Volume 201 - Issue 11
Rural dental health care and the workforce challenges
Author: Leonard A Crocombe
Med J Aust 2014; 201 (11): 644-645. || doi: 10.5694/mja14.01379
Published online: 15 December 2014
Published online: 15 December 2014
Rural people have high needs but experienced practitioners prefer cities
To the Editor: Rural Australians have poorer oral health than metropolitan Australians,1 and this oral health gap is not decreasing.2 Possible reasons for poor oral health among rurally located people are that they tend to be of lower socioeconomic status,3 which is known to be linked with a marked inequality in oral health,4 and that rural people have a different concept of health,5 which may influence their use of health services.
Another reason that has been suggested for poor oral health among rural people is poor access to dental care due to an inequitable geographic distribution of the dental workforce,6 with progressively fewer dentists as remoteness from major cities increases. It is not surprising, then, that dentists practising in non-capital city areas have been supplying more patient visits per year, and were more likely to be busier than they would like to be, compared with dentists in capital cities.7
Since 2005, four new dental schools have opened in Australia, at Griffith, La Trobe, James Cook and Charles Sturt universities; many of the existing dental schools have increased their student numbers; and there has been a large increase in the number of dentists coming from overseas. Anecdotal evidence indicates that rural dental practices, which have had trouble attracting dental practitioners in the past, are now receiving cold calls from new graduates looking for work. The problem of the rural undersupply of dentists may be correcting itself.
However, a continuous churn of highly skilled and experienced practitioners being replaced by less experienced ones could result, since practitioners tend to move back to capital cities once they gain some experience.8 A lack of experienced dentists could lead to rural patients being caught up in a repeat restoration cycle9 of having teeth filled and later having the same teeth refilled as restorations collapse or more decay occurs. Although ensuring that rural towns have fluoridated water supplies would be the most cost-effective way to reduce the incidence and prevalence of dental caries among rural people10 and to limit the repeat restoration cycle, enabling rural people to access dental care will decrease the effects of the disease, particularly if treated in its early stages.
Despite an increase in interest among new graduates and overseas-trained dentists in working in rural areas, there is still a great need for specialist dental services, such as oral and maxillofacial surgery, oral medicine specialist care, special needs dentistry, periodontics, endodontics and orthodontics, in rural areas. People in rural areas have high medical and dental needs and require access to experienced health practitioners. One way to provide this and to ensure a continuation of dental care in rural communities is to develop an advanced rural dentist program similar to the rural medical generalist program.11 The program could cover some procedures of specialist dental practice, some areas of practice outside of dentistry and research into rural oral health, and it could also teach the skills to create stronger links and cooperation between rural health care practitioners.
Competing interests
No relevant disclosures.
Acknowledgements
The research reported in this letter is a project of the Australian Primary Health Care Research Institute (APHCRI), which is supported under the Australian Government's Primary Health Care Research, Evaluation and Development Strategy. The information and opinions contained in it do not necessarily reflect the views or policy of the APHCRI or the Department of Health.
References
- Crocombe LA, Stewart JF, Brennan DS, et al. Is poor access to dental care why people outside capital cities have poor oral health? Aust Dent J 2012; 57: 477-485. 1
- Crocombe LA, Stewart JF, Barnard PD, et al. Relative oral health outcome trends between people inside and outside capital city areas of Australia. Aust Dent J 2010; 55: 280-284. 2
- Australian Bureau of Statistics. Household income and income distribution, Australia, 2011-12. Canberra: ABS, 2013. (ABS Cat. No. 6523.0.) http://www.abs.gov.au/ausstats/abs@.nsf/Latestproducts/6523.0Main%20Features22011-12?opendocument&tabname=Summary&prodno=6523.0&issue=2011-12&num=&view= (accessed Nov 2014).
- Sanders AE, Slade GD, Turrell G, et al. The shape of the socioeconomic-oral health gradient: implications for theoretical explanations. Comm Dent Oral Epidemiol 2006; 34: 310-319. 4
- Humphreys JS, Mathews-Cowey S, Weinand HC. Factors in accessibility of general practice in rural Australia. Med J Aust 1997; 166: 577-580. 5
- Australian Institute of Health and Welfare. Dental workforce 2012. (AIHW Cat. No. HWL 53; National Health Workforce Series No. 7.) Canberra: AIHW, 2014. 6
- Brennan DS, Spencer AJ. Trends in private dental service provision by geographic location. Aust J Rural Health 2007; 15: 189-195. 7
- Godwin D, Hoang H, Bell E, Crocombe LA. Dental practitioner rural work movements: a systematic review. Rural Remote Health 2014; 14: 2825. 8
- Elderton RJ. Clinical studies concerning re-restoration of teeth. Adv Dent Res 1990; 4: 4-9. 9
- Crocombe LA, Brennan DS, Slade GD, et al. The effect of lifetime fluoridation exposure on dental caries experience of younger rural adults. Aust Dent J 2014; 20 Oct [Epub ahead of print]. 10
- Crocombe LA, Bell E, Barnett T. Is it time for an advanced rural dentist? Aust J Rural Health 2014; 22: 86. lefthere