Western Articulator - October 2020

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A FAMILY PRACTICE The ADAWA members who work with family


Defamation risks in the age of social media

HELP YOUR PATIENTS QUIT New training from Cancer Council WA

Professor Hien Ngo Meet the new Head of School, Dean of UWA Dental School and Director of the Oral Health Centre of Western Australia adawa.com.au


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contents 4



CEO’s Comment

Education and Training

World Cavity-Free Future Day



Joint Statement on Protecting Children from Unhealthy Food and Drink Advertising on State-Owned Assets

WA Dental CPD Calendar



DPL Feature Human factors in error

A Family Practice The ADAWA members who work alongside family


12 A New Beginning Meet the new Head of School, Professor Hien Ngo

14 CPD Spotlight Dr Mark Johnstone

Legal Feature Defamation risks in the age of social media

24 ADA HR Feature Finding, recruiting and keeping the right staff

30 Help Your Patients Quit Smoking Free online training for WA oral health professionals

31 Opinion Piece By Josephine Drewett

32 WADA Golf

34 Professional Notices

26 Clinical Feature Clinical cases in oral medicine

October 2020 Western Articulator | adawa.com.au



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

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 by email. Advertisements received after the due date cannot be guaranteed to appear in that issue.

CEO’s Comment On September 7, 2020, all Western Australian MPs were sent a statement signed by WA’s leading non-government health agencies and associations, including ADAWA. The statement calls for an immediate ban on the advertising of unhealthy foods and drinks on State-owned assets, with no exceptions.

There is substantial evidence that unhealthy food advertising influences children’s food preferences and consumption and is a likely contributor to overweight, obesity and dental disease.

Please supply display advertisements as a high-resolution 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.

Cancer Council WA CEO Ashley Reid said outdoor advertising was a particular concern as it is the only medium that cannot be turned off, and directly undermines the Government’s preventative health priorities.

ISSN 2207-9351 (Online)

“No jurisdiction around the world has implemented a comprehensive ban on advertising for unhealthy food and beverages in public spaces or on publicly owned assets – WA has the chance to be a world leader,” Mr Reid said.

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.

Get Social Australian Dental Association WA @adawaoralhealth @adawa_perth Australian Dental Association WA


October 2020 Western Articulator | adawa.com.au

It is implausible that the State allows their assets to be used to promote unhealthy food and drink choices, particularly to children, whereby the consumption may lead to adverse health outcomes and ultimately negatively impact the State’s health system. ADAWA is proud to be a signatory to the Joint Statement.

The winners of the recent ADAWA member survey competition are: Dr Kay Naicker • Dr Jason Yapp Dr Clare Chantler

JointStatement Statementon onProtecting Protecting Children Joint Children fromUnhealthy UnhealthyFood Foodand and Drink Advertising from Drink Advertising onState-owned State-Owned Assets on Assets September 2020 7 7September 2020 Theundersigned undersigned public andand medical organisations support an immediate ban on advertising of unhealthyof food The publichealth health medical organisations support an immediate ban on advertising and drinksfood on State-owned with no exceptions. unhealthy and drinksassets, on State-owned assets, with no exceptions.

Priority should given to public transport and transport public transport waiting areas,sporting children’s Priorityfor for removal removal should bebe given to public transport and public waiting areas, children’s events, sporting events, and venues where families gather; but should also include facilities and settings and venues where families gather; but should also include facilities and settings that fall under State and Localthat fall under State and Local government such as hospitals, schools, sports facilities Government jurisdiction such as hospitals, jurisdiction museums, schools, sports facilitiesmuseums, and healthcare services. and healthcare services. This statement is in line with the recommendations made in the WA Health Promotion Strategic Framework 2017-

This statement is in line with the recommendations made in the WA Health Promotion Strategic 2021¹, the WA Preventive1 Health Summit 2019 Summary Report², the Final Report of the Sustainable Health Review Report of Framework 2017-2021 , the WA Preventive Health Summit 2019 Summary Report2, the Final 2019³, the Food Policy Index Progress Update 2019⁴ and the World Health Organization’s Set 3 4 of Recommendations on the Sustainable Health Review 2019 , the Food Policy Index Progress Update 2019 and the World Health the marketing ofSet Foods and Non-Alcoholic Beverages to Children⁵.of Foods and Non-Alcoholic beverages to Organization’s of Recommendations on the marketing Children5. The WA Government has shown strong leadership in keeping Western Australians safe from the health and economic impact COVID-19. International has emerged indicates that overweight andsafe obesity may behealth a risk The WA of Government has shown evidence strong leadership inthat keeping Western Australians from the and economic impact of COVID-19. International evidence has emerged that indicates that overweight factor for becoming seriously ill with COVID-19.

and obesity may be a risk factor for becoming seriously ill with COVID-19.

The need for action on halting the rise in overweight and obesity is more urgent than ever.

The need for action on halting the rise in overweight and obesity is more urgent that ever.

Ashley Reid - CEO

Prof Jonathan Carapetis - Director

Megan Sauzier - Executive Officer

Hannah Pierce - WA Branch President

Dr David Hallett - CEO

A/Prof Christina Pollard - Director

Andrew Wagstaff - CEO

Sarah Fordham - CEO WA

Dr Andrew Miller - President

BACKGROUND TO JOINT STATEMENT International reviews of large studies have concluded that food marketing has an influence on children’s nutrition knowledge, preferences, purchase behaviour, consumption patterns and diet-related health. The recommendations from these studies have been to implement policies which restrict or prohibit unhealthy food and drink promotions to children. Recent data from the World Cancer Research Fund showed children’s exposure to unhealthy advertising is directly linked to an increase in energy (kilojoule) consumption, which illustrates the strength of advertising on influencing food choices. Companies are currently using Western Australian Government property as a mechanism to market and boost sales of unhealthy food, alcohol and drinks. While this may be good for industry profits, it’s bad for the rest of us. There are serious health and social costs to Western Australians associated with their consumption. Advertising these products should be prohibited on State-owned assets, to support broader obesity prevention and alcohol-related harm strategies. Further evidence informing our position at this time includes: •

Outdoor advertising is a powerful form of food marketing around metropolitan schools, with 74% of outdoor food advertising within 500m of Perth schools being for unhealthy (non-core) foods. Perth primary schools were found to have an average of 25 outdoor food advertisements within 500m of the school boundary, secondary schools had 22 and K-12 schools had 41⁶.

Of concern is new evidence that Perth schools located in disadvantaged areas have a significantly higher proportion of total food ads, unhealthy food ads and alcohol ads (but not healthy food ads) within 250m compared to schools located in more advantaged areas⁷.

State revenue from total food advertising on Department of Transport sites is $1 million per year⁸. Policies to remove unhealthy food advertising implemented in other states and international jurisdictions have not had a negative impact on government revenue which has either remained stable⁹,¹⁰, or increased¹¹.

Only placing controls on unhealthy food and drink advertising around schools will be ineffective given the exposure children experience on their whole school journey, including school buses, as well as exposure at other community and sporting events that attract children¹²,¹³,¹⁴.

The COAG Health Council National interim guide to reduce children’s exposure to unhealthy food and drink promotion¹⁵ was developed specifically to outline what food and drinks were unhealthy and should not be advertised in government settings.

By 2026, the cost to the WA health system from obesity-related hospital admissions are estimated to reach $610 million a year if the State cannot halt the rise of obesity.

Contact ObesityPolicy@cancerwa.asn.au for any queries.

1. https://ww2.health.wa.gov.au/-/media/Files/Corporate/Reports-and-publications/HPSF/WA-Health-Promotion-Strategic-Framework-2017-2021.pdf 2. https://www.healthywa.wa.gov.au/-/media/Files/HealthyWA/New/WA-Preventive-Health-Summit/Summary-report-key-themes.pdf 3. https://ww2.health.wa.gov.au/Improving-WA-Health/Sustainable-health-review/Final-report#:~:text=The%20Sustainable%20Health%20Review%20 Final,shift%20across%20the%20health%20system. 4. https://globalobesity.com.au/2019-food-policy-index-progress-update/ 5. https://www.who.int/dietphysicalactivity/publications/recsmarketing/en/ 6. Gina Trapp “Junk-food-filled neighbourhoods – building the evidence base for change” from www.telethonkids.org.au/projects/junk-food-filled-neighbourhoods/ 7. Gina Trapp “Junk-food-filled neighbourhoods – building the evidence base for change” from www.telethonkids.org.au/projects/junk-food-filled-neighbourhoods/ 8. Western Australian Parliamentary Debates (Hansard). Fortieth Parliament First Session 2020. Legislative Council. 13 February 2020. 9. https://www.cityservices.act.gov.au/__data/assets/pdf_file/0008/782306/TAMS-Annual-Report_Volume-1_WEB.pdf 10. https://www.cityservices.act.gov.au/__data/assets/pdf_file/0018/1113444/170908-TCCS-Annual-Report-2017-Vol-1.pdf 11. http://content.tfl.gov.uk/tfl-annual-report-2019-20.pdf 12. Talati, Z., Sartori, A., Hart, E., (2020). Food advertising on school buses. WA Cancer Prevention Unit (WACPRU), Curtin University, Perth. 13. https://www.cancercouncil.com.au/blog/next-step-tackling-childhood-obesity-removing-junk-food-advertising-school-trip/ 14. https://www.opc.org.au/media/media-releases/opc-calls-for-removal-of-unhealthy-food-marketing-on-public-transport-to-protect-kids.html#_ftn1 15. https://www.coaghealthcouncil.gov.au/Portals/0/National%20Interim%20Guide%20to%20Reduce%20Children%27s%20Exposure%20to%20 Unhealthy%20 Food%20and%20Drink%20Promotion.pdf


A family practice The old adage that the apple doesn’t fall far from the tree certainly seems to hold true in dentistry, with so many ADAWA members working alongside their family by Brooke Evans-Butler

Family It’s all in the family at Warwick Family Dental Care, with practice principal Dr Peter Brooke working alongside his practice manager wife Sharon, associate dentist son Hayden and receptionist daughter Rosalie. After purchasing the practice in 2003, Peter says Sharon was happy to take a break from her secondary science teaching career to relieve him of the administration so he could concentrate on the dentistry side of the business. “It involved a very different skill set from teaching and she had to master book-keeping and human resource practice management from day one by being thrown in the deep end,” Peter says. “I was keen for Hayden to get a broad exposure to different practice styles after he graduated and, luckily, I was always able to dovetail his work at Warwick Family Dental Care, in with positions he held at other practices. This has been a good approach because he has had the benefit of my mentorship and I have also learnt new dental techniques from him.

The Brooke family

The advantages “Similarly, we have been able to dovetail Rosalie’s reception work in with her tertiary study timetable. She is learning communication and patient management skills that she will find useful in her future life.”

Peter says that in the beginning, when he and Sharon were busy parents of young children, it was good to have the opportunity to see each other and communicate during the day whilst the kids were at school. September 2020 Western Articulator | adawa.com.au



“Flexibility of work hours is another advantage, which is not always possible with other employees that require a more rigid work routine,” he says. The HR principle of cultural alignment is an important factor in good employees, and this is usually wellestablished with members of your own family. “Family members usually have an inherent investment in the success of the business and have an appreciation of the critical aspects of the business,” he explains. “They are also empathetic to pressures and stresses that I may encounter from time to time.”

The challenges “My other employees are just as valued members of staff and it is important to demonstrate in my actions that family members do not get special favours and we are in no way nepotistic,” Peter says. “Disciplining my family members at work is thankfully a quite rare event, but I think they understand that it has to be done on occasions and I try not to be unreasonable in my demands.” When it comes to the challenge of leaving work at work, Peter says he tries to avoid work conversation at home. “When I unintentionally start talking about work to my wife, I jokingly ask myself: ‘Am I being paid to think about this now?’, and this quickly puts a stop to it.

“Sometimes Hayden and I will discuss cases just to unwind a bit and let off steam. I think this is normal.”

Deepali and Jordan

Their advice When asked for his advice to other families considering working together, Peter says to enjoy it. “Not everyone is fortunate enough to be able to see and work with members of their family on a daily basis – ask any FIFO worker,” he says. “Enjoy the chance to see and interact with them on a daily basis and keep in touch with what is happening in their lives.” He says the same principles of mutual respect and tolerance that makes for a successful family life can be translated into a successful working relationship with family members. “Finally, don’t take it too seriously,” he adds. “You work to live, not live to work.”

Partners While it may not suit all married couples, for husband and wife team, Drs Deepali Mistry and Jordan Behar from Golden Bay Dental Clinic, working together is perfect. Deepali says she and Jordan have been working together for the last six years. “We co-owned our practice before the pressures of parenthood helped us to decide to sell the practice,” she recalls. “We still both work at the practice as contracted dentists.”

The advantages Deepali says they are a family practice, live locally and (in Jordan’s case) have been treating their patient base for the last 10 years. “We’ve watched families grow and patients have seen our family grow,” she says. “We recognise and are recognised by many of our patients out in the community, and a shopping trip can be a nice social outing! It is nice to


October 2020 Western Articulator | adawa.com.au


know we have each other in the practice, that we can bounce off each other and have somebody else that we implicitly trust.”

Siblings and partner

The challenges Although many try not to “talk shop” at home, Deepali says she and Jordan do talk about work after hours. “I guess it is a good counsel for us being able to discuss the issues without having to explain them,” she explains. “Conversely, when one of us is having a day off, we have to be prepared to talk about work still, so it can be hard to switch off when one of us is at home. “The other issue is that if we wish to book a holiday, we are leaving the practice with two dentists down,” she adds. “As former owners, we understand the implications of this from a business sense and from an access to care sense for our patients.”

Their advice To other couples considering working together, Deepali says the positives outweigh the negatives. “You save money on petrol! And we’re in a career where we’re pretty holed up in our own space all day, so you don’t tend to get under each other’s feet in the working environment.”

It’s a family affair at WA Dental Ellenbrook – with brothers Dr Sven Nalder and Dr Marc Nalder working alongside Marc’s dentist wife, Dr Lesley Moffat. Sven and Marc were living together in 2015 and decided if they could live together, they could work together. Later that year, they started up WA Dental in Ellenbrook and say that five years later, they are still best friends.

The advantages Lesley says a great advantage of working together is that they all have their areas of special interest (with Sven their implant dentist, Marc their orthodontic dentist and Lesley their children’s dentist). “This allows for internal referrals to create a one-stop clinic for our Ellenbrook patients,” she explains. “Working together has strengthened our bond as a family as we now spend a lot more time together, both while at work and home,” Lesley adds. “We are able share the stresses of running a dental practice while also benefiting from the flexibility of having each other to rely on.”

Sven, Lesley and Marc October 2020 Western Articulator | adawa.com.au



“Working together has strengthened our bond as a family as we now spend a lot more time together, both while at work and home.” The challenges

“Misagh has also always been so accommodating of my work availability being around my family’s circumstances,” Sahba adds. “I have always been able to be there to pick up my kids at the end of their school day. “From a clinical perspective, there have been advantages too. Our work complements each other’s. Misagh is able to do the surgical aspect of implant and cosmetic procedures for my patients at an exceptionally high standard. Knowing each other so well both professionally and personally has made this process quite seamless.”

Lesley says one of the main challenges of working together is balancing their work and personal lives. “Sven and Marc find it very difficult to talk about anything other than teeth and the business when we are away from work,” she says. “Sven has a two-yearold and is expecting a baby in a few months, and Marc and I have newborn twins. Sharing time with our young families while also managing the demands of a dental practice can be difficult, but we make it happen!”

The challenges

Their advice

Likewise, Sahba says there have been no challenges caused by working together. “There has never been rivalry or competitiveness between us. I really don’t think there

“Trust and good communication are key to successfully working together and maintaining healthy relationships,” Lesley says.

Although many think competitiveness comes into play when working with a sibling, Misagh says this has never been a challenge working with Sahba.

Siblings Siblings Drs Misagh Habibi and Sahba Habibi-Thomas began working together at NewSmile Dental in Subiaco around 12 years ago, when Misagh closed his mobile sedation service and set up his clinic. “When we both became dentists, it seemed the natural progression of events that we’d end up working together,” Misagh says. “I think we actually spoke about the idea of working together as children!” Sahba adds.

The advantages Misagh says he and Sahba share a similar experience and values, which translates in the workplace into how they look after patients, how they communicate with staff and how they view a profession of service. “It is much easier to create a culture in your practice when you have a critical mass of key people who subscribe to a similar vision of what is important,” he says. “For example, Sahba and I were both raised to not speak negatively about other people – and this is something I try my best to cultivate in my workplace culture. As far as leadership, it’s comforting to know if I’m away lecturing or travelling, Sahba is still there with the team. At any point in time there may be particular needs, which Sahba will kindly step in and look after, and I know that staff turn to her for advice. I often look for Sahba’s input in staff meetings, or about interpersonal matters in the workplace, as she has excellent skills in these areas.” 10

October 2020 Western Articulator | adawa.com.au

Misagh and Sahba


A family legacy As a fourth-generation dentist, Dr Grace Cooper is following in her family’s footsteps. Grace’s great grandfather graduated with a dental degree in England in 1920, after which her grandfather, father, and then Grace, all followed suit. However, even with her family history, Grace’s future career was never pre-ordained. Nor, indeed, was her father’s – Dr Richard Cooper. “Dad wasn’t actively encouraged to be a dentist by his family,” Grace reveals. “He liked fixing things and working with his hands, and he was interested in a job that involved caring for people. He also wanted to have a career from which he could support a family. “Similarly, although I got the idea from Dad, I was also never actively encouraged to become a dentist,” she says. “When I was in high school, I realised that I wanted a career that could be balanced with having a family, as well as the opportunity to help others. So dentistry seemed like the perfect choice.” Richard retired in 2014, and after graduating, Grace started working at Harmony Dental (the third generation to work at the practice) in 2019. “I’ve been going there for my dental appointments my whole life,” Grace says. “There are many staff who’ve been there since I was a child, and some who started working there before I was born! Additionally, the culture and ethos of the practice are exceptional, and I’m so lucky to now be a part of the team.

has ever been any trace of that, from childhood to now, although he would steal my jokes and take the credit at times,” she says. “But really it’s always been a relief and source of happiness for each of us when the other is doing well in any regard. I think we’d continue to support each other with whatever individual, professional or business decisions we make into the future.” “In terms of little things, as a brother I can be prone to speaking in a frank or lazy way sometimes, where I would speak more formally or courteously with other colleagues or staff,” Misagh says. “I guess we can take the sibling relationship for granted sometimes. But we pull each other up on that sort of thing if it does come up!”

Their advice “It should be the most natural fit for siblings to work together, but maybe I’ve just been blessed with the

Dr Richard Cooper alongside his daughter, Dr Grace Cooper, proudly display the family's dental leg acy

“I am fortunate enough to not only see my dad’s previous patients, but I also regularly encounter my grandfather’s old patients,” she adds. “Every time I meet a patient of grandpa’s, it is extremely heart-warming and humbling.” Mentorship has also been a great advantage. Grace says she has had an immense amount of mentorship from Richard – especially during dental school. “I am very fortunate because Dad was always interested in the latest technology, and educating himself on modern dentistry,” she says. “To this day I still call him to get his advice on tricky cases.”

right sibling,” Misagh says. “The only advice I could give is that although Sahba and I can take a lot for our common understanding and approach to things for granted, we are still always conscious to communicate expectations around any work-related issue. As long as we communicate and consult on a matter, we tend to come to a quick solution or agreement, and this helps avoid misunderstandings. “I know realistically there would be other sibling combinations that may be best to not challenge their relationship with the stresses of the workplace, and that would be a valid decision too. Either way the important thing is agree on clear expectations from the beginning, and to consult and communicate. Hopefully this way sibling colleagues can strengthen their relationship rather than break it.”

October 2020 Western Articulator | adawa.com.au



A NEW BEGINNING and a wealth of experience Meet the new Head of School, Dean of UWA Dental School and Director of the Oral Health Centre of Western Australia, Professor Hien Ngo He may still be new to the job, but it’s clear that Professor Hien Ngo is ready to make a big impact at UWA Dental School, which he sees as having great potential. Professor Ngo brings to Western Australia a wealth of experience, recently returning from Australia after serving as the Dean of the College of Dental Medicine at the University of Sharjah. He has also worked at Kuwait University, the National University of Singapore, the University of Adelaide and the University of Queensland. “I felt it was time to come home, because I had been away from Australia for 12 years,” he says. “This school has a lot of potential, so I picked it over other schools.” But first – his plans were slightly delayed due to spending two weeks in quarantine, thanks to COVID-19. Luckily, two weeks in a hotel room did not faze him.


October 2020 Western Articulator | adawa.com.au

“Knowing that (the quarantine period) was being done for the right purpose helped, and it was only for a very short time,” he says. “You have to be very disciplined and structured. Make sure you wake up, as if you were getting ready to go to work, do your exercise and do not sit in bed reading a book and fall asleep again. You need to be mindful of your time. You can do a lot of work in a hotel room with Zoom meetings and using other digital platforms; it was quite a different way of working but it worked well.” It is clear his focus is about the students and ensuring all students are “career ready” when they graduate. “What I see is being able to match the graduates to the expectation of their future employers,” he explains. “We have put into motion now a few projects that will deliver that in a couple of years. “On top of doing the conventional work, (our students) will be exposed to some experience in digital workflow, because that is where the future will be. But certainly, we do not forget that we need to teach them the basics first.


“A current challenge for students is our evolving curriculum. We hope we can stabilise that and have a curriculum that the students will like – and that our stakeholders will like as we will produce the kind of graduate that they can employ right away.”

five minutes with Professor Hien Ngo

Professor Ngo’s focus on students is not only from a planning level; he has an open-door policy (by appointment). “I think the Head of School needs to understand what is happening at a grassroots level,” he explains. “The opendoor policy is structured very well. The concept is that everyone has access to the Head of School – and that applies to my staff as well.”

What is your favourite part of the world? “Australia. I spent 30 years in Adelaide, and I have been away from Australia for 12 years. This is home to me. It is everything – the weather, the food, the culture, the people, the laidback approach, and the weather has been absolutely fabulous.” Why did you first get into dentistry?

Professor Ngo appears to be a Head of School that students will look up to as a mentor – he is approachable, good humoured and the students will have confidence knowing their Head of School does not just talk the talk, he has walked the walk – with extensive experience as a practitioner (as a general dentist and prosthodontist. In his early dental life, he worked in the school dental service, driving dental vans to rural areas, which he loved). In fact, it is Professor Ngo’s 20 years in private practice that has been his career highlight so far. “That is where I enjoyed the patient/dentist relationship, and being able to look after them and learn, which led me to my next path, where I went back to university to get my higher degrees, and my research has always been focused on solving clinical problems,” he explains. Professor Ngo also has many other plans for the Dental School, with some already in the works. He hopes to work with the public health system to deliver better care for patients and better education for DMD/DCD students, and is looking into the possibility of introducing special needs dentistry to the school. He also hopes to strengthen support from the alumni, and partner with ADAWA, the study clubs and the public sector, in order to develop a strong workforce.

“All my siblings are doctors, so when it came to my turn, they wanted to have a dentist in the family. In Asia, if your parents or older siblings tell you: ‘We want you to do this…’ you do it,” he laughs. “It is not like today when you have the luxury of picking and choosing what you want to do.” If you weren’t in the dentistry field, what would you be doing for a living? “I would have been a teacher. I am good at teaching so I would have been a teacher of some form.” Where is your favourite book? “The History of Dentistry in Western Australia (pointing to the book on the coffee table in his office) and Preservation and Restoration of Tooth Structures,” he laughs. “My life revolves around dentistry.” Is there anything people might be surprised to learn about you? “I am one sick golfer – because golf is a sickness,” he laughs.

He says there will be functions arranged to get to know the alumni better and professional events planned. Watch this space!

October 2020 Western Articulator | adawa.com.au



“At the clinic, I would do all the endos and my wife would do all the crowns, because she loved crowns and bridge work and restorative work. It was almost like the Marie Kondo approach to dentistry – if you hold it and it does not bring you joy, let it go. I was holding on to everything in dentistry and the thing that brought me joy was endodontics, so I let the rest go.” After finishing specialty training, Mark accepted a job in Sydney, alongside endodontist Dr Mehdi Rahimi, and soon after started working with Mehdi presenting CPD courses. Eventually, Mark returned to Victoria, where he now has his own practice, but still travels to Sydney to work with Mehdi, because he says it is hard to let go of something you love.


Dr Mark Johnstone Specialist endodontist Dr Mark Johnstone chats to Brooke Evans-Butler about his life, career and popular Rotary Endodontics course

Coming from a family of tradies, Dr Mark Johnstone is naturally good with his hands. Not being cut out for the building site and keen to pursue a career in healthcare, dentistry turned out to be the perfect fit for this specialist endodontist. “From a very young age, my dad knew I wasn’t cut out for a building site because I kept washing my hands,” Mark recalls, laughing. “Dentistry spoke to me because you are pretty much a tradesman with a health degree, and that is what drew me to the profession.” After graduating from dental school in Melbourne, Mark spent three years working in private practice (alongside his wife, Dr Jean Wu, whom he met at dental school) before beginning specialty training. “I have never been drawn to the aesthetic side of things. I think it comes back to the whole practical tradesman attitude – I have always been about function,” he says. “Out of everything in dentistry, endodontics is probably the most biologically-driven topic, and I realised this was the part of work that made me happy. 14

October 2020 Western Articulator | adawa.com.au

It is lucky Mark does love his work, because lecturing takes up a large amount of his time. “Last year, I lectured 23 out of 52 weekends,” he reveals. “It was a lot, so we have set up a big wall calendar in our study and we colour code our commitments to keep track of everything. My Sydney dates are highlighted pink, all the lectures are blue, my wife is currently doing her PhD, so she has her commitments in green, and that is how we coordinate things. If I’m doing three CPD weekends in a row, then I try to have a couple of weeks when I am not doing anything so I can spend time with my wife and my son. “We seem to make it work,” he adds. “In the end I have had to say no to a few things just because I don’t want to be away five weekends in a row, and my wife is starting to do CPD courses of her own. I need to respect that she has supported me all this time; it is only fair that she gets this opportunity for herself to go out there and get her face out in the world. It is a give and take and it is a juggle, but we make it work and because we are both very goalorientated people, we are on the same page.” Even though Mark is in Sydney less often, he and Mehdi still travel to present their CPD course, Rotary Endodontics, which covers: • How to best select and use contemporary rotary NiTi file systems • How and when to use an electronic apex locator to greatly improve the accuracy and efficiency of working length determination • An effective irrigation regimen based on current best evidence • How to integrate instrumentation and obturation to improve efficiency and achieve predictable results • Troubleshooting common endodontic procedural problems. Mark says, essentially, the course is designed as if you are doing a root-canal treatment from start to finish. He admits they often have people attending the course more than once because they enjoy it so much. “Many people who come to our course come because they hate endodontics, but they want to do better at it,” he says. “Endodontics is that one field of dentistry where


five minutes with Dr Mark Johnstone “Dentistry spoke to me because you are pretty much a tradesman with a health degree, and that is what drew me to the profession.”

your eyes almost betray you because you can’t see a lot of what you are doing. You are relying on the instruments to work on an area you can’t see; you are relying on tactile sensation. You have to take radiographs to know if what you are doing is okay. “I think endo gets a bad rap, especially with broken instruments,” he adds. “Dentists seem to freak out about breaking instruments but it is really not that big of a deal; it is how you manage the patient more than how you manage the instrument that results in a good or bad outcome. “I completed a Masters of Health and Medical Law at The University of Melbourne, so I have a little bit of legal knowledge – just enough to be dangerous – and I incorporate that into my lectures. I talk about broken instruments and how you can prevent them. My research when I was a specialist trainee was about informed consent in endodontics, so I talk a lot about communication; how you talk to the patient before and after it happens.” Mark hopes attendees take away from the course a willingness to have a go. “I hope they feel more confident that if they try something and it doesn’t exactly go to plan, it is not the end of world and it doesn’t mean that they need to give up on endodontics all together.”

Rotary Endodontics, presented by Dr Mark Johnstone and Dr Mehdi Rahimi will be will be held in 2021 at UWA Dental School.

Which three words best describe you? Rational problem solver. I am very analytical. I love puzzles. I love solving problems. I was the math nerd in high school and I always want to find the most efficient way to come to a solution of any problem. If you weren’t in the dentistry field, what would you be doing for a living? A science fiction author. I would be sitting at a laptop writing stuff that my wife would never read. What do you do in your spare time? My wife and I play modern board games and I am an avid reader – I will devour a couple of books a week. I also enjoy working in the veggie garden. Where is your favourite book? We have a Compactus in our living room, with nine shelving units attached to it, all filled with books. Asking your favourite book is like asking to choose a favourite child. But if I had to choose, it is a toss-up between Red Rising by Pierce Brown or The Name of the Wind by Patrick Rothfuss. Where is your favourite place in the world? Anywhere in Japan. If someone said to me that I could spend six months of every year eating my way from one end of Japan to the other, I would be a very happy man. I can’t speak the language at all but I can certainly eat. Is there anything people might be surprised to learn about you? It is a bit of a shock factor, but I paid my way through dental school playing poker. My family did not have much of anything and the only money I had was what Centrelink gave me. I would take my Centrelink money, go to the casino, and then use the money I won to survive for the next few weeks, before doing it all over again. I even somehow won my way into a State-wide poker tournament in the middle of dental school. I toyed with the idea of doing that as a career – but there are less stressful ways to make money than playing poker. October 2020 Western Articulator | adawa.com.au



Study Club for Young Clinicians Study club for recent graduates and clinicians with up to 5 years’ clinical experience

October 1, 2020 November 5, 2020 Venue: ADA House, 54 Havelock Street West Perth @ 6pm To register, please email prosstudyclub@gmail.com

Contemporary Prosthodontics 2020 Saturday, October 17, 2020 | Duxton Hotel, 1 St Georges Tce, Perth | 8.30am – 4.00pm Dr Armand Putra: Key to Success in Implant Aesthetics – Surgical and Prosthetic Considerations

Dr Paul Gorgolis: A Contemporary Approach to Restoring Teeth – Partial Crowns and Bonding

6 CPD Hours APS members: Free Non-members: Join APS for $175 and register for free RSVP before October 1, 2020 to apswasec@gmail.com

Save the date The RACDS WA event ‘Top Hacks for Outstanding Dentistry’ with Dr Michael Mandikos has been rescheduled for 30 July, 2021. More details to come.


October 2020 Western Articulator | adawa.com.au

Dr Hezel Cohen: Dental Materials Choices; So Many Choices, What Do I Use When and Why?

$1,870 inc GST

Porcelain Veneers & Ceramic Onlays – A Practical Approach to Multiple Restorations Friday 6 & Saturday 7 November | CPD Hours: 13 Presented by Dr Asheen Behari & Dr Paul Gorgolis Registration from 8.45am, Course 9am to 5pm UWA Dental School, 17 Monash Ave, Nedlands Bookings & Enquiries adawa.com.au/cpd There will be a substantial hands-on component to the course.

Lecture component:

About the Presenters:

1. Recognition of appropriate cases. 2. Case work up. 3. Rationale for the design of the relevant restorations. 4. Material options. 5. Occlusal registrations and articulation. 6. Bonding and cementation protocols.

Dr Asheen Behari is a general practitioner in private practice in Claremont, Perth. He graduated at the University of the Witwatersrand in 1993 and has completed a Postgraduate Diploma in Clinical Dentistry in Oral Implants at the University of Sydney. Dr Behari has also been a lecturer and tutor to final year dental students at The University of Western Australia.

The practical component will focus on:

Dr Paul Gorgolis is a general practitioner currently in private practice in Wembley Downs, Perth. He is a Fellow of the International Congress of Oral Implantologists. In London he developed the UK’s first multi-disciplinary general and specialist practice where patients could be comprehensively managed and treated “under one roof”.

1. Multiple porcelain veneer tooth preparations. 2. Multiple ceramic onlay/partial crown preparations. 3. Predictable impression techniques. 4. Provisional restoration manufacture. The focus will be on receiving practical tuition and guidelines for the diagnosis and treatment planning processes required to facilitate multiple restorative dentistry. This course will focus on “CERAMIC VENEERS”

Dr Gorgolis has also been a lecturer and tutor to final year dental students at The University of Western Australia. Sponsored by:

October 2020 Western Articulator | adawa.com.au


Dental CPD Calendar OCTOBER


Predictable and Easy Root Canal Instrumentation and Filling Techinques



AOS WA Dinner Meeting

Winthrop Professor Paul Abbott AO

Dr Nova Gibson “Implant in digital age” & “Bone graft – the good, the bad and the ugly”

UWA Dental School, Nedlands

University Club, Crawley

Dr Cigdem Kipel



P Friday: 9.00am–5.00pm

UWA Dental School, Nedlands

ADAWA Annual General Meeting


ADA House, West Perth




Dr Josh Graieg

Practical Oral Surgery

ADA House, West Perth

Y Saturday: 9.00am–2.00pm ULL


Dr David Booth & Dr Carolyn BOOStulner

Friday: 6.00pm–9.00pm Prosthodontic Problems? Plan to Prevent Them!


Dr Ben Lee

ADA House, West Perth (virtual meeting)

Australian Prosthodontic Society – Contemporary Prosthodontics 2020


Saturday: 8.30am–4.00pm



ADA House, West Perth (virtual meeting)

Diabetes and Dental Health – Dinner Course


University Club, Crawley

NPP Day FREE full day event for those who have graduated within the last five years

WA Dental CPD Events ADAWA General Meetings


Drs Leticia Algarves Miranda & Mahnaz Syed

Extensive marketing of your practice to ensure the best possible price achieved Clear communication throughout the sales process

Saturday: Time 10.00am

Socket and Ridge Preservation Hands-on Workshop

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

Wednesday: 6.30pm–9.30pm


Event Types:


Dr Jane McCarthy & Dr Janina Christoforou

UWA Dental School, Nedlands

Thursday: 9.00am–5.00pm


UWA Dental School, Nedlands


Kylie Robb

Porcelain Veneers and Ceramic Onlays – A Practical Approach to Multiple Restorations Friday & Saturday: 9.00am–5.00pm

T Saturday: 9.00am–5.00pm POS

Infection Control: Ensure you and your Team are Confident and Compliant


Dr Asheen Behari & Dr Paul Gorgolis

Duxton Hotel, Perth RSVP to apswasec@gmail.com

The A-Z of Mastering Anterior Crowns

CTEC, Crawley


Wednesday: 9.00am–5.00pm

Other CPD Events


Wednesday: 6.15pm (Eat & Meet)

ADA House, West Perth and via Zoom

Dr Ben Lee


Guest speaker: Dr Hezel Cohen

Tuesday: 5.30pm–7.00pm

ADAWA NPP: The Patient who won’t see the Prosthodontist

Anxiety Relief in the Dental Surgery Dr Steven Parker

Friday: 6.30pm–9.00pm

Friday: 8.30am–5.00pm

Communication Skills Webinar



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

Saturday: 9.00am–2.00pm 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. 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. 18

October 2020 Western Articulator | adawa.com.au

WA CPD Event Bookings & Enquiries: Additional event information and online bookings available at adawa.com.au Bookings, Course and Payment enquiries: Tel: (08) 9211 5600 Other Enquiries to Dr Jenny Ball: Mob: 0419 044 549

Email: cpd@adawa.com.au Email: jenny@adawa.com.au

DECEMBER NED O P T Saturday: 9.00am–5.00pm POS


Practical Oral Surgery


Pain Relief for Your Patients Dr Steven Parker

UWA Dental School, Nedlands

Dr David Booth & Dr Carolyn Stulner

Saturday: 9.00am–2.00pm CTEC, Crawley

FEBRUARY 2021 To Prep or Not to Prep Dr Clarence Tam


Saturday: 9.00am–5.00pm

UWA Dental School, Nedlands

Posterior Composites


Dr Clarence Tam

Sunday: 9.00am–5.00pm

UWA Dental School, Nedlands


Guest speaker: Dr Hezel Cohen Dr Cohen will be speaking on: “The Lost Art of Designing Partial Dentures: The When, The What and The How.” The lecture will cover: • Abutments • Surveyed crowns • Framework design • Cases

ADA House Lecture Theatre RSVP adawa@adawa.com.au

6.15PM “Eat and Meet”

Dr Hezel Cohen completed his Bachelor of Dental Surgery at the University of Stellenbosch. After moving to Australia he undertook the ADC exam, completed a Certificate in Restorative Dentistry (Prosthodontics) through Kings College in London and a Doctor in Clinical Dentistry degree from the University of Melbourne. He now works in private practice as a prosthodontist.

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

7.30PM General Meeting Immediate start

8.00PM Lecture Hezel Cohen

October 2020 Western Articulator | adawa.com.au


$693 inc GST

Socket & Ridge Preservation Hands-On Workshop Saturday 21 November | CPD Hours: 4.5 Presented by Dr Leticia Algarves Miranda & Dr Mahnaz Syed Registration from 8.45am, Course 9am to 2pm ADA House, 54-58 Havelock Street, West Perth Bookings & Enquiries adawa.com.au/cpd Course outline:

About the Presenters:

Extracting teeth is part of everyday clinical practice. We know that once a tooth has been removed, the inevitable consequence is dimensional bone and soft tissue alterations.

Dr Leticia Algarves Miranda is the Discipline Lead in Periodontics at the UWA Dental School. She obtained her dental degrees in Brazil, and her PhDs in Brazil and Karolinska Institute in Sweden. Leticia has held appointments at a number of universities in Brazil. Leticia moved to Perth two years ago.

One treatment option which has been scientifically shown to maintain ridge volumes once teeth have been removed is socket and ridge preservation. Socket and ridge preservation are some of the easiest methods of hard-tissue preservation and augmentation in future implant sites. If the science behind extraction socket healing is applied to our daily work, patients and dentists will benefit. This hands-on course will cover different techniques for hard tissue augmentation to preserve ridges, and instruct attendees on some suturing-specific techniques. Pig heads will be used for the hands-on component.


September 2020 Western Articulator | adawa.com.au

Dr Mahnaz Syed obtained her qualifications in the United Kingdom. She worked as a specialist periodontist in private practice and as clinical lead in mucogingival surgery and implant soft tissue augmentation at the Royal London Hospital before moving to Perth in 2007. Mahnaz practises as a specialist periodontist in Subiaco and is part time clinical implant tutor at The University of Western Australia. Sponsored by:


Human factors in error It has been said that “to err is human”. Dr Annalene Weston, dentolegal consultant at Dental Protection, highlights the human factors that can contribute to error in dental practice, and considers how to address them

Naturally, healthcare is not the only discipline focused on identifying and managing risk, with other high-risk industries also pursuing the paradigm of perfection. Aviation, in particular, has made great inroads into the identification of human error signs, identifying that there are more than 300 error incident precursors at play. These have been distilled into the ‘dirty dozen’ – 12 key elements that are proven to influence people into making mistakes.

1 2

1. Lack of communication Both between practitioner and patients, and practitioners and staff members. 2. Distraction From our core role, which may be related to factors inside or outside our workplace, or simply due to tiredness.

3 4 5 6

3. Lack of resources Particularly if accompanied by an unanticipated rise in demand. 4. Stress In all its many manifestations, and with its far-reaching effects. 5. Complacency Whether through over-familiarity, lack of respect for the process, or simple boredom. 6. Lack of teamwork Perhaps as a direct result of steep practice hierarchies, disempowerment of certain staff members, clunky processes, or maybe even due to a disruptive member of the team.

7 8

7. Pressure Both personal and workplace-related pressures can impact on our risk.


9. Lack of knowledge Perhaps we don’t know enough to do the job well, or we don’t have a full and thorough understanding of the regulations and processes we are required to follow to ensure patient safety.


10. Fatigue Fatigue impacts on our cognition and behaviour and, consequently, it increases our risk. This has been borne out in road safety research that tells us “that being awake for 17 hours has the same effect on your driving ability as a BAC (blood alcohol concentration) of 0.05. Going without sleep for 24 hours has the same effect as a BAC of 0.1, double the legal limit”. When we consider the above research relating fatigue to blood alcohol concentrations, could we accept then that fatigue likely affects our dentistry?


11. Lack of assertiveness If we cannot speak up for safety, both by setting safe boundaries for our practice, and raising concerns with a colleague about their intended practice, then we cannot truly ensure patient safety.


12. Norms As in normalisation of sub-par performance or behaviours, often referred to within Dental Protection as ‘ethical fade’. But why would we care? Isn’t the ‘dirty dozen’ endemic through all businesses? And do they really do any harm? Regretfully, human error is linked to harm, at alarmingly high levels. A recent meta-analysis undertaken to systematically qualify the prevalence, severity and nature of preventable patient harm confirms this, concluding that around one in 20 patients are exposed to preventable harm in medical care; going on to say that at least 12% of preventable patient harm causes permanent disability or patient death. Perhaps, then, if we are to meaningfully manage our risk at work, our focus needs to be on eliminating the dirty dozen from our workplaces, bearing in mind that stress and fatigue are also linked to burnout. Perhaps too, to truly address the pervasive nature of stress, fatigue and burnout, we need to start by approaching this subject without assigning fault or blame on the practitioners, but from a position of support. As “to err is human, to forgive divine”.

Want to know more? Download the RiskBites podcast Human Factors in Error, or Dental Protection members can log on to PRISM to watch the webinar of the same name.

8. Lack of awareness Of what we are trying to achieve or perhaps of how our behaviour and actions could be impacting on others. October 2020 Western Articulator | adawa.com.au



Defamation risks in the age of social media: what you need to know by Emma Jack Social media is a powerful tool to be used with care. Whilst it can be effective in building a personal and professional brand, every individual and business is now potentially a “publisher”, carrying with it the potential risk of liability for defamation. The instantaneous and far-reaching nature of communications on social media means that the risk is significant, with more than half of defamation proceedings between 2013-2017 involving digital publications.

Defamation – What is it? What are the elements 1. The matter (which includes social media comments, posts, photos and Google reviews) must be defamatory; 2. The matter must refer to the plaintiff; and 3. The matter must have been published to a third party without a lawful excuse.

the community, injures the plaintiff in their trade or profession, or is likely to result in the plaintiff being shunned, avoided, made fun of, or despised. What are the lawful excuses? In summary, it is a defence to the publication of defamatory matter if a defendant can demonstrate substantial truth, contextual truth, privilege (absolute and qualified), it was contained in a public document or fair report of a proceeding of public concern, fair comment/ honest opinion, innocent dissemination, or triviality. Remedies Damages may be awarded for hurt feelings, injury to reputation, loss of business and economic loss with the risk of jail time for extreme cases.

What constitutes publication on social media? Obviously, if you make a defamatory post on social media, then you will be deemed to have published that material. For example, if you posted:

When is matter defamatory Defamation occurs when the matter injures the plaintiff’s reputation in the eyes of ordinary people in 22

October 2020 Western Articulator | adawa.com.au

“My colleague Dr Jo Bloggs has the grubbiest hands I’ve ever seen! Can’t believe she’s still allowed to practice.”


This would have the potential to harm the reputation not only Dr Bloggs but also your employer (to the extent that your employer is readily identifiable) as it implies that the dental clinic is poorly managed. As the publisher of the post, you could be liable for defamation. Equally, whilst it is normal to get frustrated with difficult and unpleasant patients, if you had an outburst on social media and vented about your experience in sufficient detail you could be liable for defamation. That seems fairly clear and straightforward, but what about if you simply ‘like’ or ‘share’ or ‘comment‘ on a post? On most social media platforms, liking, commenting and sharing a post can bring it to the attention of your network of friends or connections who may not have seen the original post otherwise. This, of course, causes more harm to the person being defamed.

You should take care and precaution when engaging in social media, both in a professional and personal capacity, to protect yourself from civil and/or disciplinary action.

Online reviews about your clinic Individuals and small businesses (with 10 or fewer employees) in Australia can sue if they have been defamed by a review.

Online reviews are integral to any dental clinic’s business and reputation and, unfortunately, sometimes all it takes is a single bad review to have a negative impact on your business. Some health professionals have been successful in suing an individual reviewer. For example, health professionals have been awarded damages after previous patients have alleged that they acted improperly and incompetently.

Even if only one additional person were to see the post as a result of your interaction with it, the matter is deemed to have been published in a legal sense and has the potential to negatively affect the person’s reputation and constitute defamation.

But what if the reviewer is anonymous?

With respect to commenting, it may be relevant if your comments approve or otherwise adopt the defamatory sentiments of the original post.

However, it cannot be overstated that defamation is a complex, time-consuming and expensive legal matter. It is recommended that dentists and clinics try to resolve disputes before resorting to formal proceedings.

With respect to sharing, this may have repercussions for the original author as every time a post is accessed or downloaded it may be considered to be re-published. There is also a risk that, if you were to see a defamatory comment on one of your posts and choose not to delete it when you have the power to do so, you may be considered to have published that comment. This has recently been held to also apply to administrators of public Facebook pages (such as business pages).

Importantly, even if you were to ‘unlike’ a post or delete your ‘share’ or ‘comment’, you could still be held accountable provided at least one person saw it beforehand. Disciplinary risks Any inappropriate conduct on social media has the potential to damage a dentist’s personal and professional integrity and negatively impact the public’s confidence in the dental profession and its standards more generally.

Internet providers like Optus can be ordered to provide details of customers who write anonymous Google reviews which have adversely impacted a dentist’s business.

Key takeaways

1 2

Check the Dental Board’s Social Media Guide on the appropriate use of online platforms.

Take care when engaging with social media and be aware of the consequences and implications of interacting with other people’s content.

3 4

Ensure none of your social media posts are capable of causing offence or damage to the reputation of others.

Remove any potentially defamatory material or comments from your personal and business profile.

Consequently, by participating in any publication of defamatory material, you are not only at risk of being held liable for defamation but also at risk of being the subject of disciplinary proceedings brought by the Dental Board of Australia. October 2020 Western Articulator | adawa.com.au



Finding, recruiting and keeping the right staff Finding and recruiting new employees can be a challenging process for most practices. The challenge is not finding candidates but finding the right candidates for the role and for the practice. A highly qualified and skilled candidate may not be the right fit if they don’t align to the culture and values of the practice. On the other hand, finding the right job can be a frustrating process for candidates too, especially for new graduates who feel the pressure of starting in a practice that will break ground for establishing a successful career.

While many people struggle with recruitment, allocating the necessary time and resources to recruitment to ensure an informed, fair and transparent process is undertaken will, in turn, generate noticeable improvements in workplace culture, job satisfaction, and employee retention. Practices often realise the unsuitability of employees within a few months of recruiting them. In most cases, it is indicative of the fact that the practice has not undertaken a proper process for finding and recruiting new staff. This article is a guide for employers and employees to go through an effective recruitment process.

to either show their interest or reject the practice based on the first impression it has created. To correctly market itself, a practice should ensure that all recruitment material including job descriptions, advertisements, and interview questionnaires, is coherent and designed for to depict their culture, the position and the candidate they are looking for.

Defining the job Practices are strongly encouraged to invest time in defining the job before trying to find the employee for it. This would involve collecting necessary information regarding the duties, responsibilities, essential skills as well the work environment in which the employee is expected to perform. This analysis would enable a practice to develop the correct job description and subsequently any recruitment material from it.

Devising the correct recruitment strategy Depending on the area or locality a practice is situated in, a practice may find it quite useful to have a broad recruitment strategy that encompasses posting job advertisements on various mediums including, online recruitment portals, newspapers, the ADA’s job boards, local university job boards and its website.

Practices represent their image to candidates through the recruitment process and the strategies they undertake. It is therefore important to create an image that is representative of a practice’s culture and vision to attract candidates who look for the same attributes in the workplace.

There is an increasing trend to post job advertisements on social media platforms to create a wider pool of candidates to select from. Some practices may find it more efficient to engage recruitment agents or agencies who provide tailor-made recruitment solutions for dental practices. The cost associated with this process may be justified against the speed to recruit and quality of the placement. Individuals in the profession may also wish to consider registering with a dental recruitment provider which may be able to source suitable roles on your behalf and advance your application.

Professionals seeking job opportunities critically evaluate a practice through the public image it creates and choose

In all cases, a practice should ensure that the job advertisement does not state requirements that could

Creating the right image


October 2020 Western Articulator | adawa.com.au


directly or indirectly discriminate against certain candidates. It is therefore important to have up to date knowledge of relevant state and federal anti-discrimination laws. Taking the time to consider what type of candidate is needed will impact the compatibility of the individual within the practice and the position. For example, if a graduate dentist is needed, a local university job board or contacting the university careers officer will help increase a practice’s pool of appropriate candidates and success. The Australian Dental Association has a job board online for each state that can be accessed and is a great recruitment resource. Other common online platforms include Seek and Indeed.

Interview and Selection Processes A job posting may attract various candidates to apply, however not all applications are relevant. Practices should shortlist candidates based on their relevance to the job description. The interview should be approached as an opportunity for the practice, and candidate, to mutually assess the suitability of the role and workplace. While candidates will be prepared to answer questions about themselves and their professional experience, practices should be equally prepared to promote the practice, workplace culture, and employment opportunities that are associated with the role.

Transparency in the recruitment process will often enable candidates to identify an employer of choice which will lead to a reduction in poor recruitment placement. The practice manager or the practice owner should make sure to ask open-ended questions during the recruitment process to encourage the employee to speak more and therefore showcase their personality. Similarly, a candidate should ask as many questions as possible to find out more about the practice and to assess their cultural fitness for the workplace. At this stage, the parties should also finalise the type of employment relationship they intend to enter into. This will give an opportunity to clearly articulate the expectations out of a particular role or job. Professionals working in a dental practice are required to possess specific skills and therefore testing these skills during the interview process would be of great practical use. Testing is an effective way of identifying a candidate’s work and communication profile and will also help assess how that candidate will perform within the existing team dynamic. Test work can be paid and unpaid depending on the nature and extent of the testing or demonstration required. If the trial involves no more than a very brief demonstration of the person’s skills (e.g. during an

interview) where they are relevant to a vacant position, then it can be unpaid. Where a candidate is required to do actual work on a patient or in the practice, this will need to be paid. The interviewer should make and review notes from each candidate’s interview to narrow down or to make the final selection.

The importance of adopting an induction process A formal induction process for new employees is a vital part of the recruitment process. A good induction process will create a strong bond between the practice and the new employee, and increase the chances of retention.

The practice should put in all efforts to welcome the employee and prepare them for their role. At this stage, employees should have access to all relevant manuals, policies, and procedures within a comprehensive employee handbook or induction pack. New employees often lack confidence and tend to feel isolated during their first few weeks. Practices should introduce them to each team member at the practice and assign a buddy who will be critical during the early weeks of employment. An employee who feels welcome is more likely to perform well and adapt to the requirements of the practice than an employee who is unable to communicate with other team members.

Keeping the right employee Finding and recruiting the right employee is half the story, the other half is ensuring that the employee stays with the practice. Practices are strongly encouraged to develop an effective retention strategy for new employees. In addition to inducting a new employee through a formal process, this would generally involve providing the employee with regular training, feedback, attractive compensation, monetary and non-monetary benefits or incentives, personal recognition, and prospects of professional development. Creating a work-life balance is also an essential factor in ensuring employee retention. We know that recruitment takes time, however, effectively planning and executing the recruitment process will ensure that practices are recruiting for success which will ultimately see improvements in engagement, productivity, retention, and workplace culture.

For further information or assistance in relation to finding, recruiting and keeping the right employees please do not hesitate to contact the ADA HR Advisory Service on 1300 232 462.

October 2020 Western Articulator | adawa.com.au



Clinical cases in oral medicine Dr Lalima Tiwari, Oral Medicine Specialist

A 67-year-old male presented to me for routine review and management of salivary gland hypofunction secondary to radiotherapy that he received for metastatic cutaneous squamous cell carcinoma (SCC), involving his right parotid gland. His xerostomia was being effectively managed with moisturising dry mouth products and frequent sipping of water. On presentation, however, he reported unexplained, spontaneous bruising of his legs and arm. He does not recall injuring the areas where the bruising had developed. He had recently seen a dermatologist regarding this issue who informed him that the bruises were a result of ageing. His medical history is significant for right temple cutaneous SCC that metastasised to the right parotid gland. He received surgical excision, including parotidectomy and post-operative radiotherapy that was completed nine months ago. He also has a history of a basal cell carcinoma excised by his dermatologist twelve months ago and is currently under the management of the dermatologist for actinic keratosis. He is an exsmoker with a 35-pack year history and does not consume alcohol. He is otherwise medically fit and healthy and does not take any medications.

Figure 2: Clinical image demonstrating a 3mm deep-red haemorrhagic bulla affecting the left dorsal tongue. Extra-oral examination revealed two haematomas, 5-6 cm in diameter, affecting the left arm (Figure 1). No regional lymphadenopathy was palpable, extraorally. A 3mm, deep-red, haemorrhagic bullae was noted on the left dorsal tongue, demonstrating positive diascopy (Figure 2). Bilateral red petechiae was noted on the hard palate (Figure 3). The right buccal mucosa was noted to have patchy erythema with some areas of petechiae and an amalgam tattoo (Figure 4). Saliva of a frothy consistency was also noted. Blood investigations were ordered including a full blood count, coagulation profile and liver function test to rule out an underlying haematological disorder. Blood investigations revealed severe thrombocytopenia with a platelet count of 6 X 10⁹/L. Blood film revealed normal erythrocyte and leucocyte morphology. Immature platelet fraction was noted reflecting 14.6% thrombopoiesis in the bone marrow. Coagulation studies and liver function tests were within normal limits. Given the severely low platelet counts, a working diagnosis of immune thrombocytopenia (ITP) was made and subsequently confirmed by the patient’s haematologist.

Figure 1: Clinical image demonstrating two 5-6cm haematomas affecting the left arm.


October 2020 Western Articulator | adawa.com.au

Immune thrombocytopenia (ITP) is an autoimmune disease that is characterised by platelet count of less than 100 x 10⁹/L with no evidence of


Figure 3: Clinical image demonstrating multiple petechiae noted to affect the hard palate. leukopenia or anaemia and carries an increased bleeding risk. This condition was once referred to as idiopathic or immune thrombocytopenia purpura, however with increasing knowledge about pathogenesis, it can no longer be considered idiopathic. Furthermore, many patients do not present with purpura at the time of diagnosis. While the need for accurate tools to assess bleeding risk from invasive dental procedures are required, platelet counts of greater than 50 x 10⁹/L remain the currently adopted threshold for performing invasive dental treatment. Oral manifestations of ITP include mucosal haemorrhaging ranging from petechiae, ecchymosis and haematomas generally affecting the soft palate and buccal mucosa. Spontaneous mucosal or gingival bleeding, or development of deep red to black haemorrhagic bullae is often seen with platelet counts less than 30 x 10⁹/L. Severe ITP (< 30 x 10⁹/L) can become life-threatening due to the potential outcome of gastrointestinal or intracranial bleeding. While the risk of spontaneous bleeding is rare, oral manifestations remain one of the early signs of ITP. As such, the dental practitioner plays a vital role in the diagnosis and management of ITP. Early recognition of clinical signs and symptoms can lead to a timely diagnosis and aid in providing appropriate management for the ITP patient.

Figure 4: Clinical image demonstrating a patchy area of erythema and small petechiae on the right buccal mucosa. Treatment initiation after an ITP diagnosis is generally based on several patient factors including platelet counts less than 30 x 10⁹/L, clinical bleeding tendency, disease stage, and is managed by a haematologist. Corticosteroids remain the mainstay of initial management. Other first-line treatment options also include intravenous immunoglobulin (IVIG) and anti-D immune globulin. Patients with persistent or chronic ITP may undergo treatment with rituximab or splenectomy.

The above patient unfortunately did not show consistent increases in his platelet counts after undergoing two, four-day courses of 40mg prednisolone. He was subsequently placed on weekly infusions of Rituximab for four weeks, with an initial improvement in platelet count to 164 x 10⁹/L. His platelet counts will be monitored weekly for the next two months, followed by further haematological review to determine the need for a splenectomy.

Contact Dr Lalima Tiwari if you are interested in more information or references: lalima@pomds.com.au

October 2020 Western Articulator | adawa.com.au



World Cavity-Free Future Day

World Cavity-Free Future Day falls on October 14. We look at the importance of this day, the resources available, and how to have the conversation with your patients about keeping their teeth cavity-free “Dental decay is the most common non-communicable disease in the world,” says Dr Fleur Creeper, committee member of the Oral Health Committee and spokesperson for the Australian Dental Association of Western Australia. “It is expensive to treat, impacts quality of life and can cause hospitalisation. Often dental caries does not receive priority in health planning as the consequences and impact are often underestimated. It is entirely preventable through relatively simple and cost-effective population wide and individual interventions. Therefore, global awareness campaigns such as WCFF are so important.”

Why are dental caries such a big deal? If your patients shrug off yet another cavity, it is likely the facts about dental caries will shock them. “Dental caries is still, in 2020, the most common, preventable chronic disease world-wide,” Fleur says. “In Australia, we know from the 2020 Oral Health Tracker report card that 32.1% of adults have untreated tooth decay. Worryingly, this is an increase of 6.6% from 25.5% in 2004/2006. “In children, 27.1% (2018 data) of 5- to 10-year-olds had untreated tooth decay in primary teeth,” she adds. “This also translated into 9.3 per 1,000 preventable hospitalisations due to dental conditions, which is a big deal. 28

October 2020 Western Articulator | adawa.com.au

“We know that poor oral health can lead to pain, discomfort and hospitalisation. It can affect employment, school attendance, impact on systemic health and significantly impact on quality of life.” Who is at risk? Fleur says dental caries is primarily driven by sugar, but it is a biofilm mediated disease, which is multifactorial and dynamic in nature, resulting in cyclical demineralisation and remineralisation of the dental hard tissues. “The equilibrium and relationships of the multitude of factors determines whether disease initiates and then progresses,” she explains. “Sugar consumption is a big part of the issue both here in Australia and globally. Dental caries does not develop in the absence of dietary sugars. “In 2017, WHO recommended that intake of free sugars should be less than 10% of the daily energy intake, but if possible, limiting it to 5% is even better. Free sugars are in the vast majority of packaged foods and drinks and can hide under other names such as (but not limited to) agave nectar, dextrin, maltodextrin, barley malt, corn syrup, malt syrup, sorghum syrup and turbinado, along with more common names such as sucrose, maltose


and fructose. Sugar-sweetened beverages are a primary source of free sugars for many population groups, including Australians.” Fleur adds that oral diseases, like dental caries, share many common risk factors, which affect the whole-body health. “Like other systemic health conditions, different individuals have different risk factors for developing new lesions and also having existing lesions progress,” she says. “Assessment of the various factors allows classification of individuals into categories allowing for more tailored care. These risk factors may be at a patient level or oral level.”

Fleur says high caries risk at a patient level include: • • • • • • • •

Dry mouth Head and neck radiation Inadequate oral health practices High frequency/amount of sugar consumption Deficient exposure to topical fluoride Symptomatic-driven attendance SES/access barriers Mother’s high caries experience

She says intra-oral risk factors also need to be considered, including: • • • •

Dry mouth/hyposalivation Caries experience Thick plaque Exposed root surfaces

“Guidelines suggest that for best practice a 4-D approach should be taken,” Fleur adds. “This is a holistic and individual approach to caries management to ensure that we preserve tooth structure and restore only when necessary:

“We need to encourage patients to appreciate the impact that decay has on the quality of life over the years and to take preventative action not only for themselves but also their families. “It is easy to think that a little extra sugar here and there is not such a big deal, but the odds are a lot of us are taking in far more than we realise, especially in these times as more people are working from home, spending more time at home and snacking between meals. “In addition, access to dental care may be limited and oral hygiene practices may not be as consistent due to changes in schedules and routines.” Fleur says figures show that the average Australian is consuming 14 teaspoons of sugar a day, a whole lot more than the maximum six teaspoons a day recommended by the WHO. Seventy per cent of children (aged 9-13 years) consume too much sugar. “Food labels are extremely difficult to read and guidance should be provided,” she adds. “Resources including fact sheets and videos are available on the ADA Inc website and can help to identify sugar in all its forms and to decipher these labels. “In addition, it sounds simple and repetitive but the key oral health messages of brushing and flossing are still not being heard. We know that only 53% of adults brush twice daily. And, of course, tap water should be encouraged as the drink of choice.”

Get involved Visit https://www.acffglobal.org/wcffday/ resources-for-professionals/ to download professional resources, family resources and social media graphics – and use the #WCFFDay hashtag on your practice’s social media.

Determine patient level risk; Detect and assess caries; Decide on a personalised care plan; Do appropriate prevention and preservation interventions.”

The conversations you should be having with your patient There is no secret formula; Fleur says it is important just to start the conversation. “We are health professionals and we need to educate our patients in order for them to help themselves, rather than just treat the results of the disease,” she advises. “Often people assume that dental caries is inevitable and just happens – they often do not realise how it happens, that it is entirely preventable and the significant impact their dietary choices and oral hygiene practices are having. October 2020 Western Articulator | adawa.com.au



“The training is equally suitable for oral health professionals with limited knowledge of smoking cessation, as well as experienced professionals wanting to refresh or compare their current work practices with evidence-based best practice,” she adds. “The training will give you the skills, knowledge and confidence to have a smoking cessation brief advice conversation with your patients.” ADAWA treasurer and oral medicine specialist Dr Amanda Phoon Nguyen says the training is comprehensive and practical.

Help your patients quit smoking with this free online training

“I was pleasantly surprised with how many great resources were available for people attempting to stop smoking, and wish I looked into these years earlier,” she says. “Often, we do a good job with noting the patient’s smoking history at the appointment, and then miss the opportunity to take this further and explore this with the patient. Sometimes, this is because we lack confidence and training, and this is the perfect way to address this.” Amanda says discussing smoking cessation is extremely relevant for oral health professionals, as smoking has numerous effects on the oral cavity and body. “We have many opportunities to address this, for example post tooth extraction, as part of the soft tissue examination, during periodontal probing or before a scale and clean to remove staining.

Cancer Council WA’s Make Smoking History has launched free online training for oral health professionals in Western Australia

“Studies show that most patients expect their dentist to offer smoking cessation advice. Short, non-judgemental brief advice is effective (two to three minutes) and a majority of patients appreciate their dentist advising them about the effects of smoking on oral health.”

Oral health professionals are well-placed to provide advice on smoking cessation – after all, they are the ones seeing many of the damaging effects of smoking.

“The average 40-year-old smoker will have made around 20 unsuccessful attempts to quit, and it is estimated that about 1 in 33 conversations can lead to someone successfully quitting smoking. We can make a real difference in our patients’ journey towards being smoke free.”

To get oral health professionals up-to-speed on the bestpractice smoking cessation care, Make Smoking History has launched a free online training program. Make Smoking History manager Libby Jardine says the training was developed by Quit Victoria and adopted and contextualised by Make Smoking History for WA health professionals.

For more information visit www.makesmokinghistory.org.au

Resources for oral health professionals “Most people who smoke want to quit and expect their oral health provider to talk to them about smoking,” Libby says. “The training has been designed and tailored especially for oral health professionals with all members of the dental health team in mind.” The smoking cessation brief advice online course will help oral health professionals initiate conversations about smoking using the three-step brief advice model (“Ask, Advise, Help”). “It has been shown to be fast, simple and well-received by patients and professionals alike,” Libby says. 30

September 2020 Western Articulator | adawa.com.au

• Chairside guide for oral health professionals • Resources for other health professionals: https://www.makesmokinghistory.org.au/healthprofessionals/publications-and-resources • Resources for clients and dental practices: https://www.cancerwa.asn.au/resources/ publications/mshpublications/ (including Quit Pocket Guide, Quit Kit) • Smoke-free and positive messaging signage/ posters: https://www.makesmokinghistory. org.au/community-services/training-andresources/resources-for-partners


The age of wisdom By Josephine Drewett There is a well-quoted saying attributed to George Bernard Shaw: “Youth is wasted on the young.” The phrase is loaded with wisdom, wistfulness but also a modicum of envy. There is also some doubt as to whether he did say those exact words, but the phrase has passed into the common vernacular. It is often used by an older person who, after witnessing some mishap by a younger person, will shake their head and with a half-smile of indulgence quote the words of Shaw. For those of us with a few years of experience under our belt it is easy to agree with GBS’ statement. We look back on opportunities missed, chances squandered, errors made and with the hindsight of time and knowledge envisage a different outcome. Yet, at the time, if an older person had offered words of wisdom, with eye-rolling and the unspoken thought of “you’re an old duffer, what would you know?” we would blithely ignore the advice and continue on our erroneous path. Only with the benefit of a lifetime of experience can we see how wrong we were to ignore the well-meaning advice. However, youth has its own advantages, not the least of which is good health and, from the perspective of a dentist, no back, neck or shoulder problems. Add optimism, an eagerness to succeed and confidence that would stall a dinosaur and one can see how the young have the durability to bounce back after setbacks. In a new, postCOVID-19 world, the flexibility of the younger generation

will be an extra component that will enable them to succeed. In the dental world routines and protocols are paramount to our everyday working lives. Such embedded routines are hard to break, especially for the dentists who have spent a working lifetime performing them. But for the newly graduated or those still at dental school, dentistry is still a fresh skill and their flexibility to cope with a changed world gives them an advantage over the older dentist. But as with every aspect of life there is always a need for a balance or a trade-off. Whilst the newest cohort of dentists have their energy and greater ability to adapt to an evolving environment, they are also entering a rapidly changing profession. As older dentists, whose super has been reduced by the recent stock market volatility, choose to work for longer and patients find they have less money to spend on what many perceive as an optional extra, jobs for young associates will be harder to find. Life for all of us, both young and old, in all walks of life, has changed irrevocably with the emergence of this virulent coronavirus. Who knows if an even more potent strain will emerge in the future? Whatever our personal worries, this problem is bigger than all of us, professionally or nationally; it is a global concern. And yet it will take every one of us, acting as individuals to make an impact. October 2020 Western Articulator | adawa.com.au



ADA Cup, Royal Perth 2020 Royal Perth Golf Club hosted the August ADA Cup, sponsored by Dentsply/Sirona and represented on the day by Russell Redpath. Thank you for your ongoing support, Russell. This is the only stroke event on the WADA Golf calendar and the first winner of this prestigious Cup dates back to 1936!

NOVELTIES Nearest the Pins: 2nd Hole (WADA Golf)....................R. Williams 6th Hole (Swan Valley Dental Laboratory – David Owen)............... M. Razza 12th Hole (Health Linc – Brad Potter).......................................R. Jagota 14th Hole (WADA Golf)...................M. Welten Longest Drive: 18th Hole (Dentsply/Sirona)..........P. Douglas Stableford Prize (WADA Golf)........R. Redpath (30 pts) Best Gross.........................................J. Scully (80 pts)

MAIN PRIZES 3rd 73 Net ............................................ G. Washbourne 2nd 73 Net on countback................... J. Scully 70 Net............................................. K. Thyer 1st Well played Kris, you’re on a hot streak! John Scully WADA Golf Captain dentistgolf@gmail.com

PERTH’S BEST IT SUPPORT FOR THE DENTAL INDUSTRY Simplifying Technology supports 37 dental practices in WA. We understand the daily technology challenges that dentists face, and we are able to help.

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It doesn’t matter if you have 5 computers or 50 servers in your dental practice, we support all of them. We support secure local and cloud server options. Contact us and see how we can help your practice. Sign up with us this month for our managed services agreement and win a prize such as Apple Airpods, iPad or Gaming Keyboard. Ask us about our small business IT support packages.

October 2020 Western Articulator | adawa.com.au

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

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Dr Lisa Bowdin

Dr Naomi Kohan

Dr Stephen Kwang




Specialist Paediatric Dentist BDSc, DClinDent (Paed), MRACDS (Paed)

Smile Time Orthodontics is pleased to announce Dr Naomi Kohan will be joining our practice. Dr Kohan welcomes referrals for all aspects of orthodontic care.

Specialist Endodontist BDSc (Hons), BScDent (Hons), DClinDent (Endo), MRACDS (Endo)

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.

Fremantle Cottesloe Mt Hawthorn Mindarie Dunsborough

FIRST SMILES Suite 7, 38 Meadowvale Ave South Perth WA 6151

Email: info@smiletime.com.au Web: www.smiletime.com.au

Dr Stephen Kwang is pleased to announce the opening of a new branch clinic Floreat Endodontics. Stephen welcomes new referrals for all aspects of endodontic treatment and continues to operate at Yokine Endodontics. Unit 3 434 Cambridge Street Floreat WA 6014 Tel: (08) 9383 7400 Email: reception@floreatendo.com.au Web: www.floreatendo.com.au

Tel: (08) 9367 9277 Email: hello@firstsmiles.com.au Web: www.firstsmiles.com.au

Michael O’Halloran

Dr Nandika Manchanda

Professional Notices




Additional practice locations in Kalamunda and Joondalup

Specialist Paediatric Dentist BDSc (Hons), DClinDent (Paed Dent), MRACDS (Paed)

Michael O’Halloran will now be offering services at the Perth Hills Specialist Centre, 182 Canning Road, Kalamunda, and at Joondalup Health Campus, Suite 1 Medical Centre East, Ramsay Private Hospital, 60 Shenton Ave, Joondalup. All bookings for specialist oral surgery and implant dentistry services are through Mediref or main rooms at Cambridge Periodontics. 174 Cambridge Street West Leederville WA 6007 Tel: (08) 9388 3453 Fax: (08) 9388 3442 Email: specialistoralsurgeryperth@gmail.com


Toothbuds Paediatric Dentistry is pleased to announce that Dr Nandika Manchanda has joined Dr Rod Jennings and the team. Dr Nandika has immediate availability and is happily accepting referrals for all facets of paediatric dental care. In keeping with the Toothbuds ethos, the care of all eligible children will be bulk billed under the Medicare Child Dental Benefits Scheme. Toothbuds clinics are located in Midland, Bunbury and Busselton. You can contact the friendly Toothbuds team on 6155 9899 or at admin@toothbuds.com.au

September 2020 Western Articulator | adawa.com.au

Australian Dental Association (WA Branch) Inc

To add a professional notice to these pages, email media@adawa.com.au. Please include all relevant information and a high resolution image or logo. PO Box 34 West Perth WA 6872 Tel: (08) 9211 5600 Fax: (08) 9321 1757 Email: media@adawa.com.au Web: adawa.com.au

TePe Interdental Brush with soft neck


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TePe high quality interdental brushes are made in Sweden and developed in collaboration with dental experts for a healthier everyday life. Contact TePe Australia & NZ for more information or try out some of our products. Made in Sweden

info.au@tepe.com www.tepe.com

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