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Australian Indigenous HealthBulletin
 

Oral health

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Oral health

Oral health is defined as ‘a standard of health of the oral and related tissues that enables an individual to eat, speak and socialise without active disease, discomfort or embarrassment and that contributes to general wellbeing’ ([1] cited in [2], p.1). That is, oral health is more than simply the absence of disease in the oral cavity; it is a standard of oral functioning that enables comfortable participation in everyday activities.

The two most common oral diseases are caries and periodontal disease [3]. Dental caries is caused by acid-producing bacteria living in the mouth, which proliferate on foods high in sugar. Caries is reversible in its early stages, but, if untreated, can cause pain, abscesses and eventually lead to tooth loss. Periodontal disease (affecting the gums) is caused by bacterial infection associated with poor oral hygiene, infrequent dental visits, age, tobacco use, and certain health conditions (such as diabetes and CVD).

Extent of oral health problems among Indigenous people
Prevalence

Oral health problems were reported by 32% of Indigenous children aged 0-14 years in the 2008 NATSISS [4]. Almost one-half (46%) of those for whom oral health problems were reported were aged 10-14 years. The prevalence of reported oral health problems differed by jurisdiction, ranging from 38% in Vic to 20% in the NT. The prevalence of reported oral health problems was higher for children living in non-remote areas (34%) than for those living in remote areas (24%).

According to the 2004-2005 NATSIHS, 78% of Indigenous people aged 15 years and older had lost fewer than five adult teeth in their lifetime; the number of teeth lost increased with age (Table 27) [5]. The proportion of Indigenous people aged 55 years or older who reported using dentures was higher for non-remote areas than for remote areas (55% and 19%, respectively); the proportion requiring dentures was higher in remote areas than in than non-remote areas (19% and 10%).

Table 27: Proportions (%) of Indigenous people reporting numbers of lost teeth and denture use, by age-group and type of condition, Australia, 2004-2005
 Age-group (years)
15-2425-3435-4445-5455+All ages
Source: ABS, 2006 [5]
Notes:
  1. Some low proportions should be viewed with caution
  2. ‘-‘ refers to nil or rounded to zero
Number of teeth lost            
0 80 50 27 17 8 45
1-4 18 40 48 37 22 33
5-9 1 6 16 21 14 9
10-14 - 1 2 7 10 3
15+ 1 1 4 15 37 8
Uses/requires dentures            
Uses dentures 1 2 8 23 45 10
Requires dentures 1 4 10 12 13 6
Caries

A higher proportion of Indigenous people than non-Indigenous people experience caries. The child dental health survey (CDHS), conducted in 2000-200322, found the prevalence of caries in deciduous teeth (first set of teeth) was higher among Indigenous children aged 4-10 years living in NSW, SA and the NT than that among their non-Indigenous counterparts [6]. The greatest difference between Indigenous and non-Indigenous children was for those aged 6 years: 72% of Indigenous six-year-olds had caries compared with 38% of their non-Indigenous counterparts. Across all ages between 4 and 10 years, the mean number of decayed teeth was higher for Indigenous children than for their non-Indigenous counterparts [6]. The greatest difference was for four-year-olds, where the mean number of decayed teeth was more than three times higher for Indigenous children than for non-Indigenous children.

According to the CDHS, poorer oral health for Indigenous children continued when they got their permanent teeth [6]. A higher proportion of Indigenous children aged 6-17 years living in NSW, SA and the NT had caries than did their non-Indigenous counterparts; the proportion increased with age from 8.4% of Indigenous children aged 6 years (compared with 3.2% of their non-Indigenous counterparts) to 73% of Indigenous 17-year-olds (compared with 61% of their non-Indigenous counterparts).

Indigenous children in the CDHS also had more severe levels of decay in their permanent teeth than did non-Indigenous children [6]. The greatest difference was for Indigenous 15-year-olds who had 2.7 times the mean number of decayed permanent teeth than did non-Indigenous 15-year-olds.

According to the National survey of adult oral health (NSAOH), Indigenous adults had more caries than non-Indigenous adults in 2004-2006 [7]. Indigenous people aged 15 years or older had 2.3 times more untreated caries than did their non-Indigenous counterparts: 57% of Indigenous adults and 25% of non-Indigenous adults had one or more teeth affected.

The severity of decay experienced by Indigenous adults was also higher than that experienced by their non-Indigenous counterparts in 2004-2006 [7]. Indigenous adults had more than three times the number of decayed tooth surfaces than did non-Indigenous adults. Indigenous people aged 35-54 years had five times more decayed tooth surfaces than did their non-Indigenous counterparts.

Periodontal diseases

Periodontal diseases, including gingivitis and periodontitis, are more common among Indigenous children and adults than among their non-Indigenous counterparts [6][7]. Children rarely develop severe periodontal disease but gingivitis is relatively common, particularly among older children [6]. Gingival bleeding, a common symptom of gingivitis, was generally more common among Indigenous children living in NSW and SA in 2000-2003 than among their non-Indigenous counterparts (information is not available for other states and territories). Gingival bleeding was around three times more common among Indigenous children aged 13-14 years living in NSW than among their non-Indigenous counterparts. Almost one-half (49%) of Indigenous 12 year-olds living in SA had gingival bleeding, compared with 23% of non-Indigenous 12 year-olds. Around 60% of Indigenous children living in remote communities showed some evidence of gingivitis and 21% of children were at moderate risk of developing gingivitis. Almost 42% of Indigenous children aged 15-16 years were at moderate risk and 25% were at high risk of developing gingivitis.

The 2004-2006 NSAOH found that 27% of Indigenous people aged 15 years and older had gingivitis [7]. The prevalence of moderate or severe periodontitis was about 1.3 times higher for Indigenous people than that for non-Indigenous people. Similarly, more Indigenous adults had slightly higher levels of deep (4+mm) periodontal pockets and clinical attachment loss than did their non-Indigenous counterparts.

Indigenous people are affected by periodontal diseases at younger ages than are non-Indigenous people [7][8]. The NSAOH found that the prevalence of moderate or severe periodontitis was around twice as high among Indigenous people aged 15-34 years than among non-Indigenous people in the same age-group (14% compared with 7.3%) [7]. The prevalence of both deep periodontal pockets and clinical attachment loss were higher for Indigenous people aged 15-34 years than for their non-Indigenous counterparts: 18% compared with 13%, and 24% compared with 17%, respectively. The prevalence of tooth sites with deep periodontal pockets was more than twice as high for Indigenous people as it was for non-Indigenous people in this age-group (1.3% compared with 0.6%).

Edentulism

Edentulism, or complete tooth loss, reflects both extensive oral disease and past surgical approaches to the treatment of oral diseases that relied largely on extractions [7]. The 2004-2006 NSAOH found that edentulism increased with age for both Indigenous and the non-Indigenous people, but the age distribution of edentulism among Indigenous people was noticeably different from that of other Australians. Edentulism was almost five times more common among Indigenous people (7.6%) aged 35-54 years than among their non-Indigenous counterparts (1.6%). For people aged 55-74 years, 21% of Indigenous people suffered from edentulism compared with 14% of non-Indigenous people.

Hospitalisation

In 2008-10, there were 3,224 hospital separations for oral health problems among Indigenous people living in NSW, Vic, Qld, WA, SA and the NT [4]. The hospitalisation rates for children aged 0-4 and 5-14 years were higher for Indigenous children than those for non-Indigenous children (Table 28). There were similar hospitalisation rates for Indigenous and non-Indigenous people aged 15-24 and 34-44 years, but the rates for those aged 45 years and older were lower for Indigenous people than those for their non-Indigenous counterparts. After age-adjustment, the overall hospitalisation rates were similar for Indigenous and non-Indigenous people.

Table 28: Age-specific hospital separation rates for dental problems, by Indigenous status, and Indigenous:non-Indigenous rate ratios, NSW, Vic, Qld, WA, SA and the NT combined, 2008-10
Age-group (years)IndigenousNon-IndigenousRate ratio
Source: AIHW, 2013 [4]
Notes:
  1. Rates per 1,000 population
  2. Rate ratio is the Indigenous rate divided by the non-Indigenous rate
  3. Rate ratio for ‘All ages’ directly age-standardised using the 2001 Australian standard population (*)
0-4 9.4 4.2 2.2
5-14 6.5 4.4 1.5
15-24 0.6 0.7 0.8
24-34 0.7 0.7 1.0
35-44 0.7 0.8 0.8
45-54 0.6 1.0 0.5
55-64 0.4 1.2 0.4
65+ 0.3 1.0’ 0.3
All ages 3.1 1.6 1.2 *

References

  1. UK Department of Health (1994) An oral health strategy for England. London: Department of Heath
  2. Chrisopoulos S, Harford JE (2013) Oral health and dental care in Australia: key facts and figures 2012. Canberra: Australian Institute of Health and Welfare
  3. Northern Territory Department of Health (2011) Healthy smiles: oral health and fluoride varnish information for health professionals. Darwin: Northern Territory Department of Health
  4. Australian Institute of Health and Welfare (2013) Aboriginal and Torres Strait Islander health performance framework 2012: detailed analyses. Canberra: Australian Institute of Health and Welfare
  5. Australian Bureau of Statistics (2006) National Aboriginal and Torres Strait Islander Health Survey: Australia, 2004-05. Canberra: Australian Bureau of Statistics
  6. Jamieson LM, Armfield JM, Roberts-Thomson KF (2007) Oral health of Aboriginal and Torres Strait Islander children. Canberra: Australian Research Centre for Population Oral Health (ARCPOH)
  7. Slade GD, Spencer AJ, Roberts-Thomson KF (2007) Australia's dental generations: the national survey of adult oral health 2004-06. Canberra: Australian Institute of Health and Welfare
  8. Harford J, Spencer J, Roberts-Thomson K (2003) Oral health. In: Thomson N, ed. The health of Indigenous Australians. South Melbourne: Oxford University Press: 313-338

Endnotes

  1. Data from each state/territory were collected within a 12 month period, but in different years: data from NSW were obtained in 2000, data from the NT were obtained in 2002, and data from SA were obtained in 2003.
 

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    Last updated: 29 June 2014
     
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