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Oral health

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Oral health

Oral health is defined as ‘the ability to speak, smile, smell, taste, touch, chew, swallow and convey a range of emotions through facial expressions with confidence and without pain, discomfort and disease of the craniofacial complex’ [1]. The two most common oral diseases are dental caries (tooth decay) and periodontal disease (gum disease) [2]. Caries is caused when bacteria in the mouth interact with sugars in foods to produce acids that degrade tooth enamel. Caries is reversible in its early stages, but, if untreated, can cause pain, abscesses and eventually lead to tooth loss. Periodontal disease is caused by bacterial infection associated with poor oral hygiene, infrequent dental visits, age, and smoking, and is related to health conditions including diabetes and CVD. Gingivitis, an inflammation of the gums, is an early reversible form of periodontal disease. Untreated gingivitis may lead to periodontitis, a serious gum infection.

Extent of oral health problems among Aboriginal and Torres Strait Islander people
Prevalence of self-reported oral health problems

The NATSISS collected data about the self-reported tooth or gum problems of Aboriginal and Torres Strait Islander children. In 2014-2015, the proportion of 4-14 year old children with reported tooth or gum problems was 34%, a decrease from 39% in 2008 [3].

The AATSIHS collected information about the self-reported tooth loss of Aboriginal and Torres Strait Islander adults aged 15 years and over, excluding wisdom tooth loss. In 2012-2013, 49% of adults reported no tooth loss; 47% had lost one or more teeth; and 4.7% reported complete tooth loss [4].

Prevalence of caries

A person’s experience of caries is measured by the ‘decayed missing and filled teeth’ index (dmft) for deciduous (baby) teeth, and by the DMFT index for permanent (adult) teeth [5]. Both indices measure how many teeth (t/T) are decayed (d/D), missing (m/M) or filled (f/F), based on a clinical examination [6] [7]. Mean (average) dmft/DMFT is one indicator of caries severity.  

Recent information about caries prevalence and severity among Aboriginal and Torres Strait Islander children undergoing school dental examinations is available for Qld, WA, SA, Tas, ACT and the NT [4]. In 2010, the proportion of Aboriginal and Torres Strait Islander children aged 5-10 years with no decayed, missing or filled deciduous teeth was 24%, compared with 45% of non-Indigenous children. The proportion of Aboriginal and Torres Strait Islander children aged 6-15 years with no decayed, missing or filled permanent teeth was 48%, compared with 63% of non-Indigenous children. The mean dmft for Aboriginal and Torres Strait Islander children aged 5-10 years was 3.8, compared with 2.2 for non-Indigenous children. The mean DMFT for Aboriginal and Torres Strait Islander children aged 6-15 years was 1.9, compared to 1.1 for non-Indigenous children.

National clinical data about caries among Aboriginal and Torres Strait Islander adults has not been collected for some time. The National survey of adult oral health (NSAOH), which includes a dental examination component, was last conducted in 2004-200644. In 2004-2006, Aboriginal and Torres Strait Islander people aged 15 years or older had 2.3 times more untreated caries than their non-Indigenous counterparts: 57% of Aboriginal and Torres Strait Islander adults and 25% of non-Indigenous adults had one or more teeth with untreated caries [8]. Aboriginal and Torres Strait Islander adults had more than three times the number of decayed tooth surfaces than non-Indigenous adults. Those aged 35-54 years had five times more decayed tooth surfaces than their non-Indigenous counterparts. A recent study of evidence published in peer-reviewed journals about the prevalence of clinically measured caries in Indigenous adults in Australia found that caries prevalence ranged from 46% to 93% [9].

Prevalence of periodontal diseases

Children are unlikely to develop severe periodontal disease but gingivitis is relatively common among Indigenous children, particularly older children [10]. The National child oral health survey 2012-2014, to be published shortly, should give a national picture of gingivitis levels among Aboriginal and Torres Strait Islander and non-Indigenous children. Early results from Queensland estimate gingivitis to be almost twice as prevalent among Aboriginal and Torres Strait Islander children aged 5-14 years (34%) as among non-Indigenous children of the same age (18%) [11].

As with caries, national clinical data about periodontal disease among Aboriginal and Torres Strait Islander adults has not been collected for some time. The 2004-2006 NSAOH found that 27% of Aboriginal and Torres Strait Islander people aged 15 years and older had gingivitis [8]. The prevalence of moderate or severe periodontitis was about 1.3 times higher for Aboriginal and Torres Strait Islander people than for non-Indigenous people. A recent review of evidence published in peer-reviewed journals about the prevalence of clinically measured periodontal disease in Aboriginal and Torres Strait Islander people adults in Australia found that almost all rural-dwelling Aboriginal and Torres Strait Islander adults had periodontal disease [9].

Dentist visits and hospitalisation

In the 2012-2013 AATSIHS, around 4.8% of all Aboriginal and Torres Strait Islander people and 4.6% of children aged 2-14 years reported visiting a dental professional in the two weeks prior to the survey [12]. In the 2004-2006 NSAOH, 51% of Aboriginal and Torres Strait Islander adults reported visiting a dentist in the previous 12 months, and 43% reported usually visiting a dentist at least once per year [8].

National potentially preventable hospitalisation rates for dental conditions in 2014-15 were 1.3 times higher for Aboriginal and Torres Strait Islander people than for non-Indigenous people after age-adjustment [13]. The hospitalisation rate for Aboriginal and Torres Strait Islander people living in remote areas was more than twice as high as for those in major cities [13]. The hospitalisation rates were higher for Aboriginal and Torres Strait Islander children aged 0-4 and 5-9 years than for non-Indigenous children, but the reverse was true for those aged 10-14 years (Table 26).

Table 26. Age-specific hospital separation rates for dental conditions among children aged 0-14 years, by Indigenous status, and Indigenous:non-Indigenous rate ratios, Australia, 2014-15

Age-group (years)

Indigenous

Non-Indigenous

Rate ratio

0-4

8.0

5.0

1.6

5-9

12

9.9

1.2

10-14

3.3

6.0

0.5

Total 0-14 years

7.9

7.0

1.1

Notes:

  1. Rates per 1,000 population
  2. Rate ratio is the Indigenous rate divided by the non-Indigenous rate

Source: Steering Committee for the Review of Government Service Provision, 2016 [13]

Aboriginal and Torres Strait Islander people undergo more intensive hospital dental treatments at younger ages than the general population [14]. In 2013-14 for all Australians, dental procedures requiring a general anaesthetic were most common in people aged 15-24 years (17 per 1,000 persons); for Aboriginal and Torres Strait Islander people, the procedure rate was highest among 5-9 year-olds (11 per 1,000 people) [5].

References

  1. FDI World Dental Federation (2016) FDI unveils new universally applicable definition of ‘oral health’. Retrieved 6 September 2016 from http://www.fdiworldental.org/media/press-releases/latest-press-releases/06092016-fdi-unveils-new-universally-applicable-definition-of-%E2%80%98oral-health%E2%80%99.aspx
  2. Northern Territory Department of Health (2011) Healthy smiles: oral health and fluoride varnish information for health professionals. Darwin: Northern Territory Department of Health
  3. Australian Bureau of Statistics (2016) National Aboriginal and Torres Strait Islander Social Survey, 2014-15. Canberra: Australian Bureau of Statistics
  4. Australian Institute of Health and Welfare (2015) Aboriginal and Torres Strait Islander health performance framework 2014 report: detailed analyses. Canberra: Australian Institute of Health and Welfare
  5. Chrisopoulos S, Harford JE, Ellershaw A (2016) Oral health and dental care in Australia: key facts and figures 2015. Canberra: Australian Institute of Health and Welfare
  6. 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
  7. World Health Organization (2013) Oral health surveys: basic methods. 5th ed. Geneva: World Health Organization
  8. 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
  9. de Silva AM, Martin-Kerry JM, McKee K, Cole D (2016) Caries and periodontal disease in Indigenous adults in Australia: a case of limited and non-contemporary data. Australian Health Review; Online early(http://dx.doi.org/10.1071/AH15229):
  10. Williams S, Jamieson L, MacRae A, Gray C (2011) Review of Indigenous oral health. Perth, WA: Australian Indigenous HealthInfoNet
  11. Do L, Spencer AJ(Eds) (2014) The beginning of change: Queensland child oral health survey 2010–2012. Brisbane: Australian Research Centre for Population Oral Health
  12. Australian Bureau of Statistics (2014) Australian Aboriginal and Torres Strait Islander health survey: first results, Australia, 2012-13: Table 23 [data cube]. Retrieved 26 March 2014 from http://www.abs.gov.au/ausstats/subscriber.nsf/log?openagent&table%2023%20health-related%20actions%20by%20age,%202012-13%20-%20australia.xls&4727.0.55.001&Data%20Cubes&276261A1D5915A31CA257CA6000E36E1&0&2012-13&26.03.2014&Latest
  13. Steering Committee for the Review of Government Service Provision (2016) Overcoming Indigenous disadvantage: key indicators 2016 report. Canberra: Productivity Commission
  14. Australian Institute of Health and Welfare (2014) Oral health and dental care in Australia: key facts and figures trends 2014. Canberra: Australian Institute of Health and Welfare

Footnotes

44. Indigenous data from the 2004-2006 NSAOH should be interpreted with caution due to the very small number of Indigenous people sampled (n=87) and the method of sampling used [10].

 

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