Issue 56 August-September 2020
The official newsletter of the Dental Hygienists Association of Australia Ltd
DRUGS GET TO KNOW YOUR
A full round up of pharmaceuticals used in oral hygiene
ANAESTHETHICS IN DENTISTRY
Unravelling some of the common misunderstandings
Keep yourself COVID safe
Some best practices to observe when working through this pandemic
The battle for provider numbers
The DHAA are leading the charge
STATE ROUND-UP Find out what’s happening in your local area
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Two new initiatives break cover HAPPY WINTER EVERYONE! If you’re anything like me, you’re counting down the days until the warmer weather starts. But I know there are those of you out there loving the cooler months, so I hope you’re making the most of it - within whatever level of restriction you are under at the moment, of course. Over the past few months we have been working hard to launch two very different but very important initiatives. We all have times where we could use a good in-depth chat with someone who understands the dental landscape. The Dental Board of Australia recently announced their Practitioner Support Program, a 24/7 crisis counselling service (see more details here); and now the DHAA have introduced a complimentary DHAA Peer Support Service. This new service will link to an experienced practitioner who will be on-hand throughout times of stress; be that an AHPRA notification, a PI Insurance claim, patient complaint, or workplace issue. I would like to thank Roisin McGrath, Deb Brown, and Lyn Carman for volunteering their time and expertise in putting this together, to Bill Suen for coordinating it, and all of those who have volunteered for this service. For more details please see the DHAA website. For many years members have been wanting to know when we're getting provider numbers. The Dental Board Registration Standard changes came into effect last month, and we believe that this is the time to go all-out on our advocacy campaign for provider numbers for dental hygienists, dental therapists and oral health therapists. We have developed our message and are delivering it to key politicians, stakeholders, and decision makers. Along with these high-level officials, we need to get this out to local politicians, health industry associations and consumer advocate groups – and this is where you come in. You can access all the resources on the DHAA website to help set up and have a meeting or discussion. The key messages are the things you talk to your patients about every day, so there's nobody better qualified to speak on this subject than us? With Victoria currently experiencing a second wave of Covid-19, and other states likely to follow suit, it's important to remain vigilant to help stop the spread. Things are changing day-by-day and we will bring any information to you as quickly as possible. Keep up with the latest information in your local area and check the ADA website for updated resources. The DHAA has member support groups in each state and territory, which are a great way of sharing information and chatting about any concerns. To access these please contact your local committee or email contact@dhaa.info. Margaret Thatcher said, “You may have to fight a battle more than once to win it” and that certainly seems to be the case with Covid-19. Keep fighting everyone and stay safe.
Contents 04 The battle for provider numbers The latest on the DHAA Bad Mouth campaign
08 Lifetime of devotion
The story of DHAA Life Member Wendy Dashwood
10 Keep COVID-safe
Outlining some best practices to observe
12 Road to independence
What does it mean to be an independent practitioner?
COVER STORY
14 Know Your Drugs
A full round up of the pharmaceuticals and anaesthesia used in the oral hygiene field of practice.
22 We've got your back
Introducing the new DHAA Peer Support Service.
24 What's your AQ?
How adaptable are you to change in your career?
28 The battle of Gingivitis
Meet the inhabitants of the Kingdom of Gingiva and the evil nation of Biofilm
30 The power of resilience A look at how we deal with adversity using 'resilience'
32 State of the Nation
Your quarterly round-up of what's happening near you..
Cheryl Dey DHAA National President
Key Contacts CEO Bill Suen CONTACT
PRESIDENT Cheryl Day CONTACT
MEMBERSHIP OFFICER Christina Zerk 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
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The ongoing battle for provider numbers The DHAA are picking up the pace on their campaign for dental hygienists, oral health therapists and dental therapists to have access to Medicare provider numbers THE DHAA HAS sought approval from the Federal Health Minister and the Secretary of the Department of Health for dental hygienists, oral health therapists and dental therapists to have access to Medicare provider numbers. We have published a brochure and stories to support our advocacy on this with the campaign title “Bad Mouth - the neglected reality”. The Bad Mouth campaign The paper highlights that oral diseases are associated with many chronic medical conditions, poor nutritional
status and can affect quality of life through pain, discomfort, speech impairment and social withdrawal. Launching the campaign publicly in August, DHAA President Cheryl Dey said: “ For generations, our country has neglected oral health and dental services despite evidence indicating they are closely linked to general health and wellbeing. Historically, dentistry adopts a treatment-dominated, invasive and high-tech approach to care that is often expensive.”
The stats don't lie Statistics show that one in five Australians delays or chooses not to see a dental practitioner due to the cost. Australian consumers pay 58% of their dental costs out of pocket compared to just 12% for pharmaceutical - and only 11% for medical expenses. This disparity in government funding has put regular oral health care out of reach of many. Approximately 60% of older people over 85 years do not have access to dental care. Residents in aged care facilities are at a higher risk for aspiration pneumonia because of bad oral health. In some cases
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this necessitates acute hospital care and may even lead to death. Many common oral diseases are preventable and early intervention has a significant positive impact on the quality of life of patients while diminishing the economic burden for society. Dental hygienists, oral health therapists and dental therapists are an underutilised, yet powerful workforce that could improve the current undesirable situation. We have a strong preventative and health-promotion focus, and should be a key driving force to combat the neglect of oral health and dental services for all Australians. “Our members are keen and ready to reach out to rural and remote locations, residential aged care facilities and deliver preventative care and early intervention to fill the service gaps. The public’s access to these preventive services is blocked if they wish to utilise their entitlements via government schemes for veterans
“ Statistics show that one in five Australians delays or chooses not to see a dental practitioner due to the cost. Australian consumers pay 58% of their dental costs out of pocket compared to just 12% for pharmaceutical and only 11% for medical expenses”
(DVA) and children (CDBS), or their private health insurance,” Cheryl explains. “Dental hygienists, oral health therapists and dental therapists are among the very few health professional groups that do not have Medicare provider numbers”. The main message The paper calls on the government's funding organisations and health service providers to act to: 1. Ensure equity of oral health services for all Australians 2. Shift towards the paradigm of oral disease prevention and health promotion 3. Restore oral health as an integrated element of overall health and general wellbeing We point out that the first step towards this is for the Federal Government to issue dental hygienists, oral health therapists and dental therapists with a Medicare provider number to ensure public access to these preventive oral health care services in an equitable way. We are inviting members to help by contacting your local federal MP to discuss how provider numbers may help improve public access to optimal dental care in the community. If you would like to be involved, please email your postcode and suburb name to bill.suen@ dhaa.info. n
Check out the DHAA campaign for yourself The brochures and supporting information are available to members via the DHAA website:
From the Big chair A few words of encouragement from DHAA Bulletin editor, Robyn Russell WELL, WHAT CAN I say after a very different few months for all of us? I’m sure you have all experienced a change in your day-to-day practicing lives. Some of these changes, whilst inconvenient, may be for the better, and some maybe not so. Dentistry may well be practiced differently since the advent of COVID-19. I know for our friends in the USA this has meant a whole new world of PPE and aerosol reduction techniques. Whilst we have not felt the same incidence of COVID-19 community infection, undoubtedly we have all experienced the effects of the uncertainty that this virus has created. With change often comes uncertainty and regret; we are all working hard and trying our best to stay optimistic during this time. What history has shown us is that nothing stays the same, our new normal practicing lives will bring challenges, but I’m also confident that this adversity will shape a new breed of formidable clinicians. Robyn Russell DHAA Bulletin Editor bulletin@dhaa.info
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Ask DHAA... Your opportunity to ask the questions, check the rules and share your knowledge Dear DHAA... Now that we have independent practice status, how do I get my provider number? Jane, Qld
Provider numbers provide the holder to access various Medicare and health insurance dental benefit payments. It doesn’t affect the ability of any practitioner to practice independently but in its absence would prevent patients from claiming their entitlements through these funding sources. The Medicare provider number is issued to dental providers so that they can claim payments under various schemes including the DVA and CDBS. ‘Dental provider’ is defined by the Dental Benefits Act 2008. At this stage dental hygienists, oral health therapists and dental therapists are not recognised as ‘dental providers’ so we are unable to be issued with provider numbers. Provider numbers are also used in private health insurance and this is to be negotiated directly with the respective health fund. The DHAA is currently advocating on behalf of members for access to these
Is pregnancy a potential issue in the dental practice?
payment schemes and provider number is the main focus of our campaign. Dear DHAA... I am pregnant, is it safe for me to work in my dental clinic which is located in a COVID-19 hotspot? Charlotte, NSW
Since the COVID-19 pandemic, there has only been a small handful of reports that dental clinics were exposed to the virus. In most cases the contact had been brought into the clinic and not spread from it. This is an reflection of the stringent infection control measures being applied. However, there are always risks involved when working
or involved in any social contact during a pandemic. People who are pregnant, immunocompromised, old aged, or with chronic medical conditions may be at a higher risk. It is therefore important that you seek medical advice to determine if you should continue to work. Dear DHAA... So far 2020 has been a stressful year full of threats and uncertainties which are quite overwhelming. How can DHAA help me? Olivia, WA
At the DHAA we pool our resources, expertise and connect members to
relevant information, people and organisations so that members are supported with appropriate solutions, advice or referrals to meet their professional needs throughout your career. Members are kept up to date with news and developments via timely emails and social media posts. The live interactive webinar DHAA Connect has been run weekly at the peak of the pandemic and now runs monthly to foster discussion and communication on topical issues. The DHAA website also provides member access to all recordings of these communications and other
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FROM THE TOP
Ready for anything relevant resources. A local support group has been set up to foster communication, share information and resources, and provide emotional support to each other locally at each state. Please contact your state chair to be connected. The industrial relations advice line is available for any workplace IR issues. For workplace practice based clinical issues there is an expert advisory panel to provide guidance, either through referral from the advice line, local support groups or directly to the CEO. The same referral system is also in place for the new DHAA peer support service, which offers an experienced and trained dental practitioner to help the member in need through the stressful period by phone. DHAA has offered financial relief for its’ loyal members by deferring the membership and professional indemnity insurance renewal by five months to the end of November, and applies a 30% discount for those who are in financial hardship. Members are able to renew online anytime between now and 30 November and select the discount if needed. As a DHAA member, help and advice is just an email, web link or phone call away, and you should never have to face a challenge alone. n
A lot has happened at the DHAA since our last Bulletin, and it's all for the better.
Bill Suen DHAA CEO
“ We have utilised both our new website, email communication capabilities and social media functions to keep members up to date with relevant and timely updates in response to the rapidly changing environment”
WITH THE CHANGING situations associated with COVID-19 in different parts of the country, we are now better prepared from the lessons learnt so far. We have established a close working relationship with the Dental Board, ADA, ADOHTA, and many other stakeholder organisations with enhanced communication for consultation and sharing of information. We have utilised both our new website, email communication capabilities and social media functions to keep members up to date with relevant and timely updates in response to the rapidly changing environment. The DHAA IR advice line has settled down after the surge of queries over the past few months. We have since launched our expert advisory panel to provide advice and review many clinical and practice based queries from members through the pandemic. Earlier this month we launched the DHAA Peer Support Service (see page 22) which complements the Dental Board of Australia’s Dental Practitioner Support Service. All members, including students and graduates, can now seek the help and advice of an experienced peer to see them through difficult periods. The ‘Bad Mouth’ campaign has also been launched to advocate for provider numbers and this has so far received good support from members and positive feedback from stakeholders. Unfortunately the timing has coincided with the second wave in Victoria, but we are still confident that it will generate appropriate attention and interest from our target decision makers. As you may recall, the DHAA has extended the membership and PI insurance renewal by four months to 30 November this year, together with a 30% discount to ease the financial burden for our members throughout the COVID-19 crisis. When this was announced a number of members pledged their support to DHAA and fellow members by indicating their desire to renew on time and in full. I am most grateful for the one third of members who have already renewed so far, which has helped our cash flow significantly. You are able to renew and select the optional discount anytime, from now until the end of November, by logging into your member portal and clicking the renew button. I believe that the DHAA is now in a much better position to respond to both new and existing challenges. This is made possible by the passion, determination and hard work of the board directors, the state committees, the special interest groups and working groups, many members and volunteers and my wonderful staff. I cannot thank all of you enough for having each other’s back – you are a great bunch! Together we can face any challenge. Thank you and keep safe. n
8 ying Assisting the Fl in 1971 ice rv se s Doctor
With DHAA President Cheryl Dey at the Brisbane ISDH in 2019
A lifetime of devotion DHAA Life Member Wendy Dashwood tell her own story of a career that spans 40 years
Making the social pages of the DHAA Hygiene Mirror in 2003
FROM THE TIME I was five, I was interested in dentistry and began my dental career as a trainee dental nurse in February 1969 (yes the Summer of 69 – one of my all-time favourite songs and when man walked on the moon, seen on a black and white TV with aluminium foil extensions on the “rabbit ears” antenna in the Prosthetic Department of the Dental School at the Royal Adelaide Hospital). After completing my studies, I worked there until 1971 going into a private practice where I had my first experience of being part of the Flying Doctor Services dental run, flying into isolated parts of SA. In 1974 I was offered by my dentist to study dental hygiene at Guys Hospital in London, but I wanted to travel first. While travelling overseas in 1975, I worked as a dental assistant in London and completed further study, upgrading my dental nurse qualifications to be able to work in northern Canada where my then boyfriend and now husband is from.
On returning to Adelaide, I was fortunate to be selected to study dental hygiene in 1977, run then by the Department of Further Education based at the Dental School in the Royal Adelaide Hospital. I was in the third training group (10 students per year were accepted). After graduating in 1978, I worked at a general private practice in the Adelaide Hills before moving to Canberra where dental hygiene practice for the ACT was undergoing legislation to be passed through parliament. At that point in time, SA was the only state where hygienists were able to register and work. I was the first registered hygienist in the ACT and from there dentists in Canberra began employing overseas hygienists as there were still only around 30 new SA hygiene graduates, most working in Adelaide. These overseas hygienists, many of whom have now called Australia home, worked with me to establish the ACT branch of the DHAA. Other states followed on with more training programs and a few Canberra dentists sponsored their dental nurses to study in Adelaide and return. Our numbers began to grow and soon we were running professional development days and
“ I was the first registered hygienist in the ACT – from there dentists in Canberra began employing overseas hygienists” seminars. The support we had from our employer dentists was amazing, attending our PD days (mostly to boost numbers at our insistence) and support our sponsors and trade but also because we had wonderful camaraderie. I worked in private general practice in Canberra from 1980-1987 before moving to Yass to raise my family and start a horticultural business with my husband, where we still are today. In 1989 I recommenced part time dental hygiene work in Canberra and started working at Yass Valley Dental in 2003. I have worked closely with Valmar, a support agency for clients with physical and intellectual disabilities, living independently and in group
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homes, having attended dental courses specifically for carers and running seminars for carers and clients to assist with their home dental care. I completed the Aged Care Certificate 3 at Yass TAFE to have more understanding of the ongoing care and the needs of the aged, as dental hygienists step up to be more involved in the dental and health care of the aged. I am currently working with aged care patients, pre COVID-19, holding a regular dental clinic at Yass Valley Aged Care for preventive care as well as screening residents with emergency dental issues prior to attending the dental surgery. I am also a board member at Yass Valley Aged Care and volunteer screening visitors during this COVID-19 period. Throughout my career I have been involved in many aspects of the DHAA – serving on the ACT executive board and as a committee member and state representative at a national level (including being editor of the Bulletin). Travelling to national and international symposia with my hygiene “buddies” was an important part of my career as it kept me stimulated and wanting for Working with children and (stuffed) animals
more knowledge as I fine-tuned my interests ending up with recognising the need for more input into aged care health. I retired from clinical practice a year ago but maintained my clinic at Yass Valley Aged Care (until COVID struck). Right now, I am still helping as a locum in Yass and regularly visiting residents to assess their issues and arranging appointments. I have seen so much change in my 40 years of dental hygiene and enjoyed the ride immensely. It’s very hard to give up. n Life membership is voted on by the board and awarded to members who have made significant and enduring contributions to DHAA Ltd.
Therapeutic Guidelines Oral and Dental A summary of the changes in the new edition By Robyn Russell
THE LATEST EDITION of the Therapeutic Guidelines Oral and Dental Version 3 has a vast amount of new and revised information which is relevant for the changing needs of every patient. The expanded guide includes contemporary information on the use of NSAIDs (a common and effective drug used for acute dental pain), that can have adverse effects for patients. Guidelines on how to determine whether these medications are appropriate for each patient now include recommended dosages of analgesics for use in children. Antibiotic therapy is often used as an adjunct for the treatment of acute odontogenic infections. The indications for the use of these antibiotics are highlighted in a handy new table. Photographs have been added to assist the clinician in recognising mucosal lesions, plus a new table which outlines the features and management of oral candidiasis and candida associated lesions. see pag e 14 A new section provide guidance in the treatment of patients who are immunocompromised, or who may have a cardiac implanted device, a bleeding disorder, or diabetes that is treated with a SGLT2 inhibitor. Specific advice has also been included for those patients taking antithrombotic drugs, as it is very important for these patients to be evaluated prior to any dental procedure. A flowchart helps practitioners assess the risk of medication induced osteo-necrosis of the jaw (MRONJ) in patients taking antiresorptive and antiangiogenic drugs who may require a bone invasive dental procedure. A discussion on antibiotic prophylaxis includes an illustration of when antibiotics may or may not be indicated. Being an area that has created a lot of confusion, this section helps to clarify some of the misconceptions around the prophylactic use of antibiotics prior to dental procedures. A new table assists in choosing the correct local anaesthetic (LA). The maximum dose should always be calculated prior to the administration of any LA agent and an example calculation is included. There is also new guidance on the safe use of anxiolysis (minimal sedation) to assist during dental procedures. A summary which outlines the advantages and disadvantages of benzodiazepines and nitrous oxide aids the clinician in choosing the correct drug. A patient information sheet has been provided which summarises the use and management of patients who receive anxiolysis. Assistance is also provided for medical practitioners (especially GPs) who may treat patients with common oral and dental conditions. How to identify, manage/triage and refer, as well as info on oral hygiene, dental anatomy, terminology and peri-implant mucositis and peri-implantitis. For more information on “Oral and Dental 3 Therapeutic Guidelines” visit www.tg.org.au or freecall 1800 061 260 (within Australia) n
READ OUR FU L DRUGS L REPORT
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KEEP COVID SAFE
Care for yourself Provide better care of your patients
Margie Steffens OAM outlines some best practices to observe when working through this pandemic – and some that we should observe at all times 2020, EXTRAORDINARY TIMES – confusing, uncertain, and changeable, but a time to reflect on where we sit in this world. More importantly, how we respond now sets us up for the future. As chair of the Special Needs Special Interests Group (SIG), I work with some exceptional people at the forefront of infection control (in particular Dr Sharon Liberali) who are constantly reviewing and making recommendations based on current knowledge. Keep in mind that we are dealing with the ever-changing landscape
surrounding the unpredicatble behaviour of COVID-19 and indeed the behaviour of viruses in general. Without wanting to over simplify concerns, remember that knowledge is power; and that taking the time to quietly review the good literature – written by respected and knowledgeable authors – can help us to dispel the fear of the unknown. Social media, and the media in general, can further cause us disquiet and increase our anxiety. We tend to grasp at the first thing that hits our inbox, and it
is so easy to respond to that information as it may have been sent by a wellmeaning friend. I have been asked to share some information that I trust will give some guidance and help you to discern and gain confidence as the respected health care professional that you are! Managing patients 1. Screening will possibly become the norm. The basic checks regarding recent health history, travel and possible contacts is a sensible
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approach. How often do patients ring in if they have a cold or tummy bug to check if it is OK to come in? We should be rescheduling people that are unwell as these viruses are virulent and easily spread. 2. If you are working in hot spots or with a suspected case, the questions are of utmost importance and if people are awaiting results from testing then defer their treatment. 3. If you absolutely must treat someone then refer to the additional precautions outlined in this feature that include the wearing of properly fitted (P2)N95 masks, gowns and the provision of isolation areas. However, it is not recommended unless it is emergency care, and then the recommendations about not causing any aerosols apply. 4. If your patients are frail elderly, people with autoimmune disease, or generally poor health, and your area has been deemed a “high risk” area then you must follow the advice guidelines from your state and territory’s guidelines. If treatment advice has escalated to Level 2 it is not recommended to treat these folk and, of course, Level 3 is emergency only. You must adhere to these recommendations as they come from the Dental Board. To breach them you risk a fine and notifications plus it is likely that your indemnifier would not cover you if there was an incident. 5. Upon entering the operatory ensure that patients have washed their hands with soap and water or use an alcohol gel. Also, perform a pre-treatment rinse with Hydrogen Peroxide or Chlorhexidine. When we consider that we are always working with moisture present – saliva, aerosol, coughing, talking at close proximity in the clinic etc – the use of a pre-op mouth rinse is not a bad work practice to adopt. 6. Extend appointment times. Rationalise with your dentist about the importance of the practice reputation
and maintaining optimal patient quality care. Is it not more sensible to reduce patient numbers and minimise risks? The alternative could mean having to close the practice for weeks and incurring a significant loss of revenue as well as putting the public and the practice at risk. 7. Reappoint your patients if they have viruses. Herpes viruses, such as cold sores, are easily spread if they are still at blister stage or the early healing stage. Keeping yourself safe 1. Remember that you are equally as important as your patients and your health matters too. All of the aforementioned practices form part of keeping yourself safe. 2. Ensure that if you are unwell, or more
“ To contravene these regulations is an offence and can incur a fine and can have serious consequences for the practitioner” vulnerable to ill health and have preexisting autoimmune conditions, and are working in high risk areas then you are advised to not put yourself in danger by treating a patient who is a possible transmission risk. Refer to item 4 of 'Managing your patients'. 3. Take time for self-care, exercise, sleep, good nutrition, and meditation. Lyn Carman’s 21 days of abundance on the DHAA Facebook page is a great guide and simply following the meditation section is a good starting place. 4. 'Gratitude' is such an uplifting word – I say it every day and it gets me through some very tough times! Spend
time with your family, friends, and colleagues; appreciate what we do have rather than what we don’t. 5. If you are finding yourself constantly anxious and need to talk there is the DHAA Peer Support Service (read more on page 22). This new initiative allows you to communicate with other people who have acquired skills in support systems. 6. Communicate with your employer honestly and without blame. Present any concerns in a manner that expresses that your primary interest is the patient’s well-being, the reputation of the practice and the care for all your co-workers. Most people will generally see reason. 7. Does your practice have a COVID-Safe plan in place? The ADA website has clear and practical information for all dental practitioners to access. 8. If you are unwell – Stay Home! PPE and reinforcing additional health information: 1. Masks. The same recommendations remain – P2/N95 if you are working in a hotspot with a possible 'known' case. 2. L3 masks are sufficient for all of us and the same recommendations remain with regard to changing after every patient or should you need to leave the surgical space. MASKS SHOULD NEVER BE WORN “AS A NECKLACE” REMOVE COMPLETELY AND REPLACE! 3. If you are required to wear a P2/ N95 mask the questions remain. Are you working with a known case? Are you, or your patient, immune compromised? Are you working in a hotspot? Are you creating aerosols as part of a necessary treatment on a possible, or known, case and in particular is this in a hotspot? Are you unwell yourself and if not then should you actually be working? 4. Consider why we wear gowns. If you are working in a hotspot or with a >
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patient with questionable status or if it is to prevent transmission in a high risk area or situation then you must wear one and change it after each patient. 5. If you are pregnant or have other health conditions then talk with your GP or specialist. We do not know enough about the behaviour of the virus to make a generalised statement. 6. We are unable to give absolutes at this time regarding precise transmission and how the virus is behaving, and it is ill-advised for anyone to make blanket statements. Keep communication open with your dentist/ADA and keep watching for changes from the Department of Health in your state or territory. 7. What we do know is that if we follow infection control protocols as a guiding principle – wash your hands, don’t touch any surface, your face etc., or other people if you have coughed, sneezed, been to the toilet or you are feeling unwell! Follow all of the things that we know about best practice; this will minimise harm and reduce risks. 8. Most importantly – we should adhere to good infection control standards at all times! Guidelines and regulations – These regulations are set down by the Regulator and not by the associations. To contravene these regulations is an offence and can incur a fine and can have serious consequences for the practitioner. The regulations are there to protect us all – the dental practitioner, the staff at the practice and the public, our patients, our family and our friends. Keep safe and continue to learn, grow as a clinician and a caring confident human being. I may be contacted via email – margie. steffens@adelaide.edu.au or via the DHAA and our CEO Bill Suen should you have any further concerns or queries. n
The road Bulletin Editor Robyn Russell takes a personal view of what it means to be a truly independent practitioner
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HAT DOES THIS MEAN FOR US ALL? I have been talking quite extensively with many of my dental colleagues these last few months, and a lot of the banter has been around 'independence'. The main discussion has been, “So, what does this change in status to independent practitioner actually mean?’ A few clinicians may feel that this change in status is a great opportunity to move forward and open their own dental clinic and practice as a solo practitioner, or even a group practice. True, this may be appealing for a few. Although I would argue that the vast majority of practitioners would find that owning and operating a dental clinic – at the same time as conforming to the standards of practice accreditation, managing risk, surviving competition, and finding financial support and backing – a serious challenge to ensure a real return on their investment. I realise that for many other clinicians, the change in the Dental Boards wording around independent practice may be insignificant, or a concept you may not have even thought about. Many will probably be working in the same surgery and performing similar dental procedures in much the same way as they always have. Many practitioners also feel that without the provision of provider numbers, the idea of true independence is a remote
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to independence reality. However, it’s worth remembering what the provision of provider numbers actually means to health practitioners. Provider numbers are linked to the payment for services rendered, enabling practitioners to bill for services directly to Medicare and other health insurers. This is something that is still very important, and I believe essential, for all dental hygienists (DH), oral health therapists (OHT) and dental therapists (DT). Lobbying for provider numbers has begun in earnest and I am confident that ultimately reason will prevail, and we will be granted provider numbers. Although provider numbers have not yet been forthcoming, this is not an issue that should completely occlude our thoughts when moving forward as independent practitioners. I know that at times it feels like we are encumbered and held back from achieving our goals and walking our own path to independence. This thinking can sometimes be reflected in the language used to describe our role – often being referred to as dental auxiliaries. I’m not sure what thoughts this term conjures up for you all, but for me it can make me feel like half of a practitioner, with the dentist being the main event. I guess though, what is more important is the term I use to describe myself, rather than the term others may use. Having a definitive script to describe your role to others is vital. I would urge you all to construct a concise and accurate description of your position. It can unlock so many doors for you as you to add to your true value. With independence comes great responsibility. Looking within ourselves and finding where our real talents lie as clinicians and finding the areas where we all have gaps in our learning is imperative. Independence relies on honest selfevaluation, so to be truly independent we must all acknowledge what we do not know. What are the things that you would like
to do? What training or further education do you need to fully embrace being an independent practitioner? The learning and growth must never stop when we are operating under the premise of true independence. Who makes the decisions on your gaps in clinical skill and knowledge? Some may challenge this thinking and insist that AHPRA, or the Dental Board decide where the gaps exist; although I would interject that the individual clinician is responsible for their own knowledge. The responsibility lies with us as the individual to build a strong knowledge base and continue to add
“ Embrace this concept wholeheartedly and realise that the handbrake to independence may well lie with you”
layers to this foundation each and every year. What I actually realised as I reflected on my own thinking on independence was that I was already an independent practitioner. While there is great security in conforming to the restraints that I placed on myself in an effort to do the right thing by my patients and my practice; I had already been practicing as an independent and capable clinician for 15 years. So stop asking for permission to do something. As an independent practitioner your decisions, treatments and outcomes are your responsibility. They always have been. I encourage you all to embrace this concept wholeheartedly and realise that the handbrake to independence may well lie with you. Step forward, embrace and accept you are independent! n I would love to hear your ideas of what independence means for you. Please email me at robynrussell@dhaa.info
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A full round up of what you need to know about pharmaceutical products used by dental hygienists, oral health therapists and dental therapists? By Bill Suen
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TABLE 1
The 10 schedules and examples of their use SCHEDULE
PHARMACEUTICAL PRODUCTS are an important element in dentistry. Analgesics and anaesthetics provide pain relief and comfort during and after dental procedures; antiseptics and antibiotics are used for infection control and provide prophylactic, empirical and directed antimicrobial therapy. Corticosteroids may be used to treat oral ulcers or to support antibiotic treatments in managing a range of inflammatory conditions caused by bacterial infection. Dental Hygienists (DH), Oral Health Therapists (OHT) and Dental Therapists (DT) are trained and permitted by law to possess and administer a range of pharmaceutical products when practising within their own scope in dentistry. However the range of products and the extent of their applications in practice vary across different states and territories due to local drugs and poisons regulations. In Australia, medicines and chemicals are classified into the national “poisons schedule’’ in accordance with the Standard for the Uniform Scheduling of Medicines and Poisons (SUSMP) under the auspice of the Therapeutic Goods Administration (TGA). The scheduling is based on the potency and risk of harm of each substance that, in turn, determine the level of control over the availability of the medicine or poison required to protect public health and safety, while at the same time providing appropriate public access to these substances. At the present time there are 10 schedules under SUSMP (see table 1). >
DESCRIPTION
S1
This schedule is currently blank
S2
Pharmacy Medicine Substances, the safe use of which may require advice from a pharmacist and which should be available from a pharmacy or, where a pharmacy service is not available, from a licensed person.
Some fluoride products, antiseptics, analgesics
S3
Pharmacist Only Medicine Substances, the safe use of which requires professional advice but which should be available to the public from a pharmacist without a prescription.
Some fluoride products, antiseptics, analgesics, and topical corticosteroids
S4
Prescription Only Medicine, or Prescription Animal Remedy Substances, the use or supply of which should be by or on the order of persons permitted by State or Territory legislation to prescribe and should be available from a pharmacist on prescription.
Most medicines including anaesthetics, antibiotics, analgesics, corticosteroids and fluorides
S5
Caution Substances with a low potential for causing harm, the extent of which can be reduced through the use of appropriate packaging with simple warnings and safety directions on the label.
S6
Poison Substances with a moderate potential for causing harm, the extent of which can be reduced through the use of distinctive packaging with strong warnings and safety directions on the label.
S7
Dangerous Poison Substances with a high potential for causing harm at low exposure and which require special precautions during manufacture, handling or use. These poisons should be available only to specialised or authorised users who have the skills necessary to handle them safely. Special regulations restricting their availability, possession, storage or use may apply.
S8
Controlled Drug Substances that should be available for use but require restriction of manufacture, supply, distribution, possession and use to reduce abuse, misuse and physical or psychological dependence.
S9
Prohibited Substance Substances which may be abused or misused, the manufacture, possession, sale or use of which should be prohibited by law except when required for medical or scientific research, or for analytical, teaching or training purposes with approval of Commonwealth and/or State or Territory Health Authorities.
S10 Substances of such danger to health as to warrant prohibition of sale, supply and use Substances that are prohibited for the purpose or purposes listed for each poison.
EXAMPLE OF SUBSTANCES USED IN DENTISTRY
Narcotic analgesics
The main schedules that have applications to dentistry include S2, S3, S4 and S8. There are various state based legislations governing the possession, prescribing, supplying and administering them. In general, dentists are permitted to possess, prescribe, supply and administer all these four categories across all states and territories. Dental hygienists, oral health therapists and dental therapists are able to possess and administer S2 and S3 substances at their dental practices. However they are not permitted (except in WA) to supply these products to patients to take home. TABLE 2
Fluoride preparations for humans DESCRIPTION
SCHEDULE
Sodium Fluoride 1.105% Gel 122g
S3
Sodium Fluoride 0.2% Mouthwash 473ml
S2
Sodium Fluoride 50mg/ml Varnish liquid 10ml
Not scheduled
Many substances are listed in multiple schedules depending on their strength (concentration), mode of administration and/or supply quantity. For example, Ibuprofen 200mg tablets packed in 25 or less are not scheduled, so DHs, OHTs and DTs are permitted to supply them to patients at the practice. Larger packs are S2 and must be supplied by the dentist. Ibuprofen 400mg tablets are S3 or S4 depending on their pack sizes. According to the poisons schedule, fluoride preparations for human use are also in multiple schedules. For example, for
therapeutic use, they are S2 if it is 0.5mg or less (of fluoride ions) per dose for ingestion, or in topical liquid preparation 0.1% or less; and liquid fluoride preparations of 0.55% or less are S3. However a high concentration dental fluoride varnish has been determined by the SUSMP to be unscheduled so DHs, OHTs and DTs are able to use it in dental practice without any restriction (see table 2). It is therefore important for dental practitioners to check the scheduling of each product to determine the legal status of these products at the Australian Register of Therapeutic Goods (ARTG) through the TGA website: While dentists are permitted to possess, prescribe, supply and administer S4 and S8 items for dental use, DHs, OHTs and DTs are also permitted to have limited access to possess and administer a range of S4 local anaesthetics and some antibiotic preparations. Each state and territory’s medicines and poisons legislation has specific provisions for DHs, OHTs and DTs. In NSW, Northern Territory, Queensland, South Australia and Victoria, the local legislations identify specific S4 substances that DHs, OHTs and DTs are permitted to possess and administer. On the other hand, ACT, Tasmania and Western Australia have provisions for open-ended approval conditional upon each jurisdictional boundary. ACT provides a blanket approval for OHTs and DTs to purchase, possess and administer all S4 local anaesthetics and topical dental use products, while a DH must obtain them through the dentists.
“ It is therefore important for dental practitioners to check the scheduling of each product to determine the legal status of these products � Tasmania's legislation allows OHTs and DTs to administer S4 local anaesthetics, topical fluorides, Demeclocycline and Triamcinolone acetonide for dental treatments. There is no provision for a DH to handle S4 medications. For dental treatment, Western Australia's legislation allows DHs, OHTs and DTs to possess and administer S4 and S8 items, or to supply S2 or S3 items on a direction given by a dentist, or if there is a written structured administration and supply arrangement (SASA) in place for the treatment conditions and relevant medications. Table 3 summarises the provisions for dental hygienists, oral health therapists and dental therapists on handling S4 substances for dental treatments by state and territory: The DHAA website site provides valuable resources to assist members in checking the respective legislations for each state and territory. >
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TABLE 3
Medicines that Dental Hygienists (DH), Oral Health Therapists (OHT) and Dental Therapists (DH) may possess and administer ACT
NSW
Articaine Benzocaine Bupivacaine Ciprofloxacin Clindamycin Demeclocycline
QLD
SA
TAS
VIC
WA
Only in gazetted clinics and in accordance to treatment plans
Schedule 4 agents for possession and administration
Amoxycillin
NT
OHT, DT may purchase, possess and administer any S4 for topical dental use and for local anaesthetics
nnn nnn nnn
DH may obtain medicines from dentist and to possess and administer them
nnn
nnn
nnn
nnn
nnn
nnn
nnn nnn
OHT, DT may administer S4 when used in dental treatment: Demeclocycline; Local anaesthetics; Topical fluorides; Triamcinolone acetonide
nnn
nnn
Demeclocycline and Triamcinolone in combination for topical endodontic use
nn
nnn
Felypressin
DH, OHT, DT may possess and administer S4 and S8 either: 1 On a direction given by a dentist, or; 2 In accordance to a structured administration and supply arrangement (SASA)
nnn
Felypressin when in preparations continuing Prilocaine
nnn
Fluorides, topical Levobupivacaine Lignocaine/Lidoicaine
nnn nnn
nnn
Mercury (metallic) for human therapeutic use Mepivacaine
nnn
nnn nnn
Minocycline
nnn
Neomycin
nnn
PolymixinB
nnn nnn
nnn
nnn
nnn
nnn
nnn
nnn
nnn
Prilocaine
nnn
Procaine
nnn
nnn
Ropivacaine
nnn nn
Tranexamic acid
nnn
Triamcinolone acetonide
nnn
Triamcinolone in preparations for treatment of dental pulp
nnn
nn
Metronidazole
Tetracycline in preparations for treatment of dental pulp
nnn
nn
Key to table: n Dental Hygienist n Oral Health Therapist n Dental Therapist
ANAESTHETICS IN DENTISTRY
Unravelling some of the misunderstandings around the use of anaesthesia by oral health professionals By Carol Tran
ANAESTHETICS IN DENTISTRY have been one of the cornerstones of patient care. While it is widely taught and accepted that dental hygienists (DHs), oral health therapists (OHTs) and dental therapists (DTs) are able to provide local anaesthesia, it is less clear in relation to their roles in providing treatment under other forms of anaesthesia. Under the current Dental Board of Australia guidelines and state legislations, DHs, OHTs and DTs are not permitted to prescribe, supply or administer relative analgesia (RA) such as Nitrous Oxide, conscious sedation (CS) or general anaesthesia (GA). After consulting with our professional indemnity insurer (BMS), the DHAA and BMS Risk Solution group have revised their joint position statement to clarify the scope of practice of a DH or OHT in relation to treating patients that have been administered relative analgesia (nitrous oxide), conscious sedation or general anaesthesia.
Implications for dental hygienists, dental therapists and oral health therapists 1. DHs, DTs and OHTs may treat patients under RA, CS or GA provided that the treatment or procedure undertaken is within their scope. 2. DHs, DTs and OHTs must be properly trained, proven competent and keeping up to date with the specific skills required to treat and manage patients under RA, CS or GA. 3. The RA, CS or GA is administered by a qualified and registered practitioner with the appropriate accreditation or endorsement, and that person is taking full responsibility for the patient and is present at all times when the DH, DT or OHT is working on the patient.
Specific practice requirements for conscious sedation The Dental Board Registration Standard: Endorsement for conscious sedation specifies that
any CS endorsed dentist must be assisted by another specifically qualified dentist, medical practitioner or nurse unless the dental procedure is being undertaken by another registered dentist or dental specialist. For CS patients, DHs, DTs or OHTs must not perform the dental procedure unless both the CS endorsed dentist and the additional registered health practitioner as listed are both present.
Types of anaesthesia Relative Analgesia Relative analgesia is a commonly used and safe technique used by clinicians for treating anxious patients utilising nitrous oxide and oxygen. READ MORE > 4. Conscious sedation Conscious sedation is a technique in which the use of a drug or drugs produces a state of depression of the central nervous system (CNS) enabling treatment to be carried out, but during which verbal contact with the patient is
General anaesthesia a drug-induced state in which patients do not have a purposeful response to stimulus
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maintained throughout the period of sedation. The drugs and techniques used to provide conscious sedation for dental treatment should carry a margin of safety wide enough to render loss of consciousness unlikely. Conscious sedation retains the patient's ability to maintain a co-patent airway independently and continuously. There are more risks with IV sedation. The patient’s heart rate, blood pressure, and breathing must be carefully monitored in moderate or deep sedation. READ MORE > Conscious sedation is when a medication is, or medications are, administered to result in the depression of consciousness. The patient should not require assistance maintaining their airway, cardiovascular function, or ventilation, and
should respond purposefully to commands, such as verbal and light touch, for the patient’s own safety and to avoid deep sedation. The aim is to achieve an optimum state without introducing additional risks of deep sedation or general anaesthesia. Deep sedation is not recommended for dental procedures, as it is essentially not safe practice due to its associated increased level of morbidity and mortality. READ MORE >
5. General anaesthesia General anaesthesia is defined as a drug-induced state in which patients do not have a purposeful response to stimulus, they lose their reflexes and their ability to protect their own airways, and there can be
respiratory and cardiovascular depression. General anaesthetic is provided by a specialist medical anaesthetist who is responsible for the patient’s airway and vital signs while the dental practitioner provides appropriate treatment.
How do I receive training around treatment under RA/CS/GA? It is a practitioner’s responsibility to outline their duties and competencies with their employer. For further information, please refer back to the Dental Board of Australia’s page on Conscious Sedation. > The Dental Board of Australia emphasises the expectation that the treating clinician has an overarching responsibility to maintain patient safety >
throughout procedures. The code of conduct states: “Practitioners have a duty to make the care of patients or clients their first concern and to practise safely and effectively. Minimising risk to patients or clients is a fundamental component of practice. Good practice involves understanding and applying the key principles of risk minimisation and management to practice.”
All practitioners involved in delivering care for a patient are responsible for the safety of the patient: “The dentist responsible for administration of the anaesthesia is accountable for the effects of the scheduled medicine on the patient, and another practitioner can provide treatment while a patient is sedated as long as the dentist administering the anaesthesia can assure himself/herself that she/ he can maintain this accountability at all times regardless of who is providing the dental treatment. If dental treatment is performed by another practitioner while the patient is sedated, the practitioner providing that treatment is responsible for the treatment, not the dentist administering the anaesthesia.”
The Australian and New Zealand College of Anaesthetists Guidelines on Sedation and/or Analgesia for Diagnostic and Interventional Medical, Dental or Surgical Procedures describe the following risks: “Practitioners who administer procedural sedation and/or analgesia should be aware that
the transition from complete consciousness through the various depths of sedation to general anaesthesia is a continuum and not a set of discrete, well-defined stages. The margin of safety of drugs used to achieve sedation and/ or analgesia varies widely between patients and loss of consciousness with its attendant risk of loss of protective reflexes may occur rapidly and unexpectedly. Therefore practitioners who administer sedative or analgesic drugs that alter the conscious state of a patient, and those who supervise recovery from sedation, must be prepared to manage the following potential risks: • Depression of protective airway reflexes and loss of airway patency. • Depression of respiration. • Depression of the cardiovascular system.
Conscious sedation allows verbal communication with the patient to be maintained
• Drug interactions or adverse reactions, including anaphylaxis. • Unexpectedly high sensitivity to the drugs used for procedural sedation and/or analgesia that may result in unintentional loss of consciousness, and respiratory or cardiovascular depression. • Individual variations in response to the drugs used, particularly in children, the elderly, and those with pre-existing disease. • The possibility of deeper sedation or anaesthesia being used to compensate for inadequate analgesia or local anaesthesia. • Risks inherent in the wide variety of procedures performed under procedural sedation and/or analgesia.”
The revised position statement is available on the DHAA website.
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ANAESTHETICS Q&A
FAQs on relative analgesia (RA), conscious sedation (CS) or general anaesthesia (GA)
Is this within my scope to treat patients under RA, CS or GA? It is dependent on your own individual scope of practice. You must determine if you have been properly trained and are competent in dealing with patients under RA, CS or GA, and that the RA, CS or GA is being administered and monitored by an authorised professional at all times. How can I be trained to treat patients under RA, CS or GA? There are many factors to consider if a particular training course can expand your scope of practice. You should refer to the training organisation that provides the training to confirm if the training meets the criteria for expansion of scope. You should always look for a course from a reputable training organisation that offers theoretical and hands on training for treating patients under sedation and anaesthesia. Can I administer RA, CS or GA? No. DHs, OHTs and DTs are not allowed to prescribe, supply or administer relative analgesia (Nitrous Oxide), conscious sedation or general anaesthesia. Please note that state and territory legislations do NOT allow DHs, OHTs and DTs to administer Nitrous Oxide under any circumstances, even when training has been undertaken. Can I treat patients under RA, CS or GA without the dentist’s (or the anaesthetist’s) presence? While the dentist responsible for
administration of the anaesthesia is accountable for the effects of the scheduled medicine on the patient, and another practitioner ( e.g. a DH, OHT or DT) can provide treatment while a patient is sedated as long as the dentist/anaesthetist administering the anaesthesia can assure himself/ herself that she/he can maintain this accountability at all times regardless of who is providing the dental treatment, DHAA recommends that our members only treats patients if the person administering the RA, CS or GA is present to monitor the patient. DHs, OHTs or DTs should not be put in the position to monitor the patient’s RA, CS or GA status as well as providing dental treatment as this is putting patients at risk. According to the Dental Board Guidelines for CS, patients under CS must be treated by a dentist. Is this still valid? The Dental Board CS guidelines specify that any CS endorsed dentist must be assisted by another specifically qualified and registered dentist, medical practitioner or registered nurse. The exception to this rule is when the dental procedure is being undertaken by another registered dentist or dental specialist. If either of these conditions are met, DHs, OHTs or DTs may participate in treating the patient within scope. However, it is unlikely in practice that a DH, OHT or DT is required when there is already a dentist performing a dental procedure on the patient.
Am I covered by my PI insurance if I am treating patients under RA, CS or GA? The DHAA BMS PI insurance covers everything that is within your scope. The DHAA/BMS position statement clearly defines the conditions that you are permitted to practise within your scope. There are no additional requirements or premium for this. Please check with your insurer if you are with other insurance companies. If I was trained at university to treat patients under RA, CS or GA but I have not done so since I graduated, can I still treat these patients? The DBA recency of practice registration standards requires practitioners to be kept up to date within one’s scope. If you have not practised a certain skill for over three years, or if you do not feel confident about this, you must seek further training to ensure your competence. In this case, relevant CPD to update your skills may be required. I am not sure if I can do this and no one can give me a definite answer of how to proceed. What do I do now as my employer is demanding me to treat patients under RA, CS or GA? Unless you can be sure that you are competent and it is within your scope, you are not allowed to practice in any aspect of services as a registered dental practitioner. Treatment under RA, CS or GA is no difference. If in doubt, do not perform this treatment. n
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We've got your back! The all-new DHAA Peer Support Service has been created to help anyone feeling challenged by professional circumstances THE NEW DHAA Peer Support Service (PSS) is intended to support DHAA members (including graduates and students) on matters related to the many challenges and demands imposed on dental practitioners in Australia. The service provides an experienced dental practitioner to act as a listening ear over the phone, as well as advising on other support services in times of stress. The volunteer may also provide advice on where to seek appropriate professional support. The service is appropriate for members who are: • The subject of a professional practice investigation either through the PI insurer and/or AHPRA • Affected by an occupational health and safety or industrial relations situation at the workplace • Seeking advice on practice matters that may lead to a PI insurance claim or AHPRA notification Please be aware that this is NOT an instant information service, nor an emergency counselling lifeline. These areas are covered by the Dental Board Dental Practitioner Support service or other emergency support services. How the process works All DHAA members may access the service through the following ways: a) A referral from the BMS insurance or DHAA IR support lines. When members seek support through these services they are offered the opportunity to access a peer support volunteer in addition to the PI and IR professionals. b) A member may contact the PSS directly via the online form on the DHAA website to request support.
“ The service provides an experienced dental practitioner to act as a listening ear over the phone, as well as advising on other support services in times of stress”
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The relationship between DHAA PSS and the DBA Dental Practitioner Support The DBA Dental Practitioner Support service is a 24/7 telephone and online service for all dental practitioners. Anyone calling the service does not have to give their name and can seek support anonymously. Callers will have instant access to an experienced team from Turning Point who can provide confidential advice and referral on a wide range of issues, including mental and physical health and general wellbeing. Where the DBA service provides 24/7 on-the-spot emergency crisis management support and referral to callers, the DHAA Peer Support volunteer will be assigned to assist and support the member throughout the term of a case, even when PI insurance and IR lawyers or other professionals are involved. It is valuable that members going through a rough time have access to an experienced peer to talk things through, and this is what the DHAA peer support service is about. Turning Point is aware of the DHAA service and they may refer callers to our service for ongoing support as appropriate.
Requests will be reviewed by the PSS coordinator and where appropriate a volunteer support professional will be assigned. The PSS volunteer will contact the member by phone and/ or email to provide relevant support and advice. The volunteer will be available to provide advice by appointment until the Insurance or IR case is completed with an outcome. Maintaining your privacy Privacy and confidentiality will be maintained within the boundaries of the legal framework. A member may seek anonymity when making the request to the PSS coordinator. Only de-identified details of cases will be used for program evaluation and ongoing volunteer training and debriefing purposes.
Applying for peer support The Peer Support request form is available within the members area of the DHAA website. If you require an immediate emergency response please refer to the numbers below: n
Emergency help In an emergency that requires an immediate response, please refer to the numbers below: Fire, Ambulance or Police 000 Lifeline 13 1114 Suicide Call Back Service 1300 659 467 DBA Dental Practitioner Support For confidential advice and support 24/7 please call 1800 377 700.
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CAREER DEVELOPMENT
What's your AQ? How adaptable are you to change in your career? By Melanie Hayes
MOST OF US have heard of IQ (Intelligence Quotient) and EQ (Emotional Quotient) – but what is AQ? AQ is Adaptability Quotient, and it is gaining increasing attention due to the everchanging nature of work. While IQ focuses on knowledge and facts, and EQ on emotional awareness and abilities, AQ focuses on one’s ability to be agile and adapt to change. It should be noted though that these metrics don’t function in isolation from one another - research has highlighted the importance in developing emotional intelligence to strengthen career adaptability.1 To be adaptable, it is necessary to have a strong sense of self-awareness, to be able to regulate your own emotional responses, and to empathise with others. AQ is not a new concept in career development literature. Some 40 years ago, Super and Knasel (1981) defined the term career adaptability as one’s “readiness to cope with changing work and working conditions”.2 More recently, Savickas (2005) has identified four core competencies for career adaptability: concern, control, curiosity, and confidence. These reflect an individual’s ability to be aware of and prepare for the future, to take personal responsibility for their career, to explore and learn, and to successfully overcome obstacles.3 AQ helps individuals to adapt to unpredictability, changing demands, and career transitions throughout their life.4 Further, research has shown that career adaptability is important for career satisfaction.5
How can you develop your AQ? Here are some simple activities that might help you respond positively to life and work changes: • Take time to consider your values and motivations, and how you would like them to influence your work • Plan how to achieve the goals you have for yourself • Learn new skills (continuing professional development) • Boost your resilience by identifying examples of change in your life, and how you positively responded to this change (or alternatively, how you would behave differently next time) There are also Career Development resources in the Members area of the DHAA website, which may help you learn about career development across the lifespan, and how to work towards fulfilling and meaningful careers.
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.
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Adapting to survive Jacquie Biggar is an ideal example of somebody reacting to her environment to remain relevant THE WORLD OF work is constantly changing, and this has never been more evident than during the COVID-19 pandemic. For this edition, I interviewed Jacquie Biggar from Senior Dental Care about her career, and as you can see from her diverse range of work experiences and her ability to adapt her new business during COVID-19, AQ was an important part of her career journey. Tell us about your current role. My current role involves being a jack of all trades. I am helping manage a private practice as well as being a clinician. Unfortunately, the students at the University of Sydney are not treating patients due to COVID-19 so my clinical educator role is on hold. I started a new business called Senior Dental Care at the start of the year which has definitely been a highlight and has taught me a whole new role as being a business owner.
What education or experience did you need for this role? Being a business owner is something I am learning about all the time, I have never owned a business before, and the only experience I have had in the past is the small managing roles in private clinics. I completed the Graduate Certificate of Oral Health Science in 2018 and this gave me the scope and confidence to be able to treat people over 18. The Senior Dental Cares model is to provide continuous preventative dental treatment to seniors that are in and out of aged care facilities. This extra study wasn’t required but it gave me confidence in my examination and diagnosis skills for referrals. What are the day-to-day activities? Unfortunately, COVID-19 hit a fortnight after my first day of patients and since then it has been difficult to access these high-risk patients. I have taken this time to refine my business plan and incorporated teledentistry.
“ Unfortunately, COVID-19 hit a fortnight after my first day of patients” I have also tried to grow my social media presence and have kept in contact with a few people who are interested in doing something similar! What’s the scariest or most challenging part of choosing an alternate career path? Instead of choosing an alternate path altogether I chose to work part time in private practice as I increase awareness of my services. It was super scary to take the leap of becoming a business owner as I felt out of my depth with the taxation/accounting side of things, however I would choose to do it over again and again! I have had the idea of Senior Dental Care brewing for over eight years but
roadblock after roadblock stopped me from going ahead with it, the best piece of advice I was given was from an old boss and practice owner, just do it and learn along the way, you’re never going to know everything! Were there people along the way who helped you get the career you wanted? Mentors are so important and I’m so lucky to have a few of them in my life! My family friends were great support but the people who were in the industry and who are already business owners were the people who helped the most! I surrounded myself with people who provided support and advice and this was priceless. Do you have any advice for DH or OHT who are looking for a change from clinical practice? Yes definitely, there are so many career pathways other than clinical practice! We are health professionals who have a set of very unique skills, if you are at all interested in other things like business ownership or education explore them! I highly recommend both! n References 1 Coetzee, M., & Harry, N. (2014). Emotional intelligence as a predictor of employees’ career adaptability. Journal of Vocational Behavior, 84(1), 90-97. 2 Super, D. E., & Knasel, E. G. (1981). Career development in adulthood: Some theoretical problems and a possible solution. British Journal of Guidance &Counselling, 9, 194- 201. doi:10.1080/03069888108258214 3 Savickas, M. L. (2005). The theory and practice of career construction. In S. D. Brown & R. W. Lent (Eds.), Career development and counseling: Putting theory and research to work (pp. 42–70). Hoboken, NJ: John Wiley & Sons 4 Maggiori, C., Rossier, J., & Savickas, M. L. (2017). Career adapt-abilities scale–short form (CAAS-SF): Construction and validation. Journal of Career Assessment, 25(2), 312–325. https://doi.org/10.1177/1069072714565856 5 Chan, S. H. J., & Mai, X. (2015). The relation of career adaptability to satisfaction and turnover intentions. Journal of Vocational Behavior, 89, 130-139.
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What is Citrox®, and how does it work against infection in your patients’ mouths? Research is starting to reveal the potential of mouthwashing procedures as an additional protection against viral and bacterial infections. Citrox® is one of the key ingredients of gargling solutions that helps fight them. But what is it really, and how does it work? Keeping the mouths of your patients free from infection affects not only their oral health, but also has long-term effects on their general, long-term well-being. While not meant as primary means of fighting infection, Citrox® is an important ingredient in several mouthwash solutions and provides additional protection against bacteria and viruses when it’s needed most, such as after surgery. What is Citrox®? Citrox® is a natural combination of organic acids, and bioflavonoids derived from bitter oranges. It has been designed to serve as a powerful antimicrobial, antiviral and antifungal agent. Slowly proving itself as an important ingredient in efficient mouthwash solutions, we believe that Citrox®, together with cyclodextrins, will play a crucial role in the future of oral healthcare. Health starts in the mouth, and using mouthwashes to protect the mucous membranes against harm can help lower the risk of your patients becoming infected and developing a range of serious noncommunicable diseases and conditions. How does Citrox® work against bacteria and viruses? The effect of Citrox® largely comes down to the flavonoids in it. The bioflavonoids bind to bacteria’s receptor sites, blocking the passages that bacteria need for feeding and emptying. Unable to sustain these processes, the bacteria essentially drown, killed by the flavonoid.
FREE SAMPL
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Furthermore, unlike some other compounds used for infection control in dentistry, Citrox® is non-toxic, noncorrosive, non-carcinogenic and non-allergenic. It doesn’t stain teeth or alter food flavor, and it’s dermatologically tested, biodegradable, safe and eco-friendly. When can Citrox® help? Citrox® has been designed as an ingredient in oral care products, enhancing their healing and protective effects. Citrox®-enabled mouth rinses can help especially: and after oral surgery • Before Against disease • Against periodontal candidal infections • Combined with other ingredients (such as chlorhexidine), serving as an important additional In these situations, Citrox®-containing oral health products can form part of the prophylactic measures that you can recommend to your patients to help them keep their oral mucosa protected, helping reduce risk of infection. Learn more about additional valuable compounds for your dental practice and how they benefit your patients, in our summary on cyclodextrins and how they work and how mouthwashes and gargling can serve as an important additional protection against infection. In the end, it’s complex care of the mucous tissues what helps protect the patient from becoming infected. And with mouth rinse procedures being fast and easy to apply, we believe that in the future, they will become even more important for keeping your patients healthy – especially in situations when the mucosa is exposed to physical stress such as after surgical procedures or during viral epidemics. Sources: https://www.researchgate.net/publication/49739491_Antimicrobial_ activity_of_Citrox_R_bioflavonoid_preparations_against_oral_microorganisms
Patients can reap the benefits of natural ingredients. Try a new generation of mouthwashes. You can apply for a Perio Plus+ sample here perioplus.com.au
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the
GREAT BATTLE of GINGIVITIS A fictional tale about the ongoing battle between the inhabitants of the Kingdom of Gingiva and the evil nation of Biofilm Story by: Jesse Kourakis, Victoria Abela, Rehka Akula and Brianna Carswell – 1st Year Advanced Diploma of Oral Health (ADOH) Students TAFESA.
THIS IS A creative writing piece written by first year ADOH Students from Gilies Plaines TAFE SA. Their task was to create a story, dialogue or video about the pathogenesis of gingivitis. Ensure that you include the histological stages of development of disease and provide and explanation for the clinical signs of the disease. CHAPTER 1
O
Initial Lesion
nce upon a time there existed an evil nation, called Biofilm, that sought to expand their dominion in our great Kingdom of Gingiva. Due to a period of long-lasting peace, we began to neglect the care of our Kingdom and the nation of Biofilm began to grow in number and encroach on our epithelial borders. The first assault happened two to four days after they accumulated their army. They released a poison into our Kingdom which began to wreak havoc amongst our land. The sentries, called Neutrophils and Mast Cells, discovered this invasion and sent messengers for back up. This allowed the roads (blood vessels vasodilation) to be cleared to ensure back up soldiers could move quickly to the site of invasion. The flood gates to the Kingdoms surrounding moats were also ordered to open. These filled up with plasma fluid to create a protective barrier and flowed out beyond the Epithelial border in the hope to slow the enemy down.
The Neutrophils mobilised and gathered in force to form the first line of defence, otherwise known as, “Operation Chemotaxis”, and migrated directly to the site of insult. It was lucky that we were prepared for these kinds of attacks. All seemed to be going well, and so far, our defences were holding. As long as the Epithelial Junction at the border held, we would have nothing to worry about. CHAPTER 2
U
Early Lesion:
nfortunately, things took a bit of a southward turn and things started to worsen. The Biofilm Nation was just too strong and began to build in number and accumulate further into our territory. They began to fortify within our land by building the foundations of a plaque wall near the Epithelial border and from here they continued to assault our Kingdom. At this point we were seven days into battle. While the Neutrophils continued to fight the invasion at the border, some Biofilm Bacteria soldiers had managed to break the defences and move into the Kingdom. We had no choice but to call on the PMN soldiers to bombard the site of invasion. Unfortunately, in doing so, it also meant we lost many important collagen structures along the way as a result of their destructive Enzyme powers – a price that had to be paid.
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It wasn’t all bad news. At the same time, we It was an all-out war! were able to call on our other divisions, namely the The Biofilm Nation had further fortified their Lymphocytes, which released Growth Factors that Plaque Wall, which now consisted of huge defensive helped fortify our defences by creating blood rivers structures and weapons of mass destruction. Their (capillaries) so more reinforcements could quickly Bacteria soldiers continued to multiply and invade arrive in our defence. our border. We continued to call on reinforcements; At that time soldiers were fighting everywhere, and macrophages, lymphocytes, plasma cells… we were many structures were being destroyed. The Epithelial throwing everything at this enemy and soldiers were border also unfortunately dying left, right and centre. began forming ridges, which More of our Kingdoms “While the Neutrophils wasn’t the best sign. All the Collagen structures were while the flood gates were continued to fight the being destroyed and the fully open, and the newly ridges on the Epithelial invasion at the border, formed capillaries were border were growing in size. some biofilm bacteria painting the battle ground a The Epithelial Junction, the soldiers had managed bloody red. main protective barrier, It wasn’t looking the had become so ulcerated it to break the defences” greatest, but we were hopeful! finally loosened and gave The Epithelial Junction at the in. A great pocket opened border, though becoming a little battered, was still up and the border became weaker and weaker. More holding strong. If the onslaught ceased, we would bacteria soldiers flowed into our Kingdom and we definitely be able to bring this around. were beginning to lose hope. Even the capillaries were losing flow and becoming stagnant. Everything was stained red and due to the lack of new blood things CHAPTER 3 were beginning to darken - everyone was looking pretty blue. How could we recover from this? Was it too late? Even if we managed to destroy the enemy, would we kay, so we might have been a little too be able to fully repair the damage that was caused? hopeful as things weren’t looking very good. This war will go down in history, and forever leave The onslaught had continued for weeks and its mark. The Great battle of Gingivitis… we were now 21 days into the battle. To be continued... n
O
Established Lesion
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SELF DEVELOPMENT
D The
POWER of
RESILIENCE An in-depth look at how we deal with adversity and the role that 'resilience' plays in how we cope By Lyn Carman
URING THE EVENTS of the last eight months, most of us have felt, at the very least, a slight tug of the rug out from underneath us. And not every response has been the same – some people have dramatised it; some have totally nailed being calm and centred and some are still working out what to wear. During this time, with coronavirus spreading around the world, loss can take many different shapes. For some people, it’s a loss of loved ones or their health. For others, it’s affecting their financial security, job, essential resources. It may also be a sense of losing freedom and hopes for the future. While for others it can be all of the above and still they have optimism and positivity in the knowledge that we will thrive and be stronger, even in the face of adversity. Have you ever wondered why some people seem to remain calm in the face of a crisis while others appear to come undone at the slightest hint of trouble? People who can keep their cool have what psychologists call ‘resilience’, or an ability to cope with problems and setbacks. So, what is resilience? Psychologists define resilience as the process of adapting well in the face of adversity, trauma, tragedy, threats or significant sources of stress — such as family and relationship problems, serious health problems, workplace and financial stressors, or COVID-19. Another definition from Merriam Webster is ‘the capability of a strained body to recover its size and shape after deformation caused especially by compressive stress’ – or to bounce back. Resilience is our ability to bounce back from the stresses of life. It’s not about avoiding the stress but learning to thrive within the stress. I think this expressed well by Eric Greitens in his book Resilience: Hard-won Wisdom for Living a Better
31
Life, when he writes: “Life’s reality is that we cannot bounce back. We cannot bounce back because we cannot go back in time to the people we used to be. The parent who loses a child never bounces back. The nineteen-year-old who sails for war is gone forever, even if he returns. You know that there is no bouncing back. There is only moving through. “What happens to us becomes a part of us. “Resilient people do not bounce back from hard experiences; they find healthy ways to integrate them into their lives. “In time, people find that great calamity met with great spirit can create great strength.” 1 SELF AWARENESS
2 MINDFULNESS
3 SELF CARE
5 PURPOSE
4 POSITIVE RELATIONSHIPS
So let’s all come together with great spirit, I say! It is believed that we are not born with resilience but that it can be learned and developed – and there is a recipe. “When life gives you lemons, make lemonade” – so the saying goes. But how do we make lemonade you may well ask? Let’s look at five key ingredients for the recipe: 1 Self-awareness Is having a clear perception of your personality, strengths and weaknesses, thoughts, beliefs, motivations, and emotions. Allow yourself to feel and know that you have choices of how to feel in any given moment. Become aware of the choices you are making. 2 Mindfulness Be aware in the moment, breathe and become present, being actively open to this moment – yesterday has gone, tomorrow hasn’t come yet, all we have is this moment.
“ Resilience is our ability to bounce back from the stresses of life. It’s not about avoiding the stress but learning to thrive within the stress” 3 Self-care This is unique for every one of us, though it is generally the practice of taking an active role in protecting our own well-being and happiness, in particular during periods of stress. 4 Positive Relationships These are the people who support and care for us — and we care for them. One of the most profound experiences we can have in our lives is the connection we have with other human beings. Choose to be around people who support and care for us. “You are the average of the five people you spend the most time with” Jim Rohn 5 Purpose Recognising that we belong to and serve something bigger than ourselves. Our purpose helps to shape the mindset and attitude we have toward others and the events we experience. Apply equal amounts of these ingredients and voila we have lemonade! But we all know its really not that simple, right? For some of us it is simply taking one small step in the direction we want to go and continuing to head in that direction, the majority of the time. Acknowledge that we are all human, and that there will be setbacks, and we can integrate this too and become a little more resilient. Other useful quotes include: “Resilience is more available to people curious about their own line of thinking and behaving,” Brene Brown, and: “The only thing that is constant is change.” – a famous quote by the ancient Greek philosopher Heraclitus. Resilience is important for several reasons; it enables us to develop mechanisms for protection against experiences which could be overwhelming, it helps us to maintain balance in our lives during difficult or stressful periods, and it can also protect us from the development of some mental health difficulties and issues. I have gratefully used many quotes already in this article as I stand on the shoulders of giants and I leave you with this final one from Hellen Keller: “Although the world is full of suffering, it is full also of the overcoming of it.” Keep well! n
A full state-by-state run-down of Association happenings around the country
STATE NATION ACT
NSW
NT
Qld
ACT Contacts Michelle Bonney contactact@dhaa.info
NSW Contacts Steven Chu chairnsw@dhaa.info
NT Contacts Bill Suen ceo@dhaa.info
Qld Contact Jen Turnbull chairqld@dhaa.info
Warrick Edwards directornsw@dhaa.info
n Susie Melrose has recently stepped down as chair of the ACT Committee due to competing commitments. Thankfully she still remains as a committee member to support DHAA. We would like to thank her for her tireless work and leadership that has been serving our ACT members so well over her tenure. We are now seeking other local members to fill this vacancy. It is also expected that the deputy chair position will be available in several months’ time. This is a great opportunity for members to get involved in shaping the organisation and the profession through the branch committee’s activities. Please contact ceo@dhaa.info for further information or expression of interest.
n While things have been reasonably settled and quiet in NSW, the increasing COVID-19 clusters have been monitored closely by the government. At this stage we ask members to be vigilant but not alarmed, and we will report any developments that may impact dental practices as soon as they become available. Please contact NSW chair Steven Chu (chairnsw@dhaa. info) and director Warrick Edwards (directornsw@ dhaa.info) if you wish to discuss or report any local issues and they will be available to support you. A big thank you to Alissia Hughes, Gabriela Stan and Cate Corcoran for their support in the Bad Mouth campaign in NSW.
Lizzy Horsfall contactqld@dhaa.info
n With the NT Chair and director’s positions both vacant at the moment, CEO Bill Suen is managing the territory’s affairs at the moment. Please contact him at ceo@dhaa.info if you wish to discuss any issues or seek help. Deputy chair Alicia Jubb has temporarily relocated to Queensland, but will continue to work with Bill to support NT members. Work in our provider number campaign is gradually building up and we are grateful for life member Hellen Checker’s help with our Bad Mouth campaign in Alice Springs
.
n Queensland Chair Jen Turnbull has been working with members to knock at local politicians’ doors to discuss the DHAA Bad Mouth campaign. We also acknowledge the help of Kellie Krause and Cheree Wheaton who responded to our call for local support. We extend a warm DHAA welcome to Lizzy Horsfall who just commenced serving as Queensland Deputy Chair. There have been some significant legislative amendments recently that came into force in July. All employers in Queensland are now required to report injuries within eight business days, regardless of whether a workers’ compensation claim is made or not.
33 For all the latest info on DHAA events please visit www.dhaa.info/events
SA
Tas
Vic
WA
SA Contacts Sue Tosh chairsa@dhaa.info
Tas Contact Michael Charlton chairtas@dhaa.info
Vic Contacts Sarah Laing chairvic@dhaa.info
WA Contacts Carmen Jones chairwa@dhaa.info
Sally Hinora contactsa@dhaa.info
Alyson McKinlay directortas@dhaa.info
Desiree Bolado contactvic@dhaa.info
Rhonda Kremmer contactwa@dhaa.info
n Margie Steffens, Alison Taylor and Lynda van Adrighem recently met with ADASA president Angelo Papageorgiou and CEO Dan Pawlyk to explore collaborative opportunities in aged care between the two associations. Members of the SA committee have also been approaching local MPs to discuss the DHAA ‘Bad Mouth’ campaign. We would also like to thank Lynda van Adrighem, Alison Taylor and Lyn Carman for their contribution to the campaign.
n There has not been much local activity in Tasmania, but state chair Michael Charlton-Fitzgerald (chairtas@dhaa.info) and director Alyson McKinlay (directortas@dhaa.info) are keen to hear from TAS members about how they are travelling with COVID-19, as well as any needs or issues that they can assist locally.
n With the rapidly worsening COVID-19 situation in Victoria, there has been a significant amount of behind the scene work done in clarifying dental restriction status, communication with members and other organisations, as well as advising members on practice based issues. In response to requests from Victorian members working in the public sector, we have recently commenced preliminary work with ADOHTA to prepare for the next round of public sector dental practitioner enterprise bargaining agreement in Victoria. A number of Victorian members are working with the committee in approaching marginal seat MPs to discuss our Bad Mouth campaign. Thank you Shai-lee Kennedy, Adrea Stamusz-Zsori, Ellen Larkin, Cathryn Carboon, Amber Stevanov, Paulette Smith and many others who offered to help.
n With the relaxation of social restrictions in WA, the committee is visiting Curtin University to promote DHAA membership to oral health students. DHAA-BMS memorabilia have been provided to support the activity. Ongoing discussions are being held to plan a joint DHAA-ADOHTA event for early 2021, The event which will be depending on the progress of COVID-19 over the next few months as it will affect speakers and attendees due to uncertainties in border accessibility across the country. n
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Develop Empower Support www.dhaa.info
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