Dentistry Implementation at CSU

Facts and Figures

• The Association for the Promotion of Oral Health has estimated that in order to maintain existing levels of dental service in Australia, there will be a shortage of about 1500 dental and oral health workers Australia-wide - or a shortfall of 3.8 million visits - by 2010 (Association for the Promotion of Oral Health, Submission to the 2005 NSW Upper House Inquiry on Dental Health, Services and Education (2005) p. 8).
• Rural areas have significantly less access to dentists and oral health workers than metropolitan areas.
• The table below shows distribution of dentist per 100,000 of population from worst to best in 2002 (Association for the Promotion of Oral Health (2005), p.32)

	NSW Area Health Service	Dentists per 100,000 of population (2002)*
1	Macquarie (including Blue Mountains)	16.53
2	Far West (including Broken Hill)	21.02
3	Greater Murray (including Albury)	25.10
4	Mid Western (including Orange and Bathurst)	25.22
5	Central Coast	26.66
6	Southern (including Wagga Wagga)	27.41
7	Mid North Coast	27.65
8	Hunter	29.03
9	Illawarra	29.61
10	New England	30.02
11	Wentworth	31.56
12	South Western Sydney	32.07
13	Northern Rivers	35.48
14	Western Sydney	38.41
15	Central Sydney	45.49
16	Northern Sydney	67.72
17	South Eastern Sydney	88.97

• of the 17 statistical divisions in NSW, 5 of the top 6 worst areas are within CSU's direct educational and community footprint.
• In 2000 Australia had a rate of 46.8 practising dentists per 100,000 of the population, which is nineteenth on a list of OECD countries. Growth in the dentist labour force up to the year 2009 is projected to slightly out pace population growth, with the practising rate per 100,000 population increasing from 46.8 to 48.5 dentists. However, by 2013 the practising rate per 100,000 population starts to decline, indicating that projected growth in the labour force will not keep pace with the population growth in the longer term. (Teusner DN & Spencer AJ Projections of the Australian dental labour force (2003) AIHW cat. No. POH 1. Canberra: Australian Institute of Health and Welfare Population Oral Health Series No. 1 p25).
• In 2000 it was estimated that the combined capacity of the allied dental labour force to supply dental visits was 15.1% of all visits supplied. By 2015 this percentage is expected to decline slightly, with the allied dental practitioner labour force providing 13.4% of all dental visits.
• The projected total capacity to provide dental visits in 2015 is 31.8 million visits, an increase of 11.4 %. It appears that this growth will not keep pace with projected growth in the population, as the visits per capita will decline from 1.49 visits per capita in 2000 to 1.45 in 2015 (Teusner DN & Spencer p 45).
• It has been reported that Central Sydney has 11.05 public dentists per 100,000 of population, while the Far West has 1.05, the Southern area 1.31, Greater Murray 2.23, Macquarie 2.53 and Mid Western 2.4 (Association for the Promotion of Oral Health (2005), p.32)
• in the last year in which the NSW Government reported on waiting lists for public dental care (1997) there were 140,000 people waiting up to 58 months for dental services. The number of visits to publicly funded emergency dental care increased from 239,224 visits to 319,045 between 1997/8 and 2001/2 (National Advisory Committee on Oral Health (2004) Healthy Mouths Healthy Lives: Australia's National Oral Health Plan 2004-13 p.10).
• For rural people, the disease experience is acute. It has been reported that avoidable hospital admissions for people with oral health conditions "...are substantially more common in rural areas, particularly among children. In the 0-9 year age group, admission rates are more than three times higher in rural areas compared to metropolitan areas." (National Advisory Committee on Oral Health (2004) p 8 citing Queensland Hospital Admitted Patient Data Collection, Queensland Health (2001)).
• Dental disease causes pain and discomfort, and has a huge economic impact. As an indication of the social impact of oral disease, there were more than one million days of work lost and over three million days of limited activity associated with oral disease in the Australian population in 1983 (Spencer, A.J. and Lewis, J.M. (1988) 'The Delivery of Dental Services: Information, Issues and Directions'. Community Health Studies 12:1).
• The report on the Oral Health of Public Dental Patients in Rural Areas, (AIHW, November 2004 Research Report Number 12) outlined the following impacts:
  • the percentage of edentulous patients having no natural teeth was higher in rural areas (9.2%) than those in urban areas (5.5%),
  • rural patients had more missing teeth compared with urban patients but fewer filled teeth than urban patients,
  • rural patients seeking emergency care had a higher number of decayed teeth than urban patients but the number of filled teeth was lower for rural compared with urban emergency care patients,
  • rural patients in general care had higher levels of missing teeth (7.4%) compared with urban patients (4.2%) and
  • higher percentages of rural (20.9%)compared with urban (16.4%)patients had full upper dentures and conversely, lower percentages had partial dentures.
• The Australian Institute of Health and Welfare Dental Statistics and Research Unit, October 2004 Economic Aspects of Dentistry in Australia highlighted the following points:
  • Total dental services expenditure in Australia for 2002-2003 was estimated at $4.4 billion, or 6.1% of total services expenditure.
  • Dental services expenditure is primarily funded by individuals (68%), with only 17% derived from Government sources. This is in contrast to health services, which are 68% government funded and just 20% sourced from individuals.
  • The average real rate of growth of dental services expenditure over the last decade was 3.9%, the same as the rate of growth in real GDP ((3.9%).
• The future environment for dental care will be characterised by:
  • an ageing population
  • an increasing number of people being eligible for public dental care
  • a population becoming increasingly dentate
  • an increase in community expectations as a result of heightened concern over general dental appearance
  • an increased demand for more dental care which will place more stress on the public dental sector
  • competing demands for the health care dollar
  • significant and sustained downward pressure on cost and expenditure
  • continuing redistribution of resources into community and primary health care
  • pressure to achieve greater 'customer focus' and personalised care.
• A literature review on primary medical care in rural areas showed that "rural background was clearly the primary predictor of entering rural practice, and the link between rural placements in training and later working in rural practice is more tenuous, though there still appears to be an association." (Levitt, JD., "Rural origin and rural medical exposure: their impact on the rural and remote medical workforce in Australia" Rural and Remote Health 3 (online), 2003 p 5 citing McDonald, J., Bibby, L and Carroll, S., Recruiting and retaining general practitioners in rural areas: improving outcomes through evidence-based research and community capacity-building. Evidence-based review. Final Report Ballarat, VIC: Centre for Health Research and Practice, University of Ballarat, 2002)
• "the strongest association with rural practice was having a partner who grew up in a rural area." (Levitt (2003) p 10)
• "The period during which medical students train, in many instances, coincides with the time they find a life partner, which can influence their choice of practice location..." The author of the study argues that this "provides an argument for policies that ... maintain quality primary and secondary education in non-metropolitan areas." (Levitt (2003) p 10)
• An independent analysis commissioned by Charles Sturt University found that 83% of graduates from the Faculty of Health Studies at Charles Sturt University who were originally from regional areas, and 28% of graduates from metropolitan areas, were shown to have taken up their first job in a regional area (Western Research Institute, Destination of on-campus graduates of Charles Sturt University, 2004).
• To place this in a practical context, between 1995 - 2000 (before the first CSU pharmacy graduates) an average of 3 metropolitan trained pharmacists located to regional areas each year. Every year since Charles Sturt University's first pharmacy graduates, 35 graduates or more have chosen to practise in rural and regional settings. That's an extra 117 pharmacists practising in rural and regional Australia in a period of just three years.