In my final year of dentistry, I was lucky enough to volunteer in Dubbo for four weeks. As a part of the clinical rotation I was given the opportunity to work with the Royal Flying Doctors Service of New South Wales (RFDS) to provide much needed services to remote and often isolated outback towns with virtually no access to a dentist.
Like most of you, I never knew that the Royal Flying Doctors Service had a dental division or any vested interest in oral health. However, upon my arrival in Dubbo, I received a very welcome re-education and was shown that these flying doctors also included flying dentists. In New South Wales's remote communities there is very limited access to healthcare in general, let alone oral healthcare, so to address this issue the Royal Flying Doctors Service initiated The Outback Oral Treatment and Health (TOOTH) programme in 2012. Based in their hangar in Dubbo, the aptly named TOOTH programme flies out a dentist and an oral health therapist to towns in NSW such as Bourke, Collarenebri, Goodooga and Lightning Ridge where general and emergency treatment is delivered to both adults and kids.
I was invited to join the team on several occasions on their trips to Bourke Community Clinic. Luckily in Bourke there are two dental chairs attached to the medical centre, which means dental equipment doesn't need to be carried around on the small aircraft. The flight itself through the Australian outback was a highlight and took over an hour from Dubbo which shows just how remote Bourke really is. They don't call it the "back o' Bourke" for nothing, as this isolated north-western community with a population of 2,000 has been without a local dentist for several years and the drive to the nearest facility in Dubbo is over four hours long. To help paint a picture of the maldistribution of dental services, in Sydney there are six dentists per 10,000 people (with that ratio set to increase) and this does not include dental auxiliaries such as hygienists, therapists and technicians who are readily accessible. To say there is a dire need for oral health services in Bourke and rural NSW in general is an understatement, and this was clearly seen when I started seeing patients.
Under the supervision of the Royal Flying Doctors Service dentist I treated both emergency and general patients, many of whom had been on a long waiting list. The patients were very appreciative to see us because a lot of them were in pain as their decay had turned into abscesses. As a result a lot of emergency treatment was carried out which included extractions and large amalgam fillings. In fact on my first day I had to do a full mandibular clearance for an elderly gentleman, which was certainly an experience I will never forget. One thing to be said about the locals is that they are tough and go about having their dental treatment with gratitude and minimum fuss or complaint (which is great when you are a student!).
I also assisted the dental therapist who treated the kids there. A large proportion of paediatric patients were aboriginal children who had never visited the dentist before. The lack of oral health promotion in the local community meant that these kids often came in with abscessed teeth and multiple caries. We did our best to encourage better tooth-brushing but sometimes it would be heart-breaking to see child after child with virtually a mouth full of rotten teeth. Not surprisingly, the guardian seemed helpless and sometimes even oblivious to the child's oral health status until we showed them! We placed a lot of GIC fillings with these kids and spent a lot of time instructing them and their siblings on better oral hygiene. We were also able to see first-hand the impact of having non-fluoridated water in these outback communities as the caries incidence was astoundingly higher than that of metropolitan areas.
Overall the experience was eye-opening as it was great to get a glimpse of the Royal Flying Doctors Service and the invaluable services they provide to some of the most disadvantaged communities in rural NSW. It was an exciting programme to be a part of as it was different to your usual rural dental elective. I gained a lot of experience in emergency treatment particularly in difficult extractions. It made me appreciate the work I was doing and I felt that I was really making a difference because for a lot of these patients their dental problems had adversely affected their quality of life. It's a worthwhile programme and something I'd like to revisit later on in my career.
Dr. Andrew Wong
Dental Graduate