Report of the National Advisory Council on Dental Health

Outcomes and Impact of Oral Disease

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 start of this Chapter defined oral health − this section provides details on why good oral health is important. Oral disease is very common and its impact on individuals and society is significant. We believe these impacts can be underestimated for both the individual and the health system. It is important to understand that for those who find access difficult, the delay in dental treatment can often result in serious infection and pain with poor oral health outcomes. Beyond the individual, the broader cost to the health system is also a concern, with costs focused on the treatment of pain and infection, rather than access to a dental practitioner for the treatment of the underlying cause.

      Impacts on Individuals

      The National Oral Health Plan 2004–13 highlights the importance of oral health and the impact of oral disease:

      “Oral health is fundamental to overall health, wellbeing and quality of life. A healthy mouth enables people to eat, speak and socialise without pain, discomfort or embarrassment. The impact of oral disease on people’s everyday lives is subtle and pervasive, influencing eating, sleep, work and social roles. The prevalence and recurrences of these impacts constitutes a silent epidemic.”31

      31 Healthy Mouths, Healthy Lives: Australia’s National Oral Health Plan 2004–13 (2004). Prepared by the National Advisory Committee on Oral Health.

      Oral diseases and disorders create short term and prolonged physical discomfort. Pain, infection and tooth loss are the most common consequences of oral disease, causing difficulties with chewing, swallowing, speaking, and can disrupt sleep and productivity. The National Survey of Adult Oral Health 2004–06 indicates that of the Australian population: 17.4 per cent avoid foods due to dental problems; 15.1 per cent experience toothache; and 22.6 per cent experience orofacial (jaw) pain.32 Dental disease can also lead to destruction of soft tissues in the mouth, leading to lasting disability and, in rare cases, death.

      32 Harford, J. and Spencer A.J. Chapter 7 – Oral Health Perceptions, 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, pp.173–184.

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      Health and wellbeing

      Oral health is integral to general health. Tooth loss is directly associated with deteriorating diet and compromised nutrition,33 which can impair general health and exacerbate existing health conditions. Further, the mouth is often an entry point for infections, which may spread to other parts of the body.34 International research indicates there are associations between chronic oral infections and heart and lung diseases, stroke, low birth–weight and premature births. Associations between periodontal disease and diabetes have also been noted in international literature.35

      33 Locker, D. (1992), ‘The burden of oral health in a population of older adults’, Community Dental Health, June; 9(2), pp.109–24.
      34 US Department of Health and Human Services (2000), Oral health in America: A report of the Surgeon General, Rockville, MD: US Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health, pp.104–109.
      35 ibid, pp.109–123.

      Dental disease negatively impacts general quality of life, affecting not only physical wellbeing but also psychological and social wellbeing.36 The US Department of Health and Human Services notes these impacts include: “a tendency to avoid social contact as a result of concerns over facial appearance... [and]… persistent pain has similar isolating and depressing effects”. Further: “given the importance of the mouth and teeth in verbal and non–verbal communication, diseases that disrupt their functions are likely to damage self–image and alter the ability to sustain and build social relationships”.37 Dental disease can affect the way a person looks and sounds, with a significant impact on wellbeing – a person whose appearance and speech are impaired by dental disease can experience anxiety, depression, poor self–esteem and social stigma which in turn may inhibit opportunities for education, employment and social relationships.

      36 “The World Health Organization defined health as the ‘complete state of physical, mental, and social well–being and not merely the absence of infirmity’. Physical well–being assumes the ability to function normally in activities such as bathing, dressing, eating, and moving around. Mental well–being implies that cognitive faculties are intact and that there is no burden of fear, anxiety, stress, depression, or other negative emotions. Social wellbeing relates to one’s ability to participate in society, fulfilling roles as family member, friend, worker, or citizen or in other ways engaging in interactions with others.” ibid, p.133.
      37 ibid, p.137.

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      Financial

      The financial impact of oral disease for individuals includes the out–of–pocket costs for private care, estimated to be $4.698 billion per annum as at 2009–10. Acute dental conditions also can restrict the participation of adults in the workforce, including restricted duties and lost work days due to dental related illness.38

      38 US Department of Health and Human Services (2000), Oral health in America: A report of the Surgeon General, Rockville, MD: US Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health, pp.7 and 147.

      Children

      Children face the additional challenge of poor oral health and/or poor oral health habits having far reaching effects into their adulthood. Dental conditions in childhood can restrict children’s participation in schooling and education through days lost to illness. Impaired physical appearance due to dental disease can further limit children’s ability to socialise with confidence and develop social norms and relationships.

      Waiting lists

      For some Australians, the impacts of dental disease are magnified and prolonged because they are unable to afford private treatment and opt to go on public sector waiting lists for treatment. These people may wait significant periods for care, thereby worsening their oral health outcomes. Problems which could have been fixed relatively easily become more complex and costly to the individual. There are up to approximately 400,000 patients on public dental waiting lists; a figure which has been decreasing since 2004.39 However, the waiting time has been increasing – in South Australia, preschool children are waiting an average of over two years for general anaesthetic for dental treatment in public hospitals.

      39 Given inconsistent definitions and measures of waiting lists numbers across the states and territories, the estimate of 400,000 currently on public dental waiting lists is based on the best available data as gathered by the state and territory public dental services through the National Dental Directors Committee.