Dental and oral health

Introduction

Untreated dental decay is the most common health condition worldwide.¹ Oral diseases effect nutritional intake, the ability to socialise and work without pain or embarrassment,² and are associated with several chronic diseases, including diabetes, stroke, cardiovascular and lung diseases and adverse pregnancy outcomes.³ Although largely preventable, socioeconomic inequalities and inadequate prevention and treatment contribute to ongoing high levels of oral disease. Oral health outcomes improve with good oral hygiene and nutrition, regular dental visits with the first visit before 2 years of age, and access to fluoride through community water supplies and oral care products.⁴

Oral health burden

Oral diseases form the 5th highest burden of non-fatal disease in Queensland males 5 to 9 years, and 6th for females, in 2018.⁵ The number and standardised rate for years of healthy life lost nationally in 2022 were 129,174 years (standardised rate 4.5 per 1,000 persons).

Nationally, total healthcare expenditure on oral disorders was $7.786 billion in 2019–20.⁶

Diseases

Dental decay

Dental decay is used as an overall measure of dental health and is measured as either:

• the presence of decay without treatment
• decay experience.

Decay experience measures primary (baby) and/or secondary (adult) teeth that are decayed, filled or are missing due to decay to represent the cumulative impact of decay.

Dental decay in Queensland children and across Australia has not been recently measured at a population level, with the most recent population study in Queensland in 2010–12 for children 5 to 14 years.⁷ This study reported:

• 1-in-2 (53.7%) had teeth affected by dental decay in their teeth (Figure 1a), including:
  • 1-in-2 children 5 to 10 years with decay experience in their primary teeth
  • 1-in-3 children 6 to 14 with decay experience in their secondary teeth
  • 1-in-3 (29.9%) had untreated decay in their primary teeth, and 1-in-10 (12.9%) in their secondary teeth (Figure 1b),
• Queensland had the 2nd highest proportion of children with decay experience (50.2%) and untreated decay (29.9%) in their primary teeth, second only to Northern Territory (53.1% and 39.5%, respectively),
• 1-in-3 children 6 to 14 years had decay experience in their permanent teeth and 12.9% had untreated decay (Figure 1b), a higher level of decay compared to most other states and territories.

The impact of dental decay in adults was last measured in Australia over 2017 and 2018,⁸ and the study showed that in Queenslanders aged 15 years and over:

• 9-of-10 (89.1%) had decay experience (Figure 1a)
• 1-in-4 (22.6%) had untreated decay (Figure 1b)
• An average of 12 teeth were affected by decay (decay experience)
• Decay experience improved slightly since the previous oral health study in 2004–06:
  • The average number of teeth affected by decay decreased from 13.1 to 11.6
  • The proportion of adults affected by decay dropped from 91.0% to 89.1%.^8,9

Tooth loss

Teeth are important to eat, talk and socialise. Of the 32 teeth in usual adult dentition, 21 are required for functional chewing, diet and nutrition, and having less than 10 teeth (severe tooth loss) significantly affects diet and may lead to malnutrition or obesity. Teeth are mostly lost due to decay, however periodontitis (severe gum disease) and trauma also cause tooth loss. The recent Australian adult oral health study reported:⁸

• 1-in-10 (10.1%) Queensland adults have less than the required number of teeth for functional chewing, similar to that reported for all Australians (10.2%)
• 2.7% of Queenslanders have severe tooth loss

Gum disease

Gum disease is caused by bacteria that accumulate in dental plaque. Periodontitis is a serious gum infection, involving inflammation of the gums and other tissues around the tooth, the loss of attachment of teeth from the gum and loss of bone. Periodontitis may also lead to abscesses and cause pain, and in severe circumstances may lead to loss of teeth.¹⁰

On a population level, severe gum disease is measured as ‘moderate/severe periodontitis’ and relates to the level of loss of attachment of the gum to teeth. In a recent adult oral health survey 37.1% of Queensland adults 15 years and older had moderate/severe periodontitis, compared to 30.1% across Australia. Gum disease increases with age—in Queensland adults 75 years and older the prevalence of moderate/severe periodontitis in Queensland was 69.0%, comparable to the national prevalence of 69.3%.⁸

Hospitalisations for dental conditions and dental decay

There were 35,614 hospitalisations due to dental conditions in 2020–21 by Queensland residents to Queensland hospitals. Dental decay makes up 20% of hospitalisations due to dental conditions and is disproportionate across ages and vulnerable populations.

In 2020–21, Queensland hospitalisations for dental conditions were (Figure 2):

• over one-third (38%) were due to dental conditions in children 0 to 19 years (5,296 in children 0 to 9 years and 8,183 children 10 to 19 years)
• in children 0 to 9 years, the hospitalisation rate was 1.5 times higher for First Nations children compared to other Queensland children (1181.9 and 775.6 per 100,000 population, respectively)
• the hospitalisation rate for dental conditions had increased among all age groups (Figure 2a, 2b, 2c) when compared to 2018–19.

Regarding hospitalisations due to dental decay in Queensland in 2020–21:

• there were 7,249 hospitalisations due to dental decay in Queensland in 2020–21, being 20% of all hospitalisations for dental conditions (Figure 3)
• Over half of the hospitalisation for dental decay were in children aged 0-9 years (51%: 3,709/7,249)
• For children aged 0-9 years hospitalisations due to dental decay made up 70% of hospitalisations for dental conditions.

Additional information

Data and statistics

For more information, visit:

• Australia’s National Oral Health Plan 2015–2024
• The World Health Organisations Global oral health status report: towards universal health coverage for oral health by 2030

Section technical notes

Where presented, ratios were calculated using higher precision estimates than in text. Ratios calculated using estimates in text may differ.

Hospitalisation data reported in this section were sourced from the Queensland Hospital Admitted Patient Data Collection (QHAPDC). Individual record in the QHAPDC are episode-based, meaning that multiple episodes from the same person will be counted each time.

Separations for interstate residents, public psychiatric hospitals, and those flagged as unqualified newborns, organ donors or boarders are excluded. Records from 47 previously declared hospitals are excluded.

References

1. Peres M.A., Macpherson L.M.D., Weyant R.J., Daly B., Venturelli R., Mathur M.R., Listl S., Celeste R.K., Guarnizo-Herreño C.C., Kearns C., Benzian H., Allison P. & Watt R.G. 2019. Oral diseases: a global public health challenge. The Lancet. 394(10194): 249–260. doi: 10.1016/S0140-6736(19)31146-8.
2. Council of Australian Governments Health Council. 2015. Australia’s National Oral Health Plan 2015-2024. Adelaide: Australian Government.
3. Dörfer C., Benz C., Aida J. & Campard G. 2017. The relationship of oral health with general health and NCDs: a brief review. International Dental Journal. 67: 14–18. doi: 10.1111/idj.12360.
4. National Oral Health Promotion Clearing House. 2011. Oral health messages for the Australian public. Findings of a national consensus workshop#: Oral health messages for the Australian public. Australian Dental Journal. 56(3): 331–335. doi: 10.1111/j.1834-7819.2011.01339.x.
5. Australian Institute of Health and Welfare. 2018. Burden of disease. Accessed: March 7, 2023.
6. Australian Institute of Health and Welfare. 2022. Disease expenditure in Australia 2019-20. Accessed: December 20, 2022.
7. Do L.G. & Spencer A.J. (Eds). 2016. Oral health of Australian children: The National Child Oral Health Study 2012–14. University of Adelaide Press.
8. Brennan D.S., Chrisopoulos S., Do L.G., Ellershaw A., Luzzi L. & Peres M. 2019. Australia’s oral health: national study of adult oral health 2017-18. Adelaide: Australian Research Centre for Population Oral Health.
9. Dental Statistics and Research Unit. 2008. The national survey of adult oral health 2004–06: Queensland. Cat. no. DEN 178. Dental Statistics and Research Series no. 42. Canberra: AIHW.
10. Victoria Department of Health. 2022. Gum disease. Accessed: March 7, 2023.