Member spotlight: Meet ADA Board Director Dr Andrew Gikas

A longtime active member of ADA committee life, and one of the current directors of the ADA Board, Dr Andrew Gikas is all about setting up the profession, and the next generation of dental practitioners, for ever increasing success.

Tell us about your current professional situation?

I have recently left the suburban private practice in Oakleigh in Victoria, that I set up and built in 1994. I thoroughly enjoy private practice and it has been difficult leaving my long-term patients after 30 years of looking after them, but I am not about to hang up the handpiece yet.

I currently have two jobs. One is as a visiting medical officer in dental services at the Alfred Hospital in Melbourne. For half a day per week I run an oral appliance clinic that focuses on treating patients diagnosed with snoring and obstructive sleep apnoea. It is a busy clinic that plays an important role in the multidisciplinary care of patients with sleep disorders. Dental students, medical registrars and interested colleagues come through the clinic at various times to follow patients through their journey to finding better sleep and better health. As the clinic grows, we are exploring some research opportunities in combination with some of Melbourne’s and Monash’s world-class sleep researchers.

My other job is as the Clinic Director and private practitioner at the 50-chair Melbourne Dental Clinic (MDC), which was established by the University of Melbourne in 2013 to provide excellence in clinical education for the next generation of dental professionals, and increase access to comprehensive dental care for members of the public. As one of the largest academic dental clinics in Australia, we are unique in our ability to offer comprehensive general dentistry services, as well as services in six specialty areas in one location. We also have private practice rights for interested academics and a select few clinicians who provide private patient care.

The MDC is part of Melbourne Teaching Health Clinics (MTHC), which provides patient care in dentistry, eyecare, hearing, speech, and mental health in a central location in Melbourne and general medical practice in Shepparton. The focus now is on collaborative practice, collaborative learning and collaborative curriculum development.

You practised in regional Victoria before returning to the city. How do the two experiences compare?

Like most recent graduates I went where the jobs were at the time. I was lucky to end up in a busy practice in Morwell with a great boss, a new surgery fit-out, plenty of patients and a solid group of local ADA member dentists who became my first mentors. I thoroughly enjoyed the collegiality and the ability to share cases and experiences as I developed my skills and private practice following. Patients were genuinely thankful that I had taken on the role, and it didn’t take much time to fill up the books.

With a good flow of patients, I had plenty of opportunities to undertake the full scope of general practice and, with limited ability, to refer to specialists; I pushed myself a little bit more than I would have done in the city. Within four years I was confident enough to come back to Melbourne and set up my own practice. I am not sure that would be possible today, doing the simple math – it would be a much different risk profile doing the same in 2024 compared to 1994.

You’ve been involved at both a state and federal level with the ADA. How has your involvement in the ADA influenced your career?

When we graduated, it was expected and an honour to be invited to join our professional Association. To have some of my teachers, mentors and dentists I looked up to be in the same room was a drawcard. The collegiality, the networking and the professional learning that one can achieve face to face is second to none. The lockdown years accelerated our involvement in digital and social media networking, but there is something about reading body language, sharing an off-the-cuff comment, and about human connection, that gives more bang for your networking buck.

I enjoyed running the local ADA suburban study group. A highlight for me was the presentation by our ADA Councillor, who would bring to the group the latest information on what was happening with PHI, government funding, local regulation, practice accreditation and CPD. Dental politics is something we all have our views on, and being able to sit in on the conversation as it was happening appealed to me.

From the suburban group, I received enough encouragement and votes to nominate for the Victorian Branch Council, putting my name up for election on eight or nine different occasions and successfully (and other times unsuccessfully) to get to this point in my ADA career.

I understand volunteering is not for everyone but if anyone is interested, I would certainly encourage them to nominate for ADA committees or Council. A healthy Association needs members across the whole spectrum and we each play our role. Some have a capacity to help, and others a capacity to be helped. A long as one knows what they would like to gain from their membership and we have the capacity to deliver, then we are in a good space.

The cost in time away from the practice is not measurable, and probably eye watering if you did the math, but the benefits in contributing, working with some excellent people, building a network, building a profile, contributing to the greater good and helping to shape decisions about our profession is something that resonates with me. If I wasn’t involved in the ADA, I probably would have been involved in the local council, having spent some time on the local Chamber of Commerce and local footy club boards.

As a practice owner I felt that I represent the views of other practice owners. As my career has shifted away from private practice, I feel that I hear about career opportunities often, and many times I might be involved in suggesting someone for a job. But contacts and references only get someone so far; results and achievements come with hard work.

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What are your areas of special interest?

It’s probably easier to list what I am not interested in. Although I do enjoy learning and building my knowledge up on orthodontics and implant surgery, it’s not something that I have enjoyed enough to pursue in clinical practice. I have completed a couple of full banding cases and a couple of implant surgeries, but unless I am dedicated enough to perform dental treatment to the standard that my patient deserves, then I would rather refer it to someone who does more of it than I do.

My big interest is in dental sleep medicine (DSM), particularly oral appliance therapy for sleep disorder-associated breathing. DSM was very new in the late ’90s; only a handful of dentists Australiawide were involved in the field, so I felt that I could do it as well as they were doing it. I kept up to date and involved by travelling to conferences all over the world, sitting in the same room as the world leaders in the subject. I have always been driven by wanting to run a world-class DSM clinic, and I have done this now for some time – most recently partnering up with the sleep units at the Alfred, the Royal Melbourne and the Austin Hospitals, where the focus is on public patients, teaching and future oral appliance research.

Dental sleep medicine is fast becoming a mini speciality. Through the Australasian Sleep Association, we have set the foundations for a fellowship in the field and, to date, we have put through 30 dentists in Australia, with a planned 15-20 each year. As numbers grow and long after I retire, I envisage that sleep will play a bigger role in general dental practice and may even become a specialty on its own.

You are currently a clinical tutor at your alumni (UMelb). How do you see current students’ experience compared to yours?

Fundamentally, the learning of dentistry is not dissimilar. There are didactic lectures, exams, vivas and patients to see. Competencies are well articulated, and students are either ready or not ready to graduate at the end of their time, but there are differences in the experiences overall.

When I went through dental school it was straight from year 12, and it was a five-year course. Now they must have completed a separate undergrad degree before entering dental school. This makes them older, wiser, more educated and in greater debt when they graduate. When we graduated, practices were owned by dentists; they took on new grads with the expectation and knowledge that they were taking on a work in progress. Patients would look at us as 23-year-olds, get that we were new to the profession, and afforded us some learning leeway. I fear today, with the combination of non-dentist practice owners and the expectation to catch up to their peers as quickly as possible, that there is a greater focus to be ready and productive earlier.

Of course, technology has changed. The use of sim labs and technology has meant that current students are able to practise their hand skills faster, and learn techniques more quickly and safely. What they gain on practising on models is counterbalanced by the need to be better at communicating, better at treatment planning and better at managing the patient, in a time when risk of notifications and insurance claims is greater.

Finally, the aesthetic demands of patients are higher. Awareness, improvements in materials, adhesives, techniques, digital photography, scanning and the demise of amalgam means that every restoration is going to be judged next to the standard that patients can see on Instagram. You can’t expect to get away with ugly.

So, knowing all this, the current student expects and wants to do as much as possible during their shorter time at dental school, do it at the highest standard and is disappointed if they are not provided with the opportunity to get there, whereas we just wanted to scrape through, have a great time and get out the door as quickly as possible.

What do you see in the future for Australian dentistry?

AI, technology and robotics are going to change the way we practise. I don’t have a crystal ball but it won’t be long before we have machines cleaning teeth, loops/glasses with AI built in that will guide you to cut the perfect prep and restorations printed benchside. Once we get adhesives that work underwater, then the future will be cool.

The challenges will be how dentistry is funded. With rumblings about incorporating dentistry in Medicare, the growing inefficiencies of PHI and the growing public dental lists, it will be vital that the profession remains united in our advocacy. While your professional Association represents most dentists (over 70%) then we have a solid voice that we can take to the decision-makers. We may not always get what we lobby for, but the alternative of a fractured profession, individual groups advocating on different platforms and not singing from the same hymn sheet, will be challenging on a number of levels because governments making decisions without input from the professions will get it wrong.

You’ve been involved in promoting oral health for some time. How did you get involved in this?

I started presenting oral health messages to new mums and dads as part of Monash Council’s and DSHSV’s ‘Freeway to a Great Smile’ and ‘Donate a Day’ programs in the late ’90s. There was a call-out to dentists who were keen to be involved, and we were given some basic resources to take with us to nursing mothers’ groups. I had seen some cases of nursing-bottle caries and thought it would be a good service to my local community to help inform people about oral health and hygiene before the first teeth appeared. I did this a couple of times a year for many years.

While my kids were playing contact sports during school, I started doing similar with mouthguard awareness campaigns for Sports Medicine Australia and local sporting clubs. After all these years, it is amazing that some of the children I interacted with back then are now bringing their own children in to see me. The messaging and the awareness did work!

Following on, I volunteered for the ADAVB Oral Health committee, where we built on the policies, messaging and resources that are still available today for oral health promotion. I still enjoy it, and have been actively involved in Dental Health Week media work over the last few years.

What does the ‘life’ part of your work/life balance look like?

Early in my practice career I was working clinically 5.5 days a week and seeing large numbers of patients. I worked out in my 30s that this was not sustainable, so I cut down to four days a week when my kids were young. I spent a lot of time taking them to extracurricular activities and was happy to finish up early on nights they need to go to training, etc.

I am down to 1-1.5 days clinical work now, and spend the rest of my week on the Clinic Director role and ADA business, which can be done remotely and flexibly. This allows me to travel, spend time with my family, go down to the holiday house and play a bit of golf. I love footy, so the weekends are taken up with following Collingwood. I am happy with my work/life balance, and it feels like I can keep going at this pace for some years to come.

This article was first published in the ADA's News Bulletin, June 2024