Liana Luzzi

Dental service patterns among private and public adult patients in Australia

BackgroundWhile the majority of dental care in Australia is provided in the private sector those patients who attend for public care remain a public health focus due to their socioeconomic disadvantage. The aims of this study were to compare dental service profiles provided to patients at private and public clinics, controlling for age, sex, reason for visit and income.MethodsData were collected in 2004–06, using a three-stage, stratified clustered sample of Australians aged 15+ years, involving a computer-assisted telephone interview (CATI), oral examination and mailed questionnaire. Analysis was restricted to those who responded to the CATI.ResultsA total of 14,123 adults responded to the CATI (49% response) of whom 5,505 (44% of those interviewed) agreed to undergo an oral epidemiological examination. Multivariate analysis controlling for age, sex, reason for visit and income showed that persons attending public clinics had higher odds [Odds ratio, 95%CI] of extraction (1.69, 1.26–2.28), but lower odds of receiving oral prophylaxis (0.50, 0.38–0.66) and crown/bridge services (0.34, 0.13–0.91) compared to the reference category of private clinics.ConclusionSocio-economically disadvantaged persons who face barriers to accessing dental care in the private sector suffer further oral health disadvantage from a pattern of services received at public clinics that has more emphasis on extraction of teeth and less emphasis on preventive and maintenance care.

Factors influencing the use of public dental services: An application of the Theory of Planned Behaviour

BackgroundThere is limited evidence of the influence of psychosocial factors and health beliefs on public dental patients patterns of service use in Australia. The research aims were to examine associations between dental attitudes and beliefs of public dental service users and dental visiting intention and behaviour using the Theory of Planned Behaviour.Methods517 randomly selected adult public dental patients completed a questionnaire assessing dental attitudes and beliefs which was matched with electronic records for past and future dental service use. A questionnaire measured intentions, attitudes, subjective norms and perceptions of behavioural control and self-efficacy in relation to visiting public dentists. A measure of dental attendance at public dental clinics was obtained retrospectively (over 3 1/2 years) and prospectively (over a one year period following the return of the questionnaire) by accessing electronic patient clinical records.ResultsParticipants had positive attitudes, subjective norms and self-efficacy beliefs towards dental visiting but perceived a lack of control over visiting the dentist. Attitudes, subjective norms, self-efficacy and perceived control were significant predictors of intention (P < 0.05). Intentions, self-efficacy and past dental attendance were significant predictors of actual dental attendance (P < 0.05).ConclusionPublic dental patients held favourable attitudes and beliefs but perceived a lack of control towards dental visiting. Reducing structural barriers may therefore improve access to public dental services.

Job satisfaction of the oral health labour force in Australia

BACKGROUND Job satisfaction among registered clinical dentists in Australia was measured to identify issues influencing recruitment and retention. METHODS A questionnaire was mailed to a random sample of 2202 dentists, stratified by state and gender, selected from the 2005 Australian Dental Association directory. RESULTS A total of 61.9% of dentists responded. Analyses showed significant differences in levels of satisfaction for various dimensions of job satisfaction by gender, age group, practice type and geographic area. Differences in satisfaction between male and female dentists related to the relationships with colleagues and administrative responsibilities dimensions. Dentists of different age groups differed on eight dimensions: relationships with colleagues, patients, staff; personal time; intrinsic satisfaction; community; administrative responsibilities and resources. Differences among private and public dentists related to autonomy, relationships with patients, staff, community, compensation and resources dimensions. Dentists working in different geographic areas differed on relationships with staff and community dimensions. CONCLUSIONS Differences existed between private and public dentists, metropolitan and non-metropolitan dentists, male and female dentists and dentists of different ages. Such differences should be addressed in order to improve recruitment and retention rates of dentists. Workplaces that offer job autonomy, competitive pay, flexible working hours and minimal administrative burden may improve dentist job satisfaction.

Social inequality in use of dental services: relief of pain and extractions

Objectives: The aim of this study was to assess social inequality in use of dental services by examination of visiting for relief of pain and receipt of extractions.

Public dental service utilization among adults in South Australia

BACKGROUND Longitudinal patterns of public dental service use may reflect access issues to public dental care services. Therefore, patterns of dental service use among South Australian adult public dental patients over a 3(1/2)-year period were examined. METHODS Public dental patients (n = 898) initially receiving a course of emergency dental care (EDC) or general dental care (GDC) at baseline were followed for up to 3(1/2) years. Patient clinical records were accessed electronically to obtain information on dental visits and treatment received at those visits. RESULTS Some 70.7 per cent of EDC and 51.3 per cent of GDC patients returned for dental treatment post-baseline. EDC patients returned within a significantly shorter time period post-baseline, received significantly more courses of care and were visiting more frequently than GDC patients. A greater proportion of EDC patients received oral surgery, restorative, endodontic and prosthodontic services, but fewer received periodontic services. EDC patients received significantly more oral surgery and fewer preventive services per follow-up year, on average, than GDC patients. Large proportions of EDC (52.4 per cent) and GDC (63.8 per cent) patients who returned sought emergency care post-baseline. CONCLUSIONS Patients appeared to be cycling through emergency dental care because of lack of access to general care services, highlighting access problems to public dental care.

Income-related inequalities in inadequate dentition over time in Australia, Brazil and USA adults

OBJECTIVE To assess changes over time of the absolute and relative household income-related inequalities in inadequate dentition (ID) among Australians, Brazilians and USA adults. METHODS This study used nationwide oral health survey data from Australia (n = 1200 in 1999; n = 2729 in 2005), Brazil (n = 13 431 in 2003; n = 9779 in 2010) and USA (n = 2542 in 1999; n = 1596 in 2005). Absolute income inequalities were calculated using Absolute Concentration Index (ACI) and Slope Index of Inequality (SII), while relative inequalities were calculated using Relative Concentration Index (RCI) and Relative Index of Inequality (RII). RESULTS Prevalence of ID in the studied period dropped from 8.7% to 3.1% in Australia; from 42.1% to 22.4% in Brazil; and remained stable in USA, nearly 8.0%. Absolute income inequalities were highest in Brazil, followed by the USA and Australia; relative inequalities were lower in Brazil than in Australia and the USA. ID was higher among Brazilian females (2010) and for the poorest group in all countries and periods. A remarkable reduction in absolute inequalities were found in Australia [Slope Index of Inequality (SII) and AIC 60%] and in Brazil (SII 25%; ACI 33%) while relative inequalities increased both in Australia (RCI and RII 40%) and in Brazil (RCI 24%; RII 38%). No changes in absolute and relative income inequalities were found in the USA. CONCLUSION There were still persistent absolute and relative income inequalities in ID in all examined countries. There has been a reduction in absolute income inequalities in ID but an increase in relative income inequalities.

Trends in dental visiting avoidance due to cost in Australia, 1994 to 2010: an age-period-cohort analysis

BackgroundThe cost of dental care may be a barrier to regular dental attendance with the proportion of the Australian population avoiding or delaying care due to cost increasing since 1994. This paper explores the extent to which age, period and cohort factors have contributed to the variation in avoiding or delaying visiting a dentist because of cost.MethodsData were obtained from four national dental telephone interview surveys of Australian residents aged five years and over conducted in 1994, 1999, 2004 and 2010 (response rates 48% - 72%). The trend in the percentage of persons avoiding or delaying visiting a dentist because of cost was analysed by means of a standard cohort table and more formal age-period-cohort analyses using a nested models framework.ResultsThere was an overall increase in the proportion of people avoiding or delaying visiting a dentist indicating the presence of period effects. Financial barriers were also associated with age such that the likelihood of avoiding because of cost was highest for those in their mid-late twenties and lowest in both children and older adults. Cohort effects were also present although the pattern of effects differed between cohorts.ConclusionThe findings of this study suggest that, in addition to the increase in costs associated with dental care, policies targeting specific age groups and income levels may be contributing to the inequality in access to dental care.

Inequalities in Tooth Decay in Australian Children by Neighbourhood Characteristics and Indigenous Status

Objective. Tooth decay is related to poverty, measured at individual and neighbourhood levels. It is however uncertain if living in an advantaged neighbourhood reduces tooth decay similarly in Australian Indigenous and non-Indigenous children. Methods. This study describes tooth decay by neighbourhood characteristics and Indigenous status, and examines inequalities by Indigenous status. Results. In deciduous dentition the percentage of children with tooth decay and untreated decay decreased on average 26% and 20% respectively in the non-Indigenous sample from poor to affluent neighbourhoods. In Indigenous children tooth decay and untreated decay decreased on average 6% and 8%, respectively, from poor to affluent neighbourhoods. Conclusion. While all children from affluent areas had less tooth decay, the gap between non-Indigenous and Indigenous children remained significant across neighbourhood characteristics. This suggests that both universal and targeted prevention programs should be considered for all Indigenous children irrespective of where they live.

Root caries experience among Australian adults

BACKGROUND Increase in life expectancy and tooth retention in contemporary Australian adults may increase population-level burden of having root caries. This study aimed to describe patterns and evaluate associations of root caries with socio-demographic, socio-economic, clinical and behavioural factors. METHODS A secondary analysis was undertaken using data from the National Survey of Adult Oral Health 2004-2006, which included 5505 randomly general adults 15+ years old. Participants underwent an oral examination and completed an interview and a questionnaire. Prevalence and mean number of decayed/filled root (root DFS), untreated root (root DS), filled root (root FS), gingival recession, oral hygiene and gingival status were derived from examinations. Socio-demographic, socio-economic and behavioural factors were self-reported. Multivariable models were generated to estimate prevalence ratios (PR), mean ratios (MR) and confidence intervals (95% CI), adjusting for number of surfaces with gingival recession. Additional analysis for older adults 60+ years old was presented. RESULTS The prevalence of root caries was 25.3% (CI=23.6-27.1) and 62.0% [CI=58.7-65.1] among general and older adults, respectively. Risk factors found were similar in both populations. Smokers had higher prevalence and mean number of root DFS, DS and FS than never-smokers. In contrast with poor oral hygiene, high income and frequent brushing were significantly associated with lower mean root DS. Frequent dental visiting was associated with higher root FS and DFS. CONCLUSIONS Root caries affected about a quarter of Australian general adults and more than a half of older adults. People who were smokers presented a significantly higher prevalence and severity of root caries.

Changes in Area-level Socioeconomic Status and Oral Health of Indigenous Australian Children.

Objective. Dental diseases have shown to be influenced by area-level socioeconomic status. This study aims to assess the effects of change in area-level SES on the oral health of Australian Indigenous children. Methods. Data were collected from a national surveillance survey for children’s dental health at two points of time (2000–2002/2007–2010). The study examines caries experienced by area-level SES and whether changes in area-level SES (stable-high, upwardly-mobile, downwardly-mobile and stable low) affects caries experience. Results. Dental caries in both the deciduous and permanent dentition increased significantly among Indigenous children during the study period. In stable low-SES areas, the experience of decayed, missing and overall dmft/DMFT in both dentitions was highest compared with other groups at both Time 1(2.15 vs 1.61, 1.77, 1.87 and 0.86 vs 0.55, 0.67, 0.70 respectively) and Time 2 (3.23 vs 2.08, 2.17, 2.02 and 1.49 vs 1.18, 1.21 respectively). Conclusion. A change in area-level SES was associated with experience of dental disease among Indigenous Australian children.