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Aust. J. Rural Health (2014) 22, 86
Grazing Is it time for an advanced rural dentist? The oral health status of Australians residing outside capital cities is poorer than that of those living in capital cities.1 Non-capital city residents are more likely to suffer complete tooth loss, to have an inadequate dentition (less than 21 teeth), to wear dentures, to have missing teeth than capital city residents and are more likely to avoid certain foods due to dental problems than capital city-based people.1 Although the oral health of Australians improved, the rural–metro gap in oral health outcomes was as great in 2004–2006 as it was in 1987–1988.2 This suggests that whatever is making rural oral health poorer is not being adequately managed nor satisfactorily explained. One reason for the poorer rural health has been poorer access to dental care. There is an uneven distribution of dentists towards larger centres.3 Hence, it is not surprising that dentists from non-capital city areas supply more patient visits per year, are more likely to be busier than they would like to be, tend to have a broader scope of practice and are less likely to supply preventive care than capital city dentists.4 People in rural areas commonly describe health as an absence of disease,5 and their money is spent on disease management rather than on primary care and health promotion.6 People not living in capital city areas are more likely than those living in capital cities to have a problem-orientated pattern of dental attendance, less likely to make an annual dental visit and less likely to have a particular dentist that they usually visit.1 The high workload of rural dentists suggests that rural dentists would not feel particularly threatened by change in the clinical practice environment if such change improved patient care and oral health outcomes. One response to this crisis in rural oral health service provision is to develop an ‘advanced rural dentist’ program similar to the rural medical generalist program. The program could cover some procedures of specialist dental practice and some areas of practice outside dentistry and research, but it could also teach the skills required for stronger links and cooperation between rural health care practitioners. It would enable other health workers (inclusive of oral health therapists, dental hygienists, dental therapists, dental assistants) to
The authors are chief investigators with the APHCRI Centre for Research Excellence in Primary Oral Health Care.
© 2014 National Rural Health Alliance Inc.
provide services that complement those of the dentist. Important to this would be the maintenance of strong network ties to a range of medical, nursing and allied health primary care providers to ensure that treatment is both timely and coordinated with other communitybased preventive strategies. Leonard A. Crocombe,1,2 Erica Bell,1 and Tony Barnett1 1 The University of Tasmania 2 The University of Adelaide
References 1 Slade GD, Spencer AJ, Roberts-Thomson KD. Australia’s dental generations: the National Survey of Adult Oral Health 2004–2006. Canberra: Australian Institute of Health and Welfare, 2007. 2 Crocombe LA, Stewart JF, Barnard PD, Slade GD, Roberts-Thomson KD, Spencer AJ. Relative oral disease reduction in capital city areas and the rest of Australia. Australian Dental Journal 2010; 55: 280–284. 3 Teusner DN, Chrisopoulos S, Brennan DS. Geographic distribution of the Australian dental labour force, 2003. AIHW Cat. no. DEN 168. Dental Statistics and Research Series no. 37. Canberra: Australian Institute of Health and Welfare, 2007. 4 Brennan DS, Spencer AJ. Trends in private dental service provision by geographic location. Australian Journal of Rural Health 2007; 15: 189–195. 5 Humphreys J, Jones M, Jones JA, Mara PR. Workforce retention in rural and remote Australia: determining the factors that influence length of practice. Medical Journal of Australia 2002; 176: 472–476. [Cited 17 Nov 2013]. Available from URL: http://www.hwa.gov.au/rural-medical -generalists; Health Workforce Australian. Rural Medical Generalists. 6 Coster G, Gribben B. Primary care models for delivering population-based health outcome. Wellington, New Zealand: National Health Committee, 1999.
Aust. J. Rural Health (2014) 22, 86
Grazing Is it time for an advanced rural dentist? The oral health status of Australians residing outside capital cities is poorer than that of those living in capital cities.1 Non-capital city residents are more likely to suffer complete tooth loss, to have an inadequate dentition (less than 21 teeth), to wear dentures, to have missing teeth than capital city residents and are more likely to avoid certain foods due to dental problems than capital city-based people.1 Although the oral health of Australians improved, the rural–metro gap in oral health outcomes was as great in 2004–2006 as it was in 1987–1988.2 This suggests that whatever is making rural oral health poorer is not being adequately managed nor satisfactorily explained. One reason for the poorer rural health has been poorer access to dental care. There is an uneven distribution of dentists towards larger centres.3 Hence, it is not surprising that dentists from non-capital city areas supply more patient visits per year, are more likely to be busier than they would like to be, tend to have a broader scope of practice and are less likely to supply preventive care than capital city dentists.4 People in rural areas commonly describe health as an absence of disease,5 and their money is spent on disease management rather than on primary care and health promotion.6 People not living in capital city areas are more likely than those living in capital cities to have a problem-orientated pattern of dental attendance, less likely to make an annual dental visit and less likely to have a particular dentist that they usually visit.1 The high workload of rural dentists suggests that rural dentists would not feel particularly threatened by change in the clinical practice environment if such change improved patient care and oral health outcomes. One response to this crisis in rural oral health service provision is to develop an ‘advanced rural dentist’ program similar to the rural medical generalist program. The program could cover some procedures of specialist dental practice and some areas of practice outside dentistry and research, but it could also teach the skills required for stronger links and cooperation between rural health care practitioners. It would enable other health workers (inclusive of oral health therapists, dental hygienists, dental therapists, dental assistants) to
The authors are chief investigators with the APHCRI Centre for Research Excellence in Primary Oral Health Care.
© 2014 National Rural Health Alliance Inc.
provide services that complement those of the dentist. Important to this would be the maintenance of strong network ties to a range of medical, nursing and allied health primary care providers to ensure that treatment is both timely and coordinated with other communitybased preventive strategies. Leonard A. Crocombe,1,2 Erica Bell,1 and Tony Barnett1 1 The University of Tasmania 2 The University of Adelaide
References 1 Slade GD, Spencer AJ, Roberts-Thomson KD. Australia’s dental generations: the National Survey of Adult Oral Health 2004–2006. Canberra: Australian Institute of Health and Welfare, 2007. 2 Crocombe LA, Stewart JF, Barnard PD, Slade GD, Roberts-Thomson KD, Spencer AJ. Relative oral disease reduction in capital city areas and the rest of Australia. Australian Dental Journal 2010; 55: 280–284. 3 Teusner DN, Chrisopoulos S, Brennan DS. Geographic distribution of the Australian dental labour force, 2003. AIHW Cat. no. DEN 168. Dental Statistics and Research Series no. 37. Canberra: Australian Institute of Health and Welfare, 2007. 4 Brennan DS, Spencer AJ. Trends in private dental service provision by geographic location. Australian Journal of Rural Health 2007; 15: 189–195. 5 Humphreys J, Jones M, Jones JA, Mara PR. Workforce retention in rural and remote Australia: determining the factors that influence length of practice. Medical Journal of Australia 2002; 176: 472–476. [Cited 17 Nov 2013]. Available from URL: http://www.hwa.gov.au/rural-medical -generalists; Health Workforce Australian. Rural Medical Generalists. 6 Coster G, Gribben B. Primary care models for delivering population-based health outcome. Wellington, New Zealand: National Health Committee, 1999.
