Aboriginal and Torres Strait Islander Health Performance Framework - 2010

1.10 Decayed, missing, filled teeth

Page last updated: 26 May 2011

Why is it important?:

Oral health refers to the health of tissues of the mouth, including muscle, bone, teeth and gums. This performance measure focuses on one component of oral health that is available in the national data (i.e. the teeth), and particularly on the average number of decayed, missing and filled infant/deciduous (dmft) and adult/permanent (DMFT) teeth. The number of teeth with dental decay (termed ‘caries’), reflects untreated dental disease, while the number of missing and filled teeth reflects the history of dental health problems and treatment. The number of teeth with untreated decay is often higher in the younger age groups, while older people are more likely to have missing or filled teeth (Davies 2000).

Decayed teeth can cause illness and pain. The loss of permanent teeth can lead to difficulties in chewing, discomfort while eating and subsequent nutritional problems and embarrassment. Although the evidence is not conclusive, poor dental health may impair speech and language development. It may also exacerbate other chronic diseases (Jamieson et al. 2010).

Aboriginal and Torres Strait Islander peoples are more likely than other Australians to have lost all their teeth, have gum disease, and receive less caries treatment. They are less likely to have received preventive dental care and more likely to have untreated dental disease (Jamieson et al. 2010).

Periodontal disease (i.e. of the gums) is associated with increased age, poor oral hygiene, infrequent dental visits, smoking, low education and income levels, and certain medical conditions, especially diabetes. Research has also found an association between periodontal disease and pre-term, low birthweight babies, cardiovascular disease, and rheumatoid arthritis (NATSIHC 2003; Thompson et al. 2004) and with substance use, particularly inhalant use (Jamieson et al. 2010). Consumption of sugary drinks and a lack of fluoridation of water supplies in some communities have also contributed to high levels of decayed teeth (Jamieson et al. 2010; Slack-Smith et al. 2009).

Findings:

In 2008, 32% of Indigenous children aged 0–14 years were reported to have teeth or gum problems. Approximately 15% had untreated cavities or dental decay and 16% had teeth filled because of dental decay. A further 7% had teeth pulled out due to dental decay. Of those children that needed to go to a dentist and did not go (8%), one-third (32%) of parents reported the waiting time being too long or the service not available at the time required as the main reason for this. For one-fifth, cost was the main issue.

Comparisons between Indigenous children and other Australian children are now dated. For the three states for which reliable data were available (NSW 2000, SA 2003 and the NT 2002), the mean number of decayed or missing deciduous teeth and of decayed permanent teeth was much higher for Indigenous children than other Australian children. The differentials varied with age, but dmft and DMFT scores of Aboriginal and Torres Strait Islander children were more than twice as high in any age groups. By 15 years of age, Aboriginal and Torres Strait Islander children had 50% more decayed, missing or filled teeth compared with non-Indigenous children. More recent data on hospitalisations for dental conditions (between July 2006 and June 2008) support these disparities for children aged 0–4 years, showing rates of 9 Indigenous children per 1,000 population were hospitalised for dental conditions compared with 5 per 1,000 population for other children. This indicates poor access to, and a large unmet need for, dental care in this age group. Hospitalisation rates for dental problems decline sharply after 14 years of age with Indigenous rates slightly under non-Indigenous rates.

Indigenous children living in rural areas tend to have the poorest level of oral health followed by Aboriginal and Torres Strait Islander children living in metropolitan areas with non-Indigenous children in rural and metropolitan areas having the best oral health. In the general population, higher levels of socioeconomic disadvantage are associated with poorer oral health in children. There is a similar pattern for Indigenous children, but within each socioeconomic grouping, Indigenous children have poorer oral health than other Australian children (Jamieson et al. 2006).

The only data on trends in dental health are for school-age children in the Northern Territory. There was little change in dental health for Indigenous children from 1991 to 2001. A study in the Northern Territory found that the prevalence of dental caries amongst non-Indigenous children improved from 1989 to 2000 while the prevalence amongst Indigenous children worsened during the same period (Jamieson et al. 2007). Between 1 July 2007 and 3 June 2009, Northern Territory Emergency Response health checks included an assessment of dental health. Oral health problems were identified in over 40% of children who had a Child Health Check. At December 2009, of the 2,349 children who had had a dental check, over half (54%) the children were treated for previously untreated caries.

In 2004–06, the average number of decayed teeth was higher for Indigenous Australians aged 15 years and over (15 compared with 13 for non Indigenous). A higher percentage of Indigenous persons aged 15 years and over had no natural teeth (8%) than non-Indigenous persons aged 15 years and over (6%).

Implications:

More recent data are required. Available data indicate that dental health is worse for Indigenous Australians than other Australians, for both children and adults. These findings raise significant policy questions about access to dental services and population health measures to prevent dental disease and support oral health. In NSW an Aboriginal Oral Health Unit has been established at the Sydney Dental Hospital to promote and enhance communication, relationships and oral health services across Aboriginal communities and advise on the effectiveness of oral health services and promotion activities.

Table 18 – Number and proportion of Indigenous children aged 0–14 years(a) with reported teeth or gum problems, by type of dental or gum problem, 2008

Type of teeth/gum problem
No.
%
Cavities or dental decay
27,089
15
Tooth or teeth filled because of dental decay
27,647
16
Teeth pulled out because of dental decay
12,203
7
An accident caused breakage or loss of teeth
7,474
4
Bleeding or sore gums
4,927
3
Other problems with teeth or gums
6,713
4
Total has teeth or gum problems(b)
57,056
32
Does not have teeth or gum problems
121,177
68
Total(c)
178,233
100
Not known
3,581
. .
(a) Indigenous children who have teeth. Excludes children who do not have teeth
(b) Total will be less than the sum of the components as a child can have more than one tooth or gum problem
(c) Excludes not known responses
Source: AIHW analysis of 2008 NATSISS

Figure 26 – Age-specific hospitalisation rates for dental problems, by Indigenous status, NSW, Vic., Qld, WA, SA and NT, July 2006 to June 2008


Figure 26 – Age-specific hospitalisation rates for dental problems, by Indigenous status, NSW, Vic., Qld, WA, SA and NT, July 2006 to June 2008
Source: AIHW analysis of National Hospital Morbidity Database
Text description of figure 26 (TXT 1KB)

Table 19 – Mean number of decayed, missing and filled deciduous and permanent teeth, by age and Indigenous status, NSW (2000), SA (2003) and NT (2002)

NSW
SA
NT
Indig.
Non-Indig.
Ratio
Indig.
Non-Indig.
Ratio
Indig.
Non-Indig.
Ratio
4-6 year olds, deciduous teeth
decayed
1.6
0.7
2.3*
2.2
0.9
2.4*
3.3
0.9
3.8*
missing
0.2
0.0
5*
0.3
0.1
4*
0.1
0.1
2.7
filled
0.4
0.2
1.9*
1.1
0.6
1.9*
0.4
0.5
0.9
dmft
2.3
1.0
2.3*
3.7
1.6
2.3*
3.8
1.4
2.8*
8-10 year olds, permanent teeth
Decayed
0.3
0.1
2.2*
0.5
0.2
2.5*
0.5
0.1
3.6*
Filled
0.1
0.1
1.3
0.3
0.3
1.2
0.1
0.2
0.9
DMFT
0.5
0.3
1.8*
0.8
0.5
1.8*
0.7
0.3
2.2*
12-14 year olds, permanent teeth
Decayed
0.7
0.3
2.1*
0.9
0.4
2.3*
1.2
0.4
2.8
Filled
0.4
0.3
1.1
0.9
0.7
1.3
0.4
0.5
0.7
DMFT
1.1
0.7
1.6*
1.8
1.1
1.7*
1.6
1.0
1.6
* Represents significant differences in the Indigenous/non-Indigenous comparisons.
Source: AIHW analysis of Dental Statistics and Research Unit data

Figure 27 – Mean number of decayed, missing or filled teeth by Indigenous Status, 2004–06


Figure 27 – Mean number of decayed, missing or filled teeth by Indigenous Status, 2004–06
Source: Roberts-Thomson & Do 2007
Text description of figure 27 (TXT 1KB)

Figure 28 – Persons aged 15 years and over with no natural teeth (complete tooth loss), by Indigenous status, 2004–06


Figure 28 – Persons aged 15 years and over with no natural teeth (complete tooth loss), by Indigenous status, 2004–06
Source: Roberts-Thomson & Do 2007
Text description of figure 28 (TXT 1KB)

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