title: Oral health comparisons between children attending an Aboriginal health service and a Government school dental service in a regional location.
abstract: BACKGROUND
  Indigenous children in Australia have higher dental caries levels than their non-Indigenous counterparts. Indigenous communities in South Australia's mid-north region have identified dental health as one of their top health priorities. In response to this, an oral health program based at the Pika Wiya Health Service in Port Augusta was established, with a dentist providing care for adults, and a dental therapist providing care for children, 2 days per week each. The purpose of this article is to compare the socio-demographic and oral health characteristics of children attending for care at the Pika Wiya Health Service Dental Clinic with those of their counterparts attending the general Port Augusta School Dental Service (SDS). Both Indigenous and non-Indigenous children were included.
  
  
  METHODS
  Data were obtained from the South Australian Dental Service (SADS), which routinely collects socio-demographic and dental information from patients seen through their system. Examinations were conducted by SADS-employed dental professionals. A full enumeration of children attending for care at Pika Wiya and the Port Augusta SDS from March 2001 to March 2006 was included. Surface level tooth data was captured using the EXACT treatment charting and management information system. The Socio-Economic Indices For Areas (SEIFA) were used to determine socio-economic status, and the dmft (sum of decayed, missing and filled teeth in the deciduous dentition) and DMFT (sum of decayed, missing and filled teeth in the permanent dentition) indices were used to assess oral health outcomes. Both measures were used for children aged 6-10 years because in such age groups children have a mixed dentition (both primary and permanent teeth are present). Caries prevalence (dmft/DMFT>0) and severity (mean dmft/DMFT) were calculated, as well as the Significant Caries Index (SiC) and Significant Caries Index 10 (SiC 10). The SiC is the mean dmft/DMFT of the one-third of the sample with the highest caries score; while the SiC 10 is the mean dmft/DMFT of the one-tenth of the sample with the highest caries score.
  
  
  RESULTS
  In the 5 year observation period, 760 children were seen at the Pika Wiya Dental Service while over 6800 were seen at the Port Augusta SDS. A higher proportion of pre-school children attended for care at Pika Wiya, while proportionally more children aged > or = 11 years attended for care at the Port Augusta SDS. More females attended for care at Pika Wiya. Almost all children (99%) attending for care at Pika Wiya lived in the most disadvantaged areas according to the SEIFA scale. Children attending for care at Pika Wiya had three-times the mean number of decayed deciduous and permanent teeth than their counterparts attending the Port Augusta SDS. Over 75% of children attending for care at Pika Wiya aged 10 years or less had dental caries experience in the primary dentition compared with just over 50% of children attending for care at the Port Augusta SDS. Children attending for dental care at Pika Wiya aged 10 years or less had 1.8 times the mean dmft, 1.4 times the SiC and 1.4 times the Sic 10 of their counterparts attending for care at Port Augusta SDS. Over half the children aged > or = 6 years who attended Pika Wiya for dental care had caries experience in the permanent dentition compared with 38% of their Port Augusta SDS-attending counterparts. Children aged > or = 6 years who attended Pika Wiya for dental care had 1.9 times the mean DMFT, 1.8 times the SiC and 1.6 times the SiC 10 of their similarly-aged Port Augusta SDS-attending counterparts.
  
  
  CONCLUSIONS
  Children attending for care at the Pika Wiya Dental Service were more likely to be pre-school-aged, female, Indigenous and living in a socially disadvantaged area, in comparison with children attending the Port Augusta SDS. Pika Wiya-attending children had 1.5-3 times the dental caries prevalence and severity in both the primary and permanent dentition of children attending for care at the Port Augusta SDS. The higher levels of dental caries experience, untreated disease and social disadvantage of children attending Pika Wiya provides further evidence for the need to address the health inequalities for Aboriginal children living in South Australia's mid-north region. While the Pika Wiya Oral Health Program is attempting to address some of these needs, a much broader focus to address the social and health inequalities will be required to improve the oral health characteristics of this population. It is hoped that through the Pika Wiya Dental Service's dedication to increasing Aboriginal child dental service participation rates, the proportion of untreated decay will diminish.
authors.affiliation: University of Adelaide School of Dentistry, Frome Road, SA, Australia. eleanor.parker@adelaide.edu.au
authors.forename: Eleanor J
authors.initials: EJ
authors.lastname: Parker
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Jamieson
mesh_terms: D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D003731:Dental Caries / Q000453:epidemiology; D003752:Dental Health Services / Q000706:statistics & numerical data*; D005260:Female; D006303:Health Services, Indigenous / Q000706:statistics & numerical data*; D006306:Health Surveys; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009909:Oral Health; D015995:Prevalence; D012572:School Health Services / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D013021:South Australia / Q000453:epidemiology