For much of his professional life in the United Kingdom, Professor Anthony Blinkhorn has focussed on improving the oral health of children in poorer communities through collaborative approaches with government agencies. This work saw him appointed as Chair of Population Oral Health at the University of Sydney in 2007, funded by the NSW Health Centre for Oral Health Strategy.
The Chief Dental Officer for NSW, Professor Clive Wright and his successor, Dr Peter Hill, agreed to support a pilot study to determine whether a program undertaken as a collaborative venture with Aboriginal communities, was practical and supported by Aboriginal health workers.
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'The pilot was successful because Aboriginal leaders in remote areas had been complaining about the negative impact dental decay had on young children in their rural communities,' Professor Blinkhorn said.
Over half (52.4%) of 3- to 4-year-old Aboriginal children suffer from dental caries compared with only 16.5% of non-Aboriginal children.1
'The problem had not been solved by current oral health care strategies. It was clear that innovation was needed to combat this problem of severe Early Childhood Caries (ECC) and its impact on the quality of life of Aboriginal children. With funding from a NHMRC Project Grant we developed a trial program working with Aboriginal health workers.'
ECC is an aggressive type of dental decay that affects young children and rapidly destroys their teeth as they erupt into the mouth. There is a high prevalence of ECC in Aboriginal children.
'It is also associated with severe pain, sleep loss, sepsis, facial swelling, difficulty in eating and sleep loss. Treatment is difficult because the children are so young, and the gross infection renders local anaesthetic ineffective,' Professor Blinkhorn said.
'A general anaesthetic is required which is not only expensive but requires a child to be taken to a specialist – no easy task if you live in a remote location.
'The key issue is to ensure the oral environment is less "hostile" to baby teeth, so they have a chance to survive.
'Our work revolutionised the children’s dental health by helping parents to establish oral health care habits which offered freedom from ECC.
'Offering this advice to parents just as the baby teeth erupt was so positive. We capitalised on the joy and wonder of the arrival of the first baby tooth.'
Aboriginal health workers met with the families when their child was enrolled in the trial at the age of 6 months, and then every 3 months until the child was 3 years of age. The program provided free 'sippy cups' to encourage weaning as well as free fluoride toothpaste and brushes for the whole family. Other key health messages included not having sugary drinks and foods between meals and stopping using a feeder bottle as soon as possible.
At the end of the trial, only 3 children had any dental decay, compared with 29 in a matched historical control group. This was a remarkable result for such a low-cost exercise and is a tribute to the dedication of the Aboriginal health workers.
Next steps
The Centre for Oral Health Strategy NSW Health may continue the project by using a larger community-based trial to determine whether the results can be replicated on a state-wide basis. The educational materials and program protocol are available free of charge to interested researchers.
Chief Investigator (CIA)
Professor Anthony Blinkhorn
Institution
University of Sydney
Title
Aboriginal Health Worker led prevention of early childhood caries in Aboriginal children
Team members
Associate Professor Fiona Blinkhorn
Dr Ngiare Brown
Mrs Rachael Moir
Dr Leanne Smith
Grant information
$526,328
2012–2017
Project Grant
1 Smith L, et al. (2015) '[An assessment of dental caries among young Aboriginal children living in New South Wales Australia: a cross sectional study', BMC Public Health, 15:1314.