Published by the Australian Dental Association (Queensland Branch)
CONTACT
24 Hamilton Place Bowen Hills Qld 4006
PO Box 611, Albion Qld 4010 Phone: 07 3252 9866
Email: adaq@adaq.com.au
Website: adaq.org.au
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DISCLAIMER
ADAQ Dental Mirror is published for the information of Members only and is not for general distribution. Copyright is reserved throughout. No part of this publication may be reproduced in part or whole without the written consent of the publisher. This publication is for the purpose of promoting matters of general interest to Members of the Association. The views expressed in this magazine do not necessarily reflect the views and policies of ADAQ or ADA. Publication of advertisements for products or services does not indicate endorsement by ADAQ. All material is positioned and published at the discretion of ADAQ.
ADAQ COUNCILLORS
PRESIDENT Dr Jay Hsing
SENIOR VICE PRESIDENT
Dr Kelly Hennessy
JUNIOR VICE PRESIDENT
Dr Paul Dever
COUNCILLORS
Dr Carl Boundy (Peninsula)
Assoc Prof Alex Forrest (Moreton)
Dr Peter Jorgensen (Sunshine Coast)
ADAQ SUB-BRANCHES
Bundaberg Dr Paul Dever
Dr Alexander McDonald (Gold Coast)
Dr Ellen Rogers (Moreton)
Dr Grace Sha (Moreton)
Ipswich Dr Andrew Wong
Cairns Dr Brian James Kingaroy Dr Man Chun (Simon) Lee
Gold Coast
Dr Norah Ayad
ADAQ COMMITTEES
Awards and Honours Committee
Convener: Dr Jay Hsing
Volunteering in Dentistry Committee
Convener: Dr Jay Hsing
Mackay Dr Raghu Channapati
Dr Rachael Milford (Western)
Mr Glen Beckett (Skills-based)
Policy, Advocacy and Advisory Committee
Convener: Dr Norah Ayad
Rockhampton Dr Chloe Sturgess
Sunshine Coast Dr Peter Jorgensen
Toowoomba Dr Phoebe Fernando
FROM THE PRESIDENT DR JAY HSING
As the time for membership renewal is here again, it's important to reflect on the significant value that our membership brings. For many of us, renewing is a straightforward decision, given the tangible benefits and support our professional association provides.
VALUE OF MEMBERSHIP
Moreover, it's about contributing to a larger cause and feeling a sense of belonging within our profession. Being a member isn't just about individual benefits; it's about being part of a collective effort to advance our profession.
In alignment with this commitment to collective advancement, ADAQ membership offers a range of invaluable resources and services that not only enhance our individual practice but also contribute to the overall progress of our profession. Here are some examples of how our organisation’s strength translates into effectively delivering member support and advocacy:
SCAN THE QR CODE TO CONTACT ME
9 Consultancy services covering topics such as infection control, accreditation, water quality. If you need any assistance, the team can be emailed at training@adaq.com.au
9 A Member Assistance Program for mental health including access to three confidential counselling sessions (per year) in addition to podcasts, monthly newsletters, information sheets and other resources. Scan the QR code to access the portal.
9 Provision of additional HR resources as the need arises, e.g. general independent legal advice regarding payroll tax obligations last year and recently released resources to assist us to meet new obligations regarding Positive Duty under the Sex Discrimination Act (brought in by the Australian Human Rights Commission).
9 Advocacy on behalf of the profession, e.g. water fluoridation, funding for public dental care, workforce resourcing needs. We have regular meetings with Ahpra, the Chief Dental Officer and other stakeholders. We have a dedicated Policy & Projects Coordinator on staff and a committed and hardworking Policy and Advocacy Advisory Committee made up of members who volunteer their time.
9 Quality-assured CPD courses provided at 20% less than cost price while non-members pay 40% above cost price. This means that attending just a couple of courses offsets your ADAQ membership fee. As an example, for the two full days of hands-on composite courses with Michael Mandikos recently, members paid $1340 while non-members paid $2340. This saving of $1000 is more than the cost of ADAQ membership.
9 Excellent value professional indemnity insurance with inhouse claims assistance. The latter means that ADAQ’s clinical and compliance professionals can support and guide you seamlessly through the entire process from start to finish. If a peer opinion is required, the team can arrange this through ADAQ's peer panel, composed of experienced general dental practitioners and specialists, anonymously.
9 A dedicated compliance and advisory services team –for health fund advice, Ahpra/OHO matters, advertising compliance or simply responding to a Google review.
ADAQ Council takes great pride in our sustained ability to provide outstanding support and advocacy for members. With robust governance and operational systems in place, including diligent budgeting and careful spending, we've consistently delivered essential services while maintaining financial stability, evident in an average operating profit of $378K over the past four years.
This success underscores our commitment to sustainable support. Furthermore, we’ve been able to achieve this without needing to increase membership fees for eight consecutive years. In addition, we introduced a 10% early bird discount a couple of years ago, further enhancing the value proposition. With prudent financial management, we continually seek new avenues to expand our support and services to benefit members.
Of course, none of this would have been possible without the magnificent team at ADAQ. We should all take a moment to express our appreciation for the dedication, passion, hard work, and unwavering commitment of the entire team at ADAQ. From our CEO, Lisa Rusten, and her exceptional management team to each and every staff member, it's their tireless efforts that underpin the success and invaluable support our association provides.
YOUR FEEDBACK IS VALUABLE
Human brains are wired to pay more attention to negative stimuli as a survival mechanism. Negative experiences are often perceived as threats, triggering stronger emotional responses and deeper processing in the brain compared to positive experiences. Negative feedback tends to leave a deeper imprint on our memory due to its stronger emotional impact and evolutionary significance.
As practicing dentists, we're intimately familiar with this phenomenon. While the vast majority of our procedures go smoothly and we receive positive feedback, it's often that 1% when something doesn't quite go as expected that sticks in our minds.
I value all feedback, including constructive criticism, and encourage team members to express their thoughts openly. This is how we make continued improvements. Equally important is showing appreciation to the team. We all know how important it is to make our dental teams feel appreciated, and the team at ADAQ is no different. The team would love to hear from you at adaq@adaq.com.au. I would also love to hear from you at president@adaq.com.au
Furthermore, I believe in the collective power and responsibility of all of us. I believe our Association’s effectiveness relies on the engagement and contribution of all members. I want to inspire you to actively participate in discussions and propose solutions. If there’s a resource you’ll like or a particular course you would like to suggest for our CPD program, please raise it. After all, we are a community where everyone plays a vital role in achieving its
MEETING WITH OUR HEALTH MINISTER
Last year I had the honour of representing ADAQ at our state parliamentary inquiry into reducing rates of e-cigarette use in Queensland. Recently, I had the privilege of returning to Parliament House to meet with Queensland’s Health Minister, the Honourable Shannon Fentiman, alongside our CEO, to discuss important issues affecting our community's oral health. The Minister was generous with her time and we had a productive meeting.
Minister Fentiman also invited ADAQ to collaborate on writing a letter to the Federal Health Minister, the Honourable Mark Butler, on reform opportunities that have the potential to significantly improve access to public oral health services for Queenslanders, and to ensure that publicly-funded dental care is readily available to eligible children and adults across Queensland. I gratefully accepted this invitation and we have now written to Minister Butler.
CPD ADVISORY PANEL
In my previous (Autumn edition) address, I wrote about our recently endorsed CPD Advisory Panel. I’m pleased to announce that four more members have joined the ranks including:
• Dr Kaye Kendall
• Dr Chris Muir
• Dr Nymphia Naik
• Dr Lydia See
FDI CONGRESS AND ADA FEDERAL
Like many members, I was surprised and disappointed to read about the $4.5 million loss from the FDI Congress. The ADA Federal Board’s announcement of their commitment to making the necessary changes to their processes and systems to minimise the risk associated with running future conferences is welcomed.
Transparency and accountability in the Association’s decisionmaking processes and actions are vital. The ADA Federal Board’s promise to improve their governance, oversight, and accountability moving forward is also welcomed. This isn't something that happens in a day; it's a gradual process, so I will continue my communication with the ADA Federal Board on this.
FINAL THOUGHTS
It's hard to believe we're already approaching the halfway mark of 2024. Amidst our busy lives and the challenges we encounter, it's crucial to prioritise caring for one another and tending to our mental well-being. Together, we can create a culture of gratitude, compassion and well-being in our community. Until next time,
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SUSTAINABILITY IN DENTAL PRACTICES
LYNNE MCLEAN & MARICEL MOSS
ADAQ TRAINING AND PRACTICE CONSULTANCY TEAM
"Dentistry as a profession should integrate sustainable development goals into daily practice and support a shift to a green economy in the pursuit of healthy lives and well-being for all through all stages of life.”
FDI World Dental Federation Policy statement: Sustainability in Dentistry,
2017.
Sustainability in dental practices in remote areas of Australia presents unique challenges and opportunities. The following are some key points for implementing sustainability:
TELEDENTISTRY
Utilise teledentistry services to reach patients in remote areas. This involves using technology to conduct consultations, assessments, and follow-ups remotely, reducing the need for patients to travel long distances for routine check-ups. Telehealth improves sustainability of services to rural and remote communities, while reducing levels of both staff and patient travel.
WATER CONSERVATION
Implement water-saving measures in dental practices, such as installing low-flow taps/faucets and using water-efficient dental equipment. This is particularly important in remote areas where water may be scarce or expensive.
ENERGY EFFICIENCY
Invest in energy-efficient appliances and lighting to reduce energy consumption in dental practices. This not only helps lower operating costs but also reduces the environmental impact of the practice. Encourage staff to turn off lights, computers, and equipment when not in use.
RECYCLING AND WASTE MANAGEMENT
Implement recycling programs and proper waste management practices to minimise the environmental footprint of dental practices. This includes recycling paper, plastics, and other materials used in dental procedures, as well as properly disposing of hazardous waste.
Aim to curtail the use of plastics including limiting the purchase of plastic and plastic-packaged items: encourage plastic recycling and consult with manufacturers about their utilisation of plastic and sustainability. Investigate the use of products containing safer and more sustainable chemicals which will have environmental benefits and be healthier for both staff and patients.
LOCAL SOURCING
Whenever possible, source supplies and materials locally to support the economy of remote communities and reduce transportation emissions associated with shipping goods over long distances. Try to choose eco-friendly dental supplies and equipment. Look for products that are made from recycled materials, are biodegradable, or have minimal packaging. Engage with suppliers to discuss options that could be more environmentally sustainable in terms of manufacturing, packaging, and delivery.
TRAINING AND RETENTION
Provide ongoing training and support for dental professionals working in remote areas to ensure they have the skills and resources needed to provide quality care. Retention strategies, such as offering competitive salaries and professional development opportunities, can help attract and retain talented staff.
STOCK MANAGEMENT
One of the most effective ways to influence environmental impact and reduce costs is through an efficient stock control system. The dental practice should review current stock management processes with a view to reducing the frequency of ordering and therefore, minimise waste.
To minimise the frequency of stock orders, it is imperative to understand your current inventory levels and daily consumption patterns. This means that informed predictions can be made about which stock items might run low, and plan accordingly.
When placing stock orders:
9 Evaluate your current ordering processes.
9 Assess your finances including expenditure, freight costs, and savings that could be made by bulk ordering.
9 Set practice-wide ordering goals to decrease costs, save time, and reduce carbon emissions.
9 Create a stocktake list.
9 Evaluate suppliers to find one aligned with your sustainability goals.
9 Provide and update staff training in receiving and verifying stock orders and maintaining accurate records.
ADA FEDERAL'S STOCKTAKE LIST
For efficient stock management, documenting your processes is recommended as it will allow you to reflect on your current processes and find ways to be more efficient. It will also allow you to onboard new staff quickly and save you time training.
Key tips:
Train staff on product use, stock control, and waste reduction.
Practice stock rotation and storage tips.
Follow storage temperature requirements as stated on the product packaging.
Determine if items need refrigeration or can be stored on shelves, accounting for seasonal temperature variations when the practice is closed, and heating and/or air-conditioning is switched off.
Stay informed about product changes and technological advancements to optimise your stock management practices.
Commercial software specifically designed for the dental industry is available. This can manage your workflow, and perform automated stock management, ordering, reconciliation, budgeting, and forecasting.
By implementing these strategies, dental practices in remote areas of Australia can work towards sustainability while continuing to provide essential oral health care services to underserved communities.
The ADAQ TPC team provides practices with support and consutlancy services through a team of skilled professionals with experience in infection control, practice accreditation and practice management.
To find out how the ADAQ TPC team can help you, contact consultancy@adaq.com.au
ADA FEDERAL'S SUSTAINABLE PRACTICES GUIDE
For efficient stock management, documenting your processes is recommended as it will allow you to reflect on your current processes and find ways to be more efficient.
DISCOVER HOW THE TPC CAN HELP YOUR PRACTICE
ADAQ REGIONAL EMERALD EVENT
On May 24 2024, we were thrilled to host our inaugural ADAQ Regional Event in Emerald with the aim of providing quality CPD to our regional members in accessible locations. We brought together dentists and dental team members for a day of quality education sessions and netowrking.
IMPORTANCE OF ADAQ REGIONAL
ADAQ members have spoken, and we’ve listened. Our regional and rural members want access to quality speakers and to relevant professional development close to home. So, we’re hitting the road and bringing ADAQ to you with our annual events.
ADAQ STRATEGIC PLAN
The Australian Dental Association (Queensland Branch) (ADAQ) actively seeks to engage with Members and the public to be the preferred and trusted source of knowledge and information about oral health and clinical practice.
9 ADAQ as a vibrant and sustainable organisation
9 Continuing Professional Development for dentists and the dental team
9 Expand our reach across all dental sectors and geographic regions in Queensland
9 Building and developing effective relationships
ADAQ Regional is an integral step in achieving ADAQ's Strategic Plan and delivering value to our members.
LET US KNOW WHERE TO VISIT FOR ADAQ REGIONAL 2025
ADAQ REGIONAL EMERALD EVENT
Good company. Was nice to meet and chat with regional dentists. Regional location was attractive to make a trip for CPD.
-Emma M.
All aspects of the day were insightful, part of my everyday work day and great for maintaining my scope of practice
-Cheraline B.
I always have to travel for events but having one close to home was great!
-Caitlin B.
INDIGENOUS AUSTRALIAN HEALTHCARE WORKERS
DR SOM-LING LEUNG | ADAQ
POLICY AND ADVOCACY COMMITTEE (PAAC)
Growing up in both Hong Kong and Australia had already aroused my interest in different cultures, so I found the Indigenous Australian culture, along with the unique landscape of Central Australia, fascinating.
Dr. Som-Ling Leung, a dedicated dentist with a heart for service, has journeyed through diverse landscapes, both personally and professionally. In this Member Spotlight, she shares her remarkable experiences, insights, and challenges encountered while serving First Australian communities.
CAN YOU PLEASE INTRODUCE YOURSELF, AND YOUR POSITION WITHIN ADAQ?
I am on the Policy and Advocacy Advisory Committee (PAAC) in the ADAQ.
I began my dental career by working in various rural and regional towns in Northern NSW, Cairns, and Alice Springs. Eventually I owned a practice in Murwillumbah, NSW for a decade before selling it to focus on supporting underserved populations. One of my significant experiences was helping to establish a dental clinic in rural Solomon Islands, where I saw firsthand the severe lack of dental care, motivating me to return the next year.
I sought to broaden my understanding of primary healthcare in international settings, by pursuing a Master of International Health at Monash University. For the past decade, I've been juggling dentistry with charity work in the Solomon Islands. Currently, I am stationed in Honiara, Solomon Islands, supported by the Australian Government as a volunteer. My role involves collaborating with the Provincial Health Department to enhance public health programs. I still intend to practice dentistry on a part time basis.
Outside of work, I enjoy activities like cooking, bushwalking, and kiteboarding.
WHAT INSPIRED YOU TO WORK IN FIRST NATIONS COMMUNITIES?
My first exposure to First Nations culture came after graduating when I worked in Alice Springs public health services for a sixmonth locum. Growing up in both Hong Kong and Australia had already aroused my interest in different cultures, so I found the First Nations culture, along with the unique landscape of Central Australia, fascinating.
Although I wanted to extend my stay to explore the rural communities, I recognized my lack of clinical skills in my first year out of university. The opportunity to work with Rural Allied Health Corp (RAHC) arose while I was seeking contract work to facilitate my charity work in the Solomon Islands and pursue my master’s degree.
I am stationed in Honiara, Solomon Islands, supported by the Australian Government as a volunteer. My role involves collaborating with the Provincial Health Department to enhance public health programs.
WHAT ARE SOME ISSUES FACED BY INDIGENOUS COMMUNITIES?
The poor general health of First Nations in communities negatively impacts on their oral health, and is further exacerbated by inadequate access to proper dental care, poor oral health awareness and poor diets. The rapid introduction of Western foods without concurrent awareness education, led to traditional cultural eating habits being replaced by the worst aspects of the Western diet.
Data from 2015-2017 show that the life expectancy of First Nations populations living in remote and very remote areas is 14 years less than non-indigenous populations. The reality of this can be seen when working in these communities. Deaths and funerals occur regularly. For instance, during one three-week visit to a community of 2000, there were three deaths, including one from suicide.
They suffer health issues from a young age, frequently starting with a failure to thrive, followed by multiple skin, eye and ear infections. Acute rheumatic fever is very common in those aged 5 to 14. As individuals reach adulthood, a myriad of health issues emerges, including diabetes, respiratory disease, kidney and liver disease, hypertension and mental health issues.
Advanced periodontal disease is common among people with complex health problems, especially uncontrolled diabetes. Sadly, I have seen people in their early thirties with terminal dentitions, requiring full dentures. Without access to regular dental care, treatment of periodontal disease and denture provision is impossible. Adding to the difficulty is the impact of domestic violence. For these individuals, restoring their smile is not just about looks, it is crucial for them to feel confident and move forward with rebuilding their lives alongside their families.
WHAT STRATEGIES HAVE YOU FOUND EFFECTIVE IN PROMOTING ORAL HEALTH AWARENESS?
First Nations communities are generally allocated four visits a year, however, many only receive one or two visits a year due to staff shortages. Depending on the population, we may travel to two or three communities in that three- or four-week period. The busyness with treatment poses a challenge for comprehensive oral health promotion efforts. However, I generally try to provide basic toothbrushing instructions at the end of each visit.
Last Dental Health Week, I conducted an oral health promotion at a youth centre. Activities included guessing sugar content of beverages and showing the effects of acidic drinks on cooked eggshells. Despite the visible impact, engagement was low, possibly due to cultural factors, which prioritise relationshipbuilding.
Sadly, I have seen people in their early thirties with terminal dentitions, requiring full dentures.
HOW DOES DENTAL CARE DIFFER IN FIRST NATIONS COMMUNITIES?
Dental care in First Nations communities is completely different to urban or mainstream settings.
Firstly, there is no appointment book. In most communities, numbers surge once word spreads that a dentist is available. It can be overwhelming to suddenly discover six or seven people waiting. We frequently work extra hours or through lunch breaks to accommodate as many people as possible.
In contrast, Oral Health Therapists can struggle with attendance now that they cannot go directly to the schools. The decay severity combined with their limited scope often results in kids arriving at the clinic for pain relief, only to be told that they must wait for the “adult dentist”.
In communities, we have full autonomy over our work. Typically, we allocate 45 minutes to an hour per patient and request others to return in the afternoon. Despite most patients seeking pain relief, we try to complete at least one quadrant or side of the mouth and provide cleaning while under local anaesthesia. Patients genuinely appreciate maximising their visit's effectiveness. We often utilise silver diamine fluoride to slow decay progression and temporise others, knowing that they may not be able to get another appointment for a while.
The co-morbidities and multiple medications often necessitate consulting with the doctor before treatment. Additionally, there are many severe dental emergencies, such as advanced cellulitis and Ludwig’s Angina. Surgical extractions are common due their dense bone structure, and often without access to x-rays. This can be stressful knowing that there is no back-up from other clinicians.
So, the next time, we involved the primary healthcare team, displaying the eggs in the lunchroom. This approach, fostering laughter and chatter among staff and patients familiar with the nursing team and Indigenous Australian Healthcare Workers, proved more impactful and culturally suitable.
ARE THERE SPECIFIC CULTURAL CONSIDERATIONS OR SENSITIVITIES THAT YOU'VE HAD TO NAVIGATE IN YOUR WORK WITH FIRST NATIONS PATIENTS?
The main notable difference is the clinic’s setup. There are generally two entrances or two waiting rooms catering to what they refer to as "poison cousins." This term denotes individuals who are prohibited from interacting due to cultural taboos. All First Nations groups have a taboo relationship between a man and his mother-in-law, but often it extends more broadly across the kinship.
Some patients may avoid making eye contact, which I've learned to address by turning my focus to shared notes or sketches on paper to facilitate communication and put them at ease. The length of time you must wait for a question to be answered is longer, partly due to the language barrier, but it is also culturally polite to give a question due consideration before answering.
If patients have limited English language skills, it's crucial to adjust language to their level, avoiding medical jargon and using clear, simple terms. When more complex information needs to be conveyed, reaching out to an Indigenous Australian Healthcare Worker for assistance proves invaluable. Learning some of the local dialects is also worthwhile.
CAN YOU SHARE ANY SUCCESS STORIES?
In First Nations communities, seeing positive outcomes from our dental interventions brings immense satisfaction. One of the most rewarding moments is when a patient completes their treatment and demonstrates improved oral hygiene efforts. Achieving this with even one or two patients per contract is a significant accomplishment.
Our short visits make it difficult for patients to complete multiple visits, especially when several extractions are required. Additionally, community members may forfeit their own appointment in favour of those in immediate pain.
Maningrida is a notable success story. Here, the Indigenous-led Health Service funded additional dental visits beyond the usual four per year provided by the NT government. This initiative has had a positive impact, with strong attendance records across all ages and noticeably less decay, better oral hygiene habits and less coke consumption amongst youths. The nurses believe that the increased access to dental services encouraged dental care seeking behaviour, and having consistent dental professionals visit fostered trust, leading to improved oral health outcomes.
WHAT ARE SOME OF THE BARRIERS TO ACCESSING DENTAL CARE?
´ Physical accessibility: Limited dental visits poses accessibility challenges, exacerbated by travel constraints due to family obligations or illness. This infrequency limits available services, notably denture procedures.
´ Weather Constraints: Weather conditions, especially during the wet season, limits access with road and runway closures. Cyclones lead to clinic cancellations. Extreme temperatures deter walking to clinics.
´ Cultural and language barriers: Cultural and language disparities exacerbate anxiety; kindness and clear communication mitigate this, with some finding comfort in holding the dental assistant's hand.
´ Some healthcare clinics are more proactive and collaborative, where patients request for their regular healthcare provider, such as their diabetes educators, rheumatic heart nurses or an Indigenous Australian Healthcare worker, to accompany them to the appointment.
´ Poor health literacy: Some patients may not fully grasp the importance of dental hygiene or understand how conditions like diabetes can affect oral health. Good communication and collaboration with their regular healthcare provider, such as the diabetes educator can assist this.
If patients have limited English language skills, it's crucial to adjust language to their level, avoiding medical jargon and using clear, simple terms.
HOW DO SOCIOECONOMIC FACTORS IMPACT DENTAL HEALTH OUTCOMES?
Socioeconomic factors significantly affect the dental health outcomes in First Nations communities.
Food insecurity is the biggest issue. The cultural norm of communal sharing contributes to rapid food depletion in the household. Fresh produce is expensive, partly due to transport costs, and the monopoly held by a single shop. Unfortunately, the shop often offers a poor selection of healthy foods and fried options are the predominant take away choice. Food can be inconsistent in supply, especially during the wet season when road access is affected. This leads to a reliance on processed foods, which are less nutritious and high in sugar, increasing the risk of dental decay and chronic conditions like diabetes. Controlling sugar intake becomes challenging, often resulting in periodontal complications and premature tooth loss.
Inadequate and overcrowded housing conditions significantly raises the risk of rheumatic heart disease, which has long-lasting effects such as maternal health issues, heart complications, and the need for prophylactic antibiotics, complicating dental management.
The challenge of maintaining oral hygiene is compounded by overcrowded housing and the communal sharing culture, making it difficult to retain their personal toothbrushes.
BARRIERS TO ACCESSING DENTAL CARE
PHYSICAL ACCESSIBILITY
Limited dental visits poses accessibility challenges, exacerbated by travel constraints due to family obligations or illness. This infrequency limits available services, notably denture procedures.
WEATHER CONSTRAINTS
Weather conditions, especially during the wet season, limits access with road and runway closures. Cyclones lead to clinic cancellations. Extreme temperatures deter walking to clinics.
Inadequate employment opportunities, historical and systemic factors, such as discrimination and colonisation have contributed to poor mental health, especially amongst the youth. This negatively impact self-care practices and oral health outcomes.
ARE THERE ANY SPECIFIC ORAL
HEALTH
PROGRAMS THAT YOU'VE BEEN INVOLVED IN?
I haven't personally been involved, but I am aware of several programs where First Nations healthcare workers are trained to apply fluoride varnish to community members.
I spoke with a registered child health nurse who participated in such a program while working as an First Nations healthcare worker in Aṉangu Pitjantjatjara Yankunytjatjara (APY) lands. She reported that it was highly successful and well received by the community, additionally, it taught her the importance of oral health. She was one of the most active in referring young children to us and was able to deliver dietary guidance in a culturally safe manner.
WHAT ARE THE MAIN PRIORITIES OR AREAS OF FOCUS FOR IMPROVING DENTAL HEALTH?
Enhance access to Dental Care, a crucial priority is to ensure better access to dental services. For over 15 years, the Rural Allied Health Corp (RAHC) has dispatched dental teams to remote Northern Territory communities. However, this service will be discontinued from July 2024, without any replacement initiative announced. This cessation exacerbates the already critical shortage of dental services in these communities.
There is a pressing need for more frequent and consistent dental services, so we can move beyond simply addressing immediate dental issues and work towards improving overall oral health.
Promoting Behavioural Change, another significant priority is tackling the high consumption of sugary drinks like Coke. Young adults and children are frequently seen walking around with a large bottle of Coke and is a major contributor to the rampant early childhood caries. There is a need for increased awareness regarding the harmful effects of Coke Zero, which is often mistakenly believed to be less damaging to their teeth.
DO YOU COLLABORATE WITH OTHER HEALTHCARE PROFESSIONALS TO SUPPORT HEALTH OUTCOMES?
The morning team meetings with all the healthcare professionals provides the opportunity to connect and collaborate. The extent of collaboration varies, depending on factors such as when the last dental team visited and the community’s service seeking behaviour.
During busy times, we collaborate with the nurses, First Nations healthcare workers, and the rheumatic heart teams to prioritise patient triage. Priority is always given to patients who sought nurses’ assistance for pain relief in previous nights. First Nations healthcare workers are always aware of patients’ availability and needs, while the rheumatic heart teams can assist with prioritising those with both severe heart disease and toothache, to minimise the risk of heart complications. In less busy times, we may collaborate with the diabetes educators, midwives, heart teams, podiatrists to refer their patients to us while they are in the clinic.
Collaboration with child health nurses is also common, especially when dental concerns are identified during health checks. In these cases, we may use silver diamine fluoride before referring patients to dental therapists for further care.
HAVE YOU ENCOUNTERED ANY MISCONCEPTIONS OR STEREOTYPES?
There is a common misconception that dental care in First Nations communities solely involves extractions or mere pain relief. While extractions are frequent, I have observed a notable rise in requests for restoring front teeth, especially compared to the past. This shift could be attributed to increased exposure to social media and the desire to look good for photographs. Whenever possible, our goal is to provide comprehensive treatment, aiming to achieve a stage of oral health stability.
CULTURAL AND LANGUAGE BARRIERS
Cultural and language disparities exacerbate anxiety; kindness and clear communication mitigate this, with some finding comfort in holding the dental assistant's hand.
POOR HEALTH LITERACY
Some patients may not fully grasp the importance of dental hygiene or understand how conditions like diabetes can affect oral health. Good communication and collaboration with their regular healthcare provider, such as the diabetes educator can assist this.
WHAT ADVICE WOULD YOU GIVE TO OTHER DENTAL PROFESSIONALS?
It is both highly rewarding and inherently challenging. The dental work can be challenging with almost no ability to refer. It is also best to approach the experience with a spirit of adventure and readiness for the unexpected.
Delays in flights, luggage and accommodation issues, as well as computer or internet problems frequently occur. Moving and working in different clinics can also be stressful.
However, you get to explore some of the world’s most unique and breathtaking landscapes. From stunning sunsets to awe-inspiring thunderstorms, the experience offers unforgettable natural beauty.
Working in First Nations communities provides a rare chance to be part of a dynamic, multi-professional team. The passion and diversity among the nurses who live there is inspiring and uplifting. I always enjoy the close relationship with my dental assistant as we navigate challenges. Then, at the end of the contract, you share a celebratory night with other RAHC dental team members in Darwin before heading home.
WHAT ROLE DOES CULTURAL COMPETENCE PLAY IN PROVIDING EFFECTIVE DENTAL CARE?
I still don't consider myself fully "culturally competent" when working in First Nations communities - the culture is so rich and diverse. Every community is different. I still encounter situations where creating a comfortable environment is challenging.
What is important is maintaining an open and curious mindset, showing kindness and empathy, and recognising the layers of challenges they face.
The morning team meetings often highlight the complex family structures and social issues at play, helping me to understand behaviours and attitudes. Sometimes, all it takes is slowing down and allowing space and time for trust to develop. It is a team effort - sometimes, my dental assistant can effectively comfort the patient. Other times, I reach out to my fellow team members who are more familiar with the community for guidance.
From stunning sunsets to aweinspiring thunderstorms, the experience offers unforgettable natural beauty.
Galiwinku Northern Territory
DO YOU SEE THE FUTURE OF DENTAL CARE EVOLVING IN FIRST NATIONS COMMUNITIES?
Looking ahead to the future dental care in First Nations communities, the insights from the dedicated dental teams with decades of experience working within these diverse communities would be invaluable for guiding future initiatives.
At present, I feel we are focused on service provision. It would be interesting to see if active community engagement to create partnerships can yield more impact, as sustainable oral health improvement demands self-efficacy and the development of new behavioural norms.
Recognising the unique nature of each First Nations community and considering the substantial financial costs associated with transporting dental teams to communities, services should be designed to reflect the community’s need and interest.
First Nations culture values relationship building and generally reach decisions through discussions and consensus. Therefore, it may be beneficial for dental service providers to spend time establishing relationships within community groups. This can then be followed by focus group meetings with community Elders and key stakeholders to discuss relevant oral health concerns and opportunities. Improving health literacy and understanding the social determinants impacting oral health may effect behavioural change and improve outcomes.
Comprehensive oral health programmes for young mothers, children, and well managed chronic disease can be offered for interested community members. A follow up consultation can determine the interested participants and design the programme and identify the frequency of service required. Those interested in comprehensive care can be registered, while pain relief services can continue to be offered to others.
Key considerations:
9 Length of the visit: Short one-week visits may suffice for pain relief, but longer, less frequent visits maybe more impactful for comprehensive care.
9 Clinic hours: Coordinating clinic hours with community preferences may enhance attendance rates. Some communities prefer early morning appointments to avoid the heat, while others have more nocturnal lifestyles.
9 Consistency of healthcare providers: Having a core team of practitioners returning over several years will enhance trust and rapport within the community.
9 Seasonal weather considerations
9 Local oral health management empowering First Nations healthcare workers or appointing separate oral health champions can assist follow up and organisation, potentially improving effectiveness and efficiency.
9 Preventive and early intervention programmes with locally applied fluoride varnish programmes or potentially silver diamine fluoride will improve oral health outcomes.
9 Integration with diabetes management: collaborating with diabetes educators and dieticians to incorporate a structured oral health management plan into diabetes care.
By addressing these considerations and fostering collaboration between stakeholders, dental care in First Nations communities can evolve towards more tailored, comprehensive, and impactful models. While this may initially result in disparities in service provision, the mobility of community members is likely to spread awareness and encourage adoption of more comprehensive oral care models across other communities.
The passion and diversity among the nurses who live there is inspiring and uplifting. I always enjoy the close relationship with my dental assistant as we navigate challenges.
CONTACT THE VOLUNTEERING IN DENTISTRY COMMITTEE
BRINGING SMILES TO THE OUTBACK A JOURNEY OF MOBILE DENTAL CARE
DR GARRET ROBLES
ADAQ MEMBER & MOBILE DENTAL SERVICE PROVIDER
Project Outback Dental (POD) was born out of the inspiration below. I saw this photo on the internet and thought to myself, I would like to experience this! Crazy as it may sound, this is the true beginning of my company.
In the vast expanse of Queensland's northwest, where the horizon stretches endlessly and communities are scattered like rare gems in the rough terrain, access to essential services like dental care can be scarce. However, amidst these challenges, Dr Garret Robles emerged as a beacon of hope, bringing dental services directly to the doorsteps of those in need.
In this Member Spotlight Interview, we delve into Dr Robles's inspirational journey, exploring the inception of his private mobile dental services, his innovative approaches to overcoming barriers to dental care access, and the impact of his work on rural communities.
Digging the mobile dental clinic out of the mud on it's tour of ourback Queensland State Library of Queensland, Australia
"With no knowledge of mobile dentistry and remote areas, my wife and I (and two dogs) drove as far as we could in our Land Rover Defender station wagon to explore North QLD (Greenvale) and we followed Australia’s dinosaur trail in Hughenden and Richmond and talked to people".
INCEPTION OF PROJECT OUTBACK DENTAL (POD)
Dr Garret Robles's vision for POD was sparked by a simple yet profound inspiration - a photo depicting the rugged beauty of the Australian outback. Reflecting on this moment, Dr Robles's shares, "I saw this photo on the internet and thought to myself, I would like to experience this!" This seemingly whimsical notion planted the seeds for what would become a transformative endeavour in rural dental care.
As a clinical placement lead supervisor at James Cook University (JCUDental Townsville) in 2015, Dr Robles recognised the pressing need for accessible dental services in remote areas of North Queensland. Armed with determination and a desire to make a difference, he embarked on a journey of exploration, driving deep into the heart of the outback with his wife and two dogs. This expedition not only acquainted them with the unique challenges of rural dentistry but also laid the groundwork for POD.
In addition to its mobile services, POD established a city surgery in Townsville, providing continuity of care for outback patients between rural visits. This integrated approach ensures that patients receive comprehensive dental care irrespective of their geographical location.
CATERING TO DIVERSE COMMUNITY NEEDS
POD's commitment to inclusivity is exemplified through its diverse range of services tailored to meet the specific needs of Northwest Queensland's communities. Dr Robles's extensive experience in paediatric and special needs dentistry, coupled with a deep understanding of Indigenous health disparities, underpins POD's holistic approach to care.
Dr Robles's explains. From preventive measures to complex restorative procedures, POD's mobile setup enables the delivery of comprehensive dental services, bridging the gap between rural populations and essential care.
"The Australia’s National Oral Health Plan 2015–2024 identifies groups of people who require much needed dental services. They are (1) people who are socially disadvantaged or on low incomes, (2) Aboriginal and Torres Strait Islander people, (3) people living in regional and remote Australia, and (4) people with additional and/ or specialised health care needs. Project Outback Dental caters to these priority groups.
With no knowledge of mobile dentistry and remote areas, my wife and I (and two dogs) drove as far as we could on our Land Rover Defender station wagon to explore North QLD.
Despite facing initial setbacks, including rejections from several banks hesitant to invest in the viability of a mobile dental practice, Dr Robles's persisted. With unwavering determination and the support of Westpac, he secured the necessary funding to bring his vision to life. Collaborating with local partners, including a caravan dealership and dental fit-out company, Dr Robles's meticulously crafted a dental van (or "pod") tailored to meet the specific needs of remote communities.
SUSTAINING POD: A TESTAMENT TO CONSISTENCY AND COMMUNITY SUPPORT
POD's success hinges on its commitment to quality, consistency, and community engagement. Operating without government assistance, Dr Robles's emphasises the importance of maintaining unwavering standards in service delivery. "Our main strategy is consistency," he explains. "Consistency in our quality of work, the operators providing the service, and adequate frequency of visits." Despite the absence of government funding, POD thrives thanks to the steadfast support of local patients and council shires.
VIEW AUSTRALIA'S NATIONAL ORAL HEALTH PLAN
"I have special interest in paediatric and special needs dentistry and have been teaching and practicing in these fields for decades (I completed my overseas postgraduate training in paediatric dentistry in 2002 and had university teaching experience in community dentistry and paediatric dentistry before migrating to Australia). I have also been providing services to indigenous communities for the last 8 years. With this experience I am able to provide a wide range of services".
We cater to priority groups identified by Australia's National Oral Health Plan.
ADDRESSING UNIQUE DENTAL HEALTH CHALLENGES
The mobile nature of POD enables timely access to dental care, particularly in emergencies. Dr Robles's recalls instances where POD's swift intervention prevented potentially dire outcomes, such as diagnosing a patient's fractured jaw following a pub brawl.
"I suspected that it was not just his molar being split as his occlusion was off, it had a step and I suspected that his lower jaw was likely broken as well. I asked him not to waste time and have someone drive him 600 kms to the city hospital. I rang the patient later that day and found out that his jaw was broken in three places".
By collaborating with local hospitals and healthcare providers, POD ensures seamless continuity of care for rural patients, exemplifying the vital role of mobile dental services in addressing unique health challenges.
"Another example is when the base hospital (Mt Isa) was unable to send their school dental van service to certain towns, they relied on my diagnosis and treatment planning, to facilitate appointments for children needing general anaesthetic. By collaborating with the base hospital, children needing general anaesthetic need not travel hundreds of kilometres twice for consultation before treatment is done".
Except in certain clinical cases, those temporary fillings simply will not do! When I started a mobile practice, I knew that, if my fillings fall out within a short period of time, people will probably chase me out of their town!
"Except in certain clinical cases, those temporary fillings simply will not do! When I started a mobile practice, I knew that, if my fillings fall out within a short period of time, people will probably chase me out of their town! So, when I run my probe from tooth to filling with a dental explorer, and the probe is happy to glide along the cavo-surface margins of my prep to the surface of the filling without a catch, I know that my filling will last at least 5 years! I also never start an oral surgery I know I cannot finish. A sound clinical diagnosis, simple but definitive treatment planning and careful case selection ensure patients get the safest and most predictable successful outcomes".
COLLABORATIVE PARTNERSHIPS
I suspected that it was not just his molar being split as his occlusion was off, it had a step and I suspected that his lower jaw was likely broken as well.
INNOVATIONS IN RURAL DENTAL CARE
POD's embrace of digital technology has revolutionized rural dental care, enhancing diagnostic accuracy and treatment efficiency. Portable x-ray machines and digital sensors enable rapid diagnosis, while tele-dentistry facilitates remote consultations and treatment planning. Moreover, POD's investment in mobile equipment allows for on-thespot procedures, minimizing the need for patient travel and maximizing convenience.
"We have a full range of mobile dental equipment that allows us to treat a patient in the dental van, within a person’s home or institutions like a hospital or aged care facility, and take the same gear to theatre for my regular dental anaesthesia lists at the Townsville Mater Hospital".
ENSURING QUALITY AND CONTINUITY OF CARE
Sound clinical judgment, meticulous treatment planning, and transparent communication form the cornerstone of POD's patient care philosophy. Dr Robles's emphasises the importance of delivering durable, long-lasting solutions, ensuring patient satisfaction and trust. Despite the challenges posed by a mobile setup, POD prioritizes quality outcomes, earning the loyalty and appreciation of rural communities.
POD's success is indebted to the collaborative efforts of local councils, schools, healthcare organizations, and fellow dental professionals. By fostering strong partnerships and alliances, POD extends its reach and impact, delivering essential dental services to underserved communities. Dr Robles's collaboration with specialists and public healthcare providers further strengthens the continuum of care, ensuring patients receive comprehensive and timely interventions.
IMPACT ON ORAL HEALTH OUTCOMES
Dr Robles's dedication to rural dentistry has garnered recognition, including the NQPHN Health Professional Award in 2018. His work exemplifies the transformative potential of mobile dental services in improving oral health outcomes and overall well-being in regional areas. By championing accessibility and equity in dental care, Dr Robles's inspires a new wave of initiatives aimed at narrowing the rural-urban divide in healthcare.
POLICY RECOMMENDATIONS FOR RURAL DENTAL SERVICES
Drawing from his extensive experience, Dr Robles's advocates for policy reforms to support and expand rural dental services in Australia. From investments in digital infrastructure to incentivizing private mobile practices, his recommendations underscore the importance of proactive government intervention in addressing systemic barriers to care, specifically:
1. The Queensland Government should consider an investment in establishing access to digital OPG machines at every base hospital or small regional town. This will help facilitate teledentistry.
2. Consider providing a public dental voucher system to private mobile dental practices to allow mobile private dentists to see patients with concession card holders.
3. Encourage private health funds to give preference to mobile dental practices in rebates, rather than limiting it to citybased fixed surgeries. Not all health funds allow Hicaps claims via mobile terminals – so I advise patients to check the ADA website and consider a health fund shift rather than be told to drive the nearest city-based preferred provider 500km away.
4. Priority should also be given to children living in rural and remote areas to access dental general anaesthetic services, together with ancillary services such as travel and accommodation.
ADVICE FOR ASPIRING RURAL DENTISTS
In parting, Dr Robles's offers sage advice to fellow dental professionals embarking on a similar journey. "Passion combined with a good business sense will balance out all the unrealistic hopes and unfounded fears in engaging in rural dentistry," he advises. Embracing the challenges with resilience and determination, Dr Roble's story serves as a testament to the transformative power of compassionate care and unwavering commitment.
"I could not say that my dental van has been stuck in mud like the good old dental van in the photo, but I’ve lost a wheel while towing without even knowing it. A million things could have gone wrong but almost ten years later, we are still going".
CHARTING THE COURSE: A CALL FOR ACTION
In conclusion, Dr. Garret Robles's pioneering efforts in rural dental care exemplify the profound impact that individual dedication and innovative thinking can have on underserved communities. As POD continues to traverse the dusty roads and remote trails of Northwest Queensland, it leaves behind a legacy of empowerment, resilience, and brighter smiles.
Passion combined with a good business sense will balance out all the unrealistic hopes and unfounded fears in engaging in rural dentistry.
CELEBRATING TEN YEARS OF THE FIRST NATIONS STUDY GRANTS
NATASHA DAGLEY
ADA DENTAL HEALTH FOUNDATION
The ADA Dental Health Foundation First Nations Study Grants are available to students of Aboriginal or Torres Strait Islander background who are undertaking a course of study that will lead to registration as a Dental Hygienist or Oral Health Therapist.
This year commemorates a decade since the inception of the First Nations Study Grants program, a significant milestone for the ADA DHF, a registered charity pivotal to ADA's dedication to promoting equity and social responsibility in oral healthcare.
The program awards four study grants to Australian students who identify as Aboriginal or Torres Strait Islander who are currently pursuing studies in dental hygiene or oral health therapy. Each recipient receives a $5,000 stipend aimed at alleviating financial burdens associated with clinical placements, including support for travel and accommodation expenses. This financial assistance aims to reduce overall financial stress, enabling students to focus more on their studies and career development.
Throughout its existence, the ADA has collaborated with various partners, including dental schools and Indigenous health organisations, to enhance the program's reach and impact. Through these collaborative efforts, the ADA has not only supported Indigenous students' educational endeavors but also contributed to fostering a more inclusive and culturally sensitive dental workforce. Making career dreams come true can take a lot of time, effort and money.
To make things a little easier, the ADA Dental Health Foundation (ADA DHF) is offering up to four study grants, worth $5000 each, to Australian students who identify as Aboriginal or Torres Strait Islander who are undertaking a course of study that will lead to registration as a dental hygienist or an oral health therapist.
The ADA DHF is a registered charity whose mission is to address the inequality between those Australians who can access the dental care they need, and those who can’t. As part of fulfilling that mandate, the First Nations Study Grants, previously known as the Indigenous Study Grants, offer students funding that may be used to cover costs of dental equipment, textbooks and to financially support students while they are on placements or living away from home.
Ashley Bainbridge was a recipient of the grant in 2023. Ashley is completing a Bachelor of Oral Health at Central Queensland University in Rockhampton.
After being a successful recipient of the First Nations Grant in 2023 Ashley shared these words: My goal is to graduate from CQU with a Bachelor of Oral Health with Distinction while proudly representing my ancestral heritage as a First Nations Person,” says Ashley. “The inspiration behind my application for this grant is its potential to help alleviate the financial stress associated with completing a full-time degree, which will allow me to focus on achieving my educational goals without the stress of employment".
The inspiration behind my application for this grant is its potential to help alleviate the financial stress associated with completing a fulltime degree.
The ADA Dental Health Foundation reached out to Ashley to ask her how the grant has supported her in her studies this year:
WHAT ARE YOU STUDYING/WHAT YEAR ARE YOU IN AND LOCATION?
I am studying Bachelor of Oral Health, I am in my third and final year. I am currently doing my placement in Cairns which I am lucky as this is my home town.
HOW HAS THE FIRST NATIONS GRANT HELPED TO SUPPORT YOU IN YOUR STUDIES?
The First Nations Grant has helped me by giving me the freedom of not having to stress about work throughout my clinical placement this term.
ONCE YOU HAVE GRADUATED, WHAT DOES YOUR IDEAL JOB LOOK LIKE?
When I graduate and get the clinical experience required, I would love to do fly-in and fly-out work within the rural and remote communities of Australia.
WHAT ADVICE DO YOU HAVE FOR THOSE LOOKING TO GET INTO ORAL HEALTH/ DENTISTRY?
I would recommend doing the CQU STEPS program, this gives you the basic knowledge and experience of what the University will be like. Don’t be afraid to give it a go! I was nervous about applying and how I would go throughout the course as I didn’t do well in school, however, the teaching staff and the university are very supportive.
HOW DID YOU HEAR ABOUT THE FIRST NATIONS GRANT?
I heard about the First Nations Grant, through the university from the Head of Course for Oral Health, Karen Smart.
ELIGIBILITY REQUIREMENTS
The ADA DHF First Nations Study Grants will be open to applications from 1 March 2024 and close on 31 May 2024. Successful applicants will be advised of the outcome in July during NAIDOC Week.
To be eligible, applicants must meet the following criteria:
9 Reside in Australia and identify as Aboriginal or Torres Strait Islander.
9 Currently enrolled in a program of study in Australia that leads to registration as a dental hygienist or an oral health therapist.
9 Provide a reference from a representative of an Aboriginal and/or Torres Strait Islander organisation.
SELECTION
2024 grant applications will open in May 2025. To apply, complete the application form available on the ADA DHF website. Applications will undergo review by the ADA DHF’s review panel.
For further information, please contact us at 1300 880 978 or via email at scholarships@adadhf.org.au
LEARN
MORE ABOUT THE ADA DHF FIRST NATIONS STUDY GRANT
Don’t be afraid to give it a go! I was nervous about applying and how I would go throughout the course as I didn’t do well in school, however, the teaching staff and the university are very supportive.
ADVANCED BONE AUGMENTATION CADAVER COURSE
10 -12 OCTOBER 2024 | 21 SCIENTIFIC HOURS
THE SCHOOL OF DENTISTRY | UQ
Elevate your expertise with The University of Queensland's CPD courses.
TOPICS COVERED
SINUS BONE GRAFT
Biomaterial science, membranes and graft material selection head and neck surgical anatomy. Functional anatomy of maxillary sinus lateral window. Flap design & suturing techniques.
MANDIBULAR RIDGE AUGMENTATION
• Functional anatomy floor of the mouth
• Flap design, dissection, and suturing techniques,
• Horizontal and vertical ridge augmentation
• The Sausage Technique.
BONE BLOCK GRAFTS
Donor sites and bone defect preparation. Adaptation and fixation. Suturing techniques. Case selection and complication management.
EVENT DETAILS
PRESENTERS
• Dr Jamil Alayan
• Assoc Professor Ryan Lee
• Professor Saso Ivanovski
SCAN THE QR CODE FOR FURTHER INFORMATION AND TO REGISTER
Prof Purnima Kumar
Dr Joseph Kan
Dr Franck Renouard
Dr Kris Chmielewski
Mr Graham Blackbeard
Dr Ioana Datcu
Dr Salah Huwais
Prof Koo Ki-Tae
Dr Rodrigo Neiva
Dr Eugene Foo
Dr Rebecca Ellis
Dr Mario Beretta
Tabitha Acret
With 20% off the cost price of ADAQ courses for members, explore popular courses at the recently renovated ADAQ CPD and Training Centre at Bowen Hills, Brisbane, scan the QR Code to learn more and register before it's too late.
LOOK BEFORE YOU LEAP
FROM OUR PARTNER - BOQ SPECIALIST
Securing your dream practice requires thorough consideration, plenty of research and advice from a trusted source.
Buying a commercial property can set up dental professionals for life—if they get it right. There are a multitude of factors to consider to ensure you get a property that is fit for purpose, not only today, but is also able to deliver long-term value. According to our finance specialists, here are some things to weigh up.
LOCATION, LOCATION, LOCATION
A commercial area that seems perfect today could lose its lustre in the future.
However, assessing the strengths of a suburb and checking out past business trends in the area can minimise any risks. Is the population on the rise? Does the site have access to public transport? Are there anchor tenants in the commercial zone or planned development within the area? “Practices located near shopping precincts with a strong anchor tenant will give the greatest exposure to foot traffic” says Nicole Balneaves, Senior Product Manager at BOQ Specialist.
She adds that buying on a site with good street frontage and the potential to erect eye-catching signage can make a real difference.
Nicole says it also often helps if practice owners have exposure to the area and its demographics prior to looking to purchase their own site. Another option for dental professionals could be to acquire property within close proximity to other healthcare providers.
A thorough review of competition or potential synergies within the area should also be part of your extensive research.
We have the industry knowledge and can help clients ask the right questions. This is what we do every day, and we are focussed on helping dentists achieve their professional goals.
Nicole Balneaves, BOQ Specialist
THE STATE OF THE ECONOMY
Before signing on the dotted line for a commercial property, consider how the economy is performing.
Commercial property owners are more exposed to financial ups and downs than residential owners because people always need a place to live, whereas demand for high-end service providers can wax and wane. A sudden downturn could reduce an owner’s personal income, and limit their capacity to lease additional space to other businesses. Nicole recommends speaking to financial experts to gain an understanding of current economic and market trends.
SUPPORT SERVICES AND ACCESSIBILITY
A second-floor dental clinic without a satisfactory lift is a sure turn-off for potential patients, especially the elderly, disabled or parents with children. “A practice needs to be easily accessible and accommodating to the needs of your patient base,” Nicole says.
Other factors such as parking, security and access to IT infrastructure should also be part of the equation. Superior and well thought-out property facilities can aid your practice in the day-to-day, but also could ultimately contribute to a higher potential resale value of the site in the future as well.
EXISTING LEASES AND TENANTS
An investor in commercial property should understand their legal obligations when it comes to taking on an existing leasing arrangement when acquiring a property. If, for example, a tenant’s current leasing arrangement or terms are inconsistent with market norms, this may impact profitability on the property. Conversely, if the leases of high-paying tenants are about to expire, the new owner runs the risk of purchasing suites that could soon be vacant. “So it’s important to look at the tenancy demand and vacancies within an area, including the profiles of the existing tenants,” Nicole says.
GROWTH GOALS FOR YOUR PRACTICE
Nicole says prospective commercial property owners should understand the growth plans for their practice before agreeing to a purchase.
“Some practitioners may currently be operating out of a one or two room practice, but their goal might be to expand in the future,” she says. “Does the property you’re looking at accommodate those growth plans?”
Failing to account for the anticipated growth could result in significant costs should a bigger site be required within a few years, particularly if your practice requires purpose-built fixtures and fittings.
OTHER ELEMENTS TO THINK ABOUT INCLUDE:
9 Zoning and heritage-list guidelines – converting an existing house or property into a purpose-built dental practice could be subject to strict council planning laws.
9 Taxing times – the purchase of a commercial premises can attract GST, especially when buying off the plan, and that can make a significant difference to cashflow or the financial viability of the site. Also factor in costs such as stamp duty, initial set-up costs and signage.
9 Contract of sale – such a contract will typically set out the terms and conditions for the sale of the property, including a description of the property, the purchase price, a list of any fixtures or fittings that are included in the sale, and the settlement date.
Doing your due diligence on a commercial property is a must, according to Nicole. That means paying attention to financial and legal considerations, having a building and pest inspection that discloses any underlying structural concerns with the property and infrastructure. It is also important to check that the property is correctly zoned for the intended use and relevant permits held if required.
This often exhaustive checklist underlines the importance of seeking advice from trusted banking, finance and legal advisers before finalising a commercial property deal.
“We have the industry knowledge and can help clients ask the right questions,” Nicole says. “This is what we do every day.”
BUSH MEDICINE TOOTHACHE REMEDIES
BY DR GARY SMITH & ALESSANDRA BOI ADAQ MUSEUM OF DENTISTRY
An informal collection of common natural remedies for teeth and gums problems, including some truly whacky ones.
All human civilisations feature some form of pre-scientific medicine systems, consisting of cultural beliefs and natural remedies to treat disease, wounds and pain. These remedies are integral part of a culture’s set of beliefs that explains why the pain or problem exists, and why the corresponding remedy works.
In most traditional medicine systems, the use of remedies sourced from the natural environment is only a part and complement to deeper spiritual beliefs. At the core is often the need to keep one’s soul and body balanced. This is common to many cultures. For example, Chinese Traditional Medicine is based on the belief that illness is an imbalance between yin and yang forces. Rongoā Māori, and Aboriginal and Torres Strait Islander knowledge all encompass herbal remedies, physical therapies and spiritual healing.
In Western cultures, for millennia, medicine and healing processes remained closely intertwined with magic and superstition. In many European countries this meant the local flora was not enough: fauna too was needed for teeth problems! Therefore, we have extreme acts such putting a live frog inside the mouth, or crossover treatments with other animal teeth, including other humans’ (if already dead). Powerful changes in religious beliefs meant that, for the most devout Christians, simple holy water could do the trick.
Modern Western medicine is surprisingly indebted to traditional healing systems. Some studies estimate around 40% of pharmaceutical products and scientifically-proven treatments derive from ancient wisdom and traditional knowledge on the effects of plants or other natural products. Famous examples are aspirin, which is derived from the bark of the willow tree, and the smallpox vaccine, from the scientific study of ancient inoculation practices. Lesser known is the fact that synthetic hormones for contraceptive pill have been derived from wild yams (diosgenin) and, more recently, kangaroo apple (solasodine).
In biotechnology, modern research tools are helping to discover which natural compounds will be the next pharmaceutical advance. Artificial intelligence (AI) capabilities are already being harnessed to speed up drug innovation. AI can identify and study promising trends hidden in plain sight within hundreds of traditional medicine systems around the world.
In biotechnology, modern research tools are helping to discover which natural compounds will be the next pharmaceutical advance.
Indigenous Australians’ pharmacopoeia is considered one of the most promising for the development of new pharmaceutical drugs. Australian bush medicine is full of wonderful ideas for the treatment of oral conditions and tooth pain. Some use plants unique to Australia or the Indo-Pacific, but others mirror solutions with plants from the same family as identified in the traditional wisdoms of Eurasia, Africa and the Americas.
Meanwhile, many countries already incorporate traditional and complementary medicine in their health system. This is encouraged by the World Health Organisation (WHO), which notes the potential advantages in the management of chronic disease, for example. Australia is one of the few Western countries where Chinese Traditional Medicine is a nationally registered profession. In Africa and South America, often traditional healers remain the most popular, if not the only available, health care providers. In other parts of the world, traditional herbal medicine often resurfaces in dentistry for emergency ‘dental treatment’ in areas where modern dentistry and pain relief medication is not easily accessible or not affordable.
Fads such as oil pulling for rinsing and cacao powder for tooth brushing resurfaced in Western mainstream culture, their popularity helped by social media influencers.
Indigenous Australians’ pharmacopoeia is considered one of the most promising for the development of new pharmaceutical drugs.
In Queensland, according to a 2022 review (Turpin et al.) there are 135 native plants used in Indigenous pharmacopaeia – excluding those which Aboriginal and Torres Strait Islander Elders have declined to share knowledge with non-Indigenous Australians.
Families with most species with recorded medicinal properties were Myrtaceae (14), which include eucalypti and melaleucas, Fabaceae (11), Lamiaceae (8), and Apocynaceae, Asteraceae, and Euphorbiaceae. Around half are trees, and the most common part used are leaves. Different parts are used, depending on the treatment needed and the therapeutic capabilities of the plant in question, including branches, bark, leaves, fruits and seeds, roots and resins. Burning medicinal plants and natural products by inhalation or use of ashes and soot.
Tribulus cistoides Caltrop, Goat’s head burr, bull’s head (similar to Bindii –Tribulus Terrestris)
Menispermaceae Whole plant
Toothache
In the list, we can identify thirteen (13) plants for toothache treatment, and one for sore gums.
FULL INVENTORY OF ABORIGIONAL MEDICINAL PLANTS OF QUEENSLAND
Garlic & Onion
Garlic (Allium sativum) and onion (Allium cepa) have been used in Europe and Africa. Crushed garlic are applied directly to the tooth cavity, for its antibiotics and slightly anaesthetic properties. Onions were used for decoctions.
Cocoa
The use of cocoa (Theobroma Cacao) for the treatment of gingivitis and caries features in South America and later Ayurvedic medicine. Some researchers have found theobromine can harden enamel and hinders plaque formation. Nothing as dramatic as chocolate’s mood boosts of course.
Tobacco
Turpin G, Ritmejerytė E, Jamie J, Crayn D, Wangchuk P. Aboriginal medicinal plants of Queensland: ethnopharmacological uses, species diversity, and biodiscovery pathways. J Ethnobiol Ethnomed. 2022 Aug 10;18(1):54. doi: 10.1186/s13002-02200552-6. PMID: 35948982; PMCID: PMC9364609.
NATURE'S WONDERS
In its booklet titled Bush Medicine Plants of the Rosewood Scrub, of which we have a copy (kindly donated by Christine Reinhardt), Arnold Rieck adds Melaleuca alternifolia (medicinal tea tree) oil used as germicide on boils and abscesses. In fact, tea tree oil is now sold commercially. Rieck compiled a list of curative plants found in the Rosewood Scrub, Ipswich region. Peace Park Nature trails feature most of the Queensland bush medicine plants listed here as used by First Nations and early settlers.
ACCESS BUSH MEDICINE PLANTS OF THE ROSEWOOD SCRUB
This may be surprising, but the crushed leaves of the tobacco plant (Nicotiana tabacum or Nicotiana rustica) were believed to lessen caries pain and whiten teeth. Crushed tobacco leaves would be packed in the cavity. Unfortunately, colonialism facilitated the spread of tobacco as the new panacea for all sorts of conditions, including dental. Knowledge of this capacity of tobacco to ‘numb pain’, although very mild, made tobacco very popular in Europe. To this day, especially in areas where dental treatment is still very costly, smoking a cigarette for toothache relief is still a popular advice, even given to older children. The menthol sort is especially ‘effective’…
Cabbage
Another popular remedy characteristic of the Mediterranean area is the application of boiled cabbage leaves to alleviate and deflate an abscess.
Sweet potato
Looking around the veggie patch, sweet potato (Ipomoea batatas) is anti-inflammatory and heals mouth ulcers. The Irish also used potato for tooth pain.
Chewing sticks
In Australia, Africa and some parts of Asia, chewing sticks help with plaque removal. An example is Garcinia mannii, an African sap tree similar to mangosteen that seems to arrest caries and remineralise teeth when used daily. Garcinia’s chemical constituents are being researched today.
Coconut
Lemongrass
We add to this list native lemongrass (Cymbopogon ambiguus) for mouthwash as used by Aboriginal people.
Myrrh
Natural remedies from European popular culture vary. In the Mediterranean basin, myrrh (Commiphora myrrha) has been used for millennia as a medicinal, among other things to gargle and for tooth pain. Myrrh has some astringent and antibiotic properties. Powdered myrrh would be boiled in water, then filtered and applied to the gums.
Essential Oil
Many sources cite essential oils as remedies: oil of cloves for toothache, peppermint oil or aniseed especially for gingivitis. Of course, oil of cloves contains eugenol which has been used in mainstream dentistry in the past for disinfecting and dressing cavities and dry sockets. Vitamin-rich lemongrass oil is useful as anti-inflammatory and for pain relief, as mentioned earlier.
Cocos nucifera (coconut) roots and flour have been used in Africa and around the Pacific to treat tooth ache. The effect of coconut decoctions as mouthwash or gargles is probably due to antifungal properties and the presence of lauric acid which fights plaque bacteria.
To this day, especially in areas where dental treatment is still very costly, smoking a cigarette for toothache relief is still a popular advice, even given to older children.
Avocado
Avocado (Persea americana) seeds and leaves are apparently anti-inflammatory and anti-fungal. Crushed and boiled, they fight pain and mouth sores. If you’re a young Australian, the fruit flesh smashed on toast might prevent you from owning property however… The Sphilanthes plant (Acmella oleracea) is actually called toothache plant in many places. This medicinal herb to treat toothache and throat infections due to its anti-inflammatory and saliva producing properties. In Queensland, the root of a similar plant, Acmella grandiflora was used by local Aboriginal tribes to treat toothache. Acmelle are of the same family as sunflowers: Asteraceae.
Arnica
Another plant from this family widely used in traditional medicine across the Northern Hemisphere is arnica (Arnica montana). It does contain tannins which account for its anti-inflammatory and antiseptic properties. It also contains helenalin which is quite poisonous if ingested.
Bitter Kola
Bitter Kola (Garcinia kola), a type of mangosteen, has long been used as herbal medicine in its native Africa for respiratory ailments as well as oral health. The roots and stems are cut into short chew sticks used for cleaning teeth. Kola is being studied for its anti-microbial properties. Seeds are an aphrodisiac.
Kava
In the South Pacific, Kava (Piper methysticum) is used as anxiolytic in ceremonial rituals. Chewing kava roots causes numbness, which explains why it’s also a toothache remedy. Its pain-relief and anti-anxiety properties have earmarked it as a potential alternative to opioids and benzodiazepines as kava’s effects are non-addictive. However, there are serious concerns about its liver toxicity.
DISCOVER MORE DENTAL HISTORY AT ADAQ'S MUSEUM OF DENTISTRY
Kawakawa
In Māori medicine, a similar pepper tree, the Kawakawa (Piper excelsium) is used for dental pain, as well as Karakeke or New Zealand Flax (Phormium tenax) and Manuka tea tree (Leptospermum scoparium)
Apart from botanical remedies, there are other natural products known to have therapeutical uses in many cultures. Propolis is a resinous biomaterial produced by honeybees as binding glue for their hives. It may be useful in periodontics and endodontics for its bactericidal, anti-inflammatory, and antifungal properties.
CONCLUSION
ADA's position summary on complementary or alternative therapy associated with dental practice: Dentists practising non-dental, complimentary or alternative therapies do not do so in their capacity as a dentist. These activities must be regulated by legislation (negative licensing) and require separate consent from patients.
ADA POLICY ON COMPLEMENTARY OR ALTERNATIVE THERAPY
CONSIDERATIONS OF THE GROWING ACCESS TO DENTAL CARE
ZOE DEREK | ADAQ COMPLIANCE AND ADVISORY SERVICES
With dental health services for regional and remote areas becoming more accessible through various means, there are requirements and regulations for all dental practitioners to consider when providing care in these circumstances.
Many dentists have a passion for making dental healthcare accessible for all and doing what they can to contribute to a healthier community, but it's important that all dental practitioners mitigate any potential risks for something to go wrong and to improve patient outcomes.
Let’s discuss some aspects that should be considered when providing treatment to patients when volunteering overseas or working remotely or regionally to ensure that you aren’t opening yourself to liability:
ARE YOU WORKING WITHIN YOUR SCOPE OF PRACTICE?
As a dental practitioner, your scope of practice is self-assessed which requires you to ensure that the treatment you are providing to the patient is within your scope. Your relevant experience, CPD and training should be considered before performing complex dental treatments.
An issue that often arises from remote and regional practice is the lack of specialists within close proximity to the location, with patients who aren't willing to travel to have their dental needs seen to.
Even if the patient understands that you feel the work isn't within your scope and has asked you to provide the care regardless, you are opening yourself up to liability.
ACCESS AHPRA'S SCOPE OF PRACTICE GUIDELINES
Providing care outside of your scope not only increases the risk of something going wrong, but if a complaint is made to a regulatory body such as Ahpra, there would undoubtedly be findings and conditions placed on your registration.
Dental practitioners are required to complete 60 hours of CPD activities over a 3-year period. Ensuring that you are up-to-date with your CPD is vital for your Ahpra registration, but is also a useful way of up-skilling while maintaining compliance.
As an ADAQ member you have access to both ADAQ and ADA on-demand CPD sessions, in addition to discounted face-to-face CPD courses offered year-round. For practitioners working in remote and regional areas, this is an excellent way to access content.
VIEW ADAQ'S ON-DEMAND CPD COURSES
ARE YOU SURE THAT YOU HAVE INFORMED CONSENT?
‘Informed consent is a person’s voluntary decision about healthcare that is made with knowledge and understanding of the benefits and risks involved’ (Ahpra shared Code of conduct).
Does your patient understand what treatment you are recommending? If you're unsure, it’s safe to assume that you don't have informed consent, need to seek further clarification and we recommend you don’t provide treatment unless you are certain.
Specific risks should be advised, and patients should be given the opportunity to discuss and ask questions. Your informed consent procedure may include:
A treatment plan, including the costs associated;
Discussion of anticipated outcome and benefits;
Discussion of possible complications, side-effects, and risks; and
Discussion on possible alternative treatments, including no treatment and referral.
There are barriers and other factors to consider with regional or overseas practice, but also within general practice to ensure informed consent has been provided, such as:
• Language barriers;
• Financial constraints;
• Whether the patient has the capacity to consent; and
• Whether additional elements of consent are necessary based on their cultural background such as ensuring that a female team member is present at all times.
When you have additional barriers affecting communication between yourself and the patient, having the patient repeat back to you what has been discussed can assure you that the patient understands.
Steps to ensure informed consent is received:
1. Know your obligations around informed consent;
2. Ensure you obtain appropriate informed consent for every appointment – this includes explaining everything in detail and ensuring the patient understands the procedure/s and associated risks;
3. Document your consent process – if it’s not written down it didn’t happen; and
4. Contact ADAQ and your PI provider if you need assistance.
VIEW ADAQ MEMBER RESOURCES
INSURANCE - HAVE YOU NOTIFIED YOUR INSURER OF YOUR INTENTION TO PRACTISE OVERSEAS?
If you're planning on volunteering and practising overseas for a short period of time, ensuring that your insurance covers you when providing dental services is vital.
Contacting your indemnity insurance provider prior to travelling gives you peace of mind should something go wrong. When insured with ADAQ, there are some countries that have already been accepted by the insurer and we can provide you with this reassurance, or request for the insurer to consider any new countries not already approved.
PROVIDER NUMBERS - IS YOUR PROVIDER NUMBER APPROPRIATE TO USE WHEN PRACTISING?
If you are practising at a regional location for a short period of time, you might question whether it is acceptable to use your current provider number.
As a registered dentist, you are recognised under the Health Insurance (Dental Services) Determination 2007 by Medicare.
You are provided with a Medicare Provider Number under this legislative instrument. Your provider number is unique to you and the location at which you practice. If practising at a second location, then you would need a provider number for each location.
There is an exception when providing treatment at a location for a short period of time and this is when you are acting as a locum, working at another practice for a period of less than two weeks. In these instances, it is acceptable to use your provider number from another location.
Should you be acting in a locum position for a period longer than two weeks or plan to work there more than once, a new provider number would be required for the relevant location. If it is a oneoff situation or less than two weeks, then locum arrangements would be acceptable regarding using your current provider number, but you would require a provider number for the location if this was to be a regular occurrence, or if longer than two weeks.
TELEHEALTH FOR DENTAL CONSULTATIONS
Dental consultations through teledentistry for patients is another tool that assists with providing access to dental care for remote or regional locations, but it also has its own considerations.
STEPS TO ENSURE
Know your obligations around informed consent.
Ensure you obtain appropriate informed consent for every appointment.
Document your consent process – if it’s not written down it didn’t happen.
Contact ADAQ and your PI provider if you need assistance.
Teledentistry is not suitable for procedural dental treatments. Teledentistry is still considered dentistry; therefore, the same requirements will apply as if you were in a 'typical' dental practice setting. This will include the same standard of record keeping and billing as an example.
The Australian Schedule of Dental Services and Glossary has a section specifically for teledentistry and item numbers for use relating to remote consultations that should be considered.
CULTURAL SAFETY
ADA FEDERAL'S SCHEDULE OF DENTAL SERVICES AND DENTAL GLOSSARY
Recent amendments to National Law outline the significance of ensuring culturally safe practice. Working in remote areas with a larger community of differing cultures, means that you should be ensuring that your practice is a respectful and safe environment for them. Three out of the eleven principles of the code of conduct mention culturally safe practice, showing the importance placed on this and as a registered dental practitioner, you have an obligation to follow these guiding principles:
9 Principle 2 – Practitioners should consider the specific needs of Aboriginal and Torres Strait Islander Peoples and their health and cultural safety, including the need to foster open, honest and culturally safe professional relationships.
9 Principle 3 – Respectful, culturally safe practice requires practitioners to have knowledge of how their own culture, values, attitudes, assumptions and beliefs influence their interactions with people and families, the community and colleagues. Practitioners should communicate with all patients in a respectful way and meet their privacy and confidentiality obligations including when communicating online.
9 Principle 7 – Good practice involves putting patient safety, which includes cultural safety, first. Practitioners should minimise risk by maintaining their professional capability through ongoing professional development and self-reflection and understanding and applying the principles of clinical governance, risk minimisation and management in practice.
It is also important to ensure that the workplace is a culturally safe and harassment free environment for your team members.
Having a policy in place relating to expectations that patients should have in relation to the culturally safe care you provide is recommended. It is equally important for you to have an internal policy, ensuring that workplace discrimination and harassment can be appropriately managed.
The Compliance and Advisory team are here to assist ADAQ members. If you have any questions and wish to get in contact with our team, we are available at assist@adaq.com.au or via phone on 07 3252 9866 and would be happy to help.
No one likes to be left exposed.
With the release of the new ADA Infection Control Guidelines it is a great time to review your dental practice infection control processes and policies and book an ADAQ staff training session or infection control health check.
ADAQ’s dedicated Education and Practice Advisory Team can assist with increasing efficiency and compliance and improving overall practice performance.
HOW YOUR DENTAL RECORDS ASSIST IN IDENTIFYING DECEASED PERSONS
QUEENSLAND HEALTH FORENSIC ODONTOLOGY TEAM
Police are asked by a relative living interstate to conduct a welfare check on their elderly mother. They inform the police that she is a very private individual who lives alone and tends to keep her doors locked and window shades drawn.
She does not believe in doctors and does not trust hospitals, preferring to treat herself with home remedies. They have not been able to contact her recently and they are becoming concerned.
Police visit her house as requested and find the doors and windows locked. A locksmith gains access, and on entry, the police notice a foul odour. On entering the bedroom, they discover a deceased female person lying on a bed. She is discoloured, and the extent of the decomposition renders her unrecognisable. The police rapidly determine that there are no suspicious circumstances, and she is transferred to the mortuary.
At this stage, the coroner is notified, and a coronial investigation begins. This involves confirming her identity and determining as far as possible the cause of death.
The police suspect that they know the identity of the deceased lady for obvious reasons, but because she is not recognisable, formal identification is required and she cannot be released from the mortuary until this is established to the coroner’s satisfaction. Meanwhile, the relative of the lady is informed of the circumstances and told that they cannot arrange a funeral until the identity of the deceased is definitively established. Naturally, this causes anxiety because no estimate of the time this might take can be provided. The family and friends of the lady live locally, interstate, and some overseas, and many wish to attend her funeral to pay their respects. They have engaged a funeral director, but a date for the funeral cannot be set until she is released from the mortuary. Stress levels are naturally high. The relative has been told that if DNA is required, they will need to donate a sample for profiling, and this could result in a delay of weeks or months while profiles are obtained, prepared, matched and reported.
We know that relatives do less well if their grieving process is prolonged unduly, so any delay is bad news, to say nothing of the stress that may be involved in coordinating a funeral. So how can we help?
At this stage, the coroner is notified, and a coronial investigation begins. This involves confirming her identity and determining as far as possible the cause of death.
IDENTITY IS A HUMAN RIGHT
The right to an identity is enshrined in article 6 of the United Nations’ Universal Declaration of Human Rights (https://www. un.org/en/about-us/universal-declaration-of-human-rights) as a basic human right. It reads “Everyone has the right to recognition everywhere as a person before the law”. In forensic science, this is a profound tenet that underpins much of our work. It means that each and every person must be identified in the eyes of the law.
WHAT DO WE MEAN BY IDENTIFICATION IN FORENSIC ODONTOLOGY?
In many cases, identification is not controversial – someone dies at home or in a hospital, or in circumstances where their identity is clear. If they are not disfigured, relatives may be able to visually identify them. However, if the coroner requires that identification needs to be undertaken, then a scientific method may be needed. There are three “major identifiers”, each of which is recognised as being able to provide a definitive scientific opinion as to identity. These include fingerprint comparison, dental comparison and comparison of DNA profiles. Police rapidly determine that the lady has no fingerprints on record, and DNA profile comparison takes significant time (and it is invasive, requiring a sample from a blood relative with which to compare), so the Forensic Odontology unit is asked to assist with identification.
We do this by comparing the dental features of the deceased person with dental records relating to the person they are believed to be. And this is where you come in. The dental records you have compiled are the most vital part of the process – we can do nothing without them.
WHO ARE WE?
Most often, the Forensic Odontology team will contact you directly from Queensland Health Forensic and Scientific services. Speaking as dentists to the dental team, communication is far more effective than dealing with a third party such as police when we do that. We will clearly identify ourselves as Alex Forrest, Neil Evans, Annu Nangia, Hai Jiang, Jane Kim and Alistair Soon.
WHAT ARE DENTAL RECORDS?
The quality of our outcomes is dependent on the quality of the dental records we receive from you. Poor or absent records leave us with nothing to work with. Excellent records mean we can often complete a case within a couple of hours.
We will ask for any and all records that you might have. These include medical histories (useful for helping provide information to forensic pathologists who might be carrying out an autopsy to determine a cause of death), written treatment notes, images, which include plain film radiographs (OPGs, PAs and Bite Wings, occlusographs or any other specialised images such as TMJ tomograms), clinical photographs, CT and CBCT data, and importantly, any 3D intraoral scan data you might have. Referral letters are also valuable since they may identify specialist practitioners with additional records. Copies are fine –keep the originals as they may be required later if there are any court proceedings. Ideally, we would receive these as quickly as possible by email or secure file transfer. We all have our individual Queensland Health email addresses, but we also have a group address: FSS-Forensic-Odontology@health.qld.gov.au Sometimes you may have other items such as study models or partly completed intraoral appliances. These are also useful, but generally we will ask for these items if images are not available or are of poor quality.
Importantly, we do not judge the quality of dental records, nor do we report any deficiencies to any authority. We use them ONLY for forensic purposes, so please don’t be hesitant in making them available, regardless of whether you feel they might contain inadequacies. We are only interested in the forensic outcome and whatever you provide us with will remain strictly confidential.
WHAT ABOUT THE PRIVACY RULES?
We are all aware of our obligations under the Information Privacy Act (2009), which was most recently updated in March 2023. Patient records are confidential and contain sensitive information about individuals. The Commonwealth Privacy Act (1988), last updated on 18 October 2023 (www.legislation.gov. au/C2004A03712/latest/text), defines an individual as a “natural person” (Section 6 (individual)). The Office of the Information Commissioner of Queensland notes that a “natural person” “can only be a living person (www.oic.qld.gov.au/guidelines/forgovernment/guidelines-privacy-principles/application-of-the-ipact/when-do-the-privacy-principles-apply). Section 22 (b) of the Coroners Act 2003, last updated on 1 February 2024, states that a person who has any medical records of the deceased person is required to give them to the person conducting the autopsy. Since you will be being advised on behalf of the coroner by us that a person is believed on reasonable grounds to be deceased, and therefore no longer a “natural person”, you are not in breach of the Information Privacy Act under this provision, and as you are acting in good faith on that basis, no civil or criminal penalty can arise. If necessary, we can obtain a coroner’s order for the records, but that involves a delay while we secure the signed form. Penalties apply for failing to provide the records – Section 22(b)(5) of the Coroners Act 2003 – “The person to whom the notice is directed must comply with the notice, unless the person has a reasonable excuse (Maximum penalty – 40 penalty units)”. Part VIA(a)(i)and (ii) of the Commonwealth Privacy Act also make specific provision for collection of personal information in relation to emergencies or disasters.
QUESTIONS ON RECORD KEEPING? CONTACT THE COMPLIANCE AND ADVISORY SERVICES TEAM
Poor or absent records leave us with nothing to work with. Excellent records mean we can often complete a case within a couple of hours.
The best records are images, because they are objective and not subject to interpretation or mis-recording. We will always ask for these!
WHAT DO WE DO WITH YOUR RECORDS?
We will compile your records into a representation of the last known dental state of the individual. Since your particular records may only cover a specific period in the patient’s life and the patient may have attended other dentists and been referred to specialists, this can be a significant task. We will then compare them with the dental features of the deceased. Images are especially useful to us. Every person coming to the mortuary will undergo a CT scan with a medical CT scanner. If dental identification is likely to be needed, we can request a highresolution scan of the head. Our forensic radiographers are adept at producing reconstructions from this data simulating periapical and OPG images, and we can very quickly compare these with any images of the deceased person. Otherwise, we may compare details in treatment notes with our post-mortem records of treatment derived from physical examination and radiography of the deceased.
FROM THIS COMPARISON WE CAN COME TO ONE OF FIVE CONCLUSIONS:
CONFIRMED IDENTIFICATION
There is absolute certainty that the postmortem and ante-mortem (before death) records are of the same person.
PROBABLE IDENTIFICATION
The post-mortem and ante-mortem records are very likely to be of the same person but we cannot establish this beyond all doubt (usually because we don’t have images as part of the dental records of the person).
POSSIBLE IDENTIFICATION
There is insufficient ante-mortem or postmortem information to establish identification, but we cannot rule the possibility.
INSUFFICIENT EVIDENCE TO DECIDE
This speaks for itself, a common conclusion cannot be met due to a lack of evidence.
EXCLUSION
The ante-mortem and post-mortem records derive from different individuals.
In Queensland, we provide our outcomes and reasons to the Coroner, police, forensic pathologists and courts by means of a formal statement of evidence.
THE ROLE OF A CORONER
The Coroner determines if there is sufficient evidence on which to identify a deceased person. Consequently, we provide advice on our findings to the Coroner but the decision as to identification is theirs alone. They may have access to additional information to which we are not privy, and this plays into their final decision. The provision of an opinion from Forensic Odontology in respect of a confirmed identification is generally accepted without question, however, as odontology is recognised as one of the three scientifically validated “major identifiers”.
WHAT HAPPENS IF THERE IS A DELAY?
If there is unnecessary delay in us receiving dental records, that will inevitably delay the whole process. The deceased cannot be released to relatives, they cannot plan their funeral, and they cannot get on with their grieving process while the identity of the deceased remains unconfirmed. This causes huge stress at a time when they least need it and can have carry-over effects on their well-being long after the incident is over.
THE GRIEVING PROCESS AND HOW WE HELP
It’s always important to put yourself in the shoes of somebody who has just lost a loved one, often in confronting circumstances. What would you feel if the process of identification was held up? You would remain uncertain that it was your loved one who had actually passed on, and that is a difficult thing to live with.
We work for the living. There’s nothing we can do once a person is deceased except to honour them with the best work we can. Our working hours are limited – we are only employed between the hours of 0800 and 1200 on Mondays, Wednesdays and Fridays. If we ask for dental records and receive them that morning, we can often provide our opinion before 1200 hrs. The relatives will therefore experience no delays and may not even be aware that formal identification was undertaken. Conversely, if delays in receiving dental records happen, it can have major implications for family and friends. So please, provide your records to us as soon as you can. Privacy laws are no barrier, and you will help us help the loved ones of the deceased. This is one of the most important individual services dentistry can provide outside of direct diagnosis and treatment.
There’s nothing we can do once a person is deceased except to honour them with the best work we can.
THE OUTCOME
In our hypothetical case, the deceased lady was CT scanned on admission to the mortuary, and our forensic radiographers prepared multiplanar reconstructions of the high-resolution head data to produce an image that resembled an OPG. On arrival at work, we received an email from the Coronial Support Unit of the Queensland Police notifying us of the case. We were able to track down the dental surgery which she had most recently attended, and they supplied us with dental records and a recent OPG by email. We compared the CT image with the OPG and concluded that both images derived from the same person.
Accordingly, we prepared a legal statement of evidence to that effect which included the images demonstrating our reasoning and the basis for our conclusion, and including the assumption that the conclusion was based on the supplied dental records belonged to the person named on them. This was peer reviewed and sent to the Coroner by 11 am. The deceased lady’s remains were released the next day following post-mortem examination, and the relatives were able to begin their grieving process immediately.
As you will now be aware, we can’t do our job without you! We rely on you and thank you for your help.
REGISTER FOR THE DISASTER VICTIM IDENTIFICATION COURSE
DISASTER VICTIM IDENTIFICATION
2022 & 2023 Events
I really enjoyed the content of the course and it gave a great rundown and summary of what is involved in victim identification. I thought it was thoroughly interesting to see what else one can do with their dentistry degree.
- Evelyn M.
The deceased lady’s remains were released the next day following post-mortem examination, and the relatives were able to begin their grieving process immediately.
Really enjoyed the presentation from the police detective. Informative, felt applicable to actual trauma cases.
- Megan T.
It was evident that the Forensic Dental team at QHFSS were so passionate about the delivery of this event. It was well organised, informative and did not disappoint!
- Lynn-Maree T.
Professor Forrest is a wealth of knowledge and it is always a pleasure to hear him speak on his personal experiences in DVI.
- Elizabeth R.
EMBRACING WORKPLACE DIVERSITY AND ACCEPTANCE VALUING THE WHOLE TEAM: A CORNERSTONE OF DENTAL PRACTICE SUCCESS
FROM OUR PARTNER - WORKPLACE WELLNESS AUSTRALIA
SUSAN LONG | CLINICAL DIRECTOR
In the busy world of dental practice, success isn’t just about the bottom line, technical skill, the newest equipment, or a full client list – it’s about the people who make it all possible and cultivating a workplace culture of acceptance and appreciation.
From the receptionist who warmly welcomes your patients to the hygienist who ensures their comfort, every team member plays a vital role in creating a positive patient experience and delivering exceptional care. Cultivating a workplace culture where every team member, regardless of background, is valued and respected is the key to practice success. Elements that contribute to a thriving practice and better patient outcomes include the following:
STRENGTHEN WORKPLACE ACCEPTANCE OF ALL TEAM MEMBERS
Workplace acceptance embodies respect, understanding, and appreciation for the diverse backgrounds, cultures, and experiences that each team member brings to the table. In a diverse industry like dentistry, where individuals from various backgrounds come together to work towards a common goal, embracing workplace acceptance is not just a nice-to-have –it’s essential for a cohesive team and fostering a positive work environment.
Cultivating a workplace culture where every team member, regardless of background, is valued and respected is the key to practice success.
VALUING EVERY TEAM MEMBER
Every member of a dental practice plays a pivotal role in delivering comprehensive oral health care. From dentists and hygienists to receptionists and support staff, each person contributes to creating a welcoming and inclusive environment where patients feel comfortable seeking dental treatment. Valuing the whole team means recognising and appreciating the unique skills, perspectives, and contributions of every individual, irrespective of their role within the practice.
THE IMPACT ON ORAL HEALTH CARE
A workplace culture that prioritises acceptance and values the whole team is one that fosters trust and collaboration among staff members. Research demonstrates that organisations with inclusive culture experience higher levels of employee engagement, job satisfaction and productivity. This, in turn, translates into improved patient experiences and better oral health outcomes, particularly for any patient who may have faced barriers to healthcare or felt unwelcome in traditional healthcare settings.
EMBRACING CULTURAL DIVERSITY
Cultural diversity, crucial for dental practice success, encompasses a variety of backgrounds and beliefs among clinic staff and patients. Understanding and respecting these differences are vital for inclusive care. It means valuing each member’s unique perspectives and creating an inclusive workplace. For patients, it involves ensuring they feel welcome and adapting approaches and treatments to respect and accommodate various cultural preferences and practices, ensuring optimal oral health outcomes for all patients. Training can always be helpful to upskill in improving cultural and diversity awareness.
PRACTICAL STRATEGIES FOR CULTIVATING WORKPLACE ACCEPTANCE
Creating a culture of acceptance and appreciations takes time and intentional effort.
Leadership strategies for fostering acceptance and appreciation in your practise can include:
9 Lead by example - Practice leaders should set the tone for the practice by demonstrating inclusive behaviours and respectful behaviours.
9 Provide training and education - Offer training sessions on topics such as diversity, equity and inclusion to help team members understand the importance of these qualities in the workplace.
9 Encourage open communication - Create opportunities for team members to share their thoughts, ideas, and concerns in a safe and supportive environment.
9 Celebrate diversity - Recognise and celebrate the unique backgrounds, experiences and talents of every team member. Create opportunities for cultural exchange and learning within the practice.
9 Foster teamwork and collaboration - Encourage collaboration and teamwork among team members, and recognise and reward achievements.
MOVING FORWARD TOGETHER:
Just as we embrace diversity within our practice, embracing diverse forms of support can enhance our ability to cope effectively. Speaking with a psychologist, counsellor or trusted professional can offer valuable insights and strategies tailored to meet your individual needs, contributing to a more inclusive and supportive workplace culture. Consider reaching out to your Member Support Line for confidential assistance or visit us at www.workplacewellnessaustralia.com.au to learn more. SCAN THE QR CODE TO ACCESS ADAQ'S MEMBER ASSISTANCE PROGRAM (MAP)
THE ADAQ MEMBER ASSISTANCE PROGRAM CAN BE ACCESSED AT ADAQ.ORG.AU/MAP TO DISCUSS SUPPORT FOR YOUR EMPLOYEES OR FOR INDIVIDUALS TO ARRANGE SUPPORTIVE COUNSELLING.
SEAMLESS SUCCESSION: PLANNING FOR THE FUTURE OF YOUR DENTAL PRACTICE
FROM OUR PARTNER - WILLIAM BUCK
ANGELA JEFFREY | DIRECTOR
As a dentist, you have invested significant time and resources into building a practice that provides high quality care for your patients and a supportive environment for your colleagues and employees. However, have you given thought to what your life will look like after retirement? More importantly, have you begun planning for your eventual succession?
A well-conceived and executed succession plan is crucial not only for your financial security but also for the continued success of your practice. It ensures that patients continue to receive uninterrupted care, provides job security for your employees, and maintains the practice's profitability and stability for partners. Even if retirement seems a distant prospect, starting the succession planning process early can help ensure a smooth transition when the time comes.
A dental practice is often one of a dentist’s most valuable assets, representing years of hard work and significant financial investment. By planning for succession, you can capitalise on the equity you have built up over the years.
WHERE TO START?
Succession planning can seem daunting, especially given the day-to-day responsibilities of running a dental practice. However, it doesn’t have to be overwhelming. With a clear plan, the right professional guidance, and the willingness to ask essential questions, you can navigate the process effectively.
KEY SUCCESSION SCENARIOS
Succession options for dental practices fall into one of four categories:
Selling to a Dental Professional within Your Practice
This could involve selling to an associate or to the entire staff through offering a certain percentage of the business to help them be vested in the practice.
Selling to a Corporate Entity
This involves selling your practice to a larger dental corporation or group.
Selling to an Unrelated Party
This involves finding an external buyer interested in purchasing your practice.
Terminating the Practice and Liquidating Assets
This is the last resort if no suitable buyer is found.
Each option presents unique challenges and considerations. The best choice for you depends on various factors, including the structure and type of your practice. For example, a group practice will require a buyout agreement with partners, while a solo practitioner may need to find an external buyer or merger partner.
A well-conceived and executed succession plan is crucial not only for your financial security but also for the continued success of your practice.
PLANNING AND EXECUTION
Successful succession planning involves understanding the range of potential options, developing a structured plan, and following through with the help of experienced advisors. Start planning at least five to ten years before you intend to retire. This timeframe allows for the smoothest transition and maximises your options.
TO GUIDE YOU THROUGH THE PROCESS, HERE ARE THE MOST IMPORTANT STEPS
1. ASSESS AND ENHANCE YOUR PRACTICE’S VALUE
Begin by evaluating the financial health and market value of your practice. This includes analysing revenue streams, expenses, and profitability. A professional valuation can provide a clear picture of your practice’s worth and highlight areas for improvement. It will also help to potentially align a potential purchaser with your sales price and provide a negotiation tool. Implement strategies to enhance the value of your practice, such as improving financial performance, upgrading equipment, maintaining a fresh and inviting look for your practice. Having written down procedures and processes for how your practice runs day to day, is also of great value to an incoming owner.
2. IDENTIFY POTENTIAL SUCCESSORS
If you plan to sell within your practice, identify and groom potential successors early. This could be an associate, partner, or a group of employees. This is also a way to get them more vested in your practice and share the responsibility load of management tasks in the lead up to selling to them. If selling externally, start looking for potential buyers who align with your practice’s values and vision.
3. DEVELOP A BUYOUT AGREEMENT
For group practices, creating a buyout agreement with your partners is crucial. This agreement should detail compensation, timelines, and other essential aspects of the transition.
4. OPTIMISE YOUR PRACTICE
Enhance the value of your practice by improving financial performance, upgrading equipment, and enhancing patient care services. Ensure that the financial statements and accounting records are tidied up to exclude any personal expenses and assets. A well-run, profitable practice is more attractive to potential buyers.
5. PLAN FOR LEGAL AND TAX IMPLICATIONS
Work with legal and tax professionals to understand the implications of selling your practice. Proper planning can help you take advantage of tax concessions, such as Capital Gains Tax (CGT) concessions available, which can significantly reduce your tax burden. However, there are criteria to meet and it is important that you consider these well in advance and obtain advice on what you can potentially do to become eligible for the concessions if in the first instance you might not be. There are many legal issues to consider such as lease transfers, employment agreements, ongoing liability obligations and other considerations on sale that need to be addressed as part of the initial heads of agreement, confidentiality agreement and finally the sales contract.
Having written down procedures and processes for how your practice runs day to day, is also of great value to an incoming owner.
Angela Jeffrey | Director William Buck
6. CREATE A TIMELINE
Establish a timeline for the succession process. This includes key milestones such as when to start looking for buyers, when to finalise agreements, and the official transition date. Consider how long you are willing to stay on in the practice, is it one year, two years, part time or full time, or an easing back over time. This allows you to provide some comfit to the incoming owner that you are able to transition staff relationships, patients and processes of your practice.
7. COMMUNICATE YOUR PLANS
Maintain open communication with your staff, patients, and potential buyers throughout the transition process. Transparency helps build trust and ensures a smoother transition. This helps to obtain buy-in from existing staff and patients, to maintain support during a changeover process.
CASE STUDY: A SUCCESSFUL TRANSITION
Consider an example of a long-standing dental practice owner looking to retire. The practice was too large for a single buyer, and the owner initially received offers from corporate buyers. However, they preferred a different approach. By identifying three younger dentists within the practice interested in ownership and collaborating with a doctor-owned group, a smooth transition was achieved. The owner successfully exited, and the younger dentists took over, ensuring continuity and satisfaction for all parties involved.
Succession planning is a multifaceted process that requires careful consideration and expert guidance. If you require any assistance or are interesting in obtaining further information please contact your nearest William Buck Advisor.
Ensure that the financial statements and accounting records are tidied up to exclude any personal expenses and assets. A well-run, profitable practice is more attractive to potential buyers.
DR. LYDIA SEE IS COMMENCING HER SPECIALIST SERVICES IN SPECIAL NEEDS DENTISTRY AT BOWEN HILLS, BRISBANE QLD
Dr. Lydia See is commencing her specialist services in special needs dentistry at Bowen Hills, Brisbane QLD. She provides oral health management and treatments for individuals with diverse needs, including medical complexities, psychosocial challenges, intellectual and/or physical disabilities.
Her goal is to ensure dental treatments are customised to the patient’s medical, dental, and psychosocial circumstances. Lydia has particular interest in medically complex and geriatric patients, as well as those with severe anxiety and phobias. She looks forward to working collaboratively with all dental professionals in managing special needs patients.
CONTACT
Further information and referral form available via snda.com.au Direct contact: info@snda.com.au
MARKING OVER 45 YEARS OF DENTISTRY UTILISING GENERAL ANAESTHESIA IN BRISBANE
Dr Anthony Speed, in association with anaesthetists from the Wesley Anaesthetic Group, wishes to advise that he can facilitate treatment for patients requiring general anaesthesia in our outpatient facility at Holland Park. This is particularly useful for patients who have no private hospital insurance.
With an extensive range of experience, the team is willing to undertake wisdom tooth removal, implant placement and perform routine restorative dentistry on all age groups including children aged 3 and above.
Anxiety sufferers, local anaesthetic problems, severe gag reflex sufferers, special needs patients, and dementia sufferers have all been successfully treated over the years.
Additionally, we are now able to offer Cerec single visit crowns so that the patient does not have to return for subsequent cementation. Patients who are medically compromised can be treated at St Andrew’s Private Hospital by arrangement.
CONTACT
If this service can be of assistance to some of your patients, please phone the reception staff on 3397 1339 for further information. Referral booklets are available on request.
MODERN, HIGH-GROSSING PRACTICE IN GYMPIE
Centrally located, ground floor practice with three surgeries consistently grosses over $1M a year over the last three years.
The recently renovated practice has a stylish design and fitout, with a light-filled reception area designed with patient comfort in mind. The practice generates impressive figures without operating evenings or weekends. The owner is willing to stay on, subject to negotiation.
CONTACT
For more information, email lisa.singh@practicesalesearch.com.au
