Rural oral health and access to dental care

Background

Why the oral health status of rural Australian adults is poorer than that of metropolitan adults has not been satisfactorily explained. Objectives To determine if the reason was poorer access to dental care

Methods

Data were obtained from the Australian National Survey of Adult Oral Health (2004–06), a clustered stratified random sample of people aged 15+ years using telephone interviews, oral epidemiological examinations, and questionnaires. Postcodes were used to create three ARIA+ regional groups: major city, inner and outer regional areas. Oral health status was measured by the DMFT Index, and the numbers of decayed, missing and filled permanent teeth. Six variables were used to indicate access to dental care. A two-step analysis was undertaken: comparing the dependent variables by regional location, socio-demographic confounders and preventive dental behaviours, and then including access to dental care variables, to investigate if there were significant regional effects in the first, but not in the second modelling step.

Results

Of the 14,123 people interviewed, 5,505 (43.7%) were examined, and 4,170 completed the questionnaire. With socio-economic and preventive dental parameters in the first regression model, inner regional people had higher DMFT (Regression coefficient=1.30, 95%CI=0.55,2.06), more decayed (0.30, 0.02,0.59) and missing teeth (0.64, 0.17,1.10), but not filled teeth (-0.36, -0.28,1.00), than major city-based people. In the second step analysis, inner regional people still had a greater DMFT (1.16, 0.40,1.92), but not decayed (0.17, -0.13,0.46), missing teeth (0.46, -0.03,0.96), or filled teeth (0.53, -0.15,1.21) than major city-based people.

Conclusion

Inner regional areas have a higher dental caries experience, more decayed and missing teeth than major city areas. This was maintained after controlling for sociodemographic status, but not for decayed and missing teeth when also controlling for access to dental care. Dental care access was one factor in poorer oral health in inner regional areas