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MATT EVERATT INTERVIEWS THE SINGING DENTIST - AKA DR MILAD SHADROOH Page 24
DEBORAH M. LYLE DIABETES RISKS TO YOUR PATIENTS Page 19 DRS. BARRY GLASSMAN AND DON MALIZIA CURIOUS HISTORY OF OCCLUSION Page 29
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CONTENTS P. 4 Adopt a growth mindset for your dental practice P. 6 Is your work environment a healthy one? P. 7 British Dental Conference and Dentistry Show 2020 P. 8 Dr Barry Oulton - The future of dentistry P. 11 Nicki Rowland - Emotion-led dentistry: injecting life back into practice
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P. 15 How to land your next dental nursing job P. 17 Delivering smiles at sea Editor Matt Everatt E: editor@dentalpracticemagazine.co.uk
P. 19 Deborah M. Lyle, RDH, MS: Diabetes risks to your patients
Advertising Manager Chris Trowbridge E: sales@dentalpracticemagazine.co.uk T: 07399 403602
P. 21 An update on caries prevention
Designer Sharon Larder E: inthedoghousedesign@gmail.com Published by The Dental Practice Magazine PO Box 430, Leatherhead KT22 2HT. T: 01372 897463 The Dental Practice Magazine is an independent publication and is not associated with any professional body or commercial establishment other than the publishers. Views expressed in this journal are not necessarily those of the editor, publisher or the editorial advisory board. Unsolicited manuscripts and photographs are welcome, though no liability can be accepted for any loss or damage, howsoever caused. No part of this publication may be reproduced in any form without the express permission of the editor or the publisher. Subscriptions The Dental Technician, Select Publisher Services Ltd, PO Box 6337, Bournemouth BH1 9EH
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P. 22 The John Zamet Memorial Prize in Periodontal Research P. 24 Katie Bell - Wellness & health for the Dental practice team P. 25 The Singing Dentist - AKA Dr Milad Shadrooh P. 27 Rebecca Waters - The threats of the past, today
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P. 29 Drs. Barry Glassman and Don Malizia - Curious history of Occlusion P. 32 Ryan Scott - Dentists and Dental Nurse Shortages
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ADOPT A GROWTH MINDSET FOR YOUR DENTAL PRACTICE BY AUTHOR & EDITOR MATT EVERATT FOTA
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ave you heard of a growth mindset or fixed mindset? There is a lot of science behind mindsets. Over 30 years ago, Dr Dweck coined the terms ‘fixed mindset and growth mindset’ to describe the underlying beliefs people have about learning and intelligence. Their research showed students who believed they can get smarter, understood that effort makes them stronger, therefore were more likely to put the effort in and achieve better results. Having a fixed mindset will hold you back and make you question yourself from taking the next step forward, hold back on the studying or go and get that new job, or chase your big dream. Our 6-year-old son came home from school last term and told me all about it! Our primary schools are even teaching this stuff to our kids! In a 6 year olds words; 'Daddy, a growth mindset is about believing in yourself and just giving things a go!' They have a song for it, it's a bit of an earworm, granted, however it gives a great message to our kids and we could all do worse than just 'having a go, it's how we grow’. A growth mindset is a set of attitudes and behaviours that does not limit individuals, it encourages innovation and creativity, whilst developing leaders. So what can we learn from our infants and how can we develop a growth mindset?
innovations. Encourage them to look at available courses, new products, encourage company representatives to come in to the practice. Give your team permission to step out of their daily role, shadow a colleague or you can share some of your experience and knowledge. Setting aside time to do this develops relationships within the team and is likely to improve collaborations and inspire others. 1. Nurture a culture that is willing to try new things and learn from failures Continual learning and innovation is key to developing a growth mindset culture. Encourage staff to suggest new products and services, and be welcoming of new ideas. This is a real key element to getting your team on board and more willing to make a success of a project. Give your team freedom to put those ideas into fruition, if they don’t succeed, learn from those experiences and be mindful not to criticise those for trying. 2. Share and Learn Give your team permission to learn, it sounds obvious, however so many practices get this wrong. Don’t just rely on your nurses and associates to fulfil their eCPD requirements and expect them to come to the table with exciting
3. Creating commitment and value It is unsurprising that businesses that have a growth mindset culture get the best out of their team, research has showed that employees feel more committed to their work when they feel they have potential to grow, learn and develop their role within the organisation. Furthermore, the research showed that employees act more transparently and work more so as a team, driving innovation and fuel the growth of the business. Creating and nurturing a growth mindset culture within your dental practice is about encouraging, growing, valuing, and seeing potential in every person, moment, failure, and success. A growth mindset will help grow your practice and position yourself and your team for growth, increase profits, and success in the future.
BRUXISM AWARENESS WEEK OCTOBER 21-27TH 2019 4
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Bruxism. How can you help? With bruxism affecting over 80% of the UK population at some point during their lives, did you know that you can offer potentially life-changing treatment within 20 minutes? A condition that is commonly overlooked and underdiagnosed, it has never been more important to show patients that you, the dentist, can provide a solution to their problem.
Successful Splint Therapy for TMD and Bruxism presented by Dr Barry Oulton
Join us for this 1-day seminar, which will equip you with everything you need, to offer this treatment in your practice, including: •
an overview of bruxism and TMD
•
how to correctly diagnose the condition and screen patients
•
communication tips for discussing treatment with patients
•
a live fitting demonstration of the Sleep Clench Inhibitor (SCi) Chairside appliance
2020 Dates now available Limited Availability Book now at s4s.co/bruxism
BRUXISM AWARENESS WEEK 21ST - 27TH OCTOBER 2019
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Use code BRUXISM10 when booking any 2020 Successful Splint Therapy seminar during bruxism awareness week to receive 10% off. 5
IS YOUR WORK ENVIRONMENT A HEALTHY ONE? BY HELEN EVERATT – NUTRITION COACH, MISSION NUTRITION Web: www.missionnutrition.co.uk I Insta: mumonmissionnutrition I Facebook: iloveMissionNutrition
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ow do we ensure our places of work are not just absent of diseases and infirmity, but are also places of physical, mental and social well being? I believe nutrition has a significant role to play here. It is well publicised that we are experiencing an obesity epidemic. The cost of obesity related illness, type 2 diabetes, heart disease, stroke… is crippling the NHS. Is it damaging our workplaces too? Our working environments have an important role to play in our health, we are after all spending on average 40% of our waking hours there. In this article I am going to discuss one vital area that affects our health in the workplace, lunch breaks. Skipping meals, eating at our desks in front of a PC, relying on snacks instead of a nutritious meal, leaves no time to rest, move, talk and re-focus in preparation for a productive afternoon. Did you know lack of adequate sleep and rest lead to overeating? Restrictions lead to binges. As a Nutrition Coach, I know this only too well. Coaching clients who have in the past or are in the present restricting themselves of meal times and food in general, only end up binging on fast, convenient sugary snacks to give them the pick-up they need to get them through the rest of their working day. Sound familiar? “I don’t eat lunch because I don’t have time/I’m not hungry/ I’ve got too much work to do/my boss doesn’t so I don’t feel I can…” (Delete where applicable). Parkinson's law is the adage that "work expands so as to fill the time available for its completion". Deciding at 8:30am that you will be breaking for lunch at noon for 45 minutes gives you a deadline to complete the mornings tasks. There is time, if you decide to
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make time. It may require planning, staggered lunch breaks, turn taking, even 25 minutes is better than nothing and it could make all the difference, not just to your health but to your productivity in the afternoon too. SNACKS ARE KILLING THE LUNCH BREAK Eating too frequently, grazing throughout the day is confusing for your body. It disguises hunger and fullness signals, making them harder to identify, often leading to over consumption of food and calories, leading to weight gain. In my experience, despite perhaps the volume of snacks being less than a meal, the calorific value is often far greater (not to mention the sparse nutrient value). This is a topic I regularly discuss in coaching sessions with clients. The resolution? PLANNING AND PREPARATION. Planning meals ahead of time, writing a shopping list and preparing meals in advance. This doesn’t have to be difficult. It may be as
simple as doubling up on the ingredients for dinner the night before and filling tupperware to take to work for lunch. If I have a spare evening I will batch cook chillis, curries and soups and keep dozens of pots in the freezer ready to defrost at lunchtime. It is a chore that once practiced, becomes easier and second nature. It is cost effective and a whole lot healthier than Uber eats. My challenge to you is to lead by example, ditch the snacks, stop the starvation and come to work prepared. Dig out the tupperware, freeze your leftovers or pop to the supermarket and buy some fresh soup, salad or even a fresh healthy microwave meal. Take the time to sit, eat, value the break from a mornings work, enjoy the time catching up with colleagues, nurturing workplace relationships. This is the time to eat nutritious food, get sustenance, nourishment, and refuel. It will have a significant impact not just on your health, but on the health of your working environment too.
HEALTH – (AS DEFINED BY THE WORLD HEALTH ORGANISATION) “ St ate of c o m p l ete p hy s i c a l , m e nt a l , a n d s o c i a l we ll b e i n g , a n d n ot m e re ly t h e a b s e n c e of d i s e a s e o r i nf i r m it y."
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THE BRITISH DENTAL CONFERENCE AND DENTISTRY SHOW 2020, HERE WE COME! l The British Dental Conference and Dentistry Show 2020 is set to be the event of the year. With education and innovation for the whole team, make sure you don’t miss out! Delegate feedback from 2019 included: “Some good, knowledgeable speakers who provided great detail in their presentations that you can take back to practice and use immediately.” Christine Auckland and Christine Deakin, dentists “A diverse and well-organised show with a variety of lectures.” Alisa Chauhan, dental therapist “Very good set up. Stands are easy to see and spaced out well. Good CPD courses for all.” Kelly, dental nurse
A CONTINUED BDA COLLABORATION l The British Dental Conference and Dentistry Show is delivered by the BDA and CloserStill Media to ensure a diverse, relevant and high quality educational programme. Following its success in previous years, the 2020 event is set to offer even more enhanced CPD in a wide range of topics. Leading speakers from across the profession
will once again offer insight into the latest clinical and business concepts, helping all members of the dental team enhance their patient care and practice protocols. Don’t miss the BDA Theatre and many other learning opportunities at the British Dental Conference and Dentistry Show 2020.
ALL THINGS ENDO AND PERIO The Speciality Interest Theatre at the British Dental Conference and Dentistry Show 2019 provided a wealth of information and advice in the areas of endodontics and periodontology. Leading professionals in the field explored intriguing topics, including Mark Ide, Sanjeev Bhanderi and Peter Galgut. Tatsiana Samalazava, dentist from Mount Wise Dental Practice, commented: “This was my first time at the British Dental Conference and Dentistry Show and I found it very informative, covering a wide range of topics. I loved the lectures on endodontics and periodontal disease.”
THE BRITISH DENTAL CONFERENCE AND DENTISTRY SHOW 2020 – 15TH AND 16TH MAY – BIRMINGHAM NEC, CO-LOCATED WITH DTS. For all the latest information, visit www.thedentistryshow.co.uk, call 020 7348 5270 or email dentistry@closerstillmedia.com
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THE FUTURE OF DENTISTRY DR BARRY J OULTON BCHD DPDS MNLP
Owned Haslemere Dental Centre in Surrey for nearly 20 years, turning it into an award-winning practice with a reputation for outstanding customer service. In 2017, he founded The Confident Dentist Academy, created to help dental professionals and teams learn communication skills and selling with integrity so they can have more impact and make a bigger difference, both personally and professionally.
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hen the organisers of the Innovation Symposium asked me to talk about the future of dentistry, I had to ask myself, ‘What do they think I know about it?’ I then thought, what does anybody know about the future of dentistry? Even those who think they know sometimes struggle; after all, nobody has a crystal ball. What we all can do, however, is imagine where we’ll each be in five years’ time. Then look back and think about what has happened over the last five years to get where we are now − as a profession, an individual, a team member, or part of an organisation. HANDLING CHANGE Change is inevitable. Firstly, there's a new NHS contract coming our way next year, which will affect everyone in dentistry – even
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those who don’t have a contract. Inevitably over the next five years, there will be an increase in private practices and Corporates will continue their growth. We’ll see more digital innovations coming into dentistry and an increased need to embrace practice management systems fully. With all of that, whatever sector you're in and whichever demographic you're treating in terms of NHS, private or mixed, I think there's a huge opportunity for us to deliver great dentistry and enjoy what we are doing. Part of that is having an effective marketing strategy and when you’re in a generation not brought up on technology, like me born in the 1970s, it’s hard to communicate with, for example, generation Z. For them it’s all SnapChat and Instagram; they haven’t used a pen and paper for years. As an example, I’ve developed a comfortable dental injection technique (CDIT), whereby
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Dr Barry Oulton reports back from the Henry Schein Dental Innovation Symposium in June, sharing insight into how dental professionals and patients can benefit from new innovations in dentistry through improved communication.
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my patients are completely unaware that they've had an injection. I really want people to know about it and for dentists and therapists to use it, however, I’ve had dental undergraduates come up to me after one of my training courses to tell me my marketing is awful. That my traditional methods of marketing don’t touch them. As practice owners what’s needed is a fresh new look at marketing and having a social media guru at the helm (aka someone from generation Z). Which brings me on to digital dentistry. What a massive growth area. Students of today are being trained how to prep teeth digitally using virtual handpieces on virtual patients. I had the opportunity to use the equipment myself at Leeds Dental Institute recently and it blew me away. It’s possible to scan your patient, upload the stl file into the virtual patient and literally practise the preparation of a tooth again and again before actually prepping the actual tooth in the real patient. Moving forward, a digitised system is a must – if we’re not on board with it we’re going to get left behind. Yet, quite understandably, we have to consider the cost implications and the learning curve for the use and implementation of the systems. Every practice needs to consider a business development plan, looking at the options, investment cost and ROI. IT’S STILL PERSONAL Having presented a snapshot of some of the kinds of changes in the pipeline for dentistry, for me, in some respects, it doesn't really matter what’s ahead of us because there's one thing that will never change. And that is that we are still a one-to-one, generally hands-on, relationship-based business. Irrespective of how much digital kit I've got or how fancy my 3D printer is, unless I'm interacting with my patients no money is going to come through the door. I firmly believe that even with the best digital kit in your practice it will be your communication, and your patient journey, that ultimately dictates how well you do in the future. And it’s not just looking after patients, it’s about looking after each other, too. Stress and work pressures take their toll, irrespective of whether you are NHS or private. The BDA released figures in January 2019 of a survey carried out within the profession. Here is the shocker, and I'd like you to think about it for a few seconds; 17.6% of dentists in the UK seriously thought about suicide last year. We must
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have a movement focused on mental health and we must support one another. People don’t like to talk about it – there’s a stigma. I’m going to put myself out there in the hope of starting to change that. I had mental health issues 12 years ago when I was going through a divorce and again two years ago when my mum unexpectedly died. Those are two episodes in 10 years, so my ‘guesstimation’ is that everybody in the profession, at some point, is going to be touched by some form of mental health issue. I got help, but not from the profession. It wasn’t there for me to access. That needs to change. EMPOWER YOURSELF I want to empower you if you are one of that 17.6% or ever become one of them. Elements of what I teach is based on NLP – neuro-linguistic programming. This is a model of communication. We experience things in our lives through our senses − sight, hearing, smell, taste and touch. IN NLP we call it visual, auditory, kinaesthetic, olfactory and gustatory. Our thoughts about our senses are what we would call an internal representation. So, for example, think about a time you rode a bike. Did you remember it in the form of a picture, a movie, a sound, and / or maybe some feelings? That’s an internal representation and it influences your emotional state. What's interesting is they also interact with our body posture. If you are upset, your posture will automatically change – you hunch over, shoulders drooping, head down. And actually, that’s how dentists sit every day they are practising. I think this is a huge influencing factor when it comes to feeling depressed. To understand more about this and learn to counteract it, which
is so important, please watch the TED Talk at https://bit.ly/1he9hAR. It isn't going to solve everything, but it’s a start. RAPPORT AND RELATIONSHIPS The next thing I want you to be aware of is how to build rapport. Rapport is your first, your last, your everything. If you can learn the simple techniques of how to build genuine rapport, it changes every relationship you have. Meta programs are personality preferences and how we present our treatment to people should be based on how THEY want it presented. If a person is ‘global’, they want an overview; they’ll be bored with detail in about 10 seconds. A ‘specific’ person wants more information, to dot the ‘i’s and cross the ‘t’s. Knowing how to identify whether a patient is specific or global will determine whether I am successful in presenting my treatment plan. It will determine whether somebody spends £25,000 with me or goes elsewhere. That might be because I didn't give them enough information or because I was boring the pants off them. It’s easy to identify a person’s personality preferences and how to communicate effectively with ANYONE once you know how. There’s more to this than can be put in a one-hour presentation or an article, so if you would like to know more about effective communication for dentists, team members and specialists visit www.theconfidentdentist.com, email sally@theconfidentdentist.com or call 0333 220 2447. Our next course dates are 29th & 30th November in Sheffield with every dentist course fee getting a ticket to the S4S charity ball on the Friday and 6th & 7th December in London. A positive future is ours for the taking – we just need to learn how to approach it effectively!
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EMOTION-LED DENTISTRY:
INJECTING LIFE BACK INTO PRACTICE Nicki Rowland, director of Practices Made Perfect, discusses the importance of building human connections in your dental practice to drive new footfall and business growth. To this end, finding your ‘purpose’ is vital.
Nicki has recently set up Practices Made Perfect by Nicki Rowland, primarily as a dental consultancy and training organisation. She is impassioned about sharing her knowledge and enthusiasm with other practices to help them survive and grow. Visit www.pmp-consulting.co.uk
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WHAT IS YOUR PURPOSE? As a practice owner or a dental professional, you know you stand for more than just making money or being compliant. You know that you need ‘a higher order’ in your practice, and a greater reason for delivering dentistry. This sounds very evangelistic but as healthcare professionals, we entered the profession to make a difference to our patients’ lives. Patients want our brands to stand for more than just making money. They want us to have a purpose. This means our practices need to have a belief system and ethos that staff adhere to. Your team needs to find a greater purpose to guide their decision-making and follow it through to the delivery of care. This may feel like profits are taking a back seat but finding a higher purpose and demonstrating your integrity will ultimately drive footfall and sales in your practice. WHAT IS YOUR BUSINESS’S PURPOSE? Your business purpose is the reason that you set up your practice in the first place. The title of this article is my business’s purpose – ‘Emotion-led dentistry – Injecting life back into practice’. Essentially, it should be one sentence or phrase that states what you stand for. Think about your purpose as what people say about you and what you wish to be remembered for. It should be transparent, tangible and consistently demonstrated to each patient every time that they visit your practice. Your purpose creates emotional connections with your people, be that with staff, patients or stakeholders. MISSION VERSUS PURPOSE To understand your business purpose, it is crucial to distinguish it from your vision and mission. Your vision is your destination,
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NICKI ROWLAND BSc (Hons) holds a diploma in leadership and management and has lived and breathed practice management since opening Perfect 32 Dental Practice in East Yorkshire with her husband in 2005. Over the past 10 years, she has nurtured her team to achieve exemplary standards in both clinical and customer service areas.
GETTING BACK TO BASICS In this day and age, the world of dentistry is driven by compliance, legislation, technology and UDAs. Dental teams are fearful of the General Dental Council (GDC), the Care Quality Commission (CQC), the Information Commissioner’s Office (ICO) and other powers that can come crashing down on them at any time. Patients have extremely high expectations that are fuelled by the media and legislative organisations expressing themselves in the public domain. Dental teams are exasperated by systems, technology and the hype for compliance perfection. I am not saying that governance is a bad thing as it raises standards and provides guidance for best practice. But what about the human element? Where has that gone? The drive to raise governance standards and comply with legislation is detracting from the delivery of care, a genuine connection with the patient and their fundamental needs. I meet dental teams day in, day out, who are highly frustrated with the current dental climate. They just want to get back to the basics of delivering dignified, respectful dental care in an environment where patients’ feelings and emotional requirements are top of the priority list, not compliance. In many cases, dental teams are so busy that contemplating any change can be daunting. This can be a ‘I can’t see the wood for the trees’ situation. However, there is a way forward and that is to strip everything back to basics and build it from the bottom up. The keyword to the ‘rebirth’ of your practice is ‘purpose’. What is your purpose? What is your practice’s purpose? What is your team’s purpose? How can we demonstrate our purpose? Read on and you will see how the word ‘purpose’ is the most powerful spanner in your toolkit.
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that is, your definition of success. You may envisage your vision in terms of money or by your reputation within the community. Your mission, however, is the journey that you take your team on to achieve your vision. Generally speaking, your mission is the strategic part of your business and the goals/ KPIs that you set yourselves. Your purpose is very different for many reasons. It is how you deliver ‘what you say on the tin’ with veracity, emotion and trustworthiness. Here are the differences between Disney’s mission and purpose:HOW CAN YOU DEMONSTRATE YOUR PURPOSE? I have a 12-point plan that strips the fundamentals of your practice back to basics. This is a purpose-proof recipe that, followed methodically, will drive your practice to the destination that you first envisaged:1. Ink your purpose Sit down as a team and genuinely determine what every individual’s purpose is and how they fit with your greater business purpose. Every team member needs to buy into your practice’s ethos.
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2. Recruit the right people Make your purpose very clear on all recruitment material. During interview, present applicants with your purpose and ask them how they will contribute the bigger picture. Likeminded individuals will give you an answer as to how they fit into your culture readily. Those that do not will struggle. This exercise sorts the men from the boys. When interviewing, always have a personal specification form that you can score applicants against. These forms list the attitudes, attributes and characteristics of an individual that you are looking for. This is not a discriminatory process if it is systematic and scored in the same way for each individual. If you have short-listed applicants, invite them into practice to work for the day. This can be very revealing and disclose how the individuals communicate, integrate and interact with your current team members. It is much easier to appoint someone to the post once you have seen how they integrate into your culture. 3. Induct rigorously Once recruited, team members need to have a full understanding of your expectations. This is where your induction and probationary
procedure comes into play. Ideally, the induction should run across the whole probationary period (usually three months). Expectations can be system based but also on how you culturally and emotionally deliver your service. 4. Use an ‘inner view’ Really get to know every member of your team and what makes them tick. Make that human connection. An inner view is a list of questions that should be asked in a relaxed environment that allows you to dig deeper and find out what motivates, excites and drives the individual at work and at home. It will also help flush out any anxieties or issues that the individual maybe fearful of. Only then can you really start to manage and support people, gain their commitment and get the best out of them to drive your practice forwards. 5. Appraise your team members Annuals appraisals are an obligatory activity within the CQC’s remit. However, one to ones across the year maintain open communications and support individuals to focus on their own aspirations and the objectives of the practice. An open-door policy is essential to supporting your practice’s purpose.
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6. Lay down your expectations to patients Any relationship needs to be set on firm foundations and your relationship with your patients is no different. Consistently spell out your practice’s purpose in all your practice literature and website and what you expect in return i.e. publish your zero-tolerance violence and aggression policy and your payment policy. 7. Know your demographic Assess your demographics and ensure that you are promoting your services to the right people with the right needs. For example, if you are located in a university town, you need to be delivering services that meet the need of the student population. Do not always assume that this demographic is short of cash. It is prudent to have a three-tiered pricing structure that caters for all budgets and requirements. Give your patients choice and they will thank you for it. 8. Maintain a human connection with each patient Show each patient that you mean what you say on your promotional material. It is essential to build on the human connection that has drawn them to you in the first place. The customer care experience is vital. ‘People buy people’ so you need your best people on reception to create a first and lasting impression. As humans, we want to feel needed, wanted and appreciated and the best way to connect emotionally with patients is to make them feel important. Allocate a named person to each new patient who they can call up at any time during working hours. Ideally, this should be the person that spoke to them in the very first instance such as your patient care coordinator or a member of your reception team. These team members should have personal business cards that they hand to their patients. This gesture strengthens the human connection by leaving the patient feeling significant and special. Courtesy calling following a dental procedure further cements the bond between the patient and the practice. 9. Get to know your patients Just as you need to be able to relate to each team member, you need to be able to connect with each patient. Exceeding patient expectations is the driving force behind word of mouth referrals. More than that, it promotes long-standing relationships and generates repeat business. I am a great advocate of having a treatment coordinator/
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MISSION
PURPOSE
WHAT WE DO
WHY WE DO IT
OPERATING A BUSINESS
SHARING A DREAM
STRATEGIC
CULTURAL
MOTIVATIONAL
ASPIRATIONAL (TRUE NORTH)
CREATES ‘BUY-IN’
INSTILLS ‘OWNERSHIP’
PROVIDES FOCUS
FUELS PASSION
BUILDING A COMPANY
BUILDING A COMMUNITY
LAYING BRICKS
BUILDING CATHEDRALS
PARKING CARS
CREATING HAPPINESS
patient care coordinator in your practice. This team member is perfectly positioned to nurture the human element, build a trusting relationship and demonstrate the integrity of your brand. 10. Reward patients for their recommendations When your patients generate word of mouth referrals, reward them for it. This is not black mail but a sincere demonstration of gratitude for promoting your business on your behalf. I would suggest giving a gift unrelated to your services, for example, a gift voucher for a local store.
demonstrate that they operate in an ethical manner. This is so important at a time when dentistry’s public persona is viewed very negatively. Embrace charitable campaigns such as National Smile Month and Mouth Cancer Action Month and take your skills out into the greater community. You may even decide to support a local campaign to care for the homeless. CSR can cost small amounts in time and money but the return on investment is significant.
11. Publish testimonial As I said above, people sell people and there is no better way of promoting your service than publishing written or video testimonials. There is a psychological concept called the ‘Me Too’ effect. People connect with the humanness of a testimonial and usually think ‘if its good enough for them then its good enough for me’.
A NEW ERA Patients have come to expect dental practices to protect them, whether it is their oral health, privacy, data or safety. They are willing to follow their emotions and complain if necessary. In this new era of authenticity, you need to examine what you are doing to protect your patients and deliver your purpose to them. Bring integrity to your service and exceed patients’ expectations and your business will flourish through powerful testimonials and word of mouth referrals.
12. Introduce Corporate Social Responsibility (CSR) CSR refers to the efforts made by a company to ‘give back’ to the community and
FOR MORE INFORMATION For further support on how to create and deliver your purpose in practice, contact Nicki at info@pmp-consulting.co.uk
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Dental Practice Magazine
HOW TO LAND YOUR NEXT DENTAL NURSING JOB BY JOSHTYN ANN OMIDVARAN
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1. THINK LIKE AN EMPLOYER The first thing to do is imagine yourself the employer. Think about what they might be looking for. What qualities, characteristics, qualifications, experience, achievements etc. Make your initial list from your own experience. Now think deeper. Different practices may be looking for different things, so the next thing to do is to look into the practices you are most interested in. If they carry out certain types of dental treatment they may like a dental nurse with experience in those areas. If they highlight patient care as a
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t isn’t always easy knowing how to put yourself forward for a new dental nursing job in a way that makes you stand out from the crowd. Knowing what to say in interviews, what content to include when putting together your CV or writing your cover letter can be confusing. In fact, it can easily feel like you sound just like everyone else, stating all the similar things. However, there are easy ways to make yourself stand out and increase your chances of getting your next dental nursing job. This just comes down to drawing the right information out of yourself and knowing how to add it to your CV. You have everything you need in yourself already. Here are the secret tips that will set you apart from the rest (protip: pull out this page and save it for when you are next applying for your job).
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priority on their website they may like a dental nurse who has shown a passion for the same. Write down everything you find and use this as a guide later to look at what skills or experience you may have that matches what they might be looking for. Later we look at how you can write this in a more powerful way that makes your future practice manager stop and take notice. 2. UNCOVER YOUR STRENGTHS List what you are good at. List everything. This is not the time to be humble, but to look honestly at yourself and uncover greatness. If you want to get a good job, then you should also be good at your job. This means you will have to find genuine strengths. This is a great exercise because you have to look at yourself from the outside and often discover useful things about yourself that you had yet to recognise. It may sometimes help to ask your colleagues if you struggle or your current manager if appropriate. Occasionally asking family and friends may also help. Particularly search for strengths that may align with the list above of what your potential employer looks for. For instance, are you great at patient care, patient communication, assisting for the specialist endodontist, comforting patients when they are scared etc. Listing the value you have added to your current or previous practice may also highlight your value to a future employer, so don’t forget to focus on this. Examples such as having encouraged patients to uptake treatment by describing their benefits, having created a new organisational system that has increased efficiency in the practice, taken a course which lets you take x-rays, won an award which showcases a skill relevant for dentistry or having directly impacted the successful outcome of a CQC inspection - all these could place you a cut above the rest. 3. STRUCTURE YOUR CV Make sure to structure your CV in a way that is easy to read. It should be easy to do a quick overview to find the needed sections. Make sure the page isn’t overstuffed with information, as too much information makes it difficult to read and digest. The CV should be a maximum of 2 pages and if the page looks crammed with information then there is too much written - cut out the fluff. Make it easy for the hiring manager to spot the information that shows why you are the dental nurse to hire. Too much information hides the
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great nuggets of gold that showcase why you are the one to hire. Don’t hide. Include all the usual information such as name, location and contact details at the top for ease for the practice manager - and make sure these are accurate. Other sections to include are: skills, experience, education and awards and achievements. Some also choose to add a small personal statement, this is only worthwhile if it adds value. You can add whatever other sections you feel give your CV a boost, but don’t add sections just to avoid empty space. Remember that everything on your CV should be there to showcase you and therefore must add value. And note that adding content that is irrelevant detracts from the good stuff you want to say about yourself and can deter a practice manager from reading your CV in full. 4. DON’T JUST MAKE STATEMENTS, GIVE EXAMPLES. Every statement you make in your CV should be a reason that explains why you are the one to hire. Practice managers want to know exactly what you have to offer that is above and beyond what they read from everyone else. They want to know that you understand what makes a really great dental nurse and that you have that. So what makes a really great dental nurse. The answer to this may vary, but is something along these lines: a great dental nurse is someone who understands that the patient experience is key, looks after and anticipates the dentist’s needs, is reliable and loyal, is excellent at infection control as well as health and safety, is organised and therefore knows where everything goes and keeps everything tidy, who looks after materials and equipment as if it is their own and isn’t wasteful, who communicates well with patients, who trusts their dentist’s treatments, who is friendly and approachable, who brags about their dentist’s treatments, who genuinely enjoys their work and who makes the dentist feel confident that they are with a nurse who is ready for any treatment. Hence saying the usual stuff such as ‘good at teamwork’, ‘punctual’, ‘good suctioning technique’ is uninteresting and vague. Instead you want to express yourself in more interesting statements that are true, but also bring your statements to life.This is what gives your statements power because they will be noticeable: ‘prioritise tasks to ensure efficient running of the day’ ‘organise surgical
instruments strategically for smarter use when needed’ ‘complimented on my suctioning technique’ ‘help patients improve their oral hygiene by discussing oral hygiene techniques’. Essentially, a statement that explains (1) what you do and (2) the effect is has, makes a bigger impact than just starting what you do alone. 5. TAKE THE EXTRA STEP If there is a particular practice you have been wanting to join, walk in with a copy of your CV, introduce yourself to the practice manager or principal dentist (whoever does the hiring). Make a good impression, ask about the kind of dentistry they do and conversationally throw in your experience if relevant. Say what you admire about the practice and that if they happen to have an opening you would be interested. If they don’t have a position available now, offer to leave your CV. Then follow up with an email that highlights who you are, that you were in to meet them and would they please store you CV for the future. If you made a good impression they are more likely to remember you this way. 6. INTERVIEW TIPS Firstly, research the practice you are going to visit. This is a must. We live in a world where so much information is available online. I always ask someone I am interviewing what they know about our practice and it disappoints me and shows their lack of interest if they haven’t bothered looking. Lots of places will not only have websites, but also social media accounts. Browse them, even if just briefly. Referring to something you have seen on the website or on social media during your interview will show the manager how interested you are. Secondly, always have at least one question to ask. It is important that the practice is as much the right fit for you as it is for the practice, so feel able to ask what you need. It also looks good as it shows maturity (most people don’t ask anything) and interest in the job. Great questions to ask are: “I would like to think I am a pretty good dental nurse, but what do you think makes an exceptional nurse?” or “It is important to me that I continue to grow and improve, do you provide regular feedback?”. And lastly, be yourself and smile. You have done everything else and there is nothing else to do but relax and do your best to impress. This and all the above should give you the best chance of finding a lovely practice that is the right fit for you.
Dental Practice Magazine
DELIVERING SMILES AT SEA Dentistry in ‘unusual environments’, Eschmann speaks to Katie Rowe, a dental nurse who played a key part in the initiative Smiles at Sea, created by Smile Together – an employee owned community interest company that delivers emergency and community care to patients across Cornwall and the Isles of Scilly.
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“I liaised closely with The Fishermen’s Mission to put together a timetable that would see us at key harbourside locations on dates and times (and tides) that would best suit the fishermen, and from there I raised interest in the initiative with posters and letting local businesses know what were going to be doing so that they could help spread the word.” Of course, offering dentistry in this manner is fairly unique, and the team involved in Smiles at Sea wanted to provide dental care without having to interrupt the daily schedules of the fishermen they wanted to treat. “Once the MDU had arrived at its location and been set up, the volunteers and I went out and about to proactively encourage fishermen and their families to pop by. The checkups and treatment ran on a first come, first served basis so the fishermen didn’t have to wait long if at all, and therefore had plenty of time to carry on with the rest of their busy day. Each patient had a free check-up, immediate dental treatment, oral cancer screening and subsidised further treatment with Brighter Dental (the private dentistry arm of our business) as recommended by our dentist on the day.” “Throughout the two weeks I was at every location with my colleagues to help set up the MDU, and coordinated our volunteers who came each day to promote Smiles at Sea and encourage fisherman and their families to u CONTINUED ON PAGE 18
KATIE ROWE is a dental nurse who works for Smile Together – a multi award-winning organisation with a strong focus on social and community impact in Cornwall and the surrounding areas.
n the UK we often take easy access to dental care for granted. However, for some patients finding the opportunity to see the dentist is not so straightforward, especially those that work in challenging industries such as fishing. Understanding this, in June 2018 with funding from Seafarers Hospital Society and in partnership with The Fishermen’s Mission and Healthy Cornwall, Smile Together took a mobile dental unit to harboursides across Cornwall and Brixham to provide dental care and health checks to fishermen and their families. Katie Rowe, Project Lead Dental Nurse for the initiative explains: “We were inspired to start this initiative as many of the families and fishermen in the area were in need of dental care. In fact, 70% of the patients we treated during the initiative hadn’t seen a dentist in over 5 years! To make Smiles at Sea a reality my manager, Joy Callender, had arranged for us to borrow a mobile dental unit (MDU) from Community Dental Services in Bedfordshire for two weeks in June so that we could provide these people with the dental care they needed.
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come for a checkup. I was able to resolve any issues or problems immediately and was able to personally manage the decontamination procedure each day.” Offering dental care from a small mobile unit is bound to bring some challenges, and the team soon found that they had plenty to face. “Being summertime many of the harboursides were busy and therefore the logistics of getting the MDU safely into some of the (very tight) harbourside locations was interesting! Smiles at Sea also coincided with this summer’s heat wave and we were positioned in some relatively exposed locations, often in full sun. However, I’d packed suncream, sunhats and plenty of drinking water for us all, there was air-conditioning in the MDU plus fans, and of course we could go swimming in the sea after hours to cool off! Operating out of a small, mobile unit offered space restrictions, but did this affect any daily protocols such as infection control? “We maintained infection control exactly the same way as we do in our usual clinical environment. We used the same products to clean down the equipment such as Clinell wipes, hand washing procedures were the same as the MDU had access to fresh water
from running taps so we used our regular hand soap and alcohol gel. The majority of the instruments used were disposable and were therefore placed into a large sharps bin immediately after use. Any instruments that were not disposable were placed into a sealed box, sprayed with protective spray and transported to the nearest clinic to be disinfected and autoclaved. “We adhered to GDC regulations for patient care, cross infection regulations, and health and safety guidance at all times just as we would in a standard dental clinic. The MDU did come with its own policy and user guidelines though, and we had to follow these regulations as well!” It’s initiatives like Smiles at Sea that push the profession forward in the shared goal to treat as many patients as possible. It’s easy to forget that rural communities and those who work in
demanding industries may not have the time or access to dental care, so offering these people a mobile option enables professionals to help support their communities. “Smiles at Sea was a tremendous success and I gained so much from this experience. It’s not an opportunity many dental nurses would get, but working for a dental social enterprise which invests its profits back into the local community means we get to be involved in exciting projects such as this. I love working for Smile Together and being able to genuinely make a difference to our patients!”
without the need for primer. Furthermore, the adhesive is quick and simple to use, as it requires no mixing and only takes one application to be effective. Find out how effective a dental adhesive can be by choosing Scotchbond universal adhesive today. For more information, call 0800 626 578 or visit www.3M.co.uk/Dental
bleach shades, but each of these shades also has a universal opacity that meets the needs of the majority of clinical indications. There is also an innovative Filtek Universal Restorative Pink Opaquer shade from 3M that has been designed to mask metallic defects and stained dentition, helping you to achieve optimal aesthetics. Start your journey to simple restorations today by contacting 3M Oral Care. For more information, call 0800 626 578 or visit www.3M.co.uk/Dental
For more information on the highly effective and affordable range of decontamination equipment and products from EschmannDirect, please visit www.eschmann.co.uk or call 01903 753322.
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w Your restorative material needs to be adaptable to the way you work as well as usable in a wide array of indications. With Filtek Universal Restorative from 3M Oral Care, achieving this is easy. Not only does Filtek Universal Restorative from 3M have only eight shades that cover the whole spectrum of VITA classical and
Dental Practice Magazine
DIABETES RISKS TO YOUR PATIENTS
DEBORAH M. LYLE, RDH, MS
C
lose to 3.7 million people in the UK have been diagnosed with diabetes, with around another million thought to be undiagnosed, and still more in the process of developing Type 2 diabetes.1 As you are no doubt aware, diabetes mellitus is associated with oral health problems and can potentially cause complications during orthodontic treatment. Between the overall rise in the numbers of individuals with diabetes and increasing numbers of older patients seeking orthodontic treatment, you are more likely than ever to encounter patients with the condition. The hallmarks of uncontrolled diabetes include (but are not limited to): dry mouth and burning sensation, brittle teeth, dental caries, oral thrush, an acetone smell, ulcers, increased susceptibility to infections and delayed healing. Some diabetics will not exhibit any of these symptoms of course, but they must still be made aware of the importance of an immaculate oral hygiene routine to prevent any problems. Data confirms that diabetes is a major risk factor for periodontitis in fact, susceptibility to periodontitis is increased by approximately threefold in people with diabetes.2 Consequently, there may be erosion of the periodontium and bone resorption, which can result in teeth moving and becoming misaligned, potentially increasing the likelihood that these patients will seek orthodontic surgery. 3
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Deborah received her Bachelor of Science degree in Dental Hygiene and Psychology from the University of Bridgeport and her Master of Science degree from the University of Missouri - Kansas City. She has 18 years clinical experience in dental hygiene in the United States and Saudi Arabia with an emphasis in periodontal therapy. Along with her clinical experience, Deborah has been a full time faculty member at the University
of Medicine & Dentistry of New Jersey, Forsyth School for Dental Hygienists and Western Kentucky University. She has contributed to Dr. Esther M. Wilkins’ 7th, 8th, 9th and 10th editions of Clinical Practice of the Dental Hygienist and the 2nd and 3rd edition of Dental Hygiene Theory and Practice by Darby & Walsh. She has written numerous evidence-based articles on the incorporation of pharmacotherapeutics into practice, risk factors, diabetes, systemic disease and therapeutic devices. Deborah has presented numerous continuing education programs to dental and dental hygiene practitioners and students and is an editorial board member for the Journal of Dental Hygiene, Modern Hygienist, RDH, and Journal of Practical Hygiene and conducted several studies that have been published in peerreviewed journals. Currently, Deborah is the Director of Professional and Clinical Affairs for Waterpik, Inc.
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The general advice regarding diabetes is for patients suspected to have the condition to get checked by their GP and for them to make appropriate changes to their diet, with exercise also being recommended where possible.4,5 When patients are known to have the condition this should of course be factored into their treatment. Provided that patients with diabetes are keeping control of their glycaemic states and properly monitored, diabetes is not a contraindication for treatment.6 Periodontitis is often present in diabetic patients and should be treated prior to any orthodontic procedures.7 RECENT DEVELOPMENTS There are quite often exciting reports in the media of breakthroughs in the treatment and management of chronic and life-threatening conditions. An example of this is the recent coverage of a Dutch surgical intervention, where the gut’s mucous membrane was destroyed and allowed to regenerate, with promising results after a year for patients with Type 2 diabetes.8 Promising though this may be, more often than not such breakthroughs are either overstated, fail to materialise into a viable treatment, or take considerable time to move from the research phase to frontline treatment. For these reasons, no matter how exciting potential breakthroughs are, though sooner or later one will no doubt be very successful, wherever possible avoiding the condition in the first place will always be ideal. In Britain a “sugar tax” was recently implemented whereby a surcharge has been added to particularly sugary drinks.9 The stated intention was twofold, to encourage companies to reduce the sugar content of their products and to sway consumers into buying beverages with either less sugar or sugar-free alternatives, with the belief that this would help tackle obesity and related conditions. It is far too early to say whether this tax will be successful in its stated objectives, but we should perhaps sound a note of caution over pushing people towards sugar substitutes. Aspartame and other artificial sweeteners have been linked to a number of health conditions including Type 2 diabetes, with some suggesting that these products could be just as bad or worse for the consumer than ordinary sugar.10,11 This is
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not settled science, with much debate and conflicting study results being produced, however, it may be wise to inform patients of the potential risk so they do not become complacent in their consumption of products containing sugar substitutes. On the bright side, a reduction in consumption of sugarrich beverages should at least help reduce levels of tooth decay.12 Taking statins has also been suggested to cause an increased risk of developing diabetes, the precise level of increase varying according to type (pravastatin being relatively low risk, atorvastatin being comparatively high for example). However, the benefits of statins for high-risk cardiovascular patients are still considered to outweigh the risks, so will likely continue to be prescribed for the foreseeable future.13
A. Mayyad A., Bardisi W., Alshammari S., Alsihati Z. Orthodontic treatment consideration in diabetic patients. Journal of Clinical Medicine Research. 2018; 10(2): 77-81. Available at https://www.ncbi.nlm.nih.gov/pmc/ articles/PMC5755646/ Accessed October 25, 2018. 4
Diabetes. NHS. Available at https://www.nhs.uk/
conditions/diabetes/ Accessed October 25, 2018. 5
Golbidi S., Badran M., Laher I. Antioxidant and anti-
inflammatory effects of exercise in diabetic patients. Experimental Diabetes Research. 2012; 2012: 941868. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC3191828/ Accessed October 25, 2018. 6
Almadih A., Al-Zayer M., Dabel S., Alkhalaf A.
Mayyad A., Bardisi W., Alshammari S., Alsihati Z. Orthodontic treatment consideration in diabetic patients. Journal of Clinical Medicine Research. 2018; 10(2): 77-81. Available at https://www.ncbi.nlm.nih. gov/pmc/articles/PMC5755646/ Accessed October 25, 2018.
RECOMMENDATIONS For patients with diabetes and other conditions that compromise their oral health condition, the Waterpik® Water Flosser is an easy recommendation to make. The Water Flosser makes it easy to painlessly and effectively clean between the teeth as well as below the gum line to reach areas that are difficult or impossible to reach with conventional flossing and brushing. As a dental professional you are in a position to spot signs of diabetes, and can play a role in encouraging your patients to take steps to avoid developing the condition and getting checked for it. With appropriate advice and treatment diabetes is sometimes preventable and usually manageable, and by being proactive in anticipating it you can help improve not just your patients’ oral health but their overall health too.
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Almadih A., Al-Zayer M., Dabel S., Alkhalaf A. Mayyad
A., Bardisi W., Alshammari S., Alsihati Z. Orthodontic treatment consideration in diabetic patients. Journal of Clinical Medicine Research. 2018; 10(2): 77-81. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC5755646/ Accessed October 25, 2018. 8
Van Baar A., Nieuwdorp M., Holleman F., DeViere
J., Crenier L., Haidry R., Batterham R., Hopkins D., Grunert L., Neto M., Vignolo P., Costamagna G., Bergman J. Duodenal mucosal resurfacing elicits improvement in glycemic and hepatic parameters in type 2 diabetes – one-year multicenter study results. Diabetes. 2018; 67(Supplement 1): 1137-P. Available at http://diabetes.diabetesjournals.org/content/67/ Supplement_1/1137-P Accessed October 25, 2018. 9
HM Treasury. Soft drinks industry levy comes into
effect. GOV.UK. April 5, 2018. Available at https:// www.gov.uk/government/news/soft-drinks-industrylevy-comes-into-effect Accessed October 25, 2018. 10
Swithers S. Artificial sweeteners produce the
counterintuitive effect of inducing metabolic
For more information on Waterpik® please visit www.waterpik.co.uk. Waterpik® products are available from Amazon, Asda, Costco UK, Boots.com and Superdrug stores across the UK and Ireland.
derangements. Trends in Endocrinology and Metabolism. 2013; 24(9): 431-441. Available at http://dx.doi.org/10.1016/j.tem.2013.05.005 Accessed October 25, 2018. 11
Choudhary A. Aspartame: should individuals with
type ii diabetes be taking it? Current Diabetes Reviews.
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Diabetes UK. Diabetes Prevalence 2017 (November 2017). Diabetes UK. 2017. Available at https://www.
2018; 14(4). Available at http://www.eurekaselect. com/152839/article Accessed October 25, 2018. 12
Which foods cause tooth decay. NHS. Available at
diabetes.org.uk/professionals/position-statements-
https://www.nhs.uk/common-health-questions/dental-
reports/statistics/diabetes-prevalence-2017
health/which-foods-cause-tooth-decay/ Accessed
Accessed October 25, 2018. 2
Preshaw P.M. et al. Periodontitis and diabetes:
October 25, 2018. 13
Rahal A., ElMallah A., Poushuju R., Itani R. Do
a two-way relationship. Diabetologia. 2012
statins really cause diabetes? A meta-analysis of
Jan; 55(1): 21–31. https://www.ncbi.nlm.nih.
major randomized controlled clinical trials. Saudi
gov/pmc/articles/PMC3228943/ [Accessed
Medical Journal. 2016; 37(10): 1051-1060. Available
December 17th 2018]
at https://www.ncbi.nlm.nih.gov/pmc/articles/
3
Almadih A., Al-Zayer M., Dabel S., Alkhalaf
PMC5075367 Accessed October 25, 2018.
Dental Practice Magazine
AN UPDATE ON CARIES PREVENTION BY JUSTIN SMITH DIRECTOR OF MARKETING CALCIVIS LTD
F
luoride varnish applications are usually targeted at children with a high risk of caries, or where it is considered beneficial to complement the fluoride found in water, from dietary sources and toothpaste. The preventive effect of fluoride varnish has been the subject of numerous studies conducted over many years in children, adolescents and adults. 1,2,3 There are claims that fluoride varnish can substantially reduce the incidence of caries and even reduce the number of caries related hospitalisations. However, new research published in Caries Research in June 2019, has revealed some interesting information. LATEST NEWS A systematic review and meta-analysis to assess the effectiveness of fluoride varnish therapy in reducing the risk of developing new cavities and tooth decay-related hospitalisations was conducted with pre-school age children. After reviewing 20 past studies about the use of fluoride varnish, which included 13,650 children aged between 2 and 5 years, it was found that fluoride varnish resulted in caries on one fewer tooth surface per child who received treatment. At tooth level, no significant difference was observed between children that received
fluoride varnish, and those that did not. The meta-analysis showed the risk of developing new dentine caries lesions was reduced to 12 percent for children when fluoride varnish was applied. This was described as a ‘rather modest benefit’ as a large number of children developed new dentine caries lesions regardless of fluoride varnish use. The researchers found that in a population of preschool children with 50% caries incidence, fluoride varnish must be applied in 17 children to avoid new caries in just one child. They concluded that applied fluoride through varnish made hardly any difference for the risk of developing new caries in children. Furthermore, no study reporting on cariesrelated hospitalisations was found.4 DENTAL SEALANTS As part of an overall prevention strategy, dental sealants may also be used to protect the teeth from caries. First developed in the 1970s and 80s, these thin plastic-coatings are used to fill depressions, pits and fissures and form a protective shield over the tooth enamel. This provides a smoother, easier surface for patients to clean and acts as a barrier from cavity forming plaque and acids. Sealants are usually applied to the chewing surfaces of the permanent molars soon after eruption (at around the age of 6 or 7 years) and last for as long as 5 to 10 years.5 Their efficacy has been established and confirmed in various studies and a report released by the Centres for Disease and Control in 2016 stated that school-age children without sealants have almost three times more cavities than children with sealants.”6
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THE CONTROVERSY Bisphenol A or BPA as it is commonly known as, is a chemical used for the manufacture of polycarbonate plastics, epoxy resins and methacrylate resins and is widely used in many products including dental sealants. In animal studies, a number of adverse health effects have been associated with BPA including effects on hormonal activity, asthma, diabetes, obesity, behavioural changes, cancer, infertility u and genital malformations.7
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The other major concern is that BPA may have an oestrogen effect. Animal studies have indicated that BPA is effective in stimulating prolactin hormones from the pituitary glands and increased growth activity in cells lining the mammary glands.8 Nevertheless, BPA exposure from sealants is small and has been described as “negligible” as a much larger source of human exposure to BPA is from food and beverages packaging, such as cans coated with BPA based epoxies.7 EDUCATIONAL, EVIDENCE-BASED, PREVENTIVE CARE To support an evidence-based approach and to revolutionise the way in which dental caries are managed, a team of cariologists and industry experts have developed the CALCIVIS imaging system. This unique dental device uses a bioluminescent photoprotein to detect free calcium ions as they are released from actively demineralising tooth surfaces. By capturing this information as glowing images, it provides definitive evidence of the caries disease process at the very early stages (as the tooth enamel first begins to lose minerals). This means that preventive, non-invasive measures can be implemented to prevent further progression at a much earlier stage than has been previously
possible. Equally, the engaging CALCIVIS images help to better understand their oral health status and empower them to take the necessary preventive steps to avoid further disease progression. The effectiveness of any strategy to prevent caries can be improved by assessing the risks and educating patients. Innovation now enables dental professionals to identify these patients more easily and intervene during the initial stages of the disease process to improve the way this prolific disease is managed.
prevention_in_children.pdf [Accessed 23rd July 2019] 3
recommendations and supporting systematic review. J Am Dent Assoc. 2013 Nov; 144(11): 1279–1291. https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC4581720/ [Accessed 23rd July 2019] 4
de Sousa F.S.O et al. Fluoride Varnish and Dental
Caries in Pre-schoolers: A systemic review and metaanalysis. Caries Research. June 2019. https://www. karger.com/Article/FullText/499639 [Accessed 23rd July 2019] 5
For more information visit www.calcivis.com, call on 0131 658 5152 or email at info@calcivis.com
Weyant R.J. et al. Topical fluoride for caries
prevention. Executive summary of the updated clinical
NHS. Live well. Children’s teeth. Healthy body.
https://www.nhs.uk/live-well/healthy-body/taking-careof-childrens-teeth/ [Accessed 23rd July 2019] 6
American Dental Association. (ADA) Sealants. https://
www.mouthhealthy.org/en/az-topics/s/sealants
REFERENCES 1
Holm G.B. et al. The caries-preventive effect of a
[Accessed 23rd July 2019] 7
Becher R. et al. Presence and leaching of bisphenol
fluoride varnish in the fissures of the first permanent
a (BPA) from dental materials. Acta Biomater
molar. Acta Odontol Scand. 1984 Aug;42(4):193-7.
Odontol Scand. 2018; 4(1): 56–62. https://www.
https://www.ncbi.nlm.nih.gov/pubmed/6594021
ncbi.nlm.nih.gov/pmc/articles/PMC5974758/
[Accessed 23rd July 2019]
[Accessed 23rd July 2019]
2
Marinho V.C.C et al. Fluoride varnishes for preventing
8 Rathee M. et al. Bisphenol A in dental sealants and
dental caries in children and adolescents. Cochrane
its oestrogen like effect. Indian J Endocrinol Metab.
Database of Systematic Reviews 2013, Issue 7. Art.
2012 May-Jun; 16(3): 339–342. https://www.ncbi.
No.: CD002279. http://www.mhsmobiledental.
nlm.nih.gov/pmc/articles/PMC3354837/ [Accessed
com/uploads/2/6/5/3/2653728/cochrane-caries_
23rd July 2019]
THE JOHN ZAMET MEMORIAL PRIZE IN PERIODONTAL RESEARCH
Offered in association with the Alpha Omega London Chapter and Charitable Trust BACKGROUND The John Zamet Memorial Prize has been established to recognise and commemorate the significant contribution made to clinical periodontology by the late Dr John Zamet. Dr Zamet was an Honorary Consultant and Senior Research Fellow at the UCL Eastman Dental Institute, a Past President and Honorary Member of the British Society of Periodontology and the founder Chairman and a Trustee of the Alpha Omega London Chapter and Charitable Trust. PROTOCOL Applications are open to all UK-based postgraduate dental students studying for a Masters degree or PhD who are undertaking or who have recently
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completed original research associated with clinical periodontology. The prize will be awarded biennially with a value of £2,000. Applicants should submit a covering letter and an abstract not exceeding 1000 words which should, at least, cover the following areas: 1. Background to project 2. Aims 3. Methods 4. Relevance to clinical periodontology 5. Start and completion dates (estimated completion date will suffice if ongoing) SUBMISSION Three paper copies of the application should be submitted by 31st December
2019 to: Professor Andrew Eder, Chairman, The Alpha Omega London Charitable Trust, 2nd floor, 57a Wimpole Street, London W1G 8YP And also sent electronically via email to: andreweder@restorative-dentistry.co.uk The applicant must also submit a letter of support from their research supervisor confirming their supervision of the project. The submission will be considered by a panel of at least two Specialists in Periodontology whose decision is final. The successful applicant would normally be invited to present the results and/or clinical implications of the research at a meeting of the Alpha Omega London Chapter.
Dental Practice Magazine
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WELLNESS & HEALTH FOR THE DENTAL PRACTICE TEAM BY KATIE BELL - PHYSIOTHERAPY & WELLNESS
A
s an owner of a large Physiotherapy & wellness company I am delighted to have been asked to contribute and share my ideas and thoughts on all thing’s wellness! For my first month I have chosen to talk about Autumn Wellness and what we can do to really focus on our self-care, after all we spend all day focusing on everyone else’s! Autumn is here and the trees are about to show why it’s okay to let things go! With this change in seasons comes shorter days and cooler weather. Thankfully, we don’t need to curl up and hibernate just yet! Autumn is a wonderful time to set new intentions for selfcare, begin a new wellness routine or revamp what you have been doing for a while. The Christmas holidays will be here before you know it and prioritising self-care now will help you stay on track during those even busier winter months. In Eastern Medicine, Autumn is regarded as a time to pull our energy inward to prepare for winter. Autumn is about layering up and slowing down. It’s normal during this transition to feel a sense of loss as the light fades, but a great way to cheer yourself up is to spend some time outdoors and enjoy the gorgeous colours. Cultivating balance is key during any transition. Do you notice how many people tend to get sick in the Autumn and Winter seasons? Often, it’s because we’re depleted, not living in alignment with the season and in serious need of rest. Recognising that we are part of the cycle of nature and that there is a time to put our energy outward (Spring and Summer) and a time to draw our energy inward (Autumn and Winter) sets the foundation for a sustainable wellness practice. Making even slight lifestyle adjustments to our everyday rituals will support our wellbeing on many levels. Once the summer energy is far behind us it can be hard to get motivated to take care of ourselves. The more you can prepare now, the more likely it is that you will be able to stay on track during those cold, darker months ahead.
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GET PLENTY OF REST Sleep is essential to keeping us happy and healthy. Studies show that over time, lack of quality sleep impairs the immune system which makes us more susceptible to colds and viruses that frequently float around during those cooler months. KEEP IT SIMPLE Don’t go overboard setting crazy goals for yourself. It’s important to consider our obligations and what our current schedule looks like when we’re in the goal setting process. In the long run it’s more beneficial to set goals that are reachable, and then add on from there. CHECK YOUR VITAMIN D LEVELS We get the majority of our vitamin D from the sun. Naturally our intake decreases in cooler months from spending more time indoors. Vitamin D increases fertility keeps our bones strong and supports the immune system. We see many people in clinic who have muscular aches and pains and often it is low vitamin D levels which is the cause. Schedule a visit with your doctor to check your vitamin D levels so you can know how much you need to supplement with. This is a very routine test with a quick turnaround time for results.
NOURISH WITH SEASONAL FOODS Squash, dark leafy greens, apples, beets, soups and stews are all great places to start. Autumn is an ideal season to spend some time in the kitchen preparing your favourite nourishing foods. Autumn is a great time to enjoy warmer meals prepared with love. Set aside a few hours each weekend to prepare some of your favourite foods for the week. My favourite is homemade chicken soup using the carcass to make the broth and packed full of dark leafy greens and beans. LEARN TO SAY NO! Over committing is something we all do! No is a very powerful word, much more powerful than YES! Look at where and what you are spending your time on or at, and what you would like to change in your week. Do you feel you never take time for yourself, do you always say yes and then have a feeling of regret? Saying no is not selfish, but often necessary to not use all your energy reserves up for other people, family, friends, events etc. What can you say NO to and be happy with your decision? CHOOSE ONE THING YOU ARE GOING TO ACTION THIS WEEK AND SHARE IT WITH SOMEONE!
Dental Practice Magazine
INTERVIEW WITH...
Matt Everatt interviews The Singing Dentist AKA Dr Milad Shadrooh
from Ascot via South London via Tehran, Iran! lol So, Milad aka The Singing Dentist from Basingstoke, where did you qualify and why did you choose to study dentistry? Milad Qualified from Barts and The London
in 2004 and I chose dentistry as I wanted a healthcare job where I could use my people skills and my scientific intellect, but also my manual dexterity and dentistry seemed perfect.. I also knew I wanted a 9-5 type of job so I could go home at the end of the day and have a family life! OK, great! You clearly have a passion for your profession. Over the past few years we have seen a lot of unhappiness within our profession what do you think are the main pain points for dentists these days? Milad The constant threat of litigation from
patients and the potential problems from our regulator, the parameters of the NHS and having to work in a system which is incredibly difficult to work in, the constant feeling of pressure from all the red tape that working in dentistry consists of…. And as a practice owner, finding the balance of running a business and making a profit whilst carrying out health care work is not an easy task! So, I'm guessing this was your reason for the alter ego 'The Singing Dentist'? Milad Actually not at all!! The Singing Dentist
was a complete accident! I did a freestyle one day in my surgery when a patient didn’t show up for root canal and I filmed myself as I thought it was funny, I sent it to a mate and he posted it online! It grew from there, it was never meant to be a thing at all!
Dental Practice Magazine
What has been your greatest achievement as the Singing Dentist? Milad The feedback I get from the public is
the main reason I keep doing it, parents telling me their kids are now brushing because of the songs, nervous patients telling me they aren’t nervous anymore, students telling me I have inspired them to study dentistry, other dentists telling me I have brought fun and positivity into our profession,,, receiving comments like that on a daily basis is what keeps me going as I can see it is making a difference Who's the most famous person you have met? Milad Ed Sheeran for sure! After I did a
parody of his song, I was invited to be backstage at his concert at the Royal Albert Hall and we met there,, he was soooo nice and said he had heard my parody and he liked it! We had a photo and it was a great moment,,,
A FEW QUICK FIRE FUN QUESTIONS! What's been your favourite parody song you've done? Milad Ed Sheeran one – its genius Give us an interesting fact about you. Milad I can do over 400 kick-ups What's the best and worst car you have owned? Milad Best – Range Rover Sport. Worst –
nothing really, I've always had sick cars! My first was a MK2 Golf with rims and an awesome sound system!! How many pets do you have? Milad 1 – a Jug called Chilli. Jug is half Jack
Russell and half Pug What Football team do you support? Milad Arsenal
Who's the person you most admire in your life right now? Milad Wow,, tough question,,, I would always
If you had a choice between two superpowers, being invisible or flying, which would you choose? Milad Invisible for sure – could do anything
say my dad,, being a parent now, I understand the sacrifices that you make for your kids and what my parents did for me is something I can never repay,,, having to flee their motherland during the Iran-Iraq war with a 5 year old to set up a brand new life in a new country is a monumental task and if they didn’t do that, I genuinely don’t know where I would be now,,,
you wanted and get away with it! But, it would have to be controllable, otherwise what’s the point?? Wouldn’t want to be invisible all the time!! You would really miss my eyebrows!!
And professionally, who have you been most inspired or influenced by? Milad Dentistry wise, my best mate
Nilesh Parmar. We qualified together from The London and since then, he has absolutely smashed it with all the postgrad qualifications, the charity work and he’s just a nice genuine guy with an amazing work ethic… I’d also big up my mate Avik Dandapat for his work rate and skills too, he is also an amazing dentist and big time family man, which is what it’s all about.
Back to the serious questions, What type of dentistry do you most enjoy? Milad Cosmetic work to improve people’s
smile – it’s the most rewarding part of the job,, whether its with aligners, bleaching and contouring, or implants or even with a lovely denture, giving people the ability to smile and be confident in that smile is the best feeling What is your least favourite part of dentistry? Milad The haters in the profession who bring
negativity for no reason! There are so many pressures in the industry, getting it from peers and colleagues too is just a sad affair and something I hope will eventually fizzle out once we all learn to love each other!! lol
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Matt E. In a Cilla Black off of Blind Date back in the 90s style, What's your name and where do you come from!? Milad My name is Milad Shadrooh and I’m
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I love what you have achieved so far as The SD, some people may not appreciate it, however, I have listened to the stories of the parents saying how the SD has encourage their child to brush their teeth, or that their autistic son now wants to go and see his dentist even though in the past he was too scared to go. What do you hope to achieve with The Singing Dentist in the future? Milad I want to continue to bring positivity
and fun into the industry, keep getting the messages out there as I do think they are being heard,, I would love to work on some actual government initiatives to help the oral health situation in the UK, especially with getting tooth brushing into schools, I’m releasing my own range of dental products soon too with the aim of making it affordable and easy for everyone to access a good brush and paste so hopefully things will continue to grow!! Thanks Milad, as ever, you've entertained us! What's the next thing we will be seeing from you? Milad I genuinely never know!! I just keep
doing what I enjoy and it seems to be working! Most likely some more parodies, hopefully some TV stuff and I am writing a book too so that should be ready in the early part of 2020!!
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w The BRILLIANT Crios reinforced composite bloc combines performance, functionality and aesthetic fit to offer a solution unlike any other for single-tooth restorations. The material from leading restorative manufacturer, COLTENE, is particularly useful for patients who have implantsupported crowns or suffer from bruxism, as its shock-absorbing qualities and tooth-like elastic modulus leads to fewer fractures. The BRILLIANT Crios bloc is also more flexible in maintaining layer thickness and can be modified and repaired easily, ensuring longer
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Dental Practice Magazine
THE THREATS OF THE PAST, TODAY
Y
ou’d be forgiven for thinking that in the modern day; diseases of the past are no longer a concern. After all, in the last century the advances we have made in medicine and understanding in regards to pathogens, have meant that some once deadly diseases such as smallpox have been all but eliminated. However, our lifestyles and attitudes towards diseases and vaccinations have also changed and this means that some of the conditions we may no longer consider to be a threat are poised to make a comeback.
LIFESTYLE AND DISEASE We now live in a much cleaner, clinical world. Despite this, certain lifestyle factors still mean that old fashioned diseases have the opportunity to thrive once more. In the case of non-infectious diseases such as rickets and scurvy, a lot of this has to do with diet and sunlight exposure. Children are spending more and more time indoors,4 and the growing number of people living in poverty within the UK is restricting access to nutritional foods.5 As both scurvy and rickets are caused by vitamin deficiencies, it means that these diseases are spiking in poorer communities and amongst children who aren’t u CONTINUED ON PAGE 28
REBECCA WATERS, CATEGORY MANAGER, INITIAL MEDICAL Rebecca has worked in the Healthcare sector for the past 15 years and was a Research Chemist with Bayer Cropscience prior to joining Rentokil Initial in 2003. She keeps up to date on all developments within the clinical waste management industry and is an active member of the CIWM, SMDSA and BDIA.
DICKENSIAN DISEASES TODAY The very mention of something like typhoid or scarlet fever is likely to conjure images in your mind of the grim streets of Victorian London, where soot and mist hangs in the air and whooping cough echoes out of the slums. However, though these diseases seem more suitably placed within the pages of Charles Dickens’ Oliver Twist rather than the modern day, they are actually in threat of making a marked return. But why is this happening? The first thing to remember is that these diseases never fully disappeared to begin with. It’s easy to look at statistics and believe that these diseases are suddenly appearing out of nowhere, but the fact remains that it’s actually our ability and methods to fight off these diseases that’s changing, not necessarily the presence of the pathogens themselves.
WHICH DISEASES ARE MAKING A COMEBACK? According to statistics gathered by the NHS, old fashioned diseases making a comeback include whooping cough, scarlet fever, gout, rickets, scurvy and many more. Cases of these diseases have increased a considerable amount in just a short period of time. Scarlet fever, for example, had 429 reported cases in the country in 2010-2011, but this number rocketed to 1,321 in 2017-2018.1 Whooping cough has seen a similar surge in cases. Although the disease was all but eliminated in the UK following a wide-scale vaccination effort in the 1950s, hospital admissions due to the condition rose by 59% from 2010 to 2018.2 These worrying trends are not UK specific, however, and in the United States there has been evidence of even scarier conditions raising their heads once more, including mumps, measles, tuberculosis and, terrifyingly, the bubonic plague.3 Although many of these diseases can be treated with antibiotics and other defences that were unavailable to people in Victorian times, this doesn’t mean that the conditions can’t have life-threatening implications. Children, in particular can suffer considerably after contracting any one of these diseases, and this is because their immune systems are weaker and less developed. But what reasons are behind these diseases rearing their heads once again?
Dental Practice Magazine
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eating properly or getting enough sunlight. However, the lack of vitamins may also be contributing to a higher number of infectious disease cases as well. Our immune systems cannot fight off viruses and bacteria if they are not supported by essential minerals, vitamins and amino acids and this means that people are becoming more susceptible to pathogens in their environment. 6 Another very worrying factor that could be influencing this resurgence is the growth of the anti-vaxxer movement. Anti-vaxxers are those who believe that vaccinations can cause autism, and therefore refuse to have their children vaccinated. There is no substantial proof supporting this claim, and this is proving to be a dangerous decision as it is leaving young children susceptible to diseases such as measles, mumps and rubella that vaccinations effectively defend against. WHAT CAN DENTISTS DO? As dental professionals it’s your responsibility to inform patients about the importance of a good diet, which should help lower the instances of dietary caused conditions such as scurvy. However, what you can’t do necessarily is change people’s views about vaccinations. As such,
limiting the potential for the spread of diseases becomes a core priority, especially as dental practices are a perfect environment for these diseases to transfer between people. The use of highly effective cleaning products throughout the practice is essential in order to prevent this. The Steri-7 Xtra range of disinfectants from Initial Medical is particularly recommended, especially as these can be used in all areas of the practice. Incorporating hand treatments, surface cleaners and other essential products, this range kills 99.9999% of pathogens and also has Reactive Barrier Technology – a special feature that means that once dried on a surface, any viruses and bacteria cannot recolonise these areas for up to 72 hours.
For further information please visit www. initial.co.uk/medical or Tel: 0870 850 4045 REFERENCES 1
CNN. ‘Dickensian Diseases’ Are Making A
Comeback in the UK. Link: https://edition.cnn. com/2019/02/02/health/dickensian-diseases-britainscli-gbr-intl/index.html [Last accessed July 19]. 2
CNN. ‘Dickensian Diseases’ Are Making A Comeback
in the UK. Link: https://edition.cnn.com/2019/02/02/ health/dickensian-diseases-britain-scli-gbr-intl/index. html [Last accessed July 19]. 3
Health. Five Old-Time Diseases That Are Making A
Comeback. Link: https://www.health.com/childhoodvaccines/5-old-diseases-that-are-making-a-comeback [Last accessed July 19]. 4
The Express. Deadly Victorian Diseases Make A
Return From Obscurity, But Why Now? Link: https://
LET’S HEAD BACK TO THE FUTURE The fact that these diseases are making a resurgence is concerning given that so many of these cases are preventable. However, by making sure you use effective cleaning products and advise patients properly about the importance of a good diet, you can do your bit to ensure that these diseases cannot spread and that they remain where they belong – in the past.
www.express.co.uk/life-style/health/910967/victorian-
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removing plaque from between the teeth and below the gum line where traditional brushing and flossing cannot reach. Make sure your patients are ready for action by contacting Waterpik® to arrange a Lunch and Learn in your practice now! For more information on Waterpik® products please visit www.waterpik. co.uk. Waterpik® products are available from Amazon, Asda, Costco UK, Boots and Superdrug online and in stores across the UK and Ireland.
disease-syphilis-rickets-scurvey-pirates-tuberculosis [Last accessed July 19]. 5
The Guardian. New Study Finds 4.5 Million Children
Living in Poverty. Link: https://www.theguardian.com/ society/2018/sep/16/new-study-finds-45-million-ukchildren-living-in-poverty [Last accessed July 19]. 6
Bourke, C., Berkley, J., Prendergast, A. Immune
Dysfunction as a Cause and Consequence of Malnutrition. Trends Immunol. 2016 Jun; 37(6): 386–398.
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JOIN WATERPIK® IN THE FIGHT AGAINST MOUTH CANCER w Waterpik® is supporting Mouth Cancer Action Month by helping to raise awareness and reduce the thousands of new cases that are diagnosed every year. Regular screening by a dental professional, self-examination and healthy habits are fundamental to reduce the risks of mouth cancer. To improve the oral health routine, the Waterpik® Water Flosser provides a gentle but efficient way floss,
Dental Practice Magazine
THE CURIOUS HISTORY OF OCCLUSION IN DENTISTRY EMPIRICAL EVIDENCE GUIDES OLD MAPS, WHICH PREVENTS EXPLORATION OF NEW FRONTIERS BY DRS. BARRY GLASSMAN AND DON MALIZIA DentalTown, USA. Can be found at: http://www.dentaltown.com/dentaltown/Article.aspx?i=432&aid=6176
DR. DON MALIZIA Dr. Don Malizia's practice is limited to upper-quarter chronic pain and sleepdisturbed breathing at the Allentown Pain & Sleep Centers in Allentown and Wilkes-Barre, Pennsylvania.
Dental Practice Magazine
T
he tendency in dentistry is to think of occlusion as a static relationship that describes how maxillary and mandibular teeth fit together when the elevators contract and maintain contraction - in other words, maximum intercuspation. The concept is simple, but it's fascinating how the concept of occlusion can evoke such significant disagreement and controversy. Occlusal concepts are at the heart of every dental visit every day in every dentist's office, and yet there's no greater cause of disagreement amongst dentists. Competing concepts of "occlusion" have been at the center of the conflicting TMD camps over the years. The existing controversies are one of the contributing factors that has led to limited teaching of occlusal concepts at the undergraduate level in dental schools worldwide. At the heart of the problem: Many "facts" about occlusion have been introduced into dentistry empirically and passed down as truths. By examining the history of "evidence" of occlusion, we can reveal how several assumptions about occlusion came into existence (and why they continue to be taught as "science"). Exposing these potential myths and beginning the discussion about their origin and validity is critical to help all dentists more thoroughly and accurately understand the role of occlusion in their patient's health and, consequently, improve their daily dentistry. THE HISTORY OF THE "SCIENCE" OF OCCLUSION An attempt to trace the history of the study of occlusion takes us back to 19th-century orthodontists, who sought to decipher nature's grand plan for the arrangement of the dentition. "At a meeting of the Philadelphia Academy of Stomatology in 1898, Edward H. Angle proposed that orthodontics be based on the
science of dental occlusion and offered a definition of normal occlusion as the ideal to be attained in the treatment of malocclusion."1 Angle's concepts of an ideal occlusion became widely accepted as a goal of orthodontic treatment "and the basis of normal dental function and health." No serious attempts to examine this hypothesis were made until 75 years later, when the National Institute of Dental Research and the National Research Council of the National Academy of Sciences "assembled three independent panels of orthodontic experts to evaluate research related to malocclusion, variations in dental occlusion and disabling orthodontic conditions." The concepts of ideal occlusion developed by Angle, and the assumptions of the dysfunction and pain associated with malocclusions remained untested and unchallenged in dentistry.1 In 1901, Karolyi's paper2 discussing the role of occlusion in bruxism is among the first found, but contains no references. Without any evidence, Karoyli theorized that "abnormality of occlusal structure was a basis for abnormal temporomandibular joint function, abnormal masticatory muscle function, periodontal disease and bruxism." 3 Ackerman says, referring to occlusion, that "there was even some quasi-religious beliefs about the nature and perfection of form that were tied to it." This theory was continually taught and passed down through generations. Dr. Peter Dawson, in his third edition, refers to the fact that "Karolyi got it right." 4 In fact, the concepts became further reinforced by Costen in 1934.5 Costen, an otolaryngologist, used 11 case reports of patients with decreased vertical dimension who reported having ear symptoms that included altered hearing ability and dizziness. Costen referenced Goodfriend, whose work demonstrated joint changes in cadavers, but had no correlation to assumed symptoms, simply stating that there are changes in the joint structures, which occurred u CONTINUED ON PAGE 30
BARRY GLASSMAN, DMD Maintained a private practice in Allentown, Pennsylvania, which is limited to chronic pain management, head and facial pain, temporomandibular joint dysfunction and dental sleep medicine. He is a diplomate of the Board of the American Academy of Craniofacial Pain, the Board of the Academy of Dental Sleep Medicine and the American Academy of Pain Management; a fellow of the International College of Craniomandibular Orthopedics; and a member of the American Academy of Orofacial Pain and the American Headache Society. He is on staff at the Lehigh Valley Hospital, where he serves as a resident instructor of craniomandibular dysfunctions and sleep disorders.
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over time. He made the assumption that these changes were related to "occlusion." Goodfriend dissected cadaver heads in the 1920s with attempts to relate the dental occlusion with joint anatomy.6 There was no control group, and he had no clinical or social histories on these cadavers. Nevertheless, he drew the conclusion that "muscle spasms, external injuries, deleterious habits, and stressful life situations unquestionably play an important role in the predisposition and exacerbation of craniomandibular disorders." He said that therapy should consist of "re-establishment of harmonious balanced dental occlusion that supports adequate maxillomandibular relationships and positions the closed-jaw condyle relationship in the forecenter of the temporal fossa." 7 Costen reports changes in symptoms with increased vertical dimension with an assumption that the altered pressures on the joint were responsible for those changes. "The mechanics of occlusion and dental problems are not included here"- as he proceeds to make the assumption that "occlusion," including vertical dimension, is directly related to TMJ pathology. He suggested that this altered pressure in the joint served as an etiology for glossopharyngeal neuralgia and altered Eustachian tube function. This, then, is the birth of the concept of the need for posterior joint support and what we have termed the "occlusion/pain and dysfunction connection"—a concept that continues to be taught today. Costen, referring to the work of Goodfriend, stated that either pathological or adaptive changes in the joints of cadavers occurred using a mechanical model of force distribution. They thus created an "anatomic explanation of pain connected with disturbed joint function" that, according to Costen, was "fairly simple."5 More recent work has delved deeply into force vectors in terms of direction and magnitude, and it's now recognized that the forces are related to the direction of the muscle contraction as well as the details of the dental contact - including the observation that the more anterior the posterior point of dental contact is, the less force on the joint itself. 8, 9 It has also been shown that there is no relationship between "posterior support" and the development of degenerative changes in the joint.10 Goodfriend, whom Costen references for the "dental science," needed to support his clinical findings and assumptions of mechanism. Both can truly be called pioneers, but their work was performed and written about without the use of the scientific method. The map they created is now outdated, yet its concepts are still taught.
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spasms and pain" and the "the most significant interference was a discrepancy between centric relation and centric occlusion." They reported bruxism in all 32 patients, and related the cause of bruxism to both psychic and occlusal factors.
RELYING ON FAULTY "EVIDENCE" In 1956, Sears published a paper that further cements the relationship between occlusion and temporomandibular joint "disturbances," reporting that the use of pivot appliances had been so predictably effective for resolving both dental and nondental related symptoms that there had been a hesitation to publish the findings. Sears quotes McPhee, who writes, "In the evaluation of this survey, there appears to be a close relation between malocclusion and insanity." 11 The mechanism provided includes a report that the condyles are "forced into strained relations in the fossa" by the teeth meshing and that anterior contact creates a Class III lever, and suggests that the cause of these dental and nondental symptoms is the occlusion. Sears states, "The tooth occlusion out of harmony with jaw relation causes mechanical stress of the temporomandibular joint." This paper continues to be referenced and is on the reading list for many prosthetic graduate programs to this day, as a result of being part of the Navy Lit Review. The work of Travell and Ramjford both appear in the early 1960s. 12-14 Ramjford's 1961 study involved occlusal adjustments on 32 patients with pre- and post-EMG studies with no control group. They reported complete relief of all patients with both intracapsular and extracapsular disorders by occlusal adjustments. Conversely to Costen's work, they suggested that vertical dimension was not related to symptoms, but that "any type of occlusal interference was found to trigger muscle
EMPIRICAL VERSUS EVIDENCEBASED STUDIES The first area of concern is, of course, the fact that the definition of centric relation itself has undergone many changes, and the definition itself remains an area of controversy in dentistry. "It could be argued that the progressive modifications in the definition of CR have done more to eliminate centric slides than 20 years of grudging acquiescence of the precepts of gnathology." 15 In addition is the predominance of evidence that has led to the occlusion and pain "disconnect." Pullinger states, "Belief in and rejection of a relationship of occlusion and temporomandiublar joint (TMJ) condyle-fossa position with normal and abnormal function are still contentious issues. Clinical opinions can be strong, but support in most published data (mostly univariate) is problematic." 16 In her study in 2006, Michelotti introduced interferences into patients without causing increased symptoms,17 and in her review article in 2010 she listed a series of welldone studies that demonstrated no evidence between malocclusion and "TMD."18 Mock equilibrations have been done and have resulted in similar results to actual equilibrations.19 It is generally accepted that nocturnal bruxism is a centrally mediated disorder, and yet "old maps" continue to dominate dental education. At about the same time that Ramjord's study was released, Janet Travell's theory of muscle spasm - particularly of the lateral pterygoid - related to the interferences Ramfjord was referencing began to surface. Travell references Morgan's text,7 which had an entire chapter on muscle spasm, as well as a chapter by Goodfriend. Travell's viciouscycle theory suggests that dental interferences cause hyperactivity and muscle spasms, most notably in the lateral pterygoid. However, that spasm is very rare and occurs only in rare cases of dystonia.20 Furthermore, Lund demonstrated that interferences do not cause hyperactivity but results in hypoactivity.21 His evidence-based pain-adaptation theory replaced the vicious-cycle theory, but the latter continues to be taught in dentistry. Travell's muscularly oriented theory suggesting a direct relationship to dental occlusion is critically important to those who depend on the role
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OCCLUSION VS OCCLUDING: THE STIPULATION OF OCCLUSION It may seem, then, that there's an argument for the hypothesis that there's no relationship between occlusion and pain. From a clinical standpoint, this would be a very difficult argument to make, because every dentist has adjusted an occlusion and noted a significant change in a reported pain pattern. Every dentist has created a high spot in a restorative technique that led to a patient complaint that was then resolved with an occlusal adjustment. The issue, then, isn't if occlusion matters, but when and how it matters. Looking specifically at the mechanisms that cause occlusion to be a factor in pain and dysfunction becomes the real issue. As dentists, our education leads us to the tendency to "stipulate" occlusion: We tend to think of the maxillary and mandibular teeth as units that "fit" together. When given maxillary and mandibular stone models, the first thing dentists tend do is put them together and evaluate how they "fit" in a goal to determine the quality of the "occlusion." In reality, maximum intercuspation rarely occurs during function. There is some form of dental contact on an average about 20 minutes total in a 2- hour period.23 "Occluding" actually rarely occurs, as evaluated by articulating models. Occlusion as noted by articulating models occurs only in patients when their elevators go into contraction and stay contracted. This occurs when we ask a patient to voluntarily "close," but not commonly in function. Dentists often check lateral movements on an articulator as though lateral excursions occur in function. Again, this is a result of the stipulation of occlusion being an essential part of the dental education. As a result, when thinking about occlusion, we have suggested that we consider not just the occlusion itself, but when this "occlusion" occurs. We refer to the noun of occlusion as becoming a factor when it becomes the verb of occluding. In addition, we have suggested that maximum intercuspation is actually, in some ways, pathological. This concept has often been misinterpreted as though it's being suggested that occlusion
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doesn't matter. Of course it does! What's being proposed is that the stipulation of occlusion is at the heart of the empirical science of the 20th century, and a contributing factor that prevents the evidenced-based information from becoming part of the dental knowledge base. This "stipulation" makes the role of occlusion and the anecdotal changes we observe easy to explain, and many of the myths associated with occlusion are dependent on such stipulation. Clearly, then, the occlusal changes can be related to the symptomatic changes, but the mechanism of that change needs to be reconsidered. WHY ARE THE OLD MAPS FOLLOWED, RATHER THAN BEING REWRITTEN? Alvin Toffler has written: "The illiterate of the 21st century will not be those who cannot read and write, but those who cannot learn, unlearn, and relearn." It's a generally accepted fact that temporomandibular joint dysfunctions, as well as nonodontogentic pain patterns, are not points of emphasis in the undergraduate dental setting. Without exception, our general dental residents confirm this. Many of the "old maps" created the basis for various TMD philosophies taught by pioneers. These old maps became the guidelines for the concepts of legendary pioneers that either still teach or have surrogates who teach, resisting the newer information based on more powerful evidence than the empirical evidence of many of the 20th- century studies. When the National Institute of Dental Research and the National Research Council of the National Academy of Sciences conducted their studies in the early to mid1970s, they concluded that there was the lack of a clinically meaningful definition of malocclusion, and that there was no interference in function (or aesthetics) that could be related to malocclusion.24, 25 Ackerman states, "The 'science of occlusion' emerged from a pseudoscientific tradition already characterized in the 19th century as 'composed merely of so-called facts connected together by a misapprehension under the guise of principles' 26 and that, from the beginning, there were strong overtones of religious belief in the concept of occlusion." The "TMD" camps and restorative gurus, thus, continue to teach many of these myths, and the myths are taught as facts, leading to controversy ‌ often with religious fervor. There seems to be a concern that our old pioneers will be proven incorrect. Under no circumstances would we suggest that those who created the early maps were wrong, and today
they remain respected pioneers. Sadly, this has not been the case in dentistry. Much has been learned and continues to be learned about the role of mandibular growth and function. Ackerman writes, "A departure from the dogma of ideal occlusion does not reduce contemporary orthodontists to 'de facto cosmetologists,' but rather frees them to enhance a patient"s dentofacial appearance and, in some cases, oral function. It opens the way to establishing a scientifically sounder model of occlusal function and oral health. Regrettably, some orthodontists, to paraphrase W.C. Fields, would on the whole rather be in 19th-century Philadelphia." 1 New maps would free the general dentist to understand in greater depth the role of occlusion in pain and dysfunction as a potential contributing factor, rather than making assumptions about its key role and the need to idealize occlusions based on some non-evidence-based concepts. The acceptance of the contributing role of occlusion in temporomandibular joint pathology as well as extracapsular disorders would allow other contributing factors to be appropriately considered without eliminating inappropriate dental contact as a potential contributing factor itself. Greene and Reid have carefully reviewed the key role of conservative reversible therapies and the need to have specific diagnostically driven therapies based upon well-designed risk benefit considerations in an ethical dental model.27 The old maps that lead us only to the role of occlusion and interferences in pain and dysfunction often take us down the wrong road, and often lead dentists in honest attempts to help their patients with pain and dysfunction down frustrating paths. LEARN MORE ABOUT OCCLUSION FOR CE CREDITS Dr. Barry Glassman's two-hour online course gives useful, common-sense advice and reviews TMD concepts so common patient reports of pain and dysfunction can be more readily diagnosed and conservatively treated. To take the course and earn 2.5 hours of CE credit. REFERENCES 1
Ackerman, J.L., M.B. Ackerman, and M.R. Kean, A
Philadelphia fable: how ideal occlusion became the philosopher's stone of orthodontics. Angle Orthod, 2007. 77(1): p. 192-4. 2
Karolyi, M., Beobachtungen uber Pyorrhea alveolaris.
Oesterr-Ungar Bierteljahrsschrift Zahnheilkunde, 1901. 17: p. 279.
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of interferences in occlusal theories - so the empirical evidence and anecdotal reports that support this theory continue to dominate claims, and are used to refute more recent science. The fact is that very little is understood about the physiology of muscle pain, and it is realized that trigger points are more likely a central sensitization issue, as opposed to a true peripheral physiological phenomenon.22
u
DENTISTS AND DENTAL NURSE SHORTAGES – BEING A LOCUM HAS NEVER BEEN MORE ATTRACTIVE Ryan Scott – Director S4S Team Dental Recruitment Specialists
DEMAND EXCEEDS SUPPLY Over the past 15 years I have worked in several industries as a Recruitment Consultant, before becoming a founder member at S4S Team – Dental Recruitment Specialists. During my time working in the recruitment industry I have mainly worked in the ‘White Collar Construction’ and ‘Education’ sectors. These industries do have their own struggles in attracting staff with the right experience, qualifications and skills. But within the first few weeks of working in the dental profession, I soon discovered that dentistry was a completely different proposition altogether. When it comes to skills shortages, there can’t be many other sectors where the gap between the number of vacancies, and the number suitable candidates on the job market to fill these roles, is quite as a large. In my first week of working with dental practices, I returned from a client meeting full of excitement to have been given the task of working on several permanent roles for a small dental body corporate. Each commanding a large agency fee on successful placement of the candidates. It soon became apparent, following several more ‘successful meetings’, that practices were struggling to employ dentists and dental nurses. According to ‘My Dentist’ CEO Tom Riall in 2018, on speaking to a national newspaper he was reported to say ‘Last year, 68% of the UK’s dental practices that tried to recruit struggled to do so, and this problem is only going to get worse unless this issue is addressed.’ Despite successfully placing a few new staff into new roles, it would seem that we have a huge shortage of staff in the dental profession and the demand way exceeds supply. A GREAT TIME TO BE A LOCUM Are you a Dentist, Hygienist, Nurse, Therapist or Orthodontic Therapist? If you are, you are massively in demand. There is of course lots
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of political uncertainty at the moment with Brexit on the horizon and let’s face it, the whole the Dental Profession has seen happier times. Know your worth, if you are in a role that you enjoy, maybe now could be a good time to ask for more holidays, or dare I say it, a pay increase? Or you may fancy a change without wanting to commit to one place of work. Locum work doesn’t suit everyone, however, with the current situation we have more choice and excellent rates of pay and a variety of positions, Locums can almost pick and choose where to work. We are managing to negotiate excellent rates for all Locum positions, seeing Nurses commanding up to £18 per hour and dentists £500 per session, with specialists commanding even higher rates. It is almost a given that a Nurse or a Dentist registered with a Locum agency will be given work on a daily basis, some being able to choose a longer term position, for example to cover maternity/paternity leave. According to a 2018 report of the Dental Industry by Chrisite, Locum usage accounts for 8% of total staff days, this is a huge number considering there are almost 41000 dentists and 57000 nurses registered in the UK. This is great news for anyone considering a Locum position within the UK, the trends seem to be your favour.
bank of Locums within our team, they always tell us how much they enjoy the variety, the flexibility to pick and choose when and where they may work, the flexibility with family life such as childcare and holidays is a huge positive. Furthermore, the pay is generally much more attractive when compared to being in a salaried role in the same practices. One of our nurses said one of the most rewarding things is ‘Helping out a dental practice at a time when they are most in need of the help! You feel like one of the most important people on the team when you get to the practice!’ WANT TO KNOW MORE? If you would like to know more about becoming a Locum, or you are a dental practice needing a Locum, do not hesitate in contacting a local dental recruitment agency. S4S Team would be more than happy to discuss your requirements or answer your questions should you wish.
PROS & CONS OF BEING A LOCUM There are so many positives to being a Locum and of course there are some downsides. The biggest downside for some is the variety in locations of work and varied travel. To some, this is a real positive, gaining a varied experience from working in different practices and meeting a more varied group of colleagues. When we speak to the
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MARKETPLACE your practice and when people are out and about. To find out more, contact CosTech Dental Laboratory. For more information about CosTech Dental Laboratory, please visit: https://costech.co.uk/monolit or call 01474 320076
TEN DENTAL FACIAL: SUPPORTING DIABETICS
COSTECH DENTAL LABORATORY: MARKETING MONOLITH TO YOUR PATIENTS COSTECH DENTAL LABORATORY: THE BEST PATIENT OUTCOMES, EVERY TIME w Dr Nadjafi has been the owner and principle dentist at Dulwich Dental Clinic in London since 2000. Following requests from his patients, he opened the Aesthetic Dental Zone to offer cosmetic treatments. His clinic has a long-term working relationship with CosTech Dental Laboratory. He says: “I have been working with CosTech for about seven years now. We have a good understanding between us – we have worked on quite a few big jobs together. They collect and deliver all of our cases, and we even know the drivers personally. I have never had to cancel a patient because work was not delivered on time; miscommunication between us is extremely rare. I find them to be very professional. “I would definitely recommend CosTech to other practitioners.” CosTech provides a complete service to hundreds of practices across the UK, with all cases produced to consistently high standards. It also offers a free collection and delivery service in its own fleet of cars in London, Birmingham and the Southeast, with new areas coming soon. Talk to the team at CosTech today to find out how they can take your restorative and aesthetic work to a whole new level. For more information about CosTech Dental Laboratory, please visit www. costech.co.uk or call 01474 320076
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w CosTech Dental Laboratory is pleased to announce that it now offers accompanying Surgery Packs for practices that supply Monolith FullContour Zirconia to their patients. Including patient leaflets filled with all relevant information and a leaflet stand for your practice, each Surgery Pack is an ideal way to ensure that patients have the information they need. Leaflets are also useful as patients can take these materials home to consult should they want to consider the option before moving forward. The Surgery Packs also contain posters, and other branded promotional material – perfect for raising awareness both inside
w Diabetes can have devastating effects on a patient’s periodontal health, which may require more advanced treatment from a specialist. Consider referring to the multi award-winning Ten Dental+Facial clinic, who provides one of the UK’s most trusted referral services. Ten Dental+Facial is highly experienced in treating patients with complex oral health needs, including those who suffer from diabetes. The professional team have the knowledge and skills to treat both simple and advanced cases, using the latest techniques, materials and technology to ensure patients benefit from the highest quality treatment. Patients are then returned to the referring clinician for ongoing care and review, which is fully supported by Ten Dental+Facial. Call today for further details. For more information visit: www.tendental.com or call on 020 33932623
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Rehabilitation, 2013. 40(7): p. 546-561.
MARKETPLACE S4S DENTAL LABORATORY SHORTLISTED FOR DIGITAL TRANSFORMATION PROJECT AT THE SHEFFIELD BUSINESS AWARDS w Recognised for their commitment and investment in digital technology, S4S are delighted to have been shortlisted for Sheffield Business Awards 2019, Digital Transformation Project of the Year. In the dental industry, digital intra-oral scanning and 3D printing is surging, opening up a whole new aspect of working. This strive for digital expansion has seen S4S invest in equipment, energy and staff, allowing the business to grow significantly, with almost 50% of work now being received digitally compared to only 5%, 3 years ago. In a quest to remain innovative and at the forefront of digital technology, S4S have invested heavily in a digital workflow
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management system. The system allows each case to be tracked, signed off and uploaded onto a customer portal – allowing customer interaction on their cases at every stage. Investing in this innovative system has included staff training to ensure the implementation of this digital workflow system will maximise efficiency as well as new equipment. For the future, 3D printing is a form of technology in its infancy compared with many other well-established autonomous production systems. As early adopters of 3D print technology, S4S have invested heavily in this area, becoming the first organisation in Europe to adopt the Structo
Elements 3D digital printing automation robot. Yet to be fully installed, S4S are proud to be pioneers in this area, keeping at the forefront of digital dentistry. S4S are a forward thinking Laboratory and with the investment of the latest 3D printers combined with the introduction of the new digital workflow system, which will allow them to keep up with the ever changing digital landscape of the dental industry. The Sheffield Business Awards will take place on the 5th December, with S4S being shortlisted against other forward thinking Sheffield based organisations all competing to be crowned Digital Transformation Project of the Year.
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MARKETPLACE ZIRKONZAHN IMPLANT PROSTHETIC COMPONENTS: EVERYTHING FROM A SINGLE SOURCE w Zirkonzahn has acquired a worldwide reputation as a manufacturer of zirconia, elaboration materials and CAD/CAM solutions. However, it is less known that Zirkonzahn has become one of the largest suppliers of implant components! All our components – available for more than 100 implant systems – are conceived and manufactured at our production site in South Tyrol. Everything is produced according to the high standards we apply to our production process – intelligent solutions, precision and quality. To craft our implant components, we primarily use high-quality, grade 5 titanium. Our portfolio is comprised of titanium bases, Scanmarkers, White Scanmarkers, ScanAnalogs – our laboratory analogues used as scanmarkers, impression copings,
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laboratory analogues, Multi Unit Abutments, Raw-Abutments® and healing caps. We consistently expand our exhaustive product line with innovations, such as the all new White Metal Scanmarkers, Zirkonzahn Titanium Posts and LOC-Connectors. Together with our implant components, we provide our clients with useful tools such as the Titanium Spectral-Colouring Anodizer for colour-coating titanium bases. With quality as our highest priority, we assume our responsibility to ensure our implant products can be used with precision and guarantee. Zirkonzahn implant abutments are warrantied up to 30 years, including the implants from other manufacturers used with Zirkonzahn implant abutments. For our users, all implant prosthetics components are 100% integrated into
Zirkonzahn’s workflow and software via corresponding libraries. Together with the Zirkonzahn.Implant-Planner, our clients can provide dentists with all components required for an implant case simultaneously (surgical guides, immediate load restorations, custom impression trays and/or milled models with laboratory analogues). Exocad and 3shape users may also download and implement Zirkonzahn components for free in their design software through the Zirkonzahn Library Download Center. Have a look at our range of components at www.zirkonzahn.com and check if they are compatible with your implant system! Orders placed before 11 a.m. will be delivered within the next working day. Just email info@zirkonzahn.com or call us at +39 0474 066 660!
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