Digging deep


miningwebAustralia’s mining boom saw a rapid expansion in the size and number of mining towns dotting the vast outback. Remote, sparsely populated and with minimal facilities, these communities have a frontier feel that sends a shiver up the spine of most city folk.

Even though big wages draw people to these wild surrounds, the most popular form of employment is fly-in-fly-out (FIFO) contracts. You might fly in, work 12-hour days for two weeks, then fly out to a capital city for a seven-to-10-day break. Then you do it all again…

While the mining boom seems to be on the wain, there are still tens of thousands of people employed by the mines. These workers are in a unique situation in regard to lifestyle, travel, employment and social interaction—and all of these factors have a direct impact on the state of their oral health.

“The rates of tooth erosion and wear in the mining towns are many times the rate of the rest of Australia,” says Dr Chris Hart, director of the Life Time Smiles group based in Brisbane. Prior to taking on his current position, Dr Hart ran a string of practices that stretched from Mt Isa to Darwin. These practices often dealt with workers employed by coal, copper, zinc, silver and gas mines.

In fact, it was the coal mines who put out a tender to provide a dental service for their communities. “They made a capital contribution and in return we took on a five-year lease with a five-year option on those facilities,” says Dr Hart. “We organised the buildings and fit-outs and I employed a team of dentists to service those communities.”

The next time you’re grumbling about an 8am appointment, you might spare a thought for the dentists employed by Dr Hart. “It was hard graft. We flew dentists in 11 days on, 10 days off. After the hour-and-a-half flight to get there, they had to drive up to 325 kilometres to reach some of these towns.”

A lot of the oral health problems in these remote communities can be squarely attributed to lifestyle. Living in a place with minimal or no distractions often leads to excessive alcohol and food consumption. Couple this with high rates of sleep apnoea due to abnormal working hours and it’s a disaster waiting to happen. “Gastro-oesophageal reflux, sleep apnoea and bruxism are the tooth destruction triad that rips through enamel. All three of those things are present in these towns,” says Dr Hart. “And it’s not just teeth at risk—there are problems on a number of fronts. These workers are at risk of cardiac disease, and sleep apnoea leads to poor work performance that can affect safety. I don’t know how you fix it. Most of these men and women are living away from home and seeking some kind of comfort in alcohol, food and whatever other vices are there.”

Dr David Cox of David Cox Dental runs a practice in Brisbane’s inner-city suburb of Milton as well as Biloela, a rural town in Central Queensland that’s 120 kilometres from Gladstone. Using a combination of live-in and FIFO dentists, he services the mining communities around those areas—and most of the cases he sees are already at the acute stage.

“The workers suffer from a lot of classic acid erosion,” he says. “There are very high temperatures down the shafts which causes dehydration in the workers. Unfortunately, this leads to a vast intake of sugar and caffeine via soft drinks, energy drinks and sports drinks. It’s also very common for mines employees to have irregular sleep patterns which means there is no regular oral hygiene routine.”

Dr Jonathan Cichero, of Coopers Plains Dental in the outer suburb of Brisbane, services the mining communities of Longreach, Barcaldine and Emerald, all in central west Queensland. While they have local dentists in Emerald, they are supplemented by Brisbane-based dentists who fly in and fly out. Dr Cichero explains, “We supply services to the local communities who otherwise would have to travel to other locations to get the treatment. In the past if they couldn’t get treatment in Emerald then they would have a two-and-a-half hour drive to Rockhampton. For a half-hour appointment, they would lose an entire day.”

While the standard of oral health in these communities is poor and most of the cases are acute, the dentists all agree on one thing—once treatment has been received, the patients are highly motivated to improve their oral hygiene.

“I try to sort out all the causative factors—whether it’s sleep apnoea, bruxism, diet, or a combination of issues—before I rebuild the tooth material that is missing,” says Dr Hart.

It would appear that the dental health of mining communities improves in direct correlation to the livability of the town. In order to attract live-in dentists, doctors, hairdressers, chemists, solicitors and other professionals, money has to be spent by the mines on facilities and lifestyle.

“People come to these places for the big wages but, to be honest, some of these coal field towns are not particularly nice places to live,” says Dr Hart. “You would be lucky to get a dentist to live in them for 12 months. On the other hand, I can’t speak more highly of the residents in those towns. They are good people who appreciate good service and they always pay their bills on time.”

Dr Cox has seen a return of dentists to a lot of these remote communities—something he believes is directly due to the current oversupply of dentists. “These towns traditionally had dentists but over time they shut down and moved to the cities. Now I’m seeing dentists moving back to the rural and regional areas. It’s only early days at the moment but my gut feeling is that pure fly-in fly-out practices do not sustain a healthy lifestyle. This new crop of rural dentists should ultimately have a very positive effect on these communities.”

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