A project to improve the dental health of Indigenous residents in remote and regional NSW is delivering impressive results. Clea Sherman reports
For the majority of Australian children, a soft drink is a special treat. In regional communities, it is often the only option for a cold beverage.
A lack of access to clean, refrigerated drinking water is just one of the roadblocks to oral health for Indigenous Australians who live in remote areas. Distance is also a factor. For residents in central northern NSW, as recently as a few years ago, visiting the dentist meant a trip across the border to Queensland. Having no car or public transport service made this journey all but impossible.
In 2013, Sydney’s Poche Centre for Indigenous Health launched a project aimed at transforming Indigenous oral health. Led by Adjunct Associate Professor Kylie Gwynne, the resulting initiatives have led to remarkable improvements.
“Six years ago, trips to the dentist were rare in remote communities,” explains Dr Gwynne. “Most people we encountered would only seek help when they were in extreme pain.” As a result, encounters with the dentist were expensive, painful and traumatic.
Developing a new model
With the lack of access to dental care presenting a major problem for Indigenous communities, Dr Gwynne and the team at the Poche Centre took a multi-faceted, co-design approach. This gave the people who were impacted by the problem the opportunity to contribute to the solution.
After travelling to regional NSW, “we got everyone together. This included local elders, community members, teachers and community health services”, says Dr Gwynne.
“We held discussion sessions and asked people what they wanted. One of the major requests was to have dental care within walking distance.”
The idea that emerged from discussions was to implement mobile dental clinics and portable treatment kits, rather than expecting people to travel for hours to see a dentist.
Now, a mobile dentist is stationed in one regional town, with a roster which takes him or her to surrounding communities throughout the week.
Creating jobs. Creating smiles.
For Indigenous communities, there have always been cultural challenges when it came to visiting the dentist.
“We refer to this as ‘cultural safety’,’’ says Dr Gwynne, who has 30 years’ experience in designing and implementing essential services for vulnerable Australians.
In the past, seeing the dentist meant visiting an unfamiliar and sometimes hostile environment. A lack of understanding between cultures meant a less than ideal experience.
To counter this, the young dentists who work with Indigenous Australians in regional clinics are given information about understanding local customs.
Another step to bridge the cultural divide has been recruitment and training. “We now offer scholarships and support local community members so they can complete their Certificate III and IV as dental assistants,” explains Dr Gwynne.
Having locally qualified practitioners means dental patients see a familiar face when they visit a clinic.
Education completes the picture, both for local communities and regional dentists, who tend to be junior practitioners.
“Newly graduated dentists and oral health therapists participate in our regional programs as part of their intern year. To fill their knowledge gaps, we rely on teledentistry. A compulsory online clinic is hosted every week and young clinicians take turns presenting cases. The presiding specialist reviews the case and helps the clinician determine the right treatment plan.”
Teaching children about dental hygiene takes place in local schools. “We have implemented brushing programs, with toothbrushes and toothpaste provided. Teachers also discuss the importance of drinking water instead of soft drink to prevent tooth decay.”
Around many communities, the vital problem of a lack of fresh drinking water has also now been resolved, with community programs providing this to children at no charge.
A better future
Dr Gwynne’s program is showing signs of real success.
“Aboriginal children in Australia have double the rate of tooth decay of other children. Before we commenced, the children in the NSW areas we were focusing on had four to five times the rate of tooth decay. The impact of this was huge, with time off school and expensive treatments required.”
The Poche Centre published in the past that many children in regional areas believed that drinking water was unsafe. “Now, they drink water every day,” says Dr Gwynne, whose team is set to publish findings about how the program has reduced rates of decay and gingivitis among the children it has reached.
The co-designed, mobile nature of the Poche Centre’s Indigenous oral health model gives it sustainability.
“I was visiting a community again recently and the positive impact was amazing. During this visit, I had the team teaching me the protocol that we implemented four years ago. The changes are embedded. Better oral health is happening without the need for us to be there.”