Introduction by Croakey: Oral health is important for the social and emotional wellbeing of First Nations people, underscoring the importance of improving access to culturally safe oral healthcare, according to a study conducted in South Australia.
The research, published recently in The Medical Journal of Australia, involved 136 Indigenous adults who were part of a project evaluating provision of culturally safe, comprehensive dental care. Study governance was provided by an Indigenous Oral Health Unit Reference Group with Indigenous leadership to centre cultural authority and cultural safety across all study dimensions.
Adelaide University researchers Dr Ria Aiyar and Nicolas Reid say oral health should be integrated alongside chronic disease assessment and in primary health services, such as Aboriginal Community Controlled Health Organisations. Their article was first published at The Conversation.
Ria Aiyar and Nicolas Reid write:
When it comes to healthcare in Australia, the mouth is too often considered separate to the rest of the body. Medicare doesn’t cover a trip to the dentist in the same way it covers other types of healthcare.
But for many Indigenous people, health is viewed holistically, where body, mind and emotions, family and kinship, community, culture, Country and spirituality are intertwined.
The mouth has also long-been seen as a key part of wellbeing, including being central to participating in traditional cultural practices such as men’s business, initiation, weaving and fishing.
In our recent research, published in The Medical Journal of Australia, we asked Indigenous people what they thought about oral health.
We showed how it remains a central aspect in Indigenous social and emotional wellbeing. This needs to be reflected in how we design and roll out services to promote Indigenous oral and wider health.
Oral health is much wider than having healthy teeth and gums. The World Health Organization acknowledges it relates to being able to comfortably eat, speak, breathe, smile and participate in the wider community.
But in Australia, there’s an oral health gap. Indigenous people have a higher prevalence of untreated tooth decay, tooth loss, and toothache than non-Indigenous people.
These inequities highlight the impacts of colonisation, ongoing system-wide discrimination, and a lack of access to culturally safe, affordable dental care.
This oral health gap sits within a significant, broader health gap between Indigenous and non-Indigenous people.
Indigenous people have an eight to nine-year lower life expectancy than non-Indigenous people. Their burden of chronic diseases such as diabetes, cancer and coronary heart disease is higher.
So our research aimed to draw attention to health inequities, and develop evidence-based strategies to improve Indigenous people’s oral health.
Research processes and findings
We collaborated with Aboriginal Community Controlled Health Organisations, Elders, Indigenous participants and dental practitioners to design and refine our research to prioritise cultural safety and centre Indigenous voices.
We yarned with 136 Indigenous South Australian adults to explore their oral and general health, social and emotional wellbeing, and experiences of dental care.
We also advised on oral healthcare, and conducted health assessments to check blood glucose, inflammation, cholesterol and kidney function.
Many participants acknowledged the connection between oral health and the rest of the body. One emphasised looking after your mouth to prevent wider disease:
there’s links between [oral health] and wellbeing how they impact each other, so the mouth is your gateway to your body right? You’ve gotta look after it.”
The appearance of teeth, gums and smile were important to people’s social and emotional wellbeing. One person said:
it affects the person’s emotion, affects everything. Vanity, ego. You name it. You’ve got bad teeth, you don’t look deadly. Good teeth, you’re deadly inside and outside […] It has the impact greatly on social and emotional wellbeing big time.”
Participants said they had experienced judgement or discrimination in social situations due to the appearance of their teeth. They recognised that overall health was intertwined. One said:
Not only can [oral health] impact you socially because you might not want […] people seeing your teeth and mouth or bad breath or judgement like that but also, what it can do if you do have like abscesses like things that can go into your bloodstream and affect your heart.”
Some participants described how they didn’t access dental care as they felt ashamed of their oral health, describing it as a “shame-job”.
One participant said it may feel like a “shame-job” to access oral healthcare. But the benefits of culturally safe care, free of judgement and that ensures the physical and emotional safety of clients, could promote better outcomes:
So you’ve got to see the value even though it might be kind of like shame-job to reach out, get somebody to start looking at your teeth and start working towards a healthier mouth […] the end result of that is so impactful positively that I think good teeth changes your life.”
Participants also said that a culturally safe service that focuses on managing oral health and assessing important health markers (such as blood glucose, cholesterol, and inflammation) for further referral and specialised management would be an important step in “closing the gap” in Indigenous health inequities:
really interesting to know because I’ve got a family history of diabetes, kidneys and heart, so it was really very refreshing.”
Implications for practice and policy
We showed how holistic approaches are needed to tailor healthcare for Indigenous Australians in closing the health gap. This type of care might involve mobile, at-home oral and general health assessments, which we provided in our study.
A model of care like this can be de-stigmatising in instances where people have had past negative experiences with healthcare. It provides a safe space for people to share their concerns. Connecting with Elders and community leaders about locally owned ways of promoting community oral health would be essential when designing and delivering such services.
Our findings also indicate the need to integrate oral health alongside chronic disease assessment and in primary health services, such as Aboriginal Community Controlled Health Organisations.
This would require interdisciplinary collaboration, where training in oral health promotion is provided to healthcare practitioners and Indigenous health workers. These changes can empower communities, minimise shame and improve oral and general health.
Author details and acknowledgements
Dr Ria Aiyar is a Postdoctoral Researcher, School of Dentistry, Australian Research Centre for Population Oral Health, Adelaide University. Her research interests include health equity, wellbeing, and culturally responsive care using qualitative research methods. Her work also includes a focus across the broad areas of oral health, access to dental care, family wellbeing and experiences of support in the First 2000 Days (across conception to age 5 including in pregnancy and early childhood).
Nicolas Reid is a PhD Candidate, Australian Research Centre for Population Oral Health, School of Dentistry, Adelaide University. He is Senior Dentist and Manager of the Oral Health Program, The Royal Flying Doctor Service (SA/NT) and Director of the Indigenous Dental Association Australia.
The authors acknowledge Lisa Jamieson, one of the chief investigators behind the research mentioned in this article, who receives funding from the National Health and Medical Research Council. They thank the Indigenous Oral Health Unit team for supporting this research, and express our sincere gratitude to the participants who generously shared their stories.
See Croakey’s archive of articles on oral health
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