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AUSTRALIAN DENTAL ASSOCIATION WA | EDITION 7 2021

This issue Beat and Drill

End of an Era

Kimberley Dental

The musical dentists

Thank you, Dr Archibald

Our students give back

THE RECOGNISED VOICE OF ORAL HEALTH IN WA

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48 Kimberley Dental Team 4 6 8 14 16 18 22 26 28

President’s Report End of an Era Thank you, Dr Archibald

Beat and Drill The musical dentists

A Life of Service Peter Van Duren

ADA HR Feature

Legal Feature

DPL Feature

Clincal Feature

Clinical Feature

In Memoriam Julian O'Brien

Is Your Practice Cybersafe? Part two of our cybersecurity feature

CPD Spotlight Meet Winthrop Professor, Paul Abbott

Young Dentists' Conference CPD Calendar

47 48 52 54

Sexual harassment at work

Changes to the Fair Work Act

Perio and the pandemic

Funding for research into head and neck cancers

Getting the right bite and the bite right

WADA Golf Kimberley Dental Team Our students give back

Good News Stories Professional Notices

Cover image Dr Luke Chow. Read about the other musical dentists on page 8. Photographer: Steve Laue

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The Final

President’s Report Dr Sean Archibald ADAWA President

Two years ago, as I was stepping into my new role as ADAWA President, I had some loose targets in mind around technology modernisation and communications, but nothing of a specific timeline. I had been fortunate to see firsthand, great displays of leadership and strategy by previous branch presidents and was excited about the things to come. What has eventuated has been one of the most interesting, challenging and overall rewarding times of my life, and something that I will never forget. In the early weeks, major changes to the implementation of our indemnity policy seemed like they would define my presidency, and I remember saying something to this effect to our CEO. This now seems like a speed bump before we started down the long road of the global pandemic and COVID 19. In a way, these events “forced our hand” to accelerate many of our plans. It's been a pleasure to be involved in an organisation that has been able to rapidly pivot to adapt to the many unexpected challenges we have faced with unwavering focus on its core objective of supporting its members. This was only possible through the amazing group of people working for our association. In my two years I have seen many occasions where each and every staff member has gone above and beyond to support our members, our CEO, or me personally. Everything from answering the phones to listening to the troubles of our members, 11pm membership emails and continuing to work from home when your family has just been displaced with bushfires. I don’t believe there would be many organisations in existence where staff members and even the CEO’s wife have taken the time to cook and deliver dinner for a company’s President, as happened during my term. As members, we are incredibly lucky to be part of this association. I like to think that I have been part of positive changes in the last two years and I have no doubt that we are now more agile and dynamic and I know that for some, this is an uncomfortable process, and as is always the risk with change. ADAWA is nearly 110 years old and all I hope is that I have played my small part in keeping our association on track and aligned for the challenges it will face in the future. Thank you all for being part of our association and allowing me the honour of being your ADAWA President.

,Sean 4

EDITION 7 | 2021 Western Articulator

All correspondence to T (08) 9211 5600 E media@adawa.com.au A PO Box 34 West Perth WA 6872 President Dr Sean Archibald Chief Executive Officer Dr David Hallett Editorial Team Lisa Shearon Brooke Evans-Butler Designer Amie Mason ADVERTISING Please supply display advertisements as a highresolution PDF file (embed all fonts) or a JPEG file to media@adawa.com.au. Please ensure any graphics are of a high quality. Articles should be submitted as a WORD document with any graphics attached as separate files. ISSN 2207-9351 (Online) DISCLAIMER The views and opinions expressed in this publication and its attachments by advertisers and contributors are not necessarily endorsed by The Australian Dental Association (WA Branch) Inc. The Branch, its members, employees and agents do not assume any loss or damage which may result from any inaccuracy or omission in this publication, or from the use of the information contained, and make no warranties, express or implied, with respect to any of the material contained herein.

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Thanks Dr Archibald Another two years has passed, and with it the end of another ADAWA Presidency. We pay tribute to the tireless work and efforts of Dr Sean Archibald. Taking on the President’s role at 32 years’ old, Dr Sean Archibald was the second-youngest President (slightly pipped by Dr Kang Kim) in ADAWA history. When Sean took the reins, he had no intention of making any drastic changes, but said he wanted to leave the branch in a slightly better condition than when he started. It was fewer than five months’ later that COVID hit our State. As many would be aware, Sean’s commitment to advocating on behalf of and keeping members updated during the lockdowns of 2020 and 2021 were admirable. Supported by our CEO and Executive team, Sean spent numerous long nights and early mornings at ADA House – on the phone to the Department of Health and the Chief Dental Officer to get information out to the membership as soon as it was available. He was happy to jump on to social media to instantly share news and the Facebook Live events, facilitated by Sean and David, were very popular and appreciated by the membership.

I think our communications, the way we talk to the members – the tone, the frequency and the transparency – has changed dramatically over the past two years. Sean believes COVID has resulted in more member engagement in the industry than ever before. “It feels as though we have a tighter community than we did two years ago, just because of what we have all been through. I guess it's like a shared trauma,” he says. For Sean, one of the highlights of his Presidency was procuring three months’ free insurance for members during COVID. “I don’t think anyone would have expected that a branch like ours could make that happen, which is really the power of the group policy,” he recalls.

EDITION 7 | 2021 Western Articulator

Aside from his work during COVID, Sean has advocated strongly on behalf of the West Australian dental community – as demonstrated when HBF opened HBF dental practices. “HBF is a very complex scenario with not a lot of Government regulation around it, but I think we are in a very good position with that now,” he says. “We do talk a lot to HBF and there are ongoing discussions there, which from an advocacy point of view is the best that you can ask. We are constantly there, being a voice.”

“I think our communications, the way we talk to the Sean has also been a familiar face within dental circles, members – the tone, the frequency and the transparency giving his time to assist with various events. An active – has changed dramatically over the past two years,” he adds. “We are bringing things to the membership earlier committee member of the New Practitioners’ Program, now and saying: ‘we are working on this’ rather than Sean and the rest of the NPP committee have worked waiting until everything is all wrapped up.” to make the program and Young Dentists' Conference the envy of young practitioners around the country – As well as his practice commitments, post-Presidency, going above and beyond to help the new generation of Sean says he has a few other things on the go. “It’s never dentists thrive in their new profession. hard finding something to do,” he says. “There are still some projects for the branch that I will be involved in, and For the branch staff, Sean has visited ADA House there are a few not-for-profits that I assist. Personally, I regularly to update the team on important matters. have another house to renovate, so that will be fun. Fancying himself a bit of a tech enthusiast, he has always been happy to investigate any computer problems and has been on-call for any technical issues at the lecture theatre.

“The branch is still stuck with me for two years as the Immediate Past President, so I’ll still fix the computers,” he laughs. “I’ll still be involved in NPP, and I will still be involved in the branch as a member beyond that. I will not be dropping off the radar; this has been a huge part of my life. In a way it is lucky I didn’t have a wife or a girlfriend, because they would not have seen a lot of me in the past two years. “(The Presidency) has been very interesting, challenging – I have definitely enjoyed it. It has pushed me to use a lot of skills and bits of my brain that I have picked up over the years and apply them to what we have been doing.

“I am excited to see where we will be two years from now with all of the things we have planned. Knowing what we have on the agenda is exciting.” Does he think he has left ADAWA a little better than when he started? “I hope I have,” he says. “There’s a lot that I feel has changed and I hope the membership has seen that. Not every member is going to have seen everything; I think that is a challenge. The core things we have always done, that David has always done, is building on that work that has always been there. The background support of our members is so important – and the word support comes up a lot. “If we can keep supporting our members and keep everyone engaged as much as we have, then I think we are in a pretty good standing. Delivering to our members is our reason for existence.”

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THE MUSICAL DENTISTS Our members are well-known for pursuing artistic endeavours outside of the dental practice. It will come as no surprise, then, to discover that many are musical, as Brooke Evans-Butler discovers.

EDITION 7 | 2021 Western Articulator

Dr Luke Chow Orthodontist Luke Chow plays electric guitar, sings, and used to be a recording engineer/producer. “I’ve been playing in bands since I was 12 years’ old,” he says. “I started playing electric guitar at boarding school, after I quit the choir for rock n roll, however, I was made to take classical guitar lessons by the Head of Music as punishment. I then moved back to Hong Kong, where I did a singer-songwriter acoustic thing and got back into the electric.” Luke plays indie rock with band Kestrels and Kites, and says he uses music as a distraction from life stress in general.

“When I was a general dentist, my hands would be quite tired at the end of the day, so would normally play on weekends,” he says. “I recommend thick, 50s-style guitar necks for less hand stress. “I play with my wife and it’s a nice escape from the children – it’s like we’re in our 20s again. I generally write the songs; I just make them up. I don’t have any formal music training; I play by ear.” Kestrels and Kites kestrelsandkites.com facebook.com/KestrelsAndKites Photographer: Steve Laue

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Clinical Professor Bernard Koong Many years ago, this highly experienced and internationally respected oral and maxillofacial radiologist was taking the stage as a vocalist and keyboardist with a covers band. Although he’s no longer centre stage, Bernard still finds time for song writing and electronic music production.

Finding this balance between the rigorous application of radiological skills and the opportunity to express myself creatively is really important to me. “I had classical piano training and also play a bit of self-taught guitar,” he says. “While I absolutely marvel at those with amazing technical skills, I very much enjoy the creativity in song writing and music production.” Bernard has interests in two genres – the singer/songwriter pop genre, which has a hint of 80s influences – and electronica/electronic dance music (EDM). 10

EDITION 7 | 2021 Western Articulator

“I have very much been focusing on the latter in the last four or five years,” he says. “While I do enjoy writing a song for a singer-song writer/ band format, electronica gives me freedom on a whole different level. In electronica, the entire world is your orchestra; every sound that exists or that you can create is an instrument! “While clinical dentistry involves both art and science, there is absolutely no artistic expression in radiology! It’s all just shades of grey,” he says. “I’ve been playing and writing music since my teenage years, and it certainly engages a different part of my brain. This is particularly true of song writing, which engages the purely creative, emotional and expressive aspects of one’s brain over the technical elements of mastering an instrument.” “Finding this balance between the rigorous application of radiological skills and the opportunity to express myself creatively is really important to me. Having said that, recording and music production is largely done on a computer, so I do find myself sitting in front of one after a long day staring at a computer screen at the practice!” “The act of creating a piece of music – which essentially had not existed previously – gives me so much joy.” To check out Bernard’s current ongoing electronica project, go to soundcloud.com/user-989860774/sets/bktracks/s-MZEy8BARjYU To hear his song writing and vocals, head to soundcloud.com/user-602378060/sets/onemore-time/s-TpMUcFZ7luP for his “singer songwriter pop” EP recorded in 2017, with prosthodontist Glen Liddelow playing bass and co-producing. You may prefer to use the QR codes for these SoundCloud links instead. Bernard recommends using head/earphones or a hi-fi sound system for the best listening experience, especially for EDM/ electronica where “hearing the full range of frequencies is crucial to the tracks!”.

Dr Alisdair Wallace Ali Wallace plays the drums for band Circle of Trust, playing covers, mostly with an 80s influence, but also covering tracks from the 50s up to current times. “I’ve been playing drums in a band for over 10 years,” Ali says. “I’ve played piano since we bought one for the kids and they never touched it. I’m not formally taught. YouTube is my teacher.

It is a wonderful way to de-stress and unwind from the day-to-day running of a busy practice. I always look forward to my weekly rehearsal night. “Since then, I’ve been in and out of a few different bands, but stuck with mostly the same people from the start.” When asked if playing in the band is a way to express his artistic side, Ali laughs. “Artistic side? This makes me chuckle,” he says. “Playing covers is about reproducing popular sounds other more talented people have created. I don’t regard myself as creative. It is a wonderful way to de-stress and unwind from the day-to-day running of a busy practice. I always look forward to my weekly rehearsal night. “Most importantly, we do it for fun,” he adds. “We play a combination of gigs for fun and for fundraising, with the odd paid performance. We do enough paid work to buy new PA equipment every now and then.” Circle of Trust circleoftrust.band facebook.com/circleoftrustoz

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Dr Lyndon Abbott Lyndon started playing the flute when he was 10, going on to study a Bachelor of Music (Performance) at the Sydney Conservatorium of Music.

“I’d like to think that working as a dentist should not define you as an individual, and having interests outside of work is really important,” she says.

During his DMD studies (2016-19), he was the principal flute in the WAYO (West Australian Youth Orchestra), WACO (West Australian Charity Orchestra) and Western Australian Wind Symphony.

“There’s a lot of hard work that goes into the rehearsals for a gig and that does help you switch off from work. There is no time to think or talk about dentistry when we’re busy rehearsing.

“During my music degree (2012-2015), Sydney University asked me to tour around NSW as a soloist,” Lyndon says. “I played in the Sydney Conservatorium of Music Orchestra and was even filmed playing the flute on an episode of The Bachelor on Channel 10.” Lyndon says, currently, playing is his outlet after a day in the clinic. “I see it as a way to use a completely different part of my brain. It’s my way of communicating things I can’t say in words. Playing is a way I can forget about all the stresses from that day. “It’s also a discipline,” he adds. “Much as swimming laps is to a swimmer, playing scales and practising is the way I can keep my fingers agile and chops in check.”

Drs Sophia Hawes and Simon Tee Sophia Hawes is the vocalist for the band, Fragments, with fellow dentist, Simon Tee, on drums. The band plays a mixture of jazz classics and rock-pop standards at community events and private functions. “I’ve been singing for as long as I can remember,” Sophia says. “I did classical voice training during school days and have always been involved in music.

Lyndon playing in a chamber ensemble while at the Sydney Conservatorium of Music.

I played in the Sydney Conservatorium of music orchestra and was even filmed playing the flute on an episode of The Bachelor. “Performing in a band and feeling the joy you bring to others when you perform in the community is something special.” Simon has played the piano since he was five, taking up drums at age 15. “Music for me has always been an escape from the daily grind,” he says. “As a dentist, it’s particularly nice to have a pleasant sound coming from your instruments for a change, instead of the usual scraping, hissing, and beeping noises we’re used to!” Fragments Contact Ron Banks ron.banks@iinet.net.au

Dr Phil Robson Phil Robson plays bass guitar for the band, The Parkas. “We’ve been playing gigs around the pubs and clubs in Perth and Fremantle for six months now, and we’re getting a bit of a following,” Phil says. “We play mainly Britpop/British indie covers from bands such as Oasis, Blur, Stone Roses, Radiohead, to name a few.” Phil first bought a bass when he was 16 and living in the UK; during dental school he found himself living with a couple of guys who played guitar. “This got me back playing again, but my progress was curtailed as I soon left the UK after graduating and went travelling with my best mate from dental school. We eventually made it to Sydney, where I bought an acoustic bass, and my mate bought a guitar, and we drove up to Cairns in our camper van. “Fortunately, we both ended up getting jobs at the same dental surgery in Townsville. We worked there for a year and a half, and I took some bass lessons. I feel like it was this period when I can actually say that I started playing bass.” He says a breakthrough for him occurred in 2016, when he attended an “interview” for his current job. “Upon hearing that I ‘played bass’, I was offered the job on the spot! My new boss (ADAWA member Dr Ben Campbell) was a keen guitarist too and within months of this new job we started up a band along with some others, including another ADAWA member, Ali Wallace. “We played a handful of gigs, mostly private parties and birthdays of people we knew. Then, after doing this for three years or so, I saw an online advert from a few guys looking to start a British indie/Britpop cover band

and they needed the services of a bass player. As this is actually the genre of music that I grew up listening to, I jumped at the chance. “We’ve been playing together for two years now. We had a bit of a staggered start, what with COVID and bringing on board a new lead singer, but for the last six months we’ve been playing a number of gigs in the pubs and clubs around Perth and Fremantle.” Phil says, serendipitously, dentistry has placed him in the right place with the right people to give his musical

I even have a bass at the surgery to tinker with either in-between patients or at lunchtimes. life a kickstart. “I’m also eternally thankfully of the free time that dentistry allows me to practise, rehearse, perform and therefore enjoy my music,” he says. “Over the years, playing my bass has become my go-to activity for my spare-time, especially now with the need to be often learning news songs for upcoming gigs or practising the current ones. “I even have a bass at the surgery to tinker with either in-between patients or at lunchtimes. I used to read a lot more in my spare time, but now, I prefer to play music.” The Parkas facebook.com/theparkas

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A life of service A life well lived

BY ROB BOWER

Peter van Duren

BDSc (WA), MB BS (Adelaide), FRCS

Peter van Duren was born 1942 in the Dutch town of Boekel, about 20km from the German border. Not a good address at the time. He was the eldest of Mathys and Maria van Duren’s three children. When the family arrived in Fremantle from war-weary Europe in June 1952, Peter was nine years’ old and spoke no English. He attended Armadale High School for three years and was awarded an Education Department Endowment Trust Scholarship to complete his schooling at Kent Street Senior High School. He was obviously bright. None of this was known to his classmates in 1961 when he started at Dental School at UWA. He was simply “Dutch”, something of a tearaway and obviously bright as well as dextrous (we started constructing technique complete denture prostheses and a cast partial denture in first year!). During the five years of the course, firm friendships were forged, and one standout relationship developed between “Dutch” and Bob Heady. They share-farmed together on leased land at Kalannie near Koorda to support their studies. University breaks and occasional weekends were spent seeding, spraying, and harvesting. They were such successful farmers that each boasted a new car at the end of one season. Peter and Bob added spice to the dental course. Like saffron, they brought out the best in us and added colour to a time-demanding and rather grey university course.

EDITION 7 | 2021 Western Articulator

At graduation in 1965 Peter achieved equal top marks and received the Leonard Nathan Prize in Oral Medicine and Oral Surgery. Like many of us, Peter had received a State Government Dental Bursary, which required a return of service working for the Dental Health Service nominally for up to five years, of which the first few were spent in the bush. Peter worked from Derby to Esperance and in the Eastern Goldfields, but one notable stint was spent working at small sidings along the Trans Australian rail line on the Nullarbor Plain – Curtin, Chifley, Forrest, etc. With no 240-volt power, Peter was given a foot treadle-powered dental drill (no high speed either). As he told it, at the outset his hand moved in unison with his leg action! In 1967, Peter married Lorraine Treeby and commenced dental practice in Fremantle. It was while in general dental practice that he decided to study medicine and he and Lorraine moved to Adelaide with their twins Stuart and Michael. During his medical studies Peter supported his growing family, later to include Susan, by working parttime as a dentist. In his final year, Peter spent an elective at Port Hedland Regional Hospital, which was to influence his later decision to practice well away from the city. After graduation, he continued his studies working at Fremantle Hospital for five years to obtain Fellowship of the Royal Australasian College of Surgeons as a General Surgeon. After a brief stint working in private practice as a general surgeon in the southern suburbs of Perth, Peter decided to move north and in 1985, he relocated to Derby as a regional surgeon providing service from Kununurra and Wyndham in the east and Broome and Derby in the west. By this time, he and Lorraine had separated, which may also have motivated the move north. In 1986 Peter married Louise Hunt who had worked with him as a theatre nurse in Fremantle. They continued to work together in mutual love for life.

Class of 1965 Malcolm Bird Rob Bower Gregory Doran Hartley Edwards Dick Hardy Bob Heady

Dental Surgeon Periodontist Anatomist Dental Surgeon Dental Surgeon Prosthodontist

It was during his seven years in the Kimberley that Peter’s interest in horse racing re-emerged, but his dental classmates recall its first flowering – a keen interest in harness racing that saw Peter pick most, if not all, the winners at the “trots” one evening. In 1992 Peter and Louise moved to Port Hedland where he was the only full-time surgeon in the Pilbara. The horse training continued with at least one local winner in the “Round”. Peter’s next move was to surgical practice in Northam to which he and Louise commuted from their horse stud property at Bakers Hill. By this time Peter had trained winners in the Kimberley, and now in the city. Kalgoorlie, Peter’s original dental genesis, called and for the next seven years he worked in private surgical practice while training horses that were placed in two Kalgoorlie Cups. In 2006 Peter “retired”, but after six months he resumed practice in Port Hedland and spent the next seven years there, eventually retiring for good in 2013. Always a fit man, in 2012 Peter travelled to New York to compete in the NY Marathon but Mayor Bloomberg cancelled the event at the last minute due to Hurricane Sandy. Undeterred, Peter secured a late entry in the Seattle Marathon and ran there. At age 68 Peter took up skiing and he and Louise travelled many of the snow slopes of the world over the next few years after divesting themselves of the horse stud, but not the property at Bakers Hill. Peter van Duren did not practise dentistry for long but his effect on dentistry was profound. Through his intelligence, ambition, and determination he influenced fellow dental students to strive. He was a loyal and generous friend. In 2018 Peter noticed his memory failing and, as ever, his diagnosis was sound – Alzheimer’s. Louise cared for him lovingly up to 27/08/2021, when he died aged 78 years.

David Hodby Bill Marsell John Mathieson* Robson, Norm* Van Duren, Peter* Wall, Chris*

Dental Surgeon Dental Surgeon Dental Surgeon Dental Surgeon Dental & General Surgeon Prosthodontist

*deceased

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In memory of Dr Julian O’Brien In this edition of the Western Articulator, we pay tribute to Dr Julian O’Brien. Julian was born in Victoria and moved to WA to enlist in the dental school and fulfil his long-held ambition to be a dentist. From his early childhood, Julian had expressed an interest to become a dentist. It was revealed in his eulogy that when he was three or four years' old, his father found him with an old-fashioned brace and bit, drilling into a brick. When his father said: ‘What are you doing with that?’ Julian answered, ‘I want to be a dentist!’ It was at dental school that Julian met and became close friends with Dr Chris Barker. Chris recalls there were over 100 students enrolled and only 26 places in second year. “It was tremendously competitive, and we were both very pleased that we got through the rest of the course.” Chris says Julian’s talent as a dentist was clear early on. “He was extremely dextrous and very talented intellectually and at the practical side of things,” Chris says. “He was never happy unless he could really investigate something thoroughly.”

“Julian was awesome. He was driven by his own will to do the very best that he could do. He also was someone who would think outside of the square. An amazing practitioner and person generally.” Chris says Julian was adept at inserting implants and he would often refer his patients to Julian. “I also felt very comfortable as a patient of his,” Chris says. Richard adds Julian’s patients were very loyal. “I am still principal dentist at the practice and I’m often chatting to patients who speak very fondly of years gone by and talk about some of Julian’s funny ways.

He was very good at putting people at ease, very calm and humorous with it.

“Patients are always reflecting on the great work he did. He was very good at putting people at ease, very calm and humorous with it. He was a very Dr Richard Williams recalls meeting Julian within a few days of arriving in Australia, back in early 1992. warm character and a very popular dentist.”

“I was looking for a job in dentistry, having qualified in the UK,” Richard recalls. “There were very few jobs at that time, and I went through the Yellow Pages and was cold calling dental practices and there happened to be a job at his practice (Aardent Dental Centre in Victoria Park).”

Richard says as well as a mentor, Julian was also a great mate. “Even after he retired, he lived next door to the practice and I would go over for a coffee and a chat. He was very forward thinking and always contemplating novel solutions to problems. He was a very good and guiding influence in things outside of dentistry as well.

Initially, Richard worked with Julian as an associate self-employed dentist, and later became Julian’s business partner, working together for over 25 years. “He was a great emailer – that will bring a wry smile to many a person’s face. He was if Richard says Julian was an amazing practitioner. anything sometimes a bit overactive with the “When I first met Julian, I was totally blown away emails,” he laughs. by his ability,” he recalls. “His level of skill and his dedication to dentistry was awe inspiring to me as a young dentist and totally formative for me. I was very much the beneficiary of his great knowledge and expertise which led me down the right path. 16

EDITION 7 | 2021 Western Articulator

Away from dentistry, Julian was a keen diver and underwater photographer. He was also known for his woodworking talent. “Julian had a terrific workshop which was very

well equipped with woodworking tools and machinery,” Richard says. “Over the years we did some projects for the practice involving woodworking, which always took much longer than we thought it would take. But of course, it was more to do with the camaraderie than the project itself at the end of the day. I have some very fond memories of tinkering away in his workshop over the years.”

perhaps best summed up in a preamble in a book by Iain Bamforth called A Literary Anthology of Modern Medicine". He spoke about Chesterton, who was a mercurial journalist and a brilliant polemicist. He was writing when fascist Italy was recommending corporatism as a political philosophy. He then quoted Chesterton in his book, The Medical Mistake - What's Wrong with the World, in 1910:

When asked about Julian’s contribution to the profession, Richard says he stood up and led by example, as a dentist, a mentor and in his role as President of the Australasian Osseointegration Society (WA branch). “Julian promoted implant dentistry quite extensively,” he says.

“Chesterton said, 'I maintain, therefore, that the common sociological method is quite useless. The only way to discuss social evil is to get at once to the social ideal. We can all see the national madness, but what is national sanity? I have called this book What's Wrong with the World and the upshot of the title can be clearly stated. What is wrong is that we do not ask what is right.'"

In the mid and late 1990s, Julian was a member of the ADAWA Schedule and Third-Party Committee and was an active member of the HBF Consultative Committee. Once HBF embarked upon the preferred provider scheme concept, the ADAWA no longer engaged with HBF in this manner. Julian was very vocal against HBF’s participating provider scheme. Terry Pitsikas chaired this committee and Julian accompanied Terry in a joint submission and interview with the Productivity Commission in December 2004. Terry recalls the opening statement from Julian that went: “I'm not versed in the grand national economics of dentistry, but I think what I would like to say is

Terry says as luck would have it, Commissioner Banks from the Productivity Committee, who chaired the meeting, was familiar with Chesterton’s writings and philosophies. From that moment on, they had a wonderful audience with the Commissioner. Julian's well-read, warm-hearted, quirky and slightly eccentric nature wil be remembered by all of those who knew him. Dr Julian O’Brien passed away, aged 72 years, in July. He was an ADAWA member for over 45 years. Our sympathies to his family, friends and loved ones. adawa.com.au

PA R T T W O

Is your practice

cybersafe? With Australian businesses under increasing threat online, we examine the particular risk posed to health providers. Cybercrime has increased by nearly 13% in the past year, with one incident reported to the Australian Cyber Security Centre every eight minutes. A new report shows that more than 67,500 cybercrimes were reported in the last financial year after criminals targeted vulnerable people and – significantly – health services. Reports of ransomware – software designed to block access to computer systems until a ransom is paid – increased almost 15% from last year.

EDITION 7 | 2021 Western Articulator

Igor Pavic, Director of Office Solutions IT, says the most common weak spots that put businesses at risk of cybersecurity breaches include:

Weak passwords “Weak passwords are one of the most common culprits of cybersecurity breaches,” Igor says. “A weak password makes not only yourself but also your business an open welcome mat for a data breach.”

Outdated software applications “We know updating software can be a bit of a hassle, especially if you still find the current version fine,” Igor says. “But these updates are necessary to install any patches and make your confidential data more secure. That’s why your systems must always be updated to their current versions to minimise risk.”

People “Aside from weak passwords, employees are usually the ones putting businesses at risk of cybersecurity breaches,” Igor says. “These breaches can mostly happen due to honest mistakes, no awareness of phishing tactics, and everything else in between.”

Reducing your risk Introduce a policy of least privilege, specifically around Personal Identifiable Information (PII), recommends Adam Gordon, ANZ Country Manager at Varonis. “Dental practices store a lot of personal information such as patient data. They also hold credit card details on their IT systems, and it is their responsibility to keep this information safe,” he explains. “There are strong regulations in place to protect this data, and dentists need to ensure compliance or risk paying hefty penalties. To maintain compliance, practitioners should introduce a policy of least privilege, which ensures staff are only given access to the information they need to do their jobs. This lessens the risk of an external hacker or even an insider exposing sensitive information. “Do remote team members such as IT contractors need access to the entire network, which includes sensitive

patient files and credit card details? Absolutely not. By reducing accessibility to these highly sensitive files, dentists reduce their risk of a cybersecurity breach, enabling them to avoid the significant fines associated with the exposure of PII.”

Keep ‘smart’ dental technology on a separate network to the one which holds your sensitive patient files “Dentistry has come a long way since the turn of the century,” Adam says. “However, the downside is that these internet-connected devices open dental practices up to cyber-attack,” he says. “The same devices that make the patient experience more pleasant, also give hackers new attack routes. Any device connected to the internet, even the most unassuming ones like printers or scanners, can give hackers access to a dentist’s wider IT system. By keeping these devices on a separate internet network, away from the rest of your network which carries your sensitive patient information, dentists can limit the amount of damage done if they experience a breach.”

Undertake a cybersecurity audit “Dental practices should work with a cybersecurity company to understand exactly where their most sensitive files are, and create a map of their entire IT network,” Adam recommends. “How many places are these sensitive files stored, who is accessing them, and from what locations? What protocols are in place to secure this data and prevent a data breach? These are key questions that all dentists must ask, in order to secure their sensitive data.”

Is your practice under threat? If your practice has been targeted, Dr David Glance, Director of the UWA Centre for Software and Security Practice, recommends contacting your IT provider in order to investigate and restore the systems. “This may involve a specialist company as there is no point restoring a system if you are restoring the malware at the same time,” he adds.

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Legal advice Enore Panetta, Managing Director of Panetta McGrath Lawyers, says dental practices have legal obligations to protect their patients’ health information, and that establishing and maintaining information security practices is an essential legal requirement.

“If there has been a notifiable data breach, the dental practice must prepare a statement and give a copy to the Australian Information Commission as soon as practicable after the entity becomes aware of the notifiable data breach. The statement must:

“The Privacy Act outlines the privacy responsibilities that most dental practices have to comply with in managing health and personal information,” he says. “All reasonable steps must be taken to protect the security of patient records.

• identify the entity and provide contact details;

“Patient records must be stored in a manner that preserves the confidentiality of the patient, and protects against misuse, interference and loss, unauthorised access, modification or disclosure,” he adds.

• provide recommendations about the steps that individuals should take in response to the eligible data breach.

“To ensure that electronic patient records are kept safe from damage, loss or theft, they should be password protected, passwords changed on a regular basis, backed up regularly and backed up offsite. You should use antivirus software, keep your portable devices safe and secure and encrypt your files where possible.” If a dental practice is targeted by a cyber-attack, and records are accessed/compromised, Enore says a dental practice must notify the Australian Information Commissioner of a notifiable data breach, as well as notify the affected individuals. “Where there has been unauthorised access or disclosure of personal information through a cyber security attack, and a reasonable person would conclude that the access or disclosure would be likely to result in serious harm to any of the individuals to whom the information relates, then it must be reported,” he explains. “Where the dental practice has reasonable grounds to believe that there may have been a notifiable data breach, the entity must carry out a reasonable expeditious assessment of whether there are reasonable grounds to believe that the relevant circumstances amount to a notifiable data breach, and must take all reasonable steps to ensure that the assessment is completed within 30 days.

EDITION 7 | 2021 Western Articulator

• provide a description of the eligible data breach that the entity has reasonable grounds to believe has happened; • identify the kind of information concerned; and

“This statement must also be provided to the individuals to whom the personal information relates or those at risk of having their personal information disclosed, if it practicable to do so.” Enore adds that where the dental practice cannot notify each individual, it must publish the statement on their website or otherwise take reasonable steps to publicise the contents of the statement: Privacy Act 1988 (Cth), s 26WL(2). “Note, if the dental practice uses the My Health Record, and becomes aware of an unauthorised collection, use or disclosure of health information or that the system may have been compromised, then they must notify the Australian Digital Health Agency as soon as practicable. If the dental practice does not, they will be liable for a civil penalty,” he says. The dental practice must: • as far as is reasonably practicable contain the data breach; • evaluate any risks; and • notify all individuals affected by the data breach, or ask the Australian Digital Health Agency to notify all the affected individuals.

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Meet

WINTHROP PROFESSOR

Paul Abbott ao

Winthrop Professor Paul Abbott needs no introduction within dental circles. A well-known and respected endodontist and educator, his contribution to UWA Dental School and to the continuing education of dentists and dental students is enormous. Paul is also a regular presenter of WA Dental CPD courses. We spoke to him about his extraordinary career.

As with all great careers, there is a beginning – and when asked why he decided to pursue dentistry, Paul says as a young boy he was always interested in the human body. “My family all suspected that I would do medicine and I guess I thought that way too but then as I got into high school, I liked the idea of the hands-on practical aspect of dentistry,” Paul recalls. “I also knew a few people doing dentistry and they were pretty happy with what they were doing and the course. I visited a couple of dental practices to see what dentists did and decided on dentistry because it was a mix of medicine and a very hands-on profession.” Paul graduated from The University of Western Australia in 1979 and after four years as a general practitioner, decided to specialise. “I am a strong believer in needing a good foundation of general practice before you specialise in anything,” he says. “Even now, if I was selecting people to do specialist training, if two people were equal in everything apart from general practice experience, I would go for the one who had more general practice experience. “One of the key things in endodontics is what happens to the tooth afterwards, because it has to be restored somehow. The decision-making around that is very subjective, but largely based on experience; not just experience of doing the restoration but seeing that restoration over time.” When asked why he decided to specialise in endodontics, Paul says he went through the process of considering orthodontics, paediatrics, and oral surgery – but kept coming back to endodontics. Additionally, there was only one endodontist in Perth at the time (Tony Sandler), so when Paul was selected to do the program at the University of Adelaide, he grabbed the opportunity. Part of the reason Paul wanted to specialise was so he could teach. “I always had an interest in teaching, even before doing dentistry,” he recalls.

EDITION 7 | 2021 Western Articulator

Paul Abbott It is clear teaching quickly became a passion. “The interaction with your students is important but seeing the results of your teaching is the really rewarding thing,” Paul says. “It’s more than just teaching students about dentistry or endodontics. The postgraduate students tell me they see it as a bit of life coaching as well. That’s not something I actively go and do but it just happens along the way. They see you under different circumstances and how you cope with things and they see your involvement beyond just treating patients. “I was very fortunate in my post-grad training in that I was treated more as a colleague or as a staff member than as a student, and I try to do that as well with my postgraduate students.” As well as his commitments at the Dental School, Paul has a busy lecturing schedule – both locally and internationally – with an impressive lecturing resume spanning over 45 countries. “If you ask my family, I was a very shy kid and they cannot believe that I lecture to lots of people,” Paul says. “Again, lecturing was an opportunity. When I was in Adelaide finishing my Master’s degree, UWA was looking for someone to teach endodontics. The people here knew I was heading back to WA, so even before I finished in Adelaide I was asked to come in and teach. Being a bit obsessive compulsive, like most dentists, especially endodontists, I really wanted to do it well, but it was a bit of a mad scramble that first year to get a series of lectures together, as well as trying to get a practice going and raising a young family.”

If you weren’t in the dentistry field, what would you be doing for a living? If I’d done medicine, I would have had to do a speciality that involved my hands, maybe a surgeon. The other thing would have been teaching. What do you in your spare time? I used to go mountain bike riding, but I haven’t in recent times, largely because of time. It’s usually a whole day of exercise and it’s not something you can do by yourself – you need at least one or preferably several people because if something happens when you’re out on a trail, you need help. I have certainly had a few falls and injuries along the way but survived them all. I don’t have a lot of spare time, but I do enjoy doing handyman type of things and doing small woodworking projects. What is your favourite book? I wouldn’t say a favourite book, but one thing I do like to do in my spare time is reading crime fiction. I tend to read authors such as Michael Connelly, James Patterson and Jeffrey Archer. What is your favourite part of the world? My favourite part of the world is Perth, but having travelled a lot, there are beautiful places everywhere. Three of my favourite places to visit are New Zealand, Ireland and England. And there is some beautiful scenery in South America. I could list so many other places too. What is your favourite cuisine? Indian and Thai – I like spicy food. Is there anything people might be surprised to learn about you? I like cooking Indian and Thai food – particularly Indian. I really enjoy using the spices to create different flavours.

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Pre-COVID, Paul would travel every month to lecture – overseas four or five times a year, and five or six times interstate, as well as squeezing in time to visit his son in Canada and wife and fellow endodontist Jacky Castro’s family in Columbia. “A lot of my travel can be work related but there are advantages too,” he adds. “I have been to places that I would have never gone to if I had not been asked to go there for a conference. “It’s often locals who are looking after you when you’re in a new place for a lecture or conference, and you might go to their homes and you learn a lot about their society and their culture, as well as seeing the sites. You make some good friends and build up a big network.” Even though the travel for lectures has quietened over the past year, Paul has been keeping busy on various committees, boards and other commitments, including the Dental Board of Australia (his term finishes this year), the Editor-in-Chief of the journal, Dental Traumatology, as well as sitting on the editorial board of the Australian Dental Journal. He is also on the research committee of the International Association of Dental Traumatology, and on another committee to honour the late father of dental traumatology, Jens Andreasen. “Jens was a lovely guy, and I was asked to chair a committee to come up with some ways of remembering him, so we have developed a series of lectures on some key topics that he was particularly involved in.” Paul is also well-known for his research, and says at the moment, his main research projects are through the postgraduate students. “One is a survey on dentist’s knowledge on how to manage dental trauma. Another one is in the process of development is looking at dentists’ diagnosis and management of tooth resorption, which is often associated with trauma but not entirely. The other one is looking at bacterial movement through tooth roots with different materials used for root canal fillings.”

EDITION 7 | 2021 Western Articulator

Paul is also working on a project for terminology for diagnosis. “We are trying to get a worldwide or international classification for the different conditions we treat,” he explains. “I developed a classification some years ago, which I still think is quite good, but not everyone agrees,” he smiles. “It is an interesting process linking up with big name people and seeing how they think differently.” With such a varied career, when asked about what he enjoys most, he says it’s seeing the ‘end result’ of teaching, when a student graduates and becomes a specialist. “My involvement with undergrads is less than it used to be but it’s still really nice to see them finish and then to follow their career,” he adds. “To know you have had some influence is rewarding. It is similar to clinical treatment, when you do some treatment and see your patient heal – you always get a buzz out of that.” As well as various allocations for his teaching, Paul was honoured to receive an Officer of the Order of Australia in the General Division (AO) in 2015. “It certainly was an honour and a surprise too,” he says, “When you get the letter you wonder what it is, because it comes with the Governor General’s insignia on it. I have been fortunate to receive various awards, but most of them have been within the profession or some teaching awards from the university. This was something totally out of the profession and at that sort of level, it was a huge honour.”

ADA support “ADA has been great, especially here in WA,” Paul says. “The support that ADAWA provides professionally is great. “I think we had the advantage many years ago that we were a smaller branch. There were only about 400 or 500 dentists on the register when I graduated – now there are around 2,000, but the local ADA has always had a very high rate of membership and I think this last year the support offered by ADA has been amazing.”

It’s often locals who are looking after you when you’re in a new place for a lecture or conference, and you might go to their homes and you learn a lot about their society and their culture, as well as seeing the sites. You make some good friends and build up a big network. What’s next for Paul Abbott? After 41 years in private practice, he stopped seeing patients last year to make more time for the Dental School. “We are in the process of revising the curriculum for DMD at the moment,” he says. “I am heading up that, so it’s a big job, but it’s interesting and challenging.”

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This year’s New Practitioner Program is going out with a bang on Saturday November 13, with the annual, all-day, and much-anticipated Young Dentists’ Conference, for dentists who’ve graduated within the last five years. A fitting and celebratory end to 2021’s New Practitioner Program, this year’s conference will take place at ADA House. Organiser Dr Amanda Phoon Nguyen says the free, all-day conference will cover things a young dentist needs to know – as well as an opportunity to network and socialise. “We have a line-up of amazing speakers including specialists and general dentists,” Amanda says. “There will be some very exciting topics, including biomimetic dentistry and modern rubber dam isolation. We are also including topics that attendees asked for last year, so I will be doing an update on medications and Leon Smith will be talking about things that can go wrong after hours and how to prevent them.” Sponsored by DPLA, the full-day event will include clinical and practical advice, as well as risk management. “This is very important, because as the studies show, dentists get one AHPRA notification every 10 years on average, so you should know what do to just in case.” As always, the Young Dentists’ Conference is a social event, offering a chance to catch up with friends and colleagues. There’s also the chance to pick up some great prizes including an Apple Watch from DPL, and vouchers from WA Dental CPD. “Some exciting changes this year is that we have really listened to what attendees want, so we are starting later, having breaks in-between lectures, and we are getting in tacos for lunch,” she says. “We are also organising food trucks to come to ADA House so we can finish the day off with a bang. “It’s something I think many young dentists around Australia wish they could go to,” she adds. “We are quite lucky to be able to hold an event like this in WA, in a friendly, safe environment.” Back by popular demand, attendees will have the opportunity to ask a specialist panel questions at the end of day. “I would encourage anyone who wants to attend to email me questions prior that we can ask the panel.” Questions can be emailed to amandap@adawa.com.au and can be asked anonymously. Question submissions will also enter a prize draw, so please ask away! If you’ve graduated within the last five years and you’d like to register for the Young Dentists’ Conference, email adawa@adawa.com.au

SATURDAY NOVEMBER 13 The event will feature the following speakers and topics: Dr Annalene Weston Common Complaints and How to Avoid Them Dr Amanda Phoon Nguyen 10 Tips for Medications Drs Tim Maxwell and Maheer Shah Introduction to Biomimetic Dentistry Drs Greg Crane and Rebecca Penco Isolation Mr Leon Smith What Can Go Wrong and How to Prevent It Drs Michael Khoury, Lisa Bowdin, Nandika Manchanda, Armand Putra and others Specialist panel with this year’s NPP speakers

Join the NPP committee Are you a young dentist who wants to make a difference? The New Practitioner Program committee is looking for a young dentist to join them as a member. This is a wonderful opportunity for you to bring new ideas to the table, to help ensure the program remains current and delivers what is important. If you would like to find out more about joining the NPP committee, please email amandap@adawa.com.au

6.5 Friday 22 Oct 2021 CPD Registration from 8.45am, Course 9am to 4pm Albany Entertainment Centre 2 Toll Place Albany Bookings & Enquiries adawa.com.au/cpd

$ inc GST

594 Dentists 396 Hygienists/Therapists/OHTS + light lunch & afternoon tea

N TA T

Photo courtesy: Tourism WA

Red, White, Night and Bite

ALBANY

Presented by Dr Amanda Phoon Nguyen COURSE OUTLINE Join Dr Amanda Phoon Nguyen for a day of practical and contemporary oral medicine seminars. From lesions in the mouth that appear red and/or white, to dental sleep medicine and orofacial pain, Amanda will discuss a variety of oral mucosal conditions, premalignant and malignant conditions, orofacial pain disorders and temporomandibular joint disorders that you will encounter in your patients. She will also discuss tips for a comprehensive head and neck examination, screening for obstructive sleep aponea, and conclude the day with interesting case presentations and discussions.

ABOUT THE PRESENTER Dr Amanda Phoon Nguyen is an oral medicine specialist in Perth and Darwin, adjunct senior lecturer and PhD candidate at the University of Western Australia. Her clinical and research interests

include oral mucosal disease, orofacial pain, temporomandibular disorders, dental sleep medicine and paediatric oral medicine. She is the Editor and an examiner for the Royal Australasian College of Dental Surgeons, co-chair of Australasian Sleep Association Dental Sleep Medicine Council, and widely publishes for multiple journals. She also represents her specialty at multidisciplinary groups and strongly believes in team collaborations. She is an executive member of Australian Dental Association (WA), heavily involved with many professional committees, and dedicates her energy to many community volunteer causes and online oral medicine educational/ special interest groups. An international and national speaker, she is passionate about her speciality, regularly lecturing and teaching. She has a public appointment at the Oral Health Centre of Western Australia.

Dental

CPD CALENDAR October World Cavity Free Future Day Crown Preparation – from conventional to bonded

14 14

Dr Joshua Graieg

Decision making for the Avulsed Tooth

Uni Club, Crawley

Szabolcs Hant & Dr Graham Carmichael

Uni Club, Crawley

Dr Nabil Khzam

Albany Entertainment Centre, Albany

ADA House, West Perth

Professor Lisa Heitz-Mayfield More details to come

Saturday 8.30am–3.00pm Young Dentists' Conference Saturday

Is Ice Cream a Pulp Test

Saturday

More details to come

ADA House, West Perth

ASP WA Looking Forward, Looking Back – A Tapestry of Periodontics Over 45 Years

March 2022 Dr Michael Khoury

ADA House, West Perth

Friday 9.00am–4.00pm

Peri-implantitis A Risky Business Thursday

Friday 9.00am–5.00pm Saturday 9.00am–5.00pm

Red, White, Night & Bite

ADAWA Annual General Meeting Wednesday evening

5/6

Dr Asheen Behari & Dr Paul Gorgolis

ADA House, West Perth

Perth Convention and Exhibition Centre

Thursdays 6.30pm–9.30pm

Western Australia Dental Update

Radiology Update 2022 Envision Medical Imaging

Saturday (morning)

UWA Dental School, Nedlands

Friday 9.00am–5.00pm

Dr Amanda Phoon Nguyen

W. Prof. Paul Abbott & Dr Jilen Patel

Porcelain Veneers & Ceramic Onlays

Thursdays 6.30pm–9.30pm The Art of Digital Photography & its Clinical Applications

February 2022

November

MRONJ Dinner Dr Amanda Phoon Nguyen & Dr Leon Smith

Thursday

More details to come

Dr Albert Tan

The Western Australian Dental Foundation and the UWA Dental Alumni Society would like to invite all members to attend the 2021 Annual General Meeting

Wednesday 27 October 2021

More details to come Predictable & Easy Root Canal Instrumentation & Filling Techniques

W. Prof Paul Abbott

Friday 8.30am–5.00pm

UWA Dental School, Nedlands

Public Holidays

ADA House, West Perth 6pm for a 6.15pm start

Christmas Day

Saturday 25 Dec

The meeting will be held prior to the

Boxing Day

Sunday 26 Dec

ADAWA Annual General Meeting.

RSVP 20 October 2021 gwennac@gmail.com

Bookings & Enquiries

Additional event information and online bookings available at adawa.com.au/cpd Bookings, Course and Payment: T (08) 9211 5600 E cpd@adawa.com.au Other Enquiries to Dr Jenny Ball: M 0419 044 549 E jenny@adawa.com.au

WA School Holidays Friday 17 Dec - Sunday 30 Jan

Event Types: WA Dental CPD Events

Please note that parking is very limited for any daytime courses at ADA House, West Perth. Attendees should make themselves aware of public parking facilities in the area, or use public transport. The Red CAT bus route is conveniently located for ADA House. Online Bookings are available on the ADAWA website adawa.com.au in the CPD area. A receipt will be issued listing the course name, date and applicable CPD hours, when registrations are processed. A Certificate of Participation will be provided after attending the course. Replacement certificates cannot be provided.

EDITION 7 | 2021 Western Articulator

ADAWA General Meetings Other CPD Events

join us AT THE

ADAWA Annual General Meeting ADAWA's AGM will see Dr Sean Archibald pass on the Presidency to Dr Amit Gurbuxani, as well as a presentation from Dr Dayea Oh.

Finding Wizzy - Third Molar Imaging

Wednesday 27 October

presented by Dr Dayea Oh

ADA House 54-58

Oral and Maxillofacial Radiologist

Havelock St West Perth

Senior Lecturer at UWA’s Dental School, Dr Oh leads the Oral and Maxillofacial Radiology components for the DMD programme. She works at Envision Medical Imaging and has recently been appointed as a Divisional Head in Oral Diagnostic and Surgical Sciences at OHCWA.

Available on Zoom for those unable to attend in person

6.15pm Eat and Meet 7.30pm General Meeting 8.00pm Lecture RSVP Wed 20 Oct to adawa@adawa.com.au

adawa.com.au

CPD

Thursday 4 Nov 2021 Registration from 6.15pm, Course 6.30pm to 9.30pm limit : 34

University Club Hackett Drive, Crawley Bookings & Enquiries adawa.com.au/cpd Three course dinner

242 INC GST

In-n-Out Teeth Dilemmas & Decision Making for the Avulsed Tooth Presented by Winthrop Professor Paul Abbott and Dr Jilen Patel COURSE OUTLINE

ABOUT THE PRESENTERS

James, aged 7, and his brother, Coen, aged 10, are

Winthrop Professor Paul Abbott is a Specialist Endodontist. Prior to

playing footy. James trips over Coen and lands

taking a full-time University position in 2002, as Dean and Head of the

on his face, meanwhile the momentum carries

Dental School and Director of OHCWA, from 2003 – 2009 and then

Coen forwards and he hits his face against the

lead in endodontics, he spent 17 years in private specialist endodontic

goal post…the tumble results in each of the boys

practice in Perth and Melbourne. He has presented hundreds of

avulsing a tooth!

CPD events all over the world and published numerous articles and

Although both boys sustain a similar traumatic dental injury, the two children can have very different outcomes and much depends on the immediate and follow-up management by their

textbook chapters. In 2015, he was appointed as Editor-in-Chief of the international journal Dental Traumatology. He has received numerous awards for excellence in teaching and for service to the dental profession, particularly in education and research. In 2015, he was

dentist. There are things we must do as part of the

appointed as an Officer of the Order of Australia.

emergency management as well as things that

Dr Jilen Patel is a specialist paediatric dentist. He is a Senior Lecturer

we should not do. Various sequelae can develop

in Clinical Dentistry at the UWA Dental School and Consultant at Perth

during the follow-up period and their management

Children’s Hospital. He is the recipient of several grants and awards

can range from simple things such as observation

including multiple community service grants aimed to extend dental

to much more complicated treatments such as

services to vulnerable communities. He has previously received both

decoronation, loss of the tooth, etc.

the both the Royal Australasian College emerging lecturer award and

This lecture will explore the potential complications

Australian Dental Association/Pierre Fauchard Academy’s young

and outcomes, along with outlining what we can do N TA T

as dentists for these two patients.

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.

Education & Training

Multi-disciplinary study club for young clinicians Date:

First Thursday of every month

Start time: 6pm Venue:

ADA House, 54 Havelock Street, West Perth

Cost:

No cost

Presenters: Dr Hezel Cohen (Prosthodontist) & Dr Eman Elhassan (Periodontist) RSVP:

prosstudyclub@gmail.com

adawa.com.au

ADA HR FEATURE

Managing sexual harassment in the workplace Sexual harassment is a serious issue for practices to contend with. A study conducted by the Australian Human Rights Commission showed that 39% of women and 26% of men had experienced sexual harassment in the workplace. Often these incidents are witnessed, however, the study showed that 69% of witnesses did not intervene or report the incident to management. In addition, the study showed that 19% of victims who did report the incident were labelled a troublemaker, 18% were ostracised or victimised, and 17% resigned, largely due to inaction. These statistics highlight the importance of addressing sexual harassment in the workplace. To do so, practices must ensure that a comprehensive sexual harassment policy is in place to mitigate risk and provide for an open and honest work environment. In addition, swift action should be taken if allegations are raised.

Government Inquiry into workplace sexual harassment Managing sexual harassment in the workplace is also a priority for the Australian Government, which has undertaken a National Inquiry into sexual harassment in the workplace (called the Respect@Work Inquiry), which revealed that it is pervasive, with one in three workers experiencing sexual harassment. In response to the Respect@Work Inquiry, Government has committed to amending the Sex Discrimination Act 1984 and the Fair Work Act 2009 (FW Act). The proposed amendments to the FW Act include: • Granting the Fair Work Commission the power to make ‘Stop Sexual Harassment Orders’ • Amending section 387 of the FW Act to clarify that sexual harassment can be conduct amounting to a valid reason for dismissal in determining whether a dismissal is harsh, unjust, or unreasonable • Amending the definition of serious misconduct to include sexual harassment

EDITION 7 | 2021 Western Articulator

Have experienced sexual harassment in the workplace

DID NOT intervene or report the incident

What is sexual harassment?

Sexual harassment in dental practices

Sexual harassment includes unwelcome sexual advances, unwelcome requests for sexual favours, or other unwelcome conduct of a sexual nature which makes a person feel offended, humiliated, or intimidated, where a reasonable person would anticipate that reaction in the circumstances. Examples of sexual harassment can include, but are not limited to: • unwelcome touching or staring • deliberately brushing up against a person and any other excessive familiarity • suggestive comments, jokes, insults, or taunts • intrusive questions about a person’s private life or body • the sharing or taking of sexually explicit pictures • unwanted invitations to go out on dates or requests for sex • sexually explicit physical contact • sexually explicit phone calls, emails, or text messages Some types of sexual harassment may also warrant criminal charges, such as physical molestation or assault, indecent exposure, sexual assault, stalking, and explicit communications, such as telephone calls, text messages, emails, or letters. Sexual harassment can have significant impacts on the victim, and witnesses. This includes: • feelings of isolation, social isolation, or family dislocation • loss of confidence and withdrawal • physical injuries as a result of the assault • stress, depression, anxiety, and post-traumatic stress disorder (PTSD) • illness such as cardiovascular disease, musculoskeletal disorders, immune deficiency, and gastrointestinal disorders, eg as a result of stress • negative impacts on a person’s job, career, and financial security • suicidal thoughts

Sexual harassment is illegal in workplaces. Practices can be held responsible for any acts of sexual harassment engaged in by their employees, volunteers, unpaid honorary officers, board of directors, contractors, consultants, and business partners.  Although individuals who engage in sexual harassment are held primarily responsible for the act, liability can extend to the practice too. Practices may also end up paying more compensation if they are found liable due to having “deeper pockets” than the perpetrator. Compensation may also increase where the practice was aware that an employee was being sexually harassed or was aware there was a real possibility of it occurring and did nothing to stop it. In recent years, there have been few allegations of sexual harassment made against dentists. However, a lack of reporting does not necessarily indicate that incidents do not occur. The Australian Human Rights Commission has noted that in dental practices, victims of sexual harassment more often choose to resign from their position instead of reporting the incident. It has been further stated that the relationships between dentists and auxiliary practice staff have the potential to create a power imbalance where sexual harassment is more likely to occur and make the victim less likely to speak up.

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Workplace Health and Safety

Sexual Harassment Policies

All employees have a right to be safe at work. Employers must provide a safe working environment and this includes psychological and physical safety.

The most effective way for practices to combat sexual harassment is to actively implement anti-harassment policies and procedures.  When drafting the policy, it is recommended that practices include the following:

Practices, therefore, must prevent sexual harassment within their practice by ensuring that the working environment at their practice is not sexually permeated or hostile. In other words, practices need to tackle any organisational culture that may make one gender feel unwelcome, or unable to participate in and enjoy their work environment, and ensure that actions of sexual harassment are prevented, and appropriately addressed should they arise.

How to handle a sexual harassment complaint in the practice Practices must have a formal strategy in place to handle sexual harassment. This involves taking all reasonable steps to prevent sexual harassment from occurring. The definition of what constitutes reasonable steps will vary depending on the practice, as what is reasonable for one practice may not be reasonable for another. The following steps are paramount in managing and avoiding sexual harassment in the workplace: • Take steps to prevent sexual harassment from occurring including drafting a sexual harassment policy, implementing the policy, and monitoring its effectiveness • If sexual harassment does occur, have appropriate procedures for dealing with complaints if they are made including reporting mechanisms, investigation processes, and taking effective action • Employees should not be penalised or victimised for making a sexual harassment complaint. An employee also has the right to complain about a sexually hostile working environment, even if the conduct does not directly affect them.

• A strong opening statement on the organisation’s attitude to sexual harassment, commitment to ensuring a harassment-free environment, and a zerotolerance policy for such conduct • A comprehensive strategy for eliminating sexual harassment and managing complaints should they occur • A clearly worded definition of sexual harassment, consistent with the legal definition, with examples relevant to the practice and an explanation of the circumstances in which sexual harassment may occur • Examples of behaviour that do not constitute sexual harassment, such as actions based on mutual attraction, friendship, respect, and consent • A statement that sexual harassment is against the law • A clear explanation of the options available for dealing with sexual harassment and the consequences that will be imposed by the practice if the policy is breached • The responsibilities of management and staff in ensuring the policy is successful, including monitoring, reporting, and enforcement • Information on where individuals can receive advice, assistance, and/or make a complaint Policies must be well implemented, including through the provision of ongoing training, communication, and reinforcement. A policy that is not implemented through regular communication, education, and enforcement will be of little to no use in reducing liability for practices and will be difficult to rely on when managing complaints in the practice.

If you have any questions about this article or any other employment relations inquiries, please do not hesitate to contact the ADA HR Advisory Service on 1300 232 462.

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Radiology Update 2022 It’s not all black & white!

Envision Medical Imaging invites you to join us for a morning of education, catch up with mates and support the new ADAWA charity, Uniting Smiles Ltd. Guest Presenter Dr Lawrence Dembo

Cardiologist. Imaging Specialist. Cardiac Transplant Service (FSH)

Our guest lecturer will deliver an engaging update on the latest in cardiac risks relevant to you and your patient. You do not want to miss this!

Presenters

URS 3.5 HOTIFIC SCIEN CPD Clin Prof Bernard Koong Oral and Maxillofacial Radiologist

Dr Tom Huang Oral and Maxillofacial Radiologist

Course Topics • Cardiac Risk: You and Your Patient • Seeing root canals like you’ve never seen before. • It is now an essential skill to be able to correctly view a CBCT scan – Let us show you how!

Dr Dayea Oh Oral and Maxillofacial Radiologist

• What’s that interrupted white line on the PA radiograph and OPG? – should I normally see this? Does it matter? • What imaging test should I prescribe for undiagnosed facial pain when it looks normal on PA radiography and OPG?

Date: Saturday 12 February 2022 Time: 8:45 registration for 9:00am start. Morning tea refreshments served. Concludes 1:00pm Venue: Perth Convention and Exhibition Centre RSVP: Please book early as seats are limited TO REGISTER for this event please pay $50.00 to: Name Uniting Smiles BSB 951-200 Account 014 102 460 Reference Surname and ADA Member Number (e.g. Brown12345)

All registration fees will be funding ADAWA’s new charity, Uniting Smiles

High Court puts the brakes on

casuals double dipping

BY JENNY EDINGER SPECI AL COUNSEL & MORGAN BARNSBY L AW GRADUATE

From time to time, casual employees make claims for leave payments from employers, arguing that they are not a “true” casual but are in fact a permanent employee.

As a consequence, the Federal Court held that Mr Rossato was entitled to be paid annual leave as a permanent employee but also to keep the casual loadings paid to him.

Workpac v Rossato

However, the High Court on 4 August 2021, overturned the earlier Full Court decision.

This case concerned the employment of Mr Rossato by Workpac Pty Ltd (Workpac), a labour hire agency. Over several years, Mr Rossato was employed by Workpac as a ‘Casual Field Team Member’ to provide services to Glencore Australia Pty Ltd at several Queensland coal mines. At all relevant times, Workpac engaged and paid Mr Rossato as a casual employee and as such did not pay him any annual leave or other paid leave entitlements. When Mr Rossato retired, he then claimed that he was a permanent employee and sought payment for his leave entitlements. Workpac first sought a declaration from the Federal Court that Mr Rossato was not entitled to the claimed leave payments and that he was a casual employee. Workpac also claimed that if Mr Rossato’s employment had been mischaracterised, that the casual loadings paid to him should reduce the amount of any leave payable by a commensurate amount. The Federal Court held that Mr Rossato was a permanent employee and not a casual employee for various reasons, including that when the totality of his employment circumstances were considered, Mr Rossato had an expectation of continuing work according to an agreed pattern. Importantly, the Federal Court placed more emphasis on the regularity of Mr Rossato’s roster and less emphasis on his employment contract that stated he was employed on an “assignment by assignment” basis.

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The High Court held that Mr Rossato was a casual employee because: • his contract of employment clearly stated he was a casual employee engaged on an assignment-byassignment basis; • his rosters did not establish a commitment to ongoing employment after each assignment finished; and • Mr Rossato worked as a casual employee on an assignment-by-assignment basis, consistent with his employment contract.

Implications for employers and their casual employees Firm advance commitment The High Court accepted the prevailing understanding of lawyers and employers alike, that casual employment is characterised by no firm advance commitment as to the duration of the employee’s employment or the days and hours the employee is expected to work. Importantly, the High Court held that Mr Rossato’s regular and systematic roster was not inconsistent with the definition of casual employment because his employment was time limited to the length of each assignment. However, employers should still be cautious about implementing regular work rosters for their casual employees because it is still a factor which may be considered by a court should a casual employee claim leave payments.

LEGAL FEATURE The High Court held that whether Mr Rossato was a casual employee with a firm advance commitment for ongoing employment must be determined by reference to the enforceable terms within the contractual arrangement between the employee and employer. It was not to be determined by the unenforceable expectations or understandings thought to exist by the parties. An employer who gives clear expression to the casual nature of the employment and confirms that work is offered to the employee with no firm advance commitment as to the duration or the days and hours they are required to work will have more certainty that the employee’s casual status will not be disturbed by a Court or Tribunal. For employers and employees operating within the state employment system (that is, not covered by the Fair Work Act 2009 (FW Act)), the High Court’s decision is instructive of the circumstances in which a state court or tribunal should find that a person was engaged as a casual employee.

Amendments to the Fair Work Act 2009 regarding casual employees The High Court’s decision in Rossato reflects recent changes to the FW Act and provides guidance on factors that Australian courts should consider when determining whether a person is engaged on a casual basis. In March 2021, the Federal Government introduced legislative amendments including a statutory definition of casual employee and what factors are relevant to the characterisation of an employee as a casual. The FW Act inserted the following definition of casual employee: • a person who receives an offer of employment that is made on the basis that the employer makes no firm advance commitment to continuing and indefinite work according to an agreed pattern of work; and • accepts that offer on that basis; and • is an employee as a result of that acceptance.

Relevant factors which are to be considered when determining if someone is a casual employee include: • whether the employer can elect to offer work, and whether the person can accept or reject the work; • whether the person will be work as required according to the needs of the employer; • whether the employment is described as casual employment; and • whether the person will be entitled to a casual loading or a specific rate of pay for casual employees. Additionally, a regular pattern of hours does not of itself indicate a firm advance commitment.

Key takeaways In drafting any casual employment contract, dentists should take time to carefully word the contract in such a way that it specifies that the employee is engaged on a casual basis and there is no firm advance commitment to ongoing employment. © Panetta McGrath Lawyers 2021. This information is intended as a general overview and discussion of the subjects dealt with. The information provided is not intended to be, and should not be used as, a substitute for taking legal advice in any specific information. Panetta McGrath is not responsible for any actions taken on the basis of this information.

If you would like to know more about how your business can manage risk and introduce greater certainty into your employment arrangements, please contact our Employment and Workplace Relations team on (08) 9321 0522.

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Perio and the pandemic: a cause for concern? BY ANDREW WALKER & COLM H ARNEY DENTOLEGAL CONSULTANTS

Will the disruption caused by COVID-19 heighten the risks around periodontal disease? In recent years, the dental profession has been concerned about litigation in relation to periodontal disease. More recently, members have contacted the Dental Protection advice line, worried about whether the current pandemic situation may put them at further risk of a periodontal claim for compensation. A particular issue that some members have wanted to discuss is the need to undertake periodontal treatment with hand instruments, when they are unable to use ultrasonic scalers. The Covid-19 pandemic has given rise to many unprecedented situations. As such, it is difficult to predict with any degree of certainty what the impact will be on, for example, future claims compensation. Although, it is worth considering the following points in relation to periodontal claims for compensation.

Hand instrumentation is effective In the first instance, we should bear in mind the evidence in the periodontal literature, which does say that hand instrumentation and powered instrumentation can be equally effective. This is also mentioned on the British Society of Periodontology (BSP) website. It is therefore appropriate to consider providing periodontal treatment with hand instruments when required. However, it is also accepted that clinicians only maintain the skills they use. The BSP website also goes on to state:

EDITION 7 | 2021 Western Articulator

“…. Clinical experience indicates that non-AGP management of periodontal diseases, whilst being effective, requires hand instrumentation carried out to a high standard. This may take more time than the equivalent use of powered scalers and can be technically challenging in some circumstances.” It is quite possible that there are some dentists, hygienists or therapists who do not use hand instruments regularly, or simply prefer powered instrumentation. In this regard, as well as ensuring efficiency of treatment, it is equally important to ensure that you are using an instrument safely. If you are concerned about using hand instruments, the first thing that can be done is to see whether there is any CPD or revision available to update your knowledge and skills. Again, professional societies are a useful point of reference and the BSP has produced helpful webinars on this very topic.

Educating patients on their own role In relation to potential claims, there are several points that should be reviewed. Firstly, if many periodontal treatments are planned with a phased approach. The first of these is motivating and supporting patients to obtain and maintain successful removal of the supragingival dental plaque biofilm, as well as controlling risk factors for the disease. In other words, this can be viewed as patient education and motivation. If entering a phase where professional intervention is potentially or possibly harder, it may call for a refocus on the patient’s role in managing their own disease. This in itself can have many benefits, and good documentation of any further advice provided to the patient can be vital if a claim is brought. In relation to any claim, it is often the case that the records and patient need to be reviewed by an independent expert witness. One of the roles of the expert is to comment on the standard of care provided.

HIF Corporate Program ADA WA members are entitled to a 12% discount on health cover each year when premiums are paid by direct debit. Existing HIF members need only call or email to have the discount applied to their membership.

In relation to the standard of clinical treatment, this is meant to be compared against that of one’s peers, or what would be expected of a reasonable dentist, hygienist, or oral health therapist. In this situation, it would be hoped that an independent expert would acknowledge and take into consideration that, during the current situation we are all facing, periodontal care may be a little different.

Perio is a longer-term issue While we don’t know how long this period of uncertainty will last, we can hope that it is a relatively short period in a lifetime of periodontal need. Moving on from this, it is worth remembering that all periodontal patients should have regular and careful assessment and reassessment. In most of the periodontal claims seen by Dental Protection, the claim relates to care over a long period of time, where the periodontal condition has deteriorated over many years. Therefore, if you are concerned about any deterioration that you feel has occurred, communicate this with the patient and talk through the potential options. The above point is perhaps the most important message, and it is essentially the same principle as before COVID-19. Your duty is to provide a reasonable standard of care for the time the treatment was undertaken and offer referral if, after that, you are still concerned. This may be for a variety of reasons, such as you feel you have reached the limit of what you can offer, or you feel the patient is still not stable despite your best efforts. In some cases, you may also be of the opinion an early referral to a local specialist may be a reasonable option for the patient. Again, as in any time, when you do have these discussions, and when difficult clinical decisions need to be made, good documentation in the clinical records is paramount.

Visit hif.com.au/adawa and use the access code ADAWA Alternatively call HIF on 1300 13 40 60 or email sales@hif.com.au adawa.com.au

Clinical Feature

Funding awarded for work into the genomic profile of head and neck cancers The Australian Centre for Oral Oncology Research and Education has been awarded $2.23 million in funding to continue their work into the genomic profile of head and neck cancers and precancers. Professor Camile Farah, executive director of the Australian Centre for Oral Oncology Research and Education (ACORE), says his team was absolutely delighted to receive the funding, which is through the Australian Government’s $20 billion Medical Research Future Fund, and part of the Genomics Health Futures Mission. “We are very grateful for the funding. It’s very difficult obtaining large, competitive research grants these days, with the running average for success in the National Health and Medical Research Council general round at about 10%. The competitive nature of the funding cycles has increased significantly in recent years, and the quality required to pass the bar for success is extremely high.”

The project

Why the research is so important

The project “Evaluating clinically relevant biomarkers to improve early detection and treatment of head and neck cancer” will be undertaken in collaboration with colleagues at the Peter MacCallum Cancer Centre, Genomics for Life, Icon Cancer Centre, and CSIRO. Camile established ACORE as a private research centre to leverage his academic, clinical and industry partnerships for the advancement of oral oncology translational research, personalised patient care, patient and clinician education and professional development, and overall advocacy for patients with head and neck cancer.

Camile says a “one size fits all” approach doesn’t provide the best outcomes for patients. “(We hope) to increase survival rates, making sure patients don’t get recurrences of their tumours and that they respond to the correct treatment, whether that be a drug or surgery or other therapy. The ultimate goal is to improve outcomes for patients and that is why our research is so important. The survival rates of head and neck cancer with traditional treatment these days is just over 50% overall. We believe that is still very poor and would like to improve that, so by understanding the molecular profile of a particular tumour and tailoring a treatment solution to that particular patient and lesion, we believe we can improve survival outcomes for patients.”

“The premise of this grant builds on my previous work and that of my colleagues in genomic medicine,” Camile explains. “Mostly taking what we understand about the molecular aspects of head and neck cancers, specifically oral cancers and pre cancers, and trying to translate that to clinical practice by mapping the genomic profile of these lesions and then matching that to a potential treatment for a patient; a concept called precision genomic medicine.” Camile says currently what happens is cancers and pre cancers are treated the same way for different patients, generally in a “one size fits all” approach. “Currently we don’t really take any regard for the genetic profile of the patient or the molecular profile of the tumour,” he explains. “What we’re proposing is that instead of just looking at the clinical features of a lesion or the patient risk factors, moving forward we would additionally consider the genetic profile of the patient and the molecular profile of the lesion and personalise a treatment for that particular patient. Of course, that implies there are differences in molecular profiles, which we’ve shown previously in our research. That also implies that if you can find these molecular differences, you can act on them. In essence, that’s what we’ll be exploring with this round of funding.”

Message for dental colleagues “When we started this research, people called it ‘pie in the sky’ work, because they didn’t really understand what we were doing,” Camile says. “I think we’ve got to the stage where people understand a little bit more about genomic medicine. This has occurred more recently with COVID, as more people have been hearing about genomic sequencing of COVID, so suddenly people have taken more of an interest in genomic sequencing, what it means, how it works and why it’s so powerful. “What I would like my dental colleagues to understand is that this is getting closer and closer to clinical practice,” he adds. “As we move forward, there’s a need for the dental profession to understand the wider implications of personalised and precision medicine on healthcare generally as patients really take up these approaches in earnest. Our focus can’t continue to be just on the patient’s dentition, as there are broader implications for the profession in understanding genomic medicine because it will impact on our patients. I would really like to see the dental profession champion the precision medicine approach for the benefit of their patients.” “Medical research is like running a marathon, but we’re getting to the stage where we can implement some of the findings that we’ve been working on together over the last 10-15 years and translating them into clinical practice. This new funding will accelerate that significantly,” he adds.

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Clinical Case

A case in point directly relevant to the dental profession relates to a 57-year-old male who was referred for a recurring non-homogeneous oral leukoplakia on the right antero-ventral tongue (Fig 1). He reported being a non-smoker but consumed alcohol irregularly. His leukoplakia had first appeared some four years earlier and had been treated with various modalities on several occasions with frequent recurrences, and had previously demonstrated mild to moderate dysplasia on histopathology (Fig 2).

Next generation DNA and RNA sequencing was undertaken on the lesion. This demonstrated somatic mutations in tumour suppressor genes CDKN2A and TP53 and oncogene TERT. The lesion demonstrated low Tumour Mutational Load, no Homologous Recombination Deficiency, and no somatic Copy Number Variations (Fig 3). This information categorized the leukoplakia within the “classical” subtype of oral cancers which accounts for only 22% of these tumours. CDKN2A encodes tumour suppressor protein p16 which is involved in cell growth and cell cycle control, and specifically blocks progression from G1 to S phase of the cell cycle by inhibiting Cyclin D1, resulting in cell senescence and subsequently dysplasia. Inactivation of protein p53, encoded by gene TP53, results in alterations to cell growth arrest, apoptosis and disturbed cell cycle due to cellular stress such as DNA damage. The “classical” profile of this leukoplakia clarified that the lesion was not of the more common “basal” or “mesenchymal” subtypes accounting for 42% and 35% of oral cancers respectively. “Basal” subtypes demonstrate NOTCH1 inactivation and co-mutation of HRAS-CASP8, while the “mesenchymal” subtype demonstrates modifications to immune-related genes. “M” class lesions are DNA mismatch repair proficient and thought to occur in a p53-independent tumourigenesis pathway in patients without a significant history of smoking or alcohol consumption. Finally, the “atypical” subtype is commonly seen in HPV-associated lesions.

Figure 1 - Top left, Figure 2 - Bottom Left

Assessment of the genomic profile of the leukoplakia was used to understand its biology, to appreciate the reason for recurrences, to understand the malignant potential of the lesion, and finally, to decide if surgical excision or other therapy was the most appropriate approach for future management.

EDITION 7 | 2021 Western Articulator

The leukoplakia was surgically excised and the patient is under long term surveillance. In the future, patients could be treated with pharmacotherapeutics either systemically or delivered to the lesion locally. This could result in silencing of an oncogene such as TERT. Alternatively, the patient could receive recombinant gene therapy against TP53 to replace the mutant gene with a wildtype equivalent in order to restore normal p53 activity. These therapies are currently being explored in clinical trials. It is clear that understanding the genomic profile of a lesion as articulated in this example will become vitally important, so the most appropriate therapy can be selected for an individual patient and lesion.

Molecular Analysis • Clinically actionable (druggable/predictive/prognostoc and/or with diagnostic/classification implications in the disease primary site and histology in which it has been identified • Variants of this gene in this primary site/histology are established as clinically actionable (druggable/ predictive/prognostoc and/or with diagnostic/classification implications), however the specific sequence variants is not one of the currently reported variants in this gene in the histology

SOMATIC DNS MUTATION DETECTED (POSITIVE) CDKN2A

TP53

TERT

c.238C>T

c.742C>T

c.1-124C>T

p.R80*

p.R248W

Promoter

Tumour Suppressor Predicted Driver Mutation

Oncogene Known Driver Mutation

Reference Sequence: NM_001195132.1 CDKN2A Exon 2.

Reference Sequence: NM_000546.5 TP53 Exon 7.

Reference Sequence: NM_198253.2 TERT (Promoter)

Mean Coverage: 10525X. Variant Aliele Fraction: 5%

Mean Coverage: 8481X. Variant Aliele Fraction: 6%.

Mean Coverage: 349X. Variant Aliele Fraction: 12%

DNA Variants

146 Genes Negative Mean Coverage: 8609X. 51 Genes Negative

Somatic RNA Fusion

Total Reads: 6771436X.

Tumor Mutational Load

TML Low

Homologous Recombination Deficiency

HRD Not Detected

Figure 3

Mutation Load per MB: <1.0

Clinical Feature

Getting the Right Bite and the Bite Right Dr Amanda Phoon Nguyen | Oral medicine specialist

Occlusal dysesthesia (OD), otherwise known as phantom bite syndrome or occlusal hypervigilance, is a condition where affected patients complain of bite discomfort without evident occlusal abnormalities. Originally described by Marbach in 1976 as a “monosymptomatic hypochondriacal syndrome”, and more recently known as a type of “somatic symptom disorder” as outlined in the criteria laid down in the 5th edition of the Diagnostic and Statistical Guide to Mental Disorders (DSM-5), OD may have overlapping features similar to those with body dysmorphic disorder (BDD).

There is unknown prevalence or incidence of this condition, and it can present at any age, in any gender, with the condition often lasting decades. The exact aetiology is not sufficiently understood, however, it is perceived only in the waking state. Some literature has reported that some patients were experiencing an unusually stressful phase of their lives around the time of the first manifestation of the condition and that they had undergone dental treatment at the same time.

This is a condition in which tooth contacts that are not clinically identifiable as premature contacts nor associated with other disorders (eg of the periodontal tissues, the dental pulp, the masticatory muscles or the temporomandibular joints) have been perceived as disturbing or unpleasant, for six months or more. The clinical findings bear no recognisable relation to the type and strength of the complaints reported. Affected patients suffer from severe psychological and psychosocial stress, and they experience OD as a continuous impairment of their oral or physical wellbeing. They can be intensely preoccupied with their symptoms.

A middle-aged female was referred to me as she has had something stuck in-between her teeth for five years and cannot floss it out. She has seen multiple dentists, and no one can reach it.

Some studies have reported that they may be less capable of adapting to changes in their dentition, have higher levels of psychosomatic distress, and are often diagnosed with depression, anxiety disorders or somatic stress disorders related to other parts of the body.

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My Case Examples:

A middle-aged male was referred by an orthodontist as he would like a third round of fixed orthodontics to correct a “bad bite”, and the orthodontist suspected hallmarks of occlusal dysesthesia. A middle-aged female seen as she had many complaints about her multiple dentures and felt that the poor bite of her dentures were causing body asymmetry, with her clothes no longer fitting her well. She has also noted that her glasses would no longer “sit straight” on her nose as the dentures were changing the shape of her face. She was on her fourth set of dentures and was fixated on obtaining the next set of dentures which would fix her problems.

Marbach’s Diagnostic Indicators of PBS PATIENT INDICATOR

EXAMPLE

Believe that severe symptoms are all due to their occlusion

Perception of a serious bite or cosmetic defect, with frustration that multiple clinicians cannot find the problem. There is a discrepancy between the clinical findings and the patient’s subjective sensation.

Perceived dental knowledge

They often know dental jargon. They may talk about their ‘bite’ or ‘occlusal’ problems, ‘interferences’ and ‘shifts’, and suggest how they should be changed, or altered, to correct their problems. May be vehement.

Have study casts and detailed clinical records

May come to the appointment with numerous diagnostic casts that they have accumulated over the years, or even an articulator.

Sustained delusion

Patients may have many photos and have prepared detailed documents in an attempt to explain the problem. While there may be some initial placebo effect, the symptoms are rarely improved by occlusal splint therapy, orthodontics, occlusal adjustments or “equilibration”, or prosthodontic interventions of different types by different dentists or various specialists. Patients may often report that multiple treatment providers have unsuccessfully tried to “adjust” their occlusion. Patients many have strong negative emotions regarding previous treatment providers, combined with excessive positive expectations of their new treatment provider. They may be very flattering.

Well-Presented

May be seen more commonly in high socio-economic status patients (as they can afford to undergo repeated and extensive treatments to solve the problems), with above average intelligence, who are often very articulate about what needs to be done.

Difficulty accepting diagnosis or accepting referral to psychiatry

Resistant to the idea that their problem is psychiatric in origin and may refuse to be referred for this. Patients often tightly hold the belief that their problems were caused by previous dentists and if they could just find the "right" dentist to do the treatment they want (including orthodontics, prosthodontic treatment or even surgery), all their issues will be solved.

Management Unfortunately, the acceptance of the occlusal dysesthesia diagnosis is low among patients. Patients with OD often stay attached to their somatic explanations. Management is difficult as patients usually remain resolutely convinced that if they could only get someone competent enough to get their “bite right” then all their problems would be solved. Defocusing is the main therapeutic objective. Multidisciplinary care is often required, and referral to a specialised clinic that considers concomitant psychological therapy should be offered. Patients may not respond well to the suggestion of psychiatric input, and if this is the case, discussion should be left to the specialist involved with the patient’s care. With care

of OD patients, as with all somatic stress disorders, the prognosis is often poor, and management can be challenging. Expert-based consensus recommendations include patient counselling and education, psychological or psychiatric care, physical exercise, relaxation and psychotherapy, mindfulness training, and pharmacotherapy with medications such as chronic pain medications, tricyclic antidepressants, nor adrenergic and specific serotonergic antidepressants or atypical antipsychotic drugs. It is generally inadvisable to treat a suspected OD by adjusting the occlusion, as an occlusal adjustment may intensify the syndrome. References available via amanda@pomds.com.au

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4617AEDITION | 2021Belmont WesternWA Articulator Wheeler 7Street, 6104 • Phone (08) 9479 3244 • Fax (08) 9479 3255 • Email sales@westcoastdental.com.au

WADA GOLF

Sunshine & blue skies Royal Perth Golf Club

Blue sky and some welcome sunshine were enjoyed by the 34 keen WADA golfers who embarked on our August fixture at Royal Perth Golf Club. At stake was the annual Lester Charlesworth Pairs Trophy, sponsored by Maven Dental. Royal Perth was in pristine condition and scoring proved difficult for most, with only seven of the group playing to their handicap or better. Results for the day were: Nearest the Pin and Long Drive Swan Valley Dental Laboratory - 2nd hole NTP

Craig Lewis

Health Practice Brokers - 6TH hole NTP Michael Yuan Dentsply-Sirona - 12th hole NTP

Oli Jones

The Health Linc - 14th hole NTP

Paul Tan

WADA - longest drive 18th hole

Michael Welten

Individual competition winners:

Lester Charlesworth Pairs Trophy winners – John Scully and Craig Lewis. Congratulations to our winners. Our thanks are extended to our corporate prize sponsors for the day and their representatives Russel Redpath from Dentsply Sirona, Garry Bishop from Health Practice Brokers, David Owen from Swan Valley Dental Laboratory and Brad Potter from The Health Linc. Due to Covid restrictions, we were unable to host any representatives from Maven Dental head office. We appreciated the efforts of local Maven principal dentist Peter Shipway in presenting the winners' prizes on behalf of Maven Dental. Sincere thanks to Maven CEO Chris Williams and his team at Maven for their generous support of WADA Golf. All dental golfers are welcome to join the group. Please contact me via email, should you be interested in having a game. Good golfing,

1st

John Scully

Michael Whitford

Ian McCarrey

3rd

Craig Lewis

WADA Golf Captain dentalgolf@gmail.com

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Our students give back with the

Kimberley Dental Team At ADAWA, we encourage and celebrate the volunteering efforts of our members. Via ADAWA grants, we were pleased to assist some of our student members give back and have the experience of a lifetime on a Kimberley Dental Team trip.

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Brigitte O’Brien ADAWA GRANT RECIPIENT Brigitte says going on the Kimberley Dental Team trip this year was an incredible experience. “I am so thankful to the KDT and ADAWA for selecting me to go,” she says. “The trip taught me so much and was eyeopening in more ways than one! “Practising in remote areas where often there isn’t an opportunity for people to attend the dentist easily really showed me the power of dentistry and the importance of good dental health,” she says. “Access to services is so variable because of the spread and distribution of people within this country, meaning remote areas like the Kimberley often have

people we met on our trip were so beautiful, kind and welcoming of us. The first day we went to a new location, people were slow to start arriving at the clinic, especially in Halls Creek. However, come the second day when word had got around what we were doing, we couldn’t get out of the clinic at the end of the day as it was so busy.” Brigitte says the highlight of her trip was working alongside the wonderful team. “Along with this, practising in the Purnululu National Park community was a dental highlight for me,” she adds. “This place, as well as being an Instagram-worthy tourist attraction

I feel extremely fortunate that I had the opportunity both here and elsewhere to be able to go into places that don’t exist on the map, meet the locals and make a difference limited access to all services, especially health care. Many of the people in remote communities have to drive for multiple hours to get emergency care of any kind, so to be able to practise dentistry in their town or community makes it so much easier for people to get the dental care they need. Since the KDT wasn’t able to do the trips last year because of COVID-19, the last dental care some people had was in 2019, which made the work we were doing even more important. “Doing extractions without x-rays and having to use small movable units to power handpieces added challenging elements to the care we were able to provide, and I will never look at outdoor deck chairs the same way after they were converted to makeshift dental chairs when fully reclined,” she adds. “The

for its beautiful natural rock formations, is home to an Indigenous community, and I feel extremely fortunate that I had the opportunity both here and elsewhere to be able to go into places that don’t exist on the map, meet the locals and make a difference.” Brigitte says she would 100% recommend any dental students apply for the Kimberley Dental Team trips. “Going on the KDT has been the best experience of Dental School for sure,” she says. “The days are long, you spend a lot of time outside in the heat, and it’s definitely not a holiday, but the experience of practising dentistry in remote Australia was absolutely awesome and I got to do it with some amazing people.”

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“As we complete our 12th year of KDT, we continue strong professional relationships with ADAWA, the Office of the Chief Dental Officer, Dental Health Services, the International College of Dentists (ICD), Academy of Dentists International (ADI), SDI Limited and OHCWA. “This year, ADAWA provided three awards to assist three of our four final year students, with Richard Tien, Brigitte O’Brien and Xie Jie Tan joining us in 2021. Alice Gregory was the recipient of the John Prichard Memorial Travel Scholarship, which is a generous prize that supports a student in the

Kimberley every year. We now have had 38 final-year dental students join our Kimberley teams since 2010. “All four students were excellent, engaged well with community, listened and worked closely with our experienced volunteer mentors on the team, all of which are ADAWA members. “Our Kimberley communities were busy, and they all provided some great clinical outcomes including complex restorative, difficult extractions and seeing some good bush prosthodontics. Thank you to our five great Teams of 2021”

Jan and JohnOwen Xie Jie Tan ADAWA GRANT RECIPIENT Xie Jie says volunteering with the Kimberley Dental Team has easily been the highlight of her Dental School experience. “Working with the amazing team to provide care in East Kimberley communities solidified my passion for rural dentistry,” she explains. “The opportunity to work in a remote setting and learn from such experienced practitioners against the backdrop of the beautiful Kimberley landscape was one of a kind.” She says she would highly encourage any student thinking of joining the Kimberley Dental Team on their future trips to apply. “Thank you to ADAWA for their generous grant and awarding me this incredible experience,” she adds.

EDITION 7 | 2021 Western Articulator

Richard Tien ADAWA GRANT RECIPIENT “Volunteering with the Kimberley Dental Team was a fantastic experience that allowed me the opportunity to experience and confront disparities in oral health in rural and remote Australia face-to-face,” Richard says. “It’s one thing to learn about oralhealth disparity and barriers to care in the classroom, but certainly an entirely different and eye-opening experience to get to live, work, and travel in the communities. “At the same time, it’s heart-warming to see the relationships and brilliant impact that the KDT has made in the communities over their many years of operation,” he adds. “Overall, volunteering with the KDT was a highly rewarding and unforgettable experience.” Richard says he wholeheartedly encourages any student to apply to volunteer with the Kimberley Dental Team for a highly rewarding and enjoyable experience. “I would love to thank the ADAWA for their generous support to allow students to participate in this excellent opportunity,” he adds.

Alice Gregory JOHN PRICHARD MEMORIAL TRAVEL SCHOLARSHIP Alice says during the trip they travelled over 800km across the Kimberley region, setting up treatment areas in schools, as well as community centres, in remote Indigenous communities. “Treatment ranged from examinations and cleans, to fissure sealants, restorations and extractions,” she explains. “Each day also had a strong focus on delivering important oral health messages to the community. It was eye-opening to see the burden of disease in these regions, but positive to see the impact that the KDT has had during their visits over the years. Being part of the team was an amazing experience, assisting in delivering much needed oral health care to such disadvantaged areas.” Alice says volunteering with the Kimberley Dental Team has been one of the highlights of her time in Dental School. “I could not recommend it more to students considering applying for future trips,” she says. “I am so appreciative to the John Prichard Trust for their support that allowed me to attend the trip,” Alice adds. “I am also very grateful to Jan and John Owen, and all of the hard-working volunteers at the KDT, whose hard work and commitment have kept the organisation going over the years.”

adawa.com.au

GOOD NEWS STORIES Thank you to our members

Soup fundraiser

We recently put a call-out to members who could help cover appointments for a gravely ill dentist in the Northern Suburbs. We were truly humbled by the overwhelming response to our request – and were inundated with phone calls, emails and messages.

It was great to see so many people at ADA House buying soup and raising money to support Head and Neck Cancer Australia. Soup was also sold in the OHCWA courtyard. Well done to the UDSS for once again arranging such a great fundraiser. More than $1,000 was raised, which is more than double previous years’ fundraisers.

A locum was found to cover the appointments, and the dentist’s family were extremely grateful. It once again shows us what a wonderful, supportive and truly caring dental community we have in WA.

LensNation Studio helping to share the work of Dental Rescue Days A huge thank you to Bobby Sandhu from LensNation Studio. He kindly filmed and produced a video of a Dental Rescue Day (pro bono) at Rockingham Dental a couple of years ago. When the ADHF recently asked if he could make some edits to the video for them to use nationally, he obliged, once again not charging for his services as part of his regular pro bono work. Thank you, Bobby, for helping us spread the word of the wonderful work our dentists are doing!

Support service A reminder that support is available for dental practitioners via Dental Practitioner Support, a national 24/7 health and wellbeing support service. The service offers health and wellbeing support to all dental practitioners, including dentists, dental prosthetists, oral health therapists, dental hygienists and dental therapists. It is also available to dental students, educators, employers, Australian Dental Council exam candidates and concerned family members and friends. The site also features useful tips and wellbeing articles. Phone 1800 377 700 or go to dpsupport.org.au

Dental4Windows for Healing Smiles

The Difference

Thank you to Centaur, who has provided complimentary access to Dental4Windows for Healing Smiles. “A central patient management system for Healing Smiles has been essential for our ability to work as a team, and co-ordinate care for our group of patients,” says Dr Jacinta Vu, Clinical Coordinator of Healing Smiles. “We are very thankful to Centaur for their sponsorship of Healing Smiles, providing access to their platform, as well as training.”

We were proud to see Dr Zara Torre on Channel 10, in her role as the founder and CEO of The Difference.

EDITION 7 | 2021 Western Articulator

She spoke about the mobile app that's helping to make change in the world, one transaction at a time, as well as a new sustainable clothing line. 10play.com.au/change-makers/web-extras/2021/changemakers-where-are-they-now-zara-torre/tpv210920yqptj

Specialists in Darwin The Specialists in Darwin course was a great success! Great thanks go to the speakers, who made the full-day course so interesting for attendees.

World Cavity Free Future Day World Cavity Free Future Day is October 14 — a valuable awareness day to share with your patients. Information about WCFF Day and resources for your patients are available at acffglobal.org/

Health and Dental Autism Training Program The Health and Dental Autism Training Program from the Autism Association of Western Australia is live, with online training and resources to implement strategies to improve the health care experience for children and adults with autism. To access the learning portal, go to aawa.learnbook.com.au/login/index.php

Art at ADA House It was lovely to see a group of dentists at the Paint & Sip class at ADA House. Special mention to Smita and Rouvin, who were celebrating their 12th wedding anniversary. Rouvin is a dentist in the Pilbara, and as the group was painting a scene called ‘The Pilbara Twilight’, they thought it was very fitting! Thanks to Credabl, who partially sponsored the evening. If you are interested in coming along to an ADAWA Social Club event, keep an eye on your emails and the ADAWA Members’ Facebook Group for future event details, and email AmandaP@adawa.com.au with any ideas or suggestions.

adawa.com.au

Professional Notices

September's Dental Rescue Day

Dr Adam Hamilton

Dental Rescue Day was a huge success, with a particularly high attendance rate. In all, 34 patients had the opportunity to be assessed and treated by Dr Tracey Gold’s team of OHT 3rd Year Students and volunteer dentists: Dr Lida Sayadelmi, Dr Jonathan Lo, Dr Andrew Chan, Dr Ashlee Bence, Dr Amit Gurbuxani, Dr Vuk Paripovic, Dr Hyun Mun and Dr Emrik Graff.

Specialist Prosthodontist

It was a combined team effort with TAFE DCA students, who volunteered as chairside assistants, and TAFE Supervisor, Valerie, as well as Curtin OHT Supervisors, Tracey L and Sylvia, OHT Clinic DA Tash, and Curtin Admin Assistant, Makayla. Many patients had complex dental issues and were in need of urgent dental care. Thank you to all for your compassion and working so tirelessly to assist the vulnerable and disadvantaged in our community. Special thanks go to ADHF’s Andrea Paterson, for her wonderful, tireless, efficient organisation. Without you, these days could never happen. Some of the referring organisations were: Uniting WA, Centrecare, The Salvation Army, MercyCare , St Barts, Street Doctor and Homeless Healthcare.

BDSc Hons (WA), FRACDS, DCD Pros (Melb)

Centre For Prosthodontics is pleased to announce the return of our Prosthodontist, Dr Adam Hamilton. Pursuing an academic career, Dr Hamilton joined the faculty at the Harvard School of Dental Medicine in Boston in 2016, where he became the Director of the Division of Regenerative Sciences and Implant Dentistry and an Assistant Professor in the Department of Restorative Dentistry and Biomaterial Sciences. He remains a lecturer for its Advanced Graduate Implant Dentistry program. Dr Hamilton has been appointed the Discipline Lead of Prosthodontics at UWA and will also be based at our South Perth practice accepting referrals for all aspect of prosthodontic care, with a special interest in implant dentistry.

Volunteer Profile Jane Bartley – Dental Assistant For dental assistant Jane Bartley, volunteering at Homeless Connect Rockingham recently was an opportunity to give back to the community. “I volunteered with other organisations prior to becoming a mum,” Jane says. “I jumped at the chance to get back out there, doing the work.” Jane says she loved the fast pace with the highly skilled dental team. “Twenty-one patients in five hours with two chairs, in a caravan run on a generator – what an achievement!” To other dental assistants considering volunteering, Jane says there is excellent leadership, support and organisation at every level. “It is a very inclusive environment,” she says. “You will be out of your comfort zone in a good way. You will meet wonderful people and have fun.”

EDITION 7 | 2021 Western Articulator

20 Lyall Street South Perth WA T (08) 93680888 E info@centreforpros.com.au W centreforpros.com.au

Dr Lisa Bowdin at New Location

Relocation Announcement CENTRE FOR PROSTHODONTICS

Dr Ahmed Saleh and Dr Albert Tan are

FIRST SMILES is excited to share the

The Centre for Prosthodontics Perth has

delighted to welcome Dr Julio Rincon

Dr Julio Rincon

news that Dr Lisa Bowdin, Specialist

relocated its South Perth practice to a

to the Perio Perth team. Dr Rincon’s

Paediatric Dentist, will be providing

brand-new, purpose-built centre. Our new

30 years of clinical and academic

care for patients in Jandakot and

facility has been fitted with advanced

experience is an invaluable addition

Claremont. Dr John Winters and

technology and equipment, on-site

to our practice. We look forward to

Dr Lisa Bowdin will continue to see

laboratory and has improved parking

welcoming and caring for your patients’

patients for paediatric dental care at

with easier access off the freeway.

periodontal and implant needs.

the FIRST SMILES clinic in South Perth. We welcome referrals for all aspects of paediatric dental care at all three locations. Please contact our office if you need business cards for Dr Bowdin for the new locations.

Drs Adam Hamilton, Armand Putra, Janice Kan, and Thomas Elliott will look forward to supporting your patients with their prosthodontic needs at this new South Perth location, whilst Dr Hezel Cohen will be primarily based at our recently opened Midland practice.

Suite 5/6 Davallia Road Duncraig WA 6023 T (08) 9447 3700 E reception@perioperth.com.au W perioperth.com.au

20 Lyall Street South Perth WA CLAREMONT Suite 9, 40 St Quentin Ave Claremont JANDAKOT

T (08) 93680888 E info@centreforpros.com.au W centreforpros.com.au

Suite 4, 234 Berrigan Dr Jandakot SOUTH PERTH Suite 7, 38 Meadowvale Ave South Perth T

08 9367 9277

E hello@firstsmiles.com.au W firstsmiles.com.au

New Opening Times THE ENDODONTIC PRACTICE PERTH Specialist Endodontist The Endodontic Practice Perth will remain open Monday to Thursday, 8:30am to 5:30pm, and Fridays and Saturdays by appointments from mid-

811 Canning Highway

August 2021.

Applecross WA 6153

We have made provisions to accept emergency patients/referrals on all

working days within 24- to 48-hours’ notice.

E info@endopractice.com.au

(08) 61184567

W endopractice.com.au

adawa.com.au

Turn the goodwill of a practice today, into a loan for tomorrow

Our extensive experience lending to dentists means we understand the value of your profession – and we’re able to lend up to 100% of the purchase price of an existing practice, using goodwill as security rather than your home.* Like you, we recognise the time it takes to build that goodwill. That’s why we take into account the sustainability of the practice and the value of intangible assets such as people, patients and intellectual property. At BOQ Specialist, we back you and your business, giving you flexibility and support over the long term. Learn more at boqspecialist.com.au/goodwill or speak to your local finance specialist on 1300 131 141.

BOQ Specialist. The bank for dental professionals *Subject to credit approval. The issuer of these products and services is BOQ Specialist - a division of Bank of Queensland Limited ABN 32 009 656 740 AFSL no. 244616 (“BOQ Specialist”). Terms and conditions, fees and charges and lending and eligibility criteria apply. Any information is of a general nature only. We have not taken into account your objectives, financial situation, or needs when preparing it. Before acting on this information you should consider if it is appropriate for your situation. You should obtain and consider the relevant terms and conditions from boqspecialist.com.au before making any decision about whether to acquire the product. BOQ Specialist is not offering financial, tax or legal advice. You should obtain independent financial, tax and legal advice as appropriate. We reserve the right to cease offering these products at any time without notice.

Western Articulator Edition 7 2021