Report of the National Advisory Council on Dental Health

Oral Health and Visiting Patterns of Australian Adults

The National Advisory Council on Dental Health (the Council) was established as a time-limited group to provide strategic, independent advice on dental health issues, as requested by Minister for Health and Ageing, to the Government. The Council’s priority task was to provide advice on dental policy options and priorities for consideration in the 2012-13 Budget.

Page last updated: 03 September 2012

      Information and data on the oral health of Australians is largely available through population health survey data from the Australian Research Centre for Population Oral Health (ARCPOH) and its constituent unit, the Australian Institute of Health and Welfare’s Dental Statistics Research Unit (AIHW DSRU). This report discusses the oral health of Australians by looking at adults and children separately. This will help focus the development of long–term policy and shorter–term programs more appropriately, reflecting the different reasons for poor oral health in each group and the need to develop different approaches to improve outcomes.

      Adult oral health indicators

      There are several measures of adult oral health, including complete tooth loss (edentulism), inadequate dentition, untreated decay and periodontal disease. These measures of oral health vary across the population depending on concession card holder status (i.e. whether or not a person is a holder of a Health Care Card (HCC) or Pensioner Concession Card (PCC) issued by the Commonwealth Government), Indigenous status, education and age (particularly in terms of the generation within which people were born). In 2008, only 11 per cent of adults rated their oral health as excellent.3

      3 Australian Institute of Health and Welfare (AIHW)(2010), ‘Self–rated oral health of adults’, Research Report Series No. 51.

      Tooth loss

      The 2004–06 National Survey of Adult Oral Health showed that 6.4 per cent of the Australian population had lost all of their teeth. For all ages combined, the prevalence of complete tooth loss was 17.1 per cent for people eligible for public dental care compared to 2.7 per cent of those who were ineligible. However, there was little difference in complete tooth loss between Indigenous and non–Indigenous Australians. Improvements and changes in dental practice have seen declining rates of edentulism in younger generations.4

      4 Roberts–Thomson, K. and Do, L., ‘Chapter 5 – Oral Health Status’. In Slade, G.D., Spencer, A.J., Roberts–Thomson, K.F. (editors) (2007), Australia’s Dental Generations: The National Survey of Adult Oral Health 2004–06, AIHW Dental Statistics and Research Series No. 34, Canberra, pp.82–84.

      Inadequate dentition

      Inadequate dentition is defined as having fewer than 21 teeth, because of the impact this has on function and appearance. For dentate Australians (having any number of teeth), 11.4 per cent had fewer than 21 teeth. Those without formal education beyond Year Nine had the highest proportion of inadequate dentition, at 34 per cent. The number of missing teeth increases with age. Further, people eligible for public dental care had 1.7 times more the number of missing teeth compared to those who were ineligible to access public dental care.5

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      5 ibid, pp.85–93.

      Periodontitis

      Moderate or severe periodontitis (gum disease) is present in 22.9 per cent of the Australian population. Periodontitis is strongly linked to age, with older generations having a much higher prevalence of periodontitis than younger people.6

      6 ibid, p.119.

      Dental caries

      The prevalence of untreated dental decay is also strongly linked to Indigenous status and increasing age.7 There is a relationship between income and dental caries prevalence, although the relationship is not strong (refer to Figure 1.1 below). For example, the mean decayed, missing and filled teeth (DMFT) of people in households with incomes of less than $20,000 per annum was 14.97 compared to 13.34 in high income households of $80,000 per annum. However, what is significant is that 39.8 per cent of low income households had untreated decay compared to 17.3 per cent of high income households.8 This suggests that differences in income make a difference to the treatment pathway, rather than the initial experience of decay (refer to Figure 1.1 below).

      7 ibid, p.105.
      8 Spencer, A.J., ‘Oral Health and Dental Services in Australia’, Presentation to the National Advisory Council on Dental Health, 5 October 2011.

      Figure 1.1: Income levels and DMFT and untreated decay among Australian adults 18+.
      Figure 1.1: Income levels and DMFT and untreated decay among Australian adults 18+. D Top of page

      Age and sex adjusted.
      Source: Professor John Spencer, presentation to National Advisory Council on Dental Health, 5 October 2011.

      It has also been found that people attending public dental clinics tended to have higher levels of decay as well as fewer filled teeth compared to those attending private dentists.9

      9 Australian Research Centre for Population Oral Health (2009), ‘Caries experience of private and public dental patients’, Australian Dental Journal, Vol. 54, pp.66–69.

      Adult visiting patterns

      Visiting patterns are a good indicator of oral health because the frequency and reason for dental visits indicates the likely pathway for treatment or service. Visiting patterns also provide an indication of the risk of poor oral health. Visiting patterns can be defined as favourable, unfavourable or intermediate. People with favourable visiting patterns generally have good oral health, visit the same dentist once a year and visit for a check–up rather than a problem. People with unfavourable visiting patterns do not usually visit the same dentist, do not visit yearly, are often seeking treatment for a problem rather than visiting for a check–up and tend to have poorer oral health (see Tables 1.1 to 1.3 below). In comparison to adults with favourable visiting patterns, adults with unfavourable visiting patterns are half as likely to receive preventive treatment and four times more likely to receive extractions.10 Australian adults’ visiting patterns show that:

      • 39 per cent of adults have favourable visiting patterns;
      • 29 per cent of adults have unfavourable visiting patterns; and
      • 32 per cent of adults have a mixed or intermediate visiting pattern.11

      10 Ellershaw, A.C. and Spencer A.J. (2011), Dental attendance patterns and oral health status, AIHW Dental Statistics and Research Series No. 57, p.23.
      11 Spencer, A.J. and Harford J. (2008), Improving Oral Health and Dental Care for Australians. Prepared for the National Health and Hospitals Reform Commission (NHHRC), p.7.

      Table 1.1: Treatment received during previous 12 months by pattern of dental attendance (per cent (a))

      Treatment received Confidence Interval Dental attendance pattern Favourable (%) Dental attendance pattern Intermediate (%) Dental attendance pattern Unfavourable (%)
      Received and extraction (b) 95% Cl 8.9
      (7.8,10.0)
      19.4
      (17.3,21.4)
      32.8
      (29.0,36.6)
      Received a filling 95% Cl 38.3
      (36.4,40.1)
      51.7
      (49.0,54.4)
      45.8
      (41.7,49.9)
      Received a professional clean and polish and/or scaling 95% Cl 84.3
      (82.8,85.7)
      59.2
      (65.5,61.9)
      41.0
      (37.2,44.7)

      (a) Age and sex-adjusted via logit model.
      (b) Confidence Interval.
      Source: Ellershaw, A.C. and Spencer, AJ. (2011) Dental attendance patterns oral health status, Australian Institute of Health and Welfare, Canberra (Dental Statistics Research Series No.57, p.23).

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      While poor oral health is present across all visiting patterns, the most significant risk of poor oral health is likely to be for lower income households with poor visiting patterns. This is consistent with 2004–06 survey data which links visiting patterns to adult oral health. For example, 9.4 per cent of adults with favourable visiting patterns have fewer than 21 natural teeth compared to 23.3 per cent of adults with unfavourable visiting patterns (see Table 1.2). Both moderate to severe periodontal disease and untreated decay are also more likely in adults with unfavourable patterns compared to adults with favourable patterns.12

      12 Spencer, A.J. and Harford, J. (2008), Improving Oral Health and Dental Care for Australians, Prepared for the NHHRC, p.26.

      Table 1.2: Oral health of dentate adults by pattern of dental visiting.

      Pattern of dental visiting DMFT untreated decay (%) moderate/severe periodontal disease (%) <21 teeth dentate adults (%)
      Unfavourable 13.9 38.4 31.1 23.3
      Intermediate 14.4 26.9 39.7 14.5
      Favourable 14.1 14.4 21.2 9.4

      Age and sex adjusted estimates.
      Source: Spencer, AJ. and Harford, J. (2008) 'Improving Oral Health and Dental Care for Australians'; Prepared for the National Health and Hospitals Reform Commission, p.26.

      Around 56 per cent of high income households have a favourable visiting pattern compared to 22.1 per cent of lower income households. There is an inverse relationship with unfavourable patterns with only 16.2 per cent of high income households with unfavourable visiting patterns, compared to 43.7 per cent of low income households.13 However, the data show that unfavourable patterns are present across all income groups, with significant numbers of people in each of the income groups.14 This is an important caveat, because it indicates that unfavourable visiting patterns and the risk of poor oral health is present across the population although in unequal proportions (see Table 1.3).

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      13 Ellershaw A.C. and Spencer, A.J. (2011), Dental attendance patterns oral health status, AIHW Dental Statistics and Research Series No.57, p.12.
      14 Spencer, A.J. (2011), Improving access to dental services and oral health for Australians – implications from surveillance data. Presentation to the Australia Department of Health and Ageing, 29 August 2011, Canberra.

      Lower income groups are more likely to include a significant number of priority groups, including concession card holders, Indigenous Australians, lower income workers and people with more severe chronic diseases and disabilities, especially those whose illness or disability includes access to health concession cards. These priority groups and their oral health status are discussed in more detail in Chapter Three.

      Table 1.3: Pattern of dental attendance, by annual household income (per cent (a))

      Annual household income Confidence Interval Pattern of dental attendance
      Favourable (%)
      Pattern of dental attendance
      Intermediate (%)
      Pattern of dental attendance
      Unfavourable (%)
      Less than $20,000 (b)95% Cl 22.1
      (19.1,25.5)
      34.2
      (30.3,38.3)
      43.7
      (39.7,47.8)
      $20,000 - < $40,000 95% Cl 28.9
      (26.8,31.2)
      34.6
      (32.2,37.1)
      36.5
      (34.1,38.9)
      $40,000 - < $60,000 95% Cl 38.7
      (36.1,41.4)
      33.0
      (30.6,35.6)
      28.2
      (25.5,31.1)
      $60,000 - < $80,000 95% Cl 43.5
      (40.3,46.7)
      31.5
      (28.5,34.6)
      25.0
      (22.2,28.0)
      $80,000 - < $100,000 95% Cl 51.8
      (48.5,55.1)
      27.6
      (24.6,30.8)
      20.6
      (18.0,23.5)
      $100,000 and over 95% Cl 56.0
      (53.0,59.0)
      27.8
      (25.2,30.5)
      16.2
      (13.9,18.9)

      (a) Age and sex standardised via direct standardisation method.
      (b) Confidence Interval.
      Source: Ellershaw, A.C and Spencer, A.J. (2011). Dental attendance patterns oral health status, Australian Institute of Health and Welfare, Canberra (Dental Statistics Research Series No.57, p.12).

      People with private health insurance have more favourable visiting patterns than those without private health insurance. Across all age groups, people with private health insurance were 1.5 times more likely to have visited a dentist in the previous 12 months. Seventy per cent of people with private health insurance were likely to visit for a check–up compared to 43.2 per cent of uninsured people. Some caution needs to be applied in concluding that private health insurance is the sole reason for the increased visits because of certain demographic and socio–economic factors that influence private health insurance holders. Even so, studies have shown that insured people who are also eligible for public dental care will access dental care at similar levels to holders of private health insurance who are not eligible for public dental care.15

      15 Spencer, A.J., Sendziuk, P., Slade, G. and Harford, J. Chapter 9 – Interpretation of Findings. In Slade, G.D., Spencer, A.J., Roberts–Thomson, K.F. (editors) (2007), Australia’s Dental Generations: The National Survey of Adult Oral Health 2004–06, AIHW Dental Statistics and Research Series No. 34, p.242.