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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 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].36 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%).

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 28) [5]. The proportion of Indigenous 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

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)
15-2425-3435-4445-5455+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

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 2007 in NSW and 2008 in SA, Tas and the NT, the proportions of Indigenous children aged 5-10 years with no dmft ranged from 29% to 43% (which was lower than the proportions for their non-Indigenous counterparts) [7]. Indigenous children aged between 6-15 years generally had higher DMFT scores than non-Indigenous children in all age-groups. The combined dmft/DMFT scores increased with age for both Indigenous and non-Indigenous children aged 6-15 years.

Recent information about the oral health of Indigenous children is available from the Stronger futures in the Northern Territory oral health program (SFNT-OHP) [8]. In 2013, 41% of Indigenous children who received dental treatment as part this program received treatment for caries. The proportions of Indigenous children (aged 1-15 years) receiving dental treatment between July 2012 and December 2013 that had dmft/DMFT ranged from 56% of those aged 1-3 years to 89% of those aged 8 years. Among children treated as part of this program, the proportion of children with caries decreased in most age-groups between 2009 and 2013.37

According to the National survey of adult oral health (NSAOH), Indigenous adults had more caries than non-Indigenous adults in 2004-2006 [9]. Indigenous people aged 15 years or older had 2.3 times more untreated caries than their non-Indigenous counterparts: 57% of Indigenous adults and 25% of non-Indigenous adults had one or more teeth affected. Indigenous 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 Indigenous children and adults than among their non-Indigenous counterparts [9][10]. 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 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 across Australia 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 [9]. The prevalence of moderate or severe periodontitis was about 1.3 times higher for Indigenous people than that for non-Indigenous people.

Indigenous people are affected by periodontal diseases at younger ages than non-Indigenous people [9]. 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%). 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 [9]. The 2004-2006 NSAOH found that edentulism increased with age for both Indigenous and non-Indigenous populations, 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.

Dentist visits and hospitalisation

According to the 2012-2013 AATSIHS, around 4.8% of Indigenous people reported visiting a dentist in the two weeks prior to survey [11]. Proportions were similar for remoteness levels: 4% of Indigenous people living in non-remote areas and 6% of Indigenous people living in remote areas reported visiting a dentist in the two weeks prior to survey [12].

According to the NSAOH, 51% of Indigenous people reported having visited a dentist in the previous 12 months, and 43% reported usually visiting a dentist at least once per year in 2004-2006 [9]. Around one-third (34%) of Indigenous people reported that cost had prevented dental treatment and 27% reported that they would have a lot of difficulty paying a $100 dental bill.

In 2008 for Indigenous children requiring a dentist, the most common reasons for not taking them included: wait times were too long; appointments were not available when required; the cost; and the carer could not find time to take the child [7].

In 2012-13, after age-adjustment, national hospitalisation rates for dental conditions were 1.3 times higher for Indigenous people than for non-Indigenous people [7]. The hospitalisation rate for Indigenous people living in remote areas was more than twice as high as for Indigenous people living in non-remote areas. The hospitalisation rates were higher for Indigenous 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)IndigenousNon-IndigenousRate ratio
Source: Steering Committee for the Review of Government Service Provision, 2014 [7]
Notes:
  1. Rates per 1,000 population
  2. Rate ratio is the Indigenous rate divided by the non-Indigenous rate
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

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. Steering Committee for the Review of Government Service Provision (2014) Overcoming Indigenous disadvantage: key indicators 2014. Canberra: Productivity Commission
  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. 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
  12. Australian Bureau of Statistics (2013) Australian Aboriginal and Torres Strait Islander health survey: first results, Australia, 2012-13. Canberra: Australian Bureau of Statistics

Endnotes

  1. The 2012-2013 AATSIHS did not collect information on oral health.
  2. 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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