What I love about running a large dental practice

Starting at 18, with no experience

Amy Turner joined Smile Solutions at 18, hired as a trainee dental nurse with no previous nursing experience.

Her description of the early days: incredibly challenging — sink or swim.

The team of specialists, dentists, nurses and receptionists working alongside her were supportive, and although the learning curve was steep, a good — if exhausting — routine came before long. That team is now listed in full on our team, with the registered specialists identified as such.

If you are reading this because you are considering the same start, the practice runs a dental internship and a graduate program, and current vacancies are on the careers page.

The fish tank story

It has not all been smooth sailing.

As a junior dental nurse it was her responsibility to refill the fish tank. She believed she could multi-task, forgot the tap was still running, and flooded one of the rooms.

She was shy and scared to own up — and confessed anyway.

The response is the part worth noticing. The boss was surprisingly calm, worked with her to fix the problem, and implemented systems to stop it happening again.

That reaction does two things at once. It resolves the immediate mess, and it makes owning up the rational choice next time — for her and for everyone who hears the story. A practice where mistakes are punished is a practice where mistakes get hidden, and hidden mistakes in a clinical setting are considerably more dangerous than flooded rooms.

The tank itself has its own history, told in Watergate: the Smile Solutions fish tank saga.

“Creative problem solving is encouraged, and that results in rapid personal development” is how she describes the pattern.

She moved from nursing to reception, and in 2010 accepted the role of practice manager.

What a practice manager actually does

The role does not always have a clear job description. It involves being both good cop and bad cop, as the situation demands.

Three things are held in mind simultaneously:

The patient — what’s best for the patient, always trying to see things through their eyes. The Smile Solutions experience describes what that is meant to feel like from the other side of the desk, and how important is communication in dentistry? why it is treated as a clinical skill rather than a courtesy.

The team — at the time of writing in 2015, responsibility for a team of over 100 clinicians and support staff, each with their own personality and communication style. The practice principal wrote the counterpart piece: how do I manage to keep 60 demanding clinicians happy — all under the one roof?.

The practice itself — always in the back of her mind.

Contrary to John Lydgate’s observation that you cannot please all of the people all of the time, the practice manager’s job is to try.

She is quick to add that she is not alone: a team of managers who came up through the ranks as the practice grew over the preceding decade, taking a proactive approach to ensuring every aspect of a patient’s experience is carefully orchestrated. My life as the Smile Solutions Tooth Fairy is another view of the same place from a non-clinical role.

There is a boundary around all of this that is set externally rather than by the practice, and it is worth stating because it governs who does what in a building this size. The Dental Board of Australia’s Scope of practice registration standard applies to every registered dental practitioner and “requires dental practitioners to practise within the scope of their education, training, and competence at all times.” No amount of management structure changes that. It is why a large practice is organised around who is registered to do what rather than around who is available.

Why the environment matters

Many people are apprehensive about dental care. That is measurable rather than impressionistic. In the 2002 National Dental Telephone Interview Survey, analysed by Armfield, Stewart and Spencer for BMC Oral Health (2007) across 6,112 Australians aged 16 and over, 11.9 per cent said they were “very” afraid of going to the dentist and a further 5.2 per cent “quite” afraid, with 15.1 per cent “a little” afraid and 67.7 per cent not at all.

What she says she is most proud of is having helped create an environment where patients are treated with respect and given every possible comfort.

This is not incidental to clinical care. Dental anxiety is one of the main reasons people delay treatment, and delayed treatment is how small problems become large ones. The same study puts numbers on both halves of that sentence: 43.9 per cent of the very afraid had last seen a dentist more than two years earlier, against 29.1 per cent of those with no fear; and 67.3 per cent of the very fearful said their usual reason for attending was a problem, against 44.9 per cent of those with no fear. Taken together as a pattern — delayed visiting, dental problems and symptom-driven attendance — 29.2 per cent of the very afraid fitted that profile against 11.6 per cent of people with no dental fear, an adjusted odds ratio of 3.33 (95% CI 2.67 to 4.15).

Two caveats the authors insist on, and which matter here. The design is cross-sectional, so “causality cannot be inferred from the results”, and they are explicit that “it is certainly not the case that having high dental fear is a necessary and sufficient precondition for poor oral health outcomes” — nearly seven in ten of the very afraid did not fit the pattern at all, and 11.6 per cent of people with no fear did, which the authors attribute to cost, time, apathy or lack of interest. So fear is one route into delayed care, not the only one, and a comfortable waiting room does not by itself fix any of the others.

The way a practice feels to walk into is part of whether people come back. The practical side of that is covered in dental anxiety, how can I ease my anxiety about visiting the dentist? and, for those who need more than reassurance, sleep dentistry. For children it starts earlier still: combating dental anxiety in children.

We offer the full range of dentistry — from general care and hygiene through to registered dental specialists — so patients are cared for in one location. See general dentistry, specialist care and the full list of services; everything under one roof — we do it all at Smile Solutions explains what that arrangement is actually for, and why would I need to see a dental specialist? when it matters. The argument for size is made at greater length in Is a bigger dental practice better? Part 1 and part 2. At the time of writing in 2015, the practice had some 80,000 patients on its books.

The things that sit behind the experience rather than in front of it: the technology in use, the on-site Smile Solutions laboratory, and the practice’s charitable work.

The answer to the question

In a word: everything.

There are many days where everything runs like clockwork, leaving time to focus on working with the team and growing the practice. And there are enough challenges to keep it interesting.

Perhaps best of all — and this is the line that explains why someone stays somewhere from 18 onwards — she still works closely with patients every day.

If you are weighing the practice up rather than reading for interest, why choose us, reviews, the awards page and our media are the places to look, and what makes a truly great dentist? and finding a dentist online in Australia are the articles worth reading before you choose anywhere at all.

What those pages can and cannot tell you is set by law, not by editorial choice, and knowing the rule makes them easier to read. Ahpra’s advertising guidelines for regulated health services, made under section 133 of the National Law, state that advertising may be false, misleading or deceptive where it “compares health outcomes, regulated health professions or practitioners or prices without complete information” or “makes claims about providing a superior regulated health service” — so no Australian dental practice, this one included, is permitted to tell you it is clinically better than another. The guidelines also prohibit “testimonials or purported testimonials”, which they define as recommendations or positive statements about the clinical aspects of the service; by contrast, “comments about customer service or communication style that do not include a reference to clinical aspects are not considered testimonials” and may be published. That is the line a reviews page has to sit behind. Maximum penalties were increased in 2022 to $60,000 per offence for an individual and $120,000 for a body corporate.

So the genuinely useful checks are the ones that do not rely on anybody’s marketing: look the practitioner up yourself on the Ahpra public register, which shows whether registration is current, what division it is in, whether specialist registration is held and in which recognised specialty, and whether any conditions apply.

Common questions

The team here includes dentists, hygienists, therapists and nurses. How do I know who is treating me, and what they are allowed to do?

Ask, and then check. The Ahpra register records each practitioner's division of registration, and the Dental Board lists separate registration requirements for dentists and for dental hygienists, dental therapists and oral health therapists — they are different registrations with different scopes, not grades of the same one. Over the top of all of them sits the Scope of practice registration standard (in effect since 1 July 2020), which requires practitioners “to practise within the scope of their education, training, and competence at all times.” Specialist registration is narrower again: the Board requires that a dentist seeking it “must have general registration and be on the Register of practitioners under the division of dentists”, plus a minimum of two years in general dental practice.

Two things are worth knowing that practices rarely volunteer.

Public understanding of these roles is genuinely poor, and that is a recognised problem rather than your oversight. A consumer submission to the 2017 Senate inquiry into private health insurance argued directly that “the Australian public should be informed of the scope of practice for dental therapists and oral/dental hygienists”, asking whether they are qualified to perform basic dental work in the private sector. If you are unsure which registration the person cleaning your teeth holds, that is a fair question and there is a register that answers it.

“Dr” does not mean what most people assume in dentistry. The same submission records the Dental Board's position that there are no provisions under the National Law specifically prohibiting dentists from using the title, but that “any use is merely a courtesy title”. It is not evidence of a doctorate, and it says nothing about specialist registration — which is the thing that is actually protected and actually checkable.

So the useful question at reception is not “is this person good” but “what registration does this person hold, and is this procedure within it?” Dentists & Registered Specialists.

What does a business award actually tell me about the dentistry?

Nothing clinical, and it is not permitted to be presented as though it did.

A business award is a judgement about a business — growth, systems, service, employment practices, innovation. It is awarded by people who have not examined anybody's teeth. That does not make it meaningless: a well-run business is more likely to answer the phone, keep records properly and still exist in ten years, all of which matter to a patient. But it is not a clinical outcome measure, and no award process in Australia audits clinical results.

The law reinforces the distinction. Ahpra's advertising guidelines treat advertising as potentially misleading where it “makes claims about providing a superior regulated health service” or “compares health outcomes, regulated health professions or practitioners or prices without complete information”. So a practice may say it won a business award; it may not use that award to imply its dentistry is better than someone else's. If you see the second framing anywhere — here or elsewhere — that is the thing to distrust, not the award itself.

The same guidelines explain why a reviews page reads the way it does. Statements about clinical aspects of care are prohibited as testimonials, while “comments about customer service or communication style that do not include a reference to clinical aspects are not considered testimonials”. A page full of comments about parking, reception and how well something was explained, with nothing about clinical results, is a page complying with the rule rather than hiding anything.

If something goes wrong, who is actually accountable in a practice with a hundred staff?

The individual practitioner, first — which is the point of the standard quoted above. Registration, scope of practice and the obligation to work within one's education, training and competence attach to the person, not to the business, and the Dental Board also maintains a professional indemnity insurance arrangements registration standard that every registered practitioner has to satisfy. A management structure organises who does what; it does not transfer clinical responsibility.

In practice, the order to work through is:

  1. Raise it with the treating practitioner, and ask for the explanation and the plan in writing.
  2. Escalate within the practice — in a large practice there is a practice manager whose job includes exactly this, which is one of the few genuine advantages of size.
  3. Get an independent examination if the disagreement is clinical, because that produces the evidence any later step would need. Second Opinions & Corrective Dentistry.
  4. Make a notification if it is not resolved. Ahpra explains that the national health practitioner boards are responsible for “managing complaints and concerns (notifications) about the health, conduct or performance of practitioners”, with different arrangements in some states — New South Wales through the Health Care Complaints Commission and the Health Professional Councils Authority, and Queensland jointly through the Office of the Health Ombudsman. Advertising breaches go through a separate Ahpra channel; its material gives 1300 419 495 for information.

More on the earlier steps, and what to ask for, in how important is communication in dentistry?

I am eighteen and thinking about this as a career. What does registration actually involve?

More standards than most people expect, and they are all published. The Dental Board of Australia maintains registration standards covering criminal history, scope of practice, continuing professional development, English language skills, professional indemnity insurance arrangements, recency of practice, specialist registration, an endorsement for conscious sedation, general registration for overseas-qualified dental practitioners, and limited registration for teaching or research and for postgraduate training or supervised practice.

Three of those shape a career rather than just an application. Continuing professional development and recency of practice are ongoing obligations, which is why a long break from clinical work is a registration matter and not simply a gap on a CV. The endorsement for conscious sedation is the model for how additional scope is acquired later: the ADA's position is that a practitioner seeking it should first have completed a mandatory two-year period as a dentist in general practice, and that moderate sedation requires Board endorsement and a Board-approved program of study.

One honest note on the route described at the top of this page. Dental nursing and reception are not among the divisions the Dental Board registers — the Board's own standards and register cover dentists, dental hygienists, dental therapists, oral health therapists and dental prosthetists. A start as a trainee dental nurse is therefore a workplace-trained entry into the industry rather than a registered clinical qualification, and moving into a registered role means an accredited program of study. If a clinical role is what you want, decide which division it sits in early, because the study pathways differ substantially. The practice's own entry routes are on careers, the dental internship and the graduate program.

Sources named on this page

Related reading

Practical details

Written by Amy Turner, Practice Manager.

Smile Solutions, Level 1, 220 Collins Street, Manchester Unity Building, Melbourne VIC 3000 — getting here. Phone 13 13 96, contact us, or theteam@smilesolutions.com.au. Monday–Friday 8.00am–6.00pm, Saturday 8.30am–1.30pm, Sunday by appointment. Published fees are in the price guide.

Specialist registration can be verified on the AHPRA register, or by calling 1300 419 495.

Published 11 May 2015. Team and patient figures quoted are as at that date. Registration standards, their dates of effect and the complaints pathways described in the questions above change over time; check them at their own sources. General information only; it does not replace advice from your treating practitioner.

Smile Solutions trades under ABN 28 193 514 103.

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