Patterns of dental visiting can have an important influence on an individual’s oral health.19 Regular dental visits and check-ups provide the opportunity for preventive care, early detection and treatment/management of disease, as well as monitoring and treatment of known problems. Individuals who visit regularly are more likely (than those who do not) to report that their oral health has a positive effect on their quality of life.20
Adults who usually made a dental visit once a year or more have fewer missing teeth on average (five) than those who usually visited once every two years (six) or less than once every two years (seven).21 There is also evidence to support that adults are increasingly making dental visits for check-up purposes. Data from the 2010 ARCPOH NDTIS shows that the proportion of adults making a dental visit in the previous 12 months increased from 55.4 per cent in 1994 to 60.5 per cent in 2010. Additionally, of those adults who made a dental visit, the proportion who last visited for a check-up increased from 46.3 per cent in 1994 to 59.8 per cent in 2010. Given the link between oral health and dental visiting, this can be expected to positively affect oral health outcomes.
Populations for specific action
The National Oral Health Plan 2004 – 2013 identified the following populations for specific action for improving oral health outcomes:
Regular dental visits in childhood are shown to be associated with better oral health in adulthood.22 The National Oral Health Plan 2004 – 2013 highlights that good oral health for children underpins good oral health throughout life – hence the focus on this group as a specific action area. Australian children overall enjoy high levels of oral health and access to dental care23, however there is room for improvement:
Untreated decay can be used as an indicator of a need or dental treatment, and in 2005 more than 40 per cent of Australian children aged five to six years had untreated decay, and nearly one-quarter (24.8 per cent) of children aged 12 years had untreated decay.24
In 2005 children aged five to six years living in lower socioeconomic status (SES) areas had more untreated decay than those from higher SES areas, and a mean number of decayed, missing and filled deciduous teeth about 70 per cent higher than those from the highest socioeconomic status areas.25
In 2005 children aged 12 years living in lower SES areas also had more untreated decay than those from higher SES areas, and a mean number of decayed, missing and filled permanent teeth about 70 per cent higher than those from the highest socioeconomic status areas.26
In 2010, the prevalence of dental visiting increased with age, with just over one-quarter of pre-school age children (those aged two to four years) having made a visit in the previous 12 months, compared with over three-quarters of school aged children (75.7 per cent of children aged five to 11 and 81.8 per cent of children aged 12 to 17).27
Australia’s population is ageing, and the trend to the retention of natural teeth brings a greater need for dental maintenance. For quality of life, older people need good oral health to be able to eat, speak and socialise, yet they are also shown to have poorer oral health outcomes compared with other age groups. For example, information shows:
While those aged 65 and over were most likely to have made a dental visit in the previous 12 months (66.9 per cent), they were the second most likely to have visited for a problem (44.0 per cent) and second least likely to have visited for a check-up (56.0 per cent).28
Those aged 65 and over had the highest average number of missing teeth (11.91) and the highest rate of inadequate dentition (fewer than 21 teeth).29
Those aged 65 and over were most likely to have had a tooth extraction than any other age group, with the most common reason for tooth extraction being decay and periodontal disease.30
Low income and socially disadvantaged people
Oral health services are primarily provided in the private sector, and it is the only place non-concession card holding adults, and those ineligible for other Commonwealth programmes, can access dental care. Private services have to be funded by individuals and families, and even for people with private health insurance, consumers can face relatively high out-of-pocket costs for dental services.31 Oral health outcomes for people with low income and at social disadvantage, which can include some people from non-English speaking backgrounds, homeless people, people in institutions or correctional facilities, can therefore be compromised. This is supported by information which showed:
The proportion of adults who made a dental visit in the previous 12 months reduced as annual household income reduced, and was lower for cardholders than non-cardholders.32
Of those who made a dental visit, lower income households were more likely to have visited for a problem, rather than a check-up.33
The average number of missing teeth was highest for adults from the lowest income households, and on average cardholders had more missing teeth than non-cardholders.34
Those in lower household income groups and cardholders were more likely to report they would have difficulty paying a $150 dental bill, that they had avoided or delayed visiting a dentist due to cost, that cost had prevented recommended treatment and that dental care had been a large financial burden.35
In the National Oral Health Plan 2004 – 2013, special needs refers to people with intellectual or physical disability, or medical or psychiatric conditions, that increase their risk of oral health problems or increase the complexity of healthcare.Good oral health for this population is important in supporting their overall health, independence and quality of life.36 Limited information exists on oral health outcomes for this population as a whole.
Some information is available from the 2010 ARCPOH NDTIS on people with a chronic condition (including asthma, cancer, heart disease, diabetes, arthritis, stroke, kidney disease, high blood pressure and depression). This showed people with a chronic condition were more likely to experience toothache, be uncomfortable with their oral appearance, to avoid certain foods due to oral problems and to experience orofacial pain. They were also more likely to have inadequate dentition (fewer than 21 teeth), which makes it difficult to chew food, than people with no chronic condition.37
The Australian Dental Association have also noted that special needs patients receive predominantly emergency care, rather than general dental care, access to care may be further limited as treatments required can be beyond the capacity of a private surgery setting, so treatment can often be through hospital admission or under general anaesthesia.38
The National Oral Health Plan 2004 – 2013 highlighted that with changes in lifestyle and dependence on new introduced foods, oral diseases are now common in most Aboriginal and Torres Strait Islander communities.
As for people with special needs, there is limited information on the oral health of Aboriginal and Torres Strait Islander people. The Australian Institute of Health and Welfare report Australia’s Health 2012 noted ‘although there have been a number of local studies of the oral health of Aboriginal and Torres Strait Islander people, there are a number of gaps in nationally representative data on their oral health. Methods used to collect data on adult oral health tend to under-represent Indigenous Australians, especially those living in remote locations. However, all comparisons point to poorer oral health among Indigenous Australians than other Australians. (Williams et al. 2011)
People living in rural and remote areas
People living in rural and remote areas are likely to experience poor access to dental services. With a positive link between dental visits and oral health, this poor access can result in poorer oral health outcomes. Less access to services and poorer oral health for people living in rural and remote areas is evidenced through a range of information.
Remote/very remote residents were the least likely to have made a dental visit in the previous 12 months (45.8 per cent) compared with 63.1 per cent in major cities, 55.7 per cent in inner regional areas and 54.1 per cent in outer regional areas.39
Of those who had a dental visit, as remoteness increased they were less likely to have visited for a check-up, and more likely to have visited for a problem.40
Remote/very remote residents had the highest number of missing teeth on average.41
ARCPOH’s 2008 report Improving Oral Health and Dental Care for Australians highlighted the rates of untreated caries in rural residents is 31.7 per cent compared with 24.8 per cent in urban residents, and the rate of moderate to severe periodontal disease is 32.8 per cent in rural residents compared with 26.1 per cent in urban residents.42
Additionally, the Australian Institute of Health and Welfare’s publication Dental Workforce 2012 highlights that for almost all of the registered oral health workforces (except dental therapists), the full-time equivalent rate per 100,000 population for each practitioner type is lowest in remote and very remote areas.