Background

The geographic distribution of health care staff and infrastructure is a strategically important consideration when planning for access to adequate health services into the future. Matching manpower to disease levels is contingent on the availability of valid and reliable information on both manpower and the level of disease present.

Dental Services for children in Ireland are currently provided through the salaried Public Dental Service (PDS) of the Health Service Executive (HSE) and privately through dental surgeons in general practice. Throughout Ireland there is wide geographic variation in the amount and the severity of tooth decay (Whelton et al., 2006). Age 12 is recognised by the World Health Organisation as one of the key index ages to be prioritised for inclusion in oral health surveys. Sixth class children (aged 11-12) are often prioritised by the HSE dental services for examination and treatment before they leave primary school. Two electronic health records systems are currently in use in many parts of the Public Dental Service. The availability of electronic health records systems offer the potential to generate valuable oral health data on this key age group.

A history of tooth decay is a strong predictor of future disease (Zero et al. 2001). In 11-12 year olds and in teenagers, the risk of developing new decay interproximally (between teeth) is higher in children who have higher decay levels when they are younger (Arrow 2007, Gustafsson et al. 2000, Stenlund et al. 2002). The identification of geographic areas with a high level of tooth decay in 12-year-olds and analysis of these data incorporating data on the overall dental workforce (HSE and general dental practice) will provide a wealth of valuable information for planning delivery of dental services for children and also for older age groups. Mapping the locations using the Geographic Information System Health Atlas along with the levels of disease and the available workforce greatly enhances the meaningfulness of the data collected.

The data generated by this research can be used as a sentinel for the dental care needs of teenagers and young adults. This research will pinpoint geographic areas of high disease prevalence in 12-year-olds indicating a likely need for dental services in the near future and will also help to identify areas where there is a shortage of dental professionals relative to population and disease prevalence.

Aim

To harness the potential of recently developed information technologies in the health service in Ireland and to combine them in a novel way to produce valid, relevant and up to date information to assist the HSE in planning the delivery of dental services for children. Specifically it will use the information technologies to identify the gap between the need for dental services, service utilisation and the provision of dental services for children in Ireland.

Applying successfully developed and piloted methodology, this project will translate routine electronic service data extracted from the dental informatics databases in the public dental service (SOEL Health and Bridges) into measures of service need and performance (outcome measures). It will also gather and geo-code data on the distribution and profile of private and public dentists/surgeries, clinical dental technicians and dental hygienists.

The data will be combined in layered maps and will be available as a research tool and resource for health service policy makers and planners.

Objectives

1. To compile a comprehensive geo-referenced database of all private and public dental practices in Ireland.

2. To compile a comprehensive geo-referenced database of the skill mix of the dental workforce i.e. dentists (including specialists), dental hygienists, and clinical dental technicians employed in Ireland.

3. To describe the demographic profile of the dental workforce in the Republic of Ireland.

4. To compare the distribution and density of the dental workforce with the general population statistics of the areas in which they work (using data from the 2011 census).

5. To obtain oral health data and service utilisation data for 6th class children (11 to 12 year olds) from SOEL Health and Bridges electronic health record systems.

6. To use the online Geographic Information System, Health Atlas to conduct a ‘black spot’ analysis to examine the balance of provision of dental professionals against population factors (using data from the 2011 census).

7. To establish a baseline integrated geo-referenced database of dental workforce demographics, dentist to population ratios (supply), service utilization (met-demand) and disease levels (need) among children. Thus enabling information-based manpower and service management incorporating: input measurement; performance measurement and outcome evaluation in an iterative fashion to ultimately improve oral health through improved use of resources.

8. To qualitatively investigate any discrepancies between dental service provision, need and utilization that may be disclosed by the integrated geo-referenced database.

References

ARROW, P. 2007. Incidence and progression of approximal carious lesions among school children in Western Australia. Aust Dent J, 52, 216-26.

GUSTAFSSON, A., SVENSON, B., EDBLAD, E. & JANSSON, L. 2000. Progression rate of approximal carious lesions in Swedish teenagers and the correlation between caries experience and radiographic behavior. An analysis of the survival rate of approximal caries lesions. Acta Odontol Scand, 58, 195-200.

STENLUND, H., MEJARE, I. & KALLESTAL, C. 2002. Caries rates related to approximal caries at ages 11-13: a 10-year follow-up study in Sweden. J Dent Res, 81, 455-8.

WHELTON H, CROWLEY E, O'MULLANE D, HARDING M, GUINEY H, CRONIN M, et al. (2006). North South Survey of Children's Oral Health in Ireland 2002, 2006. [Available at: http://lenus.ie/hse/handle/10147/119028]

ZERO, D., FONTANA, M. & LENNON, A. M. 2001. Clinical applications and outcomes of using indicators of risk in caries management. J Dent Educ, 65, 1126-32.