title: Building a stronger child dental health system in Australia: statistical sampling masks the burden of dental disease distribution in Australian children.
abstract: BACKGROUND
  In Australia, over the past 30 years, the prevalence of dental decay in children has reduced significantly, where today 60-70% of all 12-year-olds are caries free, and only 10% of children have more than two decayed teeth. However, many studies continue to report a small but significant subset of children suffering severe levels of decay.
  
  
  METHODS
  The present study applies Monte Carlo simulation to examine, at the national level, 12-year-old decayed, missing or filled teeth and shed light on both the statistical limitation of Australia's reporting to date as well as the problem of targeting high-risk children.
  
  
  RESULTS
  A simulation for 273 000 Australian 12-year-old children found that moving from different levels of geographic clustering produced different statistical influences that drive different conclusions. At the high scale (ie state level) the gross averaging of the non-normally distributed disease burden masks the small subset of disease bearing children. At the much higher acuity of analysis (ie local government area) the risk of low numbers in the sample becomes a significant issue.
  
  
  CONCLUSIONS
  The results clearly highlight the importance of care when examining the existing data, and, second, opportunities for far greater levels of targeting of services to children in need. The sustainability (and fairness) of universal coverage systems needs to be examined to ensure they remain highly targeted at disease burden, and not just focused on the children that are easy to reach (and suffer the least disease).
authors.affiliation: Centre for Rural and Remote Oral Health, The University of Western Australia, Perth, Western Australia, Australia; present address International Research Collaborative, Oral Health and Equity, Department of Anatomy, Physiology and Human Biology, The University of Western Australia, Perth, Western Australia, Australia . marc.tennant@uwa.edu.au.
authors.forename: M
authors.initials: M
authors.lastname: Tennant
authors.affiliation: Centre for Rural and Remote Oral Health, The University of Western Australia, Perth, Western Australia, Australia; present address International Research Collaborative, Oral Health and Equity, Department of Anatomy, Physiology and Human Biology, The University of Western Australia, Perth, Western Australia, Australia . estie.kruger@uwa.edu.au.
authors.forename: E
authors.initials: E
authors.lastname: Kruger
mesh_terms: D001315:Australia / Q000453:epidemiology; D002648:Child; D019140:Dental Care for Children / Q000706:statistics & numerical data*; D003731:Dental Caries / Q000453:epidemiology* / Q000208:ethnology; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D009010:Monte Carlo Method; D015995:Prevalence; D012959:Socioeconomic Factors; D009057:Stomatognathic Diseases / Q000453:epidemiology
keywords: Australia/Pacific; Dentistry; Evidence-based Care; Management/Administration; Other; Public Health; Workforce