Enabling Aboriginal dental assistants to apply fluoride varnish for school children in communities with a high Aboriginal population in New South Wales, Australia: a study protocol for a feasibility study

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.Electronic supplementary materialThe online version of this article (10.1186/s40814-019-0399-4) contains supplementary material, which is available to authorized users.

Aboriginal dental assistants can safely apply fluoride varnish in regional, rural and remote primary schools in New South Wales, Australia

“…A simple caries risk questionnaire was developed for completion by the oral health therapist at the first fluoride varnish day or when a new child joined the program on a subsequent fluoride varnish day. 17 Given the overall high risk of dental caries among Aboriginal children found in all recent population surveys in Australia, 14 and that no children were excluded on the basis of this caries risk assessment during the study, this step was removed in from 2019 onwards.…”

“…This study took a conservative approach to the risk of dental fluorosis by ensuring the children were not enrolled in another fluoride varnish program run by another organisation or had received a recent fluoride treatment as part of routine dental treatment. A simple caries risk questionnaire was developed for completion by the oral health therapist at the first fluoride varnish day or when a new child joined the program on a subsequent fluoride varnish day 17 . Given the overall high risk of dental caries among Aboriginal children found in all recent population surveys in Australia, 14 and that no children were excluded on the basis of this caries risk assessment during the study, this step was removed in from 2019 onwards.…”

“…The names of each of the ACCHS Aboriginal dental assistants who successfully completed additional training provided by NSW TAFE to qualify them to apply fluoride varnish (HLTOHC006 Apply Fluoride Varnish) 19 along with training on the study protocol 17 were submitted to the Chief Health Officer of NSW for approval.…”

“…15 This quality improvement report describes the use of Aboriginal dental assistants in applying fluoride varnish (Duraphat 16 ) in 8 schools in NSW using a standard protocol. 17…”

“…There is a growing number of Aboriginal dental assistants in NSW with formal Technical and Further Education (TAFE) qualifications with several targeted scholarship programs available for the past 5 years 15 . This quality improvement report describes the use of Aboriginal dental assistants in applying fluoride varnish (Duraphat 16 ) in 8 schools in NSW using a standard protocol 17 …”