bite august 2011

1 Bite

BiteBetter Business for dentists

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Women’sworldis a specialist women’s group like the victorian Women dentists’ Association still relevant in modern dentistry? dr Anne stewart and others explain why it is

Chaos at AHPRA Were the issues with the

changeover to national accreditation just teething

problems, or more system?

Image problems The world of CBCT scanning has been rocked by a minor

bureaucratic change. Find out how, page 26

SPECIAL REPORT:Everything you need

to know about the latest and greatest handpieces on the

market, starting on page 34

Heavy metal What’s driving the latest flare-

up in the debate about the safety of dental amalgam?

Asleep at the wheel The problem with the lack

of a uniform approach to sleep apnea. Page 23

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Bite 3

News & events05. Growing teethOne mouse has given a kidney to change the world of oral health, by letting Japanese scientists grow a tooth in it. ALSO THIS MONTH: The ADA is urging consumers to check their dental prostheses; why people should blame their others for their poor oral health; research proves a link between obesity and poor oral health; and much more …

What women wantAs more women become dentists, the Victorian Women Dentists’ Association is seeing its membership dwindle. Does a women-only group have a place in modern dentistry?

18Cover story

Features

Your world14. Things fall apart

Was the chaotic switchover to national accreditation a

result of teething problems, or more systemic failure?

Your business23. Asleep on the job

Dentists are finding themselves on the frontline

of dealing with sleep apnea, but a lack of

uniform approach is posing problems for both patients

and practitioners

26. Image problemsThe minor change of a

Medicare provider number has generated intrigue and a stream of off-the-record

commentary in the world of CBCT scanning

30. Heavy metalThe debate over whether or not dental amalgam is safe appears to flare up regularly. But is this just the result of lobbying by

interest groups?

Your tools34. Handpieces

special reportThe latest and greatest

handpieces on the market

39. Tools of the tradeThis month, the smallest,

cheapest and most effective way of dealing

with excess gutta percha; the best OPG for impants;

and much, much more?

Your life42. Passions

Dr John Owen of Midland Orthodontics,

Midland, WA

Contents03

August 2011

23

Bite 3

Editorial Director Rob Johnson

Sub-editor Kerryn Ramsey

Contributors Sharon Aris, Nicole Azzopardi, Kerryn Ramsey, Lucy Robertson, Maureen Shelley, Gary Smith

Creative Director Tim Donnellan

Commercial Director Mark Brown

For all editorial or advertisingenquiries:Phone (02) 9660 6995 Fax (02) 9518 5600

[email protected] 4.08, The Cooperage 56 Bowman Street Pyrmont NSW 2009

Bite magazine is published 11 times a year by Engage Media, ABN 50 115 977 421. Views expressed in Bite magazine are not necessarily those of the publisher, editor or Engage Media.

Printing by Superfine Printing.

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Japanese scientists report they have grown an entire tooth from stem cells implanted into the kidney of a mouse

A research group led by Professor Takashi Tsuji (Professor in the Research Institute for Science and Technology, Tokyo Univer-

sity of Science, and director of Organ Technologies Inc.) has provided a proof-of-concept for bioengineered mature organ replacement by transplanting a mature bioengineered tooth, periodontal ligament and alveolar bone, into a prop-erly sized bony hole in the alveolar bone through bone integration by recipient bone remodeling in a murine transplanta-tion model system.

In simple terms, the team grew the tooth from a mouse’s stem cells, which were grown inside a drop of collagen, and placed inside a living mouse’s kidney. The new tooth was then transplanted successfully into another mouse’s jaw. Speaking on ABC radio, Queensland University of Technology cell biologist Dr David Leavesley says creating a fully functional, complex cell tissue is the vital step scientists have been waiting for.

“(The tooth) is the Golden Fleece, or

if you like, is the gold at end of rainbow that we’re aiming for,” he said.

Imperial College Structural Ceramics chair Professor Eduardo Saiz says it is an exciting step forward.

“They have been able to recreate in the lab a complete tooth ... that’s already a big accomplishment,” he said.

Professor Tsuji says the ultimate goal is to grow livers and kidneys to relieve the world’s shortage of organs for transplants.

Professor Tsuji is a research team member in ‘Health Labor Sciences Re-search Grant: Research on Regenerative Medicine for Clinical Application (Domain Leader: Professor Akira Yamaguchi of Tokyo Medical and Dental University)’. This research was collaborated with Professor Teruko Takano-Yamamoto (Division of Orthodontics and Dentofa-cial Orthopedics, Graduate School of Dentistry, Tohoku University, Japan) and Professor Shohei Kasugai (Oral Implan-tology and Regenerative Dental Medicine Graduate School, Tokyo Medical and Dental University, Japan).

The sacrifices he makes for science …

Japanese scientists grow tooth

Bite 5

The Australian Dental Association (ADA) has advised patients to ensure that any custom-made dental prostheses and appliances are compliant with the Therapeutic Goods Administration’s require-ments by asking their dentist to confirm the origin and regula-tory approval status of any such prostheses or appliances.

Local suppliers to the dental in-dustry have lobbied governments and the ADA for the past couple of years over the use of imported products and equipment which is available cheaply to the end-user because they avoid TGA scrutiny.

The ADA now says it has become aware of some reports which allege that dental prosthe-ses or appliances made overseas and imported may be dangerous to the health of patients due to a lack of quality and safety in their production. ADA president, Dr Shane Fryer, said, “Dentists are required to ensure that custom-made dental prostheses or appliances made overseas comply with the Therapeutic Goods (Medi-cal Devices) Regulations 2002 (TGR 2002) and are listed on the Australian Register of Therapeutic Goods (ARTG).

“The TGA has very strict guide-lines on what can and cannot be imported. The ADA supports the TGA’s restrictions. It is illegal for any dentist to use imported dental prostheses or appliances if they do not comply with TGR 2002 and ARTG,” said Dr Fryer. “If patients have any concerns, we ask them to double-check with their dentist that any materials are TGR 2002 compliant and registered on the ARTG,” Dr Fryer concluded.

ADA says consumers check your prostheses

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ADX11 at the Melbourne Exhibition Centre is promising not only the latest products and services, but a professional skills program to help you make the most of it

ADX11: a one-stop shop

Dentists and allied oral healthcare professionals looking at the procurement of new products and services

should look at attending the ADX11 Melbourne dental exhibition to be held over 16-17 September 2011 at the Melbourne Exhibition Centre. What makes this year’s dental exhibition important is that it is accompanied by a professional skills program.

“We recognised the need to keep the dental profession up to date with the latest products offered by the dental industry. Consistent with this need, we have organised a number of leading suppliers to offer seminars to provide an update on how to best utilise the latest dental equipment and also how services employed by member companies can best support the profitability of dental practices,” said Troy Williams, Executive Officer of the Australian Dental Industry Association (ADIA).

According to Mr Williams’ this is what makes the ADX11 Melbourne dental exhibition different. He said the focus on allowing dentists to maximise the profitability from their dental practices was a major focus of the skills program.

“Not only can dentists review the latest products, they can attend seminars on issues related to how to purchase equipment. The seminars provided at ADX11 Melbourne cover a range of issues from product selection to innovative financing options,” he said. Visitors wanting to attend the professional skills program can complete a registration form online at www.adx.org.au/cpd or email [email protected] or

call 1300 943 794 for assistance.Dentists wanting to finance the

purchase of new equipment should visit the Investec Dental Finance Café. This is an important component of the exhibition, allowing dentists and allied oral healthcare professionals to review the innovative product and services required to deliver quality dental care.

“In such a busy setting, the ability for leading suppliers to meet informally with dentists over coffee is important, something made possible by the Investec Dental Finance Café,” said Troy Williams.

Dentists often need to finance the purchase of large equipment so the support of Investec Dental Finance for the ADX11 Melbourne dental exhibition is important. Investec Dental Finance is a specialist finance company that

provides financial solutions specifically created for professionals in the dental and oral healthcare sector. Committed to developing and providing innovative products and specialist services personal and practice funding requirements, sponsorship of the café was a logical decision for them.

“The ADX11 Melbourne dental exhibition represents a great opportunity for Investec Dental Finance to support dentists in the acquisition of the latest products,” said Barry Lanesman from Investec Dental Finance. The Investec Dental Finance Café will be located in a central position within the exhibition space. Dentists and allied oral healthcare professionals intending to visit the ADX11 Melbourne dental exhibition can register to attend at www.adx.org.au.

06

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6 Bite

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Bite 9

09

News bites

Poor oral health can be passed through generationsThe result of a 27 year-research project suggests that mothers with poor oral health are likely to have children who also have poor oral health when they reach adulthood. The long-term study of over a thousand children born in New Zealand in 1972 and 1973 provides strong evidence that the children of mothers with poor oral health are more likely to grow up with above average levels of tooth loss, tooth decay and fillings. The findings strengthen the notion from previous research that adult oral health is affected by a combination of genetic and environmental factors. The research compared the oral health of the children at the age of five in 1978, and again at the age of 32. The findings were compared with the mother’s own self-rated oral health measured in 1978. Analysis 27 years later indicated that approaching half of children (45.1 per cent), whose mothers rated their oral health as ‘very poor’ had severe tooth decay. Around four in every 10 children (39.6 per cent) experienced tooth loss in adulthood.

The research commented on the influence of environmental risk factors on oral health including social economic status (SES), attitudes, beliefs and oral health related knowledge persisting across generations, providing further evidence in how a mother’s view of her own oral health can affect that of her child’s.

Chief executive of the British Dental Health Foundation, Dr Nigel Carter, said: “These findings represent important confirmation of a trend that has long been recognised. Work by Per Axelsson in Sweden in the 1970s clearly demonstrated that a child’s likelihood of decay was determined by the amount of bacteria in the mother’s mouth and that this was passed from mother to child. If further findings into oral health risks transmitting from one generation to the next can be substantiated, then we must target parents to educate their children in the hope they can better their own oral health and pass the message on to future generations.”

With dental decay a totally preventable disease by identifying at-risk children from their mother’s self- rated oral health, it should be possible to further reduce decay levels.

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10 Bite

10

News bites

Obesity contributes to poor oral healthPoor oral health has joined the list of knock-on effects of obesity, a recent study has concluded. The study, published in the Journal of Clinical Periodontology, revealed the higher the severity of tooth decay, the higher proportion of subjects with a Body Mass Index (BMI) of 30 or over, a figure according to the World Health Organisation is generally considered as obese. In 2008, 1.5 billion adults, aged 20 and older, were overweight. Of these, over 200 million men and nearly 300 million women were obese, a trend also reflected in the results of the study. During the inaugural National Childhood Obesity Week, chief executive of the British Dental Health Foundation, Dr Nigel Carter, expressed his concern at the findings and encouraged doctors to take a greater role in tackling poor oral health.

Dr Carter said: “Periodontal pockets are essentially food and plaque traps that irritate and decay teeth to the point the tooth will eventually fall out. As almost one in four adults in the UK are classed as being obese, there is clearly a significant oral health risk to those people.

“There has been much discussion about broadening the role of the dentist to check for illnesses such as diabetes, and

when it comes to obesity, there is definitely a case for doctors relaying information on how their diet is directly affecting their oral health.

“As well as recommending people brush for two minutes twice a day using a fluoride toothpaste and they visit their dentist regularly, the foundation also recommends people cut down on how often they have sugary foods and drinks. By following these three key rules, you stand a much greater chance of having and keeping healthy gums, thereby reducing the risk of gum disease, tooth loss and decay.”

Studies and experts have pointed to grazing and snacking as a possible cause in the rise of obesity. A team from the University of North Carolina analysed data from food surveys carried out in the United States during the ’70s, ’80s, ’90s and the last decade, and while obesity rose in each, increases in the number of eating occasions and portion size seem to account for most of the change.

Dr Carter added: “Snacking and grazing is becoming an increasing problem, particularly as people are working longer hours. The notion of ‘desk grazing’ might suffice short-term hunger, but it is considerably better for your teeth and general health if you eat three meals a day.”

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Equipment, fitout and practice assets are critical to the way in which you run your practice and care for your patients. Investec Dental Finance has a range of finance structures where you can select repayment options to suit your cashflow, enabling you to update your equipment now and be best placed to treat your patients’ needs.

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12 Bite

12 New ProductsNew-release products from here and around the world

SunnyWipes By utilising the amazing properties found in nature, Sun-nyWipes has created a product range that is truly unique. SunnyWipes moisturising antimicrobial hand gel exceeds the World Health Organisation’s recommenda-tions and standards; as it has a dual effect. The alcohol kills germs swiftly and evaporates, leaving the moisturiser to prevent skin dehydration, which is a major problem with many current products on the market. In addition, the eucalyptus oil helps prevent skin irritation from occurring.

SunnyWipes® antimicrobial gels and general virucidal and antimicrobial wipes can help protect you and your pa-tients from 99.99% of harmful bacteria, including Influenza Type A virus strains and other bacteria and viruses that are resistant to antibiotics such as MRSA.

Using SunnyWipes® products can significantly reduce your exposure to bacteria and viruses through hand con-tact and contaminated surfaces. SunnyWipes® protection helps you stop germs before they infect you and your patients.

Healthcare solutions company Medivac Limited, recently secured a distribution contract with NSW Ambulance for its new SunnyWipes Antimicrobial Hand Sanitising & Moisturising Gel.

Infection Control Manager for NSW Ambulance Service, Ms Kate Hipsley, said that paramedics’ user feedback was overwhelmingly positive.

Business Development Manager, Paul Cross said, “This contract with a significant player in the healthcare market is major news for MediVac and our new SunnyWipes profes-sional range, and demonstrates the market demand for our unique gel, and all SunnyWipes range of products.”=

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ICU Protect™W9 Pty Ltd continues the expansion of its Ongard range of products with the introduction of the ICU Protect range of protective eye wear. Exclusively available to Medical and Dental professionals, the ICU Protect range offers a number of eye protection solutions for practitio-ners, staff and patients alike. With features such as UV 525, anti-fog, soft silicone nose pieces and ultra-light weight, ICU Protect are available in sporty wrap around and over-spec designs. The range also includes full face and eye shields with replaceable lenses.

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14Your world National registration

ne year ago, the Australian Health Practitioner Regulation Agency (AHPRA) took control of the registration process for all health practitioners from 80 state and territory boards. What followed was chaotic. “Thousands of doctors, nurses, allied health professionals and graduates entering the workforce for the first time were not

registered or re-registered on time,” says Peter Dutton, shadow minister for Health. Many were deregistered and prevented from practising. Others were unable to take up jobs and some lost jobs because of administrative failures in AHPRA.

“Health Minister Nicola Roxon was warned that transitioning from a myriad of state bodies to one national body would be a huge undertaking," the shadow minister says. "One that should be staged over time, but as usual Labor knew best and decided it could be done overnight.”

Last month a Senate inquiry handed down the results of its investigation into AHPRA’s delays in renewing registrations for health practitioners. The delays resulted in health professionals being unable to practise despite sending in their registration forms before deadline, and in patients losing Medicare rebates.

Liberal Senator Mathias Cormann moved to establish the inquiry, by the Finance and Public Administration Committee, after it was revealed that thousands of doctors, nurses,

physiotherapists and other health workers have been unable to work after bungling by AHPRA left them without professional registration.

Health ministers intervened earlier this year to give the agency extra resources and federal Health Minister Nicola Roxon promised no-one would be denied their Medicare rebates because of the problems.

Hundreds of dentists were among the many health practitioners left adrift by registration chaos. But one of the more frustrating aspects of that was professional bodies had been warning of the possibility of chaos for some time beforehand. Addressing the Senate inquiry, ADA chief executive Robert Boyd Boland said, “The logic of the arrangement seemed clear to us; we had eight dental boards registering 10,000 or 11,000 practitioners, and we could see the economies of scale in relation to having one central organisation do that.

"Sadly, it appears that in its early stages AHPRA failed to gather the intelligence it needed from those state boards to identify the issues that it would need to address.”

Without being able to give exact numbers of dentists who had been affected (because the ADA did not log the number of calls it received), Boyd Boland estimated that it was about 500 nationally. Although that figure isn’t large, he said the changeover did affect every practitioner.

“They have all been affected, quite simply, in a financial sense in that the registration fees have significantly increased. In our submission we quoted that it was $250 for registration in

Was the chaotic switchover to national accreditation a result of teething problems, or more systemic failure?

Things fall apart

14 Bite

Article Helen Mellunwellun

Western Australia and it has increased to $545,” he said.It wasn’t just practitioners affected, he said: dental

academics—of which there is already a shortage—also had a strong disincentive to continue their work with the new AHPRA fee structure. “There is a significant shortage of academic staff in universities training dentists,” Boyd Boland told the inquiry. “I have an instance of one member who sought to register. He lectures two days a week and, for first-year students in a pre-

clinical area, there is not a patient to be seen. He is required to register. His existing registration fee is $101. He had to reapply, so that is $275, and then apply for registration, $545. In an environment in which we are struggling to get academics into the universities, that is a big negative for that person. I am sure there are other academics in a similar situation.”

The Senate committee made 10 recommendations in the Senate report to drive necessary changes through the Australian Health Workforce Ministerial Council to ensure that

AHPRA can adequately fulfil its role in the future. In the report’s conclusion, the committee wrote: “The implementation of the new registration and accreditation regime for some 500,000 health practitioners was a huge undertaking … However, the implementation was far from well managed. The Australian Medical Association described it as a 'debacle'. Ramsay Health Care Australia did not classify the difficulties being experienced as 'teething problems', rather it expected problems to last for the next two years.

“The committee was provided with extensive evidence on the impact of AHPRA's flawed processes. Practitioners reported loss of income, and in some cases loss of employment. Some practitioners argued that their reputations have been damaged as a result of incorrect registration information or deregistration through no fault of their own. They also reported added stress and anxiety as a result of their registration difficulties. Concerns were raised about the implications for legal liability when practitioners continued to practise when they did not know that they were not registered. As noted by many practitioners, these problems took them away from their core task: the provision of health services to patients.”

AHPRA’s response to the damning report was to hail it as a success for the agency. In a press release following the release of the report, Mr Peter Allen, chair of the Agency Management Committee of AHPRA, welcomed the Senate’s scrutiny of the early implementation of the national scheme, and was pleased that the inquiry did not identify any new issues that were not already being addressed by AHPRA.

“They have all been affected, quite simply, in a financial sense in that the registration fees have significantly increased.”Robert Boyd Boland, Chief Executive, ADA

Hundreds of practitioners were suddenly rendered

unable to practise because of AHPRA bungling.

Bite 15

“The National Scheme is a world-first regulatory reform of unprecedented scope and ambition. While the transition period was not as smooth as we had hoped, that chapter is now behind us,” Mr Allen said.

“I am confident that our action plan comprehensively addresses the areas of concern about early implementation of the National Scheme raised with the Committee by individuals and organisations.

“Our extensive program of work aims to improve services to registrants, support national consistency and continue to bring out the benefits of the National Scheme.

“AHPRA acknowledges that many concerns expressed by our stakeholders about the early implementation period were valid. Nonetheless, we are encouraged that most submissions from organisations confirm support for the National Registration and Accreditation Scheme. We are committed to working closely with our stakeholders to realise the full benefit of the National Scheme for all Australians,” Mr Allen said.

Allen pointed out that an important example of the improvements underway is the registration renewals campaign which AHPRA is currently implementing. This campaign has seen greatly expanded communication with practitioners and close partnership with employers and professional associations to encourage practitioners to ‘Renew on time, on line’.

Other recent service improvements introduced include:

Establishment of customer service teams in each AHPRA State and Territory office with increased resources, to quickly and effectively respond to practitioner and community questions and queries; Improvements to the AHPRA website to make it easier to use, streamlining, simplifying and supporting the basic processes of registration and renewal; Expanded online services including online graduate applications and capacity for practitioners to track application/renewal status on the web.

A major benefit of the National Scheme is that the public, practitioners and employers can check registration details of over 520,000 individual practitioners on the National Register which provides information about areas of specialty/endorsement, registration expiry dates or registration types.

Employers can also use the National Register to confirm an individual’s ability to practise in a regulated health profession in Australia. If a practitioner appears on the National Register, he or she may practise in that profession in Australia within the scope of their registration. AHPRA CEO Martin Fletcher says. “We are working closely with employers and professional associations to make sure that all practitioners who want to continue to practise have renewed on time.”

National registration

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A major benefit of the National Scheme is that the public, practitioners and employers can check registration details of over 520,000 individual practitioners.

s there a need for a women’s dental association at a time when the profession has got to a stage where females are no longer a minority? This is the question currently being considered by the Victorian Women Dentists’ Association (VWDA). Although great advances have been made, dentistry and female dentists in particular are facing new challenges.

The VWDA, unique in Australia as a formal women’s dental group, has been suffering dwindling numbers both of members and in people willing to participate actively in the committee. As well, it is struggling to get enough people to attend its continuing professional

development events—a challenge other organisations have also felt since CPD became compulsory a year ago and the number of organisations including businesses offering such courses has mushroomed. The VWDA is having a re-think of its aims and approaches and is considering whether there is a need to rein-vent the association and how they can attract a new breed of female dentists to continue to work on improving the position of women in dentistry and providing an important support network.

The association, which formed a decade ago, provides a mentoring service that can be crucial for students and new graduates, as well as providing awards and other benefits—and the cost of membership is low compared to other organisations,

As more women become dentists, the Victorian Women Dentists’ Association is seeing its membership dwindle. Does a women-only group have a place in modern dentistry?

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Your world Women in dentistry

What

want

18

Article Vivienne ReinerPhotography Ian Wilson

at only $70 a year. The VWDA website cites some revealing statistics that show how quickly things have changed: in 1888 in Victoria, there were only two female dentists out of a total of almost 500, with incremental increases over 10-year periods. Then from the 1950s the numbers started doubling. Today, female dental students slightly outnumber men.

Women have also started to take on leadership roles in dentistry, although they are still in a minority. In 2000 VWDA founder Pamela Dalgliesh became the second-ever female president of the Victorian Branch of the Australian Dental Association. Another important milestone is the fact that the ADA federal branch’s Karin Alexander is set to be the first female president of the ADA. Dr Dalgliesh says although the VWDA has played an important role in raising the standing of female dentists, there is still more to be done.

Internationally, female dental associations have had great success Dr Dalgliesh says, pointing to the strength and size of the American Association of Women Dentists (AAWD) run under the auspices of the American Association of Dental Schools. The AAWD website urges female dentists to help shape the changing nature of dentistry: “Although the gender composition of US dentists has changed dramatically in the last 20 years,

Dr Hugh Fleming in his Sydney surgery.

ADAVB immediate past president, Dr Anne Stewart: The VWDA reconsidering its future is a positive thing, she says.

Women in dentistry

there’s not much else that has... AAWD benefits its members from dental school through retirement.” In Australia, women’s dental groups operate in some other states, the notable one being in Queensland, which has existed for longer than the VWDA. However Victoria is not the only state having difficulty recruiting—for example, a networking group in South Australia for female dentists no longer meets.

Dr Dalgliesh has been contracted by the VWDA as a consultant to look at the challenges the association faces and make recommendations on whether it should continue and if so, in what capacity. VWDA president Jennifer Campbell, in announcing the

review in a member newsletter, wrote: “The current committee is concerned about the direction of the VWDA and its relevance to the current audience… is the VWDA relevant in the current environment?”As part of her research, Dr Dalgliesh conducted focus groups including non-members and participated in a planning day. Dr Dalgliesh’s conclusion is that the association should continue to be relevant today but that, with significant changes that have taken place in the past decade, the associa-tion will need to look at new ways to inspire and empower the new generation of female dentists.

“The issues [for female dentists] are still there; they haven’t really changed,” she says, pointing to the income disparity that persists between male and female dentists and continuing issues regarding trying to balance work and family life.

Dr Dalgliesh says the women’s dental network is well placed to continue to help promote and recommend women for particular jobs and advocate for better female representation in leadership positions.

Dr Dalgliesh believes one way forward for the VWDA may be

to focus less on the specifics of professional development for general practice and more on networking as well as sharing information about issues that unite all women who have trained in dentistry, regardless of their specialty. As well, she recom-mends having a broader range of people on the committee and more use of visionary speakers who can talk about current issues and trends. She also supports input from successful women outside of dentistry.

Mina Borromeo, an academic at the Melbourne Dental School specialising in special needs dentistry, says that as a young dentist starting out, she found the networking and having the opportunity to ask questions of other female practitioners were of great benefit. But Dr Borromeo, who holds a number of roles including president of the Australian and New Zealand Academy of Special Needs Dentistry, says that as an academic it can be difficult to take a whole day off to attend the VWDA’s annual CPD day during teaching time.

The VWDA is currently considering a range of new approaches as it looks over Dr Dalgliesh’s recommendations, including ideas about how to attract more people to meetings. However their small membership means getting people to events remains a challenge even when they have compelling presenters, explains VWDA secretary and long-time member Dr Ruth Paluch. She cites the example of an evening seminar organised late last year with a panel of women who have been successful in different areas of dentistry—which failed to draw many registrations. Another event boasted the high-profile trailblazer in minimal-ist dentistry, Geoff Knight. Dr Knight, a general practitioner who has worked to make cosmetic dentistry more accessible at a lower cost, has lectured to packed rooms. However, his VWDA talk was not booked out, despite the fact that it was not restricted to members or females.

“We’ve certainly discussed increasing our profile—for exam-ple placing advertisements in the monthly ADA Victorian Branch newsletter,” Dr Paluch says. But previous advertising has not had much effect. Membership maintenance and communicat-ing the benefits to the wider profession is a challenge, with the association only having some 40 financial members currently—one third of the number of founding member numbers in 2000. The VWDA has also ventured into the world of social media; however their Facebook page is a closed group so non- members cannot view the page to see if it is something that would be relevant for them.

Dr Paluch, who has 30 years’ experience as a dental practi-tioner, says the association has remained true to its mission and continues to carry out a number of things it first set out to do, including nurturing female talent, citing as an example the fact

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Despite the issues for women in dentistry remaining the same,

membership interest in the VWDA seems to be dwindling.

“The current committee is concerned about the direction of the VWDA and its relevance to the current audience… is the VWDA relevant in the current environment?”Dr Jennifer Campbell, VWDA president

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that the VWDA awards an annual prize to the most outstanding exam candidate. The association has also been leading the way in their mentoring program; however they currently have numer-ous experienced dentists who have offered to be a mentor but are struggling to get people to put up their hand to be men-tored. Mentoring programs that the association has run have focussed not only on recent graduates but also on overseas practitioners from cultures where women do not tend to be as active in the wider community.

The committee is considering a range of new offerings: a group for young mothers and their children, and other social activities such as subsidised dinners.

It is the personal stories that are often most useful for women in the early stages of their careers. Dr Paluch says dentistry is a flexible profession with a range of options, from going into research and academia to working short shifts as a general practitioner employee or having greater control by owning your

own practice. After gaining several years’ experience, Dr Paluch managed to combine her work and family life by opening her own practice that was accessed via a separate entrance in her home in the Melbourne suburb of Caulfield. She juggled raising two young children with home help and running the dental prac-tice. The downside of being a practice principal is the admin-istrative side of things. “It is your responsibility—you can’t just close the door at the end of the day and switch off,” she says.

Anne Stewart, immediate past president of the Victorian division of the ADA and a member of the VWDA, agrees that choosing between career verses family is not necessary in dentistry. “You can practice at the highest level and you don’t need to be there full-time,” she says.

Dr Stewart says research through the University of South Australia suggests a trend towards women in dentistry work-ing less hours, with more practitioners working part-time. The ADA Victoria Branch’s own figures show how the demographics are changing: Active members currently comprise 61 per cent males to 39 per cent female, however the proportion is reversed in student members, with 39 per cent males and 61 per cent female. “The change in profile will certainly change things in the future,” Dr Stewart says.

She says the fact that the VWDA is reconsidering what its role will be in the future is a positive thing. “I think that’s a healthy sign—rather than keeping on keeping on, they’re looking at making it relevant in changing times,” she says.

Women in dentistry

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Active ADAVB members currently comprise 61 per cent males to 39 per cent female, however the proportion is reversed in student members.

t’s a condition that almost one in three Australians will suffer from in their lifetime, but many sufferers have no idea about it as they are sound asleep—or at least assume they are. Figures regarding sleep apnea vary among practitioners. Some claim it is as low as five per cent, while others insist it is closer to 30 per cent and will affect one in four men over the age of 30. According to the Australasian Sleep Association, almost 90 per cent of Australians will suffer from a sleep disorder at some time, with 30 per cent suffering a severe sleep disorder.

One of the problems with sleep apnea has been it has some-thing of an image problem. For the sufferer, unlike bleeding gums or a painful tooth, sleep apnea is not easily identifiable as it occurs during sleep.

In basic terms, sleep apnea occurs as the walls of the throat come together during sleep, blocking the upper airway. Breath-

ing stops for a few seconds or even up to one minute, until the brain registers the drop in oxygen levels and sends a wake-up call. The sleeper rouses slightly, opens the upper airway with a gasp, and then drifts back to sleep, usually unaware of the situa-tion, which can occur as many as a hundred times a night.

The result is the sufferer wakes feeling unrefreshed, and then endures general fatigue and poor concentration, and it has long-term implications like hypertension and cardiac problems.

Dentists have emerged on the frontline of practitioners treating the condition, but debate continues over the best approach of dealing with sleep apnea.

“The problems some dentists have had is related to the misdiagnosis of sleep apnea,” says Dr Derek Mahony, a Sydney specialist orthodontist. “Many people think if you snore you must have sleep apnea, and that if you have sleep apnea, then you must snore. Well, the two are not always related.

“As many dentists have a basic understanding of sleep disor-dered breathing problems, they think they just need to create a snoring appliance and it will work. But the thing with a snoring appliance is they are only successful in patients whose primary site of obstruction is at the base of the tongue.

“What all dentists must do before they prescribe a snoring appliance is to ask the patient to have a sleep study performed to see how severe this problem is. Then it can be determined if this is a mild, moderate or severe apnea case, or if it is purely a snoring problem.” The sleep study (a polysomnograph or PSG) is usually conducted in a hospital sleep lab where the patient’s sleeping pattern is monitored throughout the night. The informa-tion can then be used in the diagnosis of whether sleep apnea is indeed a health issue.

Dr Mahony says a more pro-active approach needs to be adopted in tackling the issue, starting with more discussion with patients about lifestyle issues.

“If the medical profession was indeed getting it right, you would not have this number of people being misdiagnosed and

23

Dentists are finding themselves on the frontline of dealing with sleep apnea, but a lack of uniform approach is posing problems for both patients and practitioners

Asleep on the job

Your business Sleep apnea

Article John Burfitt

Bite 23

Just because your nights are like this does not mean he has sleep apnea—and dentists need to understand why.

“As many dentists have a basic understanding of sleep disordered breathing problems, they think they just need to create a snoring appliance and it will work.”Dr Derek Mahoney, specialist orthodontist, Sydney

undiagnosed,” he says. “There are three things to look for. First, check the small area at the back of the throat. Next, check if the lower jaw is recessive, and if someone has a long soft pal-ate and a large tongue. Finally check if the side of the tongue has signs of scalloping from the teeth.

“Then talk to the patient about their sleeping habits and snor-ing. And with children, dentists should be looking at the size of the tonsils. So rather than just the teeth and gums, you should be looking at the back of the throat and asking questions.”

Dr Vas Srinivasan, the clinical director of the Depart-ment of Orthodontics at the University of Sydney, says this year he has already treated 20 patients at his practices in South-East Queensland presenting with problems from the appliances they had been

fitted with for sleep apnea.“Patients began presenting with side effects and issues

but without any pre-treatment records from their dentist, so it seems like they had been prescribed an appliance just the way you would do with a company manufactured model, rather than seeing who is really eligible and who is not,” Dr Vas Srinivasan says. “This is where the importance of a PSG becomes clear.”

Among the side effects have been bite changes, crowding of teeth, pain and discomfort and ineffectiveness of the device, with the return of the sleep apnea.

When patients begin presenting with side effects and issues, Dr Srinivasan says it only highlights the importance of ordering a sleep study before embarking on a course of treatment.

“If you do not know the relevance of a sleep study, then you are only taking a blind shot at it,” he says. “It is important we all address this. Rather than just making up an appliance, the dentist must first order the sleep test, and obtain relevant records. This will also cover the dentist later on if there are indeed problems. You then have the evidence for why you felt they were eligible for the treatment in the first place.”

Dr Mahony adds that while he knows of only a few com-plaints against dentists regarding treatment for sleep apnea problems, he says the best way to avoid potential liability prob-lems is to embark on an appropriate treatment plan in the first place—one that serves the patient and also covers the dentist.

“This is a serious problem that needs to be addressed,” he says. “The onus on the dentists is not to just jump in and create a snoring appliance, but to actually get a full medical work plan to see what the patient actually requires.”

“I believe that in the next five-to-10 years, there will be a huge push to do this,” Dr Srinivasan says. “I would like to see dental practitioners attend an accredited sleep course, and to have a component of sleep medicine as part of their practice. It demonstrates to patients their dentist is a person who takes a holistic approach to their overall health.”

Your business Sleep apnea

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Dr Erskine-Smith, is well known for his lectures which deliver practical, innovative solutions for many clinical procedures. He is also a keen inventor who has developed several products which he has marketed successfully in Australia and Internationally. The Cracked Tooth Model (sold over 12,000 pieces), Dentagauges (used by prominent USA lecturers), Piksters (sold in over 14 countries) SuperDaps and most recently Preeben and Foamies.

At ADX he will deliver a personal and down to earth guide on how to bring your products to market. Many of you will have thought of great ideas before now - here’s the chance to gain first hand insight on the trials, frustrations and success of one dentists’ journey and how you too can make your idea a reality.

To attend this free seminar complete a registration form online at www.adx.org.au/cpd (Friday 16 September at 3.00pm)

ED-AUGUST 2011 BITE.indd 1 4/08/2011 3:35:02 PM

You’re invited to share an amazing Rugby World Cup 2011 experience, while earning up to 18 CPD hours. From the moment you step on board the 5-star luxury cruise ship, the ms Volendum, you’ll enter into a world of Rugby-themed bars and entertainment.

This unparalleled CPD event includes three days of on-board education, followed by the opportunity to mix with Rugby legends: Nick Farr-Jones, Bob Dwyer, Gordon Bray, Cobus Visagie and Mark Ella. On top of the quality cuisine, bars, activities and leisure

facilities you’d expect from a world-class hotel, you’ll be getting ‘match fi t’ with inside knowledge given by these Rugby legends. If it fl oats your boat, pack your trainers and get ready for an on board training camp with the Rugby legends as we sail to Wellington.

Departing Tuesday, 4th October – Returning Monday, 10th October 2011

Tuesday, 4th October Wednesday, 5th October Thursday, 6th October

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• ms Volendam departs from Sydney at 5.00pm

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26Your business Technology

ith high image quality and detail, and a low radiation doses one-tenth that of a conventional CT scan, it’s not hard to see why Cone Beam Computed Tomography (CBCT) has become diagnostically popular, not only in specialty fields like ortho-

dontics and dental surgery but in general dentistry too. Indeed, the uptake has been so rapid that the technology was out front of the administration of the system: until recently machines had to be registered as X-ray or orthopantomography equipment on the Diagnostic Imaging Services Table (DIST), with claims corresponding to these items. In May this year, it seemed the government was finally catching up when it was announced from the first of July there would be a specific Medicare Benefits Schedule (MBS) item for CBCT. This was to be interim, pending a review by the Medical Services Advisory Committee (MSAC), which was due to report in September.

So far so good. However this new item placed CBCT in Group I2 – Computed Tomography on the (DIST) of the MBS and owners of this equipment are now required to register (or re-register) CBCT equipment as CT. Furthermore, in defining CBCT effectively as a CT, the implication is a radiologist has to be present when the scan is taken. This is a sensible precaution for actual CT scanning, where typically a radioactive dye is injected into the patient, some of whom suffer adverse reactions, but not so obvious for a scan on equipment dentists and other profes-sionals have been readily trained to use. Indeed this significantly impacts on the e-medicine model many dentists and radiog-raphers had signed up to, which ensures scans taken are not only read by the dentist but also remotely by a teleradiologist—a radiologist with sub speciality skills in dental radiology who reads the images over secure internet connection. With a significant

number of tumours detected in these dental scans, such read-ings are ethically, and likely legally, required. And for any kind of Medicare rebate to apply, an image must be read by a radiolo-gist. However, it is estimated only around one quarter of CBCT machines are installed anywhere a radiologist is capable of being physically present.

What is more, the amount of money rebateable for such read-ing via Medicare has also been slashed, now capped at 95 per cent of $113.15 if someone bulk bills, or 85 per cent if there is a co-payment with the patient. Previously it was $250.

To explain these somewhat inconsistent changes, conspiracy theorists (there are plenty off-the-record) are noting who ben-efited from the old system and who will benefit from the new. Some accuse the larger city-based radiology practices, to whom patients may have to be referred, with wanting to squash the competition. Others charge different health practices with over-servicing, over-charging, self-referring and cost-shifting and others again are critical of dentists being brought into the Medicare system at all.

As to what actually is going on, Geoffrey Parker, business de-velopment manager with International Teleradiology Corporation, sees several forces converging. For a start, he says, the fee drop seems a fairly straightforward case of the government moving to curb costs. However, the net effect is likely to make it hard for small regional practices whose patients would have to either travel significant distances to a city to undertake a CBCT scan, or,

The minor change of a Medicare provider number has generated intrigue and a stream of off-the-record commentary in the world of CBCT scanning

Image problems

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Article Sharon Aris

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CBCT has become diagnostically popular in not only in specialty fields like orthodontics and dental surgery but in general dentistry too.

Under new govern-ment rules, does a

radiologist need to be present when

you’re doing this?

should a local radiologist be found, would have to be convinced of the merits of investing in the machine themselves. He particularly takes issue with the notion of dentists as over-users of the technology, noting a ‘field of view’ analysis, based on the scans his firm reports on, found the vast majority of dentists only scanned a highly specific region of the mouth—a scant two per cent scanning the full maxilla mandible and cephalometry.

“The government has been promoting the new e-medicine initiatives as part of its sales pitch on the NBN. Yet this decision seems to run counter to the aims of the NBN by not allowing the benefits of this technology to be passed on to patients. Surely we must use this valuable diagnostic resource in the most efficient way possible and let all patients benefit from this e-medicine technology,” says Parker.

Rob Dewhurst is a principle dentist at Dewhurst Dental in Armidale in country NSW, a practice with two dentists, a therapist (part-time), two hygienists and a full-time technician. With no resident specialists in Armidale and just a visiting orthodontist and oral

surgeon, “basically we do whatever walks though the door,” says Dewhurst. “A lot of third molars, implants, orthodontics, root ca-nals, sleep medicine, TMD and periodontal therapy.” Given that range, he says, getting a CBCT scanner just added up, espe-cially as “there’s a fair bit of pressure from patients to not have to travel for treatment.” They installed one in November last year.

Initially they tried to talk the local university into buying one, and when that fell through, the local radiologist, but according to Dewhurst, “They were more interested in ultrasound and nuclear medicine.” Finally, they decided it was up to them. With the only inland machine between Newcastle and Toowoomba, they now have many dentists referring to them, with the scans read by a teleradiologist in Adelaide.

Dr Dewhurst is a supporter of the changes in principle. “I think the government has a right to bring in changes. I think it will have to be dealt with as a separate category to medical CT and have different guidelines and a well-defined reasonable rebate as there is a need for specialist radiolodical reporting. These machines cover such a large field of view.” He says it was possible the system was abused. However, by bringing in these changes, it’s practices like his that will suffer. “We only take about eight films a

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week. People like ourselves don’t over-treat patients. For us, $180 to $200 would be a very reasonable rebate. It shouldn’t be seen as a cash cow.” To date most have been bulk-billed, though he says in all likelihood a hybrid mix of part-patient payment will have to come in. “Nobody in our practice who needs a scan will not get one.” So it will be billed for what they can get and they’ll still get it read. “We didn’t buy it to make money, but it does have to pay,” Dr Dewhurst says.

At the Australian Dental Industry Association, Troy Williams, executive officer, says: “As a matter of policy, within the context of the regulatory framework, ADIA welcomes the introduction of any new technology that improves patient health outcomes and naturally this extends to the use of CBCT imaging in dentistry.” He points out the two issues—public funding for, and the regu-lated use of, CBCT imaging in dentistry—are entirely separate.

“When it comes to funding of CBCT imaging through Medi-care, ADIA supports such funding if it is required to deliver qual-ity patient health outcomes. The expert advice available to ADIA suggests that CBCT imaging equipment can be used by any appropriately trained individual, not just a radiologist.”

As this story went to press, one of Parker’s clients received advice from the Medical Benefits Division Department of Health and Ageing that indicated radiologists are not required to be physically present with the changed regulations. But, as with everything associated with this subject, that advice hasn’t been officially broadcast.

The numbers There are around 125 CBCTs in Australia. Between 15 and 20 are in radiology practices, so probably the rest are dentist-based or radiology- based practices. CBCT scanners have typically cost $300,000 to $400,000. They are frequently leased over several years. Most of the CBCT equipment has been installed in the past 18 months as the result of the Investment Allowance.

The scans done by the majority of dentists aren’t ‘field of view’ scans, suggesting they don’t over-use the equipment.

Did you know?People with diabetes are more susceptible to gum disease1.

Always read the label. Use only as directed. See your dentist if symptoms persist. 1) Taylor and Borgnakke, (2008). Oral Diseases, 14: 191-203; Khader, Albashaireh and Hammad, (2008). La Revue de Sante de la Mediterranee orientale, Vol 14, No.3: 654-661;

2) Blinkhorn, et al. (2009), British Dental Journal, Vol 207, No.3: 117-205;. 3) Fine, et al. (2006). Journal of the American Dental Association, 137: 1406-1413

Colgate recommends diabetes educators discuss oral health and gum disease with their patients.

Visit www.colgate.com.au for further details

Diabetes & Dental HealthIt is recommended that people with diabetes make regular visits to a dental professional to detect and treat gum disease. The twice daily use of an antimicrobial toothpaste is also recommended to minimise the progression of gum disease2.

Fight gum disease with Colgate Total toothpasteColgate Total toothpaste reduces 90% of plaque germs that can cause gum disease3. Colgate Total has a clinically proven antibacterial formula which works by removing the plaque bacteria on the surface of teeth and gums. Its formula also helps prevent plaque bacteria reappearing for up to 12 hours by creating a protective barrier around the teeth and gums.

ASMI 19208 - 0711

30 Bite

30Your businessMercury

r Ron Georgiou has treated thou-sands of patients during his time as a dentist and has seen the debate over amalgam raise its head over many years. For him, it all comes down to balance. “Firstly, there is no such thing as a non-toxic filling,” Dr Geor-giou said. “It doesn’t matter whether it is amalgam, gold or porcelain fillings, they all contain something.

“Secondly, you have to assess each patient on a case-by-case basis to see what is best for their mouth. Thirdly, you have to give the patient all the information so that they can make an informed decision.”

The debate over amalgam fillings is hotly contested. Concern has been raised over the mercury in amalgam fillings and the issue has been studied extensively.

Dental amalgam is the end result of mixing approximately equal parts of elemental liquid mercury and an alloy powder.Yet researchers have not found evidence of significant health problems related to the use of amalgam in fillings, according to the Columbia University College of Dental Medicine.

The US Food and Drug Administration has recently been hearing evidence as to whether amalgam fillings are safe.

“The question is whether or not dental amalgams should be banned altogether,” says Dr Jeff Shuren, director of the FDA’s Center for Devices and Radiological Health. “Now, the panel

did not recommend that. They did point out that there may be certain populations who are more sensitive to dental amalgam, like young children and pregnant women.”

Consumer advocacy groups in America have argued that mercury causes kidney and mental problems. Millions of Ameri-cans have fillings. It is estimated that 78 per cent of Americans have at least one cavity by the time they are 17 years old.

Norway, Sweden and Denmark have banned mercury fillings. “Composite fillings have now become so strong that the

Danish National Board of Health says that we can expand the ban to also include amalgam fillings,” says the former Danish Minister of Health Jakob Axel Nielsen.

The Australian Dental Association has consistently maintained that the use of amalgam fillings is safe. Dental amalgam has been in widespread use for more than 150 years and is one of the oldest materials used in oral health care. Its use extends be-yond that of most drugs and is predated in dentistry only by the use of gold. “Dental amalgam has an indisputable safety record and has been extensively reviewed,” says Dr Anne Stewart, Victorian branch of the ADA (ADAVB) immediate past president. “People are exposed to more total mercury from food, water and air than from the minuscule amounts of mercury vapour generated from amalgam fillings. Some 6000 tons of mercury enters the environment each year—about a third generated by power stations and coal fires. Much settles in the oceans where it enters the food chain and is concentrated in predatory fish like tuna. About 60 grams of tuna may provide as much mercury as

The debate over whether or not dental amalgam is safe appears to flare up regularly, most recently fired by an FDA ruling suggesting caution with young children and pregnant women. But is this just the result of lobbying by interest groups?

Heavy metal

30 Bite

Article Louis White

Bite 31

having 10 amalgam fillings over a lifetime. Scientific panels assembled by the US Public Health Service, US Food and Drug Administration, Centres for Disease Control and Prevention, the World Health Organization and the Australian Dental Standards Laboratory and the National Biological Standards Laboratory—both Commonwealth Government organisations—have concluded there is no scientifically relevant and definitive evidence to demonstrate a causal link between dental amalgam and adverse health effects, except in rare instances of allergic reactions.”

The ADA feels so passionately about the subject that in No-vember last year it amended its policy statement on amalgam fill-ings, which states, amalgam should continue to be available as a dental restorative material, and amalgam restorations should not be removed and replaced with alternative restorative materials for non-specific or perceived health complaints unless the patient has been fully informed of the implications of this decision.

But still, that won’t stop the critics. A field report entitled, ‘Symptoms of Intoxication in Dentists Associated with Exposure to Low Levels of Mercury’ written by Masoud Neghab, Alireza Choobineh, Jafar Hassan Zadeh and Ebrahim Ghaderi from the Occupational health department, School of Health and Nutrition, Shiraz University of Medical Sciences in Shiraz, Iran, concludes the following: “The findings of this study collectively indicate that occupational exposure to mercury, even at low levels, is associ-ated with a significant increase in the prevalence of symptoms of intoxication. Additionally, they provide circumstantial evidence in favour of the notion that the current value of TLV of this metal do not provide sufficient protection against the appearance of neuropsychological symptoms.

“Finally they may cast doubt on the appropriateness of cur-rent value of BEI, per se, as a sensitive means for bio-monitor-ing of mercury exposed individuals.”

Dr Stewart says, “Claims that the removal of amalgam leads to recovery from multiple sclerosis or that the use of amalgam leads to arthritis or Alzheimer’s disease are unsubstantiated and without scientifically established cause and effect.”

Composite resins are popular, especially if you are in the music industry with a prevalence for hip-hop. Gold seems to be the flavour of the day. But for the rest of us mere mortals, we just want a functioning filling that will do the job and allow our mouth to function normally.

“Composite resins are popular because they are tooth- colored, but they have not been as effective as dental amalgam

Despite concerns, people seem to have survived having these for some time now.

Bite 31

“People are exposed to more total mercury from food, water and air than from the minuscule amounts of mercury vapour generated from amalgam fillings.Dr Anne Stewart, ADAVB president,

in providing durable and long-lasting restoration, especially in the case of large fillings,” Dr Stewart says. “Composite resins are subject to technique sensitivities.”

Acknowledging an international trend to crackdown on mercury, the ADAVB, through the Australian Industry Group and its covenant with Environment Protection Authority (EPA) Victoria, commissioned an environmental report on amalgam waste. The report highlighted the need for ADAVB members to be proactive, recommending the installation of amalgam waste separators for about 1000 dental surgeries across Victoria. EPA Victoria and Melbourne water bodies formed a partnership with ADAVB to develop a program—Dentists for Cleaner Water—to help eliminate amalgam waste from the sewerage systems.

“Rather than mandating the installation of amalgam separators, a three-year program to encourage dentists in private practice to install amalgam separators was developed,”

Dr Stewart says. “The program ended on 30 June 2011 and more than 700 dental practices are expected to have installed amalgam separators through Dentists for Cleaner Water. Part of the program requires practices to have an amalgam waste agreement with a waste collector.”

The reality is that amalgam will continue to be used around the world for fillings (in most countries) until a proven alternative

substance can give the same results. Although generally not used in children or pregnant women anymore, amalgam fillings are the most tried and tested for the general adult population.

“The reality is that nothing has been as successful as amal-gam fillings,” Dr Georgiou says.

“In my practice I use a mixture of amalgam and resins but that is dependent upon each case.

“The reality is that it can be 25 to 40 per cent more expensive for resin restoration and a lot of people can’t afford that.”

Mercury comes in all forms and shapes and we can obtain it everyday through what we eat and drink.

“If you want to get rid of mercury, stop eating fish from the Sydney Harbour,” Dr Georgiou said. “At the end of the day we still have to fix people’s teeth and amalgam is still the best op-tion available in most cases.”

Your business Mercury

32 Bite

Set your home free

medfin.com.auMedfin – finance for your: Car • Equipment • Practice • Property • Cash flow needs

Are you using your home as the security for your practice Goodwill?

Set this valuable asset free to grow your personal wealth with a Medfin Goodwill.

With up to 100% finance for approved applicants, Medfin’s Goodwill is secured against your practice – not your home.

Want more information?Call your local Medfin Relationship Manager on 1300 361 122 or visit medfin.com.au and request a quote.

Important Information: Because we do not know your personal objectives please consider whether this product is appropriate for your circumstances. Before acting on any of the information in this brochure, please seek independent financial advice. Approved customers only. Subject to credit assessment. Terms and conditions apply. Fees and charges apply. Medfin Australia Pty Limited ABN (89 070 811 148). A wholly owned subsidiary of National Australia Bank Limited (ABN 12 004 044 937), and part of the NAB Health specialist business. (B8/11)

Bite.indd 1 21/07/2011 2:18:11 PM

“At the end of the day we still have to fix people’s teeth and amalgam is still the best option available in most cases.”Dr Ron Georgiou

LED’s be independent

Regardless of which unit or drive you are using, new Alegra LED turbines lightyour way with their very own light supply. The secret? A built-in generator. Thelight? Neutral, white and pleasing. The downside? No other device comes close bycomparison. The Alegra LED series: now available from your specialist retailer.






120 Years W

&H.


ren’s Villages!

100519_WH_AD_ALEGRA_AEN_A4_ADEC:Layout 1 19.05.10 11:58 Seite 1

120 Years W

&H.


ren’s Villages!

120 Years W

&H.


ren’s Villages!

LED’s be independent

Regardless of which unit or drive you are using, new Alegra LED turbines lightyour way with their very own light supply. The secret? A built-in generator. Thelight? Neutral, white and pleasing. The downside? No other device comes close bycomparison. The Alegra LED series: now available from your specialist retailer.






120 Years W

&H.


ren’s Villages!

100519_WH_AD_ALEGRA_AEN_A4_ADEC:Layout 1 19.05.10 11:58 Seite 1

©2011 A-dec® Inc. All rights reserved.AA580_Inkredible1637-17



1637-17_AA_"led's be independent"_AD Mag_1A.indd 1 25/01/11 5:49 PM

34Handpiece product guide

Advertorial

34 Bite

W&H the leader in handpiece design

When it comes to dental handpieces, one company stands out as a quality and technology

leader, backed by a class-leading two-year warranty.

This is the view of Shal Hafiz, the W&H Product manager at A-dec, which has chosen W&H instruments as an original equipment supply partner for A-dec delivery systems.

“W&H has a reputation for quality and reliability which is also a cornerstone of A-dec, making W&H a partner of choice, as well as enabling dentists to get the very most out of their A-dec delivery systems,” Mr Hafiz said.

Mr Hafiz said W&H’s premium Synea handpieces are the quietest and most powerful on the market, yet also have the narrowest head profiles and by far the best LED lighting system available.

Synea handpieces also feature a 5 port ‘Penta Spray’ cooling system, providing effective cooling at high speeds. This is especially important when using today’s powerful oral evacuation systems, which can result in overheating of the bur and possible damage to the tooth pulp when using less efficient handpiece cooling systems.

A history of world firstsDentists may be surprised to learn W&H produced its first dental handpiece in 1895 and has never stopped innovating. It is no exaggeration to say W&H is responsible for some of the most significant developments in handpiece design over the past 120 years.

“In fact, it’s hard to think where handpiece design would be today without the pioneering work of W&H and its many breakthrough innovations. This includes the precursor to the modern contra angle - patented by W&H back in 1907 - and the first endodontic handpiece, the W&H Endo Cursor, patented in 1926.”

Just a few of the many W&H milestones over the years include

the addition of transmission gears to handpieces, the world’s first air- operated ball bearing turbines, the first push-button chuck system for FG burs (Turbo 60) and the first-ever 1:5 speed-increasing contra-angle with 200,000rpm cutting speed.

See better with LED+Today the user has access to W&H turbine instruments that are lightweight, quiet, powerful, have better oral access due to miniaturization and with class-winning LED+ technology.

The secret to the effectiveness of W&H LED handpieces is in the patents surrounding the quality of light produced by the LED chip and its positioning right near the head of the instrument.

Mr Hafiz said the patented W&H LED design has the greatest brightness, widest focal beam and highest colour rendering index (CRI) of any LED lighting system. This makes it possible to differentiate between healthy and diseased hard and soft tissues and see more clearly through the coolant spray during procedures.

LED lighting is available in W&H’s premium Synea LED+ turbines and handpieces also the innovative Alegra and W&H surgical ‘independent’ LED+ instruments.

W&H quality at an affordable priceNew for 2011, W&H introduced the Alegra high-speed turbines with ‘independent’ lighting. The Alegra represents a more affordable option, backed by W&H manufacturing quality while still giving access to superior LED+ technology.

The Alegra independent High Speed is an ideal retrofit to any delivery system as it produces its own power from a miniature internal dynamo and does not require an external power source like light-equipped motors, lighting modules in the delivery system or expensive fibre optic tubing. This makes Alegra a cost effective upgrade to any delivery system to provide the benefits of the

very best LED+ illumination.The entire range of Synea and

Alegra turbines is sterilisable and thermodisinfectable. Synea turbines are available with and without light, both with Roto Quick as well as Multiflex connections for a universal fit.

Class leading warrantyMr Hafiz added that despite their superior quality, W&H handpieces provided good value to the dental professional. “There are cheap handpieces out there with inferior ‘add-on’ LED lighting and with lesser quality internals and construction. W&H stands by its product with a full two-year warranty on its Synea handpieces, providing further peace of mind for the investment in such a premium precision instrument.”

“Any dentist who wants to deliver the very best in preventative or restorative dentistry, periodontics, endondontics, maxillofacial surgery and prosthetics, could not go past W&H instruments and equipment,” Mr Hafiz said.

More information is available from A-dec at www.adec.com.au

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Don’t skimp on your dental handpiece!

It’s hard to imagine a more crucial instrument to the practice of modern dentistry than the modern handpiece, yet dentists often

skimp on this vitally important tool. The handpiece is quite literally at the cutting edge of both reconstructive and prophylactic dentistry. A high speed or speed-increasing handpiece is a precision instrument and must operate at extremely high RPM, be lightweight, comfortable and ergonomic to use. As such, quality is all-important.

Using the wrong handpiece will result in less-than-optimum clinical results, and unnecessary operator fatigue, according to precision handpiece manufacturer, W&H.

Experience has shown that noisy handpieces also contribute to patient anxiety, especially during extended use.

W&H product manager at A-dec in Sydney, Shal Hafiz, said modern advances by W&H have produced a range of handpieces with technical innovations of real benefit to dentists and patients alike.

“The newest W&H Synea LED+ is a precision instrument allowing dental professionals to deliver the very best treatment and achieve the best

productivity with the least effort.”Mr Hafiz said the Synea range

delivered better performance than any other LED equipped handpiece for a number of reasons:

Superior illuminationW&H is the pioneer of LED lighting in dental handpieces and patented a process that delivers a colour temperature of 5,500K corresponding to natural ‘daylight’. This quality is guaranteed by integrated ballast electronics to consistently produce powerful quality light in all W&H LED handpieces.

High colour rendering index (CRI)W&H is the first manufacturer to successfully achieve an unprecedented high colour rendering index (CRI) of 90 with LEDs. Conventional LEDs attain only a CRI of between 60 and 85, which gives a coloured cast. A high CRI makes a significant contribution to optical perception. Also the red component of lesser quality LEDs is too low - a considerable drawback for dentistry and oral surgery. Synea turbines, on the other hand, take advantage of new LED+ technology. The result is a CRI over 90, which

allows high-contrast natural rendering of red shades in the mouth.

Perfect LED positionBy placing the LED chip directly on the head of the instrument, W&H Synea and Alegra turbines offer the largest illumination area. As the powerful LED is mounted close to the bur, illumination of cavities is optimised. The perfect positioning of the LED also contributes to the greater brightness and optimum rendition of colour that can be lost through the ‘traditional’ glass rod design. Instead of the light being focused as a bright point, the W&H LED+ gives a broad field of illumination to optimise visibility during procedures.

Small headSynea LED turbines also offer the best possible visibility thanks to their compact head sizes, which enables the dentist to focus on the treatment area and take full advantage of the superior LED lighting. At the same time Synea turbines are both quiet and powerful, delivering 17-20W of power and capable of bur lengths up to 25 mm.

Information on W&H instruments and equipment is available from A-dec on 1800 225 010.

Opposite page, top: Only W&H LED’s CRI of 90 allows high-contrast natural render-ing of red shades. Bottom: Output of W&H LED+ com-pared to ‘spotlight’ effect of competitor brand. This page: The Synea LED+ Penta-Spray turbine in action, and (right) the new Alegra instruments.

MICRO-SERIES ERGONOMICS& PERFORMANCEPerfect balance and handling, exceptional power and control,

uniquely versatile.

The Micro-Series micromotors, contra-angles and handpieces

redefi ne the standards for dental instruments.

The Bien-Air Micro-Series brings together new LED micromotors

and the new generation of ultra-short contra-angles and handpieces.

The result is a combination which is up to 30% shorter and 23% lighter

than previous generation models, while still offering the power and con-

trol of the best electric micromotors on the market.

The best performance / ergonomics / price-ratio on the market,

the best of Bien-Air.

Standard version

Micro-Series

Turbine

Ph 02 8865 0300 www.williamgreen.info

Visit u

s at A

DX Melb

ourne

2011

Stand

47 Se

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— 37Handpiece product guide

Advertorial

Micro-series: size matters

Bite 37

MICRO-SERIES ERGONOMICS& PERFORMANCEPerfect balance and handling, exceptional power and control,

uniquely versatile.

The Micro-Series micromotors, contra-angles and handpieces

redefi ne the standards for dental instruments.

The Bien-Air Micro-Series brings together new LED micromotors

and the new generation of ultra-short contra-angles and handpieces.

The result is a combination which is up to 30% shorter and 23% lighter

than previous generation models, while still offering the power and con-

trol of the best electric micromotors on the market.

The best performance / ergonomics / price-ratio on the market,

the best of Bien-Air.

Standard version

Micro-Series

Turbine

The Bien-Air MICRO-SERIES brings together the new range of Bien-Air contra-angles and handpieces with the new

generation of micromotors with LED light. Up to 30 per cent shorter and 23 per cent lighter, the Bien-Air MICRO-SERIES units offer you the very best in terms of grip and balance, guaranteeing more precise control and less fatigue at the end of the day. Why? Simply because they are shorter and lighter, yet they still offer all the technological advantages of conventional models.

MICRO-SERIES, welcome to a new dimension.

Micro-series instrumentsThe new Bien-Air Micro-Series contra-angles and handpieces offer you the very best in terms of grip and balance, guaranteeing more precise control and less fatigue at the end of the day. Why? Simply because they are shorter and lighter. Despite this, they are still as ultra-precise, reliable and quiet as conventional models.

Micro-Series CA 1:5 L Ref. 1600690-001Micro-Series CA 1:1 L Ref. 1600691-001Micro-Series CA 20:1 L Ref. 1600692-001Micro-Series PM 1:1 Ref. 1600693-001

MX2 micromotor

Micro-Series instruments

Standardversion

Micro-Series

0 10 000 20 000 30 000 40 000

Speed (rpm)

30

20

10

0

Torq

ue (m

Nm

)

Bien-Air MX2 LED

Brand K

Brand ST

Brand W

Brand N

MICRO-SERIES INSTRUMENTS

The new Bien-Air Micro-Series contra-angles and

handpieces offer you the very best in terms of grip

and balance, guaranteeing more precise control

and less fatigue at the end of the day. Why? Sim-

ply because they are shorter and lighter. Despite

this, they are still as ultra-precise, reliable and quiet

as conventional models.

Micro-Series CA 1:5 L Ref. 1600690-001



Micro-Series PM 1:1 Ref. 1600693-001

MX2 MICROMOTOR THE LITTLE PRODIGY

The MX2 brushless micromotor, with adjustable

LED light, is Bien-Air’s latest little prodigy. Despite

its compact size, it offers the same performance as

the famous MX micromotor: power, versatility (at low

speed), and perfect control of the speed, torque and

reversing the direction of rotation, features which

have earned Bien-Air its place as the uncontested

leader in dental micromotors. Another key feature

of the MX2 is its soft, more natural LED light with

adjustable intensity. Thanks to its lifetime-lubricated

ball-bearings, the MX2 is a maintenance-free ster-

ilizable micromotor which offers further improved

standards of hygiene and ease of use.

The Micro-Series instruments are compatible with

Bien-Air’s new short nose motors.

MX2 Ref. 1600677- 001

MC2 LED Ref. 1600681- 001

MC3 LED Ref. 1600680- 001

MICRO-SERIESSIZE MATTERS

Bien-Air Dental SA Länggasse 60 P.O.Box 2500 Bienne 6 Switzerland Tel. +41 (0)32 344 64 64 Fax +41 (0)32 344 64 91 [email protected] internet : www.bienair.com

Bien-Air USA, Inc. Medical Technologies 5 Corporate Park Suite 160 Irvine, CA 92606, USA Phone 1-800-433-BIEN Phone 949-477-6050 Fax 949-477-6051 [email protected]

Bien-Air UK Ltd Arundel House Unit 1 - Ground Floor Amberley Court Whitworth Road Crawley West Sussex RH11 7XL Tel. +44 (0) 1293 550200 Fax +44 (0) 1293 520481 [email protected]

RE

F 2

50

04

07

/ P

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Sw

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land

Mx2 micromotor— the little prodigyThe MX2 brushless micromotor, with adjustable LED light, is Bien-Air’s latest little prodigy. Despite its compact size, it offers the same performance as the famous MX micromotor: power, versatility (at low speed), and perfect control of the speed, torque and reversing the direction of rotation, features which have earned Bien-Air its place as the uncontested leader in dental micromotors. Another key feature of the MX2 is its soft, more natural LED light with adjustable intensity. Thanks to its lifetime-lubricated ball-bearings, the MX2 is a maintenance-free sterilisable

micromotor which offers further improved standards of hygiene and ease of use.

The Micro-Series instruments are compatible with Bien-Air’s new short nose motors.

MX2 Ref. 1600677- 001MC2 LED Ref. 1600681- 001MC3 LED Ref. 1600680- 001

*3M ESPE Data on file.

3M, ESPE, Impregum, Imprint, Penta, Pentamix and Position are trademarks of 3M or 3M ESPE AG.

Please Recycle. Printed in Australia© 3M 2011. All rights reserved. PB5182/0611

3M Australia Pty Limited. 950 Pacific Highway, Pymble NSW 2073. ABN: 90 000 100 096 Ph 1300 363 454

3M New Zealand Limited. 94 Apollo Drive Rosedale, Auckland 0632 Ph 0800 80 81 82

NEW

It’s precision!It’s not just a syringe.

More precision, less waste, easier handling: get it all in one.The single-use syringe features all you can wish for to prepare an accurate and flawless impression*:

• Excellent ease of use – easy to load, easy to dispense, ergonomic design.

• Precise application leads to excellent accuracy of final restorations.

• Very hygienic usage and procedure: no messy clean-up, no disinfection.

• Choice of wash material type and brand.

• Less waste material within mixing tips compared to common gun dispenser.

Impregum™

Intra-oral Syringe Single-Use Syringe for Polyether

Imprint™ 3 Intra-oral Syringe Single-Use Syringe for VPS

Innovation for Wash Delivery!

For a FREE sample please contact your local 3M ESPE representative Australia www.3M ESPE.com.au New Zealand www.3MESPE.co.nz

Bite 39

Tools of the tradeThis month, the smallest, cheapest and most effective way of dealing with excess gutta percha; the best OPG for impants; and much, much more

Bite 39

Touch ’n Heat 5004by Dr John Cropley, John Cropley Dental, Nelsons Bay, NSW

The Touch ’n Heat 5004 is manufactured by SybronEndo, a company that specialises in endodontic instruments. This small and manoeuvrable handpiece is used to melt excess gutta percha once you have completed a root canal.

What’s good about itThe traditional method for removing excess gutta percha was to heat a metal instrument over a bunsen burner, carry it over to the patient and use it to tidy up the root canal.

Not surprisingly some patients found this to be quite a scary process. The Touch ’n Heat is so much more convenient. There’s no mucking around, no open flame and the perception for patients is much better. The instrument has a very small tip so the heat stays localised to that area.

There are similar instruments to this on the market but they are all quite high tech. Most of them offer the option to dial up the amount of heat. The operator can set it anywhere on a temperature gradient from 180 degrees up to 220 degrees. The drawback of these other units is that they are larger and much more expensive.

What I particularly like about the Touch ’n Heat is that it’s probably the smallest, cheapest version of these types of devices and yet it does the job easily and efficiently.

What’s not so goodThe only drawback is that after continuous use, the tip tends to discolour and bend. You need to replace the tip about every six months or so.

Where did you get itHenry Schein Halas.

Galileosby Dr Jeremy Norris, Noosa Dental, Noosa, QLD

Galileos is an OPG that produces a three-dimensional image of the skull. It takes about 500 slices and then creates a composite picture that allows you to fly around the image. It’s also possible to take a section through whichever plane you choose.

What’s good about itI specifically chose this machine because it works great with implants. Galileos allows you to do all the positioning and shows if there is going to be a problem. That problem can then be fixed with a bone graft or whatever is required to get the position just right. Once the position of the implant has been planned, software links it with a Cerec to place the crown exactly where you want it. So before you have taken an impression or done anything surgically, the finished product is positioned where you can see it. It’s also really fantastic for checking past root-canal fillings by allowing you to look around the root of the tooth. We had a patient with impacted wisdom teeth and the standard X-ray revealed nothing. He was complaining about mild pain so we took a scan with Galileos and discovered a huge cyst. Even though it had nearly broken through his mandible, it would have been missed without a 3D scan.

What’s not so goodThere are so many different settings that I simply don’t have time to learn them all. The technician set it all up really well when it was installed but every now and then I’ll need to change something. I then have to call the technician.

Where did you get itSirona.

39Your tools

Reviews

*3M ESPE Data on file.

3M, ESPE, Impregum, Imprint, Penta, Pentamix and Position are trademarks of 3M or 3M ESPE AG.

Please Recycle. Printed in Australia© 3M 2011. All rights reserved. PB5182/0611

3M Australia Pty Limited. 950 Pacific Highway, Pymble NSW 2073. ABN: 90 000 100 096 Ph 1300 363 454

3M New Zealand Limited. 94 Apollo Drive Rosedale, Auckland 0632 Ph 0800 80 81 82

NEW

It’s precision!It’s not just a syringe.

More precision, less waste, easier handling: get it all in one.The single-use syringe features all you can wish for to prepare an accurate and flawless impression*:

• Excellent ease of use – easy to load, easy to dispense, ergonomic design.

• Precise application leads to excellent accuracy of final restorations.

• Very hygienic usage and procedure: no messy clean-up, no disinfection.

• Choice of wash material type and brand.

• Less waste material within mixing tips compared to common gun dispenser.

Impregum™

Intra-oral Syringe Single-Use Syringe for Polyether

Imprint™ 3 Intra-oral Syringe Single-Use Syringe for VPS

Innovation for Wash Delivery!

For a FREE sample please contact your local 3M ESPE representative Australia www.3M ESPE.com.au New Zealand www.3MESPE.co.nz

Your tools Reviews

40 Bite

Straumann Guided Surgery Kitby Dr Terry Rose, Smile in Style, Moonee Ponds, VIC

I purchased the Straumann Guided Surgery Kit in early 2011 and have completed 10 implants (four single and one full upper arch with six implants) using the kit. To perform guided implant surgery you need a range of things in place, including a guided surgery kit. Of course, training is a necessary prerequisite for success.

I have done a number of Straumann courses and the implant mini-residency course offered by Progressive Orthodontics and Dentistry (POS course) in Sydney. The Straumann sister products to the guided surgery kit are Codiagnostix software) and Gonyx (surgical guide production). Both are unavailable in Australia and can not be supplied to Australian customers through Europe or the US markets. The Straumann Asian division considers Australia too small a market at this stage to launch and support these products. POS implant training enabled me to plan my cases and build my own diagnostic guides. Initially, I exported the cone beam multiformatted DICOM files to 3DDX.com in the USA for planning.

Recently I purchased Simplant to import cone beam files and do all my planning in-house. The surgical guide production is still done through Materialise Dental. When using the Straumann, longer drills are needed for the osteotomy, so care must be taken with planning when moving posteriorly and if there is inadequate opening. It’s

also necessary to ensure the guide is stable during the procedure, including use of fixation screws in fully edentulous cases.

What’s good about itMore relaxed, faster surgery. Less likely to need to raise flaps. Increased accuracy in determining implant placement. Fewer rude surprises on post op PA’s. More control!

What’s not so goodMore time in planning. Higher costs to patients (surgical guides through Materialise Dental add an extra $1000 to the procedure). Having said this, most patients recognise the value in ideal implant placement and are willing to bear the additional cost. Higher costs in setup with software, guided surgery kit, diagnostic and surgical guides. Further training is also needed.

Where did you get itFrom Straumann Australia (second kit sold in Australia).

Call us on 1300 855 966 for a demonstration

Including the important Sterilisation Tracking module

Protaperby Dr Nick Teo, Tindale Dental, Penrith, NSW

Most dentists dread working on root canals because of hand files. I always say to my colleagues, if you aren’t using a rotary endo, that’s probably the reason why you hate root canals. When I started at Tindale Dental, they were using the Protaper system and my boss strongly suggested I take a course and learn how to use it. My life immediately became much easier.

What’s good about itThis rotary endodontic instrument makes root canals a whole lot easier and quicker. It produces a consistent and reproducible result that doesn’t leave you with a horrible thumb cramp like the old hand files. It also allows you to access teeth further back in the mouth.

The files that come with this system are nickel-titanium which makes them very flexible. You could grab a file, bend it into a U-shape and it will spring back to its original position. That’s not to say that you don’t occasionally get breakages when the canal is extremely curved. However, it very rarely happens with the Protaper system because of the torque strength and speed of the file settings.

What’s not so goodBeing a fairly straightforward instrument, there’s not much more that can be done to improve it. It cleans out the canals, rarely breaks and can be controlled in the same manner as a hand file. It’s a very consistent tool. The only way it could be improved is if the material from which it is manufactured was upgraded so that it could negotiate canals more easily.

Where did you get itDentsply.

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42 Bite

During the ’90s, I was very keen on high-altitude trekking and climbing. I climbed Kilimanjaro, Mera Peak and joined Tim

Macartney-Snape on a reconnaissance climb in North-ern India. While I was on K2 with Peter Hillary [son of Sir Edmund Hillary], I saw helicopters perform a few high-altitude rescues. I decided that when I got tired of sleeping in the snow and the wind on freezing moun-tains, that’s what I would take up.

“In 2001, I enrolled part-time at helicopter flying school and it took me 22 months to get my commer-cial licence. In 2003, I purchased a fast, four-seater Robinson 44 helicopter, picked it up in Queensland and flew it back to WA with another pilot. The heli-copter has about a 600km range, so the journey was

completed in a series of hops to refuel. It took us four days.

“For my 50th birthday, my wife Jan and I took three months off and travelled around Australia in this he-licopter. We flew across the red centre to Brisbane then

coastal to Thursday Island, around the Gulf of Car-pentaria, across the top to Darwin, and down the WA coast via the majestic Kimberley. The following year, we followed the southern coast across the Nullabor and flew from Cape Ottaway to Tasmania. I also use my helicopter during our work with remote commu-nities. The Kimberley Dental Team goes out to the communities about every second day. At the moment we have four final-year dental students from the UWA working with us alongside another 22 volunteers. All get to see these communities up close. It makes them think about social justice issues and cultural sensitivities. Without the helicop-ter, this would be impossible.

Dr John Owen AM, Midland Orthodontics, Midland, WA

42Your lifePassions

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“I also use my helicopter during our work with remote communities.”

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launches on Sept 16

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DENTSPLY eStore

experience it live at ADX11 stand 24

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2260 eStore Bite ad Aug 2011.indd 1 5/08/11 2:27 PM

Not a Qantas Frequent Flyer member?Nominated persons can join through Gunz Dental and pay no joining fee (a saving of AU$82.50) orongoing membership fees+. Simply visit qantas.com/joinffgunzdental and follow the prompts tobecome a Qantas Frequent Flyer member. The nominated persons new Qantas Frequent Flyermembership number can then be included on the Gunz Dental registration form.

Important Information# Eligible Customers means dental practices or dentists who have an account with Gunz Dental and do not fall within the list of excluded customers (suchas corporate, government, not for profit and healthcare fund customers) as set out in the Gunz Dental Rewards Program terms and conditions.* To start earning points on eligible products, the Eligible Customer and nominated points earner must join the Gunz Dental Rewards program and the nomi-nated point earner’s Qantas Frequent Flyer membership number must be provided to Gunz Dental. The Gunz Dental Rewards enrolment form is available atgunz.com.au. Gunz Dental Rewards program membership is subject to the Gunz Dental Rewards terms and conditions available at gunz.com.au/rewards.Qantas Frequent Flyer points are earned in accordance with and subject to the Gunz Dental Rewards terms and conditions. Exclusions and limitations apply.Points are earned on eligible products only and exclude alloys. Qantas Frequent Flyer membership and the earning and redemption of points are subject to theQantas Frequent Flyer program terms and conditions available at qantas.com/frequentflyer.+ A joining fee usually applies, however, Gunz Dental has arranged for this fee to be waived for nominated persons who aren’t already members and applyusing the website link set out above.^ Classic Awards are subject to capacity controls and availability is strictly limited. Store products are available for delivery in Australia and New Zealand only.

Visit gunz.com.au/rewards for full details, terms and conditions.

TALK TO USPh: 1800 025 300 Fax: 1800 025 202 www.gunz.com.au

JOIN TODAY!Earn one Qantas

Frequent Flyer point*for every dollar spent on

eligible purchases atGunz Dental.

Announcingthe Gunz Dental Rewards Program!

Earn Qantas Frequent Flyer points with the Gunz Dental Rewards ProgramEligible Gunz Dental Australia customers# can join the program and nominate themselves or one eligible individual to earn Qantas Frequent Flyer points with Gunz Dental. The nominated points earner will be credited with one Qantas Frequent Flyer point per $1 spent* by customers on selected dental supplies, equipment and services purchased from Gunz Dental.

You’ll be surprised how quickly Qantas Frequent Flyer points can add up for great rewards! They can be redeemed for Award flights and upgrades (if available) or choose from an extensive range of quality merchandise, retail and travel vouchers and exceptional experiences at the online Qantas Frequent Flyer store^.

It’s easy to get started!Already a Qantas Frequent Flyer member? To start earning points, if your practice has an eligible account, simply complete the registration form and provideus with your nominated points earner’s Qantas Frequent Flyer number and we’ll link it to your Gunz Dental account!

1. Visit gunz.com.au/rewards to download the registration form2. Return the completed registration form to Gunz Dental (post or fax)3. Once your registration form is processed, nominated persons can then earn one Qantas Frequent Flyer

point per $1 spent on eligible products purchased on the Gunz Dental account.

QFF Gunz Ad ADP:Layout 1 19/07/11 11:27 AM Page 1

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