Oral health and dental care in Australia

Transcription

1 Oral health and dental care in Australia Key facts and figures trends 2014

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3 Oral health and dental care in Australia Key facts and figures trends 2014 Oral health and dental care in Australia: Key facts and figures trends 2014 i

4 The Australian Institute of Health and Welfare is a major national agency which provides reliable, regular and relevant information and statistics on Australia s health and welfare. The Institute s mission is authoritative information and statistics to promote better health and wellbeing. Australian Institute of Health and Welfare 2014 This product, excluding the AIHW logo, Commonwealth Coat of Arms and any material owned by a third party or protected by a trademark, has been released under a Creative Commons BY 3.0 (CCBY 3.0) licence. Excluded material owned by third parties may include, for example, design and layout, images obtained under licence from third parties and signatures. We have made all reasonable efforts to identify and label material owned by third parties. You may distribute, remix and build upon this work. However, you must attribute the AIHW as the copyright holder of the work in compliance with our attribution policy available at < The full terms and conditions of this licence are available at < Enquiries relating to copyright should be addressed to the Head of the Digital and Media Communications Unit, Australian Institute of Health and Welfare, GPO Box 570, Canberra ACT A complete list of the Institute s publications is available from the Institute s website < ISBN Suggested citation AIHW Oral health and dental care in Australia: key facts and figures trends Cat. no. DEN 228. Canberra: AIHW. Australian Institute of Health and Welfare Board Chair Dr Mukesh Haikerwal AO Director David Kalisch Any enquiries about or comments on this publication should be directed to: Digital and Media Communications Unit Australian Institute of Health and Welfare GPO Box 570 Canberra ACT 2601 Tel: (02) [email protected] Published by the Australian Institute of Health and Welfare Please note that there is the potential for minor revisions of data in this report. Please check the online version at < for any amendments. ii Oral health and dental care in Australia: Key facts and figures trends 2014

5 Contents Acknowledgments v Abbreviations vi Summary vii 1 Introduction 1 2 Healthy teeth Children Adults... 3 Tooth decay... 5 Gum disease... 5 Missing teeth... 6 Other oral health impacts Dental care Visiting a dental practitioner... 8 Who visits a dental practitioner? Reasons for visiting...12 Types of practices visited...13 Visiting patterns...14 Services received Preventing tooth decay in children Hospitalisation...15 Avoiding hospital...15 Procedures involving general anaesthetics Costs...20 Cost as a barrier to seeking dental care Dental workforce Trends in the dental workforce Who makes up the dental workforce?...23 Appendix: National dental data sources...26 National Survey of Adult Oral Health...26 National Dental Telephone Interview Survey...26 Child Dental Health Survey...27 Health expenditure data...27 Hospital data...27 Dental practitioner workforce data...28 Oral health and dental care in Australia: Key facts and figures trends 2014 iii

6 Glossary 29 References 31 List of tables 32 List of figures 33 Related publications 34 iv Oral health and dental care in Australia: Key facts and figures trends 2014

7 Acknowledgments The authors wish to acknowledge all those who contributed to the data collections used in this report. Mr Sergio Chrisopoulos and Dr Jane Harford from the AIHW Dental Statistics Research Unit Australian Research Centre for Population Oral Health (ARCPOH) at the University of Adelaide provided some of the data tables and analysis. The Australian Government Department of Health funded this report. Oral health and dental care in Australia: Key facts and figures trends 2014 v

8 Abbreviations ABS AIHW ARCPOH CDHS dmft DMFT DSRU FTE NDTIS NSAOH PPH WHO Australian Bureau of Statistics Australian Institute of Health and Welfare Australian Research Centre for Population Oral Health Child Dental Health Survey decayed, missing, filled (deciduous) teeth decayed, missing, filled (permanent) teeth Dental Statistics and Research Unit (AIHW) full-time equivalent National Dental Telephone Interview Survey National Survey of Adult Oral Health potentially preventable hospitalisation World Health Organization vi Oral health and dental care in Australia: Key facts and figures trends 2014

9 Summary This report highlights key trends in the oral health and dental care of the Australian population using the most recently available data. It is the latest in the Oral health and dental care in Australia: key facts and figures suite of printed publications and web products. Oral health The major measures of oral health in Australia suggest that there have been improvements over the long term. In recent years, however, there is some indication that the positive trends have either plateaued or have begun to head in a negative direction. For example: From 1977 to 1995, data from examination of school-aged children in school dental services suggests there was a steady drop in the average number of children s baby teeth affected by decay. There has, however, been a gradual rise from Between and , national surveys reported a decrease in the average number of teeth affected by decay (caries experience) in adults. From 1994 to 2010, the proportion of people aged 15 and over reporting any adverse oral health impact generally rose from survey to survey, with exceptions in 2002 and The proportion ranged between 31.4% (1994) and 39.9% (2008). Dental care In contrast to the recent negative trends in oral health, the trends in dental visiting patterns have generally been more positive. The proportion of people aged 15 and over who made a dental visit in the previous 12 months increased from 56% in 1994 to 62% in The proportion of adults with a favourable visiting pattern generally rose from 36% in 1999 to 46% in Despite this, cost of dental care remains a barrier for some. According to the National Dental Telephone Interview Survey, from 1994 to 2010, there was an increase in the proportion of adults avoiding visits to a dentist due to costs, from about 25% to 30%. There has been a recent growth in the supply of dental practitioners that may have an influence on the availability of dental care across the population. Between 2011 and 2012, the number of dental practitioners employed increased from around 18, 700 to nearly 19,600. Over this period, the full-time equivalent rate of dentists per 100,000 population rose from around 55 to 57 dentists. Oral health and dental care in Australia: Key facts and figures trends 2014 vii

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11 1 Introduction Oral health is an integral aspect of general health. Poor oral health is likely to exist when general health is poor, and vice versa (AHMAC 2001). Oral health is a standard of health of the oral and related tissues that enables an individual to eat, speak and socialise without active disease, discomfort or embarrassment (UK Department of Health 1994). This report highlights important trends in oral health and dental care in Australia and summarises the latest key findings. Data were sourced from surveys that the Australian Research Centre for Population Oral Health (ARCPOH) manages and administrative data sets that the Australian Institute of Health and Welfare (AIHW) maintain. This report complements AIHW s webpages available at <Dental and oral health (AIHW)> and is the latest in the Oral health and dental care in Australia: key facts and figures suite of printed publications and web products. The topics covered in this report are described below. Chapter 2 presents data on children and adults, including decay experience in both in baby and permanent teeth, gum disease (periodontal disease), missing teeth and the social impacts of poor oral health such as toothache, avoiding certain foods and feeling uncomfortable about appearance. Chapter 3 covers dental care. This includes who visited dental practitioners, why and how often they visited, the types of practices visited and the services received. Hospitalisation for dental care is included, as well as potentially preventable hospitalisations (PPHs). PPHs are those conditions where hospitalisation is thought to have been avoidable if timely and adequate non-hospital care had been provided and may be indicators of the quality or effectiveness of non-hospital care. Total expenditure on dental services in Australia is investigated, as well as who funds the expenditure governments, individuals or private health insurance. Financial burden is often cited as a reason why people do not seek regular dental care or comply with recommended treatment (AHMAC 2001), so cost as a barrier to seeking dental care is also explored. Chapter 4 covers the dental workforce, consisting of registered dentists, dental therapists, dental hygienists, oral health therapists and dental prosthetists. The dental workforce plays a vital role in the maintenance and improvement of the oral health of Australians through the provision of preventive and restorative dental services. The characteristics of the dental workforce and the number of specialist dentists are outlined. Chapter 5 describes the data sources used in this report including their limitations and general data quality. Oral health and dental care in Australia: Key facts and figures trends

12 2 Healthy Healthy teeth teeth Deciduous Deciduous caries caries experience experience (dmft) (dmft) is recorded is recorded as the as number the number of deciduous of deciduous (baby) teeth (baby) that teeth are either that decayed are either (d), decayed missing (m) (d), because missing of (m) dental because caries of or dental filled (f ) caries because or of filled dental (f) caries. because It is of based dental on the World caries. Health It is based Organization the protocol World Health (WHO 1997) Organization with further protocol guidelines (WHO from 1997) Palmer with et al. further (1984). guidelines from Palmer et al. (1984). Permanent caries experience (DMFT) is recorded as the number of permanent teeth that are either decayed Permanent (D), missing caries experience (M) because (DMFT) of dental is caries recorded filled as (F) the because number of of dental permanent caries, and teeth is also that based are on either WHO decayed protocol (D), (WHO missing 1997). (M) because of dental caries or filled (F) because of dental caries, and is also based on the WHO protocol (WHO 1997). 2.1 Children Children From to to 2010, 2010, data data from from examinations examinations of school-aged of school-aged children children in school in dental school services dental suggests services there suggests was a there drop was overall a drop in the overall average in number the average of children s number baby of teeth children s affected baby by decay. teeth There affected has, by however, decay. There been has, a gradual however, rise from been a gradual rise from The trend has has been been similar similar for permanent for permanent teeth teeth at age at 12, age with 12, a with gradual a gradual increase increase from the late from 1990s the (Figure late 1990s 2.1). (Figure The rise in 2.1). average The rise dmft in (decayed, average missing dmft (decayed, or filled baby missing teeth) or or filled DMFT baby (decayed, teeth) missing or or filled DMFT permanent (decayed, teeth) missing with age or filled is an indicator permanent of the teeth) accumulation with age of is the an indicator number of of teeth the affected by decay accumulation as children of age. the It number should be of noted teeth that affected data by were decay not available as children for New age. South It should Wales be for noted 2001 to 2006 and that 2008 data to were 2010 not and available for Victoria for from New South Wales for 2001 to 2006 and 2008 to 2010 and for Victoria from Average number of affected teeth 6 5 Permanent teeth (at age 12) Baby teeth (at age 6) Note: From 1977 to 1988, data are from the Australian School Dental Scheme evaluation. From 1989 data are from the Child Dental Health Survey. Note: From Data 1977 for 2003 to 1988, and data 2004 are are from combined. the Australian Data School were not Dental available Scheme for New evaluation. South From Wales 1989 for data 2001 are to from 2006 the and Child 2008 Dental to 2010 Health and Survey. for Victoria Data for 2003 and 2004 are combined. Data were not available for New South Wales for 2001 to 2006 and 2008 to 2010 and for Victoria from from Source: Child Dental Health Survey, 1977 to Source: Child Dental Health Survey, 1977 to Figure Figure 2.1: 2.1: Trends Trends in decayed, in decayed, missing missing or filled or filled teeth teeth in children, in children, 1977 to to Oral health and dental care in Australia: key facts and figures trends, Oral health and dental care in Australia: Key facts and figures trends 2014

13 Table 2.1: Tooth decay and children, 2010 key facts Baby teeth In 2010, the proportion of children who visited a school dental service that had decayed, missing or filled Table baby teeth 2.1: Tooth varied decay from about and children, 48% for those 2010 key aged 5 facts to 63% for those aged 9. Baby Children teeth aged 5 had an average of 2.32 decayed, missing or filled baby teeth, those aged 8 had 2.63, and those aged 10 had The smaller number of affected teeth in children aged 10 was related to their In 2010, the proportion of children who visited a school dental service that had decayed, missing or filled baby having fewer baby teeth. teeth varied from about 48% for those aged 5 to 63% for those aged 9. Permanent teeth Children aged 5 had an average of 2.32 decayed, missing or filled baby teeth, those aged 8 had 2.63, and those aged 10 had The smaller number of affected teeth in children aged 10 was related to their having In 2010, nearly half of children aged 12 had experienced decay in their permanent teeth. The general fewer baby teeth. increase in affected teeth with age is related to both the number of permanent teeth older children have, Permanent and the increased teeth time that their teeth have been at risk of decay. In Children 2010, nearly aged half 6 of had children an average aged 12 of had 0.13 experienced decayed, decay missing in their or permanent filled permanent teeth. The teeth, general while increase those aged 10 in affected teeth with age is related to both the number of permanent teeth older children have, and the had 0.73 and those aged 15 had The lower number for children aged 6 is related to them having increased time that their teeth have been at risk of decay. fewer permanent teeth. Children aged 6 had an average of 0.13 decayed, missing or filled permanent teeth, while those aged 10 had Source: 0.73 Child and Dental those Health aged Survey 15 had The lower number for children aged 6 is related to them having fewer permanent teeth. Source: Child Dental Health Survey Adults 2.2 Adults Between and , national surveys reported a fall in the average number of teeth affected by decay Between (caries experience) and in , adults. The national decrease, surveys from nearly reported 15 teeth a fall to around in the 13 average teeth, was number a result of of falls teeth in both affected the average by decay number (caries of teeth experience) with untreated in adults. decay, The and decrease, the average from number nearly of 15 teeth teeth missing to as a around result of 13 decay teeth, (Figure was 2.2). a result of falls in both the average number of teeth with untreated decay, and the average number of teeth missing as a result of decay (Figure 2.2). Average number of teeth Decayed (D) Missing (M) Filled (F) DMFT Caries experience Source: National Oral Health Survey, Australia, ; National Survey of Adult Oral Health, Sources: National Oral Health Survey, Australia, ; National Survey of Adult Oral Health, Figure 2.2: Average number of permanent teeth with caries experience, dentate peoples aged 15 and Figure over, : Average and number of permanent teeth with caries experience, dentate people aged From and to over, 2010, the proportion and of people aged 15 and over reporting any oral health impact generally rose from survey to survey, with exceptions in 2002 and The proportion ranged between 31.4% (1994) and 39.9% (2008). The highest percentage point increase over the period was in the proportion of people uncomfortable with their appearance (a 4.5 percentage point rise), most of this increase being Oral health and dental care in Australia: Key facts and figures trends 2014 in the 8 years since

14 From 1994 to 2010, the proportion of people aged 15 and over reporting any oral health impact generally rose from survey to survey, with exceptions in 2002 and The proportion ranged between 31.4% (1994) and 39.9% (2008). The highest percentage point increase over the period was in the proportion of people uncomfortable with their appearance (a 4.5 percentage point rise), most of this increase being in the 8 years since The proportion that experienced toothache increased by 4 percentage points. The The proportion proportion of people that experienced avoiding certain toothache foods did increased not show by a significant 4 percentage change points. over the period (Figure The 2.3). proportion of people avoiding certain foods did not show a significant change over the period (Figure 2.3). Per cent Any oral health impact Uncomfortable with appearance Toothache experience Avoided certain foods Note: Note: To account To account for any for any changes changes in population in population age age structure structure over over time time results results have have been been directly directly age-standardised age-standardised to the to 2001 the 2001 Australian Australian population. population. Source: National Dental Telephone Interview Survey, 1994 to Source: National Dental Telephone Interview Survey, 1994 to Figure 2.3: Dentate people aged 15 and over reporting any oral health impact, Figure 2.3: Dentate people aged 15 and over reporting any oral health impact, (per cent) (per cent) aged 15 and over, and Oral health and dental care in Australia: Key facts and figures trends 2014

15 Tooth decay Table 2.2: Tooth decay and adults key facts Men and women In , 3 in 10 adults aged had untreated tooth decay. More men had untreated decay than women, 28.2% compared to 22.7%. Men had a higher average number of decayed teeth than women, 0.70 compared to Women had more filled teeth than men, an average of 8.14 compared to Geography In , people living in Inner regional areas had the highest average DMFT at Fillings contributed the most to DMFT scores in all remoteness areas. People in Inner regional areas had the highest average number of teeth missing due to decay. The proportion of people with untreated decay varied from 23.5% in Major cities to 37.6% in Remote/Very remote areas. Income, insurance and concession cardholders In , the proportion of people with untreated decay was higher for those with household income of less than $12,000 per year, and lower where household income was $100,000 or more. A higher proportion of uninsured people (31.1%) than insured people (19.4%) had untreated decay. Insured people had a higher overall DMFT due mostly to a higher number of fillings. About 1 in 3 cardholder adults had untreated decay (32.9%), compared to less than 1 in 4 non-cardholders (22.9%). (People who hold an Australian Government concession card, generally by virtue of their household income cardholders may be eligible for free or subsidised dental care that state and territory governments provide.) Source: National Survey of Adult Oral Health Gum disease Table 2.3: Gum disease and adults key facts Age In , people were at higher risk of gum disease if they were older 2.7% of people aged had gum disease, compared to 53.4% aged 65 and over. Men and women More than one-quarter of men suffered gum disease (26.8%), compared to less than one-fifth of women (19.0%). Geography People living in more remote areas had higher rates of gum disease 36.3% had gum disease in Remote/Very remote areas compared to 22.1% living in Major cities. Income, insurance and concession cardholders People on lower household incomes generally were more likely to have gum disease than those on higher incomes, varying from 42.3% for those in households earning less than $12,000 per year to 14.3% for those in households earning $100,000 or more. A lower proportion of insured (19.4%) than uninsured (27.0%) people had gum disease. Cardholders had higher rates of periodontal disease (33.6%) than non-cardholders (19.5%). Source: National Survey of Adult Oral Health, Note: Gum disease (periodontal disease or periodontitis) is the inflammation of tissues surrounding the tooth. It affects the gum, ligaments and bone, and is caused by bacterial infection. This inflammation can develop into pockets or gaps between the tooth and its surrounding gum and the loss of ligaments and bone that support the tooth. In severe cases, there can be extensive loss of bone that supports the tooth, resulting in the tooth becoming loose and even causing tooth loss. Oral health and dental care in Australia: Key facts and figures trends

16 Missing teeth Table 2.4: Missing teeth and adults key facts International comparisons In Australia, the average number of missing teeth decreased from 6.2 to 5.2 teeth per person from 1994 to Australian adults aged 18 and over were less likely than those in New Zealand to have lost all of their teeth 5.5% of Australians (in 2010) compared to 9.4% of New Zealanders (in 2009). For adults aged 20 and over, rates of complete tooth loss were closer to those for Canadian adults 4.4% of Australians (in 2010) compared to 6.4% of Canadians ( ). Age In 2010, the proportion of people aged without any natural teeth was 5.5%, compared to 21.1% for those aged 65 and over. The average number of missing teeth varied from 2.2 teeth for people aged to 11.9 teeth for those aged 65 and over. The proportion of people (still with some natural teeth) who wore dentures ranged from 0.9% for those aged to 47.4% for those aged 65 and over. Men and women On average, women had more missing teeth than men (5.7 and 4.8 teeth, respectively), and a higher proportion of women had lost all their teeth (6.4% compared to 4.1%). Income, insurance and concession cardholders In 2010, adults in the lowest 4 household income categories (<$40,000 per year) had between 6.7 and 10.3 missing teeth, while those in higher household income groups (>$40,000 per year) had from 3.6 to 5.6 missing teeth. Adults without insurance had more missing teeth than those with some level of insurance (6.2 compared to 4.7 missing teeth, respectively). ln Major cities adults without dental insurance had more missing teeth than those with insurance (5.8 and 4.4 teeth, respectively). Cardholders had more missing teeth, on average, than non-cardholders (8.5 and 4.3 teeth, respectively). Across age groups, the differences were only significant for people aged 45 and over. Sources: National Dental Telephone Interview Survey, 1994 to 2010, NZMH 2010 and OCDOC Note: About 90% of all tooth loss can be attributed to dental caries (tooth decay) and periodontal disease (gum disease) (AHMAC 2001). Tooth loss occurs primarily because of a treatment decision to extract 1 or more teeth. Teeth are usually extracted because of extensive disease precluding other treatments, the preference of a patient and the recommendation of a dentist (Slade et al. 2007). Measures of tooth loss include prevalence of complete tooth loss (edentulism) and the average number of missing teeth. 6 Oral health and dental care in Australia: Key facts and figures trends 2014

17 Other oral health impacts Table 2.5: Impacts of poor oral health in the previous 12 months, 2010 key facts Experience of toothache In 2010, about 1 in 7 people (15.0%) aged 15 and over reported that they had experienced toothache (17.1% of those aged 25 44) compared to 10.1% of those aged 65 and over. Nearly 1 in 5 cardholders reported toothache (18.8%), compared to about 1 in 7 non-cardholders (13.9%). A higher proportion of those without insurance experienced toothache compared to those with insurance (19.4% and 11.7%, respectively). There were no statistically significant differences in toothache experience based on sex, geography or income. Uncomfortable about dental appearance In 2010, for people with their natural teeth, those reporting feeling uncomfortable about their dental appearance ranged from 18.7% for those aged to 28.8% for those aged Among adults without any natural teeth (edentulous), those aged 65 and over were less likely to be uncomfortable with their dental appearance (11.3%) than those aged (75.2%). Females were more likely to be uncomfortable about their dental appearance than males (27.8% compared with 21.8%). There were no differences across remoteness areas. Adults in higher income households ($100,000 and over) were less likely to be uncomfortable with their dental appearance than those in lower income households. Uninsured persons were more likely than insured persons to be uncomfortable with their dental appearance (30.1% compared with 21.0%). Cardholders were more likely to report feeling uncomfortable (28.9%) than non-cardholders (23.6%). Avoided certain foods because of problems with their teeth In 2010, the proportion of people who reported avoiding certain foods because of problems with their teeth ranged from 12.2% for people aged to 20.9% for those aged Adults with some natural teeth were less likely to avoid certain foods than those with no natural teeth (16.5% and 30.6%, respectively). Adults aged with some natural teeth had significantly lower rates of avoiding certain foods than the 2 age groups and 65 and over (12.2%, 19.7% and 19.3%, respectively). Women were more likely to avoid food than men (21.6% compared with 12.9%). Avoiding certain foods was more frequent in the 3 lowest-income household groups (<$40,000 per annum) compared with the 3 highest-income household groups (>$40,000 per year) (34.5%, 26.7% and 28.9% compared with 16.8%, 13.5% and 10.4%). Avoiding certain foods was more frequent for uninsured persons than for insured persons (22.2% compared with 13.5%). Avoiding certain foods was more frequent for persons eligible for public dental care compared with ineligible persons (26.6% compared with 14.0%). Source: National Dental Telephone Interview Survey Oral health and dental care in Australia: Key facts and figures trends

18 3 Dental 3 Dental care care There are 2 main reasons a person may visit a dental professional for routine check-ups and for an established There dental are problem. 2 main Generally, reasons a people person who may seek visit regular a dental and professional for routine care report lower routine rates check-ups of extractions and and for relatively an established low rates dental of fillings problem. (Ellershaw Generally, & Spencer people 2011). who seek regular and routine care report lower rates of extractions and relatively low rates of fillings (Ellershaw & Spencer 2011). 3.1 Visiting a dental practitioner 3.1 Visiting a dental practitioner The proportion of people aged 15 and over who made a dental visit in the previous 12 months increased from 56% in 1994 to 62% in The proportion of people aged 15 and over who made a dental visit in the previous 12 The proportion months of increased children aged from % who in made 1994 to a visit 62% in in the previous 12 months was steady over this time at around 80% (Figure 3.1). The proportion of children aged 5 14 who made a visit in the previous 12 months was steady over this time at around 80% (Figure 3.1). Per cent People (15+) Children (5 14) Note: To account for any changes in population age structure over time results have been directly age-standardised to the 2001 Australian population. Source: National Dental Telephone Interview Survey, 1994 to Note: To account for any changes in population age structure over time results have been directly age-standardised to the 2001 Australian population. Figure 3.1: Last dental visit was in the previous 12 months, dentate children aged 5 14 Source: National Dental Telephone Interview Survey, 1994 to and dentate people aged 15 years and over, (per cent) Figure 3.1: Last dental visit was in the previous 12 months, dentate children aged 5 14 and dentate people aged 15 years and over, (per cent) The proportion of people aged 15 and over who last visited for a check-up rose from 48.3% in 1994 to The proportion of people aged 15 and over who last visited for a check-up rose from 48.3% in 61.4% in to 61.4% in After declining After from declining 80.9% from in % to 70.8% in 1994 in 1996, to 70.8% the proportion in 1996, the of children proportion aged of 5 14 children who visited aged for 5 14 a check-up steadily increased until it reached a high of 83.1% in 2010 (Figure 3.2). who visited for a check-up steadily increased until it reached a high of 83.1% in 2010 (Figure 3.2). 8 Oral health and dental care in Australia: key facts and figures trends, Oral health and dental care in Australia: Key facts and figures trends 2014

19 Per cent 100 Per cent People 15+ Children People 15+ Children Notes 1. Data Notes in this figure relate to a dental visit in the previous 12 months. 2. To 1. account Data for in any this changes figure relate in population to a dental age visit structure in the over previous time 12 results months. have been directly age-standardised to the 2001 Australian population. Source: Notes National Dental Telephone Interview Survey, 1994 to To account for any changes in population age structure over time results have been directly age-standardised to the 2001 Australian 1. Data population. in this figure relate to a dental visit in the previous 12 months. Figure 3.2: Last dental visit was for a check-up, dentate children aged 5 14 years and 2. Source: To account National for Dental any changes Telephone in population Interview Survey, age structure 1994 to over time results have been directly age-standardised to the 2001 Australian dentate population. adults aged 15 years and over, (per cent) Figure 3.2: Last dental visit was for a check-up, dentate children aged 5 14 years and dentate adults Source: National Dental Telephone Interview Survey, 1994 to aged 15 years and over, (per cent) Of those Figure who 3.2: made Last dental a dental visit visit was in the for previous a check-up, 12 months, dentate the children proportion aged 5 14 of children years and aged dentate 5 14 who adults aged Of those 15 years who and made over, a dental visit (per in cent) the previous 12 months, the proportion of children aged visited a public dental service remained low from 1994 to From 2002, the proportion who visited a private 5 14 Of those practice who who rose, visited made with a a public dental complementary dental service visit in the drop previous in remained those 12 visiting low months, a from school 1994 the dental to proportion service From of (Figure 2002, children 3.3). the aged proportion who visited a private practice rose, with a complementary drop in those visiting a 5 14 who visited a public dental service remained low from 1994 to From 2002, the school dental service (Figure 3.3). proportion who visited a private practice rose, with a complementary drop in those visiting a school dental service (Figure 3.3). Per cent 100 Per 90cent Private Public School Dental Service Other Private Public School Dental Service Other Notes Notes 1. School 1. dental School service dental describes service the describes school or the community school or community dental service dental that the service health that department the health or department authority in or each authority Australian in each state Australian and territory state and operates. Notes territory operates. 2. Children from both public and private schools are eligible for dental care through a school dental service School Children dental from service both public describes and the private school schools or community are eligible dental for dental service care that through the health a school department dental service. 3. Other includes: armed forces dental service, clinics that private health insurance companies operate, dental technicians or authority and in other each (not Australian elsewhere state and 3. territory Other operates. includes: armed forces dental service, clinics that private health insurance companies operate, dental technicians and other (not classified). 2. Children elsewhere from classified). 4. Data in this figure relate both to public a dental and visit private in the schools previous are 12 eligible months. for dental care through a school dental service Other Data includes: in this figure armed relate forces to a dental dental service, visit in clinics the previous that private 12 months. 5. To account for any changes in population age structure over time results health have been insurance directly companies age-standardised operate, to dental the 2001 technicians Australian and population. other (not 5. elsewhere To account classified). for any changes in population age structure over time results have been directly age-standardised to the 2001 Australian Source: National 4. Data population. Dental Telephone Interview Survey, 1994 to in this figure relate to a dental visit in the previous 12 months. 5. Source: To account National for Dental any changes Telephone in population Interview Survey, age structure 1994 to over time results have been directly age-standardised to the 2001 Australian Figure Figure population. 3.3: 3.3: Type Type of of practice visited at at last last dental visit, visit, children children aged aged years, years, (per cent) Source: National Dental Telephone Interview Survey, 1994 to (per cent) Figure 3.3: Type of practice visited at last dental visit, children aged 5 14 years, (per cent) Oral health and dental care in Australia: key facts and figures trends, Oral health and dental care Oral in health Australia: and dental key facts care in and Australia: figures Key trends, facts and 2014 figures trends

20 A favourable A favourable dental dental visiting visiting pattern is pattern where adults is where have adults a usual have dental a usual care provider dental care that provider they visit that at least once they a year visit for at the least purpose once of a year a check-up. for the An purpose unfavourable of a check-up. pattern, is An visiting unfavourable the dentist infrequently pattern, is and usually visiting for a dental the dentist problem infrequently (Ellershaw and & Spencer usually 2011). for a dental problem (Ellershaw & Spencer The 2011). proportion of adults with a favourable visiting pattern increased from 36% in 1999 to 46% in 2010; however, The proportion there was a of decrease adults from with 44% a favourable in 2002 to visiting 38% in 2008 pattern (Figure increased 3.4). from 36% in 1999 to 46% in 2010; however, there was a decrease from 44% in 2002 to 38% in 2008 (Figure 3.4). Per cent Favourable Intermediate Unfavourable Note: Note: Data Data in this in figure this figure relate relate to dentate to dentate people people aged aged 15 years 15 years and over. and To over. account To account for any for changes any changes in population in population age structure age structure over time over results time results have been have directly been age-standardised directly age-standardised to the 2001 to the Australian 2001 Australian population. population. Source: National Dental Telephone Interview Survey, 1994 to Source: National Dental Telephone Interview Survey, 1994 to Figure 3.4: Dental visiting patterns, dentate dentate people people aged 15 aged years 15 and years over, and over, (per cent) (per cent) Between 1994 and 2010, for adults who visited the dentist in the past 12 months: the average number of visits was around 2.4 Between 1994 and 2010, for adults who visited the dentist in the past 12 months: there was a drop in the average number of fillings received (0.9 to 0.75) the average number of visits was around 2.4 there was around 1 scale and clean service there was the average a drop in number the average of extractions number of fillings had an received inconsistent (0.9 to trend 0.75) but was lower in 1994 (0.21) there was than around in scale (0.32) and (Figure clean 3.5). service the average number of extractions had an inconsistent trend but was lower in 1994 (0.21) than in 1999 (0.32) (Figure 3.5). 10 Oral health and dental care in Australia: key facts and figures trends, Oral health and dental care in Australia: Key facts and figures trends 2014

21 Number 3.0 Number Visits Fillings Visits Fillings Extractions Scale and cleans Extractions Scale and cleans Note: Data Note: on Data number on number of scale of and scale clean and treatments clean treatments received received were not were collected not collected in Data in in this Data figure in this relate figure to dentate relate to people dentate aged people 15 years aged and 15 over who years made and a over dental who visit made in the a previous dental visit 12 in months. the previous To account 12 months. for any To changes account in population for any changes age structure in population over time age results structure have over been time directly results have age-standardised been directly to age-standardised the 2001 Australian to population. the 2001 Australian population. Note: Data on number of scale and clean treatments received were not collected in Data in this figure relate to dentate people aged 15 Source: National Dental Telephone Interview Survey, 1994 to years Source: and over National who made Dental a Telephone dental visit Interview in the previous Survey, months. to To account for any changes in population age structure over time results have been directly age-standardised to the 2001 Australian population. Figure Figure 3.5: 3.5: Types of of services received by people aged and and over, over, (average) (average) Source: National Dental Telephone Interview Survey, 1994 to Figure Between 3.5: Types 1994 and of services 2010, the received average by people number aged of visits 15 and for over, children generally (average) declined from Between survey 1994 to and survey 2010, the but average the overall number change of visits was for not children statistically generally significant. declined from There survey were to no clear Between survey changes 1994 but the overall in service and 2010, change types the was (extractions, average number not statistically fillings of significant. and visits fluoride for children There were treatment) generally no clear changes over declined the in period from service (Figure types survey (extractions, 3.6). to survey but the overall change was not statistically significant. There were no clear fillings and fluoride treatment) over the period (Figure 3.6). changes in service types (extractions, fillings and fluoride treatment) over the period (Figure Number 3.6). 2.5 Number Visits Extractions Visits Fillings Extractions Fluoride treatments Fillings Fluoride treatments Note: Data on fluoride treatments received were not collected prior to Data in this figure relate to children aged 5 to 14 years who made a dental visit in the previous 12 months. To account for any changes in population age structure over time results have been directly age-standardised to the 2001 Australian population. Note: Data on fluoride treatments received were not collected prior to Data in this figure relate to children aged 5 to 14 years who made a Note: dental Data Source: visit on fluoride in National the previous treatments Dental 12 Telephone received months. To were Interview account not collected Survey, for any 1994 prior changes to in population Data in this age figure structure relate over to children time results aged 5 have to 14 been years directly who made a dental visit age-standardised in the previous 12 to months. the 2001 To Australian account for population. any changes in population age structure over time results have been directly agestandardised to the 2001 Australian Figure population. 3.6: Types of services received by children aged 5 14, (average) Source: Source: National National Dental Dental Telephone Telephone Interview Interview Survey, Survey, 1994 to to Figure 3.6: Types of services received by children aged 5 14, (average) Figure 3.6: Types of services received by children aged 5 14, (average) Oral health and dental care in Australia: key facts and figures trends, Oral health and dental care in Australia: Key facts and figures trends 2014 Oral health and dental care in Australia: key facts and figures trends,

22 Who visits a dental practitioner? Table 3.1: Who visits a dental practitioner? key facts Age In 2010, 2 in 3 people aged 5 and older visited a dental practitioner in the past year. Almost 4 in 5 children aged 5 14 visited a dental practitioner in the previous 12 months (78%), and 9 in 10 visited within the previous 2 years (91%). Almost 60% of adults aged had visited a dental practitioner in the previous 12 months and 78% had visited in the previous 2 years. Australians were more likely to have visited the dentist in the past 12 months than New Zealand residents. However, in , Canadians were 30% more likely to have visited than Australians, across all age groups from 20 to 79. Men and women In 2010, a higher proportion of females visited within the previous year than males (67% and 61%, respectively). Geography Adults living in Major cities were most likely to have visited a dental practitioner in the previous year (64%). Only half of those living in Remote/Very remote areas (51%) had visited in the previous year. Income In 2010, people living in lower income households went to the dentist less often than those in higher income households. Half of those with a household income of less than $12,000 per year had visited the dentist in the previous year (50%), compared to two-thirds of those with a household income of at least $100,000 (67%). Around one-third of the lower income group hadn t visited the dentist at all in the past 2 years (34%), compared to less than one-fifth (16%) of the higher income group. Insurance In 2010, almost three-quarters of those with dental insurance (72%) visited a dentist within the previous year, compared to about half of those uninsured (50%). Concession cardholders Just over half of dentate adults (those who had some natural teeth) who were cardholders (57%) had visited the dentist in the previous year. Almost two-thirds of non-cardholders (63%) had visited. Source: National Dental Telephone Interview Survey 2009, 2010, NZMH 2010 and OCDOC Reasons for visiting Table 3.2: Reasons for visiting a dental practitioner, 2010 key facts Age In 2010, more than 4 in 5 people aged under 25 reported that their last dental visit was for a check-up (from 80% for those aged to 83% for children aged 5 14). Almost half of adults aged attended because of a problem (47%). Australian adults aged 25 to 74 were more likely to have last visited a dentist for a check-up than their New Zealand counterparts. Across these age groups, the increased likelihood of visiting for a check-up ranged from 24% to 30%. Geography People living in Major cities had higher rates of visiting for a check-up (67%) than those in Outer regional areas (57%). 12 Oral health and dental care in Australia: Key facts and figures trends 2014

23 Income In 2010, nearly three-quarters of those with a household income of $100,000 or over had last visited for a check-up (72%). Only half of people in the $20,000 $30,000 and $30,000 $40,000 household income groups had visited for a check-up (51% for both). Nearly two-thirds of people in the lowest income group had last visited for a check-up (62%). Insurance More people who had insurance (70%) reported that their last visit was for a check-up, than those without insurance (57%). Concession cardholders A smaller proportion of cardholders visited for a check-up (56%) than non-cardholders (67%). Sources: National Dental Telephone Interview Survey 2010 and NZMH Types of practices visited Table 3.3: Types of dental practice visited, 2010 key facts Private or public In 2010, almost 9 in 10 (88%) people reported that their last dental visit was to a private dental practice, compared with about 1 in 20 to a public dental service (6%) or a school dental service (5%). Age Just under one-quarter of children aged 5 14 (23%) attended a school dental service for their last dental visit and over two-thirds (68%) attended a private practice. Geography Use of a school dental service was highest in Remote/Very remote areas (25%) and lowest in Major cities (3%). The use of public dental services was lower in Major cities (5%) and higher in Inner regional areas (9%). Income In 2010, with the exception of the lowest income group (<$12,000 per year), households with up to $40,000 per year used a public dental service at higher rates than those on higher incomes. Over a quarter of dentate people in the $12,000 <$20,000 household income bracket (28%) visited a public dental service at their last visit. This compares to only 1% of those with a household income of $100,000 and over. Use of school dental services was relatively even across all income groups. Insurance A higher proportion of insured people accessed private care at their last visit than uninsured people (95% and 77%, respectively). Concession cardholders Nearly three-quarters of cardholders (74%) accessed private care at their last visit. Over 9 in 10 non-cardholders (92%) accessed private care. Note: In all jurisdictions children from both public and private schools are eligible for dental care through a school dental service. Source: National Dental Telephone Interview Survey Oral health and dental care in Australia: Key facts and figures trends

24 Visiting patterns Table 3.4: Favourable dental visiting patterns, 2010 key facts Age In 2010, dentate adults aged 65 and over had higher rates of favourable attendance than those aged (51% and 42%, respectively). Higher rates of unfavourable attendance were reported for people aged than those aged (23% and 16%, respectively). Men and women A higher proportion of women had favourable visiting patterns (50%) than men (41%). Geography Dentate adults who lived in Major cities had higher rates of favourable attendance (49%) than those in Remote/Very remote areas (31%). Income In 2010, under one-third of adults in the lowest income group (28%) had favourable visiting patterns, compared to over half of those in the highest group (56%). Insurance Almost two-thirds of dentate adults who were insured (61%) had favourable visiting patterns, compared to under one-third (27%) of those without dental insurance. Concession cardholders Just over one-third of adult cardholders had favourable visiting patterns (36%), compared to almost one-half of non-cardholders (48%). Note: Favourable attendance relates to visiting a dentist once or more per year, usually for a check-up, and having a usual dental provider. Unfavourable attendance relates to visiting less than once every 2 years and usually visiting for a problem, or visiting once every 2 years usually for a problem and without a regular dental provider. Source: National Dental Telephone Interview Survey Services received Table 3.4: Services at the dentist, 2010 key facts Services In 2010, dentate people aged 5 and over who visited a dental practitioner in the last 12 months made, on average, 2.34 visits. On average each person had a scale and clean, 2 in 3 people had a filling and 1 in 4 had an extraction. Geography There were no significant differences in the average number of dental visits across regions, number of extractions or the number of fillings received in the past 12 months. Income There were no significant differences between household income groups in the average number of extractions. Insurance There was no significant difference in the average number of visits in the previous 12 months between insured and uninsured people, although insured people had fewer extractions and fillings, and more scale and clean services. Concession cardholders There was no significant difference in overall number of visits between cardholders and non-cardholders. Cardholders had more extractions and fillings, and had less scale and clean services, than non-cardholders. Source: National Dental Telephone Interview Survey Oral health and dental care in Australia: Key facts and figures trends 2014

25 3.2 Preventing tooth decay in children A common and effective way to stop the development of active tooth decay in permanent teeth is fissure sealing. A resin or glass-ionomer (cement) material is applied to fill the pits and grooves of permanent teeth (usually molars), sealing them to prevent build-up of bacteria and plaque. The Child Dental Health Survey in 2010 showed children aged 5 14 with some decay in their permanent teeth were more likely to have a fissure sealant than children of the same age who had no decay. This may reflect a tendency towards using fissure sealants as a preventive measure on children more likely to develop decay. Overall, the average number of fissure-sealed teeth among children aged 12 rose from 0.38 teeth in 1989 to 0.73 in 2010 with a peak of 1.05 in 2001 (Figure 3.7). 1.2 Number Source: Child Dental Health Survey, 1989 to Source: Child Dental Health Survey, 1989 to Figure 3.7: Teeth with fissure sealants, Australian children aged 12, (average) Figure 3.7: Teeth with fissure sealants, Australian children aged 12, (average) 3.3 Hospitalisation 3.3 Hospitalisation Avoiding hospital Early intervention can help keep people with oral disease out of hospital. Potentially Avoiding preventable hospital hospitalisation (PPHs) separation rates (rates of completed episodes of care) for oral health conditions can be an indication of inadequate access to dental care. PPHs are Early hospital intervention separations can help where keep people the principal with oral diagnosis disease out of the of hospital. hospitalisation Potentially is thought preventable to be hospitalisation avoidable. (PPHs) A high separation rate of PPHs rates may (rates indicate of completed an increased episodes prevalence of care) for of oral the health conditions conditions in the can be an community, indication of poorer inadequate functioning access to of dental the non-hospital care. PPHs are care hospital system separations or, alternatively, where the an principal diagnosis appropriate of the hospitalisation use of the hospital is thought system to be to avoidable. respond to A greater high rate need of PPHs (AIHW may 2013a). indicate an increased prevalence of the conditions in the community, poorer functioning of the non-hospital care system or, alternatively, Between an appropriate and use of the the hospital total number system to of respond PPHs due to greater to dental need conditions (AIHW 2013a). rose from 57,955 to 63,327. This was in line with population growth and the age-standardised Between separation rate and remained steady the total at number 2.8 per of 1,000 PPHs population due to dental (Figure conditions 3.8). PPHs rose from are most 57,955 to 63,327. common This was in in people line with aged population under 15 growth (Figure and 3.9). the age-standardised separation rate remained steady at 2.8 per 1,000 population (Figure 3.8). PPHs are most common in people aged under 15 (Figure 3.9). Oral health and dental care in Australia: Key facts and figures trends

26 Separation rate Separation rate NSW Vic Qld WA SA Tas ACT NT Total NSW Vic Qld WA SA Tas ACT NT Total Notes Notes: 1. Potentially avoidable hospitalisations related to dental care are defined as the following ICD-10-AM 6th edn. (see NCCH 2008) Principal diagnosis categories: K02 Dental caries; K03 Other diseases of hard tissues of teeth; K04 Diseases of pulp and periapical tissues; K05 Gingivitis and periodontal Notes: 1. Potentially diseases; K06 avoidable Other diseases hospitalisations of gingival related and edentulous to dental alveolar care are ridge; defined K08 Other as the disorders following of teeth ICD-10-AM and supporting 6th edn (see structures; NCCH K ) Other Principal cysts of oral region, not elsewhere classified; K09.9 Cyst of oral region, unspecified; K12 Stomatitis and related lesions; K13 Other diseases of lip and oral 1. diagnosis mucosa. Potentially categories: avoidable K02 hospitalisations Dental caries; related K03 Other to dental diseases care are of hard defined tissues as the of teeth; following K04 ICD-10-AM Diseases of 6th pulp edn and (see periapical NCCH 2008) tissues; Principal 2. K05 Excludes diagnosis Gingivitis multiple categories: and diagnoses periodontal K02 for Dental the diseases; same caries; separation K06 K03 Other within diseases the same of of gingival group hard tissues and and records edentulous of teeth; with K04 care alveolar Diseases type ridge; of Newborn of K08 pulp Other (without and periapical disorders qualified tissues; of days), teeth Hospital and supporting boarders K05 Gingivitis and structures; Posthumous and periodontal K09.8 organ Other procurement. diseases; cysts of K06 oral Other region, diseases not elsewhere of gingival classified; and edentulous K09.9 Cyst alveolar of oral ridge; region, K08 unspecified; Other disorders K12 Stomatitis of teeth and 3. related Number supporting lesions; of separations structures; K13 Other per K09.8 1,000 diseases Other population. of cysts lip and of Separation oral region, mucosa. rates not were elsewhere directly age-standardised classified; K09.9 using Cyst the of oral estimated region, resident unspecified; populations K12 Stomatitis as 30 June and for related the respective lesions; year. K13 Other diseases of lip and oral mucosa Excludes Total includes multiple other diagnoses territories and for the excludes same overseas separation residents within and the unknown same group state and of residence. records with care type of Newborn (without qualified days), 2. Hospital Excludes boarders multiple and diagnoses Posthumous for the organ same procurement. separation within the same group and records with care type of Newborn (without qualified days), Source: AIHW 2009, 2010, 2011, 2012 and AIHW Hospital Morbidity database , unpublished. Hospital boarders and Posthumous organ procurement. 3. Number of separations per 1,000 population. Separation rates were directly age-standardised using the estimated resident populations as at 3. Figure 30 Number June 3.8: for of the separations Hospital respective per year. separations 1,000 population. Separation for potentially rates were directly preventable age-standardised hospitalisations using the estimated resident due populations to as at 30 June for the respective year. 4. dental Total includes conditions, other territories state and excludes or territory overseas of residents usual and residence unknown state of residence. 4. Total includes other territories and excludes overseas residents and unknown state of residence. Source: AIHW 2009, 2010, 2011, 2012 and AIHW Hospital Morbidity database , unpublished. Source: AIHW 2009, 2010, 2011, 2012 and AIHW Hospital Morbidity database , unpublished. Figure 3.8: Hospital separations for potentially preventable hospitalisations due to dental conditions, Figure 3.8: state Hospital or territory separations of usual for potentially residence preventable hospitalisations due to dental conditions, state or territory of usual residence Oral health and dental care in Australia: Key facts and figures trends Oral health and dental care in Australia: key facts and figures trends, Oral health and dental care in Australia: key facts and figures trends, 2014

27 Separation rate Male Female Total Notes: Notes 1. Potentially (1) avoidable Potentially hospitalisations avoidable hospitalisations related to dental related care are to defined dental care as the are following defined ICD-10-AM as the following 6th edn ICD-10-AM Principal diagnosis 6th edn categories: Principal K02 diagnosis Dental categories: caries; K03 Other K02 Dental diseases caries; of hard K03 tissues Other of teeth; diseases K04 Diseases of hard tissues of pulp and of teeth; periapical K04 tissues; Diseases K05 of Gingivitis pulp and and periapical periodontal tissues; diseases; K05 K06 Gingivitis Other and periodontal diseases of gingival and edentulous alveolar ridge; K08 Other disorders of teeth and supporting structures; K09.8 Other cysts of oral region, not diseases; K06 Other diseases of gingival and edentulous alveolar ridge; K08 Other disorders of teeth and supporting structures; K09.8 Other elsewhere classified; K09.9 Cyst of oral region, unspecified; K12 Stomatitis and related lesions; K13 Other diseases of lip and oral mucosa. cysts of oral region, not elsewhere classified; K09.9 Cyst of oral region, unspecified; K12 Stomatitis and related lesions; K13 Other diseases 2. Excludes multiple diagnoses for the same separation within the same group and records with care type of Newborn (without qualified days) and records for Hospital of lip and boarders oral mucosa. and Posthumous organ procurement. 3. The separation rate (number of separations per 1,000 population) is a crude population rate based on the 2011 estimated resident population. (2) Excludes multiple diagnoses for the same separation within the same group and records with care type of Newborn (without qualified days) Source: AIHW Hospital and records Morbidity for Hospital database boarders , unpublished. and Posthumous organ procurement. (3) The separation rate (number of separations per 1,000 population) is a crude population rate based on the 2011 estimated resident population. Figure 3.9: Hospital separation rate for potentially preventable hospitalisations due to dental conditions, by sex and age group, Source: AIHW Hospital Morbidity database , unpublished. Figure 3.9: Hospital separation rate for potentially preventable hospitalisations due to dental conditions, by sex and age group, Table 3.5: Table Potentially 3.5: Potentially preventable preventable hospitalisations, hospitalisations, key key facts facts Potentially preventable hospitalisations due to dental conditions Potentially preventable hospitalisations due to dental conditions In , the total number of PPHs related to dental conditions was 63,327 or 2.8 separations per 1,000 population. Tasmania and the Australian Capital Territory had the lowest age-standardised separation rate at 2.2 separations Western Australia per 1,000 had the population. highest 3.8 separations per 1,000 population. Western The rate Australia of PPHs had was the lowest highest for Major at 3.8 cities separations (2.7) and highest per 1,000 for population. Very remote (4.3). The rate of PPHs was lowest for Major cities (2.7) and highest for Very remote (4.3). Children Children aged aged had had the the highest next highest number number of separations (7,791, or 5.3 (13,503 per 1,000 separations children aged or 0 4) 9.8 separations (Figure 3.9). per 1,000 children aged 5 9). Sources: AIHW 2013a and AIHW Hospital Morbidity database unpublished. Children aged 0 4 had the next highest number (7,791, or 5.3 per 1,000 children aged 0 4) (Figure 3.9). In , the total number of PPHs related to dental conditions was 63,327 or 2.8 separations per 1,000 population. Tasmania and the Australian Capital Territory had the lowest age-standardised separation rate at 2.2 separations per 1,000 population. Children aged 5 9 had the highest number of separations (13,503 separations or 9.8 separations per 1,000 children aged 5 9). Procedures involving general anaesthetics Sources: AIHW 2013a and AIHW Hospital Morbidity database unpublished. Hospitalisation for dental procedures requiring a general anaesthetic includes restorative dental work, bridges, replantation and splinting. In the general population, these procedures are most common in people aged 15 24, with a rate of 16.3 per 1,000 persons (Figure 3.10). For Aboriginal and Torres Strait Islander people, the procedure rate is highest in the younger years (Figure 3.11). The rate in those aged 5 9 (14.9 per 1,000 persons) is almost as high as those aged in the non-indigenous population. This suggests that there is a greater tendency toward more intensive treatments Oral health and dental care in Australia: Key facts and figures trends

28 Procedures involving general anaesthetics Hospitalisation for dental procedures requiring a general anaesthetic includes restorative dental work, bridges, replantation and splinting. In the general population, these procedures are most common in people aged 15 24, with a rate of 16.3 per 1,000 persons (Figure 3.10). For Aboriginal and Torres Strait Islander people, the procedure rate is highest in the younger years (Figure 3.11). The rate in those aged 5 9 (14.9 per 1,000 persons) is almost as high as those aged in the non-indigenous population. This suggests that there is a greater tendency toward more intensive treatments at younger ages for the Indigenous population. This may be due to differing management approaches, more severe issues in the population or lack of access to dental services. at younger ages for the Indigenous population. This may be due to differing management approaches, more severe issues in the population or lack of access to dental services. Separation rate 25 Male Female Total Notes: Notes Hospital Hospital separations separations requiring requiring general general anaesthesia anaesthesia for dental for conditions dental conditions as defined as by defined following by Australian following Classification Australian Classification of Health interventions of Health (ACHI) interventions 6th edn. Block (ACHI) numbers 6th and edn. procedure Block numbers codes: 457 and Nonsurgical procedure codes: removal 457 of tooth; Nonsurgical 458 Surgical removal removal of tooth; of tooth; Surgical Pulp treatment; removal 463 of tooth; Periradicular 462 Pulp surgery; treatment; 465 Metallic 463 Periradicular restoration; surgery; 466 Tooth-coloured 465 Metallic restoration; restoration; Inlay, Tooth-coloured onlay, indirect; 469 restoration; Other restorative 468 Inlay, dental onlay, service; indirect; 470 Crown; 471 Bridge; 472 Other dental service on crown and bridge; Tooth root resection, per root; Replantation and splinting of tooth; Other restorative Transplantation dental of tooth service; or tooth 470 Crown; bud; Bridge; Exploration 472 Other or negotiation dental service of calcified on crown root canal, and bridge; per canal; Tooth Obturation root resection, of resorption per root; defect or perforation; Replantation and Interim splinting therapeutic of tooth; root filling; Transplantation Provision of tooth of resin or splint, tooth indirect; bud; Exploration Provision of or metal negotiation splint, of indirect; calcified root canal, Metallic per canal; inlay for denture tooth. Obturation of resorption defect or perforation; Interim therapeutic root filling; Excludes Provision records of with resin care splint, type indirect; of Newborn (without Provision qualified of days) metal and splint, records indirect; for Hospital boarders Metallic and Posthumous inlay for denture organ tooth. procurement. 3. The separation rate used in this table (number of separations per 1,000 population) is a crude population rate based on the 2011 estimated resident 2. Excludes records with care type of Newborn (without qualified days) and records for Hospital boarders and Posthumous organ procurement. population. Source: 3. AIHW The separation Hospital Morbidity rate used database in this , table (number unpublished. of separations per 1,000 population) is a crude population rate based on the 2011 estimated resident population. Figure 3.10: Rate of hospital separations for hospitalisations requiring general anaesthesia Source: AIHW Hospital Morbidity database , unpublished. for procedures related to dental conditions, by sex and age group, Figure 3.10: Rate of hospital separations for hospitalisations requiring general anaesthesia for procedures related to dental conditions, by sex and age group, Oral health and dental care in Australia: Key facts and figures trends 2014

29 Per cent Male Female Total Notes 1. Hospital separations requiring general anaesthesia for dental conditions as defined by following Australian Classification of Health interventions (ACHI) 6th edn block numbers and procedure codes: 457 Nonsurgical removal of tooth; 458 Surgical removal of tooth; 462 Pulp treatment; 463 Periradicular Notes: surgery; 465 Metallic restoration; 466 Tooth-coloured restoration; 468 Inlay, onlay, indirect; 469 Other restorative dental service; 470 Crown; 471 Bridge; 472 Other dental service on crown and bridge; Tooth root resection, per root; Replantation and splinting of tooth; (1) Hospital Transplantation separations requiring of tooth general or tooth anaesthesia bud; for Exploration dental conditions or negotiation as defined of calcified by following root canal, Australian per canal; Classification Obturation of Health of resorption interventions defect or perforation; (ACHI) 6th edn block Interim numbers therapeutic and procedure root filling; codes: Nonsurgical Provision of removal resin splint, of tooth; indirect; Surgical removal Provision of of tooth; metal splint, indirect; 462 Pulp treatment; Metallic 463 inlay Periradicular for denture surgery; tooth. 465 Metallic restoration; 466 Tooth-coloured restoration; 468 Inlay, onlay, indirect; 2. Excludes 469 records Other with restorative care type dental of Newborn service; (without 470 Crown; qualified 471 days) Bridge; and records 472 Other for Hospital dental service boarders on and crown Posthumous and bridge; organ procurement. Tooth root resection, 3. The separation per root; rate used in this Replantation table (number and of splinting separations of tooth; per 1, population) Transplantation is a crude population of tooth or rate tooth based bud; on the 2011 Exploration projected Aboriginal negotiation and Torres Strait Islander population. of calcified root canal, per canal; Obturation of resorption defect or perforation; Interim therapeutic root filling; Source: AIHW Hospital Morbidity Provision database of resin , splint, indirect; unpublished; Australian Provision Bureau of metal of Statistics, splint, Projected indirect; Aboriginal Metallic and Torres inlay Strait for Islander denture population, series B, June tooth. (2) Excludes records with care type of Newborn (without qualified days) and records for Hospital boarders and Posthumous organ procurement. Figure 3.11: Hospital separation rate for hospitalisations requiring general anaesthesia for procedures related to dental conditions, by sex and age group, Aboriginal and Torres Strait Islander peoples, (3) The separation rate used in this table (number of separations per 1,000 population) is a crude population rate based on the 2011 projected Aboriginal and Torres Strait Islander population. Source: AIHW Hospital Morbidity database, unpublished; Australian Bureau of Statistics, Projected Aboriginal and Torres Strait Islander population, series B, June Figure 3.11: Hospital separation rate for hospitalisations requiring general anaesthesia for procedures related to dental conditions, by sex and age group, Aboriginal and Torres Strait Islander peoples, Table 3.6: Hospitalisation for dental procedures involving general anaesthetics, Table Hospitalisation 2012 key for facts dental procedures involving general anaesthetics, key facts All Australians All Australians In , the total number of hospital separations for dental procedures requiring a general anaesthetic was 128,712, or 5.7 separations per 1,000 population. separations per 1,000 population. People aged had the highest number of separations (51,364, or 16.3 per 1,000 persons). People aged had the highest number of separations (51,364, or 16.3 per 1,000 persons). Those aged 65 and over had the lowest number of separations (5,288, or 1.7 per 1,000 persons) (Figure 3.10). In , the total number of hospital separations for dental procedures requiring a general anaesthetic was 128,712, or 5.7 Those aged 65 and over had the lowest number of separations (5,288, or 1.7 per 1,000 persons) (Figure 3.10). Aboriginal Aboriginal and and Torres Torres Strait Strait Islander Islander people For the Aboriginal and Torres Strait Islander population, the total number of hospital separations for dental procedures requiring a general anaesthetic was 3,174 in , or 5.5 per 1,000 Aboriginal and Torres Strait Islander population. Children aged 5 9 had the highest number of separations (955, or 14.9 per 1,000 children aged 5 9), followed Adults aged by those 65 and aged over had 0 4 the (758, lowest or number 10.7 per of 1,000 separations Aboriginal ( and per Torres 1,000 Strait Aboriginal Islander Torres children Strait aged Islander 0 4). Adults persons aged aged and over) had (Figure the 3.11). lowest number of separations (14 or 0.7 per 1,000 Aboriginal and Torres Strait Islander persons aged 65 and over) (Figure 3.11). For the Aboriginal and Torres Strait Islander population, the total number of hospital separations for dental procedures requiring a general anaesthetic was 3,174 in , or 5.5 per 1,000 Aboriginal and Torres Strait Islander population. Children aged 5 9 had the highest number of separations (955, or 14.9 per 1,000 children aged 5 9), followed by those aged 0 4 (758, or 10.7 per 1,000 Aboriginal and Torres Strait Islander children aged 0 4). Sources: Australian hospital statistics unpublished. Source: AIHW Hospital Morbidity database , unpublished. Oral health and dental care Oral health in Australia: and dental key care facts in Australia: and figures Key facts trends, and figures 2014 trends

30 3.4 Costs Total expenditure on dental services in Australia was $8,336 million in , an increase of $2,203 million from $6,133 million (constant prices) in (Table 3.7). Table 3.7: Total expenditure ($ million) on dental services, constant prices, by source of funds, to Source of funds Federal Year Federal government direct outlay State and local government government premium rebates Health insurance funds Individuals Other Total , , , , , , ,069 4, , ,076 4, , ,122 4, , , ,261 4, ,336 Note: Rows may not sum to total because of rounding of estimates. Source: AIHW health expenditure data cubes. Cost as a barrier to seeking dental care Respondents to the National Dental Telephone Survey 2010 were asked a range of questions relating to the financial burden of dental care, including whether they had avoided or delayed dental care due to cost, whether cost had prevented dental treatment that a dental professional recommended and whether dental visits in the previous 12 months had been a large financial burden. In the case of children, an appropriate adult was asked to answer the relevant questions on their behalf. Whether or not people have private health insurance that covers all or part of the cost of dental care may influence the affordability of care. According to the National Dental Telephone Interview Survey, from 1994 to 2010, there was an increase in the proportion of adults avoiding visits to a dentist due to costs, from about 25% to 30%, though this difference was not statistically significant. For children, the overall trend was unchanged at around 14%, but varied between 8.5% and 17.0% over this period (Figure 3.12). 20 Oral health and dental care in Australia: Key facts and figures trends 2014

31 Per cent 35 People (15+) Children (5 14) 30 Per cent 35 People (15+) Children (5 14) Source: National Source: Dental 1994Telephone National Dental Interview 1996 Telephone Survey Interview Survey Figure 3.12: People avoiding dental visiting due to cost, Figure 3.12: People avoiding dental visiting due to cost, Source: National Dental Telephone Interview Survey For the period 1994 to 2010, the proportion of adults who avoided treatment because of cost remained Figure 3.12: fairly People stable avoiding at around dental 20%. visiting For due children, to cost, there was little change overall from 5.0% For the period in 1994 to 2010, 4.9% in the 2010, proportion though of the adults proportion who avoided varied treatment between because 4.3% and of cost 8.3% remained over the period fairly stable at For (Figure around the period 3.13). 20%. For 1994 children, to 2010, there was proportion little change of adults overall who from avoided 5.0% in treatment 1994 to 4.9% because in 2010, of cost though the proportion remained fairly varied stable between at around 4.3% and 20%. 8.3% For over children, the period there (Figure was little 3.13). change overall from 5.0% in Per 1994 cent to 4.9% in 2010, though the proportion varied between 4.3% and 8.3% over the period (Figure ). People (15+) Children (5 14) Per cent People (15+) Children (5 14) Source: 1994 National Dental 1996 Telephone Interview 1999Survey Figure 3.13: Cost prevented recommended treatment, Source: National Source: Dental Telephone National Dental Interview Telephone Survey Interview Survey Figure 3.13: Cost prevented recommended treatment, Figure 3.13: Cost prevented recommended treatment, Oral health and dental care in Australia: key facts and figures trends, Oral health and dental Oral care health in and Australia: dental care key in facts Australia: and figures Key facts trends, and figures 2014 trends

32 Table 3.8: Costs of dental care key facts Cost In , the largest source of funds for dental expenditure was individuals, paying directly out of pocket for 56.8% of total dental costs. In 2010, National Dental Telephone Interview Survey data indicated that more than one-quarter of people aged 5 or older (28.0%) avoided or delayed visiting a dentist due to cost. This ranged from almost 14% of children aged 5 14 to 37% for adults aged In 2010, about one-quarter of adults aged avoided their recommended treatment because of cost. Cost prevented only 5.4% of children aged 5 14 from having their recommended treatment. Sources: AIHW 2013b and National Dental Telephone Interview Survey Table 3.9: Dental insurance key facts Expenditure Health insurance funds provided 15.1% of the funds for dental expenditure, the second highest proportion after individuals paying directly out of pocket. Australian Government premium rebates accounted for 6.3%, and other government contributions funded 21.3% of total expenditure (12.7% Australian Government direct outlay and 8.6% from state and local governments). Age and geography In 2010, over half of all people aged 5 and over (53.8%) had some level of dental insurance. Adults aged had significantly higher rates of dental insurance, and those aged 65 and over had significantly lower rates of insurance than other age groups. Dentate adults (having some natural teeth) who lived in Major cities were more likely to have dental insurance than dentate adults who lived in Inner regional or Outer regional areas. Over three-quarters of dentate adults in the highest household income group ($100,000 and over per year) (76.3%) had some level of dental insurance. Income Less than one-third of adults in the bottom 3 household income groups (<$30,000 per year) (ranging from 27.3% to 29.8%) had dental insurance. Paying for dental care The majority of adults with insurance reported that their insurance paid some (78.7%) or all (7.8%) of the dental costs of their last visit. Only 9.4% of insured adults paid all their own dental expenses. Almost one-fifth of insured adults (17.3%) who were required to cover their own dental expenses said it caused a large financial burden. Sources: AIHW 2013b and National Dental Telephone Interview Survey Oral health and dental care in Australia: Key facts and figures trends 2014

33 4 Dental 4 Dental workforce workforce 4.1 Trends 4.1 Trends in the dental in the workforce dental workforce Between Between 2011 and 2012, 2011 the and number 2012, the of dental number practitioners of dental employed practitioners increased employed from around increased 18, 700 from around to nearly 18, 19, (Figure to nearly 4.1). This 19,600 may (Figure have an 4.1). influence This on may the have availability an influence of dental on care the within availability the of dental population. care In within the same the time population. period the full-time In the same equivalent time period (FTE) rate the of dentists full-time rose equivalent from around (FTE) 55 to rate of 57 dentists dentists per 100,000 rose population. from around There 55 was to 57 a fall dentists in the number per 100,000 of employed population. oral health There therapists, was a fall while in the the numbers number of dental of employed hygienists therapists oral health increased. therapists, However, while changes the numbers in the numbers of dental of oral hygienists health therapists therapists, increased. dental hygienists However, and dental changes therapists in may numbers in part of be oral due health to the change therapists, of methods dental used hygienists to and assign a primary dental practitioner therapists may type to in those part practitioners be due to the holding change more of methods than 1 division used of to general assign registration a primary (i.e. those practitioner registered in more type than to those 1 dental practitioners profession) holding (AIHW 2014a). more than 1 division of general registration (i.e. those registered in more than 1 dental profession) (AIHW 2014a). Number of practitioners 20,000 19,800 19,600 19,400 19,200 19,000 18,800 18,600 18,400 18,200 18, Note: For 2012, employed dental practitioner data exclude those with provisional registrations. Source: AIHW 2014a. Note: For 2012, employed dental practitioner data exclude those with provisional registrations. Figure 4.1: Number of employed dental practitioners, 2011 and 2012 Source: AIHW 2014a. Figure 4.1: Number of employed dental practitioners, 2011 and Who 4.2 makes Who up makes the dental up the workforce? dental workforce? Table 4.1: Table Dental 4.1: workforce Dental workforce 2012 key 2012 key facts facts In 2012, there were about 57 dentists, 4 dental therapists, 5 dental hygienists, 3 oral health therapists and 5 dental prosthetists employed per 100,000 people. In 2012, there were about 57 dentists, 4 dental therapists, 5 dental hygienists, 3 oral health therapists and 5 dental prosthetists employed per 100,000 people. On average, On average, dentists worked 37.0 hours per week. Dentists working in a clinical practice were younger (43.1 years compared to 51.2) and worked more hours per week than those in non-clinical roles (37.1 hours compared to 34.3). Dentists working in a clinical practice were younger (43.1 years compared to 51.2) and worked more hours per week than those in non-clinical roles (37.1 hours compared to 34.3). One One in 3 practising in 3 dentists was female (36.5%). Most dentists were employed in Major cities (79.7% of all employed dentists), while only 0.9% were in Remote/Very remote areas (0.9%). Most dentists were employed in Major cities (79.7% of all employed dentists), while only 0.9% were in Remote/Very remote areas (0.9%). Major cities had the highest rates of dentists and dental hygienists, while Remote/Very remote areas had the lowest rates of all dental practitioners, except dental therapists. Major cities had the highest rates of dentists and dental hygienists, while Remote/Very remote areas had the lowest rates of all dental practitioners, except dental therapists. Oral health and dental care in Australia: Key facts and figures trends Oral health and dental care in Australia: key facts and figures trends,

34 Comparison with other health practitioners Medical practitioners, working as clinicians, worked more hours per week (average 42.9), were a little older (an average age of 45.7) and a fairly similar proportion were women (37.7%). The supply of medical practitioners, in terms of FTE employed, was generally greater in Major cities than in Remote/Very remote areas. The supply of general practitioners was highest, however, in Remote/Very remote areas, while overall these areas had the lowest supply of medical practitioners in total. Nurses and midwives worked on average 33.4 hours per week, had an average age of 44.6 and 89.8% were women. The geographic supply of nurses and midwives was fairly even, ranging from 1,071.3 FTE per 100,000 population in Outer regional areas to 1,302.8 in Very remote areas. Dental specialists The largest group of dentists with speciality qualifications was orthodontists (518 or 39.0%) (Figure 4.2). The majority of dental specialists were employed in Major cities (89.1%). The jurisdiction with the highest FTE rate per 100,000 population for dental specialists was the Australian Capital Territory (10.3), and the lowest was the Northern Territory with an FTE rate of 2.2 (Figure 4.3). Sources: AIHW 2013c, 2014a, 2014b. Specialty Orthodontics Periodontics Oral and maxillofacial surgery Prosthodontics Endodontics Paediatric dentistry Oral medicine Oral surgery Special needs dentistry Forensic odontology Public health dentistry Dental-maxillofacial radiology Oral pathology Number of specialists Source: National Health Workforce Data Set: dental practitioners Source: National Health Workforce Data Set: dental practitioners Figure 4.2: Employed dentists not working in the area of general dental practice, by Figure specialty, 4.2: Employed 2012 dentists not working in the area of general dental practice, by specialty, 2012 FTE rate Oral health and dental care in Australia: Key facts and figures trends

35 Source: National Health Workforce Data Set: dental practitioners Figure 4.2: Employed dentists not working in the area of general dental practice, by specialty, 2012 FTE rate NSW Vic Qld WA SA Tas ACT NT Australia State/territory Notes 1. Notes: Derived from state and territory of main job where available; otherwise, state and territory of principal practice is used as a proxy. If principal practice Derived details from are unavailable, state and territory state and of territory main job of where residence available; is used. otherwise, Records with state no and information territory on of principal all 3 locations practice are coded is used to as Not a proxy. stated. 2. If principal Australia practice includes details dental specialists are unavailable, who did state not and state territory adequately of residence describe is their used. location Records and with those no information who were overseas. on all 3 locations 3. are FTE coded rate is to per Not 100,000 stated. population. Australia includes dental specialists who did not state or adequately describe their location and those who were overseas. Source: FTE rate National is per Health 100,000 Workforce population Data Set: dental practitioners Source: National Health Workforce Data Set: dental practitioners Figure 4.3: Employed dental specialists not working in the area of general dental practice, Figure 4.3: Employed dental specialists not working in the area of general dental practice, by state by state and territory, 2012 and territory, 2012 Oral health and dental care in Australia: key facts and figures trends, Oral health and dental care in Australia: Key facts and figures trends

36 Appendix: National dental data sources Dental and oral health information published on the AIHW website is from a range of collections. These include the National Survey of Adult Oral Health (NSAOH), the National Dental Telephone Interview Survey (NDTIS) and the Child Dental Health Survey (CDHS). The AIHW Dental Statistics and Research Unit (DSRU), located in the Australian Research Centre for Population Oral Health (ARCPOH) at the University of Adelaide, conducts these surveys. The AIHW DSRU is a collaborative arrangement between the AIHW and the University of Adelaide for collection, analysis and reporting of population oral health data. National Survey of Adult Oral Health The NSAOH provides a descriptive snapshot of oral health in the adult population of Australia. Data are collected from people aged 15 years or more, residing in all Australian states and territories. Information is collected using interviews and standardised dental examinations. The survey aims to describe levels of oral disease, perceptions of oral health and patterns of dental care within a representative cross-section of adults in all states and territories of Australia. A further aim is to evaluate trends in oral health since the first national oral examination survey, conducted in The NSAOH was last conducted in The National Oral Health Plan, see <National Oral Health Plan >, calls for an adult survey to be conducted every 10 years. National Dental Telephone Interview Survey The NDTIS is a telephone survey of a random sample of the Australian population aged 5 years and over. Respondents include users and non-users of dental services and people eligible and not eligible for public-funded dental care. The survey collects basic features of oral health and dental care within the Australian population, including access to services. There is no clinical component to the survey. The purposes of the National Dental Telephone Interview Survey (NDTIS) are to: collect oral health and dental care data within the Australian population monitor the extent of social inequalities within the dental sector investigate the underlying reasons behind dental behaviours, and the consequences of these behaviours. The survey is conducted every 2 3 years. Surveys were conducted in 1994, 1996, 1999, 2002, 2005, 2008, 2010 and A data quality statement for this collection is available at: <National Dental Telephone Interview Survey 2010>. 26 Oral health and dental care in Australia: Key facts and figures trends 2014

37 Child Dental Health Survey The CDHS is an annual data collection which monitors the dental health of children aged 4 15 enrolled in school and community dental services that the health departments or authorities of state and territory governments operate. Dental therapists and dentists collect the data for the CDHS at the time of conducting routine clinical examinations. The objective of the CDHS is to collect data to examine the distribution of oral health status by geographic location and demographic factors, as well as the identification of high-risk groups. The survey examines changes in oral health status among children over time. The CDHS been collected annually since Data were not available for New South Wales for 2001 to 2006 and 2008 to 2010 and for Victoria from A data quality statement for this collection is available at: <Child Dental Health Survey 2009>. Health expenditure data Health expenditure data, collected and reported annually through AIHW s Health expenditure Australia, includes estimates of expenditure on dental services, private and public, for state and territory governments and the Australian Government. A data quality statement for this collection is available at: <Health expenditure database >. Hospital data The National Hospital Morbidity Database (NHMD) is a collection of records from admitted patient data collection systems in Australian hospitals. The data supplied in the NHMD are based on the National Minimum Data Set (NMDS) for Admitted patient care. The AIHW compiles the database from data supplied by the state and territory health authorities. It contains demographic, administrative and length of stay data, and data on the diagnoses of the patients, and the procedures they underwent in hospital. Dental services are classified according to ACHI (Australian Classification of Health Interventions). ACHI is the Australian national standard for procedure and intervention coding in Australian hospitals. The National Outpatient Care Database (NOCD) is a collection of records for outpatient clinic occasions of service in public hospitals. The data supplied are based on the NMDS for Outpatient care. The AIHW also compiles this database from data supplied by the state and territory health authorities. It contains demographic data, data about clinic type (which includes dental clinics), number of occasions of service and number of group sessions. The National Public Hospital Establishments Database (NPHED) is a collection of records on non-admitted patient occasions of service. The NPHED is based on the NMDS for public hospital establishments. The NPHED includes a range of non-admitted patient care services that are not in scope for the NOCD. Data quality statement summaries for these collections are available at: <Appendix A: Database quality statement summaries (Australian hospital statistics )>. Oral health and dental care in Australia: Key facts and figures trends

38 Dental practitioner workforce data The National Health Workforce Data Set combines data from through the National Registration and Accreditation Scheme with data collected from the Dental Workforce Survey conducted at the time of a practitioner s annual registration or renewal. The Australian Health Practitioner Regulation Agency collects these data. The data set includes information on the size and characteristics of the dental workforce (dentists, dental hygienists, dental therapists, dental prosthetists and oral health therapists) as well as: the type of work done by, and work setting of, dental practitioners the number of hours worked in clinical or non-clinical roles the numbers of years worked, and the years they intend to remain in, the dental practitioner workforce. those registered dental practitioners who are not currently undertaking clinical work or who are not employed. The AIHW reports these data annually in health workforce publications. A data quality statement for this collection is available at: <National Health Workforce Data Set: dental practitioners 2012; Data Quality Statement>. 28 Oral health and dental care in Australia: Key facts and figures trends 2014

39 Glossary Caries: Bacterial disease that causes the demineralisation and decay of teeth and can involve inflammation of the central dental pulp. Clinician: A clinician is a dental practitioner who spends the majority of his or her time working in the area of clinical practice that is, the diagnosis, care and treatment and including recommended preventive action, of patients or clients. Current prices: The term current prices refers to expenditures reported for a particular year, unadjusted for inflation. Changes in current price expenditures reflect changes in both price and volume. Decay: Decay of the teeth caused by caries, and progressing to cavities in the enamel or cementum and the dentine. Deciduous dentition: Primary (baby) teeth. Dental appearance: Self-reported perception of dental appearance related to frequency of feeling uncomfortable with their dental appearance ( never or hardly ever compared with very often, often or sometimes ). Dental disease: Dental decay or cavity resulting from dental caries. Dental hygienist: Registered health practitioner who educates the community in the principles of preventive dentistry and motivates individuals to take responsibility for their own oral health; performs a restricted range of clinical services and works under the direction of a dentist, who is responsible for patient diagnosis and prescribes the treatment to be carried out by the hygienist. Dental prosthetist: Registered health practitioner who is responsible for construction and fitting of dentures and sporting mouthguards; maintains, repairs and relines dentures either by direct consultation with a patient or by referral from a dentist. Dental therapist: Registered health practitioner who undertakes promotion of oral health and dental health education; performs a restricted range of clinical services, predominantly on school-aged children. Dentate: Having at least one natural tooth. Dentist: Registered health practitioner who provides a range of preventive, diagnostic and restorative dental services. Dentition: The set of teeth. A complete dentition comprises 32 adult teeth. dmft: Deciduous decayed, missing (due to decay) and filled teeth. DMFT: Permanent decayed, missing (due to decay) and filled teeth. Edentulism/edentulous: Complete tooth loss; loss of all natural teeth. Employed: An employed dental practitioner is one who either: worked for a total of 1 hour or more in the week before the survey in a job or business for pay, commission, payment in kind or profit, mainly or only in a particular state or territory usually worked, but was away on leave (with some pay) for less than 3 months, on strike or locked out, or rostered off. Endodontics: The study, treatment and prevention of diseases of the pulp of teeth; a major part of treatment is root canal treatment. Favourable pattern of dental visiting: Dental behaviour related to making regular dental visits for a check-up; deemed favourable because timely dental care may be less invasive. Fissure sealant: A special varnish that seals pits and fissures in teeth to prevent cavities from developing. Food avoidance: People who reported avoiding some foods very often, often or sometimes in the previous 12 months. Oral health and dental care in Australia: Key facts and figures trends

40 Frequent visiting pattern: Making a dental visit usually 2 or more times per year. Gingivitis: Inflammation of the gums. Gum treatment: Treatment for disease of the gums and other tissues that attach teeth to the jaws; also referred to as periodontal treatment. Insurance status: Dental care is not covered under Medicare, therefore people seeking cover can elect to carry private dental insurance. Oral health: Health of the mouth, tongue and oral cavity; the absence of active disease in the mouth. Orthodontics: The branch of dentistry that is concerned with the growth and development of the face and jaws and the treatment of irregularities of the teeth. Periodontics: The branch of dentistry that is concerned with the tissues that support and attach the teeth and the treatment and prevention of periodontal disease. Periodontitis: Inflammation of the gums and deeper tissues in the tooth socket. Periodontal status is based on the definition used by the Centers for Disease Control and Prevention (CDC). The CDC defines periodontal disease using a combination of deep periodontal pockets, clinical attachment loss and the number of sites affected (Page & Eke 2007). Permanent dentition: Adult teeth. Potentially preventable hospitalisations: Those conditions where hospitalisation is thought to be avoidable if timely and adequate non-hospital care is provided. Prevalence: The proportion of people with a defined disease or characteristic within a defined population. Preventive services: Refers to measures taken to prevent dental diseases; may include fluoride treatment, scale and clean services, dental sealants etc. Principal diagnosis: The diagnosis established after study to be chiefly responsible for occasioning an episode of admitted patient care. Private dental services: Dental care provided by private practitioners to adults and children, usually self-funded by the recipient. Prosthodontics: The branch of dentistry that is concerned with the provision of dentures, bridges and implant-retained prostheses. Public dental services: State- or territory-funded dental care available to adults with low income or other forms of social disadvantage. Recurrent expenditure: Expenditure incurred by organisations on a recurring basis, for the provision of health goods and services. This excludes capital expenditure. For all years, recurrent expenditure includes capital consumption. Remoteness area: A classification of the remoteness of a location using the Australian Standard Geographical Classification Remoteness Structure (2006), based on the Accessibility/Remoteness Index of Australia, where the remoteness index value of a point is based on the physical road distance to the nearest town or service. These categories are: Major cities, Inner regional, Outer regional, Remote, Very remote and Migratory. Separation: A completed episode of care for an admitted patient, which can be a total hospital stay (from admission to discharge, transfer or death) or a portion of a hospital stay beginning or ending in a change of type of care (for example, from acute to rehabilitation). Separation rate: The total number of completed episodes of care for admitted patients divided by the total number of people in the population under study. Often presented as a number per 1,000 or 10,000 members of a population. Unfavourable pattern of dental visiting: Dental behaviour related to making irregular dental visits, usually in response to a dental problem; deemed unfavourable because problems that could have been treated in an effective and efficient manner may have deteriorated so that restorative treatments will be more extensive or may no longer be a viable option. 30 Oral health and dental care in Australia: Key facts and figures trends 2014

41 References AHMAC (Australian Health Ministers Advisory Council) Oral health of Australians: National planning for oral health improvement. Adelaide: South Australian Department of Human Services, on behalf of the Australian Health Ministers Conference. AIHW (Australian Institute of Health and Welfare) Australian hospital statistics Health services series no. 33. Cat. no. HSE 71. Canberra: AIHW. AIHW Australian hospital statistics Health services series no. 34. Cat. no. HSE 84. Canberra: AIHW. AIHW Australian hospital statistics Health services series no. 40. Cat. no. HSE 107. Canberra: AIHW. AIHW Australian hospital statistics Health services series no. 43. Cat. no. HSE 117. Canberra: AIHW. AIHW 2013a. Australian hospital statistics Health services series no. 50. Cat. no. HSE 134. Canberra: AIHW. AIHW 2013b. Health expenditure Australia Health and welfare expenditure series no. 50. Cat. no. HWE 59. Canberra: AIHW. AIHW 2013c. Nursing and midwifery workforce National health workforce series no. 6. Cat. no. HWL 52. Canberra: AIHW. AIHW 2014a. Dental workforce National health workforce series no. 7. Cat. no. HWL 53. Canberra: AIHW. AIHW 2014b. Medical workforce National health workforce series no. 8. Cat. no. HWL 54. Canberra: AIHW. Ellershaw AC & Spencer AJ Dental attendance patterns and oral health status. Dental statistics and research series no. 57. Cat. no. DEN 208. Canberra: AIHW. NCCH (National Centre for Classification in Health) The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM), Australian Classification of Health Interventions (ACHI) and Australian Coding Standards (ACS), 6th edition. Sydney: University of Sydney. NZMH (New Zealand Ministry of Health) Our Oral Health: Key findings of the 2009 New Zealand Oral Health Survey. Wellington: Ministry of Health. OCDOC (Office of the Chief Dental Officer of Canada) (2013). Ontario: Health Canada. Viewed 17 June 2013, < Page RC & Eke PI Case definitions for use in population-based surveillance of periodontitis. Journal of Periodontology 78: Palmer JD, Anderson RJ &Downer MC Guidelines for prevalence estimates of dental caries. Community Dental Health 1: Slade GD, Spencer AJ & Roberts-Thomson KF (eds) Australia s dental generations: the National Survey of Adult Oral Health Dental statistics and research series no. 34. Cat. no. DEN 165. Canberra: AIHW. UK (United Kingdom) Department of Health An oral health strategy for England. London: Department of Health. WHO (World Health Organization) Oral health surveys basic methods, 4th edition. Geneva: WHO. Oral health and dental care in Australia: Key facts and figures trends

42 List of tables Table 2.1: Tooth decay and children, 2010 key facts... 3 Table 2.2: Tooth decay and adults key facts... 5 Table 2.3: Gum disease and adults key facts... 5 Table 2.4: Missing teeth and adults key facts... 6 Table 2.5: Impacts of poor oral health in the previous 12 months, 2010 key facts... 6 Table 3.1: Who visits a dental practitioner? key facts Table 3.2: Reasons for visiting a dental practitioner, 2010 key facts Table 3.3: Types of dental practice visited, 2010 key facts Table 3.4: Services at the dentist, 2010 key facts Table 3.5: Potentially preventable hospitalisations, key facts Table 3.6 Hospitalisation for dental procedures involving general anaesthetics, key facts Table 3.7: Total expenditure ($ million) on dental services, constant prices, by source of funds, to Table 3.8: Costs of dental care key facts Table 3.9: Dental insurance key facts Table 4.1: Dental workforce 2012 key facts Oral health and dental care in Australia: Key facts and figures trends 2014

43 List of figures Figure 2.1: 0 Trends in decayed, missing or filled teeth in children, 1977 to Figure 2.2: Average number of permanent teeth with caries experience, dentate people aged 15 and over, and Figure 2.3: Dentate people aged 15 and over reporting any oral health impact, (per cent) aged 15 and over, and Figure 3.1: Last dental visit was in the previous 12 months, dentate children aged 5 14 and dentate people aged 15 years and over, (per cent)... 8 Figure 3.2: Last dental visit was for a check-up, dentate children aged 5 14 years and dentate adults aged 15 years and over, (per cent)... 9 Figure 3.3: Type of practice visited at last dental visit, children aged 5 14 years, (per cent)... 9 Figure 3.4: Dental visiting patterns, dentate people aged 15 years and over, (per cent) Figure 3.5: Types of services received by people aged 15 and over, (average) Figure 3.6: Types of services received by children aged 5 14, (average) Figure 3.7: Teeth with fissure sealants, Australian children aged 12, (average) Figure 3.8: Hospital separations for potentially preventable hospitalisations due to dental conditions, state or territory of usual residence Figure 3.9: Hospital separation rate for potentially preventable hospitalisations due to dental conditions, by sex and age group, Figure 3.10: Rate of hospital separations for hospitalisations requiring general anaesthesia for procedures related to dental conditions, by sex and age group, Figure 3.11: Hospital separation rate for hospitalisations requiring general anaesthesia for procedures related to dental conditions, by sex and age group, Aboriginal and Torres Strait Islander peoples, Figure 3.12:.People avoiding dental visiting due to cost, Figure 3.13:.Cost prevented recommended treatment, Figure 4.1: Number of employed dental practitioners, 2011 and Figure 4.2: Employed dentists not working in the area of general dental practice, by specialty, Figure 4.3: Employed dental specialists not working in the area of general dental practice, by state and territory, Oral health and dental care in Australia: Key facts and figures trends

44 Related publications This report and other dental and oral health publications can be downloaded free from the AIHW website < The website also includes information on ordering printed copies. Oral and dental health webpages can also be viewed and downloaded free from the AIHW website < Related publications can also be downloaded from the Australian Research Centre for Population Oral Health (ARCPOH) website < The following AIHW publications may also be of interest: AIHW 2013a. Australian hospital statistics Health services series no. 50. Cat. no. HSE 134. Canberra: AIHW. AIHW 2013b. Health expenditure Australia Health and welfare expenditure series no. 50. Cat. no. HWE 59. Canberra: AIHW. AIHW 2014a. Dental workforce National health workforce series no. 7. Cat. no. HWL 53. Canberra: AIHW. 34 Oral health and dental care in Australia: Key facts and figures trends 2014

45

46 This report is the latest in the Oral health and dental care in Australia: Key facts and figures suite of printed publications and web products. It highlights the key trends, which suggest there have been improvements over the long term but there is some cause for concern in recent years. In adults, there was a decrease in the average number of teeth affected by decay from nearly 15 in to around 13 in From 1994 to 2010, however, the proportion reporting any adverse oral health impact generally increased and ranged from 31.4% in 1994 to a peak of 39.9% in 2008.