A person who specialises in special needs dentistry is one who is concerned with the oral health care of people with an intellectual disability or with medical, physical or psychiatric conditions that require special methods or techniques to prevent or treat oral health problems or where such conditions necessitate special dental treatment plans.39 Specialists in special needs dentistry work with a diverse client group with complex needs, and liaise and work with all members of an individual’s care team, taking a holistic view of oral health.
How are specialists in special needs dentistry trained?
To be eligible to gain registration with the DBA as a specialist in special needs dentistry, a person must be a qualified dentist, have a minimum of two years general dental practice experience, and complete an approved postgraduate programme of study in prosthodontics. Currently, there are three approved three-year Doctor of Clinical Dentistry in Special Needs Dentistry programmes in Australia, offered by the University of Adelaide, the University of Melbourne, and the University of Sydney.40
What is the assessment process for overseas-trained specialists in special needs dentistry?
An overseas-trained specialist in special needs dentistry must have their specialist qualification assessed as substantially equivalent to an approved qualification for the specialty. The ADC review and make recommendations about overseas-trained specialist applications to the DBA.
In addition to having their specialist qualification assessed as substantially equivalent, the DBA’s Specialist Registration Standard requires specialist registration applicants to have completed a minimum of two years general dental practice in addition to meeting all other requirements for general registration as a dentist. The general practice requirement may be achieved by experience outside Australia, subject to assessment and approval by the DBA.41
What issues have stakeholders identified for the specialists in special needs dentistry workforce?
A wide range of factors were highlighted by stakeholders as affecting the special needs specialist dental workforce. It was noted demand for the workforce is increasing, resulting from:
Increased survival of children with complex or multiple disabilities, and an associated transition of care from paediatric dentists to appropriately trained dentists and specialists
Increasing complexity of medical care provided and increasing population expectations with respect to retaining teeth
Increasing life expectancy for people with disabilities and chronic disease, with more surviving into middle and old age
Increasing number of people surviving cancer with oral morbidity
Increasing volume of oral disease, particularly among socially disadvantaged groups such as people with disabilities – for some, potentially a by-product of increasing levels of independent living, where there may be less rigorous daily oral care, less supervision of diet, and less support in accessing oral health care services.
Despite increasing demand, stakeholders highlighted the following issues with the existing workforce:
There are few registered specialists in special needs dentistry (Table ), with no specialists currently registered in Western Australia, Tasmania, the Northern Territory and the Australian Capital Territory.
The existing workforce is ageing, with an average age of over 50 years in 2012 – this will impact the ability of the workforce to meet demand in future.
Additional to concerns about the number and characteristics of the existing workforce, stakeholders also highlighted issues with the supply streams of education and immigration that will exacerbate existing supply issues:
Limited capacity in the training pathway, with a total capacity of up to five students in each year for special needs dentistry training
Potentially restricted numbers of overseas-trained special needs dentists migrating, due to the newness of the specialty both in Australia and internationally – this is likely to limit the number of overseas-trained specialists found to have completed a substantially equivalent training programmes to those offered in Australia.
Further to the limited capacity of the training pathway, stakeholders also highlighted the number of people currently training is less than capacity, so attraction to the specialty as a career option is also an issue. Financial factors are thought to limit the attraction of special needs dentistry. A specialist training programme represents a significant investment in time and costs (including lost income for the three years of training) for dentists. As there is a high likelihood that employment for special needs dentistry specialists will be in the public sector, with lower remuneration compared with private practice, special needs dentistry may be a less attractive option to prospective specialists than other specialty fields.
Existing workforce position
The existing workforce position was determined from expert opinion from jurisdictions and the profession. A traffic light approach was used (as described in Appendix D). Reflecting the issues raised by stakeholders above, the existing workforce position for specialists in special needs dentistry existing was assessed as red – perceived current shortage.
There are a small number of registered special needs dentist specialists in Australia (Table 32). In both years more than half of those specialists were female, and more than two-thirds worked primarily as clinicians. Care should be taken when interpreting these figures due to the small number of specialists.
Table : Employed registered specialists: special needs dentistry, workforce characteristics, 2011 and 2012
% over 55
Average working hours
Source: NHWDS: dental practitioners 2011 and 2012
Table shows there were approximately three times more employed dentists (both specialists and general dentists) reporting special needs dentistry as their principal area of main job than employed registered special needs dentist specialists in 2011 and 2012.
Table : Employed dentists (including specialists): principal area of main job reported as special needs dentistry, workforce characteristics, 2011 and 2012