Australia’s dental data landscape

Data on the oral health of Australians and their use of dental services are of fundamental importance as they can serve as the foundation for evidence-based decision-making in dental health care policy and practice. Accurate, comparable and comprehensive data enable authorities to:

• identify oral health trends
• assess the effectiveness of existing dental programs
• allocate resources efficiently
• develop targeted strategies for improving oral health outcomes.

Moreover, such data can facilitate early intervention, preventive measures and better‑informed patient care, ultimately contributing to the overall wellbeing and quality of life of the population.

This article describes the dental data landscape in Australia. It examines ways that data on the oral health of Australians and their use of dental services are currently collected and translated into information that can be actioned. It comments on inconsistencies in, and barriers to, collecting and using that information, and on opportunities to innovate and enhance the landscape, strengthening the evidence base.

Brushing up on oral health

Oral health refers to the condition of a person’s teeth and gums, and the health of the muscles and bones in their mouth. Poor oral health – mainly tooth decay, gum disease and tooth loss – affects many Australian children and adults.

Good oral health is fundamental to overall health and wellbeing. Without it, a person’s general quality of life and the ability to eat, speak and socialise is compromised, resulting in pain, discomfort and embarrassment (COAG 2015).

A dental visit gives a person a chance to receive preventive dental care and treatments that can maintain and enhance their oral health and may even reverse oral diseases and damage to their teeth and gums.

Untreated tooth decay reflects the level of dental decay in the population and access to dental treatment.

Dental caries

Dental caries is a bacterial disease of the teeth. It becomes apparent when a tooth has decayed to the point of permanent damage to its enamel in the form of little holes that expose the inner structure and nerves of the tooth. The level of dental caries in the population is a key indicator of oral health and is measured by counts per person of the number of teeth that are decayed, missing or have had caries filled by a dentist. This measure can be counted either as:

• a dmft, which is a decayed, missing or filled tooth in the ‘primary dentition’ (the first set of teeth a person has, sometimes referred to as baby teeth)
• a DMFT, which is a decayed, missing or filled tooth in the ‘permanent dentition’ (a person’s second set of teeth, sometimes referred to as adult teeth).

The average numbers of dmft/DMFT in different populations are shown in Table DD.1. The data presented are the most up to date currently available. (The timeliness of the surveys from which they are derived is discussed in further detail below.)

1. Data are for 2012–14 and report caries experience in the primary dentition.
2. Data are for 2012–14 and report caries experience in the permanent dentition.
3. Data are for 2017–18 and report caries experience in the permanent dentition.

Sources: Do and Luzzi 2019; Ha et. al. 2016.

Australia’s National Oral Health Plan

In recent years, national-level data needs relating to oral health care have been largely framed by Australia’s National Oral Health Plan 2015–2024 (NOHP). Given that the current NOHP is due to expire at the end of 2024, the Department of Health and Aged Care is developing a new NOHP.

The goal of the NOHP is ‘to improve health and wellbeing across the Australian population by improving oral health status and reducing the burden of poor oral health’ (COAG 2015).

Foundation areas and priority principles

The NOHP outlines guiding principles that underpin Australia’s oral health system; it also provides national strategic direction, including targeted strategies in 6 foundation areas and across 4 priority populations.

Australia’s 6 NOHP foundation areas are:

• Oral health promotion – all Australians have access to oral health promoting environments and to appropriate evidence-based information and programs that support them to make informed decisions about their oral health.
• Accessible oral health services – all Australians have access to appropriate oral health care in a clinically appropriate time frame.
• Systems alignment and integration – social, health and education systems work together to support healthy mouths and healthy lives.
• Safety and quality – oral health services are provided in accordance with the Australian Safety and Quality Goals for Health Care.
• Workforce development – the workforce for oral health is of an appropriate size and is appropriately trained and distributed.
• Research and evaluation – appropriate and timely data are available at both the population and service level for planning, monitoring and evaluation.

The 4 priority populations are the groups who experience the most considerable barriers to accessing oral health care and the greatest burden of oral disease:

• people who are socially disadvantaged or on low incomes
• Aboriginal and Torres Strait Islander (First Nations) people
• people living in regional and remote areas
• people with additional and/or specialised health needs.

Comprehensive and up-to-date data are needed to support the NOHP’s goal to improve the oral health of the Australian population and reduce the burden of poor oral health.

Key Performance Indicators

To monitor progress of the NOHP strategies, 26 core Key Performance Indicators were developed and have been reported on twice:

• Baseline data were reported in 2017, presenting data for the reporting period July 2014 – June 2016 (or as close as possible to this period). This report was published on the Council of Australian Governments (COAG) website in 2019 and, following the dissolution of COAG in 2020, can now be accessed via Trove (COAG, 2019).
• The AIHW produced a second performance monitoring report, published in 2020 (AIHW 2020), which presented data for the reporting period July 2016 – June 2018 (or as close as possible to this period).

These 2 reports highlighted the lack of routinely available national data to assess a number of indicators, and the particular difficulties encountered in assessing changes for people in the priority populations.

Table DD.2 provides a summary of the 26 indicators, their data sources and the frequency of collection.

ABS = Australian Bureau of Statistics; VET = vocational education and training.

Source: AIHW 2020.

Other indicators

Alongside the NOHP, the Aboriginal and Torres Strait Islander Health Performance Framework monitors progress in First Nations people’s:

• health status and outcomes
• determinants of health
• health system performance.

It reports on 68 measures across these 3 domains (tiers). Measure 1.11 Oral health in Tier 1 – Health status and outcomes describes the oral health of First Nations people. It highlights the main areas of improvement and those of continuing concern, aligning with the broader objectives of the NOHP. 

Timely data from all sources mean that policy advisors can accurately assess the effectiveness of existing strategies and adjust them where necessary to deal with emerging oral health challenges. Without such data, it is hard to understand the oral health of the population and disparities in its oral health; it is also difficult to monitor progress, allocate resources effectively and target interventions at identified problems.

Scale of the data

The aim of the NOHP is to improve the oral health status of Australians – a challenging aim as there are no comprehensive national data sources from which to derive data on the status of Australians’ oral health. Most of the available data on Australians’ oral health status and their use of dental services is sourced from national population surveys and administrative data sets. 

These and other data sources – such as the Australian Dental Association’s annual consumer survey, which collects data on oral health – help to paint a clearer picture of the oral health status of Australians and their use of dental care services.

National population surveys

National population surveys are large-scale data collections that gather information on a country’s population. They largely rely on self-reported data: individuals provide information about themselves through interviews, questionnaires or via online forms. These surveys aim to be representative by collecting data from a sample population that mirrors the demographic and geographic diversity of the broader population from which the sample is drawn. This is to ensure that statistical findings reflect the characteristics and experiences of the broader population.

ARCPOH surveys

The Australian Research Centre for Population Oral Health (ARCPOH) at The University of Adelaide regularly conducts surveys to monitor the oral health of Australians and their use of dental services. These surveys are considered to be representative of the Australian population.

Some ARCPOH surveys include a clinical examination component and are conducted on a 5-yearly cycle, alternating between adults and children. In this way, the data for each population group are updated about every 10 years.

• The National Survey of Adult Oral Health (NSAOH) was conducted in 1987–88, 2004–06 and most recently in 2017–18, with another planned for 2027.
• The National Child Oral Health Study (NCOHS) was first conducted in 2012–14 with the NCOHS 2023–2025 currently underway.

ARCPOH National Dental Care Survey

To complement the data from these surveys, ARCPOH also conducts the National Dental Telephone Interview Survey (NDTIS) – now called the National Dental Care Survey –about every 3 years; it is a population survey of self-reported oral health and use of dental services.

The first NDTIS was undertaken in 1994 and the most recent in 2021, with another tentatively scheduled for 2024. These surveys collect self-reported data on the oral health status of the Australian population – for example, on:

• the average number of decayed, missing or filled teeth
• Australians’ use of dental services (such as the type of dental practices people visit and their visiting patterns).

ABS Patient Experience Survey

The ABS conducts the Patient Experience Survey annually. It collects information from people aged 15 and over on their experiences with selected aspects of the health system in the 12 months before their interview. This information includes patients’ views and observations on the services they have received from dental professionals (such as their views on the accessibility of and barriers to services) as well as aspects of the patient–clinician interaction.

In the most recent Patient Experience Survey (ABS 2023):

• around 1 in 2 participants (52%) reported visiting a dental professional in the previous 12 months
• participants living in areas of least socioeconomic disadvantage were more likely than participants living in areas of most socioeconomic disadvantage to see a dental professional (65% compared with 42%)
• around 1 in 6 (18%) participants reported delaying or not seeing a dental professional when needed due to cost.

Limitations and challenges of national population surveys

These national population surveys are a valuable source of oral health data; however, they do have their limitations and can present various challenges. These drawbacks include:

• they do not provide data for small areas
• they demand a considerable amount of effort and resources, both in terms of coordination and data collection. As such, they may be conducted less often than would be considered ideal
• they may necessitate that participants attend appointments (for instance, surveys that include a clinical examination component like those conducted by ARCPOH), thus posing substantial logistical challenges
• they inherently rely on the willingness of respondents to participate, which can result in varying response rates, potentially introducing response bias
• they predominantly rely on self-reported data. This can be problematic when gathering clinical information about one’s oral health status (for example, the extent of damage to teeth) and introduce inaccuracies into the data. Individuals might also struggle to recall the timing of dental visits, and a less than favourable visiting pattern may indicate an individual’s poor overall understanding of their dental health.

Nevertheless, national population surveys remain an important tool for understanding Australia’s oral health status. They are particularly well suited to gathering subjective insights, such as one’s experience with dental services or how one feels about their own dental appearance.

Administrative data sets

Administrative data sets also play an important role in contributing to the oral health and dental care data landscape in Australia, complementing the information gathered through surveys.

They are collections of structured information, gathered and maintained by organisations (including Australian, state and territory governments) and are typically a by‑product of providing a service. These data sets:

• offer a rich source of real-world data that can potentially cover a wide portion of the population – or at least a well-defined portion of it (based on eligibility for the service or program)
• can be de-identified and repurposed for analysis, research and policy evaluation, making them a valuable resource for data-driven decision-making
• if collected routinely and consistently, are a reliable resource for tracking trends and monitoring health-care use.

Like surveys, administrative data sets come with their own unique challenges and nuances that need to be considered. Some of the major national administrative health data sets and their limitations (in terms of yielding data on dental and oral health) are described below. They include:

• hospitals data
• health expenditure data
• Medicare Benefits Schedule data
• Pharmaceutical Benefits Scheme data.

Hospitals data

Data about dental services provided in hospitals are captured in the AIHW National Hospital Morbidity Database (NHMD) – a compilation of episode-level records from admitted patient clinical and administrative management systems in Australian hospitals. The data supplied include:

• demographic data about patients
• administrative details associated with the hospitalisation
• data on the diagnoses of the patients and the procedures they underwent in hospital.

The information is recorded in the hospital setting, compiled by state/territory health authorities and transformed into required formats (and so on). The AIHW then collates it for national reporting. The data captured in the NHMD are somewhat limited in providing a national picture, given that:

• most dental services are provided outside the hospital setting
• states and territories may differ in terms of which procedures are performed in hospital, rather than in alternative settings:
  • for example, extenuating clinical circumstances that might warrant hospital‑based care may be considered by some but not all
• some dental procedures are performed in hospital emergency departments and are therefore not captured in the NHMD. While some information on these emergency presentations is captured in the National Non-Admitted Patient Emergency Department Care Database, the diagnosis recorded is not specific enough to identify most dental/oral health-related diagnoses.

Health expenditure data

Dental services expenditure data are derived from the AIHW Health Expenditure Database, a collation of more than 50 data sources that capture health spending by governments, individuals, private health insurers and other private sources in each financial year. This data set provides an indication of the financial contributions to dental services from different entities.

However, since data from some of the sources can be obtained only after a considerable time lag, it can take from 15 to 18 months after the end of the financial year to release the data.

Medicare Benefits Schedule data

The Medicare Benefits Schedule (MBS) contains details of attendances, tests and procedures that qualify for a Medicare Benefit under the Health Insurance Act 1973 (Cwlth). The MBS data collection contains information on services that resulted in a payment of this benefit. The resultant data are a by-product of the administration of the Medicare ‘fee-for-service’ payment system by Services Australia.

Most general dental procedures do not qualify for a Medicare Benefit; however, the MBS data collection includes data for dental-related services provided by:

• approved dental practitioners (approved before 1 November 2004) in Category 4 – Oral and Maxillofacial Services
• dental practitioners registered in the specialty of orthodontics (limited services), registered dentists (limited services), and medical practitioners who are specialists in oral and maxillofacial surgery in Category 7 – Cleft Lip and Cleft Palate Services
• medical practitioners who are specialists in oral and maxillofacial surgery mainly in Category 1 – Professional Attendances (specialist attendances) and Category 3 – Therapeutic Procedures (surgical operations) of the MBS.

Pharmaceutical Benefits Scheme data

The Pharmaceutical Benefits Scheme (PBS) data collection contains information on prescriptions dispensed to Australians who hold a Medicare card, and to other eligible residents (as defined on the Schedule of Pharmaceutical Benefits) for whom a subsidy might be paid. This includes medicines prescribed by dentists (who can prescribe a restricted range of medicines – predominantly antibiotics and pain killers).

The database comprises information about PBS scripts and payments, patients, prescribers and dispensing pharmacies. It does not cover private prescriptions, over-the-counter purchases or off-label prescribing information.

It is not possible to quantify the number of prescriptions written by general practitioners for patients presenting with dental problems through this data source.

Extracting the data

This section explores the different arrangements that exist from which we can extract dental health data, providing an overview of the varied mechanisms for data acquisition.

How are dental services accessed in Australia?

Dental services are funded, and can be accessed, in a number of ways:

• privately
• through public dental clinics, depending upon eligibility
• through other funded dental programs; for example, the Child Dental Benefits Schedule, the Department of Veterans’ Affairs.

For people who purchased services privately, some may have had all or part of the costs of the service subsidised.

Publicly funded or subsidised dental health care

Government funding in the dental care sector not only improves accessibility of services but also creates opportunities to source valuable data for research and evidence-based policy development. Public dental care is available only to some Australians, usually people with a health-care card or Centrelink pensioner concession card (and their dependants).

When government funding is allocated to dental services, it often requires rigorous data collection and reporting to be done to ensure the investment is used effectively. A wide range of information can be required, including service usage data, costs, patient demographics and their oral health status. Yet, in Australia, the currently available data are fragmented and can lack comparability, given the different arrangements under which public dental services are provided across the states and territories.

Besides the general health administrative data sets outlined earlier in this article, there are also some dental-specific data sets compiled as a by-product of the administration and delivery of services.

Funding for public dental services

The Australian Government provides funding to states and territories to support the provision of public dental services, via the:

• Federation Funding Agreements
• National Health Reform Agreement
• Royal Flying Doctor Service
• Child Dental Benefits Schedule.

The states and territories provide the Australian Government with data on service use, the number of patients on waiting lists, average waiting times, Indigenous status, rural and regional status and the number of services provided by the private sector.

The AIHW compiles the Public Dental Waiting Times National Minimum Data Set annually. This data set enables reporting on the length of time that patients on a waiting list wait for public dental care in Australia. However, the data collated at the national level are limited as:

• public dental services are operated by state and territory governments, with eligibility for services and the organisation of services varying greatly across the jurisdictions; this affects the comparability of the data collected
• they capture only a minority of public dental care patients as the majority receive care through priority or emergency care arrangements and are not necessarily placed on a waiting list. Further, priority access arrangements can differ between jurisdictions.

The AIHW is currently working with the Department of Health and Aged Care and state and territory health departments to develop an alternative data set to capture more complete data about care provided through public dental services, including that offered under jurisdictional level incentives or programs (see Bridging the gap and filling the holes for more information).

Child Dental Benefits Schedule

The Child Dental Benefits Schedule (CDBS) provides access to benefits for basic dental services to around 3 million eligible children. Services Australia administers the payment of benefits. These dental services include examinations, x‑rays, cleaning, fissure sealing, fillings, root canals and extractions. They can be provided by public or private dental practitioners.

A child is eligible for these services if aged between 0–17 at any point in the calendar year, eligible for Medicare, and if either they or their caregiver receive an eligible Australian Government payment. Eligible children have access to a benefit cap of $1,095 (2024 cap) over a 2-calendar-year period. Around 1 in 2 children are eligible to receive services under the CDBS but, historically, only around 1 in 3 eligible children use the program.

In 2022–23, 5.2 million services were subsidised under the CDBS (Services Australia 2023).

Private health insurance

Individuals or families can purchase private health insurance to cover all or part of the cost of health care not covered by Medicare. For people who are eligible, private health insurance premiums are subsidised by the Australian Government via the Private Health Insurance Rebate. This government funding obliges the private health insurers to provide data to the government on what their funds were used for.

Private health insurance cover is generally divided into hospital cover, general treatment cover and ambulance cover. General treatment cover provides insurance against costs of treatment by ancillary health service providers, including dentists. The extent of cover depends on the type of policy purchased.

In 2022–23:

• 1 in 2 (50%) or around 13.2 million people had general treatment cover, excluding people with general treatment ambulance only cover (APRA 2023a)
• 50.0 million dental services were subsidised by private health insurance providers (APRA 2023b).

Privately funded dental health care

Privately provided dental services paid for wholly out-of-pocket by the individual present a distinct challenge for people who map the data landscape. It is inherently difficult to access data from these providers as there is no centralised repository for such information.

Not having comprehensive data from these providers is a major obstacle to fully understanding the nation’s oral health status and use of dental services. In turn, this hinders the development of evidence-based policies and comprehensive research efforts in this sector.

Some general data about the Australian population’s use of privately provided dental services are available, however, through national population surveys. In the future, more data may be made available in some way – for example, through reporting by sentinel dental practices.

Bridging the gap and filling the holes

Better data on oral health and dental service use can lead to better health outcomes for patients, reduced inequalities and an optimised oral health service. Outputs from the statistical analysis of data allow people with oversight of the health system to:

• develop evidence-based policy
• plan effective resourcing of the health system, resolving gaps in adequate care.

The AIHW is currently supporting the Department of Health and Aged Care with longer term public dental reform by identifying and developing a set of core public dental data for use at the national and jurisdictional level to accurately measure and describe dental service activity and recipients of services. Funding allocated to the AIHW for this activity is available to the end of June 2025.

This data set would likely enable some basic level of reporting on:

• the number and type of clinical dental services provided through public dental care programs
• demographic characteristics of clients receiving services
• information on the funding or administrative arrangements associated with these services.

The collection may also incorporate data needed to inform performance measures (such as waiting times) and support other measures of interest, along with data needed for routine reporting under funding or other arrangements.

The data eventually collected via the newly developed public dental national minimum data set will not only facilitate the measurement and reporting of public dental service activity but also serve as a valuable resource for identifying individuals in priority populations in the health‑care system. This broadened data set will enable a nuanced understanding of eligibility criteria, incorporating factors such as age, pre-existing medical conditions, socioeconomic status and geographic location, to support more equitable and targeted public dental care interventions.

Regular check-ups are important

Collecting dental data routinely is a fundamental component of monitoring and improving overall oral health at the population level. Harmonising data collection methods, terminologies and reporting standards ensures consistency in data reporting between different providers, thereby creating a comprehensive and reliable data set to inform public health efforts.

Further reading

For more information on the oral health status of Australians and their use of dental care services see:

• Oral health and dental care in Australia (AIHW web report)
• National Oral Health Plan 2015–2024: performance monitoring report (AIHW web report)
• Aboriginal and Torres Strait Islander Health performance Framework – Measure 1.11 Oral health

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