Dental Hygiene Down Under

When hygienist Veronica Manoa-Hofbauer read about RDH magazine’s 2006 Under One Roof conference on the Internet last spring, she decided to show the information to her boss.

“Look at this conference,” she said. “It sounds great, and I’d love to go, but I don’t think I can afford it.”

When her boss offered to pay her way, Ronni was flabbergasted. Why was it so surprising? Because she lives in Melbourne, Australia. She was thrilled to be able to come to Las Vegas for UOR, and the other attendees were thrilled to meet her. Here’s what life (and dental hygiene) are like Down Under.

Though she’s lived in Australia since 1985, Ronni is originally from Tuvalu, an island nation in the Central Pacific. You may have heard of Tuvalu. It’s been in the news lately because the islands are slowly being inundated by the ocean due to what some scientists believe is global warming. Proponents predict the island will be completely under water in 10 years. That’s a pretty sad and scary thought if you’re from Tuvalu, but Ronni keeps her best memories of home uppermost in her mind.

“Life in Tuvalu is pure paradise,” she says. “The average wage when I lived there was $200 a fortnight. Money is no big deal over there; it’s more just a special treat. The Tuvaluans live on their plantations, raising bananas, taro, breadfruits, potatoes, and fish. They breed pigs and chickens and have them for special occasions such as island feasts, Christmas, weddings, funerals, or birthdays.

“The people are very friendly, shy, and beautiful. In Tuvalu, ‘Big is Beautiful.’ You don’t see a lot of slim Tuvaluans.

“If you’re a harried city slicker wanting to disappear for a while, you could do a lot worse than head to Tuvalu. On average, it receives fewer than 1,000 tourists a year. If all you want to do is sit under a palm tree and never be bothered by anyone, you’re in luck. This is what I miss about Tuvalu ... its quiet, peaceful lifestyle!”

Ronni is one of 10 children. Her parents and all but one of her sisters have emigrated to either New Zealand or Papua New Guinea, but the Manoa family has been very important to Tuvalu. Her father named the country’s only fishing boat, and her oldest brother wrote its national anthem, “Tuvalu mo te Atua,” in 1978 (see sidebar).

Ronni met her husband, Wolfgang Hofbauer, when he was stationed with the Australian Defence Force (Army) in Tuvalu. They left Tuvalu after their marriage in 1985, and moved around Australia with the Army until Hofbauer retired after 20 years’ service as a cartographer. He is now a financial educator in Melbourne.

The couple has a son, Kevin, 18, who plans to attend the Victoria College of Arts in Melbourne next year. He is a member of the School of Performing Arts in Tasmania. The Hofbauers also had a son, Justin, who died as an infant.

Ronni works for Dr. Ross Foster at Toorak Village Dental Care in Toorak, a suburb of Melbourne. She calls the area “a fusion of fashion, exclusive boutiques, restaurants, and health and beauty salons set in a cozy local village atmosphere, where society’s elite mix and shop. Frequently, well-known individuals can be seen picking up the morning papers and sitting down for breakfast and coffee.”

Toorak Village Dental Care offers restorative care, cosmetic procedures, preventive care for adults and children, and periodontal, prosthetic, and endodontic services. Orthodontic and surgery cases are referred to specialists. The staff consists of two dentists, three hygienists, four dental nurses (similar to assistants), and one practice manager.

Ronni says, “I’m very fortunate to work for Dr. Foster, who supports the idea of continuing education for his staff 100 percent. Even though he and I don’t support the same Aussie Rules football team, we always agree to work effectively, cooperatively, and productively with each other and the rest of the team, to achieve the highest standards of quality dental treatment.”

When she came to UOR, Ronni was interested to see that dental equipment is similar in the two countries, but dental products may have different names.

“For example, GC Tooth Mousse in Australia is GC MI Paste in the United States; Colgate Neutrafluor 5000 Plus in Australia is Colgate Prevident 5000 Plus in the United States. Chlorhexidine products are readily available for our patients in Australia, and the highest percentage available is 0.5 in gel form. I was told that the highest percentage available in the United States is 0.12.”

Ronni started her health-care career after high school in Tuvalu. She worked for the Red Cross as a teacher’s aide in the rehabilitation of disabled children, seeing children who were physically, intellectually, and visually impaired.

Because she enjoyed working with children so much, she decided after moving to Australia to look for a job in the dental field. After working as a dental nurse, she earned a two-year diploma in dental therapy from Westmead College of Dental Therapy in Sydney, New South Wales. She then worked in the public sector in New South Wales and Queensland.

A dental therapist, says Ronni, is an educator and motivator who works under the direction of a dentist. The age group a therapist works with depends on the state in which she works. In Victoria, for instance, dental therapists may provide dental care for people up to age 18 and, on the prescription of a practicing dentist, for those between the ages of 19 and 25.

Duties of a dental therapist in Australia include intra- and extraoral assessment, scaling and polishing, applying pit and fissure sealants, taking radiographs, providing dental health education, undertaking routine restorations in primary and secondary teeth, extracting primary and permanent teeth, undertaking pulpotomies of primary teeth, administering local anesthetic, providing emergency temporary placement of crowns and fillings, taking impressions, and constructing mouthguards.

Dental therapists have recently gained a foothold in the United States (see sidebar).

When the opportunity came for Ronni to upgrade her academic level to hygiene, she went back to school in Brisbane. She attended the University of Queensland and Queensland University of Technology in a new conversion course designed for dental therapists who wanted to become hygienists.

“I was given two years part-time to do the hygiene course due to my past experience and credits. Unfortunately, those of us who took on this course only received a certificate in dental hygiene and health promotion.

“I’m planning to study an extra year and do four more units in health promotion to obtain a degree in health science (public health) and diplomas in business (marketing and frontline management) next year.”

Most dental hygiene programs in Australia now, she says, offer a combined dental therapy and dental hygiene degree in three full-time years.

Australian hygienists’ licenses allow the following duties:

• Pre- and postoperative instruction
• Irrigation
• Insertion and removal of surgical packs
• Removal of periodontal packs
• Application and removal of rubber dams
• Polishing of restorations and teeth
• Topical application of coatings, sealants, fluoride, and preventive medicaments
• Supra- and subgingival scaling
• Root planing
• Removal of sutures
• Selection of orthodontic bands
• Removal of orthodontic arch wires, bands, and attachments
• Intra- and extraoral radiography
• Impressions
• Recording of periodontal disease
• Dental health education
• Dietary counselling
• Administration of local anesthesia

Hygienists in Victoria currently are not allowed to do bleaching, open debridement, diagnosis, application of antibiotic solutions, or administration of nitrous oxide. The Dental Practice Board of Victoria, however, will review Codes of Practice for Dental Hygiene and Therapy in April 2007.

Hygienists and therapists are licensed by the Dental Registration Board of each state and territory, Ronni says, and hygienists in Victoria are required to complete 30 hours of continuing professional development every two years.

“Hygiene is the dream career I wanted many moons ago, and I’m very fortunate to live that dream now. I’m always interested in educating people, and hygienists are the prime source of preventive patient education. The patient’s oral health is our ultimate priority. It is our obligation and professional responsibility to educate and provide therapeutic and maintenance care to our patients.”

As a hygienist, Ronni has been active at state and national levels. She’s been a member of the Dental Hygienists’ Association of Australia (DHAA Inc.) since 1999, and is a member of the Australian Periodontal Society, Victorian Branch.

She was fortunate to be involved in establishing the DHAA branch in Tasmania, and was its first state president in 2003-2004.

“I was also the newsletter editor of ‘Hygiene Connection’ for the Tasmanian Branch, and between 2004 and 2005 I was editor of the DHAA Inc. ‘Bulletin,’ the national newsletter for hygienists. After we moved to Melbourne in 2004, I became vice president of the Victorian Branch.”

Ronni sees a long and productive future as a dental hygienist in Australia. As a participant on the Amyrdh.com e-mail list, she keeps in touch with new friends and stays updated on U.S. and Canadian dental hygiene. Her employer has already agreed to send her to the 2007 UOR conference in Washington, D.C., and she would like for him to come along.

“I had the most wonderful experience of my life at UOR in Vegas,” she reports. “I brought back a lot of knowledge and fun-filled memories.

“See you in D.C. next year!” RDH

Dental Therapists in the United States

Dental therapists, used for nearly a century in Australia, New Zealand, Canada, Great Britain, and other countries, are beginning to operate in the United States. Access to oral health care in remote areas of the United States has been a continuing problem, and in 2003, the Alaska Native Tribal Health Consortium (ANTHC) began to address the issue with a new solution, the Alaska Dental Health Aide Initiative.

Based on a medical model that has been in use since the 1960s, the initiative places dental health aide therapists (DHATs) in Alaska to provide basic dental care where there is a shortage of dentists.

The American Dental Association opposes the use of DHATs, and filed a lawsuit last January against ANTHC to prevent DHATs from working in rural Alaska. The ADA argues that DHATs are operating outside state law.

In response, ANTHC argues that because they are federally governed, federal law supersedes state law.

The therapists, who are mostly Alaska tribal members, receive 2,400 hours of classroom training and clinical experience over a two-year period at the Otago University School of Dentistry in New Zealand. Training is followed by a 400-hour preceptorship under the direct supervision of a dentist. Therapists are certified by the Federal Community Health Aide Certification Board.

DHATs provide oral health education; preventive services such as fluoride application, sealants, and cleanings; fillings; and uncomplicated extractions.

In the past, Alaska Native tribes have utilized volunteer and itinerant dentists to serve rural communities, but have lacked continuity of care.

“Rural communities,” says the ANTHC Web site, “need providers with a full-time presence to effectively improve oral health habits and implement preventive programs.”

Louis Fiset, DDS, a professor at the University of Washington, looked at the efficacy of Alaskan dental therapists in September 2005, and said this:

“I have evaluated the clinical performance of four dental therapists who have been providing primary care for Alaska Natives since the beginning of 2005 ... Their patient management skills surpass the standard of care. They know the limits of their scope of practice and at no time demonstrated any willingness to exceed them ... I believe that the program deserves not only to continue but to expand.”

(Information from ANTHC Web site used with permission)