The Bulletin - Issue 55 May / Jun 2020 by eroomcreative.com

Issue 55 May-June 2020

The official newsletter of the Dental Hygienists Association of Australia Ltd

WATCH YOUR MOUTH ORAL CANCER is one of the country’s biggest killers. We look at the best detection techniques. Are we aligned Has lock-down provided us the opportunity to reposition our role

Riding the wave Practice owner talks about life during and after COVID-19

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

We’ve done great. Now it’s time to do GOOD. Introducing TePe GOOD™ – A new toothbrush with the same qualities, design and feeling, as you would expect from TePe, but made from bio-based plastic. Thanks to the use of good renewable raw materials sugar cane and castor oil, we manage to recirculate up to 95% of the CO₂ emissions during its life cycle. Naturally, it’s produced with 100% green energy, partly from our own solar panels. Good for the environment and good for you.

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03 3

Learning life lessons from adversity BACK IN FEBRUARY I wrote: “As Anne Frank said, ‘what a wonderful thought it is that some of the best days of our lives haven’t even happened yet.’ I hope that 2020 brings you and your loved ones some of your best days.” At the time we were coming out of a terrible bushfire season and looking forward to the rest of 2020 with the anticipation of better days. However, ‘so far’ has not been ‘so good’. COVID-19 has affected people in different ways. When I heard it described as ‘we are all in the same storm, but we are in our own boats’ it really struck a chord with me. While this has undoubtedly been a devastating time for some, for others it has been a chance to press pause on normal life. For all of us, I hope we take time to reflect on what has happened, and how we can structure our new normal from here on. It is not often that we have a chance to press reset on our lives, but here we have a chance to take stock of what is truly important. Remember what essential really means. It’s amazing how quickly things that once seemed so vital to our existence fall away when we are faced with the challenge of empty supermarket shelves. Stripping back can help us to appreciate what we have, and not take things for granted. Give thanks to those who serve. Supermarket workers have faced longer hours and increased pressure to fill shelves. Teachers have scrambled madly to remould their curriculum to suit online or remote learning. Garbage truck drivers have continued and given us an excuse for our ‘bin-isolation outing’ every week. Posties have been regularly delivering us joy, which for some is the only contact from the outside world. Often relegated to the role of an extra in the cast of our lives, these people have now become the stars of the show, and rightly so. Continue the community spirit. It’s been heart-warming to see the many selfless acts of kindness during this time. People thinking of others and looking out for those who need it most. I have witnessed this from our members during this crisis, and have been so proud to be part of such a wonderful group of humans. As Yoda said: “Difficult to see. Always in motion is the future…” This has certainly been true recently, with our lives changing day-by-day, or at times hour-by-hour. As we venture into this next chapter let’s remember the lessons we have learned from COVID-19. If we can all be a little more patient, a little more grateful for what we have, and a little kinder to each other, then surely some of our best days are yet to come. Cheryl Dey DHAA National President

Contents 04 DHAA and COVID-19

CEO Bill Suen summarise the DHAA support activity.

06 Know your scope

The DBA's new information hub for scope of practice.

08 Inspired to achieve

The Tammie Birch Inspiration Award's first winner

10 Cancer carer

There’s a myriad of career opportunities outside of the dental practice

12 Symposium is back!

The DHAA National event has a new date next year.

COVER STORY

14 Watch your mouth

The best oral cancer detection techniques – the world's sixth biggest killer.

20 Ride the wave

Coping during the shutdown and planning for life after it

24 Are we aligned?

Has lock-down provided the opportunity to re-position our role?

26 Black and white thinking The tale of an unexpected business opportunity.

28 State of the Nation

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

Key Contacts PRESIDENT Cheryl Day CONTACT

ADMINISTRATION & EVENTS OFFICER Patricia Chan CONTACT

IT REP Josh Galpin CONTACT

BULLETIN EDITOR Robyn Russell CONTACT

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

Proactively managing the coronavirus crisis The world has been rocked by COVID-19 but there is light at the end of the Australian tunnel at least. DHAA CEO Bill Suen explains how the DHAA have responded SO MUCH HAS happened in the three months since our February Bulletin was published. As individuals and as an association we have experienced, learnt, and adapted so much in such a short space of time. As an industry organisation we have become stronger and better equipped to deliver our mission to serve our members and the profession. Support where it’s needed Dental practice restrictions caused by

COVID-19 have placed unprecedented pressure on all of our members, especially on the industrial relations front. The DHAA IR support line has been running hot with requests for information and advice; and the team led by Katrina Murphy has been working around the clock to ensure prompt support is being provided. I am pleased to see that the vast majority of our members have been able to reach satisfactory arrangements at their workplace given the very challenging

circumstance everyone has been facing. The mental wellbeing of members has been of concern throughout this very stressful period. Lyn Carman along with the state committees have come to our rescue by setting up local support groups for each state and territory. Lyn has also volunteered her personal coaching expertise and has been presenting “The DHAA Daily Bite” on Facebook where she presents tips to promote mental wellbeing. Recordings can be found on the DHAA Vimeo channel here. The peer

up-to-date information via any mobile or computer device.

The DHAA CONNECT free weekly webinar has proved to be very popular

support team led by Roisin McGrath has also been facilitating the identification and training of volunteers for the team. The COVID-19 environment has been changing rapidly with the emergence of news, advice and opinions across social media that created a secondary ‘infodemic’ as Professor Laurie Walsh at QU has pointed out. We are grateful for the help of many highly regarded and very experienced members who contribute their expertise to ensure that the correct information and advice on clinical practice is given to our members. We are also grateful for the collaboration and resource sharing with stakeholders such as the ADA, ADOHTA, ADPA, DBA and the ADC, which help immensely in terms of sourcing information and evidence-based advice. To facilitate timely communication, a weekly DHAA

Connect live webinar is being held every Tuesday evening at 8pm AEST. Members can log in for up-to-date information and discussion, as well as hearing answers to frequently asked questions from members. Online improvements The new DHAA website and membership management system was launched at the beginning of March. The transition went smoothly thanks to many months of hard work done by Christina Zerk, supported by media expert Steve Moore. The new platform has been a blessing as it gives us the ability and flexibility needed to provide timely information on the website and prompt email communications during this period of rapid change and uncertainty. Members now have easy access to relevant and

DHAA membership renewals Over the past couple of months we have been overwhelmed with offers of help from many members who themselves are also going through tough times. With that in mind and with the annual membership renewal period approaching, the DHAA Board has announced a deferment of membership and insurance renewal until November 2020. This deferment includes a 30% discount that should provide some relief for those members who find themselves under financial stress. I would like to thank the many members who have indicated that they are in the financial position to renew as normal and wish to do so in the support of their fellow members. This display show of camaraderie has been most heartwarming and the best of humanity has certainly shone through the DHAA community. Today I see a more efficient, cohesive, and proactive association and I extend a big thank you to the board, staff, committees, SIG volunteers, and everyone working so hard to get us to where we are. I am extremely proud to be part of this fantastic organisation – thank you. n

The Dental Board of Australia launches new information hub for the new scope of practice standard THE DENTAL BOARD of Australia has officially launched the ‘know your scope’ information hub and confirmed that the new scope of practice standard is effective from 1 July 2020. The new website was announced in statement issued on 13 May 2020: The hub has been developed to help dental practitioners understand their obligations under the revised scope of practice registration standard which, together with the supporting guidelines, is in effect from 1 July 2020.

Scope of practice resources developed by the Board, with input from practitioners and dental associations, can be found on the hub. Resources include •A reflective practice tool •N ew FAQs •A recorded webinar of the ‘know your scope’ stakeholder forums presentation. It is recommended that practitioners bookmark the ‘know your scope’ hub for future reference as other resources will be published as they are developed. You can read more about the hub in an article published on the DBA website which also outlines what will and what won’t change for dental practitioners on 1 July 2020.

Stakeholder forums and Q&A sessions Due to events related to COVID-19, stakeholder forums to be hosted by the Board in each state and territory were canceled after the Sydney forum in midMarch. The forums have been moved to a series of online Q&A sessions to be held in June. Practitioners and interested stakeholders can register for one of three Q&A sessions now. More sessions will be announced to meet demand. The first session is on 3 June at 8pm: Register now. More information about how to register for the other Q&A sessions is on the ‘know your scope’ hub. The Board is encouraging practitioners to watch the webinar recording and read the new scope of practice FAQs before attending a Q&A session. n

FREE TO ENTER VIDEO COMPETITION

THE DEADLINE IS looming for DHAA members to submit their own short videos to promote oral health literacy and self-care. It’s free to enter and there’s prizes up for grabs. A guide to brushing teeth, cleansing dentures, or an introduction to dental self-care products. Anything goes. Judges will select entries that are suitable for use in a future DHAA consumer social media campaign. Submissions may also form the resources on our website or education materials in the future. Full details are on the DHAA website.

Light Up The Dawn Despite lock-down the ANZAC Day commemorations still went ahead to remember those that serve our country. Here we salute the DHAA members who share that honour By Jen Turnbull – Queensland Chair

ANZAC DAY MARKS the anniversary of the fateful Gallipoli Campaign (Turkey) that commenced on the 25 April 1915; and which by its end had claimed the lives of more than 8,000 Australian and New Zealand soldiers. It has gone down in history as one the cornerstones for the ‘kinship’ that we share with our Kiwi mates and, despite its terrible outcome, has left us with an enduring legacy of friendship that has stood the test of time. ANZAC Day is typically the most sacred day of the year to any Australian or New Zealand military member, as well as their families and friends. Nowadays, we not only honour those service men and women who lost their lives in the Gallipoli campaign, but we now remember those who have ‘served and died in all wars, conflicts, peacekeeping, disaster relief and humanitarian assistance missions’. It’s a day to commemorate the hardships endured and honour those members who have made the ultimate sacrifice. It’s a time to reconnect with friends and to reflect on the impact of those missions on our two countries. Usually, ANZAC Day is marked by dawn services and marches throughout our towns and cities, but this year of course was a little different. ANZAC Day 2020 was disturbed by COVID-19, but not silenced, Australians across the country took part in ‘Light Up the Dawn!’. Thousands of households adopted the brilliant ‘Light Up the Dawn’ concept; honouring the service men and women by decorating the outside of their homes and standing at the end of their driveways with candles, flags and rosemary. People also participated in dawn services that were streamed live via YouTube or on the radio. It was our way of acknowledging the spirit of the ANZACs, which the RSL says includes: Courage, Endurance, Humour, Ingenuity and Mateship. The DHAA thanks those serving and are proud to share a few photographs of our serving members, past and present. n

QUICK FACT: Rosemary is traditionally worn on ANZAC Day and Remembrance Day because it is found along the shores of the Gallipoli Peninsula. It is also believed to improve the memory.

Kristy McClure ex-Navy Leading Seaman Dental Hygienist

Tanya Fane - (retired DHAA member) Air Force Corporal Dental Hygienist 1988-1995

Naomi Blake – RAAF Sergeant Dental Assistant, Hygienist then dental supervisor 1989-2000

Jen Turnbull – ex-Navy Petty Office Communications & Information Systems Sailor

Susan Melrose – ex-Navy Petty Officer Dental Hygienist

From the Big chair Meet DHAA Bulletin’s new editor Robyn Russell WELCOME TO MY first edition of the DHAA Bulletin as Editor; I am hoping to create a community of positive and collaborative influence. Dentistry is changing, and the roles of OHTs and hygienists are also transforming. I am honoured to have this opportunity to develop content, which will challenge and empower you all to be transformative professionals. I hope you enjoy this edition and please get in touch with me via my email address below if you have anything you want to get into The Bulletin Robyn Russell DHAA Bulletin Editor bulletin@dhaa.info

HOW PREPARED ARE NEWLYQUALIFIED PRACTITIONERS? The Melbourne Dental School (MDS), The University of Melbourne, in collaboration with the Australian Dental Council (ADC), is conducting a study into how prepared newly-qualified dental practitioners are to practice in Australia. Dental practitioners and graduates are invited to complete an anonymous online survey, with the option to participate in a further interview on the phone at a later date.

TAKE THE SURVEY

INSPIRED TO ACHIEVE The Tammie Birch Inspiration Award – created to reward excellence in the field of oral health – has it's first winner By Susan Melrose – ACT Chair

ONE OF OUR fellow dental hygienists, Tammie Birch, passed away in February 2019 from Osteosarcoma at the all too young age of 38; leaving behind her young family and her husband, Josh. Tammie obtained her Bachelor of Oral Health from the University of Melbourne and worked briefly in Sydney before finding her way to Canberra. After her passing many ACT members contacted the committee to ask if DHAA could do something to honour Tammie in some way. There were many wonderful suggestions of what would be appropriate and the ACT committee made the final call.

Since 2002, prior to nationalisation of the DHAA, ACT has awarded the Hygienist of the Year award (HOTY) to an ACT member. Conveniently there was no longer room to add the winners names so the decision was taken to evolve HOTY into the Tammie Birch Inspiration Award. The inaugural presentation of the award was due to take place at our World Oral Health Day (WOHD) dinner meeting in March 2020. Tammie’s family were invited to the dinner but due to COVID-19 situation it was unfortunately canceled two days before the event. I didn’t know Tammie personally, but

Dahlia Kruyer in her own words: The first recipient of the Tammie Birch Inspiration Award I HAVE BEEN a hygienist for just over 20 years having come to Australia in 2006. I was instantly welcomed into the community by the wonderful hygienists of the ACT, and have been working with the professional development committee on and off for the past 14 years. My career highlights as a dental hygienist so far would be: • Being interviewed and having the article published in the NZ Herald newspaper • Being interviewed and having the article published in the Sunday Star Times • Being on an infomercial as the hygienist promoting Oral B electric toothbrushes which aired in both NZ and Australia, • Working in NZ as the sole practitioner in Australasia›s very first teeth whitening spa offering BriteSmile treatments, • Being taken with a fabulous group of dental professionals I worked with on a weekend retreat to Waiheke Island with top speakers including Dr Hien Ngo who is a co-inventor of several incredible dental products

Natalie Bartone had put together these words about Tammie to say prior to the winner being announced: “As most of you may know my name is Natalie Bartone and I had the privilege and honour to work with Tammie for over eight years at Preventive Dental Options (PDO). I would also like to make a special mention to Britta Hannaford and Lulu Ishish who are the leading practitioners and owners at PDO. Thank you both for being here as well and supporting our association. I know Tammie looked up to you both and thought the world of you! I remember the first time I met Tammie. It was at a GC CPD night, I was new to Canberra and new to the dental hygiene association as well, I didn’t know many people and at the end of the presentation Tammie came up to me, she took the time to introduce herself and welcome me in. She was friendly, genuine and had a beautiful nature about her. I thought to myself it would be so nice to work with her. She left that type of impression. It’s so nice to work with someone that you know could inspire you and that you could learn from but would make a really beautiful work family as well. A few months later I had the

opportunity to work at PDO. I went on to work for Tammie when she went on maternity leave and stayed with the practice afterwards. We were so lucky to have that work family. I look back and feel so grateful for the opportunity to work with someone who was passionate about what they were doing, to work with someone so knowledgeable and that got to inspire us as clinicians, to work hard every day and to do good. I always looked up to Tammie as a clinician and as a person. She had a way with people. She was the type of person people would gravitate towards. She had an ability to be able to connect with people through her work that has made her stand out from the rest. It has really inspired us all . She was special and rare. We are all so grateful to have known her. Strive to be more like Tammie.“ In addition to their nominations we had asked members to also list reasons for their choice. The first-ever winner of the Tammie Birch Inspiration Award was Dahlia Kruyer. instead of receiving the gift that comes with the award, as soon as Dahlia was advised she was the winner she requested that a donation be made

• Getting the Hygienist of the Year trophy with that huge 11/12 sticking right out of it and not poking my eye out with it! The best parts of being a hygienist so far for me has been: • Helping connect hygienists with each other and seeing their professional and personal relationships blossom, • Helping hygienists find the right practices to work in and helping dentists find the right hygienists (no idea how this keeps happening haha) • All the amazing times we have shared as hygienists at dental symposiums and conferences all around Australia • Seeing patients both achieving and maintaining great oral health. • And mostly when the patients are so happy and say things like “I love having my teeth cleaned” and “I’ve really been looking forward to my appointment” Happy patients equals happy hygienist. Thanks again for such a terrific honour. I was absolutely shocked but I’m absolutely thrilled!!!

in Tammie’s name to Australian Cancer Research Foundation. This has been done and demonstrates why so many of Dahlia’s colleagues nominated her for this inspirational award. Here are a few of the reasons given for her nominations: •F or her inspiring attitude towards the profession •S he is so involved in all aspects with our DHHA. From helping out with organising our meetings and keeping us informed of what is happening in our hygiene world. • She put a lot of time into the DHAA • She has been a very active member of the association for such a long time, I think she should be rewarded with this award. •S he works tirelessly for the DHAA and is a fabulous representative of our association. •S he welcomes every new member personally and is an asset to our profession. We are looking forward to next year when we can hopefully present the Award in front of our members and honour Tammie in the way that she deserves. n

10 CAREER DEVELOPMENT

Emerging roles in oral health practice If you’re not loving hands-on hygiene, there’s a myriad of opportunity outside of the dental practice By Melanie Hayes

ROLES FOR DENTAL hygienists and oral health therapists continue to diversify and expand in alternative workplaces and models of care. Entrepreneurial and innovative dental hygienists and oral health therapists are now establishing businesses, and working in areas such as aged care, educational consulting, and mobile services. And why shouldn’t they? Dental hygienists and oral health therapists graduate with a range of competencies that are transferable to a range of work environments, whether it involves using their full scope or previously underutilised procedural skills, or applying broader skills such as information gathering, critical thinking, and communication. Opportunities for career development are only limited by your imagination! Universities and TAFEs also have an important role to play in shaping the future direction of the oral health professions. By providing placements and professional practice experiences across new and diverse areas of need, this can influence future service provision by creating roles where they previously did not exist. There are many great examples of this in action; Dr. Janet Wallace’s Senior Smiles initiative began as a student placement at the University of Newcastle, and is now creating jobs in Aged Care, and student placements at Peter MacCallum Cancer Centre have created additional job opportunities for oral health therapists, as demonstrated in the interview for this very column. I recently caught up with oral health therapist Shae Beaton, who I had the pleasure of knowing during her time as a student at the University of Melbourne. She shared with me her insights working in an oncology unit, including the importance a diverse educational experience, and the relevance of essential and transferable skills such as empathy.

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

Cancer Carer

Oral health therapist Shae Beaton gives an insight to working in an oncology unit Tell us about your current role. I have been working as an OHT in the dental oncology unit at Peter MacCallum Cancer Centre for the past four years. I am mainly involved in the screening of patients prior to their cancer treatment, and in the prevention and management of treatment-induced oral toxicities. I work in a collaborative fashion with a multi-disciplinary team of clinicians. What education or experience did you need for this role? In my final year at the University of Melbourne, I completed an elective study unit on radiation-induced oral side effects in patients with head and neck cancer. This involved a three week placement at the Peter Mac dental oncology unit. It was here that my passion for working with patients with special needs developed. What are the day-to-day activities? Day-to-day activities revolve around prevention, including the provision of oral hygiene instruction, scale and root debridement and patient education regarding potential side effects of any treatment. I also perform post-treatment

reviews to assess the extent that patients have been orally affected by treatment, and providing individually tailored strategies to help manage side-effects. The main side-effects that we have to manage are those of radiation-induced xerostomia, mucositis, radiation caries, trismus, dysphagia and hyperkeratosis. I also perform the following tasks on a regular basis; intra-oral radiographs and cone-beam CT scans; alginate impressions; scale and root debridement; and the review of extraction sockets (two and eight weeks post extraction). However, I see my main role is to be an empathetic listener. Anyone receiving a cancer diagnosis will experience some degree of distress. This can be a challenging journey and sometimes the best thing I can offer is just to listen, and give them a chance to vent their fears, frustrations or anxieties. What’s the most challenging part of your role? Working with cancer patients can be incredibly rewarding, and at times it can also take an emotional toll. I often find myself ruminating on the challenges faced by patients, even after work, and at times this can become overwhelming. Mindfulness and daily exercise really helps me manage this. Were there people along the way who helped you get the career you wanted? All of the dental team at Peter Mac have provided ongoing support to nurture my career, and for that I cannot thank them enough! I also worked with demonstrators during my Bachelor of Oral Health degree who showed me the importance of qualities outside of clinical skills, such as empathy. Do you have any advice for OHTs who are looking for a job outside traditional general practice? I recommend contacting your ideal place of work to explore the possibility of observing or volunteering with them. n

Oral cancer screening and prevention in Victoria

READ THE FULL ORAL CANCER REPORT page 14

THE ORAL CANCER Screening and Prevention Program is an initiative funded by the Department of Health and Human Services under the Victorian Cancer Plan 2016-2020. It aims to improve oral cancer prevention, screening and early diagnosis in the state and reduce the impact of the disease. A strong socioeconomic gradient exists, with people in low-income groups and Aboriginal and Torres Strait Islanders at higher risk. Stage one of the program focuses on supporting oral health professionals. Training was piloted in 2019 across 16 community dental agencies and private dental practices and included information on oral cancer risk factors as well as guidance on patient risk assessments, oral mucosal screening, lesion recognition and referral pathways. Findings from the pilot evaluation are now being used to develop information, training and resources that will be offered to all Victorian oral health professionals in 2020/21. Stage two plans to offer oral cancer screening and referral training to doctors and other health professionals. ‘Champions’ across the oral health professions will provide further insights to the program and help promote key messages. Interested dental hygienists, dental therapists and oral health therapists are encouraged to get in touch.

“With earlier diagnosis, a patient’s treatment and prognosis can be enormously improved.” Professor Michael McCullough The program is led by Dental Health Services Victoria in partnership with the University of Melbourne Dental School, the Australian Dental Association (Victorian Branch), La Trobe University Department of Dentistry and the Department of Health and Human Services, which also funds the program. For more information, contact program lead Kym Lang, DHSV at kym.lang@dhsv.org.au Resources Consumer information about mouth cancer has recently been updated on the Better Health channel https://www.betterhealth.vic.gov.au/health/ ConditionsAndTreatments/mouth-cancer . Keep up to date with the Oral Cancer Screening and Prevention Program https://www.dhsv.org.au/oralhealth-programs/oral-cancer-screening-and-prevention

DHAA Symposium is back in business IN LIGHT OF the COVID-19 pandemic the DHAA Symposium 2020 in October has been postponed until 13-15 May 2021 at the same venue at the Pullman Melbourne Albert Park. Registration for the symposium has now re-opened, with discounted Sunrise Registration extended to 30 November 2020 – offering savings of up to $200 per person. Existing registrants will automatically be transferred to the Sunrise rate with credits being refunded where appropriate. The Symposium program contains an impressive array of speakers and clinical topics for hygienists and therapists running in multiple streams concurrently. There are also opportunities for personal skills development in industrials relations, finance, and motivation, as well as

No judgment, just understanding by Robyn Russell...

WHAT A TIME of uncertainty we have all had these last few months. In my discussions with OHTs and hygienists I have found that on the whole they really enjoy being oral health professionals. Personally, I love how our patients let us into their lives. We often underestimate the

sessions for academics and educators. Celebrity Matt Hale will demonstrate simple, easy to implement, and practical mental techniques to increase productivity, break bad habits and improve your life. He puts a smile on your face, and brings everyone together through his positive and enlightening hypnosis presentation that has traveled around the world and recharged countless individuals and organisations Not to be missed are the contributed posters which will be on display for researchers and practitioners to share their work and linking research to practice. This is often the hidden treasure that provides endless opportunity for practice improvement and innovation. The trade exhibition hall will be packed with practitioners and industry

importance of spending time with our patients and the effect that we have. Many of us may have had some time away from our workplaces and patients, which has given us extra time with our families and an opportunity to reassess and evaluate many aspects of our lives. At the time of publishing most states and territories are transitioning to Level One restrictions. This announcement has been met

representatives keen to update you on the latest products and services available, with lots of samples, giveaways and prizes. As always the legendary Gala Dinner will be the social highlight the magnificent Crown Aviary on Friday, May 14 commencing at 7:00pm. This year’s theme is Op Shop Glam, so dust off your feather boas and bowler hats and join us for what is sure to be a fabulous night. This year DHAA Symposium is supporting cheeky Melbourne-based charity Pinchapoo who provide the needy with personal hygiene essentials through your donation of 'pinched' hotel toiletries! For further information or to register visit the DHAA Symposium website. n

with a multitude of emotions from the dental workforce. It is important to remember that every one of us comes from a different place of understanding and our feelings are often validated by our own individual experiences. We must be very careful to not judge each other during these stressful times and instead we should strive to offer support and collegiate advice to our fellow professionals.

While the dentistry landscape may well be very different post COVID-19, the oral health community has the innate ability to transform and adapt to this transient landscape. Change is often a daunting concept and something we all want to naturally resist. I would encourage us all to draw on the courageous culture of dentistry and see the opportunities for growth as health professionals. n

Farewell and thank you!

New DHAA Showcases get a warm reception DHAA SHOWCASES ARE yet another part of the ongoing DHAA strategy to combat lock-down. The live online Showcases allow companies to present their products and innovations direct to the people who use them. Not only does Showcase provide a service to our industry but they allow oral health professionals to stay informed. Some delegates who worked in the public health sector expressed that they would not normally get to meet company reps and it was a great experience for them The first two showcases ran as three blocks of 15 minutes per brand and all presenters came armed with freebies and prizes as an added bonus for attendees. Winners were selected using a random wheel of dental fortune, and they were prizes worth winning. Marcelle from Colgate gave away a ProClinical 500R Sensitive Electric Toothbrush; Kate from WaterPik gave a Sonic Fusion; Erik, Issy and Annie from Curaprox had a Hydrosonic Pro and a Chairside box. Three Dr Mark's HyGenie and Dental Fresh professional packs were given away by Steve; a filled TePe Clinic Box came from Anne Kristin of TePe presenting all the way from Sweden, and one lucky attendee got an Oral-B Genius Electric Toothbrush with Artificial Intelligence from Elizabeth. With over 100 members logging in for each event and some seriously positive feedback, the intention is to continue with a regular DHAA Showcase as another free service to members. n

Tabitha Acret

Sahil Bareja

Patricia Chan

THE DHAA BOARD accepted the resignations of the NT and NSW directors at its recent board meetings. NT Director Tabitha Acret stepped down from her DHAA directorship after representing different states and territories, as well as being National Vice President and chair of the CPD Committee. Tabitha has been instrumental in leading the CPD Committee to introduce live webinars that deliver flexible and convenient education to members while overcoming the major barrier of physical distance for many rural and remote practitioners. She has been a very popular presenter and is highly regarded both in Australia and internationally. Tabithaâ&#x20AC;&#x2122;s passion, foresight and drive have been key forces in the transformation of DHAA over recent years. She has undoubtedly left a legacy and some very big shoes to be filled. NSW Director Sahil Bareja has recently resigned after serving two and a half years on the DHAA National Board. Sahil has been pivotal in leading the National IT and Communication projects that saw the successful implementation of the new DHAA website, membership management system and the popular quarterly e-bulletin. He has been a frequent contributor and presenter for the DHAA Bulletin and CPD program. He has been one of the high young achievers of the profession and is currently an owner of his professional practice in Sydney. He has been very generous in sharing his experience and success stories and is regarded by many as their role model. Despite his resignation from the board of directors, Sahil re-affirmed his desire to continue to contribute through a range of local and educational activities to the profession and association he loves. We are also saying farewell to one of our valued longterm members of staff. Patricia Chan will leave us at the end of May after many years of service to the DHAA as both administration officer and events coordinator. Patricia has supported consecutive presidents and CEOs over the years and is the most reliable source of corporate knowledge. The Association has benefited greatly from her expertise in the support of board functions, as well as event management. Patriciaâ&#x20AC;&#x2122;s contributions will always be valued and remembered by everyone at the DHAA. We wish her the best of luck for the future. The DHAA is indebted to these wonderful people for their invaluable contributions and we would like to express our gratitude for their commitment and loyalty to both the Association and the profession. n

H WATC YOUR MOUTH ORAL CANCER is one of the countryâ&#x20AC;&#x2122;s biggest killers. We look at the best detection techniques. By Dr Lara M DeAngelis (Oral Medicine Registrar) and

Professor Michael J McCullough (Oral Medicine Specialist)

Every week in Victoria alone, more than 14 people are diagnosed with these types of cancers and five people die from them. Despite declining rates of smoking and advances in treatment, the number of non-smoking oral cancer patients is increasing, and the five-year survival rate remains at only 66%. One of the key factors leading to low survival rates is that cancer of the lips, oral cavity or salivary glands is commonly diagnosed at a late stage. By that time, these cancers are already advanced and have spread into adjacent tissue and local lymph nodes. Most early stage oral cancer is painless, presenting as innocuous lesions that are difficult to recognise during limited examination. It is not possible to predict if, or when, there will be a malignant change in a pre-existing oral lesion. These lesions are relatively common, occurring in around two per cent of the population and often appear as flat white areas in the mouth, termed â&#x20AC;&#x2DC;leukoplakiaâ&#x20AC;&#x2122;. The presence of dysplasia observed histopathologically in biopsies of tissue remains the best predictor for developing oral cancer. However, the grade of dysplasia does not always correlate with the potential for malignant transformation.

Risk factors Modifiable risk factors play a major causative role in oral cancer pathogenesis. The greatest risk factor for oral cancer continues to be tobacco use, which results in a tenfold increase in risk when compared to non-smokers. Regular alcohol consumption greater than three standard drinks per day also increases risk by threefold. The combination of these two risk factors is greater than either one in isolation, and approximately 75% of all oral cancers are associated with consumption of tobacco and alcohol. Other risk factors for oral cancer include regular use of betel nut, paan, snuff and smokeless tobacco. Rising age (over 50 â&#x20AC;&#x201C; 60 years), being immunocompromised, and a history of a previous oral squamous cell carcinoma are important risk factors for oral cancer.

Prolonged exposure to the sun without proper protection is a significant risk factor for lip cancer. Viruses, in particular the human papillomavirus (HPV) subtypes 16 and 18, have been strongly linked to oropharyngeal cancer with an increasing number of these cancers occurring over the past 10 years. However, HPV is involved in only a small number of oral cavity cancers; around two per cent. While it has been postulated that genetic predisposition may increase susceptibility to oral cancer, no specific genetic component has been clearly established as a risk factor. Hence, in many instances the risk factors for oral cancer are modifiable.

Signs and symptoms Oral cancer can present in a variety of ways and in any area of the oral cavity. The most obvious clinical presentations of oral cancer are a non-healing ulcer or an exophytic, indurated swelling with or without fixation, as well as palpable neck lymph nodes. The most common sites for oral cancer are on the lateral margins of the tongue, the buccal mucosa (lining of the cheeks) and the floor of mouth. Less obvious clinical presentations include white, red, or mixed red and white patches that cannot be removed during clinical examination. In the early stages, most presentations of oral cancer are painless. In the later stages patients have pain, numbness or altered sensation, as well as difficulty swallowing, chewing or moving the tongue. The most effective screening method dental practitioners can undertake is a thorough oral examination using good lighting to visually examine the entire oral mucosa. Any lesion that has persisted for more than two weeks without a definite cause should be referred for immediate biopsy. It should be recognised that the major cause for oral mucosal changes is trauma and such things as sharp cusps of teeth, broken fillings and ill-fitting dentures. These causes need treatment and should be reassessed for healing two weeks later. Failure to improve within two weeks requires referral for further management. >

Assessment Any patients suspected of having oral cancer should be referred, by a dentist, to an oral medicine specialist or oral and maxillofacial surgeon for further assessment. Assessment includes a comprehensive oral examination involving extraoral examination and palpation of the lymph nodes in the head and neck region. A full intra-oral examination using white dental light is conducted. The need for adjunctive tests including blood tests, selective imaging, use of diagnostic aids, cytology and histopathological assessment will be determined at the clinician’s discretion at the time of examination. For definitive diagnosis, histopathological assessment of biopsy material is required.

Management Definitive diagnosis of oral cancer necessitates referral to a tertiary hospital for multidisciplinary treatment planning and management. In the first instance, the patient would undergo extensive imaging including CT, MRI and often ultrasound examination so that accurate staging can occur to guide treatment. Multidisciplinary management usually consists of multiple treatment modalities including a combination of surgery, radiotherapy and/or chemotherapy. The team involved in managing a patient with oral cancer usually consists of oral and maxillofacial, plastic, ENT, and head and neck surgeons, radiation oncologists, speech pathologists, radiologists, dieticians and other dental specialists. The best management outcome for the patient is surgical eradication of the cancer at an early stage. For Aboriginal and Torres Strait Islander patients, it is fitting to involve a culturally appropriate healthcare professional in that person’s treatment.

Prevention and early detection Counselling by healthcare professionals is key to reducing risk factors, particularly smoking and drinking alcohol. Anyone displaying oral mucosal changes, which have potential malignant change, should be reviewed regularly; either by an oral medicine specialist or an oral and maxillofacial surgeon. Self-monitoring for changes in appearance and consistency of a lesion between review appointments should also be encouraged so that patients can represent earlier if they are concerned. Support of patients at greater risk by their healthcare team, as well as a patients’ ability to change modifiable factors, can play an important role in avoiding adverse outcomes. This article was first published in the Australian Medical Association Victoria VicDoc magazine

ways to improve your oral examination By Dr Amanda Phoon Nguyen, Oral Medicine Specialist

ORAL CANCER IS a significant health burden and is recognised as the sixth most common cancer, worldwide. In Australia, oral cancer accounts for about 2-3 per cent of all cancers. A declining trend of the incidence of lip and oral cavity cancer, and a rise in the incidence of oropharyngeal cancer has been reported. However, despite advances in treatment and management options, survival rates have not dramatically improved in the last few decades. Overall survival rates for oral cancer are poor, at about 50 per cent for all anatomical sites and stages. When looking at studies, the use of the term “oral cancer” can sometimes be confusing. Oral cancers are a heterogeneous group of conditions encompassing the main subsites of the external lip, oral cavity and oropharynx. When reading articles it’s important to consider which specific subsite the paper refers to, as the aetiology, management and prognosis of lip cancer, oral cavity cancer and oropharyngeal cancer can be different.

Improve your evaluation Early detection of potentially malignant disease has been proven to improve the clinical outcome for patients, and therefore it is very important to perform thorough intra and extraoral examinations for every patient. Here are six ways to improve the patient risk evaluation and conventional visual screening of oral tissues?

17 Loss of definition of the vermilion border and crusting involving lower lip

Tissue changes involving the floor of mouth

1 Take a good history It is important to take a good history and note any factors that may put the patient at a higher risk of oral cancer. This may include a current habit or a history of smoking, alcohol consumption, use of smokeless tobacco, use of a mouthwash containing alcohol, or a family or personal history of cancer.

2 Be aware of any suspicious changes Changes to the oral mucosa are detected visually due to light interaction with tissue. As the tissue changes, there are colour alterations that we can see. The most common signs are white and red changes to the mucosa. Changes can appear as an ulcerative, flat, raised or exophytic, red and/or white lesions. The oral cavity can also be the site of cancer metastasis from other parts of the body, most commonly of breast, kidney and lung. Signs such as firmness to palpation, pain and ulceration are more commonly seen when the lesion is already malignant. The poor prognosis of oral cancer can largely be attributed to its frequent diagnosis at an advanced stage, and early detection is key. Early lesions are usually asymptomatic.

3 Use appropriate lighting Examination with the naked eye should be done under white light where possible (projected incandescent or halogen illumination). The use of loupes and/or an

Tissue changes involving the right buccal mucosa and lateral tongue LED headlight, where available, will assist with the examination. Actinic cheilitis, also termed actinic cheilosis, actinic keratosis of the lip, solar cheilosis, sailorâ&#x20AC;&#x2122;s lip, and farmerâ&#x20AC;&#x2122;s lip, is a type of lip inflammation caused by longterm sunlight exposure. The prolonged solar exposure produces irreversible damage to the lower lip, and this is very common in Australia. It is a premalignant condition that could develop into squamous cell carcinoma. Signs include the loss definition of the vermilion border and mucosal changes to the lips, such as dry or mottled skin, white or grey plaques or patches, and crusting. Persistent ulceration, crusting or firmness to palpation should be viewed with suspicion.

4 Check the tissues in a systematic manner The development of a consistent examination sequence is important. While the actual order of this does not matter, all elements must be completed. Before looking in the mouth, a thorough extraoral examination should not be missed. This should include a general examination of the patient and inspection of the temporomandibular joints, facial skin, lymph nodes, neck, midline neck structures, plus lip and perioral structures. By doing the same sequence for all patients, clinicians are more likely to consistently check all sites. High risk sites for oral cavity squamous

cell carcinoma includes the lateral and ventral tongue, and floor of mouth. Other areas that are frequently missed include the soft palate, posterior lateral tongue and oropharynx.

5 Palpate as well as visually inspect structures Besides looking at structures, it is also important to palpate them. Two worrying signs are induration and fixation. Induration is where there is an increase in the tissue density (the tissue becomes hard), and fixation is loss of tissue mobility, where the tissue does not move. Cancer can cause tissues to become indurated and fixed.

6 Refer or review Most oral mucosal lesions of traumatic aetiology will resolve within two weeks, once the cause is removed. A common scenario is a chipped tooth causing tissue changes (such as a white patch) of the adjacent mucosa. The tissue should return to a normal appearance once the tooth is smoothed, and this should be ascertained with a review after two weeks. Good recall systems should be in place to ensure the patient returns for the review and the appointment is not missed. Any oral mucosal lesion that persists beyond a two-week period should be viewed with a degree of suspicion. This patient should be referred directly to the appropriate practitioner, such as an oral medicine specialist. n

NEW ORAL HEALTH ADVOCATE COMMUNITY OFFERS INSIGHT AND SUPPORT TO YOUNG PROFESSIONALS

f you are looking for practical oral health support and insights that you can use through your University studies right through to the practice setting, then connect with the Colgate Advocates for Oral Health: Editorial Community. A new collaboration of emerging young oral health professionals have been brought together by Colgate to offer support to fellow professionals and established clinicians via insight driven articles covering a range of topics. Advocates are driving dialogue on a wide variety of topics including preventive oral health, practice management, social responsibility, career development and sustainable dentistry, to name a few. The advocate community is made up of six passionate members with representation from around Australia. Namely, members include (in alphabetical order); Carlson-Jones, Oral Health Therapist, Adelaide • William Mikaela Dentist and Oral Health Promoter, Sydney • Sam Koh,Chinotti, Dentist, Founder of Young Dentist Hub, Melbourne • Tan Minh Nguyen, Oral Health Therapist, Melbourne • Emma Turner, Dental Student, Perth • Bianca Volpato, Dentist, Melbourne • Dr Susan Cartwright, Scientific Affairs Manager, Colgate says, “The newly established community, enabled by Colgate, is an important initiative to help support young professionals. The community’s collective voice will provide peer-to-peer insights for young oral health practitioners, spark new ideas and encourage young oral health professionals in their career development. The community understands the challenges ‘new recruits’ may be facing and this initiative provides a valuable resource for them.” The community brings together young professionals in order to leverage their experience and perspectives for the benefit of the profession. Working with Colgate, the Advocates’ articles will be published on www.colgateprofessional.com.au/advocates and shared via the Advocates’ social channels. For more information, please click on the button below.

COLGATE PROFESSIONAL

â&#x20AC;&#x153; The newly established community, enabled by Colgate, is an important initiative to help support young professionalsâ&#x20AC;? Dr Susan Cartwright Scientific Affairs Manager, Colgate

RIDING THE WAVE We speak to Brisbane practice owner David Kerr about coping during the COVID-19 shutdown period and planning for life after it by Robyn Russell

Tell us a bit about you and your dental practice. My name is David Kerr, I am the part owner with Darryl Marsh in Today’s Dentistry, a medium to large sized family dental practice in the northern suburbs of Brisbane. I have been a dentist for 22 years and our practice has been established for over 30 years. We currently employ 20 staff including five OHTs. If anything, we are a little unusual in that we have more oral health therapists than dentists and hence a very large proportion of our business is preventive – Darryl was one of the first to implement the use of dental hygienists over 30 years ago.

Apart from the current COVID-19 crisis, what are your views on private practice dentistry in the past year or so? Even before the current situation, dentistry has seen the rise in direct-topublic corporate practices in addition to those being re-branded by acquisition. I think this has definitely put a squeeze on all private practices; through competitive market presence for those that are independent, but also other practices associated with health funds has seen cannibalisation of those health fund provider relationships. The oversupply of dentists has added to, and likely fueled, the competitive aspects of corporate dentistry; and has somewhat threatened the modern dental practice workflow, especially with the dental hygienists and

therapists. I think anecdotally we are seeing the decreasing dental disease rates (socioeconomically impacted of course), and more and more practices are generating a higher percentage of the revenue via elective dentistry procedures. I feel this has had a stacking effect that COVID-19 is now exposing rather than causing?

“ We all need to embrace a recalibration of what our roles will be moving forward. I no longer think that doing recall visits is going to be enough” How did the COVID-19 crisis affect you and your practice? The business was hit and the effect was felt very abruptly. It was total shock. I was immediately forced to look at numbers, cut expenditure and evaluate the business extensively. Something, I am guilty of, although not always, is being sloppy in terms of the business side of dentistry. For a long time we have benefited from good cash-flow, there's been money in the bank, and we've worried about clinical stuff rather than business stuff. There have been some big lessons learned during this time for me, but I don't think that I'm alone in this. In particular, the evaluation of costs and returns for both practitioner and staff, but also for returns on risk.

What effect has the crisis had on your team? There is no doubt that the whole team were in shock. We had to stand down our OHTs when their roles became untenable. Other staff went on to reduced hour contract variations and practice hours were reduced to emergencies only. Staff members' partners and families were also stood down or made redundant, adding considerably to the stress. To add an extra layer of complexity, many staff are mums who are having to deal with their kids being off school. However, after the first week, the team’s mindset seemed to settle. We were lucky that our amazing team started to think about the ways we could take advantage of the downtime. Many did further CPD courses on offer, thought about ways to prepare for the upside time, and get ready for the 'go time'. All of this has put our practice on the right foot now that restrictions are now being lifted.

What strategies have you and the team been using during the restriction period? Since the announcement of the Job Keeper allowance, preparation for the return to regular practice has been our big focus. Sure, we have been seeing emergencies, but really the most productive use of our time is engaging with our database and brainstorming ideas moving forward. The world has changed. Social media, videos, virtual consults, cold calling

our active patient database, email campaigns for engagement and keeping patients agile. We have also been working on improving our marketing messages and recall strategies that were old and antiquated. The most productive and valuable meeting of all was a full-day session with our OHTs, where some great stuff was created and is currently being implemented.

When restrictions start to ease, what changes do you expect to see in the dental landscape? The reality is that all practice owners will reset. Make no mistake, they will all know their numbers and will be less sloppy on the business side. They will likely determine that their risk is not matching their reward and will look to their staff to add value to their roles. Going to work as an employee is unlikely to look the same post-COVID.

We all talk about the negatives, what are the opportunities? With every problem there comes an opportunity. Especially for dental hygienists, oral health therapists, and all practice staff members for that matter. Outside all of these negative and horrible times, remember that practice owners, hopefully for the most part, have got your backs. They love having you as part of their practice because you are dedicated to the health of your patients, you are highly educated, hard working and critical thinkers. And in my practice, the patients love this too. We all need to embrace a recalibration of what our roles will be moving forward. I no longer think that doing recall visits is going to be enough. Dental hygienists and OHTs will need to explore ways to increase the intangible value of their roles by increasing activities. It is not necessarily about seeing more patients and decreasing appointment

times; but, for example, assessing how effective you are at transferring higher productivity beyond your scope into the dentistâ&#x20AC;&#x2122;s schedule. I think it is a wonderful opportunity to find some real-world clinical communication training, hands-on and relevant courses to improve your scope of practice, add to the schedule of services that you can provide, or at least confidently communicate and use modern technology to provide something very different to what your patients have seen previously. As a dentist, I have transformed the way that I have practiced over the years, by training in orthodontics, sleep dentistry and dental implants to increase my scope. While I am aware that dental hygienists and OHTs do a lot of CPD, I feel that this needs to translate into something that practice owners are looking for. I encourage all of you to look for these opportunities. n

The impact of a healthy diet on general and periodontal health Healthy eating is important for overall health but also periodontal health. Nutrition plays an integral part in the complex balance between healthy oral tissues, host response and oral microorganisms. Dental professionals can contribute to a healthier population by educating patients in healthy eating, for the sake of oral health but also to support general health.

By Michaela von Geijer, DDS, Specialist Odontology, TePe and Anna NilvĂŠus Olofsson, DDS, Manager Odontology and Scientific Affairs, TePe

The overall effect of healthy eating The importance of a healthy diet for overall health is indisputable. A large body of research has explored the relationship between nutrition and health. Several reviews have been published supporting that a higher intake of fruit and vegetables will reduce the risk of cardiovascular diseases, diabetes, cancer and many other systemic diseases. There is also support for certain substances in the diet having an anti-inflammatory influence on the body. Shifting to an anti-inflammatory diet seems to decrease the risk of many systemic diseases. Nutrients in our diet are traditionally divided into macronutrients and micronutrients. Macronutrients, (i.e. carbohydrates, proteins and fat) are required in large quantities. Micronutrients are vitamins and minerals, of which we need a minimal amount; however, they are essential for our production of hormones and enzymes. Healthy eating and periodontal health Except for the impact on general health, a healthy diet may also influence periodontal health, disease development and treatment outcomes. Fruit and vegetables contain important nutrients that are generally beneficial. Several studies have also explored their effect on periodontal health, for instance, the role of various vitamins. The effect of vitamin C on the prevalence of periodontitis is studied quite thoroughly, as well as the importance of vitamin D for teeth and bone. There also seems to be some association between vitamin D and periodontal health.

In a randomised controlled trial, patients in the test group were asked to change to an anti-inflammatory diet containing low carbohydrates and animal proteins, more omega-3 fatty acids, and a lot of vitamin C, D, antioxidants, plant nitrates and fibres. During the four-week intervention period, they did not perform any interdental cleaning. According to the results, the antiinflammatory diet contributed to a significant reduction of gingival bleeding compared to the control group. No difference in plaque levels, subgingival microbiome composition, or inflammatory serological parameters was found between the groups. The impact of fruit intake on the progression of periodontal disease has also been researched, concluding that at least five servings of fruit and vegetables per day may prevent the progression of periodontal diseases. One study put a particular focus on the benefits of kiwi in relation to the outcome of periodontal treatment, since the kiwifruit contains exceptionally high concentrations of vitamin C, as well as minerals and polyphenols â&#x20AC;&#x201C; substances that have shown anti-inflammatory, antimicrobial and antioxidant effects. The test group was prescribed two kiwis a day for five months, before and after treatment. The results showed that patients who added two kiwifruits to their daily diet had a significant reduction of gingival inflammation, even before oral hygiene instructions or any instrumentation were carried out, compared to the control

group. The intervention group also presented less plaque formation. In this case, the intake of kiwi didn't impact the outcome of the actual periodontal treatment, though other studies have indicated that some vitamins and minerals could affect the treatment. Lifestyle effects on micronutrients A considerable proportion of individuals seems to have an inadequate intake of vitamins and minerals. Many different lifestyle factors affect the quantity of micronutrients in the body, such as usage of nicotine, drugs, alcohol, certain medications, as well as heavy sweating. Processed food should be avoided. It is better to eat healthy and freshly prepared food, but the combination of ingredients also affects the bioavailability of the micronutrients. The requirement of micronutrients varies during life. Age, growth, body composition, pregnancy, breastfeeding, menopause and systemic diseases are some factors of influence. The knowledge on nutrigenetics, (i.e. the individual’s biological response to a specific nutrient) is growing, and research has shown that due to genetics, some individuals have difficulties in making efficient use of micronutrients from food. Conclusion A diet containing fruit, berries, vegetables, root crops, nuts, whole grains, fibres and unsaturated fat seems to have a positive effect on overall health and might also be beneficial for oral health. The dental profession has an important role in advising the patient not just on how to achieve optimal oral hygiene but also a healthier diet.

References Aune D, Giovannucci E, Boffetta P, Fadnes LT, Keum N, Norat T, Greenwood DC, Riboli E, Vatten LJ, Tonstad S. Fruit and Vegetable Intake and the Risk of Cardiovascular Disease, Total Cancer and All-Cause Mortality- A Systematic Review and Dose-Response Meta-Analysis of Prospective Studies. Int J Epidemiol. 2017 Jun;46(3):1029-1056. Aune D, Keum N, Giovannucci E, Fadnes LT, Boffetta P, Greenwood DC, Tonstad S, Vatten LJ, Riboli E, Norat T. Dietary Intake and Blood Concentrations of Antioxidants and the Risk of Cardiovascular Disease, Total Cancer, and AllCause Mortality: A Systematic Review and DoseResponse Meta-Analysis of Prospective Studies. Am J Clin Nutr. 2018 Nov;108(5):1069-1091. Chapple ILC, Milward MR, Ling-Mountford N, Weston P, Carter K, Askey K, Dallal GE, De Spirt S, Sies H, Patel D, Matthews JB. Adjunctive Daily Supplementation With Encapsulated Fruit, Vegetable and Berry Juice Powder Concentrates and Clinical Periodontal Outcomes: A Double-Blind RCT J Clin Periodontol. 2012 Jan;39(1):62-72. Chapple ILC, Bouchard P, Cagetti MG, Campus G, Carra M-C, Cocco F, Nibali L, Hujoel P, Laine ML, Lingström P, Manton DJ, Montero E, Pitts N, Rangé H, Schlueter N, Teughels W, Twetman S, Van Loveren C, Van der Weijden F, Veira AR, Schulte AG. Interaction of Lifestyle, Behaviour or Systemic Diseases With Dental Caries and Periodontal Diseases: Consensus Report of Group 2 of the Joint EFP/ORCA Workshop on the Boundaries Between Caries and Periodontal Diseases. J Clin Periodontol. 2017 Mar;44 Suppl 18:39-51. Dommisch H, Kuzmanova D, Jönsson D, Grant M, Chapple ILC. Effect of Micronutrient Malnutrition on Periodontal Disease and Periodontal Therapy. Periodontol 2000. 2018 Oct;78(1):129-153. Graziani F, Discepoli N, Gennai S, Karapetsa D, Nisi M, Bianchi L, Martijn Rosema NA, Van der Velden U. The Effect of Twice Daily Kiwifruit Consumption on Periodontal and Systemic Conditions Before and After Treatment: A Randomized Clinical Trial. J Periodontol. 2018 Mar;89(3):285-293.

Hujoel P, Lingström P. Nutrition, Dental Caries and Periodontal Disease: A Narrative Review. J Clin Periodontol. 2017 Mar;44 Suppl 18:79-84. Najeeb S, Sohail Zafar M, Khurshid Z, Zohaib S, Almas K. The Role of Nutrition in Periodontal Health: An Update. Nutrients. 2016 Aug;8(9):530. Skoczek-Rubinska A, Bajerska J, Menclewicz K. Effects of Fruit and Vegetables Intake in Periodontal Diseases: A Systematic Review. Dent Med Probl. 2018 Oct-Dec;55(4):431-439. Park S-Y, Kang M, Wilkens LR, Shvetsov YB, Harmon BE, Shivappa N, Wirth MD, Hébert JR, Haiman CA, Le Marchand L, Boushey CJ. The Dietary Inflammatory Index and All-Cause, Cardiovascular Disease, and Cancer Mortality in the Multiethnic Cohort Study. Nutrients. 2018 Dec;10(12):1844. Phillips MC, Chen L-W, Heude B, Bernard JY, Harvey CN, Duijts L, Mensink-Bout SM, Polanska K, Mancano G, Suderman M, Shivappa N, Hébert JR. Dietary Inflammatory Index and Non-Communicable Disease Risk: A Narrative Review. Nutrients. 2019 Aug;11(8):1873. Shivappa N, Godos J, Hébert JR, Wirth MD, Piuri G, Speciani AF, Grosso G. Dietary Inflammatory Index and Cardiovascular Risk and Mortality—A Meta-Analysis. Nutrients. 2018 Feb;10(2):200. Varela-López A, Navarro-Hortal MD, Giampieri F, Bullón P, Battino M, Quiles JL. Nutraceuticals in Periodontal Health: A Systematic Review on the Role of Vitamins in Periodontal Health Maintenance. Molecules 2018 May;23(5):1226. Widén C, Coleman M, Critén S, KarlgrenAndersson P, Renvert S, Persson RG. Consumption of Bilberries Controls Gingival Inflammation. Int J Mol Sci. 2015 May;16(5):10665-10673. Woelber JP, Gärtner M, Breuninger L, Andersson A, König D, Hellwig E, Al-Ahmad A, Vach K, Dötsch A, Ratka-Krüger P, Tennert C. The Influence of an Anti-Inflammatory Diet on Gingivitis. A Randomized Controlled Trial. J Clin Periodontol. 2019 Apr;46(4):481-490.

Are we aligned?

We look at how lock-down may have provided us with the opportunity to reposition our role in the dental practice? By Robyn Russell

WHAT A CRAZY time we’ve all had these last few months; I don’t think I need to tell you that this has been stressful. Speaking from my own experience, it’s felt very surreal – who could have foreseen a government directive forbidding the provision of dental hygiene services? During this period of change, there has been a lot of negative traffic on social media platforms. These negative comments have come from all members of the dental community and really highlighted a lack of alignment between oral health therapists (OHT), dental hygienists (DH) and dentists. While COVID-19 may have been the bowling ball that knocked over all the pins – a lack of alignment has undoubtedly been simmering for some time. Prior to the outbreak of COVID-19 I conducted a survey that aimed to gauge the opinions of OHTs, hygienists and dentists on a variety of topics, mainly focusing on the use of OHTs and hygienists in private general practice. The results highlighted the disparities between oral health professionals and practice owners. One of the areas where I found the biggest lack of alignment was when each party was asked to define the role of an OHT/DH. A standout statistic was that 35% of OHT and DH respondents felt under-utilised within their practice. With some employers looking closely at their dental teams, there is no better time to let them know that we offer so much more than just preventative services to our patient base.

I know, the hairs on the back of your neck may be starting to stand up and bristle with this information. How can you accurately quantify the value of having OHTs and hygienists? It’s impossible to quantify the intangible values of having a preventative department. We are the relationship

“35% of OHT/DH respondents felt under-utilised within their practice”

“30% of employer respondents felt that they did not receive a significant return on investment from their OHT/DH department” builders, the ones who care for the whole patient base. We educate our patients, and spend quality time them to communicate the oral systemic link, advising on home care and apprise them of all the treatment possibilities. If utilised to our full scope we are the backbone of private general dental practices. In contrast, 30% of employer respondents felt that they did not receive a significant return on

investment from their OHT/DH department. Many employer dentists are also not aware of the scope of practice for OHT/hygienists. This causes confusion, as the education of many practitioners varies greatly, hence affecting the scope of each individual’s practice. The road to re-alignment lies in communication and collaboration. Communication is the key to all relationship building; so how can we convey the importance of our role to employers and organisations? Firstly, we need to align our visions for the OHT/DH department. This vision needs to work for the patient, the providers, and the practice or organisation. We then need to engage in open and frank conversations, which will lead to achieving congruence of ideas. Do you have an active vision for your individual role within the practice? I know from my own experience in dentistry when you lose sight of this vision, you lose focus. Late last year I resigned from a role that I loved, and on reflection the main reason was my own lack of focus – I lost sight of the reason that I was there. Let’s not allow dentistry to lose sight of the plethora of skills we all possess. n ABOUT THE AUTHOR Robyn Russell is a graduate of UQ Bachelor of Oral Health – 2005 and works in a large general family dental practice in Brisbane. The views expressed in this article are based on her own research and professional experience.

SELF DEVELOPMENT

Black & White Thinking

‘All or nothing’ thinking can have a negative impact – how do you break the cycle? By Lyn Carman

OVER THE LAST few weeks during this time of COVID-19 I have observed a lot of ‘all or nothing’ thinking and noted the impact that it can have on our lives. For many people the world is black and white – either one or the other – and made up of global generalisations. But when you reduce life to black and white you never see the rainbows. Yet, of course, the world is not a black or a white place. Our lives are full of many shades and colours. By seeing the world in black and white we buy into thinking patterns and behaviour that is not resourceful for us, and does not serve us to be our best selves. At times we have all thought of the world in black and white terms. Perhaps refusing to see the flaws in our loved ones, or being overly critical of ourselves. The human brain’s tendency to understand the world in absolutist, dualistic or dichotomous thinking has a profound effect on our relationships. You may hear some familiar thinking or language in these sentences: “I’m right, you’re wrong.” “It can only be black, it can’t’ be white.” “I have never done that.” “He never listens.” “She is always so judgmental.” “Everything I do is terrible.” “Nobody else understands.” There is an inability to think flexibly and seek out the possibilities, or sit back and relax and take in all the information and consider it. Turning a specific event into a global generalisation and see it as ‘all’ or ‘nothing’ means that we are using dichotomous thinking and limiting ourselves to a reactive and generally unresourceful response.

This scenario tends to play out a lot on social media. We see reactive responses fired out, someone else jumps on it and adds fuel to the fire, before someone else responds to them, and on it goes – with very few taking a breath to gather the information and consider all options, or perspectives. Jumping in reactively to a situation, before knowing all the facts, adds even more uncertainty to an already stressful situation for many, feeding a mob mentality, with individuals no longer needing to take any responsibility. Initially black and white thinking may make it easier to separate out good from bad, or right from wrong. Yet this kind of thinking can be exhausting and feel like we are on a roller coaster. On a deeper level, simplifying things into easy, binary terms steals away much of the complexity that makes both life and relationships so rich. Absolutism or black and white thinking is a developmental stage we go through as children, which I am sure you may be able to recognise if you have observed a child in this stage. The child does not yet have the cognitive ability to recognise the subtleties of 'the grey'. It’s all black and white to them and they are unable to think through possibilities. ie "I see this, and this, means that," or "I want blah therefore I must get blah, or nothing." This is the space where tantrums occur. Cognitively they cannot be any other way at that time because that is where they are in their developmental stage. Having compassion for those who are stuck in this pattern of thinking, and being able to see the unresourceful

impact this has on oneself and others, will support us to elevate our responses. Sit back, gather all the information and consider the possibilities. Becoming aware and taking notice of ‘all or nothing’ thinking is the first step to being open and more relaxed about events such as our various restrictions during this pandemic. Thinking of how there are always other possibilities, other versions, or other opportunities that we can become aware of. A simple exercise that you can try, involves thinking of binary or extreme words that you might use to describe a person, relationship, or situation. Then consider your, and other's language. How often do we use global terms such as – all, every, never etc. This absolute language is rarely true. Think of the teenager when they say “Everyone else is allowed to go to the party, I’m always the only one who’s not allowed” or closer to our situation “If I can’t do it this way, then I can’t do it at all”. Now imagine the more subtle and nuanced ways to describe these situations. This process can also help to actively cultivate empathy. Black and white thinking also tends to be more pessimistic. Therefore, thinking more positively may move us away from "It's either/or" way of thinking and allow the shades of grey and colour move us towards possibility. Thinking with balance and all the complex colours of the rainbow means a richer and more flexible life lived for self, and inspires others to do the same. In turn this raises the level of the conversation and our experiences. Nothing in life is black or white there is always opportunity to see a rainbow. n

â&#x20AC;&#x153; Jumping in reactively to a situation, before knowing all the facts, adds even more uncertainty to an already stressful situation for many, feeding a mob mentality, with individuals no longer needing to take any responsibilityâ&#x20AC;?

Lyn Carman is a clinical dental hygienist and a personal, team and leadership coach. You can email her at excel@lyncconsulting.com.au

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

STATE NATION OVER THE LAST three months, DHAA CEO Bill Suen has been in contact with the health ministers and departments responsible for each state and territory. He offered the services of the Association to assist in both paid and volunteer work in support of any escalating COVID-19 situation and received messages of appreciation from all correspondents. The DHAA state and territory committees have been forced to cancel all local face-to-face events since March due to the lock-down restrictions. It is hoped that we can reschedule them for later in the year when circumstances permit. Local support groups have been established for each state and territory to allow members to connect with their respective chairs. This has facilitated prompt responses to member enquiries during the crisis. We have received a significant number of requests for information and support, particularly in relation to workplace issues caused by the changing dental practice restrictions. While the situation may be less intense we still urge you to join your local group – contact details for your state chairs or deputies are in the following reports.

ACT ACT Contacts Susie Melrose chairact@dhaa.info Michelle Bonney contactact@dhaa.info

n ACT Chair Susie Melrose and Deputy Chair Michelle Bonney have been busy with supporting ACT members through their well established online chat group. The chat group has been operating for some months to facilitate communication among ACT members. During the COVID-19 crisis it has been shown to be very effective in providing assistance and support to members. The success of this platform has resulted in its replication in all other states and territories across DHAA.

NSW NSW Contacts Steven Chu chairnsw@dhaa.info Jody Inouye contactnsw@dhaa.info

n Merrin Lewis tendered her resignation as NSW Chair due to other competing demands. We thank her for

her valuable contribution and leadership over her short tenure. Deputy Chair Steven Chu has kindly agreed to step up as Chair. Steven has been on the NSW committee for some time and he is a public sector oral health therapist in geriatric medicine working for the NSW Health. We also welcome back Jody Inouye to fill the NSW Deputy Chair vacancy. A Canadian migrant who has had experience working in periodontal and general practice, Jody is now a dental hygienist practicing in the field of orthodontics. The DHAA had a trade table at the Australian Dental Exhibition (ADX2020) in Sydney 13-14 March to promote our association and the profession. DHAA Director Sahil Bareja ran the ‘Mind Your Own Business’ workshop which attracted many dental practitioners who were interested in owning their own dental or professional business. The exhibition was cut short due to the escalating COVID-19 situation at the time, and we thank DHAA staff and volunteers Patricia Chan, Shida Taheri, Sahil Bareja, Jacquie Biggar, Merrin Lewis, Steven Chu, Amy McDermott, Christina Zerk and Steve Moore

“D irector Sahil Bareja ran the ‘Mind Your Own Business’ workshop which attracted many dental practitioners who were interested in owning their own dental or professional business ” for their help in making it possible under the very challenging environment.

NT NT Contacts Meghan Argentino chairnt@dhaa.info Alicia Jubb contactnt@dhaa.info

n Chair Meghan Argentino and Deputy Chair Alicia Jubb welcome their latest recruit, NT Health Oral Health Therapist Kate Simmonds to the NT committee. Together they will continue to collaborate with local ADA delegates and other stakeholders to roll out more CPD and local events in territory.

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

Qld Qld Contact Jen Turnbull chairqld@dhaa.info

n Queensland Chair Jen Turnbull is seeking a deputy chair due to the recent resignation of incumbent Alex Tsikleas. Queensland is the home state of DHAA Vice President Carol Tran and key staff member Christina Zerk who have been providing significant support to the local committee. The role of deputy chair is to support the chair in managing local events and liaising with other state organisations such as the ADA, ADOHTA and Queensland Health. Interested members should contact Jen for details.

SA SA Contacts Sue Tosh chairsa@dhaa.info Sally Hinora contactsa@dhaa.info

n The half day hands-on workshops held in February proved to be very popular and both the GC Surface

Protection and Fibre Reinforcement workshops were sold out early. Dental Therapist Paulette Smith was one of the experienced GC Trainers and provided the required skills for participants to increase their scope of practice in these two subject areas, with the potential to create new business and encourage recall appointments. SA Chair Sue Tosh and her deputy Sally Hinora are keen to resume hosting events for members as we transition out of COVID isolation, as restrictions allow.

Tas Tas Contact Michael Charlton chairtas@dhaa.info

n TAS chair Michael Charlton is still trying to get over his huge disappointment after the cancellation of the full day CPD event planned Cradle Mountain in April. The event had attracted significant interests from both local and interstate members with its excellent location for a destination event. Michael is also seeking a deputy chair to support him and TAS director Alyson

McKinlay locally. They intend to reschedule the Cradle Mountain event as soon as possible and you may wish to be part of this and other exciting projects.

WA WA Contacts Carmen Jones chairwa@dhaa.info Rhonda Kremmer contactwa@dhaa.info

n The Sunday Lunch CPD on Diabetes was well attended at the Aloft Perth. Presenters Carey Luff (diabetes educator) and Dr Jonathon Swain (periodontist) provided an in-depth discussion on the

â&#x20AC;&#x153;P resenters Carey Luff and Dr Jonathon Swain provided an indepth discussion on the link between diabetes, the mouth and the body, and the complications in dental treatment planning for a person with diabetes â&#x20AC;?

link between diabetes, the mouth and the body, and the complications in dental treatment planning for a person with diabetes. WA chair Carmen Jones and deputy Rhonda Kremmer have been working hard to reschedule some of the canceled events to later this year or next year, with new dates to be announced soon.

Vic Vic Contacts Sarah Laing chairvic@dhaa.info Desiree Bolado contactvic@dhaa.info

n After months of planning, and having almost sold out of tickets, the joint Victorian ADOHTA and DHAA committee were forced to make the tough decision to cancel the Unite for Mouth Health weekend seminar. Victorian chair Sarah Laing and Deputy Desiree Bolado express their thanks to committee members of both organisations for their hard work, and promise everyone that they will commence work to reschedule the event as soon as possible once current restrictions are lifted. n

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STRIVING FOR EXCELLENCE

The Bulletin - Issue 55 May / Jun 2020

Articles inside

RIDING THE WAVE

ARE WE ALIGNED?

WATCH YOUR MOUTH