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Dental Issues in the Aboriginal Communities of Ramingining, Gapuwiyak, Galiwinku, Millingimbi and Yirkalla

A response by Dr John Bailey, Dentist.

What is working:

  1. An established pattern of delivery of dental services in the above communities and the Homeland community of Yilpara.
  2. A developing service in the Laynhapuy Homelands to be serviced by Dr John Bailey, dentist, and Mrs Leonie Bailey, dental assistant, out of Yirrkala commencing approximately October 2008.

What isn’t working:

  1. Treatment only delivered on a needs basis as assessed by the Aboriginal people themselves or occasionally by medical clinic staff. The Intervention addresses this need for a particular age grouping but only in the short term.
  2. Lack of fluoride and easy access to all forms of refined sugars and carbohydrates, mainly through ALPA stores in each community.
  3. In terms of dental awareness, huge obstacles exist in working with communities who live for today (food) and yesterday (culture) but do not see a need to consider tomorrow.
  4. Missing teeth, badly broken down teeth and non existent oral hygiene are not seen, by most of the Aboriginal people we treated, as important. Treatment is only sought once pain or very loose teeth are present.

Considerations for the future:

  1. There must be a way of allowing children right through from pre-natal to 12-14 years of age to receive fluoridation either in tablet or liquid drop form. Ideally, where a reticulated water supply exists, by installing fluoride injection equipment. While the initial cost may be high, the benefits would be seen within a few years and would last a lifetime. The Aboriginal population would then have access to a health prevention initiative currently afforded almost all non-indigenous Australians.
  2. Great steps forward are needed with general oral health via education through childcare centres, schools, medical and dental clinics. This is going to be challenging when one realizes the attitudinal base one is starting from.
  3. The great Australian tradition of individualism and freedom of choice has very markedly worked against all the Aboriginal communities we visited in terms of their access to Western food. Until each local community develops strategies which will see a reduction of dental disease the future looks very bleak indeed.
  4. Much more is required in treating Periodontal Disease in both juveniles and the adult Aboriginal population because of the following:
    1. The influence of Diabetes on dental tissues
    2. The rate of Rheumatic Heart Disease is 250 times more than in normal white populations
    3. An established link between Periodontal Disease and Cardio Vascular Disease
  5. Most Aboriginal children, from a very early age, present with significant dental problems which require often complex and time consuming treatment. This, most of the time, can only be delivered under a General Anaesthetic. At present these sessions are grossly inadequate. I do understand that this is greatly influenced by a shortage of Dentists, Anaesthetists and hospital theatre time.
  6. There is a significant shortage of Northern Territory dental teams available to provide much needed Post Intervention dental treatment in Aboriginal communities. The current hourly rate of pay does nothing to encourage dentists to travel from Interstate to assist in providing treatment. Most tradespeople get paid a higher hourly rate than that being offered to dentists. The accommodation offered to dental teams, in our experience, falls short of that offered to doctors and nurses. The issue of accommodation needs to be addressed if dental teams are to be encouraged to return more than once.

The above submission is in response to briefly meeting with the NTER Review Board outside the Gove Airport on Friday afternoon, 08.08.08, on our return from Gapuwiyak. The Board were on their way to the Garma Festival. I was encouraged to provide a submission to this review.

While my wife and I have only been in North East Arnhemland for 6 weeks, the experience we had establishing dental aid projects in Nepal and Kiribati equipped us well in making the observations above. The dental health we observed in the North East Arnhemland communities is as bad, if not worse, than that of the people of Nepal and Kiribati.

After 30 years of dental practice in suburban Melbourne, I was shocked at the dental devastation in all the Aboriginal communities it was our privilege to visit and work in. We have a third world health problem in our own backyard.

Dr John Bailey (dentist) and Mrs Leonie Bailey (qualified dental assistant) acted as locums for Dr Neil Lanceley and Dr Denise Salvestro during the months of June July and August 2008.

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