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Deadly Teeth Promoting oral health in Gunditjmara Country Project Report (Phase 1) May 2012 Artist: Daniel Joseph
Deadly Teeth Promoting oral health in Gunditjmara Country
Project Report (Phase 1) May 2012
Artist: Daniel Joseph
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Contents
Acknowledgements .................................................................................................................... 3
............................................................................................................................................... 4
Executive Summary ................................................................................................................... 4
............................................................................................................................................... 5
Introduction ............................................................................................................................. 5
Gunditjmara Country ..................................................................................................................... 5
Deadly Teeth: ........................................................................................................................... 6
The beginning ........................................................................................................................... 7
Literature review ....................................................................................................................... 7
Values and Principles ................................................................................................................. 9
Deadly culture ........................................................................................................................ 10
Strategies .............................................................................................................................. 10
The tip sheet yarn ................................................................................................................... 11
Design ................................................................................................................................... 12
Eat well Tip card for Families ......................................................................................................... 12
Drink well Tip Card for Families ...................................................................................................... 12
Clean well Tip Card for Families ...................................................................................................... 13
Promotion .............................................................................................................................. 13
Distribution ............................................................................................................................ 14
Pre survey results ................................................................................................................... 16
Post survey results .................................................................................................................. 17
Future direction and additional support ...................................................................................... 18
Consultations ............................................................................................................................ 20
Rationale: The importance of good oral health .................................................................................... 22
Planning and policy context ...................................................................................................... 24
The determinants of oral health ................................................................................................ 25
Oral health inequality .............................................................................................................. 26
Oral health status .................................................................................................................... 28
References ............................................................................................................................. 30
Appendix ................................................................................................................................ 32
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Table 1 project values and principles ........................................................................................... 9
Figure 1 Gunditjmara language groups, dialects and locations .................................................................. 6
Figure 2 Distribution map ......................................................................................................... 15
Figure 3. Resources currently used ............................................................................................ 17
Figure 4. Current resources cultural appropriateness ................................................................... 17
Figure 5 The impact of oral disease ........................................................................................... 24
Figure 6 Determinants of oral health .............................................................................................. 26
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Acknowledgements
The Deadly Teeth Tip Cards for Families and the three acrylic art pieces where three years in the
making (2008- 2011). Thanks go to the children, Elders and community health staff of
Winda-Mara Aboriginal Corporation who worked on phase one of the “Deadly teeth” initiative.
Special acknowledgment must go to Melissa Lillyst who initiated the pilot project in partnership
with the Health Promotion Unit at Portland District Health. To the fantastic artist Daniel Joseph
who brought all the ideas to canvas through his imagination and creative ability.
Recognition needs to be given to Michael Bell, Dianne Bell, Daryl Rose, Ros Pevitt and Tanya Geier
from Winda-Mara Aboriginal Corporation for the collaborative efforts on the easy to read
information contained in the tip sheets. Professional support from local graphic designer Damon
Yuill and the Program Print Company resulted in pulling together the final set of eye catching
resources.
Thanks is extended to the Health Promotion Unit at Portland District Health; Lynda Smith, Kristy
De Rose, Carol Stewart and Rachael Moore, and also to Dental Health Services Victoria for their
foresight in supporting what started as a small Smiles4Miles extension project in 2008.
With thanks,
Michael Bell Lynda Smith
Chief Executive Officer Health Promotion Officer
Winda Mara Aboriginal Corporation Portland District Health
Heywood, Victoria Portland, Victoria
A note on language:
The term ‘Aboriginal’ when used in this document should be read as meaning Aboriginal and Torres Strait Islander people.
The term ‘Indigenous peoples’ is used where material is drawn from the international context. Personal stories use the language of the storyteller.
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Executive Summary
The “Deadly Teeth” initiative is a partnership between Winda-Mara Aboriginal Corporation and the
Health Promotion Unit at Portland District Health (“Deadly” meaning good). It is currently a work
in progress and aims to address oral health as a “holistic concept” focusing on oral hygiene,
nutritional intake, oral health literacy and access to dental services. It aims to provide a culturally
appropriate health promotion initiative for Families with children between the ages of 0-5 years.
The project originated as an extension project of Dental Health Services Victoria’s Smiles4Miles
oral health project in 2008.
It is hoped that a myriad of resources will be created or identified and used to improve knowledge
and empower the community to take control over the issues which determine their oral health.
Phase one of the project has been launched and consists of a set of three culturally appropriate
Family tip sheets. Phase two is underway and aims to develop lay oral health promotion training
for Indigenous community health workers. The training is based on the newly released nationally
recognised Australian Government Department of Education, Employment and Workplace
Relations oral health units of competency which include:
o Recognise and respond to signs and symptoms that may indicate oral health issues
o Support clients and groups to learn practical aspects of oral health care
o Use basic oral health screening tools
o Work effectively with Aboriginal and/or Torres Strait Islander people
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Introduction
Oral health is a vital part of general health and wellbeing and has a significant effect on quality of
life. Dental health problems have persisted as a significant issue for Aboriginal children and young
people in Victoria1. The Deadly Teeth oral health promotion initiative has been established to
improve the oral health of children aged up to five years and their parents, carers and families
who live in Gunditjmara country, South West Victoria, Australia. The initiative is driven by
Aboriginal Health Workers at Winda-Mara Aboriginal Corporation with support from the Health
Promotion Unit at Portland District Health.
This project report will outline the context for oral health promotion in Victoria and the strategies
that were adopted during phase one of the Deadly Teeth initiative: partnership and resource
development. Firstly the Focus was to strengthen the relationship between Winda-Mara Aboriginal
Corporation and Portland District Health through the development of a set of three culturally
appropriate Tip Cards for Families. These resources will be used to spread deadly messages to
promote oral health.
Community consultation, participation and ownership have been a key approach during the
creation of the Deadly Teeth Tip Cards for Families. The project report will conclude with
recommendations to further develop the Deadly Teeth oral health promotion initiative.
Gunditjmara Country
Winda-Mara Aboriginal Corporation is located in the small town of Heywood, South West Victoria.
It provides a broad range of services to the local Aboriginal communities in and around the far
south west Victorian towns of Heywood and Portland in the Glenelg Shire and Hamilton in the
Southern Grampians Shire. These areas are located within Gunditjmara country spanning the
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Dhauwurd Wurrung and Djab Wurrung language groups with ancestral stories stretching back
more than 30,000 years1
Figure 1 Gunditjmara language groups, dialects and locations
(Victorian Aboriginal Corporation for Languages 2011)
According to data from the Australian Bureau of Statistics Census of Population and Housing in
2006 a total of 482 persons in the Southern Grampians & Glenelg catchment self-identified as
Aboriginal or Torres Strait Islander people, 370 in Glenelg Shire (1.9% of total persons in the local
government area) and 112 in the Southern Grampians Shire (0.7% of total persons in the local
government area). This includes Aboriginal and Torres Strait Islander people with Gunditjmara
heritage and Indigenous people with heritage from all areas of Australia. In 2006 almost 60% of
Aboriginal people were aged 25 years or less compared to about 30% of non-Indigenous people
in the Southern Grampians and Glenelg catchment areas.
Deadly Teeth:
Children are dependent on parents and Family to support their oral health. Inadequate access to
culturally appropriate oral health information, resources, services and oral health literacy limits the
ability of Family to care for their children’s overall health needs.
Healthy messages delivered to parents of a new born child have the potential to be adopted by
the rest of the Family. The earlier positive health messages can be introduced the more likely
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there is to be success. Good oral health habits can never be started too early and the messages
being delivered to children have the potential to be adopted by the rest of the Family.
Winda-Mara Aboriginal Corporation is a health and cultural service for the local Gunditjmara
people. The links between the Gunditjmara people and their land, community and spirit is
fundamental to health. Paying recognition and consideration to these connections is vital to all
local health promotion initiatives. The “Deadly Teeth” health promotion initiative aims to generate
messages that are stimulating, enjoyable and effective.
The beginning
In 2008, the Early Childhood Coordinator from Winda-Mara Aboriginal Corporation and a Health
Promotion Officer at Portland District Health discussed the possibility of running a pilot
Smiles4Miles oral health promotion program from Dental Health Services Victoria within the
three local Indigenous playgroups in Heywood, Portland and Hamilton. They quickly realised there
was a lack of culturally appropriate resources available to promote oral health. A coordinated
approach was then taken to workshop with children, adults, Elders and local artist Daniel Joseph
who produced three acrylic canvas paintings depicting key oral health messages for Family tip
cards. The result was the ‘Wellbeing Fella’ eating well, drinking well and brushing well.
A Portland District Health Promotion Officer and Post Graduate in Health Promotion student at
University of Sunshine Coast commenced a “Deadly Teeth” Strategy Literature Review to critically
investigate and examine oral health promotion programs used to address indigenous, rural and
remote oral health issues in children 0-5 globally. The findings would be reflected upon to further
support, develop and influence the “Deadly teeth” initiative.
Literature review
A strategy literature review produced an evaluative document on information presented in peer
reviewed articles and journals focussing on oral health promotion programs aimed at addressing
and supporting oral health issues in indigenous children 0-five years.
The selection criteria for reviewed documents were: nutrition, oral health education of children
and family and water fluoridation. The review found that:
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o Inadequate access to dental resources, oral health services and oral health care knowledge
limits the ability for families to care for their children’s overall oral health needs2.
o Poor practice in regards to infant bottle feeding habits and the use of pacifiers combined
with the belief of some parents that primary teeth do not matter3, further impinges on
children’s reduced oral health.
o Children have a high dependency on parents and family to support their oral health needs3.
Education of children alone will not result in a sustainable decline in risk behaviours.
However, the earlier the interventions can be initiated the more likely you are of success.4
o One off programs with a setting based approach will not result in continual health for life
behaviours2.
Strategies worth considering include regular group and 1:1 education sessions, culturally
appropriate services and staff, consideration of lay oral health promotion workers, video and
media supports as well as policy development and water fluoridation advocacy and early years
settings and supports with health promotion programs.
It is imperative that oral health promotion is based on sound theoretical background. Working in
mutual partnerships with Elders, appropriate professionals and agencies results in a health
promotion initiatives based on the social determinants of health.5
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Values and Principles
Based on the Red Lotus Health Promotion Model6 the following table explains the reasoning behind the study.
Table 1 project values and principles
Six Values and Principles of Modern Health Promotion supporting the “Deadly Teeth” initiative.
Value Principle of modern health
promotion
How
Philosophical
Ecological science
Using the science of ecology, which recognises that:
. People exist in multiple ecosystems, from the individual level, to the family group, community and population level
. All parts within systems impact on each other; the whole of any system is greater than the sum of the parts.
Recognition and consideration of the connection which indigenous peoples have with their land, people and spirit.
Holistic health
paradigm
Seeing health as a complex concept that includes physical, mental, spiritual and social aspects of wellbeing that relate to the whole person
Considering all aspects affecting children’s overall oral health and wellbeing.
Ethical
Focus of health
promotion determined
by equity
Prioritising work with people and communities that are most marginalised, vulnerable, disadvantaged and often regarded as ‘hard to reach’ based on
considerations of equity
Within the Glenelg Shire the indigenous population (according to Australian Bureau of Statistics in 2006) was 1.9%.
Active participation
of people impacted by the issue
Ensuring that the people most impacted by an issue are an integral part of all components of a health promotion change process that addresses the issue
Working in partnership with Winda-Mara and Dhauwurd-Wurrung Aboriginal community health services.
Technical
Portfolio of multiple
strategies
Using a portfolio of strategies incorporating all action areas of the Ottawa Charter.
Advocating for Healthy Public Policy, whilst working towards creating supportive environments by strengthening community action and developing personal skills whilst pressing to reorientate health services
Collaborative
governance and
decision making
Using models of governance and decision making that facilitate active and meaningful participation by all stakeholders
Collaborative partnership appreciating all participants’ skills, knowledge and input.
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Deadly culture
Communities are complex and interrelated. The links between the Gunditjmara people and their
land, community and spirit is fundamental to health. Paying recognition and consideration to these
connections is vital to all local health promotion initiatives. The “Deadly Teeth” health promotion
initiative aims to generate messages that are stimulating, enjoyable and effective.
Collaborative governance and decision-making is ensured through a partnership between the
Health Promotion Unit at Portland District Health & Winda-Mara Aboriginal Corporation with
opportunities in the future to also work with Dhauwurd Wurrung Elderly & Community Health
Services.
Strategies
A portfolio of multiple strategies was selected to address the action areas of the World Health
Organisation’s Ottawa Charter for Health Promotion.
Creating Supportive environments
• Family tip cards designed for Indigenous Families by Indigenous Families, painted by a local
Indigenous artist
• Video and media supports
• Advocacy for the inclusion of fluoride into the community water supply where fluoridation does
not happen naturally
Developing personal skills
• Oral health education sessions for parents and Family held at Maternal Child Health centres and
Indigenous health services when children are attending immunisation sessions
Building public policy and reorienting health services
• Policy development at local Indigenous playgroups, early childhood settings and preschools. This
will support nutritious food consumption and tap water or plain milk as the preferred drink for
children attending these services
• Advocate for the inclusion of all dental services to be covered by Medicare
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• Cultural training for staff at non-Indigenous controlled health services and consideration of oral
health promotion workers
Strengthening community action
• Oral health working party established with representatives of health, government and
Indigenous controlled organisations in Gunditjmara country
• Collaboratively advocate for the production of Indigenous specific oral health promotion
programs and resources
The tip sheet yarn
In June 2011 Aboriginal Health Workers at Winda-Mara Aboriginal Corporation commenced
spreading deadly messages to promote oral health, with support from the Health Promotion Unit
at Portland District Health. The first process in the “Deadly Teeth” health promotion initiative was
to produce a set of three colourful, culturally appropriate Tip Cards for Families promoting oral
health for children aged up to five years, their parents and Families. The resources were officially
launched at Winda-Mara on Wednesday 06th July 2011, during NAIDOC week celebrations.
The Tip Cards for Families promote three key oral health messages. The ‘Eat well’ tip card
promotes healthy eating behaviours because ‘deadly teeth need good foods’. The ‘Drink well’ tip
card highlights the importance of drinking tap water and avoiding ‘bad drinks that rot your teeth’.
The ‘Clean well’ tip card reminds children and families that ‘deadly teeth need good care’ and
encourages regular tooth brushing habits.
In 2008 Winda-Mara Aboriginal Corporation worked in partnership with the Health Promotion
Team at Portland District Health and Dental Health Services Victoria to pilot the
Smiles4Miles oral health program in three local Indigenous playgroup sites. The program
workers soon realised that there were no culturally appropriate oral health promotion resources
for the local Indigenous community.
In response, four oral health art workshops were held at Winda-Mara Aboriginal Corporation in
Heywood. These were attended by children, Families, Elders, Aboriginal Health Workers, a local
artist and the Smiles4Miles project worker from Portland District Health.
Indigenous artist Dan Joseph attended the last workshop and became inspired by the children’s
thoughts and ideas. Using his talent created three acrylic paintings depicting key oral health
messages based on a Western diet.
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The three paintings would become the backdrop of the culturally appropriate oral health
resources.
The Tip Cards are designed for families with children up to 5 years old to improve oral health
knowledge and promote access to dental services.
The paintings feature an Indigenous “Wellbeing Fella” collecting bush foods, drinking water from a
stream and brushing his teeth. These were interpretations of the Smiles4Miles defenders of the
tooth characters Munch Girl, Water Boy and Brush Boy. The art work and copyright was
purchased from Daniel Joseph by Portland District Health in late 2009.
More workshops were held in the community to finalise the key messages using culturally
appropriate language and words that were easy to understand. For example, the use of the
words ‘deadly’ teeth is actually interpreted as meaning ‘good’ teeth in local Indigenous culture.
A graphic designer was then employed to put together all the ideas gathered from the
community.
Design
Eat well Tip card for Families
Based on a Western diet key messages state that deadly teeth need good foods and help from
Family; this includes making foods choices that are:
• Low in sugar and acid
• High in fresh fruit and vegetables
• Low in processed/packaged foods
• Low in take-away/fast-food.
Drink well Tip Card for Families
Deadly teeth need good drinks, this includes drinking:
• Plenty of tap water
• Plain milk
Don’t have drinks that are high in sugar, like soft drink, fruit drinks, and cordials.
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Clean well Tip Card for Families
Deadly teeth need good care: this includes:
• Oral hygiene
• Brushing twice a day and flossing
• Visiting the dentist every year.
Launch
The ‘Deadly Teeth’ Tip Cards for Families were officially launched at Winda -Mara in July
2011, during NAIDOC week celebrations and at a Victorian Aboriginal Controlled Community
Health Organisation (VACCHO) state wide community members meeting in Mildura.
Promotion
The resources and partnership between Winda- Mara Aboriginal Corporation and Portland District
Health was presented at the 2010 International Arts & Health Conference in Melbourne and at a
Community Capacity Building Workshop in Camperdown, Victoria as part of the Deakin University,
Department of Health and the Department of Human Services Strategic Alliance program in March
2011.
During June 2011 a media release was developed, distributed and subsequently published in:
•VACCHO News Winter edition 2011
•Aboriginal & Islander Health Worker Journal July/ August 2011, volume 35- number 4.
•Koori Mail, The voice of Indigenous Australia, Wednesday 10th August 2011
•Deadly VIBE magazine number 175, September 2011
•Australian Indigenous HealthInfoNet website:
http://www.healthinfonet.ecu.edu.au/key-resources/promotion-resources?lid=21676
•SNAICC e-Bulletin (Secretariat of National Aboriginal and Islander Child Care)
• 2011 Christmas edition of Health Matters quarterly magazine produced by the Victorian
HealthCare Association.
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In October 2011 the Deadly Teeth Family Tip sheets initiative was one of three finalists in the
2011 Victorian Public Healthcare Awards under the Health Leaders: Secretary's Award for
improving the health & wellbeing of Aboriginal people.
Distribution
Unintended consequences
As of March 2012 orders have been placed by 6 agencies in the local district (Gunditjmara
Country). Including: Winda-Mara Aboriginal Corporation in Heywood, Portland District Health,
Dhauwurd-Wurrung Elderly and Community Health Service in Portland, Western District Health
Service in Hamilton, South West Health Care in Warrnambool; and Kirrae Health Service in
Purnim.
Orders from agencies across Victoria as of March 2012 came from: The Aboriginal Community
Development Unit at Dental Health Services Victoria in Melbourne (x 2), Gippsland & East
Aboriginal Co-Operative Dental Clinic in Bairnsdale; Budja Budja Aboriginal Co-operative in
Stawell, Healesville Indigenous Community Services Association, Rangers Community Health,
Lilydale, Knox Community Health Service, Ferntree Gully and East Gippsland Primary Care
Partnership Bairnsdale.
Orders have also been placed from agencies across Australia, including: Indigenous Professional
Support Unit, Yorganop- Western Australia, Walgett Aboriginal Medical Service, Rumbalara Dental
Clinic, Mooroopna and Blue Mountain Aboriginal “Healthy For Life” Program, Hazelbrook- New
South Wales, Flinders Island Aboriginal Association Incorporated- Tasmania and Bundaberg Youth
Justice Service, Bundaberg -Queensland.
Inquiries have also been received from the Northern Territory and South Australia.
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Figure 2 Distribution map
Locally:
Nationally:
Warrnambool Melbourne (VIC) Ferntree Gully (Vic) Hazelbrook (NSW)
Heywood Gippsland (VIC) Mildura (Vic) Flinders Island (TAS)
Portland Stawell (VIC) Yorganop (WA) Bundaberg (Qld)
Purnim Healesville (Vic) Walgett (NSW)
Hamilton Lilydale (Vic) Mooroopna (NSW)
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Pre survey results
Pre surveys were completed over the phone by all services that accessed/ purchased the “Deadly
Teeth” Family tip sheets.
Results show that out of the 17 services who have ordered the resources ten currently use some
type of oral health promotion materials and seven services did not. Of the ten that did, only two
services felt that the resources were culturally appropriate with one organisation stating that
“They are now as we had to make our own”.
When asked how the services will use the resources the following comments were made:
“Show bags for Indigenous hospital patients. Close the Gap workers and Health Promotion
Officers will regularly use”
“Co-op dental unit for patients, Health Promotion Days, dental packs and playgroup”
“To support early education and intervention for Indigenous children”
“Include with annual health screening initiatives -Dental check
list- Parent education resource on how to brush etc.”
“Place resource on line for others to access- Oral Health
Promotion. Health Promotion resource section -The number of
overall page-views the AIH website received in the period 1
may – 31 July was 551,707. This translated into 159,300 visits
to the website. As for health promotion resource pages, there
were 53,456 page-views, and 17,508 visits”
“Provide as a resource for a large indigenous population Boori
playgroup, children and health check days”
“Preschools, chronic and complex disease- engaging with
community: Child and family health, working with the Primary
health care sites, GP’s, early childhood services, Child and
Family Health Nurse and a Community health centre,
Workshops for family”
“Promote culturally specific and Vic resources at assessment sessions with Budja Budja
Community”
Photo: Michael Bell CEO at Winda-Mara Aboriginal Corporation with Health Practice Manager Janice Huggers at the launch of the ‘Deadly Teeth’ Tip Cards, June 20011.
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“Mums and bub’s playgroup- parent work groups, health newsletter, child and maternal child
health nurse once per month tooth brushing demo’s, visiting GP service”
“Patience, outreach days- Health Promotion, celebration days”
Figure 3. Resources currently used
Is your organisation currently using any resources
to promote oral health in children 0-5 years?
[Note: Total of 17 services completed the survey]
Figure 4. Current resources cultural
appropriateness
Do you feel these resources are currently culturally
appropriate?
[Note: Total of 17 services completed the survey]
Post survey results
Post surveys were carried out in April 2012. Of the eight post surveys returned 100% of services
believed that the resources were culturally appropriate, would order the resources again and
recommend them to others.
How have resources been used?
The resources had been used for; Community days, have been made available on information stands,
handed out during children’s health assessment, made available at women’s health days to share with
family, used at playgroups, festivals, and the ICACC Gathering event in Knox, Victoria
and given to parent’s at dental clinics.
They were also included in Closing the Gap information packs and show bags for various health days.
Yes
NoYes
No
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“I am invited to attend health days in both metro and regional areas and take the resources with
me, people love them- the art work, they always comment about how great it is”- Jacqueline
Watkins, Aboriginal Community Development Worker, Dental Health Services Victoria.
What has your client response been to the resources?
“Client’s really like the colours and the pictures” – Health worker, Healesville Indigenous Community
Services Association.
“Loved them, art work great, parents happy with the easy straight forward information- easy to
understand literature”. - Practice nurse, Dhauwurd-Wurrung Elderly & Community Health Service.
“The community have commented that they are very culturally appropriate”- Knox Community
Health Service.
How could we improve the resources?
The following suggestions were made as to how we could improve the resource.
� Follow up poster of each of the themes with short captions under them
� Tooth brushes with the designs on them
� A timer for children to brush their teeth with the art work on it
� Stickers with the characters.
� Maybe pocket size tip sheets
� How to brush your teeth tip card
� Maybe changing the colours to make the differences more noticeable?
Future direction and additional support
Since the development of the ‘Deadly Teeth’ Tip Cards for Families; Winda- Mara has hosted a
dental clinic day for 25 community members at their Heywood centre with support from the
Portland District Health Dental Clinic. This has now become an annual event and talks are
currently underway to run a similar clinic at Dhauwurd-Wurrung Elderly & Community Health
Service in Portland.
Winda Mara and Portland District Health have commenced conversations with Dental Health
Services Victoria to create lay oral health training for on the ground Aboriginal Health Workers.
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Winda Mara and Portland District Health also plan to promote the uptake of the new nationally
recognised Australian Government Department of Education, Employment and Workplace
Relations oral health units of competency to registered training organisations such as South West
TAFE and VACCHO. These include:
o CHCOHC404A Recognise and respond to signs and symptoms that may indicate oral
health issues
o CHCOHC402A Support clients and groups to learn practical aspects of oral health care
o CHCOHC303A Use basic oral health screening tools
o HLTHIR404D Work effectively with Aboriginal and/or Torres Strait Islander people
In late October the “Deadly teeth” initiative was announced as one of the three finalists in the
Victorian Public Health Care Awards 2011 recognising the two health services partnership in the
Secretary's Award for improving the health & wellbeing of Aboriginal people.
The Family tip sheets are the first step towards developing a holistic oral health promotion
program focusing on the social determinants of health - the conditions, in which we are born, live,
grow and work, including the health system! Which are mostly responsible for health inequalities –
unfair and avoidable differences7.
A portfolio of multiple strategies has been selected to address the action areas of the World
Health Organisation’s Ottawa Charter for Health Promotion. To further enhance the “Deadly
Teeth” Oral health Promotion Initiative by:
Creating Supportive environments
These include the Family tip cards designed for Indigenous Families by Indigenous Families,
painted by a local Indigenous artist. Other strategies to be developed may include: video and
media supports, advocacy for the inclusion of fluoride into the community water supply where
fluoridation does not happen naturally.
Developing personal skills
Oral health education sessions for parents and Family.
Building public policy and reorienting health services
Policy development at local Indigenous playgroups, early childhood settings and preschools, and
Indigenous health services. This will support nutritious food consumption and tap water or plain
milk as the preferred drink for children/ Families attending these services, advocate for the
P a g e | 20
inclusion of all dental services to be covered by Medicare, local cultural training for staff at non-
Indigenous controlled health services, Lay oral health training with a strong health promotion
focus for Indigenous health workers.
Strengthening community action
Oral health working party established with representatives of health, government and Indigenous
controlled organisations in Gunditjmara country. Collaboratively advocate for the production of
Indigenous specific oral health promotion programs and resources.
Consultations
In November 2011 the Deadly teeth working party was invited to speak at the ICAPS state wide
forum Aboriginal Hospital Liaison Officers (AHLO) in Torquay, Victoria. After providing an
overview of the Deadly Teeth initiative a brain storming session was held. Valuable information
from workers from across the state was gathered in relation to their thoughts on further
development of the initiative – their input was greatly appreciated.
Policy, planning & funding
• Philanthropic donations from dentists/cosmetic mainstream dentists
• Donated time by mainstream dentists
• Policy – allow Aboriginal people involved in the process of creating Tip Sheets to have
ownership over program
• Help plan events to promote service
• Attend the next ‘Deadly in Gippsland Conference’ which will be in 2013 in East Gippsland.
Heaps of funding bodies attend and are always looking to help fund projects that benefit
community (or look for a conference similar to that in Melbourne)
• Need to do partnership policy and planning with Victorian Aboriginal Health Service (VAHS)
and Victorian Aboriginal Community Controlled Health Organisation (VACCHO). Maybe also on
a state-wide level of policy
• Traineeships leading to future employment for Aboriginal dental assistants
• Develop an MOU between hospitals and local co-cops/AMS around servicing local Indigenous
people. Could involve a day per month, for example, just for Koori patients
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Education, knowledge & skills to promote oral health
• Encouraging children to clean teeth
• Preventative approach to dental care
• Too many myths, i.e. chewing gum
• More education on baby teeth
• Food and smoking
• Sugar content in toothpaste
• Family consultations
• Young children requiring braces need a second option
• Involve Aboriginal Hospital Liaison Officer (AHLO)/Aboriginal Health Worker (AHW)
• Parent to teach children about brushing teeth
• Oral health during pregnancy
• Oral health checks at Child Care Centres. Continue to school
• Finance/Training dollars
• Promoted through health checks
• Promoted through VACCHO
• Orthodontics
• Barrier for prisoners – don’t have access to oral health care
• Oral health should be included in Tucker Talk Tips (VACCHO)
• Health Worker training for Dental
• Family Education
• Link to traffic light messages
• More pamphlets
• Health workers to promote oral health
• Link in with Wannik KESO’s to get knowledge to students at schools
Culturally appropriate oral health resources
• Need to have Aboriginal and Torres Strait Islander flag visually on the tip sheets
• Network and work with VAHS Dental Service and ACCHOs
• Place to add local details
• Posters, business cards – promote service
• School dental services program and health care card holders
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• Breast feeding – introduction to bottles (what’s in the feeding bottle?)
• Your child and removal of primary teeth (general anaesthetic)
• Education pack
• Graphic images
• How to’s
• Why it is important
• Language ,communication (effective, local vernacular)
• Where to access
• Regional relevance
• Early education – young ones and carers
• Family-wide targeting
• Give-aways
Access to dental care
• Transport
• Knowing who to contact and how
• Cost (affordability for non HCC holders)
• Distance
• Time
• More culturally accessible dental clinics across Victoria
• Enabling access for Aboriginal families to dental clinics where there is not an Aboriginal
Dental Clinic
• Promotion through Aboriginal Health Workers
• Promotion in schools through Aboriginal Education Workers
Rationale: The importance of good oral health
High-quality oral health is a requirement for physical and psychological health and wellbeing8 and
comfortable participation in everyday activities9. It enables us to chew, swallow, sleep, speak, and
socialise without active disease, embarrassment, pain and discomfort10. Oral diseases not only
affect the mouth. They have been associated with cardiovascular diseases (8), diabetes (9), stroke
(10) and pre-term low birth weight.9 (11) Poor oral health can therefore have significant impacts
on general health and wellbeing and quality of life. Other impacts of oral disease include the
economic costs of dental treatment to the individual and to the broader health system11.
P a g e | 23
Maintaining oral health and dental intervention also has significant financial impacts. Dental caries
(tooth decay) has been identified as the second most costly diet-related disease in Australia The
economic impacts of dental decay have been compared to that of heart disease and diabetes12.
From 2001-02 dental decay cost Australia 5.4 % of total health expenditure13.
Good oral health behaviours learned in childhood can be translated to adulthood. Self-care
practices are an important component of establishing good oral health behaviours, including
brushing teeth13.
Fortunately most oral health conditions, such as caries and periodontal disease, are largely
preventable and if treated early can be reversed and cured.
Dental caries (decay) are largely preventable but many go untreated resulting in dental decay
being the highest preventable hospital admission for children. Dental treatment accounted for
6.2% of Australia’s total health expenditure in 2007-0814 . That equates to approximately 6.1
billion dollars!
‘Prevention is the cheapest, easiest, least invasive, and most appropriate ‘treatment’ option 9.
Increased policy and interventions aimed at the prevention of dental caries would be cost
beneficial.
P a g e | 24
Figure 5 The impact of oral disease
(Department of Human Services: Improving Victoria’s oral health 2007:9 (DHS 1999 cited in NACOH 2001 p. 5)
Planning and policy context
Australia’s National Oral Health Plan 2004-2013 Healthy Mouths Healthy Lives states that ‘oral
health promotion should be part of health promotion plans at local, state and territory, and
national levels’ (p. 17). Aboriginal and Torres Strait Islander people have been identified as one
population group out of seven interrelated areas for action within an overarching population
health framework in the national plan.
Portland District Health identified oral health as one of three health promotion priority areas for its
agency Integrated Health Promotion plan 2009-2012. The Southern Grampians and Glenelg
Primary Care Partnership also identified oral health as one of five health promotion priority areas
for the Primary Care Partnership Integrated HP catchment plan, 2009-201215. Portland District
Health & SGG PCP were appointed as co-lead agents for this joint priority area, with the
P a g e | 25
understanding that Portland District Health would focus on oral health promotion in the Glenelg
Shire, and SGG PCP would focus on water fluoridation in the Southern Grampians Shire.
Oral health is not specifically mentioned as a health promotion and prevention action in the
Barwon South Western Closing the Health Gap Plan 2009-13, as a key area for primary health
care in the Victorian Aboriginal Health Plan 2009 or in the health promotion framework for
Victorian Aboriginal communities presented in the Life is health is life, Taking action to close the
gap document16. However, since the recent release of the Evidence-Based Oral Health Promotion
Resource14 by the Victorian Government Department of Health, the profile of oral health
promotion has started to rise and reach the policy and planning arena. With the aim of keeping
people well through focusing on lifestyle-related risk and protective factors, the Victorian Public
Health and Wellbeing Plan 2011-2015 has identified improving oral health as one of nine public
health priority issues for promoting the health of Victorians.
The determinants of oral health
The wide range of determinants of oral health, including risk and protective factors are presented
in Figure six. The determinants of oral health includes the economic, political, social and physical
environmental conditions in which people are born, live, grow and work, as well as personal
factors such as individual health behaviours and the systems in place to deal with oral disease17.
These circumstances are mostly responsible for oral health inequalities – unfair and avoidable
differences in health status.
P a g e | 26
Figure 6 Determinants of oral health
(Watt and Fuller, p31 cited in Rogers 2011)
The social determinants of Indigenous health18 also specifically include cultural and spiritual
factors, family and community connections, connection to country, freedom from race-based
discrimination and the historical context of land dispossession, the stolen generation, social
exclusion, legislations and policies of protection and assimilation. By understanding and
addressing the social determinants of Indigenous health the Aboriginal concept of health is
recognised and includes the social, emotional and cultural well-being of the whole community, not
just physical well-being, through a whole-of-live view and the cyclical concept of life-death-life16.
Oral health inequality
In a recent evidence-based review Rogers explains that oral disease and oral hygiene
behaviours is often associated with socio-economic disadvantage14. Care must be
taken when making these assumptions as population data may not properly
distinguish between Indigenous people living in urban, rural or remote environments
and areas with low population density and low proportions of Indigenous people.
However, this may indicate an association between poorer oral health status for
Indigenous Australians and social and economic disadvantage.
P a g e | 27
Risk and protective factors
The major behavioural risk factors for oral disease include tobacco smoking, dietary intake high in
sugar, acid and alcohol, injuries, poor oral hygiene and timely visits to professional dental care
services.14
Historically Aboriginal children were considered to have good oral health with little or no oral
disease18,14,19. Since the arrival of Europeans in Australian in 1788 lifestyle practices and the
dietary intake of many Indigenous Australians has changed dramatically9. Traditional diets high in
fibre and protein have been largely replaced with cariogenic foods that are rich in refined and
fermentable carbohydrates9 (sugary foods).
Gunditjmara people living in the Glenelg and Southern Grampians Shire may also have elevated
risk of poor dental health outcomes due to limited fluoridation levels in the public water supply.
Fluoridation is considered to be a cost-effective way of preventing dental decay9,19. Fluoridation of
water supplies varies, with fluoride occurring naturally in Portland’s water supply but not in other
major towns such as Heywood and Hamilton. Other areas may be reliant on tank water with no or
minimal fluoridation. These differences in levels of water fluoridation are generally implicated in
caries levels. Fluoridation has been nationally recommended for small rural communities to
prevent tooth decay12.
‘Poorer access to timely dental care resulting in either no care or care that is delayed until the
disease process has reached an advanced stage and tooth extraction is required’
o Access to culturally appropriate dental care9
o Annual community visits by school dental service (it is unclear when the last visit
was to the Southern Grampians & Glenelg catchment areas.)
The availability and affordability of dental services can also contribute to the poor oral health
outcomes for children18.
These obstacles include long waiting lists for health care card holders, access to public dental
services; excessive out of pocket costs for people on medium to low incomes and inadequate oral
health specialists available in rural and remote areas.19
P a g e | 28
Although it is vital to maintain routine oral hygiene behaviours to prevent tooth decay9 this was
not a traditional part of Indigenous lifestyles before European settlement. Appropriate oral health
care includes frequent tooth-brushing with fluoridated toothpaste.
A range of preventative factors contributes to oral health in childhood, including improved diet,
oral hygiene, regular brushing and water fluoridation20.
Oral health status
All the above factors have led to increased risk and prevalence of dental decay and disease for
Aboriginal and Torres Strait Islander people9.
‘Oral health problems faced by Indigenous peoples are worsening and
require practical long-term solutions’21
Oral health issues for Aboriginal children now exceed levels for the general population22,23. They
are more likely to have a higher prevalence and number of decayed teeth and tooth surfaces in
deciduous and permanent teeth at all ages (past and/or present) 24and an overall higher severity
of decay9. Aboriginal children aged 6 years have been found to have an average of 3.7 teeth with
caries compared to 1.5 teeth for their non-Indigenous counterparts23,25.
Indigenous children and adults have lower level of fillings, suggesting that service utilisation was
lower and proportion of untreated caries substantially higher9. They have a higher prevalence of
missing teeth and lower age pattern of hospitalisation for dental care and extraction25,9.
Although data sources are largely incomplete and are not nationally representative, smaller
geographical studies have found an average difference of twice the level of tooth decay (caries) in
both deciduous and permanent dentition and higher levels of untreated oral diseases compared to
non-Aboriginal children27,26 ,25,23,9.
There is no comprehensive statistical data on the oral health status of children in the Southern
Grampians & Glenelg catchment28. Data recorded under the School Dental Program uses very
small sample sizes of under 60 children per local government area29 and does not identify
Aboriginal status.
P a g e | 29
Dental conditions were rated in the top-ten Ambulatory Care Sensitive Conditions for the
catchment, with the 2nd and 3rd highest rates per 1000 persons for the Southern Grampians and
Glenelg Shires respectively15.
‘The recent Child Dental Health Survey showed that dental caries experienced in Aboriginal
children in consistently higher, in on the rise and more extensive destruction of deciduous teeth
occurs when compared to non-Aboriginal children.
In 2010 the Victorian Department of Education and Early Childhood Development released a
report on the health of Aboriginal Children in Victoria It stated that 38% of Aboriginal children
aged 0-14yrs have teeth & gum problems, only 39% brush twice a day or more and 30% have
never visited a dentist30.
P a g e | 30
References
1 Weir JK. The Gunditjmara land justice story. Canberra; Native Title Research Unit, Australian Institute of Aboriginal and Torres Strait Islander
Studies: 2009.
2 Oral health comparisons between children attending an Aboriginal health service and a Government school dental service in a regional location.
EJ Parker, LM Jamieson. University of Adelaide School of Dentistry Published 02 May 2007 available from: http://www.rrh.org.au
3 A brief review of indigenous Australian health as it impacts on oral health Nicole martin-Iverson, Andrea Phatouros, Marc Tennant, Australian
Dental Journal 1999; 44(2):88-92
4 Indigenous Australian dental health: A brief review of caries experience. Nicole martin-Iverson, Tom Pacza, Andrea Phatouros, Marc Tennant
Australian Dental Journal 2000; 45 ;( 1): 17-20
5 Dental self-care and dietary characteristics of remote-living Indigenous children.4 LM Jamieson, RS Bailie, M Beneforti, CR Coster, AJ Spencer.
Australian Research Centre for population oral health, The University of Adelaide,
6 Red Lotus Health Promotion Model Values and Principles Lilly O’Hara and Jane Gregg]
7 World Health Organisation
8 National Advisory Committee on Oral Health. Healthy mouths healthy lives: Australia’s National Oral Health Plan 2004-2013. Adelaide: Australian
Health Ministers’ Conference and Government of South Australia.
9 Williams S, Jamieson L, MacRae A, Gray C. Review of Indigenous Oral Health. Australian Indigenous HealthReviews No. 7 April 2011. Australian
Indigenous HealthInfoNet.
10 Commission on Social Determinants of Health. Closing the gap in a generation: Health equity through action on the social determinants of
health. Geneva; World Health Organisation: 2008.
11 Victorian Government Department of Human Services (DHS). Improving Victoria’s oral health. Melbourne; DHS: 2007.
12 Commonwealth Department of Health and Ageing. National Aboriginal and Torres Strait Islander Oral Health Workshop Report. Canberra;
Commonwealth Department of Health and Ageing: 2003.
13 Australian Institute of Health & Welfare (AIHW), Dental Statistics and Research Unit, Jamieson L, Armfield J, Roberts-Thomson 2007. Oral health
of Aboriginal and Torres Strait Islander children, Dental Statistics and Research Series No. 35. AIHW Cat. No. DEN 167. Canberra; AIHW: 2007.
14 Rogers JG. Evidence-based oral health promotion resource. Melbourne; Prevention and Population Health Branch, Government of Victoria,
Department of Health: 2011.
15 Southern Grampians and Glenelg Primary Care Partnership, Population Health and Wellbeing Report 2009
16 Victorian Health Promotion Foundation (VicHealth). Life is health is life. Taking action to close the gap. Victorian Aboriginal evidence-based
health promotion resource. Carlton: Victorian Government Department of Health and Vic Health: 2011.
17 Commission on Social Determinants of Health. Closing the gap in a generation: Health equity through action on the social determinants of
health. Geneva; World Health Organisation: 2008
18 Mungabareena Aboriginal Corporation and Women’s Health Goulburn North East (WHGNE). Using a health promotion framework with an
‘Aboriginal lens’. Making two works work. Wodonga; Mungabareena Aboriginal Corporation & WHGNE: 2008.
19 Jamieson LM, Armfield J, Roberts-Thomson KE. Oral health of Aboriginal and Torres Strait Islander children. Canberra; Australian Institute of
Health and Welfare: 2007.
19 Barrett MJ. Features of the Australian Aboriginal dentition. Dental Magazine and Oral Topics. 1968; 85:15-18.
P a g e | 31
20 Ehsani JP, Bailie R. Feasibility and costs of water fluoridation in remote Australian Aboriginal communities. BMC Public Health 2007;7….
21 Campbell TD. Food, food values and food habits of the Australian Aborigines in relation to their dental conditions. Part V. Dental tooth decay.
Australian Dental Journal 1939; 43:177-98.
22 Roberts-Thomson K. Oral health of Aboriginal Australians. Australian Dental Journal 2004; 49:151-3.
23 Roberts-Thomson KF, Spencer AJ, Jamieson LM. Oral health of Aboriginal and Torres Strait Islander Australians [Addressing Diseases of
Disadvantage – Editorial]. Medical Journal of Australia 2008; 188(10); 592-3
24 Brennan DS, Roberts-Thomson KF, Spencer AJ. Oral health of Indigenous adult public dental patients in Australia. Aust Dent J 2007; 52: 322-
328.
25 Jamieson LM, Armfield JM, Roberts-Thomson KF. Oral health of Aboriginal and Torres Strait Islander children. Canberra: Dental Statistics and
Research Unit, Australian Institute of Health and Welfare, 2007. (AIHW Cat. No. DEN 167; Dental Statistics and Research Series No. 35.)
26 Cooper MH, Schamschula RG, Craig GG. Caries experience of Aboriginal children in the Orana Region of New South Wales. Australian Dental
Journal 1987; 32:292-94.
27 Davies MJ, Spencer AJ, West, Water A, Simmons B. Dental caries among Australian Aboriginal, non-Aboriginal Australian-born, and overseas-
born children. Bulletin of the World Health Organisation 1997; 75:197-203.
28 Willder S, Nelson J, Gray R. Research advice by Professor Morgan M and Associate Professor Marino R Oct 2011.“Indigie Grins” Dental Health
Services project number 4/2010
29 Dental Health Services Victoria Clinical Analysis & Evaluation Unit cited in DHS 2009
30 Oral Health and Denticare National Health Reform: the VHA view February 2010
P a g e | 32
Appendix
Oral Health Family Tip Cards – Order Form
It is estimated that print runs will be 3oth September and 31st March each year
depending on demand.
Total cost of order: $..................
(Cost correct as of May 2012)
Name of Organisation:
Contact person:
Address:
Email:
Phone:
Please send order to:
Portland District Health
Health Promotion Unit
33 Otway Street, Portland, Victoria, 3305
Or email to: [email protected]
Phone enquiries: (03) 55221198
Your organisation will be emailed or faxed an invoice on receipt of your order.
Item name
Quantity Total cost
Drink Well
Family Tip Sheets
(min 100-$30.00)
Eat Well
Family Tip Sheets
(min 100-$30.00)
Brush Well
Family Tip Sheets
(min 100-$30.00)
(Includes
GST)
Card size: 10cm x 21cm
