Poor oral health is a critical factor in many health conditions, including diabetes, low birth weight and premature births, arthritis, heart problems, and respiratory conditions. It effects a person’s quality of life with concerns when smiling, difficulty eating, pain, and limited employability. Other than low fluoride exposure, the causes of poor oral health, i.e. poor hygiene, poor diet, smoking, lack of access to oral health care and social determinants, are the same as the causes of poor systemic health. Unlike medicine, the vast majority of dental services are supplied in the private sector and are funded fee-for-service by the patient.
Oral health is poorer in rural than in urban areas of Australia. Although the oral health of Australians has improved over the last 30 years, the gap in oral health outcomes between rural and urban populations has not diminished. The poor oral health of the rural urban population is due to a number of factors including: poor access to dental care (caused by distance to dental practitioners, a historic undersupply of dental practitioners in rural areas and cost of treatment); rural attitudes to health that are more focused on treatment than prevention; low socioeconomic status (education, household income); the proportion of Indigenous Australians and elderly people; and low exposure to fluoridated water due to a reliance on tank water and un-fluoridated town water.
Dental practitioner (dentists, dental therapists, dental hygienists, oral health therapists and dental prosthetists/technicians) recruitment and retention issues lead to poor oral health outcomes in rural communities. Though the projected increasing oversupply of dental practitioners in Australia has seen a solving of rural recruitment problems, there is a potential for increased workforce turnover (“rural dental workforce churn”), as recent dental graduates gain work experience in rural areas and then move to urban areas after they become experienced employees. Rural dental practitioners need to have a broader scope of practice as there are often no professional help or dental specialists nearby. They often treat emergency patients with complicated conditions such as broken and exfoliated teeth and broken jaws after trauma, undertake oral surgical procedures and supply molar root fillings, orthodontic care, and advanced restorative care. They also act as leaders of their communities. The “rural dental workforce churn” has the potential to lead to lack of experienced and socially aware dental practitioners in rural areas. Another issue with improving access to dental care is the high fixed costs of running a dental practice making many rural and remote towns too small for a viable privately operated dental practice.
Equity suggests that everyone should be able to access dental treatment in Australia. A concern is that unless dental funding is targeted, people in rural areas may continue to miss out on appropriate dental care, while people in urban areas will receive more elaborate care than currently received with an associated risk of over servicing.