This 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).
People with disability
Around 1 in 6 (18%) people in Australia—or about 4.4 million—have disability (AIHW 2022). Some people with disability experience difficulties accessing and using health services. Barriers can include longer than desired waiting times, the cost of services, the accessibility of buildings and direct or indirect discrimination by health professionals. Some people with disability may also experience issues caused by a lack of communication between the health professionals treating them (AIHW 2022).
This chapter highlights dental-related findings presented in the People with disability in Australia report, with the data derived from the Australian Bureau of Statistics’ 2018 Survey of Disability, Ageing and Carers (SDAC) (ABS 2019).
Measuring and defining disability
There are many different concepts and measures of disability, making comparisons across different data sources challenging. The AIHW promotes measures based on the International Classification of Functioning, Disability and Health (WHO 2001), which underpins the disability categories used here.
The SDAC is the most detailed and comprehensive source of disability prevalence in Australia. To identify disability, the SDAC asks participants if they have at least one of a list of limitations, restrictions or impairments, which has lasted, or is likely to last, for at least 6 months and that restricts everyday activities.
The limitations are grouped into 10 activities associated with daily living, and a further two life areas in which people may experience restriction or difficulty as a result of disability – school and employment.
The level of disability is defined by whether a person needs help, has difficulty, or uses aids or equipment with 3 core activities – self-care, mobility, and communication – and is grouped for mild, moderate, severe, and profound limitation. People who ‘always’ or ‘sometimes’ need help with one or more core activities, have difficulty understanding or being understood by family or friends, or can communicate more easily using sign language or other non-spoken forms of communication are referred to in this section as ‘people with severe or profound disability’.
- Dental caries: A disease process that can lead to cavities (small holes) in the tooth structure that compromise both the structure and the health of the tooth, commonly known as tooth decay.
- Dental services: Services that registered dental practitioners provide. These include oral and maxillofacial surgery items, orthodontic, pedodontic and periodontic services, cleft lip and palate services, dental assessment and other dental items listed in the MBS. The term covers dental services funded by health funds, state and territory governments and also individuals’ out-of-pocket payments.
Use of dental services
Around 1 in 2 (51% or 1.2 million) people with disability aged under 65 living in households saw a dental professional for their own health in the last 12 months. This rate is highest among females (55% or 648,000), those in the age group 0-24 (64% or 414,500), those with an intellectual disability (57% or 305,500), and those living in major cities (53% or 855,200).
Explore the data using the interactive below.