The Probe November 2024

Half of parents say their children haven’t visited a dentist by age three

As tooth decay remains the most common reason for hospital admissions in children aged 6-10 (According to Office for Health Improvement & Disparities), new research suggests 50% of parents haven’t taken their children to the dentist by the time they are three years old, despite official guidance recommending they are taken when their first milk teeth appear, usually at six months.

Denplan’s Oral Health Survey 2024 reveals that only 45% of parents said they have taken or planned to take their children to the dentist before they turn three years old. NHS guidance recommends taking a child to the dentist when their baby teeth appear, so the dentist can identify any oral health problems at an early stage, advise on how to prevent tooth decay, and get children familiar with going to a dentist.

One in five (21%) parents say their children brush less than twice per day or not at all, up from one in seven (14%) in 2023.

Parents welcomed further education on oral healthcare habits, with 86% agreeing that good habits should be taught in childhood to improve health for life. Almost four in ten parents (37%) think the government should implement oral health education in schools to help tackle the current children’s dental crisis. Schoolsupervised toothbrushing – a policy teased by Labour ahead of the election – would be welcomed by almost half of parents (49%).

However, when questioned on whose responsibility it is, the majority of parents (89%) think they should be responsible for supervised toothbrushing, with only 29% saying teachers were responsible for their children’s oral health.

Deltapoll interviewed 5,035 adults in Great Britain online between 2nd and 7th August 2024. The data has been weighted to be representative of the British adult population as a whole.

Catherine Rutland, clinical director at Denplan, said: “Unfortunately, many parents think ‘they’re only baby teeth so there’s no need to go to the dentist.’ However, baby teeth can stay with us until we’re around 12 years old. Currently tooth decay is still the number one reason children aged 6-10 are admitted to hospital, which is deeply saddening. Many parents are also unaware that brushing should still be supervised by an adult every day until children are over seven years old to be confident they’re doing it correctly.

“It's important to offer quality oral health education in primary schools, but our research shows that it cannot be relied on as the only solution if children only benefit four or five years after their first teeth appear. We need a far wider public health education campaign and a longterm solution that gives every child access to a local dentist. To improve access, the government must address the shortage of

Digital dentistry comes to town

The Planmeca Roadshow arrived in the UK in October, highlighting the latest dental technology across the nation and impressing with its moving showroom.

The tour kicked off at Etihad Stadium, home of Manchester City, on Thursday 10th October, before riding into the Birmingham National Motorcycle Museum on Saturday 12th. From there, the moving showroom ‘flew’ down for a visit to the Army Flying Museum in Stockbridge on Tuesday 15th October, and staged its grand finale at on Thursday 17th Twickenham Stadium in London.

Visitors were greeted with a Tardis-like experience, stepping into the truck to find 10 different products on show, with plenty of space to move around and browse the

technologies. Dental professionals were able to trial Romexis, Planmeca’s all-in-one software for dentistry, and take a look at the Planmeca Pro50 dental unit.

Also aboard the truck was the Viso CBCT unit, the Compact i5 dental unit, the ProX intraoral imaging unit along with the ProSensor HD imaging sensor, the Emerald® S intraoral scanner, the Imprex mobile scanning station, the PlanMill 35 milling station, the Creo C5 chairside 3D printer, and the Planmeca ProScanner 2.0 imaging plate scanner.

“It’s been a fantastic couple of weeks being able to showcase the complete Planmeca portfolio at six locations across the UK and Ireland,” said Luke Broadhurst, Managing Director at

DentaMile Bite Splint Workflow

DentaMile Bite Splint Workflow

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dentists in the workforce and commit to reforms of the NHS contract.”

“With many people reporting they can’t afford to go to the dentist, it’s imperative we support them financially, whether as individuals or through their employers. We hear from our customers they really appreciate having the ability to claim back the cost of any dental treatment via the cover provided on our health plans, and those who have a payment plan with their dentist say it helps them spread the cost and budget for treatment. Many dentists who treat parents for a cost will treat children for free, as well as offering advice on how good habits prevent problems occurring later in life.”

To mark the launch of this year’s report, Denplan ran a BrightBites workshop with Dentaid, teaching children about oral healthcare at school.

BrightBites, Denplan’s partnership with Dentaid, aims to reach 90,000 schoolaged children through a fun and engaging oral healthcare education programme. Programme locations are chosen based on social indicators such as the number of children receiving free school meals, which aligns with BrightBites’ mission to target schools in lower socio-economic areas.

The full Oral Health Survey is available at: https://www.denplan.co.uk/thecore/industry-and-company-news/oralhealth-survey-24 

Planmeca UK. “Being part of the wider Planmeca European Roadshow, it’s been great to play our part in delivering the Planmeca experience locally to both new and existing customers in what has been a great success all round.”

For a more in-depth look at some of Planmeca’s products, flick across to page 46. ■

Scan to find out more!

Our material LuxaPrint Ortho Comfort combined with the Bite Splint Workflow in DentaMile connect, enables you to complete bite splints quickly and easily.

Our material LuxaPrint Ortho Comfort combined with the Bite Splint Workflow in DentaMile connect, enables you to complete bite splints quickly and easily.

A welcome from the editor

November is Mouth Cancer Action Month, which is more important than ever before if recent figures are taken into consideration. Cases of mouth cancer have more than doubled since the turn of the millennium, with 8,864 people in the UK diagnosed within the space of a year in 2022. The Oral Health Foundation’s Karen Coates discusses the reality of mouth cancer as an increasing illness on page 10, while The DDU’s Eric Easson explains how to increase the chances of an early diagnosis on page 11. Rounding us out with a trilogy, Dr George Wright of Dental Protection outlines what clinicians need to consider when it comes to suspected mouth cancer cases on page 64. For more information, head over to https://www.dentalhealth.org/mouthcancer

October, meanwhile, was a busy month for us, with the London Dentistry Show taking over London’s ExCel Centre, and Planmeca’s Roadshow touring the nation. You’ll find details of both within these pages. And, finally, The Dental Awards 2025 will be open for entries by the time you read this. Register your intention to enter at the-probe.co.uk/awards before 13th January to secure an early bird entry cost. Until next time, stay safe and have an enjoyable read.

Lianne Scott-Munden Clinical Quality & Complaints Risk Manager at Denplan

Dr George Wright Deputy Dental Director Dental Protection

Abi Greenhough Managing Director Lily Head Dental Practice Sales

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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

Dr Poonam Goyal Dental Specialist in Dahl Technique Krishan Davda Digital Dentistry Specialist Dental Health Care

Craig Mallorie Oral Surgery and Dental Implant Specialist

Oral Health Content Specialist Oral Health Foundation

Bas Vorsteveld Haleon Vice President

•

• Carry out supra and subgingival instrumentation

• Use a combination of our products if surgical intervention is required

• Continue to monitor and support the patients’ oral health throughout their life

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STEPS TO BETTER GUM HEALTH TACKLING GUM DISEASE TOGETHER

How can we work together to prevent gum disease?

Over 80% of UK adults show signs of gum disease.1 As dental professionals, you know that effective daily plaque control is key to tackling the causes of gum disease and stopping gingivitis in its tracks. Haleon recently hosted a panel of dental experts to discuss the barriers dental professionals face in encouraging behaviour change for improved gum health. Led by Professor Tim Newton, President of the Oral Health Foundation, the panel explored practical strategies for motivating patients.*

The experts included:

Professor Tim Newton President of the Oral Health Foundation

Rhiannon Jones

Dental Hygienist and President Elect of the British Society of Dental Hygiene and Therapy

Dr. Amit Rai GDP and Dento-Legal Adviser

Dr. Neha Mehta a newly qualified dentist

The panel discussion ranged over a series of different topics, with the panellists bringing their knowledge and insight to the conversation.

Topics discussed included:

Framing the issue

The role of the patient

Practical approaches

Working with commercial organisations Behaviour change

Listen to the conversation at Haleon HealthPartner

“BLEEDING GUMS IS SO NORMALISED.”

Dr.

“I THINK THERE’S A LACK OF UNDERSTANDING FROM A VERY YOUNG AGE OF ALL OF THE BENEFITS OF HAVING A HEALTHY MOUTH.”

Neha Mehta Rhiannon Jones

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This includes our in-surgery discussion guide, designed to support conversations about simple steps to better gum health, and to help you explain to patients the potential impacts of gum disease on overall health.

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DIY Dentistry: It’s no laughing matter.

I’d imagine it would be every clinical dental professional’s worst nightmare. I was eating my lunch in my surgery (Yes! This was 1990 and it was compulsory back then) when I suddenly heard a loud bang in my head. Well, I say I was eating my lunch… I was actually finishing off my daily routine Twix palate cleanser. I took a penultimate bite and quickly became aware of something hard in my mouth. My subsequent, thorough investigations revealed that my root-filled upper right lateral had snapped off at the root-face.

I should quickly point out that the reason for it being root-filled wasn’t down to me. I used to have TMJ really badly and, sometime in the late 1970s, my dentist felt that a pronounced cingulum on the lateral was stopping me going into centric properly. One day, he started to carry out a minimal occlusal adjustment on the tooth, inadvertently visited Mr Pulp, and endodontics ensued. A few weeks before the disastrous fracture, my dentist had treated the darkened tooth with ‘walking bleach’ since the lateral (which only had a minimal palatal filling over the access cavity, don’t forget) was not far off being intact. My dentist – extremely embarrassed – felt that the hydrogen peroxide in the walking bleach mixture had probably weakened the tooth when it penetrated the dentinal tubules.

Long story short, I then had a desperate 20 minutes before my first patient of the afternoon showed up, building up a composite temporary, getting retention by minimally overlapping the material labially and palatally. Provided I didn’t put my teeth together or try to pronounce the word ‘Frankincense,’ it was fine. That was my first ever personal experience of DIY dentistry.

As a dentist, though, I came across a few instances of patients going it alone – most of them driven to it because it was out-of-hours and either hadn’t realised we had an on-call service, or simply preferred to give-it-a-go rather than consult an unknown practitioner. However, on one occasion, the patient wasn’t driven by desperation.

“Well, what do you think?”

My patient had just plonked herself in the dental chair and was giving me a big toothy grimace. To enable me to get a better view of her teeth, she then hauled the angles of her mouth wide with her pinkies to proportions I’d only ever previously seen on the face of Jack Nicholson’s, The Joker.

The conversation that followed was so unsettling that it really could have been inserted directly into a Tim Burton movie.

“Bet you can’t believe your eyes, can you?”

I was lost. She’d smeared her lipstick with the mouth-wrangling, but I didn’t think that was it.

“The colour! What do you reckon to the colour?”

I was still in a murky haze. I didn’t quite know how to respond. Her teeth were still roughly the A3.5 to A4 that I recalled. The only thing that appeared to have changed is that the halo of green she sometimes had on the gum

margins before every scale and polish, appeared to have gone. “Well, you haven’t got that staining you’re prone to. New toothpaste?”

“No!” she said, affronted. “I’ve been bleaching them!”

“Ah,” I said, perplexed that, despite the bleaching, her teeth were roughly the same shade I remembered from six months ago. I too, was also insulted that she had been to another practice for whitening.

“And it cost me virtually nothing.”

“How so?” I enquired. I wouldn’t have paid any money for that particularly ineffective ‘whitening.’

“I did it myself,” she said proudly. “Just a bit of ****** (smoker’s toothpaste) and some Domestos.”

I remember being speechless for a few seconds, but before I could speak, she went on.

“Yes. I realised I’d got all the ingredients in the house. I just mixed up the ****** with the Domestos into a paste and scrubbed twice a day… just like you told me.”

In my defence I had never told her to ‘scrub’ twice a day. In the past had I valiantly tried to teach her the Bass technique in order to try to prevent her cervical abrasion getting worse. And I’d tried a number of times to discourage her from using ****** for the same reason. I mean… bleach and, effectively, PUMICE – what could possibly go wrong?

Despite my pleas and lectures on the potential dangers emanating from accidentally swallowing the stuff, my patient continued to use it on a regular, albeit less frequent basis than twice a day. She reckoned that she never experienced any discomfort from using the bleachy mud. “It’s no worse than Listerine,” she once told me.

Over the time I knew her (she moved away from the area four years later), she reckoned she only had ‘a bit of soreness’ one day, which necessitated

the sucking of an anaesthetic throat lozenge. Problem solved! And if you’re wondering - the colour never improved. I doubt that there are many older practitioners out there who haven’t come across the odd DIY enthusiast patient, who has taken a file to a new denture flange to ease a sore spot. What you may not have come across is a girl in her late teens with severe trismus, unilateral swelling and pyrexia from an inaccessible, partially erupted lower third molar, refusing an emergency same-day visit to the local oral surgery unit, preferring instead, to rely on drugs from her mum. I say ‘drugs’ – her mum was a homeopath. After I relayed to the mother and patient that the house officer I had spoken to had advised immediate admission and possible intravenous antibiotics, the mother replied: “Antibiotics!? No way!” They both left the surgery, resolving to use ‘powerful’ homeopathic remedies. I forget the name of the ‘medication’ she was going to ‘prescribe’ but it probably had a name like Rhus tox , Nux vom or Wot bilge or something similar. Anyway, it had a happy ending. The patient survived after being admitted 36 hours later to intensive care after surgical drainage and intravenous antibiotics.

But she wasn’t the only patient that I came across who initially refused to accept NHS treatment for a resolvable condition. I once had a new male patient who came in with severe acute necrotizing ulcerative gingivitis. He refused debridement, instead deciding to sort it out himself, with that gold standard of DIY home gum treatments: oil pulling! I vaguely recall falling into deep despair at that one.

Having lost a post-crown over a weekend, a patient of mine decided to drill out the post and core from the crown (I mean… How? And WHY?) and shove a shortened darning needle into the root canal to act as a post and then

superglue the crown over the top. When he saw me on the Monday, the slightest breeze on the crown caused it to spin like a 78rpm Buddy Holly vinyl on a Wurlitzer. Apparently, he took a swig of scotch before he rammed the needle in, fearful of the consequences of putting a needle into the ‘nerve’.

All the above were examples of ‘DIY Dentistry’ carried out in the 90s, when many patients (especially mine) had access to a full range of NHS treatments. Fortunately, none of my patients ever had to resort to the extreme of pulling their own teeth out, but the acceptance of this practice - that seems to have avalanched over the past few years – has seemingly been shrugged off by politicians of all the parties, be it blue, red or orange.

As I write, in the past few days, the Express headlined ‘NHS dentistry in crisis as Britons are forced to pull their own teeth out,’ as if it were the first time the phenomenon had ever been mentioned. A day or so later, the Mirror followed up with ‘Shock data shows almost no-one can get in with an NHS dentist if not already registered.’

If two of the bestselling national newspapers in the land are still suddenly (apparently) taken aback by the crisis in health service dentistry after all the horror stories Toothless in England and the British Dental Association have highlighted over the past few years, it feels like the abandonment of patients by Government is far from over.

I wonder if they still have a sale on at B&Q? n

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

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How to pay for healthcare is not only an issue in the dental world

All systems can be abused but the vast majority of clinicians will always do what is best for their patients

Being of such an advanced age that I am now classed as ‘vulnerable’ by the NHS, I am finally seeing a couple of the benefits of getting older, though quite rightly in my case, I am no longer going to get a winter fuel allowance.

I recently received my Covid and flu vaccinations before the rest of my family, though I had been rather bombarded with invitations from my GP practice and pharmacies via the NHS App to take advantage of their services. My understanding is that GPs and pharmacies receive an itemof-service payment for administering these vaccines and, in this case, where just the number of administrations delivered is the most important thing, this generates just the right incentive. I am absolutely not criticising the process, vaccinating a large population free of charge is a huge undertaking and benefits everyone, NHS and public, but I wonder if the item-ofservice fee is the same regardless of who administers it?

Before I was CDO, I had a slide for use in presentations that said: ‘There is no good way to remunerate dentists but the three worst are item of service, capitation and salary.’ All can be abused, and the remuneration now relates to practices rather than individuals, but, in my experience, abuse of the system generated lots of publicity but was only carried out by a small minority.

Anyone who worked in the purely item-of-service-based system before 2006 will have seen examples of financially driven overtreatment. At a time when we were learning so much about prevention and caries rates were falling quite rapidly, it seemed perverse to me to have a system which encouraged intervention over everything else. In our practice, we started applying fissure sealants to first permanent molars in children we considered at risk. The itemof-service Statement of Dental Remuneration did not allow for this but we could claim for a “sealant restoration” if caries was already present! How ridiculous was that!?

We piloted capitation in a PDS pilot in our practice and the balance of incentives changed immediately. We practised much more preventively, extended recall intervals where appropriate, and took on more new patients. Wonderful you might think but patient charge revenue fell by around 30%, acceptable in a pilot but not acceptable if delivered at scale. In developing our pilot we engaged somebody who worked for a capitation-based private payment provider, and he explained to us the issues they had with under treatment in their scheme and how they dealt with it, especially when patients moved to a new practice within their scheme with untreated disease. Capitation has to be supported by good data monitoring.

A majority of the world’s workers work on a salaried basis but that usually includes a number of Key Performance Indicators (KPIs) to guarantee an element of productivity. Anyone who has worked in secondary care will know, it is sometimes a ‘little opaque’ as to who has carried out the work when data is collected on a team basis.

As I constantly say, change is inevitable, and I often hear older, usually retired clinicians or friends from other professions complaining that their younger counterparts are more fiscally driven than “we were”. In some ways this is true, but is it wrong? When I graduated over 50 years ago, I had no decent car, had never been on an overseas holiday (apart from hitchhiking around Switzerland with three school friends) and, crucially, had no debt. Credit cards did not exist; neither did the internet, mobile phones or Amazon!

Most new graduates now, especially those having completed long courses, have a significant debt burden as soon as they graduate. The relatively easy access to borrowing, greater expectations from life in general, and a wish to have a better work-life balance are not specific to individual professions but are a reflection of our changing society.

The new government says it is working to a 10-year plan, and they will need 10 years to tackle some of the entrenched thinking in the NHS.

Why are consultant orthodontists still working in hospitals unless they are teaching? In my area, they can be members of multi-disciplinary teams while working remotely and the rest could be delivered in primary care. Many consultant dermatologists now work mainly in primary care because it is better for everyone. Those making policy decisions at national and ICB levels need to understand and be clear to the public that solving issues in secondary care, which seem to get far more attention in the media these days, means growing appropriate services in primary care, not just ploughing more money into hospitals.

Unfortunately, those making decisions at these higher levels sometimes have a vested interest in secondary care funding and dominance in our thinking of the NHS.

The next decade is going to be vital but a move away from a basically Beveridge Report-based system to one where those most in need find it hardest to get care would be heart-breaking, especially for an older, vulnerable person! n

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

The reality of mouth cancer: an increasing illness in the modern world

Every year, mouth cancer statistics have been increasing. Anecdotally, it was often said that dental professionals could go their entire career without coming across a case of mouth cancer. Over recent years, this picture has sadly changed.

The latest data collected by the Oral Health Foundation shows that 8,864 people in the UK were diagnosed within a year, more than doubling since 2000. Worldwide the figures diagnosed have now reached 650,000 of diagnosed cases.

Therefore, not only is it more likely that you will be referring more suspected mouth cancer cases, but you will also have to treat and support patients living with the aftereffects of treatment.

treatment and dry mouth

One of the most common complaints of mouth cancer survivors is dry mouth. Radiotherapy and some chemotherapy can cause damage to salivary glands, often stopping saliva production completely or making saliva thick and sticky.

As well as being extremely uncomfortable for patients, lack of a good saliva flow can leave them at a higher risk of dental decay. Saliva replacement products are available but may not necessarily be the solution for all patients.

Patients should be encouraged to try sugar-free chewing gum, if possible, take

frequent sips of water and consider a change in diet to avoid salty, dry, or acidic foods.

Patients with dry mouth may benefit from using a high-fluoride toothpaste to help to reduce the risk of decay.

trismus and reduced access

Trismus can range from mild to severe depending on the complexity and area that needs to be treated. This can impact the range of movements of the jaw that the patient is able to complete, which then affects not only how you carry out dental treatment, but also the patient’s ability to care for their teeth.

Having restricted opening of the jaw will make the use of regular oral hygiene products very difficult. Recommending a soft, baby toothbrush with a long, thin neck can help to reach more areas of the mouth. Interdental brushes with long handles will hopefully enable the patient to clean in-between their teeth effectively too. Other changes to patients’ care routines may be necessary, such as the use of a fluoride mouthwash to help to reach areas that a toothbrush or interdental tools cannot.

what are the psychological effects of treatment?

The psychological effects of the diagnosis and treatment of mouth cancer can be devastating for any individual. The scars of cancer from surgery are often visible,

which can adversely affect self-esteem and confidence. It can impact every part of their life, from going out socialising or eating and drinking with friends and family, to personal relationships with partners and children. This may make them less inclined to visit the dentist due to social anxiety. It can be a reminder for some of when they were first put onto the cancer journey, making it difficult to accept the help they need.

It is something to be mindful of when interacting with previous mouth cancer patients. Helping patients reach out to those who can help discuss these feelings is an excellent way to help them overcome some of their worries and anxiety.

These are national support groups that they may find helpful:

• The Mouth Cancer Foundation gives information and support to people affected by head and neck cancers.

• The Swallows Head and Neck Cancer Support Group has a 24-hour support line for those affected by head and neck cancer - 07504 725 059.

• The Young Tongues is a support group made up of young people who have been diagnosed with Tongue Cancer or a cancer diagnosis that involves similar treatment.

• Heads2together provides peer support for patients and their caregivers for mouth, nose, throat, ear, neck, and face cancers.

• NALC (National Association of

Laryngectomee Clubs) provides online and telephone (0207 730 8585) for support and information.

• Macmillan also runs an online forum for those who are suffering from mouth cancer and their loved ones.

People who have had mouth cancer face more complex issues than regular patients. They may struggle with maintaining oral health, be at higher risk for oral diseases, and deal with various mental health challenges. This makes their relationship with the dental team even more crucial. By providing personalised care, and offering reassurance, you can make them feel valued and confident. With a few adjustments, there is no reason why these patients cannot continue visiting their regular dentist, who can support them in their recovery.

Mouth Cancer Action Month is an annual campaign organised by the Oral Health Foundation to raise awareness about mouth cancer. It takes place throughout every November.

For more information on how you and your practice can support this important cause, please visit www.mouthcancer.org. n

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

A natural progression

Implant surgeons Alex Jones and Andy Legg from The Campbell Clinic in Nottingham discuss their experiences of using NSK’s Ti-Max Z high speed turbines

Can you tell us a little about the work that you both do?

AJ: I’m the Clinical Director at The Campbell Clinic and the main focus of my work here is restorative and implant based. As well as planning and placing implants, I also do the restorative stages of any implant treatment. I also undertake the more complex restorative cases, anterior aesthetic cases and full mouth rehabilitation cases.

AL: I am a dentist at The Campbell Clinic and co- founders and lecturer at The Campbell Academy. I do a combination of implant and restorative work very similar to Alex. This includes a lot of accessory restorative work around implants such as crowns and veneers alongside more complex restorative cases as well.

You’ve been working with nsk’s new Ti-Max Z990L and Z890L turbines. What was your first impressions of the handpieces?

AJ: I’ve used NSK turbines for quite some time and I’ve always been very happy with them. I think the main difference and where I found a big improvement is with the torque. A lot of the work we are getting now is replacing crowns that have been done elsewhere, both here and abroad. These are generally made out of zirconia, which is an incredibly hard material and therefore a difficult and time-consuming material to remove. The improved speed and torque means you can cut through and remove zirconia crowns far more easily.

AL: My first impression was they are very comfortable to use and the ergonomics is very good. We’ve been using NSK turbines with Duragrip coating for quite a while and this feature has obviously been passed on to the new turbines.

The smaller head size of the Z890L is very welcome, particularly for patients with limited opening and for those hard to reach areas of the mouth. They are very smooth handpieces with little vibration, and the increase in power is just an extension of what NSK is so good at. I find them very comfortable and easy to use to the point where I don’t really think about them, which is probably the best compliment you can give about a handpiece.

AJ: When you’re prepping teeth towards the back of the mouth, sometimes you haven’t got as much height when you have a longer bur on the handpiece. The smaller head of the Z890L gives you a couple of millimetres more space that allows you to improve the preparation and not have to worry so much about how to get the handpiece into the right position to prepare a certain part of the tooth.

As well as cutting hard materials such as zirconia, what other benefits does the increased power of the turbines bring?

AL: The increased power reduces treatment time and therefore heat production, so you’re less likely to ‘cook’ the teeth and cause pulp death. As Alex mentioned, the volume of cases coming through that require retreatment is only going up, not just as a result of dental tourism but also as a result of younger people especially choosing to have cosmetic dental work.

There is a real trend at the moment for people to have straight white teeth. The current trend is for composite bonding, but at some point that is going to fail, wear or stain so badly it will need redoing. By using handpieces with high torque and high power you are not having to lean on the materials as much. And if you don’t have to do that, you are not increasing heat and therefore the chance of complications goes down.

What difference does the 100° angle head make in relation to access and visibility during treatment?

AL: There is a noticeable smooth transition from the grip through to the head. It is not as angular as say the reverse speed turbine that you use for oral surgery, so again it’s just increasing accessibility and I think it’s a good balance.

AJ: The angulation allows you to be able to stand up and lock your wrist and elbow when you’re preparing a tooth to make sure you get the right degree of taper to give a retentive preparation at the end of the treatment.

Did the handpieces meet your expectations?

AL: They more than met my expectations, but my expectation with NSK is that I’m always going to get a handpiece that works and does the job. I think they’re a big step up from the previous generation and I would highly recommend them. What you want is reliability, something that’s smooth and doesn’t cause the patient a problem. I think NSK ticks all those boxes.

AJ: Like all NSK handpieces, they are a good, solid product, the build quality is exceptional and it’s all backed up by a really great team of individuals.

How do you find the service and support from nsk?

AL: NSK is a really great company to work with and The Campbell Clinic has been working with NSK for a very long time.

The service and support we receive is truly outstanding, especially from our rep Jo Dronfield. NSK support us not just with equipment for our education courses, but also with respect to just day to day dentistry. They are an exceptional company. n

For more details on Ti-Max Z series turbines visit:

https://tinyurl.com/Ti-Max

Contact your local nsk Product specialist

https://mynsk.co.uk/product-specialists

Alex Jones

Andy Legg

Tackling the UK dental crisis through evidence-based solutions

It comes as no surprise that the UK is continuing to face a dental care crisis. Rising cost-of-living pressures continue to impact daily lives, with patients struggling to afford basic needs such as food, heating, and, crucially, hygiene products . Many patients are unable to pay for oral healthcare products and routine dental visits and, paired with NHS dental appointments becoming increasingly difficult to come by , a mix of factors has led to declining oral hygiene levels in the UK.

As a result, people are missing out on routine care, and preventative advice and the maintenance of good oral hygiene routines at home are falling. This has led to 31,000 hospital admissions attributed to tooth decay in 2023 alone, with 52% of these cases occurring in children aged 18 or below .

This is an alarming statistic, especially when considering that tooth decay is preventable through good self-care practices such as consistent tooth brushing with fluoride, regular dental check-ups, and professional cleanings. Regular appointments with oral health professionals are a key factor in receiving preventative advice and check-ups, but good self-care practices start at home.

professional pressures

Within the industry, oral health professionals are facing extreme pressure. We know that they are trying to juggle increased demand while still providing high standards care, while remaining economically viable as a practice. Rising issues, such as fixing results from ‘DIY dentistry’ and ‘Turkey teeth’ gone wrong, are leading to emergencies. Patients presenting with ore complex cases, such as tooth decay and periodontal disease, are all putting an additional strain on oral health professionals and the healthcare system.

Moreover, ‘dental deserts’ are appearing across the UK. Some areas in England have over 3,000 people for every NHS dentist available, leading to only one in 10 adults having seen an NHS dentist locally over the last year and 40% of children no longer having access to regular dental appointments . This puts significant pressure on the practices that are accepting patients, highlighting that there are clearly issues being experienced on both sides of the coin, and reform is needed.

Uncovering the issue

As leaders in the oral healthcare space, at Haleon, we are aware of the unprecedented challenges that UK patients and oral health professionals have been facing. Over the last two years, we have been working in partnership with the College of General Dentistry on our Dental Health Barometer, to explore the provision of preventative oral healthcare to patients and oral healthcare professionals.

The initial launch of our report in November 2023, comprised a research survey of more than 500 oral healthcare professionals and over 2,000 consumers from across the UK. The results of the

research provided us with a temperature check of the current state of preventative oral healthcare advice, what this entails, and whether consumers and professionals think it is important. Crucially, the findings enabled us to provide evidence-based recommendations on how to improve consumers’ access to preventative advice as the results uncovered that many are not visiting the dentist in the first place.

Encouragingly, both consumers and oral health professional agree and clearly understand that preventative care advice is beneficial and important – with nearly half of consumers thinking it is very important, and 87% of professionals believing preventative action is beneficial for patients .

The survey also found that not all agree on what exactly counts as preventative care, and a lack of understanding from both patients and oral health professionals over whether preventative advice is offered across both private and NHS appointments. As a result, some people are still missing out on preventative care. A quarter of NHS patients responded that at their most recent trip to an oral health professional they did not receive or see any preventative care advice, and only around a third of professionals said they always offer advice to their patients . So, there were, and still are, clearly gaps to be bridged.

Finding solutions

For the next stage of our research, we have continued our partnership with the College of General Dentistry to conduct focus groups with oral health professionals across the UK. In early 2024, we spoke to over 70 oral health professionals across seven focus groups up and down the UK to explore potential solutions to the challenges our initial research identified.

This work highlighted that the main reasons many oral health professionals are unable to offer preventative care advice consistently in appointments are time constraints, lack of patient requests, longer appointment times needed, and the need for better reimbursement under the NHS.

Following this, we jointly developed a comprehensive report offering insight-driven recommendations from the focus groups on how to tackle the gap in intentions and delivery, and the practical solutions for this. This report found that oral healthcare professionals are seeking redesigned NHS contracts to allow for better provision of preventative advice and care. It also calls for improvements to education on preventative oral healthcare, better oral health habits, and debunking misinformation from sources such as social media.

We of course welcome the government’s Dental Recovery Plan as a first step, but there is an opportunity and need to go further in making NHS contracts fit for purpose by prioritising prevention and improving its access. We urge the government to work collaboratively with industry, professionals and stakeholders to seek wider professional opinions, in order to develop evidence-based solutions to the current dental care crisis.

the wider impact of preventative oral care

We know how crucial oral health professionals are to ensuring the nation’s health and wellbeing. Routine dental visits and good hygiene practices form a cornerstone of the healthcare system and people’s overall health. In fact, dental teams can detect numerous conditions before they become serious in regular check-up appointments. This includes oral cancer, autoimmune diseases, nutritional deficiencies, and diabetes.

Diabetes is one of the most common chronic conditions in Europe and is known to have a strong link with periodontitis, which is a preventable condition. Around one in three people living with diabetes are undiagnosed, with more than a million people undiagnosed in the UK alone .

In a pilot study called INDICATE, led by the University of Birmingham, it was found that almost 15% of people walking through dental practice doors who believe themselves to be in good health, exceeded the UK’s pre-diabetes/diabetes threshold, which is a troubling statistic.

To further explore this link, thanks to support from Haleon and the National Institute for Health and Care Research, INDICATE-2 will work with 50 dental practices across England and Scotland to screen more than 10,000 patients and develop a care pathway that could help health services detect and treat many more people with undiagnosed diabetes in the UK. This will allow the team to determine the prevalence of diabetes within a more representative population sample, with a view to scale this approach nationally. We look forward to continuing to work closely together to improve the capabilities of dental teams and care given to patients.

Our research and detailed proposed solutions have come at a pivotal time for the future of dentistry in the UK, with the newly appointed government citing that NHS dentistry and children’s oral healthcare

is a priority. This is an area that has been underserved in terms of policy focus thus far but, given the strong links between oral health and non-communicable diseases such as diabetes and cancer, preventative oral healthcare should be placed at the forefront. Through prioritising getting preventative care and advice right in the oral health space, we can unlock further benefits at a wider national level for our healthcare system and support healthier and safer lives at an individual level.

Delivering better everyday health

Gaining deeper insights into the landscape of self-care and patient wellbeing forms a key part of Haleon’s purpose. It is highly important for consumers to understand their own health better and, therefore, how to best support a healthy life. Projects such as the Dental Health Barometer and our research with the University of Birmingham highlight the importance of empowering consumers to take a more active role in managing their own health and ease the strain on the healthcare system.

Insights from the research bring to the forefront the vital role of oral health professionals in looking after the nation’s health. We know how crucial it is to support them in providing this level of care, which is why we are proud to delve deeper into the themes we see and to work collaboratively with the industry and government to uncover potential solutions. I look forward to continuing our work and collaborating further with government, professionals and the wider industry in order to find actionable solutions and improve the nation’s oral health. n

About the author Bas Vorsteveld,

Vice president and general Manager of great Britain

and ireland, haleon.

Water off a dentist’s back?

As a busy dental professional, you probably don’t think about the water in your practice very often. And why would you – you have plenty of other things to occupy your thoughts on any given day in the practice. However, it is important to consider water quality in order to ensure the highest standard of patient care and safety, while also maximising the working life and return on investment for your decontamination equipment.

Water quality and safety

There are various reasons why water quality is important in the dental practice. The first is to protect patients and professionals from potential infection. According to HTM 01-05, registered managers of all dental practices are responsible for ensuring that the water supply, storage and distribution meets certain standards. This includes minimising the risk of Legionnaires’ disease, which can develop within the dental unit water lines (DUWL) if the relevant pathogens are allowed to colonise in stagnant water. Historical studies have established a significant risk of contamination throughout DUWLs, highlighting the importance of cleaning them sufficiently. The Health and Safety Executive mandates that all businesses using any type of water supply where a risk of Legionella contamination exists implement adequate infection control measures. The SHTM 01-05 necessitates similar demands in Scotland, with both bodies requiring a named individual to be responsible for this decontamination process.

equipment maintenance

Another reason to maintain water quality is to protect your decontamination equipment from malfunctions or breakdowns. This is especially important if you are located in an area of the UK with ‘hard’ water. Approximately 60% of the nation has a high concentration of calcium and magnesium dissolved in the mains water supply, which dries down into limescale.

If you were using mains water for your dental units and handpieces, this limescale could build up and may cause problems rather quickly. Not only could your equipment stop functioning as efficiently as it should, but substantial limescale could stop it from working altogether. This could cause serious disruption to your services if it happens to essential pieces of equipment like your autoclave. Without cleaned and sterilised instruments rendered safe for reuse, patients would be inconvenienced by postponed appointments. Staff would also have more tasks to complete in addition to the stress of engaging with unhappy patients and arranging for engineers to fix the equipment. Of course, all of this would also have financial implications for the practice, with the costs of engineer visits, spare parts and practice downtime adding up quickly.

an alternative solution

For all these reasons and more, dental practices in the UK should steer clear of using mains water to supply their equipment. One alternative solution is to use bottled water instead, but this comes with its

own disadvantages. bottled water can be expensive for the business, it is one of the least environmentally-friendly options, and substantial space is required for bottle storage. Dental practices already generate unavoidable plastic waste and the use of bottled water would simply add to this unnecessarily.

A better option for most dental practices is to introduce a reverse osmosis (RO) water system. This reliably delivers safe and clean water in a cost-efficient and sustainable way. It is also a faster solution than a water distiller, delivering more water in a shorter space of time for optimal convenience and minimal running costs.

RO water units work by pushing tap water through a semi-permeable membrane, which removes contaminants. Everything from minerals like calcium and carbonate to totally dissolved solids (TDSs), bacteria and microorganisms are effectively removed from the water. Leading equipment combines the

use of UV light technology to further ensure the highest water quality possible.

The WRAS-approved RO Water System from expert in decontamination, Eschmann, affords all these benefits and more, quickly and efficiently producing water in compliance with HTM 01-05 and SHTM 01-05 guidance compared to alternative methods. The 12-litre water tank comes as standard, and a 60-litre version is available to meet the needs of larger practices. Easy to connect to the mains cold water supply, the system affords a rapid return on investment, often in less than 12 months. Plus, the equipment can be maintained under the Eschmann Care & Cover servicing package, with technical telephone support and expert engineers on hand to keep equipment running efficiently for longer.

Water quality might not be an everyday topic of conversation for the dental team with so many other aspects to think about. However, it is crucial for patient safety and equipment longevity. RO water systems provide a reliable, cost-effective, sustainable and fast solution, find out more today.

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 753322 n

about the author

Nicky Varney, Senior Marketing Manager at eschmann.

Choosing the right steriliser for your practice

Choosing sterilisation, disinfection and decontamination methods that effectively prevent and control the spread of pathogens in accordance with HTM 01-05 is an essential responsibility of every practitioner. With exposure to blood, saliva and the oral cavity – a natural habitat for a large number of micro-organisms – the dental setting presents a high number of opportunities for infection.

Dental handpieces can be particularly difficult to sterilise due to the complex internal structures which are considered particularly prone to contamination. To maintain a safe practice and prevent crosscontamination, a dental autoclave is an essential commodity for any busy practice, ensuring all instruments that could present a risk are safe for reuse. Due to other pressures on the modern dental practice, choosing the right steriliser will increasingly involve other considerations, such as energy consumption, speed and efficiency, and intuitiveness/ease of use. Ideally, any member of the dental team should be able to reprocess handpieces quickly and effectively to meet appointment schedule demands as well as the needs of patients.

infection control

The main infections that can be contracted in the environment are caused by bacteria, mycobacteria, fungi and viruses and prions – all of which can present a real danger to health. Contamination can be bidirectional, during treatment and afterwards, from

patient to clinician and vice versa, and can be transmitted by inhalation, injection, ingestion, or absorption through the mucosa or skin.

Potential bloodborne diseases include human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV). Due to gingival bleeding, saliva should be treated with the same caution as blood. Without the proper mitigations in place, pathogens also have the potential to be transferred from patient to patient through shared access to poorly disinfected environments, as well as inadequately decontaminated devices and instruments.

autoclave types – a summary

The steriliser of choice must be fit for purpose in terms of consistent infection control.

The ‘N’ type autoclave is appropriate for flat, unwrapped, solid medical tools. It is not suitable for sterilising hollow, porous or wrapped loads, but may be useful if your practice has a large number of solid instruments to sterilise.

The ‘S’ type autoclave is considered the intermediate choice between ‘B’ and ‘N’ type options for dental practices, and can be highly useful for sterilising porous, bagged products, although it can’t process textiles. The S class autoclave usually has a range of drying cycle options, and is generally very quick and straightforward to use, but not considered optimal for hollow instruments. Dental air turbines and straight and contra-angle handpieces can draw in contaminants during their operation. The

small parts and long, narrow cavities make these instruments particularly challenging to keep free from infection. Once they have been cleaned and lubricated, the sterilisation process is essential to ensure they are free from infection.

‘B’ type sterilisers are considered the ideal autoclave for managing these instruments. They use a pump to create a vacuum, enabling a high-pressure environment at a temperature too high for microbial survival. The resultant pressure when introducing boiling steam into the vacuum leads to an increase in the boiling point of the water. In addition, the sudden pressure-change creates very hot steam at high speeds, forcing heat through the instrument, penetrating the interior more effectively than other methods.

Speed, energy efficiency and the audit trail

Energy efficiency is a vital concern both to save money and to reduce the carbon footprint of the operation. Of equal importance to any busy practice will be the speed and efficiency of the workflow. Sterilisation must also be validated, tested, documented and audited. Sterilisers that integrate these considerations, offering ease of use as well as speedy, effective function, are hugely beneficial for the efficiency of every practice.

Choosing the right autoclave for the practice will also require consideration of the appropriate capacity and size needed for regular use. Do you have limited space, and need a compact design? Or is your

operation busy and large enough to warrant a larger unit? Do you need specialised support if things go wrong? If so, is this provided by the manufacturer?

W&H has a range of sterilisers, in compact, large and extra-large sizes to meet the needs of every dental practice. The Lisa steriliser from W&H, for example, provides both ‘S’ and ‘B’ cycles for flexibility, and offers the operator intuitive control for comprehensive and reliable sterilisation. EliTrace automates the vital audit function, meaning every instrument is automatically logged and tracked, so practices know where every instrument is in its decontamination schedule. Eco Dry+ technology also reduces the cycle time, optimising energy consumption for a more cost-effective sterilization process. And ProService from W&H provides additional peace of mind, with total technical support. Infection control is an important concern for all dental professionals, as procedures are carried out in an environment that exposes staff and patients to significant risk. Choosing a high-quality steriliser represents an opportunity to invest in the safety of your practice, as well as its overall efficiency. To find out more visit wh.com, call 01727 874990 or email office.uk@wh.com n

about the author

Jon Bryant, National Sales & Marketing Manager, W&H UK.

Smells like dental spirit

Most people are familiar with the idea that a particular smell can trigger strong memories, but as we rely on sight and sound so heavily in our daily lives smell is a sense that often goes overlooked.

We also know that negative memories of dental treatment are significantly related to dental fear, and aspects of reliving an experience are particularly important in affecting this: sight, of course, as well as sound, taste, and smell.

Integrating the latest psychological findings appropriate to dental care provides a new opportunity to shape and improve the patient experience, and affect oral health positively. Dental professionals should know how smell can affect patient fear and anxiety, and why it may be beneficial to implement changes around the practice for long-term patient and clinician benefits.

the power of scent

Dental anxiety is presented through a wide manner of actions and expressions. Heart rate, breathing, and sweating all increase as a result of fear when a ‘dentophobic’ patient is introduced to dental environments and stimuli. Unease concerning the dentist may also prompt patients to avoid attending the practice, which affects their access to dental treatment, and ultimately the quality of their oral health.

Creating an anxiety-free environment is a clear goal for any clinician, with obvious benefits for their patients. Smells such as cut dentine and bone, and materials containing eugenol have been identified as potential triggers for anxiety. The smell of eugenol, in particular, can cling to the dental practice, but it is implemented widely in clinical dentistry because of its antiinflammatory and local anaesthetic effects.

For patients, the scent may evoke memories of previous unpleasant dental care experiences, creating unease whilst they simply wait for an appointment.

Does it hurt?

Anxiety is also thought to affect pain perception in some dental treatments. When patients are more nervous about a procedure, they experience a greater physical reaction to painful treatment, which can lead to new negative memories. If clinicians can reduce patient anxiety, for example, by changing the odour within a dental environment, individuals may perceive their treatments as less painful –

an unequivocal positive. This can help to form new, positive memories of the practice and dental care, which could prompt return visits and greater attention paid to oral health and hygiene.

The role of olfaction is being explored further in pain management in more generalised healthcare. Whilst changing what patients smell cannot affect pain threshold or tolerance, it may impact the qualitative (intensity) measures of pain in response to stimuli. Studies have shown that when patients experience unpleasant odours, they have reported experiencing greater levels of pain and unpleasantness. Therefore, by implementing satisfying smells within the practice, patients could experience reduced pain intensity.

clinical nose

If patients can have their experience of dental care affected by their sense of smell – going as far as influencing their perception of pain – what is to say that clinicians cannot be impacted too?

Olfactory fatigue, the phenomenon where the body fails to detect or distinguish common scents in our surroundings, is associated with areas where we spend a lot of time. For dental professionals, the everyday smells of the practice may not be of note.

However, a 2018 study observed that the scent of anxiety body odour (ABO) can break through this barrier, and influence the way clinicians work. Fourth-year dental students that were exposed to ABO performed clinical tasks at a significantly reduced quality than those confronted by rest body odour or no additional scent at all. While the smell may not have been perceptible, it had an unconscious and quantifiable result.

Smelling better

Scents in dentistry are essential when ensuring patients enter the chair anxietyfree, and that they receive high-quality care. Implementing effective solutions throughout your practice that can eliminate odours and provide fresh, pleasant fragrances can affect how your practice is perceived.

Consider the Initial Essence air freshener from Initial Medical, featuring state-of-theart oxygen fuel cell technology for longlasting fragrance delivery. Clinicians can choose from four fragrances to rejuvenate their clinical space including; (Adore) a sophisticated fragrance that combines fresh apple notes with amber and spices; (Elate) a designer fruity, floral fragrance with musk notes; and (Spring) with intense flora notes of ylang, lavender, geranium, plus hints of fresh cologne and lemon.

Initial Essence is effective against transient odours, such as tobacco and sweat, and continuous fragrance dispersal means the desired intensity of your chosen scent is consistent over time, unlike aerosols which can have significant gaps between sprays, or gravity and passive systems.

If a simple change to the smell of a practice’s surroundings can impact patient anxiety, pain perception, clinical performance, and overall treatment experience, then surely it’s worth exploring the changes that can be made in your practice. After all, the smell of the dental practice isn’t something you would like patients to kick up a stink about, right?

To find out more, get in touch at 0808 304 7411 or visit the website today www.initial.co.uk/medical n

about the author rebecca Waters has worked in the healthcare sector for the past 20 years and earned a BSc chemistry (Hons) prior to joining rentokil initial in 2003. She works within the research and Development team and keeps up to date on all changes within the clinical waste management industry, as well as the specialist hygiene and infection control industries, and is an active member of the ciWM and HWMa. Following roles as an analytical chemist and Hygiene chemist, she has worked in a variety of leading marketing roles since 2006, making her an expert within the industry. She is a Fellow at the chartered institute of Marketing, an FciM. rebecca loves spending time outdoors and in the water – whether walking, camping, or swimming – and completed a focus on environmental studies during her university degree. She is proud to be pushing a sustainability agenda throughout her work.

To learn more about our digital solutions, contact us todaymarketinguk@planmeca.com or 0800 5200 330

What can a centre for happiness teach us?

Liverpool council recently approved plans for The Ken Dodd Happiness Centre, which will be adjoined to his beloved Royal Court Theatre. The centre will house an archive dedicated to the late comedian, including tickling sticks, Diddymen puppets and reams of jokes. Although there will be some who are not familiar with Ken Dodd’s brand of silliness (and others who will definitely not find it funny) it’s easy to see the appeal of a venue dedicated to celebrating happiness. But what is it that makes us happy or unhappy? This may be a big question, but it is one that’s very relevant to the dental profession. Statistics around stress, burnout and anxiety levels experienced by dental professionals make for difficult reading. It’s important to reflect on this question. What can we, as dentists, do to bring more joy to our lives?

Dental professionals and emotional wellbeing

Not only do dentists experience disproportionately high levels of mental illhealth during training and throughout their careers, this lack of wellbeing affects clinical decision-making, potentially impacting on treatment outcomes.

According to the clinician self-referral service, NHS Practitioner Health, high rates of unhappiness among dental professionals stems from many common factors, including pressures on time and the impact of rising costs on patients, combined with isolated working conditions and a tendency to share

a perfectionist or competitive mindset. The GDC’s own research adds the anxiety felt by clinicians around complaints, litigation and the fear of censure to the list. Clinician anxiety can also rise in response to patients experiencing poor mental wellbeing.

What are the common factors influencing wellbeing?

The study of subjective wellbeing examines what constitutes happiness, and the ways in which individuals experience and evaluate the quality of their lives. The study classifies wellbeing into three broad categories: hedonic, which encompasses the emotional states of happiness or unhappiness, joy, stress, and worry; evaluative, which includes the various factors influencing wellbeing, such as community or health; and eudemonic, which pertains to the sense of purpose and meaning associated with life.

Teledentistry today

Teledentistry has long felt like an inevitability. The concept is less sci-fi than it sounds; it is the use of electronic information and communication technologies that support dental care delivery, diagnosis, consultation and treatment.

Today, the definition feels in line with many current workflows, but back in 2000 –when just 75% of physicians in the United Kingdom, Canada and United States used the internet on a daily or weekly basis – there were concerns regarding “cyberdentists” that would solely provide consultations online. Many were also worried about the verifiable nature of sources available to patients. The latter problem has certainly become a reality. It’s not uncommon for patients to have their own diagnosis prepared by the time they enter the practice – around 21% of general health practitioners experienced patients presenting information they found online in one review. Whether they are wellinformed or otherwise depends on the case. However, the avoidance of “cyberdentists” that may be unqualified to provide treatment or do so in an unsafe manner is essential. Clinicians must take action to prevent it from becoming a significant issue in teledentistry. It’s inarguable that the digital landscape is something that dental professionals must be actively prepared to work with, and find ways to do so effectively.

an online advantage

Dental professionals must provide ethical care, and treatments cannot be compromised through the use of

A long-term study commissioned by Gallup, used these definitions to assess the relative happiness of 5 million people worldwide over the course of 15 years. The study found that 20% of all surveyed who rated their lives as the least happy tended to experience poorquality employment, inadequate income, poor community support, malnourishment and loneliness. Conversely, the happiest 20% of those polled were fulfilled by their work, had little financial stress, had community and good health, and had loved ones to turn to for help.

Work plays an enormously important part in the relative happiness or unhappiness of individuals. It has been identified as bringing a personal sense of purpose as well as positive feelings associated with contributing to the wider community. According to a recent study, when work is a positive experience, existing and future subjective wellbeing scores increase significantly. Research consistently shows that people who have strong social relationships tend to report higher levels of wellbeing. Social support can lead to better mental and physical health outcomes, reduce stress, and contribute to a sense of belonging and purpose.

Making time for happiness

How can dental professionals bring more meaning into their work, while also making time for stronger support networks, friends and family? For many the key is around a more flexible approach to work, developing a better work-life balance, and doing less of the busywork that takes away from more rewarding professional activity.

Artificial intelligence (AI) has just begun to demonstrate what it can do for beleaguered dental professionals, in terms of automating processes that cause unnecessary stress. Kiroku Co-Pilot listens to your appointment, transcribes the discussion in real-time, and then writes notes automatically for you using your own templates. These notes can then be instantly audited to ensure they are compliant, and can be converted into letters, patientfriendly information and documentation according to customisable templates, at the touch of a button. The platform makes time for a greater focus on patient care, as well as activities that lead to greater life satisfaction and the important work of increasing happiness. The Ken Dodd Happiness Centre might be able to teach us that there is more to life than the factors in life that cause us stress and unhappiness, and that the intention to spread happiness can go far in spreading a bit of joy. The key to happiness probably doesn’t specifically involve the waving of feather dusters, but making time for more satisfying work, more rewarding encounters with patients, as well as meaningful activities with friends and loved ones might be an important element.

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.

teledentistry. Where results or patient safety may diminish, it must be avoided.

However, during the Covid-19 pandemic, the Office of the Chief Dental Officer England stated that remote risk assessment/triage/ consultation opportunities should be explored as part of the patient journey. Teledentistry would understandably be beneficial should healthcare activity be stunted subject to another similar pandemic.

Given the proliferation of videocommunication programmes such as Zoom, and video call features inbuilt to most modern smartphones, teledentistry is now accessible for most of the population. Where it is used in everyday care, healthcare disparities may be eliminated and patients may have improved access to professional advice. Patients in rural areas or struggling to access a local dentist could benefit from fewer geographical limitations for professional care.

It is recognised that teledentistry offers benefits when patients need to contact their dentist in an emergency, especially from a remote location. Clinicians could evaluate a problem in detail and prescribe medicine where appropriate, saving both parties time and expense, whilst patients avoid potentially unnecessary trips to a hospital or practice.

Teledentistry also allows patients to seek a second opinion from a clinician, despite geographical obstacles. For patients who have developed a strong, trusting relationship with a specific clinician, this could bring reassurance in cases of emergency.

The use of smartphone images has also been found to be helpful when diagnosing dental caries, identifying dental erosion and recognising oral lesions. Apps have been developed to aid the diagnosis of dental trauma injuries too. These may each support the high-quality dental care that is performed remotely.

progress to be made

Clinicians and patients must be aware of the limitations of teledentistry, and current stances towards it within the field.

Firstly, informed consent is integral to the relationship between patient and clinician. Any teledental appointment must cover the conventional consent requirements, but patients should also be made aware of the risk of misdiagnosis and/or treatment due to technological failure, and the potential for patient data to be intercepted, since it must be transmitted electronically.

The General Dental Council notes that for all dental interventions, a face-toface interaction should take place at the beginning of every patient consultation prior to any treatment beginning. This enables clinicians to carry out any and all clinical assessments, and address underlying issues, whilst providing patients with a further opportunity to ask questions about their care.

effective digital solutions

One thing about teledentistry is certain –clinicians need effective digital solutions to ensure optimal care is delivered. This will include cameras and audio equipment

that allow for clear communication, and may already be a part of an in-practice computer or laptop set-up.

An effective system for managing patient appointments, patient data, and communication is also paramount. Sensei Cloud, a Sensei product from Carestream Dental, is an optimal solution. Clinicians can seamlessly schedule patient appointments across multiple practices, and it allows for important information to be accessed on the go. With the addition of Patient Bridge and its latest upgrade, Patient Portal, patients can book appointments online, and forms can be completed and signed digitally, including those for medical history, treatment plans, and consent. Patient bridge also secures all patient data with NHS audited and accredited solutions. Teledentistry still has time to develop a greater role in future patient care, and clinicians must be prepared to implement it effectively. Face-to-face interactions will always be essential, but this new workflow could offer brilliant benefits for clinicians and patients alike.

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

about the author

Nina Gilbert, carestream Senior Global product Line Manager.

Design you can feel

The subject of design is an important one for the modern dental practice. Whether you’re starting from scratch or refreshing an existing business, there are many different aspects to think about. Importantly, great design isn’t just about making the space functional – it’s about making people feel something. The construction, layout and aesthetic of the space should all come together to evoke emotion and subconsciously guide both staff and patients on a seamless journey through the practice. This is only achieved with a multisensory approach to design; one that accentuates cognition, movement, relaxation and communication.

A conscious process

As such, the design of your practice must be an intentional and well-thought-out process. Focusing on single elements, pieces of equipment or areas of the building can lead to a disjointed practice experience. Instead, you need to tell a story, ensuring a coherent narrative from the front desk right through to the waiting room and the surgery.

The concept of conscious design is, therefore, important. It promotes the idea of intentionally designing a space with awareness of the people, communities and ecosystems involved. For dental practices, this means creating an environment tailored primarily to patients, but also being mindful of the professional team. It allows for future development of the environment as the business evolves, without compromising the integrity of the original look and feel.

There is also an argument to be made for the enhanced sustainability that it facilitates, prompting principals to be more considered of their choices for longevity of their design.

A sight for sore eyes

When it comes to pleasing the senses, sight often comes to mind first. It is one of the easier aspects to accomplish – a visually stunning practice will also create an excellent first impression.

Everything from the colour scheme to the layout of the rooms and the lighting has a part to play. Taking the latter as an example, both natural and artificial light helps to define the atmosphere and function of a space. It is essential to strike a balance between ambience and functionality throughout the practice, with softer and warmer lighting making patients feel calm and at ease, while brighter and cooler lighting will be needed in clinical areas to support the delivery of high-quality treatment.

Other ways of improving the interior aesthetic include using artwork. Affording secondary benefits, the strategic placement of art has also been shown to help reduce cortisol levels and, therefore, lower anxiety in patients.

The two Ts

Two other senses relevant to the dental practice are touch and temperature. These incorporate everything that a person will physically experience when in the practice. Consequently, the initial design process should consider the materials being used for anything that a patient, in particular, will

come into contact with. Think door handles, reception desk, waiting room chairs and the dental chair as just a few of the major touch points as a patient moves through the premises. It’s just as important to consider the temperature by incorporating the relevant heating or air conditioning systems into the building design.

Mechanical stimuli

When looking further into how the practice can influence how patients feel, another sense modality may come under the spotlight –mechanoreception. For principals who are passionate about optimising even the smallest of details for a truly elevated patient experience, this is about improving how a patient detects vibration, pressure or other mechanical stimuli during their appointment. This is most likely associated with the dental chair, making it important to choose equipment that moves smoothly for optimal patient comfort.

When searching for a suitable dental chair, it can be hugely beneficial to work with experts

When percussion, ice, heat and radiographs are not enough, electric stimulation may be the diagnostic tool you need for determining the cause of the patient’s discomfort.

The Digitest® 3 electrically stimulates the tooth to test for vitality, resulting in a value ranging from 0 to 64. Comparing the response to the stimulus of the suspected tooth with a known healthy tooth’s response to an identical stimulus helps you:

 identify the source of your patient’s pain

 assess tooth vitality

 test and follow up traumatized teeth

Scan the QR code to watch the video

that completely understand the various principles of good design and how to apply them to a real-life dental practice. RPA Dental, for example, has decades of experience in designing, installing and maintaining dental practices of all shapes and sizes. The team supply an array of globally leading dental chairs, including Stern Weber, Castellini and KaVo solutions, offering dentists knowledge, advice and guidance that is second-to-none. RPA Dental will help make your patients feel comfortable, content and captivated as soon as they step into your practice, with astonishing attention to detail.

More than a pretty picture

How your practice looks is just the start. Whether refreshing an existing space or building a totally new practice, design is the first step to bringing your vision to life. It involves so much more than how the environment will look – it determines how your patients will feel and keep them coming back year after year. Making conscious design decisions on everything that will impact any of the senses is essential for the very 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 

About the author Adam Shaw, Sales Director at RPA Dental Ltd.

Product rewiewed by

Digital pulp vitality tester

Digital Pulp Vitality Tester

Hassle-free, predictable placement with Adin Guided Surgery!

Using guided surgery for implant placement has become increasingly popular among Implantologists because it offers many benefits for the Clinician and their patients.

For the patient there is dramatically reduced surgical time, which helps to improve patient comfort and reduce their apprehension. Plus, because it utilises flapless surgery it significantly improves the healing process and healing time in the majority of cases. It also minimizes the risk of surgical complications.

For the Implantologist it significantly improves implant placement accuracy, reduces the risk of complications and minimizes chair time leading to greater efficiency and cost savings.

Why choose adinguidetM?

The adinguide™ guided surgery system has been specifically designed to deliver effortless procedures plus accurate and predictable implant placement. Consequently, it delivers everything you need in a guided surgery system. It offers many unique advantages compared to other guided surgery systems.

Keyless Procedure

Unlike other systems which require the use of keys to hold the stent in place, adinguide™ is a keyless system which helps to save surgery time whilst still ensuring accurate and predictable implant placement.

activeFlowtM Irrigation technology

The adinguide™ ActiveFlow™ Irrigation Technology is a unique design that forces coolant through the guide to ensure that the irrigation reaches the bone. Within each cylinder unique channels allow the coolant to stream through the sleeve while drilling. As the drill starts to spin, ActiveFlow™ starts to operate and delivers the coolant from the handpiece directly to the surgical site and thereby helps to prevent the bone heating, which helps to maintain healthy bone for optimum osteointegration and minimised risks of post-operative complications.

Self-centering Drills & tools

The keyless, self-centering drills and tools are designed to enable Implantologists to perform faster, easier and more intuitive implant surgeries. Organized in a way that enhances safety and ease of use, Adin sleeves are embedded within the 3D printed surgical guide and precisely centre and guide the drills and insertion tools. Selfcentering drills, controlled by a main diameter cylinder at the top of each drill centres the drill in the guide’s sleeve. In order to ensure correct positioning of the drill, the surgical guide and drilling procedure are designed so that the selfcentering cylinder engages the sleeve before the drill touches the bone.

Built-in Stoppers enhance Safety

Built-in stoppers ensure precise and accurate drilling to the desired depth. The fixed value of the offset between the top of the implant and sleeve allows Clinicians to choose to use shorter

drills when they want or need to. This provides another safely measure and facilitates another layer of verification before reaching the final drilling depth.

Simplicity

The adinguide™ kits are intuitive, simple and effortless to use. There is no need for keys or any other assisting tools. They help ensure a hassle-free, logical and straightforward procedure that saves the Clinician time and worry.

Minimal Number of tools

The adinguide™ kit is organized into six areas. Each area representing a specific function during implant placement and insertion. For further information visit www.trycare.co.uk/adin, or request one of their Surgical Essentials and Adin Catalogues. To request a catalogue please contact your local representative or call 01274 885544. n

Everything you need in a guided surgery system!

Keyless guided surgery aids faster, easier, more intuitive placement

ActiveFlow™ Irrigation helps maintain healthy bone

Self-centering drills and tools ensure correct placement

What is the real cost of your dental equipment?

Setting up or renovating a dental practice is a complex and timeconsuming process, but careful planning can save both time and money in the long run. One key consideration is recognising that the cost of dental equipment extends far beyond the initial purchase price. To make a sound investment, you need to evaluate the Total Cost of Ownership (TCO).

TCO includes the initial purchase price as well as the operational and maintenance costs over the equipment’s lifespan. By factoring in both direct and indirect expenses, you can determine the best longterm investment for your practice.

Direct costs include upfront expenses like equipment purchase and installation.

Indirect costs cover ongoing expenses such as maintenance, repairs, unexpected replacements, and the financial impact of breakdowns that may temporarily render an operatory unusable.

Any time your equipment is out of service, it’s not generating revenue. Downtime not only impacts your practice financially but can also harm your reputation in today’s competitive market.

Key factors like reliability, maintenance, and longevity heavily influence the Total Cost of Ownership, separating superior equipment from lower-quality options.

The value of reliability

Choosing high-quality dental equipment designed for daily use and consistent performance is essential. Reliability starts with the manufacturing process. Brands that produce their own components rather than assembling third-party parts have better control over quality.

For instance, A-dec manufactures at least 80% of its equipment parts in-house, from sourcing raw materials to turning, drilling, and milling. By overseeing the quality of each component, A-dec ensures the overall durability and performance of its products. This attention to detail is why A-dec equipment often remains in service for 20 years or more.

The importance of regular maintenance

Proper maintenance is another critical aspect of TCO. Routine care ensures the safety of patients and staff, optimises equipment performance, and prevents costly repairs or premature replacement.

Look into the after-sales service provided by suppliers and manufacturers to ensure ongoing support for your equipment. When researching, ask your dental supplier about the average cost of maintenance and replacement parts for the brands you’re considering. Consult with your service technician about the lifespan, reliability, and ease of maintenance of different brands, and be sure to ask about parts availability. Quick access to replacement parts can mean the difference between a minor repair and a costly equipment replacement. Additionally, simpler designs often lead to fewer repairs. A-dec focuses on simplicity, which means fewer breakdowns, quicker repairs, and minimal downtime. In many cases, routine maintenance can be handled by the practice, while service technicians are only needed for more complex repairs, minimising operational disruptions.

Long-term value through durability

Investing in high-quality equipment that has been rigorously tested, combined with regular maintenance, ensures your equipment will last. Ideally, the dental chair, delivery system, and light you purchase will serve your practice for 20 years or more, supporting your growth as you integrate new technologies.

As you evaluate your options, consider factors that contribute to a strong return on investment:

• Is the equipment well-built and designed with functionality in mind?

• Will it enhance clinic efficiency?

• Will it withstand years of daily use?

• Is maintenance simple and straightforward?

• Does it come with a strong warranty?

• Is customer service readily available and supportive?

With A-dec, the answer to all these questions is a resounding “yes.” That’s why private practices, dental schools, and institutions worldwide choose A-dec equipment for its reliability, long service life, and low Total Cost of Ownership. For more information about A-dec, contact your local Territory Manager or dealer. To learn more about the A-dec difference , visit unitedkingdom.a-dec.com/showrooms, or email info@a-dec.co.uk n

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.

TePe® Hydrating Mouthwash - TePe’s mouthwash moistens the mucosa and leaves a pleasant feeling in the mouth. Not only does it help with dry mouth, but the added 0.2 % fluoride also gives that extra protection against caries.

TePe® Hydrating Mouth Gel - TePe mouth gel gives immediate and long-lasting comfort*, moistens and soothes the oral mucosa and is convenient and easy to use whenever needed – great for on-the-go.

Available from dental wholesalers. Find out more at tepe.com.

We’ve got your back!

nicola Bound, Head of Technical Operations at Henry Schein Dental, explains how Henry Schein Dental Service supports customers every step of the way

Purchasing dental equipment can be a time-consuming business with many things to consider. It involves a broad array of tasks from determining the equipment that can best help your practice, to sourcing finance, arranging installation and establishing maintenance and servicing processes to keep equipment and the business functioning efficiently.

Navigating the potential pitfalls of this process requires expertise and advice from specialists in areas ranging across dental products and technology, interior design, finance, insurance, staff training, validation, maintenance, servicing, repair, and customer support.

At Henry Schein we have a wealth of experience and specialist knowledge to support practice owners through every stage, whether that’s traditional equipment such as treatment centres, compressors and autoclaves, or high-tech equipment including the latest CBCT, X-ray and software installations.

Fast remote support

We recently introduced a fast response, same-day Remote Assistance Calls service for easy dental equipment troubleshooting. This is designed to capture the nature of any anomaly in

the equipment, typically through an error code, and we can either try to fix it over the phone or set up a video call to troubleshoot and remotely get the system back up and running.

If the fault cannot be fixed remotely, we can identify the parts required and allocate the closest engineer to attend the site, minimising equipment downtime and reducing the risk of further damage.

With you all the way

Our Equipment Sales Specialists have in-depth knowledge across Henry Schein Dental’s vast portfolio of products, so they are able to suggest the most suitable solutions and appropriate products, along with a high level of customer support.

One of the most important aspects of installing new equipment is planning. Our talented design team have a proven track record of creating innovative layouts, tailored to individual tastes and taking into account practical requirements to help ensure that everything will be installed and fit perfectly first time.

We can draw up detailed 2D and 3D computer-aided design (CAD) layouts of surgeries, decontamination rooms, reception areas and laboratories and can tailor designs to complement practice branding and any preferred colour scheme.

installation

Our Sales Support team, based in Cardiff, manages the acquisition, timing and delivery of equipment into the dental practice, using a state-of-the-art field service system to allocate the most appropriate engineers in the vicinity with the requisite skills for each installation.

Once the chosen layout is finalised, our Sales Support team coordinates the entire installation process. We have a team of 64 engineers across the UK with over 650 years’ worth of experience in the dental industry between them.

We invest heavily in the training of our engineers and ensure each is trained in person by the manufacturers of the equipment we sell, and we only use original manufacturers’ replacement parts.

service contracts

As well as the installation process, testing and validation of essential equipment such as autoclaves is also extremely important and we provide these services as part of the installation, and then on an ongoing basis as part of a regular service contract.

Any equipment breakdown can significantly affect the day-to-day running of a practice, causing costly downtime and cancelled appointments, and potentially leading to loss of revenue.

At Henry Schein Dental, we offer two different equipment servicing options to minimise the risk of any breakdowns, giving our customers peace of mind that their equipment will be maintained at peak performance, at a fixed cost for the duration of the contract.

To refine the servicing contract to specific needs, there is also a choice between contracts based on a time period or alternatively on the number of cycles, which is suitable for equipment such as decontamination units that may require more than one service a year.

complete peace of mind

Through our Dental Service, we strive to offer both peace of mind and reliable support, allowing our customers to concentrate on their daily business and on delivering high-quality patient care.

To find out more about Henry Schein Dental Service offerings visit www.hsdequipment.co.uk/service n

About the author nicola Bound, head of Technical Operations at henry schein Dental.

Ceramir CAD/CAM BLOCKS are a breakthrough in the market of CAD/CAM materials!

NEW STRENGTH

Ceramir CAD/CAM BLOCKS are manufactured using a patented and highly advanced laser sintering technology. The result is a material with the strength of particle infiltrated ceramics, the aesthetics of glass-ceramics and the flexibility similar to dentin.

For more information scan the QR-code with your phone

The ins and outs of gingival recession

Gingival recession is a common condition, affecting patients with a good understanding of the importance of oral healthcare as well as those who visit the dentist less often. The condition is multifactorial, and causes include periodontal disease, a thin periodontal phenotype, or mechanical trauma, as well as the ageing process.

Gingival recession can also be affected by problems with systemic health. The blood supply to gingiva consists of an intricate web of arteries that originate from the carotid artery, the health of which is affected by conditions like diabetes, obesity and high blood pressure, as well as by the ageing process and smoking.

approaches to treatment

Left untreated, gingival recession can reduce resistance against pathogenic stimuli such as cariogenic bacteria, and compromised plaque control can lead to bone resorption, tooth mobility and tooth loss. Treatment approaches will vary depending on the severity of the condition, as well as the causes and any underlying conditions affecting the patient’s periodontal health.

Non-surgical treatment options for gingival recession defects include establishing regular hygiene appointments and educating the patient to help ensure optimal plaque control. Gingival recession, and other periodontal problems can be associated with subgingival restorations removal of overhanging restorative material might be required. Where there is pain and sensitivity due to exposed dental tubules, a desensitising agent such as calcium sodium phosphosilicate, arginine and calcium carbonate, and strontium can help reduce exposure and relieve pain.

Surgical treatment for gingival recession

Free gingival graft (FGG) is a relatively simple procedure, and has the advantage that multiple teeth can be treated at the same time. FGG is considered a predictable treatment, and can be used in the anterior mandibular region unlike some other approaches, creating a band of keratinised tissue that can resist recession with a reasonable percentage of root coverage. Potential disadvantages associated with the procedure include postoperative discomfort, two surgical sites and a risk of haemorrhage at the donor site.

A subepithelial connective tissue graft (SCTG) is a procedure where tissue from the palate is removed and placed under thin gingival tissue. The coronally advanced flap (CAF) with SCTG has a high success rate, and achieves a more harmonious colour matching with the surrounding tissue than FGG. However, there is a risk of graft necrosis in the anterior mandibular area due to a less plentiful blood supply. Where it is not possible to harvest a connective tissue graft from the patient’s own palate, acellular dermal matrices, collagen matrices, and/or enamel matrix derivatives can be successful alternatives. Various methods and modifications of the pedicle flap procedure have also been developed to minimise operative complications. These include the lateral repositioned flap, the double papilla flap, and tunnelling technique. The latter is a procedure without coronal displacement of the mucogingival junction, and there is minimal damage to the blood supply, and a diminished risk of excessive scar tissue formation.

Overall, clinical studies indicate that CAF and tunnelling procedures

combined with SCTG is considered the most predictable surgical treatment option for gingival recession.

Healing progression

The first week after a gingival graft is a critical time, where the graft can appear to have failed. A clinician not familiar with the healing of a FGG might mistake the pallor and odour as a dead and/ or failed graft. Educating patients on this phase of the healing process is important for reassurance.

As well as tissue discolouration, gingival surgery can result in postoperative bleeding, pain, swelling, and bruising. In most cases, postoperative pain can be managed with short-term use of nonsteroidal antiinflammatory drugs (NSAIDs) like ibuprofen. Cold pack application, periodontal dressing, or surgical stents may also help with pain control after surgery. Pre-emptive analgesia may reduce discomfort in the most painful few hours post-surgery.

Antibiotics are generally not necessary after gingival flap surgery, pedicle flap surgery, or connective tissue and free gingival graft surgery. Postoperative infections following periodontal surgery are rare, occurring only 2% of the time. Generally, smokers or patients with diabetes are considered to have a higher risk for postoperative infections.

Oral

hygiene

A dental professional will spot the early signs of gingival recession on a daily basis, and offer patients advice and support on adjusting their oral homecare routines to prevent the condition from advancing wherever possible.

FLEXI interdental brushes from TANDEX, with the addition of PREVENT Gel are ideal for supporting the oral care of all patients, including those at risk of gingival recession. FLEXI interdental brushes keep gingiva conditioned, while removing plaqueproducing biofilm. PREVENT Gel adds the antibacterial effects of 0.12% chlorhexidine protection, and with 900 ppm fluoride, it helps reduce sensitivity.

Though common, gingival recession can lead to serious consequences for patients. Ensuring they have the tools to optimise their gingival health can reduce the risk of complications. Oral hygiene can help prevent the need for surgery, as well as to optimise outcomes in cases where surgery is indicated.

For more information on Tandex’s range of products, visit https://tandex.dk/ Our products are also available from DHB Oral Healthcare: https://dhb.co.uk/ n

about the author Jacob Watwood on behalf of tandex.

Expanding treatment options for patients

Dental implant treatment is becoming an ever more popular treatment option for edentulism amongst both clinicians and patients. It supports long-term oral health, along with unmatched functional and aesthetic benefits. However, some cases are less straightforward that others, requiring more preparation at the surgical site to ensure a successful treatment outcome. For example, if a patient has been missing their tooth for some time, and their jaw bone may have become thinner, and lost density. In scenarios like this, the remaining bone may be inadequate for supporting a dental implant, and as such hard tissue augmentation may be required to ensure sufficient bone quality.

What is a bone graft and why might it be needed?

A bone graft increases the volume and density of the jaw bone, using natural or labmade bone grafting material to areas where bone is lost or thin. Bone grafting enables the body to repair itself, providing structure for the bone to grow and regenerate. There are a number of different types of material that might be used for bone grafting, these include: allograft (human bone), alloplast

(lab-made substitute like hydroxyapatite, for example), autogenous (the patient’s own bone from a donor site), and xenograft (animal bone, commonly bovine or porcine).

Bone augmentation is a common procedure. As mentioned, it is often carried out to provide a strong foundation for dental implants. However, this is not its only application. Bone grafting can fill an empty socket post extraction, repair damaged bone after trauma, and stabilise and support loose teeth, amongst many other things.

Procedure and its risks and benefits

Whilst the procedure and the techniques used to provide bone augmentation will depend on a number of factors, including the type of material used, the surgical site, and the patient’s unique clinical situation, there are a few main steps involved in the treatment: lifting a flap, applying bone grafting material to the site, covering the area with membrane, and carrying out a tension-free flap closure.

Usually, bone augmentation is successful, increasing patients’ suitability for dental implant treatment. However, there is a risk of complications and treatment failure, particularly for patients who smoke or have existing medical conditions.

treating complex cases

As with many things in life, confidence to treat more complex cases comes with experience. As such, if you are a professional who places dental implants, but feels ill-equipped to tackle the more complex cases which might require bone or soft tissue grafting, you may feel held back. Some may assume that patients with minimal bone are not suitable candidates for dental implant treatment, or frequently refer cases to those with more experience.

As such, it’s important to seek out education and mentoring opportunities to expand your skillset, and ensure you are able to provide patients with more complex scenarios with the best outcomes.

High-quality education

In the UK, educational courses of the calibre required to provide excellent care are limited, with many of our top professionals seeking education in Europe or further afield. However, the ASHA Club delivers high-quality courses to dental professionals who wish to improve their skills and knowledge, and receive ongoing mentoring from leaders in the field.

Dr Selvaraj Balaji presents the Advanced Horizontal & Vertical Augmentation

course, which teaches delegates how to improve their skills in horizontal and vertical bone augmentation and soft tissue surgical work. The course comprises of theoretical and hands-on exercises, and gives attendees an understanding of how to manage various defects and the types of biomaterials and techniques to use in different situations.

In order to offer patients the best treatment options for them, clinicians must obtain the best standards of education available, enabling them to treat more complex cases. With dental implant treatment continuing to be the gold standard treatment type for patients with missing teeth, assessing patients’ eligibility and preparing the site for implant placement is essential for the best success rates.

To book, please call: 07974 304269 or email: info@ashaclub.co.uk n

about the author

Dr Selvaraj Balaji, Founder of the academy of Soft and Hard tissue augmentation (aSHa).

CERTIFIED

Choice overload

How to help patients manage multiple options

The huge number of treatment options available today can offer patients an array of choices they may never have considered in the past. General dental practitioners are now able to offer more complex treatments. Cheaper materials and payment plans make these treatments accessible to a wider range of people, not just the wealthy. The choices for patients don’t end there. Dental tourism, or direct-toconsumer products are aggressively marketed, making claims that are hard for patients to factcheck independently. This is in addition to the potentially exhausting number of choices patients have to navigate in daily life.

Choice overload is the condition of having so many options that you develop decisionfatigue and become too overwhelmed to make an informed choice. How can dental professionals introduce several options to patients, so they truly engage with and understand their choices, without leaving them feeling overwhelmed?

Decision fatigue – the consequences

Research from the US estimates that the average adult makes around 35,000 decisions a day, with varying degrees of importance. Fatigue associated with constant decision-making can affect strategic thinking skills, leading patients to take a passive, irrational or impulsive approach to making choices.

Patients who are exhausted by options may additionally experience pain more acutely. The mechanisms behind this phenomenon may be linked to anxiety and the subjective experience of pain, as well as frustration tolerance, which is impaired in patients who are overwhelmed.

Ego depletion refers to the reduced ability to exert willpower when energy reserves for selfcontrol have been exhausted due to decision fatigue. This can negatively affect executive functions involved in planning and decisionmaking. Planning, as a higher-order executive function, involves the complex coordination of other functions like working memory, attention, and cognitive flexibility. Ego depletion, in short, reduces the ability to draw on experience, to focus and make useful comparisons, and can lead to poor choices.

The impact of choice overload on executive function may be even greater for those with ADHD. Executive function, self-regulation and cognitive control can be impaired as a result of the condition, making those affected especially vulnerable to decision fatigue and burnout. ADHD can affect patients’ ability to discern the benefits of one course of action over another, especially under stressful circumstances.

effortful choice versus passive acceptance

Leading patients through effortful choices based on large amounts of complex information can be challenging, especially if the patient is burned out. However, studies have found that no matter how stressful a decision might be, people not only prefer acting on their own decisions, but tend to enjoy greater physical stamina and perform tasks better as a result.

This enables patients – once they have engaged with difficult or overwhelming information – to participate in their treatment more effectively. Offering the right support with the decision-making process increases the chances that patients will absorb the relative benefits of different options and come to a confident decision.

How to help

Carefully discussing the risks and benefits of each option, without pressure, and providing clear, accessible, evidencebased information for patients to review on their own, can be very effective for those feeling overwhelmed by choices.

This forms part of the shared decisionmaking process advised by NICE – a collaborative approach where individuals and their healthcare professionals work together to make decisions about care. Shared decision-making emphasises selecting tests and treatments based on reliable information and the individual’s personal preferences, beliefs, and values.

Fully informed consent

Shared decision-making empowers patients, ensuring they understand the potential consequences of various options – including doing nothing – through discussion and information sharing. Patient education is a key ingredient of successful collaborative care, and of ensuring consent gained is truly informed.

AeronaDental software offers a complete documentation package with which to engage and inform patients, as well as to securely obtain fully informed consent. With the innovative Design & Sign feature, practitioners can easily create templates for anything from treatment plans to patient assessments, surveys, and any documentation requiring a signature. Patients can easily access and sign documents, and all documentation is easily audited, for complete peace of mind.

When patients are exhausted by decisionmaking, and are struggling to engage with choices offered to them, evidence suggests they can be tempted to remain passive, or make a hasty choice that they might later regret. Providing opportunities for them to collaborate in decision-making will empower them to engage fully with the best possible treatment.

For more information, please visit aerona.com n

about the author

mark Garner, General manager, areona

Dental.

Lucky gap

In different cultures, a midline diastema, or gap between the central incisors, can be a sign of good luck, of fertility, or a mark of beauty, amongst other things. Chaucer’s cheeky Wife of Bath’s gap symbolises her bawdiness, as she gamely pursues her sixth husband. Before his cosmetic treatment, David Letterman used his gappy grin to add a hint of Alfred E. Newman innocence after delivering a comedic barb. Lea Seydoux’s gap gives her beauty an unconventional edge. In some African countries, the gap is such an attractive feature that some even have a diastema created through cosmetic dentistry.

Gaps between the front teeth can form during the eruption of maxillary anterior teeth. In most cases, they correct themselves after the eruption of the permanent maxillary canines. However, a diastema can have a number of causes, such as supernumerary teeth, congenital absence of permanent teeth, poor oral habits, tooth reduction due to erosion or movement due to periodontal disease, high frenal attachment, habits such as thumbsucking, and dental-skeletal discrepancies among many others.

Orthodontic treatment

Many people embrace their diastema, while there are a variety of procedures to choose from should a patient decide to pursue treatment to remove it. Orthodontic management of a diastema can be very effective, and can treat many problems associated with a diastema that affect occlusion. Treatment can involve a bracketed orthodontic arch appliance, or, in certain cases, a sectional arch wire technique may be useful. Clear aligners have also increasingly been used in the successful orthodontic treatment of a number of conditions affecting tooth position, including diastema.

Orthodontic treatment should consider alignment of the midline where possible for the best aesthetic outcome, and permanent retention is required in most cases, as the diastema can recur after even the best managed treatment. A lingual bonded fixed retainer is recommended in several studies for retention therapy. Any orthodontic treatment requires time and commitment from patients, and may require periodic tolerance of some discomfort to work properly.

Veneers

Veneers can be a great solution for treating an unwanted diastema once any occlusal, oral hygiene or other problems leading to erosion or tooth movement have been addressed.

cause micro-cracks which can decrease the flexural strength of the porcelain and eventually fracture the veneer. However, with the right cementing material and techniques, porcelain veneers average 95% survival after 7 years, and can achieve survival rates as high as 91% after 20 years.

The clinical survival rate of no-prep indirect composite laminate veneers is around 91.3%, or 7 years – lower than the average lifespan of porcelain veneers. However, composite veneers are currently preferred to porcelain alternatives by many practitioners. As well as being generally more affordable, they require less clinical intervention than porcelain alternatives, and can be a more conservative treatment for a diastema, as well as masking tooth discolorations, and restoring fractured and misshapen teeth.

Direct composite veneers have gained an important role in dental clinical applications following recently developed materials and techniques in adhesive and restorative dentistry. Direct restorations can be applied on prepared tooth surfaces or even without any preparation, in a single visit. The treatment of a diastema can increasingly be undertaken by the application of direct composite resin with highly aesthetic and durable results. This has been done successfully using wax-up restoration and building a silicon matrix. Some clinicians have achieved positive, natural-looking restorations by building up layers on the surfaces of central incisors one by one. However, restorations without a guide such as silicon matrix are not easy to perform, and successful application depends on the individual dentist’s ability and confidence.

Brilliant aesthetics, long-term results Offering patients the best possible solution for aesthetics as well as durability is the aim in any restorative procedure. Whether used for veneers, inlays, onlays or crowns in the anterior as well as posterior region, BRILLIANT Crios (CAD/CAM solution) from COLTENE is the ultimate reinforced composite bloc for permanent restoration. BRILLIANT Crios has high flexural strength, supporting permanent restorations, and with 13 shades and two translucencies, it blends in perfectly with natural teeth. The definition of a beautiful smile can vary according to convention, geography, culture, the patient’s own aesthetic ideals and preferences, or according to the variable standards in vogue at the time. If any treatment is required, the clinician and patient both should have absolute confidence that it offers them a safe, aesthetic, durable and cost-effective solution.

The long-term survivability of indirect veneers is generally very good. Minimal prep porcelain veneers have been used for many years, and have long been considered a predictable, durable and aesthetic option for restorative treatment. The disadvantages of porcelain include the higher cost compared to composites, as well as comparatively poor polishability. Its thinness and translucency can make it less appropriate for masking heavy discoloration. The etching required on the inner surface of porcelain can also

Email info.uk@coltene.com or call 0800 254 5115

COLTENE loyalty scheme: https://rewards.coltene.com n

about the author nicolas Coomber, COLtene national account & marketing manager.

PROTECTIVE SHIELD

TORNADO The shield you need

SWISS MADE

They are protected by their own coat of armor. This new latest generation Protective Shield coating is scratch-resistant and able to withstand the rigours of intensive everyday use. The protection offered by this coating prevents all traces of wear on the surface of the turbine. This shield, formed of a latest generation PVD (Physical Vapour Deposition) treatment, is unique on the market. It provides extreme protection against damaging external actions.

As of now, the Tornado are not only the most powerful Bien-Air turbines, they are now also the most robust.

Read more

Shining a light on tooth shades

The importance of aesthetic tooth shades is well known. Clinicians have to consider them when devising restorative solutions for patients, creating harmony with the pre-existing dentition. The literature even states that tooth colour must work with other factors like skin and eye colour for the best results.

Clinicians often work with the Vita Classical Shade Guide when creating restorative solutions for patients. It is not the only guide used, Bioform and Chromascop are also popular, amongst others. However, it is immediately recognisable – in name and appearance – and is a measure of aesthetics that has informed many restorative solutions.

It’s vital that dental professionals understand how the Vita Classical Shade Guide is best used, and how the subjective experience of shade matching can be optimised. When considering how the anatomy of the dentition affects appearance, dental professionals must take care in their approaches to restorative care, ensuring results appear natural in the dentition.

Whittling down to 16 shades

The human brain has the ability to identify and differentiate between nearly one million shades of colour, and current technology has pushed this boundary further, recognising approximately 10 million different shades. The colours present within the dentition differ significantly, and whilst electronic devices can identify around 100,000 dental shades, the human eye can only interpret 1% of these.

The Vita Classical Shade Guide consists of 16 colours, which typically cover most restorative dentistry needs. Three additional colours make up the Vita Bleach Shade Guide, which may be favoured by patients looking for a brighter smile. When comparing to a guide, dental professionals should target the middle site of a given tooth, as it best represents its true colour – the incisal and cervical sites are more affected by the surroundings. The colour it matches closest on the Vita Shade Guide can then be chosen for a restorative solution, such as a composite material.

Colourimeters and spectrophotometers are potentially effective adjuncts for shade identification, but are prone to reading inaccurate results because of issues such as edge loss. This is where light is scattered laterally through the translucent

portions of a tooth, out of the measuring area of the instrument – the incisal thirds of anterior teeth are particularly susceptible.

Incisal translucency

Enamel and dentine change in density as you measure from the incisal edge to the periodontium, so the colour of the tooth is also modified.

There is a progressive decrease in the chroma (saturation) of a natural tooth from the cervical to the incisal area, as well as from the most internal to the external aspect of the tooth. Reproducing this is key to achieving a harmonious and natural appearance for a restoration.

Transparency near the incisal edge is apparent for a number of reasons. Firstly, the prevalence of dentine decreases, leaving the semi-translucent enamel as the most prominent aspect of the dentition’s structure. However, this could be impacted through wear. If patients consume high volumes of acidic food and drink, experience acid reflux or frequent vomiting, or have conditions such as enamel hypoplasia or celiac disease, they may be at a greater risk of enamel erosion, creating thinner tooth surfaces.

When creating a restorative solution for patients, it’s important to consider whether a translucent appearance is necessary to look natural within the surrounding dentition. If it is required, but not considered, a patient may receive a high-quality restoration that would be fantastic for someone else – but ultimately looks out of place in their smile.

Implementation

To create an aesthetic restorative solution that gives the appearance of a natural tooth shade, including translucency at the incisal edge, clinicians have a number of options. They could employ multiple composite solutions, using a Vita Classical Shade Guide (if appropriate) to assess the option for the body of the tooth, and another shade for the incisal edge.

Dental professionals could, however, simplify the process without compromising on aesthetics by choosing the Filtek Easy Match Universal Restorative from Solventum, formerly 3M Health Care. This composite range simplifies the shade selection process by providing three solutions – Bright, Natural and Warm. They match the Vita Classical Shade Guide, and allow for intuitive care with excellent results. A naturally-adaptive opacity means that you do not need a blocker for aesthetic anterior restorations, and the solution takes on enamel-like translucency where it is required: on the bevel, and at the incisal edge.

Understanding how to implement the Vita Classical Shade Guide is important for all clinicians providing restorative care. By factoring in the need for translucency at the incisal edge, composite restorations can be provided with fantastic natural results. After all, the best dental restorations are the ones you barely notice at all. n

To learn more about Solventum, please visit solventum.com/en-gb/home/oral-care/

©Solventum 2024. Solventum, the S logo and Filtek are trademarks of Solventum and its affiliates. 3M is a trademark of 3M Company.

Deep impact

Trauma, a physical injury or wound or a psychological shock, will be experienced by 50-70% of the UK’s population at some point in their life. There can be many sources: traffic accidents, being a victim of a crime or witnessing one, playing sports or an accident in the workplace are just some of the common causes of trauma.

Temporomandibular disorder (TMD) is strongly associated with trauma to the orofacial region. As a musculoskeletal complication that affects the temporomandibular region, TMD leads to discomfort in the masticatory muscles and can ultimately inhibit eating and breathing. Trauma may cause TMD, but the psychological impact of experiencing trauma can cause further damage, making it essential that TMD patients are quickly treated.

Blunt force

In cases of blunt force trauma, the mandible is the most frequently fractured facial bone. This can cause the temporomandibular joint to break, crack or become unhinged from the skull, affecting quality of life. Assault and road traffic accidents are the most common causes for mandibular trauma, with the latter having been better controlled in recent decades by seatbelts, airbags, drink driving education and better public transport. A fist or blunt object is more likely to deliver an angle fracture from a lateral blow to the temporomandibular region compared to a traffic accident, which will instead more frequently impact the front and centre of the mandible, jolting the entire bone.

In traffic accidents such as a head-on collision, whiplash can be expected, and this is something to monitor even if patients who have been in a crash emerge with no immediate wound or injury to their jaw. Whiplash trauma can impair mastication as it may disturb the jaw-neck sensory motor function – this has been found to occur within a month of the initial trauma. However, whilst accidents and injuries can present physical damage, a multi-disciplinary approach is required because of the psychological impact a facial trauma can have.

Familiarising with PtSD

Patients with trauma-induced TMD may struggle psychologically, with facial wounds reducing self-confidence and leading to a withdrawal from social interactions, particularly if speech is impacted. Depression and post-traumatic stress disorder (PTSD) are noted as the two most prevalent psychological disorders among patients with orofacial pain. Stressed individuals are at a greater risk of worsening TMD, owing to the association with bruxism and rapid jaw movements.

Indeed, someone with TMD is more likely to have undergone a traumatic life event than someone without TMD, whilst nearly half the patients with chronic TMD have had at least one traumatic experience. PTSD develops following the exposure to an extreme traumatic stressor; around 10% of Brits will experience PTSD – over 6.5 million people. Being assaulted and serious accident/injury are two of the likely experiences to cause PTSD, with a chance of developing it at 31.9% and 16.8% from those two events, respectively. Assault and a serious accident/injury are also two incidents that may directly cause TMD, creating an overlap that warrants early intervention for patients recently impacted by either. Individuals with PTSD may be more affected by TMD due to a lower pain threshold caused by neurotransmitter disturbances. The relationship between PTSD and TMD is bi-directional: orofacial pain is increased in intensity and duration by PTSD and PTSD can induce the bruxism that worsens TMD. Identifying patients who may have been in a traumatic event is difficult, as it is likely they will find it hard to discuss. But noticing patients with TMD and having appropriate posters or brochures about the impact PTSD and other psychological disorders have on bruxism can foster a supportive environment.

Stretch it out

For TMD patients needing an effective rehabilitation system, the OraStretch® Press Jaw Rehab System from Total TMJ is recommended. User-operated, the device opens the mouth to stretch the orofacial tissues and animate the temporomandibular joint, promoting mobility and preventing and treating trismus. With a simple squeeze of the handles, patients can extend their jaw to strengthen the muscles and restore masticatory function. The OraStretch® Press is a simple yet reliable solution that patients can use on their recovery journey to eating, sleeping and living without TMD. The impact of facial trauma can be both physical and psychological, with both able to increase the damage of TMD. By adopting a multi-disciplinary approach that assesses the two impacts, practitioners will be better able to help treat patients.

For more details about Total TMJ and the products available, please visit https://totaltmj.co.uk/products/orastretch n

about the author

Karen Harnott, totaltmJ Operations Director

The Perfect Couple

Meet FLEXI & PREVENT Gel

The couple that helps you to achieve even better oral hygiene

FLEXI

• The special FLEXIBLE HANDLE makes it possible to angle the handle to achieve better and easier access to all interdental spaces.

• The non-slip handle ensures good grip even when fingers are wet.

• All brushes have plastic coated wire. This ensures no metal is in direct contact with teeth and gums, thus making them much more comfortable to use and preventing dental injuries.

• 11 sizes ensure that all needs are covered.

TANDEX PREVENT Gel

• Strengthens the enamel and has an anti-bacterial effect.

• 0.12% chlorhexidine and 900 ppm fluoride.

• The consistency combined with the needle shaped tube end make it easy to apply directly on the FLEXI brush and use wherever needed.

• Pleasant taste of peppermint.

• No alcohol or abrasives.

An understanding of Class III malocclusions

Timely interventions by the dental professional are essential to optimise a patient’s care. This is especially the case with Class III malocclusions, or an anterior crossbite. Left untreated, an individual may ultimately require orthognathic surgery.

Before surgery is considered as a solution, conventional orthodontics should be explored as a potentially viable treatment approach. The timeliness of care is reported in the literature to be key, with the modality even offered to patients under 10 years of age to optimise the orthopaedic effect.

Clinicians need to be able to identify the most appropriate time to provide treatment for the Class III malocclusion patient. Treatment might be not be comfortable, but living indefinitely with a Class III malocclusion can be far worse.

Underbite repercussions

For patients with a Class III malocclusion, their orthodontic status can severely impact everyday life. Psychologically, adolescents with Class III malocclusion have reported higher levels of social appearance anxiety, and lower self-esteem scores in comparison to those with a Class I malocclusion. This may impact their mood and social relationships, and could even cause the development of detrimental anxiety conditions.

Class III malocclusion has also been found to be damaging to everyday functions. Chewing movement has been deemed irregular and unstable for patients with untreated Class III malocclusion when compared to a control group with normal occlusion. Patients with a Class III malocclusion are also multiple times more likely to present auditory, visual, dental and interdental distortions when producing sounds such as /sa/, /si/, /sisi/, /ta/, /ti/ and /la/. An inability to articulate some aspects of speech can lead to confusion in social situations and a failure to communicate thoughts clearly, which may further cause psychological and social problems. These could include shyness, frustration, introversion and social anxiety.

Considering each of these issues, its imperative that clinicians deliver effective treatments that can restore and optimise an individual’s quality of life. A Class III malocclusion may need intensive care, but all treatment options should be explored to ensure the highest quality results can be achieved.

timely treatment

There are two forms of Class III malocclusion that must be considered for treatment: true and pseudo. A true (skeletal) Class III malocclusion features a deficient maxilla with a large prognathic mandible, whereas a pseudo-Class III malocclusion is characterised by a deficient maxilla with a normal mandible, which is caused by premature contact with functional mandible forward positioning. Both types of malocclusion, if not treated early, may affect the standard development of the maxillofacial structures, leading to restricted maxillary growth and potential mandibular overgrowth.

The literature has observed treatment options for adult patients seeking to rectify a Class III malocclusion, and found that orthodontic camouflage may be appropriate in many borderline cases rather than orthognathic surgery. Patients with a Holdaway angle greater than 10.3º could be treated successfully by camouflage alone, whereas those with an angle smaller than 10.3º will always require surgical intervention. Similarly, a Wits appraisal greater than -5.8mm could be effectively corrected through orthodontics alone, but less than -5.8mm must be treated through surgery.

Interceptive orthodontics may be an effective treatment option. By implementing orthodontic care in the mixed dentition, clinicians are able to treat pseudo-Class III malocclusion cases and reduce the need for orthognathic surgery in late teenage years.

For true Class III malocclusion cases, it is equally important to take action promptly. By implementing orthopaedic treatment in the early stages of the mixed dentition, clinicians can take advantage of bone bioelasticity and the ability to redirect growth of facial and skeletal characteristics, as well as prevent dental disharmonies from evolving to skeletal issues. This should be considered for patients as young as eight to 10 years old.

Comfort and care

Whilst timely treatment is key, it is never too late for orthodontic care to be part of a treatment solution. No matter a patient’s age, comfort throughout this intense process is necessary.

The Orthodontic Relief Wax from Kemdent provides ample support at this time. The solution is a soft gum protector that can be used to cover any fixed orthodontic brackets or protruding wires. Patients and their parents can simply warm the wax in their hands, before moulding it to suit their needs. In turn, buccal and gingival tissue can be relieved of scratches and irritation.

Class III malocclusions often require complex treatment plans, but timely intervention can reduce the need for invasive surgeries later in life. In turn, patients may be able to benefit from functional and aesthetic improvements to their dentition, helping them feel more confident in everyday life.

For more information about the leading solutions available from Kemdent, please visit www.kemdent.co.uk or call 01793 770 256 n

about the author alistair mayoh, marketing Director, Kemdent.

Quit flapping your gums

Many factors affect the outcome of dental implant treatment, making it important – albeit difficult –to control an abundance of elements that ensure immediate and longterm success. Slight deviations in implant angulation or depth could change the success of a treatment drastically, hence the need for predictable, reproducible dental implant placement strategies.

Guided surgeries have become favourable to many clinicians, and where a more accurate and beneficial result could be achieved, its current strengths must be explored.

They are also a potential aid to the problem of “minimally invasive” dentistry, which is championed in an attempt to improve the patient recovery process and avoid excessive treatment interventions. Understanding how guided implant surgery supports this is important for all dental professionals operating in this realm of care.

Battling convention

A guided placement workflow creates the opportunity to explore a flapless and therefore minimally invasive treatment approach.

Conventional surgery involves a crestal incision and the raising of a mucoperiosteal flap. This allows for improved visualisation of the surgical site and access to the alveolar bone, meaning clinicians can identify and protect anatomical landmarks. However, this approach is inherently invasive. With additional surgery performed on the soft tissue, suturing is necessary, and a degree of morbidity and discomfort is expected. It has also been shown that flap reflection is associated with gingival recession and bone resorption around natural teeth. Statistically significant results for marginal bone loss around dental implants where a conventional flap technique has been employed are reported in the literature.

New guided surgical techniques have allowed clinicians to implement flapless treatments in appropriate cases. With the development of computed tomography (CT) and cone beam CT (CBCT) scans, clinicians now have the ability to analyse and plan around the existing anatomical structures with great accuracy. Where sufficient bone quantity has been identified, a flapless technique may be employed. The planning process means clinicians can work with the anatomy, identifying the most optimal locations for implant placement –especially helpful as an alternative solution when working with severe atrophy of the residual alveolar bone.

A flapless approach has been suggested to improve healing time of the soft tissue, minimally interfere with the blood supply (which also results in a reduction of bleeding), and develop a shortened surgical time.

difference at all – but it should be noted that this aspect may be influenced by the experience of the presiding clinician. A guided approach can be especially useful when dental professionals are expanding into new personal territories of implant care.

Ultimately

unavoidable

There are cases where a flap must be raised to give a dental implant the greatest opportunity for long-term stability. When the site features resorbed or weakened bone structure, tissue augmentation may be the only viable solution that a dental professional can recommend and carry out. Luckily, the use of prosthetically-driven implant placement means clinicians can still benefit from the use of guided care. By choosing a guided workflow, clinicians can identify the need for augmentation procedures in the planning stages, and remain confident in the predictability of the final outcome. A guide design can be fabricated with considerations for an implant being placed concurrently with hard/soft tissue augmentation, or revisited once grafts have had time to begin the healing process.

A flap will, of course, need to be raised for augmentation techniques to be used so that clinicians can access the treatment site. In these cases, clinicians can use the planning process to determine that increased soft tissue recovery is an unavoidable necessity in order to facilitate long-term implant stability and health.

Developing skills

No matter the case presented to clinicians, choosing to implement guided surgical and augmentation techniques is only possible when a dental professional is appropriately trained and confident in their abilities. The Postgraduate Diploma in Advanced Techniques in Implant Dentistry from One to One Implant Education can equip clinicians with the skills and knowledge to tackle complex cases, and develop their knowledge of guided surgical interventions. The course explores hard and soft tissue augmentation, ensuring dental professionals can effectively and reliably provide care for a wide variety of patients, and use the techniques upon their return to the practice.

Guided surgery can provide a variety of benefits to the dental professional. Whilst it may not guarantee a flapless workflow and its associated recovery benefits, it can establish processes that help clinicians design the best possible approach in each given situation.

To reserve your place or to find out more, please visit 121implanteducation.co.uk or call 020 7486 0000. n

about the authors

The literature has found that flapless implant surgery provides comparable implant survival rates and complication rates to a conventional approach, making it a viable alternative without compromising care. There are debates about the efficacy of a guided approach. Some researchers suggest that freehand placement could lead to a threefold higher failure rate, others believe there is no significant

Dr Fazeela KhanOsborne, Principal Implant and restorative Surgeon.

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

Try our new splint material and workflow with a free 30-day trial!

DentaMile Bite Splint Workflow

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Effective restoration following orthodontic care with the Dahl Technique

dr Poonam Goyal presents a case of moderate crowding in the lower anterior dentition, followed by restorative treatment for tooth wear using the Dahl Technique

A33-year-old male patient presented at my practice with concerns about his smile aesthetics, seeking orthodontic treatment to resolve moderate crowing in his lower anteriors. This individual was incredibly self-conscious about his smile, and it was affecting his everyday life. In professional meetings, he would instinctively cover his mouth out of embarrassment while smiling. Providing effective restorative care would not only seek to resolve aesthetic issues, but potentially improve their psychological well-being. He had no previous history of orthodontic treatment.

assessing treatment options

Upon initial assessment, moderate crowding was confirmed in the lower anterior region, with mild crowning in the upper anterior teeth. The patient was, however, not concerned about the appearance of the upper dentition.

One carious lesion on the LR6 and the need for hygiene treatment were identified, along with visible wear on the anterior teeth. Radiographic examinations found appropriate bone health for orthodontic treatment. Upper and lower impressions were taken to formulate the treatment plan.

A number of treatment options were presented to the patient, considering the advantages and disadvantages that each may present. This included both removable aligners and conventional fixed appliances, as well as composite bonding at the resolution of treatment. Veneers and crowns were also considered and discussed with the patient, but due to the malalignment of the teeth they were not a preferable option.

The patient was only interested in straightening the dentition at this time so decided to pursue orthodontic treatment. He was given the option of seeing an orthodontic specialist but was happy to continue treatment with me, and opted for clear aligners due to their aesthetic advantage over a conventional fixed appliance.

Standard oral hygiene and dietary instructions were provided and full consent attained before proceeding.

Orthodontic treatment

The patient saw a dental hygienist prior to care. I also judged that he needed an occlusal restoration on his LR6 prior to aligner treatment and was carried out with direct composite.

Aligner treatment progressed as expected, with no significant complications encountered during this phase of treatment.

Following the planned orthodontic treatment for about 8 months, some improvement was still needed to refine the aesthetic result. The patient was provided with one set of refinement aligners, which allowed for an improved outcome. At this point, the patient was happy with the alignment of the teeth, but now saw the impact of wear on the upper and lower anterior teeth. He requested restorative work to help amend this issue.

I had undergone an Align, Bleach and Bond (ABB) course with the IAS Academy which shaped my approach to effective, holistic restorations. The patient felt comfortable proceeding with restorative treatment with me, and so I planned to restore the anterior teeth using the Dahl technique.

effective restorative care with the dahl technique

The patient’s posterior wear was minimal in comparison to the edgewear on the anterior teeth (especially on the lower incisors and left sided canines). This made him an ideal candidate for a Dahl approach. I consulted with Tif Qureshi, my mentor at the IAS Academy, following the clear aligner treatment to ensure I was taking the most appropriate approach. He agreed that this was a suitable case to implement the Dahl method and composite edge bonding techniques.

Having such support on hand was brilliant for making clinical decisions, and reinforcing my confidence in the care I was going to provide. Tif’s confirmation of my proposal and support allowed me to progress appropriately.

I discussed with the patient composite buildup on the anterior teeth, putting his posterior teeth into an open bite that could last for 8-12 weeks. Getting his informed consent was essential. He was advised that this may feel uncomfortable at first when chewing and at rest, and there was a chance that the bite would not fully settle. However, he was optimistic to proceed with this treatment, and trusted me to provide effective care.

The patient first underwent a course of teeth whitening, and a fixed retainer was placed on the lower anterior teeth to prevent relapse from orthodontic treatment. All the composite attachments were thereafter removed, with the teeth being adequately smoothened and polished at these sites.

A yellow IPR strip was also used to loosen the posterior contacts and facilitate ample eruption of the posterior teeth to assist with bite closure later on.

Free hand direct composite was placed on each of the lower incisors, as well as the LL3

and UL3, to restore a functional and aesthetic shape. On the LR3 and UR3, I opted to smoothen the sharp edges instead of applying composite due to minimal wear on these. No composite build-ups were performed on the upper incisors as they were already of an adequate profile. After the direct build ups, I was able to achieve primary occlusal contacts on the canines bilaterally, with lighter contacts on incisors and, as expected, the posteriors were in open bite on the day of build ups. On the same day, I also modified the patient’s last set of aligners to act as anterior sectional retainers. Impressions were taken too for the fabrication of temporary sectional essix retainers for both upper and lower anteriors to minimise relapse risk in the phase of posterior bite settling, which could take anywhere between 8-12 weeks. It would have been preferable to plan for composite edge build-ups when planning the initial clear aligner treatment. Doing so would’ve allowed me to create more space to facilitate this, however, it was important to work with the patient in a manner that made them comfortable. At the beginning of treatment, that meant planning only for orthodontics. A successful result was still possible with the current situation.

monitoring progression

I saw the patient at 4-, 8-, and 12-weeks to monitor the posterior occlusion settling. During this time, the patient experienced minimal complications as he became comfortable with the new bite in his dentition. By the end of the 12-week period, the posterior teeth had erupted to completely close the posterior open bite and created uniform bilateral contacts that functioned optimally. Patient also showed optimal guidances on excursions (incisor guidance on protrusion,

and canine guidance on lateral excursions with no posterior interreferences).

The patient was delighted with the outcome, acknowledging that the composite build-ups made a dramatic difference to the appearance of his dentition. He was given removable retainers for both arches and instructed to wear it consistently at night to minimise any orthodontic relapses. Upon reflection, I was also delighted with the outcome from implementing the Dahl method. The help of my mentor Tif made an immense difference, as his quick, supportive responses allowed me to devise an effective treatment plan that could be regularly monitored and adjusted where needed with confidence. Without his support, and my experience on previous IAS Academy courses, I would not have felt that I could provide effective care, and would have likely referred the patient to a restorative specialist. Luckily, I didn’t, and a fantastic outcome was achieved.

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 Poonam Goyal qualified from the prestigious university of delhi in 2010, and shortly after achieved a master’s degree qualification in Prosthodontics. she has also recently undertaken further Postgraduate training in endodontics. dr Goyal, currently is an associate dentist across two sites ¬– Bupa dental care, Brackley and mi dental, stony stratford, milton Keynes. she is extremely interested in provided comprehensive restorative care, and has taken multiple courses, including the align, Bleach and

course with the Ias

to develop her skills in this area.

Bond

academy

1, Moderate crowding in the lower anterior teeth, and mild crowding in the upper anterior dentition; 2, Lateral right side view; 3, Lateral left side view; 4, Occlusal view of lower arch; 5, Occlusal view of upper arch; 6, Anterior view following clear aligner treatment; 7, Occlusal view of lower arch following clear aligner treatment; 8, Right lateral view following clear aligner treatment; 9, Left lateral view following clear aligner treatment; 10, Free hand edge build ups and lingual fixed retainers on the lower incisors; 11, Lower anterior contacts on day of build ups; 12, Posterior open bite, right side on day of build ups; 13, Posterior open bite, left side on day of build ups; 14, Lower anteriors after whitening and composite Dahl build ups; 15, Posterior bite closure, right side 12 weeks after build ups; 16, Posterior bite closure, left side 12 weeks after build ups; 17, Occlusal view of lower arch contacts following Dahl technique; 18, Occlusal view of upper arch contacts following Dahl technique; 19, Final result; 20, Final result

The long career break

Acareer break is generally defined as a period of unpaid leave from work lasting more than two months – often without a specific job to come back to afterwards. Around 90,000 people in the UK take some form of career break every year, and 32% of the working age population have had a career break at some point in their lives.

There are many factors which could unexpectedly extend a clinician’s career break, for example in recent years the Covid-19 pandemic and overseas conflict.

Parents returning to a new workplace after a long break can find the process daunting, but especially so if they are also adapting to a new country and facing additional obstacles such as exams.

For example, Dr Clara Preethu qualified as a dentist in India in 2006. After a year in private practice, she moved with her husband to the UK, and took a career break to raise her two children. When she was ready to take the Overseas Registration Exam (ORE), COVID hit, meaning her progress was slower than she hoped, which affected her confidence.

International dentist, Dr Shameem Nisa Gulam Mohamed also struggled with her confidence after having to extend a career

break. Following her qualification in India, she moved to the UK. However, soon afterwards, Dr Mohamed needed to take an extended career break to look after her severely ill son. Re-entering the profession after a ten-year gap, as well as practising in a new country, was a daunting experience.

Returning to work after a career break

For dental professionals, a career break from dentistry could represent an opportunity to dedicate time to professional development, raising a family, travel, pursuing personal interests or to benefit from an emotional reset. However, returning to a career after a long period of absence can require hard work, mentoring, flexibility, structure and support. Resuming practice after a long pause can be especially challenging for overseas dental professionals who have not yet

practised in the UK, or for those who have taken extended leave from practice due to challenging circumstances – like illness, caring responsibilities, or having refugee or asylum status. Those returning after addressing physical or mental health issues may also face additional worries about re-joining the profession.

More than a third of individuals returning to the workplace after a career break experience a dip in confidence. Women are more likely than men to take extended leave from their careers, and are twice as likely to feel less confident about returning to work. According to a 2022 survey, 64% of women have taken a career break, with 22% taking extended time away from work due to childcare commitments. Additionally, 60% of women say they were nervous about returning to work after taking time out to have children.

Those who have taken time away to deal with physical or mental ill health may lose confidence due to stigma associated with their illness, as well as possibly struggling with debilitating symptoms. Fearing judgement or discrimination, they may not wish to disclose their health condition to a new employer, meaning they miss out on reasonable adjustments and necessary support.

A lack of confidence can significantly impact performance and patient care, so alongside the relevant requirements, individuals are advised to take measures to address their emotional and mental resilience before returning to practice.

Building confidence and returning to work

Dental professionals returning after a long career break benefit from mentoring and support as well as opportunities to work flexibly. Rodericks Dental Partners works hard to accommodate the needs of those returning to practice after a career break. At the centre of the group’s culture is a philosophy that ensures colleagues are supported by dedicated mentors, that their clinical expertise is respected, and they are empowered to work as flexibly as they need. As Dr Preethu says: “I feel very lucky to have had a lot of support from encouraging and helpful mentors at Rodericks Dental Partners. It’s really helped me.” Dr Mohamed adds: “After a 10-year gap, I was afraid I wouldn’t get the support I needed, but I’ve got an excellent mentor – he’s given me back my confidence.” Returning to practice after a long break requires courage, time and commitment. Those who are able to return within a supportive network and structured framework are much more likely to succeed and flourish in their renewed careers.

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

About the author Glenn Rhodes, Head of Marketing at Rodericks Dental Partners.

1% better every day

Starting with a personal admission: I have a tattoo, which is always, without fail, misunderstood. I chose ‘1%’ for its links with Kaizen theory – improving somehow, in some way, each day, even if it’s just by 1%. It isn’t, as is often thought, a desire to be in the top 1% of the world’s elite. Kaizen theory is all about small, incremental steps. It can be applied to most things but, for me, it is a way to navigate long-term projects. It could be about improving your career path, health and fitness, finances, or tackling down-time and relaxation. You can apply it broadly across your life or specifically in one area – such as making time to read or run. Whatever your area of focus might be, the 1% principle can be applied. 1% of your day equates to 14.4 minutes – so let’s say a quarter of one hour each day is all you need to find. You can allocate whatever time you can spare (see points three and four below) but keeping it small and manageable is the key. Also, the beauty of a short burst of time is that it gives you just enough of a buzz so you are eager for the next. Weirdly, this concept also works well for things you don’t want to do, but that’s a different article.

Top tips for 1% improvements 1. Define your focus

Think about what will serve you better. It could be nutrition, exercise, education… anything you like. Take some time to work out what ‘better’ looks like. If we pick ‘career’ as an example, it would be important to have a direction for this. Say you want to know more about opening and running your own dental practice, what do you need to know? Write it

DENTISTRY TODAY

down, reduce the big picture into several thoughts. They don’t need to be linear, enjoy exploring and thinking about what you’d like to improve.

2. Develop a daily habit that supports your 1% intent

You could decide that reading, listening to podcasts, attending webinars, talking to colleagues or starting a business plan will help you on your journey. You are likely to consider a range of resources but it’s best to make a start through the creation of good habits as the most effective way to achieve your 1%. This is because you’ll start to address your habits regularly, every day, maybe even at the same time of day.

3. Get rid of a daily habit that hinders your 1% intent

In the same way that good intentions have the most impact, so can regular negative activity. The obvious culprits are the ever-present phone addiction,

working too many hours, eating junk food, and other things that just don’t serve you. We all do it. Decide which habits can go and incorporate that as a daily action. For phone addicts, there are a few things you can try: move your most time-sapping apps off your phone’s home screen; put a timer on your daily use so you get an alert when you’ve over-indulged; think about what you can remember from yesterday’s doomscrolling (exactly, not much!) and gain some valuable time back each day.

4. Be prepared

If you are only spending a minimum amount of time each day on your selfserving, positive actions, make sure you are good to go at the right time. If you’re journalling, note-taking or planning, have your laptop, notebook and information to hand. If you are reading, have the book or Kindle in the spot where you will next have down-time. If you are listening to a

podcast, charge up overnight so you can listen on the way to work. Be 1% ready!

5. flex

Don’t be afraid to revise your daily habits, revisit and assess them, changing them as you like. You can really have some fun with this project; try combining some of your intentions, such as listening to your podcast whilst walking. If you literally can’t find time, consider your whole routine.;15 minutes should be achievable by everyone, even if it’s time stolen from your commute or lunch break. If you find it’s not working very well, be mindful of the fact that you may not see results immediately – this is long-haul, so think ‘little and often’. There’s a lot you can take away from setting yourself up to be better. I can’t think of any negatives to be honest. I find the 1% concept exciting. It’s motivating in a most particular way. It’s gradual, regular and achievable. At the very least, 1% each day, over the year, is actually a mighty 37 times improvement overall – that’s got to be worth it! n

About the author Dr Dhiraj Arora BDs MJDf rCs (eng) Msc (endo) pG Cert Ce owner of evo endo, with three practices (limited to endodontics) in Twickenham, Gerrard’s Cross and slough. Dhiraj is a passionate teacher and ambassador for all things endo. follow him on instagram: @drdij_evoendo

Late blooming forks in the road

“Life is difficult” are the opening words of M. Scott Peck’s book, The Road Less Travelled . In the 25 years since I first read it, I have recommended it to clients, patients, audiences and friends alike. It is not necessarily an easy read but neither is it difficult. Like life itself, if it was too easy, would it be worthwhile?

The book’s title is adapted from a poem by Robert Frost, The Road Not Taken , in which Frost shares the message that every choice we make impacts our future and that, whilst we may regret our choices, we can never fully undo them. We often believe we can go back, and

start again. But, like the philosopher Heraclitus taught, you can never step in the same river twice, for the river has changed and so have you. I never fully understood the need that made some of my contemporaries ‘settle down’ immediately after university. This usually meant finding an associate post and getting into a partnership as soon as possible. Looking back through my career, I occasionally felt totally out of step but, during a decade which included resident oral surgery posts in teaching and district hospitals followed by half a dozen associate jobs, I observed and sometimes endured a broad spectrum of experiences. This gave me some, but nowhere near comprehensive, knowledge and insights for when I took the decision to start my own practice.

In his essay, How to do great work , Paul Graham seeks to define what it takes. The first step is to decide what to work on and your choice needs three qualities. It must be something you have a natural aptitude for, that you have a deep interest in and that offers scope to do great work.

One problem with dentistry and medicine is that at the age decisions are made to study a vocational subject and pursue a particular career path, we don’t know what is involved. Even in medical or dental families, the truth is rarely understood. This leaves many graduates searching for some sort of holy grail, being fed into a system that demands huge commitment and investment, which are not necessarily repaid in happiness and job satisfaction. Of course, by the time someone realises they have made the wrong choice, they are so far down the path, or up the ladder, that a change of direction is a significant challenge.

I found that having spent a decade working out what I didn’t want to do in my own practice made a huge difference to me. Eventually, it also helped me to accept that, after 20 years of successful practice ownership, it was time to move on and change direction away from clinical dentistry.

Recently, to my surprise, my path has taken a new branch, and I find myself working with more

and more individuals who can be described as ‘late bloomers’. These are individuals who seek and reach significant success later in life, and whose stories offer inspiration to others who find that their ladder is leaning against the wrong wall. If you are feeling frustrated in your career or direction, it is never too late to change. As one of my clients said, “I’d hate to die wondering what else I could have done.” n

Maintaining education, inclusion and community as the BACD moves forward

Dr Luke Hutchings has just come to the end of his term as President of the British Academy of Cosmetic Dentistry (BACD).

He reflects on what the BACD’s goals were during his Presidency year and how these were achieved:

“At the start of my term, when asked about my plans, I said that while it might sound unexciting, our priority was simply to keep steering the ship. The direction of the Academy had already been well established, and our focus was on staying the course with hard work and a steady hand on the rudder. Thankfully, we’ve managed to navigate this year without encountering too many storms along the way.

“In particular, my primary goal as President was to continue to elevate the standards of cosmetic dentistry across the UK by focusing on three main areas: education, inclusion and community.

“For education, we aimed to enrich our members’ skill sets through high-quality training and continuing education. Much of this was free to members this year. I also worked hard to ensure that the BACD continued to be an inclusive and welcoming organisation, attracting a diverse group of professionals. We have always focused on being an equal opportunity Academy, and I very much believe in ensuring that the best person for a job is prioritised. Finally, we’ve

always tried to place community at the heart of everything we do at the BACD. We have connected with our members at social events and educational meetings. We will also continue to champion the growth and development of our members and share joy in their successes.”

Luke is keen to acknowledge the professionals around him that have supported his role this past year and continue to drive the BACD forwards.

He adds:

“I am immensely proud of the continued hard work and perseverance of my board and committee members. I have never met a more supportive, professional and well considered group of individuals. They have all been tireless in the pursuit of excellence, whether that be increasing membership benefits, planning educational meetings or simply trying to communicate with the membership. I can’t thank them enough!”

While it has been an excellent year for the BACD, the past 12 months have not been without their challenges. As are being experienced by individuals and organisations alike, the nationwide economy and changing political landscape has created hurdles for everyone to overcome. Luke comments:

“While not entirely unexpected, the challenges of leading a large organisation in a post-pandemic world remain significant. We’ve had to put in considerable effort to

ensure we provide the best value for our members, carefully balancing costs while maintaining high-quality events, speakers and social gatherings. It’s been a delicate process, but one that has strengthened our focus on delivering exceptional experiences.

“With this in mind, I would like to once again thank our colleagues within the dental trade for their unwavering support throughout this year, sponsoring our events and offering invaluable support to our members.”

Looking to the future, the BACD will remain dedicated to its members and facilitating the advancement of ethical, cosmetic dentistry in the UK. From the Annual Conference to Accreditation, and

everything in-between, the BACD offers individuals the opportunity to develop their skills and thrive in their careers. It also does this while providing a network for support at every step of the way. Luke concludes:

“To current and future members of the BACD, I would say that the Academy remains a place where innovation, collaboration and excellence come together. Whether you are just starting your journey in cosmetic dentistry or have been practising for decades, the BACD is here to support you, challenge you and help you grow.

“We are more than just a professional organisation; we are a community that thrives on shared knowledge, ethical practice and continuous improvement. I encourage you to take advantage of the incredible resources available – whether that is learning from the leading experts and mentors within the organisation, attending conferences, or simply networking with peers who share your passion for cosmetic dentistry. The future of this field is incredibly exciting, and together, we can shape that future for the better.”

For more information about the BACD, please visit www.bacd.com 

The art of delegation

When I speak to practice managers, I am often amazed at how they are juggling so many tasks, and absorbing tonnes of stress. My first question is always: Who is able to help and how? Burdening yourself with tasks that can easily be shared with other members of your team is not heroic. In fact, it can be a disaster.

Still, answers can be along the lines of:

- “Yeah but the owner likes me to do it, so it’s easier if I just crack on.”

- “I prefer to be sure the job’s done properly, so I’ll do it myself.”

- “Nobody will take on extra jobs without wanting more pay.”

- “We don’t have anyone that would be capable.”

It really does not need to be this way. I promise! It’s sometimes not an instant delegation, but to not explore the art of delegation is accepting more work, more stress, and, in a lot of cases, less effectiveness and efficiency. Be brave and give it a go… you will not regret it.

In the dynamic environment of a dental practice, effective time management and task prioritisation are essential to maintaining smooth operations and high-quality patient care. One of the most critical skills for a dental practice manager is delegation – the art of assigning responsibilities to team members to optimise efficiency and reduce burnout.

The importance of delegation Delegation is not just about offloading

tasks; it’s about strategic distribution of responsibilities to harness the strengths and skills of the entire team. Effective delegation can lead to several key benefits:

Enhanced productivity: By distributing tasks among team members, practice managers can focus on higher-priority activities that require their expertise. This enhances overall productivity and ensures that no single individual is overwhelmed.

Skill development: Delegation provides opportunities for team members to develop new skills and gain confidence. When employees are entrusted with responsibilities, they are more likely to take initiative and grow professionally.

Improved team morale: Trusting team members with important tasks can boost their morale and job satisfaction. It fosters a sense of ownership and accountability, making the team more cohesive and motivated.

Better time management: Delegating routine or administrative tasks frees up managers to concentrate on strategic planning and patient care. This leads to better time management and more efficient use of resources.

identifying tasks to delegate Effective delegation starts with identifying the right tasks to hand off. Here are some guidelines to help practice managers make these decisions:

Routine and repetitive tasks: Administrative duties, like scheduling appointments, managing patient records,

and handling billing, can often be delegated to administrative staff. These tasks, while essential, do not typically require the specialised knowledge of a dentist or practice manager.

Tasks that match team member skills: Consider the strengths and expertise of your team members. Assign tasks that align with their skills and interests. For example, a dental nurse with strong organisational skills might be well-suited to manage inventory or supplies.

Time-consuming activities: Identify activities that consume a significant amount of time but do not necessarily require your direct involvement. Delegating these tasks can free up valuable time for more critical responsibilities.

Tasks that provide growth opportunities: Delegating tasks that challenge team members and help them develop new skills can be beneficial for their professional growth. Look for opportunities to delegate projects that stretch their capabilities and prepare them for future roles.

steps to effective delegation

Clearly define the task: Ensure that the task is well-defined and understood. Provide clear instructions, objectives, and deadlines.

Select the right person: Choose a team member whose skills and experience match the task requirements. Consider their current workload and availability.

Communicate expectations: Clearly communicate your expectations regarding the task, including any specific guidelines or quality standards.

Provide support and resources: Offer the necessary support and resources to help the team member succeed. This may include training, tools, or access to information.

Monitor progress and provide feedback: Regularly check in on the progress of the task and provide constructive feedback. Acknowledge achievements and address any issues promptly.

Trust and empower: Trust your team members to complete the task. Empower them to make decisions and take ownership of their responsibilities.

In conclusion, mastering the art of delegation is essential for effective dental practice management. By strategically assigning tasks, practice managers can enhance productivity, develop their team, and ensure the highest standards of patient care. With clear communication, support, and trust, delegation becomes a powerful tool for achieving success in any dental practice. n

About the author Lisa Bainham is president at ADAM and practice management coach at practice Management Matters.

BADN Annual General Meeting preview

The BADN AGM, postponed from 5 October, will now be held online on Saturday 16 November 2024.

The AGM is open to all current members of The British Association of Dental Nurses (although only Full and Student Members may speak or vote), but pre-meeting registration is required. The AGM Notice has been published in the British Dental Nurses’ Journal and members who have signed up for our e-newsletters have been sent the registration link.

The AGM will begin with Honorary President Joan Hatchard handing over to incoming President Preetee Hylton. It will continue with the presentation of the Executive Committee Report, the independently audited 2023 accounts, and the introduction of Executive Committee members. The proceedings will then finish with any motions submitted. In addition to welcoming Preetee as President, we shall be saying goodbye to Anita Stanforth, who has served two terms as Education Representative/Chair of the BADN Education Committee, and welcoming Jane Dalgarno as EdRep/Chair. Joan will become Immediate Past President, and the rest of the Executive Committee will remain the same: Michelle Brand as Chairman and Ruth Garrity as Treasurer.

panel of representatives

The BADN Panel of Representatives has recently welcomed two new additions: Brittany Pittman RDN and Sally Khawaja RDN MA BSc Hons Dip Ed.

Brittany joins the panel amid a remarkable career in dentistry, from Clinical Management to specialisations in Dental Radiography and Implant Nursing. Her dedication to compliance and patient care, coupled with her active role as a CQC-registered manager and BADN member, makes her a fantastic asset to the Panel.

Sally brings to the Panel a wealth of experience from her roles in special care dentistry and dental psychology, as well as her leadership in dental education and training. As the Freedom to Speak Up Guardian at King’s College Hospital, she is committed to fostering a culture of speaking up and civility in healthcare. n

About the author pam swain is Chief executive of BADn

Preetee obtained her NEBDN National Certificate in Dental Nursing in 2010, followed by her BDA Education Certificate in Dental Radiography in 2013, and then her Preparing to Teach in the Lifelong Learning Sector (PTLLS) qualification in 2015. In 2021, she completed her DDS Treatment Coordinator Programme and, more recently, she achieved her BDA Education Certificate in Oral Health Education. In addition to her academic accomplishments, Preetee has also obtained certificates in Covid-19: Psychological First Aid, Covid-19: Helping Young People Manage Low Mood and Depression, and Supporting Victims of Domestic Violence.

RDN

Currently, Preetee works full-time as a dental nurse and safeguarding lead at a private practice in London. She is actively involved in education and training as she delivers the NCFE CACHE Level 3 Diploma in Principles and Practice in Dental Nursing. Additionally, she serves as an Associate Examiner for the NEBDN. Preetee’s contributions to the dental community extend beyond her work - she is an editorial board member of the Dental Nursing Journal and regularly authors articles. She has also been featured in Dentistry, BDJ Team, and the Dental Therapy Update, and is a Mouth Cancer Foundation Ambassador. She is an empowering and dynamic public speaker, addressing topics ranging from negotiation skills for dental nurses to raising awareness about domestic abuse.

In the past, she has held roles as a lead dental nurse and receptionist, a practice manager, and a clinical mentor to student dental nurses; and is an advocate for continuous learning and professional development. Preetee’s dedication and expertise have been recognised through various accolades.

BADN President 2024-26 – Preetee Hylton

Meet the ADI Board: Dr Andrew Little

Dr Andrew Little has been newly elected to the Association of Dental Implantology (ADI) Board for the next three years as Regional Rep for Northern Ireland. Andrew qualified from Queen’s University Belfast in 2008 with a BDS honours degree; he then completed his vocational training and returned to Banbridge where he has worked ever since. Implant dentistry has been a large component of his clinical practice since 2010 and Andrew has undertaken extensive and continuous training in this time, all the while gaining a wealth of clinical experience.

He shares a little bit about himself, and his experience with the ADI:

“I first attended the ADI as a student in 2005, with my father (a dentist at the start of his implant career). I attended intermittently until I qualified, and have been a full member since around 2011. Over the last 10 years, I have barely missed a local event, and tried to attend at least one of the bigger UK events each year. My overall experience of the ADI has been excellent. I have felt, especially in the last three to four years, that the events have offered a lot to clinicians, providing knowledge from worldleading clinicians as well as guidance, advice, tips, and tricks. Social events have also facilitated interaction with peers.

“I think the best part about the ADI is the organisation. The team behind the ADI choose good topics for events, are well organised, and attract a quality of speaker that we don’t see anywhere else in the UK. Being an ADI member has given me high value CPD in an area I have a passion for – dental implants – in a very accessible format that I would have struggled to find elsewhere. I admit that I probably do not make full use of the discounts offered by the ADI, but I have regularly used the member benefits including the patient booklets, guidance documents, and clinician-based literature.”

On why Dr Little has taken on his new role on the ADI Board, he comments:

“I have attended lots of events and meetings over the years, and I was aware that the current representative for my region was stepping down. After consideration, I felt it would be good to be involved, and to help maintain a Northern Ireland connection – it is a small region and it is important for clinicians here that we can continue to attract speakers and educational events. I also felt it was important to give back to an organisation from which over the years I had gained so much.”

Dr Little shares his top tip for career development in dental implantology:

“My top tip for colleagues in dentistry is listen to your peers, interact with other like-minded clinicians, go to meetings, and become involved in group chats. I often learn more from talking to clinicians over a coffee or WhatsApp/Facebook than I do from a textbook or journal article. Dentistry can be a lonely place, and it is important to interact with peers and seek advice –never be afraid to ask for advice. If you’re

at the beginning of your career, seek a good mentor, but learn from more than one clinician. Go to as many meetings, courses, and events as you can – have a thirst for knowledge and do not have tunnel vision with one method or one system.”

He shares his final thoughts on the ADI, and it’s benefits for clinicians:

“I think the ADI offers clinicians at all stages of their career an excellent platform to learn, develop, and maintain a high level of dental implant knowledge. It keeps you, as a clinician, at the forefront of patient care. The events are sociable, members are welcoming and inclusive, and they are very good value for money.”

For more information, please visit www.adi.org.uk

Become a member today! 

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Intraoral scanner resolution – does it really matter? And how much?

Digital impressions are growing in popularity across the dental profession, but it is important that we understand their true benefits and limitations. Newer techniques should provide clinical advantages over older ones, to justify their adoption. Intraoral scanners undoubtedly offer benefits over poor quality analogue impressions, and we know that dental laboratories receive many sub-standard impressions.1,2,3 But what about the dentists who have truly mastered the art of analogue impression taking? Will the quality of their treatment be maintained when switching to a contemporary digital technique?

How we got here

Many areas of dentistry have evolved substantially in the past couple of decades, but none more so than the digital workflow. Intraoral scanners were initially introduced to dentistry in the 1980s, and there are a growing number of users today, especially within the removable orthodontic aligner field. Though more dentists have or are planning to switch from analogue impression techniques to digital solutions, the majority still utilise traditional impressions and remain on the fence about whether to purchase an intraoral scanner. The global market for these scanners is estimated to grow from an estimated $288.3 million in 2023, to $764.0 million in 2032.4

There are numerous studies that examine the trueness and precision of current dental scanners, but readers should be reminded that our measurement methods are crude and possibly not fully applicable clinically. For example, ISO 20896-1:20195 require metrics such as the dimensions of a conical hole (to represent an inlay prep), or the scanned distances between spheres superimposed onto a dental model. This can give artificially good results, where the actual scanned surfaces are inaccurate or distorted locally, but the mean distance measurements recorded remain correct. A prosthodontist might argue that the clinically important measure is the local accuracy of the margin of the (simulated) inlay, and not just the mean distance across the preparation. How does a scanner compare to the resolution of a silicone or polyether impression taken in a rigid tray with a type 4 stone model from a clinical accuracy perspective?

a comparison

Anyone who has ever seen an intraoral scan will appreciate the beauty of the image, the crisp lines and the texture mapping that modern software can achieve. There is little argument that the scan looks great and can be a very useful tool in treatment planning and patient education. However, when the artificial colour and filters are stripped away, the results are not always what they seem.

Andy Keeling, Professor of Prosthodontics and Digital Dentistry at the University of Leeds, comments:

“Type 4 dental stone has been used very successfully to produce high

Visual comparison of the resolution of various forms of digital impression compared to the original type 4 stone model. (a) Contemporary intraoral scanner (B) dental model scanner (C) research-grade model scanner used at leeds University (d) Original type 4 stone model. note the bur marks and margin sharpness increase progressively from a to d. When striving for a 30 micron quality of fit, only (C) is likely to come close.

Colour removed to enable true 3D shape visualisation

quality fixed prostheses in many clinical situations for many years. Over 100 years of development in analogue dentistry have proven the need for this fine grit stone – clinicians can tell instantly if a lab has incorrectly used a coarser stone (or plaster) for a prosthodontic case based on the resolution of the model.

“According to ISO 6873,6 type 4 dental stone is required to reproduce a 50-µm line as a minimum. In a high-quality dental stone, more than 35% of particles have been found to be smaller than 45 microns in diameter,7 with 10% below 2 microns.8 This could conceptually be translated to an “analogue triangle size” of approximately 2-3 microns, compared to typically >100 microns for intraoral scans.”

“Triangle edge lengths in scan data from intraoral scanners are typically large, particularly over the relatively smooth cusp tips where the software tends to oversimplify the 3D mesh. I took a scan of my own mouth using the most advanced scanner on the market and extracted a full-arch mesh at the highest available resolution. The mean triangle edge length was 140 microns, with 675,000 triangles in the mesh. Triangle size was smaller in areas of high curvature – fissures, margins, gingivae – due to intelligent mesh resampling, but the smallest triangle sizes were still 50 microns.”

“In contrast, modern Type 4 stone particles are an order of magnitude smaller than these triangles, leading inevitably to greater detail (higher resolution). Combine this with the lack of literature detailing scanner resolution and its clinical effect, is it any wonder that many prosthodontists remain on the fence about moving to digital impressions?”

It is very difficult to measure resolution, which is why literature is lacking. However, visual comparisons show stark differences, as illustrated in Figure 1. Are we losing clinically significant detail by changing from analogue to digital impressions? Or does this mean that we have been working with greater detail than we needed to for many decades? Or is there still work to do before digital workflows match the standard of existing techniques? Indeed, recent research 9 has found conventional impressions to still provide significantly better retention

than digital scanners for both milled and 3D printed denture bases. Drancourt, Noemie, et al10 evaluated the accuracy of conventional and digital impressions for full-arch implant-supported prostheses and found conventional impressions to be more accurate than digital impressions. does it matter?

Not all dentistry is the same, meaning what is required from an impression may vary between the disciplines. Orthodontic needs seem to be in the order of 100s of microns while prosthodontic needs are potentially in the order of 10s – which has driven the development of light-bodied silicone impressions and Type 4 dental stone. Whilst no consensus has been reached regarding acceptable marginal gap for fixed prosthseses, there is universal agreement that this gap should be as small as possible to prevent secondary caries. A recent study showed secondary caries formation at gaps of 30 microns or more,11 so it would seem prudent to strive for this standard in modern dentistry rather than accepting lower standards such as 120microns, which were only loosely agreed upon in the twentieth century. However, we should remind ourselves that intraoral scanners reduce technique sensitivity and may provide a better option than badly taken analogue impressions, which is why they may already have a place in dentistry where throughput is valued above absolute quality. However, in certain clinical situations such as full-arch dentures, and highend fixed prosthodontics (aiming for the aforementioned minimal cement gap) analogue impressions will likely still deliver more accurate results.

Professor Keeling summarises:“There is little doubt that an expertly taken traditional impression produces the highest resolution and accuracy. But questions remain over whether this level of detail is clinically relevant. Maybe one day, if clinical parity is unequivocally shown between intraoral scanners and analogue impressions, then conventional dentists will be able to reduce their material costs by no longer requiring light-bodied washes or expensive die stones, but I suspect this is unlikely.”

https://mimetrik.co.uk n

references

1. The quality of impressions for crowns and bridges received at commercial dental laboratories. Winstanley RB, Carrotte PV, Johnson A. Br Dent J (1997) 183(6): 209–213

2. The quality of dental casts used in crown and bridgework. Alhouri N, McCord JF, Smith P. Br Dent J (2004) 197(5): 261–264

3. The quality of impressions for crowns and bridges: An assessment of the work received at three commercial dental laboratories. Assessing the quality of the impressions of prepared teeth. Storey D, Coward T. EJPRD (2013) 21(2) 53-57.

4. Fortune Business Insights. Intraoral Scanners Market Size, Share & Industry Analysis, Accessed October 2024. https://www. fortunebusinessinsights.com/intraoralscanners-market-109836

5. British Standards Institution (2019) BS EN ISO 20896-1:2019 Dentistry. Digital impression devices. Methods for assessing accuracy. Available at: https://bsol.bsigroup.com/ (Accessed: 7 October 2024).

6. British Standards Institution (2013) BS EN ISO 6873:2013 Dentistry. Gypsum products. Available at: https://bsol. bsigroup.com/ (Accessed: 7 October 2024).

7. Rejab LT, Al-Jubori SH. Examination of the particle’s shape, size and distribution. Al-Rafidain Dental Journal. November 2019; 3(2). 10.33899/ rden.2003.165764.

8. Nagasawa Nagasawa Y, Hibino Y, Shigeta H, Eda Y, Matsumoto S, Nakajima H. Characteristics of a new dental stone mixed by shaking. Dental Materials Journal. 2020. doi:10.4012/ dmj.2018-427

9. Chebib N, Imanura Y, El Osta N, Srinvasan M, Müller F, Maniewicz S. Fit and retention of complete denture bases: Part II – conventional impressions versus digital scans: A clinical controlled crossover study. The Journal of Prosthetic Dentistry. 2022 April; 30:S0022-3913(22)00464-4. doi: 10.1016/j.prosdent.2022.07.004. Epub ahead of print. PMID: 36055812.

10. Drancourt, Noemie, et al. “Accuracy of conventional and digital impressions for full-arch implantsupported prostheses: an in vitro study.” Journal of Personalized Medicine 13.5 (2023): 832.

11. Maske TT, Hollanders ACC, Kuper NK, Bronkhorst EM, Cenci MS, Huysmans MCDNJM. A threshold gap size for in situ secondary caries lesion development. J Dent. 2019;80:36–40. https://doi. org/10.1016/j. jdent.2018.10.014

about the author Krishan davda, dental Health Care, Hertford.

The future is here for patients and practitioners

In August this year, the first fullyautomated dental procedure, planned by artificial intelligence (AI) based on digital scans, and performed by a robot, took place. The phenomenon – achieved by US company Perceptive – won’t have come as any surprise to those keeping an eye on innovation in dentistry. As the demand for fresh solutions continues to grow, AI, robotics, machine learning (ML) and the automation of processes is poised to play an increasingly significant role in various aspects of dentistry, from diagnosis to treatment and beyond.

While the ethics and practicability of total automation will certainly continue to be debated, there’s no question that advancements in technology have brought increasingly complex procedures within reach of the average practice and patient. Staying abreast of technical developments has never been more important for practitioners, both to stay current, and to ensure they offer the best possible care to patients.

guided surgery – a synthesis of digital processes

Guided surgery – used widely in implantology – is an excellent example of an effective synthesis of digital technologies to plan treatment effectively, improve patient communication, achieve more predictable surgical outcomes, reduce patient discomfort, and streamline the overall treatment process.

The insertion of dental implants is now a common procedure to treat edentulism, obtaining the most effective results in terms of aesthetics and function. The correct placement of implants is essential to achieve primary stability and facilitate osseointegration. During the diagnostic phase of implant treatment, the surgeon must have reliable data relating to bone quality, volume, and any anatomical restrictions. 3D diagnostic techniques, such as computed tomography (CT) and cone-beam computed tomography (CBCT) provide an accurate view of the anatomical structures within the jaw.

Using surgical templates and computeraided methods based on this data makes the entire process more accurate and predictable, and has been shown to reduce the chance of positioning errors when the implants are being placed. Greater accuracy and speed makes the process less invasive than conventional techniques. Surgical operating times are greatly reduced, and fewer complications postsurgery are reported in patients.

Complexities around ridge dimensions, proximity to adjacent teeth, implant to root relationships, smile lines and implant angulations can present surgeons with difficult restorative decisions in anterior regions of the mouth. Guided surgery has been shown to be advantageous when approaching restorations in these areas.vi Additionally, the planning process involved in guided surgery enables prosthetically driven implant placement. Foreknowledge of the impact of the planned restoration is critical for proper implant placement. The level of accuracy in surgical planning has

made immediate placement and immediate loading of implants possible, and these protocols are now commonly performed.

Guided surgery is a perfect example of how virtual treatment plans not only provide the surgeon with vital data, but enable the clinician and patient to discuss options, risks and variables, with clear imagery to aid in decision-making and consent throughout the whole treatment process.

the future of digital dentistry

Total automation may be a distant ambition for some dentists, or a dystopian future to be avoided in the minds of others. However, many clinicians already embrace almost every element of the digital workflow used in the Perceptive example. Digital processes like 3D diagnostic imaging, intra-oral scanning, computeraided assessment, treatment planning, restoration design and manufacturing, and surgical navigation guides, are all hugely improving outcomes for patients.

Additionally, the integration of virtual reality (VR) and augmented reality (AR) into dental education and practice may revolutionise how dentists learn and perform procedures. These technologies can provide immersive training experiences, allowing dental professionals to practice guided surgery techniques in a risk-free environment.

staying current in a constantlychanging environment

As technology promises to develop rapidly, it is vital for practising implantologists to remain current, learning from professionals who are at the forefront of providing life-changing treatments, using the latest innovations.

Ucer Education and ICE Postgraduate Dental Institute and Hospital/University of Salford offer just such opportunities. The Advanced Certificate in Full Mouth Oral Implant Rehabilitation is led by eminent specialist oral surgeon, Professor Cemal Ucer, who has over 30 years’ experience successfully treating complex cases. The course, aimed at experienced implant dentists wishing to implement the latest advances in the reconstruction of fully edentulous/atrophic single or dual arches, includes the latest diagnostic and surgical techniques, making full use of the digital tools now available.

Digital dentistry, particularly guided surgery, represents a significant advancement in the field of dentistry. By harnessing the power of digital technologies, dentists can improve the accuracy and efficiency of implant placement, leading to better outcomes for patients. While challenges remain, the ongoing evolution of digital dentistry promises to enhance the quality of care.

Please contact Professor Ucer at ucer@ icedental.institute or Mel Hay at mel@mdic.co 01612 371842 www.ucer-clinic.dental n

about the author

Professor Cemal Ucer (Bds, Msc, Phd, Oral surgeon, iti Fellow).

The gateway to systemic health

As dental professionals, we are only too aware of the associations between oral and systemic health. We all dedicate time and resources trying to educate patients on the topic, whether that is during appointments or in our practice marketing. Given that Urology Awareness

Month is promoted across the UK in September, I thought this an interesting opportunity to explore the impact of oral health on this area of the body.

Urinary infections (UtIs)

A study has found a positive correlation between pyelonephritis – a kidney infection – and tooth decay. In this evaluation of children and adolescents, it was noted that those with UTIs often also had dental caries. The authors concluded that the prevention of dental decay could also reduce the risk of systemic infections such as UTIs.

Kidney disease

Other than UTIs, periodontitis has been associated with kidney disease too. Almost 80% of patients with chronic kidney disease demonstrate changes in their oral cavity, with loss

of kidney function manifesting in the mouth. The most common of these were tongue coating and pallor of the oral mucosa. Risk of tooth loss also appears to be higher among patients with kidney disease.

Urological cancers

Research has also reported a link between periodontitis and urological cancers, such as those that affect the prostate, bladder and kidneys. As is the case with other systemic interactions, it may be possible for oral bacteria to travel through the bloodstream to the urinary system. It has been postulated that the oral microbiota in patients with periodontal disease may provide biomarkers that help to predict the risk of developing various genitourinary cancers.

two for the men

Periodontal disease strikes again for men’s health, increasing the risk of benign prostatic hyperplasia by 1.68 times according to research in 2019. Authors of this particular study went as far as to suggest that periodontal disease could be an independent risk factor for benign prostatic hyperplasia, with age, hypertension status, BMI and ethnicity having no influence over the links between the two conditions.

In addition, there is growing evidence that periodontitis is a risk factor for erectile dysfunction. Men are up to 2.85 times more likely to experience erectile dysfunction when they develop periodontal disease.

ammunition for education

Many patients are unaware of the close relationship between the mouth and the rest of the body. It wouldn’t be a stretch to suggest that most probably wouldn’t link their oral health with that of their urological system. This presents

Trismus and cancer treatment

Head and neck cancer is relatively uncommon, with around 12,400 new cases diagnosed each year in the UK. Mouth cancer is the most common type, and can be difficult to detect in its early stages. As such, many patients will require invasive procedures for treatment to be effective.

Treatment for head and neck cancer can be intrusive and destructive which, whilst necessary for effective outcomes, can have consequences in the long term. After radiotherapy or surgery for head and neck cancer, patients may experience stiffness in the jaw and facial muscles. If patients are not given the appropriate preventative advice, or follow up care, this can reduce their mouth opening over time. This stiffness is called trismus, otherwise known as lock-jaw, and can have a significant impact on patients and their wellbeing.

Prevalence of trismus Research suggests that 32-50% of all head and neck cancer patients will develop trismus. Stiffness can begin anywhere from a few weeks to months following treatment, with the severity depending on the person. This is because the muscles become tight, restricting the patient’s ability to open their mouth once it has developed. Patients can easily check their mouth opening by attempting to put three fingers vertically in between their upper

and lower teeth. If they can only fit one or two fingers, they may have trismus. After radiotherapy, trismus becomes more common. This is because the blood supply to the jawbone is limited. In some cases, the jaw bone itself can die (osteoradionecrosis), however this is uncommon.

how can clinicians help

Because trismus is a condition which gets progressively worse, it’s important to monitor patients who are at risk – such as patients who have received radiotherapy for head and neck cancer. Noticing the signs early will enable you and your patient to take action to prevent the stiffness worsening. Ask patients who are undergoing radiotherapy or surgery about any jaw stiffness or pain in the area, even if the symptoms are mild. This will allow you to monitor their situation, and intervene early where appropriate. Additionally, consulting with or referring to a speech therapist can be helpful, for a multidisciplinary approach. Measuring the jaw opening can also be a good indicator, and can help you to monitor the progress of the condition, and any treatment undertaken.

This is essential as, in severe cases, patients are unable to open their mouth at all, making it very difficult to eat, drink, and talk. Trismus can also make it near impossible to clean the teeth properly, causing oral hygiene issues, and increasing patients’ risk

for tooth decay and gingivitis. As such, a thorough knowledge of trismus, and appropriate treatment and prevention methods is key for helping patients achieve the best outcomes.

treatment and prevention

If patients are finding it painful or difficult to eat, recommend that they temporarily adopt a soft food diet, to reduce the strain on the jaw joint. Consulting a dietitian can be helpful here, to ensure patients receive all of the nutrients they need during this time.

Monitoring patients’ oral health is also essential, recommending smaller toothbrushes and antibacterial supplementary oral hygiene products to enable patients to keep levels of bacterial plaque to a minimum, and reduce the risks of oral diseases.

Recommending regular appointments with a dental hygienist here can also be helpful, to keep plaque levels down. With preventative rehabilitation, research shows a 72% increase in oral opening. Jaw exercises can be helpful for reducing stiffness and pain that patients may feel. By creating a personalised exercise plan, encouraging patients to carry them out regularly, jaw exercises can help to stretch the facial tissues and strengthen the muscles in the jaw.

To assist patients with their jaw exercises, recommend the OraStretch® Press Rehab System. When used as recommended, it can increase the mouth opening by

a new opportunity for the dental team to engage with patients and share useful information or resources. There is plenty of information about Urology available right now (The Urology Foundation is a good option). Why not start the conversation in the dental practice? n

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

an average of 26 mm, dramatically improving patients’ quality of life, stretching and strengthening the jaw to enable more normal function and reduced pain and stiffness. Additionally, when rehabilitation is carried out in the early stages, trismus is found in 68% fewer patients.

tailored care at the right time

In order to offer their patients the best possible outcomes, clinicians must deliver tailored care at the right time. Early intervention for trismus patients is key for improving range of motion in the jaw, enhancing quality of life, and reducing the need for more invasive procedures down the line.

Recommending temporary changes to diet, lifestyle, and oral hygiene can help to minimise the risks to patients, whist keeping them healthy during trismus rehabilitation. Utilising specially designed rehab systems can further improve results, with variations in resistance, and predictable exercises, tailored to each patient’s specific needs.

For more details about Total TMJ and the products available, please email info@totaltmj.co.uk n

about the author Phillip Silver, Founder of total tMJ.

Cutting out the smoke

In the UK, 5.6 million adults, or 11% of the population, vape. Those who vape or smoke have doubled in number over the past three years, and the proportion of vapers is now at its highest level, with more than half being former smokers. This is both damaging to the environment, with two e-cigarettes thrown away every second, and potentially also to oral health. As cigarette smoking impacts oral health and is the biggest preventable killer in the UK, it places a strain on the NHS. The new Labour government hopes to tackle this, having expressed interest in an outdoor smoking ban that would most notably impact areas like pubs, clubs and restaurants. However, vaping remains a divisive topic due to the conflict between recommending it as a smoking cessation tool and stopping younger generations from using vapes.

Waiting for research

Tobacco influences the oral cavity, which is one of the most diverse microbial communities in the human body, housing over 700 bacterial species. This can lead to dysbiosis and fatal health complications such as oral cancer. In contrast, vaping has a greater life expectancy because it doesn’t include the cancer-causing tobacco or toxic chemicals that cigarettes do, though harmful metals may still be found in an e-cigarette. Whilst vaping is considered a safer alternative for smokers, it is not riskfree. Because vaping is a more recent phenomenon, there are fewer long-term studies on its oral health impacts compared

to smoking cigarettes. But a recent study tested the lungs of smokers, vapers and non-smokers and non-vapers, determining that vapers hold more oxygen than smokers (2.7 litres compared to 2.6 litres) but less than non-smokers (3.0 litres). As such, vapers who exercise are likely to experience breathlessness, intense leg fatigue and high levels of lactic acid in their blood. The strong link between lung disease medications and oral health may mean that vapers develop complications such as gingival diseases or thrush, prompting the need for maintaining both lung health and oral health.

Vaping may have the potential to cause xerostomia, periodontal disease, caries, oral lesions and even tooth movement. A drawback with knowing if vaping directly increases the risk of these complications is that many adult vapers are former smokers, meaning they already were at a high risk. Similarly, 14.3% of vapers switch to smoking after a year, and 25% switch after three years, limiting the ability to accurately assess the long-term oral health risks and emphasising a need to control vaping.

regulating youth

The previous government passed a Bill that would ban those born after January 2009 from being able to buy cigarettes, promoting a smokefree generation. The current government aims to continue this as a way of phasing out smoking, but prevalence for vaping is growing in younger age groups, with 7.6% of 11–17-year-olds using e-cigarettes. Many teenagers now vape before they smoke, diminishing it as a tool for cessation and potentially turning it into a gateway for cigarettes.

The variety in colourful packaging, sweet flavours and enticing branding that vapes have is appealing to young demographics. Regulations are therefore needed to calibrate youth vaping whilst supporting e-cigarettes as a quitting aid, ensuring that those who don’t smoke don’t vape.

iThe British Medical Association recently called on the government to control the widespread availability of vapes, limiting them to over-the-counter purchases only, and banning all non-tobacco vape flavours.

ii Until these measures are enforced, it is essential that practitioners educate younger patients that vaping is not risk-free, with the ability to cause issues such as dry mouth.

Stepping in to help

Stopping smoking is currently the more immediate priority over vaping, owing to the extensive research on tobacco’s carcinogenic impact. But for smokers and vapers, encouraging a consistently effective oral hygiene routine that

incorporates interdental cleaning will help reduce the risk of oral diseases.

For a reliable solution to clean the interdental spaces, consider the Cordless Advanced from water flosser brand WaterpikTM. Able to remove up to 99.99% of plaque, this innovative device is 50% more effective for improving gum health compared to string floss. Featuring 4 tips, 3 pressure settings and a 360-degree tip rotation, the Cordless Advanced can be calibrated to the level of comfort required for a consistent oral hygiene routine. Easy to use and travel with, introducing the Cordless Advanced can stop harmful bacteria accumulating.

With smoking and vaping regulations continuing to prove a topic of debate, encouraging education around their effects is crucial for the betterment of oral health.

For more information on WaterpikTM Water Flosser products visit www.waterpik.co.uk.

WaterpikTM products are available from Amazon, Costco UK, Argos, Boots and Tesco online and in stores across the UK and Ireland. n about the author

Susan hutson graduated from eastman Dental Institute School of Dental hygiene in 1988 and now has over 30 years clinical experience working in harley Street, specialist and orthodontic practices.

Aligning the figures

The changing face of orthodontic patients and how clear aligners add up for your practice

The UK orthodontics landscape is undergoing a dramatic transformation, with clear aligners at the forefront of this change. No longer just for teens and young adults, clear aligner treatment is increasingly sought after by a broader demographic.

According to the British Orthodontic Society (BOS), a staggering 76% of orthodontists have reported an increase in adult patients seeking orthodontic treatment within the past three years. Even more intriguing is that most of these patients (83%) fall within the 26-55 age bracket. This shift represents a significant opportunity for dental practices to cater to a demographic with higher disposable income and a willingness to invest in their smile.

Driving forces behind the clear aligner boom

The surge in clear aligner popularity isn’t happening in a vacuum. Several factors are contributing to this trend. The rise of remote working and video calls has made people more aware of their screen appearance. Social media and celebrity influence have raised the bar for what constitutes a ‘perfect smile’. Additionally, adults increasingly seek discreet orthodontic options that don’t interfere with their professional image.

These factors have culminated in a market projected to grow from £118.7 million in 2019 to an impressive £295.5 million by 2027, representing an 18.4% compound annual growth rate.

the practice perspective: profitability and growth

For dental practices, the clear aligner boom represents a significant opportunity for growth and increased profitability. Clear aligners offer several advantages over traditional orthodontic treatments. They provide reduced chair time, leading to more efficient patient management. Their aesthetic appeal and convenience result in higher acceptance rates.

There’s also potential for premium pricing based on perceived value and discretion. Moreover, increased patient satisfaction often results in positive word-of-mouth referrals.

meeting patient demands with flexibility

As patient needs evolve, so too must the solutions offered by dental practices. ClearCorrect, a leading clear aligner brand, has recognised this need for flexibility.

“We understand that every patient’s journey is unique,” says Caroline Cross, ClearCorrect UK marketing manager. “That’s why we offer a range of treatment options, from pay-per-aligner plans for minor corrections to comprehensive plans for complex cases.

“This flexibility not only caters to diverse patient needs but also allows practices to optimise their treatment approaches and increase case acceptance rates.”

ClearCorrect’s commitment to clinicians goes far beyond offering flexible pricing options to meet the surging demand for clear aligners.

At the core of its service is the Dr Portal, an advanced case management platform delivering actionable, data-driven insights to guide clinicians in making informed business and financial decisions.

“Our support for practices doesn’t end with providing a great product,” explains Caroline. “We’ve developed a comprehensive ecosystem to drive practice growth and success.”

This ecosystem includes dedicated support teams offering personalised guidance and training. These resources have already played a crucial role in helping hundreds of UK practices effectively market their clear aligner services and attract a steady stream of new patients.

Caroline adds, “By combining cutting-edge technology with hands-on support, we’re helping practices not just integrate

clear aligner treatments but truly maximise their return on investment. It’s about positioning ClearCorrect as a genuine partner in growth and success.”

Embracing the clear aligner opportunity

As the demand for aesthetic orthodontic solutions continues to grow, dental practices that position themselves to meet this need stand to benefit significantly.

By offering flexible treatment options and leveraging comprehensive practice support, clinicians can tap into this booming market while providing patients with the smiles they desire.

To understand how your practice can benefit from this clear aligner revolution, ClearCorrect invites you to book a free consultation. Using the new Ortho Opportunity calculator, the ClearCorrect team will provide a personalised analysis of your practice’s potential ROI from clear aligner treatments.

Book your free consultation today and discover how clear aligners can drive growth and profitability for your dental practice. www.clearcorrect-uk.com n

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Make your patients oral health experts

Biofilm control is key for preventing disease and keeping the mouth clean and healthy. As such, it’s important that patients have a good understanding of how to keep their plaque levels down at home. Even though clinicians spend time every day telling their patients that they need to improve their toothbrushing technique and clean between their teeth, they may not understand what they need to do better. Whilst it is helpful for patients to have a deep clean when they visit a dental hygienist, it is not enough to rely on this. Optimal oral hygiene using effective biofilm control techniques at home is essential for disease prevention.

Curaden understands this, which is why it hosts Individually Trained Oral Prophylaxis (iTOP) events around the globe, providing clinicians with the latest advanced biofilm management techniques and behaviour change strategies.

What is iTOP?

The leading educational programme in the profession incorporates the latest research in biofilm control. Available in four levels – Introductory, Advanced, Recall, and Educator – iTOP provides clinicians with a transformative educational journey.

iTOP Introductory

The Introductory programme explores the current shortcomings found in daily dental prophylaxis, and educates participants on this topic. It is the foundational level of the programme, and teaches delegates how to improve oral health using the proper tools and techniques. The aim of this one-day course is to give delegates an understanding of the iTOP concept and philosophy.

iTOP Advanced

The two-day Advanced seminar offers a deep dive into the implementation of techniques in the dental practice. This course offers more time for discussions, with opportunities for feedback and questions. Delegates will also get an understanding of Touch to Teach, learning the methods and techniques for daily biofilm management in small groups. The aim of the course is to prepare attendees to become effective oral hygiene instructors.

iTOP Recall

The annual seminar acts as a refresher for those who already hold an iTOP certification. The seminar aims to recalibrate delegate’s skills and update their knowledge of iTOP principles. iTOP Recall gives attendees certification revalidation for another year.

iTOP Educator

The intensive four-day seminar is specially designed for dentists and dental hygienists who would like to become iTOP instructors. Highly trained experts hold Touch to Teach sessions across the course, aiming for delegates to achieve certification as an iTOP instructor, and enabling to teach in their own iTOP seminars.

But what is Touch to Teach training?

Touch to Teach training is a core element of the iTOP programme. The hands-on aspect enables participants to master oral hygiene using different tools and techniques. It is an effective method of correcting, improving, and guiding towards excellent oral health for their patients.

revolutionise your patient care with a focus on prevention

Make prevention the priority in your practice. iTOP enables you to discover strategies to address oral health issues before they become serious problems. This proactive approach to care improves patient outcomes and their satisfaction with treatment. Participants gain science-based in-depth knowledge of biofilm control techniques, understanding how plaque forms and how to manage it to prevent disease. By becoming an oral hygiene expert, delegates become proficient in delivering patient-centred care,

focussing on each individual’s needs and preferences.

iTOP seminars are appropriate for everyone. Whether you’re a seasoned practitioner or are just starting your career in dentistry, iTOP principles aim to expand your knowledge of oral hygiene and patient care, enhance your skills, and impact your patients’ wellbeing.

So, no matter what stage of your career you’re in, take part in an iTOP course, and help your patients become oral health experts.

For more information, please visit https:// curadenacademy.com/en/ n

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The cornerstone of the practice

With a worldwide understanding of what truly makes a good practice, Craig Mallorie turned to Planmeca and its ProMax 3D Plus CBCT imaging unit to establish the flow of the South Wales Specialist Oral Surgery and Dental Implant Centre

Craig Mallorie’s impressive career includes a couple of years on London’ Harley Street, as well as a stint as a Clinical Teacher of Oral Surgery at King’s College Hospital. His CV also boasts some international flair, as he spent half a decade down under, delivering oral surgery in Melbourne. However, Cardiff is where Craig calls home. The Welsh capital is where his career began almost two decades ago, and it’s where he now serves as Specialist Oral Surgeon and Clinical Director at the newly established South Wales Specialist Oral Surgery and Dental Implant Centre.

No matter where he is in the world, when it comes to preparing a new practice from scratch, Craig pays particular attention to one key aspect: the flow of the practice.

“I’ve always had interest in the flow of practice,” he explains. “The equipment and the setup are always important to me because it all has a knock-on effect on the outcomes for patients.”

When it came to setting up and equipping the South Wales Specialist Oral Surgery and Dental Implant Centre, Craig drew upon his varied experience to create a practice with an environment designed as much for his team as it was the patients.

“I’ve worked in 25 or so different locations over the years,” Craig recalls when discussing his vision for South Wales Specialist. “I didn’t want to build a big, chop-shop centre. The building we found had the layout and the square footage that we were looking for. I wanted two operating rooms and two consultation rooms, so that patients experience a nice, fluid journey.

“We also have ample space in each of the operating rooms. For the patients, this results in a nice, peaceful place to undergo treatment.”

Craig has been placing implants for near enough the entirety of his 20-year career. Each and every time has, of course, required a CBCT scan.

“I’ve been exposed to various CBCT units over the years,” says Craig. “I must have used eight or perhaps even 10 different machines in the various facilities I’ve worked in. Just as with all types of equipment, you become a bit of a connoisseur over time, getting to understand what makes a user-friendly unit.”

So, what did Craig opt for when selecting a CBCT imaging device for his new practice?

“Planmeca has always been the standout,” Craig replies. “There’s a very clear distinction with the usability of their machines, from the patient positioning,

the settings, the options of the different fields of view alongside the option of ultra-low-dose and the linking up with Planmeca’s Romexis software. Planmeca is in a class of its own.”

Firm in the knowledge that he was going to acquire a Planmeca imaging device for South Wales Specialist, Craig ultimately opted for the ProMax 3D Plus – a complete 3D imaging unit that provides an extended view of the maxillofacial region, covering even more than the dentition.

“With some other scanners that I have used previously, it can be awkward to position patients in the unit,” says Craig. “I’ve had to ask patients to adopt all kinds of weird contortions to fit them into those machines. With the Planmeca ProMax 3D Plus, however, you can scan just the canine or premolar, or you can work your way around the arch. Either way, the results are extremely accurate.”

That accuracy is in part thanks to the innovative movement correction that the ProMax 3D Plus offer. Recognising that patient movement often poses a challenge to 3D image quality, Planmeca developed its CALM algorithm, which allows the clinician to remove artefacts caused by movement, which ultimately leads to a much sharper final image.

“If, for example, you select canine, you will get a nice field centred on the patient’s canine,” Craig explains. “It works very well. Whereas with other scanners I was finding it difficult to orientate the field of view to where I wanted it, which meant either having to do larger scans or play around with moving the patient to essentially trick the machine into getting the scan we needed.”

The high level of usability and attention to patient comfort is by design. Planmeca has

developed the ProMax 3D Plus imaging unit to combine smooth usability and optimised patient comfort to deliver an enjoyable and efficient treatment experience from start to finish, for both patient and practitioner.

The Planmeca ProMax 3D Plus also offers advanced ENT imaging. The unit’s voxel sizes range from 600 to 75 μm, while Planmeca’s Romexis software provides versatile tools for visualising airways, sinuses, soft tissues and the smallest bone structures in ears.

Craig is particularly impressed with the speed at which information is relayed.

“There is no time at all between doing the scan and having an image up on the screen – it’s instantaneous.”

The ProMax 3D Plus CBCT unit is put to good use at South Wales Specialist.

“It is the cornerstone of the practice,” Craig reflects. “Each patient’s journey begins with that machine and the images are displayed immediately on Romexis. This allows me to show the patient their images along with the diagnostic data as soon as the scan is complete. They are always impressed by instantly seeing their skull – or their jaw – in three dimensions. It always gets a nice response.”

While Craig has travelled around a fair bit, this was the first time he was involved in setting up a practice from scratch. “There’s always a bit of a fear factor when you’ve been associate for

Watch the full interview with Craig Mallorie here:

https://www.planmeca.com/testimonials/

such a long time and you’re looking to set up a place,” he admits.

“The whole build was orchestrated by Tom Cross at Woodlane Dental Equipment. It was clear that he was passionate about his trade, and he is highly regarded within the profession. Once we started working with Tom, he facilitated the introduction to the Planmeca team, who then organised the installation of the ProMax 3D Plus.

“The Planmeca and Woodlane teams worked well together, compiling the specifications for the room and completing the setup and installation. James from Planmeca got us set up on the software side, following which Jonathan came in to deliver an excellent training session for our staff. Overall, the support we have received has been fantastic.”

When asked what his top tips would be for those looking to follow in his footsteps and establish a new practice – or refurbish an existing clinic – Craig says: “If you’re going to make a big financial investment, make it a wise investment. I get asked quite frequently about what my opinions are and I’m always honest in that I would only recommend something that I would have in my practice, and that’s why, for me, Planmeca was the way to go.”

To discover more features of the Planmeca ProMax 3D Plus, visit https:// www.planmeca.com/imaging/3dimaging/planmeca-promax-3d-plus/ n

With a worldwide understanding of what truly makes a good practice, Craig Mallorie turned to Planmeca and its ProMax 3D Plus CBCT imaging unit to establish the flow of the South Wales Specialist Oral Surgery and Dental Implant Centre.

Scan the QR code to watch the full interview with Craig Mallorie

Whitening and sensitivity

What are the links and how can dental professionals help?

Dentine hypersensitivity is a well-known and common undesirable effect of teeth whitening procedures. Whether with professionally administered in-clinic procedures or self-administered at home, sensitivity has been reported by up to 80% of patients.1

Although often mild in severity, sensitivity can still make the whitening process uncomfortable or at worst, it may be sufficiently painful to lead a patient to discontinue the whitening procedure. As a result, patients do not achieve the outcome they want and could potentially discourage them from undertaking additional procedures in the future.

The increasing demand for teeth whitening products and services is being driven by factors including the influence of social media, a growing awareness of the benefits of dental health, and the rising consumption of pigmented beverages such as tea and coffee. The latter is one of the main reasons for tooth staining. Tooth staining occurs due to the presence of darker compounds called chromogens. These usually accumulate in two ways, either intrinsically or extrinsically. Intrinsic staining develops inside the tooth from potential causes including ageing, genetics and the use and effect of some medications.2 Extrinsic staining occurs on the surface of the teeth, usually from pigments in food or beverages, and as a consequence of smoking.2

To address such staining and to help improve a patient’s smile, whitening products are used. These often include bleaching agents. Whilst shown to be effective in achieving a brighter smile, they can also be associated with an

increased risk of dentine hypersensitivity. These bleaching agents have been seen to cause irregularities and porosity on the surface of enamel.3 It is thought that bleaching agents in some whitening products can quickly penetrate the enamel and move into the dentine, making it more susceptible to the mechanisms of tooth sensitivity.3 It is also thought that sensitivity could be exacerbated by inflammation of the pulp resulting from exposure to hydrogen peroxide, which is a bleaching agent.4

Currently, the most accepted theory on the mechanism of dentine hypersensitivity is Brännström’s hydrodynamic theory. It proposes that tubules in the dentine become exposed, and when these tubules come into contact with a stimulus, it triggers the movement of fluid. This in turn causes nerves in the pulp to signal a pain response to reversible pulpitis and thermal sensitivity.5,6

How can dental professionals help?

As dental professionals, we want our patients to have the most positive teeth whitening experience possible. And fortunately, there are options available to us to help alleviate the risk of dentine hypersensitivity. One route is using occlusion as a mode of action to reduce sensitivity.7 Mineral ingredients applied topically to the dental surface, usually in the form of a toothpaste or gel, promote occlusion of the tubules which limits the movement of fluid and consequently reduces hypersensitivity.7 Fluoride is also shown to be an effective occlusal agent. Fluoride also acts as a remineralisation agent, and stannous fluoride can provide additional and lasting protective benefits against the recurrence

of teeth whitening sensitivity.7 Another key ingredient available to counteract dentine hypersensitivity in the teeth whitening process is potassium nitrate. Potassium nitrate is an inorganic salt and acts in a different way to occlusal ingredients. Potassium ions can travel into the exposed dentine tubules on the tooth surface and down into the internal dental nerves. These potassium ions build protection over time to help desensitise nerves within the dentine. Potassium nitrate does this by keeping the nerve cells in a depolarised state, which blocks the transmission of pain impulses. And so, the patient does not experience a pain response to sensitive stimuli such as hot or cold drinks or food.8,9

It is natural that patients will want to maintain their whiter teeth for as long as possible after their at-home or in-clinic whitening procedure. In order to prolong the outcome, patients will often use a specially formulated whitening toothpaste. There are many of these on the market. However, whilst simply using a tooth whitening toothpaste can help keep teeth white and protect against stains, it may not have the ingredients required to help manage dentine hypersensitivity. With dentine sensitivity a common undesirable effect of the whitening process, it is worth considering a toothpaste that combines both teeth whitening ingredients and ingredients which help protect against dentine hypersensitivity. Ingredients such as potassium nitrate have been shown to be effective in alleviating sensitivity but without compromising the teeth whitening capabilities of a product. 10 Used before, during and after whitening

procedures, such a formulation could help give patients the smile they want without the pain of sensitivity. n

References:

1. Dentistry. Available at: https:// dentistry.co.uk/2006/11/22/ treatment-sensitivity-during-homebleaching/#:~:text=Managing%20 sensitivity%20during%20home%20 bleaching&text=It%20is%20also%20 prudent%20to,sensitivity%20and%20 continue%20with%20treatment Accessed April 2024.

2. Carey C. J Evid Based Dent Pract. 2014;14:70–76. doi:10.1016/j. jebdp.2014.02.006.

3. Krishnakumar K, et al. Cureus 2022;14(4):e24028.

4. American Dental Association. Whitening. Availbale at: https://www.ada.org/ resources/ada-library/oral-health-topics/ whitening Accessed April 2024.

5. Feliz-Matos L. and Yunes Fragoso P. Front Oral Maxillofac Med. 2023;5:3. https:// dx.doi.org/10.21037/fomm-21-121

6. Bubteina N. and Garoushi S. Dentistry 2015;5:330.

7. Clark D. and Levin L. Int Dent J. 2016;66:249–256.

8. National Center for Biotechnology Information (2023). PubChem Compound Summary for CID 24434, Potassium Nitrate. Available at: https:// pubchem.ncbi.nlm.nih.gov/compound/ Potassium-Nitrate Accessed April 2024.

9. Biology Online Dictionary: Depolarization. Available at: https:// www.biologyonline.com/dictionary/ depolarization. Accessed April 2024.

10. Pierote J, et al. Clin Cosmet Investig Dent. 2019;29(11):219-226.

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The team approach to preventative dentistry

Within the dental profession, we know the importance of preventative dentistry, and that the earlier a patient starts, the better. We might, therefore, be pleased to know that 89% of adults agree that good oral health habits should be taught in childhood to improve oral health for life*. This data comes from Denplan’s latest Oral Health Survey, giving an insight into the dental habits and attitudes of UK adults.

Preventative dentistry very much relies on regular dental examinations, trips to see the hygienist, and vitally important patient education – all of which should begin at an early age, as a trip to the dentist comes with new sights, sounds and smells that take some getting used to.

All too often, a patient’s perception of dental care is that it’s provided solely by the dentist. However, we need to change these perceptions by ensuring the entire team is involved to provide a seamless and comprehensive care journey. Every team member can have a positive impact on children’s oral health. Imagine your visit to the dentist as a four-year-old. At reception, you’re greeted by the lively sounds of ringing phones and the receptionist’s busy chatter. You peek over the desk to see them scanning the computer

screen. Noticing you, the receptionist asks you some questions while your parent fills out your medical history. They inquire about your favourite foods and how often you brush your teeth. You admit you don’t like brushing, marking the start of your journey into oral health education and regular dental visits. Unbeknownst to you, the receptionist’s excellent communication skills mean the dentist and dental nurse have already been informed about your love for cakes and your dislike for brushing!

Next, you find yourself in the waiting room, captivated by a colourful wall display. It features activities like finding cavities, counting sugar lumps in your favourite fruit smoothie, and illustrations on proper tooth brushing techniques and frequency. The dental nurse arrives and explains that they created this display to show you exactly what you should be doing and when.

When it’s time for your appointment, you’re greeted by a smiling dentist. They introduce themselves and explain that they’ll count your teeth, check your cleaning habits, and look for any issues. Inviting you to hop onto their magic chair, they guess, “I bet your favourite food is cake and you don’t like brushing your teeth.” But don’t worry, you’re going to visit the hygienist in the minute, and they’re going to make brushing fun,

so you’ll want to do it more than twice a day. The dentist then hands you a sticker and commends you for your excellent behaviour and tells you that if you like brushing more the next time you visit, you can have two.

Next, it’s time to visit the hygienist. They demonstrate proper brushing techniques using a giant set of teeth and let you practice, ensuring you understand. They also educate you about foods that are healthy for your teeth and those that should only be eaten in moderation, making sure the adults are informed too. After your appointment, you return to the bustling reception area. But wait –the receptionist has a goody bag for you! It includes colourful leaflets, toothpaste, and a new toothbrush, plus all the information the practice team mentioned. Are you ready to come back in six months?

As you can see, the whole team have played an integral part in having an impact on four-year-old you and your experience in the dental practice.

From the very beginning, the receptionist gets to know your interests and preferences to make the experience more personal to you. The use of the interactive and visual aids in the waiting area makes for a more child-friendly environment, helping you feel more at ease and visits more enjoyable. The positive reinforcement

offered from the dentist will motivate you to maintain good oral health habits. Not forgetting the giant teeth – using visual aids such as these can help explain dental procedures and make them less intimidating.

Whether it’s the special touches from reception, the colourful and impactful displays or the educational materials shared by the dental team, the collaborative team approach can help drive prevention by making a visit to the dentist a positive experience. It could even help the 30% of adults that have needed to take more than two hours off work for a child’s emergency dental treatment**, as their children want to have their regular dental check-ups, preventing dental emergencies from happening in the first place. n

*Sample of 5,035 adults SHOHR2024 **327 adults

about the author

lianne Scott-Munden, Clinical Quality and Complaints Risk Manager at denplan.

OUR RESEARCH SHOWS 82% OF DENTAL PRACTICES SOLD IN RECENT TIMES HAVE BEEN ACQUIRED BY INDEPENDENTS AND SMALL GROUPS AND WE PREDICT THIS TREND TO CONTINUE TO GROW THROUGH 2024 AND BEYOND.

Christie & Co has an extensive database and unparalleled reach in the market to help find the right buyer for the future of your practice.

For the latest market insights, scan here to read our 2024 Dental Market Review.

IF YOU’RE THINKING OF SELLING, SPEAK TO THE EXPERTS.

The Dental Awards 2025 is now open for entries

An early bird discount is in effect until 13th January 2025

AWARDS 2025

The countdown to The Probe’s Dental Awards 2025 is on, as entries are set to open at the-probe.co.uk/awards in November. Register before 13th January 2025 to qualify for an early bird discount of £35 per entry.

2025 marks the 27th year for The Dental Awards, presented by The Probe , which celebrates the very best of British dentistry.

As the original and most respected awards programme in UK dentistry, The Probe ’s Dental Awards are judged by a panel of leading practitioners and KOLs, providing an unrivalled opportunity for practices and DCPs to shine a spotlight on the vast skill and talent that exist within their teams.

The 12 categories forming The Dental Awards 2025 are:

• National Smile Month Award

• Dentist of the Year

• Young Dentist of the Year

• Dental Therapist of the Year

• Dental Hygienist of the Year

• Practice Manager of the Year

• Dental Nurse of the Year

• Front of House/Receptionist Award

• Practice of the Year

• Team of the Year

• Best Outreach or Charity Initiative

• Best Website or Digital Campaign

For more information on each category, including entry criteria, visit https://the-probe.co.uk/awards/categories/

“We at The Probe are so excited to announce the 27th edition of The Dental Awards for 2025 – the longestrunning awards event in British dentistry,” said James Cooke, Editor of The Probe. “And, for the fourth year in a row, we’re going to follow what has proven to be a popular and successful new format for The Dental Awards ceremony. Finalists, Highly Commended, and Winners will

all be announced via a streamed video presentation in the spring. The winners will then have the opportunity to join members of the judging panel and our sponsors for a free, intimate meal, where they will be presented with their certificates and trophies in person. So, there’s no need to pay extortionate ticket costs!”

The Dental Awards 2025 is presented 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 Hygienists and Therapists, and the Oral Health Foundation.

For more information on our sponsors and partners, visit https://the-probe.co.uk/awards/sponsors/ Entry closes 24th February 2025. Those who enter before 13th January 2025 qualify for an early bird rate of £35 per entry. All entries on or after 13th January 2025 will be priced at £60 each. 

DSL 2024: an astounding success

The hotly anticipated Dentistry Show London concluded its action-packed two-day show on 4 and 5 October at ExCel London. As one of CloserStill’s premium events in the dental calendar, it promised an unparalleled exploration of the latest innovations in dental technology and practice, phenomenal networking opportunities and inspiring presentations that did not disappoint.

The show surpassed all expectations, hosting a record-breaking number of attendees, exhibitors plus internationlly renowned and thought-provoking speakers. Dentistry Show London Event Portfolio Director, Alex Harden, said: “Dentistry Show London 2024 has been a complete triumph, and we are thrilled that it was such a success. The feedback from attendees, exhibitors, and speakers has been outstanding, and a testament to the dynamism and commitment of the entire dental community. It has been a joy to see everyone come together under one roof to network, learn and thrive.”

available at this year’s Dentistry Show were amazing. Our stand was buzzing, and it was wonderful to connect with familiar faces as well as meeting new contacts. We will definitely be returning next year.”

networking galore

The floor was ripe with discussions, introductions and laughter as everyone from practice managers to dental hygienists and therapists, dental laboratory owners, dental nurses, dentists and more came together to unite and thrive. The ‘who’s who’ of dentistry was in attendance, providing an exciting platform to make connections as well as foster new relationships.

As well as numerous events on show stands, the networking lounges were packed with enthusiastic and passionate delegates discussing the latest industry developments, plus challenges and opportunities for the sector. Many exchanged ideas and forged new partnerships, helping businesses and individuals to gain a competitive edge and contributing to the continued growth and advancement of the dental field.

industry leading exhibitors

More than 4,000 delegates entered the doors and engaged with 150 of the industry’s most innovative and dynamic exhibitors, who showcased their cuttingedge products, services and technologies. Visitors had the opportunity to explore the latest advancements in dental equipment, materials and software, gaining exclusive insights into new and current trends as well as those shaping the industry’s future. Live demonstrations and workshops also took place at numerous stands, designed to enhance knowledge and skills.

With many providing exclusive show offers and discounts, sales opportunities were ripe as delegates and exhibitors discussed needs and engaged in meaningful conversations. Those looking to kit out their practice with the very best technology and equipment were not disappointed, with an array of products and features on offer.

Harden commented: “This year’s show had innovation in abundance and provided practice owners and professionals with the tools needed to future-proof their business. With the latest and most inspiring products and equipment showcased, it provided a great platform for modern dentistry.”

Robert Lee, Dental Scientific Liaison Team Lead at Listerine, said: “The opportunities

challenges and opportunities for the new government.

• Farooq Ahmed, a consultant orthodontist at Guy’s and St Thomas’ NHS Foundation Trust and Northwick Park Hospital, who shared his insights on the best time to deliver interproximal reduction.

• Iain Chapple, Head of Research for the Institute of Clinical Sciences at Listerine, who covered a talk on The WONCA files: from Roald Dahl to the future of “putting the mouth back into the body”.

• Pam Swain, Chief Executive for the British Society of Dental Nurses (BADN), who addressed bullying in the workplace: spotting the signs and understanding the form it takes.

• Sally Khawaja, the Freedom to Speak Up Guardian at King’s College Hospital, who presented a dynamic presentation titled: ‘It is good to talk and even better to listen’.

Across the event, more than 100 hours of free innovative content was delivered by the most impressive names in the industry, helping to inspire and empower audiences. Refreshing seminars and workshops provided an unparalleled cross-speciality programme, fuelling conversations and exciting delegates.

Harden added: “We are incredibly grateful to all the speakers who took part in Dentistry Show London 2024. The quality of the talks was outstanding and showcased the best the industry has to offer. Every year we aim to raise the bar when it comes to our speakers and this year was no exception – delegates left inspired and empowered.”

dynamic show theatres

specialise in these areas of dental expertise as well as those keen to find out more about the latest developments in this field. Prestigious speakers included Tamer Theodossy, Consultant Oral Surgeon from the BAOS, who gave a talk around the ‘Limitations of 2D imaging in oral surgery’ and exploring how 3D imaging can enhance understanding of crucial anatomy and allow professionals to modify techniques. The lecture covered how CBCT scans can be formatted to extract the data and left attendees with a deep understanding of the various 2D and 3D imaging modalities available in oral surgery and their individual limitations.

CPd hours

The Enhanced CPD Theatre hosted a comprehensive two-day lecture programme designed to empower individuals and colleagues to further their continuing professional development. Lectures covered the core topics dental professionals need to be aware of, such as radiography, record-keeping and oral cancer.

With many discussions taking centre stage, from the future of dentistry and the new government’s healthcare agenda to the impact of AI and 4D printing, Dentistry Show London provided a fantastic platform to come together to debate and discuss. Many delegates downloaded the Dentistry Show event app to help plan meetings, bookmark their favourite sessions and create a personalised schedule. With so much on offer, those who planned in advance reaped the benefits.

industry leading speakers

The speaker line-up this year was exceptional and, for many, a real highlight of the two-day event. Over 100 leading speakers took to the stage to share their expertise and deliver topical presentations. Covering a host of relevant subjects, the speakers shared their unique insight and valuable advice for delegates, providing whole practice teams with access to the industry’s most respected clinical leads and experts in the dental community. Specialist areas were also discussed and played an important role on the agenda.

A few highlights included:

• Eddie Crouch, Chair of the British Dental Association (BDA), who discussed the road ahead for NHS Dentistry and the

The event hosted six show theatres, all packed full of content set to inspire and empower dental professionals. Much-loved theatres such as the Clinical Excellence Theatre sponsored by Listerine and Practice Owners & Business Management Theatre sponsored by Dental Elite made a comeback as well as the topical Aesthetic & Digital Dentistry Theatre, supported by the International Digital Dental Academy (IDDA), where attendees learned about the latest innovative technologies and treatment solutions transforming patient care and enhancing clinical outcomes in dentistry.

The Dental Care Professionals Hub was also a popular destination with specially curated content aimed at dental hygienists and therapists, plus dental nurses. Content covered topics such as oral cancer, infection control and safeguarding, helping DCPs to support patients as effectively as possible and how to achieve better oral health for all.

Another highlight this year was the new Specialty Interest Theatre, which drew attention from a wide range of visitors. Covering specialist subjects including endodontics, orthodontics, oral surgery and periodontology, the Theatre was supported by a range of high-profile partners including the British Endodontic Society (BES), British Orthodontic Society (BOS) and British Society of Periodontology (BSP), British Association of Oral Surgeons (BAOS) and the Association of Dental Implantology (ADI).

The exciting addition was well received by the audience, made up of dentists who

Up to 12 hours of eCPD content were available, helping attendees stay up to date and compliant in their dental practice. Miranda Steeples, President of the BSDHT, said: “The content was brilliant at this year’s show. The presentations were thoughtprovoking and inspiring. It is great to come together with colleagues to learn from the best whilst achieving quality CPD hours.”

look ahead

For those missing the event already or who were unable to attend, worry not. The British Dental Conference & Dentistry Show (BDCDS) makes a comeback on 16 and 17 May 2025 at the NEC in Birmingham. The event is shaping up to be another fantastic networking opportunity, celebrating developments in dentistry and exploring how the industry can unite to build a better future for the profession together.

The event will provide attendees with a valuable platform to understand and appreciate the importance of the entire dental team. Stay updated with the latest news and announcements on The British Dental Conference & Dentistry Show at birmingham.dentistryshow.co.uk and follow the event on Instagram.

Harden concludes: “Thank you to everyone that attended Dentistry Show London. This year was better than ever, and we look forward to opening our doors again in 2025. In the meantime, we look forward to connecting with the industry at The British Dental Conference & Dentistry Show, which promises to be another highlight of the dental calendar.” n

London calling

The location of any event firmly sets the scene for the kind of experience that attendees can look forward to. If you’re booking onto a relaxing retreat, you want to know that you’re headed for a quiet and beautiful location. Equally, if you’re seeking adventure and excitement, you will instead be searching for adrenalinefueled activities in the great outdoors. For the vast majority of people, London offers a combination of the experiences, thrills and opportunities they seek, making it a fantastic place to learn, network and have fun. Indeed, London was recently voted one of the very best cities in the world, second only to New York. The bustling capital of the UK is regarded worldwide as a top destination for work and pleasure. It offers a unique blend of history, culture, architecture, retail and connectivity, placing it at the centre of business and social programmes alike.

A place in time

Wherever you travel for an event, this can be an excellent opportunity to explore a new area, visit a famous landmark or experience a different culture. It also provides a chance to make a weekend of your trip – maybe take the family or a significant other and optimise that work-life balance without sacrificing your professional development or mental wellbeing!

The location is, therefore, an important consideration when deciding which events or training courses to attend. Further than

that, thought should be given to the specific venue. Accessibility is crucial – a central location with good transport links and/ or easy parking is essential on ensuring a smooth, stress-free journey. You’ll also want to confirm that the venue affords appropriate space and facilities to aid your learning. For example, there should be sufficient screens and auditory systems for safe and well-supported handson workshop settings with high-quality products and instruments. It is often the smallest details that have the greatest impact on your overall experience.

Bigging up the Big smoke

London is the perfect place to blend both business and socialising. The city attracts globally-renowned speakers and educators in all fields, including dentistry. Plus, there is so much to do after an event or course, whether you’re staying for the day, a weekend or even longer.

London ticks all of the boxes. The public transport system is widely regarded as one of the best around the globe, with tubes and trains covering the entire central area, and making toing and froing between event spaces, transport links and places to stay rather simple. Venues typically meet diverse accessibility, creativity, cultural and social needs, with new ideas and businesses constantly emerging to push boundaries and offer ever-more exciting options for visitors. No matter where you are, there are options galore for food, drink and entertainment to suit all tastes and preferences.

Hidden gems of London

If you’re headed into the city for a professional event, why not make the most of your time by planning ahead?

London has many exciting and unique experiences to enjoy, with fun for all ages and interests. For those looking to cover the main attractions, combination tickets are available from several vendors that offer cost savings.

However, for anyone seeking a quieter or more unique experience, here are some of our favourite hidden gems in London to add to the itinerary:

• A tour of London’s abandoned tube stations

• Visit the Purl London Speakeasy in Mayfair

• Check out the lesser-known Leadenhall Market

• Browse books on the floating bookstore located on Regents Canal

• Weather permitting, wander Kyoto Garden in Holland Park, West London

• Get competitive with friends at Fairgame in Canary Wharf

• Sample the flavours of the globe at Bang Bang Oriental food court, Maltby Street Market or Pop Brixton

Designed for dentistry

For all these reasons and more, BDIA Dental Showcase remains the number one choice of dental exhibition in the country

for thousands of dental professionals and industry members every year. Located at the ExCeL London, it has never been more accessible thanks to the nearby Elizabeth Line and cable car, with various restaurants and hotels within just a few minutes’ walk –including the O2 Arena. The event itself will deliver unique opportunities to see a broad selection of exhibitors who chose this as the only annual event they attend. There will also be exclusive and highly sought-after hands-on workshops, as well as several lecture programmes hosted by professional associations and presented by worldrenowned clinicians and product experts. Plus, secure the best accommodation for your requirements and within your budget by booking early through our website with BCD Meetings & Events, our appointed accommodation partner.

As such, you needn’t look any further for a dental event that will advance your skills, expose you to new innovations and enable you to network with like-minded professionals than BDIA Dental Showcase. March 2025 will be here before you know it so start planning your city break today and make the very most of your trip! n the dental community trusts BDIA Dental showcase 2025 for a reason 14th-15th March exCeL London Register your interest for 2025 at dentalshowcase.com/register-interest-pr

Don’t miss out on ADI Team Congress 2025

Dental implantology produces a number of challenges, unique to this particular field. As such, its vital that those who provide implant dentistry come together to share their views, and experiences, to support the learning of others on their clinical journey. The Association of Dental Implantology (ADI) Team Congress is the perfect platform to experience this, with attendees able to hear from the leaders on topics relevant to them, and get involved in the discussions with their colleagues.

spectacular speakers

The ADI Team Congress is delighted to introduce a range of excellent speakers, including both high-calibre clinicians and technicians, who are joining us to share their expertise in their sessions.

The line-up of clinicians includes:

• Tidu Mankoo

• Telmo Iceta

• Eddie Scher

• Professor Joseph Kan

• Raquel Zita Gomes

In addition to dental technicians:

• Bryan Matthews

• Peter Pizzi

• Alina Ceclan

• Lorant Stumpf

• Kevin Armstrong

• Hugo Patrao

This is a unique opportunity to expand your knowledge of dental implantology,

with the ability to hear from a wide range of experts sharing their experiences, expertise, and techniques. This allows you to gather advice from various walks of life and form your own conclusions. At a Congress which is specifically tailored to those interested in dental implantology, the impressive line-up of speakers is able to expand your mind and help you achieve your ambitions.

excellent education

The educational programme at ADI Team Congress 2025 is second to none. This is the ideal place to hear from internationallyrenowned speakers in a unique debate format. Speakers will be discussing key topics in implant dentistry. This is a great place to open your mind to other clinicians’ ways of work, enabling you to take these insights back to your practice and benefit your team and patients.

Hands-on workshops at the ADI Team Congress also promise to be a valuable educational tool. They are great opportunities to get expert advice and guidance on the latest developments, tools, and techniques in the world of implantology. Further to this, the ADI Team Congress offers something for the whole dental team. This makes it ideal to attend with your colleagues, enabling the whole practice to benefit from high-standard education and great social events. Additionally, the Next Gen programme means that clinicians who are new to implantology, and keen to find out more, are able to expand their knowledge of the field, and get to know the experts.

Attendees can gain up to 18.5 hours of eCPD from the ADI across the three days of Congress, all in one place.

super socials

The ADI Team Congress 2025 offers attendees a range of opportunities to socialise and network with their peers.

The Congress Drinks kicks off the festivities, celebrating the beginning of an event which enables new discussions and connections with other delegates. Additionally, the Congress Dinner promises to be an unforgettable experience – allowing you to enjoy a gourmet meal with friends and colleagues. Plus, for those who’d like to let their hair down, the Industry Party is a night of celebration and surprises.

Network with your peers and make new connections to support your day-to-day work at the ADI Team Congress 2025.

extensive exhibition

The ADI is delighted to offer a large trade exhibition at the ADI Team Congress, featuring your favourite brands in dental implantology and practice management. This is a great chance to browse the extensive stands and discover the latest technology and services that are on offer. The exhibition is a fantastic way to get in touch with brand representatives who are able to provide tailored advice to support your practice.

Beautiful Brighton

Join us in the free-thinking, vibrant city of Brighton and get involved in the ADI Team Congress. Indulge in the modern culture and admire the unrivalled architecture between lectures. With so much to do and see on the doorstep of the Congress, register and come along!

Register today for the ADI Team Congress 2025: www.adi.org.uk/association_dental_ implantology_congress

For more information, please visit www.adi.org.uk n

Reflecting on IFEA WEC in Glasgow

The IFEA World Endodontic Congress (WEC) 2024 was hosted in Glasgow by the British Endodontic Society (BES).

It drew in crowds from 70 countries around the globe, all eager to update their endodontic knowledge and engage with their peers, esteemed speakers, and brand representatives. The WEC kicked-off with a Welcome Reception at the Glasgow Science Centre, where the interactive education exhibit, ‘At the root of it’, was unveiled for attendees to explore for the first time. The exhibit leaves a legacy for the near one-third of a million annual visitors to the venue to enjoy for years to come.

the main benefit is the educational events, such as this, the Early Career Group meetings, and the Regional Meetings.”

Inspiration at the exhibition

The exhibition hall drew in delegates who enjoyed discussing the latest technologies and products with a wide range of manufacturers. This was a great way for attendees to find out about the current trends in endodontic instruments, and discover leading products from the people who know them best. Dr Sairidon Futos shared his experience of the IFEA WEC, and the exhibition:

“I have been providing endodontic treatment for the last 30 years, and

The following morning began with the Opening Ceremony, featuring a performance from the Red Hot Chilli Pipers, which had everyone on their feet, with toe tapping for some, all the way through to a full highland fling for others. This absolutely set the tone for the rest of the Congress!

Educational opportunities

Invited speakers filled the auditoriums with audiences engaged in the wide-ranging and relevant topics. With speakers across all areas of the Congress using clinical cases, research, and their own experiences to illustrate their subject areas. Speakers including Prof. Paul Lambrechts, Prof. Yoshi Terauchi, Prof. Mitsuhiro Tsukiboshi, Dr Frank Setzer, Dr Asma Khan, and Dr Ghassan Yared joined us from around the world to share their expertise and offer insights into their topics of interest, drawing in crowds eager to hear their thoughts.

Further to this, the dedicated Early Career Symposium enabled those early in their careers to learn amongst their peers in a supportive environment. As part of this dedicated track, speakers discussed their own experiences of their early careers, and the journeys which led them to the vibrant careers they have now. Likewise, the Endodontic Teachers Group meeting offered opportunities for endodontic educators to explore the latest innovations in teaching, including haptics and augmented reality.

Dr Joanna Batt shared her experience of the educational opportunities at IFEA WEC, and the BES events that she has previously enjoyed: “There is a really good variety of exhibitors in the exhibition hall, and the lectures have been really well presented, with good topics and well-timed sessions. As a member of the BES, I would say that

for everyone to enjoy at any moment. Dr Uzan Sacha shared his experience of the IFEA WEC:

“The speakers have been great! They are very intelligent people who have covered good topics. Overall, the Congress has been very good.”

Dr Peter Sidhom commented: “I have found the lectures to be very informative, and the speakers to be very good. In particular, my favourite session so far was presented by Prof. Paul Lambrechts.”

The BES prides itself on being a society that is open to everyone with an interest in endodontics. As such, its educational events are tailored to a wide range of interests and experience levels. By becoming a member of the BES, clinicians enjoy reduced rates at educational events, making it even more accessible to expand their knowledge of endodontics, and enhance results for their patients. Become a member today!

decided to become a member of the BES just over a year ago – this was a great idea! The lectures have been really nice, I particularly enjoyed the ground-breaking session presented by Prof. Yoshi Terauchi. Generally, there has been a very high level of lectures and speakers, and there have been lots of different brands and new products to explore and interact with in the exhibition hall. I even picked up some samples to take with me and try out!”

Making connections

Networking was a key feature of the IFEA WEC, with clinicians from around the world coming together to share ideas and experiences, as well as build friendships and professional relationships. The social programme spanned a welcome reception, a traditional Scottish ceilidh, and a Congress Dinner, encouraging attendees to have fun and socialise with friends and colleagues. Dr Wan-Chuen Liao shared her experience of this aspect of the IFEA WEC, and the Congress as a whole:

“The Congress so far has been very good; I have loved it. Everyone is so friendly, and it has been a great networking opportunity. I would recommend it highly as it has been a great way to attend lectures presented by prestigious speakers and update my knowledge.”

International conference

The IFEA WEC highlighted the benefits of an international conference. Speakers shared countless experiences of what it’s like to practise endodontics in their respective countries, outlining the varied needs and capabilities felt by those around the world.

The IFEA WEC boasted variety, which meant that there was always something

Refining infection protection and control

Allan Wright focuses on innovative approaches to minimise cross-infection and transmission risks in the dental environment

Aims and objectives

The aim of this article to highlight the critical importance of proper infection control and decontamination procedures in dental practices, as well as exploring key infection control strategies

On completing this Enhanced CPD session, the reader will:

• Understand the advanced infection control strategies for dental practices, with a particular focus on effective disinfection of clinical surfaces and dental water quality maintenance

• Appreciate the importance of adhering to regulatory frameworks and their role in enhancing infection control measures within dental settings

• Realise the complexities of pathogen transmission in dental environments and the critical role of disinfection

• Recognise the significance of routine monitoring and periodic adjustment of dental unit waterline protocols

• Identify the importance of continuous improvement in infection control practices, including regular audits, staff training and adaptation to emerging threats in the dental field.

Learning Outcome: C, D

Infection control remains a cornerstone of safe dental practice, continuously evolving in response to emerging challenges and technological advancements. While the principles of infection prevention and control (IPC) are well understood within the dental community, the application of these principles must be continually refined and rigorously implemented to meet the demands of modern dentistry.

The governance landscape

The regulatory framework governing infection control in dental settings across the UK is multifaceted, with distinct guidance issued for England, Scotland, Wales, and Northern Ireland, reflecting the devolved nature of healthcare governance within the UK. For instance, the Health Technical Memorandum (HTM) 01-05 in England outlines stringent decontamination requirements, serving as a key example of governance specific to England.1

Governance frameworks serve not only as compliance checklists but also as evolving documents that reflect best practice standards. They underscore the importance of a proactive approach, where infection control measures are continuously audited, and improvements are implemented promptly.

Adhering to these regulations reflects a commitment to excellence in patient care and a deep understanding of the microbial threats present in dental environments.

Transmission pathways

Dental practices are susceptible to a broad spectrum of infectious agents, including blood-borne viruses like hepatitis B and C and HIV, transmitted through exposure to contaminated blood or body fluids.

Respiratory pathogens, such as those causing tuberculosis and COVID19, present additional challenges, particularly during aerosol-generating procedures. Because of these kinds of risks, micromotors that reduce aerosol

generation have become increasingly significant, as they help minimise the spread of airborne pathogens during dental procedures.

Proper hand hygiene is essential in dental practices to prevent cross-infection and ensure the safety of both patients and dental professionals. A systematic hand wash technique should be employed at the start of every clinical session. Hands must be disinfected using an alcohol rub disinfectant before, between and after seeing each patient to minimise the risk of pathogen transmission. To maintain the pliability of the skin and prevent damage from frequent disinfection, a moisturising cream should be used at the end of each clinical session. Additionally, always

use good quality, powder-free gloves to provide a barrier against contaminants while preserving skin integrity.

Sharps safety is, of course, another critical component of infection control in dental practices. To minimise the risk of needlestick injuries and cross-infection, always use safe injection practices, such as utilising single-use needles and syringes for each patient. Proper handling of sharps involves using a sharps container immediately after use without recapping needles and avoiding unnecessary handling. Employ devices with safety features, for instance needle guards or retractable needles, whenever possible. These measures significantly reduce the risk of exposure to bloodborne pathogens.

Robust disinfection

Understanding the resilience of microorganisms on various surfaces is crucial. For example, hepatitis B virus can survive on surfaces for up to seven days, while pathogens like MRSA can persist for months.2 This highlights the necessity for rigorous and systematic surface disinfection protocols that go beyond routine cleaning. Utilising appropriate disinfectants that are both effective against a broad range of pathogens and safe for use on dental equipment is essential. The survival of pathogens on surfaces underscores the importance of selecting high-quality disinfectants and ensuring that disinfection protocols are consistently followed. The difference between

cleaning and disinfection must be clearly understood and communicated within the dental team - cleaning removes debris, whereas disinfection specifically targets and reduces the microbial load.1 Therefore, effective disinfection strategies are pivotal in mitigating the risks associated with microbial contamination in dental settings. A robust disinfection regimen should be tailored to the specific needs of the practice, taking into account the types of surfaces, frequency of contact and the microbial load. Quaternary ammonium compounds (quats) have been widely used due to their efficacy against a broad spectrum of pathogens and compatibility with most dental surfaces.3,4

However, not all quats are created equal and the team needs to search for products that have proven superior efficacy with minimal risk of damaging dental equipment or upholstery.3,4 These products are particularly recommended for high-touch surfaces that are prone to frequent contamination. For upholstery and other sensitive surfaces, it is essential to choose disinfectants that are effective without being overly abrasive, for example Clinell or Mikrozid universal wipes.

Regular auditing of disinfection practices, including surface swabbing and microbial testing, can provide objective evidence of compliance and help identify areas for improvement.1,5 Moreover, the selection of disinfectants should be revisited periodically to ensure continued efficacy against emerging pathogens.1

Waterline equipment

The quality of water used in dental procedures is another critical component of infection control, often underestimated in its potential to harbour and transmit pathogens. Dental unit waterlines (DUWLs) are particularly vulnerable to biofilm formation due to their narrow diameter and consequent low flow rates, creating a conducive environment for bacterial colonisation. This poses significant risks, as contaminated water can introduce pathogens directly into a patient's oral cavity.6 Optimal infection control in dental settings requires innovative equipment designs that prioritise safety and efficiency. Modern approaches focus on minimising infection risks through advanced features like seamless equipment surfaces that reduce crevices and joints, making thorough cleaning and disinfection more manageable.

Other aspects of dental equipment engineering with a focus on asepsis include:

• An isolated water bottle, giving you greater control over the water quality in terms of chemical composition and bacterial safety

• A delivery system control block with an innovative design that eliminates trapped, stagnant water, so that fresh water circulates every time a handpiece is activated

• Waterline tubing enhanced with antimicrobial agents, like silver ions,

offers added protection against bacteria and microbes, helping to prevent odours, discolouration, corrosion and other surface issues

• A streamlined vacuum-line cleaning system integrated directly into cabinetry allows staff to connect hoses, start the process and quickly clean lines in minutes, saving time and extending the vacuum system’s lifespan while offering a safer and more efficient alternative to traditional methods.

Ensuring water quality

Additionally, the use of high-quality disinfectants and specialised maintenance solutions for DUWLs can effectively combat biofilm formation and maintain low microbial counts. This holistic strategy ensures that dental practices not only comply with regulatory frameworks like HTM 01-05 but also provide a safer environment for both patients and professionals.

A comprehensive approach to waterline maintenance is required. This includes the use of chemical germicides, such as A-dec ICX® tablets, which are designed to prevent biofilm formation and maintain waterline effluent at a microbial load of <200 CFU/ml (colony forming units per millilitre). These tablets provide a practical solution that integrates seamlessly into daily routines, requiring minimal effort while delivering consistent results.7 Additionally, periodic shock treatments with agents like ICX Renew™ are recommended to clear biofilm and other deposits that routine maintenance may not address.8 Shock treatments should be performed based on regular water quality testing, with the frequency adjusted according to the microbial counts observed. Practices should establish a water quality action level, of ≤100–200 CFU/ml, beyond which corrective measures, including shock treatment, must be implemented.1

A dynamic need

The dynamic nature of infection control in dentistry necessitates a commitment to continuous improvement. Written protocols, regular staff training, and periodic re-evaluation of infection control practices are fundamental components of an effective IPC strategy.

Beyond adherence to standard precautions, dental teams must remain agile and responsive to new threats, adapting protocols as necessary to incorporate the latest evidence-based practices. This might include the integration of advanced technologies, such as air purification systems and enhanced personal protective equipment (PPE), which provide additional layers of protection in high-risk environments. The commitment to maintaining high standards of infection control reflects not only compliance with regulatory requirements but also a dedication to the highest levels of patient care. As new challenges emerge, the dental community must continue to adapt and innovate, ensuring that infection control measures remain robust, relevant and effective.

References

1. HTM 01-05: Decontamination in primary care dental practices. Department of Health 2013. Available at: https://bit.ly/4gceokb

CPD Questions

What is the primary purpose of revisiting the selection of disinfectants in dental practices periodically?

a) To reduce costs associated with disinfectants

b) To ensure continued efficacy against emerging pathogens

c) To improve the appearance of the dental practice

d) To comply with outdated guidelines

2. Which regulatory framework provides guidance on infection control in dental practices in England?

a) Health Technical Memorandum 01-05 (HTM 01-05)

b) General Dental Council Standards

c) Care Quality Commission (CQC) Guidelines

d) British Dental Association Recommendations

3. What corrective measure is recommended if microbial counts in dental unit waterlines exceed the practice’s action level?

a) Reduce the frequency of patient appointments

b) Perform a shock treatment on the waterlines

c) Switch to a different disinfectant temporarily

d) Reduce waterline testing frequency

4. What is the primary challenge associated with dental unit waterlines that necessitates rigorous maintenance?

a) High flow rates

b) Excessive use of disinfectants

c) Narrow diameter and low flow rates leading to biofilm formation

d) Limited contact with patients

5. What is the main purpose of using A-dec ICX® tablets and ICX Renew™ in dental unit waterlines?

a) ICX® tablets enhance water taste and ICX Renew™ improves water flow rates

b) ICX® tablets prevent biofilm formation, while ICX Renew™ performs periodic shock treatments to remove existing deposits

c) ICX® tablets reduce water temperature and ICX Renew™ disinfects dental instruments

d) ICX® tablets replace regular water testing, ICX Renew™ minimises equipment wear

2. Kramer A et al. How long do nosocomial pathogens persist on inanimate surfaces? A systematic review. BMC Infect Dis 2006; 6: 130. doi: 10.1186/1471-2334-6-130

3. Equipment asepsis guide. A-dec 2020. Available at: https://bit.ly/4g6fEFj

4. Upholstery maintenance guide. A-dec 2020. Available at: https://bit. ly/3X7Npxs

5. Dental mythbuster 17: Audit and improvement in primary dental services. CQC 2024. Available at: https://bit. ly/3X8azDK

6. Hikal W et al. Dental unit waterlines and health risks of pathogenic microbial contamination: An update review. Journal of Biological Studies; 6(4): 282-298. https://doi.org/10.62400/jbs.v6i4.8729

7. ICX dental waterline maintenance fact sheet. A-dec 2022. Available at: https:// bit.ly/47asApw

8. Efficacy of ICX Renew dental unit waterline shock treatment white paper. A-dec 2021. Available at: https://bit. ly/3XnPW7T n

For more details on how A-dec can support you in achieving best practices and ensuring the health and safety of your team and patients — including maintenance, monitoring, and shocking your DUWLs — please visit unitedkingdom.a-dec. com, email info@a-dec.co.uk, or call 0800 233285.

About the author

Allan Wright is A-dec’s Territory Manager for Scotland & Ireland

Planmeca stories from Planmeca dentists

Our Planmeca Stories video series features Planmeca dentists explaining in their own words why they chose our equipment for their formidable surgeries. Whether it’s the Ultra Low Dose feature on our CBCT units or the armchair feel of our knee break chairs, each dentist has their own reason for choosing Planmeca.

If you’re considering an equipment upgrade, a complete surgery refurb, or just want to learn more about digital dentistry, the Planmeca Stories series could be just what you’re looking for. Our first video features Colin Campbell from the Campbell Academy in Nottingham talking about the importance of relationships and long-term support when

getting his impressive, purpose-built facility up and running.

Find the link on our testimonials page https://www.planmeca.com/testimonials/ and contact us for more information. n

Developed over thousands of hours by Parkell engineers in close collaboration with teams of hygienists, DuraTip, an ultrasonic scaler insert with unmatched durability and performance, achieves the previously unthinkable: 100% efficiency through an unprecedented 3mm of tip wear, validated over a year of field testing.

Novel patented internal geometries at the tip and connecting body result in unsurpassed energy transfer and durability across a W-stack design for optimised performance and effective deposit removal.

DuraTip’s stack design provides greater rigidity and stability over time. Their continuous, like-new scaling efficiency translates into less pinch pressure, vastly superior performance over time, less chair

time and considerable savings as instruments have a very, very long life.

Duratip scaler inserts are currently available in two shapes, the universal and straight perio tip design, and come with an ergonomic, anti-slip soft grip for maximum ergonomic support.

For more information contact infoeurope@ parkell.com. Scan the QR code to watch the video where Dr Cathy Hendrickson, dental hygienist, reports her experience with DuraTip.n

• BeautiBond Xtreme: All-in-one universal adhesive with high bond strength, suitable for all etching techniques.

• BEAUTIFIL Flow Plus-X: Versatile, fluoridereleasing hybrid composite in 2 viscosities, perfect for Class I-V restorations.

• Super-Snap X-Treme Polishers: Achieve a flawless finish with our enhanced polishing disks for ultimate patient comfort.

Cleaning and disinfection of instruments is a vital step in any infection control procedures. The greener and less hazardous chemical components in Bossklein IDactiv make for a much safer solution for both the user and the environment.

Explore the advantages of these innovative products, designed to simplify your procedures while delivering superior results at: www.shofu.co.uk.n

Bossklein IDactiv easily removes organic debris through manual or ultrasonic cleaning with the additional benefit being effective against a wide spectrum of micro-organisms including TB. The proven ability to be used on a wide range of different materials ensures delicate instruments remain in prime condition. IDactiv contains plant based and biodegradable ingredients alongside naturally occurring amino acids. The modern formula is free from alcohol, chloride and PHMB. A mild fresh aroma is a pleasant change from other solutions with harsh odours.

For more information call 0800 132 373 or visit www.bossklein.com n

Hassle-free, predictable placement with Adin Guided surgery!

The adinguide™ guided surgery system delivers effortless procedures plus accurate and predictable implant placement. It delivers everything you need in a guided surgery system.

It is a keyless system which helps save surgery time, whilst ensuring accurate and predictable implant placement. It features ActiveFlow™ Irrigation Technology which delivers coolant directly to the surgical site. This helps prevent bone overheating, thereby maintaining healthy bone for optimum osteointegration and minimised risks of complications.

Built-in stoppers ensure precise and accurate drilling to the desired depth, whilst keyless, self-centering drills and tools enable

Trycare, the UK’s fastest growing dental company, supply an extensive range of PPE products to meet the individual requirements of every member of the Practice team. This includes an extensive range of disposable drapes and gowns.

Trycare’s disposable sterile surgical gowns and drapes are made of a fluid repellent three layer laminate of breathable material to ensure the comfort of the wearer during the operative procedure. Fully compliant with EN13795 and CE Marked 93/42/EEC, they are available in a range of sizes to meet every need. They are ideal for surgical procedures including implantology, periodontology or even simple extractions.

Trycare offer their drapes, gowns and ancillary items individually, in bulk packs

Implantologists perform faster, easier and more intuitive surgeries.

The adinguide™ kits are intuitive, simple and effortless to use. They help ensure a hasslefree, logical and straightforward procedure that saves the Clinician time and worry. For further information visit the Trycare website, www.trycare.co.uk/adin, or request one of their Surgical Essentials and Adin Catalogues. To request a catalogue please contact your local representative or call 01274 885544.n

and in a variety of off-the-shelf packs designed to meet the requirements of different clinical procedures. Should none of the above contain exactly what you want then Trycare can supply customised drape kits designed to meet the individual needs of the practice. Trycare also offer a reusable gown which can be washed and reused up to 75 times for anyone looking for extremely cost-effective PPE protection for non-surgical procedures.

For more information about Trycare’s comprehensive PPE range, contact your local Trycare Representative, call 01274 885544 or visit www.trycare.co.uk n

Tecnoss®’s OsteoBiol® GTO® is the Second Generation Guided Bone Regeneration Material distributed by Trycare.

All Tecnoss®OsteoBiol® products are Second Generation because they contain a Dual-Phase resorbable bone matrix incorporating both 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 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, 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.

Conceived as a universal biomaterial, easily adaptable to any bone defect, it has proven clinically valid for horizontal augmentation of two-wall defects and socket preservation with compromised buccal plates. It can also be used to treat peri-implant lesions and severe bony defects, also in combination with OsteoBiol® Soft Cortical Lamina.

For more information, call Trycare Ltd on 01274 885544 or visit www.trycare.co.uk/osteobiol n

Trycare’s Tokuyama Universal Bond II is the only self-curing bonding agent that can bond any direct or indirect restorative material using the same three quick and easy steps and without the need to light-cure, agitate surfaces, use additional primers or activators or wait in between steps. Simply mix, apply, air-dry and that’s it!

Tokuyama Universal Bond II can be used for direct anterior and posterior restorations with light-curing, dual-curing and self-curing composite materials; intraoral repair of composite, porcelain fused to metal, metal and all-ceramic restorations without a primer; cementation of indirect restorations and veneers with light-curing, dual-curing and self-curing resin cements; bonding core build-ups; bonding

denture resins to metal bases, clasps and attachments; repairing dentures; bonding opaque resin to the metal bases of resin-faced stainless steel crowns.

For more information about the complete Tokuyama range, including Tokuyama Universal Bond II, contact your local Trycare Representative, call 01274 885544 or visit www.trycare.co.uk.n

www.the-probe.co.uk

discover the latest evidence in soft tissue regeneration

Chair of the ADI/Osteology Foundation

Masterclass: Soft Tissue Regeneration, Professor Nikos Donos offers some insight into what delegates can expect from the highly anticipated event this November:

“Soft tissue regeneration is a procedure that practitioners involved in implant dentistry and augmentative procedures – will have to provide to their patients.

“For this Masterclass, the aim is that the delegates will achieve a clear understanding of the new techniques and technologies in the field of soft tissue regenration. They will also gain knowledge from experts on suturing techniques and management of soft tissues. The clinical cases will be combined with scientific evidence and clinical guidelines provided by the outcomes from consensus conferences which will also allow the participants to introduce to their practice new,

evidenced based surgical techniques.

“The last ADI/ Osteology Foundation Masterclass was a great success. I would encourage all dentists involved in the field of implantology, or those who would like to know more about the possibilities of soft tissue regeneration, to join us this November!”

ADI Masterclass: Soft Tissue Regeneration

In collaboration with Osteology Foundation 23 November 2024, Savoy Place, London Book at www.adi.org.uk n

adi.org.uk

Boost staff retention with the working environment

Studies have shown that individuals want career development opportunities and a good working environment to build job satisfaction and loyalty to their workplace.

For advice on all this, plus free CPD for the whole team and a chance to discover the latest dental materials and technologies designed to streamline your team’s daily workflow, don’t miss BDIA Dental Showcase 2025!

This event offers a unique opportunity to engage with a broad range of dental business experts and establish hugely influential connections with educational providers who can help deliver career-changing development for your entire team. You can also browse the very latest innovations on the market, with various technological and material suppliers making this

Boosting your business compact and feature rich

Knowing when to grow your practice can be tricky to gauge, with so many metrics to consider. Using a dental practice management software like Sensei Cloud from the practice and patient management brand of Carestream Dental can make the numbers easier for you to track your growth, and know when to take the next step.

Designed to optimise your practice, Sensei Cloud promotes agility and ease, offering a more convenient alternative to an on-premise system. The cloud-based software boosts productivity by offering seamless scheduling across multiple locations and specialties, allowing appointments to be adjusted with ease in the event of cancellations.

Sensei Cloud also makes balancing the books extremely easy, streamlining billing, NHS claims

and revenue tracking. By promoting simplicity and convenience, Sensei Cloud will ensure the daily workflow for you and your staff is smooth and succinct, allowing your patients to be more effectively looked after. When it comes to growing your business, Sensei Cloud is your greatest ally.

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

The ultimate combination of style and function, choose MyRay Hyperion X9 from Clark Dental. Whether you need 2D/3D capabilities, or SuperHD functionality, the Hyperion X9 system can meet your practice’s unique needs. This system is suitable for practices with limited space, as the Hyperion X9 is one of the most compact and feature-rich imaging devices available on the market. Hyperion X9 adapts to your needs to guarantee high-quality images. This means that you can effectively produce and complete efficient diagnoses – with the full field of view guaranteeing that the entire dentition is scanned, for detailed full arch imaging.

Endodontic re-treatment can be complex and daunting for GDPs. To remove some of the strain while ensuring that your patient receives first-class clinical care, consider referring them to EndoCare.

With several registered specialists in our team, we live and breathe endodontics. That means we have seen nearly every type of case and can cater for any situation with confidence. Whether you patient presents with persistent infection or complex root morphology, we have the skills and technologies to address previously failed endodontic treatment.

For more details on the broad range of

advanced endodontic procedures we offer, please contact us today.

For further information please call EndoCare on 020 7224 0999 Or visit www.endocare.co.uk n

PREVENT GEL from TANDEX, used with their range of FLEXI interdental brushes, is a great product to recommend to all your patients –especially those at greater risk of developing periodontal disease. Regular interdental brushing prevents the build-up of damaging biofilm, maintaining oral health for life. FLEXI interdental brushes come in a range of sizes, and are shaped to make accessing the hardest to reach areas of the mouth easy. PREVENT GEL has enamel strengthening and antibacterial properties. It contains 0.12% chlorhexidine, the recommended percentage to prevent harmful bacteria from causing oral diseases like gingivitis. The gel also contains 900 ppm fluoride to strengthen and remineralise the teeth, reducing the risk of caries. All products from TANDEX are manufactured and developed using the most ethical and sustainable practices possible, making it the healthy choice for people and the planet. Find out more about how PREVENT GEL from TANDEX, used with their range of FLEXI interdental brushes can benefit patients. For more information on Tandex’s range of products, visit https://tandex.dk/

Our products are also available from DHB Oral Healthcare https://dhb.co.uk/ n

tandex.dk

At Eschmann, we put excellent customer service at the heart of everything we do. And you don’t just have to take our word for it – Hayley Wright, Head Receptionist at Goldsworth Road Dental Centre in Surrey, shares her thoughts:

“We have been working with Eschmann for about nine years now. The service has always been really good. We have fantastic rapport with Karl, who is just amazing. Our calls and texts are always answered promptly and someone is constantly on hand to help if we need it. The service is brilliant, they always go above and beyond.

“We have five pieces of equipment from Eschmann, including two autoclaves and two washer disinfectors from, and have found them

Kent Brushes has introduced the SONIK electric toothbrush, alongside a full range of oral health products.

Drawing on a rich legacy in brush craftsmanship, Kent Brushes delivers a distinctive blend of luxury and affordability to the oral care arena, including its star of the show – the SONIK toothbrush, which features:

• 36,000 sonic pulses for comprehensive cleaning

• Smart 2-minute timer with 3 custom brush modes

• High-quality bristles, individually rounded for peak performance

• Exceptional 45-day battery life, with rapid 2-hour recharge

•Sleek, waterproof design that’s both ultra-

the only dental exhibition they attend all year. It’s never been more important to keep a good practice team. Boost your staff retention with a trip to BDIA Dental Showcase in March!

BDIA Dental Showcase 2025 14th-15th March, ExCeL London dentalshowcase.com

Register your interest for 2025 at https:// dentalshowcase.com/register-interest n

dentalshowcase.com/register-interest

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

to be of great quality. They are all supported by the Care & Cover service package to keep up with regular servicing.

“I would rate Eschmann 10 out of 10, I can’t think of any way they could improve!”

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 753322 n

slim and lightweight.

Moreover, SONIK boasts an ergonomic handle designed for comfort, promoting effective brushing techniques with ease. Offered in pearl pink or graphite, these toothbrushes add a touch of elegance to any bathroom. Choose from either a standalone purchase or as part of the comprehensive Kent SONIK starter kit. The kit comes complete with all the essentials for a kickstart into superior oral care, available for individual purchase as well. A subscription service is also available for all items in the starter kit.n

Positive care for lifelong oral health

unlock a brilliant smile with Kent Brushes’oral care range

the need for speed

Using film for imaging is a slow progress with room for diagnostic inaccuracy – enter the CS 7200 Neo Edition, the natural evolution in image processing.

The scanner’s sleek aesthetic and enhanced compatibility matches the simplicity of the imaging plate system. Carestream Dental has designed an innovative system to lessen hefty workloads: high-resolution images can be accessed in eight seconds through the CS 7200 Neo Edition, and their precise detail and wide exposure range will provide you with the knowledge to make a confident diagnosis quickly.

The plates are easy to insert and are scratchresistant. They automatically erase after reading so they can be reused, keeping costs and time delays to a minimum. If you do need

replacements, they are inexpensive –especially compared to film and chemical expenses.

The rapid processing of sharp images will allow patients to be accurately diagnosed quickly, streamlining your workload and boosting efficiency. A timeconsuming workload is a problem, and the CS 7200 Neo Edition is the solution.

For more information on Carestream Dental visit www.carestreamdental.co.uk

For the latest news and updates, follow us on Facebook and Instagram: @carestreamdental.uk n

Proven image sharpness from clark dental

Provide chairside diagnosis with accuracy thanks to the Xios Supreme AE from Clark Dental. The experienced team at Clark Dental understands the importance of speed and accuracy in the dental practice. That’s why they provide the system that offers excellent image quality and the ability to view images immediately on your computer screen.

The Xios Supreme AE intraoral sensor is available in multiple sizes, allowing you to comfortably accommodate adult and paediatric cases. Additionally, the dynamic sharpening slider enables you to adjust your diagnostic settings for sharpness. For more information about innovate

A good interdental brush doesn’t just make your patient’s mouth cleaner – it makes their daily oral hygiene routine easier too.

The Curaprox range of CPS interdental brushes are a first-class option for combatting gingival inflammation, halitosis and caries. The ultrafine bristles have an umbrella effect, ensuring that the brush reaches as much of the interdental space as possible, whilst the numerous sizes available guarantee that there is an option for all patient needs.

CPS interdental brushes streamline the oral hygiene routine with their long service life. When they do need replacing, it is easy – the handle can be kept and only the tip needs replenishing. This eco-friendly clicksystem reduces plastic waste, supporting the

Eschmann, a leading British manufacturer of decontamination products and provider of firstclass support services in the field, has recently received the EU Medical Device Regulation (MDR) certification for its range of autoclaves. This achievement marks a significant milestone in ensuring the safety of medical devices within the European Union.

For dental professionals, this means they have access to decontamination products that can be depended on to minimise the risk of infection among staff, patients and practice visitors. Eschmann autoclaves have been designed, tried and tested to meet the highest standards of safety, performance and reliability. With this latest certification, Eschmann remains well-positioned to continue providing

Did you know… BDIA Dental Showcase is designed every year based directly on the professional insights and recommendations of a dedicated Advisory Board? The board consists of dental professionals from across dentistry, who have experience in different roles and treatment areas. This, coupled with our close working relationships with key associations and societies, further bolsters the quality of education and networking available.

This means that, unlike other dental tradeshows, the event is tailored specifically to what dental professionals want and need at the time, ensuring relevant exhibitors and educational programmes for all members of the practice team.

Next year, attendees can expect even more exciting trade stands, with BDIA Dental Showcase being the only UK exhibition to see many of them

solutions from Clark Dental, please visit the website and contact the team.

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

planet’s as well as the patient’s health.

For the reliable elimination of harmful bacteria and food particles, get the best interdental brush with the CPS range from Curaprox.

To arrange a Practice Educational Meeting with your Curaden Development Manager please email us on sales@curaden.co.uk

For more information, please visit: www.curaprox.co.uk and www.curaden.co.uk n

high-quality autoclaves to dental facilities across Europe. Find out more about the leading decontamination products and support available to you today.

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 753322 n

for 2025. There will also be more lectures and panel discussions, and – back by popular demand – will be more Clinical Excellence Workshops offering practical training in a live setting for dental professionals. Plus, we will continue working with an array of associations and societies to further bolster the quality of education and networking available.

BDIA Dental Showcase – proud to listen and deliver.

BDIA Dental Showcase 2025,14th-15th March, ExCeL London. dentalshowcase.com Register your interest for 2025 at https:// dentalshowcase.com/register-interest-prn

dentalshowcase.com/register-interest-pr

High flexural strength, natural beauty

BRILLIANT Crios Bloc (CAD/CAM solution) from COLTENE is the ultimate reinforced composite bloc for permanent restoration. Controlled, stress-free thermal curing gives BRILLIANT Crios high flexural strength. The compact structure increases the material resistance, reducing risk of fracture.

A broad spectrum of shades in two translucencies ensures BRILLIANT Crios blends in extremely well, providing natural aesthetics. The restoration can be quickly brought to a high gloss, so easy repolishing is possible at any time. Whether for inlays, onlays, crowns or veneers, in anterior or posterior regions, BRILLIANT Crios is the ideal choice, for

Dental mergers and acquisitions can be a complex business, with processes that can cause delays to completion if not handled effectively. The expert teams at Dental Elite work seamlessly together to provide you with the specialist knowledge needed for a smooth sale.

As Dr Arun Sinha says: “We have known Julie Randle, Senior Practice Consultant at Dental Elite, for a few years now and she has always been very approachable, providing friendly and professional guidance and support.”

Dental Elite takes pride in the efficiency and experience that make its progression team so effective, ensuring every detail connected with a sale stays on track for a timely completion.

superior strength and aesthetics. Find out more about the BRILLIANT solutions from COLTENE today! Email info.uk@coltene.com or call 0800 254 5115

COLTENE loyalty scheme https:// rewards.coltene.comn

Dr Sinha thanks the whole team: “Julie and her colleague Carl Wetton, Sales Progression Manager, ensured a smooth sale process and we are very grateful.”

You will ace your dFt year!

Kiroku is the excellent contemporaneous note taking system that makes it so easy to keep perfect records.

Dentists have designed the amazing AI-powered system to make lives easier for all clinicians. Knowing how challenging a DFT year can be, Kiroku is giving a big boost to new and recent graduates, with some incredible deals.

If you graduate this year, you can use Kiroku free for a whole year, then at 50% off for the following year. If you graduated in 2023, you can have the system for a free 14-day trial, then at half price for 12 months.

PLVEs get the 14-day trial for free, and the same 50% discount for a year if they provide proof of their contract.

Contact the team today find out how they can help you!

For more information on Dental Elite visit www. dentalelite.co.uk, email info@dentalelite.co.uk or call 01788 545 900 n

With Kiroku to take care of note taking, documentation and automatic compliance checks, you can ensure you have headspace and time to build your clinical observation skills, develop a rapport with your patients and educate them on principles that will change their lives for the better.

Register today to get your head start today! To find out how to apply go to trykiroku.com/ dental-foundation-training n

Eschmann achieves Eu Mdr certification for its autoclaves

www.the-probe.co.uk

referring is in the past

Enhance your practice with the CS 8200 3D Access, an advanced CBCT scanner that can grow your business.

Carestream Dental leads the way for dentists to follow. Providing razor-sharp 3D images within an ultra-friendly user interface, their innovative CS 8200 3D Access scanner is designed for compatibility and speed and is available with an extended ten-year warranty.

Having a CS 8200 3D Access scanner at your practice removes the need to refer patients for this type of imaging, instead allowing practitioners to instantly scan with low doses during consultations. The scanner’s versatile 4-in-1 solution blends panoramic imaging, 3D model scanning, optional cephalometric imaging and

The Align, Bleach and Bond course from the IAS Academy pushes clinicians to further their restorative and cosmetic treatment capabilities.

Dr Mili Mohan, from Grosvenor Place Dental Practice, Mold, shares her experience:

“I was looking for a course where I could learn more about clear aligners and composite edge bonding. There were a lot of recommendations online; one post was asking for a life changing course, and this was amongst the responses.

“I’ve been on composite courses before, but no one has explained it all in a fool proof method like Tif (Qureshi) did. He was amazing, really approachable and knowledgeable.

“I really recommend it, not only as a composite course, but for those with an interest in aligners in general. Tif broke down the advantages and disadvantages of different systems into simple terms, and told us how to present options to

CBCT imaging to expand treatment options. These precise images will improve patient communication and education about their oral health, and ultimately ensure patient satisfaction. Eliminating the lengthy process of referrals with a CS 8200 3D Access scanner will make your practice an efficient and reliable place for patients, with the chance of gaining new ones.

For more information on Carestream Dental visit www.carestreamdental.co.uk

For the latest news and updates, follow us on Facebook and Instagram: @carestreamdental.uk n

patients for better understanding.”

Clinicians can find out more about the opportunities to develop their skillsets through the Align, Bleach and Bond course, and so many others, by contacting a member of the IAS Academy team today.

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

Amalgam waste goes green

The Back to New – Recycled Collector Cup package is the new essential service from Initial Medical for dental clinicians who want a simple, environmentally friendly, and effective way to manage their amalgam waste.

The Initial Medical team provides recycled, single-use collector cups that have been cleaned and treated to be as good as a brand new cup, for compliant use in your practice. Full cups can be simply placed in the provided collector cup drum, which ensures your storage is completely safe and compliant with current regulations.

An expert Initial Medical Service Technician will collect your collector cup drum, which will then be recycled at our specialist dental recycling centre.

The Back to New – Recycled Collector

You can feel reassured that your patients requiring advanced treatment are receiving the best care possible when you refer them to the Centre for Oral, Maxillofacial & Dental Implant Reconstructive Surgery.

Led by eminent specialist oral surgeon, Professor Cemal Ucer, the clinic has it all. With an uncompromising, comprehensive suite of advanced digital systems and equipment managed by a highly skilled and caring professional team, you always have unparalleled resources at your fingertips. Professor Ucer, Honorary Professor in Dental Implantology and postgraduate dental studies at University of Salford, has 30 years of experience in treating complex cases and helping thousands of patients to get the quality

Products

Excellent service and professionalism

Dental Elite supports clients through all aspects of their dental practice purchase, providing bespoke services to suit experienced buyers, as well as individuals just entering the market.

As Dr Sukhvir Aujla recently said of his purchase: “The team are very approachable –especially Luke Shelton, who always answered my calls, and called back even if he was busy. He clarified all my doubt during the whole procedure of buying my first dental practice. I was very nervous and scared, so was questioning them a lot but they explained it all very well.”

As an experienced buyer, Kevin Soopen had this to say: “I have acquired practices via Dental Elite and I have been impressed with

Dr John Barclay uses Kiroku, the digital note taking platform, to make his note taking more efficient. He discusses his experience with the platform, and how it has changed his note taking workflows:

“I first realised I needed a solution like Kiroku when I was repeatedly having to leave my note writing to another time and returning later to incomplete notes. My dental nurses were unhappy with that workflow. Kiroku has helped me to solve this by enabling me to take more complete and in-depth notes at the touch of a button, rather than typing the same things over and over.

“My favourite part of Kiroku is that all the warnings that I need to give to the patient relating to each procedure pop up when clicking on treatment options. This is a really helpful

Cup package is not only impressively practical, with a reduced impact on the environment it also provides a cost saving compared to individually buying new collector cups, a collector cup drum, and a collection service.

To learn more about safer amalgam waste workflows, get in touch with the Initial Medical team today.

To find out more, get in touch at 0808 304 7411 or visit the website today: www.initial.co.uk/medical n

of their lives back on track.

You and your patients can always expect excellent care, with the Centre for Oral, Maxillofacial & Dental Implant Reconstructive Surgery. Contact the team to find out more today! Please contact Professor Ucer at ucer@ icedental.institute or Mel Hay at mel@mdic.co. 01612 371842 www.ucer-clinic.dental n

their overall service and professionalism. They guided me through the transactions from start to finish. I have to give a special mention to Laura Dewes who always goes over and beyond in service she provides. Thank you!”

To find out what Dental Elite can do for you, contact the team today.

For more information contact the Dental Elite team on 01788 545900 https://dentalelite.co.uk/ n

reminder, and ensures I don’t miss any information. I’m now much more confident that my notes are complete, especially with large treatment plans which include all the relevant warnings. I also asked the Kiroku team to create my current template which I love – it made the setup process really simple.

“I would recommend Kiroku to others – I’m sure that many people like me love doing the work, but want to spend less time on record keeping whilst still achieving great notes.”

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

the importance of interdental cleaning

Studies show that interdental brushing can significantly reduce the build-up of harmful bacteria, which can otherwise lead to periodontal tissue inflammation, even after toothbrushing. FLEXI interdental brushes from TANDEX are the perfect solution to recommend to patients. Available in 11 different sizes, there’s a brush to effectively keep every interdental space clean and healthy.

While toothbrushing is vital for maintaining oral health, research shows that the actual plaque removal averages at 42% without additional interdental cleaning. Educating patients on how to use interdental brushes to reach every vulnerable area of the mouth is easy with the FLEXI Educator tool. Not only can it help patients understand how to properly keep interdental spaces clean,

Save time with payment transactions by using AeronaDental, the cloud-based dental practice management software that makes everything faster.

AeronaDental has integrated Dojo, a flexible and secure payment provider, into its efficient service. Over 100,000 business locations use Dojo in the UK as it is 58% faster than the average mobile card machine. Faster payments mean a quicker service and greater patient satisfaction.

it reminds them which size brush they need and has a handy appointment reminder. Finally, applying just a small amount of PREVENT Gel from TANDEX to FLEXI interdental brushes is recommended to add the antimicrobial effects of chlorhexidine, as well as the strengthening effects of fluoride. Find out more about the range of interdental brushes from TANDEX today! For more information on Tandex’s range of products, visit https://tandex.dk/ Our products are also available from DHB Oral Healthcare https://dhb.co.uk/ n

tandex.dk

With AeronaDental, practices can access a 30-day free trial of Dojo to see how effective it is. Its secure point-to-point encryption makes it easy for patients to pay in multiple ways –deposits and balance payments can be done in person, over the phone or via payment link. This increases their engagement and makes the appointment process easier for all.

To save time and enhance the patient experience, consider the advantages of cloud-based practice management software AeronaDental.

For more information, please visit aerona.com or call 028 7000 2040

Follow us on LinkedIn: @AeronaDental Software and Instagram @aeronasoftware for the latest updates n

Oral cancer awareness

dr George Wright outlines what clinicians need to consider when it comes to suspected mouth cancer cases

November is mouth cancer action month. Latest figures show that 8,864 people in the UK were diagnosed with mouth cancer last year1. Sadly, the 10-year survival rate is between 18% and 57% depending on the location and how early it is diagnosed, with latest figures showing 3,034 people in the UK lost their life to mouth cancer last year1

Dental professionals see many patients every year, and although it is unlikely that a dentist will see more than one or two cases of mouth cancer during their career, a vigilant approach should be adopted if malignancies are not to be overlooked. Unusual infections relating to retained roots or appearance of an infection adjacent to otherwise healthy teeth, unexplained mobile teeth, local osteomyelitis, swellings or discharges are signs to be wary of, and any oral and facial lumps, swellings and ulcerations that do not respond to the usual or accepted lines of treatment or do not heal in the usual way should be investigated further.

Screening

Luckily, when patients visit their dentist for a routine examination, it presents an ideal opportunity for carrying out an oral cancer screening. Following the basic principles of a dental hard and soft tissue examination will alert dentists to the possibility of a benign or malignant lesion requiring investigation and/or follow-up. An awareness of the risk factors and their relevance – for example, age, family history, ethnicity and social habits such as smoking or alcohol consumption –are all important considerations for clinicians. A medical history can reveal a recognised risk factor for mouth cancer, which may or may not be relevant to lesions seen in the mouth. For this reason, any such screening should include a lifestyle enquiry (use of tobacco, alcohol, betel nut, etc.) and a regular review of the patient’s medical history. Smokers should be offered and encouraged to seek professional help with smoking cessation.

The most effective oral screening is one that follows a consistent, structured and reproducible format for each and every adult patient. Ideally, this should involve a visual inspection of all areas of the mouth, including the floor of mouth, gingivae, sulci, palate, tongue and oropharynx. Any unusual lesions should be palpated and examined by touch. Careful questioning of the patient can also help to identify any abnormalities or concerns.

A record should be made in the clinical notes of the site, size, colour and consistency of any lesion. Diagrams, photographs or intra-oral camera images can be helpful too, so future comparisons can more easily be made.

Further investigation

An extra-oral examination should also be performed, routinely checking the symmetry, salivary glands, lymph nodes and temporomandibular joints. A careful review of the rest of the face can reveal a variety of skin lesions, such as melanoma, basal cell and squamous cell carcinoma.

Any suspicious findings should be followed up by prompt referral via the appropriate local pathway. Dental practitioners should be mindful that they may be the only healthcare professional who can see the patient and identify these conditions in time to make a difference to the prognosis.

Part of the monitoring process is explaining to the patient what is normal as well as what changes to look out for. Monitoring is most successful when patients are actively involved and feel that they can easily and quickly report changes or concerns. If they do, it is imperative that these reports are taken seriously and acted upon.

Second opinions

If there is any doubt about an individual case, it may be possible to ask a colleague in your practice to have a look at the patient with you. Any referral to a Maxillofacial Surgeon or Oral Medicine specialist should be made with the patient’s consent, and this will need to include an explanation as to why a second opinion is being sought. If this is done firmly but sensitively, it need not alarm the patient. Try to avoid trivialising the matter as the patient may not appreciate the need to act upon the referral.

A referral should include a proper summary of the case, including a provisional diagnosis if one can be made, and a clear statement of your concerns about the patient. It should also include all the necessary data that the specialist will require in order to determine the urgency of the referral, and a statement about the patient’s relevant medical history and relevant risk factors, as well as a description of the clinical findings.

Follow up and record keeping

Ensure you follow up and monitor every referral relating to oral lesions and suspected pathology. If the lesion is serious enough to

merit a second opinion, it is serious enough to follow up. To suggest a referral and then to take no further interest in the outcome has, in the past, been criticised as a breach of the dentist’s duty of care.

Record keeping allows the dentist to demonstrate every conversation, procedure and test that has taken place. These should include both positive and negative findings, and the consent obtained from the patient.

In a situation where a patient alleges negligence against a practice or a clinician but failed to attend a review, claims can be more easily refuted if the patient record clearly documents the examinations that were carried out and the appointments that were made. In addition, it is often helpful to have a record of the attempts to make appointments, contact the patient or follow up on any referrals made.

delays

A late referral for a suspected malignant lesion may cause the patient unnecessary distress, pain and suffering through the delay in obtaining a diagnosis or treatment. There are many cases when some delay in referral is inevitable because of the need to eliminate the more common problems, but any delay must be justified within the records, showing a proper consideration of the history taking, assessment, investigations, and appropriateness of treatment planning and monitoring decisions.

To ensure that any lumps, lesions, swellings, discharges or ulceration are properly assessed, it is important that dentists stay abreast of current developments in the assessment and diagnosis of these types of lesions.

complaints

Unfortunately, members of the dental team are vulnerable to complaints from patients

and/or their family members where it is felt there have been errors causing delays in diagnosis. These complaints require very careful management as, inevitably, the consequences for the patient can be significant and, where a patient has lost their life to mouth cancer, family members can be understandably tenacious in seeking redress. Members of Dental Protection should seek early advice as soon as they become aware of any delays in referring patients and/or diagnosis, or at the earliest opportunity following receipt of a verbal or written complaint.

Summary

The management of an oral malignancy depends on the specific diagnosis and the stage of the tumour. It is therefore crucial to refer any suspicious lesions to an experienced specialist at the earliest opportunity.

A delay in referral can have devastating consequences for the patient, leading to allegations of negligence. Effective patient management in these cases is a balance between best clinical practice, informed by regular continuing professional development, and underpinned by accurate and appropriate record keeping. n

references

1. Mouth Cancer Facts and Figures, Mouth Cancer Foundation: https://www.mouthcancerfoundation. org/mouth-cancer-facts-and-figures/

about the author dr George Wright, deputy dental director at dental protection.

The upheaval of a patient complaint could happen to anyone. Our dentolegal experts will help get things back to normal.

Understanding your practice value

Martyn bradshaw of PFM Dental explains the importance of a dental valuation, whether you are selling on the open market, to a body corporate, or as an internal (partner or associate) sale

How are practices valued?

In starting a career valuing dental practices over 20 years ago, practices were valued very differently to how they are now. Prior to 2006, practice goodwill was typically valued on a percentage of turnover. Then, to ascertain the total practice value, we would add the second-hand value of the in-situ equipment to the goodwill. However, as corporate dentistry grew, and financial modelling became more sophisticated, this changed to using a multiple of EBITDA (earnings before interest tax, depreciation and amortisation). The multiple used is the number of years in which it would take the buyer to recoup their investment (before interest, tax, depreciation and amortisation).

To calculate the EBITDA of a practice takes expertise and someone who understands the industry. There is a significant amount of adjustments made when calculating the EBITDA, of which allows us to depersonalise, remove tax reducers and things that would not continue post sale. However, there are also a number of benchmarking exercises that need to be undertaken.

Principal led vs associate led There are two EBITDA calculations that, as a valuer, we would perform. Firstly,

with an ‘associate led’ model assumes that all of the income generated has a relevant associate cost against it. The second is ‘principal led’, in which it is assumed that there is one principal and the remainder associates. We then use whichever valuation method gives us the better value, and this also provides some insight as to who the likely buyers would be. It should be noted that this is not how you currently work the practice, this is simply calculating what the ‘principal led’ EBITDA and ‘associate led’ EBITDA would be for your practice.

What happens if the associate led gives us the higher value?

If this is the case, then we can approach all types of buyers, whether they are true body corporates, small/regional corporates or owner occupiers. Typically, the larger body corporate will only look at associate led EBITDA of £250,000+, so for those with smaller EBITDAs, it is likely that the smaller/ regional corporates would be potential buyers or owner occupiers.

What if the principal led gives us the higher value?

If the principal led calculation is giving a higher value, then in reality we need to sell to an owner occupier,

as the associate led value does not provide the enterprise value that they would require. Thus, it is worth more to someone looking to work in the practice than it is to a corporate.

finding the correct buyer

Whilst the practice value will indicate the types of buyers that your practice would suit, this is also likely to be affected by what you want from the sale. If you wish to leave immediately on sale, whether you want to pass the baton to the next dentist to carry on the practice, or whether you wish to sell to a corporate and remain in the practice post sale.

conclusion

Anyone who is selling their dental practice should enlist the use of a specialist dental practice valuer. The calculation of EBITDA is one that takes expertise and experience, and calculating this incorrectly can be very costly. An undervaluing of just £10,000 EBITDA can cost you £75,000 in sale price. An experienced valuer can also look at the likely buyers specific for your practice, which will be dependent on area, type of practice, as well as the income –therefore, marketing the practice to the correct types of buyers to ensure that you get the best out of the sale. n

PFM Dental offers a comprehensive range of professional services exclusively for dentists. Since 1990 we have been trusted advisers to the dental profession with a hard won reputation for sound, ethical and independent advice. Our services incorporate 4 key departments: practice sales and valuations, independent financial advice, dental accountancy and dental legal services.

https://pfmdental.co.uk/

about the author

Martyn bradshaw is a Director of PfM Dental and heads up the dental practice sales agency.

How much marketing is enough?

Striking the balance between engagement and overload

In today’s competitive dental market, effective marketing is vital for attracting new patients. But finding the balance between engaging potential patients and overwhelming them can be challenging. Knowing how different marketing efforts complement each other is essential for success.

The patient journey: a multitouchpoint approach

Patients rarely book an appointment after just one interaction. Typically, they experience several touchpoints before reaching out. For example, a patient might click on a Pay Per Click (PPC) ad but not fill out a form. Later, they come across your practice on Instagram or Facebook, reinforcing your brand and building trust. Eventually, retargeting ads on social media help keep your practice top-of-mind, guiding the patient towards making an appointment. PPC grabs their initial attention, social media nurtures recognition, and retargeting keeps your practice visible. This synergy across platforms makes marketing more effective without overwhelming the patient.

Marketing fatigue: knowing when enough is enough

Overexposure to ads or marketing messages can harm your brand. Studies show 54% of UK consumers feel bombarded by ads, while 63% believe businesses should prioritise quality over quantity. For dental practices, where trust is crucial, too much marketing can lead potential patients to head over to your competitors.

The role of email marketing

Email is a vital tool for keeping patients engaged. For existing patients, it can offer appointment reminders or share useful information that can help strengthen your relationship. A 2023 UK study found that 72% of patients appreciate healthcare-related emails, provided they aren’t too frequent. At Connect My Marketing, we recommend sending one to two emails per month to stay connected without overwhelming recipients. For prospective patients who haven’t yet booked, targeted email campaigns can help convert their initial interest into action. Automated follow-ups with helpful information

or special offers can reignite their interest in your services.

finding the right balance

To avoid overexposure, it’s essential to tailor your marketing strategy. PPC ads boost visibility, but too many can lead to audience fatigue. Retargeting on social media is effective, but research suggests limiting impressions to four or five per user per month. Social media posts should also be balanced – posting quality content a few times a week often works better than daily updates. SEO remains a key component of your strategy, helping your practice appear organically in searches. In fact, 53% of our clients’ website traffic comes from organic search (28% if PPC ads are running), showing that even if patients don’t click on your ads, they can still find you through optimised content.

complementing rather than bombarding

Ultimately, successful marketing is about finding the right balance. Each channel should complement the others,

creating a seamless experience for potential patients. Setting clear goals, monitoring performance, and scaling back when necessary, ensures your marketing remains effective without becoming intrusive.

Navigating the world of multi-channel marketing can be challenging. As a full-service marketing agency, we can integrate PPC, SEO, social media, email, and retargeting into a unified strategy that maximises your reach without overwhelming your audience. With experts handling your marketing, you can focus on providing excellent care to your patients. n

The statistics provided in the article are based on general trends and available online reports from the following sources: Ofcom, eMarketer, Statista, Chartered Institute of Marketing (CIM), HubSpot, Marketing Week, NHS Digital, McKinsey, MailChimp, Campaign Monitor, BrightEdge, SEMrush, YouGov and Direct Marketing Association UK.

about the author

Jay Dickens, social Media Manager at connect My Marketing - Meta and Google certified. connectmymarketing.com

Telling the team

Selling your practice? abi Greenhough, Managing Director of Lily Head Dental Practice Sales, explains how and when is best to inform your team

When we take any practice to the entire market, we must present the key features of the practice and give an indication of the practice location to make it an interesting proposition to prospective purchasers.

At the same time, we must conceal the exact identity of the practice. This is so that no unscrupulous people can make direct approaches or actively try to recruit their patients. We also want to keep the news from staff to make sure the practice does not become destabilised. We conduct our own due diligence on purchasers before we share the location of the practice and the practice accounts.

Prospective buyers are bound by an NDA but will instinctively support you in this. Buyers are interested in sustainability and the staff that are directly involved in delivering the services, revenue and profit are crucial to that.

We often find vendors become conflicted when we ask them not to tell their own staff. They sometimes find themselves living a lie, talking about holidays in the next year, plans or investments that they know are no longer their remit. The principal must reconcile themself to this.

In this article, we’ll cover the best way to inform your employees, the best time to tell them, and what happens to your employees post-sale. But first, let’s consider the rationale behind withholding this information, which is often counter intuitive.

If you tell your team too early, you run the risk of competitors finding out and poaching your patients. You may also find some of your employees start looking for a new job if they are worried about job security, their terms and conditions, or the leadership style of the as yet unknown new owners.

By waiting to tell your employees, you will have to keep that information confidential for the duration of the sale and purchase process. With deals taking six-nine months to complete, there will likely be some risks to confidentiality along the way if you are not disciplined about this. When selling a business, many principals have a number (£) in mind, which is the key to the lifestyle they want in retirement. Much of the goodwill of the business lies with the clinician and the current team in the practice. The goodwill value is not just the patient list, the accounts and the brand.

One of the tasks of the principal is to maintain the value of the goodwill during the sale process for themselves and their buyers. As we know, the sale process can extend

for more than a year. If the goodwill (£) is put at risk, then it simply gives purchasers an opportunity to renegotiate the price or, worst case scenario, walk away from the deal.

Whilst a good dental broker will mitigate much of that, no broker can completely overcome circumstances that significantly degrade the goodwill value of the practice. Stability and sustainability are key components of the goodwill value.

My advice is to keep the sale confidential until you are one to two weeks from completion. That will help protect your team from their own anxiety and help you keep the practice running smoothly during the sale process.

I also recommend you conduct a review of who does what in your business. By that I mean by whom is the revenue and profit generated across your team?

High earners (£) can be a great asset to the business. However, during a sale, they can become a risk if they do not support the sale. I had a practice where the principal had to abandon all hopes of selling for the next five years because purchasers could not agree terms with a high earner.

If there are associates in your business grossing >£400,000 p.a., then consider how you can manage that risk as you consider selling the practice. As the principal, you should ensure you do not fall into this category also. This is, of course, a real dilemma because this person is responsible for delivering a

significant amount of revenue but, if they decide not to cooperate for any reason, they become an equal and opposite risk to the goodwill value.

When considering how to tell your team, I recommend working closely with the buyers and dental broker on this. You should collaborate on the messaging and agree on the timing. Completions can get delayed. Everyone has to stay very close to what the agreed completion date is and work diligently towards that date. I suggest bringing the entire team into one room, either in the practice or off site. Avoid video calls. Tell the team how much you appreciate their hard work and commitment that has led to the success of the business. Then, tell them you have sold the practice and explain your reasons for selling. You will be amazed by how many people are not shocked. People know that you cannot go on forever and, in fact, are relieved there is a succession plan in place that gives them security of employment beyond your ownership.

Next, talk about the buyer and their qualifications. Reassure them that you picked someone whom you trust to take care of them, the patients and the practice.

Following this, introduce your team to the buyer(s) as soon as possible so they can reassure your employees and begin connections. A lunch often works well. Always keep the conversation positive and focus on the future of the practice. There are some legal requirements around the transfer of staff to the purchaser.

If they are being transferred, it’s important to let them know their employee contracts will be automatically transferred to a buyer under their existing terms (excluding pension rights). If it’s a share sale, everything will of course stay the same for them.

When the new buyer takes over, all the seller’s rights, powers, duties and liabilities are passed to the buyer, together with the employee contracts.

In an asset sale, there must be a period of consultation with staff, which should take place one to two weeks prior to completion. There is no legal requirement if you are selling a limited company; it is more of a public relations exercise in these circumstances.

I have seen an alternative strategy applied, which can work. I have known principals tell their staff right at the outset of the sale and purchase process.

Whilst I don’t recommend it, I have seen it work. It really depends on the principal’s relationship with the staff. If they have always been very open about their personal life, goals, hopes and dreams, then selling may not be a surprise to those team members. If the culture of the practice is more like a family than a business, and the staff are sharing your life journey with you, then it might work just fine. n

about the author abi

Greenhough, Managing Director of Lily Head Dental Practice sales.

The 10-year contract – is the orthodontics market moving again?

As we have discussed previously, NHS contracts for providing orthodontic services have been a contentious issue for many when assessing the goodwill of their practices. After regulatory changes some years ago, contract lengths could vary by several years from county to county, resulting in highly variable goodwill, which is not always in the control of vendors. It is likely a topic we will continue to revisit due to the significant impact it has had on valuations and the sales market in many regions of the UK.

Contract length and goodwill

After the 2017 announcement by NHS England that there would be a nationwide procurement process to award new contracts to those about to expire, goodwill plummeted for many, with contracts as short as 5-6 years rolled out. Contracts for practices in London and the South East bucked that trend, with seven year contracts awarded, including an option to renew for a further three years. There was an immediate positive effect on goodwill for orthodontic practices in these areas. It came as welcome news to those in Hertfordshire and Essex when it was announced that 10-year NHS contracts in the orthodontic sector were to be rolled out from June this year, and many in the industry have been watching how the market has responded to the change with keen interest.

In the time following the introduction of longer contracts, how has goodwill been affected, and would orthodontic practices in the remaining counties in the UK benefit from the same offer?

The impact on risk perception

The impact on the dental market in Hertfordshire and Essex has already been significant. Much of this can be attributed to the changes to perceived risk.

For example, a practice in this region with a £2m turnover, with a short duration remaining on their contract, recently resulted in a maximum valuation of 500k. With luck, a 3-year extension might have added about 30% – perhaps from a corporate or a group who could afford to manage the risks associated with not having renewal guaranteed after that time.

Since the announcement, this scenario has been flipped on its head. With a 10-year contract, the same orthodontic practice is on track to be worth £3.8 million. In a sale, it can expect 70% up front on completion, deferring the remaining 30%. The gain based on the improved goodwill is substantial.

Renewed vigour

There is evidence that the added security of just a few years to orthodontic contracts has energised the market. In the time since the announcement was made, many other practices have

received healthy offers. While the longer contracts only affect Hertfordshire and Essex at the moment, the expectation is that the success of the scheme in these two counties will work for the remainder of the country long-term.

Short contracts resulted in many buyers – particularly individuals – being excluded from the orthodontic market. An owneroccupier loan against an orthodontic practice might well have a 10 to 15-year duration. It simply doesn’t add up to a buyer or lender to undertake the risk based on a 3 to 4-year contract.

A lot of orthodontists are keen to see improvements to contract duration rolled out further to support the owneroperator market. This would enable them to access practices – particularly the larger orthodontic practices – which at the moment are predominantly bought by the groups.

Managing risk

An orthodontic practice may well have a fresh 10-year contract, but by the time a sale gets to completion, that duration is reduced by a year. A bank will take a view on a 9-year contract – but there’s essentially a lot of road ahead. They can at least be satisfied that there will be consistent income for the remaining 9 years. If that was flipped on its head, with say 2 or 3 years left, that’s a less favourable risk as the income is not guaranteed for long enough.

A safety net for your income

The need to safeguard your salary is especially true for the selfemployed. Without full income protection, self-employed workers may find themselves in an undesirable financial situation if they are off for an extended period of time.

Accidents and critical illnesses are unpredictable. Dental practitioners can come into contact with dozens of people every day, increasing the risk of becoming unwell. From a few days off to an extended period away from work, self-employed dentists (either sole traders or in a partnership) need income protection insurance. This acts as a safety net to cover your leave in the event of an accident or illness, helping to maintain your standard of living.

Income insurance provides for those who are deemed medically unable to work, paying a monthly income for sick or injured practitioners. Usually, a maximum of 65% of the monthly income can be covered by the protection insurance, and this is not taxed when claimed. For self-employed workers, the 65% maximum is based on your net profit; the income after tax deductibles. Income insurance cannot be claimed whilst the person is also on sick pay – the policies don’t allow you to earn more when you’re not working. The insurance cover will last until you either return to work, retire or pass away.

There is no maximum claim length. For those who agree to a policy that covers them until they retire, it is important to ensure that your retirement plans are properly planned. For instance, if the initial retirement age you have set is 60 but you continue to work to 67, a new income insurance policy will have to be taken out for those 7 years. As a greater age may mean a greater vulnerability to illnesses, a new insurance policy may be increasingly expensive. So, ensuring that the end date of your policy aligns with your retirement is important.

Whereas other insurances like locum cover, car and home insurance have annual renewals, income protection does not. If you make any claims or you have a significant change to your health after taking a plan out, there will not be an impact on the price you pay or the cover you receive. This reinforces income protection as a reliable safety net. However, there are two ways of paying the insurance rates: at a reviewable rate, or a guaranteed rate. Reviewable policies function in shorter term periods, such as every five years or so. When that period is over, the insurance company will review your case. If, over the five years, you have made several claims or have developed health complications that may mean you are likely to make more claims in the future,

Keeping a keen professional eye on the dental mergers and acquisitions market for the past 15 years, Dental Elite offers personalised guidance, support and advice to all its clients to enable the best possible outcome on every sale. Dental Elite benefits from decades of collective specialist dental market knowledge and experience to assist buyers and vendors navigate their way through the complexities of a sale or purchase, from the initial consultation stage through to completion.

In terms of whether the orthodontic market is moving again due to longer contracts, the short answer is, yes. 10-year contracts offered in Essex and Hertfordshire have already made a significant difference, and renewed interest in the orthodontics market. Unfortunately, only two counties in the UK are currently affected, but there is good reason to think this will change quite considerably over the coming months.

For more information on Dental Elite visit www.dentalelite.co.uk, email info@dentalelite.co.uk or call 01788 545 900 

then the payment rates may increase. Similarly, if you did not make any claims and are healthy, the payment may decrease.

In contrast, a guaranteed rate sticks to the same price for the duration of the insurance policy. A guaranteed rate is not affected by deteriorating health complications or how many claims you make. Given the unpredictable nature of accidents and critical illnesses, a guaranteed rate can provide a consistency and ease both financial and health concerns. Of course –the monthly payments you will make for the insurance are linked to inflation, and so will increase accordingly with the economy and your own income.

When taking out a policy, observe any exclusions. Some circumstances, such as alcohol-induced accidents, extreme activities, and even pregnancy-related situations may prevent successful claims.

The array of policies can be overwhelming. With money4dentists, we can support you with our team of talented Independent Financial Advisers (IFA). Having spent years working with dentists to get them the best income protection policy, the invaluable experience of our IFAs can ensure your financial safety.

For more information, please call 0845 345 5060 or 0754DENTIST, email info@money4dentists.com or visit www.money4dentists.com 

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