August 2021 Newsletter

In this edition …

1. Message from the President
2. Recent complaints - Emerging issues and safe practice delivered by dental practitioners
3. Spotlight on new Council members
4. Dental Council of NSW Education and Research Grants
5. Guidance for registered dental practitioners: Using and supplying teeth whitening products
6. Promotion of COVID-19 vaccinations: Further information for healthcare practitioners and other advertisers
7. Enhancements to the Public Register
8. National Boards and Ahpra’s Joint Statement: No place for sexism, sexual harassment or violence in healthcare
9. Health and Wellbeing Support Service for dental practitioners

Message from the President

Welcome to the August edition of the Dental Council of NSW’s Newsletter. 

Unfortunately at the time of writing this message, the entire state of NSW is under Public Health Orders and restrictions. It is acknowledged that current events have affected many of us, our staff, our patients, and our families. 

While these measures are deemed necessary by the government and our health experts to keep us safe, I appreciate the impact that this has had on all of us, both as health practitioners and members of the community. On behalf of the Council, I would like to acknowledge your resilience and extend my appreciation to all of you for ensuring that our staff, patients and community continue to be kept safe.

In relation to the other aspects of the Council and its work, information relating to Council appointments/reappointments was circulated to dental practitioners on 1 July 2021. A couple of our new Council members are showcased further on in this edition of the newsletter.

It is pleasing to report that there has been a decrease in the total number of complaints received about registered dental practitioners during the last financial year. A total of 438 complaints were received in 2020/21, compared to 501 in 2019/20. The majority continue to relate to clinical care.

As you know, registered dental practitioners are obligated to practise within the definition of dentistry and their individual dental practitioner division. You must only perform dental treatment for which you have been educated and trained, and in which you are competent.

In this edition of the newsletter, we highlight emerging issues that have been the subject of complaints in recent years.

The Council continues to engage with stakeholders, including the Dental Board of Australia and professional associations.  Representatives from these bodies attend Council meetings throughout the year and this allows for the exchange of information relevant to dental practitioners in all divisions.

Clinical Associate Professor F. Shane Fryer OAM

President, Dental Council of NSW

Recent complaints - Emerging issues and safe practice delivered by dental practitioners

In recent years, the Council has seen an increase in complaints being made against registered dental practitioners that relate to practitioners practising and/or teaching procedures which involve treatments that the Council considers are unsafe because the risks outweigh the benefits and because the nature of the treatments fall outside treatments or interventions which would typically be performed by a dental practitioner. The Council is also concerned about the level of training and education that precedes these treatments because it raises doubts about the practitioner's competency to perform these treatments. 

These procedures/treatments include:

• periocular cosmetic injections;
• carboxy therapy (injections using carbon dioxide);
• lipolosis (fat dissolving injections); and
• microneedling.

These procedures/treatments appear to be administered for facial aesthetic purposes such as removal of dark under-eye circles and/or fine lines and the treatment of fat deposits.

In relation to periocular cosmetic injections, the Council reiterates that the risks of undertaking these procedures outweigh the benefits to patients because dental practitioners are not trained to recognise and manage sight-threatening complications that may result from injectables administered to the periocular region. 

The Council has also seen complaints about extra-oral injection techniques such as acupuncture, dry needling and trigger point injection techniques, using Botulinum toxin and steroids, as part of treatment options for temporomandibular joint (TMJ) disorders. Some of these techniques were performed in remote areas like the lumbar back region.

These complaints have also raised issues concerning the procurement and handling of medication in line with legislative requirements, concerns about the facilities where these treatments have been performed, including infection prevention and control, and other concerns relating to informed consent and record keeping.

While the overall number of complaints is small, the therapeutic risk to the health and safety of the public, when dental practitioners practise outside their expertise and skills and beyond the usual areas of dental practice, are, in the Council's view, not immaterial, and are, in fact, potentially significant.

The use of botulinum toxin and dermal fillers by dentists

The Council acknowledges that the Dental Board of Australia (the  Board) has defined its expectations regarding dentists and the use of botulinum toxin and dermal fillers in their practice. The Board has also developed a fact sheet for dentists. 

When using botulinum toxin and/or dermal fillers, dentists need to practise within the Board's definition of dentistry. Dentists must also adhere to relevant drugs and poisons legislation and regulations and comply with the requirements of the Therapeutics Goods Administration (TGA).

In addition, in September 2021, amendments to the Poisons and Therapeutic Goods Regulation 2008 will come into effect to improve the safety of the use of cosmetic medicines in NSW.

Cosmetic medicines include:

• Botulinum toxins
• Calcium hydroxyapatite
• Collagen
• Deoxycholic acid
• Hyaluronic acid and its polymers
• Polyacrylamide
• Polycaprolactone
• Polylactic acid

Botulinum toxin and dermal fillers should only be used if the treatment can be justified. Informed consent, including financial consent, must be obtained and the risks associated with the treatment explained to the patient and documented.

Dental Practitioners need to be particularly aware of the patient’s expectations regarding the use of botulinum toxin and dermal fillers and must communicate effectively with the patient to ensure that they are understood and that the patient’s expectations are reasonable or managed accordingly.

Expectations on dental practitioners

The Board defines dentistry as follows:

Dentistry involves assessing, preventing, diagnosing, advising on, and treating any injuries, diseases, deficiencies, deformities or lesions on or of the human teeth, mouth or jaws or associated structures. It includes restricted dental acts (see section 121 of the Health Practitioner Regulation National Law (NSW)).

All dental practitioners are expected to practise within the definition of dentistry and their dental practitioner division. The Board also stipulates that dental practitioners must only perform dental treatment for which they have been educated and trained, and in which they are competent (their individual scope of practice). 

Dental practitioners are responsible for assessing their individual practice and must be aware of their individual competence for each treatment/procedure they perform.  The Board has developed a reflective practice tool to assist practitioners to determine their individual scope of practice and to support continuing professional development.

Good practice, as defined in the Board's Code of Conduct, includes:

• considering the balance of benefit and harm in all clinical management decisions
• practising in accordance with the current and accepted evidence base of the health profession, including clinical outcomes
• facilitating the quality use of therapeutic products based on the best available evidence and the patient or client’s needs
• investigating and treating patients or clients on the basis of clinical need and the effectiveness of the proposed investigations or treatment, and not providing unnecessary services or encouraging the indiscriminate or unnecessary use of health services.

Continuing professional development

Dental practitioners are required to complete a minimum of 60 hours of continuing professional development (CPD) activities over a three-year CPD cycle. The Board reiterates that good practice involves keeping knowledge and skills up to date to ensure that practitioners continue to work within their competence and individual scope of practice.

The Board does not mandate CPD activities. Individuals should exercise professional judgement and ensure any CPD they carry out is evidence-based, relevant, assessed for commercial bias and aligns with their specific learning needs. CPD programs alone cannot be used to increase scope of practice. CPD activities may not provide dental practitioners with sufficient clinical experience to incorporate techniques and procedures into their practice.

The Board's Guidelines on continuing professional development provide direction on the characteristics a practitioner should consider when choosing CPD activities.

Professional Indemnity Insurance Arrangements

The Board's registration standard Professional indemnity insurance arrangements sets out the requirements for professional indemnity insurance (PII).  Dental practitioners must, at all times, be covered by their own or third party PII when practising. 

If any area of practice is specifically excluded from PII cover, dental practitioners must not practise in that area.

Spotlight on new Council Members

Melanie Hayes – Dental Hygienist

Melanie has been a practising dental hygienist since 2007, having worked in general and periodontal practices in NSW and Victoria. She has also worked as a teaching and research academic for the Bachelor of Oral Health programs at the University of Newcastle and University of Melbourne and is currently the Head of Work Integrated Learning in the School of Health Sciences at the University of Sydney.

Over the years Melanie has held many positions including National President and later Chief Executive Officer of the Dental Hygienists Association of Australia, Examiner and Member of the Assessment Committee and Site Evaluation Teams for the Australian Dental Council, and Board Member for the International Federation of Dental Hygienists.

Melanie is passionate about preventive oral health care and ensuring all practitioners engage in safe professional practice. Supporting and mentoring dental practitioners to develop their careers is another important focus for Melanie in our profession.

Melanie feels privileged to be accepted as a member of the Dental Council and looks forward to working collaboratively with other Council members to protect the health and safety of the public and promote safe professional practice. She feels confident that her knowledge, skills and experience as a dental hygienist and academic across a wide range of settings will provide a valuable perspective to the Council. She is also committed to providing fair and ethical assessments and decisions for the protection of the public.

Dianne Sales – Community member

Dianne joins the Council bringing experience from her years working in the public and private health sector, small business owner and Commonwealth service delivery.  Originally studying in health information and adding study in computing, adult education and management, Dianne completed a Bachelor of Management and Professional Studies (SCU, 2001).  

Before retiring from full time work Dianne was a senior manager with NSW Health for over 20 years with responsibility across a range of portfolio areas including clinical and corporate governance, complaint management, quality and patient safety, Work Health Safety, insurable risk and Executive support. Dianne is passionate about customer/client experience and quality and safety and is looking forward to utilising her skills and experience to contribute to the Council. 

Dental Council of NSW Education and Research Grants

The primary role of the Council is to protect the public by managing complaints about conduct, performance and health matters concerning registered dental practitioners practising in NSW and health and conduct matters related to registered students training in NSW.

Under section 41S of the Health Practitioner Regulation National Law (NSW) the Council may establish an Education and Research Account to provide funding for research and education purposes relating to the health, performance and conduct of registered dental practitioners and students.

The Council’s Education and Research Program provides Grants to applicants to undertake approved research/education projects – up to $10,000 per application. Grants are available to applicants who are registered dental practitioners (all divisions) whose principal place of practice is in NSW, or registered students (all divisions) training in NSW. Grants may be awarded to individuals, groups or institutions.

Examples of the types of projects the Council may support include:

• Identification of areas of need in the Council’s regulatory programs. For example, deficiencies in educational programs that lead to registration, identification of risk factors associated with complaints, or the assessment of outcomes relating to health, performance or conduct pathways
• Development and evaluation of Continuing Professional Development courses or training that will support the Council’s regulatory activities. For example, professional ethics, regulatory processes, or training for members of the Council, Tribunals or Panels
• Preparation, coordination and conduct of conferences to convey outcomes of research relevant to the Council’s regulatory work.

The Research and Education Grants Guidelines provide further information about the application process. To apply, please use the Research and Education Grants Application Form.

The Council calls for applications twice a year. Applications for the mid-year round of funding open on 1 March and close on 1 May, and the end of year round of funding opens on 1 September and closes on 1 November.

For more information, please visit the Council’s website.

Guidance for registered dental practitioners: Using and supplying teeth whitening products

The Dental Board of Australia has updated its fact sheet on using and supplying teeth whitening products for dental practitioners.

The fact sheet gives dental practitioners an overview of the laws and professional obligations that apply when they use teeth whitening products as part of their practice. It provides links to useful information, such as medicines and poisons legislation. 

Promotion of Covid-19 Vaccinations: Further information for healthcare practitioners and other advertisers

In March 2021, the National Boards and Ahpra published a joint statement to help registered practitioners and students understand what’s expected of them in giving, receiving and advising on and sharing information about COVID-19 vaccination.

More recently, in June 2021, the Therapeutic Goods Administration (TGA) and Ahpra published a joint statement about the promotion of COVID-19 vaccinations.

All promotion of COVID-19 vaccines must comply with the TGA’s guidance, including where health practitioners and regulated health service providers offer rewards for COVID-19 vaccination. Where promotion of COVID-19 vaccines involves advertising of regulated health services it must comply with both the TGA’s guidance and advertising requirements of the National Law.

The TGA’s guidance and the advertising requirements of the National law do not apply to information about COVID-19 vaccines provided as part of a consultation or treatment.

Further information regarding this joint statement is available here.

Enhancements to the public register

The Dental Board of Australia has launched its new-look public register with enhanced search capabilities.

The public register is an important tool for helping members of the public (as well as referring practitioners and employers) make more informed decisions about their healthcare. The aim of the enhancements is to make the register easier to use, especially for those communities who may have more traditional barriers to access.

Some of the changes include:

·   increased prominence of the register on the Ahpra homepage so it’s easier to find

·   simplified language with pop-up information boxes, and

·   improved search functionality, including:

• predictive text
• phonetic searching capability
• search by location (so in addition to being able to ‘check’ your practitioner, you will also be able to ‘find/search for’ a registered practitioner in a particular area. For example, you may want to look for a dentist in Carlton, who’s a woman and speaks Greek), and
• refined search filters (including being able to search by the 15 most common community languages).

The new-look register can be viewed here.

National Boards and Ahpra’s joint statement: No Place For Sexism, Sexual Harassment or Violence in Healthcare

The National Boards and Ahpra have released a joint statement reminding practitioners that there is no place for sexism, sexual harassment or gendered violence in healthcare.

No place for sexism, sexual harassment or violence in healthcare reinforces the important role registered practitioners have in building and maintaining a culture of respect in healthcare. Unprofessional conduct, including sexual harassment or assault is contrary to the National Boards’ codes of conduct (or equivalent).

To view the joint statement, please visit the Dental Board of Australia’s webpage.

Health and wellbeing support service for dental practitioners

The Dental Board of Australia (the Board) has funded a nationwide health and wellbeing support service for dental practitioners.

Dental Practitioner Support is the first national 24/7 telephone and online service for all dental practitioners. The service also offers support to dental students, educators, employers, Australian Dental Council exam candidates and concerned family members.

An experienced team of counsellors will provide confidential and immediate support, advice and referral on a wide range of health and wellbeing related issues. The service runs independently of the Board. Anyone calling the service does not have to give their name.

Access Dental Practitioner Support:

• 1800 377 700
• dpsupport.org.au

If you are experiencing difficulties, the Council strongly recommends you access this free and anonymous service.