Aboriginal and Torres Strait Islander Health Performance Framework (HPF) 2012

Tier 1—Health conditions—1.11 Oral health

The HPF was designed to measure the impact of the National Strategic Framework for Aboriginal and Torres Strait Islander Health (NSFATSIH) and will be an important tool for developing the new National Aboriginal and Torres Strait Islander Health Plan (NATSIHP).

Page last updated: 15 November 2012

Why is it important?:

Oral health refers to the health of tissues of the mouth, including muscle, bone, teeth, and gums. In relation to teeth, data are collected 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.

Decayed teeth can cause illness and pain. The loss of permanent teeth can lead to chewing difficulties, discomfort while eating and subsequent nutritional problems and embarrassment. Although the evidence is not conclusive, poor dental health may impair speech and language development, and 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 (gum) disease 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 found an association between periodontal disease and giving birth to pre-term and/or low birthweight babies; cardiovascular disease; and rheumatoid arthritis (NATSIHC 2003; Thomson 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 contributed to high levels of decayed teeth (Jamieson et al. 2010; Slack-Smith et al. 2009).Top of page

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. Cost and lack of availability of services were barriers to accessing dental care.

For the four states for which reliable data were available (NSW 2007, SA 2008, the NT 2008 and Tasmania 2008), the mean number of decayed or missing teeth was higher for Aboriginal and Torres Strait Islander children than other Australian children. dmft and DMFT scores among Aboriginal and Torres Strait Islander children were more than twice as high in all age groups. By 15 years of age, Indigenous children had 2.2 times the rate of decayed teeth and a 30% lower rate of filled teeth compared with non-Indigenous children. More recent data on hospitalisations for dental conditions (between July 2008 and June 2010) find that 9 per 1,000 Indigenous children aged 0–4 years were hospitalised for dental conditions compared with 4 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 lower than non-Indigenous rates. A study in WA found that there was a higher rate of emergency care and oral surgery for Indigenous patients indicating a higher burden of oral disease and late presentation (Kruger et al. 2010).

Aboriginal and Torres Strait Islander children living in remote areas had the poorest level of oral health compared to those living in major cities. Non-Indigenous children in remote areas and cities had better 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).

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 2011, of the 8,317 children who had had a dental check, over half (52%) the children were treated for previously untreated caries. Of the children who received a dental service between 1 January and 30 June 2011 for whom DMFT/dmft was reported, 82% had dental caries with an average of 4.5 caries per child. This is 23% higher than results reported in the 2006 Child Dental Health Survey for all children aged 6–12 years. A study in the NT examining both fluoride varnish and health promotion found significant reduction in tooth decay compared to the control communities over two years (Slade et al. 2011).Top of page

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 proportion of Indigenous persons aged 15 years and over had no natural teeth (8%) than non-Indigenous persons aged 15 years and over (6%).

Implications:

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 (see measure 3.14).

There has been an increase in MBS rebated dental care provided to Indigenous Australians since the introduction of the Indigenous Chronic Disease package, with 98% of claims bulk billed. In the 2009–10 Budget, the Australian Government announced a pilot project of $11 million over four years for Indigenous mobile dental services in rural and regional areas. The objective of the program is to assess the effectiveness of mobile dental facilities in communities where dental services and facilities are scarce. In the 2012–13 Budget, the Australian Government also announced $345.9 million over three years for public dental waiting lists, with funding directed to treating patients on waiting lists, providing services to around 400,000 adults including support to Indigenous Australians. An additional $77.7 million over four years will be provided for relocation and infrastructure grants to encourage and support dentists to relocate and practice in more remote areas.

Under the Health and Hospitals Fund 2011 Regional Priority Round, the Royal Flying Doctor Service will receive funding for a mobile dental unit to provide dental services to people in the Pilbara and Kimberley regions who receive little or no dental care. In NSW an Aboriginal Oral Health Unit has been established to promote oral health and provide dental care. Four dental teams deliver services in Sydney and regional areas in partnership with ACCHSs. The SA Government is also working in partnership with ACCHSs to provide ongoing oral health programs, including the provision of dental clinics in several communities.

Under the Stronger Futures in the Northern Territory package, funding will be allocated to continue the oral health program commenced under the Northern Territory Emergency Response. The program will aim to achieve an integrated approach with a greater focus on preventive and health promotion activity including fluoride varnish.Top of page
Table 12—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 problemNo.%
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
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Figure 42—Age-specific hospitalisation rates for dental problems, by Indigenous status, NSW, Victoria, Qld, WA, SA and the NT, July 2008 to June 2010
Figure 42—Age-specific hospitalisation rates for dental problems, by Indigenous status, NSW, Victoria, Qld, WA, SA and the NT, July 2008 to June 2010
(a)Total is age standardised
Source: AIHW analysis of National Hospital Morbidity Database
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Figure 43—Proportion of children aged 5–10 years with no decayed, missing or filled deciduous teeth (dmft=0), by age and Indigenous status, NSW (2007), SA (2008), the NT (2008), and Tasmania (2008)
Figure 43—Proportion of children aged 5–10 years with no decayed, missing or filled deciduous teeth (dmft=0), by age and Indigenous status, NSW (2007), SA (2008), the NT (2008), and Tasmania (2008)
Source: AIHW analysis of Dental Statistics and Research Unit data
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Figure 44—Proportion of children aged 6–15 years with no decayed, missing or filled permanent teeth (DMFT=0), by age and Indigenous status, NSW (2007), SA (2008), the NT (2008) and Tasmania (2008)
Figure 44—Proportion of children aged 6–15 years with no decayed, missing or filled permanent teeth (DMFT=0), by age and Indigenous status, NSW (2007), SA (2008), the NT (2008) and Tasmania (2008)
Source: AIHW analysis of Dental Statistics and Research Unit data
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Figure 45—Mean number of decayed, missing or filled teeth by Indigenous status, 2004–06
Figure 45—Mean number of decayed, missing or filled teeth by Indigenous status, 2004–06
Source: Roberts-Thomson & Do 2007
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Figure 46—Persons aged 15 years and over with complete tooth loss, by Indigenous status, 2004–06
Figure 46—Persons aged 15 years and over with complete tooth loss, by Indigenous status, 2004–06
Source: Roberts-Thomson & Do 2007
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