Research Letter

Improving oral-health-related quality-of-life for rural Aboriginal communities in Australia utilising a novel mobile denture service

AUTHORS

Michelle Irving1 PhD, Research Fellow *

Neelam Kumar2 DMD, Student

Kylie Gwynne3 PhD, Director

Folau Talbot4 Diploma in Dental Technology, Dental Technician

Anthony S Blinkhorn5 PhD, OBE NSW Health Chair, Population Oral Health; now retired

CORRESPONDENCE

*Dr Michelle Irving

AFFILIATIONS

1, 2, 5 The University of Sydney, Faculty of Medicine and Health, School of Dentistry Faculty of Dentistry, New South Wales, Australia

3, 4 The University of Sydney, The Poche Centre for Indigenous Health, New South Wales, Australia

PUBLISHED

11 September 2019 Volume 19 Issue 3

HISTORY

RECEIVED: 23 August 2018

REVISED: 28 May 2019

ACCEPTED: 10 June 2019

CITATION

Irving M, Kumar N, Gwynne K, Talbot F, Blinkhorn AS.  Improving oral-health-related quality-of-life for rural Aboriginal communities in Australia utilising a novel mobile denture service. Rural and Remote Health 2019; 19: 5063. https://doi.org/10.22605/RRH5063

AUTHOR CONTRIBUTIONSgo to url

ETHICS APPROVAL

Ethics approval was obtained from the Aboriginal Health and Medical Research Council of New South Wales, approval number 1004/14

This work is licensed under a Creative Commons Attribution 4.0 International Licence


full article:

Dear Editor

Tooth loss is associated with poorer oral health, compromised diet, nutritional deficiencies and reduced oral health related quality of life (OHRQoL)1. Aboriginal Australians have consistently poorer dental outcomes, and loss of teeth is overrepresented in Aboriginal Australians2. The Poche Centre for Indigenous Health is an organisation that forms partnerships with Aboriginal communities to co-design health services. Recently, a novel mobile denture service that fabricates dentures in a short time-frame of 4 days was designed and implemented by the Poche Centre at the request of the local Aboriginal community in northern New South Wales. The denture service is operated from a mobile clinic by an Aboriginal dental technician, pro bono prosthetists and the dental team hosting the visiting service. The hosting team includes dentists, dental assistants and oral health therapists. The service attends each host site for up to 5 days and operates approximately 12 weeks each year. The service is coordinated and primarily funded by the Poche Centre for Indigenous Health.

The purpose of this study was to evaluate the impact of the service on OHRQoL of the patients who received the dentures. OHRQoL was assessed using the shortened version of the Oral Health Impact Profile survey (OHIP-14)3. Denture recipients between July and December 2016 were invited to participate in the evaluation, completing an OHIP-14 survey at baseline and 6-month follow-up (January–June 2017), in a culturally safe manner, as an interviewer-assisted survey with an Aboriginal dental assistant. Twenty-eight recipients (82%) participated in the survey at baseline, 17 (61%) were able to be followed up. The effect of oral health on quality of life was improved in all measurement scores. At baseline, 86% of the participants had at least one item scored as ‘most/all of the time’ for oral health problems; at follow up this dropped to 23% (p=0.001). The ‘extent’ of the effect of oral health on quality of life, the mean number of times a participant ranks one of the 14 items as ‘most or all of the time’, was also significantly reduced at follow-up (3.2 v 0.5, p=0.008). The ‘severity’ of the effect of oral on quality of life, the mean overall sum of all OHIP items, was 21 out of a possible 56 at baseline; this was significantly (p=0.006) reduced at follow-up to a mean of 11 for all participants (Table 1).

Whilst all dimensions of the OHIP-14 improved over time, changes in psychological dimensions were the most significant. These dimensions included being self-conscious (p=0.003), feeling ‘shame’ (p=0.006), being worried, anxious, embarrassed (p=0.008) or being less happy with life (p=0.01) because of poor oral health. The least amount of change was seen in the questions relating to eating and day-to-day living, which may be due to the short follow-up timeframe, not allowing for time to adjust to wearing the dentures. A longer follow-up time may have seen a further increase in improvements in these areas as participants adjusted to their dentures. Continued follow-up of these denture patients is paramount, in order to continue to see continual improvement in OHRQoL.

These results suggest that the denture program is improving the OHRQoL of the denture recipients, but most importantly the psychological impact of poor oral health on quality of life for Aboriginal people. Further research, including costs analysis, with a larger number of participants to confirm these results, could be conducted, including studies on how the provision of dentures may also improve overall mental health for the community.

Table 1:  Summary scores for oral health related quality of life outcomes

Michelle Irving, Neelam Kumar, Anthony Blinkhorn, Faculty of Dentistry, University of Sydney

Folau Talbot, Kylie Gwynne, Poche Centre for Indigenous Health

references:

1 Gerritsen AE, Allen PF, Witter DJ, Bronkhorst EM, Creugers NHJ. Tooth loss and oral health-related quality of life: a systematic review and meta-analysis. Health and Quality of Life Outcomes 2010; 8: 126.
2 Williams S, Jamieson L, Macrae A, Gray C. Review of Indigenous oral health. Mt Lawley, WA: Australian Indigenous HealthInfoNet, 2011.
3 Slade GD, Spencer AJ. Development and evaluation of the Oral Health Impact Profile. Community Dental Health 1994; 11: 3.