The Bulletin - Issue 53 Dec 2019 / Jan 2020

Issue 53 Jan-Feb 2020

The official newsletter of the Dental Hygienists Association of Australia Ltd

NEW SCOPE

NEW HORIZONS

We explain the recently approved revised scope of practice that has unlocked a wealth of opportunities for oral health professionals

Mouth Breathing

Read a full case report from Dr Derek Mahony and Roger Price

Future Positive

At the start of a new decade. Where will you be in 10 years?

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

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What an amazing year it’s been!

CAN YOU BELIEVE it’s that time of year again? It’s 37 degrees in Adelaide and I’m listening to songs about roasting chestnuts and winter wonderlands; it must be Christmas time.

2019 has flown past and the countdown to 2020 is on!

2019 has been another packed year for the DHAA so I would like to take this opportunity to look back at some of the most memorable moments: • In January our CEO and former president Mel Hayes left to pursue the next phase of her career, though she continues to volunteer for the DHAA NSW and on the Bulletin • Marcy Patsanza became editor of the Bulletin – lifting it to even greater heights • Christina Zerk took on the role of membership officer, taking over from Amelia Munn who has moved onto new opportunities in Broome • We welcomed Meg Argentino as chair of the NT committee • May brought with it our new CEO Bill Suen started and has had a huge impact in just seven short months • Work continued on the Fair Work Commission review of the Health Services Award • In August we hosted our second International Symposium on Dental Hygiene, a success in every way • We said goodbye to WA Director Sam Stuart and welcomed Aileen Lewis • Our new vice-president Carol Tran was voted in, taking over from Tabitha Acret • We held the first-ever official face-to-face meeting of the DHAA Board and ADOHTA Executive Council, to discuss the future of the profession and our two associations • November saw the announcement of the revised Scope of Practice Registration Standard, granting us independent practice • Planning for a new database management system and website is well underway, with launch expected in early 2020 As the DHAA grows in members and services, it takes more and more work to keep things running. I want to say thank you to each and every person who has volunteered their ideas and input, their hard work and dedication, or even five minutes of their time to make the DHAA what it is today, particularly the SIG, state committees and all the chairs. Thank you to the staff for your continual hard work, you all go over and above your roles. Thanks to the Board for your support and guidance throughout the year; and last but certainly not least, thank you to all of the members, old and new, for giving your support to your association – you’re the reason we’re here!

I hope you have all had a great 2019 with the DHAA. We look forward to seeing you back for an even bigger and better 2020.

Contents 04 DHAA Digital D-Day

We’re getting set to release a new membership platform.

06 Making a difference

We take a look at Adelaide’s Common Ground project

10 Rural Relocation

Thinking where your first job in health might be?

12 Networking to advance

Develop quality relationships to advance your career

COVER STORY

16 New Scope. New Horizons The recently approved revised scope of practice could unlock a world of new possibilities for oral health professionals.

20 Sizing The Gap

Take a look at the cool new colorimetric IAP Probe

24 Instrument Sharpening Are your hand scalers and curettes sharp enough?

26 Mouth Breathing

A full case report by Dr Derek Mahony & Roger Price

32 Future Positive

A new decade’s about to start – do you know where you’ll be in ten years?

34 State of the Nation

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

Cheryl Dey DHAA National President

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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Digital D-Day for the DHAA As a new decade dawns so does a new era in the digital development of the DHAA – a new fully-integrated membership platform is just around the corner OVER THE PAST nine months, the DHAA board, staff and volunteers have been tirelessly working on a digital transformation project for our organisation.

The objective is to activate an online platform that allows the Association to serve our members better, improve our operating efficiency, and meet our legal and professional obligations as a peak body and membership organisation.

The new platform will coordinate and manage all member data, scheduled events, email communications and social communities via a centralised system.

All DHAA staff and members will be able to access the system through a web browser anytime and anywhere from any digital devices including laptop computers, smart phones and tablets.

“It will allow members to search and register for events and lectures; as well as plan, record and track their individual CPD progress through the streamlined operating system that is directly linked to the DHAA website,” explains Christina Zerk, DHAA Membership Officer.

“There will be plenty of online communities to allow state chapters and special interest groups to connect and share ideas and information across the country. The new platform also provides the opportunity for the Association to enhance our employment and recruitment services through a designated job board.

“ The new platform will coordinate and manage all member data, scheduled events, email communications and social communities via a centralised system” “The system will capture important member statistics and provide relevant reports to support and facilitate our state and national advocacy work.”

Those members worried about the security of their personal information

will be glad to hear that data security and privacy protection is a critical feature of the new system. The supplier has over 25 years of expertise in the field and uses best practice multilayered security measures. The DHAA are confident that the new system will provide the highest level of security for the organisation and its members.

The project is progressing well with Christina Zerk, Steve Moore and Bill Suen working on the project plan that was initially set up by Josh Galpin. Together with DHAA President Cheryl Dey, other board members, staff and volunteers, they have put in hundreds of hours of work to scope the project. This has included selecting the vendor, planning and negotiating the specifications and the implementation schedule.

The team are in the process of testing the new system to ensure it meets all the requirements and is user-friendly.

Launch is expected to be in February, 2020, so we will all soon be able to enjoy the many benefits that the new system brings. Watch this space!. n

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Looking for a meaningful gift this Christmas?

If your stumped for a prezzie idea this year then supporting a worthy charity could be the answer CHARITY DONATIONS NOT only make fantastic presents, they also make an enormous difference to people in need.

This festive season, why not give the gift of a donation to the Australian Melanoma Research Foundation.

Your donation will directly enable us to fund vital and innovative research with early career researchers in Australia aimed to further knowledge and offer better outcomes in the treatment of melanoma.

You can pay by credit card, EFT or cheque, and all donations over $2 are tax deductible. So that we know who the donations are coming from, please enter this code DHAA19 in the box that says ‘Reason for donation’, or include it in the reference if you’re paying by EFT. Make this Christmas matter.

FROM THE TOP

The DHAA continues to grow

Bill Suen DHAA CEO

“ The DHAA continues to amaze me – such an extremely high-performing organisation that achieves a lot with very little resources”

2019 HAS BEEN great for the DHAA and our profession. Membership has grown by 12%, with uptake of our Professional Indemnity Insurance increasing by 22%, and CPD attendance up by 58%, all of which has exceeded our initial expectations.

This membership survey revealed that members enjoy a reasonable remuneration, – 97% earning above the proposed award rate (which we are flighting against on your behalf) – and only 10% of respondents were underemployed at the time.

Our profession is gaining ground with the November announcement that the Dental Board had approved the removal of the mandatory structured professional relationship with a dentist from our scope of practice registration standards. This not only confirms our professional standing as independent health practitioners, but also opens up opportunities in a range of new models of care.

We are also moving towards unity when the DHAA - ADOHTA MoU was signed in August, followed by the governance bodies of both organisations meeting face-to-face in October to lay the foundation for a united approach to member services and advocacy. At a state level, many joint events have been created for members of both organisations and we are seeing great collaboration and goodwill at all levels across the country.

The DHAA continues to amaze me – such an extremely high-performing organisation that achieves a lot with very little resources. This is not only made possible by the small, highlydedicated team of staff and contractors, but also by the valuable contributions of countless volunteers who are loyal, passionate and committed to the profession and to the DHAA. I thank everyone for their input towards our success. Together we have done a fantastic job and are enjoying the results - thank you all.

I wish you all a happy Christmas and New Year break, and look forward to working with you in 2020 – another year of opportunity and prosperity for our profession. n

6

Making a difference where it matters Margie Steffens is a loyal advocate of delivering quality care for all. The successful Common Ground project in Adelaide is a worthy testament to her passion IN 2017, DHAA Honorary member Margie Steffens (pictured left) was included on the Queen’s Birthday Honours List and awarded the Medal of the Order of Australia (OAM), for her service to community health through outreach dental programs.

Add to that a recent invitation from the International College of Dentists (ICD) to become an Honorary Fellow of the Australasian section of the College, and start to realise that Margie is a powerful and positive force when it comes to caring about the underprivileged members of our community.

Margie takes her position as Director of Community Outreach very seriously and is an integral part of the team running the Common Ground Community Outreach Clinic in Adelaide.

The Bulletin takes a look at the Common Ground concept and what the future holds.

2011: Where it all began

A Commonwealth grant, in collaboration with the medical school, was successfully secured along with financial support and supply of materials from several dental companies. This funding and support was sufficient to build a dental clinic in

the new Common Ground complex on Light Square in Adelaide’s CBD. Common Ground provides tiered accommodation for people who are residentially and socially disadvantaged providing an opportunity to rebuild healthy communities with specific support systems in place.

The new building included provision for a dental surgery, allied health rooms and conference/meeting rooms.

Scheduled completion of the building was April 2011 and commencement date of the health suite was September 2011.

The Community Dental (CODP) and Medical Outreach Program teaching objectives The structure of management has an academic staff member co-ordinating and overseeing the overarching program with a core group of volunteer dentists, and medical practitioners.

The intention is to provide comprehensive care and valuable educational opportunities for undergraduate dentistry, oral health, medicine and nursing students. Offering an opportunity to collaborate with other health care providers including students from allied disciplines, and staff from service and support centres for homeless, refugees, marginalised and vulnerable people in our community.

The dental clinic currently operates over five days and includes screening, education sessions, and allocated times for debriefing – with some screening at allied off-site locations The clinical on-site sessions at Common Ground are designed to work with multidisciplinary teams offering, services that include: • Dental and medical screening or examination with opportunities to liaise with specialists in mental health, psychiatry, psychology and podiatry; • Appropriate dental and medical attention; • Referral of patients requiring more complex dental procedures to specialists that partner with us, the SA Dental Service Oral Surgery Department or the Special Needs Unit.

The program has improved access to dental services and also improved health outcomes for adults who are homeless in Adelaide. These results are consistent with the National Oral Health Plan priority action areas that encourage the creation of an environment that is non-discriminatory in all aspects of social and cultural domains.

Other positive outcomes include; • Improved learning outcomes for BDS, BOH and dental hygiene students who are gaining experience in providing comprehensive care for socially

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volunteer dentists.

The service is pro-bono however donations are welcomed from patrons or support organisations. Their partnership with the Australian Dental Health Foundation formerly National Dental Foundation aids this by accessing private dentists who provide care pro bono –usually after hours.

They also run a research project and publication with ACH/Flinders University about aging and homelessness.

disadvantaged patients with frequently complex dental and medical problems; • Interaction with the ADA(Australian Dental Association), South Australian Dental Service, Nunkuwarrin Yunti, Dental Hygienists Association of Australia(DHAA), Australian Dental and Oral health Therapy Association (ADOHTA) and other providers; • A multidisciplinary teaching and holistic health focus has facilitated an area rich in future research opportunities

“ Common Ground provides tiered accommodation for people who are residentially and socially disadvantaged” Community outreach aims to work in collaboration with all allied health services, both in private and public domains, to improve access for individuals who frequently miss or avoid conventional healthcare; thereby assisting community health outcomes.

In future they hope to obtain mobile units to enable visits to community centres and access to other marginalised people in the community.

The clinic celebrated it one thousandth patient in November 2017 – a real achievement for a single chair clinic.

They have provided basic restorative and preventive services e.g. fillings, scale and clean, oral-health education and acrylic dentures for those who have often been without teeth for many years . Plus they have access to dental laboratories and TAFE prosthodontic students providing the fabrication of dentures and night guards They run a referral system with all the inner-city agencies, as well as some suburban ones, who provide supportive services for shared clients.

Regular collaboration with staff and patrons from the day centres in Adelaide, and strong links with district nurses, and social workers, allows them to provide services for youth support and accommodation such as Streetlink, Youth 110, St John’s Ladder and Teen Challenge. In addition they have links with refugee and asylum seeker support groups such as Red Cross, Hutt St Centre, Baptist Care and Uniting Communities, St Vincent de Paul and Salvation Army Work experience opportunities exist for young people wishing to pursue a career in the dental field, while programs with residential aged care facilities enhance the learning of dental and oral health students about the barriers and services they need to consider when providing care for the elderly. Beyond graduation they provide support for new graduates yet to find full-time work by providing mentoring through their

What the future holds

The project needs to support their volunteers in practical ways and have the capacity to look to the future and have a succession plan.

In addition to the maintenance of stock, plant, and infrastructure, the sustainable future of the program requires ongoing funding to ensure remuneration for management staff, a dental assistant, and Director of the Community Outreach, as well as incentives for students and other staff Their long term goals include extending the service to inner-city agencies including under-served suburban areas; to extend outreach to suburban support agencies; to continue their work and develop multidisciplinary and inter-professional teaching and working model of healthcare delivery Margie Steffens is the Director Community Outreach. Together with her team, consisting of Dr Eleanor Parker, Dr Lisa Jamieson, Prof Richard Logan, and clinic assistant Amanda Drewer, they aim to provide advice and support for other dental professionals who may want to provide a similar service or develop programs around a shared philosophy. The hope is that this will, in turn, engender a sense of social equity and philanthropy in our up and coming health professionals. n To discover more about the Common Ground project visit their website.

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From the Big chair IT HAS BEEN an honour and a great experience to serve as the Bulletin Editor this year. I hope the Bulletin has managed to deliver some informative and highly beneficial content. The aim as I took on the role, was to provide articles which covered all aspects of our profession, tips and advice on career development as well as nurture some self-development. As the year ends, I would like to thank everyone on the team for their support and the time taken to ensure we delivered worthy material to the readers.

To the readers, thank you for taking the time to flick through the pages and giving us some feedback when you could. I hope you enjoy the final read for 2019. The SelfDevelopment article featured in this issue has certainly got me geared for the beginning of the next decade, look out for this great piece!

All the best for the new year and remember, dreams don’t work unless you do.

Seasons blessings!

Marcy Patsanza DHAA Bulletin Editor bulletin@dhaa.info

DHAA Bulletin editor Marcy Patsanza speaks AN APOLOGY In the previous issue of The Bulletin we featured the tremendous community spirit which took place as a fundraiser for one of our colleagues, Josh Galpin.

The Bulletin would like to extend an apology to the authors of this article, “All together for Josh”, and correctly state that this article was co-written by Alison Taylor and Chloe Webb as this was not clearly indicated.

We believe that it is important that all authors be acknowledged for their work.

Many thanks to those who have taken time to contribute to The Bulletin this year. We would love to feature an array of articles demonstrating how members are making a difference within our communities, and encourage members to share their work with us.

THANK YOU MARCY! Everyone involved at the DHAA Bulletin would like to thank Marcy for all of her hard work as editor.

Her input and ideas have greatly improved the publication and her enthusiasm will be greatly missed. We wish her all the best for the future. If you, or anyone you know, are interested in taking a role in creating the Bulletin, be it as editor or simply a contributor, then please get in touch on media@dhaa.info

DHAA & ADOHTA: Better Together?

FOLLOWING THE RECENT proposal to form a new peak body to represent oral health professionals we want you to have your say.

The Australian Dental Oral Health Therapists’ Association (ADOHTA) and the Dental Hygienists Association of Australia (DHAA) are working together to explore the feasibility of creating a new peak body to represent all dental hygienists, dental therapists and oral health therapists in Australia.

Your input as a member or stakeholder of the profession will be most valuable to guide the boards of both organisations in progressing this initiative.

Please click on the link below to take a quick survey and provide your input. It will only take around two minutes and could help shape the future of our industry.

HAVE YOUR SAY

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Rural Relocation Support Packages for Allied Health Graduates Are you thinking about where your first job in health will be?

Dental Pioneers

Spotted in and The Advertiser, Adelaide newspaper...

IF YOU WANT interesting work in a supportive environment that offers you variety in your clinical experience, think about country South Australia.

Rural relocation packages of up to $5,000 are available for Allied Health Graduates moving to priority locations in South Australia.

Working in the country

• A diversity of clinical work that’s part of your regular case load.

• You get to experience working with all age groups.

• Great career pathways with opportunities for professional development.

• You get to spend more time with your patients.

• You’re not on your own At RDWA they can support you to find a job and help you get there. And once you’re there, they’ll stay with you to provide ongoing support and access to funding for professional development.

Get in touch If you want to make the best move, call RDWA on 8234 8277 and ask about the Rural Relocation Support Packages or visit ruraldoc.com.au

VALE MEREDITH SINCLAIR ON FRIDAY, 8 November, 2019, Meredith Sinclair passed quietly from this life surrounded by family and friends. She was farewelled in a private family funeral.

Meredith was one of the first dental hygienists in Australia. She completed the dental hygienist training course at Kings College Hospital, London in 1972/73 and returned to Adelaide in 1976 where she took up a position of tutoring in the dental hygienist training course at the Adelaide Dental Hospital. She later joined Drs Bryon Kardachi, Sven Johannsen and Brian Sheppard in Specialist periodontal practice, where she stayed until her retirement from dentistry. She was also a part time clinical tutor at Bells Road Clinic. Meredith retired to do all things equestrian and was well known in the world of pony clubs, eventing and horse breeding and racing.

Meredith was a remarkable woman in so many ways and her legacy will remain in the memory of many.

“OPEN FOR 1OO years” (Boomer, Nov 4) brought back many special memories for me of life at the Adelaide Dental Hospital Dental School.

One of the noteworthy chapters in the history of the dental department of the Royal Adelaide Hospital, in Frome Road, was the 1975 establishment of the Dental Hygienist’s Training School.

This pioneering step resulted in the first training school for dental hygienists in the southern hemisphere.

I and eight other students were selected for the first course under the leadership of Dr John McIntyre and tutor the late Jean McNicol.

South Australia was the first state to register dental hygienists for the work in both the public and private sectors, and this group of professionals now forms an important part of dental practices and government services across our nation.

Those early pioneering days involved the establishment of a whole new industry and I was the first secretary of what is now the Dental Hygienists Association of Australia.

I am still practising as a dental hygienist 43 years on and maybe the only one still in the role from the first course.

I have a lifetime of memories with many from the dental profession and thousands of clients I have had the privilege to serve.

Sue Denton (nee Bubner) Modbury North

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12 CAREER DEVELOPMENT

Developing quality relationships to advance your career Networking, by any means, is a great way to make connections and get yourself noticed

By Melanie Hayes

WE HAVE ALL heard the saying: ‘It’s not what you know…it’s who you know’.

No wonder networking is seen as a bit of a dirty word! However, in the changing world of work, our education, training and experience is not enough – we need to develop our social capital. Developing quality relationships is a “unique, valuable, non-replicable asset” (Forret & Sullivan, 2002) that can help set you apart from other candidates, open doors to new opportunities, or even help you think differently and generate new ideas. Career goals, motivation, mobility, promotions and job satisfaction can all be positively influenced through networking (Spurk et al., 2015).

Networking can be challenging for those of us that are introverted or lack the skills to build or maintain relationship with new contacts. A less confronting way to build your social capital can be through the use of social networks such as LinkedIn or Twitter. Using these online platforms for professional purposes can help others see your professional profile and connect with you, and vice versa. You can also write posts, articles or blogs to share the work you are doing and start conversations in your network.

Conferences are another great way to network with others. Presenters and industry representatives are often keen to chat to delegates, you can connect with old colleagues, friends and mentors, be introduced to new people through existing contacts, or even strike up conversations with like-minded strangers when attending the same sessions. I myself have been lucky enough to meet people at conferences that I now value as trusted colleagues and dear friends; collaborating on research, teaching activities, committees, and conference presentations.

Dr Melanie Hayes is a dental hygienist who has enjoyed a diverse career in clinical practice, teaching, research and management. She has a Master of Education majoring in Career Development, and is now working in an interdisciplinary role at the University of Sydney.

Changing for better

An interest in research and a strong network has lead Nicole Stormon to a rewarding non-clinical career AT THE RECENT International Association for Dental Research conference in Brisbane, I was lucky to meet up with Nicole Stormon, and hear her present about her current research.

What impressed me most was her storytelling approach to presenting, and how she uniquely wove in the story of her own research experience with the scientific evidence.

I spoke to her about her current role as a PhD Candidate and Lecturer at the University of Queensland, and how quality relationships have really helped in her career development.

What education or experience did you need for this role?

During my BOH, I expressed an interest in research to an academic in the field of dental public health and began doing some research. Upon graduation I began work in clinical private practice, but also as a research assistant. In my research role I ran research projects and experienced the full cycle of research from grant and ethics applications, to

13 data collection, analysis and journal paper write-ups. From this I realised I love research and began my PhD. I was then given the opportunity to teach into the dentistry program at UQ in the simulation clinics and as a lecturer. My experience with teaching and research lead to my position at UQ now as a course co-ordinator for third and fourth year dentistry courses.

Overall, I have made many baby steps from my original degree, gaining experience to get where I am now.

What are the day-to-day activities in your role?

As with most academic roles I am expected to balance my time with both research and teaching.

In my role at UQ, I primarily sit in front of my computer analysing data on Australian children’s oral health.

Beyond the large amount of data I analyse, I use theoretical frameworks to construct empirical models of

“ As a PhD student, I have chosen to live on a students salary. I’d say the uncertainty of a steady income was the most scary.” predictors of children’s oral health and publish this in peer reviewed journals.

During the university semester, my days consist of delivering lectures on many topics including population oral health, health systems, cultural competency, prevention, communication, research methods… the list goes on! Along with teaching comes lots of marking….

What was the scariest/most challenging part of choosing an alternate career?

I think choosing to wind down my clinical roles for the uncertainty of teaching and research. As a PhD student, I have chosen to live on a students salary. I’d say the uncertainty of a steady income was the most scary.

Were there people along the way who helped you get the career you wanted?

Three main people have given my help and support to be where I am.

Dr Lan Tran – the owner and principle dentist at the private practice I work at.

She has always respected and supported my interest in teaching and research.

She has allowed me to reduce my hours gradually and has still remained an excellent mentor in developing both my therapy and hygiene clinical skills.

Prof Pauline Ford – the academic who gave me my foot in the door as a researcher. She has always been an excellent teacher and has supported me to develop my teaching and research skills. She has help transform the way I think and guided me to be a reflective learner and considered teacher.

My husband, who has supported me during the stressful transition from BOH student, to clinical OHT, to researcher, to PHD student, to academic.

Do you have any advice for anyone looking to change from clinical practice?

I made small steps from a clinical job to a career I thought was interesting. Those steps lead to a career that I enjoy so much, it doesn’t feel like a job. If you have an interest in something that isn’t clinical practice, connect with others in that space and it’s likely that they can give you guidance and support to take small (or big) steps towards your interests. We are fortunate that our profession has so many skills beyond clinical practice that can be transformed into so much more! n References Forret ML, Sullivan SE. A balanced scorecard approach to networking: A guide to successfully navigating career changes. Organizational Dynamics. 2002 Dec 1;31(3):245-58.

Spurk D, Kauffeld S, Barthauer L, Heinemann NS. Fostering networking behavior, career planning and optimism, and subjective career success: An intervention study. Journal of Vocational Behavior. 2015 Apr 1;87:134-44

The National DHAA Symposium 2020 GOOD THINGS COME to those who wait and the next National DHAA Symposium in Melbourne from 8-10 October, 2020, will definitely be something worth waiting for.

While the organising committee are busy dotting the ‘i’s and crossing the ‘t’s to finalise the list of speakers and presenters, we don’t want you to miss out on the discounted Sunrise registration package.

Sunrise Rates will end on 31 January, 2020 so if you intend to come then take advantage of the great rates available.

Credit card payments can be made on the official DHAA Symposium website.

Payment Plan Available At the DHAA we appreciate that Symposium 2020 is a sizeable financial commitment. For this reason we are pleased to offer payment instalments to help spread the cost. Payment via instalments is available for DHAA 2020. The organising committee is pleased to offer the opportunity to pay your registration in three instalments.

Payments will be charged on the thirtieth day of each month following the date that you register.

Payment plan options will be available until Saturday 14 July – which is two days before the Early Bird registration deadline.

The DHAA Symposium is always a lot of fun and very beneficial to anyone involved in our industry. We hope to see you there in October!

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14

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16

NEW SCOPE

NEW HORIZONS The recent approval of the revised scope of practice is epic news, not least because it has unlocked a wealth of new career opportunities for oral health professionals

By Cheryl Dey

AFTER TWO YEARS of consultations, surveys, submissions, and meetings, the DHAA was excited to hear in November that the revised scope of practice registration standard was approved by the Council of Australia Governments (COAG) Health Council (CHC), and that the revised Standard will take effect from mid-2020.

The decision came after significant work completed by the Dental Board of Australia to review the existing registration standards for dental practitioners. In addition to the strong evidence available, the change was also independently assessed by the Australian Commission on Safety and Quality in Health Care (ACSQHC). We were pleased to see that the Commission agreed that the proposed change will not have any adverse effect on patient safety and quality. This provides no surprises as the DHAA strongly believes that our members have the best interests for patients and our profession.

The revised standard removes the requirements for ‘independent practitioner’ and a ‘structured professional relationship.’ It has also removed reference to programs to

extend scope, giving effect to the Board’s decision to phase out the approval process of these programs.

These changes recognise the dental hygienists, dental therapists and oral health therapists as the highly trained and educated oral health professionals we are.

Independent Practice A professional can be defined as “a member of a profession… governed by a code of ethics, and profess commitment to competence, integrity and morality, altruism, and the promotion of the public good within their expert domain.

Professionals are accountable to those served and to society”.

All health professionals, regardless of their profession, division or endorsements, through the process of registering for practice are committing to providing services within their scope of practice.

Being recognised as independent practitioners will allow greater opportunities for DH/DT/OHT to practice in a variety of settings, including residential aged care facilities, group

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“ The revised Standard removes the requirements for ‘independent practitioner’ and a ‘structured professional relationship’”

homes, wards and units in hospital settings, and homes for the disabled. Services can be provided in designated underserved areas, as well as schools, institutions, residences, skilled nursing facilities, and private homes of homebound persons. This model reaches some of the most under-served populations.

Structured Professional Relationship Removing the structured professional relationship will lift the required one-on-one relationship with a dentist is which can be restricting practice for DH/DT/OHT. This will enable flexibility for dental practice and referral pathways and create opportunities to work within a collegial team-based approach to care.

DH/DT/OHT will now have more freedom to be employed in places where the dentist may not be the head of the team.

In a residential aged care facility it may be the patient’s GP who is the head of the team, for a paediatric patient it may be the speech pathologist, for a cancer patient it may be their oncologist, or in a dental practice it will be the dentist. It may be that a DH/DT/OHT chooses to open a practice and they will be the head of their own team.

How so ever a DH/DT/OHT choses to practice it must still be within their own scope of practice, and anything outside of that scope must be referred appropriately.

The DHAA welcome this new model where dentists, specialists, hygienists, therapists, oral health therapists and prosthetists can work together respectful of each other’s scope of practice, in a team-based approach to care. >

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Programs to Extend Scope The Dental Board discontinued approval of programs to extend scope on 31 December, 2018. These types of programs can now be delivered as Continuing Professional Development (CPD.) Dental practitioners who undertake CPD to increase their knowledge and learn new skills must self-assess: • The quality of the training provided, theoretical and clinical • Whether there was sufficient clinical experience • If it falls within their division of registration For example: Listening to a 30-minute podcast on tooth whitening won’t give you the theoretical knowledge nor the clinical skills to perform this procedure in practice, however a workshop with a theory component to build on your foundational knowledge and a hands-on component to learn the practical clinical skills could do so.

Determining your scope of practice The Scope of Practice Registration Standard states: “Dental practitioners must only perform dental treatment for which they have been educated and trained , and in which they are competent.

Determine your own scope When trying to determine your scope of practice ask yourself these questions: • What was I taught to do in my original training?

• What am I registered to do? DH/DT/OHT/other?

• What additional skills have I acquired through CPD? • Am I competent in these skills?

• Do I have recency of practice?

Check the rules and regulations This will give you a basic idea of what is included in your scope.

Then you will need to consider things like: • What does the National Law allow me to do?

• What do my State/Territory Laws allow me to do?

• Are there requirements from the Environmental Protection Agency?

• Are there restrictions from the Poisons Act? Every State and Territory has different legislation so if you’re moving from place-to-place it is important to find out what might be different.

What does your employment contract say?

Just because you have a certain skill it may be that your employer prefer you not perform that procedure. Conversely you cannot be forced to perform a procedure that you do not feel trained and competent in, even if requested.

Does your insurance cover you?

When determining if any skill or procedure is within your scope of practice think to yourself – “If there were a complaint made to the Board about this would I be able to give justification of why I felt trained and competent to perform this procedure?” That should give you your answer.

The Dental Board has advised that supporting documents for the newly revised standard, including updated guidelines, will be released before the standard takes effect. We will keep you updated as more information becomes available.

We are interested in hearing your views about the new changes. Please contact us via our members page through our website if you wish to voice your opinion. n References 1 Cruess SR, Johnston S, Cruess RL. (2004) Profession: a working definition for medical educators. Teaching and learning in medicine: 16(1); 74-6.

2 http://www.rdhmag.com/articles/print/volume-32/issue-1/ features/start-up-company.html 3 Approved programs of study are programs accredited by the accreditation authority for the profession and approved by the National Board under the National Law. The approved programs are those which, upon successful completion, lead to registration or endorsement as a dental practitioner in the division or specialty in which study was completed or through other assessment, examination or qualification that qualifies a practitioner for general registration (section 53 of the National Law), specialist registration (section 57) limited registration with the Board (section 65) or endorsement (section 99).

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20

Sizing The Gap A new tool on the tray Interdental cleaning just got a whole lot easier thanks to the colorimetric IAP probe

By Dr Tihana Divnic-Resnik BDS, MSc, PhD

REGULAR REMOVAL AND disruption of oral biofilm is the goal of oral selfcare and an important component of primary prevention of dental caries, periodontal, as well as peri-implant diseases. Although tooth brushing is the primary and widely used mechanical method for controlling oral biofilms, the focus of modern prevention has been shifted towards shaping and improving mechanical devices used for cleaning of interproximal areas. Various anatomic characteristics make natural (between two teeth) or artificially created (between two restored teeth or implants) interdental space, unique and susceptible to disease. Its position renders it “hidden� and less accessible to natural-cleaning mechanisms such

as saliva, tongue/lips, thus making it a good ground for undisturbed biofilm accumulation and dysbiosis conductive to caries or periodontal diseases.

Regular use of toothbrush is proven to be optimal for cleaning of flat tooth surfaces 1,2. However, the benefits of regular use of interdental cleaning devices as an adjunct to tooth brushing, have been confirmed with data from the National Health and Nutrition Examination Survey (NHANES 20112012 & 2013-2014) 3. Individuals who were using interdental cleaning devices on a regular basis, showed higher standards of oral health, with less prevalence of periodontal diseases, reduced coronal and interproximal caries, and fewer missing teeth 3.

About the author Dr Tihana Divnic-Resnik BDS, MSc, PhD is a clinical lecturer and Doctor of Dental Medicine (DMD) course coordinator in the Discipline of Periodontics at The University of Sydney. She was a lecturer in Periodontics and Oral Medicine at University of Belgrade (Serbia) for 10 years, where she also practiced as a specialist of Periodontology and Oral Medicine. She has published her work in several international journals and presented it at numerous professional conferences. She is a member of European Federation of Periodontology (EFP), Australian Society of Periodontics (ASP) and fellow of the International College of Dentists (ICD).

Dental floss has been routinely recommended by majority of dental professionals for cleaning of closed interdental spaces that may be seen in individuals with healthy periodontium, while interdental brushes are mainly recommended in periodontal patients or in those with open embrasures. There is still concern regarding their use in primary prevention at healthy sites, due to potential discomfort and trauma to interdental papilla 4.

Existing clinical studies, however, did not find any associated papilla or hard-tissue damage after the use of interdental brushes 5. In addition, it has been observed that in a group of 99 young individuals with healthy periodontium, 92.3% of interdental sites were accessible to interdental brushing 6. As compared to dental floss, interdental brushes are easier to use and readily accepted by patients.

They are more effective in cleaning of interproximal surfaces, especially in region of posterior teeth that feature mesial and distal concavities, inaccessible by dental floss 7.

Proven to be superior than dental floss, interdental brushes are becoming the first choice for mechanical interdental hygiene. However, while recommending devices for mechanical biofilm control, including interdental brushes, we must

21

keep in mind the following criteria: – the recommended device must be simple to use and should be easily accepted by the patients – it must be effective – it should not cause trauma to soft or hard tissue All the criteria may be affected by the size of interdental brush, hence the important step in selection process is the determination of dimensions of interdental spaces and matching them to the interdental brushes of appropriate sizes. As there is no established scientific method for the choice of interdental brushes, the empirical so-called reference technique is used in everyday practice 6. Interdental brushes of various sizes are used in increasing order of diameters until the one, that fits the

interdental space best without causing friction or discomfort, is identified. This technique of selection may be time consuming and difficult for the clinician, especially in posterior sites, and at the same time unpleasant for the patient.

A measuring tool in the shape of a probe has been designed to match the size of the interdental space with the best-fitting interdental brush. A color-coded interproximal access probe (IAP) designed by Curaden AG, Kriens, Switzerland, is a conical instrument with a rounded tip. Its working part contains coloured bands corresponding to dimensions of interdental brushes.

Starting from the base, interdental diameters taper off, and are coded as green, yellow, pink, red and blue.

An access diameter of interdental

brush is defined by the gauge of wire core and may affect accessibility, while an effective cleaning diameter is determined by the length of the bristles and controls efficacy. The widest part of each coloured band on the probe is designed to match with the effective cleaning diameter of the corresponding interdental brush from CPS Prime range of Curaprox©.

The IAP probe is mounted on the handle via click fastening joint that secures it in the desired position, straight or angled, for easy interdental insertion.

The technique consists of inserting a probe under light constant pressure of approximately 50 N/cm2 (0.20-gram force) horizontally from vestibular or oral aspect, until it achieves tight contact with interproximal surfaces of adjacent teeth. The coloured band that is emerging from the interdental space on the vestibular or oral aspect, depending on the direction of insertion, indicates the best fitting interdental brush.

The IAP probe is designed to be used exclusively with interdental brushes from CPS Prime range of Curaprox© and can’t be used with other brands. Its crucial role lies in precise determination of the brush that best matches the designated interdental space and is valuable in calibration of type I embrasures. The probe is autoclavable >

Images are provided by Curaden AD. The author is a licenced lecturer of individually trained oral prophylaxis (iTOP) supported by Curaden AG.

Image 1 Efficacy of dental floss and interdental brushes

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23

Method of IAP probe use and interdental access card BLUE

RED

PINK

YELLOW

GREEN

Access diameter (mm)

Effective cleaning diameter (mm)

and reusable. It is complemented by the interdental access card which allows the clinician to allocate the correct brush size for each interdental space. Patients may use the card as a map that will guide them through the process of cleaning.

The IAP probe has been tested in several studies and proven to be useful in clinical practice. I have been using the probe for clinical training and assessments of Doctor of Dental Medicine (DMD) students for several years now, and I can say that it simplifies the process of interdental brush selection, eliminates guesswork, and increases students’ confidence in the choice of the right brush for their patients.

So far, interdental brushes selected using IAP probe, are confirmed to be efficient in biofilm removal and prevention of inflammation 8. From a clinical point of view, screening of interdental spaces with IAP probe minimizes risk of bias, reduces potential discomfort and may increase patient compliance with individually tailored oral self-care. n References: 1. De la Rosa M, Zacarias Guerra J, Johnston DA, Radike AW. Plaque growth and removal with daily tooth brushing. J Periodontol 1979;50:661-64.

2. Slot DE, Wiggelinkhuizen L, Rosema NA, Van der Weijden GA. The efficacy

of manual toothbrushes following a brushing exercise. A systematic review.

Int J Dent Hyg 2012;10:187-197.

3. Marchesan JT, Morelli T, Moss K, Preisser JS Zandona AF, Offenbacher S, Beck J. Interdental cleaning is associated with decreased oral disease prevalence. J Dent Res 2018;97:773-78.

4. Chapple IL, Van der Weijden F, Doerfer C, et al. Primary prevention of periodontitis. Managing gingivitis. J Clin Periodontol 2015;42 (suppl 16):S71-S76.

5. Bergenholtz A, Olsson AA. Efficacy of plaque-removal using interdental brush and waxed dental floss. Scand J Dent Res 1984;92:198-203.

6. Carrouel F, Llodra JC, Viennot S, Santamaria J, Bravo M, Bourgeois D (2016) Access to interdental brushing in periodontlay healthy young adults: a cross-sectional study. PLoS ONE 11(5):e0155467. doi:10.1371/journal. pone.0155467 7. Imai PH, Hatzimanolakis PC. Interdental brush in type I embrasures: examiner blinded randomised clinical trial on bleeding and plaque efficacy. Can J Dent Hyg 2011;45:13-20.

8. Bourgeois D, Saliasi I, Llodr JC, Bravo M, Viennot S, Carrouel F. Efficacy of interdental calibrated brushes on bleeding reduction in adults: A threemonth randomized controlled clinical trial. Eur J Oral Sci 2016;124:566-571.

24

Stay Sharp Instrument Sharpening – Are your hand scalers and curettes sharp enough?

By Christina Zerk

How can a blunt instrument impact your patient care? a) I ncreased discomfort during debridement b) P oor removal of calculus deposits leading to poor healing c) D ebridement takes longer to perform effectively d) A ll of the above?

Your chances of a musculoskeletal injury are higher when regularly using blunt instruments to debride.

• True or False?

How can you accurately test an instruments sharpness? a) V isual inspection b) A n acrylic test stick c) T actile sensation d) A ll of the above

DURING OUR DENTAL hygiene studies, we all learn the importance of instrument sharpening. However, once we enter the world as practitioners, our appointment books get full, we are pressed for time and we are seeing more emphasis placed on Ultrasonic scaling and Air Polishing. So, are we still placing the same value on sharpening our curettes as we once did?

Maintaining sharp instruments is beneficial not only to us as practitioners, but also to our patients. A sharp instrument will grab or bite into the calculus deposit and lift it off with ease.

Whereas a dull instrument is more likely to glide over the calculus deposit, leading to an increase in pressure needed to remove the build-up and an increased possibility of burnishing calculus being left behind.

This increase in lateral pressure means we are putting more pressure on our bodies and, at times, even straining to remove deposits by having

to use numerous strokes to achieve a good result. This increase in pressure and strokes also means our patients are in the chair longer and the ‘heavy handedness’ in a single area can increase patient discomfort as we try to achieve a good result.

A sharp instrument also provides us much more tactile sensation and feedback, as it will no longer slip or glide over the calculus. Accurate strokes with less pressure therefore ensure we are not only saving time, but also work at reducing the risk of a repetitive strain injury and, best of all, our patients will be more comfortable.

How do we tell if our instruments are sharp?

A loss of tactile sensation, noticing your instrument slide over the tooth surface and in some cases even slip is a sure sign your instruments need some maintenance. You can also use an acrylic or plastic test stick, and in the absence

Answers: 1: d, 2: True, 3: d.

25

of one, you can do a visual inspection.

A dull cutting blade will have a slightly rounded or worn surface which will reflect light back towards you whereas a sharp edge will come to a point so light cannot reflect back.

When it comes to sharpening our instruments there are a number of options available including ceramic stones, natural Arkansas stones (require oil), India stones, diamond sharpening cards and even automated sharpeners like the Hu-Friedy Sidekick. Sharpening stones come in a variety of grits, however a finer stone or diamond card coupled with regular maintenance prolongs the life of your instruments by only needing light strokes to achieve a sharp instrument and this means you have sharp instruments for every patient. Infrequent sharpening means a coarser stone and more sharpening may be needed to retouch the blade and remove the blunt edge.

If it’s been a long time since you’ve

sharpened your instruments you may need to brush up on your sharpening technique by reviewing your study notes, checking out your instrument manufacturer’s instructions or even booking in for a hands-on sharpening workshop to get some expert guidance.

There will always come a point where an instrument needs replacement and if it has lost 20% or more of the working length or width it’s definitely time to think about some new instruments not only for your own benefit but also for the comfort of your patients.

How do you find time to sharpen?

Any moment you have a gap in your day, either due to a last-minute cancellation or a failure to attend, is a good time to do some instrument maintenance. If you notice an instrument that is particularly blunt, and you don’t have a replacement you can sharpen the instrument during the appointment time using a clean autoclavable stone or sharpening card

that can be autoclaved.

Well-maintained sharp instruments in turn prolong the life of your instruments and benefit the practice as a whole.

Discussing this topic with your employer or practice manager will also alleviate the fear of regular sharpening ‘wearing down instruments faster’ and will serve to educate that the opposite is true.

References/ Further Reading: Nield-Gehrig, J. (2013). Fundamentals of periodontal instrumentation et advanced root instrumentation. 7th ed. Philadelphia: Lippincott Williams et Wilkins, pp.567-611.

Hu-Friedy ‘Its About Time’ Sharpening Manual, available for download on the Hu-Friedy Website Williamson DeStefano, A. (2019). The dangers of dull instruments. RDH Website, [online] Published 2 Dec, 2018.

Available at: https://www.rdhmag.com/ home/article/16408091/the-dangers-ofdull-instruments [Accessed 1 Oct. 2019].

26 CASE REPORT

Mouth-breathing, malocclusion and the restoration of nasal breathing A study into the causes of mouth-breathing and what can be done about it

By Dr Derek Mahony & Roger Price, Australia

Introduction MOST DENTISTS AND orthodontists are aware of the impact that mouth breathing has on the development of the maxilla.

Most are also aware of the fact that even after successful realignment of teeth, unless a retainer is used, relapse usually occurs. The tongue is nature’s retainer and at the lateral force exertion of 500 Gm provides the balance required against the inward force pull of the cheek muscles, at also around 500 Gm. In an ideal world, these two forces would balance each other and normal maxillary development would take place. The primary teeth would erupt smoothly and evenly and even in the mixed dentition stage there should not be overcrowding or malalignment of teeth.

So what causes mouth breathing to occur and what can be done about it? The answer to this lies in the basic physiology that we all studied during the early part of our careers. At the time we learned it we were not able to see its overall importance as we had yet to study the full gamut of anatomy and physiology to see how it all inter-related. By the time this happened we had forgotten most of it. So it should not come as any surprise that the information that follows will certainly strike a chord and probably elicit the usual comment “But I knew that!”

Discussion Before attempting to discuss what constitutes ‘functional’ as opposed to ‘dysfunctional’ breathing it is necessary to understand the mechanism of breathing in all its complexity.

Functional breathing is initiated when the CO2 level in the arteries (pACO2) reaches 40 mm Hg and stimulates the medullary response at the base of the brain. This in turn sends a signal to the diaphragm causing it to contract and relax and so the breathing cycle is maintained. So what goes wrong? (Fig. 1) >

Fig. 1: What makes us breathe?

One of the prime roles of breathing is to maintain the pH of arterial blood at the optimal chemical axis, which ranges from 7.35 to 7.45.

This is a critical function, as it controls the transport and release of oxygen throughout the body.

When the chemoreceptors in the brainstem sense an imbalance in the chemical axis, breathing is adjusted automatically to restore optimal function.

This can increase or decrease breathing rate, depth, volume, mechanics, dynamics and behaviour patterns.

27

Optimal alveolar pressure of CO2 should be 40mm Hg

Fig. 2: Functional breathing at rest.

THERE IS NO SUCH THING AS NORMAL BREATHING Breathing is directly linked to activity, nutrition, stress levels and other external factors. The chemical axis requires constant monitoring and reacts instantaneously to any pH imbalance.

There is however a definition for functional breathing at rest, which is: • Breathing in and out through the nose • Driven by the diaphragm, not the chest • 8–12 breaths per minute • Minute volume of 5–6 litres • Silent.

Under these conditions optimal alveolar pressure of CO2 will be close to 40 mm Hg.

Alveolar pressure of CO2 drops below 40mm Hg

Fig. 3: Why breathing changes.

The constant exposure to stressors of various natures initiates the flight–fight response, which automatically triggers responses.

Among these are: • Larger and faster breaths, which reduce the amount of CO2 stored in the lungs.

• The tendency to mouth breathe in anticipation of threat or escape.

• Changes in blood clotting levels, endorphin release, blood flow away from vital organs to the muscles of flight or fight, and the body prepares for action.

• This action usually never occurs, as the dangers are perceived rather than real, and the body then has to resettle. If this is a regular occurrence, then symptoms appear.

28

There is a norm for blood pressure, pulse, temperature, chemical content of the blood etc., but there is no such thing as normal breathing. Breathing has to be appropriate for the activity at the time, and what might be okay when running around the football field is certainly not okay when sitting on a couch watching a football game, beer in hand and loads of high fatty, salt-laden snack food at hand.

So in the absence of normal breathing the best we can hope for is the determination of functional breathing at rest. (Fig. 2) In the 64 years since starting my studies as a pharmacist, and moving on to many other -ology and –opathy modalities, I have seldom come across a doctor o dentist who has looked at a patient, counted the number of breaths they take per Residual alveolar pressure of CO2 drops below 40mm Hg owing to constant loss through the open mouth

Fig. 4: The problem with mouth-breathing.

• Mouth-breathers universally have low tongue posture, leaving the maxilla without support during the growth stage.

• Lack of counterbalancing the inward forces of the buccinators causes the maxilla to narrow and form a high arch, causes nasal incursion and contributes to crowding.

• Chemoreceptors set at dysfunctional level, promoting overbreathing.

• Smooth muscle spasm can cause gastric reflux resulting in stomach acid rising into the oral cavity.

• Disrupted biochemistry has the potential to compromise growth and development.

• Upper respiratory tract infections, such as in the sinuses, tonsils and adenoids, coupled with the inflammation and congestion of the nasopharyngeal and oropharyngeal mucosa, as a result of incorrect breathing, can contribute to upper airway resistance syndrome (UARS).

• As the dysfunctional behaviour patterns change the alkalinity of the blood, less oxygen is released from the haemoglobin to the cells, causing cell death— often presented as eczema.

ATMOSPHERIC COMPOSITION

The body requires a constant pressure of CO2 of 40mm Hg or 6.5%

n Nitrogen, 78.09% n Oxygen, 20.95% n Argon, 0.93% n Carbon dioxide, 0.038% n Minute traces of neon, helium methane, water vapour, krypton, hydrogen, xenon and ozone.

Fig. 5: The carbon dioxide confusion.

• It is a total myth that carbon dioxide is a toxic waste gas and should be breathed out in big breaths to expel it from the body.

• Haemoglobin saturation of blood requires 5% oxygen to be present in the lungs. The air contains 21%—more than four times the body’s requirements of oxygen.

• Under normal circumstances, the body is never short of oxygen; what is missing is the CO2 that releases the bonded oxygen to the brain and other cells.

” Because the nose is not designed to cope with this volume of air, we become mouth breathers, and the constant lowering of CO2 through breathing through the mouth perpetuates the problem”

29

minute and commented that they are breathing for two or three people. They surely enough comment about over-eating or drinking, but the breathing is never even noticed.

Anything that happens to the human body that the system wants to resist or reject sets up a stress response. This stress response, or mini-flight or fight, causes the release of adrenalin from the adrenal glands and our breathing rate rises. This applies to what we ingest, what stressors we encounter factually, as well as emotionally or perceived, and also what physical stresses are placed on the body through poor posture and other anatomical abnormalities.

The constant messages of increased breathing rate or hyperventilation cause the chemoreceptors in the brainstem

Alveolar pressure of CO2 drops below 30mm Hg

Fig. 6: Central sleep apnoea.

Traditional medical thinking says that central sleep apnoea is the failure of the brain-generated message to breathe, to reach the diaphragm.

Multiple clinical trials at major hospitals refute this notion and have proved that it is the drop in alveolar CO2 that causes the diaphragm to halt for as long as it takes for the CO2 to rise to the point where oxygen is again re- leased from the blood to the brain.

This is primarily related to the drop in CO2 as a result of snoring and mouth-breathing during sleep.

Once breathing recommences, the dysfunctional behaviour pattern will repeat the process and a cycle will be created.

to re-set themselves at what is now regarded as the “new normal” and the standard breathing rate rises from 8–10 breaths per minute to anything from 18– 30 bpm. (Fig. 3).

Because the nose is not designed to cope with this volume of air, we become mouth breathers, and the constant lowering of CO2 through breathing through the mouth perpetuates the problem. (Fig. 4) The air contains very little CO2 as will be seen from the chart on the next page (Fig. 5). We have to produce our own, within the body, to make up the required amounts. This is done primarily as the by-product of the chemical reactions which take place during exercise and digestion. Numerous health problems arise as a result of this, mainly due to the >

Optimal alveolar pressure of CO2 returns to 40mm Hg

Fig. 7: Restoring functional breathing.

As always, there are choices: • Surgical • Orthodontic • Orthopaedic.

All of these entail four steps: • Identification of underlying causes of the dysfunctional breathing habit • Addressing and eliminating these obstacles to optimal function • Ensuring that any physical impediment is removed in order to prevent relapse • Rehabilitation to restore optimal function.

Once the system normalizes, the CO2 returns to balanced function and the organism recovers.

30

uncontrolled spasm of smooth muscle systems throughout the body which are dependent on the presence of 40 mm Hg PaCO2 and approximately 6.5% pulmonary content of CO2 to maintain integrity.

So, apart from the dental and orthodontic problems caused, myriad other problems arise due to this dysfunctional breathing. The two with most impact on the dental and orthodontic professions are:

Snoring Snoring is essentially the movement of too much air over the loose tissue at the back of the throat, causing it to rattle.

Usually accompanied by open mouth breathing it perpetuates the loss of CO2 and maintains the dysfunctional breathing pattern. In many cases, teaching the patient to reduce the breathing rate and to sleep with closed mouth virtually eliminates the problem.

Sleep apnea Sleep apnea is a little different in that it is in many cases caused by a disruption of the pH of the blood due to the decrease in CO2. This causes the blood to become too alkaline leading the brain to think that the body cells are in danger of dying (which they are). The brain’s response to this is to suppress breathing for sufficient time for the CO2 level to rise, for more carbonic acid to be produced to buffer the blood and remove the danger to the cells. Once this has been achieved the signal to breathe is again given. However, in the case of sleep apnea the ensuing breath is a large gasp and this lowers the CO2 levels again to danger point. This is why sleep apnea is characterised by a pause-gasp cycle which can occur up to 20–50 times an hour. In most cases this can be controlled by restoring CO2 levels to normal, ensuring that the pH integrity is maintained and the need to stop breathing is then removed.

Restoring nasal breathing as the norm The good news is that it is possible to reverse this situation and re-create functional breathing. This requires several steps which begin with identifying the cause of the original problem.

Unless this is done, and the habit modified, relapse is a real fact of life. It is also necessary to address the breathing mechanics and dynamics so that the optimal levels of retained CO2 can be restored. The moment this happens the medullary response recognizes that retained CO2 levels have risen and starts to reset the response to the appropriate level.(Fig. 7). n

About the Authors Dr Derek Mahony is a Sydneybased specialist orthodontist who has spoken to thousands of practitioners about the benefits of interceptive orthodontic treatment. Early in his career, he learnt from leading clinicians the dramatic effect functional appliance therapy can afford patients in orthodontic treatment, and he has been combining the fixed and functional appliance approach ever since. His lectures are based on the positive impact such a combined treatment approach has had on his orthodontic results and the benefits this philosophy provides from a practice management perspective.

Derek can be contacted at info@derekmahony.com or find out more at fullfaceorthodontics.com.au Roger Price is an internationally recognised integrative health educator with more than 60 years of experience in various aspects of human health, growth and development. For the past 20 years, he has been working with dentists and orthodontists to correct the erroneous belief that the raft of chronic diseases—caused by fractionated sleep and disturbed sleep cycles—are sleep disorders. This is, in the vast majority of cases, untrue. People do not wake because they cannot sleep; it is because they cannot breathe. He is the Director of Professional Services at the Graduate School of Behavioral Health Sciences.

Roger can be contacted at rlp@bp.edu or find out more at breathingdisorderedsleep.com

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Special offer of up to 50% off theory courses for DHAA members.

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Future Positive

SELF DEVELOPMENT

The year 2020. The start of the next decade!

What will your future self thank you for?

By Lyn Carman

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“This is the entry, the beginning, the doorway into the next decade.”

A MENTOR OF mine, Joe Pane, just shared with me the ‘BFO’ – Blinding Flash of the Obvious that next year will be the year 2020. The beginning of a new decade, we are heading into the third decade of the 21st century – that’s crazy!

So, here we are at the end of this decade and it gets me thinking, where will I be in another decade? It’s an important thing to think about. Do you know where you will be?

A quote often attributed to Bill Gates says: “Most people overestimate what they can do in one year and underestimate what they can do in ten years.” Think about this for minute.

One way to do this is consider where you were in 2010 and what you have achieved since then… haven’t those 10 years just flown by? What have you done? Where have you been? It’s incredible to think how much time has passed by so quickly.

Take a moment to think of what decisions you need to make for the next decade: What are the things you want to bring into your life? What actions do you absolutely need to commit to that are going to make a big difference?

These actions don’t have to be massive.

Just think of simple things that you can commit to, ones that your future self will thank you for.

Are there some key decisions around financial choices for you? Is it a savings strategy, or investment strategies, do you need to get some advice or expert opinions from someone who has proven runs on the board?

Sadly, one of the most

significant contributing factors to a relationship breakdown is money. There are also many successful people in their sixties and seventies who never learned to take care of their money. As a result they have had to work for the rest of their lives to pay the bills.

Whatever the next decade is for you – whether you’re turning 30, 40, 50, 60 or 70 – it’s going to pass anyway, and money is one of those things which is a significant contributor to a sense of peace. So perhaps, if the action is around finances, it may be as simple as never spending the five-dollar notes which pass through you fingers – imagine how much you could save in a year, or two, or 10 years from now?

“ The next decade is coming and its coming quick! Let the year 2020 be a wonderful opportunity, as is every year, to press the reset button” Perhaps other investments to make in the next decade are around health. Are you feeding yourself in ways that match your body type? Are you nurturing your body nutritionally to match your energy, your DNA or is this something you need more advice and support with? Take time to think of some actions you need to take for yourself to be pain-free and have all the energy in the world, to do what you need to do and desire to do.

What about relationships? Essentially your core relationships, and for those who are in a love relationship, a marriage or committed relationship – what are you investing in that? What time are you investing in your relationships? What kind of conversations are you not having that you need to be having to enrich these bonds over the next decade?

What about your emotional health, your spiritual health, your perspective, your identity? Who do you envisage yourself being, and what aspects of your identity do you want to add to?

The next decade is coming and its coming quick! Let the year 2020 be a wonderful opportunity, as is every year, to press the reset button. For the parts of our lives which are lacking and falling behind, how can we set-up our lives over the next three, six or nine months to realise our potential?

The long game means grounded, progressive results. The next decade will have it’s own unique challenges for all us in different ways. We have no idea what is going to happen. We can use our imagination of what we want to bring into our lives. We can use our imagination about what we want to stop bringing into our lives – whatever works for us.

Unpack that mental energy, physical energy, emotional energy and spiritual energy and use it to start thinking about what you want from the next ten years.

Spend time with the people that you love. This is the entry, the beginning, the doorway into the next decade.

How do you want to continue this long game? What kind of career will you have? What kind of income will you be making? Who will you making it with?

What is the difference you can make?

What message can you deliver and who will you be giving that to, and who will you be sharing that with?

Before I sign off for this decade I would like to thank all of you who have given me feedback and connected with these articles during 2019. I wish you and your loved ones, peace and joy during this time and beyond. Personally I am looking forward to 2020 and all that it brings. n 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

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

STATE NATION ACT

DHAA ACT CELEBRATED the season over a Christmas dinner served at The Howling Moon in the Rex Hotel.

Occupational Therapist Sarah Stuart provided an excellent presentation on the work of OT and gave us valuable advice on ergonomics and manual healing within the dental practice.

Her presentation covered ergonomics in the dental surgery and managing children with sensory issues. She started her presentation by giving attendees a marshmallow and two chocolate covered honeycombs in a plastic Ziploc to represent the spine.

She went on to looked at the anatomy of the spine, common disc injuries, hazardous manual handling and injury prevention.

The second part of the presentation focused on sensory processing issues in the dental surgery and offered intervention strategies. It was a great

catchup for everyone over apple martinis and delicious grazing platter following the presentation.

I would like to thank communication officer Michelle Bonney, members of the ACT committee and all volunteers that worked so hard to support me in organising all the ACT events throughout the year.

Merry Christmas to you all, and I look forward to seeing everyone in March when we celebrate World Oral Health Day on 18 March at The Duxton in O’Connor.

Susan Melrose ACT State Chair

New South Wales

OUR LAST HANDS-ON workshops of the year on instrumentation and sharpening in October were another early sell-out. In response to the increasing demand for these events, the NSW Committee will work towards providing more hands-on workshops in the coming year.

All Christmas fun and fancy cocktails for ACT members

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

We celebrated another great year over drinks and nibbles at The Royal Exchange of Sydney together with a presentation from Dr Manish Shah on sleep medicine. It was great catching up with so many friends and colleagues to finish off a great 2019.

I have taken up a new challenge as the National CPD

“ We celebrated over drinks and nibbles. It was great catching up with so many friends and colleagues to finish off a great 2019.”

Chair. My responsibility will be to plan and deliver CPD programs for DHAA Members across the States and Territories. I am most grateful for the fantastic support of the NSW Committee, and the great uptake by our members to all the events that we have organised this year. I will continue to be involved at the NSW Committee to support the new executives in planning for 2020.

Thank you everyone, and I wish you all a merry Christmas and a prosperous new year.

Jacquie Biggar NSW State Chair

Northern Territory

THE NT HALF-DAY CPD at Alice Springs in October was attended by both DHAA members and a number of local dentists. A big thank you to Hellen Checker for chairing the session and also for providing a comprehensive presentation on various forms of social media, with in depth discussion of the legal and ethical aspects associated with dental practitioners using the social media. Other relevant considerations include the Privacy Act and TGA advertising code.

Roisin McGrath traveled from Melbourne to present on mental health and provided attendees a set of strategies for dental practitioners when treating

“ The Alice Spring event was well received as the topics were relevant and supporting all practitioners”

patients with mental illnesses. She also provided insights into the Australia’s first Value Based Health Care Model for general dental services offered by the Dental Health Service Victoria.

The Alice Spring event was well received by attendees as the topics were relevant and supporting all practitioners in contemporary practice settings.

I am most grateful for the help that I have received from the NT Director Tabitha Acret and interstate colleagues in delivering these events.

I would also like to hear from any members interested in getting involved in the NT committee to support local members and advocate for our profession. Please email chairnt@dhaa.info and we can have a chat.

Merry Christmas to you all.

Meghan Argentino NT Director

Everybody was hands-on in Queensland

Queensland

THE OCTOBER hands-on workshops focused on periodontal instrumentation and instrument sharpening – key aspects of dental hygiene treatment. Both workshops were well attended and attendees were able to review and test a range of diagnostic instruments and some even found a new favourite instrument to take back and incorporate into their practice. We acknowledge the support of Hu-Friedy for sponsoring the workshops with speakers and Henry Schein Halas for providing the use of their

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conference rooms.

The 2020 World Oral Health Day evening has been scheduled for 21 March while the full day CPD in Toowoomba will be on 16 May. We look forward to seeing you all for another great year’s CPD and networking.

All of these events have been made possible by the hard work of the Queensland Committee under the leadership of Chair Aneta Zielinski and Communication Officer Christina Zerk. Aneta will be retiring from the role of Chair at the end of this year. We thank her for the valuable contribution and tireless effort in supporting DHAA and its members, and wish her well in enjoying a long overdue break.

South Australia

OCTOBER AND NOVEMBER were busy months for SA. Firstly we had the Professional Development Day at the spectacular Adelaide Entertainment

“ The Professional Development Day at the spectacular Adelaide Entertainment Centre had a fabulous line-up of highly-regarded speakers in-front of a huge audience” Centre with a fabulous line-up of highly-regarded speakers including Dr Derek Mahony, Ms Cathy Boyce and Professor Mark Bartold in-front of a huge audience.

It was followed the next day by a joint DHAA & ADOHTA full-day workshop on Silver Fluorides intended to build participant confidence in their clinical practice.

The Hu-Friedy workshops on advanced instrumentation and instrument sharpening were well-attended and provided up-to-date clinical skills for effective and efficient periodontal therapy using best instruments for diagnostic assessments.

Participants appreciated the practical tips to simplify manual sharpening techniques as well as the use of automated

Handbags and glad rags as SA support Share the Dignity

sharpening devices.

The 2019 CPD calendar in SA was completed with the end-of-year Sunday champagne breakfast at the Stamford Grand Hotel in Glenelg. People enjoyed presentations from Dr Cindy Dennis and Laura Petroff, followed by a brief report from DHAA CEO Bill Suen on the work of DHAA with an insight into opportunities for our members in 2020.

Many attendees participated in the Share the Dignity’s “it is in the bag” Christmas charity campaign by donating a handbag filled with items that would make a woman feel special which are then given to women at risk, homeless women

or those experiencing domestic violence. It was an inspiring and uplifting morning with two wonderful young women sharing their professional journey, as well as supporting women in need over the festive season.

I will be stepping down as chair after serving my threeyear tenure. I would like to thank the SA committee for all their engagement and volunteer time. I am so grateful for each person that brings their unique personality to the team. I look forward to continuing work with everyone as a SA committee member in the new year.

Lyn Carman South Australia State Chair

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

Tasmania

THE LAUNCESTON FULL day CPD was a great success and well-supported by local DHAA members. Chaired by DHAA Tasmanian Director Alyson McKinlay, the day was packed with a variety of topics presented by a range of health professionals. Medical practitioner Prof Gary Kilov provided a comprehensive overview on Diabetes; Pharmacist Dr Pankti Shastri covered pharmacology with a focus on oral health, and OHT Ian Epondulan discussed the rationale and impact of Sugar Tax and oral health promotion. There was also plenty of networking for attendees over tea and lunch.

The DHAA is grateful for the ongoing work done by local volunteers to bring these great CPD and networking events to Tasmanian members and we are currently seeking members to join us on the Tasmanian Committee. If you are interested in getting involved and making a difference, please email CEO Bill Suen at ceo@dhaa.info

Victoria

WE ENJOYED A great CPD get-together at the Kooyong Tennis Club to conclude our 2019 Victorian program.

There was a superb turn out on the day from local members to listen to Dr

Launceston event was a great success

Kooyong Tennis Club proved to be popular as ever

Sara Bryne explain the staging and grading of periodontal diseases using the new classifications. Her in-depth discussion of the classifications provided some really practical tips for members to apply at their own practice. This was followed by Dr Katy Theordore sharing her expertise in using Silver Diamine Fluoride particularly in special needs dentistry.

The morning’s highlight was hearing Dr Sharonne Zaks’ personal journey in helping patients who have experienced trauma, in particular sexual assault.

Her expertise in applying her trauma-informed approach in developing patient management guidelines for vulnerable patients was greatly appreciated by all attendees.

CEO Bill Suen provided a brief report on the work of DHAA over past months, as well as sharing his insight into 2020 for DHAA

members. Lunch was served at the conclusion of the presentations and provided a great opportunity for members to catch-up and network, with heated discussions around the lunch tables lasting for a couple of hours afterwards.

I would like to thank my Victorian Committee members for their ongoing support and hard work. We are working closely with ADOHTA in planning some joint events, with a weekend seminar scheduled to celebrate World Oral Health Day on 21-22 March. Watch this space for more details and I look forward to seeing you all in the new year.

Have a safe and happy Christmas.

Sarah Laing Victoria State Chair

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

Western Australia

THE LAST CPD event for the year in WA was held on 9 November at Ambrose Estate in Wembley Downs.

This well-attended half-day workshop provided practical skills on the protection of erupting molars, exposed root surfaces and enamel around orthodontic brackets.

It provided opportunities for dental practitioners to generate new services and encourage recall appointments.

I attended the Bali Full Day Conference on Saturday 30 November and took my husband along for a complete recuperation from such a busy year. EMS Representative Tabitha Acret presented a wonderful lecture on Implantitis and Peri mucositis, the benefits of Airflow technology and research with very graphic photos and radiographs from her case studies. Dr Christine May spoke to us about Chinese Medicine,Osteopathy,

Tongue mapping to detect health issues

“ The well-attended workshop provided practical skills on the protection of erupting molars, exposed root surfaces and enamel around orthodontic brackets” Chiropractic and other complementary health practices as an adjunct to dentistry. Fascinating information on the tongue and its mapping to detect health issues was a really impactful lecture and the take home messages were ‘if in doubt refer out’!

For the year ahead WA DHAA Committee have secured some interesting speakers and would like to hear suggestions from members for other topics that may be of interest.

Please email our vice-chair

Rhonda Kremmer wa@dhaa. info with any ideas and contributions.

We have already planned a great program in the new year, kicking off on 9 February with “Diabetes and the Mouth and Body Connection”. The 2020 World Oral Health Day celebration will be over dinner on 18 March at The Pagoda featuring Laura Drummond on remineralisation.

I am grateful for the support of WA members over 2019, and I particularly thank Rhonda Kremmer,

communication officer and the members of the WA Committee for their hard work and dedication. With my new role as WA director on the DHAA Board, I am handing over the baton to Carmen Jones who generously put her hand up to take over the WA chair role. I am confident that the WA team will continue to serve our local members well into the new decade.

Merry Christmas and a happy New Year to you all!

Aileen Lewis WA State Chair

Develop Empower Support www.dhaa.info

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