Three focus groups and twelve in-depth interviews were completed with twenty-seven community members. There was a total of 10 male and 17 female participants. Four participants were aged between 18 and 39 years, while the remaining 23 were aged over 40 years.
Nearly all of the respondents gave a high level of importance to oral health.
Yes, it is, very important… because it’s like a part of you. IDI 3 Female Participant
Four key themes were identified as influencing the importance given to oral health. These included: the severity of symptoms of oral disease, in particular pain; the demand on resources to respond to oral disease such as financial resources; the severity of the social impact of oral disease such as the damaging effect on personal appearance; and individual’s health beliefs and oral health awareness.
Severity of Symptoms
Participants gave a high importance to oral health principally because of the pain associated with untreated oral disease. These perceptions stemmed from participants’ personal experience of oral disease or their observations of the impact oral disease had on their family or other community members. We suggest it would be difficult to overestimate the experience of the pain of untreated oral disease within the community as one participant described:
You know, it’s a pain you can’t handle … tooth ache… Everybody knows how it is powerful. You lay in bed and you’re in frigging agony in your mouth. … That’s what it is, hey…Yeah, it was a pain I’ll never ever forget. FGD 2 Male Participant
The severity of the ongoing pain of untreated oral disease led some participants drinking alcohol to reduce the pain of pulling out their own teeth with pliers.
…that night, you know my tooth was aching, yeah, so what I do yeah, I just get drunk and just pull it out… then I just get the pliers and just yanked on it … that’s three times I did that. FGD 2 Male Participant
Participants were very aware of the suffering of other family and community members, with oral disease described as occurring frequently and often ongoing.
It’s something that I see the kids suffering with, and I know that there’s nowhere for them to go. … I actually had boys sitting on the carpet about a week and a half ago comparing abscesses and gum boils. “I have a lump here.” “Oh, well look at mine.” … It’s not nice to see the kids dealing with that sort of stuff.
IDI 2 Female Participant
…with the amount of holes in teeth that the kids are showing me now, and the number of abscesses and stuff, I can definitely see at some point these kids are going to be missing out on school because of their pain and their dental issues.
IDI 3 Female Participant
Demand on Resources to Respond to Oral Disease
Responding to oral disease places demands on individual family and community resources including financial resources, social support and networks, transportation and the time needed to access services. The widespread experience of financial burden associated with oral disease was a principal influence on the high importance given to oral health.
Yeah (having good teeth) is very important because when I had to pay for dental things, it cost almost 1,000 bucks… It is very expensive. FGD 2 Male Participant
Responding to oral disease was also recognised as placing a burden on the whole family. As one participant explained this burden includes relying on others for transport to and from an oral health service and taking up their time which can lead to lost work hours.
If they're not mobile then how the hell are they going to get here? So they're just relying on family and stuff. Then family have to stay there with them, which is a concern because they're doing their own thing. IDI 7 Female Participant
The importance of oral health was also linked to social impact most notably the benefits to appearance and self-esteem of a healthy mouth.
… It makes you look good. IDI 3 Female Participant
Oral disease was perceived to have a severe negative impact on appearance through the presence of severely stained, broken or missing teeth.
…everybody cares about how they look. Like even old people do. Yeah. It is important to them and it's definitely for comfort because you've got to eat every day. You want your teeth to eat every day. It's about how you see yourself. It's okay if people - how they see you, it's all right and you can take that how you take it. But it's important from how you see yourself and how [you like yourself]. Anything that improves especially eating and how you look. It's an everyday thing so - it has a big impact on you really -to having a better life and a better outlook on life. IDI 10 Male Participant
One participant noted the importance of good oral health to her confidence.
Yeah, that actually boosts my confidence a lot. Because I never used to smile because I had like a hole in my teeth, but ever since it’s fixed, I can smile freely. IDI 1 Male Participant
Oral health was also given high importance because of its importance for eating and nutrition.
Well, yeah very important just to eat.
Well you need your teeth to chew you know … FGD 2 Male Participant
Participants also highlighted the important role of oral health care with one participant reflecting on recent care:
Feels great, it’s like a second chance IDI 1 Male Participant.
One participant gave high importance to oral health due to her perception of the severely negative impact oral disease has on those with chronic disease in the community.
It means a lot because we have a lot of people here in this community that have ongoing issues with diabetes and heart problems. FGD 3 Female Participant
Health Beliefs and Oral Health awareness
Health beliefs are attitudes, values and knowledge people have about health and health services that can influence their subsequent perception of the importance of a particular disease. Knowledge about oral disease and its impact and, prevention and treatment options were observed by participants as influencing the importance given to oral health. Several participants believed that a limited number in the community did not prioritise oral health as much as they should which they associated with a lack of awareness.
I don’t think they have a priority for oral health. …. I think that’s entrenched. It’s where we’ve got to go with education and just improve that whole understanding. I mean I’ve done some women’s health days where I’ve spoken, and these are all over the place, and it’s astounding how many people don’t realise the potential for the chronic disease impact with dental health, and stuff. FGD 1 Female Participant
For the older participants, reflection on their increased awareness of oral health and oral disease prevention strategies highlighted for them both the importance of oral health and missed opportunities to protect their own oral health.
Oral health is important to me now, now that I know what I know. …. if you look after your teeth, you’ve got them for the rest of your life.
IDI 5 Female Participant
I only wish I knew then what I know now about it. That’s why, right at the beginning, that’s what we needed to know. Otherwise we’d have looked after our teeth; ate the right food and that… So, oral health is important to me now, now that I know what I know. IDI 7 Female Participant
For some older participants, new knowledge seemed to not influence their individual behaviour with many reporting they had bad teeth and yet not prioritising oral health for themselves. However, they were concerned about the next generation and wanted to impress in them behaviours that would lead to better outcomes.
My teeth are rotten, but it is (still) important. For my kids I think I push it more on them because mine are like (this) - I'm old and [it’s going to be] too late.
IDI 8 Female Participant
Despite the high importance given to oral health participants also noted that oral health is just one of many competing health and social issues within the community. This is clearly highlighted in a participant’s reflection about how the importance of oral health had changed for her over time.
You only realise these things when you grow older. Because to me at the time, it wasn’t important when I was having all my children. It wasn’t important. Like I said, the only important thing was putting food on the table… Keeping them fed, and clothed, and clean. IDI 7 Female Participant