Strategies to provide co-designed and community-led oral health promotion for Aboriginal children in rural and remote communities in New South Wales, Australia.

Abstract

Background: Australian public policy prioritises the development of evidence-based and culturally appropriate oral health promotion to improve the oral health of Aboriginal people, including children. Aim: This thesis aims to identify themes of effective and culturally appropriate oral health promotion targeting Indigenous children in high-income nations; develop, implement and evaluate oral health promotion for Aboriginal children in rural and remote communities in NSW and determine if these strategies are effective and sustainable. Methods: A collaboration took place with three Aboriginal communities in Central Northern NSW, Australia, in 2014 to collect baseline oral health status of Aboriginal children and inform potential oral health promotion strategies. In 2015, a suite of oral health promotion strategies were co-designed with Aboriginal communities in Central Northern NSW including in-school toothbrushing, installation of refrigerated and filtered water fountains, water bottle program, distribution of fluoride toothpaste and toothbrushes; dental health education and a structured fluoride varnish program. These strategies were implemented in three schools in the region in 2016. The fluoride varnish program was also implemented in seven schools in NSW in 2017 piloting Aboriginal dental assistants to apply fluoride varnish. Oral health promotion was evaluated to determine feasibility, sustainability and impact. Results: Community-led oral health promotion strategies significantly reduced dental caries among children, increased positive oral hygiene behaviours and were considered sustainable. School fluoride varnish programs are feasible and Aboriginal dental assistants can safely provide children with at least three fluoride varnish applications per year using this approach. Discussion and Conclusion: Co-designed and community-led oral health promotion is effective and sustainable and may be a solution to improving the oral health of Aboriginal children.