Dental services are a priority . . . but not for the puffer fish

17 October 2013

Fresh evidence to support the critical need to develop oral health training and resources for Aboriginal and Torres Strait Islander Health Workers is provided in a study by David Walker and others published in the current issue of the Australian Journal of Rural Health. The article endorses the position advocated by the National Aboriginal Community Controlled Health Organisation (NACCHO) that Health Workers have a key role to play in improving oral health for Aboriginal and Torres Strait Islander people.

The study findings recognise that there has been little sustainable development of such a role, despite the fact that Aboriginal and Torres Strait Islander people are among the most vulnerable when it comes to oral health.

And the service challenges are greatest outside the capital cities. There are few dental services, fluoridated water supplies are less common, and lower socioeconomic status and greater distances combine to make dental treatment less affordable. There are also differences in education and knowledge about health between the city and the country.

The study published in the AJRH acknowledges the widespread adverse health impacts of oral disease. "There’s a huge number of children - - -who have lost most of their deciduous teeth by the time they’re 5 and I suspect [that the loss] changes their dietary habits from quite a young age - because they then head towards a diet of carbohydrate and fat which is easy to chew."

This results in higher costs of care because of the need for more complex treatments. Medical and nursing personnel report frequent presentation of community members in severe dental pain when there is no dentist available.

The principal treatment of acute oral disease by authorised non-dental remote personnel is the prescription of antibiotics and analgesics. This temporarily arrests infection and relieves symptoms; however, it does not provide definitive treatment. Dental personnel noted that there is a risk of this symptomatic treatment not being followed up by definitive dental care.

Health Workers play a key role in support of dental and non-dental health personnel alike. They provide the only continuous link to patients in many communities, particularly where health professionals operate on a fly-in fly-out basis. Even though remote Indigenous communities face widespread severe systemic disease, this study found a high priority among remote health personnel given to oral health and the role of Indigenous Health Workers.
. . . and the puffer fish?
A separate study in the same issue, ‘Pufferfish attack on Thursday Island’ by Sarah Farrell and Perry Turner, presents the first case study and review of literature of a vicious bite from a puffer fish (Lagocephalus scleratus) in a child in Far North Queensland.

Renowned for its toxic impact on ingestion, the puffer fish has four large teeth, fused into an upper and lower plate, which are used for crushing the shells of crustaceans and molluscs, their natural prey. Bad news for a young boy fishing with his father! Despite nasty wounds, the patient is unlikely to have any long-term damage. The puffer fish escaped.

Learn more about AJRH at and access AJRH contents listing at

Media Enquiries: 

Gordon Gregory - NRHA Executive Director: 02 6285 4660