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The Dental Prosthetist and their Future Role in Oral Health P4

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.

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