Overview of size, composition and role
Overview of group
|Description of profession||Dental health professionals are concerned with maintaining patients’ oral health. A range of occupations are involved in dental health including dentists, dental therapists, dental hygienists, oral health therapists and dental prosthetists. Only dentists were included in the eHealth readiness survey as they not only have a direct role in patient care, but they are the primary decision-makers in terms of IT and eHealth in a practice.|
|Number||11,100 dental practitioners and 23,200 allied dental professionals and assistants12
(2006 Census recorded 29,512 in total)
|Gender mix||22% female, 78% male13|
EXHIBIT 44 - Distribution by Age and State
EXHIBIT 45 - Overview of practice attributes
Education, registration and accreditation
- 5-year undergraduate or 4-year postgraduate degree program required (degree must be accredited by the Australian Dental Council.
- Registration required for dentists, students, dental specialists, dental therapists, dental hygienists, oral health therapists and dental prosthetists with the Dental Board of Australia, one of the national boards established under NRAS.
- After entering practice, all registered dental practitioners must complete 60 hours every 3 years of continuing professional development activities.14
- Specialist dental qualifications require further university training. There are about 12-13 recognised subspecialities, some of which are really tiny like oral medicine and oral radiology, which only have a handful of practitioners in the whole country. Orthodontics is the biggest with about 550 practitioners in Australia. A few dentists go on to obtain a medical qualification and undertake advanced training in oral surgery, these are considered medical specialists.
- Allied dental professionals and assistants (e.g. dental hygienists and therapists) require a 3-year university degree such as a Bachelor of Oral Health. Dental prosthetists complete a TAFE diploma.
Funding and referral system
- Dentistry is overwhelmingly a private profession, with about 85% of dentists are providing services in the private sector. In contrast to Medicare, around 60% of the cost of services provided in the private sector comes from patient out-of-pocket costs; around 15% comes from private health insurance, which pays around half the cost of services covered.
- Public sector dentistry represents only a small part of dentistry, and is funded by State and Territory governments, and delivered through public clinics, dental hospitals and academic institutions to health-care card holders and children. A small proportion of publicly-funded services are outsourced to the private sector due to local shortages of public sector workforce
- The Commonwealth funds a limited range of dental services to particular population groups:
- A comprehensive range of dental services are provided to veterans through the Department of Veterans’ Affairs (DVA).
- The Chronic Disease Dental Scheme (CDDS) funds a broad range of dental services for people with chronic conditions and complex care needs, on referral from a GP. Eligible patients can access up to $4,250 in Medicare benefits for dental services over two consecutive calendar years. Services covered by the scheme include dental assessments, preventive services, extractions, fillings, restorative work and dentures. Public-sector services, those provided to hospital inpatients and services that are purely cosmetic in nature are excluded. (The Government has announced its intention to close this scheme, in order to fund a new Commonwealth Dental Health Program. However to date the Senate has prevented this.)
- The Cleft Lip and Cleft Palate Scheme provides for the payment of Medicare benefits for orthodontic and associated treatment rendered by accredited dentists to persons with cleft lip and cleft palate conditions, or similar conditions requiring major dento-skeletal treatment. Approved dental patients may receive treatment under the relevant Medicare Benefits Schedule items until the age of 28 years, provided they register with the Scheme prior to turning 22 years of age.
- The Scheme also provides assistance for a range of medical services of an oral surgical nature which attract Medicare benefits when performed by a medical practitioner, anaesthetist or an approved dental practitioner (oral and maxillofacial surgeon). These benefits are payable for various private and public hospital services in addition to various non-hospital services.
- Dentists also provide prescriptions under the Pharmaceutical Benefit Scheme.
- The Medicare Teen Dental Plan provides financial assistance to families to of eligible teenagers to receive a preventative dental check from a dentist who is registered with Medicare Australia. Dental therapists and dental hygienists can also provide services under the supervision or oversight of a dentist.
- Medicare rebates will not be paid for dental services that are purely cosmetic in nature. Medicare rebates can also not be claimed for dental treatment provided by public dental clinics or where the patient is an in-patient (ie an admitted patient) in a hospital, even if the patient is admitted to a hospital solely for the purpose of that dental treatment. 15
Peak National BodyA number of peak national bodies exist which relate to dental health professionals. The national governing body for dentists is the Australian Dental Association (ADA).
|Australian Dental Association|
|Address||PO Box 520|
St Leonards NSW 1590
14-16 Chandos Street
St Leonards NSW 2065
|Contact||T: +61 2 9906 4412|
F: +61 2 9906 4917
The national governing body for Dental Prosthetists is the Australian Dental Prosthetists Association (ADPA).
|Australian Dental Prosthetists Association|
|Address||Suite 2/ 9 Church Street|
Hawthorn, Victoria 3122
|Contact||P: 03 9852 9969|
There is also a peak body for hygienists and therapists called the Dental Hygienists Association of Australia.
Dental health professionals and eHealth
Examples of relevant eHealth applicationsThe key uses of eHealth that dental health professionals will benefit from include:
- Electronic health records
- Digital referrals and patient histories
- Electronic patient education resources
- Digital image transfer and storage
- Patient behaviour monitoring
Current eHealth 'Position'Dentists are generally technologically competent and comfortable with IT due to the nature of their work. A few older sole practitioners are very attached to card file systems but these tend to be the exception. The trouble is that technical support in the private sector tends to be poor and does not meet their needs, leading to problems with the security and backup of most systems. This could be a problem if minimum standards are set for privacy and data integrity, which require upgrades to current facilities.
For busy practices, the clinical interface needs to be really simple and easy to use, with minimal technical explanation required. Ideally a product would be created which would provide clinicians with the building blocks of the ideal eHealth system at the practice level as well as the system level.
In terms of dentists’ engagement with eHealth reforms, the ADA takes the view that what is missing is a road map of the ‘need to know’ requirements of each allied health profession, which would accurately chart what needs to be done to establish and use eHealth facilities. Dentists are concerned they will be excluded from a shared medical, despite the fact that oral health is inextricably linked to the health of the whole body. So too, many systemic conditions affect the mouth.
In terms of the new health identifiers, it is critical that this information is integrated with dental records for forensic purposes. This is a key issue for the ADA. Forensic identification through dental records identified 60% of all victims of the ‘Black Saturday’ bushfires as DNA had been destroyed. This is an essential part of investigating crime and disasters that cannot be replaced or replicated by other technologies.
The National eHealth Transition Authority’s use of SNOMED classifications and codes is inappropriate for Australian dentists as the SNODENT component uses charting and classification systems which are only used in the US, but not in Australia, Europe or the rest of the world. The July 1, 2012 deadline for many of the Government’s eHealth initiatives is not realistic for dentists as a result of this oversight, and the lack of available dental software that meets interoperability and other NeHTA standards.
Key insights from eHealth readiness survey
- Dental allied health practitioners are the oldest of the allied health groups, with 65% over 45 years of age. 73% practice from a single location, and 68% never visit rural or remote areas.
- Dental allied health practitioners’ leading uses of computers are administrative, including billing and patient rebates (85% use) and patient booking and scheduling (65%). Recording patient information is also a common use, both during consultations (64%) and afterwards (62%).
- In many areas, adoption of eHealth solutions by dental allied health practitioners does not currently match their desire. In particular, diagnostic imaging (6% currently order via computer, but 66% would like to; 42% view on a computer, a further 42% don’t, but would like to), and communicating with other health professionals (29% currently send or receive referrals electronically, while a further 54% would like to; 20% share health records with other practitioners electronically, a further 56% would like to).
- Few dental allied health practitioners currently use telehealth solutions (8%), although interest is strong (35% expect to be using within 3 years). The top 3 desired uses are training (16%), supervising (11%) and consulting with other practitioners (10%).
- 21% of dental allied health practitioners maintain all records in paper form, although 29% only use computers. Of the 79% storing some form of records electronically, 73% use an EHR. 47% strongly agree that computer use is expected, while 39% believe their colleagues are using computers.
- The perceived benefits of eHealth solutions to dental allied health practitioners are improving collaboration (32%) and continuity of care (21%). Improving patient safety (22%) also ranks highly.
- Several barriers resonate with dental allied health practitioners, including concerns about malfunctions or downtime (40% strongly agree), a preference for established technology (40%), and the need to maintain compatibility with existing IT systems (40%). Privacy of both practitioner performance data (39%) and patient records (35%) are also foremost.
- Dental allied health practitioners listed their top drivers of adoption as the advice of their professional body (47% strongly agree) and financial incentives (41%).
12Australian Institute of Health and Welfare 2010, Australia’s health 2010, based on unpublished data from ABS Labour Force Survey 2008.
13Australian Institute of Health and Welfare 2010, Australia’s health 2010. Number refers to dental practitioners. A much higher percentage (89 percent) of dental associate professionals and assistants are female.
14Dental Board of Australia 2010, Continuing professional development registration standard.
15Department of Health and Ageing website – Dental Health Fact Sheet for Patients