Costing the Scale-Up of a National Primary School-Based Fluoride Varnish Program for Aboriginal Children Using Dental Assistants in Australia

Abstract

There is good evidence that fluoride varnish programs are effective in preventing dental caries in children. This study aims to provide a costing for the scale-up of a child fluoride varnish program in New South Wales (NSW), Australia. Most child fluoride varnish programs are school-based, and a number of studies have examined the acceptability and cost effectiveness of using non-dental providers to apply the fluoride varnish. This paper describes the number of primary schools in Australia that could be targeted using a standard population-based risk criteria based on published data. A costing method was developed for various scenarios of school enrolment and provider types, along with potential revenue from the Child Dental Benefits Schedule (CDBS). Most of the costs of a school-based fluoride varnish program can be covered by the CDBS with assumptions of 80% child consent and 75% CDBS eligibility. While the scale-up of child fluoride varnish programs to prevent dental caries has been recommended by numerous strategic plans and reports, particularly for Aboriginal and Torres Strait Islander children, limited progress has been made. This paper concludes that using a standardized criteria for targeting schools using a combination of ICSEA and Aboriginal enrolments, and aiming at four applications a year, is feasible, and that the main costs of the program could be covered by using the CDBS.

Oral health promotion and programming provided by Aboriginal Community Controlled Health Organisations in South Australia

“…Similar approaches in the Northern Territory, 34 Western Australia 35 and Tasmania 36 have also used paraprofessionals, including Aboriginal Health Workers, for fluoride varnish application programs. The success of the fluoride varnish program in New South Wales has resulted in a call to scale up the initiative to a state‐wide program 37 . No comparable programs are currently underway in South Australia, but the existing evidence‐base suggests that a similar approach is not only feasible but could be quite successful in minimising the experience of dental caries, particularly for children 38 .…”

“…Wales has resulted in a call to scale up the initiative to a state-wide program. 37 No comparable programs are currently underway in South…”

Child Fluoride Varnish Programs Implementation: A Consensus Workshop and Actions to Increase Scale-Up in Australia

“…The greater use of the fluoride varnish items for programs targeting Aboriginal and Torres Strait Islander may also increase utilisation of the CDBS, which has been particularly low for Aboriginal and Torres Strait Islander children. If dental assistants were also able to claim for fluoride varnish services under the CDBS, this would further improve cost effectiveness while also reducing pressure on oral health services where there are shortages of dental and oral health practitioners [31].…”

Child-, Family-, and Community-Level Facilitators for Promoting Oral Health Practices among Indigenous Children

“…Currently, fluoride varnish application is restricted to dental professionals in SA, despite its value in preventing ECC [85]. Researchers in New South Wales have successfully demonstrated that Indigenous dental assistants can effectively and safely apply fluoride varnish for children in schools; these findings have the potential to better oral health for Indigenous children across Australia [86].…”