Oral Health for Better Health 2013 by Dental Health Services Victoria

FOR BETTER HEALTH

WIN A FAMILY PASS TO THE MOVIES!

Western Bulldog Mitch Wallis plays well

See inside for details

Healthy recipe book inside!

The BUZZ on energy drinks www.dhsv.org.au Like us on Facebook: www.facebook.com/DentalHealthVic Follow us on Twitter: www.twitter.com/VicDental

DENTAL HEALTH SERVICES VICTORIA Oralhealth for better health 2013/14 QUALITY OF CARE REPORT 2013/14 1

From the CEO Welcome to the 2013 edition of our Oral Health for Better Health magazine. Teens can be so busy with school, jobs, sports and social activities that they can find it hard to get time to look after their teeth. They might also eat a lot of take-away food while they are out and about, drink a lot of soft drinks or sports drinks or start smoking during this time and all of these things can lead to tooth decay, gum disease and other oral diseases. Making healthy choices can help keep your teen’s mouth and body healthy now and as they grow into young adults. That’s why this year’s Oral Health For Better Health magazine is all about teenagers and how eating well, drinking well and cleaning well can help them and their mouths to stay happy and healthy.

Around 10% of Victorian teenagers have between five and eight permanent teeth that are decayed, missing or filled and this is about five times the national average. We want to remind teens that brushing twice a day with fluoride toothpaste, drinking lots of fluoridated tap water, eating lots of healthy foods and getting regular dental check-ups are just some of the ways they can keep their mouths healthy for life. While we are busy promoting healthy habits like these, Dental Health Services Victoria staff are also working hard to improve the services we provide to teens and the rest of the Victorian community. We are using exciting new research to help us find new ways to prevent dental diseases before they become a problem and we hope that you and your community see the benefits very soon. We have also included some important information for you about our performance and some details about the great work

we are doing right across Victoria. We make this magazine available online and in waiting rooms at The Royal Dental Hospital of Melbourne and other health providers, so that as many people as possible have access to this information. As always, we have used your feedback to help shape and improve this magazine and we hope that you enjoy reading this year’s edition.

Dr Deborah Cole

Chief Executive Officer Dental Health Services Victoria

Features FOR BETTER HEALTH

The buzz on energy drinks Are energy drinks good for you? And what are they doing to your teeth and gums?

ACE MID project Our research teams are working hard to prevent teenagers from needing invasive dental treatment

Ask Professor Mike Professor Mike answers some questions about teens and their oral health

04 07 ET AR

Design: studiowarna.com

T E E T M A RT E

We acknowledge the traditional owners of Australia and we welcome all Aboriginal and Torres Strait Islander people to our services.

Mitch Wallis, Western Bulldog and DHSV Smile of the Year Award winner.

2013/14 Smile of the Year Award Winner

True red, white and blue –

Western Bulldog Mitch Wallis: our healthy smile ambassador The red, white and blue colours of the Western Bulldogs run in the family for Mitch Wallis. The 21-year-old son of former Footscray legend Stephen Wallis joined the team in 2010 after being drafted from the Calder Cannons. Since then he has been nominated for the 2012 Rising Star Award, and been recognised as the Bulldogs' Most Improved Player. Now, Mitch has won the DHSV Community Advisory Committee (CAC) Smile of the Year Award 2013/14 for his commitment to a healthy lifestyle, his ability to connect with young people across the state, and his position as a positive role model for the community. CAC Chair, Jennifer Theisinger says Mitch represented Victoria’s youth, and his contagious smile made him perfect for the award.

“Mitch’s role as a prominent AFL player, and a strong leader, will help us to connect with young people across Victoria. His on and off-field efforts to promote good health are outstanding and, with his help, we can make some big improvements to the oral health of some of our young community members, helping them to keep their teeth and gums healthy for life,” said Ms Theisinger. Mitch, who plays midfield for the Bulldogs, is passionate about good health and wants teenagers across the state to be more aware of how their general health is impacted by their oral health. He told DHSV that he wears his mouthguard every game. “I’ve seen what can happen to guys that don’t – one bad hit to the mouth or jaw and they can be out of action for months.

“Our teeth play such a big part in how we eat, how we speak, and how confident we are in social situations. Having healthy teeth means you’re free to do these things without pain or embarrassment. The last thing I want is to ruin mine during a footy game.” Mitch said that winning the Smile of the Year Award is “an honour”. “This is a chance to share how important good dental health is with the young people of Melbourne. Keeping your mouth healthy is easy: you just need to remember to Eat well, Drink well, Clean well and Play well. “Eat fresh fruit and veggies – they’re the best fuel for your body, and help keep your teeth nice and healthy. Drink tap water when you can, instead of cordials or soft drinks and brush twice a day too. And remember to use a mouthguard when you are playing your favourite sports.” DHSV is proud to present Mitch with the 2013/14 Smile of the Year award.

Oralhealth for better health 2013/14

The BUZZ on energy drinks Energy drinks come in many flavours, colours and sizes. One thing is for sure though – they are becoming more and more popular. But do you know what they are really doing to your teeth and gums?

Energy drinks are everywhere. You can find them in convenience stores and supermarkets all around Australia and people across the country, especially teenagers, are drinking them up. Though there are a variety of energy drinks on the market, their common trait is an energy boost from either caffeine or guarana. But are they good for your oral health? Energy drinks can contain as much sugar as regular soft drinks – if not more – and are just as likely to cause oral health problems, particularly tooth decay. Despite these health issues, Australian teenagers are jumping on the energy drink bandwagon with some having as many as 12 bottles each day – that’s 1.2 litres and up to 25 teaspoons of sugar every day (that’s 23kg a year!).

Quick fact: 47% of Australians under 16 years of age consume a sugar sweetened drink (including energy drinks or soft drinks) every day

Quick fact: A 600ml soft drink contains about 16 teaspoons of sugar

That sugar is helping produce bacteria which can cause tooth decay and other oral and general health problems like obesity. A recent study has found that energy drinks also have higher acid levels than most other fizzy drinks. The acidity of diet versions means that even the low-sugar versions can leave your mouth open to oral disease. Unlike tooth decay that is caused by bacteria, acid in food and drinks can damage the enamel surface of teeth which can cause dental erosion. So think twice next time you reach for that energy boost. Save some money by drinking free, fluoridated tap water instead of a soft drink. Your wallet, body and mouth will thank you for it!

What you can do Cut down the number of these drinks you have If you do drink them, use a straw Don’t brush your teeth for an hour after you’ve finished one of these drinks – the acid in them temporarily demineralises (softens) your tooth enamel and brushing too early will harm it Don’t drink them before bed

Quick fact: It is estimated that 3.4 billion litres of energy drinks are consumed throughout the world every day

Oralhealth for better health 2013/14

Swish water around your mouth after each bottle or can of drink See more at: http://bit.ly/H0dneP

Australian teenagers are jumping on the energy drink bandwagon with some downing as many as 12 bottles each day.

Be careful if you mix alcohol and energy drinks as you're at an even greater risk of dental problems.

Alcohol and oral health The main threats to your teeth and gums, from alcoholic drinks, come from the sugars in the alcohol and the acidic nature of the drinks. The sugars are broken down in your mouth, creating a breeding ground for bacteria and plaque, while the acids can lead to the wearing down of tooth enamel (erosion). Research also tells us that excessive alcohol drinking is linked to mouth, head and neck cancers.

Decay equation

How can I limit the damage? Remember to brush your teeth with a fluoridated toothpaste after a night out â&#x20AC;&#x201C; around an hour after your last alcoholic drink. If you often forget, try leaving your toothbrush on your pillow before you go out to remind you to spend a couple of minutes brushing. Swish water around in your mouth after each alcoholic drink to increase the saliva flow and rinse away sugars and acid in your mouth. Drinking water in between each alcoholic drink can also help you to feel better the next morning because youâ&#x20AC;&#x2122;re rehydrating all the time.

Sugar

(from plaque)

Forms Acid

Acid

Healthy tooth

Causes decay

Erosion

Chew sugar-free gum on your way home to stimulate saliva flow and clear the mouth of harmful sugars and acid. See more at: http://www.dentalhealthweek.com.au/Adults/Lifestyle-Risks/ alcohol.html

Bacteria

Erosion equation

Acidic food and drinks

Healthy tooth

Fact box Immediately after a piercing

Tongue and lip piercings can look great and really make a statement about you and your personality, but before you decide to take the plunge and get a piercing in or around your mouth, consider the effect it could have on your teeth and gums. Piercings can lead to broken teeth and can hurt the gums, leading to inflammation and gum disease. Mouth and tongue piercings should only be done by a professional using sterilised equipment. You should ask your piercer for advice on taking care of the piercing and avoiding infection. If you notice any damage to your gums or teeth or have any bad pain, visit your oral health professional as soon as possible.

Minimise swelling during the initial healing process by drinking cold, icy water. Rinse your mouth regularly with non-alcoholic anti-bacterial mouthwash â&#x20AC;&#x201C; especially after eating. Avoid smoking, alcohol and spicy foods until the piercing is fully healed. Do not pick, tug or touch the piercing. Visit your doctor or oral health professional immediately if pain and swelling continue after a few days, or if you have severe redness, bleeding, pain or pus around your piercing.

Once your piercing has healed

Piercings

Try to keep the piercing away from your teeth and gums to minimise damage. Ask your piercer for jewellery that is safer for your teeth and gums (e.g. plastic rather than stainless steel). Tighten the ball ends of your jewellery regularly to help stop you from accidentally swallowing them. Make sure your hands are clean first. Brush your teeth and gums (and, if you have your tongue pierced, the tongue area around the piercing) with a soft toothbrush twice a day.

Oralhealth for better health 2013/14

Professor Hanny Calache is leading the ACE MID team and helping Victorian teens to avoid dental decay

Tooth decay, to date, has mainly been managed by ‘drilling and filling’. But a new study led by DHSV aims to test other cost-effective methods that are less invasive.

ACE MID project For a long time drilling and filling teeth (and even removing teeth) has been the most common way to fix advanced dental decay. Unfortunately, these treatments do not last a lifetime and can lead to more of the tooth being removed later on, fillings being replaced and more money out of your pocket. To find a less invasive way to deal with dental decay, DHSV is looking at whether “minimal intervention dentistry” (MID) can improve the oral health of the younger members of our community. Director of Clinical Leadership, Education and Research at DHSV, Professor Hanny Calache, says there are lots of things we can do to prevent tooth decay and repair teeth without having to use surgical procedures. “MID is based on the idea that early decay can be stopped – and even healed – through diet changes, better oral hygiene, and by applying products like fluoride varnish to teeth”, says Professor Calache. In 2011, Professor Calache led a pilot study on MID for adolescents. Feedback from the adolescents and parents was very positive. “One of the teens had never flossed their teeth before the study but is now taking the time to actually brush and floss correctly,” Professor Calache says. “And the parent of another has said just how grateful she is that her daughter is now brushing her teeth without having to be asked.

“The best part though, we think, is that these new habits can rub off on brothers, sisters and parents and improve the whole family’s oral health.” To follow on from the pilot study, DHSV is now undertaking a larger two-year study. Teens are being recruited from 12 community dental clinics around Melbourne to participate in this MID study, with around 500 expected to be involved over the two years. The teeth and gums of the teens are examined at the beginning of the study, and then at the 12-month and 24-month marks. In addition, at the three-month, six-month, and 18-month stages they will be given oral care products and have fluoride varnish applied to their teeth. “The teens are shown how to brush their teeth properly and are given advice on how to eat healthily. By paying attention to the food and drinks that they have each day, they can help prevent further tooth decay,” says Professor Calache. Since the study began, earlier this year, there has been great feedback from the participants and their families. The study is scheduled to finish in June 2015. It is expected that this approach will help reduce the need for extensive treatment in this age group.

Oralhealth for better health 2013/14

Clinician

Lab

Name: Tanuja Sule

Name: Fareed Ismail

Job Title: Dentist

Job Title: Dental Technician – Dental ceramist, for crown and bridge

Training and Education: Bachelor of Dental Science

Role: I treat emergency patients and general patients and perform surgical extractions when needed Location in hospital: Level 1, General Dental Care Unit Best part of my job: The team I work with is great – they’re so friendly and supportive. Everyone brings a different strength to the unit. My favourite part is extracting wisdom teeth, though!

Meet some of our team Supply Name: Kirsty Milnes Job Title: Supply Officer Training and Education: Year 12 and then on the job training

Role: Purchasing dental consumables, stationery and handpieces (among other things) for the hospital and agencies. Once the orders are placed we follow up delivery and make sure everyone has everything they need to do their jobs. Location in hospital: Supply Office, Ground Floor Best part of my job: Meeting staff around the hospital and agencies and putting a face to the name. I love the customer service part of my role – talking to the suppliers and staff and helping them with queries and tackling any challenges that may arise. Our team is very supportive.

Training and Education: Diploma Of Dental Science Role: Constructing fixed crown and bridge cases for patients who need replacement teeth Location in hospital: Level 3, Dental Laboratory Best part of my job: Working in a great team with great work ethics and an eye for quality. It is very rewarding making a new smile for a patient and seeing a successful outcome!

We don’t just have dentists working at The Royal Dental Hospital of Melbourne. Lots of different people work together to make sure you get the best care possible. Meet a few of our team.

Records Name: Jenny Fattoretto Job Title: Health Information Services – Clerical Officer

Training and Education: Certificate III in Business Administration (Medical), Training in Radiology Reception and Dental Teaching Clinic Reception Role: I am responsible for data entry, retrieving patient records, preparing inpatient theatre files, answering phone enquires, processing archived patient records, registering study models, giving out correct information regarding freedom of information requests, terminal digit filing, clerical duties. Location in hospital: Ground Level – Health Information Services Best part of my job: Working in a good team environment and being able to apply my skills all around the hospital.

Our Community Advisory Committee (CAC), a group of consumers and patients just like you, helps us to ensure that everything we do is improving the care that we provide. They give us their opinion from a patient and visitor perspective and we use their expertise and opinions to shape written materials like this magazine, brochures and posters, online resources like websites and all of our feedback channels. We listen to our patients in other ways too. This magazine has a feedback form and the information you send to us via those forms helps shape how we create the next edition. During the year you told

us that you loved our article on how much sugar was really in drinks and that inspired you to want more healthy recipes and food alternatives. We’ve included a recipe book inside this magazine to help with just that. We’ve also improved the way that we do things within the hospital, like creating a call centre, to make sure we are available to take more of your calls more of the time and training our staff with professional development opportunities. We are also looking to upgrade some of our signs over the next 12 months to help you find your way to your appointments and there are lots of other projects under way too.

Improving us for you Feedback Complaints by category:

339

254

264

317

379

Complaints per financial year:

291

DHSV is committed to providing you, our patients and consumers, with high quality oral health care. We welcome all feedback. It gives us an opportunity to improve and helps us to provide you with a safe and quality service.

RDHM has a responsibility to be responsive and sensitive towards the rights, needs or complaints expressed by our patients (or someone on their behalf). We also need to ensure that the response is managed in a timely and sympathetic manner. We aim to resolve all complaints within 28 days but sometimes, if the complaint is complex, this process may take a little longer. In that case, the patient is kept up-to-date with our progress.

Incidents: DHSV has procedures in place to review any incidents that either harmed, or could have harmed, a patient in our care. All incidents are recorded on our database so that we can regularly review, evaluate and monitor exactly what has occurred and introduce strategies that will improve patient safety.

2012–13

2011–12

2010–11

2009–10

2008–09

We work with staff and patients to resolve the matters brought to our attention in a fair and open manner that is free from threats, victimisation and reprisal.

2007–08

Feedback we receive from patients is always sent to the manager in charge of the relevant department to action.

Access: 84 Waiting times, delays in treatment Customer service: 57 Attitude of staff, not enough information or information that was incorrect Treatment: 68 If the treatment was not good enough or if it was different to what you were expecting Cost: 12 Cost of treatment Administration: 17 Mistakes or problems with forms or paperwork Facilities: 15 The buildings and the way they work, including car parking and getting in, out and around Patient rights: 1 Confidentiality and access to personal information

In 2012–13, we received 254 complaints relating to a variety of issues. We are working hard to address every one of these issues and improve these areas based on your feedback. Oralhealth for better health 2013/14

You said it! "You should be called the Smiling Hospital, as you light up everyone’s day! Staff were all very very pleasant, students were excellent and thanks also to the staff in the office." – Beattie, Northcote "A rewarding experience from my assessment to the completion of my treatment. All staff from the receptionists through were friendly, helpful and courteous. A special thank you to the dentist for the skill and effort in fitting me with new upper and lower dentures. I am very satisfied and grateful for her commitment." – Bob, East Geelong "The staff were so professional and informative with my treatment. I am walking away today with such a happy feeling about my experience at The Royal Dental Hospital of Melbourne. The staff here, especially reception and xray area are so pleasant and professional. I feel uplifted." – Cane, Aberfeldie "My dentist was friendly, reassuring, jovial and efficient. He made a challenging and tense situation – having a tooth removed – quite a lot easier. He communicated in clear and straightforward language which I appreciated." – Sharon, South Melbourne

Accreditation Accreditation is a formal process that all health services, including DHSV, must go through to make sure health care is safe, of a high quality, and meeting certain standards. Since January 2013, public hospitals across Australia have been accredited to new National Safety and Quality Health Service (NSQHS) Standards. These new Standards are helping us to improve in the areas of: 1. Governance for Safety and Quality in Health Service Organisations 2. Partnering with Consumers 3. Preventing and Controlling Healthcare Associated Infections

"I have had a fear of dentists my entire life but left happier than ever because of the job that they did. No pain at all and my fears are gone. Professional and understanding. Sincere thanks." – Caleb, Brunswick West "My wife and I are so happy with your help. We are so thankful as we were in so much pain. Thanks again, we can never forget you and your help." – Blaze, Altona Meadows

Oralhealth for better health 2013/14

4. Medication Safety 5. Patient Identification and Procedure Matching 6. Clinical Handover 7. Preventing Falls and Harm from Falls In December 2013, DHSV will be reviewed by The Australian Commission on Safety and Quality in Healthcare for its compliance with these new standards and we will post our results on our website and in our 2014 Annual Report.

Healthy Families, Healthy Smiles In February this year, the Victorian Minister for Children and Early Childhood Development, Wendy Lovell, launched the Healthy Families, Healthy Smiles program at The Royal Dental Hospital of Melbourne. The project is funded by the Victorian Government, and aims to improve the knowledge and confidence of health professionals, early childhood professionals, and pregnant women across the state. We are helping to give them the skills and information they need to promote good oral health.

More than 60 project partners and participants came to the launch and Minister Lovell presented certificates to a group of midwives who participated in one of the initiative’s first projects – an online oral health education program. So far 33 midwives have completed the training. “We want to make sure that smiles stay healthy during early childhood and pregnancy and the best way to do that is to start early,” Minister Lovell said. Healthy Families, Healthy Smiles has worked with three early parenting centres to develop and pilot an education package called ‘Baby Teeth Count Too!’ for staff working in their services. The project is also working with professionals in the early childhood sector to develop a resource kit and training package for staff in early childhood services.

The Tooth packs project is also a part of Healthy Families, Healthy Smiles. It involved DHSV providing toothbrushes and toothpaste to families through the Maternal and Child Health Service – helping to increase the number of children who brush their teeth twice a day. Tooth packs have been given to around 1500 families in four local government areas and final results of the evaluation of this initiative are due in late 2013.

DHSV is helping to give other health professionals the skills and information they need to promote oral health.

Engaging with the community Mums and bubs who helped celebrate the launch of the Healthy Families, Healthy Smiles program at The Royal Dental Hospital of Melbourne in February

Oralhealth for better health 2013/14

How well did we do? DHSV collects data on all of the services that we provide. We look at whether patients have come back unexpectedly for further treatment and try to find out why. This helps us to improve the quality of our services. In most cases, we judge our results against targets set by the Department of Health.

Teeth retreated within 6 months of initial restoration (Adult)

9.7%

9.5%

Teeth retreated within 6 months of initial restoration (Child)

8.7% 5% 3.1%

Jul–Dec 2011

Jan–Jun2012

Jul–Dec 2012

Unplanned Return within 7 days after routine extraction

Jul–Dec 2011

3.9% Jan–Jun2012

Jul–Dec 2012

Unplanned return within 7 days after surgical extraction

Improving access to care We make sure that the quality of the care we provide is of the highest standard and we also want to help people get dental treatment as soon as possible. In 2012/13, we exceeded all government targets for offering care for clients presenting with emergencies. That means that 92.4% of the highest priority emergency clients (category 1) were offered care within 24 hours, well above the state-wide target of 85%. Not only that, the number of clients waiting for dentures was reduced by 30.9% and we also continued to work on reducing the amount of time that people had to wait for general and specialist care.

0.9%

0.8%

1.1%

0.8%

1.3%

Jul–Dec 2011

Jan–Jun2012

Jul–Dec 2012

Jul–Dec 2011

Jan–Jun2012

Jul–Dec 2012

Extraction within 12 months of commencement of endodontic treatment

6.9% 5.3% n/a Jul–Dec 2011

Since our last magazine, some things have changed with the clinical indicator measures that we use to report our data, so the information on this page might look a bit different to how it has looked over the past few years.

4.3%

Jul–Dec 2012

4.8%

1% Jul–Dec 2011

Oralhealth for better health 2013/14

4.8%

4.3%

n/a Jan–Jun2012

Teeth extracted within 6 months after pulpotomy treatment

Here is a snapshot of how we’ve been tracking at The Royal Dental Hospital of Melbourne:

Dentures remade within 12 months

Jan–Jun2012

Jul–Dec 2012

Jul–Dec 2011

Jan–Jun2012

Jul–Dec 2012

Cleaning and maintenance We have several audits throughout the year to rate how clean our hospital is. By the end of 2012/13 we achieved a cleanliness score of 94.5%. That’s well above the state-wide target of 90% but we still have some work to do. We will continue to audit and analyse our performance and make improvements throughout the hospital. Acceptable Quality Level (benchmark) for very high risk areas

96%

96.6 %

95.3%

95.8%

94.7%

90.3%

95.6%

April 2010

August 2010

Nov 2010

March 2011

May 2011

October 2011

Feb 2012

96.4%

96.5%

August 2012 October 2012

96%

94.5%

Feb 2013

July 2013

Hand hygiene

Credentialing

Falls prevention

During the year we review our hand hygiene practices and how we are complying with national standards. The benchmark is set at 70 % and this year we measured better than any of the past five years, reaching 77 % compliance. This was achieved as a result of more education around hand hygiene, demonstrations and practical learning and spot checks that made sure we were all practicing good habits. We will continue to work on our hand hygiene practices to better this number each year.

All dental professionals that provide care at The Royal Dental Hospital (RDHM) of Melbourne have the right qualifications, skills and professional registration to do their job. Our dedicated Credentialing and Scope of Practice Coordinator makes sure our staff understand all the rules about achieving and maintaining their qualifications.

The RDHM has a very low number of patient falls each year. The hospital uses a falls risk assessment tool that is based on the Falls Prevention Project by the Victorian Quality Council. This tool is used to assess patients who may be at risk of suffering a fall.

Clinical effectiveness

When people start working at DHSV, they are taught about effective risk management. The policies and procedures are also available for staff to access on the DHSV intranet. All incidents are recorded in our online reporting system. They are then investigated thoroughly to identify why they occurred and make sure they don’t happen again.

Infection control Infection control is vital in a hospital because it helps to prevent the spread of germs and diseases. Clinical instruments used in the hospital are sterilised in our Central Sterilising Services Department (CSSD). Sterilising equipment is tested daily and comprehensive checks are carried out regularly. The CSSD is required to meet relevant Australian standards and to receive Accreditation, which is a formal review of the hospital’s services. Infection control procedures are reviewed regularly and problems are identified and fixed or improved. Our Infection Control Nurse also runs training programs at the hospital to make sure all dental professionals meet infection control requirements.

We collect patient data and give it to our dental professionals to help them base their treatment and decisions on data and research. This helps them to provide high quality care. We also regularly conduct regular audits and peer reviews in RDHM clinics. Peer reviews are when professionals working in the same field review each other’s work. Innovation is also supported through our Clinical Leadership Council. This is a group of experts that develop guidelines and review clinical practices based on the latest research.

Risk management

Clinical governance Good clinical governance ensures that good clinical care is provided, risks are minimised and strategies to continuously improve what we do are developed and monitored. DHSV undertakes a range of activities, systems and processes (under the four domains of quality) as part of its Clinical Governance Reporting framework.

Oralhealth for better health 2013/14

The number of refugee and asylum seekers treated at RDHM has increased by 66.7% compared to last year.

Diversity Our Diversity and Community Participation Plan 2013–2015 (DCPP) helps shape the work we currently do and will do in the future in community participation, cultural responsiveness, Aboriginal oral health and disability services.

Community participation During the year, DHSV chose to focus its community participation efforts on some key areas including staff training, safety and quality, cultural awareness and oral health literacy. We also developed a register for patients and other community members who would like to help us with service improvement, particularly in these key areas. The register will help us to find people in our community who would like to participate in DHSV projects and give their feedback to improve our service and program delivery.

Aboriginal oral health Over the past 12 months we have seen over 1000 Aboriginal patients at RDHM – an increase of 950 (30.9%) from last year. We have also expanded our indigenous workforce, employing six dental assistant trainees and far exceeding the targets we had set out in our Aboriginal Employment Plan. Our new Aboriginal Oral Health Plan also makes sure we keep improving services for Aboriginal staff, patients and their families. A mentoring program has been developed to support the Aboriginal Employment Plan and we are focusing on improving services in public dental agencies that are close to Aboriginal communities. We’re also supporting community agencies to develop their own Aboriginal Employment Plans and helping them to focus their efforts on recruiting more indigenous staff.

Cultural responsiveness All staff at DHSV must complete cultural awareness training which helps them to understand our patients’ diverse backgrounds and unique needs. We are also making our processes and spaces safer for our patients with a new way of working. To make the journey to a new country easier we are helping families new to Australia connect with health and other support organisations. Our plan is to remove all possible barriers to care by making our services

Oralhealth for better health 2013/14

friendly and welcoming, making interpreter services readily available and quickly assessing possible health risks. We have asked a group of refugees and asylum seekers to help us with this project.

Creating a hospital that is culturally appropriate Koolin Balit is a Boonwurrung term, meaning ‘healthy people’. The Koolin Balit, Statewide Action Plan 2013–15 was created by the Victorian Government to outline their strategic directions for Aboriginal health over the coming years. A key priority of the plan is managing care better with effective services. The plan explains that access to dental services is a significant barrier to good oral health for Victorian Aboriginal people. DHSV is using this as an opportunity to build partnerships with the community to improve oral health outcomes for all Aboriginal and Torres Strait Islander people and their families. At RDHM, we work within the guidelines of the Improving Care for Aboriginal and Torres Strait Islander Patients (ICAP) program which helps health services to improve access, identification and culturally responsive care for Aboriginal patients.

Our trainee dental assistants are having a blast learning how to care for the community through our traineeship program

Here are a few examples of how we are working with Aboriginal health and community services to help Aboriginal and Torres Strait Islander teenagers access services.

Jim that Bunjil, spirit creator of the Kulin Nation, was displayed in our hospital foyer and Jim was comforted in the knowledge that Bunjil would protect him while he was in our care.

Wathaurong Aboriginal Cooperative referred Jim*, a yan yan (teenage boy) to RDHM for oral surgery. On the day of his surgery, The Royal Dental Hospital of Melbourne (RDHM) Aboriginal Liaison Officer (ALO) met with Jim and his carer because he was very anxious about the procedure.

Lauren needed to have her wisdom teeth removed and was referred to oral surgery at RDHM from the Victorian Aboriginal Health Service. She was not in pain but her wisdom teeth needed to come out to stop her teeth from moving out of place.

Our ALO talked to Jim about the treatment and how it might impact on his ability to play the didgeridoo. He felt much more comfortable when he was talking about his talents and skills and this helped him to concentrate on something other than his surgery. When the surgeon asked Jim if he was feeling ready to go into surgery he became a bit anxious and asked if he could change his mind. Our ALO reassured him that surgery was the best option and recovery would be quick so he would be able to resume his didgeridoo playing. The ALO reminded

Jim felt safe at RDHM and went ahead with his surgery which was a complete success. Jim is now visiting his local clinic at Wathaurong for follow up treatment.

After the first exam appointment, Lauren went home to talk with her family about her treatment options. As Lauren was in year 11 at high school, she was concerned about taking time off to recover and the surgery department made sure that they scheduled a surgery date at the beginning of the school holidays to help Lauren with that. Laurenâ&#x20AC;&#x2122;s surgery went well and she was back at school in no time.

Uncle Glen is a respected Yorta Yorta elder. He knows how important regular dental check-ups are for his grandchildren and sees it as his role as doormala (grandpa) and elder of his extended family to make sure they take care of their health. Uncle Glen brings his five grandchildren in for regular treatment at RDHM. He knows when he contacts his local Aboriginal services that staff will help him to schedule appointments so the whole family can travel and come in to the hospital together. This helps Uncle Glen, and people like him who are caring for lots of kids, to get the care that they need. * some names have been changed to respect patient privacy

DHSV has created a Dental Assistant Trainee Program that is helping to encourage indigenous trainees to join the public health workforce and learn new skills. We have recruited 6 trainees so far and will be looking to add to this number later this year.

Oralhealth for better health 2013/14

Smoking affects every part of your health and wellbeing. There is research from around the world that shows it can harm your organs, affect your fitness and cause cancers, amongst many other things. Smoking affects the health of your mouth and even though it damages teeth and gums, it tends to hide the signs that show damage taking place. For example, the infected gums of a non-smoker are red, puffy and bleed easily when brushed. The gums of smokers are pale and thin and do not bleed as easily, as a result of the nicotine in tobacco narrowing blood vessels. The decreased blood supply in a smoker’s gums does two things: it hides the signs of disease and reduces the body’s ability to fight infection. Nicotine also thickens saliva. This is quite different to regular, thinner watery saliva which is vital to cleaning food debris from the mouth and reducing the effects of acid attack on teeth after eating. Smoking can lead to cancer of the mouth and throat too, especially if combined with alcoholic drinks. These are just some of the reasons that smokers can suffer from decay even if they are brushing their teeth well.

Smoking

How long should I keep my toothbrush? You should change your toothbrush once the bristles show signs of becoming splayed out or become stained. But toothbrush care involves more than just changing your brush. It is important to make sure your toothbrush is clean after each time you brush so that you don’t keep putting germs back into your mouth.

Remember: • Never share your toothbrush with anyone else. • Wash your toothbrush after each use. Hold the brush under hot, running water while you rub it with your thumb once every few weeks. • Keep your toothbrush away from everyone else’s. • Keep your toothbrush upright so it can air-dry.

Quick fact: Smokers are six times more likely to have serious gum (periodontal) disease than non-smokers.

Oralhealth for better health 2013/14

Fun fact:

e k i M r o s s e f o r P k As I want to whiten my teeth. What do I need to know? Adult teeth are not naturally white. Tooth whitening is a process that helps to make teeth appear ‘whiter’ by bleaching their surfaces. Tooth colour is mostly determined by the dentine inside the tooth, which is yellow. With age, adult teeth can become darker due to the gradual thinning of enamel, allowing the dentine colour to show through. Stains on your teeth caused by food, smoking or bacteria can usually be removed or minimised without tooth whitening. Cutting down on food and drinks that can stain, like tea and coffee, and quitting smoking can make a big difference to the colour of your teeth. Regular brushing with fluoride toothpaste will also help, as will visiting your oral health provider for a regular dental check-up with a scale and polish.

Keep in mind: • Whitening is normally performed by applying an oxidizing agent (usually peroxide) to the teeth. • Results can vary. You might only see a small difference, depending on the colour of your teeth originally, the cause of colour changes on the enamel surface and the whitening technique used. • Your teeth and gums should be checked by a dentist before you undergo any whitening. • Using tooth whitening chemicals can permanently damage the enamel surface of the teeth and the soft gum tissues. • Talk to your dentist about whether tooth whitening is right for you.

What is this white coating on my tongue? Having a thin coating on your tongue is healthy and normal. However, a thick white coating could be a build-up of bacteria, plaque, or a fungal infection such as oral thrush. It could be a result of taking antibiotics, drinking alcohol, smoking, dehydration, or poor oral hygiene. In more extreme cases it could be a sign of a more serious illness such as cancer or syphilis. If you are concerned about the colour of your tongue, or if there is a colour change, visit your oral health provider for advice. A simple way to remove the white coating on your tongue – which will go a long way to improving your breath – is with your toothbrush or a teaspoon. Scrape your tongue from back to front, including on the sides. Repeat the process until your tongue feels clean. You’ll be surprised just how much comes off, and how much fresher your breath is.

Is it true that oral sex can lead to oral cancers? Yes. Oral sex can pass on the Human Papilloma Virus, leading to oral and throat cancer in men and women. The Human Papilloma Virus, or HPV, is well-known for being the virus that causes cervical cancer in women. However, research has now shown that the virus can also cause oral cancer in both men and women. Understandably, the chances of contracting HPV increase as your number of sexual partners increases, no matter whether you have heterosexual or same sex partners.

The earliest discovered bristle toothbrush was found in China and dates back to the Tang Dynasty (619–907 AD). It used hog bristle. Mass-produced toothbrushes have only been available since the mid-20th century.

Not everyone who contracts HPV will end up developing oral cancer – most of the time your body’s immune system will clear it out within a couple of years. Studies in the US are confirming though that more than half of all oral cancers diagnosed are linked to the HPV virus, with the biggest increase in numbers amongst men. A HPV infection usually has no obvious signs or symptoms, and so can go undetected for years – in some cases dating back to a previous partner. Read more about HPV and oral cancer at: http://www.dentalhealthweek.com.au/ Adults/Lifestyle-Risks/oral-sex.html#

What can I do about it? The best option is prevention: before becoming sexually active, get vaccinated against HPV. Although there is no way to remove the virus from your system once you’ve been infected, you can still test for it. Also, the symptoms and disorders caused by HPV (such as oral cancer) can be treated if they’re detected early. Finally, be active in taking care of your oral health. Visit your oral health professional regularly, and get them to check anything that has changed in your mouth and anything strange or different that lasts longer than two weeks. It doesn’t have to be painful, just different. For more information on symptoms, detection and treatment of oral cancer, visit www.oralcancerfacts.com.au

Oralhealth for better health 2013/14

Students GETT healthy life skills People with disabilities often experience poorer oral health than the general population. In 2012–13, DHSV teamed up with the Department of Human Services to offer small grants to day services across Victoria that were interested in developing ways to promote oral health. As part of the Promoting Oral Health in Disability Day Services project, the GippsTAFE Employment and Transitional Training (GETT) Centre created a program to encourage healthier diet choices and better oral hygiene for their students (aged 15–24 years). George is learning new ways to ‘Eat Well’ through the Promoting Oral Health in Disability Day Services program

The GETT Centre works with disabled and disengaged young people who face barriers to learning through mainstream education. They help students to build skills and confidence, and to transition into further study, employment or community activities. The centre has included key oral health messages in its foundation training programs, including Certificate I in Transition Education, Certificate I in Work Education, Certificate I in Vocational Preparation and Certificate II in Education and Skills Development. Other resources were also developed and shared with teaching staff and now a group of teachers are trained and ready to deliver the new content. The program was launched with a delicious healthy morning tea prepared by students.

Oralhealth for better health 2013/14

19-year-old George Croydon is one student at the GETT Centre who has learnt the benefits of healthy eating and regular dental care. George, who is currently studying his Certificate I in Work Education, loves to use his hands and work outdoors and hopes to work in a grounds maintenance crew in the Gippsland area. After taking part in the program, George decided to make some changes to his routine.

Teacher Margy Forester asked George a few questions about his experience: Margy: Why did you make some changes to your usual diet and routine? George: My teacher was always telling the class they should think about some food changes, so I thought I would. We also did lots of work about keeping our teeth healthy and about drinking lots of water and why these things were a good idea. Margy: Can you describe what changes you have made? George: I now love eating healthy foods like carrots and celery. I bring my own lunch and a drink bottle and I brush my teeth every morning. I have also bought a new toothbrush. Margy: Is it hard to continue making good choices or is it now part of your overall diet now? George: I am getting better at it so now it’s part of my everyday routine. Margy: Will you keep your healthy choices? George: Yes, because it’s good for you and it’s easy to do.

Hassan Age: 17 How many times have you visited RDHM? This is my second time to the hospital. The last time I came was two years ago to get my teeth cleaned. I love it here, and so do my little brother and sister. The service is great, and the staff are kind and respectful. What happened this time? This time was a general check-up. But they told me they’ll need to do four fillings, so I’m coming back in a few weeks. What makes this place different? The student dentists. They’re so well-trained, and if they aren’t sure about a procedure they call the head dentist. It might take a bit more time, but they make sure it’s perfect.

Patient proﬁles Patrena Age: 17 How many times have you visited RDHM? I’ve been here every month for the last five years. I had an operation to remove ten of my teeth, then a plate, and now braces. I never used to smile – I’ve looked back at all of my old photos, even my driver’s license, and I was frowning in all of them or not showing my teeth. Now I get complements all the time. How was your first visit? I was so excited. I wanted to get my braces over and done with. The dentist took photos of my jaw structure so he could compare it before and after treatment. I find it funny that some of my friends are only just getting braces now, and I’m about to get mine off. How do you feel about your treatment as a whole? It’s been incredible. I am forever grateful. When I was younger I couldn’t have imagined that my teeth would ever be straight.

Oralhealth for better health 2013/14

Word Find

PLAQUE

SMILE

MOUTHGUARD

HEALTHY

BRACES

MOUTHWASH

FILLING

RINSE

DENTIST

ORAL

TOOTHBRUSH

WATER

BACTERIA

GUM

ACID

SALIVA

SUGAR

CARE

DECAY

CLEANING

Puzzles

The Maze

Oralhealth for better health 2013/14

Photo courtesy of Dan Carson.

Name: Rachael Lynch Age: 27 Sport: Hockey Team: Australian Hockeyroos

Proﬁle: Rachael Lynch Why is sport so important in your life? I have always loved playing sports and a wide variety of them. It’s a great outlet, allows me to meet new people, spend time with friends and travel the world. I’m a competitive person so love that side but being in a team sport also teaches you so many skills.

How do you stay healthy? I enjoy eating a variety of healthy foods. I train once or twice every day and usually stay active in my spare time anyway. I love going bike riding, playing sports in the park or going for walks.

What has been one of your greatest accomplishments as an athlete? I’m proud to say I have represented my country. That is an honour and a privilege. My biggest achievement was winning a gold medal at the Commonwealth Games in Delhi 2010. We won on penalties and it was the greatest moment of my life so far.

What has been one of the best teams you have been on and why? Playing team sports creates an amazing bond. I’ve loved every single trip I’ve been on but will always remember the group of girls I won a gold medal with. Friends for life after that experience.

Do you and your team wear mouthguards in games and at training? Mouth guards are super important. I’m lucky that as a hockey goalkeeper I wear a helmet so my mouth is protected, but I keep mine handy just in case I get an opportunity to play on the field. All the other girls wear them to help stay safe.

Oralhealth for better health 2013/14

RDHM services You need to have a healthcare or pension concession card to be able to use most services at this hospital. If you do not have one of these cards, you can still get emergency dental treatment but you will need to pay a fee similar to what you would be charged at a private clinic.

If you have a dental emergency, please call (03) 9341 1040 before arriving at the Emergency Department. We will assess you over the phone and give you some advice on what to do next. Emergency care is also available at clinics across Victoria. To find your nearest clinic call 1300 360 054 or go to www.dhsv.org.au

Level 1 – General care For patients who need: check-ups cleaning fillings

Level 1 – Specialist care For patients who need: Orthodontics – alignment of teeth Oral Medicine – treatment of disease of their lips, cheeks, tongue and jaw Periodontics – treatment for gum disease Prosthodontics – dentures, crowns, bridges Paediatric Dentistry – dental care for children

Cost

Endodontics – root canal treatment

You may have to pay some money to get dental care at public clinics like the ones at The Royal Dental Hospital of Melbourne.

Special Needs Dentistry – dental care for people with intellectual or physical disabilities and complex medical histories

Some groups with special needs do not have to pay. Go to www.dhsv.org.au/fees to find out how much you need to pay or you can call (03) 9341 1000 for more information. Treatment in the Teaching Clinic is free for some people. To find out if you can get free care, go to www.dhsv.org.au.

Level 1 – EMERGENCY Emergency care is for patients who have: injured their face or mouth swelling around their teeth, mouth or face severe bleeding from the gums severe toothache and pain

Oralhealth for better health 2013/14

Level 2 – Teaching Clinic For children and patients who need: emergency or general dental services Care in this clinic is provided by students who are supervised by senior dental professionals

Level 4 – Surgery Day Surgery For patients who need: dental work done in an operating theatre. Oral Surgery For patients who need: surgical procedures for their teeth, mouth or jaw.

Priority access – helping people get the care they need

Interpreter services Interpreter services are available for all patients.

Priority access means that you do not have to go on a waiting list to receive dental treatment. You will receive the next available appointment. The following groups can get priority access to emergency and general dental care at The Royal Dental Hospital of Melbourne (specialist care is based on clinical priority): children (0–12 years) and young people

When you make your appointment please tell us if you need an interpreter and what language you prefer to speak. These services need to be booked before you come to the hospital for your appointment. Telephone interpreters can be arranged for emergency patients.

Aboriginal or Torres Strait Islander people pregnant women refugees and asylum seekers

The top six languages spoken by people who visit The Royal Dental Hospital of Melbourne are:

homeless people and people at risk of homelessness registered clients of mental health and disability services, supported by a letter of recommendation from their case manager or staff of special developmental schools More information about our services and priority access can be found on the DHSV website – www.dhsv.org.au

1. English 2. Vietnamese 3. Arabic 4. Italian 5. Greek 6. Mandarin

Oralhealth for better health 2013/14

conf ident Behind these smiles are teens now conďŹ dent enough to share the smiles they wear and the photos they take. Did you know eligible children and teenagers can get FREE care at dental teaching clinics across Victoria? General dental services in our teaching clinics are FREE if you have a health care or pension card or if you are in out-of-home care provided by the Children, Youth and Families Division of the Department of Human Services. It is also available FREE to children who attend a special or special development school. Call us on 9341 1000 between 8.30 am and 4.30 pm, Monday to Friday to see if you are eligible or to make an appointment. You can ďŹ nd your nearest teaching clinic here www.dhsv.org.au

Oralhealth for better health 2013/14