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ISSUE 58, AUGUST 2010, $5.95

INC. GST

BETTER BUSINESS FOR DENTISTS

An empire of one How Dr Harry Margets found that size isn’t the only secret to success

Something fishy

Who needs a wall in your surgery when you can have an aquarium?

Beating the bullies

How to tackle workplace bullying in your practice, page 28

Fairy tales

The true story of how one oral health therapist turned into a fairy, page 12

The turn of the screw

The tricky choice between endodontics and implants, page 25

The reviews are in!

Why performance evaluations are necessary in your practice

Passions

Dr Julian Leigh’s burning passion

!

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New Synea turbines with LED+, perfect contra-angle handpieces

TA-98 C LED 20 watt performance New LED+ technology Penta Spray New grip profile Bur length up to 25 mm

TA-97 C LED New LED+ technology Small head Penta Spray Bur length up to 21 mm

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Contents

Issue 58 / August 2010

Features

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PHOTO G RA P HY: EA MO N G A LLA G H ER

. ch ch ba a m 0 e33 Ba 95 e o t $ pag tw a on of ed vey e lu s u r on s va der a at e re Se t th le l ou dd Fil Sa

This month

IN W

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Cover story

Your world

Wild about Harry

Stephanie Wilson has combined entrepreneurial flair and fairy wings to create a clinic kids love coming to

12. Fairy Lights

The East Bentleigh Dental Group is a case study in how to build up a large successful practice by staying true to your vision

Your business

12

20. Underwater love When patients see calming vision of fish rolling through coral during their surgery at Dental Lounge, it’s not the painkillers kicking in

25. The turn of the screw Editorial Director Rob Johnson Sub-editor Lucy Robertson Contributors Sharon Aris, Nicole Azzopardi, Kerryn Ramsey, Lucy Robertson, Maureen Shelley, Gary Smith

05

Commercial Director Mark Brown For all editorial or advertising enquiries: Phone (02) 9660 6995 Fax (02) 9518 5600 Suite 4.08, The Cooperage 56 Bowman Street Pyrmont NSW 2009

7,616 - CAB Audited as at March 2010

Bite magazine is published 11 times a year by Engage Media, ABN 50 115 977 421. Views expressed in Bite magazine are not necessarily those of the publisher, editor or Engage Media. Printing by Superfine Printing.

When are implants the right decision? It’s a tricky question for any practitioner and some experts think not everyone is qualified to answer it

28. Beating the bullies Workplace bullying happens more frequently than you may think.

Creative Director Tim Donnellan

20

25

30. Good reviews

06 News & events 05. Promising nothing

At least the Greens have released a dental policy, while the others flounder and dissemble. ALSO THIS MONTH: the ADA says to major parties, ‘we’re watching’; Dental Corp goes international; a country practice does better than anyone thought; and much, much more …

If Performance Evaluation sessions are the time of year that everyone dreads, then it may be time to reconsider the way you are doing business

Your tools 35. Tools of the trade A great intraoral camera, an excellent intraligamentary syringe, and a good pair of ears and more are all on show this month

35

Your life 38. Passions Dr Julian Leigh, of Half Moon Dental Centre, has a burning passion

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05

News bites

Promising nothing A new campaign has been launched by a coalition of health organisations calling for election committments to better dental care.

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coalition of national community, dental and health organisations have launched a national campaign, Stop the Rot, calling on political leaders to make an election commitment for urgent action to address the decaying state of Australia’s dental care system. In a statement released at the end of July, the National Oral Health Alliance calls for more affordable and timely dental services, particularly for low-income Australians who are mostly likely to suffer from poor oral health. More than seven million Australians can’t access dental care when they need it because of long waiting lists and one in three people put off having dental treatment because they can’t afford it. “The health and social impact of poor oral health is immense,” the Alliance says in its statement. “For people with serious oral health problems, nine out of ten experience pain or discomfort and the same proportion have experienced embarrassment due to their teeth, contributing to poor self image, reducing their social interactions and limiting employment prospects. It is vital to improve accessibility so that all Australians have equitable access to oral health care. The alliance call comes after Labor failed to introduce a Commonwealth Dental Health Program (CDHP) in their last term of government because of the Senate’s refusal to axe the costly Medicare dental program introduced by the previous government. Labor says it will push ahead with the scheme if it is returned to power. It has rejected a recommendation by the National Health and Hospitals Reform Commission to establish a universal ‘’Denticare’’ scheme. The Australian Greens leader Bob Brown has announced the Greens will push for universal dental care and increased funding for dental health would help about 500,000 Australians,

ADA hits the hustings

As major parties avoid the issue, Greens leader Bob Brown has announced a dental policy.

languishing on waiting lists, get the treatment they needed. He estimated the proposal would cost around $4.3 billion, but produce savings to overall health costs of $2.3 billion. “Good teeth are fundamental to good health,” Senator Brown said when releasing the policy at the end of July. “Poor dental health can affect people’s overall health, ability to find employment and general well-being.” £

The ADA has requested that the major political parties respond to a list of questions on dental care programs. Reponses (or lack thereof) will then be compiled into an ADA Federal Election 2010 Report Card which will be accessible from the ADA website. “The key component of any Australian oral health solution is to focus attention on those within the community that have difficulty accessing dental care. The ADA’s strong recommendation to all parties is to introduce a scheme that will direct its immediate attention to improve access to dental services for Australia’s disadvantaged, whether this be financial or geographic” Dr Neil Hewson, President of the ADA said in a news release. A level of political stasis has settled around the debate since 2007, when the then-Rudd government’s attempts to introduce a Commonwealth Dental Health Program was blocked by the opposition and minor parties in the Senate, when they refused to allow the closure of the Medicare EPC scheme. After a brief flare-up with the introduction of ‘Denticare’ by the National Health and Hospitals Commission—which was promptly ignored by the government—the Senate stand-off continued. £

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06 News from our partners A-dec fills market niche Innovative European dental equipment manufacturer, W&H has released its ultimate generation dental turbine, the Synea LED+.

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he new Synea LED+ builds on the advanced design of the original Synea LED, which was the to first introduce LED technology into handpieces in 2007. “The ‘ultimate’ is defined as the very best of its type, and the Synea LED+ refines LED technology to a new level. If you were only going to buy one dental turbine, this would be the one to buy,” W&H Product Manager, Shal Hafiz, said. “Among the improvements to the Synea LED+ model is an enhancement to the LED unit to produce the highest Colour Rendering Index available. This has particular application in medical use. “The clarity, intensity and broad spread of light provides optimal illumination in deep cavities, helps correctly diagnose tooth structure and gum tissue in its natural colour and is bright enough to cut through the water spray during procedures.” Mr Hafiz explained that the development of W&H’s Synea turbines was all about delivering innovation that provided real benefits to the end-user. “This began with the very narrow, yet powerful Synea

Diamond

Perfect LED positioning

W&H’s ultimate generation dental turbine, the Synea LED+.

‘hygienic’ head design with penta-spray, providing the best visibility and best cooling and also prevents backflow of liquid and air into the turbine gears. Two models are available, the TA-97C LED with its extremely compact head suitable for everyday use and the more powerful 20 Watt TA-98C LED for bur lengths of up to 25 mm. All the new Synea models feature ceramic bearings, providing quiet

operation and long life, while withstanding the rigours of daily thermo-disinfector and sterilization cycles. “In fact the reliability of W&H turbines is legendary and they are also among the most comfortable and quiet of handpieces. That’s hardly surprising as W&H invented the modern handpiece and has never stopped refining it,” Mr Hafiz said. W&H Synea models feature light overall weight (with a choice of RotoQuick

Sapphire

Ruby 6 Bite

or Multiflex coupling), have a comfortable ergonomic design and grip pattern, while the lower head height provides the best view of the bur and work area during treatment.

Experien

“The LED light source is located near the head of the handpiece which provides the brightest and broadest illumination of the work area, unlike the ‘spotlight’ effect of other LED designs,” Mr Hafiz explained. “Also, there are no light transmission losses associated with inferior technologies including halogen and other LED turbines which employ glass rods from a remote LED light source in the coupling or base of the instrument. “All of these significant benefits unique to the W&H Synea LED+ add up to the ultimate dental turbine, enabling the user to work more comfortably and productively, by assisting with diagnosis and treatment through superior visibility and ergonomics inherent in the handpiece design.” The W&H Synea LED+ range comes with a two year warranty and is available from A-dec dealers around Australia. £

Quintessence

BOOKS

Hear all these Authors and more at the

2010 INTERNATIONAL

Don’t miss this rare opportunity to hear these speakers and more live in Sydney!

Quintessence Symposium in Sydney – 29-31 October

Color Atlas of Cone Beam Volumetric Imaging for Dental Applications Dale A. Miles Now regarded as the standard of care for some applications in dentistry, cone beam volumetric imaging (CBVI) is profoundly influencing clinical decision making like no other imaging modality developed in the past century. Yet many practitioners remain uncertain about its range of applications, safety, and cost, as well as how and when to integrate it into their clinical practice. This sleek, full-color atlas addresses each of these topics in succinct fashion. The author, a practicing oral and maxillofacial radiologist, introduces readers to all of the various ways of viewing CBVI data sets and guides clinicians in identifying familiar anatomic landmarks in the three planes of section (axial, sagittal, and coronal). Comprehensive case presentations demonstrate the diagnostic and treatment-planning capabilities of CBVI in its full range of applications (eg, airway studies, implant site assessment, odontogenic lesion visualization, 1:1 space analysis) while at the same time highlighting situations in which traditional two-dimensional imaging will suffice. A must-read for students and practitioners at all levels and in all specialties of dentistry. Q-5120600

$287

320 pp; 442 illustrations (mostly color)

Essentials in Piezosurgery: Clinical Advantages in Dentistry

Tomaso Vercellotti

This book presents the clinical advantages of Piezosurgery over traditional methods for tooth extraction, ridge expansion, sinus lifts, bone grafting, and clinical crown lengthening, as shown by research and clinical experience over the decade since the author first developed the technique. The reader will also find information about recent advancements in the field, including a presurgical assessment of implant site anatomy, based on a newly developed bone classification, and an innovative ultrasonic implant site preparation technique, which allows optimization of implant placement in difficult anatomic areas. In addition, the book describes the use of orthodontic microsurgery, a new orthodontic-piezosurgical technique that allows rapid tooth movement while preventing damage to the periodontal tissues. General practitioners, oral surgeons, and implant dentists will find unique insight into the clinical benefits of piezoelectric bone surgery. ®

Q-5120627

$251.31

136 pp; 340 color illus

The Science and Art of Porcelain Laminate Veneers

Galip Gurel

The Science and Art of Porcelain Laminate Veneers details the expanding field of porcelain laminate veneers in esthetic dentistry. It guides the esthetic dentist in understanding the needs of the patient and formulating a treatment plan that includes not only esthetic considerations, such as color and smile design, but also occlusal, periodontal, and functional requirements. In addition, it discusses the use of porcelain laminate veneers in diastema closure, the treatment of tetracycline discoloration, and in conjunction with orthodontic therapy. New techniques to ensure minimally invasive tooth preparation and maximum space creation for the dental technician are explored, and impression materials for porcelain laminate veneers are compared. The detailed guides to alternative porcelain materials and their step-by-step applications make this book invaluable for general practitioners, dental technicians, and the entire esthetic team. Q-5120432

$378.35

528 pp; 1,200 color illus

For more information on the 2010 Quintessence Symposium please contact Nareida Mitchell +61 2 9697 6288 or email nareida.mitchell@henryschein.com.au *PRICES MAY VARY WHEN PURCHASED IN NEW ZEALAND

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Call 1300 65 88 22

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09 News bites A country practice

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An award-winning dental clinic in Brewarrina is looking for funding to remain open for the next two years, following its unexpected success. The surgery started early last year, providing a local dental service that had not been available for years. It recruits fifth year university students to help provide greater access to dentist services for residents in the region. The Brewarrina Shire Council’s Economic Development Officer, Belinda Colless, says the practice has hit all objectives set for it: “We are just at the moment reviewing what we’ve done and getting a clear direction on where we are going to and obviously seeking to have the project refunded until 2011.” Last month, the Brewarrina Shire Rural and Remote Dental Project was selected from 216 entries from councils across Australia and announced as the winner of the prestigious National Local Government Award for Excellence. The win was a surprise for the Brewarrina Shire Council Mayor, Matthew Slack-Smith, who after accepting the award commented, “Not only does Brewarrina have improved health outcomes for the community but this award shows that even little towns like Brewarrina can come up with projects of significant importance.” Belinda Colless, from the Brewarrina Shire Council said the project is currently meeting targets and is making a real different to oral health in the community. £

Dental Corp goes international Last month Dental Corporation announced its expansion to New Zealand when Centre of Dental Excellence, based in Wellington, joined the group on 16 July. Dr Ray Khouri, executive director at Dental Corporation says, “We are delighted to announce our plans to partner with premium dental practices across New Zealand. This strategy forms a key element of our expansion plans for the business, and positions us well to continue the strong growth we have delivered over the past two and a half years. We currently have 12 New Zealand practices under purchase agreements and anticipate more than 20 New Zealand practices will join the group by the end of calendar 2010.” From acquiring the first Australian practice in October 2007, Dental Corporation is now Australia’s largest provider of dental services owning 112 practices with the addition of the first practice in New Zealand. Annualised revenue for the business now exceeds $220 million. Executive chairman of Dental Corporation, Mark Evans said, “Based on the success Dental Corporation has experienced in Australia and the outstanding response to its offering amongst dentists, it was logical for Dental Corporation to expand our operations to include New Zealand. Our partnership approach has proved very attractive to the larger sized, premium dental practices which are our target market. £

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10 News bites Boardroom blitz The Dental Board of Australia has been busy this month, with several announcements being released over recent weeks regarding continuing professional development, codes and guidelines and registration standards. But the flood of information has returned a tsunami of enquiries which has overwhelmed the agency’s capacity to respond. The body overseeing the various health practitioners boards, the Australian Health Practitioner Registration Agency (AHPRA), announced recently, “When registrants renew in the first year, they will be asked to declare that they intend to meet the pro rata CPD requirements during

The Dental Board’s hit the ground running, but not smoothly.

their period of renewal.” The DBA has also released the approved versions of their codes and guidelines relating to: mandatory notifications; CPD; dental records; infection control; the code of

conduct and limited registration for teaching. Understandably, AHPRA, which provides administrative support for all the national registration boards, says their Enquiry Contact Centre is

currently experiencing a high volume of calls. An online enquiry form is available through their website, at www.ahpra. gov.au. In a statement AHPRA said, “There have some key pressure points in the first weeks of the scheme. This includes our capacity to respond effectively to the 3000 enquiries daily to AHPRA and some IT teething issues (many of these are related to moving 1.5 million practitioner records from 85 sources into a single integrated IT system). AHPRA has identified the problems and is putting solutions in place. We regret that these issues have caused frustration. Delays are not acceptable. We are working intensively on solutions and ask for patience as these take effect.” £

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10 Bite

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12

Your world Tooth fairies

Article Rob Johnson Photography Stockxpert

Fairy lights Stephanie Wilson has combined entrepreneurial flair and fairy wings to create a clinic kids love coming to

ost dentists say they would do pretty much anything to ensure children look after their oral health. But would you dress up as a fairy? Stephanie Wilson would. And after doing so in her Brisbane practice for a number of years, she’s expanding her tooth fairy presence to the Gold Coast, books and a clothing range. Wilson, a trained oral health therapist, has been dressing up as the tooth fairy for twenty years—a practice she started while working for Queensland’s school dental service. “I’d do tooth fairy days for health promotion,” she says. “I’d dress up in the dental van as the tooth fairy. I realised the kids were so much more comfortable when I did it.” When legislation was enacted in 2003 allowing therapists to own a dental practice, Stephanie saw an opportunity to start a business realising her vision of taking away children’s dental fears before they develop. “Luckily we [she and her husband Grant] were in a financial situation where we could buy and build, so in November 2003 we found a location and built a three-chair practice there in 2004,” she says. “I always wanted to do this for the children—I started dressing up as the tooth fairy not for children to overcome their dental fears, but so they never knew there was a fear of going to the dentist. This is to get rid of that, and for them to have a pleasant experience.” She registered the TFI brand (for Tooth Fairy International), and started offering “Tooth Fairy Fridays” at the Brisbane TFI practice back in 2004, and they were sufficiently popular to expand the 12 Bite

idea to Saturdays as well. Last month she expanded her Tooth Fairy concept to the Gold Coast, with the opening two weeks ago of TFI’s new Labrador surgery. “We’ve found a lot of dentists don’t particularly want to treat children, and will refer them directly to a paediatric dentist,” she says. “So I have been going around introducing myself to practices to tell them we’re all in this together, and treating children is a challenging thing to do, so if it’s not something dentists enjoy, please feel comfortable referring them to us. We have special fairy decorations in our rooms, and we dress up as fairies to treat them. Often when we’re finished we’ll take a photo of the child with the fairies and put them up on Facebook, with the consent of the parents, of course.” Currently, TFI employs four tooth fairies—Wilson, Emina Mumi-

“We’ve found a lot of dentists don’t particularly want to treat children, and will refer them directly to a paediatric dentist.” Stephanie Wilson, Tooth Fairy International

novic, Georgia Campbell and Ingrid Seibert. The principal dentist in the practice is Dr Rhett Shapcott. Although things are humming along nicely now, Wilson says she was quite surprised by some of the attitudes she encountered when she first set up shop a few years ago. “It was amazing for me,” she says. “When I would interview dentists and tell them the philosophy of the practice, some would just stand back and say ‘you’re not a dentist’. I said that it shouldn’t matter, but a

Stephanie Wilson (on the right) with fellow tooth fairies Georgia Campbell (left) and Emina Muminovic (centre).

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Your world Tooth fairies

Wilson has extended her tooth fairy concept to a book.

lot of dentists walked away. They just didn’t want to know. And it just took one to come on board before it became acceptable.” In a move guaranteed to elicit nervous laughs from associate dentists, Wilson says, “We’d make jokes about them dressing up as tooth fairies, but the dentists were not employed to treat the children, they were there for adults. Whereas my special interests are with the kids. Obviously children under the age of four have to be treated by a dentist, but I’d take it from that age upwards.” To enhance the fairy experience for young patients, Wilson had

the walls and furniture painted in soft colours. She’s gone a step further in the Gold Coast surgery, setting up embellishments like fairy lights in the ceiling. The process of a visit to the tooth fairy for children involves being greeted by the fairy, and taken through the fairy wonderland. As a result of her interaction with children and parents, she decided to write a book incorporating some of the tooth fairy phrases she found herself using over and over. “The book came about because there’s nothing out there from the tooth fairy’s perspective. The story follows a normal procedure, and it’s illustrated by a young local girl, and self-published.” The book—The Story of the Toothfairy ... as it has never, EVER been told—is coming out this month, and Wilson has lined up sponsorship by a local radio station, as well as plans to promote it through schools and of course her surgeries. “I’ve got a few colleges booked in,” she says, “and I go to assembly in the character of the tooth fairy and I’ll read the story two a child at the school. So I’ll get a child up on stage to read the story to them.” She’s also found a deep well of support amongst her former colleagues in the school dental service, which is a positive thing for them at a time when school dental services are suffering from ever-diminishing funds. “I know how hard it is for them,” she says. “So we’re working in conjunction with them, and they’re really great to refer patients to me. They do bogged down, so we’re offering a back-up opportunity for parents who want to come privately.” £ For more on the Tooth Fairy, go to www.tfidentistry.com.

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14 Bite

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16

Your world Profile

Article Sharon Aris Photography Eamon Gallagher

Established for over three decades, the East Bentleigh Dental Group is a case study in how to build up a large successful practice by staying true to your vision

Wild about Harry his shopfront surgery of the East Bentleigh Dental Group is the life work of Harry Marget. Graduating from dentistry at Adelaide University in 1972, Marget says he realised from day one, “I wasn’t going to be a traditional dentist: one nurse, drilling and fillings all day.” His dreams were far bigger. He wanted to create an empire. So shortly after graduation he moved to Melbourne, working in general practices in Camberwell and Hawthorn before shifting to a practice specialising in crowns and bridges in Collins Street. But it wasn’t long before he set out on his own. “I decided I wanted to find a practice that was just a bombedout shell—a dinosaur. I found this one in East Bentleigh. The surgery was 40 years old. The toilet was outdoors, down rickety stairs. The dentist never worse gloves. The equipment dated from World War Two. I walked in and said ‘I heard you wanted to sell you practice’. He said ‘I want $13,000, take it or leave it.’ “I said, ‘I’ll give you $10,000.’ He took it.” Marget ran to a bank in the city and pleaded for the $10,000. It was December 30th. Over the next fortnight Marget rebuilt the surgery, ripped up the lino, painted and decorated. “I opened 10 January 1974 and have never looked back.” Which was no mean feat. Although the practice was booked out more than six months in advance when he bought it, Marget soon found it was because a sizable proportion of the patients—many of them the previous owner’s Catholic clientele—paid nothing. And the work was all surface fillings and extractions. Still, he had faith in the area’s potential. With “cows 16 Bite

grazing in the backyard”, it also had lots of growing young families. So he set about empire-building, one patient and one course at a time. From graduation, Marget embraced a philosophy of ongoing learning, travelling first to London then the US doing course after course on orthodontics. “I spent 10 years travelling the world, going to every major orthodontic conference in the States. I started branching out—crown and bridge, Invisalign, practice management—I spent two years teaching practice management. I spent three months in Japan learning complex implants.” Then he moved on to marketing. Indeed, says Marget, of all the training he’s undertaken, the one he’s enjoyed the most is the Million Dollar Round Table, “where top insurance salesmen from around the world teach you how to sell.” By the end of his first year he had his first assistant dentist. Then another, and another. “I worked out early on I wanted to create a business, and give people the opportunity to diversity themselves.” Then he bought a practice in Ellwood and started another one in the city from scratch—a retail store. “We went from no patients to being booked out weeks ahead very quickly.” Then he bought another practice. At one point he had four practices built up. The empire had expanded. Then, save East Bentleigh, he sold them all. Lesson learned. “There wasn’t a lot of profit to be made running multiple practices,” he says. “There are four lots of staff, rent, training, and problems. In terms of profitability, there is no point in having multiple practices. In one practice you can consolidate expenses and marketing.” Back at East Bentleigh he went about realising his core aim, which was practice that could treat all a patients dental needs. “We are focussed on providing every service under the sun—

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Profile

Margets realised he wanted a single practice offering everything.

children’s, orthodontic, sleep, Invisalign, fresh breath—we’re a one-stop-shop. We’re unique in that respect. I have 15 dentists and 43 staff, so we’re like a mini hospital.” They also offer integration with complementary medicines like hypnotherapy, kinesiology, osteopathy and chiropractors. “With new patients I do a complete oral examination and complete physical examination. I plant seeds: ‘Do you have problems in your back, or neck problems, do you have trouble sleeping?’ It’s my shock and awe technique. ‘How did you know my lower back was sore?’ Then I introduce the concept of whole body medicine.” But he’s a pragmatist too. East Bentleigh Dental Group is also a Medicare Private and HBA preferential provider. “I’ve been accused of prostitution in getting in bed with the health funds, but they market me and it costs me nothing, and I get 60 to 80 new patients a week,” says Marget.

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aking a large comprehensive service work doesn’t happen without the right mix of people and Marget puts considerable effort into finding the right dentists and staff. “I’ve brought people in from overseas, from the US, China, India, Canada.” The practice lists a total of 16 languages in all. His guiding staffing ethos, says Marget, is “be a dream giver, not a dream taker. When people come and work for me I say ‘let’s build the dream’ You build a comfort zone for people. Give them the capacity to reach that dream. And you have to be there to make sure that dream comes true.” It also means supporting people when things go wrong. “If someone breaks a tooth root, I hold their hand. If I have to take them aside, I take them outside. I say ‘we all make errors of judgement. This is one. We’ll make the changes needed’. Never be negative. Be inspiring, Always say ‘we’ll fix it’. I work very hard on staff. We do training every day.” His reward is staff loyalty. He adds you must lead by example. “We ask ‘how do we do this better?’ We bring in new technology. We keep standards high. Be a leader: take the slings and arrows and run up front. Who remembers who gets the silver medal at the Olympics? You remember gold.” It’s working. Marget put his numbers at seven and a half to eight million annually. Still if there is any one key, it comes down to Harry himself. “Harry has got to be one of the most enthusiastic dentists I’ve ever met,” says Mark Van Weelde, managing director, Invisalign 18 Bite

Australia. And one of the most persistent. When Invisalign first launched in Australia in 2002 they weren’t targeting general dentists. Harry however, had other ideas. “He muscled his way in,” chuckles Van Weelde, adding now he’s one of the biggest submitters in Australia. “And he’s given me a lot of input on how to make Invisalign work for general dentists. He’s been doing orthodontic work for many years and he was quite instramental in saying ‘you need to develop this product more’. He ensures we speak once a week whether I like it or not.” “Harry’s always thinking laterally,” he adds. “He’s always prepared to give things a go and he thinks outside the box. His staff have Invisalign advertising on the back windscreen of their cars. He always carries cards wherever he goes. If he receives exceptional service—and I’ve been with him in a restaurant when this happened—he offers the person a free dental consultation. He says they’ll be great advocates of his practice.” His enthusiasm also led him David Penn, a fellow dentist and CEO of Southern Cross Dental Laboratories. Initially meeting through the exceptional practice group, an invitation-only assemblage of some of the most successful dental practices in Australia, Marget is now a motivational speaker for Southern Cross when they do training in Invisalign. “He’s very passionate about what he does. He gets very emotional. His heart is very much involved in everything he does,” says Penn. But, he adds, “The integrity is there. He’s not selling you something you don’t need. He’s got tremendous business acumen and marketing skills. He’s always having a go at something. To have a hugely

“We’re unique in the respect that I have 15 dentists and 43 staff, so we’re like a mini hospital.” Dr Harry Margets, East Bentleigh Dental Group

successful practice you need good people skills but a sound clinician as well.” This infectious mix of enthusiasm, wide-ranging clinical practice, humour and good old fashioned hustle is embued throughout his practice. An enthusiast for new and social media, on the practice website, alongside the clinical information, there’s blogs, youtube links , Facebook links for teenagers undergoing orthodontic treatments, product reviews and video tours of the surgery. In his chirpy introductory video, Marget enthuses ‘the most fun I have is coming to work and enjoy being here with my team...’ ‘It feels more like a family,’ says one of his staff on the video. ‘Harry Marget doesn’t feel like a boss, he’s like our dad’. ‘It’s just great fun being here,’ says Marget to the camera. Now Harry has bigger plans again. He wants to replicate his model up and down the east coast. In his ‘lock and key’ model he find a young dentist just out of dental school. “We find a great location, look for young family areas, and we build a four chair surgery, all under one roof. We show the young dentist how to do the service mix in dentistry. We do the marketing and website design. We bring them in here for six months training. We train them in endo, Invisalign, orthodontics. We support them all the way thought and gradually release them, but we retain the freehold All they have to do is come in, wash up and sit down. It’s working with us with the ultimate idea of owning. The only thing they have to put up with is my jokes.” £

20

Your business Design

Article Rob Johnson Photography Simon Wood Photography

Underwater love When patients see calming vision of fish rolling through coral during their surgery at Macquarie Street’s Dental Lounge, it’s not the painkillers kicking in

ompeting with a view in Sydney is pretty difficult. Competing with a view of the city’s botanic gardens is nigh impossible. But that’s what Drs Mark Braund and Daniel Adamo of Dental Lounge wanted to do—find something that competed with their surgery’s million-dollar view over Macquarie Street. They discussed it with their architect, Joshua Mulder of JM Architects, and came up with a somewhat surreal solution—fish. “The suites in this building are all quite small, and there’s 16 in the whole building,” explains Daniel Adamo. “We’ve got one that looks over the Botanical Gardens, and has a beautiful view. Most of the rest of the suites are owned by the College of Physicians, and they’ve owned for years and years, and they rarely come up for sale. However, recently the one out the back of ours became available, so we bought it. Unlike our existing suites, the back one had no view, so we had to come up with something that could compete, something that made it special in and of itself.” Problem was, they’d pretty much reached the limits of their own design abilities with the front suite. “We did the build of the front suite ourselves, but we couldn’t really much it up because that view was so good, no matter what

we did it would always be fine,” says Adamo. They tossed a few ideas around, then approached Joshua Mulder and asked him to come up with a design that looked good and accommodated three chairs and a steri room. “Mark [Braund] came up with the aquarium idea, but only as a suggestion, then Josh just ran with it,” says Adamo.

“Mark [Braund] came up with the aquarium idea, but only as a suggestion, then Josh just ran with it.” Dr Daniel Adamo of Dental Lounge

“His design was nothing like what we conceived.” Mulder saw the request for an aquarium as an opportunity to take things “to the max”. “We came up with a concept that divided the main entry from other treatment rooms by having a continuous aquarium wall running down the length of the practice, to maximise the experience,” he says. But of course, nothing is ever that easy. “The biggest challenge we needed to get our head around was the issues you face when working with an older building, and with predominantly concrete walls,” says

What can compete with a view of the Botanical Gardens? Fish, of course.

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22 Bite

The biggest factor affecting the design was the weight of the fish tanks, says Mulder.

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Mulder. Those old Deco buildings look wonderful, but aren’t actually designed to be carrying around large aquariums. “The biggest factor was the weight of the tanks,” he continues. “The structure had to take the weight, and the tanks needed to be matched. So the challenge was to still get that wow factor while being mindful of those constraints. We initially thought of doing floor to ceiling tanks, but just through the nature of the construction and the weight, we were restricted to the strip through the centre. Together with the natural space constraints—the suites are quite small—the tank size had to be a certain thickness too, which impacted on the size we had to work with.” For every litre of water in the tanks, the weight would be one kilogram, which made the combined weight of the tanks more than a tonne. At that weight, the tanks had to be supported on a subframe, which then presented the challenge of levelling everything off accurately. “It’s a lot of weight in a relatively small area,” says Mulder. That wasn’t the only problem: The suites were five levels up. There was only one lift you could bring things up in. So the tanks couldn’t be manufactured off site and carried up—they had to arrive in pieces that would fit in the lift, or be ale to be carried up the stairs. “When we originally spoke with the aquarium guys, we asked them what’s the biggest tank we can get up in this space?” Mulder recalls. “They said we can do two and a half metres long by a metre high. At that point they were thinking they could get it up in the lift. Then they tried it and said no, we can’t. So they walked one piece of glass up the stairs, and the others had to be cut down to be bought up in the lift. The number of cuts were determined by the fact that you couldn’t have too many joins in the glass or it

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he original floor presented the builders with problems, but with opportunities to continue the ‘aquarium’ theme: “We found the timber floor was raised on batons, and we had problems getting flush transitions from inside to outside,” Mulder explains. “We needed to raise the floor as well, using materials which were a bit more tactile and warm, which almost gives the impression of a sandy beach. So it really had a theme of the full experience of being in water.” From the point of view of the owners, the whole experience was quite a pleasant one: business in the suites continued as normal for the course of the build, says Adamo, and while he remembers things may have gone slightly over-time and budget, it was all controlled by Mulder. And the end result is quite spectacular. “The aquarium is double-sided, so when you walk past, if you looked really hard, you could see through the wall into the treatment rooms,” Adamo says. “Of course, you don’t have a clear vision to do that—there’s plenty of distractions in the way, like plants and fish. We actually had the first day of using it recently, and we’re planning an opening party for some time this month. The people we’ve taken up there to take a look say it’s amazing.” £

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wouldn’t be as aesthetically pleasing. So it was a challenge getting the glass up there.” Rather than one continuous aquarium, the solution Mulder created involved three aquariums set into a glass wall. “The aquariums are set up at eye-level,” he explains, “so you’re walking between each one into the treatment rooms. Above and below is all glass, then it has a film of glass with an image printed on that so it looks like a water wall.”

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25

Your business Endodontincs vs implantology

The turn of the screw When are implants the right decision? It’s a tricky question for any practitioner to answer, and some experts think not everyone is qualified to answer it. Article Andy Kollmorgen Photography iStockphoto

he arrival of dental implants in the early 1970s was a hailed as a breakthrough. And with good reason. Compared to what was previously available—dentures, for instance—an implant was much closer to the real thing. Most experts say it still is. But breakthroughs tend to be dangerous when they fall into the wrong hands. With something as commercially viable as being able to permanently replace teeth, everyone wants to add the service their repertoires—regardless of whether they’re qualified to deliver it. These days there’s a growing concern that dentists are going ahead with implants when the original tooth could and should be saved. Is there a profit motive behind the perceived trend, or do some practitioners honestly not know what they’re doing? It’s a question that’s getting asked a lot lately. A recent article in the Journal of Endodontics lays out how hard the decision can be. “Not only is the choice of treatment controversial, but even the criteria for defining a tooth as compromised are controversial and subject to interpretation.” And in April last year the Journal of the American Dental Association (JADA) weighed in on the issue, saying “clinicians

regularly are confronted with difficult choices”. In cases of implants versus endodontics, however, the decision should not be “guided solely by the desires and clinical experience of the practitioner. It must be based on scientific evidence, and ideally it should preserve the biological environment”.

Dr Figdor believes the sensible way to maintain best practice is to consult a specialist before going forward. But he understands some general dentists may not be inclined to do so. Maybe it’s a matter of taking the time to figure out what’s right. Melbourne-based endodontologist Dr David Figdor says knowing when to write off a tooth or stick with the tried-andtrue approach of root canal and crown (or, when appropriate, a bridge) is not necessarily a tall order. As long you know what you’re doing—and you’ve got the patient’s interests firmly in mind. “Where the controversy has come about is that some Bite 25

Endodontincs vs implantology

people are really pushing the envelope. Some would say there are strong commercial pressures; that dentists could be better informed about the possibilities of saving the tooth.” Dr Figdor believes the sensible way to maintain best practice is to consult a specialist before going forward. But he understands some general dentists may not be inclined to do so. He says an implant is the right choice only when the tooth is “essentially unsaveable” and the endodontist is ideally placed to help make that decision. His concerns centre on “overzealous application of extraction followed by implants”. For specialists like Dr Figdor, a historical view offers muchneeded perspective. He points out that endodontic treatment “has been around for a long time and the success rate is relatively high”. The same cannot be said for implants. The latest comparative study (also published in the Journal of Endodontics ) says 129 implants required follow-up treatment after an average of 36 months and showed a “success rate” of 87 per cent, while 143 endodontically treated teeth were still in good shape after an average of 22 months and were 90 per cent successful. “We found that 12.4 per cent of implants required interventions, whereas 1.3 per cent of endodontically treated teeth required interventions, which was statistically significant.” However, the study makes clear that the need for follow-up treatment did not indicate failure of the procedure. “The success of implant and endodontically treated teeth was essentially identical, but implants required more postoperative treatments to maintain them”.

D

r Figdor says the postoperative question is critical, as is the definition of “success”. “If you look at outcome studies for implants, they generally report very high survival rates. I don’t think that’s accurately presenting the full picture. It depends on how many years you follow up and how technical and biological problems are reported. Over time, a significant proportion of patients will experience complications with implants. They can run from minor maintenance to more serious complications like bone loss or peri-implantitis.” Dr Barry L. Musikant, who says his practice’s mission is “rational” endodontic techniques and restoration of endodontically treated teeth, maintains there’s room for discretion but adds that skilled dentists know when to make the right choice. His practice is located just off New York City’s Central Park, but he has lectured internationally and written extensively on the subject. He says the issue is of universal concern for dentists as well as patients. “I believe that in some cases the choices are obvious. If a tooth is pretty much intact, there is no question that the root canal should be done, provided that the dentist or endodontist has the skills required to do what is considered a good job. If a tooth is so thoroughly broken down that saving it would take heroic efforts and result in only a guarded prognosis, there is no question that an implant should be considered if the bone is present to accept it and the health of the patient does not contraindicate it. So what we are really talking about is the gray

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26 Bite

The case for implants is based on many factors.

area, where dentists may differ in opinion on what should be placed.” JADA gets more specific, saying people with poorly controlled diabetes, compromised immune systems or those who smoke are probably not good candidates for an implant. The organisation—which has made implants versus endodontonics a frontline issue over the past couple of years—also points a finger at potential conflicts of interest. “Treatment planning usually is affected by the views of the stakeholders [patients, insurance companies and dentists], who have varying perspectives and expectations regarding the outcome of treatment. Treatment should be patient-centered, not be based only on dental insurance benefits and not be guided solely by the desires and clinical experience of the practitioner.” It also says people with chronic caries or periodontal disease problems or those who have “a limited ability to perform routine oral hygiene procedures” should probably not get an implant.

EW

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Then who should? Ultimately, the decision hinges on practitioners’ skill and objectivity in assessing the patient—and on their knowledge of where implants should go and how to keep them healthy. The Australian Dental Association, for instance, says implants have a 98 per cent success rate in the lower jaw, but “the further back in the mouth you go, the lesser the prognosis—sufficient bone to accept the implant is the major limiting factor”. According to a report by the Cochrane Oral Health Group (which describes itself as an “international organisation that aims to help people make well-informed decisions about healthcare”) published in the Australian Dental Journal, the build-up of bacteria beneath implants is the major cause of failure. “One of the key factors for the long-term success of oral implants is the maintenance of healthy tissues around them. Bacterial plaque accumulation induces inflammatory changes in the soft tissues surrounding oral implants and it may lead to their progressive destruction [perimplantitis] and ultimately to implant failure. Different treatment strategies for perimplantitis have been suggested, however it is unclear which are the most effective.” The report concludes there is no measureable advantage of antibiotics over “deep mechanical cleaning” to prevent implant failure. The lack of clear guidelines is in keeping with the issue as a whole. While some dentists may be recommending implants without due diligence, whether or not they have done right by their patients is rarely a clear-cut case. £

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28

Your business Human resources

Article Rob Johnson Photography Stockxpert

Beating the bullies Workplace bullying is an issue receiving increasing attention in recent years, and it happens more frequently than you may think.

t’s a truth universally acknowledged that dentistry is a caring profession, and so the problem of workplace bullying would not be an issue for those in the profession. Indeed, when Bite contacted one dental consultancy to discuss the issue, we were told they couldn’t make a comment because they didn’t think it happened in dentistry at all. But despite the absence of local data about dental workplace bullying, a recent New Zealand study suggests that it may be much more common than you’d think. In fact, the study—published last year in the journal Occupational Medicine, and written by Ayers, Thomson, Newton, Morgaine and Rich—surveyed Kiwi dentists and found “workplace bullying was reported by one-fifth, and over one-quarter had experienced a violent or abusive incident”. Erica King, owner of DCA Dental, goes further: she says workplace bullying is rife. “And the bullies are young female dentists,” she adds. “I’ve got eight practices, and we have a high proportion of young female dentists, and they have support staff who are all female. So you have dentists who are finding their feet, and are not always sure how to work with others, and not sure of the difference between being assertive and being aggressive. “The most common scenario is where a dentist becomes aggressive towards staff. In the last year I could cite several instances where a dentists has yelled at staff and thrown things. I take it very seriously, because I have to.” Although people have been talking about workplace bullying for over a decade, it really wasn’t until the death in 2006 of 19year-old Victorian waitress Brodie Panlock—who was bullied so relentlessly by four of her colleagues that she ended up committing suicide—that the general public, and legislators, seemed 28 Bite

to realise the serious consequences of bullying. The tragedy was compounded by injustice when, following a prosecution by WorkSafe Victoria, those responsible were let off with fines. However, following a coroners inquest, the Victorian Government announced 40,000 workplace inspections for bullying. That in itself promised to counter one of the greatest hurdles to tackling the problem—the victims’ unwillingness to tell others. Most commentators agree the problem is massively under-reported.

“My strategy is to approach the problem head-on. I go to the dentist directly about the problem. Sometimes that works, sometimes it’s a disaster. I then give staff coping mechanisms, to not react in a negative way and to create an environment that doesn’t support bullying.” Erica King, DCA Dental

According to a newspaper report last year, while the Productivity Commission says more than 2.5 million Australians have been bullied in the workplace, it’s thought that less than a third ever complain about the bullying. The paper said one reason is that one psychological effect of bullying is a strong sense of hopelessness and disempowerment. Another is simple pragmatism; people want to protect their careers. The New Zealand study cited earlier found violence and ag-

IF this is how you look to your staff, you may have a problem.

gression towards dental personnel was on the increase, even if it remains less common than in other health care workplaces. There is also wide variations in the numbers cited in various studies. “The prevalence of workplace bullying is also concerning, especially as it was associated with sick days taken and it appeared to be a particular concern for female and employee dentists and those aged between 40 and 49,” the authors wrote. “Further investigation of workplace bullying and aggression would be useful.”

E

rica King doesn’t believe it’s a new problem, but she says, “Right now, I’m finding it’s at a critical point as an employer. It creates a negative working environment.” She says in her experience most problems stem from the mood of the dentist. “Dentists are moody professionals working in a stressful environment,” she explains. “Any dental team is there to support the dentist. So the mood that the dentist is in completely dictates the way the staff behave. If the dentists arrive in a bad mood, the staff are in for a bad day. I’ve had staff who get physically unwell hearing the dentist coming in the front door.” She says anyone who believes bullying doesn’t happen in dentistry is in denial. “It’s a business, and you’re dealing with demanding patients and staff,” she says. Society has changed since then, and sometimes those changes increase the stress in a workplace. For example, she says, “When I started 20 years ago, assistants were in a service role, but now you’ve got these dynamics where young ladies are much more opinionated, more educated, and want to contribute more to the team—and that sometimes causes conflict. Another source of stress is patients

with access to the Internet who are much more savvy, and nowadays they question everything. The frequency of litigation’s up—the medical profession was always having problems with litigation, where dentistry now faces more than every before. But there’s also dental-specific problems, such as the introduction of the Medicare EPC scheme, which has created major stress for dentists because patients come in thinking they can get this free dental work done after a lifetime of neglect. Trying to get them to understand that it doesn’t work like that creates problems and that’s increased stress levels.” But the big question is, what to do about it? On a macro level, only two states in Australia have specific legislation on workplace bullying. Those two states, Queensland and Western Australia, have had a significant decline in worker compensation claims related to bullying since the introduction of bullying specific codes of practice. Queensland has reduced the number of bullying claims from 265 to 130 over five years, while Western Australia had just 20 claims in 2008. Some people believe the quickest and easiest way for a staff member to deal with bullying is to leave the job, but Erica King tries to counter that—good staff are too hard to find, she says. “My strategy is to approach the problem head-on. I go to the dentist directly about the problem. Sometimes that works, sometimes it’s a disaster. I then give staff coping mechanisms, to not react in a negative way and to create an environment that doesn’t support bullying. “We won’t tolerate it, same as we won’t tolerate discrimination. Sometimes I do lose staff and dentists over it. But its an ongoing thing with personalities, and can only be addressed when trying to balance egos, the demands of staff, and the demands of patients.” £ Bite 29

30

Your business People management

Article John Burfitt Photography Stockxpert

Good reviews If Performance Evaluation sessions are the time of year that everyone dreads, then it may be time to reconsider the way you are doing business.

here’s little chance that performance evaluations will ever win any workplace popularity contests. When it comes to days on the annual calendar that the staff looks forward to—like the Christmas party or announcements of pay rises and bonuses—the performance evaluation is usually found at the other end of the scale as a red letter day that is dreaded. Performance evaluations suffer from an image problem, so much so that many—employers and employees—will go to any lengths to avoid them. Rather than being seen as a valuable opportunity for open communication within an organisation and for the setting of new work goals, most staff seem to fear them—on both sides of the meeting table. “I have been coaching hundreds of dentists for five years around Australia and New Zealand, and have noticed a trap that dentists fall into is a fear of confrontation,” says Dr Joanna Gray, a trainer with Momentum Management. “We do training sessions with as many as 20 dentists in the group. When I ask who is has a fear of confrontation at work, 80 to 100 per cent of the room will say ‘yes’. It is a big issue for them. “But the problem in not saying anything is that the dentist then does not get what they need, and then the staff gets no direction, which can lead to general discontent, which does not help anyone.” The fear, however, can be attributed to a lack of confidence in how to actually conduct an effective performance evaluation and some of the finer details of staff management. 30 Bite

Gray recalls one dentist who was fearful of reminding an employee that the practice floor needed to be mopped regularly, which was part of the job description, but never told her. Eventually, it became a problem. “I also have many staff members saying how much they like their boss, but all they really want from them is to be told what they want in the job,” Gray adds. “So when confrontations do happen, they can happen very badly.” Bernadette Beach of Indigo Dental Consulting says the problem in managing staff stems back to the initial training a dentist undertakes for their career.

“The problem in not saying anything is that the dentist does not get what they need, and then the staff gets no direction, which can lead to general discontent, which does not help anyone.” Dr Joanna Gray, Momentum Management

“Dentists attended university to learn how to care for patients, not how to manage a business,” says Beach. “This is why it is an on-going learning curve for them as they learn how to manage staff and get the best out of them. That process can be quite overwhelming and if you don’t do it well you can have a de-motivated staff and an environment where everyone is walking on eggshells.” With perception the obvious problem, the concept of the performance evaluation needs a makeover. For evaluations to

If you don’t give her regular performance evaluations, she won’r be as effective as an assistant

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Your business People management

Without direction,staff suffer higher stress levels.

be effective, they need to be seen as a regular and constructive process of the business, and that change needs to start at the beginning—of each staff member’s employment, as well as with the way each evaluation is conducted. “It needs to become a part of the way your business operates,” says Beach. “After three month’s employment, it is essential to do the first review, and then to possibly do it again after six, nine and definitely at 12 months. “What that does is give the employee goals for every three months that will complement the goals of the practice, and then at the review you can both look at what was achieved and how it worked. It is to identify problems earlier on than later when they have escalated.

“Very often, as a result of not having set it up properly in the first place, it can become a difficult conversation.” Dr Phillip Palmer, Prime Practice

“This is something that must be scheduled in as you would schedule any other important meeting. It will also make being reviewed just part of the process for both the employee and the employer.” A comprehensive job description is the essential foundation stone guide for all employees of what their role entails. “And you would be amazed how many practices don’t have job descriptions,” adds Beach. How that staff member performs in relation to those outlined responsibilities should be the basis for the performance evaluation. One recommendation is that in advance of an evaluation, managers should present two items of paperwork to their staff. One is for each staff members to outline and rate their own performance, and the other provides an agenda of the items 32 Bite

to be discussed during the meeting. “That lets the team have a think about what they have been doing, how they have been doing it and where they want to go from here—and that is really valuable for them,” says Beach. “It also lets them feel this will be a 50-50 meeting, with the discussion going both ways.” An established agenda also assures the evaluation meeting will stay on track and cover the areas that need be discussed. If you don’t do it with written forms in front of you, then you are making it up as you go, says Dr Phillip Palmer of dental management consultancy Prime Practice. “Make sure you have a list of topics, rather than pulling things out of the air,” he says. “Very often, as a result of not having set it up properly in the first place, it can become a difficult conversation. “Telling someone that you are going to review them can almost sound like, ‘I am about to chastise you’. On the other hand, if it is properly setup as an expectation of a procedure that comes with the job then it can be an anticipation of something beneficial and a constructive review that most employees will look forward to as part of their career development.” he evaluation should also be the annual focal point of all the feedback and direction that has been given from the dental employer to the staff. It is not, insists Palmer, the time to unleash issues that have been festering away for months. “There should be no surprises in a performance review,” says Palmer. “There should have been feedback given during the course of the year as to how someone is going. The team member should know if they are doing the right thing throughout the year, rather than waiting to be told in one big meeting. If however, that is how the practice is being run, then it is time to review your management methods as well.” As is the case with any staff meeting, attention also needs to be paid to keeping the meeting focused on what the intended outcomes of the evaluation will be. “Normally, the desired result will be some kind of action plan of how that employee can continue to do what they do well, and improve in the areas they need to improve on,” adds Dr Gray. “There must be a clear plan with specific action they can take. So if they are told they need to improve their communication skills, how they go about that and how that will be measured is clear, with a timeline set and a follow-up date agreed on.” Dr Palmer adds that both sides of the meeting should emerge feeling they have achieved something productive for both their futures within the workplace. “It has got to be constructive and helping with that person’s career and personal development as well as the running of the practice,” he says. “It is not relevant whether the review is for an employee dentist, a team member or the front desk person, it doesn’t matter—it needs to be clear. “A performance review shouldn’t be something that causes distress. It should almost be celebratory, with some sort of recognition for a staff member about their good work as much as it is critical for when the work needs to improve.” £

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35

Your tools Reviews

A great intraoral camera, an excellent intraligamentary syringe, and a good pair of ears and more are all on show this month

Tools of the trade EccoVision

Listening

by Dr Sandie Earl, S H Earl Dental, Rockhampton, QLD

by Dr Glen Hughes, Alstonville, NSW

EccoVision is a computerised system for helping people with dental sleep disorders. It takes volumetric measurements of the airway and creates a graphic and numeric reading. From these readings, I am able to design a unique appliance for each patient. I receive many referrals from the ear, nose and throat (ENT) specialists in the area enabling the use of this machine on a daily basis. What’s good about it The readings are very accurate. There’s a small tube to measure each nasal airway (rhinometry) and a mouthpiece to measure the oral airway (pharyngometry). We take two different measurements. Firstly, a daytime (awake) measurement where the subject just passively breathes in and out. Then to mimic a night time (asleep) measurement, the patient takes a breath in and fully releases it slowly to mimic the collapsed, relaxed airway when we sleep. The graphic read-out gives patients a clear visual picture of their situation. They often have difficulty interpreting an x-ray but usually understand the EccoVision graphic. Whereas a lot of snoring centres rely on a one-size-fits-all appliance, I use the reading to trial various jaw positions for maximum airway. Then I have an appliance manufactured to individually fit each patient. In some cases, it even shows that nothing I can do will assist them. Once a patient is comfortable with the appliance, I take another set of readings to confirm the improvement. Referrals from the ENT specialists have a sleep study done with their appliance fitted. The patient response has been very positive.

As a dentist who has worked for many years in developing countries, I am amazed that we rarely use simple senses to diagnose. It’s almost like we can’t see without loupes, we can’t feel without a probe, we can’t smell without a culture and we can’t hear without some form of digital amplification. Listening is a very valuable tool in dentistry. What’s so good about it In the field of restorative dentistry, the sound of tooth against tooth is very different to tooth against any restorative material. I find I can ‘hear’ a correct bite with a higher degree of tolerance than can be detected with the finest articulating papers. I always listen to the occlusion after polishing fillings and often make additional adjustments even after an articulating paper record tells me the bite is clear. My return rate for occlusal adjustment has greatly improved since I started listening carefully. In endodontics, the sound of a tapped tooth that is vital is different to that of a tooth that has periapical inflammation. Instead of a ring, the sound is dull and muffled wherever pus is present. Even though I still confirm the diagnosis with pulp testing and radiographs, I have often picked up a ‘feeling’ about an asymptomatic, chronically abscessed tooth simply because it sounds different to the other teeth. Listening carefully helps to identify which tooth is different. This can be invaluable in some mouths where multiple amounts of complex dentistry make it difficult to choose between two or three teeth that all have a similar radiographic appearance. I would encourage other dentists to add technology to their own armamentarium, but never let it replace the senses we have. It would be a sad day in dentistry if we choose complexity over simplicity, or prefer the expensive over what is free. Cheap and simple are not always the enemy of good outcomes. Sometimes I have found that less is more!

What’s not so good It uses an old DOS system that really needs an upgrade or a software update.

What’s not so good There are no negatives.

Where did you get it Body Logic .£

Where do you get it It comes for free though it needs to be honed with use. £ Bite 35

Your tools Reviews

Intraligamentary syringe by Medesy by Dr Mark Schwartz, Waratah Dental Centre, Engadine, NSW This gun-shaped syringe forces anesthetic under pressure down the sides of any tooth you choose to numb. Its effect is extremely local and only provides numbness for that particular tooth. I’ve been using it since it first came onto the market in the mid-’80s and there is rarely a day when I don’t use it at least twice.

Elca Intraoral Camera by Dr Ralph Kelsey, Sure Dental, Wavell Heights, QLD I use this intraoral camera to display a moving image as I take it for a tour around the mouth. It is attached to a foot control so I can freeze the image at any point and store it in the patient file. The images are displayed on a monitor that patients can see when they are reclined in the chair. What’s good about it I wouldn’t set up a surgery without an intraoral camera. It is excellent for patient education, confirmation of clinical signs, and for clinical records. I chose this camera because it’s compatible with the Adec equipment I use. It’s ideal to have the intraoral camera software interfacing with your system software. That way, when you record an image, it’s automatically saved onto the patient file. Patients love it and often comment that they have never seen inside their mouth before. When trying to explain treatment options, it can be difficult for patients to visualise what you are saying. However, once they see an image, they understand immediately, which helps greatly with the acceptance of treatment proposals. Patients love to see the finished result after work is complete—the before-and-after shots have a great impact. I have three hygienists working with me and I have a camera set up in each room. Showing patients what is happening inside their mouth helps them understand the importance of their visit. The after shot then reinforces the benefits of being here. What’s not so good They are a little expensive to purchase but, as far as I’m concerned, the return on investment far outweighs that negative. Repairs can also be expensive, though that has only occurred twice in four years. Where did you get it Supplied by Independent Dental (Brisbane Birkdale) and installed by Ross Jones Dental 07 3391 0208. £ 36 Bite

What’s good about it In many situations, it’s an effective substitute for block injections. It works virtually immediately and doesn’t cause unnecessary soft tissue numbness. It’s also an invaluable tool for differential diagnosis. A patient with a difficult-to-isolate symptomatic tooth can have teeth sequentially anaesthetised in order to determine the source of pain. It provides ample anaesthesia for routine restorative procedures. Patients occasionally appreciate not having that numb feeling when they walk out. It’s also a valuable ancillary injection when dealing with ‘hot pulps’ resistant to traditional LA administration. When using the technique for infiltration, especially in the upper anterior area, the enforced slowness of fluid expulsion means a far less traumatic injection for the patient. Phobic patients are sometimes less stressed as they do not associate the alien shape entering their mouth to a ‘needle’. What’s not so good It is technique sensitive, so a fair degree of patience is needed to obtain consistently successful results. It can’t be used at sites affected with periodontal pocketing greater than 5mm. And there is an inherent failure rate. The anaesthetic appears to fail in about three-to-five per cent of patients. Interestingly, though, auxiliary anaesthetic to provide a perceptible numbness without clinical action often ‘magically’ remedies the ‘failure’, again demonstrating the close association between cognition and reaction. Where do you get it. Ridley Dental Supplies, Peakhurst, NSW. £

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In comparison to posterior and universal composites. Chemically compatible with methacrylate based adhesives and composites only. Compared to conventional light-cured Polymerization.

38

Your life Passions

Dr Julian Leigh Half Moon Dental Centre, Minyama, QLD ,

“I’m a firefighter for the Queensland Fire and Rescue Service. Living in Maleny, which is about 40km from my surgery, I work in a stand-alone auxiliary station. There are 10 of us and we’re on call 24/7, 365 days a year. Our nearest fire station for back-up is about 35 minutes away. Once our pager goes off, the truck has to be rolling within seven minutes, although we normally get our truck rolling in under four minutes. “We’re a frontline Fire and Rescue unit. Last financial year we had over 100 calls, which means one every three days. Most of these are vehicle accidents and we sometimes have to cut people out of cars. We don’t get called to bushfires unless it’s threatening a structure. It’s not only the fulfilment of a kid’s dream We do the being a fireman same training but it’s great to be part of the as full-time local commufirefighters nity. We do the same training as full-time firefighters, covering an area that contains about 15,000 people. “A majority of ‘000’ calls are at night or on the weekend which means I miss few fire calls while at work. A few times, we’ve had some big jobs where I’ve had to re-arrange my patient appointments. These are usually house fires or fatalities in the small morning hours. “We had one incident where we had to go into a burning house as there was a child trapped inside. The crew managed to get inside safely and rescue the child and then save the house. Sometimes after you’ve done something like that, you sit back and think, ‘That was a bit hairy’. But our training—which is excellent—just kicks in. Being a firefighter has been stimulating both mentally and physically. Mind you, when the pager goes off at 3am and you have to cut someone out of a car then rush to work and take out a wisdom tooth at 9am, it can make for a very long day!

38 Bite

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Bite magazine August 2010