ADAWA Western Articulator - September 2020

AUSTRALIAN DENTAL ASSOCIATION WA | SEPTEMBER 2020

GOOD NEWS STORIES Volunteering is back in full swing in WA

UNDERSTANDING DEMENTIA Treating patients to get better health outcomes

ADAWA COUNCILLORS CELEBRATE FATHER’S DAY

We acknowledge the dental dads of ADAWA

adawa.com.au

THE RECOGN ISE D VO I C E O F O R AL HE ALT H I N WA

Now 100% online

Do you want to set yourself apart from other dentists?

RACDS Primary Examination (General Dental Practice)

Written Paper 30 Nov – 2 Dec 2020 viva voce 9 – 14 Dec 2020 Enrol before Friday 9 October 2020 www.racds.org/PEreg

Exam benefits The RACDS Primary Exam is a highly regarded achievement, allowing dentists to develop a strong foundation of knowledge for clinical practice. The College now provides a certificate upon successful completion of Primary Exam which can help to set yourself apart in a crowded dentistry market.

Subjects covered Primary exam will assess six basic science subjects: Anatomy, Cell Biology & Biochemistry, Histology, Microbiology, Pathology and Physiology.

How to apply You’ll need to join the RACDS as an Affiliate Member first (www.racds.org/AffiliateJoin), then enrol in the Primary Exam by Friday 9 October: www.racds.org/PEreg

Exam preparation The GDP Handbook includes a guide to study and suggested reading list. RACDS offers access for those enrolled in the Primary Exam to past papers, Study Groups, Candidate Advisors, and an Orientation Course (www.racds.org/ OCreg), which is also offered online. Lectures are accessible at any time, and you will be granted 80 CPD Hours upon completion.

Exam components The Primary Examination consists of two parts: written paper of two hours duration for each subject, and viva voce examination for each subject.

Contact us Email: info@racds.org Tel: (+612) 9262 6044 Web: www.racds.org GDP Handbook: www.racds.org/gdphandbook

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President’s Report

WA Dental CPD Calendar

Clinical Presentation Answer

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ADAWA Council Notes

Education and Training

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R U OK? R U OK? Day is September 10

Understanding Dementia Treating patients to get better health outcomes

Legal Feature How the Board and AHPRA manage notifications – Regulatory Guide

10 ADAWA Councillors Celebrate Father’s Day We acknowledge the dental dads of ADAWA

14 CPD Spotlight Meet Drs Victor Matsubara and Poh Hun Loh

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Good News Stories Help for a war veteran, and round-ups from Dental Rescue Day and Homeless Connect Rockingham

DPL Feature Identifying child abuse

35 Professional Notices

25 Clinical Presentation Question

26 Clinical Feature Anatomy of the Root Canal System and its Clinical Implications Part 3: Premolars September 2020 Western Articulator | adawa.com.au

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President’s Report Dear Members,

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.

Please supply display advertisements as a highresolution PDF file (embed all fonts) or a JPEG file to media@adawa.com.au. Please ensure any graphics are of a high quality. Articles should be submitted as a WORD document with any graphics attached as separate files.

ISSN 2207-9351 (Online) Disclaimer: The views and opinions expressed in this publication and its attachments by advertisers and contributors are not necessarily endorsed by The Australian Dental Association (WA Branch) Inc. The Branch, its members, employees and agents do not assume any loss or damage which may result from any inaccuracy or omission in this publication, or from the use of the information contained, and make no warranties, express or implied, with respect to any of the material contained herein.

Firstly, in what has been a very challenging time, I believe I speak on behalf of ADAWA council, staff and the other members of the association in thanking you for maintaining your membership. The strength of our association is directly related to the commitment of our members, without which, we would not be able to undertake both the obvious and sometimes “hidden” functions of the association. In recognition of the often-unknown functions of our association we will now be including a regular summary of “Council Notes” in the Articulator to give you greater insight into the functions of your branch. As always, if you would like further information you are welcome to contact the branch or myself.

Given some of the poignant issues currently facing our profession, I am often asked about our current advocacy efforts. Advocacy is hard to quantify, takes time to develop and is a topic we rarely publicise as this can often compromise our ability to achieve our desired outcome.

Members may be surprised to know that in the time it takes for this draft piece of writing to go through production, design and printing, your CEO and members of executive will have met with multiple federal members of parliament, senators and the AMA to discuss issues on your behalf. Last week I was interviewed on ABC local radio in relation to HBF’s move to open dental practices and over the last few months a strong relationship has been built with the Cancer Council WA’s Make Smoking History team.

Many of you also play a sometimes-unknowing role in our advocacy efforts and this was particularly evident this week when meeting with a local federal member of parliament. We arrived to discuss vertical integration in healthcare only to find that her friend and long-term dentist had briefed her on the topic only a week before. I am, by no means, suggesting members should solicit their patients, but the diversity and reach of our members should not be underestimated, and in this situation, gave us a considerable leg up in the process.

Finally, a quick reminder that the print version of the Articulator will now be an opt-in process. For those members who enjoy reading the hard-copy version, we are more than happy to provide this for you but also recognise the waste that is avoided for those members who enjoy the digital version. I would strongly recommend downloading the Issuu app for a more streamlined digital reading experience.

Get Social Please contact adawa@adawa.com.au by September 18 if you’d like to continue receiving a printed copy of the Western Articulator.

Australian Dental Association WA @adawaoralhealth @adawa_perth Australian Dental Association WA

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Cheers Sean Archibald

September 2020 Western Articulator | adawa.com.au

ADAWA Council Notes Welcome Profession Hien Ngo ADAWA welcomes Professor Hien Ngo, as the newly appointed University of WA Head of Dental School and Director of the Oral Health Centre of WA (OHCWA), to Western Australia and to the WA dental profession.

The Western Articulator will feature Professor Ngo in an upcoming edition.

Thank you to Professor Robert Anthonappa ADAWA formally thanks Professor Robert Anthonappa for the outstanding work he performed in his capacity as the Interim Head of the Dental School and Director of OHCWA. Support for Victoria ADAWA will do our very best to ensure that our ADA Victorian colleagues who are currently on the distressing COVID “rollercoaster ride” are supported and not disconnected from the rest of the Association.

ADAWA Membership Renewal The ADAWA membership renewal period has been completed. The ADAWA council and office thank members for renewing. Council vows to continue to advocate and represent the membership and continue to maintain and improve services.

Dental Health Week 2020 Although Dental Health Week 2020 seemed somewhat subdued this year, many members answered ADAWA requests to provide interviews to media and be speakers to various community groups. Well done to these members who publicly represented the profession so admirably and to the many practices that participated in DHW this year.

Volunteers ADAWA-affiliated volunteerism has recommenced.

Well done to the volunteers who recently participated at Homeless Connect in Rockingham and the Australian Dental Health Foundation Dental Rescue Day at OHCWA. ADAWA is immensely proud of the high participation of members engaged across a range of dental volunteerism projects.

Council Elections ADAWA council has elected Drs Jenny Ball and Janina Christoforou as the ADAWA Federal Councillors for the next two years. Council formally thanked Dr Ross Bailey for his six years of considerable hard work and diligence in his role as Federal Councillor.

Council also elected Dr Rebecca Penco as the ADAWA representative to the ADA Recent Graduates Advisory Committee. Council thanked Dr Greg Crane for his work in supporting recent graduates on the Committee.

ADA House Renovations The ADA House building renovations are almost complete. There are many small projects outside the scope of works that still require attention. The completion of these projects will depend very much on the availability of budgetary funds over the next year or so.

HBF/Pacific Smiles Group Council remains steadfastly opposed to the recently announced HBF/Pacific Smiles Group dental practice ownership model in WA. The vertical integration model of healthcare has no place in dentistry. Council is pursuing discreet advocacy on the issue.

ADAWA Member Survey The recent ADAWA member survey is producing significantly varied responses. The variation is obviously a reflection of the diversity of the ADAWA membership.

Council thanks all those members who have participated and we look forward to more opinion from future surveys.

Cancer Council WA ADAWA is collaborating with the Cancer Council of WA to introduce Quit’s Smoking Cessation Online Training for WA Dental Practitioners. More detail of the training program will be released in the coming weeks.

ADAWA notice In accordance with Clause 39 of the ADAWA rules of the Australian Dental Association (WA Branch) Inc 2018, nominations from active (including concessional) and honorary life members are called for the election of ADAWA. Eight Ordinary Members of Council One Country Councillor (shall practice 50km or more from the Perth GPO) One Salaried Dental Councillor (shall hold a full-time Government salaried position) Nominations for Ordinary Members must be received at this office by noon, Friday September 25, 2020. A ballot (if required) will close at this office at noon, Monday October 19 2020 and will be counted during the afternoon.

Nominations for all positions must be on a form ‘Appendix B’ available at https://adawa.com.au/ members/regulations-guidelines/appendix-bnominations/ The results will be announced at the AGM on Wednesday, October 21.

September 2020 Western Articulator | adawa.com.au

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FEATURE

understanding

dementia

There are, currently, around 41,600 Western Australians living with dementia. As September marks Dementia Awareness Month, it’s timely to consider how we treat those patients with this condition

by Brooke Evans-Butler

It is very likely that at some point you will treat a patient who has dementia.

Jason Burton, Alzheimer’s WA Head of Dementia Practice and Innovation, says there are over 41,600 Western Australians diagnosed with dementia. “It is approximated that seven out of 10 people know someone who has been impacted by dementia,” he says.

Dementia is the most prevalent neurological condition in Australia and set to become the number one cause of death in the next decade. “Often people living with dementia have comorbidities of other health issues.

Management of the health needs of a person living with dementia can be more complex,” Jason explains.

“This may be due to difficulty in communicating health issues; we often see undiagnosed pain as a major untreated issue, for example.”

Medication compliance difficulty and increased risk of other health issues, such as falls or poor oral health, are also common. “Research has shown that people living with dementia are more likely to have poor oral health and that oral health issues can significantly exacerbate the person’s level of cognitive impairment,” he explains.

“ It is imperative that health practitioners understand the impact of dementia on the individual they are treating.”

“This starts with a good general knowledge of the different types of dementia, how cognitive disabilities of dementia can affect a person, and how issues such as stigma, loneliness or social malignancy can impact on mental and physical health for the individual,” he explains.

“With a solid foundation of dementia knowledge, the practitioner can then review the impacts on the individual and how these impacts are affecting health, and how they may create barriers to effective treatment.”

Common mistakes “Practitioners don’t often know the full impact of how the dementia is affecting the person and may go on feedback from the person with dementia, which may not be accurate,” Jason explains. “Another common issue is that the practitioner may put the person’s behaviour or communication down to their dementia when it may more commonly be due to the person’s health condition or the way the person is feeling.

“A study by Dementia Support Australia found that the majority of people living with dementia referred to them due to distressed behaviour had undiagnosed pain that was making them communicate their distress through their behaviour.

“Not recognising the individual needs of the patient due to their neurological condition in regards to prompts for appointment times, difficulties the physical environment may be causing or positively responding to increased stress and anxiety they may be feeling are common barriers for a person living with dementia.”

Significant oral-health issues “Common oral-health problems in older people are caries, periodontitis, reduced salivary flow, candida, and mucosal lesions,” Jason says. “Whilst not all people living with dementia are older, the majority are.

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FEATURE

“These common older-person issues are often increased for a person living with dementia. This can be due to side effects of medications such as psychotropics, poor oral hygiene practice as the person forgets to clean their teeth, poor hydration as the person may not be drinking enough fluids during the day, ill-fitting dentures due to the person forgetting to go to appointments or difficulty in maintaining oral health due to poor motor skills or apraxia.”

The person may also be reluctant to accept help from their carer as they feel their autonomy is diminishing – which can also lead to poor oral hygiene.

Challenges when going to the dentist or other medical appointments “A lack of awareness of dementia and in particular how dementia may be impacting a person’s daily life remains the greatest barrier to inclusive health care access,” Jason says. “The carer may also be facing a challenge in the person living with dementia not recognising their health needs and therefore being reluctant to attend medical appointments.

“This may be magnified if the person is feeling stigmatised and insecure because of their diagnosis and how people are responding to them.”

“If the person is living in a residential care home, the staff’s practice and level of skill and knowledge of oralhygiene maintenance may also be a contributing factor to oral-health outcomes for the individual,” Jason adds.

“People with more advanced dementia may also have swallowing difficulties and be reliant on others for their oral-hygiene needs.”

Special needs dentist Dr Daniel Sundaresan says oralhealth problems usually seen are more a reflection of polypharmacy, as well as a reliance on carers to provide oral hygiene. “Commonly this presents as caries (more so root caries) and periodontal disease,” he says. “For those patients with dentures, often we see minimal denture hygiene and the effects of that on oral tissues.”

“ Research has shown that people living with dementia are more likely to have poor oral health and that oral health issues can significantly exacerbate the person’s level of cognitive impairment.”

September 2020 Western Articulator | adawa.com.au

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FEATURE

Jason says some key areas that could be improved include: • Dementia understanding and response training for all staff in the practice • A dementia practice inclusion plan that identifies how staff will support a patient with dementia • Awareness by all practice staff of a person’s diagnosis • Understanding of the impacts of dementia on the person and a holistic support plan that reflects this • Ensuring the person with dementia is engaged in the conversation and feels included and in control of their health discussions • Providing a physical environment that is enabling and supports accessibility for people living with dementia • Considering how the practice can provide reminders to the person about their appointment date and time • Identifying ways that the person can be made more at ease including the use of personalised music or the presence of a carer or friend during procedures or consultations • Liaising with the persons primary carer to get additional information on the person’s health and challenges in treatment • Consideration of how the treatment plan will be managed by the person and any additional supports that may be needed to ensure adherence.

says. “By having an understanding of dementia, we are in a better position to be aware of what considerations we need to take into account when treatment planning.

This could include what dental materials are more likely to succeed, but also when to consider more aggressive treatment options, such as extractions, in the face of worsening cognition.”

He says knowing how dementia presents and progresses will not only aid in treatment planning, but also influence how that treatment is provided.

“ Common oral-health problems in older people are caries, periodontitis, reduced salivary flow, candida, and mucosal lesions.”

“It means that goals of care are realistic, and that carers/ family are more likely to trust in your ability to provide the best care possible, as you are able to discuss a variety of treatment options,” he explains.

Patients with advanced dementia can be seen at Fiona Stanley Hospital, but patients with mild and moderate dementia tend to be seen by their local dentists.

Special needs dentistry advice According to Daniel, a dentist cannot appropriately treatment plan a patient if they do not understand the pathology behind what they are seeing.

“There are many causes of dementia, and while presentations differ, so do rates of progression,” Daniel 8

September 2020 Western Articulator | adawa.com.au

To make visiting the dentist an easier experience for someone who has dementia, Daniel recommends keeping appointments short and limiting the number of people in the surgery. “Minimise distractions by turning the radio off, giving patients time to respond, and trying to use close-ended questions,” he adds.

FEATURE

Statistics

Carer perspectives

The dementia statistics are alarming and highlight the importance of understanding this condition: • Dementia is the second-leading cause of death of Australians.

• In 2020, there is an estimated 459,000 Australians living with dementia. Without a medical breakthrough, the number of people with dementia is expected to increase to 590,000 by 2028 and 1,076,000 by 2058.

• Currently an estimated 250 people are joining the population with dementia each day. The number of new cases of dementia will increase to 318 people per day by 2025 and more than 650 people by 2056.

• Three in 10 people over the age of 85 and almost one in 10 people over 65 have dementia.

• In 2020, there were an estimated 27,800 people with younger onset dementia, expected to rise to 29,350 people by 2028 and 41,250 people by 2058.

We asked carers and loved ones of people with dementia what they wish health professionals would know:

Source: Dementia Australia, www.dementia.org.au/statistics

Dr Daniel Sundaresan’s tips to make a dental appointment more comfortable for a patient with dementia: • Speak to the family beforehand about what their goals for dental care are • Have an updated medical history including any changes in behaviour, and level of dependence for care • Involve and educate carers – the success of any treatment plan is based on what carers know and are able to provide.

Resources for health professionals

Always speak to the care giver and do it discreetly and respectfully. (Ash) It is important for a medical practitioner to listen to the patient. We were lucky with my nanna that we had professionals around her who were patient and took their time to listen to her. (Alissa) The main thing we encountered was my dad being partially ignored during medical appointments.

This wasn’t always the case, but sometimes the doctor would forget who the patient was, similar to when treating a child. Dad would get frustrated.

Mum found certain places would make an effort to do their best to engage with Dad on some level… he may not have understood but by giving him the dignity to be included in his health management at least made this less taxing for Mum, as she would be faced by the questions from Dad as to what was going on. (Rebecca) Involving the family and carers is critical in formulating a management plan for the most optimal care. I found that taking my grandpa to appointments was invaluable since he needed someone that he could trust and also someone who would be able to further explain what was happening with management. This allowed for improved compliance during the appointment and also with home care. I still remember that he would always look to me to ensure that everything was proceeding well in the consultation. (Janina)

Jason recommends the following resources for health professionals who want to learn more about dementia: • Information for professionals and families: https://alzheimerswa.org.au/ • Creating a dementia-enabling environment: https://www.enablingenvironments.com.au/ • General dementia training: https://www.utas.edu.au/wicking/understandingdementia Dementia Australia also offers online courses through their Centre for Dementia Learning, some of which are free, https://dementialearning.org.au/

Resources for dentists Did you know? An online video series, Partnership in Practising Care: Quality Dental Care for People with Dementia (an initiative of the Australian Dental Association and Alzheimer’s Australia) is available for dentists to access via the ADA’s CPD portal.

September 2020 Western Articulator | adawa.com.au

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FEATURE

ADAWA Councillors celebrate Father’s Day Dr Ross Bailey Federal Councillor Ross is a father of two (to Tim and Clare, a dentist who works alongside her dad), and grandfather to Clare’s young children, two-year-old Logan and eight-month-old Mila.

Has being a dad (and a grandparent) made you a better dentist?

I think the responsibilities of parenthood have made me better at understanding the problems people face.

Parenthood makes a lot of people time poor (not just me). You have to be a bit more understanding of patient concerns regarding time and budget, because they are your concerns also.

“ I am proud of the people my children have become; this gives me great satisfaction. I enjoy their company and I enjoy watching Logan and Mila develop.”

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It doesn’t make paediatric dentistry any easier, although it’s made me more sympathetic to the parents of my youngest patients.

Do you look at the world differently since becoming a father and grandfather?

Without doubt. I wonder more and more what sort of world these young people are going to inherit.

What do you enjoy most about being a father and a grandfather?

I am proud of the people my children have become; this gives me great satisfaction. I enjoy their company and I enjoy watching Logan and Mila develop. We went

FEATURE

“ Fatherhood has also probably made me a bit more relaxed and contented with the smaller things in life.”

away (in WA) together for the school holidays, and the improvement in Logan’s speech and understanding over the two weeks was obvious to me. Mila is about to start crawling; her determination and effort to get moving was fascinating.

Over the years, how have you juggled fatherhood and family life with work as a dentist? Do you have any advice to a new dad dentist who is working out this juggle between parenthood and work?

My dental life, family life, and life in general would not have been the same without the support of my wife, Daphne, who through most of it has been a full-time teacher herself. I really don’t know how single parents can do it; I take my hat off to them.

My advice is to spend as much time with your children (and grandchildren) as you can.

Dr Tim Clair Councillor Tim and his paediatric oncologist wife, Annie, are the proud parents of five-year-old Lucy and five-month-old Joseph.

Has becoming a dad made you a better dentist?

As dentists, it is always good to follow the mantra of treating patients how you would expect members of your own family to be treated; and certainly since having children, the importance of family and this analogy has been emphasised to me so much more.

And it goes without saying that since becoming a father I feel my ability to relate to young patients has grown exponentially. Given I have a five-year-old daughter, I can definitely hold my own when chatting about any Disney princesses, unicorns, and most superheroes!

Has being a dentist been beneficial since becoming a father?

Working in dentistry gives a first-hand knowledge of the importance of health and general wellbeing, and I certainly reflect on this in parenthood.

Dentistry also, of course, goes hand-in-hand with skills in making decisions in the interest of someone

September 2020 Western Articulator | adawa.com.au

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FEATURE

else, balancing competing priorities, effective time management, being flexible and maintaining calm under pressure – all traits that I endeavour to bring into parenthood – albeit with mixed levels of success!

Dentistry as a profession can also offer a flexible and diverse career. We were recently in Canada for almost two years and I took time away from dental practice as we went for Annie’s medical fellowship. In this regard the flexibility that comes with being a dentist enabled me to take some time off to be the stay-at-home dad, and also opened doors to a part-time research position that I took up in the Faculty of Dentistry at the University of Toronto while Lucy was at school.

How do you look at the world differently since becoming a father?

Fatherhood has made me appreciate more each person’s individuality and I was amazed how early personality, determination and ability to reason was expressed in Lucy. As a parent I have found that you don’t get far by imposing the rule of law, and a lot of parenting seems to be about patience, tolerance and understanding someone else’s needs. This of course holds true for life in general.

Fatherhood has also probably made me a bit more relaxed and contented with the smaller things in life.

What do you enjoy most about being a father?

The love and joy that your kids give and being amazed watching them grow and develop new skills. Joe is full of smiles at the moment – and they are very infectious, so it is hard not to feel pretty good about life when he’s smiling at you. As Lucy has grown up, I always feel as though each new stage is even better than the last; long may this continue, though who knows what lies ahead with the teenage years yet to cross our path!

What would your advice be to another dad dentist who is juggling parenthood with work?

Appreciate that everyone’s circumstances are different, and solutions will be different for each family. For us, we have recently decided that I will reduce my clinical hours to four days per week, and we are both adjusting our schedules to be able to do school pickups for Lucy some days and arranging care for other days. Earlier in our time as parents, when Annie and I were both very busy with work, I would sometimes feel that I wasn’t completely nailing either work or parenthood. I used to push the envelope and be running into childcare right on closing at 6pm. I try not to do this now – it is not worth the stress.

As much as possible, I really try to focus on work when I am there and home life when away from the workplace.

We feel very fortunate to be able to make adjustments to our work schedule to benefit our family life.

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Dr Greg Crane Councillor Greg has two children with his wife Susan (three-and-a-half-year-old Angus and at the time of this interview and photo, two-week-old baby girl, Arkie).

Has becoming a dad has made you a better dentist?

Fatherhood has, without a doubt, made me practise dentistry differently, for the better. I have greater empathy for the busy schedule and financial changes being a parent brings. I have also found that being a parent has brought me a new level of connection to patients and a lot of funny stories to exchange with other parents.

I would say I’m more relaxed and don’t sweat the small stuff like I used to. For me, I feel this is a combination of both parenthood and experience in dentistry, for example, I am far less stressed when running late, be it in clinic or for Angus’ swimming lessons.

I have found having children has made me self-reflect a lot more. Children are the perfect mirrors and parrots, especially for your weaknesses.

Has being a dentist been beneficial since becoming a father?

Yes, I am very fortunate that dentistry, and the practice I work at, is supportive of part-time work and familyfriendly hours, as nearly all the staff where I work are parents. I reduced my clinical hours when Susan went back to work and it’s one of those jobs that allows a more flexible work-life balance.

Being a dentist has come in handy, not only when cleaning Angus’ teeth and preparing him for his dental visits, but for keeping a calm presence in those stressful situations and being able to empathise – although that can be challenging!

I have also found the skills of being able to multi-task, plan ahead and adapt calmly when needed very handy for both work and home.

FEATURE

How do you look at the world differently since becoming a father?

For one, I have a newfound respect for my parents, realising the sacrifices they made when raising me and my sisters. I have a more relaxed outlook as I’ve learnt that there are a lot of things that are out of your control and that life is a lot more fun when you accept that things may not run exactly to plan. For example, on the weekend my almost four-year-old and I were in line at a busy café and he yells out whist looking at the man behind me – “Daddy, why does that man have green holey teeth?” – which was a reference to decayed teeth in a recent book we had read. I attempted to explain that it isn’t polite to voice people’s differences and then got a glimpse of what he was talking about – the middle-aged man proudly sporting green elastics on his braces (and a smile).

Kids have the most amazing imagination, innocence and honesty in their view of the world, which is beautiful to be a part of.

What do you enjoy most about being a father?

It is honestly very hard to put into words – being a father is a huge challenge and is one of the biggest commitments I’ll ever make, but it has already provided me with far greater rewards than I could ever have imagined, and I’m only four years in. I love spending time with my kids, seeing the world through their eyes, hearing their funny stories, helping and watching them grow and learn, and seeing their personalities emerge.

What would your advice be to another new dad dentist who is juggling parenthood with work?

It is a big change; my advice would be: 1) Lock in some regular family time and stick to it; 2) You will have a lot less personal time but don’t neglect your own outlets and mental health. It helps me to be more focused, present and connected; and 3) Don’t be afraid to reach out for, or take, help. I would like to give a special thank you to my wife Susan. I would not be the father, or clinician, I am today without her support.

PHOTO: MISTY DJUKICH / RAW AND WILD PHOTO @RAWANDWILD.PHOTO

“ Being a father is a huge challenge and is one of the biggest commitments I’ll ever make, but it has already provided me with far greater rewards than I could ever have imagined, and I’m only four years in.”

September 2020 Western Articulator | adawa.com.au

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CPD SPOTLIGHT

Meet

Drs Victor Matsubara & Poh Hun Loh Ahead of their Single Crowns Prep course in September, Brooke Evans-Butler caught up with Drs Victor Matsubara and Poh Hun Loh

With COVID restrictions putting many hands-on courses by interstate and international lecturers on hold, we are lucky to have quality presenters at our doorstep.

It is clear both Drs Victor Matsubara and Poh Hun Loh are passionate about prosthodontics.

“Prosthodontics is a speciality where you need to know a little bit about all aspects of dentistry,” Poh Hun says.

“Fundamentally, though, it’s about improving the mouth and giving people an outcome that they are happy with.

There is nothing more rewarding than putting a smile back on a patient’s face. It’s good to know that I have had some part to play in helping them get to that point.”

As employees of The University of Western Australia, both are well-versed in teaching both students and professionals the tricks of the trade. Both also bring different experiences to the table: Victor arrived in Perth from Brazil three years ago and is a consultant in prosthodontics at OHCWA and a researcher, while Poh Hun is a prosthodontist at OHCWA and in specialist private practice.

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“(Victor and I) share an office and teach many units together. We share very similar approaches, ideas and teaching philosophies,” Poh Hun says, adding that they have agreed to disagree on the best national soccer team.

Victor and Poh Hun will be presenting their hands-on course, Single Crown Prep, in September. A range of full coverage crowns will be covered with feedback using digital tools.

Victor says attendees will have the chance to improve their skills and crown preparations using digital tools, such as intra-oral scanner and CAD-CAM technologies. “After practising different crown preparations, attendees will be able to scan their prep and we will mill a single crown that will be sent to attendees after the course,” he says.

“This course may work as a good introduction to digital dentistry.”

The hands-on course will be suitable for clinicians who are having problems with the seat and adaptation of their crowns, especially CAD-CAM restorations, and those who want to improve their restorative work by using digital tools.

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CPD SPOTLIGHT

five minutes with Drs Victor Matsubara & Poh Hun Loh Which three words best describe you?

“ There is nothing more rewarding than putting a smile back on a patient’s face. It’s good to know that I have had some part to play in helping them get to that point.”

“I hope everyone improves the self-assessment of their preparations, learning how to be more conservative without compromising the final prosthetic work, and also learns how to use digital technologies to improve their preparations,” Victor adds.

When asked what he believes are the most common challenges dentists face with tooth restoration, Victor says the challenges are related to the indication of the ideal restoration for each clinical situation that can provide long-term success and meet the patient’s expectations.

“There is no one-size-fits-all approach in restorative dentistry,” he adds.

Poh Hun and Victor will present Single Crown Preps on September 12 at UWA Dental School.

Victor: Dedicated dentist and father.

Poh Hun: Tall daggy dad.

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

Victor: I would love to be involved with any activity in the ocean, perhaps a marine biologist.

Poh Hun: I haven’t really thought about this one, but I’m sure it would revolve around food, eating, travel.

Perhaps a photojournalist for Gourmet Traveller magazine!

What do you do in your spare time?

Victor: Surfing is my favourite sport and my passion from a young age, but since the arrival of my son, playing with him is taking all my spare time.

Poh Hun: I spend time with my three kids (Elliot, 7, Aubrey, 4 and Julian, 1); they really are the centre of my world at the moment and keep me grounded.

We do jobs around the house, shop for groceries, cooking and planning our next meals together – well, the one-year-old watches with a keen eye!

Where is your favourite place in the world?

Victor: The beach in Brazil where I learned how to surf. Good memories of that place. We do not need to go too far to find a stunning view of the ocean with not many people around.

Poh Hun: I grew up in Malaysia and it’s the food and the opportunity to eat all hours of the day that makes it my happy place. But ultimately home is Perth and my favourite place to be.

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

Victor: I play a bit of acoustic guitar, but definitely need to practise more.

Poh Hun: I love to eat and cook. I even read about food on blogs, Facebook and Instagram.

September 2020 Western Articulator | adawa.com.au

15

You’ve dedicated your life to taking care of others, but in these new and uncertain times it’s never been more important to take care of yourself too.

Our wellbeing service offers: • • • • •

A free counselling service from ICAS International The eCare app, available on iOS and Android Webinars to help build resilience and avoid burnout Wellness advice booklets available to download A range of online articles, podcasts and courses to help you take care of yourself.

Find out more at dentalprotection.org.au DPL Australia Pty Ltd (“DPLA”) is registered in Australia with ABN 24 092 695 933. Dental Protection Limited (“DPL”) is registered in England (No. 2374160) and along with DPLA is part of the Medical Protection Society Limited (“MPS”) group of companies. MPS is registered in England (No. 00036142). Both DPL and MPS have their registered office at Level 19, The Shard, 32 London Bridge Street, London, SE1 9SG. DPL serves and supports the dental members of MPS. All the benefits of MPS membership are discretionary, as set out in MPS’s Memorandum and Articles of Association.

“Dental Protection member” in Australia means a non-indemnity dental member of MPS. Dental Protection members may hold membership independently or in conjunction with membership of the Australian Dental Association (W.A. Branch) Inc. (“ADA WA”). Dental Protection members who hold membership independently need to apply for, and where applicable maintain, an individual Dental Indemnity Policy underwritten by MDA National Insurance Pty Ltd (“MDA”), ABN 56 058 271 417, AFS Licence No. 238073. DPLA is a Corporate Authorised Representative of MDA with CAR No. 326134. For such Dental Protection members, by agreement with MDA, DPLA provides point-of-contact member services, case management and colleague-to-colleague support. Dental Protection members who are also ADA WA members need to apply for, and where applicable maintain, an individual Dental Indemnity Policy underwritten by MDA, which is available in accordance with the provisions of ADA WA membership. None of ADA WA, DPL, DPLA and MPS are insurance companies. Dental Protection® is a registered trademark of MPS.” 1911270755 08/20

$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: 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.

Sponsored by:

The practical component will focus on: 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”

$1,045 inc GST Single Crown Preps – a hands-on course Saturday 12 September | CPD Hours: 4.5 Presented by Drs Poh Hun Loh and Victor Matsubara Registration from 8.45am, Course 9am to 2pm UWA Dental School, 17 Monash Ave, Nedlands Bookings & Enquiries adawa.com.au/cpd This hands-on course will focus on the full coverage tooth restoration. It will focus on the premise that attendees should know how to prepare these preparations but may enjoy some guidance from experienced prosthodontists who can look over shoulders and offer some guidance.

A variety of full coverage crowns will be covered with feedback using digital tools. Along with taking a traditional impression, attendees will scan a preparation which following the course will be 3D printed, a milled crown fabricated from that model which along with the digital model will be forwarded to the attendee.

About the Presenters Dr Loh is a senior lecturer in restorative dentistry at the UWA Dental School where he is responsible for teaching prosthodontics and restorative dentistry to dental students and specialists in training. Dr Loh has been involved in continuing education and post-graduate teaching and assessments nationally and internationally. He is a prosthodontist at OHCWA and in a specialist private practice in West Perth.

Dr Matsubara is a consultant in prosthodontics at OHCWA and a researcher. His clinical activities have been focused on oral rehabilitation using implants and digital dentistry tools. Dr Matsubara has delivered lectures across different topics in oral rehabilitation and oral implantology nationally and internationally. He is currently working full-time at UWA Dental School as a senior lecturer in restorative dentistry.

Sponsored by:

September 2020 Western Articulator | adawa.com.au

17

Dental CPD Calendar SEPTEMBER It’s Not Just About the Spine: Understanding and Managing Spinal Pain

OCTOBER 04

Predictable and Easy Root Canal Instrumentation and Filling Techinques

Professor Peter O’Sullivan

Winthrop Professor Paul Abbott AO

ADA House, West Perth

UWA Dental School, Nedlands

Friday: 1.00pm–5.00pm

OCTOBER 02

05

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

D LLE

N

Tuesday: 9.00am–5.00pm CA ADA House, West Perth

AOS WA Dinner Meeting

09

Associate Professor Johan Aps

Dr Josh Graieg

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

UWA Dental School, Nedlands

ADA House, West Perth

University Club, Crawley

Saturday: 8.00am–5.00pm

The Art of Digital Photography & its Clinical Applications Szabolcs Hant & Dr Graham Carmichael

12

Single Crown Preps – a hands-on course

UWA Dental School, Nedlands

D ONE

TP POS

18

Dr David Booth & Dr Carolyn OOStulner

B

Saturday: 9.00am–2.00pm LLY

Dr Ben Lee

D ONE

TP POS

19

Infection Control: Ensure you and your Team are Confident and Compliant [PERTH]

Dr Asheen Behari & Dr Paul Gorgolis

Friday & Saturday: 9.00am–5.00pm NPP Day

22

FREE full day event More details to come

Socket and Ridge Preservation Hands-on Work Shop

24

14

Saturday: Time TBC NEW COURSE

ADA House, West Perth (virtual meeting)

E ELL C N CA Saturday: 9.00am–5.00pm

6/7

UWA Dental School, Nedlands

Thursday: 9.00am–5.00pm

Kylie Robb

Event Types:

17

Kylie Robb

Infection Control: Ensure you and your Team are Confident and Compliant [ALBANY]D

NOVEMBER Porcelain Veneers and Ceramic Onlays – A Practical Approach to Multiple Restorations

UWA Dental School, Nedlands

UWA Dental School, Nedlands

KED

17

Saturday: 9.00am–5.00pm

Friday: 9.00am–5.00pm

Practical Oral Surgery

The A-Z of Mastering Anterior Crowns

31

CTEC, Crawley

Duxton Hotel, Perth RSVP to apswasec@gmail.com

Saturday: 9.00am–2.00pm

Practical Oral Surgery Saturday: 9.00am–2.00pm

Saturday: 8.30am–4.00pm

Drs Poh Hun Loh & Victor Matsubara

Modern Techniques in Post and Core

Australian Prosthodontic Society – Contemporary Prosthodontics 2020

NEW DATE

Dr David Booth & Dr Carolyn Stulner

ADA House, West Perth (virtual meeting)

NEW COURSE

U CTEC, Crawley F

14

Wednesday: 9.00am–5.00pm

ADA House, West Perth

Dr Chris Moule

Prosthodontic Problems?

Plan to Prevent Them!

Dr Ben Lee

Friday: 9.00am–5.00pm

31

Friday: 6.30pm–9.00pm

Friday: 6pm–9.00pm

11

27

Associate Professor Axel CESpahr

Friday: 8.30am–5.00pm

Submersion into DMFR – One Day Crash Course

Perio-Potpourri: an Update in Clinical Periodontics

21

Drs Leticia Algarves Miranda & Mahnaz Syed

Saturday: 9.00am–2.00pm ADA House, West Perth

Albany Entertainment Centre, Albany

WA Dental CPD Events ADAWA General Meetings Other CPD Events Please note that parking is very limited for any daytime courses at ADA House, West Perth. Attendees should make themselves aware of public parking facilities in the area, or use public transport. The Red CAT bus route is conveniently located for ADA House.

Online Bookings are available on the ADAWA website adawa.com.au in the CPD area. A receipt will be issued listing the course name, date and applicable CPD hours, when registrations are processed. A Certificate of Participation will be provided after attending the course. Replacement certificates cannot be provided.

18

September 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

DECEMBER Anxiety Relief in the Dental Surgery

D ONE

STP O P Friday: 9.00am–5.00pm Dr Steven Parker

FEBRUARY 2021 04

Dr Steven Parker

ED PON

Saturday: 9.00am–5.00pm ST

O

P Nedlands UWA Dental School,

Dr Clarence Tam

20

Saturday: 9.00am–5.00pm

UWA Dental School, Nedlands

UWA Dental School, Nedlands

Pain Relief for Your Patients

To Prep or Not to Prep

05

Posterior Composites

21

Dr Clarence Tam

Sunday: 9.00am–5.00pm

UWA Dental School, Nedlands

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

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

ADAWA ANNUAL GENERAL MEETING 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

WEDNESDAY 21 October 2020 Ellie J Ladner Lecture Theatre RSVP adawa@adawa.com.au

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.

6.15PM “Eat and Meet” Your chance to meet with Council and other members of the Association

7.30PM General Meeting Immediate start

8.00PM Lecture Hezel Cohen

September 2020 Western Articulator | adawa.com.au

19

EDUCATION & TRAINING

Contemporary Prosthodontics 2020 Saturday, October 17, 2020 Duxton Hotel, 1 St Georges Tce, Perth 8.30am – 4.00pm

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

September 3, 2020 October 1, 2020 November 5, 2020 Venue: ADA House, 54 Havelock Street West Perth @ 6pm To register, please email prosstudyclub@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.

20

September 2020 Western Articulator | adawa.com.au

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

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

Our classifieds and job board have moved to our website. Be sure to keep up-to-date with the latest advertisements, or place an ad via the online form. Visit adawa.com.au/classifieds/

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

September 2020 Western Articulator | adawa.com.au

21

LEGAL FEATURE

How the Board and AHPRA manage notifications: the regulatory guide

by Enore Panetta

In July 2020, the Australian Health Practitioner Regulation Agency (AHPRA) published a new Regulatory Guide to provide a better understanding of how the Health Practitioner Regulation National Law (National Law) is applied in the management of notifications.

The Regulatory Guide sets out how AHPRA and the National Boards manage notifications about the health, performance and conduct of practitioners under the National Law. Key takeaways from the Guide include: 1.

Notifications A notification is a complaint about a health practitioner or a notification of certain circumstances to AHPRA or a Board by a health practitioner or employer. A person who makes a notification is called a ‘notifier’.

A person who, in good faith, makes a notification or gives information in the course of an investigation by a Board or AHPRA, is not liable civilly, criminally or under an administrative process for giving the information. Good faith is not defined in the National Law so it adopts its ordinary meaning of ‘wellintentioned or without malice’.

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September 2020 Western Articulator | adawa.com.au

There are certain circumstances in which a registered health practitioner, employer or education provider must make a notification about another registered health practitioner. These notifications are called mandatory notifications. Voluntary notifications may be made by anyone, including patients and members of the public.

2.

Preliminary assessment A Board must, within 60 days after receiving a notification, conduct a preliminary assessment.

A Board may decide, at the preliminary assessment stage, to take no further action notification if: • the notification is frivolous or vexatious • it is not practicable for the Board to investigate • the person to whom the notification relates has not been, or is no longer, registered • the subject matter of the notification has already been dealt with adequately by the Board • the subject matter of the notification is being dealt with, or has already been dealt with, by another entity, or • the health practitioner to whom the notification relates has taken appropriate steps to remedy the

LEGAL FEATURE

subject matter of the notification and the Board reasonably believes no further action is required about the notification.

3.

7.

A Board must refer a matter to a responsible tribunal if it forms a reasonable belief that: • a practitioner has behaved in a way that constitutes professional misconduct, or • a practitioner’s registration was improperly obtained because the practitioner or someone else gave the Board information or a document that was false or misleading in a material particular.

Immediate action Immediate action is interim action that a Board can take to restrict or suspend a practitioner’s ability to practise. A Board will do so if it reasonably believes that interim regulatory action is necessary to protect the public from a serious risk, or is otherwise in the public interest.

After a decision has been made to refer a matter to a responsible tribunal, the Board will start a disciplinary proceeding against the practitioner.

The responsible tribunal is responsible for managing the proceeding, and will generally order the parties attend a compulsory conference to see if the matter is capable of resolution.

Examples of conduct or circumstances in respect of which immediate action may be taken include: • alleged serious criminal conduct • conduct unconnected to practice that may diminish the public’s confidence in the profession • serious performance issues • sexual misconduct • serious substance abuse • breaches of conditions on registration • a practitioner has, or may have, an impairment 4.

Health and performance assessments In some circumstances, a Board may require a registered health practitioner to undergo a health assessment and/or a performance assessment.

The Board is responsible for paying for the assessment.

5.

Investigations A Board may investigate a registered health practitioner if it decides it is necessary or appropriate to do so.

Investigators appointed under the National Law have various statutory powers to obtain evidence and information relevant to an investigation, including: • powers requiring a person to provide information, answer questions or produce documents, and • powers permitting the investigator to search places (such a practitioner’s residence, or place of practice) and seize objects or documents.

At the conclusion of an investigation, the investigator must provide the relevant Board with a written report (which includes the investigator’s findings sand their recommendations about any action to be taken). The Board will then consider the investigator’s report and decide whether or not to take further action about the matter.

6.

Relevant action under section 178 of the National Law

Referral to the responsible tribunal

A final hearing may be required to determine any issues the parties were not able to resolve, or depending on the jurisdiction, to approve any agreed outcome.

8.

General principles relating to determinations under the National Law Decision-makers, when considering the form of determinations that are appropriate in a particular case, will consider factors including: • Specific deterrence • General deterrence • Protection of / confidence in the profession • Maintenance of professional standards • Rehabilitation • Insight • Remorse • Evidence of good character • Level of experience • Delay • Personal circumstances • Disciplinary history • Impact on complainant/victim • Impact on patient community

Some of these principles or factors will be given more or less weight than others (or not considered at all), depending on the facts and circumstances of the matter.

The full Regulatory Guide can be found here: https://www.ahpra.gov.au/News/2020-07-02-Regulatory-guide.aspx

Relevant action may include one or more of the following: • cautioning the practitioner • accepting an undertaking from the practitioner • imposing conditions on the practitioner’s registration, or • referring the matter to another entity.

September 2020 Western Articulator | adawa.com.au

23

DPL FEATURE

Identifying child abuse

by Dr Kiran Keshwara & Dr Annalene Weston, Dentolegal Consultants at Dental Protection Covid-19 has affected us all; however, those groups who are more vulnerable are most at risk. One of those most vulnerable groups of people are those who cannot defend or speak for themselves such as children in abusive homes.

In an environment of rising unemployment, social restrictions, and an increase in alcohol consumption, home confinement has shown an increase in domestic abuse.

Children can be clumsy and accidents are inevitable, however, in the provision of dental care to children, it is important to be aware of the signs and symptoms of abuse or neglect, and how to raise your concerns appropriately.

What should I look for?

Oral and facial trauma occurs in approximately 50% of physically abused children, and this may manifest in a number of ways, including: • fractured teeth • bruising, lacerations and abrasions of the tongue, lips, oral mucosa, fraenum and hard and soft palate • dislocations • avulsed teeth • mandibular and maxillary fractures Along with the physical signs, a child may be withdrawn, aggressive or fearful, and the parents or guardians may be failing to seek proper dental care. This can be indicative of other underlying issues.

What can I do if I suspect a child is being abused?

If a dental professional finds any signs of abuse, it is important for them to delicately question the child, in a non-judgemental and non-leading manner, on how the injury happened, and try to compare the stories told by the child and their carer. It is important to accurately record the injuries by means of photographs, x-rays, and thorough note taking. You should record an accurate medical history, in which the patient’s GP contact details should be included.

It can be a difficult decision to discuss concerns with the parents or guardians, as there may be a fear that they will get offended or, worse still, angry or violent. However, most parents would understand that you have the child’s best interests at heart and would be appreciative of 24

September 2020 Western Articulator | adawa.com.au

a frank discussion. In all cases, it would be important for dental professionals to trust their judgement of the situation based on how well they know the parents or guardian and the child.

It is important to note that where a child’s health and safety is considered to be at risk, the records can be released without consent of the carers in some circumstances.

In summary, a dental professional is required to make a report to child protection services if they are to form a reasonable belief that the child has been, or currently is, at risk of abuse. All states and territories in Australia have enacted mandatory reporting for suspected abuse and neglect, however, there are differences between them with regards to who is mandated to report. If dental professionals believe that a child is in immediate danger, they should call the police on 000.

Clinicians are also advised to raise their concerns with the team at Dental Protection so they can be guided through what can be a very complex issue.

Additional resources The relevant reporting authority for suspected child abuse and neglect each state can found at: https:// aifs.gov.au/cfca/publications/cfca-resource-sheet/ reporting-child-abuse-and-neglect You can also talk to trained professionals at Kids Helpline on 1800 55 1800 or Lifeline on 13 11 14.

If you are experiencing a personal crisis, you may wish to call: Lifeline: 13 11 14 Relationships Australia: 1300 364 277 1800 Respect national helpline: 1800 737 732

References https://aifs.gov.au/cfca/publications/mandatoryreporting-child-abuse-and-neglect https://www.racgp.org.au/clinical-resources/clinicalguidelines/key-racgp-guidelines/view-all-racgpguidelines/white-book/child-abuse#ref-num-142

CLINICAL PRESENTATION

Q+A

Dr Amanda Phoon Nguyen, Oral Medicine Specialist

Miss H is a 17-year-old female who was referred to me with a four-week history of a painless, firm, lower lip swelling (a). This was accompanied by: (b) Lip fissuring (c) Mucosal cobblestoning (d) “Staghorning” She also reported a history of “mouth sores”. Her medical history was significant for an allergy to peanuts, and she has eczema. Otherwise, she is fit and healthy and denies any other symptoms. She takes no regular medication.

She has never smoked and does not consume alcohol.

a)

b)

c)

d)

What is her likely diagnosis? a) b) c) d) e)

Angioedema Tuberculosis Deep fungal infection Lip filler gone awry Oral Crohns

See page 29 for answer.

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CLINICAL FEATURE

Anatomy of the root canal system and its clinical implications Part 3: Premolars

by Dr Gaurav Vasudeva, Endodontist info@rootcanalspecialist.org.au

Maxillary and Mandibular Permanent 1st and 2nd Premolars In continuation of our root canal anatomy series, this third edition primarily focuses on premolars and some important aspects of the pulp chambers that may help improve access preparations.

Both the maxillary and mandibular premolars have shown the most variations in their anatomies as compared to any other teeth. Major root canals in these teeth can range more 1 to 3 with a good percentage of them showing further variations irrespective of racial differences.

• The walls of the pulp chamber are always concentric to the external surface of the tooth at the level of the CEJ, i.e. the external root surface anatomy reflects the internal pulp chamber anatomy (Fig 2) • The distance from the external surface of the clinical crown to the wall of the pulp chamber is the same throughout the circumference of the tooth at the level of the CEJ. The CEJ is the most consistent landmark for locating the position of the pulp chamber (Fig 2) • The orifices of the root canals are located at the terminus of the root developmental fusion lines

We will focus on few clinical aspects of a pulp chamber in general that will help in accessing the pulp chamber with high accuracy and limiting iatrogenic errors whilst maintaining the remaining healthy dentine more specific to peri-cemental dentin.

The pulp chamber is a cavity situated in the centre of the crown that resembles the shape of the crown surface.

In anterior teeth, pulp chamber and root canal are continuous while in posterior teeth pulp chamber floor separates these two components.

In premolars and molars, pulp chamber usually looks like a square with six sides: the floor, the roof, and four axial walls identified as mesial, distal, buccal, or lingual (palatal).

The roof of the pulp chamber usually has projections associated to the cusps or the incisal edges that are called pulp horns.

There are some laws in regards to the pulp chamber that are common for all permanent teeth.

• The colour of the pulp-chamber floor is always darker than the walls (Fig 1) • The orifices of the root canals are always located at the junction of the walls and the floor (Fig 1) • The floor of the pulp chamber is always located in the center of the tooth at the level of the cementoenamel junction (CEJ) (Fig 2) 26

September 2020 Western Articulator | adawa.com.au

Figure 1: Location of the orifices and darker floor of the pulp chamber.

(Photo: Dr G Vasudeva)

(a)

(b)

Figure 2: Concentricity and centralised floor of the pulp chamber.

CLINICAL FEATURE

(a)

(b)

(d)

(e)

(c)

Figure 3: Mandibular 2nd Premolar 35 with significant variation of anatomy, configuration 1-3. The tooth is rotated 90 degrees, hence showing the mesio-distal anatomy instead of usual bucco-lingual. (a) Preoperative radiograph showing 2 separate roots and 3 root canals dividing at the middle 3rd. (b) Access to buccal and lingual canal. (c) Access to buccal and 2nd buccal canal. (d) Access to 2nd buccal and lingual canal. (e) obturation of all 3 canals splitting from a single canal. (Case: Dr Gaurav Vasudeva)

(a)

(b)

(c)

(d)

Figure 4: Maxillary 1st premolar 14 rotated 90 degree revealing the mesio-distal anatomy with configuration 2-1. (a) Preoperative radiograph. (b) Outline of canal anatomy made in red. (c) Shape of the pulp chamber with extended isthmus. (d) Final obturation showing true anatomy with marginal internal transportation. (Case: Dr Gaurav Vasudeva) September 2020 Western Articulator | adawa.com.au

27

CLINICAL FEATURE

(a)

(b)

Figure 5: Maxillary 1st and 2nd premolars with configuration 1-3. (a) 14, 15 Preoperative. (b) Post-obturation radiographs showing highly variable anatomy.

(Case: Dr R Short, USA) Root canal anatomy of Maxillary and mandibular Permanent 1st and 2nd Premolars based on recent micro CT studies with its variations and clinical relevance: Maxillary 1st premolar

Maxillary 2nd premolar

Mandibular 1st Premolar

Mandibular 1st premolar

Complete Root formation

11.8 – 13.5 years

12.6 – 13.8 years

11.9 – 13.3 years

12.8 – 14 years

Number of roots

1 - 43% 2 – 55.3% (29.9% buccal and palatal roots; 32.7% bifurcation at the apical third) 3 – 2.4% (two buccal and one palatal root)

1 – 86.2% 2 – 3.5% 3 – 0.3%

1 – 97.5% (86.6% apical bifurcation 2.8%; middle or apical trifurcation 10.6%) 2 - 2.5%

1 – 98.5% 2 – 1.5%

Number of root canals

2 – 77.3% 1 – 20.1% 3 – 1.2%, others (1.3%), Furcation canal – 11%

2 – 56.7% 1 – 2.7%, 3 – 0.4% others – 0.3%

1 – 71.3% 2 – 27.9% 3 – 0.1% others – 0.7%

1 – 84.7% 2 – 15.05% 3 – 0.05% others – 0.2%

Apical Foramen position

Central – 12% Lateral – 88%

Central – 12% Lateral – 88%

Central – 15% Lateral – 85%

Central – 16.1% Lateral – 83.9%

Accessory canals

17.8–49.5% (coronal, 4.7%; middle, 10.3%; apical, 74%)

12.9–59.5% (coronal, 4%; middle, 16.2%; apical, 78.2%)

8.8–44.3% (coronal, 4.3%; middle, 16.1%; apical, 78.9%)

4–48.3% (coronal, 3.2%; middle, 16.4%; apical, 80.1%)

Root Canal Configuration (Vertucci’s)

Types IV (50.1%), I (20.1%), II (17.4%), VI (4.9%), V (3%), III (1.5%), VIII (1.2%) VII (0.4%)

Types I (42.7%), II (18.7%), IV (17.6%), V (9.6%), VI (6.3%), III (4%), VII (0.5%), (0.4%)

Types I (71.3%), V (18.7%), IV (3.5%), III (2.8%), II (2.3%), VI (0.5%), VII (0.1%), others 0.7%

I (84.7%), V (13.44%), II (0.7%), III (0.5%), IV (0.3%), VI (0.07%), VIII (0.05), VII (0.04%), others (0.2%)

Apical ramifications (delta)

20 – 35.5%

22.2 – 32.2%

21.7 – 44.7%

14.8 – 80.4%

Anomalies

Cases reported on 3 canals, gemination-fusion, furcation groves and dens evaginatus

Cases reported with dens invaginatus and 3 canals

Cases reported with 3 canals, 4 canals, C shaped, dens invaginatus, dens evaginatus, gemmination/ fusion

Cases reported with 3 canals, 4-5 canals, C shaped, dens evaginatus, taurodontism, gemmination/ fusion, 2 roots.

Clinical relevance

50% variation from 2 orifice, 2 canals morphology. In cross section at the CEJ, the palatal orifice is wider buccolingually and kidneyshaped because of the mesial concavity of the root; This concavity results in the danger of a lateral perforation during instrumentation; High incidence of furcation groove on the palatal aspect of the buccal root

Mostly have 1 orifice and 1 canal but almost 60% have variations.

The root canal system is wider buccolingually than mesiodistally as the 1st premolar.

Apical curvature is very common.

The proximity of this tooth to the sinus can lead to drainage of a periradicular abscess into the sinus.

30% variation from single canal and orifice.

When a single canal is present, it is wider buccolingually than mesiodistally, oval at the cervical 3rd and tends to become round at the middle and apical thirds; When additional lingual canal present, it tends to diverge from the main canal at a sharp angle; because of the lingual inclination of mandibular teeth Access cavity preparation should be carried out from the buccal aspect toward the central fissure

The root canal is more often oval than round; the lingual canal, when present, tends to diverge from the main canal at a sharp angle.

The canal morphology may present many variations, but less often than first premolars.

Multiple internal curvatures hence care must be taken to avoid the danger of iatrogenic straightening the canal or excessive widening of the apical third of the canal as it has a high incidence of apical ramifications.

Clinical cases performed by Dr Gaurav Vasudeva except where indicated and published only for the purpose of dental education. Please contact the author for references.

Dr Gaurav Vasudeva Specialist Endodontist info@rootcanalspecialist.org.au

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September 2020 Western Articulator | adawa.com.au

CLINICAL PRESENTATION

Q+A

Dr Amanda Phoon Nguyen, Oral Medicine Specialist

From page 25.

Answer: e) Oral Crohns Oral Manifestations of Inflammatory Bowel Disease Inflammatory bowel disease (IBD) is a broad term that consists of conditions with recurring and chronic inflammation of the gastrointestinal tract, represented mainly by the disease entities Crohn’s disease (CD) and ulcerative colitis (UC). There is an approximately equal distribution of the two clinically definable entities, although in 15% of patients with UC, the distinction is not clear, and these patients are classified as having indeterminate colitis. The distribution of the inflammation in the gastrointestinal tract involves the large bowel only in UC, and most commonly the ileum and colon in CD. IBD is more common in males and is seen increasingly in children.

Australia has one of the highest prevalences of IBD in the world, with more than 80,000 Australians living with these conditions, with numbers expected to increase to more than 100,000 by 2022.

It is not uncommon for patients with IBD to describe a long diagnostic process that can take months or even years. Oral manifestations are not uncommon, with an estimated prevalence rate of between 20% and 50%, with it being more common in CD than UC. In adults, the oral symptoms appear less often than in children, and a higher degree of perianal involvement in patients with oral symptoms has been reported.

In a minority of cases, the oral involvement may precede the intestinal lesions. The oral manifestations may also be the only presenting sign in a small percentage of affected patients. While oral lesions might be more severe during active intestinal disease, approximately 30% of patients may continue to manifest oral lesions despite their intestinal disease activity being controlled.

The oral manifestations may be broadly classified into “specific” or “nonspecific” signs.

Specific oral lesions include: • mucogingivitis (gingival swelling, erythema and there may be ulceration present). This is the most common • Mucosal tags (small, localised, firm nodules which are often asymptomatic) • Cobblestoning of the buccal mucosa (mucosal nodularity where the mucosa can appear hyperplastic with corrugation) • Oral ulceration, usually linear, running along the length of the buccal sulcus or alveolar mucosa • Firm lip swelling (usually the lower lip) • Vertical fissures involving the lip Nonspecific oral lesions include: • Aphthous-like ulceration • “Staghorn sign” swelling in the floor of mouth • Pyostomatitis vegetans • Angular cheilitis • Persistent submandibular lymphadenopathy • Gingival hyperplasia • Taste changes • Oral candidosis Orofacial granulomatosis may present a diagnostic challenge, as it can present very similarly to the above.

Other considerations include an increased risk of developing dental decay, periodontitis and oral infection, and patients at risk should be encouraged to maintain frequent preventive and routine dental care. Gingival bleeding is common and occurs in about 20% of patients.

Oral lesions associated with IBD generally resolve once the gastrointestinal disease is under control. If symptomatic, the use of topical anaesthetics such as lidocaine, topical and/or systemic corticosteroid therapy may be indicated, however, liaison with the patient’s gastroenterologist is recommended.

References available via email: amanda@pomds.com.au

September 2020 Western Articulator | adawa.com.au

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MENTAL HEALTH FEATURE

R U OK? R U OK Day is September 10, offering us a reminder to check in with colleagues, peers and friends We have spoken at length this year about the mental health resources available to dental practitioners, but R U OK? Day is a good reminder to ensure you are aware of your own mental health and that you look out for your colleagues in the workplace.

Peter Diaz, CEO, Workplace Mental Health Institute, says staff in the health and medical sector, and caring professions in general, are well known to be at higher risks of stress, burnout, and mental health issues themselves.

“Part of this is due to the nature of their work, where staff are often dealing with people in highly emotional contexts and also because of the long hours and shift work,” he explains. “Most people came into this profession because they care about people, and want to help, but without the right work conditions, skills and tools, they can often end up suffering ‘compassion fatigue’, where they simply become tired of caring.

“For some people this means, they become less effective at their jobs, no longer able to give the patient the emotional support that benefits the patient so well. For others, this can lead to frustration, angry outbursts, conflict within teams, and even an end to their employment in a particular role (either by choice or following an incident) and, at the more extreme end of the scale, suicide.”

Peter offers the following advice to practice owners: • Make mental health something that is openly discussed.

• Don’t wait for people to be stressed or develop mental health problems before doing something about it. Have conversations early, Provide training in personal resilience, managing stress and compassion fatigue, and mental health.

• Ensure the job demands are doable within the timeframes provided. Don’t ask one person to do the work of three people with no extra time (or pay!) provided.

• Make sure people have time during the day to get out of the practice, to get fresh air, sunshine, a bite to eat, stretch their legs and have a change of scenery.

• Make an Employee Assistance Program or independent counselling available for staff and their family members, should they need a safe, private, and confidential space to get further support.

R U OK? resources The R U OK? website is packed full of resources. The kits include posters, tips and presentations on how to start the conversation. Resources can be downloaded from the following website: https://www.ruok.org.au/every-dayresources

Helplines Helplines are not only for people who are experiencing suicidal thoughts. They can be for anyone who needs someone to listen.

Lifeline: 13 11 14 Samaritans: 13 52 47 Beyond Blue: 1300 22 4636 30

September 2020 Western Articulator | adawa.com.au

VOLUNTEERING

Good News Stories Volunteering is back in full swing in Western Australia. Our dental volunteers jumped at the opportunity to help those less fortunate for the first time this year

Curtin Dental Rescue Day After COVID-19 restrictions delayed a dental rescue day planned for earlier this year, Curtin and TAFE students were delighted to finally get their chance to help those less fortunate in August Curtin Oral Health Therapy (OHT) students, TAFE dental assistant students and volunteer ADAWA member dentists took part in a Dental Rescue Day at the Curtin OHCWA clinic in August.

Dental rescue days are invaluable to students, according to Dr Tracey Gold, a dentist working as a Teaching Focused Clinical Professional with the Curtin University Oral Health Therapy course, who organised the Rescue Day. “The students have the opportunity to interact with and provide dental treatment to patients who are not within their usual patient pool,” Tracey says. “They can experience the satisfaction of giving back to the community. The feedback from our inaugural Dental Rescue Day in 2019 was so positive.”

Tracey says students were able to provide the full range of care to at least 30 patients, provided the patients met

COVID screening requirements. “With the two-squaremetre-rule still in place, however, we were a bit more limited with the number of patients we could have at any one time in the clinic.

As with all Rescue Days, the event was the result of the hard work of several people. “As always, the work done by Andrea Paterson on behalf of the Australian Dental Health Foundation was invaluable,” Tracey says.

“Sourcing and organising the patients for the day takes hours of work and Andrea is relentless in her quest to ensure as many people as possible benefit from this day.

We would also particularly like to thank those dentists who have volunteered their time to work alongside our OHT students, namely Drs Amanda Phoon Nguyen, Amit Gurbuxani, Ashlee Bence, Agnes Tan, Parnian Zareie and Sahara Saeedi.”

Tracey adds there is a dire need for dental care in the many underprivileged groups within our community.

“With recent worldwide events, this need has never been so great,” she says. “Dental Rescue Days are a fabulous opportunity to become involved with this.”

Anyone who would like to take part in future events with Curtin students (planned to be held bi-annually) should contact Andrea (adminwa@adhf.org.au) or Tracey (Tracey.Gold@curtin.edu.au) September 2020 Western Articulator | adawa.com.au

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VOLUNTEERING

Homeless Connect Rockingham With so many events cancelled due to COVID-19 restrictions, the ADAWA team was delighted that Homeless Connect in Rockingham could go ahead during Dental Health Week Once again, Dental Health Week coincided with Homelessness Week, so a team of volunteer dentists, dental assistants, dental students and ADAWA staff braved the cold and headed to Rockingham to take part in the Salvation Army’s Homeless Connect event.

With so many volunteering events needing to be cancelled this year (including the Homeless Connect event in Northbridge), the Rockingham event was all-the-more special. It was a timely reminder that even during a global pandemic, the needs of the homeless community remain.

The usual services were available inside the Salvos on the day. This included meals, food hampers, bill relief and counselling. A mobile food truck provided free bowls of carbonara prepared by students. The Freo Doctor was also in attendance.

Once again, with the support of the ADAWA, Dental Health Services, Henry Schein Halas and Wrigley’s Extra, Australian Dental Health Foundation was able to provide free dental care to those in need.

Thank you to Paul Taylor, the branch manager at Coates Hire Rockingham, who generously donated a generator to power the dental van – offering to do so for Rockingham Dental Rescue days into the future. Without the generator, the team cannot run the van, so it is greatly appreciated. ADAWA donated an Infrared thermometer, bottles of mouth rinse and hand sanitiser.

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September 2020 Western Articulator | adawa.com.au

ADAWA’s Andrea Andrys says it was a successful day promoting oral health. “It was cold in Rockingham, but the patients did not complain, and were grateful for the service provided to them,” she says. “It is always an eye opener to listen to the stories of the patients and their families.

“We were fortunate the day was fine and there were more patients registered than we were able to treat in a day.

It was a fantastic collaboration of services for the dental van to be positioned at Rockingham and staffed with volunteers for the day. The patients were very happy to receive oral hygiene products and everyone who visited the registration table had access to sugar free gum, stickers, flyers with information about good food and drink choices and dietary advice. There were also hand-outs for local dental support services in the Rockingham area.”

Dr Nicola Barnbrock and Ann Dry (DA) with Andrea Andrys and Andrea Paterson.

VOLUNTEERING

Extra infection control procedures due to COVID also included temperature checks, asking COVID questions to all patients at registration and extra PPE as a precaution for all staff and patients.

Andrea Paterson, WA state coordinator, Australian Dental Health Foundation, says 22 patients were treated in the van throughout the day. The patients were triaged by Dr Jonathan Lo and prioritised depending on their most urgent dental concerns.

“We were very busy inside the van and saw many patients that had complicated treatment plans. Many of them, however, had very few options regarding ongoing dental treatment,” adds Sandra Wood, ADAWA volunteerism coordinator. “Some patients said they had been told they had to wait 18 months for treatment in the Government dental clinic and many more couldn’t afford ongoing dental treatment.”

as three dental assistants and one oral health therapy student, and Dental Health Service’s dental nurse coordinator, Lisa Daw. “All the volunteers said they loved working the day and many have asked: ‘How do we come back?’” Sandra says.

“All volunteers were fantastic,” Andrea adds. “They worked tirelessly but were happy to be involved and help those in need. It was an awesome team effort!”

Paul Taylor from Coates Hire and Sandra Wood.

Special thanks go to the volunteers – five dentists (Drs Helene Belaner, Jonathan Lo, Michael Sturgeon, Nicola Barnbrock and paediatric dentist, Susan Wong), as well

Adopt a Patient success Earlier this year, there was a call-out for a special Adopt a Patient case for a client from the Salvation Army’s The Beacon (a crisis and transitional homeless facility). The war veteran, who served in Afghanistan, was in desperate need of dentures. His dental deterioration affected his ability to communicate clearly and to chew food.

Before

After

One of our volunteer dentists took on the case and provided multiple extractions, periodontal debridement, and upper lower partial dentures.

The before and after photos speak for themselves – the transformation is truly remarkable.

On receiving his new dentures, the patient said: “I am confident for the first time in years – I can actually look at people and smile! This helped me in ways that no one can understand – words simply can’t express how grateful I am.”

If you would like to Adopt a Patient and change the life of someone like this grateful war veteran, please contact Andrea Paterson, Australian Dental Health Foundation WA State Coordinator by emailing adminwa@adhf.org.au.

Volunteering Opportunities Tzu Chi Foundation, Perth Contact Lydia See timaperth@gmail.com

Bridge2Aid Australia Contact Jeremy Keating info@bridge2aid.com.au

Kimberley Dental Team Contact Jan and John Owen AM 0407 998 215

Australian Dental Health Foundation Contact Andrea Paterson (WA State Co-ordinator) adminwa@adhf.org.au

Equal Health Inc Contact Simon Shanahan info@equalhealth.org.au

Children’s Health Aid Team (CHAT) Contact CHATsecretary@gmail.com

September 2020 Western Articulator | adawa.com.au

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PROFESSIONAL NOTICES

Dr Eman El Hassan

Dr Frank Chang

Michael O’Halloran

TAYLOR ROAD PERIODONTICS AND DENTAL IMPLANTS

SOUTH PERTH ORAL & MAXILLOFACIAL SURGERY

SPECIALIST ORAL SURGERY PERTH

Specialist Periodontist BDS, DClinDent (Perio), MRACDS (Perio)

Oral & Maxillofacial Surgeon BDS, MBChB, FRACDS (OMS)

Additional practice locations in Kalamunda and Joondalup

Taylor Road Periodontics and Dental Implants is delighted to announce that Dr Eman El Hassan, Specialist Periodontist, has joined Dr Jon Swain and the team. The practice welcomes all referrals for periodontal and dental implant treatment.

Current patients are welcome and invited to continue their periodontal management at the new premises.

Dr Frank Chang is pleased to announce that he has joined Dr Mario Alberghini and Dr Emma Lewis and the team at the South Perth Oral & Maxillofacial Surgery. Drs Chang, Alberghini & Lewis are also consulting in the Northern Suburbs in Joondalup. Please contact the South Perth rooms to make all appointments. Dr Chang is accepting referrals for all scopes of practices in Oral & Maxillofacial surgery.

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.

Taylor Road Periodontics and Dental Implants 3/153 Stirling Highway Nedlands WA 6009 Tel: (08) 63820 0699 Fax: (08) 6382 0689 Email: admin@taylorrdperiodontics.com.au www.taylorrdperiodontics.com.au

South Perth Oral and Maxillofacial Surgery 76a South Terrace South Perth, 6151 Tel: (08) 9474 2133 Fax: (08) 9367 9114 www.omfs-southperth.com.au

174 Cambridge Street West Leederville WA 6007 Tel: (08) 9388 3453 Fax: (08) 9388 3442 Email: specialistoralsurgeryperth@gmail.com

Dr Nandika Manchanda

Dr Stephen Kwang

Dr Naomi Kohan

TOOTHBUDS PAEDIATRIC DENTISTRY

FLOREAT ENDODONTICS

SMILE TIME ORTHODONTICS

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

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

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.

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

Fremantle Cottesloe Mt Hawthorn Mindarie Dunsborough Email: info@smiletime.com.au www.smiletime.com.au

Tel: (08) 9383 7400 Email: reception@floreatendo.com.au www.floreatendo.com.au

You can contact the friendly Toothbuds team on 6155 9899 or at admin@toothbuds.com.au September 2020 Western Articulator | adawa.com.au

35

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