Dental Disease Outcomes Following a 2-Year Oral Health Promotion Program for Australian Aboriginal Children and Their Families: A 2-Arm Parallel, Single-blind, Randomised Controlled Trial

Abstract

Background Dental disease has far-reaching impacts on child health and wellbeing. We worked with Aboriginal Australian communities to develop a multifaceted oral health promotion initiative to reduce children's experience of dental disease at age 2 years. Methods This was a single-blind, parallel-arm, randomised controlled trial. Participants were recruited from health service providers across South Australia. Women pregnant with an Aboriginal child were eligible. The intervention comprised: (1) provision of dental care to mothers during pregnancy; (2) application of fluoride varnish to teeth of children at ages 6, 12 and 18 months; (3) motivational interviewing delivered in conjunction with; (4) anticipatory guidance. The primary outcome was untreated dental decay as assessed by the number of teeth with cavitated and non-cavitated carious lesions (mean dt) at child age 24 months. Analyses followed intention-to-treat principles. The RCT was registered with the Australian and New Zealand Clinical Trial Registry, ACTRN12611000111976. Findings Women (n = 448) were recruited from February 2011 to May 2012, resulting in 223 children in the treatment group and 225 in the control. Mean dt at age two years was 0.62 (95% CI 0.59 to 0.65) for the intervention group and 0.89 (95% CI 0.85 to 0.92) for the control group (mean difference − 0.27 (95% CI − 0.31, − 0.22)). Interpretation A culturally-appropriate intervention at four time-points from pregnancy through to 18-months resulted in improvements in the oral health of Aboriginal children. Further consultation with Aboriginal communities is essential for understanding how to best sustain these oral health improvements for young Aboriginal children.

Is There an Association between Breastfeeding and Dental Caries among Three-Year-Old Australian Aboriginal Children?

“…Recruitment was mainly through the antenatal clinics at South Australian hospitals and through Aboriginal Community Controlled Health Organizations. The study was a 2-arm parallel, outcome assessor-blinded, randomized controlled trial that aimed to assess if an intervention involving dental care to mothers during pregnancy, application of fluoride varnish to the teeth of children, anticipatory guidance, and motivational interviewing reduced prevalence of dental disease among Aboriginal children in South Australia at follow-up ages of 24 and 36 months [9,10]. The intervention took place during pregnancy and when children were aged 6, 12, and 18 months for the early intervention group, and when children were aged 24, 30, and 36 months for the delayed intervention group.…”

Early childhood caries epidemiology, aetiology, risk assessment, societal burden, management, education, and policy: Global perspective

“…Community programmes for managing ECC generally target high‐risk, low socioeconomic, disadvantaged communities using established caries prevention methods. Programmes that are culturally competent with community‐based participation and alignment with community cultures have been successful in reducing ECC in indigenous, low‐income, and migrant communities worldwide . Similarly, personal approaches such as home visiting and telephone contacts can reduce ECC by increasing caregivers’ health literacy and self‐efficacy to change behaviours to improve their infants’ oral health .…”

“…Programmes that are culturally competent with community-based participation and alignment with community cultures have been successful in reducing ECC in indigenous, low-income, and migrant communities worldwide. [44][45][46][47] Similarly, personal approaches such as home visiting and telephone contacts can reduce ECC by increasing caregivers' health literacy and self-efficacy to change behaviours to improve their infants' oral health. [48][49][50] Knowledge increases, however, may not improve oral health behaviours or reduce caries increment.…”

Follow-up of Intervention to Prevent Dental Caries Among Indigenous Children in Australia

“…The trial proved to be efficacious, with children in the immediate intervention group having less untreated dental caries than children in the delayed intervention group at follow-up conducted at 2 and 3 years of age. 11,12…”