Oral Health for Better Health 2014

FOR BETTER HEALTH

WIN A FAMILY PASS TO THE MOVIES! See inside for details

SMILE OF THE YEAR

Father Bob Maguire

TOP 10 TIPS

for senior oral health

Dr Rosemary Stanton’s

GUIDE TO HEALTHY EATING

DENTAL HEALTH SERVICES VICTORIA QUALITY OF CARE REPORT 2014

www.dhsv.org.au Like us on Facebook: w ww.facebook.com/DentalHealthVic www.facebook.com/RoyalDentalHospitalMelbourne Oralhealth for better health 2014 Follow us on Twitter: www.twitter.com/VicDental

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FROM THE CEO

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Eating well Acclaimed nutritionist Dr Rosemary Stanton's guide to healthy eating.

FEATURES

More than half of all Australians aged 65 and over suffer from gum disease. Dental disease tends to be more common in older Australians and research has found that over 21% of adults aged 65 and over do not have any of their natural teeth at all.* That is why the focus of this year’s Oral Health for Better Health magazine is on our seniors.

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Ask Professor Mike Professor Mike answers questions about denture care, teeth whitening and more.

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Ron Barassi Kicking goals for good health.

People are living longer and healthier these days. In fact, our average life expectancy has grown from 72 to around 80 in the past 20 years thanks in part to better health education and services. But it’s important to remember that looking after your oral and overall health is just as important in our later years as it is when we are young.

With all the chomping and biting that our teeth do over our lifetime, they are pretty resilient. But as we get older, the years take their toll on our teeth and other parts of the body, and the need for dental care and general healthcare also increases.

There are other external factors we need to think about too, like how some medications can dry our mouths and make us more susceptible to dental decay.

This year’s magazine gives you some great information and tips on taking care of your oral health and overall wellbeing, from eating and drinking well, to caring for your teeth or dentures.

And that’s not all. We are proud to announce Father Bob Maguire, a dedicated senior with a big heart, as our 2014 Smile of the Year. He is an inspirational Australian and we are honoured to have him as a partner in our journey towards better oral health for the community. And thanks to Dr Rosemary Stanton for giving us plenty of food for thought with her nutrition tips.

We have used your feedback to build and improve this year’s magazine and we’ll make it available to as many Victorians as possible through our websites, waiting rooms in dental clinics as well as in medical centres and other hospitals.

As always, this edition includes some important information on our performance and the work we do at The Royal Dental Hospital of Melbourne. We’ve kept some of your favourite sections too. Through your feedback you told us you wanted to see more of Professor Mike, so we’ve included more of your questions to him this year and you told us you love the puzzles and games, so those are back this year as well.

We hope that you enjoy reading this year’s Oral Health for Better Health magazine.

Dr Deborah Cole Chief Executive Officer Dental Health Services Victoria * Australian Institute of Health and Welfare: www.aihw.gov.au/dental/healthy-teeth

We acknowledge the traditional owners of Australia and we welcome all Aboriginal and Torres Strait Islander peoples to our services.

FOR BETTER HEALTH

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design: studiowarna.com

Oralhealth for better health 2014

He’s known as “The Larrikin Priest” for his affinity with people both within and outside the Catholic Church and is widely respected for his dedicated work with the homeless community in South Melbourne.

The much loved Victorian, Father Bob Maguire has been tireless for decades in his mission to end homelessness and recently, he released a hip hop single, ‘Bob Walks’ in the style of Kanye West to raise funds for his work.

Our Dental Health Services Victoria (DHSV) Smile of the Year, Father Bob Maguire, is an inspiration for devoting his life to helping the disadvantaged.

At 80 years old, Father Bob remains active in community work with Open Family, which he co-founded in 1978, and as executive director of The Father Bob Maguire Foundation which strives to help the homeless people of Melbourne find food, shelter and other essential services.

In April 2014, he became a hip hop star, releasing the single ‘Bob Walks’ to raise funds for his foundation. ‘Bob Walks’ is the first single from the ‘Father Bob Sings for a Million’ album.

Father Bob said the money raised has helped fund several initiatives, including the Hopemobile – food vans that provide nutritious food to the needy from the Melbourne CBD through to St Kilda.

“We want to keep our Hopemobile on the road and travel to even more places,” Father Bob said.

“We’ll give a healthy feed to whoever needs it; our tucker is healthy because good nutrition is important for your teeth and general health.”

DHSV Community Advisory Committee Chair, Jennifer Theisinger said Father Bob’s passion and tenacity to improve the health and wellbeing of those most in need has made him the perfect choice for the Smile of the Year Award.

SMILE OF THE YEAR Father Bob Maguire

“Father Bob is an inspirational role model. His determination to better the lives of the disadvantaged is applaudable, especially for the homeless and those at risk of homelessness, which is a priority population group for DHSV.” “His charisma, his sense of humour and his love for the people has earned him admiration across Australia and here at DHSV.” Father Bob said being chosen as DHSV’s Smile of the Year gave him a chance to highlight the importance of good dental hygiene among homeless people and improve their access to dental care.

“We need to restore confidence among our folk, and help them to access essential dental treatment.”

“This award will help me and DHSV to join forces to bring better oral health to those who are less fortunate in the Victorian community.”

“It’s my wedding smile, cheeses, I’m getting good at it.”

Find out more about the Father Bob Maguire Foundation on www.fatherbobsfoundation.com.au You can also find him on Twitter @FatherBob

Australia’s homeless There are more than 100,000 homeless people across the country.

People aged 55 and over make up about one-fifth of Australia’s homeless population and there is a large, but unquantified, number of older Australians at risk of homelessness due to their precarious housing circumstances.

While Father Bob saw himself as an unlikely Smile of the Year, he put a great smile on for the camera.

Oralhealth for better health 2014

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As we grow older, some of us tend to take more medication and experience more general health conditions that can impact on our oral health.

Here are 10 top tips for seniors and their carers to keep mouths and teeth as healthy as possible.

TOP 10 TIPS

for senior oral health

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Brush your teeth and along the gum

line twice a day with a soft toothbrush

•

ry to limit foods with high levels of sugar.

T Sugar is a major cause of tooth decay.

Cleaning and brushing teeth removes plaque (the build-up on teeth) that causes tooth decay.

•

ighly processed foods or those that contain added H sugars should be limited, especially between meals.

•

•

I f you eat sweet or sticky food, it’s best that you have it at meal times to reduce the chance of decay. This is allows a between-meal period for teeth to recover.

lean all surfaces of the teeth and gums with C a soft toothbrush or electric toothbrush twice a day (after breakfast and before bed).

•

fter brushing, spit out toothpaste. Do not swallow A or rinse with water.

•

se a suitable fluoride toothpaste. Ask your dental U professional if you should use standard or high strength fluoride toothpaste.

•

I f brushing teeth is not possible due to physical conditions or other issues, seek advice from your dental professional.

•

lso, ask your dental professional if they A recommend flossing.

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Choose healthy food options

Good nutrition is important for our teeth and general health. Find out about healthy food options with acclaimed nutritionist Dr Rosemary Stanton on page 6.

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Water is the best drink

Most of Victoria’s tap water supply contains fluoride which helps protect teeth from decay. Tooth decay occurs when acid destroys the outer surface (enamel) of the tooth. Fluoride can limit the amount of acid produced and can also repair damage before it becomes permanent.

So drink plenty of tap water every day.

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Limit sugary foods and drinks

Oralhealth for better health 2014

Caring for your dentures

If you wear dentures, be sure to brush your gums and tongue twice a day with a soft toothbrush.

•

lean dentures after meals to remove food C and plaque.

•

rush both the inside and outside of the denture with B mild soap, but do not use toothpaste.

•

emove dentures overnight and store them in a glass R of cold water. This allows the mouth to rest.

•

I f your dentures cause pain to your mouth, see your dental professional.

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luoride mouthwash can be effective F in reducing decay

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egular use of a fluoride mouthwash can help R reduce decay.

•

peak with your dental professional about whether S rinsing your mouth with mouthwash is right for you.

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Chewing sugar-free gum can help

reduce dental decay

Chewing sugar-free gum can help reduce dental decay.

It can be part of a good oral hygiene routine for older adults. Ask your dental professional if chewing sugar-free gum is right for you.

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Useful links Better Health Channe l: www.betterhealth.vi c.gov.au Use the search term s ‘teeth’ or ‘dental’ The Australian Dietar y Guidelines: www.eatforhealth.go v.au Oral health informatio n for aged care workers: www.dhsv.org.au/pr ofessionals/ aged-care-workers

Dental checks are important for

a healthy mouth

Everyone has different oral health needs. Speak with your dental professional about your oral health regularly and chat with them about your risk of dental disease.

See your dental professional if you have: •

pain in your mouth.

•

bleeding gums.

•

a ny sores, lumps or discoloured patches in your mouth.

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Quit smoking to improve oral and general health

Smoking is a major cause of mouth cancer. It can also causes gum disease. If you smoke, consider the benefits of quitting. Your general health, including your mouth, gums and teeth will thank you for it.

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Be aware of how medication can

affect your mouth

•

ome medications can cause dry mouth (xerostomia).

S Having dry mouth can increase your risk of tooth decay. Ask your pharmacist, doctor or dental professional if the medication you are taking causes any side effects.

•

lso, check if the medication you are taking is A sugar-free. If not, rinse your mouth with water after taking it. You can also ask your doctor or pharmacist if a sugar-free option is available.

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DR ROSEMARY STANTON’S guide to healthy eating Dr Rosemary Stanton OAM is one of Australia’s best known nutritionists. She is a Visiting Fellow in the School of Medical Sciences, Faculty of Medicine at the University of New South Wales. She has authored over 3500 articles, 33 books on nutrition and many scientific papers.

Dr Stanton is an advocate for healthy eating for good oral health, recommending that “a diet that’s good for teeth is also one that’s good for the rest of the body”.

“I think the mouth is an area of the body that we often ignore when talking about healthy diets,” Dr Stanton said.

Over the years, there has been greater awareness on how good nutrition can improve general and oral health and Dr Stanton is an expert on the matter.

“When I was a child, we ate sweet biscuits every day, fillings were seen as inevitable and there was little care taken to ensure teeth were straight,” Dr Stanton said.

“Older adults invariably had dentures and few people expected to keep their own teeth for life.”

However she said that many aspects of oral health have improved, including the availability of fluoridated water in most areas which has provided dental benefits for everyone.

But Dr Stanton expressed concern over the nutritional value of the diets of many Aussies.

“Sadly, diets have not improved with the recent national nutrition survey showing that consumption of sweet drinks and snack foods have continued to increase.”

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Dr Stanton says there are simple ways to achieve a healthy diet.

Choose a variety of foods from the 5 food groups every day:

• V egetables – different types and colours, 5 serves (a serve is ½ cup cooked or 1 cup raw).

• Fruit – 2 average pieces.

• Grains/cereal based foods – at least 2/3 as wholegrains, 3–6 serves (a serve is 1 slice of bread, ½ cup cooked porridge, rice, pasta, buckwheat, polenta, bulgur, quinoa, barley, ¼ cup muesli).

• Lean meat or poultry, fish, eggs, tofu, legumes, nuts, seeds – 2–2½ serves (a serve is 65g meat, 80g poultry, 100g fish, 2 eggs, 1 cup cooked legumes, 170g tofu, 30g nuts or seeds).

• Milk, cheese or yoghurt or alternatives – 2½-4 serves (a serve is 1 cup milk, 200g yogurt, 40g cheese or 1 cup soy, rice or other drink with at least 100mg calcium/100ml).

The higher levels from the meat group are for men over 50 while women over 50 need the upper levels of milk, cheese, yoghurt or alternatives.

Limit intake of:

• Sweet drinks, including artificially sweetened soft drinks because their acidity damages tooth enamel.

“It isn’t difficult to choose a healthy diet in Australia and it remains important through life.”

• Foods with high levels of saturated fat, sugar or salt, such as cakes, biscuits, pastries, confectionery, crisps, fast foods and fried foods.

“The good news is that older people are generally more diligent about including vegetables and fruit in their daily diet, and tend to consume less alcohol and fewer snack foods than other age groups.”

• Sugars and refined starches, such as those in all types of biscuits, crackers and crisps. These foods add no needed nutrients for general health and provide food for the bacteria that cause dental decay.

Oralhealth for better health 2014

The Royal Dental Hospital of Melbourne offers FREE dental care to pensioner and healthcare card concession holders.

The treatment is provided by oral health students training to become tomorrow’s dentists, prosthetists, oral health therapists and dental hygenists. Your care may take a little longer, because these are students just starting out, but appointments are supervised and your treatment plan will be discussed with you. Treatment may include cleaning, fillings or dentures.

TEACHING

To find out more about the teaching clinic or to make an appointment, please ring (03) 9341 1000 between 9am and 4.30pm (Monday to Friday only), and select option 3.

clinic

Please be aware that a screening appointment is required before receiving any treatment in the teaching clinic.

Domiciliary services are available in: • •

metro areas. outer metro areas.

What type of care is provided?

Emergency and general dental care is provided, including: • • • • •

dental assessments. oral health advice, prevention and cleaning. fillings. simple extractions. provision of dentures and denture care.

Where is the care provided?

DOMICILIARY

oral health service Did you know that we provide a domiciliary (or home) service to anyone who is housebound due to physical disabilities that make it difficult or unsafe to visit The Royal Dental Hospital of Melbourne?

The domiciliary oral health unit will come to: • • • • •

private homes. group homes. nursing homes. staff supported accommodation. hospitals.

Care is provided at the patient’s home or residence.

The location must be clean and have: • • • • • • • •

reasonable lighting. easily accessible power points. a sink with running water. a table. privacy. freedom from interference from pets. access ramp for dental equipment; no steps. access to non-meter parking or free parking within a reasonable distance.

How much does the service cost?

This service is free if you hold one of the following cards: • • • •

Pensioner Concession card.

Health Care card.

Veteran Affairs Gold card.

If you are not a Government card holder, fees are payable for this service.

For more information, visit www.dhsv.org.au/domiciliary or call (03) 9341 1000.

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OUR people

We don’t just have dentists working at The Royal Dental Hospital of Melbourne. Lots of different people work together to make sure you get the best care possible.

Meet a few of our team.

Teaching clinic Name: Wadian Abdul-Wahed

Oral surgery

Job Title: Dental Assistant Team Leader

Name: Nick Saha

Training and education: Certificate III in Dental Assisting.

Role: Managing a team of dental assistants, monitoring our budget, ensuring all instruments, equipment and consumables are available for our patients.

Location in hospital: Level 2, Dental Teaching Clinic Best part of my job: Interacting with my colleagues in the hospital and Victoria’s public dental clinics.

Job title: Resident in Oral Surgery (Dentist) Training and education: Bachelor of Dental Science.

Currently doing a Bachelor of Medicine/Surgery.

Role: I’m part of a team that examines and treats patients with complex surgical needs. Our patients include those who require their wisdom teeth removed, dental implants and those with complex medical backgrounds.

Location in hospital: Level 4, Oral Surgery Best part of my job: Being part of this amazing team that is supportive and where I can learn so much. The patients that we see are very friendly which make the early morning starts not so bad!

Specialist care Name: Anthony Varos Job Title: Dental Prosthetist Role: Designing and supplying dentures for patients at the hospital and also those referred from community centres and private dental clinics. I am also part of the Domiciliary Oral Health Unit where we travel across the Melbourne region to provide care to homebound patients.

Location in hospital: Level 1, Specialist Care and Integrated Special Needs Best part of my job: The opportunity to be part of a great and dedicated team and being able to successfully plan and produce dentures for complex cases.

Infection control Name: Wendy Bacalja Job Title: Infection Control Advisor Training and education: Masters in Public Health, Credentialed Infection Control Professional, Registered Nurse with postgraduate qualifications.

Role: I am responsible for helping the dental hospital and public dental clinics throughout Victoria comply with standards of infection control and sterilisation through audits and education.

Location in hospital: Level 1, Corporate Office Best part of my job: Discussing, getting feedback and sharing my knowledge on infection control with my colleagues in the hospital and Victoria’s public dental clinics.

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Oralhealth for better health 2014

OUR patients In 2013–14, The Royal Dental Hospital of Melbourne treated 47,460 patients.

Meet a few of them:

Zhi Hua and Hui Zhen How did you come to know about the services at the hospital?

Our granddaughter is a dentistry student here and she told us about the free treatment at the teaching clinic. We come here for general check-ups.

What do you like most about the hospital?

Salvatore

Your interpreter service. Our interpreter was excellent. She took us to see the dentist and to get our x-rays done, and was attentive and patient all the way.*

What brings you here today?

*Interview translated from Mandarin

Sabiha and Fiona

My wife is having a root canal treatment now and I’m a patient here too. I did a root canal treatment here recently. Everyone here is kind and they answer all our questions.

Do you think you live a healthy lifestyle?

Yes, I walk 4km every morning. I also enjoy gardening and I do it nearly every day. I grow lots of veggies: lettuce, cauliflower, savoy cabbage, just to name a few. And I love my salads too.

What brings you to the hospital today?

Fiona: I brought my mum here to get her fillings done and she has an appointment to get dentures fitted next month. The service is very good.

YOU said it!

"Big thanks for helping us when we needed it. I can’t thank you enough for the respect and kindness shown to us in time of great need.

Bless you all for the amazing work that you do."

"On my first ever visit to the dental hospital I was attended to by a young lady who did a lovely job on a new set of dentures. She was very helpful and always answered with a smile."

"Staff were fantastic!

I have a huge fear of dentists, injections and blood. I had an extraction done and this was the calmest and most at ease I have ever felt having a procedure done."

Marjorie, Aberfielde

George, Brighton

Alissa, Woodend

Oralhealth for better health 2014

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YOU said it!

"My treatment was excellent. Dental staff have been terrific, very competent, very friendly. On a scale of one to 10, I would give 10."

John, Narre Warren

"Although I had to wait for some time for my appointment, the receptionist was very nice and helpful. She understood my tooth situation and tried to have it fixed on the day instead of having to wait for a new appointment. I’m very grateful to her. " Joan, Coburg

"My visit was a very pleasant experience from triage to treatment. I thought I would be here for a long day ahead but I can’t believe how efficient and friendly the whole experience was. Thank you all!"

Jane, Surrey Hills

ACCREDITATION A chance to reflect on the great work that we do.

Accreditation is a formal process to ensure delivery of safe, high quality healthcare. The Royal Dental Hospital of Melbourne is accredited based on standards and processes devised and developed by healthcare professionals for healthcare services.

Health service organisations in Australia are accredited to the National Safety and Quality Health Service Standards (NSQHS).

In December 2013, accreditation surveyors were onsite at the hospital for a periodic review and to audit processes, procedures and our output against the standards. The surveyors had positive things to say about much of Dental Health Services Victoria’s work and they were particularly taken by our commitment to consumer participation, great work in infection control and outstanding services in the Special Needs and Domiciliary Services units.

The hospital’s next accreditation round is in December 2014. Surveyors will take that opportunity to conduct an organisation-wide survey, assessing us against nine national standards: 1. Governance for safety and quality in health service organisations.

"I’m in the process of having dentures made and I cannot speak highly enough of the punctuality, patience and pleasant disposition of the students and their supervisors who are checking the work and giving guidance along the way."

Patricia, Oak Park

2. Partnering with consumers.

3. Preventing and controlling healthcare associated infections.

4. Medication safety.

5. Patient identification and procedure matching.

6. Clinical handover.

7. Preventing and managing pressure injuries.

8. Recognising and responding to clinical deterioration in acute healthcare.

9. Preventing falls and harm from falls.

We will use this process to learn about what we are doing well and to continue to improve upon the great work being done throughout the hospital.

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IMPROVING US FOR YOU: consumer input helps our services grow We do all that we can to make sure your visit to our hospital is as positive as it can be. Consumers help us to improve our services through feedback and advice.

Our Community Advisory Committee (CAC) is a group of consumers and patients just like you. They help ensure that everything we do is improving the care that we provide.

They give us a patient and visitor perspective of our services and we use their expertise and opinions to shape written materials like this magazine, brochures and posters, online resources like our websites and feedback channels.

The CAC has been busy working on a number of projects in the past year and some of their achievements include: •

reating our new Community Oral Health Champion C Award (Page 20) to recognise the commitment of community workers and volunteers who help to improve Victoria’s oral health.

•

eing involved in the development of the Community B Participation Policy.

•

ssisting with the development of staff training A videos that feature the experiences of patients at the hospital, as part of the CAC consultation process. These videos are being used to help staff better understand the patient perspective and to ensure patients have a positive experience at the dental hospital.

•

Assisting us to prepare for accreditation.

k form This magazine includes a feedbac tion that rma info the and (in the centrefold) ed shape help has r yea last us t our readers sen this edition. say about what If you would like to have your out the feedback fill ion, goes into next year’s edit visit our or e azin form provided in this mag dback -fee QoC website www.dhsv.org.au/

Geoffrey Dye has been a patient at The Royal Dental Hospital of Melbourne for over ten years.

Since his first visit for a check-up in 2004, Geoffrey has been back several times for dental work and in 2011 he joined the CAC. Geoffrey says he joined the committee after seeing a poster in a waiting room calling for participants to help ‘improve the oral health of Victorians’.

“Being a part of the committee has enabled me to really contribute to improving the oral health of the community,” he said.

"Good general health starts with good oral health but so often the link between the two is overlooked.

The committee is helping spread messages about the importance of oral health and ensuring that the community is receiving them.”

Geoffrey’s experience in the education sector and with some of our priority groups (youth justice clients and people with mental health issues specifically) has come in handy in his time on the committee. He has been able to advise Dental Health Services Victoria throughout various projects and has helped us to create services that are more patient-friendly and welcoming.

“The CAC is committed to improving access and services for all people, no matter their social status.”

“Specifically, we help simplify written materials, revise text in brochures and publications, spread messages in the community about oral health, advise on project work and direct people to the hospital for care where appropriate.

It is a group effort and everybody on the committee is both passionate about and dedicated to improving the oral health of our community.”

“It’s so rewarding to be a part of a group that helps advance our health services. I’d encourage anybody with the time and interest in health to join up and help us improve oral healthcare delivery in Victoria.”

If you would like to join the CAC, please call (03) 9341 1713.

Oralhealth for better health 2014

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2013–14

he number of patients receiving surgical T treatment increased by 14.4%.

•

he number of patients treated in Day Surgery T Unit increased by 80% (2012–2013: 1,840 | 2013–2014: 3,314).

•

ait list for oral surgery was reduced by 17.9% W (2012–2013: 4,388 | 2013–2014: 3,603).

0.9%

0.9%

1.1%

1.2%

0.9%

2011–12

2012–13

2013–14

Extraction within 12 months of Commencement of Endodontic Treatment

2012–13

2013–14

Teeth extracted within 6 months after pulpotomy treatment

Oralhealth for better health 2014

2011–12

4.2%

2013–14

2.2%

2012–13

Unplanned return within 7 days after Surgical Extraction

4.6%

2011–12

6.4%

Unplanned Return within 7 days after Routine Extraction

2011–12

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Teeth retreated within 6 months of initial restoration (Child)

2013–14

2.1%

•

2013–14

2012–13

6.1%

We also exceeded all government targets for offering care for clients presenting with emergencies.

87.9% of the highest priority emergency clients (category 1) were offered care within 24 hours, above the state-wide target of 85%. Not only that, the surgery departments at the hospital saw great improvements in their operations as a result of these new models of patient care.

Highlights included:

2012–13

2011–12

4.5%

In mid-2013, Dental Health Services Victoria signed the National Partnership Agreement (NPA) on Treating More Public Dental Patients and this meant that Victoria’s public dental sector benefited from a significant financial boost. The funding opportunity allowed The Royal Dental Hospital of Melbourne to not only continue providing the best possible quality of care, but also help more people access dental treatment. In 2013–14, the hospital provided dental care to 47,460 patients, a 7.6% increase compared to the previous year.

2011–12

0.6%

Improving access to care

Teeth retreated within 6 months of initial restoration (Adult)

N/A

Dental Health Services Victoria collects data on all of the services that we provide. We look at whether patients have come back unexpectedly for further treatment and try to find out why. This helps us to improve the quality of our services. In most cases, we judge our results against targets set by the Victorian Department of Health.

1.3%

How well did we do?

5.5%

2012–13

4.3%

10.3%

2011–12

3.1%

9.1%

REPORTING

9.7%

Here’s a snapshot of how we’ve been doing at The Royal Dental Hospital of Melbourne.

2012–13

2013–14

Dentures remade within 12 months

Infection control Infection control is vital in a hospital because it helps to prevent the spread of germs and diseases.

In 2014, the Department of Health increased the staff flu vaccination target from 60% to 75%. The Royal Dental Hospital of Melbourne exceeded the staff flu vaccination target with 79% compliance. We did this by implementing a daily travelling clinic around the hospital and promoting it to staff using our internal communication channels.

Clinical instruments used in the hospital are sterilised in our Central Sterilising Services Department (CSSD). Sterilising equipment is tested daily and comprehensive checks are carried out regularly.

The CSSD is required to meet relevant Australian standards and to receive Accreditation, which is a formal review of the hospital’s services. Infection control procedures are reviewed regularly and problems are identified and improved. Our Infection Control Advisor also runs training programs at the hospital to make sure all dental professionals meet infection control requirements.

97%

97%

Feb 2014

July 2014

96.5% October 2012

We collect patient data and give it to our dental professionals to help them base their treatment and decisions on data and research.

This helps them to provide high quality care. We also regularly conduct audits and peer reviews in clinics at the dental hospital. Peer review is an opportunity for clinicians to review aspects of practice, by sharing experiences and identifying areas in which changes can be made.

This helps us to improve the quality of services offered to patients.

Innovation is also supported through our Clinical Leadership Council.

This is a group of senior clinicians from across Victoria that develop and update clinical guidelines and review clinical practices based on the latest research evidence. This group also recommends clinical professional development programs for public oral health practitioners.

97%

96.4% August 2012

Clinical effectiveness

October 2013

95.6% Feb 2012

All dental professionals that provide care at The Royal Dental Hospital of Melbourne have the right qualifications, skills and professional registration to do their job. Our dedicated Credentialing and Scope of Practice Coordinator makes sure our staff understand all the rules about achieving and maintaining their qualifications.

94.5%

90.3% October 2011

During the year we reviewed our hand hygiene practices and how we have been complying with national standards. The benchmark was set at 70% and this year we achieved 77% compliance for clinical staff.

This was mostly thanks to more education around hand hygiene, demonstrations, practical learning and spot checks that made sure we were all practicing good habits.

July 2013

94.7% May 2011

Credentialing

96%

95.8% March 2011

Hand hygiene

Feb 2013

95.3% Nov 2010

cceptable Quality Level (benchmark) A for very high risk areas

99.6%

We have several audits throughout the year to rate how clean our hospital is. By the end of 2013–14 we achieved a cleanliness score of 97%. That’s well above the state-wide target of 90%.

August 2010

Cleaning and maintenance

Preventing falls and harm from falls The Royal Dental Hospital of Melbourne has a falls policy and procedure which are based upon best practice (i.e. Preventing falls and harm from falls in older people: Best practice guidelines for Australian Hospitals 2009) and is compliant with the Australian Commission for Safety and Quality in Healthcare requirements for falls. Through this, the hospital aims to reduce the incidence of patient falls and minimise harm from falls.

Risk management When people start working at Dental Health Services Victoria, they are taught about effective risk management. The policies and procedures are also available for staff to access on the intranet. All incidents are recorded in our online reporting system. They are then investigated thoroughly to identify why they occurred and make sure they don’t happen again.

Clinical governance Good clinical governance ensures that good clinical care is provided, risks are minimised and strategies to continuously improve what we do are developed and monitored.

Dental Health Services Victoria undertakes a range of activities, systems and processes within the four domains of quality (consumer participation, clinical effectiveness, effective workforce and risk management) as part of the Victorian clinical governance policy framework.

Oralhealth for better health 2014

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department, often in groups of four to five, without having urgent clinical needs. This meant that an initial visit was usually unproductive for the patient, and other patients with more advanced clinical needs had to wait longer, or not be seen on the day.

The problem helped inspire us to improve our systems and the flow of patients at the hospital significantly.

A CULTURALLY RESPONSIVE hospital The number of refugee and asylum seekers treated at the dental hospital has increased by 106% compared to last year.

The Royal Dental Hospital of Melbourne's consumers, carers and community members come from diverse backgrounds. We are committed to creating a hospital that is culturally appropriate so that everyone feels welcome.

Improving care for refugees and asylum seeker patients In 2013–14, the hospital brought dental care closer to its refugee and asylum seeker patients by appointing a Certificate IV Dental Assistant to attend regular health triage sessions at services such as the Red Cross and Asylum Seeker Resource Centre.

In these sessions, the Dental Assistant conducts dental triage and refers patients to the hospital or clinics according to their clinical needs. We worked in partnership with other services such as the Red Cross and AMES to create the program and it has allowed patients to book a dental professional or interpreter who is fluent in their language before their first visit at the hospital.

The initiative came about after the hospital saw a spike in refugee and asylum seeker patients presenting as walk-in patients at the emergency

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Oralhealth for better health 2014

Aboriginal oral health All Aboriginal and Torres Strait Islander peoples can access services at The Royal Dental Hospital of Melbourne, including non-concession card holders. In 2013–14, we saw a 13.1% increase of Aboriginal and Torres Strait Islander patients compared to last year.

We also boosted our Indigenous workforce to make sure we keep improving services for Aboriginal staff, patients and their families.

An Aboriginal Community Development Officer was recruited to improve the oral health of Aboriginal and Torres Strait Islander peoples across the state, and we work within the guidelines of the Improving Care for Aboriginal and Torres Strait Islander Patients (ICAP) program which helps health services to improve access, identification and culturally responsive care for Aboriginal patients.

We also work closely with the Victorian Aboriginal Health Service (VAHS) and the Victorian Aboriginal Community Controlled Health Organisation (VACCHO) to ensure our services are visible and accessible to as many Indigenous Victorians as possible.

Community participation Our Diversity and Community Participation Plan 2013–2015 shapes the work we do now and in the future in community participation, cultural responsiveness, Aboriginal oral health and disability services.

The Community Advisory Committee is responsible for overseeing the plan.

The top six languages spoken by refugee and asylum seeker patients at the hospital are 1. Persian (excluding Dari) 2. Arabic 3. Tamil 4. Hazaraghi For more informat ion 5. Dari on our interpreter 6. Pashto

services, see page

22.

Top of the class – Aboriginal Dental Assistant wows at People in Health Awards A pioneer group of trainees graduated from their Indigenous Dental Assisting Traineeship program in 2013 and one of them is Dental Assistant (DA) Melissa Stevens. She won Victoria’s top honour for Indigenous Australian health professionals in training: the Koolin Balit Aboriginal Learner Award – part of the People in Health Awards in May 2014.

Melissa’s impressive resume stood out among the nominations due to her unwavering commitment to improving oral health in Victorian Indigenous communities.

Having joined Dental Health Services Victoria as a DA trainee in 2012, Melissa graduated in 2013 and has gone on to become a tireless advocate for Aboriginal and Torres Strait Islander peoples’ health ever since.

“I have to say the traineeship has opened a lot of doors and really put me where I am today,” said Melissa.

“I’m really grateful to the coordinators and the hospital more broadly, for providing me with the support to do my job.”

The importance of the win has not been lost on Melissa who said that her work in juvenile justice centres servicing troubled teens and those most in need is a story that needs to be told throughout the community.

“I have been coming to the hospital for about two and a half years now. I came to know about services at the hospital through the Aboriginal Liaison Officer.

Staff here are so wonderful. They can tell when you are getting tense and they’ll come up and say “relax, relax your shoulders, lie back” because they can tell that you are upset or very anxious.

I tell the staff that they are doing a really good job – from the lady at the reception, to the students and the doctors who are always very respectful and endearing.

They really care about you and what you are going through. So I really just say thank you. It’s been a good experience.”

Michael King

“Over the last couple of years the numbers of Indigenous patients have jumped significantly in Victoria, and doing the rounds in the clinics and community centres really makes that hit home.”

“People in our community need positive mentors and role models to face the future. I really want this win to show our community that it is really possible to go back to study, work hard, and succeed.”

Dental Health Services Victoria was also shortlisted in the Koolin Balit Aboriginal Health Workforce Initiative category, proving itself to be a leader in creating opportunities for Aboriginal and Torres Strait Islander peoples.

Oralhealth for better health 2014

15

ENGAGING WITH THE

community

Promoting good oral health in Victoria As well as providing dental services at The Royal Dental Hospital of Melbourne and public dental clinics across Victoria, we focus on promoting good oral health for Victorians. Here’s a snapshot of our achievements in oral health promotion and preventive dentistry.

Ensuring our young Victorians have a great start in oral health with Healthy Families, Healthy Smiles Our Healthy Families, Healthy Smiles initiative aims to improve the oral health of pregnant women and children aged 0–3 years by building the capacity of health and early childhood professionals to promote oral health. This initiative is funded by the Victorian Government. A range of stakeholders from health, education, early childhood and community sectors as well as a range of professional groups and associations were involved in the planning and delivery of the initiative in 2013–2014. Over 300 health and early childhood professionals participated in oral health professional development activities.

Day services In 2013–14, Dental Health Services Victoria partnered with six disability day services interested in developing innovative ways to address oral health.

The initiative aimed to build the capacity of day service workers to promote oral health and embed it in everyday practice. Some of the work included: building easy access edible gardens, increasing knowledge and skills to encourage healthier food and drink choices when preparing a packed lunch, dental screenings and staff professional development.

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Oralhealth for better health 2014

Smiles 4 Miles turns 10 The Smiles 4 Miles program celebrated its 10th birthday in 2014. Through the program, Dental Health Services Victoria works with local communities to create environments that support and promote the oral health of young children. Smiles 4 Miles trains local oral health champions who then support educators to implement the program in their early childhood services. Key actions include: healthy eating and oral health policy development, educator training, children’s learning experiences and family engagement activities. Smiles 4 Miles has come a long way in 10 years – it began in 2004 with 16 early childhood services and 776 children. In 2014, we had 563 early childhood services and over 31,000 children participating.

Providing oral health snapshots for Victoria We released useful oral health information to local councils across Victoria specific to their local government areas to help them play a part in improving oral health in their communities.

These profiles are available on www.dhsv.org.au/oralhealthprofiles

Launching Victoria’s first child oral health survey Up to 6,000 Victorian children aged three to 14 years helped shape the future of the state’s oral health care system by participating in a statewide dental health survey in 2014.

Professionals portal via www.dhsv.org.au We know that many professionals have the opportunity to influence better oral health and general health as part of their role, and this year we revamped our website to feature a range of oral health resources to support them. The redesigned website features a new ‘Professionals’ area to help health, education and other community workers to easily access oral health resources and programs.

Professional groups include: maternal and child health nurses, early childhood educators, disability support workers and aged care workers.

We also launched a dedicated job site (www.dentaljobs.org.au) to help find the right people for the right roles at Dental Health Services Victoria.

The Victorian Child Oral Health Survey (VCOHS), the first of its kind and led by Dental Health Services Victoria, is assessing Victoria’s child dental programs by conducting dental examinations with 6,000 randomly selected children and parent questionnaires with their families. The survey drew upon children from Victoria’s government, private and catholic schools to ensure a good representation of the oral health status of all of Victoria’s children.

Child Dental Benefits Schedule (CDBS) In 2014, Dental Health Services Victoria commenced the statewide introduction of CDBS, allowing up to $1,000 basic dental treatment over a two year period for eligible two to 17 year olds. Treatment is bulk billed via Medicare. Dental Health Services Victoria provided support and resources to Victorian public dental services to ensure that the rollout of CDBS was as smooth as possible.

Oralhealth for better health 2014

17

Q

I want to whiten my teeth.

What do I need to know?

Tooth whitening is a process that helps to make teeth appear ‘whiter’ by bleaching their surfaces.

ASK Professor Mike Our dental expert, Professor Mike Morgan, answers some frequently asked questions on dental health, including the issues more commonly faced by seniors.

Q

I’m getting dentures –

what should I expect?

Your denture may take time to get used to and it may feel bulky in your mouth to start with. Eating and speaking may be a challenge at first but your mouth should adjust in time. If there is pain or ulceration, see your dentist or prosthetist as soon as possible. Also remember that dentures will not function as efficiently as natural teeth so you may need to modify your diet a little to adapt to your new dentures.

Q

When will I need new dentures?

After five years or more, the structure of your mouth changes significantly and can mean your denture does not fit as well as it did when it was first made. Dentures usually last about five to eight years. After this time the denture may start to become brittle and the acrylic teeth will show signs of wear. These signs would indicate that it is time to see your dentist or prosthetist about getting a new denture.

Q

I’ve noticed my natural teeth looking

more stained; what’s causing this change?

Adult teeth are not naturally white. As we age, the outer layer of enamel on our teeth may wear gradually, allowing the natural yellow colour of dentine to show through.

Environmental factors, oral hygiene habits and nutrition also contribute to staining of teeth.

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Oralhealth for better health 2014

Stains on your teeth caused by food, smoking or bacteria can usually be removed or minimised without tooth whitening. Cutting down on food and drinks that can stain, like tea and coffee, and quitting smoking can make a big difference to the colour of your teeth. Regular brushing with fluoride toothpaste will also help, as well as visiting your oral health provider for a regular dental check-up, scale and polish.

Keep in mind:

• Teeth and gums should be checked by a dental professional before undergoing any whit ening.

• Results can vary. You might only see a small difference, depending on the colour of your teeth originally, the cause of colour chan ges on the enamel surface and the whitenin g technique used.

• Using tooth whitening chemicals can permanently damage the enamel surface of the teeth and the soft gum tissues.

Speak with your dental professional about whether tooth whitening is right for you.

Q

My mouth often feels dry –

what can I do?

Dry mouth occurs when there is not enough saliva (spit) in the mouth. The most common causes of dry mouth include drugs or medication, dehydration, mouth breathing, Sjogren’s syndrome, infection, nerve problems and some cancer treatments.

Treatment for dry mouth depends on the cause, but may include: Changing your medication – if you are taking a medicine that causes dry mouth as a side effect, the doctor may be able to alter the dose or prescribe an alternative medicine.

Saliva substitutes – your doctor or dental professional can prescribe an artificial saliva substitute. You can also get advice from your local pharmacist.

Dry mouth products – these products contain a variety of agents such as lubricants that may help reduce the dryness of your mouth. The product range includes toothpaste, mouthwash, gums and topical gels. Speak to your dental professional or pharmacist for specific recommendations.

Antibiotics and anti-fungal drugs – are used to treat any transient infection.

Treatment for other conditions – any underlying condition, such as Sjogren’s syndrome or diabetes, needs appropriate medical treatment.

Diet suggestions to help with

If you have damaged or infected pulp in one or more of the roots of your teeth, or an abscess has developed, you may need a root canal treatment. This damage or infection may have been caused by untreated dental decay, decay beneath a filling, tooth damage, tooth grinding (bruxism) or gum disease.

You can find more information about root canal treatments on our website www.dhsv.org.au/rootcanaltreatment

Q

dry mouth

dryness, try: You can adapt your diet to relieve mouth flow of saliva.

• Eating chewy foods to stimulate the avoiding • Restricting sugary foods and drinks or them altogether. mouth • Avoiding any substance that increases ks and dryness, including alcohol, caffeinated drin spicy foods.

ls to • Chewing sugar-free gum between mea a. promote the flow of saliv • Sipping fluoridated tap water often.

Q

Root canal treatment is a dental procedure that replaces damaged or infected pulp in the tooth’s root canal, with a filling.

I have been told that I need a root canal

treatment – what does this mean?

Inside the tooth is a hollow centre containing ‘pulp’. Pulp is a sensitive tissue made up of blood vessels and nerves that provides oxygen, nutrients and feeling to the tooth.

The pulp is found all through the tooth and the space where the pulp sits in the root is called the root canal.

The symptoms of a damaged or diseased tooth pulp may include:

• Intense pain in the tooth.

• Sensitivity to hot and cold (drinks and food).

• Pain when biting or chewing.

• Loosening of the tooth.

• Swelling of the gum near the affected tooth.

• Oozing of pus around the affected toot h.

• Facial swelling.

How can I tell if I have gum disease?

Gum disease affects most people at some stage of their lives. It is usually caused by a build up of plaque on teeth. The two main stages of gum disease are gingivitis and periodontis.

If you have any of these signs or symptoms, you may be experiencing signs of gum disease.

• • • • • • •

bleeding, particularly when brushing. redness. swelling of the gum. receding gums. bad breath. a bad taste in your mouth. loose teeth.

Q

What can I do about gum disease?

While it is tempting to avoid cleaning your gums when they are inflamed or bleeding, brushing your teeth will help improve the situation. Brush gently with fluoride toothpaste twice a day, even if your gums bleed. Visit your dental professional for a check-up, especially if you are experiencing any of these symptoms.

Q

What is the value of substituting

baking soda for toothpaste?

While baking soda is not harmful to teeth, it is not recommended as a replacement for commercially available fluoride toothpaste. Using toothpaste which contains fluoride repairs tooth decay in its very early stages.

If you have a question about dental health, email us at healthysmiles@dhsv.org.au

Oralhealth for better health 2014

19

FEEDBACK

Jaimie (right) with Dental Therapist, Karin Cook

Dental Health Services Victoria is committed to providing you, our patients and consumers, with high quality oral healthcare. The feedback we receive gives us the chance to improve ourselves so that we can continue to provide you with a safe and quality service. Our feedback system allows us to manage complaints, compliments and suggestions that we receive from our patients. When we receive feedback, we work with the relevant managers as quickly as possible and respond within 28 days of receipt.

In 2013–14, we received 291 complaints relating to a variety of issues. We are working hard to improve these areas based on your feedback.

291 2013–14

2012–13

254

379

339 2010–11

2011–12

317 2009–10

2008–09

264

Complaints per financial year:

Complaints by category:

Access: 115 Waiting times, delays in treatment.

T reatment: 56 If the treatment was not good enough or if it was different to what you were expecting.

C ustomer service: 50 Attitude of staff, not enough information or information that was incorrect.

Communication: 34 Miscommunication or a lack of communication that resulted in the patient having a negative experience.

A ppointment scheduling: 14 Where a wrong appointment was made or patient didn’t get an appointment.

F acilities: 12 The buildings and the way they work, including car parking and getting in, out and around.

Cost: 10 Cost of treatment.

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COMMUNITY ORAL HEALTH Champion Dental Health Services Victoria (DHSV) presented the first ever Community Oral Health Champion Award in 2014 to recognise the commitment of those who work alongside the Victorian public oral health sector. We’re proud to announce Jaimie Poorter, Project Worker, Lower Hume Primary Care Partnership the winner of our inaugural award, part of the Public Oral Health Awards 2014.

There’s no stopping Seymour resident Jaimie Poorter when it comes to improving the oral health of her community. She works tirelessly to promote the healthcare services available within the Lower Hume communities and over the years she has worked hard to engage residents through numerous community programs and initiatives.

Her list of achievements includes her pivotal role as a Smiles 4 Miles coordinator, which involves raising awareness of the importance of oral health with some of our youngest community members and their families.

“The best part about my job is that I love doing it! I get to work with adorable kids and their families to help them make better health choices that will help them to live healthier lives,” Jaimie said.

Jaimie also works with the Aboriginal and Torres Strait Islander community in the Seymour area to promote oral health to through health information sessions that emphasise the importance regular dental check-ups.

She co-hosts a monthly Sunday radio program with a respected Aboriginal elder promoting the importance of healthy eating and oral health as part of this work.

“Oral health is so important to general health and wellbeing, so I want to do all that I can to promote its importance to the community.”

But that’s not all, Jaimie recently partnered with maternal and child health nurses to present to first mothers groups on healthy eating and oral health. These healthy eating and dental health workshops reach the lower socio-economic groups who tend to have poorer oral health outcomes in her local area.

“Winning this award has helped motivate me to keep doing what I can to improve oral health for families in my community,” Jaimie said.

“It’s nice to be able to do something you are really passionate about and be recognised for it.”

PUZZLES

DOWN

ACROSS

1 Apples and oranges 2 Dietician’s forte 3 False teeth 4 The top language spoken by refugees and asylum seekers at The Royal Dental Hospital of Melbourne 5 It’s often prescribed 6 The flesh around the roots of your teeth 7 Meeting all the requirements

8 It’s applied to teeth with a brush 9 The Father Bob Maguire’s Foundation food van 10 Too much of this in food and drink can cause tooth decay 11 Happening in someone’s home 12 Older and more experienced 13 Smiles 4 Miles turned ___ years old in 2014

1

CROSSWORD Answers on page 23

2 3 8

12

9

10

6

THE MAZE

4

5

7

13

11

FIND FATHER BOB TOOTHBRUS ’S H

Located som ewhere in this magaz ine.

Answer on ou r feedback form or on www.dhsv.org .au/ to win a family QoC-feedback movie pass.

21

SERVICES AT The Royal Dental Hospital of Melbourne You will need a healthcare or pension concession card to be able to use most services at The Royal Dental Hospital of Melbourne.

If you do not have one of these cards, you can still get emergency dental treatment but you will need to pay a fee similar to what you would be charged at a private clinic.

Cost You may have to pay some money to get dental care at public clinics, including The Royal Dental Hospital of Melbourne.

Some groups with special needs do not have to pay.

Go to www.dhsv.org.au/fees to find out how much you need to pay or you can call (03) 9341 1000 for more information.

Treatment in the Teaching Clinic is free for some people. Find out more on page 7.

If you have a dental emergency, please call 1300 360 054 before arriving at the Emergency Department. We will assess you over the phone and give you some advice on what to do next.

Interpreter services Interpre

. ter services are available for all patients

se tell us When you make your appointment plea uage you lang t wha and if you need an interpreter prefer to speak. you come These services need to be booked before to the hospital for your appointment. for Telephone interpreters can be arranged emergency patients.

The top six languages spoken by people who visit The Royal Dental Hospital of Melbour ne (other than English): • • • • • •

22

Arabic Persian (excluding Dari) Vietnamese Greek Italian Mandarin

Oralhealth for better health 2014

Emergency care is also available at clinics across Victoria.

To find your nearest clinic call (03) 9341 1000 or go to www.dhsv.org.au

Priority access – helping people get the care they need Priority access means that you do not have to go on a waiting list to receive dental treatment. You will receive the next available appointment. The following groups can get priority access to emergency and general dental care at The Royal Dental Hospital of Melbourne (specialist care is based on clinical priority): •

children (0–12 years) and young people

•

Aboriginal or Torres Strait Islander peoples

•

pregnant women

•

refugees and asylum seekers

•

homeless people and people at risk of homelessness

•

r egistered clients of mental health and disability services, supported by a letter of recommendation from their case manager or staff of special developmental schools.

More information about our services and priority access can be found on the DHSV website – www.dhsv.org.au

THE LAST WORD Ron Barassi

Ron Barassi is one of the most influential people in Australian Rules football, with a 50 year career as player and coach.

Now 78, Ron is semi-retired and keeps a balance between business interests, family, friends and hobbies, including supporting his team, the Melbourne Football Club. We caught up with Ron for a chat.

How are you keeping healthy these days?

I go to the gym twice a week and on the other days I aim to have a half hour walk. Every now and then my wife, Cherryl, uses me as muscle power in the garden and I make sure to follow instructions carefully. I enjoy playing chess, backgammon and cards with my friends and family. I also regularly do crosswords and Sudoku.

I’m low-tech but I have a go at the Lumosity games on the computer too.

Are you involved in football?

I still enjoy going to the footy at the MCG (Go Demons!), and I’m patron of the Melbourne Football Club Bequest program. More broadly, I'm a passionate supporter of international and grassroots development of our great game. A pet business project of mine is promoting an innovative ‘concave’ football boot, which provides greater power and accuracy.

5 practices Ron lives by 1. Go to the doctor and dentist for regu lar check-ups; not just when you’re ill.

2. It’s never too late to give up smoking . I took up smoking when I finished playing football.

It’s a hard habit to break but well worth the effort.

I quit 25 years ago.

3. Eat plenty of fresh vegetables and fruit .

4. Take your mind off yourself. Do som ething for someone else.

5. Have some fun and count your blessing s every day.

As a senior, what is your advice to seniors on taking care of their health?

Of course things change with age – nothing works quite as well as it used to. But it’s not what happens to you, it’s how you cope with it that matters. Heading for 80 with quite a bit of wear and tear, I still try to get as much fun as possible out of every day. I like the advice of Harvard Medical School psychiatrist, John Ratey, who says that “exercise is the single best thing you can do for your brain in terms of mood, memory and learning.

Even 10 minutes of activity changes your brain.”

Photo: Courtesy Fairfax photos

Crossword answers: 1 Fruit 2 Nutrition 3 Denture 4 Persian 5 Medicine 6 Gum 7 Eligible 8 Toothpaste 9 Hopemobile 10 Sugar 11 Domiciliary 12 Senior 13 Ten

More about Ron at www.ronbarassi.com.au

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Child dental care

can now be

bulk billed.

No gap, no out of pocket costs The new Commonwealth Child Dental Benefits Schedule allows for up to $1,000 basic dental treatment over a two-year period for eligible 2–17 year olds •

–17 year olds are eligible if they 2 receive Family Tax Benefit A or other relevant Australian Government payments

•

Treatment is bulk billed through Medicare

In all Victorian public dental clinics •

Eligible children pay $0

•

no out of pocket costs

•

o wait list – your child will have the next n available appointment

What dental treatments are available?

•

ental check-ups and D cleaning teeth

•

Fissure sealants and fillings

•

Dental X-rays

•

Extractions

•

Root canals

Excludes orthodontic or cosmetic dental work and will not be paid for any services provided in a hospital operating theatre.

Find out more www.dhsv.org.au/childdental

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