There are no simple and quick fixes to improving oral health however there is relevant information and experience, constantly evolving, that can help us to improve our programs.
In 2000 a group of “bush dentists” gathered in Central Australia to look at how we could help support dental people going out to bush communities for the first time, ie people who were providing dental care away from their normal “comfort zone”.
After consultation with Aboriginal health and community members and others, “Dentistry in Remote Aboriginal Communities” was released in 2001 through the Nganampa Health Council. A small manual with information pertinent particularly to the central desert communities of Australia, but which has been widely used in other locations as well as in teaching institutions.
What has changed in 17 years?
We’ve moved beyond a collection of best practice principles and techniques to a firmer range of evidence based practices. Access to fluoride generally – via water and/or toothpaste – regular fluoride varnish applications particularly for high risk young kids, pit and fissure sealants, have all been proven to help prevent dental decay.
It’s how we implement these largely clinical practices that can challenge us. This is where we still need more evaluation and research.
Given the differences in cultural and geographical contexts, there are many similar approaches that can be considered when working in high risk communities both in Australian and overseas, where there’s no network of specialists and resources available in the next suburb.
How can we help individuals to improve their oral health? Focus first on appropriate clinical care
We are talking mainly about high risk people, who might only access dental care irregularly.
For kids, please forget about trying to fill every decayed primary tooth – think more wholistically. Caries control, caries arrestment, opening out lesions to avoid food impaction in primary teeth and opening them up to the beneficial effects of saliva, minimal intervention dentistry, safeguarding the future of permanent molars.
For adults, often relief of pain is all that is requested. But there are other ways to lower their dental caries risk. Appropriate treatment of periodontal disease also needs to be considered.
How can we help communities to improve their oral health? Focus first on finding the local champions
There are many types of community based programs – water fluoridation, school based toothbrushing, improving access to safe drinking water, working with other health programs, to name just a few. But all will fail unless the local community owns the program, either through strong individuals and/or strong local organisations.