Cadmus 2011 by Adbourne Publishing

CADMUS

THE JOURNAL OF AUSTRALIAN DEFENCE FORCE DENTISTRY

Volume 30, 2011

NobelReplace™ The world’s most used implant system.*

Internal tri-channel connection for accurate and secure prosthetic restorations

Color-coded system for accu rate and fast component identification and ease of use

TiUnite® surface and Groovy™ to enhance osseointegration

Color-coding: step-by-step drilling protocol for predictable surgical procedures

Implant design that replicates the shape of natural tooth roots

* Source: Millennium Research Group

Versatility, ease-of-use and predictability have made NobelReplace Tapered the most widely used implant design in the world.* NobelReplace Tapered is a general use, two-piece implant system that performs both in soft and hard bone, oneand two-stage surgical procedures, while consistently delivering optimal initial stability. NobelReplace Tapered

is a system that grows to meet the surgical and restorative needs of clinicians and their patients – from single-tooth restorations to more advanced multiunit solutions. Whether clinicians are just starting or are experienced implant users, they will benefit from a system that is unique in flexibility and breadth of application. Nobel Biocare is the world leader

in innovative evidence-based dental solutions. For more information, contact a Nobel Biocare representative at 1800 804 597 (from Australia) or 0800 441 657 (from New Zealand) or visit our website. www.nobelbiocare.com

CADMUS

The Journal of Australian Defence Force Dentistry

ISSN: 1834-0601

CONTENTS EDITOR’S MESSAGE

OFFICIAL ADDRESSES

ADF Operations

Training Update The ADF Dental School

Professional and Technical Items Leukoplakia: a case study

Pacific Partnership 2011 from a RAAF perspective: Contingent 2: 9 June 2011 – 22 July 2011

Treatment options following a vertical root fracture Treatment of a Tooth with Cracked Tooth Syndrome

Honours and Awards

Directorate of Defence Force Dentistry Annual Report

FEATURE ARTICLEs

Exercise Saunders 2011 – Fitzroy Crossing WA Ex Talisman Sabre 2011

Dental Officer CL1 to CL2 Case Study

Pacific Partnership 2011

Exchange Programme Long Look 2011

RAADC Corps and Historical

Update from the RAADC Association Incorporated

Unit News 55 Joint Units Royal Australian Navy Fleet News Royal Australian Navy Dental Branch Royal Australian Army Dental Corps Royal Australian Air Force Dental Branch

Kokoda Youth Leadership Challenge – 2010 JEHDI

ADF Health is published annually by Adbourne Publishing for the Australian Defence Force Health Services Division. For any correspondence regarding the content of this journal, please contact Lieutenant Colonel Genevieve Constantine, SO1 Dental Plans and Programs, Directorate of Defence Force Dentistry, CP2-7-061 Campbell Park Offices, Canberra ACT 2600 Australia. Email: genevieve.constantine@defence.gov.au The statements or opinions that are expressed in the Journal reflect the views of the authors and do not represent the official policy of the Defence Health Service unless this is so stated. Although all accepted advertising material is expected to conform to ethical and legal standards, such acceptance does not imply endorsement by the Journal or the Australian Defence Force Health Service. All literary matter in the Journal is covered by copyright, and must not be reproduced, stored in a retrieval system, or transmitted in any form by electronic or mechanical means, photocopying, or recording, without written permission. Published by: ADBOURNE PUBLISHING 18/69 Acacia Road, Ferntree Gully, Vic 3160 Phone: (03) 9758 1433 Fax: (03) 9758 1432 www.adbourne.com SOUTH AUSTRALIA Phone: 0488 390 039

CADMUS 2011

Front Cover: PTE Larissa Kulk’s (Dental Assistant –GBDC) depiction of dental support to the ADF on a backing of the Tri-Service flag.

Adbourne Publishing and the Directorate of Defence Force Dentistry cannot ensure that advertisements appearing in this magazine comply with the Trades Practices Act and other consumer legislation. It is the responsibility of the supplier of advertising materials to ensure compliance with all legal requirements.

Partners with the Worldâ&#x20AC;&#x2122;s Best...

Phone orders: 1300 65 88 22 Fax orders: 1300 65 88 10 www.henryschein.com.au

CADMUS

The Journal of Australian Defence Force Dentistry Celebrating the 30th Anniversary Volume 30, 2011

Editor’s Message 2011 marks an exciting milestone in the history of the CADMUS journal. This 30th anniversary edition showcases the extraordinary efforts and commitment of dental personnel across the ADF. ADF Dental personnel have been heavily involved in providing dental support on operations and exercises throughout 2011. Dental Officers and Auxiliaries from RAN and RAAF participated in contingents one and two of Pacific Partnership 11. The articles herein are a testament to the challenges they experienced and the rewards and knowledge they gained. Army dental personnel supported Exercise Talisman Sabre, Exercise Saunders and Exercise Long Look and by all accounts these endeavours provided invaluable military and clinical experiences. Dental Teams embarked in HMA Ships TOBRUK, MANOORA, BALLARAT, PARRAMATTA, and SYDNEY. Fleet Dental, whilst at sea also treated HMAS Ships TOOWOOMBA, WARRAMUNGA and PERTH. Upcoming deployments are expected on HMA Ships NEWCASTLE and DARWIN. Congratulations to all those involved for representing dental and your Services with pride. The production of this journal is the result an enormous amount of work behind the scenes. I wish to thank the three single-Service sub-editors – LTCOL Genevieve Constantine SQNLDR Andrew Draper, LEUT Karina Cvejic, and WO1 Wayne Butler – for their outstanding efforts in supporting me in the editing of this journal. I also pass on my thanks to those who assisted with the journal’s distribution. Most importantly, I thank all those dental personnel who have contributed to the magazine despite conflicting clinical priorities. Your efforts have made the journal the success that it is. I am also grateful for the continued support of this journal from the Director General Strategic Health Coordination, Brigadier Stephan Rudzki and Commander Joint Health, Major General Paul Alexander, at a time when the Directorate is under-manned and has the majority of its personnel working remotely around Australia and overseas. As always, the production of this magazine is made possible through the professionalism and expertise of the team at Adbourne Publishing, and those generous advertisers who support this publication. I thank the Managing Director Neil Muir and his Production Manager Emily Wallis, who worked tirelessly to ensure such a successful edition.

SQNLDR Andrew Draper CADMUS 2011

LEUT Karina Cvejic, RAN

WO1 Wayne Butler

Discover the Advantages NEW

Incredibly silent! Cutting edge technology combined with design S etting a new quality standard – whisper quiet performance (only 55dB) • High concentricity & perfect balance • Ergonomic and light • Low maintenance Small head

HC9021 20 watt/ 4 hole

HC9022 18 watt/ 3 hole

KM de A nt N

FH C9 0

Power head

KaVo C9

W&H

Compatibility Compatible to a great variety of Quick Connectors

Premium Spindle Exreme durability through perfect concentricity and carbide insert

Integrated Non-Return Valves Prevents cross-infection

40,000 LUX Solid Fibre Optic Cellular Glass Rod

K-

M de A n

NSK

Sirona

NEW

Light-weight, efficient, universal Air-driven dental polishing device, smooth, easy to handle, easy to use • Compact and light, simple care and maintenance • Unique RotaGrip© simple and fatigue-proof operation • Outer handle can be rotated 360° • Prophy Powder is efficient in the removal of coatings and comes in Mint, Lemon and Strawberry flavour

-den

A N

REF

PR10

11K

Compatible with most popular quick-coupling systems

MK-dent G E R M A N Y

MK-dent G E R M A N Y REF PR1011K

KaVo

REF PR1011WH

W&H

MK-dent G E R M A N Y

REF PR1011S

Sirona

REF PR1011NT

NSK

MK-dent G E R M A N Y

REF PR1011BA

BienAir

Authorised Dealer and Repairer For more information contact Kim Chew on 03 9707 9658 or 1300 486 2527

www.ivoclarvivadent.com.au Ivoclar Vivadent Pty Ltd

1-5 Overseas Drive, Noble Park North VIC 3174 | Australia | Tel.: 1300 486 2527

free Prophy powder* with every Prophy Line

*Mint flavour.

Joint Health Command

Message from Commander Joint Health, the Surgeon General Australian Defence Force Major General Paul Alexander, MBBS, MLM, FACLM, DTM&H, Dip Sports Med

It is again a pleasure to be invited to provide a message for CADMUS 2011. Last year’s journal was an outstanding publication and I have no doubt that this 30th Anniversary edition will be just as interesting and informative. The continuing high operational tempo over the past year has seen dental personnel across all Services involved in many exercises and deployments. Navy and RAAF dental personnel participated in Exercise Pacific Partnership 2011. LCDR Page, FLTLT Kelloway, LEUT Cvejic, LEUT Godfrey and LACW Hayes all provided dental support to the Exercise between May and July 2011. Navy dental teams aboard HMAS TOBRUK, HMAS MANOORA, HMAS BALLARAT, HMAS PARRAMATTA, HMAS SYDNEY and HMAS SUCCESS have also provided operational dental support during 2010 and 2011. Army dental personnel participated in Exercise Saunders (AACAP 18) to the townships of Eight Mile (Joy Springs) and Bayulu in the vicinity of Fitzroy Crossing, WA during the period 30 May – 28 July 11. CAPT Craig, CAPT Reed, CPL Farley, CPL Steindl, CPL Wilding and PTE Morrissey provided essential dental services and education to these remote communities. Army dental personnel from 2 HSB and 1 HSB also provided dental support to Exercise TALISMAN SABRE 2011 in July. ADF dental personnel in garrison continue to provide an outstanding level of support, particularly in preparing personnel for deployments, despite short notice and difficult access due to demanding training schedules. You should be extremely proud of your efforts and achievements over the past year. Joint Health Command (JHC) has now signed agreements with the three Services and the Defence Support Group to take over the delivery of Garrison Health Services. Transition to JHC will be carried out in stages, one region at a time, and we are aiming to have all five regions transitioned to JHC during 2011. We are centralising the nine Area Health Services to five Regional Health Services, each led by a Regional Health Director. The five Regional Health Directors bring extensive medical and Defence experience to their appointments. They will make a significant impact and improvement on the operations of our health services. Furthermore, JHC has reviewed the Garrison Health Delivery Model and established new ways to deliver health services through multi-disciplinary teams. JHC are now implementing this multi-disciplinary approach, where ADF members can receive primary health care, dental care, mental health and rehabilitation services in one convenient and coordinated health precinct on each base, nationwide. This is intended to improve and simplify how ADF members access health care services. A comprehensive Strategic Health Infrastructure Plan was endorsed late in 2010. This plan is not only the end result of significant research and consultation, but also the driver of a more integrated, streamlined and collaborative approach to Defence Health infrastructure improvement. It is envisaged by 2021 each base will have a centralised health precinct delivering primary healthcare. JHC are also working on a pilot program offering specialist training opportunities for Medical Officers. The program will be conducted at the Royal Brisbane and Women’s Hospital (RBWH) in alliance with Queensland Health. A total of five accredited specialist training positions will be offered in anaesthetics, emergency medicine, intensive care, general surgery (trauma/ burns) and orthopaedics. On completion of specialist training our Medical

CADMUS 2011

Officers will continue to be employed in major teaching hospitals, available for operational deployment, education, training of our health personnel and research. I am pleased to announce the appointment of Professor Michael Reade as the inaugural Chair of Military Surgery and Medicine at the University of Queensland. Professor Reade will focus on the unique requirements of Defence in pre-hospital care, burns, damage control, resuscitation and surgery. JHC continues to implement a comprehensive Mental Health Reform Program in order to address the recommendations of the review completed by Professor David Dunt in February 2009. A new branch was established within JHC in 2010 with a Director General appointed to coordinate and integrate Mental Health, Psychology and Rehabilitation services. This branch developed the ADF Mental Health Plan and service delivery model. The plan will provide a framework for future mental health initiatives and enable the ongoing evaluation of programs and services. A major focus of this reform program is increasing our mental health and rehabilitation provider workforce, and establishing multidisciplinary primary health care teams to deliver a greater level of integrated care and mental health research. The mental health workforce will increase by more than 50%; fifty-six new positions have been established at the national, regional and local levels. The ADF Centre for Mental Health has been created to support the development and application of effective and evidence-based mental health treatment within a Defence environment. Through the Centre, JHC is building a range of partnerships with other centres of excellence in the civilian community to ensure that ADF mental health providers are trained in the latest mental health interventions. We are also investing approximately $12m to conduct a series of operational health studies under the Military Health Outcomes Program (MilHOP). I believe these studies will give us a better understanding of the prevalence of mental health conditions such as Post Traumatic Stress Disorder among our serving personnel and identify the barriers to mental health care that may effect ADF members. Importantly, the studies will also consider the possible health impacts of multiple deployments. JHC is acutely aware of the need to not only change the way we deliver services but also to develop and implement a number of innovative and best practice health solutions. The Joint E-Health Data and Information (JeHDI) system is progressing to plan with the completion of Stage One due later in 2011. The project team have also completed a number of Solution Demonstration Laboratories which worked with a wide variety of health and Service personnel to customise the commercial system to meet the ADF’s needs. JeHDI remains on track for roll-out in 2013. It has been a real privilege to have the opportunity to serve again in a fulltime capacity and I wish to personally thank you all for your great support over the past three-and-a-half years. I have really enjoyed the challenges and truly believe we are developing a military health system that will equal the best anywhere. I wish to congratulate the new Commander Joint Health Command, Rear Admiral Robyn Walker on her appointment as the next Commander Joint Health and I am sure that she will lead the Command to greater success.

CAT5558CAD

SMART

amalgam retention The Cattani Hydrocyclone Simple and effective amalgam retention.

The Cattani Hydrocyclone:

Suction Systems

The Cattani Hydrocyclone is a simple and effective amalgam retention system, designed for the range of SMART suction systems (Micro SMART and Turbo SMART). The Hydrocyclone uses the fluid pressure created by the suction system to achieve retention.

ISO-18 – for Turbo SMART ISO-5.5 – for Micro SMART

Amalgam Retention Systems

How does it work? Fluids are forced into the Hydrocyclonic cone and forced in a downward spiral motion. When fluids reach the base of the Hydrocyclone, they are forced to make a rapid inversion, at which point amalgam particles, being heavier than the fluid, fall into the collection canister. This is all done without any moving parts in the Hydrocyclonic cone. Simple.

...because we’re the specialists

Speak to your Cattani supplier for further information, or go to www.cattani.com.au

Oil-Free Compressors

Joint Health Command

Message from the Director, Defence Force Dentistry Captain Brendan Byrne, RAN, BDS, MMDS, MBA, Grad Dip MS, psc(j), AFACHSE

Welcome to this 30th anniversary edition of CADMUS, the Journal of Australian Defence Force Dentistry. 2011 has been a productive year for our junior Dental Officers and Dental Auxiliaries with many involved in Pacific Partnership 11, contingent one and two, AACAP (Exercise Saunders), Exercise Talisman Sabre and Exercise Long Look. These have proven to be rewarding, challenging and unforgettable endeavours for all those involved. The diversity of the Dental Directorate continues to provide additional challenges in the production of this journal. Many personnel work part time and most work remotely from regions spread between Darwin, Sydney and Adelaide. I am once again grateful to LTCOL Genni Constantine for the dedication and commitment that she has shown as editor, to ensure that this edition of CADMUS met its deadline. I also wish to acknowledge the sterling single-Service editorial support provided by SQNLDR Andrew Draper, LEUT Karina Cvejic and WO1 Wayne Butler. I am also grateful to all those dental personnel who have taken the time to contribute articles to the journal despite the demands of your ongoing workloads. And as always, I wish to acknowledge and thank the companies that support the journal though their advertising, and Neil Muir and the Adbourne Publishing team, without whose assistance this journal would not be possible. 2011 has been an industrious year for the Directorate. We have focused on reviewing and updating dental policy and providing additional guidance to junior dental personnel and CHPs. We recognise that there is a need to concentrate on clinical governance particularly in those regions that lack uniformed dental personnel and this will continue to be the focal point for the future. I wish to acknowledge the magnificent contributions made by my staff, LTCOL Genni Constantine, SQNLDR Janine Tillott, LCDR Kate Bailey, WO Penny Stone and LS Ashleigh Nock. Together they have ensured the seamless functioning of the Directorate. I would also like to take this opportunity to thank COL Janet Scott, GPCAPT Greg Mahoney, CMDR Peter Fatouris, LTCOL Scott Freeman and WGCDR Doug Stewart for the ongoing provision of oral surgery and sedation services around Australia to ensure ADF personnel are ready for deployment. I also wish to thank GPCAPT Greg Mahoney for his ongoing review and collection of epidemiological data and research, in particular in reviewing

CADMUS 2011

the dental outcomes of deployed personnel on their return to Australia. His work will assist in planning for future deployed dental support requirements. I wish to acknowledge the continued advice and support offered by COL Janet Scott, COL Rick Olive, COL Stephen Curry, COL Geoff Stacey, COL Gerry Thurnwald and LTCOL Chris Daly. Your assistance in the provision of clinical case review and treatment planning has been invaluable. The Continuing Professional Development (CPD) requirements of the Dental Board of Australia are now well cemented in policy. We have a requirement to achieve 60 CPD points over a three year period. I urge all Dental Officers and CHPs to ensure that you are updating your skills and knowledge by achieving these ongoing requirements. There has been continued review of ADF deployed dental support over the last year. Although there is no intent to reduce the current level or quality of dental support, ongoing review is essential to ensure that we continue to provide the services essential to the ADF. Army dental commenced the review of its deployable dental requirement through the Combat Health Support Restructure and Force Modernisation Review. 33 Dental Company will be established in Enoggera as part of the 2nd General Health Battalion later this year. The restructure will result in the hubbing of deployable dental assets into Enoggera to ensure that dental personnel are able to achieve mentoring, guidance, release for the achievement of clinical training and a more collegiate working environment that will hopefully address many of the current retention issues for Army Dental Officers. With the removal of uniformed dental personnel from Darwin and Townsville due at the end of 2011, fly away dental teams based in Enoggera will provide essential surge and exercise support to the northern regions. Air Force has also commenced a review of deployable dental and this will be finalised with the release of the AFOD in 2012. This will be my last edition of CADMUS as DDFD as I will be posted at the end of 2011. I wish to thank all those who have supported me in this position over the last three years. I welcome COL Genni Constantine on promotion to DDFD from January 2012 and wish her well in the position. I hope that you enjoy this 30th anniversary edition of CADMUS which showcases the outstanding level of commitment and dedication demonstrated by ADF dental personnel. My thanks to one and all for your continued commitment to the provision of excellent dental care for our Servicemen and women and as always for representing your parent Services and the ADF with pride.

Royal Australian Navy Dental Branch

Message from the Leadership, Navy Dental Branch Commander Mark Brazier, RAN, BDS Warrant Officer Penny Stone, OAM, BCom, Dip. Pract. Man.

Due to an impending posting, this will be the last column that I write in my current Senior Leadership role in the RAN Dental Branch. It has been a great honour and a privilege to serve the Branch (that I am so proud of) in this capacity for the past six years. Probably the most satisfying thing for me over this period has been the enthusiasm with which our younger members, both Sailors and Officers, have embraced the patient focused culture of the Navy Dental Branch. This is not only a testament to the quality of our newer members but also speaks volumes of our more experienced personnel who are ensuring that these high standards are met and maintained. This is an exciting and challenging time for the Branch as the commissioning of the new LHDâ&#x20AC;&#x2122;s draws closer. Both will have a fully equipped dental surgery onboard which will further expand the operational responsibilities of the Branch. As you will see from the enclosed articles, the Fleet Mobile Dental Teams have continued to provide excellent dental services at sea with six deployments completed so far for 2011. Although these are turbulent times from an organisational perspective, the RAN Dental Branch is in a very strong position. Our manning is close to capacity and dental deployability levels throughout the Navy are consistently high. It will require the sustained efforts and vigilance of our people for us to maintain this position. The people that have assisted me in this role over the past six years are too numerous to mention individually. Most have volunteered their own time, from the members who have travelled around the country to fill temporary vacancies to the various sub-editors of CADMUS! The reputation that we boast as a Branch is intimately linked to every interaction that we have with our patients on a daily basis. I thank you all for your outstanding efforts and wish you all the very best in your future endeavours.

Challenges and achievements have continued throughout ADF Dental Facilities and it has been impressive how our personnel have faced adversity and exhibited initiative this year. Fleet Dental and various other RAN Dental personnel have continued to provide dental treatment in deployed environments this year. The Fleet Mobile Dental Teams have embarked on six deployments with three Dental Officers and Dental Assistants participating in Pacific Partnership. Impressively, the dental team on HMAS SUCCESS continues to provide core capability to the Fleet in dynamic and flexible environments. RAN Dental Facilities are working hard to maintain high levels of Dental Individual Readiness with figures rarely falling below 90%. A total of 31,507 patients have been treated in RAN Dental Facilities over the previous financial year and this is a testament to your diligence and commitment. The motivation and enthusiasm Dental personnel have exhibited has enabled the achievement of these commendable results. In DDFDâ&#x20AC;&#x2122;s office, we are continuing to consolidate the Monthly Dental Returns and refine the analysis of the data. Your efforts in collating and submitting the returns are greatly appreciated. Fortunately it is envisaged that JeHDI will enable future data collection and interpretation processes to be more efficient. I encourage you to maintain the precise collection of data, ensuring the information is an accurate reflection of the dental treatment you are providing. Finally, I extend personal thanks to CAPT Byrne, LTCOL Constantine and CMDR Brazier for being so supportive and empowering in my first year working in the Directorate. I also thank all the highly motivated and hard-working RAN Dental Sailors whose responsiveness and professionalism are outstanding â&#x20AC;&#x201D;well done on your achievements this year!

CADMUS 2011

Royal Australian Army Dental Corps

Message from the Leadership, RAADC Lieutenant Colonel Genevieve Constantine, BDSc, Grad Cert Clin Dent, MPH, MHM, Head of Corps Warrant Officer Class One Kym Chiesa, CSM, Corps Regimental Sergeant Major

2011 has been an extremely productive year for RAADC personnel. Firstly, I wish to acknowledge those personnel who have been involved in Exercise Saunders, Exercise Talisman Sabre and Exercise Long Look, you have represented the Corps very well. I would also like to acknowledge the ongoing commitment of RAADC personnel to the provision of the highest quality dental care in the preparation of personnel for deployments and the maintenance of individual readiness standards. I thank the Corps Committee for their tireless efforts and support throughout 2011. This has been a challenging time to be providing leadership and guidance to the Corps. LTCOL Nick Read resigned as DHOC in May this year to pursue other challenges. I thank him for his commitment to the position over the last five years and wish him well for his future endeavours. I welcome MAJ Debbie Olsson to the position of DHOC. MAJ Olsson has had recent Corps Committee experience having moved from the position of SO2 Corps Heritage and brings with her a wealth of experience and enthusiasm.

2011 has been another challenging year as the Corps has come to grips with the changes resulting from the Combat Health Support Restructure. Our Dental Auxiliaries have been remarkably flexible and adaptable as many have been reverted to the Dental Assistant trade after many years as Dental Technicians or Senior Dental Assistant – Preventives. Much of the uncertainty for future opportunities for Dental Auxiliaries within the RAADC was addressed at the Corps Conference, although these opportunities will continue to manifest themselves as the transition to the new structure progresses over the next few years. It is refreshing to see the enthusiasm that you all continue to demonstrate in spite of the constant change. I wish to acknowledge the efforts of the Corps Committee over the past year in light of the uncertainty and I once again urge Corps members to communicate your innovative ideas through your chain of command to the Corps Committee for consideration. I would also like to acknowledge the sterling efforts of the previous DHOC LTCOL Nick Read and wish him well for the future.

The Biennial Corps Conference conducted at Randwick Barracks on 5 May 11 was particularly successful. In spite of the multitude of change that the Corps has faced recently with the termination of the Dental Technician trade and the Senior Dental Assistant – Preventive stream; and the significant downsizing of Corps numbers in light of the Combat Health Support (CHS) Restructure, I was heartened by the enthusiasm and determination demonstrated by RAADC members. The final two Army dental technicians graduated in a formal ceremony at Gallipoli Barracks Dental Centre on 1 Jul 11 marking the end of an era for ADF Dental Technician training. Congratulations to PTE Keast and PTE Zhang.

Yet again your outstanding efforts in providing high quality dental treatment to ensure dental preparedness across the ADF have been commendable. It never ceases to amaze me that dental personnel maintain the ‘can do’ attitude and provide dental services above and beyond the call of duty in spite of the constant change.

The CHS restructure will result in all deployable dental positions being centralised into Enoggera. 33 Dental Company will be officially formed later this year as part of the 2nd General Health Battalion. This centralisation of personnel facilitates an excellent opportunity to provide the much lacking, yet essential, mentoring, guidance and development of our junior dental officers and auxiliaries and will ensure adequate opportunity for release to undertake continuing professional development. The posting cycle in 2011/2012 will see seven new Dental Officers enter the RAADC. This is a significant increase to a specialty that has been a critical category for a number of years. With the provision of greater support and mentoring for these new graduates, a more collegiate work environment, the addition of the CPD financial incentive and the upcoming Specialist Officer Career Structure review in 2012 it is hoped that retention of Dental Officers beyond their ROSO will improve. I want to acknowledge the recipients of the 2011 Colonel Kenny Awards. Congratulations to MAJ Debbie Olsson, CAPT Anthony Craig, PTE Samuel Kouflidis and PTE Kasey Hewitt-Freudenberg. You have been recognised for your efforts over and above that required in the performance of your duties.

RAADC members have represented themselves and the Corps extremely well during 2011. In particular, I wish to acknowledge CAPT Craig, CAPT Reed, CPL Steindl, CPL Wilding, PTE Morrissey and PTE Farley for their efforts during Exercise Saunders, CAPT van Heumen, CPL Nicholls, PTE Miscamble and PTE Axford for their efforts on Exercise Talisman Sabre and SGT McSorley for her excellent representation of the Corps to the British Army on Exercise Long Look. I also wish to acknowledge those that have received awards for efforts above and beyond what is expected. In addition to those members acknowledged by the HOC, I wish to draw your attention to the following achievements: CPL Mayo for receiving the Student of Merit award on the Dental Assistant Course and CPL McMillen for receiving the Student of Merit Award for the Senior Dental Assistant Course, these awards are a testament to your diligence and dedication. Well done. Representation at the Biennial Corps Conference was impressive with 48 members attending. These numbers were outstanding given the small size of our Corps and the limited travel funding available for RAADC personnel. Your willingness to attend (despite having to provide your own funding in many cases) was particularly pleasing. Your contributions were noted and extremely worthwhile. The Corps Committee are continuing to develop the issues discussed and feedback on these developments will be forthcoming. It has been another busy but productive year for the RAADC. Your efforts throughout this year have been admirable. I wish you every success with your career aspirations in 2012 and as always, good soldiering.

I am extremely proud of the continued professionalism, dedication and initiative demonstrated by all members of the RAADC. In spite of the constant atmosphere of change you strive to maintain your enthusiasm and dedication. I wish you all the best for 2012.

CADMUS 2011

Abutments as individual as your patients

Available fo major imp r all lant systems

Discover why Atlantis™ CAD/CAM abutments are the natural choice for patient-specific, cementretained implant prosthetics. Atlantis™ abutments are designed and produced for the specific Courtesy of Dr. Julian Osorio, Dr. Keith Phillips and Dr. Harold van der Burg edentulous spaces they will fit and in relation to the surrounding teeth and soft tissue, taking biology, anatomy and engineering principles into consideration. The result is a unique combination of four key features, known as the Atlantis BioDesign Matrix™. Atlantis BioDesign Matrix™ The four features of the Atlantis BioDesign Matrix™ work together to support soft tissue management for ideal functional and aesthetic result. This is the true value of Atlantis™ for you and your patients.

Find out more how Atlantis™ can bring simplicity and aesthetics to your practice. Contact your local sales representative today or visit www.astratechdental.com.au

Atlantis VAD™ Designed from the final tooth shape.

Natural Shape™ Shape and emergence profile based on individual patient anatomy.

Soft-tissue Adapt™ Optimal support for soft tissue sculpturing and adaptation to the finished crown.

Custom Connect™ Strong and stable fit – customized connection for all major implant systems.

Astra Tech Pty Ltd, PO Box 6071, Pymble NSW 2073, Australia. Tel: 1800 799 287. Fax: 1800 799 187, www.astratechdental.com.au

79459-U

Royal Australian Air Force Dental Branch

Message from the Leadership, RAAF Dental Branch Wing Commander Christine Cordery, BDSc, Grad Dip Org Comm, Grad Dip Clin Dent Flight Sergeant Heather Fitzgibbon

As I reflect on 2011 I would like to take the opportunity to thank all of the members of the Air Force Dental teams – both military and civilian. Your contributions to Air Force capability in your unfailing commitment to provide high quality service to patients and commanders in meeting their readiness requirements are commendable. After much anticipation and years of waiting the new field deployable dental digital imaging systems, chairs and lights have finally been delivered to the units under JP2060. Pacific Partnership 2011 has again provided a valuable opportunity to gather lessons in the application of deployable dentistry. HQHSW contributed two dental officers – FLTLTs Nguyen and Kelloway – as well as one SDA-P – LACW Hayes. FLTLT Nguyen’s report later in this journal provides a unique insight into the mission as this was his second deployment. May 2011 saw the first Air Force Dental Conference in many years, this meeting was an invaluable chance for many of the senior AF dental personnel, as well as the civilian SDENTOs who mentor junior RAAF DOs, to come together to share information as well as understand their role in HSW. There were also insights into JHC, Army and Navy dental arenas, provided by DDFD, Fleet Dental Officer, and Army Dental Head of Corps. I wish to farewell WGCDR Mark O’Sullivan who transferred to the Reserves in late July after 15 years service. His personal and professional contributions to the RAAF Dental Branch have been greatly appreciated. As we go forward into 2012 I wish all of you every success in your endeavours, both at work and home, as well as my appreciation for the valuable service you provide. Just remember “I think therefore I am” is the statement of an intellectual who underrates toothaches,” Milan Kundera.

CADMUS 2011

This year has been one of continual progress and change. It has been an extremely busy and challenging year and as a team we have achieved some outstanding results in the Mustering. Each year the ADF joins forces with Health Services from Pacific Rim nations in the joint exercise Pacific Partnerships. This year LACW Donna Hayes (SDA-P) deployed from Darwin for the period 9 Jun to 25 Jul 11. Each year, Health Services Wing (HSW) releases a signal requesting expressions of interest for the coming year. I would encourage each and every one of you to consider nominating for this tough yet rewarding opportunity. Training has been a large focus for this year. The review of the RAAF Dental Trades Occupational Specification/Employment Profile is due to commence in Aug 11. Combined with a Training Needs Analysis of RAN and RAAF Dental Supervisors and Managers to be conducted at the ADFDS; this will mean a clearer pathway for these groups. Those of you already enrolled in the Supervisors and Managers courses must complete the training as this delivers essential knowledge for the technical performance of your role. There is a commitment to improve this training, and a number of proposals are being closely examined. Due to turnover of staff in the preceding year, the expectation is that we will see some movement within the Dental mustering for 2012. Posting cycles are intended to be for a minimum of 3 years. However, service requirements may dictate that this is less in some instances. I would like to welcome our two new Dental Assistants, LACW Hourihan (Student of Merit), and ACW Sunasky. These members have just completed their training at HMAS Cerberus and been posted to Williamtown and Amberley respectively. Finally, I wish you all a safe and joyous festive season and a prosperous 2012.

Reports from Operations and Exercises

Pacific Partnership 2011 FLTLT Khai Nguyen

Pacific Partnership is an annual US Navy-led humanitarian mission that seeks to strengthen ties with our neighbouring Pacific nations as well as enhance our interoperability between military services and partner nations. This year’s mission was executed utilising the USS Cleveland as the staging vessel. Pacific Partnership 2011 was also the final send-off for the USS Cleveland, the US Navy’s third oldest vessel, with its scheduled decommissioning in September at the conclusion of the exercise. This year, Pacific Partnership visited the host nations of Tonga, Vanuatu, Papua New Guinea, New Caledonia (Liberty Port), Timor Leste, and the Federated States of Micronesia where we provided dental, medical, veterinary, and engineering services to the host countries. Our Australian contingent boarded USS Cleveland in Hawaii at Pearl Harbour Naval Base on 02 Apr 11 and disembarked in Darwin on 08 Jun 11. Our medical team was subsequently replaced with a second contingent. As part of the first contingent we visited Tonga, Vanuatu, Papua New Guinea and New Caledonia.

Fun times on board: our ‘crossing the line’ ceremony.

Delivery of Dental Services

Ships participating in Pacific Partnership 2011: USS Cleveland (foreground), HMNZS Canterbury (right background), Australian LCH‘s (left background)

Our daily routine began with a 0430h reveille for a 0530h muster for the Landing Craft Unit (LCU) (which would transport us ashore). The transit to shore could take up to an hour, followed by a bus ride to the MEDCAP (Medical Civil Action Program) site, which could also take up to an hour.

Ship Life As a RAAFie, ship life is a rare and indeed foreign experience at first, but it is also a routine that quickly becomes familiar. Set meal times (early), meetings, drills, ceremonies, and briefings fill your daily schedule. Whilst underway between countries the dental section was tasked with stocktake, inventory and packing of consumables and equipment in preparation for the next country. This was a monstrous task owing to the extensive quantities of consumables ordered and stored onboard. It took quite a while to unwrap and unpack the brand new instruments that trickled through during our replenishments at sea. Participating and witnessing this exercise highlighted the extensive budget and manpower that the US military possesses when it comes to operations.

The LCU approaching the shore in Lae, Papua New Guinea. Our four person Australian Dental team was supplemented by four US Navy Dentists, US Navy and Army Dental Assistants, two Canadian Army Dentists, two Canadian Army Dental Assistants,

CADMUS 2011

and a French Army Dentist for the Vanuatu leg of the mission. Our multinational team highlighted the interoperability and it was a spectacle to witness us all working side by side. Dental services were delivered through the various MEDCAP sites established around the ports that we were anchored at. We would often have up to three concurrent MEDCAP sites running, which meant that we had to split our Dental team and supplies. These MEDCAP sites were often located in remote locations that involved the use of the two helos onboard for flying in and out. In Vanuatu, we were joined by our Australian Landing Craft Heavy (LCH) compatriots, who accommodated and transported a separate team to another distant MEDCAP site in Tangua.

LEUT Shannon Godfrey (left) and ABDEN Melissa Lavelle at work (right).

We rendezvoused with HMNZS Canterbury in Vanuatu, which bolstered USS Cleveland’s capability, virtually matching our capability one for one. HMNZS Canterbury had arrived in Vanuatu a fortnight prior to our arrival and had already offered their services to other areas of the island nation. The New Zealand Defence Force bolstered our dental capability with their Field Portable Dental Unit, providing restorative, hygiene, and oral surgery services, along with a hygienist and maxillofacial surgeon. Their team, kit and procedures resembled ours and there was a feeling of familiarity when we were working together.

At the MEDCAP sites we provided mainly oral surgery services (exodontia) to the local population. At a few sites established on existing hospital grounds, we were able to utilise their dental facilities and provide a limited range of restorative services as well. As USS Cleveland was not equipped with portable dental field chairs, operating stools or a functioning portable dental unit we were unable to reliably deliver any other form of dental service. This was unfortunate as there were numerous patients enquiring about restorative and removable prosthodontic services.

At each of the MEDCAP sites, our fellow Dentists, Doctors, Veterinarians, Pharmacists, Nurses and Dental Assistants offered the following five services: Dental, Optometry, Adult Medicine, Paediatrics and Pharmacy. Patients were triaged at reception by the Medics and Nurses who recorded vitals before sorting and banding patients into one of the five services for treatment. When there was sufficient staffing we positioned a Senior Dental Assistant at the reception desk to assist with the triage of dental patients. US Corpsmen were employed to escort and control patient movements to and from the respective treatment areas.

Oral surgery services were delivered on portable camping chairs and Army cots which were similar to our NATO litters. Although quite functional and portable, after a long day of work, they proved fatal to my lower back and shoulders. With the aid of a translator we mastered the simple statements of ‘how many teeth would you like removed’ and ‘point to the teeth you would like removed’ in the local language. Patients were very grateful for our services and were very cooperative and easy to work on (including the kids). Perhaps this contributed to me seeing in excess of 30 patients a day and extracting over 55 teeth a day.

Dental Units

Semi-wet Suction Motors

Handpieces and Service

L&R Ultrasonic Cleaner

DCI Carts and Components

LED Curing Lights

Equipment Sales & Service Australia Wide Amapc halfpage ad_August2011.indd 1

Free Call 1800 061 343 www.ampacdental.com.au • info@ampac-dental.com.au 23/8/11 9:48:39 PM

Dental were fortunate to work within MSPU tents which were large self inflatable, air conditioned tents that could be towed behind a Hummer. These tents resembled our Trellenborg in size and dimension, with the exception of being hydraulically operated and coming with in-built generators, lighting and air conditioning units. This made working conditions a little more bearable when the air conditioning worked! There were many days when we had fuel and electrical issues that rendered the air conditioning units unserviceable and working conditions were unbearably hot.

Interoperability There were subtle differences in the way that the Americans conducted business. Whilst the majority of our oral surgery instruments are identical, the manner in which they were used, together with their names were quite different to ours. I had to relearn all the instrument numbers. Furthermore, the Americans exclusively used the Universal System for dental charting, rather than the FDI. This made it interesting when it came to labelling teeth. Fortunately, US Orthodontists use the FDI system, and so US Dentists are aware of the FDI system. Working in unison with other partner nations allowed us to exchange and share dental experience, expertise, materials and equipment. It became apparent that our Pacific neighbours and New Zealand dental practices are very similar to ours – materials, techniques, credentialing and training were virtually identical to the Australian standard. On the other hand, the Americans seemed to be advanced in terms of specialisations and FLTLT Khai Nguyen treating the credentialing. This may be due to their larger population locals in Vanuatu. base and strict regulations. They have clear niches and specialist boundaries that do not exist in Australia. Post graduate training reflects these clear demarcations, with such areas as advanced restorative and dento-alveolar surgery being offered as specialties.

MSPU tents set up at Tua Nekivale, Tonga (top), and our setup inside the MSPU (above). LEUT Shannon Godfrey and ABDEN Melissa Lavelle were lucky enough to be selected to conduct Subject Matter Expert Exchange (SMEE) sessions with orphans and a high school population within Papua New Guinea. They demonstrated Oral Hygiene Instruction and performed dental examinations on the children. This was a very rewarding and touching experience and they left a lasting impression on the children. As the days were long and intense for the dental team we were lucky to be granted liberty days on the rare rostered day off. This allowed us to explore some of the surrounding regions that we were anchored in. Visiting these island nations allowed us to spend some time snorkelling, swimming, going to the beach, and sampling local delicacies such as guava and wild roast boar.

Clinical Cases Each dentist saw between 15-30 patients a day and extracted on average 2-3 teeth per patient. It was fascinating to note the difference in the degree of difficulty between the various islander populations. Of the three countries we visited, I found the most difficult extraction cases in Vanuatu followed by Tonga then Papua New Guinea. Although physical stature can sometimes roughly indicate the ‘degree of difficulty’ of an exodontia case, this proved quite the contrary in Vanuatu, where despite their general population’s relative smaller statures, their teeth were some of the most difficult that I had ever extracted. Their surprisingly dense bone teamed with heavier decay proved a rather difficult combination.

An odontoma, finally removed, that also proved rather elusive.

Blue Lagoon in Vanuatu.

In Papua New Guinea, I saw several interesting cases, including an odontoma. Previous failed attempts to remove the odontoma had resulted in pieces of the odontoma being chipped off but the bulk of it was left in situ, preventing the gingiva from healing over. After labouring away at this odontoma (without any radiographs) I was finally able to remove it. The patient was so impressed, thrilled and relieved that she insisted that I join her and her family for a feast in celebration!

CADMUS 2011

I also unfortunately witnessed three squamous cell carcinoma cases first hand â&#x20AC;&#x201C; all of which were very advanced. The high incidence of squamous cell carcinomas is perhaps the result of high betel nut consumption within Papua New Guinea. It was confronting and difficult to not be able to offer any immediate or palliative care for these patients, owing to our limited capability.

Conclusion

Squamous Cell Carcinoma superimposed over a 6 month old pathological mandibular fracture.

The locals hosting a spectacular closing ceremony for us in Lae City, Papua New Guinea.

Pacific Partnership 2011 was a unique and rewarding experience for me. This was my second time participating in Pacific Partnership and this time round I felt more professionally and personally rewarded and satisfied. I experienced the famous Polynesian and Melanesian hospitality in exchange for my dental skills that I perhaps have taken for granted over the years. It was touching witnessing the relief from dental pain that our tools and skills provided, yet also confronting when there were those who came seeking treatment from us who had walked for days through tough terrain from their remote villages. I shared many unique times and experiences both onboard Cleveland and on shore with my many shipmates from around the world and they are memories that I will forever cherish.

ABDEN Katie Macdonald-Walker being welcomed by the Ni-Vanuatu.

Reports from Operations and Exercises

Pacific Partnership 2011 from a RAAF perspective: Contingent 2: 9 June 2011 – 22 July 2011 FLTLT Genie Kelloway

From 9 June to 22 July 2011, LACW Hayes (SDA-P) and FLTLT Kelloway (DENTO) were fortunate enough to have participated in the second contingent of Pacific Partnership 2011. We visited Timor-Leste and the Federated States of Micronesia to provide a diverse range of dental services to local populations. The following sea diary entries will provide an outline of what it was like to be part of a mission which provided health care across five countries to a total of 38,696 patients and 3,300 dental patients in particular.

Contingent 2 – Australian Team

The team at the start of the day.

Dili, Timor-Leste Our MEDCAP site is essentially a field hospital. A number of large tents have been set up to house health care providers in general medicine, women’s health, children’s health, wound care, optometry, pharmacy and of course, dentistry. In our tent we only have camping chairs to seat patients and little fold-out chairs for the dentists.

We have a multi-national team – a mix of American, Canadian, Australian and Japanese dentists, dental students and dental assistants all within the same working environment. The first day at work seems like a blur of patients, teeth and local anaesthetic. I am only consciously aware of one or two minutes passing between 0800h and 1330h. We work two chairs at the same time in a staggered pattern, where I numb up one patient, then the next, then come back to the original patient (who has had ample time now for the local anaesthetic to take effect) to extract their tooth/teeth, then move on to the second. As soon as we’re done with two, the next pair are seated and waiting. LACW Hayes is there for the patient, she gives them a lot of non-verbal support which they need in this somewhat unfamiliar situation. The patients seem calmer when she is there holding their hand or gently patting them on the shoulder, while I work with anaesthesia and instruments. Robert is our interpreter and with every confidence, I can say that we’ve had the best luck of all our co-workers, as far as interpreter support goes. Robert is a young Timorese university student in FLTLT Kelloway and his final year of studying English LACW Hayes. and he combines an exceptional work ethic with enthusiasm and a very good command of English. No other interpreter seems to be able to impart so well that everything is OK and that, even though I don’t speak my patient’s language, they are still in control of what I am doing to them. With the support of Robert and LACW Hayes, I take out 27 teeth during the first day at the MEDCAP.

Pohnpei, Micronesia We spend a week on the island of Pohnpei, one of the four Micronesian states. The local habits are wreaking havoc with the teeth of both young and old. The children are willing ‘victims’ of their families’ affection which is manifested by daily copious amounts of candy. The adults substitute candy for betel nut. My youngest patient is not yet three years old. Of the twenty teeth in her little mouth, fifteen are already unrestorable as a result of constant consumption of sweets, coinciding with no real concept of oral hygiene.

CADMUS 2011

Dentist’s Choice Value Without Compromise

Comprehensive range of dental equipment including: • Mobile self contained dental units • Portable x-ray units • Standalone dental chairs • Digital imaging devices • Surgical equipment

• Endodontic devices • Disinfection • Dental units • Plant room equipment

Phone: 1800 191 838 sales@dentistschoice.com.au Visit our website www.dentistschoice.com.au CADMUS 2011

While I extract at race pace at one of the MEDCAPs, LACW Hayes is assigned to Pohnpei Hospital Dental Clinic. Switching from one role to another, she now puts on her SDA-P hat and is fully booked with oral hygiene patients. The local population needs her services as badly as they need mine due to the effects of betel nut and poor oral hygiene. Advanced periodontitis, loss of attachment, calculus deposits and staining are rampant throughout the adult population.

• provided dental services to the hospital’s dental patients • presented seminars to Yap dental students on dental caries disease process, medical history evaluation prior to treatment and oral hygiene instruction.

• led daily theoretical and practical subject matter expert exchanges/education sessions for local dental practitioners on the topics of local anaesthesia technique, dental materials, dental pain diagnosis, exodontia technique, oral hygiene instruction, root planing and restorative technique.

Yap, Micronesia Our second week includes a trip to Yap, another Micronesian state. I think the Yap Memorial Hospital would strike anyone roughly familiar with medical care as a place of contrasts! The staff here have to find innovative ways of using a combination of new and old equipment to provide the best possible care to their patients and achieve as much as possible with what they have. How strange it is to see an excellent little medical library in the room of an old building! Or to walk through a hot, simple ward with corrugated iron doors and walls and to find in the back room a SimMan, the latter most likely a very welcome foreign donation to the hospital. The dental clinic is similar in that respect. Rather new dental chairs are complemented by outdated sterilisers. Boxes of new composite sit next to books on Oral Pathology from the 1940s. Nevertheless, the staff are resourceful and find a use for every item to provide the best care they can. While working at Yap Hospital Dental Clinic, LACW Hayes and I performed the following tasks:

• assist local dental practitioners in treatment of scheduled patients and provide clinical feedback The range of activities was varied and fulfilling and here at Yap there has been a use for every clinical skill LACW Hayes and I possess. We wish we could have stayed longer to impart more knowledge and experience. As the Senior Dentist of the clinic laid the traditional “thank-you” wreaths on our heads we all agreed that our time at Yap was nowhere near long enough!

CADMUS

Enjoy every day. With Sirona.

n n n n

Innovative Products Expert Advice Outstanding Service Manufacturer Direct

Contact your local Sirona representative for more information. T: 1300 747 662 www.sirona.com.au

Honours and Awards

Recognition of Recipients of Honours and Awards Captain Brendan Byrne, RAN, BDS, MMDS, MBA, Grad Dip MS, psc(j), AFACHSE, Director of Defence Force Dentistry

It is important that we recognise the outstanding work of our personnel by nominating them for formal recognition of their performance over and above that expected in the conduct of their duties. We wish to publicly congratulate the following personnel for their recently received awards:

DDFD Congratulates the Following: Awards Royal Australian Navy Recruit Instructor of the Year 2010 – PO Scott Norbury

Colonel Kenny Awards Bests ARA RAADC Officer – CAPT Anthony Craig Best ARA RAADC Other Rank – PTE Samuel Kouflidis Best Reserve RAADC Officer – MAJ Debbie Olsson Best Reserve RAADC Other Rank – PTE Kasey Hewitt-Freudenberg

ADF Dental School Students of Merit 10/11 DDFD also wishes to congratulate the students of merit for ADF Dental School courses on exceptional achievement in their studies. Dental Assistant Course Sep – Nov 2010 May – Jul 2011

CPL Danielle Mayo (ARA) SGT Justine Hourihan (RAAF)

Senior Dental Assistant Course PTE Kristy McMillen Jul – Aug 2010 Mar – Apr 2011 LACW Shenelle Douch Senior Dental Assistant – Preventive Course Apr – Sep 2010 ABDEN Kortney Inmon

CADMUS 2011

ROYAL AUSTRALIAN RECRUIT INSTRUCTOR OF THE YEAR 2010 – Petty Officer Scott Norbury Petty Officer Scott Norbury was awarded the RAN Instructor of the Year for 2010. PO Norbury is a dedicated instructor and this award is acknowledgement of his outstanding level of commitment.

2011 Colonel Mgt Kenny Individual Awards The Colonel M.G.T Kenny Individual Award has been awarded to serving PO Scott Norbury is members of the Royal Australian awarded ‘Navy – Instructor Army Dental Corps (RAADC) in its of the Year” 2010 current form since 1984. It is an award which is only available to members of the RAADC. This year the awards were presented at the biennial RAADC Corps Conference held on 5 May 11. The Awards were presented in the following individual categories: Best ARA RAADC Officer Best ARA RAADC Other Rank Best Reserve RAADC Officer Best Reserve RAADC Other Rank

Best ARA RAADC Officer – CAPT Anthony Craig CAPT Craig’s Citation reads: I commend you for your tireless efforts in representing the Royal Australian Army Dental Corps throughout 2010. You willingly gave of your time to participate in the dental review of health support doctrine. You also participated in several dental working groups during the Combat Health Support Restructure, providing an innovative and well considered perspective. In your role as the OIC of the 1st Health Support Battalion Dental Platoon, you have willingly accepted additional responsibilities and led and mentored uniformed dental personnel admirably. Your willingness to ensure that your subordinates are not only well trained, but also thoroughly prepared for their trade requirements is commendable. Your exemplary efforts and ‘can do’ attitude when representing the RAADC whilst deployed on Exercise Long Look, has ensured that Corps members are held in high regard. Through your

MOBILE DENTAL CHAIR

UnicLine mobile • S ame hygienic and ergonomic conditions as in stationery clinic • From box to clinic in less than 15 minutes • S uitable for dental care at military healthcare facilities, nursing homes, schools and emergency situations • E ffective wherever there is a need for mobile treatment without compromise

EXCEED EXPECTATIONS

Complete solutions for healthcare professionals. Equipment Sales and Service Our range of products includes, but is not limited to:

AKRUS 700

• Dental Chairs • Delivery Units • Laser’s • Sterilizers • Suction Systems • Ultrasonic Cleaners • Hand pieces

• F oot switch controlled electric height adjustment

• Surgical Beds/Chairs • Lights • X-ray • Washer/Disinfector’s • Amalgam Retention Units • Air Compressors • Dental Hand Instruments

• M obile Patient chair for dental examination and treatment

• S eat- and back rest adjustment electric or mechanically

1800 243 234 dentecaus.com.au 20 P

CADMUS 2011

participation in British Army Dental Officer selection boards, you were able to inject innovative practices that have been implemented into the current Australian Dental Officer Selection Board process. Your achievements are of the highest order and are in keeping with the finest traditions of the Royal Australian Army Dental Corps.

Best ARA RAADC Other Rank – PTE Kouflidis PTE Kouflidis’ citation reads: I commend you for your exemplary service as a Dental Assistant within the 1st Combat Service Support Battalion, Dental Platoon. In the short time you have had in your posting, you have demonstrated a capable, enthusiastic and hard working attitude, striving for self-improvement in all aspects of your duties. You have an efficient and effective manner and you can be relied upon to complete all assigned tasks. Your commitment to willingly accept additional responsibilities and in particular providing invaluable assistance to visiting oral surgeons is recognised as being at a level expected of a member above your worn rank. Your achievements are of the highest order and are in keeping with the finest traditions of the Royal Australian Army Dental Corps.

Best Reserve RAADC Officer – MAJ Debbie Olsson MAJ Olsson’s citation reads: I commend you for your dedication and outstanding achievement in the exemplary performance of your duties whilst appointed as the Staff Officer Grade Two Historical, Royal Australian Army Dental Corps.

Your enthusiasm, dedication and tireless contribution have been instrumental in establishing a permanent place at the Australian War Memorial where all members of the Royal Australian Army Dental Corps, past, present and future, can go to acknowledge members of the Corps who have served their nation. Your effective communication with senior members of the Australian War Memorial was instrumental in ensuring that this project benefited every member of the Corps. Your attitude to creating a standard of excellence with the Royal Australian Army Dental Corps website has been instrumental in ensuring that all members of the Corps can remain updated on current issues affecting the Corps. Additionally you have reinvigorated the Corps financial position by promoting the need for all members to pay Corps subscriptions. As a direct result, the Corps is in a much better financial position. You have ensured that you have established an outstanding rapport with all members of the Corps. The passion that you exhibit when dealing with all matters of the Royal Australian Army Dental Corps is commendable and your excellent personal interaction skills have seen you excel in obtaining superior results for the Corps members when dealing with external agencies. You are an outstanding ambassador for the Corps, and your achievements exemplify the spirit and the finest traditions of the Royal Australian Army Dental Corps.

Designed to meet the diagnostic needs of the modern dental specialist and radiology practice, Carestream Dental offer a full line of innovative and affordable dental imaging solutions. Providing the latest digital technology and exceptional image quality, the Carestream range improves patient efficiency, ensuring a healthy return on investment.

• 3:1 solution providing exceptional productivity

• Lightweight wireless flexibility

• Superior image quality

• "One Shot" cephalometric technology

• World class image quality

• Optional IPS "image Positioning System"

• Compact and easy to use

• Large field of view • Intuitive 3D software

Kodak

• Proven compact Wi-Fi technology

Kodak

• Patented true autofocus technology

Kodak

For more information on how the company’s broad portfolio of products, solutions and services can work for you, please visit www.carestreamdental.com

• Dicom integration

State of the Union – ADF Dentistry

Directorate of Defence Force Dentistry

Focus for 2011: Policy Review and Dental Initiatives Captain Brendan Byrne, RAN, BDS, MMDS, MBA, Grad Dip MS, psc(j), AFACHSE, Director of Defence Force Dentistry

The mission of the Directorate of Defence Force Dentistry (DDFD) is to exercise technical control of the provision of dental services to the ADF. This is achieved through policy development, clinical decisions and the provision of advice to Commander Joint Health on issues of a dental nature, including dental capability and resourcing, oral health standards for the ADF and dental workforce requirements.

Future Dental Reform for Consideration Review of the periodicity of dental examinations remains a priority for the Directorate. A risk assessment model which would determine a member’s recall requirement based on their individual level of risk is planned for development. This may mean for some members that they would need to be examined more regularly than annually and for others this examination period could be extended out to as much as two yearly. This does not mean that a member would not be able to seek treatment earlier than the two year period if they experienced problems, just that their risk classification would place them at low risk of dental problems arising inside that two year period.

Dental Technicians The last Army Dental Technicians graduated from their course on 1 Jul 2011. The Army Dental Technician trade was terminated on 31 Jan 2011. The graduates, PTE Keast and PTE Farley will not work as Dental Technicians rather they will work as Dental Assistants. The termination of this trade in Army sees the end of an era for ADF trained Dental Technicians. Dental Technician services are not seen as being essential in the deployable environment and these services will be provided in garrison by civilian Dental Technicians or outsourcing.

Deployed Dental Capability With the termination of the Dental Technician Trade and the Senior Dental Assistant – Preventive stream, Army has downsized its deployable dental assets to provide a more affordable and sustainable capability. Army deployable dental personnel will be concentrated into Enoggera from late in 2011. Uniformed dental personnel will be withdrawn from Darwin and Townsville and dental support to these regions for surge or exercise requirements will be met by fly away teams based at Enoggera.

Orthodontic/Orthognathic Treatment Directorate personnel and Command Level Dental Officers are required to approve orthodontic cases in excess of two years duration and cases that involve orthognathic surgery. This approval process requires significant deliberation on behalf of the dental authority. Cases are assessed in accordance with Health Directive (HD)408 for the presence of functional problems. Functional problems do not include the patient being unhappy with their appearance or requesting orthodontic treatment. The approval authority will review the case starting at the beginning of the member’s Personal Dental

Record (PDR) to determine if there is a function problem and how long the functional problem has been in existence. Was the problem recorded at the Initial Dental Examination? Is the problem becoming exacerbated? Has the problem been recorded at more than one Annual Dental Examination (ADE) and by more than one dental practitioner? The approval authority requires an outline of the treatment plan from the specialist annotating the outcomes and/or repercussions of not proceeding with the treatment. All of these factors are taken into consideration when reviewing a case for approval. Not all mouths have Class I occlusion yet, not every mouth with a malocclusion will have long term repercussions if not treated. When debating whether to refer a case for higher consideration, determine whether your case has met the criteria for approval. Junior dental practitioners should say no to orthodontic/orthognathic treatment if cases are not in accordance with the policy. Forwarding the case for approval when it does not meet the policy leads to the patient having expectations of the treatment being approved and undertaken. Patient expectations should be appropriately managed by the treating dental practitioner. Educate the patient as to why their case does not meet the policy, do not abdicate this responsibility to a higher authority.

Lead Aprons HD406 is nearing completion of the approval process and changes in this policy will outline the removal of the routine requirement for the wearing of lead aprons during dental radiography. However, there will still be a requirement for the use of lead aprons for certain at risk categories. As the routine requirement for lead aprons has been removed there will no longer be a requirement for annual testing of the lead aprons.

Monthly Reporting HB 1/2008 on dental monthly reporting procedures is being reviewed in order to convert this policy into a HD. HD425 on reporting of dental casualties is also being reviewed and it is likely that the two policies will be incorporated into one. Statistics are extremely important to DDFD in determining future clinical policy and clinical governance focuses. They also provide DDFD with the necessary information to account for the allocation of resources for dental services in the ADF. Dental facilities should continue to provide accurate returns to DDFD on a monthly basis. It is also important that Senior Dental Officers, Dental Managers and Dental Supervisors utilise these returns to reflect on the efficiencies and performance of their dental facilities.

The Way Ahead Clinical Governance of dental facilities across the ADF continues to be a focus for the Directorate. Careful training, policy familiarisation and orientation of new personnel will be essential in light of the increasing number of civilians working in ADF dental facilities and this will be the spotlight for the remainder of 2011.

CADMUS 2011

Royal Australian Army Dental Corps

Feature Article

Exchange Programme Long Look 2011 SGT Elizabeth McSorley

It was 29 April 2011, I could hear cheering, chanting and sirens coming through my window and I was filled with excitement. I was living in Wellington Barracks adjacent to Buckingham Palace, Horse Guards Parade and right in the centre of London. I woke up ready to go and be part of the action as Prince William was going to marry Kate Middleton. At 0930h I took a stroll down to Westminster Abbey which was 500 metres away from the Guard Room. There were police, media and people everywhere. I was in the thick of it in front of Westminster Abbey but could not see a thing! I decided to wander down the street towards Horse Guards Parade and found a prime location against the barriers where the procession would take place. I felt as though I could reach out and touch the Royal Family as they passed by. The guardsmen and police lined the streets providing the most beautiful yet regimented display of Military protection I had ever seen. It was an amazing event to be part of and I am very happy that I can say I was there. I was constantly pinching myself as I was living with Prince Philips PA, the guards and the band members of The Royal Palaces within London. I was working out of the Royal Horse Guards HQ, on Horse Guards Parade. There were constant changing of the guards and parades to welcome fellow Defence Ministers and Chiefs.

campaigns that were to occur in dental centres. This is an excellent idea and I hope to implement some ideas into the Dental facility now that I am home. I had the opportunity to travel to Germany for two weeks in May visiting the Hohne, Sennelager, Gutersloh and Rhiendalin Dental Centres which were spread across the north west of Germany. The UK Defence Force provides dental treatment for the spouses and families of soldiers posted to Germany due to the language barriers. The Barracks were therefore very family orientated. In addition to Dental work I also had the chance to look at the APACHE aircraft, participate in an all Corps drivers course of the British Bulldog tank, attend components of the Dutch Training area, visit the Bergen-Belsen concentration camp, watch a dog display of the military vet Corps, observe some adventure training on a parachute course, visit the Royal Chelsea Pensioners Home and go for a spin with the Firies on the airfield.

I was appointed as the Regional Resources SNCO at the Principal Dental Officers (PDO) Department for London and the South East Region Defence Dental Services (DDS). The PDO department is the HQ for that region. As the DDS has so many Dental Centres, HQ management has been allocated to regions and the main DDS HQ oversees the PDO department. It sounds quite complex but it was very effective as the PDO department consisted of a COL who was the equivalent of a CO and a WO2 Regional Practice Manager who was the equivalent of a Dental CSM. Each Dental Centre had a similar structure to the ADF so it was not hard adapting to their environment. My job involved travelling to 10 of the 14 dental centres within the London region and conducting inventory checks (100% stocktakes). I was the POC for all equipment and resources and therefore had to be conversant with all the equipment policy, SOPs and their MILIS equivalent program, DDARI. Once I learned DDARI, I was on my own and it was great. I also prepared a comprehensive investigation of losses and damages for 14 Dental Centres which was presented to the DDS HQ. I attended a Health Fare campaign meeting where we constructed a plan of dental

CADMUS 2011

Overall this was an excellent experience. Long Look affirmed the pride and privilege I feel to be part of the ADF and the RAADC. The ADF lifestyle should not be taken for granted and I am inspired to pass this on to the newer members of the Corps. I highly recommend Long Look as it is both professionally and personally rewarding and enriching. Thank you to 2 HSB and the RAADC for the opportunity to participate.

Royal Australian Army Dental Corps

Feature Article

Exercise Saunders 2011 – Fitzroy Crossing WA CPL Steindl and CPL Wilding

1 HSB Dental deployed on AACAP, Exercise Saunders from 30 May 11 – 29 Jul 11. We deployed to Fitzroy Crossing which was located four hours east of Broome, WA. Unlike previous exercises this deployment was extremely small consisting of approximately 40 members. The Headquarters element leading the contingent were ARA members from 19 CE Works. The rest of the team included a wide variety of specialist trades, the majority of which were Reserve members from 21 Construction. The remainder consisted of ARA members from 5 BOSC and 1 HSB. Our Dental Team became an integral part of the 1 HSB Health Elements for the exercise. The Dental Team comprised of members from 1HSB, 1CSSB and 3CSSB. Members were as follows: CAPT Anthony Craig, CAPT Barry Reed, CPL Kerri-Ann Steindl, PTE Nicole Morrissey CPL Jason Wilding and last but not least CPL Rhiannon Farley. Together we formed a strong team providing dental treatment and education for the communities of Bayulu, Eight Mile and, Fitzroy Crossing.

about healthy eating habits and demonstrating oral hygiene techniques. Most of the communities including the children across the Fitzroy Crossing district are now the proud owners of a toothbrush and toothpaste thanks to a generous donation from Colgate. The dental team provided treatment predominantly to the community members of Eight Mile, Bayulu and referred patients from the hospital and community health clinics. The majority of the treatment conducted was for toothaches. This of course ranged from fillings to complex extractions. CAPT Tony Craig extracted in excess of 200 teeth during the exercise. We also provided fillings, dentures, mouthguards and not to mention a lot of chair side entertainment ranging from singing, juggling, colouring in competitions and PTE Morrissey showing off her dance moves to the locals.

Initially the Fitzroy population were reserved in our presence, but after spending some time wandering the streets and meeting the locals, we developed a good rapport with the communities. It didn’t take long for word to spread that a dentist was in town. This eventuated in people flying in from everywhere including even more remote communities.

The dental team were proactive and on the occasions that patients weren’t coming to us, we went to them. This included attending AFL games on a Saturday afternoon where we supported six local AFL football teams. We arranged and treated members of the frail age hostel providing dental exams and treatment on site. One elderly member in appreciation for her dental check sang us a song on our departure. We also treated the members from the art gallery; one gentleman in particular was over 90 years of age.

The dental team spent the majority of the exercise working out of the Fitzroy Crossing Hospital. The dental facility was modern and fully equipped and comprised of two dental surgeries. Along with the provision of dental treatment we also travelled into the communities to provide dental education. This included lectures

CAPT Reed joined us in week two of the exercise. His experience and knowledge was greatly appreciated. CAPT Craig loved learning different ways of extracting difficult teeth. In the short time CAPT Reed was with us we put his skills to great use. One patient presented to the emergency department with a broken jaw. After

CADMUS 2011

a quick handover from the doctor on duty, CAPT Reed proceeded to stabilise the patient’s jaw with a sterile paper clip. In addition to providing dental treatment, the dental team combined with the rest of the health element, provided general health and oral health education to students from pre-primary to year 12. The dental education we provided was based on healthy eating habits, the importance of mouth safety when playing contact sport and teaching the students how to correctly brush their teeth. As the end of our deployment was approaching we decided to take a different approach to treating the children over the school holidays. We set up our field dental equipment at Bayulu Community Health Clinic where we worked a couple of days each week until the exercise was completed. This gave us easy access to the children needing treatment. The children loved having us there and were always keen to show us their tricks of back flips and handstands. They were also very keen to assist in locating patients. To build a good relationship with the local children we participated in their fun day Friday program at the local primary school. This involved playing sport, games and kicking the footy around at recess and lunch time. At the district high school, the health element had a careers day to showcase possibilities both within Army and the civilian sector. The dental team put together a stand to highlight the possibilities within dental predominantly focusing on the Dental Assistant.

and finishing in town. Apart from CAPT Craig (who individually entered this race and won) the health element entered 2 teams, one being dental. As always we decided to take things one step further and dress up as tooth fairies. Each five km leg was run with a giant toothbrush as our baton. We represented the RAADC very well, taking out 3rd place behind the other health team and winning best dressed. For eight weeks we were accommodated at Fitzroy Lodge, where we set up camp in amongst the “The Grey Nomads”. We lived in the standard 11x11 tents and shared the amenities block with all tourists passing through. We had our own mess tent along with an amazing kitchen. This kitchen was staffed with five cooks who served five star meals. Having our own PTI ensured we stayed fit and didn’t put on too much weight from the awesome food. We had structured PT lessons three times a week. Overall the experience was fantastic; it challenged each and every member of the team both professionally and personally. We saw a total of 561 patients along with providing 432 locals with oral health education. It was an extremely successful exercise.

The majority of members in the AACAP contingent became involved in a local fun run. This was a great way to socialise and meet the members of the community in particular, other health care workers, teachers and police officers working in the community. The run was 20 km, starting from Geike George

YOU ARE INVITED… To view and discuss your sterilisation needs with the Melag professionals from Biomedex at the forthcoming…

AMMA Conference

Biomedex Wholesale are proud importers of the Melag Range of Sterilisers, providing a nationwide ‘accredited’ network of service support.

For further information please contact:

The comprehensive Melag range can provide:-

Melbourne - October 21-23, 2011 Neil Sanderson - 0408 960 716 neil@biomedex.com.au

• Washer Disinfection • Instrument Packaging • Sterilisers • Steriliser/Load Validation • Patient/Instrument Tracking

wholesale

A division of Device Technologies

www.biomedex.com.au

Royal Australian Army Dental Corps

Feature Article

Ex Talisman Sabre 2011 CAPT van Heumen and CPL Nicholls

1 July 2011 meant it was time for the 2nd Health Support Battalion (2 HSB) to deploy their Health Support Company (HSC) on Exercise Talisman Sabre (Ex TS11). The HSC effectively occupied a flat portion of real estate at Camp Growl, Queensland (Military Training Area near Rockhampton QLD).

The vital elements of a deployed HSC are: Ops Cell, Hospital Office, Q-Store Element, Tech Support, Evacuation Section, Environmental Health Sect, Resuscitation Sect, Central Sterilising Dept, Operating Theatre, Intensive Care Unit, Patient Ward (including Isolation Ward), Pharmacy, X-Ray, Pathology, Primary Health Care Team (RAP to us old folk), Physiotherapy, Rehabilitation Gymnasium and the Dynamic Dental Team. A great new asset to our field hospital is the Weather-Haven shelters. These shelters made it possible for the hospital to be completely setup in three days by a small experienced advanced party. This allowed each department to walk in and setup their individual equipment. It is important to note that 2HSB were white force, so were not involved in the exercise itself, but were there to support real time (NODUFF) casualties for all forces involved in the exercise. Further training was also carried out for hospital staff.

CADMUS 2011

The hospital was fully operational from 6 July until 21 July 2011. During this time the Dental Team, consisting of CAPT Thomas van Heumen, CPL Sonia Nicholls, PTE Morgan Miscamble and PTE Tamara Axford treated a total of 60 patients. These patients presented with varied ailments, ranging from: wisdom tooth extractions and root canal therapy to fillings and routine scale and cleans. All treatment delivered by our dental section was to (1) relieve patients from pain and discomfort and (2) keep personnel in the field allowing commanders to utilise their potential. The statistics indicate the need for maintaining dental support for Brigades in the field. Regular medical support has neither the equipment or training to effectively manage the majority of dental casualties and without dental support, the casualties will invariably suffer delayed and costly evacuations along with compromising the mission due to reduced manpower. Prior to Ex TS we received our long awaited delivery of new DDIS Rextar Digital X-Ray unit and the new dental operating chair and light. This has further enhanced our deployability and the level of treatment we are able to provide in the field and are already proving invaluable. In summary, the dental casualties treated on Ex TS11 once again highlighted the importance of having a deployed dental team. Without it, the ADF stands to lose significant capability and resources while evacuating these dental casualties to a suitable civilian equivalent.

Simply Smarter Implant Solutions

Zirconia Abutment on Anodized Titanium Bases - $120

Anodized Titanium Bases for Custom Zirconia Abutments - $60

Implants with All-in-1 Packaging - $150-$200 Including implant, abutment, transfer, cover screw & healing collar1

Industry compatible implants with All-in-1 Packaging for Value Implant Direct Sybron continues to transform the Implant Industry with the broadest selection of implants, offering surgical & prosthetic compatibility with other major brands. Our patented combination of micro-threads for crestal bone preservation & double-lead threads for faster insertion simplify surgery & increase initial stability, essential for immediate load applications.

Zirconia Abutments on Titanium Bases for Esthetics and Strength The titanium base is anodized gold to mask the grey color & can be used in the fabrication of cad-milled custom abutments. The stock abutments, provided assembled, are offered in 0°, 8° & 15° angulations with contoured margin collars of 1mm & 2mm heights. The Zirconia can be modified intra-orally with diamond burrs, providing the benefits of custom zirconia abutments for a fraction of the cost.

Joining our full line of industry compatible prosthetics See the considerable savings for our most popular abutments

Straight Snap-On

15° Angled Contoured

Gold/ Plastic

Angled Zirconia/Ti Abutment

Ball GPS™ Attachment Attachment

Multiple-Unit w/Cap & Transfer

$85

$100

$120

$85

$210

$180

$190

$247

$107 $172

$100

Zimmer Dental®

$160

$167

Straumann®

$181

$203

$157

$339 2

$192

$193

$169

Nobel Biocare™

$186

$225

$216

$285

$217

$149

$229

Our price

Shipping included with implant/Abutment orders over USD1000.00 (3-5 day delivery) Products approved by TGA. ARTG numbers available upon request

www.implantdirect.com | 1800 654 953 Price comparisons based upon US list prices as of April 2011. 1Items included in All-in-1 Packaging varies by implant 2Comparison based upon Straumann’s CARES custom zirconia abutment. Price varies depending upon the laboratory.

All trademarks are the property of their respective companies

Royal Australian Air Force Dental Branch

Feature Article

Kokoda Youth Leadership Challenge – 2010 LACW Adriana Porcelli

As a member of the Royal Australian Air Force, walking the Kokoda Trail in the footsteps of the men who have made Australia what it is today, was an absolute honour. On September 27th I was met at the Sydney airport by my fellow trekkers. We were a group of 28 individuals and strangers, not knowing what to expect but eager for the challenge ahead. Our trekking leader, John, met us at the Papua New Guinea Airport. I didn’t know then the impact this man and the trek would have on my life. Once our international flight landed we checked into Sogeri Lodge which is on a private island with beautiful views. Here we were given our instructions. We packed our bags for the trip ahead and enjoyed the last of our creature comforts for a while. Our charter from Port Moresby to Kokoda airstrip was delayed due to mechanical problems. However, after many hours of stressful waiting (unsure if it was the size of the aircraft that bothered me or the mechanical problems) we made it safely to the strip. We commenced our trek as soon as we got off the plane. We inspected the first battle place at Kokoda and moved through little villages along the way. In the villages we were greeted by the locals who were so friendly and caring. We then trekked to Kovello village and Hoi campsite. It was there that we stayed for the first night. We enjoyed a lovely dinner and went to bed early. Day Two – we were awoken at 0500h. We got ready and were introduced to our carriers. They were Papua New Guinea fuzzy wuzzy boys. We had a carer each, although some people did not know who their carer was during the trip. My carer’s face lit up as soon as I introduced myself and we shook hands. His name was Dixie. He was deaf so we communicated with sign language. I knew instantly that I had a special angel looking after me and we developed a bond throughout the trek. As the day continued we trekked through the battle site of the abandoned village of Denki, where the second battle of Kokoda was fought. We then saw Isurava Village. We learned that this was where PTE Bruce Kingsbury was awarded the Victoria Cross. Isurava was an amazing place. It was the memorial site where four very special pillars stood surrounded by clouds and mountains as high and as far as the eye could see. The pillars were black and written in bright gold lettering on the pillars were the words MATESHIP, COURAGE, ENDURANCE and SACRIFICE-. John explained to us that by the end of the trip one of these pillars would mean something personally to us; and that they did.

CADMUS 2011

The next day we trekked down to Eora creek and then to Abuari. This was the eastern side of the range that was defended by the 53rd Militia Battalion. We also visited a beautiful waterfall. We were constantly reminded that soldiers had walked this track before us. At the breathtaking waterfall stood two metal cups canteen, reminders from all those years ago. We later found out that this was where LTCOL Key and HQ staff had been captured and killed. After a long hard day of trekking we finally made it to a village for a 1500h lunch. Pasta and lukewarm coke never tasted better. Day five – awoke at 0400h to the sound of a didgeridoo blasting the entrance of our tents. John thought this was funny. We however, did not! We began trekking in the dark and went straight to Eora Creek. We were astounded by the bullets, magazines, grenades and helmets that were lying around, still intact. We learned that Eora creek was the scene of chaos and tragedy in the Kokoda campaign. We were told stories of Aussie soldiers who were sent limping and crawling up the track while their mates were left to fight. Some men even walked this section with just one leg, yet we were struggling as fit, healthy adults. Knowing that those poor young men would have been starving, dehydrated and so badly injured whilst walking the track was heart wrenching. We reverently made our way to our campsite. We bathed in a waterfall and even though it was freezing, it was so refreshing. We had dinner around a campfire. I found out that I was to be 2IC the next day. I felt nervous at the thought as day six was apparently one of the hardest days. I went to bed hoping I would lead the group to success in the day to come. Prue (the other 2IC) and I were awoken before everyone else at 0325h. We had to make sure everyone was up, packed and fed. Getting a group of 26 young adults into their gear on time wasn’t easy! We finally got everyone together. Prue and I decided that I would lead the group in the morning and she would lead in the afternoon. The morning took us to Templeton’s crossing. The steep mountain brought silence within the group as it always did when we were walking upwards! It took the Aussies 17 days to fight through Templeton’s crossing. It was one of the most gruesome and desperate actions during the campaign. After leaving this area we went through Mother Nature’s wonderland which was very mossy and in thick forest. I was scared I was going to fall off the edge! It was so far down. Finally we reached Mt Bella which at 2200 metres was the highest point of the trek. We slept at the Bombers campsite that night. I felt proud to have been a leader on day six. I went to bed at 2000h that night and as I was drifting off I realised that it was Saturday and that I hadn’t been to bed that early on a weekend for years!

On the Sunday I was really homesick. We awoke at 0500h and began with a visit to the wreckage of an American downed bomber. We then followed the original wartime track to Lake Myola. This is where John challenged us to bear a stretcher. We found it very difficult. Then the fuzzy wuzzys took over and started running with the stretcher through the jungle! Something we had found so hard was second nature to them. It was reassuring to think that our injured soldiers would have been well looked after. We then took a long, hot, dusty trek to the Village of Naduri. We were lucky enough to meet one of the last remaining original Fuzzy Wuzzy Angels. His name was Mr Ovoru Indiki. He was 105 years old. We felt so honoured to meet such a special man. We were famished by the time we had lunch at 1500h. We were tired and grumpy but that night we were sung to by the Naduri children which brought smiles to our faces. The didgeridoo woke us again the next morning and we knew we had a huge day ahead. The area between Kagi and Efoli is probably the most rugged on the trek. This was where 6000 Japanese formed up to attack 1000 Australians. We had a briefing at this stage which we found very emotional. We sat in the mounds where Australian remains had lay and cried for the sacrifice they had made for us and for the people they had left behind. We took this opportunity to thank them. The people in the village of Mission Ridge had fruit to sell to us. The pineapples and bananas seemed like gold. Mission Ridge was otherwise known as Butchers Ridge during the battle on the 8th September 1942 due to the carnage that was left behind. We were setting up camp at Menari that night and on arrival we jumped into the river fully clothed to cool down. Day nine – I was sleep deprived as the boy in the tent next to me had snored all night. We started off the morning trekking into the dark and climbed to Ladavi Saddle which had beautiful views back to Menari. We trekked for six hours and found ourselves trekking in the rain for the first time. We were at the place where the Japanese were given orders to withdraw. Their pits still lay intact on either side of the track. As we descended further downhill it poured and poured. We were drenched and everyone was slipping over in the thick mud. We were sinking further into it with each step. Whenever I looked like slipping over Dixie always made sure I was safe. I will never forget Dixie as he had the most kind and caring face. We descended into camp late that night and all that was on our minds was a hot milo.

in a tent. We proceeded down a ridge along Matama Creek. John then challenged us to climbing to Imita Ridge without stopping. We were divided into groups of four. When we got to the top without stopping it was a true feeling of accomplishment. We were greeted with cheers from our fuzzy wuzzy boys and this made it all worthwhile. After everyone had finished we realised that this was where the Australians were ordered to hold and fight to the death if necessary, as it was the final obstacle between advancing Japanese and their objective, Port Moresby. That night we finished our personal affirmations and felt proud to be reaching the end of our journey. We had not only accomplished the trek but had also gained life skills and friendships. Before we knew it we were up and conducting our usual morning routine. We then trekked across the Goldie River and up to Owers’ Corner. The feeling of completing the trek was like no other. As we walked to the top we had a guard of honour from our fuzzy wuzzys. This was such a special moment, they sang to us and as I walked past I realised how enriched my life was from this experience. We stood together and had our picture taken as proud Australians. Adventure Kokoda takes the Kokoda youth leaders on a different track which is 59 kms longer than the more popular eco-tourist track of 155 kms. By walking the entire wartime track we had the opportunity to gain a greater understanding of the Kokoda campaign. The history John imparted and the stories he told along the way were amazing. We drew so much from these and I will never forget them. We made pledges and will endeavour to keep our promises. John told us to never have any regrets in life and from now on I will not. We visited the Bomana Cemetery for our final briefing of the campaign. We got to meet the heroes that John had spoken of during our trek. The cemetery was the most peaceful place I had ever been. I was moved on seeing the gravestones of young Australians who were the same age or younger than me. It is truly difficult to comprehend the hardships they endured.

Day ten – woke to a humid breeze, the rain had vanished. We were very excited as we knew it would be the last night we had to sleep

Kokoda Youth Leadership Challenge identifies young people within the community who are potential leaders and have the ability to motivate other young people within their community. I was inspired and educated and I hope my story can

Clean between your teeth

( ...or just the ones you want to keep) Your teeth have five sides - how many do you clean? Interdental cleaning prevents and treats gum disease - left untreated, gum disease leads to tooth loss.

F pha ind yo ur rm l a tep cy s ocal esm tock ist .co m.a iles u

1800 064 645

www.trolldental.com.au

CADMUS 2011

3 Diamond Formula for measurably better mechanical features

3 Diamond Effect for perfect colour adaption

3 Diamond Layers for a perfect natural look

Brushing and flossing can achieve more with LISTERINE® antiseptic mouthwash.

BRUSH

FLOSS

RINSE

When patients add LISTERINE® mouthwash to brushing and flossing they can reduce plaque by a further 51% and gingivitis by a further 21% .1–6 The added fluoride in LISTERINE® Teeth Defence helps prevent dental caries and strengthens teeth.7–9

LISTERINE® Teeth Defence contains Ethanol 0.22mL, Benzoic Acid 1.5mg, Thymol 0.64mg, Cineole (Eucalyptol) 0.92mg and Sodium Fluoride 0.22mg. References: 1. Sharma N, et al. J Am Dent Assoc 2004; 135: 496–504. 2. Gordon JM, et al. J Clin Periodontal 1985; 12: 697–704. 3. Overholser CD, et al. J Clin Periodontal 1990; 17: 575–579. 4. DePaola LG, et al. J Clin Periodontal 1989: 311–315. 5. Charles CH, et al. J Am Dent Assoc 2001; 132: 670–675. 6. Charles CH, et al. J Clin Periodontal 2004; 31: 878–884. 7. Fine DH, et al. J Clin Periodontal 2005; 32: 335–340 8. Fine DH, et al. J Clin Periodontol 2000; 27: 157–161. 9. Fine DH, et al. J Periodontal 2007; 78: 1935–1942. ®Registered trademark. Johnson & Johnson Pacific Pty Ltd, 45 Jones St, Ultimo NSW 2077 Australia. JJP0186/BMK 2461/11

Feature Article

JeHDI Mr David Maybin, JeHDI Project, Joint Health Command

What is JeHDI

What input has the ADF Dental community provided?

The Joint eHealth Data and Information (JeHDI) Project will facilitate the provision of one electronic health record for Australian Defence Force (ADF) personnel, from recruitment to discharge, then through to management in other agencies. The implementation of JeHDI will introduce a clinical health information system that:

Between Feb 11 and May 11, more than 70 representatives from all specialities, services and regions were identified and invited to participate in a business requirements exercise – the Solution Demonstration Laboratories (SDL). The SDL methodology is commonly employed to fast-track the development of IT systems. Working through 27 use cases (scenarios), SDL participants provided their input to the design of the JeHDI system. These scenarios included: Primary Care Dental Examination, Primary Care Dental Procedure, and Practice Management activities (e.g. accessing records, booking appointments, etc.)

• Provides a single, complete and consistent electronic health record for ADF personnel,

• Provides

the ability to manage the health records for all ADF personnel,

• Improves the productivity of healthcare personnel/contractors, • Reduces the administrative overheads associated with the provision of clinical services,

• Provides the ability to map health-related trends and patterns from ADF health data,

• Provides

the ability to derive financial reports related to the provision of healthcare, and

• Maintains the security of health data. What does JeHDI mean for the ADF Dental community? The JeHDI dental functionality will support interactions between patients and dental professionals and also, daily dental practice management activities. The dental specific module is designed to provide:

• The ability to complete electronic dental and perio charting, • The

automation of statistical reporting, including ADA code statistics (previously paper-based),

• The introduction of standards for structured clinical notes (using dental specific clinical terms),

• Improved ability to manage preventative care and recall standards, • Full integration with the Primary Care System (PCS) to produce one complete patient record,

• The ability to improve patient care through ready access to the electronic health record (EHR), and

Those representing the ADRF Dental Community included: Name

Role

Location

CMDR Phillip Ma

Senior Dental Officer

HMAS Albatross

CMDR Mark Brazier

Senior Dental Officer

HMAS Kuttabul

MAJ Karen Such

Senior Dental Officer

2 HSB

Dr David Harmatta

Senior Dental Officer

RAAF Richmond

LS Rachelle Johnson

Dental Technician

HMAS Cerberus

Mrs Christine Fysh

Dental Assistant

Duntroon Health Centre

WO Penny Stone

Navy Dental Category Sponsor

DDFD, JHC

This fundamental activity and the dental expertise contributed by these representatives will facilitate the design of improved business processes and ultimately, a system for better patient outcomes. The Project Team is finalising the JeHDI functional requirements, which when complete will be communicated to SDL participants.

What are the next steps for the JeHDI Project? The implementation of JeHDI will place the ADF at the forefront of innovation in managing clinical records and improving the delivery of healthcare for members. The majority of the journey is still to come, with deployment scheduled to begin in about Jul 2012 and completing in Aug 2013. Individuals can remain connected with Project activities and progress through regular communications and updates, accessible via the JeHDI Intranet at http://www.defence. gov.au/health/JeHDI/i-JeHDI.htm. Members are also encouraged to submit questions and feedback via the JeHDI Inbox at jehdi. project@defence.gov.au.

• The ability to rapidly enter data at the time of consultation. CADMUS 2011

3000 times more effective than bleach in bacterial disinfection Discover how ozone can revolutionise your infection control and clinical efficacy Eliminate biofilm

build-up in dental unit water lines

Intraoral disinfectant

ideal as a preprocedural mouth rinse or use during ultrasonic scaling

Powerfully disinfect

surfaces, floors, instruments, hands

Zero smell or residue safe for all skin types

No consumables*

connects to power and water

Simple to operate

easy to use and low maintenance “Ozone in water can kill bacteria and other pathogenic microorganisms by rapidly rupturing their cell membranes (within several seconds). The same effects occur when dental plaque is exposed to ozonated water as a rinse. Ozonated water has no side-effects such as unpleasant taste or tooth staining, which are characteristic of other biocides or disinfecting agents.” Professor Laurence Walsh, University of Queensland Biotek Ozone M7100 in use at Dr Andrew Ng’s practice, in Oatley, Sydney Ozotop clinical delivery system in use by Dr J Berne, Beecroft, Sydney

Biotek Ozone WT7200 in use at Beecroft Dental Practice, Beecroft, Sydney

Point of use systems

Clinical delivery systems

Whole of house systems

• Refill dental unit water bottles to counter biofilm build up • Ozonate water as a preprocedural mouth rinse • Use as an irrigant during ultrasonic scaling • Ideal for hand washing • Ideal for instrument washing prior to ultrasonic cleaning

• Caries treatment • Root canal disinfection

• Treat the entire water supply of your practice

• Extraction socket disinfection

• Eliminate biofilms

• Implant site disinfection

• Eliminate all bacteria, virus, fungi

• And more...

*(Disposable tips are required)

M: +61 417 775 252 F: + 61 2 9592 3084 P: + 61 2 8090 0994 E: tonyt@mintdevices.com.au CADMUS 2011 34 W: www.mintdevices.com.au “Leaders in Minimally Invasive Technology”

THE POWER OF OZONE DISINFECTION! According to Professor Lawrence Walsh from QLD University; Topical use of ozonated water in dentistry leverages the antimicrobial and immune stimulating properties of ozone. Ozonated water has been suggested as an alternative pre-procedural rinse to existing agents such as chlorhexidine and essential oils. Ozone in water can kill bacteria and other pathogenic microorganisms by rapidly rupturing their cell membranes (within several seconds). The same effects occur when dental plaque is exposed to ozonated water as a rinse. Ozonated water has no side-effects such as unpleasant taste or tooth staining, which are characteristic of other biocides or disinfecting agents. Ozonated water can also be used as a sterile irrigation solution for surgery (as it enhances haemostasis), or as an antimicrobial mouthrinse following tooth extraction. Of interest, ozonated water when used as a daily mouthrinse has been reported to accelerate healing of oral mucosal wounds, particularly when used over the first 48 hours after surgery. The same benefits of accelerated wound closure may be seen when used in patients with oral ulcerations from chemotherapy.

The greater speed of wound closure can be explained by the known positive effects of topical ozone on enhancing the local microcirculation. Known positive biological effects of ozone include improved oxygenation of tissues, greater cell motility and accelerating of immune responses to bacteria. Accompanying these effects is an enhancement of natural antioxidant defence systems. Ozone is known to stimulate the production of several key cytokines, including interleukins 2, 6, and 8, and transforming growth factorbeta, and to attenuate the inflammation driven by bacterial lipopolysaccharides. Recent studies have shown that ozonated water as a mouthrinse can reduce gingivitis in orthodontic patients. As a topical agent, the use of ozonated water has an excellent safety profile as ozone dissipates quickly and it is converted back to diatomic oxygen. Its use is well established in 16 countries, and there is an extensive supporting literature from the work of Bocci, Filippi and other investigators.

OZONE • Ozone is the most powerful antimicrobial agent available being over 3,000 times more effective than chlorine in bacterial disinfection. • Eliminate all known viruses, bacteria, parasites, fungi, algae, protozoa, and other microorganisms . Disinfects and prevents cross-bacterial infection. Use an irrigant during Ultrasonic Scaling.

• Environmentally safe with only Oxygen released. • Ideal for hand washing. Safe for all skin types, unlike chemical disinfectants. (Frequent use of alcohol-based formulations for hand antisepsis can cause dry skin.) • No refill, no regular purchase required

MINTDEVICES represents the latest Ozone technologies for your dental needs: BIOTEK Electrolytic Ozone Generation produces Ozone-rich water; Biotek is a global leader in non-chemical ozone sanitation design, utilising ozone’s clean and safe antimicrobial power to replace chemical treatments benefiting the end user and provide a safer environment. Biotek’s ozonated water output is raising the standards of disinfection and water purification, attacks biofilm at the source and eliminating it significantly faster, safer and more efficiently than any form of chemical or filtration systems. All biotek products produce a high purity of ozone using only your municipal water supply. OZOTOP Manufactured in Switzerland by TTT produces a precise gas volume with a defined ozone concentration via Corona discharge technology. “Ozone penetrates into fissures and dentinal tubules allowing minerals to flood in providing instant pain relief. It is more powerful than sodium hypochlorite and is an excellent coagulant.” The OZOTOP provides the minimum amount of ozone required for disinfection after extractions or before inserting implants, minimally invasive cavity preparation; Periodontology for disinfecting deep periodontal pockets. Endodontics For disinfecting the root canal and the surrounding side canals. “When my good friend Dr Anne-Marie Cole found out I was having radiotherapy to treat a malignant tumour in my neck she personally rang Mint Devices to insist an Ozotop be delivered to my practice the next day. Like me, she was aware of the debilitating mucositis and ulceration that accompanies radiotherapy to the mouth. Unlike me, however, she knew how effective ozone can be in treating ulceration. The horror stories of oral radiotherapy are many, but with the assistance of the ozotop machine I was able to heal most of the oral ulceration DURING treatment, and effectively manage the pain of those I couldn’t heal. I haven’t heard of anyone who got through oral radiotherapy as easily as me and the only difference was the ozone. Sure it’s anecdotal and a case study of one, but when the case study is you that means a lot.”

Point of Use System Biotek Ozone M7100

Clinical Delivery System

Dr Brett Taylor Sydney Australia

For more information on the latest Ozone technologies contact Tony Tomevski at MINTDEVICES CADMUS 2011 on 0417 775 252 / 02 8090 0994 or email info@mintdevices.com.au 35

Solutions for all practice types

Complete imaging solutions

3D imaging General radiography Panoramic / intraoral x-ray Digital imaging / software Radiation protection, lead shielding and glass X-ray service & repairs (all brands) EPA compliance Technical support and project management

P. 1300 60 28 58 w: australianimaging.com.au e: info@australianimaging.com.au

AUSTRALIAN

imaging medical & dental imaging specialists medical & dental imaging specialists

Training Update

The Australian Defence Force Dental School LCDR Kim Leong CAPT Paul Jacobsen WO1 Wayne Butler CPO Robert Meldrum FSGT Carolyn Carruthers PO Scott Norbury SGT Alaina Rodway

Officer in Charge ADF Dental School 2IC ADF Dental School Dental Technicians Course Manager Operations Manager Dental Assistant Course Manager Senior Dental Assistant Preventive Course Manager Senior Dental Assistant Course Manager

ADFDS 2012 Course Timetable Dental Assistant (DA) Course (103943) 23 Jan 2012 to 06 Apr 2012 Session 33 14 May 2012 to 27 Jul 2012 Session 34 10 Sep 2012 to 23 Nov 2012 Session 35 Senior Dental Assistant (SDA) Course (200544) 19 Mar 2012 to 20 Apr 2012 Session 18 29 Oct 2012 to 29 Nov 2012 Session 19 Another full and productive year is well underway at the ADFDS for 2011. It is only mid way through the year and so far the school has conducted a DA and a SDA course. The second DA course and SDA-P course are currently running. This DA course has five students and the SDA-P course has four students. Another DA, SDA and DOIC are scheduled for the second half of 2011. In addition, the ADFDS have received returns from the Dental Manager and Dental Supervisor Course. The full suite of ADFDS courses being offered for 2012/2013 is also available at the link below: http://intranet.defence.gov.au/NavyWeb/sites/ADF_ Dental_School

Dental Assistant Course (103943) Three Dental Assistant courses have been conducted since the last issue of CADMUS. Session 0028 saw two students ACW Kymberley Monck and PTE Natalie Harrison graduate. Session 0029 was an Army trio of: CPL Danielle Mayo, PTE Anna Badenhorst and PTE Jenna Ivey. The student of merit was awarded to CPL Mayo, a well deserved recipient. Session 0030 had only one student, CPL Luke Petersen. The current course, Session 0031 has five students: three Army and two Air Force. They have just commenced their clinical phase in the dental department and will finish course on 29 Jul 11.

Senior Dental Assistant Course (200544) Since the last CADMUS, the ADFDS has had 20 students graduate

CADMUS 2011

Senior Dental Assistant – Preventive (SDA-P) Course (103940) 30 Apr 2012 to 23 Sep 2011 Session 15 Dental Officer Initial (DOIC) Course (113464) 27 Aug 2012 – 07 Sep 2012 Session 11 as Senior Dental Assistants. Session 0015 had 12 students and the student of merit was awarded to PTE Kristy McMillen, (now CPL). Session 0016 had eight students and the student of merit was awarded to LACW Shenelle Douch. Congratulations are extended to both students. The course manager has also changed, and the new incumbent SGT Alaina Rodway replaced SGT Sarah Brennan. SGT Brennan discharged at the end of 2010 and has settled into civilian life in WA. SGT Rodway has been busy updating the learning criteria to ensure it meets the student’s needs and improves their knowledge of current ADF Dental Practices. Also of note – AB Kama received the April 11 Supply & Health Faculty Monthly Award. The award recognised his dedication to course studies and detailed his fine recognition of Navy values.

Senior Dental Assistant – Preventive Course (103940) The course began in early May with four motivated trainees who were extremely keen to challenge themselves. We had two RAN and two RAAF students enrol on course. Sadly this is the first course without Army trainees. The trainees this year, like those before

them were extremely eager to begin and took to the program like ‘ducks to water’. Their continued excellent results, coupled with their insatiable eagerness meant that this group was a professional team producing some strong achievements. The rapport they developed with their patients was highlighted by constant positive feedback from staff and trainees at HMAS CERBERUS. This year the trainees were surprised when they were told (the night before) to prepare a presentation to deliver to the four and five year old children at South Mornington Pre-School. The trainees accepted the challenge (not that they had any choice) and by utilising some of the resources available at the ADFDS, they provided an entertaining and informative session on brushing teeth.

Student of Merit Awards 2010-2011

The ADFDS constructed a bridging course to consolidate the training required and to highlight key accountability tasks when managing our Ionising Radiation equipment. This training fills the gaps and ties in legislative requirements and additional safety information for dental personnel. Defence Ionising Radiation Safety and Assurance has been working closely with the ADFDS in developing the course and it is nearly over its final hurdle; audit point three. After this, it is anticipated that gap training can be provided by correspondence and the course will be loaded on CAMPUS for DOs and those CERT IV (Radiography) Dental Auxiliaries. If you require any other information pertaining to the course please contact the ADFDS.

Dental Technician course

Course

Student of Merit

Dental Assistant: May – Aug 10

Not Awarded

Dental Assistant: Sep – Nov 10

CPL Danielle Mayo (ARA)

Dental Assistant: Feb – Apr 11

Not Awarded

Dental Assistant: May – Jul 11

SGT Justine Hourihan (RAAF)

Senior Dental Assistant: Jul – Aug 10

PTE Kristy McMillen

Senior Dental Assistant: Mar – Apr 11

LACW Shenelle Douch

Senior Dental Assistant – Preventive: Apr – Sep 10

AB Kortney Inmon

Defence Ionising Radiation—X-ray course (DIRPX) The genesis for the DIRPX course was the identified gap in training between the existing knowledge of the Dental Officers (DO) and Dental Assistants plus the requirements dictated by ARPANSA. The existing Defence Ionising Radiation Protection Officer (DIRPO) course went some way to meeting these requirements.

Greetings for the final time from the Dental Technician Training Wing of the ADFDS. On 7 Oct 10, the Army Personnel Committee (APC) approved the restructuring of Army’s deployable dental capability. The Combat Health Restructure determined that the TECH DEN trade was no longer a deployable requirement. The APC Summary of Proceedings of 7 Oct 10 concurred with this determination and approved the termination of the TECH DEN Employment Category WEF 30 Jan 2011. We were fortunate to be able to complete the training of the members who were undergoing training at the time of the determination. PTEs, now CPLs Rhianon Farley and Jason Wilding, completed their course and graduated from the Southbank Institute of Technology in December 2010 with a Diploma of Dental Technology. CPL Farley was posted to 1 CSSB in Darwin and CPL Wilding to 3 CSSB in Townsville. PTEs Evan Keast and Brendan Zhang are the final Army students to graduate as qualified Dental Technicians from the Southbank Institute of

RIVA SELF CURE HV RIVA SELF CURE HV RIVA SELF CURE HV RIVA SELF CURE HV RIV RIVA SELF CURE HV RIVA SELF CURE HV highHV viscosity, self curing, toothCURE remineralising IVA SELF CURE RIVA SELF HV RIVA glass ionomer restorative material RIVA SELF CURE HV RIVA SELF CURE HV VA SELF CURE HV RIVA SELF CURE HV RIVA LF CURE HV RIVA SELF CURE HV RIVA SELF RIVA SELF CURE HV RIVA SELF CURE HV RIVA SELF CURE HV RIVA SELF CURE HV RIV RIVA SELF CURE HV RIVA SELF CURE HV

riva self cure HV • • • • •

Easy to shape and contour – non sticky Strong dentin replacement BPA & HEMA free No shrinkage Great marginal adaptation

Riva Self Cure HV compares to, however is less sticky than: Fuji IX GP* Fuji IX GP Extra*

new high viscosity GIC Your Smile. Our Vision. www.sdi.com.au www.polawhite.com.au

SDI Limited toll free 1800 337 003 fax 1800 005 602 Info@sdi.com.au

*Not a registered trademark of SDI Limited.

Technology, having recently graduated in July 2011. Unfortunately these members will not be able to utilise their newly acquired skills and will be remaining in Brisbane. They will be employed as Dental Assistants at the Gallipoli Barracks Dental Centre (GBDC). On the 1st of July this year, a small ceremony was conducted at GBDC to signify the cessation of Dental Technician training in the Army. Present at the ceremony were DDFD, CAPT Byrne RAN, HOC RAADC, LTCOL Constantine, DTA-LOG RAN, CMDR van Geelen, OIC ADFDS, LCDR Leong, 2IC ADFDS, CAPT Jacobsen and seven ex-serving WO2 Dental Technicians from the RAADC Association, as well as the current serving members from the GBDC. After the ceremony and a presentation by PTEs Keast and Zhang, a luncheon was held at the Broncos Leagues Club. In conclusion, I would like to thank all those units and individuals who have supported either the students or staff during Dental Technician training over the years and I wish you all the very best in your future endeavours.

Dental Manager Course and Dental Supervisor Course (RAN & RAAF members)

Dental Officer Initial Course The second half of 2010 saw five new DOs travelling to CERBERUS to experience the Peninsula. The course delivers a curriculum including: Portable Dental Equipment, administration, denture repairs, simple procurement and a range of specialist topics, but just as importantly provides an excellent opportunity to establish DO networks across the three Services. This year the numbers will be of similar size with a panel of seven on course. Some of the specialist topics in 2011 course include: Managing Maxillofacial Trauma by CAPT Barry Reed (OMFS), Oral Medicine, Barodontalgia & RA Theory/Practical by LCDR Leong, Advanced Life Support by COL Harding & CMDR Wilson (Anaesthetists), Endodontics by LCDR Case and Implants by MAJ Chow.

Navy – Instructor of the Year 2010 Congratulations are extended to Petty Officer Scott Norbury who was awarded the RAN Instructor of the Year for 2010. A well deserved recipient, PO Norbury is a very popular and dedicated instructor. This is a significant achievement, well done.

The last twelve months has seen further development on both the Supervisors and Managers courses which has resulted in the introduction of the Portfolio of Evidence (POE) and workbook. The alteration encompasses changes to the campus courses and written assignments and the addition of a POE. These changes have already been introduced into the current sessions of both the Dental Managers and Supervisors course. While the changes have now more closely aligned the course with the roles of a Dental Supervisor and Manager, a training needs analysis will be conducted to explore alternate methods of delivery for the course and current relevance to the role in the workplace.

PO Scott Norbury is presented with ‘Navy – Instructor of the Year” 2010.

Fully Integrated Loupes & LED Illumination Loupes and illumination are always correctly aligned. 2.5 x Magnification Loupes 3 working distances: 370mm, 420mm and 470mm. 40,000 lux Coaxial LED Illumination Brilliant shadow free illumination of the cavity. Ergonomic & Durable Light weight, comfortable, durable with simple set up. Portable or Direct Mains Power Supply Li-ion power pack 4.5 hours continuous use. Dimmable Illumination 7 evenly spaced levels of illumination. Dual Function Rotatable optics allow uninterrupted headlight function. Designed & Manufactured in Australia

INTEGRATED LOUPES AND LED ILLUMINATION

T +61 3 5251 3229 E office@vorotek.com.au www.vorotek.com.au

Professional and Technical Items

Dental Officer CL1 to CL2 Case Study Lieutenant Shannon Godfrey, BDSc, RAN

A 28 year old male Recruit presented on 17 March 2010 to the HMAS CERBERUS Dental Department complaining of pain on biting for three days. When asked to identify which tooth, he pointed to the 46. He reported that the pain had kept him awake for three nights, that there were no symptoms from thermal stimuli and that a broken and loose filling caused pain while eating. The pain was slightly relieved by rinsing. He identified that the tooth had previously been problematic and he had seen a community dentist who initiated a root canal on the tooth. The only significant factor on the member’s Medical History was a 15 year history of smoking six cigarettes per day (at the time of Initial Dental Examination on 20 January 2010). On examination, the temporary disto-occlusal restoration on the 46 had fractured and was loose. Periodontal widening was evident around the mesial and distal root apices of the 46 on a periapical radiograph. Initial emergency treatment of his acute periradicular periodontitis was provided at the time of presentation. The emergency treatment was: to remove all caries and dressing, assess the restorability of the tooth, locate and extirpate a fourth canal, remove necrotic pulp tissue and irrigate all canals with sodium hypochlorite, then temporise the tooth with Cavit® and Fuji IX Extra® glass ionomer cement (GIC). A stainless steel orthodontic band was placed to protect the tooth from fracture and occlusion adjusted. The patient was advised and understood that, as the distal margin of the 46 was subgingival, the long-term prognosis of the tooth was compromised and recommended treatment options were limited. The member did not want the tooth removed and elected to have root canal therapy completed and a definitive restoration placed. As the member was yet to complete initial training, further treatment was postponed until the member began Category Training and was able to accommodate for dental appointments. However, the member was advised to present to sick parade if symptoms persisted. The member had enlisted as an Electrical Technician, which meant that his Category Training at CERBERUS (commencing immediately on graduation from Recruit School) would be greater than 12 months. This allowed for a comprehensive treatment plan to be provided to the member without an emphasis on having the member dentally fit as quickly as possible in order for him to be deployable. The member had suffered no symptoms after his Sick Parade visit so the initial appointments centred on preventive treatment, in order to stabilise his periodontal condition and to minimise the risk of existing carious lesions developing further or new lesions initiating. Whilst probing depths were all within normal limits, heavy supra and sub-gingival calculus was evident in all sextants (particularly the upper right canines and molars) and the member’s oral hygiene was very poor.

Following plaque, calculus and stain removal, oral hygiene was reviewed and reinforced regularly. Over the course of treatment the member showed marked improvement in his oral hygiene, brushing more effectively and incorporating flossing several times a week into his oral care regime. High fluoride toothpaste (Neutrafluor 5000ppm®) was issued for use at night and in line with minimal intervention dentistry principles, topical high concentration fluoride varnish (Duraphat® 2.26%) applied to the early dentinal carious lesion identified on the bitewing radiograph on the distal of the 24, as well as the initial smooth surface lesion on the buccal of 27. The patient was educated on smoking, particularly its effects on his periodontium. At this stage, the member was very motivated, had already contacted the Quitline and had reduced his cigarette intake to five per day. Over the course of treatment, the member began taking Champex to assist him quitting. Dietary education and advice was also provided at the initial visits, and it was revealed that the member had frequently snacked on sweets and drank Coca Cola prior to joining the RAN and had since reduced his sugary food intake and was limiting what he ate between meals. The member’s upper wisdom teeth (18 and 28) were not present. His lower wisdom teeth were grossly carious, distally impacted, unrestorable, and non-functional. It was decided to have them extracted. Eight carious lesions (17B, 26DOB, 27Ox2, 24M, 37B, 47OB) required operative treatment in addition to completing endodontic treatment of teeth 36 and 46. A small cavitation on the mesial of 27 was also revealed and treated during preparation of 26D. The member was informed that there was a radiopacity, likely an idiopathic osteosclerosis, on his OPG (dated 20 January 2010) approximately 1 cm below the apices of teeth 43 and 44 which appeared as an irregular/oval shaped mass with welldefined borders, approximately 1 cm diameter and of varying radiodensities. The member was advised that the lesion would be monitored radiographically and reviewed in 12 months time at his annual dental examination (ADE). Adequate isolation using rubber dam was possible for most restorations; therefore, composite resin (CR) material was predominantly used for its bonding and aesthetic properties. As the 26DOB carious lesion extended very close to the pulp, a small amount of caries was left directly over the pulp horn to prevent pulpal exposure of a vital tooth. A calcium hydroxide (Dycal®) dressing was placed and a GIC base with CR (Premise®) to restore the enamel component; this enabled for desirable properties of both GIC (such as fluoride release, dentine bonding, minimise effects of CR polymerisation shrinkage) and CR (improved aesthetics, enamel bonding, wear resistance) to be taken advantage

CADMUS 2011

of. On the third appointment, the member reported discomfort in quadrant 4 from the posterior teeth after eating which was replicated by blowing the triplex on the buccal of tooth 47. The bucco-occlusal lesion, addressed at this visit, was also very deep; a calcium hydroxide dressing was placed as an indirect pulp cap (all caries was removed) with a resin-modified GIC (Fuji II LC®) and CR ‘sandwich’ technique to restore the tooth and relieve symptoms. Once all disease had been stabilised other than 38 and 48, which were scheduled to be removed under sedation, endodontic work on the mandibular first molars was undertaken. Like the 36, the 46 had also been treated as an emergency case in a community practice prior to the member joining the Navy and four canals extirpated. An orthodontic band had already been placed on the tooth. Propex®, an electronic Apex Locator, was used to assist in determining working lengths for canals of both molars; Nickel Titanium Rotary files (the ProTaper® System) and corresponding gutta percha points were utilised for obturation with a lateral condensation technique. As the distal margin on the 46 was subgingival, the difficulties in achieving an indirect restoration with an adequate marginal seal were discussed with the member. Amalgam was chosen over resin composite for its strength and long-term sealability, and as its longevity as an extensive restoration has been shown to be similar to that of cast restorations. The orthodontic band was removed and an amalgam with full cuspal overlay was placed immediately on completion of endodontic treatment to provide protection from occlusal forces. The 36 access cavity was sealed with an amalgam core and was subsequently prepared for a porcelain-fused-metal indirect restoration as the member had a preference for an aesthetic restoration of this tooth. A temporary resin-based crown which

Zirconia blanks for all major dental milling systems: Cerec inLab

CRYStAL is the onLY brand of Zirconia to offer a LiFetiMe WARRAntY!

Wieland Zeno Tec KaVo Everest AG Ceramill HigHeSt tRAnSLUCenCY

At 1250 MPA HigH StengtH CRYStAL ZiRConiA is the StRongeSt!

Digital Dental Cercon Base and more... Contact us regarding custom milled blocks.

satisfied the protective, coronal sealing, functional and aesthetic demands was placed in the interim. The 38 and 48 were removed under General Anaesthetic by an Oral and Maxillofacial Surgeon. Four days after the surgery, the 38 site became very painful and the member presented to sick parade in a febrile state with marked swelling on his left side, some difficulty swallowing and nocturnal waking due to pain. Amoxycillin and Metronidazole were prescribed to treat the underlying infection. Pain relief medications and rinses were also provided and the patient recovered within one week. Bitewings were taken at eight months after the IDE due to the member’s high caries risk. The member was provided another scaling as a mild amount of subgingival calculus had accumulated since his previous clean and as flash was evident on the distal of the 46 the margin was recontoured

References 1.

Cohen S, Hargreaves KM. Pathways of the Pulp. 9th ed. 2006, Mosby, St Louis.

Martin JA, Bader JD. Five year treatment outcomes for teeth with large amalgams and crowns, Operative Dentistry 1997; 22:72.

Mount GJ, Hume WR. Preservation and Restoration of Tooth Structure. 1998, Mosby, London.

Shillingburg, HT. Fixed Prosthodontics. 3rd ed. 1997, Quintessence, Canada.

Thompson V, Craig RG, Curro FA, Green WS, Ship JA. Treatment of deep carious lesions by complete excavation or partial removal. J Am Dent 2008; Vol 139, No 6, 705-712.

Walton RE, Torabinejad M. Principles and Practice of Endodontics. 3rd ed. 2002, Saunders, Pennsylvania.

The Digital Dental Lab CAD/ CAM system unites scanning and design software from 3shape, Dentmill CAM software and the DentalMill milling machine. The DentalMill milling unit comes with an automatic tool measurement, integrated vacuum system, three-button PC interface, touch screen monitor and 10 position tool changer. Typical milling times are 6 minutes for wax copings, 10 minutes for Zirconia copings and bridges, and 15 minutes for acrylic temps.

Crystal zirconia Australia

PO Box 560 Moorebank NSW 1875 tel: (02) 9602 1670 Fax: (02) 8569 0652 A division of Thermal Technologies Pty Ltd www.crystalzirconia.kilnsfurnacesandautoclaves.com.au

Australian Sales and Service Agents Thermal Technologies Pty Ltd, PO Box 560 Moorebank NSW 1875 Tel: (02) 9602 1670 Fax: (02) 8569 0652 Email: sales@kilnsfurnacesandautoclaves.com.au www.kilnsfurnacesandautoclaves.com.au

CADMUS 2011

Professional and Technical Items

Dental Officer CL1 to CL2 Case Study

Leukoplakia: a case study Lieutenant Karina Cvejic, BDent, RAN

Introduction Oral leukoplakia is â&#x20AC;&#x153;a white patch or plaque that cannot be characterised clinically or pathologically as any other diseaseâ&#x20AC;?, as defined by the World Health Organisation.1 The term leukoplakia describes a clinical appearance and is diagnosed by excluding other conditions. Lesions such as lichen planus, frictional keratosis, nicotinic stomatitis, leukoedema, and white spongy nevus need to be excluded before a clinical diagnosis of leukoplakia can be made. Leukoplakia is considered a premalignant lesion. By definition, premalignant is a benign lesion, which histologically shows morphologically altered tissue that has a greater risk for malignant transformation. Although the cause of leukoplakia is unknown, tobacco smoking is the most closely associated risk factor for the development of leukoplakia. Although alcohol has been identified as a risk factor for oral cancer it has not been established as a risk factor for leukoplakia.2 One study showed that 64% of oral leukoplakia cases were associated with smoking, and the remaining 36% were idiopathic, with no apparent causative agent identified.3 A study by Freitas et al found that of the smokers who developed leukoplakia, 78% were men. The same study found that for non-smokers who developed idiopathic leukoplakia, 82% were women.4 Research conducted in Hungary found that approximately 60% of oral leukoplakia lesions disappeared when the patient ceased their tobacco smoking habit.5 Leukoplakia commonly affects persons over the age of 40. The prevalence of the condition increases rapidly with age, particularly for males. The average age of affected persons is 60 years and is similar to the average age for patients with oral cancer, however leukoplakia has been found to occur 5 years earlier (on average) than squamous cell carcinomas (SCC).6 Oral cancers, specifically SCCs, have also been associated with the presence of the Human Papillomavirus (HPV). In a study performed by da Silva et al, 50 men who were smokers were identified as having an SCC of the tongue by histological screening. These men were compared with a control group including 10 matched patients with no clinical evidence of tongue lesions. Polymerase chain reaction (PCR) was used to detect the presence of HPV genome in fresh-frozen tissue specimens from SCC of the tongue margin. Thirty-seven patients (74%) had a positive PCR for oncogenic papillomavirus, and only 1 specimen (10%) of the control group was positive for

CADMUS 2011

non-oncogenic papillomavirus. Based on the statistical analysis of this study there was a 25.6% higher risk for SCC of the tongue to contain oncogenic HPV than the healthy control tongue tissue.7 A study, by Tezal et al, looked at the correlation between chronic periodontal disease and oral cancer, specifically tongue cancer. The study hypothesised two theories, direct and indirect, for how periodontal disease can influence malignancy. The direct theory discusses the idea that microorganisms and their products such as endotoxins (lipo-polysaccharides), enzymes (proteases, collagenases, fibrinolysin, and phospholipase A), and metabolic by-products (hydrogen sulfide, ammonia, and fatty acids) are toxic to surrounding cells and may directly induce mutations in tumour suppressor genes and proto- oncogenes or alter signalling pathways that affect cell proliferation and/ or survival of epithelial cells. The other is an indirect effect through inflammation. Chronic infection may stimulate the formation of epithelial derived tumours through an indirect mechanism involving activation of surrounding inflammatory cells. Inflammation exposes epithelial cells to substances with mutagenic potential.8 The study indicates more research needs to be done in this field to find a more definitive relationship between chronic periodontal disease and oral cancer. Epithelial dysplasia is the deviation from normal of epithelial architecture seen microscopically. If individual cells display dysplasia it is termed epithelial atypia. Dysplasia is the earliest form of a premalignant lesion identified in a biopsy. Pathological evaluation of the degree of dysplasia is described as mild, moderate, severe or carcinoma-in-situ (CIS). CIS is defined as dysplastic epithelial cells that extend from the basal layer to the surface of the mucosa. The categorisation of the dysplasia is useful in determining the risk of premalignant lesions. Low-grade is a collective term for mild or moderate dysplasia, high-grade describes severe dysplasia or CIS. Most low-grade dysplasias do not develop into malignant lesions however highgrade lesions often do if left untreated. If the carcinoma invades surrounding tissues the lesion is termed malignant. Most leukoplakic lesions demonstrate no dysplasia on biopsy. Epithelial dysplasia is only evident in 5-25% of leukoplakic lesions.6 Leukoplakia identified as high-grade warrants complete removal if possible. A lesion with low-grade dysplasia is managed by

conservative measures such as smoking cessation and regular follow up.6 All oral dysplasias must be followed up at least annually even if the lesion was completely excised, and regardless of whether the patient has stopped using tobacco products. Increasing evidence shows that even when excision is confirmed both clinically and histologically, molecular clones of altered cells may remain and later give rise to further dysplasia or SCC. It is critical that the site of the previous dysplasia be followed regularly, even when it appears clinically normal. The lesion should be biopsied again if clinical changes become evident.9

to a Periodontist for treatment of his periodontal condition. A Dentist carried out the minor restorative work and a referral was also made to an Oral Surgeon specialising in Oral Medicine to consult and investigate the white lesion on the FOM.

Management of the White Lesion The Oral Surgeon consulted the patient about the white lesion and performed an incisional biopsy which was sent to a pathology lab where testing was done.

White Lesion Results

The treatment focus for SCC of the oral cavity is primarily surgical excision, primarily radiotherapy, or a combination of both radiotherapy and surgery. In a case series analysis study, Gorsky et al concluded that the five-year survival of patients with cancer of the tongue was 43% and cancer of the base of the tongue was 27%.10

Clinical Case Study A 50-year-old male presented to the HMAS KUTTABUL Dental Department for his Annual Dental Exam (ADE) in November 2010. No complaints were reported. His medical history questionnaire indicated that he previously had hyperlipidaemia, which is currently controlled with diet and exercise. The questionnaire also revealed and that he has been a smoker of 20 cigarettes per day for 20 years. He also indicated a maximum of two alcoholic drinks per day. This figure complies with the National Health and Medical Research Council guidelines.11 The patient reported brushing his teeth two times a day, morning and night and does not floss. In the routine soft tissue examination, a white lesion was noticed on the left ventral surface of the tongue. This lesion spanned 40 mm along the floor of the mouth (FOM) and ventral tongue; a small portion of the lesion crossed the midline through the lingual frenum. The lesion had irregular but defined borders, was not raised and could not be wiped off. The white lesion was homogenous in colour and consistency. On reviewing his dental record, it was found that in May 2007 a white lesion was noticed on the FOM as an incidental finding at his ADE. The lesion was described as striated. A referral to an Oral Surgeon concluded that diffuse white striations were evident on the FOM, left and right retro-molar area and the right buccal mucosa. A review in six months was recommended. This however, was not followed up. Other findings in the examination were generalised gingival recession, some deep periodontal pockets, and minor restorative work needed. His oral hygiene was poor and he displayed moderate supra and sub gingival plaque and calculus deposits generalised on both arches.

Treatment Plan At the initial appointment, the patient was given oral hygiene instruction for brushing and flossing and was also shown the white FOM lesion. A discussion with the patient ensued about the lesion and his periodontal condition. He was also advised to cease his smoking habit. The patient was referred for an Orthopantomograph to assist in a more accurate assessment of his bone levels. He was referred

The biopsy was viewed in histological sections. It showed oral mucosa with a thick layer of compact hyperkeratosis, overlying mildly thickened squamous epithelium. The pathology report also identified the presence of prominent kerato hyaline granules in the upper epithelial layers are suggestive of a “wart virus effect” (Figure 1). A focal mild atypia and disorganisation of the basal layers was also noticed. The periodic acid-Schiff fungal stain returned negative. Finally the report stated no evidence of malignancy and a possibility of low-grade dysplasia. The summary concluded a leukoplakia characterised by hyperkeratosis with mild basal atypia with a query on the “wart virus effect”. The Oral Surgeon reviewed the pathology report with the patient and advised that the leukoplakia has potential to become malignant if his smoking habit is not ceased. At a six-month review in May 2011, the patient had reported that he has reduced his cigarette smoking by half. His FOM lesion is persistent and the patient warned again of the high risk of malignancy and oral cancer.

Discussion The Australian Defence Force (ADF) requires all members to have ADE in order to maintain their Individual Readiness.12 Accurate examinations and note taking are essential in these check-ups to appropriately manage and prevent the various oral diseases and conditions and keep Service men and women fit to deploy. Due to the nomadic nature of ADF members it is common for patients to see many Dental Officers throughout their Service career. This is why it is imperative to keep good records and also inform the patient accurately of chronic conditions they may have. It is just as important for Dental Officers to review previous notes to ensure follow up is done for previous oral conditions that have been identified and may need reviewing or treatment. In March 2011 The Directorate of Defence Force Dentistry promulgated a Directive13 that discusses the role of the Dental Officer in diagnosing oral pathology. It outlines the appropriate management and follow-up of such conditions. It recommends

CADMUS 2011

at least annual follow-up appointments for all pathology identified; the Directive also indicates that if Dental Officers are suspicious of a lesion, a referral to an appropriate specialist is recommended. The Annex to the directive is an Oral Pathology record. This form, now mandatory, is designed to accurately describe the oral lesion that is being investigated. The criteria assessed on the form includes the patient details, history of the lesion, known risk factors, anatomical location described in words and also on a diagram, duration of the lesion, size, symptoms, colour, surface texture, margins, consistency, contour, provisional diagnosis and a tick box for radiographs, photos or biopsies taken. The form requires a follow up date and the findings at this appointment and requires recording for any referrals and specialist reports or correspondence received. This comprehensive form covers all the important details that assist in the diagnosis of the lesion. It prompts the Dental Officer to consider all the criteria for the appearance of the lesion and provide an accurate description. It also allows future Dental Officers to quickly identify any pathology that needs to be followed up. The patient previously discussed, is now being managed at six-monthly intervals to monitor his smoking habit and the appearance of the white lesion. The patient has also been encouraged to seek smoking cessation advice from a Medical Officer and other allied health groups such as psychologists that are available in the broader Defence health network. The hyperkeratosis present in the biopsy specimen also included mild basal atypia with a possibility of HPV association. A PCR study would confirm or discard the association of HPV; however the management of the lesion, regardless of the result would remain the same. Due to the possible low-grade dysplasia and the mild basal atypia, the lesion is not indicated for complete excision. Instead regular monitoring of the lesion is recommended. The most significant prognosis indicator for this lesion is the cessation or continuation of the patient’s smoking habit. His periodontal condition has been diagnosed as mild to moderate chronic periodontal disease that has been influenced by prolonged heavy smoking. He is currently undertaking regular treatment by a Periodontist and will then proceed on to supportive periodontal therapy, which has an aim to maintain and monitor his bone level and oral hygiene. In conclusion, leukoplakia is an oral condition which needs to be identified and diagnosed accurately as the treatment and management varies greatly dependent on the histological appearance, whether the dysplasia is low-grade or highgrade. Patients who are smokers are more likely to develop leukoplakia and malignancy if the smoking is not ceased. Men are also at an increased risk, particularly those who have been long time smokers and older than 40 years of age. The ADF has addressed the problems of diagnosing and managing oral pathology through the mandatory use of the

Oral Pathology Record. Consistent and regular reviews and follow up appointments are required for patients who have been diagnosed with a dysplastic lesion. It is the responsibility of every Dental Officer in the ADF to remain vigilant and aware of oral pathological changes within the mouths of ADF members and when in doubt, a referral to a specialist is recommended.

References 1.

World Health Organization. Definition of leukoplakia and related lesions: an aid to studies on oral pre cancer. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology 1978; 46:518-39.

Evstfeeva TV, Zaridze DG. Nass use, cigarette smoking, alcohol consumption and risk of oral and oesophageal precancer. European Journal of Cancer, Part B Oral Oncology 1992;28:29-35.

Hogewind WFC, van der Waal I. Prevalence study of oral leukoplakia in a selected population of 1,000 patients from Netherlands. Community Dentistry and Oral Epidemiology 1988; 16: 302-5.

Freitas MD, Blanco-Carrión A, Gándara-Vila P, Antúnez-López J, García-García A, Gándara Rey JM. Clinicopathologic aspects of oral leukoplakia in smokers and nonsmokers. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology 2006; 102:199-203.

Banoczy J, Rigo O. Prevalence study of precancerous lesions within a complex screening system in Hungary. Community Dentistry and Oral Epidemiology 1991; 19:265-7.

Neville BW, Damm DD, Allen CM, Bouquot JE. Oral and Maxillofacial Pathology, Second Edition. Saunders 2002: 339-45

Ribiero da Silva CE, Guerreiro da Silva ID, Cerri A, Weckx LLM. Prevalence of human papillomavirus in squamous cell carcinoma of the tongue. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology 2007;104:497-500.

Tezal M, Sullivan MA, Reid ME, Marshall JR, Hyland A, Loree T, Lillis C, Hauck L, Wactawski-Wende J, Scannapieco FA. Chronic Periodontitis and the Risk of Tongue Cancer. Archives of Otolaryngology- Head and Neck Surgery 2007;133:450-4.

Poh CF, Ng S, Berean KW, Williams PM, Rosin MP, Zhang L. Biopsy and Histopathologic Diagnosis of Oral Premalignant and Malignant Lesions. Journal of The Canadian Dental Association 2008; 704;3:283-8.

10. Gorsky M, Epstein JB, Oakley C, Le ND, Hay J, Stevenson-Moore P. Carcinoma of the tongue: A case series analysis of clinical presentation, risk factors, staging, and outcome. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology 2004; 98:546-52 11. National Health and Medical Research Council. Australian Guidelines to Reducing the Health Risks from Drinking Alcohol 2009. 12. DI(G) PERS 36-2. Australian Defence Force policy on individual readiness. 13. DDFD Directive 01/2011. Appropriate Management of Oral Pathology Presentations. March 2011

CADMUS CADMUS 2011

Pantone 3288 C

Pantone 288 C

nta

m lD igita uip l Xray Eq

Australian Owned Australian Proud Australian Quality

nta

l Ch me airs and Equip

l Acc ssories e

Our Products include: Wide range of Australian made dental chairs and stools Precise imaging with Kodak x-ray units Mobile x-ray generator with Rextar Digital photography with Doctorseyes Mobile suction unit with Vacu-Jet Plus Handpieces and motors with Bien Air and NSK Scalers and LED Curing lights with Mectron

Infection Control supplies

Plant Equipment

PH: 02 8865 0300

www.williamgreen.info

Professional and Technical Items

CL1 to CL2 Case Study

Treatment options following a vertical root fracture Flight Lieutenant Georgina J M Seto, BDent

Introduction

Initial Treatment

A 50 year old male presented to RAAF Base WLM dental section with a “sore lower left tooth”. The patient had been in pain for four days, with the tooth in question feeling “loose and sore upon biting”. Review of his medical history revealed that the patient was a non-smoker, but significantly, he had a suffered a stroke three years ago and was taking 150mg of aspirin daily.

Examination

On examination, there was a buccal swelling adjacent to his 36 and an isolated 8mm periodontal pocket. The tooth was tender to percussion, very responsive to a Fracfinder™ (Denbur Inc. Illinois) and had a delayed response to CO2 testing. A periapical radiograph was taken and it revealed a significant radiolucency at the furcation and mesial root. The occlusal and buccal restorations were removed and a fracture was visible, running from the lingual to buccal surface.

Discussions were had with the patient regarding his current predicament. It was explained to him that due to the extent of the fracture, neither a restoration nor endodontic treatment would prove successful in treating the problem. With patient consent, his 36 was extracted and a prescription was given for pain relief.

Consultation Appointment Prior to any discussions regarding treatment options, it was explained to the patient that a major factor that attributed to the loss of his 36 required addressing. That is, the patient’s bruxing habit. An impression was taken in order to provide him with a mandibular occlusal splint. Next, the patient’s chief concerns were ascertained. The patient was primarily concerned with the recent limitations to mastication on his left side – especially since this had been his dominant chewing side for the last three decades. However, interestingly, the patient was happy to leave the space at quadrant 4 as is, since he felt he was accustomed to the space.

Diagnosis A diagnosis was made of vertical root fracture of 36.

Factors Attributing to the Diagnosis There was evidence of wear facets on all his anterior teeth and most of his posterior teeth. Following questioning, it was discovered that the patient had a history of bruxing, with frequent complaints by his partner regarding this habit. Moreover, the patient had lost his 46 as a teenager, and admitted to favouring his left side for masticatory functions.

CADMUS 2011

Discussion Discussions were had with the patient regarding potential treatment options and the replacement and maintenance costs associated with each option. The following treatment options were presented to him and are outlined below.

Treatment Options No Treatment One option is to leave the space at quadrant 3 as is. This patient has already experienced this option in their quadrant 4, when he

lost his 46 as a teenager due to decay. Whilst this is a conservative option, it has various implications, as can be seen in the patient’s 4th quadrant. Since this patient lost his 46 as a teenager, the 47 has now tilted mesially, and his 16 has over-erupted. Additional problems that may arise are drifting, and/or rotation of adjacent teeth.1 Removable Partial Denture A removable partial denture (RPD) is a conservative option since minimal tooth preparation would be required to obtain occlusal rests. Other advantages are: it is a reversible procedure, it is easy to repair and is an inexpensive option. However, many patients perceive an RPD to be a bulky appliance and an aesthetic compromise.2 Moreover, plaque accumulation can occur between the appliance and supporting teeth, with increased potential for caries and periodontal problems.2 3-unit Conventional fixed bridge A fixed bridge from 35 to 37 is another option to replace the missing 36. However, since his 35 and 37 are unrestored, this would be a very invasive option. Whilst a fixed bridge can be an aesethetic restoration and constructed in a relatively short period of time, it is an irreversible procedure that proves very difficult to repair should the porcelain fracture.2 Another disadvantage with the gross reduction of tooth structure on adjacent tooth is the increased potential for pulpal trauma. A retrospective study that looked at 169 bridges found that the most frequent cause of failure was pulp death.3 Resin-bonded bridge A resin-bonded bridge is a conservative option to replace the patient’s missing 36. Since it requires less removal of tooth structure than a conventional bridge, the potential for pulpal trauma is reduced. However, there are a number of disadvantages associated with a resin-bonded bridge. Firstly, their longevity is less than that of conventional prostheses.4 Secondly, a study found that posterior and mandibular resin-bonded bridges demonstrated higher dislodgment rates.5 The reasons suggested for this dislodgement were occlusal forces and difficulty with isolation during the bonding procedure. Since this patient has a history of bruxing, a resin-bonded bridge would not be a suitable treatment option. This is because a resin-bonded bridge has a lower resistance to displacement than that of a conventional bridge. Osseointegrated Implant Another option for replacing the patient’s missing 36 is a single tooth implant prosthesis. Whilst this treatment is of lengthy duration, is dependent on adequate bone and is expensive, it also has a number of advantages. One advantage is that it is a fixed restoration that requires no preparation to neighbouring teeth. Consequently, a single tooth implant prosthesis is often the restoration of choice when the adjacent teeth are intact.2 Furthermore, a screw-retained implant crown provides retrievability should it become loose. There is currently no proof for the suggestion that bruxism may cause an overload of dental implants and of their suprastructures.6 However, it is recommended that the final treatment result should be protected, in bruxers with implants, by means of a hard stabilisation splint for night-time use, so as to minimise (or even negate) the lateral destructive forces.6 Discussions were had with the patient about the issues associated with undergoing complex dental treatment. A Dental Locality Restriction (DENTLR)7 – and its implications – was explained to the patient. He was informed that an application for a DENTLR required approval from both his Commanding Officer and Career Manager. Furthermore, it was emphasised that should he cease

continuous full-time service for any reason prior to completion of the treatment, then the Commonwealth would not be responsible for providing the dental service to complete treatment, nor for any associated treatment costs.7 The patient was made aware that posting restrictions and the downgrading of his dental fitness classification could have operational, employment and career implications.8

Assessment of the Treatment Options Following discussions with the patient and the section’s Senior Dental Officer (SDENTO), it was decided that the replacement of the missing 36 with an implant was justified on the grounds that it would enhance function now and would prevent further functional problems in the future. Such functional problems include drifting, tilting, rotating, and over-eruption of nearby teeth. With respect to replacing missing teeth, Health Directive (HD)424 states that: “The functional stability and potential longevity of treatment options should be assessed to achieve the best combination of function, longevity, strength and aesthetics (where applicable).”1 With this in mind, and taking into account both the advantages and disadvantages of the treatment options listed above, a single tooth implant was considered the best treatment option and was conservative of adjacent unrestored teeth. A referral was written to the oral surgeon and prosthodontist to ascertain their opinion for an implant placement to replace the patient’s missing 36.

Conclusion This case examined the treatment options available to an ADF member following extraction of a molar. It highlighted that the Dental Officer must consider various factors during the treatment planning process. Firstly, the Dental Officer must ascertain the patient’s chief concerns. Secondly, specific patient factors need to be considered, such as a bruxing habit, and the current state of their dentition. Furthermore, the various treatment options need to be weighed up according to their suitability for the patient now and for the future. The implications and/or restrictions to their Service life need to be clearly explained and complex treatment at Commonwealth expense must be justified. Finally, the patient was also made aware of the cost of this treatment in private practice, the need to have it reviewed periodically by a specialist, and the need for excellent oral hygiene. Success rates of posterior single tooth implants were discussed and consequences if treatment failed after the member had separated from Defence.

References 1.

Health Directive 424. Treatment Planning Guidelines for Restorative Dentistry in Australian Defence Force Dental Facilities. 1997.

Chan R, Tseng T. Single tooth replacement – expanded treatment options. Australian Dental Journal. 1194;39(3):137-149.

Cheung GSP, Dimmer A, Mellor R, Gale M. A clinical evaluation of conventional bridgework. J Oral Rehabil. 1990;17:131-6.

Rosenstiel SF, Land, MF, Fujimoto J. Contemporary fixed prosthodontics, 4th edition. St. Louis Missouri. Mosby Elsevier, 2006.

De Kanter RJ, et al. A five-year multi-practice clinical study on posterior resin-bonded bridges. J Dent Res. 1998;77:609.

Lobbezoo F, Brouwers JEIF, Cune MS, Naeije M. Dental implants in patients with bruxing habits. J Oral Rehabil. 2006;32:152-159.

Health Directive 426. Australian Defence Force Locality Restriction for Dental Treatment. 2000.

Health Directive 401. Dental Implantology in the Australian Defence Force. 1999.

CADMUS 2011

Professional and Technical Items

Dental Officer CL1 to CL2 Case Study

Treatment of a Tooth with Cracked Tooth Syndrome FLTLT Amy Dempster, BSc, BDent (Hons)

Introduction

Treatment Options

A 31 year old male patient presented for his Annual Dental Examination (ADE) complaining of pain on biting on the upper left side. The patient reported that he could no longer bite on that side at all and also complained of cold sensitivity in the area. He reported that he had been experiencing pain in the upper left on and off for years. His past dental history revealed that the 26 had a disto-occlusal restoration placed in 2000 and that he had first complained of pain on biting in the tooth in 2002. The restoration was replaced several times and in 2007 it was extended to cover the disto-palatal cusp. However, the sensitivity to cold and pain on biting returned after each treatment. The patient is a pilot in a flying squadron and his medical history revealed nothing of significance.

Immediate treatment is aimed primarily at relief of pain. In this case the patient was given the following immediate treatment options:

Examination and Diagnosis Extra-oral examination revealed no abnormalities. Intra-oral examination of hard and soft tissues also revealed no abnormalities. Visual examination of Quadrant 2 showed that the 26 had a distooccluso-palatal amalgam restoration present and the 27 had a mesio-occlusal amalgam restoration, as well as an occlusal composite restoration. Elsewhere in his mouth there were occlusal amalgam restorations in the 17, 37 and 47. The member was unable to localise which tooth on the upper left was causing the pain. Diagnostic tests revealed that no teeth in Quadrant 2 were tender to percussion and all responded positively to a cold test, although the 26 was delayed in comparison with other teeth. A cuspal fracture testing instrument (Fracfinderâ&#x201E;˘, Denbur Inc. Illinois) was then utilised and the pain was reproduced from biting on the disto-palatal cusp of the 26. Bitewing films revealed that the amalgam restoration in 26 was very deep in the distal portion. A periapical radiograph was taken but showed no apical pathology. The presenting symptoms in conjunction with the history of the tooth and diagnostic findings indicated a differential diagnosis of cracked tooth syndrome in tooth 26.

Radiographs

a. Replacement of the disto-occluso-palatal restoration with another cusp covering amalgam restoration followed by a review in four weeks time to determine if symptoms had resolved. The patient understood that he would be Temporarily Medically Unfit for Flying (TMUFF) for a period of eight hours following administration of local anaesthetic. b. Cementation of a molar orthodontic band around the tooth. If successful this would relieve the symptoms as well as confirming the diagnosis of cracked tooth syndrome. Once diagnosis was confirmed the tooth would then be suitable for definitive treatment with placement of a crown. The patient decided to have a molar band placed around 26. The molar band was cemented in place with a glass ionomer cement and a review appointment was booked for two weeks time.

Definitive Treatment At the review appointment the patient reported that the tooth had been asymptomatic since placement of the molar band. It was decided to proceed with crowning the tooth. It was explained to the patient that he would be TMUFF for eight hours following administration of the local anaesthetic. It was also discussed that following commencement of crown preparation his Dental Fitness Classification (DFC) would be downgraded to 3 until the crown was cemented. The patient was warned of the possibility of the tooth needing endodontic therapy in the future due to the risk associated with crown preparation of vital teeth.1 The crown preparation was completed and a porcelain fused to metal crown was cemented in place. The patient was reviewed two weeks after cementation and reported that he was very happy with the treatment outcome and had not experienced any symptoms in the tooth following placement of the molar orthodontic band.

Discussion Cracked tooth syndrome typically presents with symptoms of pain to biting (particularly hard grainy foods) and pain to temperature stimuli but especially to cold. Despite these characteristic symptoms this syndrome is often difficult to diagnose since diagnosis depends on reproducing symptoms in the clinical setting2. Elimination of symptoms with placement of a molar orthodontic band is also diagnostic of the syndrome3. In this case it was possible to reproduce CADMUS 2011

CAT5570CAD

Suction Systems Amalgam Retention Systems Oil-Free Compressors

PERFORMANCE & RELIABILITY

The range of Cattani compressors gives you reliability and high performance to achieve clean, dry air, all of the time. Our reputation for customer service and quality is the result of a specialisation in the field of dental air compressors and suction systems that spans over five decades. ...because weâ&#x20AC;&#x2122;re the specialists

Speak to your Cattani supplier for further information or to see a full range of compressors available to suit your clinic, go to

www.dentalcompressor.com.au

symptoms clinically as well as eliminating them with placement of the molar band. The history of this tooth revealed that symptoms were first reported in 2002 and no firm diagnosis had previously been made. This is typical of teeth with this condition and highlights the difficulty of achieving an appropriate diagnosis. Teeth diagnosed with this syndrome can present with varying degrees of thermal sensitivity. The degree of pain to thermal stimuli relates to the degree of pulpal inflammation present.2 It is often unachievable to determine how far a vertical crack has progressed through the dentine and indeed whether there is any pulpal involvement.3 Even with early diagnosis and treatment with a full coverage restoration there always remains a risk of further pulpal degeneration and eventually the need for endodontic therapy2,3,4. In addition to this the treatment of vital teeth with full coverage crowns itself carries a risk of pulpal degeneration due to the trauma of crown preparation on the pulpal tissue. On average it is expected that about 10% of vital teeth that are crowned will require endodontic treatment within 10 years.1 The treatment protocols for teeth diagnosed with cracked tooth syndrome vary greatly in the literature. Most studies agree that full coverage restorations are necessary to eliminate symptoms, but the type of restoration recommended differs.4 A study that looked at the fracture resistance of different restorations found that teeth restored with amalgam only achieved fracture energies equivalent to intact teeth. In contrast teeth restored with gold onlays or crowns had three times the fracture energies.5 The higher the fracture energy achievable the better the overall fracture resistance will be. The literature is mixed on the outcomes of cracked teeth restored with composite resin. Although some studies indicate that this treatment is successful,6 they often only evaluate restorative success and do not consider elimination of symptoms. Restoration with indirect bonded composite resin has proven more successful at eliminating symptoms than direct composite resin restorations.7 Overall though the evidence widely supports the use of full coverage crowns as the ideal treatment of cracked tooth syndrome.2,3 Dentistry in the military setting has a different focus to that in the civilian sector. It is driven by maintaining the deployability of a member and has less focus on aesthetics and to some extent financial factors. Australian Defence Force (ADF) members are classified into DFC 1 to 4 to indicate their level of dental fitness at any given time. DFC 1 and 2 indicate that a member is deployable, while DFC 3 and 4 mean that a member is non-deployable due to treatment requirements. Members must be classified after each assessment and after each treatment or consultation.8 The patient in this case was downgraded to a DFC 3 for the period of time between the crown preparation and crown cementation. It is important to discuss this with the member before initiating treatment as operational factors can influence treatment timings and decisions. This patient was a pilot in a flying squadron, and this further complicates treatment planning and must be taken into consideration during the decision making process. In dentistry there are a number of commonly used drugs that have the potential to impair a patient’s performance for a period of time. In addition to this some conditions and complicated procedures can also have a negative impact. Defence policy dictates that where aircrew may be affected by this they must be made TMUFF so as to minimise the risk.9 Following the administration of local anaesthetic aircrew must be made TMUFF for a period of eight hours.10 Health Directive (HD)411 outlines the period of time that member’s must be TMUFF for various treatments and medications. Aircrew are subject to slightly different protocols within the dental environment than other patients. Given the work environment of aircrew there are potentially more serious consequences of delayed dental treatment. Although there was no risk of an Air Safety Incident in this case, the dental practitioner should always be cognisant of the CADMUS 2011

potential of certain dental treatments and conditions to cause such an incident when treating aircrew patients. Therefore diagnosis in these patients should be based on definitive clinical testing rather than prolonged observation9. HD411 also places restrictions on materials and treatments that can be utilised in aircrew. For example, direct pulp capping and pulpotomy procedures are contraindicated. Caution should also be exercised when considering restorative materials for large posterior restorations as composite resin is highly technique sensitive and less reliable than amalgam. Minimum intervention is advocated in ADF Dentistry, but in the case of more complex treatment, consideration must be given to the cost of through-life maintenance of dental treatment following separation from the ADF.11 In this case the more complex treatment option of a crown was justified since the patient had been treated conservatively over a number of years and the problem had not resolved. The patient understood these implications and gave consent before treatment was commenced.

Conclusion Cracked tooth syndrome is a commonly seen scenario in the dental surgery and can be difficult to diagnose. It is essential to take a good history and to use this and any clinical findings to determine an accurate diagnosis. This case highlighted a number of considerations specific to dentistry in the ADF. Ideally treatment must be planned so as limit the impact on the member’s ability to perform their duties. This is particularly pertinent in the case of aircrew since even simple procedures can mean a period of TMUFF for a member. Ultimately the aim of good dentistry is to maintain a patient’s dental health whilst being as conservative as possible and this ideal is unchanged in the ADF. However, consideration must be given to the unique environment that ADF patient’s experience as well as the demands that the military places on members, as this can significantly influence treatment choices.

References 1.

Valderhaug J, Jokstad A, Amjornsen E, Norheim PW. Assessment of the periapical and clinical status of crowned teeth over 25 years. Journal of Dentistry 1997 Vol. 25; 2: 97-105.

Lubisich EB, Hilton TJ, Ferracane J. Cracked Teeth: A Review of the Literature. Journal of Esthetic Restorative Dentistry 2010; 22: 158-167.

Ailor JE. Managing incomplete tooth fractures. Journal of the American Dental Association 2000; 131: 1168-74.

Geurtsen W, Schwarz T, Gunay H. Diagnosis, therapy and prevention of cracked tooth syndrome. Quintesssence International 2003; 34: 409-17.

Hood JAA. Biomechanics of the intact, prepared and restored tooth: some clinical implications. International Dental Journal 1991; 41: 25-32.

Opdam NJ, Roeters JJ, Loomans BA, Bronkhorst EM. Seven year clinical evaluation of painful cracked teeth restored with a direct composite restoration. Journal of Endodontics 2008; 34: 808-11.

Sigmore A, Benedicenti S, Covani U, Ravera G. A 4- to 6-year retrospective clinical study of cracked teeth restored with bonded indirect resin composite onlays. International Journal of Prosthodontics 2007; 20: 609-16.

Health Policy Directive 402: The Australian Defence Force Dental Classification System.

Health Policy Directive No 411: Aviation and Diving – Dental Considerations.

10. Defence Instructions (General) OPS 22-2 Temporary Medical Unfitness for Flying and Aircraft Control Duties (Aircrew, Air Traffic Controllers and Air Combat Officers). 11. Health Policy Directive No 424: Treatment Planning Guidelines for Restorative Dentistry in Australian Defence Force Dental Facilities.

Dürr Clinic Systems Dental Suction and Compressed Air Systems

FeatureS • Reliable & flexible • Unlimited configuration • Wet and dry suction • Oil free dry air systems

• Used by international army hospitals • ISO 11143 Amalgam separation available

• Paramount levels of hygiene

For more information call Rhoda Maclean on 1300 486 2527

www.ivoclarvivadent.com.au Ivoclar Vivadent Pty Ltd

1-5 Overseas Drive, Noble Park North VIC 3174 | Australia | Tel.: 1300 486 2527

Dürr System Hygiene Peace of mind through simplicity • COMFORTABLE • GENTLE • SAFE • FAST

The Origina

l Orotol® Plus Suction Unit Disinfectant HD435 Mild Hand Wash HD440 Hand Care Lotion FD333 Quick-Acting Surface Disinfectant FD360 Vinyl Upholstery Clean & Care MD520 Impression Disinfectant

For more information call Rhoda Maclean on 1300 486 2527

www.ivoclarvivadent.com.au Ivoclar Vivadent Pty Ltd

1-5 Overseas Drive, Noble Park North VIC 3174 | Australia | Tel.: 1300 486 2527

RAADC Corps and Historical

Update from the RAADC Association Incorporated Gayle Clare, Secretary

2013 Reunion The RAADC Association looks forward to celebrating the 70th Anniversary of the Corps in April 2013 and seeks the support of members and guests for this special occasion. The 2013 Reunion will be held in Brisbane. In order to ascertain the viability of conducting the Reunion dinner and other functions, members will be contacted to obtain expressions of interest. This will be done at the same time that subscriptions are sent out later this year.

ANZAC DAY Brisbane 2011 After various Dawn Services in and around Brisbane, members and visitors formed up in George Street for another memorable and moving ANZAC Day March. Our numbers were down this year probably because ANZAC Day fell at the end of the Easter break. Our contingent was led by MAJ (Ret’d) Pat Jackman. The RAADC Association Banner was carried by Graham Sagar and Peter Ward and the 33 Dental Unit, South Vietnam Banner was carried by Haydee Stevens.

The Senior Chaplain at Army HQ, Chaplain Catie Inches-Ogden, performed the prayers, the dedication and blessing of the plaque. The HOC, LTCOL Genevieve Constantine gave a commemorative address. The plaque was located on a pedestal and unveiled by COL Viv Bird (Ret’d) and the Corps RSM, WO1 Kym Chiesa, CSM. After the unveiling, WO1 Chiesa recited The Ode. CPL Mathew Creek, bugler of the Band of the Royal Military College then played the Last Post. To conclude, the Colonel Commandant, COL Stephen Curry (Ret’d) thanked all of those involved in arranging the plaque and the ceremony and farewelled those in attendance. Some of those in attendance were: COL Ron Beynon (Ret’d); LTCOL Nick Read, DHOC, MAJ Debbie Olsson, SO2 Corps Heritage; LTCOL Murray Thomas (Ret’d); LTCOL Mike Wunderlich (Ret’d); LTCOL Sven Kuusk (Ret’d); LTCOL Bruce Peate (Ret’d); LTCOL John Sanders (Former DHOC); MAJ Kevin Konneman (Ret’d); CAPT Dave Noy (Ret’d); WO1 Wayne Butler; WO1 Lynn Daly; WO2 Adele Tippetts (Ret’d); Mr Bruce Paul and Mr Warwick Madden.

Those who marched in our contingent included Mal Slattery, Renate Provost, Bob Greenhill, Vicki MacPherson, Marty Mylne, Suzy Atkins, Rob Hazelwood, Vince De Wedger, Gayle Clare and Dana Socal. After the march many of us, along with family and friends, gathered at Gilhooley’s Tavern in Albert Street for lunch and refreshments.

WO1 Kym Chiesa, CSM and Mrs Dexter Purcell, COL Viv Bird in background, Mr Warwick Madden and COL Ron Beynon on right.

The end of Dental Technician Training in the Army RAADC Association members at the Brisbane Anzac Day Parade

RAADC Plaque Dedication Ceremony On Thursday 21 October 2010, the RAADC Association President, Mrs Dexter Purcell attended the Plaque Dedication Ceremony at the Australian War Memorial (AWM) in Canberra as the RAADC Association representative. The assembled group of past and present members of the RAADC and guests were welcomed to the event by MAJGEN Steve Gower (Ret’d), AO, AO (Mil), Director of the AWM.

CADMUS 2011

On 01 July 2011, Ron Brown, Gayle Clare, Peter Ward, Bob Keane, Barry Webb and Ian McPherson attended a ceremony to commemorate the cessation of Dental Technician Training in the Army. The RAADC Association attendees, all ex serving ARA and ARES WO2 Dental Technicians, joined serving RAADC members and guests at the ceremony in the Gallipoli Barracks Dental Centre. PTE Brendan Zhang and PTE Evan Keast were the final Army Dental Technicians (ECN 404) to graduate and the ceremony recognised the history and contribution made by Dental Mechanics/Technicians in the Australian Army. Following the official proceedings, the RAADC HOC, LTCOL Genevieve Constantine presented MAJ Karen Such with the RAADC Centrepiece, CADMUS (“Puff”), which is now located in the foyer of the Gallipoli Barracks Dental Centre.

at WRAAC School, Georges Heights. The CSM for the day, Carolyn McMahon, did a sterling job, accompanied by 1/15 Royal NSW Lancers Band, playing “Soldiers of the Queen”. A plaque dedication and flag lowering ceremony at Irving Place followed the parade. The Reunion Dinner was held on Saturday evening, also at the Kirribilli Club. There were 350 WRAAC (including some RAANC) members in attendance. The guest speaker was MAJGEN Liz Cosson, CSC (Ret’d) who had graduated as a WRAAC officer before being allocated to RAAOC. Sunday concluded the event with a church service at the Garrison Chapel, The Rocks followed by lunch aboard a cruise boat on the fabulous Sydney harbour.

PTE Evan Keast and PTE Brendan Zhang

RAADC Association AGM 2011 The RAADC Association AGM was held on the 21 May 2011 at the Sea Drift Guest House, 47 Balmoral Rd Montville. All office bearers were re- elected unopposed. President: Mrs Dexter Purcell

Vice President: Mr Mal Slattery Secretary: Ms Gayle Clare Treasurer: Mr Graham Sagar Social Member: Mr Ian Macpherson Records Member: Ms Dana Socal Property Member: Mr Ron Brown Serving Members: Cpl Johanna Theobald and Pte Morgaine Miscamble

Vale – RAADC Association Patron – Col Maurice Dingle Colonel Maurice Dingle (Ret’d) had been the Patron of the RAADC Association since July 2000. He graduated from the University of Queensland in September, 1944 and enlisted in the Australian Imperial Forces on 6 September 1944. He saw service in various dental units in both Australia and New Guinea before being posted to Japan with the British Commonwealth Occupation Forces in 1945. He returned to Australia from Japan in 1947 and took discharge. He returned to part-time military service several times in the 1950’s and 60’s. He was the first Major, Officer Commanding, 1 Dental Unit (CMF) in 1949. He was promoted to Lieutenant Colonel (Assistant Director Dental Services) N Comd in 1957 and then Colonel (Deputy Director Dental Services) N Comd in 1966. He transferred to the Reserve of Officers (Retired List) in 1979. He was President of the Queensland Branch of the Australian Dental Association in 1966. Maurice retired from private practice in 1997. He was a prolific letter writer (long hand) and over the years has provided the RAADC Association with details of his service during WW2 and later. Maurice’s loss will be felt by all members of the Association. He was a wonderful man and his knowledge and guidance will be missed by all.

L to R: Kerry Chapman, Tanya Marshman, Dexter Purcell, Trudy Thomas

25th Anniversary of the Ex-Servicewomen’s Memorial.

Dedication

the

In November 2010, RAADC Association President, Mrs Dexter Purcell attended the Service of Remembrance held at the Shrine in Melbourne to commemorate the 25th Anniversary of the Dedication of the Ex-Servicewomen’s Memorial. This dedication of the Memorial Garden and Cairn brings to close the original aims of a group of World War 2 ex-servicewomen (led by Sybil Irving) who sought to build a memorial within the Shrine grounds over sixty years ago. A landscaped garden designed by Katherine Rekaris includes ceramic violet flowers intermingled with plantings of native violets and grasses. (The violet was long regarded as the flower of remembrance, before the poppy of WW1) The garden is surrounded with young jacaranda trees and the memorial cairn is placed centrally within the garden. The ceremony was conducted by COL Jan McCarthy, AARC (Ret’d) (Ex-Director of Nursing – Army), and prayers and blessing of the cairn were conducted by MAJ Jean Smart, OAM of the Salvation Army. The memorial garden is dedicated to the women who served and are serving Australia in the Navy, Army and Air Force, some 70,000 since the Boer War.

WRAAC 60th Anniversary Reunion, Sydney 11 – 13 February 2011 The RAADC Association President, Mrs Dexter Purcell attended the WRAAC 60th Anniversary Reunion weekend in February this year. The Reunion commenced with a Meet and Greet on the Friday night consisting of drinks and finger food at the Kirrabilli Club. There were at least 400 women, all trying to recognise and renew contacts from the past. On Saturday 12 February there was a parade

Dexter Purcell placing a poppy in front of the cairn.

CADMUS 2011

Joint Units

Unit News Directorate of Defence Force Dentistry Campbell Park Offices, ACT LTCOL Genevieve Constantine and WO Penny Stone The focus for the Directorate for 2011 has been the review of outdated policy and the provision of guidance to junior Dental Officers and CHPs. The Directorate continues to operate with the majority of its staff remote from Canberra. SO1 DPP, LTCOL Genevieve Constantine works remotely from Darwin and also has the additional appointment of Head of Corps, RAADC. SO1 CDS, SQNLDR Janine Tillott works part time remotely from Adelaide on Mondays, Thursdays and Fridays. LCDR Kate Bailey works remotely from London three days per week. WODEN Penny Stone works remotely from Sydney and has been kept extremely busy as the DDFD representative for the JeHDI Solution Demonstration Laboratories (SDL). We are very pleased to welcome LS Ashleigh Nock who provides invaluable administrative support to the Directorate on one Reserve day per week.

The Directorate also continues to consult closely with representatives of all three Services, senior specialists, Dental Officers and the ADF Dental School. We wish to thank COL Curry, COL Stacey, COL Scott, COL Olive, COL Thurnwald, GPCAPT Mahoney, CMDR Brazier, LTCOL Freeman, WGCDR Cordery, LCDR Leong, CAPT Jacobsen, WO1 Chiesa and FSGT Fitsgibbon for their excellent support and advice. CAPT Byrne, RAN will be posted at the end of 2011 into the Director Navy Health position and he would like to take this opportunity to thank all those who have supported him as DDFD. He welcomes COL Constantine on promotion to the DDFD position and wishes her well for the future. We all wish you a safe and enjoyable Christmas and a happy and productive 2012.

The Directorate farewelled WGCDR Mark Oâ&#x20AC;&#x2122;Sullivan who has left the RAAF after 15 years of service. We thank him for his outstanding support and effort and wish him well in his future endeavours. We hope to utilise his specialist endodontic skills when he provides Reserve service in the future. The Directorate continues to consolidate and analyse the Monthly Dental Returns. The information contained in the PM276 and PM354 returns are providing valuable insight into treatment trends, productivity and challenges faced by units. The Monthly Returns have been collated since 2008 and with continued accuracy and prompt submission a long-term trend analysis will be achievable. Many thanks to those consistently collating and submitting the returns â&#x20AC;&#x201C; your efforts are greatly appreciated.

CADMUS CADMUS 2011

Royal Australian Navy Dental Branch

Fleet News Lieutenant Commander Peter Case, RAN, Fleet Dental Surgeon

tirelessly as the Manager of the FBE Fleet Dental for the last three years welcomed the arrival of her daughter Chloe Alicia Crump in August and will discharge from the RAN after 14 years of service. She will be sorely missed and we wish her the best. With many farewells we welcomed a string of females into the team for what would become the first all female Fleet Mobile Dental Teams. LEUT Shannon Godfrey and LEUT Sarah Benton have joined Fleet Dental at FBE and FBW respectively. Just months later we welcomed back AB Tevita Kama and AB Edward Todd as Fleet Dental Assistants. The previous 12 months has seen the Fleet Mobile Dental Teams embarked in HMA Ships TOBRUK, MANOORA, BALLARAT, PARRAMATTA, and SYDNEY. Fleet Dental, whilst at sea also treated HMAS Ships TOOWOOMBA, WARRAMUNGA and PERTH. With upcoming deployments on HMA Ships NEWCASTLE and DARWIN it has been an extremely busy year. By having the dental teams deployed, this has allowed 1500 personnel access to dental care whilst at sea. This highlights the value of deployable dental teams in maintaining the dental fitness of Fleet Personnel. The Mobile Operating Dental Units (MODU) at FBE and FBW, have both proven to be a valuable assets with many Fleet members receiving treatment in the MODU. Most days will see the FBE MODU in action on the wharf. Thanks must go to CMDR Blenkin who has spent many hours in MODU providing Annual Dental Exams for FBW based Ships. An experience that was so memorable, it has left the FBW MODU out of action.

As usual, the demand to deploy Fleet Dental Teams has remained high over the last 12 months. With much hard work completed at sea, there is little respite ashore as Fleet Dental continues to provide dental services to those Ships alongside ensuring Fleet personnel are dentally fit. The ability of the Fleet Team to continually adapt to the ever-changing HMA Ships programs shows their commitment to ensuring members are ‘Fit to Bite, Fit to Fight!’ The previous 12 months has seen the Dental Fitness of HMA Ships average over 90%. Although the Fleet Team work hard to keep seagoing members dentally fit to deploy, the support of shore based dental units must not be overlooked in their assistance. As always, 2011 has seen a number of staff changes within Fleet Dental. LEUT Simon Flanagan hung up his anti-flash and posted into HMAS WATSON as the SDO. AB Christie Woodleigh followed suit and her laughter can now be heard in the corridors of HMAS CERBERUS. LEUT Tom Yong and AB Katie McDonald-Walker have also reluctantly given up the reins of FMDT Three and both continue to work at FBW. Finally, PO Alicia Hills who has worked

As another year comes to an end, planning has already begun for what promises to be a busy new year. Plans are underway for RIMPAC, assisting Fleet Units reach readiness for deployments to the Middle East as well as remaining on 48 hours notice for sea to sail with HMAS TOBRUK for humanitarian aid.

Fleet Dental Team One and Two LEUT Sally Cochrane, RAN HMAS TOBRUK I joined HMAS TOBRUK with AB Lanie Boer and our first trip was ‘up top’ to SE Asia. To our surprise six dentists were to join TOBRUK, which had taken over from USS MERCY for the final contingent of Pacific Partnership 2010 in Papua New Guinea. On transit to PNG we were quick to put these additional assets to use. In exchange for the use of the Wardroom washing machine at midnight RAAF reservist Dr Deidre Ryan and Terri-Anne Dehncke quickly adjusted to working on moving patients. After 20 years as a

CADMUS 2011

dentist Dr Ryan said dentistry at sea was the hardest thing she had done and happily handed back the drill. This is testament to the hard work provided by all Fleet Dental personnel. AB Boer and I were fortunate enough to join the PP10 team in PNG. After many days of hard work in PNG we were back to sea for the transit home, but not without a tourist day to the Rabaul Volcano, markets and WWII sites.

reluctant to see them go. As a result ‘Team Gregs’ were offered accommodation for the Ships deployment to Samoa and Hawaii. On ‘Team Gregs’ return they welcomed the sight of SUCCESS back alongside FBE only to learn that the dental chair was U/S. So ‘Team Gregs’ remain a fixture at HMAS KUTTABUL Dental. Although they will no doubt have the portable gear out again now that we have upgraded to the portable digital x-ray system.

The Portable Dental Units are notorious for ‘playing up’ at sea. Luckily for us this wasn’t a problem with US medical technicians onboard. With a toolbox the size of a make-up bag the technicians were able to fix all our problems – a much appreciated luxury! During the return transit to Darwin I learned to never let four dentists play Uckers (a traditional Naval board game). What normally takes one hour to play turned into a four-hour marathon finishing at midnight! Needless to say I was not allowed to touch the Uckers board for the remainder of the trip. So I took up cards…. competitively too. After our work ashore in PNG we had some respite in Indonesia, Singapore and Malaysia. Although we learned to have the dental chair ready at action stations for all cocktail parties, as there always seemed to be a dental casualty in the first 10 minutes. After nearly three months in TOBRUK we treated almost the entire ships’ company. This included both routine dental appointments as well as emergency patients. At the time of disembarking TOBRUK had a dental fitness of 97%.

HMAS NEWCASTLE A request from HMAS NEWCASTLE for a Dental Team at short notice saw LEUT Godfrey and AB Lanie Boer in a mad rush to organise equipment to join the Ship on the other side of the country. Fortunately FBW came to the party and kindly gave us a helping hand. The pair is set to leave soon to begin their own game of Tetris in Aft Battle. Good luck!

HMAS DARWIN AB Tevita Kama and I are to join forces again in HMAS DARWIN for what we are hoping is a nice calm scenic tour of the Great Barrier Reef. I am hoping Tevita’s vocals talent will be heard again when what has become the cleanos music is cranked up each afternoon – So Fresh Hits of Winter 2002!

HMAS MANOORA LEUT Shannon Godfrey having just posted into the Fleet billet was excited at the prospect of her first chance to join a Ship. After a tough morning in HMAS MANOORA loading 350 kgs of dental equipment down two ladder bays into the pathology lab, LEUT Godfrey and AB Christie Woodleigh were ready for action. That action would see them sit alongside the wharf for one week. The end of their ‘deployment’ revealed news of MANOORA’s decommissioning.

HMAS SYDNEY LCDR Kelly Gregg and LS Greg Pashen, affectionately known as ‘Team Gregs,’ posted into HMAS SUCCESS in January. However with SUCCESS still in Singapore HMAS SYDNEY was to be their new home. Fleet Mobile Dental Unit One was rearranged in a game of Tetris to fit into Aft Battle. For those unfamiliar with FFG’s, Aft Battle is the size a shoebox and can only fit two Tetris blocks. After many weeks treating patients in these cosy confines, the crew was CADMUS 2011

PO Alicia Hills must not be forgotten amongst all our ‘trips of a lifetime’ as without her dedication and ability to fix anything (even from another country) it would not have been smooth sailing. Since her departure we have had a steep learning curve. We all look forward to many more tales from the high seas in 2012.

PACIFIC PARTNERSHIP 2011 (PP11) In April, LEUT Shannon Godfrey, FLTLT Khai Nguyen, AB Melissa Lavelle and AB Katie MacDonald embarked USS CLEVELAND in Hawaii for contingent one of the joint-nation humanitarian mission. They rendered much needed dental care, mainly in the form of extractions, to local people in Tonga, Vanuatu, PNG and New Caledonia before handing over the reins to LCDR Mark Page, LEUT Karina Cvejic, FLTLT Eugeniya Kelloway, CPL Donna Hayes and AB Vanessa Gamble for contingent two in Darwin. The second team then visited Timor Leste and the Federated States of Micronesia before finishing in Hawaii. The Dental team (which also included of dentists and assistants from other partner nations) saw over 3500 patients over four months in what has been described as the most successful PP mission since it’s inception in 2004. Well done to the Fleet and extended ADF team who represented us in the mission.

Fleet Dental Team Three Lieutenant Sarah Benton, RAN Well it has been a busy start to 2011 for FMDT3. I took over as dental officer for the team from LEUT Yong in January and after initially thinking it would be a quiet first half of the year with none of the west based ships wanting to employ our services, a phone call from LCDR Case in March saw myself and AB Todd packing our bags to head away with HMAS BALLARAT for a little over two months on South East Asian Deployment 1/11 (SEAD 1/11) . Full of enthusiasm AB Todd and I embarked BALLARAT in early April to head ‘up top’. In company with us were ships HMAS PARRAMATTA, HMNZ Ships TEMANA and TEKAHA. During this time the task group CTG627.1 participated in EX MASTEX, EX BERSAMA SHIELD, and EX AUSTHAI and also attended IMDEX, the International Defence Maritime Expo, in Singapore. During these exercises the ships conducted air warfare, sub-surface and surface defence manoeuvres, which certainly made dentistry a lot more interesting! It was a lot of fun doing PT on the flight deck while fighter jets were buzzing the ship and performing evasive manoeuvres. With BALLARAT heading on a Gulf deployment later this year and not returning home until March 2012, we had plenty of work ahead of us since 100% of the crew needed to be seen in order to remain IR compliant for the duration of the deployment. I am happy to report that we achieved our goal, although it wasn’t without a few late nights and many appointments scheduled after dinner time! Word also got around the task group that one of the Aussie ships had a dentist on board, so we did our bit for international relations, helping out some of the crew from one of the Royal Navy ships and one of the New Zealand ships who needed emergency pain relief. Towards the end of our time on BALLARAT, when it looked like we were going to get through everything as scheduled, the CO for PARRAMATTA requested that we cross deck to help improve their dental stats as well. So for the last leg of the trip back from Thailand to Australia, we moved all the gear over to PARRAMATTA and saw 60 patients for check-ups and treatments.

As a reward for our hard work we had some excellent port visits scheduled, spending three or four days in each of Surabaya, Penang, and Pattaya. We spent nearly two weeks in Singapore over two different port visits, and I think its fair to say that I nearly ate my weight in satay sticks and chilli crab whilst alongside. As well as a lot of fun alongside, we also had four SWIMEX, (in a lovely water temp of 31oC), a couple of steel deck BBQ’s, tombola nights and even a FISHEX. A special mention must be made of our Fleet liaisons, LS Amanda Cox and PO Alicia Hills, who were a huge help to me whilst at sea and very helpful in answering all questions and arranging follow up appointments for patients on return home. SEAD 1/11 was a great start to my posting with Fleet Dental and hopefully there will be many more adventures for 2012.

CADMUS 2011

Royal Australian Navy Dental Branch

Unit News HMAS KUTTABUL Chief Petty Officer Kenneth Swinbourn It is neither legend nor myth that HMAS KUTTABUL is one of the busiest Dental Departments in the ADF. Over eight thousand patients were seen and treated in the last twelve months, just short of seven hundred patients a month and 180 patients a week. This massive workload was shared by three uniform Dental Officers (DO), two contract Dentists, the three Fleet DOâ&#x20AC;&#x2122;s (when not at sea), five visiting contract specialists, one contract Hygienist and one SDAP. KUTTABUL also hosted the two-person team from SUCCESS for a couple months until they deployed to Hawaii with SYDNEY prior to rejoining SUCCESS on its return from re-fit in July. KUTTABUL Dental Department has consistently had five to seven surgeries working Monday to Thursday seeing patients from 0800 â&#x20AC;&#x201C; 1600. On Fridays, three to four surgeries are in operation as some of the staff members take relief from the pace by enjoying a nine-day fortnight routine. Since December last year KUTTABUL Dental staff has gone through some significant changes with an almost completely new team of Dental Assistants. The new members are now almost fully integrated and they enjoy the environment so much that some are interested in joining the ADF as Dental Assistants. In June the KUTTABUL Central Sterilising Unit and Infection Control procedures were audited as part of a Defence wide 10% audit. We passed with only a few minor recommendations being made. Ordering of new equipment and changes to some procedures are currently underway in response to the recommendations. Monthly Divisional Meetings have seen the Sailors continue to take the opportunity to show off their research and public speaking skills. This year the topic of focus has been historical Navy personalities that have made significant contributions to the RAN. So far, the presentations have been about LCDR Robert Rankin, CAPT Emile Dechaineux and VADM Sir William Creswell. For ANZAC Day 2011, the KUTTABUL Dental Department marched with the Armed Forces Dental Association, a tradition that has been upheld for a few years. The platoon was led out by the veterans consisting of Tri-Service ex-serving members, WWII veterans, Dental Officers (including two Army Dental Officers), followed finally by the Navy Dental platoon commanded by CMDR Phil Ma from HMAS ALBATROSS. Old and new faces then mingled at the Freemasons Club where the afternoon was thoroughly enjoyed by all. KUTTABUL staff have also been out and about supporting other Defence activities and units, with AB Hatzivalsamis working at WATERHEN two days per week while AB Lavelle was deployed in the first contingent on Pacific Partnership 2011 (PP11). CADMUS 2011

LEUT Karina Cvejic also deployed on PP11 in June for two months as part of the second contingent. LEUT Cvejic joined USS CLEVELAND in Darwin and provided treatment to patients in Timor and the Federated States in Micronesia where she extracted over 300 teeth, an experience that she has described as life changing. Some other notable achievements at KUTTABUL include the promotion of LS Rachelle Johnson who also took on the challenge of the SDA-P course, AB Stacey King who completed her SDA course in early 2011 and the upcoming promotion of AB Inmon who will post to HMAS CAIRNS as the LS SDA-P in September 2011. The KUTTABUL Dental team would also like to thank SDO CMDR Mark Brazier for his years of hard work and dedication to the most dynamic of Dental Departments. His leadership and mentorship to Officers and Sailors alike has been extremely valuable in the shaping of many careers. Best wishes to CMDR Brazier as he is farewelled to FBW where he will take up his new position as SHO. The team is also excited to receive CMDR Tanya Burton as the new KUTTABUL SDO in 2012.

HMAS STIRLING Lieutenant Commander Maria Cicchini, RAN The last year has been a busy year at HMAS STIRLING. In 2011, STIRLING welcomed a couple of Dental Assistants. AB Groves and AB Bayliss posted into the unit while LS Beck and AB Burr returned after maternity leave. In late 2011, AB Groves and AB Bayliss are both expecting babies, we wish them well. STIRLING has also had some changes of Dental Officers, the newest member being LEUT Wolfe, a Griffith University graduate. STIRLING provides the third Fleet Mobile Dental Team for the Dental branch. In 2011, LEUT Benton and AB Todd have been diligently providing dental treatment whilst deployed on EX TRITON. AB Gamble and AB MacDonald-Walker were also fortunate to deploy on Pacific Partnership, a five-month humanitarian assistance initiative with the US Navy and other partner nations. The junior sailors were part of the medical and dental teams that provided health care in Tonga, Vanuatu, Papua New Guinea, Timor-Leste and the Federated States of Micronesia. Another outstanding team member at STIRLING is AB Byzdra. The RAN has become a big part in her family life. Since her husband POMT Byzdra transferred from the Polish Navy six years ago, AB Byzdra and her son ABBM Byzdra, also joined the RAN. Their unique story has been well documented in the wider community of the RAN and particularly at STIRLING.

The most significant change for the department is the temporary relocation of CMDR Blenkin to an office in the medical department whilst he assumes the role of SHO. CMDR Blenkin will continue as SDO and take on the dual roles within the Health Centre until CMDR Brazier arrives from HMAS KUTTABUL in January.

Making the Change: Implementing a new system for prioritising dental treatment at HMAS CERBERUS for DFC 3 and 4 patients

The challenge provided by having up to 160 new personnel join HMAS CERBERUS each month (not including RAAF and Army category trainees) with up to 65% or more of these requiring some form of dental treatment is unique. In addition, most Army and RAAF trainees that join CERBERUS for initial category training do so directly from completion of their respective recruit courses, having received very little in the way of dental treatment so far. The constant introduction of dentally unfit personnel to the population pool makes getting on top of dental fitness at CERBERUS at times impossible.

LCDR Mark Page, RAN, BDSc(Hons) GradDipClinDent GCEd

The availability of trainees at CERBERUS

HMAS CERBERUS has seen a number of changes in 2011 with regard to dental patient management in an attempt to overcome the innumerable challenges of treating a population consisting almost entirely of trainees. HMAS CERBERUS, often referred to as the ‘cradle of the Navy’, is the primary initial and category-training site for the Royal Australian Navy. CERBERUS also supports the RAN Recruit School as well as conducting initial training for Air Force and Army in the electronics, steward, cook and dental categories. Including 400 staff and instructors, the dependency often exceeds 2400 military personnel.

The training continuum at CERBERUS has undergone significant compression in line with the reforms introduced to recruiting, training and Defence spending in the last three years. Courses have been reduced in length without a concomitant reduction in expected outcomes, which has led to intensive training courses with little non-allocated training time. As the training courses are so intense, instructors are reluctant to release trainees during instructional hours. Students face back-classing if too much time is missed. The training day begins at 0730 for most faculties, finishing at 1630. Engineering faculty (EF), representing the largest proportion of students at CERBERUS, commences much earlier in the day, finishing at 1300. This gives us guaranteed access to EF trainees from 1300-1630. In addition, EF courses are generally some of the longest, up to 12 months post-recruit school for electronics technicians, thus providing ample time to complete dental treatment for these members. However, afternoon appointments are consequently booked out well in advance, with an average wait time of seven weeks for an afternoon timeslot. This is beyond some trainees’ expected duration at CERBERUS.

In mid 2011, the contracted health administrative support staff were replaced by equivalent FTE APS positions in line with the JHC and Regional Health Service re-structure. While this presented us with some challenges regarding continuity of corporate knowledge, we have been fortunate to have gained two very competent APS 2 employees at 1.6 FTE. CPO Andrea Marsh replaced PO Rachel Edwards at the start of the year as the dental practice manager. The dental department at CERBERUS is now staffed by 4.0 FTE Dental Officers, however, with the Senior Dental Officer doublehatted as the Senior Dental Advisor – Victoria and Tasmania, the effective clinical FTE is 3.3 dental officers, 1.0 FTE hygienist and a visiting prosthodontist at 0.1 FTE (one day every two weeks). Dental assistant support is in accordance with 5.0 FTE dental assistants (including 1.0 FTE for the central sterilisation area, and 1.0 FTE military Senior Dental Assistant, who also provides chairside assistance for the SDO). Efficient treatment of trainees at CERBERUS is constrained by the availability of trainees, who need to be released from training in order to attend dental appointments. In addition to factoring in this restricted availability, there were two other factors that should be considered when structuring a recall program for dental treatment: the clinical urgency of treatment, and the relative need to have this treatment completed within the timeframe of their CERBERUS posting. The need for dental care at CERBERUS Every four weeks, a new intake of between 100 and 160 recruits joins HMAS CERBERUS. Initial dental examinations are conducted in one day for all members of the intake, midway through the first week of recruit training. The overall dental fitness of these new entrants is generally much lower than that required of a full-time serving member. While approximately 35% of new recruits join and are essentially Dental Fitness Classification (DFC) 1 or 2 (the vast majority of these requiring no more than preventive dental care in the form of scaling and prophylaxis) the remaining 65% require care ranging from one or two simple restorations, to more extensive treatment plans including complex restorative, endodontics, and surgical extractions. Recruit intakes themselves are highly diverse, with no clear pattern of treatment needs associated with the timing or population profile of the intake. Predicting which intakes will require more dental work than others is virtually impossible.

Any course involving weapons training is considered ‘off-limits’ for release of trainees, due to the OHS implications of missing key elements relevant to the safe handling of weapons. Firearms training is an essential component of the continuum for Boatswains’ Mates (BM) and Clearance Divers (CD). The CERBERUS phase of BM and CD training is already considerably shorter than others, at six weeks. Stores Naval (SN) trainees only spend six weeks at CERBERUS, and Combat Systems Operators (CSO) also only spend six weeks here before being posted to WATSON for completion of their training. Gap year entrants spend only three weeks at CERBERUS post-Recruit School, again providing limited opportunity for dental treatment for a category that usually posts directly to sea. Cooks and Stewards are bussed to TAFE at various locations on the Mornington Peninsula during the working week, and with buses leaving before 0715 and not returning until after 1630, there is very limited access to these trainees for treatment. It is obvious that dental care provided in Recruit School (RS) subsequently relieves the burden of then having to provide that care when the member moves to category training. Unfortunately, Recruit School has one of the most rigorous schedules of any training, and access to trainees during recruit training has been notoriously difficult. Historically, there has been a ban on seeing recruits for anything other than emergency treatment during working hours. Wednesday nights were utilised at CERBERUS for many years in order to provide dental care for recruits. However, there was little predictability regarding which recruits would be permitted to attend. Recruits with relatively low-priority dental treatment were often being sent for appointments on Wednesday nights, resulting in inefficient use of clinical resources. Establishing the relative need for dental treatment The first step in attempting to remediate the dental fitness of CERBERUS was to prioritise the need for treatment. Clinical need for treatment is already prioritised via the DFC system. However, the application of this system to the functional and operational

CADMUS 2011

requirements of the Defence Force needed to be established for the local CERBERUS population. First and foremost, it seemed logical that trainees who were at risk of becoming a dental emergency while at Recruit School required priority access to dental care. This has the additional benefit of then potentially avoiding the need for complex restorative or endodontic treatment later in their training. Clinical need thus takes immediate priority, and any trainee who was deemed DFC 4 was top of the list for access to dental care. The next most urgent cases were trainees who are required to be at a certain standard in order to allow them to continue their training. The only trainees who technically form this category are clearance divers who are not fit to dive. These members do ‘pre-dip’ training as soon as they have completed RS, and thus needed to be dentally fit to dive (noting that this does not necessarily mean they are required to be DFC 1 or 2) by this timeframe. Trainees who post from CERBERUS straight to sea should then have next priority, as there is clearly a greater need for them to be DFC 1 or 2 in order to meet operational goals. The actual number of trainees who fit this criterion is also small, and consists of Gap Year trainees (GX) and some BM’s. Lastly, those trainees who leave CERBERUS and immediately become part of the trained permanent force (and thus become part of the statistical IR reporting) logically take priority over members who leave CERBERUS to undergo further training. This philosophy led to the development of an index for prioritised access to dental care that can be applied to the existing dental recall system. From highest to lowest priority, this index is outlined in Table 1 below. Priority Category

Comments

1 (High)

Any member who is DFC 4

Urgent clinical need for treatment

Clearance Divers (CD) who are not fit to dive

Required to continue training

DFC 3 Gap Year entrants (GX) and Boatswains’ Mates (BM)

Short courses, coupled with high likelihood of sea posting after CERBERUS

DFC 3 Stores Naval sailors (SN), Writers (WTR), Cooks (CK) and Stewards (STD)

Short courses, difficult to access while in category training, and post to trained force billets after CERBERUS

5 (Low)

All other DFC 3 trainees who are either: a. at CERBERUS for > 6 months post RS: i. Engineering faculty (MT, ET), ii. Medical (MED) iii. Communications (CIS) or; b. continue their training at another establishment: i. Combat Systems Operators (CSO) ii. Aviation specialists (ATA, ATV) iii. CD’s fit to dive iv. Linguists (EWL)

Length of course allows more flexibility with appointment times

Post to WATSON Post to RAAF Wagga Post to PENGUIN Post to RAAF Laverton or Oakey Barracks

Table 1 – Priority Index for Dental Treatment at HMAS CERBERUS Despite the advantage of seeing members as soon as possible once they arrived at CERBERUS, obviously not every member can be

CADMUS 2011

treated while they are undergoing initial training at RS. Moreover, it was considered unlikely that RS would agree to such a schedule. Consequently, it was decided that specific treatment guidelines for recruits should be promulgated in keeping with the overall philosophy espoused in the index of treatment needs, in order to ensure a balanced and efficient approach to providing dental treatment to recruits. Treatment aims during the Recruit School phase of training It was vital to ensure that the end-point of dental treatment for members undergoing initial training at RS was made clear to both the Dental Officers and Recruit School staff, as not all members would necessarily required to be DFC 1 or 2 on completion. This allows greater access to higher priority members. The following guidelines for dental treatment for recruits logically flowed from the priority index at CERBERUS: Priority 1 (High) members: Any member who is DFC 4 should be treated so as to raise them to DFC 3 while at RS. Once upgraded to DFC 3, treatment at RS should continue in line with their new priority as outlined below. Priority 2 members: The member must be made dentally fit to dive while at RS. Note that this does not necessarily entail that they be DFC 1 or 2 IAW current policies. Priority 3 and 4 members: Members should ideally be raised to DFC 2 while at RS, however, Dental Officers should exercise their discretion when planning treatment for Priority 4 members. Those members who only require relatively simple treatment (i.e. minimal to moderate carious lesions that could be restored in two appointments or less) may be deferred until they reach category school. Priority 5 (Low) members: Should generally not receive dental treatment while at RS. Achieving these goals would mean that by the end of RS, no member should be priority 1 or 2, and most priority 3 and 4 members should be DFC 2. Even if this is not achieved, the relative amount of work required to raise priority 3 and 4 members to DFC 2 should be greatly reduced by the time they enter category training. This leaves the majority of trainees in category school as priority 4 and 5, with priority 5 making up the vast proportion of these. Implementation – Prioritising treatment in practice Following a recruit intake, Dental Officers at CERBERUS develop a treatment plan and assign a DFC to each member. This is usually completed by the end of week two following the initial entry dental examination. In the first instance, the Senior Dental Officer (SDO) reviewed all DFC 3 and 4 Personal Dental Records (PDRs). This was done in order to ascertain that similar standards for DFC 3 and 4 were being implemented across all dental practitioners. A session with all of the DO’s usually followed the review, in order to discuss and resolve any differences in the DFC assignation. Good agreement was achieved as early as the third round of intake/ review sessions. A prioritised list of members was developed in accordance with priority categories 1 to 4, and this list was sent to the course implementation officer (CIO) at RS. This was then passed to the respective class Leading Seaman, who could make individual appointments for recruit classes under their control at times that suited their program. After agreement was consistently achieved between all Dental Officers regarding the assignation of DFC’s, the SDO passed the task of developing the priority list to the practice manager. The

SDO personally reviewed yet another intake after this occurred, as a final quality control check, and found no difference between the priority list developed by the practice manager, using the above protocol, and his own. The number of trainees allocated to each priority category depends on the profile of the intake, as Defence Force Recruiting usually target specific categories for particular intakes. So far, the list of names handed to the RS Course Implementation Officer (CIO) to manage dental appointments has not exceeded 25 members. This number is acceptable to RS staff, as each class generally then has no more than four or five members that require appointments to be made during the remaining ten weeks at RS. Appointments and Recalls RS specifically requested that no allocated times be set for recruit treatment due to the difficulty of adhering to a rigid schedule when their own program was constantly subject to change. The CIO agreed that if RS was provided with a list of names and appointment information, they could actively manage recruit appointments. Recruits are now seen at any time during the working week, with appointments made during normal working hours by their divisional staff as suits. The normal working day at CERBERUS finishes at 1300 on Fridays, with essentially all trainees being available after this time to attend appointments. By having the department open at this time, those trainees who are unable to be released during the working week now had an option to attend the dental department. Staffing at the Dental Department was split on a nine-day fortnight routine in order to allow the department to remain open every Friday until 1630. The final change was made to offset the Friday routine with the late-night Wednesday. Formerly allocated to recruits, this became redundant with the new agreement reached with RS. The question remained as to how best utilise this allocated time in order to see priority patients. Cooks and Stewards finish TAFE an hour early on a Thursday, and return to CERBERUS at 1500 for sport, and this presented an ideal opportunity for us to gain access to them. The SDO discussed the concept of allocating this time only for ADF School of Catering (ADFSC) trainees with the OIC ADFSC. With his agreement to release trainees from sport on Thursday, the dental department altered Wednesday night routines so that the on-duty dentist works on Thursdays from 0730–1200, 1300–1700, and 1730–2000, these extra hours being off-set by having the following Friday off. Appointment times in the evening session were limited to 45 minutes each so as to increase the throughput of patients. This roster system uses two dentists and two assistants, who work as a team on alternate Thursday nights. The team who did not work the Thursday night work the full-day Friday, allowing the department to remain open until at least 1630 five days a week.

is sent to RS. Despite its apparent complexities, this task takes less than an hour per week. At the time of writing, the system of prioritisation of treatment at CEBERUS was in its infancy. It is too early to tell whether it has made any substantial difference to the overall dental fitness of trainees at CERBERUS. However, initial reports have been positive. The dental department has been providing RS with prioritised lists of names within two weeks of their initial dental examination, providing plenty of opportunity for training staff to organise appointments for recruits. RS have been proactive in organising appointments for those recruits identified as requiring treatment. Identification of ADFSC trainees who are DFC 3 or 4 is managed by the Practice Manager and administrative staff as part of normal recall procedures, and direct communication with ADFSC staff is occurring in order to ensure that these trainees are allocated appointment times on Thursday evenings. Even if there has been only minimal increase in the overall dental fitness of the IR reportable population, the benefits of this system lie in the management of dentally unfit members that has seen all faculties and schools having had input and their individual concerns and requirements addressed. The positive relationship the Dental Department now has with all faculties and schools at CERBERUS is worth the effort, particularly as there is an occasional need to draw on this goodwill when complex or ‘one-off’ cases require special exceptions. At CERBERUS, we believe that this targeted approach is philosophically more sensible than the haphazard approach to treatment based simply on the random recall of class 3 and 4 patients. However, we recognise that there may be flow-on effects for other dental facilities who are receiving members directly from this establishment. I must reiterate to other facilities that CERBERUS dental department does not intend to refuse priority 5 members treatment. However, the implementation of this system may mean that we treat less priority 5 members in favour of those who have higher priority treatment needs. In particular, we recognise that a greater burden for treating CSO, ATA, ATV, CD and EWL sailors may fall on other facilities. While this may be perceived as ‘buck-shifting’, the reaction from Command staff at HMAS CERBERUS has been one of support for these decisions, as they directly support the operational requirements of the ADF. Those members who are sent on to other dental facilities as DFC 3 still tend to be those whose priority remains low from an operational perspective at their new establishment. We hope that other ADF dental facilities can appreciate the wisdom of this approach at HMAS CERBERUS. Author’s note: The reader will notice the absence of dental category trainees in the priority classifications. The CERBERUS Dental Department and ADF Dental School work very closely, and between us, have the flexibility to accommodate dental trainees who require dental treatment on an as-needs basis.

Conclusion While this system of ‘priority categories’ seems complex at first, it is important to realise that these are not formally assigned ‘categories’. We do not make a note of the numerical ‘priority category’ we assign trainees to, and have done so in this paper only for the purposes of explanation. CERBERUS Dental Department has a simple, two-page SOP that describes the treatment planning philosophy that makes this system clear without the need to change the way Dental Officers do business. Education of Dental Officers, administrative staff RS, and training staff in order to ensure they understood the rationale for this system was the main concern, and this was easily achieved by meetings that went for no longer than 30 minutes. The largest workload remains with the practice manager, who is responsible for developing the list of names that

HMAS ALBATROSS Leading Seaman Katrina Hetherington The HMAS ALBATROSS Dental Department’s primary function is to provide dental support to Navy and Army personnel from lodger units in the Wollongong area as well as staffing the HMAS CRESWELL Dental Department. ALBATROSS is home to four Naval Helicopter Squadrons, Training Authority Aviation (TA-AVN), Naval Aviation Systems Program Office (NASPO), Australian Joint Acoustic Analysis Centre (AJAAC), Royal Australian Navy Tactical Electronic Warfare

CADMUS 2011

Support Section (RANTEWSS), Hydrographic Office, Aircraft Maintenance & Flight Trials Unit (AMAFTU), ARA Parachute Training School and an active military airfield. In the past year ALBATROSS has welcomed NUSQN 808 which will soon introduce the MRH-90 helicopter into service. In 2011, ALBATROSS celebrated 25 years of the Parachute Training School. The ALBATROSS Dental Department has been demonstrating New Generation Navy’s (NGN) signature behaviours within the workplace. The department now has the ability to make special trays on site. It is estimated that this practice will greatly reduce costs incurred with postage and technician fees, saving $2000 per year. The ALBATROSS team is also practicing flexible working hours for some members to maintain the work-life balance. During the past year ALBATROSS has been challenged with low staffing numbers. In an attempt to cope with the continuously high work demand and dwindling staff numbers, each member has taken on additional tasking. The Dental team at ALBATROSS is actively involved in base ceremonial activities. Members from the department attend the Ceremonial Station Colour Guard every Thursday. ALBATROSS is the only Navy base where the Colour Guard is still displayed. Strengthening relationships beyond Navy is another important focus for the ALBATROSS Dental team. Members participated in activities such as the Tour de ‘T’ Exercise, which raised funds for Greenacres Disability Services and Legacy and weekly muftiday Fridays. In order to develop communication and presentation skills within the department, each junior sailor conducted a ten minute oral presentation during monthly divisional meetings. The sailors presented on a variety of topics including World War II, Hospital Ship AHS Centaur and Entitlements to Naval Personnel. The sailors’ confidence has been enhanced by this innovation with the added benefit of increasing the knowledge of Naval history and the Navy as an employer. Professional development and continuing professional development was also a feature in 2011. The Australian Dental Congress in Brisbane was attended by CMDR Ma, LEUT Webster and Dr Kankotiya. The team received training in; Dealing with Workplace Conflict, MAO Continuum Workshop, JEHDI workshops, Electric versus Manual Tooth Brush lecture in Sydney, Forensic Dentistry for Dental Assistants, Helicopter Under Water Escape Training (HUET), Dental Officer Initial Course (DOIC) and the Navy Development Leadership Workshop. A few special mentions need to be made for some valuable team members. Dr Lieve Stassen will be leaving after six years. We wish her all the best for her new endeavours. Ms Belinda Hales is also recognised for her 11 years at ALBATROSS. Her continued efforts and extensive clinical and military knowledge is invaluable to the ALBATROSS Dental team. Also, congratulations to AB Cree on the birth of her first child Lachlan.

the Dental Department to normality and functionality after the building escaped with little damage. CAIRNS has had many staff changes with both service members and contracted Dentists. Due to the continued absence of a uniformed Dental Officer PODEN Tracey Morris has been providing administrative support on a Continuous Full Time Service contract from February 2011 and continuing until January 2012. This has filled the divisional gap as well as providing management for the provision of locum Dentists and dental fitness for Navy personnel. Due to staffing issues and the inability to forecast the availability of a Dentist, it has been difficult to book members for check-ups upon their return from deployment. This has been overcome by constant communication with Business and Contracts Managers at the Area Health Service North Queensland and by recalling members before their due date (sometimes by a couple of months) for their Annual Dental Examinations. A fairly extensive recall list has also been developed which is assisting in clearing backlog of patients. The workload associated with each ‘new’ contract Dentist is always high, with inductions, safety briefs and information overload introducing them to Health Directives and ‘the Navy way’ of doing business. Some military commitments have had to take a back seat as priority lies with getting members fit for sea. Furthermore, like many other bases around Australia, CAIRNS sometimes has a slow and lengthy process to get stores and repairs; this is an ongoing issue. Despite the enormous challenges of a small base, the Dental Department at CAIRNS have received excellent results from recent Area Health surveys, overwhelming reinforcing that the team are doing their job well. The team at CAIRNS will be welcoming LEUT Sally Cochrane as the new Dental Officer in January 2012. The addition of a full time Dental Officer will provide much needed support and knowledge so the team can build on the outstanding service and patient care that the department already provides. Finally, farewell to Dr Shane Hearps (who, over the last two years has provided a wealth of Defence and Queensland Health knowledge to help CAIRNS gain and maintain a very high level of Dental Fitness (over 95%). Dr. Hearps has moved on to remote Area Health Service in Weipa, providing much needed dental care to the Cape and outlying communities. We wish you all the best in this new chapter in your career.

HMAS PENGUIN Leading Seaman Mark Smith

Petty Officer Tracey Morris

The dental staff at HMAS PENGUIN consists of Dr Liz Close, formally of the RAN and Ms Amelia Harris who is the acting Clinical Practice Manager and DA three days per week. The small team do an excellent job of maintaining high unit IR statistics, boasting a 96% of PENGUIN’S complement dentally fit for deployment. This is a direct result of a sustained focus of administration duties and the maintenance of the department’s MIMI database, which allows visibility and management of accurate dental statistics.

HMAS CAIRNS Dental Department was met with the unwelcomed arrival of Cyclone Yasi and its aftermath in 2010/11. Important documents, files and stores were saved by moving them to the first floor of the Norman Pixley building with the expectation of a tidal surge (that never came). It was all hands on deck to return

My focus as a Leading Seaman posted to this department has been to trial a new role as the Administration Supervisor to the Sydney Area Minor Dental Units. The role is to provide administration support to the staff at all three of the RAN’s Sydney Area, Minor Dental Units (MDU) that include: HMA Ships PENGUIN,

HMAS CAIRNS

CADMUS 2011

WATERHEN and WATSON. Phone calls, emails, fleet mail and visiting the MDU have all provided means for mentoring, guidance and support to the DAs and DOs. The role also entails liaising with the CPODEN at HMAS KUTTABUL to solve manpower issues when dental staff are ill, on leave, deployed or positions are vacant. A major role for the MDU Administration Supervisor is to ensure compliance and transparency by reporting to DDFD, DRSA, DML, RHS and JHC for all three Sydney area MDUs. This has included supplying radiation reports to the DIRPO of each of the three bases. Another project has been creating numerous record keeping documents and relevant databases to improve efficiency in single man units and to improve the accuracy in reporting performance and achievements to DDFD. The Administration Supervisor is also required to attend Quality Management, Infection Control meetings and training to facilitate efficiencies and identify opportunities for improvement. WATSON, WATERHEN and PENGUIN all contain busy Dental Departments. The demand for IR of members, coupled with the maintenance of governance and management of the Sydney Area MDU meant that the role of the Administration Supervisor has proven to be very valuable. It has been demanding, educational and very rewarding.

HMAS WATERHEN Lieutenant Michelle Morze, RAN HMAS WATERHEN Dental Department is currently responsible for the dental administration of 730 members. This total includes the members of four Huon Class Minehunter crews and the MSA Tugboats, members posted ashore at WATERHEN and Clearance Dive Team One. In addition to this, the crew from the YOUNG ENDEAVOUR and Reservists from Clearance Dive Team Five are also administered by the WATERHEN Dental Department. In 2011, WATERHEN has had a focus on targeting members negatively affecting the key performance indicators (KPI’s) by reviewing the MIMI database, mustering the documents and ensuring MIMI accurately reflects the current contingent. Over the past year WATERHEN has also had some difficulties and successes with regards to stores and equipment. Fleet Dental came to the rescue by lending some equipment. HMAS PENGUIN also lent a hand by organising an SCA transfer of a duplicate piece of essential equipment. Some success was also seen when an order of long awaited clinical gowns arrived. However, the clinical scrubs are still on backorder. This has meant that the timeframe for the dry cleaning of linen items as well as the number of items sent for cleaning have been under close scrutiny in order to maintain our already depleted linen supply.

The clinical schedules have always been very busy at HMAS WATERHEN. The MHC and CDT1 routines are hectic throughout the year and forever changing which makes it difficult to track down patients for ADE’s and also to proactively book appointments, especially for complex treatment. Improvements have been made in this area by: contacting patients before they are due for their ADE in order to secure an appropriate date in advance; liaising with MHC medics and changing appointments where appropriate to accommodate those members sailing. All in all it has proven to be a very busy yet, productive year for WATERNHEN’S Dental Team. Since the department has now returned to its normal complement of personnel, improvements will hopefully be noted with regards to efficiency and KPI’s.

HMAS WATSON Able Seaman Kylie Skinner HMAS WATSON is a primary Naval training establishment for Officers and Sailors with a complement of over 350 personnel, and at times can have an additional 150 plus members undergoing training. The courses conducted at WATSON are Maritime Warfare specific and include; Combat Systems, Electronic Warfare, Junior Warfare Officer Seamanship training, Navigation, Principle Warfare Officer training, Command Team as well as the training of new Commanding and Executive Officers to RAN ships and establishments. The Dental Department at WATSON is one of three Minor Dental Units (MDU) in the Sydney area and consists of one Senior Dental Assistant (SDA) and a Dental Officer. The SDA posted to a MDU, has many responsibilities beyond the regular daily chair side assisting and sterilisation duties. The position requires proficiency in other roles including reception and administrative duties. The SDA also acts in the practice management role in operating an MDU, which includes the daily correspondence, attendance at meetings, involvement with addressing infection control issues, equipment procurement and maintenance, the management of stores, reliable record keeping and the ever increasing administration required in keeping up with new policies and procedures. 2010 saw FLTLT Khai Nguyen return to the RAAF, and Dr Christine Williams complete her contract with Defence. In early 2011, LEUT Simon Flanagan joined WATSON as the Dental Officer and the OIC of the Health Centre. Whilst only a small team, the Dental team at WATSON is valuable to the many members that pass through the establishment each year. The team is looking forward to the new challenges of 2012.

CADMUS 64

CADMUS 2011

Royal Australian Army Dental Corps

Unit News Regular Army Units 1 CSSB Dental Platoon and AHS Robertson Barracks WO2 T. Feillafe 1 CSSB Dental would like to pass on our congratulations to PTE Samuel Kouflidis on being awarded the COL Kenny Award this year. PTE Kouflidis has maintained an excellent work ethic over the past two years and is a very deserving recipient. He recently completed both the Junior Leader course and Senior Dental Assistant course where he received the Trainee of Merit award. MAJ Thien Pham, whilst fulfilling his role as Senior Dental Officer, also dedicates his time to the provision of oral surgery both on site at the Dental Platoon and in theatre at the local hospital. He works once a month at Darwin Private Hospital clearing the backlog of problematic wisdom teeth. MAJ Pham is also studying intravenous sedation at Westmead Hospital in his spare time. CAPT Lines arrived in Darwin on posting from 2 HSB this year and has been acting as the Dental Platoon 2IC in addition to his duties as a Dental Officer (DO). He has been involved in several professional development activities including the ADA congress in Brisbane. He is leaving 1 CSSB at the end of this year to undertake 12 months long term schooling to complete a Graduate Diploma of Clinical Dentistry. CAPT Lathouras has been working part time this year in order to experience work in private practice. He has relished this opportunity to broaden his skills particularly in relation to the provision of dental care for children and the elderly. With the termination of the Senior Dental Assistant – Preventative (SDA-P) stream and the Dental Technician trade, we have moved into a new era. We are fortunate to have a civilian hygienist working four days a week with another starting shortly working two days a week. Our hygiene waiting list is acceptable at present but this will change with the return of our deployed dependency. The laboratory was temporarily closed this year due to the enforced removal of lab benches and the termination of the Dental Technician trade. The transition of the Technicians to Dental Assistants has been relatively smooth. Our two Technicians have eased back into surgery and front desk area well. Being a remote location, dental specialist support is very limited. During the week 9-13 May, COL Janet Scott provided essential oral surgery support to assist in the reduction of our oral surgery waiting list. She was accompanied by LTCOL Scott Freeman as the IV sedationist. 30 patients were consulted, 18 of those patients were treated at 1 CSSB Dental Platoon under IV sedation and another four were treated under GA at Darwin Private Hospital.

CADMUS 2011

LTCOL Daly visited during June this year to provide much needed periodontal services. His visit also provided an excellent opportunity for our junior DOs to seek advice in relation to their more complex periodontal cases. As a result of the Combat Health Support (CHS) restructure all uniformed dental personnel from 1 CSSB Dental Platoon will be posted out at the end of 2011. We are therefore working very hard to ensure that the dental facility is in a good position to handover to the incoming civilian dental staff. SOPs have been reviewed and revised to reflect the personnel changes. This year dental has been involved in several field activities, commencing with IMTs. Originally this was planned for March 2011 but due to the extended wet season, it was delayed until early June and involved the majority of dental’s ORs. The lead-up training was an excellent experience for all the ORs who have had little exposure to this type of training. SNCO/Officer Training was scheduled to coincide with IMTs in March but was also delayed until June. Our two Captain DOs and WO2 Feillafe participated in TEWT training. Early this year the Dental Platoon participated in a Health Company “shake-out” and set up the field section in the Health Company compound and then redeployed to the Kangaroo Flats Training area. This was a great opportunity for the junior Dental Assistants to set up the kit both during the day and at night. The DOs also found this to be an excellent training exercise and provided clinical input in relation to the equipment set up and layout. 1 CSSB Dental Platoon did not have an opportunity to deploy our field equipment on Exercise TALISMAN SABRE or Exercise HAMEL. However, we detached four very well trained soldiers to other areas within the Combat Service Support Team (CSST) that deployed to Shoalwater Bay. The Dental Platoon staff are renowned for being some of the fittest members of the Battalion. CPL Fisk represented the Army in the Australian Country Water Polo Championships and the Inter-Service Alpine Snow sports Championships. She performed very well in both of these representational activities; well done. Battle PT this year has been scheduled once a week with sessions concentrating on endurance. Our lead up training for the Combat Fitness Assessment (CFA) in June was quite intense although on the day of the CFA all members who participated passed comfortably. PTE Sarah Anderson (Nee Chugg) gave birth to a gorgeous baby girl Hayley in April, mum, dad and bub are doing well. We are excited about the move to 33 Dental Company in Enoggera in 2012 and look forward to the opportunities that hubbing will present.

Lavarack Barracks Dental Centre (16 FD Dental/3 CSSB and LHC) WO2 M. Allen and SGT N. Lickorish 2011 saw the beginning of a very hectic and uncertain year for all within Lavarack Dental Centre. There have been numerous deployments within 3BDE which has resulted in an extremely high tempo. In addition to this we were all kept busy in preparation for the GAT audit. On Valentines Day 2011, JHC assumed responsibility for all garrison health care delivered in Lavarack Barracks including dental support.

Enoggera at the end of 2011. This will prove to be a great loss to the unit as everyone has made a significant contribution to the success of the facility. We would like to take this opportunity to thank DR Karat and Ms Marsh for their patience and assistance with the transfer from 3 CSSB to Garrison. Thanks are also extended to the military and civilian staff for their efforts, understanding and patience during this challenging period.

7 CSSB Dental Platoon CPL K. Davies G’day from the few of us left at 7 CSSB! We’ve had another dynamic year in the complicated beast that is Gallipoli Barracks Dental Centre (GBDC). Many faces have changed, some have stayed the same. We’ve worked alongside 2 HSB, JHC, CHP staff and WO1 Butler and the trainee dental technicians. We have had a busy year with unit activities and tasks, all the while getting members dentally fit for deployment. Sadly, this will be our last CADMUS submission as part of 7 BDE. Anzac Day saw us all in our finery for the march through Brisbane City. There were a couple of cameo appearances at 2 HSB Reserve evenings and weekends for those who were keen.

We have seen the arrival of Dr Karat, our new SDO as well as Kay Marsh the Practice Manager. We have also seen the recent arrival of Dr Martin, Dr Buell, Dr Ali, Dr Patel, Dr Yie, Dr Love, Sarah Tang our hygienist, Kylie Greaves and dental assistants Casey Soper, Joanne Fox, Sally Whittaker, Bianca Wheldon, Sue Collins and of course our sterilisation technician Lesley Turner, all of whom provide invaluable support to the centre. We would also like to thank Dr Cullen and Renee Judd for their casual support. WO2 Allen, SGT Lickorish, PTE Ivy and PTE Mayo have joined us this year. We have also had a number of promotions within the dental platoon, namely PTE Tippett to CPL, PTE Mueller to LCPL and LCPL McMillen to CPL. With the termination of the Dental Technician trade and the SDA -P stream, CPL Cowgill, CPL Lawler, CPL Wilding, and SGT Kaponay have been reassigned to other duties including working in the surgery. They have adapted to the roles of dental assisting and Clinical Supervisor very well. There have been a number of individual deployments/exercises this year, with SGT Kaponay deploying on OP YASI, and CPL Wilding on EX SAUNDERS/AACAP. CPL McMillen, CPL Tippett and LCPL Mueller were nominated to attend a JNCO Leadership Activity which saw them spending five days assisting in cleaning up areas in Broadwater affected by Cyclone Yasi in Jan 2011. There has been exciting news for some staff members expecting additions to their families. We wish to congratulate PTE Paul, PTE Maddock and Renne Judd. We also with to pass on our congratulations to PTE Hebbiton (currently on JLC) on her recent marriage. Now that most of the posting orders are out, there will be a significant number of uniformed dental personnel posted to

CAPT Palfreyman and PTE Petersen got to see a swampy Shoalwater Bay whilst on Exercise Diamond Dollar. A huge thank you goes to PTEs Nancy Havili and Loki Kulk from 2 HSB for their time, effort and assistance with this exercise. All of their expertise was tested as the sterilizer went down only four days after being tech inspected. However, the team adapted and overcame beautifully. Unfortunately, we missed out on using the new Weatherhaven for this exercise. CAPT Palfreyman has been busy with patients this year. He has worked consistently to get patients dentally fit. WO1 Butler has split himself between GBDC and the Uni demonstrating for the dental students and also had the opportunity to give a presentation for Defence Force Recruiting. CPL Kirstyn “Xena” Davies returned from maternity leave (another girl – Katie Louise) to some re-training as a dental assistant. She has recently returned from Sub 2 SGT and heads off on Sub 1 SGT at Canungra in August. PTE Nathan Pedemont has decided not to Corps transfer after some initial disappointment in not being able to apply for dental technician training. His skills as a Combat Fitness Leader are of great benefit to the unit as he keeps the sessions “fresh”. PTE Lucas Petersen joined us, after he Corps transferred from catering. He assisted CAPT Palfreyman on Exercise Diamond Dollar and was thrown in the deep end with our temperamental field equipment. PTE Ellie Pintus has been on leave for the majority of the year and will be discharging from the ARA later this year. We wish her well in whatever she decides for her future. CAPT Michael Robinson is no longer a 7 CSSB member. However, we still see him loitering in the hallways now and then. After much deliberation, he decided to take long service leave in Brisbane before his posting to Darwin. We said Goodbye to PTE Michelle Williams as she decided the Army was no longer for her – best of luck out there Michelle. We bid farewell to PTE Dan Cameron not long after he and his wife Becky had a little girl – Summer Rose. Dan has Corps transferred back to Armoured and happily went to 2/14 LHR. PTE Kirsty Schilling has taken two years LWOP and

CADMUS 2011

headed off to New Zealand to accompany her husband on posting. We look forward to welcoming her back. It is with some sadness that we count down the days until we have to remove the 7 CSSB colour patch. It has been an honour to “remain flexible and hurry up and wait” for the past few years. We wish you all the best for the rest of the year.

1 Health Support Battalion Dental Platoon CPL M. Broadway Welcome to all CADMUS readers, we hope you had a great year. It was a very busy 2011 with many of our members deploying on exercise this year. We have also had a constant work tempo, maintaining our dependency in a state of dental readiness. In 2010 we said farewell to Cpl Adam Collins who discharged after 20 years of service in both the RAN Dental Branch and the RAADC. Adam has left the shores of Australia to live in Oman with his wife and daughter. We welcomed several new members to the unit. SGT Ken Locker came to us from sunny Darwin. SGT Locker hit the ground running and has been a great addition to 1 HSB bringing with him a wealth of experience, despite finding it cold down here compared to Darwin. CPL Danni Gurkin returned to 1 HSB after her time at ARTC as a recruit instructor. CPL Gurkin completed her promotion courses for SGT with flying colours. Unfortunately for the RAADC CPL Gurkin is Corps transferring and is currently on her PTI course in HMAS CERBERUS. After participating in many of CPL Gurkin’s pre-course PT sessions, we have no doubt she will make a great PTI. We wish her well for the future. CPL Kerri-Ann Steindl came to us from Townsville and was a very welcome addition. She too finds it to be a little cold here. However, there was some relief from the cold when CPL Steindl participated in AACAP. CAPT Anthony Craig worked hard at the start of 2011 in preparation to deploy on AACAP. CAPT Craig found AACAP very rewarding – treating, educating and interacting with the patients in the remote communities. PTE Nicole Morrissey also joined CAPT Craig and CPL Steindl on the adventures and challenges of AACAP. PTE Morrissey passed her JLC with flying colours earlier this year. Well done. PTE Lauren Morgan deployed on Ex Talisman Sabre with SGT Locker and they were kept very busy. PTE Morgan is also getting ready for her big day as she is getting married in November, we wish her well.

2nd Health Support Battalion – 33 Dental Company CPL J. Theobald and PTE E. Keast This year has been welcomed in with true 2 HSB style and flare. We have had the usual changeover of staff with our new Senior Dental Officer (SDO) MAJ Karen Such, leading the change. MAJ Such completed her Grad Dip Dental Studies (Oral surgery) in 2010 and seamlessly transitioned into a very busy GBDC as both the SDO and OC Dental Company for 2011. Much to the delight of our staff, a fresh new face has joined us from Townsville in the form of CAPT Thomas Van Heumen. CAPT Van Heumen has assumed the role of 2IC of the Dental Company effortlessly. After farewelling a lot of our hierarchy last year we made way for SGT Amy Hall direct from 1 RTB as our dental centres new

CADMUS 2011

practice manager. SGT Hall has taken up the role alongside SGT Lizzie McSorley, our dental supervisor. CPL Johanna Theobald joined the 2 HSB team this year accompanied by CPL Daniel Kempster; each has had a positive influence on the centre in a multitude of ways. There hasn’t been too much change amongst the ORs, all are still slaving away tirelessly to fulfil both the dental centre’s and the unit’s commitments. Unfortunately PTE Brett McGrath has been spending his time detached to 1 HSB although he assures us that 2 HSB is the best. Currently CPL Sonia Nicholls, PTE Morgaine Miscamble and PTE Tamara Axford are on the frontline with CAPT “The Warrior” Van Heumen, treating soldiers on Ex Talisman Sabre. The long awaited arrival of the new field dental operating chairs, light and x-ray equipment came just in time to be deployed on Ex Talisman Sabre. This meant that a quick familiarisation of the kit was required, leading to the odd curse here and there while working out the field digital x-ray equipment (simplicity at its finest). All of our staff have been working relentlessly, especially our CHPs who manage to fill the gaps when our uniformed personnel are required elsewhere. SGT Mc Sorley has been rewarded for her hard work in 2010 with a trip on Ex Long Look with the British Army. Her time is being spent posted to Wellington Barracks in the UK with the horse guards. So far we’ve heard nothing but great reports and exciting stories, and of course, the usual e-mail to request further leave. She has dined with the Queen and was lucky enough to see the royal wedding first hand. Safe travels when you eventually head home. 33 Dental Coy has had a busy couple of months. In April we had a lawn bowls activity to celebrate the 68th birthday of the Royal Australian Army Dental Corps. Early May saw the majority of the 2 HSB dental members travel down the highway to Sydney to attend the Combined Health Conference and the RAADC Conference at Randwick. With all of the changes occurring in the RAADC as a result of the Combat Health Support Restructure, it was great to get the majority of the Dental Corps together and discuss our exciting yet challenging future. 33 Dental Coy is now working to prepare for upcoming exercises and we are looking forward to the opportunity of some more field dentistry. Members of Joint Health Command – Enoggera, are in the process of amalgamating into 2 HSB. We welcome back PTE Lisa Blencowe from a short stint away. PTEs Kulk and Axford were lucky enough to be added to 2 HSB in time for 2 HSB’s IMTs and were sent to the Wide Bay Training Area. This gave dental enough personnel to field their own dental section, AKA ‘THE Section’, led by the ever fanciful CPL Jo Theobald. Much to the disgust of 2 HSB, ‘THE section’ from 33 Dental Coy won the week of challenges. These included both mental and physical challenges that our dental representatives clearly excelled at. Congratulations to all who participated. 33 Dental Coy is looking forward to a busy year ahead with a great deal of preparation for the restructure involving both personnel and equipment, whilst also having to maintain garrison support. The Dental Coy does not currently have any Reserve members but is keenly involved in all of 2 HSB’s integrated activities. We continue to provide dental support to the Reserve members through periodic dental clinics on Reserve nights and weekends. During the year our dental staff have made a great impression on the PTIs, with CPL Theobald and CPL Kempster both successfully completing the CFL course. This resulted in CPL Theobald being recommended for the PTI course. Adding to the sporting achievements of dental was representation at the Australian Defence Force Hockey Championships in May by CPL Theobald

and PTE Kulk. The girls helped the Queensland side win every match during the tournament including the final. PTEs Evan Keast and Brendan Zhang completed the final dental technician course in June under the watchful eye of WO1 Wayne Butler. Their graduation was held on 1 July and was commemorated with the attendance of DDFD, HOC, ex-serving technicians from the RAADC Association and staff from GBDC. The day also marked the occasion of the official handing over of Cadmus (Puff), our corps centrepiece, from the ADF Dental School to GBDC and he now takes pride of place mounted on the wall at GBDC. The remainder of the year will see our staff heavily involved in the transition to the health restructure and to our delight 33 Dental Company has been provisionally raised. This will become official late in 2011.

enhances Dr Gills skill set. Dr. Clarke has also had a very busy start to the year, seeing a significant number of members from the RAAF Base and surrounding areas suffering from erosion and attrition. Our Woodside detachment has been kept busy. The RAAF takeover of the Medical and Dental Section is clearly evident. 16AD Regiment has had a civilian Medical Officer who doubles as a Royal Australian Air Force Specialist Reserve (RAAFSR) SQNLDR for some time, but he has now been joined by WGCDR Tim Horton (RAAFSR) who has been working as the Dental Officer three days a week. The dental section would not function without the expertise of Rebecca (Bec). Bec is not only the dental assistant, she is the specialist clerk, procuring officer, infection control officer, morale officer, receptionist and the list goes on. Last but not least is our Practice Manager, Shiralee Roberts. Shiralee has been with Keswick since February 2007 after serving fifteen years in the RAAF. Without Shiralee and her trusty practice planner and monthly e-mails no one at Keswick or Woodside would keep on top of all the monthly submissions of non-techs, 100% muster on equipment and documents, KPI’s, due/overdue ADE’s, maintenance, clinical reporting requirements and infection control submissions. She is also on the Emergency Response Committee. Shiralee has done all of the above as well as studying to complete her Diploma in Practice Management through UNE Partnerships. Adelaide is a rewarding and challenging posting dealing with satellite Reserve units and the diverse range of Army, Navy and RAAF members within SA. We are looking forward to 2012 ready to meet the inevitable challenges that the New Year will bring.

Kapooka Dental Section 3rd Health Support Battalion – Dental Platoon

Debra Griffin

Shiralee Roberts

The start of a new year welcomed us with a move into our new building and the challenges of a new environment. We have a wonderfully bright dark room with a window in the door and sensor lights. We were welcomed into our new building by hundreds of mice (a mice plague). However, with a broad smile we carried on despite the adversity.

Welcome to another submission for CADMUS for 2011 from Adelaide. It only feels like yesterday that we were putting submissions together for 2010. As we all know the Dental Corps is facing significant challenges at present in relation to the Combat Health Support (CHS) restructure as part of the Force Moderation Review (FMR). This is evident at the 3rd Health Support Battalion as we will be losing our last remaining military member.

The new Platoons of recruits are relentless and we face the constant challenge of trying to meet the provision of dental care despite the lack of available time in the recruit training program.

We have had a busy start to the year with the return of our HQ 9 BDE Army Reserve contingency from OP ANODE. OP ANODE is the force assigned to Combined Task Force (CTF) 634 to support the Australian led Regional Assistance Mission Solomon Islands (RAMSI). RAMSI assistance is known as Operation HELPEM FREN (Pidgin English for “Helping Friend).

We have lost our wonderful receptionist Rachel to follow her husband to RAAF Williamtown. Although she will be sadly missed, we have welcomed Warren Hartshorn as our new receptionist and also Dr Clive Connell to the Kapooka team (although Dr Connell is not new to us as he has been at RAAF Wagga for a number of years). With a few challenges in front of us, we look forward to the remainder of the year.

We would like to say goodbye to PTE Talya Dellow. Talya arrived from HMAS CERBERUS in December 2009. Talya has had a busy year with her secondary duties at 3 HSB. She is involved in the provision of dental treatment to our Reserve members on Tuesday nights and designated weekends. Talya successfully completed her Junior Leadership Course earlier this year and from all of us here at Dental we wish her all the best in her future endeavours.

Randwick Health Centre – Dental

Dr Gill has had a crazy eighteen months. If he’s not busy working at his own practice, he’s on a flight to Sydney to attend Charles Sturt University were he successfully graduated with a Grad Dip in Dental Implantology. The attainment of this qualification considerably

CPL L. Barry Since the last issue of CADMUS there have been a number of changes at the Randwick Health Centre Dental (RHC-D) facility. Whilst the facility does not have the same “operational tempo” as some of our Northern counterparts, we do have a patient load that includes a mix of Reservists and ARA to keep things interesting and constant.

CADMUS 2011

Dr Murray Hayes left the big smoke for the more relaxed pace of the Sunshine Coast. His popularity is unfounded and we still field enquiries as to his wellbeing. Dr James Sullivan and his wife Amanda welcomed their son Griff into the world. Whilst Griff’s start to life was a little rough, he has since flourished into a bouncing and very well travelled baby boy. Dr Sullivan is still dividing his days between RHC-D and our detachment at Victoria Barracks, Paddington. Dr Williams is still showing no mercy on patients who have either forgotten or misplaced their dental documents. Drs Daly and Hunter are our visiting Periodontists that provide a session once per month. We thank them for their ongoing support and guidance. WO2 Friend has had another year of balancing patients and life on both sides of the continent. Her PT sessions at Coogee are still the stuff of legends. Miss Jade Stanley left the facility to take up a position at HMAS KUTTABUL. Jade and her partner are expecting their first child in August. We wish Jade and Damien all the best on their new adventure into parenthood. CPL Sarah Harrison has finally let the sun settle on an amazing career in the ARA. Harro bid farewell in April and has pursued a dream career as a Personal Trainer. From all accounts her clients are suckers for punishment and despite her gruelling workouts and demands they just keep coming back for more. CPL Kalisa Winn is still jamming 28 hours into 24. Her intense devotion to her studies and PT is admirable. CPL Linda “Bobbi” Barry arrived to the bright lights of Sydney from Townsville in January. In keeping with tradition at RHC-D, she marched in and 2 days later found out she was expecting. Mrs Sharon Hunter has also joined our little crew this year. Sharon is new to the bright lights of Sydney and has plenty of time to enjoy them on her journey from Holsworthy to Randwick each morning and evening. Sharon’s sunny disposition and work ethic have made her a very welcome addition. The facility at Randwick will possibly see an increase in patient load if our Victoria Barracks detachment ceases operation. At the writing of this article, nothing is set in concrete and staff plans for the facility for next year are still under wraps, so I guess we will just have to wait and see!

Hunter Valley Dental Services SGT H. Mayall Here we are in our new building and although it has some interesting teething problems, it is a fantastic facility. Our new building still has no x-ray machines, six months on. Packed lunches are in order to trek over to the old building to take an x-ray if desperation takes hold. Our old building is now sitting empty (apart from our x-ray machines) and an appointment with the demolisher is looking likely. We have Dr Paul Morton back fresh from a six week trek across Spain, eleven years and many treks across the world later and he is still as enthusiastic as ever about getting our members dentally ready. Dr Alan Hicks is working hard on the morning shifts and supplying some very tasty treats along the way. Many of these baked by his lovely wife Jeannie. CADMUS 2011

Liz Burke moves into her eleventh year with us and has mentioned that you get less for murder! Liz is the “jack of all trades” and has stepped up taking on many new roles since we lost the uniformed dental positions. Our new recruit is Mrs Karen Turner who has joined us as our full time assistant and has settled in very well. PTE Leesa Rowan has been lassoed by medical into filling an admin position across the hallway and we can hear her laughs echoing through the building. We wish her all the best for her future. SGT Heidi Mayall (Reserve) is STILL with us of course and probably always will be. This year she has been providing hygiene services two days per week. She enjoys the best of both worlds working as a civilian three days a week and putting on the green for a day or two.

Darling Downs Dental Services MAJ J. Tait Another busy year and down a staff member as CPL Allison Rolles headed off on a non-Corps posting to Engineers at the end of last year. We do hope the technical training is a good change from dental for CPL Rolles. PTE Cherise Kite and PTE Yasmin Hampton are the two Army dental assistants who when not working hard in the dental surgeries at Oakey and Cabarlah are on call as Ambulance drivers for medical. Both PTEs have completed their Senior Dental Assistants course over the last year. PTE Kite went against the norm of a long engagement and was engaged and married within three months. Congratulations and may you and Troy have a long happy life together. PTE Hampton has been busy with part-time university studies and travel to Darwin and overseas. Jacky McGrath has notched up her 21st anniversary of working at DDDS. Everyone around the Oakey base knows Jacky and Jacky certainly has a wonderful memory for patients and their lives. Stephanie Flood our part-time hygienist provides two to three days services per week. Between building a house and part-time study, Steph is never bewildered by the Aviation or Signals terminology that may be thrown her way. Our long term dentist Jane Tait has her split work personality of Dr Tait for most of the week and MAJ Tait on Fridays. She will be saying goodbye at the end of the year as her husband has retired after 43 years in the same legal practice. Travel will be the main agenda for the Taits. The future of DDDS in 2012 will certainly be different from 2011. We wish the members of the ADF dental team all the best.

Puckapunyal

Dental Service

Dr R. Siriwardane Greetings from all of us here at Puckapunyal Dental Service. Since our last appearance on these pages two years ago, there have been a few arrivals and departures. Adelle Gauci, our hygienist in 2009, left for WA at the end of that year. She and her husband Matt, welcomed their beautiful baby daughter Savannah last year. Tara Banks left for Darwin,

also at the end of 2009 where she continued her role as a DA. Dr Scott Freeman left at the end of 2010 to start his own practice in Shepparton. Sharon Hooper was also a valuable member of the team who departed in 2010. We would like to take this opportunity to thank them for their wonderful service here. As for the arrivals, Trish Stewart joined us from Cairns at the end of 2009 and still has not stopped telling us how good Queensland is. Dr Deepesh Sanduja joined us at the start of 2011, settled in well and is now working three days a fortnight at Puckapunyal. Dr Rishi Siriwardane is still driving up the highway four days a week and we don’t know how he manages it! Elizabeth Hemming is now working full time with us, sharing her time between the medical and dental centres. She has been fully occupied between work and building a new home! Dr Graham Woolley has also joined us one day a month managing our complex prosthodontic cases, much to the delight of our Dental Officers. Sandy Clark is the Practice Manager and will soon be Sandy Edwards after her wedding in October and she has also recently completed her Diploma in Practice Management. After another full year we are looking forward to the Christmas Cheer! Merry Christmas to all from Pucka Dental.

Army Reserve Units Health Services Reserve Agency – SEQLD Victoria Barracks, Brisbane COL G. Thurnwald Our manning remains unchanged since last year with COL Rick Olive RFD the senior ARES Health Officer in QLD heading the agency. COL Olive was a little busy recently as the chairman of the organising committee for the World Orthodontic Congress which was held in Sydney. He has now settled into his routine of semiregular overseas trips, ADA Federal Executive commitments in Sydney and seeing the occasional patient. COL Gerald Thurnwald AM remains the Colonel Consultant Dental leading his team of specialists – LTCOL Sven Bohnstedt (Periodontist), LTCOL Rob Hazlewood (Endodontist) and LTCOL Paul Monsour (Oral and Maxillofacial Radiologist). LTCOL Bohnstedt is enjoying the delights of owning a private practice on the beautiful Gold Coast. He was last seen drowning in a sea of red tape/IAS/BAS/group certificates but will no doubt surface eventually and get on with some real work. LTCOL Hazlewood recently spent time in NZ on an adventure holiday between earthquakes and has lived to tell the tale. LTCOL Monsour has become a full professor at the University of Qld and continues in his busy private practice. This leaves little time for anything else except buying, selling (and occasionally driving) exotic motor cars. All three gentlemen continue to

provide specialist advice and treatment to the ADF and its members in Queensland at virtually no cost to Defence. LTCOL Suzy Atkins is posted as a supernumerary Dental Officer to the agency. Since ceasing FTS she is trying some private practice as well as contract dental work at Canungra. She continues to do valuable work filling in for regular ADF Dental Officers and to support surge requirements in Townsville. MAJ David Hua has retained his Corps badge but is still the SO2 MED and COL Olive’s principal Staff Officer. He had an exciting time watching the Brisbane River rise during the recent floods but managed to keep his feet and his private practice dry. MAJ Chris Butson our SO2 Dental has also been travelling to assist the ARA and has racked up two trips to Townsville already this year. He enjoys the change of treating military patients. During the year the team has organised three Tri-Service dental training nights which have been held at the Army Malaria Institute. Our thanks to Professor Dennis Shanks (Director AMI) for continuing to allow us the use of the AMI lecture facility. Topics have included Facial Pain, Dental Trauma and Drug Interactions. These meetings are well attended with excellent speakers and are our main CPD activity. CAPT Nick Palfreyman (7 CSSB) has put in an outstanding effort as the catering Officer on these nights. Our AIRN activities are all well attended, although running remains our least favourite activity. We are looking forward to our annual RAADC Mixed Formal dinner on 8 Oct 2011. We will formally farewell LTCOL Nick Read (38 years service) who recently retired and present 20 year certificates to several of our retired consultants. The Agency looks forward to 2012 and to working with the newly raised 33 Dental Company of 2 GHB.

MAJ Chris Butson at the most recent AIRN activity.

CADMUS 70

CADMUS 2011

Royal Australian Air Force Dental Branch

Unit News No. 1 Expeditionary Health Squadron FLTLT Amy Dempster The year has seen the arrival of more major new Air Force capability to Amberley with the first two KC30A air-to-air refuelling tankers and more F/A18F Super Hornet aircraft. It is an exciting time for the RAAF and the aircraft activity from this base is constant and varied. More new aircraft are expected at Amberley before the end of the year including the fifth C17, a further six F/A18F and in the years ahead, three more KC30A. The year began frantically as always here at 1EHS. FLTLT Sri Sribalachandran posted to East Sale at the end of 2010, and we welcomed FLTLT Steve Dâ&#x20AC;&#x2122;Arcy into the SDENTO role. FLTLT Amy Dempster has achieved CL2 this year, and FLTLT Tim Keys and FLTLT Troy McGowan will also progress to CL2 shortly. FLTLT McGowan leaves us in August to take up his posting to Tindal. He and his wife are also expecting their first baby later in the year. We wish them the best of luck. FLTLT Dempster is expecting her second child in October and will be leaving us on maternity leave in August. This year has been very busy with babies. Our practice manager, Mrs Leah Sheldrick left us on maternity leave in April and had a beautiful baby girl, Rachel Rose Sheldrick in June. AC Jamie Nicholls and his partner had a little girl, Brooklyn. Dr Andrew Wong and his wife also had their first baby, Ethan. Dr Anoop Thakur also had a baby girl, Asha. Our congratulations to all of these new parents.

was quietly spoken, but this myth was dispelled with the raucous laughter often issuing from the steri room! She is assisted by Mrs Amanda Salthouse, who also takes care of all of our ordering. Our civilian staff work tirelessly to keep our practice running. We recently welcomed Mrs Stacey Saunders to the team and she is proving to be a great asset. Also our thanks go to Mrs Michele Gibbon, Ms Jo Moses and Mrs Jenny Richards. We also couldnâ&#x20AC;&#x2122;t function without our two civilian hygienists, Mrs Jany Skeates and Ms Jo Thorpe. In addition to their clinical roles Jo is also responsible for the CMH OH&S role and is always the first to volunteer to organise a party, while Jany keeps us well fed with delights from her garden! As always a huge thanks to Dr Anoop Thakur and Dr Andrew Wong. In a world of ever changing military dentists they are our constant and are always willing to support and mentor our junior dentists. Our visiting specialists Dr Andrew Sainsbury, Dr David Keys and Dr Ben Erzetic have also worked tirelessly this year and again are a huge support to our junior dentists. We look forward to welcoming two new dentists to our team, sharing the role of Senior Civilian Clinician, Dr Christine Cordery and Dr Jesse Green who will join us in July. Finally, I must mention the glue that sticks our dental section together, FSGT Heather Fitzgibbon. Her extensive knowledge and experience is invaluable. Thanks Heather!

Mrs Catherine Van Der Westen was appointed Practice Manager and launched into the new role with her famous enthusiasm and ability. She is an invaluable asset to the team here and has made what could have been a difficult changeover remarkably smooth. We welcomed SGT Kerry Sears from RAAF Tindal in January as the Orderly Room supervisor. She is supported by our two APS staff Mrs Pamela Scamakas and Mrs Christine Hawes. Without their hard work our busy dental section would no doubt be a shambles! CPL Alana McKeon was posted to Tindal at the beginning of 2011 and LACW Amy Johnson followed her in April 2011. So far they are both enjoying their time and we wish them the best of luck. LACW Bianca Goodhill completed her log book recently and we look forward to AC Jamie Nicholls completing his shortly. We moved into our new facility in October 2010. There were the usual teething problems, but we managed to see patients within 24hrs of the move. The new practice has ten chairs and a hospital grade four room Central Sterilising area. With our new equipment we welcomed another addition to our team with our qualified Sterilising Technician Mrs Amy Harnell. We originally thought she

CADMUS 2011

in East Timor in January for three months, which left Dr Ryan very sad. Allanna will be taking a well deserved holiday later in the year and will be joining the lions, zebras and elephants in Africa. SGT (Marty) Blue needs a break from his civilian life and is once again going to brave the all girl Dental team in Townsville for five weeks. We thank him for fulfilling his Reserve days at a time when we are greatly in need of support. We have enjoyed having LTCOL Bohnstedt provide us with Specialist Periodontal support this year and hopefully he will continue to support us in 2011. His endless energy and enthusiasm inspires us all.

No. 1 Expeditionary Health Squadron Detachment Townsville SGT Kathy Shaw Greetings from the Dry Tropics (or not so dry this year!). We had a frightening start to the year with Cyclone Yasi skirting through Townsville and surrounding suburbs leaving us all confined to our homes or in the safe compounds on Base. We have seen civilian and military staff from RAAF Base Townsville Dental Section seconded to work in exotic locations including East Timor, the Solomon Islands and embarked with the US Navy for Exercise Pacific Partnership 2011. FLTLT Eugeniya Kelloway, our Senior Dental Officer has been busy this year, donning a few different hats to cover absences for other staff members. One of those hats is a beret as she is now a qualified linguist speaking fluent French and Russian. Her Dental assistants are picking up French as it is played constantly in her surgery and when they break for morning tea, you guessed it… croissants! FLTLT Kelloway is currently deployed on PP11, serving on USS Cleveland and we hope she is having a great time and that they are utilising all of her dental skills. Dr Ryan, our Aspen dentist has had a very busy year and once again has kept the majority of RAAF Base Townsville dentally fit for which they are all very grateful. She has also donned her FLTLT cap this year and has provided Reserve days over the weekends with LTCOL Bohnstedt. LACW Donna Hayes has come back from her SDA-P course full of enthusiasm and provides much humour to the section! She looks forward to working in the clinic full time upon her return from Deployment. LACW Hayes is also sailing the seven seas and currently serving on USS Cleveland on PP11 alongside FLTLT Kelloway. We are eagerly waiting to see if she will transfer to the Navy after gaining her sea legs and a taste for life at sea. LACW Carly Caseur returned to work after settling in to her new role as a mum. LACW Caseur and her husband Luke are patiently awaiting the arrival of a stork to deliver a brother or sister for their son Corbin in early December or if history repeats, the stork may deliver early! We hope things go smoothly and that Luke will make the birth this time round! We farewelled our Aspen Hygienist Kellie Pennell in June this year. She will be seconded with Aspen to East Timor following on from her time in the Solomons in 2010. Upon her return to Newcastle, she will marry her partner Ryan in November. We wish her all the best for their big day and their future together. Allanna Sturgiss, our Aspen Dental Assistant was seconded to work

A big thank you goes out to Renae Judd, an Aspen Dental Assistant that provided us reliable Dental Assistant cover for the second half of Allanna’s absence. Hopefully we can steal her back whilst Allanna is in Africa. I will be discharging at the end of this year to study a Bachelor of Nursing in Newcastle and to spend more time with my family. Townsville has been a huge learning curve. I have had a fantastic time and made many great friends. I have thoroughly enjoyed my time in both the Navy and Air Force but after 15 years of service, it is time for a change and a new career. To all of you that I have worked with I thank you for your support and friendship over the years and I wish you all the best for your careers and future ahead.

No. 2 Expeditionary Health Squadron FLTLT Georgina Seto Greetings from 2EHS Dental Flight Williamtown! FLTLT Liu and FLTLT Sebastian posted in fresh from the Dutson swamplands of East Sale OTS. In spite of the chilly months ahead, it has been a warm reception. FLTLT Liu joined the RAAF Williamtown Soccer Club and is cementing is position in the starting line up. FLTLT Seto in between her OHS course has been extremely busy consolidating her clinical skills and providing ongoing dental treatment. Our specialist clerk Amanda Ward never ceases to amaze us with her ability to know exactly what every patient is doing and when. She has recently completed a Certificate III in sterilisation. Dr Claire Novak (SDO) is the section’s ‘Hawkeye’ with her charisma, work ethic and patient care. Her partner in crime and experienced clinician Dr Jan Eveleens is also extremely busy providing ongoing clinical care. Richard Brodie is a real asset. Not a day passes that the clinicians don’t voice their appreciation of his expertise and knowledge. His splints, crowns and mouthguards always fit perfectly. He recently welcomed his baby boy Toran into the world. Congratulations. LACW Summersgill is hoping to be posted to Richmond. Kylie Bradford is our health guru. Keryn Slade is juggling her four and two year old children and studying Certificate III in sterilisation. Jane Leach is our computer genius and is our expert with technology! Ellie Welsh is currently studying and heavily involved in the sporting arena. LACW Walker is doing well in sunny Cerberus on the SDA-P course and hopefully she will be posted back on completion of the course! CPL Galvin has taken the first half of 2011 off to study and spend time with her girls during their first year of school. LACW Waldon settled in well from Darwin although she is frozen to the bone from

CADMUS 2011

our winter. Last but not least, FSGT McPherson has been busy as the Squadron WOFF and heavily involved in the unit Social Club. We were sad to bid farewell to FLTLT Aitken who moved to England and LACW Fletcher who is currently studying nursing. We wish them all the best for their future and hope they keep in touch.

We have a fantastic team here in Tindal and this is reflected by our excellent statistics. If you’re ever up in the Top End, drop in and say hello.

Things are about to get even busier here at 2EHS. We will be the on line unit from Aug 2011 to Feb 2012 and are currently undertaking preparatory actions, one of which was a shake out of the Field Deployable Dental Unit. We treated patients for three days from the unit to assess our readiness. It was a very successful exercise. Wishing you all well! If you’re ever in the region, come and say hello!

No. 3 Expeditionary Health Squadron FLTLT Harry Mohan

No. 2 Expeditionary Health Squadron Detachment Tindal CPL Alana McKeon Greetings from the Outback! We’ve had many changes over the last 12 months. We said goodbye to four staff members in December 2010. LACW Kate Priestley hung up her uniform to study a Bachelor of Arts at University. Good luck Kate! SGT Diane Beningfield and LACW Shenelle Douch moved up the road to RAAF Darwin, SGT Beningfield as the DENSPVR and LACW Douch into the DENTASST position. Tindal said a very sad goodbye to SGT Kerry Sears who is now shopping up a storm in Brisbane after six years as DENSPVR in Tindal. The place still doesn’t feel the same without her. LACW Terri-Anne Dehncke is currently on the SDA-P course at HMAS Cerberus. Newly promoted SQNLDR Helena Horina is kept very busy in surgery with 75SQN often deploying and many flying squadrons visiting throughout the year. LACW Amy Johnson joined us from Amberley on a short notice posting and continues to prove what a great dental assistant she is. CPL Alana McKeon posted in to Tindal Dental (again!) in January, this time as the DENSPVR. She’s enjoying the relaxed lifestyle of the NT but missing the shops in Brisbane. One of the biggest challenges we face here in Tindal is where to go on holiday with our next RLLT package. SQNLDR Horina is planning her honeymoon to a tropical location. Alana went on a month-long trip around Europe earlier in the year and Amy is weighing up her options for her first RLLT. This year we’ve been getting in touch with nature on our adventure training exercises through Katherine Gorge. We’ve been training for a 22 km walk and canoe trip, including an overnight camp by the river. We’ll be keeping our eyes peeled for crocs though!

CADMUS 2011

2011 has been an extremely dynamic year for 3EHS Dental Flight and has seemingly flown by at a rate of knots. In the last 12 months we’ve seen six members move on from the section due to postings, partners’ postings, enlistment or career transitions, whilst we’ve simultaneously welcomed three new faces into the section; FLTLT Calum ‘Punk’d’ Watson fresh out of OTS and CHP dental assistants Lauren ‘Avatar’ Johnston and Debbie ‘Pocket Rocket’ Jardine. The Dental Section’s extended family has also grown in 2011 with the birth of SQNLDR Alex Kwaan’s twins and LAC Sergey Semenishchev’s baby boy. Dr Nga Truong and DA’s Beth English and Reagan Smith also welcomed their new babies to the section – Renault Megane, Golf GTI and Focus XR5. SDO Dr David Harmata has been working tirelessly over the last 12 months as the section adapts to a structural reshuffle. He has also been involved in the JeHDI program providing input into customising the dental program for ADF. When he’s not planning and implementing improvements at work, he’s been DIY-ing up a storm at home and is currently putting the finishing touches on his brand new deck and pergola. All the staff are now eagerly awaiting invitations to a summer garden party! We have maintained a high level of operational activity and readiness in 2011 with FLTLT Khai Nguyen away on a US warship for over two months extracting 50-60 teeth per day and FLTLT Harry Mohan progressing to CL2 late last year. With the impending arrival of the DDIS and DDC&L, SQNLDR Alex Kwaan is in the midst of organising a field kit exercise and validation. We also have a busy training schedule in 2011. LACW Kellie Peters completed her SDA course in the latter half of 2010 and is now busily progressing though her competency log. Miss Emma ‘Allen’ Byrnes has transitioned into the Orderly room, learning all the tricks of the trade from our departing guru LACW Crystal Lauw. FLTLT Calum Watson will be completing a number of courses for CL1 Dental Officers and FLTLT Khai Nguyen and FLTLT Harry Mohan are both undertaking various components of the FRACDS program. Our hygienist Kim Fuller-Sale and most of the Dental Officers have also been further honing their skills with attendance at CPD events and seminars including the ADA Congress in Brisbane. Our team up at RAAF Glenbrook, FLTLT Khai Nguyen, Miss Tess Redington, Mrs Pat Speirs, Mrs Kim Fuller-Sale and visiting specialist Reservist SQNLDR John Churchin are still going strong. However, when we’re not hard at work, we are hard at play – DA’s

Tess Redington and Pat Speirs flew off to Paris and New Zealand respectively on holiday, whilst Kerrie English travelled to the far corners of Sydney in search of the 2Day FM Fugitive. October 2010 saw the RAAF Richmond dental building reach the ripe old age of 21. A small celebration was organised to commemorate this milestone. The ailing air-conditioning units have now been replaced in the building, so staff no longer have to endure northern and southern hemisphere climates. This year we farewelled Mrs Karen Conway, who could not resist returning to the blue uniform and LACW Crystal Lauw and CPL Laura Kelly who found greener pastures. Finally we would like to thank our visiting specialists, WGCDR Neil Peppitt, SQNLDR Matthew Hunter, SQNLDR John Churchin and DR John McHugh whose expertise and guidance have proved a boon to patients and Dental Officers alike.

I’m happy to report that Ms Karen Feather and Ms Tricia Santez have joined our ranks. Both have settled in well and have become part of the 3EHS family. We are all struggling to keep the extra pounds off due to Ms Feather’s Baileys cake. Ms Santez is a full time Zoo Keeper part time DA and only works to feed her menagerie. Dr Chris Mansfield is still here and we have been encouraging him to enlist, due his many years of experience with Defence. Despite the heavy workload LACW Douch has started her certificate IV in Personal Training and still managed to run away to sunny Cerberus to complete her SDA course, where she received student of merit.

No. 3 Expeditionary Health Squadron Detachment Darwin SGT Diane Beningfield This year is truly racing by. LACW Shenelle Douch and SGT Diane Beningfield were the only two new Defence members to be posted into 3EHS Darwin this year. I thought it was going to be an easy removal, after all Darwin is only 300 kilometres up the Highway from Katherine, what could go wrong? Then Cyclone Carlos hit Darwin in February dropping a record breaking 339.6 mm of water within 24 hours. My house did spring a few leaks and LACW Douch’s underground car park soon became an indoor swimming pool. 3EHS flooded yet again and for those who made it to work they spent the morning with a mop and bucket. A few sandbags later and many weeks of sunshine and Darwin is now back to her former self. While LACW Douch and I enjoyed our time in Katherine, we are certainly making the most of the markets, restaurants, shops and cafes that Darwin has to offer. This year we have had a huge turnover of both Defence and civilian staff. SGT Jason Randell is now happily instructing recruits in Wagga Wagga, LACW Kirrie Waldon is enjoying her posting to RAAF Williamtown and I’m sure LS Gregory Pashen is grateful to be posted back to HMAS Success in Sydney. FLTLT Lee has safely made it to Perth and is hopefully enjoying life as a civilian. We wish them all the best for the future. Sadly Dental Assistant Maya McDuff moved to Port Lincoln and, due to personal circumstances, Tara Banks decided to leave 3EHS Dental. Although Ms Shilpa Kudekar was only with us for three weeks she made quite an impression on our section and we still miss her bubbly personality. Unfortunately we will also lose hygienist CPL Rachael Greenshields at the end of the year. CPL Greenshields has been posted to Adelaide where she will finally be reunited with her husband.

As you all know 3EHS Dental has been seeing both Navy and Air Force personnel since the closure of RAN Dental in June 2010. With FLTLT Lee discharging in June 2011 it was up to Dr Mansfield to man the fort three days a week. Luckily 1CSSB came to our rescue. For the past two months they have been providing dental care for Army, Air Force and Navy Personnel. So a huge thank you to you all, we would have been lost without your help. Navy have supplied us with relief manning until October this year. Thank you to those who volunteered, LEUT Sally Cochrane, LEUT Karina Cvejic and LEUT Sarah Benton who has now graciously volunteered twice. If there is anyone willing to visit Darwin during November and December you are more than welcome.

No. 4 Expeditionary Health Squadron Dr. Ed Wilson The start of 2011 has been a busy one for Edinburgh Dental. It was set to be a time of significant changes both with the changeover of personnel and the promise of finally moving into the new dental surgery that has been positioned so tantalisingly close, but has always seemed so far away. On the Dentist side, SQNLDR Janine Tillott was posted out to take up a position as SO1 Clinical Dental Standards and Dr Colin O’Donnell retired after many years service in the RAAF and as a civilian. On the Dental Assistant side, Skye Briske left her full time position to pursue her dream of becoming a hygienist. Much experience has left with their departures and they will all be missed. As an attempt to fill the void, Dr Ed Wilson has taken over as SDENTO and Dr Desi Lipapis, having never previously worked with Defence, has slotted in seamlessly for three days a week. Dental Assistants Megan Ripley and Cecilia McCormack have joined us to help out the overworked Linda Kingsada and LACW

CADMUS 2011

Charlene Duncan, and both work like they have been in Defence their whole lives. The excitement of the year was undoubtedly the movement of all of Health services into a brand new hospital complex. Construction was completed in December 2010 and shortly afterwards all of the different departments moved in – all except dental. There have been a few small problems that have conspired to delay our moving, all of which seem to have now been rectified and the ‘Dental Relocation Action Plan’ or DRAP (named proudly by LACW Charlene Duncan) looks like it will be rolled out before August. There have been considerable challenges posed this year as the Army has moved the 7th Battalion, Royal Australian Regiment, to Edinburgh, increasing our workload considerably. This has blown out our bookings, making it a bit more difficult to keep everyone dentally fit, although the front desk A-team of Lisa Merritt and Rachelle Harris have taken it upon themself to get the new Army members marching to the Edinburgh Dental beat. Their tireless efforts, coupled with the flexibility of dentists Dr Ella Chronowski and Dr Peter Wong and the hard work of our ever-popular hygienist Mandy Walker, has helped avert a dental readiness disaster. So although there has been trying times, Edinburgh Dental has coped extremely well and looks forward to another year.

As always, travel is on the agenda at East Sale. Dr Barned started the year with a six day tour of the golf courses of the Gold Coast, followed by the ADAVB golf day and will finish off with yet another golfing trip. FLTLT Sribalachandran has also caught the travel bug. He will be off Malaysia and Singapore soon. East Sale Dental Section is a dedicated bunch with a great attitude making it possible for us to deliver excellent dental care.

No. 4 Expeditionary Health Squadron Detachment Pearce Dr Tony Bartels The past year at Pearce has been relatively uneventful. Our hygienist LACW Sacha Brown left the RAAF towards the end of 2010. We were all very sad to see Sacha go. She elected stability for the future and thus decided to leave. The members of our little section here at Pearce attended Sacha’s wedding on a very hot day in February on one of the local Perth beaches.

From left: Rachelle Harris, Dr Ed Wilson, Dr Peter Wong, Lisa Merritt, Dr Ella Chronowski, Cecilia McCormack, Linda Kingsada, Megan Ripley, Mandy Walker, LACW Charlene Duncan, Dr Despina Lipapis

The rest of the crew are still here. Dr Tony Bartels is now in his fourth year. CPL Charmaine Gurney is still here. Her children have now completed school and are joining the medical ranks with her son studying nursing and her daughter in first year medicine. LACW Michelle Sheils is still providing excellent service at Pearce and is in her third year.

No. 4 Expeditionary Health Squadron Detachment East Sale

Earlier in the year we were very lucky to have AB Jessie Lantry from HMAS Albatross help out for a month during a staff shortage. Jessie’s efforts were greatly appreciated. She also made the most of the trip catching up with family and friends in WA.

CPL Melissa Riseley The year began with the arrival of FLTLT Srishyam Sribalachandran to replace nomadic FLTLT Robert Cox as the Senior Dental Officer. FLTLT Cox has discharged from the RAAF and will be missed by all. We hope he is enjoying his amazing race around the world. Meanwhile, FLTLT Sribalachandran has settled in with relative ease and has taken a liking to Sale. The rest of the team remains unchanged with Dr Clarke Barned, CPL Melissa Riseley, Mrs Jo Rietschel and Miss Renae Hawkin. It has been an eventful year at East Sale. In May, we witnessed an unfortunate incident where a PC-9 crashed off base. Thankfully, the pilots ejected safely with minimal injuries. The Dental team was heavily involved in the medical response with FLTLT Sribalachandran acting as the OIC and CPL Riseley acting as the liaison to the ABCP. Lets hope we stick to just training in the future though. The Dental section finally received its long waited intra-oral x-ray machines. Two Kodak 2200 were installed to the delight of CPL Riseley, who is able to assist with the bitewings on the OTS induction days. CADMUS 2011

We had a one week visit from Lisa Holliday, a dental student on the RAAF undergraduate scheme. Lisa made the most of her week here at Pearce and was lucky enough to get a ride in a PC-9 trainer. RAAF Pearce had a major crash exercise during the year. This involved multiple civilian authorities such as the state hospital emergency service, police, fire and ambulance services. The dental personnel participated in this activity and found the experience very rewarding. This degree of civilian participation was a first for the base. Other than these events life has just continued on with no great changes of note. RAAF Pearce Dental wish all our friends and colleagues a happy and productive year.

No. 4 Expeditionary Health Squadron Detachment Wagga LACW Adriana Porcelli Welcome again to another year at Wagga Dental section.

2011 greeted us with many changes as we said farewell to three of our staff members. FLTLT Steve D’Arcy, LACW Kate Morris and DR Clive Connell. FLTLT Darcy only spent a year with us in Wagga before he was tempted back to “City Living” in Amberley. During the year though he was pleasantly surprised with Wagga and all it had to offer. We wish him all the best with his new unit. His efforts in this dental section are missed. LACW Kate Morris left the dental section over the Christmas break to peruse her re-muster as Crew Attendant. 2010 was a huge year for Kate as she not only got her dream Re-muster, she got engaged and splashed out with the purchase of a brand new car! We know she will succeed with her new career and wish her all the best. Dr Clive Connell had been with us for five years before he hung up the dental coat at RAAF Wagga Dental. He made the trip down from Canberra every week without fail to work with us for three days a week. Clive opted for a scenery change and is now working at Kapooka Dental. We thoroughly enjoyed Clive’s stories. Thankyou for your hard work! We welcomed a new member to our unit in 2010 ACW Kymberley Monck. She re-joined Defence in February and luckily skipped a few weeks of recruit training thanks to her prior service in the Navy. ACW Monck completed work experience with us before she went to Cerberus and enjoyed her time so much that she quickly returned after her training was complete. ACW Monck is a hardworking addition to our team and is very interested in seeing the REAL Air Force. She is now well settled in Wagga and can be spotted most Friday afternoons shopping up a storm at the local mall. SGT Kylie Williams enjoyed a few days break in the form of a conference at Amberley. It gave her a chance to catch up with old friends and of course do a little work. Kylie has received the good news that the section will be getting a makeover thanks to paperwork she submitted when she first arrived at the unit. Well done Kylie. Miss Kelly Boyce our Senior Dental Assistant has done an impressive job in the orderly room over the last twelve months. She also completed her studies in radiography, well done! Kelly obviously enjoyed studying last year as this year she is studying HR Management and enjoying the new challenge. Kelly welcomed a new grandson to her family this year. LACW Adriana Porcelli has been out in the orderly room this year and enjoying the change and challenges it has to offer. She was faced with one of her greatest challenges last September when she trekked Kokoda. From her stories I think she feared the plane size and ride more than anything else. Her photos and stories have been great. We all knew she could do it and she highly recommends the experience to everyone else. LACW Porcelli is off

to Vanuatu soon for a well earned break. Our three Civilian Dentists this year work between RAAF Dental and Kapooka Dental. Dr Miles Connell now works at our section every Tuesday afternoon. Dr Sharma Nand is here 2-3 days a week on rotation with Dr Robert Vella. We truly appreciate all their hard work. Thankyou! Mrs Shona Graham still makes the trip across town from Kapooka on Mondays to assist in surgery. Shona always has a smile on her face despite the fact that “It’s Monday”! That’s all the good news from freezing cold Wagga!” Keep Smiling”.

No. 4 Expeditionary Health Squadron FLTLT Robyn Barrie Dental Section, Laverton Health Clinic is currently staffed by RAAF dental personnel and Contract Health Practitioners (CHPs). The RAAF members (FLTLT Barrie, CPL Johnston and LACW Bate) are under the command and control of CO 4EHS while the CHPs report to a newly appointed Practice Manager (Tania Gentry – who is responsible for managing both the Medical and Dental Section) and are ultimately directed by the Regional Health Director of Victoria. Laverton Health Clinic genuinely strives to provide a high standard of dental care to ADF members. CPL Johnston has been on Maternity Leave since 01 Aug 10 and has enjoyed her time at home with her gorgeous baby girl (Jemma) and Jemma’s big brother Josh. LACW Bate was posted to RAAF Base Williams in Jan 2011 and has been a delight to have as a member of the team. LACW Bate discharges WEF Jul 11 to pursue a career as a make-up artist. We wish her all the best in her future endeavours. LHC also farewelled Mr Paul Reed early in 2011. Paul will not be replaced and as such is the last Dental Technician to work at RAAF Base Williams. Dr Graham Woolley provides excellent prosthodontic services to ADF members across the Victorian region and works from LHC two days per week. Sharon Smith is a calm and reassuring chair side presence who is still baking up a storm and cheering for the Bulldogs. Jane Tapp is the all singing and dancing DA with a vast amount of corporate knowledge. Dental Section at Williams benefits greatly from Jane’s corporate knowledge and outstanding administrative skills. Elizabeth Coyle provides hygiene services one day per week and likes to take a power nap during her lunch break. GPCAPT Tyas has reached CRA but thankfully will return as a CHP working one day per week. GPCAPT Tyas is still our resident globetrotter and we look forward to his post cards and lunch time slide shows. Dr Melinda Johansson provides GP services two days per week and is a wonderful member of our dental team. Melinda has just returned from a trip to India and Bhutan. LHC has had staff from Simpson Barracks and Victoria Barracks “staying” with us while their Dental Sections have been refurbished.

CADMUS 2011

The First Name in Portable Dental Gear Aseptico is internationally recognized as a manufacturer of high quality portable military dental equipment and accessories. Specialized applications that benefit from portable dental equipment include:

Presently used by:

• Military

• The Australian Defence Force (Army, Air Force and Navy)

• Public Health

• The Royal Flying Doctor Service

• Missionary Work

• The New Zealand School Dental Health Program

• Home-based Dentistry • School-based Programs • Emergency Back-up

Exclusively available from Wisbey Dental +612 9875 5588 www.wisbeydental.com

• A number of remote Aboriginal Dental Health Care Providers

Proven. Unrivaled innovation, thoughtful design, lasting integrity: A-dec 500® is based on decades of collaboration with dentists worldwide. Such cooperation has led to pressure-mapped patient comfort, robust integration of handpieces and technology to minimize reach, and a touchpad that provides single-point system control.

In a world that demands dependability, A-dec delivers a proven solution without a single compromise.

Chairs Delivery Systems Lights Monitor Mounts Cabinets Handpieces Maintenance Sterilisation Imaging

For more information Email: a-dec@a-dec.com.au Phone: 1800 225 010 Visit: www.adec.com.au

Michael Raghib Territory Manager NSW & ACT 0467 688 818 AA617_Inkredible1442-73R

Daniel Bet Territory Manager NSW & ACT 0400 391 241

Bruce Williams Territory Manager VIC & TAS 0417 766 544

Scott Williams Territory Manager VIC & TAS 0407 816 390

Brian Gardiner Territory Manager QLD 0411 189 380

James Rosborough Territory Manager QLD 0409 705 811

Nigel Davis Territory Manager SA & NT 0418 824 602

Joe Minervini Territory Manager WA 0400 001 954