The Probe June 2024

Orthodontic Solutions Post

Embarking on a New Chapter

Introducing Solventum

On 1st April 2024, 3M Health Care officially became Solventum! We’re bringing the strong legacy of our innovation and trusted expertise into the future and enabling better, smarter, safer healthcare to improve lives. "Solventum" combines the essence of 'solving' with the drive of 'momentum' - symbolising our dedication to breakthrough solutions and our agility in bringing them to life. We’re excited for the new chapter that lies ahead.

Shop Ortho

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Your UK Team Just Got Bigger!

Alan Holland

Mohab Fouda

Inside Sales Representative aholland4@solventum.com

Clinical Specialist for Clarity Aligners mfouda@solventum.com

Have you heard about We Love Ortho? If not, you’re missing out. This is our brand-new online platform where you can monitor your spend, track your tier discount and get access to exclusive promotions and educational information – and it’s completely FREE! Head over to weloveortho.3m.com to register your account today and we’ll give you an additional 10% discount on your next order just for registering!

We have recently welcomed three new members to our UK support team; Lynsey Blackburn Territory Business Manager, North England & Scotland lblackburn3@solventum.com

We’re excited to be expanding our team to enable us to improve the services and support that we can deliver to our customers.

Data finds 6.3 million avoided the dentist due to cost-of-living fears

Data from employee benefits provider Unum UK has found that 21% of employees — equivalent to 6.3 million people of working age — avoided dental appointments in 2023 due to fears over the expense. This demonstrates that the cost-of-living crisis remains a key concern amongst the British public, even for important healthcare such as dentistry. The figure also reinforces the significant financial barriers for many seeking essential dental care, with many forced to forego routine check-ups and treatments in order to make ends meet.

This is only set to increase with the latest 4% rise in NHS dental charges in England effective from 1 April 2024. Moreover, four in five dentists are now taking only private patients,[1] with the risk of creating ‘dental deserts’ where no NHS provision is available locally.[2] Such is the dentistry crisis in the UK that many have looked to other solutions to cover the costs, be that from insurers, employers or healthcare providers.

Unum Dental saw another strong surge in claims paid in 2023 — up by 29% in monetary terms to £31 million and also by 29% in the number of claims paid from 2022. This further demonstrates how demand is rising for workplace solutions to bridge the gap and mitigate the shortage of NHS dentists.

The mounting crisis in NHS dentistry is also fast becoming a key election battle ground issue, with Labour promising an

extra 700,000 urgent dental appointments and reform of the NHS dental contract. Meanwhile, the Conservatives plan to offer incentives to dentists to deliver NHS care to ramp up provision nationally.

Clare Lusted, Head of Product Proposition at Unum UK, commented: “Access to dentistry is a basic expectation, yet millions in the UK are facing barriers, be it financial or geographic, in obtaining oral healthcare.

As the connection between oral health and overall wellbeing becomes increasingly evident, there is a growing imperative to prioritise preventative health services as a proactive strategy for addressing dental issues and promoting holistic wellbeing.

“Unum Dental recently partnered with digital dentist Toothfairy to provide insured

employees with access to high-quality everyday preventative dentistry services, and with initiatives like this leading the way in corporate dental insurance, there is hope for a brighter future where individuals can access the oral care and support they need to thrive in the workplace. However, we urge the government to ensure equitable access for all. It’s time for decisive action to prioritise oral health as an integral component of societal wellbeing.”

References:

1. Four out of five dentists in England not taking on new NHS patients, research shows, The Guardian

2. New data can lift lid on England’s real dental deserts, British Dental Association

Tom Whiting joins the GDC as CEO and Registrar

Tom Whiting has joined the General Dental Council (GDC) as its Chief Executive Officer and Registrar. In his first month, Tom will meet Chief Dental Officers from the four nations and stakeholders from across the dental sector at the Dental Leadership Network on 12 June. He will also start a series of visits to meet dental teams in different settings across the UK, to find out more about where and how they work and provide more opportunities for dental professionals to engage with the GDC.

Tom Whiting, the new GDC Chief Executive and Registrar, said: “I understand the pressures that the

dental sector is under and the hard work that the whole dental team does to ensure that patients have the care they need. Trust between professionals and the regulator is important for patients and public confidence. I will listen to the views and challenges of dental professionals and stakeholders as well as get to know where and how they work.

“Building my own understanding will help me to identify shared goals and how we can work together to make a positive difference to dental professionals and patients. This will take time, but I’m committed to making a start right away.”

Dr Richard Coates

INTERVIEW

Davinder Raju, Founder of Greener Dentistry Global, page 14

PROFESSIONS

Create your own growth throughout your career, page 42

“All-on-Four” concept, page 60

Tom joins from the Independent Office for Police Conduct (IOPC) where he was Acting Director General for 17 months, having been Deputy Director General since 2019. Work on the GDC’s priorities continues while Tom is settling into his new role. These include the annual renewal of registration for around 70,000 dental care professionals, launching the updated scope of practice, and developing a new framework for registration of overseas dentists an

A welcome from the editor

There certainly seems to be a buzz about at the moment. Both within dentistry and the UK as a whole. The Euros and Olympic Games are almost upon us, while a General Election looms. As the summer begins, optimism is in the air.

That same optimism could be felt in May at the British Dental Conference and Dentistry Show. Birmingham’s NEC was packed over the course of both days in what many speculate may be the biggest attended convention since before the pandemic. Keynote speaker Steven Bartlett drew large crowds to his ‘fireside chat’ with Nilesh Parmar – a queue for the main theatre forming over an hour before the conversation was set to begin. Yet, despite theatres around the show floor overflowing with humanity (Steven and Nilesh’s conversation was live streamed to the other theatres dotted throughout the venue for those who didn’t make it into the room), it was encouraging to see that the exhibition itself hadn’t come to a standstill. The aisles were still alive with movement while plenty of conversation was to be overheard on exhibitor stands (sans fireside).

The buzz continues as we recently unveiled the winners in this year’s Dental Awards. Find a selection of winners on page 46 or scan the QR code to see the full list of finalist and winners, and to watch the presentation: https://the-probe.co.uk/awards/the-dental-awards-2024/

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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. Readers who fall

Dr Zohaib Ali Prosthodontics Lecturer King’s College London

Prof. Francesco Mannocci Professor of Endodontology King’s College London

Dr Kostas Karagiannopoulos Lecturer King’s College London

Davinder Raju Founder Greener Dentistry Global

Emily Howden Dento-legal adviser Dental Defence Union

Bas Vorsteveld Haleon Vice President

Abby Leach Content Creation Mgr Connect My Marketing

Samantha Hodgson Finance Broker

Double Dental Awards win for Smile Together

Smile Together received double honours at the 2024 Dental Awards, sweeping up the prize for Practice of the Year, while Natalie Peary was crowned Dental Therapist of the Year.

The winners and finalists were announced in on Thursday 23rd May in a broadcast hosted by BBC weather presenter and meteorologist Sarah KeithLucas. The event is available to watch again, on-demand: at the-probe.co.uk/ awards/the-dental-awards-2024/ Head of Marketing and Communications at Smile Together, Tracy Wilson, who compiled and submitted the awards entries, said: “We’d gathered around a screen in a dental surgery at Truro Health Park to hear the outcome of the awards, with cake at

the ready whether we were successful or not. When Sarah announced that we’d won Practice of the Year we were all somewhat stunned as this is such a coveted national award to win. Then when she announced Natalie as Therapist of the Year, the excitement in that room was wonderful –never has chocolate cake tasted so good!

“We’re so proud of the whole Smile Together team for the difference they make every day to our patients and across our communities. This awards recognition is so justly deserved.”

Smile Together is an employee-owned dental CIC and certified B Corporation with a mission of tackling oral health inequality for healthier happier communities. Its dedicated Outreach Team (which was also shortlisted in the awards) frequently takes

a mobile dental unit into the heart of local communities to make even more of a difference to those who need them most. For more Dental Awards coverage, turn to page 46. n

Denplan launches hygiene plan

Denplan has launched a new hygiene plan to support practices to offer affordable hygiene appointments and promote preventative care.

Hygiene is an essential part of preventative care, and the new plan enables practices to assist patients in regular hygiene treatment, care and advice by providing a payment plan to spread the cost of hygiene appointments. The new Denplan Hygiene Plan is a payment plan designed to promote the prevention of oral health intervention for

patients in future, by providing an affordable way of accessing regular hygiene treatment, care and advice. Practices can set up to five payment options for patients.

Emma Smith, a hygienist from Paul Smith Dental Care, said: “Every day I hear of the barriers to accessing oral health care. My role as a hygienist is primarily involved in the treatment and prevention of gum disease, but it also encompasses prevention of tooth decay and improving overall oral health.

“Access to regular high quality care benefits patients, reducing fear,

embarrassment, pain and discomfort surrounding their oral health, making Denplan Hygiene Plan a great help to many of my patients.”

Catherine Rutland, dentist and clinical director at Denplan, said: “We know that many of our members face barriers to offering the preventative treatment they would advise on the NHS. The new hygiene plan has a low service fee and acts as a stepping-stone for dentists to explore the benefits of a mixed-model practice, all while ensuring patients get the preventative treatment they need.” n

National Smile Month 2024 launches at the Foundling Museum

The Foundling Museum in London set the stage as National Smile Month 2024 was launched amidst an audience of approximately 100 delegates. Running under the theme of ‘Love Your Smile,’ National Smile Month aims to inspire people to prioritise oral health and wellbeing.

The campaign seeks to foster positive habits that promote healthier smiles and happier lives. The initiative encourages everyone to embrace their smiles by taking proactive steps towards better oral health.

Speaking at the event, Dr Nigel Carter, chief executive of the Oral Health Foundation emphasised the importance of the campaign as a vehicle to transform oral health habits.

Dr Carter said: “This is the 48th National Smile Month, making it one of the longestrunning oral health campaigns in the world. But it’s more than just a few weeks of dental awareness – it’s a movement. Our aim is to promote good oral hygiene, raise awareness about the importance of healthy teeth and gums, and inspire positive habits that last a lifetime.

“A simple smile can have a profound impact. We know that people who maintain good oral health tend to have better overall health. And the ripple effect

extends beyond individuals – healthy smiles contribute to stronger communities and a happier society. So, as we embark on this month-long journey, let’s remember that our smiles are not just expressions; they’re statements of wellbeing.”

Dr Carter went on to express gratitude to the event’s sponsors, including LISTERINE, the Wrigley Oral Healthcare Programme (WOHP), Oral-B, Boots, EMS, and the British Society of Dental Hygiene and Therapy.

The charity boss acknowledged their invaluable support in advancing oral health education initiatives. He highlighted the collaborative efforts of these organisations in driving positive change and fostering a culture of oral health awareness.

The event also featured speeches from Dr Ben Atkins, speaking on behalf of the WOHP, and representatives from NHS Whittington Health Trust.

Dr Atkins highlighted key statistics from the WOHP’s latest Oral Health Index and stressed the need for preventive measures in oral health care, advocating for greater awareness and accessibility to dental services.

The NHS Whittington Health Trust brought the event to a close by addressing the room to share how they use National

Smile Month as a driving force for initiatives aimed at community engagement, with a strong emphasis on promoting oral health education and awareness. A recent toothbrushing event they organised was a testament to their efforts, successfully reaching around 900 local children.

National Smile Month 2024, which is supported by thousands of organisations from various sectors such as dentistry, health, education, and nutrition, will run until 13 June.

Dr Carter added: “In closing, let me say this: Keep smiling, let’s keep working together to improve oral health, and let’s make National Smile Month 2024 a resounding success”.

For more information about National Smile Month and how to support the campaign, visit www.smilemonth.org. n

NEWS BITES

software of excellence partners with Pearl

Software of Excellence has partnered with Pearl to become one of the first practice management system providers to deliver dental artificial intelligence to the UK. Through the partnership, Software of Excellence will distribute Pearl’s Second Opinion as a standalone software to its customer base, while offering native access to Pearl’s radiologic capabilities within Software of Excellence’s leading practice management system (PMS), EXACT. This sees Software of Excellence become the first PMS provider to bring AI to the UK market. n

Henry schein One UK listed among ‘Best Places to work’

For the second successive year, Henry Schein One UK, one of the UK’s leading dental practice management software companies, renowned for its Software of Excellence and Dentally brands, has been listed as one of the UK’s top employers (for businesses with between 50 and 249 employees), in the Sunday Times ‘Best Places to Work 2024’. https://www.thetimes.co.uk/static/bestplaces-to-work-2024-medium/. n

new Clinical Director at CDs CIC

Dr Adrian Thorp has been appointed as Clinical Director at leading community dental service provider CDS CIC.

A practicing Specialist

Oral Surgeon who also has a Degree in Law, Adrian has worked in maxillofacial surgery for more than 10 years and owned his own seven surgery mixed practice in North Wales. Recently made a Fellow of the Royal College of Surgeons, he is President Elect of the British Association of Oral Surgeons. n

Clyde Munro commits to 12,000 new nHs patients across scotland Clyde Munro is welcoming NHS registrations across Scotland for up to 12,000 new patients throughout 2024. To address the escalating demand for dental services across Scotland, the group has committed to new NHS patient registrations in 12 practices across five NHS health boards: Greater Glasgow and Clyde, Ayrshire and Arran, Lanarkshire, Highlands, and Lothian. n

natalie Peary

Dr Paresh Patel, Principal Dental Surgeon “

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But are you sure?

Afew years ago, my wife (a dental nurse) and I were invited to try our hands at outdoor go-karting at a work do organised by a friend of mine, a dental laboratory owner, for his technician colleagues.

Neither of us really ‘went for it’ and, consequently, the two of us both ended up at the bottom of the race league. To rub it in, at the meal after the event, we both received a lastminute award for ‘safe driving’. Our ignominy was complete.

I can’t speak for my other half but, having never driven a go-kart before in my life (I never get out), my approach to the event was to simply enjoy the scenery and not injure anyone in the processparticularly me. I have to confess that I found driving a go-kart mildly chilling. I always get the chills when I’m reversing my car – a process I loathe almost as much as I hated endodontics. All it took was one minor scrape during reversing my Austin 1100 sometime in the 1970s and a near-lifetime fear was born. I AM Reginald Molehusband (if you are under 50, Google him).

I’ve always suffered from a lack of confidence in my abilities – in dentistry and almost every other aspect of my life, although I’m confident in being able to state that very fact, in absolute confidence.

Once, in the early days of student clinics, I was about to begin polishing after a scaling when the prophy cup dropped out of the handpiece and disappeared at the back of the patient’s mouth. A cursory sweep with an aspirator was futile. Fortunately, my patient retrieved the rogue cup herself and presented it to me calmly, but I found myself shaking with fear. As far as I was concerned, I had narrowly escaped killing my first ever patient.

The following day, I found myself in a meeting with the head of the clinic. At my dental school, if you needed a good talking to, you were summoned to an early morning ‘ad hoc’ – a euphemism for a good rollocking. It just so happened that the head of this clinic was a really nice bloke – one of the very few at my dental school – and I was particularly ashamed of the very idea that he was even having to do this. In the end, the dressing down I got was not due to the fact that I hadn’t secured the prophy cup properly“That sort of thing happens all the time!” - but that I visibly panicked in front of the patient. “You have to display confidence to the patient, all the time, Mr Jupes, even when you’re not.”

I valiantly tried to remember that throughout my career but, quite often, it was a struggle – with endodontics in particular. I rarely had any confidence in my ability to produce what I would consider to be top quality root-fillings and it was only

a couple of years before I retired that a patient returned from a referral to a local dental hospital pleased that the specialist had told her that I’d done “a really good job” on a root-filling I had recently placed on an upper canine. I remembered having looked at my post-op radiograph at the time I completed said root-filling and thinking: “God, that’s awful.” If only I’d had that boost much earlier in my career, I wouldn’t have beaten myself up so much, constantly living in fear of a letter from our favourite band of specialist solicitors up North.

The only areas of dentistry that I did genuinely have any confidence in – albeit marinated in caution - were (perhaps ironically) oral surgery and prosthetics.

Many dentists I met over the years were extremely hesitant about raising flaps and letting loose with bone burs but, for me, it was a joy whenever there was no option other than to take a surgical approach.

As a student, like a little swot, instead of participating in sport like my younger colleagues, I would volunteer to help out on a Wednesday afternoon’s free period in the local extraction clinic, which was often headed by a lovely oral surgery lecturer. I learned a lot, but never actually had the opportunity to remove an impacted lower eight.

A couple of years after I qualified, tired of referring lower eights to the local oral surgery unit, I approached the head of the unit, asking if I could have a few sessions with him so I could learn more about the mysteries of ‘The Eight.’ Happily, I was welcomed to the unit and for about a year on my weekly afternoons off from practice. I assisted and operated

in theatre, not only removing a number of third molars, but also helping expose buried canines and putting ‘power-chains’ on them for the orthodontists. That experience made me reasonably confident in all things oral surgery-related to the point that, if ever younger colleagues ran into problems during removals, I was their man.

Since the only other area of dentistry that I had any confidence in was prosthetics, I often found myself receiving referrals from within practice, particularly in the last few years I was working. My confidence in this area was probably due to the fact that I attended a lot of postgraduate courses on the subject over the years and, for a while, worked in a practice restricted to prosthetics. Above all, I knew that, statistically, patients rarely died during complete denture try-ins.

Having said that about my ‘confidence’ in oral surgery and prosthetics, I was never OVER confident. It’s amazing how many dentists I came across over the years who were supremely confident in their dental abilities but, looking back, I now realise that they were shoo-in candidates for membership of the Dunning-Kruger Effect Club, where their lack of knowledge and skill caused them to vastly overestimate their own competence.

And, of course, you will be aware that notable members of the DunningKruger fraternity are also members of the Tory government who appear to believe that they have truly extricated the NHS dental service from certain death with their stupendously inadequate and misleadingly entitled ‘Dental Recovery Plan.’ Within nanoseconds of its launch, dentists

realised that the plan was nothing of the sort. A ‘golden hello’, for example, will do little to help a longestablished NHS practice that is rapidly approaching the death-knell because of inadequate funding. You must be supremely confident to state, as the Secretary of State for Health and Social Care Victoria Atkin did, that the crisis in NHS dentistry will be solved by: “Streamlining and tackling bureaucracy, with a wider set of workforce reforms to maximise the skills across the entire clinical team.”

No.

What NHS dentistry needs is adequate funding and a fair payment system that doesn’t involve pursuing abstract treatment targets but encourages the provision of quality treatment and prevention advice.

As the British Dental Association said in March, “Empty soundbites won’t call time on ‘DIY’ dentistry. ” It adroitly summed up ‘Rishi Sunak’s 3-Point Plan for dentistry’ as “Gin. Pliers. And a bit of brute force…” With appalling results in the local elections and calls for a general election growing louder, you could have a sneaking admiration for a Conservative government that seems determined, despite all the criticism and outcry, to persist with the gaslighting and still insist that its Dental Recovery Plan will work. Now THAT is confidence. n

About the author ollie Jupes is the pseudonym of a former nHs dentist. He monitors dentistry on twitter X as @DentistGoneBadd

Political biographies can be a valuable resource

Rory Stewart’s book, Politics on the Edge, is a modern gem

It seems strange, given that I have never been a member of any political party, that I am so interested in political biographies. In my final year at dental school, I won the surgery and anaesthesia prize, which could be taken as book tokens or (preferred by the school) actual books that could be handed over at the awards ceremony. I chose Michael Foot’s biography of Nye Bevan as, even then, I had a passionate interest in the NHS and how it originated. I came back to read the book again years later while I was living in London with a lot of time on my hands in the evenings. Looking at things in retrospect can be especially informative and seeing the similarity between the BMA attitude to consultants being employed by the NHS in 1948 and later when contracts for NHS consultants were being revisited. It seemed to me that all the concessions Nye had to make to get them on board in 1948 were then being targeted for revision. It seemed so obvious that there would be trouble again.

I recently read Rory Stewart’s book, which gives a real insight into what modern politics is about and the different influences in this modern era. The references to working with Liz Truss are very enlightening. I have to say here that Rory is no longer a member of the Tory party and, having once stood to be leader, is not the most unbiased writer. The most telling quote was that, ”Liz had a

simple answer to every complex question,” and as we all know, simple answers do not usually lead to solutions, issues are complex and need answering properly, not with catchy sound bites, as I am sure we will hear lots of in the run up to July 4th.

I recently spoke with an old friend who had a connection in one of our UK embassies: the then foreign secretary, the same Ms Truss, was given a briefing from her officials so that she could talk about the significant issues of the day with her hosts in the 24 hours she had in that country. Instead of reading the brief and entering into discussions that concerned everybody, she asked for a photo opportunity to be arranged with local children! This is not leadership. Mr Stewart makes the point that policy is one thing but the key to success is quality implementation, and that is where dentistry has real issues. I was invited to the LDC officials’ day in December to discuss water fluoridation but the conversations inevitably turned to commissioning and contracting. I explained to a highly placed official in the NHS that the contractual framework is actually very flexible but it was being implemented incredibly rigidly (NHS managers love counting things) and opportunities were being lost to reinvest under spends in a positive way. Flexible commissioning is the way forward and somebody needs to make the point to

whoever is in power by the second week of July. What really bothered me, and still does, was that this highly placed person in the NHS told me that all service delivery has to be measured by UDAs and this is clearly not the case. What hope is there if officials don’t understand their own regulations? There are signs that some ICBs are beginning to move in this more flexible way but that they are not being encouraged enough from the centre. The fact that we still have any NHS primary care dental service at all is a tribute to the commitment of many practitioners and their teams, who have stuck with it through a period when all Government seems to have been interested in was reducing the cost to the NHS budget, increasing patient charges way beyond the increases in contract values, not recognising the increasing costs in delivering services, and stalling progress on significant opportunities, such as making use of the wider dental workforce and moving much of the care from secondary to primary care, where it really ought to be provided.

So what has gone wrong in the last nine years? Between 2006 and the end of 2014, access to NHS dental care increased by 2.6 million and, eventually, access to services was not a major media issue in most areas. Did somebody take their eye off the ball or was it deliberate?

I met several people in the NHS who did not understand why dentistry was actually in the NHS but they probably came from a demographic where dental disease is not widespread.

I totally disagree with the BDA view that significant legislative change is needed. This would take years, need a public consultation on any changes to the patient charges system, which would need to raise the same amount of revenue as now (currently close to £1 billion) and a way to protect the contract value of those already holding NHS contracts. I do agree that, unless more innovative thinking is applied to dental commissioning, the future looks very bleak indeed.

Coming back to Michael Foot’s book, I came to understand that having strong and sometimes very laudable views and aims is not enough if you cannot implement. Much as I liked and respected Michael Foot, his only longlasting achievement, beyond writing a great book, was to ensure that Margaret Thatcher was re-elected in 1983. n

About the author

Dr Barry Cockcroft CBe is the former Chief Dental officer for england and current chair of the British Fluoridation society.

Summer sun and dental blues

Summer is here and now many of our patients are going to be thinking about holidays.

However, these days, as well as the sun, sea and sangria our patients are often seeking so-called ‘dental holidays’ that incorporate all the things we love about holidays, plus bargain bucket dental treatment.

This phenomenon has grown year-onyear, almost to epidemic proportions, with dental tourism now causing many of our patients to suffer from long-term and permanent dental issues.

Hola and merhaba!

Although there were around 1.5 billion people worldwide that either speak English as a first or second language in 2023, it is important that we ensure any of our patients who are thinking of going overseas for dental treatment understand the

nuances and complex language required to fully explain the often very invasive dental treatment they are about to embark on.

Informed consent relies on the patient understanding not only the treatment that they are agreeing to, but also the risks, approximately how long the treatment will last, and what happens if the treatment fails. Without these safeguards in place, how can a patient give informed consent to treatment?

How many times have we heard of a patient going abroad for a couple of veneers on their anterior teeth, only to end up with 26 full crowns!? It is unimaginable that this would ever happen at a UK dental practice.

Holiday hangovers?

It is a major worry within the dental profession that more and more patients are going to experience problems and pain from this type of extensive and often unsuitable treatment.

According to the Oral Health Foundation’s last Safe Smiles survey, 84.8% of dentists stated that they had a patient visit them with dental issues caused by undergoing dental treatment abroad.

With most holiday/dental treatment packages, there is very little aftercare included. So, rectifying, repairing or relieving pain can often fall to a dentist in the UK.

Not only is this a time-consuming exercise, but it is also expensive for the patient. Some dentists will approach this type of remedial treatment with caution, wary of further issues that the patient may lay at their practice door.

so, what can we do?

We need to reach people before they go abroad and discuss with them the pros and cons of doing this. What can often seem like a great deal could leave them with years of discomfort and ongoing expenses. This can often be seen as the dental profession protecting its income, but patients don’t have to take your word for it. Why not direct them to the General Dental Council’s Going Abroad for Dental Treatment leaflet1?

Dental treatment in the UK can be more expensive due to higher overheads than other countries, however, we have one of the highest standards of dentistry and safety in the world. As we know, the General Dental Council is there to provide protection for all patients, which is peace of mind that is not usually available overseas.

To help prevent our patients playing Russian Roulette with their oral health, if they are insistent that are going abroad for dental treatment, all we can do is encourage them to do plenty of research and ask lots of questions. This due diligence will hopefully reduce the risk of overly invasive treatment being carried out and fewer problems for the patient in the long term. If your practice uses social media, we encourage you to use this as a platform to help educate your patients of the perils and pitfalls of taking a dental treatment holiday this summer season.

You could put on a link to the Oral Health Foundation’s Safe Smiles campaign, which is aimed at helping people find safe dental treatment. Encourage them to visit the website at dentalhealth.org/safesmiles. n

Reference

1. https://www.gdc-uk.org/docs/default-source/goingabroad-for-dental-treatment/going-abroad-for-yourdental-cared3d463b7cee0446882bf877483299dd4. pdf?sfvrsn=c67e2b57_7

About the author

Karen Coates, oral Health Content specialist at the oral Health Foundation, and RDn

When is it safe to dispose of patient records?

Unfortunately, a complaint or claim for clinical negligence can be made years after treatment. It is therefore vitally important to retain records as, without them, it may be difficult to defend this successfully.

How you manage a patient’s clinical records depends on the category under which they fall. For example, for patients that attend regularly, it is appropriate to keep the records to assist in the ongoing care of the patient. However, you can consider disposing of records for patients who have not attended for the recommended minimum retention period.

In England and Wales, the NHS advice on retention currently recommends 11 years as the minimum retention period for the records of an adult patient and that children’s records should be retained until the 25th birthday – or 26th birthday if the patient was 17 when treatment ended.

The Scottish government advises that the records for an adult patient should be retained for a minimum of 10 years since the patient last attended and 10 years, or up to the 25th/26th birthday (whichever is longer), for children. Meanwhile, in Northern Ireland there is guidance on record retention from the Department of Health and contained within the Regulation and Improvement Authority (Independent Health Care) (Fees and Frequency of Inspections) (Amendment) Regulations (Northern Ireland) 2011.

When a patient has died, under the statute of limitations, the deceased patient’s executors or personal representatives have a maximum of three years from the date of death to start legal proceedings in pursuit of any claim made on the patient’s behalf, and a further four months to serve those proceedings. It is prudent to keep the records of a deceased patient for a minimum of four years following their death.

The General Data Protection Regulation (GDPR) requires you not to keep personal data for any longer than necessary.

If you own a practice that you are selling, the solicitors acting for you in the sale should incorporate into the sale agreement suitable clauses requiring the purchaser to retain the records for the recommended minimum periods, along with clauses that give you reasonable access to records during that retention period, for the purposes of dealing with any complaints or claims which might arise. If you close a practice without selling it, the onus is on you to retain the records securely for the recommended minimum periods. Records retained by you will need to be stored securely to comply with your duty of professional confidentiality and data protection legislation. You can either store them yourself in a secure area over which you have control or store them at a secure commercial archiving facility. While you retain control of any patient personal data, you will need to remain registered with the ICO as a data controller.

When disposing of records, which might include study models, it is important to maintain patient confidentiality and dispose of records in accordance with national and local waste disposal requirements. If you outsource the destruction of records to a third party, then you should use a licensed confidential waste disposal company and have a suitable written agreement with them confirming

they will take all reasonable steps to protect confidentiality. Additional things to consider when disposing of records include:

• Review and appraise records carefully before destroying them

• Seek specialist IT advice about the disposal of electronic records

• Dispose of paper records in a way that protects patient confidentiality, such as shredding.

Consult the DDU guide for further information on retaining and destroying records. n

About the author emily Howden, dento-legal adviser at the Dental Defence Union (DDU)

For dry mouth – when just water is not enough

New

1 in 5 suffer from dry mouth, and water is usually the standard remedy. But for many people, water only provides brief relief. TePe’s new hydrating mouthwash and mouth gel ease the feeling of dry mouth, provides comfort, and protects teeth. We recommend the gentle, unflavoured products for those with a very dry mouth and mildly flavoured products for those with moderate problems.

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Happy mouth, happy body

Why championing preventative oral health care in the UK is critical to delivering good health and wellbeing

From helping us to talk, chew and digest food to boosting our selfconfidence, we know that having a healthy smile can be a great asset. The benefits of looking after our teeth and gums are numerous, yet the important connection between oral health and overall health is often overlooked. This year’s World Oral Health Day theme, ‘A happy mouth is a happy body’, was designed to raise awareness of this important connection. Given the links between oral health and wider health and wellbeing, it is important that we reflect on the fact that most oral health conditions are preventable. By empowering people to prioritise a good oral health routine, together with championing preventative oral care, we can seek to reduce the impact of poor oral health on individuals, society, and our healthcare system.

Understanding the challenges faced by professionals and patients

The need to prioritise preventative oral healthcare is amplified when considering the current state of play for NHS dentistry for both dental professionals and patients.

From the infamous streets-long queue for a new NHS dentist in Bristol1, to 60% of London practices unable to take NHS patients2, it is no secret that many Brits are turning to alternative methods of treatment out of desperation, which are then impacting their overall health and wellbeing. Alarmingly, more than eight in ten dentists have treated DIY dentistry cases in the years since the Covid-19 lockdowns took place3. This is also having an impact on the economy, with one in 10 adults in England reported to have taken at least two weeks off work in the last three years due to teeth and gum problems4

The situation is closely linked to and impacted by the rising number of ‘dental deserts’ across the UK, with some areas having only one NHS dentist available to treat over 3,000 people5. The lack of NHS

dental provision is set to be compounded by staff leaving the workforce. Four in 10 dental professionals have said that they are likely to retire or leave practice in the next five years6

Evidently, more needs to be done to support oral health professionals to provide the level of care they want, whilst encouraging them to stay in the profession and attract new joiners. This will support a sustainable future for the industry and the nation’s health.

the preventative care solution to drive better outcomes

Preventative oral care, underpinned by knowledge about positive oral hygiene habits, can help alleviate the pressure dental professionals are facing. A good oral health routine can help to protect patients against tooth decay, gum disease, and tooth loss, which can all have negative impacts on their general health.

As a leading consumer health company, we at Haleon want to play our part in empowering people to practice better every day self-care. This includes working to provide education around oral hygiene, as well as working closely with dental professionals to support preventative oral health care.

the current state of preventative oral care in the UK

To better understand how we can support preventative oral care, Haleon partnered with the College of General Dentistry to launch the Dental Health Barometer in 2023. Our research surveyed consumers and dental health professionals to paint a picture of the nation’s attitudes and experiences towards prevention.

The findings revealed a consensus amongst both consumers and dental health professionals that prevention is an important foundation for good dental, and general, health. However, in practice, not all routine dental appointments provide patients with crucial advice on prevention.

The 247 Dentist

Despite 87% of oral health professionals believing preventative oral healthcare advice is beneficial for patients, only 34% of said they were able to always offer it7 We understand that there are many reasons why oral health professionals don’t always offer this advice. Alongside time constraints, one of the key factors our research identified was a lack of clarity about what exactly constitutes preventative oral healthcare advice. With oral healthcare professionals facing increasing pressures, we want to work collaboratively with the sector to support them to be able to provide better preventative advice, enabling more patients to be reached.

Why we must collaborate to deliver healthy smiles and healthy bodies

One of the ways we are supporting dental professionals is through our Haleon Health Portal, where dental health professionals can access webinars, online training information, and specific details on the latest research. We are also continuing our partnership with the College of General Dentistry, exploring how we can continue to best offer our support to dental professionals. Together, we have been hosting dental health professional focus groups across the country to delve deeper into our Dental Health Barometer findings and start to uncover and address industrywide solutions – developing these with dental professionals for dental professionals.

Alongside working with dental professionals, consumer education forms another key pillar of our approach. One of our longstanding campaigns is Aquafresh’s ‘Shine Bright’, which aims to educate both parents and children on the importance of good oral health. With a quarter of five-year-olds experiencing untreated tooth decay8, early oral health education can make a significant difference by preventing common oral health issues and instilling good oral health habits from a young age.

looking ahead for the sector 2024 is sure to be a pivotal year for the dentistry sector. With a general election likely before the end of the year, and access to NHS dentistry being a key concern for the electorate, dentistry is likely to remain in the headlines.

In this context, decision-makers should be clear that only by unleashing the power of preventative care can we achieve a happy mouth for a happy body. By collaborating across the industry to support all healthcare practitioners in developing and delivering preventative advice we can improve our smiles, wellbeing and lives. n

References

1. https://www.channel4.com/news/peopleresort-to-diy-dentistry-as-uk-announcesdentistry-recovery-plan

2. https://www.standard.co.uk/news/politics/ london-dentist-practice-nhs-patients-wesstreeting-labour-b1128330.html

3. https://dentistry.co.uk/2024/02/05/diydentistry-rampant-across-the-uk-bda-warns/

4. https://www.mirror.co.uk/news/uk-news/fourmillion-work-due-dental-32318464

5. https://www.libdems.org.uk/press/release/ rise-in-dental-deserts-leaves-millionsstruggling-to-get-nhs-dentist-appointment

6. NHS faces ‘alarming’ exodus of doctors and dentists, health chiefs warn | NHS | The Guardian

7. https://cgdent.uk/2023/11/30/newresearch-reveals-the-missed-opportunity-ofpreventative-oral-care/

8. https://www.the-dentist.co.uk/content/news/ aquafresh-launches-shine-bright-campaignto-help-combat-children-s-tooth-decay

About the author Bas Vorsteveld, haleon Vice president and general Manager, great Britain and ireland

Sisters and former dental nurses, Bernice Bayliss and trudy gordon, discuss their service, the247dentist, which provides out-of-hours emergency dental care for dental practices in 18 locations across England

The247dentist was formed as an idea in 2018 and started operating in February 2019.

The original idea was a result of Bernice’s partner struggling to organise out-of-hours emergency dental care at his Dental Practice on the South Coast. Feeling that many practice owners must face similar challenges with maintaining an emergency rota for their private patients, the247dentist was born out of this necessity.

Bernice and her partner initially were the sole providers of the service but the impending arrival of Bernice’s first baby in August 2019 meant that further recruitment of dentists and nurses was needed. Trudy joined the team in 2023 to help with the expansion of the service.

Choosing to expand the service following the Covid summer of 2020 presented unique challenges relating to staff and patient safety. We also had to clear the hurdle of practices allowing us to work within their premises at a time of such strict operating restrictions.

The unique model of the business was initially a challenge to explain to the CQC but they are now fully on board with the concept and we have already passed our first CQC inspection.

The geographical spread of locations poses greater challenges for compliance but technology and a great compliance team help with this. Strangely enough, when we first started, one of the hardest things was to convince dental practices that our service was indeed free to use for them! This has become easier as time has gone on.

Currently the247dentist provides outof-hours emergency dental care for Dental Practices in 18 locations across England, whilst also providing remote consultations via video or telephone for practices nationwide. The service is completely free for practices to use, with patients paying the247dentist directly for any care received.

In 5 years’ time, our aim is that the247dentist will be used by the majority of practices across the UK, allowing dentists and nurses to enjoy their free time in the knowledge that their patients are well looked after. n

Future-proof your dental practice

Davinder raju, Founder of Greener Dentistry Global, a sustainability programme devised for dental teams, discusses his mission to make dentistry more sustainable and future-proof dental practices

where did your passion for sustainability in dentistry originate?

My father was a very spiritual person, and I was raised with an appreciation and respect for nature. My passion for sustainability comes from seeing how humans have monopolised the planet, encroached into other species’ habitats and changed the biosphere. I saw a statistic that humans and livestock now account for 96% of all mammal biomass, leaving just 4% that is wild1. We’ve had a monumental impact on the planet and I’m worried future generations won’t experience the same abundance of nature I grew up with. I had a lightbulb moment when studying for my Masters in Minimal Intervention Restorative Dentistry. I was thinking about the microbiome in the mouth and how humans provide a hospitable, warm environment for the microbiome and, in turn, it looks after us by tackling pathogenic bacteria and preventing infection. When that microbiome is thrown out of balance, it becomes dysbiotic, and this causes the host to become unbalanced and unhealthy. I saw a parallel with dentistry; many aspects, such as the use of single-use plastics, are having a negative impact on our host (the planet) and disrupting the global biome.

Do you think sustainability is beneficial from a business perspective?

In the UK alone, 40% of Gen Z consumers say that they are more likely to buy from a business that displays strong environmental credentials2, and 73% are willing to pay more for sustainable products3. While you might think that is just a small slice of the market, these younger generations will soon hold the majority of the world’s purchasing power4 From the point of view of a business, it makes complete sense to become more environmentally friendly. It looks after patients, it looks after the planet, and it can help to future-proof the business. There is also evidence that millennial employees are more likely to stay with an employer if the employer has good environmental standards5 I’ve seen this play out in my own practice – my team is motivated by a bigger sense of purpose beyond the profession alone.

what do you think is holding dental practices back from becoming more sustainable?

For dental practices, patient safety is paramount and there is no doubt that we have become more risk-averse in response to a rise in litigation cases over recent years. However, an average of 21 singleuse plastics are used for every routine adult primary care dental procedure6. The environmental impact is huge, both in terms of plastic pollution and the fossil fuels required to produce them.

As a profession, I feel we need to reintroduce some common sense and develop processes and systems that enable us to reduce our reliance on single-use plastics and adopt more sustainable practices, whilst maintaining high safety standards.

How does Greener Dentistry Global help make sustainability more achievable?

My aim is to make sustainability as easy as possible by creating an online hub for all things green. One of the first things we created was the forum, which is a community for like-minded people and a place for dental practices to share ideas and thoughts. The forum is also where we crowdsource product recommendations to create our database of eco-friendly dental supplies. Once the database is complete, it will be quick and easy to search for a product or piece of equipment and find the most eco-friendly option.

We’re also striving to reduce the likelihood of greenwashing with our practice accreditation scheme. In order to be accredited, practices must complete a certain number of initiatives and submit evidence for each one. Initiatives span social responsibility, team wellbeing, energy use, recycling, travel, awareness and more. Once accredited, practices receive a badge to display on their website that includes the Greener Dentistry Global logo and how long they have been accredited for.

Any member of the public is able to view a practice’s Greener Dentistry profile, the initiatives they have completed, and their plans for the future. If they think that something isn’t quite right, they can contact us, and we will investigate. Transparency is really important.

Join Greener Dentistry Global by visiting https://greenerdentistry.global

Find out more about Henry Schein’s Practice Green initiative at https://info.henryschein.co.uk/practice-green

Henry Schein has their own sustainability initiative in Practice Green, but they have also supported you and Greener Dentistry Global. Can you tell us more about that?

I used to think that there was apathy in the profession towards sustainability, but it has been inspiring to see what Henry Schein has done with its global programme Practice Green, and how it is helping to raise the profile of sustainable dentistry. I look at dentistry as one big ecosystem and we can all help each other flourish.

Last year, Michael Fahey, Henry Schein’s Commercial Director in Australia, gave Greener Dentistry a shoutout at the FDI World Congress in Sydney. In his presentation, he outlined the package of resources we offer to our members to enhance a practice’s sustainability. It was a fantastic moment of recognition. Henry Schein is also good at introducing like-minded individuals and companies to each other, and it’s through them that I’ve found other individuals who share my vision.

what do you think the next big challenges will be in making dentistry more sustainable?

When I think about aspiring to a greener future, one of my main concerns is clear aligners. The market was worth 2.5 billion USD in 2020, and it is forecasted to exceed 19 billion USD by 20307. That amounts to millions of aligners that we’ll be unable to recycle. While every patient has the right to want straighter teeth, I’m not sure it should come at the expense of the planet, so a biodegradable aligner solution is desperately needed.

There’s also a big question mark over whether amalgam will be banned in Europe in 2025, and there’s a rush to develop a more durable material than resin composite. It feels like we’re on the wrong track; we should be focusing on prevention, and the profession should be remunerated equitably for this type of oral health care. This works on a wider scale, too, as periodontal disease has been connected to systemic disease. If we can tackle periodontal disease at a preventative level, we are helping to prevent systemic diseases from developing in the future, thus reducing further environmental impact on the health system downstream. n

References available on request

Transforming day-to-day endodontics

professor Francesco Mannocci

shares his experience of working with the new X-Smart Pro+ Endo Motor with integrated apex locator

I’ve been working with Dentsply Sirona’s new X-Smart® Pro+ Endo Motor for several months in practice. I’ve noticed a number of differences between this motor and any other endo motor around; all very positive features that makes it a standout motor for anyone working in the field of endodontics.

The X-Smart® Pro+ is a powerful, portable motor which, unlike its predecessor, features an integrated apex locator. It is designed for use with all Dentsply Sirona’s endodontic file systems in both continuous rotation and reciprocating modes, including WaveOne® Gold, ProTaper®, ProTaper Ultimate™ and TruNatomy®.

sophisticated torque control I find the X-Smart Pro+ has very sophisticated torque control. This allows for a large variation in torque (0.2 N.cm to 7.5 N.cm) so you can use instruments with a higher torque as needed. This level of control helps to make instruments more effective, safer and at far less risk of file separation.

If you compare using the X-Smart Pro+ against other endo motors, there is a noticeable reduction in vibration which allows for very smooth penetration of the file. This is particularly relevant when you are working with difficult canals, which is what I do for the majority of my cases.

easy functionality

Another important feature of the X-Smart Pro+ is the large touchscreen interface which is easy to control even when wearing surgical gloves. Just a touch of the screen is required to change the function of the motor to a combined function with the apex locator or back to the apex locator on its own.

The touchscreen gives you access to a large number of file sequences which include ProTaper Next and ProTaper Gold and a combination of both reciprocating and continuous rotation instruments. It has a file library with preset settings for Dentsply Sirona files as well as the option to customise up to 30 file sequences according to your own preferences. It can also be updated

to accommodate future file systems.

The wide choice of file sequences delivers excellent performance in both rotary and reciprocating modes, which makes it extremely effective at streamlining workflows and increasing my efficiency.

save time and space

An integrated apex locator with the motor means working with one device instead of two. This is really helpful during treatment, and it also helps to save space on my working bench.

The dual function with pre-set file sequences significantly reduces procedure time while maintaining precision and accuracy in reaching the apex. This is important because the quicker the instrumentation procedure is, the more time you have to clean and irrigate the canals and give the irrigant more time to work effectively.

The apex locator itself is very well designed, extremely reliable and very precise. It makes treatment more efficient by continuously monitoring the apical limit during active shaping of the canals.

An auto-reverse function prevents the file getting too close or going beyond the apex which is an important new feature of this motor. It increases safety and helps to reduce the risk of file separation.

the perfect partner

These days I use TruNatomy and ProTaper file systems for the majority of my complex cases, while for more straightforward cases I continue to use WaveOne Gold. The X-Smart Pro+ motor suits all of these systems. It is very light and easy to use and its dual functionality makes it a great investment to improve the effectiveness and efficiency of endodontic treatment. It reduces treatment times, which is an advantage not just for me as I work very long hours, but also for my patients, who spend much less time in the chair. There’s no question it makes my life as a clinician easier.

To find out more about Dentsply Sirona’s X-Smart Pro+ with integrated apex locator please visit https://www.dentsplysirona. com/en-gb/categories/endodontics/xsmart-pro-plus.html or scan the QR code n

about the author prof. Francesco Mannocci Md, dds, phd, FHea is a specialist in endodontics and restorative dentistry. He obtained his Md (pisa, italy, 1986) and dds (pisa, 1990) in italy, and his phd in clinical dentistry from King’s college london in 2001. after having worked in private practice in pisa for 18 years while collaborating with the university of siena as a Visiting professor, he became lecturer in endodontology at King’s college london in 2004, senior lecturer/ Honorary consultant in 2006, Head of endodontology in 2008, and professor of endodontology at King’s college london in 2011.

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Reducing the stress of it all

Dentistry is widely acknowledged to be a particularly stressful profession compared to others, with dentists most anxious about making mistakes, patient complaints and patient confrontation among a long list of potential concerns. There are various things that can be done to reduce the pressure that individuals are under on a daily basis, and one of these is building strong working relationships with team members. This includes both practice staff and professionals that support the practice with products and services.

the effects of stress

The impact of this stress on dental professionals is substantial. Firstly, it is associated with reduced wellbeing among dentists, increasing the risk of mental health concerns like depression and addiction, as well as burnout. There is also some evidence to suggest that high levels of prolonged stress can negatively affect professional standards and clinical performance, although more research is needed in the field to better determine the link between the two.

Finding ways to reduce the stress experienced by dentists and dental teams every day is, therefore, crucial.

collaboration

Research has shown that effective collaboration within the workplace is hugely beneficial. One study showed that working well as a collective can motivate individuals to achieve more, to enjoy their work and to perform more productively. The same experiment suggested that people working together also developed greater endurance for the task at hand, meaning they were able to persist for longer without experiencing a negative psychological impact. This teamwork can be optimised in a wide range of circumstances by establishing strong working relationships. This is particularly true for individuals who hold leadership or management roles (including principals, practice managers, lead dental nurses, treatment coordinators etc.) but can be applied to those in many different positions. As such, it’s important to consider the rapport that is built across the business, both within the practice and between practice staff and external sources such as equipment suppliers and software support services.

communication

To establish and maintain these strong working relationships between colleagues, open and honest communication is important. This encourages engagement between team members and is key to both facilitating professional relationships and developing the organisation as a whole.

Dentistry beyond words

Dentists and their teams are required to document everything that happens during a patient appointment. From the results of clinical assessments to the specific oral hygiene advice given, a written record is created and saved. The General Dental Council (GDC) Standards for the Dental Team mandate that “as much detail as possible” is included in these patient notes in order to accurately represent the conversations that took place. The same standards also obligate that dental professionals should be aware of how both their tone of voice and body language could be perceived by patients. This is challenging for even the most diligent dental professional for a number of reasons, not least of which is the inability to completely and contemporaneously reflect the sentiment of conversations merely through the written word. Finding a way to keep a record of such things is important to ensure that clinicians are given credit for the comprehensive way they engage with their patients. In response to this, dynamic technological solutions have been developed that are changing the game for clinical note taking.

it’s not what you said… What you say as a professional to your patient, as well as how you say it, are essential considerations within dental consultations. Research has demonstrated tone of voice to significantly impact how words are construed, in particular, emphasising negative or positive connotations. Specifically within a healthcare setting, effectively using the right tone of voice has also been

Good communication also plays a vital role in improving productivity and building trust –both of which are essential within the dental practice. Once again, these are applicable both with regards to internal and external relationships. However it is achieved, studies have linked effective communication with a more supportive working environment and reduced stress levels.

an equipment supplier you can count on

To achieve a stress-free life in dentistry – or as close to it as possible – you need to know that you’re working with an equipment provider that shares your commitment to collaboration and communication. You need confidence that your questions will be answered quickly and by the right people. Your team also needs to know that any equipment malfunctions will be responded to rapidly. It is just as crucial that you trust your provider to keep you in the loop when software upgrades are due or new parts are being ordered. Without these aspects, your practice schedule will likely be disrupted, your patient appointments could be delayed and your business will likely have to contend with additional costs and inefficiencies. Such situations will do little to reduce stress levels in the practice, so preventing them is essential. This is why choosing a supplier you can count on is vital.

Working with a team like RPA Dental for your dental equipment needs will help you avoid all of this. Louise Hilton, Practice Manager at PBA Dental & Implant Clinic in Liverpool, says of her 20+ year relationship: “We trust RPA Dental. They really understand our business and we know the team well enough to trust in what they say. The whole team is fantastic and they communicate well. We’re like a close-knit family – over the years, we have built a brilliant working relationship and this makes a big difference to our practice. I think they’re brilliant.”

teamwork at its finest

There are many potential sources of stress for the modern dental team. Don’t let equipment maintenance be one of them for your practice. Find an equipment supplier that works effectively with you, communicates clearly and builds an excellent working relationship with your practice for the best results.

For more detail about the solutions and services available from RPA Dental, please visit www.dental-equipment.co.uk, call 08000 933 975 or email info@rpadental.net n about the author adam Shaw, Sales Director at rpa Dental Ltd

shown to strengthen patient-professional relationships and enhance the exchange of information.

A 2023 study reviewed the impact of both voice tone and word choice within a medical setting. When doctors emphasised the benefits – in this case about weight loss – in a positive and upbeat sentiment, patients responded more favourably. Professionals whose tone and words took a negative approach and were delivered in a slower way, saw increased hesitation from patients to follow advice. This is why it’s crucial to think about both what you say and how you say it when communicating with patients in the dental practice.

All of this presents a challenge – how do you accurately record the way information is delivered to the patient during a consultation when keeping solely written notes?

Details matter

To maintain contemporaneous, accurate and complete notes – as per GDC requirements – dental professionals must document as much information about appointments as possible. Writing notes in real-time may seem like the best way to achieve this. However, multitasking by healthcare professionals is associated with a lower quality of patient care. Not only is your attention, or that of your dental nurse taken away from your patient in order to write notes there and then, but the opportunity for errors and missed details also increases.

The alternative is to complete notes after the event, in the evening, for instance. But this approach affords its own issues. For a start, it relies on adding details from memory – which allows crucial

details to be overlooked. A study also found that dentists remembered far fewer psychosocial details than technical elements from an earlier consultation, which leads to further loss of clarity, context and sentiment within the records. This leads to another major challenge in accurate record taking – when and how do you document details, without missing out relevant nuances or compromising patient care?

the revolution is here

For many clinicians, relying solely on written record keeping is a flawed, outdated and inefficient approach to documenting patient interactions and consultations. Digital dentistry has revolutionised many other aspects of the daily workflow and it has the capability to do the same in the clinical note taking space. It’s time we made the change. With the right technology and support, it is possible to deliver exceptional patient care while protecting the professional team from potential legal disputes that can arise from inadequate clinical notes. Innovative software now allows you to record every single conversation with every single patient. It provides an accurate representation of what was said and how it was said, documenting the exact wording used in minute detail. What’s more, it does all of this while having nothing but a positive impact on the quality of care provided. Your attention is not pulled away from your patient and you needn’t worry about what you will and won’t remember at a later time.

How is this possible?

Dental Audio Notes (DAN) makes the documentation of complete, accurate

and contemporaneous clinical notes effortless. It provides an audio recording of consultations, so both you and your patient are protected by a genuine account of everything that actually happened. The software optimises the consent, security, privacy and storage of data for the full 11 years required for total peace of mind, allowing recordings to be safely shared with patients to enhance their engagement too. In addition, it is simple to integrate within your existing systems and can be set up and ready to go straightaway.

the future of clinical record keeping

Most dental professionals will agree that dental record keeping can be an arduous process, despite its importance in protecting patients and dentists. Manually creating written records is no longer the best option for clinical notes – modern technology is trailblazing a new approach. Upgrade your processes to streamline your administrative workflow and elevate patient care standards at the same time.

For more information about Dental Audio Notes (DAN), or to arrange a free demo, please visit dentalaudionotes.com n

about the author aleksandra rozwadowska (ala) is a dentist and the co-founder of Dental audio Notes alongside her husband, adam. Dental audio Notes was created in response to the challenges of trying to master every aspect of clinical dentistry.

Back to basics – how well do you know the colour code?

Careful handling of the waste products from your dental practice is essential to ensure the safety of clinicians, patients, and the wider environment. Numerous guidelines are in place to ensure waste items are appropriately managed – with dedicated pathways for those that can be recycled, treated, incinerated, or sent to landfill.

Given the broad range of waste generated in the dental practice, effective segregation is important for the safe and efficient treatment of this waste. This requires consistency among staff, as it only works when everyone contributes.

However, it can be difficult to remember which waste items should be separated for which treatment method, which is where the colour code comes in. This provides a simple way to identify waste items according to the level of risk they present, as well as the appropriate disposal methods for those items. Dental professionals should take the time to refresh their knowledge of the colour code waste system to optimise clinical waste management within the practice.

current guidelines

One of the most important sources of information regarding the colour code waste system is the Health Technical Memorandum 07-01 (HTM 07-01), which offers comprehensive advice for the safe and sustainable management of healthcare waste. The guidance is not mandatory but provides best practice recommendations for practices striving to ensure the highest standards for their patients, staff and business.

HTM 07-01 allocates 13 different colours to each component of healthcare and infectious waste. It provides a clear and concise way for professionals to implement safe and effective waste segregation onsite. A decision-tree is available within the document that clearly defines which waste items go where.

colour breakdown

Three of the most commonly used waste streams in dentistry are for infectious, highly infectious and offensive waste, represented by orange, yellow and tiger colouring (yellow with a black stripe), respectively. To judge which colour waste stream is most appropriate in any given moment, you must establish whether an item is infectious, and if so, the risks it poses.

If a waste item has been in contact with a patient who is either being treated for infection; is carrying a transmissible disease; has a known history of infection, such as a bloodborne virus; or if the item is/has been in contact with a culture, stock, or sample of infectious agents from laboratory work, allocate it into the appropriate orange or yellow waste stream. Where the waste is infectious and contaminated with Category A Pathogens, medicines or chemicals, it is allocated yellow – otherwise, place it into the orange stream. Separating these accurately is essential, as highly infectious waste (yellow stream) will most often be sent for incineration, whereas known infectious items (orange stream) may be suitable for alternative (and less energy-intensive) treatment.

Be aware, not all clinical waste is infectious. When an item doesn’t meet this criteria, it must be placed in the offensive stream (tiger colouring). You may find this makes up a majority of your disposal needs. This includes products that have been in contact with bodily fluids – if they are not hazardous or infectious, opt for a tiger container. Aside from non-infectious clinical waste such as single-use PPE, other products that can’t be mixed with municipal items, such as nappies, inconvenience pads, and feminine sanitary items, should be placed in here too.

Dental waste is signified by white in the colour code – with a skull and crossbones (hazardous) for amalgam and without (non-hazardous) for gypsum. This protects people and the environment from potential mercury vapour that can be released from waste amalgam, keeps waste gypsum away from general landfill, and prevents it from creating dangerous sulphide gas. Mixed municipal waste, which is black in the colour code, encompasses waste that can be disposed of in landfill and usually includes food packaging, plastics that can’t be recycled, and tissues.

The remaining colours in the code are unlikely to be managed in the dental practice, but are still worth professionals being aware of. These are purple cytotoxic and cytostatic waste (used if you provide cosmetic procedures such as botulinum toxin injections in your practice); red anatomical waste; blue pharmaceutical waste (which includes used or partially used anaesthetic cartridges); and clear lateral flow testing waste.

effective solutions

In addition to educating staff and giving them access to resources that refresh their knowledge and understanding about safe waste segregation, it can be helpful to provide reminders. For example, signposting staff to useful resources online can help to refresh their understanding of how the best practice colour code applies to their everyday work. Physical reminders located around the premises can also be beneficial, such as placing posters outlining appropriate waste streams and their allocated colour at relevant points in the practice. Experts in the field, Initial Medical, offers an array of posters that are free to download from its website, which can be utilised in the dental

practice to facilitate safe and efficient waste segregation by all colleagues. However you support your team in implementing safe management of clinical waste, it’s important they can do this confidently. Much waste is generated in the dental practice and effectively segregating it means that businesses can minimise its environmental impact, by ensuring waste is treated in the most sustainable and least energy-intensive way possible. As you move

further towards best practice standards, be sure to review your waste protocols. To find out more, get in touch at 0808 304 7411 or visit www.initial.co.uk/medical n about the author rebecca Waters, category Manager, initial Medical.

Work-life balance

Dental professionals are up to three times more likely to experience burnout than other professionals and suffer from very high levels of stress. Their personal as well as professional lives can suffer as a result. A 2016 study on burnout in the profession found that 46.80% of respondents felt worn out at the end of the working day, and 47.83% had less energy and less time for family and friends. A more recent survey showed that 53% of dentists and 37% of dental nurses feel that they did not have a good work-life balance.

A well-balanced life may mean different things to different people, but broadly, it represents the idea that there is minimal conflict between roles inside and outside of work, and that individuals can experience a high level of engagement in both without negative consequences.

Survey after survey has revealed that since the pandemic, more of us tend to be focused on work-life balance rather than financial rewards when seeking new employment. Individuals want to be valued and respected professionals, as well as individuals with a private life.

Why is work-life balance important?

When work-life balance is off, everybody loses. Not only do dental professionals suffer when work is out of balance with life; the quality of their work suffers. Strong networks outside of work leads to increased job satisfaction, and a greater sense of commitment to work and patients.

Working in a way that enables more nonwork-related activity vastly increases engagement at work.

Where the balance is right, professionals are 2.5 times more likely to put in extra effort. Improved effort contributes to greater career advancement and professional success, which in turn tends to make people feel more satisfied in their personal lives. Patients benefit from this too. When dental professionals have strong social and support networks outside of work, improved morale is strongly linked to positive outcomes for patients.

Work that precludes a satisfying personal life has negative consequences for all team members, but many people with added caring responsibility, for family members or others, find themselves struggling to keep their heads above water. Individuals may well find themselves worrying about work when they’re with those they care for, and worrying about the responsibilities at home while they’re at work. It may feel impossible to perform well in either situation, and that there is little respite. Work–family conflict can have a serious impact on mental health and well-being, as well as physical health.

the physical and mental impacts of overworking

Cardiovascular disease (CVD) – chiefly heart disease and stroke – is one of the leading causes of premature death in the UK. Multiple studies have shown CVD to be strongly linked to a number of unhealthy work conditions, including a poor work-life balance and long working hours. A study conducted

by UCL of more than 10,000 participants stated that professionals who worked three or more hours longer than required had a 60% higher risk of heart-related problems than those who didn’t work overtime.

Several studies have also associated long working hours with depression and anxiety. Sleep can be affected, which can result in a number of problems, including mood disorders. During the pandemic, female dental professionals were revealed to be more affected by the negative mental health effects of work-life imbalance than their male colleagues. Due to the additional caring responsibilities that tend to fall to them, women in dentistry are more affected by emotional exhaustion, work–family conflict and resultant symptoms of stress.

Striking a better balance

It’s important to speak up when things start to feel out of hand, and if you manage a team, there are lots of things you can do to help improve their wellbeing. Many mental health charities, as well as the Health and Safety Executive (HSE) offer free resources and guidance on managing personal and team stress in the workplace, as well as recognising the signs.

Practice managers can really help their teams by encouraging a culture of openness, and regularly checking in on pressures that might be affecting the team’s workload. Implementing strong systems, policies and procedures, and supporting team members to set boundaries so work doesn’t creep into their home lives can make all the difference. And the time-

consuming practicalities of running a busy dental practice can increasingly be supported by digital systems.

The dental practice management software (DPMS) from AeronaDental is a system designed to take the stress out of the dayto-day operation of dental practices. Online consultation tools – including integrated video consultation – allow team members to work more flexibly. The system is cloudbased, and offers full integration with notes, forms, billing information, communication and survey tools. Business and finance tools are also fully integrated, so practice managers and business owners can analyse performance to plan for improved business resilience.

With the right encouragement and support, it is possible for dental professionals to achieve a healthier worklife balance. Support by management and co-workers, alongside clear policies and effective systems and procedures, can have a positive impact on the individual’s life both inside and outside of work. As well as contributing to a more engaged dental team, improved staff retention and increased profits, it just makes everybody happier, and what’s not to like about that?

For more information, visit aerona.com n

about the author Mark Garner, General Manager, areona Dental.

The heart of the dental surgery

As dental equipment rapidly evolves, it is beneficial for the dental practice to embrace new opportunities. Dental units impact the aesthetics and function of a dental surgery, providing patients with a comfortable experience, and supporting smooth professional workflows.

ergonomic benefits for you

In modern dentistry, musculoskeletal disease (MSDs) are considered an occupational hazard. However, they are preventable in many cases, with workplaces able to make changes to equipment and workflows to reduce the strain on the clinicians’ bodies. MSDs are a group of injuries or disorders of the muscles, nerves, tendons, and joints in the arms, legs, neck, shoulders, and back. Conditions which fall under this umbrella include carpal tunnel syndrome, sciatica, myofascial pain disorder, and tension neck, and the most commonly affected areas are the neck, shoulders, lower back, and upper back.

It is important to consider modifying workflows, or choosing more ergonomic equipment – to reduce the risk of developing an MSD. This might include implementing ergonomic dental units and stools, magnification loupes, prismatic spectacles, and ergonomic dental instruments, as well as providing educational resources about working ergonomically.

The dental unit can be a crucial aspect here. One study found that half of dental units did not have an adjustable headrest. This can cause difficulty for the clinician when accessing the treatment area, causing them to work in an uncomfortable position. When surgeries implement dental units with an adjustable headrest, access is effortless for the clinician, as viewing is improved by customising the position of the patient’s head to optimise treatment.

Clinicians should consider all aspects of their own posture, and the impact that this may have on MSDs. As much as possible, clinicians should sit up straight and use an adjustable and supportive chair/stool. When providing treatment, clinicians should work close to the body and minimise excessive wrist and finger movements. For the neck and back, clinicians should alternate working between sitting, standing, and being beside the patient, and adjust the height of the stool and the dental unit to be the most comfortable. Clinicians should also consider the patient’s position, and the position of the adjustable light to optimise visibility.

ergonomic benefits for your patient

Dental units should not only optimise posture for the clinician, but also provide support and comfort for the patient. Using a dental unit which offers patients a comfortable experience is likely to improve their overall opinion of the care they receive, boosting patient satisfaction

in your practice. Additionally, research into sensory triggers of dental anxiety include the noise of the dental handpiece, the sight and feeling of dental needles, and the muscular tension felt when positioned in an uncomfortable dental unit. Because of this, investing in equipment which is customisable and adjustable, that facilitates a comfortable experience, could actually reduce the levels of dental anxiety felt by patients during treatment.

Get more from your dental unit

Digital dentistry continues to develop, changing the workflows of many clinicians across the profession. By integrating digital solutions into every aspect of your surgery, you can expect improved comfort, patient communication, and treatment acceptance. Seek out dental units which facilitate digital customisation, allowing you to easily control handpieces, all in one place for further enhanced ergonomics. Functions may also include monitors, allowing you to edit and display clinical images for easy viewing during treatment, and to enable a more inclusive consultation. This will boost treatment acceptance and ensure patients are comfortable and informed, every step of the way.

The treatment centre is at the very heart of every dental surgery. It can contribute to patient comfort, and help you to streamline treatment workflows. Clark Dental has over 48 years of experience in dentistry, and

is able to help you choose the perfect treatment centre for your unique surgery – like the state-of-the-art Dentsply Sirona Axano treatment centre. The advanced treatment centre offers exceptional ergonomic features as well as options for customisation, and integrated digital functions including the SiroCam AF+, Sivision monitor, and Smart Touch user interface. The Axano treatment centre’s design is optimised to produce excellent workflows – from the initial diagnosis to case completion. Axano allows treatment steps to be performed intuitively, benefiting you and your patients.

Dental units affect each step of the treatment workflow including ergonomics, patient comfort, and even communication. Because of this, it’s important to choose equipment which will have a positive impact, boosting case acceptance, patient comfort, and reducing the risk of developing MSDs. If you’d like to find out more about Clark Dental’s solutions, call the team on 01268 733 146, email info@clarkdental.co.uk or visit www.clarkdental.co.uk. n

about the author Stuart clark, Managing Director, clark Dental.

Suddenly, home didn’t feel like home anymore.

A complaint to the GDC can turn your world upside down. Our dentolegal experts are here to help turn it the right way up again.

and be ready for whatever life throws at you.

The benefits of using AI in implant dentistry

Artificial intelligence (AI) is very quickly growing in healthcare – including within dentistry. This has led to a number of significant innovations in recent years, and the implementation of AI-driven technology across the profession. In dental implantology, it is important that clinicians understand the current and potential future uses of AI in the field, and the ways in which these might support, or elevate their current workflows.

clinical applications of ai Diagnosis and treatment planning

While AI facilitates enhanced workflows, helping to improve and speed up existing processes in the practice, it should not act as a substitute for the work of clinicians. Increasingly, practices across the UK are implementing AI-driven tools to support practitioners in diagnostics and treatment planning in various areas of the profession. AI has been used to analyse radiographs, assessing images for pathologies and pre-existing restorations, as well as in treatment planning to help enhance predictability. Machine learning and deep learning, two types of AI, prove to be very useful in these areas, assisting clinicians in diagnosis, decision making, predicting treatment outcomes, and treatment planning. Further to this, with 3D imaging systems such as CBCTs becoming more widely available, AI-assisted diagnosis and treatment planning is becoming increasingly accessible too.

prediction of treatment outcomes

Particularly in the field of dental implantology, which is regarded by many as a litigious area, the need for predictable treatment outcomes is essential for patient satisfaction. As dental implants continue to be the preferred option for replacing missing teeth, it is becoming increasingly important to minimise the risk of complications – and the additional time and costs associated with this. It can be difficult to predict implant loss or complications, due to the wide-ranging risk factors associated with the treatment type. Practitioners’ knowledge and experience is relied upon here, allowing for a certain degree of human error. This is an area which would hugely benefit from a reliable AI risk-assessment tool.

robotic implant surgery

Whilst this may still feel like a futuristic prospect to many, the advancement of AI may mean that robotic dentistry, including in the field of implant dentistry, becomes more commonplace in the years to come. Currently, it is expected that clinicians will still plan treatment, and oversee the surgery – enabling them to intervene if necessary – however surgical workflows of the future may be heavily supported by AI.

research and development in dental implantology

Optimised implant designs

In the future, AI may have an impact on research and development. In the field of dental implantology, this may mean that AI models are used to optimise dental implant design. This could focus on the mechanical

behaviour of dental implants, with an aim to optimise the concentration of stress at the implant-bone interface. Ideally, this progress would result in more predictable treatments, and increased implant survival rates. perfect prostheses

Whilst current processes for producing prostheses have reached incredibly high standards, AI may have the potential to make further improvements. Research suggests that, as patient expectations are becoming ever higher, the use of AI may help clinicians to improve the standard of care they can offer. Within prosthodontics specifically, this might mean improved decision making, and more intuitive manufacturing processes. The integration of AI with CAD/CAM technology in particular may prove extremely useful in dental implant supported prostheses workflows, enabling clinicians and dental technicians to save time, keep down costs, and reduce the risk of errors in the final prosthesis.

enhanced efficiency and patient care record keeping

In order to keep an accurate record of dental appointments. Clinicians must ensure that their notes are complete and contemporaneous. This can be an incredibly time-consuming task, and one which many dental professionals will agree is challenging – particularly in the litigious field of implant dentistry. It is incredibly important to ensure all aspects of consultations and treatments are recorded in the clinical notes, both to protect yourself, for you and your colleagues’ future

reference, and to ensure that patients are receiving the most appropriate care for them. As such, it can be useful to utilise AI-driven digital platforms which improve the process, without compromising the quality and personal aspect of the notes.

Association of Dental Implantology (ADI) members gain access to a specifically designed ADI template on Kiroku, the AI-powered digital note taking system, as part of their membership. The ADI works to uphold standards in the field, with a widereaching educational offering to ensure that clinicians stay up-to-date on all the latest developments in the field. Further to this, the ADI understands the day-to-day challenges faced by clinicians who provide dental implants, which is why it offers its members access to Kiroku, to help improve their workflows, and enhance the care they provide their patients.

Whilst strides are being made in AI supported dentistry every day, it is important that clinicians maintain high standards of patient care and stay up-to-date with the latest advancements. Becoming part of a supportive and education-focussed group can be incredibly helpful when aiming to achieve best practise.

For more information, visit adi.org.uk n

about the author Dr Zaki Kanaan, aDi president.

NHS dentistry wearing thin? Could dental technology assist in the management of tooth wear?

As has been well documented in recent years, the NHS is in crisis. It has been reported that 90% of dental practices cannot offer NHS appointments to new adult patients, with 80% not accepting new child patients either. The government has published their plan to recover and reform NHS dentistry outlining a number of areas for improvements, and suggestions as to how this might be done. However, many in the dental profession feel that this falls short, with the BDA stating that the government “risks condemning a generation to decay and widening oral health inequality”.

This highlights the value of preventative care for patients, particularly when it comes to tooth wear which, when allowed to worsen, can require extensive restorative treatment. However, many question whether widespread prevention is achievable within current NHS dentistry, and whether technology may be able to assist clinicians in the long-term.

tooth wear: a growing problem

At its inception, NHS dentistry was fundamentally designed to manage caries, rather than prevent it. As such, disease prevention is not rewarded in the current UDA system, despite the introduction of the new minimum UDA value. However,

as the incidence of caries reduces, tooth wear is increasing and is projected to be a significant problem facing patients and clinicians in the years to come. Levels of caries and gingivitis appear to be decreasing, while tooth wear is increasing in the UK – with 75% of those assessed having some form of tooth wear.v Currently, the NHS is not equipped to deal with this – especially considering that the UK has an ageing population and can expect patients who have kept their natural teeth to require greater assistance managing tooth wear in order to prevent damage and the need for extensive restorative treatment plans.

While tooth wear is considered age-related, its severity and patterns can be attributed to a number of factors – including lifestyle, diet, and oral hygiene. It is highly prevalent globally, affecting between 20-45% of permanent teeth, with the highest levels in Europe found in the UK. The NHS is not set up for effective preventive care or the management of complex tooth surface loss, so what can be done to assist the patients affected going forward?

How is tooth wear managed?

Checking for signs of tooth wear is crucial to assess which patients might be at risk for dental trauma or disease in the future. Whilst certain levels of tooth wear are expected in all patients as a natural part

of ageing, significant tooth surface loss indicates an area of concern. The longterm monitoring of tooth wear is key for preventing pathological wear, and returning the rate to that of physiological wear. To do this, monitoring patients and diagnosing them early is key for preventing further tooth surface loss. Depending on the severity, some patients may require the application of fluoride varnish to remineralise the tooth, whereas others may require restorative intervention, or endodontic treatment where pulpal involvement occurs. Currently, monitoring the progression of tooth wear requires taking regular clinical photographs, and the periodic production of study casts. Whilst these offer clinicians a point of reference to measure tooth wear over time, they lack accuracy are time consuming and are difficult to compare. Digital solutions may present a solution here, but current models are costly, and may not be a realistic option for NHS dental practices.

effective use of technology

Across the entire dental profession, digital solutions are improving clinicians’ workflows. Day-to-day tasks are becoming more efficient and, with the continued implementation of AI-assisted technology, clinicians and their patients can enjoy more comfortable and interactive experiences.

In many cases, digital solutions could be very helpful for monitoring tooth wear over time. Looking to the future, digital dentistry will help to more effectively prevent catastrophic root fracture and the need for expensive treatments. This could provide an alternative system for monitoring tooth wear not currently available in the existing NHS framework. Digital solutions can be useful in the treatment of tooth wear too, by means of 3D planning and design of restorations to ensure that they are the appropriate dimensions to support recovery. Further to this, digital solutions may be used to prevent damage to the restorations once in place, by fabricating mouth guards. Digital technologies are already making the processes needed to complete these workflows far more efficient, which is promising for the future of dentistry, and particularly preventive dentistry. They will enable clinicians to monitor their patients with intense accuracy, providing the ability to offer the right interventions at the right time. n

about the author alyn Morgan, past-president of the British endodontic Society.

Exceptional service from Clark Dental

Dr Katharina Thiel worked with Clark Dental to renovate two surgeries in September 2023. She shares her experience of working with the team on this project

Imade the decision to renovate two surgeries in my dental practice (Central London) in March 2023. I had initially decided to embark on this project as one of my old dental chairs was falling apart, and it was no longer possible to repair. It took me until September to start the project and I was dreading it. In the end I decided to replace two dental chairs. After 25 years of using our current dental unit, I decided on the Intego Pro treatment centres from Dentsply Sirona this time and ended up renovating two surgeries, including new Edarredo cabinetry.

I came across the Dentsply Sirona chairs at the International Dental Show in Cologne in March last year where I tried out several companies, including Belmont and Kavo. I thought the Dentsply Sirona Intego chair was well thought through, good quality, and good value for money.

I considered working with several companies. I did not take this process lightly, comparing prices and services, and I always go for a bit of gut feeling as well. In the end, I decided to work with Clark Dental and I did not regret it for a single moment!

The project was smooth and painless. Also, with the help of some reliable builders who I had known for years, it finished in the predicted time frame of two and a half weeks.

Initially I started off working with Matt Rowlingson, Technical Director at Clark Dental, who is not just a good salesman but also a good deliverer. He was just the right man, he stuck to his promises and timetables and could also be hands-on when he needed to be. Also, he was always there on the other end of the phone if a problem arose, even after the installation, he was quick to provide a solution to any query. I knew that I had found the right match.

During the installation I got to know the technicians, who were very competent, helpful, on time and nice to have around. It is always

nice to see people taking pride in doing a good job.

I would rate Clark Dental 10 out of 10 for the overall experience and exceptional service. I wish the company, who have created a very reliable, good value for money business, all the success they deserve.

For more information call Clark Dental on 01268 733 146, email info@clarkdental.co.uk or visit www.clarkdental.co.uk 

Naturally GTO®. From syringe to defect. GTO®

Peri-implant defect treated with OsteoBiol® GTO®

Author: Dr Patrick Palacci, Marseille, France

• Outstanding stability due to ideal viscosity

• Ready-to-use in sterile syringe

• Easily adaptable to the recipient site

• Innovative dual-phase biotechnology

• TSV Gel inside for optimal stickiness

• Directly injectable into bone defect

• Faster and safer surgical handling

• Cortico-cancellous collagenated matrix

What does it mean to deliver patient-centric care?

Patient-centric care is the future of dentistry. It’s also the reason that patients will keep coming back to the same practice time and time again. As the shift away from NHS dental services and towards private care continues, it is becoming increasingly important to create an excellent patient experience during every single visit.

the importance of the patient experience

How a patient feels about their dental team and practice will have a far-reaching impact for them, their dental provider and the wider healthcare system. For a start, a positive patient experience has been associated with improved compliance with healthcare recommendations and therefore better clinical outcomes. This also stands individuals in good stead for the future, enhancing their understanding of and appreciation for preventive measures. This means that patientcentric care can lead to higher standards of oral health across the nation.

In addition to supporting patients’ oral health in the long-term, a high-quality experience in the practice will also benefit the business. Happy patients will be more loyal to the clinic and are therefore far more likely to return time and time again, boosting business profitability and sustainability. This is further optimised by the impact that satisfied patients have on the reputation of the practice, attracting new patients to the business from within the local community.

What affects patient perceptions?

There are many aspects that affect the dental patient experience. The most obvious is the physical environment in which patients receive care. For instance, the atmospherics within the practice will influence patient emotion and, as such, should be considered carefully. Colour psychology should be employed to encourage perceptions of a clean, calming and friendly practice, eliciting the right emotions from patients. Steps should also be taken to ensure a physical comfortable space that accommodates at least basic needs, like drinking water, a bathroom and adequate space in the waiting room.

But the patient experience is impacted by much more than the colour of the walls and the comfort of the chairs. The entire dental team plays an important role in creating a truly serene, inclusive and caring atmosphere. For example, one study found that patients valued having a supportive and caring dental team above all else. They felt that this helped them maintain a higher level of control over their oral health. It was also shown to lead to greater changes in oral hygiene behaviours, enhancing patient engagement with their daily routines.

The quality of communication between dentist and patient has also been highlighted as key to patient satisfaction. Research suggests that dynamic communication is crucial, allowing a two-way conversation to optimise patient interaction and understanding. This contributes significantly to patient autonomy and enables individuals

The competitive edge

In a rapidly expanding market, dental practice owners are increasingly aware of the need to maintain a competitive edge. Most healthcare professionals don’t have an MBA, and some aspects of managing a business can be daunting. Analysing metrics may be far from the mind of the principal dentist, but developing an insight into the drivers of profit and loss helps business owners succeed. It is important for practice leaders to align internal processes to meet the needs, opportunities and challenges within their business environment.

internal processes

According to Forbes Magazine, the number one factor giving businesses an advantage over competitors is humanised services. It may seem counter-intuitive to suggest that streamlining services using digital systems enables practices to offer a more personal service, but they can provide practitioners with the time and headspace – as well as the tools – to focus on patients. And in a society where almost every service we use – from shopping to banking – maintains a simple, seamless and secure digital userinterface, expectations are high. Quick access to comprehensive patient notes, including high-res scans and images, is an essential part of the clinician/patient relationship. For patients, seeing that their up-to-date records are at the fingertips of their clinicians goes beyond customer care or convenience, it builds confidence and trust. A poor data-

to be more involved in the decision-making process regarding dental treatment –something that most patients desire.

Making a positive difference

Achieving this means ensuring transparency with every patient and taking steps to improve their understanding of both their oral health status and any proposed treatments. This is crucial to building trust and managing patient expectations in order to increase their satisfaction with the results achieved. Even when describing what you may deem to be simple procedures, patients still need to be able to visualise what will be done and why. Delivering this procedural insight in a way that patients understand is not only a GDC requirement, but it will also contribute significantly to their satisfaction and experience. By giving patients this higher level of control, practitioners are also likely to see an increase in treatment acceptance for a boost in productivity, efficiency and profitability too.

How can all this be done within the normal constraints of a dental appointment?

With help from cutting-edge technology, of course. Chairsyde – the innovative consultation platform – streamlines patient communication and engagement for an enhanced patient experience. It offers an array of animations that clearly explain oral health conditions and related treatments, including their benefits, risks and limitations, and automatically sends a copy of any videos shown in-practice for patients to browse in their own time at home. This ensures fully informed patients and enhanced consent, but also gives the patient what they need to engage with their oral health and actively participate in the decision-making process.

the future of dentistry

Most in the field will agree that patientcentred care is the future of dentistry. It provides a way of better engaging with patients and encouraging them to take responsibility for their health. With on-going education and a supportive environment, dental teams can help more patients improve their dental health for many years to come. For more information, or to book a demo, please visit www.chairsyde.com or call 020 3951 8360 n

about the author Loven Ganeswaran, ceO and founder, chairsyde.

management system could affect clinical outcomes, and could leave practices open to serious consequences, including legal action, fines and reputational damage.

Increasingly in today’s market, patients will spend much of their journey between seeking treatment and the time they sit in the dental chair using digital platforms, and they will expect a seamless, efficient experience in the practice too. A completely streamlined practice management system avoids the risk of a disjointed experience for patients, and for the dental practice, it avoids a wasteful duplication of processes, or relying on third-party integration tools, which can be unreliable and costly. Complete software integration prevents disruption to daily workflows.

Analysing metrics – for example, looking at the relationship between patient retention and the relative demand for a certain procedure over the course of a year, against costs and potential income –will enable a practice to develop a robust strategy around services. They will be able to better measure their successes, as well as identify where they need to direct more energy, enabling them to develop meaningful and relevant Key Performance Indicators (KPIs).

Practice management systems may well collect useful data, but if the information is not fully integrated, or is multiple clicks away, the process may be fragmented and laborious. Clinicians may find themselves monitoring their performance less regularly, meaning they lack the insight of competitors.

Dental software – meeting business needs

To remain competitive, practice systems and procedures should be effective and efficient. If you decide you need to make a change, procuring the right fully integrated business management system takes research. In addition to ensuring the system works to cover all your required functions, things to consider are security, affordability scalability and flexibility. A few questions might be:

1. Security:

a. Does it comply with all statutory regulations?

b. Do safeguards interfere with performance?

2. affordability:

a. Does the system offer benefits that equal or outweigh the costs? What are the long-term costs and benefits?

b. What is the cost and timescale of data migration and is the process fully supported?

c. What does ongoing training and support cost for the system?

3. Scalability:

a. Does the system suit the needs of my existing business, and will it grow and develop accordingly?

b. Can it be used seamlessly across multi-site practices?

4. Flexibility:

a. Does the system use technology that is likely to be continually updated alongside other common systems?

b. Do new users adapt to the system intuitively and easily?

Finally, when deciding on a shift to a new system, it’s important to consider the company. Are they well-established? Do they have a successful track-record of innovation? And does their operation indicate they are responsive to the changing needs of clients as their practices develop?

Sensei Cloud Enterprise, from the practice and patient management brand of Carestream Dental, has been developed by dentists to provide an answer to the needs of any dental practice. Sensei Cloud Enterprise is a cloud-based, centralised business platform. With intuitive visualisation tools, it makes analysis easy, and insights can inform your business in real time, straight from your dashboard. Sensei Cloud offers built-in support for patients with a fantastic online bookings interface, alongside user-friendly security for a system that safely retains data for easy access, whether your practice is multi-location or based in a single site. From safely managing your patients’ data, to pulling financial reports for auditors, to providing relevant analytics to move your practice forward, a practice management system that is fully integrated and streamlines processes will give any dental practice a competitive edge.

For more information on Sensei Cloud visit https://gosensei.co.uk/ n

about the author Nina Gilbert, Senior Global product Line Manager, carestream Dental.

Find equipment and support you can depend on

The decontamination equipment you choose for your dental practice will have a significant impact on the quality of patient care you can deliver, the safety standards you can maintain and the workflow efficiency your team can achieve. Implementing effective solutions in the right way can also help create a stressfree working environment for increased job satisfaction among professionals.

It is just as important to select a manufacturer and supplier that provides high-quality and rapid-response technical support that keeps your equipment operational and your business running smoothly. In the event of a product malfunction, having peace of mind that the experts are available to resolve issues fast is invaluable.

Having had a poor experience with customer support in the past, Dr Chris Pritchard appreciates now working with a

supplier that delivers the quality infection control products and service that he and his team need.

Chris graduated in 1998, completing postgraduate General Professional Training (GPT) at Edinburgh Dental Institute. He worked as an associate in Edinburgh and New Zealand before buying his current practice, Gentle Dental Care, in 2010 from a retiring dentist who he knew from his Dundee Dental School days. About his business, Chris says: “It is a two-surgery, family practice in the centre of the famous town of St Andrews. We offer NHS treatment to our young patients and a range of private dental services for adults. On average, we see between 10-20 patients each day. Our focus is on delivering great quality dentistry, but we are also passionate about providing excellent customer service and genuinely getting to know our patients.”

The infection control workflow is crucial for the safety of patients and staff throughout the practice. Meeting high standards begins with training the dental team, ensuring that all relevant members have the knowledge and confidence to facilitate effective decontamination processes. Chris comments on how he ensures his team remain compliant: “We provide mandatory training as part of our staff inductions within the area of infection control. All new dental nurses are shadowed and mentored for at least 1-2 months until they are competent in understanding and replicating our crossinfection control policies.”

Chris switched provider of decontamination equipment last year because he was dissatisfied with the service he had received from the previous company. He says: “The equipment you use is hugely important for your practice processes. I had previously invested in lesser-known brands of autoclaves, which I found to be temperamental and unpredictable. The engineers would fix one issue, only for another unrelated problem to develop a few days later. This impacts the efficiency of the practice, disrupts patient care and creates frustration for the team. The autoclaves are the critical step in the decontamination process, so it is vital that they run consistently, without any breakdowns.”

Chris purchased a Miele PG58581 washer disinfector from Eschmann last year, followed by two Little Sister SES 3000B autoclaves and a Reverse Osmosis (RO) System from Eschmann

more recently. He shares his reasons for sourcing equipment from Eschmann:

“I chose Eschmann as, amongst my peers, it was repeatedly recommended as being the best company for quality and reliability when it comes to decontamination equipment.

“I decided to introduce the RO System because we were having frequent issues with the water quality in our area and we were keen to streamline the maintenance and servicing of our equipment. Rather than purchasing multiple pieces of equipment from various different companies, we felt that keeping everything under the umbrella of Eschmann made sense.

“We now have a designated engineer, Andy, who provides us with a first-class service every time, complete with a smile! So far, we have just needed routine maintenance, so long may it continue.” Eschmann provided ECPD training for Chris and the team when installing the new equipment, in addition to the on-going maintenance already mentioned.

If you’re passionate about maintaining the highest possible standard of patient care, and creating a positive working environment for the team, be sure to invest in quality equipment. Only with the right tools and adequate support can your practice fulfil its potential.

For more information on the highly effective and affordable range of infection control products from Eschmann, please visit eschmann.co.uk or call 01903 753322 

Weight loss and halitosis

Weight loss can be a taboo topic for many individuals, with people taking drastic action to address health issues, change their appearance, or achieve other targets. It can also be an entirely unintentional product of changing lifestyle habits or illness, with causes ranging from depression to diarrhoea, viral infections such as a common cold, or extreme illness like cancer.

Losing weight, especially in a short span of time, can affect a person’s oral health and hygiene in a number of ways. Dental professionals are in a unique position to help manage unfortunate side effects of weight loss, which include the development of halitosis.

Choosing the right foods

A change in diet can be an effective method of losing weight. Patients may choose to cut calories from their daily intake either by taking in smaller meals or adjusting the types of food they eat. When taken to the extreme, it is sometimes called a crash diet. The food that individuals replace their everyday meals with makes an enormous impact on both their general and oral health. For example, the ketogenic diet, sometimes just called the keto diet, sees people adopt a high-fat, moderate-protein, low-carb intake to achieve ketosis. In short, this is the body’s natural adaption to a lack of carbohydrates as an energy source. It overproduces acetyl coenzyme A to serve as the replacement, but the process also sees increased levels of ketone bodies –acetoacetate, ß-hydroxybutryric acid and acetone – which will eventually be used for energy too.

The acetone is our main focus. Its presence can alter an individual’s breath in an unfortunate manner, previously described as the odour of decaying apples, which can be both noticeable and repugnant. Patients may attribute the malodour to an issue with the dentition, or perhaps even an infection, but it is the duty of the dental practitioner to recognise that the source may actually lie in their diet or general weight loss.

Weight loss in-demand

When the matter of weight loss takes up headlines now, it is often linked with the use of semaglutide, better known by the brand name Ozempic. The type 2 diabetes medication is a weekly injection that, aside from its benefits for diabetic patients, causes a reduction of appetite and slows down the movement of food in the gut. In turn, users eat less and feel full for longer, making it an effective weight loss aid – though current guidelines emphasise

that it must not be prescribed solely for weight loss purposes.

Semaglutide and its effect on oral health is still being explored, and may see further studies established given the interest around its weight loss abilities. At this moment, there are some things we can assess. A small-scale 2023 report saw three female patients taking the drug for weight loss purposes, each stated that they had dry mouth, or xerostomia, which has links to caries, oral fungal infections, and halitosis.

Whilst patients may experience this as a result of limited water intake because of their suppressed appetite, there are other potential causes related to semaglutide. The drug has known body water loss properties, and one of its common side effects, chronic diarrhoea, could lead to total body dehydration. This could bring on xerostomia, and the resultant bad breath that sometimes accompanies it.

The effect of semaglutide on the gut has also been considered a potential causation of halitosis. Theories suggest that the drug could contribute to gut dysbiosis. One animal study found that a GLP-1 receptor agonist (liraglutide) that shares qualities with semaglutide decreased microbial diversity and led to gut imbalance. Because this drug, like semaglutide, slows digestion, it could lead to a proliferation of gut bacteria known to produce volatile sulphur compounds, which are heavily linked to halitosis.

effective support

Dental professionals might be able to identify the cause of halitosis as a change in diet or the use of weight loss aids, but patients may be unwilling or unable to alter from their current health practices. In the case of semaglutide use, this may be because the patient is also type 2 diabetic, for example.

In such a case, clinicians must be able to provide an effective solution that combats halitosis directly. Consider the Fresh Breath Oral Rinse from The Breath Co., a powerful and alcohol-free mouthwash that fights bad breath for up to 12 hours. Available in mild mint and icy mint flavours, they each use sodium chlorite to activate the power of oxygen to tackle bacteria, and negate halitosis. The unique formula is pH-balanced, unlike other acid-based mouthwashes.

Understanding the potential links between weight loss, the medications used to help it, and the effects on oral health is essential for every clinician. Providing support when a patient encounters a side effect like halitosis can ensure they maintain confidence in everyday life, no matter the associated cause.

For more information about The Breath Co., visit http://www.thebreathco.com/ n

about the author andrea hammond is a Dental hygienist and Waterpik Professional educator.

Mental health and oral health

Patients experiencing mental illhealth are more likely to suffer from suboptimal oral health, including tooth loss, periodontal disease, and tooth decay. Many depressive symptoms, such as anhedonia or lack of motivation, feelings of worthlessness, and fatigue, may adversely affect oral hygiene maintenance. Some antipsychotic medications can cause tardive dyskinesias – an involuntary body movement associated with bruxism and jaw clenching – as well as xerostomia.

Young people: mental health in crisis

The significant rise in the number of young people requiring emergency care due to mental ill-health has recently been described by the Royal College of Psychiatrists as a ‘crisis’. The World Health Organization warns that one in seven young people between 10 and 19 are suffering from a mental health disorder. Mental illness accounts for 13% of all health issues affecting this age group globally. Mind, the mental health charity, reports that one in six young people between the age of five and 16 in the UK have experienced a mental health problem, up from one in nine in 2017. Mental health conditions affecting young people range from emotional disorders including anxiety, panic disorders and depression, behavioural disorders, conduct disorders, eating disorders, psychosis, selfharm and risk-taking behaviours, like heavy drinking or drug-use.

According to NHS figures released in 2023, the number of under 18s referred to Child and Adolescent Mental Health Services (CAMHS), has risen by 53% since 2019. A quarter of a million young people have not been able to access NHS support in the last year, and the future looks uncertain for people in crisis due to workforce shortages.

Dental professionals may come into contact with young people displaying worrying symptoms, such as tooth erosion due to bulimia. Although practices will have clear safeguarding policies, individuals may feel uneasy about how to communicate concerns about a patient’s mental health or potentially unhealthy circumstances.

Stigma and awareness

Although some information about Special Care Dentistry – the newest specialism recognised by the GDC – is introduced to undergraduates, many dentists in general practice lack confidence in treating patients experiencing mental ill-health. A good first step for practitioners is to develop greater awareness. This helps challenge preconceptions that contribute to stigmatising behaviours.

mental health is vital to avoid possible contraindications. Commonly prescribed pharmaceuticals, such as NSAIDs and opioids can cause complications for patients taking anti-depressants or anti-psychotics.

optimising engagement for healthier outcomes

Record-keeping is important for all patients, but accurate and contemporaneous records of observations or findings is vital for patients experiencing mental ill health. Doing so ensures all professionals involved in the patient’s care are aware of any needs, contraindications or issues identified in consultation without a patient or carer having to explain on each visit. It is important for clinicians to communicate with patients, relatives, carers, and guardians with clear and accurate information, avoiding unnecessary jargon, in a form the recipient can understand. Further, clinicians should communicate effectively with referring professionals, ensuring continuity and coordination of patient care. Finally, they should involve their young patients as much as possible in their care, seek informed consent, and implement treatment plans which minimise disabling barriers.

Ensuring contemporaneous notes are accurate and complete during consultations, as well as creating relevant documentation for a patient with complex needs can require a great deal of time and attention. It is estimated that healthcare professionals spend a third of their time on clinical documentation, which can compromise their time spent with patients and their carers, as well as eat into their own valuable personal time.

Although people do now speak more freely about mental health, a recent survey reveals that 51% of the UK population still believes that there is a great deal/fair amount of shame associated with mental health conditions. 56% of respondents experiencing mental ill health feel ashamed of their condition. More than one in 10, or 12% of respondents believe that individuals living with mental illness should be ashamed of their mental health problem. Open discussion about

Kiroku is an incredible solution, powered by AI and designed by dentists, that enables clinicians to create detailed contemporaneous consultation notes with the touch of a few buttons. Kiroku notes can be configured to suit any number of different examinations, and the system comes out of the box with a large bank of customisable stock templates. With the touch of a button, Kiroku Docs can then automatically convert notes into any documentation you might need, including relevant and clear information in patient-friendly language, consent forms or referral letters using clinical terminology. Treatment outcomes benefit from professionals having the tools to communicate with and educate young patients and their carers. Doing so helps boost their patients’ sense of efficacy around their own health, and as patients grow older, a good experience with their clinician will help them feel less anxious about visiting independently. Clear communication, combined with empathy and understanding helps lessen the stigma of mental ill health, and helps lay the foundations for lifelong oral health.

To find out more about Kiroku, or to start your free trial, please visit trykiroku.com n

about the author hannah Burrow, Ceo of Kiroku.

Oral hygiene and impaired motor skills

As we know, excellent oral hygiene is crucial for maintaining oral health, and ensuring a good quality of life. However, for some patients, keeping the teeth and gingiva clean is physically challenging. Certain medical conditions can mean that it is hard to take care of personal hygiene. For example, patients with impaired motor skills or memory can find this particularly difficult.

Conditions which pose challenges

There are a number of conditions which might impact a patient’s ability to carry out effective oral hygiene. These might mean that patients are unable to move normally, or have problems with memory. Some of the most common of these conditions include multiple sclerosis (MS), cerebral palsy, epilepsy, rheumatoid arthritis, Parkinson’s disease and Alzheimer’s disease or having had a stroke.

Reduced mobility can make it difficult for some patients to open their mouth, or to hold and move a toothbrush properly. This can mean that it’s difficult to remove plaque from all tooth surfaces leading to an increased risk of gingival irritation and

inflammation, and oral diseases such as caries, gingivitis, and periodontitis. These conditions can be painful, and can lead to infections and tooth loss in the long-term.i

When the memory is affected, this might mean that patients forget to brush their teeth, or make and attend dental appointments. It can be helpful to discuss strategies to help manage this with a patient’s family or carers, as this will help them to maintain a good quality of life, and help to keep their mouth healthy. Additionally, some medications or conditions can cause dry mouth – making the mouth feel sore. Because of this, some patients can find toothbrushing painful, and the lack of saliva can make them more prone to caries. It’s important to help patients manage this to maintain a healthy mouth.

Helpful adjustments to make a difference

To help maintain a healthy mouth, there are a number of adjustments both to lifestyle and oral hygiene that could be made. It’s important for patients (and/or their family or carers) to understand how best to take care of the mouth, and the effects that certain factors can have on oral health.

Firstly, brushing the teeth properly –either independently or with assistance – is important for preventing the development of oral diseases. This means brushing twice a day using a toothpaste which contains sufficient fluoride (1350-1500ppm). Further to this, interdental cleaning once per

day is important for removing plaque in areas regular brushing cannot reach –demonstrating how to do this effectively is crucial for solidifying patient understanding.i

Making lifestyle adjustments can also be key for prevention. This might mean increasing the amount of fruit and vegetables they eat, cutting down on sugary food and drink, and opting for sugar-free versions where appropriate. Limiting the amount of alcohol patients consume can also be helpful for protecting oral health, as well as quitting smoking – this is because both of these can increase the risk of mouth cancer. Regular dental appointments are essential. Where dental professionals are able to monitor patients’ oral health status regularly, they will be able to more easily intervene and prevent the development of oral diseases. Clinicians should also recommend solutions for dry mouth, where applicable, to help make brushing easier, and more comfortable.

Targeted solutions for periodontal health

The implications of poor oral hygiene on soft tissue health can be substantial. If the gingiva becomes consistently inflamed, red, and sore, the patient may develop periodontitis. The disease is characterised by bleeding, swelling, pain, and bad breath and, in severe cases, it can cause the gingiva to pull away from the tooth and bone. Eventually, if left untreated, tooth loss is a possibility. Periodontal disease is estimated to affect around 19% of adults, globally.

In some cases, particularly for patients who find toothbrushing difficult, a mouthwash can be a helpful tool. This should be used at a different time to toothbrushing and, with the right ingredients, may help patients to keep plaque levels under control. Perio plus Balance Mouthwash from Curaprox reduces the risk of tooth decay and is ideal for long-term use. This makes it a great solution for patients who have impaired motor skills, with a chlorhexidine concentration of 0.05% giving patients the benefits of its antibacterial properties, and its unique formula offering long-term protection against harmful bacteria. If patients are struggling to carry out oral hygiene effectively, due to a health condition or a motor issue, it is important to work with them to help find solutions which work for their unique situation. In particular, establishing a routine which is simple to follow and uses tools which are accessible for them will offer the best results. Regular check-ups will help you to monitor their progress, and make adjustments to their routine and offer treatments where needed. For more information, please visit curaprox.co.uk andcuraden.co.uk 

About the author Tom Alcraft, Curaden UK Commercial Director, UK & Ireland

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Rehabilitation after oral cancer

Oral cancer affects 650,000 people per year worldwide. Currently men are twice as susceptible as women, though female cases are increasing. It is calculated that more people in the UK die of oral cancer than of cervical and testicular cancer combined, and the incidence rate has risen by 49% in the last 10 years.

Malignant diseases of the head and neck can require radical treatment, sometimes resulting in loss of teeth and bone, causing drastic changes in anatomy and aesthetics. The implications of this are life-changing: dental function, speech, swallowing and appearance can all be altered, deeply affecting a patient’s social and psychological wellbeing.

The goal of treating oral cancer is not just the reconstruction of affected areas, but the restoration of function and aesthetics. Dental rehabilitation after maxillary oncological resection can be demanding. There are technical difficulties once the anatomy of the region has been altered. Surgeons are tasked with re-establishing a separation between the oral cavity and the nasal/ paranasal regions, as well as rehabilitating oral function with a prosthesis that can also deliver satisfactory facial aesthetics.

In the past, rehabilitation was mainly obtained with a removable obturator prosthesis. This solution is not sufficient in many cases of radical resection, and patients often have difficulty wearing conventional prostheses due to mucosal irritation, dryness or ulceration. Pedicled or free muscle flaps are successful in separating the oral cavity from the nasal/

paranasal region. These procedures do not restore function or aesthetics.

After maxillary oncological resection, reconstructive procedures with osteomyocutaneous composite flaps have been used to create enough bone volume for endosseous implants. However, the shape of the defect can preclude this form of treatment. As well as requiring a number of interventions and several healing periods, further complications can arise due to the effects of post-operative radiotherapy.

Zygomatic implants: a game changer for survivors of oral cancer

Zygomatic implants (ZIs) were first introduced in 1988 for the treatment of oncologic patients as an anchor for obturator prostheses. But through the years, ZIs have been used for different protocols with increasingly promising results. Successful outcomes are increasingly a reality despite the effects of radiotherapy, which in turn is significantly less likely to affect healthy adjacent tissue during treatment than in previous decades.

Zygomatic bone acts as an ideal anchor, due to its resistance to metastasis. Its anatomical features represent an alternative anchorage for implants even after major resections in the maxillary bone.

ZIs are rapidly advancing in the field of dental implantology as an immediate and predictable treatment for severe maxillary atrophy. They can provide remote anchorage for a variety of oral and facial prostheses that can dramatically and rapidly improve function and quality of life for patients being treated for maxillary and mid-facial tumours.

The use of ZIs has several advantages, such as a considerable shortening of treatment time, decreased morbidity because the technique eliminates the necessity of a graft (and thus a graft donor site), a smaller number of implants to support fixed prostheses, and a decrease of the patients’ costs. ZIs have enabled the oral surgeon to overcome the local osseous deficiency by engaging hard tissue at the distant zygomatic bone, allowing increased retention and stability of an obturator or prosthesis.

Several approaches are now in use for the rehabilitation of the maxilla, with tilted implants and bilateral/single ZIs. The treatment of severe maxilla atrophic jaws with zygomatic implants is increasingly considered a safe and minimally invasive procedure, reaching a cumulative success rate of 96.1% after more than 5 years.

It is now possible to perform immediate loading procedures in oncologic patients by the utilisation of zygomatic implants, hugely reducing the time between cancer removal and the complete rehabilitation of the patient. Patients with head and neck cancer who receive zygomatic implant prostheses are generally found to have more favourable outcomes in terms of speech, aesthetics or facial contour and eating and drinking function without nasal leakage.

The installation of ZIs is a major surgical procedure and should be performed only

by properly trained clinicians. Due to the complexity of the zygomatic structures, there is considerable risk of soft tissue complications around the abutments and of sinusitis.

Leading global brand, W&H, has developed the Zygoma Surgical Handpiece SZ-75, as a comprehensive solution for even the most complex of ZI cases. The 20:1 transmission ratio gives surgeons powerful accuracy with easy action. Among many unique features, the Zygoma handpiece incorporates optimal angulation to make access to difficult surgical sites easy. Ergonomic design also takes the fatigue out of conducting intricate procedures over a long duration. W&H offers a broad surgical solution with the Zygoma handpiece used alongside the Implantmed Plus surgical motor offering a wealth of options to enhance surgical treatment. Oral rehabilitation after maxillary oncological resection is challenging, both for dental surgeons and patients. However, it is important to consider quality of life when treating survivors of oral cancer. Loss of function and aesthetics can have a dramatic effect on patients’ lives and, for many, this represents a shorter duration due to the nature of their diagnosis. The shorter treatment period involved in zygomatic treatment is a real gamechanger for patients.

To find out more visit wh.com, call 01727 874990 or email office.uk@wh.com n

about the author Kate Scheer, Marketing executive, W&h (UK) ltd.

Ultra-processed food and cancer risk

Ultra-processed food (UPF) otherwise known as ‘junk food’ is affordable and accessible, but offers a low nutritional value with high saturated fat, sugar, and salt content. In the UK, 57% of adults’ daily intake is derived from UPF, even higher in adolescents (66%). While processed food in itself is not a bad thing, with some processes making food safer and increasing shelf life, ultra-processing is associated with health issues from over-consumption. These well-established risks include heart disease, obesity, and type 2 diabetes.

Impact on oral health

UPF is often sugary or starchy, which can have a negative impact on patients’ oral health. When consumed regularly, and in excess, sugary snacks and drinks can lead to oral diseases such as caries and gingivitis. Research suggests that higher UPF consumption is associated with increased rates of caries in children and adolescents, highlighting the need for improved diets and oral hygiene education to protect long term oral health.

risk of oral cancer

Furthermore, researchers at the University of Bristol have analysed the diet and lifestyle data of 450,111 adults over 14 years. They found that eating more UPF

may be associated with a higher risk of developing cancer in the mouth, throat, and oesophagus. One study identified the association between UPF consumption and cancer, concluding that replacing processed and ultra-processed foods and drinks with minimally processed foods might reduce the risk of various cancers.

Results from the study showed that eating 10% more UPF is associated with a 23% higher risk of head and neck cancer, and a 24% higher risk of oesophageal cancer. Researchers suggested reasons behind this association. These included the additives found in UPF, such as emulsifiers and artificial sweeteners, which are associated with increased risk of disease, as well as contaminants from the food packaging and manufacturing processes. Each of these could, in part, explain the correlation found in their study.

The authors also commented that, while there is a clear association between UPF and adverse health, it is unclear whether they are the direct cause. They suggested that other factors, such as general health-related issues and socioeconomic position, might play a role too. This being said, this research does indicate a link between UPF and oral cancer, and the World Cancer Research Fund International recommends limiting the consumption of processed foods which are high in fat, starch, or sugar for a healthy lifestyle.

Monitoring for oral cancer

While changing patients’ behaviour is always going to be a challenge, it’s important to make them aware of the risks of their behaviour, whether that’s smoking, drinking, or their diet, and offer them helpful advice. Many patients may be unaware that the food they eat is linked to various cancers, and might not even know they are at risk. As such, it’s important to monitor every patient closely for the early signs of oral cancer to pick it up early and improve survival rates.

Currently, an estimated 70% of oral cancers are detected in advanced stages where survival rates are around 50%.

However, when diagnosed in stages I and II, survival rates rise to 90%. As such, advising patients to check their mouths for anything unusual, and attend regular dental check-ups, means that lesions can be identified and treated as quickly as possible.

Consistent monitoring

Using a pre-diagnostic chairside test when you spot an unusual lesion can be incredibly helpful for picking up on oral cancer in its early stages, and offering you and your patients peace of mind. The early signs of cancer can be indistinguishable from other conditions, such as mouth ulcers, so it’s important to be vigilant and perform the appropriate tests at the right time.

The BeVigilant OraFusion System from Vigilant Biosciences® is a quick and easy prediagnostic test which is designed to be used at point of care, using saliva. If a dentist spots a lesion which they think is suspicious, the BeVigilant Orafusion System can be used to identify the presence of biomarkers associated with oral cancer, producing a result in 15 minutes or less. This is ideal for clinicians who would like to feel more confident when referring patients, and assessing for oral cancer. Whether you have identified an abnormal lesion or not, it is important that dental professionals continue to promote a healthy lifestyle to their patients. Recommending patients have a balanced diet, low in free sugars and UPF is helpful for reducing their risk of oral cancer. Most importantly, clinicians should recommend that their patients attend dental appointments regularly to help ensure that nothing is missed for the best chances for their long-term health. For more information, please visit www.vigilantbiosciences.com or email info@vigilantbiosciences.com n

about the author

Phil Silver, Founder of total tMJ, which distributes innovative technologies from leading healthcare manufacturers to dentists and clinicians around the UK.

Getting a head start in dentistry

It is crucial that dentists starting out in the profession have an opportunity to consolidate and advance their skills in a safe and supportive environment. They need access to on-going training and education that is pitched at the right level, as well as a network of colleagues who can offer effective guidance and mentorship.

Clyde Munro understands this well and offers a purposefully structured journey for the early career dentist. From vocational training (VT) to the first five years of dentistry through to specialism, the group actively facilitates skill development and career progression for all.

The VT year, for example, gives dentists the chance to work in cuttingedge practices with vastly experienced colleagues. It is also supported by the Best Foot Forward Programme, which offers three sessions with an overnight event. This covers everything from artificial intelligence (AI) in dentistry, to endodontics and stress management. This is designed to complement the VT training and dedicated study days, ensuring a comprehensive education for young dentists.

Dr Paul Capanni is currently doing his VT with Clyde Munro in the Scottish Highlands. He reflects on what he has found to be the biggest challenges of moving into the practice environment after university:

“The increased workload has been very apparent. It’s also a little daunting to have to make all the decisions for yourself; you have to think on your feet a lot. There is

also more pressure on you to refine your skills and build confidence, as you know that you only have until the end of the year to be able to work independently. The key is finding a balance between developing your skills and doing so safely with your mentor.”

Paul considers how the group has supported his development at this crucial stage of his career:

“Clyde Munro offers dedicated VT study days and additional training, which has all been really good with a lot of excellent sessions covering relevant topics. These are also great opportunities to meet other VTs

Marylebone Clinic: 74–78 Seymour Place, London, W1H 2EH info@happykidsdental.co.uk

from all over the country. The clinical training has opened my eyes to what is possible in dentistry today. It’s been really interesting to see some of the advanced treatments and understand just what practitioners can achieve in general practice.

“The practice I work in is unique in its size – it’s one of the largest practices in Scotland. This means there are lots of other trainees working alongside me and I have found speaking to them and seeing how they do things to be very helpful during my VT so far. In addition, there are plenty of experienced dentists to ask for advice or to refer multidisciplinary cases to, which also gives me a chance to observe more advanced cases in orthodontics or even dental implants. The more you are exposed to in your early career, the better, and I enjoy having this variety. It also ensures I gain a broad grounding across the profession.

“The practice environment itself is also conducive to our development. We have a patient care coordinator (PCC) who ensures a smooth patient journey and supports all the dentists on a daily basis. I actually don’t do a great deal of admin in general – all of this is taken care of. We also have access to very good equipment. We have a CT machine and intraoral scanners available to use in-house. These really help to speed up treatments and improve the quality of patient care we can deliver.

“Working within Clyde Munro, you feel like you’re a part of something bigger. There’s a lot of support in everything from clinical aspects to logistical and financial. It’s nice

to be at the forefront of digital dentistry and to be exposed to things you might otherwise not be exposed to. It’s a good group to work for; they are always investing in you in some way.”

Based on his experience so far, Paul offers some advice for other VTs who may be beginning their journey into practice:

“This is the year to try lots of things, to be exposed to complex cases, to ask lots of questions. It’s easy to avoid certain treatments if they feel beyond your remit and you simply refer, but it’s more beneficial to work through it in some situations – under the supervision of a mentor. I have found it helpful to do a lot of tutorial cases with my trainer, as this allows me to learn as much as I can from them while providing safe patient care. You also begin to see patients coming back to the practice in your VT year, so there’s a chance to reflect on your own work and improve your approach.”

Once Paul and other VTs have completed their training year, that’s not the end of the training with Clyde Munro. At this point, the group offers the Flying Start Programme, which continues to support individual’s development for several years into their careers. When appropriate, there are then supported pathways to help clinicians further broaden or specialise their skills. Find out more about the career opportunities and vacancies available with Clyde Munro today at careers. clydemunrodental.com or contact joinus@clydemunrodental.com for a confidential chat. n

Chelsea Clinic: 18 Cadogan Gardens, London, SW3 2RP chelsea@happykidsdental.co.uk 020

Evolving perceptions of masculinity and men’s health

As healthcare professionals, we are concerned for the health and wellbeing of everyone –regardless of gender, sex, age, culture, background or beliefs. However, it can be helpful to focus on a certain group at a time in order to really understand the health challenges that many people are facing. With Men’s Health Week celebrated in June, I thought this a timely opportunity to consider why there is still so much work needed in the field.

the risks of being male

Men are at a higher risk of various systemic health conditions. These include cardiovascular disease and stroke mortality, which are up to five times higher and twice as high in men than women respectively. Kidney stones are also more common among men. Differences have been found between the sexes regarding the immune system as well, with men experiencing more severe symptoms of conditions like the coronavirus. Regarding dental health, men disproportionately experience periodontal disease and dental trauma. In most cases, hormones are suspected to be behind differences in the sexes.

In addition, men have a higher risk of cancer compared to women at most shared anatomical sites – including kidney, gastric cardia, biliary tract, skin, liver, oropharynx, bladder and larynx. With regards to male-specific concerns, the number of prostate cancer diagnoses in Europe has increased by 41% between 1993/95 and 2015/17, though this slowed to 4% between 2005/07 and 2015/17. In the UK, more than 52,000 new cases of prostate cancer were diagnosed annually between 2016 and 2018. The good news is that the survival rate of prostate cancer for 10 or more years is nearly 80%, so it remains a fairly manageable disease if caught early. The disease is a key focus of the Men’s Heath Week 2024 campaign.

Barriers to healthcare

In this day and age, you would hope that no barriers exist based on sex that would prevent someone from getting essential care. However, there are still areas that we as a society need to work on.

A systematic review from 2016 reported several factors influencing the uptake of health screening for men. Facilitators included the partner’s role, a desire to be healthy in order to look after family and a non-invasive screening procedure. Key factors that prevented men from attending health screenings included fear of receiving a disease diagnosis, a perceived low risk of long-term problems, fear of a painful screening procedure,

time restraints and a lack of knowledge about health or screening.

Within the social domain, knowledge, attitudes and values, fear and masculinity attributes featured widely. This highlights the continued existence of a stigma around men’s health and a perception that to seek help is a weakness of some kind. The study found that heterosexual self-presentation and the avoidance of femininity were leading barriers to health screening for men.

Sadly, these findings support previous research that men would rather hide signs of pain of suffering in order to meet societal expectations of them. A more recent poll also found that one in three dads wouldn’t know how to talk to their sons about health, 17% of which would find it awkward and uncomfortable.

This is something that must change if we are to give men the healthcare and support that they need – and deserve – without fear of judgement.

Modern masculinity

And it seems this change is already afoot. The attitudes of younger generations today are driving new ideals and challenging traditional values of what a ‘man’ should be. A 2021 systematic review reported an evolution of public perception towards all manner of topics, including sexuality, emotional intimacy and the establishment of any gender roles. The new generation is challenging traditional values in favour of increased inclusivity and a whole new approach to masculinity.

It is hoped that this change in public perception will encourage men to be more open about their health and related concerns. In turn, this would increase the number of men who attend health screenings and enhance early detection –and therefore improved management – of all health conditions.

Back to the dental practice

Of course, all of this is interesting stuff, but what we need to focus on as dental professionals is how we can better care for our patients. Keeping in the mind the impact that traditional values may have on our male patients, we should be trying to beat the stigmas with conversation and education. Where we can, it’s our duty to get the conversation started. By sharing important health information and signposting individuals to trusted resources that they can browse in their own time, we can encourage more men to educate themselves on a range of health topics. We can also show that these are not taboo topics to discuss. If we can talk about them in an unbiased, judgement-free way, we set a good example for others to follow. For further information please call EndoCare on 020 7224 0999 or visit www.endocare.co.uk n

about the author endoCare, led by Dr Michael Sultan, is one of the UK’s most trusted Specialist endodontist practices.

The long-term effects of sleep apnoea

Obstructive sleep apnoea (OSA) is a common condition. It’s estimated to affect around 1.5 million adults in the UK. However, up to 85% are undiagnosed and untreated. This is because symptoms can be difficult to notice, as they mainly happen during sleep. The condition causes the airway to narrow while asleep, stopping patients breathing properly. Symptoms include interrupted breathing, gasping, snorting, or choking, sleep disruption, and loud snoring. During the day, patients may notice that they feel tired, have trouble concentrating, have mood swings, and have headaches when they wake up. It’s important that patients with OSA receive a diagnosis, and their condition is treated, as it can have an effect on their health in the long term.

What are the health implications?

If OSA is not treated, it can lead to other problems – some of which can have long-term effects on an individual’s health. These include high blood pressure, increased risk of stroke, type 2 diabetes, and depression. Additionally, because OSA disrupts sleep, patients often experience tiredness. In turn, this can lead to an increased risk of having a serious accident, like a car accident, for example – as well as difficulty concentrating at work or school. Sleepless nights can also put a strain on relationships, causing difficulty.

In addition to these, sleep apnoea can affect the digestive system, leading to fatty liver disease and worsening gastroesophageal reflux disease (GERD). The nervous system can be impacted too, sometimes leading to numbness and tingling sensations. In men, OSA can also contribute to infertility.

Because sleep apnoea can impact so many areas of the body, having an effect on long-term health, it’s important to treat it effectively.

how can we treat it?

Sleep apnoea can have a number of potential causes, so there are various ways dental and medical professionals can treat it with their patients. OSA has been linked to obesity, having a large neck, age, genetics, smoking and drinking alcohol, having large tonsils, sleeping position, and chronic obstructive pulmonary disease (COPD).

In some cases, lifestyle changes can make huge improvements to OSA symptoms. As such, for patients with mild sleep apnoea, clinicians might recommend losing weight, regular exercise (this can help improve sleep for many people ), creating good sleep habits and a regular sleep schedule, sleeping on their side – some patients find it helpful to use a bed wedge or pillow to help stay on their side during the night.

While the above may be helpful for some patients, many are recommended a CPAP machine to treat OSA. It pumps

air into a mask worn over the mouth and/or nose to improve breathing and preventing the airway from narrowing. For many who are able to use the machine consistently, this means that they feel less tired during the day and have a reduced risk of additional health problems, such as high blood pressure.

the problem with CPaP

Some patients are unable to tolerate treatment using a CPAP machine. This is the most common treatment for OSA, especially in moderate and severe cases. When used consistently, CPAP is effective, restoring patients’ quality of life. However, research suggests that about 50% of CPAP patients do not use the machine consistently, or discontinue their treatment. Whilst every patient is different, commonly patients cannot tolerate CPAP as it is uncomfortable, irritating, noisy, and it causes dry mouth. Additionally, some patients remove the mask while they’re asleep, find that their breathing is out of sync, or are intolerant to the air pressure.

O2Vent is an effective alternative treatment for OSA patients. The device is customised to fit each patient, which helps to treat the condition comfortably and discreetly. When the airway becomes blocked, the device draws in air through the device, allowing it to reach the back of the throat. O2Vent also stabilises the lower jaw, brings the tongue forward, and encourages the airway to open. Because of this, the device is an effective treatment option for OSA.

The ability to provide patients with a comfortable treatment option for their obstructive sleep apnoea is essential for long-term compliance. When clinicians are able to consistently treat OSA, patients can expect long lasting health benefits, and a lower risk of issues in the future.

To find out more visit openairway.uk, email infouk@openairway.com, and follow us on LinkedIn: linkedin.com/company/o2ventuk n

about the author

Justin Smith, Commercial Director, open airway Dental Solutions UK ltd.

In the face of failure

Implant dentistry is not perfect. The treatment is reliable, with many patients receiving a restoration that is longlasting and functional. Unfortunately, though, success rates are not, and may never be, 100%.

There are many reasons a dental implant may fail. Patients could have a systemic health condition that puts an implant at risk, like diabetes or osteoporosis. Patients with poor levels of glycaemic control are likely at risk of postoperative surgical complications, and osteoporotic individuals that do not look after their nutritional needs or indulge in lifestyle habits such as smoking may face a similar fate.

Patients without pre-existing health conditions may still experience failure, through the development of peri-implantitis following poor oral hygiene, or the occurrence of an implant fracture, as two examples. Luckily, for many patients, in the face of implant failure there may still be hope. With effective and timely care, they may yet have a restoration that stands the test of time.

Identifying failing implants

Every dentist should know what a failed implant looks like, from general dental practitioners to specialist oral surgeons.

Early implant failure may result in minor peri-implant bone loss, and will typically occur prior to or at the abutment connection. Extensive bone loss may be present in the case of late implant failure, which is seen after occlusal loading, and is more common than early failure.

Both patients and clinicians may be able to identify implant failure, and individuals

should be advised to contact their dentist immediately if they suspect there is an issue. Signs of complications may include difficulty chewing, inflamed or recessed gums around the implant site, increased swelling, severe pain and discomfort, or the mobility or loosening of the implant or crown.

Early detection and intervention are essential to control the progression of bone loss around an implant, and have a chance at reversing its fate. Regular patient visits post-surgery may allow you to spot the signs of implant failure in a timely manner. This does not only mean in the immediate weeks and months following placement. In subsequent years, it is still important to regularly see patients and assess the health of an implant site.

Intervene early

If and when you spot complications with an implant, devising an effective treatment plan is essential. In many cases, the hard and soft tissue at the implant site will already be affected. Preserving its health is a fundamental first step, before it can then be treated for a potential replacement of the dental implant, should it be eventually necessary.

A patient with peri-implantitis may find the greatest chance at a full recovery with surgical treatment. The mechanical decontamination of the implant surface, perhaps with ultrasonic devices or appropriately designed curettes, or implementation of laser implant treatment have been discussed as options – even in conjunction with each other – but the literature concludes that with proper case

selection, surgical intervention is most effective when resolving peri-implantitis. There are a variety of surgical interventions that may be of use, and promising results have been observed in studies that use a combination of bone graft or bone substitutes with guided bone regeneration for regenerative therapy.

Appropriate case selection is fundamental. When there is a bony defect of 3 or 4 walls, with favourable anatomy, guided bone regeneration is recommended as the treatment of choice. Where this is not the case, it may still be of use, but the judgement of an experienced clinician will be invaluable. The procedure typically includes the raising of a flap in order to access an infrabony defect, where decontamination of the implant surface is carried out. Supplementary antimicrobial agents may be of use here. Bone grafting material is then utilised to fill the defect with the subsequent addition of a barrier membrane – note that there is no one bone augmentation material or membrane that is agreed to facilitate superior treatment outcomes.

Clinical judgement

Whilst surgical intervention and guided bone regeneration are recognised as effective treatments for recovery of a failing implant, clinicians must only carry out these procedures when they have the appropriate training and experience to do so. If an individual presents with a complication regarding their implant, and you cannot confidently provide effective care, you must refer the patient to an appropriately trained professional.

Consider referring them to clinicians like Dr Fazeela Khan-Osborne and Dr Nikolas Vourakis of The One to One Dental Clinic, London. Dr Khan-Osborne is the founder of the clinic and One to One Implant Education, where she is joined by Dr Vourakis in providing effective care in complex implant cases, as well as training and supporting the next generation of clinicians in implant dentistry. Both professionals are backed by years of clinical and educational experience, and actively take on referral cases to support patients and clinicians alike. With early intervention, implant failure can be avoided. Employing effective surgical solutions, such as guided bone regeneration, may help in the recovery of an implant site, and provide a greater opportunity for successful retreatment in the future.

To learn more about referrals to The One to One Dental Clinic, visit 121dental.co.uk/for-dentists/referrals/ or contact 0207 486 0000 n

about the authors Dr Fazeela KhanOsborne, Principal Implant and restorative Surgeon.

Dr nikolas Vourakis, Senior Implant and restorative Surgeon in private clinics in London and edinburgh.

Putting pressure on a posterior restoration

When a dental professional is planning for an effective treatment resolution, it’s important to consider how the issue came about in the first place, and what that means for the potential future of a restoration.

Those that suffer with bruxism, the involuntary and subconscious performance of teeth grinding, may see this issue come up often when seeking effective care. The constant presence of masticatory forces may be of detrimental effect to posterior occlusal restorations, and these may be needed because of the initial damage caused by bruxism.

One study found that the maximum bite force during bruxism events was as high as 1,100N, which was greater than the largest voluntary bite force. Whilst this pressure is not present for an extensive period of time, it is especially noteworthy to understand the risks it presents if the action is recurring, and the appropriate considerations that must be made when planning a posterior occlusal restoration. After all, whilst cessation is preferred, it may not always be immediately achievable.

Solutions for the posterior dentition

Bruxism presents the potential for occlusal trauma and breakdown of the periodontal tissue. When the surface of the posterior teeth is worn away, a clinician must be able to suggest a

restorative solution that can adequately replace the once-present tooth structure.

The options are endless. Resin composites are a versatile material that the literature has crowned the first choice for restoring posterior teeth, thanks to its capabilities within a minimally invasive workflow. However, clinicians may have doubts around the aesthetics and durability of some direct composite solutions; the latter is unequivocally important in the bruxism patient. Choosing the correct resin composite for a case is fundamental.

On the other hand, ceramic reconstructions hold some popularity due to their aesthetic advantages, and zirconia ceramics have seen an increase in use thanks to their stability and toughness. Full crowns, as you will know, fall at the invasive hurdle, with studies saying it can demand a removal of up to 75.6% tooth structure.

Another option that may be suitable for some patients, dependent on the extent of the attrition, could be an occlusal veneer. Whilst materials vary greatly, restorations as thin as 0.3mm could be used in areas subject to masticatory stress, whilst retaining aesthetics and allowing for a conservative tooth preparation. However, they are technically demanding, and alignment can prove difficult. Each solution has its own merits, and this is not necessarily an exhaustive list. The unique treatment needs presented to clinicians – based on factors such as the level of damage and

wear that is present, the presence of bruxism habits, and a patient’s aesthetic preferences – may all change the choice of material and overall approach that is used.

Planning for future restorations

When a bruxism patient requires a restoration in the posterior, a clinician must consider the potential for future damage to the dentition.

The cessation of bruxism is obviously ideal, and wouldn’t require such foresight. The interruption of parafunctional habits may be possible through occlusal adjustments and oral rehabilitation; the elimination of causative factors such as smoking, alcohol and coffee; or even the management of psychological factors through psychotherapy, relaxation, or yoga. However, this is unique between each individual patient, and may not be a simple fix. Instead, clinicians should approach an initial restoration with the need for eventual repairs in mind.

Considering this, additive techniques are preferable, and more invasive restorative techniques such as ceramic crowns, whilst not totally ruled out, should not be considered the first clinical option for a posterior restoration. Resin composites show immense promise here. A majority of clinical failures of composites allow for minimally invasive repairs that are shown to extend the clinical durability of the solution in posterior teeth.

meeting today’s demands

Function and the potential for repair are imperative considerations from a clinical point of view, but there are other factors to consider. Patient expectations around dental restorations are slowly changing in front of our eyes, and the social media generation is putting more emphasis on aesthetic solutions. When bruxism puts an extraordinary level of stress on a posterior restoration, some patients may feel they have to compromise and settle for a solution that trades appearance for improved function – but this doesn’t have to be the case.

A solution like the award-winning* Filtek One Bulk Fill Restorative (from Solventum, formerly 3M Health Care), is designed to combine aesthetic brilliance, clinical simplicity, and most importantly excellent wear resistance in the posterior dentition. The innovative use of AFM and AUDMA monomers also help reduce shrinkage and stress within the restoration. The Filtek One Bulk Fill Restorative is designed especially for posterior restorations, and is an effective choice for a wide variety of treatment indications. The bruxism patient will likely need a posterior restoration within their lifetime, and potentially multiple if the habit continues to damage the dentition. Choosing the right solution for each case, whilst considering modern treatment demands and the prospect of future repairs, is essential for every treatment workflow. n

How to create an inclusive practice

Students in England will soon be able to take British Sign Language as a GCSE. It will be taught in schools from September 2025 and will be open to all pupils. As we move towards an ever more inclusive society, dental professionals must ensure that patients with additional needs have access to the same level of oral health services and expertise as others. Understanding their unique challenges, adapting techniques, and creating a welcoming environment can help create a positive dental experience for these patients.

Dental patients with additional needs can encompass a wide range of disabling conditions including intellectual disability, dementia, physical limitations, movement disorders, behavioural disorders, and chronic medical conditions. Many of these individuals can be treated in routine dental settings with minimal special accommodations or with interventions that are well within the scope of most dental professionals.

Some patients with additional needs do, however, require interventions that go beyond the scope of routine behaviour management techniques. These techniques can include desensitisation, anti-anxiety medications, therapeutic immobilisation, sedation and general anaesthesia.

Unmet needs

Under the Equality Act 2010, public sector organisations have to make changes in their approach or provisions to ensure that services are accessible to disabled people as well as everybody else. People with learning disabilities might have difficulty with

reading or writing, explaining symptoms and understanding new information. They have higher levels of gum disease, greater gingival inflammation, higher numbers of missing teeth, increased rates of edentulism, higher plaque levels, greater unmet oral health needs, poorer access to dental services and less preventative dentistry. They are often unaware of dental problems and may be reliant on their carers.

Similarly, under the Accessible Information Standard dental surgeries that provide NHS services must ensure that people who are deaf are provided with information in a format that makes sense to them. This also applies to hearing parents that have deaf children or deaf parents with hearing children.

Indeed, effective communication is crucial. It’s important to take the time to establish a rapport and build trust with patients with additional needs and their carers. The dental team should use simple and clear language, visual aids, and alternative communication methods if necessary. They should be encouraged to express their concerns or queries, ensuring their participation in the decision-making process.

Sensory considerations

Many patients with additional needs may have heightened sensory sensitivities, making dental visits overwhelming. It is important therefore to be mindful of the clinic environment by minimising noise levels, using natural lighting, and providing comfortable seating. Practices should consider allowing extra time for patient appointments to help alleviate any stress or anxiety.

Visual supports can help to aid

understanding and reduce anxiety. Using stories or creating illustrated step-by-step guides to explain dental procedures and routines may help some patients. These tools can provide reassurance and a sense of familiarity, making the experience more predictable and less intimidating for patients with additional needs.

Dental professionals can implement techniques to make the dental experience more sensory-friendly. For example, using desensitisation techniques, gradually introducing patients to the dental environment, and involving them in play therapy to familiarise them with dental tools and equipment.

collaboration with carers

Collaboration with carers is vital to providing comprehensive care. Dental professionals should encourage open communication and provide carers with educational resources, such as instructional videos or printed materials, to help them maintain optimal oral hygiene practices at home.

Positive reinforcement can also significantly impact a patient’s experience.

Dental teams can offer praise and rewards for cooperation and positive behaviour during dental visits. This reinforcement can help to build a trusting relationship and reduce anxiety in subsequent visits.

Oral hygiene can present a challenge for many patients with additional needs, including those with sensory or motor dysfunction. Recommending the right oral hygiene products for our patients is essential for their oral health. The FLEXI range of interdental brushes from TANDEX can help

some patients with additional needs as they are easier to grip and less tricky to use than string floss. Each product’s handle is flexible, and the brush can be bent into the perfect shape to clean in between the teeth. Available in 11 different sizes, the line presents a solution for each individual patient, for a comfortable and effective clean. Given that patients with additional needs are more prone to tooth decay, the brushes can be used to apply PREVENT GEL too, a product which contains 0.12% chlorhexidine and 900ppm fluoride which offers antibacterial and enamel strengthening properties.

Caring for patients with additional needs in the dental setting requires understanding, empathy, and adaptability. By implementing effective communication strategies, creating a sensory-friendly environment, collaborating with carers, and tailoring treatment plans, dental professionals can provide optimal dental care to this vulnerable population. With this knowledge and approach, patients with additional needs will receive the treatment they deserve, contributing to their overall well-being and quality of life.

For more information on Tandex’s range of products, visit https://tandex.dk/ Our products are also available from CTS Dental Supplies: www.cts-dental.com/ n

about the author

Jacob Watwood on behalf of tandex.

Jacob is an associate dentist at Fieldside Dental practice.

Unconventional methods for dental anxiety relief

Dental anxiety is thought to affect up to an estimated 30% of the global adult population. Endodontics, in particular, can be an area of fear for many – mostly due to the anticipation of pain. Patients might experience a range of physical anxiety symptoms such as nausea, difficulty breathing and dizziness when faced with the prospect of dental appointments, examinations, and treatments. As such, dentists have tried a range of methods to help keep their patients calm and improve treatment acceptance.

Effective communication with patients, as well as creating a quiet and calm ambiance in your practice, can help to keep patients relaxed in anticipation of their appointments. However, when preparing for more nervewracking procedures, such as a root canal, some more involved and sometimes unorthodox anti-anxiety interventions might be helpful. So, how might dentists providing endodontics keep their patients calm?

acupuncture

One unconventional method for relieving dental anxiety which has been explored by researchers is acupuncture. Those in favour of the technique claim that placing acupuncture needles in certain areas of the body can reduce anxiety by stimulating the central nervous system. Research has found that this is particularly helpful when the anxiety is related to a specific situation – like dental anxiety – more so than long-term anxiety

disorders. While the effects will likely vary from person to person, one study found a significant reduction in median anxiety scores after treatment with acupuncture, allowing planned dental treatment to go ahead for all participants. Additionally, literature suggests that patients feel more relaxed within minutes of acupuncture starting.

While more research into its efficacy is needed, clinicians should not ignore the clinically relevant levels of anxiety reduction reported which suggest that acupuncture could be a valid tool for tackling dental anxiety among some patients.

Hypnosis

Another possible solution for reducing dental anxiety might lie in hypnosis. While many associate hypnotism with magicians, health professionals and therapists are increasingly offering hypnotherapy to try and treat conditions, change habits, and promote relaxation. While it may not be a suitable option for everyone, and potentially harmful for those with psychosis or personality disorders, it might be a helpful tool for some patients to help reframe their thinking. So, what are the benefits of hypnosis for dental anxiety? It may help reduce general feelings of dental anxiety and phobia, as well as manage responses that impede treatment – like the gag reflex and tongue defence. Additionally, it can help dental patients feel more engaged and impowered in their treatments, promoting an overall

more positive outlook, helping to improve communication, and creating more positive associations for future treatments. Overall, the aim of hypnosis for dental anxiety will be to improve patients’ confidence, compliance, and retention. Researchers have looked into the specific effects of hypnosis on dental anxiety patients. They found that it had a positive effect, reducing dental anxiety and fear during dental treatments. This means that it might be a beneficial intervention to counteract dental fear.

putting the mind at ease

While the slightly more unorthodox anxiety managements methods we have discussed might offer patients benefits, and ultimately foster behaviour change, sometimes solutions are much simpler. Generally, by building a positive relationship with patients, and keeping up a good rapport, clinicians will find that patients feel more comfortable around them, and are more likely to trust in their advice and treatment recommendations. By adopting a predictable and repeatable workflow, you might be able to put patients’ minds at ease in the lead up to their treatment. For some patients, it might be helpful to explain the treatment process in steps, to help them get an understanding of what they can expect. Additionally, by explaining that you have adopted a standardised and reliable protocol, you can offer them a repeatable treatment workflow which is designed to keep them safe.

The HyFlex OGSF file sequence from COLTENE is designed to do exactly that. The sequence enables fast and reliable root canal preparation for simple and complex root canals, and enhances reproducibility and safety. The HyFlex EDM OGSF file system comprises of an Opener, Glider, Shaper, and Finisher, to be used in a simple pecking motion for effortless, smooth, and accurate root canal preparation up to working length. Additionally, this helps the clinician to stay in control of the treatment, and the straightforward sequence simplifies treatment while shortening the learning curve. Ultimately, dental professionals want to provide the best possible care to their patients, to improve their oral health and free them of pain. Endodontic treatment, in particular, can seem very daunting. As such, it’s important to find ways to put patients’ minds at ease in the lead up to dental treatments, with approached specifically tailored to each patient’s needs. For more information, contact info.uk@coltene.com and 0800 254 5115 COLTENE loyalty scheme: https://rewards.coltene.com n

about the author

Mark allen, General Manager at cOLtene

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Bioglasses in toothpastes

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The Fluoride 1350, 1450 and 1500 misconception

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For further information visit the Trycare website, www.trycare.co.uk/biomin, contact your local Trycare representative or call 01274 885544. n

For the dentist thinking, “What comes next?”

Implant dentistry is a major ambition for some clinicians, with the complex workflows allowing individuals to treat a wider variety of patients with care that is effective and long-lasting. To embark on this journey, and actively learn from some of the most respected professionals in dentistry, look no further than the MSc in Dental Implantology from the ICE Postgraduate Dental Institute.

The course is perfect for those looking to make their start in implant dentistry, and already have some post-qualification experience in a hospital service or general dental practice. It teaches the skills needed to confidently and safely carry out each step in the implant workflow. This includes everything from treatment planning and implant placement to restoration.

Hands-on learning

The way you learn new skills can impact how you process information, and eventually use it in your own care. With the MSc in Dental Implantology, you engage with the theory in an active, hands-on manner, because we feel there is no better way to fully comprehend the core surgical and restorative skills needed for implant dentistry. Throughout the course, you will be supported with high-quality tools, patients and direction from world-class mentors that allows you to treat a diverse range of implant cases. Delegates can work on pig and deer heads (optional) as well as

model heads, before placing a minimum of four implants in live patients throughout the course. Dependent on your prior experience and performance during the course, this could be more.

Each aspect of the theory and clinical support provided to delegates is grounded in evidence-based learning, and the course thoroughly explores current knowledge and practices in implant dentistry. This includes new technologies such as minimally invasive guided surgery and CAD-CAM restorative treatment techniques. Alongside this, topics like infection control, medico-legal and ethical considerations, as well as human factors will all be discussed in depth.

tutors you can trust

The virtues of the MSc in Dental Implantology expand to its mentors, like Specialist Oral Surgeon, Professor Cemal Ucer. Since the 1990s, Professor Ucer has provided advanced training programmes in bone and soft tissue grafting for comprehensive dental implant and jaw rehabilitation, and has become a recognised authority for teaching dental implant workflows. In fact, he has personally trained and mentored more than 1,000 clinicians in implant dentistry, making him one of the leading providers of implant education in the UK.

As a past president of the Association of Dental Implantology (ADI), Professor Ucer has always been passionate about progressing implant dentistry, and helping

the clinicians that he works with grow as both people and professionals.

improvements across the board

Dr Fatima Soussi of mydentist, Wimbledon, worked closely with Professor Ucer when she undertook the MSc in Dental Implantology, and spoke of how he helped her learn new techniques.

“They offered us some shadowing days with Professor Ucer, and I went and spent a full day placing implants with him. For him, placing an implant as common nature as taking a tooth out! He made everything straightforward, and he uses the most up to date techniques. Professor Ucer is clearly very experienced, and does a lot of 3D digital planning. He showed us a lot of the computer work, and how we can make digital workflows easier, which was very helpful.”

Dr Soussi was still looking for the right place to learn the implant placement workflow after trying other course providers. She spoke about how the hands-on approach to the MSc in Dental Implantology made the difference for her.

“I tried another course on implants, and I was not very happy with it. I did my research for a few different universities, and Salford had a really good reputation. I chose this course because I wanted to do something more than just placing implants.

“I was really happy with this course, and I can tell that this one gives you the most experience. By that I mean it incorporated

clinical days with actual patients, and that’s what I enjoyed the most. Every month we had clinical dates, letting us start to place implants safely very, very soon.

“This is the whole point of it, no matter how much you study – and this applies to all of dentistry, but especially with implants as a surgical field. If you don’t try it when training, then you don’t really know anything about it.”

The MSc in Dental Implantology is comprehensive in its teachings, and Dr Soussi was delighted with the variety of skills learnt from it. She said, “I learnt a lot more regarding extractions and the healing process. Also, I am now able to raise flaps easily – I couldn’t do it as well before, I was very scared because you don’t do much of it at university.

“The course made my surgical skills a lot better. Not just in placing implants, but in general.” To learn more about the MSc in Dental Implantology at the ICE Dental Institute and secure your space, contact Professor Ucer at ucer@icedental.institute or Mel Hay at mel@mdic.co. 01612 371842 www.ucer-clinic.de n

about the author Professor cemal ucer (BdS, MSc, Phd, oral Surgeon, iti Fellow.

A comprehensive approach to oral health

Comprehensive dentistry

can be defined as whole patient care, and requires an understanding of all disciplines of dentistry, such as prosthodontics, periodontics, orthodontics, oral surgery and endodontics. Any or all of these approaches may be employed to meet treatment goals related to aesthetics, function, structure and the biological needs of the patient.

The systemic health of patients is affected by oral health and vice versa, so comprehensive care benefits from an awareness of all factors affecting patients’ health. To this end, dental professionals benefit from developing effective communication skills. Considering the whole patient, and taking thorough and relevant case histories is a real advantage when creating the best treatment plans. Many advanced procedures are traditionally outsourced to specialists. Where there is effective communication here too, collaboration between multiple professionals improves patient safety and quality of care. However, the accessibility of education and training have enabled dentists to upskill with relative ease, and provide many elements of a comprehensive treatment plan themselves.

evidence-based practice

Evidence-based treatment integrates individual clinical expertise with the best available external clinical evidence obtained from systematic research.

Before a dental clinician can develop a proposed therapy, they should consider whether their own knowledge and expertise

meet the demands. According to best practice, there should be a genuine and honest appraisal of the clinician’s own familiarity with available evidence regarding the effectiveness and safety of the proposed treatments. Finally, what are the patient’s values, preferences and circumstances? Demonstrating an evidence-based approach promotes confidence and trust from patients.

Maintaining trust is both a core standard for all dental professionals, and a real advantage in promoting case acceptance and adherence to advice. Patients are less likely to seek vital treatment where trust is lacking, especially those experiencing dental anxiety.

In our age of information, deepening knowledge or understanding about conditions affecting patients, and increasing clinical skills is very accessible for all clinicians. Applying evidence-based knowledge into practice requires sifting through an inordinate amount of information, which can cause a kind of paralysis. Inability to select appropriate evidence, and critically appraising the evidence are the main challenges a practitioner may face. However beneficial additional learning may be, each clinician must think strategically about how they broaden their own skillset. It can be a major decision. Clinicians will choose learning opportunities in light of their own professional aims as well as the risk factors involved in taking on new responsibilities. However, current knowledge is advantageous when filtering an enormous amount of information from a patient. Pertinent information must progress from the assessment and diagnostics stage into a problem list, treatment options and goals, and a comprehensive treatment

plan. Technical competency comes with practice and reflection. High-quality training and mentorship with appropriately skilled professionals are, therefore, key.

Putting the patient first

Patients are at the core of the dental profession. Along with dizzyingly rapid technological advances, our age has been remarkable for the increasing emphasis on patient choice and participation in treatment. The GDC ‘Standards for the Dental Team’ document firmly places patient empowerment, dignity and wellbeing at the centre of every clinician’s practice. This has been a trend, prompted partly by human rights and equality legislation, partly by a greater appreciation of the efficacy of person-centred care.

Patient-centric care is central to evidencebased practice, and a comprehensive approach to dentistry. Effective treatment planning involves a systematic, comprehensive approach that considers the patient’s values and goals and gives them and the clinician more control in managing their care.

Embracing a multidisciplinary and patientcentric approach ensures overall health and well-being, and oral health is integral to this. Quality continuing education coupled with an evidence-based approach can endow the practitioner with the expertise to offer comprehensive and streamlined care throughout the patient’s dental journey.

Quality continuing education

The Complete GDP course from IAS Academy teaches dentists how to examine, diagnose, predictably plan, and treat every patient. The two-day

course is designed over three modules: 1) Examination, Records & Splints - getting to “YES”; 2) Predictable Treatment Planning; 3) Aesthetic and Restorative Principles to maximise learning and implementation through hands-on training. This course provides the framework to ensure each patient is treated appropriately and ethically to achieve biologically stable, functional and aesthetically-pleasing results. All this combines with post course assignments and mentoring to compound learning. Delegates will discover the best techniques to gain a more comprehensive understanding of every patient’s complex and unique needs, ensuring nothing is missed.

Maintaining an awareness of new information and developing new skills through quality learning experiences is the responsibility of all clinicians in meeting the needs and expectations of patients. This development is a vital step towards comprehensive, evidencebased and patient-centric practice, and also contributes to a long and interesting career.

For more information on upcoming IAS Academy training courses, please visit www.iasortho.com or call 01932 336470 (Press 1) n

about the author dr tif Qureshi, founder and a clinical director of iaS academy.

Building confidence to practise with clinical freedom

The move from foundation dentist (FD) to associate can be daunting for professionals, so finding a supportive environment in which to take this step is crucial.

Dr Pooja Gupta is currently benefiting from the FD+1 programme available through Rodericks Dental Partners. This unique programme is designed to deliver valuable support for clinicians as they transition from FD into an associate role. Individuals gain access to on-going educational events for further skill consolidation and development, as well as being part of an extensive network of colleagues for reassurance and motivation.

Specifically, the year-long scheme offers hands-on teaching that covers a range of topics from restorative dentistry to endodontics, clinical photography, composite bonding and oral surgery. Sessions are run by highly experienced clinicians and focus on the practical application of skills in reallife practice. All FD+1s are also assigned a dedicated Clinical Support Lead who will hold regular meetings and drop-in sessions to discuss their progress in detail and offer bespoke guidance. The entire programme is geared towards building dentists’ competence and confidence, so they can always safely and effectively put their patients’ best interests first.

prioritises communication by regularly engaging with individuals across the organisation and keeping everyone up-to-date with relevant company and industry news. This includes a clinical newsletter that is sent out weekly to all professionals, which helps to foster a supportive and inclusive environment for the whole team.

As a young dentist, Pooja finds these communications particularly helpful in her everyday practice, adding: “The clinical newsletter is very helpful as it provides

Reflecting on the greatest appeals of the programme for her, Pooja comments: “I chose to join Rodericks Dental Partners on the FD+1 programmes because I felt comfort in knowing that I could get advice and up-skill through the study days provided. The programme provides the support of having a clinical mentor to turn to, as well as the ability to utilise further CPD opportunities and gain further skills.”

Reflecting on what she has found most valuable, Pooja says: “I have really enjoyed the opportunity to access practical study days to improve my skills and knowledge in a useful way. This has helped ease the transition from FD to associate. The knowledge that I have someone to message when I am unsure or would like a second opinion has been very reassuring. This is invaluable for all new dentists. The ability to contact other clinicians and discuss treatment plans nurtures a community feel and ensures continuous mentorship opportunities.

“Overall, the FD+1 programme has allowed me to grow my confidence and skills within a safe environment and has provided me with opportunities which I would not otherwise have been able to access.”

Aside from the FD+1 programme, Rodericks Dental Partners strives to create a positive, supportive and motivational environment for all clinicians and dental team members to work. The focus is always on providing excellent patient care, and this requires that dentists have all the necessary skills, equipment and clinical freedom to tailor treatment according to every patient they see. Career progression and professional education are key, so Rodericks Dental Partners ensures these are readily available to all. The group also

opportunities to access further CPD, as well as chances to meet other clinicians.”

Beyond the FD+1, Pooja and her colleagues will have various opportunities available to them to continue their education and broaden their skills with Rodericks Dental Partners. All clinicians retain access to a wide network of professionals throughout the organisation, who provide invaluable clinical, administrative and personal support.

For anyone considering their next career

move, whether you are just starting out or have 30 years of experience, Rodericks Dental Partners has a place for you. Pooja concludes: “Rodericks Dental Partners is definitely a supportive environment to grow as a clinician, to up-skill and learn. I’d definitely recommend working here.”

To find out more about what it’s like to work with Rodericks Dental Partners and to discuss current vacancies, visit rodericksdentalpartners.co.uk/careers 

How to create your own growth...

...throughout your career

As we know there are natural career paths within dentistry – and as we navigate through each step, we move closer to the goals we set ourselves. But a growth plan isn’t just about the clinical component, it encompasses everything that we need for successful, holistic, all-round development. Ideally, we need to strive towards a healthy balance that includes a mental, social, physical, emotional and spiritual structure. Being in sync means that each of these personal pillars supports the others, so it’s a real inner team effort. You just can’t flourish if you’re out of alignment. You might have the most impressive, well-perfected endodontic game but it won’t serve anyone if you’re falling asleep on the job or haven’t been able to communicate with your patient. Whilst working on every aspect of yourself, you’ll be following your own dental career path. The expected routes are not for everyone, and you may find yourself at a point in your career where your route becomes more circuitous and explorative as opposed to clear-cut and linear. We will each have our own definition of success. I’d say to not be afraid of meandering seemingly off-course wherever inspiration strikes if it feels

right and engages you. Take the course, attend the meeting, feed your curious self.

For me, career development went in the opposite direction to the norm. My dental practices came before the postgraduate qualification in endodontic practice. I learnt the business side of dentistry and then upgraded (and continue to upgrade) my clinical skills in the area that I am most passionate about: endodontics. Learning how to be a businessperson was important and interesting to me – like building my boat and learning to sail before I hit the high seas! Within the practices I can hone all sorts of skills – business practice, people management and communication. The teaching I do fulfils another side

of my thirst for improving myself. It allows me to share my knowledge and experience, develops my confidence and presenting abilities, motivates me to keep learning, teaches me to listen more and takes me to great places where I meet all kinds of people.

On our development journeys it would be the worst kind of narcissist who doesn’t include those around them in the process. Whoever is with you – your colleagues, family, mentors, students – they are all looking to grow in their own way. There’s an incredible word, one of my favourites: ‘sonder’. Sonder is the realisation that everyone in your life doesn’t exist solely in relation to you, they each have exactly the same 360-degree life that you do.

“Park facing downhill”

Astrange phrase, but one of the best bits of advice I was ever given. Not being a car owner at the time, I didn’t see the wisdom of it. But later, on those cold, cold Newcastle mornings when the battery of the ancient Ford Escort van I had saved from the scrapheap refused to even turn the engine over, I came to understand. Leave the car parked facing down Westgate Hill; next day, choke out, ignition on, clutch in, find second gear, take the handbrake off and let the car roll. Let the clutch out and off you go. Easy! Life could become interesting later in the day – or night. The van was used to transport my mobile DJ equipment, but I developed a

sixth sense for a slope and was good at asking passers by for help.

It took me a few years working in practice (until I was a practice owner, in fact) before the sense of “Park facing downhill” finally dawned on me. As an associate, I had become used to every day being almost out of control, with interludes that were both manic and panic.

It wasn’t until my coach, now sadly long gone to draw 2x2 boxes on that flipchart in the sky, suggested that I devise a day that I – sorry, we – controlled, that worked for me, for my team and for our patients. He told me about a writer friend of his who, at the end of every day, finished his work by stopping halfway through a sentence. That way, there was a small task to complete the next day, helping to navigate the hardest movement in a writer’s life: sitting down at your desk and starting again. The writer themselves was probably fictitious – we all invent or at least embellish characters so that our stories make their point.

As I have heard from numerous clients of my own, “That’s all very well for a writer, we don’t have a problem starting, in fact we are often overwhelmed within half an hour.”

By being generous with your time and knowledge we all do better together. Also the people around us provide no end of lessons – humility, inspiration, fun. We’re all naturally at the centre of our own stories but the people around us are more than our supporters, they are at the centre of their own stories too.

I can’t mention a growth plan (or most things!) without reference to Kaizen – small incremental steps to improvement. In this context, Kaizen is a good reminder that any steps are worth taking – whether they are forwards, sideways or even backwards – if they serve you. n

About the author

Dr Dhiraj Arora has two dental practices in Twickenham and Gerards Cross. He is also a Dental foundation Training educational supervisor for Health education england, Honorary Lecturer in endodontics at QMUL Masters programme, and runs his own courses via evo endo in Central London for general dentists. His background spans nHs and private settings, from Harley street to community HealthCare.

His response was to the point: “Everyone has some kind of problem when they start, and yours is being parked on a hill that’s too steep and full of traffic. How can you start slower? Let’s look at what happens.”

We spent a couple of hours with the coach – we being my three other team members, who were all equally fed up with the daily transition from stationary to flat out, and myself.

We decided that the first step was to make sure that the decks and desks were cleared at night. All instruments sterilised, trays for the first half a dozen patients prepped and ready, models, radiographs and notes all in the right places – these were a long time ago in pre-digital days when, thanks to a great system, I can boast that we never lost or mislaid a set of notes in 20 years. Next, deal with the time and the money. Pay your team members for prep time ahead of the day and “wash-up” at the end. Arrive on time yourself – as if punctuality isn’t important to you why should it be for everyone else? I have lost count of the number of times I have queued outside a practice’s

front door with the day’s first half a dozen patients and their team members waiting for the door to be open at exactly the time that the first patient should be sitting in their chair.

Anticipate the start, if you spend a while ‘warming up,’ don’t start with technically challenging cases, and don’t book persistent late attenders at the start of the day –they will only mess you up. Analyse what works and what doesn’t and change your habits accordingly. Learn and adapt and be prepared to amend. It’s your life, for heaven’s sake! In fact, for your own sake, make the changes. You’ll be surprised what you can control when you put your mind to it, even it means parking facing downhill. n

Saving every tooth possible

Some seemingly minor dental complaints, may eventually result in more serious problems. As such, when a patient presents with a chipped or cracked tooth, it’s important to assess it carefully, and treat it appropriately, to prevent it from worsening.

The prevalence of cracked teeth in adults is high – with a study suggesting 70% of patients presented with visible cracks in at least one posterior tooth. As such, it’s important to be familiar with different types of cracks, their severity, and when it’s best to treat endodontically or refer.

Cracked teeth – when is endodontic treatment appropriate?

Research suggests that, while rates of cracked teeth were already high, they worsened during the COVID-19 pandemic in both the UK and US – most likely as a result of increased anxiety and sleep disturbances, leading to bruxism and excess forces on the teeth. Cracked teeth are likely to display a variety of symptoms, so performing a number of pressure and temperature tests, in addition to imaging, is useful when locating the source of any pain and sensitivity. There are a number of different types of cracks. These include craze lines, fractured cusps, cracked teeth, split teeth, and vertical root fractures. Cracked teeth are the most common, with about 20% symptomatic.

Sometimes, cracks are preventable, if patients avoid chewing hard foods/objects, don’t clench/grind their teeth, and wear a mouthguard during sports. However, should a crack appear, it may be treatable through restorative or endodontic treatment, depending on the severity and extent of the damage to the tooth structure and pulp.

Continuing education to stay up to date

In order to keep your knowledge of the appropriate treatments for common dental complaints up to scratch, it’s important to stay up to date with the latest research, techniques, and technologies by attending educational events such as the IFEA World Endodontic Congress (WEC) 11th – 14th September 2024, organised by the British Endodontic Society (BES). The WEC provides a fantastic opportunity for endodontists, and those with an interest in the field, to come together and learn from world-renowned experts from across the globe. As part of the educational programme, a number of speakers are presenting sessions around the subject of trauma. This includes two presentations directly related to dental fractures including “Root Fractures: From Diagnosis to Clinical Treatment” presented by Dr Montserrat Mercadé Bellido and “Decoding Root Fractures: Integrating Clinical Perspectives and Advanced Research in Contemporary Exploration and Treatment Modalities” presented by Dr Wan-Chuen Liao. Attendees can expect to hear from Daniel Černy, Elisabetta Cotti, Adham Abdel Azim, Phil Tomson, and Paul Lambrechts, to name a few, with representatives from different countries sharing their knowledge.

Delegates can enjoy an enriching educational programme, discussing cuttingedge techniques in endodontology, and how they might apply them in their practice.

Building referral networks for the best care

Not only that, but the WEC is the ideal place to network on a global scale. With over 2,000 delegates expected to attend from around the world, what better way is there to expand your referral network and meet with likeminded colleagues?

The social calendar will not disappoint either – this is a great excuse to immerse yourself in Scottish culture for the weekend.

Attendees can expect a Welcome Reception held at the Glasgow Science Centre, a Ceilidh at the Merchant Square, and a Congress Dinner taking place at the Kelvingrove Art Gallery and Museum. This is a fantastic opportunity to spend time with friends and colleagues and really make the most of your time in Scotland.

IFEA WEC 24 – Join us in Glasgow!

Those who wish to attend the IFEA WEC should register as soon as possible to ensure they secure the best rates – https:// ifea2024glasgow.com/registration-2/. Additionally, the event is partnered with the Glasgow Convention Bureau, who have worked to make sourcing accommodation as easy and convenient as possible: ifea2024glasgow.com/accommodation/.

Whether you’re an experienced endodontist, looking to meet with colleagues, or are new to the field and want to find out more, IFEA WEC 2024 is the ideal event for you. In order to keep providing patients with the highest standards of care, and save every tooth possible, continuing your education is essential. The BES encourages highquality education for everyone, and looks to support its members in any way it can.

Register today for IFEA WEC 2024 at ifea2024glasgow.com/registration

For more information about the BES, or to join, please visit the website www.britishendodonticsociety.org.uk or call 07762945847 

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Keeping busy at the Dentistry Show

BADN enjoyed a very productive two days at the Dentistry Show at the NEC, Birmingham on 17 and 18 May. As usual, we had a stand right next door to the Aura-sponsored Dental Nurse Lounge – and opposite the Dental Nurse Forum.

BADN President Joan Hatchard RDN chaired the Forum, with a packed twoday programme of dental nurse-relevant presentations. Many of the speakers were dental nurses themselves – including BADN members Hannah Grieves RDN of {my} dentist (Career pathways for dental nurses) and Jo Dawson RDN of Awesome Oral Health (The benefits of smiling). BADN Panel of Reps member and dental nurse guru Rebecca Silver RDN, together with ADAM Chair Lisa Bainham, delivered a talk on conflict resolution (see more below), while GDC’s Kristin Bottrell provided a GDC update and Certified Silva Method instructor Karin Barnes presented Dealing with anxiety. The second day included BADN Panel of Reps member Natalie Marucci RDN discussed implants, certified Silva Method instructor Aktar Chowdhury tackled dealing with stress, and Sarah Haslam RDN and Joycee Rebelo RDN of the BADN Education Committee spoke on neurodiversity and the role of the dental nurse (sponsored by RA Medical Ltd). Former BADN Chair Dr Debbie Reed RDN delivered a talk on career progression pathways for dental nurses and her recent survey on dental nurse recruitment/retention (sponsored by NEBDN), Rebecca Silver returned to describe fostering trust between members of the dental team (sponsored by Johnson’s Workwear), and Ella Evans RDN and

Iattended the Dentistry Show in Birmingham recently and had the privilege of presenting five talks. One of my talks was centred around Conflict vs Drama, the title being Pulp Friction I was astounded at how many people attended and nodded along when I went through my presentation. I was further astounded by the number of owners who came and asked me if I could help them with conflict and drama issues in their teams.

I honestly don’t think any practice gets away with avoiding it at some point, if not every day! The misery it can cause is huge. I thought it would be good to base this month’s article on some snippets from the presentation, as I’m sure it resonates with most of us trying to manage our practices and teams with as little drama as possible.

Conflict:

Nature: Conflicts tend to be longerterm, less negotiable, and may even be resistant to resolution

Cause: Conflicts arise due to various factors, such as differences in communication styles, work expectations, personal values, or conflicting opinions on treatment plans

Opportunity: Conflict is not inherently negative. It can be an opportunity for growth and improvement within the team

Darja Taravski RDN finished things off by exploring the Oral Health Practitioner role.

Darja Taravski RDN finished things off by exploring the Oral Health Practitioner role.

BADN President-elect Preetee Hylton RDN also spoke in the Enhanced CPD Theatre, sponsored by CGDent, on safeguarding in dentistry.

Meanwhile, we were kept busy on our

their membership or refer colleagues. Some in the “Keep Calm – I’m A BADN Dental

Meanwhile, we were kept busy on our stand, with dental nurses queuing up to join their professional association, renew their membership or refer colleagues. Some stopped by just to have a photo taken in the “Keep Calm – I’m A BADN Dental Nurse!” photo frame!

providers of BADN Rewards, was also

how much members could save with BADN

Jenny Hollywood of Parliament Hill, providers of BADN Rewards, was also there to explain how to get the most out of membership benefits, and to demonstrate how much members could save with BADN Rewards using her online calculator.

By the time you read this, Joan, Jacek and I will also have attended the Scottish Dental Show in Braehead, near Glasgow!

Quick reminder: our Coffee Catch Ups are held on the last Saturday of each month, at 3pm – a speaker, offering CPD; networking opportunities and a chance to ask questions. We’ve moved from Zoom to Teams – full details of how to register for the CCU and how to operate Teams are available by signing up to our e-newsletters (www.badn.org.uk/newsletter). 

Quick reminder: our Coffee Catch Ups networking opportunities and a chance to the CCU and how to operate Teams are (www.badn.org.uk/newsletter).

Pulp Friction

Drama:

Nature: Drama is often short-term and negotiable

Cause: Drama typically stems from interpersonal issues, gossip, rumours, and emotional reactions

Impact: It affects our team morale, work environment, and overall well-being, even when team members are not directly involved

The Importance of managing conflicts quickly

Team Morale and Productivity:

Proactively resolving conflicts prevents negativity from spreading among team members. When conflicts are addressed promptly, team morale remains high, and productivity is not compromised.

Patient Care: A harmonious team provides better patient care. When team members collaborate effectively, they can focus on delivering quality treatments and services to patients.

Retention and Recruitment: A positive work environment attracts and retains skilled professionals. Addressing conflicts proactively reduces turnover rates and ensures continuity of care.

Cost Savings: Unresolved conflicts can lead to inefficiencies, errors, and wasted resources. Proactive conflict resolution minimises these risks, saving time and money.

Professional Reputation: A dental practice known for its positive team dynamic attracts more patients and builds a strong professional reputation.

Reasons for conflict

Core Values: Discuss how misaligned core values can lead to friction within the team.

Unstructured Organisation: Explore the consequences of unclear roles and lack of direction.

Self-Interest: Address situations where team members prioritise their own interests over teamwork.

Now, let’s do some roleplay…

Wrong Scenario: The Drama Triangle

Dr Smith is overseeing the clinic when Sarah approaches, looking stressed.

Sarah: Dr Smith, Mr Johnson is upset about the wait time. He’s complaining and making it difficult for me to work.

Dr Smith (Rescuer): Don’t worry, Sarah. I’ll talk to Mr Johnson and smooth things over.

Dr Smith approaches Mr. Johnson.

Dr Smith: Mr Johnson, I apologise for the wait. Let’s get you in right away.

Mr Johnson (Victim): It’s about time! This clinic is always disorganised.

Dr Smith (Persecutor): Well, we’re doing our best. You’re not the only patient here.

Correct Scenario: Breaking the Drama Triangle

Dr Smith takes a different approach:

Dr Smith: Mr Johnson, I understand waiting can be frustrating. First, I apologise for any inconvenience. We value your time, and we’ll work to improve our scheduling process. Mr Johnson: Thank you for acknowledging that. I appreciate it.

Dr Smith: Sarah, let’s make sure we communicate wait times clearly with patients. Mr Johnson, feel free to share any other concerns.

Key Takeaways

• Awareness: Recognise the drama triangle roles (victim, rescuer, persecutor).

• Contrary Action: Dr Smith avoided rescuing Sarah and instead addressed Mr Johnson directly.

• Neutral Attitude: Stayed calm and empathetic.

• Balance Responsibility: Shared responsibility for improving the situation.

Remember, healthy communication breaks the cycle! 

About the author

Lisa Bainham is President at ADAM and practice management coach at Practice Management Matters.

The time of our lives

The field of dentistry has come a long way in recent years when it comes to cosmetic solutions. More and more people are seeking treatments to enhance their smiles. There has been an increasing interest in orthodontics, for example, with internet searches for ‘invisible’ aligners up by around 75% in the last five years. Modern society is placing increased value on physical appearance, with dental aesthetic procedures gaining prominence for their ability to complement facial beauty. However, the expectations and preferences for aesthetic dentistry can vary among different generations.

The Baby Boomers, often classified as those born between 1946 and 1964, were a generation that grew up in a time when aesthetic dentistry was not as advanced as it is today. They experienced a time when dental care was primarily focused on basic oral health rather than cosmetic enhancements. As a result, Baby Boomers may view cosmetic dentistry as a luxury rather than a necessity. While some may choose to pursue cosmetic treatments, many Baby Boomers are more motivated by maintaining their overall dental health or restoring dental function.

Generation X, born between the mid1960s and early 1980s, witnessed the evolution of dentistry and the rise of aesthetic treatments. This generation saw the introduction of tooth-coloured restorations, which allowed for more naturallooking results. As a result, Generation X

individuals tend to have higher expectations for cosmetic dentistry compared to their predecessors. They desire a smile that looks attractive and youthful, and they are more open to pursuing cosmetic treatments to achieve that goal.

Instagram influence Millennials, born between the early 1980s and mid-1990s, are a generation that has grown up in the early digital age. This demographic group is often known for their interest in self-image and appearance. Social media platforms like Instagram have contributed to the surge in interest for a perfect smile among this demographic. As a result, Millennials tend to be more proactive in seeking cosmetic dentistry.

Gen Z, born between the mid-1990s and early 2010s, is the first generation to have grown up entirely in the digital era. They are well-informed and highly influenced by social media platforms and celebrity culture. Gen Z individuals have developed an even higher level of concern about their appearance. Indeed, twothirds of Gen Z employees feel judged and have received unwanted comments about their appearance. This generation values aesthetics more than any previous generation, and they are eager to obtain the perfect smile. They are likely to pursue cosmetic dentistry treatments at a younger age, thanks to their access to information and a heightened focus on personal image.

Cosmetic dental treatments that are popular across generations include teeth whitening, orthodontics and minimal-prep veneers. Teeth whitening is a relatively simple and non-invasive procedure. A 2020 survey found that 22% of British respondents would get their teeth professionally whitened, with a further 10% reporting that they definitely would or that they already had. In the youngest age group – 18 to 24 years of age (Gen Z), 40% of respondents reported that they probably would whiten their teeth.

According to a recent study, one third of under 35s have had a cosmetic dental procedure or treatment in the last 12 months, spending an average of £3,677. Amongst those aged 24-34, one in 10 has spent £25,000 or more.

Application in practice

It is interesting to learn that across the generations, from Boomers to Gen Z, the one thing they all have in common is that everyone prefers to visit a dental practice/ dentist that has been recommended to them.

This is something that dental professionals should utilise in order to reach new patients and expand the business. How you request and record patient reviews will depend on your current and target patient demographic – perhaps using social media for younger patients and referral cards for older visitors to physically give to their family and friends.

To ensure these reviews are always as positive and complimentary as they can be, it’s essential to ensure that the cosmetic

dental treatments being delivered are ethical, high-quality and predictable.

This in itself is no mean feat, though it is achievable with adequate professional educational, training and support.

Membership of the British Academy of Cosmetic Dentistry (BACD) provides access to all this and more, affording confidence that you are able to deliver exceptional cosmetic dentistry to patients of all ages. To take your skills to the next level, you may even consider completing the BACD Accreditation programme, which recognises clinical excellence in a comprehensive range of relevant topics from smile makeovers to indirect shade matching, minimally-invasive techniques and complex whitening.

Generational expectations and preferences for aesthetic dentistry vary based on the historical context, advancements in dental technology, and societal influences. To encourage satisfaction across all the age groups and give your practice the best chance of success, make sure your clinical skills and confidence are up to scratch.

For further enquiries about the British Academy of Cosmetic Dentistry visit www.bacd.com 

About the author Luke Hutchins, BACD President, 2024

‘And the winners are’ - Part One

The Probe proudly presents The 2024 Dental Awards

The 2024 Dental Awards marks the 26th edition of this prestigious event that, for more than quarter of a century, has sought to recognise the outstanding individuals and teams whose dedication and drive continues to raise standards throughout the UK dentistry profession.

Winning or becoming a finalist in the Dental Awards is a tremendous accolade that provides a significant boost to the profile of a practice. Not only is the event an opportunity to share in the happiness and success of those who win an award, but it offers the chance to see what fellow dental professionals are doing across the United Kingdom.

The Dental Awards presentation, which streamed on the-probe.co.uk, as well as on The Probe’s Youtube channel, is available to

dentist of the Year

winner: rachel derby, Chapel dental, Flackwell heath )

Qualifying in 2010, Rachel aptly demonstrates the importance of combining excellent dentistry with careful attention to the patient journey and experience. Always focusing on the highest levels of patient care and adopting a listening approach that enables patients to feel comfortable, Rachel is keen to foster a personable approach throughout the practice. Taking over Chapel Dental with her husband in 2022, Rachel’s leadership and management skills have set the tone for the practice, engendering an ethos that benefits both staff and patients alike

highly Commended: Martina hodgson, the dental architect, leeds

Finalists: aly Virani, north Cardiff dental, Cardiff

andre Faro leite, Inspired dental Care, exeter

wajiha Basir, trinity house dental Care, wilmslow

Young dentist of the Year

winner: Chloe harrington-taylor, hereford dental Implant Clinic, hereford

Deciding to become a dentist aged 14, Chloe’s love of dentistry came through loud and clear to the judges. A committed professional and gifted dentist, Chloe continues to strive to make an impact on the profession, working with the team to develop her own clear aligner training course.

highly Commended: dharmesh Mistry, YOr dental, salford Quays

Commended: Uzair Janjua, Clear smiles, wolverhampton

Finalists: wiktor Pietraszewski, Fulham road dental

watch on-demand now. Scan the QR code (across) to see the winners of The Dental Awards 2024 react to their victories, as well as to discover who was named a finalist in each of the 12 hotly contested categories.

The Dental Awards 202is brought to you by B.A. International, Colosseum Dental, Dental Elite, and Waterpik, in association with The Association of Dental Administrators and Practice Managers, British Association of Dental Nurses, British Association of Dental Therapists, British Society of Dental Hygiene and Therapy, and The Oral Health Foundation.

For more, visit https://the-probe.co.uk/ awards/the-dental-awards-2024/

Karam singh lalli, staffa lodge smile Clinic to see the full list of our winners, highly commended, and finalists, and to watch the 2024 dental awards Presentation, scan the Qr

rachel derby

Chloe harrington

dental therapist of the Year

winner: natalie Peary, smile together dental CIC, Bodmin

The judges described Natalie as an inspirational dental therapist working within a supportive setting to reach those who might usually be missed when it comes to dental care, especially in an area where NHS care is difficult to access.

highly Commended: Kayley McCauley, dorset dental Clinic, Poole

Finalists: Victoria akinfenwa, new Cross dental Practice, london

Jagjit Malhi, Clear smiles, wolverhampton

Francesca rhodes, Mola dental, sheffield

dental hygienist of the Year

winner: amanda harbrow-harris, sharrow dental Group, Chelmsford

Joining the profession as a dental nurse at the age of 19, Amanda believes that Dental Hygiene is the foundation of dentistry. Without health gums and bones there are no teeth. Educating and enabling patients by giving them their own autonomy and linking any health inequalities they may experience, and/or using conditions, such as inflammation, as a motivational tool to encourage patients to follow their treatment plans.

highly Commended: Poppy Irvine, adel dental Practice, leeds

Finalists: Gemma O’Callaghan, the Periodontal therapy Clinic @ 10 dental, southport

sakina syed, Bupa dental Care, london Bank

Zara shirvani, Zara the hygienist

dental nurseof the Year

winner: Brittany Pittham, Inspired dental Care, exeter

Qualifying as a dental nurse in 1993, Janine moved into dental practice management in the early 2000s. Extremely efficient and well organised, Janine ensures the practice always runs smoothly. Understanding the financial picture, she manages the practice diary to improve and stabilise cashflow. Continually developing her skill set, she has a real talent for conflict resolution and attracting exceptional, loyal new team members. Considered by her team as the quintessential Practice Manager, they all hope that she never retires.

highlyCommended: shannon wilkes, euston Place dental Practice, leamington spa

Finalists: rebecca silver (highly Commended)

wiktoria wisniewska, ridge dental, Bristol

natalie Marucci, Clear dentistry, southampton

n atalie Peary

a manda h arbrow- h arris

Brittany Pittham

ONE CEMENT TO BOND THEM ALL … Universal cement MAXCEM ELITE

Aims and objectives

To explore the cementation processes of Maxcem in affixing a wide range of dental prosthetics, including crowns, bridges, prosthetic posts, onlays, and fiberglass root posts.

Objectives:

• To understand the background of adhesive prosthetics

• To develop an understanding of Maxcem Elite’s make-up

• To gain practical knowledge of how Maxcem Elite works in practice

Learning Outcome: C

The journey of adhesive prosthetics commenced with the advent of using ceramic veneers bonded to the front of teeth. Initially, the design of both the veneer and the tooth's surface offered no possibility for mechanical grip or frictional resistance to enhance the bonding strength between the prosthetic and the tooth. The sole force keeping the veneer attached to the tooth was chemical adhesion. This was feasible because the veneers were affixed to the enamel, which, after being etched and treated with specific bonding agents, achieved the highest possible chemical bonding strength with the cement, and thus with the ceramic veneer's surface, within the mouth. This process not only secured the veneer in place but also reinforced its structure, which was extremely fragile and had low mechanical strength when made solely of layer-fired ceramics before being attached to the tooth.

The shift towards metal-free dental works, prized for their biological and aesthetic benefits, spurred the creation of stronger ceramic materials, including pressed and milled ceramics, and the use of advanced composite materials. Dentists expanded their use to a broader range of prosthetic repairs, such as crowns, bridges, inlays, and onlays, beyond just veneers. However, these applications demanded robust adhesion to dentin, often in cases with minimal enamel contact, like with crowns and bridges. Adhesion to dentin proved significantly weaker than to enamel, especially after etching. The bonding process, following the total etch technique, involved multiple steps of primer and adhesive application, making it complex and prone to errors. Moreover, light polymerization of the cement was less effective for prosthetics other than veneers. Consequently, the adhesive bonding of metal-free restorations to dentin was fraught with a high risk of failure.

The complexities previously encountered in dental adhesion have been addressed with the advent of selfadhesive dual-curing cements, a prime

Fig.4 Kerr’s unique NexusTM Technology Tertiary-amine and BPO free self-cure initiator system (Non-Amine redox initiator

Fig. 5 Metal splinting of incisor teeth after trauma with the use of orthodontic wire and SimpliShade/OptiShade composite; Fig. 6 Open pulpal chambers of both incisors after pulpectomy, before mechanical preparation of canals. Visible fractures of the crowns involving root surfaces from the palatal side of teeth; Fig. 7 Teeth 11 and 21 after canals obturation with gutta percha, moment before further procedures of cementing EASYPOST glass post inside; Fig. 8 Optidam system dental dam used for isolation of teeth for endodontic procedure and cementing glass posts at the same visit. Note additional flow material colored blue for fixing the clamps; Fig. 9 Gutta percha filling inside apical part of canal visible after preparation for glass posts, and removal of most part of liquid guttapercha applied before

example being Maxcem Elite from Kerr. This product achieves robust adhesion to dentin effortlessly, bypassing the intricate application steps traditionally required, due to its formulation with Glycerol phosphate dimethacrylate (GPDM). This GPDM formulation allows for its effective use in affixing a wide range of dental prosthetics, including crowns, bridges, prosthetic posts, onlays, and fiberglass root posts (figs 1 & 2).

With the addition of a suitable type of silane, Maxcem Elite also excels in

securing metal-free and metal-based restorations. Thanks to the simplified cementation procedure, the risk of operator error is minimized, and the procedure itself is short, leaving plenty of time for careful removal of excess cement after cementation.

In addition, Maxcem Elite offers a broad palette of colors unique to its category— Clear, White, Yellow, and White opaque— each tailored for specific uses (fig 3).

• For aesthetic metal-free restorations such as crowns, bridges, or veneers,

dentists have the ability to subtly adjust the color of the restoration crafted in the prosthetic laboratory by choosing MAXCEM White, Yellow, White Opaque, or maintain its laboratory-produced color by opting for the Clear shade.

• White Opaque is particularly beneficial for cementing fiberglass root posts, providing a strong contrast that aids in future dental procedures such as subsequent prosthetic preparation or the need to undergo re-endo.

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Fig 1. GPDM monomer bonds onto the metal and ceramic surface through metal chelation process; Fig 2. GPDM monomer bonds onto Lithium Disilicate; Fig.3 Different colors of Maxcem and ability to mask or change shade beneath. From left side: opaque white, white, yellow and clear. Portions of material are thick about 1 mm and still effect can be seen;

system);

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Fig. 10 Maxcem Elite Opaque White applied inside canals with a thin cannula. Image taken form under microscope, with active anti-polymerization filter, hence yellowish tint of a picture; Fig.11 Easy Post glass posts diameter 1,375 mm introduced inside canals filled with cement. It should be located in the central part of canal, with visible spare space for core material; Fig. 12 Polymerization of cement with a lamp after 2 minutes of wait for chemical part of polymerization to commence. MAXCEM is dual cure so it will harden deep inside canal even if polymerization light will not reach it there; Fig. 13 Prepared pillars of teeth 11 and 21 for composite crowns. Note that part of each pillar is made of Build-it FR core material, but most is just dentine tissue; Fig.14 Both crowns ready on plaster model, made in dental laboratory of composite material; Fig.15 To increase adhesion of a cement to inner surface of a crown it is advisable to air-abrade inside crown with aluminium dioxide powder using standard air abrasion device used in restorative dentistry; Fig.16 Another solution for increasing adhesion is application of Silane Primer to chemically activate surface of a composite and restore oxygen inhibition layer; Fig.17 Silane should be applied with a good quality microbrush, and brushed into inner surface of a crown for 20 seconds. Then silane should be left on the surface for 60 seconds to evaporate; Fig.18 It is important to remember to bleed a small amount of cement from cannula on the side, then we can be sure that cement will be mixed in even proportions when applied; Fig.19 Maxcem should be applied inside prosthetic crowns or bridges to fill it completely without any voids. In this case CLEAR shade was chosen, as color of prosthetic work matched teeth color, so there was no need to change it with additional shade of cement; Fig.20 Easy excess removal was carried out in a gel phase of cement curing, in case of Maxcem it is very intuitive, and always leaves clean and plain margins of the crown/tooth tissue contact; Fig.21 Proper cementation from palatal side, where fracture of the crowns deepest, was only possible with a dental dam, that was able to push away gingival margin, and make humidity isolation possible; Fig.22 Thanks to wide variety of shades of MAXCEM it s always possible to match the color of cemented prosthetic work with patient’s teeth

CPD Questions

1. Veneers are attached to tooth surfaces using which forces?

a. Chemical adhesion

b. Mechanical grip

c. Frictional resistance

d. Torque momentum

2. When adhesively cementing a prosthetic crown, which surface may require the use of a bonding agent?

a. Dentin

b. Metal alloy

c. Composite core build up

d. All of the above

3. Which luting cement color will not change the shade of prosthetic work after cementation?

a. Opaque white

b. Yellow

c. Clear

d. White

4. The color stability of composite luting cement depends on the addition of:

a. GPDM monomer

b. Non-amine redox system

• For prosthetic metal posts and onlays, White or Yellow shades are ideal to seamlessly blend the restoration with natural tooth tissue on the occlusal surface, while Clear and White Opaque can accentuate the distinction between the prosthesis and enamel.

Brought to you by

c. MDP-10

d. Zirconium oxide filler

Boasting exceptional color stability due to its non-amine redox system, Maxcem Elite ensures the longevity and perfection of the restoration’s shade (fig 4).

Its simplicity in use, combined with its adaptability, positions Maxcem Elite as the go-to dual adhesive cement for dentists, applicable across all dental restoration tasks.

In the described clinical scenario, a 12-year-old patient presented with injuries to their upper incisors, incurred 6 hours prior, involving partial luxation of teeth 11

and 21. The injuries were compounded by crown fractures and significant pulp exposure, with the fractures extending subgingival on the palatal side. Initial treatment involved splinting the teeth and performing pulpectomies. (fig 5)

Subsequent visits focused on root canal treatment using the Traverse& Zenflex system to prepare the canals to an ISO size 35, taper 06, and filling them with warm gutta-percha through the Elements IC system (figs 6, 7, 8 & 9).

To reinforce the incisors, Easypost glass fiber posts were anchored into the canals using Maxcem Elite (white opaque) cement, followed by polymerization (figs 10, 11, & 12).

The tooth crowns were further strengthened using the Built-it FR material and OptiBond eXTRa Universal adhesive system, in preparation for prosthetic crowns (fig 13)

Considering the patient’s age and potential for future tooth color changes, laboratory composite crowns were chosen for their ease of replacement. Cementation was performed using Maxcem Elite Clear. The crowns were tried on and their inner surface were treated by sandblasting with aluminum oxide powder with diameter of 35 µm and applying Silane Primer for optimal adhesion (figs 14, 15, 16 & 17)

The prosthetic abutments were cleaned and smoothed before applying the cement inside the crowns using Occlubrush. A small portion of the cement was squeezed out to allow it to mix properly. Later, cement was applied inside the prosthetic crown. The crown was placed on the abutment and the excess was removed. It is best to wait for cement to react to gel phase and then clean all the excess with a simple move of dental probe, without any risk of damaging crown surface. The procedure was repeated for the second crown. After 2 minutes, polymerization

was carried out using polymerization lamp (figs 18, 19, 20, 21 & 22)

Conclusion

The use of MAXCEM cement typically yields aesthetically outstanding results in cementation processes. This is attributed to the ability to choose a suitable cement color and adjust the prosthetic work’s color, coupled with the straightforwardness of the cementation procedure. n

About the author Maciej Mikołajczyk

DDS PhD Graduated from the Dental Faculty of Lodz Medical University. Author and co-author of multiple thesis on minimally invasive treatment in prosthetics and traumatology. He received his PhD degree in 2008 for a thesis on “Evaluation of ozone influence on dentine infected with caries bacteria”. He holds classes for foreign students in English at Dental Faculty of Lodz Medical University. In 2010-2012 he was a scientific director and speaker for international educational program organised by “Forum Dentysty Praktyka” magazine. Since 2013 editor in chief of “Endodoncja w praktyce gabinetu” (“Endodontics in dental practice”) educational publication cycle. Member of scientific board of “Cosmetic Dentistry Beauty and Science” magazine. Speaker in multiple conferences and workshops focusing on minimally invasive techniques in dental prosthetics, ergonomy, restorative dentistry and endodontic treatment in Poland and abroad. Owner of a private dental practice in Łódz. KOL and paid consultant of Kerr.

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Shaping the future of dental health practices

Justin Hind examines the significance of ergonomics within dental practice, providing advice on implementing ergonomic principles into equipment design and workspace setup to boost practitioner and patient well-being

Aims and objectives

The aim of this article is to explore the importance of ergonomics in dental practice, offering guidance on how to implement ergonomic principles in equipment design and workspace arrangement to enhance practitioner well-being and improve treatment efficiency.

On completing this Enhanced CPD session, the reader will:

• Understand the importance of ergonomics in dentistry and how it affects both the dentist’s and patient’s health

• Be able to identify the key ergonomic design principles that contribute to effective eye-hand coordination and optimal workspace arrangement in the dental setting

• Have gained the skills to evaluate and select dental chairs and other equipment based on their ergonomic features to ensure they support healthy posture and minimise the risk of musculoskeletal injuries

• Have learned to apply practical guidelines for positioning the workspace and patient to maintain a balanced and symmetric working posture, adjusting for both dentist and patient needs

• Have an increased awareness of how to assess current dental practice setups and implement improvements based on ergonomic principles to enhance practitioner comfort, patient care, and overall efficiency in dental procedures.

Learning Outcome: B, C, D

Dentistry, a field that inherently demands precision and prolonged static postures, has recognised the critical need for ergonomic equipment to support both the health of dental professionals and the comfort of their patients.

Guidance issued by the FDI World Dental Federation in 2021 states that, during traditional dental procedures, dentists frequently lean over the patient to perform precise treatments. This bending can result in an unnatural and detrimental posture, adversely affecting the dentist’s health.

Meanwhile, the International Ergonomics Association (IEA) describes ergonomics, also known as human factors, as the scientific study focused on analysing the interactions between humans and various elements within a system. It is a profession dedicated to using theoretical principles, data, and methodologies in design processes to enhance human well-being and improve the performance of the entire system.

With all this in mind, modern dental chairs and operational tools are being designed with advanced ergonomic features that help mitigate the physical strains faced by dentists. These innovations are crucial not only for the comfort but also for the long-term health and efficiency of dental practitioners.

The geometry of motion

Hokwerda and colleagues (2007), a group made up of dental ergonomists and practising dentists, created guidelines and recommendations for designing, constructing and selecting dental equipment.

Within that document, they emphasise that the eye-hand coordination kinematic chain (i.e. the geometry of motion) in dentistry involves various body segments that must move in sync to execute dental tasks effectively. Dentists use their fingers and hands to manipulate tools within the patient’s mouth, relying on precise

coordination guided by their eyes. This coordination is achieved through a kinematic chain that includes the fingers, hands, arms, upper body, shoulders, neck, and head, which aligns the direction of the eyes’ gaze.

The authors continue that, for successful task execution, dentists require visual, tactile, and proprioceptive feedback. This sensory information is processed to guide the movement of the kinematic chain, with a focus on the hands and fingers for

task performance. The arrangement and positioning of the workspace are critical to ensure the kinematic chain operates optimally, allowing the body parts to function within the limits of a healthy posture based on anatomical dimensions.

The dentist’s functional synthesis between the biological and technological systems must therefore be designed with ergonomic considerations to maintain a healthy posture. This includes positioning the workspace

directly in front of the dentist and setting the instruments at an optimal height, distance, and angle for easy access. Offering a summary, the experts published three positioning principles that are crucial for optimal workspace arrangement in the patient’s mouth:

1. Positioning the workspace in the symmetrical plane to ensure a balanced working posture. The symmetrical plane is a vertical line that bisects the body into two equal halves

www.the-probe.co.uk

2. Adjusting the patient’s head along three axes - forward/backward, side bending, and rotational - aligns the treatment area with the dentist’s line of sight, facilitating a perpendicular viewing angle to minimise postural adjustments

3. Setting the correct height of the workspace within the patient’s mouth, requiring a minimal arm elevation of 10 degrees for shorter dentists and up to 25 degrees for those who are taller. This ensures a comfortable distance between the dentist’s eyes or glasses and the workspace, typically between 35 to 40 cm, with slight adjustments for taller individuals.

Advanced design features

Clearly, for the dental professional, every piece of equipment, from the patient chair to the instrument tray, plays a role in maintaining optimal ergonomic conditions. The patient chair itself should offer adjustability in height to accommodate different procedures and dentist heights, with features like swivel capabilities to enhance accessibility in constrained spaces (Valachi B, 2009). Another essential aspect of the chair design is including sufficient free space behind the base for the dentist’s feet and foot control. This space should ensure sufficient room for leg movement and easy access to foot controls without causing the dentist to adopt awkward postures.

A-dec’s ergonomic solutions

• Embrace a new standard in dental care with A-dec’s innovative, ergonomic dental chairs, designed to meet the demanding needs of modern dentistry.

• With decades of collaboration within the dental community, A-dec offers solutions that bring unparalleled comfort and efficiency to your practice.

• For example, the A-dec 500 dental chair, featuring a thin backrest and headrest, ensures that you can maintain close proximity to your patients while supporting a healthy posture. Coupled with the precision of the A-dec LED dental light, every procedure becomes simpler, less strenuous, and more focused.

• Experience the difference that smart ergonomics can make in reducing the physical strain of repetitive movements. Choose A-dec for a pain-free practice where you can feel the improvement in every task. Feel the difference, see the results— transform your practice with A-dec’s dependable, ergonomic solutions. Discover more at unitedkingdom.a-dec.com and elevate your practice today.

Moreover, the chair should be designed with a thin backrest and minimalistic armrests to allow the dentist to get close enough to the patient without compromising their posture. Valachi (2009) highlights an important point: many dental chair manufacturers have traditionally emphasised patient comfort, producing chairs that are plush and equipped with broad, comfortable armrests.

Yet, when considering the time spent in these chairs, the average patient is reclined for only a few hours each year, compared to the dentist, who spends over 2,000 hours annually working above the patient. This disparity raises the question: who is truly at greater risk of experiencing discomfort or pain?

Thus, all the above-mentioned features are vital for reducing the risk of musculoskeletal injuries commonly associated with dental practice.

Appropriate equipment placement

Moving on to dental chair accessories, the management of dental instruments may be enhanced through the use of a horizontally oriented arm equipped with a swivel coupling placed directly below the instrument console, according to Hokwerda and colleagues (2007). This design allows for the tray holder to be adjusted easily and positioned optimally, ensuring that instruments are within a convenient reach without interfering with the operation.

Indeed, the placement of hand instruments is vital for an efficient workflow. Trays for hand instruments should be positioned within 20 to 25cm of the dentist’s body at a height that aligns with their natural working posture to prevent unnecessary reaching or bending. This setup not only facilitates easy access but also ensures that the dentist can maintain a neutral body position, reducing fatigue and increasing procedural efficiency.

The concept of four-handed dentistry further enhances this ergonomic approach. In four-handed dentistry, the dental assistant actively participates in the procedure, handling instruments and materials so that the dentist does not have to reach or twist frequently.

This teamwork approach is well documented as minimising motion and maximising efficiency by keeping all necessary tools within easy reach and properly oriented towards the workspace. The assistant’s role in handing off instruments that are oriented for immediate use significantly reduces the physical strain on the dentist and speeds up the workflow.

The flexibility of this system is critical for maintaining the dentist’s focus and ergonomic posture throughout dental procedures. Implementing fourhanded dentistry practices, combined with strategically placed dental chair accessories, can transform the efficiency and ergonomic safety of dental operations, ultimately enhancing patient care.

A necessity for modern practices

The thoughtful integration of ergonomic principles into dental equipment design is not merely an enhancement but a necessity for modern dental practices. By

CPD Questions

1. According to the FDI World Dental Federation’s 2021 guidance, what common issue arises from the posture dentists adopt during traditional dental procedures?

a) Decreased precision in treatments

b) Development of unnatural and harmful postures

c) Increased patient comfort

d) Enhanced system performance

2. What is the focus of ergonomics as defined by the International Ergonomics Association?

a) Decreasing the reliance on data in system processes

b) Designing tools for automated system performance

c) Understanding and designing human-system interactions to improve well-being and system performance

d) Theoretical principles to reduce system interactions

3. In the guidelines for dental equipment design, what is emphasised as a key component of the eye-hand coordination kinematic chain?

a) Movement synchronisation of various body segments

b) Decreasing the need for visual feedback

c) Sole reliance on proprioceptive feedback

d) The isolated use of fingers without hand support

4. What essential design feature of the patient chair helps prevent musculoskeletal injuries in dentists?

a) High base for better visibility of the patient

b) High armrests for patient comfort

c) A plush, cushy seat design

d) Thin backrest and minimalistic armrests to allow close proximity to the patient

5. What is a key feature of the A-dec 500 dental chair that supports the dentist’s posture and patient proximity during procedures?

a) Adjustable footrest

b) Thin backrest and headrest

c) Integrated music system

d) Programmable massage settings

focusing on the detailed aspects of chair and instrument placement, as well as the mobility and accessibility of operational controls, dental professionals can achieve a significant reduction in physical strain. This advancement ultimately leads to greater efficiency, improved health outcomes, and a more positive experience for both practitioners and patients. With ergonomic considerations at the forefront of dental equipment design, the profession is poised for healthier, more sustainable practices that prioritise the well-being of its most valuable asset - its workforce.

References

• Ergonomics and posture guidelines for oral health professionals. FDI World Dental Federation 2021. Available at: https://bit. ly/3Uz3Wt5. Accessed 25 April 2024

• Hokwerda O et al. Ergonomic requirements for dental equipment.

Guidelines and recommendations for designing, constructing and selecting dental equipment. Updated 2007. Available at: bit.ly/44gqe7d. Accessed 25 April 2024

• International Ergonomics Association. What is ergonomics (HFE)? Available at: https://iea.cc/about/what-isergonomics/. Accessed 25 April 2024

• Valachi B. Ergonomic guidelines for selecting patient chairs and delivery systems. Dentistry Today 2009. Available at: https://www. dentistrytoday.com/sp-52800858/. Accessed 25 April 2024 n

Advanced restorative techniques and the full mouth reconstruction: occlusal concepts

Tipton is delighted to bring you this article, with the aim of supporting the ongoing Enhanced CPD needs of dental healthcare professionals in improving and maintaining the oral health of their patients.

Learning Aims:

1. To understand the historical development and principles of key occlusal concepts in advanced restorative techniques, particularly gnathology and the Pankey Mann Schuyler (PMS) theory.

2. To evaluate the clinical implications and practical applications of different occlusal schemes in full mouth reconstruction, including the impact of new dental materials.

3. To apply fundamental occlusal concepts to develop effective treatment plans for full mouth reconstruction, ensuring optimal patient outcomes in both function and aesthetics.

Learning Objectives:

• Explain the Development and Fundamentals of Gnathology

• Compare Occlusal Concepts in Restorative Dentistry

• Analyse the Impact of Different Occlusal Schemes

• Assess the Role of New Dental Materials in Restorative Techniques

• Apply Occlusal Concepts to Clinical Case Studies

Learning Outcome: C

Most advanced restorative dentistry techniques have changed little over the last 20-30 years, including that of the full mouth reconstruction. However, the impact of new dental materials, such as titanium and zirconia, has had a major influence on aesthetic dentistry and implantology during this time period. As a result, the profession may have an over-reliance on new materials rather than tried and tested techniques.

Gnathology

Stallard first coined the term gnathology in 1924, defining it as the science that relates to the anatomy, histology, physiology and pathology of the masticatory system. McCollum formed the Gnathological Society in 1926 and is credited with the discovery of the first positive method of locating the transverse horizontal axis and transferring the recording to an articulator using a facebow.

Stuart became associated with the Gnathological Society early and published the classic ‘Research Report’ with McCollum in 1955. Their observations led to the development of the principles of mandibular movements, transverse horizontal axis, maxillomandibular relationships, and an arcon-style articulator that was designed to accept the transfer of these occlusal records. The goal was to truly capture maxillomandibular relationships that accurately reproduced border jaw movements and which would then allow the technician to produce the most stable, functional and aesthetic occlusal form for indirect cast restorations. The registration of the horizontal and sagittal movements of patients was believed to allow the maximum cusp height-fossae depth with proper placement of ridges and grooves to enhance stability, function and aesthetics.

Fundamentals of Gnathology

The fundamentals of gnathology include the concepts of retruded axis position (centric relation), anterior guidance, occlusal vertical dimension, the intercuspal design, and the relationship of the determinants of mandibular movements recorded using complex instrumentation to the occlusion in fixed prosthodontics. This has evolved into the five principles of occlusion I embrace today:

1. RCP = ICP around RAP

2. Mutually protected occlusion

3. Anterior guidance

4. No non-working side interferences

5. Posterior stability.

The early gnathologists studied the recorded tracings made during mandibular movements. When the mandible travels forward along the sagittal plane it is considered a protrusive excursion or protrusion. Therefore, retrusion is the movement toward the posterior; and it is the most retruded physiologic relation of the mandible to the maxilla to and from which the individual can make lateral

movements that initially defined retruded axis position (RAP) or centric relation (CR) to the gnathologist. Further investigations led the gnathologists to believe that mandibular (condylar) movements are governed by the three axes of rotation. The concept of retruded axis position evolved into a three-dimensional position, resulting in its description as the rearmost, uppermost, and midmost (RUM) position of the condyles in the glenoid fossa. More recently, with the input of anatomists and physiologists, the concept has

Fig. 1: Full face pre-op view

Fig. 3: Upper arch pre-op

Fig. 2: ICP

Fig. 4: Facebow recording

also included a bone braced position slightly anterior to the RUM position. Whilst there can be discussions between groups as to the exact definition of RAP, it is generally accepted as a muscular relaxed, reproducible and braced position that is an area not a pinpoint and can only be achieved with relaxed musculature.

Placing the condyles with the correct position and having immediate disclusion (canine guidance and incisor guidance) upon movement away from that position, with no vertical or horizontal deflective contacts is fundamental to gnathology. Tooth wear is considered pathological in gnathology and one of its fundamental concepts is trying to advance a dentition with minimal wear.

Alternative occlusal concepts: Pankey Mann Schuyler

As gnathology was evolving, several competing occlusal concepts and permutations were theorised, such as the Pankey Mann Schuyler (PMS) theory of occlusion. The Pankey Mann Schuyler concepts evolved out of an initial study group headed by LD Pankey on the east coast of America. Nomenclature was different and included centre relation (CR)

instead of retruded axis position (RAP); centre related occlusion (CRO) instead of retruded contact position (RCP) and centric occlusion (CO) instead of intercuspal position (ICP). Beyron, following his observations on Australian Aborgines, suggested that uniform tooth contact and resultant wear on several teeth in lateral occlusion was a positive and inevitable outcome. As a modification of canine guidance, the Pankey Mann Schuyler philosophy in complete full mouth reconstruction was to have simultaneous contacts of the canine and posterior teeth in the laterotrusive (working) excursion, known as group function, and only anterior teeth contact in the protrusive excursive movement.

Schuyler further suggested that incisal guidance without freedom of movement from a centric related occlusion (CRO) to a more anterior tooth intercuspation (CO) will ‘lock-in’ the posterior occlusion (long centric).

The incisal guidance, along with ‘long centric’, is determined by the distance from transverse horizontal axis-centric relation and the normal freedom of movement in the envelope of function. This method requires that the incisal

guidance be established and the mandibular posterior buccal cusps be placed to a height measured along the occlusal plane as dictated by the curve of Monson. The maxillary posterior teeth are developed after the completion of the mandibular restorations as dictated by a wax functionally generated path record. The definitive restorations are equilibrated into a centric relation position with mandibular buccal cusps onto a flattened fossae-marginal ridge contact with ‘freedom in centric’ anterior guidance and group function in laterotrusive (working) excursion.

Deflective Contacts

Though 90% of natural dentitions have a deflective occlusal contact or an occlusal ‘prematurity’ between centric related occlusion (CRO) and centric occlusion (CO), it is usually in the form of a slide that has both a vertical and horizontal component occurring in all three planes. According to Ash and Ramfjord, the horizontal ‘long centric’, from centric related occlusion to centric occlusion, should be incorporated into a restoration by means of a post restorative occlusal adjustment.

Dawson illustrates the ‘freedom in centric’ concept within the lingual concavity of the maxillary anterior teeth. He redefines long centric as ‘freedom to close the mandible either into centric relation or slightly anterior to it without varying the vertical dimension at the anterior teeth’. Additionally, long centric accommodated changes in head position and postural closure (Mohl position).

Gnathology versus PMS

Gnathologists believe that once the condyles are positioned in retruded axis position (centric relation), any movement out of this position should disocclude the posterior segment, thus nullifying any horizontal cusp-fossae area contact. This belief, combined with the immediate anterior disocclusion, forms the basis of a mutually protected occlusion and limits tooth wear. The PMS occlusal scheme, however, encourages multiple occlusal contacts during lateral movements (group function or wide centre) and during protrusive movements (long centric). This may have the effect of increasing tooth wear. It is, therefore, logical that the PMS occlusal scheme recommends that occlusal wear is

Fig. 5: Upper cast front view

Fig. 8: Lower study cast

Fig. 6: Upper cast right-hand view

Fig. 9: Diagnostic waxing front view

Fig. 7: Upper cast left-hand view

Fig. 10: Diagnostic waxing right-hand view

Fig. 11: Diagnostic waxing left-hand view

Fig. 15: Upper prep guide

Fig. 16: Lower prep guide

Fig. 17: Upper right restoration on fully adjustable articulator

Fig. 18: Upper left restoration on fully adjustable articulator

Fig. 12: Lower wax-up

Fig. 13: Prototypes upper arch

Fig. 14: Prototypes lower arch

physiological, not pathological as suggested by gnathologists. The task of adjusting maximum intercuspation contacts in two different positions on an articulator may result in a lack of precision in both positions. However, the masticatory system has the ability to adapt to various influences and though, in the author’s opinion, the concept of gnathology will produce stable longterm results, some patients may require more freedom in their occlusion and the PMS concepts are not to be dismissed in these patients. Indeed, some PMS concepts such as waxing-up the curve of Spee and Monson prior to occlusal rehabilitation are incorporated into every day occlusal practice.

Case study

Patient A was referred to me for a full mouth reconstruction and aesthetic improvements to her smile (Figures 1-3). Initial impressions, facebow and jaw registration were taken for mounted study models (Figure 4). The study models showed the degree

CPD Questions

1. What is Gnathology primarily concerned with?

a) The study of dental aesthetics

b) The science of masticatory system anatomy, physiology, and pathology

c) The development of new dental materials like titanium and zirconia

d) The practice of single-day dentistry techniques

2. Which technique is associated with capturing maxillomandibular relationships accurately?

a) Immediate disclusion

b) Bone braced position c) Arcon-style articulator d) Single-day dentistry

3. Which occlusal concept is defined as the rearmost, uppermost, and midmost position of the condyles in the glenoid fossa?

a) Centric Occlusion (CO)

b) Retruded Axis Position (RAP)

c) Immediate disclusion

d) Group function

4. What does the Pankey Mann Schuyler (PMS) occlusal scheme emphasize?

a) Immediate anterior disocclusion and minimal tooth wear

b) Multiple occlusal contacts during lateral and protrusive movements

c) Use of only anterior teeth contact in all excursive movements

d) Avoidance of centric relation positions

of over-eruption of her anterior segments and disturbances to the occlusal plane (Figures 5-8).

Initial diagnostic waxing (Figures 9-12), prototypes (Figures 13 and 14) and prep guides (Figures 15 and 16) were completed using a lower curve of Spee of a 4” radius (anatomical average as recommended by the PMS techniques).

Initial prototypes were placed with large palatal ramps on the upper anterior teeth to allow anterior tooth contacts and thus an immediate disclusion style of occlusal scheme as recommended in the gnathological approach.

During the course of the initial preparation and prototypes and after a period of stabilisation, the patient was struggling to come to terms with the palatal ramps from a speech and comfort point of view.

The decision was made to change the occlusal scheme to a PMS ‘freedom in centric’ style approach where initial guidance in both left and right lateral excursions came from posterior teeth until such time as the canines contacted and then took over as canine guidance. In protrusion, a similar long centric was established on posterior teeth so that in protrusive movements the initial guidance was from the posterior teeth until such time as the incisors touched and then took over the further smooth protrusive movements. This was achieved by using a fully adjustable articulator to complete the restorations (Figures 17 and 18).

Conclusions

The definitive anterior crowns were made of Procera all ceramic (Nobel Biocare) (Figures 19-21). The posteriors were

constructed of traditional porcelain fused to metal with large flat areas on the palatal cusps for the establishment of both ‘long and wide centric’ (Figures 22-24) as in the new intercuspal position there were no anterior contacts (Figure 25) due to loss of the palatal ramps. The final aesthetic result can be seen in Figures 26 to 29. Occlusion and the various occlusal concepts have caused – and continue to cause – debate. Whilst the author has been trained throughout his career in the concepts of gnathology, there is the recognition that other occlusal concepts, such as PMS and bilateral balance, may have a part to play in treatment of some patients. n

About the author

Professor Paul Tipton BDS, MSc, D.G.D.P RCS, Dip Rest Dent, Dip Imp Pros, Dip Pros, Dip Aesth Dent, FCGDent. Specialist in Prosthodontics. Visiting Professor of Restorative and Cosmetic Dentistry, City of London Dental School.

Professor Tipton is the founder of Tipton Training, Europe’s largest private post graduate dental training provider, offering a range of Level 7 dental courses, accreited by EduQual and the Royal College of Surgeons of England. Tipton Training’s courses include those in Restorative, Aesthetic, Operative Dentistry and Dental Implantology. To view the full range of courses, visit www.tiptontraining.co.uk

Fig. 19: Anterior crowns front view

Fig. 21: Anterior crowns left-hand view

Fig. 23: Upper right quadrant with palatal ramps

Fig. 25: Intercuspal position with no anterior contacts

Fig. 27: Upper anteriors final view

Fig. 29: Full face final view

Fig. 28: Lower anteriors final view

Fig. 26: Upper anteriors

Fig. 24: Upper left quadrant with palatal ramps

Fig. 22: Upper arch occlusal view

Fig. 20: Anerior crowns right-hand view

Preparation guidelines for posterior partial coverage lithium disilicate restorations

There is an increasing reliance and demand on minimally invasive treatment modalities driven by a combination of patient preference and research outcomes. When applied appropriately, these procedures allow clinicians to utilise contemporary adhesive techniques whilst working efficiently and within financial constraints.

The obvious benefits of partial coverage restorations are numerous:

1. Preservation of natural tooth structure

a. We can limit the extent of circumferential and axial preparations as there is no reliance on traditional retention and resistance form.

b. Through the understanding of bio-mimetic principles together with deep margin elevation (DME), we can preserve more tooth tissue.

2. Fewer endodontic complications

Preservation of dentine, removal of undercuts and immediate dentine sealing (IDS) all limit negative effects on pulpal tissue and protect it.

3. Opportunity for further intervention

There is no perfect treatment modality. However, conservative partial restorations frequently allow re-treatment at time of failure.

Ceramic materials as a group are considered most appropriate as enamel substitutes. Specifically, lithium disilicate is well established and documented as an extremely versatile material serving both the anterior and posterior dentition. Restorations can be milled following a CAD/ CAM workflow or alternatively, pressed from ingots. The purpose of this article is to present contemporary adhesive restoration of posterior teeth using lithium disilicate, along with auxiliary restorative procedures to optimise the tooth-restoration interface.

Lithium disilicate

Lithium disilicate ceramics are extremely versatile, silica-based ceramics. They consist of lithium disilicate micro-crystals that are uniformly dispersed in a glass

matrix. Their propensity for etching with hydrofluoric acid enables them to form mechanical and chemical bonds with adhesive resin cements through the use of a silane coupling agent. Lithium disilicate restorations can be manufactured by either pressing or milling. Initial LiSi Press ingots are aesthetically versatile with a range of 4 different translucencies while Initial LiSi Blocks offer outstanding opalescence at 2 translucency levels. Initial LiSi Blocks are fully crystallised milling blocks that do not require firing. The clinician or technician have the choice of manual polishing and cementation or ‘painting’ followed by firing. The painting can be done with Initial IQ Lustre Pastes or using a microlayering technique with the Initial IQ ONE SQIN concept.

Adhesive Protocols

For partial coverage restorations any exposed dentine can be protected with the IDS concept at the time of tooth preparation. This has been shown to reduce patient symptoms and to increase bond strength and fracture strength of ceramic onlays. It aids in the establishment of the hybrid layer, which can be crushed under the pressure of adhesive cementation, particularly using self-adhesive products. This is more problematic when the adhesive is not polymerised prior to seating of the restoration. Furthermore, the resinous

base allows reinforcement and filling of undermined cusps and undercuts to provide the necessary geometry for the ceramic restoration. This could be done with G-ænial Universal Injectable or with everX Flow.

Lithium disilicate, being an etchable, silica-based ceramic, has a well documented history of adhesion to dental structures through a silane coupling agent. Resin cements are recommended for adhesive luting. Within the resin cements family, lithium disilicate can be bonded with both self-adhesive resin cements as well as conventional resin cements following phosphoric acid etching.

The recommended surface treatment for lithium disilicate is etching with 5-9% hydrofluoric acid for 20 seconds. Air particle abrasion with alumina is not advised as it may create microcracks leading to premature failure. Etching with hydrofluoric acid after try-in is necessary to optimise the fitting surface. Cleaning with alcohol in an ultrasonic bath for 2-5 minutes is recommended prior to application of a silane coupling agent such as G-Multi PRIMER.

Preparation Guidelines

Posterior onlays/overlays include occlusal coverage and the recommended clearance is minimum 1 mm. Any intracoronal features or boxes should have a taper of 6-10 degrees with rounded

corners and line angles. An inclined bevel on the buccal cusp will enhance aesthetic integration, increase enamel surface area and restoration thickness. Porcelain bonded restorations should have uniform thickness throughout the occlusal table and deep boxes and steps should be avoided. The concepts of IDS and DME aid in reducing any surface irregularities and prevent exaggerated ceramic thickness. A fundamental principle of onlay/overlay preparation is to prepare where necessary, addressing the defects present and where the space for lithium disilicate is required.

A common indication for a lithium disilicate onlay is a failing MOD direct restoration (Fig. 1). The recommended bur for occlusal reduction is a parallel-sided, fine red-band diamond with rounded end. This will result in a butt joint between the occlusal surface and the axial wall (Fig. 2). Bevelling these butt joints along the axial wall will increase enamel surface area for adhesion, create converging compressive forces to the centre of the tooth and achieve a more aesthetic integration between restoration and tooth. The transitions between occlusal planes and boxes as well as any bevelling of the cusps is best done with flame-shaped, fine grit diamonds (Fig. 3). Rounding off corners and line angles is critical in reducing stress concentrations during cementation and loading. This can be achieved with small discs or silicone points.

Fig. 1

Fig. 2

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Onlays and overlays, unlike crowns, do not have prep guidelines set in stone as each tooth has its unique topography of the space to be restored. Based on the extent of the defect and aesthetic parameters the 3 following margin designs can be used and sometimes all within the same tooth: butt joint, bevelled margin and shoulder (Fig. 4). The butt joint is mostly indicated on lingual/palatal cusps as it has the least aesthetic outcome. The overlay shoulder is indicated where the cusp defect is significant enough to justify ‘dropping’ the margin at the equator or even the gingival margin.

In terms of minimum thickness of lithium disilicate onlays, the consensus is 1 mm. Some studies have shown similar fracture resistance and clinical performance at 0.7 mm while also increasing the thickness from 1.2 mm to 1.6 mm showed no difference in fracture resistance. The factors that will influence the desired thickness are the amount of enamel present, location in the mouth and any evidence of bruxism. Figure 5 summarises the preparation steps for a bevelled onlay preparation.

Luting Protocol

Adhesive cementation/luting of any restoration is best carried out under full rubber dam isolation. (Fig. 6). This will give the operator a clean working field eliminating any compromises in adhesion through moisture contamination from blood, saliva and breathing moisture. In vivo research has also recently shown that higher bond strengths will be achieved under rubber dam isolation.

Air particle abrasion with alumina will clean the tooth preparation from plaque and biofilm whilst also activating enamel, dentine or IDS rendering them ready for adhesive cementation.

For a posterior onlay/overlay the following three options are available as adhesive cements:

1. Light-cured restorative composite: this can be a low viscosity composite or heated composite paste

2. Universal, dual-cured self-etching resin cement (such as G-CEM ONE)

3. Dual-cured conventional, multistep resin cement (such as G-CEM LinkForce)

There is no gold standard on which of the above is preferred. Rather, a decision should be based on an objective assessment of the tooth-restoration assembly in addition to operator experience. Factors to consider include:

1. Opacity of restoration

2. Accessibility of margins for excess removal

3. Restoration thickness Thicker and opaque (low translucency) onlays will favour dual-cured cements due to poor light penetration.

Contraindications

Clinical situations where lithium disilicate is not indicated include:

• Increased occlusal load (e.g. restoring second molars in a bruxist)

• Ultra-thin ceramic bonded restorations

• Poor substrate adhesive capacity (e.g. sclerotic dentine)

Recommendations

Lithium disilicate offers a wide range of options when planning partial coverage indirect restorations in posterior teeth. Monolithic restorations have superior mechanical properties to layered ones and they are indicated in the posterior region where staining/glazing or hand polishing would be aesthetically adequate. We recommend using dualcured resin cements for posterior onlays for 3 reasons:

1. Access may be compromised for light-curing

2. Low translucency ingots/blocks may be used to mask and inherent discolouration (eg replacing old amalgam restorations)

3. The restoration may have variable thickness and prevent resin polymerisation due to inadequate light penetration If nevertheless a high translucency onlay is utilised and it has a thin, uniform thickness then a light-cured

resin could be used to adhesively cement it (heated composite paste or high viscosity composite)

In terms of tooth preparation we suggest the following:

• A minimum of 1 mm occlusal clearance

• Involve the cusps and marginal ridges that have defects rather than full occlusal coverage in all cases regardless of extent of defects

• Avoid sharp, sudden transitions and line angles

• Aim for uniform onlay thickness using the IDS and DME techniques

Finally for surface treatment we recommend the hydrofluoric acid to be applied after try-in to simplify the steps involved. n

About the authors

Dr Kostas Karagiannopoulos graduated from Queen Mary University, whereafter he specialised in prosthodontics in King’s College (London, UK). Passionate about education and comprehensive dentistry, he is currently offering patient care in two specialist clinics near London and teaching training specialists at King’s College.

Dr Zohaib Ali graduated from Trinity College Dublin, Ireland. He completed his specialist training in Prosthodontics at King’s College London and is motivated by improving the standard of clinical practice in the UK. He works between two specialist referral centres with his main interests being tooth wear and management of failing dentitions.

Fig. 4: Different options for a marginal finish with partial coverage restorations. a) butt joint; b) soft bevel or inclined plane; c) shoulder.

Fig. 5

Fig. 6

The “All-on-Four” concept restoration on lower jaw

The “All-on-Four” concept is based on the placement of four implants in fully edentulous jaws to support a provisional, fixed, and immediately loaded full-arch prosthesis. Combining tilted and straight implants for supporting fixed prosthesis can be considered a viable treatment modality resulting in a simpler and less time-consuming procedure, in decreased financial costs and a more comfortable post-surgical period for the patients.

Introduction

A 58-year-old man, partially edentulous for a long period of time due to periodontal disease, was referred to us. Patient had been suffering for a long time trying to get used to various types of prosthetic dentures on the lower jaw. We chose this case because it was complex, involving removal of the remaining teeth and bone grafting. Patient requested fixed prosthetic restoration on lower jaw, his words were: “Fed up of removable dentures on lower jaw.”

Case report

A 58-year-old man was referred by his own dentist due to significant problems with retention of his lower denture. The remaining teeth were painful and

the denture was extremely loose. The patient was unable to eat, speak or carry out many every day functions.

Various options were considered, but we agreed four Meisinger implants with multiunits and immediate implant-retained temporary denture.

The distribution of Meisinger implants is key in order to establish “All-on-Four” principles. After five to six months of healing and implant integration, we will be placing final screw retained appliance. Under local anaesthesia, remaining teeth were removed, and sockets cleaned. Full thickness

crestal incision was performed from the right first molar region to the left first premolar one. A midline releasing incision was carried out to facilitate a flap reflection space of around 2-4 mm osteotomy, made in order to make the alveolar crest even. All sites were prepared using the manufacturer’s guidelines for Meisinger Implants under copious sterile saline irrigation. A control of a possible communication between implant sites was done before implant placement.

The patient was delighted with the result and can now eat and function normally with a secure and stable denture.

Discussion

Four Meisinger implants were placed in planed region.

After soft tissue management and closure, straight and angulated multiunits were placed onto the implants. A new temporary denture was constructed, which allowed the plate to be securely placed to the implant multiunits.

A recent shift in practice paradigm has been to minimise treatment costs and patient morbidity while providing the most satisfying patient-centred treatment outcomes according to a state-of the-art dental practice. The “All-on-Four” treatment concept is an attempt to reach these objectives by providing a relatively straightforward, predictable treatment option to rehabilitate edentulous patients with a high outcome of quality of life. In the present case report, we were removing remaining teeth, levelling the bone crest and, because of the sufficient bone thickness distally, we were able to place four axial implants. The majority of lower jaw restoration cases require placing implants at an angle, because of the mental nerve foramen. Furthermore there are no significant differences between axial and tilted implants in terms of success rates and marginal bone loss. 

Five months later, new impressions were taken for a final screw-retained appliance.

Implant training that exceeds expectations

Dr Amit Bhalla completed the Campbell Academy’s Year Long Implant course, which is supported by Straumann®. He reflects on the training and the impact it has had on his dentistry since:

“I wanted to become proficient at placing and restoring implants and after doing my research I felt that the Campbell Academy was best suited for me to do this.

“The training exceeded my expectations with respect to the excellent course content, delivery of the material by superb speakers and on-going support after the course had finished which was very important to me. Particular highlights included placing my first implant and performing a sinus lift procedure with Colin Campbell.

“It was also useful to have access to the Straumann® solutions, which include an excellent implant system that can cater for different surgical and anatomical scenarios.

“Since completing the course, I have been able to successfully implement implant dentistry into our practice with the help of the Campbell Academy.

Discover all educational courses supported by Straumann® at www.straumanncourses.comn straumanncourses.com

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Exclusive

Among the many exclusives at BDIA Dental Showcase 2024 was an opportunity to engage with the Interim Chief Dental Officer England, Dr Jason Wong, and his team throughout the CDO Theatre and Zone.

Dental professionals had a chance to hear directly from the CDO about the latest news and current perspectives at government level, which was particularly interesting when conversation turned to the amalgam ban. Attendees also had a chance to pose their own burning questions throughout the programme, challenging the status quo and sharing their own stories with colleagues.

As one of the only platforms the CDO Office uses to interact with the profession

free from methacrylate, and does not irritate soft tissues. Patients report immediate relief from sensitivity lasting up to six months.

For more information visit: https://europe.parkell.com/predictabioactive-desensitizer

Contact info: Parkell Europe AB, Sweden, Tel. +46 708 593 481, infoeurope@parkell.com

Parkell Europe AB, Finvids väg 8, SE-194 27 Upplands Väsby, Swede Tel. +46 708 593 481 infoeurope@parkell.com n

Designed to quickly remove contamination and target pathogens that may remain on the surface of a dental impression. IMPactiv P is a market leading concentrated impression disinfectant from Bossklein.

The unique powder-based solution is used at an economical 2% dilution. That’s just 20g per litre of cleaning solution, so a single 700g tub can create up to 35 litres. IMPactiv P is safe to use on all types of impression materials without affecting the mould stability and shape.

An ultra-quick contact time of only 60 seconds is up to 15 minutes quicker compared to rival products and ensures

Air flow is controlled via the standard chair-side foot pedal. Water delivery port is sealed off.

For more info, visit: www.dpsdental.co.uk or email: info@dpsdental.co.ukn

directly, there were also invite-only roundtables and audience-wide debates as clinicians brought important issues to the fore.

Helen Paisley from Community Dental Services CIC said: “The programme of talks in the CDO Theatre has been excellent. I have attended the event over both days and found the stands to be excellent too, with brilliant networking!”

Save the dates for BDIA Dental Showcase 2025 and don’t miss out!

BDIA Dental Showcase 2025 14th-15th March, ExCeL Londonn

comprehensive, efficient cleaning and protection for all dental impressions. Bossklein IMPactiv P is available now. For more information call 0800 132 373 or visit www.bossklein.com n

celebrating achievements: Professor Nikolas donos

Professor Nikolaos Donos, academic representative on the ADI Board, has been honoured with the prestigious IADR Distinguished Scientist Award for Research in Periodontal Disease.

This accolade is the highest international award in periodontology. It celebrates exceptional contributions to research in this field. This award recognises Professor Donos’s remarkable achievements and his commitment to advancing periodontal science. He has played a pivotal role in oral health research, facilitating innovation and excellence in the profession.

The IADR Distinguished Scientist Award

No imaging system encapsulates sheer power, versatility and simplicity quite like the CS 8200 3D Neo Edition from Carestream Dental.

This system provides the ability to capture hi-resolution 2D and 3D images for a wide array of diagnostic needs. Plus, not only does the CS 8200 3D Neo provide an impressive nine selectable fields of view, it can capture the entirety of a full arch in just one scan. Patient safety, as always, is of the upmost importance. For panoramic needs, our Tomosharp algorithm creates razor sharp images, whilst reducing the dose by up to 50% in the effective low-dose mode. Better yet, the low-dose mode delivers high-quality 3D images with up to 86%

in Research in Periodontal Disease is a testament to Professor Donos’s unwavering commitment to excellence in dental research.

Find out more on the Queen Mary University of London website: https:// www.qmul.ac.uk/media/news/2024/ For more information, please visit www.adi.org.uk n

less radiation than a standard panoramic exam.

To learn more about the versatile and effective options the CS 8200 3D Neo Edition can bring to your practice, contact the Carestream Dental team. For more information on Carestream Dental and our new extended warranties visit www.carestreamdental.co.uk For the latest news and updates, follow us on Facebook and Instagram @ carestreamdental.uk n

cdo Access at BdIA dental showcase 2024 All the answers, one effective system

Future Insights, savings, and Innovation at BdIA dental showcase 2025

As the largest and longest running dental exhibition in the UK, BDIA Dental Showcase 2025 will return with hundreds of premier brands across the trade floor.

The exhibition provides a hub full of information and expert insights to help guide strategic planning for dental practices across the UK. This will be the perfect platform for dental professionals to have their questions answered and to seek industry help in order to make the right critical decisions for successful business development.

This, combined with exclusive promotions and discounts, as well as innovative product launches, means that visitors can save money and maximise investment in their practices. Don’t miss BDIA Dental

Showcase 2025 – 14th-15th March 2025 –get the dates in your diary and reserve your FREE pass today: https://dentalshowcase.com/register-interest-pr.

Save the date

BDIA Dental Showcase 2025 14th-15th March, ExCeL London n

Immediate

function, optimal results

These are truly exciting times for innovations in technology allowing for the immediate restoration of a smile in edentulous patients. Neodent® tops the list with the Grand Morse® implant system, combined with NeoArch® Immediate fixed full-arch solution. Neodent® Grand Morse® Implant System significantly improves oral healthrelated quality of life for edentulous patients, including those with a severely atrophic maxilla. The optimised implant designs from Neodent® achieve high primary stability in all bone types, even with different conditions of the residual alveolar bone. The NeoArch® immediately restores function and natural-looking aesthetics thanks to the stable foundation.

Find out more about the life-changing solutions offered to patients by the Neodent® Implant System today.

For more information on the Neodent® Neoarch® Immediate fixed full-arch solution, visit www.neodent-uk.co/portal n

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 effective 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 and comfort. It is the only toothpaste approved by the Oral Health Foundation for sensitivity relief and remineralisation.

For further information visit the Trycare website, www.trycare.co.uk/biomin, contact your local representative or call

trycare Ltd - full day restorative hands-on workshops with Joan Mach

Featuring Tokuyama’s patented RAP monomer and aesthetic spherical filler technology, Estelite Sigma Quick delivers an extended working time in ambient light yet cures in only 10 seconds! There is also less residual monomer and minimal after cure colour change for long-term aesthetic satisfaction.

In association with GC UK and NSK, Trycare are running a series of Full Day Workshops by Joan Mach, one of Europe’s leading exponents in minimally invasive aesthetic and restorative dentistry. Joan will cover all the key points for achieving excellence in direct anterior composites using a biomimetic and non-invasive approach. Including how to

A polished performance

Translucency is one of the fundamental factors influencing the aesthetic performance of dental restorations. In nature, the translucency of dental enamel varies from tooth to tooth and from patient to patient.

BRILLIANT EverGlow™ from COLTENE boasts a sophisticated colour system, offering three levels of translucency and improved Duo Shade colours, which can be used flexibly for single-colour and multi-layered restorations.

Excellent polishability and long-lasting brilliance are another two of the advantages dental professionals – and their patients –can benefit from when using this Universal Submicron hybrid composite.

BRILLIANT EverGlow™ possesses good

accomplish outstanding aesthetic results and longlasting treatments in the anterior region using the latest products, including Tokuyama’s Estelite Sigma Quick. Offering 6 ½ Hours CPD with Learning Objective C, the Workshops will be held in Birmingham (Friday 14th June) and London (Saturday 15th June). Course fee, including all course materials and refreshments, £395.00 + vat (before 30th April 2024) and £495.00 + vat (after 30th April 2024).Call on 01274 885544 or visit the website.n

All Tecnoss® OsteoBiol® products are Second Generation because they contain a Dual-Phase resorbable bone matrix incorporating mineral component and collagen. Unlike ceramatised first generation materials which undergo very little resorption and are therefore never completely replaced by newly formed bone, Dual-Phase biomaterials do resorb progressively and are replaced by adequate new vital bone.

Handling like a sticky putty, OsteoBiol® GTO® is Tecnoss®’s state-of-the-art ready-to-use pre-hydrated biomaterial that can be easily dispensed into defect sites direct from the syringe. It enables clinicians

to skip the hydration phase with saline or blood, saving time and decreasing the risk of accidental exposure to pathogens.

OsteoBiol® GTO® contains Tecnoss®’s innovative OsteoBiol®TSV Gel which ensures optimal stickiness of the material, allowing easy adaptability to the recipient site and extreme stability.

Call Trycare on 01274 885544 or visit www.trycare.co.uk/osteobioln

Embrace the digital revolution

There are numerous benefits to providing digital design and manufacture (CAD/ CAM) in-house. While it may be a learning curve for the dental team, digital dentistry improves workflows, and encourages treatment acceptance – great for your patients.

For clinicians who are ready to embrace the digital revolution, and introduce chairside CAD/CAM workflows into their practice, Clark Dental offers professionals the cutting-edge Primescan intraoral scanner, Primemill milling machine and the Primeprint 3D printer. The equipment works together to offer a seamless digital experience. With these systems you can create accurate, high-grade surgical guides for guided implant treatment and

due process

modellability and dimensional stability, together with exceptional wettability ensuring minimal stickiness to the instrument. Discover how BRILLIANT EverGlow™ can meet your patients’ aesthetic expectations by visiting the COLTENE website today! For more information, info.uk@coltene.com and 0800 254 5115 n

The due diligence process is a key aspect in the buying and selling of a dental business. As a seller, you want to make your practice look and feel like an opportunity with a prosperous future. And as a buyer you want to be reassured of the true value of a practice so that you are paying the right price.

It is a painstaking process but the last thing both parties want is a renegotiation of the terms of the sale or for the sale to fall through.

That’s why Dental Elite advises in its Practice Sales Guide, available to download free of charge from the website, that sellers present their buyer with a full

even produce zirconia restorations, in-house. Clark Dental also ensures that you are adequately supported, for total peace of mind.

To find out more, please contact the team at Clark Dental.

For more information call Clark Dental on 01268 733 146, email info@clarkdental. co.uk or visit www.clarkdental.co.uk n

clarkdental.co.uk

suite of Due Diligence documents within a month of Heads of Terms being agreed. To find out how Dental Elite can assist you in optimising your success in a future sale, contact the team today. For more information contact the Dental Elite team on 01788 545900 https://dentalelite.co.uk/ n

dentalelite.co.uk

Don’t miss BDIA Dental Showcase 2025 for two days of vibrant and comprehensive education, delivered through a variety of engaging seminars, interactive debates and practical workshops.

Seven conference streams will return to the ExCeL London, including the extremely popular hands-on clinical workshops presented in 2024 for the first time. These and other sessions presented by some of the most highly respected and celebrated speakers in the global field.

Dental professionals will discover new clinical techniques, be exposed to outsidethe-box ideas, get updated on the latest research and gain hours of enhanced CPD in important topics.

What’s more, all members of the dental team will benefit from networking with colleagues who share a passion for excellent patient care, with the chance to build and strengthen working relationships across the profession and supply chain.

Don’t miss BDIA Dental Showcase 2025! Save the date

BDIA Dental Showcase 2025

14th-15th March, ExCeL Londonn

Freshness is easy with aligner foam

Swiss oral health company Curaden presents Curaprox Aligner Foam, featuring a unique combination of ingredients to maintain conditioning, freshness and brightness during aligner treatment.

Bacteria can collect in aligners, mouth guards and retainers, even when patients follow recommended care routines.

Curaprox Aligner Foam harnesses the powerful natural properties of magnolol to fight the bacteria that cause plaque and tooth decay. Magnolol, found in the bark of the magnolia tree, is a bioactive compound that fights streptococcus mutans, which is heavily involved in biofilm formation and the development of dental caries.

In a convenient pocket-sized package, just a small amount of refreshing, minty foam added to the aligner or swished around the mouth after brushing, protects and conditions teeth for a brighter smile throughout treatment. Find out more today.

For more information, please visit www.curaprox.co.uk and visit www.curaden.co.uk n

Take control of your practice from anywhere, at any time, with Sensei Cloud, the dental practice management Software-as-a-Service platform from Sensei, the practice and patient management brand of Carestream Dental.

This cloud-based solution allows dental professionals to access important information and schedule appointments securely, with full GDPR compliance. By using the internet, it can be used on the go without the need for additional IT infrastructure on hand.

All information is made safe and is continuously backed-up and secured with disaster recovery tools, for complete peace of mind. Sensei has also joined forces with leading experts in cybersecurity to prevent and deter any potential threats.

Banking on a loan?

If you’re thinking about buying your own practice, or growing your practice with the purchase of another site, it’s important to note that choosing the right lender is just as important as buying the right practice. By ensuring that your lender is suitable for you and your situation, you’ll have a higher chance for a successful loan and overall transaction.

Gaining the advice and guidance from an expert is one of the best ways to ensure you can successfully navigate the complexities of securing a loan. With its unique ‘fact find’ process and its comprehensive understanding of how current bank policies operate, DE Finance can guide you towards your ideal lender.

Sensei Cloud is perfect for the multi-practice professional, who wants to access invaluable business insight without needing to be at one specific desk.

To learn more about practice management that excels from anywhere in the world, contact the team today.

For more information on Sensei Cloud visit https://gosensei.co.uk/ For the latest news and updates, follow us on Facebook and Instagram @ carestreamdental.uk n

To find out how DE Finance can assist you on your buying journey, contact the team today. For more information contact the Dental Elite team on 01788 545900 https://dentalelite.co.uk/n

A good surprise for patients with Endocare Empowering patients with instant information

Patients are often fearful of endodontic treatment because they think it will hurt. That is not the case at EndoCare, where we do everything in our power to ensure pain-free root canal solutions.

And you don’t just have to take out word for it. One patient recently left us a 5-star review, commenting: “My root canal treatment was a painless procedure. I was kept fully informed of the detail of the work. Afterwards, I was pleasantly surprised in having absolutely no pain.”

To give your patients a good surprise and prove them that high-quality

endodontic treatment needn’t be painful, refer them to EndoCare. Simply complete the secure online form through the website and we’ll be in touch. For further information please call EndoCare on 020 7224 0999 Or visit www.endocare.co.uk n

Empowering patients with personalised and pertinent information is just a click away with Kiroku Docs.

Educating patients is a core part of modern collaborative care, and of obtaining informed consent. Kiroku Docs enables clinicians to create any documentation needed to help patients gain the knowledge they need to understand their options for treatment.

Powered by AI, the system automatically converts Kiroku notes into any number of customisable documents. Patient information letters, treatment plans, consent forms and referral letters can be created in an instant.

Clinicians have full control over the

level of complexity of the language used, ensuring the information is appropriately delivered to each recipient. Instant conversion from notes to documents enables clinicians to spend more time discussing treatment and oral health advice with patients.

Find out more about how Kiroku Docs can help you communicate with patients today.

To find out more about Kiroku, or to start your free trial, please visit trykiroku.comn

Dr Kumar Thanki, Principal of Healthy Smiles Dental Practice in Luton, reflects on his more than two decades of experience working with Eschmann for his business’ infection control needs:

“I have consistently found Eschmann to provide lovely service and support, which helps my practice to run worry-free. You just know that your autoclave will be well looked after and will always be in working order.

“The autoclave itself has also been of high quality and we have had it in the practice for many years now.

“I would rate Eschmann 10 out of 10 –and I would definitely recommend them to colleagues!”

For more information on the highly effective and affordable range of infection control products from Eschmann, please visit www.eschmann.co.uk or call 01903 875787 n

The Complete GDP from the IAS Academy is a comprehensive two-day course to give clinicians a hands-on experience of accurate assessment and predictable treatment planning.

Three modules cover examination, records and splints, treatment planning and aesthetic and restorative principles, followed up with a post-course assignment and online mentoring to help compound delegates’ learning.

Attending this course teaches dentists to understand every single patient’s complex and unique needs, ensuring nothing is missed.

Delegates will examine different treatment options, and will learn different approaches to restoration techniques and preparation approaches, including direct vs indirect restorations, minimal and no-prep restorations approaches and much more.

Find out more about this comprehensive course, and how it can benefit your practice today.

For more information on upcoming IAS Academy training courses, please visit www.iasortho.com or call 01932 336470 (Press 1)n

www.the-probe.co.uk

sequence solution

When it comes to root canal treatment, the Hyflex EDM file system from COLTENE offers a tailor-made solution for fast and reliable preparation.

COLTENE believes that its new instrument sequence offers a single, straightforward protocol which goes towards increasing reproducibility and safety. Any curvature of canal can be treated by following this simple sequence.

The Hyflex EDM OGSF are all manufactured using the thinner 1.0 mm wire for more conservative tissue removal. The sequence includes an Orifice Opener and Glidepath file for opening the glide path, as well as a Shaping file for shaping the root canal over the full length. The Finishing File in size 30/.04 provides the optimum space for efficient

cleaning and preparing the canal for its own matched GP point.

Hyflex EDM files have a unique surface and stand out for their durability and high fracture resistance. This is achieved by an innovative manufacturing process using ‘Electric Discharge Machining’, hence EDM.

To learn more about the Hyflex EDM OGSF sequence visit the website today!

For more information, info.uk@coltene.com and 0800 254 5115 n

Professional throughout the entire process

At Dental Elite, we know that finding a new role in dentistry can be stressful, and the last thing you want is to be left in the dark. Our team is always on hand for support and guidance throughout the job searching process, and it reflects in the thoughts of the professionals that use our service.

Tiphanie Jackson said: “Toni (Dental Elite’s Recruitment Consultant) was very professional throughout the entire recruitment process. She was great at communication, through both messages and calls.”

My Sonder felt the same way, saying: “Toni is amazing. She was quick with her responses, and really efficient with the communication between me and the new employer.”

If you’re looking for a new role in dentistry, or looking to hire at your practice, Dental Elite can support you at every step of the process.

To learn more about specialist recruitment that keeps you in the loop, contact the Dental Elite team today! For more information contact the Dental Elite team on 01788 545900 https://dentalelite.co.uk/ n

Maximise the life of your autoclave with Eschmann Antibacterial protection where

Do you have questions about how to prolong the life of your Eschmann autoclave? Do you need technical support you can rely on?

Eschmann is the decontamination expert to turn to.

Our comprehensive Care & Cover servicing and maintenance package provides everything from Annual Validation and Pressure Vessel Certification (PSSR) to annual service and software upgrades, unlimited breakdown cover, unlimited Eschmann parts and labour, and Enhanced CPD user training. We will keep your Eschmann autoclave running smoothly, detecting potential issues early, and helping you to minimise the hassle, stress and cost associated with equipment downtime.

We also have an excellent 91% first time fix rate when called out to assess possible equipment issues. Our team of expert engineers are trained specifically on our technologies and carry original manufacturer parts to ensure a consistently fast and efficient response to customer queries.

For more information please visit www.eschmann.co.uk or call 01903 753322n

Do you want to offer your patients the benefits of chlorhexidine and Citrox®? Easy!

The Perio plus range of oral rinses from Curaprox makes it simple to provide key antibacterial ingredients to those who need them.

With options including Forte, Protect, Regenerate, and Balance – each including different chlorhexidine concentrations – clinicians can easily tailor their recommendations to each patient. The range is ideal for those who have had oral surgery, or who have heavily irritated gingiva, as Citrox® – which is naturally extracted from bitter oranges ¬– ensures

long-lasting antibacterial effects.

To find out more about the Perio plus range, please contact the Curaprox team.

For more information, please visit www.curaprox.co.uk and www.curaden.co.uk n

If you’re looking for high-quality, accredited orthodontic training you can apply immediately to your practice, then look no further. The IAS Academy has developed an excellent two-day certification course in fixed braces, delivered by respected practitioners. This ethical, non-extraction approach to anterior aesthetic orthodontics (AAO), is suitable for beginners in fixed appliances. Attendees will become familiar with methods to handle simple fixed and clear aligner cases immediately after taking this comprehensive course.

The IAS Academy supports learners every step of the way. Monitored post-course assignments are part of the accreditation process, and every case included comes

recycling correctly

Employing environmentally friendly disposal workflows is key to helping to fulfil your sustainability targets. Recycling is fundamental, and you should choose to work with a waste management team that is proven to excel in this area – like Initial Medical.

with lifelong mentoring. Clinical support and governance helps keep you clinically safe.

Find out more about how the IAS Academy can help you develop your skillset today.

For more information on upcoming IAS Academy training courses, please visit www.iasortho.com or call 01932 336470 (Press 1)n

Initial is recognised as one of the top 20 UK companies excelling in Environmental, Social, and Governance (ESG) Performance, with a place firmly cemented in the Euronext Vigeo United Kingdom 20. Optimising your disposal methods is paramount, and is possible with Initial Medical, who owns one of the most advanced dental recycling plants in the world. 100% of the recyclable dental waste we collect is treated and recycled efficiently, to help reduce your impact on the environment. If you want to learn more about recycling in dentistry, and how Initial Medical can help you reach new heights, contact the team today.

To find out more, get in touch at 0808 304 7411 or visit the website today www.initial.co.uk/medical n

Dr Mozhgan Setoodeh describes her experience of working with Clark Dental on her new surgery:

I wanted the project to go smoothly, so I looked to work with a company that we could count on and who would be there for us if we had a problem. I have worked with Clark Dental previously and, I trusted the team, which was very important to me.

As the number of patients we were seeing grew, I knew for a while that we would need to convert the additional room into a new surgery. Because of this, I spoke to Matt Rowlingson, Technical Director at Clark Dental, nearly a year in advance about the project.

Perfect prompts

Dr Huma Javeriya, is a BDS graduate and founder, director and host of the podcast, Indian Dentist on Spotify. Working in busy NHS practices, she often finds herself working with dental nurses who can’t type, or worse still, without a nurse, which makes taking notes time-consuming and difficult.

However, Kiroku, the AI-assisted notetaking platform, has changed all that. Proven to help dental professionals complete their notes 60% faster, using Kiroku gives Huma lots more time to focus on her patients. “I love that there is more patient/dentist interaction because I spend less time on my notes,” she says. “They are ready in minutes after a consultation so there are less delays between patients

Clark Dental helped with the design of the room, and presented my options for new equipment such as dental chairs and cabinet materials. We discussed the details and decided what would be best for the practice.

My advice for anybody looking to undertake a similar project would be to find a company that you trust and stick with them. I trust Clark Dental, and felt confident that they would support me during this project.

Call Clark Dental on 01268 733 146, email info@clarkdental.co.uk n

too.”

Huma particularly likes the system’s templates which she describes as ‘well-written’ and appreciates its prompts which prevent oversights. “The prompts ensure that I record everything I’ve discussed with the patient,” she explains.

A keen advocate of the system, particularly for newly graduated dentists and dental therapists, Huma also recommends Kiroku to dentists from overseas who are new to note taking. “It’s a real boon,” she says.

To find out more about Kiroku, or to start your free trial, please visit trykiroku.comn

trykiroku.com

Attention economy – Why less is often more

One of the things we prepare our clients for is the viewings that prospective buyers undertake usually prior to making an offer. This is often a new experience for our clients, and they can be apprehensive about how the meeting will unfold. What will the buyer want to know? What do I do if I don’t know the answer to a question? Will they judge me? How many people are coming? What information should I not share? What discussions should I have and, probably of more importance, what should not be discussed?

I remind our clients that this it is an opportunity for them to get to know the prospective buyers and to decide how they would feel about working alongside them as part of a handover. It is also an opportunity for them to showcase their practice and discuss the more clinical aspects.

The meeting is not an opportunity for buyers to drill into the appointment book, CRM reporting, financial performance of the practice or the patient list. All that will be dealt with after they have had their offer accepted and during the due diligence process.

Vendors are reassured to know that we have conducted due diligence on the buyers to verify they are positioned to move forward with a credible offer. There is

no need for our clients to start discussing those kinds of topics with buyers during a practice viewing.

The most important thing is not to get into any kind of negotiation with a buyer during a viewing. It is our job to represent the vendor in any kind of negotiations. We understand the value of the business and are equipped with the information and skills to substantiate that value to buyers. On the odd occasion it has happened, it makes for some delicate discussions with buyers to explain that we are retracting a verbal agreement made during a viewing.

Of course, there is a sales element for vendors during a viewing. It is important to highlight the benefits of their practice as well as the reasons why it is a great example of that particular model of business.

But it is also possible to say too much and get involved in lengthy discussions that are not relevant to the buyer.

It was Herbert Simon, the American economist and Nobel Prize winner, who said: ‘A wealth of information creates a poverty of attention.’

Herbert Simon published a white paper in 1971 accurately predicting that in an information-rich world, there is a scarcity of attention. When you consider he presented this theory 12 years before the internet was even invented, and 25 years before the

internet became available to the general population, this was very insightful.

The essence of what he wrote was that when we are inundated with too much information and have too little time and attention to consume it, we don’t fully understand it.

In this case, Simon defines attention as a slice of our overall mental processing capability. That our attention is a limited resource.

In the case of our practice viewing, sellers must not provide the buyer with a ‘data dump’ of information as it compromises the buyer’s ability to digest and take on board information. It is to be expected that the buyer is considering multiple opportunities and a wealth of information. You must compete for that person’s attention with the internet, social media, other opportunities, family, internal meetings, paperwork, and their own jobs.

What Simon found in the research for his white paper was that we humans make rational decisions about how to allocate our limited attention across the multiple information sources demanding it. In other words, we prioritise investing our time in those sources of information that provide the largest value.

It’s one thing to attract the attention of a buyer and get them to commit to a practice

viewing. It’s another thing altogether to capture and hold onto their attention.

The value the buyer receives from you in exchange for the time they gave you is a fundamental building block of developing a relationship and keeping your practice top of mind. It’s the explicit bargain at the heart of every sales and purchase decision. A buyer invests some of their time in you. You must provide them value in return. There must be an ROI on the time they invested in coming to your practice and meeting you. When we engage with buyers, we talk about the ROTI they can expect from us. By that I mean the Return On the Time buyers Invested.

We should all strive to ensure that spending time talking to us is a good use of the buyer’s time.

The great thing is that you don’t need more time with buyers because you can accomplish more with less of their time if you stay focused and share relevant and valuable information. n

about the author

chris Mayor, commercial Director at Lily Head Dental Practice sales.

Embracing social media trends: A clinician’s gateway to modern marketing

In the fast paced world of digital marketing, staying ahead of the curve is paramount. For clinicians, this means not only understanding the value of traditional marketing strategies but also recognising the potential of the dynamic landscape of social media. However, one aspect of social media marketing that often leaves clinicians hesitant is the notion of jumping on trends. From viral challenges to popular memes, these trends may initially seem frivolous or even irrelevant to the serious business of dentistry. Yet, delving deeper reveals their untapped potential as powerful tools for engagement, brand awareness, and patient education.

Firstly, let’s address the elephant in the room: the perception of silliness surrounding social media trends. Many clinicians understandably associate their profession with professionalism and gravitas, and may feel hesitant to associate themselves with seemingly lighthearted trends. However, what they may not realise is that embracing these trends can humanise their practice, making them more relatable and approachable to current and potential patients.

Consider the viral challenges that sweep across platforms like TikTok or Instagram. While some may involve quirky dances or comedic skits, others present unique opportunities for clinicians to showcase their expertise in a fun and engaging manner. For

instance, participating in a dental related challenge could involve demonstrating proper brushing techniques, debunking common dental myths, or showcasing before and after transformations. By leveraging these trends, clinicians can not only capture the attention of a wider audience but also impart valuable oral health knowledge in an easily digestible format.

Moreover, social media trends offer clinicians a platform to showcase their personality and creativity. Whether it’s sharing behind the scenes glimpses of the practice, introducing team members, or

sharing patient testimonials in innovative ways, embracing trends allows clinicians to inject a dose of personality into their online presence. This human touch can foster stronger connections with followers and foster a sense of trust and familiarity. In addition to humanising their practice, clinicians can also leverage social media trends to stay top of mind among their target audience. Trends have a notoriously short lifespan, with new ones emerging almost daily. By actively participating in trending topics, clinicians can ensure that their practice remains relevant and visible in an increasingly competitive digital landscape. This visibility not only strengthens brand recognition but also increases the likelihood of attracting new patients who may have otherwise overlooked their practice.

Furthermore, embracing social media trends can provide clinicians with valuable insights into the preferences and behaviors of their target demographic. By monitoring trending topics and observing audience engagement, clinicians can gain a deeper understanding of what resonates with their audience and tailor their content accordingly. This data-driven approach not only enhances the effectiveness of their social media efforts but also informs their overall marketing strategy, enabling them to make informed decisions that yield tangible results.

Lastly, incorporating educational videos into their social media strategy allows clinicians to showcase their knowledge and

expertise in a dynamic and engaging format. Whether it’s explaining common dental procedures, discussing the importance of oral hygiene, or addressing frequently asked questions, educational videos provide a valuable resource for patients seeking reliable information. By positioning themselves as trusted authorities in their field, clinicians can attract a loyal following of engaged patients who value their expertise and commitment to patient education.

In conclusion, while the idea of jumping on social media trends may initially seem daunting with the serious nature of dentistry, the reality is that these trends represent a powerful avenue for engagement, brand building, and patient education. By embracing trends with creativity and authenticity, clinicians can humanise their practice, stay top of mind among their target audience, and gain valuable insights into audience preferences.

In today’s digital age, staying ahead means not only appreciating traditional marketing techniques but also being willing to embrace the constantly evolving world of social media trends. n

about the author abby Leach, content creation Manager and social Media specialist at connectmymarketing.com

Sustainability and scalability with the Tyscor suction systems

Radial blower reduces energy consumption by up to 75%.*

Monitoring and remote maintenance by VistaSoft Monitor reduces CO 2 emissions .

Grows with the practice: From two to twelve users, without replacing the machine.

They

Factors that hinder a lending application

POV: you want to buy a dental practice and will need bank funding. What do you need to prepare in advance of a lending application? What do you need to avoid? Here are some of the main things to consider.

1. income vs spending

Lenders factor your monthly spending into their calculations – the more you spend, the more drawings they deem you will need from your target practice. If you declare that you require £60,000 p.a. to cover your spending but you are currently spending £80,000 p.a., the bank’s credit team will not approve the lending application unless you can provide strong evidence as to why you require less. Keep an eye on your spending and try to reduce unnecessary purchases to show a true reflection of your monthly costs. Aim to save as much cash as you can in the run up to a purchase. If you are a high earner, lenders will question where your money has gone if it is not in savings, property or business. Note the type of spending on your bank statements – regular gambling is a red flag for credit teams.

2. High debt & payment defaults

As with most loans – payment defaults or high levels of debt that cannot be repaid before you take out the loan can result in your application being rejected. High levels of personal or business debt indicate your finances are already strained.

Spending on a credit card is fine, providing it can be cleared either monthly or in full prior to loan drawdown, and the level of spending is not outside of your current earnings.

3. insufficient deposit + poor financial standing

100% loans are possible, providing you have a good financial standing, e.g. a good level of equity in property or existing businesses. However, it is more typical for lenders to require a minimum of 10%-20% deposit.

Lenders want to see commitment from a buyer. This could be in the form of a cash deposit and/or a charge over your property. If you don’t have available cash to commit, lenders will view you as a riskier investment and are more likely to want a charge on your property.

It is important to note that to calculate equity, most lenders will write the value of your property down to 70% of its current on-market value and then deduct your current mortgage. So, whilst a £500,000 property with a £300,000 mortgage may look as though you have £200,000 equity, lenders will calculate this as:

• £500,000 x 70% = £350,000 property value

• £350,000 - £300,000 = £50,000 equity

The costs involved in buying a practice will also be factored into your current cash reserves, reducing the potential useable deposit. Buying costs are typically around £15,000 - £20,000.

4. Lack of experience or expertise

Lenders are hesitant to approve an application if you have less than three years’ experience in the dental industry. They want to see that you are settled as a dentist and, hopefully, that you have some form of management experience. They will ask to see your CV to evidence this. You may want to consider partnering with a mentor or seeking additional training to strengthen your application.

Being a good associate and being a good practice owner are two different challenges. You will need to provide a brief business plan for the practice, to show you have considered things you want to keep and things you want to do differently. Lenders like to see stability and any potential plans for future growth.

5. no accounting history & unpaid tax

Lenders will want to see three years’ associate accounts/tax returns, so keep on top of your accounts.

Don’t delay paying your tax bill – your accountant will be required to confirm that all tax is paid up to date.

6. uncertain practice revenue & staffing

You will need to evidence that the target practice can generate sufficient income to cover expenses and loan repayments. Ensure you have full financial information

for the practice plus details of any changes over the last few years. If practice income has not been stable or is growing, you will need to explain why and how, and ensure that current income can be maintained. More recently, lenders have started to factor in staff stability and recruitment. This is due to increased NHS underperformance and difficulty in recruiting associates. If additional dentists are needed at the practice, you will need to confirm how you plan to recruit and how income will be maintained.

7. Poor application

Your initial lending application needs to be detailed and address any potential concerns early on. Failure to do so will result in your application being delayed or possibly rejected. Use an experienced healthcare broker to tackle any potential issues head on. n

about the author s amantha Hodgson is a finance broker and practice valuer, helping dentists with their practice purchase finance requirements. P f M Dental are leading professional advisers to dentists for: sales and valuations of dental practices, financial advice, legal and accountancy services.

Building and maintaining financial stability

Financial stability will mean slightly different things to different people. Generally speaking, it can be defined as the ability of an individual to cover their living expenses as well as essential irregular costs without a struggle or getting into debt. Given the economic turbulence experienced around the globe in recent years, this stability has been more elusive for more people than it was previously. The good news is that there are things everyone can do to improve their financial situations. To assess your own circumstances and consider areas that could be improved, it is helpful to begin with the following areas:

income

Every financial assessment starts with income. Consider all sources of income from your monthly wages/salary, to bonuses, dividends and any other places from which you receive money. Increasing income is often much easier said than done and how you achieve this will depend on your position within the dental practice. For associates, consider increasing efficiency and productivity to see an extra patient each day. Alternatively, you may decide to provide more private dental services, or focus on treatment areas that afford a high return in order to grow your income. For practice principals, it is important to review how you take income from the business and look to

optimise your tax-free earnings with the right combination of salary, dividends, director’s loans and expenses.

Outgoings

When you know what’s coming in, it’s essential to review what’s going out. From here you will be able to calculate the disposable income leftover once compulsory bills are paid.

It can be difficult to reduce outgoings, especially with regards to mandatory expenditure. However, shopping around for low interest rates on mortgages or utility bills can help to minimise outgoings as much as possible. Budgeting for food, travel and entertainment can also make spending more predictable and therefore more controlled.

For business owners or those in the higher earning brackets, it can also help to seek financial support when it comes to paying taxes and other major bills. Being smart with your money could significantly reduce how much you have to pay back each year.

savings and investments

For those who can afford to do so, allocating a sum each month or year to save or invest is an excellent way of maximising your income in the long-run. High interest rates might mean there are some excellent deals to be had on savings accounts. There are also some great opportunities available for investment.

Whether you have a couple of hundred or several thousand to put away for a rainy day, investing in anything from shares to property could reap substantial financial rewards. Of course, it’s important to understand the level of risk you are prepared for and to seek support if you are new to the sector or looking to invest a large sum. Another investment in yourself is your pension – be sure to pay into an appropriate scheme that will adequately support you when you stop working.

Protection

Financial stability is often the result of careful planning – and no plan would be complete without some form of protection. There are various insurances and policies available for dental professionals to consider, including life insurance, income protection, critical illness cover and more. Each offers something slightly different so it’s important to really understand which is most suitable for you and your current situation. It’s then necessary to review the small print of any policy you are considering to make sure you are gaining the protection you need.

secure your future

No matter how long you have been working as a dentist, which area of the profession you operate within or what your role is within the practice, sound financial planning is crucial. This should

include a comprehensive evaluation of all income and outgoings, as well as budgeting, savings and investment plans, and solutions that offer some form of financial protection for you and/ or your family.

For the highest level of stability and security, consider working with money4dentists – our independent financial advisors have extensive expertise in all aspects of finance and can help you protect your future with confidence. Providing even more opportunities for dental professionals, the team recently merged with the trusted experts at Ruby Financial, expanding their already awardwinning services.

To build a stable financial future, it’s important to really understand your current situation. Even just making small changes and commitments now, could create significant financial rewards in the years to come.

For more information, please call 0845 345 5060 or 0754DENTIST.

Email info@money4dentists.com or visit www.money4dentists.com n

about the author

Richard T Lishman, Managing Director of

the 4dentists Group of companies.

MINIMALLY INVASIVE

SOLUTIONS

SHORT IMPLANTS

(FROM 4,5 MM)

RETHINK TREATMENTS FOR BONE ATROPHIES

FOR 3

REASONS:

1. Less trauma: no complex reconstructions.

2. More success without postoperative complications.

3. Greater patient acceptance: no delays in rehabilitation and no cost increases

Deferred consideration in the current market

When selling a dental practice there are many intricacies to manage, and the process can be challenging. Vendors must ensure the process complies with regulatory frameworks, and they have to consider the welfare of their patients as well as staff. Realistically many larger sales will involve negotiation of terms around deferred consideration, which involves accepting a percentage of the value of the practice on day one and deferring the remaining payments – usually over a period of around two to five years – after completion. Advice from specialists in dental mergers and acquisitions is vital to help the vendor think through and manage all the logistics around the sale.

In the current climate, more often than not a dental practice valued at £2 million or above is likely to be sold with some deferred consideration. The deferred amount could be a fixed sum to be paid after an agreed time frame, but more typically it is linked to practice performance after completion of the sale.

Deferred consideration will often be linked purely to practice revenue or EBITDA, which can represent the income of a whole practice, or individual sites. When developing an accurate projection, it is important that the vendor – who may have been chiefly concerned with individual performance during their tenure – fully understands whole-practice revenue and/or profit and loss forecasts especially with EBITDA as this can be open to interpretation.

Deferred consideration is different from retention. In this context, retention is when

part of the purchase price is kept as security for the buyer to cover potential breaches by the seller of a warranty or indemnity. Retention is used where the buyer has doubts about its ability to recover from the seller, due to concerns about the creditworthiness of the seller, a planned emigration, or there being a high probability of monies needing to be re-paid.

assurances and options

Vendors have a number of decisions to make during the process of selling their practice. They must assess whether it will be worth maintaining a stake in the business, reassuring the buyer, and overseeing continued profitability through an earn-out, or whether they are happier to rely on a well-negotiated contract. Do they want to sell to a smaller investor, whose buying power may be humbler, but who might be more open to negotiation around terms of the contract? Or would selling to a larger corporate, which might have greater marketing and buying power, possibly result in a more secure or faster deal? A corporate buyer may have a good headline price based on deferred consideration, but is it better to wait a year, pocket the profits, and sell to a smaller buyer who doesn’t want guarantees? Whatever the preference, it is very important to get experienced professionals involved in negotiations from the outset, both to support in developing the best deal, but also to mitigate against risks. If the deferred consideration is based on performance how are risks mitigated?

Vendors are advised to negotiate a requirement for the buyer to support and promote the turnover of the practice after the sale has been completed. There should be a strong element of the contract ensuring the buyer can’t cease to invest in marketing, or deliberately keep turnover lower than the threshold agreed to make the deferred consideration payable.

Any deferred payments should be adequately protected in the share purchase agreement to provide the seller with the necessary assurance, and payments should not put excessive cash flow risk on either the business or the buyer.

Security over the payment should be carefully considered. Every practice owner has to consider how the buyer is going to pay the money across. Realistically, this money will come from the practice itself, but this isn’t guaranteed. There may be a need for additional security, or reassurance that the buyer has a genuine stake in the success of the practice. Buyers may need to support the transaction through some personal guarantees.

bring on the experts

When negotiating a deferred consideration, a legal advisor who understands the specific concerns around dental mergers and acquisitions is very important. As vital, is an experienced agent who not only understands the specific legal frameworks, but can truly advise vendors on how to ensure the whole process is safe, secure and meets their expectations. Dental Elite has fourteen years of specialist experience in

Building a stellar reputation

Business reputation is widely regarded as one of the most important factors for success. How customers perceive an organisation will go a long way in determining whether they choose to purchase goods or services from it. This will also impact whether they recommend a business to others.

In dentistry, the reputation of a dental practice is even more important. What patients think about the practice will influence their loyalty, their treatment acceptance, their online reviews and the likelihood that they make family and friend referrals.

The pillars of reputation

Various elements will have an impact on your practice’s reputation. Many of them will influence the patient journey, which encompasses everything from the welcoming and caring nature of the dental team to the physical environment. Key aspects include:

• Communication – patients want to feel included in their care and part of the decision-making process. If communication with the dentist is open and honest, and the patient is truly engaged in their oral health, they are likely to have a higher opinion of the practice.

• Treatment outcomes – patients want to achieve good results from dental treatment in order to realise the value of any investment in their mouths.

• Timely and efficient care – especially with regards to private dental care, the practice reputation will be enhanced by consistently delivering efficient care that patients don’t have to wait too long for.

• Accessibility and authority – patients need to be able to communicate with their dental practice in a way that suits them, making tools like online booking and live chat features useful. They also need to trust that their dental team has the knowledge and skills to provide the high standard of care they are promising, so showing that authority in the field is important throughout marketing avenues.

encouraging positive reviews

Positive online reviews have become essential for all types of businesses and service providers around the world. People buy from people, and the vast majority will consider others’ experiences before making a purchase decision. Consequently, reviews can have a significant impact on business reputation, boosting credibility, revenue and growth. For a dental practice, this is critical in showing new patients that you offer a high-quality service and that you can help them to enhance their oral health.

managing all the complexities of the sale of a dental practice. Dental Elite goes above and beyond for a more consultative approach, ensuring the unique needs of vendors as well as buyers are met.

Because of the dental industry’s strict regulatory frameworks, selling a dental practice in the current climate can be extremely challenging. Every buyer is different, every sale is different but, ultimately as a vendor, if you have agreed to deferred consideration, you need to feel reassured that the money is going to come when it’s due. Having the knowledge and expertise at hand is vital to help you secure the fairest deal, as well as the right one for you and your circumstances.

For more information, visit www.dentalelite. co.uk, email info@dentalelite.co.uk or call 01788 545 900. n

about the author Luke Moore is one of the founders and Directors of Dental elite and has overseen well in excess of 750 practice sales and valuations. With over 19 years working in the dental industry, Luke has extensive knowledge in both dental practice transfers and recruitment and understands the complexities of nHs and Private practices.

business bites addressing everything business

Encouraging online reviews from existing patients should, therefore, be a priority as part of any practice’s growth strategy.

Optimising the patient journey

Technology can be a life-saver for practices looking to optimise every aspect of the patient journey. Communication, in particular, can be enhanced no-end by utilising some of the latest innovations in the market. For example, a live chat feature on the website allows patients to ask basic questions and receive fast answers, even when the front desk team are busy. From a clinical perspective, solutions like Chairsyde offer a way of enhancing patient understanding of oral health and recommended treatment for an optimised treatment experience. This stateof-the-art consultation platform explains procedures through easy-to-understand animations, covering benefits and risks for informed patient consent and greater patient engagement in decision-making. There are many areas you can focus on to build your practice’s reputation. Being proactive in ensuring an excellent patient journey and encouraging positive feedback are both essential in maintaining a great reputation in the long-term. For more information, or to book a demo, visit www.chairsyde.com or call 020 3951 8360 n

Loven Ganeswaran, ceO and founder chairsyde.

Helping dentists around the world empower their patients to make better decisions about their health.

We’re a specialist dental practice sales agency, so whether you are looking to sell your dental practice on the open market, selling to your associate or intrigued with Corporate interest, we’ve helped thousands of dentists like you.

You cannot be in better hands with our expert valuers, a single point of contact throughout the sale and in-house legal team, allowing us to

We work with dentists all over the UK

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Expert Valuations

Accurate valuations for associate & principal led models with advice on enhancing the practice value.

advise you from start to finish. Supportive Throughout

We liaise with solicitors, buyers, and CQC to ensure everything is in place to minimise stress and give a smooth sale.

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• Continue to monitor and support the patients’ oral health throughout their life