With the ageing of the Australian population there is a growing challenge to maintain health into older age and to meet the health needs of this expanding sector of the population. In Australia, the proportion of adults aged 65 years and over is projected to increase from 13% in 2004 to 26-28% in 2051. The health system increasingly faces issues in managing multiple chronic diseases into older age. Oral health is considered fundamental to overall general health and wellbeing.

Oral conditions affect 3.9 billion people world-wide, with untreated caries in permanent teeth being the most prevalent condition in the Global Burden of Disease 2010 Study. Oral diseases such as dental caries are a major public health problem; the experience of pain, problems with eating, chewing, smiling, communication, discoloured or damaged teeth can have a major impact on people’s daily lives. Consistent with widespread dental problems, health expenditure on dental services in Australia is large, accounting for over $8.9 billion in 2013-14.

For adults in Australia there has been a marked decline in complete tooth loss or edentulism, with a reduction in the level of tooth loss linked with increased dental treatment needs, especially in older people. A study of older adults found that those who retained higher numbers of teeth had more periodontal disease and dental caries experience, and reported a past pattern of visiting the dentist more frequently.

Oral diseases are common in Australia and impact on peoples’ lives. Over 90% of Australians born before 1970 have some experience of tooth decay; a quarter of adults have untreated coronal decay, and one in five adults have moderate or severe gum disease. An international study of 26 countries found that higher levels of caries existed in adults than in children, suggesting that caries will remain as a problem in adults even with low caries levels among children. General health tends to be worse not only when there are more health problems present, but also where there are higher numbers of impacts related to oral health problems.

According to the National Advisory Council on Dental Health, oral health is integral to general health. There is a direct association of tooth loss with compromised nutrition, which can impair general health and exacerbate existing health conditions. The mouth is also considered as an entry point for infections, which may spread to other parts of the body. International research has documented associations between chronic oral infections and heart and lung diseases, stroke, low birth‐weight and premature births, as well as between periodontal disease and diabetes. Dental disease also negatively impacts general quality of life, affecting psychological and social wellbeing in addition to physical wellbeing.

Our ageing population is tending to keep their teeth into older age. This leads to problems such as tooth wear, tooth fracture, root caries and pulpal infections (National Oral Health Plan 2004-13). Older people also face access issues relating to receiving adequate dental care, resulting in worse overall oral health with many impacts on their quality of life. Good oral health and adequate dental care are important to facilitate healthy ageing, and can contribute to better general health which can alleviate strain on the health system.

The local public dental care provider in South Australia is the South Australian (SA) Dental Service. Patients’ eligibility for public dental care is determined by concession card status. Patients requesting non-emergency care are waitlisted before being seen at a community clinic, for a period of months to years.

Aims

This research project conducted and evaluated a community-based randomised trial of priority (no waitlist) and waitlisted public dental care for people aged 75 years or older, living at home, who held concession status. The overall aim was to address whether priority dental care via referral by Health Assessments can contribute to successful ageing and help prevent declining health in older age. The research aimed to provide new knowledge to benefit patients, policymakers, service providers, other researchers, and the broader community.

The objectives of the study were to,

1. Evaluate oral health, general health and their relationship in this sample of 75 years or older persons
2. Assess whether persons accessing priority dental care have better oral health outcomes than those waitlisted
3. Assess whether persons accessing priority dental care have better general health outcomes than those waitlisted