Oral Health version 4

ORAL HEALTHORAL HEALTH

GENERAL COMMENTS

Dr Hugo Sachs Past President, Australian Dental Association Chair, ACHS Oral Health Working Party Version 4

The CIs provide the capacity to compare the Australian picture with international research reports. Overall the set shows some improvements in outcomes, though CI 1.1 (Restorative treatment – teeth retreated within 6 months) shows a steady increase in retreatments of restored teeth which is of concern. In regard to CI 2.1 (Endodontic treatment – same tooth within 6 months of initial treatment) the number of completed endodontic treatments remains to my mind an exceptionally poor result. For HCOs this figure should be investigated as to the cause.

FEATURE CLINICAL INDICATOR

CI 1.2 Routine extraction – complications within 7 days Postoperative complications associated with exodontia are numerous and varied. They include dry socket, postoperative bleeding, infection, jaw fracture, swelling, haematoma and neurosensory alteration (dythesias, anaesthesias, etc.) A brief review of the literature shows a concentration of statistical incidence rates for dry socket. Abu Younis & Abu Hantash1 reports an incidence rate of 3.2%, while Babatunde & Godspower2 reported an incidence of 1.4%. International reports vary from 1 to 6% in general and a female to male incidence ratio of 2 to 1. The incidence rate for metropolitan HCOs of 1.27% and nonmetropolitan rate of 1.97% comes well within the reported literature incidence (though these statistics are not specific to dry sockets alone). The significant variation between the two groups is interesting, but in the overall picture a very acceptable result. Maintenance of these outcomes is imperative, but it may be beneficial to subgroup the cause of the return so that comparisons for a specific post-operative complication like dry socket can be made.

REFERENCES 1. Abu Younis MH, Abu Hantash RO. Dry Socket: Frequency, Clinical Picture, and Risk Factors in a Palestinian Dental Teaching Center. The Open

Dentistry Journal. 2011 Feb;5:7-12. 2. Babatunde OA, Godspower T. Dry Socket: Incidence, Clinical Features, and Predisposing Factors. International Journal of Dentistry. The

International Journal of Dentistry. 2014 Jun;2014:Article ID 796102.

ORAL HEALTHORAL HEALTH

SUMMARY OF RESULTS

In 2018 there were 997 submissions from 88 HCOs for 9 CIs. Five were analysed for trend, 3 of which improved, 1 deteriorated and the remaining CI showed no evidence of trend. In 2018, significant stratum variation was observed in 3 CIs. One CI showed greater systematic variation, with centile gains in excess of 50% of all events. Outlier gains in excess of 25% of all events were observed in 0 CIs. See Summary of Indicator Results below.

Summary of Indicator Results

Indicator HCOs Aggregate rate %

Best Stratum Outlier HCOS (%)* Outlier Gains (%)+ Centile Gains (%)+ Events# Trend

Unplanned returns to the dental centre 1.1 Restorative treatment - teeth retreated within 6 months (L) 68 6.34

12 (18%) 1,237 (6%) 6,005 (31%) 19,102

1.2 Routine extraction - complications within 7 days (L) 64 1.52 Metropolitan 6 (9%) 95 (6%) 586 (38%) 1,550

1.3 Surgical extraction - complications within 7 days (L) 39 2.63

1 (3%) 20 (7%) 80 (26%) 302 1.4 Denture remade within 12 months (L) 36 2.10 NSW 4 (11%) 108 (18%) 368 (60%) 611

Endodontic treatment 2.1 Endodontic treatment - same tooth within 6 months of initial treatment (H) 58 69.8 2 (3%) 211 (12%) 461 (26%) 1,804

2.2 Endodontic treatment - teeth extracted within 12 months (L) 62 3.04 12 (7%) 172

Children’s dental care 3.1 Restorative treatment (children) - teeth retreated within 6 months (L) 72 2.20 SA 4 (6%) 311 (7%) 3.2 Pulpotomy (children) - deciduous teeth extracted within 6 months (L) 63 3.68 1,262 (28%) 4,553

24 (14%) 169

3.3 Fissure sealant treatment (children) - retreatment within 24 months (L) 75 2.36

14 (19%) 657 (8%) 887 (11%) 8,112

# Number of undesirable or non-compliant events + % of events that contribute to outlier/centile gains * % of outlier HCOs