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JUNE 2013, $5.95 INC. GST

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Finance product guide, page 37 Changing chairs How often should you update your capital equipment? Page 32 Google juice What does SEO mean now? And how do I use it to grow my business? Growing up, not smiling GUS rules are announced, and the ADA isn’t happy, page 4 The whole TOOTH Next stage of the TOOTH outback program, page 10

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Associate Professor Rodrigo Mariño and his colleagues from Melbourne Dental School are taking the promise of tele-dentistry from science fiction to reality


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contents

COVER STORY

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Contents News & events

Your tools

8. products 35.New Infection control product guide The best new and Everything yougear need to gadgets know about the best

June 2013

COVER STORY

4. 4. Not CPDhappy, outrageJulia The ADA isn’t smiling about the Growing Dentists around the country are new outraged Up Smiling rules; and more… as the federal government announces limits to the tax deductibility of professional education; a world call for a national approach to your fluoridation; and more… 10. From rescue to recovery The challenge for The Outback Oral Treatment your world & Health (TOOTH) program is establishing dental moreagain than crisis management 10. Oncare theasroad Can Australia deliver on dentistry for your business Australian teens? Perhaps New Zealand has a private model we mean can look at 15. What does SEO now? Despite its slightly tarnished reputation, search enginebusiness optimisation (SEO) is a skill, your a15. science and an essential ingredient of The business of dentistry any successful websitehas developed an  A Queensland college accredited post-graduate business course 25. Superheroes for dentists The added extras that super funds provide access to can bethe of benefit 22. Cracking code to your employees How do building codes affect your decisions 28. exposure whenNorthern establishing a surgery? The new dental school at James Cook University far-north 26. Man in with a vanQueensland has combined cutting-edge architecture with Orthodontist Dr John Brabant has created state-of-the-art facilities a service to help the homeless which has extended to a service addressing oral health 32. Rise of the machines In these straitened financial times, how often Your should you betools updating your equipment? 8. New products The best new gear and gadgets

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High-speed pursuit The data speeds promised by the National Broadband Network is revolutionising tele-dentistry and, as a result, the delivery of public healthcare, as a team of researchers at the Melbourne Dental School and the Oral Health Cooperative Research Centre are discovering

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infection control products on the market today 37. Finance product guide Bite guide to the best finance 39. magazine’s Tools of the trade products for dentists on the market today A brilliant 3D diagnostic tool, blinding whitening, a disincentive for thumb-suckers and more are 43. Tools of the trade under the spotlight this month More efficient root canals, going all flowable, a universal torque wrench and more Your life 42. Flying high In search of the ultimate adrenaline rush, Your life Dr Taoran of The Chatswood Dental 46. RoyalWang racquet Practice in NSW threw herself a plane Dr Barry Johnson is always up out for aofgood game of royal tennis Editorial Director Rob Johnson

Sub-editor Kerryn Ramsey

Creative Director Tim Donnellan

Contributors John Burfitt, Francesca Newby, Chris Sheedy, A.M. Walsh

9,231 - CAB Audited as at March 2013

custom content

Commercial Director Mark Brown

For all editorial or advertising enquiries: Phone (02) 9660 6995 Fax (02) 9518 5600 info@bitemagazine.com.au

Bite magazine is published 11 times a year by Engage Media, Suite 4.17, 55 Miller Street, Pyrmont NSW 2009. ABN 50 115 977 421. Views expressed in Bite magazine are not necessarily those of the publisher, editor or Engage Media. Printed by Bright Print Group.


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ADA not smiling about new GUS rules It’s like they don’t listen, says the ADA about the federal government

T

Health Minister Tanya Plibersek released the new benefits rules.

“As designed, it is introducing two-tiered dentistry—one for GUS recipients with limited services and another for those that can access and receive clinically necessary treatment. This government will be known as the government that introduced ‘poor dentistry for poor people’ because this scheme as currently designed

does just that,” added Dr Alexander.“At nearly 20 per cent below a dentist’s average fees, based on the ADA fees survey of July 2012, the GUS scheme will, at its introduction on 1 January 2014, offer rebates that will leave no alternative for dentists but to charge co-payments for services to deserving populations just to cover costs. “While dentists have been underwriting services for veterans and their families, the goodwill of the profession is being stretched to crisis point. The dental profession cannot and should not be obligated to provide services at a loss.” The rules also provide details of the administrative arrangements to be followed under the GUS scheme which the ADA will be reviewing in great detail. Dr Alexander concluded: “The administrative requirements as detailed in the rules will require careful scrutiny. We will not be encouraging our members to become involved in this scheme until we are confident that there has been adequate education of the profession and consultation to ensure that there are no unwarranted administrative requirements.” 

Dental board versus word of mouth The Dental Board has identified “The ongoing issues with respect to advertising by dental practitioners” as an area of concern to the Board. At the same time, dental marketing group IDM has begun to circulate an online petition questioning the guideline regarding the use of patient testimonials. The Board’s communiqué says its response to ongoing debate about

advertising means that “it has agreed that a Taskforce Dental Advertising group (the Taskforce) be established. The Taskforce will comprise members of the National Board and AHPRA staff with relevant legal backgrounds and will meet as appropriate to discuss and make recommendations to the National Board on the AHPRA approach to the management of notifications on advertising matters.”

It adds that the National Board reminds all dental practitioners that they are responsible for the content of all advertising material associated with the provision of their goods/ service, regardless of the type of media used to advertise and should ensure that advertising is compliant with the National Law and Advertising Guidelines. The IDM petition is at www.dentalsurvey.com.au/idm. 

Photography: credit

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he release of the Dental Benefits Rules 2013 by federal Health Minister Tanya Plibersek demonstrates that the consultation process undertaken by the Department of Health and Ageing was a ‘Clayton’s’ consultation, said the Australian Dental Association Inc (ADA). “The ADA has repeatedly called on the government to ensure that prevention and oral health promotion are key features of the Child Dental Benefits Scheme—Grow Up Smiling (GUS). The ADA sought the facilitation of a full range of dental treatments, and not just “basic” treatments. The release of the rules, in just over a week after the consultation process closed, demonstrates that these rules were written long before the consultation phase was completed, and no notice was taken of the comments and advice provided by stakeholders, such as the ADA, through the submission process,” stated Dr Karin Alexander, ADA federal president. In its submission to the department, the ADA advised the government that limiting treatments would compromise the level of care provided to children under the scheme. The ADA platform was that the entire schedule of dental services should be available under the GUS scheme so as to provide the same level of care as would be available in the general community.


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Most dental expenses out of pocket

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Individuals contributed 58 per cent of the $7.9 billion spent on dental services in Australia in 2010-11, according to a report released by the Australian Institute of Health and Welfare (AIHW). The report, Oral health and dental care in Australia: key facts and figures 2012, shows that the $7.9 billion spent on dental services in 2010-11 was two per cent more than the previous year. The report shows that in 2010, 64 per cent of people aged five and over had visited a dentist in the previous year. This ranged from 78 per cent of children aged five to 14 to 57 per cent of adults aged 25 to 44. Noting that just over half of all people aged five and over had some level of private dental cover in 2010, most adults with some level of dental insurance made co-contributions towards the cost of dental visits, said AIHW spokesperson Professor Kaye Roberts-Thomson. “Nearly one in 10 insured adults paid all their own expenses, and of these about 17 per cent reported that this caused a large financial burden,” she said. A second report, The dental health of Australia’s children by remoteness: Child Dental Health Survey Australia 2009, presents similar results for children living in remote and very remote areas. “This report describes the state of dental health of Australian children examined by school dental service staff in 2009,” Professor Roberts-Thomson said. “It shows the mean number of decayed, missing or filled permanent teeth at age six and 12 were higher among children in remote and very remote areas than among children in major cities.”

Researchers increase the success rate of tooth implants Elderly or people with osteoporosis, smokers, diabetics or people who have had cancer are sometimes not eligible to receive dental implants as their bones are unable to correctly integrate the new prostheses which replace the root. A report from researchers at the Universitat Jaume I (UJI) in Castellón, Spain, claims they have developed an implant coating with a novel biodegradable material aimed at people with bone deficit. It will also increase the overall success rate of implants through an enhanced biocompatibility and reduce the time of osseointegration or bone integration. If so far the titanium radicle replacing the tooth root took at least two months to be anchored to the jawbone, the prototype developed will reduce the waiting so that patients can receive the ceramic crown which replaces the visible part of the tooth earlier, and thus regain their normal life sooner.

 Julio José Suay, coordinator of the research group of Polymers and Advanced Materials explains: “It consists on covering the implant with a biodegradable coating that, upon contact with the bone, dissolves and during this degradation process is able to release silicon compounds and other bioactive molecules which induce bone generation.”

 This is a totally innovative research line as the systems used to date consisted of increasing roughness of the implants to facilitate its integration into the bone. In this regard, Suay stresses

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that Soldent is a collaborative project between academia and industry developed in the framework of the call ‘Innpacto’ of the Spanish Ministry of Economy and competitiveness.

 For the Soldent project, researchers at the Jaume I and the University of the Basque Country are working with the company Ilerimplant SL in the development of this competitive prototype. After in vitro testing with cell cultures of the different biomaterials, they proceeded to the live animal evaluation, until achieving the prototype with the best results. The next phase consists of a clinical evaluation, in order to obtain the marketable sanitary product within two or three years.

 The research aims to improve the success rate of dental implants, especially for people with jawbone deficiencies. In this regard, non-replacement of a lost tooth involves a series of biomechanical problems such as change of the bite line, the disordering of the teeth and the creation of empty spaces between them. This can ultimately lead to periodontal diseases as gingivitis and periodontitis that deteriorate clamping mechanisms of the teeth and cause the loss of more teeth. This is why it is so important to replace teeth, in addition to the full recovery of the masticatory functions and normal social relations.

ADA slams the federal budget The Australian Dental Association has announced its “disappointment” over the deafening silence on oral health issues in this week’s federal budget. “Having laid groundwork for the delivery of dental care for children in the previous budget, it is disappointing that this action has not been accompanied by any further investment in the delivery of dental care to deserving groups in the 2013-14 federal budget,” the association said in a statement. The 2013-14 Federal Budget includes a measure to improve municipal and essential services, including water supplies, for indigenous communities. The ADA questioned whether this would include fluoridation. Despite the effectiveness of this population health measure, the Department of Health and Ageing deflected responsibility for fluoridation to states and territories rather than lead in this key area. “This is even more puzzling given their proposed investment in the Child Dental Benefits Scheme—Grow Up Smiling (GUS),” the association added. The ADA also pointed out that it has been seeking assistance from government on dental workforce issues such as the introduction of a HECS forgiveness scheme for dentists who agree to work in the public dental system or in rural and remote areas and the provision of tax exempted grants offered under the Dental Relocation and Infrastructure Support Scheme. Further, it asked that Health Workforce Australia extends its study of the oral health workforce to specifically examine the oral health academic workforce. The placement of a cap on the number of Commonwealth Supported Places in dental program (dentist and oral health therapy courses) was sought. There were no measures to address these issues. “In fact, the Australian government’s imposition of a ceiling of only $2000 on self education expenses puts health delivery at risk,” the organisation added. “Self-education ensures the quality of services professionals provide. The ADA and other professional groups will join to oppose the introduction of this measure.” 


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New products New-release products from here and around the world

08

PROTAPER NEXT™: next generation technology for next generation results DENTSPLY Australia is pleased to announce that the next big thing in endodontics, PROTAPER NEXT (DENTSPLY Maillefer), is now officially available to clinicians in the Australasian market. After a successful prelaunch and delegate response at the 35th ADA Congress in April, this new innovative root canal treatment system is set to continue to impress. The PROTAPER NEXT rotary system is a convergence of the most proven and successful generational designs from the past, coupled with the most recent advances in technology. The system is the successor to the ProTaper® Universal System, which has been the gold standard in endodontics for many years. Now, the next generation of the gold standard in endodontics has been developed, based on the same principles including the variable tapers for an optimised crown down technique.

The additional benefits of the PROTAPER NEXT file system arise from next generation technology including the M-Wire NiTi material and the patented, off-centred rectangular cross-section which gives the files a unique ‘swaggering’ movement in the canal. This swaggering effect reduces file binding, improves debris removal and improves file flexibility. Together, these advancements in technology give rise to several next generation results including:  Increased patient safety and clinician confidence—the risk of file

separation is reduced and at the same time, respect of the original root canal anatomy is improved.  Increased efficiency—fewer files are typically required.* Only two files are required to reach tip size 025, 6% taper. Additionally, only one torque and speed setting is needed for all files, resulting in a shorter clinical sequence.  Potential coverage of more clinical cases due to increased flexibility of the files. For convenience, the files are packaged in pre-sterilised blister packs. Matching paper points, gutta percha points, and GuttaCore™ obturators complete this innovative new system. It’s an experience to believe. Take advantage of our risk-free trial by visiting www.dentsply.com.au/NEXT or by contacting your local DENTSPLY sales specialist.  *Compared with ProTaper Universal.


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Support  Clinical support in real-time, either via phone or LiveChat online  Ask the Expert mentoring facility on our website  Track cases and manage your account via your Virtual Practice Site

Visit us at www.scdlab.com


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From rescue to recovery Twelve months in, the challenge for the TOOTH program is establishing dental care as more than crisis management. By John Burfitt 010 10

‘‘I

t is so hard as a dentist to describe what is actually out there. It is almost Third World conditions. When you have a kid open their mouth and there is only one clean tooth in there, that is not what you expect to see in Australia in 2013.” They’re the words of Dr Lyn Mayne, senior dentist of the Royal Flying Doctor Service South Eastern Section, based in the outback city of Broken Hill. She oversees The Outback Oral Treatment Health (TOOTH) program in the western NSW communities of Bourke, Collarenebri, Goodooga and Lightning Ridge. TOOTH was set up to address the poor and deteriorating oral health in some of the state’s most remote communities. Of the patients the TOOTH dental team attends to, 49 per cent are indigenous Australians and over 60 per cent are health care or pension concession cardholders. “These communities are very remote and isolated by that fact, and are often a lower socio-economic group,” Dr Mayne says. “Access to dental services is poor and in the past, people would have to travel over four hours or so to places like Dubbo to

get their teeth checked. There is also data that has shown indigenous communities have a greater amount of decay and missing teeth than their counterparts. “What we are trying to do with TOOTH is fulfil that need for access to dental services. Just being out there, people are now coming forward to have treatments done and we are starting to make a difference. It comes down to that age-old thing of people being scared of the dentist, and just by having a regular presence in those towns, it is taking some of that fear away.” TOOTH began in February 2012, as a partnership between the RFDS and the Investec and Gonski foundations. Its three year funding comes at a cost of $2.5 million. In its first year of operation, TOOTH has provided dental care to over 1600 patients in areas where there had previously been either only intermittent or no dental health services at all. Before TOOTH, dental decay in children in these remote communities was recorded as being five times the national average. At the end of the first 12 months, the fly-in, fly-out TOOTH program is being hailed as a success. Among its achievements is a 19 per cent increase in the number of new patients, a marked overall reduction in the number of actively decayed teeth in children and a decrease in

untreated decay and other forms of oral disease. It also met its goal of 256 clinics in its first year. TOOTH operates with dentist Dr Callum Addison and dental therapist Rebecca Hovington providing a clinic per week to the four communities. Another aspect of TOOTH is the dental student mentoring it provides, as the program is run in consultation with Charles Sturt University, the University of Sydney and Griffith University. On each visit that dental specialists Addison and Hovington make, an intern dentist accompanies them to assist. In total, 30 interns have worked on TOOTH in the past 12 months. Dr Mayne says it is seeing the outback communities through the eyes of the intern students that often provide the most sobering reminder of the state of dental health in the area and the way many people have become accustomed to live. “When you talk to the students after they have done the visits, they are always shocked at the conditions some people will continue to exist in with their teeth,” says Dr Mayne. “They are astounded the pain people will put up with and what they will let their teeth get down to due to the lack of services. I don’t think you ever get used to it.” As TOOTH enters its middle year of


11

“I think just being out there, people are now coming forward to have treatments done,� says Dr Lyn Mayne of the RFDS.


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operation, Dr Mayne says the challenge is about educating the remote communities that dental health care is more than just treating in a time of crisis. “One of the best things about the first 12 months of TOOTH is that while we have had an increase in the number of new patients, we have also provided a great deal of diagnostic and preventative services to ongoing patients,” she says. “I see the challenge we have in the next six months is about continuing to get people to come back through the door. “Sometimes, if you get people out of pain, you won’t see them until they are in pain again, rather than maintaining a regular treatment program. It cannot be a case of just removing the pain and keeping going. We are offering dental health care as an ongoing part of life.” The most effective way to achieve this, she believes, is by the TOOTH dentists very presence in the region, so for new generations in these communities, access to dentist care will become a consistent across their growing years. “Through the access, we can provide

New TOOTH dentist Dr Callum Addison (left) and David Gonski of the Gonski Foundation, one of the founders of the TOOTH program.

them with education so these kids grow up used to seeing dentists and we can stop things happening so they get to the stage where they stop smiling because they don’t have any teeth. Just yesterday, I had in some girls in their twenties, and I was looking at their teeth that have to come out and will affect their smile. As a dentist, that is very sad to see.” Dr Mayne has worked in the Broken Hill area for 15 years now, having previously worked in a private practice in Hobart. She points out that the biggest difference between working in dental care in a metropolitan practice and in outback

communities is the reaction of the locals. “In these communities it is the appreciation of the people; they just so want you to be there and are glad to see you. As a dentist, that is astounding. Years ago when I was working in private practice, all I heard all day was, ‘I hate seeing the dentist’,” she says with a laugh. “It is rewarding to go to an area where they are glad to see you and you know you are able to make a difference to their health. We have another two years to go now and I am hoping we get recurrent funding to continue, and I hope we get the funding next time for two dentists.

The DHAAQ Third Annual

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To register, visit: www.dentalhygienist.com.au/events

Registrations open until 12th July 2013 DHAAQ & ADOTHA members $75 Non-members $160 DAA members & Students $35 3 hours verifiable CPD


Dr Ron Ehrlich SyDnEy HoliStic DEntal cEntRE & noRtH SyDnEy DEntal PRacticE, nEw SoutH walES

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I would often see other practices as my competitors, now I view my fellow Dental Corporation practitioners as colleagues who I can both learn from and impart knowledge to. Working in such a collegiate environment stimulates my passion for providing the best care for my patients. I have access to some of the top minds in the field to discuss treatment options and learn new techniques. I still run my practice my way but can tap into and feel part of something much bigger than I’ve ever experienced before.

To hear more about Dr Ron Ehrlich’s experience with Dental Corporation visit www.dentalcorp.com.au/Bitevideos or phone +61 2 9422 4715


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If you want customers to find your website, you need to come to grips with what SEO means now.

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Despite its slightly tarnished reputation, search engine optimisation (SEO) is neither a dodgy tool nor a black art—it’s a skill, a science and an essential ingredient of any successful website. By Francesca Newby

G SEO

What does

mean now?

etting to grips with SEO can seem like a lot of work with no clearly defined payoff, but if you’re running, or planning to run, a website that is designed to bring in new business rather than simply service existing clients, then you just can’t afford to be without it. At its heart, SEO is really quite simple. Search engine optimisation, or SEO, is the umbrella term for the techniques used to drive traffic to a particular website. Essentially, it’s all about having good quality content that is fresh, relevant and original, and then presenting and marketing that content in a way that allows the people who might be looking for it to actually find it. In order to make your site readily findable, its content needs to satisfy the algorithm used by the search engine the query was entered into. The difficulty is that the parameters of the algorithms used by the major search engines are closely guarded secrets. Establishing an effective and busy website is most definitely not a case of ‘build it and they will come’. Paid advertising has its place when it comes to attracting attention to your site, but


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research consistently shows that the majority of online searchers are looking for what the industry calls ‘organic’ results. That is recommendations made by other users, links from related sites and, most importantly, a result on the first page of their Google search. Whether you’re looking to build a new site for a practice or to refresh an existing one, just how much you need to know about the detail and specifics of SEO depends on how involved you are when it comes to building and managing it. There are options that run from the entirely self-created end of the spectrum through to full-service firms that specialise in websites for dental and medical practices. Do-it-yourself sites have never been easier than they are now, and readily accessible tools allow anyone with moderate tech skills to build a decent looking site. Companies like Wordpress and Wix market a range of free and paid themes that simplify the design process and require little or no programming skills. What they do need in order to operate competitively is a variety of SEO and analytics plugins that enable you to implement the simpler techniques, such as key words and optimised URLs. While the DIY packages offer increasingly sophisticated widgets for managing SEO tools, what they don’t provide is the skills required to implement them successfully. This is the gap that major hosting companies, such as Net Registry and Web Central, have stepped up to fill by offering stand-alone SEO marketing packages. There’s a lot to be said for the building block approach to purchasing the services you need to create, refresh or maintain a site. They offer a kind of bridging service for small-business owners who want to keep much of the process of creating a website in house without having to personally navigate the complexities of SEO. One of the challenges facing small and medium businesses is how to take advantage of the benefits offered by good SEO without recourse to the marketing departments and budgets of large corporations. Opting for an SEO specific package is a good way to ensure that the underlying architecture of your site is solid and working for you rather than driving your page down

How much you need to know about search engine optimisation depends on how hands-on you’re going to be with your website.

Oliver Bárány’s 3 keys for effective SEO:  It’s all about good content that is fresh, original and regularly updated.  You have four seconds to catch and keep the attention of someone who clicks on your link.  Networking and ‘introductions’, through associations and links, are vital to ranking.

the rankings. SEO plans are separate from the various site build and content creation packages out there; they’re about modifying content. While there’s a lot we don’t know about the precise details of the search engine algorithms, one thing we do know is that content is key. However you choose to handle your SEO needs, it’s important to understand that, more than ever, fresh and original content is vital. Earlier this year, Google released Panda, its latest algorithm update, and one of its key aims was to beat the shucksters who had been gaming its system with key words inserted into irrelevant places, low-quality replicated content and doorway pages. The new standards are an effort to improve the quality of searches, but have also penalised a number of genuine sites.

“The point of a search engine is to assess and organise information and it’s quite easy to unwittingly post information on your site that’s actually detrimental to its ranking,” explains Oliver Bárány, online marketing strategist at Surf Pacific, a Queensland based company that specialises in building websites for the dental and medical fields. He says SEO specialists are certain that Google is measuring the availability of fresh, new content as part of its algorithm. “SEO is all about good, new content and we look after all content marketing, tying your FB page, blog and site together. It’s all about coming up on the front page of the search engine on a key word search.” This is where the full service firms come into their own. Regularly creating and adding original new content to a website is a time-consuming business if you don’t know what you’re doing, and sometimes even when you do. Being able to hand over the responsibility will be more expensive than choosing to go it alone, but when done well, good SEO should earn its own outlay back in the first year. “Our clients went to university to train to be a dentist, not to learn marketing,” says Bárány. “A good site is not just there to look beautiful, it’s there for a purpose, and that’s to help the dentist get more business.” 


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High The speed

pursuit n academic research project that ended late last year provided a fascinating and vital insight into the power of broadbandenabled internet. The idea of the project, which involved researchers from the Melbourne Dental School, the Oral Health Cooperative Research Centre and the Institute for a Broadband Enabled Society (IBES), based within the University of Melbourne, was to figure out whether a remote dental examination using an electric toothbrush-sized camera and a broadband web connection could be as accurate as a face-to-face examination. “Obviously there was a difference in results,” says Associate Professor Rodrigo Mariño from the Melbourne Dental School. “A face-to-face examination is always going to deliver a better result. But what we discovered, in controlled laboratory conditions, was that the remote examination was accurate to an acceptable degree. It was not as accurate as face-to-face, but it was not far off.” Assoc Prof Mariño is now running a new research project in more of a real-world situation rather than in laboratory conditions. He and his team are conducting remote examinations of people within nursing homes in order to continue to test results and to discover new uses for, and restrictions of, the web-based technology. “A lot of the success of such technology is down to the National Broadband Network (NBN) and its implementation,” Assoc Prof Mariño says. “For example, we have calculated that a file containing a 15-minute remote examination on high-resolution video

uses about one gigabyte of data per minute. With pre-NBN data speeds, such a file would take hours to stream to the specialist via online channels, so a 15-minute examination would become an all-day time waster. But with NBN speeds, the file is almost instantaneous. It streams in seconds.”

Remote consultation for remote regions Assoc Prof Mariño is quick to point out that tele-dentistry will never be a replacement for face-to-face consultations. Much of dentistry is about touch and feel so issues such as soft tissue conditions will never mix well with tele-dentistry in video form. But for many remote areas of Australia where there may be no dental services, or within specific areas of society that tend to experience lower oral health standards, such as nursing homes, tele-dentistry is much better than what patients are offered right now. Tele-dentistry, in some form, has actually been around for a very long time, Assoc Prof Mariño says. Dentists have sought advice from colleagues or specialists in other territories over the phone, or by email. But broadband internet and its ability to stream high resolution video takes tele-dentistry on a giant leap forward into a new era of real-time consultation and advice. “Our objective is to find out how we can use this technology for various purposes and many beneficial options are revealing themselves,” Assoc Prof Mariño says. “We’re currently working with nurses in nursing homes who can manipulate the cameras as we conduct an examination, for instance. This works very nicely as a form of preventative care as often there might be a condition that is able to be resolved by the nurse, under instruction from a dental specialist, in real time.”

PHOTOGRAPHY: eamon gallagher Photography: credit

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The data speeds promised by the National Broadband Network is revolutionising tele-dentistry and, as a result the delivery of public healthcare, as a team of researchers at the Melbourne Dental School and the Oral Health Cooperative Research Centre are discovering. By Chris Sheedy


Associate Professor Rodrigo Mari単o from Melbourne Dental School.


COVER STORY

What a remote consultation may look like in the NBN-enabled future.

20

“Also, imagine if somebody is located in a rural area that has a dentist but no specialists. A patient experiences a serious dental problem that requires specialist knowledge and experience. Previously they would have had to travel to the city and endure the expense of accommodation and travel, as well as time away from home and work, in order to have the problem seen to. But if a specialist can do a tele-consultation and offer advice to the local dentist in real time over a broadband connection then it’s possible the issue can be resolved without the need for travel.” “Finally, if a dental specialist must travel to a nursing home to assist a patient or patients with particular types of problems, a tele-consultation conducted before they leave can ensure the right specialist with the right equipment is sent on the job, and that they experience no unexpected surprises when they arrive.” The technology is moving forward at a rapid pace, Assoc Prof Mariño says. Consider that just 10 years ago such real-time communication and video streaming was not just impossible, it wasn’t even on the radar. While we don’t know what the next decade might bring, as the NBN is completed and the dental industry innovates around such technology, researchers such as Assoc Prof Mariño and those within his faculty are putting the basic building blocks in place to ensure that by the time tele-dentistry becomes commonplace, the industry doesn’t

have to learn from its own mistakes. “We’re conducting another project with the Royal Children’s Hospital in Melbourne that is also centred around helping patients based in rural areas to avoid trips to the city for treatment. In the case of people suffering a dental

Quote

IBES says over the next 45 years the number of Australians aged over 65 is expected to double. Social isolation among the elderly is already becoming more prevalent, leading to its own special set of problems. A rise in chronic diseases is already beginning to reveal

Associate Professor Rodrigo Mariño of Melbourne Dental School

“We’re currently working with nurses in nursing homes who can manipulate the cameras as we conduct an examination.” trauma, for example, in the past, if they could not get local treatment, they had to come to the city. But sometimes with high-speed broadband technology and a dental professional at the other end of the web connection, that travel can be avoided and some treatments can be carried out locally under teleconsultation. This doesn’t just save money and hassle for the patient, it frees up resources in city hospitals and clinics, many of which are already experiencing punishing demand and long waiting periods.”

Futuristic solutions for future problems It’s no secret that the ageing population in Australia, as in many other territories around the globe, is going to place massive pressure on our already-stressed medical system. The

shortfalls in the health workforce and problems in some areas around access to specialist care. The elderly require greater medical care than any group in society. As the tax-paying worker base shrinks while the pool of retirees expands over the next few decades, new solutions are vital. Many, including researchers at the IBES, believe one of these solutions will involve tele-care for in-home consultations. The ability to have medical check-ups and monitoring conducted within the home, in consultation with remote specialists, will help to reduce pressure on hospitals which, current research shows, within the next few decades will not have enough beds to take care of chronic patients. Such bodies as the IBES and the Asia-Pacific Ubiquitous Healthcare Research Centre (APuHC), directed by


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Professor Pradeep Ray at the University of New South Wales, have been at least partly set up to look into using technology as a solution to develop ways and means of providing health care to people in their homes and in remote regions. The APuHC is also looking into using wireless web technology to provide first-class medical assistance on the ground after a natural disaster such as a tsunami or an earthquake, particularly in less developed nations. It’s important, in this specific case, that the solution is wireless as other web infrastructure is often knocked out during a natural disaster. The dental industry in Australia will require the same types of advanced and innovative solutions to cope with future issues. Once the technology is up and running it is likely to make a genuine difference to many people in various geographical, age and socio-economic regions, groups and sectors.

redefining healthcare spaces..

Quote Associate Professor Rodrigo Mariño “This technology won’t just save patients from having to travel in to cities—it will also allow dental experts from around the world to share and gain knowledge.” Two-way web traffic The NBN won’t just be good for sending information from a patient to a specialist. Assoc Prof Mariño says he and his team are also looking at ways to maximise its effectiveness in sharing knowledge and skills with dental professionals nationally and around the globe. “This technology won’t just save patients from having to travel in to cities—it will also allow dental experts from around the world to share and gain knowledge through video tutorials and live courses that they are able to attend from anywhere with a broadband web connection,” Assoc Prof Mariño says. “It means that anybody, anywhere in the world can empower themselves with knowledge, and share their own expertise, which should add enormously to the knowledge and skill levels of dental experts globally.” It’s not just dental experts who stand to gain from such technology and knowledge sharing. Researchers at the IBES say broadband technologies will also help older people maintain their independence and live in their own homes for longer by allowing easier access to health care, helping the elderly to engage socially rather than become isolated, and allowing them access to lifelong learning opportunities. The dental profession is an important part of the new frontier as the technologies on offer appear to solve several traditional problems. “My specialty is in public health and I see this technology as a possibility to improve the oral health of the entire population,” Assoc Prof Mariño says. “If you improve oral health then you improve quality of life, particularly in remote communities. I can see this happening in the very near future. I think we’re close.” 

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Northern exposure The new dental school at James Cook University in far-north Queensland has combined cuttingedge architecture with state-of-the-art facilities. By Kerryn Ramsey

T

he first thing you notice about the James Cook University School of Dentistry in Cairns, Queensland, is the ultra-modern exterior of the building. It could be easily mistaken for an art gallery rather than a place of learning. Designed by the architectural firm, dwp|suters, they have created a visually stunning building that is also a state-of-the-art dental facility. Rather than a stark and utilitarian

look, the Dental School sits organically in its landscape. “Externally, the greens and yellows reflect the dappled colours of the rainforest leaves,” says Geoff Street, Queensland managing principal of dwp|suters. “The strong vertical elements on the exterior of the building resemble the solid straight trunks of the trees in the rainforest creek that bounds the dental building site along the western side. “The building was designed to have a glare-free level of natural light internally, which was achieved with drops of external screens over the windows

replicating the Queensland blinds that we used to see on old houses. These devices also act as debris screens during cyclones to protect the windows from damage,” he says. While the dental school at James Cook University (JCU) was established in 2008, this purpose-built building was not opened until the beginning of 2011. The original clinic had 15 chairs and the new building has added 84 chairs for students, and another four staff chairs. “At the moment with third-, fourthand fifth-year students, we run about

Photography: credit

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COVER STORY


Art gallery or dental school? Only the big word ‘Dentistry’ on the front gives it away.

94 chairs a day,” says Professor John Abbott, director of clinical dentistry. “We have 100 patients at each morning and afternoon session, five days a week. This means that between students, staff and patients, we have 250 people in the building every morning and afternoon. It’s quite a business.” One of the major hurdles with the design of this unique project was the lack of a yard stick to go by. Not only did the dwp|suters architecture team visit the recently completed Oral Health Centre in Perth, Western Australia, they researched

Quote

Professor John Abbott, director of clinical dentistry

“We have 100 patients each morning and afternoon, five days a week. This means that between students, staff and patients, we have 250 people in the building every morning and afternoon. It’s quite a business.”


YOUR BUSINESS

The dental simulation laboratory at JCU Dental school is state of the art.

30

at length the implications of incorporating the specialised equipment that the school would accommodate. “We were also fortunate to have a very good team of university people to develop their brief with us,” says Geoff Street. “The end result was extremely rewarding for all involved.” The building houses an 80-seat dental simulation laboratory, prosthodontics and science laboratories, a dental clinic and student home group rooms. The dental school at JCU is only the third school in Australia located outside a capital city. It’s also the only dental school in Queensland that’s located outside the metropolitan areas of the state’s south-east. “We’re in an area of considerable disadvantage and very poor oral health,” says Professor Andrew Sandham, head of James Cook University’s discipline of dentistry. While they have been making headway with the 2000 people on the waiting list when the clinic opened, they also have a new hurdle to overcome. Cairns Regional Council started removing fluoridation from its water supply last March. “In Cairns, dental decay is probably the foremost problem compared to other parts of Australia,” says Prof Abbott. “Nearby Townsville has fluoride in its water and you can see the difference in the teeth of the people from Townsville compared to the teeth of the people here in Cairns.” Another major concern is that Queensland health patients have been on the waiting list for such a long time, their teeth are in a state of collapse. “The common problems are too many missing teeth, ill-fitting dentures, and the need for a lot of root canal work and extractions. This whole area

Quote

Professor John Abbott, director of clinical dentistry

“In Cairns, dental decay is probably the foremost problem compared to other parts of Australia. Nearby Townsville has fluoride in its water and you can see the difference in the teeth of the people from Townsville compared to the teeth of the people here in Cairns.” is in dire need of dental care,” explains Professor Abbott. Most dental schools have a range of clinics specialising in one area of dentistry, whether it’s periodontics, oral surgery, prosthodontics or pedodontics. At JCU, the clinics are laid out in bays of eight chairs and in that bay, one student might be doing endodontics, another could be making a denture, one could be seeing a child, while someone else is doing perio. Whereas a normal university has every student seeing the same sort of case at the same time, JCU offers more of a general practice mode. This helps prepare the students


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for their future clinical career. Last year, JCU had more than 1300 applications for the 80 places it offers. The five-year course starts with the basic didactic material but they also do practical skill development from year one all the way through to year four. In year five, the students go out on placements to Darwin, Katherine, Alice Springs, Mt Isa, Cairns, Townsville, Mackay or Proserpine. They are only back to base for about a month during that year. There is also the optional elective to spend a month overseas in either Cambodia, Hong Kong or at a twinned university of Tromsø in Norway. A new elective placement is being developed in Sri Lanka for 2013. “One thing that we really wanted to achieve was to have more indigenous students in the JCU dental program,” says Prof Sandham. “I am pleased that we met that goal. JCU now has 14 indigenous students, more than all the other dental schools in Australia combined.” With the very first batch of graduations due in November this year, it’s quite amazing to consider the number of people helped at JCU. Between February and December of 2012, they had 18,000 patient attendances. The need for such a facility is almost overwhelming. The JCU dental school also stands as a beacon on how to do development right. With foresight, planning and an attention to detail, this architect-designed building is functional, efficient and improving the lives of students and patients alike. On top of all that, the entire project came in under budget. “The most amazing outcome with this building, and a source of great pride for us, is how much it cost to construct,” says Geoff Street of dwp|suters. “It came in at $2900 per square metre. Comparable buildings in the south, where construction is cheaper, usually cost over $5000 per square metre. The savings enabled the university to build a new stand-alone 120-seat interactive teaching and lecturing space—which we also designed—but that’s another story for another day.” 

T +61 3 9824 8555 M 0409 357 669 F +61 3 9824 8580 tony.hood@williambuckvic.com.au

REVIEWERS WANTED We want you to write for Bite Every issue we’re asking dentists to review their tools— telling us in a couple of paragraphs what they love about them and what they don’t like. Check out the reviews starting on page 43. There’s only two rules—you have to be a practicing dentist, and it has to be something you use. The whole idea is to start a conversation between our readers. We don’t want to tell you what to buy. We want your peers—the people actually using the equipment—to guide you to what’s good and what isn’t. If you’d like to write a review, email Rob Johnson at rob@engagemedia.com.au, and he’ll tell you what’s involved.


032 32

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Rise of the machines In these straitened financial times, how often should you be updating your capital equipment? The answer isn’t as straightforward as you think, says A.M. Walsh

hen the OPG machine at Dulwich Dental stopped working recently, the practice had to make a decision. Spend up to $80,000 to repair it, or simply buy a new one for a little more? Despite the cost, to not replace the machine was simply not an option given the service it provides. This kind of decision is not as straightforward as it used to be. It seems that dentists are feeling the pre-recession pinch as much as anyone. According to the Australian Dental Industry Association (ADIA), equipment sales fell by 12 per cent in 2012. Apart from those who have opened entirely new practices, most dentists have all the tools they need to provide professional care, but with increased competition for patients, are there some things dentists can’t afford not to replace? One area where ADIA’s figures show a plateauing in sales is in imaging equipment, indicating that X-rays and CT scans are the kind of procedure dentists feel offer better diagnostic ability as well as value for money. Sharmaine Crooks, manager of Australian Imaging, agrees that sales have been steady for her company. “Intraoral imaging is now simple and fast. Add to that the development of 3D imaging and what that technology can do for a practice. Even

the most basic of practices can diagnose and treatment plan in one consultation, making the technology not only of clinical importance, but commercially also,” she says. “Showing the technology is a real selling point for the practice.” Dr Fadi Dalati of Dulwich Dental in Sydney’s inner-west is already a convert to this approach. “When an X-ray is needed,

Quote

Sharmaine Crooks, Australian Imaging manager

“Intraoral imaging is now simple and fast. Add to that the development of 3D imaging and what that technology can do for a practice.” a lot of patients are quite surprised that all they have to do is walk down the hallway to another room. It saves them time, and it saves us time too because we can give them a diagnosis sooner. It’s unfair to a patient to tell them to go away and have an X-ray then come back in a week. We can make a diagnostic decision pretty much immediately.”


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If your dental unit looks like this, it is safe to say it is time for an upgrade.


YOUR BUSINESS

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Dr Peter Dayman of Dayman Dental in Sydney’s Potts Point also relies on an OPG machine for best practice, but that doesn’t mean not keeping an eye out for better technology. “You need to keep up with current trends, and not work on outdated equipment. It’s a standard of care. Whatever we purchase has to have a benefit to the patient. A lot of equipment is sold to you on the basis that it will make you a lot of money. What’s most important to us is whether it works and provides a service we don’t have.” For both dental practices, a CT scanner is probably their next purchase, although neither is rushing into it. “A CT scanner can cost you anywhere up to $250k which is a large amount of money to outlay,” says Dr Dalati. “It might not be anywhere near as productive for the patient in getting an accurate record, and the time you actually spend with the machine getting the scan done, compared to something more conventional you can get with an OPG.” Dayman Dental has the same cautious approach. “In terms of standard of care and what other people are talking about, I think the CT scanner is probably the next thing to have,” says Dr Dayman. “We’re pretty happy with our OPG machine but if we had to replace it, the CT would be the next purchase. Eventually the numbers stack up and it makes sense to do it.” The cost of major equipment has to flow onto the patient, and this means a lot to a practice. “There’s an imaging centre 15 minutes from our practice and it doesn’t cost the patient anything because they’re able to bulk bill it,” says Dr Dalati. “Obviously if we purchase a CT scanner, we’ll have to charge the patients more.”

Quote

Dr Peter Dayman, Dayman Dental

“You need to keep up with current trends, and not work on outdated equipment. It’s a standard of care. Whatever we purchase has to have a benefit to the patient.” Dr Dayman agrees. “Purchasing expensive equipment that doesn’t directly benefit the patient can have the danger of over-servicing by a dentist, which is not something we want to do,” he explains. A shorter life span also means more pressure on billing a patient. Crooks says: “Most imaging equipment will still work after 10 years but generally would have been superceded by a new product that is either easier to use, better quality, faster, cleaner or cheaper.” In contrast to digital equipment, a dentist’s chair can have a long and very productive life, especially if it’s maintained well. Simon Taggart, marketing manager of A-dec Australia, cites his company’s attitude to retaining customers: “Our equipment is manufactured to accommodate future technology. This provides for integration or upgrading of existing

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Digital equipment will still work, but will become outdated.

technology into our dental units. For instance, our new LED light product is capable of being retrofitted to chairs we have manufactured dating back to 1993.” At Dayman Dental, this regular maintenance has shown its benefits. “We’ve had our autoclave for 20 years, we’ve had one chair for 20 years. Usually you have to replace your chairs every 10 years because they just disintegrate,” says Dr Dayman. This is not the case for all equipment, however. Sharmaine Crooks says she’s surprised at the low uptake rate by dentists on service contracts for major equipment, compared to other health professionals. “Perhaps it’s because dentists use their tools more than doctors and expect them to be replaced more often,” she says. With more dentists set to graduate over the next few years, coupled with a tightening economy, investing in big-ticket items might be even more closely scrutinised. Positive word of mouth is essential in committing to a purchase. “You might get told about a certain piece of equipment by your friends,” says Dr Dayman. “Anecdotal evidence is the first way you might get interested in a piece of equipment, then you’d do your own research.” Compared to this time last year, patient numbers are definitely quieter, Dr Dalati says. While this won’t translate into not purchasing that new OPG, it certainly has an impact. “Dentists do have a bit of a habit of buying shiny new equipment but it’s a question of whether something that costs hundred-thousand dollars is actually going to provide better care,” he says. “That’s always going to be our prime concern.” 

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NEWS & EVENTS

COVER STORY

your business

product guide

YOUR LIFE

Finance product guide

37

Bite magazine’s guide to the best finance products for dentists on the market today


NEWS & EVENTS

COVER STORY

your business

product guide

YOUR LIFE

Finance product guide Manage, don’t minimise At the end of the financial year it seems sensible to minimise your taxable income. But that’s not necessarily the best idea.

38

nvariably, dentists all have high taxable incomes, so they are always looking for extra deductions around this time of year—it’s very rare that somebody would not need or want that,” explains Investec’s Andre Karney. “So our role comes in when they’re looking to purchase assets or stock or anything to get them those extra deductions. We can offer financial products and help structure those facilities to maximise their tax efficiency. Obviously, we don’t offer tax advice—that’s the job of the individual dentist’s accountant or financial adviser—but we will say to them, ‘Here are some structures you might want to consider’.” A possible example could be where the dentist might want to take out a loan to buy some stock, then immediately pre-pay the interest on that loan. If that was the case, there would be a range of products available to them, says Andre. “In that particular example, we could offer an unsecured product, or one secured against the practice, or against commercial property or residential property. That’s an example of where we can be really flexible compared to other banks.” A strategic approach to managing your income can pay dividends, but it’s important to plan, says Investec’s Stafford Hamilton. A strategic approach means investigating which costs you can prepay, such as leases on equipment, interest on loans and any other expenses you might like to pay that relate to the coming financial year. It’s a strategy that doesn’t just apply to practice owners, says Hamilton. “When it comes to employees, or those that don’t have large practices, prepaying investment properties or car loans, or interest on any commercial property they can prepay may be worth considering,” he explains. “And don’t forget superannuation—depending on your circumstances, you may not have used this year’s allowance for concessional contributions to super.” To take advantage of these strategies generally, you’ll need access to cash, says Hamilton. But if that proves difficult, using an overdraft, then paying it back over the next six or twelve months, can prove useful. “Some people do find that idea a bit weird—taking on debt in order to pay down debt, but we often see clients adopt this strategy so they can prepay some loans to gain the tax advantages,” Hamilton adds. “If you’re looking at a big tax bill and you can manage that liability forward


Buying a new car in the end-of-financial-year sales may open up some deductions, even if you buy the car on the last day of June, says Investec’s Stafford Hamilton (opposite page, bottom). Opposite page (top): Investec’s Andre Karney.

a year, that’s an extra 12 months you can hang on to your tax money.” An alternative to taking on an overdraft may be to use your credit card for purchases, which can have a similar effect of spacing repayments across the financial year. Of course there might be expenses associated with that strategy, but they may be balanced out if your card offers generous incentives such as frequent flyer points for eligible spend If they’re not thinking of cash flow, some people may be planning to take advantage of various end-of-financial-year sales to do a bit of shopping. It’s often the best time of year to buy a new car, for example, and, “there are commonly concessions for buying a new car,” says Hamilton. “With cars it may be that you can claim some deductions even if you buy the car on the 28th June. When you’ve only owned it for two days. And if you finance and prepay a lease, you might realize $10– to– $15k worth of deductions.” If you own a larger practice, other opportunities present themselves, including purchasing equipment on a lease agreement and prepaying twelve months in advance: “For a $100k purchase you might get $24k+ worth of deductions almost immediately on a well-structured lease agreement,” Hamilton explains. “And further benefits come into play with interest rate reductions: prepaying a lease can mean a one or two per cent saving on the effective interest rate which can result in a significant benefit.” Many financial institutions will allow you to prepay interest

on property, but not all of them will, so if your property loan is with a lender who doesn’t, you may want to investigate refinancing—which brings us back to the issue of planning ahead. If you looking to refinance your property, planning ahead will help and it is worth speaking to us as early as possible. But Investec’s speed and efficiency generally means the business comes their way, says Andre Karney. “We have people calling us up in the morning to get a car in the afternoon,” he says. “They’re used to that, and we do it. It can be the same day. If you’re talking about a mortgage, of course there’s a process. People use us because of our speed and efficiency, because we go to see them, we’re very flexible and competitive because we specialise in lending to this market.” In general, says Hamilton, “We say to people every year, plan early because until you have an idea of what your income may be, it’s very hard to do any planning to manage your income.”  The information contained in this article (“Information”) is general in nature and has been provided in good faith, without taking into account your personal circumstances. While all reasonable care has been taken to ensure that the information is accurate and opinions fair and reasonable, no warranties in this regard are provided. We recommend that you obtain independent financial and tax advice before making any decisions.


advertorial NEWS & EVENTS

COVER STORY

your business

product guide

YOUR LIFE

Finance product guide The Finlease factor

Specialist independent finance brocker Finlease offers a fresh approach to finance that respects your time

I

40

ndependent research has shown that customer satisfaction with the major Banks has plummeted; especially since banking Relationship Managers (RM’s) have replaced the old style Bank Manager. Unfortunately RM’s spend the majority of their time on paperwork, and often see their RM role as a mere stepping stone to other roles within the Bank. RM “churn” remains at high levels. Dentists are tired of having to re-educate their new RM’s and are moving to Specialist Independent Finance Brokers. Specialist Independent Finance Advocates such as Finlease are knowledgeable and experienced in the Dental field, and they use a number of financiers. Information is gathered from the client ONCE and the ongoing process is managed holistically. They act for the Dentist to source the best funding options in the market. These are specifically tailored to the client’s situation. Finance documents are signed in person at a time and place that is suitable to the client, often after hours or on weekends. The best thing about money is that, (once you’ve got it),

Westpac’s money, Bank of Queensland’s money or CBA’s money is just as good as NAB’s or ANZ’s. So why don’t I just call all of the Banks myself? Four reasons. 1. Recorded messages and wearing out your fingernails pressing “ONE” either costs Practice time or Family time. 2. Credit departments within Banks require detailed and compelling business cases. 3. Finlease introduced $350M in 2013 and sources the best solutions in the market 4. There is true wisdom in spreading your debt across a range of funders A good Specialist offers a single point of contact so that clients never have to talk to the Bank. Finlease visits each client to gain a full understanding of their practice and then reverts with a proposal. If it’s acceptable the client may proceed. If not, the client may decline with no obligation, sure in the knowledge that all details are archived for the next purchase.  Article provided by Steve Daley, Finlease – 0448 480 405.


advertorial NEWS & EVENTS

COVER STORY

your business

product guide

YOUR LIFE

Finance product guide Who’s paying for your advice? Trailing commissions and other rewards for your financial adviser might make you question their motives and advice.

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NEWS & EVENTS

COVER STORY

your business

YOUR TOOLS

YOUR LIFE

Tools of the trade More efficient root canals, going all flowable, a universal torque wrench and more are in the spotlight this month

Filtek and G-aenial flowable composites

Elements Obturation System by Dr Sam Lawrence, Tendler Dental, Hawthorn East, VIC This system is used for the obturation of root canal treatments and comes with two handpieces. One is a System B plugger which is a heated instrument used for searing off the ends of the gutta percha points. The other handpiece delivers heated gutta percha into the root canal system to backfill and finish off the obturation. What’s good about it It cuts down the treatment time of the obturation phase considerably. Rather than having to put lots of accessory points into the canal, I just use one master cone, burn off all but the apical 4 or 5mm, and then backfill with heated gutta percha. Not only is it quicker, it’s more efficient. For a three rooted molar tooth, I finish my obturation in 10 or 15 minutes rather than the usual 30 or 45 minutes. I also like that I no longer need to use a Bunsen burner to heat an instrument as this invariably frightened my patients a little bit. I’ve owned this system for four years and use it on nearly every root canal I perform. What’s not so good The unit is freestanding, needs to be plugged into a wall socket and takes up quite a bit of bench space. It would be fantastic if it could be integrated into my chair. Where did you get it Sybron Endo. 

by Dr Dale Gerke, prosthodontist, South Terrace Dental Care, Adelaide, SA   I do not use traditional composite paste in my surgery, instead relying on these two flowables. I am pretty sure I am the only dentist in Adelaide that has adopted such a practice.   What’s good about it I get a better result using these two flowables. It is more technique sensitive but the marginal integrity is much better than with a traditional composite. There is better adaptation to the tooth’s surface along with any pins, posts or superstructure that are used. There is much less leakage, it is easier to place and there is no wastage because you only use what you need. It is suitable for virtually all situations including posterior and anterior build-ups. The only time I do not use the flowables is with a class 5 on the gingiva. In these cases, I usually use GIC [glass ionomer] restorations. While it is technique sensitive and care needs to be taken when you first start using it, the adaptation to the margins, the flowability and ease of placement make it definitely worth trying.   What’s not so good There is a higher shrinkage factor so multiple layering is required to overcome this problem. You also get occasional voids but they are easily fixed by drilling out and injecting some more flowable resin.   Where did you get it G-aenial—GC Australia, Filtek—3M. 

43


NEWS & EVENTS

COVER STORY

your business

Tools of the trade

Transbond Plus Self Etching primer by Dr Jonathan Chi, Castle Hill Orthodontics, Castle Hill, NSW

44

Transbond Plus Self Etching primer is a superior dental product and I would recommend it to orthodontists who have a heavy case load. What’s good about it In the past, I used the basic etch, bond, prime and rinse technique when bonding braces to teeth. Now I use Transbond when putting on braces or repairing broken braces and it saves a good 10-15 minutes per band up. Previously I needed to etch the teeth, rinse them, dry them, place a primer on them, dry them, and then place on the bracket. This removes all of those steps. All I have to do now is to dry the teeth, paint on this solution, wait for a few seconds and then I can bond straight away. There is nothing special needed to remove Transbond. It’s simply a bonding agent that comes off when the braces are removed. What’s not so good There is a danger that if it is smeared over the gums, it can create a very light bleaching burn. If this happens it generally disappears within 24 hours but you do have to be a little bit cautious when applying it to the teeth. Initially, the bond strength is weaker than traditional etch and bond. You have to be extremely careful when applying force to the braces in the first 24 hours. However, it soon gains strength and then there are no issues. It’s also a good idea to warn patients to be a little more careful in the first 24-hour period. Where did you get it 3M Unitek. 

YOUR TOOLS

YOUR LIFE

(continued from page 43)

Torq Control universal torque wrench by Dr Larry Benge, Bond Street Dental Studio, South Yarra, VIC This torque control device is made by Anthogyr and is used for placing abutments on implants. The instrument is particularly helpful when using the All-On-4 technique. I use the Torq Control multiple times a day. What’s good about it The wrench has different torque settings ranging from 10 newton centimetres up to 35 newton centimetres. It allows you to hold the instrument with one hand and tighten at the same time. This makes placing the multi-units far easier than when using a manual screwdriver. With a screwdriver, it was difficult to access the back of the mouth, hold the multi-unit abutment and tighten the screw at the same time. This wrench makes the job as easy as possible. When I run my implant courses, dentists often see it in action for the first time and immediately want to purchase one. This wrench is compatible with all implant systems as long as they have a latch driver. It gives good accurate torque and is simple to use. What’s not so good It can be a bit temperamental because of the autoclaving. The instrument is completely mechanical but the change of torque is the thing that tends to go wrong. Autoclaving takes a toll on most things and we autoclave non-stop. In the past, we needed to send repairs overseas but now there’s a local company that can repair them in a day or so. Where did you get it Gulmohar Dental. 


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NEWS & EVENTS

COVER STORY

YOUR BUSINESS

YOUR TOOLS

YOUR LIFE

Royal racquet

46

I started playing royal tennis through a friend of mine who had just won an A-grade squash tournament. He was invited to play a game of royal tennis and admitted to me afterwards, “Barry, I missed the ball by six feet”. His son started playing with my son and I was invited along. I am now a fully fledged member of the Royal Tennis Court of Melbourne. Royal tennis [also know as real tennis] is a cross between lawn tennis, billiards and chess. The penthouse—a half roof on an angle of 40 degrees—runs along one wall and two ends. When you serve, the ball must land on the side penthouse towards the receiver’s end. It can then go down and hit the back wall or the back penthouse or come up and hit the side wall and pick up spin. It might bounce three times before it lands on the floor. “The first purpose-built royal tennis court was constructed for Henry the VIII at Hampton Court in 1530. Lawn tennis evolved in the 1880s as a cheap adaptation of royal tennis. I believe that someone decided to use the ladies’ croquet court and play outside. “As it’s played indoors, you never have to worry about the weather. Hot, cold, raining … you can always have a game. Our club uses handicaps so we don’t get groups of people who never talk to each other. It’s all very friendly. If there’s a court free, they’ll ring around and ask if you can come in and play. “It takes a few months before you can even begin to follow the rules. The ball is heavy so it travels faster and picks up spin quickly. And because they are solid, they don’t slow down in mid-air. It’s a hard ball if it hits you. Some of the older players can hardly move around the court but they can read the ball so well, they almost know where it’s going before the other player actually hits it. “We’ve won the pennant a couple of times. After playing pennant, the teams take turns to produce a supper and at about 10.30pm, we sit down with a glass of wine. Last time we had a nice baked fish and some dips. The club’s bar is based on an honesty system, so you can just pick your bottle of wine and sign a chit for it. It’s a very social club.

Interview: KERRYN RAMSEY

No matter what the weather, Dr Barry Johnson of Carlton Dental in Victoria is always up for a game of royal tennis


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Bite June 2013