Following three decades at the top of her profession, there’s little that Dr Sarah Raphael has left to prove. Yet when it comes to the race to eliminate sugar from children’s lunch boxes, the veteran practitioner feels she’s barely out of the starting blocks, as Tracey Porter discovers.
It seems almost inevitable that dedicated paediatric powerhouse Dr Sarah Raphael would one day find herself at the forefront of children’s oral health best practice. Introduced to the dentistry sector courtesy of her late father, a GP dentist whose career spanned more than 50 years, Dr Raphael was still two years from finishing high school when she began nagging her parents to approve her absence so she could work as a receptionist-cum-dental assistant at her dad’s West Perth clinic.
While her contemporaries vacillated about which direction to head, Dr Raphael set about achieving a Bachelor in Dental Studies from the University of West Australia. But forced to withdraw in her final year due to illness, and getting disillusioned with her prescribed course which required her to repeat her final year, she made the bold decision to transfer her studies to Adelaide University where her goal was to obtain her degree before moving on to another area of health.
Passion for paediatrics
It was here she had the good fortune to cross paths with two academics who reignited her passion for work and helped equip her for post-student life. Not only did the pair help restore her self-belief, they also taught her what good leaders look like, she says.
“The move showed me that I had skills that were valuable and that I could use for the good of oral health.” As a new graduate, her first job was for the South Australian School Dental Service where she was required to work from a dental caravan parked on the school premises in remote locations up to six hours north of Adelaide.
Having determined that children’s oral health was where she belonged, in 1993 she moved to Sydney to complete a master’s degree in paediatric dentistry. “One of the things I loved most was trying to get a difficult kid to sit in the chair for an exam or simple treatment. When you have that responsibility, it can make or break people’s ‘dental experience’ for many years to come. To be part of the process of creating a good dental experience for people is very important,” she says.
Dr Raphael, whose husband Dr Kareen Mekertichian is also a specialist paediatric dentist, says she felt drawn to this career because “children have no pretence and take everything at face value. It’s lovely seeing them get to an age where they get a sense of humour. But tiny tots are so innocent, vulnerable and have such great openness that it makes for very rewarding work.”
Stints in the paediatric dentistry department at Westmead Hospital followed before Dr Raphael was invited to join the team at Colgate, focusing on knowledge translation, advising its marketing, pharmacy, regulatory and consumer information service teams and assisting with its education, research and advocacy initiatives. It was a role she would hold on and off for the next 20 years and one which would see her gain a scholarship to attend the Senior Dental Leaders Course, a collaboration between Global Child Dental Fund, Harvard School of Dental Medicine and Kings College London.
Today the 53-year-old mother of two (son Daniel aged 17 and daughter Sophia 15) has established an international reputation for being at the top of her game when it comes to knowledge translation, education and research consultancy. Recently, Dr Raphael has commenced as Advocacy & Policy Advisor at ADA NSW as well as continuing some research at the University of Sydney. ADA NSW provides the perfect platform for her work to improve oral health. The support from ADA NSW Board, CEO and colleagues in the communications team made it possible for her to be a voice advocating for good oral health.
Having sat on numerous national and local committees for the past two decades—with the ADA NSW, the Australasian Academy of Paediatric Dentistry and the Alliance for a Cavity Free Future among them—she has also found the time to collaborate with several university colleagues undertaking research and publishing papers on everything from Parental Awareness of the Emergency Management of Avulsed Teeth in Children to a systematic review of whether there is a place for Tooth Mousse in the prevention and treatment of caries.
“[Dr Raphael] offers the general public evidence-based advice which will help children have a healthy disease-free smile. Her advice is simple, easy to understand and can be implemented by the average family without too much fuss or effort.”—Professor Anthony Blinkhorn OBE, NSW Chair of Population Oral Health, NSW Health
Of late it has been her crusade to encourage parents to eliminate sugars from their children’s lunch boxes which has not only seen her reputation as a formidable academic cemented but also led to accolades including an ADA NSW meritorious service medallion.
Meeting of the minds
Professor Anthony Blinkhorn OBE, the NSW Chair of Population Oral Health at NSW Health and a distinguished paediatric dentist, has known Dr Raphael for more than a decade. He describes her as a credit to the dental profession and attributes her with being at the forefront of offering advice on the prevention, rather than the treatment of, oral health disease.
“She offers the general public, especially parents, evidence-based advice which if followed will help children have a healthy disease-free smile. She makes sure her advice is simple, easy to understand and can be implemented by the average family without too much fuss or effort.”
A/Prof Richard Widmer is a leading Sydney-based paediatric dentist and is the head of Westmead Children’s Hospital dental facility. He says he has been impressed by Dr Raphael since the first time he spoke with her about the possibility of postgraduate training in paediatric dentistry.
“I subsequently met Sarah some months later when she started her training. It was evident she was intelligent, determined, very organised and would embrace her paediatric training with passion.
“Sarah, like all clinicians, especially paediatric dentists, has always focused her clinical work around prevention and treatment. Prevention naturally includes an understanding of how pervasive is the problem of added (or hidden) sugars in our diets.”
Through her work at ADA NSW, Dr Raphael has become involved in the Western Sydney Diabetes Alliance and as a result has become ‘the face’ of the sugar moratorium movement. She says that while Australians like to think they’re in good shape when it comes to the state of the country’s oral health, overall the trends are not looking good.
“This region of Sydney currently has one of the highest rates of type 2 diabetes in Australia and the projections for the next decade, if there are no significant changes, are frightening. If you average out the whole of Australia, the oral health has improved a great deal over the past 50 years. In fact, one of the difficulties in aged care is that people are keeping their own teeth longer and often the required dental services in the aged care sector are not readily available.
“However, we now have a situation where just over a third of five- to six-year-olds have decay in their primary teeth and almost 40 per cent of 12- to 14-year-olds have decay in the permanent teeth. The alarming thing is that the 10 per cent of teenagers with the most extensive decay have up to five times more decay than the average.”
Dr Raphael says what this means is that there are groups of people who still suffer from very poor oral health, in particular rural and remote Australians and indigenous Australians.
She says there are many different pressures on families today which have contributed to these issues. She cites Western Sydney’s ‘food deserts’—localities where there are a high percentage of households without access to a car and where there is no supermarket within half a kilometre but usually at least one takeaway option within the half kilometre area—as an example. “It’s easy to talk about laziness, lack of education or being time-poor but clearly for some, it is a battle to live a healthy lifestyle.”
“Once people hear the same message from all angles, appropriate resources are available and they become responsible for their own health, it will bring about the necessary changes.”—Paediatric dentist Dr Sarah Raphael, Advocacy & Policy Advisor, ADA NSW
While there are some cases where simply raising awareness and providing good advice will make an incredible difference, there are many others that require a complete program to result in gains in health, she says.
For its part, the Sugar Research Advisory Service (SRAS), a scientific education service group funded through the Australian Sugar Industry Alliance and New Zealand Sugar, agrees with the ADA NSW stance that poor nutrition and a sedentary lifestyle are closely associated with ill health.
Give teeth a rest
Mary Harrington, the group’s nutrition manager and program lead says there is no doubt that tooth decay is caused by consuming sugar but argues it is often forgotten that any fermentable carbohydrate can also have the same result. The less obvious non-sweet foods, such as hot chips or bananas, can also be a problem for teeth.
“The real issue is the frequency with which sugary and fermentable carbohydrate foods and drinks are consumed,” says Harrington. “It’s easy to snack and sip all day long but you’re not doing your teeth any favours. Saliva is our body’s protection system and neutralises acid produced in the mouth. But you need to give it time to do its job. That’s why it’s recommended to give teeth a rest between meals and snacks (for around two hours). This allows the natural protective buffering of acids and repair of teeth by saliva.”
Harrington says SRAS agrees with the ADA NSW and its advice to make sure diet doesn’t negatively affect teeth. This includes limiting sugary treats to meal times, rather than between meals.
She says regular brushing with fluoride containing toothpaste and flossing removes dental plaque and decreases the risk of acids being made when eating and drinking.
But the way forward, as Dr Raphael sees it, is to specifically target vulnerable groups with more awareness, education and resources, while at the same time continuing the message to all Australians to take better control of their own oral health.
Slow behavioural changes
“At the end of the day, we [peak bodies, professionals, governments] all have to work together to bring community change about sugar. Once people hear the same message from all angles, appropriate resources are available and they become responsible for their own health, it will bring about the necessary changes.”
While on many days it can seem like an uphill battle, Dr Raphael remains optimistic that change can occur. However, she also acknowledges advocates such as herself need to be realistic in their approach because behavioural change “is always slow.
“Ultimately, once we get credible celebrities on board with the message, it should start to get further traction. All you can do is keep consistent messages going and realise it takes time. I don’t think it’s a hopeless fight. I’m just one tiny part of the whole big picture and I’m happy to keep doing my part.”