CADMUS 2009 by Adbourne Publishing

CADMUS

The Journal of Australian Defence Force Dentistry

ISSN: 1834-0601

CONTENTS EDITOR’S MESSAGE

OFFICIAL ADDRESSES

ADF Operations

Army Aboriginal Community Assistance Program

Professional and Technical Items Between the Composite Resin and the Dentine… Case Study: Management of Unilateral Condyle Fracture Case Study: Restoration of Traumatic Crown Fracture

Other ITEMS AND ACTIVITIES

ASEAN Regional Forum – Voluntary Demonstration Response Exercise TENDON VALIANT VII

From Dental Assistant to Senior Dental Assistant Timor Leste – Operation ASTUTE: An Australian Perspective

Pacific Partnership 2009 – USNS RICHARD E. BYRD Exercise LONGLOOK

RAADC Corps and Historical

Exercise TALISMAN SABRE

The career of Major Werner Johann Josef Voss

Members on non Corps Posting 2009

Honours and Awards

Directorate of Defence Force Dentistry Annual Report

Update from the RAADC Association Incorporated From Headquarters Forces Command

Unit News

Joint Units

FEATURE ARTICLE

The RAN Dental Branch – A Bite of History

Royal Australian Navy Fleet News Royal Australian Navy Dental Branch Royal Australian Army Dental Corps

Training Update

Royal Australian Air Force Dental Branch

The ADF Dental School

ADF Health is published annually by Adbourne Publishing for the Australian Defence Force Health Services Division. For any correspondence regarding the content of this journal, please contact Lieutenant Colonel Kittie Dugan, SO1 Dental Plans and Programs, Directorate of Defence Force Dentistry, CP2-6-039 Campbell Park Offices, Canberra ACT 2600 Australia. Email: kittie.dugan@defence.gov.au The statements or opinions that are expressed in the Journal reflect the views of the authors and do not represent the official policy of the Defence Health Service unless this is so stated. Although all accepted advertising material is expected to conform to ethical and legal standards, such acceptance does not imply endorsement by the Journal or the Australian Defence Force Health Service. All literary matter in the Journal is covered by copyright, and must not be reproduced, stored in a retrieval system, or transmitted in any form by electronic or mechanical means, photocopying, or recording, without written permission. Published by: ADBOURNE PUBLISHING 18/69 Acacia Road, Ferntree Gully, Vic 3160 Phone: (03) 9758 1433 Fax: (03) 9758 1432 www.adbourne.com SOUTH AUSTRALIA Phone: 0488 390 039

CADMUS 2009

Adbourne Publishing and the Directorate of Defence Force Dentistry cannot ensure that advertisements appearing in this magazine comply with the Trades Practices Act and other consumer legislation. It is the responsibility of the supplier of advertising materials to ensure compliance with all legal requirements.

Front Cover: Surgeon Dentist Milton Spencer Atwill at sea in HMAS AUSTRALIA (1) in 1918 during World War 1. Australian War Memorial Negative Number EN0020

CADMUS

The Journal of Australian Defence Force Dentistry Celebrating the inauguration of the RAN Dental Branch Logo and Motto Volume 28, 2009

Editor’s Message This is a special year, as we celebrate the inauguration of the Royal Australian Navy Dental Branch Logo and the Motto ‘Fit to bite, fit to fight’. This edition is the first issue since 2004, when the journal became a tri-Service publication, that the RAN Dental Branch has taken centre stage. Lieutenant Shannon Godfrey, RAN, one of the newest naval dental officers has written a brief informative article on the Dental Branch after his diligent research of its 90+ years of history. In this edition, we have also included a number of interesting reports from Exercises in which our dental members have participated, over half of which were multinational efforts. This journal cannot produce itself. I thank the three single-Service subeditors Lieutenant Commander Tanya Burton, RAN, Captain Mike Lines, and Squadron Leader Andrew Draper, for their willing assistance and sterling effort in collating the materials. I also thank the many others who assisted with reviewing and checking the content. I thank the many authors who have contributed articles of both high standard and fine content. Without their efforts, this edition would not be the success that I believe it is.

LTCOL Kittie Dugan

I am also grateful for the continued support of this journal from the Director General Garrison Health Services, Commodore Robyne Walker, RAN and Commander Joint Health, Major General Paul Alexander, at a time when the Directorate has been faced with serious under-manning and a myriad of competing priorities.

As always, the production of this magazine is made possible through the professionalism and expertise of the team at Adbourne Publishing, and those generous advertisers who choose to support this publication. I thank the Managing Director Neil Muir and his Production Manager Claire Henry, who ensured that the 2009 edition was printed to such a high standard. The cover page this year is an historical photograph of Surgeon Dentist Milton Spencer Atwill at sea in HMAS AUSTRALIA in 1918 during World War 1 and incorporates the RAN Dental Branch Logo, officially approved by the Chief of the Navy on 14th August 2007.

LCDR Tanya Burton

CADMUS 2009

CAPT Mike Lines

SQNLDR Andrew Draper

Joint Health Command

Message from Commander Joint Health, the Surgeon General Australian Defence Force Major General Paul Alexander, MBBS, MLM, FACLM, DTM&H, Dip Sports Med

Providing this message for CADMUS 2009 is again a great opportunity for me. Last year’s edition was another high standard publication and packed with interesting articles. The feature article regarding the loss of Surgeon Lieutenant Mervyn Townsend and the HMAS SYDNEY was of particular interest and I am keen to see the results of the DNA testing on the unknown sailor. Providing dental treatment for a Queensland Police dog indicates a wide variety of cases for the dentists at RAAF Base Amberley! CADMUS continues to be a practical, educational and social forum for all staff of ADF dentistry. This has been another year of changes within both the ADF and in particular Joint Health Command. The White Paper and Strategic Reform Program (SRP) changes have seen the Government reaffirm it’s commitment to the Defence of Australia and an increased future capability. Joint Health Command will contribute to the SRP and sees the program as an opportunity to enhance our processes and improve our service. The SRP is consistent with the broader strategies that are being considered by Joint Health Command in relation to Health reform. We have seen the beginning of our change initiatives over the past 12 months and significant activities are currently underway. Service Level Agreements have been signed between Vice Chief of Defence Force and the Single Service Chiefs for the provision of healthcare. This clarity of understanding around the services that will be provided by Joint Health Command has allowed us to now focus on the development the Regional Level Agreements that will explain how services will be delivered at each location. As part of the reform program we are continuing to develop strategic alliances with State Health facilities, progressing the development of the e-health solution, currently reviewing the garrison health model and also improving delivery of our mental health services. These are key activities within Joint Health Command and have been recognised as key enablers for the successful delivery of combat health and will enable us to develop a more efficient and effective garrison health system while reinforcing our contribution to ADF operational capability. In the last 12 months, Joint Health Command has developed important new dental policy in relation to management of wisdom teeth that is soon to be signed. It will provide clearer guidance as to which teeth need to be removed prior to deployment, and those teeth that can be safely managed conservatively, thus maximising individual readiness whilst still minimising dental casualties on deployment. Other new policies under development include complex dental treatment, dental implants, scope of clinical practice for auxiliaries, and cardiopulmonary resuscitation preparedness of ADF dental facilities. It has been very pleasing to see the ADF dental units continue to lead the way in 2009 by collecting rate of effort and costing data for in-house dental services, using Australian Dental Association (ADA) item numbers. This new work practice will enable the cost of delivering dental care to the garrison using in-house providers to be compared to the cost of provision by the private sector, thereby providing clear proof of the value and cost-effectiveness of the high quality dental services that you all help to deliver. I would like to take this opportunity to congratulate you all and acknowledge your contributions over the last year. It has been a year of challenges but the dedication of the dental staff across the ADF is evident in your efforts to maintain the dental fitness of the ADF. As I continue my regional visits I hope to meet with you all.

CADMUS 2009

Joint Health Command

Message from the Director, Defence Force Dentistry Captain Brendan Byrne, RAN, BDS, MMDS, MBA, Grad Dip MS, psc(j), AFACHSE

Welcome to the 2009 edition of CADMUS, the Journal of Australian Defence Force Dentistry. This volume has been unusually challenging to prepare because manning at the Directorate of Defence Force Dentistry was halved in 2009. For most of the year the Directorate has been manned by only myself and LTCOL Kittie Dugan, with CPL Liza Wynen providing much needed administrative support one day per week. I am therefore indebted to LTCOL Dugan for the determination and commitment that she has shown as editor, to ensure that this edition of CADMUS met the publication deadline. I also wish to acknowledge the sterling single-Service editorial support provided by LCDR Tanya Burton, SQNLDR Andrew Draper and CAPT Michael Lines. My sincere thanks to all dental colleagues who have contributed articles. And as always, I wish to thank the companies that support the journal though their advertising, and Neil Muir and the Adbourne Publishing team, without whose assistance this journal would not be possible. 2009 has been a year of challenges, marked by manpower shortages at many levels and the requirement to reduce spending in order to achieve Strategic Reform Program savings. My first six months in this Directorate were certainly not what I had expected. Upon posting into the Director’s position, I was immediately dual-hatted as the Director of the Joint Health Support Agency, a demanding role which left precious little time for dental matters, especially as it coincided with the outbreak of the H1N1 swine flu pandemic. However, I was overwhelmed at the way that various dental colleagues rallied around to assist me to keep the Directorate functioning. First and foremost, I wish to acknowledge the outstanding contribution made by LTCOL Kittie Dugan, who acted as Director in my absences and ensured that the many policy, data gathering, analysis, planning and clinical approval processes continued to operate. Kittie was ably supported by WO Shaye Metcalf until her April departure, with Shaye taking particular pains to bed in the rate of effort data capture processes. Since leaving the directorate, Shaye has continued to lend invaluable support remotely from Victoria on reserve days. I would also like to take this opportunity to thank COL Janet Scott, the Chair of the Dental Consultative Group, who has provided assistance with policy development, helped to develop CADMUS 2009

the new visiting oral surgery team program, and delegated for me at the 2009 World Military Dental Congress. My thanks go also to GPCAPT Greg Mahoney who has lent excellent support with epidemiological data and research, which will help shape and justify the future garrison and deployed roles for uniformed dental personnel. On an issue near and dear to all of our hearts, SQNLDR Andrew Draper has voluntarily led the charge from Amberley, to conduct an extensive trial of all of the various process challenge devices (PCD) on the market, in order to identify which PCD(s) will trigger consistently in our Type B pre-vacuum benchtop sterilisers. I would also like to acknowledge the three dental branch heads – CMDR Mark Brazier, LTCOL Suzy Atkins and WGCDR Christine Cordery – who have done admirably in leading their respective dental staffs, and have worked hand-in-hand with the directorate to prepare position papers in response to several challenging strategic reforms. Significant manpower and financial savings have been mandated under the Strategic Reform Program and the need for three uniformed dental services will be closely examined in order to ensure best fit with the ADF’s current and future concepts of operations. There is no intention of reducing the level or standard of dental support to the ADF. However, the number of uniformed dental positions will come under close scrutiny, so this directorate and your branch heads will be preoccupied in the next twelve months with confirming operational roles and identifying sustainable structures for each of the Dental Branches and Corps. I would like to take this opportunity to acknowledge the departure from the ADF of two of my esteemed DDFD predecessors – COL Stephen Curry and COL Geoff Stacey. Steve completed 33 years of dedicated Army service in January 2009, culminating as the Director of Defence Force Dentistry from 2006-2008, and has now entered semi-retirement in the Canberra area. Geoff will leave the ADF early next year, after a 30-year career with Army, in which he achieved an enviable reputation as a specialist prosthodontist, Director, marksman and athlete. Geoff will also semi-retire to the Canberra-Monaro district. Steve and Geoff will be sorely missed by all who knew them as friends and colleagues and I thank them for their magnificent service to the ADF and for their legacy in establishing this Directorate. I hope that you enjoy this edition of CADMUS. My thanks to one and all for your professionalism, pride and commitment to your single and tri-Service dental organisations, and for continually punching above your weight as providers of first class dental care to our servicemen and women.

Royal Australian Navy Dental Branch Message from the Leadership, Navy Dental Branch Commander Mark Brazier, RAN, BDS Warrant Officer Shaye Metcalf, Dip. Pract. Man

It gives me great pleasure to be able to contribute to this special edition of CADMUS celebrating the inauguration of the RAN Dental Branch logo and motto. The logo was officially approved by the Chief of the Navy on 14th August 2007. As with many of these things, many thanks are owed to a number of people who combined to enable the initial idea to come to fruition. CMDR David Dugan and CPO Penny Stone first conceived the idea during their posting to Fleet Dental to bring the Fleet Mobile Dental Teams under one cohesive banner. LS Adam Collins (now CPL Collins) utilised his considerable artistic prowess to draft a number of possible logos before the current design was finalised. The concept proved to be so popular that the whole Branch adopted and endorsed the idea. WO Shaye Metcalf and WO Peter Kenworthy then worked towards official recognition of the logo by the CN. It is of course the people that define and continue to define the RAN Dental Branch and my appreciation goes to each and every one of our members that have contributed to the maintenance of the oral health of ADF personnel throughout Australia and overseas.

It is with much excitement that I put pen to paper for this CADMUS issue. Much of the excitement stems form the inaugural RAN Dental Branch logo which continues to provide our dental team with an individual identity within our much larger Health and Naval family. This logo resulted from much hard work by many existing and previous dental staff and I add my personal thanks to them all, especially CPL Adam Collins, CPODENM Penny Stone, WODEN Peter Kenworthy and CMDR David Dugan.

Now that Defence Health has entered a significant phase of restructuring under Joint Health Command it is more important than ever that our services are maintained and improved both operationally and in garrison support areas. Although periods of organisational change can be difficult, they can also present opportunities. It is up to all of us to identify and embrace these opportunities as they arise in order to move forward as a strong Dental Branch. A major milestone in March 2009 was the official launch of the Navy Health Service (NHS) by the Director General Navy Health Service (DGNHS) and the Director of Naval Health (DNH). The RAN Dental Branch is very much a part of the NHS and contributes significantly to the mission: ‘To optimise the health and well being of Navy personnel’. It is important that we take pride in our Branch but that we always remember that we are an integral part of a larger organisation.

In the last twelve months, interest in joining the RAN Dental Branch, has been unprecedented, leading to greater numbers, greater flexibility in postings and training courses, and better retention levels. During this period of ‘plenty’ I recommend that you all take advantage of our numbers and continue to ‘work hard, play hard’. With this in mind I would encourage our Senior Dental Assistants (SDA) to consider panelling for the SDA Preventive course for 2010. Although this course does not have a direct civilian equivalent, the skills you gain and the capability you represent are valuable assets to the ADF. You will be able to interact and intervene at a personal level with patients as a clinician, providing prescribed services, advice, guidance and education on oral health. This career path also provides an opportunity for those in no hurry to undertake an administrative role, to remain in surgery for longer and develop further clinical skills before the next rank.

We have been fortunate over the past 12 months to experience minimal turbulence within the Dental Sailor Category. However, the significant loss of Dental Officers is a reminder that recruitment is an ongoing concern and that it is up to all of us to contribute wherever possible. On a final note I would like to thank CMDR Peter Fatouris, CMDR David Dugan and WO Shaye Metcalf for their significant contributions to the RAN Dental Branch over careers spanning 23, 15 and 20 years respectively. Their efforts have done much to ensure the strength and stability of our current Branch and their work is appreciated by all.

This year has seen the bedding in of the dental monthly returns and I ask for patience as we attempt to streamline our reporting processes so you can concentrate on your core business. These reports continue to provide evidence of the quality of the dental support you provide and the broad scope of data has been used in a variety of decision-making processes. I thank all those members who took the time to provide feedback and host the DDFD Corporate Governance visits to NSW, ACT and VIC. We are aiming to reach all other dental sites over the next 18 months.

I have continued to work closely with the Directorate of Sailor Career Management (DSCM) and ADF Dental School (ADFDS) to ensure current training still reflects the needs at the ‘coal face.’ I thank the staff from DSCM and ADFDS for their ongoing support. I thank you all for your continued efforts and look forward to working with you in 2010.

‘Fit to Bite, Fit to Fight’

CADMUS 2009

Royal Australian Army Dental Corps Message from the Leadership, RAADC Lieutenant Colonel Suzy Atkins, BDSc, Head of Corps Warrant Officer Class One Kym Chiesa, CSM, Corps Regimental Sergeant Major

The RAADC has had yet another very busy year. The pace of force preparation continues unabated and I know that officers and soldiers at all levels have had a hand in ensuring that ADF members deploy with the very best dental preparation possible. There is no doubt that at all levels of command, the Army is well aware of how busy we are and how tirelessly we work. We do, however, face many challenges with shortages of dental officers and dental technicians and an unbalanced workforce structure. Specifically, we have not yet been able to redress the previous establishment changes that have led to a lack of opportunity for promotion to CPL rank in dental assisting and the imbalance in the MAJ/CAPT ranks. This has been a year of reviews and changes with the introduction of The Adaptive Army and the Combat Service Support Review. I have been very impressed with the levels of innovation, dedication and passion from all members of the Corps who have provided widespread input into these reviews. I am personally hopeful of real change that will allow our Corps to not only survive but to thrive. Whatever the outcome, I am confident that no stone will have been left unturned in the effort to restructure and re-energise the Corps. One of the highlights during my first year as Head of Corps was the significant number of Army Dental Officers at the Dental Officer Initial Course at ADF Dental School. We have 3 new ARA dental officers: CAPT Mike Lines (who comes with a wealth of experience in AAPYSCH), CAPT Thomas Van Heumenm (posted to Townsville), and CAPT George Lathouras (posted to Darwin). Reserve dental officers: CAPT Shane Hearps and CAPT Quintin Wilson were also in attendance. There have been some significant achievements with recruiting, and I am happy to report that we currently have 6 dental students in sponsorship. The strength of our Corps has always been the people and so it is a great loss to farewell 2 officers with a combined 70+ years of service. Major Werner Voss, a Federation Star recipient leaves us after 40+ years and will be sorely missed. The Corps is full of soldiers and officers whom he has trained and mentored. COL Geoff Stacey is also leaving for greener (or fishier) pastures after 30+ years. COL Stacey would be the most well known member of our Corps, having represented Army in many shooting competitions for many years, having served twice as HOC, having served as DDFD, and through his involvement in many instances of forensic victim identification. One of his legacies is the Army Field Dentistry Handbook, a landmark document that has proved invaluable for the training and deployment of field dental teams. Our small Corps has been well represented this year in so many areas, but in closing, I wish to make special reference to: CAPT Anthony Craigâ€™s stellar performance at the Arafura Games with 3 gold medals and 2 game records in running; the deployment of CAPT Shirley Robinson to Timor Leste; the exchange of CAPT Karen Such and PTE Karla Hosie on LONGLOOK; and the noteworthy participation of MAJ Wayne Chow, SGT Mark Allen and PTE Evan Watson-Keast at the ASEAN Regional Forum in the Philippines. To my fellow fang farriers, you have certainly done all of us proud!

CADMUS 2009

It is with great delight that I write this article as the RSM for the RAADC, as this appointment has been a career aspiration of mine. It is difficult to condense a yearâ€™s work into half a page, so my primary focus is that of change. Change started this year with our HOC. I would like to acknowledge the unfailing support that COL Stacey provided to me in my endeavours as your Corps RSM. Without exception, COL Stacey was always willing to let me explore new avenues for the purpose of affecting change for the RAADC. Further to this, he was always supportive and would listen to what I had to say when speaking of Corps issues. I now offer my congratulations to LTCOL Suzy Atkins in her efforts as our new HOC. I would also like to welcome to the RAADC Committee our new Deputy HOC, LTCOL Genni Constantine, and our new SO2 Corps for Health Services, MAJ Bruce Murfin. Both members are highly regarded and bring fresh outlooks and ideas to our meetings. This year we have seen the advent of such programs as the Adaptive Army Initiative, the Strategic Reform Program and the Army People Plan. We have also seen the roll-out of GORPS. All of these initiatives have been endorsed at the highest possible level within Defence. If you have not realized by now, we really are an Adaptive Army. This means that we must also remain adaptive to new and emerging programs and initiatives. If we are not, we are simply going to be left behind. The responsibility lies with each and every one of us, to get on board and move with the times. If we do not, we are doing this wonderful Corps an injustice. This year has seen unrelenting support for the RAADC by the Command Health Officer, COL Georgina Whelan. By the time this goes to print, the RAADC CSS Workshop on reshaping our future will have been conducted, after a work up of over 12 months and in spite of many obstacles and cancellations. It arose out of the necessity for Dental Corps personnel to have influence over their own futures in conjunction with other health assets. COL Whelan has provided the funding for selected Corps personnel to participate in the workshops and discuss how we can best deliver dental capabilities into the future. My sincere appreciation goes to COL Whelan for her tenacious nature and her persistence in ensuring that we have an opportunity to voice our opinions in shaping the platform for our future Corps and how we will best conduct business in conjunction with auxiliary health assets. I am pleased that once again this year many members have been involved with extra-curricular activities that not only allow the ongoing development of their skill sets, but also have displayed opportunities to show that we have some outstanding ambassadors within this Corps. I am elated that we have had RAADC personnel on Exercise LONGLOOK since 2005. I congratulate CAPT Karen Such and PTE Karla Hosie on their successful completion of the exercise. In closing, I wish to convey to each and every one of you, officers and soldiers alike, my admiration and appreciation for your roles in seeing us through what I consider to be a difficult time for the RAADC. You are to be commended for your unyielding determination to overcome the difficulties we are facing and to produce a better outcome for our Corps, our members and the wider ADF. I wish you every success with your career aspirations in 2010 and as always, good soldiering.

Royal Australian Air Force Dental Branch Message from the Leadership, RAAF Dental Branch Wing Commander Christine Cordery, BDSc, Grad Dip Org Comm, Grad Dip Clin Dent Warrant Officer Janet Brennan, BSc

Greetings from Seattle! Thanks to the wonders of DREAMS and a very modern and adaptable organization, Headquarters Health Services Wing (HSW) has allowed me to continue my work as the Air Force Specialist Dental Advisor from the USA. Operating at a distance can be challenging - thank you to those of you who have filled in for me on occasion. Thank you to my predecessor, SQNLDR Mark O’Sullivan, who was a great representative for the RAAF Dental Branch. He did a fantastic job of juggling the demands of Head of Branch, running a busy dental section and a part-time specialist practice, and is to be applauded for the work he did during his time in the chair. 2EHS (RAAF Williamtown and RAAF Tindal) was put to great use during Exercise TALISMAN SABRE 2009. All reports were extremely positive regarding the contributions the dental team made and I’m sure the lessons learned will stand us in good stead in the future. On the operational front, Pacific Partnership went ahead in 2009, albeit with reduced numbers due to the effects of the swine flu epidemic. Tindal-based CPL Diane Beningfield participated aboard the USNS RICHARD E. BYRD. This operational opportunity was once again highly sought after and we will endeavour to ensure that 2010 will provide another chance for those who are keen to take part. RAAF Tindal featured heavily this year in ‘despatches’. SGT Kerry Sears, was recognized with the prestigious McCarthy, Rowbottom and Jones Award for outstanding contributions to ADF Operational Health Support. Well done to SGT Sears for her consistently outstanding work. As HSW continues to mature the Air Force’s Operational Dental Review, I will continue to provide advice to leadership and ensure that I seek input from the Dental Branch on these matters. While this review is underway, the Air Force will also be negotiating with JHC regarding its role in garrison dental support. Each of the dental sections has already made invaluable contributions to these important activities by way of Dental Returns. Having recently been an SDENTO, I understand these reports involve a significant time and effort to complete and I thank each of you for your efforts. The data that you provide is helping decision-makers to understand the value of your work in real terms. SQNLDR Draper had an important role in revising the Dental Returns process and is to be congratulated for his contribution. Lastly, I would like to welcome all the newcomers to the Air Force Dental Branch. I hope you are as happy with your decision to join the ‘big blue’ as I have been for the past 16 years. Farewell to those who have gone on to new ventures, we thank you for your service. I wish the very best to everyone for a merry Christmas and a safe, prosperous 2010.

CADMUS 2009

As Dental Trade Adviser, it has been an extremely busynd challenging year. As a team, we have achieved some outstanding results in the musterings both in Branch and in Air Force Health. Without doubt, my 2009 highlight was visiting the Battle of the Somme sites during long service leave. My LSL started on 2nd May 2009 and I travelled to Italy, then Norway, Denmark, Sweden, Finland, Russia (St Petersburg and Moscow), Belarus, Poland, Germany and finished in France on 5th June 2009. It was breathtaking to see the poppy seeds in full bloom and to walk the fields associated with so much grief. The whole experience was very humbling. I also sailed the Neva River and walked under the Brandenburg gate and past the infamous ‘Check Point Charlie’. Work wise, my involvement in Exercise PACIFIC PARTNERSHIP 09 (PP09) was immense and I did not even deploy! PP09 was a USPACFLEET (and other agency) activity designed to provide humanitarian assistance in South East Asia and Oceania with a focus on medical, dental and public health. Unfortunately, due to H1N1 virus, PP09 was changed at late notice and the proposed 4-person dental team was reduced to just DENTSDAP CPL Diane Beningfield from 2EHS DET TDL. She deployed in June 2009 and returned to TDL in Sep 2009. CPL Beningfield acquitted herself very well and should be congratulated on her efforts. There will be more opportunities for similar deployments in 2010 – so keep your eyes open for the EOI message. For DENTASST and SDAP it is important to remember when submitting any similar EOI – you must have completed the SDA course or have been granted RPL by DDFD. The SDA course provides participants with the necessary skills to deploy into an operational environment and as such is a deployment enabler for applicants. Applicants with this qualification will be viewed more favourably than those without it. I welcome all our new dental members, congratulate those identified for promotion in 2010, and encourage all of you who will be posted at the year’s end to embrace the changes ahead of you. In these difficult and often confusing times, I encourage you all to make the most of any opportunity to broaden your skill set, get out of the surgery and do something different – even if only for a day. I thank WGCDR Christine Cordery (Air Force Specialist Dental Advisor) for her support and also extend a special thank you to FSGT Sheryl McPherson who undertook the role of Dental Trade Adviser while I was absent. Finally, I wish you all a safe and joyful festive season and a prosperous 2010.

Reports from Operations and Exercises

Report of Activities from 19th May to 9th July 2009

Army Aboriginal Community Assistance Program Corporal Daniel Kempster, Dental Technician

The Army Aboriginal Community Assistant Program (AACAP) for 2009 was held in the town of Mapoon in far north Queensland. The 1st Health Support Battalion (1HSB) was tasked to provide a range of services for the locals, one of those being dental. Several dental personnel from 1HSB, 11th Combat Service Support Battalion (11CSSB), Randwick Health Centre (RHC), and our British counterparts served in this program on a rotational basis between 19th May and 9th July. The first phase included CAPT Amanda Lean (1HSB), CPL Rachel Taylor and CAPT Emily Close (both from Exercise LONGLOOK). For the second phase, members included CAPT Shane Hearps (11CSSB), myself (RHC) and PTE Lauren Morgan (1HSB). CPL Maryann Broadway (1HSB) stuck it out for the entire period.

Summary Points: Typical Health tasks for AACAP • • • • • • • •

Health support to ADF personnel Environmental health support and advice Community first aid training Community health awareness and health promotion Conduct physical training and education programs Augment dental health programs already in place Veterinary assessments and awareness training Health specific cross-cultural awareness training

AACAP is a co-operative initiative between the Department of Families, Community Services and Indigenous Affairs and the Australian Army to improve living and environmental health conditions in remote Aboriginal communities. AACAP demonstrates a commitment to practical reconciliation, while delivering training benefits to the Australian Defence Force.

Mapoon is one of many small communities located in the top end of Australia, and like so many services, dental is one that is in very limited supply. The closest dental support available to the locals is in the neighbouring town of Weipa, an hour’s drive away. The ‘fly in’ or part-time dentists in these areas are in high demand and it is said that they charge exorbitant prices for their services. The limited access to dental treatment impacts on the living conditions of the already low socio-economic community of Mapoon.

oral hygiene. We treated various age groups from the children of Mapoon Primary School to the town elders. The personal stories of the people and their backgrounds were interesting and not something we city folk were accustomed to. For example, some patients had never seen a dentist in their lives. Some had been living in pain for days, weeks and even months, and some just needed a set of dentures to eat and smile with. This has really opened our eyes to things that we have often taken for granted.

When we arrived, the community responded positively and dental appointments ‘went like hotcakes’. Tooth brushing classes were implemented to educate the locals on the importance of good

We saw many patients, worked long days and were granted R&R (Real Recreation!) for

The local medical and the Army dental team (rear L-R) CPL Broadway, CAPT Hearps, CPL Kempster, and (front) PTE Morgan

CADMUS 2009

New dentures bringing back old smiles Saturdays. Some of us took the opportunity to immerse ourselves in the strong fishing culture of the area. After fishing the creeks and coast, it didnâ€™t take us long to realise that the waters were infested... with very large fish! CAPT Hearps entered and won the community prize for the largest Barramundi. The only major consequence of our fishing was the belly ache after eating such a huge amount of fish. The laid back community lifestyle of Mapoon is something we couldnâ€™t help but admire. Providing a dental service to a community in genuine need was very fulfilling and gave us a great deal of satisfaction and a real sense of accomplishment. The program enhanced our trade skills in the field, as many of us have not had much opportunity to treat patients outside of ADF dental facilities. Happy smiles on our patientsâ€™ faces reminded us of the positive impact and lifechanging experience we had brought to them. AACAP 2009 was a very worthwhile program with which we consider ourselves privileged to have been involved.

Reports from Operations and Exercises

Report of Activities from Philippines 4th to 8th May 2009

ASEAN Regional Forum â€“ Voluntary Demonstration Response Sergeant Mark Allen, 2nd Health Support Battalion

The 2009 Association of South East Asian Nations (ASEAN) Regional Forum on Voluntary Demonstration Response (VDR) was the first medical exercise between government agencies of the ASEAN countries. It was hosted by the Armed Forces of The Philippines (AFP) and The Philippines National Disaster Coordination Centre (NDCC). The United States Pacific Command (USPACOM) took the lead role in the health planning and the conduct of the operation, in conjunction with The Philippines Government.

MEDCAP. A dental team and an environmental health (EH) team were provided by 2nd Health Support Battalion (2HSB) to the exercise. The participating members, from 2HSB were MAJ Wayne Chow, SGT Mark Allen, and PTE Evan Watson-Keast for dental; CPL Stephen Shelverton and PTE Andrew Chappell for EH.

The exercise was primarily a civilian-led activity, supported by the military, in order to display the capabilities of ASEAN Regional Forum (ARF) members in response to natural disasters. The exercise used a hypothetical situation of a disaster aftermath where an international humanitarian relief effort was required to support the affected region and local population. The aim of the ARF VDR 2009 was to co-ordinate Philippines Government and international military efforts towards building security cooperation in areas such as humanitarian assistance and disaster relief. The objectives included reconstruction of a school building and a bridge, installation of a water reticulation system and the provision of medical and dental treatment to about 8,000 people in the Central Luzon area (Olongapo and Sapang Bato). The scenario used for ARF VDR 2009 was a Signal 4 or Category 5 super typhoon, which has hit The Philippines during the month of May, resulting in catastrophic landfall and widespread destruction. There were over 20 participant countries in 2009. Some of these countries include The Philippines, United States, Japan, Papua New Guinea, Indonesia, Cambodia, Sri Lanka, Singapore, and Australia. Each participant country contributed personnel and assets towards engineering capabilities (ENCAP) and medical capability (MEDCAP). Other concurrent activities were conducted in Manila and Clark Air Force Base as part of the ARF VDR 2009. These included round-table discussions on International Disaster Response, static displays of search and rescue aircraft from different countries, and demonstration of medical evacuation capabilities.

Australian Contribution

The ADF responded by sending 18 personnel from Brisbane, Sydney and Melbourne to the respective engineering (ENCAP) and medical (MEDCAP) projects. There was a large representation of reservists from 3rd Health Support Battalion (3HSB) on

2HSB members at the Clark Air Force Base with WGCDR Paul Hickerton, HQJOC This was the first time many of the ASEAN nations had the opportunity to cooperate and provide a real-time service on the ground. The exercise provided mutual benefits to the host nation and the participant countries where they were able to test the interoperability of their medical capabilities. During the initial phase of ARF VDR 2009, the US health planners allocated 2 teams for the MEDCAP projects. Every effort was made to ensure there was an even spread of skills and capability amongst each team. The dental and EH teams from 2HSB were allocated to the Iram Resettlement at Olongapo whilst the remainder of the contingent were allocated to Barangay Sapang Bato. At Sapang Bato, several thousand patients were seen by the international military teams. Doctors and medical assistants provided general practice consultation and limited treatment to the local people. Many required treatment for open wounds and infections. They did not have access to, nor could they afford to seek treatment at the regional hospital.

CADMUS 2009

Whilst the doctors were at work, medical assistants provided valuable assistance in the clinics and took routine vital observations. They were also called upon to control the flow of patients during the first two days of the exercise. An immunisation clinic was run concurrently, where medical assistants and nurses administered polio and tetanus toxoid vaccines for children. PTE Sonia Brookes, a reserve medical assistant who deployed on this exercise made the following observation: “….we adapted and made things work. From a medic’s point of view, we had to provide assistance so that the doctors could continue to see patients. We had to work under difficult conditions and were faced with limited resources such as dressing and drugs. It was very rewarding to work with health professionals from other nations. Many of the locals were warm and welcoming towards the Australians. The smiles on their faces were priceless….” At Olongapo, CAPT Dan Schmidt, a Nursing Officer from 3HSB and a civilian nurse at the Alfred Hospital in Melbourne, also had a very rewarding experience whilst working on the MEDCAP project. He conducted stock control at the pharmacy to ensure that the right medicines were dispensed to the locals. He provided training and supervision to local teachers who volunteered in the pharmacy. CAPT Schmidt said, “…it was an awesome experience with lots of learning points. Professionally, it was a great chance to see disaster management theory being applied during this exercise.”

technicians (a PAF dental technician is the equivalent to an ADF dental assistant). MAJ Chow led the ADF dental team, together with dental technician SGT Allen and dental assistant PTE WatsonKeast. The facility inside the classroom was very basic. There was no lighting or running water, only student desks and tables were available for use. After a quick recce, the dentists decided to set up 3 student desks facing the window as the dental chairs. The

PTE Watson-Keast, torch bearer dental instruments were provided by the Filipinos and allowed us to perform examination and basic extractions. Cold sterilization, using glutaraldehyde solution, was the only available method for disinfecting the instruments in between patients. PTE WatsonKeast had to adapt very quickly to a different way of dental assisting to keep up with the hundreds of patients lining up outside the classroom. Over 550 dental extractions were performed in 3 days. MAJ ‘balut’ (duck egg) Chow said, “….it was a back-breaking job… I have never pulled out so many teeth… whilst we cannot solve their dental problems overnight, the little that we have done would hopefully have helped the local villagers immediately”. There was no equipment or material to provide dental prostheses during the exercise. The local population would benefit greatly if the PAF dental team could provide this service for future exercises. SGT Allen reverted back to life as a dental assistant and provided valuable assistance to the dentists at their operating chairs.

ADF and PAF dental teams, led by MAJ Chow and CAPT Abner Viray at the local school in Olongapo The ADF and the Philippines Air Force (PAF) dental teams set up in two classrooms at the local school in Olongapo. The PAF dental teams consisted of three dental officers and five dental

ARF VDR was a rewarding experience for all the deployed 2HSB and Australian contingent members. It provided RAADC personnel an opportunity to provide treatment to a population demographic that we are not exposed to in garrison. At a higher level, military cooperation took place between all of the participating nations.

Reports from Operations and Exercises

Report of Activities from Indonesia 23rd June to 3rd July 2009

Exercise TENDON VALIANT VII Major Wayne Chow, 2nd Health Support Battalion

Introduction The Southeast Asia - Pacific Medical Readiness and Training Exercise (MEDRETE), Exercise TENDON VALIANT VII (TV VII), was conducted in the Bandung area of the Republic of Indonesia from 23rd June to 3rd July 2009. The city of Bandung (see map below) is the capital city of the Indonesian province of West Java. It is approximately 180km from Jakarta and has a population of 7.4 million people. TV VII is now into its 7th year. It was co-hosted by Tentara National Indonesia (TNI) and the United States Army Pacific Command (USARPAC). Participating countries included Australia, Cambodia, East Timor, Indonesia, Malaysia, The Philippines, Singapore, Thailand, Tonga, Vietnam and the United States. In 2009, the multi-national health teams provided real-time health services to the local population in Indonesia. There were many lessons learned to assist the planning of future exercises.

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to develop professional skills of multi-national military medical and dental teams working in unfamiliar groups in basic conditions, treating large numbers of patients in a humanitarian assistance setting;

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to exchange knowledge and information relating to military health operations in the Asia Pacific region; and

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to promote a positive image of the military in the Indonesian community.

Conduct of the Exercise An opening ceremony was followed by a 2-day medical conference at the beginning of the Exercise. Each participant was allocated to one of the three health teams where they had the chance to meet and familiarise themselves with one another prior to the commencement of work. Contingent commanders and health specialists from each country presented a wide range of medical topics to the forum during the medical conference. The clinical phase of the exercise was conducted over the next three days. Each day, health teams travelled to different sites chosen by US health planners. All three health teams demonstrated versatility in unfamiliar environments. Team leaders were deliberately given very little knowledge of the site and the local population in accordance with the Exercise instructions. Health teams had to set up and operate in buildings located at community health centres and local schools. The infrastructure available ranged from basic to sub-standard. They had hard-standing and basic furniture, such as desks and chairs. There was no power for lighting or other electrical equipment. Not all facilities had running town water from the tap.

Objectives The Exercise had the following objectives:

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to support Australian Defence Organization (ADO) international engagement with the US, Indonesia and other regional nations;

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to improve interoperability between health elements of participating countries and cooperation between military teams of the Asia Pacific region;

CADMUS 2009

Team leaders retained overall control and responsibility of the operation of the health clinic, which required them to conduct a site appreciation on arrival and to decide the layout of the health clinic. They would also decide on a plan for patient flow. Exercise TV VII provided valuable training opportunities for each team and its leaders. In a disaster situation, health intelligence may be limited. Rapid and effective responses require flexibility and a very good knowledge of their own team and capability. The health specialists were allocated, based on an even spread of skills and experience across all three teams. Each health team was lead by a senior doctor and was issued a local mobile phone for communication.

team, under the directions of the team leader, had to divide the supplies into three-day parcels. The drugs were common, over-thecounter items such as antibiotic, pain-killer and anti-inflammatory. The supply also consisted of eye-drops and vitamin supplements.

Daily Routine Health teams had to travel to various villages in escorted convoys of locally chartered mini-vans. The vehicles would depart from the hotel at 0700h and return at approximately 1700h each day. Each team would visit a different site each day, of no more than 60 minutes’ travel time by road. A total of nine different villages and communities were covered during the three-day clinical phase. Take-away lunchboxes were delivered from the hotel during lunchtime. At each site health teams would set up the following components of the clinic:

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Patient registration and reception area Primary medical clinic Dental clinic Pharmacy

The US Army supplied drugs and miscellaneous pharmaceutical supplies during the exercise. The drugs were ordered by the US pharmacist and purchased from the local economy. Each health

Due to the sheer volume of patients seen at each site, the task of crowd control became crucial to the smooth operation of the health clinics. TNI personnel, with the help of nurses and local authorities, conducted patient registration. Nurses on TV VII also controlled the flow of patients, with assistance from Indonesian volunteers and interpreters. Medical students from Bandung also volunteered during the Exercise. They were extremely helpful with bridging language and cultural gaps between the local population and the medical staff.

Many health specialists felt that the treatment and medicines given were a ‘band-aid’ solution with limited benefit in the long term. It was hoped that clear guidelines and individual job statements for each position of the health team could be developed for future exercises. They should outline an expectation and a common understanding of what to treat, and what not to treat. Further, a list of equipment should be included for each position, in order to carry out their roles. This information should be issued by the US in the first instance.

The ‘back-breaking’ work of extractions began the minute the health clinic was opened. With no illumination units, the dental officers had to seat the patients next to windows for natural light in order to look inside their mouths. As the queue outside the clinic grew by the minute, the amount of time each dentist could spend on each patient became shorter. Most patients seen were grateful for the free treatment provided by the contingent. They were happy to sit still and pointed to the tooth that they wished to be extracted. Even children were no exceptions (most anyway)!

During the planning phase, several countries were instructed not to deploy with any equipment for the Exercise. As a result, medical and dental officers from Australia, Malaysia, Cambodia and The Philippines had to rely on loan instruments from the TNI and the local health centres. With insufficient numbers of instruments, delivery of the health effect was compromised and reduced the number of patients that could be seen. 4,500 local villagers were seen during TV VII 2009.

Discussion. An ADF dental team typically consists of a dental officer, a dental assistant and a dental technician. For humanitarian tasks such as TV VII, where there is a limited and defined scope of work, it is suggested that assembly and deployment of a modified dental team would be a worthwhile consideration. Whilst this is not referenced in any Army health doctrine, a modified dental team needs to be very light and mobile. It may consist of a dental officer and a dental assistant, where the dental officer is of competency level 2 as a minimum (preferably with very good skills in minor oral surgery) and the dental assistant is of grade 2 – a senior dental assistant (SDA) - as a minimum for these missions. At a minimum, a modified dental team should deploy with a set of dental extraction instruments that can be allowed to be checked-in on civilian aircraft. A list of suggested dental instruments (most commonly used) may include mouth mirrors, syringes, elevators and luxators, upper forceps, lower forceps, suture kits, and head lamp. This recommendation has been submitted to HQJOC for consideration to deploy a modified dental team on future overseas exercises. It is also recommended that medical and dental assistants be trained beforehand in a safe protocol for the correct handling of glutaraldehyde for cold sterilization, a practice which has ceased in Australia.

Health Team Capability Each health team had the following positions: a paediatric doctor, a general practice doctor, medical assistants or technicians, a nurse, a dentist, dental assistants or technicians, a pharmacist, and a pharmacy assistant.

Conclusions

Dental Capability. 2009 was the first time an ADF dental team was sent on TENDON VALIANT. The primary treatment provided was dental extractions due to gross caries and periodontal diseases. The age of the local population seen at the dental department varied greatly. The youngest patient seen was a three-year-old. Many villagers do not have access to any dental care. Dental officers from Australia, Malaysia and the Philippines were deployed on TV VII without their dental assistants. This decision was due to poor understanding of the construct for a dental capability during the planning phase. As a result, dental officers rotated to provide dental assistance and preparation of instruments for other dental officers. This is a potential area for improvement for better utilisation of the time and resource.

TV VII was undoubtedly a rewarding experience for all deployed members. It provided an opportunity for ADF personnel to sharpen their medical skills and to treat patients at the grass roots level. At a higher level, military-to-military coordination in health operations took place between all the participating nations. Overall, the objectives of the Exercise were achieved. During the Exercise, interoperability between Australia and the other countries was clearly demonstrated. Exercise TENDON VALIANT, now into its 7th year, has provided a joint military operation framework that could be expanded into other areas, to facilitate the setting up of larger scale, multinational health clinics and disaster relief operations. From the dental perspective, the exercise was a rewarding and valuable experience and will hopefully pave the way for further deployments of ADF dental capability on overseas exercises.

Although the dental set up was very basic, a large supply of cotton (but not gauze), anaesthetic solution (in vials) and antibiotics were available for dental procedures (provided by the US). Loan dental instruments were available from the TNI and local dentists. X-ray units or other radiographic equipment was not available for diagnosis. An autoclave unit was not available to sterilize dental instruments. For infection control, TNI and the US provided activated glutaraldehyde solutions (Cidex) for cold sterilization. The chemical is toxic and this method of disinfection is far below the current Australian Standards. However, it was the only method available to clean instruments and maintain a turn-over of patients.

CADMUS 2009

Reports from Operations and Exercises

USNS RICHARD E. BYRD T-AKE 4 (30th June to 18th September 2009)

Pacific Partnership 2009 (PP09) Humanitarian Assistance Mission Corporal Diane Beningfield, Senior Dental Assistant Preventive

Introduction The United States Navy Pacific Fleet has continually embarked on an annual humanitarian outreach mission known as Pacific Partnerships since 2004, following the tragedy of the Asian tsunami that year. The participants on the missions come from many US Government and non-government organisations (NGO), as well as foreign nations. The Australian Defence Force (ADF) has been actively engaged in this mission every year since 2006, and joined the contingent again this year, working with their colleagues to improve the health, sanitation and infrastructure of those living in the countries of the Pacific rim.

At a glance: USNS RICHARD E. BYRD (T-AKE 4) - Lewisand-Clark class dry cargo and ammunition cargo ship

Mission - deliver ammunition, provisions, stores, spare parts, potable water and petroleum products to the US Navy’s carrier strike groups and other naval forces worldwide Delivered - 14 Nov 2007 Maximum Speed - 20 knots Normal complement - approx. 172 personnel Unclassified Source http://www.nvr.navy.mil/nvrships/details/AKE4.htm

USNS RICHARD E. BYRD on 14th August, underway with 2 RAN heavy landing craft, HMAS BETANO (L 133) and HMAS WEWAK (L 130), in the Solomon Islands on PP09

The Mission 2009 The ship originally chosen for the mission was USNS DUBUQUE, but shortly before it was due to sail there was a need, for operational reasons, to reconfigure the mission for the USNS RICHARD E. BYRD. The USNS RICHARD E. BYRD is a smaller ship of the Auxiliary Dry Cargo Carrier class and is only a few years old, crewed mostly by civilian contractors to Defence (CIVMORS) and complemented by a small crew of regular naval sailors. Luckily for us, this meant no extra duties for the hosted Defence members after hours. The CIVMORS were contracted for all cleaning, servicing and catering supplied on the ship. So we were a little spoiled!

I found the meals were great and I always had healthy options available. We were able to maintain our fitness in the two well equipped gyms, consisting of a cardio and weights room with all new equipment. The six accommodation decks all had their own TV room and laundry. It was shared accommodation, with three or four people per room, with our own shower and lavatory. In short, we lived in luxury while at sea. The Americans truly do look after their personnel well on this ship. Travel to and from shore was either by helicopter ‘HELO’ for the outreach sites or by rigid hull boats ‘RHB’ which carried up to 12 people to the wharf. A gangway staircase was suspended from the side of the BYRD and was our main way of getting down to the RHB, but if the weather was a little too rough, we had to scale down a rope ladder. I was deployed from the 4th July to 18th September, and in this time we visited Samoa, Tonga, with a three-day liberty in New Caledonia, Solomon Islands, Kiribati and Marshall Islands. I was very keen to work in Tonga as my father, who served as an engineer for the Army, was posted to Tonga for two years from 1982, where a lot of my happy childhood memories were made.

CADMUS 2009

A few things have changed in this time – the main transport is no longer pushbike or horse-and-cart. Instead the roads are crowded with cars which have had a hard life on this beautiful island. The Islanders may be influenced by our ‘mod cons’, such as mobile phones and TV, but they still hold their easy going island values. Most of houses do not have walls; they are simple little shacks with all of the occupants’ worldly possessions on display. There is no need for security screens or padlocked doors. Everyone that lives there has grown up together and has no need to worry about violence or theft. Happy children still run around playing with toys made from natural resources, but it is obvious that there is an outside influence when you are greeted by children with a smile and an ‘R&B-style’ hand gesture.

MAJURO, Marshall Islands: RADM Thomas Cullison, Deputy SurgeonGeneral, observes RAAF CPL Diane Beningfield, embarked aboard the Military Sealift Command dry cargo/ammunition ship USNS RICHARD E. BYRD (11th September 2009)

AUKI, Solomon Islands: PP09 team members from the US, Australia and Canada provide dental treatment to patients as a medical civic action project at Kilu’ufi Hospital (11th August 2009) The Australian contingent was composed of a group of Army Engineers, an Air Force Senior Dental Assistant Preventive (me!), a Naval Medical Officer, a Naval CIMIC officer; in addition to two Landing Craft Heavy (HMAS BETANO and HMAS WEWAK) and their crews.

Every day, the dental staff would see over 100 patients, each one of them in genuine need of dental care. The days were long, hot and exhausting, but very rewarding. If we were not there for PP09, many of these people would still be in pain or at risk of severe infection. Surgical procedures, restorative treatments and preventive care were delivered to these needy cases. The American equipment brought for the mission was of the latest technology. We were well supplied with a wide range of instruments and a seemingly endless supply of consumables. In each port where we conducted outreach missions, the excess consumables were generously donated by the US Navy to hospitals and schools, and were gratefully received. The deployment gave me a chance to break away from routine procedures and broaden my appreciation of the broader military environment and strategic outlooks, both from Australia and abroad, and the different approaches to dental treatment provided by members of the team. We were faced with extreme dental cases normally only seen in textbooks, and had to provide care in a challenging physical environment. My role in the team would change daily. I was utilised not only as a clinician in preventive care, but also as a dental assistant for both restorative and surgical procedures, as well as working in sterilisation. Cold sterilisation seemed to be the only solution for the remote sites and the high turnover of instruments. I am very thankful to my colleagues on PP09 for their support and leadership, and to the ADF for giving me the opportunity to travel overseas for such a worthy cause. I take home with me many fond memories and friendships from all over the world, which I will now have for life.

BLKENIBEU, Kiribati: ADML Robert F. Willard, Commander US Pacific Fleet, and his wife Donna Willard, speak with RAAF CPL Diane Beningfield, senior dental assistant preventive, during a tour of Tungaru Central Hospital, the site of a Medical Civic Action project (MEDCAP) held as part of PP09 (26th August 2009) I thought it might be difficult being the only Australian dental person on board working with a mix of Navy, Army, Air Force personnel and civilians from many different nations and organizations. I am happy to report we quickly formed a tight bond and worked well together as a team. CADMUS 2009

Reports from Operations and Exercises

Report of Activities

Exercise LONGLOOK 2009 Captain Karen Such, 3rd Combat Support Services Battalion and Private Karla Hosie, 1st Health Support Battalion

CAPT Such, Dental Officer For 4 months from March to July this year, PTE Karla Hosie and I participated in the Exercise LONGLOOK exchange program with the British Army. LONGLOOK was something that I always wanted to experience and I was very fortunate to get the opportunity. I exchanged with CAPT Emily Close, who spent 4 months at 3CSSB in Townsville, while I took her place at the Hohne Dental Centre in Germany. The Hohne Dental Centre provides dental treatment for the British Army soldiers of 7th Armoured Brigade and their families who are stationed in Haig Barracks as well as the civilians who work in Haig Barracks. Additionally, the Hohne Dental Centre is the Regional Headquarters (HQ) for the Defence Dental Services Germany DDS(G) in the Hohne Garrison which includes the dental centres in Fallingbostel and Celle. For the majority of the exchange, I worked in surgery at the Hohne Dental Centre as a Dental Officer providing dental care to soldiers, dependants and civilian staff. I particularly enjoyed treating the children of the soldiers as it was an interesting and challenging change from looking in the mouths of soldiers. I was also appointed as the Training Officer for the Hohne Garrison and was responsible for establishing a weekly training program for the Hohne Dental Centre, attending the Training Officer meetings at the Principal Dental Officer (PDO) Department for Germany, and monitoring the dental nurse training pathways. I was tasked with organising an adventurous training activity for the DDS(G) and found myself OIC of the Competent Crew Sailing Activity, which was conducted by the Kiel Training Centre. Over the 5 days of sailing, we visited a number of small seaside towns in Denmark, which was great fun. However, the weather was unpredictable with limited sunshine and lots of wind, rain and even hail (at times it felt like being in the Perfect Storm). CADMUS 2009

Besides spending time at Hohne Dental Centre, I attended a number of military and dental training activities with the DDS(G). In May I travelled across to Longmoor, England to participate in Royal Army Dental Corps (RADC) Military Annual Training Tests (MATT) week which involved personal fitness test (PFT), gas chamber training, qualifying on the SA80 rifle, Army first aid course, field craft, and mandatory training lectures. PTE Hosie was also at MATT week so it was a good opportunity for us to catch up and share our experiences in the first month of our exchange. As a lead up to MATT, we attended the Army-Navy rugby match at Twickenham which was one of the biggest social events on the British Armyâ€™s calendar. Following MATT, I visited the dental centre in Wellington Barracks, London and spent a few days staying at the Honourable Artillery Company, the oldest unit in the British Army. I travelled down to the PDO Department in Wegberg and the dental centre at Joint HQ Rheindahlen on a number of occasions for meetings, which gave me the opportunity to visit another area of Germany and also Holland. I attended the DDS(G) Lubbecke Clinical Conference on 24th-26th May, which brought together all the civilian and military dentists for 2 days of clinical lectures and an evening dinner function.

In late June, I spent a week visiting a few different British and allied dental centres in Europe. I went to the RAF dental centre and the German Army dental centre at the NATO Base in Brunssum, Netherlands as well as the NATO dental centre in Brussels,

Belgium, which has both UK and US Army dentists. I visited the International Dental Centre at Supreme Headquarters Allied Powers Europe (SHAPE) in Belgium, which is commanded by a US Army Dental Officer but contains British, Canadian, Polish, Dutch, Belgian and German Dental Officers. It was really interesting to walk down the corridor of the dental centre and see the subtle differences between the surgeries of each nation. In early July, I spent a few days in the UK where I attended the British Dental Association (BDA) Armed Forces Study Day at the BDA HQ in London. I visited the Army Medical Directorate Headquarters at the former Army Command and Staff College in Camberley, UK and also the RADC Ball at Sandhurst. In my final week, I visited the US dental centre at the US Air Force Base in Ramstein, Germany with the RAF dental team from Brunssum; they travel to Ramstein every month to treat the British personnel posted there. The tour of the Ramstein Dental Centre was definitely a highlight of my exchange as it showed the enormity of the US Military. The Ramstein Dental Centre had 56 dental surgeries which were divided into wings across 3 floors according to the various specialities. It was a very impressive set-up. Overall I found LONGLOOK to be a fantastic experience and I would recommend it to anyone in the RAADC. It is a particularly good exchange for Dental personnel because there are many similarities between the two nations and the way that we undertake dentistry, enabling us to work in our exchange locations and really immerse ourselves in the life of the British Army. It was good to meet a few Brits who had experienced LONGLOOK before, and many years on they still have very fond memories of their time in Australia (in particular WO2 Kristy Willoughby, formerly Grant, who came to Darwin on LONGLOOK in 2000). I really enjoyed the mess life – the formal dinners every night were definitely a change from the relaxed tropical ways to which I am accustomed. I tried my hand (although not very skilfully!) at polo with a few of the other officers! I was fortunate to spend the majority of the exchange in Germany which allowed me to get to know most of the DDS(G) members quite well over the 4 months. Being in Germany made it easy for me to do lots of travelling and sightseeing around Europe on the weekends. I feel that I really made the most of every minute of the excellent opportunity that was LONGLOOK.

PTE Hosie, Dental Assistant Exercise LONGLOOK saw me happily jetting off to Catterick Garrison situated in North Yorkshire in the United Kingdom. I was full of excitement and jet lag as I arrived at the largest Army Garrison in the UK. I was employed in the Headquarters of the Principal Dental Officer of Northern England and Northern

Ireland, taking on the role of PDO Corporal, assisting in regional management and equipment issues. Out of garrison, I was continuously detached to various areas of England, Scotland and Wales. Unfortunately I wasn’t able to work directly from Northern Ireland due to the heightened risks in the area at the time. But the many centres in each of the UK regions kept me busy and there was never a shortage of volunteers to show me the local sites and culture. I attended the RADC MATT, an annual military skills exercise. The MATT package was a week-long exercise, mostly run and solely undertaken by RADC members. This was a great opportunity for me to meet the majority of the people in RADC and to experience the differences in tactics associated with field craft. I had some comfortable nights out field, despite the cold, thanks to the traditional whiskey nightcap. I attended the 2-week running of the MATT as part of the instructing team and as a participant. An experience unlike any other at home was working with the RADC Recruiting Team in Glasgow, Scotland. During the BDA annual dental conference and exhibition, the RADC spent 4 days captivating people’s attention with their eye-catching display of British ration packs and a diorama of a Field Dental display. The conference attracted over 4,000 attendees from the dental community with the military’s focus on direct recruitment of civilians. Recruiting events such as this create high awareness in the wider dental community, enabling the RADC to maintain a standing force of around 150 Army dentists. I was given the opportunity to work in 2 dental centres within London. The first was at Wellington Barracks, just around the corner from Buckingham Palace, where we would hear the Changing of the Guard daily. The second was the Baird Dental Centre, a tri-Service centre situated within St Thomas’ Hospital. My time in London coincided with the Queen’s Birthday Parade which took place on the Horse Guards Parade Ground. On this day, it felt as if the whole of Britain had stopped to spectate and participate in the celebration. With the commentary being broadcast everywhere I was in awe with the crowd at the impeccable drill and timing of the 1,400 soldiers, 400 musicians and 200 horses on parade. It was a fantastic and truly memorable display. Adventurous training for the UK regions was held in South Wales. It was a brilliant week of mountain hiking, rain, sea kayaking, rain, bike riding, rain and various other activities. Of my 4 months stay, this was the week that my new fashion accessory, the Gortex jacket, proved most useful. Adventurous training was certainly an entertaining way to experience the coast and countryside of Wales and a great end to such a memorable LONGLOOK exchange.

Reports from Operations and Exercises

Report of Activities from 13th to 26th July 2009

Exercise TALISMAN SABRE Squadron Leader Mark O’Sullivan, No. 2 Expeditionary Health Squadron

Exercise TALISMAN SABRE 2009 (TS09) was a US-led, Australiansupported military command post field training and live fire exercise, focused on the planning and conduct of a campaign entailing ‘High End’ war–fighting, conducted over the period of 13th to 26th July 2009. Where exactly does dental fit into this activity you may ask? Well, for the exercise period and several weeks preceding this, No. 2 Expeditionary Health Squadron (EHS), based out of RAAF Base Williamtown, deployed a headquarters element and an Expeditionary Health Facility Level 2 (EHF2) to RAAF Base Tindal. The purpose of this exercise from the health perspective involved two deliverables. The first deliverable involved support to a trial of a new deployed Air Force command structure, the Air Base Wing (ABW); and the second deliverable was to provide aeromedical and health support to TS09.

with Air Force’s Concept of Operations, the basic construct of an EHF2 comprises a primary medical health care team with the ability to provide resuscitation and environmental health support, with the addition of an aeromedical evacuation capability. We are then able to supplement this capability with additional ‘bricks’ such as x-ray, pharmacy, and of course dental. Usually, a dental capability would accompany a longer-term deployment, which in the case of this exercise, matched the scenario given.

Dental setup in Trelleborg tentage

EHF2 deployed to RAAF Base Tindal consisting of 46 staff For the first 3 weeks of this activity, I was fortunate to be involved in the ABW headquarters (HQ) element working as the S07 or Medical Liaison Specialist. This task provided a steep learning curve, as it was an inaugural role in the RAAF construct and is usually filled by a medical officer in the tri-Service environment. Nevertheless, the breadth of experience I had gained through my years of operating within health stood me in good stead to handle this role. As the requirement of this initial phase of the exercise was to test the structure and processes of the HQ, a ground threat environment was developed, which then brought into play the EHF2. In line CADMUS 2009

FLTLT Steven D’Arcy, along with CPL Margie Galvin and LACW Natalie Summersgill, provided the dental support for this exercise, ably assisted by the resident staff at RAAF Base Tindal. The opportunity to deploy FLTLT D’Arcy, despite him being midway through his CL1-CL2 transition, was an excellent example of flexibility within our system, taking advantage of a co-located CL3 mentor and providing a great training opportunity. Naturally, due to the actual length of the exercise, the number of dental casualties was few. However as is often the case on deployment, the dental team was one of the busiest areas of the health facility, maintaining the regular dental fitness of the exercise participants. Amid the regular demands of operating a dental facility on exercise, the ground threat provided some interesting times for the dental staff. We were called upon to assist in the care and management of the ‘wounded’ patients and enemy, as well as

providing the necessary defence of the medical facility during the major enemy ‘injects’. By all reports the enemy and patients alike were treated well, with the dental staff working seamlessly within the medical team. As the ‘ground war’ wound down, the ‘air war’ phase picked up, with a large number of aircraft operating in and around RAAF Base Tindal. During this phase, the ABW trial ceased and my role changed to be more directly involved with the EHF2 as the OIC. Again, FLTLT D’Arcy, along with FLTLT Helena Horina, led the dental team, whilst I concentrated on providing overall health support to the exercise.

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FLTLT D’Arcy and LACW Summersgill with an exercise participant Opportunities to experience all that working within Defence can offer were enthusiastically taken whenever available, albeit with the realisation that tactical flying in the back of a C-17 can get fairly ‘old’ after a few 1000ft drops into nothing. Needless to say, most came back a few kilos lighter than they had left, some smiling more than others. Overall, the opportunities afforded to all personnel that deployed as part of TS09 were many and varied, particularly for the dental personnel involved. It provided an excellent opportunity to exercise the field dental capability, as well as consolidate the training of our new personnel. In the current operational climate, where deployment of dental assets is a rare occurrence, exercises such as these are perfect opportunities to refresh our corporate knowledge and maintain our ‘reason for being’.

This requires the brushing of your teeth with it once or twice a day to help strengthen enamel and reverse white spot lesions better than a 900 ppm fluoride topical crème containing calcium phosphate. It comes in a pleasant tasting flavour of vanilla mint. The company said it designed this product to be used in place of conventional toothpaste, and is part of a professional program for the prevention and control of tooth decay. “It gently cleans extrinsic stains without unnecessary abrasion, important for patients with delicate and exposed root surfaces,” Aaron Pfarrer said. Another of the firm’s new products is Clinpro White Varnish. This is a fluoridated clear varnish for treatment of hypersensitive teeth, appropriate for use on both enamel and dentine. It is moisture and saliva-tolerant, so flows smoothly on moist teeth, binding firmly to their surfaces. Product application is simplified through easy individual dosing because it is available in a box of 50 unit-dose blister packets and comes in a fresh mint flavour. 3M ESPE has also recently released a durable hypersensitivity treatment that also delivers fluoride, calcium and phosphate and it remains on the tooth for six months or longer. This is Clinpro XT Varnish, which protects exposed and sensitive root surfaces, especially newly cleaned surfaces following scaling and root planning. For more information, contact your 3M ESPE sales representative, visit www.3MESPE.com.au/ preventative, or call 3M ESPE hotline: 1300 363 454. n

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Honours and Awards

Recognition of Recipients of Honours and Awards Captain Brendan Byrne, RAN, BDS, MMDS, MBA, Grad Dip MS, psc(j), AFACHSE, Director of Defence Force Dentistry

It is important that we recognise the fine work of our personnel by nominating them for formal recognition of their performance over and above that expected in the performance of their duties.

DDFD Congratulates the Following:

We wish to publicly congratulate the following personnel for their recently received awards:

Honours Congratulations go to

MEMBER OF THE ORDER OF AUSTRALIA Professor (Group Captain) Martin John Tyas, AM Professor Tyas was awarded the Member of the Order of Australia (AM) on the 8th June 2009 Queen’s Birthday Honours List, for service to dentistry and dental education, to the Australian Dental Association and the Royal Australasian College of Dental Surgeons and through the development of industry standards. Professor Tyas has served on the College Council since 2000 and has been an active member of many other College Committees and Boards since joining the College in 1992. He has also acted as an Examiner and is currently Censor-in-Chief. Professor Tyas is currently in the Royal Australian Air Force Specialist Reserve serving as the Group Captain (GPCAPT) Consultant in Dental Material to Commander Joint Health / Surgeon General Australian Defence Force.

CONSPICUOUS SERVICE CROSS Colonel Janet Fiona Scott, CSC Colonel (COL) Scott was awarded the Conspicuous Service Cross (CSC) on the 26th January 2009, for outstanding achievement as the Commanding Officer of the 3rd Health Support Battalion and as the Senior Dental Officer in South Australia. COL Scott has made a substantial and lasting contribution to the development and operational preparedness of the 3rd Health Support Battalion due to her outstanding personal commitment and exemplary management skills. Her performance as the Commanding Officer has greatly enhanced the Army’s medical support capability and 3rd Health Support Battalion’s ability to provide efficient and effective health support for exercises in Australia and for operational requirements.

AUSTRALIA DAY MEDALLION Flight Sergeant Carolyn Sandra Carruthers Flight Sergeant (FSGT) Carruthers was commended for her outstanding effort as the Senior Dental Assistant instructor at the Australian Defence Force Dental School. FSGT Carruthers has consistently demonstrated her ability to co-ordinate, administrate

Professor (GPCAPT) Martin Tyas, AM

COL Janet Scott, CSC

Awards Australia Day Medallion – FSGT Carolyn Carruthers The MRJ Memorial Award – SGT Kerry Sears The Soldier’s Medallion – LCPL Allison Rolles Commendation Certificate - Defence OHS Awards – PO Scott Norbury The University of Sydney Academic Merit Prize – LEUT Kelly Gregg, RAN The Campbell Harry Graham Prize – LEUT Kelly Gregg, RAN The Wrigley’s Prize for Oral Diagnosis & Radiology – LEUT Kelly Gregg, RAN The Rudolf Gunz Medal – LEUT Kelly Gregg, RAN The Brigadier Gordon Rowell Prize – LEUT Kelly Gregg, RAN

ADF Dental School Students of Merit 08/09 DDFD also wishes to congratulate the students of merit for ADF Dental School courses on exceptional achievement in their studies. Dental Assistant Course 02-Feb-2009 to 24-Apr-2009 18-May-2009 to 07-Aug-2009

PTE Elena Rowland PTE Nicole Clark

Senior Dental Assistant Course 16-Feb-2009 to 27-Mar-2009

LACW Charlene Duncan

ADF Dental Technician Course Jan-2008 to Dec-2009

CPL Kirstyn Davies

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actions exemplify the Health Services Wing motto: Compassion, Skill and Courage. The award is open to all RAAF personnel employed within the Air Force Health Services. Sergeant (SGT) Sears was awarded the MRJ Memorial Award in 2008 for her exceptional dedication and outstanding devotion to duty in carrying out her duties as Dental Supervisor of Number 2 Expeditionary Health Squadron detachment Tindal. She was instrumental in maintaining the dental readiness of units and squadrons at RAAF Base Tindal during an extended period where they did not have a dentist posted to the base.

FSGT Carruthers receives her Australia Day Medallion and instruct effectively, despite the overall workload increasing substantially over the last 12 months, with the Gross Training Requirement being raised and with extra number of trainees on course. FSGT Carruthers’ commitment and dedication has ensured that the Australian Defence Force continues to graduate a high standard of dental care professional. FSGT Carruthers has an enthusiastic manner, she has no hesitation in staying behind after hours to complete tasking, and to prepare for the next day, or assist a trainee. Her personality has greatly assisted with the delivery of instruction, which in turn has contributed to excellent trainee results. Over the past 3 years, FSGT Carruthers has consistently received positive feedback from trainees. These achievements are of the highest order and are in keeping with the finest traditions of the Royal Australian Air Force and the Australian Defence Force.

THE MCCARTHY, ROWBOTTOM, AND JONES MEMORIAL AWARD Sergeant Kerry Maree Sears

SGT Sears has consistently proven herself to be an industrious, resourceful and enthusiastic worker, especially during a particularly challenging year in 2008 with no dental officer posted to the base. SGT Sears and her team sourced relief manning from across all three Services and with the relief dentists, achieved the highest dental individual readiness of any dental section in that period. Additionally, SGT Sears was actively involved with the medical section throughout the year. She provided valuable assistance to the medical orderly room and during emergency medical situations as the emergency vehicle driver on multiple occasions. SGT Sears deployed on Exercise Pacific Partnership 2008, a US Military led joint humanitarian mission, providing medical and dental aid to various impoverished parts of the Asia-Pacific region. Her professionalism, organizational skills and motivation were instrumental to the success of the dental team seeing in excess of 90 patients a day. Her work ethics and positive attitude in the most arduous conditions served as a sterling example for all crew members and earned her abundant praise from the clinicians and section commanders.

THE SOLIDER’S MEDALLION Lance Corporal Alison Rae Rolles Lance Corporal (LCPL) Rolles, Royal Australian Army Dental Corps, is awarded the Soldiers Medallion for exemplary service to 1st Combat Service Support Battalion. LCPL Rolles has proved to be a capable leader who at all times reflects the qualities of a junior non-commissioned officer. LCPL Rolles has demonstrated initiative, commitment and motivation which have resulted in excellent results in the execution of her duties. Her dedication to her duties has enabled her to achieve excellent results above the standard of her current rank. LCPL Rolles’ dedicated initiative, application and determination have earned her high regard from her superiors and the respect of her peers. Her actions have bought great credit upon herself, the Royal Australian Army Dental Corps and the Australian Army.

SGT Sears (right) and her husband SGT Mingay at the MRJ Memorial Award presentation The McCarthy, Rowbottom, and Jones (MRJ) Memorial Award is established in memory of the Air Force health personnel who lost their lives as a result of the Sea King Shark 01 crash in Nias, Indonesia on 2nd April 2005. It was introduced in 2007 to recognise outstanding contributions to Australian Defence Force operational health support by Air Force health personnel whose

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2009 DEFENCE OCCUPATIONAL HEALTH AND SAFETY AWARDS - Commendation Certificate Petty Officer Scott Leslie Norbury Petty Officer (PO) Norbury was awarded a commendation certificate in the category of Best Individual Contribution to Occupational Health and Safety (OHS) on 24th September 2009. This award recognises an individual whose contribution has made an exceptional difference to OHS in their workplace, in particular to an employee who does not have responsibility for OHS as a part of their duties. PO Norbury is also currently a finalist in the Safety Rehabilitation and Compensation Council Awards.

Iven Klineberg, the Nobel Biocare chairman, for her proficiency in clinical Removable Prosthodontics. LEUT Gregg was presented the Wrigleyâ€™s Prize for Oral Diagnosis and Radiology by Dr Antonio Scott, head of Discipline of Oral Radiology, for her proficiency in Oral Diagnosis and Radiology. LEUT Gregg was presented the Rudolf Gunz Medal by Professor Eli Schwarz KOD, Dean of the Faculty, for her proficiency in knowledge and clinical work in all aspects of the 4th year of the Bachelor of Oral Health program. LEUT Gregg was presented the Brigadier Gordon Rowell Prize by Associate Professor Elizabeth Marin, theme head of Total Patient Care and sub-dean of Clinical Affairs, for her proficiency in the Dentist and Community Theme. Our congratulations to LEUT Gregg for a truly outstanding academic achievement.

PO Norbury (second right) is presented his Defence OHS Commendation Certificate by the Vice Chief of Defence Force, LTGEN David Hurley

ANNUAL FACULTY OF DENTISTRY GRADUATION PRIZES FOR THE CLASS OF 2008 â€“ UNIVERSITY OF SYDNEY Lieutenant Kelly Anne Gregg, RAN Lieutenant (LEUT) Gregg was awarded multiple prizes for her outstanding achievements among the final year Bachelor of Dentistry students within the Faculty of Dentistry at University of Sydney. LEUT Gregg was presented the University of Sydney Academic Merit Prize by Professor Don Nutbeam. LEUT Gregg was presented the Campbell Harry Graham Prize by Professor

Royal Australian Army Dental Corps

Colonel M.G.T. Kenny Awards 2009 The Colonel M.G.T. Kenny Individual Award has been awarded to serving members of the Royal Australian Army Dental Corps (RAADC) since 1984. It is the single award, outside of the Australian system of Honours and Awards and Commendations for Service, which is available to publicly recognise exemplary service by members of the RAADC. Colonel Maxwell Gordon Treadgold Kenny, AM, RFD, ED was appointed as a Captain to the Royal Australian Army Dental Corps, Active Citizen Military Forces on the 20th of October 1949. He was promoted to Major in 1956 and was posted as OC 1 Dental Unit where he remained until he was posted as Deputy Assistant Director, Dental Services, HQ Northern Command in 1960. 1963 saw his promotion to Lieutenant Colonel as he took up the appointment of Assistant Director Dental Services, Northern Command. After various appointments Max Kenny was promoted to Colonel in 1971 and posted as Director Dental Services, Northern Command. He continued to serve with distinction in many roles within the Army and was appointed Dental Consultant Director of Dental Services, Army Office in 1976 and also held the appointment as Honorary Dental Surgeon to the Governor General of Australia. Colonel Max Kenny died on the 16th March 1983 and shortly after a number of awards was established, including the Colonel M.G.T. Kenny Individual Award.

supported at the 2007 Corps Conference. Henceforth, the Colonel Kenny Award will now be awarded in the years that Corps Conferences are conducted. This award is held in high esteem, and all members of the Corps are urged to continue their efforts to strive for the 2010/2011 award.

BEST ARA RAADC OFFICER This category was not awarded this year, as no nominations were received.

BEST GRES RAADC OFFICER This category was not awarded this year, as no nominations were received.

BEST ARA RAADC SOLDIER 8214519 Corporal David Clark Citation reads: I commend you for your tireless and exemplary performance in carrying out your responsibilities and extra duties whilst posted to the Dental Platoon of Health Company, the 1st Combat Service Support Battalion in Darwin, as a Dental Technician. You are highly regarded and are a well respected member of the Platoon. Your standard of excellence and work ethic sets an example amongst the junior and even more senior members of the Platoon to follow. You demonstrate courage and resilience in your ability to handle increasing workloads and you continue to display good character in you attitude towards your work and your peers. Your contribution to Dental Platoon, Health Company, the 1st Combat Service Support Battalion, both in your technical abilities and you performance of duties are well above that normally expected of a junior non commissioned officer.

It is pleasing to acknowledge the outstanding achievements, dedication to duty and hard work from members of the Corps. This award is an important part of the RAADC history as it fosters Esprit de Corps and promotes the history and traditions of our fine Corps.

Your achievements are of the highest order and exemplify the spirit and the finest traditions of the Royal Australian Army Dental Corps.

The proposal that the Colonel Kenny Award would be awarded in the years the Corps Conferences are conducted was unanimously

This category was not awarded this year, as no nominations were received.

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BEST GRES RAADC SOLDIER

State of the Union â€“ ADF Dentistry

Directorate of Defence Force Dentistry

Focus for 2009-2010: Governance Captain Brendan Byrne, RAN, BDS, MMDS, MBA, Grad Dip MS, psc(j), AFACHSE, Director of Defence Force Dentistry

The mission of the Directorate of Defence Force Dentistry (DDFD) is to exercise technical control of the provision of dental services to the ADF. This is achieved through policy development and the provision of advice to Commander Joint Health on issues of a dental nature, including dental capability and resourcing, oral health standards for the ADF and dental workforce requirements.

Clinical or Corporate Governance? Governance within the garrison environment is of critical importance to DDFD. Reinvigoration of the clinical governance process will be my principal focus during my tenure as your Director. It is my opinion that many health service managers do not clearly differentiate between corporate and clinical governance. Corporate governance requires us to comply with all relevant legal statutes and binding professional standards and to exercise good stewardship of Commonwealth funds and other resources. Clinical governance, on the other hand, requires us to verify that the quality of the health services that our corporate governance should have facilitated was actually achieved. Clinical governance requires dental subject matter experts to verify that our ADF members are receiving oral health care at or above the Australian community standard and in accordance with all relevant health policies. If any aspect of health service delivery can be managed, verified or audited by a non-subject matter expert, it is generally a matter of corporate governance. If a health subject matter expert is essential in order to verify compliance or achievement of standards, it will generally be a matter of clinical governance. Given the extensive privatisation of healthcare delivery in Australia, there has been a growing trend throughout the industry for corporate (non-expert) governance to supplant clinical (expert clinician) governance. But this model has a potential flaw in that non-health experts can only guarantee the quality of a health service to a certain degree, for example, with credential checks and quality assurance compliance. They are not able to assure the patient that a particular quality of health service was provided, only that they put everything in place to facilitate it being provided. In the private healthcare arena, the patient has to trust that their clinician is proficient in their field and has complied with all regulations and standards. But the patient retains the right to choice of clinician, so this level of risk is considered acceptable. However, Defence delivers and/or pays for healthcare services and to a certain extent limits its membersâ€™ choices in terms of healthcare providers. It is therefore incumbent upon us, on behalf of the Commonwealth and our members, to ensure that the healthcare providers that we utilise, deliver clinical services to the expected standard and in accordance with all relevant policies. This is the role of clinical governance.

Summary Points: Corporate governance requires us to comply with all relevant legal statutes and binding professional standards and to exercise good stewardship of Commonwealth funds and other resources. Clinical governance requires us to verify that the quality of the health services that our corporate governance should have facilitated was actually achieved. Commander Joint Health has approved the reinvigoration of the clinical audit process and the continued development of our corporate governance processes.

The Former Governance System Until the mid-1990s, the three Services each had an Operational Command, a Training Command and a Support Command and every Defence establishment belonged to one of these nine Commands. Each Command had a Command Dental Officer at LTCOL(E) rank and it was their responsibility, twice every year, to conduct an extensive corporate and clinical audit of all dental units in their domain. When these command dental officer positions were disestablished, the responsibility for conducting clinical supervision and audits passed to the uniformed Senior Dental Officers of each unit, but on a less structured basis. In the intervening years, more and more Senior Dental Officer (SDO) positions have been disestablished or gapped by their parent Services. This has resulted in many junior dental officers, both uniformed and contracted, having no experienced SDO to exercise clinical governance over them, to mentor them, to interpret dental policy for them, to confirm referral case selections, to identify clinical deficiencies, to encourage targeted continuing professional development (CPD), or to arrange refresher training with Reserve specialists. The decline has been insidious because when uniformed SDOs were first replaced by contracted SDOs, the majority of original contractors were ex-Defence Dental Officers, with the necessary prior military experience to undertake their military mentorship and governance roles. However, successive generations of contracted SDOs have seen many of these positions filled by contractors, who despite holding impeccable clinical qualifications, will often have had no prior experience of Defence.

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This decline in corporate knowledge amongst our dwindling uniformed workforce and our growing contracted workforce is likely to continue, so we must position ourselves to ensure that dental clinical governance in those areas requiring an operational background, does not decline as well.

An Example of the Problem â€“ Wisdom Teeth One of the issues to recently manifest itself as a result of this decline in clinical governance has been a gradual increase in the number of wisdom teeth being recommended for removal. Health Directive 404 makes it very clear that wisdom teeth are only to be removed when associated with pathology, not for prophylactic reasons. However, a number of dental units have gradually expanded their case selection to include some cases that are only marginally compliant with the strict evidence-based guidelines in the Health Directive. They have done this with good intentions, thinking to reduce the risk of dental casualties and medivacs on deployment. While clearly a preventative measure, this could be perceived as over-servicing and has the potential to decrease individual readiness levels amongst those awaiting surgery and to increase operating theatre and fee-for-service costs. Accordingly, a new Health Bulletin will shortly be released, providing more prescriptive guidance on wisdom tooth case selections. Our clinical governance system will also be reinforced, in order to ensure that delivery of dental services at every dental unit complies strictly with all relevant Defence health policies.

The Way Ahead The single Services will continue to work to address their uniformed dental manpower shortfalls â€“ a difficult task in this time of national under-supply of dental clinicians. In the meantime, DDFD will focus

on reinvigorating the clinical governance process. Appropriately qualified and experienced uniformed and contracted SDOs will be appointed and resourced to exercise clinical governance over not only their own dental units, but over other regional dental units, if those units may be lacking the military experience necessary to exercise local governance to the desired level. To this end, Commander Joint Health has approved the implementation of traditional dental clinical audits, along with the continued development of our corporate governance processes. Directorate staff will travel to several regions during FY 2009/2010 to conduct dental clinical audits. I urge all dental personnel at those units being audited to regard these clinical audits as opportunities to have your policy queries resolved and your compliance verified in a non-punitive environment. We must all of us remain open to any opportunities to improve and to provide a higher standard of dental care to our dependencies.

Other Initiatives While clinical governance will be the number one priority during 2009-2010, other key foci for DDFD will include the capture of rate-of-effort and costing data for fee-for-service treatments, the regular deployment of permanent and reserve oral surgery teams to manage wisdom teeth and provide training opportunities to junior dental officers, and new or revised health policy on dental implants, radiation safety, mercury hygiene, wisdom teeth, complex dental treatment, scope of clinical practice for auxiliaries, andÂ cardiopulmonary resuscitation preparedness. I look forward to working with the Senior Dental Officers Advisory Group and the Reserve Dental Specialist Consultative Group to deliver this ambitious program of work.

Royal Australian Navy Dental Branch Feature Article

The RAN Dental Branch – A Bite of History Lieutenant Shannon Godfrey, RAN, BDSc

The first recorded ‘official’ dental services in the Royal Australian Navy took place during WWI in a makeshift dockside surgery at Garden Island, on the decommissioned HMAS PIONEER. However, it was not until 1st July 1918 that orders were promulgated authorising the establishment of a permanent Royal Australian Navy Dental Branch. Since that time the Branch has evolved to become a significant and essential component of the Navy, characterised by innovative technologies, highly trained clinicians, and both sea and shore-based dental teams. The importance of dental services in the Navy is best described by the newly approved branch motto - ‘Fit to Bite, Fit to Fight’. The commissioning of the first uniformed Dental Officer in the RAN – Surgeon Lieutenant (D) Milton Spencer Atwill – occurred on 2nd July 1918 and he immediately boarded the battle cruiser HMAS AUSTRALIA, then operating with the RN in England. The primary role of the dental officer, then as now, was to minimise oral disease or trauma impeding the duties of naval personnel. The following year saw HMAS AUSTRALIA take the first dental mechanic to sea. And in 1921, when AUSTRALIA was placed into Reserve, Surgeon Lieutenant (D) Henry A. Lambert took post at HMAS CERBERUS as the first uniformed Dental Officer on an RAN Shore Establishment.

Summary Points: The RAN Dental Branch was established on 1st July 1918. Expansion of the Branch occurred due to poor levels of dental fitness on entry and lack of access to dental care at isolated land establishments and at sea, resulting in dental officers ashore and dental teams at sea with mobile equipment. The greatest needs during WWII were extractions and prosthetic services with training taking place at Flinders Naval Depot and Balmoral Hospital. In addition to seagoing dentistry, the dental officer’s role has expanded to include health administration; training in decontamination of Nuclear, Biological and Chemical (NBC) casualties; basic maxillofacial skills; resuscitation; and forensic identification training. The Branch continues to provide dental services to reduce the impact of dental disease on the fighting capabilities of the Australian Defence Force and to maintain all personnel at a level of dental fitness compatible with combat readiness.

until the Sick Berth Attendant (Dental) category was established during WWII. Training of dental attendants was undertaken at Flinders Naval Depot at HMAS CERBERUS from 1939 and has remained there to the present day.

Surgeon Lieutenant (Dentist) Milton Atwill at sea in HMAS AUSTRALIA (1) during World War 1. Prior to this, civilian and Army dentists had been relied upon for the provision of dental services. In addition, medical officers would offer treatments of extractions or simple fillings. The Navy Medical Department supplied assistants for the Dental Officers

WWII was a period which saw continued and rapid expansion of the Branch. However, the increase in the size of the Navy to 39,000 personnel and the simultaneous lowering of dental entry standards to meet conscription targets, resulted in an arduous work load for the Navy’s Dental Officers. The treatment of an increasing number of poor dentitions was made even more complicated, due to the sailors’ long periods of service at sea and the wide geographic spread of personnel across 580 ships and establishments around the globe. The rapid growth of the Navy at the outbreak of war could not be met by a similar surge in recruitment of Dental Officers, particularly since proposals put forth before the war for a reserve dental branch had been rejected. The nine permanent officers comprising the Naval Dental Branch at the outbreak of war

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struggled then, and indeed throughout WWII, as the greatest number of Dental Officers ever allocated to the RAN by the Central Dental Committee was just 33! It was during this conflict that the sinking of HMA Ships PERTH and SYDNEY resulted in the Dental Branch’s first deaths in action. Surgeon Lieutenant (D) Mervyn C. Townsend and Sick Berth Attendant (D) Stewart T. Laxton lost their lives in the HMAS SYDNEY –KORMORAN action of 1941, and Surgeon Lieutenant Commander (D) Alleyene C. Tregear and Sick Berth Attendant (D) Federick B. Wright were killed on board HMAS PERTH at the Battle of Sunda Strait in 1942.,

US forces, particularly the US Navy at Subic Bay, were the main providers of dental services during the Vietnam conflict, and the RN was also able to provide assistance when RAN ships visited Hong Kong or Singapore. In spite of this, once again, insufficient resources were available to provide emergency treatment during the Vietnam conflict, because no Dental Officers were posted onto major warships. The problem was somewhat alleviated, but never adequately resolved, by having a Dental Officer conduct clinics on board each ship during its work-up period in Australian waters, prior to departure for the area of operations.

Numbers of Dental Attendants and Dental Mechanics were also deficient in WWII. The Women’s Royal Australian Navy (WRAN) provided additional Dental Attendants, and in one instance, a Dental Mechanic, but they were not permitted to serve at sea or, for the most part, on tropical shore stations. Like their male counterparts, WRANs undertook their training at Flinders Naval Hospital and Balmoral Depot. The number of Dental Mechanics in the RAN ballooned from 6 to 22 by war’s end, owing to the unquenchable demand for dentures. Mechanics provided prosthetic facilities at all mainland Australian ports, at Madang in New Guinea, in HMA Ships PLATYPUS and MANOORA, and in all cruisers, yet still could not keep up with the demand for their services. Throughout the war, the numbers of teeth extracted climbed inexorably and the need for dentures and denture repairs kept pace.

In addition to seagoing dentistry, expanded roles for the modern operational Dental Officer include: health administration; leading Ship’s Medical Emergency Teams; training in decontamination of Nuclear, Biological and Chemical (NBC) casualties; training in basic maxillofacial skills; advanced resuscitation skills; and forensic identification training. They may also be called upon to train for more mainstream roles such as Helicopter Control officer. Additionally, the modern Dental Assistant, who is an integral part of any Fleet Mobile Dental Team, will fill operational roles as a member of the Ship’s Medical Emergency Team and in manpowerintensive tasks such as damage control and replenishment at sea evolutions In this way, the modern Naval Dental Officer and Dental Assistant augment the other medical services, augment the ship’s company, and help to maintain the deployed force at the required level of combat readiness.

It was observed by Surgeon Captain W.J. Carr that the most common complaints of a ship’s crew focussed on ‘the absence of beer, mail and dentists’. Initially it was only the five principal cruisers that had Dental Officers but towards the end of the war, the three landing ships KANIMBLA, MANOORA and WESTRALIA, as well as the depot ship WHANG PU, also had Dental Officers posted to them. The scant allocation of Dental Officers ashore was: six at Flinders Naval Hospital, six in the Sydney bases, two each at Brisbane, Darwin and Fremantle, and one each at Townsville and Cairns. Mobile equipment was allocated to a Dental Officer stationed in New Guinea, so that he could move between ports as required. Facilities in Balmoral and Flinders Naval Hospital included prosthetic and x-ray facilities and office space for clerical work. WWII was four years old before HMAS HARMAN in Canberra, where dental health had become the worst in the Navy, became the final shore establishment to gain a Dental Officer in 1943. During WWII, Australians were becoming more attuned to the necessity of dental care, but few personnel in the Navy were dentally fit. Tropical service seemed to have an especially detrimental effect on the oral state, and rapid deterioration of dental fitness was noted on ships throughout the war. Ships would leave on operation for an indefinite period with many of their company not having received essential dental treatment during their port visits, due to the over-booking of dental surgeons and lack of staff and equipment. For this reason, a mobile outfit was later taken to sea by a Dental Officer appointed to the Destroyer Flotilla, in order to accommodate the urgent needs of those serving on small ships, who were frequently isolated from shore establishments for extended periods. The first mobile units were pedal-powered and consequently satisfactory for neither operator nor patient. Additionally, when electric units were introduced, they were not freely interchangeable between ship and shore – not only because ships were supplied with direct current and establishments with alternating current, but also because voltage varied between ships. By comparison, the Mobile Dental Units (MDU) now available are compatible with multiple voltage sources and conveniently transported onboard, providing services comparable to that of a regular clinic to keep personnel IR compliant. Today’s Fleet Mobile Dental Teams (FMDT) operate from Fleet Base East (HMAS KUTTABUL) and Fleet Base West (HMAS STIRLING). CADMUS 2009

At present, 23 uniformed Dental Officers serve in the Permanent Naval Force, many recruited via the undergraduate scheme, with another 40 Officers in the Reserve Force. In addition to this, five ADF-trained hygienists practise throughout the RAN and over 40 dental sailors work in clerical, administrative, sterilisation, instructing and dental assisting roles. The RAN Dental Branch logo and motto, designed by Leading Seaman Adam Collins and authorised by the Chief of Navy in 2004, is a strong reminder that dental fitness is an important component of combat preparedness. In an increasingly high-technology Navy, where sensor operators, combat systems operators, helicopter pilots and other specialists must remain highly alert and avoid any form of distraction, the need to eliminate dental disease and pain has never been greater. The role of the RAN Dental Branch will continue to evolve in keeping with Australian community standards, Australian incidence of dental disease, and the operational roles of Navy personnel and the operating environment of Navy warships. However, two certainties that will continue unchanged are that Navy personnel will always be susceptible to dental diseases and Dental Officers will always be required ashore to prepare the force and at sea to maintain the force – ‘Fit to Bite and Fit to Fight’.

References 1. Anon. RAN Dental Branch enters 50th year, Navy News Vol. 11 No. 15, 19 July 1968; 5 2. Anon. On this Day: 1914-1918 > WWI, Australian War Museum, Naval Historical Society of Australia, http://www.navyhistory.org.au/the-journal/ Date Accessed: 22 Jul 09; 6 3. Wilson, LGR. Skilled Hands at Sea, The Story of Her Majesty’s Australian Ship Nirimba And Naval Training in NSW 1855-1983, Chapter 10, Dental Department, 1982: 49 4. Other, AN. HMAS Pioneer – The RAN’s First Cruiser, Australian War Museum, Naval Historical Society of Australia, http://www.navyhistory.org.au/hmas-pioneerthe-ran%E2%80%99s-first-cruiser/ Date Accessed: 22 Jul 09 5. Walker, AS. Medical Services of the RAN, Australia in the War of 1939–1945, Series 5 – Medical, Volume IV, Chapter 17, 1st ed. Adelaide, 1961: 163-167 6. Historical Museum, HMAS CERBERUS 7. O’Keefe, B. Medicine at War, Medical Aspects of Australia’s involvement in Southeast Asian Conflicts 1950-1972, NSW, 1994: 261 8. Brooke, M. Mobile Dental Unit fit to bite, Navy News, Vol 49, No. 13, 27 July 2006 9. Mahoney, GD. The Role and the Need for the Operational Dental Officer in the Australian Defence Force, 2001: 138-140 10. Mahoney, GD. A View From The Front – The Expanded Role of the Dental Officer, Australian Military Medicine Vol 12 No 1; 15-16

Training Update

The Australian Defence Force Dental School CAPT Paul Jacobsen, Adv Dip Den Tech CPO Robert Meldrum, Dental Manager FSGT Carolyn Carruthers, Dental Manager PO Scott Norbury, Dental Supervisor SGT Vivienne Harris, Dental Supervisor

Officer in Charge ADF Dental School Operations Manager Instructor Dental Assistant Course Instructor Senior Dental Assistant Preventive Course Instructor Senior Dental Assistant Course

And so another year quickly draws to a close. From the outside looking in, it would appear that comparatively, this year has been a bit quieter for the ADF Dental School (ADFDS) with the cancellation of the Senior Dental Assistant Preventative (SDAP) course. None the less we have had instructor changes, pivotal positions gapped and personnel on leave, meaning those left behind have had to maintain the intensity to keep the learning churning and get the trainees out into the workplace.

Course dates 2010: Dental Assistant Course (103943) 01 Feb 2010 to 23 Apr 2010 17 May 2010 to 06 Aug 2010 06 Sep 2010 to 26 Nov 2010 Senior Dental Assistant (200544) 15 Feb 2010 to 26 Mar 2010 20 Sep 2010 to 20 Oct 2010 Senior Dental Assistant (Preventive) (103940) 05 Apr 2010 to 27 Aug 2010 Dental Officer Initial Course (113464) 23 Aug 2010 – 03 Sep 2010

have taken onboard your suggestions about the training and will continue to update and plan the course curriculum accordingly.

Course Updates: Front (L-R): CAPT Jacobsen, FSGT Carruthers, PO Norbury, CPO Meldrum

Course Curriculum This year saw the Training Services Facility (TSF) descend upon the ADFDS with a critical eye on the Dental Assistant (DA) course. TSF found that it was an effective and well written course, being one of the easier to audit. The staff at ADFDS are now busy updating the course to reflect the suggestions made by TSF, making the DA course even more lean, value-packed and informative for the Certificate III qualification. The next course in our sights for an innovative overhaul will be the Senior Dental Assistant (SDA) course. It will be assessed against what is actually required of a SDA and delivered in such a manner that the trainees are back out to their units in minimum time with a solid knowledge base. We

Dental Assistant Course (103943) Since the last instalment of CADMUS, the ADFDS has conducted three DA courses. The last course of 2008 was huge – 14 trainees were too many for us to train in the Dental Clinic and we had to post some course members to their units earlier. Because of that circumstance, the Student of Merit (SOM) was not awarded for that course. The other two courses in 2009 were undersubscribed but this was due to the fact that all three Services are happily overborne with military DAs. The first course had six trainees with two from each Service and the SOM was awarded to LCPL Elena Rowland. The next course had five trainees – one Navy and four Army. Being a smaller group, the SOM was highly contested with PTE Nicole Clarke being awarded the title. The final course for the year begins on the 7th September and runs till the 27th November, with final numbers yet to be confirmed.

CADMUS 2009

Senior Dental Assistant Course (200544) As you all know, we conduct two SDA courses per year. The last course of 2008 saw eight trainees graduate with LCPL Casey Dor’e being awarded the SOM. The first course of 2009 was fully panelled once again and LACW Charlene Duncan was awarded the SOM. The ADFDS has pushed the last course for 2009 back to late October and this will enable us to raise the panel from 8 to 12 trainees. This increase in the course size will reduce the number of trainees waiting to complete this course, allowing members to progress to the next stage of their careers. A priority in the latter stages of 2009 will be to have a critical look at the current course curriculum and make changes where required. We must retain some of the core subjects, but are looking very closely at some of the ‘supplementary’ lessons with a view to bringing the course back to a five-week duration, which may allow for an additional course to be conducted each year. Dental Technician Course The Dental Technician course in its new format at Southbank Institute of Technology (SIT) has seen its first graduate. CPL Brett Lawler graduated in July 2009 with a Diploma of Dental Science and will be posted to Townsville in January 2010. Facilitated by WO1 Wayne Butler, the Dental Technician course at SIT currently has two students undertaking training - PTE Jason Wilding and PTE Rhianon Farley. Both are expected to complete the course in November 2010. Selection for the next course, commencing in January 2010, is now well underway. Senior Dental Assistant Preventive Course (103940) It is always fun conducting a SDAP course because the trainees are at CERBERUS for five months and we get to know them very well. The 2008 course had four successful graduates with LCPL Barry awarded the SOM. Due to staff shortages, the 2009 course had to be cancelled. However, the 2010 course will be going ahead and the course panel is eight. So if you are interested, please inform your supervisor of your intentions, remembering that you need to have completed the SDA course prior to attending this course. The panelling signals will be released in due course and we look forward to training the next generation of clinicians in this discipline. The training delivered on this course is of an excellent standard. Potential applicants should focus on the opportunities, the exposure and the variety of new skill sets that this course can offer within the military workplace, rather than the gap to obtain external registration. The course provides comprehensive instruction on oral hygiene and develops your ability to have a

direct clinical one-on-one impact in helping patients with their oral health and oral hygiene. Dental Officer Initial Course (113464) This course was conducted in the second half of 2009 and was very well subscribed with 16 dental officers. The course provided a fantastic introduction for new dental officers on portable dental equipment, denture repairs, simple procurement, unit administration and a range of specialist topics. Reports to date suggested that the dental officers who completed the training enjoyed the content and have found it useful at their units. Dental Supervisor and Practice Manager Course (RAN and RAAF members) This year has seen an increase in the number of participants on both courses. The Dental Supervisor (DS) course has now been issued to some LS(E) for completion as well as existing PO(E) ranks. This will be the case from now on as this course is a prerequisite for promotion to PO(E) DS. Due to the volume of work involved with this course, the timeframe allocated to complete the course was lengthened from 12 to 24 months. The reason for the increase in timeframe is to limit the impact of the mandatory study on your workplace. 24 months will allow you and your supervisor to allocate time for both the completion of the course content and your regular dental duties.

The Staff We have not had many outings this year and precious little gossip to share, but we had significant staff changes at the start of 2009. LCDR Mark Page, RAN went on long term schooling and is expected to be posted back to the Dental Department at CERBERUS in 2010. CPODENM Andrea Marsh departed the school after 7 years and is now managing the sailors at the Rogers Division. We lost PODENS Craig Watkins to STIRLING and we wish him well in his new position and promotion to CPO. We thank them all for their years of dedication and the professional knowledge that they imparted whilst at ADFDS. On to the new blood! CPODENM ‘Molly’ Meldrum has taken up position as the OPS Manager and PODENS Scott Norbury replaced PO Watkins as instructor. Congratulations must go to CPO Meldrum and his partner Kirsty for the birth of their daughter, Lille. Congratulations are also due for SGT Viv Harris and husband Brendon for the birth of their second daughter, Gabrielle. And so as another year draws to a close, from all of the staff here at the School, enjoy the remainder of your year and adieu.

CADMUS 40

CADMUS 2009

Professional and Technical Items Restorative Dentistry

Between the Composite Resin and the Dentine… Group Captain Martin Tyas, AM, BDS, PhD, DDSc, GradDipHlthSc, FADM, FICD, FRACDS, FPFA, FADI, RAAF Specialist Reserve

Introduction It is now widely accepted that pulp damage following a restoration is a consequence of bacterial micro-leakage, and not due to the chemical composition of the restorative material. It is therefore imperative that a restoration provides a marginal seal, as well as meeting functional requirements. Many resin composite restorations are placed with margins in enamel, however, many will have margins in dentine. To the extent that resin composite is increasingly replacing amalgam as a restorative material, partly because of its aesthetic benefits, it is important to consider its marginal qualities and integrity.

Dentine Bonding Agents The bonding of resin to enamel using the acid-etch technique was first described over 50 years ago,1 has been in clinical use for over 30 years, and provides the best possible seal in the oral cavity. Bonding of resin composite to dentine has had a much more variable history, and although first described in the 1960s,2 it was not until the early 1980s that it became a commercial reality. The bonding of a restorative material to tooth tissue has benefits additional to the prevention of micro-leakage. The incidence of secondary caries will be reduced, and for tooth-coloured materials, marginal discolouration will be reduced. The commercial products of the early 1980s were mainly phosphate esters of bis-GMA, i.e., ‘enamel bond’ with a phosphate group grafted onto the bis-GMA backbone. These materials were designed to bond ionically to the dentinal calcium, however clinical results (assessed by retention of resin composite restorations in non-carious cervical lesions without enamel etching) were poor. It subsequently became apparent that the bond was being mediated by the ‘smear layer’, which had only recently been characterized by using scanning electron microscopy. In reality, the dentine bonding agent was being absorbed into the smear layer rather than ionically bonding to dentinal calcium. The smear layer consists of denatured collagen, hydroxyapatite and possibly bacteria, is a few micrometres thick, is a weak structure and is weakly bonded to the underlying dentine. Thus, when resin composite restorations were lost from non-carious cervical lesions, it was probably due to smear layer failure.3 This recognition led to a new approach to the bonding of resin composite to dentine. The smear layer clearly had to be removed in order to expose the structurally sound dentine and in addition a new bonding mechanism had to be developed; ionic calciumphosphate bonds could not be created at intra-oral temperature within the few seconds necessary. However, an additional problem CADMUS 2009

arose following smear layer removal: the dentinal tubules were opened by the acid used to remove the smear layer, which allowed dentinal fluid to flow out of the tubules onto the dentine surface. This therefore precluded the use of a hydrophobic resin-based bonding agent. The solution to this problem was to develop a 3-step dentine bonding system: removal of the smear layer by an acid (usually phosphoric acid, in order to carry out simultaneous enamel and dentine ‘etching’); placement of a water-soluble polymerisable methacrylate ‘primer’ (usually hydroxyethyl methacrylate, or HEMA) which would infiltrate the collagen exposed by demineralization of the surface dentine; placement of a ‘bond’ or ‘adhesive’ (usually bis-GMA based) which would chemically bond to the HEMA and to the resin of the resin composite. Interestingly, this technique was first described by Nakabayashi4 in Japan in 1993, but many of his early papers were in Japanese. Also, there was a reluctance in ‘western’ dentistry to place acid on dentine, as it was thought that it would damage the pulp. From about the 1990s, therefore, almost all commercial products have used this approach. ‘Etching’ the dentine results in exposure of a layer of 3-5 μm deep of surface collagen, also extending into the widened dentinal tubules. Infiltration of the primer into the collagen produces the so-called ‘hybrid’ or ‘resin reinforced’ layer and thus micro-mechanical retention of the restoration. The last 20 years have seen many developments in the hybrid-layerforming products, mainly aimed at simplifying and making more reliable their use and performance. Using a 3-step (etch; prime; bond) material was clearly quite tedious and time-consuming, and if each step was not done in accordance with the directions for use, the result would be compromised. For example, if etching was carried out for too long, too great a thickness of collagen could be exposed and the base of the collagen layer may not be infiltrated by primer. This ‘unprotected’ collagen may be susceptible to degradation by oral proteolytic enzymes. Possibly a more significant problem is the extent of drying the etched dentine after washing off the (phosphoric acid) etchant. Ideally, the dentine should be dried such that it retains physiological moisture and thus its fibrillar structure. If it is over-dried, it will collapse and fail to absorb the primer; if it remains too wet, it will dilute the primer. It may be possible to reconstitute over-dried collagen, but this could depend on the primer solvent. Water, alcohol and acetone, or mixtures, are all used as solvents in various proprietary products. Water-based primers will penetrate ‘normal’ collagen well, and may reconstitute over-dried collagen; alcohol-

based primers will penetrate normal collagen quite well, but will not reconstitute over-dried collagen; acetone-based primers will penetrate normal collagen extremely well, but will not reconstitute over-dried collagen. Simplification of 3-step systems was initially developed in two ways: conventional etching followed by simultaneous priming and bonding; simultaneous etching and priming, followed by conventional bonding. The former of these tended to be marketed by US and European manufacturers and the latter by Japanese manufacturers. Unfortunately, the terminology of dentine bonding agents has now become complex, as different authors and manufacturers use a variety of different terms (Table 1). The 3-step (etch; prime; bond) systems and the 2-step (etch; prime+bond) systems are often termed ‘total-etch’ or ‘etch-andrinse’ systems, since the (phosphoric acid) etch has to be washed off prior to the next step. As can be seen, the 2-step (etch; prime+bond) system also has the same problem as the ‘etch; prime; bond’ system regarding the critical amount of drying of the dentine after etching and washing. The 2-step ‘etch+prime; bond’ systems are also called ‘self-etching’ primer systems. One benefit of such systems is that there is no washing involved; the self-etching primer is applied, the solvent evaporated and the primer photo-cured, and the bond applied and photo-cured. As could be predicted, the next development was to carry out all three steps (etch+prime+bond) simultaneously, and such ‘all-in-one’ systems are now available. Some are supplied as two bottles which are mixed at the chairside prior to application, and others are supplied as a single bottle. The terminology ‘generations’ has become prevalent in the literature and in manufacturers’ advertising. The use of ‘generations’ is deprecated, since it has no clinical value and has essentially become a promotional tool. Almost all current dentine bonding agents bond by the formation of the hybrid layer; the essential difference is the way they are presented and used. Laboratory assessment and research on candidate dentine bonding agents is invariably by bond strength to dentine and micro-leakage tests. Both tests are widely promoted in advertising, with the implication that such tests will predict clinical performance. Unfortunately, neither is quantitatively useful; at best, bond strengths may give a qualitative prediction. The bond strength values obtained are highly dependent on the test method, and 8- or 10-fold variations in reported values are not uncommon.5 Regarding laboratory micro-leakage, one recent author has recommended abandonment of such screening tests as they have no clinical relevance.6 Given the issues of laboratory testing, clinical evaluation of dentine bonding agents becomes an important consideration. However, whereas laboratory testing is quick and relatively cheap, clinical data can take several years to acquire and is expensive. In addition, many products have a short market life before they are superseded by an ‘improved’ version. Further, problems of clinical testing concern ‘external validity’ or ‘generalisability’; the extent to which the results can be applied to other populations. For example, most clinical evaluation of dentine bonding agents is in non-carious cervical lesions: would the results be valid for ‘affected’ occlusal dentine? Would the results from a hospital study (mean patient age of 65 y) be applicable to a student health centre practice (mean patient age 25 y)? No data are available to resolve these questions. Despite these considerations, many publications have examined the clinical performance of dentine bonding agents. In 2005, a review paper was published7summarizing these clinical studies, and reported the following mean annual loss rates: 3-step systems,

4.8% (range 0 – 16%); 2-step etch-and-rinse systems, 6.2% (range 0 – 19.5%); self-etching primer systems, 4.7% (range 0 – 19.3%); all-in-one systems, 8.1% (range 0 – 48%). (For comparison, the glass-ionomer data were: mean, 1.9%, range 0 – 7.6%.) It should be emphasized that the poor all-in-one result was dominated by a single product, which has now been replaced by a completely different version with a similar name. Clinical studies of two other all-in-one systems by the author and Professor Michael Burrow at the University of Melbourne have recorded minimal loss of restorations in non-carious cervical lesions up to 5 years.8, 9

Glass-Ionomer Cements The alternative to using a dentine bonding agent as the adhesive between resin composite and dentine is to use a glass-ionomer cement (GIC) liner/base. The potential benefits of using GIC are reliable, long-term adhesion to enamel and dentine, biomechanical properties similar to dentine, release of fluoride and the possible promotion of remineralisation of ‘affected’ dentine. One disadvantage of GIC is that the bond to tooth tissue and to resin composite is not strong, as it is mediated by the (brittle) GIC, and thus should not be relied on for retention of a restoration. However, most restorations (with the possible exception of those in non-carious cervical lesions) obtain retention by other means than bonding to the lining/base material, e.g., cavity configuration, enamel etching. At the University of Melbourne, our undergraduates are taught to use GIC as a dentine replacement, and the final restorative material (resin composite or amalgam) as an enamel replacement. A dentine bonding agent (specifically a self-etching primer system) is available and in general is only used when space is inadequate for GIC and resin composite, e.g., shallow non-carious cervical or occlusal ‘cupping’ lesions. The previous paragraph referred to the apparent lack of bond strength of GIC to enamel and dentine. GIC bonds to dental hard tissue by the ‘ion-exchange layer’.10 This layer consists of various ions such as calcium, phosphate, hydroxyl and fluoride, partly arising from the GIC and partly from the hard tissue. It is developed by dissolution of surface enamel/dentine when the freshly mixed GIC is placed, bi-directional diffusion of ions, followed by solidification when the GIC sets. As a corollary, it is clear that the mixed GIC must contain free acid, assessed by a shiny appearance, when placed. The possibility of remineralisation of ‘affected’ dentine by GIC is becoming of increasing interest.11, 12 It appears that under appropriate conditions the affected dentine may be transformed into fluoridated carbanatoapatite, which has a higher mineral content than hydroxyapatite or fluorapatite. A further advantage of using GIC as a dentine replacement in the larger cavity is the reduction in polymerization shrinkage of the final resin composite, as a smaller volume of resin composite will be used.13 It is well known that the highest incidence of secondary caries occurs at the cervical margin of a restoration. In the case of an approximal resin composite restoration of a posterior tooth, this will be at the base of the box. It is difficult to achieve a marginal seal with resin composite at this site, as the enamel is thin and aprismatic and the dentine bonding has the difficulties described above. In addition, isolation from saliva and gingival crevicular fluid can be problematic. One approach to overcome these problems is to use GIC in the ‘cervical lining’ technique.14 This involves placing a suitable GIC in the apical part of the box, and resin composite or amalgam as the final restorative material. (This technique has come to be called the ‘open sandwich’, a name that the author does not favour!) Clinical trials have shown the promise of this technique in achieving a cervical marginal seal,15-17 but it is imperative that the GIC is kept well apical to the contact area, as plaque accumulation just apical to the contact area may

CADMUS 2009

result in dissolution of the GIC in the same way that the original caries lesion was initiated.18

8. Burrow MF, Tyas MJ.

One commercial resin-modified glass-ionomer is available (Fuji Bond LC; GC Corporation, Tokyo) which can be used in a similar way to a dentine bonding agent, i.e., in a very thin layer. A 5-year clinical study of resin composite restorations in non-carious cervical lesions, bonded by Fuji Bond LC, showed a retentive rate of 96%.19

9. Burrow MF, Tyas MJ.

Conclusion Since dentine bonding agents became commercially available in the early 1980s, they have undergone major changes such that they can reliably bond resin composite to dentine. However, many products remain ‘technique sensitive’, and strict adherence to the directions for use is essential. GIC used as a liner/base material has many benefits as an alternative to dentine bonding agents.

3-step 2-step 2-step 1-step

Alternative Name ‘Total etch’ or ‘Etch-and-rinse’ Self-etching primer All-in-one

Etch 1 1

Five-year clinical evaluation of one-up bond f in non-carious cervical lesions. Am J Dent 2007;20:361-4

10. Mount GJ. Longevity in glass-ionomer restorations: Review of a successful technique. Quint Int 1997;28:643-50

11. Ngo H. Biological properties of glass-ionomers. In: An atlas of glass-ionomer cements. A clinician’s guide. 3rd ed, GJ Mount (eds). 2002, Martin Dunitz, London; pp. 43-55.

12. Smales RJ, Ngo HC, Yip KH, Yu C. Clinical effects of glass

ionomer restorations on residual carious dentin in primary molars. Am J Dent 2005;18:188-93

13. Tolidis K, Nobecourt A, Randall RC.

Effect of a resinmodified glass ionomer liner on volumetric shrinkage of various composites. Dental Materials 1998;14:417-23

14. McLean JW, Gasser O. Glass-cermet cements. Quint Int

Table 1 Classification of dentine bonding agents System

Clinical trial of g-bond all-in-one adhesive and gradia direct resin composite in non-carious cervical lesions-results at 1 year. J Dent 2007;35:623-5

1985;16:333-43

15. Andersson-Wenckert IE, van Dijken JW, Kieri C. Durability

Steps Prime 2

Bond 3 2

2 1

of extensive class II open-sandwich restorations with a resinmodified glass ionomer cement after 6 years. Am J Dent 2004;17:43-50

16. Lindberg A, van Dijken JW, Lindberg M. 3-year evaluation

of a new open sandwich technique in class II cavities. Am J Dent 2003;16:33-6

17. Sachdeo A, Gray GB, Sulieman MA, Jagger DC. Comparison

Summary Points •

Laboratory bond strength and micro-leakage data should not be relied on for prediction of clinical performance.

•

Dentine bonding agents have undergone major improvements in clinical effectiveness over the last 10 years.

•

Meticulous observance to the directions for use is required for successful clinical performance of dentine bonding agents.

•

GIC can be used as a liner/base instead of a dentine bonding agent, and has certain benefits

•

The ‘cervical lining’ technique, if used correctly, can optimise the integrity of the cervical margin of posterior approximal restorations

References 1. Buonocore M. A simple method of increasing the adhesion

of acrylic filling materials to enamel surfaces. J Dent Res 1955;34:849-53

2. Soderholm KJ. Dental adhesives.... How it all started and later evolved. J Adhes Dent 2007;9 Suppl 2:227-30

3. Tao L, Pashley D, Boyd C. The effects of different types of

smear layer on dentin and enamel bond strengths. Dent Mater 1988;4:208-16

of wear and clinical performance between amalgam, composite and open sandwich restorations: 2-year results. Eur J Prosthodont Restor Dent 2004;12:15-20

18. Scholtanus JD, Huysmans MC. Clinical failure of class-II

restorations of a highly viscous glass-ionomer material over a 6-year period: A retrospective study. J Dent 2007;35:156-62

19. Tyas MJ, Burrow MF. Clinical evaluation of a resin-modified

glass ionomer adhesive system: Results at five years. Oper Dent 2002;27:438-41

Competing Interests None Declared.

Address for Correspondence Group Captain Martin Tyas AM Consultant in Dental Materiel to CJHLTH Professor and Head in Restorative Dentistry School of Dental Science Faculty of Medicine, Dentistry and Health Sciences The University of Melbourne 720 Swanston St Melbourne VIC 3010 m.tyas@unimelb.edu.au

4. Nakabayashi N, Nakamura M, Yasuda N. Hybrid layer as a dentin-bonding mechanism. J Esth Dent 1991;3:133-8

5. Leloup G, D’Hoore W, Bouter D, Degrange M, Vreven J. Meta-analytical review of factors involved in dentin adherence. J Dent Res 2001;80:1605-14

6. Heintze SD. Systematic reviews: I. The correlation between

laboratory tests on marginal quality and bond strength. II. The correlation between marginal quality and clinical outcome. J Adhes Dent 2007;9 Suppl 1:77-106

7. Peumans M, Kanumilli P, De Munck J, Van Landuyt K, Lambrechts P, Van Meerbeek B. Clinical effectiveness of contemporary adhesives: A systematic review of current clinical trials. Dent Mater 2005;21:864-81

CADMUS 2009

Professional and Technical Items

Dental Officer CL1 to CL2 Case Study

Management of Unilateral Condyle Fracture Lieutenant Simon Flanagan, RAN, BSc, BE, BDent

A 25 year old male patient was referred to the dental department from medical sick parade complaining of being unable to bite fully, having a tender right side jaw joint on closing, sensitive and chipped teeth, and being only able to eat soup. Five days previously he had been seen at the Naval Ward St Vincent’s Hospital Sydney, having sustained a laceration beneath his chin after falling off his bicycle. An OPG was taken but was considered inconclusive regarding any possible fractures.

The patient’s medical history had little of significance except that he was due for an ankle reconstruction in within the next few weeks. He had a minimally restored dentition with no wisdom teeth present. On examination the patient had sutures present beneath the chin, his right temporomandibular joint (TMJ) was tender to palpation, mouth opening was limited to 20mm and his occlusion appeared normal. His General Medical Practitioner had prescribed Mobic (COX2 inhibitor) to assist in reducing inflammation and Nexium (PPI) to manage the gastric upset which tends to occur with Mobic. At this stage a soft tissue injury to the TMJ was suspected. The OPG taken at St Vincent’s was requested. St Vincent’s takes digital OPGs and they kindly agreed to produce a hard copy and send it to us. In the meantime, a new OPG and plain films were ordered, to rule out mandibular fractures. The patient was reviewed same day. An OPG, lateral skull and PA skull films were provided. The OPG showed a faint diagonal radiolucent line through the right mandibular condyle. No other fractures, large displacements or step deformities were noted on any films. A provisional diagnosis of a non-displaced fracture of the right mandibular condyle was made and the patient referred for an urgent consult with an Oral CADMUS 2009

and Maxillofacial Surgeon (OMFS). The patient was also sent for a CT scan. The radiologist’s report stated that: ‘There is a vertical crack fracture through the mandibular head in the sagittal plane for a distance of 2cm maximally. No significant displacement is seen. The fracture line extends to the articular cortex.’

The OMFS concurred with the provisional diagnosis and the treatment was conservative i.e. soft diet, restrict oral opening, complete course of anti-inflammatory (previously prescribed by GMP) and delay ankle reconstruction surgery by six weeks to allow the jaw fracture to heal. Intubation for general anaesthesia might have displaced the fracture and complicated healing. At review two weeks after injury, the patient’s mouth opening was now significantly improved to 40mm, and he complained of a lower front tooth wobbling and being sensitive to cold, as well as chipped teeth. The patient was now in less pain and able to open wider, so a limited oral exam was conducted. Tooth 15 had a palatal cusp fracture exposing dentine and tooth 42 had a class 2 mobility. In consultation with the patient it was decided that no treatment would be conducted for a further two weeks in order to minimise pressure on the fracture. At 4 weeks following injury the patient was seen by OMFS who stated that the patient showed good improvement, he should continue with a moderate diet and would be fit for ankle surgery in a further four weeks’ time. Tooth 42 now had a class 1 mobility and a vertical enamel fracture towards the distal of the tooth was visible. Tooth 15 was treated without local anaesthesia and resinto-dentine bonding was used to restore the palatal cusp. The patient was not seen again until after he returned to work from convalescent leave, following ankle reconstruction surgery,

approximately 15 weeks after the condylar fracture had occurred. At this review, the patient’s mouth opening had returned to normal. However, he complained that the right side of his jaw ‘popped’ on opening and sounded like ‘a rusty gate’. It was also ‘uncomfortable’, but not painful. On examination, his left TMJ translated before the right TMJ and there was a palpable ‘clunk’. Sensitivity from teeth 15 and 42 had resolved. Tooth 42 tested positive to CO2, periodontal probing depths were within normal limits and no periapical radiolucency was detected on periapical radiographs. However, in comparison to adjacent teeth, the periodontal ligament space was slightly widened. Fractures of the mandibular condyle are classified into head, neck and subcondylar regions, with fractures in the head and neck classified as intracapsular fractures. Intracapsular fractures result in remodelling of the TMJ. Following trauma, the muscles of mastication co-contract as a protective measure, the discal ligaments elongate resulting in clicking and catching of the disc on translation of the condylar head. Due to the remodelling of the TMJ, some malocclusion can be expected. However, from 6 months post-trauma, neuromuscular and dentoalveolar adaptations can be expected to correct this spontaneously. Conservative treatment i.e. non-surgical treatment of condylar head fractures, are considered appropriate, especially in non-displaced cases as surgery adds little benefit, while risking vital structures such as the facial nerve. Displaced and/or bilateral fractures of the mandibular condyle are significantly more complicated and the morbidity consequently higher. In general the prognosis for this patient was considered good. Whilst he may have some ongoing treatment needs regarding the dental trauma he sustained, he can expect improvement in occlusion and range of mandibular motion from six months onwards, resulting in satisfactory function. His right TMJ will undergo remodelling and possibly, as a consequence, also the left TMJ. Possible TMJ complications include ankylosis (0.2-0.4% of fractures), hypomobility (8-10% of fractures) and late arthritic changes that may eventuate 10-50 years post-injury.

References 1.

Zachariades N, Mezitis M, Mourouzis C, Papadakis D, Spanou A. Fractures of the mandibular condyle: A review of 466 cases. Literature review, reflections on treatment and proposals. Journal of CranioMaxillofacial Surgery 2006;34:421-432

Throckmorton G, Ellis E, Hayasaki H. Masticatory motion after surgical or nonsurgical treatment for unilateral fractures of the mandibular condylar process. Journal of Oral Maxillofacial Surgery 2004;62:127138

Palmierei C, Ellis E, Throckmorton G. Mandibular motion after closed and open treatment of unilateral mandibular condylar process fractures. Journal of Oral Maxillofacial Surgery 1999;57:764-775

Nussbuam M, Laskin D, Best A. Closed versus open reduction of mandibular condylar fractures in adults: a meta-analysis. Journal of Oral Maxillofacial Surgery 2008;66:1087-1092

Epker J, Gatchel R, Ellis E. A model for predicting chronic TMD: practical application in clinical settings. Journal American Dental Association Vol 130:1470-1475, October 1999.

Ellis E. Complications of mandibular condyle fractures. International Journal Oral Maxillofacial Surgery 1998;27:255-257

Murakami K, Yamamoto K, Sugiura T, Yamanaka Y, Kirita T. Changes in mandibular movement and occlusal condition after conservative treatment for condylar fractures. Journal Oral Maxillofacial Surgery 2009;67:83-91

Ellis E, Palmieri C, Throckmorton G. Further displacement of condylar process fractures after closed treatment. Journal Oral Maxillofacial Surgery 1999;57:1307-1316

Ellis E, Simon P, Throckmorton G. Occlusal results after open or closed treatment of fractures of the mandibular condylar process. Journal Oral Maxillofacial Surgery 2000;58:260-268

10. Okeson, JP. Management of temporomandibular disorders and occlusion. 6th ed. Mosby USA 2008.

Competing Interests None Declared.

Address for Correspondence Lieutenant Simon Flanagan, RAN HMAS KUTTABUL Dental Department 1 Wylde Street Potts Point NSW 1335

CADMUS 46

CADMUS 2009

Professional and Technical Items

Dental Officer CL1 to CL2 Case Study

Restoration of Traumatic Crown Fracture Lieutenant Kelly Gregg, RAN, BDent(Hons)

Introduction

Immediate Treatment

A 20 year old male patient presented as a dental casualty complaining of a fractured upper right central incisor (tooth 11) following an alcohol-related assault 36 hours prior. He has no medical history of note, was taking no medications and was a non-smoker. The member presented with good oral hygiene and was concerned about the loss of the tooth. He was posted at the time to the Fleet Support Unit and was not expected to post to sea within the next 6 months.

Provisional treatment options for crown fractures are premised upon reducing patient discomfort, creating a hermetic seal against bacterial invasion into dentine tubules (thereby permitting the pulp to recover and elicit repair) and preventing drifting of the tooth itself and of opposing or adjacent teeth.

Examination Extra-oral examination revealed lip lacerations, mild nasal bridge swelling and occipital ecchymosis. Previous examination by a general practitioner cleared the patient of traumatic facial fractures and no sutures were required for the lip lacerations. Intra-oral examination revealed an uncomplicated crown fracture 11, with 1/3 labial tooth structure remaining, 1.5mm interproximal and 1.0mm tooth structure remaining palatally. The pulp was visualised as a pinkish tinge below an extremely thin layer of dentine. There was no trauma to the adjacent dentition and no evidence of periodontal trauma, though concussion was probable. Moderate to severe sensitivity to thermal changes and mastication were reported.

Immediate restorative options that were considered include reattachment of the original fragment; restoration with a composite resin (CR); glass-ionomer cement (GIC) bandage; or temporary acrylic crown. Given that the tooth fragment was lost, aesthetics were not a major consideration for the patient, the pulp was very close to being exposed and would be further irritated by acid etching, there was minimal enamel in which to form a reliable micromechanical bond with CR and there was limited clinical time in which to provisionally restore the tooth. Accordingly, it was decided to restore the 11 with a GIC bandage. GIC (Fuji IX速 shade A2 with no. 171 crown form) was used to cover the exposed dentine and adjacent enamel and the 11 was taken out of occlusion. Given that it was decided to undertake elective root canal therapy (RCT) on the 11 to aid in retention of the definitive restoration, a lining of calcium hydroxide under the temporary GIC restoration was deemed unnecessary. GIC has the advantages that: the material does not require etching, it can adhere to newly exposed dentine with an outward flow of dentinal fluid, little micro-leakage is found, there is good pulpal biocompatibility and the relative bond strength of GIC to enamel and dentine facilitates its removal.

Fig 1. Extra and intra oral photographs at initial examination (image reproduced with the express written permission of the patient) The injured area was thoroughly cleaned with water spray, followed by an assessment of the extent of the exposed dentine, as well as a careful search for minute pulp exposures. Clinical examination included sensibility testing as a point of reference for later evaluation of pulpal status and a baseline periapical radiograph.

Fig 2. Immediate restoration 11 (left) and provisional restoration (right) (image reproduced with the express written permission of the patient)

Definitive Treatment Factors to consider concerning the final treatment of crown fractures include: the age of the patient; size of the fracture; bite

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function, occlusion and parafunction; aesthetic need; economy; and skills of the dentist1. Definitive restoration options that were considered for this crown fracture included re-attachment of the original crown fragment; full coverage crown; restoration with CR; partial coverage or laminate veneers; or extraction then restoration with partial denture/implant therapy/fixed bridge.

Comparison of Treatment Options Restoration with Composite Resin. CR restoration of the fractured tooth is conservative to tooth structure, has minimal risk of pulpal complication and offers an immediate aesthetic solution to the patient immediately following the injury. Restoration with CR relies upon micromechanical bonding to exposed enamel and resin-dentine bonding to exposed dentine. The clinical durability of resin to dentine bonding is, however, unknown, given the lack of long-term clinical studies. Clinical failure may arise due to polymerisation contraction, thermally induced dimensional changes, mechanical stress or fatigue of the material used. This may imply renewed contamination of the dentine surface and subsequent risk to pulpal integrity. While the use of dentine bonding agents may appear relatively easy, the process requires great sensitivity of technique and places responsibility upon the clinician for meticulous tissue and moisture control and attention to detail, if the treatment is to be successful1. Only one longitudinal clinical study has been published where modern composite resins were used to restore traumatically injured teeth. The study showed that the number of necessary restoration replacements increased and reached 100% after 7 years. The main reasons for replacement were: loss of the restoration, loss of marginal integrity, discolouration caused by loss of pulp vitality. At the end of the study 48% of the replaced restorations had been replaced at least one more time2. Because few publications on longevity of crown build-ups are available, long term prognosis may also be based on the experience of caries lesions in anterior teeth restored with class IV restorations. Findings of the few studies on longevity of direct crown build-ups of fractured teeth and class IV restorations have lead to the concept that CR should be considered as a semi-permanent restoration with a median survival of 4-5 years1. CR crown build-ups will often be able to cover the demands for aesthetics, biological acceptability and resistance to abrasive wear, where the size of the fracture is small to medium, and should be the choice of treatment in young and older patients. In more extensively traumatised teeth composite resins may provide an adequate interim restoration which may be changed or repaired a couple of times before the tooth is restored with a full coverage restoration, at a time when the pulp is out of danger for a more invasive preparation. In this case CR was not chosen as the restorative option due to the extensive tooth loss and lack of retention, lack of long term studies regarding the success and longevity of resin to dentine bonding, significant technique sensitivity/skill required for treatment success, and the long term risk of bacterial leakage at the gingival margin resulting in risk of pulpal damage. Full Coverage Crown. For larger crown fractures the choice of treatment may more often be a ceramic/full coverage restoration. Considerable loss of tooth structure makes retention of restorations more problematic with an increased likelihood of restoration fracture during functional loading. When loss of coronal tooth structure is extensive, such as in a large crown fracture, a complete crown becomes mandatory. Retention and support must be derived from within the canal, because a limited amount of coronal dentine CADMUS 2009

remains once the reduction for complete coverage has been completed3. A tooth that has lost essential coronal dentine due to fracture may remain vital but have insufficient supragingival tooth structure for retention of a new restoration. In this case the root canal system may be considered an extension of the restorative zone and the tooth electively devitalised to allow placement of a post/core/crown restoration4. All ceramic crowns are the preferred full coverage restoration for anterior teeth as they provide the best aesthetic option (better translucency and less visible margins). Given the greater flexibility of all-ceramic crowns they are a preferable option in endodontically treated teeth as the crown tends to fail before the tooth. 5 year survival rates for all ceramic crowns are 93.3% compared to 95.6% for metal ceramic crowns. There are very few long term studies of all ceramic crowns, however it is believed that all ceramic crowns have an increased failure rate of 0.5 – 1.0% per year compared to metal ceramic crowns, with an approximate 10 year survival rate of 85%. In this case, given the high aesthetic requirement, steep anterior guidance, the extensive loss of coronal tooth structure and the subsequent lack of retention and support, prophylactic endodontic therapy was elected, followed by a cast post/coreretained, full-coverage, all-ceramic crown. Extraction and partial denture/implant therapy/fixed bridge. Extraction was not considered a suitable treatment option given the availability of several less invasive alternative treatment choices and the patient’s preferences.

Treatment Following discussions with the patient, a full-coverage all-ceramic crown restoration with elective root canal therapy (RCT) and retention via a cast gold post and core was chosen as the definitive restoration for the 11. Elective RCT was performed to allow for the preparation of a cast gold post and core. The RCT was prepared by hand instrumentation to 1mm from the apical foramen and obturated with a lateral/vertical condensation technique. A 15mm long post space was prepared with Gates-Glidden and gold parapost drill. It was assessed that this post space provided sufficient retention and allowed stress distribution over a large area, reducing the probability of radicular fracture4,5.

Fig 3. Radiograph 11 RCT with cast post and core (left) and crown preparation 11 (right) Initial crown margin preparation was undertaken and the tooth was provisionally restored with a stainless steel Parapost and Protemp® crown cemented with Temp Bond. The cast post and core was prepared using on-site laboratory assistance and cemented with Fuji Plus®. The choice of luting agents seems to have little effect on post retention or the fracture

resistance of dentine. However, adhesive luting agents have the potential to improve the performance of post and core restorations, with laboratory studies showing improved retention3.

coronal tooth structure meant that retention and support needed to be derived from within the canal. Therefore the prosthetic considerations negated the pulpal response.

The crown was prepared for a zirconia coping with porcelain veneering. A 360° rounded shoulder margin of 1.5mm (to mask the gold core), rounded internal line angles, 2.0mm incisal clearance and 1.5-2.0mm ferrule was prepared. Preparation of sufficient ferrule was the most essential aspect of the crown preparation to ensure long term survival of the restoration and tooth. Crown preparations with as little as 1mm coronal extension of dentine above the margin have double the fracture resistance of preparations in which the core terminates on a flat surface immediately above the margin4.

Restoration of a fractured crown with CR and dentine bonding techniques can be regarded as an effective tooth repair, with a predicted longevity of 4-5 years. In traumatised teeth CR may provide an adequate interim restoration which may be changed or repaired a couple of times before the tooth is restored with a full coverage restoration.

The shade was selected using Vita® shade guide and the crown was constructed at an off-site laboratory. Given that zirconia is nonetchable, any cement could have been used. Adhesive cementation with CR was chosen, given the 75% success rate of ceramic crowns cemented with acid etched CR compared with the 43% success rate when cemented with GIC or zinc phosphate6.

The overall treatment took approximately 3 months. This time frame was acceptable given the member’s posting cycle. If the member were posted to a seagoing ship, an alternate treatment plan could have been to maintain the vitality of the 11, promote pulpal healing, restore with a simple CR restoration and defer the restoration with a more complex full coverage restoration until the ship’s programme allowed for more time for complex treatment to be undertaken.

Competing Interests None Declared.

Address for Correspondence Lieutenant Kelly Gregg, RAN Dental Platoon 3rd Combat Service Support Battalion Lavarack Barracks Townsville MILPO QLD 4813 Fig 4. Final restoration 11 on the day of insert

References 1. Andreasen JO, Andreasen FM, Andersson L. Textbook and

The patient was very happy with the overall aesthetic and functional results. He was advised to avoid high risk trauma activities and take preventative measures, e.g. wear mouthguard when playing contact sport to reduce the risk of future traumatic injuries to his dentition.

Discussion

The management of traumatic crown fractures involves a balance between pulpal response to injury and treatment; and prosthetic considerations arising at the time of the injury and final definitive treatment plan. It remains preferable to maintain the vitality of a traumatised tooth. However, in this case the extensive loss of

5. 6.

colour atlas of traumatic injuries to the teeth. 4th ed. 2007, Blackwell, Copenhagen. Spinas E. Longevity of composite restorations of traumatically injured teeth. Am J Dent 2004;17:407-11 Rosensteil SF, Land MF, Fujimoto J. Contemporary fixed prosthodontics. 4th ed. 2006, St Louis. Mosby. Cohen S, Hargreaves KM. Pathways of the pulp. 9th ed. 2006, Mosby, St Louis. Walton RE, Torabinejad M. (2002) Principle and practise of endodontics: 3rd ed. 2002, Saunders, Pennsylvania. Goodacre CJ et al. Clinical complications in fixed prosthodontics. J Prosth Dent 2003;90:31-41.

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Other Items and Activities Personal Experiences

From Dental Assistant to Senior Dental Assistant Able Seaman (Dental) Two Christie Woodleigh

The 26th November 2007 marked my first posting to HMAS KUTTABUL as a dental assistant (DA). KUTTABUL Dental was a wonderful learning platform, with lots of opportunities to work with specialists and consolidate my basic dental assisting skills. I found all the civilian DA a huge help in tutoring me in becoming a competent DA and the overall working environment friendly and enjoyable. After a few months working at KUTTABUL I was given the opportunity to gain work experience at HMAS WATSON. I enjoyed immensely the responsibilities which were given to me to administer the department and it was an exhilarating insight into the next step of my career. Many thanks are owed to Dr Murray Hayes, Dr John Ashton and CAPT Victor Ollson-White for their help at WATSON. I returned to KUTTABUL after three months. I had completed my competency log book and was working two days in surgery and three days in administration under the wonderful mentorship of CPODENM Rob Meldrum. As a new DA there were plenty of questions to be asked and at all times CPO Meldrum was a fantastic guide. I was not very good at spreadsheets or word documents, but working with CPO Meldrum has definitely taught me how to improve on the overall presentation of my work. CPO Meldrum has a wealth of knowledge of the dental world and was a great support in reaching my goal of attending the senior dental assistant (SDA) course. In February 2009 I flew to sunny HMAS CERBERUS to start my SDA course. I was nervous but quite excited to be accepted to go on course. Within the six-week course we learned many things including how to take x-rays, give oral hygiene instructions, presentation skills, how to deploy a minor dental unit and our responsibilities as a SDA. Working with other DA from the Army and Air Force was a joy for me. I had many laughs with the six girls I was on course with and we all worked together to get the best results on our tests. This often entailed after-class tutorials which involved a glass of wine, cheese and quizzing each other. I’m a big believer in learning in a fun environment and we all got great results on our tests. The SDA course was something I will always remember and it opened up new and exciting opportunities for me as a DA in the Navy. At the end of March 2009 I posted into HMAS WATERHEN to take over from LSDEN2 Mark Smith to become the new SDA. With LEUT Liz Close as my dentist I’m having a fantastic time here, the atmosphere is very relaxed and it’s like a little family. Starting out I was very busy and had to work on my time management and task prioritization as I found it hard to fit everything in. With guidance from LEUT Close, I am becoming more efficient. Our civilian DA Dani Delahunt is now working an extra day allowing me more time CADMUS 2009

to deal with dental administration. I am applying all I have learned and my experiences from KUTTABUL, WATSON and the SDA course into this department. (CPO Meldrum will be very pleased to know all the folders are now colourcoordinated and are all very neatly presented.) The medical team at WATERHEN are always willing to give us a hand. I enjoy working with the medics and on my admin days, I often put up my hand to be the testing dummy. I have had my leg plastered and got to test the new central thermal heating blankets. I just want to thank them because their help really does make a big difference.

Most DA will agree with me when I say that dental assisting can become a little repetitive over time, but being a SDA has given me a greater opportunity to contribute more to the dental treatment of our sailors. I give flossing and brushing instructions with a giant mouth model to our patients. I find that it can be really rewarding when a patient starts to get involved with it. I also take the bitewing x-rays and most of the periapical x-rays for the patients. LEUT Close is an excellent tutor and she always encourages me to keep up all my competencies I learnt from my SDA course. I feel very privileged to be given the responsibilities I have as a SDA. My next posting is to a sea billet, which I’m very excited about. It will be another change but will give me a chance to expand my skills even further. I must say I didn’t think becoming a DA in the Navy would be so challenging, but I can honestly say that I’m truly enjoying my career.

Other Items and Activities Personal Experiences

Timor Leste – Operation ASTUTE: An Australian Perspective Captain Shirley Robinson, RAADC

From the desk of the Health Services Desk Officer at Contract Management Cell in HQ JTF 631, Timor Leste: After 22 years in the Army (19 of those in RAADC), I finally got a deployment! I was excited and a little nervous at the prospect and I felt truly lucky to finally get the so called ‘guernsey’. My pre-deployment preparation went quite quickly and before I knew it, on 2nd August 2009, I kissed my family goodbye and headed off to Darwin. I spent one dreadful night at ‘Tin City’ at RAAF Base Darwin and then flew into Dili on the ‘red-eye’ flight on Monday 3rd August 2009. I was met at the airport by LT Zac Von Bertouch who was the Health Desk Officer I was to replace, and he was extremely happy to see me as my arrival indicated his departure was close at hand. Following a somewhat intensive week of hand-over, I was left to my own devices as the Health Services Desk Officer at the Contract Management Cell located at Camp Phoenix Timor Leste.

resuscitation, resuscitative surgery, critical care/high dependency care, inpatient care, diagnostic services (including imaging and pathology), rehabilitation services and all associated health logistics, including blood banking. Additionally, they provide environmental (preventive) health services, casualty retrieval (AME and CASEVAC) and the provision of all medical consumables. Due to the professionalism of the teams at PDL Toll and Aspen, the job is not too difficult and as long as the soldiers are happy and healthy, life is pretty good.

My job is quite diverse; the main focus is the management of the contract that provides the health support to the ISF and other dependencies on current operations in Timor Leste. The position is responsible for working closely with the contractors in the delivery of medical, dental, preventive health and casualty retrieval services and the reporting of all health surveillance information to HQJOC and other Defence agencies. The health support in Timor is provided in 2 ways. Firstly the Level 1 Integral Health Support is provided to the troops on the ground by the deployed elements within the Timor Leste Battle Group (BG). Currently 2RAR are providing the BG and elements of 3CSSB are supporting. The medics, with and without ADF ambulances, are located throughout the BG at the Forward Operating Bases and are managed by the RMO and WOMED who are located at the heliport in Dili. The Preventive Health Support is provided by the preventive medicine technician who is also located at the heliport and supported at the FOB by the medics on the ground. Secondly the Level 2 and Level 3 Health Support are provided through PDL Toll who has sub-contracted Aspen Medical from Australia. Aspen provides a similar type of care that our soldiers can expect back in Australia and the PDL Facility is world class for a deployed health element. Soldiers can expect timely and responsive health care from all elements and preservation of the force is the health mission. PDL Toll provides primary health care, pharmacy support, dental support (both emergency and routine), emergency

Dili itself is quite an experience. A friend once told me that the smell of the place is the hardest to forget. Hard to imagine, but I have to agree. Most things are different here – sights, weather, vegetation, people - but the most significant differences are definitely the smell and the traffic! The smell can be quite overbearing, a mixture of fish, rotting garbage and excrement mixed with burning vegetation and burning garbage. The traffic in Dili has hundreds of small motorcycles and scooters nipping in and out of the traffic with gay abandon and constant horn ‘bleating’ on one-way streets and narrow two-way streets, complicated by an apparent lack of road rules and centre lines. The transport mode of choice for the locals is either the motorcycles or scooters where helmets are optional, girls sit side-saddle on the back, and of course one vehicle carries a whole family (Mum and Dad with 3 or so kids); or the yellow taxi with a maximum speed of around 20 kph; or the Microlet. The Microlet is a variance of a small people mover

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like a mini-bus with the seats along the inside walls like a troop carrier. They are usually decorated very brightly with stickers and logos and have a myriad of coloured lights, loud music and terrible novelty horns. It costs around 10c to travel in the Microlet and since it is apparently cheaper to travel on the outside, many locals chose to hang off the outside or have most of their body hanging out of the doorway. Chickens and pigs travel on concession. A trip through the traffic of Dili is always an entertaining experience and luckily the maximum speed is 45 kph. The people are truly beautiful and love interacting with the ISF, especially when you are female. The kids are gorgeous and it is amazing just how happy and carefree they are. Compared to my children, they really have very few possessions and worldly goods but are always ready with huge smiles and â€˜high fivesâ€™. The people of Timor Leste are predominantly

Catholics and there are a number of shrines and statues dedicated to the Catholic religion throughout the island. In particular Dili has the Jesus and Pope Statues, both are huge and mark the outer boundaries of the Dili area. Scattered around are numerous Catholic churches, schools and orphanages where the varying Catholic diocese provides support to the local population. The outer districts are quite an experience. I have been lucky to score a few helicopter flights to the outer areas of Timor Leste, including a trip to the Oecussi Enclave on the western side of the island. The island is very diverse in its landscape, varying from very dry and sparse in vegetation, through to lush pockets of green agriculture and even rainforests. There are towering mountains and extremely low plains with gorgeous coastline and crystal clear or turquoise water. The monsoonal river beds are a sight to behold. I am constantly enthralled by the massive dry river beds, in some places a kilometre or so in width, that are a frequent feature of the landscape. In the dry season, the locals live in the dry river beds and source the dirt they use to make bricks and other building materials for their homes and other structures. I canâ€™t wait to see the river beds filling up with water in the wet season. The highlight of my trip so far has been experiencing the local culture in many different ways from the trips out to the districts, to the local markets and interacting with the locals when out and about. The recent Trade Expo held in Dili highlighted the traditional culture in crafts and food and was an experience that will stay with me for a long time. I feel the Timorese people have a long way to go in the development and stability of this young nation and our military and non-military support is an important aspect of this development.

RAADC Corps and Historical In recognition of over 40 years of full time service in the RAADC

The career of Major Werner Johann Josef Voss Captain Paul Jacobsen, RAADC

The Interview of a Lifetime For those who have worked with Major Werner Voss, you will have experienced his professionalism, dedication and work ethic. Besides a handful of serving RAADC members, this man joined the Australian Regular Army before you were born. So with his 42-year career coming to a close in February 2010, it is befitting that we celebrate his service and the contributions he has made along his journey. MAJ Voss was born in Dusseldorf, West Germany, in 1950. He migrated to Australia with his parents in 1962, completing his secondary education at Strathmont Boys Technical High School, South Australia in 1966. Discontented with his employment as a clerk and living in a small country town, he enlisted in the ARA in September 1967. Why the military? My father was a sailor on a mine sweeper in the port of Bremen during World War II, but that was not the reason for joining the military. Although I did try to enlist in the Navy as an apprentice at 15 years of age in Adelaide, in the end, I decided on the Army and was allocated to the Royal Australian Army Service Corp. I then completed initial training as a driver at Bonegilla, Victoria.

training as a dental technician at the United Dental Hospital (now Sydney Dental Hospital). What attracted you to RAADC? My first wife spotted a notice in Area Routine Orders advertising positions for dental technician training which led me to the RAADC. My father was a dental technician so I knew what was involved in the trade. The pay and promotion were also my motivators (as for everyone else!). Dental technicians were one of the highest paid trades and at the time, all technician positions were SSGT rank. By the time I qualified, the 5 SSGT DEN TECH positions in all the Dental Units had been reduced to 1 SSGT and 4 CPL. Successful completion of the apprenticeship in late 1971 saw MAJ Voss posted as a Corporal to 8th Dental Unit, Watsonia. During this period he was detached to Albury Wodonga and then moved to 17th Dental Unit, Puckapunyal in February 1973. He was promoted to Staff Sergeant at Puckapunyal in 1975.

Werner Voss in full white PT ensemble (ahh, the 80s!) with technician trainees Howie Chapman and Paul Jacobsen

Did you want to be in Transport? Yes! What else would you choose to do when the Army won’t let you drive Caterpillars. I was young, liked cars and trucks...

How did you find the transition into the SGT Mess? Needless to say, when I was promoted from CPL to SSGT, it upset a few of the old warhorse SSGT around Puckapunyal and it didn’t make me the most popular new member in the SGT Mess. For those unaware, up until 10 years ago the technician trade was the only one in the Army that promoted directly from CPL to SSGT. As you can imagine, this would always raise an eyebrow or two.

On his first posting to the Military Hospital, Liverpool, MAJ Voss saw the light and applied for a transfer to the RAADC and secured

How close were you to deploying to Vietnam? I finished the technician training in Sydney the year before the Labour

1987 Werner Voss with technician trainees at Healesville (L-R): Lee Melberzs, Scott Thomas and Tanya Kench

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Government was elected. When I got promoted I was the only SNCO in the mess without a war service. In 1980 Major Voss was posted to Watsonia Dental Unit on promotion to Warrant Officer Class Two. This is where I had my first encounter with WO2 Voss and I must say that he did not leave me in two minds on the direction he wished me to take. That dental unit was pumping - the halls were filled with military staff and the atmosphere was fantastic. This can only happen when the staff is happy and they enjoy coming to work.

of 9CSSB gave me enormous satisfaction and pleasure. Leading 9CSSB in an ANZAC Day March (the CO was ill) was a true highlight, unfortunately, there was no photographic record of this event. Being the OC at Randwick Health Centre also rated highly, the opportunity to command a facility comprising a dental and medical unit which was larger than those in which I had served in at all rank levels was pretty special. The opportunity to do it myself as opposed to how I thought others would have done was very satisfying. Being able to guide, reward and promote those who deserved it was very special to me and not to mention ensuring that all the other boxes of command were ticked. Finally, my most enjoyable occasion was marrying Lynnie. What has driven you to serve for 42 years? I am not sure that I have been driven. I have always thought it odd that soldiers would create a career for 20 years and then leave to start all over again. My father who worked as a dental technician, had provided me with the opportunity to work in a civilian practice every few years, which only confirmed to me every time that the Army provided far better career opportunities for a technician compared to in civvy street. There is always a chance of promotion and even a complete career change within the system, of which my career is the perfect example.

1985 Subject 2 for WO course, Healesville (rear L-R): Ian Macpherson, Noel Denman, John Lynch, Werner Voss, (front L-R) Gayle Milne and Dexter Purcell (wearing the famous burnt orange dress) After 5 years at Watsonia, his trade training and the development of on-the-job training (OJT) concept for Army Dental Technicians led to a posting to the School of Army Health from 1985 to 1988 where he was responsible for the Technician Training. During that period he also moved the training from Healesville to Portsea and continued to produce high quality technicians. It was during this time that he met WO2 Lyn Mitchell. Do you think Lyn changed your life? I know she did; she made things complete. Birdie’s opinion (COL Viv Bird, ex ARA, current Colonel Commandant RAADC) was that she’d changed me... After a few more postings as WO2 TECH, Major Voss was commissioned as a Prescribed Service Officer (PSO) Captain in 1993 and posted as the Officer-in-Charge (OIC) at the Dental Training Section in the School of Army Health, Portsea, a position he held until 1999 by which time the role of the School transferred to Army Logistics Training Centre. Major Voss was promoted to his present rank in 1999 on posting to the Area Health Service (AHS) South Australia, where he held the position of Senior Administrative Officer and was instrumental in combining the elements of 3 Services into a single unit. In 2002, he was posted to 9CSSB at Warradale Barracks as the Secondin-Charge (2IC). In 2006, Major Voss was posted to Sydney as the Officer Commanding (OC) at Randwick Health Centre in the AHS Sydney including the medical and dental section at Victoria Barracks, Paddington. In 2009, he was posted to Defence Community Organization (DCO), Townsville as a Military Support Officer where he will complete his service until discharge in February 2010. What has been your most enjoyable or satisfying job? I have had many satisfying jobs. They include promotion to WO2 TECH at 8th Dental Unit and the job as WO2 Instructor at the School Of Army Health, Healesville. Accepting the commission also rated highly. So was the time with WO2 Geoff Lott to advance the technician training to a higher level. My achievements as the 2IC CADMUS 2009

Tell us some of the special friendships that were created over the journey. Lotty (WO2 Geoff Lott, ex ARA) is very special to me. What we have achieved together was very satisfying and we clicked as friends including with his wife, Wendy. Dexter (WO1 Dexter Purcell, ex Corps WO) holds a special place in my life. Ian (MAJ Ian Cameron, OC 8 Dental, ex ARA) and I got on well and still do. Greg and Nita (WO2 Greg Natt and WO2 Nita Natt, ex ARA) have become close friends of ours and MAJ Chris Reed (JOSS, Townsville) and I socialise when we can. A little coincidence, the majority of these friendships was spawned at the ‘pumping’ Watsonia in the early 1980s. Who is your favourite character or what is your favourite story? Ken Watson - his owl impersonations at Watsonia definitely rate a mention. He would squat on a chair, drag his shirt over his legs, cup his hands over his eyes and then he would start the owl hoot. (Alcohol did enhance the impersonation, but it should be stated that only responsible alcohol consumption was condoned.) MAJ Voss also added, ‘…it is hard to have war stories when you haven’t been....’

Now and then: at Recruit School - 1967 What advice would you give a new dental assistant just starting out in the system? Examine and re-examine your reason(s) for being in the RAADC; if it’s to serve overseas, change Corps even if it is temporary. Ensure your reasons for selecting technician training are strong because the incentives for me are no longer in existence, and you do not need to become a technician in order to gain higher office.

What is your best quality? All those qualities stated in the Chinese Horoscope for Oxen. How many children do you have? Two: Kelly and Sean. Kelly lives near Woy Woy with her 3 children. She and her husband hold the Hungry Jacks franchises in the area. Sean is a WO2 aspiring to be the RSM of the Surveillance and Target Acquisition Regiment in Brisbane next year. What are your plans on retirement? Lyn and I plan to ride our motorbikes frequently including a tour of Australia. I hope to be able to assist Lyn in her endeavours to become a marriage celebrant, to be closer to my mother in her old age and to visit my friends at least annually. Our plan is to move back home to Adelaide.

Medals & Awards MAJ Voss has been awarded the Federation Star, the Defence Force Service Medal, and the Australian Defence Medal. The Federation Star recognized 40 years of effective service. There are currently 7 serving members wearing the Star, with a total of 248 Stars issued since its introduction in 2002.

Conclusion When I was writing this article, I knew it would be difficult to articulate fully MAJ Voss’ 42 years of service. Fortunately, I have had the privilege to work with MAJ Voss and have experienced his leadership and management skills. He has truly applied the same principles to all areas of his career and his life: enjoy yourself and do your job well. It is as simple as that! There is no grey area and this has given clear boundaries for his staff to relate,

communicate and get on with the jobs. He has enormous pleasure when guiding soldiers to develop into effective leaders and this is surely one of his legacies. His challenge to do the best ensured that the majority of technicians passing through the School had the work ethics to produce their best. On behalf of past and serving RAADC members, congratulations on an outstanding career and we wish Lyn and you all the best on retirement. We look forward to catching up with you both in the future.

Words from WO2 John Flemett: I first met MAJ Voss in 1995. He was my Senior Instructor on the Dental Technician course. Over the years, on the occasional Corps gathering, I gleaned pearls of wisdom from MAJ Voss on red wine, volley ball, double strength cappuccino, volley ball, financial investment, volley ball, motorbikes and yep, how to stack your team to win a game of volley ball. It wasn’t until 2006 when I worked with MAJ Voss as OC Randwick Health Centre that I really got to know him. While he has the reputation of being a hard, but fair commander; he cares about his soldiers and their careers and he constantly encourages them to improve their knowledge. He always challenges soldiers to challenge themselves, to improve themselves and to gain a better understanding of the next positive steps for their careers. MAJ Voss enjoys living life fully and loves sharing all the finer things in life with his wife Lyn. I was privileged to be present at the celebrations when MAJ Voss received his Federation Star in 2007. MAJ Voss will be sorely missed as one of the passionate members of the RAADC.

RAADC Corps and Historical

Members on non Corps Posting 2009 Warrant Officer Class Two Kerry Chapman, RAADC

It is always exciting to receive a copy of the Cadmus magazine and find out where everyone is and what they are doing. I decided this year to catch up with some members of the Corps and to find out what they are up to. Adelaide has some very nice wineries and hidden treasures: COL Janet Scott (Reserve) is the Chairman for the Consultative Committee in Dentistry to the Surgeon General Defence Health Reserve and is part of Specialists Platoon at 3HSB. MAJ Lee Melberzs (Regular) is the 2IC 3HSB. WO1 Tanya Kench (Reserve) is the Plans Warrant Officer 3HSB. WO2 Lynn Daly (Regular) is an instructor at the Warrant Officer and Non-Commissioned Officer Academy of the South Australia Wing. Over in Western Australia, WO1 Joe Ring (Reserve) is the RSM of Western Australia University Regiment in sunny Fremantle. In Brisbane, MAJ David Hua (Reserve) is the SO2 Dental for the Queensland region south. Up the track in Townsville I caught up with MAJ Werner Voss (Regular), who is at Defence Community Organisation. A blast from the past, MAJ Chris Reed (Regular) has been at Joint Operational Support Staff for the last 3 years in Townsville and loving every bit of his exciting job. He is posted to JOSS Northern Territory in a few weeks. 11CSSB wouldn’t know what hit them with WO1 Paul Boothroyd as the Training Warrant Officer for the recruits.

Regiment as our Administration Officer. As for myself (still in the Regular), I am at Melbourne University Regiment in the Senior Nom-Commissioned Officer Wing at Training Company Simpson Barracks. It has been a real eye-opener on the training side of things. Leaving the mainland and over in Tasmania is CAPT Alisa Wickham (Regular) in ‘the secret posting’ as 2IC 10th Health Coy 2FSB. Over the deep blue sea on Operation ASTUTE is CAPT Shirley Robinson (Regular). She loves the sights and smells of Timor Leste as the ISF Health Planner and Contract Manager Health, working under HQ JTF 631. The next 6 months will fly! In 2010, she is posted as the SO3 Trades with the role of Assistant Employment Category Manager at ALTC. It was great to catch up with as many members as possible either by email or phone calls. It was good to hear the old stories and life journeys. One thing is for sure: the Corps is still running deep through everyone’s veins!

In Sydney, MAJ Victor Tsang (Reserve) is the SO2 Dental at Health Services NSW. A hard one to track down was WO1 Steve Tester (Reserve) who was last seen at APA – Sydney and is now the SO2 Recruit Liaison Army Reserves at AHQ Russell Offices in Canberra. At ARTC, the girls – SGT Amy Hall, CPL Danielle Gurkin, and CPL Alaina Rodway (all Regular) – are extremely busy as instructors at ‘the home of the soldiers’ where it never sleeps. I continued my pilgrimage to Albury Wodonga and caught up with MAJ Debbie Olsson (Reserve) at Training Wing of the Development Group ALTC. She is posted to the dental heritage position in the HOC Cell – Army School of Health in 2010. The Army Museum Bandiana will not be the same as WO2 Nay Rockliff (Reserve) is leaving the role of assistant curator to take up a new role as the Property Officer in the HOC Cell - Army School of Transport. In Melbourne, we have LTCOL Dominic Ho (Reserve). He still holds the position as SO1 Dental for the southern region but is currently on a break from the Army Reserve, enjoying fatherhood. Congratulations on the birth of your daughter. WO1 Dexter Purcell (Reserve) keeps herself busy as the National President of the RAADC Association and supports Melbourne University

CADMUS 2009

RAADC Corps and Historical In recognition of over 40 years of full time service in the RAADC

Update from the RAADC Association Incorporated Mrs Dexter Purcell (WO1 Standby Reserve) President

President’s Message Greetings to all ADF dental members. We are well and truly gearing up for the Reunion next year in Canberra, 23rd-25th April 2010. It will be held at the Crowne Plaza Hotel and will include the Corps Anniversary Dinner on Friday, a guided tour of the Australian War Memorial on Saturday, the AGM and the ANZAC Day march. I hope you have logged it in your diaries and will be making some serious attempt to join us for what will be a fabulous event. Details will be published on our website soon. Our Treasurer is working hard on a few surprises!

historic and iconic Mess is now closed (it closed down a few days prior) because there is little military presence at Victoria Barracks these days. On arrival at Victoria Barracks we learned that quite a few had been there earlier for the 0500h ‘gunfire’ breakfast. All the RAADC members and family had about an hour or so at the Mess renewing old and current friendships. After a few refreshing drinks we headed for the Form Up Point (FUP) in the city. Some members went straight to the FUP in Margaret Street.

We are having a recruiting drive to encourage serving dental members to join the Association. The aims of the Association are:

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to collect, preserve and display all manners of military historical material relating to the Royal Australian Army Dental Corps;

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to encourage camaraderie between past and present RAADC members, both regular and reserve;

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to publish and circulate newsletters on subjects of interest to our members; and

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to engender esprit de corps by arranged activities and to renew and foster friendships amongst members who served together over a period of many years.

Initial cost of membership is $35.00. This comprises a once only joining fee of $10.00 plus the annual subscription of $25.00. We extend an invitation to all dental members of RAN and RAAF to join us. Our Association welcomes membership by RAN and RAAF dental members with the same rights and conditions as Army dental members. Membership is also open to civilian dental employees of the ADF. Subscriptions are our main source of funding other than an annual raffle, which raises a little extra to keep us afloat. Take a look at our website where you can find the State Representatives and an application form to join. Go to: www.raadcassociation.com I do hope to see you at the Reunion next year! Regards, Dexter

Anzac Day Brisbane 2009 Brisbane turned on a typical day in Queensland on 25th April 2009, beautiful one day, glorious the next. Individual RAADC Association members attended various Dawn Services in and around Brisbane before meeting at Victoria Barracks Officers’/ Sergeants’ Mess. The Mess was opened specifically for Anzac Day but it was extremely sad and disappointing to hear that this

At the Mess: Ian MacPherson, Ray Wilkinson, Alan Hannah, and Graham Saga It was gratifying to see the number of members forming up. To see RAADC form up in rows of 6 is a very rare occurrence. We had about 42 in the contingent and this included children and grandchildren who marched alongside their families. This was the largest number since our 2000 Reunion. Our contingent was led by LTCOL (Ret’d) Martin Mylne RFD. Marty had served in the ARA and saw service with 33rd Dental Unit in South Vietnam. When he retired from the ARA, he served in the Reserve in various appointments including as OC of 1st Dental Unit and as CO of 1st Division Dental Unit at Enoggera (his final posting). It was particularly pleasing to see the number of serving RAADC members who marched with us. Our magnificent RAADC Banner was carried by PTE Jason Wilding and PTE Ryan Cowgill from Gallipoli Barracks Dental Centre (GBDC). Our 33rd Dental Unit, South Vietnam Banner was carried by SGT Tracey Feillafe who was accompanied by her husband and their 3 children. Other GBDC members marching were LTCOL Suzy Atkins, MAJ Wayne Chow, SGT Karina Peacock and her daughter, PTE Nancy Havili, PTE Lisa Blencowe and PTE Rhianon Farley. Our representative for serving members, CPL Haydee Stevens and her son, also marched.

CADMUS 2009

We are so pleased that these members from GBDC joined us. This is what we are all about and the Association exists just as much for serving, as well as past RAADC members. Also the number of serving and past RAADC Officers who marched was gratifying to see. Some of those marching were: Marty Mylne, ‘Macca’ MacPherson, Pat Jackman, Len Boulton, Phil BushellGuthrie, Dana Socal, Bob Keane, Mal Slattery, Ray Wilkinson, Brendan Wilkinson, Bob Greenhill and grandchildren, Alan Hannah, Graham Sagar, a WWII friend of the late Jack Graham, Ross Graham, Nick Read, Rob Hazlewood, Gerry Thurnwald, Rick Olive, Wayne Butler, Tom Condon, Dave Larment, Ron Brown, Catherine Jackman, and David Hua - what a great turn-up!

perfect host and the food and hospitality were first class. Members on the ‘sleepover’ were Marty, Ron Brown, Geoff Austin, Mal Slattery, Pat Jackman, Len Boulton, Dick Outridge and Dexter Purcell. We had a BBQ dinner on Friday night and a fabulous BBQ ‘brekky’ on Saturday morning. Thanks also to Dane and Maree Roberts who welcomed us to their favourite local restaurant Le Relais Bressan for excellent French cuisine on. Dana Socal, Peter Burge and Graham Sagar joined us for dinner on the Saturday evening. The AGM started at 11.05am on Saturday. The following members were elected or appointed to the Executive and Management Committee for FY 2009/2010: Patron: President: Vice President: Secretary: Treasurer: Social Member: History/Records: Property/Regimental: Serving Member’s Rep:

COL Maurice Dingle (Ret’d) Mrs Dexter Purcell Mr Mal Slattery Vacant (Mal Acting) Mr Graham Sagar Mr Ian ‘Macca’ Macpherson Ms Dana Socal Mr Ron Brown CPL Haydee Stevens

We are still seeking volunteers for positions of Vice-President and Secretary. Mal is hanging in there covering both jobs and is in need of some relief after his dedication above and beyond the call of duty. We are restricted only in that the office bearer for Secretary must reside in QLD. At the FUP: LTCOL (Ret’d) Marty Mylne, RFD leading

Annual General Meeting 2009 The AGM for FY 2009/2010 was held on Saturday 16th May 2009 at the Seadrift Guest House Montville. We are grateful for the accommodation provided courtesy of Marty Mylne. Marty was the

Anzac Day Brisbane 2010 For those members who reside in South East QLD and are unable to attend the Reunion in Canberra but would like to march on Anzac Day in Brisbane, arrangements will be made for you to attend with 11th Field Ambulance Association, followed by a gathering at Gilhooleys Hotel. Further details of this event will be provided closer to the day.

From Headquarters Forces Command Colonel Murray Hayes, BDS, Dip Photoimaging

After quite a number of years without senior representation in the Land Army, I am very happy to report that RAADC is now represented on Headquarters Forces Command (HQ FORCOMD) with the establishment of a SO1 Dental position in the health cell. This is excellent news as it is very important for us to have a voice at this level. So what is FORCOMD you may ask? As a part of the Adaptive Army initiative, Land Command and Training Command have been combined to form FORCOMD. HQ FORCOMD is based in Victoria Barracks in Sydney, has a health cell headed up by COL HLTH, COL Georgina Whelan and includes a SO1 Dental position (at the moment, it is reserve but this may change in the future). This is only one of many changes happening across Army. As part of the Combat Services Support Force Modernisation Review, we, along with all other Support Corps looked at what was required to provide a deployable asset and how that might be structured within Forces Command. Where we choose to put these deployable positions is being closely looked at and some of the ‘courses of actions’ will engender considerable change. To quell the ‘doom and gloom’ rumours, we are not being disbanded. It is widely accepted that we CADMUS 2009

need to maintain a deployable dental asset, including technicians. Early discussions are underway and the current view is that we need to bring our uniformed dental elements together to provide more opportunity for development and training. We would like to form a ‘centre of excellence’, with one or two satellite elements to add posting variety within FORCOMD. Gallipoli Barracks is the most likely place for the HQ, which ideally will be commanded by a LTCOL. In addition, there will need to be other postings and positions in Joint Health Command. The changes that may happen in the garrison work space will be part of the Joint Health Command restructure. There remains plenty to discuss as we are still very much in the planning phase. At the time of writing, I am preparing for a conference at which representatives from across our Corps will be present and have the opportunity to pass ideas up the chain. I’m very confident that our best interests are being well represented and that COL Whelan is very supportive. This is an exciting time for us all - we are on the edge of what could be the biggest change to our Corps in its history. I look forward to playing my part in this and will endeavour to represent you all to the best of my ability.

ADVERTORIAL

Strong Torque rewards customer loyalty

andpiece sales superstore and repair centre, Strong Torque Dental, has launched a new programme to reward its many customers for their loyalty with “cash back credits” towards their next purchase. “We’ve built Strong Torque Dental by giving our customers the best value for their money on handpieces and handpiece repairs so when it came to developing a loyalty programme, the premise was simple,” said managing director Jan Gray. “If you give us more business, you get even more bang for your buck. “For every $100 you spend with us, we will credit you $10 towards your next purchase. This applies to new handpiece sales or handpiece repairs. The more business you do with us, the greater the rewards. Simple.”

service technicians and pride themselves on providing a great service at a competitive price and in most cases turnaround is the same day the instrument arrives in the workshop. All products carried by Strong Torque Dental are listed on the TGA’s Australian Register of Therapeutic Goods. For more information, call call 1300-765-398 or see www.strongtorquedental.com. n

New website for handpiece management

trong Torque Dental has launched its new website featuring the HerMes Handpiece Management System to help its customers manage the maintenance of their handpiece inventory.

Mr Gray said that for practices spending large amounts on repairs and continually replacing handpieces, the rewards quickly turn into bottom-line savings. “A customer sent five handpieces to be repaired and bought six replacement handpieces as well recently and his bill came to $5,308. Now with the cash back credit, he has $530 which will be deducted from his next purchase or handpiece service. So it’s real money in real time, plus the customer got terrific pricing in the first place so it’s a win-win all round.” Strong Torque Dental charges $280.28 including Post and GST for a KaVo premium handpiece repair and customers now receive a cash back credit of $28.02. A replacement fiber optic handpiece to fit a Kavo, W&H, NSK, or Sirona coupler costs $675 with a $67.50 credit. “Handpieces are vital tools, practices need several per chair to work efficiently and they are reasonably complex devices with lots of parts moving at high speed,” Mr Gray said. “Add to that the stresses of repeated autoclaving and the failure rate can be high if proper service and maintenance is not carried out. “Based on feedback from clinicians, practice managers and technicians around Australia, we have evolved our business to be able to offer dentists a complete handpiece service that includes purchasing a choice of brands and types of handpieces including high speed, low speed and lab motors and even have disposable prophy heads that are popular with hygienists. Plus, we fully service and support our own products and handpieces from all other manufacturers. “We’ve also done away with quotes and individual pricing on repairs for highspeed handpieces and now have two pricing options on all Major Brands as essentially there are only two ways to repair a handpiece. Customers either pay for a standard rebuild which is bearings, ‘O’ rings, washers and a thorough clean; or it’s a complete rebuild from one end to the other. So there is no need to wait for a quote - it’s either one or the other. “We still quote on slow speed models and hygienist handpieces as a range of different problems can occur in these instruments.” Strong Torque Dental is a family owned and operated business based in Ormeau, Queensland, 30 mins south of Brisbane. Principals Jan and Shirley Gray and their staff are trained, qualified handpiece

“HerMeS is a free service provided to all customers of Strong Torque Dental,” said Jan Gray, managing director of Strong Torque Dental. “If you’re already registered with the HerMeS Handpiece Management System, you can simply book in your handpieces before you send them to us for repair and then track the repair using the website. “You can see when we receive the handpiences in our repair centre, full details of the work completed and then when they were dispatched back to you. “In most cases, your handpieces are dispatched within 24 hours of receipt in the repair centre. “The website also includes fixed pricing for all high speed handpiece repairs so you no longer need to wait for a quote.” The Hermes Handpiece Management System is a comprehensive system that allows you to keep track of all your handpieces, review service and maintenance histories and manage repairs. With HerMeS you can: • Maintain an inventory of handpieces; • Review maintenance and repair history; • Check on handpieces being repaired; • Check diagnosis reports; • Check technician reports; • See repairs that have been conducted; • See what tests have been conducted; • Book in new handpiece repairs via the Strong Torque website; • Receive confirmation that handpieces have been received; • Receive quotes in a timely manner; • Check the progress of any repairs; and • Receive confirmation when handpieces are dispatched. For more info, call 1300-765-398, see www.strongtorquedental.com or send your repairs to Strong Torque Dental, PO Box 618, Ormeau Qld 4208.

First printed in Australasian Dental Practice magazine, September/ October 2009 issue.

CADMUS 2009

Joint Units

Unit News Directorate of Defence Force Dentistry Campbell Park Offices, ACT LTCOL Kittie Dugan This year saw the Directorate farewell three quarters of our staff and welcome half a new Director into the fold (the other half of CAPT Byrne arrived 6 months later, after he stopped having to double as Director Joint Health Support Agency). We farewelled SQNLDR Andrew Draper when he posted to RAAF Amberley in December 2008. We farewelled COL Steve Curry in February 2009 when he departed after 33 years of service to well-earned retirement. COL Curry now returns to Campbell Park one day a week as a Reservist at the Directorate of Health Material Logistics and Pharmacy. CAPT Brendan Byrne, RAN was ‘handed the weight’ (in Navy parlance) as DDFD in February. After 6 years in the general health arena, he has relished coming back to the dental fold, even if he has only one staff member to boss around. We farewelled WODEN Shaye Metcalf in April 2009 as she left for LSL after 20 years of service, before discharging in August. WO Metcalf returns to DDFD as a reservist (via DREAMS) 3 days a week. CPL Liza Wynen took discharge from ARA in July 2009 and is now working for DDFD one day a week as a Reservist. She is valiantly helping to clear the mountainous backlog of administration. LTCOL Kittie Lai married her life-love, CMDR David Dugan, RAN in August and changed her surname, in a vain attempt to hide from the deluge of incoming emails and phone messages.

facility may be more than just a pipe dream. We are also looking after the dependency at the new HQJOC at Bungendore, a recent addition to our patient dependency. The road conditions between Canberra and Bungendore remain trying, requiring significant allowance for added travel time. Our staff are all civilian contractors, except for visiting specialists LTCOL (retired) Bruce Peet (oral surgeon) and COL Geoff Stacey (prosthodontist). The dentists at Duntroon are Dr Sonja Kuehl, Dr Jaafar Tehrenian, Dr Sue Worboys, Dr Rick Worboys, and Dr Serge Chan. We have only one hygienist, Miss Sarah Tang. Our DAs are Miss Kimberly Hawkins, Miss Amanda Smith, Mrs Liza Brew, Mrs Jillian Paff-Hayes, and Mrs Annie Martin. Our SDA is Miss Emma White. We have a new Practice Manager this year, Miss Audrey Gildea. Mr Peter Quintus-Bosz looks after our laboratory requirements and also our social calendar - both are very important jobs. We enjoyed a great Hawaiian theme night dinner cruise on the lake earlier this year. Ms Bonnie Fawell has moved on to become the Allied Health Manager and 2IC of Duntroon Health Facility but she is never far away and is always willing to help out when needed back at her old stomping ground.

The Directorate continues to consult closely with representatives of all three Services, senior specialists and dental officers, and the ADF Dental School. We wish to thank CMDR Brazier, COL Stacey, COL Curry, COL Scott, LTCOL Atkins, CAPT Jacobsen, WO1 Chiesa, GPCAPT Mahoney, WGCDR Cordery, and WOFF Brennan for their excellent support and advice. We all wish you a safe and joyful Christmas and a happy and productive New Year.

Duntroon and Russell Health Centres – Dental Canberra, ACT It is time again to report on what has been happening in the dental world of Canberra. At Duntroon, we have just finished with the RMC inductions where we saw 120 cadets on 13th July for exams, x-rays and mouthguards. It was a great day, very busy, but a highly successful outcome. We do our best within the space constraints at Duntroon and at Russell, however, we hear that a new combined

CADMUS 2009

The dentists at Russell are Dr Marc Brady, Dr Denisa Tutunaru, Dr Alex Warnakula, and Dr Rabeeh Bahrampourian. Our hygienists are Miss Claire Long, Mrs Shaughna O’Sullivan, and Miss Mel Wilson. Our DAs are Miss Kylie Malone, Miss Rebecca Wallert, Mrs Briony Kirby, and Mrs Kelly Skilton. Mrs Christine Fysh is our Practice Manager. Despite the staff changes this year, we have continued to deliver quality dental services to all our members. From everyone at the Duntroon and Russell Dental Departments, we wish you all a successful and happy year ahead.

Royal Australian Navy Dental Branch

Fleet News LCDR Phil Ma, RAN, Fleet Dental Surgeon

As always, there has been a high demand from Fleet units for Fleet Dental to provide dental services ashore and on deployments. Please take some time to read the reports from the Fleet Dental Teams; they showcase the varied life experiences during sea deployments. I encourage anyone who wishes to make the most of their time within the RAN Dental branch to aspire towards the goal of joining Fleet Dental.

Finally, I congratulate LEUT Pope on his acceptance into the speciality endodontics training program in Melbourne. Welcome to LEUT Simon Flanagan, LSDENSDAP Tanya Boge, ABDEN2 Christie Woodleigh and ABDEN2 Katie McDonald-Walker, who will all be joining Fleet Dental in 2010.

Dental fitness rates for all Fleet units remained high throughout the year, with an average of over 90%. The introduction of the Deferral of Dental Treatment system in 2006 has proven to be very functional and widely accepted in the Fleet, and maintenance of dental Individual Readiness (IR) by individual Fleet units has been more standardised. The Fleet Dental Teams have produced outstanding work both ashore and at sea. Credit must also be given to the personnel at the various shore establishments - without their support Fleet Dental would not have been able to provide a high level of service.

Dental Department HMAS SUCCESS

There have been a significant number of staff changes at Fleet Dental. LCDR Pat Caldwell has left the Permanent Naval Force to live the high life as an Endodontist. However, as the saying goes: ‘you can take the person out of the Navy, but you can’t take the Navy out of the person’. Pat returned in May to provide three weeks of reserve time. PODENS Alicia Hills was promoted earlier in the year and has taken over from PODENS Scott Norbury as the Fleet Dental Petty Officer. PO Norbury was posted to HMAS CERBERUS as the Senior Dental Assistant Preventive (SDAP) instructor. LCDR Dan Allan has taken over my previous posting on HMAS SUCCESS. In addition LSDEN2 Nicole Walker has replaced LSDEN2 Heather Flannery as DA onboard SUCCESS. LEUT Oliver Pope, LEUT Tom Yong, LSDEN2 Amanda Cox, ABDEN2 Rachelle Johnson and ABDEN2 Magdalena Cree have all posted to the Fleet Mobile Dental Team (FMDT) units. A ‘very well done’ to AB Johnson who, after 22 years of living in Australia, has finally seen and experienced another part of the world, i.e. has travelled overseas! I was fortunate enough to deploy in HMAS MANOORA for her ‘up top’ trip together with AB Johnson and SMNDEN1 Tevita ‘David’ Kama, who was onboard as a ‘Life Experience at Sea’ sailor. Being at sea again brought back many unforgettable memories and experiences - none of the excitement had gone out of it. All past and present members of Fleet Dental will confirm that a posting to Fleet is one of the most rewarding and an unforgettable Navy experience. Being part of a ship’s company at sea, deploying on operations and exercises, providing humanitarian assistance, seeing different places of the world and experiencing their sights and culture with shipmates, are memories that will always be treasured. CADMUS 2009

LSDEN2 Nicole Walker The Changing of the Guard. This year on HMAS SUCCESS saw a change-out of the entire sickbay staff with LCDR Allan joining in December 2008 to take over the reins from LCDR Ma, and LS Walker posting in January 2009 to replace LS Flannery. This year has once again been a busy year for SUCCESS, starting with the Fleet Concentration Period, followed by the Fleet review in Sydney Harbour and the Freedom of Entry through the streets of Sydney. It was then time to head off on a 3-month South East Asian deployment. First up was a quick overnight stop in Darwin, before SUCCESS headed to Manila, where they spent Easter in one of the most catholic countries in the world. Here LCDR Allan attended the re-enactment of the crucifixion and tasted the ‘cultural’ delights, while LS Walker visited the ‘must see’ attractions found in the world famous Hobbit House bar. The Ship then headed to Qingdao, China to take part in the International Fleet Review, to celebrate the 60th anniversary of the Chinese Navy. This port visit coincided with ANZAC Day where SUCCESS, PIRIE and HMNZ Ships ENDEAVOUR and TE MANA conducted a joint ceremony that included a stirring ‘haka’ as the sun rose. We also had a guest visit from LCDR Caldwell who enjoyed the world famous Tsingtao Beer that is brewed in Qingdao. Whilst there, we were able to go on a 2-day tour of Beijing to see the sights. It was an early start to fly out of Qingdao but the opportunity to visit the Great Wall of China, the Forbidden City, Tiananmen Square and the Temple of Heaven was an opportunity not to be missed. It was an amazing feeling being able to climb the Great Wall and only in retrospect do you really consider how long it has stood and the amount of work that must have gone into building it thousands of years ago. The next port of call was Hong Kong for some well earned rest and a lot of shopping, before heading to Singapore for a small maintenance period and taking part in Exercise BERSAMA SHIELD. After the exercise we spent some more time in Singapore,

seeing the sites and of course more shopping. We were also told that the Ship had been re-tasked and instead of heading home via Adelaide, we were now heading to Darwin to collect stores before commencing Operation RESOLUTE. The involvement of SUCCESS in Operation RESOLUTE turned out to be the shortest operation ever with the ‘in-chop’ and ‘out-chop’ happening on the same day because the Ship was ordered back to Sydney.

jackstay from ship-to-ship whilst underway). Unfortunately, AB Johnson was not able to participate in the Ship’s Flight Deck Team but maintained her Ship’s Medical Emergency Team (SMET) skills during the exercises. The Flight Commander ‘FLYCO’ of KANIMBLA was very interested in the day to day running of a FMDT onboard – and he frequently visited the pathology laboratory where he ‘posed as dentist for a day’. In exchange, FMDT were treated to SK50 Sea King Helicopter flights over the stunning north ‘Bay of Many Islands’. Other memorable moments of the transit included steel-deck BBQ and regular deliveries of Tim Tams ‘worth their weight in gold at sea’. The entire ship power outage did not stop LEUT Pope from working. His fibre optic light source provided our only light! Chocolate eggs delivered by the cooks for Easter were hypocritically welcomed by the dental team.

After two weeks at home that went by too quickly, it was time to head out again in company with HMAS TOBRUK to take part in Exercise TALISMAN SABRE 2009. The exercise was a busy time for the Ship’s company with lots of Replenishment at Sea evolutions with the US and Australian Ships. The Dental Department worked hard to ensure the dental fitness of ship’s personnel for the upcoming deployment. We will arrive home soon for another quick break and make preparations for our next deployment with port visits to Manado (Indonesia), Lammut (Malaysia), Singapore, and Tokyo and Kure (Japan). As the current Dental Assistant on SUCCESS, I recommend to all Leading Hands that they volunteer for a posting to SUCCESS, as I have found it to be a fulfilling and fun posting.

FLEET MOBILE DENTAL TEAM ONE LEUT Oliver Pope, RAN and ABDEN2 Rachelle Johnson A New Zealand Experience. On 16th March 2009, FMDT1 embarked in HMAS KANIMBLA at Fleet Base East. The aims of this New Zealand deployment were to train junior personnel and to foster diplomatic relations. Upon stepping aboard KANIMBLA, there was an air of excitement, as this deployment was viewed by the crew as a reward for the operational stresses endured by the Ship in the previous year. Dental was set up in the pathology laboratory 2 decks below with cold temperatures where AB Johnson felt very much at home! Ship’s dental fitness and IR compliance rates were low. With only a 4-week deployment to improve the dental IR of the ship’s company, the team worked long and hard from day one. The obvious pay-off was the extended 3-4 day port visits of North Island cities: New Plymouth, Napier and Wellington. Accompanying KANIMBLA across the ‘ditch’ was HMNZS CANTERBURY. AB Johnson had the opportunity to test her line work when she participated in multiple ‘Replenishment at Sea’ exercises (an evolution whereby stores are transferred by heavy

AB Johnson in a SK50 Sea King Whilst treating the Commanding Officer, LEUT Pope rather foolishly suggested that ‘driving a warship cannot be that hard’. Within an hour, ‘Fangs’ was called to the bridge and given the helm of the ship. LEUT Pope was soon relieved of his command after completing a tight figure-of-eight and several doughnuts. Needless to say the Dental Officer will never be given the helm again! Highlights of the port visits included a weekend in Rotorua – home of the hot thermal springs. Although featured on Getaway numerous times as a great tourist destination, the smell was never mentioned! A day trip to Taupo saw the largest lake in the world, mountains from Lord of the Rings, various adventure sports (bungy jump, abseiling, slingshot, white water rafting) and a Hawke’s Bay winery tour in a priceless 1928 Rolls Royce Phantom. Unfortunately the 4-day port visit to Wellington was cut short. KANIMBLA had an 8-hour stop over in Wellington in order to conduct a cocktail party for diplomats, NZ Defence Force personnel and invited guests. The Ship then departed Wellington for Fleet Base East. After 4 weeks onboard, FMDT1 were able to improve the Ship’s dental IR to above 90% and take what felt like a never-ending quantity of bite-wing radiographs, all processed in a manual developer. A memorable trip was had by all with the Team taking the “work hard, play hard” motto very seriously.

FLEET MOBILE DENTAL TEAM TWO ABDEN2 Rachelle Johnson A long way from Penguin, Tasmania. On 12th May 2009 LCDR Ma and AB Johnson deployed in HMAS MANOORA for a 3-month

CADMUS 2009

South East Asia ‘up top’ deployment. We were lucky enough to have SMN Kama onboard, who experienced his first time at sea on a Life Experience at Sea program (LASEX). We set up in the pathology laboratory where we worked in almost 30°C temperature for 3 weeks, until our air conditioner finally arrived. Having grown up in a small town called Penguin in Tasmania, I was not accustomed to the beginning of the warm weather that was to come. . . Our first port of call was an 8-hour stopover at Weipa, Queensland where a tank deck full of Army vehicles was offloaded. From here the ship sailed for a 4-day stopover in Darwin where the ship conducted her Mission Readiness Evaluation. This tested the ship’s skills against bomb, wharf and waterborne threats, which enabled MANOORA to carry out operations overseas. MANOORA then sailed for Kota Kinabalu in Malaysia for a 4-day port visit, where we got to live like kings. I lounged on the beach and enjoyed snorkelling off Manakit Island in the clearest waters I have ever seen. Also during this time, MANOORA prepared herself to conduct Exercise COMMANDO RAJAH 2009 with the Royal Navy Marine Commandos. There were over 120 Royal Marines embarked in the ship via stern door marriages and flying evolutions. This was a great opportunity for LCDR Ma and I to escape our dental den and participate in the aviation operations.

LCDR Ma – dive exercise

LCDR Ma was able to make his 12th Operation RESOLUTE trip after the ship was re-tasked from Exercise TALISMAN SABRE 2009. This included more port visits to Darwin. Since leaving Tasmania, I have now been to Darwin more times than any other place in Australia. The ever changing Fleet Activity Schedule (FAS) saw MANOORA re-tasked back to Exercise TALISMAN SABRE 2009 during Operation RESOLUTE where over 250 Army troops from 3RAR embarked in Townsville. A very busy 10 days during this exercise saw many flying serials and stern door marriages conducted to disembark troops ashore. After 3 months onboard, dental fitness and IR compliance rates were above 99%, delivering on our motto of ‘Fit to Bite, Fit to Fight’.

SMN Kama – in Lynx The next port of call for MANOORA was Singapore, the gateway to South East Asia. Singapore Slings, the Great Singapore Sale and the legendary Singapore Zoo were the highlights of my 5-day visit, where I rode an elephant for the first time. Organised sport with the local clubs was also popular amongst the ship’s company, with SMN Kama participating in the rugby team but MANOORA being flogged 45-5. I participated in the women’s netball team and alas, we were also defeated by 7 goals in the >30°C heat. LCDR Ma enjoyed his time in Singapore, paying a ritual visit to the Orchard Towers and purchasing new horology artefacts. Next stop for MANOORA was Exercise NEW HORIZON 2009, which marked a goodwill visit to Surabaya, Indonesia. This was a significant event as it was the first time in 10 years, that an Australian warship had visited an Indonesian Port. It was here that I was able to visit KRI dr. SOEHARSO, the Indonesian Navy hospital ship, which is only 2 years old. Their dental surgery was very spacious and very new. Our tour guides were out to impress us by showcasing their badminton court on the flight deck and their sit-down morning tea in the Ballroom. Unfortunately due to security threats, the Ship’s company were not allowed to leave the secure wharf area. CADMUS 2009

Highlights of the deployment included: SMN Kama on the lookout for the ‘Equator Buoys’ and eager to participate in the Great Malaysian Tiger Hunt, both of which were of course myths to new sailors onboard. Countless swim exercises, steel deck BBQs, fishing stations, seafood buffets and the Crossing of the Line Ceremony, were some of the great experiences and traditions of life at sea. Elephant riding, snake handling, experiencing the different culture and cuisines have all made me yearn for more overseas travel. Hailing from a small seaside town on the North West Coast of Tasmania, I have definitely had my horizons broadened! Although there have only been 2 deployments thus far, I consider myself incredibly lucky to have embarked in both sister Ships KANIMBLA and MANOORA with LEUT Pope and LCDR Ma. The opportunities I have been given so soon after joining the Navy Dental Branch have made it a memorable experience. I look forward to one day serving on the Landing Helicopter Dock (LHD) ships when they eventually come on line in the RAN.

FLEET MOBILE DENTAL TEAM THREE LSDEN2 Nicole Walker and LSDEN2 Amanda Cox This year saw many changes for FMDT3. LEUT Yong took over the billet from LEUT Katherine Bailey and LS Walker filled in for ABDEN2 Phillippa Denholm whilst she completed the Senior Dental Preventive Course. LS Walker has since been posted to HMAS SUCCESS and LS Cox has posted in.

FMDT3 deployed on HMAS TOOWOOMBA for a period of 3 months in August 2008. It was a busy time with the first deployment being Operation RESOLUTE. The Ship held lots of events to keep the crew busy whilst on RESOLUTE which included BBQ on the flight deck followed by trivia nights, sporting events and a ‘Miss Toowoomba’ competition. The Ship then headed overseas to take part in a multinational Fleet Review in South Korea. This was a memorable occasion for LEUT Yong and LS Walker as they had never taken part in an event that involved ships from all over the world.

around 43°C. The most impressive view from the harbour was of the old fort atop the hill. It’s no great secret that we love our PT here in the West so LEUT Yong and LS Cox have been keeping up with the sporting tradition and playing a game or two of squash each week. Luckily I appreciate that it’s not about winning, losing or even how you play the game, it is about consistency. I have consistently lost every game I have ever played and (sadly) I don’t think anything will spoil my untainted losing streak. This year FMDT3 placed an entry in the first ever Bake-Off Competition at Fleet Base West Health Centre. Our entry was a ship-side-grey Pirate Ship flying a FMDT3 flag, with the judges, CMDRs David Dugan and David Parry, walking the plank. We took out 1st place in the most creative category and won a medal and a bottle of wine for our efforts.

LEUT Yong - ‘Crossing the Line’ During this deployment they were many ports visited which included Darwin, Christmas Island, Ashmore Island, Broome, Pusan and Singapore. This was also the first time LEUT Yong and LS Walker crossed the equator at sea and took part in the naval tradition of a ‘Crossing the Line’ Ceremony. This year has been a busy year for FMDT3. The first half of the year has kept the FMDT3 and Fleet Base West dentists extremely busy by undertaking ADE (a total of 562!) for ships and submarines and the subsequent dental treatment to maintain IR for operational deployability. The latter half of the year saw FMDT3 join HMAS WARRAMUNGA for their return journey home from the Gulf via Oman and Phuket. AB McDonald-Walker undertook her first deployment as part of the Fleet Dental Team. Oman was a great port visit. The only down side was the heat with a daily temperature

FMDT3 – Health Centre Bake Off We are looking forward to ending our year as we began and ensuring that the west-based Fleet Dental Team is in date, dentally deployable and ready for a busy schedule in 2010.

Oman Fort

CADMUS 2009

Royal Australian Navy Dental Branch

Unit News Fleet Base East Dental Department HMAS KUTTABUL

Fleet Base West Dental Department HMAS STIRLING LSDENSDAP Jade Van Haeff

HMAS KUTTABUL Dental department is not a place one would choose to pop in for a quick yarn over a brew, not unless of course you have a strong back and you are ready for work. The hectic buzz of the department only dulls to a pleasant silence come 1631h Monday to Friday. All 6 surgeries are in full swing with up to 21 patients sitting in each chair each day, with both contracted and military DAs jostling to maintain maximum efficiency and the best service to an extremely busy Defence Force. The day begins with a staff meeting (aka lightning rounds) when staff discuss the patient cases and events for the day. This is the time when we plan our day and find out updates such as the dental fitness of KUTTABUL is at 91%. Some of the processes we participate in to improve our service delivery include a weekly meeting of our Senior Dental Assistants Preventive (SDAP) to discuss improvements and review efficiencies in the hygiene world, and the establishment of the Sydney Area Infection Control Committee which is formalising processes and continually elevating standards. We enjoy 2 departmental PT hours a week and the department is about to start a 7-week fitness challenge which should have us in peak condition for summer. In the year 2009, KUTTABUL experienced a number of highlights. We have seen a visit from the Spanish Royal family, the Queen Mary II berthed alongside our wharf, the many addresses from the Chief of Navy to his sailors and officers, and an amazing Freedom of Entry march by all of our east-based sailors and officers. KUTTABUL donned our best dress on two of these occasions. We were in our whites for the massive Freedom of Entry march through the streets of Sydney during Navy Week. The Freedom of Entry was the biggest showing of the Naval Force in Sydney since WWII. The other occasion was for the time-honoured tradition of ANZAC Day. The Dental Department marched under the Joint Services Dental Banner and it was a great day to catch up with many familiar faces. The arrival of Queen Mary II into Sydney was a particular high point. It truly is one of the most amazing examples of modern maritime architecture and luxury (at $300,000 for a ride). We also had another view blocker visit our base - the new New Zealand warship HMNZS CANTERBURY. We really do have some of the best views from our naval bases in Sydney. It is just the place we can’t wait to get out of bed and get to each morning. Got to love that Sydney traffic! Here is to another day living the dream.

CADMUS 2009

Front (L-R): LS Cox, CPO Briers, LEUT Doyle, CMDR Dugan, LCDR Cicchini, LEUT Yong, PO Watkins. Rear: Ms Grove, AB Barbour, Mrs Crick, LS De Lange, Ms Smith, LS Van Haeff, AB Burr, AB Skinner, Ms Grainger. At HMAS STIRLING, we adhere to one of the Navy’s favourite sayings of ‘work hard, play hard’. With the ups and downs of people coming and going, we have used every minute wisely, whether for work or play. The end of 2008 meant the end of time here for our fantastic practice manager CPODENM Penny Stone and Fleet liaison LSDEN2 Nicole Walker. LSDEN2 De Lange and I had to manage the department with the great help of our newest member LSDEN2 Amanda Cox. I was the practice manager until the new Chief-to-be PODENS Craig Watkins stepped in and relieved me of my duties, so I could return to the surgery as a SDAP. Another newcomer was SMNDEN1 Vanessa Gamble, who returned after doing work experience as a General Entry Sailor in 2008 and we are even happier to have her back this year as a qualified DA. As our numbers increased, we were reaching all new highs with our dental statistics and then came the sad news that we would lose our SDO and his Deputy. The semi-tropical island of STIRLING was not enough for LCDR Maria Cicchini, so armed with her crocodile repellent and umbrella, she headed to Darwin on posting to COONAWARRA. Good luck Ma’am.

It wasn’t the weather that affected CMDR David Dugan. He was more after the ladies… well one in particular. CMDR Dugan is moving on to bigger and better things, moving to the east coast to get married. Our congratulations to you and your lovely lady! We will miss your personality and the fun we had in redecorating you office. We had so much fun on your mystery adventure tour (the going away fun day), we are all looking forward to more laughs at your farewell Teppanyaki-Karaoke dinner (Funky Cold Medina).

trained LCDR Cicchini to practice her superb baking for us, ending her time here with a great banquet of scones, curry puffs, cheese cake and various other delicious appetisers. The rest of 2009 looks like the craziness will continue. We are very busy continuing with our high standard of dental care, community childcare interaction talks and keeping our statistics well above 90%. With the Fleet team away on HMAS WARRAMUNGA and only 2 dental officers here, we are looking forward to the arrival of LEUT Sarah Benton and LEUT Sally Cochrane in early July on completion of NEOC.

HMAS CERBERUS Dental Department ABDENSDAP Pippa Denholm Greetings from sunny CERBERUS, home of the sailor, 1500 recruits down, another 500 to go and we are all still smiling. Let’s start with hails and farewells for 2009. This year has seen the most military staff in the department since 2004. Hail to LEUT Shannon Godfrey, ABDENSDAP Phillippa ‘Pippa’ Denholm, SMNDEN1 Melissa Webb and SMNDEN1 Melissa Lavelle. In addition, we welcome our new receptionist, Mrs Libby McCormick and new DA, Ms Kathryn Williams. We say a sad farewell to Mrs Trish Johnston who crossed over to work in the Medical Department and to a very well liked Tash Crawford, who has left us to tour the UK. Redecorations of CMDR Dugan’s office With numbers always changing we went on a mission to increase our clan so we had enough people for a soccer team rather than just a badminton team. So with a little help from an old dental friend we worked hard to combine medical and dental to one health team. With the increase in numbers and strength we were able to ease off the working side of things and had more time to play. We introduced weekly health centre PT, monthly divisional meetings and adventure training. Adventure training was a blast with 18 of us heading down south for 5 days of fun and adventure, though I was a little worried with the pounding rain on our never-ending hike and the usual array of camp fire games. Luckily the weather held out and the next few days of kayaking, abseiling and caving made up for it, although some thought it would be their last adventure when hanging off the edge of a 45-metre cliff. This year has seen an increased workload with the dental statistics rising above 90%. The entire department has made a fantastic effort to achieve this, with the additional incentive of a cheesecake from Management. Here at CERBERUS you might think we are all work! work! work! and no play, but in the last 12 months, the Health Centre CERBERUS have been on several team-building days. One occasion saw one of our dentists getting lost in the bush at Coolart Wetlands in the rain and cold for quite some time. We have also participated in ten-pin bowling and next up is a laser skirmish.

Our super health team didn’t stop there; we have been enjoying frequent BBQ, lunches and one huge Bake-Off which as previously mentioned, was won by our friendly Fleet team. We have even

At the end of last year CERBERUS held a fun day in which dental and medical joined forces and became the MENTALS. This day consisted of the MENTALS running around base in medical scrubs and Santa hats participating in a multitude of activities including lawn bowls competition, volleyball, shooting hoops and pulling a dinghy around the base. Unfortunately, we do not seem to have a photo of this event, or not one that anyone is admitting to having. CERBERUS has also participated in the Dental Health Week, which is run through the ADA. This involved great competitions

CADMUS 2009

including how many floss in a jar, a quiz and putting teeth models in order of age - ranging from early children through to late 40s. Some of the prizes included electric toothbrushes, T-Shirts, razor kits, and gift vouchers. Thanks to Colgate, Oral B, CReST, and all the local business that contributed prizes. Other department events that have occurred throughout 2008/2009 include ‘MoVember’, where Dr Johnstone allowed one of the DA to style his newly acquired goatee. All monies raised went to prostate cancer research. In March, Dr Smith’s suggestion of taking part in Harmony Day was a great success. Respecting each other’s cultures allowed us all to try native dishes from Sri Lanka to New Zealand. We have had an exciting year and look forward to what 2010 has in store.

HMAS ALBATROSS Dental Department LSDENSDAP Tanya Boge As tax time rolls around again so do the submissions for Cadmus and it’s time to reflect on the year that was at HMAS ALBATROSS - home of the Fleet air arm. LCDR Kim Leong still holds the fort as SDO, for her third year, and we remain dedicated to the oral health of Defence Personnel within the Shoalhaven. The department encourages preventive dentistry with treatments such as fluoride application, oral hygiene instruction and mouth guards always available. We do not have a full laboratory but we do have the facilities to make our own mouth guards and special trays in-house saving us money and time, compared to the other jobs sent out to external laboratories. It also provides an extra skill for our staff to have under their belts. We have continued training sessions run by our dedicated contract dentists, Dr Eugene Le Breton and Dr Lieve Stassen, which keep our skills current. Our department consists of 3 dentists, 1 practice manager, 2 SDAP, 1 SDA, 3 DA and 5 contract support staff. Without the tireless support from our contractors our department would not run as efficiently and smoothly as it continues to do on a daily basis. We provide treatment for the ships’ companies of ALBATROSS and CRESWELL and their residential units including the Wollongong Hydrographic Surveyor Office and the ARA Parachute Training School (PTS). We see 2 intakes of officers on the New Entry Officer Course (NEOC) each year. This is a busy time within the department as initial examinations for all new officers, followed by treatment are carried out during the second week of NEOC at CRESWELL, with one class seen per day. Treatment that cannot be finalized on that day will be followed up at CRESWELL during their course. LCDR Leong and AB Lantry travel down to Jervis Bay once a week to provide this treatment. Thanks to LEUT Oliver Pope for travelling a long way to ALBATROSS from FBE Dental to provide us with an extra set of hands during this time. LEUT Simon Flanagan also helped us out during the year for 2 weeks whilst LCDR Leong attended civil schooling.

enjoyed her time at sea and is off on her SDA course at the end of this year to advance her skills and knowledge. SMNDEN1 (now ABDEN2) Lisa Jansen was awarded a Ship’s Warrant Officer award for her outstanding commitment to ship’s welfare. Lisa spent tireless hours in her kitchen baking delicious cakes for us all raising money to be donated to the ship’s fund. Sadly Lisa posted out in January 2009 to join HMAS WATSON and the department’s waistlines have shrunk back into shape! In February we said farewell to LEUT Belinda Martin our Divisional Officer (DO). LEUT Martin discharged after 4 plus years of service to join her husband in the USA. LEUT Kathy Videon (MAO) took over as the sailors’ DO and provides continued support to us all from her office in the building next door within the Medical Centre. February also saw the arrival of LSDENSDAP Tanya Boge. With her passion for dental hygiene, friendly nature and fetish for laminating almost everything she sees in different colours, she has brought a bright ambience to the department. April was a busy month for us all. ABDEN1 Charni Groves and ABDEN1 Lanie Boer competed fiercely in the 5km Albatross Fun Run, which saw them take-out 1st and 3rd respectfully. Well done girls! Charni also became engaged to her partner Mitch and we congratulate them both. ALBATROSS Dental participated in this year’s ANZAC Day march through the streets of Kiama. LS Boge led the Catafalque Party with AB Boer and AB Lantry in tow as part of the guard. The moving service was short lived for AB Lantry as she went down on one knee. She watched the remainder of the service in the back stalls under medical surveillance! LSDENSDAP Katrina Hetherington returned off maternity leave and has rejoined the team for 3 days a week. May 2009 saw the arrival of CPODENM Ken Swinbourn into the practice manager position. This billet has not been filled by a senior sailor in more than 3 years. So we all welcomed Chief with open arms - especially our SDO! It was perfect timing to step into the madness and mayhem that has been brought to our department with our current renovation. The upgrade of our change rooms, central sterilizing room and laboratory areas has given the department a new coat of paint, which was well overdue. Construction is still going on and the builders and painters are almost now part of the furniture! We’re in the process of ironing out a few issues and hopefully once they are sorted we’ll have a fully functioning department back once again. ALBATROSS is the perfect base to gain those extra courses you require without causing too much disruption and absence from the department. Training Authority - Aviation (TA-AVN) has supported LS Boge throughout the year in completing her workplace assessor course, internal auditor course and hazardous

ABDEN2 Chris Fehrenbach joined the department in November 2008 as our SDA. Chris has settled in nicely to the relaxed lifestyle in Nowra and has been enjoying the change of pace from Sydney. Chris was the latest volunteer for a 6-week stint in our Station Colour Guard. He also volunteered to shave his head in ‘Shave for a Cure’ raising almost $500 for Leukemia research. We encouraged him to make it a double header and shave both his head and beard off, but wife Fiona said it’s the head or the highway! At the end of 2008, ABDEN1 Jess Lantry landed a trip away on LASEX (Life at Sea Experience) on TOBRUK and SUCCESS. She thoroughly CADMUS 2009

substances safety officer course. She is currently putting her newly acquired skills to practice within the department by assessing the junior sailors and signing off competency log books, conducting an internal audit of the central sterilizing room, and updating the MSDS and hazardous substance registers with the use of Chemalert. LS Boge, AB Groves, AB Lantry and AB Boer also have had the opportunity to skydive this year with the PTS. After the nerves on the way up and then the screams on the way down, you couldn’t wipe the excitement and smiles off our faces after we had jumped! ALBATROSS is a great posting, set in beautiful surrounds and we definitely don’t deny ourselves the perks of working in the military.

HMAS CAIRNS Dental Department LSDEN2 Heather Flannery HMAS CAIRNS has undergone some major renovations with a $76m face lift, including a new gym and proper car park, a new command centre, a health centre and FSU buildings, which were completed in June 2009. This year the Dental Department was able to get a contracted dentist, Dr Shane Hearps, who has taken a year of LWOP from QLD Health, and coincidently, he is also an Army Reserve Captain dental officer. LSDEN2 Heather Flannery came up here from HMAS SUCCESS and LSDENSDAP Emma Sills headed down to HMAS KUTTABUL. Since the beginning of the year it’s been all work and hardly any play, as CAIRNS has been without a dentist for so long, there was a massive back log of work to catch up on. Due to the lack of dentists and specialists in far north QLD, most of the members have gone without, until now. With Shane’s experience working in the remote communities further up north, we are now tackling jobs that would have previously been referred out. Our lovely PODENS Tracey Morris was helping out on reserve days with hygiene work and administration, but unfortunately that was only until June. We’re hoping that we can get more reserve days for her soon, as she is greatly missed. In September the Health Centre, along with other members of the base, will be taking part in the annual Cairns-to-Cooktown Cardiac Challenge bike ride. This bike ride is 335km and is to help raise money for the local cardiac unit in Cairns. So currently we are all crazily training for that. That’s all from up here!

HMAS COONAWARRA Dental Department LCDR Maria Cicchini, RAN, LSDENSDAP Greg Pashen and Ms Malita McCabe With time flying by, we are now well into 2009. The dry season is a welcome change from the sticky hot wet, although it does have its own appeal. Darwin crams most of the year’s social events into this 2½-month period of the dry season, so it’s a very popular time to be in the ‘Top End’. Since we last wrote, LEUT Johnathan Grove has moved onto greener pastures, having been accepted into Orthodontics training in September 2008. We already miss his vibrant personality around the department. LCDR Maria Cicchini flew in for the month of November to help maintain our dental fitness. Then for the remainder of the year, with no dentist on site, we provided support to 1CSSB before heading off on leave.

While we awaited confirmation of a full-time dentist joining us in the New Year, we relied on the Air Force and Army to help with emergency treatment. Area Health Service Darwin came to our rescue in early February and supplied us with a CHP dentist, Dr Robert Hosking, for 4 days per week. Malita worked out at 1CSSB 1 day a week and I was on call to help out as needed. Dr Hosking stayed with us until the arrival of our new SDO, LCDR Cicchini, in mid-June 2009. Since her arrival we have been very busy with a lot of Defence business and activities such as the KPMG report, White Paper brief, a visit by the CN, a Freedom of Entry march through the CBD of Darwin, and the Navy Open Day, marking the start of Navy Week. With the proposed sale of Defence Establishment Berrimah, we have entered into meetings regarding where the Dental Department will be relocated. One option is to merge with RAAF Darwin Dental Flight, although space is proving to be a big issue. Another possible option is to move in with the Medical Department at Larrakeyah Barracks, as the Medical Centre may be housed in purpose-built demountables in the interim until a new health facility is completed. We favour the latter option as the way ahead, because we believe this will facilitate best service delivery to our patients, but relocation involves myriad considerations, so time will tell. As you can see, we are keeping ourselves very busy in the ‘Top End’. We wish you all the best for the rest of the year and look forward to reading about you in Cadmus.

HMAS PENGUIN Dental Department ABDEN2 Michael Hatzivalsamis HMAS PENGUIN supports Navy operations through hosting the RAN Diving, Hydrographic and Medical Training Schools. They in turn draw on the support provided by PENGUIN Health Centre, Submarine and Underwater Medicine Unit and the Recompression Chamber facility. PENGUIN Health Centre remains the Navy’s primary medical facility, and utilises a ward at St Vincent’s Public Hospital, aptly named ‘Navy Ward’. The Navy Ward provides primary medical care to military personnel across the wider Sydney area. The PENGUIN Dental Department is situated on the ground floor of the Health Centre. HMAS PENGUIN is also home to many sailors. It provides accommodation and messing facilities for all ranks and can accommodate more than 300 people in the Junior Sailors’ Mess, Senior Sailors’ Mess and Wardroom. PENGUIN Dental is a minor dental unit managed by the SDO, who is responsible to the Medical Officer-in-Charge (MOIC) for the dental management of HMAS PENGUIN members, those referred from outside establishments and pre/post operative cases. The current SDO is Dr Amanda Sullivan. She joined Penguin in late 2008 and is working part-time as a CHP. Around that time, PENGUIN Health Centre was under refurbishment and Dr Sullivan and I were working from one of the surgeries of WATERHEN Dental. We moved back into PENGUIN Health Centre in mid-April 2009. Ever since Dr Sullivan came aboard we have been able to run a solid and consistent routine, and that means we have been able to maintain a high percentage of dental fitness. PENGUIN Dental is responsible for about 300 military personnel including the RAN Diving Branch and the Army Dive Wing from 1 Commando Company (1 CDO COY). 1 CDO COY have a high operational readiness requirement and frequently require flexible working hours due to (very) short notice for deployments.

CADMUS 2009

It is certainly a challenge running this department. Being the only DA here, I have many responsibilities. My role here is very similar to the role of a Fleet traveling DA. Dr Sullivan and I work closely together to run an efficient schedule to keep our members dentally fit and ready to deploy. I have been working here now for just over 2 years, and I look forward to continuing to provide top quality dental care here at PENGUIN.

HMAS WATERHEN Dental Department LEUT Elizabeth Close, RAN, and ABDEN2 Christie Woodleigh July 2009 marked nearly one year since I posted into HMAS WATERHEN and it has been a busy and enjoyable 12 months. WATERHEN, tucked away on the north shore of Sydney harbour, was a change of pace from the big practice at HMAS KUTTABUL, but has provided plenty of challenges. WATERHEN caters for about 650 patients, including clearance divers and personnel from the Mine Warfare FEG and Huon Class Minehunter boats. I took over the position from LCDR Kate Galloway, who was proceeding on discharge to sail around Australia with her family. ABDEN2 Mark Smith was on his second posting to WATERHEN and gave me great assistance in my first SDO position, until his promotion and subsequent posting in January. He was followed by ABDEN1 Elisha Larkin who did an excellent job filling in, until ABDEN2 Christie Woodleigh posted into the billet from her SDA course. AB Woodleigh has proved to be a great addition to the department and has been enthusiastically consolidating her clinical and administrative SDA skills. We were also joined in November by Dr Amanda Sullivan, who spends 1 day a week with us and 2 days at HMAS PENGUIN. The recent addition of our civilian DA Dani Delahunt, for an extra day a week, has further enhanced our capability allowing us to get (and keep) our KPI up and streamline some of the departmental administration. When I joined the department, our second (hygiene) dental surgery was being used by PENGUIN Dental, as their facilities were undergoing renovation. This was an enjoyable arrangement but did make our small department rather cosy. I think they were relieved to move back to Balmoral in April. As well as our clinical work, there are many other things going on at WATERHEN. We enjoy an excellent working relationship with the Medical Department and this has also provided some great social events, including our periodic breakfast meetings, a memorable Christmas party and various small ‘dinner and drinks’ occasions. We have been involved in 2 Freedom of Entry marches, a small local one and the large Sydney-wide event in March, and enjoyed catching up with the other Sydney bases for the Anzac Day celebrations. We have also managed to fit in some professional development, including a 2-week oral surgery course at the Sydney Dental Hospital and an upcoming department

training day with our medics at the PENGUIN Simulation Clinic. Our latest expedition is a WATERHEN ‘team building’ ski week which AB Woodleigh and I will attend in September. I have really enjoyed my time at WATERHEN so far and can definitely recommend this posting to anyone who enjoys working with a close team and experiencing the demands and rewards of a small but busy base.

HMAS WATSON Dental Department LEUT Katherine Bailey, RAN, and ABDEN2 Lisa Jansen At the time of writing this report, the foremost thought in the minds of this 2-(wo)man Dental Department of HMAS WATSON, is not the events of the past 7 months, but more the goings-on at the WATSON Ship’s Ball, held 2 days ago at the Star City Casino. More details of this wholesome event will no doubt come to light but I can confirm that the Dental Department does not seem to have suffered any long-term damage, in spite of the abundance of champagne and presence of a 42-piece Swing Band! We adhere to the adage that ‘what happens on tour stays on tour’. However, I can reveal that the dental department was definitely the life of this particular party – in a very tasteful and appropriate manner of course. This year the Dental Department has gone from a rather tumultuous period of tag-teaming, kept sane by the unflappable ABDEN2 Magdalena Cree, to a period of delightful regularity with the posting of ABDEN2 Lisa Jansen and LEUT Katherine Bailey into our compact base. Following a period of adjustment – spent largely coming to terms with working in a facility that could feature appropriately in the ‘Retro’ section of the Antiques Roadshow, with no two walls the same colour and ‘highly collectible’ airconditioning and chairs – the team settled down to the business of communicating with Seaman Officers. Preliminary results have been mixed and we are still coming to terms with the periodic XO rounds through our dental surgery. In our spare time between patients, sterilization, dental administration, laboratory work and being genuinely grateful that we chose the Dental Branch over Medical, we like to admire the million-dollar harbour view. Occasionally we may glimpse a whale or a really expensive yacht and fantasize about the concept of an ‘outdoor dental surgery’ – but only when the weather is particularly good. As this year draws to a close the base will see more changes in the dental staff line-up, with LEUT Bailey transferring to reserves to live in Canberra. AB Jansen will remain to hold the fort, with the ever-present Dr John Ashton for company. We have no doubt that the lessons learned by the team this year will be valuable in the year ahead.

CADMUS CADMUS 2009

ADVERTORIAL

Advanced Dental Laser Surgery Dr. Rudolf Walker, Dr. Gerd Volland, Germany

he laser application in dental surgery has become a standard tool for many dental clinics around the world. The instrumentation became less costly and more advanced. The use of a diode laser demonstrates many advantages compared to the scalpel, but as in life one has to deal with some disadvantages also. One of the main hurdles has been the price and the teaching about laser applications in dentistry. Fig. 1 Fox with sapphire knife (Jazz)

Fig. 2 Sapphire knife (side view).

The main advantages for the laser are the cutting effect on tissue at the same time tissue is removed and bleeding is almost stopped. By using the laser beam in the bare fiber mode one of the disadvantages is the temperature rise at the edges of the wound. Due to this effect the wound healing is prolonged in comparison to the standard scalpel cut. Those edges do show a carbonization zone, which is responsible for the prolonged healing time.

However to achieve proper cutting the surgeon has to apply enough leaser energy to cut and vaporize tissue. To overcome the prolonged healing the stitches have to be in the wound longer than it would be compared to the standard scalpel cuts.

and no cleaning of the wound is required during surgery. Higher visibility at the cuts and faster healing compared to the laser cuts are the results of this exiting invention. (Abb. 3 to 6) Using this knife during the last month we have demonstrated the superiority of this technique. The very first tests have been performed using a pork liver to research the cuts and look at the histology of the wound edges. The histology has proven that the edges do not show any major necroses zones. The cuts are clean with minimal demonstrations of heat been applied. To compare those cuts with the standard free beam laser cuts, one can immediately see the difference. The large necrosis zones with the laser are highly visible and therefore lead to the prolonged healing time, whereas the cuts with our new JAZZ are clean and almost comparable to the standard scalpel cuts. (Figs. 7 and 8) n For more information on the FOX Diode Laser or Jazz Sapphire Scalpel, contact: Paul Baltas Innovative Medical Technologies Pty Ltd 101 Atherton Road, Oakleigh VIC 3166 Australia Telephone: 1800 88 983 Fax: 03 9569 5549 Email: paulb@inmedtec.com

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Fig. 7

Fig. 8

With the electro cauter the edges of the wound are even more coagulated than with the laser beam. The wound healing does show the same effect like the laser cuts. The patient has the advantages of the laser cut, however has to accept the longer wound healing. To avoid all those disadvantages we have developed a scalpel which carries the laser energy from the diode laser to the sharp edges of this knife. This sapphire knife was developed in cooperation with surgeons working daily with this new technology now. As a producer of the FOX diode laser we have developed this knife to overcome the problems of the free beam laser and also the problem of cutting with the scalpel alone. (Fig. 1)The revolution is the coagulating, cutting knife. The scalpel can be used as a standard surgical knife with all the advantages of the tactile feedback, but at the same time having the laser to coagulate at the sharp edges. The laser light exits the knife at the edges where it cuts. (Fig. 2) The temperatures achieved with the sapphire knife are in the range of > 65째 to allow coagulation, but less then 100째 to avoid carbonization. The cut is only performed by the knife itself. To allow the laser to exit at the right edges a mathematical calculation has been performed for maximum transmission and reflection inside the knife. Thus the absorption inside the knife is minimal and no temperature rise at the handle is produced. The result is a cut which is almost free of bleeding

Fig. 3-6 Fig. 3 Fig. 4 Fig. 5 Fig. 6 Fig. 7 Fig. 8

Patient 75 years lower jaw Implants with recurring inflammation at the implant (regio 33). Initial situation Missing attached gingival at implant regio 33. Vestibulum plastic cuts with lateral denaturation. Deep cut: muscle cut in two and inlaying strands pre suturing. First day post OP. Prosthesis was immediately prolonged at the edge. Fibrin eschar. Patient without pain and complains. Cut in a liver using the Jazz. Reference cut with a free laser beam into a liver.

CADMUS 2009

Royal Australian Army Dental Corps

Unit News Regular Army Units Dental Platoon 1 CSSB and JHSA Robertson Barracks, Darwin, NT LCPL Conor Gray Hello from sunny, hot, humid and sticky Darwin and that’s just the dry season! This year has been another back-breaking challenge for us getting through all the pre- and post-deployment dental treatment, on top of our regular workload. We have also assisted RAAF and Navy when required. 1CSSB Dental has had a lot of staff changes since our last update. We said goodbye to MAJ Ray Heffer who has gone back to Perth. CAPT Amanda Leen was posted to 1HSB in Sydney. We can always count on CAPT Leen for cooking up our morning tea goodies. CAPT Michael Hall has since discharged from the Army and is now working in sunny Cairns. His dry sense of humour and witty remarks are sadly missed. SGT Mark Allen made the big move down to Brisbane to 2HSB. CPL Alaina Rodway went to Kapooka as a RI. CPL Alison Rolles was posted to Oakey. CPL Rolles was also awarded the Soldier’s Medallion for her excellent work while she was here. PTE Greg Willson finally passed his swim test and was accepted into the RAAC and is now posted to 2/14 LHR. Good luck Greg! There are many new faces here. MAJ Thien Pham, our new SDO and resident oral surgeon, moved up to Darwin from LTS in Perth. CAPT George Lathouras graced us with his presence straight out of university and was very wide-eyed and innocent in the beginning. After completing his SSO course, we can no longer salute him with our left hands! CPL Sonia Nicholls is a hard worker and a great team member. We were sad to lose Sonia after a short period. She is now posted to 2HSB and we wish her all the best (your family is in our prayers and thoughts). CPL Jo Parlour posted out at the start of 2008 but came back quick as a flash. She got married and has since had a baby boy, Damien. She is on maternity leave after having a busy year and will join us again in November. PTE Madeline Gurkin joined us from Randwick and went straight on her SDA course and then JLC. She is competing for a position on the technician course for 2010 and we wish her the best of luck. PTE Miranda Capstaff was posted in after coming off maternity leave and is hoping to do her SDA course this year. PTE Yasmin Hampton posted in last August but will be leaving at the end of the year for Oakey and taking her collection of exotic wild animals along with her. At the end of 2008, the clinical phase of the basic DA course was completed at 1CSSB by PTE Alastair Matthews and PTE Nicole Morrissey. Both successfully passed and were subsequently posted here as their reward. PTE Morrissey is looking forward to walking the Kokoda trail later this year. PTE Matthews is on leave and yet to return.

Those that stay on: CAPT Palfreyman is keeping busy ensuring we all know of his marvellous crown preparations and working hard to prevent our technicians from travelling to and from work in the daylight hours. WO2 Tammy Smith has been extremely busy as always with the administration, stores and equipment. Every now and then, she keeps the diggers in line as acting/acting CSM in the absence of the acting CSM. SGT Ken Locker has recently been promoted and was immediately sent out field with the CSST(-) as PL SGT. He keeps the dental team fighting fit as the Combat Fitness Leader for the Coy. CPL David Clark has been working nonstop in the laboratory keeping on top of the immense workload coming in from the 4 bases in the NT region and from CAPT Palfreyman. Despite the workload, he still managed to complete the work on his 1954 Holden hot rod and it looks awesome! PTE Michelle Williams successfully completed her SDA course and JLC. She is also trying out for the technician selection. We wish her all the best with her new posting down to Brisbane.

CAPT Palfreyman, SGT Locker and I travelled out to Mount Bundy Training Area with the CSST in late May, setting up our equipment and improving on our field dentistry skills. When the troops could not come to us, CAPT Palfreyman and SGT Locker took the dentistry (dental advice and supplies) out to them, which proved to be a real morale booster. Some DOs and DAs got involved with the forensic identification at the Royal Darwin Hospital mortuary on a rotational basis. This was a real eye-opening experience for the soldiers and we greatly appreciated the first-hand experience in the basic procedures involved in victim identification and forensic dentistry. As for me, I was promoted recently and am now W02 Smith’s little leprechaun helper. I am moving on to join 3HSB and am very excited and keen to start this new chapter. I will, however,

CADMUS 2009

really miss the crew here and will have many fond memories of my time here. A special thank you must go to all our civilian staff: Dr. Pushpa Karat, Ms. Sarah Billing (DA), Ms. Kylie Greaves (hygienist), Ms. Karen La Fontaine (hygienist), Dr Rob Hosking, Ms. Malita McCabe (DA), Dr Rob Rogers, and Ms. Maya McDuff (DA). Their efforts are much appreciated and their contributions enable us to carry out our military commitments. What a fabulous job we have done here at 1CSSB Dental in 2009 - well done to all of us!

Dental Platoon 3 CSSB Lavarack Barracks, Townsville, QLD CAPT Thomas van Heumen This year, the crew at 16FD has clocked up one of the busiest time in recent memory. Due to the majority of the Brigade deploying, there were limited exercises planned for the calendar. Activities so far have included EX SEA LION and EX STARLIGHT, with CATA pencilled in for August and September. We traded away our SDO CAPT Karen Such for CAPT Emily Close from the British Army, as part of EX LONGLOOK, leaving CAPT Anthony Craig as the A/SDO for 4 months. We congratulate him on performing an excellent job and keeping the entire team running smoothly, much like his running prowess. We will say farewell to half the platoon this year when SGT Sarah Staggard (congratulations on your promotion) heads back down south to be part of the teaching faculty at HMAS CERBERUS. CAPT Such has been MIA from 3CSSB for the majority of the year with her much anticipated tour of Europe. She will be leaving 3CSSB and returning to university to commence a postgraduate course in oral surgery in Perth. CAPT Craig departs to an undisclosed southern location; he is a regular in the Townsville Bulletin but now dreams of featuring in other prominent newspapers. We would like to wish all of our departing members the very best in their new units. For those staying and soldiering on, WO2 John Flemett has maintained his eagle eye on the unit, CPL Barry’s 4-colour Bic pen, and the heated fantasy league cup (rumoured to be rigged). Congratulations go to LCPL Kerri-Ann Steindl on her promotion and completion of the SDA course. CPL Casey Dor’e has been deployed with the RCB since April and all reports indicate that she is enjoying her time in the wild Malaysian jungle and is doing a wonderful job representing the unit and the Corps. CPL John Kaponay has been the only permanent technician in the laboratory this year and has been flat out keeping up with all the dentists, as well as completing his Subject 1 for SGT. CPL Linda “Bobbi” Barry completed the SDAP course and we congratulate her on achieving the SOM. She is continuing her passionate fight against plaque and smoking. PTE Robin Pitt has a special new addition and no, it is not a tattoo. We extend our congratulations to Robin and Nathan on the arrival of baby Dorothy. There has been a baby boom recently at dental coinciding with an ever growing gambling problem of betting on due dates. The new faces to 3CSSB include 4 DA and 1 dentist. Fresh out of ADFDS are PTE Natasha Tippett, PTE Kristy McMillen, PTE Bob Maddock, and PTE Letisha Mueller. PTE Tippett was tasked with the epic job of oral surgery, keeping her very busy with the administration required. Our youngest (and quite possibly smallest) recruit (though not a gap year), PTE McMillen, assists CAPT Craig. No one warned her that the added task when assisting CAPT Craig is to laugh at his jokes! What Kristy lacks in size, she makes up for with her ‘mane’ of gold locks. PTE Maddock is the new big man of the team who enjoys doing the ‘grapevine’, playing Halo, drinking ‘V’, and wearing shirts that are questionably several sizes too small. PTE Mueller has done a great job helping out in CADMUS 2009

the laboratory and, being the quiet achiever, has ambitions of being selected for technician trade training in the near future. New to the endangered species (dental officers) list is CAPT van Heumen, a recent graduate from UQ who joined us in January and has made the transitional leap from civilian to Army life quite smoothly, working hard at changing radio station preferences and also gaining himself the title of ‘The Tank’ along the way. In March we provided the dental support as part of CSST on EX SEA LION up at Cowley Beach near Innisfail. We had CAPT Craig, CAPT van Heumen, WO2 Flemett, PTE Tippett, PTE Mueller and PTE Maddock on the team. For many it was their first field dental experience. CAPT van Heumen was armed with only a tent pole as he was not yet qualified on the Steyr. We were occupied day and night doing ADE for CSST members, surviving in our shell scrapes through several contacts by the MAF, and playing several rounds of cards. We also took part in EX STARLIGHT, a health company shake out that eventually was condensed into a night sleep-out under the stars on the base. Due to our full books the dental team operated like a ghost in the night. We set up in the dark and were packed up ready for work before most of the others had even woken up. CATA at high range will be our next exercise. In April, as part of LONGLOOK, we farewelled CAPT Such and welcomed CAPT Close. Many were upset to lose CAPT Such, the socialite of the platoon but it was quickly realised that CAPT Close was more than a fair trade. In a nutshell CAPT Close is Irish but has lived much of her life in Scotland, and is in the British Army working on a base in Germany. During her time here, she has visited many of the sites up and down the East coast of Australia. She recently teamed up with CAPT Amanda Leen from 1HSB on a week long tour of Weipa treating the local indigenous people. CAPT Close left Australia at the end of July and we will hopefully be seeing the return of CAPT Such. A big thank you deservedly goes to CAPT Leen, PTE Lauren Morgan and SGT Ken Locker who visited 3CSSB to provide us with crucial support during the year. A special mention must go to our visiting maxillofacial specialists, Professor Bob Jones and Dr Geoff Dance, for their assistance. We thank all of our permanent and temporary Aspen colleagues for their valuable services and hard work: Dr Adrian Buell, Dr Mary Love, Dr Vaishali Patel, Dr Paul Ichim, Dr Alan Martin, Dr Andrew Harrold, Lisa Hamblin, Sarah Stapleton, Carly Fredrickson, Lesley Turner, Renee Judd, Bianca Wheldon, and Sally Whittaker. We congratulate Carly and John on the arrival of baby Lucas as well as Sarah with Troy and Lesley with Steve on the upcoming new arrivals. May the rest of 2009 bring even more excitement and challenges for the crew of 16FD.

Dental Platoon 7 CSSB, 2 HSB and JHSA Gallipoli Barracks, Brisbane, QLD 7 CSSB LCPL Jo Theobald A year later and we are still living it up in this glorious state enjoying the sunshine, the fresh crisp air, and of course 7CSSB. Once again another busy year was forecast - in between clinical time at GBDC and field exercises we weren’t quite sure what to expect! Thank you goes to 2HSB, JHSA and the wonderful civilian contractors for sharing the load. The start of the year saw a new 7CSSB Dental team consisting of LTCOL Suzy Atkins, CAPT Mick Robinson, the good old WO2 Mark Gorman, CPL Robert Pike, LCPL Jo Theobald, and PTE Brendan Zhang. We farewelled 2 of our favourite members - SGT Tracey Feillafe and CPL Zac Wilson. Both were a breath of fresh

air and were known as the bubbly two. They have posted to JHSA where they keep the morale sky high within GBDC.

TALISMAN SABRE. Overall, the exercise was a memorable one with plenty of laughs and interesting moments.

The first exercise of the year was a week out at Greenbank as a company shake-out. Dusting off the cobwebs we prepared and loaded the gear. For some it was an unbelievable experience and for others a steep learning curve on simple things, such as lacing a cam net to shooting on a MTR range. CAPT Robinson taught us how to cook pancakes on a gas burner without blowing himself up. WO2 Gorman and I watched from under the cam net with fire extinguisher and first aid kit in our hands. We ended up with not just a pancake, but a ‘Pan Cake’ that took a total of 3 hours to cook. All the while PTE Zhang was off enduring the tough yet rewarding JLC experience. He navigated the course successfully and finished just prior to our next field exercise.

CAPT Robinson is hard at work during EX DD Upon our return, CPL Pike had completed his Subject 1 for SGT. WO2 Gorman was kept busy in the laboratory. LTCOL Atkins took on the role as Head of Corps and spent most of her days in surgery or travelling about in her new role. CAPT Robinson had been away to study for his fellowship. Wrapping up, we had a very interesting and rewarding year and shared many special moments. We would like to thank every one that had faith in our CSS dental team. Your kind wishes and prayers bought us safely home. We look forward to what the New Year brings. WO2 Gorman stands safely on the opposite side of the tent from the gas explosion waiting to happen Our latest addition is PTE Daniel ‘Camo’ Cameron, he marched in mid-year after transferring from 2/14 LHR. As a welcome to the Dental Corps, we went out field for 4 weeks, followed immediately by a further 3-week exercise. EX BATTALION READY led into EX DIAMOND DOLLARS. There was plenty of preparation of equipment and consumables as nobody knew what lay ahead. The 4-man team had the fearless leader CAPT Robinson, the foreign spy PTE Zhang, the gun-staker PTE Cameron, and the good CPL. Phase one of the mission involved venturing up to SWBTA. We spent the next 2 gruelling months roughing it, with arduous terrain and harsh conditions (and a ‘Play Station’, and fridges, and several trunks of jack rations). The team was geared up and never failed to meet the timings of the exercise and the needs of patients. In the first few weeks of the exercise, we pumped through over 130 odd patients with treatment ranging from annual dental exams, to fillings and extractions (all the while under fire from the enemy). Days turned into weeks and before long the first part of the exercise was over. We were all ready to head home and have a little ‘R&R’. EX TALISMAN SABRE saw our return to SWBTA, armed and ready for the next phase. This time we lost the dentist. Without our vital asset, we were forced to work as a triangle - a triangle of extra duties! Rat packs were issued on arrival, as were ticks, cold dark nights, hot days, and loads and loads of pickets. PTE Cameron became the most experienced gun-staker. Between pickets and odd jobs, Camo spent a lot of his days and nights staking and re-staking the guns. PTE Zhang practiced dixie bashing weekly, as a good cheesecake cook understands the importance of clean dishes. A big thank you goes to CAPT Chris Buttson and PTE Casey Hewitt-Freudenberg who filled in for a couple of days on

PTE Zhang, thinking up new recipes made from CRP

2HSB CPL Lizzie Browne Welcome back to 2HSB for 2009. MAJ Wayne Chow is our SDO this year and has been very busy in surgery with implant cases. Dr David Keys, the periodontist, has been by his side and they have achieved many positive results. CAPT Michael Robinson has left us for 7CSSB. He is still in the building so we continue to enjoy his smiling face and sparkling wit. We welcomed CAPT Michael Lines, our brand new DO and our very own Student of Merit on LOBC. Congratulations Sir and welcome to Dental Corps. He is a legend, just ask him! SGT Mark Allen came to us from Darwin and is our laboratory supervisor. SGT Karina Peacock had a busy year on courses, in water polo competitions, and the daily running of the dental centre. SGT Tony Conlon has discharged after serving for 20 years, and we had a great morning tea to pay tribute to

CADMUS 2009

his career. Good Luck SGT Conlon. CPL Haydee Stevens did not move too far, from 2HSB to JHC-SQ. She is determined to complete her university studies. CPL Tammy Guganovic joined us from Singleton and has been helping out in surgery and in CSD. LCPL Leanne Keith has discharged and is now working with an oral maxillofacial surgeon in a private practice, but is still maintaining the link by transferring to active reserve with 7CSSB. Good Luck Leanne!

PTE Evan Watson-Keast is working hard in surgery and is off to the Philippines for holidays next week. PTE Nancy Havili is our storeman and is doing a great job both in surgery and managing stores. PTE Lisa Blencowe marched in straight from ADFDS in December 2008 and has been doing really well. Lisa is a qualified dental technician in civilian street, but had to start somewhere in the Army. We farewelled PTE Miranda Capstaff on maternity leave. PTE Jason Wilding joined us from 1HSB - he has been working with LTCOL Atkins and is getting ready for his technician course. PTE Rhianon Farley has arrived from 3CSSB and is getting all ‘coursed up’ in preparation for her technician course. Rhianon and Jason will be leaving us to commence LTS in June - good luck guys! CPL Lizzie Browne has been posted from Darling Downs to the CPL SDAP position in 2HSB. In between courses and work, she is planning her wedding in October. This sums up the hustle and bustle of 2HSB. Tune in next year to see who comes and goes – and take it easy!

currently studying to become a counsellor at ACU. CPL Kirstyn ‘Xena’ Davies joined us from LTS after completing the technician course. CPL Davies also recently gave birth to her daughter Sophie – congratulations! PTE Ryan Cowgill posted in from Randwick Health Centre and successfully completed his JLC in June 2009. WO1 Wayne Butler moved from HMAS CERBERUS to Gallipoli Barracks to oversee the dental technician training and mentor the trainee technicians alongside the TAFE curriculum. The newest trainee technicians are PTE Jason Wilding and PTE Rhianon Farley, both were posted across from 2HSB mid-2009. One of the stayers is CPL Tash Senior who gave birth to her son James. CPL Senior will be Corps-transferring to RAAPC, and will sadly be leaving ‘Team Dental’ in May 2010. All the military staff would like to thank the civilian staff for all their work and dedication in the past year. Miss Riss, our only APS staff, is still rocking the reception. Dr Michael Stevens, Dr Grant Dawson, Dr David Thomson (prosthodontist), Dr Sam Tseng (endodontist), Dr ‘Bob’ Hazlewood (endodontist), Dr David Keys (periodontist), Dr Gordon-Macleod (oral surgeon), Ms Sarah Gollagher (hygienist), Ms Sheena Austine (DA), MS Andrea Dixon (DA), Ms Rebecca Ferny (DA), Ms Ida Cuylenborg (sterilization technician), and Ms Roz Pini (sterilization technician). This wraps it up for another year, so from all of us, good luck and see you next year.

JHC SQ Gallipoli Barracks

Dental Platoon 1 HSB Holsworthy Barracks, Sydney, NSW

PTE Ryan Cowgill

CPL Adam Collins

Greetings from the Sunshine State! The past year has seen a changing of the guard and a name change - we have been renamed JHC-SQ from JHSA-SQ. We said goodbye to PTE Tony Anderson when he discharged in November 2008 - he promptly grew a beard and got a few more ‘tatts’. We also said goodbye to PTE Kerrie Redford who discharged in August 2008 and then married the love of her life. SGT Doug Honess discharged in January 2009 after many months of training to be a train driver and is now working with Queensland Rail. CPL Rob Pyke posted across to 7 CSSB as their resident technician and is currently on Subject 1 for SGT. CPL Brett Lawler has successfully completed his technician course and will be posted to 2HSB before a posting to 3CSSB in 2010. Good luck to you all!

Another year has passed at 1HSB and as usual, a great deal has been accomplished. CAPT Amanda ‘not so mean, keep ‘em keen’ Leen joined us as our OIC. Ma’am has been kept busy with the many roles of DO and the extra responsibilities of OIC. CAPT Leen also provided dental support to 3BDE for pre-deployment exams in Townsville and participated in AACAP16 (2009). SGT ‘welcome to my world’ Kilpatrick has worn a few different hats over the past 12 months, but has mostly been performing the PL SGT role. He is now on LSL until late September, having a well deserved rest and to do some more work on the Hummer (due for completion sometime before CRA). CPL Adam ‘instant family man’ Collins returned to 1HSB after his TDY to RHC and took up the laboratory supervisor role. He welcomed his first child, a baby girl Chesapeake Atamahina in April. Mr Mark ‘ex ARA, ex RAAF Williamtown, ex Duntroon’ Morris joined us in June and has been carrying the technician workload in both SGT Kilpatrick’s and CPL Collins’ absences.

After the goodbye, we started 2009 with many new members. We welcomed ‘The Voice’ SGT Tracey Feillafe from 7CSSB to become the Clinical Supervisor of GBDC. SGT Feillafe completed her Subject 1 for WO with very good results. CPL Alexander ‘Zac’ Wilson, also joined us from 7CSSB and is the CPL DA of GBDC. CPL Haydee Stevens joined us from 2HSB to be our SDAP and is CADMUS 2009

CPL Maryann ‘all day, every day, my way’ Broadway returned to 1HSB after successful completion of her SDAP course. She has

cheerio to farewell SGT Adrian Baggio, who is discharging later this year. He is happily working away at his dental laboratory on his LSL after completing 20 years of service in the ARA. CPL Howard Chapman discharged in May 2009 and has moved to Brisbane and is now a reservist at 7CSSB. We hope Chappy is enjoying the yearround sunshine so rare in Adelaide and loving the break after 26 years of service in the ARA.

developed a passion for hygiene and is enjoying the freedom and responsibility of having her own patients and running a surgery. CPL Broadway participated in AACAP and was able to put her skills to good use by educating the local indigenous population on oral hygiene. CPL Rachel ‘our LONGLOOKER’ Taylor joined us for 4 months in this lucky sunburnt country. She was a great asset and is already sorely missed by all. CPL Taylor participated on AACAP and was able to tour some of the other RAADC centres on her adventure. PTE Karla ‘me so nosie’ Hosie was deployed to the mother country on LONGLOOK and has recently returned with many tall (young and handsome) tales to tell. PTE Lauren ‘it was me’ Morgan has been kept busy in surgery after joining us in 2009. She participated in a reserve weekend in support of 5BDE for which she received a BZ (Bravo Zulu is a naval signal, meaning ‘well done’) from the CO of the exercise for her hard work and professionalism - well done Lauren! PTE Morgan went on AACAP for 15 days, with some of her 1HSB brethren providing dental care as required. PTE Elena ‘where’s my fogger’ Rowland joined us fresh off DA course and has been diligently completing her log book. PTE Rowland used to work next door at Environmental Health, and has occasionally arrived for work at the wrong car park. We have had an OJT, LCPL Luke ‘I’m not a pogue yet’ Duncan, from 3RAR with us for the past 3 months. He has proven a quick learner and has been seamlessly settling into RAADC life. Welcome to the world of blood, spit and sneers! We lost a few to postings, courses and discharges. MAJ Jeff Ong went to Randwick, CPL Danielle ‘mil skills’ Gurkin posted to ARTC, PTE Jason ‘No. 1’ Wilding posted to 7CSSB, PTE Angela ‘it’s or-det’ Audet posted to Adelaide, and CPL Kim ‘our siddha meditation intensive program officer’ Stephens went to shore - is that an Army term? We were able to fill some gaps in 2009, namely some of the specialist positions, and now have the full gamut. This has enabled us to provide complete and comprehensive dental clinical care to the LMA. 1HSB Dental has also taken over the responsibility of oral surgery treatment for the Sydney area and is making good use of the operating theatre and its support staff - some 550 surgical burs per annum! Of course, none of this would be possible without the continuing support of our team of dedicated civilian staff, some of whom have been here long enough to be entitled to LSL. Well that’s it for 2009 with the printable news. We look forward to 2010 with the crew of civilian old faithfuls and the inevitable military re-shuffle to keep us on our toes. Until then, we are ‘hazy grey and underway’ for next year.

Dental Platoon 3 HSB Keswick Barracks, Adelaide, SA Miss Shiralee Roberts and PTE Angela Audet It feels like yesterday we were writing for Cadmus 2008 but so much has happened in the mean time for Cadmus 2009. Firstly we said

PTE Angela Audet arrived from 1HSB in January with husband Brenton, children Alyssa, and Mason in tow. Angela’s husband has just re-enlisted into the Army and is posted to Puckapunyal. Congratulations to Angela and Brenton as they are expecting a new baby in November. Angela will follow Brenton to his new posting on maternity leave. Big thanks go to Angela for her hard work in the document muster and the MSDS muster for Keswick and Woodside - which got lost on the last AFX Whyalla. PTE Sarah Thomas deployed on OP RESOLUTE for 4 months. We haven’t heard much from her but we know she is enjoying herself up north. Hopefully she has acclimatised to the tropical weather as she is posted to 1CSSB next year. We are hoping Sarah will be panelled for the next JLC and we wish her all the best in her future endeavours. Dr Karzhan Gill and Dr Peter Clarke are still working hard with seeing all our tri-Service and reserve members in additional to working in their own practices. They have become permanent fixtures within the dental centre and we are thinking of issuing them NSN numbers and placing them on our subaccount as ‘valuable and attractive’ items. SQNLDR Steve Mason and MAJ Jenny Skarlat are our reserve dental officers. SQNLDR Mason parades on the first Tuesday night of the month and MAJ Skarlat parades most Tuesday nights. Both of them have been keeping up the dental fitness of the reserve members within Adelaide. Congratulations to MAJ Lee Melberzs who is now holding down the fort as the 2IC of 3HSB. Congratulations to CPL Karla Ross on her promotion to CPL in January. Karla is our RAAF reserve SDAP, who is currently studying the Advanced Diploma in Dental Hygiene. Karla will be off to Brisbane with her daughter, Yasmin, and partner Mick Hapel in 2010. We wish you all the best. Our Woodside detachment has been kept busy with Dr Jane Cusack and Rebecca Berriman - both are making sure that everyone they are responsible for is dentally fit. Jane and Rebecca saw 120 members in 2 days to get them dentally fit to deploy to Timor Leste. With only 20 exam kits available, one sterilizer and the mountain of associated paperwork, it was truly a great effort from Jane and Rebecca, with the members walking away happy and…deployed. Shiralee Roberts, our Practice Manager, has been with Keswick since February 2007 after leaving the PAF. She stays on top of all things that keep a dental practice running, with her trusty practice planner of non-technical inspections, stock takes, KPIs, due and overdue exams, and myriads of reports. Shiralee is studying for her Certificate IV in Practice Management and she will complete her Diploma in Practice Management in 2010. It has been a busy year getting the regular and reserve members dentally fit for a significant number of deployments. It is a challenge keeping up with all the reserve categories. Their different requirements keep us on our toes regarding policies and procedures. We look forward to welcoming CPL Conor Gray from 1CSSB, and his wife and daughter in 2010. We are ready to meet the inevitable challenges that the New Year will bring. Adelaide is a rewarding and challenging posting, dealing with many satellite reserve units and the diverse range of Army, Navy and Air Force members within SA. You have to come and experience it for yourself!

CADMUS 2009

Joint Units (Army) Albury Wodonga Dental Services Latchford Barracks, Bonegilla, VIC Ms Kate Batcheldor AWDS have had another wonderful and busy year. Currently, we have 2 dentists: Dr Neela Nath and Dr Geoff Webster. Both are kept busy and never seem to have time to get bored. Our Hygienist Christine Anderson is still maintaining the oral hygiene of our members. Kate Batcheldor is our proud Practice Manager, and Adelle Gormly, Jacqueline Spong, and Melissa Mezzomo are our wonderful Das. They all contribute to keeping the dental facility functioning professionally and productively. Congratulations on your efforts! Over the past 12 months, we have worked hard and achieved our set goals. Our employer, Aspen Medical, has been a great company - it has always offered us support and assistance to maintain the positive direction in which this facility is heading. It has not been all smiles though as we said goodbye to Meredithe Kerr (DA) who relocated with her family to sunny Brisbane, and Jocelyn Schilg (DA) who has also moved up to Brisbane. Although we are nearing the end of 2009, we still have a lot of work to do and once again, there will be another farewell to Jacqueline Spong (DA) who is leaving to move to Brisbane with her family. This year has passed so quickly it is hard to believe 2010 is almost here! 2009 has been another great year, working with a great team. I would like to thank every one for their efforts to make AWDS the great workplace that it is today.

Darling Downs Dental Services Oakey, QLD CPL Alison Rolles

LCPL Winn is planning to transfer to Psych Corps and will be posted to Randwick in 2010. We wish you all the best! We were joined by a civilian hygienist Ms Stephanie Flood, who moved to Toowoomba from Adelaide and works 2 days a week with us. CPL Alison Rolles posted in from 1CSSB and is still adjusting to the cooler climate and a less frantic environment. PTE Cherise Kite joined us straight from ADFDS at the end of 2008.

CPL Rolles and PTE Kite strapped in and ready for a hard day at the office LCPL Winn and PTE Kite were both selected for the catafalque party for ANZAC Day at Kumbia and after putting in many hours on the drill square, they did a fantastic job, and represented themselves and the Corps proudly. There are many advantages to being posted to the Army Aviation Training Centre - we have a wonderful team to work with, and we also have the opportunity to take trips in the Black Hawks - to see the amazing views of the Downs from above. You get to experience just what a Black Hawk can do and PTE Kite now knows about the best way to combat air sickness while strapped into the back of one. CPL Rolles, LCPL Winn and PTE Kite also had the opportunity to spend 4 days detached to the Queensland Ambulance Service and experienced major trauma scenarios on many occasions. All 3 enjoyed the experience immensely. We wish the rest of the Corps a great 2010.

Hunter Valley Dental Services Lone Pine Barracks, Singleton, NSW PTE Leesa Rowan

PTE Cherise Kite, in ANZAC Day Ceremony 2009 A warm hello from the frosty Downs! MAJ Tait still leads the team, working 4 days a week (3 days contract, 1 day reserve). Between the dental centres at Oakey and Cabarlah, we have managed to keep on top of the dental needs of the Darling Downs members. It has been a productive year out here. Earlier in the year we bid farewell to Dr Shayrn Hansel, who after 10 years working with the AATC, headed back to Toowoomba to continue working in the civilian world. Jacky, who manages our orderly room, has been here longer then most of the furniture and is still going strong. LCPL Kalisa Winn is still with us and has been busy completing her university degree in psychology (has achieved excellent results). CADMUS 2009

A big happy hello from the team at Hunter Valley, the wine country! 2009 has been another busy year for our small team of one dentist, Dr Paul Morton, one APS DA, Mrs Elizabeth (Liz) Burke, and one uniformed DA, PTE Leesa Rowan. Luckily for us, we recently welcomed Dr Allan Hicks who has joined us and is working 2 days a week. Dr Hicks has previously worked at HVDS in the mid-1990s and was an ARA Dental Officer back in the day. It has been an easy return for him and we welcomed him with open arms as his contribution is very much needed. 2009 has seen a large volume of trainees come through the School of Infantry. All of them required a mouthguard, due to the unarmed combat portion in their training. This has substantially increased our workload, in addition to AIRN compliance. CPL Tammy Guganovic and her little girl Chloe head north to Brisbane in December 2008. PTE Rowan joined us from Darling Downs Dental Services in 2009. Leesa and son Trae have settled

into their new surroundings very well. They are country folk from way back and fitted into the country life instantly. Our faithful stayers, Dr Morton and Liz, are into their 9th year with HVDS and continue to power away for 3 hectic days every week. We are lucky enough to continue enjoying the company of SGT Heidi Mayall (she is also part of the furniture), who happily works away as a reservist a few times a month, providing preventive dentistry. We hope all our comrades around the country are happy and healthy. We look forward to reading all the other Cadmus stories and catching up with the news from around the globe.

Kapooka Health Centre - Dental Blamey Barracks, Kapooka, NSW Ms Debra Griffin As always, this has been an incredibly busy year. Kapooka Dental loves this time of the year, when the throughput of recruits slows down a little so that we have a chance to reflect on the year that was. It is time for us to work out how we can improve, write our wish lists (a new OPG machine please), do the big catch-up, and prepare for the next 6 months that will have us running all the way through to the December madness. We lost Deb Buchanan last year to the sunshine of Queensland. The team welcomes onboard Shona Graham, who has slotted in like she has always been here. Shona makes awesome vanilla slice which is a blessing on charting days. The dental crew consists of Dr Miles Connell, Dr Robert Vella, and Dr Sharma Nand. We share our dentists with RAAF Wagga. Malinda Knight is our SDA, Kate Skeers has returned from maternity leave to DA for us alongside Shona. Rachel Maden is manning the front desk and does a fine job assisting Debra Griffin, our Practice Manager. Kapooka Health Centre has a new OC, MAJ Ann Martin. She has been a great support to all of us at dental and we thank her for her support and guidance.

Medical and Dental Services Karrakatta Irwin Barracks, Perth, WA MAJ Ray Heffer and CPL Jane Roberts Greetings from WA! The big changes over here are political: we elected a Liberal Government and we said ‘no’ to daylight saving and Sunday trading. Some might say one step forward and two steps back, but we are just happy to keep the rest of Australia out of a recession! Dental is busier than usual. As we continue to keep the SASR dentally compliant for all their overseas operations, the

tempo has been increasing, since we have also supported 13BDE for their deployments on OP ANODE and RCB 87. MAJ Djordje Zlatkovic departed for private practice in Busselton on the South West coast and is expecting to be a father for the first time early next year. We also farewelled Dr Lyle Henderson once again, who, after 30 years of loyal part-time service, has finally retired! We welcomed the new OC, MAJ Ray Heffer, from Darwin. In between bike crashes (one day he might slow down), he juggles looking after the Health Centre, working at his private endodontic practice, and teaching at UWA Dental School. CPL Joanne Reed marched in from Randwick and took time adjusting to the fact that there are two ‘Armies’ and that she is now in the West Australian Army. Jo is currently on her Subject 1 for SGT. Dr Jeff Ong joined us as a full time CHP dentist. Jeff loves the uniform and he parades as MAJ Ong in the reserve at 13CSSB. WO2 Ursula Friend was here on TDY from Randwick and has provided excellent support in preventive dentistry, for which we are very grateful. The stayers include SO1 DEN and Consultant Periodontist, LTCOL Darryl Andrews. Dr Greg Gee and Liz Vears rotate between the Army dental unit, Navy dental department, and private practice, as the mighty prosthodontic team. PTE Sarah Fisk continues her annual pilgrimage on the inter-Service snow boarding trials and followed the trials with a skiing holiday with her family in NZ. CPL “Miss Jane” Roberts soldiers on and has developed a recent interest in the Australian Customs and Boarder Protection Service! Until next year, we wish you all the best from the West!

Puckapunyal Health Centre - Dental Puckapunyal, VIC Ms Sandy Clark Hello from all of us at Puckapunyal Dental. We have had a very eventful year with people coming and going, and our dental unit has changed dramatically. Carley Tolson, our Practice Manager, got married last year and is now Mrs Kelly. Since then, Carley has had another beautiful baby girl Lilli Mae and is on maternity leave for 12 months until May 2010. Sandy Clark is now our Practice Manager during Carley’s absence. She is excited about the new challenge of running the unit and it has been a great learning experience. Sandy is also studying for the Diploma of Practice Management. We have some new additions to the unit too, one of them being Adelle Gauci, our lovely hygienist. Adelle joined us in January and has proven to be a great asset, working 2 days a week. We also have Tara Banks, our newest DA. Tara has fitted into the unit well, having only joined us in May and is having fun learning about dental in Defence. Elizabeth Hemming was happy to have completed her Certificate III in Dental Assisting in February. We are still graced by the presence of both Dr Rishindra Siriwardane (our SDO) and Dr Scott Freeman, who by some miracle, find Puckapunyal appealing. Rishi has now passed his 6 years mark here at Puckapunyal Dental and is working 4 days a week. Scott has been with us since June 2008 and is working 1 day a week. It has been a tough couple of months recently. The most challenging was ‘the great flood’ which had the unit closed for 4 days. I would like to thank everyone for their help and understanding at that time. Thankfully, the carpets and the dental chairs survived unscathed. The unit has gone through a great change in the past 12 months, not unusual in the Defence environment. I would like to say thank you to our dental team here for all their hard work and support during this time. We maintained our high standard even at the most difficult times, for which I know the members are grateful. We wish everyone the best as the end of 2009 approaches.

CADMUS 2009

Randwick Health Centre – Dental Randwick Barracks, Randwick, NSW CPL Kellie Davies and CPL Sarah Harrison Hello to all fellow Corps members from Randwick Dental. Just like every other year, there is a continuous cycle of promotions, postings and discharges and here at Randwick Barracks we are no exception. 2008 ended in style with a cruise on the Sydney Harbour for the Health Coy Christmas Party. During the cruise, farewells were conducted as we docked in one of the many beautiful bays. There was a mass exodus with MAJ Werner Voss, CPL Sonia Nicholls, CPL Joanne Reed, CPL Kim Stephens, PTE Ryan Cowgill and PTE Maddie Gurkin, all posted out for the promise of warmer climates elsewhere. The start of 2009 began with the march in and (surprise) out of our new OC, MAJ Jeff Ong. After one week of being posted in from Holsworthy, he left and is now working at Irwin Barracks in Perth as a civilian dentist. His discharge left WO2 Ursula Friend as our acting OC. In late March we welcomed the new OC, MAJ Brett Dick (RAAMC). CPL Kempster has had a busy time this year. He went on his Subject 1 for SGT at late notice, and on return, went to support 1HSB on AACAP for 3 weeks in Weipa. The following week he went to HMAS KUTTABUL to assist in the laboratory while the technician was on leave. While he was away, CPL Davies (posted in from 3CSSB) has been holding the fort in the laboratory and performing her magic with the constant influx of crowns and dentures. CPL Sarah Harrison was newly promoted at the end of 2008 and was posted in from 3CSSB. Jade, our civilian DA joined us late last year. CPL Harrison and Jade are busily keeping things on track at Randwick Barracks, as well as running the desk and surgery over at Victoria Barracks 2 days a week. The back bones of the unit are SGT Nikki Kirkhope, the dental supervisor, and WO2 Ursula Friend, the WODEN. SGT Kirkhope keeps the place running like clockwork and is the guru on all things policy, especially when it comes to reservists. WO2 Friend divides her clinical time as a hygienist between Randwick Barracks and Victoria Barracks.

Dr Hayes and his wife Tamara on the birth of their baby girl Piper in March. That’s it from Randwick Dental. It has been a great year so far. We are not short of work, personalities or PT, and have decided we are never leaving.

Watsonia Dental Services Simpson Barracks, Macleod, VIC Ms Celeste Boothroyd The dental facility provides dental treatment to all full-time members and provides dental exams to reservists from units such as DFSS, 1MP, DFSM, Army Band Melbourne, 108SIS SQN, 138SIG SQN, LWC, HQ4BDE, 4/19PWLH, 4CSSB, 4CER, 5/6RVR, 4BOSC, and 8/7RVR in Ballarat. We have a dependency of about 788 full time members, and about 1,500 reserve members. Simpson Barracks Dental consists of all contracted staff: Dr Tony Doan (dentist), Dr Kym Trewin (dentist), Celeste Boothroyd (practice manager), Anna Pachioli (DA), Melissa Gioutsos (DA), and Sarah Baron (hygienist). Dr Doan is our full time dentist. He graduated from Melbourne University in 1997, and was an ex-serving ARA dental officer. Dr Kym Trewin is our part-time dentist. He was an ex-serving RAAF dental officer. He has been in dentistry for over 20 years, and owns his own private practice in Doncaster. Dr Trewin loves flying his light plane around Victoria. Celeste is our practice manager who is also a certified DA. She completed her DA course through the ADA in 1994. Her managerial experience comes from a background in private practice and working for the NT government at the Darwin Dental Clinic. Anna, our certified DA, gained her extensive background in private practices. She completed her DA course in 1994, at the Royal Dental Hospital and continued working in specialists’ practices. Melissa, another certified DA, has a remarkable knowledge of dentistry as she has been a DA since 1986. Sarah, our part-time hygienist, works 1 day a week. She qualified in 2004 and has worked at both private practice and government clinics. Dr Stewart Cottis, an ex-serving ARA dental officer, looks after our members requiring specialist prosthodonticc care. His private practice is located in Glen Iris. Dr Rowan Story is our specialist Oral Maxillofacial Surgeon. Rowan is a Group Captain in the RAAF Specialist Reserve. His private practice is located in the Melbourne CBD. We would like to take this opportunity to thank all the members who come through our door. It makes coming to work so much more enjoyable. All of us here have made many friends along the way.

Army Reserve Units Dental Platoon 5 CSSB Banksmeadow, NSW MAJ Keith Heap

It wouldn’t be much of a dental unit without our dentists, Dr Murray Hayes and Dr Christine Williams. Dr Williams has taken her family for a holiday in Fiji as we write. Congratulations go to CADMUS 2009

Hello from 5CSSB. I’ve been actively involved in conducting dental exams for 5BDE soldiers at 5CSSB and 1HSB. I would like to say thank you to PTE Lauren Morgan who generously helped out on these weekends for the dental support tasks. Life at 5CSSB has been rewarding, knowing that the Reserve soldiers are very grateful that they can be examined, particularly those from the rural and remote areas. Another thank you goes to COL Murray Hayes, CAPT Amanda Leen and PTE Lauren Morgan, who generously put their hands up to help with providing dental exams to RCB-

88 members prior to their deployment to Malaysia. Without their support, the task would not have been possible. I am looking forward to taking the field dental equipment to Singleton to support the cadets as part of their annual field exercise in October 2009. Apart from dental work, I have also been active in the resuscitation bay with the Health Coy scenarios, improving my military skills, attending leadership development courses and keeping up with the never ending administration. Anyone wanting to get in contact can reach me at my civilian work email - keith.heap@justicehealth.nsw.gov.au . I would like to wish everyone a Merry Christmas and a Happy New Year from 5CSSB Health Coy.

Dental Platoon 11 CSSB Townsville, QLD CAPT Shane Hearps Greetings from 11CSSB - 2009 sees the return of 11CSSB to CADMUS. Our numbers have doubled this year with the arrival of PTE Maher after discharge from the ARA to pursue study at James Cook University. We can now conduct AIRN dental exams without having to borrow a DA from 3CSSB. For me, I have changed civilian employment and am now working for Aspen Medical as the CHP dentist at HMAS CAIRNS. There have been multiple weekend trips to Townsville for AIRN and HRR dental work and one week filling in for CAPT Craig at 3CSSB whilst he set the pace at the Arafura Games. I was fortunate to do the second dental rotation at AACAP Mapoon with CPL Broadway,

CPL Kempster and PTE Morgan. Highlights included catching the biggest barramundi in the fishing contest with another stainless steel fixation bar and screws to add to the AACAP trophy cabinet. I also attended part of the Dental Officers Initial Course at HMAS CERBERUS. It was a pleasure to meet a large group of ‘new’ ADF dental officers. In October, I will be involved with a Community Engagement Activity on Mabuiag Island in the Torres Strait with 51FNQR, as part of OP RESOLUTE. We will be providing AIRN dental exams for the military personnel and some general dental services to the locals, who only get a dental visit every 2 to 3 years! Hopefully the rubber-band powered handline will fit in and I may be able to provide some photos for the next CADMUS.

Dental Platoon 13 CSSB Perth, WA SGT Kelly Miller Greetings from the West! The past 18 months has seen some significant personnel changes. SGT Gaven Hogan has been posted inactive in 2008 to accompany her husband on a 2-year exchange posting to the US. Congratulations Gaven and we look forward to hearing your stories upon your return at the end of 2010. The vacancy was filled by SGT Kelly Miller who posted in mid2008 from MDSK - the first time in a couple of years this position has been filled by an ARA soldier. It has been a huge learning curve, as 13BDE has been a hive of activity with the deployments of our reservists a top priority for the Health Coy. So far this year, we have deployed 13BDE soldiers to RCB from August to November, with more deploying on OP ANODE in November. MAJ Ben Feng was promoted in December 2008 and has been busy enjoying courses and developing his linguistic skills by involving himself with support tasks. Just recently he successfully completed the MARC module 1 and will be completing module 2 in 2010. In 2009 we welcomed 2 newly transferred DO from the ARA. MAJ Jeff Ong and CAPT Victor Olsson-White both joined 13CSSB after many years of combined dedicated service to the ARA. 2010 will prove to be another busy year for 13CSSB with the return of the OP ANODE contingent in April when 13CSSB will once again provide a dedicated service of quality dental care and education to the members of 13BDE. We will also be actively recruiting to add to our dental team. Best wishes to all RAADC members.

CADMUS 86

CADMUS 2009

Royal Australian Air Force Dental Branch

Unit News No. 1 Expeditionary Health Squadron RAAF Base Amberley FSGT Heather Fitzgibbon

We have been fortunate enough to be visited by Director General Garrison Health Support, CDRE Robyn Walker, RAN and by Director General Corporate Health Management, AIRCDRE Tracey Smart during their staff visits earlier this year.

Greetings from 1EHS Dental Amberley. We’ve had a busy, yet exciting year so far. As usual there was a large turnover of personnel this year. At the start of the year we saw the arrival of SQNLDR Andrew Draper, finally escaping from Canberra to an Air Force unit. He is spending 2009 with us, then off to spend the next 3 years discovering what periodontists actually do, as he proceeds on civil schooling at Griffith University. Congratulations are also in order to SQNLDR Draper and wife Louise on the impending birth of their second child, due in December 2009. This year saw the induction of another new dental officer, FLTLT Sribalachandran who has hit the ground running and hasn’t looked back; he has completed all of his required courses and is now ready to gain further clinical experience as he works towards CL2 attainment in 2010. FLTLT Richard Lee has completed his requirements for CL2, which sees him off to Darwin in 2010. Best of luck Richard! WGCDR Michele Walker (left) CO 1EHS, FSGT Heather Fitzgibbon (centre) and CDRE Walker, RAN during the DGGHS visit in February 2009 The construction of a new dental facility, as part of a larger redevelopment of the 1EHS medical facility, is well under way. Once completed in early 2010, we will occupy a state-of-the-art 10-surgery facility with dedicated CSSD. For the first time, dental will be providing CSSD services to the whole medical and dental unit, and we have been asked to provide refresher training in the practical and theoretical aspects of sterilising for outpatient facilities.

We welcomed LACW Alana Price from Tindal at the start of the year, who in May married Brad McKeon in a beautiful tropical surrounding. She was also identified for promotion to CPL. Congratulations Alana, well deserved! She is off to the SDA course in October. We also welcomed ACW Amy Johnson and ACW Nicola Foot, both from HMAS CERBERUS. Our 2 military SDAP, CPL Kath Shaw and CPL Jo Thorpe, have worked tirelessly in clinic and both have been identified for promotion to SGT – congratulations! CPL Shaw has been posted to Townsville in 2010 while CPL Thorpe is remaining at Amberley, where we will utilise her outstanding skills in clinic and with her ongoing OH&S and audit commitments. Mrs Pamela Scamakas, our dedicated APS dental clerk, has returned to Amberley after 3 years in Darwin. Welcome back Pamela! CADMUS 2009

Congratulations are in order for Dr Andrew Wong, who was inducted into the International College of Dentists for his work with the ADA. This was announced at the ADA congress in Perth in March 2009. Congratulations Andrew! We are also provided with the ongoing support from our dentists, Dr Anoop Thakur and Dr David Rees, who consistently hold down the fort. We are very fortunate to have such a dedicated team of civilian staff and definitely could not have done without: Mrs Leah Sheldrick who is our Chandler-Macleod Health (CMH) practice manager, who keeps the place running along with DAs - Mrs Michelle Gibbon, Mrs Ally Grant, Mrs Jenni Richards, Mrs Catherine Van Der Westen, and our resident casual Ms Ally Carroll. New DAs joining the team are: Mrs Jules Van De Leur, Ms Felicity Martin, and casual Ms Lauren Gill. Thank you team! The sustained great team effort was recognised by CMH with a Team Excellence Award in July 2009. We have also seen the welcome return of Mrs Catherine Van Der Westen after some overseas travelling - it was only 5 weeks but

seemed like a lifetime. Congratulations to Mrs Annette Page who gave birth to a beautiful baby girl, Charlotte. A special mention must be given to the visiting specialists who have been providing their invaluable services. Periodontist Dr David Keys who retired from the Air Force after 30 years service, endodontist Dr Andrew Sainsbury who obviously missed the Air Force so he joined the reserves and our oral maxillofacial surgeon Dr Ben Erzetic, who we keep extremely busy. Overall it’s been a great year, with great people. We are excited about our move to the new facility in early 2010.

No. 1 Expeditionary Health Squadron Detachment Townsville RAAF Base Townsville LACW Donna Hayes “Aloha” from the ladies in tropical North Queensland. Big changes have come about for the Townsville dental section this year as we became 1EHS detachment Townsville. Our staffing has also had a makeover. The end of 2008 saw Dr Deirdre Ryan, Miss Shirley Beldan and LACW Donna Hayes holding the fort, as the other personnel posted closer toward the South Pole with the penguins. We welcomed the arrival of LACW Carly Caseur and civilian hygienist Miss Kellie Pennell, and saw the departure of FLTLT Nguyen to sunny Richmond. Reservist FLTLT Deirdre Ryan stepped up to the plate and is now the SDO While De was busy hitting the rails and carving the pipes on her snowboard at Mt Hotham, we had the pleasure of working with Dr Peter Craig, who flew in from Brisbane to help out (we have been offering him lots of homemade cakes and cookies in the hope that he will want to come back again). A big thank you goes to FLTLT Richard Lee who also took the time to help out our busy section in March this year. In 2010, we will be welcoming CPL Kath Shaw (SGT on promotion) as our dental supervisor and FLTLT Genie Kelloway as our new military dentist. The warmer weather has worked its magic for LACW Caseur, for not long after arriving in Townsville she is ‘baking her first bun in the oven’. Bubby is due to arrive on 1st October 2009 so unfortunately we will be missing Carly for a period of 12 months while she enjoys being a new mum. It has been a busy year with the various exercises taking place and constant deployments. We would like to take the opportunity to sincerely thank our civilian staff: Deirdre, Shirl and Kellie for their continual hard work and support. Together we all make an awesome dental team!

No. 2 Expeditionary Health Squadron RAAF Base Williamtown

Exercise ‘Cavity Search’ at the ADF Basic Flying Training School in Tamworth was another exercise undertaken by staff in March of this year. Deploying with the field portable kit and in conjunction with dental members from RAAF Richmond, FLTLT Kelloway, FLTLT D’Arcy, CPL Galvin and LACW Summersgill thoroughly enjoyed their Tamworth experience; tennis, restaurants, sightseeing, wineries, familiarisation flights in the famed CT-4, and even some dentistry thrown in! The start of this year saw the arrival of 2 new DENTOs to the unit. FLTLT Steve D’Arcy, an ex-Navy chopper pilot turned dentist and FLTLT Kate Aitken. We haven’t seen too much of Kate, who has been busy with OTS, however we look forward to seeing her more regularly in the second half of the year. We also welcomed ACW Teegan Walker, fresh off DA course and a new dental technician, Mr Theren Saxon, who filled the void created by our outgoing tech, Mr Mark Morris, who left us for Canberra. Fortunately, we still have dentists Dr Jan Eveleens and Dr Claire Novak holding the fort whilst everyone else is off playing in the bush. Keryn Slade is currently on MATL following the birth of her second child, Kate. The SDENTO bought a new house and hosted such a wonderful housewarming afternoon, all staff attending decided it would be the perfect location for our end of year party (unbeknownst to SQNLDR O’Sullivan) – I’m sure it will be fine! And lastly, CPL Ellie Desantis is leaving the Air Force. Ellie has accepted an APS position at Singleton and commences her new career in September 2009. Having completed almost 12 years in the Air Force both as a clerk and DA, we wish Ellie and her boys the warmest wishes and best luck for their future ventures. Finally, many thanks to our contractors and reservists, Dr Ian Wilson (oral surgery), Dr Steve Cave (orthodontist), WGCDR Matthew Ma (prosthodontist), and SQNLDR Matthew Hunter (periodontist) all of whom provide valuable services, specialist expertise and excellent learning opportunities for the younger dentists.

FLTLT Genie Kelloway and LACW Ellie DeSantis The year appears to be moving at a hectic pace here at RAAF Base Williamtown. At the time of writing this article we see SQNLDR O’Sullivan, FLTLT Steve D’Arcy, CPL Margy Galvin and LACW Natalie Summersgill all on Exercise Talisman Sabre in Tindal, NT. From all accounts it’s been a worthwhile opportunity to ‘shake out’ the deployable equipment prior to going on line again in September 2009. Dental staff treated patients during the exercise amidst ‘stand to’ and enemy attacks. The equipment and staff performed admirably over a number of weeks until the suction unit became a casualty itself, driving the dental staff back into the homely confines of the Tindal Base dental building. It was a demanding but rewarding month for all involved, with everyone happy to be home, despite the cooler climate of Newcastle.

No. 2 Expeditionary Health Squadron Detachment Tindal RAAF Base Tindal LACW Terri-Anne Dehncke 2009 started off exceptionally well - welcoming us back for the New Year was a 1 metre long brown snake in our orderly room. With our trusted wildlife expert CPL Di ‘Snake Catcher Extraordinaire’ Beningfield, on snake removal duties, we were ready to start our year with a full team on board for Tindal dental. We were unfortunate to lose LACW Alana Price to the sunny life

CADMUS 2009

at Amberley, but I am sure she is having a grand time with the new access to retail therapy. Look out IKEA! We also need to extend our congratulations to Alana, for her marriage to Bradley - we are certain that she would have made a beautiful bride. We welcomed FLTLT Helena Horina who posted in from Williamtown in January. Taken from the ‘big smoke’, to down-town Katherine, Helena has jumped into her role as SDO of an all-girl section, high heels and all. However vibrant she may be, as she enters the building at the start of each day, we know her heart is in her recently purchased property in Newcastle.

Courage. Last but not least, we have our dedicated SDAP, CPL Diane Beningfield, who has made the grade in being promoted to CPL in December 2008. Di has also been chosen to go on the Pacific Partnership deployment for 2009. We have all been very busy with courses - the whole dental section are now 4WD qualified, and also Defence Emergency Vehicle qualified - even Shenelle, who seemed to think that she could take a short cut on her journey, through the rocks, rather than around them! We are looking forward to Exercise Talisman Sabre at the end of June. Well the Tindal dental girls bid you a fond farewell for another year, we will be back next year to let you know all about the happenings up in the farthest place you will ever want to be posted, or not!

No. 3 Expeditionary Health Squadron RAAF Base Richmond SGT Rachel Dudgeon

We welcomed ACW Shenelle Douch, who was posted in from DA school at HMAS CERBERUS. Shenelle has a new-found love for the NT and it will be a hard task to remove her. FLTLT Horina and Shenelle make a great team - we are often amused by the sound of giggling coming from their surgery. Our FTA rate has lowered since their arrival and the Tim Tams are flowing. LACW Terri-Anne Dehncke transferred from RAAFAR to PAF in January and posted into Tindal following an 18-month CFTS position in Richmond. She has been around the dental traps for quite a few years and is glad to be back on the permanent payroll and loving Tindal.

The past year has seen not only a change and growth in staff but also a change in name – finally! No. 3 Combat Support Hospital has now been renamed to No. 3 Expeditionary Health Squadron. We have welcomed many new members and farewelled those who moved onto new squadrons throughout Australia. This year’s posting cycle has seen many new faces join the dental team in Richmond. With ACW Kellie Peters (DA), ACW Sarah Bate (DA), Miss Reagan Smith (DA), FLTLT Khai Nguyen (dentist), CPL Laura Kelly (SDAP), FLTLT Amy Dempster (dentist), ACW Crystal Lauw (DA), and Miss Leela Ridout (DA) all arriving in various stages throughout the year, we finally have the staff to support the growing dental demands of RAAF Base Richmond. 3EHS now boasts 5 dentists, 2 hygienists, 7 DA and a supervisor. We congratulate CPL Kelly posted in from Townsville on promotion. She has spent the better part of the year with an inconveniently broken finger but we are looking forward to her reducing the wait time for hygiene services here in Richmond. We welcomed both ACW Kellie Peters and ACW Bates who have graduated from the basic DA course in December 2008 after spending a month here under our watchful eyes for OJT. The dental team at Richmond farewelled LACW Terri-Anne Dehncke (posted to Tindal), LACW Michelle Sheils (posted to Pearce), and LACW Rebecca Teeling (posted to Williamtown). We wish them all the best in their new postings and endeavours. 2008/2009 has seen the field dental kit taken to Tamworth, the ADF Basic Flying Training School, and run through its paces alongside 2EHS, under the strict supervision of our very own FLTLT Nguyen (OIC). ACW Peters was also part of this exercise and found the experience to be a rewarding and steep learning curve.

SGT Kerry Sears is in her fifth year of her third stint here. Kerry was put on the ‘A’ list, when she was awarded the McCarthy, Rowbottom, and Jones Memorial Award for 2008. The award is in recognition of outstanding contributions to ADF operational health support by Air Force health personnel, whose actions exemplify the Health Services wing motto: Compassion, Skill and CADMUS 2009

With all the new members here at Richmond we must not overlook the hard work put in by the continuing members, both military and civilian. Without them, our unit would not be the same welloiled machine: Dr David Harmata, SQNLDR Alex Kwaan, Dr Nga Truong, SGT Rachel Dudgeon, Miss Kim Fuller-Sale, Miss Karen Conway, Miss Elizabeth English, Mrs Pat Speirs, and Miss Tess Redington. A big thank you also goes to our visiting specialists Dr David Wheatley, Dr Neil Peppitt, Dr Clarence De Silva, Dr Martin Cherry, Dr Matthew Hunter, and Dr Tony McHugh, who manage to work their way through all the tough cases. After all the changes and implementing of new systems and constantly evolving procedures it is hard to see what else we could possibly cram into the remainder of 2009. We are always looking forward to the challenges ahead!

No. 3 Expeditionary Health Squadron Detachment Darwin RAAF Base Darwin CPL Rachael Greenshields and LACW Kirrie Waldon Greetings all from tropical Darwin. The New Year started with the arrival of a couple of new faces. SGT Jason Randell, dental supervisor, posted in from the Australian Federation Guard to replace SGT Cath Brownin, who posted to Wagga. FLTLT Will Huynh saw greener pastures and has discharged to move to Tasmania for further training in Oral Surgery. Mrs Karen La Fontaine, hygienist, left us in July to work at Robertson Barracks and was replaced by CPL Rachael Greenshields, who returned after 5 years as a civilian. Let’s not forget the stayers - Dr Chris Mansfield and LACW Kirrie Waldon. They help to keep the place powering along through thick or thin. We look forward to the safe arrival of a uniformed dentist again, with FLTLT Richard Lee arriving in December on posting from Amberley.

the final stage of transition across from CSU-HSF to the new command structure, with us now coming under 4EHS. Meanwhile, Officer Training School (OTS) has continued to keep us on our toes, along with the increase in base personnel appointments and sick parade cases. We have also had the pleasure of being able to meet all of the new dental officers as they undertook their initial military training at OTS this year.

No. 4 Expeditionary Health Squadron RAAF Base Edinburgh FLTLT Harry Mohan My first day at the Edinburgh Dental Section began with a stirring speech by our practice manager Lisa ‘Coco-Pop’ Merritt, calling for a focus on professionalism in 2009. The floor was opened to discussion and a number of interesting points were raised and promptly lost in translation. A period of transition followed as I left for OTS, Rachel Greenshields re-enlisted as a CPL SDAP in the RAAF and then promptly moved to Darwin. SQNLDR Janine Tillott returned from maternity leave to relieve the relieved Dr Chris O’Donnell as SDO. As the days passed by, Rachelle Harris (DA) sought solace in her online fantasy life as a woodchopper, Karen Arnold (DA) romanticised about Edward Cullen, and our hygienist Mandy Walker acquired plastic poos to hide in the surgeries. Meanwhile in the bat cave (aka the dentists’ office), our resident armchair pilot Dr Richard Goyne dreamed of blue skies and white clouds, while Dr O’Donnell played his part in the global economic crisis. Dr Ella Chronowski and Dr Peter Wong continued to torture LACW Kate Priestley (DA) with tales of their 8-course dinners at the Hilton, as she survived on pizzas and 2-minute noodles while her boyfriend was at 1RTU, training to be a cook. And all the while Cecelia McCormack (DA) watched on, ruefully nibbling on her low-sugar snacks. With the superb efforts of our team we managed to maintain over 93% of the base dentally fit for deployment. LACW Priestley and SQNLDR Tillott completed the Ambulance Driver’s Course and are now rostered for patient transport, while I have spent a large part of the year attending required courses and training for dental officers. As we look forward to 2010, we say a sad goodbye to LACW Priestley, who is heading up to Tindal, and we begin to think of detox diets, summer fashions, and a renewed focus on ‘professionalism’. Good luck to us!

No. 4 Expeditionary Health Squadron Detachment East Sale RAAF Base East Sale

The dental team remains the same with FLTLT Robert Cox, CPL Melissa Riseley, and contractors Dr Clarke Barned, Mrs Kay Hambly-Clark, and Mrs Jo Rietschel keeping the Dental Section running smoothly. FLTLT Cox has spent most of the year in and out of the unit. He is preparing and sitting the FRACDS primary examinations in November, attending a 1-week dental conference in Japan in January, has taken on the new role of Unit Security Officer and commenced dental work placements at the Central Gippsland Hospital in Sale, which have exposed him to a number of cases that would be rarely encountered in the military. Dr Barned works tirelessly in continuing to keep the section running when the OIC is away and still finds spare moments to work on his golf swing. He has also provided significant support to the section in quality management, system maintenance and system improvement. CPL Riseley has reduced her hours working part-time to spend more time at home with her son. Kay has been busy keeping on top of the clinical and administrative duties while balancing her workload to allow sufficient time with family and friends. Jo has enjoyed working at the base on OTS intakes and we are grateful for her assistance on these challenging days. Jo also acts as replacement when Kay is on leave keeping the section at full strength. The Dental Section is happy to have received a long-awaited OPG machine and the associated construction of a purpose built OPG room. The second OTS course for 2009 was the first course on which all students had their OPGs taken utilising this new equipment. The dental team has continued with their dedicated approach throughout the year and the addition of new signage, both internal and externally, has helped raise the profile of the section. We continue to work well together in a friendly and welcoming environment, which is evident in the feedback from the base population, who have indicated their appreciation for our efforts in attaining optimal dental IR and providing quality dental care.

CPL Melissa Riseley Well hello for another year from 4EHS detachment RAAF Base East Sale. This year has been one of our busiest and has included

CADMUS 2009

No. 4 Expeditionary Health Squadron Detachment Pearce RAAF Base Pearce LACW Sacha Brown This year we saw the posting of LACW Kate Morris to RAAF Base Wagga. We hope Kate is enjoying being closer to her family home being in Canberra. In her place, LACW Michelle Sheils joined us. Michelle was introduced to the beautiful sights of Perth with a flight in a PC9 – many thanks to FLTLT Ray Hurley of 2FTS who was Michelle’s pilot for the trip. Michelle and her fiancé CPL Ben Cowley have decided to call Perth home. They are currently building their first home. House warming presents are of course welcome.

LACW Sheils in her PC9 flight Dr Tony Bartels is enjoying his time here. He has just moved into an old farm house at a vineyard in the Swan Valley. If you know his history you would know he is happiest when pruning grape vines to his hearts content. The unit will certainly be okay for fresh grapes in the New Year but we are really hanging out for the results of the wine making! CPL Charmaine Gurney, our dental supervisor, is as always keeping a watchful eye on the team and keeping us in line. With the introduction of HealthKEYS, Charmaine transferred all the Pearce members over to the new system without a hitch. She has also taken some well deserved LSL this year. LACW Sacha Brown is still on PTLWOP, enjoying motherhood to a two-year-old. The base here at Pearce has been abuzz with demolitions and redevelopment. Everything except the dental centre, it seems! We have had a major security exercise, which saw our resident dentist put on his former military hat to become our medical liaison officer. We have continued to provide dental care to the base, including our overseas comrades from 130SQN, the Royal Singaporean Air Force Pilot Training School. The team here at Pearce look forward to more drilling and filling and smiles all round. Have a great year!

No. 4 Expeditionary Health Squadron Detachment Wagga RAAF Base Wagga LACW Kate Morris As I sit here and ponder the year that has been, I hear the faint sounds of ‘left, left, left, right, left - change step’ as our future CADMUS 2009

airman try to march in time. This year our staffing numbers have remained the same, however, we lost our SDO FLTLT Marsha Muller and gained a DENTASST LACW Kate Morris. FLTLT Muller discharged from the PAF in March and returned to Queensland to be with her family. We wish Marsha all the best with her future career. We hold out in hope that one day soon, the manning gods will grant us a new SDO. Meanwhile SGT Kylie Williams is busy completing her Dental Supervisors Course and is preparing for her FSGT promotion course later in the year. Kylie has mastered the art of juggling as she took on extra duties as the OIC of our Dental Section in addition to running around after her sporty girls, who play in almost all of Wagga’s sporting teams. LAC Craig Leonard loves dental assisting but he is delighted to have been called to the bright lights of Canberra to join the Australian Federation Guard in July. We wish his shiny shoes safe travels in this new adventure. Craig was presented his 15 years service medal in March, a shiny addition to his uniform which will look impressive as he represents the RAAF in his new ceremonial role. LACW Charlene Duncan completed her SDA course this year and had her skills tested on her return to the section, taking bitewings for the whole recruit course on the first day back. Nothing like being thrown in the deep end! Charlene will be missed as she goes on maternity leave later in the year, we are currently taking bets on the baby’s sex and look forward to her return next May. LACW Morris joined us from Western Australia and was disappointed to realise that the 5 o’clock wave at Wagga beach was a furphy. Kate has learnt this year that it does not matter what you join the military to be, we all become clerks eventually. She spends her days trying to organise 1RTU with the help of her crystal ball. Miss Kelly Boyce continues to be the face of our orderly room, keeping the recruits and trainees in line - she is a force to be reckoned with! Kelly’s laughter can always be heard through the hall, making it an enjoyable place to work. Kelly is also completing her Certificate IV in Dental Assisting in her spare time. Our 3 civilian dentists remain a permanent fixture this year. Dr Miles Connell shares his time between here and Kapooka, charting up a storm. Dr Clive Connell ventures across to Wagga 3 days a week to help us with the never ending fight against caries. Dr Sharma Nand hangs up his soccer boots on Mondays and puts on a mask to run circles around teeth with a scaler. Sharma brings with him from Kapooka his trusty DA Shona Graham. Shona is new to us and replaces Debbie Buchanan. Well, that’s all folks for another year. Fingers crossed that the following one brings us some new faces and more adventures.

No. 4 Expeditionary Health Squadron Detachment Williams RAAF Base Williams CPL Leah Thomas We have had many changes here at the dental section. Two of our civilian staff left at the end of 2008 to have beautiful baby girls. Hayley Tehan had gorgeous Zarah and Chloe Stone had lovely little Ava. We welcomed CPL Corryn Perna in late 2008. Another addition is CPL Leah Thomas, as the new dental supervisor in 2009. Our new hygienist Sam Stuart is also settling in nicely. Sam has just returned, completely tanned, from 2 weeks holiday in Fiji and we are glad to have her back. Corryn just completed her CPL promotion course and has enjoyed every minute of it. She is also very excited about her upcoming wedding to Greg Johnston in October and we all wish her the best for married life.

Cook. This is our busiest time of year so we all have our heads down working hard. Our fearless leader, FLTLT Robyn Barrie, is currently on PTLWOP which has her working 6 days per fortnight seeing patients and being the Unit Safety Advisor and Infection Control Officer for all of 4EHS DET WIL.

We currently service RAAF Base Williams, 2CDO COY in Williamstown, SCMA in Geelong and 8/7RVR in Ballarat. We also service Gap Year students undertaking their training at Point

Our other dentists do not disappoint either. Dr Melinda Johansson works 1 day a week, while also being a budding writer! GPCAPT (Prof.) Martin Tyas graces us with his presence 2 days per week, when he is not jet-setting to universities all over the world. He was recently appointed a Member of the Order Australia (AM) in the 2009 Queen’s Birthday Honours List – congratulations! Our resident prosthodontist, Dr Graham Woolley has received the WM & AV Eggleston Trust ‘Excellence in Teaching’ Award from the Melbourne University and provides prosthodontic and implant treatment to many ADF members across metropolitan Melbourne. Sharon Smith and Tania Henry are, as always, working hard to assist our dentists and keeping the place cheerful and the staff plump… please Sharon stop being such a great cook! If you are ever down in Laverton, please drop in and visit - we will have a cuppa waiting!

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CADMUS 2009