NDIA Accountability Project

Submission 32 — Dr Carol Tran — Inquiry into the Thriving Kids initiative

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Submission to the Inquiry into the Thriving Kids Program

– Oral Health Supports

From: Dr Carol Tran, BOH, PhD

Oral Health Therapist

Managing Director, Oral Health Home Pty Ltd

Date: 25/09/2025

Summary

This submission highlights the critical role of oral health supports in helping children with developmental delay, intellectual disability (ID), and autism thrive. Dental caries (tooth decay) is the most common chronic disease of childhood in Australia—yet it is entirely preventable with the right supports.

Our play-based, trauma-informed, and family-centred oral health programs—delivered in community settings—demonstrate measurable improvements in children’s cooperation, oral self-care, and overall health outcomes. Oral health practitioners are uniquely positioned to deliver these supports. Traditional dental services/clinics, occupational therapy, or allied health programs do not adequately address the behavioural and functional aspects of oral hygiene for children with developmental needs. Addressing the Terms of Reference

  1. Evidence-Based Supports for Parents Parents of children with global developmental delay (GDD), intellectual disability, and autism frequently report challenges with daily oral hygiene and the burden of oral disease. Our programs employ positive behaviour supports, including play-based tools, sensory-friendly approaches, and trauma-informed strategies, to help parents and children establish oral self care routines.

  • Example: Through funded sessions, children who previously resisted toothbrushing now engage willingly, with observable reductions in distress and improved cooperation.

  • Measurable changes include: o Greater independence in brushing. o Reduced resistance behaviours. o Increased tolerance of preventive care activities. o Improved cooperation with dental practitioners, reducing the need for general anaesthesia (GA). o Lower future disease risk through improved oral hygiene habits.

  1. Effectiveness of Current and Previous Initiatives Conventional dental services are not designed for coaching parents or modifying children’s behaviour. As a result, many children with GDD/ID require hospital-based treatment under GA

for caries management. This is costly, traumatic, and largely preventable with early oral health supports.

  • Oral health supports embedded in playgroups, special schools, mainstream schools, and homes provide continuity while directly addressing behavioural and developmental barriers.

  • Unlike occupational therapists or speech pathologists, oral health therapists are trained in both clinical oral care and behavioural techniques specific to oral hygiene.

  1. Equity and Intersectional Issues Children from First Nations and culturally and linguistically diverse (CALD) backgrounds experience disproportionately high rates of untreated dental caries. Delivering oral health supports in trusted, community-based environments (e.g., neighbourhood centres, playgroups, cultural hubs) ensures culturally safe and accessible care.

  2. Workforce Gaps and Training There is a recognised gap in workforce structures and training for oral health supports outside the dental clinic. Oral health practitioners—including oral health therapists, dental hygienists, and dental therapists—are ideally placed to deliver these interventions. Training priorities should include:

  • Trauma-informed care.
  • Positive behaviour support strategies. • Engagement with parents and carers in disability and early childhood contexts,

delivered in environments where families feel safe.

  1. Policy Experience and Best Practice International evidence highlights the benefits of integrating oral health supports into

developmental frameworks for children with disability. In Australia, various funded oral health programs have already demonstrated:

  • Reduced need for GA procedures.
  • Improved daily oral hygiene at home.
  • Greater cooperation with healthcare providers. Parents consistently report increased ease with oral care tasks and reduced stress around oral hygiene routines.
  1. Seamless Transition Through Systems Embedding oral health supports within Thriving Kids would ensure that:

  • Children with mild to moderate support needs develop oral self-care capacity before disease develops.

  • Parents receive ongoing, structured education.

  • Preventive oral health can be normalised within playgroups, early learning, and school settings.

Why Oral Health Supports Are Critical

  • Dental caries is the most common chronic disease of Australian children (AIHW, 2022; Do & Spencer, 2016). It affects quality of life, learning, nutrition, growth, and social participation.

  • Children with disability are at higher risk of untreated caries, extractions, and hospitalisation under GA (Azimi et al., 2022; Fenning et al., 2020).

  • Children with cerebral palsy, autism, developmental delay, and Down syndrome experience greater aversions to dental care, increased treatment complications, and difficulty accessing dentists willing to provide care (Nelson et al., 2011).

  • Economic burden: Hospitalisations for preventable dental disease cost over $1 billion annually in Australia (AIHW, 2020). Dental decay accounts for around 20% of dental hospitalisations, disproportionately affecting vulnerable children (Queensland Health, 2023).

  • Oral disease is preventable through targeted supports that empower children and families to manage their own oral hygiene.

    • Early, community-delivered oral health supports reduce the long-term costs of

treatment and improve both participation and developmental outcomes.

Recommendations

  1. Recognise oral health supports as core to Thriving Kids: Integrate oral health into developmental screening, family education, and intervention pathways.

  2. Fund play-based oral health programs: Ensure NDIS-style supports are accessible across mainstream early childhood and school settings.

    1. Strengthen oral health workforce capacity: Recognise and fund oral health

practitioners as key developmental support providers, distinct from dentists.

  1. Embed equity strategies: Ensure culturally safe, trauma-informed, and accessible oral health supports for First Nations and CALD communities.

  2. Measure outcomes: Track behavioural changes, reduced GA reliance, and improved oral hygiene to demonstrate health and economic impacts.

References

  • Australian Institute of Health and Welfare (AIHW). (2022). Australia’s oral health and dental care. Canberra: AIHW.

  • Do, L. G., & Spencer, A. J. (2016). Oral health of Australian children: The National Child Oral Health Study 2012–14. Adelaide: University of Adelaide.

  • Nelson, L. P., Getzin, A., Graham, D., Zhou, J., Wagle, E. M., McQuiston, J., & Huntington, N. L. (2011). Unmet dental needs and barriers to care for children with significant special health care needs. Pediatric Dentistry, 33(1), 29–36.

    • Fenning, R. M., Steinberg-Epstein, R., Butter, E. M., Chan, J., McKinnon-

Bermingham, K., Hammersmith, K. J., … & Kuhlthau, K. A. (2020). Access to dental

visits and correlates of preventive dental care in children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 50(10), 3739–3747.

  • Azimi, S., Wong, K., Lai, Y. Y. L., Bourke, J., Junaid, M., Jones, J., … & Leonard, H. (2022). Dental procedures in children with or without intellectual disability and autism spectrum disorder in a hospital setting. Australian Dental Journal, 67(4), 328–339.

  • AIHW. (2020). Oral health and dental care in Australia: Key facts and figures. Canberra: AIHW.

  • Queensland Health. (2023). Dental and oral health. In Report of the Chief Health Officer Queensland: The health of Queenslanders. Queensland Government.

https://www.choreport.health.qld.gov.au/archive/2023/our-health/dental-and-oral health