Community based programs to improve the oral health of Australian Indigenous adolescents: a systematic review and recommendations to guide future strategies

Josephine Gwynn,Vita Christie,John Skinner,Kylie Gwynne,Boe Rambaldini,Angela Masoe,Yvonne Dimitropoulos,Woosung Sohn

doi:10.1186/s12913-020-05247-w

Abstract

BackgroundTo review the international literature on community-based interventions aiming to improve the oral health of Indigenous adolescents and identify which demonstrate a positive impact.MethodsData sources were MEDLINE, EMBASE, CINAHL, SCOPUS, the COCHRANE library and the Australian Indigenous HealthInfoNet. Articles were included where they: were published in English from 1990 onwards; described oral health outcomes for Indigenous adolescents aged 10 to 19 years; implemented a community based oral health intervention. The Quality Assessment Tool for Quantitative Studies from the Effective Public Health Practice Project was applied.ResultsNine studies met inclusion criteria; two rated strong in quality; only one study was conducted with an urban community; five reported moderate community engagement. Five intervention strategies were identified, and schools were the most common setting reported. Statistically significant improvements were described in eight studies with the most frequently reported outcome being change in decayed missing or filled teeth.ConclusionsFew good quality peer reviewed international studies of community-based oral health interventions which address the needs of Indigenous adolescents exist. Studies must include strong Indigenous community leadership and governance at all stages of the research, adopt participatory action-based research approaches, and are required in urban communities.

Highlights

To review the international literature on community-based interventions aiming to improve the oral health of Indigenous adolescents and identify which demonstrate a positive impact
This study aims to systematically examine the quality, community engagement and components of existing oral health interventions for Indigenous adolescents globally
Articles were included in the review if they met the following criteria: 1) described outcomes for Indigenous adolescents in the age range of 10 to 19 years [25]; 2) quantitative measures that allowed for comparison between groups with and without interventions; and 3) described changes in one or more of the following measures: nutrition, tooth brushing behaviours, oral health knowledge, the number of decayed, missing and filled primary and/or permanent teeth, dental caries, oral hygiene, gingivitis, and periodontal disease

Summary

Introduction

To review the international literature on community-based interventions aiming to improve the oral health of Indigenous adolescents and identify which demonstrate a positive impact. Indigenous peoples experienced thriving rich and diverse cultures over tens of thousands of years until the processes of colonisation severed connections to land and culture and devastated many communities [1]. This resulted in loss of land, spiritual and kinship disconnection and high burdens of poor physical and mental health [2] including poor oral health [3]. Determinants of poor oral health for Indigenous peoples identified in the international literature in Brazil [5], Ecuador [6] and Canada [7] include: remoteness and community infrastructure such as access to electricity; consumption of processed foods; and racism

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