Bite Magazine February 2009

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Food fightsWhat dentists can do to fight the tricks of multinational junk food advertisers, page 8

Loan rangersWhat to look out for when you’re looking for finance, page 24

Target practiseThe best way to market your practice, page 27

Running for coverHans Zoellner and others are fighting the government to keep a successful public dental scheme open

Tools of the tradeReviews of SimPlant software, SDI Lojic +

Amalgam and Cerec 3D, page 31

Take your partnerHow to make sure your partnership doesn’t go pear-shaped, page 20

PassionsWhat Dr James Younessi learnt from DVA patients

could fill a book—and did, page 34

BiteISSUE 41, FEBRUARY 2009 $5.95 INC. GST

BETTER BUSINESS FOR DENTISTS

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NEWS & EVENTS 4. News and eventsA new report by the Health Issues Centre confirms the link between low incomes and poor oral health; Triodent launches a new impression tray that minimises crown distortion; and Treasurer Wayne Swan announces a 10 per cent investment allowance for new assets purchased before June.

YOUR WORLD Running for cover

With public dentistry in crisis, one Federal program seemed to promise a solution to treating some of the neediest patients. So why’s the government now doing everything it can to destroy it?

12 Cover story

Features

YOUR BUSINESS 8. Flying in the teeth

Advertising is a strong beast, fed with money and

governmental backing. Michelle Starr asks the

question: what can dentists do about it?

20. Howdy partnerTaking on a partner or

buying into a practice can work either for or against

you. Maureen Shelley weighs the advantages and

disadvantages of working with an associate.

24. Debt and taxesChoosing a loan to fund a new practice purchase or fancy fit-out is about as thrilling as a bucket

full of amalgam. But not all loans—or the facilities

that hand them out—were created equal, as Lucy

Robertson reports.

27. Target practiceThere’s more to marketing

than handing out flyers and an ad in the Yellow Pages. Dominique Antarakis talks

about finding the right method for your practice.

YOUR TOOLS31. Product reviews

A virtual 3D porcelain replacement builder, a fast and cheap amalgam, and

implant surgery simulation software make light

work this month.

YOUR LIFE34. Passions

When Dr James Younessifled war-torn Iran, he never expected to follow the path

of dentistry, as his literary tendencies attest.

02Contents 03

Bite 3

Issue 41 / February 2009

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Editorial Director Rob Johnson

Sub-Editor Michelle Starr

Contributors Dominique Antarakis, Kerryn Ramsey, Lucy Robertson, Maureen Shelley, Danielle Veldre

Creative Director Tim Donnellan

Designer Mahnaz Parman

Advertising & Marketing Manager Maxine Guterson

Commercial Director Mark Brown

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

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.

Suite 4.08, The Cooperage 56 Bowman Street Pyrmont NSW 2009

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A new report has confirmed the link between low incomes and poor oral health.

ost people joining public dental waiting lists in Victoria

have very acute needs and much poorer oral health than the Australian average, according to a new study launched in December by the Health Issues Centre.

“Yet, despite improve-ments in recent years by the State Government, such low-income Victorians are still having to wait over two years at this centre for care—a to-tally unacceptable and unfair situation,” said Tony McBride, CEO of Health Issues Centre. “The Senate’s blockage of $72.9 m of funding ear-marked for public dental services is denying around 258,000 Victorians timely ac-cess to dental treatment.”

The report was welcomed by the Federal Health Minister, Nicola Roxon, who issued a press release say-ing the findings of the study “confirm the urgent need for more funding for public dental care—and demonstrate ex-actly why Australia needs a Commonwealth Dental Health Program.”

The issue of the crisis in public dental health care flared up again at the end of last year as the Minister refused to release funds from the new program until the Senate agreed to scrap the Medicare Enhanced Primary Care program (for more on this, see our cover story on page 12).

The Health Issues Cen-tre study—Why Is He Not Smiling: The Dental Costs Study—was conducted with

Dianella Community Health and Dental Health Services Victoria. It found strong evi-dence of continuing inequali-ties in oral health status.

“Alarmingly, less than four per cent of the study partici-pants had what could be de-scribed as healthy teeth and gums, and of those that had visited a dentist in last year, over half were for emergency treatment,” said McBride. The report also indicated that, because of the high acute needs, a very low eight per cent of care was able to be focused on preventive care (eg. scaling and cleaning), despite the high need for it.

“This report shows the high needs of our clients and the urgency of increasing the level of dental services we can provide. We must be able to act quicker so that chronic conditions do not arise, as this report shows they are,” said Dianella CEO Mark Sullivan.

The study also examined the costs to the government of long waiting lists. There was little difference in costs to the system for the care planned for those at the be-ginning or end of the waiting lists. However, this calculation

did not include any emer-gency treatment provided elsewhere (e.g., at Dental Hospital), or co-payments by consumers or the social costs on them. Also, the estimated cost of the dental work planned by dentists was much higher than the state average of public care actu-ally provided in Victoria.

McBride added that most people had some significant social impact from their poor dental status, e.g., ongoing pain, poorer sleep, restric-tions on what they ate.

“We need greater capac-ity in the system to reduce the dental waiting list,” he concluded. “We also need greater focus on prevention and ways to maximise oral health while people wait for dental treatment.” £

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Can’t afford dental care? Your oral health will be poor. Wow!

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Teen dental expandsThe government announced the Medicare Teen Dental benefit has increased from $150 per eligible teenager to $153.45 from the beginning of January. The scheme has also been slightly extended to include teenagers (aged 12-17) receiving the Disability Support Pension, Parenting Payment, Carer Payments or Special Benefits. The Department advises that approximately 15,000 teenagers will become eligible for the Medicare Teen Dental Plan as a result of this amendment.

The new rules are available for viewing at: www.frli.gov.au £

There was little difference in costs to the system for the care planned for those at the beginning or end of the waiting lists.

Poor oral health

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Triodent launches the TriotrayA new impression tray that minimises distorted crowns.

There’s nothing much worse than that moment

when you try in a crown and it won’t fit. It’s why there has always been a lot of suspicion about the reliability of triple trays, says Triodent CEO Dr Simon McDonald.

But Triodent, which has a reputation for innovative dental solutions, is launching the Triotray, a metal posterior impression tray that Dr McDonald says is the most rigid and accurate tray around.

He is confident that the tray will be as much of a winner as Triodent’s V3 Sectional Matrix System. Early feedback from

dentists certainly seems to indicate that it will be.

The metal tray’s unique and key feature is the bendable side tabs, which support the impression material and, most importantly, prevent the tongue from distorting the lingual arm of the tray. Dr McDonald says it helps to see the problem from the patient’s point of view. “They are asked to close together with this glob

of slow-setting material in their mouth. They’re lying back, trying to protect their airway, and of course they can’t always control their tongue, so it often puts upward pressure on the lingual part of the tray. The tongue is very strong and can cause significant distortion and the dentist has no idea it’s happened. Once the impression is removed, it is sent to the lab and, during transit, it ‘bounces-back’, causing a distorted impression.”

Another useful feature of the Triotray is its thin, rigid design in the retro-molar area, which allows the patient to close easily and comfortably in centric occlusion. The side tabs can be bent to fit all mouths, and the design eliminates the need for tray adhesive.

Triodent continues to reap the benefits of another of its brilliant ideas, the V3 Sectional Matrix System. For two years in a row, Triodent has been among the top 10 fastest-growing companies in New Zealand and was recently named the country’s fastest-growing manufacturer.

In 2007, Triodent’s revenue growth, measured over the previous three years, was 940 per cent. As the company has matured, that growth has begun to even out, but it still managed a stunning 392 per

cent revenue growth in the three years to 2008.

Triodent’s mantra is “innovative, simple, smart”, not for show, Dr McDonald says, but because he firmly believes the future of the company lies in finding easier, better ways for dentists to do their jobs. In the past year, the success and growth of the company has allowed him to focus

even more on research and development. No surprise, then, that 2009 should begin with a new product—and expect more good news as the year goes on.

For more information about Triodent products, including the V3 Ring, V3 Matrices and Wave Wedges, call 1800-350-421 or visit www.triodent.com £

The side tabs can be bent to fit all mouths, and the design eliminates the need for tray adhesive.

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At the end of last year, Fed-eral Treasurer Wayne Swan announced a temporary 10 per cent investment allowance for new assets purchased, ordered or commenced construction prior to 30 June 2009. The investment allowance will take the form of an addi-tional tax deduction equal to 10 per cent of the cost of acquiring or constructing the new asset.

“By boosting business confidence and encourag-ing business investment, this measure will provide an important short term stimulus to the Australian economy in the face of the

global financial crisis,” Swan said in a press release.

The investment allowance is in addition to the $10.4 bn Economic Security Strat-egy designed to bolster households and business-es, strengthen the economy and support jobs during the global financial crisis.

“In practical terms, this is an added incentive for businesses to proceed with their investment plans in this difficult environment,” the Treasurer said.

The investment allowance will apply from 12.01 am AEDT 13 December 2008 until the end of 30 June 2009. To be eligible for the investment allowance, a taxpayer must start to hold the asset under a contract

entered into between those times, or start to construct the asset between those times. Assets must also be installed ready for use by the end of 30 June 2010. The allowance is claimed through the income tax re-turn of the taxpayer for the year the cost is incurred.

The investment allowance will be confined to new as-sets and new expenditure on existing assets, used in Australia. It also excludes capital works, such as land and buildings, trading stock, and intangible assets and rights.

The investment allow-ance applies to expenditure over $10,000 on individual assets. Where an asset is used partly for non-taxable purpose, only the portion used for taxable purposes will count towards the $10,000 threshold.

The Treasurer said the measure is estimated to cost $1.6 bn over the for-ward estimates period.

For more details, contact the ATO on 132 866. £

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Federal Treasurer Wayne Swan

08 Your world junk food

Flying in the teethAdvertising is a strong beast, fed with money and governmental backing. Michelle Starr asks the question: what can dentists do about it?

ustralia is now the most obese nation in the world and, ac-

cording to a 2006 World Health Organisation study, we also have the fastest growing childhood obesity rate. However, small indus-try organisations fighting to combat this are facing an uphill battle.

“We’re fighting multi-national entities that have enormous advertising bud-gets. The ADA’s a minnow compared to them,” says Australian Dental Associa-tion CEO Robert Boyd-Bo-land. “We’re an association of dentists, funded solely by dentists, we don’t receive governmental assistance.”

But what has obesity to do with dentistry? Obesity is

caused by poor diet—which also causes poor oral health. And junk food con-sumption has risen dramati-cally in the last 20 years.

Could the increase in junk food intake be accounted for, at least partially, by junk food advertising? Well, yes. That’s what advertising is for. And another alarming statistic shows that, with 30 per cent of ads during children’s viewing time be-ing for food and drink, 81 per cent of which are for junk food, Australia has the highest rate of junk food advertising during children’s television in the world.

However, when the Australian Communications and Media Authority (ACMA) released a draft of the long-overdue revised Children’s

Television Standards in Oc-tober last year, it had made no changes to the current rate of food advertising on children’s television. ACMA declined to comment to us on this decision, but chair-man Chris Chapman told The Sydney Morning Herald that current data does not indicate a clear causal link between junk food advertis-ing and poor health due to junk food consumption.

ACMA also stated in a report about the draft that the economic impact of restricting or banning junk food advertising to children far outweighed any benefit to health that may occur. In light of this, it seems there is very little the dental industry can do to fight the advertis-ing juggernaut.

The trick is not to at-tack head-on at the same level. “We try and provide educational campaigns,” says Boyd-Boland. “We can’t mount significant PR, television commercial-type campaigns—we just don’t have the funds for that—but we do what we can with the budget we have.”

This can include any-thing from making sure the ADA website contains the most up-to-date oral health information to running educational programs for Dental Health Week to call-ing out advertisers the ADA feels are overstepping their bounds. This latter is what happened in October 2008, when Coca-Cola released a series of advertisements whose message flatly con-

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The ACMA reckons junk

food advertising doesn’t cause

health problems. Bollocks to that,

say dentists.

tradicted oral health mes-sages from the ADA.

“The advertisement was attempting to dispel certain myths in relation to Coca-Cola, one of which was that Coca-Cola rots teeth,” says Boyd-Boland. “We just said, ‘Look, that’s plain silly, that isn’t the case, it is detrimen-tal to teeth and it shouldn’t be misrepresented’.” And ADA president John Mat-thews went on to add, “We shouldn’t rely upon Coca-Cola for giving us dental health advice.”

It’s a lot like a tug-of-war, with each side attempting to educate the public accord-ing to its own agenda.

“We conduct oral health education campaigns indicating the importance of a good diet in relation

to maintaining good oral health,” says Boyd-Boland. “Healthy diet, healthy teeth has always been one of our mantras.

“The Dental Health Week campaign in August, we called it Dental Bootcamp, was very popular in the schools. It was a week-long multi-step program that we created that encouraged kids to look after their teeth. It was directed to parents, teachers and kids. The me-dia picked it up and it went to a readership of over 10 million Australians.”

The Dental Bootcamp was a seven-day program with educational materials and exercises designed to teach children about the impor-tance of oral health, each day concentrating on one

aspect, culminating with a visit to the dentist. Dentists helped distribute information and the fact sheets and ex-ercises remain on the Dental

Health Week website for anyone wanting a refresher course. Of course, the suc-cess of such campaigns is difficult to measure—but reaching as many people as possible is key.

But it’s the people at the top who have the power to make serious changes and getting heard—and listened to—at that level is an en-tirely different ball game.

The ADA is also a member of the Coalition on Food Advertising to Children (CFAC). Focusing on televi-sion advertising, the CFAC lobbies extensively to raise awareness of and to try and get restrictions placed around junk food advertis-ing to children. “The CFAC is a coalition of public health organisations who recognise

“We conduct oral health education campaigns indicating the importance of a good diet in relation to good oral health. Healthy diet, healthy teeth has always been one of our mantras.” Robert Boyd-Boland, Australian

Dental Association CEO

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Your world junk food

that the commercial promo-tion of unhealthy foods and beverages high in fat, sugar and salt to children is a significant concern to their nutrition and future health,” says Chair Kathy Chapman.

Like the ADA, the CFAC works from a grass-roots level. The main aim is to make sure that the voice of the consumer is heard, through such tactics as the Pull the Plug postcard campaign. This saw the CFAC collect over 20,000 postcards signed by parents calling for restriction—or outright ban—of junk food advertising to children.

“It’s important that the government listen to views of parents who overwhelm-ingly support restrictions on junk food advertising when children are watching TV,” says Chapman. “In a ran-

dom survey conducted last year, 86 per cent of parents supported a ban on advertising of unhealthy foods at times when chil-dren watch TV; and 89 per cent agreed the government should introduce stronger restrictions on food adver-tising at times when children are watching.”

Such tactics have, after all, had some kind of effect: in late October, the Aus-tralian Food and Grocery Council pledged to only advertise healthy food to children under 12 from January 2009. “This code is a step in the right direction,” says Chapman.

“But the proposed code is voluntary and only applies to programs that are specifi-cally shown to children aged under 12 years old. It does not apply to the peak chil-

dren’s viewing times of 6pm to 9pm, when large num-bers of children are watch-ing popular TV programs.”

As such, the CFAC is still pushing for compulsory gov-ernmental bans—and the ADA continues in its own way to educate the Austra-lian public, in spite of the odds against it. “Dental care

is not a sexy topic,” says Boyd-Boland. “But at least there appears to be some recognition of the problem from the campaigning that’s being undertaken.”

It is very much an up-hill battle—but the small victories won along the way show that it’s very much a battle worth fighting. £

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Sugary drinks—even fruit juice—can be the worst thing for teeth.

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12 Your world dental Medicare

ue Alexander lives in Ulverstone, a small tourist town on the mouth of the Leven River on Tasmania’s northwest coast. Even though it’s off the beaten track, it has good private medical and dental services. This is a blessing for Sue, because she’s going to need medical help for the rest of her life.

Sue suffers from Complex Regional Pain Syndrome, a chronic condition for which there is no known cause and no known cure. A variety of treatments exist to alleviate the pain, but these

lead to other problems: “The medications I take cause dry mouth and I’m at risk of bone density problems,” she explains. “I don’t heal well, and if I go to the dentist and need a filling, the needles can cause the condition to spread—at the moment it affects my hands and feet, but needles may possibly spread it to my face.”

It goes without saying that a treatment plan for Sue would require regular attention from a dentist, and could be more complex, and expensive, than one for a regular patient. Luckily for Sue, her GP knew about the Enhanced Primary Care (EPC) program, a virtually unknown and under-utilised scheme where eligible patients could get Medicare rebates of up to $4250 over two years. Even the Australian Dental Association—long opposed to any form of Medicare dental—praised the scheme: “[The EPC

program] should ensure more complete treatment will be deliv-ered,” then-ADA president Dr John Matthews said in a lukewarm press release when the scheme was announced.

In November 2007, Sue got a referral for her dentist, Dr Ian Flint. The EPC scheme was no mystery to him: “We already had half a dozen people accessing the scheme when Sue came along,” he says. Sue’s first appointment was in December 2007, and she made a second for the end of March 2008.

But on 25 March, Sue received a letter from the Department of Health and Ageing (DHA) informing her that “The Medicare dental scheme will be closed to new patients after 30 March 2008”, and that “No Medicare benefits will be payable for any dental services provided after 30 June 2008”.

At the same time, Sue’s dentist received a similar letter. There was only one problem. The letter was wrong. The EPC scheme wasn’t closed. But it seemed no-one from the government or the Department was planning to tell patients.

Selective blindness The Minister for Health, Nicola Roxon, has long made clear that the Federal government intends to close the EPC scheme, or Medicare dental. In a speech to Parliament on 12 March last year, she described Medicare dental as a “failing program” that had only helped 15,000 people in four years, “including not a single child or person under the age of 24 in the Northern Territory and not a single child under the age of 14 in South Australia.” She

It’s open! It’s closed! It’s a success! It’s a failure! With public dentistry in crisis in Australia, one federal program seemed to promise a genuine solution to treating some of the neediest patients—the chronically ill. So why’s the federal government now doing everything it can to destroy it? Rob Johnson reports.

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Associate Professor Hans Zoellner, chairman of

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added that the scheme was not targeted to the finan-cially disadvantaged, but any wealthy person lucky enough to have a chronic illness could waltz into the dentist and de-mand subsidised treatment.

“We agree that it [Medicare dental] helped some people,” the Minister conceded, “but we made a decision, as governments need to, about the way we can help the most people.” To be fair to the Min-ister, it’s possible the sudden success of Medicare dental took the government by surprise. Up until the end of 2007, it was a failed scheme. It was only when the previous government expanded the services covered and rebates available that it really began to take off.

At the time of the Minister’s speech, the services delivered under the scheme had been roughly doubling every month since November-December 2007: from 16,000 at the end of 2007 to 22,000 in Janu-ary, approximately 45,000 in February and approximately

90,000 in March 2008. It was true that few teenagers or young people had accessed the Medicare scheme—be-cause the Medicare scheme was only available to the chronically ill. Few young people met the criteria.

The government’s argument that the scheme isn’t targeted at first appears disingenu-ous—how could a scheme so narrowly targeted to chronical-ly ill people not be targeted? Again, to be fair, if you look at the Medicare scheme in social equity terms, the Minister is right. It isn’t targeted. Neither, for that matter, is Medicare itself, which is available to everyone. But to accept that part of the Minister’s argu-ment, you must first accept that health issues are primar-ily about social equity—not about health.

Fighting back On June 19 last year, the coalition, minor parties and independents teamed up in the Senate to block the government’s proposal to

scrap Medicare dental. Minis-ter Roxon subsequently wrote to dentists, reminding them about the Federal government dental schemes that were being introduced in the new financial year: the Medi-care Teen Dental Plan and

the Commonwealth Dental Health Program (CDHP). The letter stated “The CDHP will commence on 1 July 2008” (writer’s emphasis).

In the same letter, she wrote that the government’s clear intention was to dis-continue Medicare dental because: it was not targeted to patients in financial need;

it was complex for patients to access; and has had limited uptake in many areas and from many needy populations.

One could add that the lim-ited uptake was linked to the fact the government had told many patients the scheme had closed. The letter said savings from closing Medicare dental would go towards off-setting the cost of the CDHP and Teen Dental schemes.

But, while the Minister wrote to dentists to inform them Medicare dental was still oper-ating—but nearly closed—no-one bothered to tell patients. Sue Alexander found out by accident in August last year. “I was after a referral for a phys-iotherapist,” she explains, “so I was looking on the Medicare website and found out the scheme was still going. That was the first time I knew it hadn’t been scrapped.”

It was news to her dentist, Dr Flint, too. He had assumed the scheme had finished. Incensed, Sue wrote to her local member, Sid Sidebot-tom. When she found his reply unsatisfactory, she rang a reporter who worked at the lo-cal paper, The Advocate, who followed up the story, asking Sidebottom why patients hadn’t been told the scheme was still available.

The explanation the Member offered is bureaucratic double-speak worthy of Yes, Minister. “It would be misleading for the Rudd government to write to every person currently using this scheme to inform them of its limited continuation, as it may end up costing them a lot of money,” he told the paper. In other words, telling a lie is acceptable because the lie may come true in the future: telling the truth, however, would be ‘misleading’, in case the lie became true. High demandSo why is the Federal Govern-ment so determined to close

Your world dental Medicare

“I was looking on the Medicare website and found out the scheme was still going. That was the first time I knew it hadn’t been scrapped.”Sue Alexander

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Without Medicare dental, Sue Alexander will not be able to afford treatment for her chronic illness.

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the Medicare scheme if it appears to be working? One possible explanation lies in a Parliamentary Library brief-ing paper dated 30 October. That paper said the number of dental services provided under the Medicare scheme up to August 2008 totalled 818,749, with “total benefits paid reaching $133.8 m for the period”. In nine months, with limited publicity and active government discour-agement, Medicare dental had cost nearly half the entire three-year funding allocation for the new Commonwealth Dental Health Program.

In order to pressure the op-position and minor parties in the Senate into changing their minds, the Government de-cided to delay the introduction of the CDHP. This created a whole new raft of problems.

The government’s intran-sigence on this issue—you can either have a CDHP, or Medicare dental—forced other organisations to choose between the two. State area

health services, for example, were keen to see the Labor promise of a CDHP become reality. “We would very much like to get the CDHP up and running,” says Dr Peter Hill, acting chief dental officer for NSW Health, “because that will assist the patients that we deal with.”

Despite the Minister signing off on each state’s propos-als for spending the CDHP money, no cash has been forthcoming. Staffing and planning commitments have been made, but now funds will have to be found from existing money.

Dr Flint explains the prob-lem quite succinctly. “Tasma-nia-wide, the public dental system is terrible,” he says bluntly. “And all of the state systems are similar. I think patients should be treated in the private system if they can afford it and the public system if they can’t. But the real prob-lem is there aren’t sufficient staff in the public system to deal with demand.”

Following the Australian Health Ministers’ Confer-ence in December, the States asked the federal government to release part of the money set aside for the CDHP to cover costs already incurred.

“The government said it will consider doing that,” Dr Hill says. “They have always said they will negotiate with the Senate, but, realistically, it’s going to be difficult.” As a result, NSW Health has re-quested Area Health Services write to all patients currently on waiting lists for dental care to let them know they may be eligible for dental care under the Medicare EPC scheme if they have a chronic health condition which affects their oral health. The grim truth Two other lobby groups came out strongly in support of the government’s position. In a newspaper story published at the beginning of December last year, the Australian Health and Hospitals Association (AHHA, a lobby group for State public services) and the National Rural Health Alliance (NRHA, a government-funded

lobby group for rural health issues) said that accord-ing to Medicare data, nearly 40 per cent of funding had been spent on unnecessary procedures, like purely aes-thetic crown and bridge work. An anonymous dentist was quoted saying that “greedy” dentists were using the un-regulated Medicare scheme to give patients aesthetic work.

Although there has been some debate about the interpretation of the figures, even supporters of Medicare dental acknowledged there was a higher-than-expected amount of crown and bridge work being done under the scheme. But is it really a case of multi-millionaire patients with chronic illnesses and movie star smiles?

Chris Planer has been using the scheme since he found out it was available (follow-ing research by his dentist). “I don’t know how much is left in the pot for me to use,” he says. As a result of his cancer treatment he requires ongoing dental work. “At this stage I’m using what I have to,” he says.

In 2005, Chris was diag-nosed with carcinoma in the floor of his nose and the roof of his mouth. By the time he could get surgery, the tumour had spread to his forehead. Plastic surgeons reconstructed his face during a 16-hour oper-ation. Afterwards, he required chemotherapy and radiother-apy, the latter of which burnt a hole through his new nose, requiring further surgery. The result was a need for regular dental treatment. “Neither I nor my dentist were aware of the [Medicare dental] scheme at first,” he says. “My dentist looked into it when he realised there was a fair bit of treat-ment and ongoing work.

“I had two crowns done. I had one tooth that I had chipped and I lost a lot of nerve endings—nerve end-ings were damaged during the cancer treatment—so to repair that, they had to take away a tooth and replace it with a crown.”

Chris bristles at the sug-gestion that crown and bridge work done under Medicare dental is just cosmetic work for wealthy people. “The crowns weren’t done to look good,” he says, then adds, poignantly; “If you saw my


Despite the Minister signing off on each state’s proposals for spending the CDHP money, no cash has been forthcoming.

Minister for Health and Ageing Nicola Roxon believes the EPC scheme simultaneously ineffective and too widely available.

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face, a couple of crowns aren’t going to make me feel any better about it.”

Minister Roxon is vaguely familiar with Planer’s case, in so much as it has been covered on SBS television and in The Sydney Morning Herald. When his story was bought up in Parliament on 12 March last year, she said Planer should not have been covered by the Medicare den-tal scheme, and that’s why the government’s proposed replacement—which would push Chris into the waiting list for public dental services—would be preferable.

While newspaper stories were about greedy dentists rorting the Medicare system, Gordon Gregory, NRHA ex-ecutive director, says the po-sition of NRHA—and, for that matter, of the AHHA—was that both Medicare dental and the new CDHP could be maintained, merely by limiting the services available under the Medicare scheme.

“The NRHA had some sym-pathy with the view that the EPC should be abolished if that was the only way to fund the CDHP,” he says, “until we saw there was a way we could have both. We know the geographic distribution under the EPC is pretty bad. But when the AHHA came and said here’s a way we can get the cost of the EPC scheme down and have both programs—even the Liberals were pro the idea.” Have cake and eat it? A leading voice in opposition to the government’s plan is Associate Professor Hans Zoellner, chairman of The Association for the Promo-tion of Oral Health (APOH). He acknowledges flaws in the Medicare dental scheme, but points out that it is still having positive impact on the limited group of eligible patients. Furthermore, he is frustrated

that the scheme’s alternative is manifestly inadequate. He points out that the CDHP is a ‘top-up’ to already-exist-ing state funds, and that the amount of public funding per patient differs significantly from state to state. However, the Medicare scheme is the same generous rebate, no matter where you live.

Also, as is well known, the current state dental services are already overstretched. Under the Medicare system, patients can see a private dentist anywhere. For that reason, Zoellner believes, at the very least, the government should retain both systems.

“Sure, that’s going to cost them money,” he says. “I’m pretty sanguine about that. Our association is not the ‘Association-for-saving-the-federal-government-money’. It’s very clear that people need dental services. They’re not getting them, so we’re promoting the delivery of oral health services. And I can’t accept the idea that Australia is so impoverished that we can’t afford the expense.”

APOH began to promote the Medicare scheme to its membership base, which is primarily in NSW. “We have very good contacts with the Council of Social Service of New South Wales (NCOSS) here,” he says, “and it’s through NCOSS and its contacts that we were able to alert special interest health groups to the existence of this scheme.” As a result, up until September last year, 57,796 patients in NSW were treated under Medicare dental. By contrast, the scheme is not being used as much in other states. In WA, where APOH has virtually no contacts, the scheme has had a very poor uptake, with fifty times less service than in NSW.

By his own admission, Zoellner has had some “frank” email exchanges with various


ADA state branches over the issue, and much of that comes down to APOH’s general support for the idea of all dentistry being covered by Medicare, as opposed to the ADA’s position that only financially disadvantaged pa-tients should be covered by Medicare. But despite their philosophical differences, all sides within the profession acknowledge (albeit some-times reluctantly) the benefits of the EPC scheme.

“It’s cumbersome, it’s bu-reaucratic, yes,” says Zoell-ner. “Can it be improved? Yes, of course. Is it an instru-ment of the devil? No. It’s just another way through which people can receive treatment, and for the patients who haven’t got money, you can now, through this scheme, deliver comprehensive care. I worked in general practice for 10 years, and I would have loved there to be an EPC scheme for patients who couldn’t afford to pay. That would have been fantastic.” Political expediency We tried several times to contact Minister Roxon to discuss the government’s position on Medicare dental and the CDHP in more detail, but she was unavailable for comment. But based on pub-lic statements she has made, the government’s basic op-position to Medicare dental appears to be that it was only targeted to sick people, and was universally available.

That presents the problems with public dentistry in Aus-tralia as a social equity issue. But Hans Zoellner argues it’s not a social equity issue—it’s a health issue. Policy should be informed by discussions of a patient’s health needs, not by their bank balance. He proposes a more elegant so-lution to the current impasse that would cost no more money, and maintain both

programs as they are. And it involves looking at the $490 m Medicare Teen Dental scheme.

“The Teen Dental Plan is to fund an examination for a teenage kid every year,” he says. “Now, the current stan-dard in the public system for teenage kids is an examina-tion every two years. So all the Federal Government has to do is say we’ll get teen dental in line with the public system. That would halve

the cost of the Teen Dental program by nearly the total cost of the CDHP. They could fund it just by doing that.” But would they?

“There’s no way they’ll do that. Because with the current Teen Dental system, every year, every eligible household gets a voucher—written proof that Kevin Rudd loves you. Every year, Kevin loves me so much, he’s given me $150 worth of dental treatment for my little rascal of a teenager.

“But when my teenager turns 20, he can rot. Or if my kid is 8 years old and has non-insulin dependent diabetes, he can rot as well. Or if you’re a 48-year-old, overweight bearded bastard like me, you can also rot.” Snowball in Hades On December 11, the Min-ister put out a press release

describing Medicare dental as “the Liberal’s failed dental scheme” despite the exis-tence of a Background Note from the Parliamentary Library which said demand for the scheme “has skyrocketed since its introduction”. The Minister said the alterna-tive, Labour’s CDHP, would deliver services targeted at “key priority groups including people with chronic illness”.

The release said; “The Coalition must reconsider their irresponsible opposition to this desperately needed injection of funds into public dental services”. But it’s the Minister who is refusing to release the funds.

After 11 years of neglect under the coalition govern-ment, it seems the brief flash of hope that public dentistry in Australia would have its problems addressed has been extinguished. £

Zoellner: “I worked in general practice for 10 years, I would have loved there to be an EPC scheme.”

“Teen Dental is proof Kevin Rudd loves me. But when my teenager turns 20, he can rot. Or if my 8-year-old has diabetes, he can rot as well.” Hans Zoellner

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20 Your business partnership

Howdy pardnerTaking on a partner or buying into a practice can work either for or against you. Maureen Shelley weighs the advantages and disadvantages of working with an associate.

any people enter general dentistry practice

because they like to be their own boss—but while it may be great to be an individualist, if you want to expand a practice, enter employment or buy into a partnership, then the things that make you successful as an individual may make you a poor partnership prospect.

Business consultant Andrew Lawson of Best Practice Consulting is one who knows. In a former life, he co-owned a dental practice, and he and his associates work with dozens of practitioners each year helping them to improve their business.

“We work with dentists on the simple things and

get them to do those things well,” Lawson says. “We’ve helped 10 to 20 dentists a year, and some of them have grown their practices by as much as $900,000 within 18 months.”

Lawson says many of the advantages of a partnership as a business structure are financial. Partnerships are relatively cost effective to establish, they can be less complicated than a company structure and are relatively simple. Getting a partner into a business can mean halving the costs of both set-up and the ongoing costs of the practice. “With a minimum set-up these days of $200,000 and fitouts up to $1m possible (which I wouldn’t recommend), setting up a practice is expensive,” Lawson says.

However, he counsels, there are pitfalls for the unwary. “It’s important that both established practices where the dentist may want to move into retirement or the practice has grown and an associate is needed, or for new businesses, that everyone’s expectations of the other are very clear.

“It’s amazing, really, that people can get very nasty when their expectations aren’t met.”

He recommends the first thing you should do is create a document. “It is important that you set out the expectations and conditions.

“Secondly, a trial period is good for both parties. Having to work alongside each other means that you can see whether you are going to be able to work together,

you can test whether you have the same values. Do you both feel the same way about quality care and customer service?

“Thirdly, it’s important to have open communication. If you can iron out these things in advance, you are well on your way.

“Finally, I tell people to consider getting external advice. Before entering into a partnership, you should at the very least consult your accountant and your lawyer—it would also be good to consult a business advisor. When you consult those experts, ask them about the value of the practice—is the cost worth it? Ask them about the agreement—is it fair and equal? If these things are ironed out in advance, then

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many conflicts can be avoided.”

Professor Geoffrey Meredith from The University of New England (UNE) concurs that setting out each party’s expectations clearly is essential for a better partnership. He adds that an understanding of business management is vital.

In fact, the business of dentistry has become so complex there are now tertiary diplomas available in dental practice management for dentists and their administrative staff.

UNE has around 600 to 700 new students each year studying practice management, mainly in dental and medical practice.

As well as covering legal, financial, marketing and client service issues, course graduates are also able to determine the feasibility of a new practice opportunity; develop a business plan; and review the practice’s performance.

“We’re not concerned with clinical care, and we don’t cover it,” Meredith says. “We expect that doctors are providing skilled and competent care.

“We focus on the business of practice management because most patients are satisfied with the clinical services they receive, but often leave the practice because they are dissatisfied with management matters.

“They have to wait too long for an appointment or too long when they get to the surgery. And there is a lack of follow up.

“As soon as a patient contacts the practice, the communication during their visit and the communication after their visit, these are all important. The person who does the mechanical work associated with that is the administrative staff.

The communication is approved and supervised by the dentist, but is done by someone else.

“This communication has a dramatic impact on patient satisfaction but dentists are very reluctant to delegate it to the people who are qualified to do it. There is a gap—the gap is management, and that is where the dentists can say to staff: ‘We want you to do this for us’,” he says. “You can put much of it down to communication.”

According to Meredith, graduates of the Diploma of Practice Management have a 99 per cent satisfaction rating with the courses provided by UNE.

“We follow up with our students, and we have

detailed feedback from our graduates and the dentists who put through their staff. Most of them modify their practices and their partnerships then work much better.

“Our general philosophy is to encourage doctors to hand over the administrative and management sides to administrators, while doctors are still in charge and calling the shots. That way the practices improve and the patients and the dentists are much happier. Our graduates are very positive.”

Long-term practicing dentist Dr Tony Wasserman believes that partnerships can work, provided that the more experienced dentist works as a mentor with the junior dentist.

“When I started out as a young dentist, I was bullied. I entered into a partnership, but it wasn’t an equal partnership and it didn’t work out. It got into the legal area and it was very unfortunate,” Wasserman says.

As the principal of Chatswood Dental Centre on Sydney’s North Shore, Wasserman has run a successful practice for more than 30 years.

“I’ve employed associates, but as employees. I haven’t had a partner, but I’m in that transition period now and in the next two to three years, I’ll have to take someone on.

“I think partnerships can work, but you have to have compatible personalities. I think before you go into it, a trial period is essential. You need to make sure you have the same values—a Myers Briggs personality test could help to see if you can work together and get along. And I think that training for the senior dentist in how to work with a partner and the junior dentist would be helpful.”www.practicemanagement.edu.au

www.bestpracticeconsulting.com.au £

“Our general philosophy is to encourage doctors to hand over administrative and management side to administrators while doctors are still in charge and calling the shots. That way the practices improve and the patients and the dentists are much happier.”Professor Geoffrey Meredith from The University of New England

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Delegate the small details, and you and your partner can concentrate on the bigger picture.

24 Your business dental finance

Debt and taxesChoosing a loan to fund a new practice purchase or fancy fit-out is about as thrilling as a bucket full of amalgam. But not all loans—or the facilities that hand them out—were created equal, as Lucy Robertson reports.

ost people will apply for a loan at some point. And while it

might be fun to decide what colour to paint your new practice, choosing where you’re going to borrow the money from is not nearly as sexy. Unfortunately, it’s the latter that often sticks around the longest, with many loans still being paid off long after the feature wall has faded.

But it doesn’t have to be like this. With new, specialised money lenders populating the market, it might actually be possible to get a loan from somebody who genuinely understands your specific needs and can structure your finance to suit. Really.

NAB Health specialises in finance for medical profes-sionals like dentists. Manag-ing Partner James Carter says a loan facility like his offers finance against the value of the dental prac-tice—instead of a dentist’s own house.

“There are a number of reasons that a specialised loan is a good idea for dentists,” he says. “For starters, a dental practice or doctor’s surgery requires a significant amount of money to get things set up, which means the business costs a lot before anybody has even come in for treatment. So we can lend against the value of that practice and it means we don’t necessar-ily have to use a dentist’s house as collateral.”

Jannali-based dentist Dr Vincent Blefari used a loan from NAB Health to pur-chase his current practice, Health First Dental. Priding himself on using the latest technology in his surgery, he also purchased new equip-ment through Medfin.

For Dr Blefari, the choice to go with NAB Health was more due to the fact he had existing loans through them rather than any specific ben-efits he came across during his researching of finance options. Still, he’s happy with the result.

“I have history with the NAB,” he explains. “I started my medical career with a loan from them. I’ve used my house as collateral to borrow money in the past and that’s allowed me to

move further forward in terms of setting up practices and buying in equipment.

“When I bought this prac-tice, my loan was divided into two elements: NAB covered the purchase of the practice and a reburbish-ment was funded through Medfin. Then the whole thing was brought together under one goods and chat-tel mortgage, so it was very neat and tidy—and it had some tax advantages, too.”

Dr Blefari is the first to admit he wasn’t interested in getting into the fine print of his chosen finance. Like most dentists—and, indeed, most borrowers in gen-eral—he relied on specialist advice for that.

“Obviously I have an ac-countant who knows what

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Don’t go to this guy. His hair is too fabulous.

Never trust a lender with fabulous hair.

he’s doing; he insisted that the goods and chattel loan was the way to go,” he said.

Carter explains that, as Dr Blefari’s accountant pointed out, any loan used to finance a business should suit the life expectancy of that business and the equip-ment in it. This, he says, is another advantage of using a specialist lender.

“In the case of funding as-sets like dental equipment, which usually has a useful life expectancy of around seven to 10 years, you can structure your loan repay-ments for the same period,” Carter says.

“So you’re matching the funding of that asset with the life of that asset. It’s a more attractive option than a longer-term loan that

you’re still paying off long after the equipment is out of date.”

Or before the paint on the feature wall has faded, as the case may be.

“The other main advan-tage of using a specialised

lender is that, wherever you have a loan used to fund the set-up of the practice, that debt should be tax deduc-table,” Carter continues.

“Some dentists, if they don’t get the right advice, end up with a debt that’s notionally against the family home and potentially not tax deductable.”

NAB Health “sits side-by-side” with similar medico lender, Medfin, in an arrangement that further streamlines the borrowing process for dentists.

“We use them to coor-dinate the funding options for dental equipment and similar assets in a dental practice,” says Carter. “It works well, because they know all the manufactur-ers and can give advice

on things like maintenance costs and the expected life of the equipment.”

This level of cooperation between different lenders might seem like a foreign concept for many borrow-ers, who find themselves explaining the nature of their business several times before they’re finally under-stood by a bank—if at all.

Carter says this ‘one-stop-shop’ feature is a ma-jor advantage when looking at specialised lenders.

“A dentist predominantly deals with just one partner, who coordinates all of their leases, loans and other wealth management prod-ucts like business protec-tion insurance. That partner can arrange everything the dentist needs them to do

“The main advantage of using a specialised lender is that, wherever you have a loan used to fund the set-up of the practice, that debt should be tax deductable,” James Carter, NAB Health,

Managing Partner

Your business dental finance

without having to obtain any permissions or get access to other institutions.

“And, because that partner is also only dealing with medicos, they develop a better understanding of what’s best practice in the industry and what compet-ing dentists might be doing. The dentist essentially has access to all that informa-tion through their NAB Health partner, which can be a huge advantage for time-poor practitioners.”

Of course, not everyone agrees that specialist lend-ers are the way to go—or that they’re any different to a regular bank.

One Sydney-based ac-countant who specialises in loan structuring says each borrower has a different set of circumstances that makes them more suited to

one specific type of loan—or one specific type of lender—over another.

“Every business has costs involved—especially in those early stages of start-up. A bakery owner needs to buy their mixing equipment and industrial ovens. A fisherman needs to buy a boat and purchase a fishing license. A farmer needs to build fences and buy stock. Most of them will get some kind of loan to fund those assets, and a dentist is really no different to any of them, except that their costs are particular to dentistry,” he says.

“A cynic would say that specialty lenders exist just as a way to make certain high-income borrowers feel special and are , therefore, a more appealing choice to those types of custom-

ers. And that’s really not a problem, as long as the dentist has independent advice about the best way to structure their loan in the first place. After they are fully versed in what their op-tions are, it’s nothing more than a personal choice.”

But Dr Blefari disagrees: “I think dentists are quite unique in terms of their large start-up costs. If a dentist chooses to set up their own practice, they’re up for a huge amount of money straight away. And there’s also no question that the overheads needed to run a practice are expensive.”

Further, he says, young dentists just out of university are more at risk of falling into the high-debt trap than their older counterparts.

“I was lucky that my university degree was gratis,

so I had no debt when I was starting out in my career. But today, many young den-tists are coming out of their university degree with huge loans to pay back—some-times as much as $100,000 or $200,000. So unless they’re in the fortunate position of having some-one who can pay for that course, they start out with a big debt before they’ve even had the chance to set up a business. It makes me very grateful that I did my dentistry degree when I did it,” Dr Blefari says.

All things considered, re-gardless of who you are and what your costs are, finding the right loan seems more important now than ever. And having someone who understands your specific needs could just be a step in the right direction. £

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Target practiseThere’s more to marketing than handing out flyers and an ad in the Yellow Pages. Dominique Antarakis talks about finding the right method for your practice.

ou’re an existing dentist and would like to grow your business, or a

recently established dentist and you want to build a client base. Should you use internal marketing techniques if you are already established or try external methods? If you’re a newcomer, what method is best for you?

Marketing and business experts agree that dentists should ask these questions—but they may not necessarily be the ones dentists should start asking first.

Douglas Nichol of Mongrel Marketing says that dentists “understand oral hygiene but not marketing hygiene”.

“They need to start with the basics,” he says. “They need to look at their existing patient database and understand who their customers are. Then they need to take a look at their appointment book and see when they have time available.

“Most dentists have holes to fill in their day. There’s no point in doing a mail-out—even to your existing clients—if you are going to attract more people for the times of the day when you’re already busy.

“If you’re considering marketing, you need to reach customers who are going to fill in the gaps,” he says.

Business consultant John Lawson of Best Practice Consulting agrees. “It’s more important to target your marketing than to decide whether you want to use internal or external marketing methods. You may need to use both,” he says.

The marketing hygiene factors that dentists should ensure they are practising, according to Nichol, are: ¢ know your existing customer base; ¢ know your catchment area;¢ become familiar with your target market; and ¢ be proactive in marketing your business.

“They could start with simple things, like asking

existing patients if there is anyone else in the family who could use their services.

“My wife was taking our three children to a local dentist and I was going to a dentist in the city. It didn’t really suit me and, after about two years, I switched to the local practice. The local dentist could have had my custom a lot sooner, if they’d asked,” Nichol says.

Lawson agrees that many dental practices could target their marketing efforts better than they currently do.

“Dentists have to define who their target audience is before deciding whether internal or external marketing is the way to go,” he says.

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“They need to analyse their client database and understand what that database’s makeup is. How many male or female patients do they have? How many are teenagers or older people? Are they servicing younger people?” Lawson asks.

“Is it a family practice or is it a singles practice? Many dentists believe they inherently know who their audience is, but what they think and what it is may be very different.

“Dentists need to decide whether they want to continue with the market segment they have; or go upmarket to a more affluent market; or target a different segment,” Lawson says.

Before launching an expensive marketing campaign, Nichol suggests spending time getting to know your existing client base as well as the demographic of the area in which the practice is based.

“If you know who your customers are, then how long are they going to stay with you and what are they likely to spend in that time?” Nichol asks.

“There’s no point deciding to spend time and money pursuing new patients only to find it costs more to get them

than they will spend in the first year.”

Working out how much you can afford to spend in recruiting a new patient is matter of analysing the customer database. If you don’t have a customer database, then start with the demographics of the area in which the practice is based, he suggests.

“You can buy data from companies who will map people within a 20-minute drive of your business. They will do a pen portrait of the different social profiles with the four or five that dominate in your catchment area,” Nichol says.

Nichol says that at $150 to $250 per 1000 names, plus a set-up charge, this is value for money. Alternatively, you can go to the Australian Bureau of Statistics website or that of your local council for a demographic profile of your area. This secondary data should then be used as a general guide for your marketing efforts.

“There’s no point in specialising in children if you have a large retiree population in your area,” says Lawson. “Many dentists would like a really varied family practice, but they may not have the groups

Seek out your target demographic during their leisure time.

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needed to fill out their appointments—you need to work with what you’ve got.”

Dr John Hardman of Complete Family Dental employed Integrated Dental Marketing (IDM) to maximise traffic to the practice’s website. Hardman, working with IDM and his son, made use of search engine optimisation (SEO) techniques, so if people search online for a dentist in the Blacktown or Quakers Hill area, then Complete Family Dental is in the top 10 Google search listings.

Practice manager Raelene Simmons says about half of the practice’s new patients come through the website. “Last month we had 18 new patients; nine of them came through word-of-mouth and the others all came through the internet,” she says “That is average.”

Complete Family Dental uses a recall system to ensure follow-up visits from patients take place. “Apart from that, we don’t do much marketing. The quality of our practice means we get word-of-mouth referrals, and the website does the rest,” Simmons says.

Lawson says that in order to attract a specific target group, marketing activities should be

based on where those people are. “If you wanted to attract older patients who might want dentures, you could do a 15- to 20-minute presentation on oral care as you age to a group of older people. They go to art or craft groups, social clubs or associations. Go where they go.

“You would target your efforts within a two- or three-suburb radius. You need to demonstrate to your target group that you have the skills for the treatment they need.”

Nichol suggests a simple mail survey to existing clients could tell a dentist a lot about their patients. “You could send out a survey and offer to donate an amount to a local charity for every completed survey returned.

“You could ask them who is in the family, where they go to the dentist now, whether anyone would use other services you offer. The more you know about your patients, the more you can target your marketing efforts,” he says.

Whatever the method, Nichol says the marketing dollar must be targeted and practices shouldn’t spend more than they can afford.

“You need to know the break-even point,” he says. “Say if you want to do a mail-out, and you need a 25 per cent response rate to break even—it’s not going to be worthwhile. But if you only need a five per cent response rate, then it’s a better investment. Or you might find that sponsoring the local soccer team will build a better profile for you than advertising,” he says.

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Best Practice Consulting www.

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Integrated Dental Marketing www.

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Complete Family Dental www.

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“You can buy data from companies who will map people within a 20-minute drive of your business. They will do a pen portrait of the different social profiles that dominate in your catchment area.” Douglas Nichol, Mongrel Marketing

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Your tools reviews

Tools of the tradeA virtual 3D porcelain replacement builder, a fast and cheap amalgam and implant surgery simulation software make light work this month.

31

Bite 31

Cerec 3DDr Andrew Baderski, Andrew Baderski Dental, Ingleburn, NSW

I think back to when I graduated—I’m celebrating my 25-year reunion this year—and this would have been like something out of Star Wars.

It’s a cadcam system for fabricating indirect restorations. You spray a light powder over the tooth so the infrared camera can read it and capture a three-dimensional image on your computer. You then have the option to virtually design whatever you need to repair the tooth. Once you are happy with the design, a ceramic block is fitted into a separate unit and, 15 minutes later, the shaped piece of porcelain is produced.

What’s good about itIt gives you a lot of flexibility and patients only need

one appointment. There is more adjustment required as opposed to the traditional method, where you sent everything off to the lab. However, the extra work is more than offset by the patient getting everything done in one appointment. It’s also better for the tooth, as there is no need to open it twice.

In some cases, you can be less aggressive during preparation and conserve more tooth, which is much better for the patient.

What’s not so goodThere is a steep learning curve, though the software is easy to understand. It’s definitely easier now than it was eight years ago, and that’s going to be constantly evolving.

The purchase price is pretty heavy and there are frequent software updates, so there’s a reasonable cost in maintaining the system. But, as with all high-end technology, there is always high-end maintenance.

Use a virtual 3D image to map out your repair piece, which is built then and there. Piece of cake tooth!

SDI Lojic+ AmalgamDr Andrew Swincer, Lime Dental, Mildura, VIC

I run a busy country practice and needed a fast, cheap restoration solution for the many cusp fractures that were becoming evident. I realised that, with a flexible matrix band and a spherical alloy that flows under load, the patient could bite down and condense the alloy better than I could. SDI Lojic+ Amalgam works well in this situation.

My technique is predicated on wedging a plastic matrix band, painting the cavity with GIC, then quickly placing the bulk amalgam. I hand-condense to spread the alloy and get the patient to bite hard and rapidly on a piece of thin plastic. The band is left in place while the restoration is carved along the anatomy developed during biting.

What’s good about itDue to the strength and malleability of the Lojic+ Amalgam, it’s a fast procedure resulting in tight margins. Minimal steps means decreased technique sensitivity and the result is an inexpensive, long-lasting restoration.

What’s not so goodThe large, five-spill-sized alloy is only available in regular set, which is a bit slow for this technique. It means that only one restoration can be performed for each appointment.

SimPlantDr Sandra Short, Dentartistry, Double Bay, NSW

SimPlant allows me to perform surgery in cyberspace before I go anywhere near the patient’s mouth.

Its software is designed to interpret CT scans. It creates a three-dimensional image of the jaw along with three different X-ray views. All these images are synchronised and can be rotated in any direction.

It is also flexible, since different structures can be made transparent or differently coloured for greater contrast. Surgical guides can be placed over the image and implants are created as exact replicas.

Your tools reviews

General oral hygiene needs, bridges & implants, posterior and anterior usage

Small anterior spaces, endodontic canal scrubbing

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Under ortho wires & for large spaces

Bridges, ortho & general use

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What’s good about itThe guide allows me to place implants accurately. It’s fantastic for big cases where there is not much bone and cases that are close to an anatomical feature like a nerve.

I started off using SimPlant on a small case, which I thought was complete overkill and unnecessary. The image revealed that the patient had a huge incisive canal that I knew wouldn’t have been picked up with an OPG X-ray. After seeing the canal with SimPlant, I realised why it’s such a great tool.

It uncovers all the problems before you get to the surgical stage, which means you don’t have to make allowances or start compensating when you are in surgery. There are no surprises, little stress, little failure and no unknowns.

It is also wonderful for explaining things to patients. When you can show them the anatomy underneath and what you are trying to do, they really appreciate it.

I have found that the more you use SimPlant, the more you realise that it’s vitally important.

What’s not so goodThere is an additional cost to patients. I give them the choice and I explain the pros and cons. Generally, patients are happy to go ahead with it. £

Your tools reviews

Bite 33

SimPlant is like a practise run before you get to the main event.

Your life passions

Dr James YounessiOral and Maxillofacial Surgeon, Hornsby NSW

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34 Bite

T here was a revolution in Iran in 1979, and war

broke out soon after. I was a lad of 11 then. I contrast my peace-ful, fun childhood with the immediate aftermath, which was quite unpleasant, and then migration to, first, the US, and then to Australia—it was quite a lot of upheaval before I managed to settle.

“I felt that there were stories to be told. Had I never been in a revolution, had I never been forced to migrate to this country and learn a new language, I may never have been a dentist. I might’ve chosen the path of literature.

“The first book is entitled From Threads to Fabric. It is a story about two boys, about how their friendship endures. It takes place in pre- and post-revolutionary Iran and it centres around a famous high school. It’s loosely mod-

eled after my own life.

“My second book is about Australianisms. It’s called How Australian Are You? It is a set

of multiple-choice questions testing your knowledge of Australian sayings; like Buckley’s chance, what does that mean.

“I met patients and spoke to them and didn’t understand their meaning. Then I quizzed them and went and researched. That’s how it was; meet somebody and ask them questions—typically it was the DVA old codgers. Sometimes they would tell me furfies, so I would have to go and research to be sure they weren’t pulling my leg.

“It’s been quite one thing to come to work to look after patients; of course, it’s satisfying in itself, it needn’t be seen as a job—certainly not in my case. It’s nice to be able to have that love for your work. The joy of writing is entirely different. I’ve made maybe $50 in royal-ties from writing this book, and that’s been the sweetest money I ever made.” £

“Had I never been forced to migrate to this country, I may never have been a dentist.”

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Bite Magazine February 2009

Documents

Transcript of Bite Magazine February 2009