ADAQ Dental Mirror - Spring 2023

RURAL DENTISTRY SPOTLIGHT

CQUNIVERSITY'S ORAL HEALTH

OUTREACH PROGRAM

REMINISCENCES OF COUNTRY DENTISTRY

OUR REGIONAL DENTAL COMMUNITIES

EDITOR

Dr Kelly Hennessy

EDITORIAL TEAM

Dr Jay Hsing

Dr Gary Smith

Ms Lisa Rusten

Ms Melissa Kruger

PRODUCTION

Published by the Australian Dental Association (Queensland Branch)

CONTACT

26-28 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

ADVERTISING KIT

Information on advertising, deadlines and artwork specifications are available in the ADAQ Advertising Kit: adaq.org.au/advertising

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 Kevin Ang (Peninsula)

Assoc Prof Alex Forrest (Moreton)

Dr Jayarna Hartland (Gold Coast)

Dr Peter Jorgensen (Sunshine Coast)

FEDERAL COUNCILLORS

Dr Kaye Kendall (Moreton)

Dr Rachel Milford (Western)

Mr Andrew Waltho (Skills-based)

Dr Keith Willis (Moreton)

Dr Norah Ayad Dr Martin Webb

IMMEDIATE PAST PRESIDENT

Dr Matthew Nangle

ADAQ SUB-BRANCHES

Bundaberg

Dr Paul Dever

Ipswich

Dr Andrew Wong

Kingaroy

Dr Man Chun (Simon) Lee

ADAQ COMMITTEES

Policy, Advocacy and Advisory Committee Chair

Convener: Dr Norah Ayad

Awards and Honours Committee

Convener: Dr Jay Hsing

Mackay

Dr Peter Monckton

Sunshine Coast

Dr Peter Jorgensen

Rockhampton

Dr Kelly Hennessy

Recent Graduates and Students Committee

Toowoomba

Dr Phoebe Fernando

Gold Coast

Dr Norah Ayad

Cairns

Dr Brian James

Convener: Dr Phillip Nguyen

Volunteering in Dentistry Committee

Convener: Dr Jay Hsing

FROM THE PRESIDENT

DR JAY HSING

In the 1980s, Texas had a massive littering problem on their roads. The Department of Transportation came up with slogans like 'Keep Texas Beautiful'. It did nothing. Then they hired a man by the name of Tim McClure to come up with a solution.

WE ARE IN THIS TOGETHER

One day, McClure was on a walk and saw rubbish everywhere which reminded him of his mother scolding him to clean up the mess in his room when he was a boy. The word 'mess' led him to the now famous slogan: 'Don’t mess with Texas.'

Along with the catchy slogan, the Department enlisted popular musicians, sportspeople and other public figures to sell the message. Soon after, the littering reduced dramatically. Instead of telling people what to do, it invoked a feeling of state pride and inclusion. Texans, collectively, took ownership of their state. The slogan is still used to this day.

Likewise, I hope we all see our association not as an entity separate to us but rather as a collective of each of us. The point is we are in this together. By taking ownership individually, we can achieve great things together.

I truly appreciate the time and dedication of so many people who volunteer their time to make things better for the profession and for all of us. As Theodore Roosevelt pointed out, we ought to praise those who are out there striving valiantly, recognising that there can be no effort without error or shortcoming and those who wholeheartedly dedicate themselves to a worthy cause deserve credit.

In recent times, it’s also been great to see the increased engagement from individual members, Sub-Branches, ADAQaffiliated study clubs and specialty associations with our professional association. There are initiatives coming soon for public sector and regional dentists that I hope will continue to build on this momentum.

ADAQ VICE PRESIDENTS

For those that aren’t already aware, our Senior Vice President is Dr Kelly Hennessy from Rockhampton, and our Junior Vice President is Dr Paul Dever from Bundaberg. As I alluded to above and in previous communications, success is built on the back of teamwork. I have lent on them, and others, for counsel. I have greatly appreciated their words of wisdom.

Given that this issue of the Dental Mirror spotlights ADAQ’s initiatives for regional members, it presents an ideal occasion to hear directly from our Vice Presidents who are both from regional Queensland. I hope you enjoy reading about their experience and insights as much as I did.

FINAL THOUGHTS

As your President, I hope to inspire each and every one of you to contribute to our association, and to the profession for the collective good. It can be as simple as encouraging a colleague to become part of our professional body to support the work that it does or sending in a recommendation. Small acts add up.

Thank you to all the members who have reached out to me via email and social media to offer words of support. I also appreciate members coming up to speak with me at various dental meetings.

I WOULD LOVE TO HEAR FROM YOU TOO, SCAN TO CONTACT

DR KELLY HENNESSY SENIOR VICE PRESIDENT

k:

kelly.hennessy@adaq.com.au

I have spent the majority of my life and career in regional areas, mostly in Queensland, and also in Victoria. Most of my career I have been a public health/defence force/ university employee. I have never been a dental practice owner.

I wasn’t an ADA member from the start. I thought as a Defence Force, then public health dentist, that I didn’t need to be. Then I realised I could get ADA membership AND Professional Indemnity insurance for the same price as indemnity insurance alone with other insurers! Not long after, I used that benefit when I had a patient complaint. I’m fortunate in that I’ve only had a couple in my career. But both times the ADAQ Assist Team have been excellent in assisting me to manage those concerns. Both were resolved without any legal action being taken, and the Assist Team assisted with drafting of letters and meetings with patients as needed.

I have often used the resources that ADAQ provides regarding compliance requirements. I have taken the journey, along with every other oral health professional, to navigate COVID-19, the TGA changes and more recently the Payroll Tax concerns. ADAQ has been with me every step of the way, providing timely advice to my inbox to help me navigate these complex scenarios. If you haven’t already, take a look at the excellent Infection Control templates and resources available on the ADAQ website. These are useful for everyone, as we all have a regulatory duty to ensure safe practices in our workplace.

The Member Assistance Program (MAP) and Workplace Wellness Portal offer a variety of resources to assist with maintaining our mental health. I enjoy listening to the Podcasts, one of my favourite ones is “Value Based Living”. There is also a fantastic Weekly Mental Health Check-in Worksheet which I have used. In the stresses of practice (and life!) today, I think these resources are so valuable, especially when they’re all available and easy to access in the one place. You can also access up to three confidential counselling sessions per year!

The primary reason I joined ADAQ Council was to represent regional areas (all of them, not just Central Queensland), as I think we have different challenges and opportunities to SEQ dwellers. I’m also passionate about engaging nonpractice owners and public health dentists. I’m pleased to let you know that ADAQ is listening to regional members, and that there are some exciting programs in the pipeline, but I don’t wish to reveal these prematurely!

DR PAUL DEVER JUNIOR VICE PRESIDENT

k:

paul.dever@adaq.com.au

The high level of support that ADAQ has offered me over my 18 years of being a member has been varied and very much appreciated. As a recent graduate, the Assist Team helped reassure and guide me through my first patient complaint. The support of the Assist Team made the whole process much less daunting and fortunately the complaint was resolved successfully. As a young practitioner, it was comforting to know that I had someone in my corner looking out for me.

Unfortunately, I am too old to be able to say that I have taken advantage of an ADAQ mentoring program as a mentee. However, I am excited to now be a part of this program in a mentor role. I can remember as a recent graduate, my mind was being torn in a thousand directions – am I any good at endo? Should I consider specialist training? Will I get faster at Class II restorations? As an ‘oldie’ I am now enjoying answering these types of questions and helping my current mentee navigate her first six months in general practice. There is a lot to be gained on both sides of the mentor/mentee relationship.

One of the boring, but essential services that I have always valued is the combined Professional Indemnity and Public Liability Insurance bundled with my ADAQ annual subscription fees. I have always found the policies offered through ADAQ to be great value for money.

I am guilty of not having utilised any ADAQ CPD in the past. Looking at the line-up of speakers and topics that the CPD Team is now offering, highlights my missed opportunities. I encourage all our members to visit the ADAQ CPD website and support your organisation by accessing the most up to date, comprehensive CPD courses on offer.

Now, as a practice owner, I find myself tapping into a whole other level of services. In the past seven years of owning our practices we have called on ADAQ for assistance with HR/staffing issues, infection control advice and training of our dental assistants. ADAQ has also provided guidance through contemporary issues that have arisen such as COVID-19, TGA changes to custom-made therapeutic devices and payroll tax advice. The information that ADAQ provided was always timely, practical, and well researched.

As a member of ADAQ council, I am excited and inspired to expand our members’ services and offer even more ‘bang for our buck’!

REOCCURRING PATIENT COMPLAINTS

BY ELEANOR GILMORE & RIANNA CASTLE-SMITH | ADAQ COMPLIANCE AND ADVISORY SERVICES

The ADAQ Compliance and Advisory Services team regularly assist with patient complaints, from both ADAQ members and patients themselves.

There is significant diversity with regard to the nature of the patient complaints that we receive, however, there are a number of complaints that are more common than others. We have outlined in three case studies reoccurring issues to help ADAQ members understand and manage patient complaints.

CASE STUDY #1 | COMMUNICATION & CONSENT

Patient B saw Dr File for root canal treatment. Patient B was an elderly patient from China with hearing difficulties and spoke very limited English. Patient B was usually accompanied by his daughter on their visits to the dentist to see Dr File, so that she could translate for him. However, on this occasion, the elderly man arrived at the clinic alone without his daughter to translate for him. Dr File assumed that his dental assistant in the surgery, who spoke basic Mandarin, would be sufficient to translate for the appointment and proceeded without the daughter present. Dr File advised briefly of the risks of the root canal procedure to make it easier for his DA to translate this to the patient. Patient B appeared to understand and agree to the treatment,

to complete it and for costs he would incur with the endodontist. The OHO referred the matter to Ahpra for further investigation given the nature of the complaint.

ISSUES IDENTIFIED BY AHPRA

Ahpra sent Dr File details of the complaint made by Patient B and requested he provide a response. Following review of the provided information and clinical records, Ahpra found Dr File failed to gain informed consent and failed to keep sufficient clinical records. Specifically, Ahpra noted:

´ The dentist proceeded with treatment without assessing whether a suitable and proper translator/family member was needed

´ The dentist failed to check that the patient understood the information received and rushed when providing information

As a result of these findings, Ahpra decided to impose conditions on Dr File's registration that included:

9 4 hours of formal education on communication with culturally and linguistically diverse patients

9 4 hours of formal education on informed consent communication with patients

9 The requirement to provide a reflective report to Ahpra following completion of the education

9 The conditions be listed on the public Ahpra register of practitioners

however Dr File did not take any further steps to ensure the patient had given his informed consent and did not note this interaction in his clinical records.

During the root canal treatment, a file broke and Dr File had to refer the patient to see an endodontist. Patient B was unhappy with needing to attend another dental practitioner and the additional costs he would incur with further treatment. Patient B had not been warned of this risk or offered referral to a specialist for treatment until this adverse event occurred.

THE REASON THE PATIENT COMPLAINED

The patient complained to the Office of the Health Ombudsman for the lack of information he was given about the procedure prior to treatment, including that he had not been informed of the risks and possible additional costs. The patient also requested a full refund for the treatment with Dr File as he had been unable

CASE STUDY #2 | CLINICAL RECORD

KEEPING

Patient X has been a patient of Dr Crown's for 13 years. Patient X required multiple restorations. Patient X was given a treatment plan to attend four appointments to complete the restorations. It was her understanding that the restorations would be completed by quadrant. However, Patient X found the appointment scheduled was regularly amended. On the first instance, Dr Crown completed a restoration in Q1 and two others in Q2 as she was concerned about the proximity of the cavity in Q1 to the nerve so felt this was a priority. On another occasion, Dr Crown advised she ran out of appointment time to complete all of the planned restorations in Q3 and noted Patient X would need to return to finish these at another time. Following this last visit, Patient X requested a copy of the treatment completed so far and details of treatment still to be completed as she had lost track of required treatment. The front office staff spent some time reviewing this before advising they would need Dr Crown to confirm this and that it would be emailed to Patient X as soon as possible.

THE REASON THE PATIENT COMPLAINED

Following her last dental visit with Dr Crown, Patient X moved interstate at short notice for work commitments. Patient X followed up her request for a copy of her treatment history and pending treatment, as well as a copy of her full dental records, as she would be seeking treatment with another practitioner. Patient X had to follow up with the practice a number of times over the following month for the records to be provided as requested.

When reviewing the notes with her new dentist, Patient X found that the records did not accurately depict the treatment she believed she had received. In particular, it appeared she had received additional treatment she was not aware of and had not consented to. While Patient X had not been requested to pay for this out of pocket, she was not happy with having treatment completed she was not informed of and was not happy this had been claimed to her private health fund. Patient X made a complaint about this to the OHO, who referred the complaint to Ahpra.

ISSUES IDENTIFIED BY AHPRA

Ahpra sent Dr Crown details of the complaint made by Patient X and requested she provide a response. Following review of the provided information and clinical records, Ahpra found:

´ Dr Crown administered local anaesthetic to the patient and failed to record this in the clinical records

´ Dr Crown took an exceedingly long time to send Patient X her clinical records.

´ The patient was not aware that composite bonding was completed on tooth 14, Dr Crown only noted teeth 22 and 13, so failed to get informed consent

As a result of these findings, Ahpra decided to impose conditions on Dr Crown's registration that included:

9 6 hours of formal education on effective communication and clinical note-taking

9 The requirement to provide a reflective report to Ahpra following completion of the education

9 The conditions be listed on the public Ahpra register of practitioners

CASE STUDY #3 | INFORMED CONSENT

Patient S is a teenager with autism spectrum disorder who has seen Dr Bond for the past 6 months. The patient trusts Dr Bond, and her parents trust his treatment.

Patient S's parents made an emergency appointment for her to see Dr Bond after school to treat her toothache that had started the night before. Patient S presented to the practice alone after school and explained to Dr Bond that she was in severe sharp pain from tooth 17. Patient S said she wanted the pain to stop immediately and requested the tooth be removed. Dr Bond went over some information about the process of a tooth extraction with Patient S before extracting the 17.

When Patient S went home that night, she advised her parents Dr Bond had extracted the tooth. Patient S informed her parents she felt under pressure to have the tooth removed as Dr Bond noted he 'squeezed' her appointment in that afternoon as she was in pain. Patient S explained to her parents Dr Bond talked her through the process but didn’t discuss what happens next regarding tooth replacement, which she was now very anxious about.

Patient S felt the tooth extraction was the best option based on Dr Bond's information, his willingness to extract the tooth and in the absence of any other options offered.

THE REASON THE PATIENT COMPLAINED

Patient S's parents were furious that Dr Bond did not obtain appropriate informed consent from them or Patient S. The parents contacted Dr Bond to raise their concerns with him, however Dr Bond was firm in his position the treatment was what the patient requested and that her consent was sufficient. As a result, the parents made a complaint to the OHO on Patient S's behalf, which was referred to Ahpra.

ISSUES IDENTIFIED BY AHPRA

Ahpra sent Dr Bond details of the complaint made by Patient S's parents and requested he provide a response. Following review of the provided information and clinical records, Ahpra found:

´ Care was not taken to ensure the patient fully understood the treatment and he failed to get informed consent

´ Dr Bond did not appropriately assess the patient’s capacity to provide consent

´ Dr Bond did not properly communicate all treatment options, risks and recommendations before completing the extraction As a result of these findings, Ahpra decided to impose conditions on Dr Bond's registration that included:

9 The practitioner must undertake and complete a program of one-on-one education including: patient consent (minimum of 4 hours); and clinical record keeping including assessment, diagnosis, treatment planning, patient discussions and consent in patient records (minimum of 4 hours)

9 The requirement to provide a reflective report to Ahpra following completion of the education

9 The conditions be listed on the public Ahpra register of practitioners

LESSONS TO BE LEARNT

These case studies demonstrate the importance of communication and clinical record keeping. While the patients were unhappy with the treatment provided, Ahpra identified communication, consent and record keeping as the key areas of concern and risk to patients.

It's important to ensure you understand your obligations around informed consent and clinical record keeping requirements. Ahpra provide information to assist practitioners with their understanding of these requirements, while ADAQ provide members with helpful resources to ensure you don’t end up in the same unfortunate position as the above practitioners and patients. We recommend practitioners ensure a comprehensive informed consent process for all dental treatment being provided that is appropriate to the patient presenting. We also recommend you ensure you maintain comprehensive records as this assists patient continuity of care or can assist in your defence if required.

All three practitioners contacted the ADAQ Compliance and Advisory Services team for assistance with advice; assistance with responding to Ahpra; and with complying with the conditions on their registration.

If it has been a while since you have reviewed your obligations and processes for informed consent and clinical record keeping, we recommend you get in touch with the ADAQ Compliance and Advisory Services team for advice and direction to some relevant resources. If you have received a patient complaint and require assistance, please get in touch with the ADAQ Compliance and Advisory Services team, as well as notify your professional indemnity provider as soon as possible. Scan the QR code below to contact us.

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SETTING UP YOUR PROFESSIONAL PRACTICE RIGHT FROM THE OUTSET FROM OUR PARTNER – BOQ SPECIALIST

There are many advantages to choosing an escrow facility over other finance options when it comes to buying what you need to open your new practice.

Approaching the set-up of your new practice the right way can help you get one step ahead. It's an exciting time, and you will likely want everything in place from day one. The decisions you make around the equipment, the layout, and even the look and feel of your practice will contribute to its ongoing success.

However, the cost of practice fit-outs for a start-up can be up to $500,000, so it’s useful to have a clear idea on what your financing options are.

Some of your assets, like equipment, will be income-producing from the beginning. Others, such as software, will be higher depreciating assets. That's why it’s more important that your financing demands are in line with revenues from the outset. The real question to ask is whether that particular piece of equipment or soft cost can wait for a few months until you’re generating income. If it can, then it’s best to hold tight—this will ease some of the cash flow pressure and help you navigate the first few months. Equipment shelf life and industry trends are also important aspects to consider. What seems like cutting-edge gear today can be out of date in a few years. Taking into account the lifetime of a product is essential, as you will want to ensure it pays for itself, as well as assessing its impact on your cash flow.

On the other hand, if it can’t wait and needs to be ordered or installed from the start, there are finance options like an escrow facility which can help with the scheduling of repayments to best suit your needs.

WHY ESCROW?

While a loan or even a credit card are common financing options for fitting out your practice, another option to consider is an escrow facility. This is a master limit facility which can be progressively drawn as you need during the fit-out. The escrow facility allows you to pay any supplier related to the fit-out at your discretion or you can acquire assets using your own funds and reimburse under the facility. In using the escrow facility you are only charged for the funds you use, when you use them.

One of the key advantages of an escrow facility is that it allows you to make variations or changes along the way. It's not uncommon during a fit-out to decide on higher-end furnishings or different office equipment than first anticipated. An escrow facility allows you the flexibility to do that. It is common, for example, for a client to take out a $500,000 limit and then only end up needing $400,000. However, you're not going to pay for that extra $100,000 unless you actually use it.

Another benefit is that an escrow facility wraps up all the financial elements of a fit-out into one simple lending agreement. As the invoices can come at different times from different vendors, these are instead managed by the bank rather than the practice owner. The payments are made on your behalf via the escrow facility and a full record of all transactions is maintained. Then at the end of the fit-out period, the escrow facility is converted into a lease or loan facility or split between both, depending on what is most advantageous for your business’ tax and cash flow needs.

The final key benefit of an escrow facility is that you don't make any payments until the project finishes. The final amount loaned can be rolled into a longer term agreement, such as a chattel mortgage or a lease with fixed or structured repayments. This makes an escrow facility an attractive option for new practice owners as you won’t have to start paying off your fit-out until it is complete and the doors are open for business.

WHY BOQ SPECIALIST?

Knowing the market and the right questions to ask when dealing with suppliers can make all the difference. BOQ Specialist has helped finance many practice fit-outs, and know that there are smaller intangible cash flow costs associated with a fit-out. That’s why in addition to the escrow facility, they can provide a cash flow solution via an overdraft facility to manage the initial and ongoing cash flow needs of the business. Understanding the financing options available to you can make the world of difference. Whether you’re just getting started or setting up your fourth practice, BOQ Specialist’s 30+ years of industry experience means they can tailor solutions built around the strength of your qualifications.

TRANSITIONING INTO YOUR CAREER

BY SUSAN LONG FROM OUR PARTNER - WORKPLACE WELLNESS AUSTRALIA

Well done! You have finally obtained your dentistry degree after years of hard work, and you are ready to embark on your career in clinical practice

While the change may be something you have anticipated for a long time, you may experience a range of emotions in your transition from university to clinical practice. Like most new excited graduates, you may feel overwhelmed about wanting to do well and adapting to challenges. As such, now is a good time to reflect on ways that you can stay proactive about your wellbeing through this transition.

Approaching new experiences positively can help you adapt better to change. Having a good support network is a key aspect in maintaining your mental health and wellbeing. Naturally, as we get busier and as our workload increases, looking after ourselves can take a backseat. It is important however, that we continue to look after our mental health by continuing to support ourselves both professionally and personally.

Here are a few self-care tips to be mindful of as you transition into professional dentistry.

1. BE AWARE OF YOUR WORK-LIFE BALANCE

It can be easy for new work pressures and expectations to interrupt time previously spent participating in activities you enjoy and spending time relaxing or being with others. You might be tempted to immerse yourself totally into your new career at full speed, however it is important to make time for self-care and connecting with others. These are important lifestyle choices that will support you as you manage the stressors of your new role. Examples of this include planning your week to include activities that create joy, have fun, involve movement and rest. The challenge is then to protect this time as a priority. Burnout prevention starts with maintaining balance in our lives.

2. PRIORITISING THE BASICS

When thinking about lifestyle changes, it’s worth keeping in mind that it is the basics that count. The core three elements of good physical health; sleep, nutrition and exercise is where we can always start. Reflect on these aspects of your life and ask yourself ‘what is one small step or change I can make’ to improve these areas. Incorporating 30 minutes of exercise a few days a week, eating a healthy balanced diet, getting enough sleep, and limiting alcohol will help to boost your mood to cope with the increase in work pressure you may be feeling. Looking after your physical health can also include fun and with others.

Think about ways you can involve your friends and family and even your co-workers. Perhaps you can schedule a weekly walk with your friends or walk to a nearby coffee shop with your fellow colleagues during your break.

3. PRACTICE MINDFULNESS

When our brains experience an increase in mental load, and when we are experiencing an increase in learning and growth, it is easy to always feel distracted or possibly overwhelmed. Bringing our attention back into the present is one way of attending to what is most important, and helps us to stay aware of how we are doing right now. Simple mindfulness activities like a one minute breathing exercise or doing a body scan to notice how you are feeling can be simple ways to include mindfulness into your day. Incorporating yoga or meditation each day can help you focus on the present moment. Research suggests that incorporating mindfulness into your day also contributes to increased concentration and attention when dealing with life stressors.

4. BE INTENTIONAL ABOUT SELF-COMPASSION AND KINDNESS TO SELF

It is easy to set high expectations around how you are adjusting to your new role. High expectations can help us to achieve and reach our goals. Research indicates though that these expectations are most helpful when paired with an approach of self-compassion and permission to learn and grow. This means when we make mistakes, we forgive ourselves for being human and take a learning approach by looking at ways we can grow through the experience. It also includes being intentional about actions of self-kindness. Take some time for yourself each day, whether it is grabbing a coffee, going for a walk, or sitting outside in the sun during your lunch break. Make sure you continue to do things you enjoy, not just because they make you feel good but because they also symbolise you intentionally caring for yourself as you stretch and grow into your new role.

5. CONNECT WITH OTHERS

It is easy to want to withdraw when feeling a sense of overload. Our brains are also wired to need rest when the cognitive demand increases. This can occur when moving into professional life. It is important to take the rest time, however it is also important to stay connected to people in your life where you can relax and

re-energise yourself. We are the type of species that needs others to function at our best. When we connect with others, and we feel safe and accepted – our bodies produce endorphins and oxytocin. These chemicals counterbalance the increase in stress chemicals – cortisol and adrenalin – that we often experience when going through change and experiencing an increase in stress. A core element to maintaining resilience is building and sustaining strong relationships with others. Consider ways in which you can stay connected as a way of investing in your wellbeing while you transition into professional life.

6. TALK TO SOMEONE ABOUT THE CHALLENGES

Remember that you might not always fully understand the causes behind your stress or symptoms, or how to approach things. Talking with someone outside of the situation such as a psychologist or counsellor may help to obtain extra support and may also help with strategies to navigate the situation. Talking to your GP or other professionals can be a safe sounding board and help you to cope more effectively. Consider contacting your Member Support Line to talk confidentially with a professional. www.workplacewellnessaustralia.com.au

7. ENGAGING IN A REGIONAL COMMUNITY

Moving to a regional community may feel daunting at first, but once you take proactive steps to activate action you will start to feel supported as you engage in the community. Getting to know the community does not have to be boring! You can explore the hidden gems of the town by trying things you enjoy, like finding a good brunch spot or scenic route for a bike ride.

You can also research and join community groups whether that is a running group or a painting workshop. Start chatting with others in the community by joining community Facebook groups, you may even find volunteering opportunities for the local charity, or some free furniture - and who doesn’t love free stuff!

Network, network, network. There’s no better way to get the support you need than to network with like-minded professionals who are experiencing similar adjustment periods and challenges. Build good working relationships with colleagues and engage with other grad students in the field to form new connections.

Finally, seek advice from senior employees and get their advice and tips and tricks on how to thrive in clinical practice. A mentor can provide invaluable knowledge, support, and guidance when you’re starting your career. You can find a mentor through the ADAQ Mentoring Program or through your workplace.

KEEP AN EYE ON THE ADAQ MENTORING PROGRAM FOR 2024

If you are unsure of where to start when moving to a new community, give your Member Assistance Program a call for support and ideas on how to get involved.

SCAN THE QR CODE TO ACCESS ADAQ'S MEMBER ASSISTANCE PROGRAM (MAP)

RURAL DENTISTRY SPOTLIGHT

BY DR SANDRA DOLAN ADAQ MEMBER & CURRENT REGIONAL DENTIST

Dr Sandra Dolan was interviewed by ADAQ for our Rural Dentistry Spotlight. What makes Dr Dolan knowledgeable in rural dentistry is her vast experience in metro and rural regions across Queensland and the United Kingdom.

I graduated from the University of Glasgow, with a Bachelor of Dental Science in 1991. During our clinical years of dental school, I had the opportunity to be based at the Glasgow Dental Hospital and had the pleasure of being the first to experience Scotland's dental vocational training. We were required to complete a formal assessment to gain a place in the first year of the vocational program. The idea behind vocational training is to provide support for new graduates, to build their skills, competence and confidence. We worked within a supportive environment and practices that had placements for vocational training had the ability and time to provide mentorship.

The Scottish Council for Postgraduate Medical and Dental Education (now part of NHS Education for Scotland), made the decision to develop a competency-based system for vocational training. In 1992 vocational training became compulsory, not voluntary. Vocational training was a fantastic way to learn how to treat a wider variety of cases in a supportive environment. The best advantage vocational training provided was the opportunity to discuss cases between students but also with mentors, it was a fantastic way to learn from practitioners that had experiences in a wide range of dental treatment.

After completing my vocational training I transitioned into an independent practice, also known as a hybrid practice, where I saw patients funded by the NHS and private patients. After two years our practice dissolved as the partners chose to move in

different directions. I became a partner dentist during my third year after my graduation, this was very challenging. Following this change, I stayed on for a year before pursuing a career in Community Health. In Scotland, Community Health is a particular field which provided me with the opportunity to work within School Based Oral Health Programs, with patients that have special needs and spend time providing dental care to hospices across Glasgow, I have to say this work was an honour. Being able to work with patients that are experiencing their final time was one of my professional highlights. These patients were the most appreciative and least demanding I have worked for. Not long before starting my Community Health work, I lost my mum to cancer, but I was very happy to help where I could to other people in need.

I then spent a year on the Isle of Lewis before moving back to mainland Scotland and became a partner at a practice in Wick. We had the best view from this practice, we overlooked the ocean with the waves crashing against the fishing boats in the harbour. After the loss of both of my parents, my friend who was living in Australia at the time, suggested to move on over.

We left Scotland and its -15 to a warmer 45 in Wagga Wagga, what a shock!

I commenced employment with Australia Health Management (AHM), when it was a not for profit organisation in 2007. Working with AHM provided professional satisfaction as we had a prime focus on preventative dental, which included dietary advice and salivary tests for every patient.

While I was at AHM, Charles Sturt University had just started their Bachelor of Dental Science and Bachelor of Oral Health, I was asked to conduct supervision and later lectured. After a couple of months I was asked to be their Clinical Director. I remember that my first lecture I gave was in Radiation Physics, I spent the night before relearning what I was once taught. I was at CSU for two years, I loved it, I totally enjoy teaching, and I loved the opportunity to wear a teaching hat as well as a clinical director's hat. Upon leaving I was gifted a plaque from CSU and was made light to an informal saying throughout the faculty, "if in doubt, do as Dolan does".

I relocated to Queensland and had the pleasure of working at the Darling Downs Hospital and Health Service, as the Clinical Director of Metro South and then to Roma's South West Hospital and Health Service as the Director of Oral Health in 2017.

Upon arriving in Australia, I was taken back by the oral health of Australians compared to the UK. Interacting with the public in Australia, I found that there was a large portion of the population who had poor oral health, I did not see oral health diseases to this extent across Scotland. The NHS provides any clinically necessary treatment needed to keep your mouth, teeth and gums healthy and free of pain. After living in Australia for 16 years, the topic of Government funded dental care is gaining traction again and I do hope to see a change in my working career.

DIFFERENCES IN PRACTISING AND LIVING REGIONALLY

Regional living hosts many benefits for new graduates and current practitioners. Practising regionally provides you with the perfect environment to continue to learn and professionally develop into a practitioner that holds strong ethics and professional capability. I took the opportunity to be rural, as it is where we are needed the most.

Regionally you are involved in a smaller team. When I was the Clinical Director of Metro South, I found that being part of a larger team, because there are other people with different capabilities, you are compartmentalised within a framework of such a large organisation. Working regionally you have a multidisciplinary job and are involved in innovative projects that benefit your community. The ability to have a helicopter view allows you to gain a further understanding of not

only how other dentists work but also how an organisation operates. A common theme that you will find working regionally is the appreciation we receive from our patients. You develop a deep, personal connection with your patients and this helps your ability to practise clinically and build your interpersonal skills which are vital to be a successful dentist.

The ability to make a difference is very rewarding, my staff and myself are proud of what we have all learnt and achieved.

Reflecting on private practice, I found that the profession is more competitive. If you want to practise privately, you will need to market yourself to gain patients and will find yourself feeling that you are working against other dentists. The skill set required to remain practising privately, particularly in metro regions due to such a high number of dentists, is broad, you need to have skills in finance, marketing and business administration. I have had friends of mine that are great practitioners, but they were not successful at running a business. Regionally, you can focus on your clinical ability and still have exposure to how a business runs, which is valuable for your future success.

A lot of practitioners in the metro regions treat in a solo practice or do not work alongside other dentists, you may find that you are isolated and not supported well, especially if you are a new graduate. We need to provide mentoring to our younger members as practising can still be daunting for some. Out in regional areas you work within a team and you will find that our profession is quite small, you will develop a network quickly which will embrace you. We also have the opportunity to work closely with our medical practitioners, this allows us to better help our patients and create a professional team where we can rely on each other for education and support.

Living regionally is a different lifestyle, we may not have an abundance of shopping centres, cinemas and strips of restaurants, but this does not mean there is a lack of activity or ability to create a meaningful work-life balance. You have more of an opportunity to develop a sense of connection which will be more valuable for our graduates, younger dentists wishing to start a family or practitioners wanting a discover a new lease on life.

Living regionally will do every practitioner well, some of the best dentists I have had the pleasure of working alongside, have resided regionally. Personally speaking, after a car accident and spending time with specialists, I was surprised at how many medical professionals spent time regionally.

AREAS WHERE REGIONAL DENTISTRY NEEDS IMPROVEMENT

A huge problem faced in our profession is the lack of staff, which includes dentists, specialists and dental support staff. Recently I attended a CPD Event and was discussing this issue with my colleagues as we are all finding it hard to find and also retain staff. With how vast regional Queensland is, it is even more challenging to fill positions. I have been very fortunate that I have an almost full team, but private practices are struggling regionally with the younger members of our communities relocating to the city.

When you practice regionally, you will find that we provide services over vast distances, due to this there are opportunities to travel. The opportunity to travel does cause excitement as you will explore beautiful landscapes and meet people from all walks of life. A problem that is intertwined with the lack of staff is the frequency that we have to travel. Some dentists do find is quite isolating being in a new environment or challenging to travel on a regular basis when they have a young family.

WHY NEW GRADUATES SHOULD PRACTICE IN REGIONAL AUSTRALIA

For our recent graduates, your first two years post graduation is crucial in your long-term success. Limiting your initial exposure to a wider range of treatment cases can effect your ability to be able to treat more complex and challenging cases, especially oral surgery.

It is known within our profession that going regional is a great opportunity for personal and professional development.

A common situation my colleagues and I have found with dentists in suburban, private practices is deskilling. From a general perspective, when you operate in a practice for a number of years, with a particular demographic you can potentially deskill in certain areas. I have had other practitioners admit to me that they have lost confidence in their skills at an early point in their career.

Similarly in the public system, you may have to deal with a higher rate of patients that are requesting emergency dental treatment or provide a particular type of treatment repetitively. Again, this can lead to a deskill to work that may not be offered frequently, like prosthodontia work.

I have found that in the metro region, with the greater accessibility to specialists, that younger dentists are referring a lot of work out as they want to remain within their comfort zone and not take on more challenging cases so they are not growing their skillset as they should be in their first years. If you take on the challenging cases early on, your clinical life will become easier as your career progresses. If you choose the easy option now, your clinical life will be challenging. Regionally, you will quickly build your skills as you will need to rely on your training and professional support to complete treatment. It is up to an individual to find a speciality that they enjoy and ones they do not, but for our new graduates, we need to be mindful to make sure that you do not deskill too quickly especially in areas where you do not get a lot of exposure. It is hard to regain skills and confidence when you have deskilled.

When you are out in regional locations, you have the opportunity to provide a wider scope of dental treatment and care that you have been trained in. This will lead to a decreased risk of deskilling early on in your career as you will be the professional point of contact and relied upon. It is always more satisfying to being able to provide quality dental treatment, complete procedures that challenge your skills and continue to develop your understanding of dentistry everyday.

MISCONCEPTIONS TO RURAL DENTISTRY

In regional locations due to such a small number of dental professionals, you are very much in the limelight. You will find that your reputation will develop in a short amount of time and you will be well know in your community quickly. With such a public presence, you need to be good at what you do as you will be held accountable. In regional areas, your Google reviews will not be the factor that will effect your treatment diary, it will be word of mouth. A way to help your reputation will be your involvement in community events, not only will you be a dental professional, you will be known as a pillar of the local community and a source of valuable and trustworthy information.

There is incorrect information that is circulating in our profession that regional areas have a lack of dental equipment. Across the different health services I have worked for, I can say we have great access to high-quality facilities and services. I recently had a colleague that loves conducting molar endodontic treatment, and we made sure he has access to the best rotary equipment available. We are prepared to provide the resources and training you need to do your job, we unfortunately do not have the access to a quantity of specialists, so we offer the best equipment available to our general dentists.

We also offer the opportunity for staff to practise in private practices and explore that opportunity. We can offer highly skilled dentists to private patients and they are also very appreciative as in the past they would have travelled far to receive treatment.

ADVICE FOR NEW GRADUATES

9 With limited access to specialist services in rural areas, clinicians can be presented with challenging cases that they may not treat in a more urban area. Rural experience early in your career is a great way to build your confidence and experience diverse training. You do not have to remain regional forever, but open yourself up to new experiences, develop great foundational skills and make the most of lower cost living. You will find this experience invaluable if you make a move back to the city.

9 Find what motivates you, we are here to give people's smiles back, and if that is how you go into our profession then that is a great way to look at a career in dental. I have interviewed practitioners for many years and one question I ask is, 'why do you want to work as a dentist?' and the majority of responses are '...I want to give back to the community...'. This may sound like a good answer but it has been overused and lacks heart, instead why not practise where you are needed the most. When you become a dentist with conscious and heart, you will have a much longer and rewarding career.

9 Ergonomics is vital. Over the last decade we have been taught how important good ergonomics are. If you set yourself up with good behaviors, you will find that you career will be as long as you make it.

9 Be mindful of your first year as this is where your foundational skills start. If you have a bad start, and unfortunately I know young dentists who have, you will burn out too quickly. It is not uncommon to be scared, starting out as a dentist can be daunting, finding a good practice where you are not being worked to make dollars, where you have good mentorship and supervisory support, you will set yourself up for a successful career.

9 Leave your ego at the door, be prepared to receive feedback and be able to self reflect. You will learn a lot of valuable information when you open yourself up to what members of our community teach you. You will need to learn how to operate in a team as you will rely on each other heavily.

STRUCTURING AND TAXATION TIPS FOR GRADUATING DENTISTS

ANGELA JEFFREY | DIRECTOR

FROM OUR PARTNER - WILLIAM

BUCK

When looking to commence either as a contracting dentist or service fee agreement (SFA) dentist, we have several tips for you. First and foremost, planning and preparation are essential in starting your role as a working dentist, especially when starting in private practice.

1. BUSINESS STRUCTURE: GET IT RIGHT FROM THE START

Your business structure has not only taxation implications such as income tax, capital gains tax and stamp duties; but also, costs of legal liability issues and ability to add new investors. It can potentially be a costly exercise to unwind if set up incorrectly or on the sale of your practice. We recommend that you obtain specialist advice prior to setting up and entering any contracts. It is best that you keep it simple and understand what your accountant has advised in the setup of your practice. Ask questions!

2. YOU DON'T NECESSARILY NEED A COMPANY TO PRACTICE

When starting in private practice, a common myth is that you should set up as a company to minimise your tax and potentially avoid any liability issues. However, a company can add unnecessary compliance costs, and it does not offer you any additional protection from personal/professional liability claims in relation to dental practice issues. It does not increase your asset protection in those circumstances.

The ATO imposes strict rules when operating a dental company, and you can be the only shareholder and director and it cannot generate a profit, nor gain access to the company tax rate of 25%. All income must be paid to you and be reported in your own personal income tax return. You earn the money; you pay the tax.

3. SAVING FOR TAX

The most common thing we see, is that where dentists start out under a contracting arrangement, they spend all their income and forget to save for tax. As an employee, your employer will take care of your tax and superannuation (and HELP debt, where you notify them of it) obligations along the way, with each payment.

However, as a contracting dentist, the ATO will not know that you are earning this income until you lodge your first income tax return, therefore your first tax bill will only occur at this point.

This will generally be up to 12 months after the end of the respective financial year (if you are using a tax agent to lodge your income tax return). If you have not saved for this tax along the way, this may come as a rather big and ugly surprise.

To ensure that this does not happen to you, we recommend that you allocate approximately 40% of your earnings aside for tax and do not spend this money. If you have a mortgage with an offset account, this may be a great place to park it, as it is saving you interest on a non-tax-deductible debt.

Once the ATO knows that you are earning this income, they will require you to pay tax instalments each quarter, in advance, for that financial year’s tax bill. We call this period a tax holiday and it will likely (depending on the increase in your patient fee earnings), take 2 to 3 years before the tax instalments equal your actual tax bill for the respective tax year moving forward.

4. GST REGISTRATION

Where you are contracting and/or operating as a dentist under an ABN, you will be required to register for GST once your gross earnings exceed or are expected to exceed $75,000 for the financial year. However, where you are under an SFA, you may voluntarily register for GST, as you will likely receive a refund of GST due to the nature in which you are paid. We also note that most practices will require you to be registered for GST.

Once registered, you will then be required to prepare and lodge quarterly Business Activity Statements. Alternatively, your accountant can assist you with this.

5. SUPERANNUATION

As an employee, your employer must pay you superannuation of 11% (from 1 July 2023), however, as a contracting or selfemployed dentist this is entirely up to you. You are not forced to pay superannuation to yourself, however, if you contribute up to the concessional superannuation cap of $27,500, you can claim a full tax deduction for this amount.

In addition, if your superannuation balance is less than $500,000, then you can carry forward the unused concessional cap and make additional contributions (over and above that year’s cap) and obtain a tax deduction for the additional amounts. These unused cap amounts will carry forward for up to 5 years before they are lost. If your balance exceeds $500,000 at 30 June in the preceding year, you will no longer be able to make these contributions of the unused cap amounts.

6. SPOUSE AND FAMILY MEMBERS CAN BE ACTIVE PARTICIPANTS IN THE PRACTICE

A dental practitioner can employ a spouse or family member in their personal services business; provided the employment is bonafide and wages are at a reasonable level (market rate). A spouse working for the dental practitioner can receive a superannuation contribution up to the maximum age-based limits without attracting tax avoidance provisions. This cannot be done under a contracting arrangement, where you are paid a percentage of your patient fees.

7. HAVE A BUSINESS PLAN

Creating a business plan is an important part of setting up your own private practice. It helps to have a clear picture in mind of what you want to create, where you want to get to, and what you want to be part of now and in the future. This document does not have to be a novel but rather a one or two-page document that will evolve over time. To begin with, include considerations such as financing, marketing, patient demographics, specialist services, staffing requirements and practice software, to name a few.

A very useful tool is also a breakeven analysis or cash flow. This is to nut out what you are expecting to earn, what your overheads will be and how much contribution you need to make each month. This can be mapped out for 12 months to estimate cash flow and your breakeven point.

THE PROFESSIONAL EDGE

BY ALICIA CLARK | ADAQ MEMBERSHIP COORDINATOR - INSURANCE

ADAQ has partnered with PSC Mediprotect to bring our members comprehensive professional indemnity and public liability insurance - ProfessionalEdge

WE HAVE YOU COVERED

ADAQ in partnership with PSC Mediprotect, are proud to bring members comprehensive Professional Indemnity (PI) and Public Liability (PL) insurance and best-in-class risk management solutions with ADAQ ProfessionalEdge underwritten by AIG.

AIG is a leading global insurance organisation operating in approximately 70 countries and jurisdictions. Operating in Australia since 1957, AIG combine international experience with local expertise.

We are commonly asked, 'I’m an interstate member. Can I purchase ADAQ Insurance?' - Yes, if you are an ADA member you can purchase insurance through ADAQ.

Whether you are practising in tropical North Queensland or braving the cooler months in picturesque Tasmania, we have all ADA members covered.

CLAIMS HAPPEN

No matter how careful and exact your treatment is, your work is open to constant scrutiny when it doesn't go to plan, leaving you exposed to an allegation of negligence or failure to provide sound treatment. Investigation and defence costs can be crippling, and many professionals cannot afford the compensation or specialist legal assistance required for a fair hearing. That’s where we can help.

PI Insurance protects you against a claim alleging that you have been negligent in the practise of the profession of dentistry. It covers the cost and expenses of defending a legal claim, as well as any damages (compensation) payable.

LET US HELP YOU TO NAVIGATE THE COMPLEX

Our experienced Compliance and Advisory Services Team consists of clinical and compliance professionals who offer customised support to help you make sense of complaints, health funds and other compliance matters.

Our team know the ins and outs of the often-stressful process of responding to a complaint. So, rest assured, you’re in good hands.

DON'T TAKE THE RISK

Our lives are busy and we're often juggling priorities, don't take the risk of practising without PI insurance. Take steps now to ensure you always remain covered; set a reminder in your calendar ahead of your insurance expiring, if your insurance is with ADAQ ensure your email address and mobile number are up to date and follow us on our socials; Facebook, Instagram and LinkedIn, so that you never miss important communications.

You are personally responsible for meeting the Dental Board’s registration standards relating to PI insurance. Ahpra undertakes random audits to ensure that you have continuous and appropriate coverage. If you are practising without PI insurance, Ahpra can take action against you which may include, for example, suspending your registration. Having appropriate PI insurance also provides you with the security of knowing that you are not personally liable for making payment for claims made against you.

With more than 11 years’ experience in Health Regulation as Deputy Registrar at the Dental Council in New Zealand, I understand the importance of having PI insurance in place. I joined the team at ADAQ in February 2023 and if you're considering switching insurers or looking to make changes to your existing insurance with ADAQ - give me a call, we have you covered.

For full terms and conditions of PI Insurance, please refer to the policy wording available at adaq.org.au.

CLAIMS MANAGEMENT

9 Our unique partnership with PSC Mediprotect allows the Compliance and Advisory Services Team to offer in-house claims management. You can rest assured you won't be dealing with a contact centre; you'll speak with an ADAQ Member Advisor who knows your case every time.

DISPUTE RESOLUTION

9 Resolve disputes quickly and easily, with the Compliance and Advisory Services team managing expectations and facilitating positive outcomes for you.

PEER PANEL ADVICE

9 The peer panel give clinical opinion, advice, and peer reviews as part of the claims management process. They provide much needed support and can be in integral part of the settlement process.

RUN-OFF COVER

9 Run-off cover is available at no additional cost for qualifying members who notify ADAQ within the policy period. Your policy will be endorsed to provide ongoing indemnity cover for 84 months following the date you ceased practice.

If you require any assistance with patient complaints or have enquiries regarding compliance, please contact ADAQ Compliance and Advisory Services Team at assist@adaq.com.au

IF YOU WOULD LIKE A QUOTE, PLEASE SCAN THE QR CODE OR CALL 07 3525 9866 AND SPEAK TO THE ADAQ MEMBERSHIP TEAM.

P lan out the rest of your year with our new CPD courses including the annual ADAQ Clinic Day.

Scan the QR codes with your mobile device to view the course page and register.

Oral

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Laser Training:

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Fibre Reinforced Composites in Daily Dental Practice

CQU ORAL HEALTH OUTREACH PROGRAM

BY LIBBY WARLOW & DR KELLY HENNESSY | CQU ORAL HEALTH CLINICAL DIRECTOR & LECTURER

The CQUniversity student-led Dental Outreach Clinic provides mobile dental services to vulnerable populations in Central Queensland. The objectives of the clinic are to overcome barriers to accessing dental health care in vulnerable populations in regional Queensland and to enhance the clinical experience for Oral Health Therapy students.

The Dental Outreach Clinic commenced in March 2021, at the invitation of the newly opened Binbi Yadubay 'Healthy Beginnings' alcohol and drug rehabilitation centre in Rockhampton. Robinson P.G., et al (2005) discusses that recovering drug-users require higher access to dental care, due to higher rates of dental diseases. They are more likely to self-medicate for dental pain, and therefore timely dental treatment can help prevent relapse of drug use. In addition, during recovery they can focus more on their health. On-site same day dental treatment is an opportunity to assist recovering drug-users with self-esteem, motivation, selfcare and construction of a non-drug using identity.

Australia’s National Oral Health Plan identifies population groups with poor oral health and significant unmet dental treatment needs. The Dental Outreach Clinic allows staff and students to provide dental care to these vulnerable groups, such as people who are socially disadvantaged, Aboriginal and Torres Strait Island people, people living in regional or remote Australia, and people with specific health care needs. Clients at the Binbi Yadubay rehabilitation centre identify as many of these vulnerable population groups. As recovering addicts, all have additional health care needs, approximately 25% are Aboriginal and Torres Strait Island people, and all are from rural and regional Queensland.

This free service began with providing screenings at the Binbi Yadubay rehabilitation centre, with limited resources; no dental chair, light, suction, triplex or handpieces

In the second half of 2022, the Dental Outreach Clinic was fortunate to receive a grant from the Australian Dental Health Foundation and Mars Wrigley Foundation’s Healthier Smiles Community Service Grant. This enabled the purchase of portable dental equipment (with a triplex, high speed, slow speed and ultrasonic scaler) and a portable dental chair.

Image Students attending Binbi Yadubay, Rockhampton.

14.7% projected employment growth for professionals in health care

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Initially screenings used simple lighting and hand instruments only.

With the expansion of equipment, the CQUniversity Dental Outreach Clinic expanded their mobile dental services to several sites throughout the Capricorn Coast region. As well as continuing services at the Binbi Yadubay rehabilitation centre, mobile services are also visiting retirement villages, residential aged care facilities and childcare centres.

All patients undergo an initial limited or comprehensive dental examination. Realistic treatment plans are generated and implemented as possible on the same day. Risk assessments are conducted and fluoride varnish is applied as indicated. All patients receive tailored oral health education. Other treatments on site may include debridements (scale and cleans), simple restorative and emergency treatments. It should be noted that Central Queensland, like much of regional Queensland, does not have fluoride added to the public water supply. Fluoride was only added to the water supply from 2010 - 2013.

73% of Dental Practitioners live in capital cities, compared with other jobs that average 62%

From July 2022 to June 2023, over 100 clients have received free on-site dental screening, preventive and simple restorative services using this mobile equipment. By becoming an onsite dental service, clients no longer face the barrier of finding transport to attend clinics for dental treatment. In addition, many of these clients are unable to find affordable dental care and the waitlist for public dental services is currently at 15+ months in our region. The team at CQUniversity are actively applying for grants to enable us to purchase a portable dental x-ray unit. 90.1% of clients would have benefited from dental radiographs at their examination appointment in the mobile service to guide clinical decisions, inform patients of required treatment, and enable commencement of additional treatment onsite and immediately.

Positive feedback from clients has been significant, the beneficiaries have reported that the service has also been a great source of learning for them. The students and staff have inclusively worked with the facility teams to educate them on the importance of Oral Health in the overall care of their clients. The goal of the CQUniversity team is to expand the Dental Outreach Clinic and continue to overcome barriers to accessing dental care for vulnerable people in our community.

REFRENCES:

1. COAG (Council of Australian Governments) Health Council (2015). Healthy Mouths, Healthy Lives: Australia’s National Oral Health Plan 2015–2024. Adelaide: South Australian Dental Service

2. Robinson PG, Acquah S, Gibson B. (2005) Drug users: oral health-related attitudes and behaviours. Br Dent J. Feb 26;198(4):219-24, discussion 214.

This mobile service has also been identified as a partner in the delivery of the Leading Australian Resilient Communities (LARC) program. This program, sponsored by the Australian Government’s Building Resilient Regional Leaders Initiative, involves initiatives and projects that build healthy relationships and increase sustainable wellbeing in regional, rural and remote communities. As well as reducing barriers to care for clients, access to portable dental equipment enriches the students' learning experience and develops the students' clinical skills. These experiences are an opportunity for students to understand the complexities of accessing health care in regional Australia and the need for interprofessional collaboration with the client as a central focus.

Student feedback from this work-integrated learning experience has been very positive. They love getting out of the traditional dental clinic and engaging with a broader range of clients with complex needs. The outreach program has allowed students to engage with clients across their lifespan, from the elderly in high dependency nursing homes, who are often bedbound, to treating young children outside in the sunshine at the local kindergarten.

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CQUniversity students using the overhead lighting, dental chair and portable equipment at a local childcare centre.

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CQUniversity students using portable equipment to perform treatment for a patient at Binbi Yadubay “Healthy Beginnings” alcohol and drug rehabilitation centre in Rockhampton.

COMMON INFECTION CONTROL ISSUES

SHARYN DUNN

& MARICEL MOSS | ADAQ

TRAINING AND PRACTICE CONSULTANCY TEAM

Some of the basic infection control issues we are seeing are of the same nature and these responsibilities cannot be delegated to dental assistants, practice managers, or practice owners. Rather, each registered dental practitioner must ensure that they fulfil their obligations to practice in a safe and hygienic manner.

LIDDED CONTAINERS FOR THE TRANSPORT OF DIRTY INSTRUMENTS

Instruments should be carried to the reprocessing area in a cassette or in a container that is preferably lidded and puncture proof, to minimise manual handling of items. Use of a lidded container also reduces the chance of deposits drying onto the surfaces of instruments before they are cleaned and lowers the risk of a penetrating injury if the container is dropped during transport. A systematic approach to the decontamination of instruments after use will ensure dirty instruments are segregated from clean items. Contaminated instruments should be carried with gloved hands to the cleaning area and placed on the bench in the ‘contaminated zone’ of the reprocessing room. For the staff members working in the reprocessing room, suitable utility gloves are to be worn when loading items into ultrasonic cleaners or into instrument washers. Appropriate thick utility gloves are also required for manual lubrication of handpieces, for loading automated handpiece lubricators, and for the manual cleaning of delicate or specialised items. Before putting on utility gloves, hand hygiene must be performed. In the reprocessing room, this involves handwashing.

THE USE OF TRANSFER TWEEZERS

If additional instruments and materials have to be retrieved from outside the contaminated zone during an appointment that is underway, it must be by a method that does not contaminate other instruments or materials in the drawers or cupboards. The recommended technique is to remove gloves, perform hand hygiene with alcohol-based hand rub, retrieve and dispense the additional materials using clean hands, and then perform hand hygiene again and put on fresh gloves. The same ‘clean hands’ approach can be used when moving from the contaminated zone to a clean zone when the intention is to touch non-clinical items without a barrier, such as the operating controls of an intra-oral x-ray unit. It is no longer acceptable to use over-gloves or to open drawers by elbow touch and then retrieve items with transfer tweezers. This is because such retrieval methods have inherent risks of contaminating clean supplies.

MANUAL OR MECHANICAL CLEANING OF ALL INSTRUMENTS

Manual cleaning is discouraged wherever mechanical cleaning can be used, i.e., there must be no hand scrubbing before instruments are placed into an ultrasonic cleaner or into an instrument washer/thermal disinfector. The requirements for manual cleaning should be minimal since all routine instruments should be processed through a mechanical cleaning device, namely, an ultrasonic cleaner or instrument washer (not both) for regular solid instruments, and a lubricator for dental handpieces.

If it is necessary to clean a delicate or specialised item, cleaning techniques used should aim to avoid spraying liquids into the air. The instruments should be held low in a dedicated instrument cleaning sink that has been pre-filled with lukewarm water and instrument-grade detergent (not domestic detergent). To remove debris, a long-handled instrument brush or a non-scratch nylon scourer should be used until the item is visibly clean. Abrasive cleaners such as steel wool and abrasive cleaning powders should not be used as they can damage instruments and may leave residue. A wire bur brush, maintained in good condition, may be used for cleaning tungsten carbide and diamond burs. All cleaning brushes used for manual cleaning must be washed, rinsed, and then stored dry.

PERSONAL PROTECTIVE EQUIPMENT IN THE REPROCESSING AREA

When loading ultrasonic cleaners or instrument washers, or performing manual cleaning, in addition to heavy-duty utility (puncture and chemical-resistant) gloves, staff must wear eye protection/face shield to protect them from splashes. A mask must also be worn to protect from splashes to the lower face and from aerosols. While not always required, a waterproof/fluidresistant gown/apron is also recommended when undertaking large amounts of manual cleaning, to prevent any splashes of water or cleaning agents reaching the skin. Any such splashes on the skin must be washed quickly with clean water, and the site treated in accordance with the instructions for use. Wearing a hair net is recommended when packaging instruments, to prevent any shed hair falling onto the work area or into packages. For the same reason, beards should be covered. During operation of the ultrasonic cleaner, the lid must be kept on to prevent dispersion of aerosols and droplets of fluids.

INFORMATION RECORDED IN STERILISER CYCLE RECORD SHEETS

For every steam sterilising cycle (including those that do not have packs of critical instruments), the recorded entry for the cycle in the steriliser log must include:

AT THE TIME OF LOADING THE CHAMBER

• the steam steriliser number or code (if there is more than one steriliser in the practice, in order to identify the machine the item was sterilised in);

• the date;

• the cycle or load number on that date;

• a summary of the contents of the load, e.g., wrapped or unwrapped items;

• which cycle parameters were used (time and temperature)

• ensuring these are appropriate for the load type being processed – whether wrapped or unwrapped;

• batch numbers of packs included in the load (if any); and

• identification of the loading operator.

AT THE TIME OF UNLOADING THE CHAMBER

• check for the correct physical readout data (on the digital display or on the printout) for the cycle;

• check of the chemical indicators used in the cycle (this includes checking all external Class 1 chemical indicators as well as any visible internal chemical indicators);

• check of packages (if present) for the integrity of the seals;

• check of packages for dampness; and

• identification of the unloading operator. After the last dot point has been completed, the unloading operator has now authorised release of the load (parametric release) for use in the clinic.

The Training and Practice Consultancy Team are here to support you and answer any questions you may have regarding infection control.

CPD EVENT GALLERY

TOOWOOMBA SPRING SYMPOSIUM

1st & 2nd September 2023

Really appreciate ADAQ for bringing such a high quality program regionally. It’s a great opportunity to see our local talent speak on varied topics but also some legends in their field - Neil Savage and Barbara Woodhouse presented excellent topics. A great mix of speakers! Not to mention great food and a great social function on Friday night. Hoping this to be regular on the CPD calendar!

- Nicole S.

The Toowoomba Spring Symposium was well planned and managed by Madonna and her team. It’s so great to have resources accessible for regional members to run scientific programmes. Thank you ADAQ!

- Phoebe F.

ADAQ member dentists from far and wide gathered in Toowoomba to attend the Spring Symposium CPD event presented by gold sponsor Geistlich. It wasn’t by accident that this relevant, informative and cost-effective CPD event coincided with the beauty and splendour of Spring at the official start of the Carnival of Flowers, making it a draw-card event.

- Gina C.

ORAL SURGERYMODULE 1

27th July 2023

I felt like the lectures were really clear and concise - easy to understand but still very informative. Good mix of practical and theory. Really enjoyed it - and the lecturers were really lovely as well! Super willing to answer questions and help with technique. I wish I’d been taught this well at uni!

- Phoebe K.

The

9 Ahpra & OHO notifications and responses

9 Patient complaints

9 Insurance claims

9 Health fund audits

9 Updates on the profession

9 Compliance guidelines and news

9 and more…

Contact ADAQ when you need support assist@adaq.com.au

REMINISCENCES OF COUNTRY DENTISTRY

ALESSANDRA BOI | ADAQ

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Edward Kennington Wilson (1884-1978) practised in Pittsworth and Toowoomba for over forty years. Wilson was a past president of the sub-branch there and was later made honorary member of the association. Wilson qualified under the old apprenticeship system and passed the Dental Board of Studies examinations in 1907. These are some of his recollections of his early years of practice, as recorded by ADAQ historians in the 1960s.

In 1908 I bought a practice in Pittsworth for £60 and after spending another £50 at Bosch Barthel and Co. in Brisbane, I thought I had a good set-up.

In 1908 I bought a practice in Pittsworth for £60 and after spending another £50 at Bosch Barthel and Co. in Brisbane, I thought I had a good set-up. There was no electricity or water supply at that time and my only lighting by kerosene lamp. The cuspidor was attached to the chair, and to be cleaned it was taken to the workroom after each patient and washed in a bucket, which was emptied in the backyard at the end of the day. The dental engine was worked by foot, which was very tedious, but in those days nothing better was available.

Sterilisation of all instruments consisted of washing and then immersing them in a fairly strong solution of carbolic acid.

At the time, cocaine was the only local anaesthetic used, and I was never happy with it, as some patients had an idiosyncrasy to it, and there was no way of finding out until after the injection was given. I had my anxious times... one day when reading an overseas journal, I noticed a reference to Novocaine. As it was unprocurable in Australia, I sent to England for some tablets. The trouble was then to get distilled water [to dissolve them]. So, I made some, several times a week, by attaching a glass tube to a small kettle, where I had removed the spout, then caught the steam in a sterilised bottle. By adding salt tablets, I had a good physiological solution with a pH hydrogen ion concentration of 5 or 6.

Before using the solution, it was boiled again in a metal cup over a methylated spirit lamp. I then added the Novocaine tablets, and, in this way, I had a fresh solution for every patient. All the time I used this I had no trouble or complaints. It was injected warm and was quite effective. Later, Novocaine was procurable in Australia, and largely took the place of cocaine, which I did not regret.

[...] I decided to work some of the outlying districts, and this was done by buggy and pair, which was the general mode of conveyance at that time. All roads were black soil [...] at the best of time rough and after rain, boggy and full of potholes.

One day a month I made time to visit the Westbrook Reformatory where I did dental work for sixty boys - mostly extractions. [...] I had to be up at 4.00 am to feed my horses and prepare my breakfast at the surgery.

Before Pittsworth, I had a good deal of experience with gold crowns of devitalised teeth and would have liked to continue, but owing to having no gas, I was unable to do so. Then one day I was in the local jeweller's shop, and he showed me how to use a blowpipe with kerosene. It was a sort of metal pot with a spout protruding from it, into which a wick was inserted. This generated a very powerful heat and proved quite satisfactory [for soldering or sweating of bands].

Later, the Dental Depots produced a methylated spirits blow pipe which could be used the same way as gas, and this solved all problems. It was most useful later when inlays became general. Before this, I used a method of burnishing thin platinum foil in the drilled-out cavity, filling with wax, removing and investing in pumice and plaster, and after boiling out the wax filled the cavity with 22 carat gold. In some places it was a good substitute for the way inlays were done later, and it saved hours of work compared to the gold foil method, and believe me, they lasted for years.

Image

Edward Kennington Wilson's Pittsworth practice - 2023

Image Interior of rail dental clinic - 1946

Image Digging the mobile dental clinic out of the mud on its tour of outback Queensland

When I took over from the previous dentist, I found he had been using a nitrous-oxide gas device for extractions. So, I decided to use it, and many a fright I got. It was a far cry from the modern nitrous-oxide plus oxygen method now in use, but it did serve a useful purpose in extracting abscessed teeth. All general anaesthetics were given in the patient's house, usually on the kitchen table. And chloroform was the only method used.

All prosthetic work was in vulcanite, and the vulcanising was done on a primus stove: the thermometer had to be constantly watched. Some of these dentures are still in use as I discovered the last time I was in Brisbane (1966) when a patient came in with a full set, which I made 1920 or earlier. Certainly, some of those vulcanite dentures lasted amazingly well - too long, being quite unhygienic…

SOURCE:

1. A history of the Australian Dental Association Queensland Branch, 1906-1992. H.G. Jones. ADAQ Archives.

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ROMA RHYMES AND RHYTHM

As we shine a spotlight on rural dentistry, we thought of this poem by Geoff Grundy, retired dentist, ADAQ honorary member and unofficial Qld dentistry bard. Geoff practised extensively in rural settings and often turned his dental ‘battle stories’ into poems. He told us: "I was thinking back on my last working day in Winton in the 1990s, I realised that...

EVERYTHING IS RELATIVE

“City folk think Roma’s rural” this lady said to me.

“You could throw a bloody stone from Roma to the sea.”

From down the Diamantina, she had driven half the day, Just to reach the nearest town, three hundred k’s away. Her appointments at three thirty were for Christopher and Jane,

And when my contract finished, I would not be back again.

Along the track there had been rain. She’d had to travel slow.

At the hour she’d planned to be in town, there was forty k’s to go.

When she arrived at half past four, she seemed about to cry,

But her lateness was no problem. As it happened, so was I.

They’d had no food since breakfast, so we dealt with first things first.

Some biscuits for their hunger and soft drink for their thirst.

And I worked on way past sundown. There was quite a lot to do.

But just what made it all worthwhile, was the way she said, “Thank you.”

Next day I drove to Roma – good roads throughout the day,

And I thought about the lady who’d go home the other way.

Back to where it’s really rural, and amenities are few. Uncomplaining and accepting. She really was “true blue.”

The mothers of the real outback deserve our admiration.

Through their dogged perseverance and their sheer determination

They overcome the hardships, and the pain and endless strife.

Which do confront them daily – part and parcel of their life.

City people take for granted what is luxury out there, Like fresh fruit and ice-cream and basic dental care. Technology may be making old challenges humdrum, But the tyranny of distance we have yet to overcome.

Image Staff from the mobile dental clinic eating lunch while on tour - 1928

DID YOU KNOW?

Ninety years ago, in August 1933, The Queensland Dental Magazine (today’s Dental Mirror) was launched as a means to ‘inform our country members of the many activities of our young association’.

The formal amalgamation of the many local dental science societies and associations into a unified state branch of the National (then renamed Australian) Dental Association had been completed less than a decade before. The new Official Organ of ADAQ would have been an invaluable source of information and education for remote Queensland members, undoubtedly fostering a feeling of unity and collegiality.

'It will provide our country sub-branches and individual members with a vehicle for expressing their thoughts; indeed, let us hope that many original articles from the country will grace its columns. The problems of the country members have always been with us – for some years I was a country member of the former Odontological Society of Queensland and so I appreciate their view-point. It must not be forgotten that there are always two sides to any question, and it must be recognised by all that most of the hackwork falls upon the city members who are nearest the centre of affairs.

Unity is strength and I feel that, in the coming years, unity in our profession will be necessary more than ever; the halcyon-days of old, with little competition and lack of interference, are passing. Our profession has reached a state of responsibility towards the community and itself, that must be faced by all its members. Public appreciation of the necessity of dental service is no longer to be doubted.

May this magazine grow in importance and value as the years go by. If it coalesces the mass of dental opinion in this State, its existence will be more than justified if it helps to bind all Queensland dentists together into one Association, then its production will fulfil our most ardent wishes'.

SOURCE:

1. HA GOLDFINCH [from the President’s foreword, The Queensland Dental Magazine, page 1, August 1933. ADAQ Archives

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The August edition of The Queensland Dental Magazine from 1933

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