Twelve individual interviews and 2 yarning groups with 3 and 5 people respectively, were conducted. All participants were mothers with the exception of one aunty. Of the people approached, no one declined participation. The majority of the participants were recruited from the larger study population attending the health clinic. According to previously collected data, the families in the study population had an average annual income of <$37,000 (US) and 85.5% of mothers were unemployed [24]. Both researchers were present for the group sessions and for 3 of the interviews. The other 9 interviews were conducted by the non-Indigenous researcher independently. Yarns took place at a number of different locations including: the clinic, church and school halls, cafes and local parks. The duration of the yarns ranged between 35 minutes and 2 hours. Along with discussions regarding the impact of child oral health, which have been previously published [25], participants shared their personal narratives on the topic of oral health. The additional discourse is reflective of the yarning process and the participant focused approach of the study. Congruence was observed in participant responses, with women sharing similar experiences and perceptions in both the interviews and group yarning sessions. The themes raised were associated with three stages of life: growing up, as an adult and as a mother and are organised under each stage as shown in Table 1.
Table 1. Stages of life and themes raised during yarning
Growing up
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As an adult
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As a mother
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· Teenage perceptions
· Fluoride
· Traditional approaches
· Diet
· Negative impacts
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· Disease
· Traumatic past experience
· Cost
· Tooth loss and wellbeing
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· Pregnancy
· Diet
· Lack of information
· Recommendations for health promotion
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Oral health growing up
Childhood experiences of oral health varied for participants. The geographic location of participants when they were growing up, along with their age and resources of their parents all influenced their experiences. Most participants indicated that they have more information now than their parents did; cleaning teeth was an accepted practice, but the regularity and approach varied amongst families. Some families were quite ‘strict’, and parents supervised tooth brushing at least once a day. Others indicated that their parents provided the supplies (tooth-brush and toothpaste), but didn’t necessarily monitor their oral hygiene habits. Some participants grew up in regional and remote areas and did not have running water or electric power which acted as a structural barrier to regular oral hygiene habits, even if they did have the personal resources.
We weren’t taught about mouthwash or flossing, we were just taught about brushing, we didn’t know it was about your gums too, I never remember that. But now we learn all that, you know, brush your gums, and clean your whole mouth. Yeah, when I was a teenager, I didn’t give a toss, but then you come to full circle into an adult and you start taking care of it, you remember ‘oh yeah that’s why’, and you start to do things. (Interview – Mum A)
Of those who insisted their parents were ‘strict’ about oral health and regimented tooth brushing, there was not a consensus on whether this influenced their own approach to oral health care in their youth. Many participants remarked that oral health did not become a priority for them until they themselves were adults and started having problems with their oral health. Many participants acknowledged that they did not practice regular oral hygiene habits as teenagers and remember actively disliking having to maintain their oral health. However, most did participate in school dental service visits, which in Queensland are designed to screen all children and render all dentally fit: this was their primary source of professional dental education.
I hated it. There was a period of time where I never used a tooth-brush at all, I just used a towel or whatever I had and went like this (action of rubbing towel across teeth with fingers), but now I brush all the time because I don’t want false teeth. (Group 1 – Mum 1)
Many participants remembered attending school dental services regularly and the use of fluoride tablets administered by the school or their parents. The use of fluoride was generally accepted as a good thing and participants recalled fluoride either being in the water naturally, being added or receiving tablets. Fluoride tablets, along with disclosing tablets (chewable tablets with a vegetable-based dye that colours dental plaque) seemed to evoke a lot of detailed memories for participants and they shared stories of learning about plaque and the tablets they were given to demonstrate how to brush effectively. These tablets caused some embarrassment but were indelible in participant’s memories as a kind of ‘rite of passage’ during childhood.
I remember one time because my front tooth crossed over the other, it would be really dark and I hated it and we would have to take them home and we would have a pink one at home and you would have to chew on it before you brushed your teeth and it would show (the plaque) then you would brush your teeth to see if you were getting it. (Group 1 – Mum 2)
Traditional approaches to oral health such as the use of charcoal for cleaning teeth was discussed by a number of older participants; younger participants also indicated that they remembered their parents sharing traditional teeth cleaning methods with them and had an interest in reviving traditional methods for themselves. One participant had acknowledged how oral health had come ‘full circle’ with the availability of charcoal toothpastes in conventional stores. Participants remembered fondly that in addition to teeth cleaning, their parents and elders had used charcoal in a number of household products. This was attributed to cultural practices, but participants also acknowledged that cost was a factor in utilising alternative methods; often conventional items were more costly than home remedies.
They cooked in the charcoal, and they didn’t shake it off, they just ate it. I can remember going fishing they chucked the fish on the coals. I can remember sitting there spitting out charcoal, you know what I mean about the crunchy gritty bits, but that’s how they lived off the land. (Group 2 – Mum 3)
Along with more culturally specific practices such as the use of charcoal, participants reminisced about the difference in their diets when they were young. Acknowledging that foods were less processed in their childhood and they had less exposure to sugars.
Fluoride was in the water, so we had the healthiest teeth in the cemetery. But being a child back in my day, my folks and I didn’t have a lot of money, so we ate a lot of fruit and mum killed her own cows and stuff, and we did all that. We never went to the shops to buy anything, because mum milked the cows, the goats. We used to eat chook eggs, the duck eggs, you know. (Interview – Mum B)
- Negatives impacts to oral health
Not all past practices were as well regarded as the use of charcoal and home-cooking. Participants shared that they felt that the past social acceptance of smoking likely contributed negatively to their oral health as an adult. As did a lack of preventative dentistry and some dietary habits, such as having baby bottles containing tea or a carbonated, high sugar, beverage. Participants were cognisant of the yellowing of their teeth from a young age and this was seen as undesirable, even when they were young.
You know one thing I feel really strongly about now that I know, is we were brought up with mum and dad smoking in the house. Mum and dad smoking in the car. Mum and dad smoking around children. You know what I mean, and then I look at my teeth and think to myself how yellow they are. And when I go to the dentist, they ask how long have you been smoking: I have never smoked in my life. You know what I mean and then I look back at it and think to myself, like for them to say smoking causes yellowness, and you have that yellow look on your teeth. (Group 2 – Mum 3)
Oral health as an adult
Despite the varied experiences of participants as children, whether they had practiced regular preventative oral health habits or had less structured habits, most indicated that as adults they had experienced poor oral health. Some participants acknowledged that their experience was likely a result of their poor oral health as teenagers. Whereas others felt that they had poor oral health despite the efforts they made to support good oral health. Disease, traumatic past dental experiences and cost were raised as impediments to their current oral health, with tooth loss and its effect on well-being also a commonly shared concern.
A number of participants explained that good oral health was taken away from them by another health condition. Conditions discussed included diabetes, cancer and hypothyroidism. There was a sense in the discussion that they had no agency over their oral health because of their systemic disease. A shared sentiment was that their poor oral health was ‘coming from the inside’ and that externally it didn’t matter what they tried, their oral health seemed to be out of their hands.
For me I had the perfect teeth, you know, and it wasn’t until I got diabetes and I’m fanatical with brushing teeth and mouthwash and flossing, you know, but because of diabetes and stuff like that - I mean don’t believe everything you hear about: ‘if you don’t do this and you don’t do that, this is what’s going to happen’. You can do all the right things and still end up with no teeth. Like I’ve got no teeth because I got really bad infections from my wisdom teeth. I’ve got no molars and I had root canal here, so you can be fanatical as you want. (Group 2 – Mum 2)
- Traumatic past dental experiences
A number of participants shared ‘dental horror stories’, where their oral health and well-being was negatively impacted during dental visits and this made them reluctant to ever attend the dentist again. Some participants readily articulated that they had a dental phobia, whereas others reflected that the fear of pain and their childhood memories of the dentist put them off attending.
And then I got wisdom teeth down and the dentist lady used my good tooth to anchor off and she shattered it. So I still have bits of jaw bone come through, yeah so I’m picking bone out every now and then. I’m picking bone out going, where did this come from? (Interview – Mum B)
There was a consensus amongst participants that the cost of dental care for adults was prohibitive. Many shared anecdotes of the dental restorative work they required but had put off indefinitely because they could not afford it. Participants agreed that they would just wait until there was an issue of pain or loss of function and going to the dentist was no longer optional. For some participants, there was the notion that the dentist was not a welcome place unless you had the work done that was recommended, so why bother going for prevention. One participant shared how she was saving up to go overseas for dental care, hoping to have dentures made as the cost of keeping her teeth in Australia was too much.
I’ve got extras health insurance and I still don’t to go unless I have to and there is something going on. I’m supposed to have a plate to wear when I am sleeping but that thing costs like $400-$500 dollars. (Group 2 – Mum 1)
Tooth loss was a commonly shared concern amongst participants. As was the impact on well-being and confidence when teeth were removed or damaged. Participants explained that tooth loss influenced the way they ate, drank, spoke, smiled and laughed. One participant shared how it had affected her ability to find work because of judgement from potential employers.
Your face changes, even the way you talk, even just rinsing your mouth after you brush your teeth, you know water spurts out. You have to be careful when you are out drinking or eating. I work in a high school and I don’t even laugh anymore because of it. (Group 1 – Mum 3)
Few reasons for tooth loss were discussed specifically. As mentioned previously, some participants shared that their overall health contributed to their poor oral health and others also shared how pregnancy contributed to tooth loss. However, some participants indicated that tooth loss was a result of their limited choices in dental care. Suggesting that given more options for oral health services, they could have kept their teeth.
Going to the dentist nowadays it is cheaper to get a tooth taken out than filled most of the time. (Group 1 – Mum 2)
Oral health as a mother
All participants indicated that their oral health changed when they became a mother. Most insisted there were noticeable physiological changes. Others suggested that the change came from the deficit in time and energy associated with becoming a mother: their focus was moved to their children. As has been reported previously [18], supporting children’s oral health can be stressful and mothers have multiple priorities to juggle including the oral health of their child.
Participants had a lot to share on the topic of pregnancy and oral health. It seemed accepted and commonplace that a woman’s oral health would be impacted with pregnancy. A couple of participants shared some interpretation of the proverb: ‘gain a child, lose a tooth’. There wasn’t a lot of negativity in the yarning, it was just accepted as a fact of motherhood that with children, came poor oral health and even tooth loss. Participants described being drained of nutrients and their bodies giving everything to the baby. No comments were made regarding maternal oral health education or information and so it is difficult to comment whether participants felt that they should have had been provided with more information during their prenatal period.
I think all of it too is having kids, they are just drawing everything out. They just suck the life out of you. They do, because it is all nutrients, the baby is taking everything, you know everything in your gums. That’s when I first started having trouble with my teeth. (Interview – Mum C)
I actually had pretty good teeth up until 19 years ago. And yeah it was true, the minute I fell pregnant I started having issues with my teeth. I was 18 and yeah that’s when I first started having problems. I mean I had fillings all though school, but that’s when they really started deteriorating and the first pulled. (Interview – Mum D)
All participants were aware of the damage that sugar could cause to teeth and shared their approaches to finding balance with their child’s sugar consumption. Many participants shared how it had been an ongoing education for them learning about the effects of sugar on teeth. One participant acknowledged that it had become easier since the obesity epidemic to understand the negative impact of sugar, but still felt there were a lot of mixed messages in society.
The biggest thing for me, I mean my kids still have sugar, they still have soft drink, they still have lollies, chips, ice-blocks. I think it’s all about kind of balancing. You know we might have a treat day, and then the next day we will cut back a little bit, but I’m not so concerned about that. Or that’s not my main concern. But I’m not going to put her to bed with a coke, you know, she is still being breastfed, she’s not having a lot of that food, so I’m not too worried. (Interview - Mum E)
It comes down to your dietary intake, eating your fruit and vegies, if they don’t like what they see in solid, I will blend it and put it on pizza bases or in spaghetti bolognaise. They are going to get it one way or another. (Interview – Mum F)
A number of participants explained that they either ‘learned the hard way’ or had to go out and get information for themselves because of a lack of oral health information, specifically regarding child oral health. One participant in a group yarn shared that she felt that many people in her community did not have enough information and she had never seen any culturally specific information, the group agreed there was nothing available. This sentiment was also shared in other individual yarns with participants commenting on how they perceived the lack of information for their community.
You still see it now when you’re out walking, kids with parents, the kids are just handed a bottle of coke. (Interview – Mum A)
A few participants shared that they had ‘done the wrong thing’ and gave their children milk or juice in bottles or sippy cups as they got older, believing that milk and juice were healthy.
I had to go research it myself, there’s not a lot of parents that get to have the internet and stuff. Like I can’t get on the internet. It’s not like old-school where you can go to an encyclopaedia. Yeah maybe through the school, there is not enough in the school. (Interview – Mum B)
- Recommendations for health promotion
There were mixed feelings about oral health promotion. Most participants agreed that they had more information than their parents, but they also felt that that in some instances some of the approaches that were used when they were children were more beneficial and got a stronger message across than what was available now. For instance, the use of the tablets to colour plaque, school-based interventions and commercials on television. A number of participants lamented that Australian children no longer had a ‘Mrs Marsh’ to learn from. During the ‘70s and ‘80s, television commercials featuring ‘Mrs Marsh’ were aired in Australia, promoting oral health behaviours. A shared sentiment was that more information was needed in schools and parents needed more clear information when children were very young. A few participants shared that it would be good if oral health was addressed when child health nurses came for infant checks or when they had health checks done. Further integration of both primary health care and dental services was raised specifically by one interview participant.
I think it (dental) could be more into the medical side of things, like medical centres as well because you know it seems so separate. You know you got the dental side and the medical side, and I think they really need to push it, you know when they do the health checks, they really don’t check too much about the dental. (Interview – Mum E)
I think to educate kids, especially little, because that is where it starts. You need to start these little jingles up again about brushing your teeth. We do it with hand washing, do it with teeth, you know. Take this jingle back home to mum, like “slip slop slap”. And then maybe with the preppies to year 3, create a person that will come in and dress up as a tooth and show them how to brush their teeth, you know. (Group 2 – Mum 3)
I also think there does need to be more education for the parent, particularly in those early years. If they don’t have good dental hygiene, they are not going to be able to teach the kids well and for them just waiting until school age, there needs to be something out there for the parents. (Group 2 – Mum 1)
In addition to information, some participants acknowledged that limited oral health resources were a problem for families.
Your mouth is, you know talking, eating, and drinking. There is just so much involved around it. I used to do Indigenous support in high schools and we used to have a program focusing on general well-being and puberty and body image, and it was focused on your hygiene and we would sit down and talk to the kids as something as simple as: ‘it was important to brush your teeth twice day’. I mean some of these kids didn’t even have a toothbrush. Well this is when I was working in Toowoomba and we would have to fund it ourselves. We would have to outsource toothbrushes and toothpastes and you know little deodorants and soaps and you would be surprised how many Indigenous kids did not have the equipment, the means to get that and it was really sad. (Interview – Mum E)