Creating an anti-racist dental profession

Estimated reading time: 6 minutes

Australia still has a way to go in creating a completely anti-racist dental profession, but a recent research project is moving things forward. By Frank Leggett

Racism is insidious and, frequently, a subconscious form of prejudice. Whenever someone points out that they saw a nice Chinese doctor or that the dentist was Aboriginal but did a really good job, the comment highlights a subconscious belief that one group of people is superior to another.

Racism can also happen on a grand scale. Last year, Australia held a referendum to recognise First Peoples of Australia. It was defeated 60 percent to 40 percent.

“A common distortion spread by social media was that blackfellas were coming to take your land and home,” says Dr Jess Manuela, a dentist and palawa woman from lutruwita. She is also co-president and director of the Indigenous Dental Association Australia (IDAA), the peak body for Aboriginal dental clinicians.

“People need to take off the blinkers and see reality. Indigenous people in this country are suffering because of the ongoing effects of genocide and invasion. We’re often told to get over it. Well, maybe that would be possible if we weren’t seeing our people dying, youngsters killing themselves, the highest rate of incarceration, and the worst health outcomes. The referendum was a very difficult time for our mob.”

Addressing the problem

Last June, the inaugural anti-racism in dentistry workshop was hosted by the University of Adelaide’s Indigenous Oral Health Unit. It was a launch of the research project—’The mouth as an expression of racial injustice: Building the evidence to foster an anti-racist dental health system in Australia’, funded by the Medical Research Future Fund.

The workshop was attended by key stakeholders such as the Australian Health Practitioner Regulation Agency and the Victorian Aboriginal Community Controlled Health Organisation. It was co-presented by members of the IDAA. The aim was to build a strategy for the research program so it can be presented to the general dental population down the track.

“Projects like this are important,” says Dr Chris Bourke, a Gamillaroi man, the first Indigenous dentist in Australia, and chair of the Australian Dental Council (ADC). “This type of initiative is crucial in developing strategies for a healthcare system free from racism. At the ADC, ensuring culturally safe care and eliminating racism in healthcare are key objectives. We actively support projects that work towards this goal.”

Dr Nicolas Reid is a member of the Dharug nation, a dentist working with the Royal Flying Doctor Service, and a director at the IDAA. “Without the research, we have no evidence to support any policy,” he says. “Without policy change, it’s difficult to change people’s mindsets. I’ve spoken to a lot of dentists who think it doesn’t concern them because they don’t treat any Aboriginal patients. Of course, if they’ve completed training so they’re mindful of their biases, it makes them a more compassionate and empathetic dentist. Care should always be delivered in a way that’s equitable and non-racist. That benefits everyone no matter what their background. It’s just better care.”

Learning not to be racist

Tackling racism in the dental profession starts at universities. One of the major aims of the anti-racism project is to co-design and implement an anti-racist curriculum for dental students that can be robustly evaluated.

“Universities have a systemic racism issue that needs to be addressed,” says Dr Manuela. “We’ve had multiple complaints from students in the past few years saying they’re experiencing racism. Usually, it’s just ignorance from other dental students but there are also issues with academic staff.”

One of the students who has lived this experience is Latisha Sykora, a Mudburra and Jingili woman who is a director at the IDAA. She’s also a dental assistant, oral health therapist and dentistry student at South Australia’s University of Adelaide.

“I’ve been a student for eight years and, unfortunately, I’ve experienced a lot of racism,” she says. “I’ve even had staff question why I would work in community. The negative attitudes and behaviours of professors and tutors impact all students. Australia is very welcoming and understanding of multiculturalism. Despite this, things are still dire for most of the Indigenous population. Why are we still at the bottom of the barrel?”

Education and retention

Another aspect of the research program is investigating how to support the attraction, retention and wellbeing of the Aboriginal and Torres Strait Islander dental workforce. A 2021 report put the overall proportion of Aboriginal and Torres Strait Islander dental practitioners at less than 0.5 per cent.

“We must address the disproportionate under-representation of Aboriginal and Torres Strait Islander people in healthcare,” says Dr Bourke. “The ADC emphasises the importance of promoting careers in oral health and the significance of cultural safety in dental education and practice.”

When Aboriginal and Torres Strait Islander patients receive culturally inappropriate care or are marginalised by the system, it engenders a distrust and antipathy to the provider.

“The Aboriginal and Torres Strait Islander Inclusion Committee is trying to improve workforce participation,” says Dr Reid. “And that’s not just dentists—that’s oral therapists, hygienists, assistants and front office staff. Often racism happens in the front office with how Indigenous people are spoken to on the phone or the way they are treated when they walk through the front door.”

Hope for the future

Projects like the anti-racism research and workshop make the prospects of an anti-racist health system all the more promising.

“While national improvements like a treaty haven’t happened yet, small things such as an Acknowledgement or Welcome to Country before presentations is a great first step,” says Latisha Sykora. 

“For the dental profession, I want to see an industry where all members are accepting, welcoming, honest and true. We need to be mindful of one another while providing thoughtful and unbiased care across the board. We’re just getting started but that’s a massive step in itself.”

When talking about anti-racism, there are three terms that are important to understand:

• Cultural competence—The simple definition is to be respectful and open to different cultural perspectives in order to interact and build relationships with people different from us.

• Cultural responsiveness—Value is placed on diversity, even if it conflicts with ideas, beliefs and values of your own culture. It does not place one culture above another, instead seeing the differences as equal.

• Self-determination—Indigenous people determine what is culturally competent and responsive. They decide what is racist or safe, so the person undertaking cultural education needs to think about how the person on the other end receives you and your care.