Code of conduct for Australian Dentists

  

The shared Code of conduct

The shared Code of conduct (the code) applies to registered health practitioners in 12 professions. The code sets out National Boards’ expectations of ethical and professional conduct for the health practitioners they regulate.

The code outlines 11 principles which include information about how to apply the code in practice. Underpinning the code is the expectation that practitioners will use their professional judgement to achieve the best possible outcomes for their patients.

Put patients first – Safe, effective and collaborative practice

Principle 1. Practitioners should practise safely, effectively and in partnership with patients and colleagues, using patient-centred approaches, and informed by the best available evidence to achieve the best possible patient outcomes.

Aboriginal and Torres Strait Islander health and cultural safety

Principle 2. Practitioners should consider the specific needs of Aboriginal and Torres Strait Islander Peoples and their health and cultural safety, including the need to foster open, honest and culturally safe professional relationships.

Respectful and culturally safe practice for all

Principle 3. Respectful, culturally safe practice requires practitioners to have knowledge of how their own culture, values, attitudes, assumptions and beliefs influence their interactions with people and families, the community and colleagues. Practitioners should communicate with all patients in a respectful way and meet their privacy and confidentiality obligations including when communicating online.

Working with patients

Principle 4. Basing relationships on respect, trust and effective communication enables practitioners to work in partnership with patients. Practitioners should maintain effective and professional relationships with their patients and provide explanations that enable patients to understand and participate in their care.

Working with other practitioners

Principle 5. Good relationships with colleagues and other practitioners strengthen the practitioner-patient relationship, collaboration and enhance patient care. Good relationships require health care to be free of discrimination, bullying and harassment.

Working within the healthcare system

Principle 6. Practitioners have a responsibility to contribute to the effectiveness and efficiency of the healthcare system and use resources wisely.

Fluoride Modalities in Caries Prevention

Use of fluoride for caries prevention 

Fluoride has been widely used for caries prevention for several decades, and it is considered to be one of the most effective measures in reducing the incidence of dental caries. There are different ways to apply fluoride for caries prevention, including:

1. Topical fluoride: This involves applying fluoride directly to the teeth in the form of a gel, foam, varnish, or mouth rinse. Topical fluoride works by strengthening the tooth enamel and making it more resistant to acid attacks. 

1. Systemic fluoride: This involves ingesting fluoride in the form of fluoridated water, dietary supplements, or fluoride-containing toothpaste. Systemic fluoride works by strengthening the teeth from the inside out as the fluoride is incorporated into the developing tooth structure. 

Fluoride helps to prevent caries by: 

1. Reducing demineralization: Acid-producing bacteria in dental plaque can cause the enamel to lose minerals, a process known as demineralization. Fluoride helps to make the enamel more resistant to demineralization by creating a stronger, more acid-resistant mineral structure.
2. Enhancing remineralization: Fluoride can also enhance the remineralization process, where lost minerals are replaced in the enamel, resulting in stronger and healthier teeth.

Overall, the use of fluoride for caries prevention has been shown to be safe and effective, with numerous studies demonstrating its benefits in reducing the incidence of dental caries in both children and adults. 

 

Reduction of caries incidences due to fluoride use in Australia in children below 12 years of age.

The use of fluoride for caries prevention has been widely implemented in Australia since the 1960s. The Australian government has mandated the fluoridation of community water supplies since the 1970s, and fluoride toothpaste is widely available and recommended by dental professionals for daily use. 

The National Child Oral Health Study, conducted in 2012-2014, found that the prevalence of caries in Australian children aged 5-6 years was 32.7%, while for children aged 9-10 years, it was 43.1%. However, it should be noted that these rates vary across different regions of Australia and are influenced by factors such as socio-economic status, oral health behaviors, and access to dental care. 

Overall, studies have shown that the use of fluoride has led to a significant reduction in caries incidence in Australian children. According to the Australian Dental Association, the prevalence of caries in Australian children has declined by around 50% since the 1970s, with fluoridation of community water supplies being one of the most significant contributors to this reduction. 

Moreover, a systematic review of studies on the effectiveness of water fluoridation in Australia and New Zealand found that water fluoridation led to a 26% reduction in caries in deciduous teeth and a 29% reduction in permanent teeth in children aged 5-12 years. 

In conclusion, the use of fluoride in Australia has contributed significantly to the reduction of caries incidence in children below 12 years of age. Fluoridation of community water supplies, fluoride toothpaste, and other forms of fluoride applications have all played a crucial role in improving the oral health of Australian children. 

Write a detailed note on different preparations of fluoride along with compositions for application on teeth for caries prevention. 

Fluoride is a mineral that is essential for healthy tooth development and has been shown to be effective in preventing dental caries. There are several different preparations of fluoride available for use in dental care, including:

 

5. Fluoride toothpaste: Fluoride toothpaste is the most commonly used fluoride preparation for caries prevention. It typically contains 1000 to 1500 parts per million (ppm) of fluoride and is recommended for twice-daily use. The fluoride in toothpaste works by remineralizing the tooth enamel and making it more resistant to acid attacks.

6.  

6. Fluoride mouthwash: Fluoride mouthwash is another form of topical fluoride application that is used to prevent caries. It typically contains 0.05% sodium fluoride and is used once or twice daily after brushing. The fluoride in mouthwash helps to strengthen the tooth enamel and prevent demineralization. 

7. 
   

7. Fluoride varnish: Fluoride varnish is a topical fluoride application that is applied directly to the teeth by a dental professional. It typically contains 22,600 ppm of fluoride and is recommended for use every 3 to 6 months. The fluoride in varnish works by strengthening the tooth enamel and making it more resistant to acid attacks. 

8. 
   

8. Fluoride gel: Fluoride gel is a topical fluoride application that is applied directly to the teeth by a dental professional. It typically contains 1.23% fluoride and is recommended for use every 3 to 6 months. The fluoride in gel works by remineralizing the tooth enamel and making it more resistant to acid attacks.

9.  

9. Fluoride foam: Fluoride foam is a topical fluoride application that is applied directly to the teeth by a dental professional. It typically contains 1.23% fluoride and is recommended for use every 3 to 6 months. The fluoride in foam works by remineralizing the tooth enamel and making it more resistant to acid attacks.

10.  

10. Fluoride tablets: Fluoride tablets are a form of systemic fluoride application that are ingested by individuals. They typically contain 0.25 to 1.0 mg of fluoride and are recommended for use in children who do not have access to fluoridated water. The fluoride in tablets works by strengthening the teeth from the inside out and making them more resistant to acid attacks.

11.  

Overall, fluoride is an essential mineral for healthy teeth, and its use in dental care has been shown to be effective in preventing caries. Different forms of fluoride preparations are available for use, and the choice of preparation depends on individual needs and preferences. Consultation with a dental professional can help determine the most appropriate fluoride preparation for an individual's oral health needs. 

SBQ

Scenario: Sarah is a 2-year-old child living in Australia where the potable water contains 2 ppm fluoride. Her parents are concerned about her dental health and want to prevent dental caries. 

Question: What is the most effective way to prevent dental caries in Sarah? 

A) Giving her fluoride supplements

B) Using fluoride toothpaste twice a day

C) Using a fluoride mouthwash once a day

D) Taking her to the dentist every 6 months for fluoride varnish application

E) All of the above 

Correct Answer: B) Using fluoride toothpaste twice a day. 

Explanation:

For a 2-year-old child living in an area where the potable water contains 2 ppm fluoride, using fluoride toothpaste twice a day is the most effective way to prevent dental caries. Fluoride supplements are not recommended for children under the age of 3, and a fluoride mouthwash may be difficult for a young child to use properly. While taking Sarah to the dentist every 6 months for fluoride varnish application can be helpful, it is not the most effective means of preventing caries at home. Therefore, option B is the most probable correct answer for this scenario.

Do more SBQ practice in Iridium course.

Image credit: Shutterstock

Teeth Whitening

Introduction

Tooth whitening is done to correct the discoloration of a tooth. When we talk about discoloration of a tooth, we mean to say that the colour of a tooth has become from its normal white colour to light, light brown to dark brown or from light Gray to dark Gray or to complete black. The discoloration may be of one tooth, or all the teeth may be discoloured. Discoloration of a tooth is caused by several factors. It may be due to deposition of external stains over the surfaces of a tooth, or it may be because of the internal position of certain chemicals into the teeth structure at molecular level during the period when teeth were being formed in the mother’s womb.

External Discoloration of the Teeth

External stains deposited on the surface of the teeth may be due to smoking, drinking tea or coffee or food colorants like turmeric. Poor oral hygiene habits may also lead to the external discoloration of teeth. 

Internal Discoloration of Vital Tooth

Tetracycline, excessive fluoride or other medication intake by a pregnant mother during developmental phase of the teeth of the foetus may result in the discoloration of the teeth as a child.

The Internal Discoloration of a Non-Vital Tooth

The discoloration of non-vital teeth is caused by the death of the pulp tissue due to trauma. In such cases, the pulp of the traumatized tooth goes through the death process and becomes necrotic. The necrosis or rotting of the pulp tissues produces Sulphur compounds that give the light brown to dark grey color of that particular tooth.

Procedure of Teeth Whitening

The procedure for teeth whitening depends on whether the tooth is vital or non-vital. These procedures should be performed by a qualified dentist. For common people, teeth whitening kits are available in the market. They can be utilized by anyone with care. The chemicals used for tooth whitening may be hydrogen peroxide or carbamide peroxide.

Technique of tooth whitening for non-vital teeth 

• It'll be a good idea to wait for at least 2 weeks after the completion of root canal treatment before the start of the tooth whitening procedure. During this time period we should watch for the development of any symptom. If no symptoms arise, then we should proceed for the tooth whitening procedure.

• Colour of the tooth should be matched with the shade guide, and it is recorded in the patient’s file.

• A successful root canal treatment of the dead tooth should be done.  Then only, a tooth whitening procedure should be performed to correct the discoloration of the tooth involved.

• The temporary filling material used to fill the access cavity after the root canal obturation should be removed up to 3 millimeters beyond the cervical line.

• Then, the remaining root canal filling material is covered by a setting calcium hydroxide paste of 1 millimeter thickness. The walls of the access cavity should be smoothed with the help of a dental bur. During the smoothening procedure, a smear layer develops over the smooth surface of the cavity. 

• This smear layer should be removed from the walls of the access cavity. This is necessary otherwise the opening of the dentinal tubules will remain blocked, and the tooth whitening chemical will not give its full effect. To do this, 37% orthophosphoric acid is applied over the surface of the access cavity and left for 20 seconds. It is rinsed thoroughly with water and air dried.

• A cotton pledged, soaked in hydrogen peroxide or carbamide peroxide is placed inside the access cavity and sealed by a temporary filling material, e.g. zinc oxide eugenol cement.

• It is left there for 2-3 or more days and continuously observed. The patient is instructed to report back when the colour of the tooth becomes slightly lighter than the neighbouring tooth, the cotton pledge is removed from the access cavity and a suitable filling is done.

Teeth whitening of the vital teeth

Sometimes, few of us, especially younger ones, think that the colour of their teeth is yellow or Gray, not the white. These days, beauty conscious people seek the help of teeth whitening procedures to lighten the teeth colour and make it look whiter. This is done by “Vital Teeth Whitening Procedure”. 

Technique of Vital Teeth Whitening 

• The original shade of the tooth is noted in the file.

• The shade guide is shown to the patient and the desired shade is also noted.

• A thorough scaling and polishing is done.

• All over the face, petroleum jelly is applied for protection from spill of etchant.

• Soft tissues are protected by protecting gel which is supplied by the manufacturer.

• The whitening agents are mixed as per manufacturer’s instructions and applied over the labial surfaces of anterior teeth, from canine to canine or from premolar to premolar.

• A light source is placed over it to enhance the chemical reaction.

• It is left there for the time period specified by the manufacturer.

• The whitening gel is washed away after the specified time.

• The colour of the teeth are matched with the help of a shade guide.

• If needed, the procedure is repeated again and again till the desired colour is achieved.

As a last step, the teeth, after washing away the whitening gal, are coated with a fluoride containing varnish.

The patient is instructed to not eat or drink anything, especially the carbonated drinks for one hour. This period is necessary for remineralization of the enamel by calcium present in the saliva.

Before a patient leaves the dental office, (s)he is advised to avoid eating or drinking foods that may speed up the discoloration of the teeth.

A lot of home kits are available for teeth whitening in the market. They can be used at home by anyone with little care. They are useful for mild to moderate discoloration of teeth.

Image source: Smile Dental (https://www.smilingdental.com.au/)