For decades, conversations around healthcare inequality have focused on hospital waitlists, specialist access, and chronic disease. Dentistry is often left
out of that discussion. But new findings from Cotreat suggest oral health may
be one of the clearest and most measurable examples of healthcare inequity in
Australia today.
Using AI-assisted analysis of dental radiographs and clinical photographs,
Cotreat analysed 81,919 patient records across public and private dental
settings using standardised nomenclature.
The differences were striking.
After age standardisation, public-sector patients were:
- 1.7x more likely to present with missing teeth
- 1.9x more likely to exhibit tooth wear
- 2.2x more likely to have advanced periodontal bone loss
- 4.9x more likely to experience complete edentulism
- 6.2x more likely to develop root surface caries
The report also found substantially higher rates of deep caries reaching the
pulp — disease severe enough to require root canal treatment or extraction.
Importantly, these findings were generated using the same AI analysis system
across both patient populations. The imaging protocols, staging systems, and
classification criteria were identical. What changed was the population itself.
A Pattern Seen Globally
The trends identified in the Cotreat dataset mirror broader international
public health findings.
Globally, lower-income populations consistently demonstrate higher rates of
untreated dental disease, greater tooth loss, later presentation of periodontal
disease, and reduced access to preventive care
But what makes this report particularly compelling is the visibility of
inequality. The disparity is not abstract - it is anatomically visible and
measurable.
One of the report’s most revealing observations is that some conditions —
including secondary caries and periapical pathology — were actually less
common in public patients. However, this was not interpreted as better oral
health outcomes. Instead, the likely explanation was simpler and more
confronting: fewer remaining teeth and fewer existing restorations.
Beyond Dentistry
Perhaps the most important implication of the report is methodological.
This analysis demonstrates how large-scale AI-assisted imaging systems can be
used not only for clinical workflows, but also for population-level health
surveillance. Dental radiographs may contain a much deeper public health
story than previously appreciated.