Social Inequities in Access to Dental Care in Australian Adults over Time.

INTRODUCTION: Social inequities in dental caries are reflected by both inequities in the social structures that contribute to disease severity and inequities in the provision of dental care. This study aimed to describe social differentials in the dental caries experience among Australian adults across a 13-y period and to examine if the highest magnitude of oral health inequities persisted across dental caries prevalence (decayed teeth [DT]) or its management (missing teeth [MT], filled teeth [FT]). METHODS: Data were from 2 population-based cross-sectional surveys of Australian adult oral health conducted in 2004-2006 (National Survey of Adult Oral Health-1 [NSAOH-1], n = 5,505) and 2017-2018 (NSAOH-2, n = 5,022). In each survey, representative samples of adults were obtained through a 3-stage, stratified sample design within metropolitan and regional areas in each state/territory. Clinical outcomes included the prevalence and mean of DT, MT, FT, and DMFT. Equivalized household income was grouped into approximately quartiles from low to high. RESULTS: Across all income quartiles, the mean DT and % DT >0 was higher in NSAOH-2 than in NSAOH-1. The increase in prevalence was highest in the third highest income group (prevalence difference [PD] = 8.4, from 24.1 to 32.5). Similarly, % MT >0 was lower in NSAOH-2 than in NSAOH-1 across all income groups, with the decrease most marked for the lowest income group (PD = -6.5, from 74.1 to 67.8). Across all income quartiles, % FT >0 was lower in NSAOH-2 than in NSAOH-1. The decrease was the most marked for the lowest income group (PD = -8.9, from 81.1 to 72.2). CONCLUSION: The findings confirm that although oral health inequities decreased for the most extreme management outcome of dental caries (MT), inequities increased for experience of that disease (DT) and the more conservative management of dental caries (FT). For all D, M, and F components (DMFT), inequities between the lowest and highest household income groups increased from 2004-2006 to 2017-2018. KNOWLEDGE TRANSFER STATEMENT: This study found that social inequities in oral health (experience of untreated dental caries and missing teeth) increased between the most socially advantaged and disadvantaged groups between 2004-2006 and 2017-2018. This suggests that models of dental service provision in Australia are increasingly benefitting those who can afford and access the care and who arguably need the services less than their less socially advantaged counterparts do.

Population Impact of Sugar-Sweetened Beverages on Dental Caries and Overweight/Obesity in Australian Children.

KNOWLEDGE TRANSFER STATEMENT: The reported findings greatly consolidated evidence of detrimental effects of sugars intake on child oral health and overweight and obesity, some of the most prevalent chronic conditions in children. Evidence on population impact of sugars intake is directly informative to policy makers and the public about the potential impact of population-based programs targeting sugars intake to prevent dental caries and overweight and obesity.

Access to dental care barriers and poor clinical oral health in Australian regional populations.

BACKGROUND: This paper investigated the associations between oral health with behavioural, demographic, periodontitis risk, financial and access to dental care barriers and compared the results in three Australian regional areas. METHODS: Data were obtained from the Australian National Study of Adult Oral Health (2017-18). Oral health status was measured using DMFT-score, and mean numbers of decayed, missing or filled teeth and periodontitis prevalence using the Center for Disease Control and Prevention (CDC) and the American Academy of Periodontology (AAP) Periodontal Classification. The analysis included these dependent variables by three regional areas, seven socio-demographic variables, two periodontal disease risk factors, two preventive dental behaviours, two barriers to dental care and three access to dental care variables. RESULTS: Of the 15,731 people interviewed, 5,022 were examined. There was no significant difference in periodontitis prevalence between the regions. All the socio-demographic characteristics, periodontal disease risk factors and preventive dental behaviours were significantly associated with at least one of the dental caries indicators. In multivariable analysis, there was no significant association between regional location with any of the four clinical dental caries variables. CONCLUSION: Poorer oral health outside major cities was associated with household income, education level, higher smoking, usual reason for and frequency of dental visiting.

Oral health changes among Indigenous and non-Indigenous Australians: findings from two national oral health surveys.

BACKGROUND: Historically, Indigenous Australians experienced poorer oral health than non-Indigenous Australians. We aimed to ascertain if Indigenous Australian oral health improved relative to non-Indigenous oral health between the 2004-06 and 2017-18 National Surveys of Adult Oral Health (NSAOH). METHODS: Both NSAOHs were population-based cross-sectional surveys of Australian adults aged 15 years or more. In both surveys, representative samples of adults were drawn through a three-stage, stratified sample design within metropolitan and regional areas in each state/territory. Frequencies of Indigenous and non-Indigenous self-reported and clinical oral health variables were ascertained, and differences were calculated between the 2004-06 and 2017-18 NSAOHs. Ninety-five per cent confidence intervals were calculated and weights were used to account for the complex sampling methodology of both surveys. RESULTS: In 2004-06, 229 Indigenous and 13 882 non-Indigenous Australians provided self-report data, and 87 and 5418 of these had dental examinations, respectively. In 2017-18, 334 Indigenous and 15 392 non-Indigenous Australians provided self-report data, and 84 and 4937 of them had dental examinations respectively. Between the surveys, relative to their non-Indigenous counterparts, Indigenous Australians experienced greater levels of: inadequate dentition (4.2%), experience of toothache (4.8%), problem-based dental attendance (4.5%) and 1+ teeth decayed, missing or filled (4.4%). CONCLUSIONS: The gap between poor self-reported and clinical oral health between Indigenous and non-Indigenous Australians was greater in the more recent survey.

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).

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.

Do people trust dentists? Development of the Dentist Trust Scale.

BACKGROUND: This study aimed to adapt a measure of trust in physicians to trust in dentists and to assess the reliability and validity of the measure. METHODS: Questionnaire data were collected from a simple random sample of 596 Australian adults. The 11-item General Trust in Physicians Scale was modified to apply to dentists. RESULTS: The Dentist Trust Scale (DTS) had good internal consistency (α = 0.92) and exploratory factor analysis revealed a single-factor solution. Lower DTS scores were associated with less trust in the dentist last visited, having previously changed dentists due to unhappiness with the care received, currently having dental pain, usual visiting frequency, dental avoidance, and with past experiences of discomfort, gagging, fainting, embarrassment and personal problems with the dentist. CONCLUSIONS: The majority of people appear to exhibit trust in dentists. The DTS shows promising reliability and validity evidence.

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.

Job satisfaction among 'migrant dentists' in Australia: implications for dentist migration and workforce policy.

BACKGROUND: Migrants occupy a significant proportion of the dental workforce in Australia. The objectives of this study were to assess the level of job satisfaction of employed migrant dentists in Australia, and to examine the association between various migrant dentist characteristics and job satisfaction. METHODS: All migrant dentists resident in Australia were surveyed using a five-point Likert scale that measured specific aspects of job, career and satisfaction with area and type of practice. RESULTS: A total of 1022 migrant dentists responded to this study; 974 (95.4%) were employed. Responses for all scales were skewed towards strongly agree (scores ≥4). The overall scale varied by age group, marital status, years since arrival to Australia and specialist qualification (chi-square, p < 0.05). In a multivariate logistic regression model, there was a trend towards greater satisfaction amongst older age groups. Dentists who migrated through the examination pathway (mainly from low- and middle-income countries) had a lower probability of being satisfied with the area and type of practice (OR = 0.71; 0.51-0.98), compared with direct-entry migrant dentists (from high-income countries). CONCLUSIONS: The high level of job satisfaction of migrant dentists reflects well on their work-related experiences in Australia. The study offers policy suggestions towards support for younger dentists and examination pathway migrants, so they have appropriate skills and standards to fit the Australian health care environment.

Applied scope of practice of oral health therapists, dental hygienists and dental therapists.

BACKGROUND: Oral health therapists (OHTs) are an emerging workforce whose training incorporates the skills of dental hygienists (DHs) and dental therapists (DTs). There are concerns that OHTs are underutilized. This study compares the employment characteristics and applied practice scope of OHTs with those of DTs and DHs. METHODS: Members of two professional associations representing DHs, DTs and OHTs, were surveyed by mail. Data collected included demographic and employment characteristics and clinical activity on a typical practice day. Applied practice scope was described by calculating the proportion of practitioners that had provided ≥1 of a selected range of key services. Log binomial regression was used to compare OHTs to DTs and DHs. RESULTS: The response rate was 60.6% (n = 1083) and of these 90.9% were employed. Preventive services dominated service provision. The proportion of OHTs that provided fluoride applications (77%) was higher than the proportion of DTs (53%, p < 0.05), and was not significantly different from the proportion of DHs (70%). The proportion of OHTs that provided (48%) fissure sealants was lower than the proportion of DTs (70%) and substantially higher than the proportion of DHs (10%, p > 0.05). CONCLUSIONS: Overall, the applied practice scope of OHTs appeared to differ from DTs and DHs.

Development of life story experience (LSE) scales for migrant dentists in Australia: a sequential qualitative-quantitative study.

INTRODUCTION: The integration of qualitative and quantitative approaches introduces new avenues to bridge strengths, and address weaknesses of both methods. OBJECTIVE: To develop measure(s) for migrant dentist experiences in Australia through a mixed methods approach. METHODS: The sequential qualitative-quantitative design involved first the harvesting of data items from qualitative study, followed by a national survey of migrant dentists in Australia. Statements representing unique experiences in migrant dentists' life stories were deployed the survey questionnaire, using a five-point Likert scale. Factor analysis was used to examine component factors. RESULTS: Eighty-two statements from 51 participants were harvested from the qualitative analysis. A total of 1,022 of 1,977 migrant dentists (response rate 54.5%) returned completed questionnaires. Factor analysis supported an initial eight-factor solution; further scale development and reliability analysis led to five scales with a final list of 38 life story experience (LSE) items. Three scales were based on home country events: health system and general lifestyle concerns (LSE1; 10 items), society and culture (LSE4; 4 items) and career development (LSE5; 4 items). Two scales included migrant experiences in Australia: appreciation towards Australian way of life (LSE2; 13 items) and settlement concerns (LSE3; 7 items). CONCLUSION: The five life story experience scales provided necessary conceptual clarity and empirical grounding to explore migrant dentist experiences in Australia. Being based on original migrant dentist narrations, these scales have the potential to offer in-depth insights for policy makers and support future research on dentist migration.

Dental anxiety screening practices and self-reported training needs among Australian dentists.

BACKGROUND: It is recommended that dentists screen for dental anxiety (DA) so that fearful patients may be better managed. The main aim of this study was to determine what dentists are being taught in relation to DA as well as whether and how anxious patients are identified in the clinic. METHODS: Two hundred and forty-six practising dentists (adjusted response rate = 40.1%), from a random sample of registered Australian dentists, completed a mailed questionnaire. RESULTS: Dentists estimated that high DA affected 23.3% of children and 19.4% of adults seen. Only 3.7% of dentists reported using a published scale for screening DA, with the most common reason being lack of awareness (56.5%). Approximately one-half of responding dentists directly asked their patients about DA and this was more common among younger dentists (χ(2) = 7.75, p = 0.021). There were few differences in DA screening by other practitioner or practice characteristics (p > 0.05). Only one-third of dentists had received undergraduate training related to DA and only 41.7% considered this to be 'good' or better. Almost 37% of respondents expressed an interest in future training opportunities. CONCLUSIONS: The use of formal, validated scales for screening DA is minimal. Training in anxiety management appears to be low and is an area that could be expanded upon.