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The Dental Prosthetist and their Future Role in Oral Health P6

We’ve got tooth loss , we got patients , we’ve got demand , we’re now in the  oh my gosh can we  actually provide services to  meet  that demand . What is happening at the moment? This shows you dentures, extractions and fillings according to age group. Dentures on the black bar, extractions on the middle and fillings in the darkest bar. If you look at this you can sees that there i still  of the  patients who are getting publicly funded care   roughly one on five of those patients 19% ,20.4%, 21% are having  extractions . They are still lots of teeth being removed in this country in public eligible patients, large numbers in fact. You need to talk to student who has been on placement in one of these cliques who can easily tell you they took out three hundred teeth when they are on placement in a clinic because that’s on reason why we send students to such places, to get oral surgery experience. You also don’t need to look too hard to find a lot of data on the waiting list for dentures around the country.  If you look down the central column you can see that the stated waiting list actually varies quite enormously depending on what the parameters are used to report them. So it’s clearly a bunch of unmet demand in the system. If we had met that demand, would there be   greater cause on those services? The answer is almost certainly yes. So it’s a bit of constraining in the system which is happening at the met.

Do patients in need of denture care are they good attenders anyway. So if you look at the time since the last  dental visit , if you look at the decentralist patients, the dark grey , you can see that the time since the last dental visit for half  those  patients  was five or more years . So it’s a gig bed of patients who are not being seen for relines and adjustments in general maintenance. They are actually falling off the radar screen and that quite impotent o know. If you’re seeing patients in you dental and prospective patients and they are becoming back to see you every one or two years ten you are looking at the patients awe are in these two little grey bars over here. Therese grate that patients who constitute nearly half of the denture population .His is as very interesting graph, this is the likelihood of you having a visit, this is the number of visits in the last year. Often people are told you should have vastest per year one visits per j year. You can see that there is actually a nice little variation up and  down by age , it drops down the last  few years  and as you  would expect  if you super impose  on that graph the amount  of money that was spent it looks  exactly like that .. It follows exactly the same pattern.

So if you look at the 75 and over group just as an example their main expenditure in 2008 was lost exactly $400 on dentistry in that year. So people  who went spent about $400  on some ting , If you then think about the  impact of poverty and what does $400 actually look like , this was a  slide that i came across at a work  shop i went  to which  looks at  nationally  oral health plan ,. It looks at the impact of oeporvery. his  here shows you what $400 looks like in terms of  payments that these patients  may receive for an  employment or for a pension or  a budget and those numbers which are  above the line this is the poverty line are below that annual spend . As you can see just to give you a relativity of what that looks like to a patient in one of those groups.

We know from lots of data that fewer patients on the card holder group have got any sort of insurance   for dental things and you can see that it’s down by about a half according to those sort of analysis. If you look at  people who avoid a dental care because of its cost than that’s twice as likely to happen if you are a card holder  across all the different  years that this data is available  for . So we know that people who are avoiding care because they can’t afford it. That’s part of the story.

So you’ve seen there is a whole mixture of interesting things that are affecting this sort of total picture of demand and workforce. So let’s think about who will provide these services. Let’s just jump to the other side of the world and look a nice little experiment. In  the UK is grappling with the  introduction of all health therapist and dental prostesitics which we have had  in Australia of course for a very long time and the idea of  ask being dowel  by other  members of the   dental team  is a very  new idea in the UK . It’s a nice model being done on it so I’m going to share that modelling with you. The UK has a shortage of dentist by round about a 4000. You recall that in 2001 a lot of work from Adelaide show that there was massive shortage in dentin in Australia bad that led to a lot of expansion in the dental education sector. This year in the UK there is a 21 % gap between demand and supply a. as a result the up so cranked up oral health therapy student, dental students aiming to be self-sufficient by 2025. The Australian government expects all of the profession in Australia to be self-sufficient buy 2020. I know that because i asked Nicola Roxanne theta question  in here office  in Cambridge about 6 weeks  ago  That’s the answer that she looked me  in the eye and  told make and that’s actually what they both [Inaudible] . I’m just stalling you straight from the horse’s mouth.

There are   actually aim in the UK to become self-sufficient, in fact get little bit of a surplus after that. So what does that mean in terms of providing care for patients who may need dentures? Tychy model this in terms  of how much  time in your week would  you spend treating patients who are over u65 and you can  see that the  proportion  for prostates over  the 20 years from 2008 to 2028 didn’t actually change at all because  they already seeing  those patients in their  practise . There was a small increase for dentist in OHT quite bout an h third. So as   soon as prostates was in traduced in the   UK they began to start to hammer away at thsi back log of work, no eat surprise there. This s the scenario that was misled if all the denture work in the UK was done by prostetus. This is the work force that you would need to handle patients in the UK age over 65. You would bed over tgathat 20 year period to grow the dentist  by  45% , the OHT by 41% and the  prostetus  by 84 %  if number terms to me that  projected  need  need form 1900 to  3493.

If  anybody is feeling like a trip over to England for a little bit of  work you can see that they have a significant shortage and that  are projecting a very , very large  increase in numbers that won’t  be provided through prostetus  training in the UK . So they are going to be net importers of prostetus in   very big way based on what you can see on that. That’s just to treat the people who are over 65 who need dentures, not those peel who are younger.

So you can see that they hake vet got a real shortage on their hands to i grapple with. What about Australia? Let’s look at how many of the prostetus workforce hare h actually providing care in Australia. I’m going to show you two reports which were  released only about  a week ago , those  one on All hope practitioners , larboard force projections  to 2025 and thesis on which is based on the  data collected in 2006 when people  did all their dental board  registration stuff.  So this is the demand projections. Here we have the demand growing it the same rate its being growing for the last 20 years. Here we have it growing at have and those is  basically five you assume this going to be a major  global melt down , everyone  is going to keep all their  hand anther  prostates and not  spend any money . Even under that scenario there is still net increase. The idea that  somehow that dental  services  on a whole are going to contract across  Australia is Ludacris , the  numbers don’t support that at all , they are going to counting use  to grow  in fact .

So i now want to talk about ratios. Because these ratios are actually very, very useful and quite informative. So in Australia at the moment he have roughly one dentist per 2000 population or 50 per 10, 000. I will show you the prostetus one at the moment but you will see it’s almost exactly a one to twelve ratio between dentist and prostetus. When i stalk about the dents number growing remember that. It’s got to be almost 112 to keep the balance right. In dentistry  they are more female dentist who statistically have been   shown to have less total  FTE hours  in the workforce , there’s been some little wobble  around dental work because of  the gribble , financial crisis and certainly with new schools .. If h you look around Australia we’ve got roughly 11, 700 dentist on the register in Australian at the moment. We had quite big shortage as i mentioned where we were short, the ration had doped down to roundabout to 46. Now the ratios is getting back up to where it should be   about 50 but the population is beginning in to grow. It’s growing at a fast rate and its demanding so the net pitcher is actually a pitcher of growth.

Simulate the number of OHT is also i rising and this shows the projections output to 2020 and 2025 where the rat per hundred thousand population will go up to about 7-8. You’ve got 50 dentist, 7 -8 OHTs and as you will see on the next coupled of slides four prostetus. So basically OATs per prostetus is sort of the magic ratio. So if i look across Australia j in 2003 h and 20005 at protesters practising in clinical practise you can see that the national average was 4.2 in 2005. So roughly 4 per 100, 000 population. The populations is about ten in the Tasmania about 2 n in South Australia butt ignoring those two wobbles most of the things are reasons close to the average of both. So the ratio per emits which is related to  per population actually has to increase and that’s got some implications in terms of total growth. Let’s look at that.

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