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]. 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. Dental caries is caused by acid-producing bacteria living in the mouth, which proliferate on sweet and sticky food [2]. Caries is reversible in its early stages, but, if untreated, can cause irreversible damage. Periodontal diseases (affecting the gums) are caused by bacterial infection associated with poor oral hygiene, infrequent dental visits, age, smoking, low education and income levels, and certain medical conditions [2], especially diabetes mellitus [3] and osteoporosis [4].
Extent of oral health problems among Indigenous people
Most information available about oral health in the Indigenous population relates to dental caries among children, and there is limited information about the oral health of adults. Generally the extent of caries in deciduous teeth among young Indigenous children has been increasing, whereas it has been declining for their non-Indigenous counterparts [5].
According to the WAACHS, an estimated 19% of Aboriginal and Torres Strait Islander children were reported by their carers to have holes in their teeth [6]. Prevalence of cavities was lowest for children 0-3 years (8%) and highest for children aged 4-7 years (31%). Carers reported 28% of children had never had a tooth filled and almost one-in-ten had had a tooth removed because it was not amenable to restorative dental care.
In the Child Dental Health Survey, Northern Territory 2000, considerably fewer Indigenous children than non-Indigenous children were found to have had no history of caries [7]. Indigenous children up to the age of 9 years old had approximately 3 to 4 times more decayed teeth than non-Indigenous children and dmft scores (for deciduous teeth) one-and-a-half to two-and-a-half times higher (two indices are used to measure caries: ‘dmft’ is the number of deciduous (baby) teeth (t) that are decayed (d), missing due to caries (m), or filled due to caries (f); and ‘DMFT’ is the corresponding index for permanent (adult) teeth.). For permanent teeth, Indigenous children had a higher mean number of decayed teeth and a higher mean DMFT score.
Dental decay in deciduous and permanent teeth of Indigenous children living in SA in 2001 was about twice the level for non-Indigenous children, and the proportion of dental decay that was untreated was also greater [8]. An earlier study in South Australia found that the lowest levels of dental decay in Indigenous children were in remote communities (mean dmfs = 1.0), with higher levels in other non-metropolitan areas (mean dmfs = 7.9) and in Adelaide (mean dmfs = 5.2) [9].
The mean number of teeth affected in Indigenous children aged 5-6 years living in the A nangu lands in the cross-border region of WA, SA and the NT (3.2) was more than twice that of children in the total Australian population (1.44) [10]. Compared with the decline in deciduous caries for children in the total population since 1987, A nangu children aged 5-9 years had experienced a 42% increase in the mean number of teeth affected. A nangu adults experienced low levels of dental caries, but tooth loss was found more frequently among adults with diabetes (mean 5.51) than non-diabetics (mean 1.53), and severe periodontal disease was more prevalent among diabetics (79%) than among non-diabetics (13.8%).
The extent of tooth loss and periodontal disease is higher among older Indigenous people than among their non-Indigenous counterparts [5]: around 16% of older Indigenous people had no natural teeth, compared with 10% of non-Indigenous people [11]. The extent of tooth loss results partly from the relatively poor periodontal health of Indigenous people aged 35 years or older [12]. The most common periodontal condition in Indigenous people aged less than 45 years accessing public dental services and Indigenous dental clinics was the presence of calculus (tartar) [8]. For people aged 45 years or older, 23% had periodontal pockets (space between the root of the tooth and the gums) of 6mm or more, and 25% had periodontal pockets of 4-5mm.
References
1 UK Department of Health (1994) An oral health strategy for England. London: Department of Heath
2 Australian Institute of Health and Welfare (2002) Chronic diseases and associated risk factors in Australia, 2001. (ISBN 1 74024 153 3) Canberra: Australian Institute of Health and Welfare
3 Genco RJ (1996) Current view of risk factors for periodontal diseases. Journal of Periodontology;67(10):1041-1049
4 Jeffcoat MK, Chestnut C (1993) Systemic osteoporosis and oral bone loss: evidence shows increased risk factors. Journal of the American Dental Association;124(11):49-56
5 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
6 Zubrick SR, Lawrence DM, Silburn SR, Blair E, Milroy H, et al. (2004) The Western Australian Aboriginal Child Health Survey: the health of Aboriginal children and young people. Perth: Telethon Institute for Child Health Research
7 Armfield JM, Roberts-Thomson KF, Slade GD, Spencer AJ (2003) Child dental health survey, Northern Territory 2000. (AIHW Catalogue no. DEN 125) Adelaide: University of Adelaide
8 Australian Bureau of Statistics, Australian Institute of Health and Welfare (2003) The health and welfare of Australia's Aboriginal and Torres Strait Islander peoples 2003. (ABS Cat no.4704.0, AIHW Cat no. IHW11) Canberra: Australian Bureau of Statistics
9 Bourke C, Baima D, Allister J, Spencer AJ (1999) Caries experience of Aboriginal children in South Australia 1991. Journal of Dental Research;78(5):951
10 Endean C, Roberts-Thomson K, Wooley S (2004) Anangu oral health: the status of the Indigenous population of the Anangu Pitjantjatjara lands. Australian Journal of Rural Health;12(3):99-103
11 AIHW Dental Statistics and Research Unit (2000) Oral health and access to dental services among Indigenous Australians. Adelaide: Australian Institute of Health and Welfare
12 Australian Health Ministers' Advisory Council(2001) Variations among population sub-groups: Indigenous Australians. In: Australian Health Ministers' Advisory Council, ed. Oral health of Australians - national planning for oral health improvement. Final report. Adelaide: South Australian Department of Human Services:36
This web site contains PDF documents that require the most current version of Adobe Reader to view. To download click on the icon below.
