ABSTRACT
Background: Why the oral health status of Australian adults residing outside capital cities is poorer than that of persons living in capital cities has not been satisfactorily explained.
Objective: 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 two regional groups: capital city and remainder of state. 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 parameters in the first regression model, non-capital city people had higher DMFT (Regression coefficient=1.15, 95%CI=0.43,1.88), more decayed (0.42, 0.18,0.65) and missing teeth (0.85, 0.42,1.28), but not filled teeth (-0.11, -0.70,0.47), than capital city-based people. In the second step analysis, non-capital city people still had a greater DMFT (1.00, 0.26,1.75), more decayed (0.27, 0.02,0.53) and missing teeth (0.74, 0.29,1.18), but not filled teeth (0.00, -0.64,0.64) than capital city-based people.
Conclusion: Dental caries experience, and the number of decayed and missing teeth was greater in non-capital city than capital city areas. This was maintained after controlling for sociodemographic status, and again when controlling for access to dental care. Other factors, such as lifetime fluoride exposure or psychosocial variables, are needed to explain the difference.