From rescue to recovery

“I think just being out there, people are now coming forward to have treatments done,” says Dr Lyn Mayne of the RFDS.
“I think just being out there, people are now coming forward to have treatments done,” says Dr Lyn Mayne of the RFDS.

Twelve months in, the challenge for the TOOTH program is establishing dental care as more than crisis management. By John Burfitt 

It is so hard as a dentist to describe what is actually out there. It is almost Third World conditions. When you have a kid open their mouth and there is only one clean tooth in there, that is not what you expect to see in Australia in 2013.”

They’re the words of Dr Lyn Mayne, senior dentist of the Royal Flying Doctor Service South Eastern Section, based in the outback city of Broken Hill. She oversees The Outback Oral Treatment Health (TOOTH) program in the western NSW communities of Bourke, Collarenebri, Goodooga and Lightning Ridge.

TOOTH was set up to address the poor and deteriorating oral health in some of the state’s most remote communities. Of the patients the TOOTH dental team attends to, 49 per cent are indigenous Australians and over 60 per cent are health care or pension concession cardholders. “These communities are very remote and isolated by that fact, and are often a lower socio-economic group,” Dr Mayne says. “Access to dental services is poor and in the past, people would have to travel over four hours or so to places like Dubbo to get their teeth checked. There is also data that has shown indigenous communities have a greater amount of decay and missing teeth than their counterparts.

“What we are trying to do with TOOTH is fulfil that need for access to dental services. Just being out there, people are now coming forward to have treatments done and we are starting to make a difference. It comes down to that age-old thing of people being scared of the dentist, and just by having a regular presence in those towns, it is taking some of that fear away.” TOOTH began in February 2012, as a partnership between the RFDS and the Investec and Gonski foundations. Its three year funding comes at a cost of $2.5 million. In its first year of operation, TOOTH has provided dental care to over 1600 patients in areas where there had previously been either only intermittent or no dental health services at all. Before TOOTH, dental decay in children in these remote communities was recorded as being five times the national average.

New TOOTH dentist Dr Callum Addison (left) and David Gonski of the Gonski Foundation, one of the founders of the TOOTH program.
New TOOTH dentist Dr Callum Addison (left) and David Gonski of the Gonski Foundation, one of the founders of the TOOTH program.

At the end of the first 12 months, the fly-in, fly-out TOOTH program is being hailed as a success. Among its achievements is a 19 per cent increase in the number of new patients, a marked overall reduction in the number of actively decayed teeth in children and a decrease in untreated decay and other forms of oral disease. It also met its goal of 256 clinics in its first year.

TOOTH operates with dentist Dr Callum Addison and dental therapist Rebecca Hovington providing a clinic per week to the four communities. Another aspect of TOOTH is the dental student mentoring it provides, as the program is run in consultation with Charles Sturt University, the University of Sydney and Griffith University. On each visit that dental specialists Addison and Hovington make, an intern dentist accompanies them to assist. In total, 30 interns have worked on TOOTH in the past 12 months.

Dr Mayne says it is seeing the outback communities through the eyes of the intern students that often provide the most sobering reminder of the state of dental health in the area and the way many people have become accustomed to live.

“When you talk to the students after they have done the visits, they are always shocked at the conditions some people will continue to exist in with their teeth,” says Dr Mayne. “They are astounded the pain people will put up with and what they will let their teeth get down to due to the lack of services. I don’t think you ever get used to it.”

As TOOTH enters its middle year of operation, Dr Mayne says the challenge is about educating the remote communities that dental health care is more than just treating in a time of crisis.

“One of the best things about the first 12 months of TOOTH is that while we have had an increase in the number of new patients, we have also provided a great deal of diagnostic and preventative services to ongoing patients,” she says. “I see the challenge we have in the next six months is about continuing to get people to come back through the door.

“Sometimes, if you get people out of pain, you won’t see them until they are in pain again, rather than maintaining a regular treatment program.
It cannot be a case of just removing the pain and keeping going. We are offering dental health care as an ongoing part of life.”

The most effective way to achieve this, she believes, is by the TOOTH dentists very presence in the region, so for new generations in these communities, access to dentist care will become a consistent across their growing years.

“Through the access, we can provide them with education so these kids grow up used to seeing dentists and we can stop things happening so they get to the stage where they stop smiling because they don’t have any teeth. Just yesterday, I had in some girls in their twenties, and I was looking at their teeth that have to come out and will affect their smile. As a dentist, that is very sad to see.”

Dr Mayne has worked in the Broken Hill area for 15 years now, having previously worked in a private practice in Hobart. She points out that the biggest difference between working in dental care in a metropolitan practice and in outback communities is the reaction of the locals.

“In these communities it is the appreciation of the people; they just so want you to be there and are glad to see you. As a dentist, that is astounding. Years ago when I was working in private practice, all I heard all day was, ‘I hate seeing the dentist’,” she says with a laugh.

“It is rewarding to go to an area where they are glad to see you and you know you are able to make a difference to their health. We have another two years to go now and I am hoping we get recurrent funding to continue, and I hope we get the funding next time for two dentists. The need is there.”

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