Dental and oral health

Introduction

Oral diseases, including tooth decay, gum disease, and oral cancers, affect almost half of the global population, with untreated dental decay the most common health condition worldwide.¹ Based on these figures, oral health has been declared an urgent public health challenge.²

Oral diseases affect nutritional intake, the ability to work and socialise without pain or embarrassment,³ and are associated with several chronic diseases, including diabetes, stroke, cardiovascular and lung diseases, and adverse pregnancy outcomes.⁴ Although largely preventable, socioeconomic inequalities and inadequate prevention and treatment contribute to ongoing high levels of oral disease.³ Oral health outcomes improve with good oral hygiene and nutrition, regular dental visits with the first visit at 12 months of age, and access to fluoride through community water supplies and oral care products.⁵

In 2024, health burden from oral disorders accounted for 131,935 disability-adjusted life years nationally with an age-standardised (ASR or standardised rate) of 4.5 per 1,000 persons.⁶ In Queensland, oral disorders were the 5th highest ranked disease group for non-fatal disease burden in males 5 to 9 years, and 6th for females of the same age in 2018.⁷

In 2022–23, total spending on dental services amounted to $12.511 billion in Australia. Queensland’s expenditure was $1.782 billion, of which the Australian Government funded $276 million (15.5%) and the State and Local Governments funded $221 million (12.4%). Almost half of dental expenditure was out-of-pocket costs for individuals at $777 million (43.6%). Out-of-pocket costs were notably higher for dental services compared to primary medical services. For example, individual’s out-of-pocket costs for primary medical services made up only 10.6% of expenditure on these services.⁸

Diseases

Dental decay

Dental decay (also known as dental caries) is used as an overall measure of dental health and is measured as either:

• the presence of decay that hasn’t been treated
• as decay experience.

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

Children

In children, the impact of dental decay was measured across Australia over 2012–2014. At that time, 1-in-2 (50.2%) Queensland children 5 to 10 years had decay experience in their primary teeth, which was higher than the national average (41.7%) and second only to Northern Territory (53.1%).⁹

The study also found that for Queensland (Figure 1):

• 1-in-3 (29.9%) children 5 to 10 years had untreated decay in their primary teeth
• 1-in-3 (30.7%) children 6 to 14 years had decay experience in their permanent teeth, including 1-in-10 (12.9%) with untreated decay.

Across Queensland, the prevalence of decay experience varied by geographical regions:

• For children 5 to 10 years, the prevalence in primary teeth was—39.3% in the Townsville region, 57.2% in the rest of Northern Queensland, 46.0% in Brisbane, and 50.1% in the rest of South East Queensland.
• For children 6 to 14 years, the prevalence in permanent teeth was—22.3% in the Townsville region, 30.3% in the rest of Northern Queensland, 30.4% in Brisbane, and 29.4% in the rest of South East Queensland.

Dental decay in Queensland children was more recently measured in 2024 with results expected to be published this year.

Adults

In adults, dental decay was last measured in Australia over 2017 and 2018.¹⁰ The study showed that for Queenslanders 15 years and over:

• 9-in-10 (89.1%) had decay experience, including 1-in-4 (22.6%) with untreated decay (Figure 1)
• an average of 12 teeth were affected by decay (decay experience).

Decay experience improved slightly since the previous oral health study in 2004–2006:

• The average number of teeth affected by decay decreased from 13.1 to 11.6 teeth.
• The proportion of adults affected by decay dropped from 91.0% to 89.1%.^10,11

Figure 1: Dental decay experience and untreated decay in Queensland and Australia

Tooth loss

Teeth are important to eat, talk and socialise. Twenty-one teeth are considered necessary for functional chewing, diet and nutrition, and having less than 10 teeth 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 2017–18 Australian adult oral health study reported that:¹⁰

• 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 (had fewer than 10 teeth).

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 bone loss. Periodontitis may also lead to abscesses and cause pain, and in severe circumstances it may lead to loss of teeth.

In the most recent adult oral health study in 2017–2018, 37.1% of Queensland adults 15 years and over had severe gum disease, compared to 30.1% across Australia. Gum disease increases with age—the prevalence of severe gum disease in adults 75 years and over was 69.0% in Queensland and 69.3% nationally.¹⁰

Potentially preventable hospitalisations for dental conditions and dental decay

Hospitalisations for dental conditions, including dental decay, are regarded as potentially preventable hospitalisations (PPHs). PPHs are seen as a measure of access to primary health care, however, for dental conditions, PPHs also reflect access to hospital care. Higher access to hospital treatment for dental conditions may result in a higher number of PPHs.

Australia-wide, hospitalisations for dental conditions were the most common PPH in 2021–22 at a rate of 3.1 per 1,000 population.¹² In Queensland, the rate of hospitalisations for dental conditions was higher at 3.6 per 1,000 persons for the same period.

In 2022–23, among Queensland residents there were 20,599 hospitalisations due to dental conditions in Queensland:

• a quarter (24.9%) were in children 0 to 9 years (Figure 2)
• the hospitalisation rate was higher for all age groups compared to 2018–19 (Figure 2)
• one-third (34.6%) were for dental decay (Figure 3).

Figure 2: Queensland hospitalisations for dental conditions, 2018–19 and 2022–23

Of the hospitalisations for dental decay (data not shown):

• the standardised rate of hospitalisations for dental decay has increased by 27.8% from 2018–19 (3.0 per 1,000 to 3.9 per 1,000 persons)
• over half (52.7%) were for children 0 to 9 years (Figure 3), with the rate of hospitalisation increasing by 34.1% from 2018–19 to 2022–23 (4.3 and 5.8 per 1,000 persons, respectively).

Figure 3: Queensland hospitalisations due to dental conditions and dental decay, 2022–23

Prevention

To maintain good oral and dental health, Queenslanders can:

• brush teeth twice daily with age appropriate fluoride toothpaste
• visit a dental practitioner for regular dental and oral health check-ups
• access fluoride through fluoridated water and oral care products.

To support oral health behaviours and promotion, 11 evidence based oral health messages for Australia were developed by consensus by leading experts.⁵

Community water fluoridation

Water fluoridation is a safe, effective and inexpensive public health strategy to help prevent tooth decay. Decay experience among children is higher in areas where residents do not have access to a fluoridated water supply, including in Queensland, even after accounting for other sociodemographic and environmental risk factors.¹³

Nationally, about 89% of the population has access to a fluoridated drinking water supply. In Queensland approximately 72% of the population has access to fluoridated drinking water,¹⁴ although access to fluoridated drinking water varies significantly by geographic regions. A recent study found that people living in lower socioeconomic status areas are less likely to have access to fluoridated drinking water.¹⁵

Additional information

Strategies and information

For more information, visit:

• Queensland Health Oral health website
• Queensland Health’s Statewide oral health services plan
• Oral health messages for Australians
• Australia’s National Oral Health Plan
• World Health Organization’s Global strategy and action plan on oral health 2023–2030

Section technical notes

ASpR refers to age-specific rates.

Age-standardised rates were calculated by standardising to 2001 Australian standard population.

Hospitalisation data reported in this section were sourced from the Queensland Hospital Admitted Patient Data Collection (QHAPDC). The QHAPDC is episode based, meaning that multiple episodes from a single person will be counted in a reporting period. Separations from interstate residents, public psychiatric hospitals, and those flagged as unqualified newborns, organ donors or boarders are excluded.