Australian Dental Journal

Australian Dental Journal
The official journal of the Australian Dental Association

Australian Dental Journal 2020; 65:(1 Suppl): S23–S31
doi: 10.1111/adj.12761
Tooth loss, denture wearing and implants: Findings from the

National Study of Adult Oral Health 2017–18
Marco A Peres,*,† Ratilal Lalloo‡
*Australian Research Centre for Population Oral Health (ARCPOH), Adelaide Dental School, The University of Adelaide, Adelaide, South
Australia, Australia.
†Menzies Health Institute Queensland and School of Dentistry and Oral Health, Griffith University, Gold Coast, Queensland, Australia.
‡The University of Queensland, School of Dentistry, Brisbane, Queensland, Australia.
ABSTRACT
Background: We aimed to describe the prevalence of different tooth loss outcomes along with the use of dentures and
implants among Australians aged 15+ years across socioeconomic and demographic groups. In addition, we performed
time trend analyses of tooth loss.
Methods: Data from the National Study of Adult Oral Health 2017–18 included gender, age, residential location, house-
hold income, Socio-Economic Indexes for Areas, possession of dental insurance and pattern of dental visiting. Outcomes
were complete tooth loss, inadequate dentition, average number of missing teeth, denture wearing and implants. We
compared our findings with data from previous surveys carried out in 1987–88 and 2004–06.
Results: Tooth loss decreased from 14.4% in 1987–88 to 6.4% in 2004–06, and to 4.0% in 2017–18. The proportion
of people with lack of functional dentition halved from 20.6% 1987–88 to 10.2% in 2017–18; the average number of
teeth lost due for any reason slightly reduced from 2004–06 (6.1) to 2017–18 (5.7). Tooth loss increased with age and
was higher among socioeconomically disadvantaged, uninsured and those with unfavourable pattern of dental visiting
groups than in their counterparts.
Conclusions: An overall improvement in tooth retention was identified over the last decades. However, socioeconomic
inequalities persist.
Keywords: Adults, dental prostheses, oral epidemiology, surveillance, surveys.
Abbreviations and acronyms: CI = confidence intervals; IFDP = implant supported-fixed dental prostheses; NDTIS = National Dental
Telephone Interview Survey; RPD = removable partial dentures; TSFDP = tooth-supported fixed dental prostheses.
(Accepted for publication 17 April 2020).
swallow, . . .”.13 A recent systematic review reported

INTRODUCTION
that people suffering from Alzheimer’s disease had
Oral diseases are a significant and neglected global greater tooth loss and edentulism.14 Another system-
public health problem and there is an urgent need to atic review and meta-analysis showed that individuals
address this with radical action.1,2 Tooth loss is an of low income had greater odds of losing teeth.15
indicator of damage, mostly due to dental caries and In both partial and total tooth loss function can be
periodontal disease. It can however also be an indica- (partially) restored with removable or fixed prosthe-
tor of cost and health system barriers to repair a dam- ses, with or without tooth support or dental implants.
aged tooth and/or patient preference. Usually this will All these restoration options, and especially the fixed
lead initially to partial tooth loss but over time might prostheses with implants, are costly; and might
lead to total tooth loss (edentulism), having a signifi- require dental specialist care.
cant impact on both oral health-related and general The estimated global prevalence of total tooth loss
quality of life.3 Furthermore, tooth loss has been asso- decreased from 4.3% in 1990 to 4.1% in 2015;
ciated with adverse health outcomes such as malnutri- however, the number of people with no teeth
tion, hypertension and obesity.4–6 The impact of both increased from 157 million to 276 million over this
total and severe tooth loss is significant on general time period.16 Over a similar period (1990–2010)
and oral health-related quality of life (OHRQoL).3,7– severe tooth loss (defined here as having fewer than
12
The impacts are often wide-ranging affecting “. . . 10 teeth) decreased from 4.4% to 2.4%.17 Severe
the ability to speak, smile, smell, taste, touch, chew, tooth loss was ranked in the 36th position among the
© 2020 Australian Dental Association S23
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MA Peres and R Lalloo
most prevalent chronic diseases that affect life expec-

METHODS
tation. It affects 2% of the world population,18 and
its treatment directly costs, together with other den-
Sample size calculation and selection
tal diseases, about 4.6% of global health expendi-
ture.19 This is an analysis of the National Study of Adult
The Australian National Oral Health Survey car- Oral Health 2017–18. The study comprises an inter-
ried out in 1987–88 showed that 14.4% were view questionnaire undertaken online or via telephone
edentulous.20 Later in 2004–06 data from the interview and a dental examination. For methodologi-
National Survey of Adult Oral Health revealed a cal details, please see Chrisopoulos et al. (2020)29 and
prevalence of edentulism of 6.4%, but this was Do et al (2020)30 in this issue.
almost 36% in those aged ≥ 75 years of age.21 The
percentage of people with fewer than 21 teeth was
Independent Variables
11%, but this was 55% amongst those born before
1930. Both total and partial tooth loss was signifi- For this present paper, we used the following vari-
cantly related to socioeconomic status, being higher ables, all self-reported: sex (males or females), age
in those with fewer years of schooling, among group (15–34, 35–54, 55–74, and 75+ years), region
those eligible for public dental care and with no (Major city, regional, and remote), household income,
dental insurance. The more recent National Dental Socio-Economic Indexes for Areas (SEIFA), dental
Telephone Interview Survey (NDTIS) carried out in insurance (insured and uninsured) and pattern of den-
2013 reported that edentulism was overall slightly tal visiting. SEIFA ranks areas in Australia according
lower at 4.4% but was almost 20% in those aged to relative socioeconomic advantage and disadvan-
65+ years.22 Overall, the average number of miss- tage. The index is based on information from the five-
ing teeth was 5, but amongst the 65+ year age yearly national census.31 The pattern of dental visiting
group the average was almost 11. In the 65+ age is based on three indicators: usually visit a dentist at
group, those earning less than A$30 000 had on least once a year (How often on average do you seek
average 12 missing teeth compared to five in those care from a dental professional?), usually visit the
earning A$140 000+. same dentist (Is there a dentist you usually go to for
The treatment options to restore function for tooth dental care?) and usually visit dentist for check-up
loss is wide-ranging. These can include removable (What is your reason for visiting a dental profes-
full or partial prostheses, fixed prostheses with or sional?). Favourable attendance is visiting a dentist
without tooth-support or dental implants. These once or more per year, usually for a check-up and
treatment options have differing impacts on quality having a usual dental provider. Unfavourable atten-
of life.23 A recent systematic review showed that dance is visiting less than once every two years, usu-
implant supported-fixed dental prostheses (IFDP) had ally for a problem or visiting once every two years,
greater short-term improvement in OHRQoL com- usually for a problem and without a usual dental pro-
pared to removable partial dentures (RPD) and vider. Any other combination was considered as an
tooth-supported fixed dental prostheses (TFDP).23 intermediate pattern of dental visiting.
IFDP and TFDP showed both short- and long-term
improvements. In general, patients report positive
Outcomes
effects for both fixed and removable prostheses.24–26
Data from the NDTIS 2013 survey showed that 12% Outcomes were obtained from the interview and den-
of Australian adults had a denture, and this was tal examinations. Percentage of complete tooth loss
almost 42% amongst those aged 65+ years. In the was estimated from the following interview question:
2004–2006 national adult survey only 60 implants Do you have any natural teeth? Possible responses
were seen in the 5505 examinations.21 A comparison were Yes/No. Crowns and caps were considered as
of dental services provided by dentists in Australia in existing natural teeth while dental implants were not.
1983–84 and 2013–14 showed a higher rate of Self-reported fewer than 21 natural teeth in those den-
crowns and lower rate of dentures.27 tate estimated the prevalence of inadequate dentition.
The aim of this paper is to report the prevalence Percentage of people who wore dentures among den-
of total and partial tooth loss, denture wearing and tate persons was estimated by the question Do you
presence of dental implants, number of missing teeth have removable dentures or false teeth? Possible
and these replaced by prostheses, from the National responses were ‘No dentures’, ‘upper only’, lower
Study of Adult Oral Health 2017–18.28 The oral out- only’, both upper & lower’ or ‘don’t know’. The
comes were further compared for demographic and prevalence of people with dental implants was calcu-
socioeconomic factors as well as for time trends since lated using the interview question: Do you have any
1987–88. dental implants?
S24 © 2020 Australian Dental Association
Tooth loss among Australian adults
The average number of missing teeth lost for any fewer than 21 teeth was found among those in the
reasons, missing teeth replaced by prostheses per per- lowest income group (23.7%) while the lowest preva-
son in the dentate population and the mean number lence was found among those reporting favourable
of implants per person were estimated by the dental patterns of dental visiting (6.2%) (Table 2). The pro-
examination. portion of people wearing dentures was slightly over
For time trend analysis we used data from National 10% with no difference between sexes. Adults from
Study of Adult Oral Health (NSAOH) 2017–2018, the lowest household income group had almost seven
the National Survey of Adult Oral Health, 2004–06, times higher proportion of wearing dentures com-
and The National Survey of Adult Oral Health carried pared to in the highest income group. Adults who
out in 1987–88. were living in regional and socioeconomic disadvan-
taged areas reported greater use of dentures. Unin-
sured and those with an unfavourable pattern of
Data analysis
dental visiting reported twice the proportions of wear-
All data were weighted to ensure the representative- ing dentures than those insured and with a favourable
ness of the target population as described by Chriso- pattern of dental visiting (Table 3).
poulos et al. (2020)29 in this issue. Mean, and The proportion of adults reporting that they had
proportions and respective 95% confidence intervals dental implants was 5.6% overall ranging from 2.5%
(CI) were estimated using SAS. among the 15–34-year age group to 10.1% among
the 55–74-year age group (Table 4). Men reported a
slightly higher proportion (6.1%) of having dental
RESULTS
implants than females (5.0%). There was no signifi-
Table 1 presents the proportions of Australian adults cant variation in the percentage reporting dental
reporting complete tooth loss. Overall, the prevalence implants by residential location within age groups
of complete tooth loss was 4.0% of the whole sample (data not shown). The overall mean number of dental
aged 15 years and over and 86% of them were wear- implants per person was 0.1 with a higher average
ing full dentures (data not shown). The prevalence of among people aged 55–74 (0.2), among insured (0.3),
edentulism was higher in older age groups and ranged and those in the highest income group (1.4) (Table 5).
from 1.1% for 35–54 year–old to 20.5% for those Table 6 presents the mean number of missing teeth
aged 75 years and over. Females had a higher, but replaced by fixed and removable prostheses per per-
not statistically significant, proportion of tooth loss son. Overall, the mean number of teeth replaced by
than males. There was a clear socioeconomic gradient prostheses was 1.0; this increased with age reaching
in the prevalence of adults with tooth loss across 4.8 teeth replaced by prostheses among those aged
income and SEIFA groups. The lower the household 75+. Females had a slightly higher average than men,
income and SEIFA, the higher the prevalence of total 1.2 and 0.9 respectively. Those in the lowest income
edentulism. The highest proportion of edentulism was group, uninsured and with an unfavourable pattern of
found among those on the lowest income tertile dental visiting had a higher average number of teeth
(10.3%) while the lowest was found among those in replaced by prostheses than their counterparts.
the highest income tertile (0.5%). Uninsured and Figure 1 displays the time trend of figures of tooth
those with an unfavourable pattern of dental visiting loss over time. The percentage of Australians aged
has nearly six times higher prevalence of edentulism 15 years and over with complete tooth loss decreased
than those insured and with a favourable pattern of from 14.4% in 1987–88 to 6.4% in 2004–06, and to
dental visiting. Australian adults living in regional 4.0% in 2017–18. The proportion of those with lack
areas had the highest prevalence of complete tooth of functional dentition halved from 20.6% 1987–88
loss (5.4%). to 10.2% in 2017–18; the average number of teeth
The overall prevalence of lack of functional denti- lost due for any reason slightly reduced from 2004–06
tion (fewer than 21 natural teeth) was slightly over (6.1) to 2017–18 (5.7).
10% of the Australian adult population. There was
no difference between sexes. The lack of functional
DISCUSSION
dentition increased with age varying from only 0.7%
among those aged 15–34 years to nearly half of those The findings of the present study reveal an overall
aged 75+ years. Participants living in regional and improvement in tooth retention among the Australian
socioeconomically disadvantaged areas, those earning adult population in the last three decades. Between
low income, uninsured and with an unfavourable pat- 1987–88 and 2017–18 edentulism has fallen by 72%
tern of dental visiting had a higher prevalence of lack and the lack of functional dentition by nearly 50%.
of functional dentition than their better-off counter- The average number of missing teeth for any reason
parts. The highest proportion of adults reporting slightly reduced in the last 13 years. However, almost
Table 1. Proportion of people with complete tooth loss in the Australian adult population by age groups
N % (95% CI) Total Age (years)
15–34 35–54 55–74 75+

% (95% CI)
Total 15731 4.0 (3.6, 4.4) — 1.1 (0.7, 1.6) 8.1 (7.0, 9.3) 20.5 (18.1, 23.1)
Gender
Males 6781 49.2 (48.1–50.0) 3.4 (2.9, 3.9) — 1.1 (0.6, 2.0) 6.5 (5.2, 8.1) 19.1 (15.6, 23.2)
Females 8950 50.8 (49.6–51.0) 4.7 (4.1, 5.3) — 1.0 (0.6, 1.8) 9.6 (8.0, 11.5) 21.5 (18.4, 25.0)
Region —
Major city 9372 71.8 (68.6–74.0) 3.5 (3.0, 4.0) — 1.0 (0.6, 1.7) 7.4 (6.0, 9.0) 18.8 (15.9, 22.0)
Regional 5572 26.4 (23.3–29.0) 5.4 (4.7, 6.3) — 1.1 (0.6, 1.9) 9.5 (8.1, 11.2) 23.9 (19.8, 28.6)
Remote 787 1.8 (0.9–3.0) 4.8 (3.0, 7.5) — 2.2 (0.6, 8.1) 9.5 (5.6, 15.6) 31.9 (17.8, 50.3)
Income tertile —
Lowest (<$40 000) 4163 31.0 (29.7–32.0) 10.3 (9.2, 11.6) — 2.9 (1.5, 5.7) 11.6 (9.7, 13.8) 25.0 (21.9, 28.3)
Middle ($40-<$100 000) 4358 35.8 (34.6–37.0) 2.0 (1.5, 2.7) — 1.2 (0.6, 2.6) 5.3 (3.8, 7.3) 7.6 (4.2, 13.3)
Highest ($100 000+) 4023 33.2 (31.7–34.0) 0.5 (0.3, 0.8) — 0.3 (0.1, 0.9) 1.9 (1.1, 3.2) 8.9 (2.9, 23.9)
Seifa tertile —
Lowest 5076 33.5 (29.0–38.0) 5.8 (5.1, 6.6) — 1.4 (0.7, 2.5) 11.2 (9.3, 13.3) 26.1 (21.8, 30.9)
Middle 4955 33.2 (28.5–38.0) 3.8 (3.3, 4.5) — 1.1 (0.6, 2.1) 8.4 (6.8, 10.3) 18.1 (14.4, 22.5)
Highest 5700 33.2 (29.0–37.0) 2.4 (1.9, 3.1) — 0.8 (0.4, 1.8) 4.2 (2.6, 6.5) 16.2 (12.6, 20.6)
Dental insurance —
Insured 8238 51.1 (49.5–52.0) 1.7 (1.4, 2.0) — 0.5 (0.3, 1.1) 3.6 (2.8, 4.5) 9.2 (7.0, 11.9)
Uninsured 7206 48.9 (47.2–50.0) 6.5 (5.8, 7.2) — 1.8 (1.1, 2.8) 12.7 (10.9, 14.8) 28.3 (24.7, 32.3)
Visiting pattern —
Favourable 6626 44.9 (43.5–46.0) — — — — —
Intermediate 4692 32.1 (30.9–33.0) 0.4 (0.3, 0.6) — 0.0 (0.0, 0.1) 1.0 (0.5, 1.9) 3.1 (1.7, 5.7)
Unfavourable 3375 23.0 (21.8–24.0) 5.7 (4.8, 6.7) — 0.5 (0.2, 1.2) 10.4 (8.1, 13.3) 29.1 (23.8, 35.0)
N = unweighted sample size; 95% CI = 95% confidence Interval.

Data in this table were taken from the Interview.
1 in 6 Australians are either edentulous or have a lack This is a nationwide study which represents the
of a functional dentition. Despite these advances, entire Australian adult population, as discussed in the
socioeconomic inequalities on tooth loss persist or even methodological paper published in this issue.29
is worsening; those at the top of the social ladder had NSAOH 2017–18 followed the same protocol used in
more retained teeth and less total edentulism than NSAOH 2004–06, allowing comparisons over time.
those on the bottom. The most socioeconomically dis- Oral epidemiological examinations covered different
advantaged group is wearing more prostheses than tooth loss and ways of tooth replacement outcomes,
those who were better-off. The edentulism ratio followed international standards and examiners had
between insured and uninsured adults increased from high clinical reliability measures. On the other hand,
3.0 to 3.8, while the lack of a functional dentition the study was not capable of capturing a full picture
raised from 1.8 to 2.8 between 2004–06 and 2017–18. of Aboriginal and Torres Strait Islander Peoples oral
The overall improvement in retention of teeth is health status, the most socioeconomically vulnerable
due, hypothetically, to some upstream and down- group of the Australian society, given that this
stream factors. The nationwide use of water fluorida- requires a different study design.
tion and fluoridated toothpaste are considered as the The dominance of private mode of delivery dental
two most important public health measures to prevent care in Australia might have an impact in the persis-
dental caries, the most important cause of tooth tent socioeconomic inequalities on tooth loss, dental
loss.32 The favourable pattern of dental visiting, implants and wearing prostheses. Almost one in four
including higher proportion for check-up has been adults had an unfavourable pattern of dental visiting,
mentioned as one factor to improve dental health and almost half of the studied population has no
either in high- or low-income countries.33,34 The pro- health insurance. There are ongoing problems with
portion of adults who reported usually visiting a den- the affordability of dental care reported by Aus-
tal professional for check-up increased from 56.2% in tralians. A recent patient experience survey showed
2004–2008 to 64.9% in 2017–18. These are the most that 17.6% of people delayed seeing or did not see a
plausible explanations for our findings given that the dental professional due to cost compared to 7.7% for
figures of financial barriers to dental care due to cost medical specialists and 3.4% for general medical prac-
were almost identical in the two last national sur- titioners.35 Another problem is the longstanding geo-
veys.21,28 graphic maldistribution of the dental profession
Table 2. Percentage of people with fewer than 21 teeth in the Australian dentate population
N % (95% CI) Total (95% CI) Age (years)
15–34 35–54 55–74 75+

% (95% CI)
Total 14868 10.2 (9.5, 10.9) 0.7 (0.4, 1.2) 4.9 (4.1, 5.7) 22.2 (20.5, 23.9) 45.6 (41.9, 49.3)
Gender
Males 6447 49.6 (48.4–50.8) 10.1 (9.2, 11.1) 0.8 (0.4, 1.6) 4.8 (3.7, 6.1) 23.0 (20.7, 25.6) 46.0 (40.5, 51.5)
Females 8421 50.4 (49.2–51.6) 10.3 (9.4, 11.2) 0.6 (0.3, 1.3) 4.9 (3.8, 6.4) 21.3 (19.1, 23.6) 45.3 (40.6, 50.0)
Region
Major city 8957 72.2 (69.0–75.2) 8.9 (8.1, 9.7) 0.6 (0.3, 1.1) 4.2 (3.3, 5.2) 20.3 (18.2, 22.5) 43.7 (39.2, 48.3)
Regional 5168 26.1 (23.0–29.4) 13.8 (12.4, 15.3) 1.1 (0.4, 3.0) 6.9 (5.3, 8.8) 26.0 (23.2, 29.0) 50.1 (43.7, 56.5)
Remote 743 1.7 (0.9–3.2) 10.2 (7.3, 14.2) 1.5 (0.4, 6.1) 5.0 (2.5, 9.7) 25.5 (19.8, 32.1) 44.3 (22.6, 68.3)
Income tertile
Lowest (<$40 000) 3623 28.9 (27.5–30.3) 23.7 (21.7, 25.8) 1.9 (0.6, 5.3) 12.0 (8.5, 16.6) 31.2 (28.3, 34.2) 49.9 (45.1, 54.6)
Middle ($40-<$100 000) 4251 36.6 (35.3–38.0) 7.7 (6.7, 8.9) 0.5 (0.2, 1.1) 5.0 (3.6, 6.7) 18.6 (15.7, 21.8) 36.5 (28.0, 45.9)
Highest ($100 000+) 3989 34.5 (33.0–36.0) 3.0 (2.5, 3.7) 0.7 (0.3, 1.5) 2.1 (1.4, 3.1) 10.2 (7.7, 13.3) 47.3 (27.3, 68.2)
Seifa tertile
Lowest 4663 32.9 (28.4–37.7) 13.5 (12.2, 15.0) 0.6 (0.2, 1.5) 7.6 (6.0, 9.5) 28.1 (25.3, 31.0) 53.3 (46.5, 60.0)
Middle 4682 33.3 (28.6–38.4) 10.7 (9.6, 11.9) 1.0 (0.4, 2.3) 5.3 (4.1, 7.0) 23.3 (20.2, 26.7) 46.6 (40.6, 52.7)
Highest 5523 33.8 (29.6–38.3) 6.4 (5.7, 7.2) 0.5 (0.2, 1.3) 1.8 (1.2, 2.6) 14.6 (12.5, 16.9) 36.2 (30.6, 42.2)
Dental insurance
Insured 8009 52.4 (50.7–54.1) 6.7 (6.0, 7.4) 0.5 (0.2, 1.1) 2.0 (1.4, 2.8) 15.3 (13.6, 17.3) 33.3 (28.9, 37.9)
Uninsured 6591 47.6 (45.9–49.3) 14.4 (13.3, 15.5) 1.0 (0.5, 1.9) 8.6 (7.1, 10.4) 30.0 (27.4, 32.8) 57.0 (51.6, 62.2)
Visiting pattern
Favourable 6597 45.5 (44.1–47.0) 6.2 (5.5, 6.9) 6.2 (5.5, 6.9) 0.5 (0.2, 1.2) 2.0 (1.3, 3.1) 30.4 (26.1, 35.2)
Intermediate 4635 32.4 (31.3–33.6) 10.7 (9.6, 12.0) 1.0 (0.4, 2.4) 4.9 (3.4, 6.9) 25.9 (22.9, 29.2) 51.8 (44.7, 58.8)
Unfavourable 3101 22.0 (20.9–23.3) 17.5 (15.9, 19.2) 0.7 (0.2, 2.3) 9.4 (7.4, 11.9) 34.2 (30.5, 38.0) 69.6 (61.7, 76.5)

Table 3. Percentage of people who wear denture(s) in the Australian dentate population
15–34 35–54 55–74 75+

% (95% CI)
Total 14914 11.3 (10.7, 12.0) 1.1 (0.7, 1.7) 5.8 (5.0, 6.7) 24.5 (22.8, 26.3) 47.4 (44.1, 50.7)
Gender
Males 6456 49.5 (48.4–50.7) 10.8 (9.8, 11.8) 1.3 (0.7, 2.4) 6.1 (4.9, 7.6) 23.2 (20.8, 25.7) 45.8 (40.9, 50.8)
Females 8458 50.5 (49.3–51.6) 11.8 (11.0, 12.8) 0.9 (0.5, 1.5) 5.5 (4.4, 6.9) 25.8 (23.4, 28.4) 48.6 (44.0, 53.2)
Region
Major city 8984 72.2 (69.0–75.2) 10.3 (9.6, 11.0) 1.0 (0.6, 1.6) 5.3 (4.4, 6.3) 23.2 (21.0, 25.5) 47.2 (43.3, 51.1)
Regional 5183 26.0 (22.9–29.4) 14.3 (13.0, 15.8) 1.4 (0.5, 4.1) 7.4 (5.7, 9.7) 27.3 (24.4, 30.4) 48.1 (41.9, 54.3)
Remote 747 1.7 (0.9–3.2) 9.0 (7.0, 11.3) 0.1 (0.0, 0.5) 3.1 (1.1, 8.6) 25.4 (20.0, 31.7) 40.8 (23.4, 60.9)
Income tertile
Lowest (<$40 000) 3641 29.0 (27.6–30.4) 23.8 (21.9, 25.8) 0.6 (0.2, 1.3) 10.0 (7.2, 13.7) 32.9 (29.9, 36.2) 50.4 (46.2, 54.7)
Middle ($40-<$100,000) 4253 36.6 (35.3–37.9) 8.6 (7.6, 9.8) 1.3 (0.7, 2.3) 5.7 (4.3, 7.6) 19.8 (17.0, 23.0) 36.7 (29.2, 44.8)
Highest ($100,000+) 3998 34.4 (32.9–36.0) 3.5 (2.9, 4.4) 0.3 (0.1, 1.2) 3.3 (2.3, 4.7) 10.9 (8.4, 14.0) 36.6 (18.3, 59.9)
Seifa tertile
Lowest 4684 32.9 (28.5–37.7) 13.6 (12.3, 14.9) 0.5 (0.2, 1.0) 7.0 (5.5, 9.0) 29.6 (26.5, 32.9) 50.5 (44.6, 56.5)
Middle 4694 33.3 (28.6–38.4) 12.2 (11.2, 13.4) 1.8 (0.9, 3.5) 6.6 (5.2, 8.3) 26.1 (23.0, 29.4) 48.9 (43.5, 54.3)
Highest 5536 33.8 (29.5–38.3) 8.2 (7.4, 9.1) 0.9 (0.5, 1.9) 3.8 (2.8, 5.1) 17.3 (15.1, 19.7) 42.3 (36.9, 47.9)
Dental insurance
Insured 8034 52.4 (50.7–54.1) 8.5 (7.8, 9.2) 0.7 (0.4, 1.2) 3.7 (2.8, 4.8) 18.7 (16.8, 20.7) 38.0 (33.4, 42.8)
Uninsured 6611 47.6 (45.9–49.3) 14.6 (13.6, 15.7) 1.5 (0.9, 2.5) 8.1 (6.6, 9.8) 31.1 (28.6, 33.8) 55.9 (51.0, 60.7)
Visiting Pattern
Favourable 6614 45.5 (44.1–47.0) 8.1 (7.3, 9.0) 0.5 (0.2, 1.1) 3.4 (2.4, 4.8) 16.9 (15.0, 19.1) 38.3 (33.5, 43.3)
Intermediate 4650 32.4 (31.3–33.6) 12.2 (11.1, 13.5) 1.4 (0.7, 2.7) 6.3 (4.8, 8.4) 29.6 (26.6, 32.9) 52.9 (46.4, 59.3)
Unfavourable 3114 22.0 (20.9–23.3) 16.1 (14.6, 17.8) 2.0 (1.0, 4.1) 7.9 (6.0, 10.2) 32.1 (28.4, 36.0) 60.3 (52.0, 68.1)


Table 4. Mean number of missing teeth for any reasons per person in the Australian dentate population
15–34 35–54 55–74 75+

Mean (95% CI)
Total 5022 5.7 (5.5, 6.0) 3.2 (3.0, 3.4) 4.8 (4.5, 5.0) 8.8 (8.2, 9.4) 13.2 (12.2, 14.2)
Gender
Males 2249 49.6 (46.9–52.2) 5.4 (5.1, 5.8) 2.8 (2.5, 3.1) 4.5 (4.1, 5.0) 8.6 (8.0, 9.3) 13.6 (12.5, 14.6)
Females 2773 50.4 (47.8–53.1) 6.0 (5.7, 6.4) 3.6 (3.4, 3.8) 5.0 (4.6, 5.3) 9.0 (8.0, 10.0) 12.9 (11.3, 14.6)
Region
Major city 2969 72.7 (69.1–76.0) 5.4 (5.1, 5.7) 3.1 (2.9, 3.3) 4.6 (4.3, 4.9) 8.4 (7.6, 9.2) 13.3 (12.0, 14.6)
Regional 1814 25.7 (22.4–29.4) 6.6 (6.2, 7.0) 3.6 (3.3, 4.0) 5.1 (4.6, 5.6) 9.6 (8.8, 10.4) 13.0 (11.6, 14.5)
Remote 239 1.6 (0.9–3.0) 5.8 (4.5, 7.1) 3.5 (2.6, 4.5) 6.0 (3.9, 8.1) 8.2 (6.8, 9.6) 12.7 (7.7, 17.8)
Income tertile
Lowest (<$40 000) 1409 32.1 (29.6–34.8) 8.0 (7.5, 8.6) 3.6 (3.3, 4.0) 5.6 (4.9, 6.4) 9.9 (9.0, 10.8) 13.5 (12.4, 14.7)
Middle ($40-<$100 000) 1289 32.0 (29.6–34.5) 5.4 (5.0, 5.8) 3.0 (2.7, 3.4) 4.8 (4.2, 5.5) 8.2 (7.3, 9.1) 11.4 (10.2, 12.7)
Highest ($100 000+) 1531 35.9 (33.3–38.5) 4.4 (4.0, 4.7) 3.3 (3.1, 3.6) 4.4 (4.0, 4.8) 6.7 (5.3, 8.1) 10.8 (6.9, 14.7)
Seifa tertile
Lowest 1596 33.3 (28.3–38.7) 6.1 (5.6, 6.6) 3.0 (2.7, 3.4) 5.2 (4.6, 5.8) 9.6 (8.7, 10.4) 13.2 (11.9, 14.5)
Middle 1561 33.3 (28.0–39.2) 6.1 (5.7, 6.5) 3.4 (3.2, 3.7) 4.9 (4.6, 5.3) 9.6 (8.5, 10.8) 13.6 (12.4, 14.8)
Highest 1865 33.3 (28.6–38.5) 5.0 (4.6, 5.4) 3.2 (2.9, 3.5) 4.1 (3.6, 4.7) 7.1 (6.2, 8.0) 12.9 (10.3, 15.4)
Dental insurance
Insured 2548 45.3 (42.5–48.1) 5.3 (5.0, 5.6) 3.6 (3.3, 3.8) 4.3 (3.9, 4.7) 7.6 (7.0, 8.3) 10.8 (9.8, 11.8)
Uninsured 2385 54.7 (51.9–57.5) 6.2 (5.8, 6.6) 3.0 (2.7, 3.2) 5.2 (4.8, 5.7) 9.8 (9.0, 10.7) 15.0 (13.4, 16.5)
Visiting pattern
Favourable 2054 39.4 (36.8–42.1) 5.4 (5.0, 5.7) 3.5 (3.2, 3.8) 4.5 (3.9, 5.0) 7.1 (6.5, 7.8) 11.0 (9.8, 12.2)
Intermediate 1664 35.5 (33.1–38.1) 5.8 (5.3, 6.3) 3.1 (2.7, 3.4) 4.9 (4.5, 5.2) 10.3 (9.0, 11.6) 13.4 (11.9, 14.9)
Unfavourable 1113 25.1 (22.7–27.5) 6.4 (5.9, 7.0) 3.2 (2.9, 3.5) 4.8 (4.3, 5.3) 10.2 (9.1, 11.4) 18.2 (15.6, 20.9)
95% CI = 95% confidence interval; N = unweighted sample size.

Data in this table were taken from the Examination.
Table 5. Mean number of dental implants per person in the Australian dentate population
15–34 35–54 55–74 75+

Mean (95% CI)
Total 14772 0.1 (0.1, 0.1) 0.1 (0.0, 0.1) 0.1 (0.1, 0.1) 0.2 (0.2, 0.2) 0.2 (0.1, 0.2)
Gender
Males 6395 49.5 (48.3–50.6) 0.1 (0.1, 0.2) 0.1 (0.0, 0.1) 0.1 (0.1, 0.2) 0.2 (0.2, 0.2) 0.2 (0.1, 0.3)
Females 8377 50.5 (49.4–51.7) 0.1 (0.1, 0.1) 0.0 (0.0, 0.0) 0.1 (0.0, 0.1) 0.2 (0.2, 0.3) 0.2 (0.1, 0.2)
Region
Major city 8894 72.1 (68.9–75.2) 0.1 (0.1, 0.2) 0.1 (0.0, 0.1) 0.1 (0.1, 0.2) 0.2 (0.2, 0.3) 0.2 (0.1, 0.3)
Regional 5139 26.1 (23.0–29.5) 0.1 (0.1, 0.1) 0.1 (0.0, 0.1) 0.1 (0.0, 0.1) 0.2 (0.1, 0.2) 0.1 (0.0, 0.1)
Remote 739 1.7 (0.9–3.3) 0.1 (0.0, 0.2) 0.0 (0.0, 0.0) 0.1 (0.0, 0.2) 0.2 (0.1, 0.4) 0.0 (0.0, 0.0)
Income tertile
Lowest (<$40 000) 3601 28.9 (27.5–30.3) 0.1 (0.1, 0.2) 0.1 (0.0, 0.1) 0.1 (0.0, 0.3) 0.1 (0.1, 0.2) 0.1 (0.1, 0.1)
Middle ($40-<$100 000) 4218 36.6 (35.3–37.9) 0.1 (0.1, 0.1) 0.0 (0.0, 0.1) 0.1 (0.1, 0.2) 0.2 (0.1, 0.3) 0.4 (0.2, 0.6)
Highest ($100 000+) 3971 34.5 (33.0–36.1) 0.1 (0.1, 0.1) 0.1 (0.0, 0.1) 0.1 (0.1, 0.1) 0.3 (0.2, 0.4) 1.4 (0.0, 2.8)
Seifa tertile
Lowest 4639 32.9 (28.5–37.7) 0.1 (0.1, 0.1) 0.0 (0.0, 0.0) 0.1 (0.1, 0.2) 0.1 (0.1, 0.2) 0.1 (0.0, 0.2)
Middle 4653 33.3 (28.6–38.4) 0.1 (0.1, 0.2) 0.1 (0.0, 0.1) 0.1 (0.1, 0.2) 0.2 (0.2, 0.3) 0.2 (0.1, 0.3)
Highest 5480 33.7 (29.5–38.3) 0.1 (0.1, 0.2) 0.1 (0.0, 0.1) 0.1 (0.1, 0.1) 0.3 (0.2, 0.4) 0.2 (0.2, 0.3)
Dental insurance
Insured 7966 52.6 (50.9–54.2) 0.1 (0.1, 0.2) 0.1 (0.0, 0.1) 0.1 (0.1, 0.1) 0.3 (0.2, 0.3) 0.3 (0.2, 0.4)
Uninsured 6546 47.4 (45.8–49.1) 0.1 (0.1, 0.1) 0.0 (0.0, 0.1) 0.1 (0.1, 0.2) 0.2 (0.1, 0.2) 0.1 (0.0, 0.1)
Visiting pattern
Favourable 6564 45.7 (44.2–47.1) 0.1 (0.1, 0.1) 0.0 (0.0, 0.0) 0.1 (0.1, 0.1) 0.3 (0.2, 0.3) 0.2 (0.1, 0.3)
Intermediate 4595 32.3 (31.1–33.5) 0.2 (0.1, 0.2) 0.1 (0.0, 0.1) 0.2 (0.1, 0.3) 0.2 (0.2, 0.3) 0.3 (0.1, 0.5)
Unfavourable 3083 22.1 (20.9–23.3) 0.1 (0.0, 0.1) 0.1 (0.0, 0.2) 0.1 (0.0, 0.1) 0.1 (0.0, 0.1) 0.1 (0.0, 0.1)


Table 6. Mean number of missing teeth replaced by prostheses per person in the Australian dentate population
15–34 35–54 55–74 75+

Mean (95% CI)
Total 5022 1.0 (0.9, 1.2) 0.1 (0.0, 0.2) 0.3 (0.2, 0.5) 2.2 (1.9, 2.6) 4.8 (3.6, 6.0)
Gender
Males 2249 49.6 (46.9–52.2) 0.9 (0.7, 1.0) 0.1 (0.0, 0.1) 0.3 (0.1, 0.6) 2.0 (1.5, 2.4) 4.3 (3.1, 5.5)
Females 2773 50.4 (47.8–53.1) 1.2 (0.9, 1.4) 0.2 (0.0, 0.3) 0.4 (0.2, 0.5) 2.5 (1.9, 3.1) 5.2 (3.3, 7.0)
Region
Major city 2969 72.7 (69.1–76.0) 0.9 (0.7, 1.1) 0.1 (0.0, 0.2) 0.3 (0.1, 0.5) 2.0 (1.5, 2.5) 4.9 (3.3, 6.5)
Regional 1814 25.7 (22.4–29.4) 1.4 (1.1, 1.6) 0.1 (0.0, 0.3) 0.5 (0.2, 0.7) 2.7 (2.0, 3.5) 4.6 (3.1, 6.0)
Remote 239 1.6 (0.9–3.0) 0.8 (0.5, 1.0) 0.0 (0.0, 0.0) 0.2 ( 0.1, 0.4) 2.1 (0.9, 3.4) 5.0 (0.7, 9.4)
Income tertile
Lowest (<$40 000) 1409 32.1 (29.6–34.8) 2.0 (1.6, 2.4) 0.3 (0.0, 0.6) 0.5 (0.2, 0.9) 2.7 (2.0, 3.4) 5.1 (4.0, 6.1)
Middle ($40-<$100 000) 1289 32.0 (29.6–34.5) 0.9 (0.6, 1.2) 0.1 (0.0, 0.2) 0.6 (0.1, 1.0) 2.1 (1.4, 2.8) 2.6 (1.2, 4.1)
Highest ($100 000+) 1531 35.9 (33.3–38.5) 0.2 (0.1, 0.4) 0.0 (0.0, 0.1) 0.2 (0.0, 0.4) 0.9 (0.4, 1.4) 1.7 (0.2, 3.2)
Seifa tertile
Lowest 1596 33.3 (28.3–38.7) 1.1 (0.9, 1.4) 0.1 (0.0, 0.2) 0.5 (0.1, 0.9) 2.5 (1.9, 3.2) 4.2 (2.8, 5.7)
Middle 1561 33.3 (28.0–39.2) 1.2 (0.9, 1.4) 0.2 (0.0, 0.4) 0.2 (0.1, 0.4) 2.7 (1.9, 3.6) 5.7 (4.3, 7.0)
Highest 1865 33.3 (28.6–38.5) 0.7 (0.5, 1.0) 0.1 (0.0, 0.2) 0.3 (0.1, 0.5) 1.4 (0.9, 1.9) 4.5 (1.4, 7.6)
Dental insurance
Insured 2548 45.3 (42.5–48.1) 0.8 (0.6, 0.9) 0.1 (0.0, 0.1) 0.2 (0.1, 0.4) 1.8 (1.2, 2.4) 3.1 (2.1, 4.1)
Uninsured 2385 54.7 (51.9–57.5) 1.3 (1.0, 1.5) 0.2 (0.0, 0.3) 0.5 (0.2, 0.7) 2.6 (2.1, 3.2) 6.1 (4.1, 8.0)
Visiting pattern
Favourable 2054 39.4 (36.8–42.1) 0.8 (0.6, 1.0) 0.1 (0.0, 0.3) 0.4 (0.1, 0.8) 1.5 (1.1, 2.0) 3.3 (2.2, 4.4)
Intermediate 1664 35.5 (33.1–38.1) 1.1 (0.8, 1.3) 0.2 (0.0, 0.3) 0.2 (0.1, 0.4) 3.3 (2.3, 4.3) 4.3 (2.9, 5.7)
Unfavourable 1113 25.1 (22.7–27.5) 1.3 (0.9, 1.7) 0.1 (0.0, 0.2) 0.4 (0.1, 0.6) 2.5 (1.8, 3.2) 9.4 (5.7, 13.1)

Data in this table were taken from the Examination.
25
funding by the government, only approximately 25%
1987-88 2004-06 2017-18 of dental care is.36 This, despite the majority of both
Per cent (%) /Mean number of teeth
20
dental care and general medical care being provided
in private practice.38 For all of these reasons, it is nec-
15
essary to address the ongoing separation of dental
care from general health in health care.
10
Dental caries, the leading cause of tooth loss might
be prevented by the appropriate use of fluoride. Aus-
5
tralia has already one of the highest coverage rates of
water fluoridation in the world, nearly 90% of the pop-
0
<21 teeth Edentulous Missing teeth ulation.39,40 However, the extension of the coverage of
water fluoridation to smaller Australian communities
<21 Missing
teeth Edentulous teeth has been recommended given the substantial dental
1987-88 20.6 14.4
2004-06 13.8 6.4 6.1
health inequalities for more remote and regional com-
2017-18 10.2 4 5.7 munities.41 There is an opportunity to maximize the
Fig. 1 Time trend of complete tooth loss, inadequate dentition and aver- benefit of WF in the country by implementing this pol-
age number of teeth lost for any reasons. Data of 1987–1988; 2004–06 icy in small, remote, rural areas.42
and 2017–18 surveys. Proportion (or mean) and 95% CI.
We can conclude that an overall improvement in
tooth retention was observed among Australian adult
relative to the population.36 This is not a problem population in the last three decades. However, a clear
that is peculiar to dental care and Russell’s proposal37 socioeconomic gradient exists with those socioeco-
for a “Dental Service Corps” has echoes of the nomically disadvantaged experiencing higher preva-
recently de-funded Voluntary Dental Graduate Year lence of edentulism, inadequate dentition, wearing
Program, which provided one mechanism for tempo- denture than their better off.
rary deployment of recent graduates to areas of need.
Finally, the low level of public subsidy for dental care
ACKNOWLEDGEMENTS
compared to general medical care reveals the low pri-
ority that the field has received. While approximately The National Study of Adult Oral Health (NSAOH)
80% of the cost of general practice medical care is 2017–18 was funded by the Australian Government
Department of Health, and National Health and 16. Kassebaum NJ, Smith AGC, Bernabe E, et al. Global, regional,
and national prevalence, incidence, and disability-adjusted life
Medical Research Council (Partnership Grant years for oral conditions for 195 countries, 1990–2015: a sys-
#1115649). Sponsorship was provided by the Aus- tematic analysis for the global burden of diseases, injuries, and
tralian Dental Association, Colgate Oral Care and risk factors. J Dent Res 2017;96:380–387.
BUPA. State/Territory health department and dental 17. Kassebaum NJ, Bernabe E, Dahiya M, Bhandari B, Murray CJ,
services were partners in the study. The research team Marcenes W. Global burden of severe tooth loss: a systematic
review and meta-analysis. J Dent Res 2014;93:20S–28S.
would like to acknowledge the Australian Govern-
18. Marcenes W, Kassebaum NJ, Bernabe E, et al. Global burden
ment Department of Human Services, state and terri- of oral conditions in 1990–2010: a systematic analysis. J Dent
tory dental health services and the participants Res 2013;92:592–597.
involved in the study. A full list of acknowledgements 19. Listl S, Galloway J, Mossey PA, Marcenes W. Global economic
is provided in the main report for the study. impact of dental diseases. J Dent Res 2015;94:1355–1361.
20. Barnard PD. National Oral Health Survey Australia 1987–88.
Canberra: Australian Government Publishing Services, 1993.
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The official journal of the Australian Dental Association

Tooth loss, denture wearing and implants: Findings from the

swallow, . . .”.13 A recent systematic review reported

most prevalent chronic diseases that affect life expec-

15–34 35–54 55–74 75+

N = unweighted sample size; 95% CI = 95% confidence Interval.

15–34 35–54 55–74 75+

N = unweighted sample size; 95% CI = 95% confidence Interval.

15–34 35–54 55–74 75+

N = unweighted sample size; 95% CI = 95% confidence Interval.

© 2020 Australian Dental Association S27

15–34 35–54 55–74 75+

95% CI = 95% confidence interval; N = unweighted sample size.

15–34 35–54 55–74 75+

95% CI = 95% confidence interval; N = unweighted sample size.

S28 © 2020 Australian Dental Association

15–34 35–54 55–74 75+

95% CI = 95% confidence interval; N = unweighted sample size.

S30 © 2020 Australian Dental Association

© 2020 Australian Dental Association S31

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