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The South Australian Government s 
seven year plan for oral health care

DENTAL CLINIC

SOUTH AUSTRALIA s 

Oral Health Plan
2019 - 2026



We offer sincere thanks to the many contributors to the 

development of the South Australian Oral Health Plan 2019 - 2026.

Author: SA Dental Service, Central Adelaide Local Health Network, 
SA Health, Government of South Australia, Adelaide, South Australia

Design and layout: Cathy Nelson, SA Dental Service

Aboriginal Health Impact Statement, form ID 66

  Copyright, State of South Australia, SA Health 2019

This publication is copyright, no part may be reproduced by any process 

except in accordance with the provisions of the 

Copyright Act 1968.

This document is also available as a PDF online:

www.sahealth.sa.gov.au/oralhealthplan

ISBN 978-1-76083-202-5

South Australia s Oral Health Plan 2019 - 2026

www.ausgoal.gov.au/creative-commons



South Australia s Oral Health Plan 2019 - 2026 2

The South Australian Government s 
seven year plan for oral health care

SOUTH AUSTRALIA s 

Oral Health Plan
2019 - 2026



3South Australia s Oral Health Plan 2019 - 2026

CONTENTS

1 Foreword                                                                                                                   6

1.1  One page summary 7

2 Introduction 9

2.1   What is oral health? 9

2.2   What determines oral health? 9

3 Overview of Oral Health Status in South Australia 10

3.1   Burden of disease 10

3.2   Children 11

3.3   Adults 12

3.4   Priority Populations 14

               3.4.1   People who are socially disadvantaged or on low incomes 14

               3.4.2   People living in regional and remote areas 14

               3.4.3   Aboriginal and Torres Strait Islander people 15

               3.4.4   Culturally and Linguistically Diverse people 15

               3.4.5   Frail older people 15

               3.4.6   People living with mental illness 16

               3.4.7   People with disabilities 16

               3.4.8   People with complex medical conditions 17

4 The Oral Health Workforce 17

5 Oral Health Sector in South Australia 19

5.1   Private dental sector 19

5.2   Public dental sector - SA Dental Service 19

5.3   Public hospitals 19

5.4   Academic, education and research sectors 19

               5.4.1   University of Adelaide    19

               5.4.2   Australian Research Centre for Population Oral Health 19

               5.4.3   TAFE 19

5.5   Funding arrangements for oral health in South Australia 20

6 Framework for the South Australian Oral Health Plan 21

6.1   Alignment with the National Oral Health Plan 21

6.2   Links with SA Health Plans 21

6.3   Implementation and Monitoring 21



South Australia s Oral Health Plan 2019 - 2026 4

7 SA Oral Health Plan 2019 - 2026 Action Areas 22

1   Oral Health Promotion and Prevention 22

               1.1   Optimise preventive effects of fluoride 22

               1.2   Increase oral health literacy 23

               1.3   Promote oral health and nutrition 24

               1.4   Build capacity of health, education and community workers 24

               1.5   Integrate oral health and general health policy 25

2   Accessible Oral Health Services 26

               2.1   Reduce transport barriers 26

               2.2   Provide universal access for children   26

               2.3   Ensure access for priority populations 27

3   System Alignment and Integration 29

               3.1   Establish inter-sectoral collaboration 29

               3.2   Utilise integrated models of care 30

               3.3   Optimise technology for integration 31

4   Safety and Quality 32

               4.1   Maintain dental service infrastructure 32

               4.2   Facilitate consumer engagement 32

               4.3   Implement oral health standards across sectors 33

5   Workforce Development 34

               5.1   Build workforce capacity to meet the needs of priority populations 34

               5.2   Increase cultural competency of the oral health workforce 35

               5.3   Optimise oral health workforce utilisation 35

               5.4   Provide oral health competency training 36

6   Research and Evaluation 37

               6.1   Contribute to oral health evidence          37

               6.2   Utilise population oral health data 37

8 Glossary 38

9 Appendices 39

9.1   Development of the South Australian Oral Health Plan 39

10 References 40

CONTENTS



South Australia s Oral Health Plan 2019 - 2026 5



1  FOREWORD

6South Australia s Oral Health Plan 2019 - 2026

I am pleased to release the South Australian Oral Health Plan 2019-2026 which aims to improve the oral health of South 

Australians, particularly those groups who experience, or are at greater risk of, poor oral health.

This Plan builds on both the foundations and achievements of the inaugural Plan released in 2010 and provides the South 

Australian context for the goals and principles of Healthy Mouths   Healthy Lives, Australia s National Oral Plan 2015-2024.

A healthy mouth is fundamental to overall health, wellbeing and quality of life. It enables people to eat, speak and socialise 

without pain, discomfort or embarrassment.  Poor oral health can interfere with daily function, impacts on social interactions 

and work productivity and is associated with a number of health problems and conditions.

Whilst oral health has improved in recent decades for many South Australians, the evidence shows there are still significant 

inequities in our community and areas of unmet need remain.  The purpose of this Plan for the next seven years is to guide 

coordinated action that contributes to improved oral health.  

In recognition of the wider impacts of oral health and the underlying causes of oral disease and conditions, this Plan 

necessarily involves not only the dental sector but the broader health and community sectors.  The strengthening of existing 

partnerships and the development of new partnerships are a key feature of this Plan.  It is these collaborative partnerships 

across the six foundation areas and eight priority population groups identified that will be a key enabler of the success of 

this Plan.

The development of this Plan has incorporated two consultation phases which included the public as well as the dental, 

wider health and community sectors.  I would like to thank everyone who provided feedback and in doing so shaped and 

influenced the Plan.  A monitoring group comprising representatives from key stakeholders, including community, will be 

established in the near future to advise on implementation of the Plan and track progress.  

I look forward to seeing the achievements that can be made under this Plan.

Hon Stephen Wade MLC

Minister for Health and Wellbeing

12 September 2019



1.1  One page summarySOUTH AUSTRALIA S ORAL HEALTH PLAN 2019 - 2024
The South Australian Government s seven year plan for oral health care

People living
in regional
and remote

areas

Aboriginal and
Torres Strait

Islander
people

Culturally
and 

linguistically
diverse people

Frail older
people

People living
with mental

illness

People with
disabilities

People with
complex 
medical 

conditions

People who are 
socially 

disadvantaged or 
on low incomes

Oral Health Promotion 
and Prevention

Accessible Oral 
Health Services

Systems Alignment 
and Integration

Safety
and Quality

Workforce 
Development

Research and 
Evaluation

Provide 
evidence-based

oral health information 
and programs

Provide South 
Australians with 

accessible 
oral health care

Work together to 
support healthy 

mouths and 
healthy lives

Provide safe, 
quality oral health 

services

Ensure the oral health 
workforce meets the 

needs of the 
community

Use research and data 
to understand the oral 

health needs of the 
community

&gt;   Optimise preventive  
     effects of ? uoride

&gt;   Increase oral health  
     literacy

&gt;   Promote oral health 
     and nutrition

&gt;   Build capacity of 
     health, education and 
     community workers

&gt;   Integrate oral  
     health and general  
     health policies

&gt;   Reduce the impact of 
     transport  barriers

&gt;   Provide universal  
     access for children

&gt;   Improve access for  
     priority populations

&gt;   Facilitate inter-sectoral
     collaboration

&gt;   Develop integrated 
     models of care

&gt;   Optimise technology    
     for integration

&gt;   Maintain dental 
     service infrastructure

&gt;   Facilitate consumer
     engagement

&gt;   Implement oral health
     standards across
     sectors

&gt;   Build workforce 
     capacity to meet the
     needs of priority
     populations
   

&gt;   Increase cultural 
     competency of oral  
     health workforce

&gt;   Optimise oral     
     health workforce 
     utilisation

&gt;   Provide oral health 
     competency training

&gt;   Contribute to 
     oral health evidence

&gt;   Utilise population oral 
     health data

FOUNDATION AREAS

PRIORITY POPULATIONS

G
O

A
LS

A
C

TI
O

N
 A

R
EA

S

South Australia s Oral Health Plan 2019 - 2026 7



SOUTH AUSTRALIA S ORAL HEALTH PLAN 2019 - 2024
The South Australian Government s seven year plan for oral health care

People living
in regional
and remote

areas

Aboriginal and
Torres Strait

Islander
people

Culturally
and 

linguistically
diverse people

Frail older
people

People living
with mental

illness

People with
disabilities

People with
complex 
medical 

conditions

People who are 
socially 

disadvantaged or 
on low incomes

Oral Health Promotion 
and Prevention

Accessible Oral 
Health Services

Systems Alignment 
and Integration

Safety
and Quality

Workforce 
Development

Research and 
Evaluation

Provide 
evidence-based

oral health information 
and programs

Provide South 
Australians with 

accessible 
oral health care

Work together to 
support healthy 

mouths and 
healthy lives

Provide safe, 
quality oral health 

services

Ensure the oral health 
workforce meets the 

needs of the 
community

Use research and data 
to understand the oral 

health needs of the 
community

&gt;   Optimise preventive  
     effects of ? uoride

&gt;   Increase oral health  
     literacy

&gt;   Promote oral health 
     and nutrition

&gt;   Build capacity of 
     health, education and 
     community workers

&gt;   Integrate oral  
     health and general  
     health policies

&gt;   Reduce the impact of 
     transport  barriers

&gt;   Provide universal  
     access for children

&gt;   Improve access for  
     priority populations

&gt;   Facilitate inter-sectoral
     collaboration

&gt;   Develop integrated 
     models of care

&gt;   Optimise technology    
     for integration

&gt;   Maintain dental 
     service infrastructure

&gt;   Facilitate consumer
     engagement

&gt;   Implement oral health
     standards across
     sectors

&gt;   Build workforce 
     capacity to meet the
     needs of priority
     populations
   

&gt;   Increase cultural 
     competency of oral  
     health workforce

&gt;   Optimise oral     
     health workforce 
     utilisation

&gt;   Provide oral health 
     competency training

&gt;   Contribute to 
     oral health evidence

&gt;   Utilise population oral 
     health data

FOUNDATION AREAS

PRIORITY POPULATIONS

G
O

A
LS

A
C

TI
O

N
 A

R
EA

S

South Australia s Oral Health Plan 2019 - 2026 8



i  Where available, South Australian data is referenced, otherwise Australian data is used.

2.1   What is oral health?
Good oral health refers to the health of the mouth which includes the   oral and related tissues that enable an individual 

eat, speak and socialise without active disease, pain, discomfort or embarrassment .1 It is a key indicator of overall health 

and is important for general wellbeing and quality of life.2  Poor oral health interferes with daily function, impacts on social 
interactions and work productivity and is associated with health problems such as stroke, cardiovascular disease, aspiration 

pneumonia and adverse pregnancy outcomes.3 

As described in the National Oral Health Plan 2015-2024 - Healthy Mouths Healthy Lives, the major oral diseases that cause 

poor oral health are dental caries (dental decay), periodontal disease (gum disease) and oral cancers.  Oral diseases are 

amongst the most common and costly health problems experienced by Australians; oral disease is a highly prevalent chronic 

disease. 

2.2  What determines oral health?

Oral health, as with general health, is determined by a complex interaction of social, economic, environmental, lifestyle and 

individual factors which influence early life opportunities, exposure to health hazards, and adoption of health behaviours.4 

Evidence shows that disadvantaged groups experience poor oral health outcomes more frequently.2 In addition, people 

often experience multiple factors of disadvantage, compounding their effect on health and wellbeing. For example, the 

link between poor education and low income is well known, while low income is, in turn, associated with poor health and 

inferior housing.5 

Research has demonstrated the strong link between income and the risk of poor oral health, with low income affecting 

access to health care, utilisation of dental services, oral health literacy, knowledge and attitudes towards oral health.6   

Socio-economic status is linked with levels of sugar, tobacco and alcohol consumption which in turn 

impacts oral health:

    &gt;     Consumption of high levels of sugar increases the risk of dental decay

    &gt;     Consumption of tobacco increases the risk of gum disease and oral cancer

    &gt;     High levels of alcohol consumption increase the risk of oral cancers.1

The common risk factors for oral disease and several other chronic diseases such as obesity, heart disease, cancer and stroke, 

allow for shared prevention strategies across chronic disease.7  However, social disadvantage may counter health promotion 
and prevention strategies and should be taken into consideration in the provision of oral health services.8 

2  INTRODUCTION i

South Australia s Oral Health Plan 2019 - 2026 9

The South Australian Oral Health Plan 2019 - 2026 is the South Australian Government framework for oral health action 

in South Australia for the next seven years. It provides an overview of the current oral health status of South Australians, 

including priority populations, and identifies key action areas to address the oral health needs of the population. The success 

of this Plan will depend on the strength of collaboration and engagement between all stakeholders in the South Australian 

community.



South Australia s Oral Health Plan 2019 - 2026 10

Dental problems are common in the Australian population with more than a quarter of children aged 5-10 years (27%) and 

adults (26%) having untreated dental decay.9,6 Nationally, dental decay is the third highest cause of potentially preventable 

hospital admissions (PPHA) which could be avoided if timely and adequate primary care had been provided.1  As reported 

in the Chief Public Health Officer s Report, dental problems are the most common acute condition causing PPHAs in South 

Australia.4

3  OVERVIEW OF ORAL HEALTH STATUS IN SOUTH AUSTRALIA

3.1   Burden of disease

Chronic  Obstructive Pulmonary Disorder
Congestive Cardiac Failure

Diabetes Complications
Iron Deficiency Anaemia

Angina
Asthma

Hypertension
Rheumatic Heart Disease

Bronchiectasis
Nutrition

0                          10                         20                         30
                                      Proportion (%)  Chronic                 Acute                                                 

Proportion of chronic and acute potentially preventable hospitalisation in South Australia, Jul 2016 - Jun 2018

Dental
Urinary Tract Infections

Cellulites
Ear Nose Throat

Convulsions/Epilepsy
Gangrene

Perforated/Bleeding Ulcer
Pelvic Inflammatory Disease

Pneumonia (Non Vaccine Preventable)
Eclampsia

25.6
19.2

15.5
13.2

10.8
9.9

2.8
1.8

 1.1
0.2

27.4
22.5

18.2
13.7

11.5
2.6

1.9
1.2

0.9
0.0

Source: Protect, Prevent, Improve - The Chief Public Health Officer s Report 2016 - 2018

Nationally and in South Australia, children in the 0-9 year age group experience the highest rate of PPHAs.1  Dental decay is 
the main oral health problem that results in PPHA in this age group and often involves a general anaesthetic.1 

Oral cancers, affecting lips, tongue, salivary glands, gums, mouth or throat, are the seventh most commonly diagnosed 

cancers in Australia.10   Oral cancer is more common among older age groups, men (two thirds higher than women) and 
Aboriginal and Torres Strait Islander people (three times higher than the rest of the Australian population).11 Risk of oral 

cancer is associated with tobacco and alcohol consumption and human papilloma virus infection.12  In 2013, of the 124,000 

new cases of cancer diagnosed across Australia, just over 3,000 were oral cancers.13  Many oral cancers are not diagnosed 

until they are in the advanced stages with significantly higher mortality rates.14  The National Oral Health Plan 2015-2024 

recognises the important role that dental practitioners play in screening and early detection of oral cancers, which markedly 

improves five-year survival rates.1 

Oral diseases are a major financial cost to the South Australian community with individual s out of pocket payments 

contributing the largest source of funds for total dental expenditure. The 2016/17 dollars spent on dental services in South 

Australia were provided through individual out-of-pocket payments ($169m), health insurance funds ($164m), the 

Commonwealth Government ($126m) and the State Government ($56m).15



SA School Dental Service - 12 year old Mean DMFT

3.2   Children

South Australia s Oral Health Plan 2019 - 2026 11

According to the National Child Oral Health Study 2012-2014 (NCOHS), despite some 

improvement, child oral health remains a significant population health issue with a clear 

social gradient in oral health status.9 Poor oral health early in life is the strongest predictor 
of poor oral health in adult life.

From the 1970 s through to the 1990 s there was a significant reduction in dental decay 

among South Australian children. This was largely due to water fluoridation, use of fluoride 

toothpaste and increased access to dental care focused on prevention and early 

intervention. 

The 12 year old DMF(T)ii  of South Australian children enrolled in the School Dental Service 

(SDS) decreased steadily from 4.5 in 1977 to 0.47 by 1996. However, over the next decade 

the 12 year old DMF(T) of children accessing SDS doubled to 1.05 by 2008. 

Source: SA Dental Service Evaluation Unit: unpublished data (2018)

19
77

19
79

19
81

19
83

 

19
85

 

19
87

 

19
89

 

19
91

 

19
93

 

19
95

19
97

19
99

20
01

20
03

20
05

20
07

20
09

20
11

20
13

20
15

20
17

5.00

4.00

3.00

2.00

1.00

0.00

4.5

0.47

1.05 0.76

ii   The DMF(T) index is the mean number of Decayed, Missing or Filled Permanent Teeth and is a measure used to quantify dental health. 
      Twelve year old DMF(T) is recognised as an international measure for child oral health.

Stemming the decline in child oral health was one of the 11 themes of the inaugural SAOHP. As a result of deliberate and 

sustained activities, good progress has been made and the DMF(T) of children enrolled in the School Dental Service has 

shown substantial improvement in recent years. South Australia and the Australian Capital Territory (ACT), have the lowest 

prevalence and severity of dental decay in the child population across the States and Territories.9

NSW    VIC      QLD     SA       WA     TAS      NT      ACT         AUS

60%

50%

40%

30%

Proportion of children (2-17 years) 
accessingoral health care through a 
Government funded oral health 
program (Jul 2014 - Jun 2016)

Sources: State/territory public dental service 
data Australian Government Department 
of Human Services



South Australia s Oral Health Plan 2019 - 2026 12

3.3   Adults

Current South Australian population data is not available for people aged 15 years and over. 

The most recent national population wide data is from the National Study of Adult Oral 

Health (NSAOH) 2004 - 2006; a new National study commenced in 2017.6 The average decay 
experience in adults decreased between 1987 and 2006, due to a decline in the average 

number of teeth with untreated decay, attributed to improved access to dental care over this  

period. However, decay experience is still disproportionate across the social gradient and for 

specific populations.

Average DMFT scores are higher for Aboriginal and Torres Strait Islander people and older age 

groups, whilst adults from regional areas have the highest average number of teeth missing due to 

decay. Uninsured people have a higher level of untreated decay and teeth missing due to decay. 

Insured adults have more filled teeth with less untreated decay or missing teeth which is consistent 

with receiving timely dental care.6

One in five South Australian adults (19.8%) experience moderate to severe gum disease, with prevalence increasing with 

age.6

aged 15-64 years

30%

aged 65+ years

26%

Proportion of dentate South 
Australian adults with 
untreated tooth decay

Source: National Survey of Adult Oral Health 2004 - 2006

NSW        VIC        QLD       SA          WA        TAS         NT        ACT       AUS

23.0%
24.1%

12.6%

26.4%

22.9%

26.4%

19.8%

29.5%

21.8%

Proportion of dentate young people and adults (15+ years) with 
moderate or severe gum disease

However, the NCOHS 2012-2014 demonstrated that the gains have not been consistent across all age groups and that there 

is a higher prevalence of dental decay in particular socio-economic, geographic and demographic groups.16  Nationally and 

in South Australia, there is a higher prevalence and severity of untreated dental decay and total decay experience among 

children who are:

        &gt;   Aboriginal and/or Torres Strait Islander

        &gt;   from families where parents had school level education

        &gt;   in low income households

        &gt;   living in remote or very remote areas, and/or 

        &gt;   whose last dental visit was for a problem, rather than a check-up.9



NSW    VIC    QLD     SA      WA     TAS      NT      ACT       AUS

30%

25%

20%

15%

Proportion of adults (18+ years) 
eligible for state/territory provided public 
dental services who access care
(Jul 2014 - Jun 2016)

Sources: State/territory public dental service 
data

South Australia s Oral Health Plan 2019 - 2026 13

In South Australia, public general adult restorative waiting lists have improved over the past decade with fewer people 
waiting for general restorative care, for less time.

Ju
n-

07

D
ec

-0
7

Ju
n-

08

D
ec

-0
8

Ju
n-

09

D
ec

-0
9

Ju
n-

10

D
ec

-1
0

Ju
n-

11

D
ec

-1
1

Ju
n-

12

D
ec

-1
2

Ju
n-

13

D
ec

-1
3

Ju
n-

14

D
ec

-1
4

Ju
n-

15

D
ec

-1
5

Ju
n-

16

D
ec

-1
6

Ju
n-

17

D
ec

-1
7 

Ju
n-

18

Adult Public General Restorative Waiting Lists

    Numbers waiting on 
    General Waiting List

    Weighted Ave (Time 
    Already Waited)

45,000

40,000

35,000

30,000

25,000

20,000

15,000

10,000

5,000

54

48

42

36

30 

24

18

12

6

0

N
u

m
b

er
 o

f 
Pe

rs
o

n
 s

 N
am

es

 Source: SA Dental Service Evaluation Unit: unpublished data (2018)

M
o

n
th

s 
A

lr
ea

d
y 

W
ai

te
d

 (
w

ei
g

h
te

d
 a

ve
ra

g
e)

People on low incomes have less favourable dental visiting patterns than people from higher income households. The cost 

of dental care is frequently reported as a barrier to accessing care, even more so than the cost for general health care.6 

Concession card holders are more likely to avoid care or delay recommended treatment due to cost.1

While public dental services ideally provide a comprehensive safety net for access to dental care, the reality is that only a 

small proportion of eligible adults access the public system and waiting times can be long.1 For example, in a two year 
timeframe the South Australian Dental Service treated approximately 23% of the eligible adult population, which is similar 

to the National average of approximately 21%. 



South Australia s Oral Health Plan 2019 - 2026 14

3.4   Priority Populations

People with self-assessed low health status are more likely to have experienced other factors of disadvantage.5 People 
experiencing multiple disadvantages have poorer outcomes across a range of health and wellbeing indicators which can be 

perpetuated across generations.6  Unfortunately, children and adults at highest risk of oral disease have the greatest difficulty 
in accessing care due to the compounding effect of multiple disadvantages. Evidence demonstrates that there are particular 

populations which experience the impacts of untreated dental decay more frequently and consistently and benefit from 

targeted oral health strategies.3

3.4.1   People who are socially disadvantaged or on low incomes

Adults who are socially disadvantaged or on a low income have more than double the rate of poor oral health than those 

on higher incomes, including higher rates of untreated dental decay and higher rates of tooth loss.6 People living in low 
income houses are more likely to be uncomfortable with their dental appearance, experience toothache and avoid certain 

foods because of dental problems.6

Reasons for this are multi-dimensional, including affordability of care, communication and language barriers, transport 

challenges and appropriateness of service delivery.3 In addition, people who seek dental care for a dental problem rather 

than a check-up are less likely to receive comprehensive treatment plans and preventive services, due to the extent of 

treatment required, resulting in less favourable outcomes.6 

3.4.2  People living in regional and remote areas

  Across all measures surveyed in the 2013 

  National Dental Telephone Interview

 Survey, people living in regional and 

 remote areas had poorer oral health 

 compared with those living in major cities.6 

Untreated tooth decay and tooth loss were higher and the frequency and recency of attendance at dental services were 

all lower in comparison to urban and metro populations.6 Reliance on public dental services is higher for the regional and 

remote population, but there are fewer dental practitioners available in these areas resulting in access limitations. In 

addition, limited resources, affordable and accessible transport, fluoridated water supplies, affordable healthy food and oral 

hygiene products and higher service delivery costs contribute to poorer access and oral health outcomes.20

22.6% of the South Australian 
population live outside the 
greater Adelaide area

19

8.3% of the South Australian 
population live in remote areas19

People living
in regional
and remote

areas

People who are 
socially 

disadvantaged or 
on low incomes

Aboriginal and
Torres Strait

Islander
people

Culturally
and 

linguistically
diverse people

People with
disabilities

People with
complex medical 

conditions

Frail older
people

People living
with mental

illness

The South Australian Oral Health Plan identifies eight priority populations, including children and adults, for whom targeted 

action is required due to additional access barriers and higher oral disease burden:

Research indicates that people who are socially disadvantaged, particularly women and children, are more likely to 

experience abuse.17  Violence, abuse and trauma are associated with poorer health outcomes, including oral health, and 

victims require trauma-informed care to meet the unique treatment needs of these clients.18  



3.4.3  Aboriginal and Torres Strait Islander people

Differences in the social determinants, health risk factors and access to health care services contribute to the health gap 

between Aboriginal and Torres Strait Islander people and the rest of the population.21 Many Aboriginal and Torres Strait 
Islander people experience multiple factors of disadvantage which compound their burden of disease.22 For example, 

Aboriginal and Torres Strait Islander people experience a higher burden of chronic diseases, whilst a large proportion of 

Aboriginal and Torres Strait Islander people live in rural and remote areas with the associated limitations to health care 

access.23,24

Aboriginal and Torres Strait Islander people experience poorer oral health in comparison with the rest of the 

population.25   Aboriginal and Torres Strait Islander children experience higher levels of decay in deciduous (baby) teeth, 

whilst dental decay, tooth loss and periodontal disease are higher for Aboriginal and Torres Strait Islander adults.6,26

15South Australia s Oral Health Plan 2019 - 2026

Culturally appropriate, acceptable and safe dental services, integrated and co-located with primary 

health systems, are required to close the oral health gap. 

3.4.5   Frail older people

One in six people living in South Australia are over the age of 65 (18.3%) and South 

Australia has the highest proportion of people aged 85 years and over (2.7%).31 

In the 2016 Census, half of the people aged 85 years reported a need for assistance 

with a core activity such as mobility, communication or self-care.31 

Accessibility to health care services is a particular issue for older Australians 
including challenges related to transport, physical access and the cost of care.1 

The Australian Bureau of Statistics (ABS) defines cultural and linguistic diversity (CALD) using country of birth, language other 
than English spoken at home and English language proficiency. 

People with low English proficiency often experience high levels of disadvantage and multiple barriers to accessing services 
related to cultural translation and communication difficulties, challenges in navigating the health system and either 
unemployment or low-income employment. In particular there are substantial barriers for older people from CALD 
backgrounds to accessing health, aged care and community services.29,30

3.4.4  Culturally and Linguistically Diverse people

24% of South Australians were born overseas27,28

17.4% of South Australians speak a language other than English at home27,28



16

In 2017-18, one in five Australians (20.1%) reported having a mental or behavioural condition and 3.6 million Australians 
(15.8%) reported co-existing long-term mental, behavioural and physical health conditions.33

Many people living with mental illness experience co-morbidities and multiple risk factors for poor oral health. Excessive 
alcohol and caffeine consumption, drug use and smoking, as well as dry mouth from the side effects of prescribed 

medications, negatively affect oral health.34

3.4.7  People with disabilities

In the 2015 Survey of Disability, Ageing and Carers, almost one in five Australians (18.3%) reported living with disability. 

More than 50% of those with a disability reported having two or more intellectual, psychiatric, sensory/speech, acquired 

brain injury or physical/diverse disabilities.37

The majority of people with disabilities are on a disability support pension or access other allowances and concessions, and 

cost is frequently reported as a barrier to accessing health services.39 

Many people with a disability may not perceive or may be unable to express their need for oral health care. Carers may see 

oral health care as a lower priority or may lack time or resources to support daily oral hygiene or regular dental care visits.38

Older people have higher rates of dental decay, moderate and severe gum disease and residents in care facilities have a 

higher prevalence of oral health problems.6 Frail older people often require support in the maintenance of oral hygiene to 
avoid the adverse impacts of poor oral health on their overall health.32 

The dental needs of frail older people are often complicated by multiple comorbidities and poly-pharmacy issues which 

increase the complexity of treatment and impact oral health (e.g. medications which cause dry mouth). The prevalence of 

dementia further contributes to the need for targeted oral health strategies for this population.1

People living with mental illness have, on average, six more decayed, missing or filled teeth and are 

three times more likely to have lost all their teeth than people without mental illness.1, 35

South Australia s Oral Health Plan 2019 - 2026

People living with mental illness are often disconnected from the general and oral health system, are disproportionately 

affected by unemployment or low income and are more likely to live in unstable accommodation or experience 

homelessness.36   Poor mental health can contribute to higher rates of potentially preventable hospitalisation.6 

3.4.6  People living with mental illness

There is no national oral health data on people with disabilities; however dental service profiles 

indicate that people with disabilities suffer from poorer oral health when compared with the general 

population.38  



3.4.8  People with complex medical conditions

In 2015, 50% of Australians had at least 1 of 8 selected chronic conditions.22 The likelihood of having one or more chronic 

disease increases with age and increasing numbers of Australians have several complex and often chronic medical 

conditions.38

Management of certain medical conditions, including infectious diseases and immune suppressing conditions, requires good 

oral health to prevent serious or potentially fatal complications.41 

People with complex medical conditions may also experience oral health complications due to the treatment of their 

underlying condition. However, oral health care is not consistently included in general health care for people with complex 

medical conditions, resulting in sub-optimal care and less favourable outcomes.1 

There is strong evidence linking poor oral health and chronic conditions, in particular the 
association between periodontal disease and cardiovascular disease, diabetes, osteoporosis, obesity and 

malnutrition.40

South Australia s Oral Health Plan 2019 - 2026 17

4  THE ORAL HEALTH WORKFORCE

The oral health workforce comprises registered dental practitioners (dental hygienists, dental prosthetists, dental 

specialists, dental therapists, dentists, and oral health therapists), non-registered dental assistants and dental technicians.1 
South Australia compares favourably to other jurisdictions with a relatively higher number of dental practitioners per 100,000 

population.

2016
State and 
Territory

Headcount Total FTE
Avg. 
total 

hours

Rate per
100,000

population

NSW 6,025 5,724.3 36.1 77.8

VIC 4,589 4,230.4 35.0 74.3

QLD 4,067 3,885.6 36.3 83.9

SA 1,630 1,412.3 32.9 95.1

WA 2,331 2,062.5 33.6 91.1

TAS 345 339.5 37.4 66.7

ACT 357 342.1 36.4 88.5

NT 140 137.9 37.4 57.0

TOTAL 19,490 18,139.6 35.4 80.5

Distribution of dental practitoners in Australia by State/Territory, 2016

 Source: NHWDS Data Tool and Resources, Australian Government, Department of Health 2016



2016
State and 
Territory

Headcount Total FTE
Avg. 
total 

hours

Rate per
100,000

population

NSW 6,025 5,724.3 36.1 77.8

VIC 4,589 4,230.4 35.0 74.3

QLD 4,067 3,885.6 36.3 83.9

SA 1,630 1,412.3 32.9 95.1

WA 2,331 2,062.5 33.6 91.1

TAS 345 339.5 37.4 66.7

ACT 357 342.1 36.4 88.5

NT 140 137.9 37.4 57.0

TOTAL 19,490 18,139.6 35.4 80.5

South Australia s Oral Health Plan 2019 - 2026 18

     The national trend of fewer dental professionals practising in rural and remote areas holds true for 
       South Australia, making access to care challenging in these areas. 

Distribution of employed dental practitioners by remoteness area, 2016

89.3% Major City

62.8% Inner Regional

55.5% Outer Regional

42.6% Remote

23.8% Very remote

8% 
Dental Hygenist

5% 
Dental Therapist

3% 
Oral Health Therapy
(Hygienist)

7% 
Dental Prosthetist74% Dentists 

(Including Dental Specialists)

2% 
Oral Health Therapy
(Therapist)

2% 
Other job areas

FTE rates of dental practitioners per 100,000 population 2016 by remoteness areas

Source: NHWDS Data Tool and Resources, Australian Government, Department of Health 2016

Source: NHWDS Data Tool and Resources, Australian Government, Department of Health 2016

Percentage of dental practitioners per dental sector, 2016

Source: NHWDS Data Tool and Resources, Australian Government, Department of Health 2016

81.9% 
Private sector only 14.4%

Public sector only

2.5%
Both private and public



South Australia s Oral Health Plan 2019 - 2026 19

5  ORAL HEALTH SECTOR IN SOUTH AUSTRALIA

A number of stakeholders across government, non-government organisations and associations contribute to the oral health 
sector.

5.1   Private dental sector
The private dental sector offers oral health care to adults and children and is the only dental service option for 

non-concession card holder adults. Both nationally and in South Australia the private dental sector is the largest provider of 

oral health care.42  

5.2   Public dental sector 

SA Dental Service provides universal access to dental services for all South Australian children under 18 years through the 

School Dental Service (SDS). The Community Dental Service (CDS) and Adelaide Dental Hospital (ADH) provide dental 

services for South Australian adults with eligibility limited to current concession card holders. Specialist services are provided 

at the ADH. SA Dental Service works in partnership with the University of Adelaide and TAFE to educate and train many of 

the State s oral health workforce.

The Royal Flying Doctor Service operates a Commonwealth funded Dental Outreach Program which provides dental services 

for clients in specific rural and remote areas.

5.3  Public hospitals
Flinders Medical Centre operates a dental clinic for hospital inpatients. The Women s and Children s Hospital operates a 

tertiary specialist paediatric dental unit. The Royal Adelaide Hospital, The Queen Elizabeth Hospital and SA Dental Service 

operate a joint specialist Oral and Maxillofacial Surgery Unit in partnership with the University of Adelaide.

5.4  Academic, education and research sectors

5.4.1  University of Adelaide

The University of Adelaide provides undergraduate training for dentists and oral health therapists and a range of post 

graduate courses and specialist training. Student oral health practitioners gain most of their clinical experience in South 

Australian Dental Service clinics and contribute to public dental service delivery.

The University of Adelaide, via its Community Outreach Dental Program, provides dental and other health services for people 

experiencing homelessness or who have difficulty accessing conventional care. Services are provided on a voluntary basis by 

University of Adelaide staff, students, private dentists and allied health professionals.

5.4.2  Australian Research Centre for Population Oral Health

Established at the University of Adelaide, the Australian Research Centre for Population Oral Health (ARCPOH) undertakes 

research and training in population oral health. In partnership with the Commonwealth Departmentof Health and State/

Territory Health Departments, ARCPOH is conducting the National Study of Adult Oral Health 2017-2018.  Previous national 

child and adult studies have also been led by ARCPOH.43

5.4.3  TAFE

TAFE SA provides training for dental hygienists, dental technicians and dental assistants and delivers courses in radiography 

and dental practice management. 



20South Australia s Oral Health Plan 2019 - 2026

The proportion of out-of-pocket costs for individuals for dental care is consistently higher than all other health services both 
nationally and in South Australia.

0

20%

40%

60%

80%

100%

2012/13                  2013/14 2014/15 2015/16 2016/17

27%

14%

27%

32%

23%

15%

28%

33%

26%

10%

29%

33%

25%

11.7%

29.9%

32.2%

24.1%

32.2%

10.7%

31.4%

Other

Individual

Health Insurance Funds

State and Local Govn.

Aust Govn. and Health 
Insurance Rebates

Percentage of Total Dental Expenditure SA 2012-2017

Source: Australian Institute of Health and Welfare 2018. Health expenditure Australia 2016-17

Oral health funding arrangements have remained relatively stable over the past several years with the following 
breakdown for South Australia in 2016/17:15 

   

Source: Australian Institute of Health and
Welfare 2018. Health expenditure Australia
2016-17.

Total expenditure on dental services in South Australia has increased slightly in recent years between 3% to 5% each year 

from $457m in 2012/13 to $523m by 2016/17.15

5.5  Funding arrangements for oral health in South Australia

24%
Commonwealth 
Government funding

11%
State Government 
funding

31%
Health Insurance 
funding

32%
Individuals funding 
out-of-pocket costs

0

100

200

300

400

500

600

2012/13 2013/14 2014/15 2015/16 2016/17

$457 $470
$494 $512

$523

To
ta

l $
 M

ill
io

n



21South Australia s Oral Health Plan 2019 - 2026

6  FRAMEWORK FOR THE SA ORAL HEALTH PLAN

6.1  Alignment with the National Oral Health Plan
The National Oral Health Plan 2015-2024 is based on two national goals, four guiding principles, six foundation areas and 

four priority population groups. The South Australian Oral Health Plan 2019-2026 aligns with this framework outlining 

action areas related to the six foundation areas of the National Plan. The thirty action areas are specific to the South 

Australian context and include eight specific priority populations.

6.2  Links with SA Health Plans
It is expected that the South Australian Oral Health Plan 2019-2026 strategies align with the SA Health Strategic Plan 

2017-2020 and associated policies. The following South Australian plans, reports and frameworks identify oral health as an 

attribute of general health and wellbeing and support the South Australian Oral Health Plan: 

          &gt;     Health and Wellbeing Strategy 2019-2024 

          &gt;     South Australian Mental Health Strategic Plan 2017-2022

          &gt;     South Australian Alcohol and Other Drugs Strategy 2017-2021

          &gt;     South Australian Tobacco Control Strategy 2017-2020

          &gt;     South Australian Public Health Plan 2019-2024

          &gt;     Chief Public Health Officers report 2014-2016

          &gt;     Aboriginal Health Care Plan 2010-2016

          &gt;     SA Health Aboriginal Workforce Framework 2017-2022

          &gt;     SA Aboriginal Health Needs and Gaps Report 2017

          &gt;     SA Health and Local Health Network Reconciliation Action Plans

6.3  Implementation and Monitoring
A monitoring group of key stakeholder representatives, including community, will be established to advise on the 

implementation of the South Australian Oral Health Plan 2019-2026, identify the lead agencies and partners involved and 

report against National Oral Health Plan 2015-2024 indicators within the South Australian context.

Improve the oral health status by reducing the incidence, prevalence and effects of oral disease
 

Reduce inequalities in oral health status across the South Australian population

Population health 
approach

Appropriate
and accessible

services

Integrated oral
and general

health

Proportionate
universalism

Oral health
promotion

Accessible 
oral health 

services

System 
alignment

and 
integration

Safety 
and 

quality
Workforce

development

Research 
and 

evaluation

People who
 are socially 

disadvantaged 
or on low 

income

People 
living in 

rural and 
remote 

areas

Aboriginal
and Torres

Strait 
Islander
people

Culturally
and

linguistically
diverse
people

Frail
older

people

People
with

mental
illness

People
with

disabilities

People with
complex
medical

conditions

G
O

A
LS

PR
IN

C
IP

LE
S

FO
U

N
D

A
TI

O
N

A
R

EA
S

PR
IO

R
IT

Y
PO

PU
LA

TI
O

N
S

N
at

io
n

al
St

at
e

N
at

io
n

al
St

at
e/

N
at

io
n

al



7   SA ORAL HEALTH PLAN 2019-2026 ACTION AREAS

1  ORAL HEALTH PROMOTION AND PREVENTION

Oral health promotion aims to address the upstream causes of oral disease and promote preventative interventions. Multiple, 
evidence-based interventions are available at individual and population levels.

Collaboration across the dental and broader health and education sectors is important for: 
          &gt;     Creating supportive environments
          &gt;     Improving oral health literacy
          &gt;     Integrating oral health and general health
          &gt;     Addressing the social determinants of health.
       

1.1  Optimise preventive effects of fluoride

The National Health and Medical Research Council has confirmed that Australian community water fluoridation programs 

are a safe, effective and ethical way to reduce dental decay across the population.44  

Socially disadvantaged children and adults with high rates of dental decay and limited access to dental treatment and other 

forms of fluoride, benefit from water fluoridation.20  Water fluoridation is a population level prevention strategy in line with 

the principle of proportionate universalism.45  In South Australia, 92% of people have access to optimally fluoridated 

water. 20  This is slightly higher than the national average of 89% and is similar to other jurisdictions.

South Australia s Oral Health Plan 2019 - 2026 22

Maintain current water fluoridation access and promote alternate forms of fluoride for 
people without access to fluoridated water supplies

Collaboration with key stakeholders and partners across public and private sectors will be required to develop and 

implement strategies related to the following action areas. Where relevant, strategies should address the specific needs and 

impacts on children and adults of the eight priority populations.

     GOAL: Provide evidence-based oral health information and programs

Water fluoridation is the primary 

source of fluoride exposure and 

helps reduce dental decay for all, 

at all stages of life. 

It is widely accepted and recommended that individuals brush their teeth 

twice daily with fluoridated toothpaste as an important oral health 

promotion practice. The National Child Oral Health Study 2012-2014 and 

the Australian Dental Association Oral Health Tracker Technical Paper 

indicate that the rate of twice daily brushing for Australian children (68.5%) 

and adults (51%) could be improved.46  Regular, twice daily toothbrushing 

with an appropriate fluoride toothpaste should be promoted, especially in 

areas without water fluoridation.



1.2  Increase oral health literacy

South Australia s Oral Health Plan 2019 - 2026 23

According to the AIHW s 16th biennial report on the health of Australians, only 41% 

of Australians aged 15 74 were assessed as having adequate or more than adequate 

health literacy skills.47  

The Australian Commission on Safety and Quality in Health Care identifies individual 

health literacy and the health literacy environment as the core components 

contributing to overall health literacy levels. Strategies aimed at increasing health 

literacy should focus on building the capacity of individuals as well as the capacity of 

the health system to support individuals in making healthy choices.47

Low health literacy is a risk 

factor for poor health and 

has been shown to impact 

the safety and quality of 

healthcare, and 

contribute to higher 

healthcare costs.48 

It is important that evidence-based recommendations for personal preventive behaviours are consistent, simple and widely 

available to health professionals and the public. Eleven evidence-based oral health promotion messages were developed in 

2009 for the Australian public and are aligned with recommended general health messages regarding breastfeeding, tap 

water, nutrition and smoking cessation.1 

These messages should be promoted by the oral health sector and the wider health and education sectors in traditional and 

non-traditional environments.

An individual s health literacy refers to their ability to access, understand and apply information to make effective decisions 

about their health and healthcare. Improved health literacy can affect a person s ability to navigate the health system, seek 

support from health professionals and understand treatment and prevention instructions.46

Health literacy is influenced by individual factors such as level of education, cultural background, and the health care 

environment. Low health literacy amongst socially disadvantaged and low income earners compounds the health 

disparities experienced by these groups.46 

Strategies to improve oral health literacy of priority populations should include the provision of specific, culturally sensitive 

oral health information, using plain language and simple diagrams and pictures.1 

Alternate forms of fluoride, such as fluoride varnish programs can be used for communities with limited or no access to 
water fluoridation. Legislation changes are required to enable non-registered practitioners, such as dental assistants and 
Aboriginal Health Care Workers, to apply fluoride varnish.

Promote national key oral health messages across health, education and community settings,
using a wide range of promotion channels

Improve the oral health literacy of priority populations and build their capacity to make 
healthy choices



Promote national key oral health messages across health, education and community settings,
using a wide range of promotion channels

Whilst the dental sector cannot directly affect the pricing of nutritious foods and oral hygiene products, it can play an 

advocacy role in raising awareness of the direct links between these enablers and positive oral health outcomes. Oral health 

promotion programs for regional and remote areas should take into account the specific barriers experienced outside major 

population centres, including the higher cost of nutritious foods and oral hygiene products.

1.4  Build capacity of health, education and community workers

The importance of optimal childhood development and its impact on adult health and wellbeing warrants specific attention 
during key developmental stages. Despite being preventable, dental decay is one of the most common childhood 
infections, causing adverse impacts on individual quality of life and a high cost burden for families, communities and the 
health care system.50

Non-dental professionals can provide information and support for pregnant women, parents, carers and children regarding 
key preventive dental behaviours such as toothbrushing, the use of fluoride toothpaste and initiation of the first dental visit. 

Non-dental professionals can also play a critical role in the detection of early childhood caries and referral for treatment.4

The Council of Australian Governments (COAG) Health Council endorsed five actions in 2016 to limit the 

impact of unhealthy food and drinks on children, which includes collaboration across health, education 

and the sports and recreation sectors.49

It is important that these sectors facilitate health promoting partnerships to provide expertise and 

evidence-based resources focused on healthy eating and drinking messages, standards and policies. 

Child Care, pre-school, school and sports/recreation settings are key environments for 

developing healthy habits for life-long impacts. 

1.3  Promote oral health and nutrition

Poor nutrition, especially high sugar consumption, is a risk factor for dental decay. Embedding oral health and nutrition 

standards and policies focused on reducing sugar consumption across non-dental settings is an important strategy for 

reducing the prevalence and severity of dental decay, particularly in the early childhood years. 

South Australia s Oral Health Plan 2019 - 2026 24

Strengthen and embed oral health and nutrition policies in early childhood, education and 
community settings

Promote the benefits of and advocate for affordable nutritious foods and oral hygiene 
products in regional and remote communities

Work with health professionals who interact with pregnant women, parents, carers, and 
children to ensure that they have the information they need to maintain good oral health at 
the key stages of childhood development



25South Australia s Oral Health Plan 2019 - 2026

1.5  Integrate oral health and general health policy

Integration across settings is an effective system-level strategy for improving access and health outcomes and reducing costs. 

Early intervention and prevention to address common risk factors, such as high sugar 

consumption, alcohol and tobacco use and dry mouth, will impact 

the burden of preventable chronic diseases, including oral disease.

In South Australia, the Health in All Policies (HiAP) initiative and Public Health Partner Authorities (PHPAs) provide a 
framework for working across government agencies in developing public policies aimed at integrating oral health into 
population health and wellbeing strategies.51

Advocate for the integration of oral health in general health and education policies and plans 
at the local, state and national level



Advocate for the integration of oral health in general health and education policies and plans 
at the local, state and national level

South Australia s Oral Health Plan 2019 - 2026 26

2  ACCESSIBLE ORAL HEALTH SERVICES

Service uptake is impacted by health literacy, the ability to perceive the need for services and by barriers which limit access. 

Clients should  have access  through service availability and should be able to  gain access , where services are 

approachable, acceptable, affordable and appropriate.52

2.1  Reduce transport barriers

Identify opportunities to reduce the impact of transport as a barrier to access

In most cases transportation is required for accessing health services. 

Whilst the dental sector is not able to provide transportation services 

to improve access, transportation opportunities should be considered 

when planning and reviewing dental services, policies and funding 

arrangements. 

2.2  Provide universal access for children

Maintain and promote universal access to publically funded dental services for all children 
until their 18th birthday

Regular check-ups, prevention focused dental care and specific programs targeting high risk children are the foundation for 

good oral health. The public sector School Dental Service was established based on principles of prevention and population 

health and is a universal service providing comprehensive dental care for all South Australian children until their 18th

birthday. 

The National Child Oral Health Survey highlights the lower disease rates of those jurisdictions with established school dental 
services. For example, whilst more South Australian children live in low income households than the national average, South 
Australian children have lower dental caries experience and untreated decay. 

In addition, South Australian children have higher than national average initiation, frequency and recency of dental check-up 
visits and fissure sealants.9  

Identifying public transport 

routes, existing transport 

programs or funding schemes 

is especially important for 

priority populations.

GOAL: Provide South Australians with accessible oral health care



South Australia s Oral Health Plan 2019 - 2026 27

2.3   Improve access for priority populations

The social gradient in health outcomes is especially pronounced for oral health with many people grappling multiple factors 

of disadvantage. Only one in five Australians can access the oral health care they need and almost 6 million Australians live 

with at least one untreated oral health issue.55

Whilst the public dental sector runs programs for priority populations, it can only accommodate about one fifth of the 

eligible population every two years, resulting in long public dental waiting lists.6  The Commonwealth funded National 

Partnership Agreement (NPA) on Adult Public Dental Services is focused on reducing public dental waiting lists.56 However, 

funding cycles and activity targets limit opportunity for long-term workforce and infrastructure investment. The bulk of this 

federal funding is expended through private sector dental schemes.

The Commonwealth funded Child Dental Benefit Schedule (CDBS), implemented in January 2014, has increased access 

across both public and private sectors for children in families eligible for Family Tax Benefit A.53 However, as noted in the 

fourth review of the Child Dental Benefits Act, utilisation rates have been lower than expected with only 38% of eligible 

children accessing the benefit in 2018.54  Recommendations from the review included improved communication and 

promotion of the benefit and eligibility criteria.

The overall out of pocket costs for dental care are much higher than any other healthcare costs, with 32% of annual dental 

care spend in South Australia contributed by individual out of pocket payments.6 

Research has shown that despite being eligible for public dental 

services, concession card holders are more likely to avoid or delay care 

due to cost and report cost as a barrier to accessing recommended 

treatment.1 In addition, the number of low income households is 

increasing, including low income earners not eligible for public dental 

care who are unable to afford dental care in the private sector.57

Work with the Australian Government to ensure that low income earners are able to receive 
regular dental check-ups and timely treatment

Financial burden is often 
cited as a reason why people do not 
seek regular dental care or comply 
with treatment recommendations.6

Continue to work with the Commonwealth Government to ensure sustainable federal 
funding to support access for priority populations



Work with the Australian Government to ensure that low income earners are able to receive 
regular dental check-ups and timely treatment

Continue to work with the Commonwealth Government to ensure sustainable federal 
funding to support access for priority populations

South Australia s Oral Health Plan 2019 - 2026 28

Since the mid 2000 s, SA Dental Service has implemented strategies to increase the number of Aboriginal and Torres Strait 

Islander people accessing publicly funded dental care in South Australia. The Aboriginal Oral Health Program uses multiple 

strategies to address a broad range of issues that might prevent Aboriginal and Torres Strait Islander people from accessing 

dental care and achieving good oral health. 

Closing the Gap funding is used to employ Aboriginal and Torres Strait Islander project staff to raise awareness of oral health 

and community engagement with dental services. As a result the number of Aboriginal and Torres Strait Islander adults and 

children seen by SA Dental Service has increased significantly over the past ten years.58 

Maintain programs which increase access to dental services for Aboriginal and Torres Strait 
Islander people

Maintain priority access to public dental care for concession card holders who have complex 
medical conditions

Oral health care should be included in the coordination of health care for people with complex medical conditions as poor 
oral health can adversely affect the management of a number of medical conditions.39  

Delays in the provision of dental care can have serious consequences; priority access to public dental services, via appropriate 
referral pathways from hospitals units and medical practitioners, is required.1 

P1

The Aboriginal Health Council provides funding to SA Dental Service which contributes to clinical care for 

Aboriginal and Torres Strait Islander people in rural and remote areas. SA Dental Service works in 

partnership with the following organisations, providing funding for dental programs operated by:

          &gt;     Tullawon Health Service based in the Yalata community,

          &gt;     Umoona Health Service in Coober Pedy, and

          &gt;     Nunkuwarrin Yunti in Adelaide.



3  SYSTEM ALIGNMENT AND INTEGRATION

Coordinated responses to reduce oral health service gaps and improve access are a challenge due to the complexity of the 

oral health system with multiple service providers, diverse funding sources and unregulated pricing. 

The limited capacity of regional and remote areas to sustain multiple 
health care service providers requires innovative strategies to maximise 
the use of available resources. Exploring opportunities for collaboration 
and partnership between private, public and non-government service 
providers is essential for the sustainability of service delivery. 

Integrated and flexible service delivery models have the potential to 
maximise workforce capacity and capability.

Strategies focused on 

integrating oral health within the 

general health system require 

system alignment, collaboration and 

cooperation across the dental sector 

and broader health system.59

3.1  Establish inter-sectoral collaboration

Facilitate inter-sectoral collaboration between the oral health and general health sectors at 
policy, program and service delivery level to improve integration and increase access for 
priority populations

Inter-sectoral collaboration between dental and general health care sectors is a cost-effective approach for improving access 

and providing efficient services, especially for priority populations. Successful collaboration facilitates active 

engagement from stakeholders and is more likely to result in sustainable policy, program and service delivery outcomes.

Targeting common risk factors, service mapping and raising awareness of available services with the local community are 

important strategies to improve system alignnment and integration.

Collaborative partnerships have been shown to improve service quality through innovation, information sharing and 

co-ordination. Collaborative health care providers tend to be more responsive and patient centred, leading to increased 
patient involvement in decision-making and engagement in healthy behaviours.60

South Australia s Oral Health Plan 2019 - 2026 29

GOAL: Work together to support healthy mouths and healthy lives



Facilitate inter-sectoral collaboration between the oral health and general health sectors at 
policy, program and service delivery level to improve integration and increase access for 
priority populations

South Australia s Oral Health Plan 2019 - 2026 30

The lack of healthcare policies and strategies which include oral health, 
as well as inadequate interdisciplinary training and workload increase, 
are all listed as common barriers to integrated general and oral health 
care. The perception of oral healthcare needs, by both the patient and 
primary healthcare provider, is also a major contributing factor as oral 
health conditions are rarely life threatening and therefore not often 
prioritised.57

Oral health is a significant factor affecting older people s quality of life and overall health and wellbeing. Tooth decay, 

tooth loss and use of dentures, gum disease and dry mouth are commonly experienced by older people.6

                                                                  

Ongoing educational and support programs are required to sustain oral 

health literacy in a workforce with high staff turn-over, as well as building 

the capacity of the emerging aged care workforce.  Effective strategies for 

integrating oral health into daily hygiene, general health assessment and 

care planning processes are available through Better Oral Health Care 

resource packages.62

Preventive oral health care and 

effective self-care strategies should 

be integrated into primary health 

care settings, with training provided 

for screening and referral for dental 

treatment.

Carers and care workers are well placed to support maintenance of oral hygiene,  recognise oral health problems and 

incorporate oral health into care planning and dental referral processes.32

The ability of carers and care 
workers to maintain and 

improve the oral health of older 
people has been 

effectively demonstrated 32

Integrating oral health best practise into models of care for general health optimises patient outcomes and strengthens 

health professionals understanding of the relationship between oral health and general health. The SA Dental Service 

Children s Population Oral Health Program is a primary prevention approach for 0-5 year olds, particularly those children at 

risk of developing early childhood caries. The program provides training for non-dental professionals to promote oral 

health messages and screen young children for early childhood caries. A simple referral pathway for priority dental treatment 

in the public or private dental sector is available for young children with early childhood caries.63

Support non-dental professionals to undertake a simple, evidence-based oral health 
screen and referral for children from birth to 5 years

3.2  Develop integrated models of care

Develop evidence-based models of care that incorporate oral health education, prevention 
and screening in the general health sector

Recent publications indicate that primary health care providers don t often consider oral health care in their care planning 
due to a lack of knowledge and awareness of the impact of oral health on general health and wellbeing.61

Incorporate oral health into existing screening, care planning and care processes for carers 
and care workers of frail older people



South Australia s Oral Health Plan 2019 - 2026 31

3.3  Optimise technology for integration

E-health technologies such as online education, electronic health records and web-patient portals could be used to facilitate 

information sharing, system alignment and integrated care. Technologies such as telehealth, especially for specialist care, 

may deliver long term cost efficiencies allowing resources to be redirected to other service delivery costs.

Technology in dentistry can provide opportunities for communication and the exchange of clinical information and images 

for dental consultation, diagnosis and treatment planning. This has the potential to improve access and engagement with 

clients and ultimately minimise the disparities between rural and urban service delivery, ultimately reducing costs in the long 

term.65

Evaluation of the Children s Population Oral Health Program showed the evidence-based Lift the Lip screening and referral 

tool was accurate and effective for use by non-dental professionals.57  The Program has been successfully integrated into the 

child health assessments conducted by the Child and Family Health Service nurses across South Australia.60

Optimise the use of technology to enhance oral health service delivery and increase health 
system integration in South Australia



Optimise the use of technology to enhance oral health service delivery and increase health 
system integration in South Australia

South Australia s Oral Health Plan 2019 - 2026 32

Accreditation against the National Safety and Quality Health Service (NSQHS) Standards is required for all public dental clinics 

and services and is voluntary for private dental practices. Ensuring continuous improvement in the safety and quality of oral 

health services should be a priority for all stakeholders of the oral health system.

4  SAFETY AND QUALITY

In August 2012, the Australian Health Ministers endorsed the first Australian Safety and Quality Goals for Health Care, which 
include: 

Safety of care
That people receive health care 

without experiencing 

preventable harm 

Appropriateness of care
That people receive 

appropriate, 

evidence-based care

Partnering with consumers
That there are effective 

partnerships between 

consumers healthcare providers 

and organisations at levels 

of healthcare provision, 

planning and evaluation.66

 
GOAL: Provide safe, quality oral health services

4.1  Maintain dental service infrastructure

Ensure oral health service infrastructure is maintained at a standard which supports the 
delivery of high quality, safe services

In order to provide high quality, safe services, dental service infrastructure needs to be maintained and upgraded to meet 

contemporary standards.65  This not only impacts the quality of dental services provided, but is also important for supporting 

clinical training for dental students and attracting and retaining a high calibre dental workforce. 

It is important that where possible, dental services are located in health precincts to improve access and enhance 

collaboration and co-ordination of health services.

Involve consumer representatives and stakeholders in the planning, design, delivery and 
evaluation of oral health services in South Australia

4.2  Facilitate consumer engagement

The National Safety and Quality Health Service (NSQHS) identifies consumer-centred care as one of three dimensions 

required for a safe and high-quality health system in Australia, emphasising the importance of placing consumers at the 

centre of the healthcare system.65



South Australia s Oral Health Plan 2019 - 2026

Involve Aboriginal and Torres Strait Islander community and stakeholders in the planning and 
delivery of oral health services in South Australia

The second edition of the NSQHS Standards defines six actions 

to specifically meet the health care needs of Aboriginal and 

Torres Strait Islander people, including improved consumer 

engagement and cultural safety of health services.68

Community and consumer engagement from a strengths-based 

approach recognises the critical importance of culture as a health 

protective factor for Aboriginal and Torres Strait Islander people 

and is underpinned by cultural respect, meaningful engagement 

and genuine partnerships with families and communities. 

Development of strategies to improve the 

physical health and wellbeing of 

Aboriginal and Torres Strait Islander 

people requires a holistic approach that 

incorporates the social and 

cultural context of the community. 

Community engagement requires a relationship built on trust and integrity between groups of people working towards 

shared goals and should occur through partnerships with Indigenous organisations such as community-controlled health 

organisations.68  Active community participation, local decision-making, locally controlled resources, and respectful support 

by non-Aboriginal partners are critical for effective engagement and service delivery.

Consumer participation should occur across the three levels of service delivery, namely individual care, program planning 
and design, as well as organisational governance.  There is clear evidence that consumer engagement improves consumer 
experience, the quality of health care and delivers a range of service benefits, including: 
          &gt;     Increased compliance with prescribed treatments 
          &gt;     Reduced anxiety and greater confidence in the treatments received
          &gt;     Improved consumer management, safety and service delivery
          &gt;     More responsive and innovative programs, and 
          &gt;     Cost savings through decreased use.1

NSQHS Standard 2 - Partnering with Consumers provides a framework for health services to create an environment that is 
responsive to patient and carer input, needs and priorities.65

33

4.3  Implement oral health standards across sectors

Collaborate with peak bodies to develop and implement oral health standards and tools 
across sectors

Oral health components are included in the accreditation standards of a few health services and industries (e.g. Mental 

Health, Child Care, Aged Care). Developing oral health tools and standards across various sectors is an important policy-level 

strategy to raise awareness of the impact of oral health on general health and wellbeing and include the non-dental sector 

in responding to poor oral health outcomes.



5  WORKFORCE DEVELOPMENT

Access to care is dependent on the availability of an oral health workforce with 

the appropriate composition, size and capacity to meet the community s needs for 

prevention and treatment of oral health conditions.

Sustainable education programs developed in partnership between the tertiary 

education sector and dental service sector are required to ensure sufficient supply 

of qualified South Australian based oral health providers. Dental and oral health 

students gain much of their clinical training by treating public patients in public 

dental clinics. This is enhanced by the support of clinical leadership from dental 

specialists, including those in the tertiary education sector.  

5.1 Build workforce capacity to meet the needs of priority populations

Build capacity in the oral health sector to effectively address the needs of priority populations

South Australia s Oral Health Plan 2019 - 2026 34

Training and professional development for the oral health workforce should reflect the 

competencies required to address the needs of priority populations. The existing and 

future oral health workforce need to work as part of multidisciplinary teams to address the needs of Priority Populations.

For people with additional or specialised needs, the combination of multiple disadvantages and health challenges results in 

complex oral health needs. These additional and specialised needs often require specialised dental services which often have 

long waiting lists due to resource constraints.1 Increased competency amongst the broader workforce is required to address 

the needs of people with additional and/or specialised health care needs.

Education and training for general dental practitioners through the South Australian Special Needs Dentistry Network is an 

effective method for building capacity and expanding access. Expandedrural scholarships and rural placements for students 

are important incentives to addressing mal-distribution of oral health workforce across regional and remote service sites.

Ongoing training, support 
and professional 

development is critical for 
building a workforce with 

high-level skills and 
capacity to provide safe, 

high quality oral health 
services.   

GOAL: Ensure the oral health workforce meets the needs of the community



5.2  Cultural competency of the oral health sector

Promote incorporation of cultural competency and safety across training, education and as-
sessment, clinical management protocols and guidelines for the South Australian oral health 
workforce

Lack of cultural competency within the health workforce is a barrier to the provision of health services for Aboriginal and 
Torres Strait Islander people and people from culturally and linguistically diverse backgrounds. Increasing the cultural 
competency of the oral health workforce will improve equity, access and the oral health outcomes of people from culturally 
diverse backgrounds.

The revised 2017 Australian Commission on Safety and Quality in Health Care accreditation standards require health services 
to implement strategies to improve cultural competency and cultural awareness of the health workforce to meet the needs 
of Aboriginal and Torres Strait Islander consumers.66

The SA Health Aboriginal Cultural Learning Framework has been developed to provide a consistent approach to building 
cultural competency and safety, enabling health care staff to deliver quality, culturally safe, responsive health care for 
Aboriginal and Torres Strait Islander people.69

Cultural and clinical safety are essential for delivery of high quality care. Increased representation of Aboriginal and Torres 
Strait Islander people amongst the oral health workforce and in the planning of services will enable more culturally 
appropriate and effective oral health services.

The SA Health Aboriginal Workforce Framework 2017-2022 aims to attract, retain and develop Aboriginal and Torres Strait 
Islander staff, and increase the cultural competence of the SA Health workforce.70  

5.3  Optimise oral health workforce utilisation

Optimising the full range of skills within the oral health workforce, aligned with relevant legislation and regulation, is 
essential to enable flexible service delivery. 

The strategic utilisation of an appropriate skills-mix across the oral health and non-oral health workforce has the potential to 
improve access and oral health outcomes for South Australians. 

South Australia s Oral Health Plan 2019 - 2026 35

Optimise oral health workforce utilisation to maximise flexible and efficient service delivery 
across South Australia

Increase representation and engagement of Aboriginal and Torres Islander in the 
South Australian oral health workforce



Optimise oral health workforce utilisation to maximise flexible and efficient service delivery 
across South Australia

South Australia s Oral Health Plan 2019 - 2026 36

Enhance programs to recruit and retain dental practitioners students and professionals in 
South Australian regional and remote areas, including rural scholarships and graduate 
placements

The challenges of attracting and retaining oral health workforce in regional and remote areas have a significant impact on 

the cost of establishing and maintaining services. Targeted workforce development strategies are required to make regional 

and remote placements attractive and professionally worthwhile for dental practitioners. 

Regional and remote scholarships, tertiary education fee assistance, graduate placements and remote vocational training 

programs can assist in incentivising placements and reducing inequitable distribution of the oral health workforce. 

5.4  Provide oral health competency training

The education and training of other health and human service professionals should include oral health units aimed at 

increasing knowledge and understanding of the relationship between oral health and general health and the importance 

of integrating care for improved health outcomes.

Training packages and competency units are available to support skill development for non-dental professionals, care 

providers and educators, for integrating oral health literacy, screening and referral into their practice.71 

Work with the South Australian tertiary education and vocational sector to include oral health 
units of competency in health and community service qualifications



6  RESEARCH AND EVALUATION

An evidence-based approach for the design, implementation and review of oral health programs and services requires access 

to both population and service level data. This information assists decision making regarding the required service level and 

mix, and informs planning when services gaps are identified and changes are required. 

South Australia s Oral Health Plan 2019 - 2026 37

6.1  Contribute to oral health evidence

It is important to use a robust and contemporary evidence-base for oral health promotion and service delivery. Research 

should support the development and evaluation of models of care, interventions and programs for priority populations. 

Collecting data and building evidence regarding the oral health status, management of dental conditions, service gaps and 

barriers impacting priority population will ensure tailored programs are effective and efficient.

6.2  Population oral health data

As outlined in the National Oral Health Plan 2015-2024, population-level evaluation across public and private dental 
sectors is challenging due to limited data availability. This also includes limited representation of priority populations in 
existing data-sets, due to challenges associated with population size, identification and standard data collection practices.

An increased focus on ensuring nationally representative data on Priority Populations is required to support evaluation of 
access and outcomes for prioritygroups.1

 
                      GOAL: Use research and data to understand the oral health needs of the 
                      community

Support the routine collection, reporting and sharing of population oral health data to 
facilitate continuous improvements and innovation

Support research and evaluation that contributes to the development of evidence-based 
programs and models of care for priority populations



Support the routine collection, reporting and sharing of population oral health data to 
facilitate continuous improvements and innovation

Support research and evaluation that contributes to the development of evidence-based 
programs and models of care for priority populations

South Australia s Oral Health Plan 2019 - 2026 38

ABS              Australian Bureau of Statistics

ACT              Australian Capital Territory

ADH              Adelaide Dental Hospital

AIHW              Australian Institute of Health and Welfare

ARCPOH Australian Research Centre for Population Oral Health

ATSI              Aboriginal and Torres Strait Islander

CALD              Culturally and Linguistically Diverse

CDS              Community Dental Service

COPD              Chronic Obstructive Pulmonary Disease

CPHO              Chief Public Health Officer

DA              Dental Assistant

DMFT              DMFT: Decayed Missing and Filled Permanent Teeth

DT              Dental Therapist

NCOHS              National Child Oral Health Survey

NOHP              National Oral Health Plan 2015-2024

NSAOH              National Study of Adult Oral Health

OHT              Oral Health Therapist

PHC              Primary Health Care

PPHA              Potentially Preventable Hospital Admissions

SA              South Australia

SADS              South Australian Dental Service

SAOHP              South Australian Oral Health Plan 2019-2026

SDS              School Dental Service

8  GLOSSARY



South Australia s Oral Health Plan 2019 - 2026

The South Australian Oral Health Plan provides the strategic context for the operation of SA Dental Service, the wider oral 

health sector as well as SA Health with respect to oral health in South Australia. 

The SA Oral Health Plan incorporates the vision and priorities of the South Australian Government for oral health for South 

Australia from 2019   2026. Much effort in developing the SA Oral Health Plan has been devoted to consultation with 

stakeholders. This approach recognises that the fundamental areas identified for action in the inaugural plan remain 

relevant, supplemented by emerging trends and new issues. 

Several stakeholder workshops were conducted and a consultation paper was sent to a wide range of government and 

non- government agencies and associations for comment. The Consultation paper was placed on the SA Government 

 YourSAy  website. Feedback was used to develop the Draft South Australian Oral Health Plan which was redistributed for 

further feedback.

Development of the plan was overseen by the South Australian Oral Health Plan Working Group and endorsed by the Hon 

Stephen Wade MLC, Minister for Health and Wellbeing.

South Australian Oral Health Plan Working Group Members

39

9  APPENDICES

9.1  Development of the South Australian Oral Health Plan

Kay Anastassiadis, Principal Project Officer, Mental Health Strategy, SA Health

Prof David Brennan, Australian Research Centre for Population Oral Health, University of Adelaide 

Mark Chilvers, Executive Director, SA Dental Service 

Simon Clark, Principal Project Officer, System Redesign &amp; Clinical Engagement, SA Health

Kerry Clifford, Senior Project Officer, SA Dental Service 

Ali Krollig, Director Health Policy, Country SA Primary Health Network

Dr Sophia Matiasz, Board member, COTA SA and Consumer Advisory Panel member, SA Dental Service 

Dr Samantha Mead, CEO Australian Dental Association, SA Branch

Kristy Nixon, Manager Health Promotion, SA Dental Service

Dr Sarbin Ranjitkar, Associate Dean Clinical, University of Adelaide

Kerri Reilly, Director Aboriginal Health and Research Translation, Central Adelaide Health Network

Dr Anthony Smerdon, President Australian Dental Association, SA Branch

Lyndall Thomas, Principal Project Officer, Public Health, SA Health

Janet Weeks, Director Service Quality &amp; Performance Improvement, SA Dental Service

 

 



South Australia s Oral Health Plan 2019 - 2026 40

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