Position Summary
Research must be funded to better understand the dental needs and issues of Aboriginal and Torres Strait Islander people. Steps must be taken to address the social, cultural, economic, and geographical disadvantages suffered by these groups that negatively impact on their oral health.
1. Background
1.1. Oral diseases are more prevalent in Indigenous Australians than non-Indigenous Australians. In addition, they may have reduced access to oral health care. Both of these issues contribute to serious ill-health and lower life expectancy of Aboriginal and Torres Strait Islander people (“the 17-year life gap”).
1.2. In the 2016 census there were 798,400 people identified as being of Aboriginal and Torres Strait Islander origin and over a third lived in major city areas.
1.3. The Indigenous population is much younger overall than the non-Indigenous population. The median age of the Aboriginal and Torres Strait Islander population at 30 June 2016 was 23.0 years, compared to 37.8 years for the non-Indigenous population.
1.4. Compared to non-Indigenous Australians:
• Indigenous children have approximately twice the caries experience and more untreated carious lesions than non-Indigenous children, and caries experience in children is rising.
• Indigenous adults have more missing teeth.
• periodontal disease is more prevalent for Indigenous Australians and evident in younger populations.
• non-insulin dependent diabetes, smoking, poor oral hygiene and infrequent dental care are more common in Indigenous people, leading to more rapid progress of periodontal disease.
• Indigenous adults are at a much higher risk of exacerbating diabetes and related conditions from uncontrolled periodontal disease which also reduces the effectiveness of chronic disease treatment.
• Aboriginal and Torres Strait Islander people are at increased risk of rheumatic heart disease.
1.5. The social and cultural determinants of oral health are an important factor in Indigenous oral health.
1.6. Access to affordable, culturally and emotionally appropriate and acceptable dental care is difficult for most indigenous Australians. Attendance is generally problem-based and often results in tooth loss rather than oral health maintenance.
1.7. The representation of Indigenous practitioners within the oral health workforce is lower than their representation within the Australian population.
1.8. The Policy Statement reflects the “Close the Gap, Indigenous Health Equality Summit, Statement of Intent” (Appendix) to which the ADA is a signatory. The statement is as follows:
“This is a statement of intent – between the Government of Australia and the Aboriginal and Torres Strait Islander Peoples of Australia, supported by non-Indigenous Australians and Aboriginal and Torres Strait Islander and non-Indigenous health organizations to work together to achieve equality in health status and life expectancy between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians by the year 2030."
1.9. The Policy Statement also reflects the principles that guide the National Aboriginal and Torres Strait Islander Health Plan 2013 – 2023.
2. Position
Research
2.1. Research that enhances a better understanding of Indigenous oral health issues should address:
• a national survey of the levels of oral diseases, perceptions of oral health and patterns of accessing dental care among Indigenous adults as per the National Survey of Adult Oral Health;
• the consequential health and social effects of oral diseases over the lives of Indigenous people;
• the barriers and facilitators to accessing both problem-based and regular prevention focused oral health care; and to responding to oral health promotion strategies outlined below;
• the building of a national evidence base which describes the most effective Indigenous oral health promotion activities and programs, particularly within primary health care services;
• the best practice combination of primary health care services and oral health care services that will deliver equitable and effective oral health services that meet the oral health needs of Indigenous people;
• evidence-based, best practice protocols for the clinical prevention and treatment of oral diseases, particularly periodontal disease in diabetic people; and
• the social and cultural determinants of Indigenous oral health.
Oral Health Promotion
2.2. Oral health promotion and oral health care need to be integrated within targeted primary health care programs and services, in particular, in Aboriginal and Torres Strait Islander community-controlled health services.
2.3. The following known effective strategies need special modification to target the social, cultural, economic and geographic disadvantage suffered by Indigenous people:
• community water fluoridation of all Indigenous communities with a population of 500 or more;
• promotion of fluoride usage, such as fluoridated toothpaste and professional application of fluoride varnish;
• education relating to diet and nutrition;
• oral hygiene instruction;
• discouragement of tobacco use and betel nut use;
• trauma prevention and management; and
• minimisation of alcohol, drug and substance abuse.
2.4. The following social and cultural determinants of Indigenous oral health should be addressed:
• access to affordable healthy food, such as fresh fruit and vegetables;
• reduce access to and consumption of sugars, especially sugar sweetened beverages;
• access to oral hygiene products;
• places for the storage of oral hygiene products;
• adequate hygiene facilities;
• adequate housing; and
• education.
Delivery of Oral Health Care
2.1. The social and cultural determinants of Indigenous oral health need to be recognised and addressed.
2.2. Aboriginal and Torres Strait Islander people need to be actively involved in the design, delivery and control of future services.
2.3. The participation of Indigenous practitioners within the oral health workforce should be encouraged.
2.4. In conjunction with research programs to guide planning and development, it is recognised that all members of the primary care workforce, teachers, childcare providers and other relevant service providers need better training and knowledge of primary oral health care.
2.5. Policy makers and senior managers within primary health care services need to be trained and made accountable for planning and funding of oral health care services and oral health outcomes.
2.6. There should be increased identification of Indigenous Australians as suitable members of the dental workforce and granting of special places and additional support for them in the vocational and higher education sectors.
2.7. Training in cultural safety to raise awareness of oral health and social issues among Indigenous people should be provided to undergraduate, postgraduate and continuing professional development programs.
2.8. Government should support and encourage dental schools and the dental workforce to work with Indigenous community controlled health services and within Indigenous communities.
