ADAWA June Western Articulator

WESTERN

YOUR ASSOCIATION IS HERE FOR YOU

ARTICULATOR

JUNE 2020

Dr Martin Glick

Dr Sean Archibald

Dr Jenny Ball

Dr David Hallett

Sue Hurley

Dr Ross Bailey

Dr Greg Crane

Dr Roslyn Franklin

Dr Timothy Crofts

Dr Sahara Saeedi

Dr Brian Koch

AUSTRALIAN DENTAL ASSOCIATION (WA BRANCH) INC

Dr Bec Penco

Dr Amit Gurbuxani

Dr Peter Wilkins

Dr Tim Clair

Jenny Catto

Andrea Andrys

Dr Peter Duke

Dr Amanda Phoon Nguyen

Dr Anish Shah

adawa.com.au 1 June 2020 Western Articulator | adawa.com.au adawa.com.au

We’re probably the only bank who knows that 48 stands for wisdom

Don’t worry, we’re not suggesting that we could even begin to do what you do.

However, after 25 years of working closely with dental professionals, we’ve done more than pick up some of the language.

We have designed products and services that meet your unique and specific needs.

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June 2020 Western Articulator | adawa.com.au

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contents 06

Meet the 2020 graduate dental officers

22

Drs Lyndon Abbott and Samuel Deng

07

The superdentist syndrome

By Dr Gaurav Vasudeva

24

By Martin Foster, Dentolegal Consultant at Dental Protection

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Men’s health matters

Part 2: Anatomy of the root canal system and its clinical implications

21mm mouth opening

By Dr Jacinta Vu

26

Men’s Health Week (June 15-21)

Potential reactions from the use of a common dermal filler

By Dr Janina Christoforou

12

CPD spotlight

27

Meet Dr Andrei Tutoveanu

14

2020 Dental CPD calendar

By Dr Josephine Drewett

28

Latest CPD events

18

ADA HR Feature Helping staff through a patient complaint or negative review

20

Reminiscences of dental school

Volunteer for yourself and others

By Dr Emma Perry

33

Investing in new equipment – is now the right time?

By Debbie Kiely, Credabl Finance Specialist

Avoiding contractual obligations – What are your options?

By David McMullen, Panetta McGrath Lawyers

June 2020 Western Articulator | adawa.com.au

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p07 Australian Dental Association Western Australian Branch Inc All correspondence to: PO Box 34, West Perth WA 6872 T: (08) 9211 5600 F: (08) 9321 1757 E: media@adawa.com.au President Dr Sean Archibald Chief Executive Officer Dr David Hallett Editorial Team Brooke Evans-Butler Lisa Shearon

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Designer Carmen Collings

Closing Date for Bookings: Ads: The 7th day of the prior month or the nearest business day before.

All advertising must be submitted by the due date either by email. Advertisements received after the due date cannot be guaranteed to appear in that issue.

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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.

Connect Australian Dental Association WA @adawaoralhealth @adawa_perth 4

Australian Dental Association WA

June 2020 Western Articulator | adawa.com.au

CEO’S COMMENT D R D AV I D H A L L E T T, A D AWA C E O

ADAWA and our stakeholders, Dental Protection Ltd and MDA National Insurance, have combined to provide ADAWA members with a comprehensive COVID Relief Renewal Package for the current 20202021 membership renewal. Most members will receive a 25% reduction on all premiums and subscriptions charged by these parties.

The members are ADAWA’s greatest asset. Irrespective of whether you have had an active or passive participation in Branch activities, ADAWA has always appreciated your respect and loyalty in creating our collaborative ADAWA community.

It is therefore only appropriate that in challenging times, the ADAWA Executive and Council have the bravery and vision to respond to hardship within our membership community. This one-off renewal reduction can be achieved without diminishing membership support and services by drawing on investment funds and judicious budgeting within the branch.

Of course, the fiscal value of this reduction is worthless without credible and effective leadership to ensure ADAWA continues to prioritise the well-being of our members and upholds the relevancy and reputation of the dental profession in WA. The ADAWA President, Council members and office staff make that pledge.

www.adawa.com.au Sue Hurley

Jenny Catto

Andrea Andrys

ADAWA RENEWAL TEAM You will be receiving your annual membership renewal by email this week.

This year we have made it easier for most members to renew via our online system. Simply follow the link on our home page and proceed through the steps to renew your membership for 2020-21. Payment for your policy can now be made online by credit/debit card or by setting up a direct debit.

Our dedicated membership team is available to assist you through renewal time, either via the membership email, memberships@adawa.com.au, or by calling the office on (08) 9211 5600.

The “ADAWA Zoom Brady Bunch” of Councillors and membership renewal team.

The image captures the unique diversity and experience of ADAWA Council and our Membership Team, as well as providing some insight as to how they have been actively interacting with the members and each other over the past three months.

Dental Protection Limited Australia is committed to the Covid Relief Renewal Package that is being offered to all current members in partnership with ADAWA and MDA National Insurance for the 2020-2021 renewals. A concrete and generous financial gesture to members will I hope demonstrate our commitment to the welfare of dental practitioners in Australia, and indeed wherever Dental Protection operates worldwide. I wish you all the best in these challenging professional and financial times.

Dr Mike Rutherford Senior Dentolegal Consultant DPLA June 2020 Western Articulator | adawa.com.au

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MEET THE 2020 GRADUATE DENTAL OFFICERS IN A YEAR LIKE NO OTHER, OHCWA’S GRADUATE DENTAL OFFICERS, DRS LYNDON ABBOTT AND SAMUEL DENG, ARE STILL MANAGING TO SHINE.

By Brooke Evans-Butler

It’s no secret that securing a year-long contract as a graduate dental officer at the Oral Health Centre of WA (OHCWA) is highly coveted.

“I was interested in this position after hearing the positive responses from the previous graduate dental officers, who spoke highly of the supportive environment and learning experience,” Dr Samuel Deng recalls. “I was excited to work with staff I was familiar with, and with dental colleagues who have contributed so much in my four years of studying.”

Certainly, both Samuel and Dr Lyndon Abbott are experiencing a plethora of dental cases, as they treat and manage patients at OHCWA who are not suitable or do not wish to be seen by students, as well as completing rotations in oral surgery and hospital dentistry.

As graduate dental officers, Samuel and Lyndon are both familiar with their working environment, as well as the dentists and dental specialists who are on hand to assist with advice and treatment.

It’s also comforting for both young dentists to know that they’re in this together. “The jump from being a student to a graduate is massive, so having another new graduate working next door gives me support.”

Despite only being part way through their contract, both Samuel and Lyndon already have a long list of highlights. “I’ve enjoyed observing specialists while they work and learning many new techniques from them; having supportive and experienced clinicians so close to me who are happy to answer all my questions; having reception support to help book patients and schedule appointments; and performing a wide range of dental procedures,” Samuel says. “With specialists so close at hand, I have the confidence to perform more complex procedures under their supervision.”

After completing surgical extractions, Lyndon is learning they are not quite as terrifying as they 6

June 2020 Western Articulator | adawa.com.au

Left to right: Drs Lyndon Abbott and Samuel Deng

The jump from being a student to a graduate is massive, so having another new graduate working next door gives me support. seemed during dental school. He has also enjoyed crowning completed root canals, and learning from dental nurses with many, many years of experience.

Another highlight was the gift of a devil’s ivy plant from a patient. “I’m still not sure if this was their way of subtly saying something to me,” he laughs.

When asked about the challenges, Samuel says he has had to adapt to the greater responsibility he now has as a clinician, run on time, and write concise but detailed clinical notes for many patients every day.

Many new graduates will nod in agreement when Lyndon says one of his challenges has been learning to call the tutors by their first name. “I am also realising that the more I learn, the more questions I have, and just how little I truly know,” he adds.

To final year dental students considering applying for a graduate dental officer position, Lyndon says to go for it. “It is a great experience,” Samuel adds. “The transition from dental student to clinician is always going to be difficult but starting work at the Oral Health Centre is a great place to make that transition.”

DPL Insights

The superdentist syndrome

BY MARTIN FOSTER, DENTOLEGAL CONSULTANT AT DENTAL PROTECTION

Dentists, along with most healthcare workers, are notoriously reluctant to take time off when they are sick. The commitment to avoiding ‘absenteeism’ and persisting with going to work as usual may be well-intentioned but is essentially misplaced and essentially causes ‘presenteeism’ – the individual may be in the workplace but performance is not efficient and the work produced will not be up to standard.

There is an engraved attitude in the culture of healthcare professionals that clinicians do not acknowledge their own health concerns or take time off sick. There seems to be a widespread expectation amongst professionals that somehow, they must always present as a picture of health and strength to the wider community. There is an acceptance of all of the downsides of their calling, such as long hours, no breaks, irregular meals and lack of rest, simply because it is the profession they have chosen and these elements are just part of the deal.

There is almost a sense of giving in to illness as being a sign of weakness. This perpetuates an almost superhuman belief system, which for doctors is known as the superdoctor syndrome. In the case of dentists, it can be called the superdentist syndrome.

Dentists who find themselves in the superdentist trap expect the unachievable of themselves: “I have to work excessive hours”, “work is life”, “I cannot get sick”, “hard work and self-sacrifice equals goodness” etc. There is a danger that trying to live up to the superdentist expectation of self comes at the cost of burnout. Ensuring that goals are realistic and sustainable is an important step in maintaining a healthy approach and building resilience.

In a recent survey by Dental Protection in Australia, 70% of dental professionals say they will always come into work, even when they are not feeling well or resilient enough to work safely.

Almost 60% say they feel guilty when taking time off. However, only 13% of responding dental professionals said that it was their colleagues who actually make them feel guilty.

Guilt is a very important concept when dealing with presenteeism and the superdentist trap. Guilt is more internally than externally driven and that explains the above result of the survey. When looking at workload, and the ability to take a break, we are seeing a similar dynamic: respondents recognised the need for others to take a break but did not feel able to do so for themselves.

Working while sick, or not taking time off to recover after an illness, can result in a number of issues in addition to those arising through not performing efficiently, which can have far greater repercussions than the inconvenience caused to patients and colleagues by the dentist calling in sick. Going to work when ill can increase a dentist’s risk of longer-term sickness absence, the development of mental health issues, and it can also lead to burnout.

When dentists feel burnt out it is not only bad for the dentists concerned but also for patients and the wider dental team.

Dentists who are happy and engaged find it much easier to be compassionate and provide better care.

do our jobs is part of building our own resilience but, as a profession, we could do more to tackle this complex issue. The importance of avoiding the superdentist syndrome is a key resilience-building concept, and we recognise that it is not easy.

Organisations, line managers and practice owners should all play a role in driving a culture change and insist that dentists look after themselves better.

In the “Breaking the Burnout Cycle” report we call for organisation-wide interventions to safeguard the wellbeing of dental professionals – including a recommendation that all dental organisations have clear policies and procedures in place to ensure dentists and the wider team feel able to take breaks and to take time off when ill.

Taking sickness leave when this is required is responsible, professional behaviour and should be viewed as such.

All staff should be made aware of the risks of burnout and educated on the importance of taking breaks and time off. The resilience of individuals and teams must be seen as a priority. Of course, it is not all about policies. We as a profession should also support our colleagues, and those in senior positions should lead by example.

Dental Protection is committed to supporting members of the profession dealing with burnout and also to encouraging working practices to help prevent this.

This link between superdentist behaviour and dento-risk is clear and Dental Protection has an obvious interest in this area. As individuals, accepting when we are not fit to June 2020 Western Articulator | adawa.com.au

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Men’s health matters With a theme of “working together”, this year’s Men’s Health Week (June 15-21) provides an important opportunity for us all to focus on the mental and physical health of our male practitioners and patients. By Brooke Evans-Butler Men’s Health Week runs from June 15-21. Dr Neil Hall, director of the Men’s Health Information Resource Centre, says this year, Men’s Health Week focuses on everyone working together for the mental and physical wellbeing of men.

“There has been a perception that men’s health is just for the men, so we want to make it clear that everyone in society has a part to play in improving men’s health,” he says. “All genders, all cultures and all communities can work together – and that is important for a number of reasons.

Amanda says a psychologist can be a great support at any stage, even when you are not feeling depressed or anxious.

However, if you are experiencing difficulties, some indicators you need to seek help are:

“The health of men across the board is generally poorer than women; their lifespan, work-related accidents, motorvehicle-related accidents, gender-specific cancers, they all impact men at greater rates than women.

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Current suicidal thoughts or plans

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Losing enjoyment in activities you used to like

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Trouble sleeping or sleeping more than usual

“And, most pressingly, the issue of suicide. Males make up three-quarters of the number of people who take their own lives. Six men per day will take their own lives. It is a startling statistic.”

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Appetite changes

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Feeling more irritable than usual

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Feeling like you are not coping

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Having many worries that feel overwhelming

MENTAL HEALTH Amanda Curran, psychologist and vice president of the Australian Association of Psychologists, says research shows that one in eight men will experience depression and one in five will experience anxiety in their lifetime.

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“While this is lower than the rates of depression and anxiety in women, what is concerning is that men are more likely to die by suicide, with six men dying a day. Men are also far less likely to seek treatment for mental-health concerns, with only 27.5% accessing treatment for a current mental health concern.”

June 2020 Western Articulator | adawa.com.au

Amanda says it is important to find a way to seek help that feels comfortable for you. “For some it is helplines or online therapies but for many, seeing someone consistently face to face is the best option,” she says.

“Everyone is different and seeing the same person can help to identify your personal situation and come up with a plan to support you to make change. An individual treatment plan is often the best option and will help you move through your difficulties quicker, getting back to the level of functioning you want. There is also a lot of evidence that the healing that occurs is often due to feeling understood, supported and being in charge of your own treatment course.”

Amanda’s tips to keep mental health in check: •

Make sure you talk about what is going on for you. A lot of men feel they have to keep any vulnerabilities locked away and just get on with things

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Find someone non-judgemental to support you

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Keep active and healthy

What we can do as health practitioners Neil says there are some easy ways dental practitioners can check in with their clients and patients, particularly if you know them well.

“You may recognise there has been some kind of change in their health status or their mood or in their general approach to life. Take that opportunity when you notice something to ask if everything is going ok for them.”

Neil recommends dentists and other health professionals have material displayed in their offices or waiting rooms, such as Men’s Health Week posters, which are available for download from the website: https://www.menshealthweek. org.au/events/resources/2019-brochures “Someone waiting to see their dentist might see a poster or resource and think ‘That’s me’ or ‘I know someone like that’,” Neil says.

PHYSICAL HEALTH General practitioner Dr Muhammad Mohsin, founder of 13 CURE, a national home doctor service, and founder of the online doctor service, PrimeMedic.com.au, says the most common health complaints he sees in his male patients are headaches, upper-respiratory and lower-respiratory tract infections, STDs, depression and anxiety (in patients less than 45 years of age), and diabetes, hypertension, obesity, COPD and osteoarthritis (in male patients above 45 years of age).

Muhammad says after 65 years of age, an annual check-up with your GP is recommended. “I do suggest regular checkups regardless of age. This provides the opportunity to discuss any issues or general concerns,” he says.

During health checks, a general practitioner will check for BP, weight, height, waist circumference, BMI, heart rate, blood sugar, cholesterol, skin check, and baseline ECG. “It is also an opportunity to discuss any issues or general concerns.”

Muhammad recommends the following for men to keep their health and wellbeing in check: •

Physical activity and exercise – 30 minutes a day, 5 days a week

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Maintain a healthy, well-balanced diet

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Limit sugar and salt intake

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Avoid smoking and drink within safe limits

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Undertake regular GP check-ups

SKIN CHECKS Dr Richard Hamilton, who specialises in the surgery of skin cancer, says skin cancer is very common in people with fair skin living in Australia.

“Australia has been described as the skin cancer ‘capital of the world’”, he says. “Australian males are more prone to skin cancer than females in the ratio of about 2:1,” he adds.

“But unfortunately, males ted to ignore the warning signs whereas females tend to seek help early.”

Richard recommends that all Australians should have a complete annual skin check in their 40s. “However, if an individual has a lot of moles on their body it should be done earlier, perhaps in their 20s,” he adds. “These skin checks should be carried out by their general practitioner and family doctor who is trained to spot suspicious lesions.”

HEART HEALTH Bill Stavreski, Heart Foundation general manager of heart health, says there are 380,000 men living with heart disease in Australia, with heart disease being the single-leading cause of death for Australian men (as it has been since the 1960s).

“Heart disease is more prevalent with men at a younger age,” Bill reveals. “Australian men aged 18 to 34 are more than twice as likely than their female counterparts to have four or more risk factors for heart disease.”

Males 65 years and over are more likely than females of the same age to have at least three risk factors for heart disease.

“In addition to the number of risk factors, one million Australian men are at high risk of having their first heart attack or stroke in the next five years,” he says. “Separately, more than half a million men in Australia are at risk of having a subsequent heart event.”

Bill says there are two types of risk factors for heart disease – non-modifiable risk factors (those that you cannot change, such as age, sex or family history) and modifiable risk factors (those that you can change). Modifiable risk factors include: •

Controlling your blood pressure and cholesterol levels.

One-quarter of Australian males have high to severe blood pressure levels and more than 30% have high cholesterol

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Improving your diet and maintaining a healthy weight.

Almost 75% of men are overweight or obese

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Being active. More than 81% of Australian men do not do enough exercise.

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Being smoke free

Bill says the Heart Foundation recommends all Australians from 45 years, and from 30 years for Aboriginal and Torres Strait Islanders, have a Heart Health Check, which is now covered by Medicare.

“During a Heart Health Check, your doctor or health practitioner will take blood tests for your blood cholesterol and blood glucose levels, check your blood pressure, BMI (body mass index) and waist size,” he explains. “They will ask about your lifestyle including your diet, how active you are, whether you smoke, your alcohol intake and discuss your immediate family’s medical history.” Visit www. heartfoundation.org.au/your-heart/know-your-risks/hearthealth-check

June 2020 Western Articulator | adawa.com.au

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EATING RIGHT Joel Feren, dietitian and spokesperson for the Dietitians’ Association of Australia, says good nutrition is critical for men at all stages of life. “A nutritious diet helps to promote growth and development, fuel your activity and helps you to work at your best, while also reducing your risk of developing diet-related chronic diseases – such as heart disease, type 2 diabetes, some cancers. Diet can even help promote good mental health.”

“This information will help your doctor assess whether you are high, medium or low risk of having a heart attack or stroke in the next five years,” he adds. “Depending on your results your doctor might suggest some lifestyle changes or prescribe medication to manage your cholesterol or blood pressure or both.

“It’s never too early for men to start thinking about their risk factors,” Bill says. “The best place to start is to have a conversation with your GP to understand the changes you can make today to reduce your risk of a heart attack or stroke.”

To be heart healthy and reduce your risk of heart disease, the Heart Foundation recommends: •

Get a heart health check. A new Medicarefunded heart health check is available to all Australians aged from 45 years, or from 30 if you’re Aboriginal or Torres Strait Islander

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Be more active more often. You should be active on most days of the week, and preferably all, aiming for at least 2.5 hours of moderate exercise or 75 minutes of vigorous activity each week

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Eat a heart-healthy diet. A healthy eating pattern doesn’t focus on one type of food or one particular nutrient. Heart-healthy eating relies on a combination of foods, chosen regularly, over time. A good pattern gives us food that is low in saturated and trans fats, salt and added sugar, and rich in wholegrains, fibre, antioxidants and unsaturated fats

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Quit smoking. Smoking is one of the major risk factors for heart disease, not to mention a host of other health problems

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Know your numbers. High blood pressure and high cholesterol are known as silent killers because there are usually no obvious signs or symptoms, yet they increase your chances of having a heart attack or stroke

10 June 2020 Western Articulator | adawa.com.au

Joel says that men tend to drop the ball when it comes to nutrition. “Anecdotally, the men I see don’t eat enough veggies,” he says. “While this is not a gender-specific issue, it’s a cause for alarm. Eating vegetables is one of the cornerstones of good health. Further, while the statistics show some improvement in our alcohol consumption, blokes can do more to reduce their intake.”

For dentists who are usually busy between patients, Joel admits it can be tricky to eat well at work. “Often it’s just not on our list of priorities. But we know making time for healthy choices will put us ahead mentally – boosting memory, concentration, and evading that mid-afternoon dip in energy.

So, make nourishing yourself a priority” He recommends planning ahead. “Consider some healthy lunches and snack options to take with you to work – your waistline and hip pocket will thank you,” he says. “Build a number of key essential elements into your lunchtime meal – wholegrains, veggies, healthy fats and protein. For example, a chicken, avocado and salad sandwich on wholegrain bread ticks all the boxes. Go-to snacks include nuts, fruit, cheese and biscuits, yoghurt, veggie sticks with dip and wholegrain bars. It needn’t be complicated. But exercising a little foresight can go a long way to helping you up your nutrition game.

“Overall, we should all be including foods from the five core food groups,” he adds. “To remind you, these are whole grains, lean protein, fruit and vegetables and dairy.

Prioritising whole foods is gold standard. And, we should all limit booze, sweet biscuits, chips, fruit juice and chocolate.”

Joel Feren, dietitian and spokesperson for the Dietitians’ Association of Australia, offers his healthy-eating tips for busy men: •

Don’t forget your veggies. We could all benefit from including more vegetables in our diet.

•

Get cooking. Studies show that while men are interested in cooking, they just don’t it. Studies also show that when we cook meals at home, we consume fewer calories and less salt and sugar.

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Fibre is your friend. Fibre has been shown to reduce our risk of chronic diseases as well as certain types of cancers. Fibre-rich foods include wholegrains, fruit and vegetables and nuts and seeds.

CPD Opportunity

CPD Opportunity

$1,250 incl GST

Hands On Extractions

Friday 26 June | CPD Hours: 4 Presented by Associate Professor Dieter Gebauer Registration from 12.45pm, Course 1pm to 5pm CTEC, Hackett Drive, Crawley Bookings & Enquiries adawa.com.au/cpd/ This course allows participants the opportunity to extract a variety of teeth on cadavers with an oral surgeon looking over their shoulder. This will enable the participant to ask questions during the procedure and for the oral surgeon to offer tips and suggestions on extraction. There will be one head per two participants. Due to the nature of the course, availability of teeth to be extracted will vary. The course focuses more on simple extractions rather than difficult surgical procedures.

The team of oral surgeons participating in this hands-on course will be headed by A/Prof Dieter Gebauer. *Please note that this course will be carried out on human cadavers.

About the Presenter: Associate Professor Dieter Gebauer is a specialist Oral and Maxillofacial Surgeon with degrees in medicine and dentistry. He is also a fellow of the Royal Australasian College of Dental Surgeons. Dieter is currently Head of Department at Royal Perth Hospital and a consultant facial trauma surgeon.

Dieter’s keen interest in facial trauma has taken him to Illinois medical district in Chicago (the largest medical district in the world, hosting Cook County Hospital, The University of Illinois Chicago Hospital, The Veteran’s Affairs Hospital and The Rush Presbyterian Hospital) and Johannesburg General Hospital.

June 2020 Western Articulator | adawa.com.au

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MEET

Dr Andrei Tutoveanu Who better to teach a “drugs in dentistry” CPD course than dual-qualified dental practitioner and pharmacist Dr Andrei Tutoveanu?

During his post-graduate degree in pharmacy, Dr Andrei Tutoveanu received entrance to both dentistry and medicine – with dentistry winning out.

“Although pharmacy will always be a soft spot for me, I find dentistry has allowed me to take further control and lead comprehensive treatment plans, instead of only dispensing prescriptions and discussing interactions with patients,” he says. “Having more of a primary role in patient treatment was my main focus and goal in choosing dentistry.”

Andrei believes his pharmacy and dentistry skills are symbiotic. “I have become a keynote speaker within the pharmacy profession, speaking on patient dental concerns. This later evolved into various therapeutic update lectures and pharmacies requesting me as a consultant to train team members and staff regarding over-the-counter medications and common dental conditions presenting in the community pharmacy.”

Lecturing certainly takes up a lot of time for Andrei, who is passionate about continuous education and is an active presenter on both the domestic and international lecture circuits. He is a keynote speaker for the Pharmaceutical Society of Australia and presents for the Australian Society of Implant Dentistry and the Western Sydney Local Health District, amongst others, as well as consulting with medical registrars and specialists at the Royal North Shore Private Hospital. However, he says he really enjoys being across both health professions and thrives for imparting knowledge to his dental and pharmacy colleagues.

This year, Andrei will head to Perth for the first time, to present “The Dynamics of Drugs in 12 June 2020 Western Articulator | adawa.com.au

Dentistry”. “We, as dentists, deal with a plethora of drugs – from the very limited list we usually prescribe to the extensive lists we are exposed to in our medical history taking.

“We are expected to know just as much about the drugs we don’t prescribe as the ones we do prescribe – their rationale of use, mode of action, adverse reactions and various interactions. Coupled with the ever-growing list of ‘generics’ and ‘brand substitutions’ on the market, it is quite easy to become overwhelmed and disinterested. However, once the void in drug knowledge and prescribing is filled, your confidence will increase, and your overall patient healthcare and experience will improve.”

Andrei says participants will leave his CPD course well-versed with the numerous drug classes and treatment modalities, understanding drug outcomes, undertaking comparative analysis of medicines and expanding on drug armamentarium.

“Expanding your prescribing power and knowledge of drugs and disease-states will result in superior patient management,’ he says, adding that he hopes attendees take away from the course confidence and control over difficult medical history profiles, superior pain

CPD Spotlight

The Dynamics and Dilemmas of Drugs in Dentistry Friday 10 July 2020

MINUTES

with Dr Andrei Tutoveanu

Registration from 8.30am, Course 9am to 5pm ADA House, 54-58 Havelock St, West Perth Bookings & Enquiries | adawa.com.au/cpd/ The medications our patients are taking are constantly changing. These medications include prescribed, overthe-counter and recreational substances. As dentists, we are expected to know just as much about the drugs we prescribe and the ones we don’t.

The overall aim of this course is to become updated and better versed with the numerous drug classes, how they are used and to improve our prescribing habits. This will lead to superior patient management.

Register online www.adawa.com.au/cpd management and post-operative care, especially in oral surgical cases.

Clearly, Andrei has a lot on his plate, not only with his lecturing schedule but also working at his private practice in Mosman, which he says is the only true 24-hour emergency practice in Sydney, open 365 days a year.

“We offer a 24-hour pharmacy/medication advice line available to patients, but more and more dentists and medical colleagues from hospitals and private practice are using this service,” he explains, adding they have various referrals from colleagues for more difficult surgical procedures and/or compromised medication profiles.

As busy as his schedule is, Andrei is clearly not one to sit idle, and says he hopes in the future to bridge the gap further between dentistry and pharmacy to benefit patient outcomes and practitioner education and treatment confidence.

Which three words best describe you?

Always continually learning.

If you weren’t in the dentistry field, what would you be doing for a living?

I probably would have followed through with medicine, however, I feel I made the right choice during my pharmacy years.

What do you do in your spare time?

Spare time has lately become scarce, but I enjoy being outdoors in the sun.

Who inspires you?

A book I read a fair bit is called The Prophet by Kahlil Gibran. It really helps you to think and reflect on the important stuff that makes us human.

Who inspires you and why?

My own mentors who still have a passion for the dental profession at their maturity similar to when they first graduated.

That’s a true gift that hopefully I will also share.

“Also, after many requests in the profession, I am in the process of writing a textbook on dental prescribing and surgical protocols – a heavy workload indeed,” he adds.

Dr Andrei Tutoveanu will present “The Dynamics and Dilemmas of Drugs in Dentistry” at ADA House.

June 2020 Western Articulator | adawa.com.au

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Dental CPD Calendar JUNE Simplified Clinic Endodontics Winthrop Professor Paul Abbott AO Friday: 8.30am–5.00pm UWA Dental School, Nedlands

*POSTPONED* Introductory Course in Neuromodulators and Dermal Fillers

AUGUST 5

Associate Professor Dieter Gebauer Friday: 1.00pm–5.00pm CTEC, Crawley

Ceramic Restorations Dr Asheen Behari & Dr Paul Gorgolis Friday & Saturday: 9.00am–5.00pm UWA Dental School, Nedlands

12/13

26

26/27

Dr Vanessa William Saturday: 8.45am–1.30pm UWA Dental School

It’s Not Just About the Spine: Undertanding and Managing Spinal Pain

10

The Art of Digital Photography & its Clinical Applications

4

25

5

Dr David Booth & Dr Carolyn Stulner Saturday: 9.00am–2.00pm CTEC, Crawley

Event Types: WA Dental CPD Events ADAWA General Meetings Other CPD Events 14 June 2020 Western Articulator | adawa.com.au

06

Prosthodontic Problems? Plan to Prevent Them!

14

The A-Z of Mastering Anterior Crowns

17

Dr Ben Lee Saturday: 9.00am–5.00pm UWA Dental School, Nedlands

11

Infection Control: Ensure You and Your Team are Confident and Compliant [PERTH]

22

Kylie Robb Thursday: 9.00am–5.00pm ADA House, West Perth

18

Professor Peter O’Sullivan Friday: 9.00am–5.00pm UWA Dental School, Nedlands

Practical Oral Surgery

Winthrop Professor Paul Abbott AO Friday: 8.30am–5.00pm UWA Dental School, Nedlands

Dr Ben Lee Wednesday: 9.00am–5.00pm UWA Dental School, Nedlands

Szabolcs Hant & Dr Graham Carmichael Friday: 9.00am–5.00pm ADA House, West Perth

Modern Techniques in Post and Core

02

Dr Josh Graieg Friday: 6pm–9.00pm ADA House, West Perth

Associate Professor Johan Aps Saturday: 8.00am–5.00pm UWA Dental School, Nedlands

10

Predictable and Easy Root Canal Instrumentation and Filling Techinques

ADAWA NPP: The Patient who won’t see an Endodontist

Professor Peter O’Sullivan Friday: 1.00pm–5.00pm ADA House, West Perth

Submersion into DMFR - One Day Crash Course

Drs David Hallett and Rob Bower Friday: 6pm–9.00pm ADA House, West Perth

The Primary Dentition: Pulp Therapy and Stainless Steel Crown Restorations

21

SEPTEMBER

Dr Andrei Tutoveanu Friday: 8.30am–5.00pm ADA House, West Perth

ADAWA NPP: Dilemmas in Dentistry

Oral Surgery Dr Barbara Woodhouse Friday: 9.00am–5.00pm ADA House, West Perth

JULY The Dynamics and Dilemmas of Drugs in Dentistry

05

Dr Melanie McAlpine Friday: 6pm–9.00pm ADA House, West Perth

Dr Kate Morlet- Brown Friday & Saturday: 9.00am–5.00pm The Rose Medical Centre, North Fremantle

Hands On Extractions

ADAWA NPP: The Patient who won’t see a Periodontist

OCTOBER

Infection Control: Ensure You and Your Team are Confident and Compliant [ALBANY]

24

Kylie Robb Saturday: 9.00am–5.00pm Albany Entertainment Centre, Albany

19

Perio-Potpourri: an Update in Clinical Periodontics

27

Associate Professor Axel Spahr Tuesday: 9.00am–5.00pm ADA House, West Perth

Rotary Endodontics Drs Mark Johnstone and Mehdi Rahimi Saturday: 8.00am–5.00pm UWA Dental School

31

WA CPD Event Bookings & Enquiries: Additional event information and online bookings available at www.adawa.com.au Bookings, Course and Payment enquiries: P: (08) 9211 5600 | E: cpd@adawa.com.au Other Enquiries to Dr Jenny Ball: M: 0419 044 549 | E: jenny@adawa.com.au

NOVEMBER Porcelain Veneers & Ceramic Onlays - A Practical Approach to Multiple Restorations

2021 FEBRUARY 6/7

Dr Asheen Behari & Dr Paul Gorgolis Friday & Saturday: 9.00am–5.00pm UWA Dental School, Nedlands

NPP Day FREE full day event with more details to come Saturday: Time TBC

14

4

Dr Steven Parker Friday: 9.00am–5.00pm UWA Dental School, Nedlands

Pain Relief for Your Patients

Dr Clarence Tam Saturday: 9.00am–5.00pm UWA Dental School, Nedlands

20

Posterior Composites

DECEMBER Anxiety Relief in the Dental Surgery

To Prep or Not to Prep

5

Dr Steven Parker Saturday: 9.00am–5.00pm UWA Dental School, Nedlands

SELLING OR BUYING A DENTAL PRACTICE? HPB Health Practice Brokers offer a dynamic fresh approach to Dental Business Broking in WA

Dr Clarence Tam Sunday: 9.00am–5.00pm UWA Dental School, Nedlands

21

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 www.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.

ADAWA GENERAL MEETING Pharmacology in chairside dentistry Presented by Dr Maryam Jessri Maryam is an Oral Medicine Specialist who graduated from Harvard School of Dental Medicine.

She is currently the Discipline Lead and Program Convenor in Oral Medicine at UWA Dental School.

She completed her PhD in genetics of head and neck cancer. In addition to her basic science research, she’s conducting clinical research in psychology of orofacial pain and oral presentations of systemic conditions.

WEDNESDAY 8th July 2020

Ellie J Ladner Lecture Theatre

Extensive marketing of your practice to ensure the best possible price achieved

This brief presentation will touch on medications and their oral side effects, medications and their systemic side effects as they relate to general practice of dentistry, CYP and common interactions, and how to collect a reliable list of medications.

Clear communication throughout the sales process

6.15PM “Eat and Meet”

7.30PM General Meeting

8PM Lecture

Your chance to meet with Council and other members of the Association

Immediate start

Dr Maryam Jessri

Exceptional Customer Service Confidentiality assured

Call Andrew Maurice 0410 642 660 or Garry Bishop 0414 825 855 for a confidential discussion or visit www.hpbaus.com.au

RSVP By Wednesday 29th June 2020

RSVP Details: Due to the popularity of some lectures, it is essential to RSVP. Please phone, fax or email by Wednesday, 29th June 2020.

P 9211 5600 | F 9321 1757 | E adawa@adawa.com.au

June 2020 Western Articulator | adawa.com.au

15

CPD Opportunity

CPD Opportunity

$528 incl GST

The Primary Dentition: Pulp Therapy and Stainless Steel Crown Restorations Saturday 25 July | CPD Hours: 4 Presented by Dr Vanessa William Course 8:45am to 1.30pm UWA Dental School, 17 Monash Ave Nedlands Bookings & Enquiries adawa.com.au/cpd/ The primary molar presents a significant restorative challenge to dentists due to their unique anatomy and characteristics.

The strength of the primary molar itself is often the major limiting factor in the choice of a successful restoration.

Their bulbous shaped crown, cervical constriction, prominent pulp horns and broad at contact can make intracoronal adhesive restorations more difficult to retain. The stainless steel crown restoration offers an exceptional alternative to other restorative materials due to its durability, cost effectiveness, ease of technique and offers the advantage of full coronal coverage.

This half day course will take the participant through the indications for using stainless steel crowns, a step by step guide for tooth preparation and kit requirements for your dental practice.

Pulp therapy in the primary dentition is a highly successful clinical procedure following careful case selection. Three different pulp therapy procedures (indirect pulp cap, pulpotomy and pulpectomy) will be discussed in detail during the lecture. The hands-on component will include pulpotomy technique and the use of current medicaments including Mineral Trioxide Aggregate (MTA).

Topics to be covered:

About the Presenter:

Pulp Therapy: diagnosis of pulp status, pulp treatment options (indirect pulp cap, pulpotomy, pulpectomy), pulpotomy technique and current medicaments available.

Dr Vanessa William graduated from the University of Western Australia with a Bachelor of Dental Science in 1996, completed a Doctor of Clinical Dentistry specialising in Paediatric Dentistry at the University of Melbourne in 2004 and attained her Fellowship at the Royal Australasian College of Dental Surgeons the same year.

Stainless-Steel Crown Restorations in the Primary Dentition: Indications for use and technique guide.

Hands-On Practical Session Pulpotomy: preparation on two teeth using two different pulp medicaments followed by stainless-steel crown preparations on two teeth following pulpotomy.

16 June 2020 Western Articulator | adawa.com.au

Vanessa is a co-owner of Bicton and Cockburn Paediatric Dentistry, has been the past President of the Australian and New Zealand Society of Paediatric Dentistry (WA Branch); involved in arranging the most recent Australasian Academy of Paediatric Dentistry Scientific Program and is currently on the Board of Studies for Paediatric Dentistry for the Royal Australasian College of Dental Surgeons.

Set yourself apart RACDS Orientation Course 7 July – 5 August 2020 via Zoom & eLearning 3 evening sessions per week Enrol before Friday 26 June: www.racds.org/OC

Course delivery All lectures are pre-recorded and accessible at any time, supplemented by elective scheduled live sessions covering both Q&A and Exam Preparation. You’ll be granted 80 CPD hours upon completion.

Subjects covered Orientation Course will cover six basic science subjects that Primary Exam assesses: Anatomy, Cell Biology & Biochemistry, Histology, Microbiology, Pathology and Physiology.

RACDS Primary Exam (Enrol now) 30 Nov - 14 December 2020

Exclusive discount RACDS will offer a 40% discount on the course fee for 2020 candidates – just $1,930 for candidates who enrol as an Affiliate Member (current dental registration required).

Who can attend It is open to both RACDS members and nonmembers. Candidates are encouraged to become a member for a small annual fee (this replaces Subscription in 2020), which is more cost effective and provides added College benefits.

For enquiries, please contact info@racds.org

June 2020 Western Articulator | adawa.com.au

17

Helping Staff through a Patient Complaint or Negative Review ADA’s HR Advisory Service sets out best practice ways to help staff through a patient complaint or negative review The importance of managing a patient complaint or negative review within a practice cannot be overstated. Moreover, helping staff both directly and indirectly affected by a negative customer complaint is paramount to the trust and morale amongst staff within any business.

The most important thing is to offer support to your staff when they receive a customer complaint or a negative review. Some complaints are completely warranted – if this is the case then acknowledge so, provide support to your staff in resolving the issue, and move on.

Why customer complaints and negative reviews are not always a bad thing

If you can deal with a complaint in a positive and constructive manner, it will be beneficial to the working environment for your staff and to the growth of your practice in the long run.

Receiving a patient complaint or a negative review can often be seen as a challenging issue to deal with, however, listening to and managing such complaints is beneficial to the growth of any practice.

In this respect, it is imperative to be efficient, effective and supportive when it comes to helping staff through these situations.

Contrary to initial reactions, a customer complaint can actually benefit a practice as it can show where the practice may be falling short of customer expectations, where the practice may need improvement, or where staff may require further support or development.

Supporting staff through a customer complaint or a negative review It is important to not only listen to the customer in what they are complaining about (the golden rule still stands that the customer is always right), but moreover what the employee involved takes the situation to be. For example, if a customer complains that something took too long, it may be a matter that staff are feeling overwhelmed with their workload, that there was an underlying issue with technology, or that they are lacking confidence in their ability to service patients – all issues that can be dealt with to maximise patient satisfaction in the future.

18 June 2020 Western Articulator | adawa.com.au

Have a complaints-handling policy Employees will often feel demoralised when they read, hear, or receive a complaint about themselves or even about one of their colleagues. Whilst this is a perfectly normal reaction, it is important that staff learn from complaints rather than take them personally.

If you do not already have one, it is recommended that practices develop and implement a complainthandling policy that staff feel confident relying upon when they receive a complaint or a negative review.

Having such a policy to address patient complaints more promptly will also minimise any damage that may be had and will prevent a complaint from escalating.

A complaint-handling policy should inform staff what they need to do when a complaint is received – it should identify the steps that need to be taken to discuss, address, and resolve a complaint.

A strong complaint-handling policy will typically address protocols such as thanking the customer for raising their feedback, apologising for any inconvenient caused, taking detailed information concerning the complaint, investigating the complaint (where appropriate) or escalating

the complaint to management, and providing a resolution.

It is imperative that staff are trained to follow this procedure so that complaints can be resolved promptly, effectively and with the required support for staff.

Social media and customer complaints It is common knowledge that when a customer has a complaint, they will often not complain to you directly but will complain to others, and with advancements in technology, customers have more power than ever.

Practices today have the added pressures of social media to navigate, and whilst a positive promotional tool, social media can also be a platform where customers may raise their negative comments and concerns in a very public way. Staff who are the subject to these complaints and who read them may very easily become demoralised.

Handling such complaints with staff should be no different to any other complaint, however, we would recommend that you do not engage with the complaint online other than perhaps acknowledging that you have received it. It is best to take negative commentary offline as you do not want this kind of feedback on a public forum nor do you want to create more anxiety within the staff that the complaint relates to.

If you consider it appropriate to do so, ask if the employee feels comfortable addressing the complaint themselves in a less public forum. The complaint will be resolved far more quickly, and often with greater customer satisfaction, if the customer is able to raise their concerns to and

“

The most important thing is to offer support to your staff when they receive a customer complaint or a negative review.

receive a response directly from the employee. This will not only be the most efficient way of solving the problem, but it will also instil trust in your employee that you support them and that you are confident in their ability to interact with customers and manage a complaint or negative review.

Acknowledge employee compliments Lastly, it is so important to share any compliments or positive feedback you receive about an employee or group of employees. Whilst there is no getting around customer complaints, sharing customers more positive experiences and feedback gives a more balanced perspective to the practice and its employees of how customers view the practice, practice staff and the patients overtime experience.

For further information or assistance in relation to helping employees through a customer complaint or negative review, please do not hesitate to contact the ADA HR Advisory Service on 1300 232 462.

June 2020 Western Articulator | adawa.com.au

19

Avoiding contractual obligations What are your options? By David McMullen COVID-19 has presented great challenges for dental practices As Dental Service Restriction levels are lowered, and practices gradually return to ‘normal’, it may become apparent that various kinds of contractual obligation either have not been met, or have become difficult or impossible to meet going forward. In some cases, a dental practice may be the party that has encountered difficulty. In other cases, it may be your supplier or contractor that has not performed, or will not perform.

What does the law make of these situations?

The usual position

Where a party voluntarily enters into a contract, the usual position as a matter of general contract law, is one of ‘absolute liability’. That is, the contract will be binding and must be performed.

In the context of COVID-19, however, it is possible that relief from the obligation to perform a contract may be found in the common law doctrine of ‘frustration’, and/or in a ‘force majeure’ provision of the contract itself.

Frustration: “Things are now radically different than when the contract was entered into” What circumstances might frustrate a contract?

Frustration is a common law concept. It does not depend on the inclusion of any particular contractual wording.

Frustration occurs where circumstances have arisen, through no fault of the parties, making a contractual obligation incapable of being performed because (to use language adopted by the High Court) ‘the circumstances in which performance is called for would render it a thing radically different’ from what was contemplated by the contract.

20 June 2020 Western Articulator | adawa.com.au

Determining whether a contract has been frustrated is an exercise in contractual construction: Has a “frustrating” event occurred that has such an effect on contractual performance that it could be said the parties never agreed to be bound in circumstances which have ultimately (and unexpectedly) arisen?

There is no single exhaustive list of “frustrating events” or set of rules about what events will be deemed a frustrating events by the courts.

The standard of proof is very high – typically higher than circumstances contemplated by a force majeure clause. Frustration will apply to fundamental obligations of a contract only.

A court is unlikely to find frustration of a contract where, for example: •

there is an operative force majeure clause that can deal with the relevant issue;

•

the relevant event reasonably could have been (or in fact was) foreseen by the parties;

•

the alleged frustration is the fault of a party or self-induced;

•

the intervening event has not led to serious consequences;

•

the circumstances encountered are temporary or transient only;

•

the contract remains performable (even though in a reduced or compromised fashion).

Raising frustration is therefore usually an option of last resort if a force majeure clause is available.

What happens when a contract is frustrated?

When a contract is frustrated, it is automatically terminated at the point when the frustrating event occurs. This occurs by operation of law, without

Legal Feature

the need for election or notice being given by any party (though for practical reasons if nothing else, it would usual to notify the other party if frustration is asserted).

Future obligations are discharged (and no party can claim damages for non-performance because no party is at fault), while obligations which fell due for performance before the frustrating event remain in operation.

Force Majeure: “This is an event outside the control of my control, and the contract provides for relief”

Is COVID-19 capable of frustrating a contract or triggering force majeure?

It is not possible for us to answer this in a generic way or abstract way, because each situation will turn on its own facts and circumstances.

Dental practices affected by COVID-19 might be able to establish frustration or rely on force majeure, but this will be fact and contract specific. Relevant considerations may include: •

The terms of the relevant contract: Has your dental practice been prevented from performing the terms of a contract with its corporate owner, due to shutdowns? Or perhaps a supplier of your practice has failed to deliver materials that you required, due to border closures?

•

Was performance of the contract merely delayed, or prevented only temporarily? Is the delay or failure to perform capable of remediation as restrictions are lifted? Or is performance impossible?

•

Where and when was the contract entered into? It could be difficult to argue an unforeseen event if, for example, a contract was entered into after COVID-19 had reached pandemic level.

•

Does the contract contain a force majeure clause?

What does the clause say? Normal rules of contractual construction will apply. Even in the absence of specific language such as ‘infectious disease’ or ‘pandemic’, events arising from COVID-19 (as opposed to the virus itself) may still constitute force majeure.

In what circumstances might force majeure apply?

Relief for force majeure will depend on the existence of an appropriate clause within a contract.

The usual intent of a force majeure clause is to relieve a party from performing their contractual obligations where a defined event occurs, preventing performance (either wholly or in part). The breadth of what will constitute a force majeure event varies from contract to contract; though common definitions refer to events that are beyond the parties’ control, and which could not have reasonably been foreseen.

Force majeure events listed in a contract may include: wars, riots, acts of terrorism, acts of God, natural disasters, ‘government action or interference’, ‘labour shortages’, ‘national emergencies’, epidemics and pandemics. But to reiterate, force majeure is dependent on the wording used in a given contract.

What happens when force majeure is triggered?

A force majeure clause should identify not only what will constitute a triggering event, but also the consequences of such an event occurring. These may include some or all of the following: •

suspension of contractual obligations (wholly or in part);

•

relief from liability for non-performance or delay while the force majeure event continues;

•

extension of time to perform obligations;

•

renegotiation of certain terms to resolve the problem, and obligations to cooperate to find a solution;

•

termination (either immediately or after the force majeure event has continued for a specified period of time).

Parties should always exercise caution and take advice before asserting frustration of a contract or force majeure, because to do so in error may lead you to incur liability towards the other party. That said, depending on the facts and the particular contract, it is possible that legal relief may be available where contractual performance has been affected by COVID-19.

The contract will specify any particular steps that must be followed to rely on force majeure – such as formally notifying the other party. The party asserting force majeure must also be able to establish causation between the force majeure event and its effect on performance of the contract.

June 2020 Western Articulator | adawa.com.au

21

ANATOMY OF THE ROOT CANAL SYSTEM AND ITS CLINICAL IMPLICATIONS Part 2: Mandibular permanent central incisor, lateral incisor and canine Dr Gaurav Vasudeva, Specialist Endodontist

In the previous edition we learnt about the complexity and importance of root canal anatomies for achieving clinical success with focus on maxillary anterior dentition.

(a)

(b)

(c)

(d)

(e)

(f)

Besides focusing of mandibular anterior teeth in this article, I would like to introduce and discuss the classifications of root canal systems based on canal morphology and its variations.

Over the past few decades, a number of clinicians and researchers have made an attempt to classify root canal anatomy. By far the most popular and commonly used are Wein’s classification and Vertucci’s classification.

Wein’s classification was simple and was accomplished by sectioning natural permanent teeth and taking their radiographs.

Based on that, the root canals were classified into four major categories (figure 1). Vertucci’s classification was based on dye staining of 200 maxillary 2nd premolars and configurations of canals discovered. Eight major canals systems were identified and classified.

There were few other classifications published in the past decade, but their limitations remain and couldn’t achieve the simplicity and popularity of the above two classifications.

Vertucci’s classification remains the most popular and widely used classification to date, especially when it comes to teeth with variation of two roots or root canals that are either mandibular anterior and both maxillary and mandibular premolars.

(a)

Fig 3. Example of a Type 4 canal system (Vertucci’s). (a) #41 with symptomatic apical periodontitis due to a failed RCT. (b) Removal of GP and debridement. (c) Canal instrumentation shows two separate canals with separate orifices and apices. (d) Final master cone fit. (e) Post-op radiograph with no angulation shows single canal obturation. (f) Distal tube shift reveals obturation of two separate canals. (b)

(c)

Fig 1. Wein’s Classification.

Fig 4. Example of Type 3 canal system (Vertucci’s). (a) #31 Symptomatic apical periodontitis. Radiograph doesn’t reveal existence of two canals. (b) Instrumentation shows presentation of two canals but with a single orifice. (c) Final obturation confirms type 3 canal system with single orifice that divides into two separate canals and again merges at the apex.

(All clinical cases performed by Dr Gaurav Vasudeva and published only for the purpose of dental education. Please contact author at info@rootcanalspecialist.org.au for references.)

Fig 2. Vertucci’s Classification.

22 June 2020 Western Articulator | adawa.com.au

Root canal anatomy of mandibular permanent incisors and canine based on recent micro CT studies with its variations and clinical relevance: Mandibular Central Incisor

Mandibular Lateral Incisor

Mandibular Canine

Complete root formation

8.1 – 9.2 years

8.8 – 9.9 years

11.4 – 13.5 years

Number of roots

1 - 100%

1 - 99.94% 2 - 0.08%

1 - 98.6% 2 - 1.4%

Number of root canals 1 - 86.5% 2 - 14.4%

1- 79.57% 2- 20.2%

1 - 92.4% 2 - 7.3%

Apical foramen position

Central – 25% Lateral – 75%

Central – 20% Lateral – 80%

Central – 30% Lateral – 70%

Accessory canals

0–20% (coronal, 3%; middle, 12%; apical, 85%)

0.9–18% (coronal, 2%; middle, 15%; apical, 83%)

4.5–30% (coronal, 4%; middle, 16%; apical, 80%)

Root Canal Configuration

Types I (86.5%), III (8.1%), V (2.8%), II (2%), IV (1.4%), VII (0.1%)”

Types I (79.7%), III (11.9%), V (3.8%), II (2.6%), IV (1.8%), VII (0.1%)

Types I (92.4%), III (2.7%), II (1.9%), IV (1.5%), V (1.2%)

Apical ramifications (delta)

3.2% - 7.8%

3.2% - 7.8%

2.2% - 46.9%

Anomalies

Rare case reports on 3 canals, gemination-fusion and dens invaginatus.

Cases reported with dens invaginatus, dens evaginatus, deep radicular groove, 3 canals with 2 separate roots, fusion/gemination and dilaceration.

Rare reports on 2 canals, 3 canals with 2 separate roots.

Clinical relevance

•

•

•

•

Most root canals are straight but with a higher incidence of 2 separate orifices. Hence it is important to always look for the 2nd canal which is mostly hidden and is lingual.

Ideal access should be closer to the incisal edge to access both canals if present and for better straight-line access.

Both the central and lateral incisors roots are thin mesio-distally and the mechanical preparation should be restricted preferably to ISO file size 30 or under with limited taper.

•

Higher incidence of • anomalies as compared to the central incisor.

Higher incidence of 2 canals as compared to central incisor with • majority of them merging at the apex making it type 3 canal system (Vertucci classification). Again, the lingual shoulder must be removed and access closer to the incisal edge to locate the 2nd canal.

Large bucco-palatal diameter in comparison to mesio-distal that must be kept in mind while performing cleaning and shaping.

Removal of internal lingual shoulder is advisable for better access especially if there is possibility of two canals that is found in about 8% cases.

June 2020 Western Articulator | adawa.com.au

23

21mm Mouth Opening!

A 53-year-old female was referred regarding a long history of limited mouth opening, as well as jaw tension. There was no clicking or locking of the TMJs. The patient reported a possibility of nocturnal clenching/bruxing. She denied any history of trauma to the jaw, head or neck.

Her remaining medical history was essentially noncontributory. She had gastroesophageal reflux disease for which she was taking Pariet. There were no known drug allergies. She was a non-smoker and consumed four to six alcoholic beverages per weeks. The patient was married, with three adult children no longer at home. She was on long-service leave from her teaching job and did not note any significant stressors.

Dr Jacinta Vu, Oral Medicine Specialist

Radiological findings MRI of the TMJs (Figure 2) demonstrated a normally positioned TMJ disc in the mouth closed position. CT of the TMJs (Figure 3) revealed normal osseous anatomy of the TMJ. As seen on both MRI and CT, with mouth opening (Figure 4), there was marked restriction of condylar translation. CT further demonstrated marked bilateral coronoid hyperplasia (Figure 5), with abutment of the coronoid processes and the deep surface of the zygomatic arches on mouth opening, more marked on the right (Figure 6).

Images courtesy of A/Prof Andy Whyte, Perth Radiological Clinic

Examination Extra-oral examination did not reveal any regional lymphadenopathy. The bilateral sternocleidomastoid and trapezius muscles were tender. Pain-free interincisal opening was 21mm (Figure 1), an active opening of 25mm and passively assisted opening of 27mm. Right lateral movement was 5mm, left lateral movement was 4mm and protrusive was 6mm. There was no deviation/deflection on jaw opening, and no joint sounds were noted. The bilateral temporalis, masseter and medial pterygoid muscles were tender to palpation. There was moderate wear of the dentition and she had a class I occlusion. Soft tissue examination was normal.

Figure 2. MRI (T2 Sagittal Sequence). TMJ Disc (D) is normally positioned in the closed mouth position

Figure 1. Photograph demonstrating limited pain free jaw opening of 21mm

Figure 3. CT (Bone window). Normal osseous anatomy of the TMJ. 24 June 2020 Western Articulator | adawa.com.au

Figure 5. CT – coronal sequence. Blue dotted arrows show marked coronoid process hyperplasia.

Figure 4. CT (Soft tissue window). Marked restriction of condylar translation on mouth opening.

ABOVE Figure 6. 3D CT reconstruction. Blue dotted arrows show bilateral coronoid hyperplasia

LEFT Figure 7. CT – soft tissue axial sequence. Red open arrows show abutment between coronoid processes and the deep surface of the zygomatic arches.

Diagnosis In this case, the patient’s diagnosis was bilateral coronoid hyperplasia, as well as masticatory and cervical myalgia on background of sleep bruxism.

Discussion Bilateral coronoid hyperplasia is a rare condition, which may be commonly mistaken for internal derangement. It usually causes an insidious, painless and progressive limitation of mouth opening and excursive jaw movements. This is due to physical limitation of mandibular movement from osseous impingement of the

coronoid process against the medial or temporal surface of the zygomatic arch. In this case, radiological examination provided the key to accurate diagnosis. The masticatory myalgia was likely related to parafunctional nocturnal bruxing.

As bilateral coronoid hyperplasia is a progressive condition, further limitation of mouth opening can severely impact quality of life, oral hygiene and even be life-threatening if intubation is required. Thus, bilateral coronoidectomy is the treatment of choice for this patient. The literature suggests excellent functional outcomes with appropriate post-operative jaw physiotherapy aimed at rehabilitation.

June 2020 Western Articulator | adawa.com.au

25

Dr Janina Christoforou Oral Medicine Specialist

POTENTIAL REACTIONS FROM THE USE OF A COMMON DERMAL FILLER

T

he use of dermal fillers is gaining increased popularity as a non-surgical means to counteract signs of facial aging. Dermal fillers are commonly used for filling in facial wrinkles and for lip augmentation. A commonly used dermal filler is hyaluronic acid in the form of a gel.

Hyaluronic acid has been popular since it can act to create facial volume by acting as a matrix which attracts moisture. It is thought to be biocompatible, non-immunogenic, and relatively easy to administer.

Although rare, hypersensitivity reactions may still be associated with hyaluronic-based fillers. It is impossible to predict, and it may occur in both previously injected and first-time patients. Late-onset reactions may manifest from weeks to many months after an uneventful hyaluronic acid injection. This may depend on the location of the injected product and the time taken to degrade at that site. The hypersensitivity reaction presents as a diffuse, non-fluctuant, red inflammation of the sites containing the dermal filler. Delayed reactions are particularly difficult to diagnose due to the time lapse from the last injection.

Therefore, a thorough medical history is essential.

The aetiology of the delayed hypersensitivity reaction in relation to hyaluronic acid fillers is not completely understood. We can speculate that the dermal filler may have contained an immunogenic protein, potentially introduced through the manufacturing process. The fillers are usually composed of nonanimal origin hyaluronic acid with a cross-linking agent. The technology of the cross-linking varies amongst different manufacturers and the modification of the hyaluronic acid molecule to such a large extent, may lead to it no longer being recognized as hyaluronic acid, and thus potentially leading to immunological reactions, ie. foreign body reactions.

Furthermore, the manufacturing process may introduce impurities from the cross-linking and fermentation processes.

Hence, as new products enter the market, hypersensitivity reactions may become more common.

Management of these reactions usually require the use of corticosteroids to alleviate the inflammation.

HIF Corporate Program ADAWA 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.

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 26 June 2020 Western Articulator | adawa.com.au

REMINISCENCES OF DENTAL SCHOOL Dr

I

n difficult times and during periods of great uncertainty, as exists in our world at the present time, it is comforting to look back on childhood experiences and even to our days at dental school.

Dental school is a melting pot of fears, deprivations and exams (lots of them) but outside of clinical areas it is also a time when lifelong friendships are formed, life partners found and there is a plethora of parties and social activities.

As we age, memories of the bad times fade and the fun times come into sharper focus. We forget the late nights spent studying, the sweaty palms and dry mouth before a viva, the general hard slog that is the life of a dental student and instead we remember the evenings spent down the pub, the fun pranks played on unsuspecting colleagues and the joy of being young and healthy. However, there are exceptional events that are so forceful they are seared into our brains for ever.

One such incident happened to me in my first clinical year. After a gruelling academic year at the medical school and then months in Optec, we were finally released into the exciting, heady atmosphere of student clinics. We were privileged to have at my UK dental school one of the world’s foremost experts in oral medicine. He was a full professor at age 32 and possessed an enviable, nimble brain. However, he displayed a dislike of all students, but most particularly female ones.

The professor ran an oral medicine clinic for our group of students on a Thursday afternoon, immediately after lunch. The great man would deign to arrive last, after we had arranged ourselves on benches around

Josephine Drewett

the walls (wearing sparkling clean, white coats) with the patient already seated in the centre of the room.

He strode into the room where, with pens poised at the ready, an expectant, reverent hush awaited his pronouncements. As the weeks progressed, the professor took to arriving later and later each session.

As students, we also welcomed the opportunity to grab a few minutes extra lunch time before showing up to clinic, seating ourselves in good time before the professor walked in. One fateful week I happened to be the last student to arrive and to my horror found he had already entered and was in full flow expounding the patient’s diagnosis.

I slunk into the consulting room, endeavouring to make myself invisible. Before I could reach the safety of the benches his voice stopped me in my tracks.”Miss Collins, explain yourself,” he spat out, as if the word “Miss” was something unpleasant in his mouth.

Without daring to raise my eyes I mumbled something incoherent. If I ventured an excuse or explanation, I would most likely fail oral medicine that term and all the following terms. I stood there quivering, scarlet with embarrassment. No doubt my peers were sympathetic to my plight, but I was unaware; I was lost in my own misery, wishing the floor would open up to swallow me whole. From the distance of many years, I cannot remember what punishment was doled out to me that day. Perhaps the mortification I suffered was punishment enough. But I did learn one very valuable lesson: never be late, and never, ever arrive after the professor.

June 2020 Western Articulator | adawa.com.au

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Volunteer for yourself and others The Tzu Chi Foundation solves dental problems for those in need. However, as volunteer dentist Dr Emma Perry explains, TIMA is also a place for dental professionals to celebrate their skills, work with a compassionate and motivated group of people, and contribute to their own mental wellbeing Have you ever had an experience where you’ve felt the pure, unadulterated glow of love and compassion? Feels good, huh? This is not usually the first thing that comes to mind when someone asks you to volunteer. I know where my mind goes: “I’m too busy, I’m too stressed, I need a sleep in on Sunday mornings, I won’t make much of a difference, someone else can do it.” Then, instead of relief, on come feelings of guilt for being “selfish”. Where is the good in this situation? I’ve helped no one, including myself.

Mental health problems like anxiety and depression are on the rise in our community; nobody is immune just because they have enough money, a good job, a supportive family.

The WA Government initiative Act-Belong-Commit has an evidence-based approach to improving communitywide mental health. The “Commit” corner of this triangle urges people to nurture their own mental health by doing “something meaningful”. This can take the form of learning a new skill, helping a neighbour, taking on a challenge, and volunteering. As a dental professional, you have a unique set of skills that will make your volunteering experience all the more meaningful. Not just anyone can volunteer as a dentist, oral health therapist, dental hygienist, or dental assistant. You can.

I started volunteering with Tzu Chi Foundation Perth’s Tzu Chi International Medical Association (TIMA) in 2016, but Dr Lydia See and her team at TIMA Perth have been growing their programme in Perth since 2013. It has gone from emergencies in a single day, twice a year, to monthly clinics supporting the oral health of homeless and refugee people living in our local community. Patients are screened and found through community organisations that looks after homeless, refugees and socially disadvantaged individuals.

The waitlist for appointments has grown, but don’t mistake this for a stressful environment. It’s merely a reflection of the success of the initiative, and the great need for providing basic dental care to those who have fallen through the cracks of our government-run welfare system.

The actual clinic days are efficiently organised and provide volunteer clinicians with autonomy around appointment lengths. TIMA is founded on compassion, not just drilling and filling. The time spent building rapport with patients is valued just as highly as the perfect contact point and occlusal balance of a restoration. I have never felt rushed, stressed, compromised, or out of my depth when treating TIMA patients, thanks to the overwhelming support of the clinical and non-clinical volunteers alike.

It also doesn’t have to be a big commitment. For the monthly clinics to date, there have been over 30 dentists, over 20 auxiliaries, over 40 students involved, with each monthly clinic utilising around 30 clinical and nonclinical volunteers each session. Giving one or two days a year lightens the load for everyone, and it does make a difference. The non-clinical volunteers make the clinics run smoothly by providing breakfast and lunch for volunteers, 28 June 2020 Western Articulator | adawa.com.au

escorting patients around the building, completing administration tasks, and spending important time chitchatting with patients as they wait. The result is a well-oiled machine, and the least intimidating environment possible for patients and volunteers alike. It’s impossible to leave the half-day clinical session without a smile, a full belly, and a nourished soul.

Yes, TIMA is helping solve dental problems for those in need. But it’s also a place for dental professionals to celebrate their skills, work with a compassionate and motivated group of people, and contribute to their own mental wellbeing. Don’t volunteer out of guilt. As the Pulitzer Prize-winning poet and environmentalist Gary Snyder said about our planet, “Don’t feel guilty. If you’re gonna save it, don’t save it out of guilt, or anger, or fear.

Those are the very things that are actually making the world worse. Save it because you love it. Because it’s part of you.”

If you’d like to find out how to be part of Tzu Chi Foundation’s TIMA projects in Perth, please contact Lydia at timaperth@gmail.com.

“Tzu Chi Foundation Perth would like to thank the continual support and contribution of the University of Western Australia - Oral Health Centre of WA, as well as the wider West Australian community including oral health promotions team at dental health services, all our patients, case/support/recovery workers and our volunteers.”

The Value HelloFRESH Hunter www.hellofresh.com.au

I enjoy cooking. Spending time in the kitchen preparing meals for my family and friends is something that brings me joy, and I love trying out new recipes. However, finding the time and energy to do so on a regular basis is something that I struggle with, and I am sure that I am not the only one with this problem, given the exploding popularity of the ingredient delivery service HelloFresh. Cooking a meal is more than the time spent at the stove; there is also the time spent choosing what to eat, meal planning, shopping at the grocery store, food preparation, and then the actual cooking process. I once fell into the routine of having the same chicken and salad dish for a whole 2 weeks, because I didn’t have the time to think of new recipes, and while I know some people enjoy the routine, I quickly grew tired of it. Ordering in or eating out is great as an occasional treat but is neither healthy for the body or wallet on too regular a basis. I had tried frozen meal delivery services like Lite and Easy before but missed having fresh foods.

Ingredients are sourced where possible from Australian farmers and they try to deal directly with small family-owned businesses. The plans are flexible with no lock-in contracts.

This was a really positive experience, and I am glad I gave it a try! I will continue to order from them. Should you wish to try HelloFresh, please use your ADA Frequent Values voucher for $20 off your first four orders of any box, or $40 off the first 2 orders of any family box. Details available at http://adawa.frequentvalues.com.au Till next time!

Dr Amanda Phoon Nguyen

I had seen HelloFresh around. My neighbour swears by it, several friends had trialled it and ADAWA president Sean Archibald is also a fan. While isolating at home, I figured this was the perfect time to give it a try. In a nutshell, HelloFresh is an ingredient delivery service. While you still have to cook the food, it solves many of the logistical issues: you don’t have to come up with different meal ideas nor venture to the grocery store, and there is less food wastage as you are only sent what you need. Though I did not directly compare this, I also suspect we saved money, particularly with the ADA Frequent Values card discount.

I tried HelloFresh for 2 weeks and selected the classic box.

Ordering was easy via the website, and they had other options including a family box, and a vegetarian box. I did note that they could not cater for specific allergies and dietary requirements beyond the vegetarian option. After selecting a box, you could choose the number of recipes per week, and the number of serves per meal. If there were meals on the plan that you did not like, you were able to swap it for another option. I was sent the ingredients to make 3 meals, for 2 people. Delivery was non-contact and fuss-free. I watched the delivery driver leave a wellpackaged cardboard box on my porch, and upon opening it, discovered the meats were in a cool bag and the meals were conveniently bagged in paper. Though I was home, I felt that the box could have easily stayed on my covered porch for the day, with the ingredients staying cool. We had the meals for dinner over the next 2 weeks, and I was really pleased that they were healthy, varied, tasty and simple to make.

Some simple ingredients like salt and oil were not provided, but these items that most households should have in their pantries. The list of excluded items is on the Hello Fresh website.

It is clear that HelloFresh has put a lot of thought into their products. Browsing their website, I was pleasantly surprised to learn that the soft plastics were recyclable and that they use paper packaging where possible. Recipes are refreshed weekly to avoid any monotony and have a health focus.

June 2020 Western Articulator | adawa.com.au

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SOCIAL PAGES NEW PRACTITIONER PROGRAM ZOOM CATCH-UP The ADAWA New Practitioner Program May event with Dr Josh Graieg needed to be postponed, but a Zoom social catch up was scheduled for members instead. Social distancing catch ups done right! We are excited to announce a new event with Drs David Hallett and Rob Bower on July 10. Please visit the website for more information ADAWA council also joined in on the fun of video conferencing. How great is this photo?

TOOTH-FRIENDLY COOKBOOK The Federal branch is looking for your best toothfriendly sweet treats. It’s part of an initiative for Dental Health Week 2020, and 20 winning recipes low in sugar will go into a cookbook. Entries close on June 19, ada.org.au/DHW-Competition

NEW PODCAST GUEST ON BONDING WITH ADAWA On the latest episode of the ADAWA podcast, Dr Amanda Phoon Nguyen interviewed Alex Hof, a Clinical Psychologist from WA. Alex shared her perspective on the COVID-19 pandemic, recognising emotions, and managing staff layoffs due to the pandemic.Tune in on Spotify! https://anchor.fm/bondingwithadawa

ADA HOUSE RENOVATIONS ADA House renovations were in full-swing prior to COVID-19 restrictions, and the exterior of the building is looking good.

WAR ROOM CLOSED FOR BUSINESS With restrictions down to Level 1, the War Room is officially closed. We are sure the ADAWA executive team will not be missing the long hours they spent here campaigning and keeping members up-to-date in the midst of Level 3 restrictions.

30 June 2020 Western Articulator | adawa.com.au

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For further information contact Andrea Andrys mediref@adawa.com.au June 2020 Western Articulator | adawa.com.au

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Professional Notices

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Michael O’Halloran will now be offering services at the Perth Hills Specialist Centre, 182 Canning Road, Kalamunda 6076. All bookings for specialist oral surgery and implant dentistry services are through Mediref or main rooms at Cambridge Periodontics.

Dr Franc Henze of Faceworx is happy to announce that he has taken over Perth Oral & Maxillofacial Surgery (POMS) from Dr Clive Purcell. In order to provide continuity of care for his previous patients and referrers, Dr Clive Purcell remains available for advice if required. Dr Franc Henze maintains Dr Clive Purcell’s former theatre list at Southbank Day Surgery.

Dr Brad Shepherd is pleased to announce that Dr Hezel Cohen, Specialist Prosthodontist, has joined him in practice. Hezel is accepting referrals for fixed, implant and removable prosthodontics.

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Investing in new equipment – is now the right time?

By Debbie Kiely, Credabl Finance Specialist We are currently living in strange and uncertain times.

From the pressures on doctors on the front line, to the strain on the healthcare system and its supply chain, and of course your own personal health, we recognise the impact that COVID-19 is having on the medical community is onerous and significant. For some, this is compounded by the devastating bushfires that swept the country recently, leading to a challenging first half of 2020.

However, as we see various restrictions lifted, planning your recovery journey is a critical part of the pandemic journey. Reviewing your current business plans and strategies should be top of mind. If upgrading or purchasing new technology and equipment fits within those plans then you should still consider the investment.

As we approach the end of financial year, don’t forget that the financial year started on 1 July 2019, so prior to the most recent quarter, you have good earnings to manage with the tax man. Thanks to recent changes to the Government stimulus package, you can also upgrade technology, support long-term growth in your practice and reduce your taxable income.

Government stimulus package to support business investment The Government recently announced its goal to deliver support for business investment as part of its economic plan. This included a fivefold increase to the instant asset write-off threshold from $30,000 to $150,000 for eligible assets, which include new or second-hand assets first used or installed ready for use from 12 March 2020 until 30 June 2020 – unless extended*.

Further, for eligible assets that exceed $150,000 acquired from now to 30 June 2021, you can now take advantage of accelerated depreciation with 50 per cent upfront and the balance over the typical depreciating useful life of the asset. Generally, tax deductions only apply at your marginal tax rate so in uncertain environments it’s critical to discuss your cash flow with your specialist advisor if you’re looking to take advantage of this.

Equip yourself and your practice for success Reviewing the needs of your practice is vital in ensuring your practice runs smoothly and efficiently, especially in times like this where there’s so much uncertainty. The equipment a dental practice needs to perform efficiently may vary based on your specialty and technological advancements or size and scope of the practice.

Anyone fitting the eligible criteria should be seriously considering their options when it comes to buying assets used within their business, such as dental equipment, IT equipment, practice furniture and fitout and all work vehicles.

What financing is available?

A common misconception is that you can only get the instant write off if you pay for the goods. This is not true, you can borrow the funds and still receive the benefit.

Interestingly, often the interest on a loan over say three years will be similar to the interest you can earn on the equivalent cash in the bank.

Facilities such as a chattel mortgage, lease and rental provide a range of financing options that can be tailored to best suit the needs of the business.

As always, it’s best to speak with your financial advisors/ accountants about specific advice for your own situation, and the team at Credabl are always here to support your plans with bespoke funding solutions.

Contact the Credabl team today to find out about your equipment and technology finance options. www.credabl.com.au 08 6280 1255 1300 CREDABL (1300 27 33 22)

This article is a guide only and does not constitute any recommendation on behalf of Credabl Pty Ltd (ACN 615 968 100) or any of its related bodies corporate (Credabl).

The information in this article is general in nature and we have not taken into account your personal objectives or financial circumstances or needs when preparing it.

Before acting on this information you should consider if it is suitable for your personal circumstances. Credabl is not offering financial, tax or legal advice. You should obtain independent financial, tax and legal advice as appropriate. * The instant asset write-off scheme will expire on 30 June 2020, presenting a very short window of opportunity to take advantage. After June 30 2020, the arrangement will revert to an instant asset write-off for purchases Federal Government’s COVID-19 Economic Stimulus Package under $1,000, with all other purchases deducted under normal depreciation schedules, which depend on the normal operating life of the asset.

June 2020 Western Articulator | adawa.com.au

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We’re not letting the distance come between you and our team.

Working remotely means our service just got more personal.

At Credabl, our priority is making sure the medical community has easy and immediate access to the financial support they need to get through uncertain times and plan for the recovery journey ahead.

From a video chat with a familiar face, to providing financial support to fund business or personal expenses, our specialist lending team is here to support you.

credabl.com.au 08 6280 1255 1300 CREDABL (1300 27 33 22)

Practice Purchase • Commercial Property • Goodwill Loans • Overdraft Facilities • Home Loans • Car Loans • Equipment & Fitout Finance • SMSF Lending The issuer and credit provider of these products and services is Credabl Pty Ltd (ACN 615 968 100) Australian Credit Licence No. (ACL) 499547.