Has the Child Dental Benefits Schedule improved access to dental care for Australian children?

Stakeholder Attitudes, Experiences and Perceptions of the New South Wales Primary School Mobile Dental Program

OBJECTIVES

Tooth decay is a leading cause of total disease burden among Australian children. In 2019, the state government of New South Wales, Australia implemented the Primary School Mobile Dental Program (PSMDP) across five local health districts. Understanding stakeholder satisfaction of the PSMDP is an important measure of quality, to determine appropriateness as relevant to the needs of populations. The aim of the study was to explore parent/caregiver and provider attitudes, experiences, and perceptions of the PSMDP.

METHODS

This study reports on the qualitative component of a mixed methods study examining parent/caregiver and provider (oral health staff) experiences of the program. Two of the five local health districts were selected for study sampling. Parents/caregivers were recruited using flyers administered via schools and oral health teams. Interviews were conducted between 2022 and 2023. The interviews lasted 20-60 min, were recorded, and transcribed verbatim. A critical realist lens was applied, and thematic analysis was conducted. Data saturation was achieved, and bias was reduced through member checking, researcher reflexivity, and team triangulation of the data.

RESULTS

In total, 79 individuals (58 parents/caregivers and 21 providers) were interviewed. Analysis revealed six key themes: (1) oral healthcare access, (2) informed consent, (3) parental attendance, (4) rewarding experiences, (5) operational barriers, and (6) communication clarity. The PSMDP promoted oral healthcare access while some parents/caregivers reported informed consent challenges. Providers cited rewarding experiences but face operational barriers including time constraints. Stakeholders diverged on parental attendance at school dental appointments, and most importantly, parents/caregivers requested follow-up communication clarity and coordination, particularly in feedback letters.

CONCLUSIONS

Qualitative findings identified generally positive attitudes and experiences with the PSMDP, and implications have been identified that would support the scale-up and sustainability of the PSMDP across the state. Study insights could be useful for similar programs, such as extending the attendance time per child, giving greater consideration to parental involvement, and improving communication and follow-up coordination.

Utilizing Aboriginal Participatory Action Research-Dadirri-Ganma to Co-Design the Deadly Dental Home

This study aimed to co-design a "Deadly Dental Home" for Australian Aboriginal and Torres Strait Islander people (herein referred to as First Nations). Participatory Action Research-Dadirri-Ganma methods utilized respectful listening (Dadirri), self-reflective knowledge sharing (Ganma), and Yarning to design a model of care for the community. Consumers of dental services, community leaders, healthcare providers, and dental service leaders designed a culturally safe and holistic approach to dental care, bringing together First Nations and Western perspectives. A "Deadly Dental Home" is a dental service that arranges continuously available, comprehensive, coordinated, and culturally appropriate dental care. The expression "deadly" carries a sense of empowerment and positivity within First Nations cultures, representing strength, praise, resilience, and excellence. The research emphasized the integration of cultural needs into dental services. Key themes included Reaching Mob, Dental Care Delivery, and Care Across the Life Journey. Continuous and culturally responsive dental care tailored to different life stages from infancy through elderhood included hands-on education and prevention strategies. The need for a culturally competent workforce, a welcoming dental environment, and flexible appointment scheduling was necessary to foster trust and accessibility. The Deadly Dental Home model promotes a comprehensive approach to care extending beyond traditional dental treatment to address broader health determinants. Continued community engagement, partnership with dental services, and research are essential to refining and implementing this model, ensuring it effectively addresses the unique needs of First Nations people.

Australian dental practitioner attitudes to expanding Medicare to include more dental services

BACKGROUND

The exclusion of dentistry from Medicare in Australia means there is limited public funding available to address widespread disparities in access to dental care, which is provided predominantly by private practitioners. The aim of this study was to investigate dental practitioners' attitudes towards expanding Medicare to include more dental services.

METHODS

An online survey was distributed to Australian dental practitioners between November 2024 and February 2025. The survey collected demographic information and assessed support for various models of Medicare expansion and perceptions related to affordability and access.

RESULTS

A total of 447 dental practitioners completed the survey. Overall, 64.7% supported expanding Medicare to include more dental services, with higher support amongst females, non-dentists (oral health therapists, dental therapists, dental hygienists and dental prosthetists), those with more experience, and practitioners in regional/remote areas or the public sector. Respondents reported a significant proportion of their patients faced challenges affording dental care. Practitioners favoured means-tested and capped schemes that included diagnostic, preventive, restorative and periodontal treatments. Tensions between social responsibility and business imperatives were evident, with concerns raised about the impact on income, potential for overservicing, and the need for appropriate oversight.

CONCLUSION

There was strong support from dental practitioners for expanding Medicare to include more dental services, particularly to financially disadvantaged patient groups with targeted and capped schemes and a focus on essential dental care. This study reinforces the need to reform the dental care system in Australia and take steps towards universal health coverage for dental services to address disparities in access and health outcomes.

Parents' perceived barriers and enablers to providing optimal infant oral care

BACKGROUND

Early childhood caries (tooth decay) can adversely affect child growth, development and well-being and is a leading cause of preventable hospitalisation for pre-school aged children. This necessitates the introduction of preventive measures in infancy, including twice daily toothbrushing and timely dental visits. This study explored the barriers and enablers parents face in providing optimal oral care for their young children.

METHODS

We interviewed Australian parents with 0-36-month-old children about two key behaviours related to their child's oral health: (1) the timing of first dental visit and (2) twice daily toothbrushing. Parents were recruited via social media advertising and all interviews were conducted online via Zoom. Interviews were based on a semi-structured interview guide mapped to the Theoretical Domains Framework (TDF). All interviews were audio recorded and transcribed. Data was coded to the TDF, summarised, and categorised as a barrier or enabler before being grouped into themes and sub-themes using framework analysis.

RESULTS

Fifteen interviews were completed between May 2022- May 2023. Thirteen of the 14 TDF domains were represented in the data. The three most dominant TDF domains across the dataset were social influences, environmental context and resources, and knowledge. Four themes were developed from the data: (1) Conflict, (2) Family and social norms, (3) Wanting a positive oral health experience, and (4) Uncertainty. These themes represent both barriers and enablers to optimal infant and young children's oral care. Parents face complex decision-making challenges regarding their young children's oral health care, particularly managing actual and perceived conflicts with their child. Knowledge and social and family norms influence their approach to managing these barriers.

CONCLUSIONS

The key influences enabling or preventing optimal infant oral care identified in this study lay the foundation for interventions to target these behaviours. To encourage a timely first dental visit, parents need consistent messaging from dental and other health professionals. To encourage twice daily toothbrushing, parents need more support in managing their child's behaviour and competing priorities.

Pediatric non-traumatic dental presentations to the emergency department: a ten year retrospective study in an Australian tertiary hospital

BACKGROUND

Non-traumatic dental conditions (NTDC) that present to the emergency department of a tertiary hospital tend to be related to dental caries, including facial cellulitis, abscess and toothache. This study aimed to report the types of dental conditions and the characteristics of children that presented to an urban tertiary hospital emergency department for NTDC.

METHODS

Medical records were reviewed for children less than 19 years of age who presented to the emergency department over a 10-year period with a NTDC. Principal diagnosis, sociodemographic data and source of referral was obtained with treatment and investigations collated for those who were subsequently admitted.

RESULTS

Across the total 4483 dental presentations, 2481 were NTDC. The most common age group was from 0 to 3 years of age (average 6.3) and 57.2% of children were male. Dental caries related diagnoses were the most common reasons for emergency department presentations. A total of 297 children were admitted for investigations and treatment.

CONCLUSIONS

Children present to emergency departments with caries related conditions more often than traumatic injuries. Targeted interventions are needed to ensure adequate oral health care access for children to avoid overburdening the emergency services in tertiary hospitals with NTDC.

Change in Dental Visits Among Eligible Children Under the Impact of the Child Dental Benefits Schedule in Australia

OBJECTIVES

In Australia, although there have been some improvements, child oral health continues to be a major public health issue. The Australian Government introduced the means-tested Child Dental Benefits Schedule (CDBS) in 2014 to support access to dental services for children and adolescents aged 0-17 years from low-income families. There is a lack of evidence documenting whether the CDBS improved the dental attendance rate. This study aimed to evaluate the impact of the CDBS on dental visits among eligible children and adolescents in Australia.

METHODS

The study analysed the data set from the birth cohort (B cohort) in the Longitudinal Study of Australian Children (LSAC). This is a nationally representative cohort survey collected biennially since 2004. The information on dental visits in the last 12 months was reported by the parents. A difference-in-differences analysis was used to examine 22,985 observations in the period 2008-2018. A propensity score matching (PSM) method was employed as a robustness check for the main findings.

RESULTS

The proportion of children and adolescents eligible for CDBS in the six biennial surveys from 2008 to 2018 was 62.0%, 54.4%, 47%, 41.2%, 35.5%, and 28.9%, while the proportion of eligible individuals visiting dentists was 38.0%, 45.6%, 53.0%, 58.8%, 64.5%, and 71.1%, respectively. The analyses showed that the CDBS policy had a statistically significant and positive impact on dental visits among eligible children and adolescents. There was a 6.1-6.4 percentage point increase (p-value < 0.001) in dental visits across different specifications after the introduction of the CDBS policy.

CONCLUSION

The removal of financial barriers was beneficial to improve dental visits; however, the target group still faces the other remaining barriers, especially those related to inequalities in the social determinants of health, impeding the uptake of free dental services.

Triple Jeopardy in Oral Health: Additive Effects of Immigrant Status, Education, and Neighborhood

PURPOSE

To estimate the additive effects of parent's nativity status/language spoken at country of birth, education, and area-level socioeconomic status (SES) on untreated dental caries among children aged 5 to 9 y in Australia.

METHODS

Cross-sectional population-based data were obtained from the 2014 National Child Oral Health Study (N = 12,140). Indicators of social position used to explore additive effects on dental caries included nativity status, language, university degree, and neighborhood socioeconomic level. Multiple-way interactions were examined, and departure from additivity resulting from 2- and 3-way interactions were estimated as relative excess risk due to interaction (RERI).

RESULTS

Children marginalized across multiple layers of disadvantage had substantially higher frequencies of dental caries compared with children in the most advantaged category. RERI for the 3-way interaction between immigrant status, education, and neighborhood SES was negative (RERI3: -0.14; 95% confidence interval [CI]: -1.68, 1.40). When operationalizing language, education, and neighborhood SES, the joint effect of the 3 marginalized positions was additive (RERI3: 0.43; 95% CI: -2.08, 2.95).

CONCLUSION

Children marginalized across multiple intersecting axes of disadvantage bear the greatest burden of dental caries, with frequencies surpassing the cumulative effect of each social position alone. Findings emphasize the need to account for intersecting inequities and their oral health effects among children with immigrant backgrounds.

KNOWLEDGE TRANSFER STATEMENT

Our analysis underscores the necessity for policies and public health strategies targeting dental caries-related inequities to comprehensively account for various indicators of social disadvantage, particularly encompassing language proficiency, educational attainment, and neighborhood socioeconomic status. Within the intricate interplay of these factors, we identify a vulnerable subgroup comprising children with the highest prevalence of dental decay. Therefore, prioritizing this specific demographic should be the focal point of policies and public health initiatives aimed at fostering equitable oral health outcomes.

'The Letter Says I May or May Not Be Eligible… It Is a Big Doubt and Frustrating:' A Qualitative Study on Barriers and Facilitators to Children's Oral Healthcare From the Perspective of Karen Refugee Parents in Victoria

BACKGROUND

Australia has a longstanding tradition of resettling refugees and individuals in humanitarian need. Among these, the Karen community from Southeast Asia is rapidly growing in Australia. The absence of data on the barriers they face in accessing dental services is concerning. This study explores the barriers and facilitators Karen refugees encounter when seeking oral healthcare for their children in Australia, aiming to understand their experiences.

METHODS

Using a qualitative research design with a phenomenological approach, we conducted semi-structured interviews with 23 parents (17 females and 6 males) who had been in Australia for 1-17 years. Each interview, lasting between 35 and 60 min, was audio-recorded and transcribed verbatim. The transcripts were thematically analysed through an inductive, data-driven approach, focusing on open coding and participant-based meanings.

FINDINGS

Nine main themes were identified. At the individual level, cultural practices, parental behaviours and perceptions were the primary barriers. At the organisational level, long waiting lists in the public dental system were significant barriers. Additionally, a lack of knowledge about financial benefits and government support for children's dental care deterred refugees from seeking dental services. The results also highlighted the strengths of support networks, free dental care for children and school-based dental care programmes. Parents reported experiences of inadequate oral healthcare, citing issues such as insufficient cultural sensitivity training among dental service providers, interpreter problems and shortages. These experiences revealed gaps in the provision of oral healthcare services.

CONCLUSION

When designing tailored oral health promotion programs, all stakeholders must consider the lived experiences of refugees as valuable sources of information.

PATIENT OR PUBLIC CONTRIBUTION

The authors thank the parents and carers from the Karen refugee community for sharing their experiences with the oral healthcare of their children. Recruitment was facilitated by the Karen Organisation of Bendigo and Bendigo Community Health Services. An interpreter from the Karen refugee community assisted in all the interviews.

Geographic patterns of dental service use in the Child Dental Benefits Schedule: 6 years of claims in the Longitudinal Study of Australian Children

ISSUE ADDRESSED

This article explores the geographic patterns of claims within the Australian Government's Child Dental Benefits Schedule (CDBS).

BACKGROUND

The CDBS is a means-tested schedule implemented in 2014 to improve access to dental services for children. Under the schedule, eligible children receive funding to subsidise dental services.

METHODS

This study used data from the Longitudinal Study of Australian Children and linked data from the Medicare universal healthcare system, to examine dental service use amongst a subset of children aged 10 and 14 years. Dental service items were classified using Two-step Cluster Analysis, and appointments were analysed using multinomial logistic regression. Geographic characteristics were included as predictor variables.

RESULTS

The study found that the majority of dental appointments were non-operative (70.7%, n = 5808), with diagnostic, radiographic, and preventive items being the most common. There were slightly higher proportions of operative appointments (fillings and extractions) compared with non-operative appointments in remote and very remote areas, low socio-economic areas, and Queensland and Northern Territory. Cluster analysis identified eight groups of non-operative appointments and four groups of operative appointments. New South Wales had a higher proportion of 'prophylactic IV' appointments than any other State and Territory, which included debridement and topical fluoride services.

CONCLUSION

Cluster analysis identified distinct groups of non-operative and operative appointments, each with unique characteristics. The distribution of appointments varied by State/Territory and region.

SO WHAT

Further research and interventions are needed to ensure equitable access to services and a shift to preventive care for disadvantaged populations of Australian children. Exploring alternative funding models that support clinically relevant claims, rather than maximising financial benefits such as time-based renumeration models should be explored.

Socially constructed beliefs and the uptake of the Child Dental Benefits Schedule

BACKGROUND

The Child Dental Benefits Schedule (CDBS) provides automatic access to subsidized dental care for eligible Australian children, but uptake is low. As cost is not a factor, socially constructed perceptions, which may be subscribed to without personal experience, were explored as potential barriers.

METHODS

Two studies with parents (child <18 years) were conducted. In Study one (N=317) participants completed a free-response task eliciting socially constructed perceptions about the dentist. These were factor-analysed in Study two (N=231), and the salience of these perceptions in relation to uptake was measured for the 113 eligible to access the CDBS participants.

RESULTS

In Study one, similar positive, negative, procedural and time words were elicited across conditions. Study two revealed Negative, Positive and Hassle perception factors associated with the dentist and that 61% of eligible participants had accessed the CDBS. Generalized Structural Equation Modelling with eligible participants revealed Positive and Negative perceptions were negatively correlated, Negative perceptions were positively correlated with Hassle, and, as Hassle increased, the probability of parents accessing the CDBS significantly decreased.

CONCLUSIONS

Confusion around eligibility to access CDBS is still an issue. Low CDBS uptake may be associated with perceived hassle associated with the dentist, which may reflect parental negative perceptions. © 2024 Australian Dental Association.

Qualitative study exploring general dental practitioners' views of MIH and its management in the UK and Australia

BACKGROUND

Molar-incisor hypomineralisation (MIH) is a prevalent condition, and how it is managed varies greatly between professional groups.

AIM

To explore, and compare, the UK and Australian general dental practitioners' management of MIH in children.

DESIGN

Face-to-face (remote) semistructured interviews were undertaken, using country-specific topic guides. Participants were purposively sampled and recruited through national conferences and research networks (eviDent Foundation and Northern Dental Practice Based Research Network). Interviews (from each country) were audio-recorded, transcribed verbatim and independently analysed using thematic analysis.

RESULTS

Two major themes arose from the UK interviews: (i) decision-making complexities and understanding of treatment options and (ii) need for specialist input. The main Australian themes were (i) multidisciplinary approach to management supporting decision-making complexities and (ii) economic implications for care. Several difficulties, such as financial implications, multidisciplinary care and clinical decision-making, were identified as barriers to effectively managing MIH by GDPs in primary care.

CONCLUSION

There are similarities and differences in the knowledge and management of MIH amongst UK and Australian nonspecialists. The different healthcare systems played a significant role in shaping how GDPs manage MIH with barriers relating to affordability, multidisciplinary care and clinical decision-making.

Association between lack of dental service utilisation and caregiver-reported caries in Australian Indigenous children: A national survey

AIM

To investigate the association between the lack of dental service utilisation and dental caries in Australian Indigenous children.

METHODS

Data from the Longitudinal Study of Indigenous Children, which is a longitudinal population-based cross-sectional study in Australia were analysed. A total of 1258 children were included, consisting of the baby cohort and the child cohort at Wave 7. Logistic regression analysis was conducted to examine the association between caregiver-reported child dental caries and dental service utilisation. Multiple imputation using the fully conditional specifications approach was used to account for missing data.

RESULTS

Around one tenth (12.3%) of Indigenous children did not see a dentist when required. Lack of dental service utilisation was associated with an increased likelihood of caregiver-reported dental caries (odds ratio (OR) 2.4; 95% confidence interval (CI) 1.5-3.8) and teeth removed due to dental caries (OR 2.3; 95% CI 1.1-4.7). These associations remained after adjusting for confounders (caregiver-reported dental caries OR 2.3; 95% CI 1.3-3.8; teeth removed due to dental caries OR 2.1; 95% CI 1.0-4.4). The reasons reported for not utilising dental services when required were the lack of an available dentist (31.4%), difficulties with physical access (19.8%), long waiting times (13.9%), financial issues with cost (5.8%) and feeling that 'they could cope' (4.6%).

CONCLUSIONS

Lack of dental service utilisation was associated with dental caries and extraction due to caries in Australian Indigenous children.