1. health and fitness
2. dental care

Improving Victoria’s oral health
July 2007
Department of
Human Services
Improving Victoria’s oral health
July 2007
Published by Victorian Government Department of Human Services,
Melbourne, Victoria.
July 2007
Also published on www.dhs.vic.gov.au
© Copyright State of Victoria 2007
This publication is copyright. No part may be reproduced by any process except in
accordance with the provisions of the Copyright Act 1968.
Authorised by the Victorian Government, 50 Lonsdale Street, Melbourne 3000
Improving Victoria’s oral health iii
Ministerial Foreword
Improving the oral health of all Victorians has been a priority of the Victorian
Government. Over the past seven years, the Bracks Government has allocated an
additional $158.2 million to oral health. These increased funds are being used to:
• reduce waiting times
• increase access for preschool children
• improve recall times for primary school children
• expand the dental workforce
• build new and bigger public dental clinics
• promote oral health.
Improving Victoria’s Oral Health describes the Victorian Government’s proposed
directions and strategies for the next four years. It has been developed by the
Department of Human Services in consultation with Dental Health Services Victoria.
Over the next four years, the Government will continue to invest increased resources
into public dental care to maintain the reduced waiting times and to reduce them even
more. However, I also believe that there are major opportunities to reorganise the way
we manage and deliver public dental care so that all Victorians can enjoy better oral
health.
For example, there is still a gap between Victoria’s oral health requirements and the
number of clinicians available to meet them. Recruitment and retention approaches
need to be reviewed and improved in order to produce a skilled and competent
oral health workforce of adequate size and distribution to meet the need of eligible
Victorians.
We need better integration of child and adult services and better integration of dental
care into community health services. More integrated service delivery will provide a
family-centred approach that also makes better use of expensive dental infrastructure.
Community dental clinics need to be planned and developed in a way that balances
accessibility with the need to create clinics and teams that will attract and retain
clinicians and provide them with opportunities to develop skills and experience.
Finally, and very importantly, there are groups in the community whose oral health
remains much worse than the general community. Providing programs and dental care
to these groups will be our number one oral health priority over the next four years.
Improving Victoria’s Oral Health is a commitment by the Victorian Government to
continue to maintain and improve the oral health of all Victorians.
Hon. Bronwyn Pike, MP
Minister for Health
iv Improving Victoria’s oral health
Improving Victoria’s oral health v
Contents
Executive summary
vii
Introduction
1
Setting the scene
Victoria’s public dental service
Recent achievements
Why good oral health is important
3
3
5
8
Policy context
Growing Victoria Together and A Fairer Victoria
National Oral Health Plan 2004–2013
Care in your community
Other relevant policies and strategies
15
15
15
16
16
Vision and principles for improving Victoria’s oral health
Vision
Principle one: The best place to treat
Principle two: Together we do better
Principle three: Technology to benefit people
Principle four: A better health care experience
Principle five: A better place to work
Roles and responsibilities
Minimum standards
17
17
17
17
17
17
18
18
19
Strategic development
Oral health service planning framework
Integrated service model for adults and children
Workforce strategy
Oral health promotion
Responding to high-needs groups
Oral health funding, accountability and evaluation
21
21
24
26
30
33
36
Appendices
Appendix 1: Community dental clinics in Victoria
Appendix 2: Dental ACSC admissions ranking by catchment for 0–14-year-olds
compared to all ACSC admissions ranking, 2004–05
Appendix 3: Maps of catchment areas
Appendix 4: Regional profiles
Appendix 5: References
39
41
42
45
53
vi Improving Victoria’s oral health
Improving Victoria’s oral health vii
Executive summary
Introduction
Victoria’s public dental health services are a vital component of the Victorian health
system. This strategy proposes a vision and set of principles that can guide the
development of oral health care over the next four years. The strategy also outlines
six strategic developments or major projects that are the actions that will move the
public dental system towards realising the vision.
Setting the scene
Most dental services in Victoria are provided by private practitioners and paid for by
clients with or without the assistance of private health insurance. Following withdrawal
by the Commonwealth Government, only the Victorian Government now takes
responsibility for the delivery of public dental care for children and disadvantaged
adults in Victoria. There is a gap, however, between Victoria’s oral health requirements
and the number of clinicians available to meet them.
Over the last seven years there has been significant development of the Victorian
public dental system through increased resources for general treatment and dentures
as well as capital investment to build new, modern and expanded clinics and fluoridate
rural water supplies.
Between December 2005 and December 2006, five new public dental clinics were
opened, bringing the total number to 68. This allowed an additional 26 dental chairs to
be opened, increasing the number of dental chairs in Victoria to 393. In 2007, the total
number of chairs will further expand to 408. Of these, 256 will be in community dental
clinics, a 66 per cent increase over the last eight years.
In 2005–06, there were 478,087 visits to community dental clinics, an increase of
52,894 or 12 per cent over the previous year. From June 2005 to June 2006, the average
time to treatment for dentures improved by 20 per cent, while the average time to
treatment for restorative dental care improved by 16 per cent.
The value of fluoridation is undeniable and from 2005 and by June 2007, water
authorities will have fluoridated the drinking water supplies for Wallan, Robinvale, Moe,
Morwell, Warragul Sale, Traralgon, Horsham, Wangaratta and Wodonga. However, large
areas of rural and regional Victoria remain unfluoridated.
Workforce shortages continue to affect the public dental system, particularly in rural
areas where shortages are also felt in the private sector. Ongoing workforce initiatives
include statewide professional development, mentor support for recent graduates,
accommodation and travel assistance for dentists moving to rural areas, significant
rural allowances and an international recruitment campaign.
viii Improving Victoria’s oral health
Importance of good oral health
Oral health is fundamental to overall health, wellbeing and quality of life. A healthy
mouth enables people to eat, speak and socialise without pain, discomfort or
embarrassment. The impact of oral disease is not only on the individual through pain
and discomfort and the broader impact on their general health and quality of life, but
also on the nation generally through health system and economic costs.
Dental caries are the second most costly diet-related disease in Australia, with an
economic impact comparable with that of heart disease and diabetes (AHMAC 2001).
Approximately $5.1 billion was spent on dental services in Australia in 2004–05,
representing 5.8 per cent of total health expenditure. In Victoria, approximately
$1.5 billion was spent on dental services in 2004–05, representing 6.9 per cent of
total health expenditure (AIHW 2006).
The state of Victoria’s children report (DHS 2006b) recently reported on children’s oral
health. Good oral health in childhood contributes to good oral health in adulthood,
with less decay and reduced loss of natural teeth. Just over three-quarters of children
(77.1 per cent) aged six months to 12 years were reported to have excellent or very
good oral health; however, children living in rural areas had notably poorer oral health.
The department has recently analysed hospital admissions in Victoria caused by dental
ambulatory care sensitive conditions (ACSCs).1 Dental ACSCs have the highest rate of
all ACSCs for under-18-year-olds and the second-highest rate for all ACSCs for all ages.
In 2004–05, dental caries or associated conditions accounted for over 80 per cent of
all dental ACSC admissions, and 95 per cent of ACSC admissions for 0–9-year-olds.
These admissions were treated with removal of teeth in over 75 per cent of cases.
Younger children and rural people are more likely to be admitted to public hospitals.
Dental ACSC admissions have risen over the last decade across the state and in
all regions. There is a significant concentration of dental ACSC conditions in the
2–10-year-old age range. This is primarily to do with the difficulties of managing more
complicated dental treatment with young children in a dental clinic chair and the
preference of dentists to carry out these treatments using a general anaesthetic.
There is a significant difference in ACSC admission rates between regions across
Victoria. Access to fluoridated water in the catchment and the proportion of
households living in poverty are significant predictors of the difference. That is, dental
ACSCs were significantly higher in those catchments with lower access to fluoridated
water supply and where the proportion of households in poverty was higher.
1
Ambulatory care sensitive conditions are conditions for which hospitalisation is thought to be
avoidable with the application of public health interventions and early disease management, usually
delivered in an ambulatory setting such as primary care. High rates of hospital admissions for ACSCs
may provide indirect evidence of inadequate public health programs, problems with patient access to
primary health care, inadequate skills and resources, or disconnection with specialist services.
Improving Victoria’s oral health ix
Policy context
Growing Victoria Together commits the Victorian Government to high-quality, accessible
health and community services. This will provide improvements in the health of
Victorians, improvement in the wellbeing of young children, reduced emergency,
elective and dental waiting times and increased consumer confidence in health and
community services. A Fairer Victoria, the Government’s social policy statement,
establishes a framework to address disadvantage by developing and implementing
innovative approaches to service delivery.
In July 2004, Australia’s Health Ministers endorsed the National Oral Health Plan
2004–2013 (AHMC 2004b). Four broad themes underpin the plan:
• Recognition that oral health is an integral part of general health
• A population health approach, with a strong focus on promoting health and the
prevention and early identification of oral disease
• Access to appropriate and affordable services – health promotion, prevention, early
intervention and treatment – for all Australians
• Education to achieve a sufficient and appropriately skilled workforce, and
communities that effectively support and promote oral health.
The National Oral Health Plan identified the importance of reducing the major
disparities that exist in oral health status and in access to dental care. In a submission
to the Senate Select Committee on Medicare (2003), Professor Andrew Wilson
described the link between economic status and oral health: ‘This is a condition which
is probably, of all the conditions in Australia, the most strongly socioeconomically
related. The people who have the worst oral health are the most disadvantaged in the
community … there is a large amount of dental disease in the community, and we
need a strategy to deal with it.’
Care in your community is the Victorian Government’s framework for a consistent
approach to the development of a health care system that is integrated and
coordinated around the needs of people, rather than around service types, professional
boundaries, organisational structure or funding and reporting requirements.
x Improving Victoria’s oral health
Vision and principles for improving Victoria’s oral health
Vision
All Victorians will enjoy good oral health and will have access to high-quality health
care delivered in an affordable and timely fashion when they require it.
Principles
‡
‡
‡
‡
‡
The best place to treat
Together we do better
Technology to benefit people
A better health care experience
A better place to work.
Roles and responsibilities
• Dental Health Services Victoria, as the leading public oral health agency, has a
role in:
− training, recruiting and retaining the oral health workforce
− setting the agenda for oral health promotion
− ensuring the quality of oral health services, including clinical leadership
− advocating, through partnerships, for oral health
− supporting and encouraging innovation and research in oral health.
• Dental Health Services Victoria has lead responsibility for:
− purchasing integrated community dental services
− planning the best distribution of purchased services
− providing generalist and specialist services through the Royal Dental Hospital
of Melbourne.
• Community Health Services are responsible for delivery of integrated communitybased dental care and for local health promotion activity.
• The Department of Human Services has lead responsibility for the development of
strategic policy and funding.
Improving Victoria’s oral health xi
Strategic developments
Realisation of the vision and principles will come about through implementation of six
strategic priorities:
1. Oral health service planning framework
2. Integrated service model for adults and children
3. Workforce strategy
4. Oral health promotion
5. Responding to high-needs groups
6. Oral health funding, accountability and evaluation.
The planning framework together with the integrated service model will mean that
public oral health services will be an integrated part of Victoria’s network of Community
Health Services, and will work collaboratively to provide health promotion, prevention,
early intervention, treatment and self-management.
The workforce strategy will develop and consolidate a diverse, robust public dental
workforce and will equip the Victorian oral health care system to meet the future
needs and expectations of communities and individual users. The strategy will build
on existing Government health and human services policy, and provide a longerterm strategic direction to Victorian dental health workforce planning. The Victorian
Government, Dental Health Services Victoria, universities, dental health professional
organisations and Community Health Services will all work together to achieve these
aims.
The National Oral Health Plan called for an integrated and cross-sectoral approach that
would achieve significant improvements in both general and oral health. ‘Oral health
promotion should be part of health promotion plans at local, state and territory, and
national levels.’ (p. 17). Oral health promotion activity will become a vital component in
the integrated health promotion approach that already exists throughout Victoria, led by
Primary Care Partnerships (PCPs) and implemented through health services and local
government.
Oral disease is almost totally preventable. Good oral health and reduced demand for
dental services are therefore best tackled through population health and prevention
strategies. The National Oral Health Plan reported that oral diseases share common
risk factors with other national health priorities such as cancer, diabetes and
heart disease. These risk factors include, in particular, inappropriate diet, tobacco
smoking, alcohol consumption and exposure to ultraviolet radiation. Therefore, it is
important that oral health is integrated into a holistic assessment and clients have the
opportunity to access services in a multidisciplinary setting.
xii Improving Victoria’s oral health
The National Oral Health Plan also identified a number of groups within the community
who have poor access to dental care and whose oral health status is well below the
rest of the community, in particular Aboriginal and Torres Strait Islanders, people in low
socioeconomic groups and people with special needs relating to disabilities, health
conditions or ageing. The plan noted that fluoridation remains the most important
population health measure that will assist high-needs groups to achieve better oral
health.
Victoria’s public dental system is already highly targeted towards people in low
socioeconomic groups. Adult public dental services are only provided to low-income
people through a means test arrangement.
The department will undertake work in the areas of funding and accountability that will
support improved service planning and integration. This will include the establishment
of better performance indicators so that the community and providers can better
understand the operations of the dental system and the extent to which it is achieving
its goals.
Improving Victoria’s oral health 1
Introduction
Victoria’s oral health services are a vital component of the Victorian health system.
Over the last seven years there has been significant development of the dental system
through increased resources for general treatment and dentures as well as capital
investment to build new, modern and expanded clinics and fluoridate rural water
supplies.
The strategy briefly describes the current system and recent achievements (‘Setting
the scene’) and also outlines the consequences of poor oral health. The strategy
summarises the broader policy context for public dental health, particularly noting the
National Oral Health Plan and Victorian social policy including Care in your community.
The strategy then proposes a vision and set of principles that can guide the
development of oral health care over the next four years. Flowing on from the vision
and principles is a set of six strategic developments or major projects that are the
actions that will take the public dental system forward.
2 Improving Victoria’s oral health
Improving Victoria’s oral health 3
Setting the scene
The National Oral Health Plan (AHMC
2004b) reported that the ability of the
public and private dental sectors to
provide the dental services demanded
by Australians is threatened by a
worsening national shortage of dental
providers.
The majority of dental services in Victoria are provided by private practitioners and paid
for by clients with or without the assistance of private health insurance. The Australian
Dental Association (2003) estimated that the average cost of private dental treatment
is about $300 for a course of care, putting private dental care out of the reach of many
Victorians. Following withdrawal by the Commonwealth Government, only the Victorian
Government now supports the delivery of public dental care for children and
disadvantaged adults in Victoria. Despite significant increases in expenditure over
recent years, a gap remains between Victoria’s oral health requirements and the
number of clinicians available to meet them.
The National Oral Health Plan (AHMC 2004b) reported that the ability of the public
and private dental sectors to provide the dental services demanded by Australians is
threatened by a worsening national shortage of dental providers. ‘By 2010 there will
be 1,500 fewer oral health providers (general and specialist dentists, dental therapists,
dental hygienists, oral health therapists, prosthetists and dental assistants) than will
be needed just to maintain current levels of access. (Spencer, Teusner, Carter, Brennan
2003)’
Victoria’s public dental service
Dental Health Services Victoria (DHSV) is responsible for delivering dental care
directly at the Royal Dental Hospital of Melbourne, as well as through a small number
of Dental Health Services Victoria–managed dental health services and the School
Dental Service. It is also responsible for subcontracting to Community Health Services
under conditions set by the department. The Royal Dental Hospital of Melbourne
operates 16 general dental chairs, 72 teaching chairs, 45 specialist chairs and 6 oral
surgery chairs. The hospital has four operating theatres, of which three have been
commissioned.
Community Health Services provide public dental care that are community-based
and delivered in either fixed or mobile clinics, but there are also outreach services
to some schools, supported residential services and residential aged care facilities.
(See Appendix 1 for a list of community clinics.) In some cases, dental care is provided
by private clinicians through voucher schemes.
Public dental services provide routine and urgent care. People seeking urgent care are
assessed, triaged and managed using the Emergency Demand Management Strategy.
People triaged as requiring urgent care are offered an appointment and those who
require routine care are placed on the waiting list. Agencies are required to manage
waiting lists in accordance with departmental policies.
The community dental services and the School Dental Service (SDS) are currently
managed as separate services, although in many clinics they are physically co-located.
The funding streams differ and there is separate reception and administration for
the School Dental Service and community dental services. Patient records are not
shared and there are often different opening times for the services in the same clinic.
Consumables and maintenance are also managed separately.
4 Improving Victoria’s oral health
The complexity of these arrangements can create confusion for staff and patients alike
and results in inefficiencies. There is significant opportunity to enhance dental services
and create a better working environment, especially for the School Dental Service staff,
by integrating the community and school dental services.
There is also a lack of integration of dental services and other primary health services
and programs provided in community dental clinics. Generally community dental
services have not adopted service coordination principles and do not utilise service
coordination tools.
Services for children
Children up the age of 12 have priority access to public dental care. Priority access is
also provided to children aged 13–17 who are dependants or holders of health care or
pensioner concession cards. Primary-school–aged children are offered services on a
recall basis that depends on their need. The service is free for dependants or holders of
a health care or pensioner concession card. For other families, the service costs $27 for
a course of care per child (up to a maximum of $108 per family).
Services for adults
Health care and pensioner concession cardholders and their dependants over the
age of 18 are eligible for public dental care. The service costs $22 per visit, up to a
maximum of $88 for a complete course of care. Dentures generally cost around $105.
Specialist services
Specialist services are provided at the Royal Dental Hospital of Melbourne and certain
community dental clinics. A referral to these services is necessary. The co-payment
required varies based on treatment needs.
Dental teams
Dental teams are made up of dentists, dental therapists, dental hygienists, dental
assistants and dental prosthetists. All members of the dental team contribute to
Victoria’s public dental system by delivering quality services to patients based on
their age and needs. This range of expertise allows team members to deliver the most
appropriate care for each client.
Education and training
Clinical training of the dental team occurs at the Royal Dental Hospital of Melbourne
and community dental clinics. The department provides bonded scholarships for
Bachelor of Dental Science, Bachelor of Oral Health and Bachelor of Oral Health
Science students. In addition, the department provides funding to the University of
Melbourne and La Trobe University to support pre-clinical training in the Bachelor
of Oral Health and Bachelor of Oral Health Sciences. Dental Health Services
Victoria provides introductory programs for overseas-trained dentists, a professional
development program for the dental team and a mentoring program for Bachelor of
Dental Science graduates.
Improving Victoria’s oral health 5
More extensive information and policies relating to the public dental system can be
found on the Dentistry in Victoria website at www.health.vic.gov.au/dentistry.
Recent achievements
More facilities
Between December 2005 and December 2006, five new community dental clinics
were opened, bringing the total number to 68. This allowed an additional 26 dental
chairs to be opened, increasing the number of dental chairs in Victoria to 241. This
includes 16 community dental chairs at the Royal Dental Hospital of Melbourne. The
total number of chairs will further expand to 256 in 2007 (Figure 1), a 66 per cent
increase in community chairs over this eight-year period.
Figure 1: Community dental chairs, 1999–2007
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Reduced waiting times
From June 2005 to June 2006,
the average time to treatment for
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In 2005–06, there were 478,087 visits to community dental clinics, an increase of
52,894 or 12 per cent over the previous year. From January to June 2006, 242,801
people visited community dental clinics – an increase of 25,190 or 12 per cent
compared with the same period the previous year. From June 2005 to June 2006,
the average time to treatment for dentures decreased from 28 months to 22 months
(20 per cent), while the average time to treatment for non-urgent dental care decreased
from 28 months in June 2005 to 23 months in June 2006 (16 per cent) (Figure 2).
6 Improving Victoria’s oral health
Figure 2: Adult waiting times for non-urgent dental care, 2004–06
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Fluoridation
The value of fluoridation is unquestionable. The World Health Organization has
concluded that ‘community water fluoridation is safe and cost-effective and should be
introduced and maintained wherever socially acceptable and feasible’ (WHO 1994).
Much of rural Victoria, however, is yet to be fluoridated, resulting in needless caries
and severe complications including hospitalisation. In 2005, the Secretary of the
Department of Human Services requested the relevant water authorities to fluoridate
the drinking water supplies for Moe, Morwell, Warragul Sale, Traralgon, Horsham,
Wangaratta and Wodonga (Figure 3). This has been implemented in the majority of
locations. Other towns to receive fluoridated drinking water in 2006 were Wallan and
Robinvale.
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Improving Victoria’s oral health 7
Figure 3: Water fluoridation in Victoria and dates of introduction
8 Improving Victoria’s oral health
Workforce initiatives
Workforce shortages continue to affect the public dental system, particularly in rural
areas where shortages are also felt in the private sector. Ongoing workforce initiatives
include statewide professional development, mentor support for recent graduates,
accommodation and travel assistance for dentists moving to rural areas, significant
rural allowances and an international recruitment campaign.
Support for education initiatives has been extended substantially since 2005–06 to
increase the supply of dental professionals. The Government has invested heavily
in the establishment of the Bachelor of Oral Health Science at La Trobe University
Bendigo and expanded bonded scholarships and funding for clinical placements
and training at La Trobe University and the University of Melbourne. Up to 26 new
scholarship recipients will be working in the rural public sector at graduation each
year as a result of these initiatives. The Government has also recently announced
the establishment of a second dentistry program at La Trobe University Bendigo.
The program will include clinical training at community dental clinics and bonded
scholarship places will also be offered to students.
Children’s oral health
Since 2003 there has been a focus on the oral health of children under preschool age.
The Government invested in initiatives that increase access for kindergarten children
to dental care. Children under primary school age are eligible for priority access at
community dental clinics. In addition, health promotion to children aged 0–5 years
focuses on strategies that promote early childhood oral health practices and increase
the oral health promotion skills of primary health care and education professionals
working with infants and young children.
Smiles 4 Miles oral health promotion program operates in Neighbourhood Renewal and
Best Start communities. Children under school age and their families who are at high
risk to oral disease are targeted with prevention and treatment initiatives. The program
has been operating since 2003–04 in Corio-Norlane, Moe, Morwell, Churchill-Traralgon
and Broadmeadows, and in 2005 expanded into Wimmera–Horsham, Sale-Wellington
and Ballarat-Daylesford. Funding was approved in 2005–06 for six more sites:
Warrnambool, Hamilton-Portland, Shepparton, Wodonga and Peninsula.
Why good oral health is important
Oral health is fundamental to overall health, wellbeing and quality of life. A healthy
mouth enables people to eat, speak and socialise without pain, discomfort or
embarrassment. The impact of oral disease is not only on the individual through pain
and discomfort and the broader impact on their general health and quality of life, but
also on the nation generally through health system and economic costs (Figure 4).
Improving Victoria’s oral health 9
Figure 4: Impact of oral disease
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10 Improving Victoria’s oral health
Internationally, WHO (2006) ranks
Australia 17 among OECD countries
for adult dental caries, a relatively poor
performance in light of Australia’s
much better performance on other
leading health indicators such as life
expectancy.
Dental caries are the second most costly diet-related disease in Australia, with an
economic impact comparable with that of heart disease and diabetes (AHMAC 2001).
Approximately $5.1 billion was spent on dental services in Australia in 2004–05,
representing 5.8 per cent of total health expenditure. In Victoria, approximately
$1.5 billion was spent on dental services in 2004–05, representing 6.9 per cent
of total health expenditure (AIHW 2006).
Periodontal disease contributes to cardiovascular disease, preterm birth and low birth
weight. Oral disease is also associated with aspiration pneumonia, hepatitis C, HIV,
infective endocarditis, otitis media and nutritional deficiencies in children and older
adults (AHMAC 2001).
Caries and periodontal disease account for 90 per cent of all tooth loss. Brennan and
Spencer (2004) estimated that 11 million Australians have new decay each year.
Despite significant improvements in the oral health of children in the last 20–30
years, there are persistent high levels of oral disease among Australian adults (AIHW
2002a). Poor oral health in this country is most evident among Aboriginal and Torres
Strait Islander people, people on low incomes, rural and remote populations, and
some immigrant groups from non–English speaking backgrounds, particularly refugees
(AHMAC 2001).
Internationally, WHO (2006) ranks Australia 17 among OECD countries for adult dental
caries, a relatively poor performance in light of Australia’s much better performance on
other leading health indicators such as life expectancy.
Children’s oral health
The state of Victoria’s children report (DHS 2006b) recently reported on children’s oral
health. Good oral health in childhood contributes to good oral health in adulthood,
with less decay and reduced loss of natural teeth. A range of preventive factors (water
fluoridation, improved diet and oral hygiene, and regular brushing) contributes to
oral health in childhood. The availability and affordability of dental services may also
influence the dental health of children (AIHW 2005).
The report presents data taken from the Victorian Child Health and Wellbeing Survey
2006 and the School Entrant Health Questionnaire 2006. Parents were asked in the
Victorian Child Health and Wellbeing Survey to rate their child’s oral health. Just over
three-quarters of children (77.1 per cent) aged six months to 12 years were reported
to have excellent or very good oral health; however, children living in rural areas had
notably poorer oral health.
As Table 1 shows, children living in rural areas were more likely than those living in
metropolitan areas to have had toothache, a filling, dental treatment in hospital under
general anaesthetic, or a tooth extracted because of a dental problem.
Improving Victoria’s oral health 11
Table 1: Oral health status of children in rural and metropolitan areas, 2006
Rural
(%)
Metropolitan
(%)
Victoria
(%)
Child has (ever) had toothache
31.2
23.1
25.4
Child has (ever) had a filling
25.2
18.0
20.0
Child has (ever) had a tooth extracted
11.4
6.5
7.9
7.2
3.1
4.2
Child has (ever) had any dental treatment
in hospital under general anaesthetic
Source: Victorian Child Health and Wellbeing Survey, 2006
The state of Victoria’s children report also identified the following relevant findings for
child oral health:
• Children aged 2–12 years living in rural areas were much less likely to drink tap water
than children living in metropolitan areas.
• Just under three-quarters of children aged 2–7 years were reported to use
low-fluoride toothpaste.
• While the majority of parents said they actively assisted their children under seven
years of age with toothbrushing, just less than one-fifth of parents reported they
never did so.
• Children were more likely to have seen a private dentist at their last dental visit
(64 per cent) than a dentist from the School Dental Service (27 per cent) or from
other government or community dental services (7.5 per cent).
• Nearly one-third of children aged six months to 12 years had never seen a dentist,
and younger children were much more likely to have never seen a dentist than older
children.
• The most common explanation for not having seen a dentist (50.5 per cent of
children) was that there was no reason to visit (for example, the child had healthy
teeth and gums). The second most common reason was that the child was
considered too young to need dental services (31 per cent). A minority of parents
(5 per cent) identified cost as the main factor.
• Parents of Indigenous children were more likely than parents of non-Indigenous
children to be concerned about their children’s teeth. However, Indigenous children
were less likely than non-Indigenous children to have visited a dentist in the last one
to two years.
12 Improving Victoria’s oral health
Dental ambulatory care sensitive conditions
The department has recently analysed hospital admissions in Victoria caused by dental ambulatory care sensitive conditions
(ACSCs).2 Dental ACSC admissions have the highest rate of all ACSC admissions for under-18–year-olds and the second-highest
rate for all ACSC admissions for all ages. Most admissions are same-day and the average number of bed-days for all dental ACSC
admissions is relatively low (1.83 days in 2004–05).
In 2004–05, dental caries or associated conditions accounted for over 80 per cent of dental ACSC admissions, and 95 per cent of
ACSC admissions for 0–9-year-olds. These admissions resulted in removal of teeth in over 75 per cent of cases. These extractions
could all have been prevented with earlier treatment.
Younger children and rural people are more likely to be admitted for dental care. Over the last decade, dental ACSC admissions have
risen across the state and in all regions (see Figure 5).
Figure 5: Dental ACSC admissions by DHS region, 1997-98 and 2004–05
+
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There is a significant concentration of dental ACSC conditions in the 2–10-year-old age range, as shown in Figure 6. This is primarily
due to the difficulties of managing more complicated dental treatment with young children in a dental clinic chair and the preference
of dentists to carry out these treatments using a general anaesthetic.
2
Ambulatory care sensitive conditions are conditions for which hospitalisation is thought to be avoidable with the application of public health interventions and
early disease management, usually delivered in an ambulatory setting such as primary care. High rates of hospital admissions for ACSCs may provide indirect
evidence of inadequate public health programs, problems with patient access to primary health care, inadequate skills and resources, or disconnection with
specialist services.
Improving Victoria’s oral health 13
Figure 6: Dental ACSC admissions by age, 2004–05
&!'%%
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Source: Victorian Admitted Episodes Dataset
There is a significant difference in ACSC admission rates between regions across Victoria. Access to fluoridated water in the
catchment and the proportion of households living in poverty are significant predictors of the difference (see Appendix 2). Dental
ACSC admissions were significantly higher in those catchments with lower access to fluoridated water supply and where the
proportion of households in poverty was higher.
This analysis demonstrates the value of providing fluoridated water supplies in reducing dental disease and subsequent need
for treatment, especially for treatment in hospitals. The analysis also demonstrates the importance of providing access to dental
services for families and individuals on low incomes.
14 Improving Victoria’s oral health
Improving Victoria’s oral health 15
Policy context
The vision, principles and strategies described in this strategy paper are built on a
number of current social and health policies that are briefly summarised below.
Growing Victoria Together and A Fairer Victoria
Growing Victoria Together commits the Government to the provision of high-quality,
accessible health and community services. This will lead to improvements in the health
of Victorians, improvement in the wellbeing of young children, reduced emergency,
elective and dental waiting times and increased consumer confidence in health and
community services.
A Fairer Victoria, the Government’s social policy statement, establishes a framework
to address disadvantage by developing and implementing innovative approaches to
service delivery. The guiding elements of this framework are:
• ensuring that universal services provide equal opportunity for all
• reducing barriers to opportunity
• strengthening assistance to disadvantaged groups
• providing targeted support to the highest-risk areas
• involving communities in decisions affecting their lives
• making it easier to work with Government.
National Oral Health Plan 2004–2013
In July 2004, Australia’s Health Ministers endorsed the National Oral Health Plan
2004–2013 (AHMC 2004b). Four broad themes underpin the plan:
• Recognition that oral health is an integral part of general health
• A population health approach, with a strong focus on promoting health and the
prevention and early identification of oral disease
• Access to appropriate and affordable services – health promotion, prevention,
early intervention and treatment – for all Australians
• Education to achieve a sufficient and appropriately skilled workforce, and
communities that effectively support and promote oral health.
The National Oral Health Plan identified the importance of reducing the major
disparities that exist in oral health status and in access to oral health care. In a
submission to the Senate Select Committee on Medicare (2003), Professor Andrew
Wilson described the link between economic status and oral health: ‘This is a
condition which is probably, of all the conditions in Australia, the most strongly
socioeconomically related. The people who have the worst oral health are the most
disadvantaged in the community … there is a large amount of dental disease in the
community, and we need a strategy to deal with it.’
16 Improving Victoria’s oral health
Care in your community
Care in your community is the Victorian Government’s framework for a consistent
approach to the development of a health care system that is integrated and
coordinated around the needs of people, rather than around service types, professional
boundaries, organisational structure, funding or reporting requirements (DHS 2006a).
It adopts the principles set out in Victoria: a better state of health, which are further
underpinned by a number of specific values that inform the development of the
Victorian health care system. These are:
• The best place to treat
• Together we do better
• Technology to benefit people
• A better health care experience
• A better place to work.
Care in your community will refocus planning and investment to ensure the best mix of
inpatient and community-based integrated care services. It will respond to the need for
prevention, early intervention, self-management and health promotion.
Planning and investment for the delivery of integrated, community-based health care
will be:
• based on a single set of area-based planning catchments
• informed by a single set of planning principles
• supported by area-based planning networks
• focused on three high-level areas of need
• conducted on the basis of defined modes, settings and levels of care.
Other relevant policies and strategies
Other policies and strategies that are relevant to the development of public dental
health care in Victoria include:
• Dental Health Services Victoria Oral Health Strategic Plan and Service Plan
2005–2010
• The Primary Care Partnership Strategy, which provides the partnership arrangements
among local primary health care providers, including dental health providers
• The Community Health Services Policy, which provides the strategic directions for
Victoria’s network of Community Health Services, many of whom are public dental
providers
• The Metropolitan Health Strategy, which provides direction for the delivery of health
services in Melbourne
• Rural directions for a better state of health, which describes the directions for
development of public rural health services in Victoria.
Improving Victoria’s oral health 17
Vision and principles for improving
Victoria’s oral health
Vision
All Victorians will enjoy good oral health and will have access to high-quality health
care delivered in an affordable and timely fashion when they require it.
In achieving this vision, the Government will implement effective population health
measures, provide dental care for disadvantaged Victorians and build the capacity of
the dental health system and workforce.
Principle one: The best place to treat
Dental care will be provided in community-based settings, whenever it is safe and costeffective to do so. Dental services will be brought together with other ambulatory care
services and integrated to improve accessibility, availability and quality of care. Dental
services will build safety and continuous quality improvement into their systems. Dental
clinicians will be regulated to ensure professional conduct and fitness to practice.
Principle two: Together we do better
Planning for good oral health will incorporate a population health approach that
recognises the social determinants of health and prioritises health promotion and
illness prevention. The provision of dental care will be based on partnerships among
levels of government and public and private health care services. Individuals, families
and carers, will be encouraged to take more responsibility for their health care and will
receive support for self-management.
Principle three: Technology to benefit people
There will be a consistent, planned approach to developing the infrastructure for the
delivery of integrated health care, including dental care, which includes information
and communications technology (ICT), standard tools and protocols, facilities and
equipment. ICT will be used to better inform people about their dental health and about
how to better manage their health.
Principle four: A better health care experience
Care will be ‘person and family centred’, focusing on the needs of the whole person as
these change over time. People will have equitable, timely and appropriate access to
dental care regardless of where they live. The delivery of dental care will be based on
the best evidence available and will be planned on an area basis to meet the needs of
defined populations.
Information about people and the services they receive will be consistently managed
and coordinated across health care services to protect privacy and support integrated
service delivery and continuity of care. Funding and accountability arrangements for
the delivery of quality dental care will support the provision of the right care, at the right
time, and in the right place.
18 Improving Victoria’s oral health
Principle five: A better place to work
The dental workforce will be configured to deliver integrated health care. The future
workforce will be flexible and multi-skilled to deliver care in a variety of settings. The full
range of dental providers will be available to work together and provide an appropriate
and multidisciplinary range of professional expertise. Consolidation of service delivery
in community-based settings will support improved working conditions, more efficient
use of the workforce, and better quality systems.
Roles and responsibilities
Dental Health Services Victoria
Dental Health Services Victoria is the leading public sector oral health agency.
Dental Health Services Victoria has a statewide leadership role in:
• Training, recruiting and retaining of the oral health workforce, including the
establishment of partnerships with universities in the education, training, and
continuing professional development of clinicians; and the development and
provision of re-entry and mentoring programs for the oral health workforce.
• Oral health promotion including setting the agenda, leading oral health promotion
initiatives, integrating oral health promotion into health promotion more generally
and developing oral-health–specific health promotion resources.
• Quality assurance, including clinical leadership and ensuring compliance with
relevant standards.
Dental Health Services Victoria has lead responsibility for:
• Purchasing integrated community dental services
• Planning the best distribution of purchased services
• Providing generalist and specialist services through the Royal Dental Hospital
of Melbourne.
Department of Human Services
The department has lead responsibility for:
• Policy development
• Capital and service planning
• Funding and accountability.
DHS regional offices have overall responsibility for local primary health service and
capital planning and coordination of department-funded services. The regional offices
will therefore contribute to dental services and capital planning.
Community Health Services
Community Health Services are responsible for:
• Delivery of integrated community-based dental care
• Local health promotion activity.
Improving Victoria’s oral health 19
Minimum standards
The following minimum standards have been adapted from the National Oral Health
Plan to provide performance benchmarks for the Victorian oral health system:
Standards for children
• Children should receive emergency dental care as needed, with priority based on
clinical need.
• Children should receive at least one course of oral health care, including appropriate
oral health promotion, every two years. Children with greater dental needs should be
recalled more frequently.
Standards for adults
• Adults should receive emergency oral health care as needed, with priority based
on clinical need.
• Adults should receive at least one course of general dental care every three years
on average.
• Adults who require denture services should have access to a set of dentures once
every eight years on average, with dentures being approved more frequently only
where indicated by clinical parameters.
Standards for the whole population
• Decayed teeth and other oral disease should be treated in time to prevent expensive,
complicated oral health care and tooth loss.
• Oral health care should always include the provision of information to the client
and/or their parents to enable them to prevent further oral disease.
• Oral health care should be provided within the local community in a socially and
culturally acceptable manner.
20 Improving Victoria’s oral health
Improving Victoria’s oral health 21
Strategic development
Realisation of the vision, principles and minimum standards described in this paper will
come about through implementation of a set of six strategic priorities:
1. Oral health service planning framework
2. Integrated service model for adults and children
3. Workforce strategy
4. Oral health promotion
5. Responding to high-needs groups
6. Oral health funding, accountability and evaluation.
Oral health service planning framework
The planning framework together with the integrated service model will mean that
community dental clinics will be an integrated part of Victoria’s network of Community
Health Services, and will work collaboratively to provide health promotion, prevention,
early intervention, treatment and self-management.
Background
The planning framework for public oral health services in Victoria into the future is
underpinned by the principles of Victoria – A better state of health and Care in your
community. These policies promote the delivery of quality client-centred services that
are based in the community and integrated with other health services to provide a
seamless continuum of health care. Other polices such as Community Health Services
– creating a healthier Victoria, Rural directions for a better state of health and the
Metropolitan Health Strategy add further support to these directions.
Consistent with the approach described in Care in your community, oral health services
will be planned so they are:
• based on a single set of area-based planning catchments
• informed by a single set of planning principles
• supported by area-based planning networks
• focused on three high-level areas of need
• conducted on the basis of defined modes, settings and levels of care.
Integrated area-based planning (including dental planning) will use the following steps:
1. Determine the needs of the local catchment population in terms of the three
areas of need (chronic and complex, episodic and urgent care, integrated health
promotion and illness prevention).
2. Profile the existing service system on the basis of the program planning parameters
for configuration of community-based health care services set out below.
3. Determine how the planning principles and program planning parameters apply to
the local service system.
22 Improving Victoria’s oral health
The overall objective in this planning
approach is to increase self-sufficiency
in community-based health care
(including oral health care) within
each catchment.
4. Conduct an assessment of the local service system based on the identified local
needs and the application of the planning principles and program planning
parameters to the local service system.
5. Develop recommended priority actions to achieve service system integration
goals and to move towards the future service system configuration in line with
the program planning parameters set out below.
Planning catchments
The overall objective in this planning approach is to increase self-sufficiency in
community-based health care (including dental care) within each catchment.
Each catchment will provide a comprehensive range of community-based health
services, except where this is not possible for reasons of critical mass, economies
of scale, or safety and quality.
The department has adopted a single set of planning catchments to support a
consistent approach to area-based planning that can apply across the range of
programs and services providing health care in the community, including public dental
care. These catchments have been defined at a sub-regional level, are built up from
Local Government Areas, and fit within whole-of-government regional boundaries
(based on Department of Human Services regions). These catchments align with
Primary Care Partnership catchments and are, therefore, already in use by a number
of department programs and a range of agencies. Because they are built up from
Local Government Areas, a substantial amount of planning data is readily available
and it is possible to build on the Municipal Public Health Plans prepared by councils,
Community Health Plans and Catchment Plans prepared by Primary Care Partnerships.
Maps of the integrated area-based planning catchments are provided in Appendix 3.
There are 12 metropolitan Melbourne catchments and 19 rural Victorian catchments.
Program planning parameters for dental services
The following service planning principles have been developed taking into account the
policies identified in the ‘Policy context’ section above:
• Planning will be based on the catchments described in Care in your community
(see Attachment 3 in that document) with a view to achieving self-sufficiency for
community dental services within those catchments.
• Services will be planned to provide one dental chair (dentist, dental therapist
and/or dental prosthetist plus assistant and support staff) per 5,000 eligible
people (concession cardholders and dependants and children up to 12 years).
• Services will be planned on a minimum of four chairs for greater cost efficiencies and
to facilitate recruitment of staff, except in rural areas where smaller clinics may be
required to maintain accessibility (supported by a larger district or regional service).
Improving Victoria’s oral health 23
• The greater proportion of resources will be directed to areas with greater eligible
population numbers with higher levels of need using the Socio-Economic Index for
Area and available population data.
• Community dental clinics will be co-located with Community Health Services,
improving the range, level and quality of services delivered.
• Planning will identify which services in the specific local context can be delivered
safely, effectively and efficiently in community-based settings, and which services
should be delivered in hospital settings.
• Planning for delivery of dental care will start from the preferred options of providing
services close to where people live, work, shop, meet or relax.
• Planning will maximise ease of access to services, co-locating services where
possible and undertaking service development/redevelopment in locations that
people can easily get to.
• Planning will deliver collaborative outcomes, based on partnerships focused on a
population health approach.
Area-based planning networks
As a component of the Care in your community program, planning will be conducted
within each catchment by an area-based planning network, made up of local
stakeholders and involving, at a minimum, health services, local government, nursing
services, Divisions of General Practice, consumer representatives and the Department
of Human Services regional offices. Planning for community dental clinics will be a
priority for planning networks.
Planning will lead to the development of a comprehensive picture, on a catchment
basis, of the needs, priorities, capacities and strategic direction for the development of
an integrated community-based health care service system, including planning for good
oral health. This information will be used to support decision making on the allocation
of department service growth funding, new initiative funding and capital development
funding. Dental Health Services Victoria will be responsible for planning the best
distribution of purchased services, in conjunction with the department and its regions
and with providers and communities through area-based planning networks.
Priority actions
1. Trial the oral health service planning framework in three planning areas in 2006–07.
2. Implement the oral health service planning framework for all catchments from
2007–08 to 2009–2010.
24 Improving Victoria’s oral health
Integrated service model for adults and children
The integration of dental services with other primary health services will improve
access to services and result in shared knowledge and resources, leading to better
outcomes for patients.
The integrated service model will result in:
• a holistic health assessment as clients’ needs will be identified early using service
coordination tools
• improved referral for dental and other primary care
• effective demand management
• the seamless movement between dental and other primary health services.
Dental Health Services Victoria is the provider of generalist and specialist services
delivered through the Royal Dental Hospital of Melbourne and is the purchaser of
integrated community dental services. It is also responsible for statewide coordination
of health promotion, clinical mentoring, quality assurance, specialist services and
special needs services.
Dental Health Services Victoria will also be responsible for planning the best
distribution of purchased services, in conjunction with the department and its rural
regions and with providers and communities through area-based planning networks.
Role delineation within metropolitan
catchments and rural regions will
improve service planning and
coordination, facilitate integrated health
promotion, provide clinical leadership
and expand training and development
opportunities.
Community dental clinics will provide a single service for children and eligible adults
operating under the management of Community Health Services. Role delineation
within metropolitan catchments and rural regions will improve service planning and
coordination, facilitate integrated health promotion, provide clinical leadership and
expand training and development opportunities.
The service system will have three levels of agency:
1. Lead regional agency
One lead agency will be identified for each region that will provide coordination and
clinical leadership for community dental services in that region, provide preventative,
primary and specialist dental care and provide training for dental clinicians.
2. District agencies
One or more district agencies (which may be a lead agency) will be identified in each
catchment that will provide preventative, primary and specialist dental care and
provide training for dental clinicians.
3. Local agencies
One or more local agencies (likely to have only one or two chairs) will be identified in
each catchment that will provide preventative and primary dental care and provide
clinical placements for dental clinicians.
In metropolitan Melbourne, identification of agencies could occur at a catchment level,
while in rural regions this will take place at a regional level. The lead regional agency
will have a regional coordination position to support their roles in catchment planning,
Improving Victoria’s oral health 25
service coordination and workforce development. The department together with Dental
Health Services Victoria will designate these agencies.
In some regions there may be opportunities to move to a single regional intake, recall
and reminder system.
Table 2: Roles and responsibilities of agency types
Tasks/roles
Regional
lead
District
Local
Lead catchment planning
¸
Manage consolidated waiting list
¸
Manage recall and reminder service for children
¸
Preventative dental care
¸
¸
¸
Primary dental care
¸
¸
¸
Specialist dental care
¸
¸
Lead outreach services
¸
¸
Dental laboratory services
¸
¸
Lead oral health promotion planing
¸
¸
Participate in oral health promotion
¸
¸
¸
Develop (with DHSV) recruitment and retention strategies
¸
Coordinate clinical placements
¸
Provide clinical placements
¸
¸
¸
Coordinate professional development
¸
Provide support services to local clinics
¸
¸
Provide links to other sectors (e.g. children’s services,
aged care services)
¸
¸
The department will be responsible for the development of strategic policy
development for community-based oral health services in the state. Department of
Human Services regional offices will oversee the ongoing management of Community
Health Services within their regional catchment.
Priority actions
1. Designate the agency level of existing agencies.
2. Review demonstration projects of integrated service models in three sites and at
the new service at Goulburn Valley Health during 2006–07.
3. Determine a schedule for integration of services starting from early 2007–08.
4. Complete service integration across the state by June 2008
5. Implement service coordination principles and tools across the public dental system
from July 2007.
26 Improving Victoria’s oral health
Workforce strategy
The workforce strategy will deliver a three-year program to develop and consolidate a
diverse, robust public dental workforce. This strategy aims to equip the Victorian oral
health care system to meet the future needs and expectations of communities and
individual users. It builds on existing Government health and human services policy,
and provides a longer-term strategic direction to Victorian dental health workforce
planning. The Victorian Government, Dental Health Services Victoria, universities,
dental health professional organisations and community dental clinics will all work
together to achieve these aims.
Background
The department established the
Dental Workforce Project to provide a
strategic approach to dental workforce
planning. The project has succeeded
in expanding and developing the
workforce.
The dental workforce includes specialists, dentists, therapists, hygienists, assistants,
prosthetists and technicians. The Dental Practice Board of Victoria defines the scope of
practice for dental health clinicians.
Along with infrastructure, the availability of a skilled and competent workforce is a key
element in providing public dental care. Historically, the public sector has not recruited
and retained enough clinicians to maintain the dental health workforce, and demand is
currently outstripping supply.
Commissioned in 1999, the Victorian oral health services labour force planning report
predicted a workforce shortage of 20 per cent by 2010 and acknowledged that the
public dental sector was at significant risk of shortfalls. The report identified public
sector recruitment and retention issues including:
• remuneration, with public sector salaries lower than the private sector
• issues relating to re-entry and re-training
• inflexibility in work arrangements
• poor access to professional development
• poor career paths.
In response, the department established the Dental Workforce Project to provide
a strategic approach to dental workforce planning. The project has succeeded in
expanding and developing the workforce. Achievements to date include:
• Certified Agreements for specialists and dentists
• improved remuneration and career structures for clinicians
• a professional development training needs analysis
• scholarships for undergraduate courses
• prosthetist training recommencing at Royal Melbourne Institute of Technology
• a Bachelor of Oral Health Science program commencing at La Trobe University
Bendigo.
Improving Victoria’s oral health 27
Policy context
Nationally, health workforce policy is guided by the National Health Workforce
Strategic Framework, which has guiding principles relating to supply, distribution, skill
development and planning. Workforce planning also aligns with the National Oral
Health Plan’s objective to develop a sustainable and appropriately trained dental
workforce to meet identified oral health needs across the Australian population.
Several statewide policies also underpin this workforce strategy. Growing Victoria
Together, the whole-of-government policy framework, integrates and shapes the
policies and plans for the future of Victoria’s health services. A Fairer Victoria supports
the social policy directions set out in Growing Victoria Together.
The department’s Human Services Strategic Framework 2005–06 includes the
objective of ‘building sustainable, well-managed and efficient human services’. One
of the outcomes under this objective is ‘a skilled and high-performing workforce
across Victoria’. The Workforce Strategy will support implementation of these national,
statewide and departmental objectives.
Moving forward
Over the period from 2006–07 to 2008–09, the workforce strategy will provide both
short-term priority actions and a longer-term strategic approach to workforce planning
and the recruitment, development and retention of the Victorian dental workforce.
This involves both planning for and developing the future workforce, and putting in
place initiatives that create appropriate incentives and opportunities for the current
workforce.
The department recognises that making the dental workforce sustainable and able to
adapt to the changing needs of Victorians will take time, sustained commitment and
appropriately targeted resources, from government as well as the sector. Over the next
three years, initiatives arising from the workforce strategy will represent a significant
investment by the Government in the Victorian public dental system.
This strategy aims to provide an integrated, flexible and strategic approach to dental
workforce planning and development. Implementing the priority actions outlined
throughout the document will help achieve the outcome of a skilled workforce of
adequate size and distribution to provide quality dental care to eligible Victorians. The
strategy will also be monitored and evaluated to gauge its effectiveness and identify
future requirements.
The groups responsible for making real changes resulting from these priority actions
are:
• Department of Human Services
• Dental Health Services Victoria
• the tertiary education sector
• Dental Practice Board of Victoria
28 Improving Victoria’s oral health
Three key functions – recruitment,
retention and optimising the dental
team – provide a framework within
which the key stakeholders in the
Victorian public dental health sector
can work together to create a strong
and sustainable workforce.
• Community Health Services
• the dental workforce and relevant professional bodies.
Collectively, these groups have responsibilities in the following areas:
• Attracting people to consider dental health through secondary and tertiary career
promotion activities
• Financial support for undergraduate students in dental health disciplines
• Training of dental professionals, including student clinical placements, retraining and
ongoing professional development
• Recruitment and retention of dental professionals in the public sector
• Extension of private sector involvement in and support of the public dental system
• Supporting optimal configuration and full utilisation of the dental health team.
Three key functions – recruitment, retention and optimising the dental team – provide
a framework within which the key stakeholders in the Victorian public dental system
can work together to create a strong and sustainable workforce. Implementing the
priority actions summarised in the table below will help meet current demand for public
dental services, and develop a workforce that can adapt to future needs.
The priority actions aim to provide a pathway to success towards the strategy’s
overall goal of an educated, experienced and skilled workforce of adequate size and
distribution to meet the dental needs of eligible Victorians.
Improving Victoria’s oral health 29
Priority actions
Priority action
Responsibility
Performance indicators
Recruit – Promoting public sector learning and employment opportunities
Promoting dental health as a diverse, viable career choice
1
Review the dental health recruitment strategy, including career
promotion.
DHSV and DHS
Review completed
2
Develop a recruitment strategy to provide ongoing, annual
promotion of public dental health careers.
DHSV and DHS
Recruitment strategy completed
3
Implement the secondary education sector career promotion
strategy.
DHSV
Revised secondary career promotion
strategy implemented
Continue to advocate to the Commonwealth to extend its activities
on issues relating to workforce planning, including exploring
opportunities for additional tertiary training positions for dental
health professionals.
DHS, universities
a. Update evidence base about Victorian
public sector workforce requirements
Explore options for greater collaboration and integration between
undergraduate courses in all dental health disciplines.
Universities
Increasing Victorian training and education places
4
5
b. Explore the feasibility of a dental intern
program
Identify options for integrating elements of
undergraduate courses
Supporting undergraduate clinical placements in public dental health services
6
Develop a statewide plan to offer effective undergraduate clinical
placements in all dental health disciplines.
DHS, universities,
agencies
a. Develop a state plan for dental clinical
placements
b. Implement state plan
7
Support students of all dental health disciplines in accessing rural
clinical placements.
Universities
Develop a range of support mechanisms for
students on clinical placements
DHSV
a. Revised strategy for undergraduate
communication activities implemented
Promoting public dental health careers
8
Implement the revised recruitment strategy to provide ongoing,
annual promotion of public dental health careers.
b. Revised strategy for recruiting overseastrained dentists implemented
9
Review and revise scholarship initiatives.
DHS
a. Review completed
b. Scholarships revised
10 Investigate re-entry programs for non-practising dental health
professionals.
DHSV
Programs implemented for all dental
disciplines
11 Undertake a statewide campaign to encourage private dental
health professionals to work in public sector dental health.
DHSV
a. Campaign developed
12 Investigate the feasibility of private practice in public clinics, and
implement the recommendations of this investigation.
DHS
b. Campaign fully implemented
a. Review completed
b. Implementation plan developed
c. Options implemented
30 Improving Victoria’s oral health
Priority action
Responsibility
Performance indicators
DHS
Research completed
14 Redevelop the existing professional development plan to address
all dental disciplines.
DHSV, professional
bodies, universities
Implementation plan redeveloped
15 Extend the public sector mentor program to offer professional and
social mentoring to all members of the dental team at all levels.
DHSV, professional
bodies
Program extended
16 Develop mechanisms to support provision of advanced clinical and
client management training to enable all members of the dental
health team to develop and reinforce new skills.
DHSV
a. Mechanisms developed
Retain – Increasing pride and participation in the public sector
Public sector dental health as an employer of choice
13 Research the drivers of retention for all dental health professions.
Enhancing professional and career development
b. Targeted continuing professional
development program available
Optimise – Making the best use of the dental health workforce
Promoting flexible teams and innovative models of care
17 Explore opportunities for role redesign that fully utilise the dental
team.
DHS
Implementation of an integrated public
dental service
Oral health promotion
Oral health promotion activity in Victoria
will become a vital component in the
integrated health promotion approach
that already exists throughout Victoria,
led by Primary Care Partnerships.
Oral disease is almost totally preventable. Good oral health and reduced demand for
dental services are therefore best tackled through population health and prevention
strategies. The National Oral Health Plan reported that oral diseases share common
risk factors with other national health priorities such as cancer, diabetes and heart
disease. These risk factors include, in particular, inappropriate diet, tobacco smoking,
alcohol consumption and exposure to ultraviolet radiation.
Based on the work of the Task Group on Health Promotion for Oral Health (2000), the
National Oral Health Plan called for an integrated and cross-sectoral approach that
would achieve significant improvements in both general and oral health. ‘Oral health
promotion should be part of health promotion plans at local, state and territory, and
national levels.’ (p. 17).
Oral health promotion activity in Victoria will become a vital component in the
integrated health promotion approach that already exists throughout Victoria, led by
Primary Care Partnerships.
Improving Victoria’s oral health 31
Background
Future directions for oral health promotion
In 2005, the department contracted Dental Health Services Victoria and University of
Melbourne to review the Victorian Oral Health Promotion Strategy 2000–2004 (DHS
1999). The review identified a number of important themes to consider for the future
of oral health promotion:
• The importance of the relationship between oral health and general health
• Exposure to fluoride
• Active development of partnerships by and with the oral health sector
• Research design and evaluation of interventions
• Access to timely and appropriate oral health care.
Health promotion priorities 2007–12
The Department of Human Services and the Victorian Health Promotion Foundation
(VicHealth) have worked together to develop statewide health promotion priorities for
2007–12. This work was carried out through statewide consultations and with input
from across program areas within the department. Over the next five years, health
services will align their local health promotion program and planning activity to the
identified statewide priority issues.
The overarching aim of the health promotion priorities is to improve overall health and
reduce health inequalities. To achieve this aim the seven priority issues are:
1. Promoting physical activity and active communities
2. Promoting accessible and nutritious food
3. Promoting mental health and wellbeing
4. Reducing tobacco-related harm
5. Reducing and minimising harm from alcohol and other drugs
6. Safe environments to prevent unintentional injury
7. Sexual and reproductive health.
Neighbourhood Renewal sites were also confirmed as one of the priority settings for
health promotion practice for 2007–12.
The department, led by the Public Health Branch, is working to develop future actions
to support the health promotion priorities from a statewide level. To support the seven
priority issues, the following underpinning principles have been developed to guide
health promotion and prevention policy and practice:
• Addressing the broader determinants of health
• Basing action on the best available data and evidence
• Acting to reduce inequalities and injustice
• Emphasising active consumer and community participation
• Empowering individuals, communities and organisations through capacity building
action
32 Improving Victoria’s oral health
• Ensuring an explicit consideration of diversity (including gender, culture, ethnicity,
age, disability and sexual orientation)
• Working in collaboration across sectors to ensure an integrated approach to action
• Ensuring access for all to health-promoting activities.
A management group, comprising representatives from program areas across the
department and VicHealth, will strengthen the health promotion action across sectors
in Victoria. For each priority issue the department will involve relevant stakeholders. It
is anticipated that further information about implementation action will be released in
2007.
In future, oral health promotion interventions will be coordinated at a catchment
level as part of Primary Care Partnerships’ Integrated Health Promotion strategies.
Oral health promotion interventions will be evidence-based and led and managed by
Community Health Services as part of their Integrated Health Promotion plan.
Dental Health Services Victoria
Dental Health Services Victoria plays a significant role in oral health promotion. They
will continue to provide statewide leadership in oral health promotion and remain the
key provider of oral health advice and resources for health promotion interventions
managed by Community Health Services. In addition, Dental Health Services
Victoria will continue to implement statewide evidence-based oral health promotion
interventions such as Smiles 4 Miles.
Fluoridation
Water fluoridation has been deemed
one of the ‘ten great public health
achievements’ of the 20th century by
the United States Centers for Disease
Control
Fluoridation of public water supplies is the single most effective population health
measure for reducing dental caries. The National Oral Health Plan estimated that
fluoridation remains a cost-effective measure down to communities with a population
of 1,000 people.
Water fluoridation is a safe and effective public health measure that benefits
everybody in the community regardless of age, gender, income or education level.
Water fluoridation has been deemed one of the ‘ten great public health achievements’
of the 20th century by the United States Centers for Disease Control.
Currently around 75 per cent of Victorians (primarily in metropolitan Melbourne) have
access to a fluoridated drinking water supply. Over 25 years, it is estimated that water
fluoridation has saved the Victorian community about $1 billion through avoided dental
costs, avoided loss of productivity, and saved leisure time.
Victorian School Dental Service data show that six-year-olds living in fluoridated areas
of Victoria experience 45 per cent less tooth decay in their baby teeth than those
in non-fluoridated areas, with 12-year-olds experiencing 38 per cent less decay in
their adult teeth. The ACSC admissions data reported on page 11 also show clearly
the better oral health outcomes from fluoridated water supplies.
Improving Victoria’s oral health 33
Since 2004, the department has worked with many rural communities to expand
fluoridation. The process to introduce water fluoridation commenced with the
development of a suite of balanced, evidence-based resources about water
fluoridation in partnership with Dental Health Services Victoria and the Australian
Dental Association. In late 2004 the department distributed information to health
professionals throughout the state. This was followed by engagement with both the
health and community sectors in Sale, Morwell, Moe, Traralgon, Warragul, Wangaratta,
Wodonga and Horsham during which information about water fluoridation was provided
directly to households in each of these areas, briefings and presentations were
provided to the health sector and to community groups, and there was active use of
local media and promotion of a toll-free water fluoridation information line.
In late 2005, under the Health (Fluoridation) Act 1973, the Secretary of the department
requested that the relevant water authorities fluoridate the drinking water supplies in
Wangaratta, Wodonga, Horsham, Sale, Moe, Morwell, Traralgon and Warragul. In 2006,
water fluoridation commenced in Sale, Warragul, Moe, Morwell, Traralgon, Horsham and
Robinvale. Wodonga commenced fluoridation in May 2007 and Wangaratta will do so in
July/August 2007. Under this expansion, approximately 150,000 additional Victorians
will benefit from a fluoridated drinking water supply.
The recent review of evidence by Dental Health Services Victoria and the University of
Melbourne found good evidence of effectiveness in multi-strategy programs involving
the provision of fluoridated toothpaste for young children in high-risk populations. This
provides some direction for oral health promotion work in non-fluoridated parts of rural
Victoria.
Priority actions
1. Publish updated evidence-based guide to oral health promotion interventions.
2. Incorporate oral health promotion in the integrated health promotion approach
that already exists throughout Victoria, led by Primary Care Partnerships and
implemented through Community Health Services, local government and others.
3. Build on existing partnerships on both a statewide and catchment basis to promote
oral health in relevant non-health settings (e.g. children’s services and schools).
4. Implement effective health promotion strategies, using the Integrated Health
Promotion framework, for improving access to fluoride in small rural communities.
Responding to high-needs groups
The National Oral Health Plan identified a number of groups within the community
who have poor access to dental care and whose oral health status is well below the
rest of the community, in particular Aboriginal and Torres Strait Islanders, people in low
socioeconomic groups and people with special needs relating to disabilities, health
conditions or ageing. The National Oral Health Plan also noted that fluoridation remains
the most important population health measure that will assist high-needs group to
achieve better oral health.
34 Improving Victoria’s oral health
Victoria’s public dental system is already highly targeted towards people in low
socioeconomic groups. Adult public dental care is only provided to low-income people
through a means test arrangement.
Indigenous people
Compared to the Australian averages, indigenous Australians have: twice as many
caries and a greater proportion of untreated caries in children; more missing teeth in
adults; and generally poorer periodontal health (National Oral Health Plan).
In 2004, the Victorian Aboriginal Community Controlled Health Organisation (VACCHO)
published a review of access to oral health by Kooris. VACCHO concluded that dental
services to indigenous people in Victoria are inadequate. The review found a strong
reliance on the already stretched public dental system and the three dental clinics
(Fitzroy, Bairnsdale and Mooroopna) managed by Aboriginal organisations.
The VACCHO report called on the department, Dental Health Services Victoria and
VACCHO to work together to improve oral health care for Kooris. In particular the report
called for a hub-and-spoke approach, with more partnership arrangements to support
smaller local clinics, and priority access to community dental clinics for Kooris.
There have been a number of initiatives recently aimed at improving access for Kooris:
• Expanding the dental clinic at Rumbalara Aboriginal Cooperative (Moroopna) as part
of the Rural Dental Clinical School, which has its main campus at Goulburn Valley
Health in Shepparton. The Rumbalara clinic is also supporting the dental workforce
development among local Kooris.
• Extending public dental services at Barwon Health to include an oral health clinic at
Wathaurong Aboriginal Cooperative (Geelong).
• Establishing an oral health clinic at Murray Valley Aboriginal Cooperative (Robinvale).
Priority actions
1. Support Aboriginal Community Controlled Health Organisations to enter into
collaborative relationship with community dental clinics to adopt strategies to
improve responsiveness of public dental agencies to the oral health needs of Kooris.
2. Support local planners and service providers to develop oral health promotion
strategies in partnership with Indigenous communities.
People with special needs
The National Oral Health Plan defined ‘special needs’ in relation to oral care as
meaning people who have intellectual or physical disabilities, or medical or psychiatric
conditions, which increase their risk of having oral health problems or more complex
care needs (p. 30). This group has higher existing levels of oral disease, a higher risk of
having oral disease in the future, and less access to dental care.
A research study undertaken through the University of Melbourne (Hopcraft 2006) has
demonstrated very good results in improving access to dental care for special needs
group by adopting an outreach approach in supported residential services.
Improving Victoria’s oral health 35
Priority actions
1. Identify, through better service coordination mechanisms, people with special
needs at their first point of contact with Community Health Services so that the
implications for dental care can be better managed.
2. Through local area-based planning, better identify special needs groups within local
areas and develop strategies to better meet the needs of these groups.
3. Establish teams of dental hygienists to provide oral health services to residents
of supported residential services.
Pregnant women
Recent research (Dasanayake et al. 2005) shows a link between gum disease and
premature birth and low birth weight in babies. In pregnant women, hormonal changes
may lead to an increase in the amount of plaque on teeth. If plaque isn’t removed, it
can cause gingivitis or other gum diseases, with symptoms including bleeding and
swelling of the gums. Some pregnant women suffer from ‘pregnancy gingivitis’, with the
condition likely to appear in the second trimester; hormonal changes induce bleeding
in the gums despite the best possible hygiene measures, although gums usually revert
to normal after the baby is born.
If not treated, gingivitis can develop into more severe forms of gum disease such as
periodontal disease. Periodontal disease is a chronic bacterial infection of the gum
tissue that supports a person’s teeth, where the bacteria start to move deeper and
thrive in the gap between the gum and the tooth, causing the attachment of the tooth
and its supporting tissues to break down. If identified, this must be treated as a matter
of urgency as gum disease has been linked to premature birth and low birth weight in
babies.
In light of these findings, it is important that eligible women who are pregnant get
priority access to public dental care, rather than being placed on waiting lists where the
are unlikely to be treated prior to the birth of their baby.
Priority actions
1. Provide eligible women who are pregnant with priority access to public dental
services.
2. Link with existing pre-natal programs to provide better oral health education to
pregnant women.
People with chronic and complex conditions
The prevention and better management of chronic disease is a key health priority for
the Victorian Government. Patients with a chronic disease who need ongoing care
are the main focus of the Commonwealth Medical Benefits Scheme chronic disease
management items and represent a high proportion of clients accessing public dental
services in Victoria.
36 Improving Victoria’s oral health
The chronic disease management dental items allow for three dental care services
annually. In Victoria the chronic disease management dental items are underutilised.
Only 500 people received dental care under the program in 2005–06. This represents
a per capita utilisation well below the overall national per capita utilisation.
Priority action
1. Work with the Australian Dental Association and General Practice Divisions Victoria
to maximise the uptake of the chronic disease management dental items.
Oral health funding, accountability and evaluation
The department will undertake work in the areas of funding and accountability that
will support improved planning and service integration. This work will also allow for the
establishment of better performance indicators so that the community and providers
can better understand the operations of the dental system and the extent to which the
it is achieving its goals.
Funding review
This initiative will review and refine the funding arrangements for public dental care
with a view to achieving better alignment between funding, service delivery, policy
objectives and value for money. The review will provide recommendations on:
• ways in which the current funding arrangements could be streamlined to support
service integration, workforce strategies, demand management and oral health
promotion
• options for how three-year funding could be provided to agencies consistent with
department policy
• improving the effectiveness and efficiency of budget allocation and payment
processes and performance measures
• aligning reimbursement processes for services delivered by agencies and private
sector providers with department and industry best practice
• whether overhead/operational costs are reasonable relative to industry standards.
The review will be carried out during 2006–07 and findings will be implemented from
2007–08.
Common dataset
In 2005–06 the department conducted a review of data reporting requirements of
Dental Health Services Victoria for community dental services. The review found
that the current reporting approach is ad hoc and provides a mix of high-level and
aggregated data that does not always meet the needs of program accountability and
service planning.
Improving Victoria’s oral health 37
The department will undertake a common dataset project that will streamline data
reporting required of Dental Health Services Victoria. The outcome of the project will be
the replacement of current data reports with unit-level data collection for 2007–08 and
beyond. This will enable the department to produce reports to meet identified needs
and provide performance feedback to Dental Health Services Victoria.
Monitoring and evaluation
The National Oral Health Plan proposed a set of national key performance indicators
to monitor the implementation and outcomes of the plan. These same indicators can
provide a strong basis for monitoring the performance of the Victorian public dental
health system. The Victorian Government is working with representatives of other
states and territories on implementing and monitoring these indicators.
Priority actions
1. Complete the Dental Health Program funding review.
2. Implement the new three-year funding arrangements from July 2007.
3. Implement the common dataset from 1 July 2007.
38 Improving Victoria’s oral health
Improving Victoria’s oral health 39
Appendix 1: Community dental clinics in Victoria
Metropolitan clinics
Agency name
Address
Suburb
Postcode
Telephone
Inner East Community Health Service – The Craig Centre
7 Samarinda Avenue
Ashburton
3147
9885 6822
Bentleigh Bayside Community Health Service
Gardeners Road
Bentleigh East
3165
9575 5333
Cardinia/Casey Community Health Service – Berwick
28 Parkhill Drive
Berwick
3806
8768 5141
Whitehorse Community Health Service
Level 2, 43 Carrington Road
Box Hill
3128
9897 1792
Dianella Community Health
35 Johnstone Street
Broadmeadows
3047
8345 5410
Moreland Community Health Service
11 Glenlyon Road
Brunswick
3056
9387 6711
Greater Dandenong Community Health Service – Kingston
Cnr Heatherton & Warrigal Road
Cheltenham
3192
9265 1294
MonashLink Community Health Service
33 Dunstan Street
Clayton
3168
9543 2116
Cardinia/Casey Community Health Service – Cranbourne Site 140–150 Sladen Street
Cranbourne
3977
5990 6226
Greater Dandenong Community Health Service – Dandenong
Level 3, 229 Thomas Street
Dandenong
3175
8792 2300
Darebin Community Health Service – East Preston
125 Blake Street
East Reservoir
3073
8470 1111
Nillumbik Community Health Centre
917 Main Road
Eltham
3095
9431 1333
Plenty Valley Community Health Service
187 Cooper Street
Epping
3076
9409 8766
Knox Community Health Service
1063 Burwood Highway
Ferntree Gully
3156
9757 6201
North Yarra Community Health
75 Brunswick Street
Fitzroy
3065
9411 3505
Western Region Health Centre
72–78 Paisley Street
Footscray
3011
8398 4150
Peninsula Community Health Service – Frankston
Hastings Road
Frankston
3199
9784 8184
ISIS Primary Care – Wyndham
117–129 Warringa Crescent
Hoppers Crossing
3029
8734 1400
Doutta Galla Community Health – Kensington
6 Gower Street
Kensington
3031
8378 1670
Ranges Community Health Service
17 Clarke Street
Lilydale
3140
9737 6355
Doutta Galla Community Health – Niddrie
3–15 Matthews Avenue
Niddrie
3042
8378 3566
Darebin Community Health Service – Northcote
42 Separation Street
Northcote
3070
9489 1388
Central Bayside Community Health Services
335 Nepean Highway
Parkdale
3195
8587 0350
Inner South Community Health Service – Prahran
240 Malvern Road
Prahran
3181
9520 3177
Darebin Community Health Service – PANCH
300 Bell Street
Preston
3072
9485 9060
North Richmond Community Health Centre – Richmond
23 Lennox Street
Richmond North
3121
9420 1302
Eastern Access Community Health – Maroondah
124 Mt Dandenong Road
Ringwood East
3135
9259 4900
Peninsula Community Health Service – Rosebud
288 Eastbourne Road
Rosebud
3939
5986 4677
Inner South Community Health Service – South Port
341 Coventry Street
South Melbourne
3205
9690 9144
Greater Dandenong Community Health Service – Springvale
55 Buckingham Avenue
Springvale
3171
8558 9165
ISIS Primary Care – Brimbank
1 Andrea Street
St Albans
3021
9296 1360
Sunbury Community Health Service
12-28 Macedon Street
Sunbury
3429
9744 4455
Banyule Community Health Service – West Heidelberg
21 Alamein Road
West Heidelberg
3081
9450 2000
40 Improving Victoria’s oral health
Rural clinics
Agency name
Address
City/town
East Grampians Health Service
Girdlestone Street
Ararat
Postcode
3377
Telephone
5352 9327
Bairnsdale Regional Health Service
Ross Street
Bairnsdale
3875
5152 0278
Ballarat Health Services
Cnr Sturt and Drummond Streets
Ballarat
3350
5320 4225
Barwon Health – Belmont
Cnr Reynolds Road and Colac Highway
Belmont
3216
5260 3710
Northeast Health Wangaratta – Benalla
45 Coster Street
Benalla
3672
5761 2200
Bendigo Health Care Group
100–104 Barnard Street
Bendigo
3552
5454 7994
Boort District Hospital
2 Coutts Street
Boort
3537
5455 2306
Latrobe Community Health Service – Churchill
11 Philip Parade
Churchill
3842
5122 0400
Colac Area Health Services
15 Hart Street
Colac
3250
5232 5352
Barwon Health – Corio
2 Gellibrand Street
Corio
3214
5273 2227
Hepburn Health Service – Creswick
1 Hill Street
Creswick
3363
5345 8165
Hepburn Health Service – Daylesford
13 Hospital Street
Daylesford
3460
5348 2523
Wimmera Health Care Group – Dimboola
Lloyd Street
Dimboola
3414
5389 1301
Echuca Regional Health Service
Leichardt Street
Echuca
3564
5485 5820
Edenhope and District Memorial Hospital
Lake Street
Edenhope
3318
5585 9800
Hamilton Dental Clinic
Tyer Street
Hamilton
3300
5551 8347
Wimmera Health Care Group – Horsham Base Hospital
Baillie Street
Horsham
3400
5381 9248
Maryborough District Health Service
87 Clarendon Street
Maryborough
3465
5461 0388
Sunraysia Community Health Services
132 Langtree Avenue
Mildura
3500
5021 0944
Latrobe Community Health Service – Moe
42–44 Fowler Street
Moe
3825
5127 9189
Rumbalara Aboriginal Cooperative
Rumbalara Road
Mooroopna
3629
5825 2111
Barwon Health – Newcomb
104–108 Bellarine Highway
Newcomb
3219
5260 3540
West Wimmera Health Service – Nhill
51 Nelson Street
Nhill
3418
5391 4266
Omeo District Health
12 Easton Street
Omeo
3898
5159 0100
Orbost Regional Health
Boundary Road
Orbost
3888
5154 6625
Mallee Track Health and Community Services
Britt Street
Ouyen
3490
5092 1121
Bellarine Community Health
Nelson Road
Point Lonsdale
3225
5258 0828
Portland District Health
Bentinck Street
Portland
3305
5521 0390
Central Gippsland Health Service
155 Guthridge Parade
Sale
3850
5143 8618
Goulburn Valley Health
Graham Street
Shepparton
3630
5832 3050
East Wimmera Health Service – St Arnaud
52 Northwestern Road
St Arnaud
3478
5477 2175
Swan Hill District Hospital
73 Beveridge Street
Swan Hill
3585
5033 9336
Tallangatta Health Services
Barree Street
Tallangatta
3700
02 6071 5200
Northeast Health Wangaratta
24 Green Street
Wangaratta
3676
5722 0325
South West Healthcare
26 Ryot Street
Warrnambool
3280
5563 1499
Wodonga Regional Health Service
81 Vermont Street
Wodonga
3690
02 6051 7530
Bass Coast Regional Health
120 Graham Street
Wonthaggi
3995
5671 3268
Improving Victoria’s oral health 41
Appendix 2: Dental ACSC admissions ranking by catchment for
0–14-year-olds compared to all ACSC admissions ranking, 2004–05
Dental ACSC
admission
rate per 1,000
population
Dental ACSC
admissions rank
All ACSC
admissions rank
% access to
fluoridated water
in Jan. 2000
% households
in poverty*
Northern Mallee
16.52
1
1
1.09
12.35
Wimmera
14.27
2
2
11.79
13.41
Central Highlands
Catchment
12.53
3
22
0
11.66
Central West Gippsland
12.1
4
6
5.72
13.93
Central Victoria
9.96
5
21
7.42
11.89
Central Hume
9.41
6
17
0
12.35
Bendigo Loddon
9.32
7
12
0
12.37
Southern Mallee
9.04
8
16
10.72
13.86
East Gippsland
8.45
9
13
0
14.6
Grampians Pyrenees
8.18
10
19
0
14.31
Campaspe
8.07
11
4
46.65
11.3
South West
7.52
12
11
4.77
12.13
South Coast
7.15
13
25
0
13.95
Barwon
6.75
14
27
0.1
11.67
Southern Grampians-Glenelg
6.26
15
3
33.71
13.16
Goulburn Valley
6.12
16
8
55.46
11.58
Moonee Valley-Melbourne
6.11
17
23
100
12.77
Hume-Moreland
5.99
18
14
90.43
10.25
Lower Hume
5.72
19
20
0
10.07
Brimbank-Melton
5.55
20
9
99.6
9.6
North Central Metropolitan
5.43
21
18
98.35
11.43
Banyule-Nillumbik
5.18
22
30
99.74
7.6
Boroondara
4.95
23
32
100
7.7
Outer East
4.79
24
28
92.4
7.43
Wellington
4.68
25
5
55.88
12.93
Westbay
4.52
26
15
100
10.18
Inner East
4.46
27
31
100
8.12
South East
4.36
28
7
96.43
9.02
Inner South
4.27
29
29
100
9.33
Frankston and Peninsula
3.54
30
10
100
9.65
3.1
31
26
100
8.58
2.44
32
24
†
11
Kingston-Bayside
Upper Hume
* This ‘poverty index’ is a small-area–level estimate of disadvantage constructed by the National Centre for Social and Economic Modelling and based on household
disposable income . The index was produced by a spatial microsimulation model called STINMOD, which simulates the impact of major federal government cash
transfers, income tax and the Medicare levy on individuals and families in Australia. Data input to the model includes information from the ABS 1989–99 Household
Expenditure Survey Confidentialised Unit Record File and the Australian Bureau of Statistics 2001 Census Expanded Community Profile datasets.
†
Access to fluoridated water for Upper Hume catchment is unavailable as households are connected to New South Wales water supplies.
42 Improving Victoria’s oral health
Appendix 3: Maps of catchment areas
Integrated area-based planning catchments – Metropolitan Melbourne
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IAP Catchment
North & West Region
Banyule-Nillumbik
Pop. 177,946 Area: 493 km2
Hume-Moreland
Pop. 284,038 Area: 555 km2
North Central Metropolitan
Pop. 323,567 Area: 564 km2
Brimbank-Melton
Pop. 245,776 Area: 651 km2
Moonee Valley-Melbourne
Pop. 170,835 Area: 78 km2
West Metropolitan
Pop. 253,121 Area: 637 km2
Local Government Area
Banyule
Nillumbik
Hume
Moreland
Darebin
Whittlesea
Yarra
Brimbank
Melton
Melbourne
Moonee Valley
Hobsons Bay
Maribyrnong
Wyndham
IAP Catchment
Southern Region
Frankston & Peninsula
Pop. 257,724 Area: 853 km2
Inner South
Pop. 296,661 Area: 86 km2
Kingston-Bayside
Pop. 225,916 Area: 128 km2
South East
Pop. 392,162 Area: 1,822 km2
Eastern Region
Inner East
Pop. 578,689
Outer East
Pop. 394,215
Area: 318 km2
Area: 2,647 km2
Local Government Area
Frankston
Mornington Peninsula
Glen Eira
Port Phillip
Stonnington
Bayside
Kingston
Cardinia
Casey
Greater Dandenong
Boroondara
Monash
Whitehorse
Manningham
Knox
Maroondah
Yarra Ranges
Population numbers are based on Estimated Resident Population 2004 by LGA.
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GZ\^dc
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8VbeVheZ
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<^eehaVcY
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<^eehaVcYGZ\^dc
8ZcigVa=jbZ
=jbZGZ\^dc
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JeeZg=jbZ
:Vhi<^eehaVcY
Improving Victoria’s oral health 43
Integrated Area-based Planning Catchments – Rural Victoria
44 Improving Victoria’s oral health
Integrated Area-based Planning Catchments – Rural Victoria (cont.)
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Ede#').!,.( 6gZV/+!',&`b'
<gZViZg<ZZadc\
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Hjg[8dVhi
Hdji]LZhi
8dgVc\Vb^iZ
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BdncZ
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<aZcZa\
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6gZV/&(!%((`b'
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8ZcigVaLZhi
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7Vhh8dVhi
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<gVbe^VchGZ\^dc
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Cdgi]Zgc<gVbe^Vch
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Ede#&))!)(( 6gZV/,!%',`b'
<daYZcEaV^ch
=ZeWjgc
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=^cYbVgh]
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=dgh]Vb
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7ZcVaaV
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AdlZg=jbZ
B^iX]Zaa
Ede#)*!)-' 6gZV/+!,).`b'
Bjgg^cY^cY^
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<gZViZgH]ZeeVgidc
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6gZV/.!-%(`b'
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EdejaVi^dccjbWZghVgZWVhZYdc:hi^bViZYGZh^YZciEdejaVi^dc'%%)WnA<6#
Improving Victoria’s oral health 45
Appendix 4: Regional profiles
Barwon-South Western Region
Dental clinics
&
Barwon Health – Corio (4)
'
Barwon Health – Newcomb (6)
(
Barwon Health – Belmont (6)
)
Barwon Health – Wathaurong (1)
*
Bellarine Community Health (4)
+
Colac Area Health (2)
,
Hamilton Dental Clinic (2)
-
Hamilton SDS (2)
.
Portland District Health (2)
Hdji]Zgc<gVbe^Vch"
<aZcZa\
,
& '
) '
(
Hdji]LZhi
.
&
&% (
*
7Vgldc
+
&% South West Healthcare
– Warrnambool (3)
Mobile dental vans
&
Colac Mobile Dental Van (2)
'
Corio Mobile Dental Van (2)
(
Warrnambool Mobile Dental Van (2)
Numbers in parentheses are the number
of dental chairs.
Eligible
population
No. of
chairs
Eligible population
per chair
104,358
27
3,865
South West
26,027
5
5,205
Southern Grampians-Glenelg
15,677
6
2,613
146,062
38
3,844
Planning catchment
Barwon
Total
46 Improving Victoria’s oral health
Gippsland Region
Dental clinics
&
Bairnsdale Regional Health Service (4)
'
Bass Coast Regional Health (4)
(
Central Gippsland Health Service (2)
)
Latrobe Community Health Service
– Churchill (2)
*
Latrobe Community Health Service
– Moe (6)
+
,
:Vhi<^eehaVcY
8ZcigVaLZhi
Morwell SDS (2)
,
Omeo District Health (1)
-
Orbost Regional Health (1)
.
Sale SDS (2)
*
&%
+
LZaa^c\idc
&
( .
)
Hdji]8dVhi
'
&% Warragul SDS (2)
Numbers in parentheses are the number
of dental chairs.
Planning catchment
Eligible
population
No. of
chairs
Eligible population
per chair
East Gippsland
19,210
6
3,202
Central West
48,462
12
4,039
South Coast
23,408
4
5,852
Wellington
18,001
4
4,500
109,081
26
4,195
Total
Improving Victoria’s oral health 47
Grampians Region
Dental clinics
&
Ballarat Dental Clinic (8)
'
East Grampians Health Service (1)
(
Edenhope District Memorial Hospital (1)
)
Hepburn Health Service – Creswick (1)
*
Hepburn Health Service – Daylesford (1)
+
West Wimmera Health Service (2)
,
Wimmera Health Care Group
– Dimboola (1)
-
Wimmera Health Care Group
– Horsham (2)
+
,
L^bbZgV
( -
Mobile dental vans
&
Ararat Mobile Dental Van (2)
'
Ballarat Mobile Dental Van (2)
(
Horsham Mobile Dental Van (2)
(
<gVbe^VchEngZcZZh
& '
)
Numbers in parentheses are the number
of dental chairs.
*
'&
8ZcigVa=^\]aVcYh
Planning catchment
Eligible
population
No. of
chairs
Eligible population
per chair
Grampians-Pyrenees
14,018
3
4,673
Central Highlands
60,959
12
5,080
Wimmera
16,163
8
2,020
Total
91,140
23
3,963
48 Improving Victoria’s oral health
Loddon-Mallee Region
Dental clinics
&
Bendigo Health Care Group (19)
'
Boort District Hospital (2)
(
Echuca Regional Health (4)
)
Mallee Track Health and Community
Service (2)
*
Maryborough District Health Service (4)
+
Murray Valley Aboriginal Co-operative (1)
,
Sunraysia Community Health Centre (8)
-
Swan Hill District Hospital (2)
' ,
+
Cdgi]ZgcBVaaZZ
)
(
-
Hdji]ZgcBVaaZZ
Mobile dental vans
&
Castlemaine Mobile Dental Van (2)
'
Mildura Mobile Dental Van (0)
(
Swan Hill Mobile Dental Van (2)
'
(
8VbeVheZ
7ZcY^\d"
AdYYdc
Numbers in parentheses are the number
of dental chairs.
&
*
&
8ZcigVaK^Xidg^V
Planning catchment
Eligible
population
Bendigo-Loddon PCP
46,094
21
4,190
Campaspe PCP
16,395
4
4,099
Central Victorian Health Alliance
28,952
6
4,825
Southern Mallee
18,014
4
4,504
Northern Mallee
23,974
11
2,179
133,429
43
3,103
Total
No. of
chairs
Eligible population
per chair
Improving Victoria’s oral health 49
Hume Region
Dental clinics
&
Goulburn Valley Health (12)
'
Northeast Health – Benalla (2)
(
Northeast Health – Wangaratta (2)
)
Rumbalara Aboriginal Co-operative (2)
*
Seymour SDS (1)
+
Tallangata Dental Clinic (1)
,
Wodonga Regional Health Service (10)
,
)
'
Wangaratta Mobile Dental Van (2)
JeeZg=jbZ
'
<djaWjgcKVaaZn
8ZcigVa=jbZ
*
Kilmore/Seymour Mobile Dental Van (2)
('
&
Mobile dental vans
&
+
&
AdlZg=jbZ
Numbers in parentheses are the number
of dental chairs.
Planning catchment
Upper Hume PCP
Eligible
population
21,894
No. of
chairs
Eligible population
per chair
11
1,990
Central Hume PCP
26,077
6
4,346
Goulburn Valley PCP
43,463
14
3,105
Lower Hume PCP
18,173
3
6,058
109,607
34
3,224
Total
50 Improving Victoria’s oral health
North and West Metropolitan Region
Dental clinics
&
Altona SDS (2)
'
Banyule Community Health Service (8)
(
Darebin Community Health Service:
East Preston (4)
)
Darebin Community Health Service:
Northcote (2)
*
Dianella Community Health (6)
,
Doutta Galla Community Health
– Kensington (4)
.
Cdgi]
8ZcigVa
BZigdeda^iVc
=jbZ"
BdgZaVcY
&
Darebin Community Health Service:
PANCH (7)
+
-
'&
7VcnjaZ"
C^aajbW^`
&.
&'
+
7g^bWVc`"
BZaidc
&%
Doutta Galla Community Health
– Niddrie (7)
.
''
&&
Footscray SDS (5)
-
BddcZZ
KVaaZn"
BZaWdjgcZ &)
,
&(
(
*
&*
'
)
&- &+
'% &,
&
&% Isis Primary Care – Brimbank (10)
LZhi
BZigdeda^iVc
&& Isis Primary Care – Wyndham (8)
&' Melton Latrobe Site (12)
&( Moomba Park SDS (2)
&) Moreland Community Health Service (3)
&* Nillumbik Community Health Service (3)
&+ North Richmond Community Health
Centre – North Yarra (2)
&, North Richmond Community Health
Centre – Richmond (7)
&- Ozanam Day Centre (1)
&. Plenty Valley Community Health
Services (9)
'% Royal Dental Hospital of Melbourne (139)
'& Sunbury Community Health Centre (5)
'' Western Region Health Centre (6)
Mobile dental vans
&
Melton Mobile Dental Van (2)
Numbers in parentheses are the number
of dental chairs.
Planning catchment
Moonee Valley
Eligible
population
No. of
chairs
Eligible population
per chair
52,317
12
4,360
101,242
21
4,821
56,709
11
5,155
126,939
31
4,095
Hume-Moreland
121,767
16
7,610
Melton-Brimbank
106,206
24
4,425
Total
565,180
114
4,915
West Bay
Banyule-Nillumbik
North Central
Royal Dental Hospital of Melbourne chairs not included
Improving Victoria’s oral health 51
Eastern Metropolitan Region
Dental clinics
&
Eastern Access Community Health
– Maroondah (3)
'
Inner East Community Health Service
– The Craig Centre (4)
(
Knox Community Health Service (10)
)
MonashLink Community Health
Service (10)
>ccZg:Vhi
*
Ranges Community Health Service (6)
'
+
Whitehorse Community Health
Service (10)
'
DjiZg:Vhi
+
*
&
& )
(
Mobile dental vans
&
Burwood/Clayton Mobile Dental Van (0)
'
Coldstream Mobile Dental Van (2)
Numbers in parentheses are the number
of dental chairs.
Planning catchment
Eligible
population
No. of
chairs
Eligible population
per chair
Outer East
138,519
21
6,596
Inner East
177,833
24
7,410
Total
316,352
45
7,030
52 Improving Victoria’s oral health
Southern Metropolitan Region
Dental clinics
&
Bentleigh Bayside Community Health
Service (7)
'
Casey Community Health Service
– Berwick (Southern Health) (2)
(
Casey Community Health Service
– Cranbourne (Southern Health) (8)
)
Central Bayside Community Health
Service Inc. (8)
*
Frankston Community Health
Centre (Peninsula Health) (10)
+
Greater Dandenong Community Health
Services – Dandenong (Southern
Health) (6)
,
Greater Dandenong Community Health
Services – Kingston (Southern Health) (1)
-
Greater Dandenong Community Health
Services – Springvale (Southern Health) (3)
.
Inner South Health Service – Prahran (4)
&% &(
.
>ccZg
Hdji]
&
,
@^c\hidc"
7Vnh^YZ
)
(
& +
'
Hdji]:Vhi
(
*
'
&&
;gVc`hidc
EZc^chjaV
&'
&% Inner South Health Services
– South Port (4)
&& Peninsula Community Health Service
– Hastings (4)
&' Peninsula Community Health Service
– Rosebud (3)
&( Port Phillip Special School (2)
Mobile dental vans
&
Dandenong Mobile Dental Van (2)
'
Hastings Mobile Dental Van (0)
(
Mosgiel Park Mobile Dental Van (2)
Numbers in parentheses are the number
of dental chairs.
Planning catchment
Eligible
population
Inner South East PCP
83,073
Kingston-Bayside PCP
No. of
chairs
Eligible population
per chair
17
4,887
73,968
8
9,246
South East PCP
159,870
24
6,661
Frankston-Peninsula PCP
101,244
17
5,956
Total
418,155
66
6,336
Improving Victoria’s oral health 53
Appendix 5: References
Australian Dental Association (ADA) 2003, News bulletin No. 317, December 2003.
Australian Health Ministers’ Advisory Council (AHMAC) Steering Committee for
National Planning for Oral Health 2001, Oral health of Australians: National planning for
oral health improvement: Final report, South Australian Department of Human Services.
Australian Health Ministers’ Conference (AHMC) 2004a, National Health Workforce
Strategic Framework, NSW Department of Health, www.health.nsw.gov.au/amwac/
pdf/NHW_stratfwork_AHMC_2004.pdf.
Australian Health Ministers’ Conference (AHMC) 2004b, National Oral Health Plan
2004–2013, South Australian Department of Health.
Australian Institute of Health and Welfare (AIHW) 2002a, Australia’s health 2002, AIHW
cat. no. AUS 41, AIHW, Canberra.
Australian Institute of Health and Welfare (AIHW) 2002b, Victorian oral health services
labour force planning, Rural and Regional Health and Aged Care Services, Victorian
Department of Human Services, www.health.vic.gov.au/dentistry/downloads/report_
oralhlth_labourforce.pdf.
Australian Institute of Health and Welfare (AIHW) 2005, A picture of Australia’s children,
AIHW cat. no. PHE 58, AIHW, Canberra.
Australian Institute of Health and Welfare (AIHW) 2006, Health expenditure Australia
2004–05, Health and Welfare Expenditure Series no. 28. AIHW cat. no. HWE35, AIHW,
Canberra.
Brennan DS and Spencer AJ 2004, Oral health trends among adult public dental patients,
AIHW cat. no. DEN 127, Dental Statistics and Research Series No. 30, AIHW, Canberra.
Dasanayake AP, Li Y, Wiener H, Ruby JD and Lee M 2005, ‘Salivary Actinomyces
naeslundii genospecies 2 and Lactobacillus casei levels predict pregnancy outcomes’,
Journal of Periodontology, 76(2):171–177.
Dental Health Services Victoria (DHSV) 2005, Oral Health Strategic Plan and Service
Plan for Victoria 2005–2010, Dental Health Services Victoria.
Department of Human Services (DHS) 1999, Promoting oral health 2000–2004:
Strategic directions and framework for action, Public Health Division, Victorian
Department of Human Services.
Department of Human Services (DHS) 2003a, Directions for your health system:
Metropolitan Health Strategy, Metropolitan Health and Aged Care Services Division,
Victorian Department of Human Services, www.health.vic.gov.au/metrohealthstrategy.
Department of Human Services (DHS) 2003b, Primary Care Partnerships strategic
directions 2004–2006: Better health – stronger communities, Primary and Community
Health Branch, Victorian Department of Human Services, www.dhs.vic.gov.au/phkb.
Department of Human Services (DHS) 2004, Community Health Services – creating
a healthier Victoria, Primary and Community Health Branch, Victorian Department of
Human Services, www.dhs.vic.gov.au.
54 Improving Victoria’s oral health
Department of Human Services (DHS) 2005a, Departmental plan 2005–06:
Department of Human Services, Victorian Department of Human Services, www.dhs.
vic.gov.au/dhsplan.
Department of Human Services (DHS) 2005b, Rural directions for a better state of
health, Rural and Regional Health Services Branch, Victorian Department of Human
Services, www.health.vic.gov.au/ruralhealth/.
Department of Human Services (DHS) 2005c, Victoria: A better state of health,
Victorian Department of Human Services, www.health.vic.gov.au/betterstate/betterstate-health.pdf.
Department of Human Services (DHS) 2006a, Care in your community: A planning
framework for integrated ambulatory health care, Victorian Department of Human
Services.
Department of Human Services (DHS) 2006b, The state of Victoria’s children report
2006, Office for Children, Victorian Department of Human Services.
Hopcraft M 2006, Access to dental care in aged residential facilities: Role of the dental
hygienist, Presentation to the Victorian Department of Human Services, November
2006.
Last JM 2001, A dictionary of epidemiology, 4th edn, Oxford University Press, Oxford.
Senate Select Committee on Medicare 2003, Medicare – healthcare or welfare?, AGPS,
Canberra, www.aph.gov.au/senate_medicare.
Task Group on Health Promotion for Oral Health 2000, Health promotion report for oral
health: Report to the National Public Health Partnership.
US Department of Health and Human Services 2000, Oral health in America: A report
of the Surgeon General – Executive summary, US Department of Health and Human
Services, National Institute of Dental and Craniofacial Research, National Institutes of
Health, Rockville, MD.
Victorian Aboriginal Community Controlled Health Organisation (VACCHO) 2004,
A review of access to oral health care by Aboriginal people in Victoria, VACCHO,
Melbourne.
World Health Organization (WHO) 1986, Ottawa Charter for Health Promotion, WHO and
Canadian Public Health Association, Ottawa.
World Health Organization (WHO) 1994, Fluorides and oral health: Report of a WHO
expert committee on oral health status and fluoride use, World Health Organization,
Geneva.
World Health Organization (WHO) 2006, WHO Oral Health Country/Area Profile
Programme, www.whocollab.od.mah.se.
Improving Victoria’s oral health
July 2007
Department of
Human Services