Oral Health Rural ECOH Karen Marini Consumer Engagement Manager kmarini@lmmml./org.au 0429 709 882
Rural ECOH Project Rural ECOH is a three year funded partnership project funded by the National Health and Medical Research Council aiming to evaluate use of the Remote Services Futures (RSF) method for rural community participation in Australia. 6 communities working in partnership with health professionals to develop a LOCAL action plan to improve oral health.
Why choose oral health? • Tooth decay is one of Australia’s most prevalent health problems • Dental admissions are the highest cause of acute preventable hospital admissions in Australia • Annually there are more than 40,000 hospital admissions for preventable dental conditions - over 26,000 of these are children under 15 years of age • Direct annual expenditure on dental treatment was $6.7 billion in 2008 – 09 and $1.9 billion in Victoria • Oral disease is the second most expensive disease group to treat, just below cardiovascular disease • It’s more expensive than the treatment of all cancers combined
Why choose oral health? An Aussie smile is an instant indicator of socioeconomic status, employability and self- esteem. It’s also a predictor of physical health . The average number of children’s baby teeth affected by decay has risen. Around 45% of children aged 12 have decay in their adult teeth. Over one-third of adults have untreated decay. And more than 20% of people aged 65 and over have lost all their teeth. Poor oral health and dental decay are the cause of pain, poor nutrition and embarrassment. When appearance and speech are impaired by dental disease, this may inhibit opportunities for education, employment and social interactions. Behavioural risk factors • a high sugar diet including high sugar drinks and juices • excessive plaque build-up • limited exposure to fluoride available in toothpastes, community water fluoridation or other sources
The burden of oral disease Good oral health is important for general health and wellbeing Oral diseases place a considerable impact on individuals, families and the community. The burden of oral disease comes from four main conditions: • tooth decay • gum disease • oral cancer and • oral trauma • less common malocclusion (misalignment of teeth) and the erosion of teeth • Oral health disease causes pain, sepsis and nutritional impacts • It has strong links with mental health, cardiac disease, cancer, diabetes, osteoporosis, rheumatoid arthritis and adverse pregnancy outcomes • Oral health is poorer in rural compared with urban Australia • Aboriginal Australians experience poorer oral health than their non indigenous counterparts as do refugees and immigrants .
At risk community groups
Population Health Profile Population Health Profile Data Taken from PHIDU Medicare Local Report SLA Region FOCUS AREA KEY EVIDENCE LMMML Baseline Gr. Bendigo (C) - Central Gr. Bendigo (C) - Eaglehawk Gr. Bendigo (C) - Inner East Gr. Bendigo (C) - Inner North Gr. Bendigo (C) - Inner West Gr. Bendigo (C) - S'saye Gr. Bendigo (C) - Pt B Estimated resident population and projected growth Total population 17,712 9,044 23,954 11,639 18,030 8,077 12,090 Estimated population by 2020 19,817 10,229 26,941 13,507 20,512 9,180 13,264 SEIFA Index of Relative Socio-Economy Disadvantage SEIFA ranking within LMMML Ranking 1 best to 24 worst 22 24 4 3 7 1 6 Maternal and Child Health Low birth weight babies 7.1% 6.8% 8.1% 6.9% 7.4% 7.3% .. 8.4% Smoking during pregnancy 20.5% 21.3% 29.1% 13.4% 13.8% 19.4% 0.0% 20.8% % fully immunised all children I yr olds 92.1% I yr olds 92.8% I yr olds 90.8% I yr olds 91.5% I yr olds 93.1% I yr olds 95.1% I yr olds 94.5% I yr olds 92% 2 yr olds 94.5% 2 yr olds 94.4% 2 yr olds 94% 2 yr olds 94.1% 2 yr olds 95.5% 2 yr olds 95.6% 2 yr olds 96.5% 2 yr olds 96% 5 yr olds 92.2% 5 yr olds 93.5% 5 yr olds 90.5% 5 yr olds 93.3% 5 yr olds 94% 5 yr olds 94.2% 5 yr olds 94.9% 5 yr olds 94.5% Health Inequalities and Demographic trends Income support Health care card holders 10.3% 13.5% 13.2% 13.6% 9.8% 10.2% 8.0% 10.2% Pension card holders 28.2% 28.4% 34.8% 25.7% 20.3% 26.6% 17.0% 28.2% Families Single parent families with children aged less than 15 years 25.2% 36.0% 39.7% 29.1% 22.8% 24.1% 11.9% 19.3% Private health status Private health insurance (modelled estimate), persons aged 15 years and 81 70 63 97 93 77 129 78 over (Standard Ratio) Aboriginal and Torres Strait Islander people Indigenous population 1.8% 2.3% 2.6% 0.9% 1.6% 1.1% 0.7% 1.2% Refugees and new arrivals People born in a predominantly non-English speaking (NES) country resident 3.5% 4.1% 1.7% 4.9% 2.6% 2.8% 2.2% 3.4% in Australia People born overseas who speak English 'not well' or 'not at all' 0.4% 0.7% 0.2% 0.7% 0.3% 0.2% 0.2% 0.1% Special needs populations Mothers and young children Female sole parent pensioner (% of females aged 15-54yrs) 6.9% 8.1% 12.1% 7.1% 5.3% 7.8% 3.9% 6.5% Young people at risk % NOT Learning or Earning at ages 15 to 19 19.9% 27.4% 26.6% 15.0% 18.4% 19.7% 10.4% 20.3% Older people Number % aged >65 years 17.7% 17.4% 16.8% 16.4% 12.1% 14.4% 8.3% 16.7% People with significant disabilities People with a profound or severe disability 5.6% 7.1% 6.9% 5.1% 5.6% 4.8% 2.9% 5.3% Risk factors Smoking Rates Ranking within LMMML 1 Worst to 10 1 22 15 12 24 14 24 Best Obese persons (modelled estimate), 18 years and over Ranking within LMMML 1 Worst to 2 1 23 22 16 24 17 24 Best Self-assessed health status Fair or poor self-assessed health Ranking within LMMML 1 Worst to 2 1 15 12 11 23 13 24 Best Access to health services Average annual GP attendances per person (From MBS) Ranking within LMMML 1 Worst to 10 4 12 18 11 17 6 24 Best Cancer screening participation rates Bowel 40.9% Bowel 42.1% Cervical 66.2% Bowel 39.8% Cervical 60.0% Bowel 42.6% Cervical 63.1% Bowel 43.1% Cervical 54.2% Breast Bowel 41.8% Cervical 58.9% Breast Bowel 44.3% Cervical 54.2% Breast Bowel 37.9% Cervical 53.1% Breast Cervical 53.9% Breast 67.4% Breast 60.2% Breast 60.6% 57.2% 62.6% 57.8% 51.9% Breast 60.2% Barriers to Access People delayed medical consultation because they could not afford it 15.9% 18.2% 18.9% 16.4% 17.1% 14.7% 10.8% 14.3% Utilisation of health services People delayed purchasing medication because they could not afford it 12.8% 15.7% 17.0% 10.3% 11.6% 12.6% 7.7% 12.6% Persons who often has a difficulty or can't get to places needed with 4.9% 5.7% 6.7% 4.9% 4.5% 4.9% 2.6% 4.5% transport People who had difficulty accessing services 35.0% 34.8% 34.5% 34.6% 34.0% 34.1% 33.6% 34.0%
Common risk factors Figure 3 Average number of teeth affected by tooth decay by age in Australia* Source: Evidence-based oral health promotion resource, Department of Health, Government of Victoria, 2011. * Note that for six year olds, the tooth decay shown is in the primary, not permanent, teeth
Your mouth is the gateway to your body • It’s a window into what's going on in the rest of your body, often serving as a helpful vantage point for detecting the early signs and symptoms of systemic disease • Growing research shows there's a relationship between the bacteria and the inflammation that bacteria cause in the mouth with lots of other diseases • Research shows that if you have an infection in your mouth, it can increase your risk for cardiovascular disease, diabetes, Alzheimer's disease, and even pregnancy complications. • Studies are showing that the inflammation found in periodontal / gum disease may play a more specific role in causing or increasing the risk for certain conditions. • Bacteria that builds up on teeth make gums prone to infection. The immune system moves in to attack the infection and the gums become inflamed. The inflammation continues unless the infection is brought under control. • Over time, inflammation and the chemicals it releases eat away at the gums and bone structure that hold teeth in place. The result is severe gum disease, known as periodontitis. Inflammation can also cause problems in the rest of the body.
Public dental services In 2012-13, over 341,000 people were treated through Victoria’s public dental services • Of these, approximately 189,000 were adults, 152,000 were children and over 140,000 were emergency patients • There are approximately 1.7 million people in Victoria who are eligible for public dental services
Rural ECOH project achievements • Partnership approach, working together • Completed a rapid review of the guidelines around tooth brushing programs in schools • Consulted with and involved our partners at Dental Health Services Victoria • We are now moving into planning the feasibility pilot study at Swan Hill Primary School • Delivered a range of resources that can be used within the community. • Developing brochures promoting local dental health services • Developing a summary of the Child Dental Benefit Scheme information about eligibility
What our communities want in Victoria Communities don’t expect complicated and costly solutions • They don’t want expensive interventions • They want to raise awareness with community and professionals • They want reminders in different settings about the importance of oral health • They want to capitalise on existing partnerships to convey the message of the importance of oral health • www.ruralecoh.com/ • www.dhsv.org.au • www.lmmml.org.au
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