Remoteness Areas Major Cities of Australia Inner Regional Australia Outer Regional Australia Outer Regional Australia Remote Australia Very Remote Australia Burden of oral disease among Rural and Remote Populations Australian Bureau of Statistics (Jul2021-Jun2026), Remoteness Areas, ABS Website, accessed 28 July 2024. Image source: https://tgn.anu.edu.au/resource/rural-remote/   - Major Cities of Australia - Inner Regional Australia - Outer Regional Australia - Remote Australia - Very Remote Australia *Australian Bureau of Statistics (Jul2021-Jun2026), Remoteness Areas, ABS Website, accessed 28 July 2024.* *Image source: https://tgn.anu.edu.au/resource/rural-remote/* Labelled diagram: A map of Australia color-coded to show Remoteness Areas, with a legend indicating that dark green represents Major Cities of Australia, medium-dark green is Inner Regional Australia, medium-light green is Outer Regional Australia, light green is Remote Australia, and pale yellow is Very Remote Australia. Clinical photo: A photograph showing an older man and two children sitting on a vehicle in a rural landscape with trees and blue sky, illustrating the concept of 'Rural and Remote Populations' mentioned in the slide text. # How do we define rural and remote communities? – Modified Monash Category ## Modified Monash Model The Modified Monash Model (MMM) 2019 has been updated to align with the latest available census data (2016). The model was developed to better target health workforce programs to attract health professionals to more remote and smaller communities. The MMM classifies metropolitan, regional, rural and remote areas according to geographical remoteness, as defined by the Australian Bureau of Statistics (ABS), and town size. Health programs will begin transitioning to the new MMM 2019 from 1 January 2020. The MMM is used to determine eligibility for a range of health workforce programs, such as rural Bulk Billing Incentives, Workforce Incentive Program, Bonded Medical Program. | Modified Monash Category (MMM 2019) | Description (including the Australian Statistical Geography Standard – Remoteness Area (2016)) | | :--- | :--- | | **MM 1** | **Metropolitan areas:** Major cities accounting for 70% of Australia’s population<br>All areas categorised ASGS-RA1. | | **MM 2** | **Regional centres:** Inner (ASGS-RA 2) and Outer Regional (ASGS-RA 3) areas that are in, or within a 20km drive of a town with over 50,000 residents. <br>For example: Ballarat, Mackay, Toowoomba, Kiama, Albury, Bunbury. | | **MM 3** | **Large rural towns:** Inner (ASGS-RA 2) and Outer Regional (ASGS-RA 3) areas that are not MM 2 and are in, or within a 15km drive of a town between 15,000 to 50,000 residents. For example: Dubbo, Lismore, Yeppoon, Busselton. | | **MM 4** | **Medium rural towns:** Inner (ASGS-RA 2) and Outer Regional (ASGS-RA 3) areas that are not MM 2 or MM 3, and are in, or within a 10km drive of a town with between 5,000 to 15,000 residents. For example: Port Augusta, Charters Towers, Moree. | | **MM 5** | **Small rural towns:** All remaining Inner (ASGS-RA 2) and Outer Regional (ASGS-RA 3) areas. For example: Mount Buller, Moruya, Renmark, Condamine. | | **MM 6** | **Remote communities:** Remote mainland areas (ASGS-RA 4) AND remote islands less than 5kms offshore. For example: Cape Tribulation, Lightning Ridge, Alice Springs, Mallacoota, Port Hedland. <br>Additionally, islands that have an MM 5 classification with a population of less than 1,000 without bridges to the mainland will now be classified as MM 6 for example: Bruny Island. | | **MM 7** | **Very remote communities:** Very remote areas (ASGS-RA 5). For example: Longreach, Coober Pedy, Thursday Island and all other remote island areas more than 5kms offshore. | https://www.health.gov.au/resources/publications/modified-monash-model-fact-sheet?language=en   The Modified Monash Model (MMM) 2019 has been updated to align with the latest available census data (2016). The model was developed to better target health workforce programs to attract health professionals to more remote and smaller communities. The MMM classifies metropolitan, regional, rural, and remote areas according to geographical remoteness, as defined by the Australian Bureau of Statistics (ABS), and town size. Health programs will begin transitioning to the new MMM 2019 from 1 January 2020. The MMM is used to determine eligibility for a range of health workforce programs, such as: - Rural Bulk Billing Incentives - Workforce Incentive Program - Bonded Medical Program #### Modified Monash Categories (MMM 2019) | Modified Monash Category (MMM 2019) | Description (including the Australian Statistical Geography Standard – Remoteness Area (2016)) | | :--- | :--- | | **MM 1** | **Metropolitan areas:** Major cities accounting for 70% of Australia’s population.<br>All areas categorised ASGS-RA1. | | **MM 2** | **Regional centres:** Inner (ASGS-RA 2) and Outer Regional (ASGS-RA 3) areas that are in, or within a 20km drive of a town with over 50,000 residents.<br>For example: Ballarat, Mackay, Toowoomba, Kiama, Albury, Bunbury. | | **MM 3** | **Large rural towns:** Inner (ASGS-RA 2) and Outer Regional (ASGS-RA 3) areas that are not MM 2 and are in, or within a 15km drive of a town between 15,000 to 50,000 residents.<br>For example: Dubbo, Lismore, Yeppoon, Busselton. | | **MM 4** | **Medium rural towns:** Inner (ASGS-RA 2) and Outer Regional (ASGS-RA 3) areas that are not MM 2 or MM 3, and are in, or within a 10km drive of a town with between 5,000 to 15,000 residents.<br>For example: Port Augusta, Charters Towers, Moree. | | **MM 5** | **Small rural towns:** All remaining Inner (ASGS-RA 2) and Outer Regional (ASGS-RA 3) areas.<br>For example: Mount Buller, Moruya, Renmark, Condamine. | | **MM 6** | **Remote communities:** Remote mainland areas (ASGS-RA 4) AND remote islands less than 5kms offshore. For example: Cape Tribulation, Lightning Ridge, Alice Springs, Mallacoota, Port Hedland.<br>Additionally, islands that have an MM 5 classification with a population of less than 1,000 without bridges to the mainland will now be classified as MM 6 (for example: Bruny Island). | | **MM 7** | **Very remote communities:** Very remote areas (ASGS-RA 5).<br>For example: Longreach, Coober Pedy, Thursday Island, and all other remote island areas more than 5kms offshore. | *Source: https://www.health.gov.au/resources/publications/modified-monash-model-fact-sheet?language=en* Map of Australia colour-coded to illustrate the Modified Monash Model (MMM) classification system, visually distinguishing metropolitan areas from regional and remote communities based on geographical remoteness and town size. Labelled diagram illustrating the seven Modified Monash Model (MMM) categories used to classify Australian communities based on remoteness and town size. The figure displays color-coded horizontal bars corresponding to specific classifications: MM1 = Metropolitan, MM2 = Regional centres, MM3 = Large rural towns, MM4 = Medium rural towns, MM5 = Small rural towns, MM6 = Remote communities, and MM7 = Very remote communities. # Oral health challenges for those living rural and remote **a lack of affordable or accessible transport. (There is a complex mix of non-emergency health transport funders, providers and programs that lack a consistent overarching framework approach.)** **increased cost of healthy food choices and oral hygiene products (including fluoride toothpaste).** Australian Institute of Health and Welfare (2023) *Oral health and dental care in Australia*, AIHW, Australian Government, accessed 15 January 2024.      - **Transport:** A lack of affordable or accessible transport. (There is a complex mix of non-emergency health transport funders, providers and programs that lack a consistent overarching framework approach.) - **Cost of goods:** Increased cost of healthy food choices and oral hygiene products (including fluoride toothpaste). *Australian Institute of Health and Welfare (2023) Oral health and dental care in Australia, AIHW, Australian Government, accessed 15 January 2024.* > [!note] Lecturer — Rural Access Barriers > Rural and remote areas have fewer dental practitioners because their populations are smaller, and clinical infrastructure is limited. > > - Specialist care is particularly difficult to access. > - Transport between communities can be challenging, including travel to primary health care centres. > - Access to fluoridated water is reduced in some parts of Australia, particularly Queensland; nearly 21% of Queensland was described as non-fluoridated. > - This was attributed to anti-fluoridation politics and the transfer of responsibility for fluoridating drinking water to local government areas and authorities. > - Rural and remote communities often include Indigenous and Aboriginal populations, who experience additional oral health challenges discussed in an earlier recording. > [!note] Lecturer — Burden Data Sources > The lecture stated that there were no specific burden-of-disease findings available for some of the priority populations discussed. > > - The National Oral Health Survey conducted in 2017–18 was used as a source of information for the older population. A simple white icon of a molar tooth on an orange background. This graphic serves as a visual bullet point for the slide text stating there are 'fewer dental practitioners in regional and remote areas per head of population than in metropolitan areas'. Icon: A white silhouette of an airplane on a grey background. Icon: A white water drop on a blue background. It illustrates the oral health challenge of reduced access to fluoridated water in regional and remote communities. Labelled diagram: A stylized white icon of a toothbrush with toothpaste applied to its bristles, set against a green background. Icon: A stylized white silhouette of a healthcare professional (head and shoulders) wearing a stethoscope, set against an orange background. Australian Burden of Disease Study 2018 Select from the following: Hyperlinks: - Measure: [DA Qatar] - Year: 2018 - Sex: Persons - Disease group: Oral disorders DALY = Disability-adjusted life years; YLL = Years lost; YLD = Years lived with disability The DALY rate in Remote and very remote areas was 1.6 times as high as Major Cities. 34.9% of in Remote and very remote areas could have been avoided ORAL BURNING OF DISEASE IN REMOTE AND RURAL AUSTRALIA Australia [categorised random rate] Australia 4.5 Major cities 4.1 Inner regional 5.2 Outer regional 5.8 Remote and very remote 6.5 Australian Institute of Health and Welfare (2021) Australian Burden of Disease Study 2018: Interactive data on disease burden, AIHW, Australian Government, accessed 28 July 2024.  #### Australian Burden of Disease Study 2018 - **Measure:** DALY (Disability-Adjusted Life Years) - **Year:** 2018 - **Sex:** Persons - **Disease group:** Oral disorders *Note: DALY = Disability-adjusted life years; YLL = Years of life lost; YLD = Years lived with disability.* #### Key Findings - The DALY rate in Remote and very remote areas was **1.6 times as high** as in Major Cities. - **34.9%** of the burden in Remote and very remote areas could have been avoided. #### Oral Disease Burden by Remoteness Area (DALY Rate) - **Australia (Average):** 4.5 - **Major cities:** 4.1 - **Inner regional:** 5.2 - **Outer regional:** 5.8 - **Remote and very remote:** 6.5 *Australian Institute of Health and Welfare (2021) Australian Burden of Disease Study 2018: Interactive data on disease burden, AIHW, Australian Government, accessed 28 July 2024.* - ==DALY rates for lip and oral cavity cancer were described as nearly 50% higher than the national average in rural and remote areas.== Chart: This bar chart illustrates the comparison of age-standardised DALY rates for oral disorders across different geographic remoteness areas in Australia in 2018. The data shows a trend where the burden increases with remoteness, rising from 4.1 in Major cities to 6.5 in Remote and very remote areas. **Oral burden of disease in remote and rural Australia** Remoteness area **Comparison of age-standardised DALY rate by disease: Persons, 2018** Rate difference compared to national average (AUS) - Lower than national ... - <10% greater - 10-19% greater - 20-29% greater - 30-39% greater - 50%+ greater - No difference Hover over boxes for more information and scroll for more diseases/injuries. | Disease group | Disease/Injury | Australia | Major cities | Inner regional | Outer regional | Remote and very remote | |---------------|------------------------|-----------|--------------|----------------|----------------|------------------------| | Oral disorders | Dental caries | 2.0 | 1.8 | 2.4 | 2.6 | 3.0 | | | Periodontal disease | 1.6 | 1.5 | 1.6 | 2.1 | 3.0 | | | Severe tooth loss | 0.9 | 0.9 | 1.2 | 1.1 | 0.6 | | | Other oral disorders | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | | | Lip and oral cavity cancer | 0.4 | 0.3 | 0.4 | 0.6 | 0.7 | Australian Institute of Health and Welfare (2021) *Australian Burden of Disease Study 2018: Interactive data on disease burden*, AIHW, Australian Government, accessed 28 July 2024.  Comparison of age-standardised DALY rate by disease: Persons, 2018. | Disease group | Disease/Injury | Australia | Major cities | Inner regional | Outer regional | Remote and very remote | |---|---|---|---|---|---|---| | Oral disorders | Dental caries | 2.0 | 1.8 | 2.4 | 2.6 | 3.0 | | | Periodontal disease | 1.6 | 1.5 | 1.6 | 2.1 | 3.0 | | | Severe tooth loss | 0.9 | 0.9 | 1.2 | 1.1 | 0.6 | | | Other oral disorders | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | | | Lip and oral cavity cancer | 0.4 | 0.3 | 0.4 | 0.6 | 0.7 | ##### Rate Difference Legend (Compared to National Average) - Lower than national - <10% greater - 10–19% greater - 20–29% greater - 30–39% greater - 50%+ greater - No difference *Australian Institute of Health and Welfare (2021) Australian Burden of Disease Study 2018: Interactive data on disease burden, AIHW, Australian Government, accessed 28 July 2024.* Chart: A legend displaying color-coded categories for the 'Rate difference compared to national average (AUS)', ranging from blue squares indicating rates lower than the national average to red squares representing rates 50% or greater. People with additional and/or specialised oral care needs https://www.australianageingagenda.com.au/contributors/opinion/stop-the-rot-in-oral-care-for-elderly-australians/ https://www.dental.wa.gov.au/Dental-Services/Special-services/ ---   People with additional and/or specialised oral care needs - https://www.australianageingagenda.com.au/contributors/opinion/stop-the-rot-in-oral-care-for-elderly-australians/ - https://www.dental.wa.gov.au/Dental-Services/Special-services/ Clinical photo: A healthcare worker or carer assists an elderly person in a wheelchair with oral hygiene at a bathroom sink, illustrating the support required for people with additional and/or specialised oral care needs. Clinical photo: A male patient is seated in a dental chair, laughing and clapping his hands, with a dental delivery unit visible to the left. ### Table:Composition of this priority population and related challenges | **Priority Population** | **Challenge to oral care/service** | | :--- | :--- | | **People living with mental illness** | 1. Live in unstable accommodation (severe illness) | | | 2. A lifestyle that contributes to co-morbidities. | | | 3. Multiple risk factors for poor oral health, including mouth dryness. | | | 4. increased risk of excessive alcohol consumption, drug use and smoking. | | **People with disabilities** | 1. May not perceive or express the need for oral health care. | | | 2. Ambivalent attitudes of disability carers. | | | 3. Costs: Disability schemes do not cover most dental care | | **People with complex medical conditions** | 1. Complex needs requiring specialist services. | | | 2. Higher costs of care. | | **Frail old people** | 1. Complex needs including dementia. | | | 2. insufficient oral health resources within aged care settings; | | | 3. inherent unaddressed structural workforce challenges related to policy, staffing models, changing workforce demographics, and workplace culture, | | | 4. inadequate access to oral care services (**WAITLIST**). | Australian Institute of Health and Welfare (2023) *Oral health and dental care in Australia*, AIHW, Australian Government, accessed 15 January 2024. | Priority Population | Challenge to oral care/service | | :--- | :--- | | **People living with mental illness** | 1. Live in unstable accommodation (severe illness)<br>2. A lifestyle that contributes to co-morbidities.<br>3. Multiple risk factors for poor oral health, including mouth dryness.<br>4. Increased risk of excessive alcohol consumption, drug use and smoking. | | **People with disabilities** | 1. May not perceive or express the need for oral health care.<br>2. Ambivalent attitudes of disability carers.<br>3. Costs: Disability schemes do not cover most dental care | | **People with complex medical conditions** | 1. Complex needs requiring specialist services.<br>2. Higher costs of care. | | **Frail old people** | 1. Complex needs including dementia.<br>2. Insufficient oral health resources within aged care settings;<br>3. Inherent unaddressed structural workforce challenges related to policy, staffing models, changing workforce demographics, and workplace culture,<br>4. Inadequate access to oral care services (waitlist). | *Australian Institute of Health and Welfare (2023) Oral health and dental care in Australia, AIHW, Australian Government, accessed 15 January 2024.* > [!note] Lecturer — Additional Population Details > The lecturer added further detail about the composition and practical challenges of these priority populations. > > - The four groups include frail older people, who are often living in residential aged care. > - Medications used to manage mental illnesses can contribute to additional health challenges. > - Some, or most, people with disabilities may be entirely dependent on disability carers or other carers, and people living in institutionalised care may be particularly affected by ambivalent attitudes among those carers. > - People with disabilities often have complex oral care needs, and specialist services may involve very long waiting lists. > - Aged care workers may come from multicultural and migrant communities and may have ambivalent attitudes towards oral health. > - There may be long waiting lists when accessing public services, particularly specialist care. **Some findings – Elder population – NOHS 2017-18** ARCPOH: https://health.adelaide.edu.au/arcpoh/ua/media/821/australias-oral-health-2017-18.pdf ARCPOH: https://health.adelaide.edu.au/arcpoh/ua/media/821/australias-oral-health-2017-18.pdf # Some findings – Elder population – NOHS 2017-18 <!-- Chart content below --> ARCPOH: https://health.adelaide.edu.au/arcpoh/ua/media/821/australias-oral-health-2017-18.pdf  ARCPOH: https://health.adelaide.edu.au/arcpoh/ua/media/821/australias-oral-health-2017-18.pdf Chart: A stacked bar chart illustrating the average number of teeth categorized as Missing (blue), Filled (white), and Decayed (grey) across various age groups, comparing data from three specific time periods ('87-88, '04-06, and '17-18). # Some findings – Elder population – NOHS 2017-18 **Per cent (%)** 15–24 | 25–34 | 35–44 | 45–54 | 55–64 | 65–74 | 75+ | All ages ---|---|---|---|---|---|---|--- 1987–88 | 0.5 | 5.0 | 16.6 | 32.7 | 53.5 | 72.1 | 79.8 | 20.6 2004–06 | 0.1 | 0.4 | 2.5 | 10.5 | 24.9 | 43.7 | 55.6 | 13.8 2017–18 | 0.7 | 0.7 | 3 | 6.8 | 17.4 | 28.9 | 45.6 | 10.2 Source: National Oral Health Survey of Australia 1987–88, National Survey of Adult Oral Health from 2004–06, and National Study of Adult Oral Health 2017–18. **Figure 7.2: The percentage of people with less than 21 natural teeth among dentate Australians aged 15 years and over, 1987–88, 2004–06, and 2017–18** ARCPOH: https://health.adelaide.edu.au/arcpoh/ua/media/821/australias-oral-health-2017-18.pdf  #### Percentage with Fewer Than 21 Natural Teeth | Survey Year | 15–24 | 25–34 | 35–44 | 45–54 | 55–64 | 65–74 | 75+ | All ages | |---|---|---|---|---|---|---|---|---| | 1987–88 | 0.5 | 5.0 | 16.6 | 32.7 | 53.5 | 72.1 | 79.8 | 20.6 | | 2004–06 | 0.1 | 0.4 | 2.5 | 10.5 | 24.9 | 43.7 | 55.6 | 13.8 | | 2017–18 | 0.7 | 0.7 | 3.0 | 6.8 | 17.4 | 28.9 | 45.6 | 10.2 | *Figure 7.2: The percentage of people with less than 21 natural teeth among dentate Australians aged 15 years and over, 1987–88, 2004–06, and 2017–18* Source: National Oral Health Survey of Australia 1987–88, National Survey of Adult Oral Health from 2004–06, and National Study of Adult Oral Health 2017–18. ARCPOH: https://health.adelaide.edu.au/arcpoh/ua/media/821/australias-oral-health-2017-18.pdf This figure is a bar chart illustrating the percentage of dentate Australians with less than 21 natural teeth across seven age groups and an 'All ages' category for three survey periods: 1987–88 (blue), 2004–06 (orange), and 2017–18 (grey). The vertical axis represents the percentage from 0 to 90, while error bars on each column indicate statistical variability. A data table below the x-axis provides the specific numerical values corresponding to each colored bar. # Some findings – Elder population – NOHS 2017-18 <table> <tr> <th></th> <th>15–24</th> <th>25–34</th> <th>35–44</th> <th>45–54</th> <th>55–64</th> <th>65–74</th> <th>75+</th> <th>All ages</th> </tr> <tr> <th>1987–88</th> <td>1.3</td> <td>6.5</td> <td>19.7</td> <td>34.8</td> <td>52.5</td> <td>65.0</td> <td>78.0</td> <td>21.5</td> </tr> <tr> <th>2004–06</th> <td>0.5</td> <td>2.4</td> <td>5.5</td> <td>15.6</td> <td>29.2</td> <td>48.0</td> <td>61.2</td> <td>14.9</td> </tr> <tr> <th>2017–18</th> <td>0.8</td> <td>1.3</td> <td>3.8</td> <td>7.9</td> <td>19.1</td> <td>32.1</td> <td>47.4</td> <td>11.3</td> </tr> </table> Source: National Oral Health Survey of Australia 1987–88, National Survey of Adult Oral Health 2004–06, and National Study of Adult Oral Health 2017–18. **Figure 7.3: The percentage of people wearing denture(s) among dentate Australians aged 15 years and over, 1987–88, 2004–06, and 2017–18** ARCPQH: https://health.adelaide.edu.au/arcpoh/ua/media/821/australias-oral-health-2017-18.pdf  #### Percentage Wearing Denture(s) | Survey Year | 15–24 | 25–34 | 35–44 | 45–54 | 55–64 | 65–74 | 75+ | All ages | |---|---|---|---|---|---|---|---|---| | 1987–88 | 1.3 | 6.5 | 19.7 | 34.8 | 52.5 | 65.0 | 78.0 | 21.5 | | 2004–06 | 0.5 | 2.4 | 5.5 | 15.6 | 29.2 | 48.0 | 61.2 | 14.9 | | 2017–18 | 0.8 | 1.3 | 3.8 | 7.9 | 19.1 | 32.1 | 47.4 | 11.3 | *Figure 7.3: The percentage of people wearing denture(s) among dentate Australians aged 15 years and over, 1987–88, 2004–06, and 2017–18* Source: National Oral Health Survey of Australia 1987–88, National Survey of Adult Oral Health 2004–06, and National Study of Adult Oral Health 2017–18. ARCPOH: https://health.adelaide.edu.au/arcpoh/ua/media/821/australias-oral-health-2017-18.pdf > [!note] Lecturer — Elder Trends > Older people were expected to have higher DMF values because they have lived longer and therefore have greater lifetime caries experience. > > - The decline in tooth loss was presented as an indication that treatment of the dentition may be improving. > - As older people retain more teeth, periodontal disease findings would be expected to be substantially higher. > - The decline in denture use was linked to the reduction in tooth loss. > - No specific burden-of-disease findings were available for this population group, so the lecture referred to the 2017–18 National Oral Health Survey. > [!note] Lecturer — Population Data > There is no substantive population-level data on oral health disease burden among people with disabilities. > Research studies are therefore used to help identify their oral health needs. Chart: A bar graph displaying the percentage of dentate Australians wearing dentures across various age groups (15–24 to 75+ and All ages) for three distinct time periods: 1987–88 (blue bars), 2004–06 (orange bars), and 2017–18 (grey bars). The chart illustrates a general decline in denture usage over time, with error bars indicating statistical variance. # *Some findings – people with disabilities* **Table 2. Distribution of children by dental status and need for preventive and/or restorative treatment** <table> <thead> <tr> <th rowspan="2">Dental status</th> <th colspan="2">Children at special developmental schools<br>n=150</th> <th colspan="2">Children at special schools<br>n=150</th> <th colspan="2">Total children<br>n=300</th> </tr> <tr> <th>Range</th> <th>Mean score (&plusmn;SD)</th> <th>Range</th> <th>Mean score (&plusmn;SD)</th> <th>Range</th> <th>Mean score (&plusmn;SD)</th> </tr> </thead> <tbody> <tr> <td>No. decayed teeth (d+D)</td> <td>0-16</td> <td>1.5(2.4)</td> <td>0-8</td> <td>1.3(1.6)</td> <td>0-16</td> <td>1.4(2.0)</td> </tr> <tr> <td>No. missing teeth (m+M)</td> <td>0-2</td> <td>0.1(0.3)</td> <td>0-2</td> <td>0.1(0.3)</td> <td>0-2</td> <td>0.1(0.3)</td> </tr> <tr> <td>No. filled teeth (f+F)</td> <td>0-8</td> <td>0.9(1.7)</td> <td>0-8</td> <td>0.7(1.4)</td> <td>0-8</td> <td>0.8(1.6)</td> </tr> <tr> <td>Total No. teeth present (t+T)</td> <td>17-29</td> <td>24.0(2.0)</td> <td>14-31</td> <td>24.6(2.3)</td> <td>14-31</td> <td>24.3(2.2)</td> </tr> <tr> <td>dmft + DMFT index*</td> <td>0-18</td> <td>2.5(3.1)</td> <td>1-10</td> <td>2.0(2.3)</td> <td>0-18</td> <td>2.2(2.8)</td> </tr> <tr> <td>No. teeth with enamel defects</td> <td>0-18</td> <td>1.2(2.8)</td> <td>0-26</td> <td>2.2(4.1)</td> <td>0-26</td> <td>1.7(3.5)</td> </tr> <tr> <td>No. teeth with attrition</td> <td>0-22</td> <td>3.1(5.1)</td> <td>0-16</td> <td>2.1(4.1)</td> <td>0-22</td> <td>2.6(4.6)</td> </tr> <tr> <th>Need for preventive and/or restorative treatment</th> <th colspan="2">No. of children (%)</th> <th colspan="2">No. of children (%)</th> <th colspan="2">Total children (%)</th> </tr> <tr> <td>None</td> <td colspan="2">18(12)</td> <td colspan="2">8(5)</td> <td colspan="2">26(9)</td> </tr> <tr> <td>Simple</td> <td colspan="2">66(44)</td> <td colspan="2">57(38)</td> <td colspan="2">123(41)</td> </tr> <tr> <td>Moderate</td> <td colspan="2">38(25)</td> <td colspan="2">53(35)</td> <td colspan="2">91(30)</td> </tr> <tr> <td>Complex</td> <td colspan="2">28(19)</td> <td colspan="2">32(21)</td> <td colspan="2">60(20)</td> </tr> </tbody> </table> \*dmft+DMFT index = sum of No. of decayed teeth (d+D), plus No. of missing teeth (m+M), plus No. of filled teeth (f+F). *** Desai M, Messer LB, Calache H. A study of the dental treatment needs of children with disabilities in Melbourne, Australia. Aust Dent J. 2001 Mar;46(1):41-50. doi: 10.1111/j.1834-7819.2001.tb00273.x Azimi S, Lima F, Slack-Smith L, Bourke J, Calache H, Junaid M, Leonard H. Factors associated with dental hospitalisations in children with intellectual disability or autism spectrum disorder: a Western Australian population-based retrospective cohort study. Disabil Rehabil. 2022 Sep;44(19):5495-5503. doi: 10.1080/09638288.2021.1936662. Australian Institute of Health and Welfare (2023) [Oral health and dental care in Australia](https://www.aihw.gov.au/reports/dental-oral-health/oral-health-and-dental-care-in-australia/contents/priority-populations/people-with-additional-and-or-specialised-health-c), AIHW, Australian Government, accessed 28 July 2024. https://www.aihw.gov.au/reports/dental-oral-health/oral-health-and-dental-care-in-australia/contents/priority-populations/people-with-additional-and-or-specialised-health-c #### Distribution of Children by Dental Status and Treatment Needs | Dental Status | Children at Special Developmental Schools (n=150) Range | Children at Special Developmental Schools (n=150) Mean (±SD) | Children at Special Schools (n=150) Range | Children at Special Schools (n=150) Mean (±SD) | Total Children (n=300) Range | Total Children (n=300) Mean (±SD) | | :--- | :--- | :--- | :--- | :--- | :--- | :--- | | No. decayed teeth (d+D) | 0–16 | 1.5 (2.4) | 0–8 | 1.3 (1.6) | 0–16 | 1.4 (2.0) | | No. missing teeth (m+M) | 0–2 | 0.1 (0.3) | 0–2 | 0.1 (0.3) | 0–2 | 0.1 (0.3) | | No. filled teeth (f+F) | 0–8 | 0.9 (1.7) | 0–8 | 0.7 (1.4) | 0–8 | 0.8 (1.6) | | Total No. teeth present (t+T) | 17–29 | 24.0 (2.0) | 14–31 | 24.6 (2.3) | 14–31 | 24.3 (2.2) | | dmft + DMFT index* | 0–18 | 2.5 (3.1) | 1–10 | 2.0 (2.3) | 0–18 | 2.2 (2.8) | | No. teeth with enamel defects | 0–18 | 1.2 (2.8) | 0–26 | 2.2 (4.1) | 0–26 | 1.7 (3.5) | | No. teeth with attrition | 0–22 | 3.1 (5.1) | 0–16 | 2.1 (4.1) | 0–22 | 2.6 (4.6) | \*dmft+DMFT index = sum of No. of decayed teeth (d+D), plus No. of missing teeth (m+M), plus No. of filled teeth (f+F). | Need for Preventive and/or Restorative Treatment | Special Developmental Schools No. (%) | Special Schools No. (%) | Total Children No. (%) | | :--- | :--- | :--- | :--- | | None | 18 (12%) | 8 (5%) | 26 (9%) | | Simple | 66 (44%) | 57 (38%) | 123 (41%) | | Moderate | 38 (25%) | 53 (35%) | 91 (30%) | | Complex | 28 (19%) | 32 (21%) | 60 (20%) | *Desai M, Messer LB, Calache H. A study of the dental treatment needs of children with disabilities in Melbourne, Australia. Aust Dent J. 2001 Mar;46(1):41-50. doi: 10.1111/j.1834-7819.2001.tb00273.x* *Azimi S, Lima F, Slack-Smith L, Bourke J, Calache H, Junaid M, Leonard H. Factors associated with dental hospitalisations in children with intellectual disability or autism spectrum disorder: a Western Australian population-based retrospective cohort study. Disabil Rehabil. 2022 Sep;44(19):5495-5503. doi: 10.1080/09638288.2021.1936662.* *Australian Institute of Health and Welfare (2023) Oral health and dental care in Australia, AIHW, Australian Government, accessed 28 July 2024. https://www.aihw.gov.au/reports/dental-oral-health/oral-health-and-dental-care-in-australia/contents/priority-populations/people-with-additional-and-or-specialised-health-c* Some findings – people with disabilities ORAL HOSPITALISATION AND INTELLECTUAL DISABILITY 5499 Figure 1. Dental hospitalisation episodes for various oral diagnoses for children with intellectual disability and/or autism born in Western Australia in three different age group cohorts. 0-6 years 6-12 years 12-18 years Desai M, Messer LB, Calache H. A study of the dental treatment needs of children with disabilities in Melbourne, Australia. Aust Dent J. 2001 Mar;46(1):41-50. doi: 10.1111/j.1834-7819.2001.tb00273.x Azimi S, Lima F, Slack-Smith L, Bourke J, Calache H, Junaid M, Leonard H. Factors associated with dental hospitalisations in children with intellectual disability or autism spectrum disorder: a Western Australian population-based retrospective cohort study. Disabil Rehabil. 2022 Sep;44(19):5495-5503. doi: 10.1080/09638288.2021.1936662. Australian Institute of Health and Welfare (2023) *Oral health and dental care in Australia*, AIHW, Australian Government, accessed 28 July 2024. https://www.aihw.gov.au/reports/dental-oral-health/oral-health-and-dental-care-in-australia/contents/priority-populations/people-with-additional-and-or-specialised-health-c  Figure 1. Dental hospitalisation episodes for various oral diagnoses for children with intellectual disability and/or autism born in Western Australia in three different age group cohorts: - 0–6 years - 6–12 years - 12–18 years *Desai M, Messer LB, Calache H. A study of the dental treatment needs of children with disabilities in Melbourne, Australia. Aust Dent J. 2001 Mar;46(1):41-50. doi: 10.1111/j.1834-7819.2001.tb00273.x* *Azimi S, Lima F, Slack-Smith L, Bourke J, Calache H, Junaid M, Leonard H. Factors associated with dental hospitalisations in children with intellectual disability or autism spectrum disorder: a Western Australian population-based retrospective cohort study. Disabil Rehabil. 2022 Sep;44(19):5495-5503. doi: 10.1080/09638288.2021.1936662.* *Australian Institute of Health and Welfare (2023) Oral health and dental care in Australia, AIHW, Australian Government, accessed 28 July 2024. https://www.aihw.gov.au/reports/dental-oral-health/oral-health-and-dental-care-in-australia/contents/priority-populations/people-with-additional-and-or-specialised-health-c* > [!note] Lecturer — Hospital Admissions > A substantial proportion of children with intellectual disability and autism had been admitted to hospital for dental caries. > > - This was concerning because it suggested that these children were not receiving adequate primary oral health care services. > - Hospital use for dental caries indicated gaps in primary oral health care. Chart: A bar chart illustrating the percentage of dental hospitalisation episodes for various oral diagnoses across three age group cohorts (0-6 years, 6-12 years, and 12-18 years). The x-axis lists specific diagnoses such as 'Dental Caries' and 'Disorders of tooth development', while the y-axis measures the percentage. The chart shows that Dental Caries is the most frequent cause of hospitalisation for all groups, though the prevalence decreases with age. **Some findings – people with disabilities** ## People with disability interactive 1: People with disability living in households, by use of dental services for own health in the last 12 months, 2018 ### Select a variable: - [ ] Disability status - [ ] Age - [*] Disability group - [ ] Remoteness Per cent ### Head injury, stroke or acquired brain injury | Male | Female ### Intellectual | Male | Female ### Physical restriction | Male | Female ### Psychosocial | Male | Female ### Sensory and speech | Male | Female ### Other | Male | Female Note: Data only includes people aged under 65 with disability living in households, unless categorised by age. Source: ABS 2019 http://www.aihw.gov.au Desai M, Messer LB, Calache H. A study of the dental treatment needs of children with disabilities in Melbourne, Australia. Aust Dent J. 2001 Mar;46(1):41-50. doi: 10.1111/j.1834-7819.2001.tb00273.x Azimi S, Lima F, Slack-Smith L, Bourke J, Calache H, Junaid M, Leonard H. Factors associated with dental hospitalisations in children with intellectual disability or autism spectrum disorder: a Western Australian population-based retrospective cohort study. Disabil Rehabil. 2022 Sep;44(19):5495-5503. doi: 10.1080/09638288.2021.1936662. Australian Institute of Health and Welfare (2023) *Oral health and dental care in Australia*, AIHW, Australian Government, accessed 28 July 2024. https://www.aihw.gov.au/reports/dental-oral-health/oral-health-and-dental-care-in-au Australia/contents/priority-populations/people-with-additional-and-or-specialised-health-c  #### Dental Service Utilization by Household Residents (2018) People with disability living in households, by use of dental services for own health in the last 12 months, 2018 (Per cent). **Selected variable:** Disability group - Head injury, stroke or acquired brain injury (Male / Female) - Intellectual (Male / Female) - Physical restriction (Male / Female) - Psychosocial (Male / Female) - Sensory and speech (Male / Female) - Other (Male / Female) Other available variables: - Disability status - Age - Remoteness Note: Data only includes people aged under 65 with disability living in households, unless categorised by age. *Source: ABS 2019, http://www.aihw.gov.au* *Desai M, Messer LB, Calache H. A study of the dental treatment needs of children with disabilities in Melbourne, Australia. Aust Dent J. 2001 Mar;46(1):41-50. doi: 10.1111/j.1834-7819.2001.tb00273.x* *Azimi S, Lima F, Slack-Smith L, Bourke J, Calache H, Junaid M, Leonard H. Factors associated with dental hospitalisations in children with intellectual disability or autism spectrum disorder: a Western Australian population-based retrospective cohort study. Disabil Rehabil. 2022 Sep;44(19):5495-5503. doi: 10.1080/09638288.2021.1936662.* *Australian Institute of Health and Welfare (2023) Oral health and dental care in Australia, AIHW, Australian Government, accessed 28 July 2024. https://www.aihw.gov.au/reports/dental-oral-health/oral-health-and-dental-care-in-australia/contents/priority-populations/people-with-additional-and-or-specialised-health-c* > [!note] Lecturer — Disability Service Use > People living with disabilities often use more dental services because they have significant dental needs. > > - Their service use occurs in the context of complex oral care needs. > - Disability schemes provide limited coverage of dental care. > - Many people depend on carers. > - Specialist services may involve long waiting lists. Chart: Titled 'People with disability interactive 1: People with disability living in households, by use of dental services for own health in the last 12 months, 2018', this bar chart illustrates the percentage of dental service use by gender across different disability groups. The variable 'Disability group' is selected, displaying categories for 'Head injury, stroke or acquired brain injury', 'Intellectual', 'Physical restriction', 'Psychosocial', 'Sensory and speech', and 'Other'. The Y-axis indicates 'Per cent' while the X-axis labels distinguish between 'Male' and 'Female' for each group. Pants Bear Revision - Concepts of burden of disease - Identifying priority population - Burden of disease among priority groups and describing reasons. Image source: https://tenor.com/en-GB/search/revision-gifs  Pants Bear #### Summary of Topics - Concepts of burden of disease - Identifying priority population - Burden of disease among priority groups and describing reasons. *Image source: https://tenor.com/en-GB/search/revision-gifs* > [!note] Lecturer — Lecture Review > The lecture reinforced the DALY concept and identified priority populations described by the Australian Institute of Health and Welfare. > > - Challenges included limited access to dental practitioners, clinical infrastructure, transport, fluoridated water, healthy food, and oral hygiene products. > - The four priority populations with additional or specialised oral care needs were people living with mental illnesses, people living with disabilities, people living with complex medical conditions, and frail older people. > - Rural and very remote communities had oral disease DALY rates nearly 1.6 times higher than major cities, with higher burdens of dental caries, periodontal disease, and lip and oral cavity cancer. > - The next recording was stated to focus on problems in the oral healthcare system, their reasons, and enablers for improving services for priority populations. Cartoon illustration of a bear character (Pants Bear) wearing green overalls, holding a large yellow pencil and writing in an open notebook with a surprised or focused expression. # Thank you --- https://giphy.com/explore/lecture-hall  Thank you *https://giphy.com/explore/lecture-hall* Photograph of a young woman with glasses sleeping in a blue lecture hall seat, illustrating the concept of boredom or exhaustion. [^1]: Original PDF page 1: [[L2.2 Burden of Oral disease among ruralremote communities and those wiht special care needs_slides.pdf#page=1|L2.2 Burden of Oral disease among ruralremote communities and those wiht special care needs slides, p.1]] [^2]: Original PDF page 2: [[L2.2 Burden of Oral disease among ruralremote communities and those wiht special care needs_slides.pdf#page=2|L2.2 Burden of Oral disease among ruralremote communities and those wiht special care needs slides, p.2]] [^3]: Original PDF page 3: [[L2.2 Burden of Oral disease among ruralremote communities and those wiht special care needs_slides.pdf#page=3|L2.2 Burden of Oral disease among ruralremote communities and those wiht special care needs slides, p.3]] [^4]: Original PDF page 4: [[L2.2 Burden of Oral disease among ruralremote communities and those wiht special care needs_slides.pdf#page=4|L2.2 Burden of Oral disease among ruralremote communities and those wiht special care needs slides, p.4]] [^5]: Original PDF page 5: [[L2.2 Burden of Oral disease among ruralremote communities and those wiht special care needs_slides.pdf#page=5|L2.2 Burden of Oral disease among ruralremote communities and those wiht special care needs slides, p.5]] [^6]: Original PDF page 6: [[L2.2 Burden of Oral disease among ruralremote communities and those wiht special care needs_slides.pdf#page=6|L2.2 Burden of Oral disease among ruralremote communities and those wiht special care needs slides, p.6]] [^7]: Original PDF page 7: [[L2.2 Burden of Oral disease among ruralremote communities and those wiht special care needs_slides.pdf#page=7|L2.2 Burden of Oral disease among ruralremote communities and those wiht special care needs slides, p.7]] [^8]: Original PDF page 8: [[L2.2 Burden of Oral disease among ruralremote communities and those wiht special care needs_slides.pdf#page=8|L2.2 Burden of Oral disease among ruralremote communities and those wiht special care needs slides, p.8]] [^9]: Original PDF page 9: [[L2.2 Burden of Oral disease among ruralremote communities and those wiht special care needs_slides.pdf#page=9|L2.2 Burden of Oral disease among ruralremote communities and those wiht special care needs slides, p.9]] [^10]: Original PDF page 10: [[L2.2 Burden of Oral disease among ruralremote communities and those wiht special care needs_slides.pdf#page=10|L2.2 Burden of Oral disease among ruralremote communities and those wiht special care needs slides, p.10]] [^11]: Original PDF page 11: [[L2.2 Burden of Oral disease among ruralremote communities and those wiht special care needs_slides.pdf#page=11|L2.2 Burden of Oral disease among ruralremote communities and those wiht special care needs slides, p.11]] [^12]: Original PDF page 12: [[L2.2 Burden of Oral disease among ruralremote communities and those wiht special care needs_slides.pdf#page=12|L2.2 Burden of Oral disease among ruralremote communities and those wiht special care needs slides, p.12]] [^13]: Original PDF page 13: [[L2.2 Burden of Oral disease among ruralremote communities and those wiht special care needs_slides.pdf#page=13|L2.2 Burden of Oral disease among ruralremote communities and those wiht special care needs slides, p.13]] [^14]: Original PDF page 14: [[L2.2 Burden of Oral disease among ruralremote communities and those wiht special care needs_slides.pdf#page=14|L2.2 Burden of Oral disease among ruralremote communities and those wiht special care needs slides, p.14]] [^15]: Original PDF page 15: [[L2.2 Burden of Oral disease among ruralremote communities and those wiht special care needs_slides.pdf#page=15|L2.2 Burden of Oral disease among ruralremote communities and those wiht special care needs slides, p.15]] [^16]: Original PDF page 16: [[L2.2 Burden of Oral disease among ruralremote communities and those wiht special care needs_slides.pdf#page=16|L2.2 Burden of Oral disease among ruralremote communities and those wiht special care needs slides, p.16]]