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Table 1 Articles that relate to the potential role of IHWs in promoting maternal oral health

From: The role of indigenous health workers in promoting oral health during pregnancy: a scoping review

Author/Study Location Article Type Aims Study Design Intervention/Program/Screening Tool Conclusion Focus Area
Adams et al., 2017 [44]
United States
Peer-reviewed journal article Evaluate effectiveness of a low-cost educational intervention program in clinically improving oral health (OH) Non-randomised controlled trial Intervention:
• CenteringPregnancy Oral Health Promotion program (delivered by midwives)
• 3-h training course for midwives
• Post-training practice session with feedback.
• Significant improvement in clinical OH outcomes as indicated by mean plaque index (p < 0.001), sites bleeding on probing (p = 0.01) & pocket depths (p < 0.001) • Potential role of IHW
• Training program
AIHW, 2011 [39]
Government report Reports on dental data collected from the Closing the Gap Child Oral Health Prevention and Promotion program in the Northern Territory (2009–2010) N/A Intervention:
• Trained registered nurses and AHWs to apply fluoride varnish to at-risk children every 6 months
• Child health checks, conducted by nurses/medical staff, for referrals and improving access to dental services
• Children who received a health check by nurses or medical staff, who also performed a Lift the Lip assessment, could be referred to the dental service for free
• 37% of children (< 16 yrs) in the communities received a dental service
• Potential role of IHW
Braun et al., 2016 [40]
United States
Peer-reviewed journal article Assess effectiveness of an OH promotion program in reducing caries increment in Navajo children Cluster-randomised trial Intervention:
• Community tribal members trained as community OH specialists
• Delivered OH intervention in classrooms and to families
• Caries rate (including decayed, missing and filled surfaces): Nil significant change in children
• Caregiver OH knowledge & behaviour: Rapid improvement after 1 year; no difference after 3 years between groups
• Potential role of IHW
Cibulka et al., 2011 [47]
United States
Peer-reviewed journal article To evaluate the effectiveness of advanced practice nurse model of care to improve the OH among low-income pregnant women Randomised controlled trial Intervention:
• Video with discussion on OH conducted by nurses
• Distributed an oral hygiene kit (toothbrush, fluoridated toothpaste and dental floss).
• No significant change in OH knowledge/perceptions of pregnant women between baseline and follow-up at 36 weeks
• Improved OH practices (e.g. frequency of brushing and flossing teeth) and attendance for dental check-up during pregnancy
• Reduced OH problems in 3rd trimester
• Potential role of IHW
Dental Health Services Victoria, 2017 [41]
Government brochure To provide culturally-appropriate information about available dental services for Aboriginal and Torres Strait Islander peoples N/A Intervention:
• Free dental services for any Aboriginal or Torres Strait Islander person at the Royal Dental Hospital of Melbourne
• Aboriginal Liaison Officer can assist with streamlining communication • Potential role of IHW
Deshpande et al., 2015 [54]
Peer-reviewed journal article Assess the impact of the perinatal OH care education program on the knowledge, attitude & practice behaviour amongst gynaecologists Cross-sectional Program:
• Flip chart and OH resource brochures provided to 46 gynaecologists
• Assessed after 1 month
• Significant improvement in OH knowledge (p < 0.001), & practice behaviour (p < 0.001)
• No significant change (p = 0.49) in attitude of respondents
• Training program
George et al., 2016 [52]
Peer-reviewed journal article Evaluate the effectiveness of the Midwifery Initiated OH (MIOH) program in improving the OH knowledge of midwives & assess their confidence to promote maternal OH post training Pre-post test Program:
• Antenatal OH education and referral
• 3 self-paced online modules over 3 months
Delivered to 50 midwives
• Significantly improved midwives’ knowledge (p < 0.001)
• At program completion 82% of respondents were confident in introducing the topic of OH in their antenatal session, 77.6% were confident with dental service referrals, and 46% were confident to undertake a visual mouth check
• Training program
George et al., 2016 [56]
Peer-reviewed journal article Undertake sensitivity and specificity assessment of the maternal OH screening tool using two comparison approaches- the Oral Health Impact Profile and a clinical oral assessment by trained study dentists Diagnostic test Screening tool:
2-Item Maternal Oral Health Screening Tool administered by midwives
1. OH status
2. OH risk factors
• High sensitivity against the gold standards measured (93.3%, 88.2–97.9% CI)
• Low specificity (20.5%, 13.2–27.8% CI)
• Tool reliable to screen and refer women with OH problems to the dentist
• Screening tool
Hunter et al., 2011 [57]
United States
Peer-reviewed journal article Describe the OH status and OH practices of low-pregnant women in San Diego, California, and determine the needs for OH care education in this population Descriptive correlational Screening tool:
12-Item Oral Health Assessment Questionnaire administered by bilingual (English/Spanish-speaking) nurse-midwives
1. OH status
2. OH risk factors
3. Dietary risk factors
• Poor OH (prevalence of tooth decay was 45.9% and gingivitis was 36.7%)
• Sample less likely to access dental services although had some good daily OH practices
• Highlighted need for additional OH education
• Screening tool
Johnson et al., 2013 [45]
Conference abstract To evaluate the effectiveness of the midwifery-initiated oral health dental service (MIOH-DS) program in improving the uptake of dental services, quality of life and OH knowledge among pregnant women Randomised controlled trial
Three groups: 1) No intervention; 2) Midwifery Intervention (MIOH); and 3) Midwifery and dental intervention (MIOH-DS)
• OH education, assessment and priority dental referrals during early pregnancy
• Delivered by midwives
• 50% improvement in dental service uptake for participants who received the midwifery-initiated oral health dental service (MIOH-DS) intervention program
• No significant difference between group receiving MIOH intervention and control group
• Quality of life significantly improved in both intervention groups
• OH knowledge significantly improved for all 3 groups
• Potential role of IHW
Lawrence et al., 2017 [48]
Peer-reviewed journal article Assess effectiveness of the Sioux Lookout Zone prenatal program on primary caregivers’ dental preventive beliefs, behaviours and feeding habits of infants and toddlers Longitudinal and cross-sectional approaches Intervention:
• One-on-one, culturally-appropriate, nutrition and OH preventive education
• Woman-and-child nutrition educators visited caregivers in their homes
• High program coverage (> 70% community received intervention) had significantly improved dental knowledge (p < 0.05) and practices (e.g. toothbrushing frequency)
• Over 90% of children were found to have early childhood caries despite changes in knowledge, beliefs and practices
• Potential role of IHW
Mathu-Muju et al., 2016 [38]
Peer-reviewed journal article To increase access to preventive dental services for First Nations and Inuit children living on federal reserves & in remote communities of Canada Cross-sectional Intervention:
• Children’s Oral Health Initiative (COHI) provided preventive dental care with culturally-appropriate OH messages
• Dental therapists and hygienists collaborated with an Indigenous COHI aide
• Increased access of preventive dental services from 2006 to 2014
• Community capacity building with the employment of COHI aide was successful in improving access to preventive dental care. Approximately 50% of children living in the reserves participated in the OH initiative.
• Potential role of IHW
McGuire et al., 1998 [49]
Peer-reviewed journal article To describe the OH workshop targeting AHW (Aboriginal health worker) trainees in a remote community Descriptive Program:
• OH program (2 day workshop) with 23 AHW trainees
• Focussed on dental conditions, OH knowledge & education, prevention & treatments (fissure sealants, fluoride, oral hygiene products)
• Described as interactive, practical & engaging
• Reported to be valuable for those in remote areas
• Training program
New York State Department of Health, 2006 [58]
United States
Clinical practice guidelines Develop clinical practice guidelines for health care professionals relating to OH care for pregnant women and young children N/A Screening tool:
2-Item questionnaire for initial prenatal screening administered by antenatal care provider
1. OH status
2. OH risk factors
• Discussed and outlined role of antenatal providers to integrate OH into maternal health • Screening tool
Öcek et al., 2003 [53]
Peer-reviewed journal article Evaluate the effectiveness of a dental health program for midwives working in primary health care services Mixed-methods Program:
• Interactive OH educational program focussed on infants
• Content based on pre-test assessment
• Program delivered to 164 midwives
• Improvement in OH knowledge among midwives (significance unreported)
• Program perceived to be relevant to practice
• Training program
Oral Health Care During Pregnancy Expert Workgroup, 2012 [22]
United States
National consensus statement Developed to assist health professionals, program administrators and staff, policymakers, advocates, and other stakeholders respond to the need for improvements in the provision of OH services to women during pregnancy N/A Screening tool: 4-Item oral health questionnaire administered by prenatal healthcare professionals
1. OH status
2. OH risk factors
3. Visual inspection
• Questionnaire developed from a national expert panel coordinated by the National Maternal and Child Oral Health Resource Center • Screening tool
Pacza et al., 2001 [51]
Peer-reviewed journal article Institute a culturally appropriate preventative OH program at a community level Descriptive survey Program:
• Pilot OH training program for 27 AHWs in a rural and remote community
• 3 modules over 96 h (36 h in the classroom; 60 h on-the-job)
• Material was relevant & enjoyable
• Difficulty was moderate
• Students perceived they had a good understanding of module objectives and relevant to their needs.
• Training program
Parker et al., 2005 [42]
Peer-reviewed journal article Describe the development, implementation and evaluation of the first stage of the OH Program (dental clinic/service) for the Indigenous community serviced by Pika Wiya Health Service Descriptive Intervention:
• Rural OH service designed to meet cultural needs of the Indigenous population
• Recruited an AHW to coordinate for administrative duties and establishing the program
• High service demand in 1 year (229 individuals, 1582 treatments)
• AHW involved in program development, health promotion & recruitment
• Potential role of IHW
Slade et al., 2011 [43]
Peer-reviewed journal article To evaluate effectiveness of trained primary healthcare workers in preventing dental caries in preschool children living in remote Aboriginal communities in Northern Territory Cluster-randomised, concurrent controlled trial Intervention:
• Nurses and/or AHWs applied fluoride varnish on children, advised parents on caries prevention, promoted traditional health, demonstrated OH practices
• Engaged members of community during events.
• Intervention consisting of fluoride varnish & OH promotion reduced caries by 24–36% • Potential role of IHW
Smith et el., 2016 [50]
Peer-reviewed journal article To evaluate the OH training program targeting AHWs in cultural appropriateness, course content and respondents’ perception of competence to offer OH advice Qualitative Program:
• Smiles not Tears OH programme (1 day with presentation, role-play & group discussion)
• Delivered to 61 AHWs educating about OH for young children
• Increased AHWs’ confidence to offer dental advice to target population
• Course received positive feedback in content and perceived to be culturally appropriate
• Training program
South Australia Dental Service, 2015 [37]
Business Plan Improve oral health outcomes for eligible Aboriginal and Torres Strait Islander people in South Australia by increasing the number who access mainstream dental services N/A Intervention:
• Aboriginal Oral Health Program trained Health Workers to assess, refer adults, children, and pregnant women to dental services
• Developed a streamline referral pathway for pregnant women
• Outlined seven key performance indicator objectives and corresponding actions/strategies • Potential role of IHW
Stevens et al., 2007 [46]
United States
Peer-reviewed journal article Describe strategies used by one adolescent pregnancy program to implement New York State Department of Health (NYSDOH) OH guidelines Descriptive Intervention:
• Nurse midwives and a nurse practitioner educated, assessed and referred patients to dental services
Screening Tool:
Two-item questionnaire (NYSDOH 2006)
• Dental risks screening, referrals, education & regular dental care were vital to program
• Nurses were “driving force” for OH promotion; they led the screening, assessment & education
• Potential role of IHW
• Screening tool