Report of the National Advisory Council on Dental Health

Oral Health and Visiting Patterns of Australian Children

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

      The oral health of Australian children has improved significantly since the mid–late 1970s, with dental disease reducing substantially. This is most likely the result of improved access to fluoridated drinking water, the use of fluoridated toothpastes, the provision of preventive oral health services and the adoption of good dental hygiene practices.16

      16 Australian Institute of Health and Welfare (2009), A Picture of Australia’s Children 2009, p.38.

      However, since the late 1990s, the prevalence of child caries and the mean number of teeth affected by dental disease in children has increased.17 The majority of child caries experience is concentrated in a minority of children who suffer a greater burden of disease. For example, approximately 20 per cent of four year olds and 20 per cent of 15 year olds have approximately 90 per cent of the total tooth decay for their age group.18 Recent studies have also revealed that there is a slight social gradient in the prevalence of child caries, with those children in the least advantaged areas experiencing approximately 1.5 times the number of caries than children in the most advantaged areas.19 However, the Council does not support an option to focus only on low income children. Caries and untreated caries are evident across all socioeconomic groups. Surprising proportions of those children affected are found in middle and upper socioeconomic groups. A universal program is the best option for reaching all children and establishing a foundation for good oral health throughout life.

      17 Spencer, A.J. and Harford, J. (2008), Improving Oral Health and Dental Care for Australians. Prepared for the NHHRC, p.36.
      18 Rogers, J.G. (2011), Evidence–based oral health promotion resource, Prevention and Population Health Branch, Government of Victoria, Department of Health, p.42.
      19 Spencer, A.J. and Harford, J. (2008), Improving Oral Health and dental care for Australians. Prepared for the NHHRC, p.35.

      Recent changes in the prevalence of dental disease in children may reflect changes in school dental programs across the states and territories as well as changes in dietary behaviours, including reduced consumption of fluoridated water and increased sugar consumption.20 Children are eating less than the recommended amount of fruit and vegetables and are consuming more than their recommended energy from sugars.21 Poor childhood oral health is a strong predictor of poor adult oral health.22

      20 Australian Institute of Health and Welfare (2009), A Picture of Australia’s Children 2009, p.38.
      21 Rogers, J.G. (2011), Evidence–based oral health promotion resource, Prevention and Population Health Branch, Government of Victoria, Department of Health, p.42.
      22 Lucas, N., Neumann, A., Kilpatrick, N. and Nicholson, J.M. (2011), ‘State–level differences in the oral health of Australian preschool and early primary school–age children’, Australian Dental Journal, Vol. 56, pp.56–62.

      Child oral health indicators

      Tooth loss

      The Australian Child Dental Health Survey (2003–04) showed that, in children of all ages, the average number of missing teeth due to dental decay was low.23 However, in groups where dental decay is an issue, dental extractions and restorations are the most common cause for hospital separations. This outcome should be preventable.

      23 Armfield, J.M., Spencer, A.J. and Brennan, D.S. (2009), Dental health of Australia’s teenagers and pre–teen children: The Child Dental Health Survey, Australia 2003–04, AIHW Dental Statistics and Research Series No.52, pp.1 and 16.

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      Deciduous (‘baby’) tooth decay

      Dental caries in children cause abscess formation, cellulitis and the systemic spread of disease.24 It also causes pain, problems with eating or drinking, loss of sleep with effects on school attendance and performance.

      24 Australian Institute of Health and Welfare (2009), A Picture of Australia’s Children 2009, p.38.

      The Australian Child Dental Health Survey (2003–04) showed that 48.7 per cent of children aged 5–6 years have experienced dental caries in their deciduous teeth and approximately 41.3 per cent had untreated decay.25 The prevalence, severity and level of untreated dental decay for these children was found to be higher in areas of lower socio–economic status.

      25 Ha, D. (2011), Dental decay among Australian children, AIHW Dental Statistics and Research Report Series, No. 53, p.6.

      Permanent tooth decay

      At approximately five years of age, children start to lose their deciduous teeth, which are then replaced by their permanent teeth.26 By 12 years of age, most children have all of their successor permanent teeth. Data from the Australian Child Dental Health Survey (2003–04) revealed that 45.1 per cent of 12 year olds had decay in their permanent teeth and 24.8 per cent had untreated dental decay.27 Similar to the 5–6 year old cohort, the prevalence, severity and level of untreated dental decay was higher in areas of lower socio–economic status.

      26 Armfield, J.M., Spencer, A.J. and Brennan, D.S. (2009), Dental health of Australia’s teenagers and pre–teen children: The Child Dental Health Survey, Australia 2003–04, AIHW Dental Statistics and Research Series, No.52, p.16.
      27 Ha, D. (2011), Dental decay among Australian children, AIHW Dental Statistics and Research Report Series, No. 53, pp.7 and 10.

      Child visiting patterns

      As with adults, visiting patterns for children are a good indicator of the risk of poor oral health. Children with favourable visiting patterns are more likely to receive preventive dental services and benefit from early diagnosis and prompt treatment. Children that fall into this category are also more likely to report low levels of extractions and possibly low levels of fillings,28 whereas children with unfavourable visiting patterns (who do not visit a dental practitioner regularly and visit to treat a problem) are at a higher risk of experiencing oral disease.

      28 Ellershaw, A.C. and Spencer, A.J. (2009), ,em>Trends in access to dental care among Australian children, AIHW Dental Statistics and Research Series, No.51, pp. 12 and 36.

      The National Dental Telephone Interview Survey (1994–2005) shows that most children have good visiting patterns, usually visiting the dental practitioner at least once a year, with prevalence ranging from 86.8 per cent to 90.4 per cent for 5–11 year olds and around 80 per cent for 12–17 year olds.29 Most children were also reported as visiting a dental practitioner for a check–up rather than to treat a problem. Children visiting a dental practitioner for a check–up ranged from 84.3 per cent to 91.3 per cent for 5–11 year olds and from 76.0 per cent to 82.9 per cent for 12–17 year olds.30

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      29 ibid, pp.27–30.
      30 ibid, pp.32 and 34.

      However, the data suggest that approximately one fifth of children are not usually visiting a dental practitioner once a year and are visiting a dental practitioner to treat a problem rather than receiving regular preventive services. A National Child Oral Health Survey, currently underway, will provide more up–to–date information on the visiting patterns and oral health of children.

      Certain child priority groups are at higher risk of poor visiting patterns, which places them at a higher risk of developing oral disease. These groups include:

      • children from lower income households;
      • dependants of parent concession card holders;
      • child concession card holders;
      • Indigenous children; and
      • homeless children.

      These issues are discussed in more detail in Chapter Three.