Innovation in school-level dental risk assessment: an evidence based Index of Dental Risk.

Objectives and importance of study: An increase in hospitalisations for complicated dental decay among Western Australian children, particularly those who are disadvantaged, is well documented. An informed, targeted distribution of limited resources is needed to effectively assist children who are most at risk. This study developed an integrated school-by-school Index of Dental Risk based on known primary risk variables for dental decay, poverty and Indigenous status. STUDY TYPE: Population-based research. METHODS: All data were collected from open web-based sources that were freely available, so no ethics approval was required. All data were collected in 2011 from 1112 Western Australian schools. Data included the nationally agreed Socio-Economic Indexes for Areas, and Accessibility/Remoteness Index of Australia. RESULTS: The Index of Dental Risk was categorised into four risk profiles for each Western Australian school: low (0-4), medium (5-9), medium-high (10-14) and high (15-18). We found that 57% of schools had a medium risk profile or higher (≥5). Nine schools had the highest risk category of 18. CONCLUSIONS: This study is the first to develop a simple Index of Dental Risk that can be applied at the individual school level to efficiently target resources. This evidence based resource allocation has the potential to reduce overall cost burdens of oral health-related pathology in the community.

Networked remote area dental services: a viable, sustainable approach to oral health care in challenging environments.

OBJECTIVE: This study examines the cost effectiveness of a model of remote area oral health service. DESIGN: Retrospective financial analysis. SETTING: Rural and remote primary health services. PARTICIPANTS: Clinical activity data and associated cost data relating to the provision of a networked visiting oral health service by the Centre for Rural and Remote Oral Health formed the basis of the study data frameset. The cost-effectiveness of the Centre's model of service provision at five rural and remote sites in Western Australia during the calendar years 2006, 2008 and 2010 was examined in the study. MAIN OUTCOME MEASURED: Calculations of the service provision costs and value of care provided were made using data records and the Fee Schedule of Dental Services for Dentists. The ratio of service provision costs to the value of care provided was determined for each site and was benchmarked against the equivalent ratios applicable to large scale government sector models of service provision. RESULTS AND CONCLUSION: The use of networked models have been effective in other disciplines but this study is the first to show a networked hub and spoke approach of five spokes to one hub is cost efficient in remote oral health care. By excluding special cost-saving initiatives introduced by the Centre, the study examines easily translatable direct service provision costs against direct clinical care outcomes in some of Australia's most challenging locations. This study finds that networked hub and spoke models of care can be financially efficient arrangements in remote oral health care.

Oral health of pre-school children in rural and remote Western Australia.

INTRODUCTION: Dental decay (caries) is a common condition affecting preschool children in Western Australia (WA). Severe dental decay can have significant consequences as indicated by previous data reporting decay as the fifth most common cause of hospitalisation among preschool children in WA. METHODS: This study examined the prevalence and severity of decay in preschool children in rural and remote WA and considered some of the factors associated with these rates. RESULTS: The study reports on the dental health of 253 children aged between 2 and 4 years within five rural and remote communities in WA. Over 40% of these young children already had one or more decayed teeth with 19% having severe early childhood caries (s-ECC) and 15% having already suffered toothache. The disease burden was far higher among Indigenous children, who comprised one-third of the study group, in comparison with the non-Indigenous children in the study. Among the Indigenous children, decay was far more widespread (69% had decay compared with 25% of non-Indigenous children), and was more severely experienced (34% had s-ECC) and 28% having suffered toothache (vs respective rates of 10% and 7% for the non-Indigenous children). Only half of the Indigenous children brushed their teeth on a daily basis and one-third had never brushed at all (vs rates for non-Indigenous children of 85% and 2%, respectively). CONCLUSION: Action to improve the prevalence and severity of decay among this group of Indigenous children is linked with promoting core messages for good oral health. A systemic approach to addressing the needs of remote dwelling people, and in particular remote area Indigenous children, must include a sustained, evidence based, primary health focus that is inclusive of oral health.

An innovation in Australian dental education: rural, remote and Indigenous pre-graduation placements.

Anticipating the looming crisis in access to dental services in rural and remote areas, the Western Australian Centre for Rural and Remote Oral Health developed an undergraduate rural placement program to provide dental students of The University of Western Australia opportunities for direct experience of rural and remote practice during the final year of the undergraduate curriculum. The Rural, Remote and Indigenous Placement program started in 2002 and, to the end of 2005, had placed 78 final year dental students in supervised clinical practice in rural, remote or Indigenous practice. In this study, the evolution of the program (2002-2005) is described and student evaluation of the program is reported. While involved in the rural placement program, students were assessed by experienced dental practitioners and provided program evaluation. This structured feedback allowed continuous improvement of the program. Data from each year's graduates was also analysed to examine the question of influence of placements on practice location during the first 6 months after graduation. Although it will be many years before the effects of outplacement programs can be specifically attained, the evidence to date indicates that the program may be a valuable tool among the plethora of strategies being investigated to augment Australia's rural oral health workforce.