Sun smiles all roundThe Carevan Sun Smiles Program makes a big impact in Sydney

Not only are their smiles from the student and staff volunteers, but more importantly, there

are smiles from the children, teachers and parents. As part of a collaboration between the Carevan Sun Smiles Program, Craig Laundry (MP of Reid), and the Faculty of Dentistry at the University of Sydney, Bachelor of Oral Health students will have continuing involvement in this well organised oral health program that has been made available for the first time in Sydney.

The university students and staff, together with the wonderful team at Carevan, had the privilege to work alongside the educational team at Homebush West Primary School (established in 1912).

Both establishments celebrate and embrace cultural diversity, but with 97% of the 500 children being from non-English speaking backgrounds there is no better time to be starting this partnership.

Homebush West Primary School

have opened their arms (and mouths) to this program. The oral health students delivered health messages and nutritional information with the aid of puppets. In addition they performed oral health screening and fluoride varnish applications to 500 children during the months of March and May.

Students at the school were polite, enthusiastic, and asked some fantastic dental questions. However, the fact that many of the children had never attended a dental clinic or had access to dental services, only went to emphasise the need for oral health care in Sydney’s western suburbs. Incredibly, 72% of those screened required a dental referral

due to dental decay, early gum disease, developmental defects or malocclusion.

The university students found the experience to be invaluable in terms of their growth and learning and are lined up to volunteer for the next Carevan Sun Smiles day. One BOH student commented; “It was really fun and I’m so glad we got to see another side of oral health promotion. It makes me even more driven to do what we do. ”

The Sun Smiles Program is an incredible asset to socially disadvantaged school students and, through its provision of services, it is providing substantial support to assist Australia’s National Oral Health Plan 2015-2024 (draft).

I look forward to the continual involvement from The University of Sydney in their support of this worthy, and most imaginative, school dental screening program. nKAREN LANSDOWN BOH MEd, Associate Lecturer, Bachelor of Oral Health, Faculty of Dentistry – Universtity of Sydney

8DHAA Student Support Funding

Background

The DHAA Ltd. is proud to introduce Student Support Funding for student members of the Dental Hygienists’ Association of Australia Ltd.

The objective of this funding is to provide support for oral health students and to promote a team approach to dentistry, inclusive of Dental Hygienists and Oral Health Therapists. It is a great opportunity for the DHAA Ltd to partner with the students members of the Association, and demonstrate their support for those devoting their time to a future career in oral health.

General Information

This finding will be managed by the DHAA Ltd Board of Directors. The application forms are available to be downloaded.

The funding, up to a total value of $5000, will be paid to any recipient for a specified event. Students may apply for a minimum of $250, and a maximum of $5000. The $5000 pool may split between up to five recipients.

A Panel of three (3) Directors will assess each application based on set criteria. The DHAA Ltd. Board has the final say as to the recipients of the grant and no correspondence will be entered into. All information is to be supplied by the due date and no application will be accepted after the closing date of 30 July in any calendar year. Funding for annual events will require another application each calendar year.

Eligibility

A recipient of this funding must be: • An enrolled student in an Accredited Oral Health

Program • A student member of the DHAA Ltd • Affiliated with a student society.

The applications will be assessed on the following basis:

Event details, including benefits of the event to Oral Health students

Promotion opportunities to be provided to the DHAA Appropriateness of the budget Where possible, oral health and dental student

integration at the event The applicants are required to complete the application form, which may be downloaded at www.dhaa.info and send electronically to:

DHAA Ltd Executive Officer – Chris Wain

Email: eo@dhaa.info

Successful Applicant Guidelines Successful recipients will be advised by 30 August. The applicant will give permission for their name and a summary of their application to be recorded on the DHAA Ltd. web site, and provide a report of the event for the DHAA newsletter.

9

I WAS LUCKY enough to be invited to the DHAA Leadership Training day in Melbourne in May this year. Being quite new to the DHAA Bulletin editorial team, this was my first opportunity to meet many of the state presidents and their teams. The DHAA team work tirelessly to advocate for us as members and our dental hygiene industry. The leadership training day focused on a talk from our industry expert Katrina Murphy who is the Managing Director of her consulting firm, Katrina Murphy Industrial Relations Pty Ltd. One of the key membership benefits provided by the DHAA is industrial relations advice, and this training day was focused on Katrina sharing the currently legislative climate, updates to the template contracts and issues being faced by our members.

Did you know that the DHAA have been working since 2009 to ensure the award free status of dental hygienists? The award free status was obtained in late 2009 and the main reason for this campaign was that the minimum award rates were very low, and did not reflect the wages that hygienists were receiving. Being award-free, it is important to ensure you have your working condition clearly outlines in an employment contract. The DHAA has worked with Katrina to develop contract templates; these are available in the

members area of the website. Katrina often gives advice to

employers and has good insight into how employers think about their employees. Although most employers are fair, there are some employers that could be potentially exploiting their workers. For example, you may know or have personally experienced being coerced into becoming a contractor over being a permanent or casual employee? If you have been coerced by your employer, it is simply unlawful.

Another issue that some DHAA members may face is that their practice only wants to pay them for clinical time (only when they are seeing patients). This is a current challenge for DHAA and causing distress for some of our members. Generally speaking, if a patient cancels last minute, or there is a gap in your appointment book, you should still be paid for your time. However, this is not the case for all hygienists. Ultimately it depends on the conditions drawn up in your employment contract. The bottom line is always make sure you have a contract drawn up to clearly state any agreed conditions on accepting the position. If you have any queries you can contact the IR (Industrial Relations) advice line.

The training day also included updates on the DHAA restructure and National

Symposium planning. Following the successful vote in favour of the National Restructure in November last year, a number of states have now voted to amalgamate into the National DHAA, so things are moving along well in this space. The NSW president Nick has confirmed the organisation of the 2015 DHAA national symposium is well underway. This year’s symposium will be held in beautiful Sydney, and a wide range of engaging speakers have been confirmed. Registration is now open so don’t miss out! Follow us on Twitter or Instagram for updates (@DHAANews and dhaainsta).

Being at this leadership day, it really made me proud to have such a great association who strive to support their members in so many ways! The Industrial Relations Training was a great theme – the knowledge we all gained will help us to all provide the best guidance and advice for our members. I would like to thank the DHAA Board for the opportunity to attend.

The DHAA are always looking for

members to contribute to state and

national committees. Would you like

to become more involved with the

DHAA? Send us an email through

the ‘contact’ link on the website.

Aged and Community Care Services Western Australia IncSIMONE MAYNE AND WENDY WRIGHT were invited to speak at the Aged Care Therapies and Wellness Forum on Tuesday

26 May 2015. The presentation given covered the benefits of dental health and a proposed model of care involving dental

hygienists as the team health link in residential settings. This was a valuable opportunity to reinforce important oral health

messages from both the carer and patient view point and promote the dental hygiene profession to this sector.

Fighting your cornerJoanna Mohammadi reports from the DHAA Leadership Training day

12

A number of mechanisms for this relationship have been proposed in the literature, the most notable physiological changes such as increased muscle tension and decreased blood flow to extremities which may exacerbate any existing tissue damage. 6 Further, stress can influence an individuals’ behavioural response to work factors, including altered working behaviours and poorer coping mechanisms. 6

Patient related factors appear to be the greatest source of psychological stress among dentists, with medical emergencies, making mistakes and dissatisfied patients the most commonly reported sources. 4

In the same study, dentists who scored poorly for psychological health were more likely to experience MSD in more than two body regions. Workplace environment factors can also contribute to increased stress; solitary work, increased patient load and increased working hours have been significantly associated with muscle pain in dentists and dental hygienists. 7-9

Job satisfaction appears to play a significant role in the prevalence of MSD among dental hygienists, and this involves factors such as perceived workplace support, involvement in practice decisions, work-life balance and wage satisfaction.

Dental hygienists who felt they were rarely involved in practice decisions were four times more likely to report shoulder pain, and twice as likely to report upper back pain. 10

Dental hygienists identifying that work often interferes with their home life were three times more likely to report neck pain than their counterparts. 10

Similarly, Swedish dental hygienists reporting work and family ‘overload’

reported more neck and upper body pain. 11 Satisfaction with wages has

demonstrated a protective effect, with dental hygienists who are satisfied with their wage reporting significantly less upper back pain than those not satisfied. 10

Dental and oral health students also appear to be suffering MSD at alarming rates, with the pressures associated with tertiary education a notable contributing factor. 12 While students often don’t have the same scheduling stressors as practising clinicians, they experience stress related to heavy course loads and working without an assistant . 13

Strategies for addressing the problem may include reviewing patient scheduling to ensure adequate time

is scheduled per procedure, and also rotation through various tasks where possible. Promoting a stress free work environment by having policies and procedures in place to effectively deal with conflict and workplace issues, and encouraging collegial networks where all team members have to opportunity to contribute to management decisions may be beneficial. 14 Of course, we must remember the multi-factorial aetiology of MSD, and therefore address ergonomic factors; using loupes and undertaking ergonomics training and regular exercise have demonstrated effectiveness . 10 n

Melanie Hayes is a Lecturer at the University of Melbourne. She was awarded her PhD in 2013, and her doctoral thesis was on the topic of MSD among the dental hygiene profession. She continues to research, publish and present on this topic nationally and internationally.

“ Dental and oral health students also appear to be suffering MSD at alarming rates, with the pressures associated with tertiary education a notable contributing factor.

References:1. Leggat PA, Smith DR. Musculoskeletal disorders self-reported by dentists in Queensland, Australia. Aust Dent J. 2006; 51(4):324-3272. Marshall ED, Duncombe LM, Robinson RQ, Kilbreath SL. Musculoskeletal symptoms in New South Wales dentists. Aust Dent J. 1997; 42(4):240-246.3. Hayes MJ, Taylor JA, Smith DR. Prevalence and symptom severity of musculoskeletal disorders among dental hygienists. BMC Research Notes. 2013; 6: 250. 4. PalliserCR, Firth HM, Feyer AM, Paulin SM. Musculoskeletal discomfort and work-related stress in New Zealand dentists. Work & Stress. 2005; 19(4): 351-359.5. Bongers PM, Kremer AM, ter Laak J. Are psychosocial factors risk factors for symptoms and signs of the shoulder, elbow, or hand/wrist?: A review of the epidemiological literature. American Journal of Industrial Medicine. 2002;41(5):315-42.6. Carayon P, Smith MJ, Haims MC.Work organization, job stress, and work-related musculoskeletal disorders. Human Factors. 1999; 41(4): 644-663.7. Chowanadisai S, Kukiattrakoon B, Yapong B, Kedjarune U, Leggat PA. Occupational health problems of dentists in southern Thailand. International Dental Journal. 2000;50:36-40.8. Shenkar O, Mann J, Shevach A, Ever-Hadani P, Weiss P. Prevalence and risk factors of upper extremity cumulative trauma disorder in dental hygienists. Work. 1998;11(3):263-75.9. Ylipaa V, Arnetz BB, Benko SS, Ryden H. Physical and psychosocial work environments among Swedish dental hygienists: risk indicators for musculoskeletal complaints. Swed Dent J. 1997;21(3):111-20.10. Hayes MJ, Taylor JA, Smith DR. Predictors of work-related musculoskeletal disorders among dental hygienists. Int J Dent Hyg. 2012; 10(4):265-269.11. Ylipaa V, Arnetz BB, Preber H. Predictors of good general health, well-being, and musculoskeletal disorders in Swedish dental hygienists. Acta Odontol Scand. 1999;57(5):277-82.12. Hayes MJ, Smith DR, Cockrell D. Prevalence and correlates of musculoskeletal disorders among Australian dental hygiene students. Int J Dent Hyg. 2009;7(3):176-8113. Thornton LJ, Stuart-Buttle C, Wyszynski TC, Wilson ER. Physical and psychosocial stress exposures in US dental schools: the need for expanded ergonomics training. Appl ergon. 2004; 35(2), 153-157.14. Menzel, NN. Psychosocial factors in musculoskeletal disorders. Critical care nursing clinics of North America. 2007; 19(2), 145-153.

14

Whether you work for a high pressure dental company, or a relaxed family dental practice,

patients or work-place situations can easily overwhelm the unwary hygienist.

Here we present and discuss some of the major contributing factors that you should keep an eye on to avoid stress.

1 PerfectionismAlthough we may joke that some hygienists are a little “obsessive compulsive”. The desire to clean each mouth perfectly, with minimal discomfort within a certain time frame can become exhausting.

2 Time managementWorking in a dental practice you are always working against the clock, from the moment your first patient sits in the chair, until your last patient walks out the door. Many of us just don’t realise how stress this can place on an individual over time.

3 Income and job securityYou may want a permanent part-time position but your workplace is only offering a casual or contracted position. What do you do? We all have bills and expenses to pay and only working for half a day because your afternoon of patients has cancelled can cause stress if it occurs repeatedly.

4 Meeting sales targetsAs health professionals, it is our role to present a patient the options available for treatment and then it is up to them to make an informed decision based our advice. However, in some dental hygiene roles the need to force decisions to meet sales targets can pose ethical dilemmas.

5 Work colleaguesAlthough we may get along with each other at work, sometimes tensions can arise between colleagues. Even if you are not directly affected you may become embroiled in gossip about another colleague. Do you take sides?

KEY CAUSES OF

STRESS6 Joanna Mohammadi tells us the ways in which stress can manifest itself in the hygienist workplace

15

6 Fears of indemnity claimsMost hygienists communicate well with their patients, and as a result we are less likely to receive an indemnity claim. However, what happens if for example, you conducted several periodontal debridement sessions on a patient and their pocketing and inflammation didn’t improve. As a result, the patient went to see a specialist periodontist where they have to pay again for treatment. The patient then comes back to your surgery upset as they have had to pay for treatment at both surgeries. How do you handle this situation?

Protect yourself from workplace stress? BE OPEN AND up-front with both your colleagues and your patients. If there is

something bothering you, rather than gossiping to co-workers, try and think of

an action plan to resolve the issue. If the solution is beyond you then speak to the

practice manager or owner.

The same principle applies when working with patients. For example, if a patient

has heavy tenacious calculus build up and you are restricted for time, explain that

to remove it all may require them to come back for a subsequent clean.

It is important to remember that as hygienists we have an intense job but we are

lucky to have the ability to meet people from all walks of life and develop a positive

rapport with them. On the whole we have good pay and work conditions with

flexibility in how much or how little we want to work.

The ultimate satisfaction that we can draw from being a dental hygienist is that,

at the end of the day, we know we have made a difference to a patient’s oral health

and this can be very rewarding.

The DHAA can offer invaluable support to it’s members so if you have a

workplace dilemma or suggestion then why not email your question through to

the editor- bulletin@dhaa.info n

16

It is well a well established fact that dentistry is a stressful occupation. Dental practitioners experience psychological demands related to the management of

patients, time scheduling and workplace support. As dental professionals, it is important that we are able

to recognise the signs and symptoms of pressure affecting mental health – not only in our colleagues but ourselves. We also need to understand where we can get help.

The following list is just some of the more common signs and symptoms of depression and anxiety.

DepressionMany of us can feel sad, moody or low from time to time but some people experience these feelings strongly for a long time, this is known as depression. Depression is a serious illness that has an impact on both physical and mental health. It’s not known what exactly causes depression but it is generally a combination of events coupled with personal factors, rather than the result of a single event.

Signs and symptoms of depressionPeople with depression may experience some of the following; – not going out anymore;– withdrawing from close family and friends;– feelings of being overwhelmed, frustrated, and

miserable;– thoughts such as ‘I’m a failure’; ‘It’s my fault’; or ‘People

would be better off without me’;– feeling constantly tired;– sick and run down;– displaying signs of significant weight loss or gain

AnxietyWhile many of us experience stress and anxious feelings in response to a situation where a person feels under pressure, it usually passes once the stressful situation has passed. Anxiety is when these anxious feelings don’t subside. Anxiety is when these feelings are continuous

Depression and anxiety - what you need to know: TRUE BLUE

Yvonne Flaskas tells us how to identify the key indicators of depression and anxiety in the hygiene workplace

17

and without any particular reason or cause. It’s a serious condition that makes it hard for a person to cope with daily life.

Signs and symptoms of anxietyGiven that we all experience some anxiety, it can be hard to know how much is too much. In order to be diagnosed with anxiety, the condition must have a disabling impact on the person’s life. There are many types of anxiety, and there are a range of symptoms for each, such as;– hot and cold flushes;– racing heart;– tightening of the chest;– snowballing worries;– obsessive thinking and compulsive behaviour.

The encouraging news is that there is a range of treatments, health professionals and services available to help people with depression or anxiety.

One very good source of information on the subject is the BeyondBlue website (beyondblue.org.au), with many resources for individuals concerned that they may be experiencing depression or anxiety and information on how to access support services.

Other resources on the website include information for people who care for someone who is suffering from depression or anxiety and a series of free online resources to raise awareness of depression and anxiety in the workplace, and provide practical strategies to support individuals and promote mental health in the workplace.

If you are concerned that you may be experiencing depression or anxiety we recommend that you contact your GP, visit the BeyondBlue website or call beyondblue on 1300 22 4636. n

Reference:Beyond Blue, The Facts. [Internet] 2015 [updated 2015; cited 2015 June 4]; Available from: https://www.beyondblue.org.au/the-facts

18

Mental Health – What are My Workplace Rights?

“...I eat morons like you for breakfast. You’re gonna be crying before this is over.”

Judge Judy’s feisty saying may or may not be wryly amusing as part of a popular American reality TV show. But if the owner or practice manager said something like this to a dental hygienist, oral health therapist or indeed any employee or contractor in the workplace, it would be unlawful. Even if the owner or practice manager claimed they were joking.

While the law can never be perfect, Australian workers have robust rights in the workforce protecting them from bullying, harassment and unlawful discrimination including on the basis of a mental health condition. They also have rights to seek workers compensation if unreasonable management action results in or exacerbates a mental health condition such as anxiety.

The problem is that many employers still do not understand the law. They assume wrongly that ridicule and harassment in a work place is acceptable if it is a “joke” or if the victim is, was or might have been a “friend” of the perpetrator. Many employers avoid taking steps to provide expert training to their employees, managers and owners in the legal requirements of discrimination, harassment, bullying and victimisation, because they fear this will “open the floodgates” and they will be deluged with unmanageable complaints. So they do not take necessary preventative action - and make a serious mistake.

All employers, big or small, are vicariously liable for the actions of their employees and for the provision of a workplace that is free of harassment, discrimination, bullying and victimisation. This means that all employers should have an adequate policy and procedure on harassment, discrimination, bullying and victimization and have provided appropriate training in these areas to all employees and managers. Such training is a fundamental defense requirement for all complaints about employers to anti-discrimination Commissions and Tribunals in all States and Territories of Australia. But the facts are that most employers in the dental industry (like most industries) do not provide such training. At best, some may have a policy and/or procedure on discrimination

and harassment (often called an “Equal Employment Opportunity Policy) and mention sexual harassment briefly in their induction process. This is not enough.

All employers should have a grievance procedure which is well known to employees which describes plainly what

an employee should do (and what the employer will do) if they have a concern or complaint about a matter that relates to harassment, discrimination or bullying. If an employee has serious concerns about adverse consequences to them of utilising that procedure (e.g. concerns of victimisation or intimidation) they may go directly to the Anti-Discrimination Tribunal in their State or Territory for advice as to how to deal with the matter or to lodge a formal complaint. DHAA members can also contact the IR Advice Line (accessible on the DHAA website) for preliminary advice and guidance on options.

Fair Work Commission will also accept applications to deal with bullying in the workplace but only if the employee is still working for the employer and the bullying is on-going. No compensation

is awarded, but Fair Work can make orders that relate to how the situation is to be managed by the employer.

Via an adverse action claim, Fair Work Commission has the ability to

“ I eat morons like you for breakfast you’re gonna be crying before this is over. ”

Judge Judy’s feisty saying may or may not be wryly amusing as part of a popular American reality TV show. But if the owner or practice manager said something like this to a dental hygienist, oral health therapist or indeed any employee or contractor in the workplace, it would be unlawful. Even if the owner or practice manager claimed they were joking.

While the law can never be perfect, Australian workers have robust rights in the workforce protecting them from bullying, harassment and unlawful discrimination including on the basis of a mental health condition. They also have rights to seek workers compensation if unreasonable management action results in or exacerbates a mental health condition such as anxiety.

MENTAL HEALTH WHAT ARE MY WORKPLACE RIGHTS?

Katrina Murphy separates your rights from others’ wrongs

19

award compensation if an employee has been treated adversely because of unlawful discrimination e.g. denied employment because of a belief that the employee suffered from a mental health condition. Such applications to Fair Work Commission, known as general protections or adverse action claims, are complex and usually require expert advice.

Workers compensation laws as they related to mental health conditions vary significantly across Australia. One consistent provision is that a mental health condition such as anxiety, if caused or exacerbated by reasonable management action (such as properly run and just disciplinary action) will not be compensable. Calling someone a “moron” or threatening to “eat them for breakfast” is never going to be deemed reasonable management action.

Distress and anxiety can be caused by employers who persist

in paying employees

incorrectly (or not at all) even

after the matter has been raised with them formally in

writing. Correct pay is a fundamental requirement

and employers must get it right. Complaints

to Fair Work Ombudsman about underpayment require detailed evidence (e.g. all relevant pay slips and time records) to support them, but can result in full back pay to the employee

and penalties to the employer. Fair Work Ombudsman cases generally result in an investigation of the employer’s time and wage records. Once the initial complaint has been lodged by the employee, the Fair Work Ombudsman looks after the case from there and conducts all necessary investigations and assessment, so there is no need for the employee to attend a conciliation, conference or arbitration.

If you have queries on issues raised in this article as to how they apply to you, please do not hesitate to contact IR advice line.

Katrina Murphy

The problem is that many employers still do not understand the law. They assume wrongly that ridicule and harassment in a work place is acceptable if it is a “joke” or if the victim is, was or might have been a “friend” of the perpetrator. They avoid taking steps to provide expert training to their employees, managers and owners in the legal requirements of discrimination, harassment, bullying and victimisation, because they fear this will “open the floodgates” and they will be deluged with unmanageable complaints. So they do not take necessary preventative action - and make a serious mistake.

All employers, big or small, are vicariously liable for the actions of their employees and for the provision of a workplace that is free of harassment, discrimination, bullying and victimisation. This means that all employers should have an adequate policy and procedure on harassment, discrimination, bullying and victimization and have provided appropriate training in these areas to all employees and managers. Such training is a fundamental defense requirement for all complaints about employers to anti-discrimination Commissions and Tribunals in all States and Territories of Australia. But the facts are that most employers in the dental industry (like most industries) do not provide such training. At best, some may have a policy and/or

procedure on discrimination and harassment (often called an “Equal

Employment Opportunity Policy) and mention sexual harassment briefly in their induction process. This is not enough.

All employers should have a grievance procedure which is

well known to employees which describes plainly what an employee

should do (and what the employer will do) if they have a concern or complaint

about a matter that relates to harassment, discrimination or bullying. If an employee has

serious concerns about adverse consequences to them of utilising that procedure (e.g. concerns

of victimisation or intimidation) they may go directly to the Anti-Discrimination Tribunal in

their State or Territory for advice as to how to deal with the matter or to lodge a formal complaint. DHAA members can also contact the IR Advice Line (accessible on the DHAA website) for preliminary advice and guidance on options.

Fair Work Commission will also accept applications

to deal with bullying in the workplace but only if the employee is still working for the employer and the bullying is on-going. No compensation is awarded, but Fair Work can make orders that relate to how the situation is to be managed by the employer.

Via an adverse action claim, Fair Work Commission has the ability to award compensation if an employee has been treated adversely because of unlawful discrimination e.g. denied employment because of a belief that the employee suffered from a mental health condition. Such applications to Fair Work Commission, known as general protections or adverse action claims, are complex and usually require expert advice.

Workers compensation laws as they related to mental health conditions vary significantly across Australia. One consistent provision is that a mental health condition such as anxiety, if caused

or exacerbated by reasonable management action (such as properly run and just disciplinary action) will not be compensable. Calling someone a “moron” or threatening to “eat them for breakfast” is never going to be deemed reasonable management action.

Distress and anxiety can be caused by employers who persist in paying employees incorrectly (or not at all) even after the matter has been raised with them formally in writing. Correct pay is a fundamental requirement and employers must get it right. Complaints to Fair Work Ombudsman about underpayment require detailed evidence (e.g. all relevant pay slips and time records) to support them, but can result in full back pay to the employee and penalties to the employer. Fair Work Ombudsman cases generally result in an investigation of the employer’s time and wage records. Once the initial complaint has been lodged by the employee, the Fair Work Ombudsman looks after the case from there and conducts all necessary investigations and assessment, so there is no need for the employee to attend a conciliation, conference or arbitration.

If you have queries on issues raised in this article as to how they apply to you, please do not hesitate to contact IR advice line. n

“ Many employers assume wrongly with that ridicule and harassment in a work place is acceptable if it is a “joke” or if the victim is, was or might have been a “friend” of the perpetrator.”

20

T here is little doubt we desperately need dental practitioners in aged care and as a follow up to

the last Bulletin issues feature ‘Aged care the great debate’ it seems prudent to refresh ethical and legal obligations the context dental service provision with in aged care regarding informed consent. This article does not provide an exhaustive list of Commonwealth and State legislation however, the aim of this article is refresh our memories and become more encourage you to become more knowledgeable about the legislative frameworks which support dental service provision and provide protection of patient’s basic rights and safety working in aged care facilities.

Ethically, informed consent facilitates consumer autonomy and exercise of individual moral rights Dental Practitioners are required to recognise legal and ethical responsibilities to the public and the profession and be compliant with commonwealth and state legislations in the workplace. It is therefore pertinent to discuss common law, legislation and delegated legislation relevant to the provision of dental services in aged care facilities.

A very elementary description of common law is decisions that have been made through the courts and legislation includes regulations which

have been made by parliament, either Commonwealth, State or Territory Delegated legislation describes the ‘Rules’ of the legislation, rules can be amended without parliamentary debate. Legislation prevails over common law and commonwealth legislation prevails over State legislation

Informed consent in the legal application exercises the consumer’s right to accept or refuse dental treatment after receiving information about the proposed treatment in a manner that enables patients to understand before patients enter into an agreement to reject or accept the proposed treatment Informed consent has three fundamental components.

1 Consent must be voluntary and be free from any duress or influence of drugs and sedatives.

2 Consent should be specific. 3 Consent should be obtained from

a ‘competent’ person.

In 2011 there were an estimated 185,000 elderly Australian living in residential facilities and it was estimated that 52% suffered from dementia (ABS) Dental practitioners working in aged care or with the elderly may be in the position where patients have impaired decision making abilities, temporary or permanent incapacities such as patients suffering dementia, unconsciousness, medication affecting decision making capacity or permanent incapacity as experienced with chronic dementia Alzheimer’s disease or mental illness

Dental practitioners are required to be familiar with relevant commonwealth and state legislation pertaining to informed consent and relevant

state legislation pertinent to dental practitioners working in aged care facilities and comply with the Codes of conduct and guidelines established and outlined such as The Dental Board of Australia, which provide clear and specific codes of practice pertaining to informed consent and patients with specific impairment to their decision making capacity. dentalboard.gov.au

Resources for dementia suffers and capacity tool kits may be accessed at capacityaustralia.org.au and www.diversityservices.justice.nsw.gov.au.

Dental practitioners working in aged care facilities in New South Wales should also be aware of the common law and statutory legislation relevant to the workplace. Dental practitioners must satisfy AHPRA registration standards as prescribed in the Scope of Practice Standard (DBA 2014) and dental hygienists and oral health therapists and dental therapists must have a ‘structured working relationship with a dentist.’ www.dentalboard.gov.au/...Standards/Scope-of-practice-registration-stan..

Structured working relationship documents can be found at dhaa.info

Patient AutonomyThe ethical principle of autonomy relates the right to make your own choices with regard to your body and for this purpose we will discuss dental health care . The practical application of this autonomy would stipulate a dental practitioner has a duty of care to respect patient rights.

Dental Practitioners working with all patients and inclusive of patients within aged care should and be aware of, and considerate of their patients’ health care rights as prescribed in the Charter

REFRESHING KNOWLEDGEHellen Checker lends very helpful hand to anyone wanting to understand the legal side of our world

21

of Australian Health Care Rights, The New South Wales Patient Health Charter and the Charter of Residents Rights and Responsibilities. resicaremanual.health.gov.au

Commonwealth LegislationRelevant commonwealth law in the provision of dental services to the elderly in care includes the Aged Care Act 1997, the Australian Aged Care Quality Agency Act 2013, Health Insurance Act 1973 which includes the Health Insurance (Dental Services) Dental Benefits Amendment Bill 2014, a delegated legislation providing a legislative framework for commonwealth administrated dental schemes. Veterans’ Entitlements Act 1986.

State LegislationState legislated Acts relevant in the provision of health services to the elderly in care in the NSW Health Service, hospitals, community centres or dental schools (NSW Policy

Directive) may include the Guardianship Act 1987, which identifies the statutory need for consent, and identifies who may give consent when there is a recognised incapacity to give consent. Your State Health Services will have specific policy directive on consent and the Guardianship ACT 1987 may differ in your state jurisdiction.

The Guardianship Act 2005 defines what treatment is considered as major dental treatment and specifies the requirements for written consent. clinicalethics.info/consent/advance-care-directives.

The Mental Health Act 2007 legislates for non- consensual services for patients who have been diagnosed as suffering mental illness whilst other relevant legislation includes the Health Records and Privacy Act 2002, Health Records and

Information Privacy Regulation 2012, Poisons and Therapeutic Goods Act 1966, Poisons and Therapeutic Goods Regulation 2008, and the Civil Liability Act 2002 which identifies accepted standards of care.

Standard of Care Failure of the dental practitioner to gain informed consent has implications under substantive law. Dental practitioners failing to provide an adequate standard of care may be subject to civil law in the form of tort law which may include negligence or be subject to prosecution in the criminal law courts on a charge of

assault and battery. The determination of

the court may establish a breach of duty of care.

Breach of duty of care may be influenced by the identification and definition of a reasonable

standard of care The Civil Liability Act 2002

REFRESHING KNOWLEDGE

23

which identifies accepted standards of care. Courts in New South Wales may consider the New South Wales Health Care Service policy directive regarding directives for informed consent as a reasonable standard of care health.nsw.gov.au

Making a complaintAccording to the Health Complaints Commission report 2013-14 in NSW forty four percent of complaints lodged concerning dental practitioners were complaints about dental treatment. Approximately eleven percent of complaints were related to communication and information and ten percent of complaints were regarding fees for service. Complaints in regard to informed consent constituted two percent of complaints concerning dental practitioners to the Health Care Complaints Commission Complaints received by AHPRA in Australia come from many sources and may be voluntary notifications those made by individuals with complaints about a practitioners performance (AHPRA 2014) In most states, complaints regarding dental practitioners are administrated via AHPRA follow AHPRA pathways.

In New South Wales voluntary and mandatory complaints are made to the Health Care Complaint Commission which is legislated by the Health Care and Complaints Act 1993 . The Health Practitioner Regulation National Law mandates by law the reporting of behaviour which include but not exclusive of, placing the public at risk of substantial harm because of an impairment (health issue), placing the public at risk because of a significant departure from accepted professional standards. (APHRA 2014) The Dental

Council of NSW hears complaints about dental practitioners and students employed in NSW however the Health Care Complaints Commission act as ‘ independent investigators and prosecutor of complaints’ (Dental Council NSW) The Dental Tribunal of New South Wales was abolished in January 2014 and the New South Wales Civil and Administrative Tribunal (NCAT) was enacted the role of the former Dental Tribunal of NSW Hearings and decisions made by the tribunal can be accessed at New South Wales Civil and Administrative Tribunal.

Negligent Action in Law In an extremely useful and very readable Australian law textbook ‘Health Care and Law’ authored by Janine McIlwraith and Bill Madden 2014 6th edition, McIlwraith describes the three main components of a negligent action which must be proved by the claimant or plaintiff In the dental care context might be explained as;

The plaintiff must show the dental practitioner/health care worker owes a duty of care to the patient.

The plaintiff must show dental practitioner/health care worker has breached that duty of care through some act or omission. The plaintiff must show the act of omission caused the patient mental or financial harm

The plaintiff must also prove that the breach of duty of care actually caused the damages claimed.

This is known as causation and

foreseeability refers to plaintiffs responsibility to prove that a reasonable person may have foreseen the risks of a careless action

It is clear that informed consent is both and ethical legal obligation of dental practitioner working in the New South Wales Health Service and as a registered dental practitioner working in aged care or any other area of health.

Voluntary and mandatory complaints are made to APHRA however in NSW In the State of NSW a mechanism for dental complaints is administrated via the Health Care Complaints Commission legislated via the Health Care Complaints Act 1993 and hearings and decisions are made by the New South Wales Civil and Administrative Tribunal however the aim of the article was to encourage dental hygienists, oral health therapists and dental therapists to refresh your ethical and knowledge of the law and recognised relevant legislation pertaining to your work environment particularly in the domain of aged care. The text ‘Health care and Law’ comes highly recommend and will help practitioners understand the law in health care. n

Referencesi, 3 Consumers Health Forum of Australia 2013 ‘Informed consent in healthcare: an issue paper’ page one viewed 13th March 2015 https://www.chf.org.au/informed-consent-project.php 2, 4 , 5 ,7, 8, 11, McIlwraith, J Madden, B 2014 ‘ Health care and the law’ 6th edition Lawbook Co.Thomson Reuters The Clinical Ethics Resources viewed 18th March clinicalethics.info/consent/advance-care-directivesNew South Wales Government Health 2005 Policy directive ‘Consent to medical treatment – patient information’ Document number PD 2006-406 viewed 15th march 2015 www0.health.nsw.gov.au/policies/PD/2005/pdf/PD2005_406.pdfNew South Wales Health Care Commission Annual report 2013-14 viewed 16th March 2015 www.hccc.nsw.gov.au › Publications › Annual reports p.24

“ In 2011 there were an estimated 185,000 elderly Australian living in residential facilities and it was estimated that 52% suffered from dementia.”

STATE NATIONROLL UP, ROLL UP! The ‘Circus Extravaganza’ is coming to The Star, Darling Harbour Sydney this November 2015! Dress up in your Circus Carnival for the National Symposium Gala Dinner! The NSW Team have been working hard preparing for the highlight of the year, the 13th National Symposium of the DHAA on November 5-7. Invite your colleagues along and register now for the Sunrise and Early Bird Registrations at sydneysymposium.com.

‘Under One Umbrella’ will feature three international hygienists among a diverse range of speakers.

• 19 hours of CPD (scientific) program

• Optional half-day workshops available on first day

• An event for the entire dental team!

• Opportunities to seek the latest products at trade exhibition!

Social events will include a welcome reception, ‘Circus Extravaganza’ Gala Dinner, and a Harbour Bridge climb for the brave!

To our NSW Branch members thank you for your support and patience with questions and comments about planning for the National Symposium. As of

this writing 84 delegates have already registered for the Sunrise Registration, 48% of sponsorship has been confirmed. We will have a General Meeting as soon as we can to update members on the process so far with amalgamation with an opportunity for a vote to go ahead.

On another note, on the 10 March, The University of Sydney BOH Students and Cathryn Carboon from Carevan Foundation partnered with Federal Member for Reid Craig Laundy MP in launching the Sun Smiles Project at Homebush West Public School. This is an example of collaborations between the profession, local government

and the community at large. Volunteers are required; contact the branch to see how you can be involved.

The Colgate Oral Health Promotion Conference on the 19 March in Sydney was an opportunity to learn about the different OHP programs happening around the country and overseas. Guest key note speaker Professor Mark Wolff Associate Dean of New York University College of Dentistry described the challenges for OHP, making it locally sustainable, cost-effective with long term solutions and not just treatment, a trait of the skills oral health practitioners should have!

Ian R. EpondulanDHAA Ltd. NSW Director

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

“ The Colgate Oral Health Promotion Conference in Sydney was an opportunity to learn about the different OHP programs happening around the country and overseas.”

New South Wales

WEBSITE

dhaansw.org.au >

CONTACT

0411 473 762

The Carevan Foundation visited the University of Sydney

25

QLD University NewsWe welcome our CQU BOH students to DHAA Ltd. Membership. Committee member Karen Smart did a small presentation to students on the benefits of being a DHAA Ltd. member and presented our newest students with a small gift.

The Central Queensland University BOH program has received accreditation until 2020 and we congratulate Leonie Short on all her hard work to achieve this.

Congratulations to Nicole Cockburn the DHAAQ 2014 UQ BOH prize recipient. Nicole received the highest mark in Advanced Oral Health Therapy II in the BOral Health Program. The UQ School of Dentistry Student Prize Night was held on Thursday 21 May and was attended by both myself and DHAAQ Inc. Vice President Debbie Holiday.

Homeless ConnectDHAAQ members worked with UQ BOH and dentistry

students at Our Homeless Connect at Eagle Farm Race course. This event is organised by the Brisbane city council to support the public who are homeless .

This year we developed a risk assessment that the UQ students used to engage the public on their Oral Health. Whether it was Oral Hygiene advice or referral to the hospital – a huge success.

Thanks Tiana Romeo , Eliza Burroughs , Amanda Nietvelt, UQ BOH and dentistry students who worked tirelessly on the day and were the contributing factor to our success at the event.

Keep an eye out for more information on Homeless Connect as we look to support this event in November later this year. We can always do with more volunteers especially as students will be in exams and are unavailable. It is a great way to support those in need, however small your contribution.

Oral Health MonthDHAAQ is running a completion for members for Oral Health Month this year. We are encouraging members to utilise our Child Care tool boxes and promoting good oral hygiene with our littlest Queenslanders, at the same time as raising the profile of our profession. Members can take photos of their events, send them into the DHAAQ Committee – the winner will receive a Norbit puppet and free admittance to our half day seminar on October 24.

DHAAQ SeminarsEveryone is welcome to attend Annual Hygiene Horizons at the Gold Coast Convention Centre on 25 July. The theme is” Engagement” Engaging members, Allied Health Professionals and the community. Speakers will include Prof Marc Tennant, Jayne Braunsteiner, Fleur Cross from Diabetes Queensland and Stacey Bracksley-O’Grady.

We look forward to catching up with all our friends on the beautiful Gold Coast. Why not join us?

Don’t forget to keep 24 Oct 2015 free for our Half Day Seminar in Brisbane with guest speaker Ron Knevel.

Robbern WhiteDHAAQ President

“ Keep an eye out for more information on Homeless Connect as we look to support this event in November later this year. We can always do with more volunteers.”

Queensland

WEBSITE

dentalhygienist.com.au >

CONTACT

Email Queensland >

We welcome the CQU BOH students to the DHAA Ltd

27

VICTORIA HAS JOINED recently joined the ranks of state branches that are winding up and ceasing to operate. At our half-day CPD event on Saturday 16 May, DHAAVB held a Special General Meeting to allow members to vote on the special resolution for our professional association to become a single entity and for the Victorian branch to voluntarily cancel our association. I am delighted to say that the vote was unanimously in favour of the special resolution and that DHAAVB is now going through the necessary steps to cease operation. We will provide progress updates to our members via email.

Our CPD coordinators have been busy again this year, ensuring that our members have the opportunity to attend low-cost, high-quality events. Our April dinner meeting was a great success and Dr Suman Bellur brought us all up to date on the diagnosis and management of gingival enlargement.

Our event on Saturday 16 May was very well attended

and was free to DHAA members.

We were very fortunate to have such great speakers, Dr Patrishia Bordar whose presented on ‘Contemporary Oral and Maxillofacial Surgery’ and our very own Dr Melanie Hayes (President DHAA Ltd.), whose topic was ‘Debunking the Myths about Oral Health and Nutrition’.

Our next event is scheduled for the 25 July and has been planned in conjunction with DPL, to offer a full-day of CPD for our members. DPL will host their ‘Gob Smacked’ session in the morning and we will host the afternoon (followed by drinks and canapes). This promises to be another enjoyable (and educational) event, with an incredible line up of presenters; Adj/Prof Hanny Calache; A/Prof Rodrigo Marino and Ms Meloshini Naicker. Invitations have already been emailed, so if you have not received yours yet please contact cpd@dhaavb.asn.au so we can make sure you don’t miss out!

Roisin McGrathPresident - DHAAVB

“ The vote was unanimously in favour of the special resolution and that DHAAVB is now going through the necessary steps to cease operation.”

Victoria

WEBSITE

dhaavb.com.au >

CONTACT

0418 336 119

the DHAA. The session also provided information on the rights and entitlements of employees, structuring an employment contract and developing a professional relationship agreement. Other interesting topics included breaches of privacy and conflicts of interest.

Dr Michael Malandris presented at our March Supper Meeting on paediatric dentistry. Some of his key points reminded us on the importance of effective and clear communication with our patients, especially our younger ones, and he also gave us some relevant clinical information on products and dosages which should be varied depending on the body weight of the patient.

World Oral Health Day was also in March and through Facebook we ran a campaign on “Smiles for life”. Members posted photos of what this means to them, and the lucky winner Tamara won a power toothbrush which was generously donated by TAFESA.

We look forward to the upcoming changes to our association and the ongoing support of our SA based members.

Ali Taylor National Councillor, DHAA (SA Branch) Inc

“ The WA Committee was recently presented with a lovely new uniform, provided generously by DPL. A heartfelt thank you to DPL for their ongoing support.”

2015 IS PASSING by at lightening speed, so much has happened at a State and National level, it is almost hard to keep up!

By now, you should have received your 2015 DHAA WA Membership pack, which included a CPD record list, a smart folder, a nail file, and a shiny new magnetised name badge – especially useful at CPD events so we can all put a name to the face!

If you have not yet renewed your membership for the year, you will need to log in to the national website in order to re-subscribe, and access the benefits that belonging to a supportive association brings. With the plethora of “free” online CPD opportunities, we still recommend attending some events in person – in this “digital everything” age, it is very easy to become professionally isolated. There are many people in the

association who are happy to lend a listening ear, or provide advice on a number of difficult topics – please talk with us!

Congratulations to Samantha El Tawil who graduated from the Curtin University Bachelor in Science – Oral Health Therapy, and was awarded the DHAA WA prize for the most improved student. Samantha, we wish you well in your future endeavors as an Oral Health Therapist.

The WA Committee was recently presented with a lovely new uniform, provided generously by DPL. A heartfelt thank you to DPL for their ongoing support.

In April, we hosted Dr Patrick Shanahan and Professor Marc Tennant, who presented an inspiring outlook on “The Future of Dental Hygiene”. We discussed many of the challenges that face Australia’s ageing population, and explored the possibilities of how preventive oral health care may be utilized in the future, to help ease the burden on a strained public health system. A broad, and

often challenging topic, that is definitely food for thought.

We will host a meeting in July, to discuss the possibility of joining in to the national restructure of the DHAA. You will receive a notification of the meeting via email in the coming month.

We have some very interesting CPD topics lined up for the remainder of the year:

DHAA WA AGM and Wellness day, including a yoga session, talks on meditation and nutrition, and a lovely healthy breakfast (more TBC) – Sunday 9 August

Dental Photography, Dr Graham Carmichael – Thurs 3rd September

OPG Interpretation, Dr Bernard Koong, Wednesday 14 Oct (Date TBC)

“The Ins and Outs of Thumbsucking” – Saturday 24 October

Please keep up to date with the events listed on our website (dhaawa.com) and contact us if you have any questions, issues or suggestions for future CPD.

Natasha HuntWA President

Western Australia

WEBSITE

dhaawa.com >

CONTACT

0449 910 455

Smart new shirts for the WA Committee

Issue 35 June-July 2015

STATE OF THE NATION A round-up of what’s happening near you

The official newsletter of the Dental Hygienists’ Association of Australia Ltd

DEPRESSION & ANXIETY What you need to know to combat this common issue

TAKING THE STRAIN The effects of stress on musculoskeletal pain

Develop

Empower

Support

STRIVING FOR EXCELLENCEwww.dhaa.info