Staff motivation and confidence

Media item: article

Date published: 12 November 2007

Subject: workplace management

This page records the media item. The original article is the property of its publisher and is not reproduced here.

The version of this that reaches patients

Generic management advice is generic. What is not generic is the Australian dental workforce, and what happens to patients when it is short-staffed — which it persistently is. How do I manage to keep 60 demanding clinicians happy — all under the one roof? is the same question from inside a practice.

Who is actually missing

The shortage is not evenly distributed, and it is not primarily a shortage of dentists in cities.

Dental assistants are the most acute and least discussed gap. They are not registered by any national board, and that is a definitional fact rather than an oversight: under the National Registration and Accreditation Scheme, a dental practitioner is a dentist, dental therapist, dental hygienist, dental prosthetist or oral health therapist — the five divisions the Dental Board of Australia registers. Dental assistants appear in none of them. The work is demanding — chairside assisting, moisture control, infection control, sterilisation and records — and pay has historically been low relative to the responsibility. When a practice cannot staff its assistants, appointment capacity falls immediately, because most clinical dentistry is four-handed and cannot safely be done alone. The roles are listed at Join our Team and on the team pages.

Dental hygienists, dental therapists and oral health therapists are in short supply nationally. These are the practitioners whose entire training is in prevention and periodontal care — exactly the work that keeps people out of the restorative cycle — and there are not enough of them. See What does a dental hygienist do?, Dental hygienist vs dentist — what's the difference?, What is the difference between a Dental Therapist and Dental Hygienist? and Dental Cleans and Hygienists.

Dentists in regional, rural and remote Australia. The national workforce is heavily concentrated in capital cities, and per-capita ratios fall sharply with remoteness. This is a distribution problem more than a numbers problem, and it shows up in the treatment people actually receive.

One Australian study makes the gradient visible, and it is worth reading carefully because of what it measures. George, Tennant and Kruger, in Rural and Remote Health in 2012, modelled hospitalisations for the removal of impacted teeth across Australia using Western Australian hospital separations from 1999–2000 to 2008–09 projected nationally. They found "a definite rural–urban divide", with age-adjusted rates of 1,363 per 100,000 people inside a 25 km buffer around metropolitan centres against 1,175 outside it — and, far more starkly, that rates in the least disadvantaged areas (SEIFA deciles 9 and 10) were almost three times those in the most disadvantaged (deciles 1 and 2). Their own comment on what that means is the important part: "If this was a purely disease-driven care, then an even geographic distribution would be expected." They attribute the gap to the ability to afford private insurance, the concentration of practitioners and hospitals in urban areas, and the need to seek treatment at all. Note what the study is and is not: it measures one procedure, in hospital, from one state's data, over a decade ending in 2009 — not the workforce directly. It is evidence about access, and on access it is unambiguous. Rural practice is covered at One man's mission to deliver smiles.

Special needs dentists and paediatric dentists, where demand substantially exceeds supply — see Specialist Care.

And the public sector, which struggles to compete with private pay and therefore carries the longest waits for the people with the least capacity to go elsewhere. For children, the Child Dental Benefits Schedule is part of the answer.

Why it happens

A short, honest list:

Unregistered roles have no career ladder. A dental assistant can be excellent for fifteen years with no formal progression and limited scope to grow into. The structured entry routes that do exist are the graduate program and the dental internship.
The physical toll. Musculoskeletal injury is the most common occupational health problem in dentistry and a recognised reason practitioners reduce hours or leave clinical work early.
Contractor arrangements. Most dentists in Australian group practices work as independent contractors paid a percentage of what they generate — which means no sick leave, no annual leave, and income tied directly to being in the chair.
Training pathways are long and expensive, and where a practitioner trains strongly predicts where they practise, which is why rural placements matter.
The pandemic, which shut down aerosol-generating dentistry for extended periods and pushed people out of the field — see The Great Resignation in the Private Health Sector and The Great Resignation in the health sector.

How a patient actually experiences a staffing shortage

This is the part worth knowing, because it is usually misread as indifference.

Longer waits for an appointment, particularly for hygiene appointments — which are the ones most easily deferred and the ones that prevent the most. Your Smile Solutions dental hygienist visit: what to expect describes what is being deferred.
Appointments running late. Almost always because an earlier one found something unexpected, not because anyone is casual about your time.
Shorter appointments, which is a genuine quality risk and the reason scheduling is treated as a safety variable in analyses of clinical error
Seeing a different practitioner. Continuity of address is not continuity of practitioner. Records stay with the practice; the person may not. See Is it important to have a family dentist?
Reduced after-hours and emergency availability — Emergency Dentistry.

And in the public system, waits measured in years for non-urgent care — though emergency care is triaged separately and the wait for it is far shorter. Anyone in pain should say so clearly rather than joining a general list — What is considered a dental emergency?

The national cost of deferred dental care is measured, and it is large. The Australian Institute of Health and Welfare counts potentially preventable hospitalisations — which it defines as "hospital stays for dental conditions considered avoidable with timely non-hospital care" — and in 2023–24 there were about 88,600 of them in Australia, a rate of roughly 3 in every 1,000 people, up from a low of 2.6 per 1,000 in 2019–20. That is the shortage, converted into hospital admissions.

What actually helps, at policy level

The measures repeatedly identified in Australian workforce reviews:

Better pay, recognition and a career structure for dental assistants, who are the load-bearing wall of every practice
Expanding the deployment of oral health therapists, hygienists and therapists, who deliver most preventive and much restorative care and are faster and cheaper to train and place than dentists — What is the difference between having your teeth cleaned by a dentist and a dental hygienist?
Rural training placements, because they predict rural practice
Sustained public dental funding, rather than programs that begin and end
Ergonomics taken seriously early, which is what keeps practitioners working into their sixties
And structurally, bringing dental care into the general health funding system — the recommendation that recurs in every review and has never been implemented. The consequence for patients is visible in the price guide.

Why practice culture is a patient safety issue

Not a slogan. Every serious analysis of clinical error identifies the same protective factors, and they are cultural:

Whether a junior member of staff will speak up when something looks wrong — How important is communication in dentistry?
Whether a near-miss can be reported without blame, which determines whether anything is learned
Whether people are rushed — scheduling is a safety variable
Whether staff stay. Turnover is the enemy of consistency in sterilisation, in record-keeping, and in knowing which patient is anxious (Dental Anxiety) and which is on anticoagulants. See Stopping staff separation and Effective delegation in the workplace.

Staff retention is one of very few externally visible signals that correlates with any of this. It is still not evidence about your treatment. Is a bigger dental practice better? Part 1 and Part 2 argue the scale side of it, and Everything under one roof the clinical side.

And one request

Abuse of dental staff is common and it is not acceptable. Reception staff absorb a great deal of anger about costs and waiting times that they did not set and cannot change.

If you have a complaint about a fee, a delay or your treatment, put it in writing to the practice. That is the route that actually gets it resolved — and if it does not, the Health Complaints Commissioner (Victoria) and AHPRA are the external avenues. Enquiries here go through Contact Us.

Common questions

Is my dental assistant registered, like my dentist is?

No, and it is worth understanding why rather than reading it as a gap in safety. Under the National Registration and Accreditation Scheme, the term dental practitioner covers five registered divisions — dentist, dental therapist, dental hygienist, dental prosthetist and oral health therapist — each of which you can look up on the AHPRA public register. Dental assistant is not one of them, so there is no register entry to check and no national scope of practice attached to the title. Assistants work under the supervision of a registered practitioner, who remains accountable. The practical consequence is about careers rather than safety: an unregistered role has no formal progression, which is part of why the shortage is worst here.

Why is it so hard to get a hygiene appointment?

Because hygiene appointments are both the most deferrable and the most preventive, so they are what gives way first when a practice is short-staffed — and hygienists, dental therapists and oral health therapists are in short supply nationally. The cost of that deferral is measurable at national scale: the AIHW counted about 88,600 potentially preventable dental hospitalisations in Australia in 2023–24 — hospital stays it defines as "avoidable with timely non-hospital care" — at roughly 3 per 1,000 people, up from 2.6 per 1,000 in 2019–20. If you are offered a longer interval than you are used to, ask whether that interval is right for your risk or simply the next available slot.

Why can I get three different quotes for the same mouth?

Because there is no national dental fee schedule in Australia, and nothing that lets a patient judge whether a quoted fee is reasonable. A 2017 consumer submission to the Senate inquiry into the value and affordability of private health insurance put the problem in exactly those terms: "Without a dental fee schedule, access to private sector dentistry is unnecessarily inequitable. It is well known that private patients can go to multiple dentists and receive conflicting diagnoses and widely varying quotes for unpredictable dental fees. There are no consumer guidelines to ascertain the reasonableness of dental fees charged." Its proposal was a recommended, non-mandatory schedule developed by government, on the model of those published by the Australian Medical Association and the Australian Psychological Society. It also argued that rural patients are worst affected, because most private dentists cluster in wealthier populated suburbs while insurer-owned clinics with no-gap fees and preferred-provider arrangements cluster in the major cities — so out-of-pocket costs are likely to be higher the further out you live. And cost is already turning people away: the submission cites an Australian Institute of Health and Welfare survey from 2013 finding that nearly a third of people aged 5 or older — 32 per cent — avoided or delayed visiting a dentist because of cost. That was one consumer's submission to a parliamentary inquiry, not a government finding, and it should be read as advocacy; the underlying absence of a fee schedule is not in dispute. The practical defence is the same in any practice: ask for the plan in writing, with item numbers, staged by priority. See Understanding your treatment and the price guide.

Who actually makes up the dental workforce?

It is sharply divided by role, and knowing that explains where the shortage falls. On the figures cited in that same 2017 submission from an Australian Institute of Health and Welfare survey in 2013, the majority of dentists were men — 62 per cent — while the vast majority of dental hygienists, dental therapists and oral health therapists were women, at 94, 98 and 86 per cent respectively. The same source records that the highest rates of dental therapists were in remote and very remote areas — that is, the practitioners most likely to be working where dentists are scarcest are in the very divisions that are hardest to recruit and lowest paid. The submission's own recommendation followed from it: that "the Australian public should be informed of the scope of practice for dental therapists and oral/dental hygienists", and that those with the relevant qualifications should be able to practise independently within that scope. You can look up any of these five divisions on the AHPRA public register and see exactly which one the person treating you holds. See What is the difference between a Dental Therapist and Dental Hygienist? and Dentists & Registered Specialists.

Practical details

Smile Solutions, Level 1, 220 Collins Street, Manchester Unity Building, Melbourne VIC 3000. Phone 13 13 96, or theteam@smilesolutions.com.au. Monday–Friday 8.00am–6.00pm, Saturday 8.30am–1.30pm, Sunday by appointment. Directions are on Location.

Every practitioner's registration can be verified free on the AHPRA public register at ahpra.gov.au.

This page records a published article and its date, with general information about the Australian dental workforce. It is not a diagnosis, a treatment plan or employment advice. Figures quoted are from the publishers named and apply to the periods and populations those publishers studied. Third-party published content is not reproduced.

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