but a lower ratio of filled teeth. A 2003 study found that complete loss of all natural teeth was higher for Aboriginal people of all age groups (16.2%) compared to non-Aboriginal people (10.2%). In remote communities, those with diabetes were found to have over three times the number of missing teeth than those without diabetes. Type 2 diabetes has been related to poor oral health. Changes in the Australian Indigenous diet away from a traditional diet, which had originally contained high levels of protein and vitamins. High in fibre and sugar and low in saturated fats – to a diet high in sugar, saturated fats and refined carbohydrates has negatively affected the oral health of Indigenous Australians. A 1999 study found that the water in rural and remote areas of Australia is less likely to be fluoridated than metropolitan areas, reducing access for many Aboriginal communities to fluoridated water. Fluoridated water has been shown to prevent dental decay. Hearing loss Aboriginals experience a high level of conductive hearing loss largely due to the massive incidence of middle ear disease among the young in Aboriginal communities. Aboriginal children experience middle ear disease for two and a half years on average during childhood compared with three months for non indigenous children. If untreated it can leave a permanent legacy of hearing loss. The higher incidence of deafness in turn contributes to poor social, educational and emotional outcomes for the children concerned. Such children as they grow into adults are also more likely to experience employment difficulties and find themselves caught up in the criminal justice system. Research in 2012 revealed that nine out of ten Aboriginal prison inmates in the Northern Territory suffer from significant hearing loss. Health dynamics A number of factors help to explain why Aboriginal and Torres Strait Islander people have poorer health than other Australians. In general, Aboriginal and Torres Strait Islander people are more likely to have lower levels of education, lower health education, higher unemployment, inadequate housing and access to infrastructure than other Australians. In particular, crowded housing has been identified as contributing to the spread of infectious diseases. Aboriginal and Torres Strait Islander Australians are also more likely to smoke, have poor diets and have high levels of obesity. A 2007 study found that the 11 largest preventable contributions to the indigenous burden of disease in Australia were tobacco, alcohol, illicit drugs, high body mass,