Helen Paraskeva, Dental Hygienist

Role: Dental hygiene

Qualifications: Diploma in Oral Health Therapy (Dental Hygiene), University of Melbourne (2000)

Registration: Registered dental practitioner, dental hygienist division, general registration, DEN0001023774

Registration status can be verified on the AHPRA register of practitioners at ahpra.gov.au. Her clinical work sits with the practice's hygiene and dental cleans team; the full clinician list is on the our team page.

Background

Helen Paraskeva graduated from the University of Melbourne in 2000 with a Diploma in Oral Health Therapy in dental hygiene.

Her particular clinical interest throughout her career has been the treatment of periodontal disease, with an emphasis on prevention.

At Smile Solutions she works alongside clinicians across the specialist departments, maintaining periodontal health through general and complex treatment.

Hygienist, therapist, oral health therapist — the distinctions

These three divisions are separately registered and their scopes differ. The distinction matters because they are used interchangeably in ordinary speech and are not interchangeable in law — what is the difference between a dental therapist and a dental hygienist? sets it out at length.

• Dental hygienist — focused on the prevention and treatment of gum disease and on preventive care. Periodontal assessment, scaling and root surface debridement, oral hygiene instruction, fluoride, sealants, radiographs. Does not place fillings or extract teeth. What does a dental hygienist do? is the fuller description.
• Dental therapist — focused on children and adolescents. Examination, fillings, extraction of primary teeth, preformed crowns and pulp treatment on primary teeth.
• Oral health therapist — dual-qualified in both of the above from a single degree, and may practise in both scopes.

Helen Paraskeva is registered in the dental hygienist division. That is the scope she practises within; the registration category on the AHPRA register is what governs it, not the title of the qualifying course. The practice records registration categories on the dentists and registered specialists page.

"Dental hygienist" is a protected title

This is not a courtesy description. Ahpra's Guidelines for advertising a regulated health service list the protected titles in the dental profession as "dentist, dental therapist, dental hygienist, dental prosthetist, oral health therapist", and list the same five as the profession's divisions. Under the National Law's 'holding out' provisions, a person "must not knowingly or recklessly claim or hold themself out to be registered or qualified to practise in a health profession or a division of a health profession if the person is not so registered" (section 117, as Ahpra summarises it).

So the division printed above is a legal statement, and it is checkable. The Dental Board of Australia confirms that "Ahpra publishes an online register of all dental practitioners that provides the profession and the public with up-to-date information about a dental practitioner's registration status". Search it free by name or registration number at ahpra.gov.au — it shows status, division, any specialty and any conditions. Finding a dentist online in Australia covers how to check a listing before you book.

What no dental hygienist may do

Crowns, bridges or veneers on adult teeth; root canal treatment on permanent teeth; extraction of permanent teeth; implant placement; surgical procedures; prescribing medicines. Where a finding sits outside scope, they refer to a dentist. Dental hygienist vs dentist — what's the difference? covers the same ground for patients.

A hygienist works within a structured professional relationship with a dentist — an agreed scope, a referral pathway, and a dentist available for consultation. They are nonetheless independently registered and independently accountable, with their own indemnity insurance, their own continuing professional development, and the same registration standards and complaints process as a dentist.

That boundary is itself a registration standard. The Board's Scope of practice registration standard, in effect 1 July 2020, requires "dental practitioners to practise within the scope of their education, training, and competence at all times" — a patient-safety rule, not an administrative one.

Periodontal disease: the honest account

Gingivitis is plaque-induced inflammation of the gum. It is common, it is entirely reversible, and it does not destroy bone. Bleeding when you brush or floss is not normal — healthy gums do not bleed, and this is the earliest and most-ignored warning sign. What is gum disease? is the short explainer.

Periodontitis is what happens when that inflammation progresses to destroy the bone and periodontal ligament that hold the teeth in.

• It is painless until it is advanced. People typically notice nothing until teeth loosen, drift or a gap opens, by which point substantial support has already gone.
• The bone lost does not grow back on its own. Treatment stops the disease progressing, and regeneration is possible in some specific defect shapes, but most lost support is not recoverable. Early diagnosis matters more here than almost anywhere else in dentistry.
• It is the leading cause of tooth loss in adults, ahead of decay.
• Smoking is the largest modifiable risk factor — and it constricts the blood vessels in the gum, suppressing the bleeding that would otherwise warn you, and it worsens the response to treatment. The effects of vaping on your oral health covers the newer version of the habit.
• Diabetes and periodontitis worsen each other in both directions; treating gum disease can modestly improve glycaemic control — diabetes and dental health: the two-way street.
• Susceptibility is partly genetic. Two people with the same plaque levels can have very different outcomes.
• It is associated with cardiovascular disease and adverse pregnancy outcomes. Association is not proven causation, and claims that treating gum disease will prevent a systemic disease go beyond the evidence. It is a chronic inflammatory disease worth treating in its own right — health problems linked to poor oral hygiene and dental health and general wellbeing set out what is and is not established.

What the diabetes evidence actually shows

This is the one systemic association where the published numbers are firm enough to quote, so here they are. The figures below come from the review Periodontitis and diabetes: a two-way relationship (Preshaw and colleagues, Diabetologia, available via PubMed Central).

• "The risk of periodontitis is increased by approximately threefold in diabetic individuals compared with non-diabetic individuals."
• Glycaemic control, not the diagnosis alone, is what drives that risk. In the US National Health and Nutrition Examination Survey (NHANES III), "adults with an HbA1c level of >9% had a significantly higher prevalence of severe periodontitis than those without diabetes (OR 2.90; 95% CI 1.40, 6.03)" after adjustment.
• It runs the other way too. The review reports that "the risk of cardiorenal mortality (ischaemic heart disease and diabetic nephropathy combined) is three times higher in diabetic people with severe periodontitis than in diabetic people without severe periodontitis", and that "incidences of macroalbuminuria and end-stage renal disease are increased twofold and threefold, respectively" in the same comparison.
• Treating the gums helps the diabetes a little. "Treatment of periodontitis is associated with HbA1c reductions of approximately 0.4%." The authors are careful about it, and so is this page: they add that "large, multi-centre, randomised controlled trials are needed to further validate these findings". A 0.4% reduction is real and worth having; it is not a substitute for diabetes care.
• Type 1 counts as well. The review states that "all patients with diabetes (including children and young adults) should be considered to be at increased risk of periodontitis".

The practical consequence: if you have diabetes, tell the person charting your gums, and tell your diabetes team that you are having periodontal treatment. See diabetes and oral health.

Treatment, in sequence

1. Assessment. Full pocket charting — six measurements per tooth — plus bleeding points, recession, mobility, radiographs and risk factors. Staged and graded.
2. Cause-related therapy. Oral hygiene instruction specific to your mouth, plus thorough subgingival debridement. This does the majority of the work in most cases — when do you need deeper cleaning?
3. Reassessment, usually six to eight weeks later, with the charting repeated. Many patients need nothing further.
4. Surgery or specialist referral where deep pockets persist.
5. Maintenance, indefinitely. Typically every three to four months. How often should I go to the dentist? explains how the interval is set.

Periodontitis is managed, not cured. Stopping maintenance reliably produces recurrence. Anyone told that one course of treatment has permanently resolved it has been misinformed. Your Smile Solutions dental hygienist visit: what to expect describes a routine maintenance appointment, and what is the difference between having your teeth cleaned by a dentist and a dental hygienist? answers the question that comes up at the front desk.

Recession and sensitivity

Gum recession does not grow back. It is caused by periodontal disease, by aggressive brushing with a hard brush, by thin gum tissue, and by tooth position. Exposed root surface is softer than enamel, decays more readily, and is frequently sensitive.

Sensitivity is managed with desensitising toothpaste used consistently (not occasionally), fluoride application, correcting brushing technique, and sometimes sealing the exposed surface. Grafting is done for specific indications — progressive recession, inadequate attached tissue, aesthetics — not for every recession. What to do if you suffer from sensitive teeth covers the day-to-day management.

Prevention: what the evidence supports

• Fluoride toothpaste twice daily. Spit, don't rinse.
• Daily interdental cleaning. Interdental brushes are more effective than floss for most adults with any recession, provided the size fits. A toothbrush cannot reach where gum disease starts — is flossing really that important?
• A soft brush, and light pressure. Scrubbing hard causes recession and abrasion; it does not clean better. See how much pressure should I apply when brushing my teeth?, over brushing: what can it do to my teeth? and which toothbrushes do dentists recommend?
• Not smoking.
• A recall interval matched to your risk, not automatically six months.
• Managing dry mouth, since many common medications reduce saliva.

Little or no supporting evidence: whitening toothpastes beyond surface stain — real teeth whitening is a separate treatment — charcoal products (abrasive, no fluoride), oil pulling, and "detox" oral products. Long-term daily use of chlorhexidine mouthwash stains teeth and is not intended as a permanent measure — the truth and myths about mouthwashes.

Registration

The Dental Board of Australia registers dentists, dental specialists, dental hygienists, dental therapists, oral health therapists and dental prosthetists. It does not register dental technicians, dental assistants or dental nurses, or administrative staff.

Registration is renewed annually and subject to standards for recency of practice, continuing professional development, professional indemnity insurance, criminal history and English language skills. Conditions and undertakings appear on the public register.

The standards that sit behind that one line

Those standards are published documents with dates of effect, not general principles. The Dental Board's current registration standards, and the dates from which each has applied, include:

Every one of them applies to a hygienist as it does to a dentist, with the exception of the specialist standard — dental specialist registration is a dentists-only category, and no hygienist, therapist or oral health therapist can hold it. That is a fact about the register, not about anybody's ability.

Why it is worth knowing: these are the things a registered practitioner has to keep doing to stay registered. An unregistered occupation has none of them — no mandated CPD, no recency requirement, no indemnity requirement, and no register on which a condition could be recorded.

Common questions

Everyone says gum disease affects the whole body. How much of that is actually established?

Less than the headlines, more than nothing — and the difference between the two is worth seeing rather than being told.

The strongest evidence is in people who already have diabetes, and it is genuinely striking. In a prospective study of 628 people with type 2 diabetes followed for a median of eleven years, age- and sex-adjusted death rates were 3.7 per 1,000 person-years with no or mild periodontitis, 19.6 with moderate periodontitis and 28.4 with severe periodontitis. After adjusting for age, sex, diabetes duration, HbA1c, albuminuria, BMI, cholesterol, hypertension, ECG abnormalities and smoking, those with severe periodontitis still had 3.2 times the risk (95% CI 1.1 to 9.3) of death from ischaemic heart disease and diabetic nephropathy combined.

Kidney outcomes in the same population moved in step with severity: incidences of macroalbuminuria were 2.0, 2.1 and 2.6 times as high for moderate periodontitis, severe periodontitis and being edentulous respectively, and end-stage renal disease 2.3, 3.5 and 4.9 times as high, compared with no or mild disease.

Now the part that is usually left out. In a seven-year prospective study of 5,848 people without diabetes, moderate and severe periodontitis were significantly associated with developing diabetes — but the significance was lost after adjusting for sex, smoking, BMI, triglycerides, hypertension, HDL cholesterol and liver enzymes. Periodontitis and metabolic disease share so many risk factors that separating them is genuinely hard.

And where the evidence is weakest, the sources say so. A study of 10,958 people with type 2 diabetes found those with no teeth had almost twice the all-cause mortality risk of those with 22 or more teeth, with an intermediate risk in between. But oral health there was measured by two questions — how many teeth, and how many days the gums bled in the past year — and the authors put it no higher than having “postulated that inflammation resulting from poor oral health may have been implicated”.

So the defensible position, and the one this page takes: in diabetes the association is strong, dose-dependent and survives adjustment. Elsewhere it is an association that may reflect shared causes. Nobody can honestly promise you that treating your gums will protect your heart. Periodontitis destroys the bone holding your teeth in, and that is reason enough.

Should I be using a mouthwash — and which one?

Start with the thing every source agrees on: a rinse is an addition to cleaning, never a replacement for it. Australian Prescriber puts it as “an adjunct to, not a substitute for, regular brushing and flossing”, and says a mouthwash “should never be the sole means of oral hygiene”. The Australian Dental Association's position is the same.

If the rinse contains no fluoride, the timing matters more than the product. A review in the British Dental Journal concluded that “rinsing with a non-fluoride mouth rinse soon after brushing with standard fluoride toothpaste may reduce the anticaries protection provided by brushing with a fluoride toothpaste alone”, and that “a mouth rinse should therefore contain at least 100 ppm fluoride if it is to be used at any time, including soon after brushing. A non-fluoride mouth rinse should preferably be applied at different times of the day”. So the cosmetic freshening rinse belongs at a different time of day from brushing, or it undoes some of the work. The concentrations named are 0.2% sodium fluoride (909 ppm F), 0.05% (226 ppm F) and 0.02% (100 ppm F) — that figure is on the label.

Fluoride rinses do work, in the right population. Cochrane found that “supervised regular use of fluoride mouthrinse by children and adolescents is associated with a large reduction in caries increment in permanent teeth”, with moderate certainty, though the effect size outside supervised school settings “is less clear”. Because of the swallowing risk, fluoride rinses are not recommended for young children.

On chlorhexidine — the one prescribed for gums — the review that settles it is Cochrane CD008676 (51 studies, 5,345 participants). Used in addition to brushing and interdental cleaning it produces a large reduction in plaque, but its effect on mild gum inflammation was small enough that the reviewers called it an effect “that was not considered to be clinically relevant”, and for moderate or severe inflammation there was not enough evidence to judge. Rinsing “for 4 weeks or longer was associated with an increase in extrinsic tooth staining” at any concentration, because the staining “appears to be closely linked to its mechanism of action” — and that stain then has to be scaled and polished off. There is “no evidence that one concentration of chlorhexidine rinse is more effective than another”.

Cochrane's own conclusion is the sentence to remember: chlorhexidine “is indicated in particular clinical situations for short periods of time”. If you have been on one for months, raise it.

I was given numbers for my gums. What do they mean, and what should I ask to see?

The charting described above produces six depth measurements per tooth, plus whether each site bled on probing, plus recession and mobility. Ask to see it, and ask for a copy. It is your clinical record, it is the only objective account of your gums, and it is the thing that makes the next appointment meaningful.

Three things to ask about it, which are more useful than the single deepest number:

• How many sites bleed? Bleeding on probing is the activity measure. A deep pocket that does not bleed behaves differently from a shallower one that does.
• What has changed since last time? A site that has gone from 3 mm to 5 mm over a year is telling you something that the number 5 on its own cannot. This is the whole reason the measurements are recorded rather than estimated.
• Which sites are being treated, and which are being watched? Those are different plans and they should be named separately.

On the numbers themselves, the research literature commonly groups pocket depths as moderate at roughly 3.5 to 5.5 mm and severe above 5.5 mm — those were the categories used in the 5,848-person study cited above. Treat that as a rough research convention rather than a diagnostic line drawn at your chair: staging and grading a case uses bone levels on radiographs, attachment loss, bleeding, risk factors and the rate at which things have changed, not a single depth in isolation.

One measurement you will not be given is a prognosis in years, and you should be sceptical of anyone who offers one. What can be said is whether the disease is currently active, and whether it has progressed since the last chart.

Three-monthly maintenance, indefinitely — is that clinically necessary or just a subscription?

It is a fair question, and it deserves a straight answer including the limits of what can be evidenced.

What is well established is on this page already: periodontitis is managed rather than cured, the lost bone does not return, and stopping care reliably produces recurrence. Maintenance exists because the biofilm re-forms below the gum within months in a mouth that has already lost attachment, and because recurrence is painless — the same feature that let the disease go unnoticed the first time.

What we could not find is an Australian guideline setting a specific maintenance interval. The three-to-four-month figure used here, and across the profession, is clinical convention rather than something a regulator or national body has published a number for. That is worth knowing, and it is the honest answer to whether the interval is “necessary”: the principle of indefinite maintenance is well supported, the specific number is a judgement.

So make it a judgement about you. Ask what your interval is based on — bleeding sites, residual pocket depths, smoking, diabetes, the rate of change at the last two reviews — and ask what would justify lengthening it. A patient with no bleeding sites and stable charts over two years is in a different position from one with several residual deep sites, and the interval should say so. A recall that has never been reconsidered is not a clinical decision, it is a default.

And ask what happens at the appointment. If it includes repeat charting compared against the last one, it is monitoring a chronic disease. If it is only a polish, it is not the same product, whatever the interval.

Practical details

Helen Paraskeva's registration can be checked free on the AHPRA public register at ahpra.gov.au. Use the contact page to book a hygiene appointment or to discuss a periodontal maintenance interval. Indicative fees are on the price guide.

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.

Sources for the externally verifiable statements on this page

• Dental Board of Australia — Registration Standards, Specialist Registration and the Scope of practice registration standard.
• Ahpra — Guidelines for advertising a regulated health service, for the protected titles and the holding-out provisions.
• Preshaw and colleagues, Periodontitis and diabetes: a two-way relationship, Diabetologia (PubMed Central) — the diabetes, mortality, renal and HbA1c figures.
• Cochrane Oral Health — CD008676 (chlorhexidine mouthrinse, 2017) and the fluoride mouthrinse review; Australian Prescriber and the British Dental Journal on rinses as adjuncts and the 100 ppm fluoride threshold.

This page records qualifications and career history as published by the practice. General information only — it is not a diagnosis, a treatment plan or a promise of any particular clinical outcome. Practitioner availability changes; confirm when booking. Registration standards and their dates of effect are set by the Dental Board of Australia and change; confirm current details with the Board.

Smile Solutions trades under ABN 28 193 514 103.