A population health approach for essential dental care

Tooth decay is one of the most prevalent chronic non-communicable diseases among children, particularly for those living in rural and remote areas. Despite the significant cost and health impacts of tooth decay and oral disease on society and the healthcare system, oral health remains absent as a critical health priority for the Australian Government.

For many Australians, and particularly for Northern Territorians, timely access to affordable oral health care is problematic. Children living in the Northern Territory have the highest prevalence of tooth decay and the highest level of tooth decay experience compared to the Australian national average. Targeted population health approaches are essential to improve children’s oral health, particularly for Aboriginal and Torres Strait Islander children, who experience a greater burden of oral disease.

The School Based Fluoride Varnish Program (SBFVP), run by the Oral Health Service Northern Territory (OHSNT), provides a population health approach to oral disease prevention and management through strong community partnerships. When fluoride varnish is applied to teeth at least twice a year, it can reduce tooth decay by at least one-third and can reverse early stages of tooth decay.

Fluoride varnish was recently approved and classified on the essential medicines list by the World Health Organization (July 2023). Currently, only registered dental practitioners and approved health practitioners have access to concentrated fluoride varnish, in accordance with the drugs and poisons regulations for each state or territory.

The SBFVP was launched in 2018 and had only a minimal service disruption during the COVID-19 pandemic. Starting with a single school in November 2018, it has expanded to 29 schools – with further scope for ongoing recruitment of schools. The SBFVP is now an integral and embedded service delivery model for recruited schools and the OHSNT.

Oral health teams within OHSNT perform basic dental screening, apply fluoride varnish on children’s teeth and arrange referrals. Treatment needs are followed-up by the dental team who, with assistance from the community health worker, arrange for identified children to come with their parent or guardian to a public dental clinic for oral health care.

Between November 2018 and June 2023, the SBFVP provided 10,415 fluoride varnish applications, generated 4,793 follow-up dental appointments and engaged with 579 children who had never received an oral health check-up. These school-based dental visits offer an opportunity to introduce dentistry in a non-confrontational, safe and friendly environment, as well as promote culturally safe practice and increase the health literacy of communities. The program also provides an additional touchpoint for children who have missed their regular oral health check-up appointments to re-engage with OHSNT.

Over 70 per cent of participants in the SBFVP were identified as Aboriginal and Torres Strait Islander children. Formal evaluation of the program is underway, with preliminary findings indicating a large proportion of Aboriginal and Torres Strait Islander children are at greater risk for tooth decay and potentially preventable hospital admissions, and benefit most from receiving early preventive-focused oral health care.

Community engagement and the contributions of education and health liaison officers are vital to the successful and sustainable implementation of the SBFVP. Through their valuable work, the program has achieved credibility within the Aboriginal communities and enabled continuity of service delivery. It has promoted health equity by increasing access to dental care for children who are not currently accessing dental services. A preventive approach to service delivery has also meant many Aboriginal children have benefited from receiving timely dental treatment, potentially diverting them from requiring general anaesthesia for oral conditions.

Another positive result has been the strong acceptance of the program among OHSNT staff, Remote Area Health Corps (RAHC) staff and partner communities.

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