch
Placement"
"Community Res=
earch
Placement"
"Community Res=
earch
Placement"
"Community Res=
earch
Placement"
"Potential
Communities"
"Where to go f=
or
information"
"Conclusion&qu=
ot;
Slide 66
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School of Dentistry=
and
Building a Better O=
ral Health
Workforce for Australia and the Pacific
Prof Newell Johnson=
Leonie Short =
Slide 2
"Outline"=
Outline
Oral diseases in Au=
stralia
Prevention of Oral =
Diseases
Interactions betwee=
n oral
and general health<=
/font>
Common risk factors=
Workforce to promot=
e oral
health
Griffith University=
Workforce mix
"Oral diseases=
in
Australia"
Oral diseases in Au=
stralia
Tooth and gum disea=
se amongst
most common causes
of morbidity in Aus=
tralia, and
linked to negative
effects on quality =
of life.[i]
Oral diseases THE m=
ost common
of the chronic
diseases: important=
public
health problems
because of prevalen=
ce, impact on individuals and society, and
expense of treatment.[ii]
Yet, governments st=
ill separate
oral health from general health and fund it quite limitedly.
[i] Spencer 1999, N=
SW Public
Health Bulletin
[ii] Sheiham 2005, =
Bulletin of
the World Health Organisation 83 (9)
"Current oral =
health
trends in..."
Current oral health=
trends in
Australia
The oral health of =
Australian
children is generally good, currently ranking 2nd among Organisation for
Economic Co-operation and Development (OECD) countries.[i] Dramatic improvements occurred betwee=
n the
1970s and the 1990s, but a recent trend reversal has been documented. Overall caries experience rose betwee=
n 1996
and 1999 among 6-year-old children, and there has been a 21.7% increase in
decay among 5-year-olds.[ii]
[i] National Adviso=
ry Committee
on Oral Health 2004. Healthy Mouths Healthy Lives: Australia’s National O=
ral
Health Plan 2004-2013
[ii] Armfield et al=
. 2003. AIHW
DSRU
"Current oral =
health
trends in..."
Current oral health=
trends in
Australia
May not hold for al=
l children.
Evidence that most =
caries
present in minority of children:
1997 Save Our Kids =
Smiles
programme in NSW showed rural children
significantly more likely to have dental caries than metropolitan.=
[i]
Indigenous Australi=
an children
are also have significantly worse dental health than non-Indigenous group=
s. [1]
[1] This and other =
ongoing
research projects are detailed at: http://www.crroh.uwa.edu.au
"Current oral =
health
trends in..."
Current oral health=
trends in
Australia
Dental health appea=
rs to
deteriorate after childhood in all populations.
18–24 age group has=
poorer oral
health than might be expected, given the low level of caries in children.=
This population has=
, on
average, 7 teeth with caries cf 2 at age 12.[i]
[i] Brennan et al. =
1997. AIHW
DSRU
"Current oral =
health
trends in..."
Current oral health=
trends in
Australia
This trend continue=
s over time
and adult oral health in Australia languishes behind that of many other
developed nations. Dental caries
represent the most prevalent health problem among Australians, and
periodontal disease is the fifth most prevalent: 90% of tooth loss may be
attributed to these two factors.[i]
[i] AHMAC 2001, cit=
ed in ADA
submission to HoR Standing Committee on Health and Ageing 2005 ‘Inquiry i=
nto
Health Funding’
"Current oral =
health
trends in..."
Current oral health=
trends in
Australia
A monitoring survey=
of dental
health among adult public patients, published in 2004 by the Australian
Institute of Health and Welfare (AIHW), showed an overall drop in oral he=
alth
status since 1995. Trends varied=
somewhat
between patients from metropolitan areas and those from rural and remote
locations.
"Current oral =
health
trends in..."
Current oral health=
trends in
Australia
Oral health in Aust=
ralia poor
among adults, deteriorating among children.
Most recent Nationa=
l Oral
Health Survey conducted 1987/88, and results of a second survey not avail=
able
for a further 3 years.
Current evidence in=
dicates those with worse teeth and gums tend =
to be
public patients, often rural .
The major causes of
morbidity and mortality [WHO]
HIV
Malaria
Tuberculosis =
Malnutrition – unde=
r and over!!
Tobacco
Alcohol and other d=
rugs
Cancer
Accidents
War and violence
Important “Oral” Di=
seases
Dental caries is va=
riably
active throughout the life span and is the major cause of tooth loss –
excluding dentists!!
Periodontal and per=
i-apical
infections cause much morbidity and ?mortality
Oro-pharyngeal canc=
ers
Mucosal diseases
Salivary diseases a=
nd
dysfunctions
Developmental anoma=
lies
Maxillo-facial trau=
ma
Slide 13
Slide 14
Slide 15
Slide 16
Slide 17
Slide 18
"Prevention of=
Oral
Diseases"
Prevention of Oral =
Diseases
Oral diseases are l=
ifestyle
diseases – they are nearly all preventable.
Both prevention and=
cure of
dental and periodontal disease are important for overall health.
"Interactions
between oral and"
Interactions betwee=
n oral and
general health
There are many stud=
ies to prove
the link, for example, that periodontal disease is linked to cardiovascul=
ar
illness. Stroke is more likely to
occur with elevated levels of the periodontal pathogens Actinobacillus
actinomycetemcomitans or Porphyromonas gingivalis.[i] Periodontal disease and tooth loss are
linked to coronary heart disease (CHD)[ii] and there is specific evidence=
of
an association between periodontitis and heart attack, even after adjusti=
ng
for well-known risk factors.[iii]
[ii] Elter et al, J=
Periodontol
2004;75:782-90
[iii] Cueto et al, J
Periodontal Res. 2005;40:36-42
"Interactions
between oral and"
Interactions betwee=
n oral and
general health
There is some evide=
nce that
effective dental treatment of individuals with Coronary Heart Disease may
result in reductions in levels of inflammatory markers (such as C-reactive
protein) and haemostatic factors (such as oxidised low density lipoprotei=
n), providing
protection against future deterioration in heart health.[i]
[i] Montebugnoli et=
al, J Clin
Periodontol. 2005;32:188-92
"Public Fundin=
g"
Public Funding
Dental services are=
, however,
almost entirely removed from medical services in Australia and many other
parts of the world. Funding is
provided separately, and there is a strong history of the Commonwealth
Government deeming dental health to be a State/Territory issue. (This is despite the Commonwealth hav=
ing
the same constitutional powers [S. 51, xxiiiA] to fund dental services as=
it
has for medical services.) There may also be an impression that, while
medical services should at least in part be provided by Government, dental
services are a matter for personal attention.
"Public Fundin=
g"
Public Funding
While all States and
Territories
provide some public=
dental
health services to =
individuals
Who cannot afford t=
o see a
dentist privately,<=
/font>
there is great vari=
ation
across the country =
in this
public provision of services.
"Public Fundin=
g"
Public Funding
The Commonwealth De=
ntal Health
Program (CDHP) was introduced in January 1994 to improve access and reduce
waiting times for public dental services by subsidising patients with
concession cards to see private dentists for restorative dental treatment
(denture services were not covered). The Commonwealth Dental Health Progr=
am
drastically reduced waiting times for public dental patients. The Coaliti=
on
Government discontinued funding for the CDHP at the end of 1996 and
responsibility for funding the bulk of public dental services therefore
passed to the State and Territory Governments.
"Funding for O=
ral
Health Services"
Funding for Oral He=
alth
Services
Total spending on d=
ental
services in Australia rose from $1.71 billion in 1992/93 to $4.37 billion=
in
2002/03 (4.9% versus 6.06% of total health expenditure).[i]
on Health and Agein=
g 2005
‘Inquiry into Health Funding’
"Funding for O=
ral
Health Services"
Funding for Oral He=
alth
Services
The Commonwealth Go=
vernment’s
proportional share of dental expenditure fell from 2.22% in 1992/93 to 1.=
78%
in 2002/03. Indirect Commonwealth expenditure, through the 30% private he=
alth
insurance rebate, was $298 million in 2002/03, representing 6.81% of total
dental expenditure. The number of dental benefits has increased since the
introduction of this rebate in 1999 from 14.4 million to 22.7 million in
2004. Costs of private health insurance are growing as a result, however,=
and
benefits are reportedly not keeping up with dental care costs.[i] <=
/td>
[i] Private Health =
Insurance
Administration Council 2005. Cited in ADA submission to HoR Standing
Committee on Health and Ageing 2005 ‘Inquiry into Health Funding’ <=
/td>
"Funding for O=
ral
Health Services"
Funding for Oral He=
alth
Services
State/Territory and=
Local
Governments spent $342 million on dental services in 2002/03, representing
7.82% of total expenditure ($32 million less than in 1999/2000, when this
funding represented 12.94% of total dental expenditure). This expenditure
includes payments for public and school dental services.
"Funding for O=
ral
Health Services"
Funding for Oral He=
alth
Services
Over 15.5% of total=
dental
spending was attributed to private health insurance funds in 2002/03, whi=
ch
is half the proportion of funds spent a decade earlier.
Direct out-of-pocke=
t expenses
account for the remaining expenditure on dental services. This has risen =
from
$984 million and 57.6% in 1992/93 to $2.96 billion and 67.3% of total
expenditure in 2002/03.
Slide 29
"Funding for O=
ral
Health Services"
Funding for Oral He=
alth
Services
The Commonwealth Go=
vernment
contributes a relatively small amount to the provision of dental care (see
Figure 3). However, it continues to fund dental care for specific
populations, such as the Department of Veterans’ Affairs, Department of
Defence, inpatient dental care and outpatient radiological dental services
(through Medicare).[i]
[i] ADA submission =
to HoR
Standing Committee on Health and Ageing 2005 ‘Inquiry into Health Funding=
’
"Funding for O=
ral
Health Services"
Funding for Oral He=
alth
Services
It also provides so=
me indirect
funding for dental services through the Aboriginal Health Council. Planned
changes to Medicare include the provision of limited subsidised dental ca=
re
for the first time for referred patients with chronic health conditions t=
hat
are exacerbated by poor oral health. Up to 23,000 people may be treated o=
ver
four years.
"Funding for O=
ral
Health Services"
Funding for Oral He=
alth
Services
All States and Terr=
itories fund
the vast majority of public dental services, but spending varies
significantly. According to the AIHW, in 2001/02 Queensland had the great=
est
expenditure ($111,000,000) and NT and ACT the least ($7,000,000). Per cap=
ita
dental expenditure was greatest in NT ($35.23) and least in NSW ($11.76).=
Per
concession card holder spend was also greatest in NT ($160.16) and least =
in
NSW ($50.40).
Slide 33
"Cost of Poor =
Oral
Health"
Cost of Poor Oral H=
ealth
Oral ill-health is =
not only
costly in terms of
personal discomfort=
; it is also
expensive in
economic terms. Dental decay is the most
expensive diet-rela=
ted disease
in the country,
costing more that C=
oronary
Heart Disease,
hypertension and di=
abetes,[i]
and it may lead
to hospitalisation:=
in 2002/03,
223 patients were hospitalised for dental conditions.[ii]
[ii] Steering Commi=
ttee for the
Review of Government Service Provision 2005, cited in ADA submission to H=
oR
Standing Committee on Health and Ageing 2005 ‘Inquiry into Health Funding=
’
"Access to oral
health care"
Access to oral heal=
th care
Although supply of =
dentists in
regional/remote areas is substantially lower than for major city areas, t=
his
does not automatically mean that people living in these areas access dent=
al
services less. Access to service=
s may
depend on car ownership, road conditions, and socio-economic issues. Although unmet demand and equity of a=
ccess
should be examined, lower rates of supply in rural and remote areas will
indicate lower access. (See Teusner [i]).
[i] Teusner 2005 Au=
stralian
Dental Journal 50:2
"Waiting Times=
"
Waiting Times
While waiting times=
in the
public sector for emergency dental care are short throughout the country,
waiting times for general dental care can be extensive (estimated to be
between 10 and 54 months in 2000).[i]
"Eligible Pati=
ents
for Public Dental..."
Eligible Patients f=
or Public
Dental Services
Over 1million perso=
ns in
Queensland
Health Care Card
Pensioner Card
Seniors Card =
Qld Seniors Card
"Dental Inflat=
ion"
Dental Inflation
Dental inflation is=
estimated
at 20% - this is greater than the Consumer Price Index as well as greater
than for other health services.
Paper at IADR Conference, 25-28 Septe=
mber,
Queenstown, New Zealand)
"Demographics&=
quot;
Demographics =
In the next ten yea=
rs (10), 30%
of the population will be over 60 years of age.
A greater proportio=
n of these
people will have natural teeth.
The destiny of our =
demography:
from pyramid to … coffin?
[Chairman Gary Bank=
s,
Productivity Commission, Policy Implications of an Ageing Australia: an
illustrative guide (http://www.pc.gov.au/speeches/cs20050927/index.html) -
presentation to the Financial Review Ageing Population Summit, held in Sy=
dney
on 27 September 2005]
"Demographics&=
quot;
Demographics =
These people will n=
eed, want
and demand oral health care
Function
Quality of life
Aesthetics
Demand may not addr=
ess
inequality
Role of technology<=
/font>
Wanting youth
Social marketing
(Steele, J. 2005 Ol=
d is the New
Young: A Changing world and research priorities, Paper at IADR Conference,
25-28 September, Queenstown, New Zealand)
Slide 41
"Workforce to
promote oral health"
Workforce to promot=
e oral
health
Overall numbers of =
dentists per
head of
population appear t=
o be
increasing
(to 46.9 per 100,00=
0 population
in
2000 from 43 in 199=
4). However,
compared to other d=
eveloped
countries, Australi=
a still lags
behind
in terms of dental =
workforce
numbers.[i] It is difficult to
project whether the=
rise will
be sustained into the longer-term although there is no doubt that the num=
ber
of dentists is low by historic levels. Numbers of dental graduates have
fallen by one-third since the 1970s.[ii]
[i] Teusner, Spence=
r 2003. AIHW
DSRU.
[ii] National Advis=
ory
Committee on Oral Health 2004. Healthy Mouths Healthy Lives: Australia’s
National Oral Health Plan 2004-2013
"Workforce to
promote oral health"
Workforce to promot=
e oral
health
Significantly fewer=
dentists
operate in rural compared to metropolitan areas (see Figure 6). Taking
Australia as a whole, a comparison by the AIHW between rates of dentists
practising in rural and metropolitan areas showed there are 55.7 dentists=
per
100,000 population in metropolitan areas and only 31.4 in rural areas in
2000. [i] In addition, rural dentists see more patients than their
counterparts in the city.[ii]
[i] Teusner, Spence=
r 2003. AIHW
DSRU.
[ii] Barnard, White=
. Australian
Dental Association News Bulletin 1999;266:13-21
Slide 44
"Workforce to
promote oral health"
Workforce to promot=
e oral
health
Most dentists work =
in private
practice.
In 2000, 82.6 of de=
ntists
worked
privately, with 16.=
2% in the
public
sector and 1.2% in =
other areas.[iii]
[iii] Teusner, Spen=
cer 2003.
AIHW DSRU.
"Workforce to
promote oral health"
Workforce to promot=
e oral
health
At the same time, t=
he cost of
studying dentistry is rising.[i] Currently, around 250 dentists qualify e=
ach
year, but Spencer et al project that, in order to meet rising demand, an
additional 120 dental graduates per year are needed across the country.[i=
i]
Only 70 more Bachelor Degrees in Oral Health (for dentists, dental therap=
ists
and oral hygienists) have been funded by the Commonwealth Government from
2005.
[i] ADA submission =
to HoR
Standing Committee on Health and Ageing 2005 ‘Inquiry into Health Funding=
’
[ii] Spencer et al.=
The dental
labour force in Australia: the position and policy directions. AIHW
Population Oral Health series No.2
"Migration&quo=
t;
Migration
250 dentists now im=
ported per
annum
Approx. equal to Au=
st.
graduates
"Suggestions to
Workforce Shortages"
Suggestions to Work=
force
Shortages
Bonded scholarships=
Intern year <=
/td>
Remuneration – sala=
ry, package,
etc.
Right of private pr=
actice
Outsourcing <=
/td>
Mr Andrew McAuliffe=
, Director,
Oral Health Unit, Queensland Health, Future Directions for Oral Health, p=
aper
at the DOHTAQ Conference, 1 October 2005.
"Teach oral he=
alth
to ALL..."
Teach oral health t=
o ALL
members of the health professions
Including doctors
"Suggestions f=
or
Workforce Changes to..."
Suggestions for Wor=
kforce
Changes to Promote Oral Health
Better workforce mi=
x – follow
nursing with protocols for dental therapists, dental hygienists and dental
technicians
Integration with ge=
neral health
Tuckshops, obesity,=
nutrition,
pregnancy, common risk factors
Oral health promoti=
on
activities including water fluoridation
"Suggestions f=
or
Workforce Changes to..."
Suggestions for Wor=
kforce
Changes to Promote Oral Health
Weighted occasions =
of service
in public sector
Changes to ADA Item=
Numbers for
private health insurance
dental therapists a=
nd dental
hygienists
differential rebate=
s
Changes to Provider=
Numbers for
private health insurance
dental therapists a=
nd dental
hygienists
"Suggestions f=
or
Workforce Changes to..."
Suggestions for Wor=
kforce
Changes to Promote Oral Health
Health Maintenance =
Organisation
type services
Australian Health M=
anagement
Group with 3 dental practices in Sydney, Parramatta and Wagga Wagga
$60 for risk assess=
ment and
lifestyle advice
Reintroduce a Commo=
nwealth
Programme
Integration of Geri=
atric
Oral Health into the General Health System
Dooland, M. 2005 In=
tegration of
Geriatric Oral Health into the General Health System, Paper at IADR
Conference, 25-28 September, Queenstown, New Zealand.
"Project One -
Community Living..."
Project One - Commu=
nity Living
Older People in South Australia
Inclusion of 6 simp=
le questions
to the Enhanced Primary Care (EPC) Health Assessment by Medical Practitio=
ner
for people 75+ years
Referral of those i=
dentified as
“at risk” for dental care (for low income adults bypassing the waiting li=
st).
"Project One -
Community Living..."
Project One - Commu=
nity Living
Older People in South Australia
Is the medical prac=
titioner the
best/the right/the only assessor?
What about Domicili=
ary Care/
Aged Care assessment teams/District Nursing Services?
Advocacy for oral h=
ealth from
The Divisions of Me=
dical
Practitioners
The Aged Care Secto=
r
"Project One -
Community Living..."
Project One - Commu=
nity Living
Older People in South Australia
Oral Health for old=
er people
and quality of life can be improved by integrating an oral health assessment within a ge=
neral
health assessment and providing timely dental care
The whole process o=
f design,
implementation and evaluation is better done with oral health more fully
integrated into the general health and aged care system.
"Griffith
University- Auatralia’s first new..."
Griffith University-
Auatralia’s first new dental school in 57 years!
Bachelor of Oral He=
alth in
Dental Science
Bachelor of Oral He=
alth in Oral
Health Therapy
Bachelor of Oral He=
alth in
Dental Technology
Bachelor of Oral He=
alth in
Dental Technology
(Post Registration)
Master of Dental Te=
chnology in
Prosthetics
"Community Res=
earch
Placement"
Community Research =
Placement
This course aims to=
provide the
knowledge base, instil attitudes, and develop skills in research, practic=
al
health promotion and in preventative dentistry on a community level.
It seeks to provide=
a balanced
education in these branches of the health sciences whereby students
appreciate the primacy of lifestyle and environment in determining popula=
tion
and community health, understand the many common risk factors for oral an=
d general
diseases and the importance of primary prevention in achieving both
individual and population health
"Community Res=
earch
Placement"
Community Research =
Placement
Learning Outcomes
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