Meeting the oral health needs of 12-year-olds in China: human resources for oral health

Abstract

BackgroundAn appropriate level of human resources for oral health [HROH] is required to meet the oral health needs of population, and enable maximum improvement in health outcomes. The aim of this study was to estimate the required HROH to meet the oral health needs of the World Health Organization [WHO] reference group of 12-year-olds in China and consider the implications for education, practice, policy and HROH nationally.MethodsWe estimated the need of HROH to meet the needs of 12-year-olds based on secondary analysis of the epidemiological and questionnaire data from the 3rd Chinese National Oral Health Survey, including caries experience and periodontal factors (calculus), dentally-related behaviour (frequency of toothbrushing and sugar intake), and social factors (parental education). Children’s risk for dental caries was classified in four levels from low (level 1) to high (level 4). We built maximum and minimum intervention models of dental care for each risk level, informed by contemporary evidence-based practice. The needs-led HROH model we used in the present study incorporated need for treatment and risk-based prevention using timings verified by experts in China. These findings were used to estimate HROH for the survey sample, extrapolated to 12-year-olds nationally and the total population, taking account of urban and rural coverage, based on different levels of clinical commitment (60-90%).ResultsWe found that between 40,139 and 51,906 dental professionals were required to deliver care for 12-year-olds nationally based on 80% clinical commitment. We demonstrated that the majority of need for HROH was in the rural population (72.5%). Over 93% of HROH time was dedicated to prevention within the model. Extrapolating the results to the total population, the estimate for HROH nationally was 3.16–4.09 million to achieve national coverage; however, current HROH are only able to serve an estimated 5% of the population with minimum intervention based on a HROH spending 90% of their time in providing clinical care.ConclusionsThe findings highlight the gap between dental workforce needs and workforce capacity in China. Significant implications for health policy and human resources for oral health in this country with a developing health system are discussed including the need for public health action.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-017-4384-7) contains supplementary material, which is available to authorized users.

Addressing the Licensed Doctor Maldistribution in China: A Demand-And-Supply Perspective

“…Due to data availability, this study only adopted total health service visits per capita rather than oral care service visits to predict the dentist density. However, dentists only provide a small proportion of health services and serve a smaller number of patients [42].…”

Using Item Response Theory to evaluate the psychometric characteristics of questions in a Brazilian programme and the performance of dental teams in primary care

“…Either through facilities development, expansion of the (number of) dental teams working in the PHC, distribution through the country, or, possibly further incentives to encourage them to take the necessary training to enable them to perform more needed dental procedures. This action could not only help to address the missing procedures amongst dental primary care, but also, and very importantly, results in improved population oral health [34,35].…”

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“…The main characteristics of the 23 selected studies are provided in Table 1. These publications were from 15 different countries across the world: Australia [23], Canada [24], Chile [25], China [26,27], Japan [28], Kuwait [29], India [30], Ireland [31], Malaysia [32,33], Oman [34], Sri Lanka [35], Taiwan [36], Trinidad & Tobago [37], the United Kingdom [38][39][40][41], and the United States of America [42][43][44][45]. Seven studies were based in the WHO American Region, followed by the European (n=5) and Western Pacific Regions (n=4).…”

“…Dentists were the dominant oral health workforce group modelled across 13 studies [24,25,36,43,44,[26][27][28][29][30][31]34,35]. Five studies considered both dental and allied dental workforce (including therapists, hygienists, clinical technicians, denturists) in the workforce models [32,33,[38][39][40].…”

“…One study has modelled all three oral health workforce groups: dentists, pediatric dentists (specialists) and dental hygienists (allied dental professionals) [42]. The population being modelled in the studies ranged from the full population of the country/region (n=10) [23,25,[28][29][30][34][35][36]40,43] or limited to include a specific group such as children (n=4) [26,37,42,45], adults (n=3) [31][32][33], or older people (n=1) [38]. Four studies focused on population based at a specific catchment area such as province/state (Liaoning Province, China [27]; Kentucky, USA [44]; Georgia, USA [42]) or a service/administrative zone (South Central Strategic Health Authority, England/UK [39]; Canadian Armed Forces service areas, Canada [24])…”