Welcome to the next installment of Australian Dental Perspectives, articles looking at issues facing community dentistry. The material for this article was drawn from the Preventive Dentistry Forum (PDF), a meeting of Australia's leading experts in oral health.
At the most recent meeting of the PDF in May 2004, members were asked to identify the top ten issues in dentistry today. Each member presented their views and, after a lively debate, a definitive list of the top ten issues was agreed upon by the group. The following article details this list of issues and some of the possible solutions identified by the PDF.
Producing and maintaining a well-trained dental workforce was identified as a major issue in dentistry today. The group expressed concern over the volume of dental school graduates and whether their experience is appropriate to meet Australia's current and future needs. In order to maintain high standards in the profession, the PDF felt it was important to focus on building research intensive dental schools. As a draw card for leading academics, the PDF believed these schools would attract and develop young minds who can maintain high standards in the future.
In addition, adequate utilisation of auxiliaries was identified as key to resolving workforce issues. The PDF concurred that role definition is vital if resourcing issues are to be improved.
The task of running a modern dental practice is a challenging one, requiring a diverse range of skills. The PDF universally agreed that up-skilling staff to ensure that services are delivered effectively and by the right person was critical to success in private practice. Ongoing training on business-related issues was identified as important. However, equally important in the PDF's opinion were business ethics, ensuring that providing benefit and service to the patient remain at the centre of the business model.
3. Funding of dental schools
The high cost of educating dental professionals was also a major concern. The PDF argued that students leaving university with a substantial debt are often driven into the private sector where incomes are higher. While lobbying for more HECS places was identified as a potential solution, the PDF also agreed that there was potential for greater innovation and creativity in the education system. For example, increasing links between private practice and academia by using practicing dentists as part-time academics and sharing resources between dental schools.
4. Access and Equity
The high cost of dental services was acknowledged as a key factor impacting the number of people who can routinely visit a dentist. Improving role definition and utilisation of auxiliaries may go part of the way to reducing the costs associated with basic services, but improving the state of publicly funded dental care and encouraging professionals into this sector will also remain critical if access to dentistry for all members of the community is to be improved.
5. Minimally Invasive Dentistry
In order for a minimally invasive approach to be adopted, the PDF commented that a dentist should be perceived as a manager of diseases rather than a seller of procedures. However, with 90% of a dentist's income derived from restorative work, moves towards 'minimal intervention' have significant potential to negatively impact this income stream. Education was again thought to be necessary to ensure the successful adoption of this approach.
6. Knowledge Explosion and Management of Continuing Education
The "knowledge explosion" in the area of dentistry reinforces the need for ongoing training and continuing education (CE). The PDF supported establishing an accreditation body that oversees CE programs and established that the system needs to be national to avoid duplication and ensure consistent standards around the country.
7. Cost/Benefit of Technology
New technology enables dentists to provide more services for their patients. However, dentists need to weigh up whether the benefits provided by the technology outweigh the high costs involved in acquiring it, as these costs are often passed onto the patient. The PDF suggested that education is needed to ensure that technology and minimal intervention work together effectively.
8. Prevention – Best Use of Available Products
Critical to the success of a preventive approach to oral health is for dentists to become physicians rather than surgeons. However, the PDF agreed that community education will play a key role in this shift. Oral health products were also identified as being crucial if patients are to embrace a preventive approach and work to maintain their oral health on a daily basis.
While globalisation has the potential to increase evidence-based dentistry around the world, the PDF commented that it is also driving the introduction of products from all corners of the globe. Members urged dentists to critically consider the introduction of these products and whether there is a real need for them in their local market.
10. Links between oral health and whole body health
The PDF also discussed the increasing amount of evidence showing links between oral health and systemic disease. The mouth must not be seen as 'separate' from the rest of the body, but rather an integral element that contributes to a person's overall health. This trend provides further support for a shift in perception that focuses on the dentist managing disease rather than selling procedures.
The PDF's discussions confirmed that dentistry in Australia is increasingly dynamic and complex. By identifying some of the major issues and potential strategies to address them, the PDF hopes to have contributed to meaningful discussion that will form part of a blueprint for success in the future.