1.11 Oral health
Why is it important?
Oral health refers to the health of tissues of the mouth: muscle, bone, teeth, and gums. The two most frequently occurring oral diseases are tooth decay (termed 'caries') and periodontal disease. If not treated in a timely manner, these can cause discomfort and tooth loss, impacting a person's ability to eat, speak, and socialise without active disease, discomfort or embarrassment (Williams et al. 2011). Additionally, oral diseases can exacerbate other chronic diseases (Jamieson et al. 2010) and have been associated with cardiovascular diseases, diabetes, stroke and pre-term low birthweight (Williams et al. 2011; Roberts-Thomson et al. 2008).
Caries experience is measured by the average number of decayed, missing and filled infant/deciduous or adult/ permanent teeth. The number of teeth with caries reflects untreated dental disease, while the number of missing and filled teeth reflects the history of dental health problems and treatment. Aboriginal and Torres Strait Islander peoples are more likely than other Australians to have lost all their teeth, have gum disease, and suffer more caries. They are less likely to have received preventive dental care and more likely to have untreated dental disease (Jamieson et al. 2010).
Tooth decay can largely be prevented by diet (for example reducing intake of processed sugary foods/drinks), fluoridation of water supplies, good oral hygiene and yearly dental check-ups. Risk factors for periodontal diseases include smoking, diabetes, stress, poor nutrition, poor oral hygiene, infrequent access to dental care, and substance use (particularly inhalant use). Oral disease is also associated with lower levels of education and income and sub-standard living conditions. Tooth loss is associated with increased age, poor oral hygiene and trauma (Jamieson et al. 2010; Williams et al. 2011).
Based on self-reported data from the 2008 Social Survey, 32% of Indigenous children aged 0–14 years had teeth or gum problems. The most common types of problems reported were fillings due to dental decay (16%), untreated cavities or dental decay (15%), and having teeth pulled out due to dental decay (7%).
The 2012–13 Health Survey included data on tooth loss. In 2012–13, 5% of Indigenous Australians aged 15 years and over reported they had complete tooth loss and a further 47% had lost at least one tooth (excluding wisdom teeth). Rates of complete tooth loss were highest for those aged 55 years and over living in non-remote areas (26%). The proportion was higher for those with: Year 9 as the highest Year of schooling (7 times those with Year 12); lowest income (7 times those with the highest income); diabetes (6 times those without); and heart/circulatory problems (4 times those without).
In 2012–13, around 21% of IndigenousAustralians reported that they didn't go to a dentist when they needed to in the previous 12 months. Reasons included: cost (43%); waiting time too long/service not available at time required (20%); and disliking professional/feeling embarrassed or afraid (19%). Of those who had seen a dentist, 33% visited private dentists, 30% a government dental clinic, 16% a school dental clinic and 16% a dentist at an Aboriginal Medical Service. Around half (51%) waited less than one week to see a public dentist (non-remote areas). Nearly 14% had never seen a dentist (compared with 5% for all Australians). Indigenous Australians living in remote areas were more likely to report having never seen a dentist—21% compared with 12% in non-remote areas (AIHW forthcoming). For Indigenous children aged 2–6 years, 52% reported having never seen a dentist. Nearly half (46%) of IndigenousAustralians reported that they brushed their teeth 2 or more times a day and a further 35% reported that they brushed their teeth once a day.
In 2010, for the five states with reliable data (NT, Qld, SA, Tas and WA), the mean number of decayed or missing teeth among Indigenous children was almost twice that for non-Indigenous children in all age groups. By 14–15 years of age,Indigenous children had twice the mean number of decayed teeth, 2.8 times the mean number of missing teeth and a mean number of filled teeth that was 37% higher when compared with non-Indigenous children. Indigenous children aged 5–10 years were less likely to have no decayed, missing or filled teeth (24%) than non-Indigenous children (45%). For those aged 6–15 years, 48% of Indigenous children had no decayed, missing or filled permanent teeth compared with 63% of non-Indigenous children.
In the two years to June 2013, Indigenous children aged 0–4 years were hospitalised for dental conditions at twice the rate of non-Indigenous children (7.8 per 1,000 compared with 3.8 per 1,000). This indicates poor access to, and a large unmet need for, dental care in this age group. Hospitalisation rates for dental problems decline after 14 years of age. Data on hospital procedures for dental conditions requiring general anaesthetic show higher rates for Indigenous childrenaged 5–9 years than total children (15 per 1,000 compared with 10 per 1,000) but lower rates in the 15–24 year age groups (around 5 per 1,000 compared with 16 per 1,000) (AIHW 2014y). A WA study reported higher rates of emergency care and oral surgery for Indigenous patients, indicating a higher burden of oral disease and late presentation (Kruger et al. 2010).
Between August 2007 and December 2013, more than 19,100 dental services were provided to over 8,800 Indigenous children as part of the Northern Territory Emergency Response Child Health Check Initiative,the Closing the Gap National Partnership Agreement and then the Stronger Futures Northern Territory. The proportion of children treated for at least one dental problem was 43%, mostly for untreated tooth decay. Trend data, available to June 2012, shows that for children who received two or more courses of dental care, there was a 12% decline in the proportion with oral health problems (AIHW 2012b).
Available data indicate that dental health is worse for Indigenous Australians than other Australians, for both children and adults. These findings raise significant policy questions about access to dental services and population health measures to prevent dental disease and support oral health (see measure 3.14). The Australian Government will provide up to $77.7 million over four years from 2012–13 for relocation and infrastructure grants to encourage and support dentists to relocate and practice in more remote areas. From 1 July 2015, the National Partnership Agreement on Adult Public Dental Services will continue funding states and territories for adult public dental services for concession card holders. The Child Dental Benefits Schedule (CDBS) commenced 1 January 2014. The CDBS is means tested, with eligible childrenaged 2–17 years entitled to benefits for dental services (capped at $1,000 over two consecutive calendar years). The range of services covered includes examinations, x-rays, cleaning, fissure sealing, fillings, root canals, extractions and partial dentures. In the first six months (to June 2014) 84,400 dental services had been provided to 19,000 Indigenous children (representing 9% of those eligible for these services). For non-Indigenous children, 16% of those eligible had received services.
Funding for the existing Oral Health Programme will continue under the new Indigenous Australians' Health Programme and the Stronger Futures in the Northern Territory (SFNT) National Partnership Agreement to reduce the prevalence, incidence, severity and impact of oral health problems on the health and wellbeing of Aboriginal children in the NT. The programme intends to reach 80% of target children under 16 years of age by 2021. The programme is working with primary health care services and other stakeholders to deliver an integrated approach across the continuum of care, with a greater focus on preventive and health promotion activity including fluoride varnish and fissure sealants—both proven to be effective, preventative care treatments (Slade et al. 2011; Ahovuo-Saloranta et al. 2004). Supporting this, the NT Government is providing training to primary healthcare providers to enable them to legally apply fluoride varnish in the NT under the Healthy Smiles Oral Health and Fluoride Varnish training programme. This programme will provide twice yearly applications where possible, and ensure children receive at least a yearly application. Under the Health and Hospitals Fund (2011 Regional priority Round), funding of $2.8 million was provided to the WA Department of Health, to construct a four-chair dental clinic on the grounds of the Narrogin Regional Hospital. The SA Government's Aboriginal Oral Health Program provides priority free mainstream dental services to Aboriginal adults and children in partnership with Aboriginal health workers and organisations. This is achieved via a number of initiatives including:
- the Aboriginal Liaison Programme, to increase attendance of Aboriginal adults at community dental services
- integration of oral health screening into Aboriginal adult health checks with referral pathways to a community dental or school dental clinic
- specific programmes targeting pregnant women, children in early years, primary school children and teenagers
- promoting the use of Australian Government Teen Dental Vouchers by Aboriginal teens.
Figure 1.11-1 shows the status of tooth loss (complete tooth loss, loss of one or more teeth, and no tooth loos) for Aboriginal and Torres Strait Islander peoples by the following age groups: 15-34, 35-44, 45-54, and 55 and over, as well as a total. As expected, the figure shows that the extent of tooth loss increases with age.
Source: AIHW and ABS analysis of 2012–13 AATSIHS
Figure 1.11-2 shows age-specific hospitalisation rates for dental problems among Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians (per 1,000 population) between July 2011 and June 2013. Data is presented for the following age groups: 0-4 years; 5-14 years; 15-24 years; 25-34 years; 35-44 years, 45-54 years; 55-64 years; 65 years and over; and the total age-standardised rate. Rates are highest for the 0-4 and 5-14 year age groups for both Indigenous and non-Indigenous children.
Note: Total is age-standardised
Source: AIHW analysis of National Hospital Morbidity Database
Figure 1.11-3 shows the proportion of Aboriginal and Torres Strait Islander children and non-Indigenous children aged 5–10 years with no decayed, missing or filled deciduous teeth. Data is for NT, Qld, SA, Tas, WA and ACT for 2010. Data is presented separately for children aged 5, 6, 7, 8, 9, and 10 years as well as a total. The proportion of children with no decayed, missing or filled deciuous teeth is higher among non-Indigenous children than Aboriginal and Torres Strait Islander children for all ages presented.
Source: AIHW analysis of Child Dental Health Survey
Figure 1.11-4 shows the proportion of Aboriginal and Torres Strait Islander children and non-Indigenous children aged 6–15 years with no decayed, missing or filled permanent teeth. Data is presented for NT, Qld, SA, Tas, WA and ACT for 2010. Data is presented separately for children aged 6, 7, 8, 9, 10, 11, 12, 13, 14, and 15 years as well as a total. Rates generally decrease with age. The proportion of children with no decayed, missing or filled permanent teeth is higher for non-Indigenous children than Indigenous children for each of the ages presented.
Source: AIHW analysis of Child Dental Health Survey