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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.55)). Thus, it 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.
Two major threats to oral health are dental caries and periodontal diseases [3]. Dental caries is caused by acid-producing bacteria living in the mouth, which proliferate on sweet and sticky food. Caries is reversible in its early stages, but, if untreated, can cause irreversible damage. Periodontal disease (affecting the gums) is caused by bacterial infection associated with poor oral hygiene, infrequent dental visits, age, smoking, low education and income levels, and certain medical conditions [3], especially diabetes mellitus [4] and osteoporosis [5].
Indigenous children experienced more caries in their deciduous (baby) teeth than did non-Indigenous children [6]. The Child Dental Health Survey (CDHS), conducted in 2000-2003 12 found that more Indigenous children aged 4-10 years in NSW, SA and the NT had caries in their deciduous teeth than did their non-Indigenous counterparts. The largest difference between Indigenous and non-Indigenous children was for those aged 6 years, for which age nearly twice as many Indigenous children than non-Indigenous children had caries (72% compared with 38%).
Not only did more Indigenous children have caries, but the CDHS found that they had a higher number of decayed teeth at all ages (4-10 years) than did their non-Indigenous counterparts [6]. The biggest difference was for Indigenous four-year-olds who had more than three times the number of decayed teeth than did non-Indigenous children of the same age.
According to the CDHS, poorer oral health for Indigenous children continued when they got their permanent teeth [6]. More Indigenous children aged 6-17 years in NSW, SA and the NT had caries than did their non-Indigenous counterparts; prevalence increased with age from 8.4% for Indigenous children aged 6 years (3.2% for their non-Indigenous counterparts) to 73% for Indigenous 17-year-olds (61% for their non-Indigenous counterparts).
Indigenous children in NSW, SA and the NT also had more severe levels of decay in their permanent teeth than did their non-Indigenous counterparts [6]. The largest difference was for Indigenous 15-year-olds who had 2.7 times the level of decay than did non-Indigenous children of the same age.
The poor oral health of Indigenous children was confirmed by child health checks conducted in 2007-2009 as part of the NTER, which found that 40% of children 0-15 years had untreated caries 13 [7].
More Indigenous adults than non-Indigenous adults experienced caries in Australia in 2004-2006 [8]. According to the National Survey of Adult Oral Health (NSAOH), Indigenous people 15 years and older had 2.3 times more untreated caries: 57% of Indigenous adults and 25% of non-Indigenous adults had one or more tooth affected.
The severity of decay experienced by Indigenous adults was also higher than that experienced by their non-Indigenous counterparts in 2004-2006 [8]. 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, including gingivitis and periodontitis, are more common among Indigenous children and adults than among their non-Indigenous counterparts [6][8]. Children rarely develop severe periodontal disease, but gingivitis is relatively common, particularly among older children [6]. The prevalence of gingival bleeding, a common symptom of gingivitis, was generally higher for Indigenous children in NSW and SA than for their non-Indigenous counterparts in 2000-2003 (information is not available for other states and territories). Rates of gingival bleeding were around three times higher for Indigenous children 13-14 years in NSW than for their non-Indigenous counterparts. Almost one-half (49%) of Indigenous 12 year-olds in SA had gingival bleeding, compared with less than one-quarter (23%) of non-Indigenous children of the same age-group. Three-in-five Indigenous children living in remote communities showed some evidence of gingivitis and around one-in-five 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. In the course of the NTER child health checks, 5.4% of Indigenous children aged 0-15 years were found to have periodontal disease in 2007-2009 [7].
The 2004-2006 NSAOH found that around 27% of Indigenous adults aged 15-74 years had gingivitis [8]. The prevalence of moderate or severe periodontitis among Indigenous people was about 1.3 times higher than the prevalence among 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.
According to the 2004-2006 NSAOH, Indigenous people were affected by periodontal diseases at younger ages than were non-Indigenous people [8][9]. Indigenous people aged 15-34 years experienced almost twice the prevalence of moderate or severe periodontitis than did non-Indigenous people of the same age-group (14% compared with 7.3%) [8]. The levels 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 than it was for non-Indigenous people in this age range (1.3% compared with 0.6%).
Edentulism, or complete tooth loss, reflects both poor oral hygiene and a past surgical approach to the treatment of oral diseases that relied largely on extractions [8]. The 2004-2006 NSAOH found that edentulism was strongly correlated to age: less than 2% of adults aged 35-54 years had complete tooth loss, but this increased to 36% for people 75 years and older. The age distribution of edentulism for Indigenous people was noticeably different from that of other Australians. For people aged 35-54 years, edentulism was around five times more common among Indigenous people (7.6%) than among non-Indigenous people (1.6%). For people aged 55-74 years, 21% of Indigenous people suffered from edentulism compared with 14% of non-Indigenous people.
12. Data from each state/territory were collected within a 12 month period, but in different years: data from NSW were obtained from 2000, data from SA were obtained in 2003, and data from the NT were obtained in 2002.
13. The oral health information provided by the child health checks is not representative of all Indigenous children in the NT.
Helping to 'close the gap' by providing the evidence base to inform practice and policy in Aboriginal and Torres Strait Islander health
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