The new dental deal Senator Richard Di Natale writes for us about his role in creating the Government’s new dental plan, page 24
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The tipping point How many surgeries is too many surgeries? The answer is on page 26 When in Roma Helping the homeless and uni students in Brisbane, page 12
Get on board Dr Quentin Rahaus realised if his patients couldn’t come to him, he’d go to them. So he bought himself a bus and turned it into a surgery
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Contents News & events
4. Could do better The Queensland health watchdog says dentists are complained about a lot; the Dental Board says renew on time; and more
12. Bridging the gap A Brisbane-based program has tackled some of the oral health programs of homeless people and helped students learn on the job at the same time
24. The new dental deal Senator Richard Di Natale explains his role in redesigning dental policy, and why it’s better than the CDDS
COVER STORY House calls What does it take to deliver care where it’s needed most? Dr Quentin Rahaus discovered the answer: a bus
26. Critical mass If you’re looking to own several practices, how do you do so effectively and efficiently? And how do you know when enough is enough? 30. May the floss be with you Ever wanted your surgery to stand out from the crowd? How about making staff wear Star Trek uniforms?
11. New products The best new gear and gadgets from suppliers you can trust 35. Tools of the trade Reviews of your favourite products by your peers
37. Cameras and magnification product guide Everything you need to know about the latest in cameras and magnification products for dentists
46. Yen for yoga After taking over Beacon Cove Dental in Port Melbourne, Victoria, Dr Fern Trinh White turned to yoga to improve her health and minimise stress levels Editorial Director Rob Johnson
Sub-editor Kerryn Ramsey
Creative Director Tim Donnellan
Commercial Director Mark Brown
Contributors Sharon Aris, John Burfitt, Kerryn Ramsey, Susanna Nelson, Chris Sheedy, Gary Smith
7,927 - CAB Audited as at March, 2012
For all editorial or advertising enquiries: Phone (02) 9660 6995 Fax (02) 9518 5600 firstname.lastname@example.org
Bite magazine is published 11 times a year by Engage Media, Suite 4.08, The Cooperage, 56 Bowman 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
NEWS & EVENTS
Could do better The Queensland health watchdog has released a report on dental practitioners
Dentists are the second-most complained-about medicos, says the HQCC
new report from Queensland’s independent health watchdog shows dental complaints could be reduced if more dental practitioners adhered to existing standards, policies and guidelines. The report, Teething problems— a spotlight report on complaints about dental care in Queensland, explores what patients, families and carers have told the Health Quality and Complaints Commission (HQCC) about the problems in dental care. The HQCC analysed all 855 dental complaints received between 1 January 2009 and 31 December 2011. Chief executive officer Cheryl Herbert said, “Dental practitioners are the second most frequently complained-about healthcare practitioner group, after doctors. It is important for us to share complaints information with health consumers and providers so we can spark discussion and drive improvement.” To measure dental practitioner improvement, the HQCC has set two key performance indicators: the number of complaints about registered dental practitioners with a target to drop below the current rate
of 9.2 complaints per 100 registered dental practitioners, and the rate of potentially preventable hospitalisations due to dental conditions with a target to drop below 2.8 separations per 1000 population. The HQCC will repeat its dental complaint study again in 2015 to determine if improvements have been made. Dental complaints accounted for 12 per cent of all of the healthcare complaints HQCC received in the same period. There was a 35 per cent increase in the number of dental complaints received during this period compared to 20 per cent increase in the total number of healthcare complaints received. 80 per cent of dental complaints were about treatment. 78 per cent of dental complaints were about private sector services. 88 per cent of complaints identifying an individual practitioner were about dentists, followed by dental prosthetists with eight per cent. 15.5 per cent of complaints were about dental care provided under the Medicare Chronic Disease Dental Scheme or the Medicare Teen Dental Plan. 16 dental practitioners received four or more complaints between 2009 and 2011.
Dental Board says renew registration online and on time Dental practitioners across Australia are reminded that their registration is due for renewal by 30 November. The Australian Health Practitioner Regulation Agency (AHPRA) is sending a series of emails to dental practitioners, for whom an email address is known, reminding them to renew their registration with the Dental Board of Australia. Board chair Dr John Lockwood AM urged the more than 18,800 dental practitioners due to renew their registration to do so online and on time. “The quickest and easiest way to renew registration is online, with more than 80 per cent of dental practitioners using this secure service last year,” Dr Lockwood said. “Dental practitioners should check that their contact email details are up to date so they receive renewal reminders from AHPRA. These reminders are confirmation that online renewal is open.” To update your contact details held by AHPRA, go online at www.ahpra. gov.au, click online services, use your unique contact number (User ID) and follow the prompts. Your User ID, included in AHPRA correspondence to practitioners, is not your registration number. If you do not have your User ID, complete an online enquiry form. Dr Lockwood said dental practitioners who do not want to renew their registration can simply ignore the reminders from AHPRA or go online to ‘opt out’ of renewing. This new online facility will provide the Board and AHPRA with better data on the number of dental practitioners who choose to opt out of renewing, to distinguish them from individuals who intend to renew. Under the National Law, practitioners who do not renew registration within one month of their registration expiry date must be removed from the National Register of Practitioners. Their registration will lapse and they will not be able to practise dentistry in Australia until a new application for registration is approved. “Neither the Board nor AHPRA has any discretion about this so our advice is clear: renew online and on time,” Dr Lockwood said.
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NEWS & EVENTS
DVA win for therapists
ollowing a vocal campaign by dental therapists and oral health therapists, the Department of Veterans’ Affairs (DVA) has advised that effective from 1 November 2012 dental hygienists, dental therapists and oral health therapists will be able to provide preventive dental services to members of the veteran community. The issue needed resolving following an audit last year by the Department of Human Services into the Chronic Disease Dental Scheme (CDDS)—a program that operates under a similar legislative framework as Veterans’ Affairs—which revealed that dentists and dental specialists were unable to claim payment through Medicare for treatment provided by hygienists, dental therapists and oral health therapists. It was the subject of a long story in the May issue of Bite magazine.
Trust me, I’m a dentist We trust our dentist more than we trust our doctor, according to new research. There is a long-held view of the traditional family GP widely trusted within the community, always on hand to dish out advice. But new research reveals that dentists are winning the race for trust, as 88 per cent of people surveyed in a new poll, confirmed that they have a very high degree of trust in their dentist, even greater than in their doctor. The poll, conducted by Bray Leino, also revealed twice as many people (19.7 per cent) value their relationship with their dentist over their doctor (9.9 per cent). The level of trust is reflected in the amount of people following advice from their dentist, with more than three in four people (76.4 per cent) deciding how often they went for a check-up based on when their dentist recommended. It isn’t all good news, as the research also points to almost two in every three people not visiting the dentist for at least three years, while more than one in four people (27 per cent) who don’t visit their dentist cite fear as the reason for not doing so.
The discovery, highlighting the current legislation being out of step with emerging industry practices, was a revelation to all. Not only was the department under the impression veterans were being serviced solely by dentists and dental specialists, but the hygienists, dental therapists and oral health therapists discovered the payment for their treatment was being claimed illegally—albeit unknowingly. The DVA now says that situation has been resolved, and therapists can treat DVA patients if they are registered with the Dental Board of Australia (DBA) and comply with approved scope of practice registration standards; covered by either their employer’s indemnity insurance or maintain their own insurance as mandated by the DBA; and qualified and competent to provide the service. The remuneration for services remains unchanged; i.e. the claim is
DVA patients can once again be treated by dental therapists.
submitted by the dentist or dental specialist on their behalf at the current DVA dental fee. The DVA has advised the ADA of its appreciation to providers for their patience while work was undertaken towards a permanent solution.
ADA plead for Access
s the Opposition admitted it will not oppose Labor’s legislation to start a new dental scheme, the ADA has revisited its DentalAccess proposal as a suggestion for future public dental plans. Last month, as debate continued on the government’s bill, a newspaper reported Opposition front bencher Greg Hunt said the coalition would not oppose the new scheme's establishment. An opposition bid to stop the government winding up the chronic disease scheme failed at that time. Around the same time, ADA President Dr Shane Fryer put out a press release saying, “As parliamentarians continue to debate closure of the Chronic Disease Dental Scheme, the Australian Dental Association Inc. (ADA) calls on members of parliament to listen to the dental profession when it comes to creating the solution to dental care delivery.” While the ADA has always expressed lukewarm support for the CDDS, Dr Fryer says it was still “like using a sledgehammer to crack a nut”. The problem, Dr Fryer says, is the 2012/13 Federal Budget will provide about $225 million for dental health
Opposition front bencher Greg Hunt won’t oppose the new scheme.
over the latter half of the 2012/13 year and the following year, but even if waiting lists are reduced by 30 per cent, the National Advisory Council on Dental Health estimates it will cost $343 million per annum to address the public sector waiting lists. “The dental profession is extremely willing to work closely with the government to design an effective and sustainable solution to the oral health of all Australians, if given the chance,” said Dr Fryer.
Panadeine Extra is the strongest analgesic available
without a prescription based on codeine content per dose
Single-agent analgesia may not be sufficient to achieve adequate pain relief.
Paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs, like ibuprofen) can be used for the temporary relief of dental pain,2,3 however single-agent analgesic therapy may not always be sufficient to achieve adequate pain relief.1
A combination of analgesics that work in different ways – like paracetamol and codeine may be beneficial.
Strengthen your recommendation in dental pain relief with Panadeine Extra
Panadeine Extra has been specially formulated, by combining the strength of codeine phosphate (15 mg) with paracetamol (500 mg) per tablet to provide fast, effective temporary relief from strong pain. Panadeine Extra contains the highest OTC dose of codeine (15 mg of codeine phosphate), making it the strongest pain reliever available without a prescription.
Paracetamol/codeine combinations have been clinically proven in post-operative dental pain4–6
Several clinical studies have provided evidence of effective pain relief when paracetamol is combined with a low codeine dose.4–6 In a study of patients who had undergone surgical removal of impacted third molars, paracetamol + codeine phosphate (500 mg/15 mg tablet x 2) [e.g. Panadeine Extra] provided significant improvement in post-operative pain relief over paracetamol (500 mg tablet x 2) alone (p=0.03), with no significant difference in side effects over 12 hours.4
...there is a significant improvement in postoperative pain relief following this combination [paracetamol 1000 mg plus codeine 30 mg] 4
Median change in pain intensity (cm/h)
This is because a combination of analgesics that have two different modes of action can enable an increase in analgesia whilst minimising side effects.3,4 In some patients it may be appropriate to offer a fixed-dose paracetamol/codeine combination rather than an NSAID or NSAID/codeine combination for the management of stronger pain, particularly for patients in whom NSAIDs are contraindicated.3
Figure 1: Median change in pain intensity with paracetamol + codeine vs. paracetamol alone (n=82)4
2.0 1.8 1.6 1.4 1.2 1.0 0.8 0.6 0.4 0.2 0
Paracetamol (500 mg tablet x 2)
Paracetamol/codeine (500 mg/15 mg tablet x 2)
Adapted from McCleod et al. 2002 4 Another study (n=139) compared the efficacy of a single tablet of either paracetamol/ codeine phosphate (300 mg/15 mg), paracetamol/codeine phosphate (300 mg/30 mg), floctafenine (400 mg) or placebo for the relief of pain following dental surgery.6 All three treatments were significantly superior to placebo (p=0.0001).6 A later study of 232 patients who underwent impacted third molar surgery, received either paracetamol + codeine phosphate (500 mg/8 mg x 2 tablets) taken every 4–6 hours or the NSAIDs etodolac (200 mg x 2 tablets taken every 6–8 hours) or diflunisal (250 mg x2 tablets taken every 8–12 hours).5 All three drugs were found to be effective in the control of post-operative pain.5
So the next time a patient requires proven relief from dental pain – consider recommending Panadeine Extra
BROUGHT TO YOU BY THE MAKERS OF PANADEINE® EXTRA IN THE INTEREST OF THE QUALITY USE OF MEDICINES. Panadeine® Extra contains paracetamol 500 mg and codeine phosphate 15 mg. Use: For the temporary relief from moderate to severe pain. Contraindications: Hypersensitivity to any ingredient in the product; children under 12 years. Dosage: Adults and children 12 years and over: 2 caplets every 4–6 hours orally with water; (maximum 8 caplets in 24 hours). Precautions: CNS, respiratory depression; high doses, prolonged use; renal, hepatic Impairment; poor CYP2D6 function; pregnancy, lactation. Adverse reactions: Dependence; Impairment of mental & physical abilities; nausea, vomiting, constipation; dizziness, drowsiness. Interactions: Anticoagulants; sedatives, tranquilisers; drugs affecting gastric emptying; chloramphenicol; hepatic enzyme inducers; CYP2D6 inhibitors. Please review full Product Information (PI) before recommending Panadeine Extra. The full PI is available from GlaxoSmithKline Consumer Healthcare on request (FREECALL 1800 028 533). Panadeine® and the Panadeine Vibration™ are trade marks of the GlaxoSmithKline group of companies. GlaxoSmithKline Consumer Healthcare. 82 Hughes Avenue, Ermington, NSW 2115. 1800 028 533. GSK0164/BIT/UC References: 1. Hargreaves K, Abbott P. Aust Dent J 2005; 50(s2): S14–S22. 2. Beaver WT. Am J Med 1984; 77(3A): 38–53. 3. Oral and Dental Expert Group. Therapeutic Guidelines: Oral and Dental. Version 1. Melbourne: Therapeutic Guidelines Limited; 2007. 4. Macleod G, et al. Aust Dent J 2002; 47: 147–51. 5. Comfort MB, et al. Aust Dent J 2002; 47: 327–330. 6. Bentley K, et al. Curr Ther Res 1991; 49: 147–54.
NEWS & EVENTS
ADA takes on the Whitecoats The Australian Dental Association has written to its members advising them to avoid registering with the new Whitecoat website, which has been developed by health insurer NIB. NIB describes the website as an online service that lets you find and compare healthcare specialists in your local area. But the ADA has told members it has a number of concerns relating to the concept and has sought legal advice on many issues relating to it. Speaking to the ABC, ADA spokesperson Terry Pitsikas, said, “People could make comments inadvertently that could be deemed to be libellous. Patients often can be in an emotional state when they’ve been treated. It’s quite dangerous.” The ABC reported the organisation wanted such sites banned, saying there is the potential for misleading impressions. “You do need the reputations of dentists,” he said. A spokesperson for NIB told the ABC that the concerns expressed by medical practitioners were valid, however, each comment will be extensively moderated and screened for profanity.
New gene test detects early mouth cancer risk 08
Researchers from Queen Mary, University of London, have developed a new gene test that can detect pre-cancerous
cells in patients with benign-looking mouth lesions. The test could potentially allow at-risk patients to receive earlier treatment, significantly improving their chance of survival. The study, published in the International Journal of Cancer, showed that the quantitative Malignancy Index Diagnostic System (qMIDS) test had a cancer detection rate of 91-94 per cent when used on more than 350 head and neck tissue specimens from 299 patients in the UK and Norway. Mouth cancer affects more than 6200 people in the UK each year and more than half a million people worldwide, with global figures estimated to rise above one million a year by 2030. The majority of cases are caused by either smoking or chewing tobacco and drinking alcohol. Mouth lesions are very common and only five to 30 per cent may turn into cancers. If detected in the early stages treatment can be curative, but until now no test has been able to accurately detect which lesions will become cancerous. Lead investigator and inventor of the test Dr Muy-Teck Teh, from the Institute of Dentistry at Queen Mary, University of London, said: “A sensitive test capable of quantifying a patient’s cancer risk is needed to avoid the adoption of a ‘wait-and-see’ intervention. Detecting cancer early, coupled with appropriate treatment, can significantly improve patient outcomes, reduce mortality and alleviate long-term public healthcare costs.” The qMIDS test measures the levels of 16 genes that are converted into a“malignancy index” which quantifies the risk of the lesion becoming cancerous.
2/11/12 12:06 PM
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NEWS & EVENTS
Bacteria offers clues to cancer
A research team led by Professor Shigeki Hontsu from the Faculty of Biology-Oriented Science and Technology at Kinki University in western Japan and a team from Osaka Dental University have developed ultra-thin, biocompatible films made from hydroxyapatite. Agence France-Press (AFP) is reporting the development could lead to products that repair teeth or replace damaged enamel. “This is the world’s first flexible apatite sheet, which we hope to use to protect teeth or repair damaged enamel,” said Professor Hontsu, AFP reported. “The moment you put it on a tooth surface, it becomes invisible. You can barely see it if you examine it under a light,” Professor Hontsu told AFP. The sheet can be made white for use in dental settings. The sheet was tested on disposed human teeth. Researchers say that they will soon be moving on to testing the material on animals and later on humans. It would take about five years for the material to be used in actual dental procedures. Typically apatite ceramics resists bending, but the hydroxyapatite film successfully developed by Professor Hontsu’s team in 2007 is the first of its kind in the world. Due to its ultra-thinness and flexibility, it has the potential to be used for many applications in the fields of dentistry such as to prevent cavities and restore the surface of enamel. Professor Hontsu and his team have applied for a patent for its dental applications.
Pancreatic cancer is highly lethal and difficult to detect early. But a new study from Brown University in Rhodes Island, USA, researchers has found that people who had high levels of antibodies for an infectious oral bacterium turned out to have double the risk for developing the cancer. The study adds support for the emerging idea that the ostensibly distant medical conditions are related. The study of blood samples from more than 800 European adults, published in the journal Gut, found that high antibody levels for one of the more infectious periodontal bacterium strains of Porphyromonas gingivalis were associated with a two-fold risk for pancreatic cancer. Meanwhile, study subjects with high levels of antibodies for some kinds of harmless “commensal” oral bacteria were associated with a 45-per cent lower risk of pancreatic cancer. “The relative increase in risk from smoking is not much bigger than two,” said Brown University epidemiologist Dominique Michaud, the paper’s corresponding author. “If this is a real effect size of two, then potential impact of this finding is really significant.” Several researchers, including Michaud, have found previous links between periodontal disease and pancreatic cancer. The Gut paper is the first study to test whether antibodies for oral bacteria are indicators of pancreatic cancer risk and the first study to associate the immune response to commensal bacteria with pancreatic cancer risk.
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NEWS & EVENTS
New products New-release products from here and around the world
Fimet Neo dental treatment Unit The ergonomic and elegant design of the Fimet Neo dental treatment unit makes your practice more functional and convenient than ever before. The Neo’s compact and small base provides more working space for both the dentist and the assistant. Smooth surfaces and seamless upholstery make cleaning and disinfection easier and ensures good hygiene. The instrument bridge and suction head can be equipped with removable hygiene covers that are easy to disinfect. The extensive movement range of the Neo’s arms ensures easy, comfortable operation and good economics. There are plenty of adjustment options to further ensure comfort. The large height adjustment range (45cm to 95cm) is designed to ensure comfortable working position while standing or sitting. The chair can be rotated 90 degree; the suction head is adjustable from the 3 o’clock to 9 o’clock positions and suitable for both left- and right-handed use. Also, the cuspidor turns 90 degree sideways providing more space for the assistant. Users can store individual settings for chair position and instrument speed changes, among other parameters. All user interfaces are clear and user friendly. The Neo dental treatment system can be controlled with a wireless foot control, joystick or using keys on the user panel. Everything within reach, instruments, trays, suction head, and cuspidor are adjustable according to the needs of the dentist, the patient and the requirements of the current treatment. Thanks to the thin backrest, the dentist can access the treatment area in an ergonomic and efficient way. For more information on the Fimet Neo dental treatment unit, visit Empire Dental online at www.empiredental.com.au or call toll free 1800 813 877.
New products from ID Health PeriOptix™ is a leading US supplier of high quality magnification and illumination systems for medical and dental professionals. The Solaris™ portable LED headlight is a fully portable lighting system that can be worn on a headband or attached to all types of surgical loupes. Solaris™ uses the most advanced LED that will virtually never need replacing and delivers an amazing 80,000 lux of light. The Solaris™ dental headlight system was given the highest five-star rating and ranked #1 by Reality Publishing, a leading independent dental testing laboratory. The Solaris Mini™ portable headlight system is the next generation in portable LEDs, and is significantly smaller and lighter than most other LED headlights. Weighing less than 6 grams, the Solaris Mini™ delivers 40,000 lux of illumination to the operative field. MicroLine TTLs (through-the-lens) loupes are the lightest and smallest dental loupes on the market. Weighing only 36 grams, the elegant and streamlined design offers a much lighter and more compact alternative. PeriOptix™ proprietary optics sacrifice nothing but weight—image size and quality are equivalent to much larger lenses. For the full range of lights and loupes, please visit ID Health at www.idhealth.net for more information.
NEWS & EVENTS
Bridging the gap 012 12
A free Brisbane-based program has tackled some of the oral health programs of homeless people and helped students learn on the job at the same time. Amanda Lohan reports.
n 2011, Sue Cramb of Brisbane’s Roma House, a Mission Australia service targeting the state’s homeless people in the greatest need, approached the School of Dentistry at the University of Queensland, seeking help to address the endemic oral health problems of the residents in her care. Recognising the opportunity to help break the cycle of need, the university and Mission Australia worked together to develop a referral pathway for residents to be seen free of charge. Final-year students at the School of Dentistry now work to treat the residents of Roma House. Dr Pauline
Ford, senior lecturer at the School of Dentistry, says that, while there are obvious benefits for the residents, students are exposed to very complex oral diseases, medical conditions and difficult social circumstances that combine to make planning and provision of treatment a very challenging but rewarding experience. “It makes such a difference to have a mouth that looks normal, that you can eat with. It makes such a difference to how people perceive you if you are going for a job or renting a flat,” says Dr Ford, “It may seem like a luxury, but without a normal functioning mouth free from infection, it’s pretty hard to get on your feet.” In addition to the treatment provided by the fifth-
year students, the project sees fourth-year students attending Roma House to provide oral health seminars to the residents and staff. “A lot of the staff were really unaware about
success of the project to the close partnership between the two organisations. “Sue Cramb does an amazing job managing residents, getting them to their appointments on time,
Dr Pauline Ford
“They’ve all been humbled because the small thing they’ve done has made a huge impact on someone’s life.” oral health issues,” Dr Ford explains. “They could see the clients had problems, but they weren’t in a position to offer advice or assistance… Increasing their oral health literacy helps to spread the message further.” Dr Ford attributes the
and always mentioning oral health and keeping it in the consciousness of staff and residents.” The students enjoy a highly supported experience. “They’re all really keen at the start, but they’ve got no idea what it will be like so it’s an eye-opening experience
Dr Pauline Ford with student and patient at University of Queensland School of Dentistry.
for them,” says Dr Ford. “Without exception they’ve all been really humbled because they see the small thing they’ve done has made a huge impact on someone’s life.” This year the team were awarded a community service grant from the Australian Dental Association Foundation in partnership with the Wrigley Company Foundation. The grant has enabled them to expand the referral pathway with the purchase of essential equipment to provide onsite screenings and specialised oral health products for patients experiencing a high decay rate
Tips for aspiring volunteers With proposed increased government spending on oral healthcare, dentists across Australia may soon experience a surge in demand from marginalised groups. This has the potential to be a confronting experience, however Dr Ford has the following advice for dentists interested in expanding their skill set by volunteering for the first time: Start by approaching an organisation and asking “How can I offer my skills and experience?” You’ll be amazed at the things you can do with a minimum investment of time. Avoid making assumptions about the needs of a particular group. Rather than saying “I’m a dentist, let me talk to you about how to brush your teeth,” a better thing to say would be, “I’m a dentist, what can I do to contribute in a meaningful way?” Adopt a team approach. You are the expert in oral health, but they are the expert in their particular group. It means they can support you in dealing with any practical issues that may arise.
Approach oral health suppliers for products and brochures you can use as giveaways. Use the goodies as a hook to start a conversation—you may find your group has lots of questions and this will make you more approachable. Remember that if you are providing dental care for patients from a marginalised group, you will need to give each patient treatment tailored to their social situation. To do this, make sure you spend time talking to them and getting to know them and their priorities. Recalibrate your understanding of the idea of ‘success’. Success is not likely to mean that every single patient receives all the dental treatment they need. Success may mean simply taking away someone’s dental pain and giving this person a really positive experience so he or she is more inclined to return. Still stuck for ideas? The Australian Dental Association has a register of volunteer groups. Check it out at www.ada.org.au/ volunteers/volprojects.aspx
and dry mouth related to other medications. The onsite screenings are expected to dramatically enhance the reach of the service. “There are more barriers than just money,” says Dr Ford. “Just because we can provide a free service doesn’t mean they’re going to flock to see us.” The onsite screenings provide a safe space for the students to talk to the residents about their problems before attending an appointment at the school In the past, data about the oral health needs of this group was limited to one paper on the homeless population of Adelaide. “We’re really going on anecdotal evidence, and we can’t use that to justify further funding,” says Dr Ford. Instead, the
team are collecting hard evidence regarding the nature and extent of oral health issues and using validated surveys to look at the impact of these issues on quality of life. “We want to understand what oral health means to them, what the program means to them, and how we can better address this issue further down the track,” says Dr Ford. Since beginning the program, the team has had to rethink their concept of ‘success’. While a few patients have received the entire course of care, it is far more common that the patients miss their appointments altogether as a result of challenging social circumstances. Success is more likely to lie in simply taking away someone’s dental pain, “Some of these
From left: Dr Pauline Ford (UQ School of Dentistry), Sue Cramb (Mission Australia, Roma House clinical nurse consultant), Travis Radunz (Mission Australia, community service worker), Janis Stollery (Roma House resident), Associate Professor Camile Farah (UQ School of Dentistry).
people have had chronic pain for so long, I don’t know how they manage— on top of everything else they’re dealing with—and
still they are so grateful,” says Dr Ford. “At the end of the day it’s such a lovely feeling. It’s a win-win situation.”
ea cle sier an ing !!
2/11/12 12:10 PM
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Miami Beach, Florida A p r il 2 5 - 27 , 2 0 1 3
Fontainebleau Miami Beach Hotel
Mark your calendar for the 2013 BioHorizons Global Symposium at the luxurious Fontainebleau Miami Beach Hotel. With topics that include immediate loading, esthetics, biologics and implant complications, the 2013 Symposium will address a wide range of contemporary issues in implant dentistry and tissue regeneration. Itâ€™s the perfect opportunity to stay abreast of the latest treatment options while enjoying time with colleagues in a beautiful resort environment. At Fontainebleau, striking design, contemporary art, music, fashion and technology merge into a vibrant new kind of guest experience. We look forward to seeing you in Miami.
Edward P. Allen
REGISTRATION Australia Martha Vagenas firstname.lastname@example.org tel: 1300 13 12 19 fax: 02 8399 0466
TUITION Early Bird Tuition USD $925 Auxiliary Tuition USD $579 ACCOMMODATIONS Hotel Rate USD $289 (single or double occupancy)
Please visit www.biohorizons.com for more information SPMP12209 REV A SEP 2012
Invisalign Education Courses 2013 2 Day Course Broad Course Outline
5 Day Course
Pre-Course: On-line module
Pre-Course: On-line module
DAY 1: Theory
DAY 1: Theory
DAY 2: Clinical
DAY 2: Clinical DAY 3: On-line module (Theory) DAY 4: Clinical (in your practice) DAY 5: Theory
Target Audience Additional Information
Course Fee Location Presenters
Dentists with prior orthodontic experience and dentists who wish to manage their own orthodontic treatment planning to deliver high-end, minimally invasive aesthetic dentistry
Dentists with little or no orthodontic experience who wish to use SCDL’s treatment planning to deliver high-end, minimally invasive aesthetic dentistry
Pre-Course module must be successfully completed
Pre-Course module must be successfully completed
Dentist must bring a suitable patient for treatment on Day 2
Dentist must bring a suitable patient for treatment on Day 2
Once completed, dentist is responsible for own treatment planning
Treatment planning is provided by SCDL’s expert panel headed by Dr Ray McLendon (orthodontist)
Option to attend Day 5 is available (fees apply)
CPD Points 33
CPD Points 19
Free DPO Invisalign website for 12mths
$2,500 plus GST (aligners not included)
$2,995 plus GST (aligners not included)
17 Courses around Australia and NZ from February through to December, 2013 Dr David Penn
Dr Peter Wroth
Dr Albert Sharp
To register or for more information call 02 9362 1177 or visit www.scdl-education.com.au
Educ tion The paradigm shift in orthodontics and aesthetic dentistry accelerates! A choice of thought-provoking, hands-on, state-of-the-art education courses which teach general dentists how to easily and rapidly integrate sequential aligner therapy (using Invisalign ď›š) into everyday practice to provide idyllic orthodontic and minimally invasive aesthetic dentistry.
An absolute must for dentists wishing to upskill for the 21st century.
ou c y e! a D bL 5 d iLa n a va y a a D 2 ow n
NEWS & EVENTS
Opposite: Associate Professor Wendell Evans, pictured at the No Drill Clinic, says we have a long window to arrest the development of caries.
Photography: Richard Birch
House calls What does it take to deliver care where it’s needed most? One dentist discovered the answer: a bus. By Andy Kollmorgen
he evidence is in: people who live far away from the nearest dental service have significantly worse teeth than people who can drive down the road and get a problem checked out before it goes critical. Quentin Rahaus knows better than most that lack of access is readily apparent when the patient finally comes in. There’s a kind of pained resignation in his voice when he talks about patients he’s seen from remote areas who have let their oral health “just sort of crumble away”. It’s not that they’re any less inclined to visit a dentist than the average Australian; it’s that there aren’t any practitioners in the neighbourhood—or anywhere near it. Dr Rahaus calls it “negligence through lack of access to service” as opposed to more active forms of negligence. “They just haven’t been able to find the time to see anyone about it.” If Dr Rahaus has his way, it will be a lot harder for that kind of negligence to take root—at least in some faraway parts of Australia. His practice is currently based in the comparative metropolis of Darwin, where he looks after the locals, but most of his patients these days live at least 250
kilometres down the road to the south. Many either mine uranium for a living or live near the sprawling Ranger mine complex about four kilometres outside of Jabiru, in Kakadu National Park. Before Dr Rahaus showed up, there were no dental clinics on hand, and very few made the trip to Darwin unless they were in serious pain or concerned that looking like a hillbilly might affect their love lives. “The decay part is quite alarming,” Dr Rahaus says. “They just tend to not do anything about it. Then your treatment options are limited.” Now they only need to get themselves to Jabiru to find a fully equipped clinic, a turn of events that the Ranger mine management is as happy about as Dr Rahaus and his patients. Before he arrived, mine employees with urgent dental problems racked up considerable sick leave because of the round trip to Darwin and back. Now the care comes to them—in a modern bus with an airconditioned waiting room that holds twelve. Dr Rahaus’s roving clinic parks in a spot made available by the Ranger mine every working day, and he has to deal regularly with hooking up the power, emptying the 360-litre grey water tank and grappling
with numerous other details that come with managing a deluxe-sized RV. It’s basically a one-man show, with Dr Rahaus doing the driving and maintenance plus the dentistry; but getting the idea off the ground required the multi-generational efforts of family as well as his partner. The collaboration appears to have paid off. By any measure, Grass Roots Dental is a luxury operation compared to the government-funded dental caravans that have traditionally rolled through the outback.
lanning for the project began about four years ago, but the original vehicle, a carefully refitted yet distinctly unmodern government caravan from Victoria, failed to meet NT radiation safety standards. The setback came after a lot of work had already been done. “We completely gutted it and re-clad it on the outside. We put three-minute [radiation] barricades around the van. We were really quite a long way along.” With stricter radiation standards in place, though, forcing new technology onto an old platform proved futile. He ended up buying a bus online, and he had to
scroll through more than a few offers to find a vehicle with the right specs. The main thing was that it had to have the engine toward the back to make room for the equipment and the waiting room. It took the better part of a year to get the bus properly outfitted, and Dr Rahaus encountered his share of delays and setbacks.
Seeking subsidy None of it would have been possible, Dr Rahaus wants to make clear, without taking advantage of federal incentives to get more health professionals into rural areas. As far as he can tell, it’s a resource that remains largely untapped. “There’s so much funding available if people would look for it.” Grants up to $500,000 are available under the Department of Health and Ageing’s National Rural and Remote Health Infrastructure Program, but applicants should prepare to do battle with the federal bureaucracy. “The grant application process was very timeconsuming. You have to put together a very detailed proposal and justify every cent you’re asking for. But in the end it’s more than worth it. The rewards of practising in areas where your services are always in
high demand are over and above anything you would get in the cities.” For accredited dentists with the requisite level of insurance cover, grants for capital works or refurbishment are available up to $500,000 and for equipment up to $250,000 (excluding GST in both cases). The projects have to operate in Australian Standard Geographical Classification Remoteness Areas two through five. (They include Inner Regional Australia, Outer Regional Australia, Remote Australia, and Very Remote Australia. Only Remoteness Area 1, Major Cities of Australia, is excluded.) To qualify for the federal funds, your idea “must support the development of innovative models of health service delivery for rural and remote communities… where a lack of infrastructure is a barrier to the establishment of new health services or the improvement of existing health services,” the government says. And since it’s a competitive process, applicants are up against other innovative ideas. Dr Rahaus’s roving bus is not entirely a new one, he concedes, but in creating a fully equipped clinic on wheels, he apparently broadened the concept
enough to secure the funding. Still, the feds could only help so much. He had to kick in upwards of $100,000 of his own money, design and outfit the bus, and upgrade his driver’s licence. It was no small undertaking.
and takes part in the NT voucher program for the indigenous population and others who live in the area. Inclusivity is central to Dr Rahaus’s mission, the roots of which go back to his days at the University of Melbourne’s dentistry
Dr Quentin Rahaus, Grass Roots Dental
“The grant application process was very timeconsuming. But in the end it’s more than worth it.” Dr Rahaus acknowledges that it’s a lot easier to deliver care if you don’t have to decamp at the end of the working day, but in an area where real estate is spread thin, a permanent office wasn’t really an option. “It’s very hard to come by any sort of commercial properties at all,” he says of Jabiru and vicinity. “And with the mobile concept, you can service a lot of different areas.”
Come one and all Notwithstanding the Ranger mine’s support of the project, you don’t have to be a mine worker to visit the bus. Grass Roots Dental also sees tourists
program. Since graduating he has also practised dentistry in various parts of Victoria, Queensland and WA—some more remote than others—but his commitment to servicing the outback has always informed his professional life. As a graduate student in the early 2000s, he urged undergrads to look toward the interior instead of settling for metropolitan regions where the dentist-to-patient ratios are comparatively high and, in Dr Rahaus’s view, newcomers tend to serve as glorified hygienists until they get their own practices up and running. For Dr Rahaus, the commitment to seeking out
and serving unmet needs has both ethical and practical dimensions. “There are so many dental graduates who end up practising near where they grew up and went to school,” he says. “These are generally not places in dire need of dental services, so the range of professional experience will be more limited. Why not take some time in your early career to provide your services to areas where there’s an endless number of patients who deserve equal access to care?” The Australian Institute of Health and Welfare’s Dental Statistics and Research Unit backs Dr Rahaus’s claim that lack of access means worse oral health. A study in 2005 showed that people in rural and remote areas were “far more likely” to only go to the dentist when a problem came up and that rural dwellers reported the highest level of complete tooth loss and the lowest level of dental insurance coverage in the research sample. Remote dwellers were also most likely to have not visited a dentist in the last two years. A 2006 study by the AIHW found that children from rural and remote areas have a higher prevalence of caries than
children from metropolitan areas and noted that the “mean number of decayed, missing and filled teeth was highest for remote dwelling five- and six-year-olds”. In a paper published in the e-publication Remote and Rural Health in 2009, lead author Jennene Greenhill, director of the Flinders University Rural Clinical School, tersely summed up the issue with regard to overall health. “Rural clinicians are confronted daily with the reality that the health status of people living in rural and remote areas is poorer than people in metropolitan areas.” Right now Dr Rahaus is faced with what would be an enviable problem for most dentists. Business is brisk at Grass Roots Dental and shows no signs of slacking off. Aside from making sure the bus and everything on board is up and running every working day, the main challenge is how to manage an endless stream of patients who are all too eager to get themselves fixed up now that the opportunity is at hand. Dr Rahaus’s core mission of inclusivity is bound to get trickier. “We don’t want to get to the point where we’re booked out for months on end.”
DENTAL CORPORATION ADVERTISEMENT NEWS & EVENTS
Corporate Dentistry–dispelling the myth As Dental Corporation celebrates its 5th anniversary since acquiring its first practice, many still question the idea of a corporate business being involved in the dental profession.
rom a start-up in 2007 Dental Corporation (DC) is about to celebrate its 5th anniversary with over 190 practice sites in Australia and New Zealand and 20 in Canada. This represents annual revenue of over $400m delivered by over 680 dentists and hygienists and supported by over 1600 staff. During this period DC has invested approximately $27 million on practice fit-outs and equipment and now spends over $2.5 million per annum in dentist and staff training programs. The DC model is unique and is driven by the partnership between the dentist and DC where the dentist remains in autonomous control of the clinical operations of their practice while receiving a comprehensive range of business support services. And these services are world class. From a central team in Sydney’s North West, DC provide administrative services in financial reporting, payroll, accounts receivable and payable, IT, human resources and staff recruitment and training, risk management and insurances, operational support, and consumables and capital equipment purchasing. To support the purchasing services to the practices DC has developed new technology such as the Procurement Portal which acts as an Amazon style internet portal with all consumable products available in one online location and at prices negotiated directly with the suppliers by DC. This enables practices to order in their own time, all in one place and to compare prices between suppliers eliminating the need to speak with multiple suppliers reps. DC also supports the practice marketing and patient communications and, while there is no change to practice branding, DC can develop and manage websites, oversee internet optimization and prepare and execute individual practice marketing plans and programs.
Dental Corporation founders Dr Ray Khouri (left) and Mark Evans.
Since inception DC has faced many questions about a corporate being involved in the dental profession. The role of DC has been at times misunderstood by those in the profession including practitioners and suppliers. Questions surrounding the sustainability of the model and what value it can bring to the profession have been discussed at length. The key is the DC partnership philosophy and our fundamental belief that our dentists have already built substantial and successful practices so why change something that works? Our core operating premise is that our dentists retain their operational autonomy and that it is still “their” practice. A dental practice is a complex business with many moving parts and tasks placing multiple demands on a dentist’s time and skills. After spending most of the day attending to patients the dentist still has a business to manage. This is
where DC fits in applying our business expertise and systems in partnership with the dentist’s clinical expertise and on-the-ground knowledge to create a win-win situation. In addition to simplifying business issues for the Principles through the provision of back office, marketing and other support services, a wide range of training initiatives including the Graduate Program, the Associate Dentist Program and the Practice Manager Program have been launched and implemented. Despite early cynicism, DC has proven to the profession that being “big” doesn’t necessarily mean “bad”. Many in the profession were waiting to see if Practice Principals would undertake a renewal and extension of their agreements following the end of the first 5 year term. The reality is that they have for a broad range of reasons primarily as they continue to retain control of their practice operations
DENTAL CORPORATION ADVERTISEMENT
The Dental Corporatiaon model frees the dentist up to concentrate on what he loves doing: dentistry.
and future direction while receiving the benefit of the support services. Founder and Executive Director, Dr Ray Khouri says “We were questioned heavily when the business first started about what would happen when the five year agreements were up for re-
to show the strength of the model and the value our practitioners place in the services and support we provide, and validates the leap of faith they took in embracing the model and the philosophy behind it,” he continues. Questions are still raised over the
Dr Ray Khouri , Executive Director, Dental Cororation
“We as practitioners are extremely qualified clinically, but don’t receive any training in managing a business.” newal with our Principals. The question of retirement and career expectations are discussed when negotiations are first entered into. We work closely with those Principals who have identified they would like to slow down at the end of their term, to train an appropriate Associate that the Principal has often identified as being a suitable successor to ensure a successful and smooth transition.” “To date, the vast majority of our practitioners whom we have had renewal discussions with have all resigned to continue practicing. This goes
hands-off approach of the Dental Corporation model with its practices. People want to know, how can a corporate not want to control how each practice is run? The answer is that DC works in partnership with the Principal Dentists and shares the rewards for growing the practice – the belief being that the best person to run the practice is the person who created it! Dental Corporation has received an outstanding response to their model and the services made available to them. Dr Ron Ehrlich, from Sydney Holistic Dental Centre says, “I saw the
Dental Corporation model as a very unique and compelling offering. The ‘hands-off’ approach gives me the scope to continue running the practice, whilst taking advantage of the added value provided by the Dental Corporation Corporate Centre in the areas of IT, Finance, Payroll, Accounts Payable, Marketing and Human Resources functions. It is great to finally have more time to focus on specialist dentistry and patient care”. Dentistry is not one size fits all and if the model reflected this ideal it would not be so successful. “Being a dentist myself I understand the frustrations that dentists suffer. We as practitioners are extremely qualified clinically, but don’t receive any training in managing a business. This model allows practitioners to focus on what they love and are good at: Dentistry,” says Dr Khouri. “The practitioners in our group have spent many years building a successful brand and practice. To change the name, change the staff and change the way they operate would not only be self defeating but would dilute the philosophy of the model and the reason for its inception. By not changing these elements it recognises the hard work these dentists have put into their practice,” he adds.
NEWS & EVENTS
The new dental deal Australian Greens spokesperson and former GP, Senator Richard Di Natale, explains why the new dental deal is better than the CDDS
recently met Michelle, a young woman who has had an all too common personal experience with her teeth. She grew up with three siblings, and her family didn’t have a lot of money so her parents couldn’t afford to take their kids to the dentist regularly. Michelle’s oral health began to decline, so the dental care she needed became more expensive, and further out of reach for her parents. Now Michelle has had to spend thousands of dollars, which she can ill afford, in restorative work. Last year Michelle’s mother, having seen the impact of neglecting her teeth, called her to apologise for not taking out a loan years earlier to pay for dental work. Michelle said that it was a heartbreaking conversation because she knows how hard her parents worked to support their kids. She has made a point of prioritising the oral health of her eight-year-old daughter because she doesn’t want to feel the same guilt her mother does. It has been hard to find the money for the family’s dental care, so recently she resorted to taking out a loan. Sadly, Michelle is not alone in choosing between
poor oral health or taking on more debt. One of the most frustrating things I faced as a doctor was seeing patients with complications from dental disease that I couldn’t help. I would send home people who are suffering from an abscess or infection with antibiotics and painkillers, knowing that the patient couldn’t afford to treat the underlying problem. It’s little known that up to one in 10 visits to a GP and 60,000 preventable hospital admissions every year result from untreated dental disease. In August, I announced a shift in dental health policy and funding, following months of negotiation with the government. From 2014, children from families on Tax Benefit-A will be eligible for Medicare-funded dental treatment, capped at $1000 per child over a twoyear period. It means that 3.4 million kids, like Michelle’s daughter, will be able to go to the dentist as easily as they go to their GP. This $2.7 billion investment aims to address dental decay in children, which has been increasing since the 1990s, and makes sure that no Australian enters adulthood, like Michelle did, already burdened unfairly with bad oral health.
I also negotiated $1.3 billion in the public dental system, building on the $515 million the Greens secured in the last budget. This investment is a 50 per cent increase in funding for the public dental system, which will mean expanded services, improved quality, more dental internships and dramatically reduced waiting lists. The Greens recognise the important role that oral health therapists (OHT) perform, so we secured more than $45 million for an OHT graduate Training program. There is also $226 million of additional grants that will help build infrastructure in rural and remote areas, which will mean more chairs and dentists where they are needed most. The government was determined to close the Chronic Disease Dental Scheme (CDDS) and the Health Minister [Tanya Plibersek] has described it as the worst example of public policy she’s ever seen. While I don’t agree with that characterisation and believe that the CDDS did help many people get access to treatment, there was significant room for improvement. The Government already tried to close down the scheme four years ago but the Greens said we wouldn’t let them close it unless there
Senator Richard Di Natale
From 2014, children from families on Tax Benefit-A will be eligible for Medicarefunded dental treatment, capped at $1,000 per child over a two-year period. was something better in its place—and now there is. One of the health minister’s favourite attacks on the CDDS has been the suggestion that it was being heavily rorted. While there are some clear examples of rorting, I know that many dentists were unfairly caught up in Medicare audits because of simple administrative errors. I was appalled when I learned of dentists being forced to pay back tens of thousands of dollars that they had earned for services that were provided in good faith to eligible patients, because they failed to fill out some paperwork. I took up this cause and tried to advocate on behalf of those dentists who were being unfairly penalised and eventually we managed to achieve the right outcome.
he Minister for Human Services, Kim Carr, announced a few months ago that the government acknowledged that some dentists had been unfairly caught up in the audits and that they would review the process retrospectively. At the time of writing this, the legislation to unravel the audit injustice hasn’t yet been introduced, but I have been briefed on the bill and gladly I expect it to be introduced imminently. However, the fact that there were so many administrative errors does actually indicate some flaws in the design of the CDDS and has been quite instructive. One of the big improvements in the new scheme is that we have dramatically reduced the administrative burden on
“I know that many dentists were unfairly caught up in Medicare audits because of simple administrative errors,” says Senator Richard Di Natale
dentists, removing the likelihood of accidental error in the future. The Greens didn’t want any gap between the schemes, and we pushed very hard in the negotiations to reduce it, but the government made it clear that keeping the CDDS open any longer would have put the new scheme in jeopardy because there is a limited amount of money in the health budget. Former CDDS patients with a concession card will now be able to get better access to quality treatment through the public system, thanks to the huge increase in Federal funding. I am proud that the Greens secured more than $4 billion in new funding for dental health and made sure that it will be spent in the most efficient and equitable way. I’m proud that we have laid the foundations for Medicare funded dentistry, which the Greens will continue to pursue. But most of all, I’m proud when I think about what impact these reforms will have on the lives of people like Michelle and her daughter.
NEWS & EVENTS
Critical mass If you’re looking to own several dental practices, how do you do so effectively and efficiently? And, most importantly, how do you know when enough is enough? By Chris Sheedy
aryl Holmes, dentist and managing director of 1300SMILES, is a father of four children under the age of six. As we speak, he is sitting in a park watching them play together. He doesn’t need to constantly stand up and run over to them to help them out of sticky situations, as many other parents do, because the older kids look after the younger ones. “When you have your first child it’s incredibly difficult,” Dr Holmes reflects. “Every challenge is new and stressful. When you have your second you find you have learnt a thing or two so it’s not as bad, but it’s still a very difficult juggle. But when you get to your third and fourth kids, things tend to become a lot easier. As long as you did a good job with the first two kids you know virtually all there is to know—you’re already an expert, at least with kids of that age. You have systems in place and you’ve become better and more efficient at doing everything that needs to be done. You know when you need to bring in help and when you can handle things on your own. And of course the older kids often take care of the younger ones, so there is sometimes less for you to do. “It’s no different with dental practices,” Dr Holmes continues. “The first is extremely difficult. The second lets you use your learnings from your first. By the time you get to three or four, as long as you have the right systems and people in place, they should begin to take care of each other. Then it’s a matter of monitoring what is going well and what is not, and managing
Dr Daryl Holmes, 1300SMILES
“By the time you get to three or four, as long as you have the right systems and people in place, they should begin to take care of each other.”
those issues when or before they arise.” The ASX-listed 1300SMILES contains 24 multi-dentist practices. The ‘multi-dentist’ part of the equation, Dr Holmes says, is extremely important. A single-dentist practice is not a growth business, he says. In order to take advantage of profits and systems from one practice to launch another, two or three dentists within a practice are a must.
A brand is more than a logo Dr Myles Holt, a dentist and business manager who has one clinic in Singapore and one in Melbourne, with another two in the pipeline over the next 12 months (a second practice in Singapore and one in Auckland), says it’s vital to get the branding of the first practice correct before trying to replicate that business. “I’m not talking about having the right logo,” Dr Holt says. “The branding is the entire experience that people have within your business, from how they book their appointment to
Daryl Holmes, dentist and managing director of 1300SMILES, says the right systems are vital.
the way it feels in the waiting area to the treatment to the information they receive from you after they leave. If you haven’t got this right with the first practice then don’t even consider launching a second practice.” Dr Holmes agrees it is essential to get the entire experience right before a successful growth move can be made. “People should know what sort of experience they are going to have every time they come in to your practice, including availability of appointments, accessibility of the practice and affordability,” he says. “The practice needs to be physically located in a convenient place—not up a dodgy set of stairs, in an out-dated arcade or in a house on a main road with difficult access. “The dental treatment itself should always be personalised for each individual patient but the rest of the experience, from the communication and the flow from front desk through to treatment and the after-care warranty should be structured and systemised to ensure absolute consistency of experience, and therefore consistency of brand,” says Dr Holmes.
For growth, be a manager Dr Holt, who consults to dental practices on branding, direction and market placement, says he knows of no magic number that represents the right amount of practices within a dental business. “I know several people that struggle with one business, and I know one individual operator who runs 12 of his own practices,” he says. “It comes down to the individual and their ability to build and manage a brand and a business. If they get their approach right in the first practice then growth is pretty straightforward. If you just think about it as more bums on more chairs equaling more money then it will only lead to more headaches.” Dr Phillip Palmer, a dentist who runs practice management consultancy Prime Practice, says multi-practice success depends on whether the business owner will also be practising dentistry. If they continue to dedicate their time to working on
Dr Myles Holt believes there’s no magic number—it’s all down to the individual and what they can manage.
patients, then it makes it difficult to run multiple practices. But if you’re a manager who works very little in each practice, he says, then there’s no reason you won’t succeed with multiple practices. “It depends on your ability to delegate and your ability to motivate and train your staff,” Dr Palmer says. “It’s about training the people working for you in systems and other hard skills, and in soft skills such as how to offer service and how to communicate. Dentists often believe the only important types of skills are clinical ones but from the patient’s perspective, they just want to be treated respectfully, which is all about soft skills. If you continually train your people in these important areas then you have a business that can be grown. “Corporates are showing that there is no real upper limit to the number of practices that can be successfully managed. Most of the corporations have a dentist close to the top or at the very top. The real difference with those experiencing success is that they know how to continue to delegate and train their people,” says Dr Palmer. As practice numbers increase, Dr Holmes says, it’s vital to constantly monitor and change the management structure to take advantage of economic scales and efficiencies. Roles should be centralised, not replicated. Management of finance, marketing, administration, stock controls and levels, etc, can all be brought under one roof. “As your family increases, you don’t buy more cars to drive them around; you instead buy a car with more seats that makes transporting a larger number of children more efficient,” Dr Holmes says. “So too with more practices. You should be altering your management structure and your systems such as IT and finance, etc. Such a structure strengthens your business, spreads risk and increases profit.”
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NEWS & EVENTS
May the floss be with you Ever wanted your surgery to stand out from the crowd? How about making staff wear Star Trek uniforms? Kerryn Ramsey meets the dentists whose passion for sci-fi informs their work.
here’s a common and pervasive idea of what a dental practice should look like— clean white walls, a well-lit reception desk, framed photos of perfect smiles and maybe a water feature or fish tank in one corner. The staff wear crisp white uniforms and the surgeries are sleekly designed to be reflections of the professionalism of the dentists and their support staff. Walk into any dental practice in Australia and you can be pretty much guaranteed of seeing a variation on this theme. But sometimes a dentist decides to throw convention out the window and create a practice that is so different, it can’t help but be memorable. Say hello to Bytes Dental in Ballina, NSW. Owner and dentist Dr Kim Davies has created a fun and funky dental surgery that’s unlike anything you’ve ever seen. The front desk is shaped like a UFO complete with flashing multicoloured lights. Obviously, there’s no point in having a UFO if it’s not in outer space, so the walls and roof are painted
black. The floor is black polished concrete with silver glitter, and hundreds of fibre-optic lights create a shimmering star-field on the ceiling. The black floor runs through the entire practice but when you walk through the UFO towards the surgeries, then you’re inside the ship and everything is lit properly. Monitors are positioned on the ceiling that display fractals, nebulas and trippy computer-generated images. The waiting room also contains a hot-pink dental chair emblazoned with spray-painted crop-circle designs. This is very popular with kids who can climb all over it and pretend to be dentists. Oh, and the staff wear uniforms that look like they have come straight from the bridge of Star Trek’s USS Enterprise. So how did a smallish country town in NSW end up with such a unique practice? It all started when Dr Kim Davies, already a qualified dentist, completed a fine arts degree in Brisbane. Her plan was to move to Byron Bay, be an artist and do a little dental work on the side. Then a friend with a construction background, Mauro Cozzolino, suggested that they build their own practice. “He kind of talked me into it,” says Dr Davies. “I was full of artistic drive due to my art degree and it was all channelled
You can tell Dr Kim Davies (in white boots) isn’t really performing dentistry—she isn’t wearing a face mask.
into the practice. I really love space and cosmology and physics—science fact more than science fiction—so we turned the practice into a space ship.” Starting such a unique practice is not without risks. Bytes Dental was the first practice Dr Davies had ever run and she was new to the town with no existing client base. It would have been all too easy to take the safe path. Dr Davies explains, “I wanted to break with convention and just be expressive. Why do we all conform to the mould that people expect? I’ve had dentists who work for me who want to change our reception area because it’s too dark, too strange and too weird.” While Dr Davies is sure that some people don’t come to the practice because of the decor, the majority of feedback is overwhelmingly positive. The general response is gratitude for doing something different. The success of the business speaks for itself. Bytes Dental opened in 2007 with one dentist—Dr Kim Davies. At present the staff includes seven dentists, a hygienist, a school
32 dental therapist and visiting specialists in orthodontics and periodontics. Another practice with an original concept is TFI Dentistry in Thornlands, Queensland. The practice specialises in children’s dentistry and gives kids the option to be treated by a real tooth fairy. In a surgery emblazoned with vibrant colours, plants, butterflies and artwork, children are examined by dental hygienist and therapist, Stephanie Wilson, dressed in a pink fairy outfit and wings. Of course, the children are encouraged to dress up for their visit too. “We wanted to create an aesthetically pleasing atmosphere that was calming and relaxing, and yet fun and entertaining for the children,” says Wilson. “We commissioned a local artist to make custom works for the practice. Being dressed as the tooth fairy just adds to the fun for myself and for my little patients.” With a second practice opening in Labrador on the Gold Coast last June, the tooth fairy concept is going from strength to strength. In the UK, a themed dental practice recently received a national accolade— dentalangel has been shortlisted for the ‘Most Attractive Practice’ category in the
Dr Davies says dentists have asked her to change the waiting room decor at Bytes Dental because it’s “too dark and too weird”, but patients keep coming back.
Private Dentistry awards at the Hilton Hotel, London, which will be announced this month. The design of dentalangel pays homage to Stanley Kubrick’s 2001: A Space Odyssey, Gerry Anderson’s Thunderbirds and the Brazilian modernist architect Oscar Niemeyer.
hile Bytes Dental has the vibrancy of the Barbarella movie, dentalangel feels like a medical bay on a futuristic space station. It’s all curved lines, air-lock doors, porthole windows and muted colours. Situated in the town of Kendal, the practice is simple, elegant and graceful. “It sits on the High Street,” says dentist Dr Girk Baytug, “quiet and dignified, providing a cornucopia of design porn for the ever-clicking tourists. We do our bit for Lake District tourism.” Again, this practice has succeeded in growing steadily. Starting with a single practitioner in 2008, it now has a team of 10. In the early days, Dr Baytug explored a number of different marketing
ideas to promote the business, but no longer. “What we have learnt is that the best forms of advertising are the building itself and word-of-mouth among the local population,” says Dr Baytug. So, marrying your passion and your practice can have very positive results. A unique and creative work space invariably leads to happy patients, content staff and a memorable and instantaneous branding. However, no matter what the design, one thing must always be front and centre. “It’s all about the dentistry,” says Dr Kim Davies. ““Running a business is not my drive—I put the patients’ needs first, and the money flows from there.” Bringing together your passion and your profession can be a risky but very rewarding experience. “I have a team that works together, hangs out together and there’s playing and laughter in a fun environment,” says Dr Davies. “Patients constantly say they can tell we really love our work,and that’s why they keep coming back. Quite simply, it’s a nice environment.”
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NEWS & EVENTS
Tools of the trade The best restorative system, magnificent magnification, an almostpainless needle-free anaesthetic and more are in the spotlight this month
Heine loupes by Dr Lam Nguyen, Bunbury Oral Care Centre, WA
E4D by Dr Christopher Dimos, Dimos Dental, Melbourne, VIC The E4D is a complete CAD/CAM dental restorative system. The teeth are scanned in order to design the restoration. Once the restoration is designed, it’s sent via a wireless network to the mill, which is traditionally positioned in the lab area. The restoration is then milled out of a block of ceramic. The furnace can then be used to stain, glaze and characterise the restoration. What’s good about it The advantage for patients is that everything is completed in one visit. They’re not going away with temporaries and they are only numbed the one time. I closely compared the E4D to another cadcam unit before purchase. The E4D doesn’t require any pre-powdering. I also like a facility in the E4D called ICE View. Instead of the scan looking like a foam model, ICE View gives a high-definition photographic image that shows the differentiation between gingival tissue and the margins of your preparation. I found the E4D software to be very intuitive—it was quick and easy to learn to use.
I’ve been using the 6X Heine loupes for about 18 months now. Prior to that I was using a 2.5X pair but once you go to a higher magnification, you never go back. I am so used to the larger image that every time I try the 2.5X loupes again, I feel like I’m not seeing things clearly. What’s good about it These loupes are mounted on a headband along with a light and a battery. This means there is no cord getting in the way as you move around. Initially I thought the loupes might be a bit heavy but they are very comfortable and don’t put any strain on my neck. The 6X magnification is quite strong but it’s great to be able to see everything so clearly. I use the loupes for all procedures including examinations, endo and identifying cracks in teeth. A lot of dentists prefer a microscope but the big advantage of loupes is that they can be carried from room to room. The battery lasts for the whole day and only takes about two hours to charge. Generally I just put it on the charger overnight. I’m very careful with my loupes but I have managed to drop these once or twice. I thought they would be broken but they continue to work fine.
What’s not so good The unit has a pretty steep learning curve. When we first tried to integrate it into the practice, it threw our scheduling into chaos until I became more proficient with its operation.
What’s not so good They’re expensive to purchase. Even the battery is expensive. Using a 6X magnification means that you don’t get to see the whole mouth. However, this is also a good thing. During an examination you are focused on one or two teeth and nothing escapes your scrutiny.
Where did you get it Henry Schein Halas.
Where did you get it Ivoclar. (continued on page 36)
NEWS & EVENTS
Tools of the trade
(continued from page 35)
discovered it’s not completely painless like they claim. I’ll keep using it, particularly on needle-phobic adults, but not on children. Even though this system is quicker, I can give a normal injection almost painlessly—it just takes a little longer. Where did you get it Dentavision.
Star Dental Explorer 5 probe by Dr Barry Johnson, Carlton Dental, Carlton, VIC I have been using the Explorer 5 as my favourite probe since I started in dentistry. Just recently I was having trouble purchasing them but I tracked them down to the supplier Dentec in Geelong. They are still being manufactured but the big dental supply companies don’t seem to import them anymore.
36 Injex by Dr Ines Nurboja, Ryde Family Dentist, Ryde, NSW I received a brochure for this product and ordered it without trying it. It is a completely needle-free anesthetic delivery system. It has a very wide range of applications but is also being marketed to dentists. It has even been featured on a couple of television current affairs shows. What’s good about it It administers the anesthetic by using pressure. Once the gun is in the correct position, a button is pushed and the anesthetic is shot straight into the gum. The effects are very localised. When patients receive upper anesthesia, they tend to walk out of here looking like they’ve had a stroke. They can’t move their lip and it’s really obvious when they smile. With this system, there is no numbness of the soft tissue and because a smaller dose is administered, it wears off a lot quicker. What’s not so good I thought it would be good for kids because they tend to panic the moment they see a needle. However, it hasn’t worked out as well as I’d hoped. I find that it causes quite a bit of bleeding which children find upsetting. It appears to be traumatic to the tissue as it shoots the liquid like a bullet. There’s also a loud clicking noise when the button is depressed. Even when using it with an adult, you really have to give them a warning. And when I used it on myself, I
What’s good about it The Explorer 5 is a universal probe with a sickle shape at one end and a little hook at the other. I use it on a routine basis when looking for cavities. I can then flip it over to get into difficult areas between the teeth. It’s also handy when placing a band on a tooth and for all sorts of other procedures. I like the Explorer 5 because of the tempering of the metal. The tip is very hard and it doesn’t blunt easily. At the same time there’s a stiffness and a certain springiness that gives a really nice feel. Other probes feel dead by comparison. You have much more sensation through your fingertips whether you’re running it across filling, tooth, enamel or dentine. You can easily feel the different textures of dentine, enamel, metal or porcelain. I use it with every patient, every day. What’s not so good As far as I’m concerned, this instrument had reached a level of perfection. In fact, I like most of the Star Dental instruments. I also use their endodontic probe No. G16 and that has a nice springiness in its feel that you don’t seem to get with other probes. Where did you get it Dentec, Geelong, VIC.
NEWS & EVENTS
Intraoral cameras and magnification product guide
Bite magazineâ€™s guide to the best cameras and magnification products on the market today.
advertorial NEWS & EVENTS
Camera and magnification product guide SoproLIFE caries detector offers huge benefits
he latest SoproLIFE intraoral camera with built-in caries detector feature offers significant benefits for those using the product in everyday practice. A-dec’s Digital Imaging Product Manager, Leni Vilivili, said Australian dentists have been quick to grasp the technology – first developed in Europe by Acteon/Sopro and now available through A-dec dealers around Australia. The compact and streamlined Sopro‘LIFE’ (Light Induced Fluorescence Evaluator) intraoral device, is now in use in private clinics and teaching institutions in Australia – including Melbourne Dental School where it has featured in a tele-dentistry trial demonstrating medical applications of the National Broadband Network (NBN). It is also used at universities around the world as an educational tool to assist dental students identify healthy and de-mineralised tooth structure, suspect lesions and areas of active caries. One of the many private dentists who use the SoproLIFE as part of their patient evaluations is Dr Anh Tran at Fitzroy Dental Care in the inner Melbourne suburb of Fitzroy. The compact SoproLIFE unit is integrated into the A-dec 500 delivery system supplied by A-dec dealer, Medident in Melbourne, which equipped the practice. According to Dr Tran, patients are ‘wowed’ by the SoproLIFE technology. “I think it is most important from a patient education point
Dr Anh Tran, Fitzroy Dental Care, Melbourne
“I regard the SoproLIFE as even more important than even X-rays now.”
of view, as patients can see for themselves what a dentist does. With the SoproLIFE you can get every detail, even occlusions and the (Sopro Imaging) program is very quick. The fluorescence feature enables you to show patients where the caries is to give them confidence in the diagnosis.” “The Sopro camera itself has very good resolution and produces a very clear image. You can magnify the image and the ‘before’ and ‘after’ feature is great for clinical work as you can monitor a filling or restoration, or track an ulcer. “I found an ulcer in one of my patients and probed it and then marked it for follow-up to see if it was a non-healing ulcer. I captured the photos and suggested the patient get a biopsy and it proved positive (to cancer).” Dr Tran added that the SoproLIFE would also be good litigation-wise – if a dentist ever needed to review the work
Dr Ahn Tran of Fitzroy Dental Care (left) has found the SoproLIFE caries detector invaluable in diagnose and patient education.
that was done in their surgery. “The SoproLIFE is more important than even X-rays. Sometimes you miss things with a visual inspection that you pick up with the camera. I regard the SoproLIFE as even more important than even X-rays now.” Dr Tran said the macro feature was particularly useful and the ease of capturing an image while hovering over a tooth. “The main advantage is taking single photos for each tooth. You can’t get in close enough with a full size camera and I’m always worried about dropping an SLR. “The SoproLIFE is fast and good quality. Unlike X-rays it is ‘live’ so you can compare suspect and re-mineralised areas while you are actually looking at the tooth. It’s fantastic and the patients think so too,” Dr Tran said. More information on the SoproLIFE and Acteon’s full range of digital imaging equipment including X-Mind X-ray generators, Sopix2 digital sensors and PSP!X Phosphor Plate systems, is available from A-dec. Phone 1800 225 010 or visit www.a-dec.com.au for your nearest A-dec dealer.
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advertorial NEWS & EVENTS
Camera and magnification product guide The next generation of intraoral scanning Omnicam represents the latest in technological innovation in intraoral imaging for CAD/CAM scanning and restoration fabrication.
eleased in August, a second camera additional to the CEREC Bluecam by Sirona, the new CEREC Omnicam is the first intaroral scanner that is not only a powder-less camera, but also captures the dentition using live streaming colour 2D video for patient information and 3D colour models for (CAD) restorative designs. The CEREC system is a combination of an intraoral scanner, with a computer added milling (CAM) unit, that is used to capture and send digital information to the lab. That same digital information can be used to fabricate one-visit chairside restorations. In its 27th year of existence, the CEREC technology has seen an evolution from the CEREC 1 to today — where we have the third generation in scanning technology and the latest in software design. Used in dental offices for the fabrication of inlays, onlays, crowns, veneers, bridges and more, the CEREC system is used in more than 36,000 offices worldwide. One of the foundations of the system has always been the ease of imaging with all generations of cameras. Despite the fact that the system required an opaque powder to be applied to the teeth, the intraoral scanning with the previous generation of camera, the Bluecam, was quite easy and set the standard for all other systems (Fig. 1). In a matter of seconds, users could spray a thin coat of powder on the teeth and use the Bluecam to capture individual images. Those images would then be processed by the software to create a virtual model on which the restoration could be designed allowing the clinician full control over the contacts, contours and occlusion (Fig. 2). The Omnicam differs in three main ways from the Bluecam which, up to this point, was considered the
gold standard in intraoral imaging in dentistry: 1. The Omnicam is completely powder-less. Simply take the camera and use it in a similar motion to an intraoral camera to capture images in the mouth. The camera captures in vivid detail the hard and soft tissues and allows the user to differentiate the dentin, from enamel to the soft tissue. Figure 3 shows the actual scan of a prepared tooth as it’s being imaged with the Omnicam. There is no powder required on the teeth prior to imaging. 2. The Omnicam images in full colour. Virtually every other intraoral imaging system takes its images in black-andwhite and renders the virtual model in a graphical representation of the teeth. The Omnicam, on the other hand, not only allows the user to visualize the teeth in full colour, it also renders the models in true photorealistic imaging. The models are not a graphical representation of the acquired information, but are in fact of the quality of a high-resolution photo. This allows the user to design the restorations on a true representation of the model. The colour capabilities were already shown in Figure 3, and the virtual model that is created by the color capture is visualized in Figure 4. 3. The images that are captured by the Omnicam are in live streaming of data format, not as individual images. The advantage of this is that the user simply waves the camera over the area they want to capture — without any powder — and the live streaming of data feed fills in all the missing data to create a virtual model. No longer is the user dependent on individual images to fill in the missing data. The clinician can
simply scan the desired arch without having to worry about any images stitching. Figure 5 shows the Omnicam capturing the buccal bite utilizing a live stream in colour. While other imaging systems have had one or two of these features, until the Omnicam, no other system has been able to combine all three features. Video capture has been done previously, but never with the ease of the Omnicam and with the absence of powder. Color has been present on, but the systems that used colour had a camera that was slow and clunky to use, and captured individual images, which require a long time to stitch together to form a virtual model. Some systems have had powderfree capabilities, but the imaging was archaic and the data captured rendered virtually useless models (Fig. 6). Not until the Omnicam has there been a system that is powder-free, captures live streaming of data and is in color. The result is a system that is easy to use by clinicians and renders accurate and precise models quickly and efficiently. Having used the Omnicam for several months now, the authors feel that it is a major step forward in the world of CAD/ CAM dentistry. For existing CEREC owners, it’s important to understand that once the image is acquired with the Omnicam, the data is processed by the same 4.0 software that was released by Sirona in 2011 and used by Bluecam users. This ensures that the learning curve is minimal. The software is modified to work with the Omnicam, but in all other aspects has the same tools and features as the regular 4.0 software that is currently available with the Bluecam — allowing users to rapidly integrate it into their practices. For more information visit www.sirona. com.au or call 1300 747 662
advertorial NEWS & EVENTS
Camera and magnification product guide The new CS 1200 intraoral camera
illiam Green Pty Ltd is proud to announce the arrival of the new CS 1200 intraoral camera manufactured by Carestream Health, with an image resolution of 1024 x 768, a video resolution of 640 x 480 and a focus range of 3mm-25mm. This device can provide clear views of all anatomical structures in your patient’s mouth. Small details like cracks and caries can be made visible to you and your patients in real time. A one-click image capture button makes it easy to acquire high-quality stills and videos. Up to 300 images can be stored on the device itself and connections to a computer or analogue displays can be made with USB, AV, and S‐video. Lighting conditions are regulated by 6 white LED lights that automatically adjust to offer a clear uniformly lit image. Other more advanced versions of intraoral cameras from Carestream are also available; they include the CS 1500 and CS 1600. The CS 1500 camera is available in both a wired and wireless version and designed for mobility. Featuring a true autofocus, the camera’s unique liquid lens technology works like the human eye to ensure effortless image capture and clear, detailed images every time. Combined with the industry’s highest still image resolution of 1024 x 768, the CS 1500 camera delivers superb image quality—right down to the smallest detail. Boasting the widest focus range on the market (1mm to infinity), the camera offers the large depth-of-view required to capture both intra- and extra oral images. Featuring an 8-LED lighting system, the CS 1500 camera delivers consistent and powerful illumination. Intuitively adjusting to your current lighting conditions, the camera’s true white LED bulbs provide optimally illuminated images in any environment. Meanwhile, the camera’s unique polarization filter automatically optimizes light reflection for easier visualization of fine details. Weighing as much as 50%
Above left: The new CS 1200, right, the CS 1600
less than other wireless cameras, the CS 1500 camera ensures maximum comfort for its users. Easily manoeuvrable, the camera’s lightweight handpiece makes exploring even the most hard-to-reach areas simple Combined with the same advanced autofocus liquid-lens used in the CS 1500, optional polarizer feature,
and sophisticated 18-LED illumination system, the CS 1600 delivers the highest image quality imaginable while aiding in the detection of suspicious incipient caries on both smooth and occlusal surfaces. At the same time, dual capture buttons ensure ease of use, promoting smooth handling for both arches.
So which camera is right for you? Feature
Caries detection aid
Still image resolution
1024 (H) x 768 (V)
1024 (H) x 768 (V)
1024 (H) x 768 (V)
640 x 480
640 x 480
640 x 480
Polarizer feature (glare reduction)
Yes-independent portrait mode
Liquid lens autofocus
No, fixed focus
Dual button capture
USB (direct to PC)
USB (direct to PC) S-video (direct to monitor)* AV (direct to monitor)*
USB (direct to PC) S-video (direct to monitor) AV (direct to monitor)
PC, video, analogue*
PC, video, analogue
Wireless (Wi-Fi) option
18LEDs (6 blue, 6 white polarized, 6 white nonpolarized)
*Portrait image capture is limited to the CS 1500 camera and CS 1600 intraoral camera systems. *Only available with wireless camera
Intraoral Cameras Intraoral Cameras from Carestream Dental
Intraoral Cameras from Carestream Dental
A tradition of superior quality and ease of use for better patient care.
Call now to book an in surgery demonstration
A tradition of superior quality | www.williamgreen.info and ease of use for better patient care. Ph 1300 363 830 7629 Intraoral Camera brochure A4.indd 1
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NEWS & EVENTS
Yen for yoga After taking over Beacon Cove Dental in Port Melbourne, Victoria, Dr Fern Trinh White turned to yoga for health and happiness
Interview: Kerryn Ramsey.
Nine years ago, I was living on the Mornington Peninsula and a patient invited me to attend her yoga class. At the time I was working six days a week and beginning to feel burnt out. I was starting to experience the common physical strains of dentistry; stress and chronic back, neck and shoulder pain. “The Hatha classes appealed to me immediately. I began stretching and unraveling my body while calming my mind by breathing through the tempo of each posture. Although I initially considered yoga as a physical practice, it began to offer me a regular framework to become still and listen to my body. “Moving back into the city, I tried many different schools of yoga. For a few years I practised Ashtanga Vinyasa, a very physically challenging yoga tradition. Eventually I found a group of teachers who truly resonated with me due to their ability to embody both physical work and mental awareness. “My yoga practice has been most helpful since taking over Beacon Cove Dental in late 2010. At the same time as growing into a more mature practitioner and advancing my skills, I was dealing with the enormous stresses surrounding a new business venture, including staff retention, maintaining patient relationships and ensuring an appropriate work/life balance. “My staff also benefit from her personalised yoga workshops. This is a wonderful team-bonding experience where all members communicate on the same level and improve their psychophysical situation at work. As a result, our relationships with each other and with our patients have improved dramatically. “Yoga allows me to appreciate and nurture my role as a health provider and the growing impact that I can have on my patients, staff and the people around me. It’s a huge part of my life.
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