Dentist wins Telstra Business Award

Media item: news report on Smile Solutions winning the Victorian Telstra Business Awards

Date published: 10 July 2014

Award: Victorian Business of the Year, and the Victorian Medium Business category, Telstra Business Awards 2014

This page records the media item. The original article is the property of its publisher and is not reproduced here.

What the award measured

Business performance. The Telstra Business Awards assessed financial results, growth, strategy, leadership, customer service processes, staff engagement, innovation and community contribution, through written applications and judging interviews.

What it did not measure: clinical outcomes, treatment quality, complication rates, or the competence of any individual practitioner. The judges were business people. They did not review patient records or clinical results, and the award does not claim to.

Australian law prohibits advertising a regulated health service in terms that claim superiority over other practitioners. Stating that a business won a named award in a named year is a verifiable fact. Presenting it as evidence that treatment goes better there would be a superiority claim, and is not permitted.

So the useful thing this page can do is set out what does tell you something.

The eight things that actually indicate a good dental practice

1. The AHPRA register, checked

ahpra.gov.au — free, searchable by name, showing registration category, any specialty held, and any conditions, undertakings or reprimands. Nothing on any website overrides it.

In particular it tells you whether someone using a specialist title actually holds specialist registration. Specialist titles are protected; "implant surgeon" and "implantologist" are not recognised specialties in Australia at all, and a PhD, a fellowship or a professorship is not specialist registration.

2. A proper new-patient examination

Not a two-minute look. It should include a medical history and current medication list, a soft-tissue examination of the tongue, floor of mouth, cheeks and throat with palpation of the neck (this is an oral cancer screen and it is one of the most valuable things done at a check-up), periodontal charting with pocket depths recorded, a tooth-by-tooth examination, and radiographs where indicated by risk rather than by calendar.

If nobody has ever measured your gums, you have not had a full examination.

3. A written, itemised treatment plan with ADA item numbers

Before anything starts, for anything beyond an examination and clean. Item numbers let you check a health fund rebate and compare a quote between practices. A practice that hands this over without hesitation is telling you something.

4. Alternatives named, including the cheap one and doing nothing

A good plan states the least expensive reasonable option and what happens if you defer. Both are legitimate answers, and a plan that offers only one route has not been explained properly.

5. A risk-based recall interval

Six months is a convention, not evidence. Some people need three-monthly care; many low-risk adults are safe at twelve. Ask what your risk assessment showed. A practice that recalls everyone at six months is applying a default.

6. Willingness to refer, and to support a second opinion

A practitioner who says "this is outside what I do, here is who should see it" is practising well. So is one who responds to a request for a second opinion without irritation. A defensive reaction to either is informative.

7. Infection control you can ask about

Ordinary questions a well-run practice answers without discomfort:

Are instruments steam-sterilised on site, in a validated autoclave monitored with biological indicators?
Is there a traceability system linking sterilised loads to patients?
How are dental unit waterlines treated and tested? (Biofilm in the narrow tubing feeding handpieces is a real and under-discussed hazard.)
Is a defibrillator on the premises, and is the medical emergency kit in date?

8. Records you can get

Ask for your own health record — clinical notes, radiographs and any scans — and for a copy to be sent to another practitioner. A practice's own privacy policy is where its access process and any charge for copies should be set out, and one that hands that over without hesitation is telling you something. Put the request in writing and keep a copy. If you are refused or stalled, records access is among the things the Victorian Health Complaints Commissioner deals with — see Where to raise a concern below.

What does not tell you much

Business awards. They measure business performance — what that does and does not mean is set out in full elsewhere in this archive.
Fit-out and technology. A practice that has bought an expensive machine has a reason to use it. "Which cases do you not use it for?" is the revealing question.
Preferred provider status. A commercial arrangement between a practice and a health fund. It lowers your gap for that fund; it is not a quality mark.
Sponsorships and "official dentist" arrangements. Commercial and practical, not clinical accreditation — see Pies get teeth into it.
Online reviews. Genuinely difficult: a patient can report whether they were happy, which is not the same as whether the clinical outcome was good, and nobody reading can verify the case or what happened at five years. Testimonials about clinical care cannot lawfully be used in advertising for precisely this reason.
Letters after a name. FRACDS, MFDS, MSc, PhD are real qualifications and none of them is specialist registration. What makes a truly great dentist is a different question again.

And the thing that matters most

Time. Elective dental treatment is almost never urgent. You are entitled to take a written plan away, think, and get another opinion. Feeling rushed is a reason to pause, not to proceed.

Genuine emergencies are the exception — spreading facial swelling, difficulty swallowing or breathing (a hospital emergency, not a dental one), uncontrolled bleeding, a knocked-out permanent tooth, or facial trauma.

Where to raise a concern

A practitioner's conduct or competence — AHPRA.
A practice, a service, fees, records access, or complaint handling — the Health Complaints Commissioner in Victoria.
Misleading or high-pressure conduct — the ACCC and Consumer Affairs Victoria.

Common questions

What does the AHPRA register actually tell me, and what does it leave out?

It settles the questions of legal standing, and it settles nothing about experience.

What it carries: the Dental Board of Australia confirms that AHPRA “publishes an online register of all dental practitioners” which “includes details of the specialty or specialties for dentists who hold specialist registration”. The entry also shows which division of the register the practitioner sits in, and any conditions imposed on their registration — the Board's own material describes circumstances in which it “may impose conditions on your registration”, for instance to align a qualification obtained elsewhere with the equivalent Australian scope of practice. That is how you distinguish a general dentist from a registered specialist, and how you find out whether a practitioner's scope has been limited.

On the specialist question specifically, the Board requires that “All dentists who wish to apply for specialist registration must have general registration and be on the Register of practitioners under the division of dentists”, plus a qualification in the specialty and “a minimum of two years general dental practice”. There are thirteen approved dental specialties in Australia. If the title on a website is not one of them, no amount of postgraduate study makes it one.

What the register does not do is rank anyone. It does not record how many of a given procedure a practitioner has performed, how recently, or with what results; it does not list where they did their undergraduate training; and it is not a directory of interests. Those questions have to be asked in the room, and a straight answer to “how many of these do you do in a year, and what do you do when one goes wrong?” is worth more than any credential on a wall.

They want X-rays at the first visit. Is that reasonable, and how much radiation is it?

Radiographs taken because a risk assessment indicates them are ordinary practice; radiographs taken because a year has passed are not the same thing. On the dose, the useful comparison comes from the International Atomic Energy Agency, whose radiation protection material states that “the doses from intraoral and cephalometric dental radiological procedures are lower, usually less than one day of natural background radiation”, and that panoramic doses “are more variable, but even at the high end of the range are equivalent to a few days of natural background radiation which is similar to that of a chest radiograph”.

Two honest qualifications. The IAEA is explicit that effective dose “and its associated risk should not be applied to individuals, but can be used to compare between modalities, techniques and other sources of exposure” — so these figures are for comparing one kind of image with another, not for calculating your personal risk. And the benchmark you might expect to exist does not: ARPANSA states that “There are no Australian DRLs for planar radiography, dental X-ray, cone beam CT or mammography” — no national diagnostic reference level against which a practice's dental exposures can be compared. Which makes the question to ask a clinical one rather than a numerical one: what are you looking for on this image, and what would change if you did not take it?

See How safe are dental X-rays? and When do safe dental X-rays become unsafe?.

A cone-beam scan has been suggested. Is that the same question?

No, and it is the clearest illustration of the “which cases do you not use it for?” test above.

Cone beam computed tomography is a genuinely valuable tool for particular problems — assessing bone before an implant, locating an unerupted tooth, investigating a root fracture. But the dose is in a different band. The IAEA puts it plainly: “CBCT doses cover a wide range, but may be tens or even hundreds of µSv of effective dose higher than conventional radiographic techniques, depending upon the technique.” It adds that “Rapid technological improvements to CBCT equipment mean that typical dose ranges are likely to change” — so a figure quoted from an older machine may not describe a newer one, in either direction.

Combine that with ARPANSA's point that Australia has no diagnostic reference level for cone beam CT, and the practical position is this: a scan should answer a question that a conventional radiograph and an examination cannot. Ask what that question is, ask whether the field of view can be limited to the area of interest, and ask who will report on the rest of what the scan shows. A machine in the building is not a reason.

Is there anything subsidised for my children?

Possibly, and it is under-claimed. The Child Dental Benefits Schedule, administered by Services Australia, provides up to $1,158 for each eligible child over 2 consecutive calendar years. Eligibility turns on two things in the same calendar year: the child is “between 0 and 17 years old for at least one day that calendar year”, and “you or they get an eligible payment at least once that calendar year” — certain Centrelink payments qualify.

What it covers, in the scheme's own words: check-ups, X-rays, cleaning, fissure sealing, fillings, root canals and extractions. What it excludes: orthodontic dental work, cosmetic dental work, and any dental services in a hospital. Two details that catch families out:

Unused money does not roll on indefinitely. If the full amount is not used within the two calendar years, “you can't use the remaining funds” — you wait for a new two-year period to begin. The clock starts in the calendar year the child both becomes eligible and has their first service.
CDBS services do not count towards the Medicare Safety Net or the Extended Medicare Safety Net thresholds.

Services Australia's own advice is to “check with your dentist if there are any item or time restrictions before starting your service”. Add one more question to that: whether the practice will accept the benefit as full payment for the planned items or charge a gap, and get the answer before the appointment. Figures and rules change — confirm the current amount with Services Australia rather than relying on this page. See Child Dental Benefit Schedule and How does the Child Dental Benefits Schedule operate?.

What goes into a risk assessment, so I can tell whether I actually had one?

This is the follow-up to point 5 above, because “ask what your risk assessment showed” is only useful if you know what one contains.

For decay and erosion risk, the Australian Dental Association's diet policy effectively lists the factors. It says acidic foods and drinks should be avoided, rather than merely limited, where a person is at high risk — and the circumstances it names are poor oral hygiene, low or no fluoride exposure, conditions which lead to a reduction in salivary flow, “exertion resulting in a dry mouth”, medications which reduce salivary flow, “sipping drinks, other than water, during interrupted sleep”, and “chewing and sucking acidic vitamin tablets”. It separately names three groups for targeted attention: parents of infants, “children and young adults”, and older people, the last “because of the increased risk of caries from reduced saliva flow and more exposed root surfaces”.

Fluoride exposure is a real variable rather than a box-tick. The NHMRC reports that “water fluoridation reduces tooth decay by 26 to 44% in children and adolescents, and by about 27% in adults”, within a supported range of 0.6 to 1.1 mg/L — so whether your supply is fluoridated, or whether you are on tank water, genuinely changes your risk category.

So a real assessment asks about your medication list, your saliva, your diet pattern (frequency, not just quantity), your water supply, your brushing and cleaning between teeth, your gum measurements, and your own history of fillings. If none of that was discussed and you were simply booked for six months, you were given a default rather than an assessment. Ask for the reasoning, in writing if you like — it is your record.

Practical details

Smile Solutions, Level 1, 220 Collins Street, Manchester Unity Building, Melbourne VIC 3000. Phone 13 13 96, or theteam@smilesolutions.com.au. Monday–Friday 8.00am–6.00pm, Saturday 8.30am–1.30pm, Sunday by appointment.

This page records a media item and its date, with general information. The award, the practitioners and the fees it refers to belong to 2014; clinical guidance, services, practitioners, rebates and fees all change, so verify anything current — including the Child Dental Benefits Schedule figures above — before relying on it. It is not a diagnosis, a treatment plan or a promise of any particular clinical outcome. Third-party media content is not reproduced. Statements attributed to the Dental Board of Australia, AHPRA, ARPANSA, the IAEA, the NHMRC, the Australian Dental Association and Services Australia are those bodies' own.

Smile Solutions trades under ABN 28 193 514 103.