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The two main forms of oral disease are dental caries (tooth decay) and periodontal disease (a group of inflammatory diseases of the gum, connective tissue and dental bone) . Oral disease also incorporates a number of other conditions, such as mouth ulcers, oral cancers, tooth impactions and misaligned teeth, and traumatic injuries to the teeth and mouth. However, oral health is a broader concept than simply the absence of disease—it covers the ability to eat, speak and socialise without discomfort or active disease in the teeth, mouth or gums .
Since the 1970s, significant effort has gone into understanding the relationship between oral health and general health and wellbeing, which has expanded on the biomedical and clinical perspective to build a broader understanding of oral health-related quality of life [4, 8, 6]. Oral health can be affected by biomedical risks accumulated over a lifetime, as well as clinical conditions or age-related functional impairment, but oral health-related quality of life also considers its psychosocial aspects and impacts [5, 7].
In Australia, there are two main sources of information on the oral health of people aged 65 and over that capture some aspects of oral health-related quality of life. The National Survey of Adult Oral Health (NSAOH) collects comprehensive information from Australians aged 15 years and over, across all states and territories, through a combination of interviews and dental examinations. The first NSAOH was conducted in 1987–88 and the second (and most recent) was conducted in 2004–06. Results from this survey were presented in Older Australia at a glance (fourth edition) .
The second main source of information is the National Dental Telephone Interview Survey (NDTIS), which is conducted every 2 to 3 years and collects oral health and dental care information from a random sample of Australians aged 5 years and over. The first survey was run in 1994 and the most recent in 2013. The NDTIS uses a number of self-reported measures—such as those detailed in Table 1. These are rated in five categories (‘very often’, ‘often’, ‘sometimes’, ‘hardly ever’, and ‘never’) .
In 2013, around 1 in 7 (16%) dentate people aged 15 years and over reported experiencing toothache—ranging from just under 1 in 10 (9%) people aged 65 and over (similar to 2010 findings in which 10% aged 65 and over reported experiencing toothache) to just over 2 in 10 for those aged 25–44 years [1, 2]. Older people who were not-insured were more likely to report experiencing toothache than those who were (10% compared to 8%) as were those older people eligible for public dentail care compared with those who were not (9% and 8%, respectively). Household income also impacted the likelihood of older people reporting toothache, with those in the lowest annual household income bracket (<$30,000) being almost twice as likely to report experience toothache as those in the highest household annual income bracket ($140,000+) 11% compared with 6% (Table 1).
In 2013, just over one-quarter (27%) of people aged 15 years and over reported that they felt uncomfortable with their dental appearance—ranging from 2 in 10 people aged 65 and over (22%, down from 24% in 2010) to 31% for those aged 45–64 [1, 2]. There was little difference for this measure across annual household incomce, insurance status or eligibility for public dental care—however, woman aged 65 and over were more likely to report feeling uncomfortable with their dental appearance than men (26% compared with 17%) and older people in Remote/Very remote areas were more likely to report feeling uncomfortable with their dental appearance than those in Major cities (37% compared with 21%) (Table 1).
In 2013, 20% of people aged 15 years and over reported avoiding eating some foods due to issues with their teeth—ranging from 15% of people aged 15–24 to 24% of those aged 65 and over (up from 19% in 2010) [1, 2]. For people aged 65 and over women were more likey to report avoiding certain foods due to issues with their teeth than men (26% compared with 20%) and those living in Major citites were much more likely to report avoiding certain foods than those in Remote/Very remote areas (24% compared with 9% (Table 1).
Sources: AIHW .
The NDTIS also collects information on people’s perceptions about their need for dental treatment. In 2013, the most common perceived need for treatment was a dental check up, with half (50%) of people aged 65 and over reporting this, followed by a scale and clean (44%), a denture (17%), and gum treatment (6%) .
For information on older people’s use of dental services, see Dental services.
Although data on oral health-related quality of life is limited with respect to older Australians, research has identified oral conditions and diseases that have the greatest impact on older people’s day-to-day lives [5, 8]. This section explores the occurrence of some of these conditions as indicators of the oral health of older Australians.
There are two main types of tooth loss—edentulism (having no natural teeth) and accumulated tooth loss (teeth are lost gradually over time) . Edentulism can involve full or partial loss, full edentulism usually involves a decision to remove all remaining natural teeth (including some healthy teeth). Research has shown that removal decisions are often related to disease or social norms, and while edentulism can resolve persistant dental issues and discomfort, it is also associated with poorer quality of life, particularly in relation to nutritional and social health [5, 8].
In 2013, 1 in 5 (19%) people aged 65 and over had no natural teeth . However, the rate of edentulism has been decreasing over time: for example, the proportion of people aged 75 and over who had lost all their teeth declined from 36% in 1987–88 to 28% in 2010 [2, 3].
In younger people, accumulated tooth loss is a strong predictor for poorer oral health-related quality of life. Research has also indicated that tooth loss over time is an ongoing issue for older people, and there is an association between missing teeth and age [5, 8], as well as missing teeth and oral health-related quality of life .
The average number of missing teeth for people aged 65 and over in 2013 was 10.8 (the number of missing teeth was derived from a self-reported number of natural teeth and includes all missing teeth, regardless of reason) . On average, women had a slightly higher number of missing teeth than men (11, compared with 10.6), and the average number of missing teeth was also affected by a number of socio-demographic factors, particularly remoteness and income (Figure 1).
Source: AIHW .
Older people living in Remote or Very remote areas had a higher average number of missing teeth (12.7) than those in Major cities (10.4). In addition, the average was higher for those without insurance than those with (12.8 and 8.9, respectively), those eligible for public dental care than those who were ineligible (11.8 and 8.6, respectively), and those living in households with an annual income below $30,000 than those with an annual household income of $140,000+ (12.3 missing teeth compared with 4.9) .
Dental caries (tooth decay) is the most commonly occurring dental condition. Dental plaque—a bacterial layer that forms on the tooth—causes the demineralisation of the structure, which results in decay . In 2010, for dentate people aged 65 and over, tooth decay was the most commonly reported reason (44%) for a tooth extraction .
Dental caries experience in adults—represented by the term DMFT— is measured by the number of teeth (T) that are decayed (D), missing due to decay (M) and/or filled due to decay (F). For people aged 65 and over, missing teeth due to decay contributed the most towards their DMFT score (Table 2) .
Source: AIHW .
Periodontitis (also known as gum disease or periodontal disease) is the inflammation of dental tissue and bone caused by bacteria. It can affect the connective tissue—particularly the gum and ligaments—and bone that support the tooth, and can develop ‘pockets’ or gaps between the tooth and surrounding gum. In severe cases, there can be extensive loss of tissue and bone, which can cause teeth to become loose or fall out .
Older people are at higher risk of periodontitis, and are more likely to experience advanced forms of the disease. This may be due to the accummulation of risk factors and longer-term exposure to periodontal bacteria—smoking, diabetes, obesity, osteoporosis, and heart disease all increase the risk of periodontitis, and the length of time a person is exposed to periodontal bacteria may increase the severity of the disease [5, 8]. According to the last National Survey of Adult Oral Health 2004–2006, 53.4% of people aged 65 and over had periodontal disease, compared with 2.7% of people aged 15–24 . In 2010, for dentate people aged 65 and over .
In Australia, oral conditions and diseases have considerable social and economic impact. In 2013–14, dental conditions were responsible for more than 8,000 hospital separations for people aged 65 and over, where the hospitalisation was considered potentially preventable. Although the number of potentially preventable hospital separations for older people due to dental conditions increased by 38% between 2007–08 and 2013–14, the separations rate only increased from 2.1 to 2.4 per 1,000 people aged 65 and over (Figure 2) .