COMPETITION: MOVIE TICKETS TO BE WON!
Oralhealth QUALITY OF CARE REPORT 2010
for Better Health
TOP TIPS
FROM OUR PRINCIPAL ORAL HEALTH ADVISOR
it h o u r O n th e r o a d w
Dream team
Dentists in the park
Photographer Wayne Quilliam focuses on oral health
About this report
Contents
6
We know that going to the dentist is an important, but not always a large, part of people’s lives. So we have designed this report for quick, easy and useful reading.
03
Smile of the Year winner
Our Community Advisory Committee members, patients and staff have helped us decide what information is important to our patients and the wider community and what articles should be included to communicate this information.
06
Hit the road with our dream team
08
Performance review - See how we’re doing
12
Dentists in the park
13
What’s periodontitis? Dr Julie Fraser explains
14
Kids’ page
15
Professor Mike Morgan shares his top tips for good oral health
We have also included information that the Quality of Care reporting guidelines of the Department of Health require all health services to report each year to demonstrate what they are doing to continually improve their services and meet the needs of their communities. Reader feedback Thank you to readers of our 2008-09 report who sent us their feedback.
12
This is what they told us: Did you find the magazine easy to read? 8%
This report is for you, so please tell us what you’d like to see in it. By completing the feedback form inside you could win a double pass to the movies.
Yes 92%
No Sort of
Distribution Last year we distributed 4,500 copies of our Quality of Care Report.
Did you learn anything new about oral health? 1%
7%
The report is made available to patients and visitors at The Royal Dental Hospital of Melbourne and to 82 public dental clinics around Victoria. We also mail the report to around 400 people and organisations, including all Victorian Migrant Resource Centres. The report is also available online at www.dhsv.org.au.
Yes 92%
No Not really
Top 6 favourite articles from our 2008-09 report Articles
Votes
Top tips from our Principal Oral Health Advisor
32
Patient journeys
12
Meet an oral medicine specialist
10
Ron Barassi kicking goals for oral health
9
Performance report/clinical indicators
8
Service directory
8
We measure the success of our distribution methods by the number of reader feedback forms we receive each year and the number of reports picked up by visitors to The Royal Dental Hospital of Melbourne and Victorian community dental clinics. This year we have printed 5,000 copies of the report to ensure that dental clinics in Victorian community health services have sufficient supplies.
What else did readers want us to include?
It’s a fact
Children’s activity page
See page 14
Number of readers who sent feedback:
Advice on oral health for pregnant women
See Top Tips, page 15
2007
6 people
Advice on tooth whitening
See Top Tips, page 15
2008
28 people
Advice on manual vs electric tooth brushes
See Top Tips, page 15
2009
77 people
More patient stories
See pages 5 and 12
Articles on specialists
See page 13
Oral health care for Aboriginal people
See page 11
Cover image supplied by Wayne Quilliam.
2 Quality of Care Report 2010
Since 2008 we have offered a free double-pass to the movies to the first 25 people whose feedback forms are drawn.
Dental Health Services Victoria provides clinical dental services through The Royal Dental Hospital of Melbourne and purchases dental services for public patients from community health agencies throughout Victoria. It also plays the leading role in Victoria in developing and delivering oral health promotion programs designed to prevent oral disease and improve oral health in the community.
Aboriginal Flag © Harold Thomas 1971 We acknowledge the traditional custodians of Australia and we welcome all Aboriginal and Torres Strait Islander people to our service.
Our cover
Wayne Quilliam Smile of the Year Award Winner
I
nternationally acclaimed photographer and artist Wayne Quilliam is the winner of the inaugural Dental Health Services Victoria Smile of the Year Award. Wayne was selected for the award by the Dental Health Services Victoria (DHSV) Community Advisory Committee and the DHSV Aboriginal Oral Health Reference Group for his capacity to promote oral health among Aboriginal people and for the positive role model he provides to our community. As well as shooting some of the world’s best known rock bands, models and film stars, Wayne travels Australia and the world, capturing and sharing images of Aboriginal people, culture and celebration. His work has appeared in more than 800 publications and been exhibited in galleries from Vienna to the Melbourne Town Hall. In 2008 Wayne was selected as the official photographer to record the Prime Minister’s Motion of Apology to the Stolen Generations and he now tours the world with the Sorry - more than a word exhibition he developed to celebrate this historic occasion. He has won a string of awards including the national 2009 NAIDOC Artist of the Year Award, the 2009 Human Rights Award for Media and numerous art awards. In between running his Melbourne-based mainstream photographic
business and devoting time to his wife Jodie and two-year-old daughter Tanisha, Wayne visits around 90 rural, remote and urban Aboriginal communities each year. He works with communities not only as a photographer, but also as a teacher, running training sessions and workshops with young Aboriginal people. “I know that oral health among Aboriginal people is poor. I see it all the time. It’s evident in my images,” says Wayne. “As a young fellow I had poor access to dental care. I’m not blaming anyone for that. I also could have done more to look after my teeth, but dental services for Aboriginal people were sadly lacking.” Originally from Tasmania, Wayne now lives in Victoria. Throughout his 20 years of photographing Aboriginal people, he has used his camera as much as a tool for social change as for art, showing his audiences both what is beautiful and what is real. “I want young Aboriginal people to know that they can have better dental health than their parents. When they get older, I want them to be able to smile at a camera without being embarrassed about their teeth.”
Award-winning photographer Wayne Quilliam wants Aboriginal children to have better oral health than their parents did.
FREE DENTAL CARE FOR CHILDREN If your child is 12 years of age or under, they are eligible for a free dental check-up and treatment at The Royal Dental Hospital of Melbourne. The service is provided by students who are fully supervised by experienced dentists and oral health therapists. Opening times: Monday to Friday, 9.00am – 4.30pm
Dental Health Services Victoria thanks Wayne for voluntarily supporting our vision of oral health for better health for the Victorian community.
Location: The Royal Dental Hospital of Melbourne 720 Swanston Street, Carlton Book an appointment on (03) 9341 1168. Oralhealth for better health 3
Where do people get their oral health information?
120 in 2010
Our Community Advisory Committee found out
T
he Dental Health Services Victoria (DHSV) Community Advisory Committee (CAC) is a group of individuals from the Victorian community with a diverse range of backgrounds. The committee helps to inform DHSV about what consumers want and need from public oral health services. In February 2010, CAC members and DHSV staff surveyed 65 patients, carers and visitors at The Royal Dental Hospital of Melbourne about where they would go to find oral health information, and how they would like to receive that information. “We were surprised by the breadth of oral health information that people were interested in,” said CAC Chair Kellie-Ann Jolly.
Felix Pintado, Chief Executive of Dental Health Services Victoria (far right), with Princes Hill Secondary College music students.
T
he Royal Dental Hospital of Melbourne turned 120 in 2010 and celebrated with a series of community events. At a barbecue for staff and patients, music students from Carlton’s Princes Hill Secondary College provided the entertainment. The Dental Hospital first opened its doors in 1890 from rented rooms above Garton’s Horse and Carriage Bazaar in Lonsdale Street. It was staffed by volunteer dentists who provided free treatment for low-income people from 9.00-11.00am each weekday. Today the Hospital has a purpose-built facility in Swanston Street that operates seven days a week with more than 400 people a day passing through its doors. Chief Executive of Dental Health Services Victoria, Mr Felix Pintado, says that while facilities and dental practices have changed over the last 120 years, two important things have remained the same.
CAC member Jan Curry surveys Dental Hospital patients.
Patient survey findings: Most people said they would seek oral health information from their dentist, general practitioner or the internet. 92% of those who had seen or heard oral health information at the Hospital said this was useful or very useful. Most people said this was because the information related directly to their treatment. 71% were interested in receiving information about maintaining good oral health and most of them preferred to receive brochures or information by mail. Some preferred to look on the internet and some would rather talk to their oral health professional. The survey results will be used to make sure we provide oral health information that is easy for people to find and understand. 4 Quality of Care Report 2010
“The Dental Hospital has always provided free or subsidised treatment to people who might not otherwise be able to afford dental care,” says Felix. “It has also always been an educational institution where students have gained clinical experience at the same time as providing a much-needed service.”
Part of a plan The oral health information survey was carried out as part of the DHSV Community Participation Plan. The plan is developed by the DHSV Community Advisory Committee with DHSV staff to ensure that patients and other community members have a say in the decisions that shape our services. Progress against the plan is reported annually to the Department of Health.
Get the message Interpreters play a crucial role in removing language barriers for many patients at The Royal Dental Hospital of Melbourne
M
ore than 23% of patients who visit The Royal Dental Hospital of Melbourne speak a language other than English at home. Interpreters are made available for any patient at the Hospital who requests one. Over the past 12 months the Dental Hospital has been looking at ways of improving the efficiency of its use of interpreter services, making sure that patients get interpreters
when they need them, and that interpreters are put to good use once they are booked. In 2009 the Hospital introduced a new block booking system, so that instead of Hospital staff booking interpreters one at a time, patient by patient, a single booking officer now coordinates all interpreter bookings with patient appointments. Interpreters of the most commonly used languages at the Hospital
are allocated weekly appointment blocks, and wherever possible, patients who speak these languages are given appointments on these days.
The first part of the evaluation has been a series of interviews with interpreters to identify advantages and disadvantages of the new arrangements.
Patients speaking other languages are grouped in blocks of two or more wherever possible.
The next part of the evaluation will include interviews with patients and staff at the Hospital to gather their views. These views will help to inform any further changes or refinements to the interpreter booking process.
The DHSV Diversity Group, which includes both staff and community members, is overseeing an evaluation of the new booking arrangements.
Planning for diversity The new DHSV Cultural Responsiveness Plan became effective on 1 July 2010 and will run until June 2013. The plan was developed with advice from the DHSV Diversity Group and the DHSV Community Advisory Committee and has been lodged with the Department of Health. It includes a series of priority activities to ensure that DHSV meets the needs of its diverse community.
Buon giorno, Signora
M
rs Vicenzina Pereira first visited The Royal Dental Hospital of Melbourne around 35 years ago at its old location in Elizabeth Street. After recently experiencing some pain in her bottom teeth, she started on a course of treatment with RDHM dentist Adam Evans. Mrs Pereira arrived in Australia from Italy in 1964 and, though she can understand and speak some English, she prefers to use an interpreter for her specialist medical and hospital appointments so she can be certain there is no misunderstanding. She has always been able to use an interpreter at
the Dental Hospital, except for one time when the interpreter was running late. “I had to get by without an interpreter at that appointment but I managed because the dentist opened her mouth wide when she spoke. It can be very difficult to understand people if they don’t open their mouths and speak clearly.� Mrs Pereira says that she has had a number of health problems which has meant visits to different hospitals. She always makes use of hospital interpreter services and has found the interpreters very helpful at communicating complicated information.
Mrs Pereira discusses her treatment with Dr Adam Evans with the help of an interpreter.
Most frequently - used languages at The Royal Dental Hospital of Melbourne 2008-09
2009-10
1
English
English
2
Italian
Italian
3
Greek
Arabic
4
Arabic
Vietnamese
5
Vietnamese
Greek
6
Turkish
Mandarin
7
Mandarin
Cantonese
8
Cantonese
Turkish
9
Somali
Spanish
10
Spanish
Somali Oralhealth for better health 5
Dream team
Continuity of care for children with special needs
A passionate and skilled team of dental professionals takes dental care to children with special needs
Dr Nick Baker and dental assistant Joanne Glew take routine and emergency dental care to children with very high needs.
W
hen dental therapist Rayleen Formosa is at work, a dental chair becomes a ‘throne for a king’, the overhead lamp is a ‘Starwars light’ and the suction nozzle is known as ‘Sam the Sucker’. Rayleen, dentist Dr Voon and dental assistant Jade Downing take their dental van to special schools around Melbourne, providing onsite treatment to children with mild to moderate special needs. The van is parked near the school, hooked up to water, power and waste disposal, and it stays there until every child in the school completes their course of treatment. “Sometimes we can be in one school for a couple of months, depending on the number of children at a school,” says Rayleen. “It can take more visits than usual to get the treatment finished because the children
6 Quality of Care Report 2010
often have heightened sensory awareness and other behaviours that we need to work around. We need to take it slowly and prepare the children for each step we take.” Rayleen and Dr Voon have almost 50 years’ experience between them working with children with physical and intellectual disabilities. Manager of DHSV special needs services, Dr Maha Ghobrial, says that the special needs program at DHSV attracts highly skilled and committed dental professionals who tend to stay around for a long time. Dr Nick Baker has worked on the second DHSV children’s special needs van for 30 years, caring for a whole generation of Victorian children. He and dental assistant Joanne Glew visit the schools and homes of children with very high needs, including children with severe cerebral palsy, high levels of autism and
other severe physical and intellectual disabilities.
Our two vans for children with special needs aim to visit metropolitan schools every two years, but with the number of schools increasing, and the numbers of children at each school also growing, this timeframe has been extending. We are working on ways to continue giving children the time and care they need, while getting around to all the schools requesting our services. The introduction of a dental therapist to the team in addition to the dentists has resulted in the team moving more quickly from one school to the next.
Nick and Joanne stress how important their teamwork is to meeting their patients’ needs. As well as making routine visits to special developmental schools, they also try to be flexible, able to respond quickly to emergencies in Melbourne and some country areas. Nick and Joanne’s van is self-sufficient and can operate anywhere they can plug into power. Every time the van hits the road, all equipment inside the van has to be stowed and strapped and then unpacked again at the next stop. Despite the logistical challenges, there are obviously emotional rewards that keep the special needs team working with passion and energy. Their vans are full of care, good humour, encouragement and piles of ‘well done’ stickers.
Dental therapist Rayleen Formosa with a happy customer at Croxton Special School.
It’s a fact Children treated in DHSV special needs vans: 2007-08 867 2008-09 1,421 2009-10 1,720
Krati brings her skills to the Dental Hospital
Dr Krati Garg trained in India as an oral and maxillofacial surgeon. She and her physician husband arrived in Australia in 2007.
Overseas trained dentists: Have a recognised dentistry qualification from New Zealand, Ireland or the United Kingdom, or Have passed the Australian Dental Council examination. Must be registered with the Dental Board of Australia.
All clinical staff working for Dental Health Services Victoria have: Qualifications and professional standing checked and verified. Referee checks carried out. Current professional registration which is checked by DHSV each year. The type of procedures that they can perform approved by an expert panel and reviewed every five years.
T
he couple settled in Sydney where Krati completed the first part of her Australian Dental Council (ADC) examination. This exam must be passed by dentists who have qualifications from countries other than New Zealand, Ireland or the United Kingdom before they can work in Australia. The following year Krati and her husband moved to Melbourne where Krati completed a 20week course run at The Royal Dental Hospital of Melbourne for overseas trained dentists (OTC). This course has been run by Dental Health services Victoria for the last 20 years. It is not compulsory for overseas trained dentists to complete the course
but it does help to prepare them for their ADC examination. “The course is designed to prepare you for all aspects of working as a dentist in Australia,” says Krati. “Not just clinical practices and standards, but also communication with patients and the workings of the healthcare system.” Krati went on to pass her ADC exam and was registered with the Dental Practice Board (now known as the Dental Board of Australia) in June 2009. She also passed the clinical exam to become a fellow in the Royal Australasian College of Dental Surgeons. Krati now brings her skills and experience to the oral surgery department at The Royal Dental Hospital of Melbourne.
Emergency dental care The emergency unit at The Royal Dental Hospital of Melbourne is open every day until 9.15 pm. In order to avoid unnecessary waits at the Hospital by emergency patients, we have introduced an appointment system. Once the urgency of a condition has been assessed, patients are given an indication of how long they can expect to wait to see a dentist. This can be done over the phone to save patients travelling to the Hospital ahead of time. If you have a dental emergency call 1300 360 054.
“It was fantastic to bring my 11 year-old daughter to see professional dentists on a Sunday after a pushbike accident.” Shane Kelberg
“I would like to say how happy we were with the treatment my son received after sustaining a mouth injury. Both the dentist and dental nurse were very supportive and encouraging to my son who was in considerable pain.” Sheriden Tate
Oralhealth for better health 7
Reviewing our performance in 2009-10
Accreditation Accreditation status The Royal Dental Hospital of Melbourne (RDHM) undertook the Australian Council on Healthcare Standards (ACHS) periodic review in November 2009. This is part of the independent accreditation process that operates in Australia to help ensure the delivery of safe, high-quality healthcare. The periodic review found that RDHM meets the required national healthcare standards and confirmed the continued accreditation status of the Hospital. Staff qualifications and credentials Dental Health Services Victoria (DHSV) has rigorous procedures in place to verify and monitor the qualifications and credentials of clinical staff. At the periodic accreditation review, the ACHS awarded DHSV an Extensive Achievement (EA) rating for its performance in this area. Consumer participation The ways in which DHSV listens to the views of patients and community members was reviewed during its most recent organisation-wide accreditation survey (2007). DHSV achieved an Extensive Achievement (EA) for its commitment to consumer participation. Continuous improvement Accreditation surveys are used as an opportunity for improvement. The ACHS provided DHSV with 14 recommendations for further improvement. These include enhancing our patient feedback system and linking incident reporting procedures into an organisation-wide system. DHSV has adopted an action plan to address all recommendations by the time of RDHM’s next accreditation survey in 2011.
Patient feedback DHSV welcomes patient feedback and last year developed a new, more visible feedback form which was made available throughout the Hospital and online. The new form was produced with advice from our patients and our Community Advisory Committee. A total of 317 complaints were received in 2009-10, representing 0.26% of all patient appointments. There were 53 more complaints this year than last year. This is likely to be the result of an extra 2,175 patients who presented at the Hospital this year and the more accessible feedback form.
Complaints by category 19%
38%
Access Time spent waiting 1% Administration Clerical error 6% Facilities Amenities and car parking Customer service Attitude of staff 27% Cost Cost of treatment Patient rights Confidentiality and access to personal information Treatment Perception of inadequate treatment
5%
4%
Infection control Clinical instruments used in The Royal Dental Hospital of Melbourne are sterilised by our central sterilising services department. Sterilising equipment is tested daily and regular comprehensive audits of the sterilising department are carried out. The department is required to meet the relevant Australian Standards in order to maintain its accreditation with the Australian Council on Healthcare Standards. Infection control procedures are reviewed regularly, with clinical audits used to identify any potential weaknesses. Targeted education and training programs are run by the Hospital to ensure that all clinicians are meeting infection control requirements. Hand hygiene The Hospital participates in the Hand Hygiene Australia initiative which aims to ensure that all hospital staff carry out correct hand hygiene procedures. In 2010 the DHSV infection control consultant qualified as a ‘Gold Standard Auditor’. She will be carrying out hand hygiene audits three times a year to ensure that staff in all clinical areas are meeting hand hygiene requirements. Audit results will be submitted to the national coordinating centre and the Victorian Department of Health. Hospital cleaning The Royal Dental Hospital of Melbourne (RDHM) regularly undergoes internal and external cleaning audits. The Victorian Department of Health minimum standard for external cleaning audits is 85%. The graph below shows that RDHM has consistently scored above 90% and in 2010 achieved a result of 96%. The Royal Dental Hospital of Melbourne external cleaning audit results Department of Health Benchmark Mar 10 Nov 09 Apr 09 Nov 08 May 08 Nov 07 May 07 0%
8 Quality of Care Report 2010
20%
40%
60%
80%
100%
Clinical governance Clinical governance at Dental Health Services Victoria (DHSV) is about being accountable for providing safe oral health care and continuing to improve patient safety. In 2009, DHSV adopted and implemented the Victorian clinical governance policy framework. Our risk management framework was independently reviewed in March 2010. This review benchmarked the quality and comprehensiveness of our risk management framework against other metropolitan health services and assessed us against the Australian Standard for Risk Management. Our performance was rated ‘very good’ by the reviewers.
Patient incidents We ensure that any incidents or adverse outcomes for patients are reported and reviewed.
Emergency patients and priority patients were seen at the next available appointment, with 87% of the most urgent patients treated within 24 hours. It is estimated that around 10% of patients choose not to attend an appointment, so it is not possible to see 100% of emergency patients within 24 hours. Average time waited statewide in 2009-10 for non-urgent treatment 25
19.6 months
General
18.6 months
15 10
6.8 months
Specialist 5 0
• In the 2009-10 financial year, patient incidents at The Royal Dental Hospital of Melbourne represented 0.36% of patient appointments. •
Denture
20 Months
Patient safety and managing risk
Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun 2009 2010
99.3% of incidents resulted in no, or minor, injury or a temporary injury that was resolved. Examples of injury include temporary change of feeling in the mouth after tooth removal, laceration/abrasion or minor post-operative infection.
Clinical indicators: What do they mean?
• Any incident that occurs within the Dental Hospital is investigated to ensure there is appropriate follow-up for each patient.
• The indicators refer to patients who have had general (non-specialist) care at The Royal Dental Hospital of Melbourne.
Falls prevention
• The years shown on the charts reflect the years in which the initial treatment was carried out.
The Dental Hospital experiences a very low number of patient falls, usually no more than two a year. In 2009 the Hospital developed a falls risk assessment tool, based on the Falls Prevention Project by the Victorian Quality Council. The tool is being used successfully in the Day Surgery Unit and is being extended to other high-risk areas of the Hospital, including the Special Needs Dentistry Unit.
Informed consent Under common law, all patients must voluntarily give their permission before any treatment can be carried out. DHSV has introduced an electronic form to help ensure that all our clinicians complete and document each step required to gain a patient’s informed consent. The form is attached to the patient’s electronic record and prompts clinicians to check that patients are provided with, and understand, information about their diagnosis and treatment.
• The clinical indicators shown here measure how many patients have had to return unexpectedly for repeated treatment.
• Key indicators have targets or benchmarks which have been set with the Minister for Health. Targets are shown where they apply. • The indicators show a high level of clinical performance. 1. Teeth re-treated within six months of initial restoration 15,891 teeth were treated with fillings (restorations) in 2009, with 7.2% of these teeth needing to have the filling replaced or another filling placed in the same tooth within six months. There was an increase in re-treatments compared to the previous year. This was investigated and as a result changes have been made to clinical practices. 8.0% 7.0% 6.0%
Accessing treatment From July 2009 to June 2010, the length of time people waited for non-urgent general and specialist dental care in Victoria decreased. Over the same period, the length of time people waited for non-urgent denture care increased slightly.
5.0% 4.0% 3.0% 2.0% 1.0% 0.0% 2006
2007
2008
2009
Oralhealth for better health 9
Reviewing our performance in 2009-10
2. Dentures re-made within 12 months 1,531 dentures were made during the 2008-09 financial year, with 2.3% of these needing to be re-made within 12 months to improve their comfort or effectiveness.
5. Extraction within 12 months of endodontic treatment 115 teeth had endodontic (root canal) treatment during the 2008-09 financial year, with two (1.7%) of these root-filled teeth being subsequently extracted within 12 months.
6.0% Target : No more than 5 %
5.0%
4.0%
3.0%
3.0%
2.0%
2.0%
1.0%
1.0% 2005-06
2006-07
2007-08
2008-09
3. Unplanned return within seven days after extraction 15,938 teeth were extracted during the 2009-10 financial year, with less than 1% of these patients needing to return due to unexpected reasons. 6.0% 5.0%
0.0%
2005-06
2006-07
2007-08
2008-09
6. Repeat emergency care within 28 days 14,236 patients received emergency treatment during the 2009-10 financial year, with less than 1% of these patients needing to return within 28 days for any further care related to their emergency problem. 6.0%
4.0%
5.0%
3.0%
4.0%
2.0%
3.0%
1.0% 0.0%
Target : No more than 5 %
5.0%
4.0%
0.0%
6.0%
2.0% 2006-07
2007-08
2008-09
2009-10
1.0% 0.0%
2006-07
2007-08
2008-09
2009-10
4. Repeat endodontic treatment within six months 132 teeth had endodontic (root canal) treatment in the 2009 calendar year, with none of these root-filled teeth needing to be re-treated within six months. 6.0%
Target : No more than 5 %
5.0%
7. Fissure sealants needing to be re-sealed within two years
4.0%
Fissure sealants are plastic coatings applied to the fissures (grooves) of teeth to help prevent tooth decay. 6,310 teeth were sealed during the 2007-08 financial year, with 3.9% of these needing to be resealed within two years.
3.0% 2.0% 1.0% 0.0%
DHSV has started collecting clinical indicators on three additional types of treatment. The first available data on these indicators is reported below.
2006
2007
2008
2009
8. Fissure-sealed teeth treated by restoration or extraction within two years Of the 6,310 teeth that were fissure sealed during the 2007-08 financial year, only 2.5% were subsequently treated by restoration (filling) or extraction within two years. 9. Teeth extracted within six months after pulpotomy treatment A pulpotomy is removal of the diseased part of the tooth nerve. 255 teeth received pulpotomy treatments in 2009, with less than 3% of these needing to be extracted within six months. 10 Quality of Care Report 2010
Christine’s seen some changes “People are starting to see that if you want to talk about the health of the whole person, you have to start with the mouth.” — Christine Ingram, Victorian Aboriginal Health Service.
Christine Ingram: a long-time advocate for oral health and Aboriginal health.
C
hristine Ingram started out in Aboriginal oral health 20 years ago, travelling around Victoria on dental vans run by the Victorian Aboriginal Health Service (VAHS). As a qualified dental assistant, she became a trainer and mentor for new dental staff, and by 1998 was managing the Oral Health Unit at VAHS head office in Fitzroy, where she remains today. She oversees a staff of two dentists, five dental assistants, four Aboriginal health workers, a dental therapist and visiting specialists. Last year the unit saw more than 3,900 individual patients.
“We try to be a onestop shop at VAHS,” says Christine. “So in addition to our booked appointments, we see a lot of patients opportunistically if they’ve come in to see a doctor about something else. We prioritise pregnant women and elders, and after that we triage on the basis of need.” Christine is also a member of the DHSV Community Advisory Committee, and the DHSV Aboriginal Oral Health Reference Group. “These are important roles in terms of me being able to advocate on behalf of our clients and ensure that Aboriginal people get the same level of care as others,” says Christine.
An oral surgeon from The Royal Dental Hospital of Melbourne spends some time each month at the VAHS clinic seeing patients who need specialist treatment. Other patients in need of specialist care are referred to the Dental Hospital. “I feel a lot more comfortable about referring our patients to the Dental Hospital these days than I used to,” says Christine. “We have a relationship with DHSV now that means I can raise any issues that have concerned patients and these get listened to.” “The Aboriginal Community Development Worker position at the Hospital has also made a big difference for Aboriginal patients,” says Christine. “People feel comfortable expressing themselves and they’re more likely to follow through with their treatment.”
Aboriginal liaison workers DHSV Aboriginal community development worker Jacqui Watkins and Aboriginal liaison officer Carleen Miller work with Aboriginal health organisations around Victoria to help ensure that Aboriginal people get the dental care they need.
11 Quality of Care Report 2009
Just a quick email to say thanks for all your wonderful help… Your kindness was a great help to Mum and the rest of us. Thank you again for arranging the appointment on Tuesday for me. Very much appreciated. It was also nice to actually meet
you. You made me feel very comfortable. Thanks for organising my dental appointment. It was a long time overdue. The dentist was great. He has booked me in for a follow up appointment and is planning to refer me to a specialist.
As much as an advocate for Aboriginal health, Christine sees her role as an advocate for oral health. “I have seen a shift over recent years in the way people think about oral health,” says Christine. “Other health workers can see the improvements that good oral health brings to people.”
Christine Ingram at a glance Yindinji (far north Queensland) woman Qualified as a dental assistant in 1992 Completed Diploma in Practice Management in 2009 Manager, Oral Health Unit, Victorian Aboriginal Health Service Member DHSV Community Advisory Committee and DHSV Aboriginal Oral Health Reference Group
It’s a fact Patients identifying as Aboriginal or Torres Strait Islander at The Royal Dental Hospital of Melbourne 2007-08 46 2008-09 125 2009-10 339
Oralhealth for better health 11
Dentists in the park Dentists and dental students gave free mouth-checks to festival-goers at this year’s Where the Heart Is... Festival in Fitzroy.
T
he Where the Heart Is... Festival is a day of music, food, art and health and wellbeing activities organised by the Royal District Nursing Service for people who are homeless or living in insecure housing. Dental Health Services Victoria (DHSV) has been a participant in the festival before, but 2010 was the first time it provided mouth-checks to festival goers. People found to be in need of treatment were given appointments at the Dental Hospital. A total of 75 people received mouth-checks on the day, with 53 of these people given appointments at the Dental Hospital and 22 actually presenting for their appointments.
Professor Hanny Calache was one of the DHSV dentists who spent some time at the DHSV stand. “The festival provided an excellent opportunity for us to get to people who would otherwise be difficult for us to reach,” says Hanny. “It also showed us that there are many people out there who need dental care, but aren’t sure how to access it, or don’t feel comfortable coming into a hospital for dental treatment.” DHSV staff are working with community health staff to raise awareness among homeless people of the availability of emergency dental care at The Royal Dental Hospital of Melbourne and some community health centres. DHSV is also planning to provide mouth-checks and referrals again at the next Where the Heart Is... Festival.
Brendon makes health a priority Brendon Foy was one of the many hundreds of people who turned out to the Where the Heart Is... Festival. “I spent the full day going round to the stalls, picked up some good stuff like some clothes and toothbrushes for me and some of the guys where I live.” Brendon has been on the move for much of his 52 years, first coming to St Kilda from Launceston when he was 15 years old. Brendon is making a concerted effort to stay on top of a number of health issues. He’s recently visited a dentist who volunteers for the Hands On Health Clinic run by the Sacred Heart Mission in St Kilda*. “I first got top dentures when I was 25 because my teeth were all chalky. I didn’t get the bottom dentures until recently. They’re OK but I’m having a bit of trouble eating with the bottom ones so I am going back to the dentist soon.”
EMERGENCY DENTAL SERVICES for people who are homeless or at risk of homelessness: • The Royal Dental Hospital of Melbourne, Carlton • Ozanam Community Centre, North Melbourne Many community health services have dental clinics. The health services below have established programs for people living in insecure housing: • Inner South Community Health Service • North Richmond Community Health Centre • Doutta Galla Community Health *Appointments
can only be made at the Sacred Heart Mission dental clinic through a caseworker. 12 Quality of Care Report 2010
Brendon Foy takes the opportunity to get a mouth-check by 4th-year dental student Leighton Phu. Frank Edwards visits Dr Patricia Lee at The Royal Dental Hospital of Melbourne following his mouth-check at the festival.
Frank follows through with dental treatment Frank Edwards knew he was well overdue for a dental check-up when he saw the DHSV stall at the Where the Heart Is... Festival. After a mouthcheck at the festival, he was referred to the Dental Hospital and has been receiving treatment there from Dr Patricia Lee. Frank had all of his top teeth and two bottom molars removed many years ago and he’s now having treatment on his remaining teeth in order to keep them and his gums healthy. “I make sure I try and eat well – greens and vegetables. I’ve had to have some medical tests recently, but everything was clear, so my health is pretty hunky-dory for the moment.” “I don’t mind travelling into the Dental Hospital for appointments and Dr Lee has been really good.”
Gum disease needs special treatment
BETTER ORAL HEALTH
for supported residents
Julie tells how
Around 2,000 people live in pension-level Supported Residential Services (SRS) in Victoria. They are people with disabilities, psychiatric conditions or frailty who need support for daily living. DHSV oral health promotion staff joined dental hygienists and dental assistants from Knox Community Health Service and Inner South Community Health Service in a pilot project to improve oral health among pension-level SRS residents. DHSV provided oral health kits, education sessions and resources to residents and staff. As was expected, the project found that the oral health needs of residents were high, with the majority of residents examined during the project in need of treatment. Knox and Inner South community health services provided dental treatment to 190 SRS residents over the course of the project. An independent evaluation of the project was undertaken, with a total of 382 residents interviewed by the evaluators. The evaluation found that cleaning teeth more often was the most common change in residents’ behaviour.
Dr Julie Fraser knew before she finished her fiveyear dental degree that she wanted to become a specialist periodontist. This took a further three years of study. These days she combines teaching at The University of Melbourne with treating patients in the periodontal clinic at The Royal Dental Hospital of Melbourne.
What is a periodontist? Julie: A periodontist is a dentist who specialises in treating severe disease of the gums, including periodontitis, and performs other surgical procedures including dental implants. What is periodontitis?
The DVD Healthy Choices for Healthy Mouths was produced by Dental Health Services Victoria specifically for residents and staff of Supported Residential Services.
Julie: Periodontitis is the most common form of gum disease. It is inflammation of the bone and gum tissues that hold the teeth into the jaws. If left untreated the disease can cause gum recession, bone loss, and the eventual loss of teeth.
How do you know if you have periodontitis?
Who can get periodontitis?
Julie: Periodontitis is not usually painful until the later stages of the disease. Symptoms can include bleeding gums, sensitivity of teeth to hot, cold, sweet or sour foods and drinks, and increasing looseness of teeth.
Julie: It is most common in people over 40 years of age who may not have maintained a high enough standard of oral hygiene.
How do you treat it? Julie: If it is detected early enough, periodontitis can be treated by removing plaque and calculus from above and below the gum-line and with daily brushing and flossing at home by the patient. If this doesn’t bring the disease under control, surgical treatment might be needed to remove infected tissues. In most cases, patients need a maintenance program that involves professional cleaning every three to six months. With careful home care, this usually stops the disease progressing. What happens if you don’t keep up regular treatment? Julie: If patients don’t stick with their treatment plans and don’t follow their home care routines, the disease will progress. The symptoms will get worse, the gums will become painful, and finally, teeth will need to be extracted.
How can you avoid periodontitis? Julie: Remove plaque from your teeth morning and night. Don’t smoke, as this has been shown to greatly increase the risk of periodontitis. Have your teeth cleaned by an oral health professional. How do you know if you need to see a periodontist? Julie: If you have any bleeding or swelling of your gums, you should report this to your oral health professional. If necessary, they will refer you to a periodontist. Early stages of gum disease can often be treated without a specialist periodontist. Why did you become a periodontist? Julie: I gain great satisfaction from seeing gum tissues return to health through my efforts and the efforts of the patient.
Oralhealth for better health 13
Oralhealth
KIDS’ PAGE for Better Health
Eat well, drink well WORD FIND
Can you find these healthy foods and drinks which are good for your teeth and for your body?
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COLOURING SHEET: Defenders of the tooth
14 Quality of Care Report 2010
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TOP TIPS
al Health rgan, Principal Or Professor Mike Mo toria, Vic l Health Services Advisor at Denta dentist a is e Mik s. ion quest answers readers’ ulation Oral Pop of air Ch te lga and holds the Co rsity of Melbourne. Health at The Unive
ealth Adv H l a r O l a ip c in r P From our
How do I choose the best toothbrush? No matter what toothbrush you use, the most important thing is that you brush your teeth morning and night using a proper brushing technique. Use a gentle circular motion that places the bristles on the gumline. Avoid a scrubbing action as this can damage teeth.
Top tips: •
Soft-bristled brushes are usually the most suitable choice for adults and children for cleaning teeth without damaging gums and tooth enamel.
• Choose a brush with a handle that allows you to reach all teeth easily. • Small-headed brushes are best for reaching all areas of the mouth. • Evidence shows there is no significant difference between electric and manual toothbrushes in terms of cleaning teeth. However, powered toothbrushes are useful for people with limited strength or control in their hands, and for people who have a tendency to brush too vigorously. • Change your toothbrush when the bristles become shaggy.
What is tooth erosion? Tooth erosion is the wearing away or dissolving of the outer enamel layer of your teeth. It is caused by frequent contact with the acid contained in some foods, drinks and medicines. Frequent vomiting and acid reflux can also cause erosion.
Top tips:
How do I look after my teeth during pregnancy? Pregnancy hormones can cause changes in the mouth that may result in gum disease. Common signs of gum disease include bleeding, redness and swelling of the gums and bad breath. Routine dental care is safe during pregnancy. In some cases, x-rays, general anaesthetics and certain medications may not be recommended in the first three months.
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Limit your intake of foods and drinks with high acid content, including citrus fruits, juice, soft drinks and sports drinks.
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Rinse with tap water (preferably fluoridated) after eating or drinking high acid foods and drinks and after using an asthma inhaler.
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• Eat a nutritious diet Wait at least 30 including fruits, minutes before vegetables, grains, lean brushing your teeth meats and calcium-rich after exposure to acidic foods. foods and drinks and after vomiting. • Limit your intake of sweet foods and drinks.
TOP TIP CHEWING
SUGAR-FREE GUM HELPS STIMUL ATE SALIVA. •
If you are experiencing sensitivity or pain in your teeth, consult an oral health care professional.
Top tips: • Be sure to have a dental check-up before and during your pregnancy. Let your dentist know you are pregnant.
• Drink plenty of tap water, especially if it is fluoridated. • Drink non-sweetened dairy milk or calcium- fortified alternatives.
isor
How does tooth whitening work? Tooth whitening attempts to make teeth appear ‘paperwhite’ by bleaching the enamel surface of the tooth. Adult teeth are not naturally ‘paper-white’ - they are commonly described as naturally ‘pearly white’. 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.
Keep in mind: •
Whitening is performed by applying a high concentration of oxidizing agent (usually peroxide) to the teeth.
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Results can vary from very positive to almost non-existent depending on the original tooth colour, the cause of colour irregularities on the enamel surface, and the whitening technique used.
• Teeth and gums should be checked for disease by a dentist before undergoing any whitening.
• Brush your teeth twice • a day using a soft toothbrush and fluoride toothpaste. • Floss your teeth regularly or on the advice of an oral health • professional.
Stains on the teeth caused by food, tobacco and bacterial pigments can usually be removed without tooth whitening. Frequent application of tooth whitening chemicals can permanently damage the enamel surface and the soft gum tissues.
Oralhealth for better health 15
SERVICE DIRECTORY
In an emergency call 1300 360 054
Type of service Who can use it?
Where?
Adults Check-ups and advice Cleaning Fillings Extractions
Health care and pensioner concession cardholders
Community dental clinics and The Royal Dental Hospital of Melbourne
$24 per visit, up to a maximum of $96 for a course of care
Children and youth Check-ups and advice every 1-2 years Dental sealants to prevent decay Cleaning Fillings
All children aged 12 years and under.
Community dental clinics and The Royal Dental Hospital of Melbourne
Free for children and adolescents if they or their parents hold a current health care or pensioner card
Children and adolescents between 12 years and 17 years if they or their parents hold a current health care or pensioner concession card.
How much do I pay?
Children aged 12 years and under whose parents don’t hold a concession card pay a fee of $29 per child (maximum $116 per family) per course of care Children and adolescents without a concession card may be eligible for free treatment in some circumstances. Visit www.dhsv.org.au or ring 1300 360 054 to check eligibility
Emergencies
Health care and pensioner concession cardholders
Community dental clinics and The Royal Dental Hospital of Melbourne
$24 for emergency treatment
Victorians without a concession card
The Royal Dental Hospital of Melbourne
Pre-payment of $100 with total cost based on dental need
Dentures
Health care and pensioner concession cardholders
Community dental clinics and The Royal Dental Hospital of Melbourne
Up to $115 for a full (upper and lower) acrylic denture
Specialist care Orthodontics Oral and maxillofacial surgery Endodontics Periodontics Prosthodontics Paediatric dentistry Oral medicine
Health care and pensioner concession cardholders and their dependants who have been referred by their dentist.
The Royal Dental Hospital of Melbourne
Depends on treatment needs. Cost will be discussed at your first appointment
Special needs
Care is available to children and adults with special needs. Talk to your local clinic for more details.
The Royal Dental Hospital of Melbourne and some community dental clinics
Depends on treatment needs. Cost will be discussed at your first appointment
Student clinic
You may be eligible for treatment by a dental student under the supervision of a senior dental professional.
The Royal Dental Hospital of Melbourne
Free for health care and pensioner concession cardholders
To make an appointment to assess your suitability call (03) 9341 1168.
Free for children aged 12 years and under
Note: These are 2010 fees and are subject to change.
Locations
Hours
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The Royal Dental Hospital of Melbourne Appointments: Mon-Fri, 8.30am-5.00pm Emergencies: Mon-Fri, 8.30am-9.15pm Weekends and public holidays, 9.00am-9.15pm
To find your closest community dental clinic call 1300 360 054 or go to www.dhsv.org.au The Royal Dental Hospital of Melbourne 720 Swanston Street, Carlton | Phone: (03) 9341 1200
Disabled parking spaces are available on Lynch Street (a one-way lane off Cardigan Street) in Carlton. Enter the lane from Cardigan Street and the disabled parking bays are on the left.
www.dhsv.org.au
Community dental clinics Check with your clinic.