Modern Dentist Magazine Issue 3

Page 1

Get your

tech in check



GDPR is here ICO


meet dentistry Neocis



Straight Teeth Direct

ISSN 2515-6128

Key contributors to this issue


through apps Brush DJ

Welcome Tech is the name of the game for issue 3 of Modern Dentist Magazine, as it is for a lot of practices today. While the latest developments have always been capitalised on in healthcare, it seems to me that this is especially the case in dentistry. The profession is being presented with and embracing technology at a rapid pace, as evidenced by the success of events like last month’s Dental Technology Showcase. As I traversed the labyrinth of the NEC Birmingham, I was overwhelmed by the variety of tools and solutions on show, and it was easy to imagine the difficulty the discerning dentists in attendance would have had in choosing which products were right for their practices. Hopefully this edition of Modern Dentist will help you demystify some of the biggest advances in technology.

by now, GDPR has arrived, and with the new regulation comes higher penalties for misuse of data. But, as the Information Commissioner’s Office explain in the News, they want to work with businesses to help make sure the data they handle is safer and more accessible and not go on a fine-seeking witch hunt. Technology and data are there for the taking and have the potential to boost the patient’s experience and the practice’s bottom line. It’s up to dental professions to make the most of the solutions that are out there, investing smartly to create a truly modern practice.

We’ll be taking a look at the broader innovations that are about to shake up the dental market. We examine how app technology can be used to create patient engagement to ultimately improve oral health and how robotics is gaining a stronger presence in dentistry across the pond. We also hear about some of the considerations practices should make before taking the big leap to invest in a new product. With the opportunities for increased utilisation of technology come opportunities for increased utilisation of the data obtained from these technologies. It’s been said that data is the new oil, and that data is only going to influence dental solutions more and more in the years to come, as well as having a profound effect on practices themselves. I hope that will be a positive effect, because, as everyone is hopefully aware of

Brendan Gurrie, Editor, Modern Dentist Magazine. 01765 600909 | @ModernBrendan |

Editorial Contributors Edmund Proffitt

Chief Executive British Dental Industry Association

Emma Buglass BDS F.J. Trevor Burke

BDS, MDS, DDS, MSc, MGDS, FDS RCS, (Edin.), FDS RCS (Eng.), FFGDP(UK), FADM, Course Director, Masters in AGDP University of Birmingham (B.Ch.D D.G.D.P.(U.K.)R.C.S. Dip.Con. Sed(Newc) The Raglan Suite

Heidi Marshall Partner Dodd & Co

BDS FFGDP RCS Director Oralign

Jo Dickinson

Sales and Marketing Director Implantium UK

Dr Geoff Baggaley

Dr Lester Ellman

RDH FAETC Hygienist and Key Opinion Leader Acteon

Joan Fernandez Sales Manager Ancar

Jon Drysdale

Independent financial adviser PFM Dental chartered financial planners

Kirsty Wainwright-Noble

Head of Sales and Marketing Towergate Insurance Brokers

Lorraine Nadel

Sara Martin

Mark Barry

Shaz Memon

Matthew Hill

Sophie Kwiatkowski

Mike Hughes

Stephen Green

Managing Director Tempdent Recruitment and Training Director ESM Digital Solutions Executive Director, Strategy General Dental Council Principal Dental Practice Consultancy Service

Rachel Moreland

UK’s Icon and Flairesse product specialist DMG Dental Products (UK) Ltd

Dr Richard Brown

Parrys Lane Dental Practice and Bupa Dental Care Geo Orthodontics

Marketing Communications Manager Medifinance Creative Director Digimax

Accountant PFM Townends LLP

CRadP MSRP MIPEM Radiation Protection Adviser, Medical Physics Expert and Radioactive Waste Adviser Stephen Green and Associates

Sue Bessant

Technical Director Wired Orthodontics

Editor - Brendan Gurrie, Project Manager - Amanda King, Editorial Assistant - Poppy Green, All material is copyrighted both written and illustrated. Reproduction in part or whole is strictly forbidden without the written permission of the publisher. All images and information is collated from extensive research and along with advertisements is published in good faith. Although the author and publisher have made every effort to ensure that the information in this publication was correct at press time, the author and publisher do not assume and hereby disclaim any liability to any party for any loss, damage, or disruption caused by errors or omissions, whether such errors or omissions result from negligence, accident, or any other cause.

Modern Dentist Magazine is published by Charlton Grant Ltd ©2018


Modern Dentist Magazine

Modern Dentist Magazine

Contents 15

The future is digital:



Interview with Alon Mozes, Neocis



GDPR is here

Robert Parker, the Information Commissioner’s Office (ICO) outlines what the new legislation means for dental professionals and how practices can make sure they remain compliant.



Rise of the robots: Alon Mozes


In this issue of Modern Dentist we looked across the pond and spoke to Alon Mozes at Neocis, developers of the Yomi robot-assisted dental surgery systems, about how the emerging technology can improve the dental experience for patients and make dental surgery more efficient for practices.

The future is digital: Adam Nulty


Dr Adam Nulty, of the Digital Dental Academy and Dentist On THE ROCK, outlines the latest developments in digital dentistry and the considerations that practices should make before investing in new technology.

Digital can close the distance: Dr Aalok Y Shukla Teledentistry is evolving, as Dr Aalok Y Shukla, Straight Teeth Direct™, explains. As society shifts to a more on-demand culture, teledentistry reflects the progress dentistry is making to meet the changing needs of patients in this space.

4|Modern Dentist Magazine


Regional Focus: Southeast

Modern Dentist’s third Regional Focus examines the Southeast, and we spoke to the Chairman of the Surrey LDC, Barry Westwood, about the difficulties faced by today’s dental professionals and how the region’s LDCs are attempting to address these.

Editorial Board

27 27 29

Promoting professionalism

Matthew Hill, General Dental Council

Why risk it?

Compliance culture and the GDC’s advertising and website guidelines


Edmund Proffitt, British Dental Industry Association

Shaz Memon, Digimax

Which is the best long-term investment – property or stocks?


Darren Scott-Guinness, Dental & Medical Financial Services

Dental Cone Beam Computed Tomography (CBCT)


Stephen Green CRadP MSRP MIPEM, Stephen Green and Associates

Self-employed status

Sophie Kwiatkowski, PFM Townends LLP

Regional Focus: Southeast


Considerations when buying and selling a dental practice

33 34 34 35 35

Mike Hughes, Dental Practice Consultancy Service

Minimising stress

Dr Geoff Baggaley (B.Ch.D D.G.D.P.(U.K.) R.C.S. Dip.Con.Sed(Newc)

Go in with your eyes open Heidi Marshall, Dodd & Co

Reducing the cyber risk

Kirsty Wainwright-Noble, Towergate Insurance Brokers

The four factors

Joan Fernandez, Ancar

Making the right decisions when investing in a new product for your practice

37 37 38 38

Mark Barry, ESM Digital Solutions

Digital discovery

Sue Bessant, Wired Orthodontics

How to recruit the right candidate for your practice Lorraine Nadel, Tempdent

Dental implant training – worth the investment? Emma Buglass BDS, Implantium UK

Promoting ‘simple’ orthodontics in your practice Dr Lester Ellman BDS FFGDP RCS, Oralign

Issue 03 | ISSN 2515-6128 Subscribe for FREE at

41 Providing patient



Prevention better than cure!


Financing and funding growth

39 39 41

Preventing periodontal disease


How to talk ‘business’ without talking business


Dr Richard Brown, Parrys Lane Dental Practice and Bupa Dental Care



Providing patient finance

Charmaine Matthew, Medifinance Ltd



When dancing meets dentistry: Interview with Ben Underwood, Brush DJ


Ben Underwood, developer of the popular Brush DJ app, explains the importance of patient communication and how app technology can be utilised to boost engagement with oral health.

Changing the face of paediatric dentistry

Dr Roksolana Mykhalus set up Happy Kids Dental, an exclusively paediatric practice in London, because she wanted to change perceptions about children’s dentistry in the UK and revolutionise the experience of dental visits for children. Treating children aged 0-18, her state-of the-art practice is fast becoming a go-to for private referrals, as this article explores.

Growing your business might seem like an entirely separate entity to providing excellent clinical care, but the truth is, the key to both is building rapport, writes Barry Oulton. Donald Sloss, BACD, delves into the world of cosmetic dentistry and what offering it could mean for your practice and patients.

Financing and funding growth

The value of distance learning to the busy dentist

F.J. Trevor Burke BDS, MDS, DDS, MSc, MGDS, FDS RCS, (Edin.), FDS RCS (Eng.), FFGDP(UK), FADM, University of Birmingham

Supported By

Consider cosmetic dentistry

Jo Dickinson RDH FAETC, Acteon

Mixing business with dentistry

Rachel Moreland, Sales and Marketing Manager at DMG UK, highlights some of the latest active care trends in Minimally Invasive Dentistry.

Jon Drysdale, PFM Dental, outlines the challenges practice owners may face when buying a second practice and the considerations they should take to mitigate these.

Case Studies

56 56 57 57

Medifinance and The Money Cloud mikrozid®

effective against TB

Customer Case Study Amy Simpson

A positive influence in practice

10 Minutes with...


Melonie Prebble

Dental Hygienist and Therapist


Modern Dentist Magazine

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GDPR is here Robert Parker,

the Information Commissioner’s Office (ICO), outlines what the new legislation means for dental professionals and how practices can make sure they remain compliant. Last month saw a big change in data protection law - The Data Protection Act 2018 (DPA 2018) implementing the General Data Protection Regulation (GDPR) became law on 25 May. It brings a more 21 century approach to the processing of personal data, and if you’re responsible for people’s personal information, which most dentists are, you should have been preparing. st

But, if you’re not quite there yet, the message is don’t panic; as long as you have started to work towards compliance then you are doing the right thing. The Information Commissioner’s Office (ICO), which regulates data protection law, has been keen to emphasise that 25 May was not a deadline, it is the start of the journey. The new reforms place more obligations on dentists to be accountable for their use of personal data. Dental surgeries need to

think carefully about the way they deal with patients’ and staff records but, if you have been complying with the previous data protection laws, you don’t need to start again, you will have already been doing much of what is necessary under the new law. Your patients will have more rights, such as being better informed about what businesses are doing with their data and having greater access and control over their data. We’ve highlighted a few points below but there are a lot of resources at:

25 May was not a deadline, it is the start of the journey

Maintaining records, policies and training

Dentists should have clear data protection policies and procedures in place, reviewed to take into account the DPA 2018 implementing the GDPR. All relevant staff should be trained on these procedures. The new law also requires organisations to maintain records of data processing activities which can be different depending on the size of the organisation.


Modern Dentist Magazine


Data security breaches

Certain data security breaches now need to be reported to the ICO within 72 hours of becoming aware of it and in some cases, where the breach is considered high risk, to the individuals affected.

Individuals’ rights

One of the main changes is dealing with subject access requests (SARs). This is a person’s right to access information held about them. The DPA 2018 implementing the GDPR gives less time to respond to these requests; information must be provided without delay and at the latest within one month. In most cases, dentists won’t be able to charge a fee. To clarify, the new law does not stop dentists contacting patients for their usual business purposes of caring for their health – you will still be able to remind patients of routine appointments. However, there is a distinction between clinical activities such as this and marketing activities which are governed by separate legislation, the Privacy and Electronic Communications Regulations (PECR). If you were already complying with the current data protection rules, you shouldn’t have problems fully implementing the DPA 2018 implementing the GDPR. The Information Governance Alliance (IGA) is the organisation responsible for information

8|Modern Dentist Magazine

If you’re responsible for people’s personal information, which most dentists are, you should have been preparing governance guidance within the NHS and has been working with a dedicated national GDPR working group on health service-specific guidance on the DPA 2018 implementing the GDPR.1 There’s a wealth of materials on the ICO’s website aimed at helping all businesses including an overview of the new legislation2 and an updated data protection toolkit for SMEs3, including dental surgeries, giving you the ability to compare what you are currently doing around data protection and what you should now be doing under the new regulation. As well as the guidance on our website, businesses can also call our helpline on 0303 123 1113. A checklist on looking after the information you hold about patients can be found at

If you would like to receive a monthly update from the ICO, you can sign up to our e-newsletter at 1 2 overview-of-the-gdpr/ 3

Robert Parker

Head of Corporate Communications, Information Commissioner’s Office

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Rise of the robots:

In this issue of Modern Dentist we looked across the pond and spoke to Alon Mozes at Neocis, developers of the Yomi robot-assisted dental surgery system, about how the emerging technology can improve the dental experience for patients and make dental surgery more efficient for practices.



Can you outline what Yomi is and how the technology assists dental surgeons?


Yomi is the first robot-assisted dental surgery system. It guides surgeons during dental implant surgery. The system allows the user to plan the surgery virtually in software using a cone-beam CT scan of the patient, and then the system provides physical, visual, and audible feedback during surgery. The dental surgeon retains control at all times. Yomi allows for intraoperative adjustments, enabling the surgeon to adapt to any clinical situation. Yomi combines the surgeon’s clinical expertise with the benefits of robotic surgery.

Is robotics an area that is seeing more interest in the dental profession, and how was the gap for Yomi identified?


There is tremendous interest in robotassisted dental surgery. Dental surgeons see the opportunity to provide improved clinical care with state-of-the-art technology. Neocis Inc. was founded in Miami, Florida in 2009 by Juan Salcedo and I, two of the first principal engineers developing robot-assisted surgery for orthopedics at Mako Surgical. My father is a retired endodontist, which led the founders to bring their robotic surgery expertise to the dental industry. It became very clear that haptic guidance was a perfect assistive technology for dental implant surgery.



As the first and only robot-assisted dental surgery system, Yomi has clear advantages over any other guided surgery option in the market: other techniques involve a choice between visual guidance or physical guidance, whereas Yomi provides both simultaneously.

Based on the results of a clinical study, Yomi obtained US market clearance from the FDA at the end of 2016. Yomi is currently in use by key Pioneer surgeons across the United States. Together, our goal is to establish robotassisted dental surgery as the new standard of care for dental implants.

10|Modern Dentist Magazine

What were the main challenges in establishing Yomi in the competitive healthcare market, and how were these overcome?


Interview with Alon Mozes

Robot-assisted dental surgery provides a great opportunity for surgeons to improve their patient education by demonstrating the plan to their patients prior to surgery


What has the reception to Yomi been like among dental professionals and patients? Was there initial scepticism of robot-assisted surgery?

Patients and dental professionals alike often ask, “Does the robot do the surgery by itself?” No, the robot does not perform the surgery alone; it assists the surgeon by keeping them on plan. The surgeon is in control at all times. This allows for wide adoption and puts the patient at ease.


Dental professionals and patients have been fascinated with Yomi Robot-Assisted Dental Surgery. Yomi Pioneer surgical teams greatly enjoy presenting the technology to their communities, whether educating potential implant patients, hosting dental practice open houses, or presenting results at study club meetings.

With any new technology, there is a healthy amount of scepticism. However, the dental industry distinguishes itself in being highly receptive to technologies that increase practice efficiency and enhance patient care, paving the way for robot-assisted dental surgery to become the new state-of-the-art.


How might robot-assisted surgery create transparency in a dental procedure to help patients better understand and engage with their treatment?

that the results will match the plan. On the Yomi monitor, patients can get a clear picture of what the surgeon is planning and even watch the surgery proceed exactly according to plan.



Yomi is designed to easily integrate into the surgeon’s workflow and address the risks of freehand surgery and the hassles of plastic surgical guides. Unlike conventional plastic surgical guides, Yomi allows dental surgeons to offer patients same-day guided implant surgery, which may reduce the number of visits needed. By eliminating the need for custom manufacturing, costs in the overall procedure may be reduced.


Robot-assisted dental surgery provides a great opportunity for surgeons to improve their patient education by demonstrating the plan to their patients prior to surgery. Yomi enables collaboration between the dental surgeon, the restorative dentist, and the patient, with the added reassurance

How can robotic assistance tools like Yomi improve efficiency and reduce costs for dental practices?


Modern Dentist Magazine


With any new technology, there is a healthy amount of scepticism. However, the dental industry distinguishes itself in being highly receptive to technologies that increase practice efficiency and enhance patient care


Do you foresee the skill sets required in dentistry changing as robotics continue to permeate practices?


Yomi is an assistive device that is designed to aid the surgeon in an intuitive manner. We believe the development of critical dental skills will continue to focus preoperatively on collaborative digital planning and intraoperatively on assessing the anatomy and recognising the need for any dynamic adjustments to plan. Clinical judgment will continue to be paramount.


How do you predict the role of robotics in dentistry will evolve, and how will their impact be felt by practices and their patients?


We believe that robotic assistance will become as common in dentistry as it has in other surgical procedures, related to the desire for accuracy, dexterity, and minimally invasive techniques. At Neocis, our goal is to support more dental and oral surgery procedures with robotic assistance. Robotic assistance in other procedures has been shown to benefit both the practice and the patient, and we believe that Yomi will change dentistry in similar ways.

Alon Mozes

Alon Mozes, PhD, is the co-founder and CEO of Neocis. Dr. Mozes has been working in computer graphics and image-guided applications in start-up companies for nearly 20 years. As a principal engineer and one of the first 20 employees at MAKO Surgical Corp., he helped develop the software for their ground-breaking Rio system for orthopedic robotic surgery. Prior to MAKO Surgical Corp., he developed Emmy award-winning technology with Sportvision, Inc. in the area of real-time sports broadcast graphics. Dr. Mozes received his Ph.D. in Biomedical Engineering from the University of Miami and his B.S. and M.Eng. degrees in Computer Science and Engineering from the Massachusetts Institute of Technology (MIT).

12|Modern Dentist Magazine

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The future is digital: Interview with Adam Nulty

Dr Adam Nulty, of the Digital Dental Academy and Dentist On THE ROCK, outlines the latest developments in digital dentistry and the considerations that practices should make before investing in new technology.


What have been some of the biggest developments in the technology available to dental practices over the past few years?


Digital intraoral scanners have evolved, and recently they exploded onto the market even though they have already been around for a number of years. It seems that it is only in the last year that digital technology has become more ubiquitous between clinicians. Everyone is aware of them, and you could put that down to how social media has evolved and made an impact; people learn from each other by talking and asking questions, and this is partly why we set up the Digital Dental Academy group and later the International Digital Dental Academy.

The software has become faster, the hardware has become more evolved and the workflows are easier, which makes the technology more accessible. The intraoral scanner has definitely been a main part of that.


How can practice managers weigh up the costs versus the benefits of new systems, processes or technologies?


Principals and owners are looking for a return on investment; they want to know what the real cost is and when the right time to invest in technology is. Nobody wants to buy something that changes a few months down the line and therefore becomes obsolete. You can’t think of these technologies as any different from your mobile

The return on investment is not just for profit making, but for the overall change that the technology makes to the practice |15

Modern Dentist Magazine

Interview upgrade, because the technology is always going to advance. The way we have to think about the return on investment is not for pleasure. The tech needs to have value, which is what an investment is. It is not an expense; you are investing in the workflow and patient experience. The return on investment is not just for profit making, but for the overall change that the technology makes to the practice.


In your experience, how have patient needs and expectations changed in recent years, and how might technology aid dental professionals in meeting these?


If you can see things in front of you, a broad visualisation, a 3D video etc., it creates a better workflow, as long as you don’t over promise the result. Digital technology has obviously had a big impact on patients’ expectations. It is more predictable, can create better quality restorations and hopefully there are fewer mistakes. It brings in more goodwill from patients, so the digital equipment brings in patients rather than just making things cost less.

Just because it is digital it doesn’t mean that it should replace everything, because there are certain circumstances where you can’t or don’t want to use digital technologies


How might technology be leveraged by dental professionals to increase patient engagement with oral health?


We are living in a digital society, and having a 3D version of a patient’s mouth is to me one of the best ways, other than a documented record, of how that patient first came to see you. For the patient, it is an invaluable educational tool as well as back up for the future. If the patient has a record of how their teeth were originally, then if they ever change in some way, such as by grinding teeth or if they have an accident, then they can not only go back and see the changes but the clinician can put them back to how they were rather than using guesswork. The clinician can also use them to look back to for other referrals and support.


What is the value of continued education around tech developments in dentistry in order to maintain a modern practice?


When we would buy equipment a few years ago, there wasn’t any support and there weren’t many courses on using the equipment, so you learned from your own usage and mistakes. We’re living in a litigation conscious dental society, so we can’t afford to be complacent, and at the same time we wouldn’t want to be.

16|Modern Dentist Magazine

That is the whole idea behind why we started the (I)DDA Facebook and WhatsApp groups and the courses. It means that everything can be covered, and we can use our own experiences to help people on that learning curve. If someone has a question, it is instantly answered, as someone somewhere in the world will know the answer to it.

cards, causing SD cards to explode on the market. We now have ridiculously micro-SDs that can hold one terabyte on something smaller than a 1p coin. We would never have had that if everything had stayed in a proprietary format. There are still quite a lot of negative connotations associated with some digital technologies, when realistically, these technologies are just tools. When everybody realises that and uses them in the right and safe way, then it becomes a part of the remit of a dentist or technician to use and create a better base experience.


What are the key components of fostering a culture that embraces innovation?


For culture to evolve in the way we hope it is going to evolve, the companies and corporations that are developing these tools have to carry on supporting dentists while they learn in a more unbiased realm. A good analogy of this is when everyone was using smart cameras. The first Sony cameras used massive memory chips. Companies all had their own proprietary formats, and they were all very protective of that. But then the limitations of everyone using their own proprietary formats became evident, and eventually everyone switched to SD


Are there areas in dentistry or within practices that are ripe for digitalisation but that haven’t yet undergone this transformation?


Digital dentures. When the hardware and software become accurate enough to scan and print a denture that is going to revolutionise things. The second thing ripe for digitalisation is associates. At the moment, digitalisation is more expensive for associates because a lot of the hardware and equipment

Interview costs tens of thousands of pounds. From everyone that I speak to, it tends to be the younger associates that want to delve into the digital world more. If there was a clear return on investment for the associates then there would be a hell of a lot more integration of digital technologies, as there are a lot more associates than principals and owners.


Lab technicians have definitely embraced digital technology more and have done for a long time, probably more than we do as dentists. That’s partly because we are with the patient, so we can’t afford the time, whereas if you’ve got a lab technician it’s easier for them to involve the technology in their everyday work. I would say that we are embracing digital technology in dentistry more than in medicine or other healthcare sectors. There are a lot of ways that dentistry can involve digital dentistry, but there are only so many ways you can involve digital in a hospital. We are ahead of the game, at least in this country.


How will patient and professional appetite for more traditional practices or forms of dentistry change as new technology continues to proliferate?


Just because it is digital it doesn’t mean that it should replace everything, because there are certain circumstances where you can’t or don’t want to use digital technologies; you can’t get away from the fact that there isn’t the technology to take an accurate functional edentulous dental impression. We have to realise that there are limitations in the technology that we are using. It is about knowing when to use which tool to get the best result. That is part of what we are doing with the (I)DDA to formulate protocols to guide dentists in when they should be using these tools.


Do you believe the dental profession is embracing technology and innovation at the same pace as the wider healthcare sector, and to what do you attribute any differences in this pace that may exist?


How do you predict dental practice technology will continue to evolve in the years to come, and how can practices take advantage of this?


How do I see things evolving? The main evolution in digital dentistry will be when they crack multi-coloured 3D printer ceramics, because at the minute we are limited to single colour resin and subtractive processes – the future is 3D printing. My advice is not to be concerned with what the future holds in terms of evolution and technology, because our equipment doesn’t have to be the latest technology, it just needs to provide value and a return on investment in everyday usage.

Dr Adam Nulty BChD MJDF RCS Eng PGCert MSc (Dist) MAcadMed

Adam is a highly experienced clinician with a special interest in Restorative & Aesthetic Dentistry and Implantology. In 2013 he completed an Master of Science degree in Aesthetic and Restorative dentistry from the University Of Manchester, achieving a Distinction, and is currently researching guided implantology in a PhD at Leeds University. Adam lectures and mentors on the Restorative and Aesthetics MSc for Manchester Uni, Digital Dentistry and is Course Director and Lecturer for the SMOP Gudied Implant System. Adam co-founded the Digital Dental Academy and now sits as the President of the International Digital Dental Academy.

The software has become faster, the hardware has become more evolved and the workflows are easier, which makes the technology more accessible

Shortlisted, Finalist and Winner of several industry awards, from Best Young Dentist 2013, 2014 & 2015 to Best Dental Team and Best Oral Health Promoter 2014 & 2015, and in 2015 he won two categories in the Aesthetic Dental Awards for Removable Orthodontic Appliance and for a Patient Choice Facial Aesthetics Case.


Modern Dentist Magazine


Digital can close the distance Dr Aalok Y Shukla Teledentistry is evolving, as Dr Aalok Y Shukla, Straight Teeth Direct™, explains. As society shifts to a more on-demand culture, teledentistry reflects the progress dentistry is making to meet the changing needs of patients in this space.


How would you define teledentistry in its current state, and how has it progressed in the past ten years?


Teledentistry in its current state exists in three different areas around the world: • Specialist dentist to general practitioner consultation for second opinions and guidance, especially utilised in rural/remote areas where a local dentist may have to manage a large population with a high need. • Oral care professional/Hygienist/ Therapist to Dentist for remote screening and advice such as in schools and care homes. • Direct to consumer teledentistry - where the consumer can directly access dental advice and treatment from a dentist. In the last ten years, in all industries there has been a shift of power and access to the end consumer so they can then access what they want when they want it. This has happened in professional services, medicine, law, and now it is in dentistry too. Teledentistry was initially used as a tool to tackle issues in underdeveloped areas, where people could not access care, or between peers as an educational and support tool. It’s now spreading

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and becoming a convenience tool for patients and also for dentists looking for a more flexible and scalable way of working.


What have been the main drivers of the demand for teledentistry?

Teledentistry is part of a wider population shift to an on-demand economy where everyone is much busier and more mobile, no longer living and working in the same location for many years. The explosive growth in mobile devices and other digital services, such as banking, has changed consumer behaviours too. This has to be reflected in the health and care services delivered, otherwise people simply will not access them. There also needs to be a model for the payment of these services. In the USA for example, last year there was an introduction of treatment codes for teledentistry visits. This opens up the payment models available so that patients can access services in a way most convenient to them. These combined forces will force the shift.


How is teledentistry addressing issues of access to dental services?

Dentistry in its modern form cannot solve the global oral health needs of the world. It is not scalable and has some fundamental flaws.

In medicine you have a medical model (reparative and preventive) and a surgical model (interventive). Modern dentistry is more about doing procedures, as that’s how money is made; • In the UK alone, 7500 dental patients per week visit their GP for Dental advice. • Thousands of children with oral pain are being taken by parents to pharmacies, A&E and other nondental services for oral pain, and it’s costing the NHS £2.3million/year. There was an incredible declaration by some world experts about the need for a new way: “We are concerned that the dental profession, worldwide, has lost its way. We are a group of senior scientists — researchers, academics and intellectuals— from various parts of the world, with over 250 years’ combined experience of working to improve the oral health of communities. Globally the profession has had little direct impact on the scale of the problem. Clinical interventions account for only a small proportion of improvements in the health of populations. This is as true of oral health as of general health.” front-matter/introduction/

Interview There are three types of prevention. Primary prevention is preventing a condition before it even exists, secondary prevention is early detection and simple resolution, and tertiary prevention is treating a condition. In clinic based dentistry, the primary business model is only tertiary prevention. Teledentistry can help resolve this as it is about

Direct™ help engage whole new populations in caring for their smile by enabling a professional service they can trust and access. We have dentists in five countries working on our platform and customers in 35+ countries. We frequently get comments about how easy and accessible the service and fast the results are.

Teledentistry is part of a wider population shift to an on-demand economy where everyone is much busier and more mobile

We have conducted some exciting research we are about to publish soon too. At the end of the day, everyone wants to live happily and be the best version of themselves that they can be. Having a healthy, beautiful smile is an important part of that, so accessible and affordable solutions like Straight Teeth Direct™ help people who have stated they would never have bought from a clinic at the price that treatment usually goes for.


Do you foresee dentistry continuing to become more global and less dependent on locality as virtual dental services become more mainstream?


Oral health is a continuum. You do not suddenly have tooth decay and need a filling. So there is a need for a wider and more longitudinal view of oral health. We have a vision through Uplift - our group - to make oral health accessible and affordable globally. We envisage the clinics of the future that do the best will be fully equipped digitally with CAD/ CAM to do most treatments as same day treatments. This would then fit in with the full model of fully digital prevention and care. This new model is then more accessible and affordable as clinics can be optimised for capacity, and due to the prevalence of second opinions, greater trust can be restored.


Are dental practices keeping up with the technological pace being set by the wider healthcare sector so that they can fully embrace teledentistry solutions?

A helping everyone who is not in your practice. Technology such as teledentistry can help deliver much greater oral health improvements when used in conjunction with clinics. It is not a replacement, it’s simply an extension.


How can services like Straight Teeth Direct™ influence perceptions of dentistry amongst patients?


50% of patients don’t go to the dentist due to cost, trust and access issues. Services like Straight Teeth

There is a huge opportunity to reinvent dentistry into a preventive model which helps all

With any group there will be those that embrace change and stay ahead, and the others that don’t. In London they’ve introduced on-demand GP appointments via smartphones. The medical profession is embracing technology, as it understands to prevent disease and increase access to care it needs to scale. Dentistry will get there, but there is currently a greater focus on business models related to clinic based intervention, so when they can see the benefits (which are clear) then they will come on board. For example, we are partnering with dentists globally to offer just this, a whole new model and new way to help more people access the care they want through their clinic in a scalable way.


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Does regulation, either in the UK or internationally, present barriers to the adoption of virtual services, and if so how can these be overcome?


Regulation is always reactive and tends to be driven by lobbies and financial interests of special interest groups. However, patient associations are demanding affordable accessible solutions and won’t stand for protectionist restrictions that don’t fit with their other medical experiences. It is simply a matter of time and the raising of the amount of literature in this space, which is something we are involved in.

In the future there won’t be teledentistry and dentistry; it will all be integrated into a complete and proactive pathway that manages and monitors your oral health continuously


Are there current and potential applications for the data obtained through teledentistry to improve patient care and opportunities for practices?


Yes there are many. These days there are more data points than ever before from wearables, devices and smart homes. There is a huge opportunity to reinvent dentistry into a preventive model which helps all. This is exactly what we work on through Uplift. We have some exciting projects coming soon.


How do you predict teledentistry will evolve in the years to come, and what will be the role of Straight Teeth Direct™ in driving this change?


In years to come we will look back on the outdated and overly interventive model of dentistry that currently exists just like when we look back at dentistry fifty years ago. In the future there won’t be teledentistry and dentistry; it will all be integrated into a complete and proactive pathway that manages and monitors your oral health continuously. By fully leveraging mobile technology, artificial intelligence and nanotechnology, there is a bright future ahead for a more inclusive and accessible dental experience globally. This is exactly what we are building with Uplift and Straight Teeth Direct™. We are early in our journey, but we are excited about the future.

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Dr Aalok Y Shukla Dr Aalok Y Shukla is a healthtech entrepreneur with a clinical background in dentistry. He has a particular focus on artificial intelligence and its clinical applications to deliver a more scalable, data driven approach to digital health services. After running his private practice in London for seven years, he sold in 2016 and refocused on the unmet demand for accessible, affordable orthodontic care. He co-founded the Straight Teeth Direct™ platform and mobile app that offers affordable convenient teleorthodontics to people who would not otherwise be seeking a solution and a new way to work for clinical dentists.


Regional Focus:

SOUTH EAST Barry Westwood Modern Dentist’s third Regional Focus examines the Southeast, and we spoke to the Chairman of the Surrey LDC, Barry Westwood, about the difficulties faced by today’s dental professionals and how the region’s LDCs are attempting to address these.





What are the main challenges that dental professionals in the Southeast are facing at the moment and how are they tacking these?

The focus recently seems to have been on introducing major initiatives without considering the effect these will have on the day to day running of practices, which was already difficult enough. A Dental Electronic Referral System (DERS) was introduced which does facilitate some referrals, but is far from perfect. Hopefully it will develop into a fully workable system. Orthodontic tendering is a massive challenge and will doubtless lead to the loss of respected practices to be replaced by the unknown. This is another unfortunate step to guide the choices available to referring GDPs. These two on top of the CQC, IG and GDPR burdens. Prices of practices have skyrocketed, so progression from associate to practice owner is only realistically possible with family money.

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What has been the key positive or negative area of change in the Southeast region in the past decade, and how have professionals in the area responded to this?

The orthodontic procurement process will be a major upheaval – whether it is positive or negative remains to be seen. The LDN and some MCNs got off to a very slow start, and in our area not much of any relevance has been achieved, albeit with little or no funding. There has been an encouraging increase in specialist provision, but unfortunately mainly in the private sector, and due to DERs practitioners are now less able than ever to build relationships with NHS secondary care providers. Other negatives are recruitment issues leading to contract under-performance, lack of opportunities for successful practices to expand and the difficulties facing Associates who wish to develop a long-term career.

Prices of practices have skyrocketed, so progression from Associate to practice owner is only realistically possible with family money


Dentists have responded to these difficult challenges by adapting and working harder and longer for less, but unfortunately some are unable to cope with the excessive burdens As ever, Dentists have responded to these difficult challenges by adapting and working harder and longer for less, but unfortunately some are unable to cope with the excessive burdens.


What are your core aims as a regional representative to the Southeast LDCs?

To endeavour to support dentists in our area and to raise the profile of the LDCs. We try to work with the LAT to develop a relationship based on mutual respect to benefit the providers and performers. We have had excellent help developing our websites, and hopefully practitioners are accessing information more easily than previously. There’s negligible pastoral support from LATs nowadays, who seem to see their role as mainly enforcement, and this adds massively to stress levels. We’re invited to attend our contract meetings, performer list and performer reviews to explain the GDP point of view. Other areas aren’t so fortunate.


How have the needs of dental professionals in the Southeast changed in the last five years?

It is increasingly impossible to run a practice profitably in the Southeast without a significant private component in practice income, and most would be lucky to break even with NHS earnings only. Patients are completely unaware of how little the NHS contributes to practice income in a high PCR area.


Chronic lack of NHS funding has resulted in poor practice investment and recruitment issues for practices, especially in deprived areas. Dentists need more support than ever, but it certainly doesn’t come from management, either central or local.


Have patient expectations changed in the Southeast and to what do you attribute any such changes?


The Southeast is an affluent area, but it’s also an area of high expectations with high living expenses. Patients are encouraged to think that want equates to need, and sometimes unrealistic expectations lead to stressful environments, particularly for the younger practitioners. It’s also very difficult to handle demanding patients via computer algorithms as on DERS to which we must abdicate decision making.


How do you and the LDCs in the region ensure LDCs maintain their relevance to the profession?


We try to engage with members of the profession, especially the younger ones, by providing training days and taking a more proactive approach to support and advice. We also try to interest younger practitioners in the LDC, but there’s little free time when you’re starting a career and possibly a home and family. It isn’t very helpful that the LAT often approach practitioners generally without prior consultation with the LDCs.


Modern Dentist Magazine


Patients are encouraged to think that want equates to need, and sometimes unrealistic expectations lead to stressful environments, particularly for the younger practitioners


How do you feel the pace of innovation differs in the Southeast compared to other regions? Where is the region ahead of curve in this area and where might it be behind?


We’re certainly at a fast pace by being the guinea pigs for DERS and orthodontic procurement, so in that respect we are ahead of the curve, but we seem to be behind in the development of some MCNs and the LDN. We are probably ahead in using private income to fund NHS shortfall, which helps to cope with the pockets of high demand and deprivation. Unfortunately, we’re helping to mask the problem of NHS under-investment.


Do you feel that the Southeast dental market has a voice in wider conversations outside of the region?


GDPC and RLG meetings at the BDA allow us to share our concerns with other LDCs throughout the country. We take back a lot of information to help our area and hopefully help others by sharing our experiences. The LDC Conference is also an opportunity to share and learn.


How do you think the dental profession is perceived by the public? Do LDCs have a part to play in building relationships on this level?


The general perception is often low and in terms of our prosperity way behind the times, but individual dentist/patient relationships are generally good. As ever, people often don’t extend their personal experience to their general view, but I think this is more of a job for the BDA than LDCs who really don’t have enough time or resource.

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As the first to experience DERS and compulsory tendering we hope to be able to help others.


What does the future look like to the dental professionals in the Southeast region?

Should the current management structure remain and tendering become the way of the Health Service we see nothing but a dumbing down of provision and ultimately little choice but private practice. The benefits that used to keep practitioners in an underfunded service such as fair

pensions, pastoral care etc. are rapidly disappearing, and dentists will follow. As I come to the end of my career as an NHS Dentist I find that very upsetting – dentistry has always been incredibly good value to the taxpayer and the government, yet they seem to be hell-bent on destroying access for the average family.

Barry Westwood Barry qualified in 1976 from Guy’s Hospital and took over a practice in Reigate, Surrey in 1983, which is now seven surgeries with a large NHS practice offering all general dental services. He has been involved in the LDC since 1990 and the RLG soon afterwards.

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Promoting professionalism

Why risk it?

In Shifting the balance we set out an ambitious vision for the future of dental regulation. A core part of that vision relies on reaching a shared understanding of the concept of ‘professionalism’ and developing a system which supports professionals to do the right things, not because of a fear of the consequences of doing otherwise, but simply because they are the right things to do. This is all about securing the best outcomes in the public interest, but if we get it right one of the desirable by-products of good upstream regulation is a reduction in the need for enforcement action after things have gone wrong.

It never ceases to amaze me that a GDC registered dental professional would deliberately purchase and use any dental equipment that they know to be counterfeit or non-compliant. But it still happens!

There is a close relationship between ‘professionalism’ and the Standards for the Dental Team. We often receive calls asking whether a specific scenario falls within the Standards. My thought in such instances is that the posing of the question itself hints at a less-thancomplete appreciation of what professionalism is all about, and this is what we’re trying to change through our upstream work.

The most common fake and illegal devices tend to be handpieces, burs and curing lights, but we are even aware of fake and extremely dangerous hand-held x-ray machines. These are generally made available from non-UK based websites.

With a broad concept such as ‘professionalism’, it is perhaps unsurprising that it features in so many aspects of our work. From increasing the emphasis on professionalism in dental education and continuing professional development, to highlighting the important role employers play in embedding a focus on patients’ best interests, to conducting research with professionals and patients about expectations and perceptions. It is a theme which flows through almost everything we aim to do. Through the many conversations I’ve had with professionals, I understand that meeting and maintaining high standards can be a challenge, both in the context of the complex landscape in which dentistry is provided and the many competing pressures faced by professionals. In developing a compelling vision of professionalism, our aim is to help registrants navigate these competing demands to deliver the best outcomes for the public. Following the direction of travel laid out in Shifting the balance, we have been talking with a wide range of stakeholders and we are intensifying our focus in this area in the coming months to gain a clearer understanding of what professionalism means to patients, students and registrants. This will doubtless present opportunities for wider involvement and we’ll be talking much more about this in the near future.

In the last few years, two GDC Fitness to Practise hearings concerning the purchase and use of counterfeit and non-compliant dental devices highlight the dangers to both patient and professional registration from using such devices. These cases reinforce the need for the dental team to exercise common sense and care when using, and if involved in purchasing, dental equipment. In effect, practices really should have adequate systems in place to ensure that any equipment used is genuine, compliant and safe.

The British Dental Industry Association’s (BDIA’s) award winning Counterfeit and Sub-standard Instruments and Devices Initiative (CSIDI), operated in partnership with the government’s medical device regulator, the Medicines and healthcare Products Regulatory Agency (MHRA), has worked hard over the last four years to raise the awareness of all GDC registrants to the dangers of counterfeit and non-compliant dental devices through its hard-hitting press and information campaign. To protect the whole dental team and patients, the Association, the MHRA and the BDA recommend that all purchases, however small, are made from reputable suppliers, and that all suspect instruments and devices should be reported to the appropriate authorities at the earliest opportunity. If you ever think that there is any ‘dodgy kit’ being used in your surgery this should be reported at www.yellowcard.mhra. Fakes and non-compliant equipment can sometimes be hard to spot, but there are a few giveaways, and you can download a guide to spotting the fakes at So, why risk it?

Edmund Proffitt

Chief Executive British Dental Industry Association

Matthew Hill

Executive Director, Strategy General Dental Council


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Compliance culture and the GDC’s advertising and website guidelines Three tips to ensure your website is compliant As a dentist, you aim to provide your patients with conscientious dental care and strive to build a culture of satisfied, happy patients. As you may know, the General Dental Council (GDC) also has a few rules about how you promote yourself as a dentist. These three tips can help you ensure your website remains compliant: #1 Show the world the real you: properly representing your dental practice According to the GDC, all dentists and dental practices should properly represent themselves. This includes providing up-to-date professional qualifications for the dental team and publishing GDC registration numbers. It is also important to mention whether your practice is private or mixed (NHS). Keep all professional qualifications and membership associations separate to avoid confusion.

IMPORTANT: Only use the term ‘specialist’ if the qualifications are included in the GDC specialist list. The GDC guidelines strictly prohibit the use of this term unless the qualifications match what the GDC lists. However, the Council allows phrases such as “experienced in…” or “with a special interest in…” to demonstrate a deeper understanding of specific areas. #2 Make it clear: presenting your dental practice in websites When it comes to promoting your dental practice, stick to facts and keep the visuals professional, decent, and ethical.

#3 Stick to the truth: advertisements, leaflets, and other publicity materials According to the GDC’s Guidance on Advertising, always ensure your advertisements, leaflets, and other marketing materials contain strictly factual and evidence-based information. Review these materials before making it available to the public. If your practice prefers a certain product or method, you are obligated to provide factual and evidence-based information so your patients can make informed decisions. Lastly, ensure your practice has an up-to-date privacy policy, data protection policy, site terms of use and a cookies policy.

Websites and social media are great for reaching potential patients.

Shaz Memon Creative Director Digimax Dental

Additionally, the GDC recommends as a best practice, for enquiries and complaints, the provision of detailed contact information including an address and website link.

Which is the best long-term investment – property or stocks? The best investment portfolio is one that’s diverse, offering you a variety of investments all working hard for you. A question many face is which type of investment will be best for the long-term and a case can be made for both property and stocks. Evaluating property Some people prefer investing in property because it’s tangible and relatively simple. However, property is also an active investment that requires constant work, from maintenance and repairs to interacting with tenants and vendors. However, property offers good protection for your investment from inflation. So while you may go through years where you don’t gain any capital, there’s a good chance you can sell for a profit, if you sell at the right time. A big downside to income gained on the sale of property is that this profit is taxable.

An eye on stocks Shares, on the other hand, are slightly more complicated than property. You will need to educate yourself on how the stock market works and the individual shares you wish to buy and/or you will need to employ a broker to help you invest. The upside to stocks is that they are easy from a management standpoint – just buy and let them do their thing or you can manage them hands-on by keeping an eye on stock trackers daily. Stocks are subject to unexpected changes – fluctuating daily and for the overly cautious it can be all too easy to sell an underperforming stock that may improve shortly after. However, ease of sale is a plus if you need money quickly, and they also have good protection from inflation. An advantage shares have is that they can be purchased through tax shelters like ISAs or pension funds.

Historic results Comparing property and stocks like this doesn’t appear to highlight a winner. Looking at past performance though can help decide which is better long-term. According to a long-term study by Credit Suisse, the hands-down winner over the years is stocks. To find out more visit our blog - http:// Ultimately, the best long-term investment is the one you are most comfortable with and our financial specialists can help you build and protect the investments you’ve made with your hard-earned money.

Darren Scott-Guinness

Independent Financial Adviser Dental & Medical Financial Services

This article does not constitute advice. Professional advice should be taken prior to acting on any part of it.


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Dental Cone Beam Computed Tomography (CBCT) Dental Cone Beam Computed Tomography (CBCT) is viewed quite rightly - nowadays as an invaluable tool for dentists in areas such as treatment planning, implant dentistry, endodontics and aspects of periodontal assessment, and current CBCT units can and do produce images with remarkable resolution and diagnostic information. But this can come at the expense of increased radiation doses, so appropriate knowledge and training on the use of these units is of paramount importance. The latest edition of the FGDP publication Selection Criteria for Dental Radiography cautions that “as with all other radiological examinations, a justification for the exposure must be made…, and the exposure should be reduced by limiting the field of view and maximising other exposurereducing factors, while still producing a diagnostic image” (Page 106).

So who needs training, and in what areas, and to what level? Back in 2010 the Health Protection Agency (now Public Health England) produced guidance on the use of CBCT units (HPA-CRCE-010) and within this document a detailed theory and practical curriculum for Referrers, Practitioners and Operators (imaging and reporting) can be found in Appendix B, with reference to recommended minimum times in the training section of the document. This is still a good extensive guide to any employer wanting to look at a detailed breakdown of the essential areas for training of duty holders. More recently, however, there does seem to have been a move toward the provision of training related to the European Academy of Dentomaxillofacial Radiology (EADMFR) concept of level 1 and level 2 courses for training in this area.

There is a buzz around the profession at the moment regarding HMRC and their review of the self-employed status of associate dentists. Any changes in HMRC’s ruling on this would be extremely detrimental to the dental sector. In 2016, Uber drivers were ruled to be employed, which has brought the employment status of dental associates back into the forefront. On the face of it, a dental associate appears to be employed. If you look at the criteria, HMRC have to determine the employment status of an individual, as an associate dentist would be viewed as employed every time. So why historically have associates been self-employed, and what does the future hold? HMRC updated its guidance following the introduction of the 2006 NHS Contract to recognise that the contract still deemed dental associates to be self-employed, and subsequently any concerns arising from the new contract were forgotten. The view has always been that the employment status of dentists depends upon the contractual terms between the associate and their principal, and considerations would be made on a case by case basis, as no two associates are the same.

So if you are a referrer, practitioner or operator intending to operate in this area make sure that you are fulfilling the requirements for add-on training – and as an employer be aware that you are required to know that the these duty holders are appropriately trained.

Stephen Green

The level 1 course is a basic level with its learning outcomes aimed at those (including referrers) with a limited range of theoretical knowledge and radiological expertise in this area, and they concentrate on areas such as selection criteria,

Self-employed status

CBCT technology and radiation protection, and basic principles of image interpretation. Level 2 is an advanced level for those practitioners justifying examinations and anyone who reports on CBCT images – and it is considered mandatory that these courses provide hands-on training on the use of software for optimising images and an in-depth knowledge of the interpretation of these examinations. Level 1 has to be undertaken before moving on to a level 2 course.

CRadP MSRP MIPEM Radiation Protection Adviser Medical Physics Expert and Radioactive Waste Adviser Stephen Green and Associates

Sophie Kwiatkowski Accountant PFM Townends LLP

In the Employment Status Manual regarding dentists (EMS4030), HMRC state that “a dentist who is not employed within the National Health Service (NHS) by a Health Authority but who provides general dental services is chargeable on his or her professional receipts as trading income and liable for Class 2/4 NICs”. It then goes on to confirm that associates who use the standard forms of agreement which have been approved by the BDA and DPA are self-employed. The future can never be predicted, and in light of HMRC issuing letters to associate dentists informing them they are reviewing their selfemployed tax status – there seems to be a great deal of uncertainty. My advice would be that as long as your contract fits the guidelines approved by the BDA, and you follow the guidance provided by HMRC, it would be difficult for them to reverse their stance. I would strongly advise getting advice from a dental specialist, who has detailed knowledge in the profession before responding to HMRC in regards to the letter.


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Considerations when buying and selling a dental practice Mike Hughes

Principal Dental Practice Consultancy Service

Minimising How can your practice create a relaxing and stress free environment for your patients?

It goes without saying that when it comes to price the objectives of a buyer and seller are diametrically opposed in that a buyer wishes to pay as little as possible for whatever they purchase and the seller to receive as much as possible. That said, are the objectives really so different? Realistically, buyers are prepared to pay what they perceive as good value for what they are purchasing and sellers have objectives beyond just price when they sell an asset, particularly a dental practice. In many ways, the needs of both parties are well aligned and we often find that it is poor perception and poor presentation that drives a wedge into the process, making matters unnecessarily adversarial.

The appropriate way to approach this challenge is to consider the patient journey and the elements within it where stress can be minimised, if not eliminated altogether.

Clearly it is the seller that starts the sales process and in the majority of cases it is a decision that has been considered over many months or possibly even years if leading up to a retirement. There is therefore much that sellers can do to ensure a smooth process by thinking about the needs of the prospective purchaser. Purchase of a practice now involves very considerable investment, and they need therefore to ensure that the transaction is sound. So, as a vendor what can you do?

When a patient first contacts the practice, ensure your reception team are trained to smile when they answer the telephone. Patients know! The telephone should ideally be answered within three rings, by a human, not an ansafone, and with a friendly manner. Empower your reception staff to be able to take the necessary time to satisfy a patient’s queries and not rush them because they are busy. The reception area itself will reflect the standards set by the rest of the practice, so make sure it is kept scrupulously clean and tidy.

Goodwill is based on the assumption of good continuing income so: • If you have an NHS contract make sure that the figures are upto-date. Are you above or below target? Your previous accounts hide a clawback? Have you been issued breach notices or be in danger of receiving any? Ultimately the answers to these questions will come to light so why not be upfront about them at outset? • If you operate full capitation, plan and make sure that the patients are correctly banded and have received appropriate treatment. Be prepared to discuss specific patients for whom you may have taken a professional view so as to avoid the potential for disputes or litigation after the event. • Make sure that you are compliant with appropriate legislation with the documentation to prove it. Often transactions are delayed through chasing documents and the perception can be of a poorly managed practice, thus undermining your hard work.

Patients should always be seen on time. If a patient is already anxious or stressed, then to be kept waiting will further exasperate those feelings. If a delay is inevitable the patient should receive an apology and an immediate explanation and be updated regularly.

In the final analysis, put yourself in the position of the purchaser and consider whether you would be prepared to purchase that which is on offer based on the information available.

A fully informed patient is often a happier one, and this information gathering can start before they even step inside the door. In today’s climate, this is your practice website, which should be accurate, up to date and easy to navigate so patients can find all the information they require – not only about their treatment, but also about the clinicians, staff, and even the location of the practice. Your website can also start to build an element of trust between you and your patient by featuring testimonials and “before and after” photos.

With anxious patients, I’ve found it helpful to arrange an initial appointment in a room that is not a surgery. Often a patient is more relaxed in this nonclinical situation and offers more information on the nature of their anxiety. The most important element of creating a stress free journey for the patient is to give them time to develop a feeling of trust. For example, even the small gestures matter – asking them how they would like to be addressed and referring to them by that name, or a reassuring yet gentle hand on the shoulder. If a patient has had a challenging treatment, a follow up call a day later is a sign that you genuinely care. By leading from the front, with the right outlook and continual efforts, a stress free environment is worth every attempt to achieve.

Dr Geoff Baggaley

(B.Ch.D D.G.D.P.(U.K.)R.C.S. Dip.Con.Sed(Newc) GDC No. 55152, at The Raglan Suite


Modern Dentist Magazine

Editorial Board

Go in with your eyes open

Heidi Marshall

What should be taken into consideration when thinking of buying your practice? Of course there are all kinds of clinical considerations, but I’ll stick to my expertise – business and finance. The first thing I make clear to my associate clients is that buying a practice is not a get rich quick scheme! An average associate dentist earns £66,318*, whilst the average mixed practice owner earns £130,076*. Often associates will see these headline figures and assume he/she will be £63,758 better off per annum as a practice owner. However, when you factor in the extra tax payable, loan repayments and working capital requirements you can often end up with little or no extra cash in your hand.

Partner Dodd & Co

The next thing to consider is what you are actually buying. There are many corporate structures in the industry, so if the practice is currently trading as a limited company, then you need to know whether you are buying the assets or the shares. There are significant differences to purchasing a practice under each of these methods, and it is essential that you understand the implications. Once you’ve established what you are buying, there is your own business structure to consider. There are pros and cons to all business structures, and this is not just a tax and financial decision; consideration needs to be given to the NHS contracts and GDC regulations. Make sure that you appoint professional advisors with expert understanding of the dental industry.

To be clear, I’m not trying to put dentists off buying practices, far from it. I just think it is important that they go into the biggest transaction of their lives with their eyes open. An affordability calculation in the early stages can save hours of time and heartache and would always be my starting point when advising a client on a practice purchase.

Once finance is in place and your offer has been accepted, you’ll need a huge amount of patience! The average dental deal takes between 9-12 months and I have seen a lot take significantly longer.

Once we’ve established that the practice is affordable (affordability levels differ significantly from dentist to dentist depending on their personal spending requirements), I would assess the valuation and advise on whether the price is reasonable.

*taken from the 2017 NASDAL statistics

The final result is well worth the hassle and there is nothing quite like being your own boss and in charge of your own destiny.

Reducing the cyber risk Is the cyber risk as prevalent in dentistry as it is in other professions, and what can be done to counter any risk that exists? Digital technologies are an essential part of business today, including in the dentistry sector where there is a reliance on IT infrastructure to some degree, in order to increase efficiency and improve productivity. This is precisely why cyber and data security breaches can be so damaging. A 2016 UK Government survey1 estimated that 65% of large firms detected a cyber security breach over a twelve month period, with 25% of these firms experiencing a breach at least once a month. The average cost of a cyber and data security breach to large businesses was reported to be £36,500, and the costliest breach identified was £3 million. While dental businesses may not be considered to be popular targets for cyber-attacks, any business that is dependent on technology and holds data electronically can be targeted.

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The most common attacks reported by the survey – nearly seven out of ten of all firms questioned – involved viruses, spyware or malware. Then, of course, there are the ramifications that exposure to these risks can cause, such as business interruption, income loss, damage management and repair, and the possibility of reputational damage if IT equipment or systems fail or are interrupted. Why it’s worth considering more specific, specialist insurance Existing dental practice insurance may provide limited cover against cyber and data risks. However, those who work in the dentistry sector should considering purchasing a standalone cyber insurance policy, particularly if they: • Hold sensitive customer details, such as names and addresses or bank information

• Rely heavily on IT systems and websites to conduct their business • Process payment card information as a matter of course In almost all cases, it is likely your dental practice does at least two of the above, if not all. Therefore, you should consider cyber insurance seriously. Today, more than ever, it is obvious that businesses need to do everything in their power to limit their exposure to these risks and mitigate the cost of damages likely to be caused by cybercrime in the future. UK Government Cyber Security Breaches Survey, 2016


Kirsty Wainwright-Noble Head of Sales and Marketing Towergate Insurance Brokers

Editorial Board

The FOUR factors

How can smaller dental practices keep up with the technological pace set by larger practices or dental groups? For years, smaller dental practices, where the ownership, management and practice of the profession fell on the same person, have been the basis and almost the entire model of dental care in most countries. However, a few years ago, the increase of larger dental groups, motivated by the desire to invest and with a legitimate economic objective, have established the visual panorama of our cities. This has influenced the understanding of the dental practice as a profession but also the service and quality that we receive as patients. Traditionally, the success of traditional practices has resided in four main factors: • The proximity factor: practices that have been established for many years or that are in the same street, neighbourhood or city; close to our habitual residence. The accessibility and closeness is a determining aspect in our choice as patients.

• The confidence factor: references from neighbours, family or friends treated in the same facilities, and even treated by the same professional. Undoubtedly, the testimonies given by the people around us towards one practice or another is a great stimulus in our decision process. • The professional factor: the precision and the excellence in the quality of the treatment is perhaps the decisive aspect that motivates the patient choice and its continuity in a dental practice. This will also motivate our new role as authentic prescribers of said practices to neighbours, friends, family and workmates… • The economic factor: the cost of the service can determine our practice choice and even the choice of the country to perform said treatment. Hence the emergence of dental groups that use the price and a certainly aggressive marketing as the main claim to attract new “customers” to their centres.

Nowadays, most smaller practices maintain and even exceed the level of technological investment made by a large investment group in each centre. Some large groups still continue to be more concerned about minimising costs and make their investments profitable, affecting their technological equipment and the quality and remuneration of professionals who work in the practice. Smaller practices should follow their investment process according to their needs and according to the technological innovations offered by the dental industry. However, the reason for their existence and the basis of their future will still be based on the four described factors. Regardless of its size, investment in technology is a necessity but an insufficient aspect to ensure the future and the effectiveness of the dental centre.

Joan Fernandez Sales Manager Ancar

Making the right decisions when investing in a new product for your practice Your needs are your needs and may differ from what the brochure tells you, what the sales guy tells you and what your peers tell you. The first step in identifying what is the right product is to clearly identify your needs. They may seem obvious at the start, but once you start looking into the product deeper, you’ll understand your real needs and more often than not you may identify new needs. You may not have initially realised some of the benefits the product may offer you. Make a wish list, do your research, speak with colleagues who have the same or similar products, learn about their experience, see

the product in action, speak with suppliers and scrutinise their knowledge of the product. Understand what the relationship is going to be going forward. For many higher value purchases, there will usually be a support or maintenance contract. You might like the sales guy but what support network has he got behind him. What if he moves department or company, where will you be then? What if there is no support contract? Fantastic! Free lifetime support and software upgrades? Is a company going to offer free ongoing support without a catch?

it as much as you will be. Let your patients experience it, and maybe even choose the ones who are hardest to please. After all, if the product is going to be used in the delivery of treatment, their opinion should count. Speak with your IT company and your lab; maybe they have an insight into the product that you have overlooked.

When considering a big purchase, make sure you try it out first. Getting a short term loan is not always practical, but make sure you get to use it in a real clinical situation. Have the supplying company support you. Let your staff get involved; most likely they will be using

Mark Barry

Don’t be afraid to go against the grain, but make sure you speak with the right people and make a decision that is right for you and your business.

Director ESM Digital Solutions


Modern Dentist Magazine


Editorial Board

Digital discovery

How to recruit the right candidate for your practice Lorraine Nadel Managing Director Tempdent

Sue Bessant

Technical Director Wired Orthodontics

April 27th saw the opening of Wired Orthodontics’ inaugural Digital Discovery Conference at Cardiff’s Royal Welsh College of Music and Drama. This ultramodern venue incorporates one of the best auditorium spaces in the UK and the conference speakers took full advantage to deliver a wide ranging programme aimed at GDP’s wanting to find their way in digital. Wired’s Sue Bessant and Ian Hutchinson planned the event to offer impartial knowledge from dentists using digital every day and this involves far more than simply installing your shiny new scanner, so delegates were soon learning the pros and cons of the main systems and seeing how practice integration and digital workflow could change their working lives. Life-changing is exactly how Sue and Ian see digital and predict that it won’t be long before there’s a real divide between digital and non-digital dentistry. Digital isn’t just for practices of course and several laboratory technicians were lined up to speak on the way they now work - a real eye opener for many clinicians. The College of Music and Drama is a great space for conferences and the steady flow of excellent refreshments kept the delegates going as they investigated the trade stands. The same scanning systems they’d heard discussed in the auditorium moments before were all available to try so it was real hands on stuff. Sue and Ian opened the conference to senior students from the School of Dentistry in Cardiff so the event had a real buzz for the whole two days, even though the gala dinner was a very late affair for some delegates! With overwhelmingly positive feedback Wired plans to host their Digital Discovery Conference again in 2019 (5th & 6th April) with a brand new programme of speakers and the latest updates from the fast moving world of Digital Dentistry.

Over the years, dentistry has become a candidate driven market, usually with candidates having their pick of jobs. Practices very often recruit one of the few people that respond to their advert, which often results in an unsuitable match and a short-lived working partnership. Recruiting the right staff for each position is key to the success of the dental practice. Gone are the days that the principal dentist can provide all the treatments, run the practice, reception area, stock control, compliance, etc., all on their own. Your bottom line – your patients’ safety, retention and satisfaction – is down to the correct recruitment and retention of the practice team. So how can you achieve this in a cost and time effective way? With 22 years’ experience in the dental recruitment business, Lorraine Nadel, Managing Director of Tempdent Dental Recruitment and Training gives her top tips on how to get it right. 1. Decide what type of candidate you are looking for, along with the desirable, essential skills and experience that they need to have to fulfil the job role. 2. Advertise the role in the right places. Depending on the type of role, there are a variety of job boards, publications and websites to choose from, e.g. for dentists or hygienists the BDJ is a smart choice, but if it’s an apprentice nurse you should consider getting the help of a training provider who can advertise on your behalf on the National Apprenticeship Service website. 3. Shortlist candidates for interview that have the relevant skills and experience, ensuring that they have not consistently job hopped or had major gaps in their CV. 4. Interview, interview, interview… spend time on conducting a meaningful interview with each candidate – asking competency based questions i.e. demonstrate their experience and success in handling different situations. 5. Arrange a trial day(s) so that both your practice team and the candidate can see if they are suited to each other. 6. Take thorough references from the two most recent employers. 7. Carry out a detailed induction and on boarding process with your recruit. Every recruit will have some skill gaps, so the creation of a personal development plan will help to close the gaps. 8. Retain your team by carrying out regular reviews/appraisals, recognising their successes, working with them on development areas and offering career progression. 9. The best way to ensure the above process successfully is to work closely with a specialist recruitment company like Tempdent.


Modern Dentist Magazine

Editorial Board

Dental implant training

- worth the investment?

Emma Buglass BDS

Sales and Marketing Director Implantium UK

With the cost of implant training running into thousands and the time that is required out of surgery, it is important to ascertain the long-term value of implant training both from a professional development perspective and financial remuneration. Evaluating the effectiveness of implant training is not straightforward and perhaps the best indicator is whether the delegates go on to place implants after their course. We have found that the large majority of delegates go on to place implants in their own practices after completing the course, if their chosen course has a hands on element and involves treating patients. Fundamentally, the support they receive after training is imperative as it takes a leap to start placing in practice. The hourly financial turnover of a dental practice obviously depends on the type of dentistry undertaken, the speed at which it is provided and the patient base. Implant placement has historically offered a high fee per hour when compared to other restorative alternatives. The overall picture is more blurred when the cost of equipment, staff training, treatment planning and increased insurance costs are added into the mix. Efficient running of implant clinics can offer a higher yield, but this is unlikely to be possible straight after initial training and will take some time to establish. There are other factors to consider such as keeping the implant business in house, job satisfaction and the wish to expand surgical repertoire and skills, which we know from speaking to delegates are usually the driving force behind the training.

Promoting ‘simple’ orthodontics in your practice Dr Lester Ellman BDS FFGDP RCS Director Oralign

NHS Practice profits have been severely squeezed in the last few years. Are they likely to get better? Is it time to look for an additional income stream outside the NHS? Adult orthodontics, which is entirely outside the NHS, is such a stream. It is usually confined to giving the adult patient a nicer smile – straightening the ‘Social Six’ without addressing any other orthodontic problems which might be present. Although, for the sake of completeness we always outline all the patient’s orthodontic problems. Know almost nothing about orthodontics? Don’t worry – we do, and our unique system enables you to tackle relatively ‘simple’ orthodontics. We plan and supervise the treatment right from the start to the successful conclusion. One of our registered specialist orthodontists will supervise treatment at all stages. It doesn’t matter where you are in the country because it’s all done online using our secure web platform. You will be fully compliant with GDPR. Case data is stored and encrypted for security but you can retrieve it in moments. We use fixed appliances as well as clear aligners to treat your patients – which appliance is dependent on the treatment required. Our specialist orthodontist will assess the case and recommend the type of appliance best suited. Below are examples of both types of treatment to show that the correct selection is important to achieve the best results for the patient.

Before any treatment

Most of the way through – Looks so much better

Relatively simple malocclusion

Much better after treatment

Phil Gardiner, a past Dentale delegate, had this to say; “The investment is ameliorated by the positive change and improvement in skill, standard and increase in the range of treatments made available to your patients and to the change in your working day. It also opens up the chance to work in different sites in a new capacity which brings great variation to working life.” To summarise, the value of the implant training depends on your choice of implant course and the amount of hands on clinical experience offered, coupled with the dentist’s overall aims and measure of success.

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Using examples like those above will enable you to promote relatively simple orthodontics secure in the knowledge that you have a specialist to guide and supervise you all the way along the journey. We provide some patient literature to assist you, but you need to make your patients aware that you can help them achieve the smile they have always wanted.

Editorial Board

Preventing periodontal disease What new technologies should practices be aware of that can assist with maintaining high levels of care and compliance? The WHO is very concerned with the impact of periodontal disease on the health of nations worldwide. Periodontal disease affects nearly half of the adult population in the UK. However, periodontitis is both preventable and treatable. The cost of both is relatively low in view of the impact it could have on the healthcare budgets of many countries, including the UK. With a growing momentum in awareness of the importance of periodontal health, there is likely to be an increase in demand for treatment and information regarding prevention. The scientific rationale is that by controlling periodontal disease, we will be improving the general health of the nation; and additionally we can expect to see that patients will be encouraged by their medical teams to attend for periodontal health assessment.

Diagnosis of periodontal disease could possibly provide opportunity for referral and diagnosis of other systemic disease at an early stage. Helping patients grasp their role in disease prevention and taking responsibility for their oral health is a difficult and sensitive subject. The use of highly developed technology such as Soprocare can assist in diagnosis and education of patients. Soprocare is an intra oral camera that uses light frequency to aid diagnosis of dental caries and tissue inflammation. High resolution images can then be shown to patients on the computer screen and then saved as part of the patient clinical notes. The Soprocare Intraoral Camera has two modes, Perio and Cario. The PERIO mode highlights new dental plaque, newly mineralised dental plaque, old dental plaque, stains, soft tissue inflammation and gingival recession.

Reports and bespoke home-care plans can then be produced either electronically or on paper, to be shared with the patient and/or other healthcare providers. Video footage is possible, allowing demonstration of oral hygiene procedures to be captured. Mature plaque is also differentiated by the varying light frequency and its relationship with inflammation in the adjacent tissues becomes very obvious. By having access to the latest technology, dental clinicians can not only provide the highest quality of clinical care but also are able to share data and clinical reports with other medical care providers.

Jo Dickinson RDH FAETC Hygienist and Key Opinion Leader Acteon

The CARIO mode highlights early occlusal caries, enamo-dentinal caries, seepage of old restorative material and secondary caries.

Mixing business with dentistry Dentistry will face many of the same challenges that it has always faced this year, along with some new ones. The usual battles of rising costs for the products we provide and the cost of keeping up with the latest batch of regulations, GDPR this time, run hand in hand with the increased scope for rival local practices to reach out to a wider audience through social media. Costs may be further affected this year by the looming prospect of “Brexit”. At dental school, we train in how to use the tools of our trade. There is still, however, little focus on the business side of running a practice. Most dentists leave training illequipped to run a practice and can only learn the ropes through post graduate training, or even more terrifying, learning on the hoof after buying! Cost aspects aside, the other big challenge we face now is the availability of open public shaming – fair or unfair. If a patient has a bad experience at the practice, and is so minded, they can cause all manner of merry hell for practices now on a variety of social media platforms. They are encouraged to do so even more by the fairly low risk “claim

culture”, dentistry being an easy target. If a patient sues for what they perceive to be poor treatment, regardless of actual quality of treatment, the option on paying out is chosen time and again. It’s quick, easy and although immediately painful, it’s more “elastoplast” than the dull drawn out ache of a long debate as to what the payment should be, or even worse, GDC proceedings.

Thankfully, despite the above challenges, the overriding key to success is good quality work that lasts, and in an environment in which the patient feels comfortable. So, if that is what your practice offers and you keep up to date with modern techniques, dental practicing life is still a great one!

Another internet issue is nearby local practices competing for your business. Often prospective clients will choose the practice based on an attractive webpage or strong presence on social media. Those active in seeking out testimonials can turn a few happy patients into what seems like a torrent.

Parrys Lane Dental Practice and Bupa Dental Care Nuvola Speaker for Nuvola courses

Dr Richard Brown


Modern Dentist Magazine



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The value of distance learning to the busy dentist F.J. Trevor Burke

BDS, MDS, DDS, MSc, MGDS, FDS RCS, (Edin.), FDS RCS (Eng.), FFGDP(UK), FADM, Course Director, Masters in AGDP University of Birmingham

In the past, dentists had to travel to a university or hotel lecture facility to be addressed by an “expert” in a given subject. However, while this traditional model of learning remains as a valuable source of Continuing Professional Development (CPD), the past decade or so has seen an exponential increase in the number of online courses being offered. Many practicing dentists are responsible for independently sourcing their own development and training provision, and making time for it, making flexible and distance learning attractive options. Prestigious UK institutions have stepped up to fulfil the need for this type of flexible learning. For example, the University of Birmingham established its Masters in Advanced General Dental Practice (AGDP) in 2002, with those studying it attending the university one day per week, term-time, for three years. The course was popular, but increasing volumes of email enquiries from abroad (and parts of the UK remote from Birmingham) prompted discussions regarding the possibility of making a distance learning version of the programme available. This was duly done, and when the first cohort of students for the new AGDP Distance Learning (DL) course commenced, it was noted that eight individuals worked and lived within easy reach of Birmingham! From responses given during student focus groups, it was determined that many chose distance learning over the equivalent ‘live’ campus-based programme for the benefits it gave to their practice. Distance learning meant they did not have to be away from the practice other than for the two residential weeks that formed part of the programme. This resulted in potentially better patient service, and, in this increasingly competitive world, it meant that they would not be away on a day when, potentially, a patient requiring a lengthy plan of treatment could be seen. Reduced absence from the practice also held a financial benefit for distance learners. Furthermore, studying could be done from the comfort of their own home, or at the practice, which was potentially easier for those with family commitments. However, the question that needs to be asked for any DL course relates to its quality control: examples of questions for anyone undertaking a DL course are “how is the quality assured, how evidence-based is it, and is it relevant to my practice?” At the University of Birmingham, for example, rigorous QA is in place and the continuous evolution of the course through successive generations of students has ensured its relevance, and its firm evidence base.

Providing Patient Finance Offering a patient finance facility can be the difference between you successfully introducing a new service or treatment and your competitor beating you to it. Patient finance is a cost effective and risk-free way to allow your patients to spread the cost of more expensive treatments that they may otherwise delay. Most lenders will allow you to offer a 0%APR option without the need for you to have an FCA licence. If you want to offer longer terms and/or an interest-bearing option, then you will need to either have/apply for an FCA licence or sign up as an Appointed Representative of a broker and offer your finance facility under their FCA licence. With a simple application form, your patient could be approved in a matter of minutes and the treatment arranged within a very short period¹. Most lenders will pay the loan out within a few days² meaning you receive the funds upfront³, directly to your practice account, easing your cashflow and without you having to wait for treatments to complete and receiving the payments over a lengthier period of time. Before deciding on which broker to approach to facilitate a patient finance option, it’s worth asking your peers which company they use. Most brokers offer a quick and easy sign up process, an online application for your patients and competitive subsidy rates. Some brokers will offer online/over the phone training, and some will offer in-practice training; both options are adequate for most practices. A very important aspect is the ongoing support and training – will you be directed to the lender to help with application issues and questions? Will you have to pay for training for your new receptionist? Will you receive ongoing support and regular contact with an experienced and friendly manager? All of these questions are important when pitting one broker against another. ¹ A 14 day cooling-off period applies to all finance agreements, with all lenders ² Payment times can vary from 2 to 30 days ³ Minus any agreed subsidy fees

Charmaine Matthew

Business Development Manager Medifinance Ltd


Modern Dentist Magazine


When dancing meets dentistry: Interview with Ben Underwood, Brush DJ Ben Underwood, developer of the popular Brush DJ app, explains the importance of patient communication and how app technology can be utilised to boost engagement with oral health.


Where did the initial idea for Brush DJ come from, and what steps led to its creation?


The idea of motivating people to brush their teeth for an effective length of time by listening to music is not new; I was taught it 20 years ago as a dental student. The problem was back then it wasn’t very practical to take a tape player or CD player into the bathroom, but with the development of mobile phones and tablets you have access to millions of songs that can be played through pretty decent speakers in a device that fits in your pocket that most people carry with them everywhere. I had the idea for Brush DJ after watching an episode of The Apprentice, where candidates were asked to design an app. I felt this would be an ideal way to make playing music for two minutes and getting evidencebased oral hygiene information across simple and fun!

get that this is the way to reach them; leaflets and posters aren’t looked at in the way they were before mobile phones. Both ethically and financially all dentists know prevention is best and can see the importance of innovative methods to promote evidence-based oral hygiene by their patients and the wider public. If you want to carry out any advanced dental treatment, the basics or good oral hygiene need to be in place first.

Ben Underwood

is a GDP and developer of the free Brush DJ app. He is also an NHS Innovation Accelerator Fellow and Clinical Lead for Dental Research at RDaSH NHS Foundation Trust.

So far the app has been downloaded in 197 countries on over 1/3 of a million devices. I am working on a new version of the app from user and dental profession feedback, which will hopefully increase the number of downloads significantly.


What has the feedback for the app been like among the public and the dental profession?


Fairly amazing! The app has received multiple prestigious awards from both dental and non-dental organisations. On both the Apple and Android app stores people can leave reviews and the vast majority give 5 stars and leave some very kind comments. The dental professionals I speak to love it because they see their patients on their phones in the waiting room and

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The challenge is grabbing people’s attention when you are competing with companies with far larger marketing budgets


Communication and engagement with patients is vital as it allows a practice to help their patients reduce their risk of oral disease and as a business helps build trust and a long-term relationship





What are some of the challenges or barriers in communicating the need for good oral health to the public?

The challenge is grabbing people’s attention when you are competing with companies with far larger marketing budgets. Once you grab attention you have to make the messages you are trying to get across something that will be listened to and acted upon. You have to use the methods the big companies use and link good oral health to happiness and fun – using music makes this possible.


How can app technology help overcome these challenges and increase patient engagement?


An app is a computer program designed to help people perform an activity – so they are not just for games and gossip. In the case of Brush DJ the activity is brushing effectively. Apps are incredibly popular with well over 140 billion downloaded from the app stores, and people are in some cases over engaged.

Why is app technology a particularly effective method of engaging children about oral health?

We know that increasingly young children are spending time in front of screens, so apps give us an opportunity to directly grab attention and motivate healthy behaviour. We also know that children can often use digital technology better than the adults that might be caring for them.


What are the benefits for practices that are able to improve engagement and communication with their patients?


Communication and engagement with patients is vital as it allows a practice to help their patients reduce their risk of oral disease and as a business helps build trust and a long-term relationship. Without patients a dental business cannot survive and patients will soon leave a practice if communication is poor. However if communication is good they will recommend a practice to family and friends, which is without doubt the best and most cost effective form of marketing.


How do you see the role of the Brush DJ app changing in the years to come?

I hope the Brush DJ app will evolve and be even more widely used. It would be great if a patient could make dental appointments via the app, fill in their medical history forms before they attend an appointment and sign it digitally or with their fingerprint. NHS blue forms could be on the app and read, completed and signed by the patient/ parent before they attend. Information about any problems or concern the patient has could be requested before the appointment, giving time for the patient to consider their responses, rather than using up relatively expensive surgery time. A diet history could be included in the app and information given to the patient by the app working out where there are dietary habits that could cause dental disease. The Brush DJ app already has videos showing how to brush, floss and interdental clean effectively – it would be great to expand this to have videos showing how to care for children’s teeth and care for teeth when braces are worn. How to self-check for oral cancer and what to do in the case of trauma, such as if a tooth gets knocked out, are also videos I am keen to include.


Modern Dentist Magazine


Changing the face of paediatric dentistry Dr Roksolana Mykhalus set up Happy Kids Dental, an exclusively paediatric practice in London, because she wanted to change perceptions about children’s dentistry in the UK and revolutionise the experience of dental visits for children. Treating children aged 0-18, her state-of the-art practice is fast becoming a go-to for private referrals, as this article explores. Strolling the streets of Marylebone, a rarefied pocket of tranquillity between bustling Edgware Road and Marble Arch, you’d never guess what lies behind the facade of an unprepossessing building on Seymour Place. But step over the threshold of Happy Kids Dental, and everything changes. Monkeys dangle from a giant tree, an elephant swings from the ceiling, a friendly hippo waits in reception. Children play and laugh. This is a dentist like no other. First impressions count

Creating an atmosphere of wonder and excitement was top of Roksolana Mykhalus’ list when it came to setting up Happy Kids Dental, her exclusively paediatric practice. In such an absorbing, interactive environment, both parents and children can effectively hit

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the reset button on their dental experience. Whatever your preconceptions about dentistry, Happy Kids Dental promises a fresh approach, making every dental visit an experience that is fun and fear-free. Beyond the jungle reception are age-zoned play areas filled with toys, iPads and consoles – and when the time comes to meet the dentist, children will find the airy surgeries don’t feel at all clinical; instead, they’re decked out in bright colours, with TVs above the dental chairs.

An unrivalled paediatric team

The next ‘must’ on Mykhalus’ list was to prove that behind those impressive interiors lies serious substance and a real commitment to advancing paediatric dentistry in the UK. Mykhalus has amassed an impressive paediatric team – a 15-strong band of passionate dental professionals that includes specialists in paediatric dentistry, surgical dentistry and a consultant orthodontist. Supported by dental therapists and dental nurses with a keen interest in the paediatric field, the team can offer a full spectrum of paediatric dental treatment, all under one roof, making Happy Kids Dental the obvious choice for dental referrals in London and beyond.

Experienced oral surgeons in-house

Happy Kids Dental welcomes referrals for paediatric oral surgery and can continue to treat children in a relaxed, calming setting regardless of how complex their needs are. As well as giving referring clinicians access to a highly experienced consultant-led surgical team, Happy Kids Dental’s child-centred, play-based environment is ideal for putting children, and parents, at ease before, during and after a surgical procedure.

When the time comes to meet the dentist, children will find the airy surgeries don’t feel at all clinical; instead, they’re decked out in bright colours, with TVs above the dental chairs

Features Special needs and dental anxiety

One of the biggest benefits of referring a child to Happy Kids Dental is the team’s ability to communicate with children of all ages and abilities. It’s a crucial skill that can often be the key to delivering effective and timely treatment. While dental anxiety among children, especially those with special needs, can be challenging for general dentists to manage, Happy Kids Dental’s experienced team has a wide range of methods at its disposal. They can offer a child all the time they need to build their confidence leading up to a treatment; appointments take an hour on average, which gives patients an opportunity to relax and not feel rushed. Paediatric dentists are extensively trained in behavioural management and hypnosis. And when it comes to special needs, Happy Kids Dental’s team is particularly experienced at supporting families with their child’s ongoing treatment.

Making children comfortable

The team at Happy Kids Dental not only offers an enhanced level of paediatric expertise, but is supported by serious investment in the latest dental technologies, which make treatment faster and more comfortable than ever. The

practice offers all forms of sedation to help anxious or special needs children through their treatment, from inhalation sedation to IV sedation and general anaesthetic. The team is equipped with technology such as The Wand, a computer-aided anaesthetic delivery system, the Isolite system for improved patient comfort, the lowest-radiation digital x-rays, Diagnocam for improved caries diagnostics and a dental microscope for endodontics.

Preventive early orthodontics

Prevention is central to Happy Kids Dental’s ethos, and early orthodontics is a modern approach that plays a huge role in simplifying or eliminating future problems. Happy Kids Dental recommends all children receive an orthodontic assessment between the ages of seven and eight. If the orthodontist identifies a potential problem, they can take advantage of a window of opportunity for gentle treatment while the jaw is soft and still growing – usually between the ages of eight and nine – preventing the need for more complex treatment in later years. At Happy Kids Dental, early orthodontic treatment can range from simple, timely support with correcting habits, such as thumb

Happy Kids Dental’s child-centred, play-based environment is ideal for putting children, and parents, at ease before, during and after a surgical procedure

sucking, to using growth-modification braces, space maintainers and removable retainers.

Making oral health fun

The team of paediatric dental therapists at Happy Kids Dental are continually coming up with creative ways to engage and enthuse children about oral hygiene. Their remit is to get children on board with good oral hygiene from day one, inspiring them during their dental visits at the practice to become better brushers at home. As well as educating children about the benefits of great oral health, the team can support parents with the latest diet and lifestyle advice. And when it comes to professional cleaning, they use advanced AirFlow polishing, which is gentler, more effective and less intimidating than the traditional scale and polish.

Meeting a real need

Treating children in a regular dental practice can pose a host of potential problems. Few general dentists and dental therapists have the time, resources or experience to dedicate to the specific needs and challenges of younger patients. In positioning itself as a partner to the profession, Happy Kids Dental aims to meet those needs, instilling confidence in referring dentists and parents that patients are receiving the highest quality of care. But Dr Mykhalus has a higher aim, too: to reduce the rise of tooth decay among children. With its revolutionary approach, Happy Kids Dental is not only the ideal destination for dental referrals, but is supporting a new generation of decay-free children who enjoy happy, healthy smiles for life.

Dr Roksolana Mykhalus is Operations Director & Founder of Happy Kids Dental.


Modern Dentist Magazine


Prevention better than cure! Rachel Moreland Sales and Marketing Manager at DMG UK, highlights some of the latest active care trends in Minimally Invasive Dentistry. Clinicians cannot actually prevent caries, but they can help control its progress through active care, including professional prophylaxis, remineralisation, use of fissure sealants and Icon. For a successful preventative approach, professional dental cleaning plays an important role. This is where products like Flairesse, which contain xylitol and fluoride, come in. Xylitol is an artificial sweetener, which reduces the cariogenicity of plaque, because it prevents the bacteria from adhering to the surfaces of the teeth as a biofilm. Clinical studies have proven its cariostatic and anticariogenic effect. Similarly, there is no question that fluorides are important for dental health.

Protection from acid attack!

Stephan’s Curve shows that the critical pH for enamel is 5.5, but only 6.5 for dentine. However, the critical pH is not fixed, but affected by the quantity and quality of saliva present in the mouth. A healthy mouth (lots of saliva, presence of calcium and phosphates etc.) requires more acid to erode the teeth, but if there is a poor saliva quality it needs to be artificially supplemented, there are a variety of products available to do this.

Icon repairs only the damaged tooth substance; there is no need to remove healthy tooth substance for access or stability reasons 46|Modern Dentist Magazine

Similarly, composite based fissure sealants incorporating fluoride are regularly used and well established, but they are technically very demanding to apply properly, ideally using rubber dam for moisture control. They also work best if the patient provides good maintenance control afterwards. However, should the acid attack result in demineralisation of the enamel or even the underlying dentine, then more direct intervention is required. However, where it is acceptable to restore a distinct carious cavity with a suitable tooth coloured restoration or even a ceramic crown in more pronounced situations, damaging otherwise healthy tooth structure in order to eliminate an unsightly, but relatively superficial white spot on the enamel is definitely not. Therefore, where patients are requesting the removal of such minor (though to them serious) flaws, a much less invasive treatment is necessary. If this can simultaneously eliminate the need for the anaesthetic needle and drill, this is even more beneficial. Icon is well established for the treatment of decay at its earliest “white spot” stage on vestibular and interdental surfaces, without the need for injections or drilling. Using Icon carious lesions can be halted in their early stages, without the need for occlusal access, which helps to preserve healthy tooth substance and improves the prognosis of the tooth. It can be used to treat lesions up to D1. Consequently, it offers a quick and painless remedy for white and brown spot lesions resulting from a variety of attacks including fixed orthodontic treatment.

How does Icon work?

Icon utilises an innovative caries infiltration concept. The special etch opens the surface layer and microporosities. After desiccating the lesion, capillary forces draw the resin infiltrate into the resulting voids. The light cured resin forms a permanent seal, starving the bacteria in the tooth structure from substrate and hereby preventing the progression of the lesion.

In addition, it restores the optical properties of the tooth structure thereby returning the tooth’s natural shade. As such it serves as a non-invasive procedure for white and brown spot lesions.

How does Icon differ from traditional fillings?

Icon does not require the removal of any tooth substance to be performed. Icon repairs only the damaged tooth substance; there is no need to remove healthy tooth substance for access or stability reasons. As such, it is as minimally invasive as a restoration can be. Anxious patients will appreciate that no injections or drilling are required. However, should the white spot develop into a distinct cavity, the situation changes and a more invasive approach using glass ionomers, composites and other restorative materials becomes necessary. Whatever treatment is provided by the clinician, subsequent maintenance care is performed by the patient. The clinician’s role is to help patients improve their skills in order to achieve this.

Rachel Moreland

UK’s Icon and Flairesse product specialist DMG Dental Products (UK) Ltd. Icon, along with the rest of the DMG range, is distributed in the UK and Ireland by DMG Dental Products (UK) Ltd.

For further information contact your local dental dealer or DMG Dental Products (UK) Ltd on 01656 789401, email or visit

Images: Dr. Marie ClĂŠment (France)

B EF O RE Icon treatment

AF TER Icon treatment

The answer to white spots: I can Icon! Quick, gentle, aesthetic: Infiltration treatment with Icon. Cariogenic white spots – as unwelcome as they are frequent, particularly after bracket removal. Now you can offer your patients a gentle form of treatment rather than an invasive intervention. Infiltration with Icon has

been shown to enable the effective masking of white spots on smooth surfaces. Mild to moderate fluorosis can also be successfully treated. Quick, gentle, aesthetic. In just one session. Good news for you and your patients.


How to talk ‘business’ without talking business Growing your business might seem like an entirely separate entity to providing excellent clinical care, but the truth is, the key to both is building rapport, writes Barry Oulton. Establishing rapport is one of the most influencing and impacting skills one can learn. It is something that we do subconsciously every day, yet when we learn how to build rapport on purpose, it results in patients having a greater sense of liking us and our practice. It also increases treatment acceptance and can enable us to handle complaints without escalation.

48|Modern Dentist Magazine

At the business end of rapport From a business perspective, rapport is needed at the point of first contact, which is often on the phone. If, during that call (and all subsequent communications) the dental team member involved can match each patient’s terminology, key words, tone and volume, it will create a sense of liking, which invariably results in increasing the likelihood that a new patient will book an appointment. It is important to build rapport with patients throughout the whole of the patient journey because, if not, patients tend to feel that they’re not being heard, or understood, or are not important, and therefore, invariably, less amenable to treatment uptake. The easiest way to build rapport is to be more physically like your patient.

Rapport – five top tips • Have the right mindset; be willing to match someone else’s behaviour, physiology, words, thought processes, or perhaps even their values or beliefs • Match their tone and volume, and speed of speech • Be sensorially aware of your patients; if they change tack you need to, too • Be subtle in your pursuit of rapport • Undertake some professional training.

Features A connection can be achieved with your patient through matching and mirroring their body language

Dr Barry Oulton Rapport building is an essential part of effective communication, sales and handling patient concerns Physiological rapport A connection can be achieved with your patient through matching and mirroring their body language and can be easily achieved from the outset. When a patient enters your practice, welcome them by shaking their hand, matching the pressure of their handshake, while maintaining eyecontact, smiling and greeting them with their name. Matching and mirroring simply means being more like your patient and, for the purposes of building rapport, it doesn’t matter whether you match (if they move their right leg you move your right leg) or mirroring (if they move their right leg you move your left leg). Observing the other person’s posture, for example the angle of their head or their body position, and subtly doing the same, or

if they use hand gestures when they talk, you can make similar gestures back at them. The idea is to be similar whilst being subtle. These integral elements of rapport-building will influence your patient’s mind to think unconsciously that you are like them, which in turn can create a sense of liking. It is human nature for us to like people who are like us, to buy from people we like, and we do not complain about people we like. Thus, rapport building is an essential part of effective communication, sales and handling patient concerns. Added value When two or more people are in rapport, they experience interaction that allows them to communicate at the deepest level. In truth, rapport is the forerunner to effective

Dr Barry Oulton has owned Haslemere Dental Centre in Surrey for nearly twenty years, turning it into an award-winning practice with a reputation for outstanding customer service. In 2017, he founded The Confident Dentist, created to help dental professionals learn advanced communication skills and selling with integrity so they can have more impact and make a bigger difference, both personally and professionally. communication, so learning how to build and maintain rapport is a highly valuable skill. If you would like to know more, The Confident Dentist offers a training programme designed for dental professionals to help them improve their interactions with patients and provide a better patient experience. “It’s the best course I have attended in over a decade” – Dr Vishal Kumar


Modern Dentist Magazine












T: 03331 500 287 Medifinance are Authorised & Regulated by the Finacial Conduct Authority.



Consider cosmetic dentistry Donald Sloss, BACD, delves into the world of cosmetic dentistry and what offering it could mean for your practice and patients. Why would you want to get involved in cosmetic dentistry?



Extra hassle

A new challenge

Fussy patients

Very grateful patients

Risk of getting sued

Make a real difference to patients’ lives

Need to spend time on additional training

Meet other like-minded colleagues on courses

what really makes a real cosmetic dentist? Is it just a case of providing some posterior composites and some anterior crowns, or is there more to it than that? How about assessing the whole smile and how it fits into the patient’s face. How does it work in dynamic function not just a static smile? How about:

If you are happy with providing good basic routine dentistry – and there is nothing wrong with that – then move on to the next article. Take pride in the work you do but please do make your patients aware of what modern cosmetic dentistry can do for them. It’s part of your informed consent. If you want a challenge - if you want raving fans telling all their friends what a great dentist you are and how you have transformed their lives, then read on. When I see adverts for dentists, everyone seems to be a ‘cosmetic’ dentist. It’s not a protected title, so it’s a claim that’s easy to make, but

• Smile line • Lip line • Spacing • Rotations • Gummy smile • Buccal corridors • Symmetry • Cants • Long axis of the teeth • Height to width proportions • Midline • Gingival aesthetics • Gingival health • Gingival levels • Black triangles/recession

• Occlusion • Overjet • Overbite • Attrition • Occlusal interferences • Guidance • CR/CO • Joint health • Teeth • Colour • Hew • Chroma • Shape • Incisal embrasures • Gingival embrasures • Characterisation


Modern Dentist Magazine


Digital photography has transformed cosmetic dentistry. How do you assess all of this? PHOTOGRAPHY. Digital photography has transformed cosmetic dentistry. Not only does it allow us to analyse a smile and treatment plan a case, but it also allows the patient to really see their own teeth. Static views can be supplemented with video to give the full view of the smile and the video can be paused to show the dynamic smile. For instance, most patients come in worried about their upper incisors when they smile, but a video shows how much they show their lower teeth when they talk. Cosmetic dentistry is NOT about veneering every patients’ teeth. It is about listening to patients and helping them evaluate their smile and decide what features of their smile they don’t like. Helping them to look at their whole smile then explaining all the possible solutions along with the possible health benefits or risks. It moves us from single tooth dentistry to whole mouth dentistry.

The feel-good factor of transforming a patient’s life cannot be underestimated

Is it worth my while investing in cosmetic dentistry?

From the emotional point of view – without doubt! The feel-good factor of transforming a patient’s life cannot be underestimated. Restoring confidence to someone who hates to smile is one of the most rewarding aspects of dentistry. Financially, it opens up an additional income stream. It also ‘creates’ additional treatments, not by ‘selling’ un-necessary treatment but by fully informing patients of all their options and allowing them to have the option to have more extensive treatment so that they can achieve their desired result.

How do you learn the skills to deliver beautiful dentistry to your patients?

As president of the British Academy of Cosmetic Dentistry (BACD), it should come as no surprise that I will advise you to join the BACD and attend the many great educational events and particularly the annual conference in November. It is a great way to learn all the techniques necessary and to network with some of the very best aesthetic dentists in the world. We are also very lucky to have many other providers of quality education, and the more you learn the quicker you will be able to deliver great dentistry to your patients.

Donald Sloss

is President of the British Academy of Cosmetic Dentistry (BACD) and is in private practice at Clock Tower Dental Care in Ripon and Dental Excellence Harewood. For more information on the BACD visit

52|Modern Dentist Magazine


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Financing and funding growth Jon Drysdale, PFM Dental, outlines the challenges practice owners may face when buying a second practice and the considerations they should take to mitigate these. For many practice owners, the acquisition of a second practice (and subsequent practices) can be more challenging than buying the first. The process needs careful planning, particularly if you’re building a group of practices. The first purchase probably had a particular financial profile. As a first-time owner seeking maximum profits, you most likely planned to be the main fee earner and the financial projections you provided for the bank were only acceptable because you committed to performing a certain number of UDAs. Perhaps the bank didn’t need financial projections because the practice you bought had proven profitability and you took over from an outgoing principal. Maybe first time around your deposit or the security offered was substantial or the amount borrowed was well within the bank’s lending limits. The financial profile which supported your first purchase, can’t necessarily be applied to the second or multiple acquisitions, not least because you can’t double up on the fee income you can personally handle. If you are attempting to build a portfolio of practices within a relatively short time, you may not have rebuilt your cash resources and the security you offered first time round can’t be secured again. Generally speaking, a lending bank will assess the performance and value of your existing

business when considering another purchase. If one business is not working, the lender won’t ‘throw good money after bad’. Trading for fewer than two years probably isn’t long enough to provide meaningful performance figures.

Average lend benefits

Banks will often consider a second lending arrangement by averaging the loan amount to practice values ratio across the existing business and the target new one. For example, existing practice one is valued at £1.0m with outstanding loans of £500,000. Target practice two is valued at £500,000 but you have no deposit funds. The average loan to value is therefore 66 per cent – far more palatable to the bank’s credit sanctioners than viewing target practice two in isolation as a 100 per cent lend. Using the ‘average lend’ scenario depends on two things. First, there being sufficient equity in existing practice one. Note that the bank is likely to require a proper valuation of your practice rather than your guestimate. The equity will depend on how aggressively you have been repaying your loan, for how long and how much deposit or security you offered initially. If you didn’t offer a main residence as security first time you may need to consider this for a further practice purchase. Second, existing practice one needs to have been trading long enough to provide meaningful financial metrics to the bank. As mentioned, fewer than two years probably won’t do it. If you are trading as a limited company, it may be possible to purchase an additional business with company money. This cash remains undiminished by personal taxation and will go

Banks might entertain some naivety from a buyer on a firsttime purchase but not second time round. further to meeting your deposit requirements. However, trading as a limited company may not be suitable for you or your business – a specialist dental finance broker and dental accountant will guide you on this.

And finally

Banks might entertain some naivety from a buyer on a first-time purchase but not second time round. Having professional advisers on your side to construct a robust lending proposition with credible financial projections and give specialist legal advice will undoubtedly be an advantage.

Jon Drysdale

is an independent financial adviser at PFM Dental chartered financial planners.


Modern Dentist Magazine

Case Studies

Medifinance and The Money Cloud Medifinance, the intelligent financial lender for healthcare professionals, and The Money Cloud, an award-winning provider of international money transfer price comparison, are delighted to have agreed a partnership to supply a real-time, sophisticated and reliable overseas money transfer solution. Medifinance offer a best-in-class portfolio of financial solutions, providing a high level of predictability and an independent viewpoint ensuring Medifinance customers are always one step ahead when it comes to their finances. The Money Cloud was founded in 2014, creating the first international money transfer price comparison site and have used their experience to build a portal with transactional

capability, where customers can store personal details securely, review all their money transfer activity and receive live pricing feeds directly from brokers. The Money Cloud represents a perfect partner for Medifinance, allowing them to offer quick, cost-effective personal and business international money transfers for their client base. Using The Money Cloud’s comparison engine, Medifinance can deliver the best exchange rates, up to 85% less fees compared to using a bank, real time FX pricing, with transparency & security for transfers of £50 up to £100m, across 168 currencies. “We are hugely excited to be partnering with Medifinance,” commented Emmanuel Addy, CCO at The Money Cloud. “They have an outstanding

reputation for looking after its clients, providing expert advice and securing the best available financial deals, lending terms and support for the entire lifetime of the customer relationship. We look forward to assisting our first customers and sharing with them our extensive knowledge of the overseas money transfer industry.” “Medifinance are thrilled to join forces with The Money Cloud. The opportunity that this offers our clients is huge,” said Brent Sercombe, Director at Medifinance. “The forging of our partnership could not have come at a better time as we are adding some exciting new additions to the Medifinance portfolio. The integration of The Money Cloud’s digital platform reinforces our commitment to using technology to enhance our overall customer proposition.”

Check out Medifinance via their website

mikrozid – effective against TB


A leading expert in infection prevention has warned against complacency in the UK about the potential threat of tuberculosis (TB), saying that: ‘Given the right conditions, TB could become a significant problem and cause of mortality.’ Dr Evonne Curran spoke at the Infection Prevention Society’s annual conference. Although the current risk of TB transmission in the UK is low, Dr Curran highlighted that ‘the UK recruits healthcare workers from areas where there is a high incidence of TB and people are also moving from these countries to the UK.’ Effective cleaning of surfaces between patients is essential to protect both staff and patients from the risk of cross infection. mikrozid® and mikrozid® universal are effective against bacteria including TB, as well as viruses like norovirus.

Both products offer dual cleaning and disinfection of surfaces, contain added surfactants to boost cleaning performance and are available in both liquid and wipes. They are rapidly effective against bacteria, and viruses so are ideal for use between patients.

For more information contact:

0114 254 3500 / email: schülke UK Ltd, Cygnet House, 1 Jenkin Road, Meadowhall, Sheffield S9 1AT

56|Modern Dentist Magazine

Case Studies

Customer Case Study Amy Simpson

I had fixed braces as a child, but like so many people I didn’t wear my retainer correctly in order to maintain the results. I became so self-conscious when my teeth began to misalign once more; I never smiled with my teeth and hated having my picture taken. Eventually, I decided I needed to do something to get my confidence back and started researching different options. I didn’t want to have metal braces as an adult so invisible aligners were my best option. I came across Your Smile Direct online and the two things that appealed to me were the price and the fact that treatment was done remotely without the need for multiple visits to a dental practice. Two things that are precious to us all are money and time! The fact that treatment would take around twenty weeks meant that issues that had plagued me for years would now be quick to rectify, which was incredible.

The process was so easy from start to finish and the team were always on hand with any questions I had along the way. After a quick assessment, I did my impressions at home and was then sent my treatment plan by one of the Your Smile Direct dentists. A couple of weeks later my aligners arrived to my door and I was all ready to begin. I felt really looked after by the team and secure in the knowledge that should there be any issues, one of the team would be on hand to help. The steps were simple and easy to follow and, aside from minor discomfort when I changed aligners, involved no pain. Since finishing my treatment, I smile confidently all the time. I get complimented on how lovely my teeth are by friends and strangers alike, which is such a boost to my confidence after years of insecurity. It’s the best decision I ever made and I couldn’t be happier with the results from Your Smile Direct.

Please visit their website and social media channels @yoursmiledirect (Instagram, FB, Twitter), for more information.

A positive influence in practice Neuro-Linguistic Programming (NLP) may not be a subject that you are likely to find on the syllabus at dental school, but that doesn’t mean that it doesn’t deserve a place in the modern dental practice. For example, anxiety can be a hindrance to both dentists and patients, but, recently, the industry has started to explore the relevance of NLP on the dental community. Unlocking the unconscious mind can open the door to success, once dental professionals know how to use the techniques in their practice. Having heard The Confident Dentist speak about using communication as a tool in pain management, dentist Pejman Khaki, an implant specialist at Avalon Oral Care Centre in West Sussex, was so inspired that he began using the techniques within his own practice immediately.

Pejman explains why: “We were taught how influencing the patient’s subconscious mind through appropriate language can reduce patient anxiety. It is a case of using language devoid of negative connotations to help relax anxious patients. It is something that can be incorporated into daily practice by any dental clinician.” Pejman has since become more aware of the psychological aspects associated with patient communication and has made a conscious effort to use appropriate language to help reduce patients’ dental anxiety. He has seen a marked improvement in reducing their anxiety simply by changing the way he talks to them. What’s more, he has found the NLP skills he now uses helpful in alleviating his own stress. It’s good for the business side of things too, and Pejman has noticed an increase in wordof-mouth referrals because of the improved the patient experience.

The Confident Dentist offers a training programme designed for dental professionals to help them improve their interactions with patients and provide a better patient experience.

For more information, please visit, email or call 0333 220 2447


Modern Dentist Magazine

10 Minutes with... Melonie Prebble Q




What has been the key positive or negative change in your area of the market?

They’re the same changes; hygienists and therapists can now work directly with patients, which is a double edged sword because patients want to access us and we want to provide the service, but there are some legislative issues that make it difficult for us to perform treatment on patients directly.

It’s one in the same for me; it’s great that all this has happened, and something had to change, but essentially I’m stuck with some legal issues around things like prescribing that make it difficult for me to actually treat the patients well.

Melonie Prebble

is a Dental Hygienist and Therapist.


Has the profession changed drastically since you started working in it?

Absolutely. I’ve been doing this a long time and it’s definitely changed. The biggest changes are in relation to how we work. Things like sterilisation and compliance have grown massively from a clinical perspective. Otherwise, there’s been an evolution in dentistry in terms of what’s available for us to use and for patients to have.

When I started this job hygienists and therapists really were in a broom cupboard, almost literally. We cleaned teeth because they needed cleaning, but our role has evolved totally to the point that we are pivotal to the patient’s experience and their health. So in every practice now you have hygienists and therapists working, whereas before we were an absolute minority. It’s much more about prevention, and that’s been evolving throughout my career. Technology is huge now, and that’s another big change. How patients reach us and how we can promote ourselves independently of a practice have been enabled by technology.

58|Modern Dentist Magazine

This had to evolve and start somewhere, and the GDC started the ball rolling. Now others have got to follow cue. Currently I feel like I do my job, but sometimes I’m doing it with my hands tied behind my back, and that’s frustrating.


Who inspires you and why?

Over the years, lots of people have inspired me. I wouldn’t say I look to one person in particular, but inspiration comes through chance meetings where people say things that change your viewpoint on something, or from people I’ve worked with who have achieved so much in their careers; they inadvertently teach you the rules and the role and how to have a long and healthy career.

Lots of people in dentistry inspire me in different ways; I think there are so many people who do this job day in and day out, making a difference to their patients, and they’re unsung heroes you don’t always hear about. Then you’ve got other people doing voluntary work for our associations who are actually making the changes happen.

Have you had/got a mentor? If so, what was the most valuable piece of advice they gave you?

I’ve had a mentor for 22 out of the 25 years I’ve practised: David Bloom. He’s given me lots of advice, and the two biggest things I’ve learned are that there are no shortcuts in dentistry; don’t try them because they don’t work, and don’t accept compromises. The other is the importance of valuing your own skills and having the confidence to feel comfortable delivering care at a price that is fair to you as well as your patients.


If you were not in your current position, what would you be doing?

I was accepted to go to drama school and made a last minute decision to become a dental nurse, so who knows where I could have been? In reality, my passion and love is horses, so if I wasn’t doing this I’d be out riding horses all day.

There are so many people who do this job day in and day out, making a difference to their patients, and they’re unsung heroes you don’t always hear about

In a world of shoutIng, the cLeaRest sound you’LL heaR is a whisper Getting your message across to people isn’t about making the most noise. It’s about making the right noise, in the right place at the right time. Precision PR is a specialist in marketing communications for digital imaging and dental technologies. If you’d like to hear about the noises we could make for you, call us on 07432 189149 or email



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