Then and now: The Australian Schedule of Dental Services and Glossary

More than 36 years ago, some members of the ADA’s Recent Graduate committee were tasked with putting together a glossary of dental terms that would assist and standardise communication between the dental profession, health funds and the general public. From humble beginnings, the affectionately acronymed ‘S&G’ has become a definitive and essential classification and reference document nationwide.

Now that the 13th edition has been released in print, here with this issue of the News Bulletin, and takes effect from 1 July, we take the opportunity to look back at how very far the Schedule has come over the years.

As far back as the late 1970s, as Dr Denise Salvestro tells it, one of the major health funds approached the NSW Branch of the ADA to see if they could compile a glossary of dental terms they could then give to all their consultants to be able to reference and understand all the different dental treatments. As Chair of the Recent Graduate committee at the time, she was called upon to tackle this considerable undertaking.

“It’s really exciting to think we were there, you know – at the instigation, the birth of it!” she says. “Being the Chair, I was in charge of the project, and I then got a few other dentists and specialists to assist me with their knowledge of their different specialties: Dr Tony McHugh, a periodontist who did a huge amount of work on it, and we also called upon Dr Terry Ratcliffe who had specialties in both orthodontics and oral surgery, so he helped us with those areas.

“Tony and I basically put it all together, and we then handed it in to the CEO, and it was published as a tiny little booklet – a little paperback thing that made up the first version of what is now the Schedule.”

At this time, the common form for billing by dentists simply stated ‘Fees for professional services’ without any kind of clarification or detail, remembers the current Chair of the Schedule and Third Party Committee, Dr David Curnow. Now, however, he sees the Schedule as going way beyond its original remit.

“Its main function is to describe the various outcomes of dental treatment in a systematised and widely understood manner; the fact that it’s used by health funds and other third parties for purposes of rebates or remuneration, etc., is now really secondary to the main purpose which is the description of dental services in a universally accepted manner,” he says.

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Definition and diagrams

The document’s beginnings as a descriptive and reference-worthy glossary, then, are important to recall.

“We both recall sitting in my unit here at Waverton on the floor doing the diagrams,” says Dr Salvestro, “doing draft after draft, editing and changing and gathering more information as we went – it was no mean feat!

“There were different aspects of each diagram, describing the different parts; then we talked about the different types of restorations and treatments that could be done, and we made sure these were not complex but very simple definitions, as it was mainly directed to lay people at that stage.”
 

Adding schedule to glossary

As dental treatment became more complex, and particularly as health funds began to give more rebates, the system of itemisation became more formalised, and more treatments began to be included. From 1996, An Australian Glossary of Dental Terms became The Australian Schedule of Dental Services and Glossary.

The ‘basic little booklet’, as Dr Salvestro describes it, kept many of the original diagrams, but started to become an essential reference as more and more treatments were progressively added. This has now become a major part of the upkeep of the Schedule, to understand what to add, when to add it – and what to leave out.

“It’s evolution rather than revolution, I think,” says Dr Curnow. “The point of doing revisions is to try and keep abreast of contemporary developments in dental treatments but, on the other hand, we don’t tend to jump on every little new thing immediately.

“We are also approached regularly by manufacturers or suppliers of new devices or materials, etc., in the hope that we will develop an item number specifically for their particular thing, but that’s not really the purpose of what item numbers are about. Whilst occasionally that’s appropriate, most of the time, descriptors of item numbers are written as generically as possible, so it doesn’t refer to specific materials. We also find that several ways of doing things, using slightly different materials or techniques, will still be covered under one item number.”
 

From the pandemic to beyond

Considering each iteration of the Schedule has a lifetime of at least a couple of years, the Committee is mindful to keep it as futureproof as possible. In the lifetime of each Schedule edition, members can see changes in commonly used materials and techniques, and the Schedule must be written and planned as to reflect the reality of dental practice in Australia.

Due to the upheaval caused by the COVID-19 pandemic, in both the profession and wider society, it would be natural to wonder how meaningfully this historic couple of years has changed and/or characterised this latest 13th edition of the Schedule.

“Well, I think the main thing with respect to the pandemic – apart from the Committee holding seemingly countless Zoom meetings to meet this challenge! – was to sort out what was momentary and what effected lasting change in the profession,” says Dr Curnow. “The ADA obviously reacted to the pandemic in a number of ways, one of which was to introduce an item number regarding teledentistry. That was an immediate response to the fact that dental practice was being limited across various jurisdictions, and by inclusion, it was effectively recommending that some consultations be carried out in that way. Now we can see that [teledentistry] seems to have been successfully utilised, so we’ve given real permanence to the item numbers related to telehealth consultation and treatment, all of which aligns quite closely with existing examination and consultation item numbers. They have become a regular feature rather than simply an emergency item number in response to the pandemic. I think, by introducing these numbers in the form that we have, we’re effectively indicating this is probably going to be an ongoing feature or component of practice.”

Teledentistry is far from the only notable change, however, with much diagrammatic content now updated, and a new maxillofacial prosthetics section.

“I think that the Committee’s worked fairly tirelessly and pretty hard,” says Dr Curnow. “We’ve probably had a broader, more extensive consultation process with stakeholders than has ever been previously conducted. The main thrust of the new Schedule, on top of the new teledentistry and maxillofacial sections, is an attempt to make the terminology we’ve used much more consistent throughout the document. With the new maxillofacial section, whilst there were limited item numbers previously for aspects of maxillofacial prosthesis, this edition’s section covers it all comprehensively. There’s also been quite a bit of work done on updating the implant prosthetics section to reflect contemporary practice and understanding of that aspect of practice.

“The Committee’s work is ongoing, even now that this 13th edition is in print, as we conduct webinars this month introducing this Schedule, and we always continue to respond to queries all year round from members and stakeholders in regards to how it is applied. It is always a work in progress, always being developed, and that is why it is such a meaningful document.”
 

Schedule clarification

Any dentist or third party requiring clarification or interpretation of the Schedule should contact the ADA as it is only the ADA’s interpretation that is valid. Send your questions to contact@ada.org.au

A guiding principle of the Schedule is that item numbers are intended to describe an outcome rather than a technique or use of a particular technology. As the treating practitioner is responsible for the accuracy of records, including item numbers used to describe their dental treatment, they should ensure the outcome of treatment is what drives their item number usage, not variations in technique or materials used, or expectations of private health insurance rebates.

“One of the principles of the Schedule is that, if we make new item numbers for something, it’s then considered to be a fully accepted form of treatment – and not everything new will reach the stage where it is routinely accepted by a majority of practitioners.

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