Varnishing point

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fluoride varnish
Jessica Mitchell, a newly graduated AHP applying fluoride varnish to her young patient’s teeth. Photography: Press1 Photography for Bendigo & District Aboriginal Co-operative

A change to regulations allows for the culturally appropriate application of fluoride varnish to children in Victorian Aboriginal and Torres Strait Islander communities. By Kerryn Ramsey

Recently, Aboriginal Health Practitioners (AHPs) completed their training to apply fluoride varnish to children at six monthly intervals. This is a breakthrough as a change to the Drugs, Poisons and Controlled Substances Regulations 2017 was required to deliver this outcome for Aboriginal and Torres Strait Islander children. Those who receive the treatment potentially reduce the risk of tooth decay by about 40 per cent.

This initiative is taking place in the north-western region of Victoria, a huge area known as Loddon Mallee that covers more than one-quarter of the state and includes major towns such as Bendigo, Swan Hill and Mildura. 

“This whole program was driven by the Loddon Mallee Aboriginal Reference Group,” says Susan McKee, CEO of Dental Health Services Victoria (DHSV). “They’ve spent years pushing to make this service a reality. Our role at DHSV was to help bring about the required change then set up the training program for the Aboriginal health practitioners.”

Change to regulations

The Loddon Mallee Aboriginal Reference Group worked closely with the Department of Health to push through the required amendments. Fluoride varnish is a scheduled drug and the new regulations allow AHPs to control, store and apply the varnish.

“It was a very complicated process with many conversations between us and the regulators in relation to safety and rights,” says McKee. “It’s the first time in Victoria that non-dental health professionals have been allowed to apply this type of varnish, which is fantastic.”

AHPs are registered healthcare practitioners who provide a wide variety of clinical services. This includes assessment and screening of physical health, promoting healthy lifestyle choices, supporting clients in self-management, and advocating, interpreting and translating for clients within the Aboriginal and Torres Strait Islander communities. Their new role will strengthen their position as health advocates in their community.

Culturally safe

AHPs are a unique resource who teach, train and clinically work with people from their own communities. People who might feel unsafe visiting a practitioner from outside their cultural background are more inclined to see an Aboriginal practitioner. The AHPs are working to improve self-determination around health outcomes in Aboriginal communities.

“They play an important role in the system,” says McKee. “When people feel comfortable visiting Aboriginal controlled health services, there’s more of an uptake of the resources. This means there is greater reach into their community. A key element of Closing the Gap strategies is about improving the health of the Aboriginal and Torres Strait Islander people. Providing culturally appropriate care is an integral part in making that happen.”

This whole program was driven by the Loddon Mallee Aboriginal Reference Group. They’ve spent years pushing to make this service a reality. Our role at DHSV was to help bring about the required change then set up the training program for the Aboriginal health practitioners.

Susan McKee, CEO, DHSV

The newly certified AHPs are already employed and embedded in Aboriginal community-controlled health organisations. Working in that space, they understand community expectations and have a rapport with people using the service. Each child and each family is a holistic unit where oral health issues go hand in hand with general health outcomes.

“We know there has been a significant increase in the number of Aboriginal and Torres Strait people accessing dental care,” says McKee. “But we also know the community feels much more comfortable doing it through an Aboriginal community-controlled health organisation. At DHSV, we are trying to reduce as many barriers as possible so the community can access the most appropriate healthcare.”

Training the practitioners

While undertaking training to apply fluoride varnish safely and effectively, the AHPs also learned about oral health and what to watch for in the children’s mouths. They will show the kids how to brush their teeth correctly and give advice on diet and sugary drinks. They are also qualified to identify a range of dental issues so they can refer the child to a dentist or hygienist as required.

“The varnish needs to be reapplied every six months so the AHPs will see the same kids regularly,” says McKee. 

“When the kids have an appointment, the whole family unit usually comes along. This enables the AHPs to build relationships and trust with the entire family.”

Barriers and success

Obviously, the biggest hurdle the program needed to overcome was changing the regulations. Once that was achieved, the next major issue was developing a culturally appropriate training program delivered in an appropriate way to the health practitioners. The practitioners had to be released from the organisations supporting them, undergo multi-day training, complete practical testing and examinations and then receive more training out in the field.

“The eight outstanding AHPs who completed the training during our first round are very enthusiastic about the program,” says McKee. “There’s no doubt they’re going to have a very positive impact. We also want to extend this initiative across the whole state so if there are any Victorian AHPs who are interested in being part of the program, please reach out to us.”

The ultimate aim of the program is simple—to improve the oral health of children in Aboriginal and Torres Strait Islander communities. An early intervention initiative like this can prevent tooth decay, pain, cavities, fillings and extractions. Likewise, it can also prevent the negative social impacts that stem from poor oral health. Missing teeth, bad breath and unsightly stains invariably affect social interaction and economic wellbeing. It’s hard to smile or get a job if you have no front teeth.

“All indications are that this new program will be a great success,” says McKee. “We need to thank the Loddon Mallee Aboriginal Reference Group for being the driving force behind this scheme. Every barrier they came up against was just another challenge to be overcome. They refused to give up. It was a fantastic effort on their part.” 

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