Indigenous Australians see oral health as a central part of overall wellbeing, with good teeth described as making one 'deadly inside and outside', according to a new study published in the Medical Journal of Australia. The research, involving 136 Indigenous South Australian adults, found that oral health is deeply connected to social and emotional wellbeing, cultural practices, and overall health.
Oral health gap persists
Indigenous people in Australia experience higher rates of untreated tooth decay, tooth loss, and toothache compared to non-Indigenous people. This gap is driven by colonisation, systemic discrimination, and lack of access to culturally safe, affordable dental care. The broader health gap sees Indigenous people having an eight to nine-year lower life expectancy and higher burdens of chronic diseases such as diabetes, cancer, and heart disease.
Lead researcher Sonia Nath from Adelaide University said the study aimed to highlight these inequities and develop evidence-based strategies to improve Indigenous oral health. 'We wanted to centre Indigenous voices and prioritise cultural safety,' she said.
Holistic view of health
Participants emphasised the connection between oral health and the rest of the body. One participant stated: 'There’s links between [oral health] and wellbeing how they impact each other, so the mouth is your gateway to your body right? You’ve gotta look after it.' Another said: 'It affects the person’s emotion, affects everything. Vanity, ego. You name it. You’ve got bad teeth, you don’t look deadly. Good teeth, you’re deadly inside and outside.'
The appearance of teeth and smile was crucial for social participation and confidence. Some participants reported avoiding social situations due to shame about their teeth, and some described dental care as a 'shame-job'. One participant noted: 'You’ve got to see the value even though it might be kind of like shame-job to reach out … the end result of that is so impactful positively that I think good teeth changes your life.'
Discrimination and cultural safety
Participants recounted experiences of judgement or discrimination because of their teeth. One said: 'Not only can [oral health] impact you socially because you might not want … people seeing your teeth and mouth or bad breath or judgement … but also, what it can do if you do have like abscesses like things that can go into your bloodstream and affect your heart.'
The study highlighted that culturally safe care, free of judgement, could promote better outcomes. Participants valued services that combined oral health checks with general health assessments, including blood glucose, cholesterol, and inflammation tests. One participant said: 'Really interesting to know because I’ve got a family history of diabetes, kidneys and heart, so it was really very refreshing.'
Recommendations for closing the gap
The researchers recommend integrating oral health into primary health services, such as Aboriginal Community Controlled Health Organisations, and using mobile, at-home assessments to reduce stigma. Training for health practitioners and Indigenous health workers in oral health promotion is also urged. 'Connecting with Elders and community leaders about locally owned ways of promoting community oral health would be essential,' the authors wrote.
The study was a collaboration with Aboriginal Community Controlled Health Organisations, Elders, and dental practitioners. The team included chief investigator Lisa Jamieson, who receives funding from the National Health and Medical Research Council.
