For children and young people in out-of-home care, looking after their teeth is not always as simple as being told to brush twice a day.
For one young person who contributed to La Trobe University research, growing up without a consistent toothbrushing routine meant they were later judged for something they had never been taught.
“I never had that routine [toothbrushing]. I never kind of knew how to brush my teeth properly and never got taught. And then it was kind of like being judged, ‘Why aren’t you brushing your teeth properly? You’re lazy,’ or something like that.”
Another young person described feeling that being identified as living in residential care could change how they were perceived when accessing health services.
“Residential kids get a bad rap because it’s like, ‘What have you done to be put in here?’ … When you go to the doctor, or you go to the dentist, they’ll say that you’re a residential kid and they kind of treat you differently to everybody else.”
These experiences are helping researchers understand why improving oral health for children in out-of-home care requires more than encouraging good dental habits.
A project led by La Trobe University’s Violet Vines Marshman Centre for Rural Health Research is working with children and young people, carers, practitioners and oral health services to identify these barriers and develop practical ways to address them.
Funded by The Borrow Foundation, the Protecting Smiles project is based on a simple premise: when children experience trauma, move between care placements and rely on multiple services, oral healthcare needs to be coordinated around their circumstances.
Through a co-design process, the research team worked with children and young people in care, foster and kinship carers, child protection practitioners, care sector staff and oral health providers to understand the barriers to good oral health.
The research found these barriers are often systemic rather than individual.
Dental appointments can be difficult to coordinate, responsibility for follow-up is not always clear, health information may not consistently move with a child, and navigating public dental services can be challenging.
For young people, that can translate into long waits for even routine care: “I think there was a point when I was going to do my dentist to get my teeth looked at, there was, going to be two months to get my teeth checked.”
For those responsible for coordinating care, delays can become even more complicated when appointments are repeatedly rescheduled or a young person changes placement.
“One of my young people has had an appointment booked for quite some time, and it’s been rescheduled numerous times. So, we’ve been waiting quite some time and now they’re moving, so we’ll have to wait until the new year,” said achild protection practitioner.
Consent can present another barrier, particularly when children require more complex dental treatment.
“We’ve had some issues with GA [general anaesthetic] consent … especially for family members looking after them and they are not legally able to give consent. To actually get the consent from the parents has been a nightmare … it’s been months actually waiting for that sort of consent,” said a dental professional.
The research also highlighted the need for more trauma-informed approaches within the oral health workforce, including greater awareness of the experiences children and young people may have had before entering care and the stigma they can experience within health settings.
Research Fellow Dr Stacey Bracksley-O’Grady said the project reinforced the importance of understanding children’s oral health within the broader care system.
“For young people in care, oral health is not just about brushing and check-ups,” Dr Bracksley-O’Grady said.
“It is shaped by placement stability, access to services, communication between systems and whether responsibility for their care is clear and well-coordinated across the systems supporting them.”
The consequences of poor oral health can be significant. Dental caries remains Australia’s most common childhood disease and, if left untreated, can cause pain, disrupt sleep, affect eating and learning, lead to avoidable hospitalisations and contribute to long-term health inequities.
These challenges can be amplified in rural and remote communities, where workforce shortages, travel distances and limited service availability can make accessing routine dental care more difficult. For children already experiencing disadvantage, these barriers can compound existing health inequities.
Professor Santosh Tadakamadla said the project is focused on developing practical solutions and strengthening collaboration between child protection staff, carers, dental services and other supports, particularly in rural communities where resources are often limited.
“Oral health for children and young people in out-of-home care is influenced by much more than individual behaviours,” Professor Tadakamadla said.
“It depends on whether the systems around them support timely access to care, continuity across placements and effective coordination between services. By strengthening those systems, we can help ensure every child has the opportunity to achieve better oral health.”
The Protecting Smiles project has now entered its next phase, translating the research findings into practical resources, such as case-study vignettes to support training for carers, practitioners and oral health professionals. Video resources are also being produced to provide engaging and accessible training materials.
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