Western Articulator - Edition 7, 2022

ADAWA welcomes our new CEO

Meet Trevor Lovelle

Volunteerism special Ways to make a difference and inspiring stories from volunteers

Young Dentists' Conference 2022

The event new practitioners will not want to miss

Give your dental practice a $10,000 Helping Hand Grant!

TAKING THE OPPORTUNTIES

A LIFE-CHANGING EXPERIENCE

EDUCATION AND TRAINING

FEATURE

FEATURE

DENTISTS

STORIES

YOUNG DENTISTS' CONFERENCE

SPOTLIGHT

CALENDAR

GOLF

PROFESSIONAL NOTICES

President’s Report The

Dear ADAWA family,

In this report, I will provide an update on our interactions with health funds, our insurance provider, the Australian Dental Council, and the Dental School, as well as exciting developments within our Association.

Working with our CEO Trevor Lovelle, we continue, on behalf of our members, to advocate to various health funds the importance of the WA dental profession and the vital role it plays in maintaining the health and wellbeing of our community. Over the last few weeks, we have hosted our insurance claims management representatives DPLA (Dental Protection Limited Australia) and our insurance provider MDA National in Perth to strengthen these relationships to ensure the continued provision of products that benefit our members. Cost effective and reliable indemnity insurance is critical to the viability and sustainability of our members and we will continue to work in these spaces to ensure that the best possible outcomes are delivered for our highly-valued members.

ADAWA continues to support the UWA Dental School on various fronts to enhance the future of our profession. Recognising that graduating student members will soon be transitioning to the workplace, ADAWA has arranged a series of information sessions about dental practitioner contracts, utilising the expertise of our longstanding Employee Relations partner.

However, our support doesn’t end with students. ADAWA attended the recent Australian Dental Council (ADC) roundtable conference, which discussed academic workforce shortages in dental schools around Australia. The highlight of this conference was the reaffirmation for me that when all the stakeholders come together and work collaboratively, positive change is more likely to occur.

At the Council level, I am looking forward to some exciting times ahead, as our CEO moves forward with a planned governance review over the next few weeks. As many of you are aware, our organisation has grown and to ensure your peak body continues to be effective and efficient, it is imperative that our governance structure reflects contemporary practice, including providing strategic leadership. In this regard and under the stewardship of our CEO, we will be undertaking a strategic planning process for the organisation that importantly will include input from our membership. Therefore, continue to stay tuned as you lead ADAWA into its next phase.

The highlight of this conference was the reaffirmation for me that when all the stakeholders come together and work collaboratively, positive change is more likely to occur.

As I have repeatedly said to many who have asked me over this last year, I am humbled to serve the membership and I am very grateful for all the membership support. A further special thanks go to the ADAWA Councillors, Executive team members, ADAWA staff, and all the other volunteers who have tirelessly stepped up at every stage, working behind the scenes, to help your Association provide the best for its membership.

Your opinion counts!

ADAWA MEMBER SURVEY

Please keep an eye out for our ADAWA member survey next month. Your participation will help us understand your needs and fine-tune our strategic direction.

The anonymous online survey is being managed by a professional research organisation and will be emailed to members in November 2022.

Watch this space.

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ADAWA WELCOMES NEW CEO

Trevor Lovelle

It is clear the association is in good hands with the appointment of Trevor Lovelle.

After nine years as Executive Director and Chief Operating Officer at national peak body for not-for-profit aged care providers, Aged and Community Services Australia, Trevor Lovelle joined ADAWA in August as the CEO. With over 20 years’ senior management experience, Trevor holds a Master of Business Administration (MBA), Bachelor of Business (BBus) and Graduate Diploma from the Australian Institute of Company Directors (GAICD). Prior to working in the aged-care sector, Trevor worked for the WA Farmers Federation as Deputy CEO after completing 10 years at the Chamber of Commerce and Industry of WA, where he was in senior management with responsibility for industry policy.

Trevor says he saw the chance to apply for the role of CEO at ADAWA as a great opportunity to further his passion for not-for-profit member associations and to contribute to the fantastic work for which the ADAWA is renown both locally and nationally.

“I’ve aspired to lead a member association and my academic credentials and industry experience have provided me with the capability to achieve this goal,” he explains. “Of course, with higher responsibility comes greater accountability and understanding that the buck does stop with the CEO is a reality that I embrace.”

His appointment marked the end of an era for the WAbranch, that for decades had a dentist in the CEO role, including Dr David Hallett and predecessors, Drs Peter McKerracher and Stuart Gairns.

Trevor says high on his list is to ensure that ADAWA is an association that members continue to be proud to be part of and that delivers absolute value and benefit to their interests.

Early days have already seen Trevor liaise with key stakeholders and meet with Western Australia’s Minister for Health and Mental Health, The Hon. AmberJade Sanderson. Trevor is also currently in discussion with ADAWA President, Dr Amit Gurbuxani, about undertaking a governance review of the association, which in conjunction with the soon to be distributed member survey, will inform the development of the ADAWA strategic plan.

“I am aware that the previous CEOs were dentists, but I strongly believe that my skillset, which is underpinned by both formal qualifications and significant industry experience, provides me with the capability to lead this member association, and contribute to enhancing the broader strategic objectives of the ADAWA for the benefit of the WA dental profession,” Trevor says.

“This is about providing management and association expertise but I also recognise the tremendous level of technical expertise within our membership. We are currently working on plans to provide a ‘help desk’ function for the membership, which will leverage the knowledge, skills and expertise of members and key stakeholders. This will provide a powerful blend of resources, which can only enhance the ADAWA’s value proposition and member experience.”

“Members can continue to rely on the ADAWA as a reputable peak body that represents their interests – and I hope to further build on the strength of our association,” he adds.

“You need an efficient and sound governance framework because that determines the way your organisation functions,” he explains. “It is not to say there is anything drastically wrong with how the organisation has been functioning, but it doesn’t hurt from time-to-time to check that things are being delivered as efficiently as possible, and that is the key phrase – efficient delivery of service. I think the development of a strategic plan for the organisation is also really exciting. Identifying what our association does and what we would like it to do and become in the future is a really good process to undertake, and I envisage that all of our members will have an opportunity to contribute to this work.”

Trevor is hoping to meet with as many members as possible to get an understanding of what members want from their association.

“Change is something that nobody really likes, but the reality is that member peak bodies, of which ADAWA is one, must keep adapting to change to remain relevant. My firm belief is that change is a process not an event, and it is perpetual. The challenge is to make effective and meaningful change without obvious disruption,” he adds.

“Yes, there will be change but it is good change and I hope members will see the benefit.”

This is a powerful blend of resources, which can only enhance the ADAWA’s value proposition and member experience.

5 MINUTES WITH ADAWA CEO, TREVOR LOVELLE

What are you doing when you are not in the office?

I love gardening. My wife often says that the garden is where I go to 'escape'. If I’m not in the garden I can probably be found wandering around the local Bunnings garden centre searching for the next addition. While I’ve developed my professional career in the business stream, I actually studied horticulture when I first left school and I’ve retained that love of gardening.

Although I am not actively playing sport anymore, I do maintain a regular exercise regime. I played soccer from an early age until I realised that I probably wasn’t going to get an offer from Arsenal and needed to consider plan ‘B’, which forced me to make decisions on a serious career.

My youngest son plays soccer, so on weekends my time is spent either watching him or running the lines during game time with a flag in my hand and trying to keep up the play. I like to think I can still show him a few tricks when we have a kick around at the park. He has also inherited the dream of playing for Arsenal, which I’m happy to indulge for the time being.

What three words best describe you? Reliable, resilient and integrity.

If you weren’t a CEO, what would you be doing for a living? My first car was an FJ Holden that I restored with my father over several years prior to obtaining my driver’s license. If anyone recalls a red FJ Holden burning around Perth streets in the late 80’s, then the chances are it was probably me in my beloved ‘tomato’. I think I've watched every car restoration program on the streaming services and think restoring old cars for a living would be wonderful, although it is probably a pipe dream.

Who is your favourite musician?

As a frustrated rock god, I’ve acquired a collection of acoustic and electric guitars over the years, which these days I play infrequently. I’ve never played in a band, but I channel Bruce Springsteen, although I think any resemblance to his sound and mine are purely coincidental. The Beatles are my all-time favourite band and I still marvel at the genius of their music and wonder what we might be listening to today if they hadn’t existed.

Don’t bequeath your super to the ATO

Who would you prefer your leftover super to go to?

If you were to die before you’ve had a chance to spend all your super, who would you prefer to receive what’s left over? Your loved ones or the ATO?

Many super accounts include a taxable component. So before it’s transferred to your beneficiaries, it may be taxed. Unless, that is, you can take advantage of the re-contribution strategy. This involves withdrawing the taxable component from your super and then re-contributing it as non-taxable contributions. This strategy has saved some clients tens of thousands of dollars. But it’s not a no-brainer. Whether and when you’re eligible, the amount you can re-contribute and the way you do it, all require a great deal of technical expertise. That’s where we come in. ■

Should you need financial advice speak to the AMA Financial Services team on 1800 262 346 or email advice@amafp.com.au

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Volunteerism – making a difference

Graduating from Dental School or a new practitioner? You will have much to learn as you embark on your career in dentistry, but you can already make a big difference to people’s lives by volunteering with The Australian Dental Health Foundation.

Russell Gordon, Chairman of The Australian Dental Health Foundation in WA, wants graduates and new practitioners to volunteer. Helping out, even occasionally, via one of the Australian Dental Health Foundation programs can not only make a big difference to the lives of the patients you treat but can provide valuable experiences for you as a practitioner.

“You are lucky to have chosen dentistry as a way to make your living,” Russell says. “I know you have all worked hard and given up a lot to get there but still you are joining a privileged group in our society.

“As a dentist, you will be given the courtesy title of Doctor, you will make a higher-than-average income and you will join a group of people who engender much greater trust from our society than most other members of the community.”

Russell adds that dentistry is one of the helping professions. “People come to us for help and advice,” he says. “Using our learned knowledge, plus experience, we give them our best advice and if they trust us, we can make our living providing their dental care. Personally, I feel very fortunate to have joined a helping profession.

“I think seeing yourself as a competent and ethical dentist is a satisfying way to spend a working life. I have found that occasionally offering my time and skills in pro bono dentistry has been extremely rewarding in so many ways that far exceed the time devoted. The ADHF focuses on homeless people whose appreciation of your help is enormous as they lack the life skills to navigate the Government services available to them.”

HOW CAN I VOLUNTEER?

You might be lucky enough to work at a practice that has a volunteerism culture. If so, you might be able to volunteer your time via a Dental Rescue Day or Adopt a Patient program:

DENTAL RESCUE DAYS

This is where practice owners offer up their premises on occasions to provide pro bono treatment for homeless or at-risk people brought to their surgery by agencies such as The Salvos and St Vinnies. Usually, treatment is of an emergency nature to treat pain and infection.

ADOPT A PATIENT

Occasionally, a patient presents on a Dental Rescue Day who the practice will decide to adopt to finish off some treatment. Or a practice can offer to take on a patient via an agency to complete a course of treatment pro bono.

ST PAT’S ORAL HEALTH CLINIC

If the practice you work at doesn’t take part in the Dental Rescue Days or Adopt a Patient programs, you can still volunteer at St Pat’s! St Pat’s provide a wide range of services to the homeless and to those in danger of becoming homeless, with emergency accommodation, food, counselling, a visiting laundry truck and visiting Street Doctor. The ADHF clinic in St Patrick’s Community Support Centre has been running since 2016. It is an excellent facility, with a lot of free equipment provided by A-dec. Henry Schein Halas has provided the clinic with a monthly account to purchase materials and Oceanic Dental lab provide some free lab work.

“The clinic has proved to be a huge boon to the ADHF’s work,” Russell says. “It provides a venue for volunteers who don’t have their own surgeries and it allows us to do more comprehensive treatment than our one-off Dental Rescue Days. It is an ideal place for people such as new graduates to dip their toes into the volunteer pool, be it regularly or as a one-off when time allows.”

DO I HAVE ENOUGH SKILLS TO VOLUNTEER?

Russell says if you are hesitant, please come along to St Pat’s and sit in on a few sessions. “Get a feel for what we do,” he says. “Please know that if someone comes in and their mouth is a mess, you are not expected to fix everything. Do what you can do confidently and within your capabilities. It does not take long to gain confidence.

“Never underestimate the value of the skills you have learned in Dental School. You can make big changes to people’s lives. Not only is this personally satisfying, but it also reflects well on our whole profession.”

HOW OFTEN WILL I BE REQUIRED TO VOLUNTEER?

The great thing about volunteering is that you can choose what fits around your schedule. Some dentists might volunteer occasionally if they have some time off. Others will volunteer regularly (some will volunteer every week). “Whether you do it as a once-off or regularly, every time you volunteer, it’s appreciated,” Russell says.

WHAT DIFFERENCE CAN I MAKE?

If you have ever doubted the difference even occasional volunteering can make, just a couple of examples from Russell’s volunteering experience will convince you:

“We used to run Dental Rescue Days occasionally at my practice in Rockingham. I remember one patient who was brought down from Guildford. She had a scarf around her neck to disguise a draining sinus on the lower border of her mandible. An OPG showed a reasonable set of teeth with one badly broken down 47. She said pus had been draining down her neck off and on for two years. A very simple extraction enabled me to make an enormous change to her quality of life. You should never underestimate the difference you can make to someone’s life using your skills.”

“Occasionally a patient presents on a Dental Rescue Day who we decide to adopt to finish off some treatment. One of my ADHF patients presented with a mouth full of stumps such that it was difficult to figure out where the pain might be coming from. I did what I could that day and then decided to get her back to

complete a clearance and make full dentures. This lady I learned had been living in a tent in the bush with a small community of homeless people for 10 years. This was an area not that far inland from my practice in Rockingham and I was completely ignorant of its existence. She had a problem with alcohol but had decided to make a change and she was over the moon when I offered to give her back her smile. She came back to see me about a year after she had completed treatment. She was with her grandson who she was minding in the school holidays and told me she was now living in a shared house. She was much more confident, and her appearance was so much healthier with clean clothes and make-up, and I could see she was proud of how she had changed her life around. I must say I went home elated because of how I had been able to contribute to her change in circumstances. Much more self-satisfying than even my best fancy CAD CAM generated Zirconia Bridge on a paying patient.”

WHAT’S IN IT FOR ME?

According to Russell, the experience you get when you volunteer allows you to treat cases you might never see in your work at a public or private practice. “You see dentistry raw,” he explains. “You will see things that I have hardly seen in all of my years in practice because you are seeing people who have fallen through the cracks.” Russell says the level of appreciation from the patients treated is really heartening, but it’s not only the patients who appreciate our efforts.

“Our colleagues tend to admire us when we volunteer as do our paying patients,” he explains. “Volunteering demonstrates that you do care and that to you, dentistry isn’t just about money. This helps to engender trust from your paying patients.”

HOW DO I SIGN UP OR FIND OUT MORE?

If you would like to learn more about the volunteering options available for new graduates, please contact Andrea Paterson, WA State Coordinator, Australian Dental Health Foundation at adminwa@adhf.org.au

Supporting dental practices with $10,000 grants

We are delighted to announce the return of our initiative – the Credabl Helping Hand Grants – aimed to support practice growth, highlight the amazing work occurring in local communities, and to help drive patient numbers and engagement.

Applications from eligible dental practices are now being accepted for 2022 and close on 31 December. The grant recipients will be selected by six judges and announced on 13 March 2023. Here’s why you should get involved and how to apply.

Why were the Helping Hand Grants launched?

Credabl launched the grants in November 2020 to recognise the challenges facing dental practices at the time.

Stafford Hamilton, Credabl CEO and Co-founder, says the return of the Helping Hand Grants is a way to continue to shine a light on hard-working healthcare practices right across Australia.

“At Credabl, we have seen first-hand how hard the past few years have been on dental practices, emotionally and financially,” Hamilton shares.

“The Helping Hand Grants enable us to support up to five businesses whilst also acknowledging the challenges many practices are currently facing – from patient retention and community engagement to financial hardship.”

What does a Helping Hand Grant consist of? The grants are valued over $10,000 and will be awarded to up to five medical practices around Australia across the dental, medical and veterinary professions.

Each grant includes $5000 cash, practice growth and management coaching from industry-leading providers including Prime Practice, a Delonghi Nespresso coffee machine, 50,000 Qantas Points* for their business and a digital guidebook filled with great tips to help boost patient numbers.

Helping practices through tough times and beyond For previous Helping Hand Grant winner, Family Dental Yamba in Yamba, NSW, the last two years had significantly impacted the practice’s growth plans, like many others.

Family Dental Yamba owners and dentists Aninke Lippert and Willem Espag share how the grant helped their practice: “Thanks to the grant, we were able to complete our renovations and upgrades despite the floods and other challenges. Without Credabl’s help and support, these dreams would not have become a reality and we are forever grateful!”

The 2020/21 Helping Hand Grant recipients also included Brentford Dental in VIC, Cygnet Clinic in WA, Modbury Veterinary Clinic in SA and Family Health Clinic in QLD.

How can I apply for a Helping Hand Grant?

If you own, manage or work for a dental practice, tell us why a Helping Hand Grant would support your business. Apply now at credabl.com.au/helpinghand22. T&Cs apply.

Who is Credabl?

Whether you’re new to seeking finance or ready for a review, we’re available to chat live any time via our website credabl.com.au or you can call Deb (0413 427 601), Ali J (0411 602 084) or Ali G (0428 563 325) in the WA team, we’d be happy to help!

*A business must be a Qantas Business Rewards Member to earn or receive Qantas Points for business. A one-off join fee of $89.50 including GST normally applies, however this will be waived for Credabl Pty Ltd (ACN 615 968 100) customers if they join at www.qantasbusinessrewards.com/credablfree. Membership and Qantas Points are subject to Qantas Business Rewards Terms and Conditions (www.qantas.com/au/en/business-rewards/terms-and-conditions). Qantas Points for business are offered under the Credabl Terms and Conditions (www.credabl.com.au/qbr/terms-and-conditions).

Taking the opportunities

Recent graduate Dr Muhamed Agag has found volunteering at St Pat’s a greatly rewarding experience –and urges dental students and other recent grads to take the opportunities to help others.

Dr Muhamed Agag has always liked to give back, but it was in his third year of Dental School when he had the opportunity to go on an overseas volunteering trip that his passion for volunteering was really ignited. “I went with a few of my classmates to Nepal and we volunteered for 10 days at a village on the outskirts of Kathmandu,” he recalls. “The stark difference of access to dental care compared to here – and how grateful those people were to see a dentist to solve problems that had been lingering for a long period of time, was an experience that really switched me onto volunteering.

“After what I experienced in Nepal, I felt as dentists we all have this training and the ability to not only get people out of pain and make them more comfortable, but to help with their self-esteem and the way they project themselves to the world, which is why I wanted to continue to volunteer.”

VOLUNTEERING AT ST PAT’S

Muhamed graduated in 2020, and a year later enquired about volunteering at the oral health clinic at St Patrick’s Community Support Centre in Fremantle, which provides support to people experiencing homelessness or who are at risk of homelessness. He has been volunteering there once a month ever since. He says all the staff at St Pat’s were very welcoming and helped him settle in quickly.

Muhamed adds the feedback from patients has been rewarding. “I have treated a lot of patients who only needed little things, but those little things have made a massive difference to their life,” he says.

“There was a young person with a broken front tooth that was giving them a lot of trouble,” he recalls.

“They had a really rough couple of years and were trying to get life back in order and trying to get a new job, but the tooth was a barrier for them. It wasn’t particularly difficult to fix but showing them the final outcome in the mirror was such an emotional moment for everyone because for them it meant the world.”

A SENSE OF SERVICE

Muhamed says volunteering has made him more grateful for the set of skills he has acquired, and for the profession he is a part of. “I am also grateful that I can help people and heal people,” he says. “Not only in the sense of pain and infection but helping patients being at peace in themselves and improving their self-esteem and confidence.

“I enjoy the sense of service that comes with volunteering,” he adds. “There is also a sense of community. As well as seeing the transformations, being this little cog in the journey of someone who is trying to better their life brings a lot of joy.”

MESSAGE TO OTHER NEW GRADUATES

To dental students and new practitioners considering volunteering, Muhamed says to go for it. “If you can, take on opportunities that are present in Dental School, whether it be one of the Rescue Days or an overseas trip, because they can be amazing experiences,” he says.

“Once you graduate, if you have the time, it is always good to give back a little and take on some volunteering days. It doesn’t have to be a huge commitment, but it can be a small part of your life that makes a massive difference to someone else’s life.”

A life-changing experience

ADAWA is proud to sponsor students to go on volunteerism trips with the Kimberley Dental Team. Three recent student volunteer scholarship recipients share their experience with us.

ANOOSHREE KATWE

Tell us about your experience with the Kimberley Dental Team I was somewhat aware of the health inequalities faced by the Aboriginal and Torres Strait communities, but that was the extent of my knowledge. After senior students recalled the incredible time they had with the Kimberley Dental Team and the commitment the program has in helping people disadvantaged by barriers to dental care, I knew I had to apply. I was lucky to be one of the six students selected and scheduled to join the week two team from May 21 to 28.

Over the course of the week in the Kimberley region we travelled to Warmun, Halls Creek and Frog Hollow

excitement on their faces when they meet Craig the Croc or when they tell us they brush their teeth every day is invaluable. I also enjoyed going on the Instagramworthy Danggu Geikie Gorge boat tour along the mesmerising Fitzroy River.

What has this volunteering experience taught you that you think will be valuable as a future practitioner? Some take-home lessons that this volunteering experience taught me is that although limited accessibility to powered equipment can be challenging, treatment such as fissure sealants and atraumatic restorative treatment can still be provided, given careful case selection. Secondly, KDT has solidified my passion for volunteering, which I believe can be a humbling change to private work. Whether it is a one-month long project overseas or a week’s stint in rural WA, I hope to continue volunteering throughout my professional career.

where we would set up clinic and treat as many children and adults as we could. Due to Jan and John’s perseverance over the years, KDT was well-known in the communities so there was a long line of people waiting to get their teeth checked. A lot of people would come with long-standing and severe toothaches because of their limited access to dental care. Treatment was versatile and ranged from fissure seals to extractions to stainless steel crowns. We even had a couple of patients tear up from glee after seeing their aesthetic anterior restorations! The beautiful faces, joyful smiles, and kind spirits of the people we met was worth the long days and working under the sweltering sun. I felt extremely fortunate to be making a difference.

What were some of the highlights? Highlights from KDT included visiting Ngalangangpum (Mother and Child) School in Warmun and Purnululu School in Frog Hollow and providing oral health education and dental screening to students. We would go into each class, teach children good oral hygiene habits with the help of the KDT mascot Craig the Croc and one-by-one identify children that required dental treatment. Seeing the

Do you have a message to ADAWA about receiving funding for the trip? I am very appreciative to the ADAWA for providing me with this generous grant and consequently the opportunity to be a part of KDT. It was truly an invaluable experience, the highlight of my final year and certainly one that I will never forget.

Do you have a message to The Kimberley Dental Team about this experience? I would like to thank Jan and John Owen, Dr Jilen Patel and the rest of the talented team for making my experience at KDT so pleasant. By the end of the week, we felt like one big family! The dedication and hard work of the KDT volunteers is what sustains this organisation.

What would you say to other students thinking about joining the Kimberley Dental Team on a future trip? I could not recommend applying for KDT more to students who are considering volunteering. It is very rare that you will be able to get the chance to practise remote dentistry in the backdrop of the picturesque Kimberley landscape alongside amazing practitioners and nurses. Just be prepared for the cane toads!

The beautiful faces, joyful smiles, and kind spirits of the people we met was worth the long days and working under the sweltering sun.

MASOOMA HASHIMI

Tell us about your experience with the Kimberley Dental Team. During the week I was with the Kimberly Dental Team, we were based mostly at the Halls Creek School with treatment focused on children. We were fortunate to have with us two paediatric dentists (Dr Patel and Dr Gilani) who also took the time to teach the students whilst treating the children! The first two days were spent systematically screening the students and the remainder of days were spent on delivering treatment. Working with the Kimberly Dental Team was a once-in-a-lifetime experience. Seeing a classroom turn into a makeshift dental clinic that maintained a high level of professionalism and infection control was very impressive. At the same time, being a part of the solution, and providing treatment to children in pain and in need gave me the greatest sense of accomplishment during my Dental School journey. The team became like family almost instantly, both in clinical setting and at home in the evenings all together. Jan and John welcomed us into their home and their lives and created an instant atmosphere of support and love.

What has this volunteering experience taught you that you think will be valuable as a future practitioner? The experience volunteering with the Kimberly Dental Team has acted as a true reminder of what it means to be a dentist, our highest purpose, and our role in helping communities. My time with the community in Halls Creek helped me further develop my communication skills. Finally, working with a predominantly Indigenous population was a new experience for me and something I believe every student should have the opportunity to experience.

The experience volunteering has acted as a true reminder of what it means to be a dentist, our highest purpose, and our role in helping communities.

Do you have a message to ADAWA about receiving funding for the trip? I can’t begin to thank ADAWA enough for the scholarship and allowing me to be a part of a wonderful team. This experience has truly been the highlight of my time at Dental School, and I am so grateful to ADAWA for proving me the opportunity to volunteer in this capacity.

Do you have a message to The Kimberley Dental Team about this experience? Thank you, Jan and John! Your ceaseless efforts and unwavering contribution to the field of rural dentistry has left a legacy with numerous past students becoming better clinicians as a result of The Kimberly Dental Team trips.

What would you say to other students thinking about joining the Kimberley Dental Team on a future trip? Apply! Don’t let financial or circumstantial barriers deprive you of this wonderful opportunity. The KDT and ADAWA are so accommodating and helpful in overcoming whatever may be holding you back from applying. It is the most rewarding experience you will have as a dental student!

ZEIDRI RASMUSSEN

Tell us about your experience with the Kimberley Dental Team. Spending a week with the Kimberly Dental Team in Halls Creek was a truly invaluable experience, and the highlight of my time in Dental School. It really gave me a tangible appreciation for the disadvantage rural and remote Indigenous Australians have in accessing dental care and the burden of poor oral health they face as a result. It was really encouraging to see the positive impact KDT has had on the dental health of the community in Halls Creek, and how excited the community was to see John and Jan as well!

It really gave me a tangible appreciation for the disadvantage rural and remote Indigenous Australians have in accessing dental care and the burden of poor oral health they face as a result.

What has this volunteering experience taught you that you think will be valuable as a future practitioner? This experience taught me how valuable volunteer services can be for communities who otherwise have no easy means by which to access dental care. It has sparked in me enthusiasm to commit to dental volunteering opportunities regularly in the future.

Do you have a message to ADAWA about receiving funding for the trip? Having the privilege to join the KDT for a week is an experience that I will remember long into my career.

Do you have a message to The Kimberley Dental Team about this experience? Thank you so much to Jan and John for inviting students to participate in the KDT trips and making us feel like valuable members of the team. The energy, time and love you both invest into making the KDT trips possible is inspiring. I hope to join you guys in the Kimberly again in the future!

What would you say to other students thinking about joining the Kimberley Dental Team on a future trip? Definitely apply! KDT is such a great experience; you won’t regret it.

The annual Young Dentists’ Conference will be back on Saturday November 5 and is set to be the not-to-be-missed event for new practitioners.

ADAWA’s Recent Graduates Committee has worked tirelessly throughout the year to provide recent graduates with a world-class New Practitioners Program – featuring indemand speakers at a series of study clubs, where practitioners who have graduated within the last five years can learn and ask questions in a safe and supportive setting. The study clubs have been very popular, so it is no surprise that to end the year they have planned a free conference that recent grads will not want to miss.

Chair of the ADAWA Recent Graduates Committee and co-organiser of the conference, Dr Bec Penco, says attendees can expect a wide variety of topics covered with a risk management theme that they can put into practise straight away.

“We have tried to reach out to people who haven’t spoken for us before, so there are some exciting, fresh faces in the line-up,” she adds.

THE EVENT WILL FEATURE SOME OF THE FOLLOWING SPEAKERS AND TOPICS:

Dr Simon Parsons: Risky Business

Dr Kang Kim: The Art and Science of Staff Communication

Dr Jee-Yun Leung: Tips on Effective Communication from a Special Needs Dentist

Dr Annalene Weston: Human Error and Bias Dr Mohammed El Hakim: Communicating with Compassion

Dr Vivian Mascarenhas: Safety with the Sedated Patient Dr Vincent Goh: Rubber Dam and CAD CAM workflow

Round Table Discussion

Managing Patient Complaints with Dr Amanda Phoon Nguyen, Dr Parnian Zareie, Dr Leon Smith and Dr Colm Harney.

Sponsored by DPLA, the event has a risk-management focus, and will include a round table discussion about formal complaints, which Bec says will be very beneficial to attendees. “Statistics say that legal action against health professionals is on the rise,” she says. “Hearing that other people have gone through it and how they managed these formal complaints is really unifying.”

Bec adds the conference is also a fantastic networking and social event for young WA dentists, with the social event after the YDC last year (featuring food trucks, fairy lights and music) incredibly popular. “It is very easy for us to become isolated in our work,” she says.

“It is great if we work in group practice, and we have lots of other dentists around us, but we tend to take on the opinions of the other dentists and this can lead to becoming narrow-focussed. It is nice to branch out and have these social events so you can talk to people about what they are doing and what CPD they have been going to and to broaden your horizons that way.

“We also find if you see a presenter do a quick 45-minute talk and you see what a fantastic lecturer they are, you are more likely to sign up for their full day hands-on course when you see that advertised in the future. It is a good way of having a taste of our local lecturing talent.”

As a new practitioner herself, Recent Graduate Committee member, Dr Parnian Zareie, says attending the YDC is a no-brainer.

“The fact that an event like this can be free is really beneficial,” she says. “We will have good food, and the after social part is really fun. With an amazing line-up of speakers, and the opportunity to have a great day with colleagues, everyone should come.”

She adds the New Practitioners Program study groups have been very helpful throughout the year. “There are so many helpful tips that you learn through the study clubs – especially about communication and tips and trick. These are things people have picked up from doing dentistry for a long time, as opposed to things you learn from a textbook during university.

“It has also been a good opportunity to connect with more experienced dentists and specialists that are happy to help. It is good to have those connections with people and know that you can reach out to them if you need to.” There is also the chance to win some great prizes, including an Apple Watch, provided by DPL. Bec adds the committee is busily creating the NPP program for 2023, and are hoping to get some international speakers as well as local talent.

Thank you to Drs Bec Penco, Amanda Phoon Nguyen, Sean Archibald, Greg Crane, Ching Wen Tan and Parnian Zareie for all of their work to make the NPP study clubs and the YDC such a success.

To book your spot for the free Young Dentists’ Conference on November 5, go to adawa.com.au/npp

Dr Michael Mandikos Meet

Prior to his upcoming courses for WA Dental CPD, we caught up with Dr Michael Mandikos.

Prosthodontist Dr Michael Mandikos initially studied dentistry with the intension of switching to a medical degree, but within a couple of years he realised dentistry was the path he wanted to take.

He received his Bachelor of Dental Science Degree with First Class Honours from the University of Queensland in 1992. “I was fortunate back then find a job in private practice on the Gold Coast, with two very well-established dentists,” he recalls. “They taught me a lot and helped inspire me to think ‘big’ about cases –to think beyond treating individual teeth and thinking instead about the patient and their mouth as a whole. It helped cement my desire to do Prosthodontics.”

Michael went on to do a three-year Residency Program at the State University of New York at Buffalo, graduating with a Certificate in Prosthodontics and Master’s degree in Biomaterials. He has researched composite resin materials extensively and is an indemand speaker and lecturer within dental circles both within Australia and internationally, with his impressive lecturing CV including Unconventional Conventions in Tanzania and Antarctica.

Michael will be heading to Perth in March 2023 to present two courses:

Anterior Composite Workshop – a workshop that will cover clinical tips and techniques, but also delve into the often-challenging topic of Shade Matching. Michael will discuss the importance of opacity/translucency as distinct from colour alone, to assist participants in selecting the right shade when trying to match tooth structure, and to allow them to select the right composite system for use in their own practice.

Perfect Posterior Composites – a comprehensive workshop that will review the role of Bulk Fill materials

as well as the dentine bonding agents presently in the market with their respective advantages and possible pitfalls. The main causes of post-operative sensitivity with posterior composites will also be addressed.

“Both of these workshops are designed to provide a predictable technique for each application, that is as simplified as it can be, yet still achieve more than a basic outcome,” he explains. “There is also theory addressing a few common clinical side effects or post-operative complications that you see with these techniques.

“You always get the best result in your clinical procedures if you don’t just follow the technique, but you understand the material as well,” he adds. “Then you know what it is meant to be doing on the tooth, so I make the point of explaining that it is important to have a good understanding of the materials.”

For Michael, who also works three days a week at Brisbane Prosthodontics, educating others is very rewarding. “I am grateful for the mentors I have had and for being able to meet some really amazing clinicians and educators,” he says. “What you get from someone who is not only passionate about what they do, but also a good communicator and a good teacher, is that desire to also share that experience and knowledge.

“If you can help people to extend their skills (and do it in a way that they can actually achieve what you are teaching them) it is a really satisfying experience.”

You always get the best result in your clinical procedures if you don’t just follow the technique, but you understand the material as well

What three words best describe you? “OCD,” he laughs. “I think I am meticulous and methodical. I like that idea of work hard and then rest. I would be happy to do two 20-hour days and then have the rest of the week off rather than do 9-5, five days a week. I like to work with some intensity, get it right, and then really enjoy the downtime that I feel I have earned.”

If you weren’t in the dentistry field, what would you be doing for a living? “Dentistry wasn’t something I set out to do but a lot of doors have opened and it has been very good to me,” he says. “When it comes to earning a living, I honestly couldn’t imagine doing anything else. In terms of doing something else to occupy my time and let someone else pay the bills, I would be thinking about something agricultural. My parents have a hobby olive and grape farm. It doesn’t produce any money – we make oil, and we give it to friends and family – but I would love to do that fulltime if someone else made the ends meet.”

What do you enjoy doing in your spare time? “Lecturing tends to provide the opportunity to go to places, like Perth, and (when the kids allow) my wife will come with me and we’ll make a couple of days of it. We can often use these little trips as a break from everyday life and see some lovely places both in Australia and overseas, and we can get to go to a number of nice restaurants.”

What is your favourite musician? “I like what I refer to as classic music, not classical but classic of my age period, like Van Morrison and Jackson Browne. I’m a big fan of Ray Charles.”

What future plans are on the horizon for you? “I have five kids and one on the way, so I am too young and too committed to retire,” he laughs. “There will probably be an extension on the teaching side of things and a slight scale back on clinical treatment in the future.”

November

First

Graham Carmichael and Clin A Prof Dr Glen Liddelow

Branemark Centre

Dentists' Conference

House

to the Future! Silver Diamine Fluoride

Jilen Patel University Club

of Exposed Roots and Implants

Adj Assoc/Prof Tino Mercado University Club

Draping in the Dental Office

Reilly & Dr Roslyn Franklin UWA Dental School

Control in the Dental Practice Dr Steven Parker UWA Dental School

Control in the Dental

Steven Parker UWA Dental School

OCTOBER

Dental Sleep

Details to come

Prep, or Not to Prep

Dr Clarence Tam

UWA Dental School

SAVE THE DATE

Simple Posterior Composite Restorations

Dr Clarence Tam UWA Dental School

Needs Dinner

Drs Jee-Yun Leung and Trudy Lin University Club

Composite Workshop

Dr Michael Mandikos

UWA Dental School

Perfect Posterior Composites Dr Michael Mandikos UWA Dental School

Dentition

Dr Vanessa William UWA Dental School

Oral Medicine Rojak

Drs Amanda Phoon Nguyen & Tom Huang Carlton Holtel, Singapore

Brain – Nutrition Workshop

Julie Meek

Simple Predictable Posterior Composite Restorations

Michael Chan

Simplified Clinical Endodontics

W/Professor Paul Abbott UWA Dental School

The Halitosis Pathosis: Diagnosis, Prognosis & More

Drs Amanda Phoon Nguyen & Melanie McAlpine University Club

Hands-On Extraction

Professors Raymond Williams & Dieter Gebauer CTEC UWA

Stress Management Alex Hof - Details to come

SAVE THE DATE

Practical Oral Surgery for Your Practice Dr Barbara Woodhouse ADA House

Those Pesky Problems

W/Professor Paul Abbott Hilton Garden Inn, Albany

LEC T URE

COURSE OUTLINE

Since its development in the 1960s, silver diamine fluoride (SDF) has been widely used and studied across the globe. Over the last decade, there has been a renewed interest in the use of SDF for the management of high-caries-risk patients, medically compromised patients, in settings with limited resources, and as part of techniques such as SMART (Silver Modified Atraumatic Restorative Technique). For the first time, a recommendation on the use of SDF has also been included in the recent 2019 ADA Fluoride Guidelines. Furthermore, the advent of COVID-19, and the need to minimise aerosols, has led to further traction and debate on the role of SDF in dentistry. This presentation will shed light on the history behind SDF, the mechanisms of action of SDF, the current evidence from both invitro and clinical research, and discuss its rationale for use in contemporary dental practice.

LEARNING OUTCOMES

Following this presentation, delegates should be able to understand:

• the history and mechanisms of action of SDF

• the indications and contraindications for the use of SDF

• how to use and apply SDF and informed consent issues.

Back to the Future!

Diamine Fluoride: history, current evidence and treatment recommendations

10 November

University Club

ABOUT THE PRESENTER

Dr Jilen Patel is a specialist paediatric dentist who completed his postgraduate training at The University of Western Australia and Princess Margaret Hospital for Children. He is a Senior Lecturer in Clinical Dentistry at the UWA Dental School and Consultant at Perth Children’s Hospital. Jilen has been awarded and has previously received both the both the Royal Australasian College emerging lecturer award and Australian Dental Association/Pierre Fauchard Academy’s young lecturer award. Jilen was also named the 2019 West Australian Young Achiever of the Year Award recognising his work with vulnerable and medically compromised children and his volunteer efforts in remote Kimberley communities.

Jilen is both a clinician and an academic actively involved with the provision of on-call and emergency services at PCH as well as teaching and research in the field of dental traumatology.

Silver Diamine Fluoride – it’s back! To book, visit adawa.com.au/cpd

Suyash Dwivedi

Coverage of Exposed Roots and Implants: Overview, Indications, Options and Clinical Techniques

16 November

from 6.15

6.30 pm to 9.30

LEC T URE

COURSE OUTLINE

This didactic course is designed for clinicians who would like to learn soft tissue problems, diagnosis and management options. The didactic component includes discussion of the presenter’s own published research on root coverage and detailed instructions on the indications and performance of coronally advanced flap. It also covers when to incorporate autogenous grafts or xenografts to manage exposed tooth roots and dental implants. The course will also touch on use of biologically active materials, such as enamel matrix derivative as adjunct to the surgical procedure. Techniques to harvest autogenous grafts for different indications and new and advanced techniques for soft tissue grafting around implants will also be covered.

ABOUT THE PRESENTER

Adj Assoc/Prof Tino Mercado is an experienced Periodontist working both in private practice and as an Adj Assoc Professor at the University of Queensland. He is the Vice President of the Australian and New Zealand Academy of Periodontists and Vice President of Pierre Fauchard AcademyNSW. His PhD topic and latest publications are on predictable management of peri-implantitis and management of periodontal recession on teeth and implants using autologous and alternative tissues. Tino recently received the Australian Dental Association NSW Service Medallion award for 2022.

His last clinical research on maxillary anterior ridge preservation won Best Clinical Research at the last Osteology World Symposium. His clinical research on recession management of more advanced gingival recession (Miller Class III-IV), using CTG and enamel matrix derivative, won best research at the last Biennial Meeting of Australian Society of Periodontology held in Perth.

Soft tissue problems, diagnosis and management options

To book, visit adawa.com.au/cpd

ADAWA works closely with a number of partners and affiliates, resulting in strong relationships with like-minded organisations and associations. We also work with par tners to provide member benefits for ADAWA members, including discounts on advantageous products and services.

DENTAL STOCK PHOTOGRAPHY

Access unique and accurate dental images for your presentations and all your practice marketing via Dental Stock Photos. ADAWA members are eligible for a 20% discount off the Recommended Retail Price to purchase photographs. Go to dentalstockphotos.com/pages/adawa to find out more.

BUNNINGS TRADE

Bunnings Trade and ADAWA are delighted to announce a partnership which gives you the opportunity to join the PowerPass Membership Program. To sign up or link your existing PowerPass account, please contact OrganisationsWA@bunnings.com.au

WA ENERGY

Local company WA Energy is stepping up to offer ADAWA members big discounts on dental practice energy bills. ADAWA members are eligible for new energy pricing and to have smart solar installed for $0 upfront. Email sales@wa.energy or call 08 6141 3252.

INVEDENT

ADAWA wants to support your practice with an easy to use and easy to implement system that enables you to manage your supply ordering and stock hassle-free. That’s why you’ll get 10% off Invedent as an ADAWA member. Visit invedent.com

AMA FINANCIAL SERVICES

ADA members are eligible to receive up to $2,000^ cashback on top of the cashback offer from the bank or lender (if eligible) on home loans successfully settled between 1 January 2022 and 31 December 2022. Phone 1800 262 346 or email info@amafinance.com.au to find out more.

ONDA

As one of ADAWA's valued corporate partners, ONDA provide timesaving services to our members, which are tailored to the busy dental professional.‍ Until the end of the financial year, ONDA are offering our members a 15% discount on all new sign-ups to their financial admin services. Contact george@ondagroup.com.au to book your free consultation.

VPG

Boutique commercial property company, VPG Property, is partnering with ADAWA to look after our members’ business and personal property needs. VPG Property is offering a free initial property consult to ADAWA members. vpgproperty.com.au

Romosozumab A new medication to recognise

BY DR AMANDA PHOON NGUYEN Oral Medicine Specialist

In the most recent American Association of Oral and Maxillofacial Surgeons’ Position Paper on Medication-Related Osteonecrosis of the Jaw - A 2022 Update, readers may have noted the mention of a new implicated medication.

Romosozumab is a new monoclonal antibody used for fracture prevention in osteoporotic patients. In Australia, the brand name of this medication is Evenity. It is given via subcutaneous injections monthly and takes about three months to reach a steady-state concentration. As the effect of romosozumab wanes, the drug is recommended to be ceased after 12 months, and transition to an antiresorptive therapy is required to preserve bone mass.

Romosozumab works via the Wnt pathway by binding to and inhibiting sclerostin, resulting in increased bone formation and decreased bone resorption. Sclerostin is produced by osteocytes and has bone resorptive effects; if sclerostin is blocked, bone density increased.

Adverse events may include arthralgia, muscle spasms and headache, injection- site reactions and hypersensitivity. Cardiovascular adverse effects have been reported, and Romosozumab should not be used in patients who have had a stroke or myocardial infarction in the previous year. MRONJ has been reported. At this stage, there is a paucity of data on the association and risk estimate of MRONJ associated with Romosozumab, although it is reported to be lower than that of Denosumab and more aligned with that of bisphosphonates. More research is required.

Patients who are about to commence therapy on Romosozumab and other implicated medications should be counselled regarding MRONJ risk. Preventive oral care methods combined with effective oral health practices are associated with a lower rate of MRONJ. It is strongly recommended that patients see a dentist prior to therapy to ensure that any teeth of questionable prognosis are assessed and extracted if necessary, with adequate healing time. Any dental prosthesis should be well fitting in order to reduce trauma. Dental screening, prophylaxis, oral hygiene instruction, tobacco and alcohol cessation counselling, and timely treatment is recommended to reduce risk.

References available and feedback welcome via amanda@pomds.com.au

FURTHER READING

Oral and Dental Expert Group. Therapeutic guidelines: oral and dental. Version 3. Melbourne: Therapeutic Guidelines Limited; 2019. Ruggiero SL, Dodson TB, Aghaloo T, Carlson ER, Ward BB, Kademani D. American Association of Oral and Maxillofacial Surgeons’ Position Paper on Medication-Related Osteonecrosis of the Jaws-2022 Update. J Oral Maxillofac Surg. 2022 May;80(5):920-943. doi: 10.1016/j. joms.2022.02.008. Epub 2022 Feb 21. PMID: 35300956. Teoh, L.; Moses, G.; Nguyen, A.P.; McCullough, M.J. Medication-related osteonecrosis of the jaw: Analysing the range of implicated drugs from the Australian database of adverse event notifications. Br. J. Clin. Pharmacol. 2020, 87, 2767–2776.

An area of exposed bone involving the lower right mandible in a 72-year-old female who received denosumab (Prolia®) injections

RISK FOR MRONJ AMONG OSTEOPOROTIC PATIENTS (Ruggeiro et al. 2022)

Bisphosphonates 0.02 percent to 0.05 percent Denosumab 0.04 percent to 0.3 percent Romosozumab 0.03 percent to 0.05 percent

WANT A HANDY RESOURCE WITH UP-TO-DATE INFORMATION ON MRONJ?

The previous guide to MRONJ has been updated by Drs Leon Smith and Amanda Phoon Nguyen in keeping with recent literature, including information from the American Association of Oral and Maxillofacial Surgeons’ Position Paper on Medication-Related Osteonecrosis of the Jaw - 2022 Update. Download your copy at adawa.com.au/membership/resources

The rise of the machines

BY DR COLM HARNEY Dentolegal Consultant

Drip, drip, drip ... technological advances are moving into the dental space, becoming ever more efficient, and this is exciting news for patients and practitioners everywhere. Digital cameras, 3D scanning, digital radiographs – these are tools of daily practice that most of us take for granted now. However, at risk of showing my age, none of these even existed for practitioners when I graduated as a Dentist.

But what about the next step? What is looming on the horizon? How many bank tellers 20 years ago would have forecast the way a local bank looks right now – we now don’t think twice about standing in line to interact with a machine built into the wall?

The Center for Global Policy Solutions produced a report in 2017 stating that “more than 4 million jobs will likely be lost with a rapid transition to autonomous vehicles”

(1). This has proven to be premature as the date for fully autonomous vehicles keeps getting pushed back, but there is no doubt with the drive (no pun intended) of visionaries like Elon Musk and his competitors this is a sure bet. What about dentistry – how vulnerable are we in our day-to-day practice to the rise of the machines, and what might the downstream implications be?

I have a keen interest in this area and have listened to a number of medical and dental radiologists speak about this over the years – they really are at the front line of this phenomenon. Take an image, run it through software, which can access a database with millions of comparable images, and out the other end comes a report with none of the flaws relating to human error, biases and any other foibles of the wet-brained human viewpoint.

Each radiologist has responded by acknowledging the advances and saying that where the human still adds immense value is stepping out of the dark room and away from the computer screen to interact and

communicate with the patient - interpretation and explanation of data to assist the patient (and referring practitioner) understand, differential diagnoses, what happens next, and all this information delivered with empathy, care and consideration. This is where their value is added by their role as living, breathing, human specialist experts.

This progression has now reached the doors of the dental practice. Pearl, a dental AI company has produced ‘Second Opinion’ which, as of March 2022, claims to be “the first and only chairside FDA-cleared AI radiologic detection aid that can help dentists identify numerous common dental conditions.” (2)

As dental professionals it is hard to envisage a scenario where AI takes over all our primary technical tasks, however, recall those bank tellers and the 4 million humans driving for a living whose jobs are in the firing line. It is worth considering that we could be sleepwalking to a time, not very far away, when a machine in a shopping mall booth will 3D scan and image a patient’s mouth and they will leave 5 minutes later with a detailed, accurate, itemised treatment plan in their hands and continue with their day.

Right now, our clinical skills are still required and very much in demand, and we must continually work to understand and improve our knowledge of what we are able to do in terms of diagnosis, treatment planning and provision of care. The machines are coming, and as the evidence points to the increasingly superior performance of the technology and machinery, a tipping point will be reached where it will no longer be clinically justifiable that a human carries out certain procedures (witness the boom in scanning and milling already which, in the right hands, is getting closer and closer to what the best human can do).

As sophistication increases and capital costs decrease, the machines will become more and more attractive to practice owners as they won’t require lunch breaks, sick days and over time. Neither will they develop a bad back nor suffer declining eyesight.

It is also equally, if not more, imperative that we continue to understand and improve our communication skills – the so called ‘soft skills’ –which is what patients really relate to when they visit us. Patients don’t understand what we obsess about - chamfered margins, selective etching, filler size or perfect cusp shaping and fissure staining. They understand that we asked about their recent holiday, listened to their concerns, gave them appropriate choices and autonomy, creating a relationship based on trust and mutual understanding.

Ultimately, how effectively we communicate conveys that we are acting in their best interests. When they experience this, they will be much more likely to return for treatment, comply with instructions, and recommend friends and family. The literature is clear from multiple sources that they are much less likely to make a complaint, even if something goes wrong.

In relation to the advance of technology, we, as a profession, should start to consider possible implications for our job descriptions, standards of care for our patients and even the overarching ethics of dental practice. Indeed, Federal ADA has already given this matter consideration and has released a policy statement relating to this very area (3).

Which procedures / aspects of dental practice will be more suited to AI / machine replacement?

What degree of professional and regulatory oversight is required? We already have a cohort of patients bypassing the ‘bricks and mortar’ based professional

and choosing to go online to purchase kits for whitening and orthodontic aligners, with varying degrees of professional oversight.

Should there be a requirement for the machines to demonstrate an equivalence or net benefit over the current accepted standard of care – a dental equivalent of the Turing test?

What will patients prefer and what will precipitate the ‘tipping point’ – price, convenience, guaranteed accuracy, painlessness?

So, the next time you telephone your bank and sit on hold for 30 minutes waiting to speak to customer service, which will often initially be a machine (select from options 1-4 and press #), think about the value you add in your role in the human-to-human interaction with your patients. It costs nothing to greet them with a smile, ask about their day and demonstrate that you care in a myriad of different ways, all before picking up a handpiece. Just like the radiologists, your valueadd is if you can deliver this service in a manner that demonstrates your empathy, care and consideration. Dentistry is still a relationships business. Perform this aspect of the role well, with purpose and intent, and not only will you enjoy a fulfilling career with more satisfied patients and less complaints – ultimately, when the time comes, those patients who value and trust your care will stick with you and forego the shiny white treatment pod coming soon to a shopping mall near you.

Health Fund Audits

They can’t do that … can they?

BY DAVID MCMULLEN

“Whoever controls the volume of money in our country is absolute master of all industry and commerce.”

JAMES A. GARFIELD

20th President of the United States of America

Health insurance funds in Australia pay in the vicinity of $2 billion towards dental services annually1. An intrinsic part of the way dental services are funded in this country, insurance monies do come with strings attached: Put simply, health funds hold the money, they pay out the money, and they prescribe terms and conditions on which that money is paid out.

The health funds would not be meeting their responsibilities if they didn’t do business with a degree of rigour. But for dentists – like any ancillary provider – this means not just having to comply to receive funding, but also the possibility of being audited for compliance after the fact.

Audit by a health fund can sometimes come as a surprise – even an imposition – to a dentist who has carefully treatment planned, completed work for a patient, and settled their account.

The fund’s right to audit and take other measures to ensure compliance with fund requirements, has contract at its core. Exact legal rights and responsibilities will be heavily dependent on the health fund you are dealing with, and the agreements, arrangements, and course of conduct (if any) you have developed with them. There are, however, some typical features found in the terms and conditions of common health funds.

It is more likely than not, that if you receive funds from a health fund, they will have carefully ensured for themselves the right to audit you from time to time – and recoup wrongly paid monies – so that everything runs as it should, for the benefit of their members.

WHAT CONTRACT? I DIDN’T AGREE TO THIS!

You might be the owner of a practice that has entered into an agreement with a health fund. This is the most straightforward scenario: Consult the agreement you signed, to understand the fund’s audit rights, and your obligations in respect of the same.

A related but different scenario is that you might be a dentist who works at a practice that has an agreement with a health fund. You may not have signed anything personally. In this situation, enquire after something termed a ‘Dental Provider Agreement’ or similar, entered into at a practice level.

• This type of agreement typically sets out the terms on which dental providers at the practice will provide services to patients who are fund members; and also, the mechanism by which the fund will pay benefits to members.

• To ensure individual practitioners at participating practices are covered by these arrangements, the approach taken by at least one of the prominent health funds, is this: The practice agrees to ensure that practitioners working at the practice are made aware of, and will agree to comply with, the terms of the practice’s agreement with the health fund.

• The ‘privity of contract’ doctrine means that only parties to a contract can enforce it or be bound by its terms. But the health fund in the scenario we have described essentially sidesteps the need for the fund itself to have a direct contractual relationship with each practitioner. The fund relies on the practice to ensure that its practitioners do what is required by the health fund. For this to work effectively a suitable agreement is needed between the practice and each practitioner. Although beyond the scope of this article, as a guide, look for clauses which require the practitioner to follow reasonable directions, adhere to practice policies and procedures, keep good records, and provide information to the practice (for example).

Another scenario is that you may be a dentist who has never signed an agreement with a health fund, and whose practice has not signed an agreement with a health fund.

• A fund paying out a benefit in these circumstances will probably have ensured they are doing so under a suitable set of terms and conditions, nonetheless.

• Recall whether you have ever received notice of any ‘recognised provider terms and conditions’ or similar. Specifically, these types of terms and conditions should have been expressed to apply when a fund pays a benefit, and a provider accepts (or a patient claims) payment of a benefit.

• A practitioner might rightly ask how it is that they can be bound by the terms of an agreement when nothing has ever actually been signed. The answer lies in some basic principles about the formation of contract: Generally, this requires offer, acceptance, an intention to be legally bound, and certainty of terms. Where the requirements are met, it is possible for a valid and enforceable contract to exist – even if not recorded in writing. This is a very fact specific exercise, however, as a party will generally not be bound by the terms of a contract if they did not have notice of those terms or have an opportunity to read them before entering into the contract. Relevant considerations may include: whether the party asserting the existence of, or seeking to rely on, a contract did what was reasonably sufficient to give the other party notice of the contract; and whether there was a consistent course of dealing between the parties.

If you have never seen, or even been notified of, a health fund’s terms and conditions, and your practice does not have an agreement with the fund, it is conceivable you might be able to refute the existence of a contract (or particular terms). This would require specific advice; and in any case, whilst it might be a strategy of some use regarding past payments, it is unlikely that you could continue to reject a fund’s terms and conditions on the one hand and continue receiving benefits from them on the other.

•

BUT WHAT GIVES THEM THE RIGHT TO AUDIT ME? The answer here depends on the health fund in question, and the nature of the agreement(s) with them. Assuming you have identified a relevant agreement or agreements, look for a framework of provisions resembling the following:

For each eligible service rendered by a practitioner the fund agrees to pay a benefit, subject to the terms of the agreement.

• Payment of the benefit may be conditional on the provider supplying sufficient information to satisfy the fund of the circumstances of the treatment.

• If the fund reasonably considers that a treatment has not been provided as claimed, or that an account or receipt is incorrect, it may have the ability to withhold payment of a benefit (pending satisfactory evidence, or correction of the error).

• If the fund reasonably considers that an incorrect benefit has already been paid, or that a benefit should not have been paid or was otherwise paid in error, the fund may have the right ask for substantiating evidence or information; and/or it may be able to give notice requiring repayment of the incorrect amount.

• To monitor compliance, and identify incorrect benefit payments, a health fund needs to have audit as a tool at their disposal. Expect to find an audit right (on the part of the fund), coupled with obligations (on the part of the practice or practitioner) to maintain appropriate records to substantiate services claimed, comply with reasonable audit requests, and provide information for audit purposes.

• As with any contract, breach of an agreement with a health fund (whether that be a breach identified during an audit, or a breach of the audit procedures themselves) will usually result in termination if the breach cannot be or is not rectified. Post-termination, the end result for you and your patients will be that the payment of benefits will cease.

CAN I SUE THEM?

The sometimes-fraught relationship between dentists and health funds is not lost on us. Recall campaigns such as ‘Time2Switch’2, and statements such as the following3: ‘While its role in providing rebates for dental, medical, and other services such as physiotherapy and optometry is now accepted as a standard part of modern practice, private health insurance is also responsible for causing problems for consumers and dental professionals alike with its lack of policy transparency and hard-tounderstand rebate procedures’.

Be this as it may, in simple terms, to successfully sue another party, you need to identify a cause of action – a legal wrong, or facts giving you the right to seek relief through the courts. If you have an agreement with (or are covered by the terms of an agreement with) a health fund, and they are correctly applying the terms of that agreement to audit you, then you are likely to struggle to find a compelling cause of action.

We stress that this is necessarily a general discussion only. Legal rights and obligations will always depend on the specific terms of contract between health fund and practice/practitioner, and between practice and practitioner.

There are also invariably other rules and requirements to be aware of, and follow, such as:

• fund rules registered with the Commonwealth Department of Health; • the terms of the electronic health claims system used by a practice.

Like all legal questions, you should therefore seek specific advice if you want to understand your own circumstances.

HIF

regarding

Health Fund Audits - please

Law team on (08) 9321 0522

1Australian Institute of Health and Welfare (2022) ‘Oral health and dental care in Australia’, AIHW, Australian Government, https://www.aihw.gov.au/reports/den/231/oral-health-anddental-care-in-australia/contents/costs.

2‘Time2Switch’: https://www.teeth.org.au/time2switch/Home.

3‘Time2Switch. Redefining the relationship with private health insurance’, https://www. ada.org.au/News-Media/News-and-Release/Latest-News/Time2Switch-Redefining-therelationship-with-priv

Frequently Asked Topics

The complexity of the Australian industrial relations system, alongside the various and rapid changes being implemented into the sphere of workplace law, can make it challenging for employers to maintain up-to-date and fully informed. The below article outlines some of the most common questions asked by practices and dentists of the ADA HR Advisory Service.

WHAT ARE THE MINIMUM RATES OF PAY?

Most recently, the ADA HR Advisory line has received a large number of questions surrounding the minimum wage increase, which was effected on July 1 2022.

The Fair Work Commission undertakes an annual wage review around 1 July each year. This directly affects the National Minimum Wage. This year, the National Minimum Wage increased by 5.2% which amounts to a $40 per week increase. As a result, the new National Minimum Wage is now $21.38 per hour which also equates to $812.60 per week calculated on the basis of a 38-hour week.

There have incidentally also been increases to the award minimum wage for most awards from 1 July. This means that from the first full pay period on or after 1 July 2022, the adult minimum award wages increased by 4.6% which again roughly equates to an increase of $40 per week and this figure is based on a 38-hour week for a full-time employee.

Other award wages including junior and apprentice wages which are calculated and based off the adult wages under the award, will also be increased proportionately. The ADA has published updated wage tables with the new rates.

HOW SHOULD SUPPORT STAFF BE CLASSIFIED?

Another common question surrounding the classification of dental assistants and other support staff. Under the Health Professionals and Support Services Award 2020 (HPSSA), the focus is less on classifying by duties and qualifications and more a reflection of the way work is performed. Employers should consider the level of accountability, responsibility and autonomy that their employee has, as this will be instrumental in classifying support staff effectively. The HPSSA does provide indicative titles which can be useful and effective for classifying the relevant staff and in the higher support services levels, a list of indicative duties are also provided. However, for lower classified staff the determination will be based on the employee’s competence.

WHAT IS THE DIFFERENCE BETWEEN SERVICES AND FACILITIES AGREEMENTS, AN INDEPENDENT CONTRACTOR AND AN EMPLOYEE?

The dental industry engages individuals in several ways. The first, and most common form of engagement is an employment relationship. This is where the practice has significant control over the performance of work, provides the equipment to employees and pays them at an hourly rate. Employees are not able to subcontract or delegate their work, and they bear no financial risk, as such risks are incurred by the business. Depending on the arrangement, employees have a standard or set hours of work and there is usually an ongoing expectation of work.

On the other hand, some practices choose to engage independent contractors as opposed to employees. An independent contractor has the ability to delegate and subcontract their work and works autonomously with extensive control over the work they perform, the location which they perform the work and their hours, and they bear any financial and commercial risks. Additionally, independent contractors often utilise their own tools and equipment and are not engaged for a rostered or a set number of hours, but rather they are engaged on the basis of completing specific tasks.

Independent contractor agreements and SFA’s are still two distinct models. An independent contractor is someone engaged to perform a service for the business: they are seeing the practice’s patients, and the practice is paying them a percentage of the patient receipts. Under an SFA, the relationship is based on one party essentially renting the space from the practice and paying a corresponding fee for this. Generally, a dentist under an SFA will see their own patients and carry on their own business from within the practice. It is a recommendation that independent contractor and SFA agreements are utilised for more established dentists, rather than new graduates.

CAN DENTISTS BE PAID ON A COMMISSION?

Employee dentists under the national system should not be paid on a commission only basis. The practice should be issuing a contract inclusive of a base retainer. The ensures that dentists are still receiving a payment that satisfied their minimum entitlements when, for example, the employee is away on leave or has not met the commission threshold for that set period. As dentists are generally Award- free, this base retainer can be calculated against the National Minimum Wage, which is $21.38 as of July 1, 2022. If a dentist is currently on a commission only arrangement, the Practice should consider utilising the commission with base retainer contract template available from the ADA HR Hub to ensure total compliance and reduce the risk of any penalties associated with.

DOES THERE NEED TO BE A WRITTEN CONTRACT?

While there is no legal requirement to have a written contract, it is deemed best practice to have one. A written contract, whether it is for an employee or a contractor, sets out enforceable terms and conditions. The relationship is described in writing and reduces the ability for matters to be left open to interpretation. As an example, explicitly requiring a certain notice period in a commercial contract means that the practice can rely on the terms contained within it, rather than having to resort to what will be considered reasonable. A further consideration is that in recent High Court decisions surrounding independent contractors, sufficiently describing the relationship in a written contract is key to ensuring that an individual is being treated correctly.

HR FEATURE

For more information on this article please call the ADA HR Advisory Service on 1300 232 462.

theWhen they are away from the practice, some of our talented ADAWA members are cooking up a storm in the kitchen.

We talk to some dentists with a passion for cooking.

Photo: MasterChef Australia

A TRUE MASTERCHEF

Deepali Behar is a passionate home cook when she isn’t chairside at her and husband Jordan’s Lakelands practice, and if there is any doubt about Deepali’s culinary talents, she has the MasterChef apron to prove it!

Deepali was a contestant on MasterChef Australia in Season 6. “I wasn’t going to apply,” Deepali recalls. “Jordan and I came out here on a working holiday visa from the UK and I really missed my Mum’s cuisine. We were obsessed with the show and Jordan said: ‘You’re a really good cook; why don’t you apply?’.

To her surprise, Deepali’s application was accepted, and she got through a first-round ‘Mystery Box’ challenge. “I was invited back the next day and told I could cook anything I wished but it had to represent me,” she says. “I cooked a vegetarian potato curry, traditional rotlis (flat bread) using a velan rolling pin that my grandfather had made, (he was a carpenter in Tanzania), dhokla and rice. The producers admired the techniques I used and said it was the best curry they had ever had. I was then invited to Melbourne, cooked in front of the judges and I was the second person to receive a coveted MasterChef apron.”

Deepali was away for recording for three months, and says the support from work, Jordan and their patients was invaluable. “I was working for Dr Michael Sturgeon at the time, and I was fortunate to have full backing from work,” she says. “They had a locum cover for me, which I was so grateful for, because there is no way I could have done it otherwise.

“They (the producers) loved my background; my mum is a fantastic cook, having grown up in Uganda and being of Gujarti origin the fusion of Indian and East African food is amazing. I was born in Wigan in the UK and being a dentist stood out a little too. I’m proud of my ancestry, upbringing and profession.

"Also, communication and working as a team was so important on the show, which is also important in dentistry, so coming from a background with those skills really helped.”

After leaving the show, Deepali started her own hustle, ‘Sugar and Spice: Deepali’s Delights’, selling a range of condiments including jams, chutneys, pickles, and spice mixes. It has been on hold since Deepali and

Jordan had children, but she still has her food safety registration if she decides to start it up again. Nowadays, cooking is for enjoyment and family. “I make random and weird cakes for my children,” she says. “The look on their faces when I’ve created a Boeing-A380, cactus or Bingo cake is priceless.

“As a family, we always sit at the dining table and eat dinner together at the end of the day to chat,” she adds. “It doesn’t have to be fancy; it just needs to taste good.”

Talking about food has also proved a good way to make Deepali’s patients comfortable. “I am proud of the fact I was on the show and every single day a patient will ask how to make something, or share a great food venue that they know I’d enjoy,” she says. “We have a beautiful patient who lived in Thailand, and she hand-wrote some recipes and gave them to Jordan to pass onto me. “It is nice because it humanises you,” she adds. “If you can break the ice with something relatable it can really help a patient, and most people love food.”

You can cook Deepali’s potato curry: bit.ly/3xLRb3L

Prosthodontist Dr Janice Kan says her and husband Sharin love food – from street food to fine dining. “We cook all types of cuisine from all around the world –Chinese, French, Spanish, Italian, Greek, Middle Eastern, South American, Japanese and South-East Asian,” she says. “We host dinner parties and often end up as organisers for many lunches and dinners for family and friend gatherings.”

Janice says she was born in the food paradise of Hong Kong, where she was mostly exposed to Cantonese cuisine. “Our family used to dine out throughout the weekend and my grandmother will involve us in the preparation of festive foods during Chinese New Year,” she says. “It is very much about bring the family together and celebrate around a dinner table.”

Although Janice grew up with a passion for food, it wasn’t until after she graduated from dentistry that she started cooking. When asked about her signature dish, she says her personal favourites are Mud crab with spring onion and ginger noodles, Tiger prawns vermicelli with XO sauce and Patagonian toothfish with lobster bisque.

“I think every dentist has a creative side to them and for me – my other avenues to express creativity are through interior design and food,” she says.

She adds her and Sharin love going to cooking classes together (she highly recommends Salt & Co in Perth) and planning culinary trips, both locally and aboard.

“Food for us is not just sustenance, but a fun and exciting process of creation, experimentation and bringing smiles and smirks to faces when they taste a mouthful of food and wish the moment will never end,” she says.

On the weekend, Janice says she loves getting fresh produce from the farmer’s market and creating something to enjoy with her family. “It’s often done over a glass of wine or cocktails, which I have recently learned from a cocktail gastronomy masterclass,” she says. “This is my retirement plan – staying in different cities around the world and experience it at a much slower pace than usual holidays.”

Dr Nick Boyd was not a fan of obituaries or fuss, so instead we offer a short tribute in appreciation.

Oral Pathologist, Dr Nick Boyd, served as the President of The Australian Dental Association of Western Australia from October 2000 to October 2002.

In his first President’s Report, Nick said he was taking up the position with a fair degree trepidation because he was following in the footsteps of a series of extremely capable Presidents, who had done a marvellous job of steering the Association trough some tricky times.

Nick needn’t have been concerned. He brought a passion to the role that did not go unnoticed. Through his great love of learning, Nick was vocal about the importance of continuing education and the importance

of supporting dental schools to give the best start to the students – the dentists of tomorrow.

With a quick wit, great sense of humour, and always with a smile on his face, he was popular with ADAWA staff, and left big shoes to fill by subsequent Presidents. He was a much-loved teacher and lecturer, so it is fitting he served as the Dean of the Dental School, the Head of School, and the Interim Head of School at UWA over different periods. His dedication (perhaps stemmed from his time in military service) was always noted in any role he took on.

Our thoughts go to his loving wife, Anna, his family, and his dear friend, Dr Gareth Davies.

Thank you, Dr Boyd.

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equipment to dentists in Western Australia. For a great deal backed by the most reliable and experienced service and support team in the state, call West Coast.

SPECIALISTS IN DARWIN

Some of our dentists escaped the Perth winter to sunny Darwin to present the much-anticipated CPD course, Specialists in Darwin. Thank you to speakers Drs Samy Francis, Greg Celine, Tom Huang, Amanda Phoon Nguyen, Nandika Manchandra, Leon Smith, David Hallett and Deon Naicker.

ADAWA GENERAL MEETING

It was great to see so many members at the recent General Meeting. Thank you to Clin A/Prof Glen Liddelow for presenting the lecture, Restoration of Traumatised Teeth. Please join us for the ADAWA General Meeting on Wednesday October 26. RSVP to adawa.com.au/membership/rsvp

THE DIFFERENCE

Congratulations go to Dr Zara Torre – her giving app, The Difference – was recently announced as a winner of the Squarespace Australia Make It Awards. Have you signed up to the app yet? It allows you to easily give to the causes you care about every time you shop. Go to the-difference.org/

FELLOWSHIP TO THE ACADEMY OF DENTISTRY INTERNATIONAL

A number of our dentists recently travelled to Melbourne where they were bestowed with a Fellowship to the Academy of Dentistry International. Congratulations to Drs Amit Gurbuxani, Tim Clair, Peter Duke, Amanda Phoon Nguyen, Gosia Barley and Drs Jacinta Vu and Dominic Longo (who were awarded in absentia).

The Fellowship in The Academy of Dentistry International is bestowed on dentists whose professional, civic, and related accomplishments are above-and-beyond towards the community and profession.

Get your practice accredited

IT'S EASIER THAN YOU THINK

Getting your practice

demonstrates your commitement to maintaining a high level of standards for the dental profession. Complying with National Safety & Quality

Services Standards is your benchmark.

THANK YOU TO OCEANIC DENTAL LABORATORY

A huge thank you to Oceanic Dental Laboratory for their outstanding and ongoing support of the ADHF and St Pat’s Oral Health Clinic team. Michael Moran and Nicholas Mann (pictured) and the rest of the Oceanic Dental Laboratory team are well-known within WA dental circles for their generosity.

Since the commencement of sponsorship of the ADHF WA branch in 2018, they have provided pro-bono laboratory services for an incredible 90 cases.

The support of Oceanic Dental Laboratory allows the ADHF and St Pat’s volunteer dentists to deliver free dentures and denture products for grateful patients, who would otherwise not have access to these services.

For more information regarding Infection Control and Practice

contact:

Andrea Andrys

MEMBER ADVISORY SERVICES andreaa@adawa.com.au

Spring Cup Kwinana Golf Club

The annual Spring Cup, sponsored by Health Practice Brokers, was played at the Kwinana Golf Club. Twenty-two intrepid golfers found their way to the outskirts of Kwinana, to enjoy a beautifully presented course, nestled within a bushland setting, including magnificent Tuart trees.

With the long weekend following and the Queen’s memorial holiday prior, a steady stream of golfers were enjoying the magnificent spring day. This made for a very slow and drawn out round. Heavily wooded fairways and fast, treacherous greens made for difficult conditions, resulting in unusually low scores.

The winner for the day was Graeme Washbourne on 32 points, taking the perpetual Spring Cup trophy on a countback from Simon Tee. In third place on 31 points was Nav Mahendran.

Garry Bishop from Health Practice Brokers presented the cup to Graeme at the conclusion of the round. Our thanks are extended to Garry and Health Practice Brokers for generously supporting this event.

Winners of the nearest the pin prizes were:

Swan Valley Dental Labs 6th hole Dean Martin Dentsply Sirona 14th hole Michael Welten

The Healthlinc 16th hole Nav Mahendran

Our next outing is the annual country trip, followed by our final event at Lake Karrinyup. Should you be interested to join the group for a friendly social game, please contact me at the email address below.

Good golfing, MICHAEL WHITFORD WADA Golf Captain dentalgolf@gmail.com

Health Practice Brokers 3rd hole

Michael Whitford

WADA GOLF

Bunnings

has all

members covered.

DR RACHEL CHYE SPECIALIST PERIODONTIST BDS, MFDS RCS (EDINBURGH), DCLINDENT (PERIO)UWA, MRACDS (PERIO)

We are excited to announce that Dr Rachel Chye has joined our team at Perio Dental. Referrals are welcome and we look forward to caring for your patients. Please contact our office if you require business cards.

NEW PRACTICE ANNOUNCEMENT

Oral Medicine Specialists Drs Jacinta Vu and Alissa Jacobs are pleased to announce the opening of their new practice, the Centre for Oral Medicine and Facial Pain.

NEW PRACTICE ANNOUNCEMENT

T (08) 6260 1832

E info@periodental.com.au

A Unit 4/19 Mills St Cannington WA

With nearly 20 years of combined experience in Oral Medicine, Alissa and Jacinta are gratefully accepting new referrals for all aspects of Oral Medicine care. They will continue to care for their existing patients at the new centre. Specialising in: Oral mucosal diseases, Salivary gland disorders, Facial pain, Temporomandibular disorders, Oral appliances for snoring/sleep apnoea.

Dr Leon Smith is pleased to announce the opening of his new practice Oral Surgery Consultants in West Perth. He will be accepting referrals for all dentoalveolar (extractions and grafting), pathology, facial trauma, orthognathic and implant treatment, whilst maintaining his public hospital appointment at Royal Perth Hospital.

Dr Smith is supported by an excellent administration and nursing team with many years of experience and an emphasis on excellent patient care.

He provides options for LA, IV and GA management.

DR FRANK FURFARO

Smile Time Orthodontics - Cottesloe is pleased to announce Dr Frank Furfaro will commence consultations from October. Dr Gosia Barley, Dr Naomi Kohan and Dr Frank Furfaro are available for consultation in our Cottesloe office. Dr Furfaro continues his consultations at our Mt Hawthorn and Mindarie practices.

T (08) 6373 6731

E reception@omfp.com.au

A Ground floor, 1 Preston St Como WA

T (08) 6468 4948

E admin@osconsultants.com.au

A 99 Outram Street West Perth

T (08) 9367 9277

E hello@firstsmiles.com.au

A Suite 9, 40 St Quentin Ave Claremont

A Suite 4, 234 Berrigan Dr Jandakot

W firstsmiles.com.au

DR VAISHNAVI GOPALAKRISHNAN

SPECIALIST PAEDIATRIC DENTIST

BDS I MDS (PAED) I MRACDS (PAED)

E info@smiletime.com.au W smiletime.com.au

Dr Siva Vasudavan and Dr Lisa Bowdin are delighted to welcome Dr Vaishnavi Gopalakrishnan to the First Smiles team. Dr Vaish is accepting referrals for all aspects of specialist paediatric dental care at the First Smiles clinics in Claremont and Jandakot.