Variations in Australian dental therapy practice by practitioner and workplace characteristics.

INTRODUCTION: Understanding dental therapy practice across clinical settings is useful for education and service planning. This study assessed if dental therapy service provision varied according to practitioner and workplace characteristics. METHODS: Members of professional associations representing dental therapists (DT) and oral health therapists (OHT) were posted a self-complete survey collecting practitioner and workplace characteristics, together with clinical activity on a self-selected typical day of practice. Differences in service provision according to characteristics were assessed by comparing mean services per patient visit. Negative binomial regression models estimated adjusted ratios (R) of mean services per patient. RESULTS: The response rate was 60.6%. Of practitioners registered as an OHT or a DT, 80.0% (n = 500) were employed in general clinical practice. Nearly one-third of OHT and nearly two-thirds of DT worked in public sector dental services. Patterns of service provision varied significantly according to practice sector and other characteristics. After adjusting for characteristics, relative to private sector, public sector practitioners had higher provision rates of fissure sealants (R = 3.79, 95% confidence interval [95% CI]: 2.84-5.06), restorations (R = 3.78, 95% CI: 2.94-4.86) and deciduous tooth extractions (R = 3.58, 95% CI: 2.60-4.93) per patient visit, and lower provision rates of oral health instruction (R = 0.86, 95% CI: 0.76-0.98), fluoride applications (R = 0.43, 95% CI: 0.33-0.56), scale and cleans (R = 0.39, 95% CI: 0.34-0.45) and periodontal services (R = 0.20, 95% CI: 0.14-0.28) per patient visit. CONCLUSION: Differences in service provision according to sector indicate that OHT and DT adapt to differing patient groups and models of care. Variations may also indicate that barriers to utilising the full scope of practice exist in some settings.

Longitudinal changes in dental services provided by Australian dentists.

OBJECTIVE: To estimate the longitudinal change in number of patients per year (PPY) per dentist by age and sex of dentists in Australia. METHOD: Dentists were selected randomly from Australian dental registers, the baseline collection was in 1983 and repeated approximately every 5 years until 2009. Dentist's practice activity was collected by mailed questionnaire. Number of PPY was calculated from work hours and number of patients per week per dentist. Mixed-effects regression was applied to estimate both individual random effects and population averaged fixed effects for the number of PPY provided by age, time, and sex. RESULTS: A total of 1,449 dentists completed 2,822 questionnaires from six waves of data collection (1983 to 2010). The average PPY decreased over the time of the study. The rate of change in PPY accelerated during younger ages and reached a peak when they moved into 50 years old (B = 86.04, P < 0.0001), and then decelerated (B = -0.90, P = 0.0002) across time. The mean number of PPY was higher in male dentists than female dentists in the same 10-year age group. The pattern of PPY change with aging was an inverted U-shape for male dentists. In contrast, there was a U-shape for female dentists. CONCLUSIONS: The longitudinal change in PPY with aging was an inverted U-shape, which accelerated during younger age, and decelerated after reaching a peak at 50 years old. Males had higher PPY than female dentists at the same age. The pattern of PPY was different between male and female dentists.

Oral health impacts on self-rated general and oral health in a cross-sectional study of working age adults.

OBJECTIVES: The aims were to assess the joint effects of oral health and general health functional problems on self-ratings of general and oral health among adults. METHODS: Data were collected from adults aged 30-61 years in Australia by mailed survey in 2009-2010. Self-rated health of 'very good/excellent' was analysed by oral health impact (OHIP-14) and number of health problems (EQ-5D) controlling for socio-demographics. RESULTS: Responses were collected from n = 1093 persons (response rate = 39.1%). General health self-ratings were higher in the high-income group (prevalence ratio [PR] = 1.06, 1.00-1.12) but lower for those with a higher number of health problems (PR = 0.84, 0.76-0.93). The interaction of health problems with oral health impact indicated that self-rated general health was worst when both the number of health problems and OHIP score were higher. Oral health self-ratings were lower for males (PR = 0.92, 0.87-0.98), those aged 50-61 years (PR = 0.92, 0.85-0.99), for those with more health problems (PR = 0.82, 0.71-0.95) and higher oral health impact scores (PR = 0.54, 0.46-0.64). CONCLUSIONS: For working age adults, oral health impact was associated with general health for those with more health problems indicating those in worse health suffer more impact from oral health problems.

Self-rated dental health and dental insurance: modification by household income.

BACKGROUND: Previous studies have reported that socioeconomically disadvantaged Australians have poorer self-rated dental health (SRDH), are less likely to be insured for dental services and are less likely to have regular dental visits than their more advantaged counterparts. However, less is known about the associations between dental insurance and SRDH. The aim of this study was to examine the associations between SRDH and dental insurance status and to test if the relationship was modified by household income. METHODS: A random sample of 3,000 adults aged 30-61 years was drawn from the Australian Electoral Roll and mailed a self-complete questionnaire. Analysis included dentate participants. Bivariate associations were assessed between SRDH and insurance stratified by household income group. A multiple variable model adjusting for covariates estimated prevalence ratios (PR) of having good to excellent SRDH and included an interaction term for insurance and household income group. RESULTS: The response rate was 39.1% (n = 1,093). More than half (53.9%) of the participants were insured and 72.5% had good to excellent SRDH. SRDH was associated with age group, brushing frequency, insurance status and income group. Amongst participants in the $40,000- < $80,000 income group, the insured had a higher proportion reporting good to excellent SRDH (80.8%) than the uninsured (66.5%); however, there was little difference in SRDH by insurance status for those in the $120,000+ income group. After adjusting for covariates, there was a significant interaction (p < 0.05) between having insurance and income; there was an association between insurance and SRDH for adults in the $40,000- < $80,000 income group, but not for adults in higher income groups. CONCLUSIONS: For lower socio-economic groups being insured was associated with better SRDH, but there was no association for those in the highest income group. Insurance coverage may have the potential to improve dental health for low income groups.

Household income modifies the association of insurance and dental visiting.

BACKGROUND: Dental insurance and income are positively associated with regular dental visiting. Higher income earners face fewer financial barriers to dental care, while dental insurance provides partial reimbursement. The aim was to explore whether household income has an effect on the relationship between insurance and visiting. METHODS: A random sample of adults aged 30-61 years living in Australia was drawn from the Electoral Roll. Data were collected by mailed survey in 2009-10, including age, sex, dental insurance status and household income. RESULTS: Responses were collected from n = 1,096 persons (response rate = 39.1%). Dental insurance was positively associated with regular visiting (adjusted prevalence ratio (PR) = 1.18; 95% CI: 1.01-1.36). Individuals in the lowest income tertile had a lower prevalence of regular visiting than those in the highest income group (PR = 0.78; 95% CI: 0.65-0.93). Visiting for a check-up was less prevalent among lower income earners (PR = 0.65; 95% CI: 0.50-0.83). Significant interaction terms indicated that the associations between insurance and visiting varied across income tertiles showing that income modified the effect. CONCLUSIONS: Household income modified the relationships between insurance and regular visiting and visiting for a check-up, with dental insurance having a greater impact on visiting among lower income groups.

Dental insurance, attitudes to dental care, and dental visiting.

OBJECTIVE: Dental insurance status is strongly associated with service use. In models of dental visiting, insurance is typically included as an enabling factor. However, in Australia, people self-select into health insurance (privately purchased) and levels of cover for dental services are modest. Rather than enabling access, insurance status may be a "marker" for unmeasured predisposing attitudes. This study aims to explore associations between dental insurance status and visiting while adjusting for dental care attitudes. METHODS: Participants (South Australians aged 45-54 years) of a 2-year prospective cohort study (2005-2007) investigating dental service use were surveyed on their attitudes to dental care and insurance status. Six attitudinal factors were assessed using a 23-item Likert scale. Bivariate associations between insurance, attitudes, visiting, and other known covariates (age, sex, and household income) were explored. A series of regression models assessed whether prevalence ratios of visiting were attenuated after controlling for attitudinal factors. RESULTS: Response rate was 85.0 percent. Analysis was limited to dentate adults with known dental insurance status (n=529). The majority had dental insurance (75.2%) and made regular visits (63.7%). Insurance status, visiting, and attitudinal factors were significantly associated. Controlling for covariates, insured adults, compared with the uninsured, were 57 percent more likely to make regular visits. After adjusting for attitudinal factors, the significant association between insurance and visiting persisted. CONCLUSION: Dental care attitudes did not confound the association between dental insurance and visiting, indicating that dental insurance status was not a "marker" for predisposing attitudes.

Practice activity trends among oral and maxillofacial surgeons in Australia.

BACKGROUND: The aim of this study was to describe practice activity trends among oral and maxillofacial surgeons in Australia over time. METHODS: All registered oral and maxillofacial surgeons in Australia were surveyed in 1990 and 2000 using mailed self-complete questionnaires. RESULTS: Data were available from 79 surgeons from 1990 (response rate = 73.8%) and 116 surgeons from 2000 (response rate = 65.1%). The rate of provision of services per visit changed over time with increased rates observed overall (from 1.43 +/- 0.05 services per visit in 1990 to 1.66 +/- 0.06 services per visit in 2000), reflecting increases in pathology and reconstructive surgery. No change over time was observed in the provision of services per year (4,521 +/- 286 services per year in 1990 and 4,503 +/- 367 services per year in 2000). Time devoted to work showed no significant change over time (1,682 +/- 75 hours per year in 1990 and 1,681 +/- 94 hours per year in 2000), while the number of visits per week declined (70 +/- 4 visits per week in 1990 to 58 +/- 4 visits per week in 2000). CONCLUSIONS: The apparent stability in the volume of services provided per year reflected a counterbalancing of increased services provided per visit and a decrease in the number of visits supplied.