Western Articulator February 2021

AUSTRALIAN DENTAL ASSOCIATION WA | FEBRUARY 2021

This issue

Celebrations For the graduating class of 2020

Life before dentistry ADAWA members share their pre-dental storiesÂ

World Cancer Day Working together to treat oral cancer

THE RECOGNISED VOICE OF ORAL HEALTH IN WA

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If you own, manage or work for a dental practice you can nominate your practice today.

Find out more and tell us how this grant would support your business at credabl.com.au/helping-hand

*T&Cs Apply

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President’s Report Life Before Dentistry ADAWA members share their pre-dental stories

A Friend and a Mentor Vale Des Fitzgerald

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20 Life before dentistry

36 I am, I will I am,I will

CPD Spotlight Meet Dr Lee Kaing

New Practitioner Program What’s coming up in 2021

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CPD Calendar Legal Feature Dental photography

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DPL Feature

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ADA HR Feature

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I Am, I Will

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Good News Stories

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Recording consultations

Variation to the Health Professionals and Support Services Award 2020

World Cancer Day is February 4

Celebrations for the graduating class of 2020

Professional Notices

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The

President’s Report

Dr Sean Archibald ADAWA President

Dear Members,

Engaging the wider WA dental industry

I hope you all had a restful break and have returned recharged for what is already shaping up to be a big year.

We have always engaged with all parts of the WA dental industry at an association level – and will continue to do so. However, we asked ourselves, could we not do better to bring all the parts of the dental team together as we do in our practices?

We have hit the ground running at ADAWA and spent the first week of January focusing on our strategic plan for the upcoming year and beyond. This process was started in December and culminated in two days of meetings involving ADAWA Executive, Council and our CEO. This process has enabled us to clarify our strategic direction.

Below is a sneak peek at some of the topics, which I will elaborate on in the coming months. For all those “A-types” out there (such as myself), you are just going to have to trust us that we have your and the dental profession’s best interests in mind and know that we will give everyone the full details when the time is right.

Segmentation of the membership The way we communicate and engage with you, our members, has changed considerably in the last few years, as email and social media have become the preferred contact method. We also know that you get a flood of emails every day and don’t want to waste time reading information that does not affect you or miss the good stuff. Our next phase in communication planning is to segment our audience, related to whether you’re a practice owner, associate, public dentist, etc. In the coming year we will ask you to provide these kinds of details and other peripheral information about your practising situation so we can be a better ADAWA for you. As always, it is your option.

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Engaging practice managers with targeted support and resources and services to help run your practice is the first on our list. The program, currently dubbed “partner in practice”, is designed to assist the person in your practice wearing the manager’s hat, whether it be an owner dentist, a staff member you employ, or anyone else. Depending on the success of this program, we will consider streams for all parts of the dental industry and team.

We are also considering how we can assist you with recruitment and are currently scoping a new job’s board to encompass all parts of dental practice.

This is obviously a considerable undertaking, but it aims to alleviate some of the financial burden of recruitment and also create a system that functions solely to suit our profession, our requirements and therefore save us time.

Our engagement with non-dentist owners and larger dental groups (corporates) was also discussed in detail and revealed many new avenues to investigate.

I hope to be able to elaborate on this in more detail in the coming months.

Community One of the core strengths of our branch has always been its sense of community. I have mentioned previously the confidence I have gained through the knowledge that our branch is always there to support me as a member, and also has the answer to almost every question in dentistry.

Over the past few years, we have endeavoured to strengthen our relationship with all areas of the WA dental community across volunteers’ groups and affiliated societies, whilst also looking further afield to wider health organisations such as the Cancer Council. Communities are not always formal associations, and I was inspired to see several of our Councillors step up to champion some new initiatives – think reunions, classic cars, dog days and other exciting projects. More details will follow so keep an eye out and get involved.

Advocacy

Aside from this, we also covered CPD in depth, the creation of a physical ADAWA library, how we implement technology to increase efficiency, and seemingly endless financial discussions.

I would like formally to thank the members listed below who were unpaid and volunteered to attend our strategy days. The success of these days would not have been possible without you, and our membership is lucky to have had you involved: Dr Jenny Ball Dr Amit Gurbuxani Dr Amanda Phoon Nguyen Dr Terry Pitsikas AM

Cheers,

Sean

President Dr Sean Archibald Chief Executive Officer Dr David Hallett Editorial Team Brooke Evans-Butler Lisa Shearon Designer Amie Mason

Closing Date for Bookings

In its most basic sense, our ability to advocate on your behalf comes from either: mobilising the voices of you, our members; or the respect our brand holds in the public arena. In recognising that you have charged the branch with representing your interests, you may have noticed that much of the initiatives mentioned previously revolve around relationships, community and engagement; these three words are at the core of any effective advocacy organisation. There will be many opportunities to advocate on your behalf in the coming year and although we are already well positioned, these endeavours and many others should continue to put us at the forefront of dentistry in WA.

• • • •

All correspondence to T (08) 9211 5600 E media@adawa.com.au A PO Box 34, West Perth WA 6872

• • • •

Dr Tim Crofts Dr Tim Clair Dr Brian Koch Dr Peter Duke

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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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Life before dentistry The path to becoming a dentist isn’t always straight and predetermined. More often than not, there are a few twists and turns along the way, as Brooke Evans-Butler discovered when she asked the question: “What did you do before you were a dentist?”

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Winemaker

DR JANE FORMA

Jane fell in love with winemaking after spending her high-school holidays working in the vineyards around Margaret River. This led her to complete a four-year Oenology degree at Adelaide University, followed by four years of working in wineries and travelling overseas.

“It was a magic time, and the lifestyle and travel opportunities were incredible – I did harvests in France, Italy and California and made lifelong friends from all around the world,” Jane recalls.

Winemaking seems a world away from dentistry, but Jane says it was tooth sensitivity that led her to switch careers.

“Wine has a pH of around 3-4, well below the critical pH of enamel,” Jane explains. “During the winemaking degree we had some lectures from the dental school about the occupational hazard of acid erosion and tooth sensitivity from wine tasting. I think this was very forward-thinking as it is critical to educate winemakers about oral health when they are basically guzzling acid for most of the working day!

“I also participated in a research study analysing the effects of acid erosion on young winemakers’ teeth, and after five years my teeth were inevitably showing the effects of constant wine acid exposure – I developed problems with erosion and sensitivity.

I also participated in a research study analysing the effects of acid erosion on young winemakers’ teeth, and after five years my teeth were inevitably showing the effects of constant wine acid exposure – I developed problems with erosion and sensitivity.

“It got to the point where I could barely touch white wine, certainly not chilled. Many of my friends in wine were in the same boat. My housemate did a week of wine-show judging and went to see his dentist just before and after – he came home with fluoride varnish everywhere and funny tubes of 'mousse' for your teeth.

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"He had even been told to not brush his teeth for the entire week and after tasting 100-plus red wines per day, his smile was a hideous black by the end – I was totally fascinated!

“My friend and now colleague, Kate, was a dentist and her passion for it was infectious, and it got me to thinking that maybe I could do something to help myself and others.

With very sore teeth and homesick for WA, my plan was to move back to Perth, see if I could get into dentistry, and then fix all the winemakers’ teeth. And so began my career change to something completely unrelated – my family thought I was crazy.”

It gives you a great appreciation for the importance of teamwork when you’re exhausted and working hard, which I think translates to dentistry and your practice team and culture.

Jane continued to work part-time in wine during the early years of her dentistry degree but had to give it up when the study workload became too much (and her black-stained hands from grape tannins began to startle the patients).

She laughs that she was much more popular at dinner parties as a winemaker, but Jane’s time in the wine industry has also given her some valuable experiences that have been beneficial as a dentist.

“During the grape-harvest period, you work incredibly long hours and often night-shifts with a small team of people – they become your world,” she explains. “It gives you a great appreciation for the importance of teamwork when you’re exhausted and working hard, which I think translates to dentistry and your practice team and culture.

“Also, obviously, life experience in general helps when you’re starting out in dentistry with patient communication, empathy, and generally looking a bit wrinkly from all those night shifts. My awesome forklift and truck driving skills are sadly redundant, but I have my confined spaces ticket for working in tiny dental surgeries!”

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February 2021 Western Articulator

Wine and dental health resource Jane shares that if any of your patients work in the wine industry or are at risk from wine acid erosion or sensitivity, there is a good resource page from the Australian Wine Research Institute titled “Tooth care for wine tasters and wine judges� available at: awri.com.au/industry_support/wine_ and_health/dental-health-wine-tasters/

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Computer Technician DR REBECCA PENCO

It’s no secret that Bec knows her way around a computer – in fact, she’s a regular at ADA House, fixing the ADAWA website and ironing out technical glitches. No surprise, then, that she worked as a computer technician whilst studying her science degree.

“My dad was a huge computer nerd, and I didn’t realise until later on how much more computer literate my brother and I were compared to other people,” Bec recalls. “My dad would teach me how to touch type before I really knew how to spell.”

Strangely enough, it was working as a computer technician that made me realise that I wanted an office job where I worked with my hands.

It was when Bec took her broken Mac to a tech shop that she was offered a job.

“I said: ‘There’s something wrong with my computer – I’ve tried this, this and this to fix it, this didn’t work and this did, so I think it’s this,’ and the guy said: ‘Ok … would you like a job?’

“I started working there part-time, doing largely admin work to start with, but I picked up a lot of knowledge and became the troubleshooting person and eventually was full-time and doing software and hardware repairs. I only gave it up because of the long hours that studying dentistry required.

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February 2021 Western Articulator

“Strangely enough, it was working as a computer technician that made me realise that I wanted an office job where I worked with my hands,” she adds. “Dentistry fit this, with the added bonus of more social interaction!”

As for transferrable skills between the two professions, Bec says her hand skills benefitted from the years of hardware repair work.

“Managing fiddly and delicate components and knowing how to avoid cross-threading screws are common skills between the two jobs,” she says. “Systematic diagnosing is also a skill that translates across – though I’ll admit computers can be a lot more predictable and easier to diagnose than the human body – and of course, computers don’t get scared or anxious.”

Although Bec is settled into her dentistry career, she continues to use her IT skills to help out whenever she can, including at her workplace, Lifetime Dental Care in Como.

“I am the go-to person for things like: ‘My mouse isn’t working,’” she laughs. “I had a day off on Friday and one of the nurses called. I was worried something was wrong with one of my patients, but she said: ‘Can you run me through how to connect the Bluetooth headphones again?’”

Optical Dispenser DR SHANASH BISHNULALL Shanash worked as an optical dispenser for four years during university – ending up in the industry following personal experience.

The most enjoyable aspect was discussing patients’ needs and being able to improve their quality of life.

“I didn’t realise I’d needed glasses for years, and then was amazed at my sight improvement once I’d gotten them,” she says. “I wanted to be a part of the same process for other people and applied to the local Specsavers while I was studying my undergraduate Bachelors. I loved the patient interaction and getting to see patients’ reactions before and after getting their new glasses.

From her experience as an optical dispenser and a close mentorship with the optometrist she worked for, Shanash thought about becoming an optometrist, but in the end was attracted to the surgical aspects of dentistry.

And although she has taken away some skills from the job, dentistry is a completely different experience.

“Being an optical dispenser helped me with communication and managing patients in some ways, but nothing could really prepare me for the real world of dentistry until I started working as a dentist,” she says. “It is a very different level of autonomy and responsibility.”

“The most enjoyable aspect was discussing patients’ needs and being able to improve their quality of life,” she adds.

Shanash celebrating Halloween with colleagues during her optical dispenser days.

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DR AMANDA PHOON NGUYEN Before she was an oral medicine specialist, Amanda began modelling, which led to becoming a fashion photographer and writer.

Fashion Photographer and Writer “This was a long time ago,” Amanda says.

“Street-style photography was massive back then, and I had friends who were starting up fashion labels and businesses that I helped out with. I soon realised I much preferred to be attending events and meeting people, and also, I liked my food. Eventually I made contacts in the style industry and I was on the PR list for several companies.”

Amanda says it grew from there, and she was fortunate enough to meet the owner of a style site who was looking for more photographers and writers, who took Amanda under her wing.

Sometimes there can be a tendency to dismiss fashion as a bit of fluff, but I saw countless people work themselves to the bone.

“I had also been blogging since I was 14 (another big thing back then), so it felt like a natural progression from writing about my life, to writing about the events I was attending, and then to photographing some of the said events. Eventually I also dabbled in writing for a food review website and blog. One of the first affairs I attended was a Bvlgari jewellery preview, and I was in awe. Melbourne Fashion Week each year was also very memorable.”

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Amanda says she enjoyed the clothes and the accessories the most about working in the industry.

“I think most dentists have a creative side,” she adds. “This really fulfilled my more artistic side, and I was able to express myself through what I wore and carried. I also gained a real appreciation for the talent, passion and effort it took to make it in that industry. Sometimes there can be a tendency to dismiss fashion as a bit of fluff, but I saw countless people work themselves to the bone for a love of what they do and what they sell, and I find that very admirable.”

Amanda’s time in the fashion world also helped her develop some skills that have continued to be beneficial.

“I attended many events by myself,” she explains.

“When reviewing restaurants, more often than not, I would also be eating by myself. Although I don’t think I was ever really a very shy person, if there was any element of timidness left in me, it was completely quashed by the sheer number of strangers I had to speak to and interview, and strangers I asked to photograph.

“In a way, that was a great learning experience as I love to meet people and am very comfortable at large events. I also gained some photography knowledge, though I must admit I have now forgotten most of it!”

Dental Assistant and Pharmacy Technician DR CHRIS BARTLETT For Chris, the journey to becoming a dentist took more twists and turns than most.

“I may be the only person crazy enough to study dentistry at UWA twice,” he reveals. “I did three years of the BDSc straight out of high school, starting way back in 1999, back when the Dental School was at PDH rather than OHCWA. “For a multitude of reasons, I dropped out after three and a bit years, and ended up moving to the UK. As dentistry was pretty much all I knew at the time, I ended up falling into dental nursing as it seemed like the sensible thing to do. I sat the nursing examination and got two years of chairside experience to get my qualification over there. Not long after I did so however, I stopped working as a nurse, as a part of me still really wanted to be on the other side of the dental chair.

“I guess my time working as a nurse did galvanise my feelings that I really wanted to be a dentist though – even if at that point I really believed that ship had sailed for me.”

After leaving dental nursing, Chris worked in a computer game shop, and then worked in a hospital pharmacy as a dispensary assistant before he studied to become a pharmacy technician.

Returning to Australia, Chris worked at Fremantle Hospital as a pharmacy technician, before going back to university – where he got a bachelor’s degree before studying dentistry again.

Clearly, Chris’ time as a dental nurse has helped him appreciate the demands of other dental team colleagues. “The thing I learned most from being a dental nurse is the stresses and worries of being on the other side of the chair,” he says. “It’s not an easy job. And I had a boss who was very demanding and particular, so it has guided me to understand how not to treat nurses and other members of the dental team.

I may be the only person crazy enough to study dentistry at UWA twice.

“I also learned how to talk to patients a little better,” he adds.

“I was very shy and quiet as a dental student first time around – having to talk to patients and calm them when they were nervous and the like really helped me when going back.”

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A friend and a mentor When Dr Des Fitzgerald passed away in November, aged 91, he left behind a legacy as a great practitioner and a much-loved tutor. We spoke to family and old friends about his life and contribution to the dental profession

Vale Des Fitzgerald Spending the early part of his career working as a dental technician, it wasn’t until his mid-20s that Des decided to study dentistry – going to night school to matriculate, before being accepted into the university course.

We thought of him as Mr Dentistry because we always held him in such high esteem.

“My assumption as to why Dad chose dentistry after being a technician is that he felt he would be able to do so much more in that position,” Des’ daughter Therese Del Casale says. “Being a technician gave him the confidence to move forward; not that Dad was afraid of taking on challenges.”

Des and his wife Phyllis were married during Des’ final year of Dental School, and after graduating in 1962, Des started his own private practice, where Therese later worked as his dental assistant. “Working with Dad gave me professional training in the art of dentistry and in my position as assistant and receptionist,” she recalls. “I saw his keen eye to detail and his perfectionist nature was ever on show.” Des’ other four children also

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worked with him in some capacity at different times over the years.

Reminiscing over coffee with Drs Gary Davis and Albert Tan, it is clear Des was a respected dentist, tutor, friend and mentor in dental circles.

Gary was a student alongside Des, telling us that Des quickly became known for his good humour. “He was always full of fun, up for a practical joke, good natured and enjoyed socialising,” he says.

Being a decade older than the majority of his cohort by the time he started the university course, Des’ previous experience in the dental industry gave him a headstart, and even in his student days, he had a reputation as being a technical whizz, as noted in the University of Dental Students’ Society magazine, The Matrix: “One of our more mature members, who continually amazes us in matters prosthodontial (sic), with his proud ‘short cuts’, which were volved during pleasant, plentiful hours while serving in the capacity of Qualified Dental Mechanic. Tells us all to try Dental Mechanics to obtain hindsight before the Dental course.”

“He had no trouble with all of that,” Gary laughs.

“We would be struggling to make one set of dentures and he would have done three.”

A large part of Des’ professional life was teaching, lecturing and tutoring at UWA for over 30 years.

The saying, “To teach is to touch a life forever” is definitely the case with Des’ influence on his students.

Periodontist Albert Tan first met Des in his third year of Dental School. He says that initially the students found Des to be quite intimidating as a tutor.

“A fellow classmate Jeff Wheat was about to do an impression and from one end of the clinic, Des yelled: ‘Get it in there! It’s a wash not a bath!’ Jeff was quite put off and went back into the laboratory and said to Des not to ever do that again in front of his patient.

Des shook his hand and said, ‘Ok, well done.’ And from then they became good mates.”

Albert himself had a similar experience: “I remember someone saying to me, ‘Des isn’t bad; if he annoys you, just tell him to piss off.’ One day I was working in the lab and Des was standing behind me and I was feeling very uncomfortable having someone hovering over me.

I asked if anything was wrong and Des said, ‘No.’ So I said in my best jesting voice: ‘Well, piss off then!’ To my great relief, Des roared with laughter and walked off.

“We all eventually figured out his bark was worse than his bite.”

“I remember once we asked: ‘What’s so special about this car, Des, compared to your other one?’ And he said: ‘This one has pig-skin upholstery.’ From that time on, any time any of us bought a car, we used to joke, ‘But does it have pig-skin upholstery?’” he laughs.

“Yes, he was a car freak,” Gary laughs. “He was the only person I have ever known to go and buy two new cars at the same time. He bought two Lancias – one for himself and one for his wife.”

Des would also join the students every Friday night at The Grosvenor Hotel, and then on to The Golden Eagle Chinese Restaurant for a meal, which became a Friday ritual. However, on Monday morning it was back to clinical professionalism at the Dental School.

After the class qualified, Des remained an important part of the lives of his students. After the 10-year reunion, the 1973 cohort (who called themselves the Stomatological Society) decided it was too long to go between drinks, so the reunions were increased to every two years over a weekend, which Des attended whenever he was able.

The class of 1973 even threw Des a surprise party when he retired from the Dental School in 1995.

He was always full of fun, up for a practical joke, good natured and enjoyed socialising.

The banter cemented Des as a friend of the class of 1973, and the cohort thought of him as ‘Mr Dentistry’.

“We thought of him as Mr Dentistry because we always held him in such high esteem,” Albert explains.

“He was practising in St George’s Terrace, lived in City Beach and drove these incredible cars, and we thought he was the epitome of success.

A Des Fitzgerald caricature from The Matrix of 1972.

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“We wanted to acknowledge his service, so we booked a restaurant on the Esplanade and we told Lyle Henderson, who was at the School at the time, to tell Des that the Stomatological Society had an extraordinary meeting. Lyle escorted Des from the Dental School to the venue. His jaw absolutely dropped. As a joke we gave him a walking stick with a bicycle bell and a little pill bottle attached, and he held it with great pride.”

Albert says Des was always a very generous person and incredibly supportive professionally.

“When I specialised, Des was one of the most loyal referrers,” he says. “As soon as I set up practice, Des was a regular referrer of patients and the loyalty from him was just amazing. Des eventually became one of my patients and I was so proud to look after him.”

When posed with the question of what Des gave to the profession, his old friends say he always gave quality to his dentistry.

Des had a reputation as an expert in dentures and anyone who had dental problems would send them to Des to fix them. He was known for his skill to make dentures that patients could eat with, talk with, smile with and be confident.

“Des was particularly good at restorative dentistry,” Albert says. “He was the restorative and the denture king. In those days, a lot of people still had full upper, full lower dentures and we would say if you are having trouble to go see Des. “Technically, he was obviously a very good dentist,” he adds. “That was where we admired him and the fact that if we needed to discuss a case, we could go to him. He was that traditional mentor and had all the old-fashioned values that we identified with. This was important. You can have all the skills and knowledge, but you must apply it in a very ethical and moral way.

That is what you saw in Des. Whatever he did, it was always with the highest ethical standards.”

Des practised dentistry for 45 years and it is clear it was not just a profession but a vocation.

TOP IMAGE: Des with Albert Tan at Des’

surprise retirement party.

MIDDLE IMAGE: Lyle Henderson, Gary Davis, Albert Tan and Des Fitzgerald.

BOTTOM IMAGE: Jeff Wheat, Carol Connor, Des Fitzgerald and Gary Davis.

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Des leaves behind his wife Phyllis, children Therese, Mark, Luke, Catherine and John, his 18 grandchildren and one great grandchild.

Meet

Dr Lee Kaing A regular presenter on the WA Dental CPD calendar in 2021, oral and maxillofacial surgeon Dr Lee Kaing shares the story of her life and fascinating career to date

Oral and maxillofacial surgeon Dr Lee Kaing developed a fascination with surgery early in her dental career, during general hospital rotations.

“I loved observing the surgeons and tried to be involved as much as possible,” she says.

“As an oral and maxillofacial surgery senior house officer in the UK, I truly cemented my passion for oral and maxillofacial surgery. I was fortunate enough to see and participate in oncology resections, neck dissections and flap reconstructions. I made every effort to surround myself and absorb as much experience and information as I could.”

I enjoy being involved with the various aspect of these, like teaching, and the diversity from implants to deformity and trauma.

It is clear Lee continues to strive for as much experience and information as she can. She is currently a staff specialist at Royal Perth Hospital, where she teaches medical students and registrars. Lee also works in private practice as an associate to Dr Carolyn Stulner (WAOMS, South Perth) and Dr Brent Allan (West Leederville).

After graduating from dentistry at the University of Melbourne with honours, Lee worked at Monash Medical Centre in their dental department, gaining experience treating medically compromised patients.

After pursuing overseas experience in the UK as an oral and maxillofacial surgery senior house officer, she started her Bachelor of Medicine and Surgery, alongside her oral and maxillofacial surgery training – balancing medical school with part-time work as a dentist.

“I completed my specialist training in Western Australia, which was challenging due to the gruelling nature of the training and being away from my family,” Lee says.

Her hard work was certainly worth it, as she not only graduated, but received the ANZAOMS medal as the top graduating candidate for the year. She was then fortunate enough to complete her overseas fellowship through Oxford University Hospitals in the UK. With such a busy professional schedule, maintaining a work-life balance is something of a juggling act. “I want to continue to help public patients, as well as maintain private practice. Therefore, I work part-time in both and try to share my time.” Lee explains. “I enjoy being involved with the various aspect of these, like teaching, and the diversity from implants to deformity and trauma, and doing both allows for this.

“And importantly, my family provides that other aspect of balance. I try to come home in time for a hug from my little girl at the end of the day.”

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Every day is different, every patient and every case is different.

Lee loves the multifaceted nature of the work. The drive to achieve the best outcomes keeps her focused and propels her passion about her profession.

She also enjoys the interpersonal aspects, including talking to patients and fellow practitioners, as well as the practical side, including extractions, planning and applying evolving techniques/technologies for implants and orthognathic surgery.

“Every day is different, every patient and every case is different,” she says. “I have forged great friendships and professional relationships with many dentists and specialists.”

Dr Lee Kaing

Which three words best describe you?

It’s hard describing yourself in three words.

However, I would choose “approachable, empathetic and precise”.

What is your favourite book?

Approaches to the Facial Skeleton, but I don’t think that’s what you meant!

I did enjoy Crazy Rich Asians.

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

I enjoy interior design and decorating. I love the detail and the artistic side of design, so perhaps I could have been an interior designer or working with a staging company for homes.

Where is your favourite place in the world?

I really enjoyed travelling in Europe.

Eze (France) was memorable; it was where we started our travels for our honeymoon.

Gorgeous views from the top of a mountain in a quaint little village. But my favourite place will always be home in Australia.

What do you do in your spare time?

I enjoy spending time with my family. My daughter is toddler, so is at a playful age and she enjoys the beach, parks, and exploring the library. In between parenting, I catch up with friends. Life’s pretty simple at the moment outside of dentistry!

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Is there anything people might be surprised to learn about you?

I’m kind of tone deaf and can’t sing, but I will participate in and enjoy some karaoke.

Lee will be presenting alongside oral and maxillofacial surgeon, Dr Frank Chang, at the dinner course ‘Blood and Guts’ in March.The course will cover basic oral surgery principles, including:

Blood and Guts

• A brief outline on patient assessment

THURSDAY MARCH 25

• Setting up for exodontia surgery As well as practical aspects of: • Extraction • Surgical – flap design and how to raise a flap • Management of complications • Odontogenic infection and draining a dental abscess Lee says the course will be beneficial to new graduates who would like to further their knowledge in basic oral surgical principles, and also for more experienced practitioners who would like to refresh their knowledge or hone their skills further. “There will be a particular focus on surgical principles and how they relate to everyday clinical settings in the dental practice,” she says.

Seemingly straightforward extractions can easily devolve into challenging, stressful, and time-consuming situations.

“Attendees will be able to expand their knowledge base with regards to extraction techniques and also gain valuable tips and insight when planning and selecting cases, as well as management of post-operative complications,” Lee adds. “The course will be presented in a simple and logical fashion and will hopefully give attendees the tools to help them manage their cases well, as well as avoiding unwanted or unexpected complications.”

Lee will also be presenting a suturing workshop in May. The course will cover practical aspects in principles of oral surgery including: • Armamentarium • Tissue handling • Suturing – different types of suturing techniques

A Dinner Course on Oral Surgery presented by Dr Lee Kaing & Dr Frank Chang 6:30pm–9:30pm University Club, Crawley

Suturing Workshop Presented by Dr Lee Kaing

SATURDAY MAY 15 9:00am–11:00am University Club, Crawley

“Essentially, the suturing workshop is aimed at revising suturing skills, which is critical for successful surgery,” Lee explains. The course will run through necessary armamentarium and offer information to assist clinicians in fine-tuning their suturing skills.

The hands-on approach will include how to place sutures, different suturing techniques and practical experience on porcine specimens.

“This is aimed at anyone who does suturing in their dental practice, whether they be a new graduate looking for some further knowledge and experience, or a dentist who would like to refresh and update their suturing knowledge,” she adds. “We hope that attendees will feel confident at the end of the course to be able to successfully suture a flap or laceration.”

Lee says oral surgery in a dental practice setting can be challenging. Appropriate case selection and having a sound foundation of basic surgical knowledge is essential to successfully and reliably treat patients and avoid complications.

“Clinicians can find emergency extractions frustrating and daunting sometimes. Seemingly straightforward extractions can easily devolve into challenging, stressful, and time-consuming situations,” she explains.

“Therefore, we would like attendees to have more knowledge and feel more equipped to handle these scenarios and case selection. If in doubt, phone a friend or a local maxillofacial surgeon – we’re here to help.”

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ADAWA's

New Practitioner Program in 2021 When the ADAWA New Practitioner Program was launched in 2020, it was with a simple idea in mind – to assist new and recent graduates to transition from a big cohort in a predicted environment to part of a network of peers.

Comprising five study clubs, held throughout the year – culminating in November’s Young Dentist Conference – the events allow new practitioners to hear from some of the best in the industry and have the chance to ask questions in a safe, supportive setting.

“The truth is, we have all been there, so the point of the program is for new dentists to get to know each other, get to know some of the senior dentists in the profession, the ADAWA and specialists.

When you leave Dental School, you might not be working with your peers and don’t know who to talk to.

Once again, the program is going to be run by last year’s committee, including Drs Sean Archibald, Amanda Phoon Nguyen, Greg Crane and Bec Penco – and they are keen to make the program even better in 2021.

“When you leave Dental School, you might not be working with your peers and don’t know who to talk to,” Amanda explains. “Many new dentists know they want a mentor but sometimes there is a barrier such as hesitation and embarrassment about talking about cases.

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February 2021 Western Articulator

“It is to build their network and talk about topics that we think are relevant,” she says, adding that the program is restricted to practitioners who graduated within the last five years.

“It is a restricted group to dentists who have been practicing for up to five years because we wanted to create a safe space that offers support for newer dentists to talk about anything they want to.”

YOUNG DENTIST CONFERENCE 2020 The New Practitioner Program ended in November with the hugely successful Young Dentist Conference.

The day was co-sponsored by Dental Protection Limited Australia, so had a risk focus.

WHAT’S COMING UP The 2021 study clubs have been confirmed, with a number of great speakers on the list. Each study club will be held on a Friday night, as per the feedback from attendees.

“We always ask for feedback after each session so the new practitioners can tell us what they want,” Amanda says. “We get amazing speakers and cover interesting topics, but we hang out as well on the Friday night – we have some beers, we have some pizza, and we chat about anything. There is a very strong collegiate atmosphere, which is very much what we wanted.”

The committee will be working on options for new practitioners who are based rurally; possibly arranging a study group in a rural location or looking into online options in the future.

The 2021 course schedule From A to Z: Endodontic Clinical Hints and Tips Michael Khoury (Endodontist) 5 Different Versions of the New Patient Experience Sean Archibald Clinical Photography and Laboratory Communication Armand Putra (Prosthodontist) What Kids Want: Tips for General Practice Nandika Manchanda and Lisa Bowdin (Paediatric Dentists)

5 FEBRUARY

14 MAY

9 JULY

10 SEPTEMBER

Young Dentist Conference

13

(speakers to be announced)

NOVEMBER

CPD hours Each evening study group is worth two CPD hours, which you will need to keep your own records for. Those attending the full-day conference will be sent a certificate following the event.

You can book for each study club individually for $25, or book for all four for $80. The full-day conference on November 13 is free. Book for the study clubs at adawa.com.au/cpd

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Geraldton, here we come

The ADAWA Executive team is delighted to announce that we will be in Geraldton on Friday, March 5 and Saturday, March 6

We thought it was time to travel north and meet our dental colleagues practising in Geraldton and surrounding areas. We’d love you to save the date for a social event on the Friday evening and a half-day of CPD on Saturday morning.

While the finer details are still being ironed out, we can tell you that Friday evening’s complimentary social event will be held at The Old Man and the Sea rooftop bar from 5pm to 8pm. Your entire dental team is welcome to attend, but please RSVP by emailing adawa@adawa.com.au

The following day, members of our Executive and WA Federal Councilors will provide engaging and informative lectures at The Gerald from 9am to 1pm.

This CPD event will also be complimentary and open to the entire dental team, including dentists, hygienists, therapists and oral health therapists.

If you’re interested in attending either or both of these events, we’d be grateful if you could let us know in advance by emailing adawa@adawa.com.au, so we can arrange catering.

We look forward to meeting you in March!

David Hallett, Sean Archibald, Amanda Phoon Nguyen, Jenny Ball and Amit Gurbuxani

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February 2021 Western Articulator

$

561 inc GST

The Primary Dentition: Pulp Therapy and Stainless Steel Crown Restorations Presented by Dr Vanessa William

Saturday 20 March 2021 5

CPD Hours Registration from 8.45am, Course 9am to 2pm UWA Dental School, 17 Monash Ave, Nedlands Bookings & Enquiries adawa.com.au/cpd

COURSE OUTLINE The primary molar presents a significant restorative challenge to dentists due to its unique anatomy and characteristics.

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

TOPICS TO BE COVERED: • Pulp Therapy • Stainless Steel Crown Restorations in the Primary Dentition • Hands-On Practical Session Pulpotomy

ABOUT THE PRESENTER Dr Vanessa William is a highly regarded specialist paedeatric dentist in Western Australia.

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Dental

CPD CALENDAR February ASP WA Event Sundowner Thursday 6pm

April 18

June

The Jens Andreasen Memorial Dental Trauma Update

16

WP Paul Abbott AO & Dr Jilen Patel

QT Hotel

Dr Clarence Tam

STPONED

PO Saturday 9.00am–5.00pm

20

UWA Dental School, Nedlands

Posterior Composites Dr Clarence Tam

POSTPONED Sunday 9.00am–5.00pm

21

30

Dr Graham Carmichael & Dr Glen Liddelow

20

Practical Paediatrics

University Club of Western Australia

July

May Dr David Booth & Dr Carolyn Stulner

1

ADA House, West Perth

The Primary Dentition: Pulp Therapy and Stainless-Steel Crown Restorations

20

ADAWA General Meeting Wednesday evening

UWA Dental School, Nedlands

Suturing Workshop

Practical Oral Surgery

Saturday 9.00am–11.00am

Dr David Booth & ED F U L LY B O O K Dr Carolyn Stulner

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Saturday 9.00am–2.00pm CTEC, Crawley

Blood and Guts – A Dinner Course on Oral Surgery

25

Dr Lee Kaing & Dr Frank Chang

Thursday 6:30pm–9:30pm University Club, Crawley

13

Hands-on Extraction Associate Professor Dieter Gebauer & Mr Leon Smith

Stretched Not Stressed

16

24

Saturday: 9.00am–12.00pm ADA House, West Perth

18

Prof Roberto Rossi

RACDS WA Event Top Hacks for Outstanding Dentistry

ADA House, West Perth (Zoom)

More details to come

30

Dr Michael Mandikos

Tuesday 6:30-8:30pm Nutrition for Life

7

CTEC, Crawley Alexandra Hof

ADA House, West Perth

ASP WA Multidisciplinary Approach on Solving Passive Eruption in Anterior Maxilla

ADAWA General Meeting Wednesday evening

Friday 1.00pm–5.00pm

15

Dr Lee Kaing

2

ADA House, West Perth

Thursday 6.30pm–9.30pm University Club, Crawley

Saturday 9.00am–2.00pm

5

Dr Lisa Bowdin

Dr Vanessa William

Dr Graham Carmichael & Dr Glen Liddelow

The Branemark Centre, West Perth

ADA House, West Perth

Princess Crowns & Pirate Teeth – Dinner Course

Restore My First Implant Friday 9.00am–5.00pm

CTEC, Crawley

10

18

UWA Dental School, Nedlands

Saturday 9.00am–2.00pm

ADAWA General Meeting Wednesday evening

Simplified Clinical Endodontics Friday 8.30am–5.00pm

Friday 9.00am–5.00pm

Practical Oral Surgery

March

UWA Dental School, Nedlands

Professor Paul Abbott

Branemark Centre, West Perth

UWA Dental School, Nedlands

Annual ANZSPD Scientific Meeting

Friday 9.00am–4.00pm

ADA House, West Perth

Advanced Single Implants & Introduction to Short-Span Bridges

11

Ms Megan Reilly & Dr Roslyn Franklin

Friday 9.00am–5.00pm

To Prep or Not to Prep

Surgical Aseptic Technique in the Dental Office

21

Ms Julie Meek

Friday 1.00pm–5.00pm ADA House, West Perth 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.

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February 2021 Western Articulator

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.

October

August ASP WA Event Connective Tissue Grafting around Implants and Teeth

17

Tuesday 6:30-8:30pm

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September 4

8

ADA House, West Perth

Dr Keith Doonan

9

Thursday 9.00am–5.00pm ADA House, West Perth

Single Crown Preps: A Hands-on Course

11

Dr Poh Hun Loh & Dr Victor Matsubara

UWA Dental School, Nedlands Professor Peter O’Sullivan

22

17

Friday 1.00pm–5.00pm ADA House, West Perth

Public Holidays

Szabolcs Hant & Dr Graham Carmichael

Labour Day

Monday 1 March

ADA House, West Perth

Good Friday

Friday 2 April

Easter Monday

Monday 5 April

ANZAC Day

Sunday 25 April Monday 26 April

WA Day

Monday 7 June

ADAWA Annual General Meeting Wednesday evening

20

Red, White, Night & Bite

22

ADA House, West Perth

Queen’s Birthday Monday 27 Sept

Albany Entertainment Centre, Albany

November Porcelain Veneers & Ceramic Onlays

5/6

Christmas Day

Saturday 25 Dec

Boxing Day

Sunday 26 Dec

WA School Holidays

Dr Asheen Behari & Dr Paul Gorgolis

Friday 2 April - Sunday 18 April

UWA Dental School, Nedlands

Satday 25 Sept- Sunday 10 Oct

Saturday 3 July - Sunday 18 July

Saturday 9.00am–5.00pm Sunday 9.00am–5.00pm

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

Saturday 9.00am–3.00pm

It’s Not Just About the Spine

ADAWA General Meetings Other CPD Events

Friday 9.00am–4.00pm

CTEC, Crawley

Dealing with Implant Failures

The Art of Digital Photography & its Clinical Applications

Dr Amanda Phoon Nguyen

Saturday 9.00am–2.00pm ADAWA General Meeting Wednesday evening

16

Friday 9.00am–5.00pm

Darwin - more details to come

Dr David Booth & Dr Carolyn Stulner

WA Dental CPD Events

CTEC, Crawley

ADA House, West Perth

Practical Oral Surgery

Dr David Booth & Dr Carolyn Stulner

Saturday 9.00am–2.00pm

Clinical A/Prof Mehdi Valizadeh

ADAWA & ADANT Specialists in Darwin Saturday 9:00am-5:00pm

Practical Oral Surgery

Event Types:

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Friday 17 Dec - Sunday 30 Jan

Dr Albert Tan

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

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Professor Paul Abbott

Friday 8.30am–5.00pm

UWA Dental School, Nedlands

Bookings & Enquiries

Additional event information and online bookings available at adawa.com.au

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

adawa.com.au

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$

616 inc GST

Presented by WP Paul Abbott AO and Dr Jilen Patel

Friday 16 April 2021 6.5 CPD Hours

Traumatic dental injuries occur commonly – especially in young children and adolescents. How confident are you to treat these cases?

Registration from 8.30am, Course 9am to 5pm

This full-day presentation will provide you with an update on the latest information about traumatic dental injuries and how to manage them for the best long-term outcomes.

ADA House, 54-58 Havelock Street West Perth

ABOUT THE PRESENTERS

Bookings & Enquiries adawa.com.au/cpd

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COURSE OUTLINE

February 2021 Western Articulator

Winthrop Professor Paul Abbott AO heads up the Endodontic program at UWA Dental School and helped update the worldwide 2020 Dental Trauma Guideline. Paul is a much-respected international speaker.

Specialist paediatric dentist Dr Jilen Patel is a Senior Lecturer in Clinical Dentistry at the UWA Dental School and Consultant at Perth Children’s Hospital. Jilen received the Dental Association/ Pierre Fauchard Academy’s Young Lecturer Award in 2019 and was as also named the 2019 West Australian Young Achiever of the Year Award, recognising his work in remote Kimberley communities.

Photo courtesy: Dental Trauma Guide

The Jens Andreasen Memorial Dental Trauma Update

Our next general meeting is drawing near - have you registered to attend yet?

Our guest speaker Professor Hien Chi Ngo, Head of UWA Dental School, will present Clinical Management of Dental Caries. This lecture aims to identify important factors that govern clinical success, reviewing possible solutions and demonstrating practical ways of preserving and restoring tooth structure.

Available on Zoom for R3 –R5 country members.

Wednesday 10 March

ADA House

6.15 pm Eat and Meet 7.30 pm General Meeting 8.00 pm Lecture RSVP Wednesday 3 March adawa@adawa.com.au

SELLING OR BUYING A

DENTAL PRACTICE?

HPB Health Practice Brokers offer a dynamic fresh approach to Dental Business Broking in WA Extensive marketing of your practice to ensure the best possible price achieved Clear communication throughout the sales process Exceptional Customer Service Confidentiality assured

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

adawa.com.au

27

Dental Photography: Remember Patient Privacy David McMullen, Special Counsel, Panetta McGrath Photography is an important tool in modern dentistry. Camera technology continues to improve and become more affordable, with impressive results able to be captured on equipment from DSLRs through to smartphones. The options for publishing, sharing and saving digital photos also continue to expand, as cloud technology, social media and communities evolve.

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This technology can and should be embraced, so long as practitioners deploy the right safeguards to protect patient privacy.

information about them in confidence, unless release of information is required by law or public interest considerations.”

Readers may already have an awareness of the ethical and professional conduct reasons to protect patient privacy and confidentiality generally. As stated in the Dental Board of Australia Code of Conduct:

This Code applies to the use and handling of patient photos. The Code, however, does not purport to cover every legal obligation that applies to practitioners, such as those under privacy legislation.

“Practitioners have ethical and legal obligations to protect the privacy of people requiring and receiving care. Patients or clients have a right to expect that practitioners and their staff will hold

There are some important obligations under the Privacy Act 1988 (Cth) (“Privacy Act”) and the Australian Privacy Principles (“APPs”) that apply to dental photography.

February 2021 Western Articulator

Applying the APPs To understand what privacy protections the law requires with regards to your patient photos, consider the circumstances.

WHAT IS THE PATIENT’S EXPECTATION? Begin by looking at the context in which you take patient photos: • What is the purpose of taking the photos? It might be for: diagnoses; treatment planning; monitoring; other clinical purposes; teaching; study; building a portfolio; the patient’s information; medico-legal or audit reasons; communication with third parties such as dental laboratories; specialist referrals; or for marketing and advertising. These are distinct purposes. Although there may be overlap in some cases, this should not be assumed.

• Has the patient consented to your intended purpose, or any other purposes, or even consented at all?

• Would the patient reasonably expect you to use or disclose the photos for a secondary purpose?

You should not take photos that go beyond what is ‘reasonably necessary for, or directly related to’ the functions or activities conducted by your practice: APP 3.1, 3.2.

If you have taken photos on the understanding that this is for clinical purposes only, you must not use the photos for completely unrelated purposes such as marketing or advertising. Or, if your patient consents to their photo being used for teaching or study, this may not extend to sharing your photos with the public at large on social media. See APP 6.1 and 6.2, mentioned earlier.

When providing photos to third parties, ensure that those parties understand the purposes for which those photos are to be used, and restrictions on further disclosure.

Patients or clients have a right to expect that practitioners and their staff will hold information about them in confidence.

Legal protection of privacy The Privacy Act protects personal information, which it defines as ‘information or an opinion about an identified individual, or an individual who is reasonably identifiable …’.

Dental practices are ‘APP entities’ to which the Privacy Act and its 13 APPs apply.

Patient information is personal information protected by the Act and APPs, and to the extent information relates to a patient’s health, it will be classed as sensitive information – which receives a higher level of protection.

• the individual would reasonably expect the APP entity to use or disclose the information for the secondary purpose, and the secondary purpose is related (or directly related in the case of sensitive information) to the primary purpose.

• Before an APP entity discloses personal information about an individual to an overseas recipient, it must take reasonable steps to ensure that the overseas recipient does not breach the APPs (APP 8.1).

• Personal information must be protected from misuse, interference and loss; and protected Of particular relevance for present purposes are from unauthorised access, modification or the following general principles found in the APPs: disclosure (APP 11.1). Once the information is no • APP 6.1, 6.2: If an APP entity holds personal longer needed, reasonable steps must be taken to information about an individual that was collected destroy the information or de-identify it (APP 11.2). for a particular purpose (the primary purpose), the • An APP entity must have a clearly expressed entity must not use or disclose the information for and up to date privacy policy about the another purpose (the secondary purpose) unless: management of personal information (APP 1.3).

• the individual has consented; or

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DO YOU DE-IDENTIFY YOUR PHOTOS? Information that is not about an identified individual, or about an individual who is reasonably identifiable, is not considered ‘personal information’. Properly de-identified information can, therefore, fall outside of the scope of the Privacy Act and APPs.

Whilst convenient, saving photos to these external locations is not just a disclosure of personal information, but potentially an overseas disclosure. So before saving to the cloud, you should investigate where the servers are located, as most popular services rely on overseas servers to some extent.

Whether or not you de-identify your photos may depend on the purpose for which you take them. If they are forming part of the patient record, you will probably not deidentify your photos. If you are using photos for teaching or advertising, however, you may wish to mask the patient’s identity.

But bear in mind that de-identifying must involve more than just cursory measures.

Ensure that if your storage service provider is located or operates overseas, they do not breach the APPs (or see that they are bound by an equivalent enforceable scheme) – otherwise you will potentially breach APP 8.1. Alternatively, proceed without such protections in place only after expressly informing the patient and obtaining their consent to the disclosure.

Before saving to the cloud, you should investigate where the servers are located, as most popular services rely on overseas servers.

According to the Office of the Australian Information Commissioner, information will be de-identified where there is no reasonable likelihood of re-identification occurring. Proper de-identification involves two steps. The first is the removal of direct identifiers. The second is taking one or both of the following additional steps: • the removal or alteration of other information that could potentially be used to re-identify an individual, and/or • the use of controls and safeguards in the data access environment to prevent re-identification.

ARE YOU SAVING PHOTOS TO THE CLOUD? You may be saving photos to a cloud-based location. This may either have been a conscious decision or because you have set up automatic cloud backups (on a smartphone, for instance).

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February 2021 Western Articulator

HOW ARE THE PHOTOS STORED AND PROTECTED? After photos are taken, they must be protected in accordance with APP 11.1.

Consider how you store photos both locally and in the cloud (if applicable), and whether they are protected from – or susceptible – to loss, or access by unauthorised persons.

Whilst your formal practice records may be safely stored onsite, you should ensure that they are backed up (to guard against loss), and secure – particularly if you rely on cloud storage in whole or in part. Bear in mind that if you are carrying patient information on smartphones or laptops, this information should be protected to the same standard.

Protect patient photographs with encryption and/or passwords – particularly when sending them to other parties – and avoid sending photos via unsecured networks.

Have measures in place to destroy or deidentify patient photos once the information is no longer needed. These types of precautions help satisfy the APPs and make your conduct more legally defensible in the event something goes wrong, or there is a complaint. Note that in the event of data breaches that are likely to result in serious harm, there is a mandatory requirement to notify the Information Commissioner and affected individuals – but this outside the scope of this article.

WHAT DOES YOUR PRIVACY POLICY SAY? Having determined how you will meet your obligations under the Privacy Act, review your privacy policy (or implement one if you don’t already have a privacy policy), ensuring that it accurately describes how you handle personal information including patient photos. Privacy policies can become out of date, particularly as new technologies emerge.

CONCLUSION In summary, use photography as part of your dental practice, to its fullest extent. But do not overlook the legal responsibilities that come with the use and disclosure of personal information.

In particular, it is recommended that dentists: • Gain written consent before taking and using photos of patients. This should be in writing and state the intended purpose of all photographs. Ideally, the consent should be signed by the patient prior to photos being taken and kept on their file. Consider having standard legally-sound consent forms for use at your practice.

• Do not use photos outside of the scope to which the patient has expressly consented, unless you are confident it is a secondary purpose allowable under the APPs. • De-identify photos wherever possible.

• Implement a written policy addressing the use of photography and patient consents at your practice.

• Exercise due diligence in how you store and share your digital photos and select cloudbased providers.

• Update your practice’s privacy policy to accurately reflect how you handle personal information, including patient photographs.

© Panetta McGrath Lawyers 2020. 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.

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Recording consultations

“Pay attention, 007” – looking back at old spy movies, it was the cutting-edge technology to conceal a lapel microphone so that HQ could listen in as the evil genius revealed their plans for world domination. Nowadays, we need to consider that most patients entering our rooms carry a potentially much more advanced recording device in their pocket or handbag – a smartphone.

This technology makes it increasingly easy for patients to record conversations whether we like it or not – most phones have a record function and there are also increasingly sophisticated apps designed specifically for recording voice conversations.

What does this mean for dental practice, especially if the idea of having a consult recorded seems invasive, suspicious or threatening?

The first and most important point is to approach this phenomenon with a degree of acceptance. We need to be mindful of the possibility and indeed embrace the fact that if every conversation with a patient might be recorded then this can be an incentive to ensure that we always communicate efficiently, effectively, and compassionately with the wellbeing of our patient first and foremost – patient-centred care.

It is also important to take the patient’s perspective and understand how recording conversations could be beneficial for them. Patients don’t always understand or recall all the information given during appointments, and recordings offer the opportunity for increased engagement and adherence by reviewing the discussions at a more convenient time.

Throw into the mix barriers to effective communication that we encounter in practice every day such as anxiety, cognitive decline, English as a second language and even simple distractions such as the noisy dental environment – then it is easy to see how a recorded conversation could be a significant adjunct to effective communication with our patients.

Additional weight can be given to use of recordings for conversations where the stakes are higher – discussion of complex treatment plans (such as full mouth rehabilitations), procedures with serious risks (such as orthognathic surgery) and where there is an increased potential for an emotional response shutting down the thinking part of the brain (such as giving an oral cancer diagnosis). To this end, apps have been developed in medicine such as ‘Abridge’, which will not only record the conversation, but use AI to transcribe the medical parts, define medical terminology and highlight key points such as medication instructions and follow-up times. This can also give an opportunity for family members or significant others to be involved in the process and facilitate support and understanding, as required.

By Dr Annalene Weston, Dentolegal Consultant at Dental Protection 32

February 2021 Western Articulator

We have until now considered overt recording, but what about covert recording, done without our knowledge? Again, the dental team should always behave in a responsible and professional manner and consequently any recording should provide evidence of that.

for the request. If you agree, you may ask for a copy of the recording so that it can be placed in their dental records. You should verbally date and time stamp the recording and state who is present so it can act as a contemporaneous record.

It is important not to let knowledge that you could potentially be recorded create a sense of distrust or defensiveness towards all patient interactions. At the same time, it is understandable that if you discover, later, that a specific conversation has been recorded, it has the potential to alter the trust base of that dentist-patient relationship, especially if you believe it was done with negative intentions.

It may be important to set some context on the information given, just as you might on something like a written treatment plan – the advice you are providing is based on the circumstances and information you have to hand at that time and may be subject to change as more information becomes apparent.

It is important not to let knowledge that you could potentially be recorded create a sense of distrust or defensiveness towards all patient interactions.

There is a legal component to consider and with Federal and State legislation regulating the making and use of audio recordings, challenging the patient can be a complicated process. Consent and privacy stand as the most obvious issues but also relevant is how the recording is used in terms of sharing with third parties, publishing (such as posting on social media), editing and/or use of selective excerpts of the piece. The legislation is not consistent across all states and territories and should an issue arise then specific advice should be sought based on your individual circumstances.

So, what should you do if a patient asks to record a consultation?

First, be appreciative that they have asked and then consider the reason or intention

If you feel that the recording could be brought to a third party such as another dentist for a second opinion, then it may be wise to acknowledge that different dentists might have different opinions or treatment philosophies, for example, variations in orthodontic opinions and treatment modalities between practitioners.

You need to be mindful that the non-verbal part of the communication will not be captured by the recording, so any diagrams, pamphlets and written plans need to be attached (use the smartphone to take a photograph). You may also need to specifically verbalise parts of the interaction that can’t be conveyed by voice recording alone, such as: “I’m showing Mr Smith a model of a cracked tooth, a pamphlet on RCT and a demo model of a crown.”

In summary, the potential for recorded conversations should not be seen as a threat, but instead a motivation for better communication. If we follow the “as if” rule, as if there is a smartphone with the record button on, this should act as an incentive for efficient, effective and courteous communication with our patients at all times.

Consequently, any overt or covert recording should provide evidence of this.

Reference: www.abridge.com

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Variation to the Health Professionals and Support Services Award 2020 As part of the four-yearly review of modern awards, the Fair Work Commission (FWC) has recently made a number of further significant variations to many awards including the Health Professionals and Support Services Award 2020 (HPSS Award)

These variations include the confirmation of casual overtime and changes to the list of common health professionals listed within the HPSS Award.

ii. Overtime after two hours (double time) will increase from 200% to 250% of the base rate of pay inclusive of casual loading; and

Please note that the changes referred to above are in addition to the annual increase to award minimum rates on 1 July 2020.

iii. Overtime worked on a public holiday (double time and a half) will increase from 250% to 312.5% of the base rate of pay inclusive of casual loading.

1. Changes to Casual Overtime Historically, under the HPSS, overtime for casual employees was calculated in substitution of the casual loading.

However, a decision at the FWC in November this year clarified the application of overtime rates for casual employees across a large number of awards.

From the first full pay period on or after 20 November 2020, overtime for casual employees is calculated according to the compounding method. That is, overtime is now calculated on the employee’s hourly rate of pay, inclusive of casual loading.

This has resulted in an overall increase in overtime rates for casual employees: i. Overtime for the first two hours (time and a half) will increase from 150% to 187.5% of the base rate of pay inclusive of casual loading;

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February 2021 Western Articulator

It very important to note that the HPSS Award prescribed a minimum rate of pay, which is to be afforded to casual employees.

Where a casual employee’s contracted rate of pay already exceeds the HPSS overtime rate, then no overtime penalty is payable unless specifically agreed.

Detailed pay guides are available through the HR Hub. Given the recent amendments to casual overtime, it is important that practices understand when and how overtime rates will be payable. Overtime penalties will apply in the following circumstances: •

Firstly, and most importantly overtime penalty rates only apply to employees who are covered by the HPSS Award.

Award-free employees have no entitlement to overtime penalties;

For further information or assistance in relation to the updated Health Professional and Support Services Award 2020, please contact the ADA HR Advisory Service on 1300 232 462.

•

Any work performed in excess of 10 hours per shift;

•

Any work performed in excess of 38 hours per week or 76 hours in a fortnight (depending on the roster structure adopted); and

•

If, on the instruction of the employer, an employee does not receive a minimum break of 10 consecutive hours off duty between shifts when they work overtime. In this situation a casual employee must be paid at a rate of 250% of the minimum hourly rate applicable to their classification and pay point until they are released from duty.

This update to casual wages also serves as a timely reminder that practices should review their roster structures to minimise the circumstances and frequency in which overtime penalties might be payable, as well as to ensure that rates of pay comply with the HPSS Award.

2. Changes to the List of Common Health Professionals In December, the FWC announced that it had finalised its review into the list of common health professionals covered by the HPSS. Practices will now need to be aware that the following occupations will be included in Schedule B - List of Common Health Professionals: • • •

Dental Hygienist; Dental Prosthetist; and Oral Health Therapist.

These variations will come into effect on 1 July 2021 and will apply to individual employees from the start of the employee’s first full pay period on or after 1 July 2021.

Although it’s common practice that the above occupations are generally paid in excess of the HPSS Award, the effect of having these occupations now fall under the coverage of the HPSS Award means that practices must be aware of award entitlements and rostering practices which may give rise to the obligation to pay additional penalties/entitlements.

In addition, now that such occupations attract other award monetary entitlements such as weekend penalty rates and annual leave loading, practices must ensure that an employee’s salary adequately compensates for all such entitlements.

We recommend that these remuneration arrangements should be reviewed at least annually to ensure compliance with the award minimum wage increases that typically occur on 1 July. This year the FWC annual wage review decision applied a 1.75% increase to the award minimum rates however another announcement will be made next year on the 2021 rate increase.

As always, a bespoke contract of employment is highly recommended and the changes to the HPSS Award presents an excellent opportunity for employees in those professions listed above to be reviewed to ensure that the rostering and salary structures are compliant, but also that a suitable contract of employment is in place to ensure that the remuneration paid is compliant with the HPSS Award or clearly reflective as incorporating all such entitlements.

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I Am, I Will, Together All Our Actions Matter

WOR LDCANCERDAY. ORG Written by Drs Alissa Jacobs, Jacinta Vu, Amanda Phoon Nguyen and Lalima Tiwari

World Cancer Day every 4 February is the global uniting initiative led by the Union for International Cancer Control (UICC). 2021 – the ultimate year of the ‘I Am and I Will’ campaign – shows us that our actions have an impact on everyone around us, within our neighbourhoods, communities and cities. And that, more than ever, our actions are also being felt across borders and oceans.

Together, our actions matter. We hope you find this article on oral cancer helpful.

Cancer of the oral cavity and oropharynx is a significant health burden, with over 300,000 new cases diagnosed annually. In 2020, it is estimated that head and neck cancers (with lip) when grouped together, were the 7th most commonly diagnosed cancers. It is estimated that over 5,168 new cases of head and neck cancer (with lip) will be diagnosed in Australia (about 3,721 males and 1,448 females), in 2021.

About 95% of all oral cavity tumours are squamous cell carcinomas, which is a malignancy arising from the squamous cells which line the oral cavity. Other less-common types of oral cancer include tumours of the salivary glands, lymphoma, odontogenic tumours, sarcomas, and oral mucosal melanoma.

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February 2021 Western Articulator

Oral squamous cell carcinoma (OSCC) is mostly preceded by lesions termed oral potentially malignant disorders (OPMDs) that have a high tendency for malignant transformation. OPMDs include oral leukoplakia (homogenous, nonhomogenous, proliferative), erythroplakia, oral lichen planus, oral submucous fibrosis, actinic cheilitis and chronic hyperplastic candidosis.

The risk of malignancy for these conditions may vary depending on several factors but has been estimated to be five to 100 times greater than in the general population.

Despite advances in diagnosis and treatment modalities, the survival rate of OSCC has not changed significantly in the last five decades.

Clinical outcomes for patients with oral cancer

are significantly affected by their TNM classification and staging (Stage I-IV) at diagnosis, with poorer outcomes associated with higher stages. The poor prognosis of oral cancer can largely be attributed to its frequent diagnosis at an advanced stage, and as such, a strong emphasis is placed on early detection and early diagnosis. As dentists, we are appropriately positioned to provide opportunistic screening for oral cancer and OPMDs during a patient’s dental visit. Any findings at this stage will ideally allow for active intervention before progression to malignancy.

The risk of malignancy for these conditions may vary depending on several factors but has been estimated to be five to 100 times greater than in the general population.

It is important to recognise that clinical signs and symptoms for oral cancers are heterogenous; varying from mixed red-white lesions, submucosal swellings, persistent ulcers or indurated, fixed mass. Early lesions can be painless, while late symptoms can be associated with pain, discomfort, and limitation in function. As a rule, any oral cavity lesion, which fails to resolve in two to three weeks, should raise the suspicion of the treating clinician. Further suspicion should also be raised if the persistent lesion has increased in size.

Figure 1 outlines common clinical signs and symptoms for oral cancer and OPMD.

‘Red flag’ features of oral mucosal disease • • • • •

oral ulcers that have lasted for more than 2 weeks oral ulcers that recur nontraumatic oral ulcers in children pigmented lesions on the oral mucosa red, white or mixed red and white lesions on the oral mucosa of unknown origin or with features of potentially malignant disease, such as: • induration • ulceration with rolled margins • fixation to underlying tissues • lesions in high-risk sites (eg. lateral tongue, floor of mouth) • facial or oral paraesthesia • persistent oral mucosal discomfort with no obvious cause • lumps or swelling, including lymphadenopathy

• swelling, pain or blockage of a salivary gland, suggestive of salivary gland disease • suspected allergy or adverse reaction to dental materials (eg. oral lichenoid lesion) • dry mouth that is not adequately relieved with artificial salivary products and nonpharmacological methods • dry mouth caused by systemic disease • suspected oral manifestations of systemic disease (eg. syphilis, Behcet syndrome, HIV, inflammatory bowel disease, lichen planus, pemphigoid) • lesions occurring in immunocompromised patients (eg. patients with neutropenia or HIV infection)

Figure 1: Therapeutic guidelines - Oral and dental, Version 3. Melbourne: Therapeutic Guidelines Limited 2019

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Early Side Effects of Therapy TISSUE

EFFECTS

Oral mucosa

Mucositis Ulceration Secondary infection

Salivary glands

Hyposalivation Changes in consistency, composition and quality

Taste buds

Decreased activity Cariogenic diet

Skin

Radiation burns Erythema and desquamation Scarring

Pharynx/ Larynx

Dysphagia Odynophagia Dysphonia

Muscles

Fibrosis and scarring

Figure 3. Adapted from Reuther, Vissink, Epstein, Giro

Late Side Effects of Therapy TISSUE

EFFECTS

Oral mucosa

Radiation mucositis Decreased ability to heal Atrophy

Salivary Glands

Hyposalivation Glandular malignancy (potential)

Taste buds

Loss of taste

Skin

Dermatitis Alopecia Erythema Cutaneous malignancy (potential)

Bone

Osteoradionecrosis Retardation of bone growth (paediatric) Decreased bone density Osteosarcoma (potential)

Teeth

Radiation caries Dental erosion

Periodontium

Periodontitis

Muscle of masticatory

Fibrosis and scarring trismus

TemporomanRadiation or surgical trismus dibular joint Figure 4. Adapted from Epstein, Hopewell, Probert, Tucker, Vissink

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February 2021 Western Articulator

Non-Homogenous Leukoplakia involving the floor of mouth

Traditionally it was older men (> 60 years) who smoked and drank heavily who were most often affected by OSCC. Smoking and drinking alcohol remain significant risk factors, and cessation of these habits will decrease the chance of developing OSCC. However, everyone, regardless of age, gender or known risk factors, is in danger of developing oral cancer. The incidence of OSCC (particularly the tongue subsite) amongst younger age groups (< 45 years), and particularly younger, Caucasian women is increasing. A majority of these patients do not have the typical risk factors; screening every patient for oral cancer is essential.

Squamous cell carcinoma of the right lateral-ventral tongue

Oral Cancer Risk Factors Modifiable

(behavioural)

Non-Modifiable

(sociodemographic)

TOBACCO SMOKING

SOCIOECONOMIC STATUS (LOWER)

ALCOHOL

GENDER (MALE)

SMOKELESS TOBACCO - ARECA /BETEL NUT

AGE (OLDER)

HPV/SEXUAL BEHAVIOURS

FAMILY HISTORY OF CANCER

ORAL HYGIENE

Figure 2. Risk Factors for Oral Cancer (Mathur, Dholam)

Factors such as poor oral hygiene, poor nutrition, exposure to environmental carcinogens and a family history of cancer have also been associated with an increased risk of oral cancer.

Whilst the survivorship of OSCC is comparatively low when paralleled to other cancers, the morbidity associated to such survivorship is high. Morbidity of oral cancer treatment may be related to surgery, radiotherapy, chemotherapy and other treatment related factors, including dental extractions and complications peri-treatment, (Figure 3 & 4).

As Aristotle so eloquently said: â&#x20AC;&#x153;The whole is greater than the sum of its parts.â&#x20AC;? Acting together, fulfilling our role correctly as oral health professionals as the health professionals best suited to screen for oral and oropharyngeal malignancy, we will reduce the incidence of oral cancer and we will together, improve survival rates.

I am a dentist, I will screen my patients, together we will reducing the impact this insidious disease has on our patients.

All our actions matter.

References available via admin@pomds.com.au

POOR NUTRITION

There are, however, certain factors that increase the risk of oral cancer, outlined in Figure 2.

Areca/betel nut chewing, with or without tobacco, is a significant risk factor. While not as implicated in oral cavity squamous cell carcinoma, the human papillomavirus (HPV), which can be sexually transmitted, has a causative role similar to cervical cancer, in oropharyngeal cancers, such as those affecting the base of the tongue, tonsils and throat.

Suspected osteoradionecrosis and osteomyelitis in a patient who was treated with surgical resection and chemoradiation for a T4aN0M0 (AJCC 7th Edition) squamous cell carcinoma of the right hard palate.

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GOOD NEWS STORIES Graduation Congratulations to the graduating class of 2020! After such a challenging final year, you should all be very proud. We cannot wait to see what you achieve.

Graduate seminar at ADA House ADAWA CEO Dr David Hallett held a seminar at ADA House for graduating UWA Dental School students to discuss health funds, record keeping and item numbers.

Photo courtesy: Pyay Chan, Eye Candy

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February 2021 Western Articulator

Professional Notices

Transition to Practice Following the graduate ceremony, ADAWA welcomed the graduating class of 2020 to the profession at a dinner held at The Melbourne Hotel.

The evening was not only a celebration, but an opportunity for the new graduates to get to know others in the dental profession.

Fluoridation roll-out for South-West communities Good news for the teeth of our South-West patients – Bunbury and Dalyellup is set to have fluoridated drinking water on tap by 2023.

Dr Gaurav Vasudeva

Dr Lisa Bowdin

THE ENDODONTIC PRACTICE Specialist Endodontist

FIRST SMILES Paediatric Dentistry & Orthodontics

BDS, MDS, MEndo RCSEd

Specialist Paediatric Dentist

Dr Gaurav Vasudeva is delighted to announce the opening of his new Endodontic practice. He will be accepting referrals from Jan 2021.

BDSc, DClinDent (Paed), MRACDS (Paed)

811 Canning Highway Applecross WA 6153 T (08) 6118 4567 E info@endopractice.com.au W endopractice.com.au

Dr John Winters and Dr Siva Vasudavan are delighted to welcome Dr Lisa Bowdin to the First Smiles team in South Perth. Dr Bowdin is accepting referrals for all aspects of specialist paediatric dental care.

Suite 7, 38 Meadowvale Ave South Perth WA 6151 T (08) 9367 9277 E hello@firstsmiles.com.au W firstsmiles.com.au

WA’s Chief Health Officer, Dr Andrew Roberton says it is an important milestone for the communities.

“Fluoridation is an important preventative health measure that improves the oral and overall health of populations,” he says.

“Poor oral health can affect an individual’s ability to sleep, eat and speak and is also associated with a range of medical conditions such as heart and lung infections, cardiovascular disease and rheumatoid arthritis.

“So improving oral health in these communities will go a long way to lifting the oral health and wellbeing of residents, particularly children.”

Dr Christophe Duigou IMPRESSION ORTHODONTICS Impression Orthodontics is delighted to announce Dr Christophe Duigou has joined the team in our Ellenbrook practice.

Dr Duigou is accepting all referrals for all aspects of Orthodontic care.

Dr Nida Khan CLASS 1 ORTHODONTICS BDSc (Hons) (Qld), DClinDent (Ortho) (Adel), MRACDS (Orth)

Dr Chris Orloff and the team at Class 1 Orthodontics are pleased to announce that Dr Nida Khan has joined the team and will be practising out of West Perth and Cockburn.

56 Mornington Parkway Ellenbrook WA 6069 T (08) 9297 6823 E reception@ impressionorthodontics.com.au W impressionorthodontics.com.au

T 1300 922 722 E prm@class1ortho.com.au W class1ortho.com.au adawa.com.au

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Dr Camile S. Farah

Dr Ken Wan

Dr Dayea Oh

Specialist in Oral Medicine and Oral Pathology

Oral and Maxillofacial Surgeon Head and Neck Cancer Surgeon

BDSc, MDSc (OralMed OralPath), PhD,

MBBS (1stHons), BDSc (Hons),

GCEd (HE), GCExLead, MBA, MAICD,

FRACDS (OMS)

AFCHSM, FRACDS (OralMed), FOMAA,

West Perth Oral & Maxillofacial Surgery and Kings Park Day Hospital are pleased to announce that Dr Ken Wan joined the practice and hospital on the 4th of November 2020. He is the only maxfacs surgeon in WA with formal micro-accreditation to perform head and neck cancer, free flap reconstructive and salivary gland removal surgery.

Oral and Maxillofacial Radiologist Dr Oh, oral and maxillofacial radiologist, has joined Clin Prof Bernard Koong and Dr Tom Huang at Envision Medical Imaging.

FIAOO, FICD, FPFA, FAIM

Dr Farah is pleased to announce the opening of The Oral Medicine Clinic at Hollywood Medical Centre. Dr Farah is a dual registered specialist in oral medicine and oral pathology and is accepting referrals for all aspects of oral medicine and clinical oral pathology including oral cancer and precancer, oral mucosal lesions, medically complex patients, bone and salivary pathology, and orofacial pain and TMD. THE ORAL MEDICINE CLINIC Suite 24, Hollywood Medical Centre Entrance 5, 85 Monash Ave, Nedlands WA 6009 T (08) 6116 8108 E admin@oralmedpath.com.au W oralmedpath.com.au

His interest is in oral pathology, oral cancer and free flap reconstructive surgery but also accepts referrals for general oral surgery.

WEST PERTH ORAL AND MAXILLOFACIAL SURGERY T (08) 9322 7363 F (08) 9322 7021 E reception@wpoms.com.au

She is also Senior Lecturer at the UWA Dental School.

Dayea is available to assist with all aspects of dental, oral and maxillofacial radiology.

WEMBLEY 178-190 Cambridge St Wembley WA 6014 T (08) 6382 3888 E bookings@envisionmi.com.au BOORAGOON 175 Davy Street Booragoon WA 6168 T (08) 6382 3888 E bookings@envisionmi.com.au

New Practice Announcement Dr Janice Kan, Dr Thomas Elliott and Dr Armand Putra are pleased to announce the opening of their new practice in Midland from February 2021.

We look forward to supporting your patients with their prosthodontic needs in both our South Perth and Midland practices.

CENTRE FOR PROSTHODONTICS - MIDLAND Suite 7, Midland Specialist Centre 81 Yelverton Drive, Midland WA 6056 T (08) 93680888 E info@centreforpros.com.au W centreforpros.com.au

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February 2021 Western Articulator

Professional Notices Centre For Prosthodontics

New Practice Announcement

Perth Prosthodontics is excited to announce our change of name to the Centre For Prosthodontics.

PAEDIATRIC DENTAL SPECIALISTS Dr John Camacho and Associate Professor Robert Anthonappa are delighted to inform all our friends and colleagues that we have recommenced seeing patients and new referrals at our new clinic located in the Southbank Specialist Centre, South Perth.

Our primary focus remains on Reconstructive, Aesthetic, and Implant dentistry.

Perth Oral Medicine & Dental Sleep Centre Perth Oral Medicine and Dental Sleep Centre is excited to announce the opening of a new clinic in Padbury. We are now accepting new referrals.

Unit 5, 6 Blackwattle Parade Padbury 6025 T (08) 9376 6789 E padbury@pomds.com.au

Whilst there is no change to our practice phone number and address, please note there is change to our website and email address.

Suite 3, Southbank Central, 38 Meadowvale Avenue, South Perth WA 6151 T (08) 93680888 E info@centreforpros.com.au W centreforpros.com.au

Feel free to contact our reception on the details below if you would like any business cards and referral pads sent to your clinics, or if you have any queries regarding referral of patients for us to see.

Suite 2, 38 Meadowvale Ave South Perth 6151 T (08) 6184 7145 E admin@pdswa.com W pdswa.com

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Wayne Young Sales & Project Manager 0417 948 121

17A Wheeler Street, Belmont WA 6104 • Phone (08) 9479 3244 • Fax (08) 9479 3255 • Email sales@westcoastdental.com.au