Chlorhexidine Mouthwash has been used and trusted by healthcare professionals for decades. To ensure effectiveness, the proven antibacterial formulation of Corsodyl Treatment Mouthwash has been speci cally engineered to leave out additives that might impact the ef cacy of its active ingredient, chlorhexidine.1,2
Recommend Corsodyl Treatment Mouthwash when you need an intensive treatment to inhibit plaque build-up, treat gingivitis and protect your patients’ gums.
NHS England and the Department of Health and Social Care have released the NHS Dental Recovery Plan.
According to Victoria Atkins, Secretary of State for Health and Social Care, the plan has three components:
1. “In 2024, we will significantly expand access so that everyone who needs to see a dentist will be able to. This will begin with measures to ensure those who have been unable to access care in the past 2 years will be able to do so – by offering a significant incentive to dentists to deliver this valuable NHS care. We are introducing mobile dental vans to take dentists and surgeries to isolated under-served communities.
2. “We will launch ‘Smile for Life’ – a major new focus on prevention and good oral health in young children, to be delivered via nurseries and other settings providing Start for Life services, and promoted by Family Hubs. We will also introduce dental outreach to primary schools in under-served areas, and take forward a consultation on expanding fluoridation of water to the north-east of England – a highly effective public health measure.
3. “We will ramp up the level of dental provision in the medium and longer term by supporting and developing the whole dental workforce, increasing workforce capacity as we have committed to do in the NHS Long Term Workforce Plan, reducing bureaucracy and setting the trajectory for longer-term reforms of the NHS dental contract.”
Increase the number of dental care professionals
The plan notes that ‘Dental care in England could not function without the vital contribution
of its dental care professionals, including dental therapists, hygienists and nurses. As set out in the NHS Long Term Workforce Plan, we will expand dental therapy and dental hygiene undergraduate training places by 28% by 2028 to 2029, and expand training places by 40% from current levels to over 500 places by 2031 to 2032.’
‘Dental therapists’ scope of practice means that they can deliver much of the routine care that dentists provide so more therapists means more care for NHS patients. In addition to dental therapists and hygienists, we will also encourage greater numbers of dental nurses and clinical dental technicians into relevant education and training programmes.’
The recovery plans also call for patients to be enabled to access care from a ‘variety of dental professionals’,
It states: ‘Enabling dental care professionals (DCPs) to work to their full scope of practice would improve access to NHS dental care for patients and allow dentists to focus on delivering more complex care, which only they can provide. However, there needs to be a shift in mindset to change the current ways of working.
‘To encourage this culture change, we have published guidance clarifying how skill mix in NHS practice can be used within existing regulations. This guidance confirmed that dental therapists and dental hygienists can open and close NHS courses of treatment and provide direct access to NHS care. We have also removed administrative barriers that prevented dental therapists and other dental professionals from opening courses of treatment. We are also developing a national return to dental therapy programme, to support dental therapists who have been working as hygienists to refresh their dental therapy skills.’
Therapist-led models of care will also be promoted.
‘Current regulations prevent dental therapists from administering medicines, including certain antibiotics and local anaesthetics, without a written direction from a dentist, even though this is within their current professional expertise. In August to September 2023, we consulted on the potential to enable dental therapists to deliver these medications to patients with fewer unnecessary administrative barriers. Removing these barriers would enable practices to fully utilise the skill mix of their teams, improving access for patients.’
Read the full report at https://www.gov.uk/ government/publications/our-plan-to-recover-andreform-nhs-dentistry/faster-simpler-and-fairer-ourplan-to-recover-and-reform-nhs-dentistry n
Over two fifths (41%) of children have missed one or more days of school due to oral hygiene concerns or treatment, according to new research from Aquafresh. Commissioned as part of the brand’s Shine Bright campaign, the survey highlights that there is still a need for the industry to be providing better oral health education for children, as 65% of teachers believe a lack of knowledge about oral care has led to children in their school having poor dental hygiene.
The dental industry is already experiencing many challenges, as seen through the British Dental Association reporting that the ongoing access problems to high street dentistry have escalated, with unmet need for dentistry now standing at 12 million patients. Despite the majority of parents (82%) taking their children to dentist once or more a year, parents are seeking further support to maintain their children’s oral health. To help relieve some this pressure and provide much needed support, Aquafresh has brought back it’s Shine Bright Academy for the sixth year, with its schools’ programme offering resources and oral health education to children in schools most in need.
Dr Kate Fabrikant, Medical Lead Northern Europe at Haleon said: “We’re proud to be relaunching our Aquafresh Shine Bright campaign for the sixth year running, raising awareness of the importance of starting a good oral healthcare routine from a young age. As a brand, we want to ensure that all children and families have access to oral health education, and this new research highlights the pivotal role educational institutions and healthcare
professionals have in driving this forward. However, 22% of parents feel that more support is needed from dentists, and teachers alike (27%), to educate their children about oral hygiene.
“37% of teachers also site lack of support with syllabus as a barrier when trying to teach about oral hygiene. Oral health brands, such as Aquafresh, can therefore help to bridge the gap by equipping parents and teachers with the best advice on how
to help their children and students to develop and maintain good oral health routines.”
In 2023, Aquafresh donated 10,000 toothbrushes to the Dental Wellness Trust, which promotes oral health among children. The Aquafresh Shine Bright Academy schools programme is available to all schools in the UK and Ireland, offering engaging lesson plans, activity packs and a competition to drive oral care education and engagement in the school setting. n
James Cooke T: 01732 371 581 E: james.cooke@purplems.com
Follow us : @SmileOHMmag
Dentistry is in the mainstream press while I type this. The NHS Dental Recovery Plan has been unveiled just as we get set to go to press with this issue. What does this mean for dental hygienists and dental therapists? According to the Department of Health and Social Care, dental therapy and dental hygiene undergraduate training places by will be increased by 28% by 2029. DCPs will be encouraged to work to their full scope to improve access to NHS dental care, and therapist-led models of care will be promoted.
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Direct Access is more than a decade old and, while there are success stories, there is still some resistance. Will the new recovery plan incite further change?
Speaking of Direct Access, we’re working on a special project here at Smile, in collaboration with our sister publication, The Probe. If you have any comments, or stories to tell, please get in touch at: james.cooke@purplems.com.
the magazine, nor of Purple Media Solutions Editorial Advisory Board: Dr Barry Oulton, B.Ch.D. DPDS MNLP; Dr Graham Barnby, BDS, DGDP RCS; Dr Ewa Rozwadowska, BDS; Dr Yogi Savania BChD, MFGDP; Dr Ashok Sethi, BDS, DGDP (UK), MGDS RCS; Dr Paroo Mistry BDS MFDS MSc MOrth FDS (orth); Dr Tim Sunnucks, BDS DRDP; Dr Jason Burns, BDS, LDS, DGDP (UK), DFO, MSc; Prof Phillip Dowell, BDS, MScD, DGDP RCS, FICD; Dr Nigel Taylor MDSc, BDS, FDS RCS(Eng), M’Orth RCS(Eng), D’Orth RCS(Eng); Mark Wright BDS(Lon), DGDP RCS(UK), Dip Imp Dent.RCS (Eng) Adv. Cert, FICD; Dr Yasminder Virdee, BDS.
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The British Society of Dental Hygiene and Therapy (BSDHT) is delighted to report that the 2023 poster competition, sponsored by Colgate, was an unequivocal success.
BSDHT members were invited to submit an abstract in advance of the OHC. The Society was thrilled to receive a total of 12 entries, 10 of which were forwarded to the final judging stage, the quality of which surpassed expectations by showcasing remarkable creativity, skill and passion for their subject matter. All posters were prominently displayed in the hall of the Oral Health Conference Bournemouth for public viewing and attracted a steady stream of conference delegates interested in the high-quality content.
The diversity of ideas and artistic interpretations made the judging process both challenging and inspiring. It was evident that each participant invested considerable effort and thought into their submissions, which also made the final selection process incredibly rewarding.
The judging of the posters, held on the last day of the conference, attracted a wide audience. The judges were:
• Marina Harris
• Simone Ruzario
• Emma Bingham
The impact and success of this poster competition underscores the importance of continuing to support
and promote initiatives that encourage creativity and professional involvement. It is evident that the participation and engagement generated by this competition within our community is welcomed. It served as a platform to showcase the exceptional talent in our profession. The winners were as follows:
1st: Vaida Kaunaite
Beyond bouncing back: Exploring undergraduate dental profession students’ perceptions of resilience.
2nd: Laura McClune
A mixed method study to establish the current level, nature and attitude to the provision of treatment under direct access for dental hygienists and dental therapists who are members of the British Society of Dental Hygiene and Therapy.
3rd:Clare Haylett
prisoners and the efficacy of prison dental services?
What intervention delivery methods are the most advantageous at improving the oral health of
Details of the winners were included in January 2024 issue of Dental Health and a series of social media posts are scheduled for January 2024 where Colgate will be formally recognised as a sponsor of this important competition. n
Nottingham City Council is working with Community Dental Services CIC (CDS) to launch a new oral health improvement service. The Nottingham City Oral Health Improvement Team will focus on improving oral health and reducing health inequalities across the city.
Maintaining good oral health has a significant impact on overall health and quality of life, while poor oral health means people often cannot participate fully in society due to pain, poor nutrition and loss of confidence. In England, tooth decay is still the most common reason for hospital admission in children aged between six and ten years. However, it can impact on individuals of all ages.
The team will deliver the oral health programmes, based on local need, working with partners to target where they can have the greatest impact, including:
• Supervised tooth brushing programmes in schools and early years settings
• Delivering training to health / non health professionals for both child related and vulnerable adult / older people services
• Supporting care homes to implement NICE and CQC guidelines
• Distributing Oral Health resources
Helen Paisley, Chief Executive, is delighted at the opportunity to deliver a new oral health improvement service for Nottingham City: “Maintaining good oral health is so important to overall health and wellbeing and quality of life. We are really looking forward to promoting positive oral health messages directly to children through supervised toothbrushing and to people working in care who support groups such as vulnerable elderly in care homes and people with complex needs. The opportunity to work in Nottingham City compliments the work of our Nottinghamshire County oral health team and our Nottinghamshire clinical community
dental service teams and will really allow us to reach right into the heart of communities across Nottingham.
“Our oral health teams have great experience in building partnerships and working through established networks to make lasting improvements in oral health where it is needed most, and we are really looking forward to working here in Nottingham.”
Councillor Linda Woodings, Portfolio Holder for Adult Social Care and Health at Nottingham City Council, said: “The health of our teeth is important for all of us as it affects what we eat, how we communicate, our self-confidence and can support older people to stay independent for longer. Tooth decay and poor oral health remain a serious issue and one that is not distributed evenly across society. It can have a negative impact throughout life including missed days at school or work.
“Taking preventative action to reduce the risks of decay is really important and this new service will play a significant role in protecting and promoting good oral health amongst Nottingham City residents.”
To find out more about the service or to book supervised toothbrushing programmes for your setting, visit: https://www.communitydentalservices. co.uk/oral-health-improvement/ nottinhamshire-oralhealth-page/nottingham-city n
The British Fluoridation Society (BFS), supported by The Borrow Foundation, is seeking to recruit a second candidate to its Career Development Fellowship.
Overall, £30,000 has been allocated for the provision of two British Fluoridation Society Career Development Fellowships. The first was awarded to principal dental surgeon Patrick Quinn in November 2023.
The BFS intends to appoint its second fellowship by March 2024 to start in June 2024, and is seeking applications from dental professionals at the beginning of their career with an interest in water fluoridation.
Dr Ray Lowry, BFS secretary, explains: “This is an exciting career development opportunity for someone at the start of their professional career.
“Water fluoridation plays a significant role in preventing dental caries and securing good dental health for all.
“Despite its long history as a successful oral health intervention, only 10% of the UK population drinks fluoridated water, and these people are benefitting from schemes that were introduced decades ago.
“Globally, more than four hundred million people have access to fluoridated water, and we are seeing an increase in political enthusiasm, including here in the UK, for more community water fluoridation schemes.
“Together with The Borrow Foundation, we have identified a need to bolster the professional foundation for fluoridation to keep research relevant, and to encourage our younger colleagues to pursue the issue as a viable career interest.
“Through our fellowship programme, we aim to help build a modern UK database of evidence and to encourage up and coming colleagues to engage in the subject. The BFS is the obvious organisation to initiate this sort of intervention as we work to support the next generation of fluoridation advocates.”
The successful candidate will have the opportunity to meet leaders in the field and work to develop a unique insight into water fluoridation and the issues surrounding it, using the fellowship funding and BFS international partnership networks.
The closing date for applications is 31 March 2024.
Barry Cockcroft, former Chief Dental Officer and BFS chair, adds: “This is an important investment in the future of water fluoridation, underpinning its effectiveness as a safe dental health intervention for future generations.
“We envisage the successful fellow will organise a suitable research or attachment programme that will include connecting with relevant colleagues and institutions in the UK and abroad, which will result in a formal end-of-fellowship report and, if appropriate, a publication in a recognised academic journal.”
Applications and the information on the process is available on at https://bfsweb.org/career-development/ n
1 in 3 adults suffer from sensitive teeth.1,2
56% of those who suffer from sensitive teeth also experience gum problems. 3
Sensodyne Sensitivity & Gum is proven to help protect sensitive teeth and provide a 40% improvement in gum health with twice-daily brushing.*4
Sensodyne Sensitivity and Gum’s proven Micro Foam technology delivers the key ingredient, stannous fluoride, to the hard to reach areas: Scan the QR code to visit Haleon HealthPartner and learn more about the science behind Sensodyne Sensitivity & Gum, and how it can help protect your patients and improve their gum health. The stannous fluoride formula targets and removes plaque bacteria for healthier, firmer gums.5
In a surprising turn of events, SmileDirectClub, once a promising disruptor in the orthodontic industry, has recently announced its closure and filing for bankruptcy. This unexpected development raises critical concerns about the repercussions for the countless individuals who entrusted their orthodontic care to the company. As the dust settles on SmileDirectClub’s downfall, the fallout is expected to include both financial implications, as well as potential concerns around disruption of treatment for patients.
SmileDirectClub built a powerful brand around delivering effective orthodontic treatment at low cost, with quick results. They also claimed to do this without the patient stepping foot in a dental practice.
And it seemed to be successful, certainly in the minds of consumers. In 2019, when it first began trading, SmileDirectClub commanded a valuation of approximately £7 billion. However, the company’s financial struggles and legal challenges caused a significant decline in stock value over subsequent years.
Despite an extensive search spanning several months, it was unsuccessful in securing a partner willing to inject sufficient capital to sustain its operations.
SmileDirectClub initiated Chapter 11 bankruptcy proceedings in September, citing a substantial debt of over £700 million. This included a notable loss of almost £70 million in 2022.
Although there are no official figures, it has been cited that SmileDirectClub was providing services to around 65,000 people in the UK.
There is a concerning prospect that a significant portion of its patients, initially drawn by factors such as cost-effectiveness, expediency, and convenience, may face challenges in maintaining their orthodontic care. Given the reasons why individuals initially opted for SmileDirectClub, the likelihood of these patients seamlessly transitioning to traditional dental care appears low. Instead, it seems plausible that a considerable number may discontinue their aligner usage altogether, risking regression to pre-treatment alignment.
While some dissatisfied patients may opt for consultation with local orthodontists, there exists a more probable scenario where individuals seek alternative online solutions, potentially from companies mirroring SmileDirectClub’s model. This trend poses inherent risks to patients, as anecdotal reports suggest potential issues ranging from inaccuracies in the initial impressions to the absence of adequate support throughout the treatment process. These concerns highlight the urgent need for comprehensive oversight and guidance in the evolving landscape of remote orthodontic solutions.
It’s undoubtedly distressing for patients to witness their teeth alignment reverting, assuming their treatment is ongoing, and they haven’t received a retainer. However, the financial strain resulting from SmileDirectClub’s bankruptcy could be equally challenging to bear.
The allure of direct-to-consumer orthodontic solutions lies in their promise of affordability, yet the financial stakes for patients could still amount to thousands of pounds. The unsettling reality faced by those invested in SmileDirectClub’s
treatment plans is the uncertainty surrounding refunds in the wake of the company’s demise.
In a challenging predicament, SmileDirectClub has advised its consumers to persist with their ongoing payment commitments for their treatment plans (the treatment they no longer have access to). However, the implications of the company’s insolvency have raised concerns about the viability of such advice. According to Which?, customers may find themselves relegated to the end of a lengthy line of creditors, diminishing the likelihood of substantial refunds. This could mean that even if refunds are granted, they will be managed by liquidators and may amount to little, if anything at all.
Patients who paid with a credit card, could try using Section 75 of the Consumer Credit Act to get their money back. This rule makes the credit card company responsible for problems, just like the company they bought from. If patients paid with a credit card, it’s a good idea to talk to their credit card provider for advice on getting their money back safely.
The problems with direct-to-consumer orthodontics are alarming. The closure of SmileDirectClub, which allegedly had as few as five dentists for 65,000 patients, highlights the risks of this streamlined approach. While the demise
of one company might seem like a resolution, the continued presence of similar services raises concerns, especially with inadequate regulations. The shift toward these suppliers is worrying, demanding urgent attention.
Anger and frustration stem not just from one company’s closure but from systemic flaws enabling such models. Swift legislative action is crucial to eliminate the dangers of directto-consumer orthodontics. The safest dental treatments occur in a traditional practice, led by qualified professionals. Prioritising patient safety over profit and convenience is essential, ensuring orthodontic care remains in capable hands. n
DR NIGEL CARTER OBE
Dr Nigel Carter OBE Chief Executive of the Oral Health Foundation.
In this exclusive interview, Miranda Steeples discusses the BSDHT’s landmark 75th anniversary, highlighting initiatives that will help to shape the future of dental hygiene and dental therapy
Miranda, congratulations on the 75th anniversary of the British Society of Dental Hygiene & Therapy (BSDHT). Can you share with our readers why this year is particularly significant?
Miranda: This year marks a time for reflection, celebration, and outreach for the BSDHT. It’s not just a milestone for our professional body, but a pivotal moment for the entire dental hygiene and dental therapy profession. We’re taking this opportunity to celebrate our past achievements and to forge a path for the future, focusing on our commitment to oral health and community involvement.
The ‘75 hours for 75 years’ project sounds intriguing. Could you elaborate on this initiative?
Miranda: Absolutely. This initiative is all about stepping beyond traditional dental care and engaging more deeply with our communities. We’re encouraging our members to volunteer in various capacities, which helps to create a stronger, more personal connection with the public. It’s a way to demonstrate that our profession is about more than oral care — it’s about contributing positively to society.
It seems inclusivity is a key theme. How can all members get involved?
Miranda: We’ve made sure that every member, regardless of their role or location, can participate. Our goal is to accumulate over 900 hours of volunteering across the regions. This collective effort symbolises the collaborative nature of our profession. Members are free to choose activities that resonate with them, from animal shelter volunteering to environmental clean-ups.
For example, I like to volunteer at my local Cats Protection rescue centre. I give my time to do whatever they need, from tidying up their toys and bedding to the best bit –cuddles.
People could litter-pick in their local town, do a beach-clean, go to a school and listen to the children read, volunteer with their local Guide or Scout group, go and give blood. There really is no limit if you are giving your time in the service of, or giving help to, others.
How will these efforts be showcased?
Miranda: We plan to share these volunteer efforts on social media, in the Dental Health Journal, and at the Oral Health Conference later this year. It’s a way to celebrate our members’ contributions and to raise awareness about our role in promoting oral health and community engagement.
Tell us more about the #BSDHTree initiative.
Miranda: Inspired by a patient’s last wishes to have trees planted in his name, the #BSDHTree initiative involves planting 75 trees to commemorate our 75 years. This goes beyond oral health to sustainability, serving as a metaphor for our growth and enduring presence. It’s a testament to our commitment to the environment and the future.
We hope trees can be planted throughout the UK, wherever this can be arranged in each regional area. Ideally an actual tree, or donations, can be made from regional funds to support this. Some communities utilise twigs from some particular trees to clean their teeth, which is another connection to oral
hygiene and health, but we will stick to native trees for this project!
The thing is, the BSDHT has been around in its current form, and as the BDHA, for 75 years, while a tree can go on for hundreds of years, and I would hope that BSDHT might do so as well.
What are some of the key events planned for the anniversary itself?
Miranda: We are co-producing a special issue of the International Journal of Dental Hygiene, offering a platform for emerging talents in our field. We are currently on the look-out for budding authors. If you would like to contribute to this project and be published internationally, now is your chance, so get in touch.
Additionally, we’re hosting a special celebration on July 6th at the RAF Club in London, where we’ll bring together our members to reflect on our journey and visualise the future. Look out for further details, coming soon!
As you reflect on this milestone, what are your feelings about the future of the profession?
Miranda: I am absolutely thrilled that this is happening during my presidency and can only hope that I do the occasion justice. Combined with that, I feel a profound sense of pride and optimism.
Our 75th anniversary is more than a commemoration; it’s a reaffirmation of our commitment to the future of dental hygiene and dental therapy. We’ve seen significant advancements in our profession, and we expect this growth to continue.
Our focus on community service, environmental sustainability, and professional advancement is setting the stage for a future where dental hygienists and dental therapists are key players in public health.
Lastly, what message would you like to share with the dental community as you look forward to the next 75 years?
Miranda: We’re at a pivotal moment where we’re not just celebrating past achievements but also laying the foundation for future successes. Our activities during this anniversary year reflect the diverse interests and commitments of our members.
As we look to the future, we do so with a sense of pride in our history and excitement for the opportunities that lie ahead. We encourage the entire dental community to join us in this journey towards advancing oral health and making a positive impact on society. n
or to request a sample, visit www.optim-idb.uk
Joss Harding explains how she became a clinical ambassador for the Mouth Cancer Foundation and the importance of regular screening
As a dental hygienist, I have always been deeply passionate about improving oral health care, especially for head and neck cancer patients.
My journey to focusing on this niche area began when I realised the lack of information and resources available on the subject.
My curiosity and concern for these patients grew when I joined my current practice in 2007 and encountered my first inpatient with head and neck cancer. I was struck by how little I knew and how insufficient the available literature was at the time.
Determined to make a difference, I started delving into research, attending lectures, and asking questions about long-term care for these patients.
‘It’s all out there’
It wasn’t until a lecture in 2016 that my path took a more determined turn. I questioned a local restorative specialist about how I could better help these patients upon their return to the practice.
Their response that ‘it’s all out there’ left me frustrated because, despite my efforts, I couldn’t find accessible, comprehensive information. This gap between the availability of knowledge and the accessibility of information to practitioners like me was disheartening.
On my drive home, an idea struck me – why not consolidate all the information I had gathered into a leaflet for easy access?
With encouragement from my boss, and despite my initial hesitation, I embarked on writing an article for the dental media. This endeavour resulted in my work being published over two editions of The Probe in June and July 2016, a proud moment for me.
Since then, my engagement with head and neck cancer care has only deepened. I’ve interacted with various patient groups, healthcare professionals, and learned immensely from each interaction. I’ve
To learn more about oral cancer, visit the Mouth Cancer Foundation website www.mouthcancerfoundation.org.
You can also hear Joss speak at the British Dental Conference & Dentistry Show in Birmingham on the 17-18 May. To find out more, register for your tickets and to see the full line up of expert speakers, simply visit birmingham.dentistryshow.co.uk
become an advocate for asking questions, never settling for the status quo, and always seeking better ways to provide care.
My journey has been a steep learning curve filled with enriching experiences that have reshaped my approach to dental hygiene.
I often think about how impactful it would have been if, during the lockdown, households received information on how to conduct self-screenings alongside Covid-19 precautions
Now, as a clinical ambassador for the Mouth Cancer Foundation, I am acutely aware of the statistics surrounding mouth cancer, especially in the post-Covid era.
The rise in cases, due in part to delayed diagnoses and treatments because of the pandemic, underscores the importance of regular dental checks and early detection.
As dental professionals, we are on the front line of identifying potential cases early, and our role has never been more critical.
The numbers are stark, with more people dying from head and neck cancers than many other wellknown cancers combined.
Education on prevention, including lifestyle changes like reducing alcohol consumption and smoking, as well as the importance of HPV vaccinations, is something for which I constantly advocate.
My practice isn’t just about cleaning teeth and providing oral care; it’s about holistic patient care, including discussing lifestyle factors that could contribute to oral and general health.
Conversations around alcohol consumption, smoking, diet, and HPV vaccinations are regular parts of my interactions with patients. The aim is always to educate and empower them for better health outcomes.
One of the most significant aspects of my work has been promoting self-screening.
If people are more aware of the normal state of their oral health, they can detect anomalies early and seek professional help.
I often think about how impactful it would have been if, during the lockdown, households received
information on how to conduct self-screenings alongside Covid-19 precautions.
Education is a powerful tool, and enabling people to understand and monitor their health is a critical step in early detection and prevention.
The Mouth Cancer Foundation has been a beacon of hope and information in this journey.
As a volunteer, I’ve seen firsthand the importance of raising awareness, creating resources, and supporting research and projects like voice banking for those who might lose their voice due to treatment.
The Foundation’s work in creating accessible, easy-to-understand materials and fostering a community dedicated to combating mouth cancer is close to my heart.
My journey from a curious dental hygienist to an advocate for head and neck cancer patient care has been transformative.
It’s a path marked by learning, questioning, and a relentless pursuit of better patient care.
Through continuous education, patient engagement, and a dedication to raising awareness, I hope to contribute significantly to reducing the impact of head and neck cancers.
It’s a challenging but deeply rewarding journey, and one that I am committed to every day as I put on my dental hygienist’s coat and greet each patient with a smile, ready to make a difference in their lives. n
JOSS HARDING
Joss Harding is a Clinical Ambassador for the Mouth Cancer Foundation and has recently written a book “Care of Head and Neck Cancer Patients for Dental Hygienists and Dental Therapists”. A book of 49 chapters kindly supported with chapters from colleagues all over the UK and the USA.
BioMin® F is the only toothpaste that delivers low level Fluoride with Calcium and Phosphate ions continuously for 12 hours after brushing. These combine to form Fluorapatite on the tooth surface ensuring the teeth are 10 times better protected to survive acid attack and therefore less prone to decay.
Soluble Fluoride, used in all other toothpastes, is rapidly washed away by saliva and has little clinical benefit just over an hour after brushing.
BioMin® F solves the problem of traditional soluble Fluoride toothpastes.
BioMin® F bioglass is the result of 15 years research and development at Queen Mary’s University, London. Uniquely, this slowly dissolving bioactive glass adheres to tooth structure releasing optimal proportions of Calcium, Phosphate and Fluoride ions over a 12 hour period after brushing. In contrast traditional Fluoride toothpastes contain soluble Fluorides which are rapidly washed away by saliva and ingested.
Developed over 20 years ago, NovaMin® represents the first generation bioglass used in toothpastes though it was not originally developed for this purpose. It had initially been formulated for bone grafting. Only later was it used in toothpastes because of its adherent and slow dissolving capabilities to release Calcium and Phosphate. It does not contain Fluoride nor optimum proportions of Calcium and Phosphate minerals.
First generation NovaMin®, the active ingredient in Sensodyne Repair and Protect, is a bioglass without Fluoride. Repair and Protect incorporates additional soluble Fluoride which rapidly washes away like all other saliva soluble Fluoride toothpastes.
In contrast, BioMin ® F represents a more advanced second generation bioglass, which has been specifically developed for dental applications and is uniquely formulated to slowly release Fluoride, Calcium and Phosphate ions over a 12 hour period after brushing. It facilitates rapid and continual production of stable, acid-resistant Fluorapatite within dentinal tubules and on tooth surfaces.
BioMin ® F with controlled release Fluoride facilitates constant Fluorapatite development on the tooth surface, which increases the acidresistance of natural tooth enamel by 1000%.
All other toothpastes contain soluble Fluoride salts that are rapidly washed away providing far less protection.
The Fluoride 1350, 1450 and 1500 misconception
Some wrongly believe that the optimal toothpaste should contain 1500ppm of Fluoride. This figure is not based upon optimal clinical benefit, but is simply the legal maximum a toothpaste can contain without having to comply with more onerous product registration requirements. No manufacturer can add more Fluoride to a toothpaste without a Pharmaceutical Product Licence. Manufacturers add as much soluble Fluoride as they are legally allowed to in order to maximise preventive properties before the Fluoride is washed away.
BioMin ® F does not have this problem because of its controlled continuous release of Fluoride with Calcium and Phosphate. Brush twice a day with BioMin ® F and Fluoride is ever present doing a fine job!
BioMin® F – Safer than high Fluoride toothpastes
The higher the Fluoride content the greater the risk of Fluorosis by accidental imbibition, especially amongst children and people more prone to swallowing their toothpaste.
With its dramatically lower 530ppm Fluoride content this risk is minimised, whilst still delivering 12 hour Fluoride protection!
Brush twice daily for 24-hour Fluoride protection and reduced sensitivity
BioMin ® F has been formulated to contain Fluoride, Calcium and Phosphate ions in the optimum proportion for rapid remineralisation. What’s more, as the oral pH decreases after consumption of sugary and acidic food and drink, the bioactive glass dissolves quicker, resulting in even faster release of these minerals, which in turn neutralises acid helping to stabilise the pH further and helping to protect the teeth from decay.
BioMin® F bioglass particles are engineered to be 60% smaller than those found in NovaMin® products, resulting in less abrasivity and deeper penetration of the dentinal tubules with acid resistant Fluorapatite. So, the formation of Fluorapatite is not just on the surface of the teeth, but also deep within the dentinal tubules. The tubular occlusion achieved with BioMin® F is much more resistant to dissolution, providing more effective and longer-lasting relief from dentine hypersensitivity. No other toothpaste can deliver such effective remineralisation of teeth and long-term protection against dentine hypersensitivity, no matter how much they spend on expensive machinery and advertising!
Published research shows that BioMin ® F outperforms other sensitivity toothpastes in its ability to block dentinal tubules, resulting in superior and long-lasting sensitivity relief (Studies available upon request).
For further information visit the Trycare website, www.trycare.co.uk/biomin, contact your local Trycare representative or call 01274 885544. n
Engaging patients in their oral and general health is an essential part of the oral healthcare team’s role today. Tackling the big issues during dental appointments may seem daunting, but professionals can have a significant impact on their patients’ wellbeing.
Miranda Steeples, President of the British Society of Dental Hygiene and Therapy (BSDHT), will be exploring this topic in more detail from within the Oral Health Theatre on Friday 22nd March. Offering a taster of what she hopes to cover, Miranda says:
“My presentation is about MECC, ‘Making Every Contact Count’. This is a Public Health England initiative and the core messages are to encourage patients to stop smoking, reduce alcohol intake, improve their diet, increase their exercise, and try to lose weight. These are all common risk factors that will impair an individual’s oral and general health.
“I will discuss how to weave this into a typical appointment, largely from my personal perspective as a dental hygienist, but it is easily transferable to a general oral health review, or an oral hygiene session with a dental nurse. We can consider aspects of the medical history that might affect oral health, encourage better general health behaviours, and bring these together to improve the patient’s oral health. Not only will this support their systemic health, but it will also bring us back around to oral health, and link it all together.”
Clearly, this is a mission that all members of the oral healthcare team can be actively involved with. This integrated approach to care will be important for dental teams to overcome some of the challenges they may face in practice. Miranda continues:
“I would say the main issue is time – more specifically, a lack of time – or at least the perception that this is a barrier. There is always a certain set of tasks that must be undertaken within an appointment. While the focus in oral health care is prevention, patients also have an expectation that you will do something for them as well; they expect less talking and more doing, and may even challenge if what you’re asking is any of your business. But it really is. For dental hygienists and dental therapists, we spend our days talking about prevention, so it comes quite easily to us.”
If communication is the bedrock of the dental hygienist/therapist’s role, it’s essential that professionals have the skills and confidence
to manage such aspects of an appointment effectively. Miranda offers some advice:
“It’s important to be confident talking about these things. Get your patter ready and wellrehearsed so it comes out naturally when in front of patients. Decide on one thing you will address at each appointment. You won’t get everything done all in one go, because there won’t be enough time and the patient may feel overwhelmed with information. It has to be taken at the patient’s pace, offering guidance when they’re ready to engage. Utilise your team, too. Refer to others in your practice who can take on this work, or who may enjoy it and be better at it. You might also consider providing leaflets for patients to take home or producing videos to play in the waiting room to reinforce your key messages.”
In addition to Miranda’s session, the Oral Health Theatre will present a number of opportunities to learn and interact with prominent speakers presenting on an array of topics. Well-known
for its trade exhibition – BDIA Dental Showcase remains the largest and longest running dental exhibition in the UK – this will also be a chance to get up to date with product launches. There will be a spectrum of organisations, including dental manufacturers and suppliers, training providers, regulators and professional societies and associations. Miranda concludes with her own thoughts about the event and comments on what dental professionals can expect from the BSDHT:
“I’ve always really enjoyed BDIA Dental Showcase and found it to be very worthwhile. As one of the first shows in the year, it’s a great opportunity to get some CPD and to visit the trade stands to see what the new year launches have been.
“The BSDHT team is promoting our Oral Health Conference 2024, which will be held in Harrogate on 22 and 23 November 2024. The Society is also celebrating the 75-year anniversary since our inception as the British Dental Hygienists’ Association in 1949, so we have much planned to mark this important milestone.
“If any members would like information on our Coaching and Mentoring programme or wish to volunteer on the team, or anyone needs details of our upcoming Regional Group Spring Study Days, we would love to meet you, too. Plus, the editorial team that produce our super journals will be on hand to discuss a special birthday edition of the International Journal of Dental Hygiene, which will be created in collaboration with our Annual Clinical Journal. Please don’t be shy, we’d love to meet you!”
If you haven’t already, register for free today and secure your place for BDIA Dental Showcase 2024! https://dental-showcase-2024.reg.buzz/register-free-pr BDIA Dental Showcase 2024 22nd-23 rd March
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Dental hygienist and therapist Megan Fairhall has been running teeth whitening training courses for over seven years, and is now also offering an advanced teeth whitening and Icon “white spot removal’ training courses alongside partners Philips and DMG. For the past year, Megan has also been one of the seven members of the {my}dentist Clinical Advisory Board, predominantly guiding the group about how to implement teeth whitening into their nearly 600 practices. Here Megan answers questions her peers have recently asked about how to successfully implement teeth whitening treatments into practice and increase the amount of whitening treatments they are carrying out.
The most often asked questions relate to:
• Marketing
• Workflow
• Legislation
Marketing
• Clinical skills
• Brand loyalty
What is the best way to engage with patients to assesstheirinterestinwhiteninginthepractice?
Forms I recommend every practice has pre-appointment form for patients to fill in. These can easily be adapted to include a question about teeth whitening which encourages the patient to tick if they are interested in improving the colour of their teeth. This is a perfect opportunity to open up a conversation during an exam or hygiene appointment, knowing that they have an initial interest.
In the Dental Chair
A dental examination or hygiene appointment is good springboard to start talking about staining and removal of extrinsic stains in order to maintain the colour of the teeth and then lead on to discuss brightening the colour of their teeth with whitening treatments.
Involvement of the whole team
The importance of a good workflow should not be underestimated. A patient should be able to talk to anyone within the practice and feel reassured that they are able to explain the various steps of the whitening treatment, including costs and appointments needs. The worst scenario is when you lose leads as a result of lack of team training or knowledge.
I always recommend that receptionists, nurses and TCOs should really get involved in the overall whitening journey. This enhances the patient experience and creates a positive patient journey whilst building a real trust with the team. The TCO will handle all my appointments, including an initial exploratory call for a preliminary discussion about whitening if necessary.
I would also recommend that every member of the team has had their teeth whitened, as this also provides opportunities for everyone to get involved in conversations with patients as they have experienced whitening first hand. One of my nurses, for instance, typically gets white spots when she has whitening treatment, so she offers reassurance to patients who might be concerned about potential complications.
How do I market myself outside the practice?
Recommendations
Utilising your friends and family and offering them teeth whitening treatments is a really good way of
starting out as it will build your confidence. This will also help with initial recommendations for treatment from their contacts. From experience, I get about 5 leads per patient I see, but that is because I invest a lot of time and effort in fostering a great experience, including post treatment follow up and review.
Social media
I cannot underline enough the importance of social media. Whether you are using the practice social media channels or your own personal platforms, this is a really vital tool to engage with prospective patients and give them the right education on whitening. Your posts will increasingly highlight that you are an expert in the field and this will help build engagement and trust.
Local events and incentives
Promoting teeth whitening at local events such as wedding fairs, collaborating with local businesses and networking events will make you the go-to person in your area for whitening.
We also run regular open days at the practice, which are very successful. I use my iPad to show some before and after cases so that prospective patients can see for themselves what I have achieved for my existing patients. We also offer incentives when people sign up for whitening on the day, such as a free Sonicare electric toothbrush.
Clinical referrals
When a patient is having veneers, composite bonding, or orthodontics, there is a good chance that whitening will also be included in the treatment plan. It is therefore important that the clinicians working in the same practice know you are offering whitening and that you have achieved great results for your patients. A two-way relationship with the clinicians is invaluable. You can also demonstrate that it is more lucrative and time efficient for them to focus on other cosmetic treatments in their scope of practice and refer the whitening part of the treatment to you.
Whitening workflow
How simple is the workflow?
Once you understand how to streamline the whitening process and everyone is on board with it, it is quite simple, however it is essential you don’t overlook some of the necessary steps.
Cooling off period
As tooth whitening is regarded as a cosmetic procedure, it is important to allow for a cooling off period after an initial briefing so that patients can make an informed decision about whether they want to go ahead with the treatment or not. Make sure this is incorporated into your workflow.
Consent
Patients should be provided with their consent forms and all details about the whitening to allow them to reflect without pressure and at their own pace. At this point, you would have been able to take photos and assess their shades in readiness for the treatment. I personally book a 15-minute consultation for this.
Whitening suitability
As part of the treatment planning process, you need to factor in a dental examination with the dentist to determine their whitening suitability, and ensure they are dentally fit. You may also schedule a hygiene air polish 30-minute treatment prior to their whitening, which is what I recommend for all patients about to undergo whitening to gain maximum results.
Prescription
You also want the referral process to be as smooth as possible. If you are a dental hygienist or dental therapist, ensure you have the prescription from the dentist, and also check that a dentist is on site when your patient is coming in for the first application of the whitening treatment.
Lab turnaround time
I scan all my patients as it gives me so much more flexibility, and is greatly preferred by patients. It also provides a much more efficient way to communicate with the lab. Many labs also work with apps now and I find it particularly useful as it means you can message them, track progress, and streamline the overall process. It is important to ensure the patient’s home whitening trays have been sent to the practice from the lab when you schedule the patient’s first appointment. This might seem obvious but with a busy practice, it is not unusual to let a few things slip.
What should the initial consultation be for?
The initial patient consultation is ideal opportunity to go through the whitening options (take home or in-chair) and discuss any concerns they might have. It is important to get to the emotional root of why they want whitening as it helps with treatment planning and ensuring desired results for each patient. Some have a single yellow tooth they want to improve, others are concerned about their teeth getting a bit darker, or it could be about white spots. Ask about their lifestyle, if they wear night guards or retainers, and also whether they
suffer from sensitivity in the event that some extra preventative work needs to be added to the treatment planning. I am a really big advocate that whitening is not a one-size-fitsall, and the only way to get good results is to tailor the treatment to each patient’s needs. As clinicians we need to educate our patients about the need to remove extrinsic stains to stop them becoming internalised over time and exacerbating the yellowing of the teeth.
The initial consultation should be viewed as a tiered treatment approach. It also provides an opportunity to check if the patient has any
• Remineralises, including lesions.
• Makes teeth shine and feel clean.
• Significantly challenges sensitivity.
• Reduces the risk of White Spot Lesions.
BioMin is unique in it’s ability to utilise bioglass technology to deliver superior fluoride protection & sensitivity relief. BioMin adheres to teeth and slowly dissolves releasing calcium, phosphate and fluoride ions over a period of 8-12 hours to form acid resistant fluorapatite. This makes BioMin much more effective than conventional toothpastes where the active ingredients, including soluble fluoride, are washed away and become ineffective less than two hours after brushing. >
interior restorations, crowns, veneers, bridges or implants. These areas are not going to whiten and we need to make sure that the patient is aware of this.
Discussions about what is actually realistic versus what is expected will also help when a whitening treatment doesn’t quite achieve the initial results a patient wants (or expects), and additional internal whitening or further cosmetic treatment could be necessary. This is the clinical expertise your patient will appreciate, especially if they have previously used over the counter or online whitening products. If time allows, do not hesitate to take a scan of the patient. This will save them an additional appointment and make the overall process really easy for them too.
Costs should be discussed at this point and if financing is needed, involve your TCO or other member of the team to follow this through. This is also the time to explain the number of appointments which will be necessary.
Before they leave ensure patients are booked for their next appointment even if the cooling off period makes them rethink about going ahead with the treatment.
Moving forward, we always look at recording the shades of the teeth at all appointments and again that is when my nurses step in. This provides another way of re-engaging with the patient to see how we can help them achieve their goal.
The initial 15-minute consultation with me is free of charge, however I will charge a fee for a no-show which is equivalent to my hygiene appointment charge.
What happens when patients want to proceed with the treatment?
For the actual treatment appointment, I allow myself about one hour and 45 minutes to two hours if the patient opts for a Zoom in-chair procedure. If they opt for take home treatment, I need to factor in time to fit the trays and demonstrate the use of the gels in the tray, I personally take 15 minutes for this.
During this time, I also make sure that patients are still happy to proceed with treatment, check that the consent forms are all signed, and take photos (again consent is needed for this).
Always book their review 15-minute appointment 2 weeks later. This will be an opportunity to assess how they are getting on with the whitening and if they are encountering any issues. Patients will hugely value the followup and the fact that you are tailoring the treatment to their needs. I want to ensure they get the results they wanted, and of course this will help with recommendations.
I typically suggest an appointment 6 months later for their top ups and their whitening maintenance. Philips has introduced a single Zoom whitening syringe which is great for top up treatments - it comes in a little pack with the leaflet to ensure patients are reminded how to apply the gels in the correct way. As a dental hygienist and dental therapist, I also feel this is also a good time to reinforce the message of good oral hygiene at home. I always suggest they should get a Sonicare electric toothbrush, and they can also consider a whitening toothpaste to manage extrinsic stains in between appointments if necessary.
Is there a rule for whitening under the age of 18?
The general rule is that whitening should only be provided to patients over the age of 18. There is a bit of leeway depending on each individual case. For instance, in the event of the presence of white/brown spots, molar
incisor hyper mineralisation or something similar which is causing some distress to the young patient, whitening might be looked at and considered appropriate. However, it is always important to check with your indemnity insurance provider.
Whatpercentage(s)shouldweuseforwhitening?
The GDC states that it is ‘illegal for teeth whitening products which contain more than 6% hydrogen peroxide or for any associated products which release greater than 6% hydrogen peroxide to be supplied or administered for cosmetic purposes’.
The Zoom teeth whitening procedure which I offer provides me with two options; a chair-side lamp that accelerates the bleaching process by activating the 6% hydrogen peroxide. As the hydrogen peroxide is broken down, oxygen enters the enamel and dentine to bleach the intrinsic staining - this is ideal for patients who are keen to get an instant result. This also means that patients already have the trays for top-ups further down the line. The home whitening Zoom options contain either 6% hydrogen peroxide for day time whitening, 10% or 16% carbamide peroxide is used for the night time whitening option.
The percentage selected depends on a lot of different factors. We need to find out if the patient is comfortable wearing trays at night time, they may suffer from sensitive teeth or might be worried about sensitivity during whitening, in which case the lower percentages such as the 10% carbamide peroxide will be preferred. Similarly, patients with white spots would also be provided with a lower percentage to ensure the issue is not exacerbated.
Clinical
How can we get best results?
We are aiming for a nice balance with the teeth being in harmony with the patient’s face.
Ideally matching the colour of the teeth to the whites of the eyes is, in my view, a good way to avoid overdoing the whitening and creating the best aesthetic result. I think whitening should not just be about achieving whiter teeth, it is essentially about looking better and healthier, with an enhanced smile and improving patients’ confidence. Scanning and taking photos really help patients see for themselves what we can achieve for them, it also opens up a dialogue about what they really want to achieve.
How do you deal with sensitivity?
I use 10% carbamide peroxide. The whitening takes longer but this will ensure you manage the patient’s sensitivity. Philips also offers ACP Relief gel - and this proprietary formula is highly effective for patients who suffer from teeth sensitivity. It combines the speed of chemical sensitivity relief from potassium nitrate with the profound, long-term relief of amorphous calcium phosphate and fluoride, which precipitates hydroxyapitite and fluorapatite, occluding the dentinal tubules.
Howdoyoudealwithpatientswithmouthguards or retainers?
If patients wear mouthguards or retainers at night, it is important that the whitening does not interfere with these. For them I recommend Philips DayWhite take home whitening to be the preferred option.
Is home whitening starting to replace chair whitening?
In my experience, the cost of Zoom chair whitening may be prohibitive for some patients, however there is definitely demand for an instant result for many. This gives some patients the flexibility to speed up the whitening process. It is also a great option if their lifestyles might mean they struggle to fully commit to using trays at home.
I have heard of Icon but don’t know what it is and when to use it?
It is a non-invasive treatment to manage white spots that works in conjunction with whitening, especially when whitening alone has not achieved the desired results. The principle is that air and water entrapments in the tooth have a lower refractive index than an intact tooth structure. This leads to unaesthetic discolourations. Icon helps to balance out this difference and the appearance blends in with the healthy tooth enamel. I have had patients with translucent areas particularly on the anterior teeth on the incisal edges. Sometimes whitening can make these areas a little bit more translucent, especially if they have white spots. We need to ensure the patient is informed of this prior to any treatment.
Why do you treat with Philips Zoom and Philips Sonicare products?
I have worked with Philips for around 7 years and genuinely think they are a brilliant company to work with. They are committed to improving 3 billion people’s health and well-being through meaningful innovation around the world by 2030 including the 66 million people living in the UK and Ireland. I trust the brand which has helped me achieve great consistent results for my patients, safely and efficiently.
For more information, please visit: www.eventbrite.co.uk/o/megan-fairhall-17244777321 n
info@dmg-dental.co.uk
Thomas Coates offers introductory guidance for dental hygienists and therapists thinking of purchasing a direct access practice
For dental hygienists and therapists, the journey to purchase direct access practices can feel worrisome, dotted as it is with legal, financial, and administrative intricacies.
With that in mind, to get the ball rolling with this exciting prospect, help is at hand here, offering a starting point to consider a variety of crucial factors, methods to overcome potential obstacles, and approaches for a seamless transition into owning a practice.
A primary legal consideration for hygienists and therapists is to confirm that accepting direct access patients is within their professional scope of practice. Ensuring the availability of suitable professional indemnity insurance is equally vital and is a legal necessity for practice owners. Seeking advice from a financial advisor or insurance broker to determine the most suitable insurance options is recommended.
For those aiming to own a practice through a limited company, the Dentists Act 1984 mandates a majority of GDC-registered dental care professionals (DCP) on the board of directors (Section 43). Individual ownership, on the other hand, requires DCP GDC registration under Section 37.
Securing Care Quality Commission (CQC) registration is also pivotal, which includes obtaining an enhanced DBS for adults and children within a 12-month timeframe. On this issue, it is also important to note that, as a healthcare professional registered with the GDC, the CQC guidelines state that you will not require a CQC-countersigned DBS and you can, ‘Provide a copy of your enhanced DBS check with barred information that you wish to use to support your application. This can be a check completed for the purposes of your employment and recruitment checks. Your DBS check must be no more than 12 months old.’
Engaging with a dental specialist accountant is crucial in the first instance, given the unique financial dynamics of dental practices. While a direct access practice typically mirrors the financial model of standard dental practices, particular attention should be paid to examining three years of past financial records, diverse income sources (such as patient numbers, capitation schemes, finance schemes, referral agreements etc.), and understanding the implications of financial loans, to make sure you properly understand the basis of the business.
It is advisable to explore bank funding options and be well-informed about any financial securities. Your finance broker will be able to advise you on the best bank funding that is available to you. The bank is likely to want to take security over the money they are lending, such personal guarantees and charges over the property.
We always encourage our clients to take legal advice on their financial obligations before committing to anything.
The due diligence process for acquiring a direct access practice is extensive. It delves into a range of areas including:
• Equipment status
• Ongoing work
• Goodwill evaluation
• Detailed financial analysis
• Company background
• Patient demographics
• Professional regulatory matters
• Tax and grant information
• Insurance details
• Existing claims
• Evaluation of the workforce.
The accuracy and thoroughness of this information are critical in making an informed purchase decision.
The nature of a purchase agreement varies, with decisions hinging on whether it involves acquiring share capital, equipment, or goodwill. These are commonly known as a share or asset purchases. Essential components of such agreements usually encompass clauses like defective treatment (more on this later), warranties specific to dental and hygiene practices, stock inclusions, apportionment of hygiene fees, and restrictive covenants, which necessitate careful review.
It is essential to approach these negotiations thoughtfully and without haste. The enquiries and insights offered by the solicitor are grounded in years of experience and a deep understanding of the key aspects of managing a business post-acquisition.
Additionally, ongoing legal responsibilities, particularly in the realm of employment law, are critical for practice owners. Staying updated with the latest employment law, which is fastchanging, and ensuring compliance can avert potential legal disputes.
Regular reviews of employment contracts and policies by an HR team can further help in maintaining legal compliance.
With the evolving economic landscape, there is a noticeable increase in contentious issues, ranging from treatment disputes to employee relations. Proactive legal consultation can help in identifying and resolving these issues early on.
Frequently encountered challenges involve handling post-acquisition complaints or subpar treatments.
It is common for new owners to overlook stipulated procedures in the Sales Purchase Agreement (SPA) inadvertently, such as notifying the previous owner before undertaking corrective actions for patients.
Familiarity with SPA terms and resisting the urge to expedite the negotiation process are key to preventing such issues. This means, once again, that engaging closely with your solicitor during the negotiation process is crucial for a complete understanding of how to implement the terms of the purchase agreement after completion.
New owners also often face dilemmas in handling operational challenges, such as equipment malfunctions or minor disputes. Offering one illustration, after completion you discover there is a broken piece of equipment. You learn that the cost of repairing this may be £3,000. Naturally, you will consider whether to sue the seller over this issue. Taking a step back, the first stage is always to try and agree an amicable settlement. However, where this is not possible, suing them is likely to cost thousands of pounds that you will not get back, especially if you instruct legal representation.
So, adopting a commercial mindset, which involves assessing the cost-effectiveness of pursuing legal action versus potential recovery, is essential. Prioritising the practice’s overall wellbeing often yields more favourable outcomes than chasing small-scale disputes.
Acquiring a direct access dental practice demands a deep understanding of the legal frameworks, meticulous financial planning, and strategic decision-making.
Dental hygienists and therapists poised to embark on this path must engage with specialised advisors, comprehend the nuances of legal and financial dealings, and adopt a pragmatic approach to manage their practice successfully. n
Buxton Coates Solicitors is a full-service, independent law firm providing bespoke legal services for dental professionals. If you would like help with any legal issues, including purchasing a practice, simply email info@buxtoncoates.com or call 0330 088 2275 in the first instance.
THOMAS COATES
Thomas Coates is
Managing Director and Corporate Solicitor at Buxton Coates.
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Whilst we are not in peak allergy season, every dental professional will know that threats can be encountered daily in the dental practice. Some solutions used in the practice can be troublesome for susceptible patients or clinicians, but thankfully unfortunate outcomes can be avoided with an appropriate armamentarium.
Allergies can impact oral health over time –potentially resulting in dry mouth or malocclusion from mouth breathing because of irritated airways1 – but the greatest risks to a person’s health may be posed by the products used in everyday treatments.
When an at-risk patient interacts with an allergen, they can experience a variety of different effects. At their mildest, an individual may have a running nose or extensive sneezing, maybe even itchy skin or a raised rash.2
In the most unfortunate situations, patients in the dental practice could experience anaphylaxis. This is an extreme allergic reaction that may transpire as swelling of the tongue and throat, and difficulty breathing or swallowing, amongst other symptoms, and it is life-threatening. 3
Harmful allergic responses in the dental practice are uncommon, but not implausible. Just this past summer, tabloid news outlets reported on allergic reactions to veneers that left a patient with ‘elephant skin’.4 Historically, multiple cases have seen young people with dairy and milk product allergies develop anaphylaxis after using toothpaste and mousses containing Recaldent.5
These are outliers from standard daily proceedings, but it’s important to know that such cases do exist. Clinicians should put in place provisions for those with known allergies, and be able to proceed appropriately if a patient suffers a reaction whilst under the dental team’s care.
On the front foot
Allergic reactions may take both patient and clinician by surprise. Neither party may be able to predict the effect that a singular ingredient will have, and if a patient has not displayed such symptoms before, a severe reaction could be a shock.
In mild cases, an antihistamine may be enough to treat a patient and alleviate any symptoms. When a reaction is more severe and poses an extreme threat to the patient’s health, then an alternative response could be needed.
The GDC states that dental professionals must follow the guidance on medical emergencies and training updates issued by the Resuscitation Council UK.6 In their standards for primary dental care, they specify that dental professionals must be educated in cardiopulmonary resuscitation (CPR) and provide other advanced life support skills if trained to do so.7 This may include specific reactions to anaphylaxis. An ambulance must be called immediately, and the patient placed in a comfortable position to aid in the restoration of blood pressure or the relief of breathing problems. The administration of adrenaline is the first-line treatment in such cases and is allowed to be provided unprescribed by an “appropriate practitioner” (including dentists) when used from an emergency drug supply. 8 Adrenaline is part of the equipment that practices must ensure they have in case of emergency.9
Reactionary measures of this ilk can save lives, and by quickly identifying major problems, patients can receive the highest standard of care needed in any given situation. However, as always, prevention is better than cure.
a turn for the worse
Within the dental practice, accurate record keeping will help to ensure that people at risk of certain medical emergencies are identified in advance of any proposed treatment.6 Consulting patients and their records can help dentists to select the appropriate treatment solutions and minimise the risk of a severe reaction occurring.
There are several potential dental-centric stimuli to trigger an allergic reaction. Antibiotics are the main cause of perioperative anaphylaxis in the UK with an incidence of 4.0 per 100,000 administrations, and amoxicillin, in particular, is most likely to be associated with such a response.
However, perhaps the most prominent allergen risk in the dental practice is, of course, latex. The natural rubber proteins found within latex have the potential to cause asthma, urticaria, and, although rare, anaphylaxis.10 Allergies to this specific substance are more common among health professionals than the general population, potentially around 9.7% and 4.3% respectively,5 which increases the need for appropriate measures to be in place for latex-free workflows.
This means providing suitable alternatives throughout the practice, to ensure completely latexfree workflows can be achieved. Practices must be able to demonstrate that they have carried out an
assessment to judge which types of gloves they should provide. They should also have an effective glove use policy that takes into account individuals – including both clinicians and the general public –who may have a latex allergy.
In any case, the practice should always be prepared for allergen needs. With Initial Medical, dental practices can stock up on a wide range of medical supplies including latex-free gloves. Our glove range is available in sizes extra-small to extralarge and can be bulk bought as 10 boxes of 100 for ultimate convenience, delivered to your door.
Although allergen risks are always likely to be present in the dental practice, with adequate training and preparation, potentially harmful stimuli can be negated from treatments.
To find out more, get in touch at 0808 304 7411 or visit www.initialmedical.co.uk.
References
1. Wee, J. H., Park, M. W., Min, C., Park, I. S., Park, B., & Choi, H. G. (2020). Poor oral health is associated with asthma, allergic rhinitis, and atopic dermatitis in Korean adolescents: A cross-sectional study. Medicine, 99(31).
2. NHS, (2022). Allergies. (Online) Available at: https:// www.nhs.uk/conditions/allergies/ [Accessed November 2023]
3. NHS, (2023) Anaphylaxis. (Online) Available at: https://www.nhs.uk/conditions/anaphylaxis/ [Accessed November 2023]
4. Van De Peer, H., Pochin, C., (2023) EXCLUSIVE: Allergic reaction to veneers leaves woman covered in agonising ‘elephant skin’. The Mirror. (Online) Available at: https://www.mirror.co.uk/ news/health/allergic-reaction-veneers-leaveswoman-30819768 [Accessed November 2023]
5. Jevon, P., & Shamsi, S. (2020). Management of anaphylaxis in the dental practice: an update. British Dental Journal, 229(11), 721-728.
6. General Dental Council, (N.D.). Medical Emergencies. (Online) Available at: https://www. gdc-uk.org/standards-guidance/standardsand-guidance/gdc-guidance-for-dentalprofessionals/medical-emergencies [Accessed November 2023]
7. Resuscitation Council UK, (2020). Quality Standards: Primary dental care. (Online) Available at: https://www.resus.org.uk/library/qualitystandards-cpr/primary-dental-care [Accessed November 2023]
8. Resuscitation Council UK, (2021). Emergency treatment of anaphylactic reactions: Guidelines for healthcare providers. (Online) Available at: https://www.resus.org.uk/library/additionalguidance/guidance-anaphylaxis/emergencytreatment [Accessed November 2023]
9. Care Quality Commission, (2023). Dental Mythbuster 4: Drugs and equipment for a medical emergency.
10. Helath and Safety Executive, (N.D.). Selecting Latex Gloves. (Online) Available at: https:// www.hse.gov.uk/skin/employ/latex-gloves.htm [Accessed November 2023]
REBECCA WATERS
Rebecca Waters, Category Manager, Initial Medical
As many patients across the UK continue struggling to gain access to dental services, i it’s important to ensure that appointments are not going to waste. With many patients being added to waiting lists that are two years long, ii it is frustrating for patients and dentists alike when a patient cancels last minute, or fails to attend their appointment. Because of this, it is crucial to keep a steady flow of patients in the dental chair, and the solution may be digital.
What are the current challenges?
Traditional patient management methods present a number of complex manual processes which could otherwise be more efficient. Day-to-day, this can put strain on the dental team as tasks are time consuming and prone to human-error. This results in low efficiency and productivity, high call volumes and long patient wait times.iii
Benefits of digital patient management
A digital waiting list creates a virtual queue of patients waiting for their turn and replaces traditional methods for managing dental appointments, check-ins and wait times. When adopted, practices no longer need to rely on sign-in sheets, or manually track patient flow. Plus, digital management solutions are often more efficient, helping to streamline processes throughout the entire practice, increasing convenience for patients too.iii
When a patient books their appointment, traditionally they would phone the practice during working hours to speak to a member of the practice team. However, with a digital solution, appointments can be booked online at any time that’s suitable for them. This helps to relieve the strain on the team, while making it easy for patients to get booked in.iii
To further reduce the responsibilities of the practice team and help to maintain a steady flow of patients, patient reminders are a key feature of digital appointment management. Digital systems are able to automatically schedule reminders to send to patients before their upcoming appointments. And, patients would ordinarily have to arrive early to an appointment to spend time filling out preappointment information. However, when this is managed digitally, patients can complete these forms from a virtual waiting room, for a more convenient and efficient solution.iii
Convenience is key for improving patient flow in your practice. Patient management tools simplify the appointment scheduling process. Rather than patients trying to find time in office hours to call the practice, online booking portals offer 24/7 access, with the ability to schedule their own appointments easily. This helps to save time for both you and your patients. Digital practice management also allows you to centralise patient data. This makes accessing data when it’s needed far easier, as everything is in one place. If the solution is cloud based, this means that clinicians will be able to securely access patient information and edit schedules at any time, and from anywhere. iii
Automation capabilities can offer more than benefits to individuals, enhancing efficiency across the practice as a business. By issuing automated appointment reminders, gaps in the appointment schedule are minimised and patient flow rates are increased for improved productivity. Integrating digital solutions also allows practices to access detailed business data
and advanced analytics. Management systems allow the team to track patient flow rates and financial information, allowing you to monitor the practice’s performance. Further to this, reports can be generated which recommend appropriate actions to improve day-to-day functioning. With so much information in one place, including patient feedback and reviews, it becomes easier to make meaningful improvements. iii
All of these features can have a significant impact on the patient experience. From the ability to book appointments at their convenience and communicate easily, to reduced waiting times and access to virtual waiting rooms, digital patient management aims to improve satisfaction in the practice throughout their entire journey.iii
Choosing the right digital solution
For maximum advantages, it’s important to choose the right platform for you. It should have a user-friendly interface, integrate with existing software, offer 24/7 access from the cloud, allow you to customise messaging, and ensure all data is secure. iii
The Sensei Cloud practice management platform from Sensei is the ideal solution for your practice. The all-in-one platform allows you to boost engagement, streamline administration and improve efficiency in the practice. Patient Bridge, a Sensei product, offers automated scheduling tools for optimised workflows and delivers alerts and reminders for enhanced communication with patients. The comprehensive solution aims to improve outreach and retention, helping to build and maintain positive relationships with your patients. Choose Sensei Cloud for online scheduling, virtual waiting rooms, smart messaging and reputation management.
While many patients across the UK are struggling to access dental care, optimising operations within the practice by implementing digital solutions can help to make it easier than ever for patients to book in. This, in turn, helps to reduce the number of patients who fail to attend, ensuring that minimal appointments go to waste.
For more information on Sensei Cloud visit gosensei.co.uk
For the latest news and updates, follow us on Facebook and Instagram @carestreamdental.uk
References
i. British Dental Association. Dentists: 4am queues for NHS care risk becoming the new normal. Accessed Sept 23. https://bda.org/news-centre/ press-releases/Pages/Dentists-4am-queues-forNHS-care-risk-becoming-the-new-normal.aspx ii. British Dental Association. Dentists: 4am queues for NHS care risk becoming the new normal. Accessed Sept 23. https://bda.org/news-centre/ press-releases/Pages/Dentists-4am-queues-forNHS-care-risk-becoming-the-new-normal.aspx iii. https://gosensei.com/blogs/news/why-yourdental-practice-needs-a-digital-waitlist
NINA GILBERT
Guests join us from all areas of the industry to provide their own unique perspectives on a wide range of topics, from manufacturers and figureheads of various dental organisations, to those in the trenches working in practice, and more.
For
Nothing is o limits in The Probe Dental Podcast, so be sure to tune in wherever you get your podcasts!
During each check-up there are many assessments which must be undertaken to establish a patient’s oral health status. This should always involve examining patients’ dental and periodontal health, looking for signs of caries and gingivitis, and recommending preventative advice or treatments. However, for a thorough oral health check, clinicians should always look out for signs of oral cancer, and take action if they find anything suspicious.
Thorough examination
When oral cancer is identified in its early stages, treatment outcomes are far more successful, and less invasive. Clinicians should check for mouth ulcers which have lasted longer than 3 weeks, red or white patches inside the mouth, and lumps in the mouth, lips, and throat. Clinicians should also ask patients if they have experienced any oral pain, or had difficulty swallowing or speaking.
Visual oral examinations are essential for picking up on and monitoring changes in the mouth. However, if clinicians do not easily recognise the early stage symptoms of mouth cancer, signs go unnoticed, with both dentists and patients unaware of the problem until it becomes more severe.
Tests to aid in early stage cancer assessments
There are a number of adjunctive tests that can help clinicians determine whether a lesion could be cancerous. Visual oral examinations are the gold standard, however, additional tests can be helpful. Adjunctive tests include toluidine blue staining, autofluorescence, chemiluminescence, cytology, and narrow band imaging.
Toluidine blue stain is used to differentiate lesions which may be at a high risk of progressing, helping to identify mouth cancer earlier, with a study showing its reliability. Autofluorescence is a rapid test used to
identify a change in concentration of fluorophores, to aid in the recognition of malignant tissues. Chemiluminescence testing is used to distinguish between pre-cancerous and malignant lesions, as abnormal cells reflect the wavelength used – although research shows this is less effective than toluidine blue staining. Cytology can be efficient at identifying early cancer, and is non-invasive. Cancerous cells can be more easily brushed away when compared to normal cells, which can then be analysed under a microscope. Narrow band imaging has been shown to be a promising adjunctive test, highlighting the surficial blood vessels as blue or brown in order to more easily identify abnormalities. Research suggests that, compared to the other adjuncts mentioned above, narrow band imaging is the most useful aid.
Diagnosis and pre-diagnosis
By identifying abnormalities early, and beginning treatment before the cancer reaches its later stages, clinicians avoid a ‘watch and wait’ approach, which can allow cancer to progress untreated until it is advanced enough for a biopsy. By adopting measures to aid initial assessments, when clinicians spot an abnormality, they may be able to pick up on mouth cancer more
According to a study published recently in BMJ Nutrition, Prevention & Health, researchers at the Medical Research Council Epidemiology Unit at Cambridge found that the sugar tax (the UK soft drinks levy introduced in 2018) may have reduced the number of under-18s having a tooth removed due to tooth decay by 12% (saving more than 5,500 hospital admissions for tooth extractions).
As you know, preventive dentistry focuses on reducing the risk of decay (together with the prospect of gum disease and tooth loss) through preventative measures, or spotting it early so advice can be offered on how to treat it.
Air abrasion is a modern technique that is gaining in popularity. It involves the use of a fine stream of particles, such as aluminium oxide or silica, that are propelled by compressed air onto the tooth surface to remove decay, remove temporary cements, repair composite restorations, or remove stains. Unlike traditional drilling, air abrasion is minimally invasive and offers several benefits.
One of the key benefits of air abrasion is its ability to preserve healthy tooth structure. Traditional drilling requires the removal of healthy tooth structure along with the affected area. This can weaken the tooth and may require more extensive restorative procedures, such as dental fillings or crowns. In contrast, air abrasion selectively removes only the decayed or discoloured portions of the teeth, leaving the healthy tooth structure intact. This not only helps to preserve the strength of the tooth but also minimises the need for additional
restorative work, resulting in a less invasive and more conservative treatment approach.
Air abrasion also eliminates the need for local anaesthesia in many cases. Traditional drilling often requires the use of local anaesthesia to numb the tooth and surrounding tissues, as it can cause discomfort and sensitivity. In contrast, air abrasion is relatively painless and does not generate the heat or vibration associated with drilling, making it possible to perform many preventive dental procedures without the need for anaesthesia. This is particularly advantageous for patients who have a fear of needles or dislike the feeling of numbness associated with local anaesthesia.
Additionally, the noise and vibrations produced by the drill can cause anxiety and unease in some patients. Air abrasion, as a silent and vibration-free procedure, is a more comfortable and relaxing experience. This can be especially beneficial for children and individuals with dental phobia, as it can help to reduce their anxiety and improve their overall dental experience.
Traditional drilling can be time-consuming, as it requires multiple steps, such as anaesthesia administration, drilling, and filling. However, air abrasion is a relatively quick procedure, as it combines the removal of decay or stains with the application of preventive materials, such as dental sealants or fluoride varnishes, in a single step. This not only saves time for both the dental professional and the patient but also reduces the overall chair time and improves efficiency in the practice.
To help patients perform more effective at-home preventative oral care, consider recommending the FLEXI range of interdental brushes from TANDEX
quickly. However, the previously mentioned adjunctive tools can be invasive and time consuming, potentially discouraging patients from accepting tests. As such, it may be useful for clinicians to use a non-invasive and rapid test to quickly highlight areas of concern during check-ups. A point-of-care system would allow clinicians to quickly establish a patient’s risk level, to inform further tests or referrals.
The BeVigilant OraFusion system from Vigilant Biosciences is able to accurately determine the risk of oral cancer based on biomarkers found in saliva combined with lifestyle factors. Producing a result in 15 minutes, the system is ideal for detecting mouth cancer early, enabling clinicians to conduct a simple test each time they notice an unusual lesion. A German study reveals that clinicians use the system to test patients who they deem to be at a heightened risk of mouth cancer due to use of alcohol and tobacco as a tool to encourage behaviour changes. The test also provides a baseline test result for patients. For more information, please visit www.vigilantbiosciences.com or email info@vigilantbiosciences.com n
PHIL SILVER
Founded in 2018, Total TMJ was created by Phil Silver, after a long career in medical devices, which gave him the knowledge to set up in his own
to help keep plaque at bay. Available in 11 different sizes, there is a correct solution for each patient, ensuring a comfortable and effective clean. Each product’s handle is flexible, and the brush can be bent into the perfect shape to clean in between the posterior teeth. Additionally, FLEXIMax features an ergonomic handle for an even easier clean. Plus, FLEXI brushes can be used to easily apply PREVENT GEL, which contains 0.12% chlorhexidine and 900ppm fluoride for antibacterial and enamel strengthening properties.
Air abrasion is a valuable tool in preventive dentistry due to its ability to preserve healthy tooth structure, provide precise treatment, eliminate the need for anaesthesia, offer a more comfortable experience for patients and reduce treatment times.
For more information on Tandex’s range of products, visit https://tandex.dk/ Our products are also available from CTS Dental Supplies at https://www.cts-dental.com/ n
KIMBERLEY LLOYD-REES ON BEHALF OF TANDEX
Kimberley graduated from the University of Sheffield in 2010, where she now works as a clinical tutor in Dental Hygiene and Therapy as well as working in practice. She has spent her career working across a variety of specialist private and mixed dental practices, for the MOD and volunteering her time to a dental charity in Nepal.
Tempit
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Gingival disease is thought to affect 50-90% of adults to some degree. Gingival inflammation has also been reported in as many as 46% of 8-year-olds, 60% of 12-year-olds and 52% of 15-year-olds – with bleeding on probing evident in approximately 40% of 15-year-olds. Irreversible periodontitis is estimated to impact more than half of the UK population at some point during their lives, though this is thought to be an underestimation.
The most common risk factors attributed to gingival disease include plaque build-up, tobacco (smoking or chewing) and alcohol consumption, with several systemic disorders increasingly playing a role too such as diabetes and cardiovascular diseases.
Several sources have described periodontal disease as an epidemic among the global population, as it has become the 12th most prevalent pathology around the world. Though incidence of periodontal disease is expected to continue rising in the near future, the greatest burden is estimated to disproportionately affect the older adult population. From an economic perspective, it was calculated that periodontal disease led to an aggregate cost for healthcare sectors of €2.52 billion (£2.1 billion) across Europe in 2018.
Awareness and understanding
Given the prevalence of gingivitis and the seemingly widespread information that can be accessed online, it may come as a surprise to learn that patient understanding of the disease is not very high. A 2023 survey of just over 200 patients found that, though 74% thought gingival health was very important, only half of those with gingivitis were worried about it and most people didn’t realise they had any periodontal issues. The same research recorded that just 50% of participants associated gum disease with poor oral health and less than 20% were aware of its association with systemic health conditions.
If patients are not fully aware of their condition, or if they don’t completely understand what their oral health status means for their wellbeing, it is very difficult to motivate changes in their behaviour. We are constantly educating patients about their oral health. But the information alone is not enough. How it is communicated makes an enormous difference.
Communication techniques
Communication skills and techniques are so important within the dental practice. Professionals are responsible for informing the patient about their health condition and the treatment options available to them, presenting the information in a way that the patient will really understand. Not only is this essential for highquality consent, but it will also impact the patient’s compliance with professional recommendations. It is difficult to determine how well a patient has really understood the information provided within an appointment. Some professionals might ask their patients to repeat back the key details to ensure that they have retained the information, but this can be tricky to do without them feeling patronised, despite the clinician’s best intentions. Other dental teams may provide a summary of the discussion that was had in the practice for a patient take home. Even in these circumstances, it is still possible that the patient doesn’t reread the information at home, or written instructions may not be the most useful or practical for them.
Getting animated
Research has demonstrated the effectiveness of visual communication aids when discussing oral health status and treatment options. In particular, animations and videos have been found to significantly improve patient understanding of health and medical information. This was recorded regardless of patient age or gender, demonstrating the benefit of animations
Recent government statistics lay bare England’s dental crisis in young children: three in 10 children aged five in England have enamel or tooth decay. The national prevalence of children with enamel and/or dentinal decay was 29.3%. Regionally, this ranged from 23.3% in the South West to 38.7% in the North West.
Children living in the most deprived areas of the country were almost three times as likely to have experience of dentinal decay (35.1%) as those living in the least deprived areas (13.5%). There were also disparities in the prevalence of experience of dentinal decay by ethnic group, which was significantly higher in the ‘other’ ethnic group (44.8%) and the Asian or Asian British ethnic group (37.7%).
It’s no surprise then that some councils, such as Nottingham, are planning to add fluoride to the water supply. Figures from the government survey show that 34.2% of five-year-olds in the city had obvious signs of dental decay with the average number of teeth affected by decay in Nottingham’s five-year-olds being 1.3, while the England average is 0.8.
All water contains small amounts of naturally occurring fluoride, but at too low a level to provide any oral health benefits. Water fluoridation schemes raise it to 1mg per litre of water.
Fluoride force
Fluoride works to control early dental caries in several ways. It strengthens the enamel of the teeth, making them more resistant to decay. The antibacterial action of fluoride is due to the acidification of the bacterial cytoplasm through the formation of the hydrogen ion and the fluoride ion from hydrogen fluoride and the disruption of the bacterial metabolism by inhibiting
for communicating treatment need and describing procedures to all patients in the dental practice.
As such, it is beneficial for clinicians to introduce software that provides access to videos that can aid the patient education and communication process. Chairsyde is a state-of-the-art consultation platform designed for dentists. It offers a comprehensive library of animations that not only enhances patient understanding of their current oral health condition, but also clearly explains treatment options – including all possible benefits, risks and limitations. The platform is easy to use, automatically featuring associated topics on each treatment page for quick and simple navigation according to the patient conversation. With a better understanding of gingival disease and the possible treatment procedures, patients are empowered to participate in the decision-making process for more engaged oral health.
Gingival disease remains a prevalent issue in the UK – and around the world. Half the battle for dental professionals is educating patients and ensuring that they really understand what the disease means for their wellbeing. Innovative communication tools can go a long way to elevating patient understanding in this and many other clinical areas.
For more information, or to book a demo, please visit www.chairsyde.com or call 020 3951 8360.
LOVEN GANESWARAN
Loven Ganeswaran – CEO and founder Chairsyde. Helping dentists around the world empower their patients to make better decisions about their health.
Is water fluoridation the panacea for tooth decay in young children?
vital bacterial enzymes such as proton releasing adenosine triphosphatase and enolase.
The use of fluoride lowers the pH. Bacteria will thus use more energy to maintain a neutral pH. Therefore, they will have less energy to grow, reproduce and generate acid and polysaccharides. The World Health Organization recommends water fluoridation as an “effective and safe public health intervention”. Fluoridated water is currently supplied to 10% of the population in England (including parts of Nottinghamshire).
However, there are also concerns about the potential health risks and ethical considerations. Some studies have linked excessive fluoride exposure to various health problems. High fluoride levels can lead to dental fluorosis, a condition characterised by discolouration and pitting of tooth enamel. Opponents contend that water fluoridation may not be the most effective way to prevent tooth decay. They say that the benefits of fluoride can be obtained through other means, such as brushing with fluoride toothpaste. Moreover, some studies suggest that the decline in tooth decay rates observed in fluoridated communities may be due to improved oral hygiene practices and dietary changes.
Indeed, what is undoubtedly key to the prevention of caries in children is the establishment of a good oral care regime from the get-go (hand in hand with limiting the consumption of sugary drinks and snacks). Brushing should start as soon as the first deciduous tooth breaks through, using just a smear of fluoride toothpaste (with a fluoride level of at least 1,000ppm). Children aged three to six years can use a pea-sized amount of toothpaste (that contains 1,350ppm to 1,500ppm) and always under the supervision of parents or carers.
From the age of seven, children should be able to brush their own teeth and new elements introduced into their oral care routine to keep dental plaque and resulting cavities at bay, such as interdental cleaning. Flossing, using conventional string floss, is a techniquesensitive process and can prove challenging for children still developing their fine motor skills. That’s where a Water Flosser may help (with supervision, of course).
The Waterpik® Water Flosser is easy to use and is needed for only a minute a day for improved oral health. Studies support its efficacy over traditional methods of interdental cleaning: for instance, one study found that cleaning interproximal regions with a Water Flosser “achieved more effective removal of interproximal biofilm” compared to a sonic toothbrush. While water fluoridation can go some way to improving the oral health of young children in a community, establishing good oral care practices within the home/care setting from milk teeth onwards, can serve to optimise its benefits. Good habits formed young can make all the difference.
Join the 3,000+ dental teams who have already benefitted from a professional Waterpik® Lunch & Learn. Book your free session for 1 hour of verifiable CPD and a free Waterpik® Water Flosser – available either face to face or as a webinar – at http://www.waterpik.co.uk/professional/lunch-learn/
ANDREA HAMMOND
Andrea Hammond is a Dental Hygienist and Waterpik Professional Educator.
Many patients won’t be aware that a bruxism habit can have serious health impacts. Unconsciously grinding or clenching the teeth during the day, or while they sleep, can be the cause of debilitating facial pain, as well as ear and headaches.
Long-term bruxism will lead to oral health problems such as tooth wear or fracture, increased sensitivity and even tooth loss. Dental professionals may be the first to spot the signs of a problem during an examination. If it is a case of nocturnal bruxism, a patient’s initial reaction may be one of relief, especially if they did not know why they were regularly waking up with pain in their head and/or jaw.
A stressed-out nation?
Nocturnal bruxism is often a symptom of stress and anxiety. The number of people experiencing poor mental health in the UK has steadily gone up year-onyear, increasing exponentially since the pandemic and the economic crisis.
The reasons for stress and anxiety are different for everyone and usually involve several things in combination. A poor night’s sleep, because of stressrelated nocturnal bruxism, will leave a person tired, irritable and often unable to perform daily tasks and routines. It isn’t just adults who are suffering, either. Bruxism has been reported in 20% of children up to the age of 11, and this figure is likely underestimated. The Bruxism Association states how “children with bruxism have a tendency towards anxiety, stress and hyperactivity. It is also strongly associated with Attention Deficit Hyperactivity Disorder (ADHD).”
As well as the dental impacts, chronic unresolved head and/or facial pain can mean time off school, social isolation and poor sleep. All of these things are stress-inducing and the cycle is vicious. A parent or carer may either not notice a child’s grinding or clenching habit, or connect their complaints of pain
with bruxism and take them to see a dentist. Children often have oral habits they grow out of, like thumbsucking or chewing and with the right education, parents and carers can understand bruxism is not something to leave unchecked.
For adults as well as children, sleep is one of the fundamental building blocks for physical and mental health. A child feeling overtired may resort to ‘bad’ behaviour at school and home; teenagers and adults struggling to get through the day often make poor lifestyle choices, like choosing comforting high-fat, highsugar food and drinks, including energy (sometimes called ‘sports’ drinks) and drinking too much caffeine. Adults may also reach for alcohol or recreational drugs to boost their low, sleep-deprived mood too which can further induce nocturnal bruxism.
We need more awareness of bruxism, the signs and symptoms and why it should not be considered just a habit. Also, people need to understand its deep association with stress and they should be encouraged to talk about and acknowledge stressful lifestyle factors. The methods that can be used to manage stress-related bruxism include talking therapies like cognitive behavioural therapy (CBT), relaxation and sleep-hygiene therapies. Ask an individual to seek a referral from their GP if you think it is necessary, and they are willing.
Other methods to manage bruxism can be classified as pharmacological, with Botulinum toxin now an established and safe treatment to reduce clenching and to relax the muscles and any tension. But not everyone will be suitable, or want to go ahead, and occlusal management will be recommended.
The dental team can play a supportive role in the management of stress-related nocturnal bruxism without the need for injections in the jaw. If there has already been damage to aesthetics and/or function,
The human mouth is home to trillions of microorganisms, consisting of bacteria, viruses, fungi, and even archaea. These microorganisms form a complex ecosystem known as the oral biome. While some of these microorganisms are beneficial and contribute to oral health, as you know, others can be harmful and lead to tooth decay, gum disease, and other oral infections.
The mouth has a variety of micro-environments that host different bacterial populations too; the tongue, the hard palate, the teeth, the area around the tooth surfaces, above the gums, and below the gums. Dentures also provide a protected habitat, especially beneath the fitting surface, which results in colonisation and growth by a range of bacteria and yeasts.
A balanced oral biome is vital for maintaining oral health and preventing disease. Imbalances in a patient’s oral flora can lead to gum inflammation and infection, leading to gum disease. Beneficial bacteria such as Streptococcus salivarius and Lactobacillus help to maintain oral health by producing antimicrobial substances, competing with harmful bacteria for resources, and regulating the immune response in the mouth.
Saliva plays a major role in determining whether the resident oral microflora has a beneficial or a destructive relationship with the host. The buffering action of saliva ensures that the pH of the mouth is maintained around neutrality, which favours the growth of the majority of bacteria associated with good oral health.
Dental biofilm is the first sign of forecasted dental problems. Biofilms present in the oral cavity are essential for the sustenance of good oral health but an increase in the volume and complexities of these biofilms can result in diseases like gingivitis and periodontitis.
conservative restorative therapies to repair the dentition can be discussed, which may be a motivating factor for anyone wanting to take control of their stress-related bruxism. Not only will they manage their grinding and clenching better, and enjoy more restful sleep, they will also improve their smile, for renewed confidence, selfesteem and enjoyment of life.
Before they get to the restorative stage, effective management can be offered with a splint, such as the SOVA® night guard distributed by Oraldent. Ideal for people over the age of 11, it is remouldable and preformed, and can be delivered as part of your everyday workflow with no need for lab impressions for a faster, cost-effective solution. Fabricated with biocompatible material and innovative Diffusix™ Technology to ensure even distribution and absorption of forces, the device is super-thin, so sleep, communication, oral hydration and breathing will be undisturbed by wearing it.
Stress-related bruxism, which often occurs at night, can have significant and long-lasting dental and other health-related impacts. More patients will want a simple solution that can be offered at their regular practice. Dental teams should build awareness about bruxism so a problem can be intercepted, and offer treatments that are highvalue, comfortable and yield great results.
For more details, please visit Oraldent.co.uk/bruxism or call 01480 862080
JULIA SVEC
The importance of supporting healthy flora in the mouth
Microorganisms present in the oral cavity form a layer on the oral surfaces. Once a single layer is formed, these microorganisms start piling up and form multiple layers which result in the formation of a multicellular matrix. Microscopic evaluation of these biofilms indicates that Streptococcus accounts for around 80 per cent of this colonisation.
Bacteria present in oral biofilms can be good or bad depending upon their role in the oral cavity. In the condition of tooth decay, there is enamel loss which is promoted by a microbial shift in the biofilms from good to bad.
As you are aware, plaque is a sticky biofilm that forms on the teeth and contains a diverse population of microorganisms. When left unaddressed, plaque can harden and turn into calculus, which is more challenging to remove. By removing plaque, harmful bacteria are eliminated, reducing the risk of tooth decay and gum disease. Interproximal cleaning, particularly with interdental brushes, effectively removes plaque from the areas that are difficult to reach with regular brushing.
The dynamic relationship between the oral microflora and the host means that there is a life-long need to maintain effective oral hygiene practices to avoid future episodes of caries and periodontal disease.
Indeed, to maintain a healthy oral biome flora, it’s important to follow good oral hygiene practices such as brushing teeth twice a day, daily interdental cleaning, and regularly visiting a dentist. Avoiding excessive use of antibacterial mouthwashes and maintaining a balanced diet that includes probiotic-rich foods can also help support a healthy oral flora.
For patients with dental restorations, such as crowns, bridges, or implants, interproximal cleaning becomes
even more crucial. Plaque and bacteria build-up around the margins of dental work and prosthodontics can lead to the development of cavities and infections, compromising the longevity and functionality of the restorations. By practising effective interproximal cleaning, patients with dental work can maintain their oral flora and oral health as well as preserve their investment.
To help patients remove plaque effectively, consider recommending the FLEXI range of interdental brushes from TANDEX. Available in 11 different sizes, there is a correct solution for each patient, for a comfortable and effective clean. Each product’s handle is flexible, and the brush can be bent into the perfect shape to clean in between the back teeth. Additionally, FLEXIMax features an ergonomic handle for an even easier clean. Plus, FLEXI brushes can be used to easily apply PREVENT GEL, which contains 0.12% chlorhexidine and 900ppm fluoride for antibacterial and enamel strengthening properties. For more information on Tandex’s range of products, visit https://tandex.dk/ or visit the Facebook page: https://www.facebook.com/TandexUK
Our products are also available from CTS Dental Supplies https://www.cts-dental.com/ and DHB Oral Healthcare https://dhb.co.uk/
KIMBERLEY LLOYD-REES ON BEHALF OF TANDEX
Kimberley Lloyd-Rees on behalf of Tandex
Aperson’s teenage years are a time of tumultuous change. It’s a period of immense physical, mental and social adjustments, where individuals come to terms with a greater sense of self and individuality.
In dentistry, the early teenage years are also an optimal time to carry out orthodontic work, since the mouth is still growing. Such treatments at this age are so common that they’re almost seen as a rite of passage.
Dental work with teens can be difficult for a number of reasons. But, when treatment can be so fruitful in this period, it’s important to understand how clinicians can best work with teens to secure a brilliant outcome.
Following guidance
Teenage oral health often simmers down to questions of compliance. General oral hygiene routines are sometimes forgone as schoolwork, friendships and hobbies take on greater importance in everyday life. If this upkeep isn’t maintained, patients may experience enamel demineralisation and gingivitis, which actually affects 50% to 70% of patients with fixed orthodontic appliances.
Imploring adolescents to maintain a fantastic oral hygiene routine – generally consisting of tooth brushing multiple times a day, paired with the use of interdental brushes – is only made more challenging given the difficulties fixed orthodontic appliances create. Food can be trapped easily and become difficult to dislodge. Teenagers will need to take their time removing debris from their appliance to maximise their health, as well as the eventual aesthetic outcomes.
When it comes to removable appliances, compliance becomes increasingly important to achieve a successful treatment outcome. The time spent wearing an aligner is, theoretically, somewhat similar to a fixed appliance. The latter stays on 24/7, but removable appliances must be worn for 20-22 hours a day (major brands recommend they are removed only when eating, drinking and toothbrushing) for predictable treatment. Teenage patients need to not only maintain compliance with their oral hygiene, but also reliably wearing the appliance. This becomes a concern when some reports suggest patients often wear the aligner for up to five hours less than indicated by their clinician.
Patient-dentist relationship
Communicating effectively with these patients is fundamental for reinforcing ideal habits. But first, a dental professional must take on the question held by so many teachers and parents; how do I get through to this individual?
The way clinicians and patients interact directly influences the level of cooperation seen throughout treatment. Building a healthy relationship on trust and honesty is key, and could be achieved with an individualised approach. Active listening and showing empathy are useful if patients experience anxiety in appointments, and could help build this relationship. Nerves are often to be expected. More than half of the UK population suffer from fear or anxiety when visiting the dentist, and this may only be enhanced with the introduction of a new, long-term orthodontic device. Interestingly, some younger patients may be somewhat eager to get braces, viewing them as a part of growing up. After all, from the perspective of
this patient, the only people they know with such treatment are those older and bigger than them; taking a similar a path could feel like a comingof-age transition. An enthusiasm to undertake this care may be promising for compliance, and should therefore be encouraged where appropriate.
Breaking barriers
Patients will only choose to be treated when the “positive” motivation is stronger than the “negative”. In adolescent orthodontic treatment, the expected advantages include a greater aesthetic and functional outcome, resulting ultimately in improved confidence. Linking oral health and orthodontic advice to important aspects of adolescent life, such as self-esteem, “fitting in” and happiness in social circles, through dating or popularity, may be a way to positively frame the oral health needs.
Treatment downsides may not only include shortterm changes to appearance, but the pain caused by an appliance too. With fixed braces, this usually occurs during the first few days following a bond-up procedure as tooth movement is triggered, but could also be from scratchy arch wires – whether leftover or uncut – which may cause traumatic ulcers.
Helping teenage patients cope with the pain of fixed appliances can not only help deliver consistent results, but may encourage overall compliance as they avoid becoming disenfranchised with the treatment. Clinicians could suggest a solution like the Orthodontic Relief Wax from Kemdent, a soft gum protector that can simply be applied to cover brackets and protruding wires that are often irritating throughout treatment. Patients can quickly remedy any pain by warming the wax in their hands, and applying it for a smooth intraoral solution. Plus, the relief wax is conveniently stored in a recyclable, eco-friendly tin that can be carried with them throughout the day.
Encouraging and attaining compliance in the teenage orthodontic patient is not often simple. Building an effective relationship with enthusiastic and reluctant patients alike, and focusing on the advantages of undergoing treatment and keeping up a good oral hygiene routine could be key to working towards an optimal final result.
For more information about the leading solutions available from Kemdent, please visit www.kemdent. co.uk or call 01793 770 256
References available upon request
ALISTAIR MAYOH
Regular toothbrushing is the cornerstone of every good oral hygiene routine. It is fundamental for removing plaque and maintaining healthy teeth and gingiva. As clinicians, it’s important to assess each patient’s oral hygiene, and ensure they have a good understanding of how best to remove plaque and maintain a healthy mouth. This means ensuring that patients are using the most effective tools for them, be it a manual or electric toothbrush, interdental tools, or even the correct technique. Sometimes, patients use too much pressure when brushing, thinking that this will help to remove any plaque, debris, and staining, but they may be doing more harm than good. A combination of patient education and recommending the right equipment is needed to improve patients’ oral hygiene routines.
How can toothbrushing lead to gingival recession
If patients brush their teeth too hard, especially when using a brush with firmer bristles, they may be causing trauma to their gingiva. In some cases, patients may even “brush the teeth away” wearing away their enamel and facing increased sensitivity to temperature and cavities. Using hard bristled brushes and more abrasive toothpaste is likely to cause this, as well as the force used during brushing.
When patients brush too hard, over a long period of time, they can cause irritation and trauma to the gingiva, eventually leading to gingival recession. This in itself can be problematic, leaving the ‘neck’ of the tooth exposed, causing increased sensitivity to heat and cold, and potentially becoming more susceptible to cavities. Significant gingival irritation and inflammation may also trigger gum disease. If this is allowed to progress, it may lead to periodontal disease which can have serious implications for oral health, including tooth loss.
Manual toothbrushing – doing it properly
For the best results and optimal plaque removal, it’s important that patients understand how to
brush properly using a manual toothbrush. It may be helpful to provide these instructions during appointments, perhaps offering a demonstration and asking patients to copy the movements to ensure they have a good understanding. This will also help them to establish the correct pressure to apply during brushing, as well as allow you to get an insight into which patients may be brushing too hard, and offer appropriate advice.
Offering manual toothbrushing instructions can be simple. Advise patients to form a 45-degree angle between the brush and the gums, and gently move the brush up and down, front to back, and in circles. Patients must brush every part of the teeth including the buccal, lingual, and chewing surfaces for optimal plaque removal. Advise patients to be careful not to brush their teeth too aggressively, particularly if they normally use a hard bristle brush, as this can irritate the soft tissues, eventually leading to inflammation, gingival recession, and tooth sensitivity in the exposed area.
Additionally, advise patients on the use of dental floss, or interdental brushes to ensure that they are removing plaque from all areas of the mouth – especially as interdental spaces are areas where plaque can easily accumulate and build up.
Could soft brushes help those with sensitivity?
In addition to adopting the correct manual toothbrushing techniques, patients with gingival recession, or those who wish to prevent it, may benefit from using a soft or ultra-soft toothbrush. Research suggests that toothbrushes which have soft or ultra-soft bristles tend to be safer and less abrasive than hard bristles, therefore avoiding damage to the teeth and soft tissues. It is also indicated that there are more severe gingival abrasions and recession in patients who have used a hard toothbrush, compared with those who have not. This suggests that, while twice daily toothbrushing is essential for removing plaque, avoiding a hard toothbrush is beneficial to the health of the soft tissues.
Unlike many conventional products that have around a thousand bristles, the Curaprox wood ultra-soft has 4,440 densely packed filaments. Curaprox toothbrushes are gentle but decisive against plaque. This is mainly thanks to the Curen ® filaments, which form a dense and efficient cleaning surface. With a diameter of just 0.1 millimetres, the filaments (bristles) of the new wooden toothbrush are exceptionally fine, smooth, and efficient. This is also a fantastic option for eco-conscious practices and patients – the Curaprox wood ultra-soft uses Swiss beech wood from sustainable forest management to create a reliable, durable, and sustainable solution.
References available upon request
We’re lucky to live at a time where we have a broader range of patients entering the dental chair every day.
More people are openly expressing themselves as members of the LGBTQ+ community, which can help clinicians identify potentially unique treatment needs.
With greater awareness of the risks presented to these patients, dentists can devise more effective treatment plans for each individual.
Blanket assumptions cannot be made for every LGBTQ+ patient, and they will have completely different oral health statuses dependent on their daily lives.
Being LGBTQ+ does not predispose you to oral health issues, but coping with stresses in daily life – such as homophobia, transphobia, social stigmas, or social isolation and rejection – may contribute to stress and oral health-related concerns. For example, lesbian, gay and bisexual adults smoke tobacco and drink alcohol at higher rates than their heterosexual peers, have a higher risk of poor mental health, and have an increased risk of oral disease due to harmful eating behaviours. Each of these have been established as factors for oral health issues.
Another significant threat displayed in a variety of reports in recent years is that LGBTQ+ people are consistently more likely to use drugs than their heterosexual counterparts. The Crime Survey for England and Wales from 2022 observed around 31% of bisexual people and 30% of gay and lesbian individuals had taken an illicit drug in the previous year. This drops to 8% of heterosexual people, which is nearly four times lower.
Cannabis was highlighted as being used by around 23% and 28% of gay/lesbian and bisexual individuals respectively. With frequent use, patients can expect to experience dry mouth (xerostomia) and periodontal disease. In fact, studies have shown an increased prevalence of gingival disease when a patient smokes cannabis, regardless of tobacco use. In turn, patients need to maintain an effective oral hygiene routine that can minimise its effects or repair the damage caused.
Talking with a patient about their substance use is often difficult; approaching the topic tactfully is essential and must not be interpreted as accusatory or judgemental. It may only be viable to ask relevant questions after trust has been established between clinician and patient, but the answers could support a better suited solution for each patient.
Holistic approaches
Also within the LGBTQ+ community, transgender patients may present some unique oral health needs as a result of ongoing transitional treatments. Transgender patients may undergo hormone replacement therapy (HRT) to feel better aligned with their preferred gender identity. Waiting times for referral and treatment are currently very long, but it is key that dental professionals provide exceptional oral healthcare whilst it is being undertaken.
Hormones change immunological responses which can potentially put patients at an increased risk of infection. A female-to-male transgender patient may be taking on HRT that increases the production of testosterone, whilst inhibiting oestrogen. An increased immune function has been linked with oestrogen deficiency, meaning patients undergoing this therapy may experience more intense gingival inflammation during periodontitis flare ups.
On the other hand, male-to-female transgender patients may be having HRT that increases oestrogen, and subdues testosterone production. An excess of
oestrogen could also result in inflammation, making the development of periodontitis more likely. Not all transgender patients will be undergoing HRT, and they may not feel entirely comfortable disclosing whether they are or not. However, awareness around the topic is helpful when approaching treatment plans, as well as providing excellent care in regular check-ups.
An effective relationship
If these factors are just the tip of the iceberg, what can clinicians do to help? The most important step may be in communication.
Engaging with each patient through an individual approach, expressing a non-judgemental manner and placing pro-LGBTQ+ leaflets or signs around a practice could help patients feel more comfortable and motivate regular dental visits. An effective patient-dentist relationship may also encourage LGBTQ+ patients to open up about personal details such as substance use or HRT experiences.
In each appointment, it is essential to reiterate the need for excellent oral hygiene routines, as improved plaque control can reduce gingival inflammation. As such, patients should brush consistently twice a day with a soft bristled brush and fluoridated toothpaste. Interproximal cleaning is also key, as regular toothbrushing is generally unable to clean these sites effectively.
A brilliant oral hygiene routine relies upon consistency and the tools used every day. Clinicians could recommend their patients use the Waterpik® Cordless Advanced Water Flosser. A compact solution that eliminates plaque in interdental spaces, the Waterpik® Cordless Advanced is up to 50% more effective than traditional floss for improving gingival health. By massaging and stimulating the gums, they are kept strong and healthy with improved circulation.
Diving into the unique challenges that face LGBTQ+ patients is essential for every clinician. By understanding the adaptions needed to everyday care, and creating a welcoming and encouraging environment, dental professionals can ensure this community is optimally treated for the coming years. Join the 3,000+ dental teams who have already benefitted from a professional Waterpik® Lunch & Learn. Book your free session for 1 hour of verifiable CPD and a free Waterpik® Water Flosser – available either face to face or as a webinar – at www.waterpik.co.uk/professional/lunch-learn/. References available upon request
SUSAN HUTSON
Susan joined Waterpik as a Professional Educator over 4 years ago. She is passionate about the work she carries out for the company delivering Lunch & Learn educational sessions to dental professionals.
This CPD article from Cat Edney DT PgDip (Dist) looks at the history, indication and use of air polishing devices. Cat explains the different types of air polishing powders currently available, what powder to use, and how to make the most of your air polishing device.
Learning aims and objectives
• Educate readers about the types of air polishing powders available to the dental profession
• Educate readers on the indications for air polishing and the techniques associated with different clinical indications
• Heighten awareness of the contraindications and considerations that should be made when choosing air polishing as a treatment method
Learning Outcomes: C
The concept of air polishing was developed in 1945 by Dr Robert Black who invented the Air Dent, a device that used compressed air, water and highly abrasive powder to eliminate pain from cavity preparation, making anaesthesia unnecessary . While the Air Dent never succeeded, the technology Dr Black created became the basis of air polishing, a technique first marketed in 1976. By the late 1970s, air polishing was readily available as a stain removal treatment.
What is an air polish?
Air polish is essentially a jet of air, water and powder that combine together outside of the handpiece to remove stains and biofilm above and below the gumline. It is an extremely simple, quick and comfortable technique, and this makes it very well accepted by both patients and clinicians.
Why use air polish?
Air polishing was originally intended as a stain removal modality for use on supragingival surfaces and sound enamel only, meaning its use was limited to only certain patients. But as methods were refined and new technologies and powders became available, air polishing was able to be used subgingivally as well.
Today, biofilm poses a big threat to oral health. Dental biofilms are communities of diseasecausing bacteria that build up on oral surfaces including teeth, gums, restorations and prostheses and left alone can cause gingivitis, decay, and periodontal disease .
When faced with reducing biofilm, clinicians need to treat the full oral cavity. 70% of biofilm comprise live organisms, in comparison to calculus which has far less viable species , so although calculus has been shown to house biofilm, it is less virulent in comparison.
Air polishing is also key to the removal of cosmetic staining. If staining is rough, it can also house biofilm, making it harder for patients to clean themselves. There are many different causes of staining, and examples include:
• Chlorhexidine: brown staining of teeth caused by long term use of medicated mouth washes prescribed to treat various oral conditions.
• Smoking: extremely tenacious staining that tends to cover multiple surfaces and is one of the most difficult stains to remove.
• Chromagenic: a bacteria-induced discolouration caused due to hydrogen sulphide produced by certain kind of bacteria in the oral cavity interacting with salivary iron content which results in chromogenous, insoluble ferrous deposition and blackening of teeth (Bandon et al., 2011).
• Dietary staining
• Poor oral hygiene
• Supplements
There are many air polishing devices to choose from and a range of manufacturers have handheld air polishing devices. There are also standalone combined units available that use a combination of Piezon technology and air polishing.
Regardless of the device you use, it is important to understand the capabilities of the machine and which powders to use. Every manufacturer’s machine works with specific powders, which differ in particle shape and size. The level of abrasiveness of the powder also plays a part, as does the patient’s medical history.
Air polishing powders
Powders require a certain level of hardness in order to work. But the harder they are, the more damage they are likely to cause to enamel and dentine, as well as restorative materials and prostheses, so it’s important to be aware of the hardness of the powder being used.
Hardness is measured using the Mohs scale of mineral hardness, a qualitative ordinal scale, from 1 to 10, characterising scratch resistance of various minerals through the ability of harder material to
common air polishing powder. It has an average particle size of 74 microns, which is quite large, but is low on the Mohs hardness scale at 2.4.
Sodium bicarbonate is contraindicated in patients with sodium restricted diets. It has been shown to cause damage to cementum, dentine and multiple restorative materials, therefore is only indicated for supragingival use on sound enamel .
Aluminium trihydroxide was developed as an alternative to sodium bicarbonate. It has an uneven particle shape and its particle size varies from 80-325 microns. It has a Mohs hardness of 4. It has been shown to cause damage to cementum, dentine, composite restorative materials and luting cements and is only indicated for supragingival use on sound enamel .
Calcium sodium phosphosilicate is a relatively new powder which is actually bioactive glass. It has a Mohs hardness of 6 and a particle size of 25-125 microns. Bioactive glass has been shown to reduce sensitivity by adhering to dentinal tubules. However, it is contraindicated on restorative materials including composite and glass ionomer cements (GICs) .
Calcium carbonate has a more uniform spherical particle shape that is 54 microns in size with a Mohs hardness of 3. It is contraindicated on root surfaces and restorative materials and is only indicated for supragingival use .
Erythritol is a sugar-alcohol with the addition of chlorhexidine. It has a small particle size of
14 microns and a Mohs hardness scale of 2 and is therefore indicated for both supra and subgingival use .
Glycine powder is actually an amino acid. It is highly water-soluble with a small particle size of 23 microns and Mohs hardness scale of 2 - similar to dentine. It is indicated for both supra and subgingival use . There are also larger particle glycine powders available of around 65 microns which would be indicated only for supragingival use.
It is essential to always check the manufacturer’s instructions and use the correct size particle powders for the equipment. Air polishing devices have very thin lumens through which the powder passes and which regulates the powder flow. A powder that has particles that are too large means the device is likely to clog up very quickly. The optimal distance between the tooth and the tip also varies depending on the equipment.
There are a number of different structures to consider in the oral environment which all have different hardness and resistance to wear. Powders need to be effective for the situation but be as minimally invasive as possible. Organic particles (i.e. erythritol, glycine) often have a small particle size and are water-soluble while inorganic powders (i.e. calcium carbonate) have a large particle size and are not water soluble.
Supragingival powders are used above the gingival margin at a 45 degree angle away from gingival margins in a circular motion. For inorganic powders used to remove extensive stain and plaque the nozzle should be moved slowly at a distance of 5-10mm so the spray can cover the entire tooth surface. A distance of 3-5mm from the tooth surface will pinpoint a stubborn area of staining.
1. Glycine powder is:
a. Organic
b. Inorganic
c. Genetically modified
2. Air polishing devices use:
a. Air and powder
b. Powder and water
c. Air, water and powder
Clinical indications for air polishing
• Periodontal maintenance
• Orthodontic brackets and attachments
• Implants and prostheses
• Denture/prosthesis cleaning with organic powders glycine/erythritol
• Fissure sealants - used as a cleaning method before fissure sealing provides a significant increase in depth penetration of sealant resin - 70%
Considerations and contraindications
• Sodium restricted diets, when using sodium bicarbonate powder
• Pregnancy and breastfeeding
• Respiratory conditions i.e. asthma, COPD
• Communicable infections i.e. cold sores
Avoid subgingival treatment after non-surgical periodontal therapy, where there is bleeding from the pocket, in areas with suppuration and on perio/endo involved teeth.
A patient-centred approach
It’s important to always take a patient-centred approach to air polishing. Look at the patient’s medical and clinical suitability at all stages, and make sure the treatment is right for them.
From the clinician’s perspective air polishing is extremely safe. It reduces the repetitive motions performed in clinic, especially when working as a hygienist and improves patient and personal satisfaction. Remember to always follow the manufacturer’s protocol. Check the packaging and the education on the company’s website or contact your local product specialist.
To find out more about air polishing download NSK’s Powder Therapy Guide available at https:// mynsk.co.uk/powdertherapyguide/
References
i. Barnes, Caren M., An In-Depth Look at Air Polishing (2010) Faculty Publications, College of Dentistry
ii. Gupta, S et al 2016 iii. https://www.rdhmag.com/patient-care/ patient-education/article/14278024/its-allabout-that-biofilm
iv. Gupta, S et al 2016
v. Bandon et al. Exogenous tooth discoloration in children: black stains Arch. Pediatr. (2011) vi. www.gemselect.com/gem-info/gem-hardness-info vii. Bühler J, Schmidli F, Weiger R, Walter C.
3. Inorganic powders are indicated for:
a. Subgingival use
b. Sound enamel
c. Soft tissues
4. Dental biofilms are communities of:
a. Disease-causing viruses
b. Disease-causing bacteria
c. Benign bacteria
Analysis of the effects of air polishing powders containing sodium bicarbonate on human teeth. Clin Oral Investig. 2015
viii. Johnson, W. & Barnes, Caren & Covey, David & Walker, Mary & Ross, Judith (2002) The effects of a commercial aluminium air polishing powder on dental restorative materials. Journal of Prosthodontics 13.166-72
ix. Banerjee A, Hajatdoost-Sani M, Farrell S, Thompson !. A clinical evaluation and comparison of bioactive glass and sodium bicarbonate air polishing powders. J Dent. 2010 Jun;38(6):475-9
x. Babina K, Polyakova M, Sokhova I, Doroshina V, Arakelyan M, Zaytsev A, Novozhilova N. The effects of ultrasonic scaling and airpowder polishing on the roughness of the enamel, three different nanocomposites, and composite/enamel and composite/cementum interfaces. Nanomaterials (Basel). 2021 Nov 15;11(11):3072
xi. Reinhart D, Sing-Hüsgen P, Zimmer S, Bizhang M. In-vitro influence on the use of erythritol powder through air polishing on the surface roughness and abrasiveness of various restorative materials. PLoS One. 2022 Jul7;17(7):e0270938
xii. Bühler J, Amato M, Weiger R, Walter C. A systematic review on the effects of air polishing devices on oral tissues. Int J Dent Hyg. 2016 Feb;14(1):15-28 n
ABOUT THE AUTHOR
CAT EDNEY DH DT PGDIP (DIST)
Multi-award winning Dental Therapist Cat Edney has over fifteen years’ experience working in specialist and private practice where she has developed a passion for multidisciplinary team working in a dental setting. Cat lectures nationally as a clinical educator for NSK, is part of the Smile Dental Academy faculty and has developed handson dental courses under her training brand ‘The Modern Therapist’. She aims to educate the dental profession about the role and integration of dental therapy, alongside focusing on providing gold standard hands-on training and ongoing support to dental teams.
• To understand the importance of good oral hygiene following oral surgery
• To consider the benefits of a chlorhexidine mouth rinse for reducing bacteria during healing
• To appreciate the importance of offering personalised advice to reduce the risk of infection and improve recovery
GDC Development Outcome: C
Amongst the many dental treatments provided in the UK, surgical procedures are likely to have a big impact on patients’ lives. Data reveals that annually, in England, there are more than 180,000 people admitted to hospital for dental procedures, in addition to more than two million outpatient appointments.i Surgical treatments can range from tooth extractions and periodontal surgery to dental implant placement,ii and each procedure carries its own risks which can affect their chances of success. In fact, a total of 42,180 hospital dental extractions in patients under 19 were carried out in the UK from 2021-2022, highlighting the high number of patients affected.
iii As such, it’s important that clinicians offer patients personalised advice about how to look after their oral health postsurgery, for optimal results and a more comfortable recovery.
While the chances of developing an infection following dental surgery are relatively low,iv it’s important to provide patients with the preventive advice they need to keep the surgical site clean and free from bacteria during healing. As such, post-operative oral hygiene is absolutely essential for removing plaque.v Some patients may find it challenging to clean the surgical site, but doing so is crucial as bacteria in the area may include pathogens related to infection.v Reducing this risk is vital as infections following dental surgery
can cause additional complications for patients. These might include worsening pain, extended recovery times, and the need for additional procedures.vi
Following dental implant or periodontal surgery, clinicians should also consider the ways in which the risk of periodontitis and peri-implantitis can be reduced too. Oral biofilms are a major contributing factor to these diseases, so reducing biofilm during healing can have a positive impact on the health of the soft tissues following surgery. While options for mechanical plaque reduction are fewer post-surgery, antimicrobial options can be recommended to remove biofilm and improve outcomes.vii
Following oral surgery, regular toothbrushing is unlikely to be suitable in most cases. However, it’s important that plaque is still removed regularly to maintain hygiene. As such, it may be appropriate to recommend that patients use a mouth rinse. These are easily able to deliver antiplaque agents, which act to directly remove bacteria through electrostatic and hydrophobic interactions. viii Antiplaque agents can be divided into first and second generations. The first generation includes antibiotics, phenols, and quaternary ammonium compounds.
They are estimated to reduce plaque levels to 20-50% when used 4-6 times per day, and have a low mouth retention. Second generation antiplaque agents, on the other hand, decrease plaque by approximately 70-90% when used 1-2 times per day. Plus, they demonstrate improved oral tissue retention and have slow-release properties.viii
An example of a second generation agent is chlorhexidine. viii In the short term following periodontal surgery, a chlorhexidine mouth rinse may be recommended to reduce plaque levels and the risk of infection. Clinicians might recommend that this type of oral rinse is used for up to a month for the best results. viii A chlorhexidine mouth rinse may also help to reduce gingival inflammation following oral surgery, and is particularly useful when oral hygiene is compromised. vii
Clinicians should consider the formula of the mouth rinse they recommend, to ensure that it maximises the effects for their patients. For example, data
reveals that mouth rinses which contain chlorhexidine, CITROX®, polylysine, and xylitol are particularly effective anti-biofilm ingredients.ix CITROX® is a natural combination of organic acids and bioflavonoids, derived from bitter oranges, that acts as a powerful antimicrobial, antiviral, and antifungal agent.x One such example of a mouth rinse which contains these active ingredients is the Perio plus Regenerate mouth rinse from Curaprox. Perio plus Regenerate provides patients with intensive care following oral surgery. Alongside CITROX®, polylysine, and xylitol, its formula combines 0.09% chlorhexidine and hyaluronic acid to promote effective regeneration of oral tissues for improved post-surgical results.
Offering comprehensive advice for what patients should do before and after surgery is key for a successful outcome, and will help patients understand what they can expect. Often, patients will be
most concerned about what will happen during the procedure, but good oral hygiene habits both before and after can improve outcomes. Whilst there are a number of instructions which clinicians should always provide, it’s important that advice is tailored to each patient, depending on their unique situation and level of ability, to ensure the best possible outcome.
Pre-operative instructions might include:
• Checking medications to avoid unexpected complications (for example, if patients take blood thinners, this may need to be altered in preparation)
• Ensuring that they understand the importance of completing courses of antibiotics exactly as directed, adjusting diet (depending on the procedure)
• Following oral care instructions to maintain the dentition prior to treatment
Post-operative instructions might include:
• Using over the counter pain relief medication to reduce discomfort
• Taking prescribed antibiotics
• Eating soft foods and avoiding chewing on the surgical site
• Carrying out an effective oral hygiene routine using an antibacterial mouth rinse and any other recommended oral hygiene products to reduce the risk of infectionxi
It's important that patients understand the essential role that they play in their recovery and treatment success. Many patients are likely to feel some anxiety surrounding oral surgery, so building a strong relationship, encouraging them to discuss their worries and answering any questions they may have can be very useful.
By making clear recommendations as to how patients can best maintain their oral hygiene following surgery, clinicians are able to support optimal outcomes and reduce the risk of infections and disease. Plaque removal around a surgical site may seem daunting to some patients, but by advising the use of a mouth rinse with antibiofilm ingredients, patients are better able to keep on top of their oral hygiene and enjoy a smooth recovery, with limited risk of complications.
For more information, please visit www. curaprox.co.uk
References
i. NHS England. Hospital Dentistry. Accessed Dec 23. https:// gettingitrightfirsttime.co.uk/medical_ specialties/hospital-dentistry/ ii. CDC. Oral Surgical Procedures. Accessed Dec 23. https://www.cdc. gov/oralhealth/infectioncontrol/faqs/ oral-surgical-procedures.html
iii. Gov.uk. Hospital tooth extractions in 0 to 19 year olds 2022. Accessed Dec 23. https://www. gov.uk/government/statistics/ hospital-tooth-extractions-in-0to-19-year-olds-2022/hospitaltooth-extractions-in-0-to-19-yearolds-2022
iv. NHS Guy’s and St Thomas’. Dental surgery and recovery. Accessed Dec 23. https://www.guysandstthomas. nhs.uk/health-information/dentalsurgery-and-recovery
v. Shigeishi, Hideo, Kouji Ohta, and Masaaki Takechi. “Risk factors for postoperative complications following oral surgery.” Journal of Applied Oral Science 23 (2015): 419-423.
vi. The Dentist. Over 282,000 people are waiting for oral surgery. Accessed Dec 23. https://www. the-dentist.co.uk/content/news/over282-000-people-are-waiting-for-oralsurgery/
vii. Solderer, Alex, et al. “Efficacy of chlorhexidine rinses after periodontal or implant surgery: a systematic review.” Clinical oral investigations 23 (2019): 21-32.
viii. Vyas T, Bhatt G, Gaur A, Sharma C, Sharma A, Nagi R. Chemical plaque control - A brief review. J Family Med Prim Care. 2021 Apr;10(4):1562-1568. doi: 10.4103/ jfmpc.jfmpc_2216_20. Epub 2021 Apr 29. PMID: 34123892; PMCID: PMC8144784.
To answer the questions below, visit www.the-probe.co.uk and log in.
ix. Jeyakumar, Jenaniy, Anton Sculean, and Sigrun Eick. “Antibiofilm Activity of Oral Health-care Products Containing Chlorhexidine Digluconate and Citrox.” Oral health & preventive dentistry 18.1 (2020): 981-990.
x. Curaden. What is Citrox®, and how does it work against infection in your patients’ mouths? Accessed Dec 23. https://gently.curaden.com/whatis-citrox-is-and-how-does-it-workagainst-infection/
xi. Muskingum Valley Oral Surgery. The Importance of Following Pre & Post- Operative Care Instructions. Accessed Dec 23. https://www. mvalleyoralsurgery.com/blog/postoperative-care/ n
Click on the ‘CPD - Brush Up’ tab. The questions for this Brush Up will appear under ‘Brush Up – Smile January/February 2024’.
1. How many people are admitted to hospital for dental procedures in the UK annually?
a. 170,000
b. 180,000
c. 190,000
d. 200,000
2. How many hospital dental extractions in patients under 19 were carried out in the UK from 2021-2022?
a. 22,960
b. 37,430
c. 42,180
d. 51,600
3. What complications might occur following oral surgery as a result of infection?
a. Worsening pain
b. Extended recovery times
c. Additional procedures required
d. All of the above
4. Second generation anti-plaque agents reduce plaque by 70-90% when used:
a. 1-2 times a day
b. 3-4 times a day
c. 5-6 times a day
d. 7+ times a day
5. Which anti-biofilm ingredient does data show is particularly effective?
a. Chlorhexidine
b. Polylysine
c. Xylitol
d. All of the above
6. Post-operative instructions might include:
a. Using over the counter pain relief medication
b. Eating soft foods
c. Effective oral hygiene using an antibacterial mouth rinse
d. All of the above
Learning objectives
• To understand the association between pregnancy and periodontal disease
• To consider why women are more susceptible to periodontal disease when pregnant
• To appreciate the advice pregnant women require in regards to periodontal disease management and treatment
GDC Development Outcome: C
Maternal periodontal disease, also known as pregnancy gingivitis or gingival inflammation, is a prevalent oral health concern that affects expectant mothers during their pregnancy.
According to data, the incidence of pregnancy gingivitis worldwide ranges from 30%-100%. ii
The condition is characterised by inflammation, swelling, redness and bleeding of the gingiva, and if left untreated, it can lead to more severe periodontal disease. Other signs or symptoms include pain when chewing, bad breath, receding gums and tooth mobility. iii The hormonal changes that occur during pregnancy make women more susceptible to periodontal
problems, making it crucial for pregnant women to prioritise their oral health to ensure a healthy pregnancy. iii
Hormonal fluctuations and their impact
During pregnancy, a woman’s body undergoes various hormonal changes, including an increase in oestrogen and progesterone levels. iv These hormonal fluctuations can impact the oral health of the expectant mother. An increase in hormonal levels can cause the gingiva to become more sensitive and reactive to plaque. v This increased sensitivity can lead to inflammation and swelling, making the gums more prone to bleeding. One of the primary risk factors for maternal periodontal disease is poor oral hygiene. Pregnant women who neglect their oral health, or who do not practice regular and thorough dental care, are even more likely to develop gum problems. Insufficient brushing and interdental cleaning allow plaque to build up, leading to the onset of gingival inflammation. vi Additionally, changes in dietary habits during pregnancy, such as cravings for sugary foods, can contribute to the formation of dental plaque and exacerbate gum issues. vii
The implications for fetal health Research suggests that maternal periodontal disease may have a significant impact on both maternal and fetal health. Studies have linked gum problems during pregnancy to adverse pregnancy outcomes, including preterm birth, low birth weight, and pre-eclampsia. viii Periodontal pathogens and inflammatory mediators associated with gingival disease may enter the bloodstream and trigger systemic inflammation, potentially affecting the placenta and the developing fetus. Moreover, untreated maternal periodontal disease can also increase the risk of gestational diabetes, respiratory complications in newborns, and other pregnancy complications. ix
To prevent and manage maternal periodontal disease, routine dental care and maintenance of good oral hygiene practices are essential, with the British Society of Periodontology recommending any treatments are best carried out in the second trimester. x Expectant mothers in the UK are entitled to free NHS dental treatment and for 12 months after the baby is born. xi Clinicians can advise preventive measures, such as professional dental cleanings and scaling, to remove plaque and tartar buildup that cannot be eliminated solely through regular brushing and interdental cleaning. Some dental procedures, such as elective cosmetic treatments or x-rays, may be postponed until after delivery to minimise unnecessary risks. xii
Maintaining a balanced diet is also crucial for oral health during pregnancy. A nutrientrich diet with a focus on fruits, vegetables, dairy products, lean proteins, and whole
grains can help support overall oral health. It is advisable to limit the consumption of sugary snacks and beverages, as they increase the risk of dental decay and gingival inflammation.
In terms of daily dental care, pregnant women should brush their teeth at least twice a day using a soft-bristled toothbrush and fluoride toothpaste. Using an antimicrobial mouthwash can also help minimise bacterial growth and reduce inflammation. Interdental cleaning daily is crucial to remove plaque and food particles from between the teeth and along the gumline, as these areas are often difficult to clean using a toothbrush alone. xiv Indeed, given that one in three (33%) adults have never cleaned interdentally, xv emphasising the importance of this to pregnant patients has never been more vital. The award-winning range xvi of interdental brushes from Curaprox boasts super-fine, extra-long, ultra-resilient filaments for gentle and effective cleaning with a single-brush action. They are suitable for use with natural teeth, dental implants, crowns, bridges and for post-surgery cleaning. The brushes come in environmentally friendly refill packs that work with all of Curaprox’s interdental brush holders. Patients can choose from a variety of holders, depending on personal preference: plastic/aluminium, straight/bent and short or long handle.
Maternal periodontal disease is a common oral health condition affecting pregnant women. Hormonal changes during pregnancy increase the risk of gum inflammation and bleeding, making it crucial for expectant mothers to prioritise their oral hygiene. For more information, please visit www. curaprox.co.uk
References
i. Srinivas SK, Parry S. Periodontal disease and pregnancy outcomes: time to move on? J Womens Health (Larchmt). 2012 Feb;21(2):121-5. doi: 10.1089/ jwh.2011.3023. Epub 2011 Oct 12. PMID: 21992584; PMCID: PMC3270055. [Accessed November 2023]
ii. Mealey BL, Moritz AJ. Hormonal influences: effects of diabetes mellitus and endogenous female sex steroid hormones on the periodontium. Periodontol 2000. (2003) 32:59–81. doi: 10.1046/j.09066713.2002.03206.x [Accessed November 2023]
iii. British Society of Periodontology https://www.bsperio.org.uk/assets/ downloads/Recommendations_for_ women.pdf
iv. Kumar P, Magon N. Hormones in pregnancy. Niger Med J. 2012 Oct;53(4):179-83. doi: 10.4103/03001652.107549. PMID: 23661874; PMCID: PMC3640235. [Accessed November 2023]
v. Mustafa Naseem, Zohaib Khurshid, Hammad Ali Khan, Fayez Niazi, Sana Zohaib, Muhammad Sohail Zafar, Oral health challenges in pregnant women: Recommendations for dental care professionals, The Saudi Journal for Dental Research, Volume 7, Issue 2, 2016, Pages 138-146, ISSN 23520035, https://doi.org/10.1016/j. sjdr.2015.11.002. [Accessed November 2023]
vi. Kim, YJ., Gil, Y.M., Bae, KH. et al. The use of interdental cleaning devices and periodontal disease contingent on the number of remaining teeth in Korean adults. Sci Rep 12, 13853 (2022). https://doi. org/10.1038/s41598-022-17885-7 [Accessed November 2023]
vii. Orloff NC, Hormes JM. Pickles and ice cream! Food cravings in pregnancy: hypotheses, preliminary evidence, and directions for future research. Front Psychol. 2014 Sep 23;5:1076. doi: 10.3389/ fpsyg.2014.01076. PMID: 25295023; PMCID: PMC4172095. [Accessed November 2023]
viii. Nannan M, Xiaoping L, Ying J. Periodontal disease in pregnancy and adverse pregnancy outcomes: Progress in related mechanisms and management strategies. Front Med (Lausanne). 2022 Oct 25;9:963956. doi: 10.3389/fmed.2022.963956. PMID: 36388896; PMCID:
To answer the questions below, visit www.the-probe.co.uk and log in. Click on the ‘CPD - Brush Up’ tab. The questions for this Brush Up will appear under ‘Brush Up – Smile January/February 2024’.
CPD questions – Periodontal disease in pregnancy
1. Which of the following factors can contribute to the development of periodontitis in pregnant women?
a) Hormonal changes
b) Poor oral hygiene
c) Sugar cravings
d) All of the above
2. Which of the following are signs of maternal periodontitis?
a) Chronic tiredness
b) Bad breath
c) Insomnia
d) Headache
3. Which of the following is a potential risk associated with untreated maternal periodontitis?
a) Weight gain
b) High birth weight infants
c) Gestational diabetes
d) Hair loss
PMC9640773. [Accessed November 2023]
ix. Abariga SA, Whitcomb BW. Periodontitis and gestational diabetes mellitus: a systematic review and meta-analysis of observational studies. BMC Pregnancy Childbirth. 2016 Nov 8;16(1):344. doi: 10.1186/ s12884-016-1145-z. PMID: 27825315; PMCID: PMC5101727. [Accessed November 2023]
x. British Society of Periodontology https://www.bsperio.org.uk/assets/ downloads/EFP_OralB_Flyer_FAQS. pdf
xi. NHS England https://www.nhs.uk/ pregnancy/finding-out/health-thingsyou-should-know-in-pregnancy
xii. BMJ https://www.bmj.com/content/ bmj/377/bmj-2022-070486.full.pdf
xiii. Gaffar BO, El Tantawi MM, AlAgl AS, Al-Ansari A. Food intake, oral hygiene and gingival bleeding in pregnancy: does lifestyle make a difference? A cross sectional exploratory study. Int J Health Sci (Qassim). 2016 Jan;10(1):13-20. doi: 10.12816/0031212. PMID: 27004053; PMCID: PMC4791153. [Accessed November 2023]
xiv. Oral Health Foundation https://www. dentalhealth.org/news/oral-healthand-pregnancy-six-things-everymum-needs-to-know
xv. Oral Health Foundation, https://www. dentalhealth.org/oral-health-statistics
xvi. Red Dot Winner 2021 and iF Design Award 2021 n
4. True or False: Diet during pregnancy has no effect on maternal periodontitis.
a) True
b) False
5. When is the best time for a pregnant woman to receive periodontal treatment?
a) First trimester
b) Second trimester
c) Third trimester
d) Never
6. How can women reduce the risk of developing maternal periodontitis?
a) Cut out caffeine
b) Maintain physical exercise
c) Practice interdental cleaning
d) Drink plenty of water
If the time has come to replace your autoclave, Eschmann offers an array of industry-leading solutions that are designed for unparalleled reliability, longevity and workflow efficiency.
Further still, Eschmann will deliver and install your new equipment seamlessly, and even provide an option for later taking away the old model so you don’t need to worry about disposing of it correctly!
Equipment options available to dental practices from Eschmann include the Little Sister range of autoclaves. The latest range features ‘B’ type vacuum and ‘N’ type non-vacuum models in a variety of capacities to suit the needs of every business. The Enbio handpiece steriliser is also the fastest ‘B’ type autoclave on the market,
offering cycles from as little as 15 minutes.
Plus, all Eschmann autoclaves can be supported by the Care & Cover servicing package, which includes Annual Validation and Pressure Vessel Certification, annual service and software upgrades, unlimited breakdown cover, unlimited Eschmann parts and labour, Enhanced CPD user training and on-site support from 50+ Eschmann engineers nationwide.
For a new autoclave you can rely on and the easy removal of your old unit at the same time, contact Eschmann today.
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Conventional 1450ppm and above fluoride toothpastes only deliver fluoride for a maximum of 90 minutes, whatever their fluoride content and provided the patient does not rinse. Despite its lower 530ppm fluoride content, Biomin F remains active for up to 12 hours, continuously releasing fluoride to strengthen teeth and protect against decay, even if the patient’s toothbrushing is erratic and inefficient.
Available from Trycare, BioMin F contains tiny bioglass particles made up of fluoro calcium phosphosilicate bioactive glass which bonds to teeth and enters the dentinal tubules, where they gradually dissolve for up to 12 hours, slowly releasing calcium, fluoride and phosphate ions. These combine with saliva to form fluorapatite which strengthens teeth, aids remineralisation of enamel and provides effective
treatment for hypersensitivity.
Patients also report that teeth feel smoother and cleaner, there is a noticeable absence of background oral sensitivity and that gums are healthier and less prone to bleeding.
A genuine Practice Builder, BioMin F enables patients to enhance their smile and improve their oral health. It is the only toothpaste approved by the Oral Health Foundation for sensitivity relief and remineralisation.
For further information visit the website, contact your local representative or call 01274 885544.
www.trycare.co.uk/biomin
FluoroDose - the top fluoride dose just got better!
Exclusively available from Trycare, Centrix’s FluoroDose is the award winning 5% sodium fluoride varnish that’s easy to apply in less than a minute.
To make your life easier, Centrix’s redesigned FluoroDose packaging has new patented features to enhance its handling, comfort and patient safety. In addition to a single dose of varnish, each LolliTray contains a Benda Brush applicator and has been designed so that it can be “popped up” with one hand, making removal simple and safe.
FluoroDose has a smooth consistency, fast application and choice of five flavours – caramel, bubble gum, mint, cherry and melon. Because the varnish is freshly mixed prior to application it always has the optimum fluoride distribution, unlike syringes which
frequently separate out leaving inconsistent mixes of ineffectively low and dangerously high fluoride concentrations. Each LolliTray contains enough varnish to protect a full adult dentition. Non-gritty and easy to apply in an undetectably thin film, it is colourless so that it does not affect the appearance after bleaching etc.
Quick-drying and long-lasting, FluoroDose is suitable for adults with caries risk factors as well as children. It can be applied as often as needed and is FDA-approved for treating dentinal sensitivity. For further information, visit the website or call 01274 885544.
It has been estimated that 41% of working-age adults in the England don’t fully understand or make use of everyday health information. Health literacy is directly linked to health outcomes and service use, so it’s crucial that public education be enhanced.
Chairsyde is a state-of-the-art consultation platform that is designed to help dentists do just this among their patients. It offers a library of animations that clearly and easily communicate a broad range of dental conditions and diseases – including dental caries – as well as the treatments associated
with them. The videos cover the risks of disease progression, in addition to the benefits, limitations and potential risks of all recommended therapies, encouraging patient understanding for long-term health benefits and improving the quality of their consent.
For more information, or to book a demo, please visit the website or call 020 3951 8360.
www.chairsyde.com
Interdental tools are able to effectively reduce plaque between the teeth, making them a great choice for patients’ daily oral hygiene routines. The FLEXI range of interdental brushes from TANDEX is ideal for your patients. Available in 11 different sizes, you can help patients find the perfect interdental brushes for them. FLEXI brushes are ideal for reducing plaque between the teeth, and should be used daily for the best results. Each size is easily identifiable by the ISO and PHD (passage hole diameter) numbers on their box, as well as their unique colours.
For patients who need an extra boost, recommend PREVENT GEL from TANDEX. It contains 0.12% chlorhexidine and 900 ppm fluoride to strengthen the enamel and provide an antibacterial effect.
For more information about oral hygiene solutions from TANDEX, please get in touch with the team.
For more information on Tandex’s range of products, visit https://tandex.dk/ or visit the Facebook page: https://www.facebook.com/TandexUK
Our products are also available from CTS Dental Supplies https://www.cts-dental.com/ and DHB Oral Healthcare https://dhb.co.uk/
www.tandex.dk
Registration is now live for BDCDS and DTS 2024!
CloserStill Media is delighted to announce that registration for the 2024 British Dental Conference & Dentistry Show (BDCDS) co-located with Dental Technology Showcase (DTS) is officially open. These premier events are set to take place on the 17th/18th of May at the NEC in Birmingham. Poised to be an extraordinary gathering for dental professionals, showcasing the latest innovations, research, and developments in dentistry, BDCDS and DTS promise to offer an unparalleled platform for learning, networking, and professional growth. Alex Harden, Portfolio Director at CloserStill Media, commented: ‘We are excited to bring together the dental community for two days of learning, innovation, and collaboration. This year, we’re pushing boundaries – not only will attendees witness the evolution of the dental practice, but they’ll be part of a movement setting new standards in patient care. This event will be a cornerstone for dental professionals seeking to advance their knowledge and practice.’ Registration is free for dental and lab professionals and can be completed online through the websites. For more information and to register, visit birmingham.dentistryshow. co.uk for BDCDS or the-dts.co.uk for DTS and save the dates in your diary!
birmingham.dentistryshow.co.uk
It may seem an obvious question but why would your dental practice want to win awards? What are the tangible benefits of being able to tell new and existing patients that you and your practice are ‘award-winning’?
Well, I think that there are 5 key benefits:
1. An award win, or even shortlisting, acts as a third-party endorsement for your practice. A win can give a seal of approval to your activities and is a sign of quality for potential patients. It’s a great way of differentiating your practice from competitors and will send out positive signals to patients. Existing patients love the fact that their dentist is recognised as it vindicates their choice of being with you. New patients will want to go to a practice that wins awards.
2. Massive awareness in terms of PR and marketing. Local media love to see a business in their area do well at national awards. Even being shortlisted can improve awareness of your brand and promote your practice to new patients. Awards celebrate hard work and success and are great PR opportunities. It’s fantastic to be recognised, so it’s important to make sure that people know what your business has achieved.
3. The opportunity to benchmark your practice. By entering an award, you are often forced to look at your business from a different perspective and compare yourself to your competitors. It is the chance to look at your practice as an outsider would and really see where you are at. This valuable exercise can allow you to appraise what you are doing, encourage you to think about ways you could be doing things better and consider the changes you may need in order to get to where you would like to be. This could benefit you in more ways than achieving the award itself.
4. Awards recognise the hard work and achievements of your team, so winning one can help boost staff morale and improve motivation. It will give team members focus on what’s great about the practice they work for and pride in being a part of it. Maximise and recognise the team effort by holding a staff celebration of your victories.
5. Who wouldn’t want to join an award-winning practice? It can be a difficult time to recruit at present and an award alongside a wellmotivated team is likely to be a much more attractive proposition to potential new team members. Convinced? I hope so! If so, what do you need to do now?
Choose your awards
Which ceremony? There are a number of dental awards and they all have their own particular spin and feel. You need to decide which will suit your practice best.
You may also consider non-dental awards –these will speak to a different audience so my
There’s still time to enter The Dental Awards 2024. You have until 23th February to get your entries in at: the-probe.co.uk/awards
advice would be to enter both. Non-dental awards are often supported by a local paper or local group, such as a Chamber of Commerce, and that means that good local media coverage is likely. It also means you will be considered as not ‘just a dentist’ but as a valuable local business embedded in your community.
Which category/categories should I enter?
What is really needed here is some self-awareness. Do you really believe that your team are the best? Is your practice up there with all the great ones in the local area? If so, these are the categories that you should enter, but don’t be afraid to look at your practice and say, “No, we won’t be in the running for that this year, but if we make changes, we can enter it next time.” In this way, awards are fantastic for business development too.
I include the plural for the reason that putting all your eggs in one basket could be a little risky, if you choose to enter only one award. It makes sense from a time management perspective to enter multiple categories as there will be commonalities across the categories – both in terms of evidence and content too.
What does a good award entry look like? This will obviously depend upon the category
that you enter and your practice’s particular achievements, but there are common themes to all award-winning entries.
Answer the question – make sure that you provide all the material that the award category asks for Pictures – they may not be worth a thousand words but they do convey more about a practice or team member than simply text can. They also help break up overly wordy entries.
Video – A good selection of video content can help your entry stand out from the crowd – patient testimonials, patient journey, promotions from social media and so on
Evidence – this is where so many well-written entries come unstuck. You can never have too much of this. For example, if you were entering a dental award ceremony for Best Patient Care, and said, “We really look after our patients,” you need to prove it. How do you? Illustrate your patient journey, show how the team go the extra mile
Strong leadership – not simply telling people what to do but truly leading them by example
Community – a dental practice is not just a business in isolation. It is part of a wider community. What part do you play in that community? CSR (Corporate Social Responsibility) is a must
You may consider the services of an award writing agency. The crafting of award entries takes time and skill and, as more and more practices enter, this could greatly improve your chances of success.
We’ve been shortlisted – what should I do now?
Congratulations! Tell people! Make sure that you let patients know when they visit the practice. Feature it in your practice newsletter if you have one and let all your followers on Facebook, Instagram and TikTok know. Online, do not be afraid to tell people several times – it is by its very nature somewhat transitory, so tell people more than once. Email your patient database and tell them how delighted and honoured you are. Contact the local press – newspaper, magazines, radio and television – make it easy for them and have a press release drafted with the important Who, What, Where, When, How and Why questions answered.
We won! What should I do now?
Repeat above! I kid you not, the beauty of awards is that by their definition they have a shortlist and a winners’ list. This means that if you win, you get two bites of the cherry. Not only can you tell everyone that you were shortlisted, now you can tell them all again that you won.
Make sure you maximise PR exposure and update your marketing materials with the award logo, including business cards, website, literature, email and treatment information.
At their basest level, people like winners, that is why any kind of award stamping you as ‘The Best’ is of value to your practice. n
