Hospitalisations for removal of impacted teeth in Australia: a national geographic modeling approach.

INTRODUCTION: The aim of the study was to project hospitalisation rates for the surgical removal of impacted teeth across Australia, based on Western Australian statistics. METHODS: Population data were obtained from the Australian Bureau of Statistics and were divided across Australia by statistical local area and related to a validated socioeconomic index. Every episode of discharge from all hospitals in Western Australia for the financial years 1999/2000 to 2008/2009 indicating an impacted/embedded tooth removal as the principle oral condition, as classified by the International Classification of Disease (ICD-10AM), was included in the study. Hospitalisation data were obtained from the Western Australian Hospital Morbidity Data System. Variables of age, place of residence and health insurance status were utilised for projecting the Western Australian rates across Australia. RESULTS: The results of the study showed a definite rural-urban divide and the estimated age-adjusted rates were almost three times greater in the higher socioeconomic areas when compared to their poorer counterparts. The costs of the procedure were estimated to be approximately $60 million per annum across Australia. CONCLUSION: The findings of this study can be used to inform health policy to guide proper allocation of resources and target services for the benefit of the community especially those residing in rural and remote areas in a vast country like Australia.

Qualitative research and dental public health.

The use of Qualitative Research (QR) methods are now getting common in various aspects of health and healthcare research and they can be used to interpret, explore, or obtain a deeper understanding of certain aspects of human beliefs, attitudes, or behavior through personal experiences and perspectives. The potential scope of QR in the field of dental public health is immense, but unfortunately, it has remained underutilized. However, there are a number of studies which have used this type of research to probe into some unanswered questions in the field of public health dentistry ranging from workforce issues to attitudes of patients. In recent health research, evidence gathered through QR methods provide understanding to the social, cultural, and economic factors affecting the health status and healthcare of an individual and the population as a whole. This study will provide an overview of what QR is and discuss its contributions to dental public health research.

Application of geographic information systems to the analysis of private dental practices distribution in Western Australia.

INTRODUCTION: Western Australia (WA), Australia's largest state, consists of approximately one-third of the country's landmass and has a population of approximately 2 million people. However, over 85% of this population live in a handful of urban centres with the majority (1.6 million) living in the state capital, Perth. Healthcare provision in this complex environment is difficult and a clear understanding of the distribution of the population and health service suppliers is critical to understanding and addressing the problem. The vast majority (80% or more) of oral health care in WA is provided by private practitioners on a fee-for-service basis. Although previous studies have examined the macro-level distribution of dentists, this study utilized a high acuity examination to examine the distribution of private dental practices in WA, especially in rural and remote areas. METHODS: Dental practice locations were collected from open access sources and geo-coded. Population data were obtained from the Australian Bureau of Statistics and divided by census districts. The Index of Relative Socio-Economic Disadvantage (IRSD) was aggregated to census district level. Population and socio-economic data were then geo-coded using ArcGIS v9 (ESRI; Redlands, CA, USA). With Perth primary post office used as a central datum point, a sequence of maps at differing magnification was overlayed with a grid of latitude and longitude lines, or graticules. RESULTS: Of the 602 dental practices mapped, 75% were within 32 km of the Perth General Post Office, and 95% were within 256 km. In metropolitan Perth, fewer dental practices were located in areas that have residents of lower socioeconomic status and the density of distribution of these practices was greatest in the inner city region. CONCLUSION: This study highlights the complex nature of providing care to irregularly distributed populations in economic environments that are driven by factors not purely related to disease burden.

The geographic and socioeconomic distribution of in-hospital treatment of impacted teeth in Western Australia: a 6-year retrospective analysis.

OBJECTIVE: The aim of the study was to test the hypothesis that all Australians based on clinical need have equal access to health services for the removal of impacted teeth as hospital in-patients. METHODS: Data for the current analysis were obtained from the Western Australian Hospital Morbidity Data System (HMDS) for the six financial years 1999/00 to 2004/05. All cases of in-hospital treatment for impacted teeth were analysed and then correlated with socioeconomic status, geographic location of the patients, place of primary residence, and age. RESULTS: In-patient extraction rates are significantly higher in the 10- to 19-year-old and the 20- to 29-year-old age groups when compared to the other age groups. A young adult from a higher socioeconomic group is 4 times more likely to have an impacted tooth removed in a hospital than his or her counterpart from a lower socioeconomic group, which is significant. Similarly, people living in highly accessible metropolitan areas have a 3 times greater chance of being hospitalised for this procedure than those from the remote and rural areas. CONCLUSION: There are significant differences among different groups based on socioeconomic status and access to health services for in-hospital removal of impacted teeth, thus rejecting the hypothesis. This raises doubts over the nature of the procedure, considering that most patients are young, non-Indigenous, and live in metropolitan areas. This implies that some of the procedures seem to be elective and there is a need for introduction of guidelines in Australia for removal of impacted teeth, which could reduce expenditures significantly. However, further research is required in this area.

Hospitalisation for the surgical removal of impacted teeth: Has Australia followed international trends?

BACKGROUND: The aim of the study was to undertake a six-year analysis from 1999/00 to 2004/05, of the demographic characteristics of hospitalisations for the surgical removal of impacted teeth in Western Australia under general anaesthesia. METHOD: Data for the current analysis was obtained from the Western Australian Hospital Morbidity Data System (HMDS). Gender, age, indigenous status, place of residence, type of hospital admitted, insurance status, and Diagnostic Related Group (DRG) cost estimates for the procedure were analysed. RESULTS: A total of 37.6% of all oral health-related hospitalisations in Western Australia over the six years were for the removal of impacted teeth. Admitted patients were predominantly females (58.8%) and very few Indigenous people were hospitalised (0.2%). The average age of patients was 21.4 years (sd=9.9). Metropolitan patients were hospitalised 1.5 times more than rural patients for this condition. The majority of patients were hospitalised at a private metropolitan hospital and were insured. The total cost of hospitalisation for this condition contributes to 27% of all the oral health condition-related hospitalisation costs. CONCLUSION: This study suggests that the hospital-based removal of impacted teeth in Western Australia is associated with factors such as indigenous status, age, gender and private hospital access along with insurance status raising interesting questions over the equity of provision of this service.