The Oral Health Centre of Western Australia

• General dental services such cleanings, fillings, dentures and extractions are provided to patients who fulfil the eligibility criteria.
• General dental services are also provided at low fees for income-support patients who are ineligible for subsidised treatment but who meet relevant low-income criteria. Evidence of income will be required.
• General dental services are provided by dental students under direct supervision by experienced dentists and dental specialists, or by qualified general dentists.

OHCWA is the sole provider of specialist dental services to public dental patients in Western Australia. Specialist services include:

Endodontics

Endodontics is the special branch of dentistry that deals with the soft tissue inside the tooth. This tissue is called the “pulp” and it is located in the root canal part of the tooth. The pulp tissue can become inflamed and then infected as a result of decay in your tooth, or when there are old restorations (fillings, crowns, etc.) that are breaking down. Cracks in teeth are another common cause of these problems. Once the root canal system becomes infected, it can cause inflammation of the tissues and bone that surround the tooth root. Hence, it is important to have these problems treated in order to avoid more complicated problems from developing.

Endodontists are specialist dentists who have had advanced education and training in managing disease of the pulp and the tissues surrounding the tooth root.

The main treatment provided for these conditions is known as “root canal treatment” and it is performed to save your tooth. It is not an uncomfortable procedure so you should not be concerned about having this treatment done to your tooth. Root canal treatment is usually done over several appointments. Your Registrar or Endodontist will explain the procedure to you so you know what to expect. In some cases, root canal treatment will not be suitable and your tooth may need to be extracted but our first aim is always to try and preserve the tooth.

Once the root canal treatment has been completed, you will need to have the tooth restored again. and you will be advised about this at your consultation appointment. It is also important that teeth are reviewed after the treatment has been completed to ensure the tissues heal. Reviews are usually done after 6 months and then after every few years, depending on the tooth and its original problem.

Root canal treatment is sometimes needed after a tooth has been traumatised – such trauma could lead to fracture of the tooth or the tooth may be knocked out of its usual position. Endodontists are experts in managing dental trauma.

Your Registrar or Endodontist will work with your general dentist or other specialists that you are seeing in order to provide the best possible outcome for you.

If you have any questions or concerns, then be sure to tell your Registrar or Endodontist so he/she can answer your questions and discuss any concerns with you.

Oral medicine

Oral Medicine is the specialist branch of dentistry concerned with the diagnosis, prevention and predominantly non-surgical management of medically-related disorders and conditions affecting the oral and maxillofacial region, in particular oral mucosal disease and orofacial pain, as well as the oral health care of medically complex patients.

Oral Medicine Specialists are specialist dentists who have had advanced education and training in managing mucosal disease of the oral cavity such as ulcers, potentially malignant disorders, fungal infections, and benign and malignant growths. They also manage pain in the orofacial region including your head, mouth, and face. Additionally, Oral Medicine Specialists are involved in managing and minimizing the oral presentations of systemic conditions. Oral Medicine Specialists manage these conditions through a range of evidence-based approaches including but not limited to pharmacological (prescribing medications), surgical intervention (excisional and/or incisional biopsy), oral and temporomandibular appliances, and long-term monitoring. Depending on the condition, many patients are reviewed by Oral Medicine Specialists every 3-6 months.

Your Registrar or Oral Medicine Specialist will work with your general dentist, general practitioner, or other specialists that you are seeing in order to provide the best possible outcome for you. If you have any questions or concerns, please tell your Registrar or Oral Medicine Specialist so they can answer your questions and discuss any concerns with you.

Oral surgery

This is a speciality that combines dental, medical and surgical expertise. The speciality is uniquely placed to manage medically complex patients who require surgical management of their oral maxillofacial pathology. The specialty deals with surgical management of benign oral maxillofacial pathology, head and neck cancer, salivary gland pathology, facial fractures, dental implants, dentoalveolar surgery, orthognathic surgery and temporomandibular joint disorders.

DMD students are taught medicine in relation to dentistry, simple dentoalveolar surgery and attend the day surgery unit where they observe the OMS team carry out dentoalveolar surgery and surgical management of benign oral maxillofacial pathology.

Orthodontics

Orthodontics is one of the specialised disciplines in dentistry that is focussed on the prevention, diagnosis, and treatment of dental and facial irregularities. These problems may include teeth that are crowded or too far apart, teeth that meet abnormally or don’t meet at all, teeth that stick out, and mismatched jaws.

Orthodontists treat existing problems, and can identify problems that are developing, and take timely action to resolve problems before they fully develop. Orthodontists treat patients of all ages, they regularly treat children, adolescents and adults.

Orthodontists use the full range of “appliances” to correct orthodontic problems. The “appliance” is the term used for the device that moves teeth. It can be a removable plate, traditional braces, clear aligners or braces on the inside of the teeth. The Orthodontist is uniquely qualified to recommend the most appropriate type of “appliance” to correct an individual’s problem.

Your Orthodontist or Registrar in Orthodontics will work together to answer any queries regarding your treatment needs and the choices that you may have for treatment.

Paediatric dentistry

Paediatric dentistry is an age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.

This speciality encompasses domains such as behaviour guidance, care of the medically compromised, children with special needs, oro-facial growth and development, prevention and management of tooth decay, sedation, pharmacological management and hospital dentistry as well as other standard domains of dentistry. These skills are applied to the needs of children throughout their ever-changing stages of development and treating conditions and diseases unique to growing individuals.

Paediatric dentistry embraces a variety of disciplines, techniques, procedures and skills that share a frequent basis with other specialties but are modified and adapted to the unique requirements of infants, children, adolescents, and those with special health care needs.

Accordingly, Specialist Paediatric Dentists provide a range of treatment including preventive and restorative services through to dentoalveolar surgery. The descriptions of care routinely offered include, but not limited to, is the management of:

• Children with complex treatment needs or extensive tooth decay including treatment under local anaesthesia, relative analgesia or general anaesthesia
• Children with medical and genetic conditions and the impact of these on oral health and dental treatment

• Dental injuries to both primary and permanent teeth
• Children with dental conditions such as missing teeth, extra teeth, enamel defects and the abnormal eruption of teeth
• Children with anxiety or behavioural issues
• Very young children and infants

Periodontics

Periodontics is the dental specialty that focuses on the treatment of gum (periodontal) disease and other oral conditions affecting the soft and hard tissues that support the teeth – the periodontium.

Periodontitis is often known as 'gum disease' and is a very common condition in which the gums and deeper periodontal structures become inflamed. This inflammation of the gums, which usually takes the form of redness, swelling and a tendency to bleed during tooth brushing, is the body’s response to certain bacteria that have been allowed to accumulate on the teeth.. If left unchecked, the inflammation can spread down below the gums and along the roots of the teeth, causing destruction of the periodontal ligament and the supporting bone. This ultimately leads to loosening and potential loss of the teeth. It is now understood that untreated periodontal disease can also have effects on general health; for example, it poses an increased risk of heart disease and diabetes, among other conditions.

Periodontists are dental practitioners who specialize in the prevention and treatment of diseases of the tooth-supporting tissues – the periodontium and their sequelae. Although all dentists receive training in the diagnosis and treatment of mild to moderate periodontal disease, it is usual practice to refer severe or complex cases to a Periodontist, who will have undertaken additional training and acquired special expertise in the area.

If youare diagnosedas having periodontal disease, your Periodontist may recommend a range of treatments. Commonly, treatment involving oral hygiene instruction and advice and thorough debridement (deep cleaning) of the tooth root surfaces will be undertaken over a number of appointments. In some cases, periodontal surgery may be required to gain adequate access to the root surfaces. In addition, a range of surgical treatments may be available to achieve a number of aims. Commonly surgery may be undertaken to:

• Gain access to the root surfaces
• Reduce the depth of periodontal pockets
• Regenerate lost periodontal attachment
• Increase the amount of tooth above the gum for restorative procedures
• Graft tissue into areas where disease has result in loss of gum tissue

After the active phase of treatment has been completed, your dentist will need to review the condition of your gums at regular intervals to check that the inflammation has been halted and prevent recurrences. The frequency of your follow-up or maintenance appointments will depend on the severity of disease and your individual risk of disease progression. months.The long-term success of periodontal treatment depends both on your own efforts with oral hygiene and those of the practice team who provide your regular care and ongoing assessment

Prosthodontics

Prosthodontics is the dental specialty pertaining to the diagnosis, treatment planning, rehabilitation, and maintenance oforal function, comfort, appearance, and health of patients withclinical conditions associated with missing or deficient teeth and/ormaxillofacial tissues by using biocompatible substitutes.

In the first instance it involves a detailed analysis of the patient’s functional and aesthetic concerns, the nature and extent of the disease processes affecting the intra and extra oral structures. Through the process known as a diagnostic workup, a determination can be made as to what the problems are, how they can be addressed, and recommendations can then be made as to whether or not treatment would be beneficial and if so the most appropriate treatment plan tailored to the individual’s specific needs. The patient will be provided with a detailed discussion on the nature of their problems, causes and preventive measures required. As needed, the treatment proposals will be presented together with the risks, benefits, longevity and investment required for the rehabilitation as well as alternative options.

Often complex situations may require multidisciplinary management so that it is incumbent on the Registrar to integrate and coordinate this process of management when involving other areas of expertise.

Broadly speaking prosthodontics involves fixed and removable prosthodontics. Each contains a broad range of materials and techniques, (both analogue and digital), which can be selected and customized for individual needs. Thecategories are classified as:

• Fixed dental prostheses are any artificial devices that are securely attached to a natural tooth or teeth, or to one or more dental implants/implant abutments. They cannot be removed by the patient.
• Removable dental prostheses are complete or partial dentures, overdentures, or maxillofacialprostheses that replace some or all missing teeth and/or supporting structures.The prostheses can be readily inserted and removed by the patient.
• Maxillofacial prosthetics is thebranch of prosthodontics concerned with the restoration and/orreplacement of stomatognathic and craniofacial structures withprostheses that may or may not be removed on a regular or electivebasis.

Your Registrar and supervising Prosthodontist will work together with you in order to provide the best possible outcome. It is important that if you have any questions or concerns, be sure to discuss these with your Registrar or Prosthodontistso that they can be addressed.

Specialist dental services are available by referrals only. Such referrals are accepted by OHCWA subject to their compliance with Specialist Referral Guidelines. Should a referral not comply with these guidelines, specialist treatment will not be provided.

An emergency clinic operates in the Centre’s annexe clinic in E Block (map) of Sir Charles Gairdner Hospital from 2pm to 5pm on Saturdays, Sundays and public holidays.

• The Emergency Clinic will only accept patients over the age of 16. Please refer to Perth Children’s Hospital Dental Emergency if the patient is under the age of 16.
• Please call (08) 6457 7626 between 1:30-4:30pm on weekends and public holidays to arrange an appointment.
• Triage will be performed over the phone and determine if an appointment will be given. The general criteria for an appointment to be given are:
  • Trauma
  • Haemorrhage (usually post-extraction)
  • Facial swelling
  • Severe dental pain – such as pain not relieved by over-the-counter analgesics, or pain that wakes you up at night
• Patients should be present at the Emergency Clinic no later than 4.15pm to enable completion of registration and treatment. The Emergency Clinic offers emergency dental treatment only. A fee applies to all emergency treatment, but a subsidy is provided to holders of Health Care and Pensioner Concession Cards. Holders of these cards will need to present a current card at the time of treatment to receive this subsidy.

For after-hours emergency treatment at other times, please contact Dental Health Services Emergency on 1800 098 818.

• OHCWA provides subsidised general and specialist dental services to members of the WA public who meet the eligibility criteria determined by the WA Government. To be eligible for subsidised treatment, patients must be a holder of a current healthcare or pension concession card. The level of subsidy depends on the amount of benefit received. Prospective patients should phone (08) 6457 4400 for information about eligibility.
• Patients are required to either produce a statement of their benefit or sign a consent form to authorise the Oral Health Centre to access their Centrelink benefit details so their eligibility and subsidy can be confirmed. Patients are required to show their up-to-date healthcare or pension concession card at each appointment.
• As part of the WA public dental system, OHCWA has a catchment area which includes suburbs from the following postcodes: 6007-6012, 6014-6015, 6018-6019.
• For eligible patients who lives outside the area, the first point of contact should be their local Dental Health Services (DHS) clinic: Find your DHS.
• For patients who are suitable as student cases or referred as specialist cases, the catchment area condition does not apply.

• Dental treatment is not covered by Medicare. All treatment at OHCWA will involve fees.
• The fees are based on the Commonwealth Department of Veterans Affairs Schedule of Fees. This fee structure is adjusted on a regular basis.
• The WA Government will subsidize a portion of the fee for eligible patients depending on their subsidy level. The patient must pay the remaining portion of the fees.
• Fees for each procedure are expected to be paid at the end of the appointment. Subsequent appointments will not be arranged, or may be cancelled, if there is an outstanding balance.
• Deposits are required for some procedures. Please ensure you discuss with your clinician what is required in order for your treatment to proceed.

There are waiting lists for different treatments at OHCWA, and especially for most specialist services.

Other than emergency appointments, patients are treated strictly in accordance with when they were placed on the relevant waiting list.

Patients on waiting lists are asked to understand and accept that the Centre must be fair to all patients. This means that we are unable to treat someone before another patient who is ahead of them on the waiting list.

Waiting lists exist for:

• Student clinic
• General dentistry
• Endodontics
• Oral medicine
• Oral surgery
• Orthodontics
• Paediatric dentistry
• Periodontics
• Prosthodontics

OHCWA has continuously maintained its national accreditation status. This is achieved through having a focus on continuous improvement, management of clinical and operational risks and ensuring a partnership approach forms the basis of dental care and treatment. We also value feedback from our patients and carers through our annual patient satisfaction survey along the opportunity for patients and carers to provide immediate feedback. Feedback can also be made through our external web site.

As part of our commitment to accreditation:

• We have a focus on patient-centred care
• We value the diversity of our patients and carers
• We engage consumer representatives in the governance of our organisation
• We provide safe quality care at all times
• We comply with evidence-based infection control practices
• We provide a safe, clean environment for patients, carers, visitors and staff
• We strive to continually improve

OHCWA has achieved continuous accreditation and is assessed against the National Safety and Quality Healthcare Standards by the Australian Council on Healthcare Standards. This requires us to ensure we uphold the rights and responsibilities for our staff, patients and carers.

There are certain standards of behaviour that both patients and OHCWA are expected to adhere to.

During your visit to OHCWA, you can expect the Centre to:

• Provide privacy and confidentiality for any discussions and treatment.
• Ensure that written and spoken communications relating to your treatment are kept confidential.
• Provide you with adequate information about the nature of your dental condition and the risks and likely outcome of your treatment.
• Give you treatment options appropriate to your dental and medical condition and needs.
• Enable you to participate in and give consent to decisions regarding your treatment.
• Enable you to have additional professional opinions if you request one.
• On request, provide you with the names and professions of those providing your dental care.
• Allow you to decline or refuse treatment.
• Support and respect your religious beliefs and customs.
• Allow you to sight your dental records and receive copies if required.
• Inform the Centre of any feedback you wish to make.

During your visit to OHCWA, the Centre will expect you to:

• Give your dentist accurate and full information about your dental problems, your medical history, the medications you take and any other matters regarding your health.
• Inform the Centre of any changes in your eligibility status in relation to your Centrelink or Veterans' Affairs benefits.
• Inform the Centre of any changes to your contact details.
• Consider the rights of other patients and of the Centre's staff.
• Attend for treatment in an appropriate state and conduct yourself with courtesy.
• Respect the Centre and personal property.
• Settle any account before leaving the Centre or as soon as practical thereafter.
• Tell your clinician of any change in your dental or medical conditions.
• Accept the consequences of declining treatment or instructions.
• Ensure that you have fully understood the treatment plan presented before accepting.
• Follow the treatment plan recommended by the practitioner coordinating your care. OHCWA is a zero tolerance work place.

OHCWA is a zero tolerance work place. There is zero tolerance towards abuse, aggression or violence in OHCWA. Security will be called if any staff member feels threatened.

• Bus routes 24/25/96/97/103/950/998 stops outside OHCWA/PCH/QE2
• Information of Transperth services to OHCWA is available via Transperth Journey Planner or call 13 62 13.

• There is a fee-payable patient carpark in front of the Centre entrance, under PCH and across from QE2 in the multi-storey carpark.
• For patients with appointments, please display your appointment letter on the dashboard in the event the appointment runs overtime.