Good oral health and strong teeth are essential for being able to consume and digest nutritious foods. Digestion of food begins in the mouth when food is chewed and mixed with saliva.
Aboriginal people had almost no dental decay or gum disease when eating a traditional diet which had a very low sugar content. Food was natural and unrefined and required lengthy and vigorous chewing. The chewing stimulated health promoting saliva and helped keep teeth clean.
People still got dental abscesses and toothache because teeth were worn right down to the gum level by coarse bush food and grit in food that had been processed. Aboriginal people used their teeth as 'tools' and a third hand, causing added wear to their teeth. Tooth loss also resulted from injury and extraction for ceremonial purposes.
Many Aboriginal children and adults have poor dental health as a consequence of:
Good oral health is important for good health in general... Dental caries (decay) and periodontal (gum) disease can cause pain and tooth loss. "The economic cost of dental decay in Australia is of the same order as heart disease and diabetes (Dooland 1998:4)." Poor oral health can contribute to a number of medical conditions and make them worse.
In 1996, Aboriginal children had three to four times the decay rate in deciduous teeth and a higher mean number of decayed permanent teeth compared to non-Aboriginal children (Australian Institute of Health and Welfare, Dental Statistics and Research Unit 1999:4). Levels of tooth decay vary from individual to individual, family to family, and to an extent, community to community. Variations are influenced by:
Bacteria in the mouth produce acid after a person eats food or drinks fluid containing sugar. Unless removed, this acid can destroy the protective enamel covering teeth, thus causing decay. Decay causes severe pain which impacts upon the ability of people to enjoy life and be productive. Decay can cause loss of teeth which impacts upon ability to eat, nutrition in general and speech.
If teeth are not brushed and plaque is left around the gum margins, gingivitis results. Gum margins look red, swollen and bleed when pressed or when teeth are brushed. A majority of adults and children from eight or nine years of age onwards have some degree of gingivitis.
Gingivitis is generally painless and almost harmless, though it can be a worry to children or adults who have just started brushing their teeth and find blood on their brushes or in their spit. Swollen gums and plaque build-up may create a niche for decay to occur and may predispose to more severe disease. It may also cause bad breath.
Prevention includes removal of plaque by properly brushing the teeth and gums with a soft toothbrush for two to three minutes once or preferably twice each day. Staff may need to give people special encouragement and support so they carry on brushing effectively when their gums are inflamed.
Periodontal disease is a separate disease from gingivitis, caused by different bacteria. It is a progressive disease which causes loss of bone around the teeth and the destruction of the ligaments that attach the roots of the teeth to the underlying bone.
The rate and severity of periodontal disease can vary greatly. Some young adults, especially those with diabetes, may have severe bone loss, tooth mobility and pain when eating. Many middle aged people may have only limited bone loss, gum recession and no pain. Most older Aboriginal people suffer quite badly from periodontal disease. Very often they have almost no bone left around the roots of teeth and may have to attend the dentist for extraction of one or more painful teeth.
Prevention of periodontal disease includes:
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See also 'Key messages about teeth' in Section 2 of this chapter |
Fluoride is incorporated into the enamel of growing teeth and makes them resistant to decay. Fluoride toothpastes are an additional source of fluoride which toughens the surface of teeth, making them much more resistant to acid produced by bacteria in plaque.
Fluoride occurs naturally in the soil, in many foodstuffs and in water. The fluoride levels in bore water vary greatly in the NT. Some communities in the Top End rely on water from rivers and reservoirs which have low fluoride concentrations. Because the NT has a predominantly warm to very hot climate, the recommended fluoride concentration in drinking water is 0.4 to 0.6 mg/L (ppm). Where there is inadequate fluoride in the water supply, THS encourages community residents to consider ways to incorporate adequate fluoride in their diets and to discuss the issue with their local oral health team.
If there is too much fluoride when teeth are developing, 'fluorosis' or mottling of the teeth occurs. In mild cases, there is white flecking of the teeth. In more severe cases, teeth are 'rusty' brown coloured, pitted and soft. Tea is very rich in fluoride and can cause fluorosis if drunk regularly by small children.
A good diet of healthy food is essential for developing and maintaining strong teeth and healthy gums. It is important to drink six to eight glasses of water a day.
Tooth-brushing is not yet generally practised in remote communities. As a rule, tooth decay and gum disease are more likely to occur if teeth are not brushed regularly. All teeth surfaces and gum margins should be brushed with a soft toothbrush for two to three minutes at least once a day to remove as much soft food and debris (plaque) as possible. Fluoride toothpaste should be used unless people live in Tennant Creek and Alekarenge where there is excessive natural fluoride in the water.
THS provides free oral health services to all people who live in remote communities who do not have access to a private service.
The Oral Health Program supports the philosophy of Primary Health Care. Key elements are:
In the Top End, many health centres have oral health facilities and dentists and dental therapists visit regularly. In Central Australia, health centres do not have these facilities. Oral Health teams visit communities in trucks especially adapted as a mobile clinics. The team stays for three to four days at a time to enable people to access care.
The following groups have particular oral health needs:
Although calcium cannot be removed from the mother's teeth by the foetus, the woman's diet should be adequate to protect her own health. Hormonal changes during pregnancy can cause gums to become swollen and bleed readily. Good brushing every day can reduce the severity of this pregnancy gingivitis.
Deciduous or first teeth are important. Tooth decay can affect growth and development of children. If teeth are lost early, speech development can be affected and space for permanent teeth can be lost. Prevention of tooth decay and early intervention are important.
Preventive measures include:
Prevention and early intervention are priorities because infants with significant decay require evacuation to hospital for treatment under general anaesthetic with its associated risks. The number of children requiring a general anaesthetic for dental treatment is increasing: 1997=58; 1998=85; 1999=67 and another 20 on the waiting list.
Prevention of decay through:
With their new permanent teeth, it is important for young people to practice and establish preventive measures for oral health (diet, tooth-brushing, non-smoking). Regular check-ups to ensure any problems are identified and treated early are also important.
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See the contact numbers at the end of Section 2 of this chapter | |