NACCHO Aboriginal Dental Health #AusVotesHealth #VoteACCHO : Professor @MarcTennant supports our #Electio2019 Recommendation 9 of 10 for more ACCHOs to deliver culturally safe dental services for our mob

” A big focus of our effort is Aboriginal health. We are one of the early teams to work on addressing issues of rural and remote dental health care access for Aboriginal people.

A crazy (in today’s thinking) simple model of fly-in-fly-out support to locally owned and run Aboriginal Medical Service based dental clinics. The gold standard today.

Aboriginal Medical Services can have, run and look after fantastic dental services, it’s right. Proven over decades.

Just do it today! I want to see every 145 ACCHO in Australia with a dental service!

EVERY SINGLE ONE!

Professor Marc Tennant, UWA Orginally published in Croakey 

NACCHO Recommendation 9

The incoming Federal Government fund Aboriginal and Torres Strait Islander Community Controlled Health Organisations deliver dental services.

  • Establish a fund to support ACCHOs deliver culturally safe dental services to Aboriginal and Torres Strait Islander peoples.
  • Allocate Indigenous dental health funding to cover costs associated with staffing and infrastructure requirements.

More info https://www.naccho.org.au/media/voteaccho/

Read over 30 NACCHO Aboriginal Dental Health articles like this HERE

I have spent three decades working in and around dental health/public health and innovation in Australia and other places.

We are a team of many, many people from all over earth – there is more than 100 people working on things with us; from Jeddah to Utah and everywhere in-between.

We have graduate students focused on addressing inequality and building systems to reform health care in Australia and across the world.

Poor dental health has become a condition of poverty and marginalisation over the last five decades.

Today the “average” (actually does NOT exist) Aussie kid has less than one decayed tooth. In fact, over half of kids have NO decay.

But, a small minority of kids have LOTS of decay and suffer a lot. These are more often than not those for poor areas or are at the edge of society.

Why has decay dropped to such a low prevalence in society? Not actually a simple, clean one-line answer. Brushing, eating better, fluoride, toothpaste…. the list goes on.

Amazing turnaround!!! In 1960’s, a 12-year-old had 12 holes in their teeth – today less than ONE! AMAZING.

This started in the late 1960’s so many adults today have low decay levels too. BUT, there are pockets of trouble too!

This trend is now in adults too – the poor suffer far more than the rich with dental disease.

Why? The risk factors are higher for the marginalised, it’s harder to access good preventive care and more risk-taking activity.

Australia has two dental systems ­– private dental care, that are small independent businesses on the whole and are free to charge as they like. This is more than 85 percent of dental care.

AND, a small public system for those on health care cards or similar. Also, here we have Aboriginal Medical Service based dental services too.

PS We also have dental care in some tertiary hospitals for tough problems, cleft lip and palate, oral cancer, jaw fractures and more.

The public dental system is small, often under-resourced, especially as dental disease is now a condition of poverty. It’s the wrong way round now (private: public ratio)

Remember, the public dental systems are run by STATE governments – the federal government does not really have a role in dental (although there are some growing bits of funding now).

Where do we need to go in dental health in Australia?

Everyone says dental should be part of Medicare. If I said the bill for that could be as large as the NDIS as a cost, you can see the problem.

And remember that most dental care is provided by small businesses where the government cannot control prices – there would be payment gaps!

Read more on Medicare Dental at https://croakey.org/a-new-publication-on-oral-health-catch-up-with-some-talkingteeth/ … It will explain in detail why that’s probably not achievable nor actually what would help Australians.

There are alternatives… We have seen some ­– targeted care for those in need subsidised by the government.

There are some efforts around to be targeted and maximising bang for buck. The most efficient models of providing good dental care are actually part of State government care systems.

State government dental care systems across Australia are run down, and the real opportunity now is to re-enforce them and grow them. Get some balance back into the nation

We now have dental workforce to do it!

In 2000, we were at a workforce crisis with a lack of dentists. Today, 20 years later, we have sufficient workforce coming though… In some places there are too many (Sydney and Melbourne) but as a nation we are now safe.

We need to get more dental workforce out of Nedlands, Double Bay and Toorak and into the rest of Australia – that’s the big effort for the next decade.

We need our dental focus to start with those in most need, the poor and marginalised (economically and geographically). This is where dental troubles are. They are not in Toorak or Double Bay.

And people in Toorak or Double Bay have access to care – some of the highest densities of dentists in the world are around those suburbs!!! True.

It is interesting that the Labor Party policy released last week has focused on the elderly. Demographic shift.

As I am explaining, dental disease is reducing in adults and those born from mid 1960’s forward are on the whole dental far better than their elders.

Focus on elder dental health is good! Australia is growing old and we still have dental troubles for people.

The maximisation of bang-for-buck from what I can see is for people to take their “voucher” (if Labor wins) and spend it in the public dental service. Help grow the safety net for others in need.

Obviously, where there is no public system, do use the local private practice but I just wish people would try their darndest to support their fellow Australians by helping grow the public system.

I should say, I am not employed either as a private or public dentist and take no money in sponsorship. I am an academic. (In addition, I do not have a share portfolio!)

And new things to think about. Telehealth is coming to dental. Yes, imagine screening teeth from images you take in your own bathroom.

Telehealth really going to be important in closing geographic gaps. Imagine screening kids to prioritise them for the dental team when they come to town.

There is a digital future in dentistry (I have seen experimental robots doing dental care! – it’s coming)’

An important initiative in dental will be big data and prediction. Well protected (privacy) coupled with good analysis is going to give us great tools to predict risk and predict where needs are.

We do need to see support going into the R&D of these big-data solutions in health. They will squeeze every bit of value from every dollar we spend on dental care. A digital future is coming to public health and dentistry.

NACCHO #ClosetheGap in Aboriginal Dental /Oral Health @AIHW Report #WOHD19 #rethinksugarydrink : It’s #WorldOralHealthDay @Live_Lighter Sugary drinks are the leading cause of tooth decay : We’re urging our mob to use this info as motivation to cut back on sugary drinks

” Indigenous Australians are more likely than other Australians to have multiple caries and untreated dental disease, and less likely to have received preventive dental care (AHMAC 2017). The oral health status of Indigenous Australians, like all Australians, is influenced by many factors (see What contributes to poor oral health?) and a tendency towards unfavourable dental visiting patterns, broadly associated with accessibility, cost and a lack of cultural awareness by some service providers (COAG 2015; NACDH 2012).” 

See Part 1 below AIHW Report

See full AIHW Web Report HERE 

Read over 35 NACCHO Aboriginal Oral Dental Health articles HERE 

” With new figures revealing almost half of Australian children aged 5-10 experience tooth decay in their baby teeth [1], the Rethink Sugary Drink alliance is urging Aussies to give their teeth a break from sugary drinks and make the switch to water in a bid to protect their oral health.

The Australian Institute of Health and Welfare figures released today also reveal this trend continues into adulthood with Australians aged 15 and over having an average of nearly 13 decayed, missing or filled teeth.

Sugary drinks, such as soft drinks, sports drinks and energy drinks, are a major contributor of added sugar in Australian children’s diets and the leading cause of tooth decay.’ ,

From Re Think Sugary Drinks Website See in Full Part 2 Below

Part 1 AIHW Report Oral health and dental care in Australia

Good oral health is fundamental to overall health and wellbeing (COAG 2015). Without it, a person’s general quality of life and the ability to eat, speak and socialise is compromised, resulting in pain, discomfort and embarrassment.

Oral health refers to the condition of a person’s teeth and gums, as well as the health of the muscles and bones in their mouth (AHMAC 2017). Poor oral health—mainly tooth decay, gum disease and tooth loss—affects many Australian children and adults, and contributed 4.4% of all the burden that non-fatal burden diseases placed on the community in 2011. Oral health generally deteriorates over a person’s lifetime

What contributes to poor oral health?

Many factors contribute to poor oral health (NACDH 2012), including:

  • consumption of sugar, tobacco and alcohol
  • a lack of good oral hygiene and regular dental check-ups
  • a lack of fluoridation in some water supplies
  • access and availability of services, including:
    • affordability of private dental care
    • long waiting periods for public dental care.

What is the impact of poor oral health?

The most common oral diseases affect the teeth (tooth decay, called ‘caries’) and gums (periodontal disease). Oral disease can destroy the tissues in the mouth, leading to lasting physical and psychological disability (NACDH 2012). Tooth loss can reduce the functionality of the mouth, making chewing and swallowing more challenging, which in turn can compromise nutrition. Poor nutrition can impair general health and exacerbate existing health conditions (NACDH 2012). Poor oral health is also associated with a number of chronic diseases, including stroke and cardiovascular disease (DHSV 2011) (Figure 1).

Figure 1 demonstrates the links between poor oral health and chronic diseases such as cardiovascular disease, lung conditions, oral cancers, adverse pregnancy outcomes, stroke and diabetes.

Poor oral health can also affect a person’s wellbeing. Dental disease can impair a person’s appearance and speech, eroding their self-esteem, which in turn can lead to restricted participation at school, the workplace, home and other social settings (NACDH 2012).

Some groups are at greater risk of poor oral health

The National Oral Health Plan identifies four priority population groups that have poorer oral health than the general population and also experience barriers to accessing oral health care—either in the private or public sector. State and territory governments are the current providers of most public dental services, and access is largely targeted towards people on low incomes or holders of concession cards. Eligibility requirements can vary between states and territories (AIHW 2018).

The four priority population groups identified in the plan are:

People who are socially disadvantaged or on low incomes: This group has historically been identified as those on a low income and/or receiving some form of government income assistance, but now extends to include people experiencing other forms of disadvantage including refugees, homeless people, some people from culturally and linguistically diverse backgrounds, and people in institutions or correctional facilities (COAG 2015). Poorer oral health results from infrequent dental care. Barriers include cost, appropriateness of service delivery and lower levels of health literacy, including oral health (COAG 2015).

Aboriginal and Torres Strait Islander AustraliansIndigenous Australians are more likely than other Australians to have multiple caries and untreated dental disease, and less likely to have received preventive dental care (AHMAC 2017). The oral health status of Indigenous Australians, like all Australians, is influenced by many factors (see What contributes to poor oral health?) and a tendency towards unfavourable dental visiting patterns, broadly associated with accessibility, cost and a lack of cultural awareness by some service providers (COAG 2015; NACDH 2012).

People living in regional and remote areasOverall, this group has poorer oral health than those in Major cities (COAG 2015), and oral health status generally declines as remoteness increases. Rural Australians have access to fewer dental practitioners than their city counterparts, which, coupled with longer travel times and limited transport options to services, affects the oral health care that they can receive (COAG 2015; Bishop & Laverty 2015). People living in Remote and Very remote areas are also more likely to smoke and drink at risky levels. They have reduced access to fluoridated drinking water and face increased costs of healthy food choices and oral hygiene products. These risk factors contribute to this population’s overall poorer oral health (COAG 2015).

People with additional and/or specialised health care needsThis group includes people living with mental illness, people with physical, intellectual and developmental disabilities, people with complex medical needs and frail older people. These people can be vulnerable to oral disease; for example, some medications for chronic diseases can cause a dry mouth, which increases the risk of tooth decay (Queensland Health 2008). A number of factors make accessing dental care more difficult for this group, including:

  • a shortage of dental health professionals with skills in special-needs dentistry
  • difficulties in physically accessing appropriate dental treatment facilities
  • the cost of treatment. People with additional and/or specialised health care needs often have their earning capacity eroded by ill health (COAG 2015).

Why does oral health vary across Australia?

People in some states and territories have generally poorer oral health than others. For example, the National Child Oral Health Study found that the prevalence of caries in the deciduous teeth of children was significantly higher in Northern Territory and Queensland than in all other states and territories (Do & Spencer 2016). Oral health status is influenced by a complex interaction of factors, as outlined above. These factors should be considered when looking at results by state and territory. For example:

  • all people living in the Northern Territory were located in Outer regionalRemote or Very remote areas, whereas the majority of the Victorian population were located in Major cities in 2016 (ABS 2018a)
  • the Northern Territory has Australia’s highest proportion of Aboriginal and Torres Strait Islander people (26% of its population) which is much higher than the next highest state, Tasmania (4.6% of its population) (ABS 2017)
  • Tasmania has the highest proportion of people living in the lowest socioeconomic areas (37%) (refer to Technical notes for explanation of SEIFA) (ABS 2018b).

The variations observed in oral health status between state and territory populations may also be partly explained by differences in individual state and territory oral health care funding, service models and eligibility requirements, which can result in varied patterns of dental visiting among residents (AIHW 2018). Oral health campaigns and policies can also make an impact. For example, water fluoridation coverage in Queensland has reduced since the Queensland Government transferred the decision whether to fluoridate water supplies from state to local governments in 2008, despite evidence that access to fluoridated drinking water has been shown to reduce tooth decay (Queensland Health 2015; NHMRC 2017).

Part 2 Australians’ love affair with sugary drinks rots the smiles of children as young as five

Leading health bodies call for people to rethink sugary drink this World Oral Health Day.

With new figures revealing almost half of Australian children aged 5-10 experience tooth decay in their baby teeth [1], the Rethink Sugary Drink alliance is urging Aussies to give their teeth a break from sugary drinks and make the switch to water in a bid to protect their oral health.

The Australian Institute of Health and Welfare figures released today also reveal this trend continues into adulthood with Australians aged 15 and over having an average of nearly 13 decayed, missing or filled teeth.

Sugary drinks, such as soft drinks, sports drinks and energy drinks, are a major contributor of added sugar in Australian children’s diets and the leading cause of tooth decay.

On World Oral Health Day today, Craig Sinclair, Head of Prevention at Cancer Council Victoria, a partner of Rethink Sugary Drink, is urging Australians to see this information as motivation to cut back on sugary drinks.

While regular sugary drink consumption leaves a lasting effect on Australians’ oral health, Mr Sinclair said the risks extend beyond just teeth.

“These super sugary drinks don’t stop at ruining Aussie smiles. In the long run they can lead to unhealthy weight gain, increasing the risk of serious health problems such as type 2 diabetes, heart and kidney disease, stroke and 13 types of cancer.”

“It’s sadly no surprise that tooth decay is hitting Australian kids hard, given the overwhelming availability of sugary drinks. Not only are there significantly more sugary drink choices available today, they are everywhere our kids look. Ironically they’re even in venues designed to help our kids be healthy, such as sports centres, sporting clubs, as well as places they visit regularly like train stations, festivals and events,” Mr Sinclair said.

“Big beverage brands don’t just stop there – they also sweet talk our kids into guzzling high-sugar drinks through social media, and outdoor and online advertising. We need government to invest in public education campaigns to cut through the marketing spin and expose the health impacts of sugary drinks.”

A/Prof Matthew Hopcraft, Chief Executive Officer of the Australian Dental Association Victorian Branch, a Rethink Sugary Drink partner, has seen the devastating impact sugary drinks has on children’s teeth and wants Australians to consider the consequences of drinking too many.

“I’ve seen firsthand the devastating impact tooth decay has on the health, nutrition, social and emotional wellbeing of these kids and their families. There are extreme cases where dentists are extracting all 20 baby teeth from kids as young as 3 – it’s not pretty.” A/Prof Hopcraft said.

“Some people may not realise every time they take a sip from a sugary drink they expose their teeth to an acid attack, dissolving the outer surface of our tooth enamel. This regular loss of enamel can lead to cavities and exposure of the inner layers of the tooth that may leave them feeling very sensitive and painful.

“Healthy teeth are an integral part of good oral health, enabling us to eat, speak and socialise without pain, discomfort or embarrassment. It’s disheartening to know 27% of Aussie kids feel uncomfortable about the appearance of their teeth. No kid should look back on their childhood and remember the distress and pain that came as a result of drinking too many sugary drinks.”

A/Prof Hopcraft said World Oral Health Day serves the perfect chance for Australians to rethink their choice of drink.

“We know less than 10 per cent of Australian adults have managed to avoid tooth decay. There is no reason why we can’t turn these numbers around. If Australians can simply cut back on sugary drinks or remove them entirely from their diet, their teeth will be much stronger and healthier for it,” A/Prof Hopcraft said

“We recommend taking a look at how much sugar is in these drinks – people may be shocked to know some have as many as 16 teaspoons of sugar. Water is always the best choice and your teeth will thank you in the long run.”

In support of World Oral Health Day the Rethink Sugary Drink alliance are calling for the following actions in addition to the restriction of unhealthy drink marketing to address the issue of sugary drink overconsumption:

A public education campaign supported by Australian governments to highlight the health impacts of regular sugary


[1] AIHW (Australian Institute of Health and Welfare) 2019. Oral health and dental care in Australia, 2014-15 and 2016-17


About Rethink Sugary Drink: Rethink Sugary Drink is a partnership between the Apunipima Cape York Health Council, Australian Dental Association, Australian Dental and Oral Health Therapists’ Association, Cancer Council Australia, Dental Health Services Victoria, Dental Hygienists Association of Australia, Diabetes Australia, Healthier Workplace WA, Kidney Health Australia, LiveLighter, The Mai Wiru Sugar Challenge Foundation, Nutrition Australia, Obesity Policy Coalition, Royal Australasian College of Dental Surgeons, Stroke Foundation, Parents’ Voice, the Victorian Aboriginal Community Controlled Health Organisation (VACCHO) and the YMCA to raise awareness of the amount of sugar in sugar-sweetened beverages and encourage Australians to reduce their consumption.

Visit  http://www.rethinksugarydrink.org.auu for more information.

NACCHO dental health news:NACCHO wants fluoride added to the water supplies of all Aboriginal communities.

dentist

NACCHO- the National Authority for comprehensive Aboriginal Primary Health  wants fluoride added to the water supplies of all Aboriginal communities.

 The National Aboriginal Community Controlled Health Organisation (NACCHO) CEO Lisa Briggs  gave evidence to a House of Representatives inquiry hearing into adult dental services today.
 

Download the NACCHO submission

In its submission NACCHO called on the federal government to provide money to Aboriginal-controlled health organisations so they could provide dental services.

Aboriginal people were more likely than non-indigenous Australians to have lost all their teeth, it said.

The organisation urged state and territory government to fluoridate all town, city and Aboriginal community water supplies.

As well more work was needed to attract dental workers to remote Aboriginal communities.

“There are concerns among dental health professionals that positions in Aboriginal communities are not seen as part of the usual career ladder,” NACCHO said.

Exposure to Aboriginal controlled health organisations during training would help attract more young dentists.

Proper funding would allow organisations to offer competitive remuneration packages that would encourage dentists to remote and rural areas

RECOMMENDATIONS

NACCHO recommends that the NPA for adult public dental services:

1. Provide culturally appropriate oral health services to all Aboriginal and Torres Strait Islander people;

2. Increase the oral health workforce available to improve the oral health of Aboriginal and Torres Strait Islander people;

3. Increase oral health promotion activity with the aim of improving health outcomes for Aboriginal and Torres Strait Islander people;

4. Improve the collection, quality and dissemination of oral health information about Aboriginal and Torres Strait Islander people; and

5. Foster the integration of oral health within health systems and services, particularly with respect to primary health care and Aboriginal and Torres Strait Islander people.

In addition, NACCHO asserts that:

 1) Oral Health is a priority health issue for Aboriginal peoples.

2) Oral health is a core part of the holistic health that Aboriginal Community Controlled Health Services aim to provide.

3) Aboriginal Community Controlled Health Services should provide primary oral health care services including emergency and preventative oral health care and oral health promotion.

4) Australia’s National Partnership Agreement to come into effect June 2014 should be fully funded and implemented, in particular in relation to measures for Aboriginal and Torres Strait Islander Peoples in particular.

5) The Patient-assisted Transport Scheme (PATS) must be extended to dental patients.

6) Dental services should be subsidised to all needy Aboriginal and Torres Strait Islander patients to reduce or eliminate cost as a barrier to accessing services..

7) Aboriginal and Torres Strait Islanders in correctional facilities should have access to culturally appropriate oral health programs.

8) All oral health workers must receive cultural awareness training either as part of their initial training or through on-going professional development. This will increase the level of culturally accessible oral health services.

9) There should be support for more Aboriginal and Torres Strait Islander individuals to be trained in all the oral health profession: dentists, dental hygienists, dental therapists, etc.

10) The Australian Dental Council (ADC) should include performance indicators for training schools for recruitment and retention of Aboriginal and Torres Strait Islander trainees and have a target of 2.4% of each profession being Aboriginal and/or Torres Strait Islander individuals.

11) Oral health should be included in the core training of all health workers including Aboriginal Health Workers.

12) Fluoridation of drinking water supplies is an effective strategy to reduce oral health problems.

13) Culturally appropriate Oral Health promotion materials need to be developed, tested for impact, and widely disseminated if effective.

14) Improved and regular collection of data on Aboriginal oral health status and use of services is needed to allow monitoring of the impact of interventions and assessment of achievement of oral health goals and targets.

NACCHO will:

15) Work with all Australian governments to develop oral health service provision at all its member health services.

16) Work with stakeholders to develop cultural awareness training for all oral health workers.

17) Campaign in support of fluoridation of city, town and community water supplies.

18) Improve the level of useful Aboriginal oral health data initially by influencing the capacity for the sector to collect national data collection in those Aboriginal Community Controlled Services with an existing oral health service – e.g periodontal and dental caries status, oral hygiene knowledge and periodontal disease links with Diabetes etc.

19) Support research to collect information on the areas of individual oral health behaviours, knowledge and barriers in regards to oral health including the availability and affordability of oral hygiene items.

 NACCHO calls upon the Federal Government, in collaboration with state and territory governments and NACCHO, to:

20) Fully fund and implement the 2014 National Partnership Agreement

21) Set and monitor goals and time specific targets in relation to meeting a range of oral health outcomes such as caries rates, periodontal disease rates and tooth extraction rates.

22) Formally recognise oral health as a key part of Aboriginal holistic health care to be provided by ACCHSs.

23) Allocate resources specifically for oral health services for Aboriginal peoples.

24) Increase oral health promotion activities in ACCHSs. This would require both increased financing for the development and testing of suitable materials, service provision and training of the AHW workforce.

25) Provide subsidised tooth brushes, tooth paste and floss to all remote communities in the first place and extend this as necessary to other communities where data collection indicates there is an access issue for these items.

NACCHO calls upon state and territory governments to:

26) Fluoridate all town, city and Aboriginal community water supplies that do not naturally contain a level of fluoride sufficient to prevent dental caries and immediately fluoridisation where this has ceased.

We welcome feedback on this recommendations