- dental hygienists’ practising rate showed a decline in outer regional areas;
- dental therapists’ practising rate across all remoteness areas decreased; and
- dental prosthetists in this same time period demonstrated a decreasing practising rate in all areas except inner regional.
The geographic size of Australia and the distribution of its population places people in regional and remote areas at a disadvantage in accessing a range of services, including dental care. This is not unique to dental services but a broader structural problem that regional and remote residents face when accessing a range of health services.
As with some medical professionals, the dental workforce is unevenly distributed across Australia. The supply of dental practitioners in regional and remote Australia is substantially lower than in urban areas. Even in locations where dentists are available, access can be affected by the availability of transport and distance to services, as well as socio–economic issues.98
98 National Rural Health Alliance (2005), Public dental service in Australia: whose responsibility?, p.25.
Structural imbalances in workforce distribution are highlighted in ARCPOH workforce data. The Dental Labour Force Collection 2006, showed an increase in the number of practising dentists per 100,000 people across all states and territories between 2003 and 2006. Practising dentists in Major Cities increased by 11 per cent, but declined in regional and remote areas. With regard to allied dental practitioners, which include dental hygienists, dental therapists, oral health therapists and dental prosthetists, workforce distributions varied slightly between 2003 and 2006:
For oral health therapists, where 2006 is the first year where they are reported on separately, there are no comparisons with earlier points in time. While addressing geographic distribution among practising dentists is paramount, the imbalances in other dental practitioners also needs to be targeted in any remedial activities.
Behaviour can have a significant influence on oral health. There are a range of complex social and behavioural changes which could lead to long–term improvements in oral health or long–term declines across a population. Improvements in oral health may be reversed by significant social changes in behaviour or new food products which result in changes in diet. For example, increased bottled water consumption may have an influence on the oral health benefits otherwise gained from water fluoridation.99 These influences are complex because they are linked to other behaviours which may also influence the outcome. For example, bottled water consumption may not be as influential in people who visit a dental practitioner regularly and have a healthy balanced diet. For children in particular, behavioural influences can establish long–term patterns which can affect their oral health into adulthood.
99 Mills, K., Falconer,S. and Cook, C. (2010), ‘Fluoride in still bottled water in Australia’, Australian Dental Journal, Vol 55, Issue 4, pp.411–416.
Diet and behaviour
Diet and behaviour can have an impact on oral health. High acid and sugary foods and poor oral health habits can lead to an increased incidence of caries and tooth erosion. The Australian Dental Association (ADA) discusses the established link between high sugar and acid diets and caries and tooth erosion and recommends the reduction in consumption of these foods.100 Other behaviours such as smoking and high alcohol consumption increase the risk of periodontal disease, tooth loss and oral cancer.101
100 Australian Dental Association (2010), Policy Statement, Community Oral Health Promotion: Diet and Nutrition, section 2.2.2.
101 Australian Dental Association (2010), Policy Statement, Community Oral Health Promotion: Tobacco, section 2.2.4.
Fear of the dentist
Dental fear and anxiety can contribute to an individual visiting a dentist infrequently, with those who are most anxious least likely to visit a dentist.102 Less frequent visiting, visiting only when there is a problem and cancelling appointments or treatment leads to greater treatment needs in the long term.103 Additionally, lower income is an indicator for dental anxiety, particularly in terms of affording the cost of treatment, and this can lead to decreased access to dental care.104
102 Roberts–Thomson, K.F. and Slade, G.D., (2008), ‘Factors associated with infrequent dental attendance in the Australian population’, Australian Dental Journal, Vol. 53, pp.358–362.
103 Armfield, J.M., Slade, G.D. and Spencer, A.J. (2007), ‘Dental fear and adult oral health in Australia’, Community Dentistry and Oral Epidemiology, Vol. 7, pp.200–230.
104 Armfield, J.M. (2010), ‘The extent and nature of dental fear and phobia in Australia’, Australian Dental Journal, Vol. 55, pp.368–377.