Oral health trends among adult public dental patients

DENTAL STATISTICS & RESEARCH Oral health trends among adult public dental patients DS Brennan, AJ Spencer

DENTAL STATISTICS AND RESEARCH SERIES Number 30 Oral health trends among adult public dental patients Dr David S Brennan Professor A John Spencer 2004 AIHW cat. no. DEN 127

Australian Institute of Health and Welfare 2004 This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part may be reproduced by any process without prior written permission. Requests and enquiries concerning reproduction and rights should be directed to the Director, AIHW Dental Statistics and Research Unit, Dental School, The University of Adelaide, South Australia 5005. This is the thirtieth publication in the Australian Institute of Health and Welfare s Dental Statistics and Research Series. A complete list of the Institute s publications is available from the Media and Publishing Unit, Australian Institute of Health and Welfare, GPO Box 570, Canberra ACT 2601, or via the Institute s website (http://www.aihw.gov.au). ISSN 1321-0254 ISBN 1 74024 359 5 Suggested citation AIHW DSRU: Brennan DS & Spencer AJ 2004. Oral health trends among adult public dental patients. AIHW cat. no. DEN 127. Canberra: Australian Institute of Health and Welfare (Dental Statistics and Research Series No. 30). Published by the Australian Institute of Health and Welfare Printed by Elect Printing

Contents List of tables...vi List of figures... viii Summary... ix Edentulism... ix Caries experience... ix Decayed teeth... ix Missing teeth... ix Filled teeth... x DMF teeth... x Periodontal status... xi Abbreviations and symbols...xii Abbreviations of places... xii Acknowledgements... xiii 1 Background... 1 1.1 Public dental patients... 1 1.2 Background: oral health data on public dental patients... 1 1.3 Purpose of the survey... 2 1.4 Structure and themes... 2 2 Methods... 3 2.1 Data collection... 3 1995 96...3 2001 02...3 2.2 Sampling rates... 4 Rationale for sampling rates... 4 Weighting... 4 2.3 Data items... 4 Caries experience... 4 Periodontal status... 4 Visit type...5 Location...5 Oral health trends among adult public dental patients iii

2.4 Sample yield... 5 Obtained yield... 5 Tooth status... 6 3 Sociodemographic and visit details... 7 4 Oral health... 8 4.1 Edentulism... 9 Edentulism 1995 96 and 2001 02: by age... 9 Edentulism 1995 96 and 2001 02: by age and type of care... 10 Edentulism 1995 96 and 2001 02: by age and location... 12 4.2 Caries experience... 14 Caries experience 1995 96 and 2001 02: by age... 14 Caries experience 1995 96 and 2001 02: by age and type of care... 16 Caries experience 1995 96 and 2001 02: by age and location... 20 4.3 Periodontal status... 24 Periodontal status 1995 96 and 2001 02: by age... 24 Periodontal status 1995 96 and 2001 02: by age and type of care... 25 Periodontal status 1995 96 and 2001 02: by age and location... 27 5 Discussion... 29 5.1 Interpretational issues... 29 Monitoring survey approach... 29 Study population... 29 Comparison with population-based studies... 29 Geographic coverage... 30 Survey participation... 30 State/territory-specific findings... 30 5.2 Oral health findings... 30 Edentulism... 30 Caries experience... 31 Periodontal status... 32 5.3 Discussion of main findings... 32 Comparison with the general population: caries... 33 Comparison with public patients: periodontal status... 34 Geographic location... 35 5.4 Conclusions... 36 iv Oral health trends among adult public dental patients

6 References... 37 Appendix A: Main findings restricted to states/territories that participated in both rounds of data collection... 43 Appendix B: State/territory-specific main findings... 47 Appendix C: Publications from the Adult Dental Programs Survey... 65 Oral health trends among adult public dental patients v

List of tables Table 2.1: Sample yields by state/territory, 1995 96 and 2001 02... 6 Table 2.2: Invalid tooth status codes per patient (%) by state/territory dentate persons, 2001 02... 6 Table 3.1: Sociodemographic and visit details (%) by year of survey... 7 Table 4.1: Edentulism (%) by year and age... 9 Table 4.2: Edentulism (%) by year and age general care... 10 Table 4.3: Edentulism (%) by year and age emergency care... 11 Table 4.4: Edentulism (%) by year and age major city patients... 12 Table 4.5: Edentulism (%) by year and age regional/remote patients... 13 Table 4.6: Caries experience by year and age of patient... 15 Table 4.7: Caries experience by year and age of patient general care... 17 Table 4.8: Caries experience by year and age of patient emergency care... 19 Table 4.9: Caries experience by year and age of patient major city patients... 21 Table 4.10: Caries experience by year and age of patient regional/remote patients... 23 Table 4.11: Periodontal pockets 6+ mm (%) by year and age of patient... 24 Table 4.12: Periodontal pockets 6+ mm (%) by year and age of patient general care... 25 Table 4.13: Periodontal pockets 6+ mm (%) by year and age of patient emergency care... 26 Table 4.14: Periodontal pockets 6+ mm (%) by year and age of patient major city patients... 27 Table 4.15: Periodontal pockets 6+ mm (%) by year and age of patient regional/remote patients... 28 Table A.1: Edentulism (%) by year and age... 43 Table A.2: Caries experience by year and age of patient... 44 Table A.3: Periodontal pockets 6+ mm (%) by year and age of patient... 45 Table B.1: Edentulism (%) by year and age New South Wales... 47 vi Oral health trends among adult public dental patients

Table B.2: Edentulism (%) by year and age Victoria... 48 Table B.3: Edentulism (%) by year and age Queensland... 49 Table B.4(a): Edentulism (%) by year and age Western Australia... 50 Table B.4(b): Edentulism (%) by year and age excluding Western Australia... 50 Table B.5(a): Edentulism (%) by year and age South Australia... 51 Table B.5(b): Edentulism (%) by year and age excluding South Australia... 51 Table B.6: Edentulism (%) by year and age Northern Territory... 52 Table B.7: Caries experience by year and age of patient New South Wales... 53 Table B.8: Caries experience by year and age of patient Victoria... 54 Table B.9: Caries experience by year and age of patient Queensland... 55 Table B.10: Caries experience by year and age of patient Western Australia... 56 Table B.11: Caries experience by year and age of patient South Australia... 57 Table B.12: Caries experience by year and age of patient Northern Territory... 58 Table B.13: Periodontal pockets 6+ mm (%) by year and age of patient New South Wales... 59 Table B.14: Periodontal pockets 6+ mm (%) by year and age of patient Victoria... 60 Table B.15: Periodontal pockets 6+ mm (%) by year and age of patient Queensland... 61 Table B.16: Table B.17: Table B.18: Periodontal pockets 6+ mm (%) by year and age of patient Western Australia... 62 Periodontal pockets 6+ mm (%) by year and age of patient South Australia... 63 Periodontal pockets 6+ mm (%) by year and age of patient Northern Territory... 64 Oral health trends among adult public dental patients vii

List of figures Figure 4.1: Edentulism (%) by year and age... 9 Figure 4.2: Edentulism (%) by year and age general care... 10 Figure 4.3: Edentulism (%) by year and age emergency care... 11 Figure 4.4: Edentulism (%) by year and age major city patients... 12 Figure 4.5: Edentulism (%) by year and age regional/remote patients... 13 Figure 4.6: Caries experience by year and age of patient... 14 Figure 4.7: Caries experience by year and age of patient general care... 16 Figure 4.8: Caries experience by year and age of patient emergency care... 18 Figure 4.9: Caries experience by year and age of patient major city patients... 20 Figure 4.10: Caries experience by year and age of patient regional/remote patients... 22 Figure 4.11: Periodontal pockets 6+ mm (%) by year and age of patient... 24 Figure 4.12: Periodontal pockets 6+ mm (%) by year and age of patient general care... 25 Figure 4.13: Periodontal pockets 6+ mm (%) by year and age of patient emergency care... 26 Figure 4.14: Periodontal pockets 6+ mm (%) by year and age of patient major city patients... 27 Figure 4.15: Periodontal pockets 6+ mm (%) by year and age of patient regional/remote patients... 28 viii Oral health trends among adult public dental patients

Summary Edentulism While the percentage of edentulous patients was slightly higher overall in 2001 02 (9.0%) compared to 1995 96 (7.9%), there were no significant age-specific differences in edentulism, indicating that the overall difference may be a result of the slightly older age distribution and greater percentage of patients from regional locations in 2001 02 than in 1995 96. Overall, there were no differences in edentulism between 1995 96 and 2001 02 for either general or emergency patients. Overall, there were no differences in edentulism between 1995 96 and 2001 02 for patients from either major city or regional/remote locations. Caries experience Decayed teeth Overall, the number of decayed teeth was higher in 2001 02 (2.65 decayed teeth) compared to 1995 96 (1.97 decayed teeth) and this trend was observed consistently in each age group of adult public dental patients. Higher numbers of decayed teeth in 2001 02 compared to 1995 96 were observed for both general and emergency care patients overall and in all age groups. Patients from major city locations had higher overall numbers of decayed teeth in 2001 02 compared to 1995 96, reflecting increased levels of decayed teeth among patients aged 18 24, 25 44 and 45 64 years, while patients from regional/remote locations had higher overall numbers of decayed teeth in 2001 02 compared to 1995 96, reflecting increased levels of decayed teeth among patients aged 25 44 and 65+ years. Missing teeth Overall, the number of missing teeth was higher in 2001 02 (6.35 missing teeth) compared to 1995 96 (5.50 missing teeth) but this trend was only statistically significant among 25 44-year-old patients. General care patients had higher numbers of missing teeth overall in 2001 02 compared to 1995 96, reflecting increased numbers of missing teeth among 25 44-year-olds. Among emergency care patients the number of teeth missing overall did not vary between 2001 02 and 1995 96, but 25 44-year-old patients showed increased numbers of missing teeth. Oral health trends among adult public dental patients ix

Patients from major city locations showed no significant difference in the overall number of missing teeth between 2001 02 and 1995 96, with higher numbers of missing teeth over time among 25 44-year-olds balanced by lower numbers among 65+-year-olds. Patients from regional/remote locations showed higher overall numbers of missing teeth in 2001 02 compared to 1995 96, reflecting increased numbers of missing teeth among 25 44, 45 64 and 65+-year-olds. Filled teeth Overall, the number of filled teeth was lower in 2001 02 (6.20 filled teeth) compared to 1995 96 (6.62 filled teeth) and this trend was statistically significant among patients aged 18 24 and 25 44 years. General care patients showed no significant difference in overall numbers of filled teeth between 2001 02 and 1995 96 but 18 24 and 25 44-year-old general care patients each showed decreased numbers of filled teeth over time. Emergency care patients had lower numbers of filled teeth in 2001 02 compared to 1995 96, reflecting decreased numbers of filled teeth over time among 18 24 and 25 44-year-old emergency care patients. Patients from major city locations showed no significant difference in the overall number of filled teeth between 2001 02 and 1995 96. However, there were decreased numbers of filled teeth over time among 25 44-year-olds and increased numbers among 65+-year-olds. Patients from regional/remote locations had lower overall numbers of filled teeth over time, reflecting decreases among 18 24, 25 44 and 45 64-year-olds. DMF teeth Overall, DMFT was higher in 2001 02 (15.20 decayed, missing and filled teeth) compared to 1995 96 (14.09 decayed, missing and filled teeth) but this trend was only statistically significant among 25 44-year-old patients. Both general and emergency care patients had higher overall combined numbers of decayed, missing and filled teeth in 2001 02 compared to 1995 96, reflecting increased combined numbers of decayed, missing and filled teeth among 25 44-year-old general and emergency care patients. Patients from both major city and regional/remote locations had higher overall combined numbers of decayed, missing and filled teeth in 2001 02 compared to 1995 96, reflecting increased combined numbers of decayed, missing and filled teeth among 25 44-year-old patients from major city locations and increased combined numbers of decayed, missing and filled teeth among 45 64 and 65+-year-old patients from regional/remote locations. x Oral health trends among adult public dental patients

Periodontal status Overall, there was an improvement in periodontal status of adult public dental patients over time, with a decrease in the percentage of patients who had periodontal pockets of 6+ mm in 2001 02 (10.3%) compared to 1995 96 (13.0%). Decreased percentages of patients with periodontal pockets of 6+ mm in 2001 02 compared to 1995 96 were observed for both general and emergency care patients. While patients from major city locations exhibited a trend towards decreased percentages of patients with periodontal pockets of 6+ mm over time, there was an increase in the percentage of patients with periodontal pockets of 6+ mm among patients from regional/remote locations. Oral health trends among adult public dental patients xi

Abbreviations and symbols Abbreviations CPI DMFT MIS NIDR OMR WHO Community Periodontal Index Decayed, missing or filled permanent teeth (Computer) management information system National Institute of Dental Research Optical mark read scan forms World Health Organization Abbreviations of places ACT NSW NT Qld SA Tas Vic WA Australian Capital Territory New South Wales Northern Territory Queensland South Australia Tasmania Victoria Western Australia Symbols nil or rounded to zero n.a. not applicable.. not available xii Oral health trends among adult public dental patients

Acknowledgements This research was assisted by the Population Health Division of the Australian Government Department of Health and Ageing. The Adult Dental Programs Survey was undertaken in collaboration with the dental authorities in the participating states/territories of Australia. The support of those dental authorities and their staff was crucial to the successful collection of data for this survey. The Adult Dental Programs Survey 2001 02 data was collected with assistance from Dr Kaye Roberts-Thomson and Mrs Lorna Lucas at the Australian Research Centre for Population Oral Health, The University of Adelaide. Oral health trends among adult public dental patients xiii

xiv Oral health trends among adult public dental patients

1 Background Social inequalities in health have been highlighted through reports of associations between mortality and factors such as occupation, income, ethnic group and social class (Marmot et al. 1987; Feinstein 1993). Even in countries with universal-access policies for health care, large differences in mortality and morbidity by social class have been reported (Davey Smith et al. 1990). In 1992 the National Health Strategy identified inequalities in oral health and access to dental services as a major public health issue in Australia (National Health Strategy 1992). In October 1999 the Australian Health Ministers Advisory Council (AHMAC) recommended that a report be prepared on the burden, trends and distribution of oral health problems in Australia and the trends in clinical approaches to dealing with those problems. The report concluded that oral diseases and disorders remain prevalent and are a substantial burden on the Australian population (AHMAC 2001). 1.1 Public dental patients Among people on low incomes, health card holders are thought to be particularly at risk of reduced oral health and access to dental services (AIHW DSRU 1993). Public patients have about twice the rate of extraction as patients in private general practice (AIHW DSRU: Brennan et al. 1997). Patients eligible for public dental care are primarily holders of government entitlement cards such as aged pensioners and the unemployed. All Australian states and territories provide public dental services. These services are largely provided by publicly employed dentists in government clinics at minimal or no cost to the patient. These clinics are generally located in major regional centres and are often associated with district hospitals or health centres. They provide access to a restricted level of care and generally do not include all aspects of dental treatment. Government-funded dental care is not accessible to many people in the community due to limited resources and small numbers of public dental clinics remote from population growth centres. There are a large number of people waiting for general dental care at public dental services. While waiting times for emergency dental care are short, waiting times for general dental care can be extensive (e.g. estimated to be between 10 and 54 months in 2000). The time that people spend waiting for general dental care indicates that, at least in some regions, there is inadequate provision of services to meet the expectations of even the minority of people who seek care from public dental services (AHMAC 2001). 1.2 Background: oral health data on public dental patients The Adult Dental Programs Survey provides information on the oral health of patients attending for public dental care in Australia. The survey began as a pilot study in South Australia in 1992 and was expanded to include New South Wales and Victoria as part of the Research Database into Dental Care for Adults in Australia 1992 93. The Oral health trends among adult public dental patients 1

Prospective Adult Dental Programs Survey was performed in 1995 96 as part of the Evaluation Project of the Commonwealth Dental Health Program. Since 1995 96 the Adult Dental Programs Survey has not been implemented as a national survey. 1.3 Purpose of the survey The purpose of the survey was to describe the oral health status of patients within public dental programs. While there are variations among states/territories in details of eligibility criteria, dental patients sampled for this survey were eligible primarily because they had one of the following entitlement cards: Health Care Card, Health Benefits Card or Pensioner Concession Card. The survey excludes school dental care. The Adult Dental Programs Survey describes the oral health status and basic demographic characteristics of patients during a course of care within the programs. The survey can answer questions such as: what levels of oral disease do patients have when they present for dental care, and do these levels differ among patient groups and geographic locations? By collecting data over a number of years, it will be possible to identify trends in oral health. 1.4 Structure and themes The survey describes demographic and visit patterns, and oral health status of patients within public dental programs. The structure of this report reflects these themes: following the outline of methods (Chapter 2), Chapter 3 presents information on sociodemographic and visit details, and Chapter 4 discusses findings on oral health status. The major research theme is the description and comparison of oral health in 1995 96 and 2001 02, controlling for age. These results were further stratified by type of course of care and location of visit. Some additional methodological considerations are dealt with in Appendix A (which presents the main findings restricted to states/territories that participated in both rounds of data collection), and Appendix B (which presents state/territory-specific findings). Appendix C lists publications that have been produced from each round of data collection. 2 Oral health trends among adult public dental patients

2 Methods The Adult Dental Programs Survey is a study of patients attending for public dental care. Estimates based on users of dental services are by definition restricted to those persons who were able to access dental care, and therefore may not necessarily be representative of the population eligible for public dental services who did not access public dental care during the survey period. It should be noted that the existence of other dental schemes within states/territories might have had some effect on the data included in this report. For example, some Aboriginal persons may have been covered through separate Aboriginal dental schemes, and denture services provided through private practitioners under pensioner denture schemes might not be included. 2.1 Data collection Data were collected from a random sample of adult patients at the beginning of a course of public dental care. The characteristics of sampled patients were initially recorded. The examining dentist then recorded oral health status. Standard criteria were used in the form of written guidelines, but there was no formal calibration. Dentists were instructed to evaluate oral health status using visual and tactile information alone, in conjunction with the definitions supplied. A periodontal probe was used to measure pocket depth (from gingival crest to the base of the pocket) and to detect subgingival calculus or bleeding. 1995 96 In 1995 96 each state and territory except New South Wales used optical mark read (OMR) scan forms to record oral health status. The remaining data on patient characteristics, visit details and service provision were either recorded on the same double-sided OMR form as the oral health data, or on data files derived from computer-based management information systems (MIS) which were linked to oral health data recorded on single-sided OMR forms. In New South Wales only the United Dental Hospital of Sydney participated in the survey, using a manual forms system designed to be compatible with the data items collected on the OMR forms. See AIHW DSRU: Brennan & Spencer (1997), and Brennan, Spencer & Slade (2000, 2001) for more details. 2001 02 In 2001 02 in each state and territory except Western Australia and South Australia, dental authorities allocated survey forms to clinics according to estimated patient volume. Patients were sampled continuously until a clinic had completed their allocated sample yield during the period 2001 02. In Western Australia patients were sampled based on selected day of birth in order to meet their sample yield. In most states/territories all clinics were included: in Victoria those clinics surveyed were selectively chosen to provide a representative coverage of urban and rural locations. Oral health trends among adult public dental patients 3

OMR scan forms were used to collect data in all states/territories except South Australia, where a computer MIS was used. 2.2 Sampling rates Rationale for sampling rates In 1995 96 sampling was based on date of birth. In all five mainland states a target yield of approximately 3,570 patients was determined to obtain 119 persons in each of six age groups. The aim was to provide prevalence estimates with a relative standard error of 40% or less within five subgroups of each age group for key outcome measures as low as 5% prevalence (e.g. emergency patients receiving preventive services). Smaller yields were proposed for Tasmania and the two territories in order to reduce the survey workload at clinics where patient flows were less. However, this limits the ability to make precise age-specific estimates by another level of disaggregation in these states/territories. In 2001 02 sample size estimates were based on measures of oral health status from the 1995 96 Adult Dental Programs Survey (AIHW DSRU: Brennan & Spencer 1997). To achieve estimates of key outcome variables (e.g. caries experience by age) with a precision of 20% relative standard error or less, target yields were set of 324 patients in Tasmania and the territories and 648 patients in the other states. Weighting Data were weighted using the estimated number of persons aged 18 years or more from the 1996 and 1999 National Dental Telephone Interview Surveys whose last dental visit was public-funded within the last year. These weighted data are representative of the number of adults receiving public-funded dental care in each participating state/territory. 2.3 Data items Caries experience Instructions for coding caries experience were based on the US National Institute of Dental Research (NIDR 1987) scoring system for coronal and root caries. Periodontal status Periodontal status was recorded using the Community Periodontal Index (World Health Organization 1997). A score of 0 (periodontal health), 1 (gingival bleeding), 2 (calculus at any supra- or sub-gingival site), 3 (pocket of 4 5 mm) or 4 (pocket of 6 mm or more) was scored for each dentate sextant. All teeth in a sextant were examined and the most severe periodontal condition observed was recorded as the sextant score. Sextants were defined by tooth position, with molars and premolars making up four posterior sextants, and canines and incisors making up two anterior 4 Oral health trends among adult public dental patients

sextants. Third molars were excluded unless they were functioning in the place of second molars. Sextants were excluded (code X) when there were no teeth present or only one tooth which could be probed. If there was only one tooth in a sextant, the score for this single tooth could be carried forward for consideration in assessing the adjacent sextant. Visit type Visit type was classified as emergency if the course of care was initiated for relief of pain; otherwise visit type was classified as general. Location Location of patients was classified as major city or regional/remote based on their residential postcode using the ASGC Remoteness classification scheme (ABS 2001). 2.4 Sample yield Obtained yield The obtained sample yields for each state and territory from the 1995 96 and 2001 02 surveys are presented in Table 2.1. All states/territories participated in the 1995 96 survey and all except Tasmania and the Australian Capital Territory participated in 2001 02. While the obtained sample yields varied between localities, limiting disaggregations in some specific localities, the total sample yield across all localities exceeded the target, thereby providing a sufficient sample size to achieve the desired level of precision. Oral health trends among adult public dental patients 5

Table 2.1: Sample yields by state/territory, 1995 96 and 2001 02 1995 96 Mode of collection NSW Vic Qld WA SA Tas ACT NT All Manual MIS & OMR OMR MIS & OMR MIS & OMR OMR MIS & OMR Obtained yield 874 1,040 2,628 160 753 359 26 269 6,109 2001 02 Mode of OMR OMR OMR OMR MIS n.a. n.a. OMR collection Obtained yield 733 593 533 1,197 1,904.... 283 5,243 OMR: Optical mark read scan form MIS: Computer management information system OMR Tooth status Invalid tooth codes include blank and multiple marks on OMRs. A breakdown of invalid tooth status codes per examined patient by state/territory is presented in Table 2.2. In this report measures of oral health, such as caries experience using the DMFT index from both 1995 96 and 2001 02, were based on examinations which had two or less invalid tooth status codes; those with more than two invalid tooth status codes per examination were excluded. The majority of invalid codes were blanks, with only 2.9% in 1995 96 and 5.7% in 2001 02 being multiple marks. While the majority of states/territories still rely on forms to collect data, in the future it is expected that the adoption of electronic systems will reduce errors through automated completeness checks. Table 2.2: Invalid tooth status codes per patient (%) by state/territory dentate persons, 2001 02 NSW Vic Qld WA SA Tas ACT NT All 1995 96 0 invalid 97.6 89.0 82.4 71.1 77.8 69.1 80.8 74.1 83.7 1 invalid 0.5 5.4 9.0 9.4 11.2 11.6 3.9 14.1 7.7 2 invalid 0.1 1.1 3.0 3.1 3.9 2.8 0.0 2.3 2.3 3+ invalid 1.8 4.5 5.6 16.4 7.1 16.4 15.4 9.5 6.3 2001 02 0 invalid 77.3 76.4 72.0 76.8 100.0.... 80.4 84.9 1 invalid 13.6 13.2 12.8 8.3 0.0.... 13.6 7.4 2 invalid 6.4 5.5 4.5 3.4 0.0.... 3.0 2.9 3+ invalid 2.7 4.9 10.7 11.5 0.0.... 3.0 4.8 6 Oral health trends among adult public dental patients

3 Sociodemographic and visit details Sociodemographic and visit details are listed in Table 3.1 by year of survey. The age distribution of patients was similar in both survey years, with fewer than 10% aged 18 24 years and between 26.3% and 34.1% in each of the remaining older age groups. There was little difference between survey years in the sex distribution of patients, with approximately 45% of patients being male and approximately 55% being female. The percentage of patients attending for an emergency course of care captured in this survey was slightly lower in 2001 02 (50.0%) compared to 1995 96 (57.5%). There was a marked difference in percentage of patients from major city locations between 1995 96 (80.0%) and 2001 02 (54.3%). While this could reflect changes in access patterns by location over time, it is more likely the result of sampling differences between the two surveys as a result of a greater proportion of regional/remote patients being sampled in some states/territories in 2001 02. As a result, the overall trends may reflect the greater percentage of regional/remote patients in the latter survey, and may need to be confirmed by reference to the separate analyses that present comparisons over time for patients from major cities and from regional/remote locations. Table 3.1: Sociodemographic and visit details (%) by year of survey 1995 96 2001 02 Age of patient 18 24 years 9.4 6.7 25 44 years 34.1 29.5 45 64 years 30.3 30.1 65+ years 26.3 33.8 Sex of patient Male 44.5 44.8 Female 55.5 55.2 Type of care Emergency 57.5 50.0 General 42.5 50.0 Location of patient Major city 80.0 54.3 Regional/remote 20.0 45.7 Oral health trends among adult public dental patients 7

4 Oral health This chapter presents findings related to three measures of oral health status among public dental patients edentulism, caries experience and periodontal status. Edentulism refers to the loss of all natural teeth. Therefore, edentulous patients are those who have lost all their natural teeth, while dentate patients are those who have at least one natural tooth. Caries experience refers to the level of dental decay and is measured using the DMFT index, which records the number of decayed (D), missing (M) and filled (F) permanent teeth. Periodontal status refers to the condition of the gums and is measured using the Community Periodontal Index (CPI). The most severe periodontal status recorded using the CPI is the presence of periodontal pockets of 6+ mm, and this measure is presented as the percentage of patients with one or more 6+ mm periodontal pockets. Each oral health measure is presented initially by time of study and age of patient, as there is a relationship between oral health and age. Then each oral health measure is presented by time of study and type of care and location, broken down by age of patient. 8 Oral health trends among adult public dental patients

4.1 Edentulism Edentulism 1995 96 and 2001 02: by age Edentulism is presented in Figure 4.1 and Table 4.1 by year and age. In both survey years the percentage of edentulous patients showed a characteristic pattern of being higher among older age groups. While the percentage of edentulous patients was slightly higher overall over time, none of the age specific comparisons were statistically significant. 30 25 Edentulous (%) 1995-96 1995 96 2001-02 2001 02 20 15 10 5 0 18 24 18-24 25-44 25 44 45-64 45 64 65+ Age (years) Figure 4.1: Edentulism (%) by year and age Table 4.1: Edentulism (%) by year and age 1995 96 2001 02 P Age of patient n=5,897 n=5,006 18 24 years 0.4 0.0 ns 25 44 years 1.2 1.7 ns 45 64 years 7.4 8.1 ns 65+ years 19.8 18.1 ns All 7.9 9.0 * *(P<0.05), ns (not statistically significant) χ 2 test Oral health trends among adult public dental patients 9

Edentulism 1995 96 and 2001 02: by age and type of care Edentulism is presented in Figure 4.2 and Table 4.2 by year and age for general care patients. The only significant age-specific difference was a lower percentage of edentulous patients in 2001 02 among patients aged 65 years or more. 30 25 Edentulous (%): general care 1995-96 1995 96 2001-02 2001 02 20 15 10 5 0 18 24 18-24 25-44 25 44 45-64 45 64 65+ Age (years) Figure 4.2: Edentulism (%) by year and age general care Table 4.2: Edentulism (%) by year and age general care 1995 96 2001 02 P Age of patient n=2,830 n=2,753 18 24 years 0.8 0.0 ns 25 44 years 2.1 3.6 ns 45 64 years 11.0 11.5 ns 65+ years 26.6 22.1 * All 11.9 13.3 ns *(P<0.05), ns (not statistically significant) χ 2 test 10 Oral health trends among adult public dental patients

Edentulism is presented in Figure 4.3 and Table 4.3 by year and age for emergency care patients. There were no significant age-specific differences between the two survey years for emergency care patients. 30 25 Edentulous (%): emergency care 1995-96 1995 96 2001-02 2001 02 20 15 10 5 0 18 24 18-24 25-44 25 44 45-64 45 64 65+ Age (years) Figure 4.3: Edentulism (%) by year and age emergency care Table 4.3: Edentulism (%) by year and age emergency care 1995 96 2001 02 P Age of patient n=3,042 n=2,189 18 24 years 0.3 0.0 ns 25 44 years 0.5 0.2 ns 45 64 years 4.5 4.3 ns 65+ years 12.7 12.3 ns All 4.6 4.7 ns ns (not statistically significant) χ 2 test Oral health trends among adult public dental patients 11

Edentulism 1995 96 and 2001 02: by age and location Edentulism is presented in Figure 4.4 and Table 4.4 by year and age for patients from major city locations. There were no significant age-specific differences between the two survey years for patients from major city locations. 30 25 Edentulous (%): major city 1995-96 1995 96 2001-02 2001 02 20 15 10 5 0 18 24 18-24 25-44 25 44 45-64 45 64 65+ Age (years) Figure 4.4: Edentulism (%) by year and age major city patients Table 4.4: Edentulism (%) by year and age major city patients 1995 96 2001 02 P Age of patient n=3,873 n=2,897 18 24 years 0.3 0.0 ns 25 44 years 0.8 0.3 ns 45 64 years 6.1 6.4 ns 65+ years 18.9 16.7 ns All 7.4 8.4 ns ns (not statistically significant) χ 2 test 12 Oral health trends among adult public dental patients

Edentulism is presented in Figure 4.5 and Table 4.5 by year and age for patients from regional/remote locations. The only significant age-specific difference between the two survey years for regional/remote patients was a lower percentage of edentulism in 2001 02 among 45 64-year-olds. 30 25 Edentulous (%): regional/remote 1995-96 1995 96 2001-02 2001 02 20 15 10 5 0 18 24 18-24 25-44 25 44 45-64 45 64 65+ Age (years) Figure 4.5: Edentulism (%) by year and age regional/remote patients Table 4.5: Edentulism (%) by year and age regional/remote patients 1995 96 2001 02 P Age of patient n=1,959 n=1,991 18 24 years 0.8 0.0 ns 25 44 years 2.2 3.0 ns 45 64 years 13.2 9.1 * 65+ years 23.2 19.9 ns All 9.6 9.3 ns *(P<0.05), ns (not statistically significant) χ 2 test Oral health trends among adult public dental patients 13

4.2 Caries experience Caries experience 1995 96 and 2001 02: by age Caries experience is presented in Figure 4.6 and Table 4.6 by year and age of patient. Overall, there were increases in the mean number of decayed and missing teeth over time, resulting in a higher mean number of decayed, missing and filled teeth (DMFT) between the two survey years. However, numbers of filled teeth were lower in 2001 02 compared to 1995 96. 20.0 18.0 16.0 DMFT (mean) Filled Missing Decayed 14.0 12.0 10.0 8.0 6.0 4.0 2.0 0.0 1995 96 1995-96 2001-02 2001 02 1995-96 1995 96 2001-02 2001 02 1995-96 1995 96 2001-02 2001 02 1995-96 1995 96 2001-02 2001 02 18 24 25 44 45 64 65+ Age (years) Figure 4.6: Caries experience by year and age of patient The higher overall number of decayed teeth in 2001 02 was observed among all age groups of patients. Higher numbers of missing teeth in 2001 02 were only observed at a statistically significant level among 25 44-year-old patients. Lower numbers of filled teeth in 2001 02 were observed at a statistically significant level among patients aged 18 24 and 25 44 years. Overall DMFT was significantly higher in 2001 02 among 25 44-year-old patients. 14 Oral health trends among adult public dental patients

Table 4.6: Caries experience by year and age of patient 1995 96 2001 02 Mean (SE) Mean (SE) P 18 24 years n=566 n=262 Decayed 3.07 (0.16) 4.61 (0.34) ** Missing 0.68 (0.07) 0.67 (0.09) ns Filled 3.68 (0.17) 2.47 (0.19) ** DMFT 7.44 (0.24) 7.75 (0.40) ns 25 44 years n=1,857 n=1,267 Decayed 2.65 (0.07) 4.14 (0.14) ** Missing 2.80 (0.10) 3.68 (0.15) ** Filled 6.73 (0.13) 5.46 (0.14) ** DMFT 12.18 (0.16) 13.27 (0.20) ** 45 64 years n=1,427 n=1,379 Decayed 1.48 (0.06) 1.89 (0.08) ** Missing 7.04 (0.20) 7.22 (0.22) ns Filled 7.51 (0.16) 7.31 (0.16) ns DMFT 16.03 (0.20) 16.41 (0.20) ns 65+ years n=1,123 n=1,468 Decayed 1.07 (0.05) 1.36 (0.06) ** Missing 9.84 (0.25) 9.69 (0.25) ns Filled 6.54 (0.16) 6.79 (0.15) ns DMFT 17.45 (0.24) 17.84 (0.22) ns All n=4,973 n=4,376 Decayed 1.97 (0.04) 2.65 (0.06) ** Missing 5.50 (0.10) 6.35 (0.12) ** Filled 6.62 (0.08) 6.20 (0.08) ** DMFT 14.09 (0.11) 15.20 (0.12) ** SE Standard error **(P<0.01), ns (not statistically significant) General Linear Model Oral health trends among adult public dental patients 15

Caries experience 1995 96 and 2001 02: by age and type of care Caries experience is presented in Figure 4.7 and Table 4.7 by year and age among general care patients. Overall, general care patients showed higher numbers of decayed and missing teeth and higher DMFT in 2001 02 compared to 1995 96. However, there was no significant difference in the overall number of filled teeth over time among general care patients. 20.0 18.0 16.0 DMFT (mean): general care Filled Missing Decayed 14.0 12.0 10.0 8.0 6.0 4.0 2.0 0.0 1995 96 1995-96 2001-02 2001 02 1995-96 1995 96 2001-02 2001 02 1995-96 1995 96 2001-02 2001 02 1995-96 1995 96 2001-02 2001 02 18 24 25 44 45 64 65+ Age (years) Figure 4.7: Caries experience by year and age of patient general care Significantly higher numbers of decayed teeth were observed among general care patients in all age groups in 2001 02 compared to 1995 96. Numbers of missing teeth were only higher at a statistically significant level in 2001 02 compared to 1995 96 for 25 44-year-old general care patients. Lower numbers of filled teeth were observed at a statistically significant level in 2001 02 compared to 1995 96 among general care patients aged 18 24 and 25 44 years. Overall DMFT was significantly higher in 2001 02 compared to 1995 95 for 25 44-year-old general care patients. 16 Oral health trends among adult public dental patients

Table 4.7: Caries experience by year and age of patient general care 1995 96 2001 02 Mean (SE) Mean (SE) P 18 24 years n=205 n=86 Decayed 2.46 (0.22) 3.99 (0.71) ** Missing 0.60 (0.11) 0.76 (0.20) ns Filled 4.12 (0.29) 2.32 (0.38) ** DMFT 7.17 (0.38) 7.07 (0.78) ns 25 44 years n=859 n=584 Decayed 2.39 (0.11) 3.53 (0.20) ** Missing 2.64 (0.15) 3.72 (0.23) ** Filled 7.43 (0.19) 6.63 (0.23) ** DMFT 12.47 (0.23) 13.88 (0.29) ** 45 64 years n=632 n=804 Decayed 1.32 (0.08) 1.71 (0.11) ** Missing 6.45 (0.30) 6.86 (0.29) ns Filled 8.08 (0.24) 7.80 (0.21) ns DMFT 15.84 (0.30) 16.38 (0.26) ns 65+ years n=569 n=890 Decayed 0.84 (0.07) 1.25 (0.07) ** Missing 8.84 (0.35) 9.22 (0.31) ns Filled 7.13 (0.22) 7.16 (0.20) ns DMFT 16.81 (0.34) 17.63 (0.28) ns All n=2,265 n=2,364 Decayed 1.69 (0.05) 2.15 (0.08) ** Missing 5.14 (0.15) 6.56 (0.17) ** Filled 7.28 (0.12) 7.03 (0.12) ns DMFT 14.12 (0.16) 15.74 (0.16) ** SE Standard error **(P<0.01), ns (not statistically significant) General Linear Model Oral health trends among adult public dental patients 17

Caries experience is presented in Figure 4.8 and Table 4.8 by year and age among emergency care patients. Overall, emergency care patients showed higher numbers of decayed teeth and DMFT, but lower numbers of filled teeth, in 2001 02 compared to 1995 96. Overall, numbers of missing teeth among emergency care patients were not significantly different between the two survey years. 20.0 18.0 16.0 DMFT (mean): emergency care Filled Missing Decayed 14.0 12.0 10.0 8.0 6.0 4.0 2.0 0.0 1995 96 1995-96 2001-02 2001 02 1995-96 1995 96 2001-02 2001 02 1995-96 1995 96 2001-02 2001 02 1995-96 1995 96 2001-02 2001 02 18 24 25 44 45 64 65+ Age (years) Figure 4.8: Caries experience by year and age of patient emergency care Higher numbers of decayed teeth were observed at a statistically significant level in 2001 02 compared to 1995 96 among all age groups of emergency care patients. While overall numbers of missing teeth were not significantly different over time, the number of missing teeth was significantly higher in 2001 02 compared to 1995 96 among 25 44-year-old emergency care patients. Numbers of filled teeth were significantly lower in 2001 02 compared to 1995 96 for emergency care patients aged 18 24 and 25 44 years. DMFT was significantly higher in 2001 02 compared to 1995 96 for 25 44-year-old emergency care patients. 18 Oral health trends among adult public dental patients

Table 4.8: Caries experience by year and age of patient emergency care 1995 96 2001 02 Mean (SE) Mean (SE) P 18 24 years n=361 n=174 Decayed 3.38 (0.22) 4.86 (0.38) ** Missing 0.73 (0.08) 0.64 (0.10) ns Filled 3.47 (0.20) 2.53 (0.22) ** DMFT 7.58 (0.31) 8.03 (0.46) ns 25 44 years n=992 n=672 Decayed 2.83 (0.10) 4.58 (0.19) ** Missing 2.91 (0.14) 3.63 (0.21) ** Filled 6.24 (0.17) 4.61 (0.17) ** DMFT 11.97 (0.23) 12.82 (0.29) * 45 64 years n=792 n=561 Decayed 1.60 (0.08) 2.09 (0.13) ** Missing 7.45 (0.26) 7.63 (0.34) ns Filled 7.12 (0.21) 6.78 (0.24) ns DMFT 16.17 (0.26) 16.50 (0.33) ns 65+ years n=551 n=551 Decayed 1.23 (0.08) 1.52 (0.10) * Missing 10.60 (0.36) 10.33 (0.41) ns Filled 6.09 (0.22) 6.38 (0.23) ns DMFT 17.93 (0.35) 18.23 (0.37) ns All n=2,696 n=1,958 Decayed 2.16 (0.06) 3.14 (0.09) ** Missing 5.75 (0.14) 6.14 (0.18) ns Filled 6.16 (0.10) 5.44 (0.12) ** DMFT 14.07 (0.16) 14.73 (0.19) ** SE Standard error *(P<0.05), **(P<0.01), ns (not statistically significant) General Linear Model Oral health trends among adult public dental patients 19

Caries experience 1995 96 and 2001 02: by age and location Caries experience is presented in Figure 4.9 and Table 4.9 by year and age among patients from major city locations. Overall, patients from major city locations showed significantly higher numbers of both decayed teeth and DMFT in 2001 02 compared to 1995 96. 20.0 18.0 16.0 DMFT (mean): major city Filled Missing Decayed 14.0 12.0 10.0 8.0 6.0 4.0 2.0 0.0 1995 96 1995-96 2001-02 2001 02 1995-96 1995 96 2001-02 2001 02 1995-96 1995 96 2001-02 2001 02 1995-96 1995 96 2001-02 2001 02 18 24 25 44 45 64 65+ Age (years) Figure 4.9: Caries experience by year and age of patient major city patients Higher numbers of decayed teeth were observed for major city patients aged 18 24, 25 44 and 45 64 years in 2001 02 compared to 1995 96 at a statistically significant level. Missing teeth were significantly higher in 2001 02 compared to 1995 96 among 25 44-year-olds but were significantly lower for major city patients aged 65 years or more. Numbers of filled teeth showed a similar pattern to that observed for missing teeth with major city patients aged 25 44 years having significantly lower numbers of fillings but those aged 65 years or more having higher numbers of fillings in 2001 02 compared to 1995 96. DMFT was significantly higher in 2001 02 compared to 1995 96 for 25 44-year-old major city patients. 20 Oral health trends among adult public dental patients

Table 4.9: Caries experience by year and age of patient major city patients 1995 96 2001 02 Mean (SE) Mean (SE) P 18 24 years n=354 n=131 Decayed 2.89 (0.20) 4.34 (0.51) ** Missing 0.68 (0.08) 0.73 (0.16) ns Filled 3.63 (0.22) 2.99 (0.33) ns DMFT 7.21 (0.31) 8.06 (0.60) ns 25 44 years n=1,128 n=649 Decayed 2.54 (0.09) 4.04 (0.20) ** Missing 2.83 (0.13) 3.42 (0.21) * Filled 6.36 (0.16) 5.51 (0.19) ** DMFT 11.74 (0.21) 12.98 (0.28) ** 45 64 years n=978 n=799 Decayed 1.41 (0.06) 1.80 (0.11) ** Missing 7.27 (0.24) 6.83 (0.29) ns Filled 7.49 (0.19) 7.57 (0.21) ns DMFT 16.17 (0.24) 16.20 (0.28) ns 65+ years n=826 n=964 Decayed 1.09 (0.06) 1.20 (0.07) ns Missing 10.13 (0.29) 8.89 (0.30) ** Filled 6.54 (0.18) 7.41 (0.18) ** DMFT 17.75 (0.28) 17.50 (0.27) ns All n=3,286 n=2,543 Decayed 1.87 (0.05) 2.41 (0.08) ** Missing 5.77 (0.13) 6.17 (0.16) ns Filled 6.50 (0.10) 6.62 (0.11) ns DMFT 14.14 (0.14) 15.20 (0.16) ** SE Standard error *(P<0.05), **(P<0.01), ns (not statistically significant) General Linear Model Oral health trends among adult public dental patients 21

Caries experience is presented in Figure 4.10 and Table 4.10 by year and age among patients from regional/remote locations. Overall, patients from regional/remote locations had significantly higher numbers of decayed and missing teeth and higher DMFT in 2001 02 compared to 1995 96, but numbers of filled teeth were lower over time. 20.0 18.0 16.0 DMFT (mean): regional/remote Filled Missing Decayed 14.0 12.0 10.0 8.0 6.0 4.0 2.0 0.0 1995 96 1995-96 2001-02 2001 02 1995-96 1995 96 2001-02 2001 02 1995-96 1995 96 2001-02 2001 02 1995-96 1995 96 2001-02 2001 02 18 24 25 44 45 64 65+ Age (years) Figure 4.10: Caries experience by year and age of patient regional/remote patients Higher numbers of decayed teeth were observed at a statistically significant level in 2001 02 compared to 1995 96 for regional/remote patients aged 25 44 and 65+ years. Numbers of missing teeth were significantly higher in 2001 02 compared to 1995 96 for regional/remote patients aged 25 44, 45 64 and 65+ years. Numbers of filled teeth were significantly lower in 2001 02 compared to 1995 96 for regional/remote patients aged 18 24, 25 44 and 45 64 years. DMFT was significantly higher in 2001 02 compared to 1995 96 among regional/remote patients aged 45 64 and 65+ years. 22 Oral health trends among adult public dental patients

Table 4.10: Caries experience by year and age of patient regional/remote patients 1995 96 2001 02 Mean (SE) Mean (SE) P 18 24 years n=203 n=124 Decayed 3.72 (0.31) 4.70 (0.47) ns Missing 0.61 (0.11) 0.55 (0.10) ns Filled 3.89 (0.25) 2.02 (0.21) ** DMFT 8.23 (0.39) 7.27 (0.53) ns 25 44 years n=703 n=604 Decayed 2.98 (0.14) 4.24 (0.20) ** Missing 2.66 (0.17) 4.03 (0.23) ** Filled 7.99 (0.21) 5.41 (0.21) ** DMFT 13.63 (0.25) 13.69 (0.29) ns 45 64 years n=439 n=539 Decayed 1.79 (0.13) 2.00 (0.13) ns Missing 5.90 (0.35) 7.64 (0.36) ** Filled 7.77 (0.30) 6.88 (0.25) * DMFT 15.46 (0.37) 16.52 (0.32) * 65+ years n=289 n=471 Decayed 0.90 (0.09) 1.68 (0.12) ** Missing 8.31 (0.53) 10.98 (0.44) ** Filled 6.57 (0.33) 5.76 (0.26) ns DMFT 15.77 (0.53) 18.41 (0.39) ** All n=1,634 n=1,738 Decayed 2.36 (0.08) 2.97 (0.10) ** Missing 4.34 (0.16) 6.53 (0.19) ** Filled 7.20 (0.14) 5.66 (0.13) ** DMFT 13.91 (0.19) 15.16 (0.19) ** SE Standard error *(P<0.05), **(P<0.01), ns (not statistically significant) General Linear Model Oral health trends among adult public dental patients 23

4.3 Periodontal status Periodontal status 1995 96 and 2001 02: by age Periodontal status is presented in Figure 4.11 and Table 4.11 by year and age of patient. Overall, the percentage of patients with periodontal pockets of 6+ mm was lower in 2001 02 compared to 1995 96, reflected in significantly lower percentages among 45 64 and 65+-year-olds. Periodontal pockets 6+ mm (%) 20 1995-96 1995 96 2001-02 2001 02 15 10 5 0 18 24 18-24 25-44 25 44 45-64 45 64 65+ Age (years) Figure 4.11: Periodontal pockets 6+ mm (%) by year and age of patient Table 4.11: Periodontal pockets 6+ mm (%) by year and age of patient 1995 96 2001 02 P Age of patient n=4,945 n=4,208 18 24 years 2.4 3.3 ns 25 44 years 9.9 8.1 ns 45 64 years 18.6 13.0 ** 65+ years 14.9 11.8 * All 13.0 10.3 ** *(P<0.05), **(P<0.01), ns (not statistically significant) χ 2 test 24 Oral health trends among adult public dental patients

Periodontal status 1995 96 and 2001 02: by age and type of care Periodontal status is presented in Figure 4.12 and Table 4.12 by year and age of patient for those receiving general care. Overall, a slightly lower percentage of general care patients had periodontal pockets of 6+ mm in 2001 02 compared to 1995 96. However, this pattern was not observed consistently in all age groups of general care patients, with a higher percentage of 18 24-year-olds, and a lower percentage of 25 44 and 45 64-year-olds, having periodontal pockets of 6+ mm in 2001 02 compared to 1995 96. Periodontal pockets 6+ mm (%): general care 20 1995-96 1995 96 2001-02 2001 02 15 10 5 0 18 24 18-24 25-44 25 44 45-64 45 64 65+ Age (years) Figure 4.12: Periodontal pockets 6+ mm (%) by year and age of patient general care Table 4.12: Periodontal pockets 6+ mm (%) by year and age of patient general care 1995 96 2001 02 P Age of patient n=2,255 n=2,294 18 24 years 0.4 9.0 ** 25 44 years 7.9 5.0 * 45 64 years 15.9 8.0 ** 65+ years 9.7 10.5 ns All 10.2 8.1 * *(P<0.05), **(P<0.01), ns (not statistically significant) χ 2 test Oral health trends among adult public dental patients 25

Periodontal status is presented in Figure 4.13 and Table 4.13 by year and age of patient for those receiving emergency care. Overall, a slightly lower percentage of emergency care patients had periodontal pockets of 6+ mm in 2001 02 compared to 1995 96. This pattern was observed at a statistically significant level only among 65+-year-olds. Periodontal pockets 6+ mm (%): emergency care 20 1995-96 1995 96 2001-02 2001 02 15 10 5 0 18 24 18-24 25-44 25 44 45-64 45 64 65+ Age (years) Figure 4.13: Periodontal pockets 6+ mm (%) by year and age of patient emergency care Table 4.13: Periodontal pockets 6+ mm (%) by year and age of patient emergency care 1995 96 2001 02 P Age of patient n=2,681 n=1,881 18 24 years 3.4 1.0 ns 25 44 years 11.3 10.3 ns 45 64 years 20.5 18.5 ns 65+ years 18.9 13.6 ** All 14.8 12.5 * *(P<0.05), **(P<0.01), ns (not statistically significant) χ 2 test 26 Oral health trends among adult public dental patients