The two reports on child dental health and toothbrushing behaviour, released yesterday by the Australian Institute of Health and Welfare, raise concerns for both the community and the dental profession.
The information in the reports is drawn from routine examinations of children enrolled in school dental services in most states and territories of Australia in 2005-06, when approximately 42% of students used such services. Victoria and New South Wales were not included in the reports as the data were unavailable.
Report on dental health
The first report finds that dental decay is unevenly distributed among children.
Just less than half the children aged between five and six had dental decay in their deciduous (milk) teeth and the same figure applied to 12-years-olds’ permanent teeth.
Children living in disadvantaged areas had about 70% more dental decay than their peers from higher socio-economic backgrounds.
This social pattern was reasonably consistent within the states and territories, although the steepness of the social gradient from high to low socioeconomic areas varied.
The prevalence and severity of dental caries recorded in the reports is an extension of the trend of deteriorating child dental health in Australia.
This trend started in the mid-1990s, after three previous decades of improved dental health.
So, why is child dental health deteriorating and how does the social pattern it reflects arise?
Since all the children involved were enrolled in school dental services and presumably had similar access to dental care, the answers to these questions lie outside dental services and in the social context.
The social context shapes community health directly through such things as water fluoridation or the availability of healthy foods, while indirect influences are exerted through family vulnerability or resilience.
And, the balance between protective measures, such as toothbrushing, and risks, such as bad food, shape individual experiences of tooth decay.
This risk-and-protection balance varies by social context and over time.
Report on toothbrushing trends
Toothbrushing is an almost ubiquitous dental health behaviour but its frequency is also somewhat socially patterned and changes over time.
This report found there was a decline in the frequency with which children’s teeth were brushed across the 1990s and the early part of the last decade.
It’s possible that these small shifts contributed to the deterioration in child dental health.
But more significantly, this fall in tooth-brushing frequency is occurring in a community whose diet and nutrition are also changing.
So the dental decay risk-and-protection balance has altered at the population level and there’s now more dental decay.
And how best to address this change poses several challenges.
Need for an integrated approach
The role of specific factors causing dental decay in children over time need to be carefully examined as do changes in those factors.
We must then take action that will engender healthier decisions in daily life, preferentially benefiting those social groups with the most dental decay.
Current initiatives revolve around positive parenting and creating support groups at a local level, which take place in settings such as pre-schools and schools.
Clearly, there needs to be a whole-of-health, integrated approach if we are to make progress.
This is especially important because many of the areas of concern here could overlap with approaches to other health issues such as childhood obesity.
The overlap lies in the frequency of snacking on high-sugar, high-calorie foods, including later in the evening before bed.
Further specific actions to increase the frequency of tooth-brushing are required if we are to reverse the negative trends in child dental health.