Oral Surgery in Public Dental Services: Patient or Provider Driven?

Objective: To examine the contribution of patient and health provider characteristics to the receipt of oral surgery in public dental clinics in NSW and SA. Methods: A random sample of 842 'emergency' patients at 5 NSW and 4 SA dental clinics was selected. Patients' socio-demographic characteristics, perceived need, previous dental history and psychosocial impact of current dental condition were collected. Patients' oral health status, measured by DT, FT, MT and CPI was recorded, as was all treatment provided. A patient risk assessment was collected and provider characteristics recorded. Logistic regression was used to examine the contribution of oral health status, patient impact, self-reported need, dental visiting history and provider characteristics in predicting receipt of oral surgery. Results: Some 32.7% of patients received at least one oral surgery procedure. Patients sex and age, remoteness, State, and oral health status were not independently associated with receipt of an extraction. Persons reporting the need for a filling were less likely to receive an extraction (P<0.01). Persons reporting a perceived need for an extraction (OR: 3.1, CI 1.3-7.1), having a loose tooth (OR:1.8,CI:1.0-3.4), very frequently having difficulty sleeping in the last week (OR: 2.1, CI: 1.2-3.4) and being very frequently worried about the appearance of ones teeth or mouth in the last week (OR: 2.2,CI: 1.3-3.6) and having received an extraction at their last dental visit (OR: 1.7,CI: 1.0-2.8) were more likely to receive an extraction than persons not reporting such characteristics. Higher perceived normative urgency (OR:2.5,CI:1.5-4.1) and risk of future periodontal disease(OR:1.9,CI:1.2-2.8), treating dentists' length of service in public sector dentistry (OR:2.5,CI:1.1-5.6) and time since graduation (OR:2.5,CI:1.0-11.0) were also independently associated with increased odds of receiving an extraction. Conclusion: In this study population, oral health status was not a predictor for receiving an extraction.Other patient and provider characteristics influenced receipt of oral surgery.