Our research has two fundamental foci:
- Monitoring and surveillance of Indigenous oral health and the use of dental services.
- Investigation of critical research themes such as social inequalities in Indigenous oral health, oral health of ‘at-risk' Indigenous groups such as young adults or those living in rural/remote locations, possible means of preventing disease, and barriers to dental care and oral health.
The Unit also aims to:
- continue and extend the Indigenous oral health research program and associated research education that is currently undertaken at the Australian Research Centre for Population Oral Health (ARCPOH) and in association with colleagues elsewhere in Australia and overseas
- extend and strengthen collaborative relationships with Indigenous oral health researchers in Australia and overseas, bringing distinguished and stimulating visitors to Adelaide and generally through ongoing interaction fostering a synergy that will increase the Unit's scholarly output and enable capacity-building of both Indigenous and non-Indigenous staff
- attract postgraduate research students of the highest potential, with a particular emphasis on Indigenous students
- maintain, increase and diversify the financial support for the Unit's research, including necessary infrastructure.
IOHU is currently involved in five exciting oral health interventions involving Indigenous Australians. The interventions, described in greater detail below, are each funded by Australia's National Health & Medical Research Council.
Past & Present Oral Health Interventions
Reducing disease burden and health inequalities arising from chronic dental disease among Indigenous children: an early childhood caries intervention ($1.4 million over 5 years).
There is evidence of four ways in which Early Childhood Caries (ECC) can be successfully prevented: provision of dental care to mother during pregnancy; fluoride varnish application to teeth of children; anticipatory guidance and motivational interviewing. Anticipatory guidance is a developmentally-based counseling technique that focuses on the needs of a child at a particular life stage, while motivational interviewing focuses on strategies to move carers from inaction to action. Funded through an International Collaborative Indigenous Health Research Partnership grant, with collaborators in New Zealand and Canada, the goal of this study is to determine if implementation of a culturally-appropriate ECC intervention, that employs a tailored approach and draws on a range of Indigenous-relevant contexts including oral health knowledge, oral self-care, dental service utilisation, oral health-related self-efficacy and oral health literacy, reduces dental disease burden and oral health inequalities among pre-school Indigenous children in South Australia.
All participants will receive the intervention benefits through a delayed intervention design. Pregnant Indigenous women residing in South Australia, their families and communities, will be included. The intervention will be implemented from birth, will continue for the first three years of a participating child’s life and will be tailored at the individual- or family-level. The research is significant because:
- ECC is a severe and highly prevalent problem among Indigenous children in Australia.
- The proposed intervention combines participation and partnership with Indigenous communities with a high quality, rigorous research methodology that will give the best possibility of valid, relevant and immediately applicable outcomes.
- The benefits of this approach and any positive outcomes of the intervention are likely to extend beyond oral health.
- If successful, this would be the first high quality oral health intervention research to be done across all three nations. An added strength is that a tailored schema will be adopted, meaning specific intervention components are personalised to match the needs of each mother and her family.
Randomised control trial of effectiveness of silver fluoride on managing deciduous caries in remote Aboriginal communities ($0.7 million over 4 years)
Despite considerable efforts to improve their oral health, Aboriginal children in rural and remote communities of Australia suffer from significantly poorer oral health compared with their counterparts in metropolitan communities and with non-Aboriginal children. It is clear that standard restorative dental treatment and prevention currently available are not capable of preventing new lesions or appropriate for restoring existing caries in those children, especially in the deciduous dentition. Thus there is a need for an effective intervention which is even less traumatic than atraumatic restorative treatment (ART) and uses even fewer resources, to arrest existing carious lesions, reduce the impact of lesions experienced and preserve the functionality of the deciduous dentition. Silver fluoride solution is a strong candidate as a novel intervention for this situation. However, there is limited evidence to support its use as an accepted community treatment intervention.
This study's hypotheses are that silver fluoride and ART are equally effectively in successfully managing untreated cavitated dental caries in the primary dentition, and that silver fluoride has an additional benefit of reducing future development of new dental caries relative to ART.
The aims are:
- To evaluate the effectiveness of silver fluoride applications in minimizing negative sequelae of dental caries in young children compared with ART.
- To evaluate the preventive effect on the development of new carious lesions of silver fluoride compared with ART.
Associations between periodontal disease and cardiovascular surrogate endpoints among Indigenous adults ($1.3 million over 3 years).
The relationship between periodontal disease and cardiovascular surrogate endpoints, both of which are high among the Indigenous Australian population, is established. This study seeks to explore the prevalence of cardiovascular surrogate endpoints among this population with periodontal disease, and to determine if implementation of a periodontal intervention leads to improved cardiovascular risk outcomes. There may be benefit in applying this model to other areas of Indigenous health research. Considering that, at the very least, periodontal therapy would improve oral health, that periodontal therapy becomes an integral component of preventive cardiology treatment is worthy of further study.
This will be a delayed intervention study, with all participants receiving the periodontal intervention benefits. The study is important in three main ways:
- It will be the first investigation examining the effectiveness of periodontal therapy in changing cardiovascular surrogate endpoint levels in an Indigenous Australian population.
- It will be the first investigation to monitor changes in cardiovascular surrogate endpoints following periodontal intervention at both 3 and 12 months.
- The findings could be used to develop a generalisable oral health policy/practice protocol for Indigenous community members with poor cardiovascular health.
An oral health literacy intervention among Port Augusta Aboriginal adults to better improve the knowledge and use of dental services ($0.6 million over 3 years).
ARCPOH researchers are proud of their close working relationship with Indigenous community members of Port Augusta (300km north of Adelaide; 20 percent of population Indigenous), established in 2004. Our background work demonstrated that those with poorer oral health literacy engage in more harmful oral health literacy-related knowledge and behaviours and that, after adjusting for confounding, poor oral health literacy-related outcomes are risk indicators for poor self-rated oral health. The goal of this study is to determine if implementation of a functional, context-specific oral health literacy intervention improves oral health literacy-related outcomes, as measured by oral health knowledge, oral health self-care, utilisation of dental services and oral health-related self-efficacy, among Aboriginal adults residing in Port Augusta and surrounds.
The study employs a delayed intervention design, with all participants receiving the oral health literacy intervention benefits. If evaluation of the project shows that an intense, interactive oral health literacy intervention improves oral health literacy-related outcomes, it will be tangible evidence of the benefit in having Aboriginal health workers employed in an oral health promotion/literacy capacity in Aboriginal medical centres. Outcomes of the initiative could also be useful for Aboriginal medical centres when negotiating with funding bodies such as the South Australian Dental Service in regards to oral health program continuation.
A case-control study of periodontal disease and risk factors among an urban Indigenous population ($0.4 million over 4 years).
Research findings on the oral health of Indigenous Australian adults in remote areas and who seek public sector care have shown that Indigenous Australians have higher prevalence of moderate to severe periodontal disease than other Australians. Indigenous Australians also experience higher rates of diabetes and stress and are more likely to smoke than their non-Indigenous counterparts. These factors increase the risk of periodontal disease. To ascertain priorities in primary prevention approaches a study of periodontal disease and its risk factors among an urban Indigenous population is being undertaken in Redfern, Sydney. The study hypothesis is that the extent and severity of periodontal disease among urban Aboriginal and Torres Strait Islander adults are related to diabetes and smoking but are compounded by high levels of stress and under-nutrition.
Specific aims include:
- To determine the risk indicators and their relative importance for periodontal disease in an urban Aboriginal and Torres Strait Islander population.
- To describe the prevalence, extent and severity of periodontal disease in an urban Aboriginal and Torres Strait Islander population.
- To provide information to guide improved oral health care for Aboriginal and Torres Strait Islander communities.