Consulting a Victorian Aboriginal community about their oral health.

BACKGROUND: The legacy of colonisation, assimilation, racism and victim blaming has created inequality in health for Aboriginal people, reflected in their oral health status. Despite the existence of community dental services, oral disease levels continue to be of concern. This study, initiated by a rural Victorian ACCHO (Aboriginal Community Controlled Health Organisation), aimed to consult their community about the barriers to and enablers of oral health and understand their lived experiences with dental services. METHODS: Using an Aboriginal knowledge framework and collaborative approach involving an Aboriginal researcher and Community Mentor, this study consulted an ACCHO community about their oral health. Following community engagement, 21 community members participated in digitally recorded yarning circles and semi-structured interviews. RESULTS: Themes emerging from the data included dental care history and past experiences involving pain and shame, the value of having community-centred services and engagement with patients and the community. DISCUSSION: Experiences of dental care are often related to pain driving attendance resulting in experiences that multiply fear and anxiety. While community-based care was considered a strength, approaches to individual dental care often resulted in increasing shame and diminishing trust. Increasing cultural safety and participatory approaches to designing and delivering dental care may increase engagement and trust. CONCLUSIONS: Important gaps in cultural and clinical understanding between the community and dental service providers have been identified. These findings will be used to inform the delivery of dental services and to develop oral health promotion programs at the ACCHO, and cultural safety preparation for student dental practitioners.

A graduate oral health therapist program to support dental service delivery and oral health promotion in Aboriginal communities in New South Wales, Australia.

INTRODUCTION: The early closure of the Voluntary Dental Graduate Year Program and the Oral Health Therapy Graduate Year Program by the Australian Government adversely impacted New South Wales (NSW) Aboriginal Community Controlled Health Services (ACCHSs). This led to the co-design of a small-scale oral health therapy graduate year program for ACCHSs known as the Dalang Project, which enabled oral health therapists to engage with local Aboriginal communities and implement culturally competent, practical and evidence-based oral health promotion activities. This article provides an overview of the Dalang Project and its evaluation. METHODS: All graduates of the Dalang Project were invited via email and social media to complete an online survey. The survey included questions about their year in the Dalang Project, why they applied, what they liked and disliked about the project, where they planned to work post-placement, and examples of the most significant changes they observed in the communities where they were placed. Host sites were also surveyed and data were collated on clinical services performed as well as oral health promotion activity. RESULTS: Prior to commencing the Dalang Project only 4 of the 15 respondents came from rural or regional areas. Nine of the 15 respondents were considering working in a regional, rural or remote area prior to applying for the Dalang Project. Twelve respondents were working at the time of the survey and half were working in regional, rural or remote locations in NSW and one in the Northern Territory. All reported that they would be more likely to work in an ACCHS as a result of being a part of the Dalang Project. The majority of respondents said they would recommend the program to future graduates. A total of 63 schools, 21 preschools and 15 community health services received regular dental health education through the Dalang Project. A total of 3250 toothbrushes and fluoride toothpastes were distributed to children and families through the Dalang Project. A key part of the program was the installation of refrigerated and filtered water fountains in schools where there was no free filtered or refrigerated water supply. The inclusion of this component in the program was part of the co-design process and links the program to the wider population health strategies in NSW to help prevent childhood obesity. CONCLUSION: The Dalang Project is an example of a successful co-designed project that has positively impacted oral health service delivery for Aboriginal children and has provided a valuable experience for new graduate oral health therapists working in ACCHSs. Overall, the Dalang Project was found to be a positive professional experience for the oral health therapists with many remaining in rural, remote and regional locations after completing the program.

Aboriginal dental assistants can safely apply fluoride varnish in regional, rural and remote primary schools in New South Wales, Australia.

PROBLEM: There are significant inequalities in oral health status between Aboriginal and non-Aboriginal children in Australia, particularly where the children have insufficient access to various forms of fluoride. There has been a growing interest in seeing fluoride varnish programs used more widely for Aboriginal children due to proven effectiveness. Despite this, there has been limited scale-up of these programs in Australia. This study investigates the feasibility of using Aboriginal dental assistants to provide regular fluoride varnish applications for Aboriginal children in the primary school setting. DESIGN: A mixed-methods approach including auditing the number of Aboriginal dental assistants were trained and then approved by the NSW Chief Health Officer to apply fluoride varnish, and collection and reporting of participant data on the each of the fluoride varnish days in the local patient management system. SETTING: Six Aboriginal Community Controlled Health Services from regional NSW were invited to participate in the study. They also nominated a primary school and an Aboriginal dental assistant to participate in the study. KEY MEASURES FOR IMPROVEMENT: Data were obtained from four 'fluoride varnish days' held at the schools over a 12-month period between December 2017 and December 2018. The number of Aboriginal dental assistants were trained and then approved by the NSW Chief Health Officer to apply fluoride varnish is also reported. STRATEGIES FOR CHANGE: In total, 8 Aboriginal dental assistants were trained to apply fluoride varnish during the study. Overall, students participating in the study received three or more fluoride varnish applications. EFFECTS OF CHANGE: Results showed that Aboriginal dental assistants are able to safely and effectively apply fluoride varnish in a school setting with remote supervision. LESSONS LEARNT: This program can be scaled at the state level in NSW, and this could provide the basis for a nationally consistent program. Initial discussions have been held with several jurisdictions to lead this process via the Australian Health Ministers Advisory Council (AHMAC) based on the results of this study and the support of key stakeholders. The Poche Centre as part of its scale-up planning for the Fluoride Varnish Program is examining the feasibility of including the apply fluoride varnish skillset in its existing Aboriginal Dental Assistant Scholarship Program.

Rural and remote dental care: Patient characteristics and health care provision.

OBJECTIVE: To describe the characteristics of patients who used the Royal Flying Doctor Service dental clinics and determine Royal Flying Doctor Service and non-Royal Flying Doctor Service dental service provision in mainland Australia. DESIGN: A prospective cohort study. SETTING: All Royal Flying Doctor Service dental clinics located throughout rural and remote Australia. PARTICIPANTS: All patients who accessed an Royal Flying Doctor Service dental clinic from April 2017 to September 2018. INTERVENTIONS: Royal Flying Doctor Service mobile dental clinics. MAIN OUTCOME MEASURES: Patient demographics and dental procedures conducted (by age, sex and Indigenous status); and the dental service provision and coverage (Royal Flying Doctor Service and non-Royal Flying Doctor Service) within mainland rural and remote Australia. RESULTS: There were 8992 patient episodes comprising 3407 individual patients with 27 897 services completed. There were 920 (27%) Indigenous and 1465 (43%) non-Indigenous patients (n = 1022 missing ethnicity data). The mean (SD) age was 31.5 (24.8) years; the age groups 5-9 years and 10-14 years received 17.6% and 15.1% of the services, respectively. There were 1124 (33%) men and 1295 (38%) women (n = 988 with missing sex data). Women were more likely (all P < .05) to receive preventive services, diagnostic services, restorative services, general services, endodontics and periodontics. Men were more likely (both P < .05) to receive oral surgery and prosthodontics. There are many rural and remote people required to travel more than 60 minutes by vehicle to access dental care. CONCLUSION: Without increasing dental provision and preventive services in rural areas, it seems likely that there are and will be unnecessary oral emergencies and hospitalisations.

Developing leaflets to give dental health advice to Aboriginal families with young children.

OBJECTIVES: Dental caries (decay) is a serious problem for young Aboriginal children, causing pain and stress. Treatment often involves extraction of teeth under a general anaesthetic. However, dental caries can be prevented by reducing the frequency of sugar consumption and brushing teeth twice a day with fluoride toothpaste. Such straightforward advice could be given to families by Aboriginal Health Workers who are trusted by their communities and have an existing advisory role. This paper reports on the development of dental health advice leaflets for use in Aboriginal communities. METHODS: An Aboriginal reference panel was recruited to comment on dental health advice leaflets prepared by an Aboriginal graphic designer. The panel was asked to consider the design, cultural appropriateness and practicality of the leaflets. Comments were collected through email and face-to-face discussions, which were collated and the leaflets altered accordingly. RESULTS: The advice from the panel resulted in greater use of pictures. For example large green ticks and red crosses highlighted healthy and unhealthy behaviours, respectively. The tooth brushing leaflet was amended to emphasise the safe storage of toothpaste in order to keep it out of reach of young children. The panel stated that all leaflets should incorporate the Aboriginal flag, and proposed that fridge magnets might be beneficial as all family members would benefit from seeing the messages every day. CONCLUSION: The consultation process refined dental advice leaflets to reflect the views of an Aboriginal Reference Panel, in terms of design, cultural competence and practicality.

An exploration of the priority remote health personnel give to the development of the Indigenous Health Worker oral health role and why: unexpected findings.

OBJECTIVE: This research was undertaken to explore the priority given by remote area health personnel to the development of the oral health role of Indigenous Health Workers and the rationale for this prioritisation. DESIGN: Semistructured individual interviews and focus group interviews were undertaken with remote area health personnel working alongside Indigenous Health Workers. SETTING: Three Indigenous community clinics and two regional centres of remote northern Australia. PARTICIPANTS: Interviews were conducted with 32 remote health personnel (11 dental, 14 nursing, 5 medical and 2 allied health personnel). RESULTS: The findings highlight the strong support found among remote health personnel for the development of the Indigenous Health Worker oral health role emphasising not only the perceived high impact of oral disease on the health of community members and community health resources, but also on the clinical practice of remote health personnel. CONCLUSION: In identifying the high priority given to the development of this role, the study has also highlighted the impact of oral disease on the practice of remote health personnel and the need to develop training for remote health personnel to respond to oral disease.

Dental professionals' perspectives working with Aboriginal children in Western Australia: a qualitative study.

BACKGROUND: The disproportionate burden of oral disease in Aboriginal children and the issues in accessing mainstream dental services are well documented. Yet little is known about dental professionals' perspectives in providing oral care for Aboriginal children. This paper presents findings from a study exploring such perspectives. METHODS: Semi-structured interviews were carried out in Western Australia following purposive sampling of non-Aboriginal dentists, dental clinic assistants (dental nurses) and oral health therapists/dental hygienists. Interviews were recorded, transcribed and analysed guided by grounded theory for key themes related to the topic. RESULTS: Findings included a service delivery model sometimes unresponsive to Aboriginal families' needs; dental professionals' limited education and training to work with confidence and cultural sensitivity with Aboriginal patients and socioeconomic influences on Aboriginal children's poor oral health considered outside dental professionals' remit of care. DISCUSSION: Findings suggest oral health policies and practices and dental professionals' education and training need reviewing for how well such policies support dental professionals in an Aboriginal context. This includes engaging with Aboriginal stakeholders, working effectively with Aboriginal families, and developing shared understandings about what is needed to increase access to care and improve oral health outcomes for Aboriginal children.

The perceptions of first nation participants in a community oral health initiative.

The Children's Oral Health Initiative (COHI) is a federally funded community-based preventive dental program for children and their caregivers living in geographically isolated Canadian Aboriginal communities. The goal of the program is to improve access to preventive dental services for children of 0-7 years of age. It utilises community health workers in collaboration with dental therapists to promote and deliver the program. Almost half of the province of Manitoba's (n=27) First Nations communities have implemented COHI since 2005. The objective of this investigation was to explore the opinions of COHI from the perspective of community members whose children had participated in the program. Purposeful selection identified caregivers of enrolled children for a semi-structured interview. The targeted caregivers had children who met at least one of the following criteria: (1) 0-2 years old; (2) 5-7 years old; (3) had two or more children either currently or formerly enrolled in COHI. Six open-ended questions guided the interview process. Content analysis was used to code transcripts and identify themes. One hundred and forty-one interviews were completed in 13 communities. Participants defined good oral health as the absence of dental cavities, which reflects a Western biomedical model of disease. The local, community-based nature of COHI was viewed as essential to its success in increasing access to preventive dental services and improving children and caregivers' oral health knowledge and behaviours. In conclusion, a local, community-based oral health prevention programme is perceived as having a beneficial effect on children and caregivers' oral health knowledge and behaviours. However, oral health preventive messages need to be further integrated into traditional Aboriginal holistic models of wellness.