Abstract
In Australia, over the past 30 years, the prevalence of dental decay in children has reduced significantly, where today 60-70% of all 12-year-olds are caries free, and only 10% of children have more than two decayed teeth. However, many studies continue to report a small but significant subset of children suffering severe levels of decay. The present study applies Monte Carlo simulation to examine, at the national level, 12-year-old decayed, missing or filled teeth and shed light on both the statistical limitation of Australia's reporting to date as well as the problem of targeting high-risk children. A simulation for 273 000 Australian 12-year-old children found that moving from different levels of geographic clustering produced different statistical influences that drive different conclusions. At the high scale (ie state level) the gross averaging of the non-normally distributed disease burden masks the small subset of disease bearing children. At the much higher acuity of analysis (ie local government area) the risk of low numbers in the sample becomes a significant issue. The results clearly highlight the importance of care when examining the existing data, and, second, opportunities for far greater levels of targeting of services to children in need. The sustainability (and fairness) of universal coverage systems needs to be examined to ensure they remain highly targeted at disease burden, and not just focused on the children that are easy to reach (and suffer the least disease).
Highlights
In Australia, over the past 30 years, the prevalence of dental decay in children has reduced significantly, where today 60–70% of all 12-year-olds are caries free, and only 10% of children have more than two decayed teeth
School-based dental services with universal coverage have been the norm in Australia for at least 30 years[4]; but with the significant resources needed for these universal services, targeting becomes a real economic/healthcare debate and in the changed disease environment this debate needs to happen in an open and transparent manner
The reporting of childhood caries rates at the near-individual or high resolution is not made available for independent research in Australia; it remains shrouded in confidentiality agreements between state governments and federal analytical organisations
Summary
In Australia, over the past 30 years, the prevalence of dental decay in children has reduced significantly, where today 60–70% of all 12-year-olds are caries free, and only 10% of children have more than two decayed teeth[1] This improvement is in no small part a result of the near universal population-level exposure to topical fluoride (be it water or toothpaste)[2]. Many studies[1,3] continue to report a small but significant subset of children suffering severe levels of decay, and this is typified by demands for general anaesthesia, in order to treat gross decay in children This debate has and continues to be promulgated with data in the literature supporting both arguments[3]. The reporting of childhood caries rates at the near-individual or high resolution is not made available for independent research in Australia; it remains shrouded in confidentiality agreements between state governments and federal analytical organisations
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