Abstract
BackgroundAustralian Aboriginal children experience high levels of dental caries (tooth decay) and are less likely to access preventive dental health services. High-strength fluoride varnish has been shown to reduce the incidence of dental caries and is commonly used in community-based preventive dental health service programs. In New South Wales, Australia, the application of fluoride varnish is restricted to dental and medical professionals. This is problematic in communities with a high Aboriginal population and limited access to oral health services, contributing to the increased risk of developing dental caries in Aboriginal children. Dental assistants are essential members of the oral health team; however, they do not have a defined scope of practice in Australia. Other countries have created formal scopes of practice for dental assistants to include the application of fluoride varnish. This protocol presents a pathway for qualified Aboriginal dental assistants to undertake additional training to legally apply fluoride varnish in New South Wales. The primary objective of this study will be to evaluate the feasibility and acceptability of utilising Aboriginal dental assistants to apply fluoride varnish to Aboriginal children in a school setting at regular 3-month intervals.MethodsSix schools across New South Wales (NSW) that enrol at least 12% Aboriginal children will be invited to participate in the 12-month study. Aboriginal children aged 5–12 years enrolled in these schools will be enrolled in the study. Six Aboriginal dental assistants will undertake training to apply fluoride varnish. Fluoride varnish (Duraphat) will be applied at 3-month intervals by the dental assistants to the teeth using a small brush. An evaluation will be undertaken to determine the feasibility and cost-effectiveness of this innovative approach. This study protocol has been approved by the NSW Aboriginal Health and Medical Research Council and the NSW State Education Research Application Process.DiscussionA qualified Aboriginal dental assistant workforce in NSW (or Australia) legally approved to apply fluoride varnish may increase the sustainability and scalability of fluoride varnish programs and improve the oral health of Aboriginal children in Australia.Trial registrationISRCTN26746753.
Highlights
Australian Aboriginal children experience high levels of dental caries and are less likely to access preventive dental health services
Sample size This study aims to recruit 500 Aboriginal children which constitute approximately 1% of all Aboriginal children enrolled in public schools in New South Wales (NSW) [22]
The proposed study has been developed in response to the long-standing priority in Australia, and NSW, to develop evidence-based, culturally competent and sustainable public oral health programs to improve the oral health of Australian Aboriginal children [13, 26, 27]
Summary
Australian Aboriginal children experience high levels of dental caries (tooth decay) and are less likely to access preventive dental health services. In New South Wales, Australia, the application of fluoride varnish is restricted to dental and medical professionals This is problematic in communities with a high Aboriginal population and limited access to oral health services, contributing to the increased risk of developing dental caries in Aboriginal children. A meta-analysis of clinical trials undertaken by the Cochrane review aimed to assess the caries preventive effect of fluoride varnish concluded that fluoride varnish applied to the teeth two to four times per year is associated with a substantial reduction in caries development [7] This included a 43% reduction in decayed, missing and filled tooth surfaces in the permanent dentition and 37% reduction in the primary dentition
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