Graphic: children learning how to brush their teeth

children learning how to brush their teeth

Giving people back their smiles

Good dental health is important to overall health, but access to oral healthcare is particularly difficult for people living in rural and remote areas.

With fewer than half the number of practising dentists in metropolitan areas available in isolated regions, there is a much higher rate of dental problems, including in children, in rural and remote areas.

Dental problems not only affect general health and wellbeing, but can lead to issues with diabetes, stroke, heart problems, pneumonia and low birth weight in babies.
Since 1998 the RFDS has operated a full-time dental service out of Broken Hill Base and since 2012 The Outback Oral Treatment and Health (TOOTH) program has run from our Dubbo Base. Dentists also travel on our week-long 'fly-in, fly-out' clinics visiting remote cattle stations and towns not regularly serviced by the RFDS.

"You've given me back my smile," was the response of one woman after attending a TOOTH clinic in Bourke recently. Not only was she no longer in pain, but she was no longer embarrassed about showing her teeth.

The TOOTH program was made possible through three years of funding collaboration with the Investec and Gonski foundations. Over that time the program has provided 695 clinics and treated 4,992 patients across the remote NSW communities of Bourke, Collarenebri, Goodooga and Lightning Ridge, where access to dental care was either non-existent or extremely challenging.

The program halved the decay in children attending clinics and established a consistently declining pattern of decay in adults. Several patients were also found to have oral cancer; dentists are usually the only ones screening for oral cancer.

Given the high needs and the success of the program to date, the RFDS SE has committed to continue the TOOTH program while it works to ensure long-term funding. The RFDS is working to improve access to dental care, teach children about good oral health and attract new dentists to rural areas.

Teaching toddlers dental care

TOOTH dental health education clinics help to educate pre-schoolers in how to brush their teeth correctly and the importance of good diet. Children are also dressed up in the types of gowns and masks worn during dental procedures so that a trip to the dentist is something they have learned about.

Dental therapists also do simple screenings by sitting each child in a chair in a separate room and using a mirror to examine their teeth. If the child is nervous about this process, they can be accompanied by a friend. Should the therapist see anything which needs work then the child is given a letter for their parent or guardian so that they can make an appointment at the clinic.

Award for collaboration project

RFDS Senior Dentist Lyn Mayne's report, Sugar Gums – Diabetes and Gum Disease, won the ACI Innovation Award from the NSW Health Agency for Clinical Innovation. Gum disease is a chronic inflammatory disease which has a direct impact on blood sugar levels, yet diabetic patients are not routinely referred for oral health checks.

The project described in the paper involved oral health care in patients with diabetes and showed that a collaborative approach to patient care can have positive outcomes. There were decreased numbers of 'call-outs' and medical appointments, decreased dental wait lists and better use of staff.

Teams involved included the RFDS oral health team, and nurses, aboriginal health workers and administrative staff across organisations of the Far West Local Health Network and Maari Ma.

Graphic: Kah Chong

New Dental Staff - Dr Kah Chong, dentist

Kah moved from Melbourne to join the TOOTH team at Dubbo and has a wide range of experience in both public and private practice in Australia and overseas.

Kah volunteered as part of CRISIS, which provides dental care to the homeless in London and also at the Buddhist Library Project in Cambodia, where he supervised dental students as they treated school children.
When not at work, Kah enjoys sailplane gliding, swing dancing and playing the ukulele.

Graphic: Emmy Leach - Dental Assistant

New Dental Staff - Emmy Leach, dental assistant

Emmy is TOOTH's first dental assistant, providing much-needed coordination between patients and the dentist and dental therapist during clinics.

Emmy has private-practice experience as well as a keen interest in making patients feel at ease in the dental clinic and working with children.

City students encouraged Outback

Anna Li is one of four dental students from Sydney University who are taking advantage of the Rural Placement Program which provides undergraduates with the experience of providing clinical care in rural clinics as a way of encouraging them to join country dental practices once they have qualified.

Anna and her fellow students have spent a month in Dubbo and going on RFDS clinic flights to the rural and remote locations such as Bourke, where the TOOTH program operates.

"It's been a real eye-opener," says Anna, who had never been to the Outback before, nor lived away from home. "All of us are very interested in moving away from the city to practice. There is a strong focus on the rural program at university. It's been really good getting to apply things we've learned."

Anna Li

City students encouraged Outback

Anna Li is one of four dental students from Sydney University who are taking advantage of the Rural Placement Program which provides undergraduates with the experience of providing clinical care in rural clinics as a way of encouraging them to join country dental practices once they have qualified.

Anna and her fellow students have spent a month in Dubbo and going on RFDS clinic flights to the rural and remote locations such as Bourke, where the TOOTH program operates.

"It's been a real eye-opener," says Anna, who had never been to the Outback before, nor lived away from home. "All of us are very interested in moving away from the city to practice. There is a strong focus on the rural program at university. It's been really good getting to apply things we've learned."

The Good Old Days

Retired stockman Jack Goldsmith is an RFDS donor with a story which shows just how desperate people could be for Outback dental care almost six decades ago.

Back in 1958, Jack was working on the west coast of the Cape Yorke Peninsula at Rutland Plains Station when he first noticed that one of his molars was aching. The pain came and went for a while, and with no dentists anywhere anyway and spending much of his time on the track, Jack treated it with everything from plugging it with tobacco or cloves to drinking to dull the pain.

But by the time he was back near the station, his toothache had become an abscess, causing his jaw to swell up. His station manager suggested Jack try catching up with the Flying Doctor on their next clinic visit to the nearby Kowanyama Aboriginal Settlement and offered to drive him out.

On the appointed day, Jack was at the end of the queue and it was dark by the time the doctor took a look at Jack's tooth under a dangling lightbulb. He was appalled, but Jack refused to leave until it was pulled out.

"I was told to sit on a box, alongside a post and to hand over my belt," explains Jack. "The doctor used the belt to tie my head to the post and got to work on my tooth with a huge pair of pliers."

Despite the doctor's best efforts pulling in different directions, the molar refused to budge for some time. Although Jack was almost fainting with the pain, he was also aware that he was being watched by everyone else and didn't want to lose his reputation for being 'real tough'.

"I got the impression they were enjoying every minute of it," says Jack of his audience.

"Eventually it came out. The doctor was standing there with this huge, bloodied tooth in his pliers saying 'no wonder it was so difficult, the roots are crossed'!"

(Jack's story features in more detail in More Great Flying Doctor Stories by Bill 'Swampy' Marsh, published in 2007 by ABC Books.)