volume 9 issue 5 october 2016
issn 1757-4625
the
technologist the official journal of the dental technologists association
In this issue: An introduction to 3D printing Thermoformed occlusal splints: benefits & drawbacks More about medical emergencies
3.75
HOURS OF VERIFIED CPD PLUS 1 HOUR OF UNVERIFIED CPD IN THIS ISSUE!
october 2016 1
the
technologist in this issue Editor: Vikki Harper t: 01949 851 723 m: 07932 402 561 e: vikki@goodasmyword.com Advertising: Sue Adams t: 01452 886 366 e: sueadams@dta-uk.org
DTA administration: Sue Adams Chief Executive F13a Kestrel Court Waterwells Drive Waterwells Business Park Gloucester GL2 2AQ t: 01452 886 366 e: sueadams@dta-uk.org DTA Council: James Green President Delroy Reeves Deputy President Tony Griffin Treasurer Gregg Clutton Andrea Johnson Mike McGlynn Nargisa Rikena John Stacey Gerrard Starnes Jack Thurkettle Marta Zarnowiecka Student representatives: Chris Keating Jelena Greb Editorial team: James Green Tony Griffin Andrea Johnson Mike McGlynn Jack Thurkettle Design & production: Kavita Graphics t: 01843 583 084 e: dennis@kavitagraphics.co.uk
Published by: Stephen Hancocks w: www.stephenhancocks.com
news letters to the editor dta column hr facts: leadership key performance indicators – 2 early cancer detection 3D printing for dentistry more options for in-lab milling and grinding thermoformed occlusal splints for TMD and bruxing situations vacant why dental technicians need to know about medical emergencies what does success look like? interview: driven by a passion continuing professional development
www.dta-uk.org the
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The Technologist is published by the Dental Technologists Association and is provided to members as part of a comprehensive membership package. For details about how to join, please visit: www.dta-uk.org or call 01452 886 366 ISSN: 1757-4625
Find out the 11 reasons to join DTA by visiting:
02 02 03 05 07 08 09
Views and opinions expressed in the publication are not necessarily those of the Dental Technologists Association.
Cost effective professional indemnity insurance for dental technicians and laboratories
Tel: 01634 662 916
2 october 2016
news&information ■ DTA FELLOWSHIP ■
AWARDED TO PROFESSOR ROBERT WILLIAMS
CHOOSING A CHARITY
As you will be aware, in 2016 DTA has supported Dentaid as its charity of choice.
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be next year. Is there a charity that you feel is worthy of our support? Do you feel strongly about a particular service in your community or a health-based charity that needs to raise funds or broaden its appeal?
As we hurtle towards 2017, our focus turns to where our support and attention should
Send your suggestions to Sue Adams at the DTA office, and based on your input, we will decide where our efforts will be focused in 2017.
TA member Andrea Johnson has led the focus with her visit to Uganda and subsequent articles in TT, sharing her experiences and seeking your support to set up laboratory support facilities in the region.
James Green and Professor Williams
■ GDC DECIDES NOT TO INCLUDE ADDRESS DETAILS ON REGISTER
Congratulations to Professor Williams from Cardiff, who was presented with a DTA Fellowship in July.
The General Dental Council (GDC) has made a decision not to include any location details about dental professionals on its online public register.
letterstotheeditor From: C Marin CPD Questions: CT scanning (Radiography) Comments: The most helpful CPD for me. Thank you. From: M Johnson CPD Questions: Cardiac arrest (Medical emergencies) Comments: Good and informative. From: C Jones CPD Questions: Burns (Medical emergencies) Comments: I would also add that a common sign of sepsis is a thin red line travelling vertically from the infected area in the direction of the heart. Recognising this has quite possibly saved my daughter’s life. From: SW Carslake CPD Questions: Healthy options (Verifiable non core) Comments: Occupational health companies offer good support to employers.
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he Council’s recent decision follows a public consultation that received responses from over 2,500 people. Seventy-four per cent of respondents wanted to remove all address information from the register, while 26% were happy for a general location, such as a postal town, to remain. Over 500 members of the patient panel were also consulted and 60% were in favour of publishing no location information on the register. As a result, the Council has made the decision to remove all address information from the online register.
Commenting on the decision, Ian Brack, Chief Executive of the General Dental Council, said: ‘The decision not to include information about a professional’s registered address brings us in line with other professional healthcare regulators, balancing our role in protecting the public with the need to treat dental professionals fairly, whilst protecting their personal information. The registration number will become the primary identifier of registration status, so particularly important for dentists and dental care professionals to start to display it appropriately.’ At their October meeting, the Council will approve changes to key documents that will formally allow the change to be made. Shortly after that, all addresses will be removed from the online register.
■ CPD meter: Year Four – from 1 August 2016 until 31 July 2017 the
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Disinfection and decontamination
CPD-o-meter
Medical emergencies
required provided in TT
Materials and equipment
provided in Articulate
Radiography & radiation protection
Other specific verified CPD (including: legal and ethical issues, complaints handling, oral cancer: early detection)
HOURS
40
30
20
10
0
The requirement is to complete 50 hours of verifiable CPD, 20 hours of which relates to core topics: decontamination, materials & equipment, (or radiography) and medical emergencies. You can use the additional hours provided in the core subjects to fulfil the total verified CPD target.
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thedtacolumn
■ DTA MEMBERSHIP IS MAGIC It’s no illusion: DTA members are supported As a DTA member, you are never a sole technician or a one-man band. You are part of a thriving community that is supported and represented at every level. It’s no wonder that over 250 new dental technicians have joined DTA in the last few months alone.
■ ten hours of medical emergency CPD; ideally two hours per CPD year ■ five hours of disinfection and decontamination; at least one hour in every CPD year ■ five hours of materials and equipment CPD; one hour per year as a guide We also feature verifiable CPD in the following recommended subject areas:
From FAQs to facts The DTA team receives daily calls and emails from members who need help and support: everything from compliance and continual professional development to audit tools and launching your own lab.
■ legal and ethical issues ■ complaints handling ■ oral cancer: early detection ■ safeguarding children and young people ■ safeguarding vulnerable adults
Logging into the members’ area of the DTA website http://www.dta-uk.org gives you access to an array of useful information. From guidance on the safe management of gypsum waste, and the ins and outs of public liability insurance, to the facts about what metals can be used in crown and bridge restorations, there is a fantastic array of fact sheets at your disposal!
In addition to supporting you to achieve your full quota of learning, our website offers you the facility to complete your CPD online, to check your scores immediately to stimulate learning, and to keep a record of your progress so that when the time comes to provide the GDC with your results, they are all organised and easily accessible.
DTA members know their worth Free CPD – it’s no magic trick One hundred and fifty hours of CPD every five years, 50 of which must be verified, can seem a daunting and potentially costly exercise, but not for you as a DTA member! Not only do you have your core and general CPD delivered to your door, or inbox, but you have the ideal online facility in our members’ area of the website to undertake it, receive immediate feedback and manage it. As a DTA member, each alternate month you receive either this journal or the e-newsletter Articulate. Both provide you with an array of interesting CPD-based articles that over a five-year cycle provide you with your target of 50 hours of verifiable CPD in the specified core areas, as well as many hours of non-verifiable CPD to support your 100-hour target for that. The core verifiable CPD provided by DTA follows the GDC’s recommended topic areas as part of the 50-hour minimum amount:
Do you feel you are under-appreciated? Maybe you think colleagues with similar experience and qualifications are remunerated better than you? How can you increase your earning potential? Start with the facts by downloading DTA’s 2016 recommended pay scale for technicians working in a private commercial dental laboratory. You’ll find it under guidance documents, in the members’ area of the website. The pay guide gives you a base document from which any discussion regarding your remuneration can begin. You can have a meaningful discussion with your employer about what you need to do to earn the next pay band. Do you need to skill up? Work faster? Show more attention to detail? Be more of a team player? Armed with our fact sheet, laboratory owners and technicians can have an informed discussion that isn’t purely based on emotion and ‘feelings’ about worth.
Indemnity is no illusion Our market is more litigious and it’s not only vital but necessary to you practising your trade that you have indemnity insurance. Your GDC registration requires it! Your indemnity insurance must either be in your own name or as part of your employer’s cover. It is advantageous to have your own insurance. Not only because you can change employment with ease, but you are protected if an event occurs outside of work, such as a traffic incident or a pub fight. For less than £4 per month, UK Special Risks, through your DTA membership, offers comprehensive, all-inclusive cover including: ■ cover for £4,000,000. Four policies in one – Professional Indemnity, Public & Products Liability and Legal Expenses, including Tax and VAT investigation ■ representation and defence costs in a GDC Disciplinary Hearing ■ no extra premium to pay after you stop work e.g. retirement, maternity. Unlike most other policies, it is not necessary to continue to buy additional cover after you stop work ■ no excess to pay in the event of a claim ■ potential liability arising from shading consultations, advice supplied to dentists, the supervision of process workers, etc., and the defence costs in GDC fitness to practise proceedings.
Join the magic circle Send a colleague to stand P70e at BDIA Showcase, and if they join DTA, a £15 retail voucher will be sent to you.
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thedtacolumn The Dental Technologists Association
New member application form Please complete in BLOCK CAPITALS Surname First name/s Title
MR
MRS
MISS
OTHER
GDC registration number Address Postcode Telephone numbers mobile work
home
Email DoB
Employed
Place of work: Commercial laboratory Speciality: Removable prosthetics
Hospital/community
Self employed
Other
Fixed prosthetics
Orthodontics
Other Qualification/s If currently studying, name of educational institute Qualification studying for
Date course ends
D D M M Y Y
I would like to apply for full / associate / student* membership *(delete as appropriate) Payment method: Cheque
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The professional representative body for dental technicians the
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october 2016 5
hrfacts
■ Leading lights
Richard Mander, HR consultant, looks at the role of leadership in a small business and shares the five key insights from recent research into what works best in practice.
T
he research suggests that the nature of effective small- to medium-enterprise (SME) leadership is fluid based on the stage of transition as your organisation grows. The balance fluctuates between ‘hands on’ problem-solving and task completion, to oversight and strategy, as the size of the operation increases. The problem is you need a completely different skill set for each and you will tend to excel in one or the other. So you need to recognise your strengths and work accordingly on the areas that come less naturally to you. SME leaders and those responsible for people management in SMEs should consider what kind of leadership their organisation needs at each particular stage in the organisation’s transition. Ask yourself:
There is no right or wrong leadership style When surveyed, effective SME leaders say that leading others is a balancing act. Different contexts will require them to apply different leadership styles, and it is essential to take in both the business perspective and the people perspective to make a decision that does not damage long-term performance of the organisation. Effective leaders take every opportunity to step back and allow their people to take a lead. Ask yourself: ■ Where can people be empowered and trusted without damaging the needs of the business? ■ Does the culture of my organisation allow individuals to take the lead? Where are the barriers?
You don’t know what you don’t know It’s tempting and understandable to judge things based solely on your experience within your own business. The ‘we’ve always done it like that’ mentality can be extremely limiting. It’s worth investing time and knowledge in developing some external benchmarks about what ‘good’ looks like in your field and how others are operating and introducing new efficiencies. The best way to do this is through informal and formal networking and the BDIA Dental Show is not a bad place to start.
You are not the font of all knowledge In the early days, as a ‘one man band’, you probably got to relish the problemsolving aspects of your work. It’s really
Standards for the Dental Team: Standard 7.3 Update and develop your professional knowledge & skills ■ Educational aim: – to give an overview of the importance of sound leadership and what it means for an organisation ■ CPD outcome: – to have a better understanding of the role of leadership and the key ingredients for introducing it
hard therefore to drop this mentality and difficult to resist continually coming up with all of the answers. The SME leadership research suggests that one of the most important transitions you can make is to allow space for the rest of your team to experiment, get things wrong and learn from their mistakes. Developing a coaching style of leadership is one of the most effective ways of helping with this switch. Coaching is more about asking good open questions* so that your teams are in a stronger position to understand things better and work out solutions for themselves.
leading lights
Keep changing as your business evolves
■ What does ‘leadership’ mean in the context of my organisation? ■ What do I expect to see happening as a result of ‘leadership’ – at the organisational and individual level? ■ Am I planning for the capabilities required of leadership in the future?
other specific verified CPD
More has been written about leadership than any other business subject, but much of the advice and guidance seems overblown and irrelevant for the needs of a typical dental laboratory.
Open questions The purpose of an open-ended question is to encourage a full, meaningful answer from the subject’s perspective. The opposite type of question is a closedended question, which tends to result in a short or single-word answer. Open-ended questions typically begin with words such as ‘Why’ and ‘How’, or phrases such as ‘Tell me about …’ To illustrate, you might ask someone, ‘Do you like your job?’ This is a closed question and would allow the subject to respond with a yes or no leaving you none the wiser. However, if you asked the question in an open way you might ask, ‘How do you like working here?’ thereby encouraging a fuller response. the
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hrfacts Be creative about your people management If you’ve read any books on the subject of people management, you’ll have noticed they all lean towards having a good process and procedures in place for managing people and performance. The evidence from recent SME research suggests otherwise. Most people get cramped up by the forms. They ignore or circumvent them so that you never quite get to the nub of improved performance. Their needs are pretty simple really: give me a broad framework to work within where I get to use my judgment and initiative, and have some level of control and influence over my work. Challenge me with constructive feedback about how I am doing and provide me with the right level of support so that I can excel. Bear this in mind as a leadership principle when you look at how you communicate your business goals and priorities and the systems you adopt to help people stay on track and develop themselves. Ask yourself: ■ Do I proactively take time to reflect on how to work smarter and add value to the business, rather than working harder? ■ What are the current barriers to agility in my organisation? Where do they come from? ■ Who are the key influencers in the business who can lead on overcoming those barriers?
Richard Mander Richard Mander is a freelance HR consultant with over 20 years’ experience. If you would like to find out more about this topic or advice on other HR matters you can contact him at www.manderhr.com 07715 326 568.
keyperformanceindicators
■ Key Performance Standards for the Dental Team: Standard 7.3 Update and develop your professional knowledge and skills ■ Educational aim: – to take a more in-depth look at the importance of monitoring your business performance with key performance indicators (KPIs) ■ CPD outcome: – to have a greater understanding of how to go about introducing KPIs
By Peter Blake A few editions back I outlined some key performance indicators (KPIs) and how they are used and calculated. In this month’s article I want to highlight a few important ones for dental technicians and how you calculate and track them to determine how your business is performing and what danger signs to look out for!
Debtor and creditor days
D
ebtor and creditor days will indicate how you are managing your cash flow. Debtor days measure how long it is taking you to get money in from your customers, whilst creditor days measure how long you are taking to pay your suppliers. As cash flow is crucial to small businesses, we are looking for these to be fairly equal to each other or, if possible, for debtor days to be slightly lower than creditor days, indicating that you are getting money in slightly faster than you are paying it out. If creditor days become very high, however,
it can be an indication that a business is struggling to pay its creditors and delaying payment because of poor cash flow. You calculate debtor days with the following formula: Trade Debtors/Sales x 365 (Trade debtors equal the value of outstanding money owed to you of whatever age.) This calculation will give you your overall debtor days’ calculation. If you want to find out the time for each individual customer, then you would use the amount that customer owes you divided by the total amount of sales to that customer in the year. You calculate creditor days as follows: Trade Creditors/Direct Costs x 365 (Trade creditors equal the amount of money you owe to people who have provided you with goods and services.) This formula will give you the overall creditor days’ figure for the year. If you want to find out how long you are taking to pay an individual supplier, then simply divide the total amount you owe that supplier by the total amount of supplies you bought from that supplier in the period.
Enquiry conversion rates A small business is usually dependent on a few good customers so obtaining new clients is crucial to its survival and growth. Keeping a record of all enquiries and then comparing them to how many actually became clients is important to work out how you are handling new enquiries. If
About Peter Blake Peter Blake is a chartered accountant, business coach and master practitioner of NLP. He has his own practice based in Wiltshire, lectures on finance and mentors new business start-ups for Gloucestershire Enterprise Ltd. For further details, contact Peter on 07912 343 265 or email peterblake@pbcoachingandtraining.com the
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keyperformanceindicators
Indicators – Part 2
Sources of new business Along with conversion rates it is also important to keep a record of where your new enquiries are coming from. This will enable you to know where you need to concentrate your marketing efforts and where you are wasting time and money and getting no results! Getting in new business is crucial to small businesses as you cannot take the risk of relying on one or two large customers who, if they decided to take their business elsewhere, would potentially catastrophically impact your business's survival.
Gross profit margin Gross profit margin is the first KPI most analysts and business owners look at to see how a business is performing. It gives you an indication of the profit you make on each piece of work before overheads. Gross profit is calculated by subtracting the direct costs of sales from your actual
turnover to customers. Direct costs are costs that directly vary with the level of sales, such as cost of materials and supplies to make the finished product, together with factoring in your time to make the product. The actual gross profit margin is calculated as follows: Gross Profit/Sales x 365 Gross profit margins should be monitored regularly to ensure they are being maintained or even improved. A fall in gross profit margin would be an indication of several possibilities that you would need to investigate further, such as: 1. an increase in material prices without a comparative increase in your sales price 2. an increase in time taken to produce the finished products 3. a decrease in sales price, perhaps as a result of discounting Doing this review on a monthly basis would be strongly recommended to make sure you keep on top of what is happening.
Turnover Turnover is another word for sales and is the one factor that tends to affect everything else in the business. Reviewing your turnover levels in combination with your gross profit margin on a monthly basis would give you an early indication if things are going well or whether you need to increase your marketing activity to quickly counteract a drop in turnover. In addition, as mentioned earlier, a breakdown of your turnover per customer should also be done to make sure you are not becoming too dependent on one or two major customers.
Complaints As much as we tend to avoid looking at any negative feedback, it is crucial to
regard such situations as an opportunity to learn vital information that might allow us to improve our customer service, avoid potentially losing other customers, and putting into place processes that will impress future customers. If you are a one-man band you might want to consider getting formal training in how to handle potential complaints and improve customer service or, indeed, if funds allow, bringing in someone who specialises in handling customer complaints. You would need to weigh up the cost of bringing someone in against the cost to the business of losing customers and not attracting in new business to see if this step would be worth doing. This is what is called a ‘cost/benefit analysis’ i.e. do the benefits outweigh the costs?
key performance indicators
If you are a one-man band and your conversion rate is poor, then you will need to take an honest look at yourself to decide if you are the right person for the job! We cannot all be good at everything so you need to consider whether some formal training would bring your selling skills up to speed or whether you need to look at options to bring in outside help. There’s no shame in admitting that marketing is not really your thing and your time could be better spent doing the things you do well and earning money, and choosing to bring in someone with more expertise and experience in that area.
other specific verified CPD
the rate is low then you should review your process. Who is handling these calls? Do they need training or is someone else in the business better equipped to take the calls? What kinds of enquiries are they? What is your process for following them up? Making the most of these opportunities is vital so monitoring your effectiveness is important also.
In summary Key performance indicators are only useful if you use them on a regular basis and then take relevant action if they indicate that something needs improving. However small your business, it’s important to get good, quick, reliable information and feedback on crucial parts of your operational performance. By implementing the above KPIs in your business, monitoring the results on a regular basis, and taking prompt action based on the results, you will go a long way towards steering your business in the direction you want it to go! the
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cancerdetection
■ Early Cancer Detection Standards for Dental Professionals: Standards 1 & 7 ■ Educational aim: – to raise awareness among dental and clinical dental technicians of the benefits of prevention and the early treatment of malignant melanoma ■ CPD outcomes: – to outline the risks related to malignant melanoma – to review some of the current recommended projection methods – to identify the links between changes that can occur in moles and cancer
Compiled and edited by Tony Griffin
INTRODUCTION Please note that this article is compiled and edited from pieces from various sources as indicated in the references to ensure that the facts are appropriate and correct.
M
elanoma is a type of skin cancer related to moles that can spread to other organs in the body. Nearly 90% of melanomas are thought to be caused by exposure to UV light and sunlight. It is believed that one blistering attack of sunburn, especially at a young age, can more than double a person’s chance of 1 developing melanoma later in life. There are three main types of skin cancer: i) basal cell carcinoma (sometimes known as ‘rodent ulcer’) ii) squamous cell carcinoma iii) malignant melanoma Authorities consider basal cell and squamous cell cancers as less serious forms of skin cancer. Also referred to as non-melanoma skin cancers, they are highly curable when treated early. the
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Malignant melanoma – made up of abnormal skin pigment cells, called melanocytes – accounts for just 10% of all cases of skin cancer in the UK. ‘However, left untreated, it can spread to other organs and be difficult to control. It is responsible 2 for most of the deaths from skin cancer.’ There are reports of there being a dramatic increase in this form of cancer e.g. ‘Twice as many cases in the over 55s in Scotland 3 than there were 20 years ago’. An early and relatively simple, local surgical operation is very often successful. But it must be dealt with early; any delay could reduce chances of success. Melanoma is not just skin cancer. It can develop anywhere on the body – eyes, 4 scalp, nails, feet, mouth, etc. The first sign of a melanoma is often a new mole or a change in the appearance of an existing mole. Normal moles are usually round or oval, with a smooth edge, and no bigger than 6 mm (1/4 inch) in diameter. These can occur anywhere on the body, but the back, legs, arms and face are regarded as the areas most commonly affected. A melanoma will often change in size, shape and colour over time, and may become raised above the skin’s surface. Inflammation or swelling is another sign that you need to see your GP for a check-up immediately. The original mole often remains the same size, while an area around or under it appears to spread or swell. Any new symptoms – such as bleeding, itching or crusting – may also be caused by 5 melanoma. Therefore, if the symptoms of melanoma are found, you should visit your GP immediately. Where a clinical dental technician is treating a patient, he/she needs to
Fig. 1
■ Asymmetrical – melanomas have two very different halves and are an irregular shape ■ Border – melanomas have a notched or ragged border ■ Colours – melanomas will be a mix of two or more colours ■ Diameter – melanomas are larger than 6 mm (1/4 inch) in diameter ■ Enlargement or elevation – a mole that changes size over time is more likely to be a melanoma
appropriately document concerns regarding a suspicious lesion and refer the patient on to a specialist as appropriate e.g. ‘6.3.3 You should refer patients on if the treatment required is outside your scope of practice or competence. You should be clear about 6 the procedure for doing this.’ Most medical guidance says, ‘See your GP as soon as possible’, if you notice changes in a mole, freckle or patch of skin, especially if the changes happen over a few weeks or months. In most cases, melanomas have an irregular shape and more than one colour. They may also be larger than normal moles and can sometimes be itchy or bleed. Melanomas often have ragged or blurred borders or edges. Normal, healthy moles tend to be much rounder, with smooth, clearly defined borders. In most cases, melanomas have an irregular shape and more than one colour. They may also be larger than normal moles and can sometimes be itchy or bleed. The signs to look out for include a mole that is:
Fig. 2: A range of moles as an artist’s impression related to the ABCDE identification in Fig. 1
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cancerdetection
getting bigger changing shape changing colour bleeding or becoming crusty becoming itchy or painful
NHS Choices provide a helpful checklist if you are concerned about a mole that you have. It provides a helpful way to tell the difference between a normal mole and a melanoma as in this ABCDE checklist shown in Fig. 1.
Metastatic cancer is more likely to be fatal because the cancer cells have already spread, or metastasised, to other parts of the body. This makes treatment complicated, as the cancer is no longer centralised. It is recommended that we all be suspicious of any lesion, particularly on the face, that fails to heal within 3–4 weeks. We should all use high factor sunscreen, reduce exposure to the sun between 11.00 am and 3:00 pm and be vigilant – check regularly for any changes to those moles.
■ Educational aim: – to introduce the concept of 3D printing and how it applies to dental technology ■ CPD outcome: – to provide a brief history of 3D printing and the principles of how it works – to illustrate how 3D printing can be applied to dental technology
Three-D printing is a technology, first commercialised in 1986 for the field of engineering, in which 3-dimensional solid objects are built up, layer by layer, using instructions from a 3D digital file. Three-D printers, now commonplace in engineering, are increasingly being found in other disciplines that are being transformed by engineeringinfluenced digitisation, such as the field of dentistry.
Implant model with gingival mask; 3D printed
D
entistry benefits profoundly from the advantages of 3D printing as part of the complete digital workflow (scanner->CAD->ouput device). The use of a 3D printer today ensures digital precision and efficiency in the production of stone models, quadrant models, implant models, surgical guides, splints, temporaries, castable partial frameworks, and orthognathic models. The new digital workflow enables a skilled designer to design for flawless customisation and fit, and promises design and production efficiency far beyond that which is possible using traditional methods. In the future, virtually all dental prosthetic output will be done directly on 3D printers. Three-D printers work on the principle of additive manufacturing i.e. building up the object layer by layer. There are a number of different 3D printing technologies in the market today. The two most common are jetting and DLP, which are the subjects of this article.
materials & equipment
Metastatic melanoma is the least common skin cancer. It’s also the most deadly because it spreads (metastasises) quickly and easily to other parts of the body.
cancer detection
So what’s the hurry about getting treatment?
Standards for the Dental Team: Standard 7.4 You must update and develop your professional knowledge and skills throughout your working life
core verified CPD
7
■ 3D Printing for Dentistry other specific verified CPD
■ ■ ■ ■ ■
3Dprinting
Jetting, as the name implies, is the deposition of each layer of material (usually acrylic resins) via inkjet printheads. These inkjet heads force microdroplets of material through tiny
References 1 Melanoma Research Foundation USA https://www.melanoma.org/understand-melanoma/ what-melanoma/melanoma-facts-and-stats 2 Web MD Boots http://www.webmd.boots.com/ melanoma-skin-cancer/skin-cancer-guide/sun-exposure 3 Example: The Times. 5 July 2016. p. 6. 4 Melanoma Research Foundation USA https://www.melanoma.org/understand-melanoma/ what-melanoma/melanoma-facts-and-stats 5 Skin Cancer – NHS Choices at http://www.nhs.uk/ conditions/Malignant-melanoma/Pages/Introduction.aspx 6 Standards for the Dental Team http://www.gdc-uk.org/ Dentalprofessionals/Standards/Pages/default.aspx 7 NHS Choices http://www.nhs.uk/Conditions/ Malignant-melanoma/Pages/Symptoms.aspx 8 Healthline http://www.healthline.com/health-slideshow /metastatic-melanoma-symptoms-treatment-outlook
Implant models with gingival mask; 3D printed
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3Dprinting Printed quadrant model
The principal advantage of the jetting technology is versatility. Groups of nozzles can print in different resins in the same print job, thereby enabling the printing of multiple models, each of a different resin, on one tray. In addition, the different resins can be blended in the same part, allowing for the manipulation of the mechanical properties (i.e. more rigid or more elastomeric), as well as colour and translucency. DLP stands for digital light processing, and uses pixelated digital light to progressively cure layers of acrylic resin held in a vat.
This technology is also capable of printing in layers that are only 10s of microns thick. When the print job is finished the remaining liquid resin is separated from the cured model, and usually the model needs a secondary curing process to finish. The principal advantage of DLP is speed of printing. A computer is required to use a 3D printer due to the fact that you can only print 3D digital data. The 3D data comes from any software package capable of taking a digital 3D object and decomposing it into horizontal layers. The 3D object is either acquired by the software via 3D scan data (think intraoral scanner, desktop scanner or CT scan) or generated from 3D design software (think
3D printed veneer try-in
CAD, such as 3Shape, ExoCAD, Dental Wings, etc). The instructions coming from the computer to the 3D printer are in fact the individual horizontal layers of the object.
The Future The holy grail for 3D printing in dentistry is the ability to print final prosthetics. The key advantages of 3D printing compared to today’s methods for making prosthetics are evident: ■ ■ ■ ■
Digital precision No waste of expensive materials Perfect customisation and fit Design and production efficiency
In addition, the ability to control production at the micro or nano level means that the designer will be able to digitally manipulate the colour, translucency and mechanical properties at every discrete 3-dimensional point in the prosthetic, and have this exactly reproduced in the final product. This means that in future, labs and clinics will be able to produce the most perfectly customised, highest performance, and most natural-looking prosthetics ever made. ■ All images courtesy of Stratasys
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materials & equipment
nozzles forming a layer which is only 10s of microns thick. Each horizontal layer is progressively deposited in the shape of the object(s) being printed. An ultraviolet (UV) light source is used to cure each layer after it is deposited.
core verified CPD
Stratasys dental selection multi-material 3D printer
Individual pixels are activated or left inactive depending on the shape of the layer to be cured in that instant; the active light pixels cure a corresponding tiny area of resin and the inactive ones do nothing (i.e. the resin in that area is left liquid).
october 2016 11
advertorial
■ More options for in-lab milling and grinding As the options for CAD/CAM restorations have become more viable, differentiating between milling units and materials and then choosing the best option for your lab can be overwhelming. Nevertheless, the rewards this new technology brings are extensive and all labs should start to consider a CAD/CAM system.
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recent survey* found that just under 15%* of dental labs in the UK have access to an in-lab CAM milling unit and approximately 40% utilise a CAD digital scanning system. By using CAD/CAM technology, the labs that have adopted this technology are benefiting significantly in terms of improved productivity and profitability. Additionally, they are also able to offer their clients a range of new materials and design options not deliverable using traditional methods. One of the main reasons cited for not adopting milling technology by labs was a fear that the unit they select will have limitations in terms of file types accepted and materials that can be milled. To overcome such limitations, Straumann has
Fig. 1: The M Series can be used as a dry or wet system. It can also be operated in a wet/dry combination mode
recently partnered with Amann Girrbach to build and design the Straumann® M Series milling unit that links directly to the Straumann® CARES® CAD/CAM software programme. The Straumann® M Series is a modern 5-axis, in-lab milling unit able to produce a broad range of prosthetics, from inlays, onlays, veneers, and single crowns, to bridges and screw-retained restorations.
Prosthetics can be milled in wet, wet/dry or dry modes in a range of materials, including glass ceramic, zirconia, PMMA, cobalt-chromium – sinter metal, wax, lithium disilicate ceramics and resin nanoceramic. The M Series is a single system that can handle the majority of your casework. With multiple workflow options, you can enjoy the full flexibility of using one system
Fig. 2: A special blank holder ensures process reliability. Three controllable slots ensure efficient processing of the blanks
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12 october 2016
advertorial
Fig. 3: Modular and upgradable with multiple material blank holders
IPS e.max CAD or Straumann Nice. And, finally, the all-zirconia reinforced crowns and bridges are available to support the growing trend towards metal-free restorations.
A new digital line-up
regardless of what case appears from your customer. For work peaks, or complex cases, our centralised milling facility operates as an extension of your lab. The Straumannn CARES® Visual CAM Module includes an elaborated collision control and evasion to ensure a high degree of process reliability: quick nesting, easy positioning, and alignment of design in the blank, as well as nesting for different blank and block shapes and sinter support block for longspan zirconia restorations. Imagine having the capacity to incorporate almost all the options in the marketplace with access to the latest materials such as PEEK, a very strong and highly biocompatible framework material; milled PMMA for the production of slim and strong denture bases and Splintec for bite splints. Additionally, wax can be milled to produce copings and substructures with greater accuracy and in a fraction of the time taken manually. Straumann® CARES® offers a range of materials for the M Series milling unit, with a portfolio of blocks and disks all manufactured to the highest quality standards to ensure reliable, robust and precise results. The options now available in the ceramic and hybrid ceramic area are extensive with access to Vita Enamic, Vita Mark 11 and Trilux or Vita Suprinity. Additionally, labs can access 3M Espe Lava Ultimate, Fig. 4: In-lab fabrication of customised one-piece titanium abutments
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With Straumann CARES® Digital Solutions, technicians now have everything they need for every step of the treatment pathway. From case planning and centralised milling to in-lab solutions, Straumann is available with a strong 10-man team to help technicians achieve complete precision and efficiency, together with the peace of mind of Straumann’s quality, reliability and service. By adding an all-encompassing digital dimension to their offering, Straumann is now much more than a dental implant company – it’s your total solutions provider! ■ For more information on how your lab can benefit from the services that Straumann CARES® Digital Solutions provide, please visit www.straumann digitalperformance.co.uk ■ Facebook: Straumann UK ■ Twitter: @StraumannUK * 2016 Dental Lab Survey. Research on file
All product brands are registered trademarks of the manufacturer named. Straumann® and/or other trademarks and logos from Straumann® mentioned herein are the trademarks or registered trademarks of Straumann Holding AG and/or its affiliates.
october 2016 13
occlusalsplints
■ Thermoformed occlusal splints for TMD and bruxing ■ Educational aim: – to describe the construction and relative advantages and disadvantages of thermoformed stabilising splints for the management of temporomandibular disorders (TMDs), bruxing and toothwear
By Elizabeth King,* Ceri Evans* & Robert Jagger** Occlusal splints are commonly used in dental practice for a variety of applications. The purpose of this article is to describe the construction and relative advantages and disadvantages of thermoformed stabilising splints for the management of temporomandibular disorders (TMDs), bruxing and toothwear.
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any types of splints have been described. They may be classified into two main groups – relaxation splints and stabilising splints – according to the way that opposing teeth contact the splint. Table 1 gives examples of each type of splint.
Relaxation splints Relaxation splints cover some or all teeth in one dental arch. They are constructed on an unarticulated dental cast. That means that when the teeth are closed together there are limited tooth contacts in the retruded contact position. Prolonged wearing of this type of splint may result in changes in occlusion. Soft splints are probably the most commonly provided type of relaxation splint. All teeth are covered by the splint, which is made by thermoforming a polyvinylacetate-polyethylene (PVA-PE) blank onto the maxillary or mandibular arch. This type of splint is usually tolerated well. They are relatively cheap and easy to make and fit. Soft splints may deteriorate quickly and need frequent replacement, particularly in patients with bruxism. They can also cause occlusal changes.
Stabilising splints The stabilising splint is constructed on articulated dental casts and is adjusted so that there are equal bilateral contacts in
the retruded contact position. Stabilising splints are more robust than soft splints and avoid occlusal changes. i. Michigan splint. This type of splint is constructed on the upper arch from dough-moulded acrylic resin.1 Ramps are created on the splint to give canine protection in lateral movement and posterior disclusion in protrusion. ii. Tanner splint. This type has similar occlusal characteristics to the Michigan splint but is made for the mandibular arch. iii. Thermoformed splint. This type may be made of a hard material or from a disc that is a laminate of hard and soft materials. The splints may be made to fit teeth in either the lower or upper jaws.
materials & equipment
■ CPD outcomes: – to gain an understanding of the types of splints and their classifications – to read a perspective of the merits and drawbacks of certain splint making processes – to gain an understanding of the thermoforming process relative to splint production
Types of splints
core verified CPD
Standards for the Dental Team: Standard 7.4 You must update and develop your professional knowledge and skills throughout your working life
Constructing a thermoformed occlusal splint The thermoformed stabilising splint for the management of temporomandibular disorders (TMDs), bruxing and toothwear can be made in the following way: i. Full arch impressions of maxillary and mandibular teeth are taken in alginate and are poured in 50/50 plaster/stone. ii. The mandibular cast is blocked out using e.g. Erkogum (EM Natt, London) to block out interdental spaces. Wax or Erkoskin (EM Natt, London) is applied to relieve the lingual gingival margins. (Fig. 1)
Table 1. Examples of splint types
Relaxation splints
Stabilising splints
Anterior repositioning splints
Soft splint SCi (NTI-tss) Anterior bite plane Posterior bite plane
Michigan splint Tanner appliance Thermoformed splint Hard or laminate
Anterior repositioning splint
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14 october 2016
occlusalsplints
A systematic review of the use of occlusal splints for the management of TMDs concluded that, in general, studies have shown that all types of splints may be effective but that there was no evidence that any one type of splint was most effective.3 Fig. 1: Blocked out cast
Fig. 2: Thermoformed blank on the cast
iii. The mandibular cast is then duplicated in hard Type 3 plaster. iv. Erkodur (EM Natt, London, UK) or similar 2 mm or 3 mm thick is thermoformed onto the dry cast according to manufacturer’s instructions to provide a hard splint. (Fig. 2)
The trimmed splint is placed onto the master model and the occlusal surface of the splint is adjusted using a pear-shaped crosscut tungsten carbide bur to give equal bilateral contacts (including anterior teeth if possible). (Fig. 4)
An Erkoloc Pro (EM Natt, London, UK) or similar laminate disk 2 mm or 3 mm thick is thermoformed onto the dry cast according to manufacturer’s instructions to provide a hard/soft laminate (dual laminate) splint. v. The formed blank is removed from the cast and trimmed using a carbide bur to the required extension. (Fig. 3) The splint should extend to: ■ cover all teeth ■ be at least 2 mm short of the lingual sulcus ■ cover one half of the buccal aspect of the crowns of the teeth
The splint is polished using the conventional technique used for acrylic resin. The edges of the laminate splint may be finished using a Lisco polishing disc (EM Natt, London). Fig. 5 shows the finished splint on the master model. vii. Fig. 6 shows the finished splint in the mouth.
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A more robust, full contact stabilising type alternative may be required. The Michigan type splint has been favoured; however, these splints are technique sensitive, time-consuming to construct and fit, and are expensive. The hard thermoformed splint is more robust than the soft splint and does not result in occlusal changes. It represents an alternative, relatively easily fabricated and more economic alternative to the Michigan splint.
Discussion The thermoforming process can produce appliances that are accurate and have good surface detail.2 Soft splints are most commonly made to manage TMDs and bruxing. This article has described the process used to produce a more robust alternative.
The laminate splint also has the advantage of the hard thermoformed splint in that it is also more robust than the soft splint. It is particularly comfortable to wear. It is not as robust as the hard splint however, and the splint may delaminate in the molar regions, particularly in patients with a heavy occlusion and marked bruxism.
Conclusions
vi. Master models are articulated in maximum intercuspation (intercuspal occlusion).
Fig. 3: Blank trimmed to the required extension
Some patients, however, may destroy soft splints rapidly. Furthermore, long-term use of relaxation splints can result in occlusal changes as a result of a Dahl type effect producing a posterior open bite.4
Splints are commonly used as part of a ‘package’ of treatment measures for TMD
Fig. 4: Occlusal surface adjustment on the articulator
Fig. 5: Finished splint on the master cast
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occlusalsplints
an alternative, relatively easily fabricated and more economic alternative to the Michigan splint.
and bruxing. Whilst there is evidence all types of splint can be effective, soft splints are widely used, as they are cheap and easy to make.
The hard thermoformed splint is more robust than the soft splint and does not produce occlusal changes. It represents
References 1. Moufti MA, Lilico JT, Wassell RW 2007. How to make a well-fitting stabilization splint. Dental Update, 34: 398–408. 2. Erkodent Ltd. http://www.glidewelldental.com/ downloads/lab/thermoforming- techniques.pdf. Accessed 29.3.16
EXPERIENCED PROSTHETIC TECHNICIAN ● Excellent rates of pay ● South Manchester ● An excellent opportunity for an experienced technician looking to progress his/her career and who can produce both private and NHS prosthetics to a high standard ● You will need to lead by example and work as part of the team in this busy modern laboratory, helping to maintain our high standards of work
Author contact details: * Morriston Hospital, Morriston, Swansea SA6 6NL ** Bristol Dental Hospital, Lower Maudlin Street, Bristol BS1 2LY Email: r.jagger@bristol.ac.uk Tel: 07709 416 175
materials & equipment
Part occlusal contact splints, however, can produce occlusal changes and soft splints may be perforated by bruxing.
It is not as robust as the hard splint however, and the splint may delaminate in the molar regions, particularly in patients with a heavy occlusion and marked bruxism.
core verified CPD
Fig. 6: Finished splint in the mouth
The laminate (dual laminate, hard soft splint) has the advantages of the hard splint. It is particularly comfortable for patients because of the soft fitting surface.
3. Fricton J, Look JO, Wright E, Alencar FG Jr, Chen H, Lang M, Ouyang W, Velly AM 2010. Systematic review and meta-analysis of randomized controlled trials evaluating intraoral orthopaedic appliances for temporomandibular disorders. Journal of Orofacial Pain, 24: 237–354. 4. Magnusson T, Adiels AM, Nilsson HL, Helkimo M 2004. Treatment effect on signs and symptoms of temporomandibular disorders – Comparison between stabilisation splint and a new type of splint (NTI). A pilot study. Swedish Dental Journal, 28: 11–20.
Full time prosthetic technician required for our dental laboratory in Harrogate Please email your CV to James Quayle at sgdentures@live.co.uk
Contact: Mark Greaves: 01619739690, or e-mail Brooklands-dental@tiscali.co.uk the
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16 october 2016
medicalemergencies
■ Update on medical emergencies for dental technicians: Why dental technicians need to know about medical emergencies Standards for the Dental Team: Standard 7.3 Update and develop your professional knowledge and skills ■ Educational aims: – to gain knowledge of the types of medical emergencies that commonly occur in the dental setting – to meet General Dental Council requirements for training in medical emergencies – to work as a team when dealing with a medical emergency ■ CPD outcome: – to be aware of the GDC’s expectations for training in medical emergencies and why dental technicians need to know about medical emergencies
What is a medical emergency? A medical emergency is an acute event that poses an immediate threat to a person’s life. While a medical emergency may be precipitated by dental treatment, it may also be a chance occurrence. Box 1 lists the medical emergencies that are commonly encountered in general dental practice.
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ortunately, the incidence of a medical emergency occurring in general dental practice is low, with reported incidence rates being one event per clinician every 3–4 years when syncope is excluded (Atherton at al. 1999). However, while the incidence is low their consequences may be serious.
Why do dental technicians need to know about medical emergencies? In August 2008 the GDC introduced compulsory continuing professional development (CPD) for dental care professionals (DCPs), which now includes technicians. Management of medical emergencies is a GDC core subject for CPD, and DCPs are required to undertake a minimum of 10 hours of verifiable CPD on medical emergencies per 5-year cycle. The GDC also states that training in medical emergencies must be on an annual basis (GDC 2009). Also, in July 2006 (with an update in July 2010), guidance for training and standards on responding to medical emergencies and resuscitation for dental
● Simple Faint (Vasovagal Syncope) ● Angina ● Epileptic Seizure ● Diabetic Collapse (Hypoglycaemia) ● Asthma ● Choking ● Anaphylaxis ● Myocardial Infarction ● Cardiac Arrest Box 1: Common causes of medical emergencies in general dental practice (Girdler and Smith 1999)
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practitioners (DPs) and DCPs was produced by the Resuscitation Council (UK). The guidance states: ■ there is a public perception that DPs and DCPs should be competent in dealing with medical emergencies ■ training for DPs and DCPs should include cardiopulmonary resuscitation (CPR), basic airway management and use of an automatic external defibrillator (AED) ■ training should be regular and involve simulated emergencies It is also important to remember these guidelines are revised regularly, therefore all DPs and DCPs should maintain up-todate knowledge and skills.
Working as a team A quick and appropriate response is only possible when the team is well prepared and works together as a unit. The GDC guidance document ‘Principles of Dental Team Working’ defines the dental team and states that if you employ, manage or lead a team, you should make sure that: ■ at least two people are available to deal with medical emergencies when treatment is planned to take place ■ all members of staff, not just the registered team members, know their role if a patient collapses or there is another kind of emergency ■ all members of staff who might be involved in dealing with a medical emergency are trained and prepared to deal with such an emergency at any time and practise together regularly in a simulated emergency so they know exactly what to do
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medicalemergencies
■ recognition of persons at risk of a medical emergency and assessment of the severity of the risk ■ the role of each team member when dealing with a medical emergency ■ the location of emergency equipment and the procedure for maintaining the equipment ■ communicating with the emergency services providing: – clear information on the nature of the emergency – age and predisposing factors of the person involved – location and access to the building
Conclusion There is clear guidance set out by the GDC on training for DCPs in managing
medical emergencies. The role of the dental technician in dealing with medical emergencies will vary given the differences between individual technicians in terms of: ■ ■ ■ ■
working environments degree of contact with patients training and competencies equipment available
Dental technicians must be trained in basic life support and management of the common medical emergencies that occur in the dental setting. They must also be able to use the emergency equipment available to them and be familiar with workplace protocols on managing medical emergencies. All training should be updated annually in combination with the practising of emergency scenarios.
medical emergencies
Given this there should be a workplace protocol for preparation and management of medical emergencies (Scully 2010). This should include:
■ Atherton GJ et al. (1999) Medical Emergencies in General Dental Practice in Great Britain Part 1: Their prevalence over a ten-year period. British Dental Journal, 186, pp. 72–79. ■ General Dental Council (2009) Continuing Professional Development for Dental Care Professionals. London: GDC http://www.gdcuk.org/Current+ registrant/CPD+requirements (updated December 2009, accessed September 2009). ■ General Dental Council (2006) Principles of Dental Team Working. London: GDC http://www.gdc-uk.org/ Current+registrant/Standards+for +Dental+Professionals (updated January 2006, accessed September 2009). ■ Girdler NM and Smith DG (1999) Prevalence of medical emergency events in British dental practice and emergency management skills of British dentists. Resuscitation, 41, pp. 159–167. ■ Resuscitation Council (UK) (2006) Medical Emergencies and Resuscitation: Standards for clinical practice and training for dental practitioners and dental care professionals in general dental practice. Revised May 2008, Updated July 2010. ■ Scully C (2010) Medical Problems in Dentistry. 6th edition, Churchill, Livingstone Elsevier, chapter 1, pp 3–6.
core verified CPD
References
Acknowledgements The help of Dr Kenneth Wilson, Consultant in Special Care Dentistry, in the preparation of this paper is acknowledged.
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18 october 2016
keynotearticle
■ What does success look like? By Kevin Lewis, BDS LDSRCS FDSRCS(Eng) FFGDP(UK) ■ It is up to each one of us to decide what our own success should look and feel like. ■ Question success defined by others, or somehow dictated by society. ■ A clear grasp of what is important to you and what you are trying to achieve will help you choose correctly when important decisions arise.
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or many successful people, a key ingredient of success is that other people respect them and recognise them as being successful. Members of the dental profession generally enjoy a privileged standing within the community, but success can be measured in many different ways. Different people will attach a different weight to the emotional/human, financial and professional/technical elements and (where it exists) what one might term the ‘strategic’ dimension of the overall picture. In the same way, opinions will differ about the relative importance of the various elements within each of them (see Table 1). All these
dimensions are inter-related and the financial element is certainly not the only one that is impacted by whether you are self-employed (perhaps owning and running your own business) or working as a salaried employee. For one individual, success might mean achieving higher professional qualifications or a senior position. For another, it might be related to research or publications. But in modern society, success is increasingly associated with money (as reflected in material ‘net worth’) and power. The term ‘net worth’ is not helpful at all, as it implies that ‘worth’ and ‘value’ can only be measured in financial terms. And all of these elements are increasingly confused with happiness, contentment and wellbeing. Arianna Huffington is co-founder and editor-in-chief of The Huffington Post, and outwardly would be viewed as one of the world’s most influential and successful
Table 1. Some of the elements of success
She refers to her ‘wake up call’ in 2007 following an accident resulting from exhaustion. Whilst waiting in the hospital, she had time to reassess her life and to question if her success with Huffington Post was what success actually looked like. By traditional measures of success, money and power, she was certainly triumphant but by any sane definition of success, life could not continue as it had. She reached the conclusion that the stress of overbusyness, overworking, over-connecting on social media and under-connecting with one another and ourselves was not healthy. Those aspects of our lives that allow us to regenerate and recharge seemed to have vanished from her life and those of most folk she knew.
Emotional/Human
Professional/Technical
● Happiness ● Contentment and wellbeing ● Fulfilment ● Values and self-respect ● Respected by family/ friends/others
● Quality of expertise ● Patient care and satisfaction ● Professional recognition ● Professional integrity ● Respected by peers
Later in the book, the author offers us her thoughts on where all the ‘spaces’ and ‘pauses’ might have disappeared. She describes our relentlessly progressive dependency upon electronic devices as ‘Over-connectivity: the snake in our digital Garden of Eden’.
Strategic
Perspective and balance
● Attainment of personal goals ● Improvement & career development ● Attainment of professional goals ● Successful business in a strategic sense (size/reputation/ethos/other non-financial determinants) ● Influence, impact and legacy
A strong undercurrent that pervades the pages of Thrive is that success is not just about what you achieve, but how you achieve it. In terms of professional/ technical (clinical) success it is worth pausing to remind ourselves that even the highest quality of clinical dentistry in a technical sense is diminished in its value if the treatment is not necessary in the
Financial ● Successful business (profitability and cash flow) ● Material success ● Money for today ● Money for tomorrow ● Money for the future the
women. In 2014 she wrote a candid and inspirational book Thrive¹ which quickly became an international bestseller, not least because it challenges each and every one of us to question what kind of success we are searching for. In the opening section of the book she shares with us a very personal moment of catharsis which could have been disastrous in its consequences but was in fact a triumph of sorts. Initially in heavy disguise, perhaps, but a triumph nevertheless.
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keynotearticle first place, or if it doesn’t serve the patient’s needs or best interests. Similarly, what is the real value of any apparent financial ‘success’ that is based upon unethical or dishonest behaviour, and/or the provision of treatment that is inappropriate or of poor quality? Using Arianna Huffington’s analogy of the twolegged stool, it may feel like success for a few fleeting seconds but sooner or later the painful reality will become apparent. The book spends time discussing the issue of ‘work-life balance’ – that elusive nirvana that so many of us were led to expect 20 or 30 years ago and the members of socalled Generation X are still looking for today. They were promised a short working life and a long leisure-rich retirement. Two recessions and a global financial crisis later, they face the prospect of an extended working life and a retirement that is more difficult than ever before to plan for and adequately resource. Whether or not it ends up being a shorter retirement may well depend on how many of the lessons of this book are taken on board. Unsurprisingly – as a career woman herself and the mother of two daughters – the author tackles head-on the dilemma faced by all those women who are trying to combine career and family and achieve success in both. But she is quick to acknowledge that while mothers are biologically equipped to have a particular role in delivering and nurturing children, fathers are also touched by some elements of the same dilemma while children are growing up. She recounts the memorable story told by Carl Honoré in his book In Praise of Slowness.² At a frantically busy time in his life, he was at an airport waiting for a flight home from Rome. Instead of relaxing and treasuring a short period of enforced ‘down time’, he was filling his time making phone calls while simultaneously flicking through the pages of a newspaper or magazine. His eye was drawn to a feature headed ‘The One Minute Bedtime Story’ which
explained that many of the classic children’s stories had been slimmed down so that they took just 60 seconds to read. His first reaction was to think what a great timesaver this could be, as he had a two-year-old son who was very fond of his bedtime stories. Instinctively making a mental note to order a copy of the book as soon as he got back home, he suddenly came to his senses, asking himself ‘Have I gone completely insane?’ It is a nice story and a thought-provoking one on many levels. Nobody tells us that every waking minute of every day needs to be packed full of ‘stuff’. That is a deluded conclusion that we come to when we are struggling to fit everything in – instead of pausing to ask ourselves whether we are fitting the right things in and prioritising them in a sensible and sustainable way. Several times in her book, Arianna Huffington challenges the reader to ask whether they are looking after themselves (in the holistic sense) or simply doing things that will please or impress others. This goes to the very heart of what success means, and to whom, and how much it matters. Her analogy of the preflight safety demonstration which exhorts parents to fit their own oxygen mask first, before attending to fitting the masks for their children, is a powerful one. In order to be truly successful, you have to invest time in yourself and be very clear about your priorities rather than picking up the crumbs after you have spent all your quality time chasing less meaningful trinkets of success. In healthcare, we cannot hope to care for others to the best of our abilities unless we ourselves are in a fit state to do so. Thrive concludes with an uplifting epilogue.
Summary It is up to each and every one of us to decide for ourselves what success should look and feel like for us personally. As with everything else in life, it is to some extent a question of finding the right balance, and with this in mind a moment of reflection upon Table 1 may be beneficial. A common mistake is to fall
into the trap of striving for somebody else’s vision of success, or indeed for success on terms that society has somehow dictated. When surrounded on all sides by urban myths of what a success looks like, it is not always easy to pursue it on your own terms, and at your own pace, but ultimately it makes little sense to do otherwise. Working in any healthcare field brings challenges that are different but no less demanding than the commercial world of business, and we need to be mindful that there are times in everybody’s life when external pressures will conspire to drive us off course and it will be particularly difficult to square the circle. Understanding and accepting that reality, whilst having a clear grasp of what is important to you and what you are trying to achieve, will help you to make the right choices when important decisions need to be made.
Notes 1. Thrive; Arianna Huffington. Published by WH Allen 2014. ISBN 978-0-75355-542-2. Reprinted by permission of The Random House Group Limited. 2. In Praise of Slowness; Carl Honoré New York: Harper One, 2004. ISBN: 978-0-60750-510
About Kevin Lewis Kevin Lewis has given 27 years of continuous service to MPS and has been Dental Director of Dental Protection for the last 18 of them. Although he stepped down from that role this year, he will still be involved with dentistry both in the UK and internationally. Originally published in Dental Protection’s Annual Review 2016; Success www.dentalprotection.org the
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20 october 2016
interview
■ Driven by a passion for bringing smiles back to life We are delighted to welcome Marta Zarnowiecka as the newest member of the DTA Council. The Technologist feature writer, Vicki Gumbley, caught up with Marta at her Gloucester home to find out what inspires and drives her career as a dental technician.
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arta comes from a family of medical professionals – dentists, doctors and nurses – and her parents raised her to always try and help people.
that the dentist does everything and often they don’t even know that dental technicians exist or what we do. Hopefully that is changing now.’ After she qualified in 2007, and while she was working as a technician in her home country, she read an article about Polish people coming to England to work in the profession. She discovered that rather than being paid per item, technicians in the UK were employed and paid per hour.
She had considered going into dentistry but her dislike of blood eventually put paid to that idea and instead she looked into following in her uncle’s footsteps and becoming a dental technician.
This piqued her interest and Marta did some research, which only served to fuel her dream of coming to the UK, learning and developing her skills and eventually setting up her own lab.
‘It’s not a very common job, even in Poland’, said Marta. ‘Most people assume
She arrived in the UK with her then boyfriend, now husband, in 2009.
‘I decided that England was the place I wanted to be, especially for my career. I had a five-year plan to come, learn all I could and launch my own lab. But, as with all the best plans, that hasn’t quite gone as I’d thought. ‘People in the UK have such different attitudes – and are more friendly. As technicians in Poland, we were always being rushed to complete one job after another. The dentists wanted everything done yesterday. ‘Now I can do a good job and feel proud. That’s not to say that some dentists still require things to be done quickly, but on the whole, the focus is on attention to detail. That makes for a much more pleasurable work life and I am far more satisfied with what I achieve.’ Marta is happy working for Tyler Crown and Bridge in Gloucester, a firm she describes as being at the top of its game with a fantastic reputation. She has now been at Tyler Crown and Bridge for seven years and says it is more like being with family than with a typical employer. ‘We have a good time together and I want to go to work – not just clock my hours as I did in Poland. There are seven women and four men at Tyler’s, so it’s very unusual for a dental lab. ‘In Poland, people can be very traditional in that they still have the attitude that women should stay at home and it was the men who had the highest positions in labs. Hopefully that is changing both there and in England. ‘I think this is one of the best labs in the UK. Our standard of work is top rate.
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october 2016 21
interview
I work very hard and I am improving my skills all the time. I love being in England and I am so grateful for where we live near the docks in Gloucester. I appreciate it every day.’ The couple has bought a flat in Gloucester and plans to stay in the UK, although Marta says her five-year plan has been put on hold for now. ‘I’m the kind of person who, if I decide to do something, I give it my all. That was why I became a DTA Council representative at the same time I joined the organisation. ‘It has worked out quite well too because I’m on maternity leave so I now have time to sit and think about how we can work together to raise the profile of the organisation.
for what you have done. They come back to life again. If I see a patient who is
grateful then I know I have helped them – and that’s how my parents raised me.’
‘I would like to help boost member numbers and spread the word about the DTA. I helped on the DTA stand in Birmingham and had some very good conversations with technicians and dentists. I also spoke to some Polish technicians, so perhaps I can help spread the word in my mother tongue too. ‘I believe that the more members we have, the stronger our word will be in the profession and the bigger difference we will be able to make.’ Having been brought up with a desire to help, the part of her job she likes most is restoring people’s mouths. ‘The most important thing for me is bringing people confidence in their mouths. People become depressed if they can’t eat properly, can’t smile or don’t have a full mouth of teeth. If people are happy and smiling they are so grateful the
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22 october 2016
continuingprofessionaldevelopment Continuing Professional Development (CPD) Programme The Technologist is pleased to include a continuing professional development (CPD) programme for DTA members in accordance with the UK General Dental Council’s regulations and the FDI World Dental Federation’s guidelines for CPD programmes worldwide. The UK General Dental Council regulations required that from 1 August 2008 all dental technicians must start documenting their CPD. They are required to complete and record a minimum of 150 hours of CPD every five-year cycle, a third of which should be verifiable CPD (50 hours). This should include verifiable CPD in the following core subjects: ■ medical emergencies (10 hours per cycle) ■ disinfection and decontamination (5 hours per cycle) ■ materials and equipment (5 hours per cycle)
The questions in this issue of The Technologist will provide verifiable CPD for those entering the programme. Complete your answers for free online at www.dta-uk.org, or use the answer sheet overleaf (or a photocopy if this is preferred, so as not to remove the page). Return your answer sheet to the DTA Head Office address with your £5 payment (please note that your CPD won’t be processed without payment) before the 14 November 2016. Online and paper responses must be received by the deadline. Dental technicians completing the programme will receive a certificate for the prescribed number of hours of verifiable CPD, together with the answers to the questions either online or by post according to the above guidelines.
Aims and outcomes In accordance with the General Dental Council’s guidance on providing verifiable CPD: ■ The aim of The Technologist CPD Programme is to provide articles and material of relevance to dental technicians and to test their understanding of the contents. ■ The anticipated outcomes are that dental technicians will be better informed about recent advances in dental technology and associated subjects and that they might apply their learning to their practice and ultimately to the care of patients. Please use the space on the answer sheet or online to provide any feedback that you would like us to consider.
Why DTs need to know about medical emergencies (Medical emergencies CPD – 45 minutes) Q1 – Which of the following are the most common medical emergencies in a general dental environment? A – Cardiac arrest and anaphylaxis B – Myocardial infarction, choking and hypoglycaemia C – Fainting and epileptic seizure D – Asthma, angina and all of the above
Q2 – What is the most common medical emergency in dental practice? A – Acute angina attack B – Simple faint (vasovagal syncope) C – Epileptic seizure D – Diabetic collapse (hypoglycaemia)
Q3 – How often does a serious medical emergency occur in our industry? A – Every year B – Every 2–3 years C – Every 3–4 years D – Less than every 4 years
Q4 – According to the article, why does the GDC state that all registrants are trained in dealing with medical emergencies? A – They had run out of core CPD topics and needed something B – It is common practice across all professions C – They recognise that team training helps with team bonding and wanted to help D – A patient could collapse on any premises at any time and everyone should know what to do
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Q5 – According to the GDC Standards for dental professionals, what is the minimum number of people that should be available to deal with a medical emergency? A–1B–2C–3D–4
Q6 – Which one of the following is not a recommendation for a workplace protocol for dealing with medical emergencies? A – Recognition of persons at risk of a medical emergency and assessment of the severity of the risk B – Disposal of expired emergency drugs C – The role of each team member when dealing with a medical emergency D – Location of the emergency equipment and procedure for maintaining the equipment
Q7 – How often should medical emergencies training be updated? A – At least every 6 months B – At least every 1 year C – At least every 2 years D – At least every 5 years
Q8 – According to the GDC Standards: A – Nominated medical emergency staff can learn by reading articles B – Members who might be involved in dealing with ME practise together regularly C – Regular practice should include a simulated emergency and b D – Everyone should have a go at dealing with a medical emergency
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continuingprofessionaldevelopment Thermoformed splints (Materials & equipment cpd – one hour) Q1 – Which of the following is not a type of occlusal splint? A – Michigan B – Toronto C – Tanner D – Thermoformed
Q10– The margins of laminate splints can be most effectively smoothed with: A – Acrylic bur B – Rubber wheel C – Lisco disc D – Crosscut fissure bur
Q2 – Michigan splints are made to fit on: A – Upper arch B – Lower arch C – Either upper or lower arches D – Upper and lower arches simultaneously
Q3 – Thermoformed splints are made to fit on: A – Upper arch B – Lower arch C – Either upper or lower arches D – Upper and lower arches simultaneously
Q4 – Occlusal splints are not commonly used to manage: A – Bruxism B – Temporomandibular disorders C – Sleep apnoea D – Tooth wear
Q5 – Part occlusal contact-type splints can cause: A – Occlusal changes B – Periodontal abscess C – Tooth wear d) Snoring
Q6 – Which of the following is the most robust? A – Michigan splint B – Thermoformed laminate splint C – Thermoformed hard splint D – Soft splint
Q7 – Which of the following is the most technique sensitive? A – Soft splint B – Michigan splint C – Thermoformed laminate splint D – Thermoformed hard splint
Q8 – Which of the following is the most effective type of splint? A – Michigan splint B – Thermoformed hard splint C – Soft splint D – None of the above
Q9 – Laminate splints: A – May delaminate in the molar regions B – Usually delaminate in the incisor region C – Discolour rapidly D – Distort in cold water
Leading Light – Leadership (Other specific verified cpd – 30 minutes) Q1 – Research into leadership in SMEs concluded that: A – One type of leadership fits most situations B – The needs change as the business grows C – Leaders are born and not made D – Leadership is less important in an SME
Q2 – The most effective leadership style focuses on: A – A balance between the business and the people perspective B – Supporting your people C – Making money D – Avoiding risks
Q3 – One of the most effective ways of developing your business is through: A – Networking and expanding your knowledge base B – Internal meetings C – Keeping doing what you have been doing D – Re-examining your past mistakes
Q4 – Coaching is all about: A – Telling people what to do B – Making people aware of their mistakes and errors C – Asking open questions to help people develop their skills and knowledge D – Getting people to work harder
Q5 – The best people processes are: A – Formal and well-documented B – Flexible and relevant to your business C – Online D – Theory-based the
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24 october 2016
continuingprofessionaldevelopment An introduction to 3D printing (Materials & equipment cpd – 30 minutes) Q1 – 3D printers in the dental sector can provide digital precision and efficiency in the production of what? A – Stone, quadrant and implant models B – Surgical guides C – Splints and temporaries and a and b D – Orthognathic models and all of the above
Q4 – What are some of the signs to look for in moles? A – Changing colour, bleeding or becoming crusty B – Getting bigger or changing shape and a) above C – A hair in a mole D – Clear metastatic action of the mole
Q5 – In what given period should you see a medical practitioner if a lesion fails to heal? A – 1 month B – 3–4 weeks C – 3–4 months D – 1 year
Q2 – What does additive manufacturing mean? A – Using a different blend of raw materials each time B – Building up the object layer by layer C – Using a combination of natural and man-made materials D – None of the above
Q3 – What characteristics of ‘jetting’ are referred to in the article? A – The deposition of each layer of material B – The material is usually acrylic resin C – Layers are usually 15 microns or more thick D – Jetting machines use inkjet print heads and a and b
Q4 – Which of the following is not true? A – Groups of nozzles can only print in one resin B – Different resins can be blended C – Manipulation of colour and translucency is possible D – Each horizontal layer is deposited in the shape of the object being printed
Q5 – Identify the correct characteristics of digital light processing: A – It uses pixelated digital light B – Its advantage is speed of printing and a and d C – Activated pixels are left as solid mounds D – Individual pixels can either be activated or left inactive
Early cancer detection (Other specific verified cpd - 30 minutes) Q1 – Malignant melanoma is made of abnormal skin pigment cells called: A – Ulcer cells B – Melanocytes C – Carcinoma D – Metacognition
Q2 – Basel cell cancers and squamous cell cancers are: A – Less serious forms of skin cancer B – The most serious form of skin cancer C – Cannot be treated and b) D – Can be treated at an early stage and a)
Q3 – Malignant melanoma can develop in: A – Body skin and scalp B – Eyes and nails and a) only C – In the mouth D – All the above
KPIs Part two (Other specific verified cpd – 30 minutes) Q1 – What does the formula trade debtors/sales x 365 give you ? A – Creditor days B – Debtor days C – Gross profit margin D – Net profit margin
Q2 – Turnover is another name for what? A – Margin B – Cost of sales C – Sales D – Profit
Q3 – Conversion rate measures how often enquirers do what? A – Hang up the phone B – Become customers C – Pay you money D – Send in orders
Q4 – Ideally how often should you review profit margins? A – Once in a blue moon B – Annually C – Every six months D – Monthly
Q5 – Gross profit is calculated by subtracting what from sales? A – Direct costs B – Overheads C – Bad debts D – Wages
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Simply fill in the multiple choice answer sheet on the inside back cover and complete the form ...
october 2016
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answer sheet the technologist october 2016 Please PRINT your details below: First Name*
Last Name*
GDC no.*
Title
DTA Member: Yes
No
DTA no.*
*Essential information. Certificates cannot be issued without all this information being complete.
Complete free online at <www.dta-uk.org>. First-time users will need to register; those already registered need only log in. Or, either remove this page, or send a photocopy to: Dental Technologists Association, F13a Kestrel Court, Waterwells Business Park, Gloucester GL2 2AT. A £5 payment must be included with your CPD answer sheet – please do not forget! Please note that you must achieve a score of 50% or more to receive a certificate.
Answer sheets must be returned before 14 November 2016 for CPD responses returned in the post and for online CPD users. Answer sheets received after this date will be discarded. Answers Please tick the answer for each question below Why DTs need to know about medical emergencies (Medical emergencies cpd – 45 minutes) Question 1:
A
B
Question 2:
C
D
Question 6:
A
B
A
B
Question 3:
C
D
Question 7:
C
D
A
B
A
B
Question 5:
Question 4:
C
D
C
D
C
D
A
B
C
D
A
C
D
A
B
C
D
C
D
C
D
C
D
C
D
C
D
C
D
Question 8:
C
D
A
B
Thermoformed splints (Materials & equipment cpd – one hour) Question 1:
A
B
Question 2:
C
D
Question 6:
A
B
A
B
Question 3:
C
D
Question 7:
C
D
A
B
A
B
Question 8:
C
D
A
B
Question 5:
Question 4:
A
B
C
D
A
C
D
A
C
D
A
C
D
A
C
D
A
B
B
Question 10:
Question 9:
C
D
A
C
D
A
C
D
A
C
D
A
C
D
A
B
Leading Light – Leadership (Other specific verified cpd – 30 minutes) Question 1:
A
B
Question 2:
C
D
A
B
Question 3:
C
D
A
B
Question 5:
Question 4:
B
B
An introduction to 3D printing (Materials & equipment cpd – 30 minutes) Question 1:
A
B
Question 2:
C
D
A
B
Question 3:
C
D
A
B
Question 5:
Question 4:
B
B
Early Cancer detection (Other specific verified cpd – 30 minutes) Question 1:
A
B
Question 2:
C
D
A
B
Question 3:
C
D
A
B
Question 5:
Question 4:
B
B
KPIs Part two (Other specific verified cpd – 30 minutes) Question 1:
A
B
Question 2:
C
D
A
B
Question 3:
C
D
A
B
Question 5:
Question 4:
B
B
Feedback We wish to monitor the quality and value to readers of The Technologist CPD Programme so as to be able to continually improve it. Please use this space to provide any feedback that you would like us to consider.
An important note for non-DTA members Non-DTA members will incur a £25 fee for undertaking CPD provided through this publication. Cheques made out to DTA should accompany your answer sheet. the
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