Dentistry in the outback
Eschmann hears from Dr Alexandria Stipis, a Dentist for the Queensland division of the Royal Flying Doctor Service in Australia.
For over 90 years the Royal Flying Doctor Service (RFDS) has been providing extensive primary health care and 24-hour emergency services to those that live, work and travel in the most rural and remote parts of Australia.
Over the years, RFDS has diversified its services to include, amongst other things, dental care to some of the country’s most deprived communities. These much needed dental services are delivered using a combination of fly-in, fly-out units and mobile units to reach those most in need, with 10,832 clinics held across Australia between 2016 and 2017. One dentist helping to make a difference is Dr Alexandria Stipis, who is one of five dental professionals working for the Queensland division of RFDS dental services:
“In regional Queensland, many Australians have limited access to dental care,” she says, “but thanks to the RFDS dental service, which has been operating in the area for four years now, more than 8,000 patients have received treatment.” To reach these communities, Dr Stipis and the rest of the team use a state-of-the-art 18-wheel semi-trailer mobile dental surgery complete with two clinics, a sterilisation area, reception desk and latest equipment.
“To give ourselves enough time to see everyone that requires treatment, we usually stay for two weeks in each town and start preparations each day at 0730. We see our first patient at 0800 and finish around 1800, which gives residents who have to work throughout the day the chance to attend the clinic. We provide a range of treatments from basic check-ups and scaling and polishing to preventive therapy, extractions and restorations, treating an average of eight to ten patients per day per dentist.
“Most initial appointments are booked in for an hour, as it is often the case that the patient requires multiple treatments. Plus, many of them travel considerable distances to reach the clinic, sometimes three to four hours, so we set aside the time to make sure that everything can be completed in one day. Poor accessibility to general dental care is a widespread issue in the communities we service and for many patients it has been years since they last visited a dentist. Thus, it’s important that we are as efficient with our time as possible.”
To help tackle the disparities in oral health access and outcomes, the RFDS dental service is completely free to all those in need of treatment across rural and remote parts of Australia. But as Dr Stipis explains, it is not always possible to help everybody. “Because we are only in a community for two weeks at a time and there is only a finite number of appointments available, we often leave without seeing everyone on our waiting list. To help ensure we see the most critical cases we have a waiting list for each community with patients split into three categories. Patients in category one – in other words anyone with dental pain – are a priority and we are usually able to get through that entire list in the fortnight. We then move on to categories two and three and try and see as many as possible.” Unfortunately, this is not the only difficulty that Dr Stipis and her team face.
“One of the main issues is regulating the temperature, because when the clinic is on the road and the air conditioners are turned off it can reach temperatures well over forty degrees. As certain bacteria can reproduce very quickly in warm and moist environments, this presents an infection control risk, amongst other things. We therefore have to be extra vigilant. The other difficulty, of course, is the limited bench space. In order to prevent cross-infection the dental assistants have to be very diligent when carrying out decontamination processes and ensuring the dirty and clean zones within the sterilisation area are maintained correctly.
“Per the infection control guidelines provided by the Australian Dental Association[i]we damp wipe all of the instruments prior to taking them into our sterilisation room in a sealed container. The instruments are then rinsed before going into our ultrasonic cleaner for a five-minute cycle, followed by a final rinse and drying with a disposable lint free cloth. The critical and semi-critical items are bagged and tagged, and the non-critical items just bagged prior to being processed in our on board autoclave. All instruments are then allowed to cool before being stored for use. As best practice, all unused instruments are strictly reprocessed at three months due to the extreme temperatures that can be reached on the truck.We also foil test the ultrasonic cleaner on a daily basis, and our first cycle in the autoclave each day is a vacuum test followed by a helix test.
“Altogether, the job is not without its challenges, but it’s very rewarding being part of the RFDS dental services and I look forward to all adventures to come.”
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Dr Alexandria Stipis graduated from James Cook University, Cairns in 2013 with a degree in dentistry. Dr Stipis has since worked in private practice in Mission Beach before starting work with the Royal Flying Doctor Service Mobile Dental Unit in April 2017 as Principal Dentist. She has a keen interest in minor oral surgery and rural and remote dentistry.
[i]Australian Dental Association: Guidelines for Infection Control, Third Edition. Accessed online February 2018 at https://www.ada.org.au/Dental-Professionals/Publications/Infection-Control/Guidelines-for-Infection-Control/1ADA_GuidelinesforInfectionControl_3