- In 2012-14, around 2 in 5 (42%) children had experienced decay in their primary (baby) teeth, and 1 in 4 (24%) children had experienced decay in their permanent (adult) teeth.
- Children in low-income households were twice as likely to have untreated decay in their primary (36%) and permanent teeth (15%) as children in high-income households (18% and 7%, respectively).
- More than two-thirds (69%) of children aged 5–14 brushed their teeth with toothpaste at least twice a day.
Good oral health is central to a person’s overall health and wellbeing, positively affecting their quality of life, social interactions and self-esteem (COAG 2015). Without it, a person’s quality of life can be compromised, with pain, discomfort and embarrassment affecting the ability to eat, speak, sleep and socialise confidently. Good oral health in children can also indicate good oral health in adults (AIHW 2016a).
Dental caries, commonly known as dental decay, refers to the development of cavities (small holes) in the teeth that compromise the health and structure of the tooth. It is the most prevalent oral disease among Australian children (AIHW 2016b, 2019).
In 2011, dental decay was the 7th leading cause of total disease burden among boys aged 5–14, and the 4th among girls, accounting for 4.3% and 5.1% of the total burden of disease, respectively (AIHW 2016b).
A complex interaction of factors contribute to a person’s oral health and their risk of developing dental decay, including:
Some factors include:
- consumption of sugar-sweetened beverages (for example, soft drinks, energy drinks, cordials and sweetened fruit juices) (WHO 2017)
- consumption of snacks containing sugar (for example, sweetened dairy, biscuits, cake, confectionary, sweet preserves and muesli bars) (WHO 2017)
- lack of good oral hygiene and regular dental check-ups (NACDH 2012)
- lack of access or exposure to fluoridated water (NHMRC 2017)
- affordability of private dental care (NACDH 2012)
- long waiting periods for public dental care (NACDH 2012).
If left untreated, dental decay can cause infection and the systemic spread of disease (NACDH 2012).
Most dental diseases are largely preventable. Early preventive strategies include:
- parental counselling about diet
- establishing sound oral hygiene practice, including the appropriate use of fluorides
- regular oral health check-ups (COAG 2015).
Box 1: Data sources on child dental health
The most recent data available on child dental health is from the National Child Oral Health Study 2012–14, a cross-sectional study of children aged 5–14 that included a clinical examination component and a parental questionnaire.
How many children have experienced dental decay?
Younger children normally have a combination of primary (baby) teeth and permanent teeth. As such, data for both sets of teeth are reported here separately.
By age 12, most children have lost all their primary teeth and gained their permanent teeth, therefore data for children over age 10 only relates to permanent teeth. Both sets of teeth are important for a child’s health and development.
- around 2 in 5 (42%) children aged 5–10 had experienced decay in their primary teeth
- over 1 in 4 (27%) had untreated decay in these teeth, according to the National Child Oral Health Study (Ha et al. 2016).
The study also found that with children aged 6–14:
- almost 1 in 4 (24%) had experienced decay in their permanent teeth
- more than 1 in 9 (11%) had untreated decay.
The prevalence of tooth decay increased with age. Children aged 7–8 and 9–10 were more likely to have experienced decay in their primary teeth (45% and 46%, respectively) than younger children aged 5–6 (34%). Older children aged 12–14 were also more likely to have experienced decay in their permanent teeth (38%) than younger children aged 6–8 and 9–11 (9% and 23%, respectively) (Figure 1).
Across all age groups, a similar proportion of boys and girls had experienced decay in their primary and permanent teeth.
Figure 1: Proportion of children who have experienced decay in their primary or permanent teeth, by age group, 2012–14
Source: National Child Oral Health Study 2012–14, published in Ha et al. 2016.
How many decayed teeth do children have?
The number of teeth decayed, missing or extracted due to decay, or teeth with fillings, is an important indicator of dental health (Box 2).
Box 2: The dmft and DMFT score
A score that counts the number of teeth (t) that are decayed (d), missing due to caries (m) or filled because of caries (f):
- dmft refers to deciduous (primary) teeth
- DMFT refers to permanent teeth.
Children aged 5–10 had an average of 1.5 decayed, missing or filled primary teeth (dmft). The average number of dmft was higher in children aged 7–8 (1.7) than those aged 5–6 (1.3) and 9–10 (1.5).
Children aged 6–14 had an average of 0.5 decayed, missing or filled permanent teeth (DMFT). The rate of DMFT increased with child’s age, from 0.1 in children aged 6–8 to 0.9 in children aged 12–14 (Ha et al. 2016).
Has dental decay in children improved over time?
Between 1990 and 2000, the mean number of dmft among children aged 5–6 declined, followed by an increase until 2010 (AIHW 2016c). However, by 2012–14, the number of dmft had decreased to a similar level to the year 2000 (Do et al. 2016b).
Similarly, during the 1990s, the mean number of DMFT among children aged 12 decreased, followed by a fluctuating increase until 2010 (AIHW 2016c). In 2012–14, the number of DMFT had decreased and was comparable to the lowest level reported in the late 1990s (Do et al. 2016b).
Is dental decay experience the same for everyone?
Some population groups face greater challenges in accessing oral health care and experience the greatest burden of poor oral health (AIHW 2019).
Children living in Remote and very remote areas (53%) were more likely to have had decay in their primary teeth than children in Major cities (39%). They were also more likely to have untreated decay in:
- at least 1 primary tooth (38%; 25% in Major cities) or
- 1 permanent tooth (22%; 10% in Major cities).
The prevalence of primary and permanent tooth decay was highest among children living in households with low income:
- half (50%) had experienced decay in their primary teeth
- nearly one-third (28%) had experienced decay in their permanent teeth.
- one-third (33%) of children in high-income households had experienced decay in their primary teeth
- around one-fifth (19%) in their permanent teeth (Figure 2).
Children in low-income households were also more likely to have untreated decay in at least 1 primary tooth (36%) or 1 permanent tooth (15%) than children in high-income households (18% and 7%, respectively).
Differences were also evident between Indigenous children and non-Indigenous children. Around:
- 6 in 10 (61%) Indigenous children and 4 in 10 (41%) non-Indigenous children had experienced decay in their primary teeth
- 1 in 3 (36%) Indigenous children and 1 in 4 (23%) non-Indigenous children had experienced decay in their permanent teeth.
Indigenous children were also more likely to have untreated decay in at least 1 primary tooth (44%) or 1 permanent tooth (23%) than non-Indigenous children (26% and 10%, respectively).
Figure 2: Proportion of children aged 6–14 who have experienced decay in permanent teeth by selected population groups, 2012–14
Source: National Child Oral Health Study 2012–14, published in Ha et al. 2016.
Dental health behaviours and risk factors for dental decay
Regular teeth brushing is critical to maintaining good oral health and reducing the risk of dental decay. It is recommended that children’s teeth be wiped or gently brushed as soon as they erupt, and that brushing with fluoridated toothpaste be introduced from 18 months of age. Australia’s fluoride guidelines recommend brushing teeth twice a day from 18 months, and at least twice a day from the age of 6 (Armfeld et al. 2016). Sugar consumption and water fluoridation are both related to dental decay (Box 3).
In 2012–14, just over two-thirds (69%) of children aged 5–14 were brushing their teeth at least twice a day with toothpaste, with girls more likely than boys to do so (71% compared with 66%) (Armfeld et al. 2016). This difference was largest between boys and girls aged 13–14, with 78% of girls brushing their teeth twice a day compared with 65% of boys.
A smaller and more recent national survey found similar overall patterns of teeth brushing for primary school children aged 6 to 12, with 73% children brushing twice a day and 24% once a day (Rhodes 2018).
Differences in teeth brushing behaviours were observed across population groups:
- 54% of Indigenous children and 70% non-Indigenous children brushed their teeth at least twice a day
- 78% of children in high-income households and 59% of children in low-income households did so.
Box 3: Sugar consumption and water fluoridation
High sugar consumption is associated with tooth decay and other associated oral health issues. WHO recommends adults and children reduce consumption of free sugars to less than 10% of total energy intake, and that reducing intake to less than 5% would provide additional health benefits (WHO 2015). This translates to 2–6 teaspoons of free sugars a day, depending on the age and energy requirements of the child.
For more information on children’s consumption of sugar, see Breastfeeding and Nutrition.
Consumption of fluoridated water helps prevent tooth decay in children by protecting their teeth against damage, and helping to repair damaged teeth (NHMRC 2017). While all Australian states and territories provide fluoridated tap/public water, coverage varies across each jurisdiction. The proportion of the population with access to fluoridated water ranges from 76% in Queensland to 100% in the Australian Capital Territory.
The National Child Oral Health Study 2012–14 estimates that 71% of Australian children aged 5–14 had almost all tap/public water as their daily drinking water from age 5 (Do et al. 2016a). Reflecting patterns in public water supply, as some people get their drinking water from other sources such as water tanks and private bores:
- 77% of children in Major cities were more likely to drink mostly tap water as their daily drinking water
- 58% in Inner regional
- 56% in Outer regional
- 55% in Remote and very remote.
Children in high-income households were also more likely to frequently drink tap water (79%) than children in low-income households (65%).
Patterns of water consumption from age 5 did not vary significantly by sex, Indigenous status or parents’ country of birth (Do et al. 2016a).
Data limitations and development opportunities
National surveys of the oral health status of children have been conducted infrequently since the AIHW’s Child Dental Health Survey series finished in 2010. As such, monitoring changes in children’s dental health since 2012–14 is not possible.
Some national data development work related to public dental services may result in some data on children’s dental health being available in the future; however this would be limited to children accessing public dental care. Data on services provided in the private dental care sector are also limited.
Where do I find more information?
For more information on:
- the oral health of Australian children and information on access to dental health services and patterns of dental visiting, see: Oral health and dental care in Australia and Healthy teeth.
- toothbrushing, see Preventative strategies.
- the number of DMFT among primary school children aged 12, see: Dental health in Children’s Headline Indicators.
AIHW (Australian Institute of Health and Welfare) 2016a. Australia’s health 2016. Australia’s health series no. 15. Cat. no. AUS 199. Canberra: AIHW.
AIHW 2016b. Australian Burden of Disease Study: impact and causes of illness and death in Australia 2011. Australian Burden of Disease Study series no. 3. Cat. no. BOD 4. Canberra: AIHW.
AIHW 2016c. Oral health and dental care in Australia: key facts and figures 2015. Cat. no. DEN 228. Canberra: AIHW.
AIHW 2019. Oral health and dental care in Australia. Cat. no. DEN 231. Canberra: AIHW.
Armfeld JM, Chrisopoulos S, Peres KG, Roberts-Thomson KF & Spencer AJ 2016. Australian children’s oral health behaviours. In: Do LG & Spencer AJ (eds). Oral health of Australian children: the National Child Oral Health Study 2012–14. Adelaide: University of Adelaide Press.
COAG (Council of Australian Governments) Health Council 2015. Healthy Mouths, Healthy Lives: Australia’s National Oral Health Plan 2015–2024. Adelaide: South Australian Dental Service.
Do LG, Harford JE, Ha DH & Spencer AJ 2016a. Australian children’s general health behaviours. In: Do LG & Spencer AJ (eds). Oral health of Australian children: the National Child Oral Health Study 2012–14. Adelaide: University of Adelaide Press.
Do LG, Luzzi L, Ha DH, Roberts-Thomson KF, Chrisopoulos S, Armfield JM & Spencer AJ 2016b. Trends in child oral health in Australia. In: Do LG & Spencer AJ (eds). Oral health of Australian children: the National Child Oral Health Study 2012–14. Adelaide: University of Adelaide Press.
Ha DH, Roberts-Thomson KF, Arrow P, Peres KG & Spencer AJ 2016. Children’s oral health status in Australia, 2012–14. In: Do LG & Spencer AJ (eds). Oral health of Australian children: the National Child Oral Health Study 2012–14. Adelaide: University of Adelaide Press.
NACDH (National Advisory Council on Dental Health) 2012. Report of the National Advisory Council on Dental Health 2012. Canberra: Department of Health and Ageing. Viewed 17 May 2019.
NHMRC (National Health and Medical Research Council) 2017. Information paper—water fluoridation: dental and other human health outcomes. Canberra: NHMRC.
Rhodes A 2018. Child oral health: habits in Australian homes. Melbourne: Royal Children’s Hospital Melbourne. Viewed 10 May 2019.
WHO (World Health Organization) 2015. Guideline: sugars intake for adults and children. Geneva: WHO. Viewed 10 May 2019.
WHO 2017. WHO technical information note: sugars and dental caries. WHO/NMH/NHD/17.12. Geneva: WHO. Viewed 7 May 2019.