Caring in the community

A curated series of articles examining the power of social

Access to oral health services has always been a challenge to our society due to little or no government subsidy to the cost of dental treatment, and the lack of focus on prevention and oral health promotion. While the DHAA has been advocating to government for equitable access and prioritising oral health promotion and disease prevention, the profession is taking the matter into its own hands through various initiatives across the country. This issue highlights some of these activities and calls for like-minded colleagues to join their great work. For further information please email contact@dhaa.info.

Sharing the love for free

Associated Professor Mina Borromeo, founder of One-One-Twelve, is advocating for dental professionals to share the responsibility to help people with disabilities

AFTER 30 YEARS in dentistry, Associate Professor Mina Borromeo retired from her clinical work in 2022, with the intention of devoting her time fully to build a workforce and raise funds to improve the oral health of people with disability.

Mina has spent her working career managing and training others about the oral health of people with special needs and was a specialist in Special Needs Dentistry (SND). She developed the first fully accredited specialty training program in SND in the southern hemisphere. She has published and spoken extensively both Nationally and Internationally on why we have the conundrum of poor oral health amongst people with challenging health issues.

She was awarded the David White Award for teaching excellence recognising her innovations in teaching special need dentistry. In addition, she received a citation for outstanding contribution to student learning, Office of Teaching and Learning, Australian Federal Government.

Mina reflected on a case she was involved in which a young individual with autism had 16 extractions under general anaesthetic because his referral letter read “difficult to manage in the dental chair”. It was clear when speaking to his family

that this young person did not wish to have any teeth extracted. He went from a buzzing young man with ambitions to someone who dropped out of school and refused to leave his bedroom. The tragedy of this case alone highlights that a seismic shift is required. We have moved away from a medical model of healthcare to a relational, human rights model that recognises dignity, acknowledges the interdisciplinary environment and web of relationships around a person with disability, assumes capacity first (rather than incapacity) and centres on a concept of inclusive equality.

Mina is passionate about changing this for people with disability. She wants to advocate and be a voice for people who can’t find a way to manoeuvre the dental world. She wants to be the bridge that links the dental profession and people with disability. She hopes to stop the water between the two sides of the river from being an insurmountable barrier. And she is seeking help to build that bridge!

Mina believes the dental profession is uniquely placed to make a real difference in the lives of people with disability. At the moment it is estimated that 4.4 million Australians are living with disability, and there are only 25 special needs dental specialists in the whole country. That is one specialist per 176,000 clients. However, Mina noted that 24,180 registered oral health practitioners have a unique opportunity to become dental champions in the disability space!

To achieve her goal, Mina set up the ONE-ONE-TWELVE (1-1-12) initiative, with the aim of improving the timeliness of access to and quality of dental services for people with disability into the next decade. The initiative involves ONE person with a disability managed by ONE oral health professional for TWELVE months pro bono.

Practitioners come with different experiences in the disability space. Some will have lots, while others may have none. Some with uncertainties based on past experiences. This is why 1-1-12 partnered with the Disability Oral Health Collaboration to develop CPD sessions to support all participating practitioners through the 12-month challenge. The CPD will bring practitioners up to date with the disability sector, including learning from those with lived experience, understanding the roles of allied health professionals, navigating the NDIS, steps to follow when engaging with supporters and existing support plans, and more. It will kick off with a chance to meet like-minded champions who’ve signed up and those who have experience caring for people with disabilities from both within and outside the dental profession. The support will be ongoing and will provide mentoring opportunities to assist everyone in working with their patient.

Already there are 29 dentists signed up as 1-1-12 Dental Champions and Mena is hoping that dental hygienists, dental therapists and oral health therapists will join them. They currently have 30 patients ranging from mild to profound disabilities that require a range of oral health services at varying levels of complexity.

To become a 1-1-12 dental champion, or to donate, please go to oneonetwelve.org

Taking it to the schools

Dealing with the challenges and outcomes of community oral health projects

by Cathryn Carboon Assoc. Dip. Dental Hygiene, Master of Health Promotion

AS CATHRYN reflects on her dental hygiene career spanning over three decades, it is her role in oral health promotion projects that has given her the most satisfaction and reward, but there have been many challenges to overcome as well, including the COVID-19 pandemic.

In 2023, Cathryn celebrates 10 years as a Carevan Foundation Board Director. During this time, she has led the Carevan Sun Smiles school fluoride varnish program, achieving many milestones along the way, including international recognition from the International Federation of Dental Hygienists and the Global Child Dental Fund.

It has been five years since Cathryn was awarded the 2018 DHAA Oral Health Award for Community Service and her involvement in community oral health projects continues to grow. Her planning, implementation and evaluation of two current community oral health projects provide a balance to her clinical role in private practice and enable her to utilise her full skill set. Putting into action the knowledge she has gained from her Master of Health Promotion to roll out the Carevan’s Sustainable Smiles and Pyjama Fairy projects.

Sustainable Smiles

Due to the Carevan Foundation’s increasing awareness and social responsibility to address the United Nation’s 2030 Sustainable Development Goals (2015) Cathryn developed “Sustainable Smiles’’ a school-based, student-led oral care recycling program. The school-based program leveraged off the success of the community-based Sustainable Smiles program Cathryn launched in 2021, as part of World Oral Health Day (20 March) in conjunction with other sustainability initiatives, including Global Recycling Day (18 March) and Earth Day (22 April).

Looking through a sustainability lens

The new Sustainable Smiles schoolbased initiative is aligned with all major dental & oral health professional Association’s increased focus and action on sustainability in dentistry and is underpinned by the priority of embedding sustainability within Australian education curriculum frameworks, as detailed below.

• World Dental Federation (FDI)

2022 Consensus on Environmentally Sustainable Oral Healthcare.

• International Federation of Dental Hygienists (IFDH)

2022 Sustainable Dentistry Survey

• Australian Dental Association (ADA)

2020 Policy Statement 6.21 “Dentistry and Sustainability”

• The Early Years Learning Framework for Australia

[Birth – 5 years] (2018) Outcome 2: Children become socially responsible and show respect for the environment. Embed sustainability into daily routines and practices.

• The National Australian School Curriculum

[Foundation – Year 10] (2018 Version 8.4) Through the inclusion of sustainability as a ‘cross-curriculum priority’, students develop the knowledge, skills and values necessary to contribute to more sustainable patterns of living.

Colgate & TerraCycle Oral Care Recycling Program

Every year, thousands of used oral care products (toothbrushes, toothpaste tubes, floss containers) end up in landfill across Australia, contributing to environmental pollution. As oral health professionals, we have an ethical duty to be responsible for the oral care products that we provide during our oral health promotion projects.

Colgate and TerraCycle have partnered to give a second life to used oral care products. The Colgate Oral Care Recycling Program provides organisations and schools with the opportunity to collect and recycle oral care products, to prevent them from ending up in landfill. The plastic from used oral care products is sorted, cleaned and melted down into pellets, ready to make new recycled products (including garden seats and school playground equipment).

Embedding this recycling program into primary schools gives children the opportunity to participate in a recycling project and develop a sense of pride that they are contributing to a healthier environment. Parents and staff can also get involved in the program.

The Sustainable Smiles classroom session, through PowerPoint, video clips and group discussion, teaches Grade 5/6 students about the impact of oral care waste on the environment and empowers students to implement a recycling program in their school.

Goals of the Sustainable Smiles program

Raise awareness of the impact of oral care waste on the environment

1. Raise awareness of ‘environmentally friendly’ toothbrush choices (ie: brushing with biodegradable bamboo toothbrushes)

2. Raise awareness of the Colgate/ TerraCycle oral care waste recycling program.

3. Launch a school-based, student-led Colgate/TerraCycle oral care recycling program.

4. Encourage families to change their behaviour and begin recycling their own oral care waste.

5. Collect oral care waste throughout each school term, for shipment to a TerraCycle recycling plant.

Outcomes from the Sustainable Smiles Program

Teachers have benefited from having skilled oral health promoters enriching their school’s curriculum content in different learning areas, including health, literacy and sustainability.

A large increase was observed in the children’s awareness of sustainability issues in oral health care (with a focus on recycling plastic oral healthcare products) and oral health knowledge.

Results from the student evaluation surveys showed:

• 83% learnt new information and ideas from the presentation and discussion

• 7% were unsure whether they learnt anything new

• 10% did not learn anything new

The program is popular with the children as is Cathryn’s book - Who is the Tooth Fairy’s Best Friend?

Ongoing oral care recycling programs have been initiated within the schools, with support from the whole school community and regular features in the school newsletters.

Embedding sustainability into all oral health promotion projects

This is definitely a program that every DHAA member should consider implementing in their own community, it is very rewarding to know that you can make a difference within the dental profession to support sustainable practices and in turn, help improve the environment by addressing the issue of oral care waste.

Sustainable Smiles is worth promoting to the profession as it is easy to implement, involves positive collaboration within the community and education sectors and can be implemented in private dental practices as well.

Connect at the DHAA National Symposium

If you feel inspired and would like to hear more about the Sustainable Smiles initiative, Cathryn will be presenting on this topic at the DHAA 2023 Synergy & Sustainability National Symposium in Adelaide on Saturday 23rd September.

www.dhaa.info/Symposium23/Home.aspx

The Pyjama Fairy: Brush, book, bed project

The Carevan’s Pyjama Fairy: Brush, Book, Bed Project is based on successful overseas Brush, Book, Bed (BBB)

Programs by the American Academy of

Pediatrics and the UK Book Trust. BBB programs provide a holistic approach to bedtime routines and a simple, “sticky” message to help families understand the importance of good night-time routines for young children, especially tooth brushing, reading together and going to bed at a regular time each night.

BBB programs help health professionals communicate more than one health message in a single delivery. By implementing BBB and providing families with a BBB pack (toothbrush, fluoride toothpaste, children’s books) hygienists and OHT’s can talk with parents about establishing good oral hygiene, early literacy and healthy sleep habits.

Carevan’s Pyjama Fairy BBB program leveraged off the success of the oral health literacy project Who is the Tooth Fairy’s best friend? combining these resources with the Sleep with Kip™ book series. Pyjamas are commonly associated with the night-time routines of bath time, brushing, book reading and bedtime. The Pyjama Fairy joins the Tooth Fairy and Fluoride Fairy in linking 3 important night-time routines into 1 health message.

Sleep with Kip™

Almost every parent has experienced a behavioural sleep challenge with their child. Challenges getting to sleep, waking in the night and early waking are common issues faced by parents across Australia.

Sleep problems can adversely affect children’s mental health and learning, not to mention making life harder for mums and dads and others caring for kids. Teaching kids healthy sleep habits is a valuable life skill and will optimise their growth and learning.

Sleep with Kip bedtime books provide a fun and friendly way to learn to manage common sleep problems in children. The books were developed by the Murdoch Children’s Research Institute in Melbourne, to share evidence-based advice on children’s sleep. Adding these resources to the Pyjama Fairy BBB program reinforces a multi-disciplinary approach to community oral health projects.

Lessons learned

• Building on already developed oral health literacy resources is a successful strategy, that has allowed the Carevan to extend the reach of already developed oral health promotion resources.

• Developing digital oral health literacy resources is important to enable greater dissemination of positive health messages, which became critically important during the Covid19 Pandemic. These resources are also more sustainable and can be utilized in future health promotion initiatives.

• It is important to have an oral health champion in each school – someone who is the point of contact for collaboration and organising the oral health promotion activities and followup evaluation of the program.

• Oral health promotion is an integral part of our professional role; however, capacity building is still needed to ensure theory can be translated into practice within the community setting.

Challenges ahead

Funding

Long-term, sustainable funding for oral health promotion programs is always a challenge. Limited, accessible funding is generally short-term in nature, which does not allow for long-term planning or implementation of programs. Many oral health promotion projects rely on unpaid volunteers which is also not sustainable in the long term.

There is an overall lack of government funding for oral health promotion programs, which makes it difficult for dental hygienists and other dental professionals to reach as many people as possible with important information and resources. Without adequate funding,

dental hygienists struggle to develop, implement and evaluate effective oral health promotion strategies, and many Australians miss out on the benefits. We need sustained advocacy from the DHAA, in partnership with ADOHTA, ADA and the Victorian and National Oral Health Alliances to address this issue.

Gaining professional recognition for health promotion

As well as being underfunded, health promotion is often undervalued and often overshadowed by clinical treatment and the bio-medical model of care.

The Australian Health Promotion Association (AHPA) is the only professional association in Australia specifically for people involved in the practice, policy, research and study of health promotion.

AHPA has 33 years of leadership and advocacy in health promotion and regularly lobbies the Australian Government to commit at least 5% of the health budget to health promotion and illness prevention, in line with the National Preventive Health Strategy 2021-2030.

AHPA is the National Accreditation Organisation for the International Union

for Health Promotion and Education (IUHPE) in Australia. By joining AHPA you have the opportunity to apply for Health Promotion Practitioner registration, recognised by the IUHPE.

IUHPE accredited health promotion courses for Health Promotion Practitioner registration are listed in the table. If you have qualifications in Health Promotion, consider applying for Health Promotion Practitioner registration, to elevate our profession and strengthen our professional recognition.

Additional reading on sustainability from the British Dental Journal

• Duane et al (2019)

“Environmentally sustainable dentistry: a brief introduction to sustainable concepts within the dental Practice” British Dental Journal Vol 226, No 4.

• Mulimani, P (2017)

“Green Dentistry: the art and science of sustainable practice” British Dental Journal Vol 222, No 12.

• Lyne et al (2020)

“Combining evidence-based healthcare with environmental sustainability: using the toothbrush as a model” British Dental Journal, Vol 229. No 5.