The Bulletin - Issue 52 Oct / Nov 2019

Issue 52 Nov-Dec 2019

The official newsletter of the Dental Hygienists Association of Australia Ltd

Alternative Therapy We explore how to manage the growing trend of complimentary medicine in the dental practice

ISDH 2019 in Brisbane

The battle of the sexes

The oral hygiene world comes to Australia to celebrate in style

Challenge the barriers to women’s career development

STATE ROUND-UP Find out what’s happening in your local area

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Collaboration is the key IT’S A BEAUTIFUL 26 degrees as I write this. Flowers are blooming and a string of sunshiny days has everyone in a good mood - spring has sprung!

It has been a busy quarter for the DHAA. ISDH 2019 has come and gone with over 1200 delegates from 34 countries making the trip. I heard nothing but praise as I walked around the Brisbane Convention and Exhibition Centre, from delegates, speakers and exhibitors alike.

Delegates loved our DHAA relaxation lounge, and both of our keynote presentations had everyone buzzing. The gala dinner at Howard Smith Wharves, was such a great night and a fitting finale. Huge congratulations to Roisin McGrath and her team on putting on such a successful event, I know it will be talked about for years to come.

After much back and forth between the two associations, I was so pleased to meet with Leticia Masters (ADOHTA National President) and sign the DHAA/ ADOHTA Memorandum of Understanding (MOU). The MOU confirms the commitment of both organisations to a positive and collaborative working relationship in the interests of oral health professions. Members of both associations can now access each other’s CPD events for a special rate, and many local joint CPD events are being planned at state level. Executives of DHAA and ADOHTA will meet and communicate on a regular basis to share information and explore collaborative opportunities of common interest.

In September DHAA CEO Bill Suen and I were invited to a Dental Board of Australia (DBA) roundtable, along with many stakeholders from our industry.

Dr Murray Thomas, Chair of the DBA, introduced a proposed National Health Support Service for the dental profession. The support service will be a confidential information and referral service, available nationally for dental practitioners and students, who may be experiencing health-related issues or life stresses. The purpose of the roundtable was to start a conversation about the development of the support service which is expected to take at least eight to 12 months to develop, so watch out for updates as they become available.

On behalf of the DHAA I wish the best of luck to all students with your end of year assignments and exams. As Dr Spock once said: “Trust yourself. You know more than you think you do.”

Cheryl Dey DHAA National President

Contents 04 Pay award update

Our full report from ISDH 2019 in Brisbane .

06 Sea change for better

Lyn Carman talks about her new sea change challenge

10 Book review

Uncovering the Secrets from a dental hygienist

COVER STORY

12 “ I want the alternative please Doctor” Does alternative medicine have a place in the practice.

18 Better late than never

Pushing for a shake-up of health care for seniors.

20 Communty Spirit

Aileen Lewis is a passionate volunteer in Vietnam.

24 All together for Josh

The oral health community have rallied for a good friend.

26 Battle of the Sexes

It still rages on in the oral hygiene workplace

28 Channel your energy

Your energy type tells a lot about who you are.

30 State of the Nation

Your quarterly round-up of everything that is happening around the country.

Key Contacts PRESIDENT Cheryl Day CONTACT

ADMINISTRATION & EVENTS OFFICER Patricia Chan CONTACT

IT REP Josh Galpin CONTACT

BULLETIN EDITOR Marcy Patsanza CONTACT

The Bulletin is an official publication of the DHAA Ltd. Contributions to The Bulletin do not necessarily represent the views of the DHAA Ltd. All materials in this publication may be readily used for non-commercial purposes. The Bulletin is designed and published by eroomcreative.com

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ISDH 2019

The oral hygiene world came to Australia in August as the International Symposium on Dental Hygiene (ISDH) descended on Brisbane

by Christina Zerk

THE BRISBANE CONVENTION and Exhibition Centre opened its doors to 1200 delegates from over 35 countries – a very special event for Australia and the DHAA who played a big part in hosting the event.

Registrations opened early on the Thursday morning with the convention centre filling up fast as attendees registered. Friends and colleagues meeting up with each other and reunions for those who graduated together yet moved apart for work or personal reasons, the atmosphere was one of excitement.

Sitting in the Grand Hall for an opening ceremony reminiscent of the Olympics was a truly wonderful experience. Festivities commenced with Roisin McGrath, Chair of the local ISDH organising committee, welcoming all attendees followed by a customary Australian welcome to country by Nunukal Yuggera.

Delegates from each represented

nation then entered the hall bearing their national flags. The cheers that arose as each took centre stage was an indication of just how many people had travelled from overseas to attend.

Robbern White and Erin Taylor lead the procession carrying the Australian flag and the Aboriginal and Torres Straight Island flags, and last, but not least, DHAA President Cheryl Dey and Vice President Tabitha Acret carried the DHAA flag to the stage where they were joined by the International Federation of Dental Hygienists flag bearers Robyn Watson, Corrie Jongbloed–Zoet, Wanda Fedora, Mary-Rose Pincelli and Michaela O’Neill.

After the opening ceremony the Exhibition Hall opened its doors allowing us a first look at the trade displays. With over 40 exhibitors there was certainly plenty to see and do in the breaks between speakers.

Meanwhile the DHAA stand was manned by staff and committee members as well as members from

our special interest groups making themselves available to meet members, and our very own Cathryn Carboon sold and signed her book ‘Who is the Tooth Fairy’s Best Friend’. We also ran a selfie competition where attendees could take a selfie at the DHAA stand and post it to social media. All entries went into a draw to win a bottle of champagne; Brisbanebased Alex Tsikleas was the lucky winner. A second competition was open to any members who signed up at ISDH to go into the draw to win a ticket to the DHAA Symposium 2020 being held in Melbourne.

After lunch, keynote speakers Dr Dagmar Else Slot, Professor Mario Rui Araujo, Dr Ron Knevel and Dr Melanie Hayes started-off the program with their presentation ‘Are you a lamp, a lifeboat or a ladder?’. This was our first introduction to the symposium theme ‘LEAD’ exploring leadership, empowerment, advances and diversity in dental hygiene.

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The afternoon kicked-off the scientific programs and each session featured a sponsored speaker in the Great Hall along with four concurrent breakout sessions. This ran over all three days and each breakout session featured speakers with a focus on one of the key themes.

Alongside the standard sessions there were over 50 posters presented with

committee members got to meet their dental hygiene heroes at the President’s Reception later that evening.

Friday night’s Gala Dinner at the Howard Smith Wharves was an opportunity for everyone to dress up and let their hair down. The dance-floor was filled all night and the photo booths were a fantastic hit once again.

“ The Brisbane Convention Centre opened its doors to 1200 delegates from over 35 countries – a very special event for Australia and the DHAA” a number of these also participating in rapid fire presentations.

This year’s social program featured welcome drinks on the Thursday night with some extra special Australian wildlife guests joining us. Everyone loved being able to meet and take photos with some of our local wildlife including a wombat, crocodile and an owl. Some of our state and executive

The Sunstar awards were presented

by Mayumi Kaneda of Sunstar Global to research award winner Danielle Clark from Canada, and the project category winner was Tan Minh Nguyen from Australia for his work on Integrating Evidence-Based Dentistry within a Public Dental Program for Children.

Saturday started with the final keynote presentation by Anh Do,

Vietnamese-born Australian actor, comedian and artist. There wasn’t a dry eye in the room as he told the tale of his life as ‘The Happiest Refugee’.

The symposium concluded with a closing ceremony and a number of awards presented by the International Federation of Dental Hygiene, as well as national awards presented by the DHAA. Dr Melanie Hayes received an award for her Excellence in Higher Education, Hannah Colantoni from SA received hers for Community Service and Tabitha Acret was awarded for her commitment to clinical excellence. We also awarded a life membership to Wendy Dashwood from ACT, for her work to grow the dental hygiene profession.

The ceremony closed with an invitation from the ISDH 2022 organising committee to attend the next symposium that will be held in Dublin, Ireland. Naturally this was followed by a taste of Irish music with a live band and dancing to wrap up the event.

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Sea change for the better Having taken the decision to try a new career path, Lyn Carman is loving her new-found freedom and the worthwhile challenges that it brings WORKING RURAL REMOTE, fly-in flyout (FIFO), with Jeanie and Dental on Eyre, as a ‘city slicker’ in the later years of my career has brought with it some amazing insights into the challenges and absolute joys of working rural and remote in South Australia.

What I do now is generally not a clinical role – we are “transforming rural remote oral health”. Along with the inspirational Dr Cindy Dennis, a dentist and thought leader from Eyre Peninsula, who knows first-hand the challenges of this region, we have an incredible vision for the future.

Cindy has been instrumental in establishing two statewide key stakeholder groups – “Rural and Remote Oral Health Coalition” and “Northern Eyre Peninsula Health Alliance” – both of which are focused on transforming the delivery of holistic health services for South Australians. Part of my role is to facilitate rural remote workshops, which bring qualified oral health professionals into rural areas and educate them about the opportunities available.

There is nothing typical about my typical day. I could be working anywhere in central Eyre Peninsula (EP) sleeping in one of our share houses dotted over EP, or I may be at my home in Adelaide remotely logged into our terminal server.

I may have flown into Whyalla, Port Lincoln or Ceduna picked up the car to drive 1.5 – 2.5 hours to where I may be working on that day or perhaps grabbed a ‘lift’ to the local airfield with a pilot who was flying in. If don’t get to the shop to buy my groceries I may well be making-do with what I have in the fridge – learning to be creative with less.

My days are full, there is a lot to do and that’s wonderful. When I breathe deeply the air is clear and fresh, everywhere I look the views are incredible, the space for contemplation and mindfulness is huge – I am very grateful for life here.

The space allows me to remember what is important in life, away from the hustle of the busy city.

The challenges dentally are great, and the community offers genuine gratitude for our care and efforts to improve the workforce issues.

The significant impact poor oral health has on overall health – even more so in particular disadvantaged groups – is a message which still isn’t heard loud enough; and when it’s 600-700kms to the nearest capital city and health facilities are thin on the ground (if there are any at all) there are even

more massive challenges in getting the message across. We could argue that technology is closing the gap for education and bringing services to remote areas, and maybe it is... for a few!

Though when a major rural town such as Wudinna - one of the very few towns which DOES have a hospital, a medical centre, and a population of 659 in the town and 1500 in the council - can’t, and is told that it won’t have NBN, then what hope have we got?

Australia’s National Oral Health Plan 2015 – 2024 states the issues for ‘Priority Populations’, however there appears to be little appetite for major stakeholders to realise the opportunity for shared responsibility, of all health disciplines to come together, share what we have in common. We need to share resources and cease working in ‘silos’, and we must focus our combined energies to bring about major change in order to resolve the issues for rural and remote Australia.

I’m a dental hygienist with 30+ years of experience, who is even more passionate now than ever about oral health and its links to general health. For the majority of my career as a hygienist and oral health professional, I have been gifted the opportunity to make a difference to the lives of my patients on a ‘one-to-one’ basis. Now I am able to think bigger and dream to have an impact on a ‘one-to-many’ basis. Supporting others to be the best they can be, in order to

7 FROM THE TOP

Growing stronger and supporting better

Bill Suen DHAA CEO serve our communities and priority populations who deserve the care and service equally, and to think outside the square. I am incredibly grateful for the skills we have as a profession and for the impact we can make, I believe that we should regularly challenge ourselves to step out of our ‘safe’ comfortable existence and ask the question ‘what if?’

To provide timely, quality and sustainable oral care to the community is not a new challenge to this region, nor many others. I am proud to say I have made the shift from city ‘sympathiser’ to rural and remote ‘action taker’ and I am grateful for the opportunity to be a voice which can be heard in a smaller community. The challenges are great, and rewards are potentially massive, on both a personal and a community level. The personal rewards are immeasurable; the connection with community, the time and space for reflection, the meaning and purpose it has given me to learn from and support a community I knew of and yet didn’t know. #LoveRural Footnote: We are constantly seeking funding to run the workshops, so that they can be free for participants.

The ADA has recently supported us by sending out an email to its 10,300 members. This has been a great help.

If you would like to know more about Jeanie workshops then visit jeanie.global

“ It is very important that we all pay attention to the mental wellbeing of both our peers and ourselves”

AFTER FIVE MONTHS on board the DHAA, I am more excited than ever. I see so much great work being done, and so many great opportunities ahead of us in the coming months and years. Everyone in the Association is so passionate, hardworking and friendly.

Despite being extremely busy, the state committees are always enthusiastic about planning DHAA events and exploring networking and advocacy opportunities.

In order to support our volunteers better, a staff member has been allocated to provide administrative support to every state committee and special interest groups.

Hopefully this will relieve some of the workload for volunteers and allow them to be more focused on membership and stakeholder engagement rather than administrative tasks.

Besides CPD events, our members have access to our industrial relations, professional indemnity insurance support and services.

Through providing these services we have learned that some members are exposed to increasing pressure from their practices. In response to this the DHAA is in the process of establishing a peer support service to help members in need. We are seeking senior members of our profession to get involved.

It is very important that we all pay attention to the mental wellbeing of both our peers and ourselves. Please join us at our Mental Health Webinar in November during which Roisin McGrath will share some tips on how to achieve a better balance.

We have commenced work on building a new DHAA website that will enhance our capacity to support members. We hope to launch it in the first quarter of 2020 so watch this space for the progress in coming months.

I would like to thank my staff, the board and all the state committees and SIG chairs for their advice and support. Together we can do a lot for our members and the profession.

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FEED

BACK We want to hear from you! For your views and ideas email the Editor at bulletin@dhaa.info

Sticker shock

Loving the Bulletin

Dear Editor

Dear Editor

I read recently that if I give Colgate Neutrafluor 5000 toothpaste to a patient, I have to place a sticker/ label with certain details on it, on the toothpaste box. Could you please clarify what details have to on the sticker/label?

First, I just want to congratulate you on what a wonderful job you are doing with the Bulletin – it looks sensational! I also wanted to let you know how much I enjoy the “State of the Nation” section.

It’s great to read all about what people are getting up to nationwide. Keep up the great work everyone!

Sam Qld

Frances Qld

Hi Sam, This is indeed a topic worth addressing in detail with credible references. I will be sure to undertake some research and we will address this as a featured article in the next Bulletin as this will be of great benefit to all our readers. Please look out for the next issue of the Bulletin.

I would recommend seeking sound information from your Colgate representative in the interim.

Thank you, Ed

Robots made me laugh

Student inspiration Dear Editor

It was lovely to see all the positive things that the three Finnish students – Anni, Hanna and Minna – had to say about their time here in Australia, and at TAFE SA. What an awesome opportunity to learn more about dental hygiene and an inspiration to others to do the same.

Amanda SA

Good advice noted Dear Editor

I had to laugh when I read the “Did you know?” article about robotic biofilm removal. I’m sure there are certain patients we’d all love to refer to a robot hygienist, but I don’t think we are in danger of losing our jobs anytime soon!

Thanks for the interesting update.

Thanks for the reminder of the importance of good clinical note taking.

It can be easy to fall into bad habits if you’re not vigilant with yourself. Yes, you might remember the main points of an appointment but those small details will likely be lost by the end of the day. It is always good to refresh the basics.

Rachel Vic

Annie NSW

Dear Editor

THE IFDH eNEWSLETTER Click this banner to read it in your browser

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From the Big chair

DHAA Bulletin editor Marcy Patsanza speaks

THANK YOU TO all of those who continue and a sentiment that is perfectly illustrated in our article on how to encourage and motivate the Bulletin the DHAA family was part of a great move in supporting one of team and I. Your positive feedback does our own – Josh Galpin. “All Together for Josh” has been a cause not go unnoticed and is always greatly which has indeed reminded us and highlighted the power of appreciated. This positivity encourages community spirit. us to strive to ensure that a continued, We are all part of the DHAA family, so let us persist in impeccable standard striving to make a difference of informative articles are constantly delivered in our individual communities. “ The greatness of a through this platform.

Meanwhile we continue to wish community is most In this edition of the Bulletin we continue our our good friend Josh, and his accurately measured regular columns on Career Development, Selffamily, all the very best with his by the compassionate Development and the Community Spirit page. personal battle. actions of its members” In particular, the Community Spirit page has As always, I hope that you proven to be very impactful and, in this issue, we enjoy this issue and please email CORETTA SCOTT KING have featured an article which displays how the me if you have any feedback, DHAA is indeed a family! questions, or if there are any Coretta Scott King, wife of Martin Luther King, once said: “The topics you would like for us to cover in future editions. greatness of a community is most accurately measured by the Marcy Patsanza compassionate actions of its members”. Telling words indeed DHAA Bulletin Editor marcy.patsanza@dhaa.info

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‘I wish I’d known you forty years ago!’

A Canberra-based dental hygienist responds to a statement from her patients by publishing her first book

About the author VALESKA TILLY IS dual-trained as a dental therapist and dental hygienist. She commenced her training in 1977 in Adelaide, South Australia and her extensive experience in the dental field includes: Providing dental treatment for children through ACT and SA School Dental Services, including children living in remote areas of South Australia; Specialist orthodontic an general practice; Prosthodontics; teaching dental courses for dental assistants; clinical tutoring for dental therapists and hygienists; and oral health talks for pre-school children and parents.

Supporting her patients in learning how to maintain good oral hygiene is her main focus and passion. Valeska strives to provide the best dental hygiene service and advice possible.

She encourages her patients to maintain their teeth for life.

By attending conferences in Australia and overseas, she maintains her knowledge of the latest research in oral hygiene techniques and equipment available. This information she happily passes on to her patients to provide them with the best there is in innovative oral health care.

AFTER COMMENCING HER dental training 42 years ago, Valeska Tilly thought the time was right to publish a book of easy tips for her patients. Three years from start to finish, `Six Simple Tips for Easier Dental Visits Secrets from a Dental Hygienist’ has just been published on Amazon. `It was written for people who are motivated to learn more about how to easily improve their oral hygiene at home with simple hints and tricks.’ says Valeska.

Many of Valeska’s `sixty plus’ year-old patients were very appreciative of her advice and found that once implemented, they often gained wonderful results ranging from a dramatic reduction in caries rate to completely ridding themselves of sensitive teeth. Patients would tell Valeska things like, `I wish I knew you forty years ago, maybe I wouldn’t have a mouth full of fillings or lost so many teeth!’

This is what prompted Valeska to consider putting into book format, some of her simple tips and tricks so more people might benefit and improve their oral health.

The knowledge she gained by listening to her patients and understanding their problems was key in providing information for each chapter. The book discusses real life scenarios where Valeska’s patients have been helped by simple suggestions and then asks the reader to consider their personal experiences when visiting the dentist.

Throughout her career, Valeska has always encouraged her patients, adults and children alike, to do more with their oral care home regime. By following the easy tips and undertaking them at home, the goal is to achieve easier dental visits, less gum disease and less caries.

This guide is not written for the dental professional, although many have said they enjoyed reading it and indeed have learnt a few easy tips to pass onto their own patients. It is written instead for people who want to have more control over the outcome of their dental visits by making small, simple changes to their home regime to improve their oral health.

A great book for the waiting room, it’s available on Amazon.

US Amazon site (Kindle and paperback versions) Australian Amazon site – Kindle version only

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Meet your volunteer DHAA Board for 2020 THE KEY ROLES on the board of the Dental Hygienists Association of Australia (DHAA) have been filled for another year.

These are all voluntary positions and we are grateful to these and all of our volunteer leaders and helpers. Without them giving their time freeof-charge we would not have an association. Please be upstanding for: National President Cheryl Dey (SA) Vice President Carol Tran (QLD) Governance, Management, Policy, Advocacy

Treasurer Michelle Kuss Finance CPD, Special Needs Dentistry Aileen Lewis (WA) Membership, Communication, Publication Sahil Bareja (NSW) Oral Health Promotion and Public Health Ron Knevel (VIC) Rural and Remote Tabitha Acret (NT) Aged Care Amy McDermott (ACT) Rural and Remote Alyson McKinlay (TAS)

Seeking a CPD Chair An opportunity now exists for a DHAA member to assume the role of CPD chair to drive the national CPD agenda of DHAA. The CPD chair will be supported by DHAA director Aileen Lewis and administration staff to plan and oversee the implementation of the National CPD program for DHAA members. You will be able to shape and lead the professional development activities, build and extend your professional network, as well as being part of a cohesive and rewarding leadership group for the profession. Further information or expression of interest to Bill Suen, CEO at bill.suen@dhaa.info or 0412 831 669 ASAP, as planning for the 2020 CPD calendar is underway.

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‘I want the alternative please Doctor’ With the growing trend of complementary therapies in dentistry What can we learn to to provide effective modern dental care?

By Dr Christine May BDS(Hons) USyd BHSc(TCM) UTS - integrative dentist

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WHO DOESN’T LOVE some DIY? The DIY industry is huge in Australia: builders, cooks, makers, innovators, hackers. Really is there anything more satisfying than solving an issue yourself and giving the bird to pricey professionals regardless of the industry? It’s lauded and promoted across our screens: the stuff of reality TV shows, glossy magazines, influencers, bloggers and sharers. So is it any surprise that people would extend this DIY mindset to health?

Yet conventional health is largely a highly regulated industry, as are many of the tools - therapies, medicines, and, most contentiously in my opinion, knowledge. Until now the only way to get expert dental help is to physically visit a dental clinic and spend at least $150 or much more - not always practical or desirable for patients. Recent studies show that 50 thousand people in Australia visit a community pharmacy every week to get help for dental issues (1,2). The rise of Dr Google is evidence of people sourcing health information and solutions in the most convenient way possible for them, despite often having low health literacy (3).

Complementary therapies are more easily accessed by the non-qualified for use as they see fit, whether that be indicated or not via supermarkets, pharmacy or online. It’s an unfortunate bi-product of the conventional health industry that can be rather dismissive of the value of complementary therapies. As they say, a little knowledge can be dangerous!

LESSON #1A Many people like to be self-empowered, in control of their destiny, enjoy the sense of accomplishment and to save a buck.

LESSON #1B Less studied therapies are less regulated and therefore more accessible to the general public for unguided self use.

Self and complementary management of oral and systemic health conditions by patients is on the rise. The challenge of accessing highly regulated conventional health services is contrasted with the easy access of less or unregulated health products, services and information, regardless of a patient’s health literacy level.

The situation is fueled by a general lack of understanding of the mechanisms of complementary therapy applications by regulated health practitioners like dentists. Developing a

deeper awareness and understanding of the relative strengths and weaknesses of complementary therapies relative to conventional therapies in overall health and wellness management is key. By doing so, dentists can better manage patients, provide informed opinions based on evidence and experience and offer more tools in the treatment box to provide effective personalised care.

What is a complementary or alternative therapy and how does it differ to conventional therapies?

Much confusion exists around what complementary therapies are, and are not. Misleading marketing strategies have people believing complementary therapies are more natural or organic, less invasive, better or safer, more holistic, more effective, or cheaper than conventional therapies. In some cases this is true, in others it is not. It depends on all the same factors to be assessed as for using conventional therapies.

Scientific evaluation as a differentiator Complementary therapies by definition refer to therapies that are used alongside conventional treatment, in an adjunctive way. Alternative therapies are used instead of conventional therapies (4). There may or may not be quality scientific evidence to support their use, which is actually the main distinguishing feature between them and conventional therapies that must be supported be scientific rigour. Many complementary or alternative therapies have a long traditional history of use in various world cultures.

Languages of health After studying and practising western medical science, dentistry, naturopathy, chinese medicine, integrative nutrition and some yoga (ayurveda), I’ve come to understand the various paradigms of health to be like the different languages of the world: each has their own structure, syntax and nuances.

Fluency in each model is key to understandable, effective communication and appropriate use of each.

Superimposing the framework of one language/health paradigm onto another will lead to misinterpretation or incorrect translation - like someone speaking English using the sentence structure or grammar of their native language. This is exactly where problems are arising currently between the use of different health ‘languages’. Patients and practitioners are using a conventional approach to the use of complementary>>

14 therapies, which is often not how they’ve been intended to be used. This is particularly true of single use or isolation of key active substances. It’s also why getting quality scientific evidence for traditional therapies in particular can be so difficult - like trying to fit a round peg in a square hole - more on that later!

LESSON #2A Conventional therapies are based on scientific rigour, complementary or alternative therapies are traditionally less so, but are used alongside or instead of conventional therapies.

LESSON #2B Like languages, paradigms of health have evolved from various cultural roots and have different ways of explaining and approaching health. Understanding this is key to successful integration of different models of care.

What do complementary therapies offer?

A qualitative matrix vs a quantitative linear approach After much struggle, over many years of study, I’ve come to explain complementary therapies as the ‘qualitative analysis’ of health, while conventional therapies bring the ‘quantitative analysis’. In my experience, conventional medicine approaches are generally quite linear and reductionist, looking for a simple or singular cause to explain phenomenon in a segmental way, or solution to remedy the problem. Not necessarily joining the dots between parallels of disease expression in different systems or parts of the body, or synergistic effects of multiple therapeutic tools. Old concepts become obsolete as new information emerges in conventional therapies, often brought about by new measurement technologies.

Contrastingly, complementary health principles can be visualised more like a matrix, instead of a linear path. There is intersection and crossover throughout the matrix that represents the whole body ecosystem. Contradiction is accounted for: it’s accepted that either/or can occur at different points in time or with a different subset of conditions through dynamism, unlike conventional assessments that tend to be more rigid.

Patterns vs discrete points Complementary therapies, through longitudinal observation by large numbers of people over many years, have developed defined patterns of symptoms that tend to occur together throughout the body in various types of ailments. These are not necessarily quantified in the way we are used to in

conventional science. Symptom presence in greater or lesser amounts ie relative terms is of more interest than solely mere presence or absence. This helps account for variability between people, ascertaining the root cause of a symptom, and guides how treatment of illness is approached. Conventional therapy studies and applications rarely account for individual variability to this level. This contributes to the range of side effects with many conventional medicines.

There’s a famous saying in Chinese Medicine (TCM): “Same disease, different treatment. Different treatment same disease” (5). This means five people who would all be diagnosed with asthma in conventional medicine and given the same medication would be treated differently in TCM. It means five people who’d be given different diagnoses in conventional medicine and treated differently because of it, would be treated the same in TCM because their overall symptom profile is very similar.

This approach makes therapies like TCM notoriously difficult to study under accepted scientific methodologies.

Standardisation of applied therapies for a given conventional diagnosis is more important than reaching the same outcome - which can often be quite variable between subjects. TCM works the opposite way around: the techniques applied may be variable (by conventional approaches), but the outcome achieved will be standardised in terms of clearly defined observational signs of a return to health: pulse, tongue appearance and 10 other key signs. Treatment success in TCM is based on a defined outcome, less on a range of improvement or amelioration that conventional medicine accepts.

Living well vs treating disease Complementary therapies when followed fully and correctly are great at providing guidelines for living well and preventing disease in everyday life. They offer protocols on sleep patterns, eating for the seasons and constitutional body type, doing exercise to support wellbeing, connecting with self and others, the importance of effective breathing and digestion, relevance of emotions to health and more (6,7). These aspects till very recently generally haven’t formed part of conventional science, but more recently are being recognised as being important and increasingly included into conventional therapy delivery.

Conventional therapies excel at managing acute and physical conditions - infections, trauma, growths, surgery, things that can be seen, measured and labelled. Conventional therapies can numb pain and help suffering be better tolerated, but this approach doesn’t necessarily resolve the underlying causative issue that can be rooted in lifestyle habits. Complementary therapies have strengths in managing chronic conditions, including ailments that are considered to have vague symptomatology, unable to be labelled conventionally.

Conventional therapy works by ‘attacking’, ‘fighting’ or ‘removing’ illness and pathogens, focusing on the manifesting

15 problem foremost. Whereas complementary therapies tend to work to ‘restore balance’ to all parts of the body’s ecosystem that supports wellness. This subtle difference to approach to healthcare is hugely significant.

LESSON #3 Complementary therapies promote selfmanaged, lifestyle-based wellness, conventional medicine fights disease but traditionally offers little guidance on how to stay well (dentistry being the notable exception to this!)

How do dental practitioners work with complementary therapies and patients wanting to use them in their care?

The beauty of dentistry as a conventional modality, in my experience, is we have a very evolved understanding of prevention, lifestyle factors contributing to, and therapy for dental disease, along with how oral health impacts on total body health and vice versa. Perhaps more so than any other conventional modality. So the dental approach to oral health is naturally holistic - even if the patient or other type of health practitioner doesn’t always appreciate it!

This mindset makes it easier to incorporate complementary therapies into dental care in an integrative way.

Science is strengthening for the use of many complementary therapies in general body and also dental applications that suits our conventional mindset tendencies. Awareness of herb-drug interactions is also important (8). Some highlights being incorporated into dentistry are listed on the next page: >>

About the author Dr CHRISTINE MAY has degrees in dental surgery and traditional chinese medicine, along with advanced studies in naturopathy, integrative nutrition, physical therapies and yoga. This expanded scope of understanding of health and wellness provides a unique perspective towards assessment, diagnosis and management of oral-systemic conditions in general dental practice.

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We’ve done great.

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17

n D ry needling/laser/acupuncture for chronic facial pain

management and TMD treatment (9,10) n H erbs, vitamins and minerals in the management of soft

tissue pathology and bruxism (11) n T ongue signs like scalloping and deviation to the side as

indicators for underlying oral-systemic health issues (12,13) acial signs like pooling under eyes, elongated face shape ●n F

and fuller lower lip in dental sleep airway issues (14) osture assessment - ascending or descending ●n P musculoskeletal syndromes in forward head posture (15) n T here are plenty more and Dr May will be discussing them in more depth at the upcoming DHAA CPD event in Bali in late November 2019.

There’s many more tools we could integrate into oralsystemic care given we’re presented with them so frequently : n Tongue diagnosis n Expanded facial diagnosis n S elected supplements, herbs and diet management to better help rebalance the oral microbiome instead of using antibacterials that contribute to sustained mouth and gut dysbiosis n H ome care management strategies for patients to take more control of their own health journeys

LESSON #4 Applying the simplest, least invasive, most preventive focused, least costly, least harmful approach to health is a good modus operandus to follow. Complementary therapies provide more tools in a practitioner’s therapy box to help this be achievable for more patients with adequate knowledge.

I believe the artistry of great care comes by applying just the right mix of a range of different tools at just the right time, conscientiously tailored to the person’s presenting situation. The more tools in your box, the options available. But I appreciate this can be hard to implement without an in depth knowledge of more than one health paradigm.

As practitioners we have a professional obligation to continue to learn and evolve in our clinical practice. Be open minded: as the science emerges, or undeniable clinical experiences present themselves, we have the ability to wager the risk/benefit ratio for new or different therapies. If it makes achieving our oral healthcare goals simpler, faster, better and the patient happier, why not investigate it and get on board?

References 1. ‘The public rely on me a lot’: Rural pharmacists’ perspectives on their roles in oral health care. https:// onlinelibrary.wiley.com/doi/full/10.1111/ajr.12460.

Accessed 28/9/19.

2. Describing the role of Australian community pharmacists in oral healthcare. https://onlinelibrary. wiley.com/doi/full/10.1111/ijpp.12241. Accessed 28/9/19.

3. Consumer Use of “Dr Google”: A Survey on Health Information-Seeking Behaviors and Navigational Needs. https://www.jmir.org/2015/12/e288/. Accessed 3/10/19 4. Complementary therapies - an overview. https:// www.healthdirect.gov.au/complementary-therapiesoverview. Accessed 3/10/19.

5. The Web That Has No Weaver: Understanding Chinese Medicine. Kaptchuk, T. Book, Contemporary, May, 2000.

6. Diagnosis in Chinese Medicine: A Comprehensive Guide, 2nd Ed.. Maciocia, G. Book, Elselvier, March, 2018.

7. The Yoga-Sutra of Patanjali: A New Translation with Commentary. Hartranft, C. Book, Random House, 2003.

8. Complementary and alternative medicine: impact on dentistry. https://www.ncbi.nlm.nih.gov/ pubmed/15316539. Accessed 3/10/19.

9. Acupuncture in Dentistry: Its Possible Role and Application. Wong, L, B. https://journals.sagepub. com/doi/abs/10.1177/201010581202100108. Accessed 3/10/19.

10. Laser therapy on points of acupuncture: Are there benefits in dentistry? Ferriera de Oliveira, R., et. al. https://www.sciencedirect.com/science/article/pii/ S1011134415002274. Accessed 3/10/19.

11. Herbs in dentistry. Taheri, JB., et. al. https:// onlinelibrary.wiley.com/doi/full/10.1111/j.1875595X.2011.00064.x. Accessed 3/10/19.

12. The association of tongue scalloping with obstructive sleep apnea and related sleep pathology. https://www. ncbi.nlm.nih.gov/pubmed/16360522. Accessed 3/10/19.

13. Analysis of using the tongue deviation angle as a warning sign of a stroke. https://www.ncbi.nlm.nih.gov/ pubmed/22908956. Accessed 3/10/19.

14. Screening patients for risk of sleep apnea using facial photographs. https://www.ncbi.nlm.nih.gov/ pubmed/29060289. Accessed 3/10/19 15. The many faces of forward head posture: the importance of differential diagnosis. https://www. tandfonline.com/doi/full/10.1080/08869634.2019.1594 003. Accessed 3/10/19.

18

Better late than never Radical improvements of oral health care for Australia’s ageing population are needed.

The DHAA are pushing hard to make sure that they happen

by Bill Suen, CEO DHAA

THE ROYAL COMMISSION into Aged Care Quality and Safety was established on 8 October, 2018, after significant public concern was raised regarding substandard and unsafe aged care services and other related matters.

The Commissions final report is due

by November 2020. So far there have been over 6,000 submissions to the Commission of which the DHAA has made two – one to advocate for the Senior Smiles program to be adopted for old Australians, and the second calling for mandatory accreditation requirements and direct dental practitioner funding for onsite oral health services to all aged care facilities.

Common oral diseases include tooth decay, gum diseases, tooth loss and oral cancers. All are highly preventable, however their treatment is often expensive and challenging to manage for consumers, service providers and funders. There is strong evidence linking oral diseases to cardiovascular disease, pulmonary disease, diabetes and dementia. They are associated with poor nutritional status and compromise quality of life in aged care residents, frequently resulting in pain, discomfort, speech impairment and social withdrawal.

There has also been compelling evidence that oral health is an integral element of overall health but government, health professionals and service providers often treat oral health separately from all other health

services in terms of funding, service infrastructure and planning. This separation has led to significant health, social and economic ramifications.

Despite being largely preventable, oral diseases are highly prevalent conditions that increase with an ageing population.

Current Australian data indicates an increase from 4.5 decayed, missing or filled teeth for young adults to 24.3 by the time one reaches 75 years old, and only 40% of Australians over 85 has access to dental care.

Research on barriers for accessing oral health care in residential aged care services in Australia revealed that while most health care providers understand and accept responsibility to provide good oral care, it receives low priority because of other competing demands for the limited time and resources available.

Literature reviews also confirm multiple barriers arising from the current accreditation and funding model of the Australian residential aged care sector.

health is maintained”. There is no further elaboration on mechanisms to maintain the care, measurement and evaluation of the service provided or outcome achieved. It is up to the providers to determine the type and level of care delivered. In practice, competing demands for very limited time and resources often lead to oral care being regarded as low priority and ignored.

There is a pressing need to improve oral health among RACF residents.

Additional resources assigned to this purpose are desperately needed and the following aspects must be considered to ensure efficient and effective use of resources to deliver the optimal outcome:

1. Paradigm shift

Historically, dentistry adopts a treatment dominated, invasive and high-tech approach to care that is often expensive. The cost has always been a major barrier for consumers and governments.

While the “ Despite being largely preventable, oral incorporation diseases are highly prevalent conditions of dental that increase with an ageing population” services into the universal Some key barriers include: health coverage would allow dental n L ack of legal or contractual protocols services to be integrated to overall and guidelines on oral health care in health care services and improve access, residential aged care facilities (RACFs) the scheme is likely to be complex and n D ental professionals’ preference takes time to develop. to work in well equipped practices A preventative, maintenance and and challenges in transportation of minimal intervention approach is needed RACF residents to these facilities, immediately to reduce the burden on particularly in rural and remote areas the clinical paradigm that has shown n A ffordability of high cost of dental to be ineffective within the current services system. Recent research has shown the n L ittle focus on holistic and success of program such as Senior Smiles collaborative approach on oral health that provides RACF residents with preventative oral care, improvement in The Australian Aged Care Quality oral health literacy of residents, staff and Safety Commission’s current and carers, and provision of a referral Accreditation Standards 2.15 stipulates pathway for timely medical care and that “care recipients’ oral and dental complex dental treatment.

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2. Restore the balance of priorities of oral care There is an urgent need to rectify the inequality of oral care in RACFs that has arisen from ongoing neglect due to other more recognised priorities within the system. This can be achieved by clear guidelines and more prescriptive directions for service providers, and appropriate incentives directly linked to provision of oral care.

Recognising current barriers, it is important that additional funding for oral care at RACFs should be provided directly to dental practitioners to prevent the allocated resources being redirected to other priorities.

Prescriptive oral health service requirements and outcome measurements should be mandated in RACF accreditation assessment checklists to ensure all RACFs plan and deliver the required services to their residents.

3.Oral care services to be delivered on site A preventative and maintenance oral health service is best delivered on site, as it does not require a dental chair or intensive equipment. Removing the need of transportation of residents to dental practices will improve access to services, reduce cost and administration efforts from RACFs. The onsite preventative and maintenance service can be used to provide screening, early detection and intervention of oral diseases, leading to appropriate and timely referral to medical and dental services.

In order to address existing problems identified, DHAA recommended to the Commission that: 1. Prescriptive assessment guidelines be developed for Standard 2.15 of the Australian Aged Care Quality and Safety Commission’s Accreditation to mandate the delivery and measurement of oral

care services for residents in RACFs. 2. Specific funding be provided directly to dental practitioners enabling on site preventative and maintenance oral care to residents dwelling in RACFs. DHAA members have extensive training and up to date expertise in screening, early detection and intervention of oral diseases. We are available to provide RACFs onsite preventative and maintenance oral care services. We are well placed to liaise with staff, other health professionals and carers to improve the health and wellbeing of residents through a holistic and collaborative approach that is desperately needed.

DHAA also indicated to the Commission our strong desire to work with stakeholders and the Australian Government in shifting paradigms and innovating to address the long standing neglect in oral care for residents of RACFs.

20 IRIT NITY SP COMMU

VIETNAM It’s easy to develop a passion for volunteering when you witness the good that comes from it

By Aileen Lewis

Managing and maintaining the limited resources on site is a challenge that husband Steve was made for

The shocking state of these children’s teeth is distressing – something needs to be done and volunteering can make a difference

PARTICIPATING AS A volunteer to visit overseas countries is a passion that I have shared for many years. Two trips to Vietnam and one to Mongolia have given me a window into the dire need for dental treatment that children in these countries require, and assistance with dental health education and pain relief.

In 2017 I travelled with Melbourne Rotary with two dentists, three dental assistants and three final year dental students from La Trobe, Adelaide and Melbourne Universities. We arrived in Ho Chi Min City and headed south to a town called Tan Chau on the Meekong Delta close to the Cambodian border.

For two weeks we saw an average of 60-100 children per day starting at 7am

and finishing at 5pm. Groups of children were given oral hygiene instruction and through a translator, the children were given lessons on diet and hygiene.

The Atraumatic Restorative Technique (ART) was used to restore cavities of minimal size and more involved teeth were assessed and referred to a local dentist for further investigation with x-rays and possible extractions – even though we had the state-of-the-art autoclave, there was no access to x-rays.

Fissure sealants were the flavour of the day as every child with partially erupting molars, premolars were assessed for suitability for sealing.

My most memorable day was visiting a few schools to meet the Directors and

the children to provide toothbrushing and oral hygiene talks and demonstrations. The whole school came out to see me arrive with my translator.

The excitement was immense as they knew something special was going to happen. The greeting was so intense I felt like one of those dressed-up mascots arriving on grand final day!

The children were also part of the Australian Rotary Fluoride rinsing program, but this positive daily routine was countered by the numerous shops selling sticky confectionary and sugary drinks along the only road into the school. The upstream problem of diet has not been addressed in this school and probably in most schools in Vietnam.

21

A few of the team take a bow infront of the much-loved team bus

“ One little four year-old girl had not eaten for sometime and had refused food – all of her upper incisors were abscessed and the pus was draining into her eye sockets” Our clinic was set up in the local hospital in a fairly run-down building that had been fitted-out for community dentistry and was generously loaned to Rotary for their use. The clinic was directly opposite a maternity

hospital. My suggestion to use a couple of interpreters to target this captive audience was basically frowned upon.

It seems such a shame to miss this opportunity to impart knowledge to new parents and effect a change that might reduce dental disease in the area.

After two weeks the team had treated approximately 600 children and visited four schools. Hopefully our visit wil have influenced the children’s choices to look after their teeth in the future.

In 2018 my husband Steve and I joined Children’s Health Aid Team (C.H.A.T), formerly known as the Christian Health Aid Team, and travelled once more to Vietnam. This time we headed for a very remote northern area towards the Laos

border in a place called Dong Xoi. One principal dentist from Melbourne and his assistant, two final year WA University students, three translators, one doctor from Melbourne and myself spent a week moving around this remote rural area and setting up makeshift dental clinics on verandahs, under trees and in local community halls to provide intense dental treatment to the children in the community.

Many of these children had never seen a westerner ,let alone a dentist, so imagine the response when we all turned up in a big bus and unloaded all this strange equipment and bags upon bags of knitted teddy bears and toothbrushing packs! >>

22

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23

“ Even though both trips were hard work and long hours, they were certainly an experience that I will regard as one of the highlights of my dental career” My husband was recruited as ‘maintenance man’. Even though he had never had anything to do with dental equipment he is an expert in all things mechanical. Two out of the five dental units were working but the other three had not worked for quite a few trips.

Steve had them fixed before we left our first stop and also did maintenance on the compressor and evacuator units – what a hero!

Our only dental assistant had soon recruited Steve into autoclaving and gave him a crash course on universal precautions, spore testing and decontamination so that she could assist the dentists, students and myself.

My main role at first was triage – assessing which children were in the greatest pain and our interpreters helped translate parents’ requests.

Many children had most of their deciduous teeth completely decayed to stumps, no pain and far too young for any dental treatment. They were given tooth brushing instruction, a teddy and advice for future treatment. Their teeth were so badly decayed that here in Australia, these children would have been given full clearances!

For the afternoon session I swapped over and began treatment planning.

Most of the teeth we saw were indicated for extraction and many children could not eat, and had not eaten for at least four days. The children in this area were very emaciated and undernourished. Attendance at school was poor due to pain and ill health that was completely related to the state of their oral health. My main role was to give all the LA to the children needing extractions and the dentist and two students then extracted the mostly heavily decayed teeth.

One little four year-old girl had not eaten for sometime and had refused food – all of her upper incisors were abscessed and the pus was draining into her eye sockets. Normally a GA would ensue but in this impoverished and remote area there was no opportunity for a GA nor time to give antibiotics and wait a week for the infection to subside. She took the LA very well and we had to be quick to get rid of all four upper deciduous incisors and our doctor administered antibiotics after the event.

The fact that we had to do this made me sick to the stomach, but the principal

dentist said that if we had not removed them she may have started to get an infection in her sinus, and eventually into her brain!

This trip was definitely not for the faint-hearted, and even though both trips were hard work and long hours, they were certainly an experience that I will regard as one of the highlights of my dental career.

I highly recommend volunteering for dental visits to overseas countries and volunteers are also needed to assist in the remote areas of the Kimberley, Pilbara and interstate in Australia, as the dental needs of the local Aboriginal people are equally critical.

To find out where there are dental volunteer trips go on the ADA website and there is a list of trips and contact details that you can email to make enquiries. Remember that most of the travel costs are at your own expense, but ADA do have opportunities for individuals to apply for funding to assist with travel expenses.

If you have a volunteering story to tell please email the editor, Marcy Patsanza, on bulletin@dhaa.info

24

All together for Josh DHAA’s Josh Galpin has recently been diagnosed with inoperable Metastatic Melanoma.

Raising funds for hugely expensive treatment saw an incredible display of support

by Alison Taylor

EARLIER THIS YEAR the DHAA IT representative, Josh Galpin, was diagnosed with Stage IV non-resectable (inoperable) Metastatic Melanoma.

Josh had PET scans and tests, and was informed the initial lesion had spread to several organs including innumerable lesions on the liver, in the stomach and small intestine. This was,

for DHAA for over 10 years, giving his time and energy tirelessly, working on several sub-committees and projects, and initiating many developments, particularly related to IT and website planning and design. Josh has also played a pivotal role in influencing and educating his dental hygiene students, and has always loved watching his

precious family – his wife Corrinna (also an OHT), and children Reilly, Misha and Oliver – as they face some of life’s biggest challenges. So, with Josh and Corrinna’s blessing, a GoFundMe page was initiated and a core team of four (Kyla Burman, Alison Taylor, James Bosworth and Chloe Webb (OHT and Josh’s sister) collaborated ideas on how, as a dental community and

Enter the event code: ISDH2019

understandably, a complete shock for Josh and his family.

Josh is a life member of the DHAA, a lecturer at TAFE SA, and was the first male to graduate from the Bachelor of Oral Health at the University of Adelaide in 2004. On Saturday, 31 August, 2019 dental hygienists, therapists, oral health therapists, dentists, plus family and friends from all around Australia gathered at TAFE SA for a fundraising event called ‘All Together for Josh’.

Josh has been a dedicated volunteer

students grow into industry-ready professionals.

After his diagnosis Josh’s oncology team offered a few treatment options, with the most ideal option – immunotherapy infusions – costing an unimaginable sum. Josh has commenced these treatments and is charged a vast amount per session.

On hearing the news of his diagnosis and treatment costs the organising team were spurred on to take action.

We wanted to support Josh and his

his friends, we could support Josh at such a time. This is when the ‘All Together for Josh’ fundraising event was created.

Josh’s request was that we raise awareness, educate, expand knowledge and inform the dental community about melanoma, with particular emphasis on immunotherapy and how it relates to dental treatment, for it to be based on the latest supporting scientific evidence and of course to have some fun! So that’s what we did. Twelve guest speakers, a live webinar reaching individuals from

each state and territory of Australia, food, drinks, raffles, silent auction, trade displays, instrumentation workshops and a community of incredible attendees. We must highlight that all speakers, helpers and contributors donated their time and gifts, not one received any form of payment other than the knowledge that Josh was being supported by their actions. Such is the generosity of our community!

The event from start to finish would not have been possible without countless kind acts of service: n T AFE SA for providing the facilities; n W ildflowers by the Sea for contributing to our silent auction and for creating the exquisite flower bouquets as speaker gifts;

“ After his diagnosis Josh’s oncology team offered a few treatment options, with the most ideal option – immunotherapy infusions – costing an unimaginable sum”

n T ravellers Rest Wines for providing

We want to recognise and thank the individuals and companies who supported All Together for Josh with their presence, help, sponsorship and contributions to the silent auctions and raffles. Truthfully too many generous contributors to list here!

A special thank you to DHAA for their generous support throughout the

sincerely thank those who were present and focused on their tasks for the whole of the event without a break. What an awesome contribution from our association.

All ticket sales, auction proceeds andsales went directly to Josh’s GoFundMe page and we reached the target goal of the day, which was to boost the GoFundMe to over $100k!

The day itself was topped off with Josh attending with Corrinna by his side. We know this event has left a lasting impression on Josh and overwhelming gratitude for our dental community. Josh received our message loud and clear that we want him to feel encouraged, empowered, motivated, blessed and loved knowing he has his

development of the event and on the day. The work Josh has done for DHAA is valued so highly, that right from the moment of inception, DHAA offered the organising team their full support for the event. They managed most of the IT through the planning stages and on the day, event promotion, delegate registration, attendance certificates and audiovisual, including setting up and moderating our live webinar. The DHAA local team organised the delicious food and silent auction platform. We

family, friends and dental community’s full support.

We were amazed by the warmth, kindness and massive heart our dental and allied health community has shown.

It’s amazing what we can achieve when we all come together.

Once again, thank you to everyone who attended or donated to Josh’s GoFundMe www.gofundme.com/f/giftjosh-some-time On behalf of Josh and his family – thank you.

their spectacular wine as gifts for the speakers; n T he Galpin family and All Together for Josh organising team n C ollaboration with ADOHTA and University of Adelaide for their provision of beverages, a huge raffle and ongoing support through the day.

26 CAREER DEVELOPMENT

The ongoing battle of the sexes

career, those seeking non-traditional career pathways may encounter gender biases that impact on women’s career development. This edition I will explore the issues that impact on women in the broader working environment.

We look at non-traditional careers for hygienists and oral health therapists and how to challenge the barriers to women’s career development

Gender stereotypes have long influenced the development of women’s careers. Beliefs that women should raise children and keep a tidy home have limited both educational opportunities and job roles for females. However, labour force statistics indicate that in today’s society women participate significantly in paid employment, and being a ‘traditional’ homemaker is now the exception rather than the rule (Betz, 2006). It is accepted in recent literature that both men and women in their pursuit of a satisfying life can balance both work and family commitments; in fact research has demonstrated that there is a strong symbiotic relationship between our career and personal lives (Betz, 2006). However, women’s involvement in the workforce continues to be vastly different from men; women are more likely to work in part-time roles, are under-represented in nontraditional roles, have lower salaries than their male counterparts, and are expected to maintain significant home duties (Betz, 2006; Patton, 1997a).

Studies of specific occupations such as academia have demonstrated that only a tiny percentage fill senior positions, and that difficulties with managing career and home life actually creates conflict (Foster, 2001).

A number of socialised barriers to women’s career development have been identified in the literature. There are still many gender biases perceived by society; roles such as nurses (and dental

By Melanie Hayes

I AM OFTEN contacted for career advice because of my own varied career path, which involves clinical care, teaching, research and professional advocacy.

However, I felt unprepared to assist people and their queries, and that led me on the path to complete formal study in career development. When I talk with colleagues, graduates and even students about their personal career development, it is clear from these conversations that their university degrees are only preparing them for a single career outcome, and graduates are unaware that the range of attributes they possess

would be transferrable to a variety of occupations or career pathways – which is what lead me to write this regular column.

However, it would be naïve to assume that recognising your abilities and attributes is enough for successful career development. Despite improvements in workplace equity, issues in career development exist for many sub-populations, including females. While dental hygiene and oral health is still a predominantly female

Identifying the barriers

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“ Women’s involvement in the workforce continues to be vastly different from men” hygienists) are considered feminine, while engineers and physicists more masculine (Betz, 2006). As such, females often feel that they are not adequate to pursue certain careers, or that it is not important given they will one day raise a family (Patton, 1997a). Such beliefs result in the avoidance of educational avenues, poor confidence levels and having low career expectations (Patton, 1997a). This is particularly noteworthy for hygienists and OHTs that are considering career pathways in academia, research, management and business. Self-efficacy is essential for exploring a variety of career options; conversely low self-efficacy results in a perceived lack of opportunity (Betz, 2006). In other words – we need to build each other up and support one another to ensure success!

While blatant or explicit discrimination is unlawful, covert discrimination is an ongoing concern for females. The advancement of a woman’s career can be influenced by the social cognitions of its organisation; for instance assumptions on leadership capabilities of males and females can influence progression, however these may be subtle and therefore unchallenged (Kottke & Agars, 2005). Ignoring the need for gender equity in education has been referred to as “passive discrimination” (Betz, 2006). For some women who are the successful minority in non-traditional roles or “breaking through the glass ceiling”, this can create barriers; as the ‘token’ female they can experience isolation and a lack of belonging, insufficient support and even hostility (Betz, 2006). Despite improvements in equal opportunity

policies in many workplaces, there is a skepticism about how these policies are actually implemented, especially in institutions which are overwhelmingly patriarchal (Foster, 2001). There have been changes in workplace practices, with an increase in work-family initiatives to counteract some of the barriers women experience in their career development; while these are positively received there are many cases of unsuccessful programs, mainly attributed to the failure of organisations to recognize the underlying factors affecting gender inequity (Kottke & Agars, 2005).

The good news Women have an important role to play in society, and this includes the workplace.

They display many positive attributes which assist them in career decisionmaking and transitions, including persistence, connection, and passion (Betz, 2006). A qualitative study of older women exploring career narratives uncovered positive attributes such as tenacity, resilience and the ability to adapt (Bimrose et.al, 2014b), despite the perception of numerous barriers.

What we can do There are a number of positive influences on women’s career development we can engage with. A recent qualitative study of older women identified that lifelong learning, chance events, and social influences impacted on their career journeys (Bimrose,

“ While blatant or explicit discrimination is unlawful, covert discrimination is an ongoing concern for females”

McMahon & Watson, 2014a). Being a part of your professional community and attending education events is one way you can achieve this positive effect. As there are multiple biases and issues that impact women’s career development, I would encourage those seeking nontraditional career paths to seek multiple mentors, with diverse backgrounds and experiences. Alternatively, career counsellors can play an important role in helping women understand the impacts on their career development, and develop positive skills to overcome perceived barriers.

References Betz, N. (2006). Basic issues and concepts in the career development and counseling of women. Handbook of career counseling for women, 2, 45-74.

Bimrose, J. & Brown, A. (2014a) Mid career progression and development: the role for career guidance and counselling. In Arulmani, G., Bakshi, A. J., Leong, F. T., & Watts, A. G. (Eds). Handbook of Career Development: International Perspectives (pp 203-222). New York, NY: Springer.

Bimrose, J., Watson, M., McMahon, M., Haasler, S., Tomassini, M., & Suzanne, P. A. (2014b). The problem with women?

Challenges posed by gender for career guidance practice. International journal for educational and vocational guidance, 14(1), 77-88.

Foster N. (2001) A case study of women academics’ views on equal opportunities, career prospects and work-family conflicts in a UK university. Career Development International, 6(1), 28-38.

Kottke J.L., Agars M.D. (2005) Understanding the processes that facilitate and hinder efforts to advance women in organisations. Career Development International, 10(3), 190-202.

Patton, W. (1997a) Women’s career development. In Patton, W. & McMahon M. (Eds) Career development in practice: a systems theory perspective. (pp. 37-46).

North Sydney, NSW: New Hobsons Press.

28

What energy

SELF DEVELOPMENT

Ever get the feeling you’re in the wrong environment? Well it could be down to your energy type. Find out if you’re just a round peg in a square hole.

Story by Lyn Carman

BEFORE WE BEGIN you may well be asking what an energy type is.

Our four energy types link to the four patterns of Carl Jung’s four personality types D, I, S and C, but I am not going to talk about personality types per se.

Personality typing can be very accurate and a fantastic tool – for instance take the highly-regarded Myers-Briggs test which many of you may know of.

However, I find personality types can box you in and can be limiting. They can give you a label to say I’m this or I’m that.

I love behavioural profiling because it approaches the four personality types from the context of them being energies, therefore it is open and limitless. It helps us to manage ourselves and others, how to communicate better, plus it’s good fun.

The four energy types are D I S C – and before we dive into this, I want to explain how I believe we can utilise these energies appropriately to get the results we desire in our life/career. Rather than a “Oh this is who I am, personality,” let’s give ourselves the opportunity to find out what energy comes more naturally to us and build on our strengths.

I like to use the four energy types as a guide to helping us work out ours and other’s strengths and challenges.

This helps with communication and understanding others.

Some of us are very aware of our strengths and I dare say some of you reading this may not be clear about what your strengths are at all.

Perhaps you feel some things just come naturally to you, but you may not be very good at them. You may notice

in your environment, your universe, your relationships, or your work, that there are themes which appear. These are themes that you notice over a period when people have given you compliments, encouragement and noticed a strength. Pay attention to these compliments because this is where you will see your natural energy-type in play and these are your natural strengths, which you can work on and become masterful at.

“ We can all manage our behaviour for short periods of time but when we are constantly living life in the wrong space and are needing to consistently perform, it will take its toll” We must also bear in mind that there are different levels of maturity around each energy type, a resourceful type and an un-resourceful type.

The table opposite outlines the various energies of DISC. Take a moment to find your best match.

Most people are a combination of two energy types, though we generally have a ‘captain’ energy type, which is our natural strength. Sometimes in life we need to access and show strength in another profile one which is not our ‘captain’ or natural type and this takes a lot more energy to sustain.

For example: If you have an ‘S’ energy or ‘mother’ archetype, and take on a leadership role in your personal or work environment, this will take a lot of energy to sustain and is likely to exhaust you. Conversely a ‘D’ energy type will be in their element in a leadership role and expend little energy.

Or, if you have a ‘C’ energy type and are expected to work in a fast-paced, loud, and busy environment, this is likely to exhaust you as opposed to an ‘I’ energy type who will thrive.

We can all manage our behaviour for short periods of time but when we are constantly living life in the wrong space and are needing to consistently perform, it will take its toll on our mood, our energy levels and even our health.

Working with our natural energy type is where our strengths lie. For some people this is where there find the perfect ‘work-life balance’. It’s the place where we have most pleasure in our day, where we have the most energy, and where our mood is high and our health is good. When we are aware of another person’s energy it helps us understand what makes them ‘tick’ The Golden Rule is: ‘Do unto others as you would have them do unto you.’ But, I prefer the Platinum Rule: ‘Treat others the way they would like to be treated.’

DHAA Chair Lyn Carman is a clinical dental hygienist and a personal, team and leadership coach. You can email her at excel@lyncconsulting.com.au if you want more information about DISC profiles.

29

type are you?

D

I

‘D’ stands for Dominance and makes up 9% of the population. This is the person who is generally big picture orientated and has the archetype of a bull – the ‘Get out of my way. I know what I am doing. I’m not interested in your opinion, just let me get there’ type of energy.

‘I’ stands for Influence and makes up 29% of the population. This is the person who is driven by a desire to be liked and has the archetype of the entertainer or joker.

This is a kinaesthetic energy.

They feel their way through the world, and if it doesn’t ‘feel’ good then its unlikely to happen. They are the person who is quite often the centre of attention while also tending to be ‘big picture’ focused.

‘D’s are competitive, decisive, move fast and take risks. They like change, challenges and focus on the big picture.

‘D’s ask What questions, tell more than they ask, talk more than they listen, speak fast and go direct to the issue.

We can manage ‘D’s by not overloading them with details and providing them with flexibility. Give them authority to make changes, supply big challenges and allow them to act independently.

‘I’s are animated with lots of facial expression. They are spontaneous, laugh out loud and often have a shorter attention span.

‘I’s ask Who questions. They will ‘tell’ more than ‘ask’. They will like to make small talk, often use stories or anecdotes, and speak fast.

Manage ‘I’s by surrounding them with people to talk to.

Give them visible awards, and provide them freedom from details. Support them with public recognition and create a positive environment.

S C ‘S’ stands for Steadiness, Stability and Steadfastness and makes up 30% of the population. This is the person who likes comfort and sameness. ‘S’ is the archetypal ‘mother’, very-much the nurturer, the compassionate one providing warming, comforting energy.

‘S’s are patient, tolerant, and happy to consult others.

They are service-orientated and loyal, with a dislike of recognition.

‘S’s ask How questions, they ask rather than tell, listen more than they talk. They have a slow steady delivery and make small talk.

We can manage ‘S’s by creating a friendly and functional work area, maintaining the status quo, and implementing standard procedures. Take time to listen to them, and give them time to adjust to changes.

‘C’ stands for Compliance.

They need to be right in the context of accuracy and precision and they are highly conscientious, making up 31% of the population. ‘C’s are very-much the archetypal thinker or the technician. They are very-much ‘in their heads’ and work with obscure levels of detail which means they are quite often found in research, science, engineering and highly specialised fields.

‘C’s focus on task and process.

They are orderly, meticulous, precise, accurate, logical and analytical.

‘C’s ask Why questions and ask more than they tell. They will listen more than talk, without providing a lot of reaction and have slower speech.

Manage ‘C’s by providing them with a ‘sterile’ work area.

Give them clear expectations and limit sudden changes.

Allow them a chance to show their expertise, and provide references and verification.

A full state-by-state run-down of Association happenings around the country

STATE NATION ACT

CONGRATULATIONS TO Wendy Dashwood who was awarded a DHAA Life Membership at the International Symposium of Dental Hygiene in Brisbane.

Wendy, who has recently retired after 50 years in dentistry, started as a 15 year old dental assistant in 1969. Her career has been dedicated to the dental industry, and she was instrumental in starting the ACT branch of the DHAA and being the first registered hygienist in ACT. As a a volunteer Wendy has held several positions in the ACT branch committee and started a service for agedcare residents in a facility in her home town of Yass.

She has been a wonderful example and mentor to new hygienists coming through and she is a highlyregarded member of our ACT community.

Thank you Wendy for all you have done for DHAA and the profession.

DHAA ACT hosted another full-day event in Canberra in October. The day’s program focused on paediatric and periodontal “Little Poppets & Big Pockets.”

It covered the changing face of paediatric dentistry, soft tissue pathology in children, treatment under general anaesthetic for children through the ACT Dental Health Program, perioscopy, soft tissue biotype and the importance of keratinized tissue, periimplantitis and predisposed risk. We also hosted the 2019 DHAA AGM over lunch.

Our Annual Christmas Dinner is scheduled for 29 November at The Rex, Northbourne Avenue, Canberra. Catch up and listen to occupational therapist Sarah Stuart who will provide an overview of occupational therapy and some advice for ergonomics and manual handling within the dental practice. She will also delve into sensory processing issues in children and how this impacts their trip to the dental surgery and maintaining oral hygiene.

To book your place at the Christmas dinner click here.

I look forward to seeing you all there.

Susan Melrose ACT State Chair

New South Wales

DUE TO EXCEPTIONAL demand, all of our scheduled CPD events over recent months had been fully booked. The NSW team is working hard to lock in more CPD in 2020 to accommodate the demand.

I would like to congratulate Sahil Bareja (NSW Director) in the nomination of his business for the Small Business Awards 2019. Well done Shell Cove Dental!

I have been part of the team working with the ADA and ADOHTA to form stronger alliances and relationships at a state level, watch this space for news on our progress.

The next major CPD event will be a Supper Meeting on 12 November at the Royal Exchange. Come along for canapés and drinks before the lecture. Dr Manish Shah, a dentist and a sleep medicine specialist will present on the topic “Dental Sleep and Nutritional Medicine”.

This is an excellent

opportunity to catch up and learn from a medical specialist that really understands dentistry and has dedicated himself to providing wholistic dental care for all his patients.

Two hands-on workshops sponsored by Hu-Friedy afre being held on 26 October in Newcastle; the first on advanced instrumentation, and the second on sharpening. Again, both of these workshops have proved to be extremely popular and we are happy to arrange more in 2020 if the demand is there.

“ I would like to congratulate Sahil Bareja (NSW Director) in the nomination of his business for the Small Business Awards 2019” Finally, it is election time.

So, if you have been thinking about volunteering for the DHAA or would like to know more please email us at contactnsw@dhaa.info. I’ve had such a great time being NSW chair for the past three years, and thank you for all your support!

Jacquie Biggar NSW State Chair

31 For all the latest info on DHAA events near you please visit www.dhaa.info/events

Northern Territory

THE DARWIN FULL day event was a huge success, with multiple guests flying from interstate, and three trade tables for 3M, Adec and NSK, to showcase their new products.

We had four presenters.

The first was Prof Laurence Walsh, whose lecture ‘Caries Prevention Update 2019’ provided the most modern concepts of caries prevention and how they can be applied at

“ We are superexcited to be holding a full-day event in Indonesia that will provide 6 CPD hours to delegates... Come along to enjoy great CPD in style at an award winning 5-star resort”

the individual level. This included an introduction of some new products soon to be developed for the Australian market, including MI toothpaste which has both CPP-ACP and fluoride in combination to reduce dental Caries risk.

Our second speaker was Danielle Begg, the co-founder and CEO of Yoga Impact Charity, a not-for-profit organisation that provides evidence based trauma sensitive yoga programs that improve physical and psychological health.

Danielle discussed how this program has been implemented for refugee groups in Sydney, and taught us some breathing techniques that she utilises for trauma minimisation and can be utilised for the anxious dental patient.

Klem Hedenig, a representative from Dementia Australia, focused on the nature of dementia, effective communication skills to implement with people who have dementia, the impact of dementia, and how to be involved in the development of a community-focused, supportive environment for a person with dementia, including issues of informed consent.

Finally, Tabitha Acret, NT DHAA Director, presented on fixed appliances and Zygomatic implants, their options, maintenance protocol, and how the dental hygienist can assist in their success, including correct preparation of the patient.

We thank our guests, trade support, presenters and Mindil Beach casino for hosting our full-day event.

On Saturday 26 October will be be hosting a halfday of CPD in Alice Springs.

Mental health and social media skills for oral health professionals are the two areas that everyone needs to be on top of.

Click here to book .

Come join us in Bali for the DHAA for our second international conference on 30 November.

We are super-excited to be holding a full-day event in Indonesia that will provide 6 CPD hours to delegates. Topics will include evidence-based complementary therapy in dentistry as well as Zygomatic implants and their maintenance. Come along to enjoy great CPD in style at an award winning 5-star resort at the Westin Resort Nusa Dua. Click here to book .

Meghan Argentino NT Director

Queensland

QUEENSLAND RAN two successful hands-on workshops on fibre reinforced composites and surface protection which were both well attended.

Facilitator Paulette shared her strategies on protecting vulnerable tooth surfaces in the morning, followed by a session on resin impregnated fibre enforced materials with aesthetic and high strength composite resins.

We are very proud to have been the host city for the 2019 International Symposium of Dental Hygiene at the Brisbane Convention Centre in August.

Thanks you to all of our

“W e are very proud to have been the host city for the 2019 International Symposium of Dental Hygiene at the Brisbane Convention Centre”

32 For all the latest info on DHAA events near you please visit www.dhaa.info/events

Queensland members who attended the Symposium and supported many of the interstate and international visitors. We had a busy but extremely rewarding time.

We are running two more hands on workshop on Saturday 26 October Instrument sharpening in the morning, and Periodontal Instrumentation in the afternoon.

I will report on these in the next issue of the Bulletin Aneta Zielinski Queensland State Chair

South Australia

THE SA ANNUAL dinner was held at the beautiful Adelaide Oval with two fabulous speakers sharing their wealth of knowledge.

One of our own dental hygienist extraordinaire and PhD graduate shared some of her fabulous work. Simona was engaging and articulate presenter sharing some of her very interesting results, giving all a much deeper understanding about the role

our gut microbiome plays watch this space.

Paedodontist, Dr Sam Gue, presented local and systemic effects of probiotics in experimental periodontics.

He didn’t share anything on MIH or caires - what he did share with us was the importance of looking at localised symptoms or physical changes and, when referred and investigated, can sometimes lead us to uncover and diagnose potentially life-threatening conditions- observation and questioning makes us a much better clinician and this was a fabulous reminder for us to look at what is not “normal”.

The event was well received by 90 guests who caught up with each other instil and all dressed for the occasion for another memorable occasion of fine dinning, tasty beverages and education.

Thank you for those who supported the Community Outreach Dental Program by attending our fund raising Estee Lauder Adelaide VIP evening. It was a great evening with great company, refreshment and lots of bargains.

Our committee also joined force with Ali Taylor and many others to organise a successful day event in support of Josh Galpin (full

“T he discussion will compare changes over time along with looking at what is being taught to new graduates now and how this differs from what our veteran professional learnt” report in this issue). The entire oral health family was involved with a great turn out at SA TAFE as well as interstate support from many who joined us via teleconference on the day.

Two hands on workshops are scheduled for Saturday November 16 on Instrument Sharpening and Advanced Instrumentation. Facilitated by accomplished dental hygienists Jane Rossi, the workshops provide a range of up to date hands on practical tips through a relaxed, informal and highly interactive settings.

Find out more here Instrument Sharpening and for Advance Instrumentation click here.

To finish off 2019 with style, you are invited to join us at Stanford Grand Adelaide Hotel on Sunday 1 December

for breakfast. Come and join in the discussion about what has changed over the years.

Join in, interact and let’s see how far our profession has come! This is a morning for everyone and will feature veterans of the dental hygiene profession alongside new graduates in an open and interactive discussion.

The discussion will compare changes over time along with looking at what is being taught to new graduates now and how this differs from what our veteran professional learnt when they graduated.

Click here for more details and I look forward to seeing you for an exciting morning celebrating how far we have come as a profession.

Lyn Carman South Australia State Chair

Tasmania

CONGRATULATIONS TO former Tasmania director Danielle Gibbens and husband Ben for the arrival of their baby son Griffin.

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34

“ This is an excellent opportunity to connect with your peers and to develop a much wider perspective of oral health ” At ISDH a couple of Tassie members came to the DHAA stand to discuss their desire to contribute to the profession through DHAA. We are in the process of recruiting Tasmanian members to support the local state committee. Not only will you be able to plan and run local events, you will be involved in TAS advocacy work supported by the national office. This is an excellent opportunity to connect with your peers and to develop a much wider perspective of oral health.

Any interested members please contact bill.suen@ dhaa.info Our next Full-Day CPD will be held on Saturday 9 November, 2019 at the Sebel Launceston. Come along to meet and mingle with your local peers, and learn from a variety of expert speakers. Ian Epondulan will provide an update of oral health promotion work and the most topical sugar

tax. Professor Gary Kilov with discuss diabetes and oral health, and Dr Pankti Shastri will share with you her wealth of knowledge on medicines that impact oral health and the range of OTC products available. Click here. to find out more.

Alyson McKinlay Tasmania Director

Victoria

I HOPE SPRING is thawing you out somewhat - it has been a long cold winter in Victoria. The next few months will be busy for us all with the end of the CPD cycle approaching and Christmas heading our way!

I do have some exciting news to share with you all - the birth of our daughter, Frida Martine, born 1 August - a little early but healthy.

In other committee news, Jess had an amazing time travelling in Europe and Desi is busy planning her upcoming December wedding and Aimee is enjoying maternity leave.

The Vic Committee has been busy consulting with ADOHTA Victoria to organise a full-day joint event with ADOHTA in Melbourne on 21 March, 2020. Please keep this day free.

Join us at the Kooyong Tennis Club for a half day CPD event on Saturday 16 November featuring three fantastic speakers and finishing up with lunch. The day will cover a range of topics from Silver Diamine Fluoride use and application with a focus on its role in special needs dentistry by Dr Katy Theodore. Periodontist Dr Sara Byrne will look at the new Periodontal Classification discuss ways to stage and grade patients. Dr Sharonne Zaks will outline skills required anxious and phobic patients and reflected on her knowledge

“T he Vic Committee has been busy consulting with ADOHTA Victoria to organise a fullday joint event with ADOHTA in Melbourne on 21 March, 2020.

Please keep this day free. ”

on the parallels between sexual assault and dental appointments. Our new CEO Bill Suen will also be in attendance to chat with attendees over lunch to gauge your needs and ideas for ongoing member support.

We look forward to catching up with you all in November at Kooyong Tennis Club. Until then…

Sarah Laing Victoria State Chair

Western Australia

WHAT AN AMAZING couple of months the DHAA have had with the International Symposium in Brisbane, webinars and events. Not only state wide but all states offering the most amazing events for all your CPD needs.

Attending ISDH in Brisbane was an amazing experience. Networking with like-minded individuals from all over the world was invigorating and inspirational and the topics presented were varied and some so popular delegates were lining

For all the latest info on DHAA events near you please visit www.dhaa.info/events

“ Networking with like-minded individuals from all over the world was invigorating and inspirational and the topics presented were varied and some so popular delegates were lining up for a seat! up for a seat! Thank you to all WA members who attended and supported such a well organised event. The next IFDH Symposium will be in Ireland in 2022.

The WA Committee collaborated with the Australian Society of Periodontology and presented a successful “Periodontal Masterclass” on the 4 October.

Our student OHT representative Nateenee Langsanam has once again organised the Spinrphex Night. It was an informative evening of dentistry and oral health hosted by Spinrphex rural student club and myself, Teeni, your DHAA 2018/2019 student leader of WA. Winthrop professor Marc Tennant and his team

presented one CPD hour of all things Telehealth and dental project he is currently working on. There were refreshments and also student skills workshop on mixing alginate and pouring up. It was a great opportunity to learn and network with other students and people in the industry.

Our next WA hands-on workshop with sponsor GC and presenter Paulette Smith be held on 9 November at Ambrose Estate, 200 The Boulevard, Wembley Downs.

The course provides clinical information on material selection options and placement techniques for protecting vulnerable tooth surfaces ie: erupting molars, exposed root surfaces and around orthodontic brackets.

Click here. to find out more.

I look forward to seeing you all at our WA Christmas Breakfast on * December at International on the Water 1 Epsom Ave Ascot. The guest speakers with cover the important topic of diabetes: Click here. to find out more.

As your DHAA WA Chair for the past three years I would like to thank all of our members for their support.

I am pleassed to say that I have been newly-appointed as your WA DHAA Director for 2020. On behalf of the

WA committee I wish to thank retiring director Sam Stuart for her contribution to the DHAA Board and we wish her all the best in her future endeavours.

Aileen Lewis WA State Chair

Special Report RUOK FOR THE SECOND year running, CQU’s Oral Health Student Association was lucky enough to receive funding from the DHAA to host an RUOK day event to raise awareness for suicide prevention and mental health. University studies and clinical placement can be a really stressful time and it was a real pleasure to be able to take a well needed break, reset our minds and enjoy each other’s company for an afternoon of fun.

Here at CQU we are blessed

“ I t was a real pleasure to be able to take a well needed break, reset our minds and enjoy each other’s company ”

with having wonderful cohorts full of incredible people from all walks of life, we have each formed special bonds due to the everyday clinical interactions that take place and the amount of time spent together at university, although at times it can be easy to forget to ask someone if they are okay- it only takes a few seconds out of your day to start a conversation with someone to check if they are okay.

By receiving this funding, we were able to cater for all three cohorts at the Rockhampton with a delicious BBQ lunch. After the event, all students were able to reflect on how important it is to come together as a cohort and spend quality bonding time together outside of the clinical setting. Each student took home a little care package to encourage everyone to take a little “me time” and look after themselves as we enter the final few weeks of the semester.

The event was a fantastic experience enjoyed by all and on behalf of all oral health students at CQU we would like to say a massive thank you to the DHAA for this opportunity.

Samantha Barbeler 3rd Year CQU Oral Health Student

36

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