Examining the Effect of Income-Based Inequalities and Dental Service Provision on Dental Service Utilization among Older Australians: A Multiple Mediation Analysis.

INTRODUCTION: Public service provision is one of the keys to reducing inequalities in the utilization of dental services. Given the increase in the aging population, there should be a focus on older adults' oral health. However, this is often overlooked. OBJECTIVES: This study investigates the effectiveness of public services in reducing income-related inequalities in dental service utilization among older South Australians. METHODS: A multiple counterfactual mediation analysis using the ratio of mediator probability weighting approach was used to explore the proposed mediation mechanism using a South Australian population of older adults (≥65 y). The exposure variable in the analysis was income, and the mediators were concession cards and the last dental sector (public or private). The outcome variable was the time of last dental visit. RESULTS: Half of the older adults with high income (≥$40,000) owned a concession card, and 10% of those who attended public dental services belonged to this group. Interestingly, only 16.3% of the study participants had visited the public dental sector at their last dental appointment. Results showed a negligible indirect effect (odds ratio [OR], 0.99; 95% confidence interval [CI], 0.85-1.05) and a significant direct effect (OR, 3.09; 95% CI, 2.24-4.87). By changing the potential outcome distributions to the counterfactual exposure distributions and taking the mediators' distribution as a counterfactual exposure distribution, the odds of dental visits occurring before the past 12 mo approximately tripled for low-income compared to high-income individuals. CONCLUSION: Income inequalities were associated with relatively delayed dental visits in older South Australians, and provision of public services could not improve this pattern. This might happen due to inequitable access to concession cards and public services. A review of policies is required, including addressing income inequalities and implementing short-term approaches to improve service utilization patterns in older South Australians. KNOWLEDGE TRANSFER STATEMENT: The findings of this study can enable policymakers for informed decision-making about the provision of public dental services for older Australians. This study emphasizes the importance of reviewing the current public dental services and subsidies and implementing short-term approaches to reduce income inequalities for older Australians.

Inequality and Inequity in the Use of Oral Health Services in Australian Adults.

OBJECTIVE: Social determinants drive disparities in dental visiting. This study aimed to measure inequality and inequity in dental visiting among Australian adults. METHODS: Data were obtained from the National Study of Adult Oral Health (2017 to 2018). Participants were Australian adults aged ≥30 y. The outcome of interest was dental visiting in the last 12 mo. Disparity indicators included education and income. Other sociodemographic characteristics included age, gender, Indigenous status, main language, place of birth, residential location, health card and dental insurance status, and individual's self-rated and impaired oral health. To characterize inequality in dental service use, we examined bivariate relationships using indices of inequality: the absolute and relative concentration indexes and the slope and relative indexes of inequality. Inequalities were depicted through concentration curves. Indirect standardization with a nonlinear model was used to measure inequity. RESULTS: A total of 9,919 Australian adults were included. Bivariate analysis showed a gradient by education and income on dental visiting, with 48% of those with lowest educational attainment/income having not visited a dentist in the last 12 mo. The concentration curves showed pro-low education and pro-poor income inequalities. All measures of absolute and relative indices were negative, indicating that from the bottom to the top of the socioeconomic ladder (education and income), the prevalence of no dental visiting decreased: absolute and relative concentration index estimates were approximately 2.5% and 5.0%, while the slope and relative indexes of inequality estimates were 14% to 18% and 0.4%, respectively. After need standardization, the group with the highest education or income had almost 1.5-times less probability of not having a dental visit in the previous year than those with the lowest education or income. CONCLUSION: The use of oral health services exhibited socioeconomic inequalities and inequities, disproportionately burdening disadvantaged Australian adults. KNOWLEDGE TRANSFER STATEMENT: The results of this study can be used by policy makers when planning a dental labor force in relation to the capacity of supply dental services to 1) reduce the inequality and inequity in the use of oral health services and 2) meet identified oral health needs across the Australian population, which is important for preventive dental care.

Use of dental services among middle-aged adults: predisposing, enabling and need variables.

OBJECTIVES: To examine if making a visit, number of visits and services varied by predisposing (gender, perceived health competence, education, previous relief of pain visit), enabling (dental anxiety, income, social support) and need (perceived need, number of teeth and oral pain) characteristics. METHODS: Dental visiting and services data from a sample of middle-aged South Australian adults were collected from 61% of participants at 12-months (n = 603) and 59% after 24-months (n = 583). Visiting over 2-years, mean visits and mean services were analysed by log binomial and Poison regression using the Andersen and Newman model. RESULTS: The percentage having a dental visit over 2-years was lower for males than females, prevalence ratio (PR, 95% CI) 0.91 (0.84, 0.99), and for higher than lower dental anxiety, PR = 0.78 (0.62, 0.98). Number of visits was associated with higher than lower income, rate ratio (RR, 95%CI) 1.20 (1.02, 1.41) but lower for those with higher social support, RR = 0.86 (0.74, 0.99). Services were lower for those with higher perceived health competence, RR = 0.72 (0.56, 0.92) but higher for those with perceived needs, RR = 1.22 (1.01, 1.46). CONCLUSIONS: While need and cost factors predict dental service use, psychosocial variables such as health competence and social support also need to be considered.

Subjective and objective social status: associations with psychosocial predictors and oral health.

OBJECTIVE: While social status and health have been investigated, there is less focus on the effects of objective and subjective social status and psychosocial factors. This study aimed to investigate oral health impacts by subjective social status (SSS) and psychosocial predictors stratified by subjective social status. METHODS: A random cross-sectional sample of 45-54-year old South Australians was surveyed in 2004-05. Oral health impact was assessed using OHIP-14. Socio-economic status was determined using objective (income) and subjective (McArthur scale) measures. Psychosocial variables comprised social support, health self-efficacy, coping and affectivity. RESULTS: Responses were collected from 986 persons (response rate=44.4%). Lower SSS was more frequently observed in the low (70.2%) than high-income group (28.5%). Lower SSS was associated (p⟨0.05) with lower education, social support, health competence, and coping, but higher negative affect within income groups. The interaction of SSS and income showed OHIP was consistently lower at high SSS regardless of higher or lower income, but at low SSS, OHIP was higher (p⟨0.05) in the lower than higher income group. CONCLUSIONS: SSS was associated with income. Their interaction indicated low SSS in combination with low income was associated with higher oral health impacts.

Temporomandibular dysfunction among working Australian adults and association with workplace effort-reward imbalance.

OBJECTIVES: To explore the prevalence of temporomandibular dysfunction (TMD) among working Australian adults and examine whether workplace effort-reward imbalance is associated with TMD. METHOD: Data were from Australia's National Survey of Adult Oral Health (NSAOH) 2004-06, a cross-sectional stratified clustered sample of Australian adults. The NSAOH data included information from a Computer Assisted Telephone Interview, self-complete questionnaire and oral epidemiological examination. Data included demographics, socio-economic characteristics, caries experience, diagnostic criteria for TMD, the Perceived Stress Scale (PSS) and a modified version of the Effort-Reward Imbalance instrument (ERI) where ERI ratio is the weighted ratio of workplace effort/reward subscales. Subpopulation analysis for working adults was conducted including complex sample descriptive statistics, bivariate and multivariable logistic regression models. RESULTS: NSAOH had 4014 participants with 2329 (65.1%, SE=1.3%) working adults included in the subpopulation analysis. Among working adults, TMD prevalence was 9.4% (SE=1.0%), which was slightly less than population prevalence (PR=9.9%, SE=0.8%), and was higher for females (PR=12.4%, SE=1.4%), people aged ⟨35 years (PR=11.2%, SE=2.2%) and uninsured (PR=11.8%, SE=1.7%). TMD prevalence was associated with the ERI ratio (OR=2.5, 95% CI: 1.3-4.5) and PSS scores (OR=1.1, 95% CI: 1.0-1.09) in bi-variate associations. In multivariable logistic regression, TMD was associated with being female (OR=2.1, 95% CI:1.3-3.6), university qualified (OR=0.43, 95%CI: 0.21-0.88) and with the ERI ratio (OR=2.63, 95% CI: 1.47-4.72). CONCLUSION: Greater effort-reward imbalance in the workplace is a psychosocial risk factor for TMD. This finding might need to be considered by clinicians managing TMD patients with need for investigating the efficacy of workplace stress management interventions.

Association between pulp and periapical conditions and dental emergency visits involving pain relief: epidemiological profile and risk indicators in private practice in Australia.

AIM: To assess the prevalence of dental emergency visits (DEV) involving pain relief and their relationship with socio-economic and clinical factors in an Australian representative sample in the primary care setting. METHODOLOGY: Data on reason for visit and patient characteristics were collected from a representative random sample of Australian dentists in private practice surveyed in 2009-2010. Information regarding socio-economic (gender, age, health insurance) and clinical factors (number of teeth, number of decayed teeth, diagnosis and reason for visit [DEV, check-up, other reasons not involving pain relief]) were retrieved from compiled questionnaires. Descriptive statistics were reported, and Poisson regression models were used to assess the association between socio-economic and clinical factors and DEV. Prevalence ratio (PR) and 95% confidence interval (CI) were calculated. RESULTS: A total of 1148 dentists responded (67%), resulting in records from 6504 patients. The overall prevalence of DEV was 20.8%. The unadjusted analysis, according to the reason of visit, revealed the following predictors for DEV: male gender (PR = 1.18; 95% CI = 1.08-1.29), age 18-64 years (PR = 2.70; 95% CI = 2.19-3.33) and over 65 years (PR = 2.64, 95% CI = 2.10-3.32), uninsured patients (PR = 1.36; 95% CI = 1.24-1.49), patients with <20 teeth (PR = 1.19; 95% CI = 1.06-1.33), decayed teeth (PR = 1.64; 95% CI = 1.48-1.81). After adjustment for confounding factors (gender, age, insurance status, number of teeth and decayed teeth) apart from 'dental trauma' (PR = 1.37), all remaining diagnoses had lower PR ('other' PR = 0.19, 'decay' PR = 0.34, 'periodontal' PR = 0.51, 'failed restoration' PR = 0.45) compared with 'pulp/periapical disease'. CONCLUSIONS: In the primary care setting, the diagnoses 'pulp/periapical' and 'dental trauma' had a stronger association with DEV compared with visits not involving relief of pain. Both socio-economic (male gender, older age and uninsured individuals) and clinical factors (tooth loss, decayed teeth, endodontic diseases and dental trauma) were identified as independent risk indicators for DEV in this population. Future public health policies should include specific preventive strategies addressing these factors, aiming to reduce the need for DEV.

Dental services provided by dentists in Australia.

OBJECTIVES: To examine the efect of age and gender on dental services provided by dentists in Australia, and compare with previous estimates across the period 1983-1984 to 2013-2014. METHODS: Data were collected by mailed survey from a random sample of Australian dentists. Private sector dentists were the focus of the analysis. Data were weighted to the age and sex distribution of Australian practising dentists. RESULTS: The analysis was based on service logs collected from n = 211 dentists. Adjusted results (rate ratio, 95% CI) showed male dentists had higher endodontic rates (1.7, 1.0-2.9) than female dentists. Dentists aged 40-49 years had higher restorative rates (1.6, 1.1-2.2) but lower preventive rates (0.5, 0.3-0.9) than those aged 20-29 years. Diagnostic services were lower for dentists aged 40-49 to 60+ years (0.8, 0.6-0.9), while denture services were higher for dentists aged 40-49 (11.1, 2.5-48.5) to 60+ years (6.4, 1.2-33.3). Crowns were higher for dentists aged 40-49 (2.4, 1.0-5.6) and 50-59 years (2.9, 1.3-6.6). Diagnostic and preventive services were consistently higher across 1983-1984 to 2013-2014. CONCLUSIONS: Younger dentists provided higher rates of diagnostic and preventive services. Over a 30-year period, there was a consistent trend towards higher provision of diagnostic and preventive services.

Confirmatory factor analysis of the health literacy in dentistry scale (HeLD) in the Australian population.

OBJECTIVE: To determine the psychometric properties of both the long- and short-form versions of the Health Literacy in Dentistry (HeLD) instrument in a large sample of the Australian adult population. METHODS: Data were from a subset of the National Dental Telephone Interview Survey 2013. Both the long (HeLD-29) and short-form (HeLD-14) were utilised, each of which comprises items from 7 conceptual domains: access, understanding, support, utilization, economic barriers, receptivity and communication. Confirmatory Factor Analysis was performed through structural equation modelling to determine factorial validity, where the Χ²/df, comparative fit, goodness of fit and root mean square error of approximation were used as indices of goodness of fit. Convergent validity was estimated from the average variance extracted (AVE) and composite reliability (CR), while internal consistency was estimated by Cronbach standardized alpha. RESULTS: The dataset comprised 2,936 Australian adults aged 18+ years. The kurtosis and skewness values indicated an approximation to a normal distribution. Adequate fit was demonstrated for HeLD-14, but not for HeLD-29. Estimates of ≥ 0.50 for AVE and ≥ 0.70 for CR were demonstrated across all factors for both HeLD-29 and HeLD-14, indicating acceptable convergent validity for both forms. Discriminant validity was also demonstrated for both forms. Internal consistency was adequate in the seven conceptual domains for both HeLD forms, with Cronbach's alpha for all subscales being ≥0.70. CONCLUSIONS: The psychometric properties of the HeLD instrument in a large sample of the Australian adult population were confirmed. The short form HeLD-14 was more parsimonious than the long-form (HeLD-29).

Components of responsibility in estimating relative value units: How do dentists value their work?

OBJECTIVES: Responsibility weights can translate services into a common scale of work effort (relative value units). The aims were to describe the responsibility weights for main areas of dental services and assess associations of ratings of the importance of the components of responsibility with responsibility weights. METHODS: Mailed questionnaires were used to collect responsibility weights and components of responsibility from a random sample of Australian dentists who were randomly assigned into panels. Across the panels, weights were elicited for 299 service items from 9 service areas. Data were weighted to the age and sex distribution of the workforce. Ordered logit regression models assessed differences in weights by ratings of importance of the 8 components of responsibility. RESULTS: Responses were collected from 846 dentists (response rate = 37%). Adjusted models showed that, with the exception of general/miscellaneous services, all remaining service areas were associated with between 3 and 7 components. Preventive weights were associated with dexterity and mental effort but negatively with perception. Diagnostic weights were associated with knowledge, judgement, experience, perception, physical and mental effort, and negatively with dexterity. Ratings of components of responsibility were associated with responsibility weights and showed varying patterns across service areas. Mental effort, invasiveness, dexterity, experience and knowledge were associated with responsibility weights in the majority of service areas. CONCLUSIONS: The observed variation in weights across service areas showed that dentists discriminated between services in a systematic and cognizant manner and so provided broad validation of weights assigned by dentists.

Health behaviours and quality of life in independently living South Australians aged 75 years or older.

BACKGROUND: This study evaluated the associations between oral and general health behaviours, self-reported health and quality of life of adults aged 75 years or older living independently in South Australia. METHODS: A cross sectional study based on a self-report mailed questionnaire was conducted in 590 independently living adults aged 75 years or older. Self-ratings of oral health and general health were assessed using single-item global ratings. Quality of life was measured using the Oral Health Impact Profile and the EuroQol instrument for health utility. RESULTS: The overall response rate was 78%. The current analyses were restricted to 354 dentate older adults. Increasing age and being female were negatively associated with EuroQol scores. Good self-rated oral and general health were more prevalent in participants with higher social status who also had lower oral health impact and higher EuroQol scores. Good self-rated oral and general health were less prevalent while oral health impact was greater in participants who ate few fruits, vegetables or dairy products. CONCLUSIONS: Self-rated health and quality of life were poor in older adults with inadequate fruit/vegetables/dairy intake and lower social status. These findings suggest that nutrition and socioeconomic factors may be important to the oral and general health of adults aged 75 years or older.

Practice characteristics and service provision rates of dental hygienists in Australia.

INTRODUCTION: Dental hygienists (DHs) have been practising in Australia since the early 1970s. OBJECTIVE: This study describes the clinical activity of Australian DHs. METHODS: A questionnaire was mailed to members of two professional associations representing DHs. Practitioner characteristics, employment characteristics and clinical activity on a self-reported typical practice day were collected. The proportion of each service item of all services provided was estimated. Associations between practice characteristics and service provision were assessed by log-binomial regression models. RESULTS: Adjusted response rate was 60.6%. Of the DHs included in analysis (n=341), 80% were employed in general practice, and nearly all (96%) worked in the private sector. About half (53.7%) of all service provided were preventive services, and one-fourth (23.9%) were diagnostic. Service provision varied by practice and practitioner characteristics, with the largest variations observed by practice type. Unadjusted analysis showed that general practice DHs provided a higher mean number of periodontal instrumentation and coronal polishing (0.92 vs 0.26), fluoride applications (0.64 vs 0.08), oral examinations (0.51 vs 0.22) and intraoral radiographs (0.33 vs 0.07) per patient visit and a lower mean number of impressions (0.05 vs 0.17) and orthodontic services (0.02 vs 0.59) than specialist practice DHs. In adjusted analysis, rates of periodontal services also significantly varied by practice type; other associations persisted. CONCLUSION: Service provision of DHs varied by practice type. Practice activity was dominated by provision of preventive services while provision of periodontal treatments, fissure sealants and oral examinations was relatively limited indicating areas in which DHs are possibly underutilized.

Dental insurance, service use and health outcomes in Australia: a systematic review.

Private health insurance plays a key role in financing dental care in Australia. Having private dental insurance has been associated with higher levels of access to dental care, visiting for a check-up and receiving a favourable pattern of services. Associations with better oral health have also been reported. In the absence of any existing review, this paper aims to systematically review the relationship between dental insurance and dental service use and/or oral health outcomes in Australia. A systematic search of online databases and subsequent sifting resulted in 36 publications, 33 of which were cross sectional and three cohort analyses. Dental service outcomes were more commonly reported than oral health outcomes. There was considerable heterogeneity in the outcome measures reported, for both service use and health outcomes. Overall, the majority of the evidence was from cross sectional studies and few studies reported analyses adjusted for confounding factors. The consolidated evidence points towards a positive association between dental insurance and dental visiting. Dentally insured adults are likely to have more regular access to dental care and have a more favourable pattern of service use than the uninsured. However, evidence of associations between dental insurance and oral health are mixed.

Hours worked and patient visits provided by dentists in Australia.

BACKGROUND: The aim was to examine the numbers of hours worked and patient visits provided by age and gender of dentists in Australia, and compare with previous estimates to describe trends. METHODS: Data were collected from a random sample (N = 2961) of Australian dentists. Private sector dentists working in clinical practise were included in the analysis. RESULTS: The response rate was 49% (N = 1345 dentists). Hours per year worked and number of patient visits per year were lower for dentists aged 65 years and older compared with younger dentists, and were higher for male compared with female dentists aged 35-45 to 55-64 years. Hours per year worked were lower in 2013-2014 than reported in 2009-2010, but the number of patient visits in 2013-2014 was similar to the previously reported estimate from 2009-2010. CONCLUSIONS: Hours worked and visits provided were only lower among older dentists aged 65 years or more. Male dentists tend to work more hours per year and provide more patient visits per year than female dentists. Over the last decade, Australian dentists maintained a stable output of visits per year despite a trend towards fewer hours worked per year.

Preferences for dental decisional control and associations with quality of life among third molar patients attending public dental services.

OBJECTIVES: To explore (1) the prevalence of dental decisional control preferences (DDCP) among third molar (TM) patients attending public dental services and associated individual's characteristics, and (2) the association between DDCP and quality of life (QoL). METHOD: Participants were adult public dental patients with internet access referred for TM consultation. Collected data included patients' socio-demographic variables, the Control Preferences Scale (CPS), the Oral Health Impact Profile (OHIP-14) and the EuroQol EQ-5D-5L. RESULTS: Participants (n=163) were mainly females (73.6%) with a mean age of 26.2 years (SD=8.3). Most participants preferred an active DDCP (n=71, 44.1%) or a collaborative DDCP (n=60, 37.3%) while a minority preferred a passive DDCP (n=30, 18.6%). Gender (P=.05) and education (P=.03) were associated with DDCP. In a multinomial logistic regression model for DDCP, females were more likely to have an active DDCP (OR=2.73, P=.04) as were participants who had tertiary education (OR=2.72, P=.04). In a linear regression model for OHIP-14, active (P=.05) and collaborative DDCP (P=.04) were associated with less impact on oral health-related QoL. CONCLUSION: Patients attending public dental services preferred to be involved (either actively or collaboratively) in dental treatment decision-making. Being a female and/or having tertiary education were associated with an active DDCP. The positive association between patients' involvement in decision-making and oral health-related QoL might support the benefit for enhancing patients' involvement in decision-making.

Oral Conditions and Health-Related Quality of Life: A Systematic Review.

The objective of this study was to verify whether oral conditions (tooth loss, periodontal disease, dental caries) are negatively associated with health-related quality of life (HRQoL) in adults. A search was carried out on PubMed, EMBASE, Web of Science, Scopus, SciELO, and LILACS databases until the end of July 2016 with no date restrictions. Quantitative observational studies written in English were included and data extraction was performed independently by 2 reviewers. HRQoL was investigated as the outcome, and tooth loss, periodontal diseases, and dental caries were exposures. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used and the quality of the selected studies was assessed by using the Joanna Briggs Institute Meta-Analysis of Statistics assessment and review instrument (JBI-MAStARI). Twenty-one studies were included. The sample sizes ranged from 88 to 15,501 subjects; 20 studies were cross-sectional designs, while 1 was a case-control study. Case definitions of the exposures were different across the studies, mainly for tooth loss, which was defined according to 11 different criteria. Fifteen studies were of "high" and 6 of "medium" quality. Eight HRQoL instruments were identified, and the most frequent was the EuroQol ( n = 8). Ten of 16 studies reported a negative impact of tooth loss on HRQoL. Four of 7 studies reported that periodontal disease impairs HRQoL, and 1 study showed that periodontal disease is positively associated with HRQoL. All studies that assessed dental caries reported a negative association between this condition and HRQoL. Despite the different definitions and measures of tooth loss and dental caries, the majority of the available evidence reported a negative impact of these conditions on HRQoL. Mixed and inconclusive findings were observed for the association between periodontal disease and HRQoL. Longitudinal prospective studies are suggested to improve the strength of the findings.

Dental responsibility loadings and the relative value of dental services.

OBJECTIVE: To estimate responsibility loadings for a comprehensive list of dental services, providing a standardized unit of clinical work effort. METHODS: Dentists (n = 2500) randomly sampled from the Australian Dental Association membership (2011) were randomly assigned to one of 25 panels. Panels were surveyed by questionnaires eliciting responsibility loadings for eight common dental services (core items) and approximately 12 other items unique to that questionnaire. In total, loadings were elicited for 299 items listed in the Australian Dental Schedule 9th Edition. Data were weighted to reflect the age and sex distribution of the workforce. To assess reliability, regression models assessed differences in core item loadings by panel assignment. Estimated loadings were described by reporting the median and mean. RESULTS: Response rate was 37%. Panel composition did not vary by practitioner characteristics. Core item loadings did not vary by panel assignment. Oral surgery and endodontic service areas had the highest proportion (91%) of services with median loadings ≥1.5, followed by prosthodontics (78%), periodontics (76%), orthodontics (63%), restorative (62%) and diagnostic services (31%). Preventive services had median loadings ≤1.25. CONCLUSION: Dental responsibility loadings estimated by this study can be applied in the development of relative value scales.

Internet use, online information seeking and knowledge among third molar patients attending public dental services.

BACKGROUND: While Australians are searching the internet for third molar (TM) information, the usefulness of online sources may be questioned due to quality variation. This study explored: (i) internet use, online information-seeking behaviour among TM patients attending public dental services; and (ii) whether patients' TM knowledge scores are associated with the level of internet use and eHealth Literacy Scale (eHEALS) scores. METHODS: Baseline survey data from the 'Engaging Patients in Decision-Making' study were used. Variables included: sociodemographics, internet access status, online information-seeking behaviour, eHEALS, the Control Preferences Scale (CPS) and TM knowledge. RESULTS: Participants (N = 165) were mainly female (73.8%), aged 19-25 years (42.4%) and had 'secondary school or less' education (58.4%). A majority (N = 79, 52.7%) had sought online dental information which was associated with active decisional control preference (odds ratio = 3.1, P = 0.034) and higher educational attainment (odds ratio = 2.7, P = 0.040). TM knowledge scores were not associated with either the level of internet use (F(2,152) = 2.1, P = 0.094, χ2 = 0.0310) or the eHEALS scores (r = 0.147, P = 0.335). CONCLUSIONS: 'The internet-prepared patient' phenomena exists among public TM patients and was explained by preference for involvement in decision-making. However, internet use was not associated with better TM knowledge. Providing TM patients with internet guidance may be an opportunity to improve TM knowledge.

Longitudinal Changes in Proportions of Dental Services Provided by Australian Dentists, 1983 to 2010.

The objective of the study was to estimate the longitudinal change over a 26-y period in the proportion of dental services provided in 10 main service provision areas by Australian dentists. A random sample of Australian dentists was surveyed approximately every 5 y, commencing 1983 to 1984. The mean proportion of dental services provided was calculated from practitioner activity logs. Mixed effects regression models estimated the longitudinal change in the proportion of services provided, by dentists' age and birth-year cohort. Response rates across data collection waves ranged from 67% to 76%. Between 1983 to 1984 and 2009 to 2010, the mean proportion of diagnostic, preventive, and crown/bridge services provided tended to increase, and the mean proportion of restorative, oral surgery, and prosthodontic services tended to decrease. Mean proportions of endodontic and orthodontic services fluctuated. Relative to the youngest cohort (born after 1984), across cohorts of older to younger dentists, the proportions of diagnostic and preventive services increased, and restorative and prosthodontic decreased. Older cohorts provided the lowest proportions of diagnostic and preventive services (oldest cohort born before 1918: ß = -32.1 ± 4.8; cohort born 1934 to 1938: ß = -11.6 ± 3.2, respectively). Older cohorts provided the highest proportions of restorative and prosthodontic services (born before 1918: ß = 27.3 ± 5.6; born 1919 to 1923: ß = 10.5 ± 2.4, respectively). Some service area trends varied across birth-year cohorts. Endodontic service provision was declining for younger cohorts but increasing for older cohorts. Preventive service provision was increasing for younger cohorts but declining for older cohorts. This study identified trends not evident in previous time-series analysis. First, provision of restorative and oral surgery services, as a proportion of all services provided, was declining. Second, there were competing intercohort trends. These may indicate that new norms in dental education are influencing clinical decision making and that new trends in dental service provision may emerge as older dentists retire. Knowledge Transfer Statement: This study identified several trends in dental service provision and indicated that not all trends were consistent across all birth-year cohorts. Findings inform dental health care policy and priorities for dental education. In addition, the identified trends have implications for the future composition of the oral health workforce.

Diagnostic services in Australia: service rates and characteristics of patients.

BACKGROUND: Diagnostic services are the most common area of dental service in Australia. The objective was to investigate differences in services per visit for examinations and radiographs in relation to the characteristics of patients receiving these services in terms of age and gender, aspects of visiting such as dental insurance and reasons for visit, and oral health such as number of teeth and presence of decay. METHODS: A random sample of Australian dentists was surveyed in 2009-2010. Data on diagnostic services and patient characteristics were collected from a service log. RESULTS: A total of 1148 dentists responded (response rate = 67%). Models adjusted for age and gender of patients showed that rates [Rate Ratio, 95% CI] of examinations were higher for insured patients [1.13; 1.06-1.21], while rates of radiographs were higher for emergency visits [1.25; 1.11-1.48]. Patients with 20 or more teeth had higher rates for examinations [1.15; 1.01-1.32] and radiographs [1.28; 1.02-1.60]. Decayed teeth were associated with lower examination rates [0.70; 0.65-0.76] but higher rates of radiographs [1.34; 1.16-1.55]. CONCLUSIONS: The finding that number of teeth was associated with higher rates of examinations and radiographs suggests that retention of teeth could be influencing the increasing rates of diagnostic services in Australia.

Dental service provision by oral health therapists, dental hygienists and dental therapists in Australia: implications for workforce modelling.

OBJECTIVE: Dental service provision rates are necessary for workforce planning. This study estimates patient and service rates for oral health therapists (OHTs), dental hygienists (DHs) and dental therapists (DTs). To identify important variables for workforce modelling, variations in rates by practice characteristics were assessed. DESIGN: A cross-sectional self-complete mailed questionnaire collected demographic and employment characteristics, and clinical activity on a self-selected typical day of practice. SETTING: Private and public dental practices in Australia. PARTICIPANTS: Members of the two professional associations representing DHs, DTs and OHTs. METHODS: For each practitioner type, means and adjusted rate ratios of patients per hour, services per visit and preventive services per visit were estimated. Comparisons by practice characteristics were assessed by negative binomial regression models. RESULTS: Response rate was 60.6% (n = 1,083), 90.9% were employed of which 86.3% were working in clinical practice and completed the service log. Mean services per patient visit provided by OHTs, DHs and DTs were 3.7, 3.5 and 3.3 and mean preventive services per patient were 2.1, 2.1 and 1.8 respectively. For all three groups, adjusting for explanatory variables, the rate of preventive services per patient varied significantly by practice type (general or specialist) and by the proportion of child patients treated. CONCLUSION: Services rates varied by age distribution of patients and type of practice. If these factors were anticipated to vary over-time, then workforce planning models should consider accounting for the potential impact on capacity to supply services by these dental workforce groups.