ADAQ Dental Mirror - Autumn 2021

Patient practitioner romance?

Dental education in a pandemic

Ergonomics for dentists

INFECTION CONTROL BREACHES

How do we stop them?

ADAQ COUNCILLORS

PRESIDENT

A/Prof Alex Forrest AO

SENIOR VICE PRESIDENT

Dr Matthew Nangle

JUNIOR VICE PRESIDENT

Dr Jay Hsing

COUNCILLORS

Dr Meglin Rathnasamy (Peninsula)

Dr Kelly Hennessy (Central)

Dr Kaye Kendall (Moreton)

Dr Sobia Zafar (Moreton)

FEDERAL COUNCILLORS

Dr Angie Nilsson

Dr Gina Irwin (Western)

Dr David Le (Moreton)

Dr Graeme Westacott (Moreton)

Mr Manuel Garcia (Skills-based)

Dr Joseph Nguyen (Burnett)

Dr Jay Hsing (Moreton)

Dr Keith Willis (Moreton)

Dr Martin Webb

IMMEDIATE PAST PRESIDENT

Dr Norah Ayad

ADAQ SUB-BRANCHES

Bundaberg

Dr Paul Dever

Ipswich

Dr Andrew Wong

Kingaroy

Dr Jonathan Pye

Cairns

Dr Karen Pettigrew

ADAQ COMMITTEES

Dental Practice Committee

Convener: Dr Matthew Nangle

Dental History

Preservation Committee

Convener: Dr Gary Smith

Mackay Dr Peter Monckton

Sunshine Coast Dr Peter Jorgensen

Gladstone Dr Patrick Dohring

Toowoomba Dr Robert Sivertsen

Gold Coast Dr Gabriela Ciubuc-Batau

Rockhampton Dr Kelly Hennessy

Oral Health Committee

Convener: Dr Kaye Kendall

Conduct and Honours Committee

Convener: A/Prof Alex Forrest AO

Recent Graduates and Students Committee

Convener: Dr Malak Fouda

WHAT DOES ADAQ OFFER YOU?

A question that often comes my way is “What does my ADAQ membership offer me?” I’d like to respond to that question because our services are many and valuable, and we should all know what is available to us as members of our professional association.

A/PROF ALEX FORREST AO

PROFESSIONAL INDEMNITY INSURANCE (PI)

PI is something we all must have as a condition of registration, no ifs and no buts. While PI is available from a number of providers, ADAQ’s arrangement with QBE ensures that your premiums remain low regardless of the number of claims

you make. (We also offer free insurance to students, and discounted premiums for the first two years post-graduation).

To help prevent notifications, ADAQ offers general advice along with CPD education such as record keeping, consent and item numbers. These sessions are available via webinar throughout the year. Previous records can be viewed at adaq.org.au/ videolibrary

You may never see the notification coming, and it may arrive as a shock, leaving you confused as to how best to respond. While several videos on OHO/ Ahpra notifications and patient complaints offering some general information and guidance are available to members on the video library, ADAQ’s in-house advisory and support services are there to work with you and support you through responding to notifications from Ahpra and the Office of the Health Ombudsman (OHO). This is a service we all hope we will never need, but when the situation requires it, we can guide you through the process in all its stages until an outcome

is reached. Over the last three years we have developed a dedicated team that is second-to-none.

This is a service we all

hope we will never need, but when the situation requires it, we can guide you through the process.

We have expert legal counsel in-house who will work with you directly to manage the process and achieve the best possible outcome for you. The costs of managing the complaint yourself can be significant and it doesn’t always achieve the best possible result, so providing this expert

Therapeutic Use of Botulinum Toxin CPD course, delivered with Griffith University.

service to you has been, and always will be, a priority for us. We also offer personalised support through Health Fund Audits of your practice. You can find a summary of these services and contact our team on any of these issues by emailing assist@adaq.com.au

CPD

Providing quality CPD to members is a major priority for ADAQ. In 2019, we conducted a survey to find out what members want from ADAQ’s CPD, and in response to this survey we have a variety of new offerings such as therapeutic use of botulinum toxin, endodontics and implants and we will continue to add more exciting topics throughout the year. Be sure to keep an eye on adaq.org.au/ eventscalendar

Recently, CPD has suffered from restrictions in face-to-face and clinical events due to the COVID-19 pandemic, however, in late 2020 we were still able to run small group face-to-face clinical events. Many of our events have been provided by free webinars so that members in regional areas are able to attend. Providing better CPD to our regional members is a focus for us moving forward. As vaccinations against COVID-19 begin and the pandemic landscape of the future becomes clearer, ADAQ is poised to take advantage of new opportunities to run face-to-face and clinical events.

Last year we appointed a full-time CPD Coordinator in-house, and our CPD Committee is being replaced by a panel of specialists to advise on events in their areas of expertise to raise the quality and variety of events on offer. We aim to provide the highest quality and best value CPD and to ensure that we are increasingly contemporaneous and relevant, we will repeat the CPD survey this year to ensure that our offerings are tuned to meet your needs.

Prior to the end of 2020 we released the CPD Video Library: adaq.org.au/ videolibrary. This content is available 24/7 and is frequently updated with new topics, many of which offer you the opportunity to gain free CPD hours at times that work for you.

MENTORING PROGRAM

In 2020, ADAQ ran the pilot e-mentoring program. Due to an excellent uptake and

positive feedback it will return in 2021. This program provides an opportunity for experienced practitioners to give something important back to their profession and for early-career dentists to have personal, confidential mentoring from a senior member of the profession.

We hope to expand the program as time goes by. The feedback we have had from all participants has been excellent, and for mentees, it provides a solid basis for professional development.

ADAQ is poised to take any advantage of new opportunities to run face-to-face and clinical events.

PRACTICE SUPPORT SERVICES

We offer benefits to practices as well as to individual members. The Practice Advisory Services team, managed by long standing staff Member Sharyn Dunn is on hand to assist practices with accreditation documentation, infection control services, audits and staff training. Members can access these services at heavily discounted prices on adaq.org.au/ consultancy

ADAQ TRAINING

The ADAQ Registered Training Organisation (RTO) provides the best available and most highly recognised training programs for dental assistants. The coursework is designed by leading practicing dental professionals, with flexible training options to allow your trainees to decide how and where they study.

All the course materials are provided online, our experienced teaching staff support students throughout their studies, and ADAQ staff come to your practice to complete the workplace assessments. This makes it easy and achievable for staff in busy dental practices to gain

ADAQ Training teachers in action at the ADAQ Radiation Lab.

A student completing her radiology prac - part of Certificate IV in Dental Assisting from ADAQ Training.

qualifications without significant work interruptions.

We offer a full suite of training options, including Certificate III and Certificate IV in Dental Assisting with both Radiography and Oral Health specialisations. There are also some stand-alone units which your staff can undertake. For more information visit: adaq.org.au/training

podcasts, confidential self-check-ins as well as links to other Community services.

OTHER STATE BENEFITS

ADAQ Training provides the best available and most highly recognised training programs for dental assistants.

MEMBER ASSISTANCE PROGRAM

Dental practice can be stressful, and recently the COVID-19 pandemic has added new dimensions of stress to practitioners and practice owners. Wellness is an important focus for ADAQ, and we offer three free confidential counselling sessions each year through Workplace Wellness Australia to each of our members, as well as 24/7 access to our Wellness Portal, accessible via adaq.com.au/MAP. The portal aims to build confidence and self-reliance in proactively caring for oneself and others, and it features informative and practical well-being resources, topical fact sheets,

Regional sub-branches provide opportunities for Members to organise local CPD and to build your professional networks. Strong and vibrant subbranches are critical to a successful ADAQ and we will be working hard in coming months to integrate sub-branches more closely with ADAQ. Throughout the year we plan to attend a meeting from each sub-branch so we can bring you up to date on important developments as well as staying in touch with our regional members.

The ADAQ Dental Mirror comes out four times each year and is available both electronically and in print, depending on your preference. You would have seen how this publication is evolving to become ever more informative, timely and relevant.

Don’t forget our e-blasts which we use to update you on critically important information. During the height of the COVID-19 pandemic restrictions on practice, you would have been receiving these daily to keep you updated on matters affecting your practice. They continue as circumstances change, providing information as needed, and you would most recently have received them during the five-day lockdown of Greater Brisbane in January. We are committed to keeping you informed about things you need to know, and you can rely on ADAQ as a source of information that can be trusted.

ADA FEDERAL BENEFITS

Your ADAQ membership also provides membership of Federal ADA and all its resources and publications including

online webinars and podcasts.

ADA represents the Dental profession and influences policymakers nationally and locally through the state branches. ADA advocacy was important in ensuring that Dentists and practice staff will be among the first to receive the COVID-19 vaccine, and it was our advice that determined the various levels of practice restriction adopted by the Federal Government during the response to the COVID-19 pandemic. Both of these measures contribute significantly to community health nationally.

ADA advocacy was important in ensuring that Dentists and practice staff will be among the first to receive the COVID-19 vaccine

Publications of special importance include a subscription to the Australian Dental Journal, Therapeutic Guidelines, Infection Control Guidelines, the ADA News Bulletin and the Dental Graduate Handbook.

A critical service ADA provides is Pharma Advice, which draws on the expert advice of Dr Geraldine Moses, a highly experienced clinical pharmacist who is able to provide advice relating to medicines and drugs. You can find this service on the ADA website www.ada. org.au/pharmaadvice. Geraldine has

ADA FEDERAL MEMBERSHIP BENEFITS

had a long association with the Dental profession and will be well known to most of us as a reliable source of up-todate information and advice that would otherwise be time-consuming and difficult to access.

Members are listed on the ADA Find-aDentist tool which allows members of the public to search for an ADA Member dentist their local area. ada.org.au/Finda-Dentist

The ADA provides access to a comprehensive member-only HR Advisory service. The service provides advice about employment relations. Your rights as an employer, employee or contractor. Information such as award and pay guides, contracts and understanding entitlements. ada.org.au/MembershipServices/HR-Hub

ADA membership allows you to access member lifestyle benefits, including significant discounts on cars, electronics, health, fitness and beauty services. If you are in the market to buy a car, you should definitely look at this service. ada.rewardsplus.com.au

At present, 77% of registered dentists in Queensland have recognised that membership of ADAQ is important and indeed integral to their professional life. This is a hugely larger percentage than the membership of many of our sister organisations and suggests that members find our services compelling. We continue to work to increase and improve our offerings to you and provide ever greater value for your subscriptions. Thank you for your continued support, and please tell those among your colleagues who are not yet members what we can offer them. The more dentists who are members, the more representative we can be of Queensland dentists and cater to their interests.

We can support early-career dentists especially well through our mentoring program and give them great opportunities to learn and develop their professional networks, and we are working to ever better support dentists in the public sector. Used well, you should be able to realise value and savings from our offerings and services that more than offset your subscriptions each year, and we are constantly working to raise the value of your membership.

Together, we are a stronger and more effective Voice of Dentistry in Queensland and across the nation.

REFERENCE

1. Thomas, L. A., Tibble, H., Too, L. S., Hopcraft, M. S. and Bismark, M. M. 2018, Complaints about dental practitioners: an analysis of 6 years of complaints about dentists, dental prosthetists, oral health therapists, dental therapists and dental hygienists in Australia, Australian Dental Journal, vol. 63, no. 3, pp. 285-293

ADAQ MEMBERSHIP BENEFITS

Various ADAQ hands on CPD courses throughout the year

WHAT HAPPENS WHEN A ROMANTIC RELATIONSHIP WITH A PATIENT DOES NOT END WELL?

The implications of romantic involvement with patients.

Dr. Dentine was employed as a graduate dentist in 2013. Not long after commencing practice he saw a patient who presented for her six-monthly exam, scale and clean. The patient returned to see Dr. Dentine for several further restorative appointments over the few months and developed a romantic interest in Dr. Dentine.

Dr. Dentine noticed the patient’s interest in him and initiated a personal relationship with the patient by asking her out for dinner. This then eventually lead to the pair commencing an intimate relationship. This relationship continued in an on and off fashion for nearly 7 years. During this seven-year period, Dr. Dentine made no attempt to end the professional dental relationship with the patient and continued to provide the patient with dental care as required.

Dr. Dentine ended the intimate relationship with the patient in 2020. The breakup was not mutual.

Three months later, Dr. Dentine received an application filed by the Office of the Health Ombudsman in the Queensland Civil and Administrative Tribunal (QCAT). This was when he became aware that the patient had reported him for professional misconduct on the basis he had abused his position of power and trust as her treating dentist and used this to enter the intimate relationship with her.

Dr. Dentine contacted ADAQ for advice on how to respond to the QCAT application. Dr Dentine had professional indemnity insurance with ADAQ. ADAQ were able to advise Dr. Dentine on the QCAT process and invoked his professional indemnity insurance policy to formally respond. This enabled ADAQ to engage independent

legal representation for Dr. Dentine which was paid for by his professional indemnity insurer.

For additional support, Dr. Dentine was able to access the ADAQ Member Assistance Program (MAP) through the ADAQ which provides complimentary access to confidential counselling. Dr. Dentine was also connected by a senior ADAQ Peer Panel member who was able to provide peer mentoring and guidance on the boundary issues raised by QCAT.

PROFESSIONAL BOUNDARIES: WHAT YOU SHOULD KNOW

• The Dental Board Code of Conduct identifies potential conflicts, risks and complexities associated with providing care to those in a close relationship (3.14 Understanding boundaries).

• The Dental Board Code of Conduct describes accepted professional behaviour and what constitutes good practice. This includes “never using a professional position to establish or pursue a sexual, exploitative or otherwise inappropriate relationship with anybody under a Practitioner’s care” and “recognising that sexual and other personal relationships with people who have previously been a practitioner’s patient or client are usually inappropriate, depending on the extent of the professional relationship and the vulnerability of a previous patient or client”1

• Many health funds restrict benefits being paid for treatment provided to patients who have a personal relationship with the practitioner, such as parents, dependants and spouses.

• A complaint against you about a boundary violation is a very serious matter and can be very stressful.

ADAQ can assist you through this process. Your ADAQ professional indemnity insurance may also respond to cover your legal costs in responding to such legal proceedings.

Please contact ADAQ Member Advisory and Support Services on 07 3252 9866 if you require assistance with matters of this nature or need information regarding the extent of your coverage under your professional indemnity insurance.

REFERENCE

1. Dental Board of Australia 2014. Code of Conduct. p. 18

ABOUT THE AUTHOR

LARISSA ALDERTON

Larissa graduated with a Bachelor of Oral Health in Oral Health Therapy and Master of Health Management, with a focus on health care law and ethics and research. Larissa has worked in the dental profession since 2004 with experience in private practice, the University sector and the NHS in the United Kingdom. Her academic background and clinical experience puts her in an ideal position to assist ADAQ members with patient complaints, health fund audits, regulatory notification and insurance queries..

CONTRACTORS AND PAYROLL TAX: WHEN SHOULD YOU PAY?

Payroll tax is a tax on wages paid by a business/employer and is levied by the State Government.

Each State has a different threshold amount and payroll tax rates. In Queensland there is currently an annual threshold of $1.3 million and a payroll tax rate of 4.75% up to a total payroll of $6.5 million. The payroll tax is only payable on the wages that exceeds $1.3 million. The various State Payroll Tax Acts have different provisions and exemptions however from 2010 most of the Acts have been harmonised so that the main provisions are similar if not identical. The definition of wages includes payments made to contractors except where exemptions apply.

WHEN IS PAYROLL TAX PAYABLE?

Payroll tax is generally not payable on payments made to contractors who are genuinely offering their services to the public. This would normally be the case where the dental contractor is working at two or more surgeries and will generally be considered more aligned with being a locum than a permanent contractor/ employee. Payroll tax is payable on payments made to contractors if the work that they do generates dental income for the practice. Contracting dentists, hygienists and dental specialists all provide services which are part of the mainstream dental income generated by the practice. This is different to where a dental surgery engages a contractor to perform IT services or marketing services on an ongoing basis as neither of these services directly generates income for the dental practice. Payments to contractors cannot be avoided by having that person form themselves into a family company or family trust.

There are three main exemptions to the payroll tax contracting provisions being; the 180 day rule, the 90 day rule and no contract.

1. THE 180-DAY RULE

The 180 day rule excludes payments to

contractors where the services provided by that contractor are of a type ordinarily required by the business for less than 180 days. This would be the case where a dental surgery requires a dental surgeon two or three times per month to handle difficult cases/extractions etc.

2. THE 90-DAY RULE

The 90 day rule applies where the individual contracting dentist provides services at the surgery on less than 90 occasions (days) during the financial year. Irrespective of whether the contracting dentist works one hour per day or a full day, each day that they attend the surgery is counted and if the total is less than 90 days then no amount of the payment is included but should it exceed 90 days then all payments are included.

3. THE NO CONTRACT RULE

The no contract rule is where the surgery merely collects 100% of the fees generated on behalf of the (contracting) dentist and then charges a 60% service fee to cover the cost of services provided. Provided the (Service and Facility Agreement) contract is appropriate and the parties are dealing with each other at arms’ length then the surgery is not considered to have contracted the services of a dentist but rather the situation has been reversed such that the contractor is renting a chair from the business. Technically the surgery is not making a payment to the contractor that is subject to payroll tax but rather the contractor is making a payment (of the service fee) back to the surgery.

Compliance with the no contract rule for dentists has been brought into question by a recent case in the Victorian Court of Appeal against The Optical Superstore (December 2019). In that case the Optical Superstore had a Service and Facility Agreement (SFA) in place with the optometrist which is similar to the ones used by many dental practices around

the country. The main difference being that the SFA for dentists charges a flat percentage (usually 60%) for the service fee whereas the optometrists were charged a service fee that was “reverse” calculated so that they were paid an hourly rate plus a “location attendance” premium. The optometrists effective timesheet was signed off by the store manager indicating that they were more like a normal employee rather than an independent contractor.

The issues surrounding payroll tax and contractors is complex with the Courts and the State Revenue Office looking at a whole range of factors to determine whether exemptions are applicable to independent contractors and in particular whether the contract itself is merely a sham. If you have any concerns regarding your procedures for engaging dental contractors then you may contact the author for a no obligation free review of your circumstances.

ABOUT THE AUTHOR

ALBERT GIGL

Albert Gigl is the founder of MW Partners, Specialist Dental Accountants. Over 35 years as a Chartered Accountant, Albert has spent the last 15 years specialising in providing taxation advice for dentists. Contact Albert on 07 5554 6400 or albert@ mwpartners.com.au for an obligation free consultation.

INFECTION CONTROL BREACHES

How do we stop them?

When the sterilising reprocessing area is busy, staff performance can suffer. This is especially evident around holiday periods when practices are busy trying to fit patients in prior to breaks – and often with reduced staff. This, together with fatigue, inexperienced staff members, and longer working hours have resulted into more reportable breaches in the sterilising of reprocessable medical devices (RMDs), reports ADAQ’s Education and Practice Advisory (EPA) Team. The EPA team visit hundreds of Queensland practices a year delivering infection control training.

Getting sterile instruments ready for the next patient in a short amount of time is one of the challenges auxiliary staff often report. This is especially more challenging when there is no allocated sterilisation assistant. In this situation, the dental assistant is both assisting the practitioner and reprocessing instruments at the same time.

It has become apparent over the last few months that more stringent quality assurance checks and processes are needed to avoid unnecessary breaches when unloading. Taking the time to train or retrain your staff at regular intervals is paramount. The EPA team have received many calls from distressed dental staff who have inadvertently used unsterile instruments on a patient, and do not know how it happened.

We are here to support you and your practice to identify non-compliances in your sterilising processes. Our team can assist you in ensuring you have strong quality assurance checks in place that prevent infection control breaches.

COMMON STERILISING ERRORS CAN INCLUDE:

• Insufficient information recorded on the sterilising log sheet for staff to interpret the correct stage in

the autoclave loading or unloading process.

• Insufficient tracking of critical items and/or a record of information in the sterilising log sheet for compliance.

• Insufficient quality assurance checking when unloading the steriliser and placing contents on cooling racks.

Quality assurance measures minimise the risk of a healthcare-acquired infection in your practice. Physical and visual inspections must be made to determine the sterility of the cycle. This includes critical parameters for release, load dryness, packaging integrity and chemical indicator change according to the manufacturer’s interpretation guidelines.

Temperature at Holding Time and Pressure at Holding Time) and sign cycle record.

3. Check and sign/initial the printout to confirm that the sterilisation process has achieved the correct sterilisation parameters.

4. After opening the steriliser, carefully remove load.

5. Be careful: the trays in the steriliser are hot and may causes burns. Apply appropriate PPE. Pull out the tray containing the control pouch, check pouch, check to see if chemical indicator (Class 4, 5, 6) has changed colour according to manufacturer’s instructions.

6. A second person should verify the critical parameters for release and sign cycle record.

7. Visual check shall be performed for the following areas:

It has become apparent over the last few months that more stringent quality assurance checks and processes are needed

To minimise the risk of an instrument reprocessing breach, firm procedures on releasing steriliser cycles must be followed and information documented.

RELEASE OF A STERILISER CYCLE

1. Before opening the steriliser, remove and check the steriliser printout / display to confirm the sterilisation parameters have been met.

2. Check physical parameters / critical parameters for release (Holding Time,

• Inspect packaging integrity of RMDs,

• Chemical indicator (Class 1) on packaging have changed colour according to manufacturer’s instructions.

8. Load content shall be placed on cooling racks, in a designated cooling area,

Unloaded RMDs must not be placed on a solid surface. or be force cooled - condensate from vapor still within the pack may result.

RMDs that have been dropped, packaging integrity compromised, chemical indicators fail to change colour, incorrect sealing, or wet shall be considered nonconforming and must be subject to a full reprocess.

Releasing of the sterile load – NOTE: this is to be recorded after each load, NOT at the end of the day, week, or month. Failure to do so increases the risk of a breach being missed.

DOCUMENTATION CYCLE RECORDS

Maintain the following records for each load:

• Name and signature of operator

• Date

• Identification of the sterilizer

• Cycle or load number

• Load type

• Cycle number

• Specific contents of the load

• Results of load (Pass or Fail)

• Critical parameters (Time, Temperature and Pressure) that correspond with the data logger or print out (to be checked and recorded after each load)

• Batch control/tracking information must correspond with the data logger or print out (to be checked and recorded after each load). Ensure you follow critical parameters for release, load dryness, packaging integrity and chemical indicator change according to the manufacturer’s interpretation guidelines.

ADAQ PRACTICE ADVISORY SERVICES

GENERAL CONSULTATION

ADAQ consultants can visit your Practice to discuss and assist on a range of topics, including:

• Accreditation

• Documentation

• Infection Control

• Dental Assistant Training (CERT III and CERT IV)

INFECTION CONTROL SERVICES (PACKAGE)

• Review and develop infection control documents, customised for your Practice

• On-site visit to conduct Infection Control Health Check (approx. 2 hours)

• Provide staff training on Infection Control

• Provide additional Infection Control documentstemplates for risk register, sharps and immunisations

Qualified persons should perform a daily audit of the load for quality assurance purposes.

WHAT HAPPENS IF A BREACH OCCURS?

The following recall procedure must be swiftly actioned:

• Identify the load and contents

• Quarantine the recalled load

• Call ADAQ staff. They will guide you through the process and send you a detailed email with the CDC six step approach to infection control breaches with potential risk of bloodborne pathogen transmission. This is a free service as part of your Membership.

• Analyse the root cause, report, and notify the local public health unit (PHU) in your jurisdiction.

• To identify which Hospital and Health Service (HHS) your practice falls in, please visit the Queensland Health HHS maps

For further information on documentation such as recall procedures, cycler record sheet, how to load, how to release a load, visit adaq.org.au/factsheets

If you would like one of the ADAQ Education and Practice Advisory team members to visit your practice and undertake an Infection Control Health Check or Infection Control Training session, visit our website Practice Advisory Services. The range of consultancy programs are offered to both member and non-member practices.

ABOUT THE AUTHORS

ADAQ EDUCATION AND PRACTICE ADVISORY TEAM

The EPA team provides practices with support and consultancy services through a team of skilled professionals with extensive experience in infection control, practice accreditation, and practice management.

ACCREDITATION DOCUMENT DEVELOPMENT

• Review of current accreditation documents (if available)

• Customisation of accreditation templates for your Practice

• Dedicated advisor will liaise with your Practice to ensure accurate customisation of documents

• Assist practice with accreditation policies

PRACTICE HEALTH CHECK-UP

• On-site visit by ADAQ staff member (approx. 2 hours)

• Verbal discussion on findings with Dentist and Practice Manager

• Written report on findings and/or recommendations to Dentist and Practice Manager.

PURSUING EXCELLENCE IN DENTAL EDUCATION IN THE MIDDLE OF A PANDEMIC

ADA members awarded by University of Queensland Faculty of Health and Behavioural Sciences

Dentistry is a profession that relies heavily on developing fine motor skills and hand-eye coordination through scientifically structured preclinical activities in preparation for clinical practice. Fine motor skills are needed to be able to prepare and restore (“drill’n’fill”) decayed or broken teeth. An intimate knowledge of dental anatomy and acquired artistic hand skills are needed, with important differences in methods and materials.

COVID-19 PREVENTED ALL-IMPORTANT FACE-TO-FACE LEARNING AND ACCESS TO EQUIPMENT

The COVID-19 pandemic has and continues to present an array of unique challenges to students and educators alike in the field of dentistry. For many months in 2020, students throughout years 1-4 of the undergraduate dental curriculum at UQ were unable

to access laboratory facilities that allowed them to develop and improve their hand skills. Indeed, many students continue to be impacted by travel bans, either unable to return to Australia to continue their studies in a timely fashion, or unable to travel overseas to see friends and family.

This need for expensive and sophisticated equipment created a huge challenge for dental academics to find ways to keep students motivated, and develop and maintain their hand skills during this period. The University of Queensland (UQ) Faculty of Health and Behavioural Sciences (HaBS) 2020 Awards celebrates the exemplary work of academic and research staff in what has been an extraordinary time. ADAQ congratulates the following School of Dentistry staff and ADA members who were recently recognised in the HaBS Faculty Awards for their contributions to student learning.

EXCELLENCE IN CLINICAL AND PROFESSIONAL SKILLS EDUCATION (ECLIPSE) AWARD

DR BILAL EL MASOUD & DR MATTHEW NANGLE

Dr El Masoud and Dr Nangle are Senior Lecturers in the School of Dentistry at UQ. As program coordinators, together they oversea the academic activities of years 1-4 of the five-year undergraduate program.

HOME-DELIVERED PRECLINICAL PACKS ALLOW CONTINUED HAND SKILLS DEVELOPMENT

From the onset of the COVID pandemic they worked together to develop home-delivered preclinical packs aimed at allowing students to continue to develop hand skills as they relate to dental anatomy and restoration.

These packs included an array of items including hand instruments, restorative and waxing materials, suturing kits, head and neck anatomy worksheets, and of course, oral hygiene

products. Students could not prepare artificial teeth at home as this requires expensive portable dental units. Instead, cavities were prepared by Drs El Masoud and Nangle, and copies were made in dental stone. Students were then guided online to restore these cavities using wax or restorative materials and then carve/ shape them to the correct anatomical dimensions.

For years 3 and 4, a traditional waxing exercise (PK Thomas technique) was modified in a way that it could be performed using household items, and an instructional video was also prepared by dental technician, Eddie Gullotta. This technique usually relies on many hours of preclinical time and a great degree of staff commitment, however the provision of select preclinical instruments and video instructions, together with use of mostly kitchen utensils (e.g., tea lights and cutlery) meant that this task could now be performed offsite.

HOW IT HAS CHANGED DENTAL SCHOOL OFFSITE TASKS

Indeed, Drs El Masoud and Nangle have now embedded this approach and other offsite tasks into the undergraduate curriculum for future years. Respecting individual student circumstances, regardless of their location across the world, all students received these packs. This helped staff at the dental school stay emotionally connected with their students, and

helped motivate and inspire them in the development of their practical training despite the trialling circumstances.

As dental academics Drs El Masoud and Nangle learned from this experience that they needed to be both flexible and open to opportunities to help students learn at home before actually being able to attend the preclinic setting, and that a large number of activities could indeed be accomplished offsite. As a result of embedding this innovative teaching and learning approach into the undergraduate curriculum during 2020 and beyond, Drs El Masoud and Nangle jointly received the UQ HaBS Faculty ECliPSE Award.

COMMENDATION FOR SUBSTANTIVE CONTRIBUTIONS TO STUDENT LEARNING (CSCSL) AWARDS

DR SOBIA ZAFAR & DR JESSICA ZACHAR

Dr Zafar is a senior lecturer in the School of Dentistry at UQ. She has critically evaluated the outcomes from using novel approaches drawing on best practice in educational research and simulation research. The impact of these projects extends well beyond the borders of her own specialist discipline of paediatric dentistry, to engage many components of preclinical education.

AUGMENTED REALITY AND DENTAL ANATOMY

Dr Zafar brought together and led teams to pursue research in augmented reality for learning dental anatomy, using Virtual Reality as a novel educational tool in paediatric and restorative dentistry, using 3D scanning and digital dental software for objective evaluations of student preclinical work in crown preparations, and dental trauma simulation training using a novel 3D printed tooth model.

She has had a powerful influence in shaping the development of preclinical education using cutting edge methods that not only improve student learning and student engagement but also could also be deployed during the pandemic restrictions, giving outreach to students when the dental clinics of the School were closed.

This new direction is essential for providing a deep and enriching experience where dental students can learn outside of the clinical setting. Moreover, she has generated notable publications in the field of dental education. She continues to be a genuine standout in all her endeavours to engage students and enrich their learning opportunities.

Copy of models containing cavities prepared by Drs El Masoud and Nangle. made from dental stone

The delivered preclinical pack included items to help students develop hand skills remotely

Learning dental anatomy using ugmented reality

Using

INNOVATIVE ONLINE TEACHING METHODS

Dr Zachar received the CSCSL Award for her impact, strong connection and nurtured sense of community amongst dental students. Despite the challenges faced last year with the COVID-19 outbreak and its restrictions, Dr Zachar continuously engaged with her students and stimulated curiosity through innovative online pedagogical methods. Through the implementation of case-based online learning activities, Dr Zachar enhanced student critical thinking and reasoning skills to better prepare them for returning to the clinical environment as restrictions eased.

(L - R) Dr Zafar and Dr Zachar

virtual reality for paediatric and restorative dentistry

PROFESSIONAL STAFF TEAMWORK AWARD

UQ

UQ Rural Dental Clinic - St George Team

UQ RURAL DENTAL CLINIC, ST GEORGE TEAM

Dr Derek Lewis, Madeline Worboys, and Macy Coveney at the University of Qld Satellite Dental Clinic in St George are honoured to receive the Teamwork Award from the Faculty of Health and Behavioural Sciences. The St George clinic opened in 2017 with four dental surgeries and receives sixteen final year BDSc (Hons) students for placements from eight to twelve weeks throughout the year.

The clinic is staffed by two full-time dental assistants with four dentists supervising for various periods during the year. The clinic is attached to an indigenous health centre run by Goondir Health Services and provides comprehensive dental care to the local indigenous community as well as concession card holders.

The students find living and working in a remote town to be very rewarding, with many past students now working in similar remote communities and small regional centres around Australia. Staff soon learn to think on their feet to manage the myriad of issues that come from working 500 km from Brisbane, but that is where teamwork is critical to providing appropriate care to those in need.

UQ RURAL DENTAL CLINIC, DALBY TEAM

The University of Queensland School of Dentistry has partnered with Goondir Health Service in Dalby to provide a five-chair dental clinic with in-house digital x-ray equipment. These dental facilities provide residents of the Dalby, Darling Downs, and the Greater Western Downs region, with much needed options for their dental care.

The UQ Dalby Dental Clinic provides a valuable and much appreciated Oral Health Service to the communities in which

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it operates. The Dalby supervising team consisting of Clinic Coordinator Jade Utz, Dental Assistant Noël Duncan and Supervising Dentist Dr Graham Miller derive a considerable amount of satisfaction upon seeing the students on rotation amplify their skills and develop their confidences in the short time they spend here, and similarity, gain a lot of pride in the accolade’s patients are openly expressing with regards to the treatment delivered.

The appreciation of the symbiosis of the UQ School of Dentistry and the Goondir Health Services has not gone unnoticed in the community.

To have the efforts of the teams of dedicated personnel involved in the delivery of these services recognised with the Team Work Award we received from the University of Queensland recently, is indeed an honour, and has encouraged us to strive for even better outcomes.

Our appreciation is further extended to those who support the provision of Dental Services in Regional and remote communities.

- R) Dr Graham Miller, Ms Noel Duncan, and Ms Jade Utz

NEVER TRUST A CANINE! (EXCEPT THE ONES THAT CAN WAG THEIR TAILS!)

The developing dentition of a child is a dynamic entity subject to considerable individual variation, genetic and environmental influences.

It is important for dental practitioners to provide timely and methodical assessment to recognise significant deviations from normal and potential warning signs of dental anomalies.

When examining the dentition of children and adolescent patients, clinicians may ask themselves these common questions:

• Is this a normal presentation of the developing dentition? (or a deviation from normal?)

• Are there warning signs for the development of dental anomalies detectable in the mixed dentition?

• Do dental anomalies have a significant genetic aetiology?

• Do environmental factors make a significant difference?

• Are dental anomalies often found in combination? (e.g. palatally displaced maxillary canines, diminutive maxillary lateral incisors, congenitally missing teeth, ectopic eruption paths of premolars, infraocclusion of primary molars etc)

• When should the labial canine bulge be clinically evident for most children?

• Under what circumstances should a primary maxillary canine be removed?

• Does timely removal of a primary maxillary canine facilitate the eruption of an ectopic permanent maxillary canine?

• When is 3D radiology justified to assess an ectopic permanent maxillary canine?

• What are the potential risks associated with an ectopic permanent maxillary canine?

• Should I refer this case to an orthodontist?

SYNOPSIS

After the third permanent molars, the permanent maxillary canine is the second most commonly impacted tooth in the dentition. The maxillary permanent canine has a long eruption path and therefore eruption anomalies are relatively common.1

Timely diagnosis of an ectopically positioned or displaced maxillary canine is critically important and can provide the clinician with an opportunity to intercept this developing problem. If interceptive treatment is not instituted or fails to achieve successful eruption of the permanent maxillary canine, surgical exposure and subsequent orthodontic disimpaction is usually required to predictably align the affected tooth. This generally results in higher treatment costs and more complex treatment

plans. Unfortunately, there are several significant risks involved with disimpacting severely ectopic canine teeth and the risk of developing negative outcomes does increase with age.

CLINICAL CASE

A 9-year-old patient presents to assess the developing dentition (Image 1,2).

RELEVANT QUESTIONS REGARDING THE DIAGNOSIS AND CLINICAL MANAGEMENT OF THIS PATIENT:

• Which clinical assessments should be performed for this 9-year-old patient?

• Are there any concerns regarding the eruption path of any succedaneous permanent teeth?

• What is an appropriate review period for this patient?

RELEVANT QUESTIONS REGARDING THE POTENTIAL CLINICAL MANAGEMENT OF THIS PATIENT:

• Which clinical assessments should be performed for this same patient, now aged 10-years-old (i.e. 12 months later)?

• Have the eruption paths of the permanent maxillary canines changed significantly since the original panoramic film was taken 12 months previously?

• Are there any concerns regarding the eruption path of any other succedaneous permanent teeth?

• Should any particular clinical management strategy now be recommended?

• What is an appropriate review period for this patient?

For an overview of the contemporary management strategies for palatally displaced and impacted permanent maxillary canines please view the complete clinical article via this link. Two Continuing Professional Development (CPD) hours will also be credited upon completion of the associated quiz.

REFERENCES

1. Freer TJ, Ho CTC. Orthodontic Diagnostic Principles. 3rd Ed; Brisbane; University of Queensland Press 2009; Localised Anomalies; p243-274

2. Olive RJ. Orthodontic treatment of palatally impacted maxillary canines. Aust Orthod J. 2002;18:64-70

ABOUT THE AUTHOR

DESMOND ONG

Desmond Ong is currently a Clinical Academic in the Discipline of Orthodontics at the University of Queensland School of Dentistry, where he is involved in both the Undergraduate and Postgraduate Orthodontic Programs.

Image 1. Intra-oral clinical photographs of a 9-year-old patient.

Image 2. Panoramic radiograph.

Image 3. Panoramic radiograph taken 12 months later, patient now 10 years of age.

LET’S TALK ERGONOMICS

“This year I’m going to look after my body better, I’m going to be more aware of my posture.” Sound familiar? You resolve to sit better, to take more breaks, to do more stretching. Yet you seem to do a much better job at looking after other people’s health and comfort than your own.

My name is Libby Mason, and I used to be an oral health therapist. I am now a Pilates practitioner, and soon to be physiotherapist. Chronic back pain not only ended my career as a dental practitioner, it also had far reaching implications on my health and wellbeing.

The prevalence of musculoskeletal disorders and chronic pain amongst dental practitioners is well documented. Chances are if you don’t experience pain from your job, you work with someone who does. For many, working in the dental environment is incompatible with a pain-free body and optimal health and wellness.

So, what’s the answer? Can you just change your operator stool or join a yoga class? How do you prevent and better manage musculoskeletal disorders caused by working in the dental environment? Ergonomics tailored to the dental setting is the key.

Dental ergonomics seeks to reduce stress both in the mind and the body to lower the occupational hazards related to the practice of dentistry. It aims to create greater comfort for the dental practitioner by preventing and contributing to the management of musculoskeletal disorders¹. The associated reduction in pain helps enhance career satisfaction, productivity and general health and wellness².

Musculoskeletal disorders affect the joints, muscles, tendons, ligaments, cartilage, nerves and blood vessels3. Inflammation and degeneration of these structures results in poor alignment, muscular imbalances and ultimately pain. In the dental environment, the clinical setting proves a major occupational hazard for musculoskeletal disorders, when dental practitioners hold awkward postures for extended periods of time over many years4,5. The prevalence is high, with 64-93% of dental practitioners reporting work-related musculoskeletal disorders of some description6,5

Dental ergonomics seeks to reduce stress both in the mind and the body to lower the occupational hazards related to the practice of dentistry

I lived with chronic back pain as an oral health therapist. Most days it was all I could do to get home from work and get myself onto the floor. There was no capacity for anything other than work in my life, because my life was full of pain. My health and wellness was severely affected, my income was reduced by my inability to endure full time work, and I didn’t enjoy my job anymore. A physical therapist even told me that I would need to accept living with pain, to which I responded “no thanks”! Chronic pain affects everything in life… happiness, career satisfaction and longevity, income, social and family life, mental and physical health². Chronic pain is usually the catalyst that drives dental practitioners to seek out dental ergonomic solutions.

The many risk factors that contribute to musculoskeletal disorders amongst dental practitioners are well documented6 and provide a positive opportunity to target preventive and corrective measures. When considering biomechanical risk factors, we can look at the ergonomics of the clinical environment, as well as the practitioners’ body’s response to it. Most notably, a carefully designed surgery layout and utilisation of ergonomically designed equipment and technologies such as operator stools, instrument design, lighting and magnification, can improve practitioner positioning and access3,5. This in turn provides improved alignment of the practitioner’s body, which is more conducive with reducing tension in the soft tissues. This approach involves

attaining knowledge and awareness on ergonomics and a commitment to implement changes to habits in the clinical environment5

64-93% of dental practitioners report work-related musculoskeletal disorders of some description

Whilst learning to modify the clinical environment to improve posture and reduce strain on the practitioner’s body is crucial, addressing ergonomics alone is unlikely to be enough to prevent and manage musculoskeletal disorders1,7. Perfectly aligned posture is simply not always realistically achievable in the dental setting, and developing new habits requires considerable active commitment from the operator, who’s attention is most often on the patient and the task at hand3,8

Integral to better management of musculoskeletal disorders and pain is implementation of corrective exercises to counteract the stress placed on the body, and utilisation of physical therapies such as remedial massage and physiotherapy as required1,5 A commitment to appropriate stabilising, strengthening and stretching can counteract the daily ergonomic demands of the dental environment.

What’s most important is that the exercises are prescribed specifically for your body, by someone who understands your

body and also understands the ergonomic demands of your working environment6. Exercises that work for one are not necessarily going to work for another because our bodies are all unique in terms of underlying structural differences, movement patterns and postural habits.

If managing chronic pain brought about by the ergonomic demands of the dental environment is front of your mind as you start the year, you are on the right path. Arm yourself with knowledge and a commitment to modification of ergonomic habits, whilst engaging in appropriate corrective exercise, and ensure your body is able to provide you with a long, productive and satisfying career.

REFERENCES

1. Gupta, A., Ankola, A., & Hevval, M. (2013). Optimising human factors in dentistry. Dental Research Journal. 10(2), 254-259.

2. Topcu, S. Y. (2018). Relations among pain, pain beliefs, and psychological wellbeing in patients with chronic pain. Pain Management Nursing. 19(6). 637-644.

3. Shaik, A. R. (2015). Dental ergonomics: basic steps to enhance work efficiency. Archives of Medicine and Health Sciences. 3(1), 138-144.

4. Meisha, D. E., Alsharqawi, N. S., Samarah, A. A., & Al-Ghamdi M. Y. (2019). Prevalence of work-related musculoskeletal disorders and ergonomic practice among dentists in Jeddah, Saudi Arabia. Clinical, Cosmetic and Investigational Dentistry 11. 171-179.

5. Roll, S. C., Tung, K. D., Chang, H., Sehremelis, T. A., Fukumura, B. M., Randolph, S., & Forrest, J. L. (2019). Prevention and rehabilitation of musculoskeletal disorders in dental professionals: A systematic review. Journal of the American Dental Association. 150(6). 489-502.

6. Hayes, M. J., Smith, D. R., & Cockrell, D. (2010). An international review of musculoskeletal disorders in the dental hygiene profession. International Dental Journal. 60. 343-352.

7. Leinonen, J., Laitala, ML., Pirttilahti, J., Niskanen, L., Pesonen, P., & Anttonen, V. (2020). Live lectures and videos do not differ in relation to learning outcomes of dental ergonomics. Clinical and Experimental Dental Research. 6. 489-494.

8. Leggat, P. A., Kedjarune, U., & Smith, D. R. (2007). Occupational health problems in modern dentistry: A review. Industrial Health. 45. 611-621.

ABOUT THE AUTHOR

POSITION YOURSELF FOR SUCCESS!

Have you ever paused to consider the day-to-day stresses that working in a clinical environment places on your body – especially in the long term?

Join Libby to learn how to identify and reduce the risk factors for musculoskeletal disorders to ensure a long, productive and satisfying career.

Dental Ergonomics – a hands on and theoretical course designed for the whole dental team.

28 MAY 2021

12:30pm - 4:30pm

LIBBY MASON

Libby Mason is an accredited clinical educator with over 20 years experience in the dental profession. She developed an interest in dental practitioner musculoskeletal disorders during her own journey with chronic back pain, and now applies that understanding to helping dental practitioners overcome the imbalances caused by the ergonomic demands of the dental environment.

SCAN TO LEARN MORE

DATA SECURITY AND YOUR DENTAL PRACTICE

From malicious cyberattacks to privacy breaches: do you know your obligations?

The incidence of cybersecurity attacks in the health sector, including in the form of phishing, malicious software and ransomware, is on the rise. The Office of the Australian Information Commissioner’s (OAIC) notifiable data breach report, published 2020, identifies the health sector as the highest reporting sector of such breaches.¹

The notifiable data breach (NDB) scheme requires that you notify both affected individuals and the OAIC where a data breach is likely to result in serious harm to an individual whose personal information is involved.

inboxes is likely to also include financial and potentially sensitive information pertaining to your patients, staff and suppliers.

Whilst the majority of notifiable breaches in the healthcare sector are the result of malicious activity, human error also accounts for a not insignificant number of reportable breaches.

Recent data breach examples that have crossed our desks include:

• The inadvertent posting of patient information on Facebook

• Multiple access attempts from offshore locations with ransomware and malware ultimately being deposited on practice servers

• What data breaches are mandatorily reportable to the OAIC, and the reporting requirements

• The steps you need to take in terms of notifying affected individuals

• Tips and tricks to meet your obligations with the least amount of disruption to your practice.

Moray & Agnew, in conjunction with ADAQ, will be holding a seminar on the evening of Wednesday, 16 June 2021. Using real life examples we hope to equip you with necessary skills to manage this increasing challenge within the healthcare sector.

REFERENCES

1. https://www.oaic.gov.au/privacy/notifiable-databreaches/notifiable-data-breaches-statistics/notifiable-data-breaches-report-july-december-2019/

The health sector is the highest reporting sector of notifiable data beaches

It is evident from both OAIC and industry reports that the health sector is being targeted by cyber criminals. A medical or dental file does, after all, hold exactly the type of information that those trading in identity theft look for. A record containing an individual’s name, date of birth, next of kin, Medicare number, private health insurance number and the like can fetch up to $1,000 on the black market.

We have also noted an increasing incidence of email inboxes being targeted, and particularly those inboxes which contain handles such as ‘admin’, ‘accounts’, ‘payroll’ and ‘finance’. Apart from the impact on your dental business, the information harvested from such

• The deposit of encryption viruses rendering practice software inoperable, with associated ransom demands

• The deposit of malware, including Emotet and Trickbot, used to extract usernames, passwords and data

• The failure to ensure sanitisation of discarded computers and other electronic devices.

However the breach occurs, if serious harm is able to be averted by way of remedial action then the breach may not need to be reported.

The message then is that the key to effectively managing a data beach is to ensure that immediately after you identify the potential breach you seek assistance to assess, contain, remediate and, if required, notify.

To find out more about:

• How to best prepare your dental practice for a cybersecurity incident

• How to put in place, and implement, a data breach response plan

ABOUT THE AUTHORS

SEBASTIAN SIMON ASSOCIATE, BRISBANE

T 07 3225 5961

E ssimon@moray.com.au

CHRISTINE HOUSTON PARTNER, BRISBANE

T 07 3225 5966

E chouston@moray.com.au

Sebastian and Christine are members of Moray & Agnew’s Health Law team.

DATA SECURITY AND YOUR DENTAL PRACTICE

Learn how to prepare your dental practice for a cybersecurity incident. Delivered by the Moray & Agnew health law team.

- 8:30pm

SUPERCHARGED

Tapping into your superannuation fund could be a smart way to grow your practice right now—but there are a few factors to take into consideration first.

Most people think of superannuation as a future nest egg that you deposit money into every month, but don’t touch until retirement. That’s generally how a standard, set-and-forget super fund works. However, if you’re a dentist with a self-managed super fund (SMSF), there may be other flexible options available. Although an SMSF requires work to set up and manage, having one gives you greater control over your investments. You can also put it to work now, rather than waiting until you retire. Here’s how …

TAKING PRACTICE GROWTH TO THE NEXT LEVEL

A thriving practice takes hard work to engage and nurture a loyal patient base, while broadening the scope of what you offer.

Eventually, a successful practice will reach the point of growth and expansion. That may involve moving to bigger or more upmarket premises to see more patients, offer additional services, raise your fees, attract a different clientele or hire more staff.

Financing this growth is a common stumbling block. One strategy you may have heard about is borrowing through your SMSF. This may be a tax-effective way to purchase your own clinic or rooms, or invest in your practice.

BUYING PROPERTY WITH YOUR SMSF

It may make sense to buy your practice premises through your SMSF and lease the property back to your business.

Owning your own premises is an investment in yourself and your business. It also offers protection against potential rent increases or sale of the premises within the leasing period.

Given many dentists extensively stay in the same premises, buying the property via your SMSF could be a savvy longterm investment. The rental payments you make on the property go back into your SMSF. If these match the loan repayments, you’re essentially creating a savings plan and hopefully a good level of capital growth in the years to come.

THE BENEFITS

Investing in commercial property with your SMSF may have significant business advantages, such as:

• Potential tax advantages: Any rental income and capital gain on the sale of the property will only be taxed at the maximum tax rate of 15 per cent

• It may be easier to manage: Property may be simpler to manage than other more volatile investments

• It may free up other capital: Using your SMSF to buy your rooms may free up capital within your business for investment in other growth areas

• It may reduce your personal financial risk: Superannuation assets may be secure from creditors if you run into financial trouble, but expert advice on this is essential.

THE CONSIDERATIONS

SMSFs take some effort to set up and manage. You’ll be responsible for complying with super and tax laws, and managing your investments. You need to factor in whether you have the time and skills to do this alongside your other commitments, or if you need financial, tax or legal advice to help you.

Determining if commercial property ownership makes sense for your business goals is key, as is assessing your purchasing and borrowing capacity – it’s important to factor in all additional costs

nature only. We have not taken into account your objectives, financial

consider if it is appropriate for your situation. BOQ Specialist is not offering financial, tax or

such as valuations, conveyancing fees and stamp duty.

There may also be the risk of putting all your SMSF funds into commercial property instead of diversifying with other investments. It might be worth looking at ways to diversify your SMSF as well.

IN CONCLUSION

Purchasing commercial property or other assets using your SMSF requires careful consideration, planning and expert advice. There can be significant upsides too, however you’ll want to consider your own personal circumstances and financial position to determine if the benefits outweigh the risks for you. Using your super to finance business assets or grow your practice may make sense now, but you want to ensure that it will also leave you in a comfortable position come retirement.

It’s a good idea to talk through all your options with your accountant, lawyer and a financial adviser before making any decisions.

MEMBER SPOTLIGHT

LAURIE WALSH: ‘EVERYONE CAN CREATE CHANGE FOR GOOD’

This issue, the spotlight is on Emeritus Professor Laurence J. Walsh AO, who was awarded ADAQ Life Membership last November.

Prof Walsh receiving his Lifetime Member Award from 2019-20 ADAQ President Dr Norah Ayad.

Laurie’s friendly smile and easy-going demeanour are very familiar to many ADAQ members and dental assistant trainees. He has indeed been involved for many years with the association: as President, in various committees, teaching multiple CPD courses. Laurie also gained the unabashed admiration of ADAQ staff members: those who worked closely with him for years describe him as an extreme trivia buff (“never play against him” suggests Leigh, our CPD coordinator), with a passion for flying things and for old electrical equipment — collecting, repairing, or blowing them up.

We invited Prof. Walsh to share more about his journey as a dental professional and reflect with us on the ‘state of dentistry’, after such a difficult year for everyone.

Dentistry was the first career choice for young Laurie, who grew up in a sugar cane farm in Ayr, North Queensland. “For me it was all about helping people in a practical way, and getting to use a lot

of really neat equipment and materials while doing it”.

Strong positive role models were instrumental, though: his father’s dentist friends were his ‘accidental mentors’, instilling their strong moral fabric and altruistic values: “my orthodontist, Dr Charles Spry, Drs John Pulvirenti and Paul Brice: men of principle and honour who were admired greatly in their community.”

The support received from ADAQ, as a young dental student and after graduation, was also invaluable: “for us, [ADAQ] was a ‘dental home’, a place to soak up what was happening to the wider profession and to learn where dentistry fit into the bigger health system.”

Dental school has changed greatly since 1983; however, Laurie agrees that final year students and recent grads still need a ‘safe home”, where they can be mentored, rather than taught, and develop those all-important skills beyond the chairside’.

Professor Walsh continues to juggle admirably research work with his involvement with ADAQ CPD programs

Thanks to well-controlled restrictions and following ADAQ’s advice closely on infection control and patient screening, Queensland dentists (and their staff and patients) have largely been spared the worst of this pandemic. As vaccination programs are rolled out hopefully soon, Laurie is cautiously optimistic.

Meanwhile, Professor Walsh continues to juggle admirably research work with his involvement with ADAQ CPD programs, with a ‘laurie-inspiring’ commitment that is borne out of passion for giving back: “…support the next generations of dentists, make their professional lives better and more informed than ours. Everyone can create change for good” suggests Laurie; “be a force for good, not only in the lives of our patients, but also in society at large.”

Laurie continues to be involved today in shaping future Queensland dentists’ journey, by helping recent graduates develop sharper skills for managing risks and steering their careers in productive directions. Laurie looks forward to seeing the Association engage even better with the ‘digital natives’, talking their language while still remaining a safe professional home “to bring a balanced view on what is happening in dentistry”.

A Special Needs Dentistry specialist, Laurie has been involved in interesting research projects with UQ School of Dentistry, including innovative endodontic techniques using nanoparticles and laser.

From his research ‘driving seat’, he gives us an insight of what dentistry will look like in a post-digital, post-COVID Australia: “There has been some great research done at UQ into ‘pandemic proof’ approaches to teaching using simulation. We are already seeing some good things emerge from research into ways to make dentistry safer to deliver in pandemics. A lot of work is also going into how to make student clinics and student labs safe places to be, and how we can handle dental emergencies better.”

In fact, the dental profession can and should advocate more effectively on all oral health matters: advocacy is a main strategic directive for ADAQ Council now more than ever, as we prepare to make our voice heard in the right arenas. While the fundamental role of oral health in general wellbeing and the implications of oral disease for society and the economy are increasingly recognised, in 2020 Queensland access barriers remained stubbornly higher for those who need care the most.

“Queensland is well overdue for a rethink around eligibility for public care and prioritization of oral health services” Laurie also notes. “Today, with good data available on the distribution of oral conditions, we can target prevention and clinical care where it is most needed. All dentists should be advocating for a better access to dental services for the disadvantaged members of our community”.

Finally, if you need some inspiration for new year’s resolutions, at the top of Laurie’s ‘to do’ list for 2021, you’ll find: “grandparenting, a book writing project, and two neglected flight simulators badly in need of attention”.

Laurie has been involved in interesting research projects with the UQ School of Dentistry, including innovative endodontic techniques using nanoparticles and laser.

Reflecting on whether the whole dental profession’s landscape will change significantly post-COVID 19, Laurie sees the silverlining opportunities in the challenges ahead, for learning and clinical practice: “online education, webinars and teledentistry have gone from the outer rim to centre stage, and it will likely remain that way” he says. “We now have mask manufacturing and testing in Australia, so are less dependent on global supply chain issues. A spirit of self-sufficiency in key resources has emerged and likely persist beyond the pandemic”.

Prof Walsh as a young dentist

FINANCIAL LESSONS LEARNT DURING COVID-19

Every business was affected in some way from the outbreak of coronavirus. Here are the lessons learnt.

Every business was affected in some way from the outbreak of coronavirus. No dental business could have been fully prepared, but the early warning signs were there especially from the shortage of masks which started in late January 2020. Those dental surgeries that were better prepared and able to adapt to the changing circumstances were not affected as significantly. Here are the lessons learnt.

QUALITY DATA

When JobKeeper was announced everybody was scrambling to understand how the new rules would apply and whether they would be eligible for JobKeeper and any other Government initiatives. Dental surgeries who were in the best position were not those with the best accountants but the ones with the best bookkeepers/practice managers. Practices who were excellent at recordkeeping with very accurate details on income (gross patient fees), expenses and payroll records were able to quickly determine what stimulus payments they were eligible for.

TIMELY INFORMATION

Dental practices who had their affairs in order and were up-to-date with their tax lodgements also fared much better in the race to receive Government assistance. They were confident of meeting the lodgement requirements for JobKeeper and Cash Flow Boost as well as make future plans about how to cope with the effects of forced closure for an extended period of time. Having up-todate information allowed these practices

to negotiate loan repayment terms with their bank, and also rental relief with their landlord.

GOOD RELATIONSHIPS

During uncertain times it is important to be able to fall back on the solid foundation of good relationships with those businesses that you rely on. It is important to have a good relationship and open communications with your bank so that they can support you in times of need and help you grow when times are good. No one could have foreseen the impact that coronavirus would have on commercial property owners but generally it was necessary for both the tenant and the landlord to work out a way forward. The dentist is unable to operate without suitable premises and it is very difficult to move location whilst on the other hand the landlord does not want to lose a good tenant especially when they can see a large number of vacant shops in their area. Having a good relationship with your suppliers will allow you to source products (e.g. facemasks) on a timely basis at a fair price. Lastly, as most dentists now realise, the relationship with their accountant was particularly important during the past 12 months. A close relationship with your accountant means that they are the ones who are most knowledgeable about the intricacies of your business and are best able to guide you through difficult situations.

TAKE CONTROL

2020 was not the time to put your head in your hands and spend time worrying about the future. The future was uncertain

for everybody and those that can embrace change, not procrastinate and make decisions (right or wrong) were well placed to continue once the pandemic was over. Business owners must be assertive and gather sufficient information from available sources so that they are in the best position to take action.

THE FUTURE IS BRIGHT

Those dentists that can learn from the above, and also put these principles into place for everyday use will not only have survived but will thrive in the future. In summary, ensure that your practice financial data is accurate and prepared on a timely basis, that you continue to build good relationships with your advisers and suppliers and that you make informed decisions to drive the business forward.

ABOUT THE AUTHOR

ALBERT GIGL

Albert Gigl is the founder of MW Partners, Specialist Dental Accountants. Over 35 years as a Chartered Accountant, Albert has spent the last 15 years specialising in providing taxation advice for dentists. Contact Albert on 07) 5554 6400 or albert@ mwpartners.com.au for an obligation free consultation.

When times are (COVID) tough, it’s even more important to get the right professional advice

When times are (COVID) tough, it’s even more important to get the right professional advice

As a client of MW Partners, you will receive prompt expert attention from someone who knows your particular nancial circumstances

As a client of MW Partners, you will receive prompt expert attention from someone who knows your particular nancial circumstances

Because MW Partners specialises in the business side of running a dental practice, we can help you with:

Because MW Partners specialises in the business side of running a dental practice, we can help you with: 

FREE CHECK UP

 Management of JOBKEEPER claims & payroll

 Deferral of tax payments

 Stimulus Package & Government Grant Claims



 Assistance with loan refinance

 Taxation advice and preparation of tax returns (individual, company or trust)

 Accounting & Bookkeeping Services

 Advice on Dental Practice Sale or Purchase

 BENCHMARKING & Practice Improvement Reviews

Why not talk to us about the financial health of your practice?

Why not talk to us about the financial health of your practice?

Or perhaps now is the perfect time for a benchmarking analysis?

Or perhaps now is the perfect time for a benchmarking analysis?

To arrange your free consultation, please call Albert Gigl on 07 5554 6400 or email albert@mwpartners.com.au

www.mwpartners.com.au

To arrange your free consultation, please call Albert Gigl on 07 5554 6400 or email albert@mwpartners.com.au

www.mwpartners.com.au

MW Partners - Specialist Dental Accountants

46 Volante Crescent, Mermaid Waters Qld 4218 (by appointment only)

Head O ce: Level 1, 99 Bay Street, Brighton Vic 3186

SILKWORMS AND SUPPURATION: THE UNEVEN PATH TO MODERN INFECTION CONTROL (PART 1)

Today, effective infection control (IC) is central to dental practice and pretty much standardised; but how did it all happen?

We’re all familiar with the role played by celebrated science giants such as Pasteur, Lister and Koch, whose discoveries marked the ‘Bacteriological Era’ and form the basis of modern IC. However, the path has been long and convoluted with good tracks covered for centuries, then revisited. Early pioneers and their pivotal discoveries were often forgotten, as the scientific method progressed our understanding of why infections happen.

THE SEEDS OF DISEASE

In antiquity, Aristotle and Varro speculated about small particles or invisible animals entering the body to cause disease, an idea that recurs several times in history. Specific to dentistry, the ‘worm’ theory appears curiously in very different cultures.

It persists for centuries as explanation for toothache and cavities.

Whatever the perceived origin of infection, people instinctively knew what worked, but not why. For instance, through antiquity and Middle Ages, authorities regularly put in place procedures during outbreaks which we still recognise as effective today: the Venetians’ quarantine system; sterilisation in extreme heat, with cauterisation of wounds, burning of diseased carcasses, cadavers, and dwellings, and social distancing. The last involved evacuating crowded areas to the country to avoid plagues, the entombment of lepers in lazarettos and ringing bells at their passage in medieval Europe.

PLAGUE DOCTORS

Image 1. ‘A Plague Doctor’ was the frontespice

a Treatise on Plague in 1721. The description translates as: robe worn by doctors and all those who visit the ill. Made of Morocco [red] leather, the mask has eyes of crystal and a long nose filled with perfumes.

Whatever the perceived origin of infection, people instinctively knew what worked, but not why

Image 2. The last

outbreak

Personal protective equipment also existed specifically for those who had to be in contact with the infected: the image of the plague doctor’s garment has resurfaced recently in people’s consciousness, with its ‘eyes of crystal and the nose filled of perfumes’.

Queensland was recorded in 1922, only 100 years ago (source: State Library of Queensland: https://www.slq. qld.gov.au/blog/black-death-queensland ).

In Renaissance Europe, Girolamo Fracastoro, surgeon, astronomer, and poet, usually remembered for identifying syphilis, devised an innovative theory of contagion. His treatise De Contagione (1565) explained that invisible living spores cause plague and typhus. These ‘seeds of disease’ attack through

of

plague

in

infected objects and people, and linger in the air awaiting new hosts. As doctor in charge, Fracastoro managed to move the entire Council of Trent to Bologna as a measure to escape the outbreak of typhus.

GIROLAMO FRACASTORO

Image 3. A striking Portrait of Girolamo Fracastoro, reminding you to wear your PPE or else! About 1528, National Gallery, London, attributed to Titian. Courtesy National Gallery.

Fracastoro’s theories explained why those unpopular but necessary pandemic measures worked. However, his intuitions were forgotten for three centuries, until microscopes proved him right. As Vivian Nutton posited, Fracastoro’s break-through was “a seed that fell among the thorns” of Galenism (1990).

BAD SMELLS AND LAUDABLE PUS

The miasmatic theory (bad air or smells) remained dominant in the causation of infection. The 1780 medical manual, Le Medecine Domestique, instructs doctors to: plug his nose with tobacco, avoid inhaling the patient’s ‘bad’ breath, and wash his clothes and hands after his visits. If one substitutes ‘miasm’ with ‘germs’ or ‘viruses’, much of the advice remains sound!

As for dentistry, preventing infection was hardly a concern for blacksmiths or early barber-surgeons and charlatans, who did their extractions or magic then left town, literally. London’s Weekly Bill of Mortality, in XVII century London, reported about 100 people a week died from dental complications. In 1665, 10% of all deaths, excluding those who died of the Great Plague, were due to teeth problems.

OUT OF [INFECTION] CONTROL DENTISTRY

Infection control was non-existent as dentistry iconography reminds us. It seems a cheerful monkey was a must, though (Image 4 & 5). (Source: Proskauer & Witt, Bildgeschichte der Zahnheilkunde, 1962)

Image

Until the XIX century, surgeons viewed infection as a rather inevitable, if not normal, stage of healing. Indeed, the presence of Galen’s laudable pus in a wound was erroneously seen as a welcome sign of absence of necrosis (The mythos of laudable pus, Freiberg 2017).

Despite pioneer researchers identifying the true mechanisms of spread, purposeful IC measures were not routinely applied in surgery, let alone in dentistry, until the late 1800s.

In 1847, Ignaz Semmelweis was heavily ostracised to the point of being interned as insane for suggesting that doctors’ moving from mortuaries to maternity wards without changing clothes or washing hands caused post-partum infections. This was an era when surgeons operated in day suits and a blood-encrusted apron confirmed their prestige.

Image 4. The tooth drawer – J.Victors – painting, Gemaelde Collection, Cologne. 1600s

5. The tooth breaker – J.Kaendler - Meissen porcelain group – 1700s

SILKWORMS

Ten years before Louis Pasteur’s seminal contributions, a poorly acknowledged Italian entomologist appears and makes his mark in the IC story: Agostino Bassi demonstrated that microorganisms cause and spread many diseases. In his research spanning 1807-1835, Bassi discovered a ‘parasitic fungus’ caused muscardine, a silkworm disease; he then successfully isolated the fungus and used it to infect a healthy worm. This research saved the Italian silk industry at the time, with the introduction of sound disinfection and isolation of infected caterpillars.

However, despite having effectively formulated the ‘germ theory’ of contagion, Bassi’s contribution was overshadowed by the subsequent experiments on broth by fellow Italian Lazzaro Spallanzani and Pasteur (who reportedly kept Bassi’s portrait on his office’s wall), and later Robert Koch’s studies.

Either way, bacteriology was finally born. These scientists’ work spurred further advances in microbiology and pathology and ultimately ushered a revolution in surgical practices and, eventually, dentistry.

At first, germ theory principles were applied to hospital settings involving surgical practices with high mortality rates. Various antiseptic methods were devised, at times quite complex, such as the one developed by Joseph Lister and Championnière.

Lister’s method was based on the use of antiseptic (carbolic acid) on wounds and dressings, and later extended to aerosols spraying and equipment cleaning. The Scottish surgeon had been the first in connecting the findings of Pasteur to wound infections: germs would get into the area, propagate, and ferment inside it, much the same way as in beer and milk. His method ensured all germs in and around the wound would be killed, thus reducing the risk of sepsis. Other methods included the use of formalin vapours (Schering’s apparatus)

Lister’s method coexisted and clashed with other stances, at the time considered separate, of sanitary reform (e.g., Florence Nightingale’s hospital design) and just plain cleanliness needs (e.g., Spencer Wells, who reportedly operated outdoors, asked attendees to bathe first and not visit hospitals or morgues for eight days prior): in short, the need to avoid germs first, asepsis. Eventually, these practices were recognised as complementary and combined as ‘infection control’ procedures (Schlich).

EARLY STERILISERS

Image 8. Surgical

the various steam sterilising equipment popular at the time, including a ‘family-size’ one useful for ‘sterilising milk’. Catalogue of surgical instruments, Source: archive.org

Image 6. Lister’s carbolic steam spray apparatus. Hunterian Museum, Glasgow. Source: WikiCommons.

Image 7. Use of the Lister carbolic spray. Antiseptic surgery, 1882. Wellcome Museum. Source: WikiCommons

supplies catalogues of the era show

As for PPE, Ernst von Bergmann was one of the first surgeons to use sterilised white gowns. In Poland, Mikulicz-Radecki invented the surgical mask, originally to prevent infection from the surgeon’s mouth, and even used cotton gloves (Strasser & Schlich). An American surgeon is credited for introducing rubber gloves, commissioned to Goodyear Rubber Co for his theatre nurses (Nield).

Ten years before Louis Pasteur’s seminal contributions, a poorly acknowledged Italian entomologist appears makes his mark in the IC story: Agostino Bassi.

SS WHITE STERILISATION EQUIPMENT

archives).

The harshness of these chemicals soon became an issue, however: carbolic acid (phenol) and formaldehyde are strong poisons. Hence, the growing popularity of steam sterilisers over nebulising apparatus. (SS White catalogues, from ADAQ’s archives).

These new measures associated with germ theory eventually trickled down to dentistry. In 1876, Ashley Barrett applied antisepsis to endodontic practice, using carbolic acid in the preparation prior to obturation.

Many submissions in Dental Cosmos, throughout the 1890s confirm the steady progress in developing sterilising techniques that fit the environment and timelines of dentistry (Nield). These features attest the growing collective realisation that the mouth is a primary source of infection transmission, a fact that put the fledgling dental profession at a much higher risk than previously thought.

To be continued in the Winter Issue (released June 2021).

REFERENCES

1. Freiberg J. A. (2017). The mythos of laudable pus along with an explanation for its origin. Journal of Community Hospital Internal Medicine Perspectives, 7(3), 196–198. https://doi.org/10.1080/20009666.2017.1343077

2. Nield, H. A short history of infection control in dentistry. BDJ Team 7, 12–15 (2020). https://doi.org/10.1038/s41407-020-0402-1

3. Nutton, V. (1990). The Reception of Fracastoro’s Theory of Contagion: The Seed That Fell among Thorns? Osiris, 6, 196-234. Retrieved January 31, 2021, from http://www.jstor.org/stable/301787

4. Redaelli, P., Visocchi, V. Agostino Bassi precursor of comparative mycopathology. Mycopathologia 2, 37–42 (1940). https://doi.org/10.1007/BF00450241

5. Strasser B. &Schlich T. (2020). A history of the medical mask and the rise of throwaway culture. Lancet (London, England), 396(10243), 19-20. https://www. thelancet.com/journals/lancet/article/PIIS0140-6736(20)31207-1/fulltext

6. Schlich T. (2015). Why were surgical gloves not used earlier?. Lancet (London, England), 386(10000), 1234–1235. https://doi.org/10.1016/S0140-6736(15)00271-8

ALEXANDRA BOI

ADAQ Dental History Preservation Committee

Image 9. This Seram electric syringe steriliser released to the market in the 1930s. The syringes were placed in the two perforated metal cylinders and sterilised with hot air. Ampoules could also be warmed before use by placing them in the metal box with a hinged lid in front of the sterilising cylinders. The small switch panel at the front is fitted with separate controls for independent operation of all the components of the device. (From the dental history calendars by WO Funk, ADAQ collection)

Image 10. Sterilising equipment doesn’t appear in dentistry catalogues: SS White catalogues of the 1930s do not advertise anything relating to sterilisation, apart from camphorated phenol, which is purported to be non-toxic (from ADAQ’s

MEMBER SPOTLIGHT DENTAL PHOBIA TO LOVING TOOTH

Dr Julia Moldavtsev has combined her love of all things dentistry with her creativity and philanthropy to begin the Loving Tooth Co.

training in sleep dentistry, which I have found to be an incredible field that allows us to make a truly life-changing difference.

YOU ALSO WORK WITH THE ROYAL FLYING DOCTOR SERVICE, WHY DID YOU DECIDE TO DO THIS?

The dental division of the Royal Flying Doctor Service in Queensland travels all over the country to areas where access to dentistry is either difficult or cost-prohibitive for many. These amazing dentists and assistants work long days to deliver free dental care in the communities. I have worked in a wonderful dental practice in Brisbane for the last 6 years and applied to work with the RFDS 3 years ago. Having grown up with poor access to quality dental care, it has been my small way of giving back to people in the same situation. I also love country Queensland and this has given me the opportunity to go on some amazing adventures with great people.

AS A RESULT OF YOUR WORK WITH RFDS YOU DECIDED TO START A JEWELLERY BUSINESS, TELL US ABOUT HOW YOU DECIDED TO START THE BUSINESS?

frontier of medical and dental innovation and I had numerous dental issues. The dentists did their best of course, but the lack of resources (and anaesthetic) made for childhood dental experiences that caused me to develop a significant phobia! I surprised everyone when I decided to pursue dentistry, which I studied at the University of Adelaide. This meant addressing a phobia in a very unique way, but it gave me the opportunity to create better experiences for those around me than what I had.

WHAT AREA OF DENTISTRY ARE YOU PARTICULARLY INTERESTED IN?

My love for dentistry is rooted entirely in the relationships I have with my patients. Over the last 10 years I have formed so many amazing bonds with the people who have placed their trust in me. I am constantly taken aback by how grateful, gracious, kind and open people are and I am so honoured to be able to help them in my small, dental way. I really enjoy restorative and prosthetic work for the finesse, detail and teamwork involved. I also love the precision of surgical work and the satisfaction of a surgical extraction well done. Over the last 5 years I have done further

Outside of (and within) dentistry I love to be creative. Loving Tooth Co came about as I was looking for a creative outlet, but I wanted it to have a purpose and to align with my passions and values. It has been an incredible journey and I have received such an outpouring of love and support from the dental community. I love that this initiative allows me to create something unique and quirky, has broadened my horizons and continues to support the amazing RFDS QLD.

DO YOU HAVE ANY PLANS IN THE FUTURE TO EXPAND THE PRODUCTS ON OFFER?

Initially I began with just the little tooth earring studs. The support I received from the dental community (and from people who just love quirky, tooth-inspired things!) allowed and encouraged me to keep going and develop the pins and necklaces, which are now available. As time goes on I would love to continue expanding the products and range.

My goal is to simply keep being creative, keep making adorable pieces and continue to raise as much awareness of and funds for the RFDS as I can.

If you would love a beautiful tooth-inspired piece of your own and to support this wonderful initiative you can visit www. lovingtooth.co. You can also find Loving Tooth Co on Facebook or Instagram and follow the journey. Your love and support are very appreciated!

ALBANY DENTAL CENTRE ALBANY, WESTERN AUSTRALIA

• Generous Remuneration Package

• Immediate start

We are seeking a qualified and enthusiastic dentist to join our friendly team in Albany. Albany is a scenic coastal city located 400kms south-east of Perth with a population of approximately 31,500.

Skills & experience

• Bachelors in Dentistry (experience preferred)

• Current AHPRA registration, no restrictions

• Professional Indemnity Insurance

• Confident, professional and compassionate patient care

FOR MORE INFORMATION

Please submit your applications to: practice2@albanydentalcentre.com.au.

Should you have any questions, please call Janine on (08) 98411238

SHINE ORTHODONTICS BRISBANE & LOGAN REGIONS

Bruce Trusler, Tony Shields, Brendan Fitzpatrick and Julie Creagh are very pleased to announce that Dr Prem Patel has joined the team at Shine Orthodontics. Prem obtained his BDSc in 2007. After 7 years of general practice Prem relocated to Adelaide where he completed his Doctorate of Clinical Dentistry degree in the speciality of orthodontics.

Prem is a Member of the Royal College of Surgeons of Edinburgh and a Fellow of the Royal Australasian College of Dental Surgeons, the ADA and ASO and is keen to share his knowledge and enthusiasm for orthodontics with our practice and with our patients. Prem will be available for appointments at our City practice as well as the branches at Underwood, Springfield Lakes, Kenmore, Caboolture, Strathpine and North Lakes.

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