Dental caries experience in Aboriginal and Torres Strait Islanders in the Northern Peninsula Area, Queensland

Bullied Because of Their Teeth: Evidence from a Longitudinal Study on the Impact of Oral Health on Bullying Victimization among Australian Indigenous Children

Making life better for Indigenous peoples is a global priority. Although bullying and oral health have always been a topic of concern, there is limited information regarding the impact of this problem on the general population, with no evidence in this regard among the Australian Indigenous population. Thus, we aimed to quantify the relationship between bullying victimization and oral health problems by remoteness among 766 Australian Indigenous children aged between 10−15-years using data from the LSIC study. Bivariate and multilevel mixed-effect logistic regression analyses were employed. Findings indicated children self-reported bullying more than parents reported their children were being bullied (44% vs. 33.6%), with a higher percentage from rural/remote areas than urban areas. Parents reported that oral health problems increased the probability (OR 2.20, p < 0.05) of being bullied, in Indigenous children living in urban areas. Racial discrimination, lower level of parental education and poor child oral hygiene increase the risk of bullying victimization. Parental happiness with life and a safe community were associated with a lower risk of bullying. Dental problems are linked with Australian Indigenous children experiencing bullying victimization. Cultural resilience and eliminating discrimination may be two modifiable paths to ameliorating health issues associated with bullying in the Australian Indigenous community.

Managing oral health care and prevention: The experience of Aboriginal and Torres Strait Islanders living in a rural community in Queensland, Australia

Objective

To understand the experience of rural Aboriginal and Torres Strait Islanders in engaging with oral health care services and programs in order to support the development of oral health services and prevention programs that better meet their needs.

Design

The study used a qualitative research design, which aims to describe participants' lived experience of engaging with oral health services and prevention programs in a rural Aboriginal and Torres Strait Islander community. Focus group discussions and in‐depth interviews were conducted with 27 participants. The 15 transcribed discussions were analysed using a 6‐step phenomenological process.

Setting

A rural community in Queensland, Australia, with a predominantly Aboriginal population.

Participants

Participants were purposively recruited from established health and community groups.

Main outcome

System‐level barriers to accessing and engaging with oral health services and prevention influence how communities manage oral health and seek treatment.

Results

The study identified 4 main themes describing the community's experience: service location and the efforts required to access oral health services; the financial burden of accessing oral health care and practising prevention; lack of confidence in oral health services; and the avoidance or delaying of accessing care for dental problems. Results confirmed a high burden of oral disease but limited attendance at an oral health facility and difficulties engaging in preventative oral health behaviours. Treatment seeking was usually instigated by the experience of pain and typically at a tertiary health facility.

Conclusion

Aboriginal and Torres Strait Islanders in rural communities experience a high burden of oral disease but have limited engagement with oral health services. This is associated with system‐level barriers to accessing and engaging with oral health services and prevention.

Biocultural Drivers of Salivary Microbiota in Australian Aboriginal and Torres Strait Islander Children

Australian Aboriginal and Torres Strait Islander children experience unacceptably high rates of dental caries compared to their non-Indigenous Australian counterparts. Dental caries significantly impacts the quality of life of children and their families, particularly in remote communities. While many socioeconomic and lifestyle factors impact caries risk, the central role of the oral microbiota in mediating dental caries has not been extensively investigated in these communities. Here, we examine factors that shape diversity and composition of the salivary microbiota in Aboriginal and Torres Strait Islander children and adolescents living in the remote Northern Peninsula Area (NPA) of Far North Queensland. We employed 16S ribosomal RNA amplicon sequencing to profile bacteria present in saliva collected from 205 individuals aged 4–17 years from the NPA. Higher average microbial diversity was generally linked to increased age and salivary pH, less frequent toothbrushing, and proxies for lower socioeconomic status (SES). Differences in microbial composition were significantly related to age, salivary pH, SES proxies, and active dental caries. Notably, a feature classified as Streptococcus sobrinus increased in abundance in children who reported less frequent tooth brushing. A specific Veillonella feature was associated with caries presence, while features classified as Actinobacillus/Haemophilus and Leptotrichia were associated with absence of caries; a Lactobacillus gasseri feature increased in abundance in severe caries. Finally, we statistically assessed the interplay between dental caries and caries risk factors in shaping the oral microbiota. These data provide a detailed understanding of biological, behavioral, and socioeconomic factors that shape the oral microbiota and may underpin caries development in this group. This information can be used in the future to improve tailored caries prevention and management options for Australian Aboriginal and Torres Strait Islander children and communities.

Carious lesions in permanent dentitions are reduced in remote Indigenous Australian children taking part in a non-randomised preventive trial

We tested the effect of an annual caries preventive intervention, delivered by a fly-in/fly-out oral health professional team, with Indigenous children residing in a remote Australian community. Around 600 Indigenous children aged 5 to 17 years were invited to participate at baseline, of who 408 had caregiver consent. One hundred and ninety-six consented to the epidemiological examination and intervention (Intervention group) and 212 consented to the epidemiological examination only (Comparison group). The intervention, which occurred annually, comprised placement of fissure sealants on suitable teeth, and application of povidone-iodine and fluoride varnish to the whole dentition, following completion of any necessary restorative dental treatment. Standard diet and oral hygiene advice were provided. Caries increment (number of tooth surfaces with new dental caries) in both deciduous and permanent dentitions was measured at the 2-year follow-up. Comparison group children had significantly higher number of new surfaces with advanced caries in the permanent dentition than the Intervention group (IRR = 1.61; 95% CI: 1.02–2.54; p = 0.04); with a preventive fraction of 43%. The effect of intervention remained significant with children in the Comparison group developing significantly more advanced caries lesions in the permanent dentition than the Intervention group children in the adjusted multivariable analysis (IRR = 2.21; 95% CI: 1.03–4.71). Indigenous children exposed to the intervention had less increment in advanced dental caries in the permanent dentition than those not exposed to the intervention.

Response of Salivary Microbiota to Caries Preventive Treatment in Aboriginal and Torres Strait Islander Children

A once-annual caries preventive (Intervention) treatment was offered to Aboriginal and Torres Strait Islander schoolchildren—a population with disproportionately poorer oral health than non-Indigenous Australian children—in the Northern Peninsula Area (NPA) of Far North Queensland (FNQ), which significantly improved their oral health. Here, we examine the salivary microbiota of these children (mean age = 10 ± 2.96 years; n = 103), reconstructing the bacterial community composition with high-throughput sequencing of the V4 region of bacterial 16S rRNA gene. Microbial communities of children who received the Intervention had lower taxonomic diversity than those who did not receive treatment (Shannon, p < 0.05). Moreover, the Intervention resulted in further decreased microbial diversity in children with active carious lesions existing at the time of saliva collection. Microbial species associated with caries were detected; Lactobacillus salivarius, Lactobacillus reuteri, Lactobacillus gasseri, Prevotella multisaccharivorax, Parascardovia denticolens, and Mitsuokella HMT 131 were significantly increased (p < 0.05) in children with severe caries, especially in children who did not receive the Intervention. These insights into microbial associations and community differences prompt future considerations to the mechanisms behind caries-preventive therapy induced change;  important for understanding  the long-term implications of like treatment to improve oral health disparities within Australia.

Trial registration: ANZCTR, ACTRN12615000693527. Registered 3 July 2015, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368750&isReview=true

Factors influencing the perceived importance of oral health within a rural Aboriginal and Torres Strait Islander community in Australia

BACKGROUND

Indigenous Australians suffer from higher rates of oral disease and have more untreated dental problems and tooth extractions than the general population. Indigenous Australians also have lower rates of accessing oral health services and are more likely to visit for a problem rather than a check-up. Multiple issues effect health service and prevention programs including: characteristics of health services such as distances to health services; existence of social and cultural barriers; available wealth and social support; and, characteristics of the individual and community including the importance given to the disease. This paper seeks to explore the perceived importance of oral health within a rural Indigenous community in Australia and the factors influencing this perception.

METHODS

The study used a phenomenology research design incorporating focus group discussions and in-depth interviews. It was undertaken in partnership with communities' Health Action Group who guided the focus, implementation and reporting of the research. A convenience sample was recruited from established community groups. Thematic analysis on the transcripts was completed.

RESULTS

Twenty-seven community members participated in three focus groups and twelve in-depth interviews. The study found that the community gives high priority to oral health. Factors influencing the importance include: the perceived severity of symptoms of oral disease such as pain experienced due to tooth ache; lack of enabling resources such as access to finance and transport; the social impact of oral disease on individuals including impact on their personal appearance and self-esteem; and health beliefs including oral health awareness. Participants also noted that the importance given to oral health within the community competed with the occurrence of multiple health concerns and family responsibilities.

CONCLUSION

This paper highlights the high importance this rural Indigenous community gives to oral health. Its findings suggest that under-utilisation of oral health services is influenced by both major barriers faced in accessing oral health services; and the number and severity of competing health and social concerns within the community. The study results confirm the importance of establishing affordable, culturally appropriate, community-based oral health care services to improve the oral health of rural Indigenous communities.

Dental caries experience in children of a remote Australian Indigenous community following passive and active preventive interventions

Objectives

To report on changes in dental caries experience in children of a remote Indigenous community following 6 years of passive preventive intervention (PPI) and 2 years of active preventive intervention (API).

Methods

Five consecutive cross‐sectional surveys were conducted on 4‐ to 15‐year‐old school going children between 2004 and 2017 following phases of Community Water Fluoridation (CWF), post‐cessation of CWF and API. Following treatment of any cavities present, API included selective placement of fissure sealants (FS) and an annual application of povidone‐iodine (PI) and fluoride varnish (FV). The World Health Organization's (WHO) “Oral Health Surveys – Basic Methods (4th Edition)” methodology was used in the first two and the International Caries Detection and Assessment System (ICDAS‐II) in the latter three surveys. ICDAS‐II codes of 3‐6, representing advanced caries, were combined to allow comparison to the decayed component of the DMF caries index.

Results

Age‐weighted mean dmft decreased by 37.7% in the deciduous (DD) and DMFT by 35% in the permanent (PD) dentitions between the pre‐ and post‐CWF surveys, followed by increases of 25% and 7.7%, respectively, between the 1‐year and 4‐year post‐CWF surveys. After 2 years of API, mean dmft decreased by 14.3% and DMFT by 7.1%. Untreated dental caries however remained a concern in the DD and PD during both phases of PPI and of API. The decline in caries experience for both dentitions following 2 years of API exceeded that for the 6‐year period of PPI.

Conclusions

The annual reductions in caries experience of 7.2% (DD) and 8% (PD) during the phase of API exceeded annual decreases of 4.7% (DD) and 4.6% (PD) during the phase of PPI. Due to remoteness, cost and logistics in ensuring long‐term viability of API programmes, CWF remains necessary in this type of community.

Association between patient age, geographical location, Indigenous status and hospitalisation for oral and dental conditions in Queensland, Australia

A retrospective analysis of hospitalisation due to oral and dental conditions (ODC) was performed for patients in Queensland. The aim was to identify the rate and cost of hospitalisation and to examine the association between hospitalisation and age, geographical location and Indigenous status. There were 81528 admissions to Queensland's hospitals due to ODC during the 3-year study period (2011-2013). The annual cost of ODC-related hospitalisation was estimated to be AU$87million. Indigenous infants (Z=4.08, P<0.001) and primary school children (Z=2.01, P=0.046) were significantly more likely to be hospitalised than their non-Indigenous counterparts. A non-Indigenous high school child was almost fourfold more likely to be hospitalised. There was no significant difference in the rate of hospitalisation for adults. Infants (Z=6.70, P<0.001) and primary school children (Z=8.73, P<0.001) from remote areas were significantly more likely to be hospitalised than their age-matched metropolitan counterparts. Whereas high school children (Z=2.74, P=0.006) and adults (Z=6.02, P<0.001) from remote areas were significantly less likely to be hospitalised. Our findings suggest that there is a need for alternative models of primary dental care to service remote areas of Queensland and Indigenous populations. Strategies that enable Indigenous Health Workers to provide dental care, and the use of teledentistry, are models of care that may reduce potentially preventable hospitalisations and lead to cost savings and better health outcomes.

Flying blind: trying to find solutions to Indigenous oral health

Objective The aim of the present study was to identify all published evidence about oral health in Indigenous children in Australia and to determine trends in Indigenous oral health over time. Methods PubMed was used to search for published peer-reviewed articles that reported caries (decay) prevalence rates and/or caries experience (based on caries indices) in Indigenous children. Studies included in the analysis needed to report clinical oral health data (not self-reported dental experiences), and articles were excluded if they reported caries in only a select, specific or targeted sample (e.g. only children undergoing hospital admissions for dental conditions). Results The review identified 32 studies that met the inclusion criteria. These studies reported data from the Northern Territory (n=14), Western Australia (n=7), South Australia (n=7), Queensland (n=7), New South Wales (n=1), Australian Capital Territory (n=1) and Tasmania (n=1). Of the studies, 47% were in rural locations, 9% were in urban locations and 44% were in both rural and urban locations. Data are limited and predominantly for Indigenous children living in rural locations, and there are no published studies on caries in Indigenous children living in Victoria. Conclusions The present study documents the published prevalence and severity of caries in Indigenous children living in Australia and highlights that limited oral health data are available for this priority population. Although risk factors for oral disease are well known, most of the studies did not analyse the link between these factors and oral disease present. There is also inconsistency in how caries is reported in terms of age and caries criteria used. We cannot rely on the available data to inform the development of policies and programs to address the oral health differences in Indigenous populations living contemporary lives in metropolitan areas. What is known about the topic? Many studies report that Indigenous people have poorer general health in Australia compared with non-Indigenous people. What does this paper add? This paper documents the available published prevalence and experience of caries for Indigenous children in Australia. It demonstrates significant limitations in the data, including no Victorian data, inconsistency with reporting methods and most data being for Indigenous children who are living in rural locations. What are the implications for practitioners? It is important for practitioners to have access to oral health data for Indigenous children in Australia. However, the present study highlights significant knowledge gaps for this population group and identifies ways to collect data in future studies to enable more meaningful comparisons and policy development.

Oral health interventions in Australian Aboriginal communities: a review of the literature

Aboriginal Australians experience significant disparities in oral health with even poorer outcomes reported in rural and remote areas. The high rates of preventable dental disease in Aboriginal communities are a serious concern from a social standpoint and in terms of service provision and health care expenditure. In this review, primary research literature was comprehensively reviewed. Papers were selected if they reported designing or implementing an intervention or oral health programme specific to the needs of Aboriginal communities. Twenty-one publications fulfilled the inclusion criteria with 19 different interventions being described. Interventions were categorized using a classification adapted from the work of Whitehead (2002). The review identified interventions that aimed to reduce early childhood caries, increase services to remote communities, develop the role of Aboriginal health workers, improve oral health literacy, establish water fluoridation and provide periodontal therapy. Implementing successful oral health interventions in Aboriginal communities is a challenge that is compounded by the complex interplay between psychosocial and cultural determinants. Even interventions that follow a rigorous and consultative design have a high failure rate in Aboriginal communities if upstream determinants of health are not adequately understood and addressed.

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.

Effectiveness of water fluoridation in caries reduction in a remote Indigenous community in Far North Queensland

BACKGROUND

Children in remote Indigenous communities in Australia have levels of dental caries much greater than the national average. One such, the Northern Peninsula Area of Far North Queensland (NPA), had an oral health survey conducted in 2004, shortly before the introduction of fluoridated, reticular water. Children were again surveyed in 2012, following five years exposure.

METHODS

An oral examination was conducted on all consenting children enrolled in schools across the community, using WHO Basic Oral Health Survey methodology.

RESULTS

Few teeth had restorations in both surveys. Age-weighted overall caries prevalence and severity declined from 2005 to 2012 by 37.3%. The effect was most marked in younger children, dmft decreasing by approximately 50% for ages 4-9 years; at age 6, mean decayed score decreased from 5.20 to 3.43. DMFT levels also decreased by almost half in 6-9 year olds. However, significant unmet treatment needs exist at all ages.

CONCLUSIONS

There has been considerable improvement in child dental health in the NPA over the past 6-7 years. In light of continued poor diet and oral hygiene, water fluoridation is the most likely explanation. The cost-effectiveness for this small community remains an issue which, in the current climate of political antagonism to water fluoridation in many quarters, requires continued study.

Effect of health promotion and fluoride varnish on dental caries among Australian Aboriginal children: results from a community-randomized controlled trial

Objectives

We tested a dental health program in remote Aboriginal communities of Australia's Northern Territory, hypothesizing that it would reduce dental caries in preschool children.

Methods

In this 2-year, prospective, cluster-randomized, concurrent controlled, open trial of the dental health program compared to no such program, 30 communities were allocated at random to intervention and control groups. All residents aged 18–47 months were invited to participate. Twice per year for 2 years in the 15 intervention communities, fluoride varnish was applied to children's teeth, water consumption and daily tooth cleaning with toothpaste were advocated, dental health was promoted in community settings, and primary health care workers were trained in preventive dental care. Data from dental examinations at baseline and after 2 years were used to compute net dental caries increment per child (d₃mfs). A multi-level statistical model compared d₃mfs between intervention and control groups with adjustment for the clustered randomization design; four other models used additional variables for adjustment.

Results

At baseline, 666 children were examined; 543 of them (82%) were re-examined 2 years later. The adjusted d₃mfs increment was significantly lower in the intervention group compared to the control group by an average of 3.0 surfaces per child (95% CI = 1.2, 4.9), a prevented fraction of 31%. Adjustment for additional variables yielded caries reductions ranging from 2.3 to 3.5 surfaces per child and prevented fractions of 24–36%.

Conclusions

These results corroborate findings from other studies where fluoride varnish was efficacious in preventing dental caries in young children.