Oral health is an important component of general health, yet there is limited financial protection for the costs of oral health care in many countries. This study compares public dental care coverage in a selection of jurisdictions: Australia (New South Wales), Canada (Alberta), England, France, Germany, Italy, Sweden, and the United States. Drawing on the WHO Universal Coverage Cube, we compare breadth (who is covered), depth (share of total costs covered), and scope (services covered), with a focus on adults aged 65 and older. We worked with local experts to populate templates to provide detailed and comparable descriptions of dental care coverage in their jurisdictions. Overall most jurisdictions offer public dental coverage for basic services (exams, x-rays, simple fillings) within four general types of coverage models: 1) deep public coverage for a subset of the older adult population based on strict eligibility criteria: Canada (Alberta), Australia (New South Wales) and Italy; 2) universal but shallow coverage of the older adult population: England, France, Sweden; 3) universal, and predominantly deep coverage for older adults: Germany; and 4) shallow coverage available only to some subgroups of older adults in the United States. Due to the limited availability of comparable data within and across jurisdictions, further research would benefit from standardized data collection initiatives for oral health measures.

A community-led oral health service for Aboriginal people in Central Northern NSW identified the need for oral health promotion, as well as dental treatment; in three remote communities with limited access to dental services. A three-stage plan based on the Precede-Proceed model was used to develop a school-based preventive oral health program. The program will be piloted in three schools over 12 months aimed at improving the oral health of local Aboriginal children. The proposed program includes four components: daily in-school toothbrushing; distribution of free fluoride toothpaste and toothbrushes; in-school and community dental health education and the installation of refrigerated and chilled water fountains to supply a school water bottle program. Primary school children will be issued toothbrushing kits to be kept at school to facilitate daily brushing using a fluoride toothpaste under the supervision of trained teachers and/or Oral Health Aides. School children, parents and guardians will be issued free fluoride toothpaste and toothbrushes for home use at three-monthly intervals. Four dental health education sessions will be delivered to children at each school and parents/guardians at local community health centres over the 12 month pilot. Dental education will be delivered by an Oral Health Therapist and local Aboriginal Dental Assistant. The program will also facilitate the installation of refrigerated and filtered water fountain to ensure cold and filtered water is available at schools. A structured school water bottle program will encourage the consumption of water. A process evaluation will be undertaken to assess the efficiency, feasibility and effectiveness of the pilot program. The proposed program includes four core evidence-based components which can be implemented in rural and remote schools with a high Aboriginal population. Based on the Precede-Proceed model, this program seeks to empower the local Aboriginal community to achieve improved oral health outcomes. TRN: ISRCTN16110292 Date of Registration: 20 June 2018.

Background: Dentistry is predominantly provided in a commercial context in Australia. Despite this, little is known about how dentists navigate potential tensions that may arise between commercial and professional obligations in private dental practice. This analysis uses a qualitative approach to explore dentists’ perceptions and attitudes toward the commercialized nature of private dental practice and how these affect their professional role in providing care. Methods: Participants were recruited by advertising on social media, as well as through a professional association and a corporate dental group’s graduate training program. Data were collected from participants through interviews and written reflections. The data were subjected to thematic analysis to reveal deeper meanings and linkages between different emergent themes. Results: Twenty dentists who worked in private practice environments were recruited to take part. The analysis revealed the following themes within the data: dentistry devalued, commercial influences on professional behavior, the effect of advertising and competition on dentistry, ethical selling, and the impacts of commercialism on consumers of dentistry. Conclusions: Consumers of dentistry may only be superficially empowered by the commercialized context of private dental practice. Empowerment to decide which services to access and from whom does not address the inherent disparities that exist within the dentist-patient clinical relationship. Advertising and the active “selling” of oral health services are all designed to create dental consumers, not to empower them. While advertising might assist patients to understand available treatments, the primary objective of marketing is not health education. Increasing competition and consumer choice within dentistry may help to empower consumers of dental services but only if the dentist-patient relationship remains founded in altruistic intent, with the doctrine of “caveat emptor” (buyer beware) having no place within dentistry. Knowledge Transfer Statement: This research provides novel insights into how dentists experience the commercial context of private dental practice and how this is perceived to be both beneficial and detrimental to the consumers of dental services. This work will help to guide policy development to address the commercial determinants of oral health generated by the nature of commercialized dental practice environments.