Dr. Vinograd lecture’s on biocompatible materials in dentistry:

Aging on the prostetus workforce the average age of the prostetus workforce is going up. You can see its risen from  2000 to nearly over  50 and most people in the room, looking around a little bit , there’s  quite a few of you that are  aged over  40 which is great to see but the hat is basically a bulge in the distribution , this is the dominant  group . This is the relatively small group at a younger age and that actually quite different as we will see in moment from dentistry there is a bulge at the end. The prostetus as a whole is aging and that has questions we can ask about replacement.

The dominant group we have in the 40 – 49 year old grow here how long did you want to keep working    that you might want to ponder because those who are coming after you are relatively small not he number at the moment and that’s why the ability to meet this demand i think is going to be a huge challenge. Just to show you how  different  it is for dentist you can see there is a very  rage proportion of  dentist who are age less than  30 and that’s been the outflow all  the  increase in dental  programs in the country . The workforce is not much better balance between these less than 30 and those age over 60. Just to go back you can see the distribution is all skewed over one side so the question of a replacement is going to be a big question because this group over here are pretty small in number in real terms.

I’m going to skip of the pattern of work and try to draw all these comments together for you. What’s have we sort of discovered through this data. What you can see is that there is a burdening gaining community , particularly in elderly females, they’re ore medically compromised woos the complexity of  patients are riding , there are more daisies and tooth loss in rural remote, indigenous , low SES, low education  parts of the community and because of that  it here Isa Mel distribution  towards  card holders and people who are  lesslikieleiiy to have dental  insurance and who will delay care and postpone because it’s too expensive . The complexity of care will also mean that there is going to be a greater need for things like implant stabilisation because of the driving effects of things like resorbtion. We’re going to then have a great need, that’s that projected demand d for more removal partial dentures as well as fairly consistent demand for complete dentures.

This things are going to be the drivers. Having said that let me just return to work mix.  On average in a  typical week in austral is ait  has been  estimated that four dentures represent  about  one third of the work that  is done and repairs the  full dentures represent about  the work which is done in practise, partials about  1/4 and partials  repair abbot  another 1/5. This is averaging all prostetus across all sectors in Australia in 2008, if you thinkm abotu the divers for those thinsg in the futuree the nuber of edentalist will drop by only 10 %. Theme number of partially edentalist is actually rising and I’m showing you the demand projections yet the prostetus workforce is gaining and the replacement dynamic is small and rather more feminise. To me there is a gap between the demand and the supply side. I will thinking it is there is definitely some space to think about what could be done into the future.

The [Inaudible] workforce is not growing in numerical terms at the same rate as other groups. Proportionally it’s shrinking, the ratios seems matched to other demans but us sort of a razor blade edge and the team competition in changing. I think this i a really water shed moment for  dental prostetus  to think about what should  out profession look like in the  future  given that these are the demand  for care which are coming down the pipeline  more of the same and if  you look at the  UK  situation they need to increase  by 3 or  4 fold so they have  massive shortage because again they  didn’t plan workforce hobby  as well as we have done either  well or by accident   in Australia . I think they are the kind of the wide angel’s shots of the profession that you could look at.

To finish what does that mean for the future. well treating more difficult cases that means more stuff like you are doing at this conference , more CPD , more learning , more sharing information with other  groups  , particularly learning more about  medical  compromise and  comorbidity .A great emphasis in  mainitnting real health because more people are going to be holding  more complexes dentitions in the future and of course a greater focus  on things  that are related to dental implant care . I guess those areas to me seem to be the learning needs for the future and finally generational change. I can see the small  groups  of  prostetus coming through are going to be  faced with an enormous workforce challenge and i think the profession at large  could be and perhaps should be discussing some ways that it can think about  planning  for the future.  Think those who have sort of given you the dooms day message don have the analysis form the numbers i have shown you today. I think the numbers speak for themselves pretty clearly. We need more, we need more to do the services that are going to be demanded but it is where those patients are who they are that within k is actually the tricky bit.

I haven’t shown a lot of information , i would  be certainly happy to share those because its allay in the public domain to share  it with  so if  you want to copy of the personation then certainly email e me or  perhaps the association  who i will provide it to as well. Thanks you very much it’s been a pleasure talking to you u this afternoon.

1: We’ll take some questions from the floor. We’ll take two questions form the floor. We just need to keep in task for the next speaker.

Audience: Just quickly the summary of what you just told us that the workforce on a whole is not growing and we all want to work less. The client base or the potential workforce  generally increasing  particularly months the poorer and  the people who are less well to main their teeth so the demands time wise against us are increasing , we want to do less, the sort of people we are looking to  deal with are lower socioeconomics and we have the least funds available  yet of you look ta the contrast of  this morning’s lecture was about doing  dentistry  as expensively as  possible  both time wise and dollar cosies.  The association that is pushing the industry has harassed  to be spending time here rather than making teeth for  people and you are saying also … how do you  marry  that up , can you speak to the contradiction there in .

LW: I don’t think there is actually a contradistinction therein. I think there are bunch of priorities that are inter meshed. If you want to be an inefficient t quality  provider then you need to do [Inaudible]  as a responsibility so i see that as an investment in quality and i think most people will argue that  there is some evidence that will  support that’s  that’s actually the cases.

My second point is that i guess the argument that you can draw again taking the points form Andrew’s presentation is that this regroup of the population is mostly in the card holder group and most of the prostetus and the private. The question is actually about funding this per people to be treated in your precise sent it. That what it’s about. It’s about whether you want it to call it dental care but some realistic funding model for the SES patient with the need to be seen in the private sector setting because n if you got that you’ve actually git many elements of what is could call the unifying solution.

Audience: Then you’ve got full up and lower at $202 government funded plus a paper load witch adds hours to the actually time in wish to do it and if we were to take primary impression that takes as long as we too this morning registration which I guess we will find out about later on how on earth do you see us ever getting back into a surplus in 2013?

LW: One of the struggled for government has been proving a fee which the government feels is fair. They don’t want the fee to be so high that people might want to over service. So its the ebakcne  between trust and control an i think once that  balance is struck apporiotately and  the givemrntent sort of at the federal level is looking for solutions because they know that dental needs are not  evenly  idstributedin the community , they know they sit in certain pockets so the question is do you expand the public convector too proved those care or  do you allow those  patients to be sent to the private  sector at a supportable  rate . I think that’s the limit for the government and that’s what they have been looking at several different solutions that might actually involve doing both of those things. I think in reality you have to probably do both some private sector care which is essentially u outsources as well as some true public csecortr care. I agree with you that the finding received for it is a struggle. Those patients occupy a significant chunk of the practise I work in and that’s a struggle for me in some ways, it’s a bit of an sdihormony for the patient. I sort of work on the [Inaudible]  and roundabout but i agree it’s an  increase  challenge because there is more  regulation , more compliance , more paper work and  so on .

I think when we  have discussion with government it’s our opportunity to a reticulate those costa and those  impacts , its not just saying give us an extra  10 or  15 % there are the reasons for it because these ram the extra compliance cost that we  had to  carry . Here are the swings and found about that’s why I think it’s important for the association to make representations to movement met about hate are fair effective solution because the government has to do something to help people out for dentistry for people in Australia. They have told that to me, it’s not great secret. They have to do something. It’s  up to us to give them effective  solutions and those  things will involve them spending  some money but that’s one reason  why we all pay taxes [;laughs] .

1: I think Laurie was in charge of the federal budget for dental we would probably all be in much better place but i really want to than Laurie for sharing his knowedleing and all those sstatyiitrsitcs. We all think we know   what the idea is or what’s actually happening  out there but he’s giving  you  food for thought and i want to wince again thank him form h association for coming in i and delivering us today .

It should be 1 per 12 in the ACT of course it’s a bit different in Tasmania. So the ratio is actually out of whack in those two states but if fact it’s much more in the lime ball in all other states where it is almost exactly matched to the ratio of dentist.  So if you look around Australia at the moment, few more in Tasmania, few more in South Australia but think about rural and remote. That’s got a very low number. In original has got the highest at 5.9. So the most protesters  during the places that are nice to live their large centres but  in  fact a lot of the dense  and the need is actually in the areas that are  just outside where the ratio so lower, at the lower end . So this is not jay disiilimialr picture for dentist but there is also a Mel distribution.  And i don’t want to bore you too much about distribution by state but i want to talk about the total number of procedures over   time. SO the populations in procedures numbers are very similar to the population growth o austral. The ratio has been shifted very much and if you look a tot this slide and  you at the ratio you can see it has gone from 4.2 , 4.5 , 4.4, its basically floating around at about  4 and a bit  per 100 , 000 population  since 1998 . So the real availability to the population is actually not increased and net growth is less than OHTS in density. So it’s the   proportion of the dental delivery of services is actually being a reduction as a proportion of a team.

This slide over here on labour force composition actually shows you that. We’ve got over here in 2003 we had about just over to a 1000 prostetus. In 2000 that when up to over 1100 prostetus. It went up by little bit less than under a hundred. If you look at that in terms of net growth oopt j grew by about 5%. Numbers in other categories grew at differential rates. So there  was a bit more a of a burst in dental specialist , very  big nursery in dental hygienist , there wasn’t  enough  numbers of  OHTS  to make the prediction but  you can see that there  has actually been  abet  of  change in he  balance of the health team at the margins because the  procedures  growth in numbers is ink affect reasonably small.

This will probably best show over here, this is the proportion of team member in 2006, 6 % of the dental team were prostetus. By 2020 based on the current numbers it will drop to about 4 % because the other groups numerically are increasing but iprsotedures numerically are not increasing at the same rate. Population is growing , ,all of dentist is growing , procedures  is not growing at the same rate has all of dentistry  i guess s is what I’m trying to day  here in relatively  simple terms . What does that mean for the future workforce it means whether you are going to be a bit short? Basically it that’s the number of it. What’s  I’m going to do now ids  just very quickly model some of the factors ,There is a  whole bunch listed here which  you can spend  days  discussing but  just going to model some of the factors i think attire  probably most important in that discussion . So I’m going to pull up some of the data from the form you fuelled in when you registered with you regional dental board in 2006. This is the most recent data i can get my grubby little hands on. This has been reported very recently again by AHW in thee different reports. I’m just going to exert what i think of the main line stories for those reports

First thing is that one in seven prostetus are not available for work. Doesnt mean that they are at home having a sick. It means they are not working they are retired, they not working as a prostetus even those they are registered as a prostetus. I believe if you add up those things up hats 14.8%. That’s one in seven avaikebele for work. Let’s not think about those who are actually in the labour force, the guys in these green box, we’ve got a 1080 in 2006. We are now down to 944. Let’s take those 944 how many of them are actually currently working in delta prosthetics. Now it’s down to 921 because of few other reasons as you can see if you sort of follow dose of those boxes down there.  Then you think about ok where they are, so if you look at the change in proportions you can see the number who in remote areas has actaully dropped. So there are list in the places that have the most disease is the first point and if you look at their distribution its remaining rough proportional to dentist, this two slides have got roughly the same proportions. Who are they mostly working for? The answer is mostly for themselves. 8.15%. Not in the public sector even though you may be seeing some public sector patients.

If you look at the type of practise here it is for procedures, private practise represent the domain at and this the same for hygienist dental specialist as you would expect. Most of the Australian industry 8- % -85% is private sector delivery as well all know. What about gender?  Gender is having a huge impact in dentist. In many dental schools female  dental students are the   domain at group and that  been a trend which is being sort of steadily increasing over a number of  years , Into he  procedures labour  force the female participation has historically been quite small but it is growing  That has influences on the hours per work  and on the patterns  of work and on the  career aspirations . If there is a feminisation occurring in denture in Australia at large which i  believe there certainly is then we need to have and think about what that means in terms of full time equivalent workers. So 10% of the prostetus in 2006 were women. The percentage  have grown from 80 %  to just over 10 5% .Now it  will be about  11% , maybe  10 %  of females    on  average , do several hours less  paper week and   hour an average ,  6 years younger . They have different patterns of work and interestibhly enough they tend to be more likely to work in the public sector which is weird. There is actually more of the patients who actually need that sort of treatment.

There is quite an interesting alignment which has been happening but much more so in the female part of the prostetus world. Just to show you the proportions in 2011 44% of dentist in Australian were women. It is predicated that by the end of this year or early next year that number will reach 50%. Isn’t that amazing? in  period of time  from 2000 – 2012 that’s going from , that’s basically doubled in real  term . It’s just absolutely remarkable. Look at  procedures  it’s at the moment siting somewhere between  11 and 16% .It’s very hard to get  accurate  current data  at this but there  basically the low and the high  trend limits when i did the mathematical modelling . That proportion is going to rise. Now i don’t know whether that is going to continue to rise at the same rate as it has for dentist but in denture it has doubled in ten years. That has an impact on dental workforce.

So let me just make a couple comments about working hours across a few different parts of the county. We’ve already talked about gender a then sort of all wrap it all up in to a couple foo closing comments. If you worked out  how long you worked  last  week  you would probably find you working the same number  of hours as you were in 2000 because there has actually been no change to working week . However, the prostetus in this middle bend of age 35- 39 are those who are working the most hours per week. Now note the figures for dentist what are put inside the yellow box over here. Dentist work on average 38.4, females work on average 33.5, males 40. 3. Remember   i already told you when you feminise a workforce you normally drop 6 or 7 hours pew week on average. That’s what the data   show. I; m it being sexist in any way, far from it. Just saying this is actually what the numbers show me. If you think about the drop by age as you’re prostetus workforce ages the older practitioners are lively to work less hours and that’s exactly what you can see here. The average hours worked per week actually drops of.

According to you state if you are in ACT you work the most hours 46.4 in WA you work the least hours. If you work in rural and remote hours you work 47.5 which is more than anyone else in the country and that because you have the most demand. It sort of makes sense doesn’t it? The natural average is 43 hours per week. Just remember that when you go back to  work next week and think about he many hours you’re going to work that’s the average and if you understood this is the  average distribution by state and i just put in the red box over here the distribution for males versus females. You can see the difference in practising hours for males and females there.

That’s [Inaudible] i won’t bore you with. Interestingly if you ask people why they are not working 43 or 47 hour peer week you get this answer, this is that analysis for those who work part time, less than the 35. About a third of them say  it’s because of their personal  preference or because of household duties  and of course this is the terns that  we’ve seen happen in dentistry whereas  the work force become  feminise you see a life choice and  you also see household duties. Note there is about 29 % who said there wants enough work around anyway so things were a bit quiet. Which is interesting given that there is demand, perhaps not in that location.

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– Dr Daniel Vinograd, DDS.

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.

Here’s the percentages which that graph is based from these are the ones that are known, not projections, these are the actual data from the national oral health survey. What i want you to look at is the trend here. So in 1979  across the encore  Australian population 15.4% roughly 1 in  7 people were  fully adentalist and by  2005 that  had dropped to 5.2 % air in 1 in 20 . Think about what happen to the population of Australian between 1979 and 2005.  You only need to go on the road in the [Inaudible] or any capitals in austral and to get the answer to that question. The answer is the population now is much, much arranger and so if the population has increased, has doubled in that time then 5 % would have been 10 % of the same number of you had kept the denominator constant.

I know it’s after lunch but hopefully you can keep the lower proportions at the back your mind. If i we look internationally we are actually doing very similar to Canada, and to the US in terms of the actual adentalist rates. So there is nothing funny happening in Australia. These are the trends that are being seen in the developed countries. Nothing unusual, that’s good to know. This is the modelling into the future. If we look at this graph at where we are not which is 2010 or 2011 just over her to 2029 what t you can see is that the h rate of reduction is actually slowing. If you look at the intervals and you look at the amount of the reduction from here to here and so on it so actually per annum beginning to slow up.

That’s the first thing, it’s not going in a proportional rate. This is a bit like what we saw in terms of the carriage reduction, it actually flattened out in 2004 and then it began to rise again. This is my most important slide to remember of the afternoon slide for you. This will bring cheer to your hearts. Look at the number of head count, head count of peopled who are fully adentalist in 2005 which i told you there is a 1.05 million people and in 2020 its still 904, 000. It’s only reduced a little bit over a period of 15 years. So straight away that gives you a li bit of an incline and those arte people who are decentralist. I’m not eve talking about the partially decentralist patient.

This is that actual head count data and oust people don’t even think about it in such a simple way. In your practise you’ve got a couple thousand of patients on your books. In 2020 you will still have a couple thousand patients on your books the same basic demand in communities is actually sitting out there. That’s just for four dentures. Complete tooth loss is not distributed equally around Australia. It is different between capital cities and outside capitals by almost too times. So you are twice as likely to have some of these fully dentures outside of capital century. If you are 75 years and over once again you can see this difference in distribution and if you look at annoying who has less than 21 teeth you also see as discrepancy. This morning when Andrew was giving you that great plug for the northern territory, he said it kind of appears there’s a lot of work, it’s a nice place to live. In terms of disease there is more missing teeth in areas of   Australia that are remote and rural per head of population than there is the major cities. Yes that’s where the workforce is mainly distributed. If people feel they are not busy enough then that might be something to have a think bout. If you are looking at this one over here this is capital virus non capital city complete adentalism in different j age groups. Well ignore the 15 – 34 bit look at tithe 55 -74. Its about 40-% and the over 70s is still high and overall it’s nearly double.

So in terms of where people who are fully adentiollious are they’re more likely to be an outside a capital city, in terms of post code analysis. A little lesson for you there. If you got to rural end and remote versus urban you can also see that there is some little differences even though there aren’t   quite so marked over here. This is urban, rural and remote.  The problem with this particular  study worthies The National Telephone survey is that it  under represented  a lot of the groups in ritual  and remote areas  because ethos past codes h are list  well populated . So there is little bit of an issue there.

What about card status and missing teeth. Well as i mentioned to you earlier if you are eligible for health care card then in any age group the dark gay bars you are going to have roughly twice the likelihood. So if you think about public sector, health services delivery then public sector delivery outside of capital city is where a lot of denture work is going to be done. In the moment  81% of  procedures in Australia and therefore as a snap shot about  40% of you are sitting in this room then 80 % of you into room  will probably work  largely in the private sector and probably in the  a larger centre but the   dentuurelisnm is  slightly off to the side . Depending on the catchment of your practise.

There is some pretty big qualities. Here is some more analysis of some recent data for you. This is looking at the 55  and over so in turns of  percent adentalist the card  holders are about  2 and a  half times  higher, less than 21 teeth  about   two and half times  higher and untreated decay about  40%  higher so card holders  have the drivers  for a lot of the need into the future. I think that would be a fair comment to make.

Shagging the same sort of trend here. Once you ‘ve seen one of these graphs you can  work those out pretty  quickly, card holders  versus non card  holders in different  age groups are morel likely  to show complete  tooth loss. This is the 55 and overs. This is the 60s and over. Once again the card holders and the harbours and the non-card holders are the lower bars so it doesn’t matter which particular study y that you look from, there is a repeat in pattern that begins to emerge from this sort of hard numbers around Australia.

This one , percentage of people  who wear a denture , card  holders versus non chard holders arts  you expect the card  holders here in purple are going to be higher and that’s  true  but the number does not  match the proportion of those who have more  missing teeth . That  tells me that there is a larger  amount  of  untreated need  in the card holder population ,EG  , waiting list to have dentures  made in petrel who are missing teeth now . Any survey you do of the population will certainly reveal that to you. There is untreated need out there in the community, there is no doubts about that t whatsoever.  What if you look at indigenous communities? If you look at the DMFT it certainly is a bit high particularly in the  younger age group but  if you look hat the untreated carries you can see its almost doubled and the rate of being adentalist across the entire community is almost tripple . So again i you will find indigenous  patients  will tend to be over represented  in terms of  people who are going to be getting severe dental disease  and slosh  having missing  teeth and therefore needing some level of replacement .

So what does all that mean? If you package all that  together in terms of  simple , how busy is my appointment  book the answer is the projected  demand for services  for  these sorts of patients is going to go up . It’s been going up and it will continue to go up.

This is from an analysis that only came out a week ago. This is brand new, web ink data   for you. This is prosthetic treatment needs across all of Australia modelled according to patient age. This is the current data, this is storm 2008 / 2009. As you can see as someone age goes up the mean number of prosthetic services per patient increases particularly of the age of 45- 54 years which is sort of what you would expect. There is a demand that links to age and the age distribution. Remember the coffin comment i made, the age distribution is changing.

Let’s give you some hard numbers, if you turn into literally specific occasions of service the box in the red are i the services for removal prose. The row above is crown and bridge. If you look at those one over here this is in thousands s this is under 1.8 million in 2005 will rise to 2.7 million in 2020. That’s assuming that there is only half of the current rate of per capita growth. This is an extremely low projection. Even that shows think you would agree ire p pretty significant increase in terms of projected and demand for care.

By 2020 its certainly going to increase if you take the most conserving protection which s hack od the current per capita growth rate, It  will incease by  about  24 % and if you take it at a realistic rate which is the current rate of per capita demand  it will go up by nearly 40% .  There are patients in need. there is tooth loss in certain groups  and there is demand so all the things that  drive practise business are actually sitting there  and they’re fairly will described  in literature today . So  in this report which is the report  that just came out  on  predicted dental demand to  2020 the removal probe services were projected  to increase by 52% an did you think abbot heat that means in  practical terms that going to mean a  lot more partial because the  patent of  adentalist have changed from  fully adentalist-ness to more wards partially adentalist-ness . So more partials.

Then if you think about those  people who were are e going to be  getting partials can  we sort of  predict who those people are going to be ,chances are from the modelling that’s being down  they are more likely living outside the capital city , they are  moreleoluy to  be in a low SES group , indigenous and have a lower level of schooling . There are   patients who may be more likely to fall into a public sector service five they are in an eligible population group. So once again you can see it’s a question about the distribution of workforce that should match that. It should be quite interesting.

So having said all of that is this evenly distributed across the country?  If you look around Australia you can sees that, you loo at the 55 group which sis the light grey and the 75 which are the dark grey you can see that they are actually fairly consistent across the country. There is not not a lot of variations. Few little wobbles in South Australia but nothing of any great major distribution. So is people actlaluu being seen is the next question.  Well, return to my comment about card holders.  One in two adults age 55 currently is eligible for card. If you look across sasutsrali at sort of a big picture level. That means list of demand for public sector care and of course lots of waiting list and lot of hardship and postponing treatment for people who can’t affords it in the private executor. That’s just the reality of the world we like in today for a whole range of reasons.

Several very effective types of varicose vein treatments are available. When performed by doctors with the right training and plenty of experience, they can be very effective. They include:

Endovenous Laser Treatment

To correctly determine if a patient actually has varicose veins, a doctor conducts a duplex ultrasound that determines if there is saphenous vein insufficiency (see how to legally offer laser treatment). This is the most common cause leading to the formation of varicose veins. Once the diagnosis is made, the doctor will determine if endovenous laser treatment is the right way to correct it.

This type of laser treatment takes 30 to 45 minutes and can be performed in the doctor’s office. There is no downtime and no scarring. In most cases, the skin is numbed before the treatment and the vein is accessed through the skin using with the guidance of ultrasound and through the use of a catheter inserted into the vein. A laser filament is put through the catheter and ultrasound verifies its placement. A numbing solution of saline with lidocaine is introduced, then the energy is emitted from the laser as it is slowly withdrawn. This energy causes the vein to seal shut.

When the process is complete, a compression dressing is worn on the treated leg for 2 days followed by a week of compression stockings usage. Most patients return to work the day after the procedure.

Doctors often make the following recommendations:

• Wear compression stockings 24 hours a day for a week, then during the day for 3 more weeks.
• Avoid running, aerobics and other high-impact activities for 3 weeks.
• Walking is to be encouraged because it can assist in the healing process.

An ultrasound is performed 3 to 7 days after the procedure to check deep veins and again 4 weeks later to make sure veins have sealed off. Treated veins can occasionally reopen, and then an injection of a foam sclerotherapy agent or another laser treatment is required. As many as 98 percent of veins remain shut a year later.

Some mild side effects are possible. This can include redness in the treated area that fades within a few days. There may also be some swelling.

Advanced Varicose Vein Treatment With The TriVex System

The TriVex system is a newer and safer way to treat people with varicose veins that can be more effective. Patients are sometime resistant to varicose vein treatment because of the possibility of pain and long recuperation times. The TriVex system is minimally invasive and allows patients to walk out of the hospital with hardly any scarring — and there’s almost no pain within two weeks or so.

The system is used during a special surgical procedure transilluminated power phlebectomy. In this case, light is passed through the skin to aid in the vein removal. The surgeon looks at the vein with the aid of a special light and does the vein removal with a special surgical device.

While standard varicose vein removal is done blind — that is, the surgeon can’t always see what he or she is doing — the TriVex system allows for unique illumination so the surgeon can rapidly and accurately find the vein visually and make sure it is extracted completely. This means extraction is more effective, more complete and less traumatic for the patient since fewer incisions are necessary to do the surgery and the surgery can be completed more quickly. Studies indicate there is less pain and a reduced chance of post-operative infection with this type of varicose vein removal.

The procedure is done as an outpatient and often takes less than an hour to complete. Studies have indicated that this is about half the time as compared with the older hook method and that the number of incisions is reduced by 50 to 75 percent. The research has also shown that there is a need for less anesthesia — and less pain after the procedure.

These things taken together mean that the TriVex system is a safer and better way to treat varicose veins than the old-fashioned methods.

Varicose Vein Treatment Progression

Treatment of varicose veins has progressed tremendously in recent years. Once the hook technique was the most common, but complications of this method included:

• tediousness for the doctor
• difficulty of the procedure to perform
• possibility that it would leave the process incomplete
• requiring of multiple incisions
• difficulty of hiding incisions
• outdated nature of the procedure
• painful, lengthy recovery period

Surface Laser Treatment

Used to get rid of spider veins, surface laser treatment involves the use of a laser bean outside the skin aimed at the veins and the closing of those veins without an incision in the skin.

Since skin pigmentation can impede laser effectiveness, the patient is instructed to avoid sun exposure for 4 weeks before treatment. This can also lessen the chance of scarring and blistering.

While discomfort from this procedure is mild, some type of cooling may be used to make the patient more comfortable. This can involve ice, cool air or a topical anesthetic. The number and length of sessions will vary based on the location and severity of the treatment area. Often, facial veins can be treated in a single session while most locations on the legs need 3 to 5 treatments to get rid of all spider veins. Treatments are performed 4 to 6 weeks apart.

The best physicians use what is called the double injury method for treating spider veins on the leg. This involves treatment with the D940 SkinPulse S laser or a similar device followed by the injecting of a sclerosing solution into the feeder vein for the area. Laser energy is applied initially through a small, light handpiece. The size of the energy beam is determined by the size of the area being treated. By treating the vein with the laser before attempting sclerotherapy, the vein goes into spasm, meaning that less of the sclerotherapy solution is necessary. This means patients get quicker resolution and a decreased risk of skin staining a brownish color.

After this type of procedure is completed, wearing a compression stocking fro 3 to 5 days is recommended. There may be mild side effects like slight redness or mild swelling of the area treated.

The following guidelines are also suggested to the patient:

• Avoid sun and tanning beds for a month before and after treatment.
• Wear compression stockings for 3 to 5 days.
• Avoid stressful activities like running or aerobics for 3 weeks.
• Walk as much as desired to help improve healing.

While discomfort is mild, cooling is sometimes done to increase comfort. This is done with ice, cool air or a topical treatment. If multiple treatments are required as is sometimes the case, treatments are usually performed about 4 to 6 weeks apart.

Sclerotherapy

Used to treat small and medium reticular veins that supply blood to spider veins or small varicose beings that persist after endovenous laser treatment as well as perforator veins that can lead to skin ulcers and other situations, sclerotherapy is performed with ultrasound or visual guidance. The procedure involves the insertion of a tiny needle and the injection of a foam sclerosant  into the vein. This causes swelling in the lining of the vein that causes it to eventually seal closed. The vein will fade away over the course of a few weeks.

Like with laser treatment, 3 to 5 sessions may be required. Possible side effects include staining or brown discoloration of the skin that can take 6 months or more to fade away before normal pigmentation returns.

More at http://dentox.com/botox-edu-news

Of course today we see more patients  who are  showing the signs of more sever tooth wear and  graphic changes in there acquisal medical dimension and this make them much  harder to treat because  we have to  stage  any change in vertical dimension for these patients extremely carefully . Allow these patents of disease are not expressed equally across the community. They are harboured into certain groups that over express them. We often talk about 80% of the disease being in 20% of the community.  When you look at carries and perrondotisis it’s not exactly try. But the proportions are relatively right. I will show you in the next  couple of slides that dental  cares and periodontists  are linked to health care card status , they are linked to rule and remote  status , they are  linked to indigenous  status m they are  certainly linked to income and they  are  Mel distributed around the country . So we might   see a different view of the world sitting in metropolitan centre than we might if we work in a rural and remote area.

Certainly if we go into an institution, we go into a nursing home or long care facility we see some of the most sever personations of surcease   that would probably not be picked up in the telephone survey or even in the community trial where you might actually go and exam people in their houses. I guess the point I’m making is that our statistics in dental disease in Australia almost certainly underestimate the true preen cue of what’s happening.

So let me just show you some of this information. Here we have decayed teeth among dental Australian aged 15 years and over, this is fork the national oral health survey 2004. This is by capital city or none capital city. So non capital cities are the black bars and the capital cities are the grey bars buy different age groups. If you look across all there is a difference again of about one third and we will hear about the rule remote versus large centre discrepancy a bit later on but there is a repeating story here that’s going to emerge. If you analyse the DMFT of adult Australian accursing to house income or card holder status or education level it is linked. There is high DMF in groups that are low income, card holders and less well educations. That has been the case in Australia for 20 years. The discrepancies as you can see are quite large. They can be the discrepancies of 4 or 5 fold. They are pretty large. They are also discrepancies   relating to gender which in this particular analyse showing that males have a lot more untreated dental caries.

If you think about the patients who attend your practise, I’m not a gambling man but I’m thinking if i was a gambling man i would probably wager you that you probably see more females in your practise than males. Think about that one for a moment.  Males aren’t generally good dental attenders and that’s true in most parts of the world. You can discuss amongst yourselves later why that may be so. When you look at missing teeth’s you see once again household income, cared holder status, education level. So the people who are missing teeth that may need prosthetic replacement are not spread evenly across the community. They sit in certain groups and that’s got impacts on how they maybe funded for care which i will return to momentarily. If you take public dental patients in Australia and you lump them together across all of the data that you have available, this was done by the Australia Institute of Health and Welfare Accolade. If people look at the DMFT decayed missing and filled teeth by age. You can see that as patients age there is certainly a trend of it increasing.

What i want you go bite if you look at the different between the red box at the very end of the slide and you look at 1995- 1996 and 2001- 2002 you can see it doesn’t look much different at all. Where has you might have hooped there might have been some big improvement in for example in missing teeth to meet that antinational health goal. Well i hate to say it that sort of different real wants delivered up pan. There is still a very large burden of missing teeth and i will give you some head count figures for that in a moment.

Look at the people who have had extraction in the last year according to whether they were card holders or not. You can see people who are card holders, you can look across different groups are certainly different. In the 60- 64 year group it’s almost doubled. 70- 74 to almost double. Of course it almost folds away a little bit in the 75 and over because by then there is onto so many teeth left to remove in these patients. The average number of teeth are becoming quite low as a result. What about personalities. Talked a lot about carries well this one nice graph that shows the link between the most severe forms of peronditis in Australia and income. If you look at this is she prevalence, this is the proportion of the population who’ve got it according to house held income the householder income is above   $80 000 there is a one in seven chance that there is an individual the n household two has got severe periodontitis if it’s less than 20 000 that rises to about 43%.

It’s quite a spectacular increase by nearly 3 times as you probably recognise. So what’s the burden of dental disease in Australia? In very imply terms by success through prevention we have more teeth but those more teeth are in population that airs now more medically complexed with dry mouth. So there are more sites art risk for root surface carries. The amount of treatment that those teeth need as actually growing and its growing ate fairly fast rate. This is what often called the problem of success. We’ve been really successful at retaining teeth bit now there are ore tot units that can lose attachment or get carries and then be lost. So to some extent the success of Australian district is now creating a new series of challenges which will all be treating for the rest of our practising lives and in particularly in the over 50s. The over 50s is the group who are called the baby boomer group. They will over represent this group and they will have most of this problem of root surface carries.

So let’s give you some hard numbers on the number of teeth that will be floating around. If you look at the period from 1989- 2019 it’s a very long change period of hanged. over that time the number  od f premeranemtn  teeth was predicated to  increase by  500% in the  45  ad over and  double in those who were over  55 . Basically from 3 out of a million to 500 million teeth and those simple fact alone is one the big drivers for dental workforce in Australia. The fact that there is more people and those people have on average more teeth with more disease in total terms is one of the big drivers of   workforce changes in this country.

Sometimes we tend to forget, we tend to think that population is constant and disease is constant, the number of teeth’s is constant but all those things are u glacially all going up. So let’s look at rate for tooth loss then. What affects this  is obviously the size  of the population , the ages, the disease, the treatments needs of people who are mentalist who pays because that’s the access to care  parameter, the translation of someone who needs  it into actually getting service and actually finally achieving that treatment  outcome .

These are all little variable that we can spend time looking at and that would have been interesting exercise is to spend some time on but I’m going to summarise the down a for you. If you look at this adentalism across the country in proportion term is going down but in terms of a head count it’s not .This is where people have often mad e a false interpretation. If you think about this in simple terms you might say in 20 years’ time they will be very few people who will be adentalist. The proportion willingly be a 5% or 10 % so do we need a large r workforce of expel, to prove care for them? The simplistic fault in that logic is that the denominator in that equations is changing. The number of people are increasing ate   enormous rate so while the portion might be falling, the nominator is rising and so the net effect is probably going to be the status quo. Rather just giving you an option i want to show you some hard numbers so you can take some comfort from that.

The head count of people  who are fully  adentalist in Australia i you predict that over the next  15 years, fully adentalist people who total numbers of  actual bodies, bums on seats will decline only formal out  1.1 million to 900, 000. Anyone who says that by 20/20 they won’t have any adentalist people is so wrong   they are actually wrong by 900 000 people. That’s fours four. We have come back to partials because that’s just baloney as we will see in a moment. It is important to realise it’s just not a reducing percentage in one age group, it’s actually the real number of people.

Let’s look at the number of teeth versus age. Here it is, this is from a telephone survey. Remember it’s a little bit of robbery it’s the numbers that we’ve got. It’s the main number of teeth according to age a. As you can see it slips down reasonably constantly after the age of 55 and across all ages you can see that the mean numbers are round about 28 which is actually pretty respectable but an average tells you nothing about the people how are the outliers. So bare that nine mind. If you look at the percentage of dental patients and if i flip between these two graphs for a moment you will notice they look strangely very similar. The percentage of dental patients with any natural teeth at all follows almost exactly the same basic trend in terms of the rate off change which is actually quite interesting.

In 2004 according it this telephone survey in the 75 year and older group we have 70 % who had some natural teeth, at least one natural tooth. You would expect as the population ages that the trend would increase. If we broke that group down in the 85s and the 95s and so on we would start to see a further progression. That what you would expect. Now i want to show you the fallacy of the graph which is being widely shown but very poorly understood. Thesis is a digraph font he Australia dental generation and when i discuss this with the dental association in Queensland we had a really interesting discussion which might be replicated later on today perhaps. This is the projections forward for adentalism rates. This is fully adentalism in Australia. You can see by 2021 you can see how the proportions are actually fall off quite dramatically even in the oldest age groups over here. That led a number of people to say well perhaps ether is not going to be a great big need of ram workforce that is focused on replacing missing g teeth. The problem is that it totalled ignores the true head count of these individuals which inn fact is quite significant.