Improving Access to Preventative Dental Care in Aboriginal Communities

The project team, led by the University of Sydney’s Professor Woosung Sohn, has secured funding from Sydney Health Partners to scale up the existing rural and regional pilot programs, developed by the Poche Centre for Indigenous Health, into urban communities.

One in six Aboriginal children has some form of tooth decay, nearly double that of their non-Aboriginal counterparts.  To combat this, the NSW Aboriginal Oral Health Plan and the National Oral Health Plan both recommend the use of fluoride varnish - a coating of fluoride applied to the teeth at regular intervals - in a community setting like a school or community centre.

TGA regulations state that this varnish must be applied by a registered dental professional.  The limited availability of dentists - particularly in rural and remote Aboriginal communities - often means that the preventative measure cannot be delivered with enough frequency to effectively prevent tooth decay in Aboriginal children.

In keeping with governments’ recommendations, the Poche Centre and TAFE Digital have trained Aboriginal dental assistants to deliver the program in local schools through a regular series of ‘Fluoride Varnish Days’.

“Aboriginal staff play an important role in providing a culturally safe environment for Aboriginal people and particularly where their kids are concerned,” said Mr Boe Rambaldini, Director of the Poche Centre for Indigenous Health and one of the study’s Principal Investigators.

Aboriginal dental assistants are already working in Aboriginal communities through Aboriginal Community Controlled Health Services and so are well-positioned both geographically and culturally to administer the varnish to children.

“There is a movement nationally towards using the wider oral health team in prevention of dental disease,” said Dr John Skinner, Senior Research Fellow at the Poche Centre for Indigenous Health. “This includes using the best fit between worker skills and the particular strategy or treatment. That means using more highly clinically trained dentists to do clinical work and treatment, while allowing dental assistants to apply fluoride varnish.”

For a dental assistant to be permitted to apply fluoride varnish, they must be granted an exemption through the Chief Health Officer for NSW. After significant consultation, a process was developed by the Poche Centre for Indigenous Health with the NSW government to gain this exemption, smoothing the path for the pilot program’s delivery.

“We found that when you go out in the real world to implement agreed national and state strategies you start to get push-back, even from oral health professionals.  So, a lot of what we’ve been doing is going back and talking to Local Health Districts, and government and industry bodies, and most importantly the Aboriginal Community Controlled Health Services” said Dr Skinner.

They have since secured the support of the Australian Dental Association (NSW), the Aboriginal Health and Medical Research Council, and Colgate (who is supplying the varnish free of charge).

After the successful roll-out of the fluoride varnish program in rural and regional schools, the Rapid Applied Research Translation Grant from Sydney Health Partners will expand the program into urban Sydney schools with the support of SLHD and WSLHD.

“This grant is enabling us to test the feasibility and acceptability of the program to non-rural communities. The results will guide us to scale up the program to the communities where there is still a need for prevention strategies,” said Professor Sohn.

The ultimate aim of the Professor Sohn’s team is to have the program embedded into the regular operations of all schools with a high proportion of Aboriginal children enrolled, and who may not have access to regular dental services.

“We’re scaling up our rural and regional work, and also fine-tuning our protocol so it can be embedded in the business-as-usual at schools”, says Mr Rambaldini. ”A major piece of work has been looking at how to make this program sustainable beyond current grants.”