Blackened stumps reveal true extent of Queensland drought
THE four walls of a mobile dental van could be witnessing the truest picture yet of Queensland's drought.
Within its stark, clinical interior, a small dedicated team is helping remove some of the burden from our farmers.
One tooth at a time - though often several - they work tirelessly to repair often neglected mouths.
"They are slogging their hearts out just to make a living. They can't afford soap, let alone toothpaste and a toothbrush," dental nurse Jo Conway says.
Placing her hand on her chest as though her heart is breaking for them, she pauses before explaining just one of the reasons her job is so rewarding.
"A lot of them are living in pain because they can't afford to go to the dentist," she says.
"Then we come and we take the pain away, we fix up their teeth, and then we charge them nothing ….. it brings tears to your eyes because they are just so grateful."
The mum works on a two weeks on and one week off roster away from her family in Goodnight Scrub between Gin Gin and Childers.
She is one of three dental nurses working on the QCoal Foundation's 18-wheel semi-trailer parked at Sapphire this particular fortnight.
The Royal Flying Doctor Service dental team is treated as royalty every time it arrives in one of Queensland's rural towns - showered with chocolate, cakes, flowers, opals and jewellery set with Central Queensland gems.
They are often shouted meals and drinks at nearby watering holes. The locals invite them to try their hand at gem fossicking, mine shaft adventures, horse riding, pigging - the list goes on.
"They just can't believe there is a service like this. We get thanks every day," Ms Conway says.
"We've even saved lives because people have a toothache but they don't realise they've actually got an abscess that can kill them.
"We had one guy who had a mouthful of them and honestly, he was so swollen, another few days and I think he would have been in hospital with some sort of blood poisoning."
Fellow dental nurse Monique Slade - who lives in Woolooga, near Gympie - says isolation and money are the major factors in oral health neglect among their patients.
"In the rural communities where you've got a lot of graziers, they're doing it really tough," she says.
"They're trying to keep cattle in the drought and keep the business and the farm running so they do put themselves on the backburner.
"Quite often you'll get the men's wives making the appointment because they're at the end of the tether.
"We've had patients who've actually extracted their own teeth with a pair of pliers, and done all sorts of damage, because they can't afford to travel to a dentist.
"The budget just doesn't stretch that far.
"Quite often they're not entitled to a health care card because they're self-employed.
"But it's also the isolation. Services aren't available because it's hard to get staff to work in these rural areas.
"We have had numerous patients now where we've had to extract every tooth, just abscesses everywhere."
But this purpose-built vehicle, brought to life through QCoal's Christopher Wallin having a passion for the bush, is also an unassuming observer to the realities of rural living - especially in indigenous communities.
Ms Slade says the mouth is the gateway to the whole digestive system and poor teeth can lead to myriad other health issues.
But she says it's cheaper to buy soft drink than water in the more remote places they visit, such as Camooweal and Dajarra in the state's far west.
"Their general overall health is really down because they're not eating properly or not eating the right foods," she says.
"In some of the indigenous communities that we've gone to, you see teenagers, and adults, walking around with a two-litre bottle of Coke because it was actually cheaper than a bottle of water.
"In some of those towns, they don't drink the (tap) water because it's just not safe."
Dentist Plessis van der Merwe, who lives in Toowoomba when he's not on the truck, says he has seen children as young as four or five buying Fanta from the pub because it's cheap.
"The CO2 in the fizzy drinks causes carbonic acid in the mouth. And all these acids are bad for our enamel and on top of that it's the sweetness," he says.
"We normally try to prevent (rather) than to solve, to cure, to treat so it is a learning curve to them.
"I think we are getting there, some of the places we are getting wonderful results, but there is still a need out there."
Ms Conway agrees they have seen a positive turn in some communities they have visited more than once.
"Everyone we see gets a clean, we tell them why we're cleaning, we show them what we're cleaning off," she says.
"A lot of people, we can't even see their teeth under the plaque or the calculus.
"Then they say 'oh my god', my teeth are all gappy, and we say 'that's how they're supposed to feel'.
"But we get a piece and show them, this is what we're cleaning off your teeth, feel it.
"We're only with them for half an hour, 45 minutes, that's the only time we've got.
"We don't bombard them and give them a big lecture but we really tell them as much as we can in that time to help them because then they're gone and they might not see another dentist for five or 10 years, you don't know."
With the drug ice getting nationwide exposure this year, it's not surprising this team is seeing the effects firsthand.
"One patient... he'd given up the ice for about four weeks. We did a lot of treatment on him and we thought he was on the road to recovery and was getting a lot of support from family," Ms Slade says.
"But then his last appointment he didn't show up for because he got back on the ice.
"I think it's partly the not eating, so they've got dry mouths and when they do eat you're not getting that saliva.
"And it's neglect, they're not brushing, they're not thinking about hygiene."
Mr van der Merwe agrees dental hygiene is limited among drug users and that causes their digestive system to suffer.
"It's that they don't care," he says.
"Already they are on the breadline so the last thing in line is your teeth."
Amid all the dental dramas the RFDS team tackle daily, they have seen a white knight with an incidental lesson on modern diets.
They met a bloke with immaculate teeth despite never owning a toothbrush.
"He was an absolute exception," Monique exclaims excitedly.
"We had a look in his mouth and we were like 'oh my god, there are no holes'.
"But he was a drover and he didn't have access to a lot of processed food and sugars, so everything he ate was whole - like beef and vegies.
"He didn't drink soft drink, he didn't have anything that was really that bad for him. And he drank a lot of water."
The RFDS team delightedly gave him tooth brushing lessons.
"He wasn't a patient, he was just a member of the community," Ms Slade says.
"He was a nice guy. Everyone is. You know what bush people are like."
* The writer was a guest of the RFDS.
Jagged and broken: But patients walk away smiling
THE landscape is full of blackened stumps - jagged and broken.
They are decayed and rotten to the point where smiling is near impossible, embarrassing even.
This isn't the view of an old farm fence line or bushland after a fire has rushed through.
These stumps have taken years to blacken.
Soft drink. Sweets. Drugs. Not brushing or flossing regularly.
Every day, dentist Plessis van der Merwe has to decide whether he can repair the stumps or must rip them out because the damage from those things is too severe.
Having put his life on the line as a ground infantry soldier, a paratrooper and SAS in "Namibia and Rhodesia" for more than a decade, he's not afraid of a challenge.
But he says this dentistry work, in a small surgery on a truck, can be tricky.
"Not that the dentistry is so difficult, it's more a matter of how much we do on a type of person that is not used to dentistry," he said.
"Bear in mind some of these people are 50 years old and they have been once or twice in a dental chair and maybe that was when they were kids.
"The Queensland Health policy is that you do one tooth at a time, but if there are 15 teeth, we tackle them.
"We almost take every tooth out by surgery, that means I must take about twice the time. So it's a demanding role."
The service has provided more than $2 million worth of free dental services to 14 rural and remote communities across central and western Queensland, since beginning in 2013.
Dental nurse Jo Conway says the worst cases can often be the most rewarding for the Royal Flying Doctor Service team.
"You get a lot of people, their teeth are actually broken off and they're left with the stumps," she says.
"They think that's all right, but it's what's going underneath that's worrying.
"Obviously if we can, we fix their front teeth and give them a whole new smile. Then people are so amazed at what you can actually do with the limited dentistry we have as opposed to a private practice.
"A lot of people, especially if they drink a lot of rum or coke, or something, all their front teeth are black and decayed and we take it all out and give them tooth-coloured fillings and they go 'oh my god'.
"It's usually just go-go-go, we see as many patients as we can, do as much work as we can.
"You do your best for all of them but there's always one person that you just think 'wow, we've changed their lives'."
Aged 37 and racking up 21 years since the last time he saw a dentist, he needed some serious work done.
He has visited the dental van four times during the fortnight to have seven teeth removed and about a dozen fillings.
Speaking with a numb face after 90 minutes in the chair, Paul, who asked not to use his last name, says he is feeling relief and "it looks a lot better too".
"They took out a lot of teeth on both sides, so it's pretty sore but when the gums heal it'll be better," he mumbles.
"There was only one tooth that used to give me trouble.
"I couldn't chew on that side, couldn't eat, because as soon as the food would go in there and hit the nerve, it was painful.
"The rest of my teeth didn't really bother me that much, it just looked terrible, and they were really decayed.
"What I needed done would have cost a fortune. Would have been thousands."
When Bill Tucker was a young lad, the dentist's needle was so long he had no desire to hurry back.
For 60 years between visits, he's genuinely surprised at how easy it is to get some fillings in and a tooth out.
Mr Tucker, 75, spent much of his life at Tieri, north of Emerald, as a cleaning contractor for the mining industry but he retired to Sapphire in 1997.
One of his friends works for the "guy who sponsors QCoal Foundation" - which has partnered with RFDS to provide the mobile dental service.
"It's a damn good idea," he says, muffling his words slightly as he clenches his jaw to keep some bloodied padding in place on the right side.
"There's a lot of pensioners here, a lot of older people.
"You only have a look around town and see people's teeth, that's the way it is.
"It's the high cost. This (dental van) is a big help, absolutely.
"It's also probably bad experiences in the past when you didn't have the technology.
"As a kid the needle was so long and they pulled it out just before it came out the top of your head.
"But I never felt a thing here. They're doing a great job."
Patsy McKenzie has taken advantage of the dental van and the "booby bus" in the year she has lived in Gemfields.
"We thought we would come up here for a lifestyle change and we're just blown away by what is available here," she says.
Living on a mining "claim" she leases with partner Garry Beecroft, they live on solar energy in a shed with a chandelier.
They didn't move "to find our fortune", but says they've already found some gems - educating the out-of-towners in the van on the various sapphire colours, and the zircon, found in the area.
As she filled her Medicare details into a form, she said "it's great to have things like this".
"I'm on a health care card so if you go to a dentist it costs you a fortune and to go into a hospital ... there's a waiting list," she said.
"I have a broken tooth and I have a tooth that's nearly fallen out, it's broken off. I want them to check on that because it does ache."
Barbara Ritchie, 64, has been another regular in the dental chair - three appointments in seven days to sort out a rotten tooth.
"Last Friday I had to have a tooth out and that played up, had four days of absolute agony and painkillers, not even codeine could fix it," she says while patting her dog, who is almost ironically named Flossy.
"So I was back in the chair on Tuesday morning and back in the chair 8.15 (Wednesday) morning and they had to do surgery.
"What happened with my tooth was something they couldn't foresee. And I'm fine now, just have a dull ache."
Ms Ritchie - a former New Zealander who lived in Hervey Bay and Blackall before moving to Sapphire 22 years ago - says she has spent many years on the waiting list at Emerald Hospital to get dental plates, suggesting the mining population explosion over the past decade is the likely reason.
Hanging out for a good steak, she says her diet these days consists of soft foods such as poached eggs, mashed potatoes and vegies until she can get plates.
Grateful for immediate relief for her pain, she says the community could not do without the dental van now.
"It's an essential service, really," she says.
"All of the staff are just amazing people.
"They're also caring and they give you a sense of belonging, that this is your facility to use any time, except they come once a year.
"But without them I think this place would be lost, absolutely lost.
"I feel for small communities that don't have dental services.
"When you go to hospital you get a patient travel subsidy, but you don't get that for dental care."
While Queensland Health does provide a travel subsidy for dental services relating to gross deformities, most dental care is not covered.
HOW YOU CAN HELP
QCoal Foundation has partnered with the Royal Flying Doctor Service to deliver the QCoal Community Dental Service.
The service operates with a five-person dental team from an 18-wheel semi-trailer. Inside there are two clinics, a sterilisation area, a reception desk, kitchenette and the latest panoramic x-ray machine.
The RFDS is a not-for-profit organisation that receives Commonwealth and state government support.
But the service relies heavily on bequests, fundraising and donations from the community to purchase and medically equip aircraft and to finance other major capital initiatives.
To donate, fundraise or find other ways to help, phone 1300 669 569 or visit www.flyingdoctor.org.au/qld