Improving Dental Outcomes for First Nations Peoples

“Aboriginal and Torres Strait Islander peoples and communities are the oldest continuing culture in the world and have generations of wisdom and practice knowledges regarding health and healing. Indigenous ways of knowing, being and doing has much to offer contemporary healthcare systems, health professions education and healthcare services in terms of improving effectiveness, quality and safety,” Satur, Forsyth and Bolton, 2021.

An ambitious plan to implement better dental care for First Nations people has taken a step closer to being realised with the launch of a new Aboriginal and Torres Strait Islander Cultural Safety Curriculum.

Led by University of Melbourne Professor of Oral Health, Julie Satur, the national curriculum will embed a culturally safe educational approach for dental students and help to foster a growing Indigenous dental workforce.

“Cultural safety is a spirit of practice taking into account Indigenous peoples’ strong connections to Country,” says Mr Josh Cubillo, Indigenous Health Leadership Coordinator at Melbourne Poche Centre for Indigenous Health.

“We are asking all dental practitioners to undertake critical self-reflection to address identified bias, assumptions and racism.”

The curriculum was commissioned by the Australasian Council of Dental Schools and has been developed based on key areas of culturally safe practice identified with the expertise of Aboriginal and Torres Strait Islander people.

It is based on six oral health focus areas – Reflect, Respect, Communication, Safety, Quality and Advocacy. Each area is underpinned by individual learning outcomes – 36 in total.

“We know dental care is expensive and oral health disparities between Indigenous and non-Indigenous Australians are significant. We also know that poor oral health has multiple effects on other aspects of health,” says Professor Satur.

“The ongoing impacts of colonisation and racism position our First Nations people in a system of disadvantage which creates inequitable barriers to achieving good oral health. These barriers also limit participation in the dental workforce by Aboriginal peoples. Fostering educational and health environments that support cultural safety is critical to improving access to, and leadership for, oral health in communities.

“We need to graduate dental practitioners who can recognise the importance of person-centred and self-determined decision making that fits with the knowledge and values of First Nations people and their communities. Without cultural safety, there is no clinical safety.”

In January 2021, the Australian Health Practitioner Regulation Authority and the Dental Board of Australia established new accreditation standards for dental programs that include a requirement for cultural safety.

The new curriculum will enable the development of these skills in all Australian dental schools across 62 accredited programs over the next five or so years.

Ms Joanne Bolton (GCert.in University Teaching 2018), Senior Lecturer, Interprofessional Practice and recipient of the 2020 University Excellence Award for Innovation in Indigenous Education, helped develop the curriculum. She says western health systems can learn a great deal from Indigenous ways of thinking about health through a community, holistic, connected and people-centred lens.

“Cultural safety practice is everybody’s business and we knew that the new cultural safety curriculum needed to be practical and flexible. Numerous resources have been included in the document that can be used and introduced at different points each semester and they have been carefully and purposefully curated to make sure First Nations voices are prioritised and listened to,” says Ms Bolton.

“If cultural safety practice is more evident in the curriculum, then educators can also benefit from making their curriculum more inclusive. In turn, this can create better experiences for Aboriginal and Torres Strait Islander students. What we didn’t want was a pretty document that will just sit on a shelf. We want it to be a practical help to support oral health educators to make changes in the way they teach.”

Eliza Collins (BOralHlth (Hons) 2022) is an oral health therapist and educator at Rumbalara Aboriginal Co-operative in Mooroopna, north of Shepparton. She shared her experiences of working in First Nations communities with the curriculum development team to help shape the content.

“People don’t feel culturally comfortable in many health practices and some of that comes down to the practitioners and how they interact, the language they use and their body language. They come to work and do their job but they often don’t step out of their own culture and ‘western ways’ of providing care to cross a cultural bridge,” she says.

“When practitioners use dental jargon, people often leave feeling confused and disempowered; we need to break that down. We need to use more person-centred language and find ways to explain things in a way that people can understand and use. I don’t think communication is taught as well as it could be – it’s not seen as having the same importance as a clinical skill but it is vital to good care.

“I hope that the new curriculum helps people realise some of the prejudices they might have and I hope it helps to develop students who are more open-minded and who understand how they come across as a practitioner and how that can make a difference to anyone – Aboriginal or otherwise.”

Professor Satur is hopeful that the new curriculum, as it is rolled out, will make a tangible difference to the oral healthcare experiences of First Nations people.

“I’d like to see every dental practitioner able to practise in a culturally safe way with any Aboriginal person. We also need to increase Aboriginal participation in dental practice and encourage more young people to see dentistry as something they want to do,” she says.

Mr Cubillo says the new curriculum is an important step forward.

“Cultural safety leads to cultural respect and a feeling of security for the patient,” he says.

“Acknowledging Indigenous ways of knowing, being and doing is the biggest step and this new curriculum is a start.”