wind-the-music-box:

wind-the-music-box:

Trying this again because my last post was getting notes but no donations.

I need to have a root canal to take care of a tooth that broke in half, and the insurance won’t pay for it. Plus I have other bills that need paying before my next check would come in.

I’m over halfway to my goal, but I need a little more help by the 15th. If you can spare even a dollar, that does SO much.

Thank you to everyone who’s already helped me out, you guys are literally lifesavers. I hate begging the internet for money, but I really am out of options.

$247.92 / $350

Pay Courtney Brink using PayPal.Me

Okay, guys, I’m having this procedure on FRIDAY and I cannot stress this enough-

If I don’t hit my goal, I will not have enough money to pay for my phone, my rent or my medication.

If you have even a dollar to spare, Hell, even 15 cents, it would mean so much.

I have done the math and CANNOT make this number any lower. As it is, I’m cutting it close.

$247.92 / $350

If you have any digital pocket change, this is a great way to spend it! Please consider lending a hand to my friend. She has until the 15th to make enough for a root canal. If you can’t donate, which is understandable, please at least reblog this and use the first five tags I’ve added below, it would mean the WORLD to us! Thank you somuch!

I’m so excited. I’m looking forward to it so much. August 5th!!

https://gofund.me/680eddf4

Michael Copeland, senior area manager at Wesleyan Financial Services, explores how dentists can get the most out of their lockdown savings.

In the face of new infection control protocols and looming backlogs of patients to see, managing personal finances might have understandably fallen to the bottom of your to-do list.

Lockdown might, however, give you the opportunity to save more than usual. Our own research found that, on average, individuals saved.

If you have been able to put some extra away, it is important to consider how you can use this money to support your personal and financial goals and make it work as hard as you do.

Here are four key things to think about when it comes to using those extra lockdown savings.

Review your savings plans and targets

Accompany any savings habit with a savings strategy. Understanding what you need the money for, combined with your own personal circumstances, will help you determine the best way to manage your money.

An ability to save that little bit extra over the past year might have meant that you’re now closer to any existing goals you had established. Or in a better position to set-up new ones.

As a very first step it is important to review your targets to ensure they align with your current circumstances.

Before putting money towards any goals, however, consider whether you need to start, or top-up, an emergency fund for a rainy day first.

Setting aside three months’ worth of net household income is a good starting buffer. With this in place, you can then think about committing money to other savings pots.

Don’t overlook retirement

For some, retirement can feel like a long way off. But it’s important to start planning for the day you step back from your practice as early as possible.

You may want to consider putting any extra lockdown savings towards your retirement plans. Speaking to a financial consultant can help you understand the best way to put your money towards your retirement. Be it investing or by purchasing additional pension through the NHS Pension Scheme.

If you haven’t yet established a retirement strategy, now could be the perfect time to do so.

Again, a financial consultant can support with this process. They can help you calculate the financial implications of choices such as buying additional pension. As well as understanding when you can start to withdraw funds from your pension savings.

Investing, investing, investing

With interest rates currently lower than inflation, simply keeping cash in the bank means that the value of your savings effectively falls over time.

Putting some of your extra lockdown savings into investments can provide a way to grow your wealth by helping to beat low interest rates, outperform inflation and build new income streams.

And you don’t need huge sums to start investing. Any amount of money you can put to work.

The very first thing to consider is whether investing is right for you.

Investing isn’t a ‘quick win’ and generally takes place over longer periods of time. At least five years, but typically longer. If you know you might need your savings sooner, investing might not be the right option.

You will also need to consider your appetite to risk. The value of your investments can go down as well as up.

Maximise tax-efficiencies

Using your tax-free savings allowances can help you make the most out of the lockdown cash you’ve put aside.

Putting your money in an Individual Savings Account (ISA) is a good option to consider.

You can save up to £20,000 tax-free into an ISA for both the 2020-21 tax year and for the upcoming 2021-2022 with no tax charged on any interest earned.

The deadline for using your ISA allowance for 2020-21 is midnight on 5 April. You cannot carry over any unused allowance from year to year.

There is a range of ISA types you can use. For example, a cash ISA allows you to save money in cash. Meanwhile, a ‘stocks and shares’ ISA – such as Wesleyan’s With Profits ISA – allows you to make investments with your money in assets like funds, bonds or individual stocks.

The Wesleyan With Profits Fund was recently ranked first place by independent actuarial services provider Barnett Waddingham. The five-year net return is 7.31%, which puts the fund in first out of 20* funds for overall performance. And because it’s an ISA, customers didn’t pay tax on any returns they earnt.

Seek support

Whatever your savings position – and however much extra you’ve saved over lockdown – speaking to a financial consultant can help you understand the best way to use your money to support your personal and financial goals.

At Wesleyan Financial Services, we understand dentists’ unique financial needs. Our specialist financial consultants are on hand to offer advice at every stage of your savings journey. From setting targets through to reviewing your pension savings.

For more information visit: www.wesleyan.co.uk/secure/dentists-1002662.

Keep in mind that investment values are not guaranteed and can go down as well as up. You could get back less than you invest.

*Only 20 of 65 funds provided five-year net return data for comparison.

The post Lockdown lifted your savings? Top tips for making your money work for you appeared first on Dentistry.co.uk.

Mars Purifier explains how its air purification system is a reliable way to help increase efficiency in the dental practice.

Mars Purifier is the only UK-based company accredited to ISO 14464. Supporting documentation is supplied with the purifier, which users can submit as evidence during an inspection.

Dentistry and COVID-19

The world is currently faced with a threat to its health that has changed millions of lives forever – COVID-19.

Research has shown that COVID-19 is an airborne virus that is most adhesive to the oral mucosa and the upper respiratory system. Working directly in patients’ mouth exposes dentists to a higher threat than most professionals (Cevik et al, 2020).

As we try to regain a sense of normality, we must be thorough and pragmatic in our approach.

Throughout the year, there has been an introduction of new guidelines. At the time of this article (March 2021), routine care has resumed with the aid of air purifiers/cleaners, which has been advised and recommended by many relevant authorities (BDA, SDCEP, FGDP, PHE, SOP)

We must remember that the safety of patients and staff is paramount and cannot be left undetermined. There should not be any ambiguity regarding how dentistry should progress. There is a need for clarity and standardisation.

This article aims to provide clarification on Mars Purifer specifically and how to use it to benefit the dental profession.

Key terminology

• Air purifierorair cleaner/scrubber – a device that removes contaminants from the air in a room to improve indoor air quality
• PPE – personal protective equipment (varies on the procedure)
• AGP – aerosol generating procedure – involves clinical procedures where airborne particles are created via highspeed drills and scalers
• CADR – clean air delivery rate. This is the value to determine the ‘power’ that varies from purifier to purifier
• Fallow time – the ‘settle down period’ after an AGP before clinicians can use the room again. Dependant on ACH = CADR/vol +/- mitigating factors
• ACH – air changes per hour – the value associated with how many times the air in a room is cycled
• UVC/UVGI – ultra violet germicidal irradiation
• HEPA – high-efficiency particulate air.

Dentistry and air purification

In response to recent events, the interest in air purification solutions has risen substantially.

The impending eventual return to everyday life means something different in the field of dentistry. Dentistry expects to see more patients to relieve the backlog caused by the stagnation of care within the last year.

Most practices at the moment are in a delicate position of trying to meet NHS targets, maintaining a safe environment and ensuring the patients feel comfortable attending appointments.

Mars Purifier effectively solves all of these problems. It is the only ISO 14644 certified purification system available that falls in line with the current NHS/PHE/ SDCEP/FGDP guidelines.

Mars Purifiers are extremely quiet, which is something that clinicians often vastly overlook. When the air is at optimal quality, the device is almost silent.

Its sleek design looks fantastic in surgery or communal areas putting both patients and staff members at peace of mind and being aesthetically pleasing.

Calculate fallow time

The current guidance from Public Health England (PHE) and advice from the New and Emergency Respiratory Virus Threats Advisory Group (NERVTAG) allows a reduced fallow period in a treatment room with 10 ACH.

To ascertain the fallow time after a Group A procedure: use powered, high-velocity instruments that also emit or require water or irrigants for cooling.

These procedures will then produce aerosol particles <5μm and require airborne transmission-based precautions, procedural mitigation and fallow time.

You must consider four factors:

1. What is the ventilation rate?
2. Is high volume suction used?
3. Are you using rubber dam?
4. Is the Group A procedure >5min or <5min?

You can calculate the ventilation rate using this formula: ACH = CADR divided by the room volume. The ventilation rate is exactly half of this.

The CADR value that essentially measures each device’s effectiveness will differ from one another.

NSS SBAR (national services Scotland) recommend air cleaners effectiveness should be ‘downgraded’ to 50% of their manufacturers’ CADR (clean air delivery rate) output when calculating ACH. Mars Purifier achieves up to 1,280 CADR; it surpasses the safe practice margin.

Mars Purifier can offer a range of products carefully tailored to room size achieving ACH greater than 10. So you can minimise waiting time and maximise patient turnover, whilst not compromising on patient safety. For reference, a window open in an average surgery will supply one ACH.

In summary, using a purifier achieving air changes greater than 10 with no other mitigating factors, fallow time is 15 minutes, with the possibility of further reducing it to 10 minutes with either high volume suction and/or rubber dam.

Technology

HEPA filtration is the gold standard for air purification. This feature is arguably one of the most important to have in a purification system. Although generally HEPA 13 is acceptable, Mars Purifier is one of the very few sources of HEPA 14 commercially available.

• H14 HEPA – effectively filters 99.995% of pollutants in the air. HEPA-14 filtration efficiency is 10 times higher than HEPA-13 filters and captures 0.1 microns
• H13 HEPA – effectively captures 99.97% of harmful particles down to 0.1 – 0.3 tiny microns. Commonly referred to as ‘medical-grade air filtration.’ Mars Purifier provides this filter as standard in all ranges
• H11 HEPA – only captures 95% greater than 0.3 microns, missing many of the concerning airborne particles. Many air purifiers in the market are H11
• UVC filtration – this is a process that deactivates the membrane around a virus. After a high-risk procedure in hospital or surgery, we recommend a source of UVC filtration. Users can achieve this either with a separate device or, in the case of Mars Purifier, an inbuilt filter as part of a multi-stage filtration setup
• Ion technology – releases silver ions repeatedly to eliminate bacteria effectively
• Photocatalyst technology – has also been introduced in the higher end models that convert water in the air to modify harmful pollutants into less harmful ones. This is based on the principle that radiation of suitable wavelengths can be absorbed by many semiconductors, facilitating the creation of reactive oxygen species (ROS) that can decompose air pollutants (Hay et al, 2015)
• Pre filter – captures large particles (hair, large dust particles) to extend the life of the air purifier
• Activated carbon filter – carbon has a large surface area, which in this case helps capture air pollutants. Adsorption of the molecules occurs as organic compounds react chemically with the activated carbon.

Air purification and coronavirus

Coronavirus has a dimension of 0.12 microns. At current times coronavirus represents a global pandemic health issue and also a significant concern that makes us all think critically about indoor air quality.

The Centers for Disease Control recognises three main routes of transmission:

1. Direct large droplet transmission between people within close proximity
2. Indirect respiratory droplet deposition on surface and object
3. Airborne transmission via small particles in aerosol containing the viable virus.

With this, we can therefore conclude that air purifiers lower the number of virus particles in an indoor space. This results in lower transmission rates (Nazarenko, 2020).

FAQs

How often do you need to replace and clean the filter?

Clean the filter every three months; do this by opening the dust sensor’s cover plate and using a blower to blow out the dust in the sensor. Also, using a vacuum to absorb the large particles around the filter.

To maintain the best performance these purifiers provide, it is important to replace the filter at the right time. The change indicator light displays on the air purifier when the filter needs replacing. The recommended filter change: six months (4,380 hours) when used 24 hours a day.

How do I use it?

Have the device running on automatic mode throughout the day. Any harmful pollutants in the air will then automatically purify – indicated with an LED colour change and a rising value.

After an AGP, we also recommend to have the device on full power for the fallow time duration.

Does it produce harmful ozone because of the UVC technology?

No it doesn’t emit ozone – the reason for this is because you can only produce ozone below 200nm. At 253nm, the germicidal wavelength Mars Purifier uses does not generate ozone.

The ultraviolet germicidal irradiation UVC wavelength is therefore an invaluable tool for air purifiers. By leveraging germicidal energy to keep refrigeration coils free of microbial growth, promoting the benefit of reducing the spread of airborne infections.

References

Cevik M, Kuppalli K, Kindrachuk J and Peiris M (2020) Virology, transmission, and pathogenesis of SARS-CoV-2. BMJ371: m3862

Hay S, Obee T,Luo Z,Jiang T,Meng Y,He J,Murphy S and Suib S (2015)  The viability of photocatalysis for air purification. Molecules 20(1): 1319-56

Nazarenko Y (2020) Air filtration and SARS-CoV-2. Epidemiol Health42

The post Air purification in dentistry appeared first on Dentistry.co.uk.

Natalie Bradley is taking over Dentistry’s Instagram account this week for autism awareness, here we find out what she has planned.

I am so pleased to launch Dentistry Online Takeover this week on the theme of autism awareness.

Autism Awareness Week runs from 29 March to 4 April. As a special care dentist I want to raise awareness of autism and how we can manage patients with autism in a dental setting.

Although I have a close family member with an autism diagnosis, I didn’t really start encountering patients in my dental surgery regularly until I started working in the Community Dental Setting.

But one in 100 children in the UK have a diagnosis of autism or autism spectrum disorder. Managing these patients is the responsibility of all the dental team. Including those who work in general practice.

Autism

People with autism can have specific challenges accessing and tolerating dentistry that we can help to address.

This week I will share tips and knowledge from my own experiences of managing these patients. This way they are able to access and tolerate the same quality of dental care as anyone else.

Whilst there are patterns of certain behaviour, please remember that every patient is different. The National Autistic Society has a saying: ‘If you’ve met one person with autism, you’ve met one person with autism.’

Every patient is different, with different habits and behaviours.

Do not judge or make assumptions but get to know your patients. Build some of their own preferences and habits into how you treat them. This is a useful skill to have.

Being patient and calm is also very important. Especially when things are not quite going to plan!

We all have a responsibility to make reasonable adjustments to the care we provide and not to discriminate because of a person’s disability according to the Equality Act 2010.

To find out more about autism, check out Dentistry Online Instagram over this week where Natalie will be sharing information such as common oral health problems in Autistic patients and tips on how to deal with those issues.  On Wednesday, Natalie will share a video teaching signing which could help you to communicate better with some patients and there will also be the opportunity to ask Natalie questions about the subject in a live Q and A.

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Following on from the Dentistry Question Time debate, Simon Thackeray answers some of the questions that came in on the night.

What do you think the future of private dentistry looks like over the coming year?

I think it looks quite good. Private dentistry got back on its feet quite swiftly. But I think there’s still some resistance from some patients to come in.

It’s quite buoyant. A lot of that is possibly because there’s still access problems within the NHS, and patients are either seeking private treatment because they have to or they are seeking private treatment because they want to. Private treatment offers the convenience of knowing they can make a phone call and be seen within a couple of weeks. That’s not always the case with NHS practices.

I’m certainly not blaming the individual NHS practices because of the scale of numbers they have to see. They have to see so many more patients that often they are inundated with emergencies.

But that said, it does mean that there’s an opportunity for smaller private practices with smaller lists to take up that slack.

I do wonder with the chancellor’s announcement about a 130% super allowance, that might see some private squats starting. So, it could become really quite buoyant.

The super allowance will certainly help improve private dental practices. But this may create a bigger divide between an NHS practice and a private practice.

There could be some stark differences yes. It will not be through the intention of private practitioners to create those stark differences. It will be the system that has created that disparity.

I also think that some of the NHS practices may have less reliance on the NHS. Although the NHS has been very good to practitioners with the funding that they’ve given them initially.

I don’t think it’s as good a package as it could be if they don’t hit these new targets. And moving forward they don’t know what these targets are – so they might want a business plan based on a more known entity.

I’ve got a pretty good idea of what my next year’s income is going to be and where it comes from with my private patients, so I can actually budget quite well.

If you don’t know what the new funding is going to be like, and don’t know what your targets are going to be like in the first quarter, where do you start business planning?

Are you currently operating close to what you were pre-COVID levels, how have you recovered, and why can NHS practices not do the same?

I’m not far off the output that we were at.

Where I might have had relaxing 20-minute gaps here and there, they are now taken up with fallow periods.

Looking at my book, it looks very similar to what it did.

I think NHS practices can’t catch up with that because it’s difficult when you’ve got more patients. There’s an unpredictability of what’s going to come in with emergencies.

If you’ve got to have a list of 3,500 patients to hit your contract numbers, that’s completely different to my list of 790 patients.

Also, if an NHS practice has the situation during that period of time where they’ve had, say, a small practice with a couple of nurses self-isolating, they’re absolutely stuck. You can’t output any work.

As we know when we shut down for 10 weeks, the backlog of shutdown was vast. The BDA said something like 20 million appointments.

So, if you work from a practice that has an exceptional circumstance, within an unprecedented time, and then if you have a couple of nurses off, you’re utterly stuck, you can’t catch up.

They’re probably frustrated because they can’t hit the targets. Particularly if they’re just given 1.2 UDAs in an emergency, whereas they normally would have recovered treatment UDAs in the following week.

They can’t actually plan their books like a private practitioner can.

As an associate, how do you convince a principal to confer from NHS to private?

That’s difficult, it’s a real challenge. It’s the principal’s business when all is said and done.

It does depend where the principal is in their career. Towards the end of their career, they are coming up to their pension maturation. It could be quite a significant hit.

Fundamentally we own a business that benefits our patients, but we have to remember that part of the reason for owning a business is to have something tangible at the end of your career that you can maybe sell or gain the benefit from.

Depending on where an NHS practitioner is in their own career, it may be more difficult to persuade them to go private.

But also, you’re getting into the very deep area of values and beliefs. Some people so strongly believe in the NHS and the concept of the NHS, and its social responsibility that to actually move away from it is damaging to their own personal beliefs. You would see why they would stay in there.

Whereas other people might say they can’t do the dentistry they were trained to do on the NHS. That’s where I personally was with it.

So, without knowing an individual’s own beliefs and values, you wouldn’t know how to then try to persuade them.

That’s a very honourable thing to do and that might be the reason why some people stay.

Is there an intermediary, can an associate work private in an NHS practice?

I wouldn’t see any reason for an associate not working privately in an NHS practice.

But they’ve got to have a very good relationship with their boss to be able to do it. And they’ve got to have gone through all those values and not undermined their principal.

But it does depend how open minded the principal is to something like that. If you’ve got a very good associate, who wants to do that. There could be a conversation that the associate has.

These are all things that need good conversations and a really honest and truthful conversation with a principal and an associate to find out what the motives are for both.

You can watch the full Dentistry Question Time debate here.

The post Dentistry Question Time – ‘opportunity for private practices’ appeared first on Dentistry.co.uk.

As a study reveals that poor oral health increases risks of frailty in older men, Nigel Carter asks whether we’re planning for the future effectively.

A new study reveals that gum disease and tooth loss links to frailty in older British men.

Researchers observed more than 1,000 men over a three-year period. They found those with poor oral health were more likely to suffer from other issues. For example, weight loss, exhaustion, reduced gripping ability, a reduction in walking speed and low physical activity.

The study showed that one in five (20%) people examined had no teeth. More than half (54%) had gum disease and nearly a third (29%) suffered from dry mouth. Around one in 10 (11%) had trouble eating.

Dr Nigel Carter is the chief executive of the Oral Health Foundation. He has used the study as an opportunity to argue the case for older adults. For those who are more likely to experience issues in the mouth. Issues that can have a direct effect on their overall wellbeing.

He said: ‘Oral health problems are more common among older adults with tooth loss, gum disease, tooth decay and dry mouth the most likely to occur. These conditions not only influence the health of the mouth but also impact on a person’s quality of life too.

‘We often see first-hand the difficulties that poorer oral health in the elderly can have. This includes making it harder to eat, swallow, speak, get adequate nutrition, and even smile. Elderly people who are suffering with poor oral health could also be in pain and discomfort and experience problems their mouth and jaw.’

Identifying needs

The participants had a dental examination. Then, the participants (who were aged between 71 and 92), had their height, weight, and waist measured. They took timed walking tests and had their grip strength recorded.

The study, featured men from 24 towns across the UK. It highlighted the importance of oral health in the elderly. Dr Carter believes more could be done to identify and manage poor oral health of older adults.

Dr Carter added: ‘Sensory impairments such as eyesight and hearing, poor physical function and a patient’s wider history of disease are often what is taken into consideration when identifying frailty. Oral health is often ignored when assessing the care of older people.

‘Dental examinations and the health of a person’s mouth could become highly useful indicators of frailty and be added to general health screening assessments in older people.

‘The government must begin to take a greater interest in identifying the needs of the elderly population. At an earlier stage, in order for healthcare providers to manage them quickly and correctly.’

An ageing population

The UK is facing significant growth to its elderly population, with the number of people over 60 expected to increase by around seven million in the next 20 years.

Amongst challenges to the workforce, housing, education and public services, additional healthcare needs continue as a growing concern.

‘An urgent and preventive approach must be taken to the population’s oral health, in order to relieve future pressure on an already over-burdened health system,’ added Dr Carter.

‘A simple daily routine of brushing our teeth last thing at night and at one other time during the day with a fluoride toothpaste could vastly improve the health of our mouth moving into our later years.

‘Reducing the amount of sugar that we consume and visiting the dentist regularly, as often as they recommend, is also really important. By doing these things, there is no reason that we cannot keep our teeth for life and also reduce our risk of frailty as older adults.’ 

The study

Ramsey S, Papachristou E, Watt RG, Tsakos G, Lennon LT, Papacosta AO, Moynihan P, Sayer AA, Whincup PH, Wannamethee SG (2017) Influence of Poor Oral Health on Physical Frailty: A Population-Based Cohort Study of Older British Men. J Am Geriatr Soc

The study is available online at http://onlinelibrary.wiley.com/doi/10.1111/jgs.15175/full.

This article first appeared in Oral Healthmagazine.

Follow Dentistry.co.uk on Instagram to keep up with all the latest dental news and trends

The post Not getting any younger appeared first on Dentistry.co.uk.

Simran Bains urges the importance of keeping up-to-date with changes in child protection policies and procedures.

According to the NSPCC, over 58,000 children in the UK needed protection against abuse in 2016. The estimation stands that one to two children in the UK die each week from abuse or neglect.

The CQC defines safeguarding as protecting a person’s health, wellbeing and human rights, and enabling them to live free from harm, abuse and neglect.

As healthcare professionals, we have a shared responsibility to safeguard children from suffering any form of abuse or improper treatment whilst receiving care.

Although members of the dental team are not responsible for making a diagnosis of child abuse or neglect; the eighth GDC standard clearly states the dental team has an ethical obligation to raise concerns if a patient is at risk and take the appropriate action.

Types of abuse

Dental neglect

The British Society of Paediatric Dentistry defines dental neglect as: ‘The persistent failure to meet a child’s basic oral health needs, likely to result in the serious impairment of a child’s oral or general health or development.’

Severe untreated dental disease can lead to toothache, malnutrition and absence from school. It is imperative we discuss maintaining oral health by eating a balanced diet, being aware of the sugar content of certain foods and drink and dental maintenance with parents.

Healthcare professionals should monitor a lack of compliance through a series of cancelled/failed appointments or repeated emergency ‘pain’ appointments.

Physical abuse

This involves deliberately hurting a child causing injuries such as broken bones, burns, bruises or cuts.

Orofacial traumas occur in at least 50% of children diagnosed with physical abuse. Injuries in the ‘triangle of safety’ (ears, side of face, neck, shoulders) should raise concerns and all children who are said to bruise easily should be screened for bleeding disorders.

Emotional abuse

Emotional abuse can cause low self-esteem, developmental delay and lack of social responsiveness.

It is important to monitor a child’s emotional state, their behaviour and interaction with their parents.

Sexual abuse

This is when someone forces an individual to take part in sexual activities. This is most likely detected through direct allegation, STIs, pregnancy, trauma or emotional or behavioural signs.

Intraoral signs associated with sexual abuse include erythema ulceration and vesicle formation at the junction of the hard and soft palate.

Identifying abuse and neglect

Abuse and neglect may present to any member of the dental team in the following ways:

1. Direct disclosure made by the child
2. Signs and symptoms, which are indicative of physical abuse or neglect
3. Observation of child-parent interactions
4. Signs or direct disclosure of domestic abuse of a parent
5. Concerns about the mental or general health of a parent (substance misuse or deteriorating health conditions).

If there are any areas of concern, meticulous notes should be made and discussed with the safeguarding lead in the dental practice, an experienced dental colleague, consultant paediatrition or child protection nurse. If you still remain concerned then you should talk to the child and parents explaining your concerns and inform them of your intention to refer them to children services.

A referral to the local children’s services should be made by telephone detailing your concerns and followed up in writing within 48 hours.

Assessment

A comprehensive history and examination is vital when assessing a child with an injury or possible signs of abuse. Areas of concern would include:

• A delay in presentation after injury
• Discrepancies between the presenting injury and history
• Any previous concerns about the child or siblings
• Any concerns about the child’s behaviour or interaction with their parent/carer.

You should not discuss your concerns with the parents if:

• It places the child at greater risk
• The discuss would impede a police investigation
• You suspect a family member is sexually abusing the child
• Where fabricated or induced illness is suspected
• If parents/carers are being violent
• If it’s not possible to contact parents or carers without causing undue delay in making the referral.

It is paramount that healthcare professionals keep up-to-date with changes in child protection policies and procedures. This ensures that we learn lessons from previous tragedies.

We must look after the safety and welfare of our patients holistically.

This article first appeared in Young Dentist magazine.

Follow Dentistry.co.uk on Instagram to keep up with all the latest dental news and trends.

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Claire Frisby discusses what it’s been like living in the Canary Islands and her love for walking.

Please introduce yourself

Born in Kent. Living in the Canary Islands since September 2020, with my husband.

I went into dentistry in the early 90s starting with dental nursing. Gaining lots of experience, qualifications and certificates over the years. I started early in the implant field back in the mid 90s.

There’s not much I haven’t seen in implant surgery. I trained in radiography, DHE, sedation, clinical photos, suture removal, plasma, phlebotomy, CT scanning. Most recently I have assisted in IVNT, facial aesthetics and PRP in the joints. I assisted with periodontists, orthodontists and endodontists but always came back to implants.

I got involved with marketing and social media in my last practice where I still lead their social media. I worked there for nearly 10 years and am still very much involved with them, albeit remotely.

Most recently I have become an associate assessor with NCFE, helping to write a dental nursing diploma.

It’s all very exciting.

What do you get up to in your spare time away from dentistry?

I love walking. I am lucky enough to be in a sunny climate now so there is so much to explore.

I have always had an interest in photography. I was always the one known for taking the photos at events or if we were out and about.

I have always been quite arty and have recently started watercolour painting again. I’m also starting to learn Spanish.

Are you a foodie? Why and what particular food do you go for?

Yes, I love food!

I actually love looking around the supermarket, especially when abroad. I make smoothies every day so I know I’m having my five a day and getting the antioxidants I need.

Everything in moderation. I love to try all foods now. When I was younger I was fussy. Now, if I know you can cook I would like to try it!

Are you into any sport? If so, what sport? Why did you get into it in the first place?

Not really into sport but I have always been sporty, if that makes sense?

I used to go to the gym before work and have always been active. When I was younger I was in a badminton team and did all the sports at school in preference to any other lessons (except art).

Now I complete 5k runs and walking.

What type of television/movies do you like – any guilty pleasures?

Netflix, Prime or Apple TV, any will do. It’s great to get into a good series! I love to watch a film. I must admit I love a good horror!

Do you like to travel and do your hobbies take you anywhere in particular?

No real hobbies, holidays were probably my hobby. We would make sure I went away whenever we could, but now it feels like a very long holiday being here, with so much to explore.

Why is it important to have hobbies away from your profession?

For me I had to have an escape, whether it was binging on a boxset or going on holiday.

I think in the dentistry world we could easily work 24 hours a day and still not complete everything. When I was in practice I would still be working at home in the evenings and always thinking about what I needed to do the next day.

I have always been someone who would take on new challenges so I would always get involved in new projects wherever I could (which obviously meant more work).

When I first moved here I needed a big rest to evolve again and now I’m back, firing on all cylinders!

You must have time to take a step back, reflect and recharge!

Catch previous Out of office columns:

• Melica Bastani – home workouts and Persian food
• Pam Swain – wine, coffee and meditation
• Christie Lawton – America’s west coast
• Hassan Asad – Game of Thrones and baklawa
• Samuel McHale – sustainable eating.

Follow Dentistry.co.uk on Instagram to keep up with all the latest dental news and trends.

The post Out of office – Claire Frisby on moving to the Canary Islands appeared first on Dentistry.co.uk.

After scooping Best Young Dentist Scotland at The Dentistry Awards, we speak to Ania Nohawica-Heer about why they entered the awards.

How does it feel to have won an award?

Ania Nohawica-Heer: I feel honoured that my efforts have been recognised at this level. It’s the first year I have applied for dentistry awards and I was pleasantly surprised with the success.

The result has been motivating me to push myself even further.

Did you enjoy the awards evening?

Ania Nohawica-Heer: I wish there could have been a face to face awards ceremony. However, the online one was still very pleasant.

I hope to catch up with all the nominees next year.

Why did you choose to enter the awards?

Ania Nohawica-Heer: Dentistry is a very isolating profession, where patients very rarely fully understand clinical efforts.

It is a pleasure to measure yourself up against your peers, thus truly understanding where you shine and what areas you could focus on more.

What do you think the awards are doing to the standards within the profession?

Ania Nohawica-Heer: I’m a huge believer in some healthy competition. It motivates you to strive for the best results, thus improving patient care and experience.

Why do you think you won?

Ania Nohawica-Heer: It is a privilege to have some wonderful colleagues and mentors in my life who also encourage self improvement and excellence.

Surrounding myself with a great team allows me to focus on both clinical and soft skills, resulting in overall excellent patient care.

Have you noticed a difference in patient numbers since winning the award?

Ania Nohawica-Heer: Many patients have complimented me on the achievements. We have some new patients who were drawn to the practice due to the awards.

Will you will be entering the awards again this year?

Ania Nohawica-Heer: Certainly!

Anything else you’d like to add?

Ania Nohawica-Heer: I would encourage all my colleagues to apply and participate in the awards. The process of applying focuses you on taking great photos and gathering evidence of all the hard work you have been putting in.

It’s a lovely feeling to have been recognised for your efforts and is a great advertisement for both you as a clinician and for the practice you work at.

Find out more about The Dentistry Awards and register your interest for 2021 at www.thedentistryawards.com.

Hear more from The Dentistry Awards winners

• Queens Gate Orthodontics.

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Tif Qureshi describes improving the smile of a young patient with tooth wear, using the Dahl technique and composite edge bonding.

The Dahl principle is a method for treating localised anterior tooth wear, before posterior wear begins (Poyser et al, 2005).

It opens the vertical dimension of occlusion (VDO), without having to treat the back teeth. The technique can be thought of as a non-invasive, preventive treatment and, for the right case, can stop a patient from developing full-mouth wear or needing oral rehabilitation. I also use it as a way of protecting anterior guidance and function.

Dahl is often viewed as an unconventional way of treating wear. However, many of the traditional restorative options have expensive final outcomes. This can be a barrier for the patient. I use the Dahl technique nearly every day in my practice. I have been doing so for more than 25 years.

Arguing for one type of approach over another is difficult. Few dentists have tried all the techniques extensively. However, I found that in cases where the combined anterior wear in both arches is 6mm or less, and there is still some enamel coverage on posterior teeth, it is my preferred mode of treatment. Teeth and guidance can be restored and within a few months, posterior contacts regained.

I usually employ traditional techniques in more severe cases. There are important caveats for using Dahl; for example, patients should have a reasonably well-aligned posterior arch, and care should be taken not to generate off-axial forces.

The Dahl principle

Modified Lucia jigs have been used as anterior deprogrammers to help the mandible find centric relation (CR). Direct composites can also be used as an anterior deprogrammer. Because of their resilience and ease of manipulation, even in small thicknesses, resin composites represent an ideal material to restore the palatal surface (Cardoso et al, 2000) and the worn lower anterior incisal and canine edges.

Dahl and Krogstad (1975) suggested creating space to treat localised anterior tooth wear. This is by separating posterior teeth, using an anterior bite plane for four to six months.

A combination of passive eruption of the posterior teeth, and intrusion of the anterior teeth, allows the re-establishment of posterior occlusion, while holding the anterior space (Dahl and Krogstad, 1982). Dahl used a metal appliance to separate the posterior teeth, but the same result can be achieved with adhesive anterior direct composites.

Case study

By identifying the difference between maximum intercuspal position and CR, using pressure to gently guide the mandible, the position of the direct composite can be set slightly posterior to maximum intercuspal position (Magne et al, 2007). This will create anterior contact on the incisial edge build-ups and possibly create premature contacts on the posterior teeth. These can be improved through minor equilibration, but the residual space will eventually close through passive compensation and settling over a few months.

The following case shows how Venus Diamond composite can be used to place balanced and axial-force generating Dahl build-ups. Lower-edge direct build-ups and an upper ‘Dahled’ retainer are used as an interceptive method to stop a teenager developing full-mouth wear.

The Dahl principle allows such cases to be treated early to help avoid more extensive work. Why should treatment only commence once the patient has developed further wear? Is it necessary for the whole occlusal vertical dimension (OVD) to be increased with full arch restorations, to treat anterior wear only?

Teenage tooth wear

An 18-year-old female came to see me at Dental Elegance because she wanted the aesthetics of her smile improved (Figure 1). Due to anterior wear, she was reluctant to show her worn teeth and she was experiencing increased sensitivity (Figures 2 to 4).

The patient was medically fit and healthy, with good oral hygiene. She presented after orthodontic treatment with a significant amount of anterior tooth surface loss, and dentine exposure on the lower and some upper edges (Figure 5). Parafunction was the likely cause.

There was no posterior wear, but she was losing anterior guidance and starting to develop posterior interferences (Figure 6). She had no temporomandibular disorder symptoms.

Minimally invasive treatment

Treatment choices to improve her smile included providing the patient with a splint, which would prevent tooth wear caused by night-time grinding. However, this method would offer no protection during the day and it was important to preserve the dentine from further erosion. Ceramic veneers were possible, but irreversible and expensive. They would require tooth structure preparation and would begin an ongoing restorative cycle.

Direct composite veneers using the Dahl technique were an option. It was explained that the surfaces of the teeth would need complete coverage, making alterations difficult and increasing the maintenance costs.

Instead, the patient opted for composite edge bonding with the Dahl technique, and tooth whitening. She preferred the minimally invasive nature of the composite edge-bonding treatment and the lower cost. She also understood that the material was easy to adjust, add to and repair.

Tooth whitening was undertaken with super-sealed home trays and Philips Zoom! Daywhite. This whitening system contains 6% hydrogen peroxide, and the patient bleached for just 35 minutes a day, over a three to four week period.

Composite build-up

The teeth were prepared using water-based air abrasion and etched with 35% phosphoric acid. Kulzer Ibond Universal was applied and light cured, in accordance with the manufacturer’s instructions.

Direct build-ups were placed on the lower 4-4 worn teeth using a freehand composite technique. Adding to the lowers increases the vertical dimension. When doing this with the Dahl principle, my aim is to prop the anteriors open, loading primarily on the canines. This was balanced and checked with articulating paper. A light contact was then generated on the incisors and checked with articulating paper.

Two weeks later, the upper teeth were edge bonded (Figure 7). The teeth were lengthened for functional and aesthetic reasons. During the same appointment, the upper anterior and canine guidance was adjusted and improved.

Restoration

Three to four millimetres of composite were added to the anterior region (Figures 8 to 10). This separated the back teeth by 1.5mm to 2mm. During the first two weeks, some condylar seating was expected, as the anterior bonding would have a deprogramming effect.

Each tooth was restored using Kulzer Venus Diamond in layers of the Opaque Light (OL) and B1 shades (Figure 11). The composite was laid freehand in a reverse triangle technique, which blocks out the light transmission on the join (Figure 12). I have used Venus composite for 10 years and it is the perfect material for edge bonding because of its high strength in thin sections.

It has a great colour match, which adapts and blends in well to the surrounding teeth. This is particularly useful when applying the reverse triangle technique. The dentine material has a natural opacity and helps to block out and mask transitions effectively (Figure 13). The matching enamel shades also blend well and have great polishing qualities.

Polishing and finishing

The patient’s teeth were given a light polish immediately after edge bonding. The patient was recalled after a month, to ensure no posterior interferences developed.

To counteract any risk of hygroscopic expansion, the teeth were polished again with the high-gloss Kulzer Venus Supra kit. This simple-to-use system does not cut or damage the composite, and the rubberised polishers are the correct shapes to create a high lustre. The final shine was achieved with a flexible felt and mylar disc, and polishing paste.

After one month, the posterior contacts were starting to settle and at the two-month review, the contacts were completely closed (Figures 14 and 15). This process appeared a little faster than usual, but younger patients do seem to ‘Dahl’ more quickly. Once the bite had settled down, an impression was taken using Kulzer Xantasil to fabricate a clear permanent Essix retainer for the patient to wear at night.

Ultimate preventative dentistry

The Dahl principle can offer dentists another way of approaching wear and occlusal issues, especially in mild and moderate cases. When used correctly, this interceptive method can stop patients from going on to develop full-mouth wear.

Directly bonded composite can act as a fixed Dahl appliance and is reversible. The clinical ease with which composite restorations can be modified and altered offers better control over the outcome of the treatment. I believe this is the ultimate preventive dentistry.

The patient was thrilled with her teeth. The treatment was simple, cost effective and can last for five to 10 years. This prevents any further anterior wear (Figure 16). If ceramic alternatives can be avoided, many patients who simply don’t have the budget can have wear issues treated and reversed at more realistic prices.

This article first appeared in Aesthetic Dentistry Todaymagazine.

References

Cardoso ACC, Canbabarro S, Myers SL (2000) Diagnostic-based non-invasive treatment. Dental Erosion. Pract Periodon Aesthet Dent 12:224-228

Dahl BL, Krogstad O (1975) An alternative treatment in cases with advance localized attrition. J Oral Rehab 2:209-214

Dahl BL, Krogstad O (1982) The effect of a partial bite raising splint on the occlusal face height. An x-ray cephalometric study in human adults. Acta Odontol Scand 40:17-24

Magne P, Magne M, Belser U (2007) Adhesive restorations, centric relation and the Dahl Principle: Minimally invasive approaches to localized anterior tooth erosion. European Journal of Esthetic Dentistry 2:3

Poyser NJ, Porter RWJ, Briggs PFA, Chana HS, Kelleher MGD (2005) The Dahl Concept: past, present and future. British Dental Journal 198:669-676

The post Teenager thrilled with simple and cost-effective makeover appeared first on Dentistry.co.uk.

Gummy smiles are becoming an increasingly apparent problem for patients. Here Manrina Rhode discusses treatment options available.

Almost once a week someone contacts me to discuss reduction of a gummy smile. There is a large demand for it, once patients are aware this is something you can help with.

When analysing a gummy smile there are several factors to consider.

Is it a gummy smile?

In my experience normal gingival display is between 0-3mm. When the patient covers their teeth when they smile, I constitute it as a low smile line. If they have more than 3mm gingival display then this is a high smile line.

I note smile lines for all my patients at the new patient consultation in records.

Ask the patient to smile and measure gingival display on one particular tooth and note this down, stating which tooth. It is standard practice to measure from the zenith (the highest point of the gum) on one of the central incisors, to the lip smile line.

Also note that when you ask a patient to smile they may give you their ‘photo smile’. It’s good to try and make them laugh in conversation and note while they laugh where their lip lifts to.

You will need to recreate this maximum smile when measuring.

Is it gummy because of teeth size, hypermobile lip, long maxilla or a combination?

The average length of a central incisor is 11mm. I also routinely measure the length of central incisors and note these down at the new patient consultation in my records.

If the tooth length is, for example, 8mm and there is 4mm of gingival display, then you are aware that by lifting the gum by 3mm you will gain a more attractive sized tooth and solve the associated excessive gingival display.

Be aware that sometimes in these cases you need to lift gum on 8-10 upper teeth.

If tooth size is fine but just the lip is hypermobile, then this requires treatment of lip movement.

If there is an elongated maxilla, then consider surgical options.

Treatment options

Toxin injections and/or lip fillers

For most of these patients, the first treatment is toxin injections using your preferred toxin. For example Botox or Azzalure.

This prevents excessive lifting of the upper lip on smiling and would need repeating initially every four months. With recurrence the frequency required will decrease.

Patients also find some reduction of their gummy smile with lip filler, as the larger lip covers more of their gum.

Gingivectomy or surgical gum lift

If the patient has excessive gingival display and a shortened central incisor, then you may want to consider lengthening the tooth with a surgical gum lift.

It’s rare that a gingivectomy alone is enough. You need to use smile design principles to work out how much gum would need removing. Then check for biological width between bone and gum.

If there is more than 3mm space between bone and gum, then gum alone can be removed, gingivectomy. However, if this would invade biological width, then it’s important to complete a surgical gum lift removing gingiva and bone.

If completing a gum lift consider restorative options after. Will it expose root surface? How will this be covered? With bonding or veneers?

This will also need discussing with the patient and including in the treatment plan.

Also if gum has overgrown, then consider why this has happened. In my experience it’s usually because of an anterior grinding habit. That would also need controlling to increase longevity and predictability of your gum lift.

Surgical lip stabilisation

There is an option to complete a surgical lip stabilisation procedure. However, it’s tricky to find clinicians offering these as they are not predictable and can relapse.

Orthognathic surgery

If the reason for the problem is a long mandible, then the patient may want to consider orthognathic surgery.

Teeth whitening

Also, whitening the patients teeth won’t help reduce the gummy smile, but can make the teeth more visible and the gummy smile less apparent.

Is it important to do a correct analysis to establish the reason for the patients gummy smile. Then explain appropriate treatment options thoroughly.

I like to start with least invasive and build up to more involved treatments. Often patients will start with toxin injections and then decide if they want more from there.

Catch up with previous Aesthetic dentistry expert columns:

• Dental photography.

Follow Dentistry.co.uk on Instagram to keep up with all the latest dental news and trends.

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Don’t kid yourself, the investment is more than cash, says Dan Fine.

With practice prices as they are there’s a good chance you’re going to be investing £1m to acquire a practice. Now you’re through the door you may need to spend a bit of cash to make the place look presentable and kit it out clinically, let’s say £100k.

There is no point buying a practice if you are not going to grow it. It will be effective marketing that drives this growth. With that in mind there may be a marketing systems investment of let’s say £35k. Then, your monthly budget to think about. Your monthly budget should be 5% of the revenue you want to have in 12 months.

So a practice growing from £1m to £1.3m (ambitious but reasonable 30% growth) will require an annual budget of £65k, or £5.4k per month. So all in you could be £1.2m in the hole.

The capital investment is the easy bit in a sense. It is tangible and specific, but just because you spend it doesn’t mean it is going to work. Ultimately what decides whether the investment and risk pays off is…you. This should be a terrifying and exhilarating insight. You are responsible for your own destiny but you will have to own it.

We can make a few assumptions about what will happen when you take over your business in the first 12 months:

• You will work harder than ever before
• Nothing in your experience has prepared you to be a business owner
• At times you will be exhausted
• Sometimes you will want to give up.

Assumptions

These assumptions point to where the less tangible but often more expensive investments will have to be made. Take them in order:

You will work harder than ever before – this does not mean clinically (although it often does too), it means you will have to invest a significant amount of time running the business. Quickly you will understand time is one of your most valuable commodities. How it is created and invested is critical in the success of your business.

Nothing in your experience has prepared you to be a business owner – even though you are more educated than 98% of the population (estimates vary) nothing in that education has direct application to the chaotic collective of people, processes and projects that is a business. You will have to learn rapidly and continually, formally and tacitly. Your investment in becoming an effective and diverse learner will best allow you to interpret and capitalise on the chaos.

At times you will be exhausted. With more hours worked and continually learning new things you will need to invest energy to drive this. This is not something to be taken lightly, it will take everything you have to keep the business running. But simply maintaining is not enough, you have to grow and this will require you to dig deep and invest energy that you did not know you had.

Sometimes you will want to give up – running a business is lonely and thankless. Your patients will think you charge them too much, your staff will think you will pay them too little, and your partner will not care. The emotional investment is often the one people are least prepared for and the one that will often make or break your success as a business leader.

So before buying a practice make sure you have thought through the true cost and consider if it is something you are happy to pay.

Your growth plan

Few businesses and very few dental businesses are good at assessing their capabilities and identifying skill gaps. Here are five ideas to try out in your new practice, says Luc Wade, management consultant at Hive Business.

Know your numbers (…again)

It’s just silly that many practices couldn’t tell you their new patient enquiry rate, treatment conversion rate or average patient value.

It’s a fact that knowing them at the start of a growth programme will make a difference. You won’t know if you’re making the right decision otherwise.

For example, if you miscalculate your average patient value you’ll favour unproductive marketing campaigns and stop ones that were actually making a profit. If your competitors calculate this value accurately they’ll have more budget to outbid you and steal market share.

Despite the heavy time resource, knowing your numbers is your most worthy marketing investment.

Be open about the direction of the business. Tell the team

Simplify your goals down to six metrics. Share these KPIs so the whole team can see how they’re doing.

Making this highly visible will help with morale. If you don’t have these systems in place you risk slowing down growth and looking at marketing as a series of one-off events.

Avoid one-off events

One-off events negatively impact growth. They are essentially any marketing effort that lasts for a limited period and feels gimmicky. They display a lack of confidence.

Practices that focus entirely on this type of marketing hurt growth because they force their teams to scramble around getting campaigns ready, launched and promoted, only to earn a return on that investment for a limited period.

This type of marketing investment, for instance on monthly promotional deals, isn’t scalable over time and you’re only as good as your last offer.

To grow faster, focus more of your time on a blend of brand building and sales activation campaigns that are unaffected by time and won’t expire.

Love the bottom of the funnel

This is about loyalty and advocacy, including efforts to retain patients and generate more word of mouth referrals and increased patient value. Don’t hesitate to ask for testimonials and online reviews across all the digital channels available to you.

By spending more time on the bottom of the marketing funnel you’ll generate additional revenue from every new customer without extra advertising costs.

This will allow you to spend more at the top of your funnel too, building market share and growing your business faster.

Don’t move slowly

This holds back so many practices. How quickly you make business decisions, get new initiatives live and test them is of critical importance to your commercial success.

Slowness seems ingrained in many dental practices and it is hard to change.

Becoming an effective business leader

People tend to have innate leadership qualities, for instance you might be a great communicator, charismatic or decisive. However, unless you are engaging in your own development you probably won’t be a well-rounded leader.

With four books on leadership published a day, it’s an incredibly deep subject with a lot of chaff, so here are two simple principles to start that development.

Detach

We all have jobs that we get paid for, that we spend most of our time doing, that we aim to become exceptional at, and this expertise blinds us from becoming an effective leader.

As a clinician you have rigorous training that allows you to interpret information in a certain way, always with the wellbeing of the patient in mind.

As a business leader this information is relevant but not gospel. It can actually impede your thinking unless you are able to detach from it.

When thinking through a problem or a situation, assume you have your clinician’s hat on. To detach you need to drop your professional expertise and consider other points of view.

What would the shareholder say? What would my enemy think? Would this improve my team?

Be humble

As a dentist you are more educated than the vast majority of society, so unquestionably you are intelligent. But knowledge of this may block you from gaining insights that allow you to become an effective leader.

You have to take yourself off the pedestal and assume that people you interact with have something interesting to tell you.

What got you to the party in the first place is not going to make you an effective leader — understanding this is the first step to getting there.

Creating order from chaos

When someone acquires a new practice a common fallacy occurs. It usually sounds something like: ‘I’m just going to run it as is for a year or so, get my knees under the desk…’ For a number of reasons this is an unacceptable strategy to take when acquiring a business.

Commercially speaking there is no reason to acquire a dental practice unless you are looking at growing it and in the dental marketplace growth looks like 30% per annum.

Because the growth opportunities are so wide it essentially means you will need to create a new business each year.

Your role as a business leader is to create order out of the potential of the future. This means you will have to have a clear vision, be comfortable with uncertainty, and embrace and understand risk. To grow a business means stepping out of a binary world of right and wrong. Thus, creating your own context by which to interpret emergent events.

The context will be the strategy of the business and your own leadership values. Without these as an anchor you will never know the opportunity you have missed out on.

The stoic philosopher Seneca the Younger says: ‘A good person dyes events with his own colour and turns whatever happens to his own benefit.’

To lead a growing business you need to understand and internalise this concept and create new order from chaos.

Summary

If you want to get ahead you need to work more than conventional hours, and I don’t know anyone who is successful in business who hasn’t understood this, at least in the period when they were building their company.

If you’re running a business you’re moving in a high-paced environment. You have to accept that things will go wrong, but despite that you’re choosing to move forward.

In business, if you haven’t set your intentions clearly you won’t be able to interpret the complex information that emerges around you consistently. On the other hand, if you’re clear on your purpose, everything that emerges around you becomes a potential opportunity.

Read part one of this article here

This article first appeared in Private Dentistry magazine. You can read the latest issue here.

Follow Dentistry.co.uk on Instagram to keep up with all the latest dental news and trends.

The post Definitive guide to buying a practice: part two appeared first on Dentistry.co.uk.

Christina Chatfield opens up about her own journey over the last 12 months and what this has meant for her and her business.

Last April, Christina Chatfield was doing all she could to save her Brighton-based practice, Dental Health Spa.

We recorded a podcast at the time where she spoke about the fight for the survival of her business: ‘I think it’s hard to describe except it’s emotionally there all the time.’

Now, we chat to her one year on to see how she’s handled the last 12 months.

‘It’s really hard to put into words how I feel because I’ve got very mixed emotions,’ she said.

‘I have mixed emotions as a professional, mixed emotions as a person, mixed emotions as a mum and mixed emotions as a caring person. To look at fellow colleagues and friends who have businesses, patients who are still not working, other colleagues who are still not working.

‘As a realist, I believe we are going to be living with COVID for a very long time. For me, as a business, I really thought I was going to lose it all.’

Listen to the podcast on Spotify, Google Podcasts, or Captivate.

Topics include:

• The struggles of the first lockdown
• What her business looks like today
• Positives of the pandemic
• The future of dentistry and dental hygiene.

The post Dentistry podcast – Christina Chatfield on 12 months of COVID-19 appeared first on Dentistry.co.uk.

Missed out on this week’s dental news? No problem, here’s what happened over the past seven days…

One year on from COVID-19 – the dentistry timeline

This week marked a year anniversary from the first COVID lockdown. We’ve pulled together a dentistry timeline, covering how dentistry has coped and whether it is now on the path to recovery.

Nominate your lockdown heroes

On the back of this, we’re asking you to nominate your lockdown heroes. We feel the government’s 1% pay rise for NHS dentists doesn’t go nearly far enough to recognise the hard work carried out during lockdown. If you’ve carried out, witnessed, experienced or heard about a lockdown hero, please submit your entry here and give them the recognition they deserve.

ARF can now be paid in instalments, says GDC

The GDC appears to be entering the 21st century. This week it announced registrants can now pay their annual retention fee in instalments. The GDC is far too slow to act on this. The regulator’s actions over the past year have been shocking. Paying in instalments will do little to appease dentists and professionals paying sky-high registration fees.

Secrets to success with Michael Apa

The Secrets to Success series is back. To kick start the second series, Jana Denzel hosts Michael Apa, who speaks about his daily routine, work ethic and how he consistently produces bespoke quality dentistry across the world.

CDO Sara Hurley urges dental teams to ‘play their part’ following death of Sarah Everard

Sara Hurley is asking dental teams to ‘play their part’ protecting women in the wake of Sarah Everard’s death. She points out that dental professionals are well placed to identify injuries to the face, head, mouth and teeth. She says: ‘Combating domestic abuse is not just a medical mission. It’s a moral mission too and dentists are determined to play their part.’

Latest webinars

Missed the Online Dentistry Show? Don’t worry, the whole day is available On Demand over on the Dentistry Study Club. You can catch all the webinars from the day as well as our huge back catalogue of lectures all at the click of a button. Here’s what’s coming up next week:

• Catch the complete Online Dentistry Show On Demand. Choose the lecture you’d like to watch here
• Man versus machine – guided versus non-guided implant surgery – with Christian Mehl – Tuesday 30 March at 19:00
• Essentials of periodontal care in general practice – with Reena Wadia – Wednesday 31 March at 19:00
• Marketing the practice and enhancing the patient experience – with Kunal Patel – Thursday 1 April at 19:00.

Follow Dentistry.co.uk on Instagram to keep up with all the latest dental news and trends.

Catch up on last week’s news here.

The post Dental news you’ve missed this week appeared first on Dentistry.co.uk.

John Rhodes presents an interactive practical and problem solving solution in endodontics. This month, he looks at how to overcome difficulties estimating root length in a case of hypercementosis.

Hypercementosis is idiopathic but has been associated with local and systemic factors such as over-eruption of teeth, inflammation at the apex of a tooth, traumatic occlusion and Paget’s disease.

It is a non-neoplastic condition characterised by the excessive build-up of normal cementum on the roots of one or more teeth. The thicker layer of cementum makes the root tip appear larger and it can be difficult to identify the apex on a paralleling radiograph.

Teeth with hypercementosis do not require root canal treatment unless associated with pulpal or periapical inflammation. The altered radiographic morphology can make treatment and in particular length estimation more complex.

Figure 1

A paralleling radiograph shows hypercementosis associated with the LR5 and LR6.

There is a periapical radiolucency LR6. The roots of this tooth are long with bulbous tips and the root canals sclerosed. The pulp has reacted to the large amalgam restoration and associated potential microleakage; there is irritation dentine in the pulp where the filling is at its deepest.

The pulp horns are highest mesially and this is where access cavity preparation will be initiated. Root filling material in the LR5 is short of the apex but there are no radiographic signs of apical pathology.

Figure 2

Small volume CBCT clearly demonstrates the hypercementosis. Four main canals can be identified and they have acute curvature in a buccal-lingual direction (something that cannot be appreciated on a radiograph). The LR5 is not associated with any periapical pathology.

Treatment

After achieving profound anaesthesia and fitting rubber dam, access cavity preparation was started.

In this case I felt that the amalgam restoration was good and decided to make access through it. Initial penetration into the highest part of the mesial pulp horn was made with a long tapered diamond bur.

Once this had been achieved the pulp chamber roof was lifted off and the lateral borders of the access defined using an Endo-Z non-end cutting tungsten carbide bur (Dentsply Sirona).

Coronal flare

The coronal third of the root canals were enlarged using a Protaper SX (Dentsply Sirona) rotary instrument, brushing in to the bulkiest wall of the root and on the outer curve in a buccal-lingual direction.

After irrigation with 3% sodium hypochlorite root length was estimated using an apex locator.

Apex locators

Apex locators are a very accurate way of determining the root length and generally better than a diagnostic working length radiograph since the apex can be up to 4mm from the radiographic terminus and this can be difficult to determine when the cortical plate is thick.

There are a few points to bear in mind when using an apex locator to get the best results and prevent false readings:

• Make sure the unit has good battery levels or is fully charged
• Metal restorations do not need to be removed you just have to make sure that the file does not touch them when using the apex locator
• Make sure that the pulp floor is dry, sodium hypochlorite will conduct electricity and may allow short-circuiting
• The canals do not need to be dry, some moisture can be beneficial
• Use a file that is ‘snug’ in the root canal
• Always work to the zero reading
• Compare your reading with the pre-operative radiograph, your knowledge of anatomy. If there is any discrepancy consider an adjunctive radiograph
• Short readings may indicate a perforation.

Root length estimation

In this case the canals were sclerosed and had significant curvature in the buccal-lingual plane.

Sizes 8 and 10 would not advance to the full working length so I used a size 6 with watch-winding action until it reached the zero reading. A glide path was then created with the 8 and 10 files using small increment filing action and watch-winding.

To see how these steps are applied visit: https://youtu.be/y7mb8_soRHQ.

Tapering the canals

Once a reproducible glide path had been established with a size 10 hand file it was safe to rapidly taper the primary root canals with rotary or reciprocating instruments.

In this case tapering was carried out with Small and Primary Waveone Gold (Dentsply Sirona) instruments. The canals were prepared to approximately two thirds of the length in one pass and completed in a second or third. Patency was confirmed with an ISO size 010 file and the canals irrigated profusely.

The canals had significant curvature in the buccal-lingual plane and so recapitulation was important to make sure that they remained patent. I confirmed the working lengths with the apex locator and exposed a diagnostic working length radiograph after preparation with the Primary Waveone Gold instrument to be absolutely confident (Figure 3).

Irrigation

The root canals were irrigated using 3% sodium hypochlorite. They were agitated with an endo-activator (Dentsply Sirona) in a pumping action (Figure 3). Master Gutta Percha cones were measured and a trial fit carried out while the canals were filled with irrigant.

Obturation

The root canal system was obturated using a vertically compacted Gutta Percha technique and AH Plus sealer (Dentsply Sirona).

Coronal seal

The access was sealed with IRM packed in to the coronal aspect of the root canals and Fuji IX compomer.

The case will be reviewed at six months to confirm bony healing apically. The general dentist will provide a full-coverage crown to prevent fracture (Figures 4 and 5).

Watch the video

To see how these steps are applied visit: https://youtu.be/y7mb8_soRHQ or search Youtube for Endodontic Practice – Retreatment of UL1 with apical resorption or johnrhodesendo.

The author is happy to answer questions directly via Youtube or Twitter @johnrhodesendo.

This article first appeared in Endodontic Practice today.

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Sarah Ide, DDU dentolegal adviser advises orthodontic practitioners to ensure patients have realistic expectations about their smiles.

As orthodontic treatment has become more sophisticated and patients have so much more choice, it has become possible to do more than simply correct malocclusions caused by overcrowded or crooked teeth. This is particularly apparent when you open any celebrity magazine and a series of ‘perfect smiles’ greets you.

The challenge for practitioners is ensuring that anyone coming to you for advice has realistic expectations. Particularly about what orthodontic treatment can and cannot achieve.

DDU research has shown that many patients will complain if they are disappointed with the outcome of their treatment. In addition, a significant proportion of complaints feature allegations of poor communication with patients saying they were unaware about possible pain, discomfort or complications, or the implications of retention.

Here are just a few of the ways you can identify and address any mismatch between a patient’s wish list and what you can realistically achieve.

Advertising

The time element often heavily markets modern orthodontic treatment. The promise of a quick result attracts many patients. However, limited treatment orthodontic appliances may not be suitable in every case. So, it should always be clear that a full consultation will be necessary.

It is therefore important not to over-sell specific options or make inflated claims in your marketing.

In its professional standards, the British Orthodontic Society (BOS) reminds members of the orthodontic team that, ‘They have a professional duty to comply with both the GDC guidance on advertising, the ASA code of practice on advertising and the MHRA’s Blue Guide. A breach of regulations may be a criminal offence. Civil or criminal action may be taken in the worst instances.’

The GDC tells dental professionals, ‘You should only recommend particular products if they are the best way to meet a patient’s needs. If you endorse products, you must ensure that you only provide factual information about the product which can be verified by evidence. You should take care not to express or imply that the whole profession shares your view.’

Initial consultation

Patients coming to you are likely to have been influenced by a variety of sources. For example: TV, magazines and social media where there are plenty of scope for misunderstanding.

A patient may appear well informed. However you still need to listen to their concerns about appearance, comfort, cost, and so on. It’s important to establish an honest and open dialogue from the outset, so you understand the patient’s priorities and can provide relevant advice. The BOS states: ‘Realistic objective setting is the responsibility of both the patient and practitioner; and you should document all aims of the treatment in the clinical notes.’ 

Ultimately, you should not agree to treat a patient unless you are convinced that the proposed treatment is reasonable, in line with current accepted practice, in the patient’s best interests, and within your training and experience. Be wary if your initial conversation with the patient gives you cause for concern about their expectations or their likely compliance with treatment.

Obtaining consent

The consent process enables you to ensure patients know exactly what to expect from treatment. To correct any misconceptions and warn patients about anything that they might want to know. Like, the possibility that it may take longer to achieve the desired result. Also, the chance that the treated teeth will relapse. Take this opportunity to advise the patient that a referral may become necessary at any point in the treatment with the patient’s consent.

The BOS expects orthodontic practitioners to have a ‘full case discussion’ with the patient. It states that ‘a description of the risks, benefits and limitations of each treatment option must be fully discussed and documented’.

It stresses the need for ‘clear explanations in language that can be understood by the patient and/or their guardian’. In addition, patients should have a ‘cooling off’ period to consider their options. As well as the opportunity to discuss their treatment plan at any time.

Provide patients with more opportunities to reflect on their treatment options and raise questions. If you do, it is more likely that they fully engage with the decision-making process. They will be aware of the risks that matter to them.

Revise plans if necessary

Once treatment has started, you need to be alert to signs that the treatment is not going as planned. If it’s unlikely the patient’s expectations can be achieved with a particular appliance within the expected timeframe, it’s better to be upfront with them. You can then reassess your plan or arrange a referral with the necessary consent.

If you leave it to the patient to raise concerns, you will damage their trust in you. Particularly if you have promised them perfect results.

From a dentolegal perspective, managing patients’ expectations is key to ensuring patients are happy with the result of treatment and to reducing the chances of a complaint or a claim.

As ever, effective and honest communication goes a long way to increase the chances of a successful outcome for you and the patient.

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A small number of NHS contract holders could be in ‘real trouble’ if changes are not made to the targets, reports NASDAL. 

This is according to Alan Suggett at the National Association of Specialist Dental Accountants and Lawyers (NASDAL).

Assessing quarter four and the target requirements, he identified two key concerns that affect practices.

1. That ‘a small but significant’ number of practices are unable to reach the 45% threshold and the subsequent impact of this ‘cliff edge’
2. Pay cuts of more than 65% for some self-employed associates who carry out NHS work.

‘I feel that a fair compromise is quite simple – remove the “cliff edge” at 36%,’ he said.

‘I worry that without this change, a small percentage of the total NHS contract holders could be in real trouble. In addition, the associates who work in those practices could suffer a pay cut in excess of 65%.’

He added that for some practices that are not meeting the 36%, they are financially better off not treating any patients at all.

NASDAL reports fall in profits

NASDAL also presented the statistics for the year 2019-2020. Some key findings included:

• A slight drop in net profit across the market as a whole
• A continued decrease in NHS practice profits
• An increase in fee income for associates (3%) and an increase in net profit (2%)
• Consistency in practice expense ratios.

The data reveals the net profit of a typical dental practice fell back to £129,178 from £134,387 in 2019.

Additionally, both NHS and private practices saw a reduction in profit. For example, NHS profits stood at £116,284 in 19/20, down from £124,475 in 18/19.

Similarly, private practice profits were £133,192 in 19/20, a fall from £140,591 in 18/19.

However, mixed practices saw a small rise from £132,940 in 18/19 to £134,342.

‘True impact’

‘What the figures will show for the year of the pandemic is conjecture at this point, but we certainly find ourselves in a very different landscape now from a little over a year ago,’ said Ian Simpson, chartered accountant and a partner in Humphrey and Co.

Heidi Marshall is NASDAL honorary secretary and also heads up the dental team at Dodd & Co Chartered Accountants. She said the end of the furlough scheme in September 2021 will see a ‘real reckoning’ in many sectors.

She said: ‘I think that we will see the true impact of what the end of furlough will mean for our economy.

‘Potentially hundreds of thousands of people could find themselves out of work and that will certainly mean a reduction in enquiries for elective dentistry. But perhaps even the more regular dental care too.’

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More people in Britain stopped visiting the dentist during the pandemic than in any other country in Europe.

This is according to new research from GSK Consumer Healthcare in partnership with IPSOS.

A significant 43% of Brits visited a dentist less often since the onset of the pandemic.

Additionally, 18% of British consumers do not intend to visit a dentist over the next six months. This is due to concerns regarding virus transmission from dental equipment or from others in the waiting room.

And although there is increased snack consumption among Brits (30%), just 9% have upped their teeth brushing.

This comes as recent PHE statistics reveal growing oral health inequalities among children.

Discrepancies in the prevalence of tooth decay in five-year-old children between the country’s richest and most deprived communities spiked from 2008 to 2019.

For dental caries and tooth loss, studies reveal that absolute inequalities narrowed over time. However, relative inequalities have not.

Good oral healthcare

Jonathan Workman is area general manager for Great Britain and Ireland at GSK Consumer Healthcare. He said: ‘We know just how important good oral healthcare is to the wellbeing of consumers. As well as the longer-term negative impact that avoiding regular visits to the dentists can have.

‘Despite the many COVID-safe environments that dentists are creating, we also recognise that there are still some concerns amongst people in the UK regarding visiting a dentist.

‘As one of the world’s largest providers of specialist oral health, it’s our responsibility to reassure consumers of the great work that dentists have done to keep their practices safe and open.

‘It’s our role to help consumers understand the necessity and benefits of regularly visiting the dentist, as part of a holistic self-care routine. With our support, we hope dentists can continue to play a crucial role in maintaining British consumer’s oral healthcare practices.’

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Farah Elnaqa writes about her experiences on her dental elective when she went to Ghana to help in the Effia Nkwanta Regional Hospital in the city of Takoradi.

In the summer after my third year at dental school, I had the incredible opportunity to carry out a dental elective in Ghana.

It was a truly remarkable experience. I believe that everyone should take part in a dental elective at least once during their time at university.

I was based at the Effia Nkwanta Regional Hospital in the city of Takoradi, which is in the western region of Ghana. Effia Nkwanta is a government-funded hospital and is the only hospital in the whole region.

It receives referrals from the 22 districts within the western region, putting it under enormous strain.

Most of the patients I saw attended the hospital distressed and in pain. Some patients travel for hours to see a dentist.

Out of the three dental chairs at the hospital, only one was functional. The other chairs had been out of use for over three months. And unfortunately the hospital was struggling to have these fixed or replaced.

The only chair that we could use did not have a working light, three in one or suction.

This made treatment considerably more difficult and limited the treatment that we could carry out.

Similarly, the radiograph machines were out of order during my time at the hospital. This meant that we could not take intraoral radiographs. We could only use OPTs within a limited capacity to aid diagnosis and treatment planning.

Challenging conditions in Ghana

During my time volunteering at Effia Nkwanta, I noticed that often teeth that may have been saved with endodontic treatment unfortunately were lost.

The only dental treatments covered by the National Health Insurance Scheme in Ghana are extractions, incision and drainage of swellings and restorations.

A lot of people are unable to afford health insurance. Endodontic treatment would cost around 900 cedis (approximately £137 at the time).

Many patients were not able not afford this and, as a result, would choose to have their teeth extracted due to financial constraints.

Under these challenging conditions, the team and I at Effia Nkwanta had to adapt in order to continue providing care for patients.

Gauze was often used instead of suction. We used phone torches as a light source.

Although this was not ideal, due to the lack of resources, we had to do what we could in order to get patients out of pain as soon as possible.

Overcoming extractions

At university I was always nervous before carrying out extractions. I didn’t have much experience and I would never know what to expect.

A great thing about my time in Ghana is that it really helped build my confidence.

The majority of treatment consisted of extractions, which meant I had a lot of practise. I always had my supervising dentist there to give me a hand when I needed it.

In fact, on my first day, I was unable to take out any teeth at all. But by the end of my time there I’d really got the hang of things.

After I returned to university in September, I realised that I was no longer worried when I saw extractions planned on clinic. I found myself looking forward to them instead!

Interesting cases in Ghana

One of the particularly interesting cases that I witnessed in Ghana, was a man that was brought in to the hospital by the police.

He was on trial for a very serious crime, and they needed to determine his age. It was on the basis of his teeth as to whether the court would try him as a minor or as an adult.

He had been claiming to be a minor, and as there were no official documents to prove his age. It was definitely something I did not expect to see!

Another fascinating experience was seeing a keratocyst in real life. This was something I have only ever seen in textbooks.

A patient attended the hospital with an extremely large swelling that had been present for the past six months. We needed to aspirate it and and take an OPT to confirm the diagnosis. We then referred the patient to a specialist for further investigation and treatment.

As you can tell, I never knew what to expect, and each day in Ghana would be different!

Oral health education

On the weekends, I spent a lot of my time exploring. I wanted to experience Ghana’s vibrant culture as much as I could.

I would visit the beaches, the markets, try the local food, and we actually took an amazing trip to Kakum National Park. This was a breathtaking experience.

But one of my favourite and most rewarding experiences was visiting the local junior school and orphanage.

My aim was to to teach both the adults and children about oral health, in the hope that they could implement healthy habits in the long term.

We had a teaching and Q&A session, following which I was able to provide supplies such as toothbrushes and toothpaste.

Many of the children had never had any sort of oral health education before. But, despite this, they were so engaged in learning. It was extremely encouraging to see, and I had so much fun.

I also carried out an oral health screening of over 100 children in order to identify those that urgently needed to see a dentist.

The school/orphanage was then able to prioritise and arrange dental appointments for those children before they were in any pain.

The whole day was absolutely exhausting. But I was extremely grateful to have had the opportunity to help others – and I would do it all over again.

‘Most fulfilling experiences of my life’

My time in Ghana allowed me to meet some truly amazing people and build my confidence in ways I could have never imagined.

The team at Effia Nkwanta always strived to provide the highest level of care possible. Even in particularly difficult circumstances.

They provided me with all the support I could have asked for, and I learned so much. Particularly from my supervising dentist, Dr Henry Acheampong, who was an amazing teacher.

It was a truly rewarding experience and I only wish I could have stayed longer.

My dental elective was one of my most memorable experiences as a dental student, and also one of the most fulfilling experiences of my life.

Although I have now qualified, I often reminisce about my trip to Ghana, and I truly hope to return there one day.

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Kimia Benam explains how KB Architects helped to create RW Perio’s comforting clinical space for patients and staff.

RW Perio appointed KB Architects to design and deliver its new specialist perio clinic in a grade II listed building in Harley Street Medical Area (HSMA), London.

The brief was to design two dental surgeries and a seminar room, which was supported by back of house staff areas and a decontamination space.

We designed the clinic within a conservation area. So as part of this process KB Architects applied for listed building consent to Westminster City Council.

This exercise and process posed a significant challenge. The level of intrusion to the existing fabric of the base building, which was handed by landlord Howard de Walden Estates, therefore needed to be monitored in micro detail to ensure the proposed concept did not damage the fabric of the existing listed building.

State-of-the-art finish

The new state-of-the-art dental clinic is located on the second floor of the building. The floor area achieved is 112 sqm.

KB Architects, as part of the process, also worked closely with the client team to develop an architectural and interiors brief that clearly defined the parameters for the project.

We utilised a number of mediums to communicate our work at key stages of the project. Such as 3D CGI visuals and 3D physical printed models. This also helped relay the scale and volume of each space and the operational setting of the spaces.

The concept proposed a modern, contemporary and minimalist architectural palette. It worked successfully in tandem with the existing listed period features of the building. This created a fusion of modern and old.

The design was also minimalist, with a clutter free environment. All joinery and finishes received a bespoke design and minutely detailed to ensure a clean and functional concept.

The design team applied biophilic design principles to enhance the patient and staff experience. Such as ceiling-mounted interactive digital screens above patients. These display nature visuals and sounds. Also applying artwork into key spaces by engaging with an artist to transform gum cells into abstract forms.

RW Perio went live and successfully operational in January 2021.

KB Architects

‘Working within a listed building to design and deliver a dental clinic can impose several constraints and limitations,’ Kimia Benam, director at KB Architects, says.

‘However, 75 Harley Street is a good example how, with a well thought through design process, you can fuse the period features of a listed building to blend with modern technology.

‘This can then offer a comforting clinical space for the patients and the staff.’

‘Kimia was a pleasure to work with during our project,’ Dr Reena Wadia, RW Perio, says.

‘She has brought innovative ideas with her architectural experience. She was very helpful in overcoming the challenges we faced during our project such as listed building consent.

‘Her attention to detail made a significant difference to the overall outcome and I would highly recommend her as an architect.’

If you would like to find out more about the design and building process we went through to achieve RW Perio clinic, please do not hesitate to get in touch for a free phone consultation.

We would love to hear about you, your practice and your future aspirations. As well as explaining how we can be of assistance.

For more information visit www.kbarchitects.co.uk, email [email protected] or call 07890 549108.

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