Dentistry in Australia: Private practices and flying doctors

Jeremy Booth, Dental Tribune International

Thu. 5. October 2023

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SYDNEY, Australia: The vast island continent of Australia is affectionately known as “the lucky country”; however, having luck with oral health in Australia can depend on where one lives and how much one earns. Read on for a snapshot of dentistry in Australia that includes details on spending, oral health status, the dental workforce and the current outlook for dental suppliers and manufacturers.

Oral health in Australia has improved significantly over the last three decades, helped by the fluoridation of drinking water and the expansion of the dental workforce. A 2023 senate report on access to dental services found that each adult in Australia spends A$432 (€255) on dental care annually, but that the high per capita spend is at odds with the country’s incidence of caries in permanent teeth and edentulism.

The senate report showed that 25% of children aged 5 to 10 years have untreated dental caries, that 4% of people aged 15 years and older are edentulous, that Australians aged 35–54 years have an average of more than ten decayed, missing or restored teeth and that most of the teeth of the average Australian aged 75 years or older are missing or decayed or have undergone restoration. A 2020 report on national oral health published by the Australian Dental Association (ADA) and the Australian Health Policy Collaboration found that the incidence of caries and periodontal disease had increased since 2004. According to the report, 32.1% of adults had untreated caries (a 6.6% increase compared with 2004 figures) and 28.8% had periodontal pockets (up by 9.0%). The report found that less than 50% of Australians had had a dental check-up in the previous 12 months.

Factors having an impact on oral health in Australia include lack of access to care, particularly for Aboriginal Australians and Torres Strait Islanders, the cost of private dental treatment and long waiting times for treatment in the public dental system.

Cost is a barrier to oral health

The cost of dental treatment varies between states, and federal and state governments provide free or subsidised oral care to citizens and some overseas visitors through the Medicare system and through concession cards for those on pensions and low incomes.

ADA data from last year shows that the average cost of a dental check-up in Australia—including prophylaxis and fluoride treatment—was A$219. Australians paid an average of A$178 for the restoration of one surface on a posterior tooth and between A$1,250 and A$2,100 for a veneered complete crown. Cost is a barrier to oral healthcare for many Australians, and it leads to four in ten people avoiding seeing a dentist.

In 2020, A$11.1 billion was spent on dental care in Australia, a fraction of the A$220.9 billion that was spent on healthcare in the same year. Dental patients footed 59% of the total spend, 20% was financed by private health insurers, and the remaining 20% was funded by the commonwealth and local governments. The federal government spent around A$1.3 billion on dental services in 2020, and health insurers spent around A$2.2 billion.

A part-time workforce with high employment

Dental professionals in Australia must be registered with the Australian Health Practitioner Regulation Agency. There are currently 26,563 registered dental professionals, some 29% more than the 20,469 that were registered in 2013. The number of registered dentists is 19,795—up from 15,479 in 2013. In 2020, there were 1,742 registered dental hygienists, 1,244 registered dental prosthetists, 924 dental therapists and 2,333 oral health therapists.

Dental therapists in Australia are registered primary healthcare professionals who treat mainly children and work under the supervision of a dentist, performing procedures such as filling cavities, extracting primary teeth, taking radiographs and performing examinations. Oral health therapists perform the same procedures as dental therapists, but they treat both children and adults and must have qualifications in dental therapy and dental hygiene. Dental hygienists in Australia perform preventive care and can also take impressions for orthodontic care, remove brackets, bands and wires, place and fix archwires and recement loose bands.

“In 2020, 95.0% of all of registered and employed dentists worked in private practices”

In 2020, around 90.0% of registered dental professionals were working in their field, including 91.1% of dentists. Government figures show that, in 2020, 49.8% of all dentists worked part-time, that 44.2% were female, that 20.1% were aged 30 years or younger and that 21.4% were 55 years of age or older. The number of registered dentists in the country who completed their initial dental education outside of Australia has remained steady at around 25% since 2014, and an additional 3% of registered dentists completed training in New Zealand.

In 2020, 95.0% of all of registered and employed dentists worked in private practices and just 4.9% worked in public clinics. One in ten dentists were employed as specialists, and orthodontists were Australia’s largest dental specialist group, numbering 560, or 35.2% of all dental specialists. The second- and third-largest specialist groups were periodontists (219) and prosthodontists (195), and men accounted for more than 70% of all dental specialists.

Remote care via air and land

Australia is the world’s sixth-largest country and has a population density of just 3.5 people per km2. In 2020, the country had 57.9 full-time equivalent (FTE) dental practitioners per 100,000 people, and the rate varied significantly between states—for example, 67.4 in Australian Capital Territory and 32.9 in Northern Territory—and dropped to 26.3 in remote and very remote areas. Remote and very remote areas in 2020 had the highest FTE rate of public sector dentists, at 9.5, and the highest FTE rate of dental therapists, at 3.7.

Australians living in remote and very remote areas face barriers to accessing dental care, and this is particularly true for Aboriginal Australians and Torres Strait Islanders, who together make up 3.2% of the total population but as much as 30.3% of the population of the Northern Territory. Around 17% of Indigenous Australians are estimated to live in remote or very remote areas, often on traditionally owned land. Operating full-time dental services in remote areas is often neither viable nor sustainable, owing to low population density and high operational costs, and both the dental workforce and the delivery of oral care have been adapted to meet the needs of populations in remote areas.

The famous Royal Flying Doctor Service (RFDS) is one example of an oral care model for remote areas. The service provides medical and oral care to communities using special airborne health services. The RFDS provided 58,975 oral care services in 2021 in 507 locations, funded by state governments, donors and private investment. The service also operates on terra firma—bringing preventive care and treatment to patients in Queensland, for example, at no cost via a purpose-built mobile dental surgery. The RFDS has been immortalised through popular culture, most notably through the public television drama The Flying Doctors, 221 episodes of which were produced between 1986 and 1992.

Australian dental suppliers and manufacturers are mainly located in the major metropolitan areas of Sydney and Melbourne. (Image: Maurizio De Mattei/Shutterstock)

In the Kimberley region in Western Australia, the successful not-for-profit dental organisation the Kimberley Dental Team uses rotating teams of volunteers to provide dental health education and treatment to aboriginal communities. The organisation originally provided mainly emergency oral care; however, over the last ten years, it has evolved to become a provider of preventive and restorative treatment that showcases the importance of tailored, community-centred healthcare solutions in remote parts of Australia.

The dental industry in Australia is growing and digitising

Australian dental suppliers and manufacturers are mainly located in the major metropolitan areas of Sydney and Melbourne, and the Australian Dental Industry Association (ADIA) told Dental Tribune International that around 75% of all suppliers and manufacturers in Australia are based in New South Wales and Victoria.

According to ADIA, demographic trends indicate that the Australian dental industry is set to experience growth. ADIA said: “A growing and ageing population, with rising disposable incomes, means the dental industry’s performance is forecast to improve and the business of suppliers and manufacturers with it.”

The association added that dental clinics in the country are expected to further invest in new technologies such as 3D-printing technologies and digital platforms that improve communication and visually demonstrate to patients the areas of diagnosis and proposed treatment. The association said that dental practices are also increasingly adopting next-generation business database systems that improve operational efficiencies and client retention rates.