bite may 2015

Australia’s leading dental magazine

MAY 2015 $5.95 INC. GST

The distinguished scientist

SPECIAL REPORTBite’s guide to the best

infection control products on the market today, page 35

When someone complainsHow to turn a negative situation into a positive one, page 16

Production valueIncreasing practice production to bolster your bottom line, page 20

Professor Lakshman Samaranayake is considered the foremost authority in oral Candida infections. His decision to specialise changed his life, page 24

A focus on aged care

ADA’s pre-Budget submission focuses

on targeting the ageing population

as a step towards a national oral health

program, page 12

CONTENTS

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COVER STORY YOUR BUSINESS YOUR TOOLS YOUR LIFECONTENTS

ContentsNEWS & EVENTSThe meaning of pain 4Pain-relieving research from Australia has been awarded on the international stage; call for better gerodontics training, and much more …

YOUR WORLDAged care: What does the future hold? 12A report on the Australian Dental Association’s pre-Budget submission

YOUR BUSINESSHow to deal with complaints 16It’s not a situation you want to be in, but there are solutions to leave everyone happy

Do you need more than a hygienist? 20Ways to increase practice production

Welcome to the comfort zone 30A clear vision and effective business model has seen Pyrmont Dental Health grow into a three-practice concern in just eight years

YOUR TOOLSNew products 10All the latest gear for your practice

Product guide 35Bite magazine’s guide to the best infection control equipment on the market today

Tools of the trade 51Reviewed by your peers

YOUR LIFEStargazer 54A life-long love affair with astronomy has seen Dr Julian Oey of Haoey Dental in Potts Point, NSW, build his own observatory and become a specialist in binary asteroids

May 2015

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Bite magazine is published 11 times a year by Engage Media, Suite 4.17, 55 Miller Street, Pyrmont NSW 2009. ABN 50 115 977 421. Views expressed in Bite magazine are not necessarily those of the publisher, editor or Engage Media. Printed by Webstar.

Editorial Director Rob Johnson

Sub-editor Kerryn Ramsey

Editor Nicole Hogan

Art Director Lucy Glover

Commercial Director Mark Brown

Sales Director Andrew Gray

Digital Director Ann Gordon

16

12

3020

COVER STORYOn a mission

Professor Lakshman Samaranayake is the world authority on oral

Candida, having made it his career mission for the past 40 years

24

MaintainWhen it comes to effective waterline asepsis, ICX® is proven. Drop a single tablet into your dental-unit water bottle before each filling and ICX immediately goes to work. The effervescing formula is patented to prevent accumulation of odor-causing bacteria. No measuring. Zero mixing. Never a mess. For keeping it clean, it’s simple.

Learn more about waterline maintenance. Contact A-dec today.

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For more information Email: [email protected] Phone: 1800 225 010 Visit: www.a-dec.com.au




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COVER STORY YOUR BUSINESS YOUR TOOLS YOUR LIFENEWS & EVENTS

4 Bite magazine

A team from the Universities of Bradford and Durham in the UK analysed the teeth of children and adults from two 19th-century cemeteries, one at a Workhouse in Ireland where famine victims were buried and the other in London, which holds the graves of some of those who fled the famine.

They found that the biochemical composition of teeth that were forming in the womb and during a child’s early years not only provided insight into the health of the baby’s mother, it even showed major differences between those infants who died and those who survived beyond early childhood.

Lead researcher Dr Julia Beaumont now hopes that the insights she’s gained from the historical graves can be used to help children in the future. She is currently testing teeth from children through the Born in Bradford project, a long-term study of a cohort of 13,500 children, born between 2007 and 2010, whose health is being tracked from pregnancy

through childhood and into adult life. She hopes to be able to correlate nitrogen and carbon isotope levels to the medical history of the mother and the future health of the children.

“We currently cannot analyse any other tissue in the body where the stress we are under before birth and during early childhood is recorded,” said Dr Beaumont. “If we can show that baby teeth, which are lost naturally, provide markers for stress in the first months of life, we could have an important indicator of future health risks, such as diabetes and heart disease.”

Charles Sturt University (CSU) lecturer Dr Rahena Akhter has been recognised with an award at the world’s

biggest dentistry conference. Dr Akhter, from CSU’s School of Dentistry and Health Sciences in Orange, New South Wales, has been presented with the 2015 Joseph Lister Award for New Investigators at the International Association for Dental Research conference, held recently in the United States.

Her research into pain catastrophising and jaw muscle activity was selected

from over 4800 applications for the award, which highlights original research in oral disease prevention or oral health promotion from young researchers.

“To have my research selected from such a large pool of projects from around the world has been an honour and has reaffirmed the importance of the research and the impact it will have on how dentists treat their patients,” said Dr Akhter.

Dr Akhter’s research examined how patients perceived pain in their jaw

muscles and how this impacted their jaw movements.

It found that patients who perceived a higher level of pain, even if the pain simulated wasn’t very high, were more reluctant to move their jaw as instructed and likely to have psychological issues related to pain.

“Each patient will perceive their pain differently and it is important for dentists to acknowledge that patients who are higher catastrophisers will perceive more pain and be less likely to use the muscles affected,” said Dr Akhter.

“In cases such as these, a holistic, multi-disciplinary approach to pain is recommended, as well as visiting their dentist or specialist. The patient sometimes needs to be referred to a psychologist to address how they perceive pain and can best overcome being a higher catastrophiser and the barrier of inflated pain perception.

“Dentists should be able to observe how their patient is reacting to pain in their muscles or joints and to initiate a multi-disciplinary approach to the patient’s problem. As health professionals, we cannot act in isolation and must be attuned to related issues.”

Dr Akhter believes this approach should be introduced industry-wide.

The meaning of pain

Victorian baby teeth predict health of children

http://www.csu.edu.au/faculty/science/dentistry-health

http://www.csu.edu.au/faculty/science/dentistry-health

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References: 1. GSK Data on File, L2630368, October 2006. 2. Kiesow A et al. The potential damage from denture cleansing methods. Presented at IADR General Session and Exhibition. June 25–28, 2014; Cape Town, South Africa. 3. GSK Data on File, Lux R. 2012. 4. Charman KL et al. Lett Appl Microbiol 2009;48:472–477. 5. Bradshaw D. Microbiological effects of household remedies vs toothpastes and denture cleansers. Presented at the IADR General Session and Exhibition. June 25–28, 2014; Cape Town, South Africa. Polident is a registered trade mark of the GlaxoSmithKline group of companies. GlaxoSmithKline Consumer Healthcare, 82 Hughes Avenue, Ermington, NSW 2115. GSK1560/UC March 2015 CHANZ/CHPOLD/0003/15.

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6 Bite magazine

Dental schools in Australia need to adjust their curriculum to better deal with tooth challenges for an ageing population, according to recent research.

The University of Western Australia-led study explained that while experts have promoted addressing geriatrics within dental training since the 1970s, little has been done to put recommendations into practice.

“It is predicted that more than 25 per cent of the population in developed countries will be over the age of 65 by 2020,” said School of Dentistry Professor Linda Slack-Smith.

“The ageing of the population and increasing retention of teeth, often with complex restorations, is expected to increase the demand for dental care in older people.”

According to research, 14.3 per cent of graduating dental students consider themselves well prepared to provide geriatric oral health care.

This is partly due to only a handful of courses offering placements in aged-care facilities, which aren’t mandatory.

In the US, Canada and Europe, most dental schools have aspects of geriatric dentistry integrated into their curricula.

Prof Slack-Smith said that while the Federal Government has recognised the need to address new challenges facing an ageing population, including the Living Longer Living Better program, this has not translated into funding support in dental training.

“It is time for academics, geriatric dental professional and policy

makers to advocate for a world where social justice is valued,

and promote geriatric dentistry education,” Dr Slack-Smith said.

Sugary drinks should be subject to the same advertising and sponsorship rules as tobacco, according to an oral health charity.

The British Dental Health Foundation (BDHF) has announced that if major sporting tournaments banned sugary drinks sponsorship—similar to the ban on tobacco advertising introduced in 2003—there would be a reduction in consumption and an improvement in the health of thousands of people.

Experts suggested more than 3000 lives could be saved by the tobacco ban, and the BDHF believes a similar ban involving sugary drinks could have benefits for a number of health conditions, notably obesity and oral health.

Sugary drinks are the largest source of sugar for children aged four to 12 and teenagers. This could be why more than one in four (27 per cent) five-year-olds, one in three 12-year-olds and nearly half (46 per cent) of 15-year-olds show signs of obvious dental decay.

BDHF trustee Professor Nairn Wilson has led the calls for the government to intervene and treat sugary drinks advertising the same as tobacco.

Professor Wilson said: “Sugar is the biggest health time-bomb we face today. The dangers of tobacco are very well documented and there has been significant progress made on tobacco advertising in general, and particularly sport.

“When the Indian associate of the British American Tobacco group sponsored the Indian World Cup Cricket team in 1996 with its Wills brand, a survey showed that smoking among Indian teenagers increased five-fold. There was also a marked increase in false perceptions such as ‘you become a better cricketer if you smoke Wills’ and ‘teams with more Wills smokers will fare better’.

“There is every reason to believe this will also apply to sugary drinks. Some of the world’s major sports events and sporting names are sponsored and endorsed by sugary drinks brands. Many of them are role models for children, so why would they not follow their idol?” asked Professor Wilson.

Subject sugary drinks to same rules as tobacco

Call for better gerodontics training Royal Flying Doctor pilot dental program TOOTH seeks fundingWhen The Outback Oral Treatment and Health (TOOTH) program, run by the Royal Flying Doctor Service, launched in NSW’s west three years ago, only seven out of 220 children at Bourke Public School had healthy teeth that didn’t require more treatment.

Since 2012, the Royal Flying Doctor Service’s dental program has been improving adults and children’s teeth in the Outback. Once or twice a week, a dentist and dental therapist have operated out of small offices in four remote towns—Bourke, Collarenebri, Goodooga and Lightning Ridge.

Prior to this, most children’s oral health was that of a developing nation, said one of the dentists working on the program. Few children or adults had seen a dentist before. Most children had an average of five decayed teeth, nearly five times the average rate.

Now the $2.5 million pilot program, which included $1.4 million funding from the Gonski and Investec Foundations, is nearly over, and is looking to Federal and State Governments to contribute so TOOTH could be continued and expanded.

The study involved UWA, Charles Sturt University and the University of Sydney.

http://www.ncbi.nlm.nih.gov/pubmed/25762049?dopt=Abstract

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8 Bite magazine

A new research project from the University of Copenhagen in Denmark has established an effective model for the fight against the escalating burden of tooth decay among children in Asia. The model is an important tool in breaking the social inequity in oral health of children.

In developing countries, the number of children who suffer pain and discomfort in addition to missing out on school lessons is increasing. This project demonstrates that the school is a vital key to better oral health. The project also shows how it is possible to organise school oral health intervention, including health promotion and disease prevention for all, in a low-income country in Asia such as Thailand.

“This project emphasises the necessity of engaging the school as well as family and school teachers,” said Professor Poul Erik Petersen, from the School of Dentistry, Department for Global Oral Health and Community Dentistry at the University of Copenhagen. “The results of the school program are impressive with a reduction of 41 per cent in new lesions of tooth decay.”

The study was based on a community trial conducted in the Songkla Province in Thailand and involved 15 schools with a total of 3706 pre-school students. The two-year study assessed the benefits of an enhanced oral health promotion program, which included closely supervised tooth brushing with an effective toothpaste containing 1450 ppm fluoride, compared to customary oral hygiene procedures.

The results will hopefully assist ministries of health, public health administrators and oral health planners in low- and middle-income countries in the Asian region in designing evidence-based school health

programs. The experience gained from the research project could also offer new insight into the global fight against poor oral health in children.

In the past month, the ACT Government has taken a number of steps to ensure the oral health of the Territory’s more vulnerable residents. On the one hand, ACT Health Minister Simon Corbell launched a new $1.6 million Mobile Dental Clinic that will provide preventative and restorative dental services over four years from a purpose-built mobile dental facility.

A day afterwards, ACT MP and former dentist Dr Chris Bourke released a report recommending that the TGA and Dental Board of Australia “consider amending the relevant regulations, codes

and guidelines to require the details about the manufacturer of a custom-made dental device to be provided to the prescribing practitioner and the patient.”

Improved awareness of the country of origin of devices would give better protection to patients and dental practitioners, the committee’s report said. Currently, there is “an implied requirement to inform patients but not a regulatory one”.

The report from the Standing Committee on Health, Ageing, Community and Social Services inquiry said that existing

Australian regulations provide some safeguards for the safety and quality of imported dental devices but compliance with reporting requirements in Australia is low for some custom-made products. The TGA does not have authority to conduct audits of overseas dental manufacturers.

“Without better data on the size of the dental devices import market and consistent reporting of problems, it is impossible to know if the reality matches the anecdotal concerns about the safety and quality of imported devices,” Dr Bourke said in a statement.

ACT looking out for dental patients

Global children’s oral health challenge Effectiveness of xylitol questionedNew research from the University of Manchester in the UK concluded that there is limited evidence to show that xylitol is effective in preventing dental cavities in children and adults. The authors of the study gathered together data from 5903 participants in 10 different studies. In most cases, the studies used such different methods that the researchers could not combine the results to create a summary effect estimate. Based on information from 4216 school children who took part in two Costa Rican studies, they found low quality evidence that levels of tooth decay were 13 per cent lower in those who used a fluoride toothpaste containing xylitol for three years, compared to those who used a fluoride-only toothpaste. For other xylitol-containing products, such as xylitol syrup, lozenges and tablets, there was little or no evidence of any benefit.

Lead researcher, Philip Riley of the School of Dentistry at the University of Manchester, said: “The evidence we identified did not allow us to make any robust conclusions about the effects of xylitol, and we were unable to prove any benefit in the natural sweetener for preventing tooth decay. The limited research on xylitol-containing toothpastes in children may only be relevant to the population studied.”

http://odontology.ku.dk/staff/?pure=en/persons/52148

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http://www.ku.dk/english/

http://www.dentistry.manchester.ac.uk/staff/151356/

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NEWS & EVENTS

FACULTY OF DENTISTRY

MORE INFORMATION: sydney.edu.au/dentistry/ce/courses/calendar.php

ABN 15 211 513 464 CRICOS 00026A

Excellence sits at the heart of what we offer as a trusted university-based CPD provider to dental practitioners. The Faculty of Dentistry provides independent and scientific CPD courses for the whole dental team which incorporate seminars, clinical simulation, hands-on workshops, patient-based treatment and observation programs.

Make sure you choose from our unique range of courses where lifelong learning with the University of Sydney is developed and maintained to benefit your clinical practice.

CONTINUING EDUCATION IN DENTISTRY

THE OPERATING MICROSCOPE IN EVERYDAY PRACTICE: GETTING A CLOSER VIEW

This course is an introduction to the microscope for dentists with limited or no experience in microscopic dentistry, or for dentists who have a microscope but are experiencing difficulties with use. At the end of the course you will be able to carry out clinical procedures using various levels of magnification, develop new skills using specialised microsurgical instruments and improve patient communication and treatment records. Presenters include Dr Steven Cohn, Dr Alan Nerwich and Dr Rick Spencer

DATE: 11 July 2015

CPD: 6

VENUE: Sydney Dental Hospital, Surry Hills, NSW

COST: $995

SUCCESSFUL ENDODONTICS FOR THE GENERAL PRACTITIONER

The objective of this course is to prepare the general practitioner to perform endodontics on a routine basis. The course is based on patient treatment, with each participant completing a multi-rooted tooth over four weekly sessions on consecutive Thursdays with Dr Steven Cohn, Dr Peter Case, Dr Alexander Lee, Dr Marcus Yan and Adjunct Associate Professor Peter Duckmanton.

DATES: 16, 23, 30 July & 6 August 2015

CPD: 32

VENUE: Sydney Dental Hospital, Surry Hills NSW

COST: $5950 (if paid by 30 May 2015)

OSSEOINTEGRATED DENTAL IMPLANTS

This intensive 3-day program led by Associate Professor Richard Chan with Dr Lydia Lim, Dr Alan Yap and Dr David Sykes is structured to introduce the clinician to dental implant therapy through lectures, demonstrations and hands-on workshops.

On completion of the program, the participant will be familiar with the components and techniques necessary to complete the surgical and restorative phases of single and multiple unit implant cases in healed sites.

DATE: 21-23 August 2015

CPD: 22

VENUE: The Four Seasons, Sydney, NSW 2000

COST: $3375 (if paid by 30 May 2015)

EXTENDED FIXED PROSTHODONTICS

Extended Fixed Prosthodontics is the most comprehensive short course in prosthodontics in Australia for dentists in general practice. The course is convened by Dr Ken Hooi and features 12 other presenters

Over 5 days, participants will have more than 18 hours of clinical simulation practice, with both traditional and innovative techniques in clinical practice covered in detail. Practical session exercises including an aesthetic diagnostic restoration concept which may be applied in clinical practice the very first day after the course.

DATE: 28 September – 2 October 2015

CPD: 40

VENUE: Sydney Dental Hospital, Surry Hills, NSW 2010

COST: $5625 (if paid by 28 June 2015)

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NEWS & EVENTS COVER STORY YOUR BUSINESS YOUR LIFE

10 Bite magazine

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CEREC Ortho Software: Easy, fast and comfortableDigital models created from CEREC Omnicam intraoral

data are transferred to Align Technology and used as part of the record submission for an Invisalign® treatment. This eliminates the laborious process of creating and sending physical impressions, which results in faster processing of the case. Patients may benefit from the earlier start of the therapy and the digital impression taking instead of conventional impression material.

CEREC’s proven digital impressioning system provides a safe and reliable step into the process for general practitioners and orthodontic specialists alike. The required new software, exclusive for CEREC Omnicam systems, will be available in selected markets by summer 2015. Existing users should contact their representatives for availability. For more information, go to sirona.com

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market again with exciting technological transformations to the 3M True Definition Scanner. The next generation system includes a revolutionary new wand with a profile so slim that it’s the smallest on the market. The new system, which has just been launched in tandem with 3MTM True Definition Scanner Software 5.0 supports faster, easier scanning with the same superior accuracy. With the new 3M True Definition Scanner, adopting digital scanning is now more comfortable and easier than ever before.

The new 3M True Definition Scanner system was built for fast scanning – once the field is prepared, an adept user can scan a diagnostic arch in as little as 60 seconds. The new wand is designed to fit in the hand like a traditional dental handpiece, with a narrow, angled tip and a slim profile so ergonomically balanced it allows for one-handed scanning. This significantly enhances the reach to the challenging posterior anatomy. The small profile and fast

scan time make scanning with 3M True Definition Scanner system more comfortable for dentists, orthodontists, their staff and patients.

“The digital world continues to move incredibly fast, and to keep pace with these trends, we continuously draw on the 3M innovation engine to bring fresh ideas to the table,” said David Frazee, Vice President and General Manager of 3M Digital Oral Care. “Not only is this wand the smallest on the market, but it’s designed to be incredibly intuitive, comfortable to hold and fast and easy to use.”

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NEWS & EVENTS COVER STORY YOUR TOOLS YOUR LIFEYOUR WORLD

12 Bite magazine12 Bite magazine

The Australian Dental Association’s pre-Budget submission to the Federal Government could create better oral health for older Australians, more

regular patient visits for dentists and substantial savings for both State and Federal Governments. It’s a win-win-win submission and ADA president Rick Olive believes the government will give it a fair hearing.

“To us,” he says, “it’s a no-brainer, and we expect the government to give it serious consideration.”

The ADA’s long-term plan is for a targeted national oral healthcare scheme that would address the needs of all disadvantaged Australians. However, in the current political/economic climate, the Association concedes that’s probably impracticable. As an interim measure, the Association’s recent submission asks the Federal Government to focus on older Australians living on limited incomes. The ADA has proposed an Aged Pension Dental Benefits Schedule (APDBS).

Oral disease is much more prevalent in older Australians, who grew up pre-fluoride. More than 50 per cent of people over 65 have gum disease or periodontitis and 20 per cent have complete tooth

Samantha Trenoweth reports on the Australian Dental Association’s pre-Budget submission

loss. Those who have retained some of their teeth often require complex restorations (crown, bridge, implants), which need careful maintenance, and problems arise when motor or cognitive skills are impaired. So their needs are not always simple.

Moreover, people on limited incomes, such as pensions, are more likely to postpone dental consultations, which exacerbates problems. Then, when disaster strikes (perhaps an abscess or infection), they might visit a hospital emergency department or their GP, which are covered by Medicare, rather than make an appointment at the dentist.

In 2010-11, more than 850,000 GP visits were attributed to dental concerns, and the vast majority of these could have been avoided with regular dental care. In the same time frame, the Australian Institute of Health and Welfare gives a conservative estimate of 60,590 potentially preventable hospitalisations as a result of dental problems.

All this is costly and, as the population ages, it will become more so. The Australian Institute of Health and Welfare reports that in 2012-13, Australia’s total expenditure on dental care was $8.7 billion. While individuals account for the bulk of this ($5 billion), governments

Aged care: What does the future hold?

Bite magazine 13

“We’ve used the statistics from Government bodies —from the Australian Institute of Health and Welfare and from the Government’s own report to the Commission of Audit —and have worked out that probably they’re going to save somewhere in the order of $350 million if they do it.”

Quote

also contribute a substantial sum. Over those 12 months, the Australian Federal Government contributed almost $1 billion and the States and Territories contributed $657 million, but that was not the whole story. There are substantial indirect costs to the Government that result from poor oral health, and older Australians contribute to those costs significantly.

Good oral health is crucial to overall health. For example, periodontal disease is more common in people with diabetes and it exacerbates the problem by limiting the patient’s diet, which can lead to further increases in blood sugar and diabetic complications. Similar associations have been found between periodontal disease and heart disease, and links have also been suggested with osteoporosis, respiratory disease, aspiration pneumonia and even some cancers.

These are all problems that are particularly prevalent amongst older Australians and those in aged care facilities are at greater risk. Studies indicate that older people in residential care are more likely to accumulate plaque deposits on natural teeth and dentures, increasing their risk of developing aspiration pneumonia.

Dislodgement of teeth, fillings and calculus, and ill-fitting dentures exacerbate the problem. Moreover,

ADA president Dr Rick Olive

children under the CDBS and we’ve estimated that the workload that would come to dentists as a result of the APDBS would be about the same.”

The primary differences would be that the APDBS would target Australians who receive the full age pension and that an expanded schedule for dental services

would apply (as older patients have more complex dental needs). Otherwise, for dentists, the systems would operate almost identically. The most significant change they might notice would be a greater number of older Australians making appointments and coming back for regular check-ups.

Moreover, the scheme would fund itself. “We’ve costed it, for the first four years, at about $267 million per year,” Dr Olive explains. The cost of not doing it—in paying for the treatment of abscesses and infections and potentially life-threatening

a study published in the Australian Dental Journal in 2014 found that nursing home residents have high levels of untreated decay. Plainly, a visit to the dentist is less painful, less costly and less life-threatening than a bout of pneumonia. So, the ADA recommends that special provisions be made within the APDBS to provide for the needs of aged care facility residents.

“I know a lot of dentists who have arrangements to visit aged care facilities,” Dr Olive says, “and there have been State Government trials that have been very encouraging.” But substantial problems remain and the ADA would like to see them addressed.

The ADA’s proposal for an APDBS has been modelled on the already existing Child Dental Benefits Schedule (CDBS).

“The CDBS commenced at the beginning of last year,” Dr Olive explains. “It’s targeted, it’s based on a means test and the cost to the government in the first year of operation was $290 million. They delivered four-and-a-half million services for that. So, we think that formula is working very well.

“Most general dentists would be seeing

YOUR WORLD

14 Bite magazine

ADA president Dr Rick Olive

“When Prime Minister Abbott came to office, he promised that once they’d completed their budget repair, this government would do something about dentistry.”

Quote

conditions for which people need to be hospitalised—is so much greater.

“We’ve used the statistics from Government bodies—from the Australian Institute of Health and Welfare and from the Government’s own report to the Commission of Audit—and have worked out that probably they’re going to save

somewhere in the order of $350 million if they do it. That’s a substantial benefit to the Budget, and it’s a conservative estimate.”

All those savings would be made by

eliminating the costs that arise from dental neglect in this age group. There would also be an immeasurable improvement in quality of life (and in some cases longevity) for older Australians.

“When Prime Minister Abbott came to office,” Dr Olive concludes, “he promised that once they’d completed their budget repair, this Government would do something about dentistry. We think we’ve found a way that he can do something about dentistry and repair the Budget at the same time. I’m looking forward to having some productive discussions with the Government about our proposal.”

The ADA’s pre-Budget submission is to improve oral health for older Australians.

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NEWS & EVENTS COVER STORY YOUR BUSINESS YOUR LIFEYOUR TOOLSYOUR BUSINESS

16 Bite magazine

How to deal with com laintsp

YOUR BUSINESS

Bite magazine 17

Customers have the power to make or break any sales-reliant business, and dentistry is no different. It can be easy to forget that even though you are a dental professional and you do know what you’re talking about, this

in itself is often not enough to keep customers satisfied. Whether you believe the complaint is or isn’t justified, it helps to put yourself in the customer’s shoes because if you can defuse a potentially explosive situation, you may still end up with a satisfied customer.

In fact, that customer will be more satisfied than the average person who walks in because you listened, the problem was solved, and that’s satisfying. Everyone knows that mistakes can happen but consumer psychologist and marketing lecturer at the University of Melbourne, Dr Brent Coker, says it’s how you deal with them that will make or break your business.

“A person who experiences a transgression with a satisfactory recovery ends up being more satisfied about the experience,” Dr Coker says. “It signals empathy to the customers and that results in the customers trusting the brand more and seeing the brand as more genuine.”

So, how do you calm down the unhappy customer? Dr David Sweeney is the principal dentist and owner of 151 Degree Dental in Sydney and Cowra Dental Group in regional New South Wales. He says the key is to slow down and be patient.

“The biggest thing is actually trying to take a step back to reassess,” he explains, asking himself and his team: “How else can we approach this? This isn’t what we wanted to happen so we need to rectify this.” Dr Sweeney says you should stop, think and assess, even if that takes one week of consideration.

If you change your thought process about complaints, this can be a powerful way to relate to the customer. Dr Sweeney thinks about

complaints as an opportunity for business growth. “If something goes wrong, rather than it being a bad situation, we sit down as a whole team and talk about what happened, how we can deal with it and how we can change the way we do business in the future.”

Dr Fadi Yassmin, principal dentist at Broadway Dental in Sydney, says many issues, such as bill shock, can be avoided with good communication. “Try and avoid costing issues completely,” he says. “Whatever treatment is agreed upon needs to be costed at the time of consultation, and you really need to document it.”

Often complications can occur that can change this agreement but even then the patient doesn’t need to receive a nasty shock. “Sometimes there are variables, and even that should be discussed prior with the patient,” Dr Yassmin says. “If nobody is quoted, the first thing the patient will say is, ‘I didn’t know how much that cost’, even though you just got them out of pain.”

At 151 Degree Dental, treatments that cost more than $200 will have a treatment plan. “When we get a new patient, our receptionist will tell them how much the initial appointment

is, and that we require an hour of their time,” Dr Sweeney says. “On that appointment they always walk out with a treatment plan.”

Patients also walk out with a welcome booklet which aims to begin the formation of more personalised customer relationships.

“It explains who the practitioners are, our opening hours, how you can get your records, and that if you have a complaint, bring it to us first. But of course, it still gives that option if they want to take it to a third party as well.”

Dr Sweeney uses this booklet alongside another method that aims to build trust so that customers feel more comfortable with bringing up complaints earlier. “We take an interest in the little things,” he says. “For example, we let the patient choose what they want to watch, and if they put something on

It’s not a situation you want to be in, but there are solutions that will leave everyone happy. Cathryn McLauchlan speaks to the experts

Dr Brent Coker, consumer psychologist

“A person who experiences a transgression with a satisfactory recovery ends up being more satisfied about the experience.”

Quote

they love, we would make a note in our social history file so the next time they come in it’s already on for them. And if we have new kids coming in, we ask the parents what their child’s favourite

YOUR BUSINESS

18 Bite magazine

doubt,” Dr Sweeney explains. “If the overall environment is clean, no clutter, people will work a little bit better and the patient will

feel more at ease, and less inclined to be looking for something to go wrong.”

Now the customer is comfy enough and they aren’t feeling on edge, they will approach you with their complaint—here, your chances of a successful encounter are looking pretty good.

But that’s not quite enough. Dr Coker says you must also acknowledge how important the issue is to the customer. “When people complain, they usually just want to be listened to,” he says. “The person wants the dentist to understand how serious they consider the problem to be. It might be trivial in reality but for a customer, it’s important, and they want you to recognise that.”

Your dental patient is the cornerstone of your dental practice so you must prioritise their concerns. Customer satisfaction begins and ends with good communication. “Good dentistry is a great relationship between the patient, dentist and the rest of the team,” Dr Sweeney says. “If that relationship just isn’t there, then there will be a lack of belief in the outcome.”

TV show is so when they come in they feel at ease.”

Many dentistry patients feel some level of anxiety when they walk through the doors, particularly if they are having a procedure. That’s why it’s so important to explain along the way. Dr Yassmin says it’s worth doing this but tread cautiously. “Treat everyone with velvet gloves because a lot of these patients are anxious. You always remember nice customer service and at the end of the day, we’re still in sales, and you need to treat each patient as your last.”

A customer’s first expectations of a practice will also have an impact on the way they handle a situation when something goes wrong. They may begin to judge small environmental impacts with more weight because of

a formed negative attitude.“If a patient walked in and saw a dead

plant in the corner then they would think they couldn’t even look after a plant. They’re already creating a moment of

People complaining want to be heard.

Dental Relocation and Infrastructure Support Scheme is funded by the Australian Government and administered by Rural Health Workforce Australia.

To see if you’re eligible:Visit: www.rhwa.org.au/DRISSEmail: [email protected]: 1800 475 433

Government grants are available for registered general dentists who want to work in private practice in a location more regional, rural or remote than their current location.

Look what’s on offer:

• Relocation grants of $15,000 to $120,000

• Infrastructure grants up to $250,000 The 2015/16 funding rounds are: • 7 September–9 October 2015• 22 February–24 March 2016

TAKE A CLOSER LOOK.

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If you’d like to write a review, email the Editor at [email protected], and she’ll tell you what’s involved.

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NEWS & EVENTS COVER STORY YOUR BUSINESS YOUR LIFEYOUR TOOLSYOUR BUSINESS

Dentistry has changed

dramatically in the past five years. The economic downturn

has changed how patients make

decisions regarding their treatment and

dental practices need to manage their operations

differently. Natasha Shaw reports

20 Bite magazine

bolster your bottom line?

Is your practice, like many others in Australia, requiring your dental hygienist to offer more than just dental hygiene? Or perhaps you have already made the move and hired a ‘two-for-one package’ in the form of

a dental hygienist/dental therapist to help improve your business’ success?

While researching employment opportunities for dental hygienists, it was interesting to discover that many practices are actually now requesting oral health therapists instead—specialists dually qualified as both a dental hygienist and dental therapist and currently registered with the Dental Board of Australia in both disciplines.

Where once dental practices only sought a dental hygienist to educate clients on dental care and utilise preventive and therapeutic methods to maintain oral health, it appears many dentists now want someone to act as their ‘right-hand man’—a professional with the ability to carry out basic dental tasks, enabling the dentist to perform more intricate tasks and increase practice turnover, both where clients and profit are concerned. According to the Australian Dental Association, an oral therapist’s role includes “examining and diagnosing

Do you need more than a hygienist to

dental decay and gum diseases and providing routine dental treatments. They also work to promote oral health and provide preventive dental services among individuals and the broader community.” Having a hygienist who can also perform basic dental work can be very beneficial.

“The role of the hygienist is definitely evolving,” says Dr Manish Shah of Smile Concepts in Sydney. “Practices that are doing well are now hiring the hygienist to take over the role for simple procedures such as hygiene, teeth whitening, taking X-rays, administering local anaesthetic, etc. This frees up time for the dentist to concentrate on other areas.”

Many of the additional tasks of an oral health therapist really aren’t too far removed from the basic position of a dental hygienist and, in fact, dental education is reflecting this trend towards the need for both hygiene and therapy specialties within a single role. Campuses all around the nation, including the Faculty of Dentistry at the University of Sydney and Charles Sturt University in the ACT, provide a Bachelor of Oral Health in the form of a three-year, full-time course that offers students dual qualifications in dental hygiene and dental therapy.

YOUR BUSINESS

Bite magazine 21

bolster your bottom line?

Educating and counsellingTeaching people to maintain good oral health can be a challenge, but an oral therapist can spend more effective time with a patient and motivate them to look after themselves, taking this pressure off the dentist and promoting the practice as one that provides all-round oral care for its patients and is not just concerned with making a buck.

Forging relationshipsThe ideal oral therapist can help your practice establish a great patient/practitioner relationship, taking into account age, social and cultural backgrounds, which allows the effective

Dr Manish Shah of Smile Concepts, Sydney

“The role of the hygienist is definitely evolving.”

Quote

Do you need more than a hygienist to

hygienist/therapist can “take away all the activities that can be done by them from a dentist so the dentist can spend more time effectively doing more complex treatments”.

For example, an oral therapist can provide routine dental treatment for children, adolescents and teenagers in a practice. This can be in the form of education and assessment as well as implementing fillings and extracting primary and permanent teeth under a local anaesthetic. In people of all ages, an oral health therapist can treat gum conditions, clean and scale teeth, take and examine X-rays of teeth and jaws, and make impressions and moulds.

“My support staff is actually an oral therapist,” says Dr Shah. “The good thing about having an oral therapist is that they can do fillings, issue Invisalign treatments and other orthodontic braces demands, and issue retainers, etc. This gives me more clinical time to concentrate on complex procedures.”

Each State and Territory in Australia has its own limitations on what an oral therapist can do in relation to patients of certain ages, radiation requirements and so on, but it truly can pay to have someone in your practice perform the roles of both a dental hygienist and dental therapist. Initially, it is more cost effective to hire one person who can do everything than hiring two or more people to do the same job. Even hiring a single diploma-qualified hygienist and increasing their responsibilities and education during the time of their employment can be beneficial to a practice in the long run.

Following are six more ways having an oral health therapist can work for you and your practice, and bolster your bottom line.

Providing an extra handDr Shah says having an extra pair of hands in the form of a dual-qualified

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delivery of dental treatment, encouraging patients to return to the practice for subsequent treatments.

“In my practice we train our staff every month on communication skills,” says Dr Shah. “My staff benefit from these events and monthly meetings and end up growing both professionally and personally. We think that to motivate people in life is not to just give them financial access, but also to develop them mentally so they feel they are contributing to the company.

“We have excellent staff and we are growing at an exponential rate due to their desire to be better,” he says.

Increasing customer serviceAn oral health therapist can act as the link between a client and any other outside specialists they may be visiting, such as temporomandibular joint specialists for jaw issues and psychologists to treat dental fear. This gives a client someone they can rely on to support their overall dental health care as part of their general health.

Boosting turnoverWhen an oral health therapist can take some of the workload from the dentist,

YOUR BUSINESS

understanding of an oral health therapist can make this necessary part of the treatment less painful on a client, limiting the possibility of them not returning for further care.

While there is no doubt the skills of a dental hygienist are necessary within a practice for the care and maintenance of clients’ teeth and gums, surely there can also be no doubt that a practice will better its bottom line if its dental hygienist is equipped with greater skills that can aid the day-to-day operations within a practice.

it means a practice can effectively treat more clients. This increasing client turnover adds to the financial turnover of the business. Having an oral therapist may also mean a dentist does not need to hire another dentist (an added expense) in order to cope with the growing workload.

Looking after patient accountsDiscussing treatment plans and payment options can be tedious for a dentist whose time can be better utilised performing procedures. The education and

An oral health therapist can take

some of the workload from the dentist.

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Bite magazine 23

ADVERTORIAL

References: 1. British Standards Institute, 1983. Glossary of Dental terms (BS4492) BSI London QST is a cost effective and conservative short term ortho option for the patient, but one which has a huge impact. It is simple and relatively inexpensive for the dentist and due to demand, generates great profits too. A genuine win-win, low cost for patients with great margins for the dentist. Successfully launched in the UK 3 years ago QST has now over 3000 Q Dentist’s with 1200 successfully trained in the last 12 months. This simple, yet highly effective system is now available in Australia.

A class II division 2 incisor relationship occurs when the lower incisor edge is posterior to the cingulum plateau of the

upper incisors. The upper (and lower) incisors are usually retroclined. The overjet is usually minimal although it may be increased1. QST describes a mild class II division 2 when the anterior crowding (from the mesial aspect of the first premolars) is less than 5mm. The skeletal discrepancy between maxilla and mandible should be class I or mildly class II, with little contributory soft tissue element to the appearance. The buccal segments should also be well interdigitated. This type of malocclusion is quite common (approximately 10 per cent) but can be very noticeable. Individuals often complain of pointy upper teeth or upper incisors that stick out (usually the upper lateral incisors), rather than the retroclined upper centrals which are mainly at fault. This is often due to the resting position of the lower lip, which restrains the upper central incisors. The upper lateral incisors, being out of lower lip control are unrestrained and can appear proclined and rotated. This malocclusion when mild, can be treated consistently and predictably using a short-term orthodontic approach (STO).

HistoryThe following case report highlights treatment of a typical patient seeking a relatively quick, economic and aesthetic alignment of his upper front teeth only. Craig was a 38 year old laboratory director whose main complaint was that his “upper

teeth stick out!” As a consequence he was embarrassed to smile on photographs and when meeting new people. He desired straighter upper teeth.

His extra-oral examination confirmed:• Class I skeletal base • Average Frankfort-Mandibular Planes

Angle • Average vertical proportions • Average nasolabial angle • Competent lips • No asymmetry

Intra-orally he presented with:• Previously extracted 34, 44• Class II division 2 incisors, class I molars,

class II canines • Increased overjet (on lateral incisors) and

increased overbite due to retroclined upper central incisors

• Lower arch crowding 1mm, upper arch crowding 2mm

• Buccal occlusion well interdigitated

In summary, Craig complained of upper teeth that stuck out. He presented with a class II division 2 incisor relationship on a skeletal I base, with increased overjet and overbite, mild upper and lower arch crowding and previously extracted lower first premolars. He had retroclined upper central incisors and proclined upper lateral incisors. He preferred to have the upper teeth only treated.

Treatment options:1. Comprehensive treatment. Extraction of 14 and 24, followed by fixed appliances to

correct the overjet, overbite and buccal segment relationship to class I. Estimated treatment time 18-24 months. This too long for the patient.

2. A QST upper fixed appliance only. Accept a residual overjet as the upper central incisors would procline with upper arch alignment only. Estimated treatment time 5-7 months.

Planning• DPT showed no abnormalities and

healthy hard tissues• Oral health was good and there was no

active caries• Upper and lower impressions were taken

for digital planning The treatment plan was therefore:

• An upper QST fixed appliance to relieve crowding, align the anterior teeth and improve the anterior aesthetics

• Accept an increased overjet and class II buccal segments. IPR to limit any overjet increase and facilitate alignment

• Indefinite retention with fixed and removable retainers Fig 1. Post -orthodontic extraoral photographs

SummaryThis treatment modality has led to well aligned upper incisors at a normal angulation with improved upper incisal levels. More importantly, the treatment had been completed within an acceptable timeframe (duration 5 months) and on budget. The real outcome is a well-treated individual who’s now confident to smile.

Backed by high quality 3M Unitek components, American Orthodontic ceramic brackets, with each case manufactured by the Dental Solution Australia in Melbourne, the QST courses are also delivered by a specialist orthodontist Preet Bhogal.

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Quick Straight Teeth Short Term Ortho Clinical Case StudyAnterior Alignment in an adult with class II division 2 incisors, using Quick Straight Teeth Fixed Braces

Fig 2. Post -orthodontic

extraoral photographs

Fig 1: Pre-orthodontic extraoral photographs

NEWS & EVENTS YOUR BUSINESS YOUR TOOLS YOUR LIFECOVER STORY

Professor Lakshman Samaranayake has lectured on the topic of oral Candida

on five continents

24 Bite magazine

On a mission

Professor Lakshman ‘Sam’ Samaranayake is the world authority on oral Candida, having made it his career mission for the past 40 years. He explains why this is one disease you should never take your eyes off. Report by John Burfitt

Bite magazine 25

As a young dentist, Professor Lakshman ‘Sam’ Samaranayake took on post-graduate studies in Glasgow in 1977 and oral Candida

soon became his fascination.Having grown up in Colombo, Sri

Lanka, it was a health issue Professor Samaranayake had barely been exposed to previously. Scotland in the late 1970s, however, was a very different story. So widespread was the condition, he soon decided to devote his studies to understanding the complexities of oral Candida. That decision would change his life and career to such an extent that today, Prof Samaranayake is held as the world authority on oral Candida.

“I was working as an oral microbiologist in the Glasgow Dental Hospital, and what constantly surprised me was the number of swabs that kept coming up with positive results for Candida,” says Prof Samaranayake. “This was something I had just never seen in Sri Lanka.

“In Scotland, there was such a high prevalence of it. There was this notion at the time that if you had all your teeth extracted, you would never get heart disease. So, we had many old men and women coming in with rather unhygeinic full dentures, teeming with Candida-laden plaque. I was fascinated and that was when I began to be really interested in investigating what it was all about.”

Almost 40 years on, Prof Samaranayake’s fascination with oral Candida shows no signs of waning. If anything, at age 66, there are new areas of investigation into the condition he now wants to explore.

Any future study will be in addition to his work that has brought him acclaim, including authoring over 400 research articles, the IADR Distinguished Scientist Award in Oral Medicine and Pathology, as well as the King James IV Professorship from the Royal College of Surgeons of Edinburgh.

As of January last year, Prof Samaranayake’s relocated to Brisbane to take on the role as the head of school P

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: Je

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y Ve

itch

and the professor of oral microbiomics and infection at the School Of Dentistry at the University of Queensland. He has been hard at work guiding the studies of dental students ever since.

As Prof Samaranayake’s career has travelled such a clear path into microbiology and unlocking the secrets of oral Candida since those days in Scotland, it comes as something of a surprise when he admits he had a fundamental dilemma about specialising in the condition in the first place. If he had listened to some critics, he could just have easily turned his back on oral Candida a long time ago.

In one corner was his mentor, Professor Wallace MacFarlance, who recognised the young student’s keen fascination that he wanted to foster and encouraged him to sit for the membership exam of the Royal College of Pathologists in Microbiology, at the same time he was completing his doctorate of dentistry.

In the other corner were Prof Samaranayake’s peers who regularly questioned why he would be wasting his time on a health issue that was, as was considered at the time, no longer relevant.

“I still remember many colleagues saying to me, ‘Sam, why are you studying this dead disease? Candida is so easily cured now. There is nothing more to it’,” he recalls.

“Only a matter of years later, the HIV epidemic came along and then

Candida became a very important issue all over again. We discovered a world of fascinating new details about it and the other ways it could show up in the mouth.”

HIV changed not only the way oral Candida presented, but how it was studied. “Candida infections were once just white patches. Then with HIV, they

showed up as red patches as well. That took me on a completely new trajectory, looking into the causes of this disease, particularly in immune-compromised patients in general.

“We then began to understand that oral Candida was a disease of the diseased. People who contracted HIV presented with oral Candida as one of the first signs of the underlying fatal disease. If you diagnose the disease early, then you can help them as well as their partners by preventing the further spread of HIV.”

In those days, as new treatments for oral Candida were being trialled and often experimental, adaptations were often made in a valiant effort to solve the problem.

“As general vaginal infections were more common than oral Candida, I can still remember giving people vaginal treatments to be used in the mouth,” he says. “They were so bitter but they were effective and did work. We have improved so much since then with far better drugs like Fluconazole.”

Since those days which had such an influence on his career direction, Prof Samaranayake has worked all over the world, having lectured on the topic of oral Candida and other infectious diseases and their prevention on five continents.

Prior to moving to Brisbane, he spent 10 years as the dean and chair of oral microbiology at the Faculty of Dentistry and Tam Wah-Ching Professor

of Dental Sciences at the University of Hong Kong. He also acted at the same time as the director of the Prince Philip Dental Hospital.

He has previously held teaching and consultant positions at the University of Glasgow, University of Alberta in Canada and the University of Peradeniya in Sri Lanka. He has also served as a director

Professor Lakshman Samaranayake

“We discovered a world of fascinating new details about it and the other ways it could show up in the mouth.”

Quote

26 Bite magazine26 Bite magazine

of the FDI World Dental Federation and the chair of its Science Commission.

Prof Samaranayake remains on a mission with his current work at the University of Queensland, intent that students do not overlook the importance of identifying the true implications of oral Candida infections.

“Some types of Candida infections should never be overlooked as it may turn out to be a primary indicator of a whole range of other things in the body that are not going so well,” Prof Samaranayake says.

“It could eventually turn out to be a cancer of the oral cavity. There is still a lot unknown about Candida infections and we have to look at that, like how it invades tissues, what it does inside the oral cavities and how it interacts with other organisms.

“One in two of us have yeast in the mouth, and under normal conditions, they live there happily. But for some

people, it begins causing disease and that is when we need to look at what it is doing. In some situations if Candida infections are neglected and not treated, about 15 per cent of cases can turn out to be malignant. It should not be easily dismissed.”

As for the overall state of oral health in Australia, Prof Samaranayake says he is impressed with what he has seen since arriving, and believes it is an improvement from some other countries he has lived in.

But it is the state of oral health in outback Indigenous communities that Prof Samaranayake now wants to examine. He hopes to launch a new study into the presence and behaviour of oral Candida and related infections in those communities.

“I am concerned about some of the news and what I have heard about the dental care in some in the more remote communities,” he says.

“I am just curious about the prevalence of Candida within Aboriginal communities as an area awaiting exploration and I plan to look at it in time to come as the disease can show up in a range of different ways.

“For instance, in some population groups in Scandinavia, Candida infections appear as chronic incurable infections of the mouth, the skin and the nails. Such conditions are always worth following as they provide clues to the strange behaviour of this ubiquitous yeast.”

The other area that remains high on his agenda is the state of funding for dental studies in higher education institutions across Australia.

He is worried what the current changes in university funding could mean to the long-term quality of dental services being provided. “It’s no secret that all the dental schools here are going through a rough patch and funding is very tough right

COVER STORY

Professor Samaranayake remains on a mission with his current work at the University of Queensland.

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Professor Samaranayake

“There are not too many specialists in this area in Australia and specialisation in general is not as strong as it once was.”

Quote

now,” says Prof Samaranayake. “I feel strongly that so many post-graduate programs are dying. There are not too many specialists in this area in Australia and specialisation in general is not as strong as it once was. That is something we need to keep an eye on as we need specialists to keep our industry strong into the future.”

His textbook, Essential Microbiology for Dentistry, has been translated into four languages and is now in its fourth edition. It stands as the definitive statement of Prof Samaranayake’s career study into oral Candida and infectious diseases. He calls the tome the “legacy of my career—something that still stands and remains as a flag to remind people of the importance of this area of study”.

And besides, even though he is the world leader in oral Candida and the man everyone turns to when they have questions, he still has questions that need answering. Even after 40 years of dedication, Prof Samaranayake admits he has one question that remains unanswered.

“The only thing about Candida that stumps me is why does it become pathogenic and what is its tipping point?” he asks. “It is the host, and systemic factors that drive the yeast to become a parasite—I believe it is the best answer I can give,” says the professor.

“So at this stage, retirement is not an option for me, as I feel I still have more work to do. When that is complete, then maybe I will slow down then. However, that is a long way off.”


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Professor Samaranayake—the world leader in oral Candida research

Bite magazine 29

NEWS & EVENTS COVER STORY YOUR TOOLS YOUR LIFEYOUR BUSINESS

30 Bite magazine

One of the biggest frustrations that dentists face is the time and energy taken up with non-clinical business matters. Whether it’s

staffing and HR or bookkeeping and BAS requirements, vast amounts of time are taken away from the core concern of the business—dentistry.

That’s not to say that the non-clinical aspects of a dental practice are unimportant—they are vital. But is it a wise use of a dentist’s time and skill to look after the business side of things?

Dr Hoang ‘Patrick’ Dang always believed there was a better way. He developed his dentistry skills at a practice in Newcastle, New South

Wales, for two years after graduating at University of Sydney. But before long, he returned to his hometown of Sydney with a vision for a new concept. Taking over what was once the Blockbuster video store in the Nokia Building in Harris Street, Pyrmont, he worked with his builder to design his debut practice.

At the same time, he approached a trusted friend, IT-specialist Lisa Le, about the prospect of them working together. “I had known Lisa for years and was aware of her background in business management,” said Dr Dang. “My idea was that she would manage the staff and the day-to-day running of the business and I would dedicate myself to the dentistry.”

“At that time, Pyrmont was empty,”

30 Bite magazine

A clear design vision and an effective business model has seen Dr Patrick Dang and Lisa Le grow Pyrmont Dental Health into a three-practice concern in just eight years. Kerryn Ramsey reports

Welcome to thecomfort zone

Bite magazine 31

recalls Le. “There were no parks, hardly any people and lots of industrial buildings. But Patrick can be very persuasive.”

In August 2007, Pyrmont Dental Health opened its doors. “I chose the name purposefully,” says Dr Dang. “I wanted to keep ‘Dental Health’ at the very heart of things. That’s why it’s not called a practice, surgery, clinic or centre. ‘Dental Health’ effectively conveys what we are all about.”

Dr Dang designed his practice to look like no other. “Half the total floor space is used as a waiting area for our patients,” he says. “I wanted this space to feel casual and non-threatening—more like a living room in an apartment rather than a dental surgery.” P

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: Li

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The waiting room is a large, open space with comfortable lounges and armchairs. A coffee machine, massaging chairs, televisions and a PS3 for the kids are freely available. There’s also a fridge and microwave and the natural colour palette is calm and contemporary.

The focal point of the room is a huge saltwater fish tank. This 3.6 metre by 90cm marvel is full of coral, starfish and vibrant ‘Nemo’ clownfish. The serene but ever-changing underwater landscape is constantly filmed by a video camera that streams a live image to a television in the waiting room.

“We want our clients to feel welcome,” says Le who’s completed various courses on management and leadership skills. “We want them to be relaxed. We want them to be in a positive state of mind as soon as they walk through the door.”

The reaction to the fish tank has been overwhelmingly positive, especially with kids. In fact, Dr Dang is often called the ‘fish dentist’ by locals. Le points out, “When you look into our Google search statistics, people actually Google ‘fish tank dentist Pyrmont’ to find us.”

Dr Dang adds, “I wanted the waiting room to be as unlike a dental practice as possible. People often have negative associations with a visit to the dentist so our waiting room is more like a living room in an apartment.”

The surgery utilises the latest technology for both dentists and patients. While in the chair, patients love watching their favourite DVD on the overhead television through wireless headphones.

With Dr Patrick Dang

concentrating purely on the dentistry and Le looking after the business aspects, word of this amazing practice soon spread. Business boomed and within two years, the entrepreneurial colleagues were looking at opening another practice.

They found premises at the Macquarie Bank office towers near King Street Wharf. The lease was signed in August 2009—exactly two years after opening their first practice.

“We could see the vision,” says Dr Dang who met Le through mutual friends. “We could see that our business model was working. Creating a welcoming and soothing environment with state-of-the-art facilities was the first step. Separating the dentistry and the business side of things into two distinct departments was the second step. The last piece of the puzzle was to base our pricing not far from the national average.”

The only snag was that the new practice took much longer than expected to open. “There were stringent council requirements and the building was a 6- or 7-star energy-rated building,” says Le. “During the installation, the engineering architect

Welcome to theSit a while, relax, have a coffee.The waiting area is designed to

keep stress levels low.

‘Fish dentist’ Dr Patrick Dang.

The ‘Nemo’ fish are a real hit with patients, especially kids.

Since 2002, hundreds of happy dentists and dental specialists across Australia have trusted Medifit to create their dream practices.

Whether a complete ground up build or a renovation, we’ll help you to get the most out of your available space and create a practice that works the way you do. Our experienced team will transform your practice vision into stunning reality, and we’ll do it on time and on budget.If you want a practice you can be proud of, in the timeframe and budget you need, contact us today for a no obligation consultation on 1300 728 133.

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had a lot of specifications he had to fulfil—everything from the kind of lights we could use to how the waste could be disposed. It was all specified under a green initiative by Sydney City Council.”

Sydney Dental Health finally opened its doors in March 2012. Once again, the business was quickly successful with clients unanimous in their love of the laid-back waiting room with an over-sized fish tank.

“There’s a lot of construction taking place at Barangaroo,” adds Le. “Ultimately, it should help add to our client base but the project is a long one. Construction is slated to finish in 2016 and the casino won’t be completed until 2020.”

Recently, Dr Dang and Le have now taken on their third practice in the MLC Centre, a Harry Seidler-designed skyscraper in Sydney’s CBD. A part-time dentist at the Pyrmont practice, Dr Todd Verner, was already working at the MLC Dental Centre. When the principal dentist decided to sell, Drs Verner and Dang went 50/50 in the business.

They took over in May last year and have just finished the renovations in the waiting room. New flooring, a paint job, an array of comfortable furniture and a massive saltwater fish tank are now all in position. Re-branding is taking place and soon Martin Place Dental Health will open its doors.

So, within eight years, Dr Dang and Le have started three practices that employ seven dentists and five hygienists. “The secret of our success is simple,” says Dr Dang. “Our common goal is always to put our patients first. It doesn’t matter if you’re a DA, hygienist or a dentist—everybody is there to assist the patient.”

Le agrees, adding: “We also make a real effort to keep all the staff in the loop. Everybody knows what’s going on, whether it’s marketing, staff updates, events or community work. We are a very clear and transparent practice. When everyone is informed, they all have something to look forward to every day.”

YOUR BUSINESS

32 Bite magazine

Dr Hoang ‘Patrick’ Dang

“People often have negative associations with a visit to the dentist so our waiting room is more like a living room in an apartment.”

Quote

The 3.6-metre-long fish tank is the focal point of the practice.

NEWS & EVENTS COVER STORY YOUR BUSINESS YOUR LIFEPRODUCT GUIDE

Infection control product guide

Bite magazine’s annual guide to the best infection control products

for dentists on the market today

Bite magazine 35


ADVERTORIAL

PRODUCT GUIDE

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Gears and ball bearings

Spray channels

The introduction of the updated Australian Standard AS4187:2014 and new terminology for reprocessing

reusable medical devices (RMDs) such as handpieces, is a timely reminder for all practices to ensure they comply with the latest infection control guidelines.

The release of the updated 4187 Standard in December 2014 has implications for all HSOs (health service organisations) such as dental practices.

It is the obligation of each practice to obtain a copy of the standard, which is available from SAI Global InfoStore. This change to the 4187 Standard - updated from 2003 - brings it in line with corresponding international standards, including the ISO15883 for WDs (washer disinfectors).

According to AS4187:2014, automated RMD cleaning units must use an effective cleaning agent to remove contaminants, and the internal air and water passages of reusable medical devices (RMDs) must be properly cleaned by the process.

In addition, under ADA guidelines (2012) it is strongly recommended that automated ‘flush-through’ devices are used for lubricating handpieces because of their lower dosing rates compared to pressurised spray lubricants applied by hand. This is because over-lubrication may impede effective steam sterilization.

Today, automatic handpiece units play a primary role in instrument

reprocessing, but not all ‘cleaning’ and lubricating units operate the same way, warns W&H Territory Manager for Australia and New Zealand, Chris Jobson.

Mr Jobson said proper cleaning was vital as dental handpieces with their narrow transmission channels and angled internal chambers placed increased requirements on thorough reprocessing. This is true of all turbine and contra-angle handpieces, which may be exposed to blood, saliva, secretions and tissue.

In addition, there are also technical contaminants such as particles resulting from abrasion and oil residues, as well as contaminants potentially contained in dental unit-supplied water (coolant) and compressed air supply lines.

“On the Australian market there are some handpiece maintenance units that claim ’cleaning & lubrication’ yet do not offer evidence to support the outcome of the cleaning process which means in effect they only lubricate, which may make them unsuitable for adequate reprocessing of dental handpieces,” Mr Jobson said.

“The new European designed W&H Assistina ‘3x3’ was designed with W&H’s mantra in mind—‘prove what you claim’. The internal and external cleaning

process has been validated by an independent hygiene institute. (The report is available online at wh.com). The Assistina meets the new standard with a validated cleaning process, while also dramatically streamlining instrument reprocessing by being able to internally and externally clean, and internally lubricate up to three instruments in just 6 ½ minutes—saving time and money.”

In conjunction with the W&H ‘Lisa’ Class B sterilizer, instruments can be completely cleaned, dried and sterilized in just 20 minutes (approximately 6 minutes in the Assistina 3x3 and 14 minutes using the fast cycle of the latest Lisa Automatic Sterilizer). Lisa’s dedicated Class B cycles and inbuilt traceability options make the W&H reprocessing system a practical and effective method of complying with the latest infection control standards.

Both the Assistina 3x3 and Lisa sterilizer are available through A-dec dealers phone 1800 225 100. For more information visit wh.com


36 Bite magazine

Updated standard a reminder for infection control

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The new Assistina 3x3 cleans and maintains up tothree instruments automatically.Validated internal and external cleaning, short cycle time,easy to use: perfect preparation of straight and contra-angle handpieces and turbines for sterilization.

Assistina 3x3:Clean inside, clean outside

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ADVERTORIAL

PRODUCT GUIDE

When buying your next dental unit, you should look at the attention provided by the

manufacturer to hygiene. A Hygiene focus that meets the demands of dental practice is of upmost importance. Similarly with a possible life span of 15-20 years for your dental unit, upgrading as standards evolve should play a role in your decision making.

Anthos, Italy’s leading dental equipment manufacturer has always been extremely attentive to hygiene and infection control on its full line of dental treatment units. Anthos aims for all-round wellbeing from the inclusion of active systems, design detail, and material selection all designed for compliance with the latest European and Australian quality and infection control standards.

Key ANTHOS HYGIENE features are listed below and are available for selection on the full ANTHOS line, Classe A, Classe R & Classe L.

(W.H.E) Waterline Continuous DisinfectionAutomated system which continually adds disinfectant (hydrogen peroxide with silver ion enhancement) to the mains water that feeds the dental unit. The (W.H.E) system performs continuous bacteriostatic activity on

the water line significantly reducing the bacterial count over time; it’s proven to act against all water-borne contaminants, including Legionella.

(W.H.E) also provides an important secondary function as a EN 1717-compliant Type A inlet air gap separation device to prevent the contamination of mains water. Together with conscientious design of all water circuits and selection of materials meaning compatibility with the strictest standards defined by German law and certified by DVGW.

(BIOSTER) Waterline Intensive DisinfectionHygiene device that performs intensive disinfection of the dental water unit lines. Similar to W.H.E however supplying more intensive dose. Recommended daily, and at the recommencement of work after a prolonged absence. Similarly possible to carry out a cycle for example after treating patients who are ascertained carrier of hepatitis, HIV or other infectious pathologies.

(S.H.S) Simplified Independent Water Feed System A simplified water bottle system that allows disinfection and flushing in either semi-automatic or manual mode. This is particularly useful where the mains water supply presents hygiene problems.

(O.D.R.) Out Drop No Retraction SystemAn automated and standard feature whereby the O.D.R device avoids retraction of residual droplets left on the instrument tip, and thereby prevents them from being retracted back inside the instruments. Overcomes the problems of anti-retraction valves which can become less efficient even just months after a dental unit installation as a result of lime scale or biofilm deposits. This reduces the requirement for continual anti-retraction valve/cross contamination testing.

(A.C.V.S) Suction System Flushing & SanitationAutomated process for suction cannula washing minimising manual work of the assistant and allowing more time for other critical hygiene functions.

Peristaltic PumpOptions for a sterile saline solution

delivery via a non-contact disposable irrigation tube at the dental unit. Suitable for surgical and implant procedures.

Passive HygieneA design mindset with the prevention of cross contamination in mind.

Removable parts for sterilisation/disinfection including Cuspidor Bowl and Cup Fill. Greater level of foot control operation thereby preventing contamination of dental units as a result of hand contact.

Upholstery is seamless co-moulded bond of SKAI upholstery, and no bellows present on unit chair and joints.

Design also pays attention to simple and effective barrier protection, exemplified in the CONTINENTAL delivery version available on all Anthos dental units.

Please consult ANTHOS in Australia on 1300 881 617 or [email protected], to find out more about the hygiene solutions available on the ANTHOS CLASSE A, R & L range of dental units.


Anthos—hygiene care and attention

38 Bite magazine

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ADVERTORIAL

PRODUCT GUIDE

Air Water Syringe (AWS) tips commonly used throughout dental practices worldwide present two areas of

concern including cleaning/disinfection/sterilisation and a secure fitting. In many countries there has been a rapid move towards disposable AWS tips.

Traditional metal tips metal have been identified as a risk area for cleaning/disinfection/sterilisation as the AWS tips and air water supply may be contaminated with bio burden. The fine lumen openings restrict the ability to thoroughly clean the inside of the AWS tips and make adequate inspection visually impossible.

The Dental Advisor (USA) published an article “Reusable versus Disposable Air/Water Syringe Tips” from research by THE DENTAL ADVISOR Biomaterials Research Center saying the following:

“The fact that microbial contamination was detected in approximately 10 per cent of the metal AWS tips tested strongly re-enforces the need to clean lumens of reusable tips before heat sterilisation” and “Inability to clean the lumens therefore provides strong support for routine use of disposable AWS tips”.

In addition Dr Martin Fulford (UK) says “The inability to pre-clean the inside of traditional metal syringe tips,

coupled with the unpredictable nature of steam penetration through fine lumen, means that effective sterilisation of such tips cannot be guaranteed. Therefore, the use of a disposable syringe tip to cut cross-infection risk is to be strongly encouraged”.

There is overwhelming evidence that traditional metal AWS tips pose an infection control threat to surgeries still using them.

The second concern is that traditional metal and cheaper disposable AWS tips are held in the syringe by friction. This does not guarantee a secure fitting presenting the strong risk the AWS tip ‘blows off’ into the patient’s throat or lungs.

A recent case study published in 2014 in The Journal of Oral Science (Japan) Vol. 56, No. 3, 235-238, 201 called Accidental Ingestion of an Air-water Syringe Tip During Routine Dental Treatment, showed an image of a friction grip AWS tip clearly lodged in the patient’s abdomen.

The Pro-Tip Turbo Disposable Air/Water Syringe tips from Astek Innovations addresses the concerns relating to both infection control and safety. Its superior design incorporates a bayonet fitting, securely locking the disposable AWS tip onto the Pro-Tip Adaptor. In addition the rigid design has

the advantage of allowing the practitioner to gently retract the cheek without bending the tip, increasing vision at the back and sides of the mouth. Astek Innovations also guarantees instant dry air achieved through a unique 2-chamber design separating both air and water in the tip. When both air and water are selected a mist is produced.

A selection of easy-to-install converters across a wide range of equipment manufacturers are available for the Pro-Tip Turbo Air/Water Syringe tips.

For more information call W9 Customer Service on 02 9987 4224 or email [email protected]


Reusable versus Disposable Air/Water Syringe Tips. John A. Molinari, Ph.D., and Peri Nelson, B.S. | Dental Consultants, Inc., Ann Arbor, Michigan. Dental Advisor Jun 2012. Journal of Oral Science, Vol. 56, No. 3, 235-238, 201Accidental ingestion of an air-water syringe tip during routine dental treatment: a case report“The inability to pre-clean the inside of traditional metal syringe tips, coupled with the unpredictable nature of steam penetration through fine lumen, means that effective sterilisation of such tips cannot be guaranteed. Therefore, the use of a disposable syringe tip to cut cross-infection risk is to be strongly encouraged,” says Dr Martin Fulford BDS.DgDP.DlbMS (UK).The fact that microbial contamination was detected in approximately 10 per cent of the metal AWS tips tested strongly re-enforces the need to clean lumens of reusable tips before heat sterilisation.Inability to clean the lumens therefore provides strong support for routine use of disposable AWS tips.

40 Bite magazine

Air Water Syringe Tips - Areas for Concern

The Double Chamber Design Keeps Water And Air Separate...Guaranteed!Many dental procedures require instant, clean, dry air. Pro-Tip Turbo has a unique 2-chamber system to separate air from water. This guarantees instant dry air when and where you need it.

• New high power air jet

• Prevents cross contamination

• Dry air every time and perfect misted spray

• Exclusive locking system secures tip safely

• Sealed separation of air and water

• Rigid for effective cheek retraction

• Fits onto all existing pro-tip converters

• Wide range of converters available for your air/water syringe

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The Double Chamber Design Keeps Water And Air Separate...Guaranteed!Many dental procedures require instant, clean, dry air. Pro-Tip Turbo has a unique 2-chamber system to separate air from water. This guarantees instant dry air when and where you need it.

• New high power air jet

• Prevents cross contamination

• Dry air every time and perfect misted spray

• Exclusive locking system secures tip safely

• Sealed separation of air and water

• Rigid for effective cheek retraction

• Fits onto all existing pro-tip converters

• Wide range of converters available for your air/water syringe

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The Syringe Tip that Locks in for SAFETY




ADVERTORIAL

PRODUCT GUIDE


Aloe Vera Gloves - Proven enhanced skin protection

1. Bearman G, Rosato A, Duane T, et al. Trial of Universal Gloving with Emollient-Impregnated Gloves to Promote Skin Health and Prevent the Transmission of Multidrug-resistant Organisms in a Surgical Intensive Care Unit. Infection Control and Hospital Epidemiology. 2010:31(5):491-497. Available at: http://www.journals.uchicago.edu/doi/abs/10.1086/651671?journalCode=iche. Accessed May 11, 2010.2. West D, Zhu Y. Evaluation of aloe vera gel gloves in the treatment of dry skin associated with occupational exposure. American Journal of Infection Control. 2003;31(1):40-42. Available at: http://www.ajicjournal.org/article/S0196-6553(02)48212-0. Accessed May 7,2010.

42 Bite magazine

Dental professionals and ancillary staff regularly clean and sanitise their hands throughout the day. Regular

washing with soaps potentially remove the skin’s natural oils while alcohol based sanitisers dehydrate. This constant abuse on the hands’ soft tissue can cause skin irritations, erythema, dry skin, dermatitis and long term damage.

In February 2003 Dennis P. West PhD and Ya Fen Zhu MS published a clinical study evaluating the effects of aloe vera gel gloves in an occupational setting. They concluded that ‘Dry-coated Aloe Vera (AV) gloves that provide for gradual delivery of AV gel to skin produced a uniformly positive outcome of improved skin integrity, decreased appearance of fine wrinkling, and decrease erythema in the management of occupational dry skin and irritant contact dermatitis.’2

Although Ongard’s Aloecare Latex and Truecare Aloe Nitrile deliver the aloe vera in each glove by different means, they both sooth, heal and moisturise the skin. Aloecare Latex gloves are powder free, textured and low protein. The aloe vera is

both incorporated within the latex mix and separately coated externally and internally. On the other hand Truecare Aloe are powder free textured nitrile gloves internally coated with freeze-dried aloe vera activated by the skin’s warmth and moisture. Truecare Aloe gloves superior flexibility offer greater comfort and hand fatigue reduction than alternative nitriles.

As the hands of clinical staff are repeatedly exposed to washing and drying, chemicals and abrasion, the long term damage to soft tissue can be greatly reduced by the use of a glove containing the natural healer, aloe vera.


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SOOTHES COOLS MOISTURISES




ADVERTORIAL

PRODUCT GUIDE

In 2009 Cavex Holland B.V introduced the Cavex ImpreSafe disinfection system after identifying the void in the

impression infection control markets. With the heightened professional concern about cross infection with diseases and viruses such as HIV, Hepatitis, Asian Bird Flu, SARS and many others, Cavex set out to offer a solution that would be an effective disinfectant while preserving the integrity of the impression. After many years of research and development, Cavex successfully launched ImpreSafe, suitable for use with all Alginate, Polyvinyl siloxane and Polyether materials.

Cavex ImpreSafe is effective against bacteria, fungi and viruses but does not affect the surface of the impression. Cavex ImpreSafe is a non-toxic disinfectant that is aldehyde free and needs no more than three minutes to be effective. Due to this short contact time the surface of the impression will remain 100 per cent intact and the end result uncompromised. Submerging the

impression into ImpreSafe covers the exposed impression and tray, unlike disinfectant sprays.

Cavex ImpreSafe is easy to use. On completion of the impression rinse the impression under water and then submerge in a filled ImpreSafe bath

containing the ImpreSafe disinfectant. Set the timer for three minutes. Remove the impression after three minutes and bag in a zip lock bag till required. Due to the ease of the system, implementing Cavex ImpreSafe into practice daily routines and impression disinfecting protocols is effortless.

In 2010 Dental Advisor USA awarded Cavex ImpreSafe with its 5+ rating: ‘Cavex ImpreSafe was evaluated by 24 consultants in over 800

uses. It received a 96 per cent clinical rating.’ In 2011 Cavex ImpreSafe was awarded a 2011 Preferred Product.

Cavex ImpreSafe has been thoroughly tested by expert laboratories (official reports on www.cavex.nl) and has proven to be a reliable and highly effective disinfection system. It complies with DGHM guidelines and EN 1040, EN 1275, EN 13727, EN 13624, EN 14561, EN 14562.

Cavex ImpreSafe is supplied in a highly concentrated disinfection fluid. 30 ml of Cavex ImpreSafe is diluted with 1L of water, making a total of 33 litres of ready-to-use disinfectant in 1 bottle. A starter kit is available and includes 1 litre of Cavex ImpreSafe disinfectant, a disinfection container, three minute timer, impression zip lock bags, and a protocol sheet.



Three minutes to safer impressions

44 Bite magazine

Cavex ImpreSafe

Appearance Clear, light blue liquid

Destiny (20*C) 1.0 g/ ml

pH value (3% solution) 9 – 11

Biological Process 3% solution, 3minutes contact timeUnder clean and dirty condition

EN1650 / EN1275EN13727 / EN14561Bactericidal activity5 log reduction

Candida Albicans (+)

EN1475Limited virucidal activityLog 5 reduction

Bovine Viral Diarrhea Virus (BVDV)Hepatitis CHepatitis BVaccinia VirusHuman Immunodefiencty Virus (HIV)

DISINFECT YOUR IMPRESSIONS IN ONLY 3 MINUTESwith Cavex ImpreSafe

Cavex ImpreSafe Impression Disinfectant System is an alginate, polyether and silicone disinfectant. In only 3 minutes Cavex ImpreSafe kills bacteria, viruses and fungi without damaging the surface of the impression.

1 litre of ImpreSafe concentrate makes 33 litres of ready-to-use disinfectant, which will last the average dental surgery 33 weeks.

Starter Kit includes EVERYTHING you need to disinfect1 x Cavex ImpreSafe 1L concentrate1 x Disinfection bath1 x 3 minute timer50 x Plastic zip lock bags



As a result Cavex ImpreSafe is faster and safer.

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ADVERTORIAL

PRODUCT GUIDE

Lesions of the inferior alveolar nerve and the lingual nerve are the most feared complications when extracting mandibular

third molars. Iatrogenic injury of the IAN or the LN often lead to legal actions for damage and compensation for sensory disturbances involving the chin, the lower lip, gums and tongue. Improved diagnostic and surgical techniques have however considerably decreased the prevalence of this complication. What follows is a description of a diagnostic and therapeutic methodology aimed at limiting surgical complications of inferior third molars starting with an accurate diagnosis followed by the use of minimally invasive surgical instruments.

IntroductionThe IAN is a sensitive nerve made of parallel nervous fibres (central/peripheric): it originates from the posterior terminal end of the posterior mandibular nerve while the LN is a branch of the mandibular division of the trigeminal nerve. The IAN and the LN are the nerves presenting more risk of unintended iatrogenic injury lesion during mandibular molar extraction.

The incidence of reported postoperative damage to the IAN and LN varies widely in literature. A 2005 survey involving all oral surgeons in California and aiming to estimate the occurrence of neurologic damage to the inferior alveolar and the lingual nerve surgical shows that 94.5% of the 535 surgeons answering the survey reported damage to the inferior alveolar nerve and 56% to the lingual nerve. (Robert et al. 1

In a study published in 2000 by J. Gargallo-Albiol et al., the incidence of

temporary disturbances affecting the IAN or the LN was found to be in the range from 0.278% to 13%. 2 In another study by John R. Zuniga , the incidence of permanent injury to the IAN and LN has been mentioned to fall in the range between 0.4%and 25% and 0.04% and 0.6% respectively. 3

Two important factors can significantly increase the risk of IAN damage: anatomy and old age. By anatomy we mean the relationship between neuro-vascular bundle and rooths of the third mandibular tooth, identifyable through orthopantomogram (OPG). As early as 1990 Rood & Shehab4 identified a list of clear indications for significatively higher risks for the inferior alveolar nerve, all identifyable through OPG, including: Angled roots by the alveolar canal; interruption of the radiopaque lines that mark the alveolar canal; Root radiolucency of the alveolar canal; Narrowing of the mandibular alveolar canal by the roots; Radiolucent and bifid root; Narrowing of roots by the alveolar canal; and Deviation of the mandibular alveolar canal.

While several studies come to the general conclusion that the deeper the third molar, the higher the rate of nerve damage, other authors stress the importance of surgical factors as significant contributors to nerve injury.

Some authors even conclude that, rather than the mandibular depth of third molar, the true cause of nerve damage is the surgical maneuver required during extraction such as lingual flap retraction, ostectomy, and tooth sectioning and not. 5,6,7,8 The technique used would in other words determine at least to some extent the probability of nerve injury.

Instruments and methodologyExtraction technique when removing an impacted or semi-impacted mandibular third molar should extremely important in order to prevent damage to the surrounding anatomical structures, such as the lingual nerve, the inferior alveolar nerve and the periodontium of the second molar. The surgical instruments used are of paramount importance.

In the case that follows an innovative instrument, the mecanical periotome Luxator LX (Directa), was used to perform a mandibular third molar extraction. The instrument allows to cut the Sharpey fibers surrounding the tooth between cement and alveolar bone, (Feneiss et al 1952) by luxating the periodontal ligament.

ConclusionMandibular third molar extractions are undoubtedly associated with neural injury risks that can cause temporary or permanent discomfort for the patient and legal actions for the dentist. A thorough pre-operative diagnosis is mandatory and complication factors such as age and anatomy - i.e. depth of impaction and presence of overlying ramus bone - need to be taken into account. The surgical approach used is of paramount importance to minimize tissue damage and neurosensory impairment. The mechanical Periotome Luxator LX proves to be a valid tool in surgical extractions allowing minimal trauma and significative reduction of post-operatory discomfort.

For more information contact 1800 064 645 or visit trolldental.com


Atraumatic extraction of mandibular third molars

46 Bite magazine

Preventing iatrogenic damage to the inferior alveolar and lingual nerves during third mandibular molar extraction by Loris Prosper, Nicolas Zunica

Bibliography1. Robert RC, Bacchetti P, Pogrel MA. Frequency of trigeminal nerve injuries following third molar removal. J Oral Maxillofac Surg 2005;63:732-5. 2. John R. Zuniga. Management of Third Molar–Related Nerve Injuries: Observe or Treat? Alpha Omegan ; 102 (2). 3. J. Gargallo-Albiol, R. Buenechea-Imaz, C. Gay-Eseoda. Lingual nerve protection during surgical removal of lower third molars. A prospective randomized study. Int. J. Oral Maxillofac. Surg. 2000, 29: 268-271. 4. Rood JP, Shehab BA.The radiological prediction of inferior alveolar nerve injury during third molar surgery. Br J Oral Maxillofac Surg 1990;28:20-5. 5. Carmichael FA, McGowan DA. Incidence of nerve damage following third molar removal: a West of Scotland oral surgery research group study. Br J Oral Maxillofac Surg 1992;30: 78-82. 6. Fielding AF, Rachiele DP, Frazier G. Lingual nerve paresthesia following third molar surgery. A retrospective clinical study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997;84:345-8. 7. Waseem J, Tahwinder U, Priya S, Farai N, et al. Risk factors associated with injury to the inferior alveolar and lingual nerves following third molar surgeryrevisited. Oral Surg Oral Med Oral Pathol Oral Radiol Endod2010; 109:335-345. 8. Mason DA. Lingual nerve damage following lower third molar surgery. Int J Oral Maxillofac Surg 1988;17: 290-294.

Luxator LX Mechanical PeriotomeReciprocating tip - quicker extractions, minimal tissue damage

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Luxator LX Mechanical PeriotomeReciprocating tip - quicker extractions, minimal tissue damage

Self directing tip - allows periotome tip to follow the root surface, reducing the risk of bone damage

Optimal access - for difficult to reach areas (molar, lingual/palatal, distal) Titanium coated - glides easier into the socket and remains sharp

available from

Start Kit1 x Handpiece1 x Tip Holder1 x Plunger2 x Tips (2mm, 3mm short)2 x Bonus Tips (2mm, 3mm long)

Made in Sweden

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Dr. Rouel Vergara works in a busy practice in a high growth area – the NSW Central Coast. “We’ve

only been there two years, but since we started it has become busier and busier,” he says. “It’s growing, which is a good thing.”

As well as running his busy two-surgery practice, Dr Vergara actively provides continuing professional development lectures and workshops for various dental schools, groups, societies and organisations locally and internationally. He obtained his Doctor of Dental Medicine (DMD) degree from the University of the East, Manila, Philippines in 1998 and acquired his General Dentist Certificate from the Australian Dental Council (ADC) in Melbourne. Dr Vergara also holds a Training and Assessment Certificate.

Additionally, Dr Vergara is a member of the Australian Dental Association, American Dental Association, Australian Society of Endodontology and Australian Prosthodontic Society.

But one of his special areas of interest is infection control—a vital component of any practice.

The worst thing that can happen to a busy, growing practice is equipment

failure. If your infection control hardware fails, you can’t treat patients again until you can sterilise your equipment. It’s part of the reason why Dr Vergara chose Gunz to supply his infection control hardware and consumables.

“I personally chose Gunz, because I’ve had good experiences with Gunz, not just for infection control but also other products as well,” he explains. “They have a complete range. From equipment to consumables and to technical support, it’s more of a one-stop-shop, if you will.

“I know the technician personally, so that’s why it’s much easier for me to communicate to them what I need to get done, if and when I need the equipment serviced.”

While there are many providers of autoclaves in the market currently, Dr Vergara based his decision on personal research as to the reliability of the equipment, and recommendations from friends and colleagues as to the best infection control equipment to use.

“What I find is that a lot of practices I know, I asked them what autoclaves they would prefer or they would recommend,” he says. “And what it came down to was the reliability of the equipment. That’s very important in our practice, because if our infection control equipment breaks

down, it affects the whole practice. We can’t work because we process instruments that we would be using.”

The personal relationship he has built with Gunz technicians as a result of having the same branded equipment throughout his practice means the process of servicing equipment becomes much easier too.

“I find that with the Gunz technical support, I deal with a technician I know personally—so I don’t ring up and ask for technical support, I ring up and ask for Mark. And Mark has been dealing with our practice since we opened. The fact that I could easily get in touch with him and get his support if something goes wrong in the chair, or in the autoclaves, or something like that, he could provide professional advice and service, which is what you want when you’re running a practice. So, that’s why I chose them.”

It doesn’t hurt that Gunz has been around for a long time, also: “If I’m not mistaken, Gunz has been here for over 75 years, so you wouldn’t have succeeded that long if you haven’t really established your connections and relationships and as well as being able to provide the best service possible.”

Contact your Gunz Dental representative or Customer Service on 1800 025 300 to talk about your Infection Control needs


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48 Bite magazine

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NEWS & EVENTS COVER STORY YOUR BUSINESS YOUR LIFEYOUR TOOLS

Snap Cosmetic Simulation softwareby Timothy Goh, Oxford Dental Practice, Unley, SA

This is a fantastic program that allows our patients to preview cosmetic dental work we can offer. It makes it easier to explain the process and they get a clear idea of the available options. It’s great from a legal standpoint as it gives patients a realistic expectation of the outcome potential.

What’s good about itWe take a photo of the patient and the software allows us to manipulate the patient’s smile. This is done by using preset options such as veneers or whitening onto the patient’s teeth. We can also manipulate individual teeth though it’s a more time-consuming process.

Whenever we are discussing the possibility of a Snap-On-Smile with a patient, I always use this program. The software preview is close to the actual outcome.

Patient reaction is always very positive. They love seeing how they will look once the treatment is completed. Comparing before and after images shows them how much their dentist can do. When they look at themselves in the ‘after’ shot, it’s easy to see the improvements that can be generated. It definitely encourages patients to accept treatment advice.

I was very impressed with this product as soon as I saw a demonstration of the software. In fact, I was the first dentist in Adelaide to purchase the program. It has totally lived up to expectations. It’s an excellent product.

What’s not so goodAny one using the software needs to do the training in order to produce a result in a single appointment. The presets of the whitening function aren’t quite as accurate as I would like it to be.

Where did you get itAustralian Dental Supplies (www.australiandentalsupplies.com.au).

Tools of the tradeSoftware allowing your patients to see outcomes; an inexpensive polishing device and much more are under review this month …

Intensiv ProxoPolishby Dr Tara Cowie, Hyalite Dental Surgery, Larrakeyah, NT

This is a simple inter-proximal polishing device that’s relatively cheap and very effective.

What’s good about itThe ProxoPolish is a diamond-coated metal strip that comes in two grit sizes. When I have a contact that is quite tight or that has a bit of bond, I often find the Mylar polishing strips are unable to get through. They will break or bend or distort and become impossible to use. Obviously I’m not going to force it through and cause the patient discomfort. The ProxoPolish is made of such thin metal that it consistently goes straight through the contact without ever distorting.

The first time I used them was when they were dropped off at the practice as a sample. I immediately liked the way they worked and ordered a couple pf boxes. I don’t use them every day but when I want to get through a tight contact quickly and easily, it’s great to have them on hand.

I still use the Mylar version but it’s nice to have an alternative when they’re not working. In fact, I think the ProxoPolish strips are probably more comfortable for patients as less vertical force is required to get through the contact. In most cases, they pass through immediately.

They are also very easy to hold due to a large finger grip at either end. We’ve nicknamed them ‘Banjos’ because they look like tiny banjos.

What’s not so goodIt’s a simple tool that’s well designed and effective. It’s hard to see a way they could be improved.

Where did you get itDavid Quinn, Dental Consumable Consultant, 0433 321 669, [email protected].

Bite magazine 51

http://www.australiandentalsupplies

mailto:[email protected]

YOUR TOOLS NEWS & EVENTS COVER STORY YOUR BUSINESS YOUR LIFE

Tools of the trade (continued from page 51)

Biowell Compact Disinfection Unitby Dr Jason Pang, Cosmic Smile Dental, Neutral Bay, NSW

Ozone is nature’s bleach and a natural disinfectant. It kills bacteria, fungi, viruses and it does it very quickly. This unit is mounted on the wall in our sterile area and produces ozonated water on demand.

What’s good about itDental water lines can contain a huge amount of bacteria if there are no flush and clean protocols in place. This bacteria doesn’t affect most people but if you are dealing with immuno-compromised individuals, it can be dangerous. We decided to see what difference ozonated water makes.

After a weekend, we tested the water in our lines on a Monday morning. The lines were full of bacteria and there was obviously room for improvement. When we flushed the lines with ozonated water and used ozonated water throughout the day, the test showed that no bacteria was present.

We also use the ozonated water in a number of other ways. Every patient has a preoperative mouth rinse of ozonated water. For perio patients, we use ozonated water in conjunction with deep ultrasonic scaling.

This helps activate the ozone and causes a bacterial killing process. We use it for irrigating endodontic procedures and we flush any perio pockets with the water. We also used it to clean all instruments and wipe down chairs and surfaces.

On top of this, there was an unexpected side effect to using ozonated water. Our dental suite is positioned in a building that doesn’t have underfloor sewage but instead uses a series of pumps. There was one drain in the lab that always smelled bad. The use of ozonated water caused that smell to completely disappear.

What’s not so goodThe unit is expensive to purchase. There can also be extra costs depending on the set-up of the surgery and whether the unit is plumbed into the water lines of the dental chair.

Where did you get itMint Devices (www.mintdevices.com.au).

52 Bite magazine

Orthophos XG 3D readyby Dr Krishan Mistry, All Saints Dental Group, Rockingham, WA

When I was studying at university, we only had old-fashioned X-ray machines on which to train. Then, when I first graduated, the surgeries where I worked either had the old machines or no X-ray unit at all. When I started at All Saints about 12 months ago, the practice had this digital OPG and it has made a world of difference to the management of my patients.

What’s good about itIt is an invaluable tool for treatment planning when faced with a certain kind of problems. When a patient comes in with periodontal disease, wisdom tooth pain or a neglected dentition, the first thing I do is take an X-ray with this OPG.

It quickly creates a clear image while using a low dose of radiation. The image is viewable by the time the patient has walked back from the machine and into my surgery. It allows them to visualise their problem and the solution while I talk through a treatment plan.

It’s easy to zoom in and out of the image. I can focus on a particular tooth or a particular problem and enhance the image to make the details very clear. It’s such an improvement over the old machines and their small films.

Patients are very impressed by the speed of the OPG and often comment on the clarity of the image.

What’s not so goodI have had no problems with this unit and I like the way the technology is striving to get a result with a lower X-ray dose. One day, hopefully, we will see a cone beam CT that uses the same X-ray dose as an OPG to produce a 3D model of the mouth.

Where did you get itSirona (www.sirona.com.au).

http://www.mintdevices.com.au



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NEWS & EVENTS COVER STORY YOUR BUSINESS YOUR TOOLS YOUR LIFE

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The first telescope I ever owned was a small three-inch reflector. I didn’t know anything about the night sky and I aimed it at what appeared to be a bright star.

When I looked through the telescope and saw Jupiter and four of her moons, I just couldn’t believe it. Later, I was thrilled to see Saturn and her rings. There was a real joy of discovery at those moments that I still feel to this day.

“As my interest in astronomy developed over the years, I kept buying better quality telescopes. I started taking pictures of stars and galaxies and that led to even bigger telescopes until I eventually decided to build myself an observatory. This was 15 years ago when I had just purchased a property in Leura in the Blue Mountains. It’s a great place for an observatory as it’s about 1000 metres above sea level and the sky is very clear with minimal pollution.

“I placed a dome on my observatory and have a fixed telescope inside. Initially, I was taking pictures of stars and galaxies using film photography but I now use digital CCD (charged coupled device) cameras. I also maintain a website with

a complete list of all my discoveries and details of my observations.“After astro-photography, I started looking into different types of

research astronomy. In 2006, I attended a large international conference for the Astronomical Society in Sydney and they encouraged us to become astro-photometrists. It requires you to take a series of images and measure the brightness of an asteroid in reference to a fixed star. If the brightness fluctuates, this means the asteroid is spinning. If a satellite is orbiting the asteroid, the light curve graph will have a small regular dip. It’s an unusual configuration but I have personally discovered four binary asteroids and co-discovered eight others.

“Recently, an asteroid passed very close to Earth and I was directly involved in the discovery that it was a binary. My name was listed on the NASA website which is always very exciting.

“Astronomy is a beautiful art coupled with challenging science requiring precise technical skills. There are also a lot of toys to play with—not unlike dentistry. It’s the thrill of discovery that keeps me going back for more and the basis of my life-long interest.

54 Bite magazine

A life-long love affair with astronomy has seen Dr Julian Oey of Haoey Dental in Sydney’s Potts Point build his own observatory and become a specialist in binary asteroids

Pho

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ey

Stargazer

Recently, Dr Oey was a recipient of a 2015 Shoemaker Near Earth Object research grant. This grant will allow him to upgrade his telescope/camera combination to observe NEOs of much fainter brightness. Visit www.bluemountainsobservatory.com.au.

Silver Coin galaxy.

NGC 2997 spiral galaxy.

Lagoon nebula.

http://www.bluemountainsobservatory.com.au/

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References: 1. Collins LMC, Dawes C. J Dent Res. 1987;66:1300-1302. 2. Xu T, Deshmukh M, Barnes VM, et al. Compend Contin Educ Dent. 2004;25(Suppl 1):46-53. 3. Fine DH, Sreenivasan PK, McKiernan M, et al. J Clin Periodontol. 2012;39:1056-1064. 4. Amornchat C, Kraivaphan P, Triratana T. Mahidol Dent J. 2004;24:103-111. 5. Davies RM, Ellwood RP, Davies GM. J Clin Periodontol. 2004;31:1029-1033.

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bite may 2015

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