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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’ ([1] cited in [2], p.1). 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.

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 is related to health conditions including diabetes and CVD.

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

Oral health problems were reported for 32% of Aboriginal and Torres Strait Islander children aged 0-14 years in the 2008 NATSISS [4]. Almost one-half (46%) of the children reporting oral health problems 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%).

Information about oral health status was not collected in the most recent AATSIHS; however, participants were asked about their oral health in the 2004-2005 NATSIHS. According to the 2004-2005 NATSIHS, 78% of Aboriginal and Torres Strait Islander 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 28) [5]. The proportion of Aboriginal and Torres Strait Islander people aged 55 years or older who reported using dentures was higher for those living in non-remote areas than for those living in remote areas (55% and 19%, respectively) and the proportion requiring dentures was higher in remote areas than in non-remote areas (19% and 10%).

Table 28. Proportion (%) of Indigenous people reporting number of lost teeth and denture use, by age-group and type of condition, Australia, 2004-2005

 

Age-group (years)

 

15-24

25-34

35-44

45-54

55+

All ages

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

Dentures

Wears dentures

1

2

8

23

45

10

Requires dentures

1

4

10

12

13

6

Notes:

  1. Some low proportions should be viewed with caution
  2. ‘-‘ refers to nil or rounded to zero

Source: ABS, 2006 [5]

Caries

People’s experience of caries is measured by the ‘decayed missing and filled teeth’ index (dmft) for deciduous teeth (first set of teeth) and by the DMFT index for permanent (adult) teeth [6]. Both indices measure how many teeth (t/T) are decayed (d/D), missing (m/M) or filled (f/F). These indices do not differentiate between a tooth with minor problems and one with major problems, nor do they provide a direct indication of the discomfort or dysfunction experienced.

In 2010 in Qld, WA, SA, Tas, ACT and the NT, Aboriginal and Torres Strait Islander children aged 5-15 years who received a school dental service examination were more likely to experience caries in both their deciduous and permanent teeth than their non-Indigenous counterparts [7]. The proportion of children aged 5-10 years with dmft ranged from 66% to 82% (which was higher than for non-Indigenous children the same age.) Differences were most pronounced at ages 5-7 years, where Aboriginal and Torres Strait Islander children were around one-and-a-half times more likely to have dmft than non-Indigenous children. For permanent teeth, Aboriginal and Torres Strait Islander children aged 6-15 years were 1.2 times (aged 12 years) to 1.7 times (aged 9 years) more likely to have DMFT than were non-Indigenous children.

Recent information about the oral health of Aboriginal and Torres Strait Islander children is available from the Stronger futures in the Northern Territory oral health program (SFNT-OHP) [8]. In 2013, 41% of children who received a clinical service were treated for caries. The proportions of children aged 1-15 years that had dmft/DMFT ranged from 56% of those aged 1-3 years to 89% of those aged 8 years. The proportion of children with caries decreased in most age-groups between 2009 and 2013.1

According to the most recent National survey of adult oral health (NSAOH), Aboriginal and Torres Strait Islander adults had more caries than non-Indigenous adults in 2004-2006 [9]. 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 affected. 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.

Periodontal diseases

Periodontal diseases, including gingivitis and periodontitis, are more common among Aboriginal and Torres Strait Islander children and adults than among their non-Indigenous counterparts [9][10]. Aboriginal and Torres Strait Islander people are affected by periodontal diseases at younger ages than non-Indigenous people [9].

Children rarely develop severe periodontal disease but gingivitis is relatively common, particularly among older children [10]. Gingival bleeding, a common symptom of gingivitis, was generally more common among Aboriginal and Torres Strait Islander 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 Aboriginal and Torres Strait Islander children aged 13-14 years living in NSW than among their non-Indigenous counterparts. Almost one-half (49%) of Aboriginal and Torres Strait Islander 12 year-olds living in SA had gingival bleeding, compared with 23% of non-Indigenous 12 year-olds. In 2000-2003, around 60% of Aboriginal and Torres Strait Islander children living in remote communities around Alice Springs (NT), in the Far West Area Health Service District (NSW) and in the Nganampa lands (SA) showed some evidence of gingivitis and 21% of children were at moderate risk of developing gingivitis. Almost 42% of 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 Aboriginal and Torres Strait Islander people aged 15 years and older had gingivitis [9]. 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.

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 [9]. The 2004-2006 NSAOH found that the prevalence of edentulism increased with age for both Aboriginal and Torres Strait Islander and non-Indigenous populations, but the age distribution of edentulism among Aboriginal and Torres Strait Islander people was noticeably different from that of other Australians. Edentulism was almost five times more common among Aboriginal and Torres Strait Islander people (7.6%) aged 35-54 years than among their non-Indigenous counterparts (1.6%). For people aged 55-74 years, 21% of Aboriginal and Torres Strait Islander people suffered from edentulism compared with 14% of non-Indigenous people.

Dentist visits and hospitalisation

Dentist visits to manage dental issues and for routine check-ups are vital for good oral health, and can result in lower prevalence of caries and periodontal disease [11]; dental hospitalisations can generally be avoided with preventative care and early intervention [2]. Aboriginal and Torres Strait Islander people report barriers to accessing dental services, including long wait times, lack of suitable appointments, and high cost [12] [9].

According to the 2012-2013 AATSIHS, around 4.8% of Aboriginal and Torres Strait Islander people reported visiting a dentist in the two weeks prior to the survey [13].

Results from the NSAOH for 2004-2006 show that 51% of Aboriginal and Torres Strait Islander people visited a dentist in the previous 12 months, and 43% reported usually visiting a dentist at least once per year [9].

The Footprints in time: longitudinal study of Indigenous children found that less than half of the children who participated in the study in 2012 (at ages 4.5 to 9 years) had seen a dentist or dental nurse in the 12 months prior to the interview [14].

In 2012-13, after age-adjustment, national hospitalisation rates for dental conditions were 1.3 times higher for Aboriginal and Torres Strait Islander people than for non-Indigenous people [12]. The hospitalisation rate for Aboriginal and Torres Strait Islander people living in remote areas was more than twice as high as for those in non-remote areas. 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 29).

Table 29. Age-specific hospital separation rates for dental conditions, by Indigenous status, and Indigenous:non-Indigenous rate ratios, Australia, 2012-13

Age-group (years)

Indigenous

Non-Indigenous

Rate ratio

0-4

8.4

4.9

1.7

5-9

12.2

9.8

1.2

10-14

3.0

5.9

0.5

All ages

7.9

6.9

1.2

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, 2014 [12]

Aboriginal and Torres Strait Islander people undergo more intensive hospital dental treatments at younger ages than the general population [2]. In 2011-12 for all Australians, dental procedures requiring a general anaesthetic were most common in people aged 15-24 years (16 per 1,000 persons); for Aboriginal and Torres Strait Islander people, the procedure rate was highest among 5-9 year-olds (15 per 1,000 people).

References

  1. UK Department of Health (1994) An oral health strategy for England. London: Department of Heath
  2. 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
  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. 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. Ha DH, Ellershaw AC (2014) Oral health of Australian Indigenous children compared to non-Indigenous children enrolled in school dental services. Australian Dental Journal; 59(3): 395–400
  8. Australian Institute of Health and Welfare (2014) Stronger Futures in the Northern Territory: Oral Health Program: July 2012 to December 2013. Canberra: Australian Institute of Health and Welfare
  9. 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
  10. 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)
  11. Ellershaw AC, Spencer AJ (2011) Dental attendance patterns and oral health status. Canberra: Australian Institute of Health and Welfare
  12. Steering Committee for the Review of Government Service Provision (2014) Overcoming Indigenous disadvantage: key indicators 2014. Canberra: Productivity Commission
  13. 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
  14. Footprints in Time (2015) Footprints in Time: the longitudinal study of Indigenous children: report from Wave 5. Canberra: Department of Social Services

Endnotes

  1. This decrease is based on combined dmft/DMFT scores and may reflect improvements in oral health or may reflect oral health differences between communities serviced by the SFNT-OHP in the NT.
 
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