Oral health services provided for Aboriginal and Torres Strait Islander peoples in Australia: a scoping review

Lisa Hai My Do; Yvonne Dimitropoulos; John Skinner; Woosung Sohn

doi:10.1071/AH24281

RESEARCH ARTICLE

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Oral health services provided for Aboriginal and Torres Strait Islander peoples in Australia: a scoping review

Lisa Hai My Do ^A ^* , Yvonne Dimitropoulos ^B , John Skinner ^C ^D and Woosung Sohn ^A

+ Author Affiliations

- Author Affiliations

^A The University of Sydney, School of Dentistry, Faculty of Medicine and Health, Camperdown, NSW, Australia.

^B HEAR CENTRE, Macquarie University, Macquarie Park, NSW, Australia.

^C Centre for Rural Dentistry and Oral Health, Charles Sturt University, Orange, NSW, Australia.

^D Department of Linguistics, Macquarie University, Macquarie Park, NSW, Australia.

^* Correspondence to: lido2817@uni.sydney.edu.au

Australian Health Review 49, AH24281 https://doi.org/10.1071/AH24281

Submitted: 15 October 2024 Accepted: 10 December 2024 Published: 13 January 2025

Abstract

Objective

The shortage of oral health professionals in rural and remote regions of Australia directly impacts the access to oral health services for people who live in these regions, including Aboriginal and Torres Strait Islander peoples. This scoping review aims to explore where and how these services are provided for Aboriginal and Torres Strait Islander peoples and the relevant workforce model used.

Methods

Electronic databases, including MEDLINE, EMBASE, Cochrane, and CINAHL, were searched. Grey literature searches included the Australian Indigenous HealthInfoNet webpage, Australian Institute of Health and Welfare, and Advanced Google search.

Results

Oral health services were classified into the following categories: (1) clinical oral health services, (2) oral health promotion to improve oral health awareness, knowledge, attitudes, behaviours, or skills at patient/community level, and (3) oral health promotion including the use of single clinical interventions (e.g. fluoride varnish). Services were delivered in a variety of settings including community health clinics and schools or using mobile dental equipment. Both the dental and non-dental workforce were utilised to provide these services. Limited data were found on the experiences and challenges faced by the workforce that provide these services.

Conclusion

Oral health services provided for Aboriginal and Torres Strait Islander peoples in rural and remote regions of Australia vary in service type, location, and workforce involved. Future research is required to explore the experiences and support of this workforce. This can enhance delivery of culturally and clinically safe oral health services for Aboriginal and Torres Strait Islander peoples, particularly in rural and remote regions.

Keywords: Aboriginal and Torres Strait Islander health, clinical services, dental health, health services, Indigenous health, oral health, rural and remote health, workforce.

Introduction

Access to dental care is difficult for many Australians, particularly people living in rural and remote locations.¹ According to the Australian Institute of Health and Welfare (AIHW), the majority of oral health practitioners are employed in major cities.² Studies found that Aboriginal and Torres Strait Islander peoples have a higher need for dental care with caries prevalent in 72% of Aboriginal children compared with 38% in non-Aboriginal children by the age of six.³^,⁴ As the proportion of Aboriginal and Torres Strait Islander residents increases with increased remoteness, the need for accessible oral health services (OHSs) for this population becomes more evident.³^,⁵

Despite efforts by state and federal governments, a shortage of both OHSs and practitioners in these locations remains.⁶^,⁷ Therefore, it is important to understand strategies to retain this workforce and continue providing care for Aboriginal and Torres Strait Islander peoples in rural and remote locations. The National Oral Health Plan 2015–2024,⁸ along with the NSW Aboriginal Oral Health Plan 2014–2020,⁹ Victoria’s Action Plan to Prevent Oral Diseases 2020–2030,¹⁰ the Aboriginal and Torres Strait Islander Oral Health Care in Queensland,¹¹ and the Aboriginal Oral Health Program in South Australia, improved access to culturally safe OHSs for Aboriginal and Torres Strait Islander peoples. Efforts to achieve this have strengthened the workforce, but the large disparity between employment in major cities and remote areas remains.

This scoping review aims to identify how and where OHSs are provided for Aboriginal and Torres Strait Islander peoples and to explore the workforce models used to deliver these services.

Methods

This review is registered with Figshare (see doi: 10.6084/m9.figshare.21162025) and guided by the Joanna Briggs Institute (JBI) methodology for scoping reviews.¹²

Search strategy

A three-step search strategy was applied as suggested by the JBI. Academic literature was searched in the following databases:

Ovid MEDLINE^®ALL (1946 to present)
Embase (1974 to present)
Cochrane Central Register of Controlled Trials (CENTRAL) (1991 to present)
CINAHL Complete.

The search strategy, including search terms, for Ovid MEDLINE was adapted for the remaining databases (Appendix 1).

Grey literature searches included the Australian Indigenous HealthInfoNet webpage, the AIHW webpage, and an Advanced Google Search. No restriction on publication year or type of evidence was applied.

Eligibility criteria

Literature describing a mode of OHS delivery and/or workforce used for Aboriginal and/or Torres Strait Islander peoples in Australia were considered eligible. No limitations were applied on age or gender. An OHS was defined as a program provided by an external organisation with or for a specific community(ies) with the aim of improving oral health outcomes for people within that community.¹³ This includes: (1) clinical oral health service delivery;¹⁴ (2) oral health promotion defined as attempts to improve knowledge, attitudes, behaviours, skills, or awareness of oral health at patient or community levels; and (3) oral health promotion including the use of single clinical interventions (e.g. fluoride varnish) to improve patient oral health outcomes.¹⁵ It was considered important to distinguish between oral health promotion programs that solely focus on improving knowledge and programs that improve oral health outcomes.¹⁶ Information extracted from selected articles included year, authors, location (state/territory and rural/metropolitan), aims/objectives, types of OHS, target population, and workforce model.

Articles yielded from each database were collated and duplicates removed. Titles and abstracts were screened independently by LD. Potential articles were retrieved in full and assessed against the inclusion criteria. LD consulted with other authors if clarification was needed for potential articles. Search results and inclusion process are presented in Fig. 1. LD extracted key information using an extraction tool based on the JBI tool¹² (Appendix 2).

Fig. 1.

Flow diagram of study selection for scoping review process. *Resources can include published articles, organisations, or programs.

Ethics

As this study is a scoping review, no primary data was collected for the completion of this study. All data was obtained from exisiting published journals and publicaly available sources therefore, ethics approval was not applicable.

Results

A total of 1233 articles were yielded from all databases. After screening titles and abstracts, and exclusion of duplicates, 38 were eligible for full-text review. Three articles were excluded after full-text review, leaving 35 to be included in the review. The Australian Indigenous HealthInfoNet webpage yielded 694 articles, 53 programs, and 15 organisations. Following exclusion of duplicates, 21 programs and 3 organisations met the eligibility criteria. After full review, 2 organisations were excluded leaving 20 programs and 1 organisation. The Advanced Google and AIHW search yielded 12 and 3 programs respectively. After exclusion of duplicates, all 12 programs from the Advanced Google search and 2 of the 3 programs from the AIHW search were included (Fig. 1).

Tables 1 and 2 summarise OHSs provided for Aboriginal and Torres Strait Islander peoples included in this review from database searches and the grey literature respectively. Figs 2 and 3 present the types of locations (i.e. rural or metropolitan) of OHSs by state and territory.

Table 1.Publications describing an oral health service for Aboriginal and Torres Strait Islander peoples from database searches.

Author (year)	State	Title	Aim	Type of service^A	Target population	Workforce model
Poirier et al. (2022)¹⁷	SA	Oral health promotion and programming provided by Aboriginal Community Controlled Health Organisations (ACCHOs) in South Australia	Identify and describe oral health programming and promotion provided by ACCHOs in South Australia	1, 2	Community wide	Aboriginal Health Workers, dental professionals
Poirier et al. (2022)¹⁷	Rural			1, 2	Community wide	Fly-in–fly-out services
Dimitropoulos et al. (2019)⁶⁶	NSW	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	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	3	Children	Aboriginal dental assistants
Dimitropoulos et al. (2019)⁶⁶	Rural			3	Children	Aboriginal dental assistants
Kong et al. (2021)⁶⁰	NSW	Aboriginal Health Workers Promoting Oral Health among Aboriginal and Torres Strait Islander Women during Pregnancy: Development and Pilot Testing of the Grinnin’ Up Mums & Bubs Program	Development and pilot test the model of care, Grinnin’ Up Mums & Bubs, to train Aboriginal Health Workers to promote oral health among Aboriginal and Torres Strait Islander pregnant women	1	Pregnant mothers	Aboriginal Health Workers
Kong et al. (2021)⁶⁰	Rural			1	Pregnant mothers	Aboriginal Health Workers
Skinner et al. (2021)¹⁸	NSW	A graduate oral health therapist program to support dental service delivery and oral health promotion in Aboriginal communities in New South Wales, Australia	Evaluate participants for the oral health therapy graduate year program, the ‘Dalang Project’	1, 2	Community wide	Oral Health Therapist (graduates)
Skinner et al. (2021)¹⁸	Rural			1, 2	Community wide	Oral Health Therapist (graduates)
Skinner et al. (2020)⁸²	NSW	Costing the Scale-Up of a National Primary School-Based Fluoride Varnish Program for Aboriginal Children Using Dental Assistants in Australia	Provide a costing for the scale-up of a child fluoride varnishing program in New South Wales, Australia	3	Children	Dental assistants
Skinner et al. (2020)⁸³	NSW	Aboriginal dental assistants can safely apply fluoride varnish in regional, rural and remote primary schools in New South Wales, Australia	Investigate the feasibility of using Aboriginal dental assistants to provide regular fluoride varnish applications for Aboriginal children in the primary school setting	3	Children	Aboriginal dental assistants
Skinner et al. (2020)⁸³	Rural			3	Children	Aboriginal dental assistants
Dimitropoulos et al. (2020)⁶⁵	NSW	Outcomes of a co-designed, community-led oral health promotion program for Aboriginal children in rural and remote communities in New South Wales, Australia	Determine the impact of a community-led oral health promotion program for Aboriginal children in rural and remote communities	1	Children	Oral health therapist and Aboriginal dental assistants
Dimitropoulos et al. (2020)⁶⁵	Rural			1	Children	Oral health therapist and Aboriginal dental assistants
Tadakamadla et al. (2020)¹⁹	QLD	Surface-Specific Caries Preventive Effect of an Intervention Comprising Fissure Sealant, Povidone-Iodine and Fluoride Varnish in a Remote Indigenous Community in Australia	Evaluates the effects of a topical intervention comprising fissure sealant, povidone-iodine, and fluoride varnishing in preventing caries on occlusal, approximal, and smooth surfaces	2	Children	Dental professionals
Tadakamadla et al. (2020)¹⁹	Rural			2	Children	Dental professionals
Dimitropoulos et al. (2020)⁶⁵	NSW	A school fluoride varnishing program for Aboriginal children in rural New South Wales, Australia	Determine if a school-based fluoride varnish program can provide Aboriginal children with at least three fluoride varnish applications over 12 months and whether the routine application of fluoride varnish for Aboriginal children in schools is a feasible approach for oral health promotion in Aboriginal communities	3	Children	Oral Health Therapist
Dimitropoulos et al. (2020)⁶⁵	Rural			3	Children	Oral Health Therapist
Jamieson et al. (2019)²⁰	SA	Follow-up of Intervention to Prevent Dental Caries Among Indigenous Children in Australia: A Secondary Analysis of a Randomised Clinical Trial	Test long-term effectiveness of an early-childhood dental intervention through a follow-up at age 5 years among Aboriginal children in Australia	1, 2, 3	Children	Dentist, study staff
Irving et al. (2019)²¹	NSW	Improving oral-health-related quality-of-life (OHRQoL) for rural Aboriginal communities in Australia utilising a novel mobile denture service	Evaluate the impact of the service on OHRQoL of the patients who received the dentures	2	Community wide	Aboriginal dental technician, prosthetists, hosting dental team (dentists, dental assistants, and oral health therapist)
Irving et al. (2019)²¹	Rural			Novel mobile dental service.	Community wide	Mobile clinic
Dimitropoulos et al. (2019)⁶⁶	NSW	In-school toothbrushing programs in Aboriginal communities in New South Wales, Australia: A thematic analysis of teachers’ perspectives	Explores how school staff interacted with a daily in-school toothbrushing program in three schools in rural areas in Central Northern New South Wales, Australia, with a high population of enrolled Aboriginal students	1	Children	Local Aboriginal people and school staff
Dimitropoulos et al. (2019)⁶⁶	Rural			1	Children	Local Aboriginal people and school staff
Roberts-Thomson et al. (2019)²²	N/A	Community trial of silver fluoride treatment for deciduous dentition caries in remote Indigenous communities	Compares the effectiveness of application of stannous fluoride (AgF) with atraumatic restorative technique (ART) in management of cavitated caries primary molars	2	Children	Dental professional
Roberts-Thomson et al. (2019)²²	Rural			2	Children	Dental professional
Ju et al. (2017)⁶⁷	N/A	Efficacy of an oral health literacy intervention among Indigenous Australian adults	Determine the effect of an oral health literacy intervention on oral health literacy-related outcomes among rural-dwelling Indigenous Australian adults	1	Adults	Indigenous Research Officers and study staff
Gwynne et al. (2017)²³	NSW	A comparison of two models of dental care for Aboriginal communities in New South Wales	Utilises a comparative retrospective analysis to compare two models of oral health care for Aboriginal people including those living in rural NSW to inform future policy decisions	2	Community wide	Dental professionals
Gwynne et al. (2017)²³	Rural			2	Community wide	Fly-in–fly-out and collective impact model
Irving et al. (2017)²⁴	NSW	Client perspectives on an Aboriginal community led oral health service in rural Australia	Examined the views of children (and parents) who accessed the service, including the extents of reported dental problems, oral health knowledge, attitudes and behaviour, accessibility of oral health services, satisfaction, and cultural sensitivity of the service	2	Children and parents	Dental professional
Irving et al. (2017)²⁴	Rural			2	Children and parents	Rotational basis ~1 week per month. Based at local Aboriginal Medical Service, community centre, or school and if no appropriate facilities are available a mobile dental van is provided
Johnson et al. (2014)⁸⁶	QLD	Effectiveness of water fluoridation in caries reduction in a remote Indigenous community in Far North Queensland	Examine all children on the rolls of the four campuses of the single-state school	4	Community wide	Dental professional and study staff
Johnson et al. (2014)⁸⁶	Rural			4	Community wide	Dental professional and study staff
Parker et al. (2012)⁶⁸	SA	An oral health literacy intervention for Indigenous adults in a rural setting in Australia	Determine if implementation of a functional, context-specific oral health literacy intervention improves oral health literacy-related outcomes measured by use of dental services, and assessment of oral health knowledge, oral health self-care, and oral health-related self-efficacy	1	Adults	Indigenous project officers
Parker et al. (2012)⁶⁸	Rural			1	Adults	Indigenous project officers
Slade et al. (2011)⁵⁸	NT	Effect of health promotion and fluoride varnish on dental caries among Australia Aboriginal children: results from a community-randomised controlled trial	Tested a dental health program in remote Aboriginal communities of Australia’s Northern Territory, hypothesising that it would reduce dental caries in preschool children	1, 3	Children	Not specified
Slade et al. (2011)⁵⁸	Rural			1, 3	Children	Not specified
Kruger et al. (2010)²⁵	SA	Primary oral health service provision in Aboriginal Medical Services-based dental clinics in Western Australia	Compare services between the Aboriginal Medical Services (AMS)-based clinics and a typical rural community clinic	2	Adults	Dental professionals
Kruger et al. (2010)²⁵	Rural			2	Adults	Dental professionals
Roberts-Thomson et al. (2010)⁵⁹	NT	A comprehensive approach to health promotion for the reduction of dental caries in remote Indigenous Australian children: a clustered randomised controlled trial	Evaluate the effectiveness of a community-orientated primary health care (CPHC) intervention on oral health behaviours of Indigenous preschool children living in remote communities of Australia’s Northern Territory	1, 3	Children	Dental professional, study staff, and primary care workers
Roberts-Thomson et al. (2010)⁵⁹	Rural			1, 3	Children	Dental professional, study staff, and primary care workers
Hammersley et al. (2022)⁶⁹	SA	Strategies to Support Sustained Participant Engagement in an Oral Health Promotion Study for Indigenous Children and Their Families in Australia	Describe the strategies employed in the study that contributed to the successful and sustained engagement of the participants. Strategies included the establishment of an Aboriginal reference group, building relationships with organisation and community, flexibility of appointment scheduling and allocation of adequate time, reimbursement for participant time, developing rapport with participants, encouraging participant self-determination, and adaptation of dietary data collection to better suit participants.	1	Children	Study staff and Aboriginal Health Workers (Reference Group)
Stormon (2022)²⁶	N/A	The use of consent forms in a ‘call from class’ model of dental care for Australian Indigenous children	Determine the effectiveness of an onsite, call-from-class model of dental service delivery at an Indigenous primary and secondary school	2	Children	Dental professionals
Stormon (2022)²⁶	N/A			2	Children	Call-from-class model
Smith et al. (2020)⁷⁰	NSW	Evaluation of an oral health education program for young aboriginal children: feedback from parents, aboriginal health workers, and managerial staff	Evaluate the health education program (Smiles not Tears) in terms of its cultural appropriateness, content, accessibility, sustainability, and implementation	1	Children	Study staff
Jamieson et al. (2018)²⁷	SA	Dental Disease Outcomes Following a 2-Year Oral Health Promotion Program for Australian Aboriginal Children and Their Families: A 2-Arm Parallel, Single-blind, Randomised Controlled Trial	Worked with Aboriginal Australian communities to develop a multifaceted oral health promotion initiative to reduce children’s experience of dental disease at age 2 years	1, 2, 3	Children	Study staff, dental professionals, and Aboriginal Australian communities
Ha et al. (2014)²⁸	WA, SA, NT, QLD	Clinical oral health of Australia’s rural children in a sample attending school dental services	Examine the association between children’s clinical oral health status and their residential location using the latest available data (2009) and to ascertain whether poor oral health among rural children is related to being Indigenous, having less access to fluoridated water, or being of lower socioeconomic status than children from urban areas	2	Children	School Dental Services
Ha et al. (2014)²⁸	Rural			2	Children	School Dental Services
Divaris et al. (2013)⁸⁵	NT	Surface-specific efficacy of fluoride varnish in caries prevention in the primary dentition: Results of a community randomised clinical trial	Determine the extent to which caries-preventive effects of a community intervention that included fouride varnish application among preschool-aged children varies according to primary tooth anatomy and baseline tooth pathology	3	Children	Trained clinical examiners
Blinkhorn et al. (2012)⁷¹	NSW	A phase II clinical trial of a dental health education program delivered by Aboriginal health workers to prevent early childhood caries	Identify barriers to the implementation of a family centred Aboriginal oral health strategy, as well as the development of evidence to assist in the planning of a Phase III cluster randomised study	1	Children	Aboriginal Health Workers
Abuzar et al. (2009)²⁹	VIC	Development of a rural outplacement programme for dental undergraduates: Students’ perceptions	Describe the development and implementation of a new rural dental outplacement model in the final year curriculum and report initial student perceptions	2	Community wide	Dental undergraduates
Abuzar et al. (2009)²⁹	Rural			2	Community wide	Rural outplacement
Parker and Jamieson (2007)³⁰	SA	Oral health comparisons between children attending an Aboriginal health service and a Government school dental service in a regional location	Compare the socio-demographic and oral health characteristics of children attending for care at the Pika Wiya Health Service Dental Clinic with those of their counterparts attending the generally Port Augusta School Dental Service	2	Children	Dentist and dental therapist
Parker and Jamieson (2007)³⁰	Rural			2	Children	Dentist and dental therapist
Bazen et al. (2007)³¹	WA	An innovation in Australian dental education: rural, remote, and Indigenous pre-graduation placement	The evolution of the program (2002–2005) is described and student evaluation of the program is reported	1, 2	Community wide	Undergraduate dental students
Bazen et al. (2007)³¹	Rural			1, 2	Community wide	Final year undergraduate rural placement program
Smithers et al. (2017)⁷²	SA	Diet and anthropometry at 2 years of age following an oral health promotion programme for Australian Aboriginal children and their carers: a randomised controlled trial	Study aimed to investigate whether a culturally appropriate multi-faceted oral health promotion intervention would reduce Aboriginal children’s intake of sugars from discretionary foods at 2 years of age	1	Children	Research officer, Aboriginal communities and Reference Group
Arrow et al. (2021)³²	WA	Atraumatic Restorative Treatment in Australian Aboriginal Communities: a Cluster-randomised Trial	A model of care based on Atraumatic Restorative Treatment and the Hall Technique (ART-HT) to manage early childhood caries was evaluated among remote Aboriginal communities in Australia	2	Children	Dental professionals
Arrow et al. (2021)³²	Rural			2	Children	Dental professionals
Smith et al. (2018)⁷³	NSW	Results of a 2 year dental health education program to reduce dental caries in young Aboriginal children in New South Wales, Australia	To assess the effectiveness of a dental health education program, ‘Smiles not Tears’ in preventing Early Childhood Caries in young Aboriginal children	1	Children	Aboriginal Health Workers
Smith et al. (2018)⁷³	Rural			1	Children	Aboriginal Health Workers
Lalloo et al. (2013)³³	QLD	Dental care provision by students on a remote rural clinical placement	Study analyses the type of treatment services provided from 2009 to 2011 by year, type of patient, and age of patient	2	Community wide	Final year dental students
Lalloo et al. (2013)³³	Rural			2	Community wide	Final year dental students

^A Type of service: 1 – oral health promotion to improve oral health awareness, knowledge, attitudes, behaviours, or skills; 2 – clinical service delivery; 3 – oral health promotion including the use of single clinical interventions (fluoride varnish); 4 – water fluoridation.

Table 2.Programs and organisations describing an oral health service for Aboriginal and Torres Strait Islander peoples from the grey literature.

Title	State/location^B	Type of service^A	Target population	Workforce model
Aboriginal dental program	SA	2	Adults	0
	SA			Dental professionals
	Rural+			Dental professionals
Baby Teeth Talk: Reducing Disease Burden and Health Inequalities Arising from Chronic Dental Disease among Indigenous Children (An Early Childhood Caries Intervention)	SA	1, 2	Children
Bila Muuji Regional Oral Health Promotion Program	NSW	1	Children and Mother’s groups	Regional coordinator (ACCHOs)
Bila Muuji Regional Oral Health Promotion Program	Rural	1	Children and Mother’s groups	Regional coordinator (ACCHOs)
Brewarrina rural and remote dental project	NSW	1, 2	Community wide (Children and Health Care Card holders)	Dental students (Griffith University)
Brewarrina rural and remote dental project	Rural	1, 2	Community wide (Children and Health Care Card holders)	Dental students (Griffith University)
Cherbourg Volunteer Dental Clinic	QLD	1, 2	Community wide	Volunteer dental students (Griffith University)
Cherbourg Volunteer Dental Clinic	Rural	1, 2	Community wide	Volunteer dental students (Griffith University)
Clean Teeth, Wicked Smiles	NSW	1	Children
Crocodile Smiles 2	QLD	1	Children	Oral Health staff, community members, Indigenous Health Workers
Crocodile Smiles 2	Rural	1	Children
Deadly Teeth	VIC	1	Children
Deadly Teeth	Rural	1	Children
Filling the Gap	NSW, NT, QLD, SA	1, 2	Community wide	Volunteer dentist and dental assistants (ACCHOs)
From Little Things, Good Teeth Grow	NT	1	Children	Dental therapists
Guards on the Go Mouthguard Project	NSW	2		Mobile oral health service
Guards on the Go Mouthguard Project	Rural	2		Mobile oral health service
Happy Teeth program	QLD	1	Children	Early childhood educators
Kimberley Dental Team	WA	2	Community wide	Volunteer dental professionals
Kimberley Dental Team	Rural	2	Community wide	Volunteer dental professionals
Koori Kids Koori Smiles (KKKS) Oral Health Program	NSW	1, 2	Children	Dental professional and Aboriginal Dental Assistant
Melbourne Dental School’s Indigenous Oral Health Placement Program	VIC, NT	2	Community wide	Oral health students (University of Melbourne)
	Rural	2	Community wide	Oral health students (University of Melbourne)
Smiles4Miles	VIC	1	Children	Dental professional
Strong Smiles Program	NSW	1	Children	Health promotion staff (Northern NSW Local Health District)
Strong Smiles Program	Rural	1	Children	Health promotion staff (Northern NSW Local Health District)
The outback oral treatment and health (TOOTH) dental program	NSW	2	Community wide	Fly-in–fly-out (Royal Flying Doctors Service)
	Rural	2	Community wide	Fly-in–fly-out (Royal Flying Doctors Service)
Taddalick Takes on Teeth Program	NSW	1	Children
Taddalick Takes on Teeth Program	Rural	1	Children
Tooth Mob Dental Volunteer Program	WA, NT	1, 2	Community wide	Volunteer dental professionals
Tooth Mob Dental Volunteer Program	Rural	1, 2	Community wide	Fly-in–fly-out
Riverina Medical and Dental Aboriginal Corporation	NSW	2	Community wide	Medical professionals
Riverina Medical and Dental Aboriginal Corporation	Rural	2	Community wide	Medical professionals
Aboriginal Oral Health Program	SA	1, 2	Community wide	Dental professionals
Aboriginal Oral Health Program	Rural +	1, 2	Community wide	Dental professionals
Oral health programs, Department of Health Victoria	VIC	1, 2, 4	Community wide (HCC holders)	Dental professional, students
Oral health programs, Department of Health Victoria	Rural +	1, 2, 4	Community wide (HCC holders)	Dental professional, students
The Northern Territory Remote Aboriginal Investment: Oral Health Program	NT	2, 3	Community wide	Dental professional, Oral Health Services Northern Territory staff
	Rural+	2, 3	Community wide
Stronger Futures in the Northern Territory: oral health program	NT	2, 3	Community wide	Dental professionals
	Rural+	2, 3	Community wide	Dental professionals
Aboriginal and Torres Strait Islander Community Health Centre	QLD	1, 2	Community wide	Dental professionals
	Rural	1, 2	Community wide	Dental professionals
Banyule Community Health	VIC	1, 2	Community wide	Dental professional
North Richmond Community Health	VIC	1, 2	Community wide	Dental professional
The Torres Strait Primary Oral Health Care Project	QLD	1, Teledentistry		Health professionals
The Torres Strait Primary Oral Health Care Project	Rural	1, Teledentistry		Health professionals
School of Health Sciences, The University of Newcastle	NSW	1, 2	Community wide	Students
School of Health Sciences, The University of Newcastle		1, 2	Community wide	Teaching clinic model
Gippsland Primary Health Network, An Australian Government Initiative	VIC	1, 2	Community wide	Dental professionals
	Rural	1, 2	Community wide	Dental professionals
Government of Western Australia North Metropolitan Health Service, Dental Health Services	WA	1, 2	Community wide	Dental professionals
	WA	1, 2	Community wide	Visiting clinicians
School operations, Dental Services	VIC	2	Children	Dental professional
School operations, Dental Services	VIC	2	Children	Mobile dental service
Grampians Health Ballarat	VIC	1, 2	Community wide	Dental professionals, dental students
	VIC			Teaching clinic model
	Rural			Teaching clinic model
Bila Muuji, Aboriginal Corporation Health Services INC.	NSW	1	Community wide	Community Health Workers
Bila Muuji, Aboriginal Corporation Health Services INC.	Rural	1	Community wide	Community Health Workers

^A Type of service: 1 – oral health promotion to improve oral health awareness, knowledge, attitudes, behaviours, or skills; 2 – clinical service delivery; 3 – oral health promotion including the use of single clinical interventions (fluoride varnish); 4 – water fluoridation.

^B State/location: Rural – service provided in rural area alone; Rural+ – service provided in rural and metropolitian areas.

Fig. 2.

Types of oral health services by state and territory. *Oral health promotion defined as attempts to improve knowledge, attitudes, behaviours, skills, or awareness of oral health at patient or community level.

Fig. 3.

Locations of oral health services by state and territory.

Clinical oral health services

Forty-one articles described clinical service delivery for Aboriginal and Torres Strait Islander peoples.¹⁷^–⁵⁷ Nineteen described clinical service delivery alone,¹⁹^,²¹^–²⁶^,²⁸^–³⁰^,³²^,³³^,³⁹^,⁴⁰^,⁴²^,⁴³^,⁴⁵^,⁵⁴^,⁵⁵ and two were used in conjunction with fluoride varnish.⁵⁶^,⁵⁷ Four services used a ‘fly-in–fly-out’ model,¹⁷^,²³^,⁴³^,⁴⁴ nine were student teaching clinics,²⁹^,³¹^,³³^,³⁶^,³⁷^,⁴²^,⁴⁶^,⁵⁰^,⁵³ one was a graduate year program,¹⁸ and five relied on volunteer practitioners.³⁷^,³⁸^,⁴⁰^,⁴⁴ The majority of services provided emergency and restorative treatments. Four services were provided in schools,²⁶^,²⁸^,³⁰^,⁵⁴ eight in community health clinics,¹⁷^,¹⁸^,²⁵^,³⁸^,⁴⁷^–⁴⁹ and two were mobile services.²¹^,³⁹ One program provided clinical services from all three settings.⁵⁶

Oral health promotion to improve oral health awareness, knowledge, attitudes, behaviours, or skills at the patient or community level

Forty-three articles described an oral health promotion that improves the oral health awareness, knowledge, attitudes, behaviours, or skills at patient or community level for Aboriginal and Torres Strait Islander peoples.¹⁷^,¹⁸^,²⁰^,²⁷^,³¹^,³⁵^–³⁸^,⁴¹^,⁴⁴^,⁴⁶^–⁵³^,⁵⁵^,⁵⁸^–⁸⁰ Eighteen were used in addition to clinical service delivery,¹⁷^,¹⁸^,³¹^,³⁵^–³⁸^,⁴¹^,⁴⁴^,⁴⁶^–⁵³^,⁵⁵ two were used in addition to fluoride varnish,⁵⁸^,⁵⁹ and another two were used in addition to both clinical service delivery and fluoride varnish.²⁰^,²⁷ In 18 studies,¹⁷^,¹⁸^,³¹^,³⁵^–³⁸^,⁴¹^,⁴⁴^,⁴⁶^–⁵³^,⁵⁵ oral health promotion used to improve oral health awareness, knowledge, attitudes, behaviours, or skills at the patient or community level was provided chair-side in conjunction with clinical service delivery. A broad range of professions were involved including Aboriginal Health Workers, Indigenous Health Officers, research officers, dental assistants, study staff, and primary care workers. Dental professionals (oral health therapists and dentists) were only involved in oral health promotion when clinical services were also provided. Programs were predominately provided for pre-school and primary school aged children in school settings.

Oral health promotion including the use of single clinical interventions to improve patient oral health outcomes

Our review identified 11 articles describing the use of fluoride varnish to improve the oral health outcomes for Aboriginal and Torres Strait Islander children,²⁰^,²⁷^,⁵⁶^–⁵⁹^,⁸¹^–⁸⁵ as well as one program providing water fluoridation to prevent dental caries within the community.⁸⁶ Six of the programs that described the use of fluoride varnish were in conjunction with other OHSs. This included two programs accompanying oral health education,⁵⁸^,⁵⁹ two accompanying clinical service delivery,⁵⁶^,⁵⁷ and two accompanying both clinical service delivery and oral health education.²⁰^,²⁷ Not all programs specified the workforce involved, in instances that it was, three used dental assistants.⁸¹^–⁸³ Two of these programs identified the dental assistants as Aboriginal and/or Torres Strait Islander.⁸¹^,⁸³ One program used oral health therapists⁸⁴ and another used trained clinical examiners.⁸⁵ Fluoride varnish was applied in schools or community health clinics and only to children (18 years or under). The study exploring the effectiveness of fluoridating the local water supply to prevent dental caries was conducted in far North Queensland and involved health practitioners and study staff.⁸⁶

Discussion

We found that OHSs for Aboriginal and Torres Strait Islander peoples in Australia were predominately provided in rural or remote regions. This reflects the important need for OHSs for Aboriginal and Torres Strait Islander peoples living in these regions.⁸^,⁹ We also found that services are provided in various settings. This includes community health clinics and schools, and the use of mobile dental equipment. For children, OHSs were varied, including both clinical services and oral health promotion. Oral health promotion for children comprised single clinical interventions to improve oral health outcomes (e.g. fluoride varnish programs), as well as programs aimed to increase oral health knowledge, oral hygiene behaviours, and oral hygiene skills. However, we found that oral health promotion programs for Aboriginal and Torres Strait Islander adults were limited. Given the burden of dental disease is significantly high for Aboriginal and Torres Strait Islander adults in rural and remote communities, compared to non-Aboriginal and Torres Strait Islander peoples, oral health promotion is crucial in preventing oral health diseases and essential to closing the oral health gap.⁴^,⁶⁵

Another finding of this review is that the workforce providing OHSs for Aboriginal and Torres Strait Islander peoples is diverse. This workforce included: oral health practitioners (including dental graduates), dental students, Aboriginal Health Workers, and school staff. This highlights the importance of relying on not only the professional oral health workforce to provide effective, accessible, and culturally safe OHSs that meet the needs of Aboriginal and Torres Strait Islander communities, particularly given the shortage of oral health professionals in rural and remote regions.⁸⁷ Mathu-Muju et al. describe the Children Oral Health Initiative (COHI) in remote Inuit communities in Canada which relied on Indigenous Health Workers, known as COHI aides. COHI aides scheduled dental appointments, performed health promotion activities, and applied fluoride varnish for Inuit children.⁸⁷ This initiative was developed to address the professional dental workforce shortage in these remote communities, and results demonstrated the program’s success as a preventative oral healthcare delivery model for remote communities.⁸⁷

Engagement of Aboriginal Health Workers or local staff can also foster better communication between practitioners and patients and can lead to improved patient engagement and oral health outcomes.⁸⁸^,⁸⁹ A recent systematic review highlighted the importance of Indigenous Health Workers in promoting maternal oral health care.⁸⁹ This review identified that the key role of Indigenous Health Workers was to reduce barriers and bridge the gap between healthcare practitioners and the Indigenous community.⁸⁹

To ensure the ongoing provision and sustainability of OHSs that rely on non-dental professionals, capacity-building for these individuals is essential.⁹⁰ This can help to maintain and enhance the level of culturally and clinically safe care provided.⁸⁹^,⁹⁰ This was evident in the COHI initiative where COHI aides were provided with training that equipped and allowed them to provide regular fluoride varnish applications and perform oral health promotion/disease prevention workshops.⁸⁷ Another oral health initiative with a similar service delivery model based in rural Alaska utilised dental health aides.⁹¹ This program successfully improved oral health outcomes for community members and increased satisfaction due to better access to culturally competent OHSs.⁹¹ This was largely attributed to the level of training and certification provided to build the oral health capacity of these individuals.⁹¹

We also found few studies reporting on the experiences of the oral health workforce providing the services. One study by Irving et al. documented the experiences of practitioners who relocated to a rural community in Northern NSW to provide dental services for Aboriginal communities.⁹² In this study, professional and personal support systems, including cultural training preparation, financial incentives, professional development, mentorship, and personal support programs, were in place for these practitioners. The presence of these supports resulted in a highly rewarding experience for the practitioners, with positive effects that outweighed the personal cost associated with living away from home and loved ones.⁹² Despite efforts by state and federal governments, retention of oral health practitioners in rural and remote regions continues to remain an issue.⁶^,⁹³ Understanding the experiences and challenges faced by this workforce and exploring strategies to better support these individuals professionally and personally is essential to addressing this employment disparity.⁹³ Gaining insights into challenges experienced by the oral health workforce in rural and remote regions can help inform targeted support programs and policies that improve job satisfaction.⁹⁴ Understanding and providing support for this workforce can lead to better recruitment and retention strategies. This could allow for continued provision of OHSs and increase access to OHSs for people living in rural and remote regions, including Aboriginal and Torres Strait Islander peoples.

We also identified that the cultural competence of the oral health workforce involved in delivering these services was inadequately described. Cultural competence is critical for increased engagement providing culturally appropriate care and improving outcomes for Aboriginal and Torres Strait Islander peoples.⁹⁵ However, most programs and studies found in this review did not provide information on how cultural competence was incorporated into service delivery or how it impacted service provision. Providing cultural awareness training for oral health practitioners in rural and remote locations and continued on-going local cultural support are critical for ensuring both culturally and clinically safe OHS provision for Aboriginal and Torres Strait Islander peoples.⁹⁵

Limitations

A limitation of this review is that unpublished health service reports and internal documents from public OHSs that are not publicly accessible were not included in this review.

Future research

Based on the findings of this review, future research should explore the experiences of the oral health workforce in rural and remote regions who work closely with Aboriginal and Torres Strait Islander peoples. Investigating the experiences of this workforce can assist in the development of strategies and policies to better attract support and retain this workforce, which could increase accessibility to culturally and clinically safe OHSs for Aboriginal and Torres Strait Islander peoples in rural and remote regions.

Conclusion

The findings of this scoping review demonstrate that OHSs provided for Aboriginal and Torres Strait Islander peoples in rural and remote regions of Australia vary in service type, location, and workforce involved. The review found that the experiences of the oral health workforce were inadequately described. Further research is required to explore the experiences of the oral health workforce in rural and remote regions.

Data availability

The data that support the findings of this study were derived from and are available in the public domain: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, CINAHL, Australian Indigenous HealthInfoNet webpage, and Google.

Conflicts of interest

The authors declare that they have no conflicts of interest.

Declaration of funding

No financial support was received for the research, authorship, and/or publication of this article.

Acknowledgements

The authors extend their gratitude to Ms Erin Taylor, Lecturer Supporting Indigenous Dental Assistant Program, The University of Sydney for reviewing the manuscript and to Profession Janet Wallace, School of Dentistry, The University of Sydney for her contribution and expertise.

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93 Battye SC, Gormly A. Increasing Dental and Oral health training in rural and remote Australia: Feasibility study. KBC Australia; 2022.

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95 Australian Institute for Health and Welfare. Cultural safety in health care for Indigenous Australians: monitoring framework. Canberra: AIHW; 2023.

Appendix 1.Search strategy.

#	Query
1	‘Native Hawaiian or Other Pacific Islander’/
2	indigenous.mp.
3	aborigin*.mp.
4	torres strait*.mp.
5	first nation*.mp.
6	1 or 2 or 3 or 4 or 5
7	Australia*.mp. or Australia/
8	Dental Health Services/
9	Dental Care/
10	Oral Health/
11	Oral Hygiene/
12	(oral health or dental care).mp. [mp = title, book title, abstract, original title, name of substance word, subject heading word, floating sub-heading word, keyword heading word, organism supplementary concept word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier, synonyms]
13	(dental service* or dental care or dental treatment).mp. [mp = title, book title, abstract, original title, name of substance word, subject heading word, floating sub-heading word, keyword heading word, organism supplementary concept word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier, synonyms]
14	Dentists/
15	Dental Hygienists/
16	(dentist* or dental assistant* or oral hygienist* or dental hygienist* or oral health therapist*).mp. [mp = title, book title, abstract, original title, name of substance word, subject heading word, floating sub-heading word, keyword heading word, organism supplementary concept word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier, synonyms]
17	Fluorides, Topical/
18	fluoride varnish.mp.
19	teledentistry.mp.
20	8 or 9 or 10 or 11 or 12 or 13 or 14 or 15 or 16 or 17 or 18 or 19
21	6 and 7 and 20

Ovid MEDLINE(R) ALL <1946 to 25 September 2022>.

Appendix 2.Data extraction tool.

Scoping review details
Scoping review title
Review objectives
Review question
Inclusion/exclusion criteria
Population (Aboriginal and/or Torres Strait Islander Y/N)
Concept (Oral Health Service delivery) Oral health promotion/education Clinical oral health service Fluoride varnish Water fluoridation
Context (type of oral health service and/or workforce model identified Y/N)
Evidence source details and characteristics
Citation Details (Author/s, date, title, aim, results)
Country (Australia Y/N)
Context (Oral Health Service delivery)
Participants (Aboriginal and/or Torres Strait Islander Y/N)
Details/results extracted from source of evidence
a.
b.
c.