The Bulletin - Issue 70 April / June 2024

The official newsletter of the Dental Hygienists Association of Australia Ltd

REASONS TO BE CHEERFUL

With renewals just around the corner, we look at the many benefits of being a member of your industry association

DHAA & PROUD

DHAA PROUD&

Dealing with dry mouth

Spotting the many signs, symptoms and treatment of xerostomia

DHAA & PROUD

Healthy headspace

Support for oral health practitioners under pressure

This could be our biggest year ever!

WELCOME TO THE first issue of the Bulletin for 2024. This promises to be an exciting year as the DHAA has big plans for our members and the profession.

I am pleased to announce that there will be no increase in DHAA membership fees this year. We have diligently managed costs and enhanced value and our fee remains as one of the lowest among health professional associations.

We have also reaffirmed our commitment to enhancing the quality of our Professional Indemnity Insurance services while ensuring premiums remain competitive. Given our profession's low-risk profile compared to other health professional groups, excessive insurance costs are unnecessary.

Our top advocacy priority this year is to secure access to Medicare Allied Health Item codes for preventive oral health services and education. This initiative not only expands funding sources but also integrates oral health prevention into GP chronic disease care plans, aligning oral health with overall healthcare objectives.

Work is continuing to co-create a new unified association to represent oral health practitioners. A consultant has been appointed to facilitate this process, and a formal unification proposal for members to review is underway, with a joint board meeting scheduled for April.

We have been working with A/Professor Nicky Kilpatrick AM and South Australian of the Year Dr. Trudy Lin to implement our ‘future leaders’ program for our members. This program will provide leadership and mentoring training for members, aiming to cultivate leadership capacity within our profession. Recruitment for participants will commence in May.

Former NSW director and Indigenous dental practitioner Warrick Edwards has kindly accepted the position of Indigenous Advisor to the DHAA Board. This is an important appointment to ensure the DHAA has appropriate advice to fulfil our commitment to supporting the oral health of First Nations people.

To support members in planning and delivering innovative projects aimed at improving oral health in their local communities, the DHAA will launch its Community Oral Health Grant around mid-2024.

After several years' hiatus due to COVID-19, the Bali CPD event will return on Saturday, June 8, 2024. As part of the ASEAN-Pacific Oral Health Alliance, this event has attracted delegates from Indonesia, Singapore, and Malaysia.

Preparations for the inaugural Joint ADOHTA-DHAA Oral Health Congress, scheduled for October 17-19, are progressing smoothly. This is a momentous event for our profession under one roof. Registration is now open for early bird savings. I also encourage everyone to consider submitting an abstract for either an oral or poster presentation to share your achievements and innovations with colleagues. Please contact ceo@dhaa.info if you require assistance in putting together your abstract, poster, and/or presentation.

Both the Joint Congress and the Bali CPD are significant events not to be missed. We look forward to seeing you soon. What an exciting year!

A/Professor

Carol Tran

DHAA President

Contents

04 World Oral Health Day

What will you be doing to raise awareness in your world?

06 From the top

CEO Bill Suen introduces the team behind the DHAA.

12 Mentoring Matters

Melanie Aley explains the importance of mentoring.

14 Ask DHAA

Your questions answered.

16 Your in good hands

Understanding the DHAA Member Insurance Program.

18 Get your CPD fix online

Learn from home.

COVER STORY

20 Reasons to be cheerful

The many reasons whey DHAA membership is great.

24 Saliva Secrets

Dealing with dry mouth

28 Positive headspace

Meet the Mindful Smiles Hub

30 Practise outside the box Operate away from the clinic.

38

Early and late eruptions

How to deal with the parents..

40 Coping with uncertainty

Be happy out of your comfort zone

42 State of the Nation

Our regular round-up of state happenings.

WOHD

World Oral Health Day 2024 is upon us! What will you be doing this year to champion oral health?

By Ian Epondulan, Chair of the DHAA Oral Health Promotion and Public Health Committee (OHPPHC)

WORLD ORAL HEALTH DAY (WOHD) is celebrated globally every year on 20 March. It is organised by the FDI World Dental Federation and is the largest global awareness campaign on oral health. WOHD spreads messages about good oral hygiene practices to adults and children alike and demonstrates the importance of optimal oral health in maintaining general health and wellbeing.

Each year, WOHD focuses on a specific theme and reaches out to the public, oral health professionals, and policymakers, who all have a role to play in helping reduce the burden of oral disease. A new campaign theme has been launched for 2024-2026: “A happy mouth is… a happy body” with a cute mascot named Toothie the Beaver being the face of World Oral Health Day.

What is the purpose of World Oral Health Day?

WOHD aims to empower people with the knowledge, tools and confidence to secure good oral health.

Who is World Oral Health Day targeted towards?

• Individuals to take personal action.

• Schools and youth groups to deliver learning activities about oral health.

• Oral health professionals and the wider healthcare community to educate the populations they serve.

• Governments and policymakers to champion better oral health for all.

So why should we care about telling our patients, family and friends about the importance of looking after their oral health?

“Oral health is a key indicator of overall health, wellbeing and quality of life. WHO defines oral health as “A state of being free from chronic mouth and facial pain, oral and throat cancer, oral infection and sores, periodontal (gum) disease, tooth decay, tooth loss, and other diseases and disorders that limit an individual’s capacity in biting, chewing, smiling, speaking, and psychosocial wellbeing.” 1

“The Global Burden of Disease Study 2016 estimated that oral diseases affected at least 3.58 billion people worldwide, with caries of the permanent teeth being the most prevalent of all conditions assessed. Globally, it is estimated that 2.4 billion people suffer from caries of permanent teeth and 486 million children suffer from caries of primary teeth.”2

We know that periodontal disease affects the tissues that both surround and support the tooth and often presents

“Globally, it is estimated that 2.4 billion people suffer from caries of permanent teeth and 486 million children suffer from caries of primary teeth”

as bleeding or swollen gums (gingivitis), pain and, sometimes, bad breath. “Severe periodontal disease, which may result in tooth loss, was the 11th most prevalent disease globally in 2016.”2 “The main causes of periodontal disease are poor oral hygiene and tobacco use.”3

We know too that dental caries and periodontal diseases are major causes of tooth loss. “Severe tooth loss and edentulism was one of the leading ten causes of Years Lived with Disability (YLD) in some high-income countries due to their aging populations.”2

“Most oral diseases and conditions share modifiable risk factors (such as tobacco use, alcohol consumption and unhealthy diet high in free sugars)

common to the four leading noncommunicable diseases (NCDs) which are cardiovascular diseases, cancer, chronic respiratory diseases and diabetes. In addition, it is reported that diabetes mellitus is linked reciprocally with the development and progression of periodontitis. Moreover, there is a causal link between high sugar consumption and diabetes, obesity and dental caries.”4, 5

What did the DHAA to celebrate World Oral Health Day in 2023?

Last year in 2023, the Oral Health Promotion and Public Health Committee (OHPPHC) launched a pilot programme focusing on Oral Health for Refugees, People Seeking Asylum and New

Diet and infant feeding

2. Avoid free sugars (all sugars added to foods and drinks by manufacturers, cooks or consumers plus those sugars naturally present in honey syrups, fruit juices and fruit concentrates).

3. Tap water should be fluoridated for optimal oral health.

4. Avoid putting babies and children to bed with a bottle.

Oral hygiene

5. Brush teeth twice a day with fluoridated toothpaste and clean in between teeth daily. Fluoridated toothpaste reduces tooth decay. Additional fluoride therapies may be suitable depending on risk – refer to the Australian Fluoride Guidelines.

6. People who have difficulty cleaning their teeth should be supported.

Mouthguards

7. Custom-made mouthguards should be worn for all sports and training where there is a reasonable risk of a mouth injury.

Dental check-ups

8. Regular professional dental check-ups are important throughout life, starting from the eruption of the first tooth.

9. Everyone has different oral health needs and risk levels which should be reflected in the frequency of check-ups.

Smoking and vaping

Migrants, and this year we are continuing the project. DHAA members and volunteers from across the country hosted information sessions for the targeted group and reached out to organisations that work with these communities.

Many thanks to Colgate Australia for sponsoring 1,000 toothbrushes and toothpastes for the pilot project. The 11 key messages promoted in the community come from the 2022 update to the “Oral Health Messages for Australia”6 which are as follows;.

Overall health

1. Oral health is integral to overall health and well-being.

10. Smoking, vaping and tobacco products, including e-cigarettes and chewing tobacco, are harmful to oral health.

Alcohol

11. Alcohol consumption is harmful to oral health.

Have you checked out the new DHAA consumer website?

Our oral health advocacy continues through our new consumer DHAA website which can be accessed by heading to the DHAA website dhaa. info, hovering over the “YOUR ORAL HEALTH” tab and clicking on “Consumer Resources and Information”. Here you will find resources to share with the community that are accessible to the public for free!

What can you do as an individual to create awareness for oral health especially with World Oral Health Day coming up?

We look forward to reaching out to these communities once again this year during World Oral Health Day! If you would like to volunteer and be a part of the project, we will have a special training session via Zoom for members interested in being a part of the project on Tuesday 6 March, 2024, at 8pm AEDT.

Join our OHPPHC which meets via Zoom every first Tuesday of the month.

Attend your state or territory DHAA event celebrating World Oral Health Day. Visit worldoralhealthday.org and check out the resources to promote WOHD.7

Share with us any photos or ideas you and your practice are doing to promote WOHD.

Use social media to communicate and share key messages in the lead-up to and on the day of WOHD and use the hashtags: #WorldOralHealthDay, #WOHD24, #HappyMouth, #BrushandBoogie.

We look forward to hearing about how you will be celebrating World Oral Health Day on March 20, 2024!

References

1 World Health Organisation. World Oral Health Report 2003. Published 2003. https://www.who.int/oral_health/ publications/world-oral-health-report-2003/en/

2 GBD 2016 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390(10100):1211-1259.

3 Petersen PE, Bourgeois D, Ogawa H, Estupinan-Day S, Ndiaye C. The global burden of oral diseases and risks to oral health.Bull World Health Organ. 2005;83(9):661-669.

4 Taylor GW, Borgnakke WS. Periodontal disease: associations with diabetes, glycemic control and complications Oral Dis. 2008;14(3):191-203.

5 Sanz M, Ceriello A, Buysschaert M, et al. Scientific evidence on the links between periodontal diseases and diabetes: Consensus report and guidelines of the joint workshop on periodontal diseases and diabetes by the International Diabetes Federation and the European Federation of Periodontology. J Clin Periodontol.2018;45(2):138-149.

6. Oral Health Messages for Australia. The University of Melbourne. Published 21 Aug 2023. https://dental.unimelb. edu.au/news-and-events/oral-health-messages-for-theaustralian-public-2022-update

7. FDI World Dental Federation. #BrushandBoogie | World Oral Health Day. Published 2024. https://www. worldoralhealthday.org/brushandboogie

NSW Volunteer Patricia Pacleb, teaching oral health instruction to refugee families WOHD 2023

FROM THE TOP

Who's who at the DHAA

Meet the extended DHAA team that make our Association tick

Bill Suen DHAA CEO

IT'S OFTEN SAID that it's not what you know, but who you know that gets you there. I would like to take this opportunity to introduce those who keep the wheels in motion for the DHAA, along with their roles and contact details, so that you can access them directly.

The DHAA Board is the governing body that sets the strategic direction of the DHAA as an organisation. It also monitors the performance of the organisation to ensure it is acting legally, ethically and effectively to attain the mission of the organisation and looking after the interests of its members. Current board directors are:

President

A/Professor Carol Tran president@dhaa.info

Vice President

A/Professor Ron Knevel directorwa@dhaa.info

Treasurer

Michelle Kuss treasurer@dhaa.info

Directors

Dr Roisin McGrath directorvic@dhaa.info

Amy McDermott directoract@dhaa.info

Jinous Eighani-Roushani directornsw@dhaa.info

The DHAA Directors also share some operational advisory roles, as follows;

Advocacy

Carol Tran and Roisin McGrath

Budget and finance

Michelle Kuss

New association (TOPA)

Ron Knevel

Aged Care

Amy McDermott

Oral Health Prevention, CPD Jinous Eighani-Roishani

State and Territory Committees are responsible for organising local membership events, and liaising with state-based stakeholders such as state governments and other professional groups and the education sector. The current State officer bearers are:

ACT Chair

Kate Spain chairact@dhaa.info

NSW Chair

Belinda Hines chairnsw@dhaa.info

NSW Deputy Chair

Angelee Murdock contactnsw@dhaa.info

QLD Chair

Gabby Williamson chairqld@dhaa.info

QLD Deputy Chair

Courtney Dicken contactqld@dhaa.info

SA Chair

Courtney Rutjens chairsa@dhaa.info

SA Deputy Chair

Jesse Kourakis contactsa@dhaa.info

TAS Chair

Karen Lam chairtas@dhaa.info

VIC Chair

Cathryn Carboon chairvic@dhaa.info

VIC Deputy Chair

Sarah Laing contactvic@dhaa.info

WA Deputy Chair

Michelle Wrights contactwa@dhaa.info

“The staff, board committees, working groups and other volunteers work closely to provide a comprehensive range of services”

The DHAA has a number of Committees and Special Interest Groups (SIG) to provide advice to the board on a variety of areas and specialties. Their chairs are as follows

CPD Committee

Jinous Eighani-Roushani directornsw@dhaa.info

Oral Health Promotion & Public Health Committee

Ian Epondulan

Aged Care SIG

Gemma Collins

Special Care Dentistry SIG

Margie Steffens OAM

Rural & Remote SIG

Lyn Carman lyn.carman@dhaa.info

Peer Support Service Advisory Group Coordinator

Bill Suen

bill.suen@dhaa.info

Bulletin Editorial Committee Editor

Brie Jones

brie.jones@dhaa.info

The DHAA has a team of Support Staff to provide operation services to the members, the board, the committees and groups within the organisation.

CEO - Bill Suen (ceo@dhaa.info)

Administration Officer

Christina Zerk

christina.zerk@dhaa.info

Administrative Support OfficerDanielle Gibbens

danielle.gibbens@dhaa.info

Industry Partnership Officer

Shida Taheri

shida.taheri@dhaa.info

Finance and Payroll Officer

Kirsty Bauer

kirsty.bauer@dhaa.info

The staff, board committees, working groups and other volunteers work closely to provide a comprehensive range of services to our members. There are opportunities to be involved in the planning and delivery of CPD, representing the DHAA on various consultations and working groups, preparing submissions or meeting with politicians to drive changes and new funding models and many more. If you are interested to find out more, please contact me directly. n

Say 'hello' to the Mouth Monster

Author Tanya Deacon explains her motivation to write her book

WORKING WITH CHILDREN is rewarding and challenging all at once. It’s not for every clinician. Unless you are in a speciality without young patients you will encounter a child from time to time. A little bit about me; I’m Tanya and I graduated from Newcastle in 2010 with a BOH. I have worked in private practice my entire career and always found myself enjoying seeing younger patients (don’t get me wrong, I still love removing calculus). These days, working exclusively with children has asked me to change the way I motivate my patients and my approach to delivering oral hygiene instruction.

We have all had that patient. A primary school kid who does not seem to care about anything to do with his/her personal hygiene and if their eyes roll one more time they might pop right out of their head. It can be frustrating when your usual approach is just reaching this kid. While some will listen because you are not their parent/guardian others will simply block you out. You really have to put your detective hat on and figure out what it is that this particular child is interested in. Video games, book series, and movies are just a few examples I can use to help connect with the child. All children really want is for someone to know who they are and to show interest in them. This will help to gain some trust and then we can move to motivating them. Which is what we are all about.

In Australia, only around seventy per cent of children brush with fluoride toothpaste morning and night with even less flossing daily as discovered by AIHW in 2017-2018. Dental caries as we all know is a preventable disease and the burden of caries on children can affect their general health and can also follow them into adulthood.

Working at Newcastle’s only paediatric practice I have noticed more and more of this type of behaviour from school-aged children and this has prompted me to write this short story. There are many wonderful books and apps (many written by fellow hygienists and OHTs) directed at preschool aged children, however, not as many for older children. The idea of this book is to motivate children to be more invested in their oral health by using a typical boy named Owen. He is interested in reading books and playing video games. We follow him on a regular day as he has a visit to the dentist where he is seen by his dental hygienist Melanie. Once again he is unmoved by her desperate attempts to motivate him to brush and floss his teeth.

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Ihad the pleasure of listening to Atomic Habits right around the new year. The time of year many of us look at making changes to our lives as Hallmark tells us to. I am and always have been a big lover of personal development books. I refuse to call them 'self-help' books, I don’t need help I just want to be better! So, this was something I would read regardless and am sharing with you as it is one of the best I have read and have actively used this every day since reading.

As with all development books, author James Clear starts by telling his story. He faced adversity (a serious baseball accident that nearly cost him his life), which led to him fighting to return to his former self. His resilience was born out of habits, what he calls atomic habits as they start as small as an atom but with their accumulative affects are atomic. James recognised that the changes he made to his life propelled him forward and changed the trajectory of his life. Goodbye baseball pro, hello habits guru! This he has backed by with many years of researching the science particularly in human psychology along with his lived experience.

BOOK CLUB

Resident Bulletin bookworm Danielle Gibbens reviews Atomic Habits. A self-help book by ex-baseball pro now

The book breaks down habit formation into four steps which makes change achievable for all of us. These four steps are stripped right back to basics which we often don’t do as we feel we ‘know’ what we are doing. An aspect of this that stuck with me was when James told the story of how he wanted to do five push ups at lunchtime. When lunchtime rolled around he went along with his usual routine and the push ups never happened because all these obstacles

“The book breaks down habit formation into four steps which makes change achievable for all of us."

cropped up such as forgetting, not knowing when to do them and so on. When James recognised his new habit was not being fulfilled, he made it more precise, I will do the push ups when

I close my laptop for lunch. No more confusion, no more reasons not to, no more obstacles, the pushups got done. I know I have many times wanted to make changes and went too big or ambiguous and over time they just faded away. Had I made a smaller change say a one percent change, with consistency the cumulative effect of that change over time, would have been tremendous. James uses the British cycling team as an example of this. Once one of the lowest-ranking teams in the world they are now the leader of track racing and have had numerous team members win the Tour de France all from making one percent improvements to all aspects of their training. In a short time that cumulative effect of being consistent with small habit changes has propelled them to the top. Consider this for your patients, we aren’t hoping for them to become world champion brushers but if encouraged to make small manageable improvements, long term we will see the cumulative effects that lead to improved health outcomes.

The conclusion of Atomic Habits is that repetition and practice are how we see improvements; which we all know but often stumble at the starting line. If we stop and make conscious decisions to make slight deviations from our regular habits, in time we will see big results. n

Have you read, watched or listened to something you think the DHAA community would find interesting or could count as CPD? Why not email it through to be reviewed? Send it through to danielle.gibbens@dhaa.info

MEMBER REFLECTIONS

Hold on to your dreams lightly and be surprised

Dental professionals enter their profession for many reasons. When I graduated as a dental hygienist in 1977, our intrepid leader, Dr John McIntyre, envisioned that we would become the uniting bridge between dental health and holistic health. My passion, like Dr Mac’s, has always been to “be a changemaker”.

My dental career has been extraordinarily varied despite being part-time for forty-seven years. It spans the public, private, special needs, locum, overseas volunteering and education sectors. In 1977, did I imagine that in my seventieth year, I would be driving around the country serving older rural people, still in my profession? Definitely not, but I am still a changemaker. As each door closed or I needed a new challenge, I dreamed of new ways to do this.

My big “mid-life” dream was to fill the rural gap in towns with visiting periodontists. I was going to return three times a year to a cluster of towns to do much-needed clinical maintenance and improve patient outcomes. I spent a lot of energy developing a business plan and contacting country dentists with no success. I wasn’t known as a “country”, so had no credibility with rural people, who had plenty of experience with unsustainable projects.

The next attempt was to try locum jobs in country towns. I landed a maternity leave job in a rural city one hour from home and shared my dreams

with Dr Michael Moran who was part of a “private dental scheme for Better Oral Care in Aged Care”. He invited me to join him by improving residents’ care three times a year. I had already purchased portable equipment, so worked part of my time in Residential Aged Care Facilities (RACF) in the Murraylands and discovered a new way to “be a changemaker”, even in formal retirement.

Currently, I travel to ten RACFs in small South Australian rural towns where no dental services are available, through my non-profit mobile oral health business. Since “retirement”, I have treated over two hundred older people in eight local council electorates, two state electorates and a federal electorate that is the size of NSW. I am an active participant of the Special Interest Group in Aged Care for DHAA and love advocating for better oral health services.

So, my advice? Hold onto your dreams, but lightly and make room for life to surprise you.

Wendy Sih

Oral Health Aged Care Consultant and Clinical Dental Hygienist

Inspired to succeed

MY NAME IS Jessica Manuel and my love for oral health was ignited by my positive experiences as a paediatric patient at the dentist. Those visits showed me how dental care could be engaging and fun. It illuminated the profound impact that a positive

experience can have on engagement with dental services. This foundation inspired me to pursue a career where I could replicate that experience for others, making the dentist's office a place of learning and enjoyment rather than fear.

Being a student with ADHD has added layers of complexity to my studies, but also a unique perspective on perseverance and adaptability. The support I've received throughout my degree, coupled with some perseverance and determination, has made this journey feasible and fulfilling. Receiving the DHAA award for Outstanding Academic Achievement has not only been a significant milestone but also a validation of my dedication to my studies and future career in oral health. I hope this can be a statement to others, that pursuing your passion amidst unavoidable personal challenges is doable.

Oral health, to me, is more than just a profession; it's a passion driven by the intricate details of dental anatomy and the complex microbiota of the oral cavity. This environment, capable of swinging between protective and risk factors, presents an ever-changing landscape full of new discoveries. These aspects make the field endlessly fascinating and intellectually stimulating, presenting challenges that keep my curiosity alive.

In this light, the DHAA's focus on providing continuous professional development and learning opportunities in response to the evolving field of oral health is invaluable. I believe that utilising such services can equip us with the latest knowledge and skills to remain at the forefront of oral health care. Throughout my career, I aspire to provide a service that is current, accessible and engaging in hopes of making a meaningful impact in my community.

Jess Manuel

Recipient of the DHAA Award for Outstanding Academic Achievement at the Charles Sturt University

Mentoring matters

Whether you're looking for professional guidance or wanting to provide it, mentorship programs are a linchpin of our industry. Never be afraid to stand on the shoulders of giants

By Associate Professor Melanie Aley

Mentoring has long been recognised as a cornerstone of professional growth and development across various industries, and the field of dentistry is no exception. For oral health therapists and dental hygienists, there are a range of advantages to engaging in mentorship relationships, ranging from personal and career development to fostering a supportive and enriching work environment. Mentoring can benefit those at any stage of their oral health career, whether it be as a student, new graduate, or mid-career professional.

For oral health students, mentorship can be a transformative experience that supports their transition through each year of study, and then from university to clinical practice. Recently, I have been involved in a mentorship program for oral health students, and have seen first-hand the benefits to both mentees and mentors. Mentors can provide insights into clinical protocols, ethical considerations, and professional conduct, as well as help students explore various study techniques, self-care habits and time management strategies.

By fostering a supportive and nurturing learning environment, mentorship instils confidence and competence in students, helping them feel like they belong in the profession. Mentors can learn a lot too – about communication and coaching, the unique perspectives of today’s students, and even how to be a more empathetic and inclusive teacher. The generation gap can even teach mentors a little about technology and new types of stress!

New graduates and early-career oral health therapists and dental hygienists stand to benefit significantly from mentorship as they embark on their professional journeys. Mentors can provide guidance on building a successful practice, developing clinical expertise, and establishing a strong professional reputation. Additionally, mentors can offer insights into practice management, financial planning, and patient communication skills, empowering early-career practitioners to navigate the complexities of clinical practice with confidence and competence.

Mentorship is not only for those starting, or in the early years of their oral health careers. Mentorship can also serve as a powerful antidote to mid-career malaise among dental professionals. As oral health therapists and dental hygienists progress in their careers, they may encounter challenges such as stagnation, lack of motivation, or a desire for professional reinvention. Mentoring offers a fresh perspective and renewed sense of purpose by connecting mid-career professionals with experienced mentors who can provide guidance on charting a new career trajectory, pursuing advanced training or certifications, or exploring leadership opportunities within the field. By reigniting passion and enthusiasm, mentorship helps oral health professionals overcome midcareer hurdles and embark on new pathways to success.

Whatever stage of your career you are at, one of the primary benefits of mentoring for oral health professionals is its capacity to drive professional development. Mentoring offers invaluable opportunities for seasoned

“Mentoring offers invaluable opportunities for seasoned practitioners to share their knowledge, expertise, and insights with mentees who are navigating their career paths”

practitioners to share their knowledge, expertise, and insights with mentees who are navigating their career paths. Through regular interactions, mentees can gain invaluable insights into clinical practices, patient management, and practice management strategies. Additionally, mentors can provide guidance on professional networking, career advancement opportunities, and navigating challenges unique to the field of dentistry. By serving as

trusted advisors and role models, they play a pivotal role in shaping the next generation of dental professionals, equipping them with the skills and confidence needed to excel.

Moreover, mentoring holds immense potential for promoting wellness at work among oral health professionals. The demanding nature of dental practice, characterised by long hours, high patient volumes, and complex clinical cases, can take a toll on practitioners’ well-being. Mentoring provides a supportive framework for addressing stress, burnout, and work-life balance issues. Mentors can offer valuable perspectives on managing workload effectively, setting boundaries, and prioritising self-care. By fostering open and honest communication, mentoring relationships create a safe space for discussing challenges and seeking guidance, ultimately contributing to enhanced job satisfaction and overall well-being among dental professionals.

You might ask, where do I find myself a mentor? Oral health therapists and

dental hygienists seeking mentors can find them in various settings within the dental community. One primary avenue is through professional associations and societies, which often offer mentorship programs or networking opportunities through local study groups, seminars or conferences. Additionally, academic institutions frequently facilitate mentorship relationships between faculty members and students. Many oral health professionals also seek mentors within their workplaces, such as senior colleagues or supervisors who can provide guidance and support in navigating clinical challenges and career development. Online platforms and forums tailored to dentistry and oral health serve as valuable resources for connecting with potential mentors,

enabling professionals to seek advice and forge mentoring relationships beyond geographical boundaries. Ultimately, the key lies in actively engaging with the dental community, both locally and digitally, to identify mentors who can offer insights, share experiences, and foster growth in the dental profession.

From guiding students through their educational journey to supporting seasoned practitioners facing midcareer transitions, mentorship fosters a culture of learning, wellness, collaboration, and continuous improvement within the dental community. By harnessing the power of mentorship, oral health professionals can unlock their full potential and thrive in their careers. n

Dr Melanie Aley (nee Hayes) is a dental hygienist who has enjoyed a diverse career in clinical practice, teaching, research and management. She has a Masters of Education majoring in Career Development, and after working in multidisciplinary roles, is now an Associate Professor and the Bachelor of Oral Health Program Director at the University of Sydney.

DHAA... Ask

Your opportunity to ask the questions, check the rules and share your knowledge

Dear DHAA... I am in the process of applying for a provider number and noticed a question asking whether I will be claiming Medicare benefits. I won't be claiming medicare benefits (CDBS) but if this changes in the future can I revise my application? Also, will I need my own ABN or can I use the practice’s current one?

Yes, you can always contact Services Australia to change details on your provider number. However, there is no reason to say no to claiming Medicare as there is no obligation to do so even if you say yes. The provider number is attached to a location so if you work at two different

Applying for a provider number? Don't say 'no' to claiming Medicare benefits

sites you need two different provider numbers. You don’t need an ABN to apply for a provider number. But when you set it up for payments to go into a bank account, you will need to advise if the income is for an individual, or a business and provide the relevant ABN if one exists. The ABN is more or less for taxation purposes.

Dear DHAA... Are dental hygienists/OHTs allowed to provide care with a laser after going through a certified course? And do we also need a laser license? No laser course is a scope extension course and that means that after doing a laser course existing

procedures (within one’s scope) can be undertaken with a laser, e.g. perio debridement using a laser rather than an ultrasonic scaler, cavity prep with a laser rather than a highspeed drill, desensitising with a laser rather than by topically applying a desensitizing gel, etc. But these trainings do NOT extend a practitioner’s scope of practice.

OHTs in the practice can use a diode laser (once they have done the training and where needed by state law gained a laser use licence) for procedures like photobiomodulation/ low-level laser therapy to desensitize teeth and reduce post-adjustment pain and accelerate tooth movement, or to disinfect periodontal pockets after debridement. All surgical procedures like exposing unerupted teeth and reshaping gingival tissue need to be done by the orthodontist themselves or referred out.

In terms of laser training, doing online training only, even though there was a “hands-on” component is not enough to demonstrate competence. You would need to do the in-person

hands-on under appropriate supervision before you could consider yourself competent.

In terms of the requirements for a laser license to operate, it depends on your state /territory. You can check your local state legislation on the DHAA member portal.

Dear DHAA... Through my university degree I was taught to place stainless steel crowns on primary teeth. Over the weekend I was on a CPD course where we were taught how to place SSCs on permanent teeth. I just wanted to check if that would now be considered as a part of my scope of practice?

It's up to you to determine if you are now competent in performing this procedure and if you have all the necessary knowledge and skills to determine when this procedure is appropriate and manage any potential complications.

The Board has a reflective practice tool to help you know your scope of practice and to support your continuing professional development:

If you have determined that placing SSC's on

Does a operating a teeth whitening business require a provider number?

permanent teeth is within your scope from your CPD, but because this is a permanent tooth, you would need to be confident that you could plan a long-term treatment plan and talk with the patient's family about the implications of placing a SSC on a permanent tooth.

Dear DHAA... I remember there was a new award for DHs and I can't seem to find this anywhere. I'm after a recommended range for someone with 20+ years experience - both casual rate and ongoing rates. Please refer to the Health Professionals and Support Services Award 2020click here.:

Section 17 outlines the pay rates for all levels of health professionals that are

covered by the award.

Schedule A.2 provides definitions of all levels of health professionals in this award.

These sections should assist you in determining your MINIMUM wage. Please note that the award only recognises ‘duties and responsibilities’, not length of experience - you could be very experienced if you are performing basic duties than the award rate reflects on the duties. In general terms, more experienced practitioners perform more complex duties, but this is not always the case.

The actual pay rate should be based on the market rate, which is published in the open domain here:

University of Queensland Open Source e-space library:

Table 3.5 provides detailed information on the current market rate (which will be updated in 2024).

Dear DHAA... I want to open my own professional whitening business. I was wondering if you could provide a bit of clarification on whether or not I will require my own provider number to provide the whitening treatment for my patients?

Provider number is purely a business arrangement among the providers, patients and funding agencies. It doesn’t affect your scope of practice or your professional and legal obligations as a registered Ahpra health practitioner.

If you wish to claim CBDS or private health insurance payment for any treatment

then you must follow their (the funding agencies’) rules and in most cases, you will need a provider number as requested by the funders.

Note that you will need to be sure that the service you provide is within your scope - the fact that funders are happy to pay for a certain treatment doesn’t mean you can provide the service if it is not within your scope.

Dear DHAA... I’m qualified to do anaesthetic in NZ and in USA. Do you know if a Dental Hygienist/OHT in NSW and in QLD needs a separate licence to do anaesthetics?

As a Dental Hygienist/ OHT you do not need an additional licence to use local anaesthetic as long as you have undergone the training to perform it as part of your scope. It is important to note that the different states are governed by different drug and poison schedules which may impact the anaesthetic you can use.

You can find all of the state legislation on the DHAA legal framework page here. n

If you have a question to ask then please email it to bulletin@dhaa.info

You're in good hands

Created by people who understand how you work, the DHAA Member Insurance Program is one of the many exclusive benefits of DHAA membership

As an oral health practitioner, you play a pivotal role in the health of your patients. People know they’re in good hands with your care. They trust your expertise and rely on your knowledge to help keep their oral health in optimal condition.

With the DHAA, you’re also in good hands. To support you, we have partnered with BMS to offer you a comprehensive member insurance program.

Why choose the DHAA Member Insurance Program?

BMS is the exclusive insurance broker for the DHAA. Through this partnership, the DHAA Member Insurance program offers a range of insurance policies, from professional indemnity insurance, public liability insurance, entity insurance, and more, to help ensure you’re covered for all aspects of your work. Benefits of the program include:

• Professional Indemnity insurance cover, plus additional cover options to suit every stage of your career

• Sponsorship of a DHAA clinical specialist to help with clinical claims queries

• Ongoing risk resources to help you manage and avoid risk

• Local BMS brokers available to assist you when you need it

• Continuous review of the cover offered in the DHAA Member Insurance program, to ensure it always meets the insurance requirements of dental hygienists, oral health therapists and dental therapists

• An easy-to-use insurance portal for managing your policy and accessing risk resources all in one place.

Looking for a different type of cover?

As a specialist insurance broker, BMS can work with you to place policies that meet your needs. Speak to BMS to find the insurance solution that’s right for you.

How is the DHAA Member Insurance Program designed?

As part of the DHAA’s commitment to providing comprehensive cover to its members, the DHAA regularly reviews the program with BMS. During this review, DHAA and BMS carefully consider trends, claims, and other factors, to ensure the program continues to meet the required Professional Indemnity insurance needs of dental

“The DHAA and BMS carefully consider trends, claims, and other factors, to ensure the program continues to meet the required Professional Indemnity insurance needs of oral health professionals”

hygienists, oral health therapists

and dental therapists. You have the opportunity to review any changes to the program each year upon renewal.

Cover for every stage in your career

The DHAA and BMS understand that your needs will evolve throughout your career. Thus, various cover options are available whether you are a student, working professional, business owner, or retiree.

Students and graduates

Under the DHAA Member Insurance program, professional indemnity cover is complimentary if you’re a student member or a first-year graduate member. This is to support you while starting your career.

Sole traders, business owners, and working professionals

Additional cover is also available whether you’re a working professional, sole trader and/or a business owner.

Additional cover includes public and products liability insurance, entity insurance, and business insurance.

Retired professionals

Run off cover is available to cover you when you cease practicing as an oral health practitioner. To activate run off cover, speak to a BMS broker prior to your retirement.

How do I get cover?

If you currently hold an active DHAA membership, you can get cover at any time. To get a quote, simply create an account or log in to the BMS Portal, and get a quote.

For more information about the program, visit the insurance page on the DHAA member portal n

You must be a current DHAA member to be eligible for the DHAA member insurance program. If your membership ceases you will not be offered renewal when your policy expires. In arranging this insurance for our members DHAA is acting as a distributor of BMS Risk Solutions Pty Ltd (BMS) AFSL 461594, ABN 45161187980. This insurance is issued by BMS under binder with Certain Underwriters at Lloyds. When acting under a binder BMS acts as agent for the insurer and not as your agent. This is general advice only and BMS has not considered whether it was suitable for your particular objectives, needs or financial situation. Please read the Policy Wording/Product Disclosure Statement and the BMS Terms of Engagement which contains the Financial Services Guide before making a decision about purchasing this policy. DHAA may receive a percentage of the commission paid to BMS by the insurer and/or a fee per policy.

Get your CPD fix online

Our regular update on some great reading to improve your skills and top up your CPD hours

Make the most of your sofa time by studying at home and keep your CPD tally rolling. Subjects in this edition's round-up cover aged-care dentistry, cultural humility and how diet choices can affect dental health and hygiene.

Whatever your special interest, there's truly something for everyone.

Cultural humility

The importance of cultural humility and cultural safety in healthcare

• Published: 15 January 2024

• MJA

• Neda So, Karen Price, Peter O'Mara and Michelle A Rodrigues.

• CPD Hours 0.25 non-scientific

advanced conceptual frameworks of cultural humility and cultural safety. Improving our shared understanding and application of cultural humility and cultural safety is a key factor in minimising health disparities and optimising health outcomes for all Australians.

Antimicrobial resistance

People-centred approach to addressing antimicrobial resistance in human health. A WHO core package of interventions to support national action plans

• Published: 19 October 2023

• WHO

• CPD Hours 1 scientific

people face when accessing health services to prevent, diagnose and treat (drug-resistant) infections. It puts people and their needs at the centre of the AMR response and guides policymakers in taking programmatic and comprehensive actions to mitigate AMR in line with a proposed package of core interventions.

Cultural competency is the concept of understanding diverse cultural groups to provide high-quality patient-centred care that is respectful of and aligned with the patient's cultural health beliefs, practices and value system.

There is a need to focus on the more

This document outlines the concept and content of the WHO people-centred approach to addressing antimicrobial resistance (AMR) in the human health sector. The proposed approach recognises and aims to address the challenges and health system barriers

The development of the peoplecentred core package of AMR interventions was based on a review of the evidence and multidisciplinary expert opinion, complemented with feedback from a global online consultation and WHO’s strategic and technical advisory group on antimicrobial resistance. As countries develop or revise their national action plans (NAPs) on AMR, the people-

centred core package of interventions can support the design and prioritisation of actions in the human health sector at the different levels of implementation and integrated with broader health system strengthening and pandemic preparedness and response plans.

Perceptions of dieticians

The aim of this project is to investigate the knowledge and practices of Australian dietitians and oral health promotion.

• Published: 8 January 2024

• Wiley Online Library

• Norrie, T.P., Ramjan, L., Sousa, M., George, A.

• CPD Hours 0.25 scientific

Oral health ageing

Good oral health is an important part of healthy ageing

• Published: 8 January 2024

• BMC Geriatrics

• Poudel, P., Paudel, G., Acharya, R., George, A., Borgnakke, W., Rawal, L.

oral health care for older people globally. This study reviewed evidence (policies, programs, and interventions) regarding oral health care for older people.

A total of 149 dietitians participated in the national survey. Overall, dietitians were knowledgeable about oral health risk factors and preventative measures across general health domains. The majority of dietitians agreed that oral health could affect nutrition interventions (95.5%) and that dietitians should be discussing oral health (88.0%). However, nearly half were not confident in providing counselling or education and felt that undergraduate training for oral health promotion was inadequate (78.2%). A small proportion (6.0%) of dietitians were already providing oral health promotion regularly. Key barriers included a lack of clear guidelines for practice, limited training opportunities and indistinct referral pathways.

• CPD Hours 0.5 scientific

Good oral health is an important part of healthy ageing, yet there is limited understanding regarding the status of

The findings from policy documents indicated a lack of priorities in national health policies regarding oral health care for older people. The most common oral health interventions reported in the published studies included educational sessions and practical demonstrations on oral care for older adults, nurses, and care providers. Other interventions included exercises of facial muscles and the tongue, massage of salivary glands, and application of chemical agents, such as topical fluoride. n

REASONS TO BE CHEERFUL

DHAA & PROUD

DHAA PROUD&

There are so many strings to the DHAA bow that we asked DHAA CEO Bill Suen to give us the lowdown on the numerous benefits of DHAA membership

DHAA & PROUD

As an industry association, it is our responsibility to provide a collective voice for the individuals that make up our membership. This multifaceted duty of professional care is something that the DHAA take very seriously. As such, we are always looking to enhance the professional lives of our members, as well as extending our circle of influence on the wider oral health industry.

One small yet significant indication of the efforts being made to bring our profession closer together, is the agreement on a new collective noun for how we reference ourselves and how others refer to our profession. From here on in, anyone previously identifying as a dental hygienist, dental therapist or oral health therapist will now be referred to as an oral health practitioner (OHP).

While this title tweak may not change your life overnight, it will create a stronger and more unified front to other professions that we work with.

As with all Ahpra registered dental practitioners, an OHP must meet the Dental Board’s expectations on professional

behaviour and conduct as set out in the code of conduct and various standards and guidelines. We perform critical roles in caring for people who are unwell, helping people to recover and seeking to keep people well. These are achieved by all practitioners putting patients first, practising safely, effectively and in partnership with patients and colleagues using patient-centred approaches for the best possible patient outcome. We need to understand our individual scope and continuously keep up to date with evidence-based best practices within a dynamic and complex regulatory framework covered by multiple levels of government. At the same time, we have to deal with workplace issues, manage staff and patient expectations, and maintain a work-life balance. We often have to deal with meeting competing demands in a challenging environment. This is where a professional association such as the DHAA is able to provide support to deal with all these requirements.

Here are a number of other advantages of being a DHAA member.

Stay up to date

As your professional association, the DHAA keeps its members up to date with relevant changes in legal and professional requirements, professional standards and guidelines, and advancements in technologies and practices, through our well-established communication channels. This is of particular importance in today’s world of social media-led communications can circulate inaccurate and unproven information. The DHAA helps to minimise the risk of acting on inaccurate information by providing members with validated information in a timely fashion. In addition, DHAA members can access a variety of useful guidance via the DHAA member portal of the website – latest drug information, relevant state and commonwealth legislation, as well as business-related resources and advice.

Continuing professional development

One of the most common reasons for professionals to join their industry association is access to continuing professional development (CPD). At present, there is a broad range of CPD being offered by a host of individuals and organisations; and, while majority of these are provided by reputable people and organisations, many are not evidence-based and often serve the provider’s interests rather than providing useful continuing education to participants. CPD is an important investment of an individual’s time and financial resources and should not be taken lightly. If done correctly, CPD could improve skills and confidence, open doors for career progression, or at the very least keep one up to speed with the latest developments within a given area of practice.

“We should not need to deal with our oral health career journey alone, the DHAA provides the support we need to enjoy a satisfying and rewarding career”

The DHAA delivers a comprehensive CPD program with a carefully designed annual calendar to meet the varying needs of its members. Anything from flexible online webinars to local faceto-face seminars, not to mention the annual DHAA National Symposium, which is our flagship education event that no one wants to miss!

The DHAA membership provides 20 hours of free online webinars (live and recorded) so that all members can easily meet the Dental Board’s CPD requirements in the comfort of your own home and at a time that is convenient to you.

Expand your network

As dental practitioners, we are likely to be working with a tight-knit team of professionals – exposed to similar people and receiving limited information. Being a part of your professional association provides the opportunity to connect with the relevant information, people and organisations for advice and support through an extensive network that cannot be matched by individuals or small teams. DHAA members can seek assistance and advice for all professional matters, from clinical practice to career development. The DHAA will seek appropriate advice from trusted internal experts and external connections.

We've always got your back Advocacy is one of the key functions of a professional association. With the success of our ‘Bad Mouth” campaign in 2020 (pic above) where the DHAA mobilised its membership to lobby politicians across the country leading to the acquisition of OHP provider numbers, we are

Redressing professional indemnity insurance

now focusing on seeking access to Medicare allied health item codes for preventive oral health services and education. This initiative not only expands funding sources but also integrates oral health prevention into GP chronic disease care plans, aligning oral health with overall healthcare objectives.

The advocacy work indeed benefits the whole of the profession and not just association members. However, the ability of our association to utilise the collective power derived from our membership relies on the size of the membership and the involvement of members in advocacy work. This is critical for success in advocacy, as evident from our provider number campaign during which many members helped share our messages with our peers and stakeholders through individual channels. The future of individual careers and our profession as a whole, is heavily dependent on everyone’s commitment and support to our professional association.

As the professional association of OHPs, the DHAA provides a wide range of services to support our members. We offer a comprehensive and affordable Professional Indemnity Insurance service (PI) that meets the Ahpra registration requirements. Launched five years ago as a member benefit, we have been able to maintain the same affordable premium without any increases. During the same period, we have witnessed all other major PI insurance providers lowering their margins in response to our entry into the PI insurance market. The insurance risk profile of our profession is among the lowest when compared with other health professionals such as doctors and dentists. There is no justifiable reason for OHPs to have to pay a higher fee to have PI insurance cover.

Maintaining relations

The workplace is often a complex and challenging environment where our members work and interact with other health professionals, management and support staff, and members of the public. The DHAA Industrial Relations Advice Service has helped countless members deal with workplace issues such as employment entitlements, contract review, bullying or unfair dismissal through our contracted IT lawyer. The DHAA Job Board connect members to employment opportunities in a safe and confidential environment.

Peer support

Services (PSS) assigns an experienced OHP volunteer to support the individual over-and-above the legal advice delivered by the IR and PI Insurance service providers. The number of members seeking PSS has been low but those who utilised it found it extremely valuable through the stressful period.

Wide-ranging member benefits

In addition to industry-leading professional support, the DHAA also provides members with financial savings on common domestic expenses through its member benefits portal. Members may access corporate pricing and discounts on a wide range of products, services and household brands from laptops, TVs, smartphones, new cars, fitness clubs, hotels and holidays, financial services and gift cards.

Take a hands-on role

MEMBER

OPENRENEWALS IN

MAYEarly-bird discounts apply

There are also ample opportunities for us to join a variety of DHAA committees and special interest groups, and hold elected roles within the organisation. There is something for everyone, with varying specialties, time commitment and these are great networking and personal development grounds for participants who will gain a lot through these connections, and at the same time make a difference to our peers and our profession. To foster the development of leadership skills and innovation for individuals and the profession, the DHAA provides a range of leadership training, mentoring, and achievement awards to our members.

To further support members dealing with workplace and professional issues such as Ahpra notifications or patient complaints, the DHAA Peer Support

We should not need to deal with our oral health career journey alone, as the DHAA provides the support we need to enjoy a satisfying and rewarding career. It is time we all utilise our professional association fully and get the best out of our DHAA membership. n

The DHAA – supporting you at every stage of your career journey

As oral health practitioners, we get to see first-hand how a dry mouth can affect the oral cavity. I am often the first to mention signs and symptoms to my patients and bring this condition to their attention. Many of my patients often have little to no idea of what a dry mouth is and how it can affect their oral health as well as the rest of their body. I have recently collaborated with Oral 7 to help educate hospital and healthcare staff on the effects that a dry mouth has on their patients.

I conduct information sessions with various healthcare departments, including cancer and radiation wards, haemodialysis wards, diabetes educators, dieticians, sleep and snoring

to protect the mouth from bacterial infections by breaking down the cell walls of certain bacteria, destroying the cell before it can proliferate and cause destruction. Salivary peroxidase is an enzyme that helps protect the mouth from harmful bacteria and fungi by catalysing reactions that produce antimicrobial substances. Lactoferrin exhibits potent antimicrobial properties against a wide range of microorganisms, including bacteria, viruses, fungi, and parasites. It accomplishes this by binding to iron, an essential nutrient for microbial growth, thereby depriving

as well as aiding speech, swallowing, digestion and taste. Saliva buffers oral acidity naturally and effectively and serves many important daily functions, including:

n Protection

Saliva helps protect oral tissues by washing away food particles and debris, as well as bacteria and other microorganisms. It also contains antimicrobial agents and antibodies that help fight against infections and maintain the balance of bacteria in the mouth.

Saliva also acts as a carrier of essential irons and minerals such as calcium, fluoride and phosphate, which help to remineralise the tooth’s enamel.

Saliva secrets

Getting to grips with dry mouth and spotting the many signs, symptoms and treatment of salivary gland hypofunction and xerostomia

by Brie Jones

clinics, oral medicine specialists and speech therapists. Here is a little refresher on the importance of saliva, dry mouth and an idea of what I discuss during my information sessions:

Saliva is important in the oral cavity because it acts as the first barrier of defence against infections, bacteria and viruses. Particular enzymes and proteins found in saliva help to protect oral tissues and destroy pathogenic bacteria. Lysozyme is an enzyme with antimicrobial properties. It helps

pathogenic bacteria of their food source and inhibiting their proliferation. Glucose oxidase contributes to the antimicrobial properties of saliva by producing hydrogen peroxide when glucose is available. Hydrogen peroxide has strong antimicrobial properties and can effectively kill or inhibit the growth of bacteria, viruses, and fungi present in the oral cavity. It helps in controlling the growth of harmful microorganisms and maintaining the microbial balance in the mouth, which is essential for oral health.

Long protein molecules in saliva lubricate the oral cavity, providing protection from trauma and infection

n Speech

Saliva moisturises the oral cavity, allowing the tongue and cheeks to move freely to produce clear sounds and pronunciation of words. A dry mouth sufferer often finds their cheeks sticking to their teeth which can impede the movement of their soft tissues and affect their speech.

n Eating, swallowing, digestion

Saliva lubricates and wets food, allowing for the bolus formation of food, ready for swallowing. Enzymes within the

“Long protein molecules in saliva lubricate the oral cavity, providing protection from trauma and infection as well as aiding speech, swallowing, digestion and taste”

saliva, such as amylase and lipase, break down carbohydrates and fats; promoting proper digestion and allowing our bodies to use the nutrients and energy effectively.

n Saliva oral clearance

Saliva plays an important role in balancing the oral microbiome by helping to flush the oral cavity of food, debris and microorganisms. ‘One millilitre of human saliva from a healthy individual contains about 100 million bacterial cells’.1 People who are affected by severe and persistent saliva reduction, retain more food and microorganisms, and thus increase their risk of oral disease.

n pH Levels

Saliva buffers pH, neutralising acids and preventing demineralisation of the enamel.

n Taste

Saliva contains chemicals that dissolve food molecules, allowing them to be detected by taste buds on the tongue and providing a sense of taste.

Dry mouth can be broken up into two categories, salivary gland hypofunction and xerostomia.

Salivary gland hypofunction is “a condition in which unstimulated or stimulated salivary flow is significantly reduced, and can also result in alterations of the chemical composition of saliva” (Hopcraft & Tan, 2010). Whereas xerostomia is defined as the subjective experience or sensation of oral dryness (Hopcraft & Tan, 2010). According to Hopcraft and Tan (2010), “xerostomia is not always related to an actual decrease in saliva quality or quantity. However, there is evidence that patients suffering from xerostomia are at greater risk of developing dental caries. Therefore, it is im portant for clinicians to have a >>

sound understanding of this condition, including diagnosis and monitoring, to ensure that they are able to adequately treat patients with xerostomia “ (p. 239)

Patients with a dry mouth typically suffer from one or more of the following symptoms:

• Dry, cracked lips

• Dry fissured tongue

• Halitosis

• Erythematous and parched oral mucosa

• Mucositis / Stomatitis

• Pain or burning sensation in their mouth

• An evident lack of saliva pooling on the floor of the mouth

• Oral thrush (candidiasis)

• Difficulties in speech or swallowing

• Taste disturbances

• Increased oral infections, dental caries or periodontal disease

Although we see the clinical signs and symptoms, it is important to note that a dry mouth not only affects someone physically but can also affect their mental state and quality of life. Painful and unsightly oral lesions, as well as difficulty in speaking and eating, can result in low self-esteem, and a lack of communication, leading to isolation and depression.

During my presentations, I introduce and discuss the Xerostomia Inventory questionnaire as a helpful tool for hospital staff. The questionnaire (see below) helps to ignite conversation between the practitioner and the patient, highlighting the oral condition and bringing it to the patient’s attention.

“Although we see the clinical signs and symptoms, it is important to note that a dry mouth not only affects someone physically but can also affect their mental state and quality of life”

The practitioner can then educate their patient on what a dry mouth is, how it affects them, what can help, and the importance of having regular dental checks. The questionnaire is a useful tool to gauge the severity of the patient’s dry mouth and allows them to recommend lifestyle changes or products to help their patient’s condition.

Being that xerostomia is a subjective condition; the Xerostomia Inventory reflects on many manifestations of the xerostomia experience and is easy for patients to follow. The questionnaire includes 11 questions and each question is rated 1-5. The rating gives you an idea of the severity of the condition. A score of 11 is characterised as very mild xerostomia and 55 represents severe xerostomia. Include a copy of the questionnaire - attached separately

Dry mouth is considered one of the most underappreciated, underdiagnosed and undermanaged oral health conditions. Approximately one in five people report some form of dry mouth, with an increasing prevalence in the elderly. Many activities or situations can cause the mouth to become dry, upsetting the delicate microbiome balance. These may include:

• Dehydration.

• Alcohol consumption.

• Smoking.

• Stress.

• Prolonged air travel.

• Mouth breathing.

• Strenuous physical activity.

• Many widely used and prescribed medications.

• Autoimmune and chronic diseases such as Sjögren’s syndrome, HIV/AIDS, systemic lupus erythematosus, rheumatoid arthritis, thyroid disease and poorly controlled diabetes mellitus.

• Xerostomia can also be observed in renal patients due to restriction in fluid intake, as well as the side effects of prescribed drugs.

• Chemotherapy drugs used to treat cancer can make saliva thicker, causing the mouth to feel dry and alter taste.

• Radiation therapy of the head and neck during cancer treatments can damage salivary glands resulting in a reduction of saliva flow.

• Trauma to the nerves in the head and neck after serious injuries can damage the saliva glands, reducing or blocking the flow of saliva.

As we are aware, a dry mouth can be extremely debilitating. Many of my patients and patients within the hospital systems suffer in silence and are unaware of the treatments available to them. Some tips I recommend to help relieve symptoms of a dry mouth include:

• Drinking plenty of water (8 to 12 glasses, or 1-2 litres a day) to maintain hydration.

• Avoid, or limit drinks with caffeine, such as tea and coffee.

• Sipping on water or a sugarless drink during meals can make chewing and swallowing easier and may also improve the taste of food.

• Chewing sugar-free gum or sucking on sugar-free hard candy or mints to help stimulate saliva flow.

• Avoid tobacco and alcohol as they dry out the mouth.

• Be careful with spicy or salty foods as these may cause irritation, pain or a burning sensation.

• Breathe through the nose, not the mouth.

• Use oral lubricants or moisturisers.

There are many products available to help patients relieve the symptoms of a dry mouth.

They can include:

Mouthwashes

• Oral 7

• Dentamed

• Peter Mac

• CloSYS mouthwash/ rinse

Mouth Gels

• Oral 7

• Biotene

• GC Dry mouth

• Dentamed (and gel satchels)

Toothpastes

• Oral 7

• Biotene

• cloSYS

• PreviDent® 5000 Dry Mouth toothpaste.

Wafers/ melts

• Xylimelts

Lozenges

• Biotene

• Gum

• Oral 7

The problem with many of today’s oral care products is that they contain detergents and chemicals such as sodium laurel sulphates, or alcohol. These products upset the delicate oral flora and can cause irritation and dry the mouth out with constant use.

Oral 7, is the only product in Australia that contains four natural salivary enzymes and proteins (Lactoferrin, Lysome, glucose oxidase and lactoperoxidase). These powerful enzymes and proteins help boost the protective benefits of saliva and strengthen the mouth’s natural defence system. It is specially formulated to provide gentle, yet effective oral care and relief without the use of harsh chemicals (NO SDL and NO Alcohol). Biotene used to contain salivary enzymes, however, they have recently changed their formula and have removed these protective enzymes. I always discuss the importance of reading the labels of all products we recommend to our patients, and ideally, trying them ourselves first. n

References

1) Pedersen, A. M. L., & Belstrøm, D. (2019). The role of natural salivary defences in maintaining a healthy oral microbiota. Journal of Dentistry, 80(Supplement 1), S3-S12. https://doi.org/10.1016/j.jdent.2018.08.010

2) Bauer, J. A., Zámocká, M., Majtán, J., & BauerováHlinková, V. (2022). Glucose oxidase, an enzyme “Ferrari”: Its structure, function, production and properties in the light of various industrial and biotechnological applications. Biomolecules, 12(3), 472. https://doi.org/10.3390/biom12030472

3) Talha, B., & Swarnkar, S. A. (2023). Xerostomia. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Available from: https://www.ncbi.nlm.nih. gov/books/NBK545287/

4) Guggenheimer, J., & Moore, P. A. (2003). Xerostomia: Etiology, recognition and treatment. Journal of the American Dental Association, 134(1), 61-69.

5) Frydrych, A. M. (2016). Dry mouth: Xerostomia and salivary gland hypofunction. Australian Family Physician, 45(7). Retrieved from https://www.racgp. org.au/afp/2016/july/dry-mouth-xerostomia-andsalivary-gland-hypofuncti

6) Hopcraft, M., & Tan, C. (2010). Xerostomia: An update for clinicians. Australian Dental Journal, 55, 238-244. https://doi.org/10.1111/j.18347819.2010.01229.x

7) Thomson, W. M., Chalmers, J. M., Spencer, A. J., & Williams, S. M. (1999). The Xerostomia Inventory: A multi-item approach to measuring dry mouth. Community Dental Health, 16(1), 12-17.

8) Han, P., Suarez-Durall, P., & Mulligan, R. (2015). Dry mouth: A critical topic for older adult patients. Journal of Prosthodontic Research, 59(1), 6-19. https://doi.org/10.1016/j.jpor.2014.11.001

Managing a healthy headspace

The Mindful Smiles Hub has been created to provide support for oral health practitioners who might need a little help

by Roisin McGrath

Late last year, we launched the Mindful Smiles Hub new online resource that focuses on the mental health and well-being of the dental team. The purpose of the Mindful Smiles Hub is to provide relevant information, resources and support, and to raise awareness about mental health issues in the dental professions. It was created by a group of dental professionals from across Australia (led by A/Prof Matthew Hopcraft) who are passionate about promoting mental health and wellbeing and breaking down the stigma in talking about our mental health. Mindful Smiles aims to help improve the mental health and wellbeing of the dental team, through leadership, education and support.

As oral health practitioners, we are at the forefront of delivering patientcentred care and ensuring optimal oral health for our clients. We recognise the importance of mental health and well-being for our clients; however, the daily demands of our profession and our role in caring for others means we often overlook our own mental health and wellbeing needs.

Every oral health practitioner knows that while our occupation is incredibly

rewarding, it can also be very stressful (I know I’ve experienced many workrelated challenges, over my 30 years as a dental hygienist, that impacted on my mental health and wellbeing.) If not managed appropriately, this occupational stress can compromise our clinical performance and job satisfaction and over time can lead to burnout.

In our 2021 survey of almost 1,500 Australian dental practitioners, we found a high burden of mental health issues. The key findings of our study were that:

• One in four dental practitioners were likely experiencing burnout,

• 32% were rated as having moderate-severe psychological distress,

• 59.4% were rated as having minorsevere non-psychotic psychiatric morbidity,

• 11.5% reported a current diagnosis of depression,

• 12.9% reported a current diagnosis of anxiety disorder.

• Of significant concern was the finding that 17.6% of respondents had thoughts of suicide in the previous 12 months, and 34.4% had ever thought of suicide.

“People are still reluctant to talk openly and honestly about mental health and there is a persistent fear of stigma and discrimination in seeking support”

When looking specifically at data from the 267 oral health practitioners (dental hygienists, dental therapists and oral health therapists) who completed our survey, we found that 16.9% had a current diagnosis of depression and 19.1% a current diagnosis of anxiety, which is higher than the dentists in the study and also higher than in the general population.

The DHAA is committed to supporting members experiencing work-related issues that impact on their mental health and wellbeing. In 2020, I was involved in establishing the DHAA Peer Support Service to provide one-onone support to members experiencing challenging situations at work. In 2023, we also launched the online Mental Health First Aid training program for members across Australia. I’d like to thank all of those who’ve participated in the course so far, and I’m looking forward to delivering this incredibly valuable training to more of you in the near future.

Although mental illness is common (one-in-five Australian adults experience a mental disorder every year), only half of those experiencing a mental health condition seek

professional help. People are still reluctant to talk openly and honestly about mental health and there is a persistent fear of stigma and discrimination in seeking support.

The evidence is clear that the sooner people get appropriate help for mental health issues, the sooner they are on the road to recovery. It can be difficult to find relevant information or support when unwell with a mental health condition. A trusted GP is always a good place to start and is an important positive step. The Mindful Smiles Hub is very simple to navigate and provides useful resources and links to a range of professional supports.

It’s important to remember that as oral health practitioners, we’re not alone in our mental health struggles. It's essential that the dental community

comes together to address the high prevalence of mental health issues in the dental team. This can begin with creating work environments where we feel safe and supported to disclose and discuss our mental health. Stigma should be replaced with empathy and judgment with understanding.

If you are experiencing any mental health issues, please speak to your GP or mental health professional. For immediate support, if you or someone else is experiencing a mental health crisis please call emergency services on 000. You can also call Lifeline on 13 11 14.

You can follow the Mindful Smiles Hub on Facebook, Instagram or LinkedIn

Practising outside the box

We take a look at an innovative solution to managing oral health issues outside the walls of the conventional clinic

by Victoria Perchyonok BOH (Adult Scope), PhD (Chemistry), BSc(Hon)

Mobile dental clinics are an “outside of the box” solution to a need for oral health care for the elderly, vulnerable, and children.

Even if most dental procedures are performed in private practices, mobile dental delivery systems (MDDS) are receiving growing interest in the field of dentistry 1,2. Many reasons can be attributed to this interest. Indeed, MDDSs, whether or not they are coupled with mobile units or vans, enable the reach of unserved communities 2 , delivering cost-effective services even if the time spent setting up the unit may be a limitation 3. MDDSs enable some barriers to accessibility to be broken, such as geographical barriers: patients from rural communities, isolated areas, etc. 1–4; socioeconomic barriers: children and elderly from families with low socio-economic status 1, patients medically underserved in poor urban areas 1, immigrants 1,5 , homeless people 1; and health barriers: vulnerable patients at home or in care facilities 1, hospitalised patients 1,3, and elderly patients 1,3. In addition, to reach patients who live in areas not provided with dental surgeons, or to gain access to destitute and vulnerable patients, MDDS can be used in a hospital environment, from room to room, or associated with the delivery of dental care under more conventional means.

Treatment planning concepts for aging patients, is it different?

Like many other developed countries, Australia is facing an aging population and these populations are extremely heterogeneous 6. In young adults, the factors that influence decision-making for oral health care are whether the patient has the will, the time, or the finances to pay for care, while for

clinicians, the decisions are whether they have the skill and the resources to carry out the treatment plan 7 .

For older adults, the decision-making includes all the previously identified factors, but they are now complicated by the patient’s medical and medication problems, the side effects of their medications, their cognitive status as well as the cumulative effects of a lifetime of physiological, traumatic and iatrogenic effects on the dentition and the oral cavity 8 .

The process of decision-making has undergone evolution and has been referred to by various names, from cost-effective care to Minimal Invasive Dentistry (MID) to rational dental care 9. Fundamentally, they are similar. Rational dental care has been defined as the process of decision-making that develops a treatment plan that is in the best interest of the patient after evaluating all the modifying factors.

When planning treatment for the elderly patient, the following questions should be asked before “irreversible steps” are taken 10

1. What are the patient’s desires and expectations?

2. What are the patient’s dental needs and how complex are their problems?

3. What is the impact of dental problems on the quality of life?

4. What is the impact of medical problems on the dental treatment?

5. What is the patient’s ability to maintain oral hygiene independently?

6. Are there any financial limitations on their treatment plan?

7. What is the ability of the dentist to deliver the care needed?

8. What is the probability of success for treatment?

The final treatment plan for geriatric patients should include the following considerations

The treatment plan needs to be developed after evaluation of the modifying factors and following the concerns raised by the decision tree 11 The treatment is divided into phases >>

“Even if most dental procedures are performed in private practices, mobile dental delivery systems (MDDS) are receiving growing interest in the field of dentistry”

and each phase constitutes a reevaluation point in terms of the patient’s tolerance for treatment 12:

a) Emergency care

b) Disease control

c) Reconstruction

d) Maintenance and monitoring

Clinical decision-making in dentistry tends to be based on qualitative, subjective estimates that the benefits of a specific treatment outweigh the possible alternatives. In geriatric dentistry, the additional major considerations should include an understanding of the influence of social and medical problems on the oral cavity and dental treatment 13

It is imperative that a step-wise approach is used and that no irreversible step is taken until an adequate risk assessment of the potential for success has been done 14. It is important to maintain ‘key teeth’, especially in the mandibular arch 15. The fundamental concept for successful treatment is to understand how the patient functions in his or her environment and how dentistry fits into his or her overall needs 16 .

Minimal Intervention Dentistry (MID): What is it and why?

Minimum Intervention Dentistry (MID) can be defined as a philosophy of professional care concerned with the first occurrence, earliest detection, and earliest possible cure of disease on micro (molecular) levels, followed by minimally invasive and patient-friendly treatment to repair irreversible damage caused by such disease 17

Minimally Invasive Dentistry, from a day-to-day dentistry perspective, focuses mostly on cariology and restorative dentistry, even though it embraces many aspects of dentistry 18 . The concept of Minimally Invasive Dentistry supports a systematic respect for the original tissue, including diagnosis, risk assessment, preventive

treatment, and minimal tissue removal upon restoration. The modern approach to the management of the disease of dental caries relies on oral health professionals taking the role of “physician” first, and “surgeon” second 19

Philosophy of MID

The ultimate goal of minimal intervention is to extend the life of restored teeth with as little intervention as possible 20. When operative care is indicated, it should be aimed at “PREVENTION OF EXTENSION” rather than “EXTENSION FOR PREVENTION” 21

The philosophy of Minimal Intervention Dentistry has now arisen in an attempt to combine all the present knowledge of prevention, remineralisation, ion exchange, healing, and adhesion with the object of reducing carious damage in the simplest and least invasive manner possible 22 . Minimally Invasive Dentistry utilises techniques and materials to assess caries that cannot be remineralised and to restore the tooth with minimal loss

of healthy structure 23. This begins with the elimination of the disease followed by remineralisation and healing of the demineralised areas. Modification of existing cavity designs should be based on the preservation of natural tooth structure and the use of adhesive, bioactive restorative materials.

What is possible?

• Minimal lntervention Dentistry (MlD) MI is a “concept of patient care that deals with the causes of dental disease and not just the symptoms” 25

How is it done in Mobile Dental Clinics Australia (MDCA): Real clinic outside the box

Destination Bali

Back by popular demand, the DHAA are heading to tropical Bali for a full day of CPD over the June long weekend

FEATURED TOPICS

n A traffic light system for bruxism and oral micosal disease

n Beyond the Clinic Walls: Navigating in mobile dentistry for our paediatrics patients

n Creating access to oral health care in aged care facilities

n Interpretation and implementation of the human needs conceptual model in the dental hygiene process of care in Indonesia

FEATURED SPEAKERS

Dr Amanda Phoon Nguyen

Oral Medicine Specialist

Shida Taheri

Oral Health Therapist

Jacqui Biggar

Oral Health Therapist

Zaeni Dahlan

Oral Health Therapist (Indonesia)

MDCA IS GROWING Join us now!

Mobile Dental Clinics Australia (MDCA) was founded in 2015 as a mobile service, providing specialist dental services to residents of aged care facilities, retirement villages, private homes and more

MDCA offers the capabilities for flexible and complete dental solutions for people who cannot visit a fixed dental clinic

We are thrilled to announce that franchising opportunities with us are now available!

Are you a Dentist, Oral Health Therapist, Dental Hygienist or have business experience in the dental field and looking to start a mobile clinic?

Having the backing of an established and reputable business, that has received awards for excellence, will help make your journey a smooth one

From comprehensive management support to cutting-edge equipment and well-established industry relationships, we have the experience and reputation to help you succeed on your mobile dentistry journey! Contact us now for more information!

“The dental needs of elderly patients have increased. Thus, the clinician requires knowledge and understanding of both dental and medical aspects of ageing for the effective management of elderly patients”

• Minimally Invasive Dentistry

A component of MID (also known as ultraconservative or micro-invasive) refers to operative procedures that preserve sound tooth tissue and tissue that has the potential to remineralise 26

• Micro-invasive techniques refer to the sealing or infiltration of lesions 27

• Minimum-intervention Oral Care (MIOC) MlOC is the concept of prevention-based minimumintervention oral care 15 .

• Biological Approach The use of techniques that alter the environment of the biofilm, disrupts the carious process and aims to halt caries progression 28

• Non-restorative Cavity Control (NRCC) This approach involves increasing access to carious cavities to improve cleanability and permit removal or disorganisation of the biofilm to halt caries progression 29

• Atraumatic Restorative Technique (ART) ART involves the use of hand instruments to remove infected carious dentine followed by restoration with a high-viscosity glass ionomer cement 30

• Silver Diamine Fluoride (SDF) SDF is a clear, odorless liquid currently licensed for use in the UK as a desensitisation agent for non-carious lesions and teeth affected by molar incisor hypo-mineralisation 31. It also has cariostatic properties.

How the MID philosophy compliments geriatric dentistry

The aging of the population, combined with increased retention of natural teeth into old age, means that clinicians now face a new caries challenge in older dentate patients. Many patients are living longer with more chronic medical conditions for which they are taking more medications 32. A resulting increase in the onset of dental caries is evident among patients who may not have had high levels of caries in the past and who may have undergone extensive restorative procedures during their lifetimes 33

The life expectancy of individuals has been improved with an increase in the number of geriatric people. This is regarded as a normal, inevitable biological phenomenon. Gerontology is the study of the physical and psychological changes that occur with aging and care of the aged is called clinical gerontology or geriatrics 34

Geriatric dentistry or Gerodontics can also be defined as the delivery of dental care to older adults involving the diagnosis, prevention, and treatment of problems associated with normal aging and age-related diseases as

part of an interdisciplinary team with other healthcare professionals 35. Worldwide, approximately 600 million people are 60 years and above and this figure is estimated to double by 2025. Further, in the 1990s, the revolutionary research outcome showed a link between oral and systemic health 36. In the elderly, the status of oral health reflects the total outcomes of oral health behaviour, diseases, and treatments undertaken. Currently, the dental needs of elderly patients have increased. Thus, the clinician requires knowledge and understanding of both dental and medical aspects of aging for the effective management of elderly patients. Nevertheless, other factors such as ambulation, independent living, socialisation, and sensory function also play an important role.

Minimal Intervention Dentistry in Geriatric Dentistry

With an aging population, dentists need to be aware of the risks posed to their elderly patients from retained teeth and exposed root surfaces. Oral health problems in later years are multifactorial, with lifestyle, plaque, and salivary factors remaining paramount 37. Root surface caries are likely to present a challenge in patients with a strong history of past coronal caries (and who have the attendant lifestyle risk factors) as well as in elderly patients who suddenly develop salivary hypofunction. Following a maximum interception approach means that specific efforts are needed to profile salivary, plaque, and lifestyle risk factors and ensure that the dentition can be cleaned by the patient and maintained in a way that gives comfort and function as well as aesthetics 37 .

Discussions around long-term objectives for oral health are important when there is a sudden decline in general health in the later years of life. It may be appropriate to use tooth surface protection for strategic anterior teeth and apply the shortened dental >>

Before After

CLINICAL CASE

High-needs elderly in the aged care facility

Limited medical history: Vascular Dementia, Parkinson’s, Diabetes type 2, bedbound, completely reliant on assistance with oral care.

• Unstable patient with periodontal disease

• BOP >30%

• Probing >5.5mm

• Pseudo pocketing <5mm BOP

• Plaque score low

• The patient needs to be in an active treatment program as well as follow up with a supportive periodontal program

• 3/12 recall

Two weeks later, after active nonsurgical periodontal treatment: What a difference: Periodontic treatment and OHI/ education

After: Disease stabilised, OH good, OH care is excellent. Re-application of anti-cariogenic therapy 3/12.

References:

1. World Health Organisation. Health Systems Strengthening Glossary. Available from: http://www.who.int/healthsystems/ Glossary_January2011.pdf. Access date 17 July 2017

2. World Health Organisation. Key components of a wellfunctioning health system. Available from: http://www.who. int/hea lthsystems/EN_HSSkeycomponents.pdf. 2010 May.

Access date 17 July 2017

3. Kandelman D, Arpin S, Baez RJ et al. Oral health care systems in developing and developed countries. Periodontol 2000 2012 60: 98–109.4. Tomar SL, Cohen LK. Attributes of an ideal oral health care system. J Public Health Dent 2010 70: S6–S14.

5. Helgeson M, Glassman P. Oral health delivery systems for older adults and people with disabilities. Spec Care Dentist 2013 33: 177–189.

6. Berwick DM, Nolan TW, Whittington J. The Triple Aim: care, health, and cost. Health Aff 2008 27: 759–769.

7. The Institute of Medicine and the National Research Council. Improving Access to Oral Health Care for Vulnerable and Underserved Populations. Washington, DC: The National Academies Press; 2011.

arch concept where patients cannot readily maintain their oral health due to frailty or medical conditions 38 . Glass ionomer materials can be used both for root surface protection and for conservative restoration where a minimally invasive preparation has been undertaken. In other cases, the arrest of lesions using silver fluoride or CPP-ACP topical treatments can delay or obviate the need for restorative interventions and forms part of the management of patients in high-care units in nursing homes. Involving all members of the healthcare team in supporting oral health is an important strategy to ensure that oral health issues are not overlooked. The challenge is to promote evidence-based self-care. A key message is to promote oral health as part of overall health 39 .

Our mission statement

n To provide and improve access to dental services for all Australians Mobile Dental Clinics Australia (MDCA) is a wholly Australian-owned family

8. Glassman P, Harrington M, Namakian M et al. The virtual dental home: bringing oral health to vulnerable and underserved populations. J Calif Dent Assoc 2012 40: 569–577.

9. Ortman JM, Velkoff VA, Hogan H. An Aging Nation: The Older Population in the United States. Washington, DC: US Census Bureau; 2014. p. 25–1140.

10. Al-Sulaiman A, Jones J. Geriatric oral health care delivery in the United States of America. Curr Oral Health Rep 2016.

11. Harris-Kojetin L, Sengupta M, Park-Lee E et al. Long-term care services in the United States: 2013 overview. Vital Health Stat 3 2013 37: 1–107.

12. Budtz-Jørgensen E, Mojon P, Rentsch A, Roeh-rich N, von der Muehll D, Baehni P: Caries prevalence and associated predisposing conditions in recently hospitalised elderly persons. ActaOdontol Scand 54: 251–256 (1996).

13. Damata C, McKenna G, Anweigi L, Hayes M, Cronin M, Woods N, O’Mahony D, Allen P F: An RCT of atraumatic restorative treatment for older adults: 5-year results. J Dent 2019 83: 95–99.

14. de Moor RJ, Stassen IG, Van’t Veldt Y, Torbeyns D, Hommez GMG: Two-year clinical performance of glass ionomer and

business providing mobile emergency, general, and dental laboratory services throughout Australia.

Mobile Dental Clinics Australia offers the capabilities for flexible complete dental solutions in both mainstream and non-standard environments. The unique business model allows the flexibility to conduct premium dental services in any setting.

n MDCA team approach to oral care of elderly, vulnerable, and children MDCA is a leader in creating and developing a paradigm shift from

resin composite restorations in xerostomic head-and neckirradiated cancer patients. Clin Oral Investig 2011 15: 31–38.

15. Frencken JE, Peters MC, Manton DJ, Leal SC, Gordan VV, Eden E: Minimal intervention dentistry for managing dental caries – a review: Report of a FDI task group 2012 62(5): 223–243.

16. American Dental Hygienists’ Association. Direct Access States. Available from: https://www.adha.org/resourcesdocs/7513_ Direct_Access_to_Care_from_DH.pdf June 2017. Access date 17 July 2017

17. Petersen PE, Yamamoto T. Improving the oral health of older people: the approach of the WHO Global Oral Health Programme. Community Dent Oral Epidemiol 2005 33: 81–92.

18. Yoneyama T, Yoshida M, Ohrui T et al. Oral care reduces pneumonia in older patients in nursing homes. J Am Geriatr Soc 2002 50: 430–433.

19. Frenkel HF, Harvey I, Newcombe RG. Improving oral health in institutionalised elderly people by educating caregivers: a randomised controlled trial. Community Dent Oral Epidemiol 2001 29: 289–297.

20. Hayes M, Allen E, de Mata C, McKenna G, Burke F. Minimal intervention dentistry and older patients. Part 2: minimally

“Mobile Dental Clinics Australia offers the capabilities for flexible complete dental solutions in both mainstream and nonstandard environments”

a service-delivery-oriented model of oral care to a more collaborative, team-based, inter-professional, and preventative approach.

Practitioners are also continuing their professional education in

invasive operative interventions. Dent Update 2014 41 (6): 500-502, 504-505.

21. Frencken JE, Holmgren CJ. Atraumatic Restorative Treatment (ART) for Dental Caries. STI Book; 1999, 99 p.

22. Fusayama, T. Two layers of carious dentin; diagnosis and treatment. Oper Dent 1979 4 (2): 630-670.

23. Banerjee, A. Minimal intervention dentistry: part 7. Minimally invasive operative caries management: rationale and techniques. Br Dent J 2013 214 (3): 107-111.

24. Innes NPT, Frencken JE, Bjørndal L, Maltz M, Manton DJ, Ricketts D, et al. Managing Carious Lesions: Consensus Recommendations on Terminology. Adv Dent Res 2016 28 (2): 49-57.

25. Brunton PA, Kay EJ. Prevention. Part 6: Prevention in the older dentate patient. Br Dent J 2003 195 (5): 237-241.

26. Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence-based medicine: what it is and what it isn’t. BMJ 1996 312 (7023): 71-72.

27. Mata, CD, Allen F. Time for routine use of minimum intervention dentistry in the elderly population. Gerodontology 2015 32 (1): 1-2.

28. Doméjean-Orliaguet S, Léger S, Auclair C, Gerbaud L,

geriatric dentistry as well as age and need-specific oral care to achieve optimum results for all patients and improve their quality of life and general health.

MDCA enables oral health needs to be treated in an “outside the box” approach, resulting in each day being unique, exciting, and immensely rewarding. On any given day, MDCA dispatches eight mobile dental teams to disparate locations with unpredictable weather and work conditions, via various modes of transport (including vans, ferries, and planes).

Conclusion and future directions

There are several barriers to the provision of adequate oral care in Australian residential aged care facilities, including insufficient resources, ambivalent attitudes of health professionals and carers to providing oral care, lack of oral health knowledge, and inadequate training of carers, including non-dental health professionals. A combination of Mobile Dental Care Models equipped with the ability, skill, dedication, and determination to provide holistic, comprehensive preventative care for anyone in need is the future for better health outcomes for our population: old or young. n

Tubert-Jeannin S. Caries management decision: influence of dentist and patient factors in the provision of dental services. J Dent 2009 37 (11): 827-834.

29. Doméjean-Orliaguet S, Tubert-Jeannin S, Riordan PJ, Espelid I, Tviet AB. French dentists’ restorative treatment decisions. Oral Health Prev Dent 2004 2 (2): 125- 131.

30. Tubert-Jeannin S, Doméjean-Orliaguet S, Riordan PJ, Espelid I, Tviet AB. Restorative treatment strategies reported by French university teachers. J Dent Educ 2004 68 (10): 1096-1103.

31. Albrecht M, Kupfer R, Reissmann DR, Mühlhauser I, Köpke S. Oral health educational interventions for nursing home staff and residents. Cochrane Database Syst Rev 2016 9: CD010535.

32. Ekstrand K, Martignon S, Holm-Pedersen P. Development and evaluation of two root caries controlling programmes for home-based frail people older than 75 years. Gerodontology 2008 25 (2): 67-75.

33. Ekstrand KR, Poulsen JE, Hede B, Twetman S, Qvist V, Ellwood RP. A randomised clinical trial of the anti-caries efficacy of 5,000 compared to 1,450ppm fluoridated toothpaste on root caries lesions in elderly disabled nursing

About the author:

Dr Victoria Tamara Perchyonok is an oral health therapist with adult scope, who graduated from the University of Melbourne in 2018 and completed the Adult Restorative Course for Oral Health Therapists. In addition, she completed an Undergraduate Certificate in Dementia Care from the University of Tasmania as well as numerous short courses in Dental Management of Geriatric and Special Needs Patients as well as Advanced Paediatric Dentistry in order to provide the best care for our patients of all ages.

Victoria has transitioned into the oral health profession after a successful scientific career both nationally and internationally and completing a PhD in Free Radical Chemistry in 2001 from the University of Melbourne.

She now combines her passion for delivering evidence-based health care to children and adults. Victoria has been practising in private practice since graduation and is a passionate advocate for bringing dental care to anyone in need. She enjoys spending her spare time with her family and her gorgeous miniature poodles Ariel and Shai.

home residents. Caries Res 2013 47 (5): 391-398.

34. Jensen ME, Kohout F. The effect of a fluoridated dentifrice on root and coronal caries in an older adult population. J Am Dent Assoc 1988 117 (7): 829-832.

35. Fure S, Gahnberg L, Birkhed D. A comparison of four home-care fluoride programs on the caries incidence in the elderly. Gerodontology. 1998 15 (2): 51-60.

36. Wallace MC, Retief DH, Bradley EL. The 48-month increment of root caries in an urban population of older adults participating in a preventive dental program. J Public Health Dent 1993 53 (3): 133-137.

37. Wyatt CCL, MacEntee MI. Caries management for institutionalised elders using fluoride and chlorhexidine mouth rinses. Community Dent Oral Epidemiol 2004 32 (5): 322-328.

38. Petersson LG, Hakestam U, Baigi A, Lynch E. Remineralisation of primary root caries lesions using an amine fluoride rinse and dentifrice twice a day. Am J Dent 2007 20 (2): 93-96.

39. Tan HP, Lo ECM, Dyson JE, Luo Y, Corbet EF. A randomised trial on root caries prevention in elders. J Dent Res 2010 89 (10): 1086-1090.

Early and late eruptions

How to effectively communicate with parents

by Christine Murthi

The eruption of a child's teeth is a natural and gradual process that varies among individuals. Understanding the normal sequence of tooth eruption can help parents know what to expect and when to seek professional advice. Parents have various concerns about teeth eruption which is a significant aspect of development. Some concerns they may have are when teeth erupt too early or when teeth erupt late and also when teeth may erupt in an irregular pattern. There is a general guideline for teeth eruption and it is the responsibility of oral health professionals to provide parents, families and caregivers with the right information at the appropriate time. Communicating with parents and caregivers about early and late eruption of teeth is crucial for ensuring proper dental care for children, maintaining optimal oral health and avoiding complications.

Timing and milestones

There is considerable variability in tooth eruption times, and some deviation from the average range is normal. Each child is unique, and teeth may erupt at different times for different individuals. In cases of eruption patterns that are outside the norm a thorough examination and further investigation is required. The use of radiographs can be helpful to provide information about the issue to the practitioner, in educating parents, relieving concerns

and in the referral process. Encourage parents to bring their children for regular checkups and be sure to monitor the development of teeth. Parents love to celebrate milestones such as when their child gets their first deciduous tooth, loses their first tooth, gets their first permanent tooth or loses their last baby tooth. These milestones can help create positive associations with dental care and create ongoing opportunities to discuss, educate and address concerns. During regular check-ups share typical timelines and give parents helpful reminders about how to look after their child’s teeth through the developmental stages. Parents may not be aware of the potential complications arising from early/late eruption therefore follow up on any referrals, delayed eruption and review oral health. By employing these communication strategies, oral health professionals can build trust, empower parents to take an active role in their child's oral health and ensure a positive and informed experience for both parents and children.

Communication

To help parents and caregivers monitor their child's oral development closely, establish good oral hygiene practices early on, and seek professional guidance if any concerns arise. Here are some helpful strategies:

Encourage questions

Get parents and caregivers involved in checkups or take intra-oral pictures to

“There is considerable variability in tooth eruption times, and some deviation from the average range is normal”

show them erupting teeth, mobile teeth or any gaps/missing teeth.

Be informative but avoid jargon

Early intervention can help manage and prevent potential complications associated with early/late tooth eruption. Provide verbal and written information, offer follow-ups and include parents in the decision-making processes. Discuss treatment options and consider their preferences. Use

visual aids where appropriate and use simple language that they can understand.

Be empathetic

Parents may feel anxious or worried about complications arising due to early/late eruption. They may be worried about cost or how complications may impact development, confidence and oral health. Be empathetic and provide reassurance.

Cultural sensitivity

Different cultures may have different views about tooth eruption and oral health. Be culturally sensitive in your communication. Understand and respect cultural beliefs related to oral health, adapting your approach accordingly.

Debunking fears

To help alleviate parents’ fears, empower them and build trust by demonstrating active listening. Foster open communication by creating a safe space to ask questions. Knowing how to respond to fears may take time but be prepared and be attentive. Document their concerns and use positive and reassuring language to reframe the way to think about teeth eruption. An example would be when a parent is worried about not giving enough appropriate nutrients during their child’s early development which they believe may have led to late eruption of teeth. These fears arise from a lack of knowledge and debunking them may result in better oral health outcomes and understanding. Be respectful of their views and redirect with positivity. n

About the author: Christine Murthi is an Oral Health Therapist who graduated from Auckland University of Technology. Prior to this, she obtained qualifications in pharmacology and secondary teaching from the University of Auckland. She has teaching/ tutoring experience spanning more than ten years. Through this teaching experience combined with her diverse cultural background, she has developed a passion for promoting diversity in clinical practice, overcoming communication barriers and connecting with the community. As a member of the Colgate Advocates for Oral Health: Editorial Community, her contributions to the dental community aim to promote good oral health for all and keeping a healthy smile for life.

Republished with permission from Colgate Advocate’s for Oral Health

colgateprofessional.com.au/Advocates

Our relationship

Learn to embrace the positives of stepping outside of your comfort zone

By Lyn Carman

with uncertainty

“Promise me you’ll always remember: You’re braver than you believe, and stronger than you seem, and smarter than you think.”

ONE OF MY all-time favourite quotes, and while it doesn’t directly mention uncertainty, it speaks to the underlying theme of facing challenges with courage and confidence, even when the outcome is uncertain. Winnie the Pooh’s wisdom reminds us to trust in our own abilities, even when we’re unsure of what the future holds.

Uncertainty can be defined as a state of ambiguity or lack of certainty about a particular situation, outcome, or future event. In the world of oral health professionals, uncertainty often lurks as an ever-present companion, posing both challenges and opportunities for professionals in their workplace and personal lives.

Uncertainty is like the starting point for growth—it’s necessary for life. Growth flourishes in uncertain situations. But often, we see uncertainty as scary and forget its power to help us grow. What if we could change how we see uncertainty?

Uncertainty often leads us outside of our comfort zone into new and unknown territories. It can feel insecure, unsafe and uncomfortable. Sometimes, the fear of what we don’t know can stop us from exploring new things outside our comfort zone. It’s like staying on the shore because we’re afraid of the deep ocean. But if we never take that leap, we might miss out on amazing experiences and discoveries. It’s only when we push past our fears that we realise the magic waiting for us beyond our comfort zone.

But what if we reframed uncertainty as an essential part of our journey—a

pathway to personal and professional growth? Just as we educate our patients about the importance of oral health, we must also cultivate mental fitness within ourselves to navigate uncertainties with confidence and resilience. Our relationship with uncertainty is a reflection of our mental fitness.

The first step in embracing uncertainty is acknowledging its role as a precursor to growth.

There’s a poignant story that beautifully illustrates the transformative power of struggle. It’s a story of a child who encounters a butterfly struggling to break free from its cocoon. Recognising the butterfly’s struggle, the child wants

“Uncertainty is like the starting point for growth – it’s necessary for life”

to help and gently pulls open the cocoon. However, instead of flying away, the butterfly’s wings remain weak and unable to support its body. The child soon learns that it was the struggle of pushing through the tiny opening of the cocoon that forced fluid from the butterfly’s body into its wings, strengthening them for flight.

This story beautifully demonstrates the idea that struggles and challenges are essential for growth and development. Just as the butterfly needed to struggle out of the cocoon to strengthen its wings, we also need to face difficulties in life to become stronger and more resilient individuals.

In the context of uncertainty, this story reminds us that while it may be tempting to avoid or go around challenges, it is often through facing them head-on that

we discover our strength and potential. Embracing uncertainty and navigating through its challenges can ultimately lead to personal growth, resilience, and amazing experiences.

In our professional lives, uncertainty can present itself in the form of new technologies, changing patient expectations, new team members and changing processes. Yet, instead of embracing change, we may find ourselves stuck in old routines, hesitant to take risks and try new approaches. However, it’s exactly during these uncertain times that innovation thrives. By having the courage to step outside our comfort zones and explore new ideas of dental care, we open ourselves up to exciting opportunities for growth and improvement.

Outside of work, uncertainty affects every part of our lives; relationships, health, and overall well-being. Just as we solve problems at work, we can use our strength to handle life’s uncertainties. Whether it’s health problems, money issues, or personal struggles, these moments can be tough. But they are also chances for growth. By facing these uncertainties directly, we can learn, grow, and become stronger.

In essence, uncertainty is not something to be feared but embraced as an integral part of our professional and personal journey. By nurturing our mental fitness, which isn’t always about maintaining a positive outlook but also about developing resilience and coping strategies, and by staying open to new ideas, we get to strengthen our relationship with uncertainty.

Let’s welcome uncertainty as a chance to grow, knowing that it brings opportunities for change and improvement. 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

Chair Kate Spain. chairact@dhaa.info

n The 2024 ACT CPD program kicked off with a dinner event at the QT Hotel on Tuesday 20 February. It was a small gathering of local members with Dr Liz Milford presenting on Australia’s national oral health score card. She provided many practical tips to participants on how to help patients to meet their goals. The next ACT event is a full day seminar on 17 August and the program will be published soon so please save this date in your diary.

The ACT hosted the first DHAA Board meeting on 3-4 February at the Rydges Canberra. The ACT chair Kate Spain and committee member Rachael Walton joined the board governance training as well as contributed to the discussions on the board agenda items. It was a productive and high yield meeting with clear strategic priorities set for the rest of the year. Dr Murray Thomas, Dental Board Chair

joined the board and the ACT chair representatives of the ACT committee for dinner over the weekend.

The 2024 ACT committee members are Rachel Walton and Natalie Lopes.

“ It [the Board meeting] was a productive and high yield meeting with clear strategic priorities set for the rest of the year ”

NSW

NSW contacts:

Director Jinous Eighani-Roushani directornsw@dhaa.info

Chair. Belinda Hines chairnsw@dhaa.info

Deputy Chair Angelee Murdock (contactnsw@dhaa.info)

n NSW welcomes their new chair Belinda Hines and deputy chair Angelee Murdoch, both commenced their roles from 1 February. The first NSW CPD event

ACT dinner event

ACT board dinner

ACT governance training

Dr Liz Milford presenting

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

for the year was the Perio Masterclass on Saturday 24 February at the Mercure Hotel Newcastle. The event was fully booked and attendees enjoyed the topics presented by well known experts Dr Tihana DivnicResnik, Tabitha Acret, Professor Dileep Sharma, Dr Vijay Tumuluri, and Dr Avinash Suryawanshi Planning has already commenced for the next NSW event to be held on

“ A joint board meeting to work on the creation of a new association for our profession"

Saturday 22 June for another full day seminar in Sydney. Given the February event was so popular and sold out early, please mark this date in your diary and look out for notice of registration opening to secure your place.

NSW will also host a joint DHAA - ADOHTA board meeting on 13-14 April to work on progressing the creation of a new association for our profession. This is an exciting occasion and we will report on its progress in our next DHAA Bulletin.

Our staff Shida Taheri attended the Sydney University BOH orientation day on Monday 19 February to provide information on our association together

with the ADOHTA representative.

The 2024 NSW Committee members are Leanne Baker, Ian Epondulan, Lilith Third and Maryam Slewa. NT

Qld

Qld Contacts: Director Carol Tran. directorqld@dhaa.info

Chair Gabby Williamson chairqld@dhaa.info

Deputy Chair Courtney Dicken contactqld@dhaa.info

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

n A special NT member briefing is scheduled for Wednesday 3 April at 7:30pm. CEO Bill Suen will provide an update of DHAA activities and seek members input into local CPD planning.

n A big thank you to Stacey Billinghurst and Karen Smart who retired from their roles of Queensland Committee chair and deputy chairs respectively. They led the Committee over the past couple of years and organised many great events for our members. We welcome Gabby Williamson as new chair and Courtney Dicken as deputy chair and they have already got into full gear to organise some great events this year.

The first event is a trip out west to Toowoomba on Saturday 9 March for a half-day covering 3D imaging and orthodontic

“ The first event is a half-day covering 3D imaging and orthodontic referrals, and management of special needs patients”

Sydney Uni BOH presentation Shida Taheri (right) and ADOHTA Trolisa Knudsen

referrals, OSA and the upper airway, and assessment and management of special needs patients.

The next event is scheduled for Saturday 13 July for a full education day with details to follow.

The 2024 Queensland committee members are Ashley Anderson, April van den Elsen, Caleb Rice, Jessica Harwood, Karen Portelli, Leigh HarrisonBarry, Karen Smart and Stacey Billinghurst.

SA

SA Contacts:

Director Michelle Kuss michelle.kuss@dhaa.info

Chair Courtney Rutjens chairsa@dhaa.info

Deputy Chair Jesse Kourakis contactsa@dhaa.info

n We thank Sue Tosh for her years of service as she stepped down from the SA Chair’s role. Courtney Rutjens moved into the Chair’s role and we welcome

“ Don’t miss out the opportunity to join your colleagues for a memorable education experience at the beautiful destination Auchendarroch House ”

Jesse Kourakis as deputy chair. Sue represented the DHAA at the 2024 TAFE SA Graduation Ceremony on 23 February and presented the DHAA Academic Excellence Prize, the Jane Chalmers Memorial Award, and the Jean McNicol Memorial Award.

Don’t miss out the opportunity to join your colleagues for a memorable education experience at the beautiful destination Auchendarroch House on Saturday 23 March 2024, please REGISTER now if you have not already done so. Topics include soft tissue lesions in general dental practice, schools mobile dentistry, opportunity for oral health prevention, health equality and the common ground, and empowerment to forge ones own path.

The DHAA has also teamed up with the Academy of Impact Mastery to offer a workshop “implants and the Dental Hygienists/OHTs” DHAA members receives a huge 20% discount on the course fee. Click here for MORE INFO

Want to register and get that great discount? LOG IN

The SA Committee members for 2024 are Amanda Trenerry, Cheryl Dey, Sally Hinora, Lyn Carman and Margie Steffens. The Committee invites colleagues and

friends to join their dinner on 22 May at the Fettle. Please REGISTER as soon as possible as places are filling up quickly.

Congratulations to SA Committee member Amanda Trenerry to receive a $300k Federal Boosting Female Founders Grant for her innovative Neomorph Mouthguards. This is a highly competitive grant that supports female founders to scale their startup business into domestic and global markets. So inspiring to us all!

Tas

TAS Contacts:

Chair Karen Lam chairtas@dhaa.info

Staff Bill Suen bill.suen@dhaa.info

n We have another great education day planned for our members on Saturday 11 May at the Tonic Bar, Country Club Launceston. Exciting topics include sleep

“ Exciting topics included are all relevant to oral health practitioners in getting that extra knowledge. ”

apnea for OHPs, diabetes and oral health, hypnotherapy and breath work as complimentary therapies, all are relevant to oral health practitioners in getting that extra knowledge. Registration is now open and we look forward seeing you there. REGISTER

TAS chair Karen Lam is seeking expression of interest from members to help her organising local events. Please email contact@dhaa.info if you are available.

Vic

Vic Contacts

Director Roisin McGrath directorvic@dhaa.info

Chair Cathryn Carboon chairvic@dhaa.info

Deputy Chair Sarah Laing contactvic@dhaa.info

n Victoria commences its CPD program with a brunch at the Royal South Yarra Tennis Club. The popular

Tas Chair Karen Lam and ADOHTA Vice President Jessica Pennay

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

“ The popular Dr Derek Mahoney will present on periodontal considerations with orthodontic treatment in adults. ”

Dr Derek Mahoney will present on periodontal considerations with orthodontic treatment in adults. There are two other events scheduled for 3 August and 23 November. Given the popularity of these events, it is advisable to mark these dates in your diary and look out for event and registration opening information.

Congratulations to Vice Chair Sarah Laing (below) who graduated from the Curtin University with a Master of Healthcare Management (population health) in February.

Victorian Committee members are Adrija Raman,

Desiree Bolado, Maddison Kennedy, Michaela Pitcaithly, Stephanie Chang, Tania Wong and Veronica Modra.

WA

WA Contacts

Director: Ron Knevel directorwa@dhaa.info

Deputy Chair: Michelle Wrights contactwa@dhaa.info

Staff: Bill Suen bill.suen@dhaa.info

n WA welcomes its new Deputy Chair Michelle Wright who joined the WA team in February

this year. The Committee kicked off its CPD program with a sold out brunch at Kailis Bros in Leederville on Saturday 24 February. The session featured Professor Marc Tennant AM on the ‘inside' stories of COVID and how we could protect our elders from the learning of this pandemic. Dr Like Chow provided presentations on OPG and early detection of orthodontic concerns, and ran some interactive activities for the delegates.

The Committee had scheduled two more events on 4 May and 30 November so please mark these dates on your diary.

Committee member

Rhonda Kremmer visited the Curtin University on 7 February and provided a joint presentation with ADOHTA to their final year students. This was an important presentation to prepare graduates for entry to practice, as well as encouraging them to join their professional association so that they can connect with the professional and receive support for they career.

WA Committee members are Aileen Lewis, Rhonda Kremmer, Wendy Wright, Jeenal Parmar, Simone Mayne and Carmen Jones n

Rhonda Kremmer with Curtin Uni final year students

WA Rhonda Kremmer with Curtin Uni first year students

2024 Event Calendar

Get your diaries out and book your time off for next year!

16 Nov TAS

22

23

28 Nov Webinar

30 Nov WA Half Day

December 4 Dec Webinar

7 Dec QLD Brunch

8 Dec SA Brunch