Themes

Intervention studies provide critical information for uptake and translation into evidence-informed, dental health related policy. There are many types of intervention studies, with the most robust a randomised controlled study. This study design requires rigour in the planning, recruitment and training of staff, recruitment and data collection from participants, implementation of the intervention, and meticulous recordkeeping on electronic data bases. It is for this reason all interventions are required to be logged in clinical trial registries.

Relevant research

Early childhood caries is a significant issue among Indigenous groups. The IOHU is unique in its programmatic approach to addressing this complex condition, with dental services engaged in the translation process. This ensures control groups receive intervention upon trial completion, ideally lowering dental caries rates and improving quality of life for Indigenous children.

Similar to intervention studies, longitudinal/cohort studies enable patterns to emerge across time that can inform dental health policy and service provision. The same rigour and data collection approach is required, however key problems can emerge in the follow-up of participants over time. Sustained rapport with both the Indigenous community and individual participants is exceedingly important for the success of these studies.

Relevant research

The IOHU aims to determine risk factors of early childhood caries in children involved in the Longitudinal Study of Indigenous Children (LISC). LISC is a comprehensive source of longitudinal information on the early childhood development of Indigenous Australians however there is no current analysis of dental data. This project will be the first to provide evidence of the antecedents of Indigenous child dental disease, with possible translation to oral health policy.

The study design is prospective longitudinal. Data is collected from children aged six to 18 months and three-and-a-half to four-and-a-half years at baseline, and every year thereafter. Data from ten waves is currently available, with children residing in urban and non-urban areas across Australia. Expected outcomes include increased understanding of the role of nutrition, early childhood behaviours involving oral health (e.g. tooth brushing), and parental social determinants across time on experience of dental disease, experience of dental care under a general anaesthetic, and experience of dental pain that impacts eating, school attendance, and overall child quality-of-life.

Modelling makes use of existing data sets, including those available from public registers that have government oversight. Modelling is a cost-effective and efficient way of maximising the use of large datasets that might otherwise be underused. Sufficient skill and software is required for sophisticated modelling, with correct interpretation required for translation back to policy makers.

Relevant research

The IOHU aims to assess acceptability, use of risk assessment instruments, training, uptake, and cost-effectiveness of oral cancer screening and the long term impact of HPV vaccination on OPSCC rates for Indigenous Australians. Indigenous community engagement has revealed strong support, with an interest by seven Indigenous health workers in being trained.

The unit will model a range of screening, diagnostic, and referral pathways, and assess the cost-effectiveness of screening the whole population or just those identified as high risk. For each analysis, the unit will simulate a large ‘virtual’ sample of the Indigenous population. All evaluations will involve extensive sensitivity analysis, using one-way and probabilistic sensitivity analysis techniques which take into account the full range of identified fitted parameter sets. The IOHU will calculate incremental cost-effectiveness ratios for both life years saved and quality-adjusted life years.

Monitoring and surveillance are crucial methods of ascertaining trends over time and determining if specific policies are both effective and accepted by the community. This is particularly true for national surveys that encompass large sample sizes and are typically representative. Modelling and surveillance are especially important in the dental health space for tracking the impact of water fluoridation.

Relevant research

The National Child Oral Health Survey (NCOHS) and National Survey of Adult Oral Health (NSAOH) are ten-yearly monitoring and surveillance activities undertaken by the Australian Research Centre for Population Oral Health, in partnership with the Department of Health and Australian state and territory governments. Reporting Indigenous trends from this data is a priority in the 2013-2024 National Oral Health Plan, and is necessary to provide a sound evidence-base for appropriate Indigenous oral health policy translation.

Regular monitoring and surveillance of oral health trends and inequities among Indigenous and non-Indigenous Australians at a representative population level enables snapshot reports to be generated quickly for both federal and state/territory policy makers. This can lead to evidence-based decision making regarding increased access to dental care for some disadvantaged Indigenous groups, or possible fee waivers in both the public and private dental sectors.