The Bulletin - Issue 60 Sept / Oct 2021 by eroomcreative.com

Issue 60 September-October 2021

The official newsletter of the Dental Hygienists Association of Australia Ltd

CPD SPECIAL

Manage your own CPD future Exploring the options for career development and advancement at your fingertips

Supporting special needs

Navigating the mayhem

Self-record CPD on neurodegenerative conditions

Hygienists making a positive out of a pandemic lockdown

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

SPONSORED ADVERTORIAL

Armour for teeth

BioMin is the first toothpaste to receive accreditation from the Oral Health Foundation panel for its effectiveness at both sensitivity reduction and remineralisation. Clinicians agree it lives up to its slogan, ‘armour for teeth’. the acid and promoting remineralisation. In fact, a further ‘smart’effect is BioMin F begins to act faster in the presence of acid in the mouth.

MoiraCrawford

Freelance health writer

The three claims the Oral Health Foundation has verified and upheld are:

ioMin F toothpaste has been available in the UK for over three years and the evidence base is growing that it is highly effective both at remineralising dental enamel and providing relief from dentine hypersensitivity. The Oral Health Foundation’s expert panel reviewed the studies relating to BioMin, and found it did live up to its claims. What’s more, dental professionals are finding BioMin to be effective in a range of situations. BioMin has an impressive scientific pedigree. It was developed in the laboratories of Queen Mary University, London, where materials expert Professor Robert Hill and his team have been studying the properties of bioactive glasses. These were originally developed for bone grafting, but found to be surprisingly effective in treating sensitivity. The Queen Mary team, however, developed a new generation of bioactive glass BioMin containing an optimum combination of calcium, phosphate and fluoride ions, designed to dissolve slowly in the mouth, releasing the ions to precipitate fluorapatite, the fluoride analogue of natural tooth mineral. Fluorapatite is more stable and resistant to acid attack than hydroxyapatite, formed by previous generations of bioactive glass, and studies in artificial saliva have shown it begins to form within an hour of brushing with BioMin F. Unlike the soluble fluoride contained in conventional toothpaste which is rapidly rinsed away by saliva, the fluoride is contained within the particles of BioMin F. These adhere to the tooth surface and dissolve slowly over up to 12 hours, entering the dentine tubules, laying down fluorapatite and gradually occluding the tubules. This effect is enhanced by the presence of the increased concentration of phosphate ions in the glass structure. The process has the dual effect of remineralising the surface and penetrating deeper into the subsurface lesions, as well as forming a plug within the tubules tha prevents fluid flow, the cause of dentine hypersensitivity. In the presence of acid in the mouth, BioMin F acts to raise the pH, neutralising

1. By brushing at least twice daily, morning and night, the regular use of BioMin F toothpaste provides relief from dentine hypersensitivity and long-lasting protection against acid attack. 2. The unique patented technology within BioMin F slowly releases calcium, phosphate and fluoride ions, forming a protective fluorapatite layer on the tooth surface and replacing lost tooth mineral 3.BioMin F toothpaste will help reinforce and protect your teeth, leaving your mouth feeling clean and fresh.

1. Relief from dentine hypersensitivity Dentine hypersensitivity has long been a conundrum to dental professionals, affecting about a third of the population at some time – and, for around 10% of them, it can be extremely debilitating. As there are several possible causes, there’s no single solution, and Dr David Gillam, an internationally respected specialist in this area, has been frustrated at the lack of an effective treatment for the problem. A chance meeting brought him together with Prof. Robert Hill, and they have developed BioMin F as a treatment for dentine hypersensitivity. Clinicians are finding it works in a number of situations. Several have trialled the product on themselves and their families before recommending it to patients suffering from sensitivity. Patients are coming back reporting improvement in their symptoms and requesting the product. Dr Don Gibson, a dentist in Yeovil, Somerset, believes it has helped almost all the patients who have used it. ‘It’s been better than I dared hope. 90% of them are passionate about it and come back for more,’ he said. Dental hygienists and therapists are also using BioMin F in the surgery to prevent sensitivity after procedures. Post scaling Irish hygienist Donna Paton and her colleague, dentist Dr Anne O’Donnell, apply BioMin F to patients following treatment and give them the product to take home. They have seen a great improvement in the incidence of sensitivity, as was also found in a clinical trial (Ashwini et al, 2018).

Post whitening An effect of whitening treatment is to expose the surface of the teeth, risking the development of sensitivity and staining in the initial stages. American hygienist and oral health educator Theresa McCarter is amazed by BioMin’s effectiveness at preventing this. She has been recommending the product to patients with extreme sensitivity from overuse of whitening products, and also routinely applies and recommends BioMin following in-surgery whitening treatments. Others with sensitivity arising from bruxism, reflux and poor dental hygiene have also seen huge improvement. Following GBT Sam Davidson, a hygienist working in several practices across the south east of England, has been using BioMin following guided biofilm therapy (GBT). This procedure not only removes biofilm but in the short term also the pellicle which protects the tooth surface. ‘I apply a smear layer of BioMin F after GBT and any scaling that I may need to do to remove tartar, and this provides a protective barrier, remineralising the tooth surface and preventing sensitivity and staining, until the pellicle is restored,’ she said.

2.Formation of protective fluorapatite Demineralisation matters, because it is because it is considered to be the precursor to frank enamel caries. Studies over recent months have proven BioMin F to be effective at precipitating fluorapatite to remineralise not only the surface of the teeth, but also penetrating deeper into the sub-surface (Bakry et al, 2018; Sivaranjani et al, 2018). White spot lesions A common problem arising after orthodontic treatment, the area around the brackets can become demineralised due to poor oral hygiene. Trials have shown BioMin F is effective at reversing the white spots by remineralising the enamel. Early enamel defects have also been reported to be reversed by BioMin F. Deep remineralisation A trial last year proved BioMin penetrates deeper below the surface enamel than had previously been realised. Comparing the effect of BioMin with fluoride gel on artificially demineralised teeth, the researchers found the BioMin group showed significantly better remineralisation values. They concluded that‘BioMin was capable of remineralising the sub- surface enamel lesions efficiently’. They hypothesise this was due to the continuous, low fluoride release from BioMin, which allowed the penetration of the calcium and phosphate ions through the porous enamel sub-surface, effecting the successful remineralisation of the demineralised enamel lesion, rather than remineralising the surface layer, as was observed with the fluoride gel. London hygienist Bhavana Dower has used the product on herself and her son, who was suffering from fluorosis. His teeth are visibly whiter, and the enamel on her patients’teeth‘actually looks thicker,’ she said.

3.Reinforcing and protecting teeth It seems clinically that BioMin F is living up to the expectations from scientific research, and even exceeding them, as dental clinicians continue to find new ways to use the product to help patients strengthen, remineralise and protect their dentition. It really is ‘armour for teeth’.

BioMin C

Figure1:Scanningelectron micrographimageshowingdentine tubulesbefore brushing with BioMin

Figure 2: Tubule occlusion after brushingwithBioMinF

Figure3: Tubuleocclusioncontinues after acid challenge

Figure 4: White spots after orthodontic bracketremoval

is available for those who do not wish to use fluoride, it contains phosphate and calcium.

03 3

Contents 04 Symposium goes online

Covid can't stop our national event plus we plan for 2022.

Welcome to the 60th issue of the Bulletin Fanny Blankers-Koen, the Dutch sprinter who won four gold medals at the 1948 London Olympics, said: ”All I've done is run fast. I don't see why people should make much fuss about that." Very humble for a world-class athlete. Fanny, aka 'The Flying Housewife', won her medals as a 30-year-old mother or two. Maybe she thought that giving birth to two children in Nazi-occupied Holland during WWII was more of an achievement than running fast? Over the 28 days of the Tokyo 2020 Olympic and Paralympic Games, we have seen amazing feats of physical and mental strength, watched dreams come true and hopes crushed, heard stories of triumph, and witnessed tragic losses as 16,193 athletes from 206 nations came together to test themselves against the best of the best in the hope of winning Olympic gold and glory. Winning gold may be the goal of many athletes, but the goal of the Olympic Movement is to contribute to building a peaceful and better world by educating youth through sport practiced without discrimination of any kind and in the Olympic spirit, which requires mutual understanding with a spirit of friendship, solidarity and fair play. Such a simple message, and still it’s a lesson as important today as it ever has been. The Olympics have long been an opportunity for athletes to come together, put aside any differences and show the world that we really can all get along. Some stand out moments include London 1948, hosting the games at short notice after the end of the second world war, Mexico City 1968, the Black Power salute, Sydney 2000, North and South Korea marching under a unified flag, and now Tokyo 2020, a world reunited. At a time when we are facing so many challenges it is wonderful to have such an inspiring reminder of what can be achieved with hard work, determination and courage – not only Olympic gold but a more peaceful and better world. Congratulations to Editor Robyn Russell and the Bulletin staff on this milestone 60th edition of the Bulletin. On behalf of the members, I want to say a very big thank you to all the staff, past and present, who have contributed to the Bulletin over the years, helping to make it the publication it is today. Cheryl Dey DHAA National President

07 From the top

CEO Bill Suen urges us to focus on patient welfare.

08 50 years of dental care

ADOHTA invites us to join the celebration while we look back at 30 years of DHAA.

14 A devotion to dental

Joan James recalls the early days of dental hygiene.

16 Meet Jen Turnbull

Introducing the volunteers that make the DHAA purr.

18 Navigating mayhem

Three hygienists that have made a pandemic positive.

COVER STORY

20 Manage your CPD future Discover how to manage CPD to your advantage.

26 Caring about aged care

A mission update on the new DHAA Aged Care Chapter.

28 Special needs CPD paper Neurodegenerative conditions and oral health.

34 The power of positive

Examining the importance of having fun at work.

.34 State of the Nation Your quarterly round-up of what's on the go near you.

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

CPD WITHOUT BARRIERS FLEXIBLE, AFFORDABLE, ACCESSIBLE, AND ENJOYABLE FOR ALL 4

2021 DHAA Symposium is going online

With domestic COVID-19 cases climbing again the decision has been made to take this year's DHAA Symposium online By Bill Suen

THE CLOCK IS ticking and we are looking forward to getting together at the end of October for our event of the year Melbourne Symposium 2021. This event is so popular that we were at capacity since May and many are already on our waiting list for a place. As we enter the end of the second year of the AHPRA CPD cycle, many are keen to participate in this flagship education event for the profession. The multistreamed education program has been carefully selected to cater for a variety of interests with expert presenters and great topics. With the recent COVID-19 outbreaks across a number of states, it is becoming apparent that having a face to face gathering of large number of members of our profession at the Symposium may

be problematic with lockdowns, border closures and quarantine requirements. To keep everyone safe and provide certainty, the DHAA board has decided to offer the 2021 DHAA National Symposium solely as a virtual event. The Symposium will be delivered live via Zoom to all registrants on Friday 29 and Saturday 30 October. Live sessions will be recorded and provided together with other multi stream session recordings to all registrants for on demand viewing later. Registrants will therefore have flexible access

provided (by 30 November) and they will receive information by email on the final program and access information to the live sessions and other recorded sessions. Existing Symposium registrants who wish to cancel their registration will need to email the conference organiser before COB Friday 24 September 2021, and a full refund will be provided. All existing registrants will be contacted by email with further details on the arrangements, and information on refunds and cancellations.

“ All existing registrants will be contacted by email with further details on the arrangements, and information on refunds and cancellations” to all sessions, at the time that suits individual’s circumstance; and there is no need to choose your stream or missing out any of the education sessions. Existing registrants who wish to attend the virtual sessions and/or access the recordings need to do nothing. A partial refund will be automatically

With 20-25 hours of high quality CPD on offer through the virtual Symposium, registration will re-open on Monday 6 September. With the flexible virtual Symposium, we can all access great CPD from subject experts without barrier. For further information on the program and registration, please visit the DHAA Symposium website. n

SYMPOSIUM

Ying Gwoyarra

2022

From the Big chair 2-4

JUNE

New Way

Save the

Date

SAVE THE DATE DARWIN 2022

Ying Gwoyarra! Ying Gwoyarra! New Way! New Way!

DISCOVER NEW OPPORTUNITIES in oral health at the 2022 DHAA National Symposium, to be held at the Darwin Convention Centre between 2-4 June. Changes surround our profession independent practice, industrial award, provider numbers, aged care reform, teledentistry, COVID... the list goes on! There is so much on the drawing board for the organising committee. Darwin is jam-packed with incredible wonders and well preserved Aboriginal history. Today, people from more than 60 nationalities and 70 different ethnic backgrounds call Darwin home. The diversity of culture has significantly contributed to the community. Darwin's famous street markets are full of delicious food from all across the world. Cultural festivals have become important social events for locals and visitors enjoy together. So mark your 2022 diary now for a mind-blowing experience that no oral health practitioner wants to miss.

~ Sixty issues and still counting – The DHAA Bulletin hits a milestone and looks to continued growth, says dhaasymposium2022.com.au Bulletin Editor Robyn Russell IT IS MY pleasure to welcome you to the 60th edition of the Bulletin. While I was not a member of the editorial committee during the inception of the inaugural Bulletin publication. I am most proud to be the current editor of this publication. The Bulletin was initially produced in print format and mailed to DHAA members, a mammoth undertaking for a small number of committee members. The Bulletin is now a digital publication, which receives submissions from a diverse group of contributors who provide insightful influence. On reflection, the 60th issue of the Bulletin acknowledges the changing face of dentistry. In preparation for his milestone, Christina Zerk unearthed a few dusty old issues from the archives. These archived issues provide a historical journey into the profession of dental hygiene in Australia, its struggles, and triumphs. In the first issue of the Bulletin newsletter – back in June 2001 – President Leah Littlejohn, wrote: “Today, we are all witnessing very important changes in the legislative review process occurring around Australia and hopefully, the changes will allow dental hygienists greater scope of practice, both in and outside of the surgery. In all states of Australia, the DHAA Inc branches are working tirelessly to assemble submissions for the Legislative review, and I highly commend their efforts. One common theme in this process is a more general scope of practice based on training rather than the retention of a list of duties. We are seeking representation on the new dental boards as it is imperative that we have representation on issues pertaining to dental hygiene”. In 2001, I hadn’t yet commenced my Bachelor of Oral Health degree! How amazing that some twenty years later we can witness how the work of a tireless few has come to realisation. The current scope of practice for DHs, DTs and OHTs is expanding beyond a well-defined list of duties, which may be increased via active participation in CPD. I have no doubt a result of the DHAA state branch volunteers, the activism of these volunteers who had the capacity to alter the narrative and build a better profession for us all. May the next sixty editions of the DHAA Bulletin see many more changes in the world of dental hygiene, dental therapy, and oral health therapy. DHAA Bulletin Editor bulletin@dhaa.info

TGA COMPLIANCE REMINDER TGA dental devices compliance reminder for dental hygienists and oral health therapists New definitions for medical devices (including a range of dental devices) that are personalised to suit an individual patient or health professional commenced on 25 February 2021. The majority of the medical devices previously eligible for supply under the custom-made exemption will meet the new definition of a patient-matched medical device and will therefore require inclusion in the Australian Register of Therapeutic Goods (ARTG). The new requirements had the potential of adding a significant amount of administrative work and compliance costs for dental practitioners, and a deadline for notification to TGA was set for 24 August 2021. To provide advice to the TGA on the

implementation of the changes, the DHAA has joined another six professional and industry bodies to establish the Dental Sector Working Group (DSWG). The group has collectively advocated on behalf of the dental sector and met with the TGA over the last three months discussing many practical issues arising from the new legislations. Through the hard work of the DSWG, the TGA conducted an additional consultation on the issues raised, which led to further refinements of the legislations: You can read the amendments here: • Therapeutic Goods (Excluded Goods) Amendment (Personalised Medical Devices) Determination 2021 LINK • Therapeutic Goods (Medical Devices— Specified Articles) Amendment (Personalised Medical Devices) Instrument 2021 LINK

These refinements have moved the ARTG registration obligations to providers of the materials and

components that practitioners use in our practice. In other words, so long as dental practitioners are using TGA approved materials and components, there is no need to have the products made for individual patients listed in the ARTG register. This is a major advocacy achievement and we are grateful for the enormous amount of hard work put in by the members of the DSWG. Practitioners who no longer need to transition as a result of these changes (including those who already have submitted a notification to TGA) do not need to take any further action at this point in time. The TGA will follow up in the coming months with further guidance and offer an opportunity for transition notifications to be “archived”. This means they will keep a record that a registration was received, but the person who made it will no longer receive emails and updates about the transition period. More details can be read here.

The Tooth Fairy’s Best Friend Digital Oral Health Literacy Project ADHF Wrigley Grant Winner The Australian Dental Health Foundation (ADHF) and Mars Wrigley Foundation recently announced the recipients of the 2021 Healthier Smiles Community Service Grants. Congratulations to the Carevan Foundation and our own DHAA member, Cathryn Carboon, for receiving a grant to promote oral health literacy as part of the Carevan Sun Smiles program. To help improve oral health outcomes for some of the most vulnerable in the community, the Carevan Foundation’s Sun Smiles Team, led by Cathryn Carboon, will work closely with a multidisciplinary team of Deakin University FreelancingHUB students to develop a suite of digital oral health resources based on the successful children’s picture book “Who is the Tooth Fairy’s best friend?” An interactive version of the book will bring the pages alive with animation and narration. These resources will be available on the Dental Hygienists Association of Australia consumer website and through social media channels. Additionally, as part of the program, more than 1000 primary school children in Homebush West, Albury and Wodonga will receive a Tooth Fairy Kit, children’s toothbrushes and fluoride toothpaste. This initiative is a great example of pivoting to online digital oral health literacy resources to meet the challenges of delivering oral health promotion during the ongoing pandemic. We look forward to sharing the project outcomes at the National DHAA Symposium in October!

FROM THE TOP

Employing our professional judgement

Bill Suen DHAA CEO

We all need to mindful of our own welfare, and that of our patients, during these challenging times THE ENVIABLE COVID-free environment that most of Australia had enjoyed came to an abrupt end with the highly-contagious Delta variant outbreaks that have emerged across the country over recent weeks. During the early part of the pandemic, non-urgent dental treatments were invariably suspended to minimise the chance of Covid-19 transmission. However, it is becoming apparent that delaying the public

“ It's time for us to rise to the occasion and act in the best interest of the patients we serve and be proud to act as independent practitioners.”

from seeking less urgent treatments may be problematic, leading to a significant increase

can be (and should be) deferred, it may

in preventable medical and dental conditions

be ‘essential’ for those who have more

down the track. Furthermore, closing or

complex oral and systemic diseases,

patients without appropriate clinical

restricting private dental clinics during a

where treatment deferral may put them

considerations is unprofessional and

lockdown will put additional pressure on

at unacceptable risk. Refusal to provide

irresponsible during a lockdown. And,

emergency public dental services that are

essential treatments in some cases may be

AHPRA would expect each individual

already stretched. As a result, some state

regarded just as unprofessional as seeing

practitioner to make the appropriate call

health authorities are now allowing dental

patients requiring non-essential treatment.

for their own patients.

practices to operate under lockdown, and

Each case is different and the factors

Practitioners who coerce others to act

asking dental practitioners to exercise their

to be considered are often multi-faceted

unprofessionally are notifiable to the Dental

professional judgement to determine if the

and complex. It is both impossible and

Board/Council. Management who coerce

treatment is appropriate and essential for

inappropriate for authorities and peak

employees to practice in a way that is

the best interest of the patients. Practitioners

bodies to list the treatments that can, or

unsafe for the staff and/or the public could

are asked to take a risk-based approach to

cannot, be provided during lockdowns.

be prosecuted under state work-safe and

balance the risk of treatment delays with the

All independent practitioners, dental

treat or to defer on their dental record. Making blanket decisions to treat all

commonwealth fair-work legislations.

likelihood of transmission and the need for

hygienists, oral health therapists and

It's time for us to rise to the occasion,

movement restrictions.

dental therapists should review each

to exercise our professional judgement

patient on a case-by-case basis. Given

in accordance with the AHPRA code of

to ascertain if practitioner judgement is

that pre-screening is a requirement, we

conduct, to make decisions and to act

required or allowed. This may change due

should consider each patient’s situation

in the best interest of the patients we

to varying circumstances.

prior to confirming the appointment, and

serve. Be proud to act as independent

document the rationale of the decision to

practitioners. n

Practitioners must check lockdown orders

While routine dental hygiene work

50 years and counting... Discover the origins of our profession as the Australian Dental & Oral Health Therapists’ Association (ADOHTA) invite us to celebrate 50 years of dental therapists providing care to children and adults in Australia by Dr Nicole Stormon, ADOHTA President, BOH, PhD EHEA

or fifty years, our professions have undergone multiple transformations and there is an increasing recognition of the important work we do to improve the oral health of the community. This milestone was celebrated at the ADOHTA across Australia developed school dental 6th International Conference (2-4 programs modelled on the New Zealand September 2021). program and began training DTs.3 Dental therapy originated from New While dental therapy was being Zealand 100 years ago in 1921. Due to established in the 1970’s in Australia, the deteriorating oral health in New the dental hygiene profession was Zealand in the 1920’s, a new profession also being introduced in Australia and of dental nurses was established to New Zealand.4, 5 Modelled from dental provide routine hygienists (DHs) in dental care for the United States, “ Due to the deteriorating school children.1 DHs were trained oral health in New Dental nurses were in New Zealand by Zealand in the 1920’s, a taught to work the Army to service within the school new profession of dental only its personnel.4 service and were to In Australia, DHs nurses was established practice ‘absolute to provide routine dental were trained and standardisation licensed to practice care for school children” only in private of techniques and rigid uniformity of dental clinics.5 In the 1 instructions and directions.’ Despite late 1990’s, Australia introduced dual resistance from the broader dental training courses producing practitioners profession, dental nurse training was registered as oral health therapists established throughout the country (OHTs) or dual registered as DTs and DHs. and the prevalence of untreated Historically, dental diseases in the child population only females lowered.1 Other countries such as were permitted the United Kingdom and Canada to undertake dental nurse training in subsequently introduced dental Australia and New Zealand.3 Femaletherapists (DTs) in the 1960’s modelled only programs ceased in the early 1980’s from New Zealand’s school dental and oral health programs transitioned nurse.2 Between 1966 and 1976, states to university training courses in the

early 2000’s.8 Despite current programs including males, the current oral health professional workforce in Australia and New Zealand consists of mostly females, estimated to be 80-95% of the workforce according to the literature and available workforce data.7, 9 Other countries such as the United Kingdom and Canada introduced dental therapists (DTs) in the 1960’s modelled from New Zealand’s school dental nurse.9 n References 1.Leslie GH. More about dental auxiliaries. 1971;16:201-209. 2.Larkin G. Professionalism, dentistry and public health. Social Science Medicine Part A: Medical Psychology Medical Sociology 1980;14:223-229. 3.Dunning JM. Deployment and control of dental auxiliaries in New Zealand and Australia. Journal of the American Dental Association (1939) 1972;85:618-626. 4.Coates DE, Kardos TB, Moffat SM, Kardos RLJJoDE. Dental therapists and dental hygienists educated for the New Zealand environment. 2009;73:1001-1008. 5.Wexler GJBjoo. Dental hygienists in Australia and their employment in orthodontic practice. 1995;22:98-100. 6.Dental Board of Australia. Registrant Data. In: AHPRA, ed, 2019. 7.New Zealand Dental Council. Workforce Analysis 2013-2015. 2017. 8.Satur J. Australian dental policy reform and the use of dental therapists and hygienists. Deakin University, 2002. 9.Mariño R, Au-Yeung W, Habibi E, Morgan M. Sociodemographic profile and career decisions of Australian oral health profession students. Journal of dental education 2012;76:1241-1249. 10.Spencer AJ, Lewis JM. Service-mix in general dental practice in Australia. Australian dental journal 1989;34:69-74. 11.Capparelli JL. Nursing Nuns: A history of caring—and changing the course of health care. AJN The American Journal of Nursing 2005;105:72H. 12.Pittman E, Fitzgerald L. The Campaigns for Men to Become Midwives in the 1970s. Health and History 2011;13:158-171.

We’ve come a long way The Dental Hygienists' Association of Australia was first registered thirty years ago. Our first president recalls those early years.

South Australia was well established and as a sign of goodwill donated $1,000 start-up funds to the National Association and continued to fund by Sue Aldenhoven AM, DHAA Founding President the activities and travel of the IFDH Delegates until the DHAA became fully ustralia is a young nation program for dental hygienists was held established and took over membership. when compared to those in concurrently with the ADA program. Support also came from Colgate the northern hemisphere ,yet Representatives from all state and Australia who offered corporate support we consistently achieve high levels of territory associations attended and in the form of logo design, letterhead success and standards on the world stage. unanimously agreed to form a national design as well as printing of stationery This is also true of the dental hygiene association. A draft timeline was agreed and a monetary donation. profession in Australia when one reflects and the writing of a Constitution. In In 2001 to coincide with its 10th on the achievements of the DHAA November 1991 the Dental Hygienists’ Anniversary the DHAA hosted the first at home and within the global dental Association of Australia Inc. was of two IFDH International Symposia hygiene community. registered in South Australia. Sue on dental hygiene, held in Sydney, From humble beginnings in South Aldenhoven was Australia. Being a young Australia where legislation was first elected as president. “ The background was association with limited passed and dental hygiene education International finances the national set to establish a established, the first dental hygienist recognition of the body established an representative body association formed, to the exponential Australian profession agreement with the that collectively spoke Branches to provide growth of our profession as other states came in June 1986 for, and represented and territories enacted legislation. when the South a percentage of their the profession on a Local dental hygienist associations Australia association surplus each year, to formed and the background was set became a member the national, in return national level” for the state and territory dental of the International for an agreed share of hygiene associations to come together Dental Hygienists’ Federation (now the surplus from the symposium. The to establish a representative body that IFDH) at a meeting in Oslo, Norway. second ISDH was held in Brisbane in 2019 collectively spoke for and represented South Australia remained the and was an enormous success. the profession on a national level. representative organisation for Australia These events raised our professional A meeting was held in Adelaide in on IFDH until DHAA Inc. was formed, profile and firmly established DHAA not March 1991 with the purpose of forming after which it relinquished its position only in Australia but on the international the Dental Hygienist Association of and passed membership on to the stage. As a consequence it provided Australia Inc. This meeting coincided National Association at the IFDH House a sound financial base upon which to with the ADA Congress that was being of Delegates Meeting in The Hague, further our goals, support our members held in Adelaide and a stand-alone CPD Netherlands, in July 1992. and strive for new horizons. n

10 DHA A M E M B E RS G IVIN G BACK ESESSON FOUNDATION IS a non-profit organisation that’s current

intervention and a compromised quality of life to name a few. We

initiative is to provide free dental care to underprivileged children.

all strive to educate our patients and treat them to the best of our

Qualified dental practitioners donate their time to provide

abilities to avoid these consequences. There is a silent problem, how

comprehensive treatment to children in vulnerable high risk groups

can we help those that don’t come to us? Can’t afford to see us?

– refugees, asylum-seekers, special needs and low socio-economic.

Cultural barriers? Transportation issues? We as a collective can do

Practitioners are supported by volunteer dental assistants and

something. We can raise awareness of this disparity, we can donate,

dental students who provide oral hygiene instruction, preventative

we can have a voice for those that cannot speak and we can change

education and clinical chairside

the methods of care delivery by tailoring

assistance to ensure the children have

it to the people that need it.

a positive experience. I can attest to

My day of volunteering was held at

the positive experiences, as I heard a

Mint Dental owned by the very lovely

great deal of laughter during my day

Dr Vicheka Lim. The children were

of volunteering.

transported to the clinic where they

Dr Ajitha Naidu Sugnanam is

were greeted by a group of amazing,

the managing director of Esesson

kind and positive volunteers headed

Foundation and has initiated this

up by the absolutely lovely Olan. These

much needed program. When Dr

volunteers played games, gave oral

Sugnanman became aware of

hygiene instructions and preventative

children with significant unmet oral

dental education... Oh, and they provided

health care needs she developed

snacks! Healthy food and snacks were

a program which aimed to provide

distributed in a fun environment while

quality, comprehensive and timely

the children enjoyed their day at the

care to reduce pain and compromised

dentist. Dr Krutika Shanbhag was

quality of life, as a result of untreated

assisted by her very helpful assistants

dental disease. Dr Sugnanam spent

Zena Safa and Tanvi Shanbhag and I

over a year to research, plan and

was assisted by Griffith University dental

collaborate with stakeholders to bring

students Selina Tran and Reivan Daddoo.

her dream into fruition. The program

My students who not only provided

would not have been possible without

clinical chairside assistance but also

the further help of sponsors; “All

afforded me the opportunity to teach

Access Community Services” in

them and answer any questions in a one

conjunction with practice owners who donated the use of their practices as treatment facilities. After hearing about Dr Sugnanam’s vision for helping underprivileged children I was moved and offered to help. I believe every child should have the same opportunity to access both quality and timely oral health care services regardless of their differences in social, cultural, physical or economic means. In 2021, it is shocking and saddening that such a discrepancy

A VOLUNTEER’S TALE A day spent volunteering is good for the soul and you can learn a thing or two at the same time by Jamelle Knight BOralH ACP

exists in the availability of treatment. All

on one practical setting. Experience I would have benefited from back in my university days! I have to commend people who have a vision for a better future in any capacity, like Dr Sugnanam who strives to improve the oral health of underprivileged children. This program not only benefits the children, it benefits their families and the community as a whole. Many hands make light work and as a group of smart, conscientious and passionate oral health care professionals, together we can make a difference. n

children regardless of their SES status or their ability to access care services, have a fundamental right to

Jamelle (pictured in the centre) is a DHAA Qld Committee Member

timely oral health care.

and owner of Dental on Nexus. To donate to the foundation or to get

As dental professionals we all know what the consequences are of not having dental treatment. Pain, infection, swelling, hospital

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OVID-19 lockdown continues, and dental surgeries continue to go in and out of lockdown for the foreseeable future, patients are having to take responsibility for maintaining their own dental health – and, importantly, that of their children. With regular check-ups, hygiene appointments and the availability of fluoride treatments suspended, it’s more vital than ever that children are encouraged to keep their teeth scrupulously clean to avoid problems developing while they can’t get in to see the dental team. In addition, other effects of the lockdown have been that children and adults alike are spending more time on their screens and devices, and they appear to be grazing and snacking more – which is likely to store up dental problems if dental hygiene isn’t kept up to scratch. Every time a person consumes a sugary snack or fizzy drink, the pH in the mouth is lowered, and it takes 2-3 hours for this level to return to normal. If another snack is consumed within that time, the mouth does not have time to recover, and the risk of demineralisation rises (Figure 1).

Worrying statistics Even before the lockdown, however, children’s dental health was giving cause for concern, both in the Australia and elsewhere. Despite being entirely preventable, dental caries remains one of the commonest diseases affecting young children. Around 1 in 4 children (27%) have had atleast one deciduous tooth with untreated decay. With 38% of those affected living in remote areas. Even more of concern, 1 in 10 children aged 6 to 14 had atleast one permanent tooth with untreated decay. (22% for those living in remote areas). In recognition of this growing problem, the advice is to use a fluoridated toothpaste of 1000 - 1500 ppm fluoride for ages 6 and over, 1400 ppm plus being general adult strength toothpase. However, a drawback of conventional toothpaste, based on soluble fluoride, is that although it delivers fluoride at the time of brushing, this level drops away to

The innovative tecnology behind BioMin F for Kids can offer enhanced dental protection to children who can’t get into see a dental professional during lockdown

non-therapeutic levels within 90 minutes. Even with high concentrations of fluoride, the protective effect of the fluoride is compromised. At the same time, many parents are concerned about giving their children high levels of fluoride because of the perceived risk of fluorosis. The challenge has been to develop a toothpaste which continues to deliver fluoride at a low, controlled dose over several hours, continuously protecting the teeth and enabling remineralisation. BioMin F, based on innovative bioactive glass technology developed in the laboratories of Queen Mary University, London, works in exactly this way, mimicking the natural processes in the mouth to restore the pH and remineralise damaged tooth enamel to strengthen and protect the teeth. Following brushing with BioMin F, the tiny particles adhere to the tooth surface, where they gradually dissolve for up to 12 hours, releasing a controlled supply of fluoride, calcium and phosphate ions in the optimum ratio to produce fluorapatite, the fluoride analogue of natural tooth mineral. This is precipitated onto the tooth surface, remineralising damaged tooth enamel. Research (Bakry et al 2018) has shown that BioMin F remineralises not just the surface but also penetrates into the sub-surface enamel, replacing lost mineral there too. At the same time as the mineral ions are released, the dissolution of BioMin F leads to a rise in pH, hence protecting against demineralisation of the tooth. Additionally, as mouth acidity increases, for example following consumption of a sugary or fizzy drink, the particles start to dissolve faster to restore the pH balance and remineralise the tooth enamel.

BioMin F For Kids The benefits of BioMin F are now available in a toothpaste specifically designed for children. BioMin F for Kids has the same fluoride strength as original BioMin F (5%, which equates to 530 ppm fluoride). This is considerably lower than the concentration of conventional toothpaste, but the level of fluoride remains higher and the protective effect remains for longer (Figure 2). A recent study in children (Garg et al, 2020) illustrated this by comparing fluoride retention levels after brushing with BioMin F and Colgate for Kids. The level of fluoride in the children’s saliva was compared after 30 minutes and one hour, and while the fluoride levels in the soluble fluoride group had dropped back to baseline, the BioMin F group of children continued to have raised levels for considerably longer. The researchers concluded: ‘These

new technology dentifrices could be a means of reducing the fluoride content of toothpastes for children, while ensuring adequate concentrations are maintained for longer. Therefore, fluoro calcium phosphosilicate toothpastes may provide a new direction for caries prevention.’ BioMin F for Kids is aimed at children aged three and over (inc adults not liking mint), and has a strawberry flavour. Feedback on the taste and texture from children trialling has been very positive. It comes as a silvery coloured gel that does not contain titanium dioxide, and has of course undergone all the required cytotoxicity and biocompatibility studies required for sale. It is dairy free and suitable for vegans. A friendly dinosaur character, Bino, has been developed to appeal to children’s imagination and support the launch of BioMin F for Kids. Bino appears on the packaging, and other support materials such as reward stickers, colouring-in sheets and advice notes for children and parents. These can be accessed via the BioMin F website.

Enhanced protection Coronavirus lockdown is not going to end permanently any time soon and it may take years before any kind of normality returns to dental practices. In the meantime, the innovative technology behind BioMin F for Kids can offer enhanced dental protection to children who can’t get in to to a dental surgery.

References Bakry AS et al (2018) A novel fluoride containing bioactive glass paste is capable of re-mineralising early caries lesions. Materials 11 1636 Garg et al (2020) Comparative retentive levels of fluoride levels in saliva following toothbrushing with sodium fluoride and fluoride-containing bioactive glass dentifrices in children – an in vivo study. HealTalk 12;3:56-58

BioMinFforKidsisavailable instrawberryflavour, recommended retail price $8.50. Pack size 50g. For information or to place an order, go to BioMinToothpaste.com.au or call 0438 586 878 Figure 1: Comparative pH levels between grazing and eating only main meals

Figure 2: Fluoride levels after brushing

We hope to see you at the DHAA National Symposium Fingers crossed we are all out of lock-down!

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A devotion to dental DHAA Life Member Joan James fondly recalls her dental hygiene journey – from the early days of the industry in Australia to some of the more disappointing decisions being made by the authorities

y dental hygiene journey started in small-town USA. My father was a dentist in Nebraska, and I assisted him after school and during school vacations. However, I was not aware of the profession of dental hygiene until I went to the University of Nebraska in 1970 (majoring in interior design) and found part time work assisting in the student health centre dental clinic. The dentists in the clinic encouraged me to apply to the four year bachelor’s degree program in dental hygiene. I was accepted into the program after doing a year of prerequisite study (after two years in my original program) while working full-time in the health clinic as a nurse’s aide. All dental hygiene subjects and clinical practice were delivered at the University of Nebraska Dental School. In the clinic we wore white (nursestyle) caps and white pant uniforms, no masks, gloves or eye protection. Infection control has come a long way since then! Upon graduation in 1975, I was employed by a dentist in Billings, Montana but soon returned to Nebraska to practice. I moved to Brisbane in

July 1977 with my future husband, an Australian, whom I had met while he was teaching orthodontics at the University of Nebraska Dental School. Dental hygiene practice was not legally allowed in Queensland in 1977 – the Dental Act allowed only dentists to practice intra-orally. I found employment as a dental assistant and was fortunate enough to work chairside with a periodontist (and a good friend), which kept me up-to-date with current trends in preventive dentistry. During that time, South Australia offered a dental hygiene course and, along with SA, other states were starting to allow the practice of dental hygiene. In 1987 the Queensland Dental Act was changed to allow qualified dental hygienists to 'list' with the Dental Board of Queensland to practice dental hygiene. Overseas-trained hygienists were required to sit a proficiency exam. The written exam was delivered in Brisbane in the early years, but the clinical exam was given in Adelaide at the Gilles Plains Dental Clinic. The Adelaide exam component was challenging and extremely unpleasant— as experienced by many other overseas-trained hygienists.

Upon completion of that exam, I felt fortunate to be able to return to the familiar periodontal practice, employed as a dental hygienist. I practiced there for 21 years, leaving private clinical practice in 2011. During that time, I was occasionally involved in the clinical assessment of students in the Academic Upgrade Program at the University of Queensland (UQ) School of Dentistry. The program (subsidised by Queensland Health, available from 1998-2005)

“ At the end of my professional life, I was an advisor with Dental Protection Limited, an indemnity insurance provider. That was very rewarding work in that esteemed organisation, and I would have relished it had I been 10 years younger!”

Left-to-right: 2005 DHAA Symposium brochure cover; presenters and DHAA Committee – Uluru 2005; Joan James presenting Len Bray with award for his services – Uluru 2005; Anna Pattison and husband Gordon, Robyn Watson & Joan James – 2006

provided school dental therapists with dental hygiene skills to add to their scope of practice. From 2009-2013, I was a part-time clinical supervisor and lecturer in the University of Queensland Bachelor of Oral Health (BOH) program. And for a short time, at the end of my professional life, I was an advisor with Dental Protection Limited, an indemnity insurance provider. That was very rewarding work in that esteemed organisation, and I would have relished it had I been 10 years younger! I was one of the foundation members of the Dental Hygienist's Association of Australia (Queensland Branch) and the inaugural president from 1991-1992. I eventually represented Queensland on the DHAA Inc. National Council and then served as national president from 2005-2006. During that time, one of the most rewarding activities was leading a team that organised the 2005 National Symposium at Uluru—'Oral Histories: Pacific Perspectives of Indigenous Oral Health'. We enjoyed a wide-ranging program around that theme, including international presenters, and a very memorable social program. It was always a pleasure to work with other dental hygienists on professional

committees and some of my dearest friends today are those I met through the association. One very challenging (yet rewarding) CPD activity that several of us organised at national level was a road trip around Australia with Anna Pattison. Anna was the 'guru' of periodontal instrumentation at the time. We booked the venues and all that was required for her clinical workshops, then accompanied her to Sydney, Adelaide, Perth, and Brisbane. Also during my time on the National Council, the first DHAA online database was developed, thanks to the invaluable expertise of Len Bray. Len was the husband of DHAA member Deb Bray, who served as DHAA secretary for some years. During my professional life, I enjoyed attending several International Symposia of Dental Hygiene (ISDH) in Sydney, Madrid, Glasgow, Toronto, and Brisbane. I was also honoured to be a member of three Australian Dental Council accreditation teams, and it has been very pleasing to see the growth of the profession in Australia over the years since 1977. However, more recently it has been disappointing to

see programs terminated. Why aren’t programs valued for the preventive oral health skills of the hygienist and OH—skills that can greatly benefit individuals and communities? For example, with an ageing population that is rapidly growing, hygienists and OHTs are perfectly placed to deliver invaluable preventive and screening oral health services in under-serviced residential aged care centres. I’m hopeful the DHAA can lobby the relevant government and regulatory bodies for recognition and integration of those services in the near future. I am now fully retired and enjoy golf at least twice a week. I was a member of the golf club Women’s Committee for six years and served as President from 2019-2020. I am active in a local group of St. Vincent de Paul and continue involvement in a book club established over 30 years ago. I enjoy singing in church choir and with larger groups from time to time. I travel back to the USA every year (notwithstanding pandemics) to keep in touch with my American family. However, I feel very privileged to live in Australia and to have had a very satisfying career in dental hygiene here. n

The DHAA wouldn’t be able to run without the time and effort of so many amazing volunteers. Our volunteers come from a range of backgrounds and help out with everything from planning and running events right through to advocating for the profession. So let’s take a moment to get to know some of our volunteers and what it is they do.

COMMITTE E VO L U N T E E R

Below: Jen's grandparents Margaret and Peter Goldsmith – Jen's grandparents. Margaret was a huge influence on Jen; Right: Jen (left) and Lizzy (Queensland deputy chair) at the Making a Splash event

Jen Turnbull What’s the most satisfying career experience you have had? I recognised a patient wasn’t healing periodontally. They seemed down and just didn’t look great, they were overly unwell. They were quite stressed and hadn’t been looking after themselves due to mental health issues. We had a good chat and I encouraged them to see their GP to have a health check. They found out that not only did they have diabetes but also an underlying heart condition that they weren’t aware of. They got a mental health plan too. I was really happy that I encouraged them to seek further advice. Something about you that your peers don’t know? I used to be a marching girl when I was in primary school in Tasmania. Who is the person that most influenced you and how? My Maternal Grandmother, Margaret Goldsmith. She has always been a strong influence in my life. She was smart, dedicated to her career (Nursing Matron), and very stoic. She

was always encouraging me to pursue my goals, reminding me that the hard work would pay off. After leaving the Navy, I was speaking to Julie Smyth-Stoitis about a career change. She introduced me to Dentistry but I didn’t think I was smart enough to go to university and become a dental hygienist, but my Grandmother told me that I could and would succeed. I joined Curtin University in WA in 2008 and graduated in 2010. Tell us about your current role with the DHAA, and why you decided to get involved. I am the current chair for Queensland. This involves planning and running our local

Far left from top: Jen says, "White girls can jump"; Jen and her graduating class; posing with her local parkrun team – where she also volunteers; Right: Trail running with friends

events and I was involved with the provider number advocacy and got to speak to my local member to raise this important topic with them. Recently I submitted suggestions of changes to the Queensland Radiation Safety legislation in their current review. I decided to become involved in the Queensland committee after a break from serving on the Western Australian and Tasmanian Committees (over the years). What’s the thing you’re most proud of from your time as a volunteer with DHAA? Being able to elicit change within the industry and not being an observer. What are you currently reading? Honestly, textbooks! I am studying at university again, this time at the University of Southern Queensland. Biology and Pathology is so interesting but so heavy in content. The human body is so interesting. Where do you go to escape? I love doing a five-kilometre run on a Saturday morning at my local parkrun. I sometimes do a tourist parkrun and enjoy a post run breakfast with my running friends. On Sundays I do my long run on trails. It’s so good being in South East Queensland because we have so many beautiful places to explore. n

CAREER DEVELOPMENT

Navigating mayhem Discovering how oral hygiene professionals have managed their time and career development through the pandemic By Melanie Hayes

THE GLOBAL PANDEMIC has initiated all sorts of unprecedented and unusual challenges for society – social distancing, mask wearing, lockdowns, home schooling and toilet paper shortages just to name a few! It is therefore reasonable to expect that there will be a knock-on effect on an individual’s career development. For many dental professionals the impact on their work-life has been immediate, with reduced or flexible hours, new requirements to work remotely online, or periods of leave or even job loss due to the shutdown of clinics and other workplaces. For some of us working outside of a clinical setting, for instance, in academia, management, or policy, workload have increased significantly pushing employees to their capacity. These immediate effects may also impact on job satisfaction, commitment, and attitudes to work. (Spurk & Straub, 2020). Disruptive and extraordinary events

such as global pandemics, have the ability to create “career shock” for individuals and organisations (Hite & McDonald, 2020). Organisations have had to be flexible and adapt the work environment, while potentially under financial strain. As individuals, we may reconsider our career choices, especially if job loss is experienced, or work roles significantly change. As the boundaries

might otherwise have not presented themselves. This edition, I asked a few of our oral health community to share with us how the pandemic has impacted their work life and careers. As you can see, while most have recognised the challenges and struggles faced working during the pandemic, they have also identified opportunities to improve or refocus

“ As we navigate the pandemic and consider what our postpandemic work life might look like, what is clear is that change is inevitable. With change can come opportunities that might otherwise have not presented themselves” between our work and non-work lives begin to blur, many may re-evaluate the priority they place on work. As we navigate the pandemic and consider what our post-pandemic work life might look like, what is clear is that change is inevitable. With change can come opportunities that

their work tasks and priorities, which will hopefully have a positive impact on their careers in the years to come. I hope some of their insights resonate with you, or alternatively, that they give you a fresh perspective as you try and navigate your own career through this pandemic.

19 Lyn Carman, Dental Hygienist and Director of Lync Consulting

I was working on rural and remote projects which like everything came to an abrupt end, I was planning to take on some locum work as my consulting business grew organically – everything stopped! I knew once practices opened again their focus would purely be on getting patients back in, working on a backlog of patients and working out how to work in the new normal. I took a job for three months working in a Telstra call centre – that was an experience! Then we all began the journey back. Overall, I am so very grateful, the place I have created for my life has meant that the pandemic has not impacted me greatly. It has enabled me to focus on my direction to be able to support individuals and practices meet their needs better. I am constantly reminded to focus on what is within my control, as there is so much that isn’t. I feel as though among all the disruption, the tough issues for many and I have great empathy, I have been given the opportunity to seek the learning and the positives to come from this time.

Kelsey Ingram

Dental hygienist and PhD candidate On the one hand, the pandemic has created stress in my work life, particularly early in the pandemic when we did not know much about Covid-19 and the limited

work experienced with lockdowns. However, on the other it has given me time to invest in research studies and developing an additional career path

Melinda Alchin

Dental Hygienist and University Clinic Manager The pandemic has allowed me to work from home which saves time in travel and allows for other things like gardening. I feel for the students as they want or need to get their practical work completed. The academics are managing so many changes to allow for online teaching as best as possible. We are all trying our best in these times!

Assoc Prof Janet Wallace OHT and Academic, University of Sydney

Working from home definitely has advantages, the ability to attend a million Zoom meetings a day, with people from all over Australia and the world. No driving to the airport, no turbulence while flying (I don’t love flying), no hotel rooms, no taxi trips that seem to take forever, because you’re in another state or another country and have no idea where you are going. I hyper-focus in my home office, work endlessly, before I realise it the sun has gone down and I’ve been sitting in front of my laptop for hours and hours. I can churn out documents and complete tasks, meet deadlines and tick off the ‘to–do’ items on my daily list with total joy.

But, what I can’t do in this pandemic work world, is chat to my work colleagues/ friends, face-to-face, walk to the café and share a coffee, exchange small talk about the weather, the government, children, grandchildren, or the latest version of 'The Voice’ and I miss that in this pandemic world!

Tabitha Acret

Dental Hygienist and Education Manager, EMS Oceania Covid-19 and my career has been a win-lose situation. While myself, along with the majority of dental clinical across the world, lost hours and wages due to lockdown last year and again unfortunately this year and there are the obvious negatives associated with this. I have still been able to have some wins and positives come out of Covid. The extra time from not working and travelling as much has meant I have been able to focus on myself and learning. Last year, I started and finished a graduate certificate in public health, started a podcast with one of my good friends in the USA called Disrupting Dentistry, and we were recently ranked top 40 health podcasts in the USA. This year I started my own private CPD business called Level UP Preventative Care providing small group CPD workshops. So overall, there have been some major positives to my career during this time that I may not have taken the leap to do if I wasn’t stuck at home for so long.

Fran Clarke

Dental Hygienist and practice owner My workload significantly increased due to additional tasks moving to essential treatments and managing Covid-19 within my dental practices. There was initial staff stress as the uncertainty of lockdowns loomed. The massive extra workload managing people under stress has increased my own stress. But to lead a team I know that I need to be mentally well. This has meant I focus more on my well-being and take actions to care for myself more so than before the pandemic. My staff with children have a higher workload trying to balance paid work with home schooling responsibilities. So I’ve tried to have consistent communication and interaction with employees to strengthen and enhance our work/life culture. At the end of the day, we are all human, and every one of us may be impacted by Covid-19 so I consistently support of all my staff in any way possible. Their wellbeing is always at the forefront of my mind. References: Hite, L. M., & McDonald, K. S. (2020). Careers after COVID-19: challenges and changes. Human Resource Development International, 23(4), 427-437. Spurk, D., & Straub, C. (2020). Flexible employment relationships and careers in times of the COVID-19 pandemic. Journal of Vocational Behaviour. Vol 119; 103435.

CPD SPECIAL

Manage your own CPD future CPD can unlock so many options for career development and advancement, but who determines your requirements? By Robyn Russell

ontinuing Professional Development or CPD as it is more commonly referred to is an essential element of any health professional’s career. Some may see this requirement as a necessary task, whereas others relish in the opportunity that participation creates. Whatever your personal bias, the overarching goal of participating in any CPD activity should lie in the relevance or validity of the learning experience to your own particular journey. Participating in CPD can offer clinicians

valuable learning opportunities to explore and add to their repertoire of clinical offerings. CPD can open the gates to create a valuable and fulfilling career in dentistry. The investment of time and money in such activities can be returned ten-fold with careful consideration and goal setting. CPD may offer a platform for connection with like-minded clinicians to collaborate and co-discover emerging techniques and technologies. Many clinicians become isolated in their practice and the ability to attend events and discuss the issues with others can

also provide a positive outlet. While COVID has restricted the travel element of many CPD opportunities. The time will come again when travel is easier, and the great joy of travelling to a location and participating in an event with you peers will return. Having an event to look forward to and learn with fellow clinicians often leaves the practitioner feeling rejuvenated upon their return to clinical practice, having had a learning 'fix'. AHPRA definition for CPD states:. “Continuing professional development

(CPD) is how health practitioners maintain, improve and broaden their knowledge, expertise and competence, and develop the personal and professional qualities required throughout their professional lives. Health practitioners who are engaged in any form of practice are required to participate regularly in CPD that is relevant to their scope of practice in order to maintain, develop, update and enhance their knowledge, skills and performance to help them deliver appropriate and safe care.”

The Dental Board of Australia (DBA) has produced guidelines for CPD. These guidelines are relevant for all dentists, dental therapists, hygienists, specialists, oral health therapists and dental prosthetists. Exemptions are given to practitioners who fall into the following categories: non-practicing registrants, practitioners with limited registration, practitioners about to sit an examination or student registrants. The DBA encourages dental practitioners to engage in CPD activities each year and accumulate a total of 60

hours over a three-year CPD cycle, 48 hours of scientific content (80%) with a maximum of 20% non-scientific content. The DBA has also written guidelines on how to choose appropriate CPD activities. The DBA no longer certifies or endorses any CPD courses. It is up to each practitioner to determine the relevance of the CPD activities to undertake. Some historical recommendations put forth by the DBA include the CPD provider disclosing the monetary or special interests they may have with

any company whose products are discussed at the course and the scientific basis of the activity should not be misled by commercial considerations. The training should address contemporary clinical and professional issues and reflect current accepted dental practice whilst based on critical appraisal of the scientific literature. CPD activities should also provide opportunities for enquiry, discussion, and questioning to confirm that you have correctly interpreted the information on offer. The DBA is also keen to stress that practitioners remain mindful that any single CPD activity may not provide them with enough clinical experience to incorporate new techniques and procedures into practice. Many practitioners have also found this to be true, you may need to perform procedures in a simulated environment many times before you add a new service to your scope of practice. While these recommendations are relatively comprehensive the onus is still on practitioners to assess the relevance of the CPD activities they participate in. Having said all of that though there is a plethora of CPD activities available in the marketplace.

The function of CPD

When dental practitioners graduate from a training facility their qualification is ratified by the Australian Dental Council (ADC). The conferment of this degree qualification allows the graduate to obtain registration as a dental practitioner with the Australian Health Practitioners Regulation Agency (AHPRA.). AHPRA recognises divisions within the practice of dentistry, these practitioner divisions include: dental hygienist (DH), dental therapist (DT), oral health therapist (OHT), dentist, dental specialist, and dental prosthesis. The scope of practice for each member of the registered dental team depends on their education, qualifications, training, experience, and competence. The DBA

expects each individual practitioner to know their own scope of practice, and in quoting the DBA: “Practitioners who wish to broaden their knowledge, expertise and competence may do so by completing continuing professional development (CPD). However, completing CPD is not enough to move from one division of registration to another” So, what does this mean for DHs and OHTs? If you wish to change your current scope of practice, CPD is the way to do this. The DBA has removed the endorsement of courses which have

“ The scope of practice for each member of the registered dental team depends on their education, qualifications, training, experience, and competence” previously been used to substantiate a change to scope of practice. The thinking from the DBA behind this change was to bring OHTs, DTs, and DHs in-line with general dentists. For example, in the event a dentist decides they wish to add the placement of dental implants to their current scope of practice they undertake CPD training to gain this skillset. This CPD training may take the form of many individual CPD events, with the dentist only deciding to add the new procedure to their skillset when they are satisfied that they are suitably educated, trained and competent to do so.

There is no 'Golden Goose', or single determinate of scope of practice for each dental practitioner. Just as many practitioners may have gained a degree from a teaching institution which covered the necessary elements for ‘adult scope' OHT status, the practitioner could well have not performed these skills since graduation, some five years prior. Is the practitioner still scoped to perform these procedures? Another question for each practitioner to ask themselves is; 'Am I educated, trained and competent to do so?' If not, then CPD is required.

The DBA does not offer any differentiation of registration division for dental auxiliaries such as OHTs who may or may not have the implied status of a ‘adult scoped OHT'. This has created a lot of confusion amongst the dental profession. CPD is the only way OHTs can equalise their scope of clinical practice. This CPD opportunity may be delivered by universities and other training organisations, or a culmination of the two. It is important for dental practitioners to remember that The DBA and ADC do not endorse or ratify any CPD courses to change a scope of

practice for any dental practitioner, regardless of registration division.

Self-reflective tool, what is the relevance of this in my clinical practice?

The DBA recommends practitioners use the self-reflective tool to assess their current clinical competencies. This tool was created to assist practitioners to reflect on their own individual knowledge and skills relative to their current clinical practice. The DBA advocates the use of this reflective tool especially when individuals are

considering the following: Updating or refreshing their current skill set or knowledge base, changes in or around your workplace, when planning your CPD cycle, or when introducing both new technologies and/or treatments into your practice. The DBA also recommends regular discussions with your dental team to assist in determining how each dental practitioner can best serve their patient base. The team-based approach to dental care is strongly regarded by the DBA, with each member of the team to perform duties that they are educated,

trained and competent to do. The tool focuses on elements which influence scope of practice. These include: - education and training, competence and experience, registration requirements, legislations and regulations and clinical need. Each element has several questions or statements that the practitioner is to reflect on and respond to. The practitioner is to keep a copy of these responses for their own career portfolio. The full “know your scope, reflective tool”, may be found here. Correct use of the reflective practice

tool may assist all dental practitioners to self-determine their current individual scope of practice and their further requirement to participate in continual professional development activities.

What style of CPD is the right one for me?

CPD may be delivered in many formats, whilst most recently CPD has been delivered largely online or virtually. As we all know, dentistry is a highly technical and tactile profession reliant on fine motor skills and well-honed communication techniques. Many of

the nuisances required for the delivery of dentistry may not be able to be adequately delivered when relying solely on content delivered virtually. Whilst the current climate of social distancing and lockdowns have provided very limited opportunity for face-to-face transfer of information the reliance on free content delivered by companies selling both dental materials and equipment may prove to provide dental practitioners with a very biased view of contemporary concepts. Free CPD may well have a place in a practitioners CPD portfolio - pursuing

25 dental clinicians chose to change career paths, as often they do not have a direct career progression pathway or plan in place. Practicing without a plan for improvement or skill development can prove to be a fatal career move. Changing career paths because you are not satisfied within your current role is a more costly then seeking satisfaction via enhancing your current role or skill set. CPD may be the provide the answer for enhancing your satisfaction within your current profession. While the Dental Board of Australia determines the number of hours required in each CPD cycle; emphasising the need for 80% of scientific content, the

“ Correct use of the reflective practice tool may assist all dental practitioners to self-determine their current individual scope of practice” current, reliable information sources from both practicing clinicians and academics who adhere to evidence based best practice should also be at the forefront of the decision matrix. Sometimes it can be tempting to compile a list of random CPD hours with very little thought to the purpose for this list of hours. Having a purpose and being self-aware of your own limitations as a clinician should be the starting point for any CPD endeavours. Yes, CPD can be an expensive activity to participate in, but it can also be a very rewarding experience too. Many

definitive requirement lies in the 'why'? Why invest time, money, or effort in any endeavours? Is it to satisfy the requirements of DBA to complete the prescribed number of CPD hours, or is it to satisfy your own requirements to be the best clinician you can be? Is merely substantiating the requirements enough for the patients that you serve? Questions that many of us do not ask when contemplating a CPD course. Let your patients know you have completed the latest and most up to date CPD training. Keep them abreast of the pledge you have made to them

via your commitment to continual learning. In our profession it is all too easy to get tunnel vision and only concentrate on what is happening in our surgery at any one given time. It’s not merely about maintaining the current minimum requirements for CPD hours but adhering to the pledge you made to yourself and your patients that you would practice wholeheartedly. If you are still performing procedures the same way you did two, three, or five years ago maybe this is not a full measure of service or commitment. Creating a yearly planner of CPD events and learning goals for your clinical portfolio is a great way to ensure you are elevating your career to the level you aspire to. Whilst also considering the prescribed number of CPD hours required for the period, the content of this CPD is completely up to the individual practitioner. Your goal may involve enhancing the list of services you perform via adding to your current scope of practice. Alternatively, you may aspire to enrich the services you currently deliver by exploring a different way to perform this service. The current guidelines from the Dental Board of Australia recommend that practitioners only practice procedures that they are educated, trained, and competent to do so. Listening to presentations delivered by companies selling products, may not satisfy the personal obligation of each individual practitioner to elevate their clinical skills. Dental hygienists and Oral Health therapists have scientific minds capable of complex reasoning and seeking CPD that resonates with this is imperative moving forward. Elevating the profession of dental hygiene and oral health therapy through a continued commitment to excellence, both in clinical skill and communication whilst investing your time and efforts wisely in your CPD undertakings could deliver exceptional treatment outcomes for those you serve. n

Caring about aged care With Australia's aged care facilities seeing a growing number of residents arriving with their own teeth it's important that professional care is available on site By Shida Taheri

Education through Flinders University. In 2018, I was awarded the DHAA Award for Excellence in Clinical Education. As part of my graduate certificate studies, I focused on interdisciplinary facilitation specifically in the aged care setting.

Tina Pezzaniti 1. Can you tell us a little bit about yourself and your current experience? I am a dental hygienist and clinical educator in the Faculty of Dental Studies TAFESA, Advanced Diploma of Oral Health (Dental Hygiene). I have worked as a dental hygienist since 2004 in a variety of general dental practices across Adelaide and the Barossa region. I have completed a Diploma in Dental Hygiene, Diploma of Vocational Education and Training, Flipped Learning certifications and more recently a Graduate Certificate in Clinical

2. What are your thoughts on the oral health of our ageing population? More people are entering into Residential Aged Care Facilities (RACFs) with their natural teeth and associated oral health risk factors where there are often barriers to provision of daily oral health care. As oral health practitioners we understand the links between oral health and systemic diseases and have the skills and knowledge to provide the necessary support to this population. I believe all people should have access to services that optimise health and wellbeing.

THE NEWLY-FORMED DHAA Aged Care Chapter has set itself an ambitious target. The intention is to get half of Australian residential aged care facilities to be serviced by a dental hygienist or oral health therapist by 2026, and 80% by 2031. The chapter was formed by a special interest group (SIG) who are passionate about oral health and overall health of our ageing population. Numerous dental professionals and experts have provided much time and thought in this education module, which was launched in July 2021 With a mission to empower members with the information and skills they would need to see aged care patients at facilities; we catch up with a few members that have already jumped on board.

3. What made you sign up to the chapter? My interest in the DHAA Aged Care Chapter was inspired by discussions with my colleague Alison Taylor. Her passion for aged care is infectious. I have always had an interest in aged care, with my first job as a 13 year old being a paper round in the RACF behind my parents house. I now also have family members who reside in residential care facilities. I want to challenge myself and step out of my comfort zone to provide a needed service which will have a positive impact on older people’s quality of life. 4. Can you comment on your thoughts and experiences so far with the modules you have started? The education program is well designed. The learning modules are structured with purposeful learning activities that have contributed to my understanding of the content covered. The readings and

additional resources are up to date and current. This information is presented by a high calibre of presenters with a wealth of knowledge and practical advice. I am enjoying the learning so far, and excited to put it all into practice. 5. What do you hope to achieve by completing this education program? I would like to take this knowledge and implement a preventive oral health program in my local RACFs. I am also interested in gathering data to contribute to ongoing research in this area. I believe this education program will provide me with the tools to support me in making a difference in my local community. 6. What does optimal oral health care look like to you in the aged care community? I would like to see each resident supported with daily oral health care for the

prevention of oral diseases. I would like to increase oral health awareness for staff and families too. Ideally oral health should be embedded into the general care at RACFs with oral health professionals as part of the interdisciplinary team to support oral health assessment and facilitate appropriate referral pathways. 7. Do you have any other comments? I commend the DHAA for placing high priority on oral health for our ageing population, along with the tireless work in putting together the Aged Care Chapter and establishing the aged care education program. Thank you and well done!

my own mobile preventative dental care business. I’m wanting to have my own business so I can work around family hours. 2. What are your thoughts on the oral health of our ageing population? It absolutely breaks my heart to see the poor quality of care that the ageing population receives. It also saddens me to hear that my previous patients no longer see a dental professional for their regular preventative care because it’s too hard to get them to a dental clinic.

1. Can you tell us a little bit about yourself and your current experience? I’m an OHT. Have worked full-time hours over a mix in private general practice and ortho since graduating in 2012. I reduced to part-time hours when I had my children and I’m currently working casual (one day-a-week) at my old practice while I start

7. Do you have any other comments? I’m excited to be a part of this amazing journey and look forward to being able to help create awareness and provide exceptional professional clinical care and support for our much loved ageing population. Thank you for creating a supportive environment for oral health professionals to learn from.

5. What do you hope to achieve by completing this education program? Being able to provide the best possible care I can to the ageing population. 6. What does optimal oral health care look like to you in the aged care community? Having a dedicated oral health professional being available and accessible to aged care residents, either in

ability to look after ourselves diminishes as we age and we rely on other people, these care-givers are not trained to do this properly. 3. What made you sign up to the chapter? I own a business (Senior Dental Care) which delivers services to the elderly. It seemed like a no-brainer to sign up to the Aged Care Chapter. I love collaborating with like-minded people, I feel like we can make a difference if we are sharing experiences, knowledge and wisdom. 4. Can you comment on your thoughts and experiences so far with the modules you have started? I haven’t started the modules yet, but am very keen to.

3. What made you sign up to the chapter? I want to enhance my clinical and personal skills in dealing with the ageing population. 4. Can you comment on your thoughts and experiences so far with the modules you have started? I haven’t started yet... but hope to get right into it soon! I’m very excited.

Brie Jones

facilities, retirement homes or in their own homes.

Jacquie Biggar 1. Can you tell us a little bit about yourself and your current experience? I am currently working in private practice, Sydney University and Senior Dental Care 2. What are your thoughts on the oral health of our ageing population? There has been an overall decline in the oral health status of the ageing population. Older Australians are keeping their teeth for longer, and as a result the more teeth present in the oral cavity the more disease they actually experience. Our

5. What do you hope to achieve by completing this education program? A solid understanding of the bigger picture, rather than just what I’m seeing in practice and what I can read and research myself. 6. What does optimal oral health care look like to you in the aged care community? Carers, nurses and facility staff to be trained in how to provide oral health care, identifying oral health problems, and realising the impact these problems have on general health. Mobile dental providers having access to patients without the financial stress. n

CPD 0.5hr

Neurodegenerative conditions and oral health Self-record CPD hours for the time spent in reading this article (DHAA recommends 0.5 CPD hour clinical/scientific)

eurones are the building blocks of the nervous system which includes the brain and spinal cord. Neurones normally do not reproduce or replace themselves, so when they become damaged or die they cannot be replaced by the body. Neurodegenerative conditions through this destruction of cells cause problems with movement (ataxias) or mental functioning (dementias). Neurodegenerative conditions affect many activities, such as balance, movement, talking, breathing, and heart function. Many of these diseases are genetic. Sometimes the cause is a medical condition such as alcoholism, a tumor, or a stroke. Other causes may include toxins, chemicals, and viruses. Sometimes the cause is unknown. Neurodegenerative conditions can be serious or lifethreatening. It depends on the type. Most of them have no cure. Treatments may help improve symptoms, relieve pain, and increase mobility. Neurodegenerative conditions can have a profound impact on a patient’s oral health. As clinicians it is important to understand the ways in which these conditions impact oral health so we can reduce the barriers patients with neurodegenerative conditions face when receiving dental treatment or advice. This article outlines the main areas that impact the oral health of people with neurodegenerative disorders, and discuss management strategies for health professionals and carers.

Limited mobility/ coordination By the DHAA Special Needs Dentistry SIG – Margie Steffens – Aileen Lewis – Angie Ioannidis – Amelia Roff

Neurodegenerative conditions often affect areas of the brain that control motor function of the extremities. Patients end up with muscle weakness, uncontrolled movements, and a lack of coordination; all issues in maintaining an

effective oral home care routine. Some neurodegenerative conditions, for example Friedreich’s ataxia, can render a patient non-ambulatory by as young as 15.5 years of age (Parkinson et al 2013). Given that many patients with neurodegenerative conditions may be relying on wheelchairs for mobility, it is important to plan ahead and ensure that your surgery is wheelchair accessible. This includes ensuring no steps, and that doorways are wide enough to accommodate the width of the chair.

Dysphagia/orofacial dysfunction

The same mechanisms that impact the declining coordination of the limbs and extremities can also impact the muscles in the head and neck. This often leads to dysphagia, tongue stiffness, impaired speech, and difficulty swallowing/ coughing (Nakayama et al 2017). This presents issues for both dental practitioners and carers as there needs to be strategies in place to reduce the risk of aspiration. Patients often have issues with food retention after swallowing due to either dysphagia or reduction in ‘purposeful lingual searching activity’ (Rae et al 2015). Because of issues with the function of the orofacial region, patients with motor neurone disease have a higher instance of mortality related to bronchial pneumonia and aspiration pneumonia (Burkhardt et al 2017). Patients with ataxia will often struggle to keep their mouth open due to muscle weakness so the use of a mouth prop is recommended (Camm et al 1987). Patients with amyotrophic lateral sclerosis have limited mouth opening. This limited opening has a negative impact on general health outcomes, hastening mortality and increasing the need and duration of ventilation

(Nakayama et al 2017). Limited mouth opening also provides a difficult situation for the management of oral health conditions by caregivers and dental practitioners and an increased risk of aspiration. There has been some suggestion that exercise therapy in the initial stages of the disease can reduce the impacts of limited mouth opening (Lui et al 2009).

Salivary function

“ The mechanisms that impact the declining coordination of the limbs and extremities can also impact the muscles in the head and neck.”

Xerostomia is not itself a side effect of neurodegenerative conditions, but medication induced xerostomia is commonly associated with neurological disorders. Co-morbidities of depression and anxiety are very common with neurological conditions. The medications used to treat these conditions leave patients with reduced salivary function and xerostomia. Hyposalivation tends to be present in patients with Parkinson’s disease, Lewy body dementia and amyotrophic lateral sclerosis (Srivanitchapoom et al 2014, Lakraj et al 2013). The use of antipsychotic medication to treat comorbidities can also increase the chances of developing hyposalivation (Maher et al 2016). Hyposalivation reduces a patient’s quality of life as

patients often feel a sense of stigma related to the condition. Hyposalivation can also increase the risk of aspiration (Yuruyen et al 2017).

Dental caries

The incidence of dental caries in patients with neurodegenerative conditions is not as straightforward as a simple increased risk of dental caries. As with any patient, the risk is determined by many factors such as saliva quality medications, diet, and home care. Many patients rely on a carer for their home care routine, so if a patient is reliant on a carer it is important to educate them on how best to manage a patients home routine. As there is an increased risk of aspiration and difficulty with opening, please refer to the ‘Mouth c are for people with neurological Conditions’ section of this article for management strategies. Due to these barriers to care, patients with Alzheimer’s were found to have had lower rates of brushing, flossing and dental visits compared to their healthy counterparts (Aragón et al 2018). As it is difficult for patients with neurodegenerative conditions to achieve sufficient caloric intake, often dietary advice includes the consumption of highcaloric, but high sugar, foods which can increase caries risk (Rae et al 2015). Medication induced xerostomia can increase a patients’ risk of decay, but conversely hyposalivation may possibly have a positive correlation on decay rates, with one small study finding no increase in decay in patients with Motor Neurone Disease, most likely due to hyposalivation (Tay et al 2014).

Periodontal disease

Some neurodegenerative conditions seem to have a negative correlation between periodontal disease bacteria

and adverse or exacerbated disease outcomes. Though a causal link has not been established, there is a growing body of evidence suggesting a link between periodontal disease and Alzheimer’s disease. It is evident that periodontal disease in patients with Alzheimer’s disease can exacerbate the condition. Chronic low-grade infection can alter the immune response to invasive organisms and virulence factors that invade the central nervous system through the blood-brain barrier (Harding et al 2017, Kramer et al 2008, Matsushita et al 2020). Serum antibody levels against P. gingivalis are found to have increased in Alzheimer’s disease patients compared to non- Alzheimer’s disease controls’ ( Scherer et al 2020).

Mouth care for people with neurodegenerative disorders

Encompassing Motor Neurone/ Amyotrophic Lateral Sclerosis, dementia, cerebral palsy, epilepsy, multiple sclerosis, Parkinsons Disease, Alzheimers disease, Ataxia, Bell’s Palsy, Guillain-Barre Syndrome,Muscular Dystrophy, strokes, Huntington Disease Many people who have neurological conditions have limited mobility, dexterity, swallowing (dysphagia) problems, dry mouth complications and/ or reduced cognitive abilities. It is important that people with these conditions maintain good oral hygiene and have a healthy diet to prevent caries, halitosis, inflammation of the gums and reduce the risk of infection in the mouth and the rest of the body. It is recognised that good oral care is pivotal in maintaining the mouth and body health connection in reduction of complications such as aspiration pneumonia, exacerbation of heart disease, strokes and to reduce infection and complications relating to diabetes.

Frequently different aids are required to assist independence and to encourage ease of oral care, for example:

Modified toothbrushes: Bending toothbrushes: a soft toothbrush can be bent for better access to the mouth. Bending a toothbrush forward can help with inner surfaces of upper and lower teeth. A backward bent toothbrush can be used to pull the cheek

away while using another brush to clean the teeth. Toothbrush adaptors may help the person or carer to brush when they have poor grip or limited movement. Using a foam or rubber handle, a cut tennis ball or commercial adaptors will help those who can brush by themselves but need extra help. Three sided toothbrushes are designed to brush all the surfaces of the teeth. They ‘hug’ the teeth to clean the three tooth surfaces and gumline at the same time. For example the ‘Collis Curve’ toothbrush. An electric toothbrush is very effective if the person can accept the noise and vibration. Again useful for those with limited manual dexterity but like to be independent. Where mouth care is provided by a carer, they can introduce the electric brush on the fingers first, then the lips and occasionally touch the front teeth until the person accepts the vibration and noise. Interproximal brushes that have extension handles with thicker grips, are efficient tools to remove food debris and plaque. They are good for carers to clean areas that are hard to reach such as dental bridges and implants. Suction toothbrushes e.g PlakVak are suitable for brushing teeth for people who are unconscious, tube fed or have dysphagia. It is used with a portable pump or wall suction and is used generally in nursing homes. It is very important for people that are unconscious, non-orally fed or have difficulty swallowing to have their oral hygiene kept to a high standard. Thus reducing the risk of chest infections (e.g. Aspiration Pneumonia) if plaque is left on their teeth and gums. Tooth rests and mouth props are used when either a person is not

cooperative with opening their mouth or for those who cannot keep their mouth open for long periods of time. Mouth props such as: a tightly rolled up flannel slightly dampened, toothbrush with a padded handle, padded tongue depressors and commercial props. They are not suitable for everyone. There are commercially made soft plastic props available. Many people with neurological conditions also experience a dry mouth or hyposalivation. Some medications can affect the salivary glands and reduced saliva can increase the risk of caries, gingival diseases and infections. Ulcers can appear under poorly fitting dentures as the dry mouth reduces the ability for the denture to adhere

“ Some medications can affect the salivary glands and reduced saliva can increase the risk of caries, gingival diseases and infections” to the soft tissues. The denture then moves when the person is trying to eat or talk causing friction ulcers and sores. Oral thrush is also a problem with a dry mouth and angular cheilitis (dry, cracked corners of the mouth) can be an uncomfortable condition that reduces the person’s ability to eat and talk. Some people also experience hyposalivation where there is too much saliva and swallowing can be difficult. It is best to have more than one carer to help in these situations and a suction toothbrush is ideal.

Additional information for carers

• Clean the person’s teeth morning and night, preferably after every meal therefore lunchtime brushing is advised. • Use a toothbrush and method that is suitable for that person, making it comfortable for the person and the carer. • May need two carers to be effective. • In group settings, keep each person’s oral hygiene equipment separate and labeled to prevent cross contamination. • Use fluoride toothpaste. Choose a non-foaming toothpaste for those who gag. • High fluoride toothpastes, antiplaque agents and other products may be prescribed by a dental practitioner for people with a high risk of dental disease. • Dentures need to be cleaned with warm soapy water not toothpaste and stored in a clean dry container to air when not in use. It is important that the mouth is kept clean by swabbing or brushing the gums and tongue and wetting the denture before placing it back into the mouth. If the person is not able to do this the carer must care for the denture and the mouth everyday. When living in supported care it is essential dentures are labeled correctly - The dental technician can embed the label into the acrylic appliance when being made. The person’s name or any identifier should never be scratched on the denture as this causes microscopic scratches which can retain plaque/bacteria that contribute to fungal infections and inflammation in the mouth

Dietary advice

• Limit sweet, sticky foods and drinks between meals. • Limit acidic drinks such as sodas, energy/sports drinks, fruit juices and cordials. • Encourage drinking or rinsing with water to help remove food debris after a meal.

Methods for carers to assist in good oral hygiene:

• Toothbrush positioning must provide support for the head and neck and be comfortable and safe for all. A good lighting is needed and the positioning should allow a clear view inside the mouth. • The ‘Cuddle position’ is best where the carer stands behind and to the side of the person. Their head is rested against the side of the carer›s body and arm and supporting the chin gently with the index finger and thumb (pistol grip). This is a supportive position and provides greater head control. • People with swallowing difficulties risk choking if the head is tilted too far back. • Use a smear or pea size amount of fluoride toothpaste on a soft bristled toothbrush. • Use a show, tell, do approach so that the person is aware of what the carer is about to do. The carer moves to the side/behind the person and places the bristles at a 45 degree angle to the gum. Brush in a gentle, circular motion. • Encourage use of a toothpaste without sodium laurel sulphate. • Rinse the toothbrush thoroughly, tap off excess water and allow it to dry. • Replace the toothbrush every 3 months or after any illness.

For oral health professionals

Spit don’t rinse is recommended for most healthy patients in general. However when working with people with specific medical conditions and polypharmacy, or chemical allergies, it is advisable to either swab the mouth out or have a very light rinse with water. There are possible contraindications with other medications, chemicals causing dry mouth or possible allergic reactions or even asthma attacks.

Medications commonly used in neurodegenerative conditions

Many medications used in the management of neurodegenerative disorders cause dry mouth and other gastrointestinal adverse effects. Oral health practitioners may need to address them to maintain oral hygiene.

Dementia and Alzheimers A number of drugs are currently available in Australia for use by people with dementia. These drugs fall into two categories, cholinergic treatments and memantine. Cholinergic treatments offer

“ Correct use of the reflective practice tool may assist all dental practitioners to self-determine their current individual scope of practice” some relief from the symptoms of Alzheimer’s disease for some people for a limited time. Drugs known as acetylcholinesterase inhibitors work by blocking the actions of an enzyme called acetylcholinesterase which destroys an important neurotransmitter for memory called acetylcholine. Memantine targets a neurotransmitter called glutamate that is present in high levels when someone has Alzheimer’s disease. Memantine blocks glutamate and prevents too much calcium moving into the brain cells causing damage. These medications may cause drug mouth, nausea and vomiting.

Multiple Sclerosis The two main aims of the drugs that are available for people with MS are to either ease specific symptoms (symptomatic therapies), or reduce the risk of relapses and disease progression (these are known as ‘disease modifying therapies.’) Acute relapses are also sometimes treated using steroids to help shorten the attack and reduce its severity. The types of drugs used in treatment depend on a number of factors, including the person's type of MS. Drug treatment may include immunotherapies, steroids and immunosuppressants, many may lead to nausea and vomiting.

Amyotrophic Lateral Sclerosis (ALS) and Progressive Bulbar Palsy (PBP) Drug treatment may involve riluzole which could cause nausea or vomiting and stomach ache.

Parkinsons Disease Most drug treatment options focus on restoring the balance of dopamine and other neurotransmitters by Dopamine replacement or dopamine agonist therapy. These agents may either cause dry mouth or excessive salivation.

Other drugs These include antidepressants such as fluoxetine and sertraline; antipsychotics such as quetiapine, risperidone and olanzapine; mood stabilisers such as volproate and carbamazepine; as well as monoamine depletors tetrabenazine and amantadine. Most of them may cause a degree of dry mouth and other gastrointestinal side effects. n

Are you interested in getting involved with the DHAA Special Needs Dentistry Special Interest Group? Please email contact@dhaa.info . Please self record CPD hours for the time spent in reading this article (DHAA recommends 0.5 CPD hour clinical/scientific) References Aragón, F., Zea-Sevilla, M. A., Montero, J., Sancho, P., Corral, R., Tejedor, C., Frades-Payo, B., Paredes-Gallardo, V., & Albaladejo, A. (2018). Oral health in Alzheimer’s disease: a multicenter case-control study. Clinical Oral Investigations, 22(9), 3061–3070. https://doi. org/10.1007/s00784-018-2396-z Burkhardt, C., Neuwirth, C., Sommacal, A., Andersen, P. M., & Weber, M. (2017). Is survival improved by the use of NIV and PEG in amyotrophic lateral sclerosis (ALS)? A post-mortem study of 80 ALS patients. PloS One, 12(5), e0177555–e0177555. https://doi. org/10.1371/journal.pone.0177555 Camm, J. H., & Carpenter, J. V. (1987). Dental treatment of a patient with Friedreich’s ataxia. Special Care in Dentistry, 7(3), 117–119. https://doi.org/10.1111/j.1754-4505.1987. tb00619.x Harding, A., Gonder, U., Robinson, S. J., Crean, S., & Singhrao, S. K. (2017). Exploring the Association between Alzheimer’s Disease, Oral Health, Microbial Endocrinology and Nutrition. Frontiers in Aging Neuroscience, 9, 398–398. https://doi.org/10.3389/ fnagi.2017.00398 Kamer, A. R., Craig, R. G., Dasanayake, A. P., Brys, M., Glodzik-Sobanska, L., & de Leon, M. J. (2008). Inflammation and Alzheimer’s disease: Possible role of periodontal diseases. Alzheimer’s & Dementia, 4(4), 242–250. https://doi.org/10.1016/j.jalz.2007.08.004 Lakraj, A. A., Moghimi, N., & Jabbari, B. (2013). Sialorrhea: Anatomy, pathophysiology and treatment with emphasis on the role of botulinum toxins. Toxins, 5(5), 1010–1031. https://doi.org/10.3390/toxins5051010 Lui, A. J., & Byl, N. N. (2009). A Systematic Review of the Effect of Moderate Intensity Exercise on Function and Disease Progression in Amyotrophic Lateral Sclerosis. Journal of Neurologic Physical Therapy, 33(2), 68–87. https://doi.org/10.1097/ NPT.0b013e31819912d0 Maher, S., Cunningham, A., O’Callaghan,

N., Byrne, F., Mc Donald, C., McInerney, S., & Hallahan, B. (2016). Clozapineinduced hyposalivation: an estimate of prevalence, severity and impact on quality of life. Therapeutic Advances in Psychopharmacology, 6(3), 178–184. https:// doi.org/10.1177/2045125316641019 Matsushita, K., Yamada-Furukawa, M., Kurosawa, M., & Shikama, Y. (2020). Periodontal Disease and Periodontal Disease-Related Bacteria Involved in the Pathogenesis of Alzheimer’s Disease. Journal of Inflammation Research, 13, 275–283. https://doi.org/10.2147/JIR.S255309 Nakayama, R., Nishiyama, A., Matsuda, C., Nakayama, Y., Hakuta, C., & Shimada, M. (2017). Oral health status of hospitalized amyotrophic lateral sclerosis patients: a single-centre observational study. Acta Odontologica Scandinavica, 76(4), 1–298. https://doi.org/10.1080/00016357.2017.142 0228 Rae, D., & Manley, G. (2015). Oral Health Care in People with Huntington’s Disease. In Diet and Nutrition in Dementia and Cognitive Decline (pp. 1125–1133). https://doi. org/10.1016/B978-0-12-407824-6.00105-1 Scherer, R. X., & Scherer, W. J. (2020). U.S. state correlations between oral health metrics and Alzheimer’s disease mortality, prevalence and subjective cognitive decline prevalence. Scientific Reports, 10(1), 20962–20962. https://doi.org/10.1038/s41598-020-77937-8 Srivanitchapoom, P., Pandey, S., & Hallett, M. (2014). Drooling in Parkinson’s disease: A review. Parkinsonism & Related Disorders, 20(11), 1109–1118. https://doi. org/10.1016/j.parkreldis.2014.08.013 Yuruyen, M., Gokturk, A., Yavuzer, H., Döventas, A., & Erdincler, D. S. (2017). Applied botulinum neurotoxin injection in a patient with dementia to reduce hyposalivation. Geriatrics & Gerontology International, 17(6), 1028–1029. https://doi. org/10.1111/ggi.12994

The power of positive Examining the immeasurable importance of having fun at work By Lyn Carman

ow, more than ever, I hear of people feeling undervalued, unappreciated, underutilised, unsafe, mistrusted, disrespected, tired and isolated. This applies to employees and business owners alike. I am curious and wonder what, as a profession we are missing; what are we accepting; and what vision have we let go of? Being in a happy environment creates ripples far beyond where we can see and what we are aware of. This is truest when we look at workplace environments - creating a workplace that people love can be critical on so many levels. If you are unhappy in your workplace, then you are unhappy in your

home place and you are unhappy in other environments as well - it changes the way you can live your life. When we feel we are contributing; feel valued, appreciated and respected; have fun and are engaged in a culture where people take joy in their work; this inspires others and is a key to success, whatever this means for you. I recently listened to a podcast featuring Bob Chapman, CEO and author of ‘Everybody Matters’, and I simply love this quote “Culture equals values plus behaviour, as my friend Lt. Gen. George Flynn, USMC (ret) says. If an organisation has a strong and clearly-stated set of values and the people act in accordance with those values, then the culture will be strong. If, however, the values are ill-defined, constantly changing, or the people aren’t held accountable to or incentivised to uphold those values, then the culture will be weak. It’s no good putting “honesty” or “integrity” on the wall if we aren’t willing to confront people who consistently fail to uphold those values, regardless of their performance.” Why do we want great culture? We often hear about branding and the importance of branding - I think branding is culture, and culture is branding. It’s not your logo, it’s your culture. If you have a space with great culture, you have great people, if you have great people, you have great clients, if you have great clients, you have great success! If you have a great culture, you have lots of fun - it’s a place where people want to hang out, it’s a place you want to be. To do this, we need to create a culture that has particular standards. We need to know what it stands for, what it represents, what it fights for and what it defends. A great culture is never about the money. Money and possessions don’t create a great culture. You can have the most amazing building, equipment and

values written on the wall but take away the people and you have nothing. If you are in an environment that you don’t like, should you stay there? Should you continue to turn up due to necessity – are you on autopilot because you are fearful of change or because it pays the bills, or for whatever reason? Is this the standard you are holding yourself to? You are the only one who drives your bus. If you get up every day and you are miserable; you are miserable because you choose to be miserable and you choose to stay miserable… nothing in the outside world can force you to stay miserable – it’s a choice that you are making. Don’t

“ If you have a great culture, you have lots of fun - it’s a place where people want to hang out, it’s a place you want to be” get me wrong – I’m not saying this is easy! From experience, I know it isn’t. It can be really hard, uncertain and scary… but then so was riding a bike for the first time. Finding a place that is a good fit for you is critical. Happiness is contagious – creating great role models and ripples of joy spread throughout. Happy employees are successful people – increasing self confidence and inspires greater performance. Happy employees bring the right attitude to your workplace – a positive can-do ethic. Reducing stress increases productivity – stressed employees are distracted. A positive work environment encourages ‘risk-taking’, enhancing

creativity and openness Happy employees support each other – a willingness to provide positive support and more likely to seek support if needed. Happy employees are not afraid to make mistakes. A supportive environment creates confidence to learn from mistakes, not fear them – enhancing growth and learning. Great leaders lead by example. Those that take joy in their jobs inspire confidence and set a positive example that encourages others. Happiness inspires creativity. Innovation provides solutions. We all enjoy working with happy people – yielding enormous benefits by improving relationships and being more willing to work collaboratively for the common good. The way we lead impacts the way people live. By default, we are all leaders in our space. Most of us understand our influence on team members’ lives during work hours but, often enough, don’t think about how leadership also affects team members outside of the workplace. At the end of our day, when we leave our workplace feeling as though we have contributed, inspired, felt valued and had a great day, we go to our home place bringing this energy. The impact our workplace permeates all that we do on many levels. Find your secret sauce. Find your voice, defining what you care about; what you fight for; and gaining clarity on your vision and values. It matters and you are worth it … and the ripple effect on people around you spreads wide. The way I see it is we have three choices: We can be miserable, unhappy and exhausted; we can get to a point where we simply exist on autopilot and are numb; or we can actively seek a workplace where we experience and bring joy. Add to the culture, don't just fit in with it! n

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

STATE NATION ACT ACT contacts: Director Amy McDermott directoract@dhaa.info Staff Bill Suen bill.suen@dhaa.info

n The ACT GC hands on workshop had a full house at the end of May. Located at the beautiful National Canberra Arboretum at Molonglo Valley, participants arrived early and enjoyed the wonderful autumn scenery prior to the workshops. Trainer Paulette Smith and her GC Australasia dental colleague Leonie took participants through a comprehensive range of practical aspects of surface protection, composite bridges and sprints. With so much information and practical exercises, the day was absolutely exhausting but most educational and satisfying for all. We also thank Susie Melrose, Michelle Bonney and Dahlia Phillips for their assistance in organising and running the event. The next event for ACT members will be the end of the year get together on Saturday 5 December, so please mark your calendar and look out for details.

GC Australasia trainer, Paulette Smith presents to packed class

37 For all the latest info on DHAA events please visit www.dhaa.info/events

NSW NSW contacts: Director Warrick Edwards directornsw@dhaa.info Chair Steven Chu chairnsw@dhaa.info Deputy Chair Jody Inouye contactnsw@dhaa.info

n Unfortunately due to a return of COVID-19 outbreak in Sydney, the July join DHAA & ADOHTA full day event at the Rydges World Square in Sydney had to be cancelled. The NSW committee has already planned another two events with the appropriate contingency plan in place. So please look out for an announcement immediately after the Sydney lockdown is concluded.

NT NT Contact: Staff Bill Suen bill.suen@dhaa.info

n NT has been relatively quiet over the past few months. The DHAA has been liaising with ADOHTA to plan joint events for NT members. We hope to swing into action as soon as possible to support local members. In the mean

time we will continue to inform members of relevant CPD activities available locally from the ADA and other organisations. The current hibernation in NT is actually the calm before the storm, as the DHAA National Symposium 2022 is to be held at the Darwin Convention Centre from 2-4 June. Please mark your calendar for these dates and we can all catch up for a most memorable experience.

“ The current hibernation in NT is actually the calm before the storm, as the DHAA Symposium 2022 is to be held in Darwin from 2-4 June ” We thank Leonie Brown for her assistance in being the local representative for the organising committee that has already done an incredible amount of work with the social and educational programs. Other NT members are encouraged to be involved. If you are interested or requiring more information about the Darwin Symposium, please email ceo@dhaa.info

Qld Qld Contacts: Director Carol Tran. directorqld@dhaa.info Chair Jen Turnbull chairqld@dhaa.info Deputy Chair Lizzy Horsfall contactqld@dhaa.info

n After our successful full-day event at the QT Hotel, Surfers Paradise on 15 May, the next full-dayer is scheduled for Saturday 18 September, at the Rumba Resort Caloundra, Sunshine Coast. The theme will be “Mind, Body and Function”. Come along to learn about the holistic relationship between clinical practice and patients. You will receive guidance on how to avoid professional burnout, pick up ideas for stretches and exercises, as well as a comprehensive run-through of clinical advice in mental health, physiotherapy and occupational therapy. This is something we all need to help us through challenging periods that all of us will face at some point during our oral health career. Jen Turnbull, the Queensland Chair has submitted an enquiry to Queensland Health in response to the recent review

“ Receive guidance on how to avoid professional burnout, as well as a run-through of clinical advice in mental health, physiotherapy and occupational therapy” of the Radiation Safety Regulation. She is seeking parity for dental hygienists, oral health therapists and dental therapists with dentists for exemption for needing a radiation licence to take intra-oral films under the Queensland regulations. We will update members on the progress of this project.

SA SA Contacts Director Cheryl Dey president@dhaa.info Chair Sue Tosh chairsa@dhaa.info Chair Sally Hinora contactsa@dhaa.info

n The SA Committee hosted a dinner meeting in June at the Lion Hotel in North Adelaide with specialist periodontist Dr Paul McHugh.

“ His [Dr McHugh's] comprehensive presentation covered key aspects of referral, ongoing shared care with oral health practitioners, and updates on bio-film and airflow use in periodontal practice” His comprehensive presentation covered key aspects of referral, ongoing shared care with oral health practitioners, as well as updates on bio-film and airflow use in periodontal practice. Lyn Carman and Margie Steffens also presented at the event. The next event will be a full day event on Saturday 19 September at the Adelaide Entertainment Centre at Hindmarsh. The program features periodontist Dr Andre Bendyk, endodontist Dr Barb Plutzer, dentist Dr Vaibhav Gorg as well as our own Sue Aldenhoven. The topics will be varied and include factors influencing treatment decision, implant maintenance, integrated oral health approach and many more. For information and registration click here.

A great attendance at the recent South Australian dinner meeting

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

Tas Tas Contact Director: Alyson McKinlay directortas@dhaa.info Chair: Michael Charlton-Fitzgerald chairtas@dhaa.info

n Following the joint event with the ADA and Pharmaceutical Society on Monday 21 June at the Rydges Hobart, Tasmanian Chair Michael CharltonFitzgerald has been planning a half-day event in Hobart on Saturday 4 September. The education program will feature periodontist Dr Alex Du Bois discussing the current periodontal classifications. Highly regarded dental hygiene educator Tara Brooks will also present for us on the day. Click here for details .

Vic Vic Contacts Director Ron Knevel. directorvic@dhaa.info Chair Desiree Bolado chairvic@dhaa.info Deputy Chair Aimee Mills contactvic@dhaa.info

n After multiple Covidrelated cancellations in 2020, the joint DHAA-ADOHTA event was also eventually

cancelled due to another outbreak. The next state event will be the Tooth Fairy’s Christmas Party fundamentals of oral health, scheduled for Saturday 4 December at the Kooyong Tennis Club. You can come and join the Victorian committee where the tennis pros hang out while enjoying a half-day CPD event before the festive season starts. Prof Mike Hubbard will discuss the role of oral health practitioners to combat developmental

“ The DHAA has had meetings with the ADOHTA, ADA and Professions Australia to explore ways to collaborate and form a stronger voice at the negotiation table” dental defects; Dr Lean Tech will present on the pharmacological management of dental pain; and Dr Katrusha Hull will provide a presentation covering the topic of pathology in oral medicine. Please look out for registration announcements, and be the first to register as this event is very popular and many have missed out in previous years. Thanks to Victorian DHAA members employed

in the public sector provided their contact details for the specific mailing list, as work has begun in preparation for the EBA negotiation for next year. DHAA has had meetings with the ADOHTA, ADA and Professions Australia to explore ways that we could collaborate and form a much stronger voice at the negotiation table. We will provide further details as they become available to public sector members. If you are working in the public sector and have not provided DHAA with your consent to go onto a specific mailing list, please email ceo@dhaa.info

WA WA Contacts Director: Aileen Lewis. directorwa@dhaa.info Chair: Carmen Jones chairwa@dhaa.info Deputy Chair: Rhonda Kremmer contactwa@dhaa.info

n The WA committee has been busy both on the event and advocacy fronts. The WA Chair Carmen Jones, Wendy Wright and Rhonda Kremmer attended a number of meetings with the health minister’s office and the State Oral Health Advisory Council and discussed new models of care in community primary

“ WA representatives attended a number of meetings with the health minister’s office and the State Oral Health Advisory Council and discussed new models of care in community primary health settings” health settings. Extensive advocacy work had been done in seeking appropriate funding to support relevant pilot programs. A free joint ADOHTA and DHAA event was held at the ADA House on 23 June. Members of both associations met for refreshments and mingled, followed by an excellent presentation from Doris Neuwerth on tobacco use and oral health. On Saturday 7 August, the half-day CPD at the Pagoda Resort in COMA was sold out. Besides the wonderful venue, the CPD program offered a wide variety of presentations including; periodontal supportive therapy, postural care for oral health professionals, myotherapy and orthodontic assessment, and autism in the dental sector. We will share further details on how the session went in our next DHAA Bulletin report. n

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STRIVING FOR EXCELLENCE

The Bulletin - Issue 60 Sept / Oct 2021

Articles inside

Special needs CPD paper

Caring about aged care

Manage your CPD future

Navigating mayhem

A devotion to dental

Employing our professional judgement

2021 DHAA Symposium is going online