The Dental Technician Magazine September 2020 by The Dental Technician Magazine

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VERIFIABLE ECPD FOR THE WHOLE DENTAL TEAM

5 THINGS I CANNOT WORK WITHOUT! BY DANIEL SHAW PAGE 12

CLIMBING OUT OF LOCKDOWN BY SIR PAUL BERESFORD

PAGE 22-23

INTERVIEW WITH RHONDA CORMACK OF THE OLD KILN DENTAL LABORATORY PAGE 32-33

DENTAL LABORATORY AIRBORNE CONTAMINANTS By Sharaz Mir PAGES 34-36

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CONTENTS

Editor Matt Everatt F.O.T.A. E: editor@dentaltechnician.org.uk Designer Sharon (Bazzie) Larder E: inthedoghousedesign@gmail.com Advertising Manager Chris Trowbridge E: sales@dentaltechnician.org.uk T: 07399 403602 Editorial advisory board Andrea Johnson Ashley Byrne Ross Chapman Sharaz Mir Sir Paul Beresford Published by The Dental Technician Limited, PO Box 430, Leatherhead , KT22 2HT. T: 01372 897463 The Dental Technician 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

Extend your subscription by recommending a colleague There is a major change in CPD coming soon. The Dental Technician Magazine is a must read. Tell your colleagues to subscribe and if they do so we will extend your subscription for 3 months. The only condition is that they have not subscribed to the magazine for more than 12 months. Just ask them to call the Subscriptions Hotline. With four colleagues registered that means your subscription would be extended for a year free of charge. At only £39.95 per year, for UK residents, this must be the cheapest way of keeping up to date. Help your colleagues to keep up to date as well. Ask them to call the subscriptions Hotline on 01202 586 848 now.

CONTENTS

SEPTEMBER 2020

Welcome 6

Welcome from the editor

Insight 6 18 22-23

From the archives Life off the road - making 3D printing child’s play. By Leonora Ward Climbing out of lockdown. By Sir Paul Beresford, BDS. MP

Focus The Personal Protective Equipment (PPE) Legislation and Sports Mouthguards Working during lockdown - Part two: Andrea Johnson Infection control & Covid-19 considerations in the Dental Laboratory. By Andrea Johnson

8-11 20-21 26-27

Technicians Insight 12

5 things I cannot work without! Daniel Shaw

Health & Wellbeing 5 simple tips for a healthier return to work. By Katie Bell Dental Technicians: The most resilient dental professionals. By Ritesh Aggarwal BDS PGCert Clin.Ed

14 15-16,18

Dental Technology Zendura - the solution to a crack-resistant, durable clear retainer Dental laboratory airborn contaminants. Part one. By Sharaz Mir Testing the VITA AKZENT PLUS Stains and Glaze Materials. By Urszula Młynarska

24 34-36 44-46

Marketing Marketing Simplified by Jan Clarke

Business Leadership & management - is your leadership style stifling your team and killing your business? By Matt Everatt F.O.T.A The British Association of Private Dentistry (BAPD) Building an exceptional team. By Ashley Byrne, Byrnes Dental Lab An interview with Rhonda Cormack of The Old Kiln Dental Laboratory

29-30 30 31 32-33

Marketplace Shofu Zirkonzahn/3Shape

33 42

ECPD Free Verifiable ECPD & ECPD questions

38-39

DTGB The Dental Technician Magazine and Dental Technicians Great Britain Facebook Group

Classifieds www.dentaltechnician.org.uk

40-41 47

WELCOME

Welcome

TO YOUR SEPTEMBER 2020 ISSUE By Matt Everatt F.O.T.A I Editor

elcome all to your September issue. I was delighted to read some of your feedback in regards the August issue and I do hope that some of the articles and new features may spur you on to send in your own ideas and contribute to the magazine. My aim is to make this magazine the journal that we all enjoy reading and include features that we can all relate to and take something away from. I wanted to let you all know about the efforts we are making and the continued improvements we are making at The Dental Technician Magazine. We are in the process of increasing our social media presence and we are pleased to see the DTGB facebook group going from strength to strength and I enjoy reading some great topics being raised. We should remember it is a professional group

and I would urge all to remember this when posting or replying to posts. The group was originally created by Alan Wright and we pooled our resources to help make the group a fantastic place for us all to meet and share ideas. In joining forces with the DTGB we made a commitment to support the charities Den-Tech and Veterans Bite Back, again we will be writing more about how we support these wonderful charities in this month’s issue. We are working towards launching the online learning platform and hope to overhaul our website in the process. Next month we plan to run our 2nd round of nominations for the Dental Technician Merit Award Scheme, further details of the scheme and will be announced in October issue. In regards to business in general, I do hope that September bring a fresh breath of

INSIGHT

From the archives l

In my search for an interesting article from the archives I came across this article on heat curing resins. This technical article form January 1948 seems to be relevant in todays laboratory and may be a good reminder on ways to avoid porosity in acrylics. I must say though, being an orthodontic technician, it has been many years since I used heat cure resin and acrylics may have improved somewhat these days. I do wonder if in just a short time, with the introduction of 3D printed resins, will we look back on the flasking and packing process as archaic?

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life into our profession. I am sure we are all sick of hearing the dreaded word ‘Covid19’ by now, its impact on the laboratory sector has yet to be fully understood. I would expect that towards the autumn we will see the levels of work get back to some kind of normal. I myself have been flying the flag for the #SaveLabsBuyBritish campaign. I have posted in many Dentist forums and have received nothing but positive responses. I have also been watching the efforts of the British Association of Private Dentistry, they are an all encompassing group and are very supportive of Dental Technicians. You will find a press release from Jason Smithson, a board member of the BAPD in this months issue. I do hope you enjoy reading this months issue and please do not hesitate in contacting me with your ideas, thoughts and suggestions, remember this is your magazine.

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FOCUS

THE PERSONAL PROTECTIVE EQUIPMENT (PPE) LEGISLATION AND SPORTS MOUTHGUARDS By Peter J Natt I Dr Garth Rolls-Willson There is a lot of confusion and misinformation within the Dental Laboratory Industry regarding the implications of the Personal Protective Equipment (PPE) Legislation in relation to the manufacture of Sports Mouthguards. Sports Mouthguards include all Mouthguards destined for sports use be they ‘Custom Made’, ‘Boil and Bite’ ‘Ready Made’ etc. This paper has been written so as to clarify matters. The Personal Protective Equipment Legislation is a completely separate piece of legislation to the Medical Devices Directive and should not be confused with it. Although the vast majority of Dental Laboratories are ensuring that they comply with the Medical Devices Directive the same is not true for the Personal Protective Equipment (PPE) Legislation which became law in 1995 which is now 25 years ago. What are PPE’s PPE are products that the user can wear or hold, in order to be protected against hazards either at home, at work or whilst engaging in leisure activities.

covered by the main Category 2 classification, which requires that testing and certification or a prototype of the Sports Mouthguard that they intend placing on the market is conducted by an Independent European Notified Body.

The PPE Legislation The Personal Protective Equipment (PPE) Directive 89/686/EEC became European Law in June 1995.

Any person or organisation that claims that Sports Mouthguards are Category 1 is incorrect and is providing others with false, misleading and inaccurate information.

It was superseded on the 21st April 2018, by Regulation (EU) 2016/425 on Personal Protective Equipment (PPE) which replaced the old Personal Protective Equipment (PPE) Directive 89/686/EEC. Categories of the PPE Legislation The PPE Legislation allows for three categories being: Category 1 Simple Category 2 Neither Simple nor Complex Category 3 Complex

Which category are sports mouthguards in? The exhaustive list of Category 1 PPE in the Regulation does not include Sports Mouthguards. They are therefore not covered by this categorisation. Sports Mouthguards do not fulfil the criteria for Category 3 PPE either, so they can only be

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Independent European notifying bodies Independent European Notifying Bodies provide EEC Certification to show that the manufacturer’s products has complied to the Personal Protective Equipment (PPE) Legislation so that manufacturers may put their CE mark on its Sports Mouthguard. Therefore an Independent European Notifying Body can help Sports Mouthguard manufacturers

FOCUS test and a retention test. In addition, the materials that the Sports Mouthguard are made from will also be tested to ensure that they and any colouring agents used to colour them are safe for use within the oral cavity. The container which is supplied with the Sports Mouthguard will also be tested as will the user leaflet containing instructions and warnings. The name of the manufacturer must be placed on the packaging so that the manufacturer can be identified. Once you have had your Sports Mouthguards etc. tested you must not change the materials or technique you use to make them as this can effect the performance characteristics of the mouthguard. If you do make any changes then you must contact an Independent European Notifying Body and ask for a re-test.

find their way through conformity, declaration, certification and CE marking and support them with prototype testing. A manufacturer of Sports mouthguards can select an Independent European Notified Body freely and is not restricted to Independent European Notified Bodies in their own country. An Independent European Notifying Body will ensure its own test covers all the Essential Requirements of the Personal Protective Equipment (PPE) Legislation in the absence of a British Standards Test for the Testing of Sports Mouthguards. The steps you need to take to comply with the Personal Protective Equipment (PPE) Legislation There are a number of steps that manufacturers of Sports Mouthguards must take to comply with the Personal Protective Equipment (PPE) legislation and these are: 1. A technical Data File must be created and must be available for inspection at the manufacturing site at all times. 2. A prototype of each of the Sports Mouthguards they intend placing on the market must be type tested and the technical data file validated by an Independent European Notifying Body. (This also includes the instructions, packaging and labelling that will be sent out with the mouthguard). 3. An information leaflet must be supplied with the Sports Mouthguard, which must include the details of the name and address

of the Independent European Notified Body, The Certificate Number, The Certificate of Conformity, The standards used in the requirements and test methods and the date that the product was certified. 4. The mouthguard and/or packaging must be labelled with the CE mark in its recognisable size and form.

Please be aware that it is the actual prototype of the Sports Mouthguard that is tested by the Independent Notifying Body. CE Marking There appears to be a misconception and urban myth within the Dental Laboratory industry that one can simply use CE marked materials and then apply the CE mark to a Sports Mouthguards or its packaging and that this is all one has to do to comply with Personal Protective Equipment (PPE) Legislation. This most certainly is not the case and by doing so is an illegal act and the manufacturer or supplier could be fined or imprisoned. You may only place the CE mark on to the Sports Mouthguard and/or packaging if a prototype of the of the Sports Mouthguard has been tested and certified by an Independent European Notifying Body. Type testing of the sports mouthguard by an independent notifying body The tests carried out on the prototype Sports Mouthguard may include an impact test, a minimum thickness test in a number of different places, a delamination test, a fluid absorption test, an innoxious test, ergonomic

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Litigation We live in an age when consumers are only too aware that they can instigate legal action against suppliers and manufacturers of goods that they believe have not come up to expectations. Defending yourself against court action brought against you by an infuriated parent whose vast financial investment in their childâ&#x20AC;&#x2122;s orthodontic treatment has been lost by one blow to the mouth, while wearing a Sports Mouthguard which was manufactured by someone who was not complying with the Personal Protective Equipment (PPE) Legislation could cost the manufacturer or supplier thousands of pounds in legal fees to try to defend. This is not to mention the inconvenience, disruption and loss of reputation to their business. Prescribers and suppliers of sports mouthguards Anyone sub-contracting/prescribing/supplying a Sports Mouthguard should take the precaution of checking that the Sports Mouthguards they are sub-contracting/prescribing/supplying has been manufactured by a manufacturer who can demonstrate that they are complying with the Personal Protective Equipment (PPE) Legislation by asking them to provide them with a copy of the test certificate and certification documentation provided by the Independent European Notifying Body rather than relying on the CE mark that has been placed on the packaging. (Unfortunately, a number of manufactures have simply been applying the CE mark to their products despite them not having their Sports Mouthguards tested by an Independent European Notifying Body). The danger being that if a prescriber/ supplier was to be found to have supplied a non-compliant Sports Mouthguard then not only may they find themselves being prosecuted by the Trading Officers but if they are registered with the General

FOCUS Dental Council then they are a ‘Notified Professional’ which means that they may also find themselves being investigated by the General Dental Council. How to comply with the Personal Protective Equipment Legislation at this moment in time At the present moment in time and in the absence of a British Standard for the Testing of Sports Mouthguards Independent European Notifying Bodies can certify to their own test methods which satisfy the requirements of the Personal Protective Equipment (PPE) Legislation. The manufacturer of the Sports Mouthguard will need to appoint a consultant to write their Technical Data File and once this has been completed get a prototype of each of the type of Sports Mouthguards they intend placing on the market tested by an Independent European Notifying Body. The Technical File Consultant will be able recommend you to an Independent European Notifying Body who can carry out the Type Testing and provide the Certification of the prototype Sports Mouthguard. Each Independent European Notifying Body will have their own test in the absence of a British Standard Test for the Testing of Sports Mouthguards. The Independent European Notifying Body may send you a standard test model to make your prototype mouthguard on. Manufacturer with multiple manufacturing sites Where a manufacturer of Sports Mouthguards has multiple manufacturing sites each site will have to comply with the Personal Protective Equipment (PPE) Legislation in its own right and supply a prototype for testing and certification for that site. Procedure for when we leave the European Economic Community (EEC) - BREXIT The EU PPE Regulation was already enshrined in UK law with effect from 21st April 2018 – before the conclusion of the Brexit process. When the United Kingdom leaves the European Union, then there will still be a system for testing and certifying Sports Mouthguards across all 27 Member States plus the UK, which will involve products carrying the CE mark, the UKCA mark, or both. The CE mark will remain valid for the United Kingdom for 2 years after we leave Europe. Test Reports from ISO 17025 accredited Testing Laboratories should still be accepted by the Independent European Notifying Bodies in support of UK CA applications.

Since the British Standards Institute (BSI) intends to remain a member of the European Committee for Standardization (CEN) and to continue to contribute to the development of European Standards, European Standards (EN) are expected to continue to be published as British Standards; although whether this will be as BS EN XXXX or just BS XXXX has not as yet be clarified.

Organisations that will be able to assist you in testing your mouthguards and writing your technical data manual: You will need to instruct an Independent Notifying Body to test your Sports Mouthguard or range of Sports Mouthguard and also have a Technical Data File written for you. Below are the names and web site details of two organisations that routinely do this for Sports Mouthguards.

For Sport Mouthguards already Certified by an Independent European Notifying Body then they will be able to continue to be sold within the United Kingdom or abroad. However, when sold within the United Kingdom then the product will be CA marked rather than CE marked.

Independent European Notifying Body: SATRA, Wyndham Way, Teford Way, Kettering Northamptonshire NN16 8SD T: 01536 410000 E: info@satra.com W: www.satra.co.uk (Satra routinely test Sports Mouthguards to their own standard in the absence of a British Standard)

If a Sports Mouthguard has not been Certified and is to be placed on the market and is just to be sold within the United Kingdom then it will require to be Tested and Certified by an Independent European Notifying Body and then once certified the manufacturer must affix a CA mark followed by a specific number to the packaging and instructions.

Technical Data File Consultant: PVA-PPE Group E: info@pva-ppe.org.uk W: www.PVA-PPE (UK) Ltd (PVA-PPE (UK) Ltd routinely write Technical Data Files for the manufacturers of Sports Mouthguards)

If the Sports Mouthguard has not yet been Certified and is to be placed on the European market then it will require to be Tested and Certified by an Independent European Notifying Body and then when certified the manufacturer must affix a CE mark followed by a specific number to the packaging and instructions. Enforcement of the Personal Protective Equipment (PPE) Legislation and Trading Standards In the UK the Personal Protective Equipment (Enforcement) Regulation 2018 (SI 2018/390) provide an enforcement and penalty regime for Regulation (EU) 2016/425 The Personal Protective Equipment (PPE) legislation is enforced by Trading Standards Officers and anyone found manufacturing PPE which are not compliant with the legislation can face a fine or imprisonment as well as having any stock confiscated. Considering the very long time that the Personal Protective Equipment (PPE) Legislation has been in force anyone that manufactures a Sports Mouthguard should be complying and ignorance of the law is no defence especially as the Personal Protective Equipment (PPE) Legislation has been in existence since June 1995. Therefore, it is very important that every dental laboratory that is not complying with Personal Protective Equipment (PPE) Legislation should take immediate action to comply.

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Development of a British Standard for the testing of Sports Mouthguards It is the long term intention to develop a British Standard for the testing of Sports Mouthguards so that Independent European Notifying Bodies can all test to the same British Standard, however until this has been developed Independent European Notifying Bodies can develop their own tests as long as they fulfil the requirements of the Personal Protective Equipment Legislation. A British Standard for Sports Mouthguards would also ensure a level playing field and a competitive element between the different Independent European Notifying Bodies.

ABOUT THE AUTHORS Peter Natt developed a range of 4 Pressurelaminated Sports Mouthguards in 1976. He has written a number of articles on Sports Mouthguards including ‘Close Fitting Contact Sports Mouthguards’ about how to construct pressure laminated mouthguards which was published in the Dental Practice magazine in June 1979 and also ‘The Flexible Custom Made Close Fitting Contact Sports Mouthguard’ which was published in The Dental Laboratory Magazine in September 1982. He has given hands on courses on constructing ‘Custom Made Multi-layered Pressure Laminated Sports Mouthguards and complying with the Personal Protective Equipment (PPE) Legislation.’ He has lectured widely on the subject of Tooth Protection and Sports Mouthguards to both

FOCUS members of the dental profession and the governing bodies of various different contact sports. He has been an active member of the British Standards Institute Protective Sports Equipment committee since 1990 and has been awarded a British Standards Institute Certificate for Distinguished Service to the British Standards Institute.

Dr Garth Rolls -Willson, MA (Cantab), MRCS (England), LRCP (London) Injury and Mental Harm Prevention Consultant and a System Analyst Consultant.

Equipment committee and its Medical Adviser since 1991 and was the chair of the Sports Mouthguard Sub Committee from 2016. He has also been awarded a BSI Certificate for Distinguished Service to BSI.

He has been an active member of the British Standards Institute Sports

The authors very much welcome any questions relating to this article.

AIM: To explain the Personal Protective Equipment Legislation. CPD OUTCOME: To be aware of the Personal Protective Equipment Legislation and its implication on the construction of Sports Mouthguards. To understand how to comply with the Personal Protective Equipment Legislation. DEVELOPMENT OUTCOMES: C & D

QUESTION 1

QUESTION 6

What does PPE stand for? A Personal Priority Equipment B Personal Protective Equipment C Personal Privacy Protection D Personal Prime Protection

Anyone prescribing or supplying a Sports Mouthguard should: A Check it is CE marked in its recognisable form B Check the Technical Data File C Check the manufacturer is complying with the Medical Devices Directive D Ask the manufacturer to provide a copy of the test certificate and certification documentation provided by the Independent European Notifying Body

When was the Personal Protective Equipment Legislation first introduced? A 1995 B 1996 C 1997 D 2018 QUESTION 3

What category of the Personal Protective Equipment Legislation do mouthguards come under? A Complex (3) B Neither Simple nor Complex (2) C Simple (1) D None of them QUESTION 4

To Comply with the Personal Protective Equipment legislation the following must be undertaken: A A technical Data File must be created and kept at the place of manufacture B A prototype of the Sports Mouthguard to be placed on the market must be tested by an Independent European Notifying Body C An information leaflet must be supplied with the Sports Mouthguard and the packaging ce marked in itâ&#x20AC;&#x2122;s recognisable form D All the above QUESTION 5

The type of different tests carried out on a Sports Mouthguard by an Independent Notifying Body may be? A A minimum thickness test, a delamination test, a fluid absorption test, an innoxious test, a retention test, a material test and a colouring agent test B A minimum thickness test, a delamination test, a fluid absorption test and a colouring agent test C An impact test, a minimum thickness test, a delamination test, a fluid test and a colouring agent test. D An impact test, a minimum thickness test, a delamination test, a fluid absorption test, an innoxious test and a retention test, a material test, an ergonomic test and a colouring agent test.

QUESTION 7

The Personal Protective Equipment Legislation is: A Part of the Medical devices Directive B A completely separate piece of legislation to the Personal Protective Equipment Legislation C Being withdrawn when we leave the EEC D Is being made part of the Medical Devices Directive when we leave the EEC QUESTION 8

An Independent European Notifying Bodies will: A Check the Technical Data File B Test a prototype of the Sports Mouthguard being placed on the market C Carry out all of A, B and D. D Check the instructions QUESTION 9

When instructing an Independent European Notifying Body to Certify a Sports Mouthguard: A It must be within the United Kingdom B It must be in Germany C It must be in France D It can be anywhere QUESTION 10

The Personal Protective Equipment Legislation is enforced by: A The General Dental Council B The British Dental Association C The Trading Standards Officers D All the above

ANSWERS 1: A 2: A 3:B 4:D 5:D 6:D 7:B 8:C 9:D 10:C

QUESTION 2

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TECHNICIANS INSIGHT

5 THINGS I CANNOT WORK WITHOUT! With Daniel Shaw Royal Hospital

I Maxillofacial Laboratory Manager at Chesterfield So, to start off at number 1, I would struggle to pack prosthetic work as neatly as I do if I didn’t use this small spatula. It was a tool I found kicking around in the lab that allows a perfect placement of silicone into the mould, without adding unwanted air. At number 2, this plaster knife is short and sharp. It is perfect for adding aesthetic detail to the plateau on Orthodontic study models, rather than waiting for the hard stone to set and then using a burr/hand piece to neaten the area. It was purchased from Technovent (Bridport, Wales www.technovent.com).

Thank you for the invite from Matt Everatt, the editor asking me to share my top five tips for happy work. There’s a saying - a bad workman blames his tools. Now be honest, you know your favourite items to work with and you would likely spend the rest of the afternoon hunting around the lab looking for that tool, whilst blaming your colleagues for again, borrowing your stuff and not putting it back!

At number 3, I have found the best way to finish pressure/vacuum formed retainers or any other suck down such as fracture splints using polycarbonate plastics, is good old Wet’n’Dry. This particular batch I bought in bulk from screw-fix (cheaper than dental companies). The finer the better as it prevents the small lesions of “fluffling” the plastic when it gets hot following burr work.

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The fourth item I don’t like working without are these Polishing mops from WHW Plastics (www.whwplastics.com). They provide a lovely finish whilst using them for your pumice work and final polishing also. As they are mops they don’t scratch the plastic surface unlike bristle style, which also allows you to put extra pressure on whilst polishing without creating a nasty groove. Finally, forgive me for this sounding a little corny but Teamwork and Communication are aspects of work that I simply cannot work without. We do an important area of manufacture that we all like to get right, first time. Unless your patients or clinicians do not effectively inform you of their requirements we can be left guessing and having to improvise. Working within the dental team is a great environment for striving to do our best for our patients and our input (as Technicians, Prosthetists etc.) is vital as part of the team.

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NEW

HEALTH & WELLBEING

5 SIMPLE TIPS FOR A HEALTHIER RETURN TO WORK By Katie Bell Physiotherapy & Wellness

s an owner of a large Physiotherapy & Wellness company I am delighted to have been asked to contribute and share my advice and ideas. For me, there has been quite a shift in people’s health & wellbeing over the last few months and not all for the positive. A period of working from home on poor desk positions, a huge change to people’s routine, new hobbies, less sport played, more screen time, and a period of isolation for many. I am predicting zoom fatigue to be a new medical term that hits the papers and as Physio’s we are seeing more people with back pain than ever before due to all these factors above, I have just listed. So, what can you do as dental technician returning to work and trying to re-establish this new normal? 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. Try and return to a routine, for many who have been away from work for a period of time, sleep has been hugely affected due to later bedtimes and rise times and the mental stress and worry during this unprecedented time.

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. Do not assume because we have a warm spring you have absorbed enough Vitamin D! LEARN TO SAY NO! Over committing is something we all do! No is an immensely powerful word, much more powerful than YES! During lockdown we have all had a moment to readdress the balance and focus on what is important. 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

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 is more beneficial to set goals that are reachable, and then add on from there. We are all returning to work, and for some of us we may have got into good habits and become more active during lockdown. How can you keep this going? What is sustainable and achievable long term? CHECK YOUR VITAMIN D LEVELS We get most of our vitamin D from the

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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? MOVE How often do you move in the day? How much of your day is spent in the lab or sat at a desk? How much time do you spend moving your body and not just going for a walk? Flexibility is the key to reducing injury risk, reducing aches and pains, and staying physically fit. We are running a full online Pilates schedule which includes Live and Pre-recorded classes and we have some complimentary sessions running in August & September. If you are interested in joining in for a FREE class, just email hello@katiebellphysio.com and we will send you the list of options. Choose one thing you are going to action this week and share it with someone!

HEALTH & WELLBEING

DENTAL TECHNICIANS:

THE MOST RESILIENT DENTAL PROFESSIONALS By Ritesh Aggarwal BDS PGCert Clin.Ed Dentist and Co-owner/Managing Director at Psynergy Mental Health

or most of us, the slow return to work and reinventing our businesses has been extremely stressful. The financial implications as well as the constant mental barrage of worries, feeling overwhelmed, hopelessness, loneliness and emotional turmoil is taking its toll on our mental state. I understand the dilemma technicians face. Are all dentists going to be open? Will they still send me their work, or will they look for cheaper alternatives? Will NHS practices do any lab work now they are receiving their contract amount regardless of activity? Will patients come to practices for treatment at all especially non-urgent treatment? As human beings we will always have stressors in our life. Some stressors are helpful and can help us to thrive. However, when they mount up, they can spiral out of control and start to create mental health issues. By learning techniques and strategies to become mentally resilient you can help yourself and those around you to not just cope with these challenges, but lead a fulfilled, happy and balanced life. Mental Resilience is the capacity of an individual to deal effectively with stressors, pressures and challenges, allowing them to perform to the best of their ability. Our best learning comes from the mistakes we make and the problems we face. We should embrace these and move on as they teach us something we need to “learn”. Not only do we win when we are doing well but we also win a “learning or improvement opportunity” when we make a mistake or are faced with problems.

People can “bounce back” from adversity because of their inherent resilience: “the process of, capacity for, or outcome of successful adaptation despite challenging circumstances.” Key components to help you become more mentally resilient: Commitment: • Commitment and hard work are essential for success • Commitment without action will produce ineffective results. We must act on our commitment choices to achieve our targets • Being fully committed will allow you to achieve your goals • Commitment allows you to fully focus on the outcome and you will do whatever it takes to achieve your desired results • Commitment is the force that drives our choices from concept to reality • Commitment can help grow your integrity and self-esteem because you develop the discipline necessary to doing what you say you will do. You are either committed or not – there is no halfway house with commitment • Fear of failure can prevent total commitment and can cause us to doubt our ability to succeed. Failure to achieve results can diminish our confidence and then we tend to make excuses for not keeping our commitment to the task • Being honest with yourself (and others) and not making excuses allows us to accept accountability and create a growth mindset. This also sustains our integrity and allows us to be lenient and forgive ourselves – nobody is perfect and no one expects you to be. Commitment is the price you are willing to pay to achieve remarkable results and your performance reveals the price you have paid.

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Motivation: • Motivation is having a strong reason to act or the desire to accomplish something • The motivation needs to be stronger than the pain of doing what you need to do to achieve the outcome • Motivation provides the drive for us to work hard at something • You will have setbacks that will test your motivation. Create a vision with the end goal in mind. Use all your senses to attach emotion to this vision to make it feel real • Find your purpose for achieving your goal. Ask yourself about this and deeply explore this purpose. Write down this purpose and list the benefits to you • You will hit a brick wall on your journey. Refer to the list of benefits to re-motivate yourself • Sharing your vision with a positive person can help you create accountability for yourself by not wanting to “let them down” • Do not focus on what you have not achieved but instead reward yourself for what you have done so far. Being kind to yourself is essential and will help you stay positive and motivated. Motivation is critical to attaining goals as it helps drive us towards positive outcomes. Celebrate your wins each day, no matter how small, as this will improve your outcome for tomorrow.

BAR HEADER HEALTH & WELLBEING Self-control: • This is your ability to control your emotions, impulses, behaviour and reactions in the face of external demands • It is vital for overcoming fears, obsessions or any kind of negative thinking and it puts us in control of our own behaviour and actions • It can help us develop patience and it is essential to attaining success and happiness • When you worry about something you can become very stressed and anxious. It can be hard to let go of the temptation to obsess about a problem but the thoughts and emotions feed on themselves and each other and you can start to become overwhelmed. The skill of turning negative thoughts into positive ones can be developed like a muscle and with enough practice will become instinctive over time. A good start is to say “no problem” to yourself when faced with adversity. Your mind over time becomes conditioned to believing it. • Reframing your situation from a negative to positive will help you gain self-control e.g. “I can’t do that” can become “I’m improving my ability to do that” • Losing your temper, worrying or any other negative emotions are immediate reactions we wish to avoid when we are triggered. No matter the outcome these reactions will always leave us with an unpleasant feeling because of the outburst. Before reacting emotionally, take a deep breath and take a moment to consider what happened and how you want to react. By taking a pause and continually breathing deeply, you can calm yourself resulting in a better response. • To control negative emotions, do the following immediately to allow you to accept the emotion without consequences: observe the feeling and NAME IT. This works as we need to think clearly to name the emotion. This is done by the prefrontal cortex which overrides the brains emotional centre, the amygdala thus allowing us to retake control. NORMALISE the emotion. You are allowed to have this emotion and it has happened several times and will occur again. You have overcome this feeling before and you will do again. Once you have named it and normalised it LAUGH at it. BY laughing at it you have dealt with the emotion and it can now go away. • When dealing with stressful situation focus on what you can personally control. This will empower you. If something is done you cannot change it but you can focus and determine what you do next. • Decide what is important now and think of the bigger picture. By taking a moment to pause and consider you can refocus your mind on what is most important now and prioritise your action plan to achieve this. • Self-awareness is vital as it precedes selfcontrol. Recognising the emotions in which we lack control such as frustration, worry or anger will allow us to develop skills to improve our self-control when faced with these emotions in the future

• Meditation and mindfulness have been known to help with improving self-awareness and your brain’s ability to resist destructive impulses. Visualise yourself acting with selfcontrol and self-restraint. • Controlling self-criticism and forgiving yourself will prevent you falling into a vicious circle of losing control and feelings of intense selfhatred and disgust. When you make a mistake, acknowledge it, recognise how it makes you feel but move on and shift your attention to what you are going to do to improve yourself in the future. We have power over our minds and not outside events. Self-control strengthens our self-esteem, confidence, inner strength and willpower.

Confidence: • Confidence is the feeling of trust in your judgement, abilities and qualities • Confidence enables us to face any situation as without it any situation has the potential to be a threat. It comes from an inner feeling of self-belief • Self-belief is how we think about ourselves or the opinion you have about yourself. If you have low self-belief you tend to have negative thoughts and focus on your weaknesses. This will lead to self-doubt which usually results in an adverse outcome. • Having strong self-belief creates a positive mindset and shows a trust from yourself in your own abilities • Confidence allows you to perform well under pressure and it shows in your body language, speech and reactions to different situations. • Confidence can be developed and improved using simple, powerful techniques of self talk and visualisations. Improving confidence in yourself will improve your outcomes. Nobody can make you feel inferior without your consent. Trust your judgement, have faith in your abilities and believe in yourself.

Focus: • Focus is when we intensely pay attention to a single object, concept, person or activity, to the exclusion of everything else • It is your ability to centre your attention and energy on a specific task for a sustained period • Being fully focused is crucial to succeeding and achieving the goals you desire • By focusing on short term tasks and goals your motivation will remain at optimal levels as you achieve results quickly • With longer term goals it can be difficult to measure progress therefore it is easy to lose focus and become distracted • To help develop long term focus set meaningful goals and list rewards when achieving these goals. Write down these rewards and they will help you maintain your focus on productivity • Develop your action plan and focus on small steps to achieve your goals. Recognise and celebrate your progress on a daily basis. This helps with motivation which has a knock-on effect to your focus

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• Consider using a template such as the Eisenhower box which places tasks into the categories for urgent, not urgent, important, not important. This helps you prioritise tasks and allows you to focus and complete the activity in a timely manner • Avoid distractions both external (your physical environment such as noises or lights) and internally (your thoughts that are not related to the task in hand). Do not multi-task as this diminishes your focus and may lead to a poorer outcome • Developing good habits and strengthening self-belief is essential to focus. Laser-like focus takes practice, discipline and dedication but the more you do it the stronger it will become. It will allow you to reach your goals more efficiently and make achievements more rewarding.

Positive Inner Voice and Positive Mental Attitude • We have an inner voice that speaks to us consciously and unconsciously all the time. Our self-esteem and self-image are developed by how we talk to ourselves • The critical inner voice is the part of you that has turned against yourself. It is the defended negative side of your personality that opposes your on-going development. It is experienced as thoughts in your head and if you listen and believe its destructive point of view you will act on it leading to serious negative consequence • The critical inner voice is not your conscious or moral guide as it is degrading and punishing leading to feelings of self-hatred. It triggers negative moods and leads to selfsabotage and it encourages self-defeating and self-destructive behaviour • It consists of negative thoughts, beliefs and attitudes that oppose our best interests (“whenever you have feelings thoughts or behaviours that you do not want or welcome, then you are being hijacked by your chimp” Professor Steve Peters) • The most important techniques, in our opinion, to developing your mental resilience is to develop a positive inner voice and a positive mental attitude • Positive self-talk consists of phrases that inspire, motivate and remind you to focus and keep moving forwards. Phrases such as “breathe”, “Keep going”, “ I can do this or I’m good at this” and “bring it on” helps you focus your attention and hopefully trigger the ideal response and action for the task in hand • Notice what your inner voice is saying to you and articulate it in the second person. For example, instead of “I’m rubbish” say “you’re rubbish”. By doing this the critical inner voice is expressed and heard with hostility that it is and makes you aware of how self-attacking it really is • When you have these critical thoughts shift your attention to something more positive • Try positive thinking which involves neutral u thoughts about any situation and naming the p. 18

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HEALTH & WELLBEING facts. For example, instead of “I’m rubbish” think “I’m not very good yet but I know how to improve and get better”. The fact maybe good but the phrase gives you direction and choices to move forward and improve • Positive thinking is associated with the psychology of achievement leading to an optimistic state of mind bringing inner satisfaction, peace and personalised success • Positive thinking helps you to visualise what you want to happen and empowers you to develop a growth mindset that empowers rather than limits your potential • Positive thinking must be accompanied with action – you can learn to be optimistic and develop by doing what needs to be done, allowing you to move to where you want to be in the future • Embrace your imperfections as perfectionism is destructive. Be willing to make mistakes and learn how to move on • When being attacked by negativity, take a few deep breaths, put it into perspective, narrow it down and place it into a tiny box.

By minimising the negativity, you can gain confidence in knowing that you can tackle and overcome it • Speak to yourself positively, visualise yourself reaching your goals and enjoying the rewards, associate yourself with optimistic, happy people, read or listen to positive articles or podcasts, commit to lifelong personal improvement, take good care of your physical health, get good nutrition and sleep, and expect to be successful with confidence and you will be rewarded with a fulfilling life.

We are what we think and a positive inner voice in conjunction with a positive mental attitude creates positive results and outcomes. We all have the opportunity to change our workplace for the better. We can choose to take control and act now or we can choose to let the situation control us. We can address the things that are not going so well and we can look to enhance our products and services to create a thriving mentally healthy workplace. Success is not just financial but holistic and developing mental resilience can be life changing. These techniques can help you achieve this. If you decide to keep an open mind and try them out, you will quickly be able to positively change the way you think, speak and act and in turn, positively impact and restore your work-life balance.

INSIGHT

LIFE OFF THE ROAD MAKING 3D PRINTING CHILD’S PLAY

Leonora Ward has been Business Development Manager at dental products supplier Eurodontic for 9 years. We caught up with Leonora to see what she’s been up to during lockdown and what a typical day looks like for her.

l ‘Most of our regular customers, especially across the South, will know me as the ‘Eurodontic lady’ and I can usually be found carrying a Biostar® or Ministar® either on the road or chatting to dental laboratories and practices about pressure forming machines and all our fabulous products! You can imagine my frustration as recent events have prevented me from doing what I do best. Like so many of us, the lockdown has meant that I’ve had to rethink how I do my job, for the time being at least. I’m still in touch with my lovely customers, via Zoom and on the phone, but I’ve still found myself with some downtime. One of Eurodontic’s key products for 2020 is the Ultimaker S3, an amazing, compact desktop 3D printer. I decided to bring one home to trial. What better use of my downtime than learning all the ins and outs of something new? My son was so excited when the printer arrived. Eager to start printing something

(anything!), we unboxed it together and set it up within minutes, but when we pressed the button on our first test print - nothing happened! We’d failed at the first hurdle. Sheepishly we had to go back to the beginning - and actually read the instructions! Believe it or not it worked - once we followed the stepby-step setup guide and downloaded the Cura software we were ready to print. We headed over to the My Mini Factory website, which has a huge range of free files. Lego Heads were the first thing we tried – surely it didn’t have to be dental related whilst I was practicing. The software is really easy to use. I was able to move the image to the perfect position, so it was flat on the glass plate, and after just 30 minutes we’d made our very own Darth Vader head! All I needed to do was remove the support material, which peeled off easily. No mess, no fuss and no need for post-processing! By then I’d definitely caught the 3D printing bug and decided to move the Ultimaker to a more permanent home in my office. Unfortunately, when we went to do a print it wouldn’t work, a printer head error. Oh no, here we are in lockdown and I’ve broken it already!

I called the Ultimaker helpline who were brilliant. During the move I had knocked the printer head out of alignment, it was an easy fix. I just had to manually realign the printer head which took a couple of minutes and I was back printing - that week I think we managed several horseshoe models, an iPhone holder, 3D puzzles and a Batman plane! I’m not hugely confident when it comes to new technology, but I have to say the Ultimaker S3 and the Cura Software are so easy to use and they’re suitable for anyone who is new to 3D printing. I’ve learned a lot over the past few months, I’ve taught myself to use a 3D printer, I’ve put together demonstration and training videos for customers - but I am looking forward to getting back on the road, only this time I’ll have a pressure formed machine in one hand and an Ultimaker S3 in the other. If you’d like to have a chat about any of our products, just give me a buzz and I’d be happy to give you an online demo - Darth Vader head anyone?’

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FOCUS

WORKING DURING LOCKDOWN By Andrea Johnson

PART TWO

As my lockdown tale continues, I very soon got into a routine working and running the fit testing teams but what I really didn’t expect or think about at the time was that almost every staff member that came in to be fit tested was super stressed, they were panicking for their own safety, the safety of their families and the safety of their patients. This meant that some of them were quite aggressive, rude and confrontational. More than once they had one of my team in tears because they didn’t like the result they were given or they didn’t like being told what to do, or they had to be turned away for a particular mask type that they thought was better because we only had a limited amount and they had to be given to others who were considered a higher priority. It soon became the norm that every day when I went into work I got shouted at many times and had to deal with incredibly confrontational doctors, nurses, consultants, surgeons, porters, cleaners to name but a very few. Especially as I was also now a trained PPE safety officer and it was now part of my job to make sure that people were wearing the right PPE at the right time and not wasting it unnecessarily - you can imagine how well that went down at times. Now I am personally thick skinned enough to deal with this and all my past experiences and training allows me to deal with such circumstances so, as and when one of my team was feeling frightened, intimidated or unfairly challenged they would come and fetch me. There was no way I was going to allow them to be treated in this way. I don’t want you to think that every day was horrible and everyone in the NHS is nasty because that is absolutely not the case but these were incredibly stressful times for all and sometimes you are just the one that

happens to be in the way when someone wants to vent. I mean what happens if they fail their fit test? When they walk in and you have to send them away again because they have facial hair and don’t want to shave, what if they have decided against all your advice that they know better and think you are not giving them the ‘good stuff’?, what if they

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are secretly hoping they will fail because they are so scared to work with the Covid positive patients? We had to deal with many staff having panic attacks whilst being fit tested. Every member of the staff in the hospital was working super hard, admin staff were having to call thousands and thousands of

FOCUS patients and cancel or rearrange appointments, some were redeployed into other areas and had the job of calling families of patients to keep them updated which did mean that they were now working in ‘yellow’ areas and having to wear PPE they have never had to before. Some redeployed staff were now porters – transporting Covid positive patients around to areas they needed to be, some had to take the dead to the morgue – very traumatic for some. Cleaners were scrubbing the hospital constantly, also having to clean the ‘yellow’ areas and wear full PPE, It was most certainly not just doctors and nurses saving the day, it was the entire NHS pulling together and doing whatever the hell was necessary to keep us all alive. Very challenging times. Whilst I was fit testing, I also found out that my lovely friend Gianni Grandi passed away from Covid, 2 colleagues at work also died due to Covid, some of my dental team colleagues lost parents to it and I had another friend fighting for his life due to it, we had staff become infected and have to go off and isolate due to it, had to test those who had recovered from it. I was also in my home life, doing all the grocery shopping etc as I was out already so why risk anyone else? I was also working together with my sister In law to look after my mother and father in law who are also extremely vulnerable and were shielding. Quite often dropping their shopping off at around 10.45-11pm after I had finished my shift. I would call in to the Morrisons on my way home with their shopping list. As part of my new routine, decontaminating myself to protect my family was essential. I would change at work out of my potentially contaminated uniform at work and drive the hour home. Once I got home I could not just walk in to the house, I had to get my family to keep themselves and my dogs locked in the main house while I came around the back – I have a downstairs bathroom- so they would leave a towel and clean PJ’s on the kitchen side for me and I would come in through the back door, put my contaminated work clothes into the washer, go into the bathroom, shower and change then add those other clothes to the washer. Turn on the washer and then I could enter the house. I did this every day for weeks and still take serious precautions even now. Some days it would be late afternoon when I made my way home after my early shift and my neighbours would be sat in their back gardens in the sun, glass of wine in hand and spend a good 5 -10 mins complaining to me about how bored they had been all day. Me stood there clutching my contaminated items, waiting for a shower, tired, worn down and hungry listening to how bored they were.

whilst safe at home on furlough, getting paid. Some saying how much they were loving being at home with their families, revaluating their lives, getting all those projects done in the garden and home they had been wanting to do, hot tubs galore everywhere I looked. Did it make me bitter – it did a little bit. Oh how I wish for some free time off! How I wish for any time off! But I work for the NHS, this is what I signed up for. All those working in retail, delivering your parcels and those hot tubs, posties, bin men, emergency services and even more besides also had to get off their asses and get to work. There were so many people with businesses who were worried about how they were going to pay their bills, could they last the distance? Were they going to get any help at all? I felt pretty bad for being so selfish and wanting the time off when I knew my bills were getting paid, I had my kid at home safe and well with me when many others couldn’t see theirs or their grandchildren. My mum, dad, step mum, grandma, sisters, nieces, nephew and in laws were alive and well. When I wasn’t at work I was trying to keep on top of the OTA and Den-Tech work. Especially the OTA, we have so many members who were, and still are, worried, stressed feeling left out by the CDO and authorities. During these months I have been constantly pushing the plight of the labs with anyone in authority who will listen to me, I am involved in regular meetings and workshops with the CDO, NHS England and NHS improvement teams. Lab issues will be heard and yes she is listening but it always has been and will continue to be an uphill struggle to get lab issues taken as seriously as we would like. Also in many of the meetings with me is Stephen Taylor of BIDST and DLA, together we will make sure labs are not forgotten! I am also involved with other projects with NHS England, helping them getting their

fit testing training programme out there up and running. Trying to get some more official guidance for labs from Public Health England and whatever else I can get done for us. Also OTA related is that we have had to cancel our face to face conference but have decided to host it online so we are working on that in the background too. Den-Tech wise, we have been working with the University of Puthisastra in Cambodia to design their first ever dental technology course - big thanks to Darren Ware who is heading this up for me. I have been working on Den-Techs first ever fundraising trip abroad to mouth Toubkal in Morocco, we have been in keeping in touch with Crisis to plan what the future holds with them, and also with other organisations and partnerships about future working partnerships AND we have our very first ever Den-Tech Patron - Finlay Sutton who is utterly amazing and we are so super proud to be represented and supported by him. I am now back in my own lab, work is tentatively starting back up, we have had so many dramas around fallow times, ventilation, sourcing appropriate PPE etc. I have also been trying to ease the burden at work by working closely with some other groups trying to source free PPE for the hospital and have to date managed to source some gowns, fabric masks – for patients to use and take awaysleeve covers and over 5000 visors. Oh and I have been sewing some fabric masks of my own too to hand out at work. My work in the lab right now consists of retainers, retainers and yes more retainers – it’s like being a trainee again! as we are trying to get as many of the completed cases debonded and out of the system as we can and hope to be starting more active treatment in August. I am still also helping out our fit testing teams as and when I can but this has been scaled back now as we conducted over 4000 fit tests during my time working with them so it is mainly now fit testing new starters, returners to work etc. I still haven’t had any time off yet but have booked a couple of weeks off in August – I’m not going far but will try and not to do too much work either. If the weather is nice it will be nice to try and get some gardening done and try and go and see my mum now that we are allowed. It has been a long 5 months without seeing her or my other family. 5 months blimey! What a roller coaster. So that is the brief summery of my time during lockdown, I do hope some of you will also share your experiences and you all know how to get hold of me should you ever need me for anything. Take care & stay safe. Andrea

I would look at Facebook, see people complaining about how bored they were

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INSIGHT

CLIMBING OUT OF LOCKDOWN By Sir Paul Beresford, BDS. MP

ockdown restrictions in the UK were announced by Boris Johnson, Prime Minister on 23 March 2020. This was a result of the increasing awareness that the United Kingdom was about to be hit by a pandemic caused by a totally new and highly dangerous virus. There is increasing evidence that China initially may have covered up the existence and progress of this deadly disease much earlier than the world became aware of it. There is also high suspicion that the virus may have been accidentally linked from a research laboratory in Wuhan. The latest suspicion is of local Wuhan officials cover-up denying the brief chance to stop the virus in Wuha. At that point little was known about the Coronavirus except that it is highly dangerous for many humans. Virtually every nation introduced varying degrees of restrictions on a normal life as this horrendous virus progressively spread from Wuhan in China as a pandemic throughout the world. Inevitably there has been much discussion, particularly in the media, on our local current Lockdown policy and its implementation. Every conceivable position has been argued, from Lockdown should not yet be used, to Lockdown began too late, that Lockdown should be released immediately - plus everything in between. Consequently, I looked with particular interest to the Imperial College London study which has assessed the impact of Lockdown on 11 European countries including ours, up to the beginning of May 2020. These researchers used sophisticated modelling to project how many deaths there would be if there had not been Lockdown.

At the beginning of May approximately 130,000 people had died from Covid in those 11 European countries. Of course, this is risen horrifically since. However, the Imperial study estimates that without Lockdown 3.2 million people would have died by 4th May if these countries have not imposed measures such as closing businesses and telling people to stay at home. The study estimates the Lockdown to have saved around 3.2 million lives at that time, including 470,000 United Kingdom, 690,000 and 630,000 in Italy. Inevitably there will be much discussion and argument when finally, we may be able to push this disease off our landscape. There will be endless attempts by opponents of the Conservative Government to emphasise areas where we could have done better and underplay/ ignore successes. Of course learning from the past, to ready ourselves for the next occasion is good management. South Korea managed to successfully battled Sars and use that experience to their benefit in the attack against coronavirus. Japan where greetings generally involve a faceto-face bow at perhaps 1 metre distance had less community spread than some of our European neighbours where the obligatory on both cheeks peck clearly increased community spread. The comparison that rankles with me as a dual NZ/UK passport holder is New Zealand. I noted at least one of the weekend papers there was New Zealand Government criticism of this country. Jacinda Arhern, the Labour Prime Minister, who introduced very harsh Lockdown on 19th March has been very successful in limiting the Covid toll to just 1504 cases and 22 deaths. A commendable achievement. However such simple comparisons are heavily flawed. New Zealand is essentially a country of rural settlements of low-density suburbs where social distancing was not too difficult. Covid arrived in New Zealand the middle of summer when viruses are at the lowest chance spreading. Also New Zealand is self-sufficient in food hence has relatively little international supplies - New Zealand has 700 international flights a week whereas Britain has many more than that in a single day plus trains and ferries arriving from other European countries constantly, especially from Spain and Italy who was suffering from

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the virus before it hit the UK. Arhern has elections later this year and will no doubt be returned on the wave of the New Zealand Lockdown success. Unfortunately for the country most voters seem relatively blissfully unaware of the huge cost per head of population of the financial support Arhern has given, along the lines of most European countries including the UK but then some! New Zealand will need a National ( Conservative) Government to return to economic sanity which is not helped by the continuing border closure causing the destruction of its international tourism business which constitutes a considerable proportion of its GDP. I am a very part-time private only dentist undertaking, when Parliament allows, a few hours of practice a week. Like every other dental surgery in England, whether NHS, mixed, or private I closed my doors at the request of Sara Hurley, the English Chief Dental Officer at the beginning of Lockdown. From the limited knowledge we had of the transference of coronavirus this was a glaring and obvious step. Latterly there have been criticism of this action, from some private dentists and private dentists groups. These have been based on the belief that the Chief Dental Officer had responsibility for NHS dentistry only. It is correct that she has responsibility for paying rations of NHS dental contractors but her role in dental health is very much broader. As the NHS England website puts it: “The Office of the Chief Dental Officer England represents the head of the dental profession in England, providing system wide professional and clinical leadership, by setting the strategic vision for England’s oral health.” It is often said particularly by the BDA, that dentistry is treated as a Cinderella health service in England. I cannot but agree although I noticed that Sara Hurley’s drive to “put the mouth back in the body” slowly but steadily gaining traction at the Department of Health all the way up to the Secretary of State For most dental practices Lockdown has been a financial disaster. Sara somehow managed to persuade the Treasury that partial NHS payments to NHS dentists was appropriate.

INSIGHT In addition, there were a number of other financial assistance schemes available to dentistry as for other UK businesses. Some of these were grants, some access to loans and delays in tax payment all offered help. As an MP, I and my team of three, over Lockdown have received in excess of 27,000 emails and letters, telephone messages. Many of these are from businesses and individuals facing the prospect of their livelihood disintegrating. It is a considerable relief to us when we are able to utilise what this Government made available to assist many. Inevitably such broad schemes, especially those designed to attempt to remove fraud, mean that very many people and businesses fall through the cracks. A lot of these have been dentists and dental surgeries. As the only dentist in the House of Commons I have been frequent requests from dentists and patients. Over Lockdown fortunately all dental practices continue to provide remote consultations, advice, prescriptions for analgesics and antimicrobials where necessary. The NHS Dental 111 call line ran dental triage supported by the dental workforce for patients who do not have their own dental practice. Additionally, Sara Hurley managed in time to set up over 600 Urgent Dental Care Centres. As of 21st June the UDCCs gave 1,707,947 remote triage

conversations and help. They referred 103,552 individuals to UDCs resulting in 69,656 faceto-face treatment. Under 1/3 of the face-to-face treatments necessitated an extraction contrary to the impression given by one Labour MP to the recent Health Select Committee hearing. The brightest news for the profession was that from Monday 8th June surgery doors could be opened. Most surgeries phased in their return. Concerns of the spread of the virus through dental surgeries was very real so practices are almost universally cautiously increasing what they offer and utilising extensive PPE. Preappointment and at the appointment triaging is becoming standard. Most practices back the extensive triaging with the taking of body temperature on arrival. Patient flow, because of extra cleaning and sterilisation, has been driven down to a trickle for most practices. Add in the cost of PPE and the often expensive, extra equipment practices are being told to obtain we get severely damaged finances of the practice of dentistry whether NHS or private. There are a number of hopeful prospects coming over the horizon. The first of these is that there is a real prospect that Covid will be

beaten. The ultimate hope for this will be the production of a vaccine or vaccines for very widespread inoculations. I am appalled beyond all measure to be subjected to a small but vocal campaign against the use of vaccination by a few of my constituents and others. Additionally some antiviral drugs seem to help very ill patients meaning fewer deaths and faster recovery. Next, somewhere in the near pipe line, there is a possibility of an individual on the spot test for coronavirus carrying that takes approximately 20 minutes. This may be developed to so that it could be used in the dental surgery- as well as at airports! Of considerable significance, I believe from previous and imminently pending research that there is no evidence of aerosolized SARS-CoV-2 (including the current coronavirus) as the primary infective vector from any study worldwide. This includes, but is not limited to, aerosols of dental origin. This brings me to the conclusion that realistic normality without the great expense of extra PPE and without the delay of excessive surgery sterilisation between patients a semblance of life as we knew it may be upon us.

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DENTAL TECHNOLOGY

THE SOLUTION TO A CRACKRESISTANT, DURABLE CLEAR RETAINER

or anyone doing orthodontic treatment, there’s nothing more aggravating than hearing a patient report a cracked clear retainer. It sets in motion a chain of often time-consuming, unpleasant and always costly events. An additional patient visit, lost chair time, possibly another scan, retainer fabrication cost, ultimately a longer treatment time, and too often an unhappy patient. Plus, you know there’s a good chance the new retainer isn’t going to last much longer than the previous one.

The first and most important step in the solution to fabricating a durable, crackresistant retainer is material selection. Any retainer you make will never be any better than the plastic material you use to fabricate it, no matter how experienced and talented a lab technician you are. Use an inexpensive commodity plastic engineered for broad use across many applications and chances are you’ll ultimately end up with a retainer that’s prone to cracking and deformation. There are two basic categories of thermoplastic material used today to fabricate retainers. The first and most common is made mostly from commodity resins, mostly polyester, or PETG for short. Most of the retainer plastics from well-known manufacturers suppliers are all PETG. Relatively inexpensive and easy to work, PETG is commonly used as the base resin for consumer products like plastic Coke and Pepsi bottles. All general and cosmetic dentists know PETG plastics well, since they’re a staple material used for a range of dental appliances like splints and bleaching trays. But PETG doesn’t have the properties essential for a crack-resistant, long-lasting retainer.

Many of the clear aligner companies use only 100% PU material for their aligners. They also use it in their retainer materials. The exceptional performance and durability of those materials has played a key role in the success and lifespan of the aligners. Zendura developed PU further and is a new generation plastic, meaning it’s hardier and more crack and stain resistant, most Zendura users buy 0.76mm thick Zendura A for all of their retainers. Even though it is about 25% thinner than most retainers, a properly made Zendura retainer will last from one to five years. Being able to use a thinner profile retainer material with confidence is a huge plus. The thinner the retainer the more comfortable it is in the patient’s mouth -- and most important -- the better the patient compliance. This is particularly important with pediatric patients. Zendura retainers today are widely considered the benchmark in the orthodontic community for clear retainers. So, if you want to fabricate retainers to the caliber of those made by the large aligner companies, really your only material choice is Zendura. It may cost more up front, but if you analyze the final cost of a cracked retainer, the cost of a premium material like Zendura pays for itself many times over in giving you the confidence of knowing the retainers you

Hence the reason why most suppliers of PTEG plastics recommend using 1mm (040”) think material for retainers. Anything thinner will be too susceptible to cracking and likely won’t last more than a month or two. The second category of plastic commonly used today for retainers is made from a specialized resin called polyurethane, or PU for short. It’s more expensive and harder to work with than PETG, but it provides the optimum balance of all the key properties essential for a highly crack resistant, durable, long lasting and highly stain resistant plastic.

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provide to your patients won’t crack and will perform exactly as prescribed for probably years to come. Says Matt Norie, GM of S4S, one of the U.K.’s leading labs, “We have been using Zendura at S4S for a couple of years now. The strength and durability of the material is fantastic. Retainers made from this material last significantly longer than other standard pressure formed retainer materials, in fact, I can't remember having to remake a retainer made of Zendura.” Distributed in the UK and Ireland by OrthoCare, Zendura is broadly used by orthodontists, dentists, and dental and orthodontic labs. OrthoCare also distributes Bay Materials’ highly acclaimed Zendura FLX material, engineered specially for clear aligners. Introduced to the marketplace less than 2 years ago, it has already become the new benchmark in the clear aligner treatment market. For helpful guidance on how to fabricate top-tier retainers, OrthoCare provides its customers with an illustrated guide titled Zendura Thermoforming Tips & Tricks Guide. It also has available on request another illustrated guide titled How to Manually CutTrim-Finish Aligners & Retainers.

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FOCUS

INFECTION CONTROL AND COVID-19 CONSIDERATIONS IN THE DENTAL LABORATORY By Andrea Johnson

as Covid-19 had much of an effect on how we run and operate our laboratories? Have our infection control processes had to change dramatically? Surprisingly not really, as we are already working in an environment where we need to be aware and take suitable precautions with regards to personal safety and cross infection control. So what do we need to think about? STAFF CONSIDERATIONS We need to think about the health implications of our working environment and the conditions in place for your staff, yourself and the resulting impact this can have on your families etc A good precaution with regards to cross infection, Covid-19 or not, is to change into and out of your work uniform at work. When you have finished with it place your contaminated uniform into the washable bag and then pop the whole bag of clothes (including the bag) into the washer to decontaminate them when arriving home. WORK RELATED STRESS & MENTAL HEALTH COUNSELLING What is stress? HSE defines stress as ‘the adverse reaction people have to excessive pressures or other types of demand placed on them’. Stress is not an illness but it can make you ill. Recognising the signs of stress will help employers to take steps to stop, lower and manage stress in their workplace. Employees feel stress when they can’t cope with pressures and other issues. Employers should match demands to employees’ skills and knowledge. For example, employees can get stressed if they feel they don’t have the skills or time to meet tight deadlines. Providing planning, training and support can reduce pressure and bring stress levels down.

risk assessments with your staff and even more so in the current climate. This will not only allow you to make sure that you have the best possible precautions and workplace environment for the safety of your staff but will also serve to reassure your staff that you are taking their personal wellbeing into account and you can help them understand and contribute any ideas to a safer way of working for them.

Stress affects people differently – what stresses one person may not affect another. Factors like skills and experience, age or disability may all affect whether an employee can cope. There are six main areas of work design which can affect stress levels. You should manage these properly. They are: • Demands • Control • Support • Relationships • Role • Change Employers should assess the risks in these areas to manage stress in the workplace. How to help The earlier a problem is tackled the less impact it will have. If you think that an employee is having problems, encourage them to talk to someone, whether it is their line manager, trade union representative, GP or their occupational health team. (Health & Safety Executive (HSE), 2020) Also, have numbers of helplines and counselors on display and easily available for staff needing professional support. HEALTH RISK ASSESSMENTS OF STAFF It is important to carry out regular health

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Training of staff in new protocols It is important that if you have put any new measures into place either because of Covid or any other reason, that you fully inform and train all your relevant staff in these new protocols, try to remember those that have been off sick, annual leave, maternity and new starters may not be as up to date as the rest of your staff so they will need a back to work refresher if anything has changed in their working environment or your expectations of them. Due to covid-19 there have been many changes in the guidance for our profession, some of these in the early days of the pandemic were changing very frequently as we learned more and more about how the virus is transmitted and its effects on the human body. Fortunately, many of these changes have reverted back to their original state but some have changed for the foreseeable future. For this reason, please make sure you regularly check for updates with the following: • Health and Safety Executive • Medicine and Healthcare Regulatory Authority (MHRA) - Medical Device Regulations (MDR) • Public Health England • Government guidelines • General Dental council • Chief Dental Officer

FOCUS • Insurance – does it cover you for all your activities and any Covid-19/pandemic issues? Lab layout Social distancing is now very important to protect your staff, it may help to have suitable floor markings as a reminder to staff. Maybe moving or decommissioning of some workstations or areas will help to facilitate this. You may also have to stagger breaks and start/finish times to allow for maximum safe capacity whilst still being able to maintain a safe social distance from each other. Hand washing – consider placing hand washing stations at entrances and exits or clear unobstructed pathways to them. Public/Patient/Visitor/delivery access – depending on your space and lab layout you may have to consider using screens in areas where you may get occasional visitors, delivery drivers etc. Make sure that you also apply Floor markings, hand gels, laminated posters in these areas to make it clear to any entering your laboratory what you expect from them.

Good ventilation can help reduce the risk of spreading coronavirus, so focus on improving general ventilation, preferably through fresh air or mechanical systems. Where possible, consider ways to maintain and increase the supply of fresh air, for example, by opening windows and doors (unless fire doors). Also consider if you can improve the circulation of outside air and prevent pockets of stagnant air in occupied spaces. You can do this by using ceiling fans or desk fans for example, provided good ventilation is maintained. The risk of transmission through the use of ceiling and desk fans is extremely low providing there is good ventilation in the area it is being used, preferably provided by fresh air. Air conditioning The risk of air conditioning spreading coronavirus (COVID-19) in the workplace is extremely low as long as there is an adequate supply of fresh air and ventilation.

If it is at all possible provide a suitable area/ staff room where staff can change into and out of their work clothes and wash their hands etc after changing.

You can continue using most types of air conditioning system as normal. But if you use a centralised ventilations system that removes and circulates air to different rooms it is recommended that you turn off recirculation and use a fresh air supply.

LABORATORY ENVIRONMENT & EQUIPMENT Air conditioning/ventilation General ventilation Employers must, by law, ensure an adequate supply of fresh air in the workplace and this has not changed.

You do not need to adjust air conditioning systems that mix some of the extracted air with fresh air and return it to the room as this increases the fresh air ventilation rate. Also, you do not need to adjust systems in individual rooms or portable units as these operate on 100% recirculation. You should

still however maintain a good supply of fresh air ventilation in the room. If you’re unsure, ask the advice of your heating ventilation and air conditioning (HVAC) engineer or adviser. Remove nonessential equipment especially from ‘dirty’ areas (Health & Safety Executive (HSE), 2020) PPE Under the Health and Safety at Work Act that PPE should be worn as standard – including face protection due to the risk of splash or injury to the face in the manufacture process. FFP2/3 masks – these I recommend for use in any procedure where you are handling a potentially contaminated item and causing spatter/aerosols such as grinding or polishing repairs or used/worn patient appliances. If wearing an FFP2/3 for these reasons it is highly recommended to get fit tested to make sure that the mask is giving you the full protection for your face shape. Another great precaution for not only your safety but also to keep the mess and dust down in your working environment is to use a grinding box for repairs. When Polishing up (repairs) – spatter etc – use lab coat, gloves, plastic apron, goggles/ visor. Use pan liner if possible, use fresh pumice and change after each appliance, dispose in clinical waste. Clean down after each use and dispose of aprons and gloves. INFECTION CONTROL The Decontamination of Medical Devices Regulations and the Health and Social Care Act 2008 apply here in that Standard precautions apply when handling and disinfecting incoming work- impressions and repairs, try ins etc Decontamination of instruments, burs, brushes, polishing lathes, hydroflasks should be completed regularly – in fact, straight away if known to have been used on a contaminated appliance. Cleaning rotas should be in place for: • Thorough cleaning down at the end of each day • Throughout the day – cleaning touchpoints such as door handles, handpieces/ instruments, counter tops, phones (and mobiles), keyboards, computer mice, kettle, microwave, fridge door, chairs. BIBLIOGRAPHY Health & Safety Executive (HSE). (2020). Air conditioning and ventilation during the coronavirus outbreak. Retrieved from Health & Safety Executive: https://www.hse.gov.uk/coronavirus/equipment-andmachinery/air-conditioning-and-ventilation.htm Health & Safety Executive (HSE). (2020). Work-related stress and how to tackle it. Retrieved from Health & Safety Executive: https://www.hse.gov.uk/stress/ what-to-do.htm

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MARKETING

JAN CLARKE BDS FDSRCPS l Jan qualified as a dentist in 1988 and worked in the hospital service and then general practice. She was a practice owner for 17 years and worked as an Advisor with Denplan. Jan now works helping dental businesses with their marketing and business strategy and heads up the Social Media Academy at Rose & Co. Web: www.roseand.co Email: jan@roseand.co Facebook: Jan ClarkeTaplin Twitter: @JanetLClarke Instagram: janlclarkeacademy LinkedIn: Jan Clarke BDS FDSRCPS

WHERE TO START WITH MARKETING POST-LOCKDOWN

ast time I talked about building relationships with your clients during this quieter post-lockdown period, spending time on strengthening these connections and finding out how you can help. I thought I could maybe expand on this and discuss some points to help you with your marketing and increasing your work load. With dental practices now opening up a little bit more and starting to carry out some AGP I am hopeful that some of you are starting if not to return to normal then starting to build up business again. You may have had staff on furlough and will be having to make decisions about whether to continue or possibly make redundancies. Now is the time to take a good look at your business and examine how you can ease the burden of these decisions before end of furlough deadlines. In my experience, dealing with our clients, there now certainly seems to be an increased request for cosmetic work and this bodes well for your recovery. As I said last time a lot of this may be teeth straightening and aligner requests but all too often these patients’ cosmetic requests are not simple and it's not always so easy just to fit aligners, they often require far more involved work including fillings, crowns, bridges, implants, and veneers. The million dollar question is what can you do now to help bring some of this work to you? I mentioned last time about building relationships and being amenable to new clients and existing clients, not being the cheapest not being the quickest, but being helpful and being there for your clients.

THE FIRST THING TO DO IS TO:

1. Make contact with your existing clients Why not just pick up the phone and call your clients to have a chat? Dental practices are still quieter with dentists having to wait between patients waiting for fallow times and therefore more likely to be able to accept your call. Ask them what problems they are facing and find out how you can help them.

By strengthening this professional bond and building connection you are more likely to find you will be the first technician they will think of when they prep for a crown. Try not to tell them about your fantastic offer but concentrate on building trust and rapport. People are more likely to buy from people they know and trust and connect with. Building rapport is as important for you with your dental practice clients as it is for the dentist with their patient. 2. Consider also spend some time revisiting your customer journey. How is your business perceived by your dental practices? How is your pickup service (if you have one) ? Can you make it easier? Can you make it more flexible or as simple as you can? How about logging in lab work is it as easy as it can be can you make it simpler maybe download lab sheets from the website? Is your billing as transparent as possible? Are your clients happy with and understand the cost that they are been asked to pay in the same ways dentists have to be transparent with their patients? 3. Look at your business brand, does it have a clear coherent message? It is time to look at your website and digital offering including your social media marketing. There is no doubt that your website is your biggest marketing tool and most likely your largest spend. If you already have a website, when was it last updated? Can you find it in a search engine? Websites need to be kept healthy with regular updates. Most websites built on the WordPress theme are easy to update with little expense, you may be even able to do this but gone are the days where a homemade put together website is acceptable people expect a little bit more sophistication now. If you haven’t already invested in a website now is the time to consider this. A new website need not cost you a fortune. You do not need a vast 40 page website to start. Think about your presence and keep your website simple to start. Just a few essential pages can start

you off but it is essential to talk to your ideal client when writing the copy for your website. Ensure your website is appearing in search engines and one easy way to update your website regularly and keep Google happy is to add a Blog page to your website. If you have an existing site and haven’t already started a blog use this time to do this. You could write about a case study in your blog and even consider a collaborative approach with a dental practice whereby you maybe do a case study of a patient you’ve been involved with. This not only strengthens your links but helps them provide content for their website too. A win win! A word of warning though, change the copy slightly for each website because Google penalises duplicated content. Utilising a blog gives a dentist a really good way of being able to see the sort of work you do and how it is implemented. Now let's look at your social media presence, have you got a social media presence? Perhaps you don't think you need one and I do realise that not many dental technicians are on social media but I think it’s a great place to be. On social media you can regularly post content to talk about your business to show a human face to your business and your team. It doesn’t always have to be about dentistry and cases or the work you do, it’s can be about the people that work there, in the same way dental patients like to see their dental practice staff and personnel and what's happening in their lives. The most obvious place to be is Facebook and Instagram. I can spend more time next month discussing this further. In the meantime why not revisit Facebook and have a look around, see what other technicians may be posting. I wish you all the best during this difficult period of transition and as usual should any of you require a face to face chat via Zoom with some pointers for your marketing I am more than happy to offer these free of charge, please just email and I will set up a call.

BUSINESS

LEADERSHIP & MANAGEMENT - IS YOUR LEADERSHIP STYLE STIFLING YOUR TEAM AND KILLING YOUR BUSINESS? By Matt Everatt F.O.T.A Author & Editor First let's reflect on what some of the common traits are and what we may experience as a controlling leader. Do you find your team struggles to share new ideas with you? Are they nervous or appear timid around you when they have an idea that may differ from yours? Do they enter into conversations about a new idea by apologising? Obviously, it could be down to their own personality type or is it down to you and your leadership style are you a controlling leader?

s part of the new Business feature, I plan to write on the subject of Leadership and Management in the coming editions. James MacGregor Burns in his 1978 book titled ‘Leadership’ writes that “Leadership is one of the most observed and least understood phenomena on earth.” One of the most common definitions used in the study and teaching of Leadership is that of Northouse who writes that “Leadership is a process whereby an individual influences a group of individuals to achieve a common goal.” There are many leadership theories, all of which can be placed into one of eight main theories. This month we take a look at a very common leadership trait that I have experienced in our profession, one that I feel is perhaps still present in some laboratories today. As leaders, it is very important that we can reflect on our leadership styles and traits, I believe that good leaders can learn and develop their skills and do not have to be 'natural born leaders'. This month we look at 'Controlling Leadership Traits', although not in its own right a ‘Leadership Theory’ the trait can exist within several and perhaps more common in the ‘Transactional Theory’ of leadership. Transactional type leadership, I suspect, is rife within our profession, where the leader focuses on a more supervisory role, whereby employees gain rewards for achievements and punishments for poor performance.

It is not uncommon for leaders to believe their own hype and think that their opinion and beliefs are superior and more important to their subordinates and peers. A leader with a controlling leadership style or nature may be totally unaware of how their peers and subordinates feel or think of them and assume everyone agrees and approves of their leadership.

makes? Seriously, be honest with yourself on this question. A controlling leader will find it incredibly difficult if they weren’t part of making the decision no matter how minor or major that decision may be. Do you find it difficult to let go of the reins? Do you fear handing over tasks or projects, no matter what they are, through fear that the job won't get done as good as you would do it? Do you find you continually look in and check on things? Do you immediately dismiss any suggestions to change the process that you have always done?

YOU FEEL YOU ARE ALWAYS RIGHT, BECAUSE YOU ARE RIGHT — RIGHT? Do you ever question your own judgement? Do you ever ask others opinions on your ideas? If the answer is no, your leadership style has controlling tendencies that could be harming to your team and your business.

This is not to say a leader delegates and just walks away. That is not what good leaders do. If you really struggle to let someone truly take charge of a task and step back to allow them to lead and make changes autonomously, it is likely you are a controlling leader. Not allowing your subordinates and peers to have a free reign sometimes can be extremely damaging to your business and the long term moral of the team. If they feel they cannot make even the simplest decisions without consulting you this can hold back innovation, it can hold back staff and lead to frustrations within the team.

Here are some things to consider about your leadership style: Do you control information? Do you keep others from having less information than you have? Do you enjoy holding the cards and to be in the position of delivering the information, maybe even holding some of that information back?

Are YOU the final authority on every decision? Give consideration to some of the decisions made in your business in the last month or year. Where you involved in all of them, did you have to have the final say? Were there any significant decisions made that you weren’t a part of making?

If you control the information you will also be more likely to control what is done with the information.

So, is a controlling leadership style necessarily a bad thing? Some subordinates and peers will do well following the rules and directions set by a controlling leader and become followers. Followers tend to stay through a sense of responsibility and loyalty, sometimes through fear of letting their leader down. The followers

Do you feel you have to be part of every decision? Do you think you should be involved the decisions your peers, subordinates or business

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BUSINESS BAR HEADER of controlling leaders tend to lack innovation and fear stepping out on their own. On the positive, followers tend to stay within organisations and will be less likely to progress into leadership roles themselves and may be the reliable 9-5ers that every business needs. On the flip side of this, those within the organisation that are leaders and who want to progress will be less likely to stay if they work for or with a controlling leader. Controlling leaders can stifle those leaders that want to grow. Their need to breathe and have creative space to take risks will be quashed by a controlling leader, the true leaders will find this difficult and won't stay around too long. Long term, controlling leadership does not work. It stifles innovation, stunts the growth of other leaders and inevitably stalls the growth of businesses. If you feel you may be a controlling leader, or someone in your business is, here are some simple things to consider if you want to move into a more open and progressive leadership style. We can start by the way we communicate and the language we use; Try using some of these language tips in your next meetings or in your daily conversations with your team.

Say “Yes” to other people’s ideas more than “No”. Ask “Why not?” more than saying “I don’t think so”. Use “Our” more than “My” and “We” more than “I”. Try to say “Thank you” more than “You’re welcome”. This one is a real game changer for controlling leaders, be willing to say “Let’s do it” or "let's give it a go" more than “We’ve never done it that way before” or "I don't think it will work" and definitely never say "That's a rubbish idea". If that is a struggle then start with "How can we do this?” rather than “This is the way I do it”.

Finally, try encouraging people to open up and grow themselves use this regularly in your vocabulary “What do you think?” We will look further into more positive traits of leaders and leadership styles in the coming issues, for now let me end this with some words from author, business and leadership coach Simon Sinek. Sinek is one of my favourite speakers and writers and I truly value his comments on being a good leader. He suggests that the 3 most valuable leadership traits are Selflessness, Empathy and Grace under fire.

THE BRITISH ASSOCIATION OF PRIVATE DENTISTRY (BAPD)

As editor of The Dental Technician Magazine, I would like to draw attention to the recent efforts made by the newly formed organization The British Association of Private Dentistry (BAPD). The BAPD has rightly adopted a joined up approach to tackle some of the issues that have arisen during the Covid-19 pandemic and the lack of leadership from our peers and Chief Dental Officer. I myself have watched the associations efforts closely and I urge Dental Technicians to consider supporting them. They are an all-inclusive group of Dentists, Technicians, Nurses, Hygienists and Therapists. I recently spoke with Jason Smithson, co-founder of the BAPD: The Covid-19 pandemic has disproportionately affected the dental industry. Practices ceased all routine care in the last week of March and were only officially permitted to reopen on 8 June. Building the delivery of treatment back up to pre-Covid19 levels is going to be a slow and long process. All of this has naturally had a devastating knock-on effect on the business of laboratories and dental technicians. As with practices, the longer-term survival of some laboratories is now in jeopardy.

The British Association of Private Dentistry (BAPD) was set up in April this year as a group to lobby for a fairer deal for private practices. Membership of the BAPD is open to all dental care professionals (DCP) as well as receptionists and practice managers. The BAPD is actively involved in protecting the interest of all of its members. The BAPD is aware of the Dental Laboratories Association’s (DLA) efforts to protect the jobs of its members, yet despite its efforts, laboratories and technicians will not survive without dental practices. This is the reality. It is vital then that while we all speak out for our individual sector of the dental industry, we also remember to stand together and add our voices to a united campaign for proper representation of private dentistry at the highest level. Everyone working in the dental industry is now facing the same challenges: ensuring patient and staff safety; continuing to deliver high-quality treatment; maintaining the viability of their business and preserving jobs. By joining the BAPD you are supporting the future of private dentistry. We are inviting all laboratory owners,

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clinical dental technicians, and technicians to become members. By having a strong association that truly represents everyone working in private dentistry, we all stand a better chance of surviving these very difficult times and building a future of quality dentistry for all patients. Finally, the quotation below most aptly sums up what dentists and technicians should be doing, and why DCPs should seriously think about joining the BAPD in these unprecedented times.

“It’s about creating strength in numbers, finding common ground and supporting each other.” (Jane Kim) We look forward to you joining our organisation. https://www.bapd.org.uk/support-us/

BUSINESS

BUILDING AN EXCEPTIONAL TEAM

- FROM NEAR DISASTER TO A WELL OILED MACHINE PART ONE

By Ashley Byrne I Byrnes Dental Lab

shley Byrne talks openly in this 4 part series on building a team to achieve amazing things. In this series Ashley talks about getting leadership wrong but managing to turn it around into an exceptional motivated and driven team. In part one he covers the issue of when a team becomes dysfunctional and the blame can only lie with company owner despite what the company owner can think (and I speak from experience). Sometimes as the boss you can get leadership wrong and about 3 years ago that’s exactly what happened to me and the lab became incredibly difficult and stressful to run. The lab was growing rapidly, we were achieving great things but the stress levels were high, too high. With a desire to grow I took my eye off the ball, my team and things in general went south pretty quick. We were making mistakes, I was getting short with the team and I probably came as close to a break down as you can get. The team were just not on board with my views and direction and I couldn’t understand why. I started to feel my beautiful company and all it stood for, was slipping through my fingers.

Project’. Leanne started in my operations team as a junior and now, after a university degree, heads up learning and development. So Leanne and Jim started by putting the most amazing survey together for all the team which I was not allowed access to. The team each filled in the survey and then Jim and Leanne interviewed each member of the team for around 45 minutes to openly and strictly confidentially talk about Byrnes, the owners and everything that involved their working day. After a few months it was complete and my wife and I spent the day offsite with Leanne and Jim to break down the information. Jim and Leanne started with 3 full pages of negative comments on myself and the company. It was brutal. I had to just sit and listen and take it all in. Whilst the first hour was hurtful and I took it personally, the next hour was all the positives and I started to see a different view. The team had all taken their time to air their views, not as I thought about the negatives, but more the ‘we love this company, but things need to change and Ash needs to change’. The full day was broken down into each aspect of the company from my vision meetings (we’ll discuss those in another section) through to training and even Christmas holidays. We spent the last few hours working on how I needed to change and it wasn’t rocket science. Listen more, offer more one to one training, share your knowledge, make time for me, be clearer in what you want in innovation and how we are to achieve that innovation. The message was simple, I was lost in my own world and not sharing my view of the company and the

future enough. I needed to spend more time with the team, be less negative and slow down my ‘let’s take over the world’ approach. The process was incredible and completely changed how the lab ran. I needed to be reminded of my changes by the team on a regular basis (and they still do now) but by allowing more of my time for the team, listening and behaving professionally when disaster struck saw a revolution at Byrnes Dental Lab. When a full arch was ruined for whatever reason, there was no blame, we just worked as a team to ensure it doesn’t happen again. I allocated time to do my emails away from the team, we even set up a ‘query board’ which meant I had time to think and answer each and every persons questions and offer that one to one time and training my team craved. The take away for me was listening to your team via a third party is priceless and it’s something I will continue to do. Ensure everyone has a voice and if the team are heading wayward, the chances are, it’s probably your leadership and attitude rather than your team. As we go through these series I’ll talk openly about Building a team for a modern lab and explaining why we need to look outside dental technology for inspiration. After that we’ll talk about Company Vision and what that means to both the company and the employees. After that I’ll talk about Employee Engagement and the power that can give a company if you can fully engage its people.

Leading a team of 25+ people isn't easy. At this moment in my life, my team were disengaged, a little dysfunctional and I felt they couldn’t wait to leave at 5:30 leaving me increasingly frustrated and angry. I spoke to a friend of mine who is a leading HR consultant - let’s call him Jim - about my problems and he reassured me that in a lot of companies, the disengagement from the company owner to the employees is common but if I was prepared to listen and be willing to accept radical change, he had a solution. Jim worked with Leanne from my team on what they called, ‘The People

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BUSINESS

AN INTERVIEW WITH...

RHONDA CORMACK

OF THE OLD KILN DENTAL LABORATORY

oday we interviewed Rhonda Cormack from the Old Kiln Dental Laboratory in Bolton. Rhonda began her career in Dental Technology in 1980 whe she was offered an apprenticeship at Edinburgh Dental Hospital and formed The Old Kiln Dental Laboratory in 2007. Rhonda, it is a pleasure to interview you today and I thank you for taking the time out of your busy day to speak with me. In my random interview style, let me ask you some really deep questions and mix in a few random fun ones. In researching your background, I read you had a couple of teaching posts, one of which was in the Seychelles, tell us more? After qualifying, I went on to do City&Guilds Advanced General and the Advanced Crown&Bridge at Telford Technical College in Edinburgh so I had a long history with Telford College and the Course leader, Paul McMahon, who offered me some part time teaching . In the early 90's I was asked to teach “an introduction to lab work” to the 2nd year Dental students at Edinburgh University It was a nice end to the week and fitted in well with my main role of Senior Dental technician in the Pros lab at the Edinburgh Dental Hospital. In October 95 I received a fax from the Ministry of Health in the Seychelles, they wanted to start a Dental technology course at the School of Health Studies on the island, was I interested? I had so many reasons to stay in Edinburgh where I loved my job, had a nice city centre flat and was happy with my life. Something inside me was saying....”do this” (to the surprise of everyone around me) in February 1996 I was on an AirSeychelles flight waving goodbye to the UK. I didn’t dwell too much on what I was actually doing, I would have freaked out, leaving my family and friends (my father’s words ringing in my ears “what about your pension!!?”). This was also before the internet so I had no idea what I was going to, I'd bought 2 travel books, that was all the info I had. The first few months were tough, my mother’s tear stained letters arriving twice a week. It was extremely difficult to source materials and the ordering process took months,

I found some unusual practical exercises for the students. In the early days we were making key rings, wire bending our names, drawing the curves of spee and monson. Then the teeth arrived…..hallelujah. The students were just the most gorgeous people, even now my heart skips a beat when I think about them all. As soon as I adapted to the pace of island life ....Oh my goodness I had the most wonderful 2 years. I met so many great people many are friends to this day, scuba diving every weekend, swimming with whale sharks, backgammon and a G&T every evening with spectacular sunsets filling the sky. I'm glad I listened to that inner voice. With your previous teaching experience, what would be the best bit of advice you would give to Dental Technology Students today? Coming from my training path I would suggest that starting in a Hospital environment is a good place for a student DT to consolidate their academic knowledge with the required practical skills, where there are less pressures and more opportunities to improve your skill set. If this route is not possible, my advice would be to get as much experience working in a lab as possible. Those long Uni breaks.... get out there, find a lab where you can shadow a DT. Also , especially if your course has no clinical sessions, spend time in a clinic with a Dentist or a CDT, it’s a huge benefit to understand the clinical process. Get on the internet, there are loads of great videos to learn from. If you have poor manual dexterity, definitely work on improving that, this is not a job you want to do if you struggle in that area. What has been your greatest achievement as a Dental Technician? I can’t think what my greatest achievement as a DT would be. Each achievement is great at the time. Every time I passed an exam or was successful in a promotion or job offer I was happy. My parents were over the moon when the Lord Provost presented me with the Scotec Gold Medal in Life Sciences in 1983, now for me that day was a living nightmare as my Braun hair curler ran out of gas. I definitely feel most accomplished when I complete a case and I know I've done a good job. More recently, as

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a CDT I experience the satisfaction of fitting my own work (I have to say ...Love you all UclanCohort17). And professionally, who have you been most inspired or influenced by? Throughout my career I've met people who have influenced me and inspired me. From my very early days as an apprentice, Ian Blair (sen Chief at EDH) and Donald Cameron (Chief at EDH) gave me the best start, quality, consistency and technique. Honestly I have to say I have learnt from every technician I have worked alongside. I admire people who have flair and are artistic. I admire people who pass on their skills and knowledge and also those who share their work. I believe when you love this job, you can influence and inspire people. A few quick fire fun questions! Give us an interesting fact about you. I'm a twin and 5ft and a ¼ tall (small) What is your favourite holiday destination? Cape Town, NewYork, Rome How many pets do you have? One old deaf dog called BillyBoy, half pug/ fenchie. Most adorable animal ever. Do you play any sports? People are often surprised that this body does not do any sports apart from a little swimming now and again. Super hero powers, which would you choose and why? I quite like the idea of teleportation, to be able to go wherever I want whenever I want. That would be amazing. Although Mrs Stretch would be good (being 5ft and a ¼ has it's draw backs). Back to the serious questions... What type of lab work do you most enjoy? I enjoy all aspects of lab work. I just love making things. Polishing Co/Cr frames is probably my least favourite as it's so dirty. I am a stickler for precision and I don't like cutting corners.

BUSINESS What is your least favourite part of being a lab owner? I enjoy having my own small lab, as there is only me and Steven, it's all very chilled. However, I wish the work coming in was more predictable, as you can go from being quiet to manic in a day. That can be stressful at times. Are you embracing the digital technology we have available to us? Tell us a bit about that. 3 years ago we set up our CAD/CAM department in the lab. We moved away from metal restorations as much as we could. Steven loves it and it has changed his work flow massively. The only negative I'd mention in relation to the digital move, is the cost to the lab versus the expectations of the clinicians for cheaper work. Digital seems to have been sold to clinicians as a faster and more economical option and we struggle with that having outlaid a great deal of money on the system.

NATURAL RESULTS MILLED FROM BLANKS: SHOFU DISK ZR LUCENT HIGH-STRENGTH MULTILAYER ZIRCONIA w SHOFU Disk ZR Lucent zirconia blanks for the first time combine high aesthetic potential with outstanding flexural strength. Ratingen - Until now, zirconia users faced a dilemma: The higher the translucency, the lower the flexural strength. However, dental manufacturer Shofu has set the aesthetic potential of lithium disilicate as a benchmark for high-strength zirconia and succeeded in combining previously incompatible properties in a new product. SHOFU Disk ZR Lucent now offers multilayer zirconia blanks whose layers not only mimic the structure of natural teeth in terms of shade – but also differ in translucency, ranging from 31 % in the cervical layer to 34 % in the enamel layer. So users can customise the value, chroma and translucency of a restoration by selecting the opti-mal nesting position in the blank. Besides, the dentin layer features an extraordinary design: It consists of three individ-ual layers creating a harmonious blend of shades and translucencies, with transitions that appear seamless to the human eye. A flexural strength of over 1,000 MPa gives users great peace of mind, regarding both anterior and posterior restorations. ZR Lucent is the right choice for anyone wishing to offer their customers monolithic zirconia restorations with the aesthetic potential of lithium disilicate.

If you had one bit of advice for any technician thinking about starting their own lab, what would that be? I wouldn’t put any DT off from opening their own lab, some people have a dream to be self employed and I think that is admirable . However I would encourage them to set out their stall and stick to that. Do not be tempted in bad times to lower your prices in an effort to get work. Working long hours for little reward is crazy and it promotes a business model that we need to avoid. We want dentists to be looking for good quality work not cheap work, that is only going to happen when we stop driving prices down. How many times have we heard, ´we are our own worst enemy´?

future. I'm working with a fellow CDT at his clinic doing a few sessions a week and it's enjoyable and fun. In our lab Steven and I are planning to expand the CAD/CAM to include Prosthetics so that’s exciting. I've got ideas to expand the services we offer in our clinic and that will involve working with the great Chris Golze and several other DTs in the digital field, I just need to wait a little longer, maybe once a vaccine is out there. I'm very aware that everyone’s situation is different and for some this is a terrible time filled with worry and stress, I think about you guys and encourage you to keep strong.

Finally, are you planning on doing any different types of work following the easing of lockdown? Now that the lab and clinic are open I'm determined to remain positive about the

SMOOTH, SEAMLESS BLEND OF SHADES

“The presintered round 98.5 mm blanks with a circumferential groove can be milled in virtually all CAD/CAM systems – an extremely economical solution, which does not require any changes”, says Ingo Scholten, who is responsible for the laboratory prod-ucts of Shofu Dental. “ZR Lucent is characterised by a particularly nice and smooth blend of shades: They harmoniously merge into each other. No transitions are visible at the ‘critical points’, meaning where cervical and dentin or dentin and enamel layers meet. In the cervical area, the shades are a little duller, so that any shade differences in the stump can easily be masked.” FIRST-CHOICE MULTILAYER AND MONOLAYER BLANKS

SHOFU Disk ZR Lucent is the ideal multilayer blank for monolithic restorations. They can be aesthetically optimised and sealed with Vintage Art Universal Stains and Glaz-es if necessary. The fluorescent GP-F Glaze gives restorations the fluorescence of nat-ural teeth. Users wishing to aesthetically perfect a reduced framework can add Vintage ZR enam-el materials to create the proper anatomical shape. In this method, the

Tooth 21 has received a stained and glazed monolithic SHOFU Disk ZR Lucent Veneer, made by dental technician Nick Mekias, Athens, Greece

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MARKETPLACE

Highly Translucent, Highly Aesthetic, Highly Durable!

framework offers the benefit of a harmonious blend of shades, and the layered enamel materials make the restoration fluorescent. The monolayer version Trans, featuring a translucency of 37 %, is the material of choice for veneers placed on normally shaded teeth. It is designed to replace enamel and can easily be characterised with the aid of stains. DISCOVER THE DIFFERENCE

SHOFU Disk ZR Lucent is now available from dental distributors in shades A1, A2, A3, A3.5, B1, C1 and D2, and in thicknesses of 12, 14, 16, 18 and 22 mm. A brochure with technical data and an overview of blanks and order numbers can be found at https://www.shofu.de/en/ produkt/shofu-disk-zr-lucent-uk/ FOR FURTHER INFORMATION, PLEASE CONTACT SHOFU UK E: sales@shofu.co.uk T: 01732 783580 W: www.shofu.co.uk

DENTAL TECHNOLOGY

PART 1

DENTAL LABORATORY AIRBORNE CONTAMINANTS By Sharaz Mir SETTING THE SCENE The world of dentistry has never been busier! Dental health has improved dramatically with falling rates of tooth decay and attention has now shifted to the needs of an ageing population, with increased emphasis upon aesthetics. The processes required to attain these prosthesis, even in a digital environment, is still creating dust and chemical fumes, and without proper protection, exposure to these may risk the health of the dental technician.

Sharaz Mir discusses the issues and regulations in relation to airborn contaminants in this 2 part article. The second part will feature in the October 2020 edition.

This series of articles encompasses not just exposure to chemical hazards, which will be discussed elsewhere, but also the generation of dust particles of various compositions and sizes. Research has shown us that the dust from the types of materials that are used in dental technology contain between 54-70 per cent of breathable particles (that is, particles of less than 5 microns in size that enter the lungs). A particular concern is the silica content of this dust, which can reach 30 per cent and may exceed maximum recommended levels during the sandblasting and grinding processes. Another is exposure to dust from heavy metals like the cobalt-chromium-molybdenum alloys. Both exposures may lead to a lung condition known as pneumoconiosis, of which several cases have been reported as being linked to dental technology. There have also been a number of cases of silicosisi, a well-known and very serious occupational lung disease that is caused by inhaling breathable crystalline silica dust. These have been highlighted in the United States Center for Disease Control’s publication Morbidity and Mortality Weekly Reports (MMWR). Traditionally, silicosis is associated with the mining, quarrying and ceramics industries. However, it appears that the materials and processes used in dental laboratories put those who work there at risk of the condition. A comment on this MMWR report notes that exposure to breathable crystalline silica in the dental lab occurs through procedures generating airborne dust such as: • Mixing powders • Removing castings from investment • Grinding and polishing castings and porcelain • Using silica sand for abrasive blasting.

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THE DANGER In general, the smaller the particle the more likely it is to damage health. Of particular concern are the ultra-fine particles (UFPs) which have a size in the nano range – that is less than 0.1 microns, or 100 nanometers. This is of major concern now ever more with the recent increase in viral load of COVID-19 which also fits into this nano-range. A recent study analysed the size range of particle which dental technicians may come into contact with during the course of their work. A number of blocks of composites used in dental prostheses were ground and the dust thus generated analysed. All of the composites released a certain amount of breathable dust. The size range of this dust extended down to the UFP level, showing that a potential health hazard exists in the dental laboratory setting. All dental laboratories should have effective air pollution control systems in place. From fine and ultra-fine dust particles created by grinding, polishing and sandblasting, to chemicals released during polymerisation, which also includes 3D Printing and its post processing, there is a wide range of pollutants that are dangerous to owners, employees and customers alike. CHEMICAL, ODOUR AND PARTICLE POLLUTION IN DENTAL LABORATORIES Without adequate filtration systems, those working or visiting dental laboratories will be routinely exposed to several or more of the following airborne contaminants. Exposure to these contaminants can lead to respiratory conditions such as occupational asthma, or aggravate existing respiratory conditions. These contaminants can also result in cancer, pneumoconiosis and silicosis. It is therefore vital that these contaminants are captured before being inhaled. Acrylic Compounds: • Methyl methacrylate (MMA) • Triethyleneglycol di‐methacrylate (TEGDMA) • Ethyleneglycol di‐methacrylate (EGDMA) • 2‐hydroxy‐ethyl‐methacrylate (HEMA) Chemicals: • Benzoyl peroxide • Bisphenol‐A • Butylene glycol • Corundum

DENTAL TECHNOLOGY • Ethyl acetate • Glutaraldehyde • Hexane • Hydroquinone • Kaolin • Nitrocellulose • Oxides of titanium, iron, and boron • Silica Metals: • Beryllium • Boron • Cobalt • Chromium • Molybdenum • Nickel • Tantalum • Plaster • Porcelain • Silica • Quartz WHAT ARE AIRBORNE CONTAMINANTS? It’s a general term for solid particles (particulates), liquid droplets (usually aerosols or mists), vapours or gases which have either become diffused or remain in suspension. In workplace air, such that they can possibly be inhaled by workers. Terms used to describe those either individually or collectively in the dental industry include: Fumes Generalised term for gases and vapours, usually where there is an odour. Dust Larger, visible solid particles. Fume The term for small particles or droplets generated by the evaporation and condensation of solid materials. Smoke Usually a general term for visible particles or droplets produced from a thermal or combustion process. PARTICLE FACTS: Particles with an aspect ratio (length to aerodynamic diameter) > 3:1 are classed as fibres. Particles where one dimension is between 1 and 100 nm (10-9 m) are described as ‘nano’ particles. Particles or droplets smaller than approx. 30µm (microns) are not visible to the naked eye. Just because particles are not visible it is often wrongly assumed they are not there.

Contaminated air, like that in high-volume dental surgeries and close-quarter dental laboratories, can be cleansed of harmful particulate, ensuring the health and wellbeing of workers.

• Fibres are considered to be more hazardous than particles because they have more of a tendency to lodge in the bronchioles and alveoli and are less easily ejected by the ciliary escalator. Many charts have been produced giving an indication of comparative particle sizes and sources, the following is best related to the dental environment. Maintaining a clean and hygienic working environment isn’t something to ignore – it’s critical to the dental industry. In a dental laboratory where aluminium oxide, gypsum, glass ceramic, airborne metal particles, zirconia and pathogens can threaten your business, air quality can have a significant impact on the health and wellbeing of you and your team. UNHEALTHY OCCUPATIONS Some jobs are just riskier than others. Take hang-gliding instructors. Or high-rise window washers. Or lion tamers, bear trap testers or even fireworks packers. But those pale in comparison to the riskiest industry: the dental industry. According to a study conducted by Business Insider, the dental industry has consistently been offered up as one of the unhealthiest occupations partake in, with professions among 974 occupations. By using a database supplied by the U.S. Department of Labour, and analysing health impacts in six categories - exposure to contaminants, exposure to disease and infection, exposure to hazardous conditions, exposure to radiation, time spent sitting, and risks related to burns, cuts bites and stings - researchers were able to tabulate scores on a scale of 0 to 100, with 100 being the highest risk.

WHY ARE THEY HAZARDOUS?

Dental technicians have consistently appeared in the top 10 with an “unhealthy” score of 63, due to high scores in exposure to disease and infection (88), exposure to contaminants (74) and time spent sitting (66).

The significance of particle size and shape • Particles or droplets larger than approx. 50µm are not usually inhaled. • Those > 10µm become trapped in the nasal cavity or upper throat area. • 3 - 5µm particles reach the upper lung area but are ejected by the mucociliary system. • 2µm particles penetrate into the alveolar lung region more than any others. • Particles < 0.5µm will mostly be exhaled but, if soluble can diffuse into the blood stream or pass into the pleural cavity.

Clearly, airborne particles - whether they be from bacteria, grinding dust or harmful chemicals and the like - contribute to making the dental profession so unhealthy. One way to significantly improve indoor air quality in dental labs and offices relies can be through air purification units. These purifiers can employ True HEPA filtration, Active Carbon, UV Lamp or a combination of them, removing up to 99.99% of airborne contaminants, like dust, allergens, chemicals, VOCs, bacteria and viruses from indoor air automatically.

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LEGAL REQUIREMENTS VS GUIDELINES UK laws have been in existence for many years, to protect workers from illnesses caused by breathing in contaminated air. A variety of guidance notes, books and Approved Codes of Practice have been produced to help employers comply with these laws, but it can be difficult to distinguish between actual legal requirements and recommendations. Hopefully I can clarify these differences and to explain the consequences of non-compliance. WHAT IS THE PROBLEM? Well, we know what that is, ‘Airborne Contaminants’ is a general term for solid particles mists, vapours or gases which exist in workplace air where they can be inhaled by workers. Dust particles up to 5 microns are the most harmful because they penetrate deep into the alveolar lung region more than any others, but particles or droplets smaller than approx. 30 microns are not visible to the naked eye.

ABOVE: Typical dust particle

Just because particles are not visible it is often wrongly assumed they are not there. Breathing in airborne contaminants can potentially result in serious respiratory illnesses including asbestosis, silicosis, chronic obstructive pulmonary disease, occupational asthma, emphysema and lung cancer. WHICH ILLNESSES COULD BE CONTRACTED? “Thousands of people die from work-related lung diseases every year, in many cases due to exposures that took place many years before. Breathing in certain dusts, gases, fumes and vapours in the workplace can cause serious, long-term lung damage”. (Extract from H&SE website). Work related lung illnesses (occupational respiratory disease) include: • Asbestosis

DENTAL TECHNOLOGY • Silicosis • Chronic obstructive pulmonary disease (COPD) • Asthma • Emphysema • Lung cancer

It is a requirement that employers provide training for workers likely to be exposed to a hazardous substance. This needs to include details of these substances, including their Workplace Exposure Limit. EH40 /2005 (republished 2011) Workplace Exposure Limits Published by the Health & Safety Executive, this document includes the table of Workplace Exposure Limits for a wide range of airborne contaminants. These are presented for most substances as time weighted averages for either 15 mins or 8 hours and in both ppm (parts per million) or mg/m3 (milligrams per m3).

WHICH LAWS APPLY? The Health and Safety at Work Act – 1974 and the Control of Substances Hazardous to Health Regulations 2002 (COSHH)ii are intended to protect workers from, amongst other hazards, airborne contaminants. These are mandatory. Non - compliance means breaching the Health and Safety at Work Act. They apply to self- employed workers as well as to employers. There are 21 Regulations. The most relevant are listed below together with their basic requirements: Regulation 6 Assessment of the risk to health created by work involving substances Hazardous to Health. This includes consideration of any relevant workplace exposure limits. Regulation 7 Prevention or control of exposure to substances hazardous to health. Where an employer cannot avoid the generation of a harmful substance, this Regulation sets out the requirement to apply protection measures and their order of priority. Regulation 8 Use of Control Measures Where control measures are provided by the employer it is a requirement that employees make ‘full and proper use’ of them. Regulation 9 The Maintenance, Examination and Testing of Control Measures Where control measures are installed they must be thoroughly inspected and tested at least once every 14 months (in practice every 12

Maintaining concentrations in the workplace below these values is mandatory i.e. contravention is a breach of the COSHH Regs and, by extension the Health and Safety at Work Act.

months). A suitable record must be kept of the examination and tests, for at least 5 years.

In 2011 the European Commission’s third Directive 2009/161/EU giving Indicative Occupational Exposure Limit Values (IOELV’s) was implemented in the UK with revised WEL’s in EH40.

Regulation 10 Monitoring exposure in the workplace

REFERENCES:

Typical EH40 Page

It is a requirement that ‘personal sampling and gravimetric analysis’ be carried out for workers in the area of a possible source of airborne contaminants if it is not possible to demonstrate by another method that adequate control of exposure can be done. An adequate method for instance would be where a process is almost completely enclosed and it can be shown that there is a flow of air into the enclosure against which contaminants cannot escape. Regulation 12 Information, instruction and training.

i https://www.cdc.gov/mmwr/preview/mmwrhtml/ mm5309a3.htm#:~:text=Exposure%20to%20 respirable%20crystalline%20silica,silica%20sand%20 for%20abrasive%20blasting).

The Health and Safety at Work Act 1974, downloadable and can be viewed at www.legislation. gov.uk/ukpga/1974/37/contents, Control of substances hazardous to health (Sixth edition) The Control of Substances Hazardous to Health Regulations 2002. Approved Code of Practice and Guidance ISBN No. 9780717665822

Continued next issue.

INTRODUCING THE DENTAL PROFESSIONALS ALLIANCE (DPA) l The Dental Professionals Alliance was formed in June 2019 by a passionate group of dental associations/societies who wanted to make sure that they have a bigger voice as and when needed. They endeavour to share experiences, challenges, collective knowledge, and information in order to inform key decisions and change and where necessary unite in actions and provide mutual support.

The DPA is made up of GDC registrants who are the elected Presidents/Chairs from their professional organisations. Currently the group consists of the Orthodontic Technicians Association (OTA), British Institute of Dental and Surgical Technologists (BIDST), The Society of British Dental Nurses (SBDN), British Association of Dental Therapists (BADT), British Society of Dental Hygiene & Therapy (BSDHT) and The Orthodontic Therapist Society (OTS).

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Other dental groups may be co-opted onto the DPA with the agreement of the DPA members. If you wish to contact the DPA please either contact any of the individual representative groups or email: enquiries@alliancedp.org

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4 HOURS VERIFIABLE ECPD IN THIS ISSUE LEARNING AIM

The questions are designed to help dental professionals keep up to date with best practice by reading articles in the present journal covering Clinical, Technical, Business, Personal development and related topics, and checking that this information has been retained and understood.

LEARNING OBJECTIVES REVIEW: n Strength of Zirconia n Implant planning n Customised Special trays n Business of Management

LEARNING OUTCOME

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Correct answers from August DT Edition:

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THE PERSONAL PROTECTIVE EQUIPMENt (PPE) LEGISLATION AND SPORTS MOUTHGUARDS

Q1. When did the PPE Directive 89/6868/EEC become European law? A 1980 B 1985 C 1991 D 1995 Q2. A B C D

What category are sports mouthguard in? Category 1 Category 2 Category 3 Category 4

Q3. A B C D

What must be created and available at all times for inspection on the manufacturing site? A Technical Data File An information leaflet CE Mark EEC Certificate

Q4. You may only place the CE mark on to the Sports Mouthguard and/or packaging if a prototype of the sports mouthguard has been tested by? A GDC B An Independent European Notifying Body C DLA D FCA

LIFE OFF THE ROAD - MAKING 3D PRINTING CHILD’S PLAY

Q5. What is one of Eurodontic’s key products for 2020? A Ultimaker S3 B Cura Software C Magna D Brightstar Q6. A B C D

The software allowed Leonora to move the image to the perfect position in what time? 10 mins 30 mins 40 mins 60 mins

5 THINGS I CANNOT WORK WITHOUT DANIEL SHAW

DENTAL LABORATORY AIRBORN CONTAMINANTS - SHARAZ MIR

Q8. Where does Daniel purchase his Polishing mops? A WHW Plastics B Ebay C Kemdent D Zirkonzahn

Q15. Particles or droplets are not usually inhaled if larger than what μm? A 50 B 60 C 70 D 80

IS YOUR LEADERSHIP STYLE STIFLING YOUR TEAM AND KILLING YOUR BUSINESS? - MATT EV-ERATT

Q16. According to a study conductedby Business Insider, Dental Technicians are at risk of exposure to contaminants at which score our of 100? A 55 B 63 C 68 D 74

Q7. Daniel would struggle to pack prosthetic work as neatly without? A Fork B Splint C A small spatula D Hammer

Q9. What year was the book titled “Leadership” released? A 1966 B 1970 C 1974 D 1978

AN INTERVIEW WITH RHONDA CORMACK

Q10. What year did Rhonda begin her career? A 1980 B 1985 C 1987 D 1990 Q11. When did Rhonda form The Old Kiln Dental Laboratory? A 2000 B 2007 C 2008 D 2010 Q12. Rhonda received a fax from the Ministry of Health in which country? A Seychelles B Kenya C Zimbabwe D South Africa Q13. A B C D

How long ago did Rhonda set up CAD/CAM in their lab? 1 year 2 years 3 years 4 years

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Q14. A B C D

Dust from dental technology contains how many breathable particles? 22 - 30% 30 - 44% 54 - 70% 70 - 82%

You can submit your answers in the following ways: Via email: cpd@dentaltechnician.org.uk or by post to: The Dental Technician Limited, Po Box 430, Leatherhead KT22 2HT. You are required to answer at least 50% correctly for a pass. If you score below 50% you will need to re-submit your answers. Answers will be published in the next issue of The Dental Technician. Certificates will be issued within 60 days of receipt of correct submission.

DENTAL TECHNICIANS GREAT BRITAIN

THE DENTAL TECHNICIAN MAGAZINE AND DENTAL TECHNICIANS GREAT BRITAIN FACEBOOK GROUP

From all of The Dental Technician Magazine

he merger of the Dental Technicians Great Britain Facebook group, with The Dental Technician Magazine took place in February last year. A very natural and fitting joining of like-minded professionals to provide the ultimate forum for Dental Technicians across the UK.

ISSUE NO. 2 TECHNICIANS MERIT AWARDS SEPTEMBER SCHEME NEWSLETTER 3. ATTACHED GINGIVA The firm, resilient, keratinised tissue that lies between the mucogingival junction and the free gingiva that surrounds the necks of the teeth (figure 1.3). This tissue is tightly bound to the underlying bone. When healthy it is an opaque, coral colour with fewer visible blood vessels than that of the alveolar mucosa.

BEST PROSTHETIC TECHNICIAN JUDGED BY CHRIS WIBBERLEY AND SPONSORED BY BREDENT UK LTD

Fig 1.3

CHRIS WIBBERLEY RDT (Dip CDT) GDC: 182605

Founder Alan Wright of Blueprint Dental and the admin and moderator team have taken the Facebook group to be the most active and popular forum for authentic Dental Technicians in the UK. Started in 2008 it was created to benefit all levels of dental technicians with the UK industry to interact and share “tips and tricks and general encouragement” that has helped many through their working days.

Dental Technicians Great Britain has proved its popularity with so many technicians interacting; offering opinions, asking questions in order to be heard. Its accessibility and the potential speed of the response from other professionals is its biggest attraction. Popular topics are raised frequently and we have been showcasing these issues in previous editions of The Dental Technician Magazine. This gives us an opportunity to reach many more technicians and hopefully encourage them to speak out and where appropriate be published in the magazine. The previous editor of The Dental Technician Magazine; the late Larry Brown once said: “Speaking with one voice can and

To represent underlying bone to which the attached gingiva is closely bound to, figure 2.4 shows dentine colours (from Ivoclar’s nexco range) layered beneath the necks of the teeth. This ‘boney’ coloured composite paste provides the underlying base colour for the healthy, coral coloured attached gingiva on the surface.

Fig 2.4

4. FREE GINGIVA As shown in figure 1.4, the free gingiva surrounds the tooth, creating a collar of tissue. It is not attached to the underlying bone or tooth surface. It usually measures from the margin of the attached gingiva to the crown of the tooth. Fig 1.4

The final composite layer (figure 2.5) in this particular case is the ‘flamingo pink’ paste from the Schottlander enigma pink composite kit. It provides a covering layer that tones down the intense reds/blues and dentine that were first layered onto the denture base.

Fig 2.1 Using a microbrush, the denture base is then covered (with a VERY thin layer) using visio.link PMMA/Composite primer. This is then left for 3 mins, so the primer can soak into the denture base, followed by 3 mins of light curing (figure 2.2).

Fig 2.5

In this issue of the TMA newsletter, I thought I would write about a subject I get asked about an awful lot. It is related to Denture aesthetics, and how to make the borders of a full denture look like natural gingiva. It involves the use of composite material (and in this case I have used a number of pastes and stains from various companies/ suppliers), and the inclusion of a very important PMMA/Composite primer that binds this material together. That primer is known as visio.link (Bredent). Before I explain how to apply the materials, it is very important to understand what we need to know about natural gingiva and it’s landmarks. When applying pink composite to a denture base, it is important to remember 5 gingival landmarks:

1. ALVEOLAR MUCOSA As shown in figure 1.1, the Alveolar Mucosa is a thin, soft and fragile continuation of the mucous membrane of the cheeks, lips and floor of the mouth. It is deep red in colour and smooth, with many visible blood vessels.

2. MUCOGINGIVAL JUNCTION The meeting point of the freely moveable tissue of the Alveolar mucosa and the firm tissue of the attached gingiva as shown in figure 1.2. It can be defined as the point where the firm tissue attaches to the underlying bone.

5. FREE GINGIVAL GROOVE A shallow line on the surface at the junction of the free gingiva and attached gingiva. It is formed due to the change in shape/profile of the tooth at the CEJ (cemento-enamel junction) as shown in figure 1.5.

Fig 2.2

Fig 1.5

Fig 1.1

Using a small art brush, the material is very easy to manipulate into position around the necks of the teeth and across the borders of the denture base. This is shown in figure 2.6.

As shown in figure 2.3, once the denture base has been light cured, red and blue stains are added. The stains shown on this case are from the Schottlander enigma composite kit. Notice they are positioned mainly in the alveolar mucosa region, where natural gingiva is deep red in colour.

Fig 1.2

Fig 2.6

Fig 2.3

THE DENTAL TECHNICIAN MAGAZINE AND DENTAL TECHNICIANS GREAT BRITAIN

DENTAL TECHNICIANS GREAT BRITAIN SOME OF THE POSTINGS DURING THIS MONTH. IF YOU WANT TO JOIN ANY OF THE CONVERSATIONS,GO ON LINE AT THE FACEBOOK PAGE FOR DENTAL TECHNICIANS GB.

THE TECHNICIANS MERIT AWARDS SCHEME

I am delighted to confirm the following judges representing these awards categories as part of the brand new “The Technicians Merit Award Scheme.” Best Ceramics/Crown and Bridge Technician - Judged by Glenn Harger (Bucks Oral Design) Best Prosthetics Technician - Judged by Chris Wibberley (CW Dentures) Best Orthodontics Technician - Judged by Andrea Johnson (OTA and Den-Tech) Best Chrome Technician - Judged by Dave Smith (Phoenix Dental Castings) Best Hospital Tech/Maxfac - Judged by Iain Mur-Nelson (St George’s University)

SOME OF THE FEATURED POSTS FROM MEMBERS ON THE FACEBOOK PAGE.

IF YOU HAVEN´T SEEN IT TUNE IN NOW!!

DENTAL TECHNICIANS GREAT BRITAIN

One of the most prominent ideas for this was the creation of "The Technicians Merit Award Scheme"

Best Innovative Technician - Judged by Magnus Underhay (MJ Underhay Dental Lab) Head Judge is Bill Sharpling (LonDEC, King’s College London)

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A winner from each of the above categories will be chosen by you, our readers and the Facebook group members from nominees chosen by our judges on a quarterly basis! The response from the above names to being invited to participate has been extremely positive, some even overwhelmed and very flattered!! Bill Sharpling is undoubtedly the best qualified to act as Head Judge and as a reference point for any judges wishing to seek advice etc.

Happy New Year to all The Dental Technician Magazine subscribers and Dental Technicians Great Britain Facebook group members!

There have been many positives to take from the last year of the decade!! The joining of forces between The Dental Technician Magazine and Dental Technicians Great Britain has brought around many exciting opportunities. It had become clear over the years that we both share the same vision; to be a trusted support system when it comes to all things technical in the dentistry world (but most importantly here in the UK!)

FROM DENTAL TECHNICIANS GREAT BRITAIN FACEBOOK GROUP AND THE DENTAL TECHNICIAN MAGAZINE Chris Trowbridge, our marketing manager has done a sterling job in contacting and listening to those of you who have thrown your hats in the ring, to form and build an organisation which can create an interesting and worthwhile Awards Scheme which recognises the skill and ingenuity of technicians for a truly well-earned award, from those of us engaged in technical dentistry.

We will be creating a monthly newsletter that will appear in The Dental Technician Magazine and sent out to our email database offering key updates on entries, judges’ feedback, nominees and general news on the awards scheme.

The Dental Technician Magazine has always respected the integrity of a very carefully run Facebook group that is Dental Technicians Great Britain; we strive to provide the content that will engage and inform its members to really help with improving as many aspects of technicians work. Here are some examples of supplier content featured on the group. If you want to feature your business email: sales@dentaltechnician.org.uk

Essentially the idea behind creating this Awards Scheme is to encourage many dental technicians across the UK to showcase their work and achieve recognition by so doing.

to maintaining. A great big thank you to the Dental Technicians Great Britain Facebook Group for supporting and promoting, online, the whole scheme. In recent times I have been amazed at how little some young technicians know about the specialities. I suppose it is because they have chosen to follow one or other path for their future work, but it would be nice to shine a light on some of the lesser known areas. Maxillo-Facial is so little mentioned in the general dental magazines, but it really is worth knowing something about the processes. Orthodontics features very little in the DT magazine and many others but is really in demand across the population. Whether it is for the traditional ortho treatments or indeed in preparation for reconstruction with bridge and crown work. There are some very clever and talented technicians involved daily in these pursuits. I do think we would all like to see more. So if you have any potential to influence the technicians involved to publish one or two pieces, please do. So far the initial entries are really quite impressive with lots of good examples in prosthetics and crown and bridge. So, read on and hopefully be impressed.

Best Sales Representative

Best Hospital Tech/Maxfac Judged by Iain Mur-Nelson (St George’s University) Sponsored by 3Shape Best Innovative Technician Judged by Magnus Underhay (MJ Underhay Dental Lab) Head Judge is Bill Sharpling (LonDEC, King’s College London)

“WE LOOK FORWARD TO CONTINUING TO WORK WITH DENTAL TECHNICIANS GREAT BRITAIN TO SUPPORT YOU ALL FOR 2020 AND THE FUTURE” CHRIS TROWBRIDGE

Best Supplier

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DENTAL TECHNICIANS GREAT BRITAIN

Best Ceramics/Crown and Bridge Technician Nomination

HEAD JUDGE:

THE MERIT AWARDS

(LONDEC, KING’S COLLEGE LONDON)

GET OFF TO A GOOD START

Best Orthodontics Technician Nomination is David Baldry of Atomic Dental Laboratory for the Clarke Twin Block Appliance

By Larry Browne I Editor

Sponsored by WHW Plastics

The merit awards scheme has started well and with some impressive examples of the talent within UK and Ireland. Many of you may have been wondering what exactly would be needed to send in your own examples of technical work and now you can see clearly what is required. In last month’s journal we featured the first batch of submissions. Very Impressive examples of what is required. Now you have seen these perhaps you will feel like submitting your own examples of your work. The aim of the Awards scheme is to have technicians judging technicians, not some commercialisation for extra sales or for the submissions to be encouraged by a particular manufacturer or agent for a particular material. All materials and every mixture you decide is needed for the case should qualify. So now there may be a time of things getting a little quiet, coming up, perhaps it is a good opportunity to show what you are made of. Prosthetics, Ceramics, Crown and Bridge, Max Fac. and Orthodontics are all equally included and will be judged by a recognised expert in the field.

CLARKE TWIN BLOCK CONSTRUCTION TECHNIQUE David Baldry Atomic Dental Lab E: David@Atomic-Dental.com T: 07810 673 831

The following detailed procedure is the technique that I use to manufacture Clarke Twin Block appliances in the most efficient way possible, whilst maintaining consistency and quality. Some steps that are obvious or not adding value have been skipped.

To manufacture a Twin Block appliance, a prescription, upper & lower impressions and protrusive bite are required. The procedure starts after the Lab infection control measures have been followed and after the models have been cast, passed QC and articulated. Remove the wax bite and if the bite is excessively open or closed, then adjust the articulator so the space between the posterior teeth is approximately 4-5mm. Follow the prescription for construction of the retention components. In this case its Adams cribs on the upper and lower 6’s & 4’s with ball ended clasps on the lower anteriors. Wax the components into place and wax out the interdental wires so that the cribs can be adjusted by the clinician if required.

Sylwia Arizpe Dtg for emax Crowns

Best Cobalt Chrome Technician Nomination Dan James - Dentacast

Best Prosthetics Technician Nomination You may be curious about what the general standard is, you may want to see what is judged to be the best in your own area of interest, you may just want of show the world of dentistry how good you can be, but whatever the reason you will know it will be judged fairly by experts. The following are chosen as the first batch of winners, which will be added to until it is time to announce the overall winners in each category. There is still plenty of time to add your own examples. I think you

will agree that those who have already submitted have set a high standard. Why not show you can fit into this quality of excellence with yourown examples. We are looking forward to seeing quite a lot more submissions before the final date and we intend to continue with the Merit Awards every year. Perhaps it is time to be recognised as one of the elite and able technicians in these Islands. Make your statement with a piece of technical magic to impress the judges.

Leon Paul Zanre - Elite Dental Restorations

Best Hospital Tech/Maxfac Nomination

Dhrumil Shah Harcourt House Dental Studios

Best Innovative Technician Nomination Jamie Scarborough

ALAN WRIGHT - DENTAL TECHNICIANS GREAT BRITAIN FACEBOOK GROUP

We want to see what you have to offer. A nomination for each category will be chosen every three months to be shortlisted for the winner in December. GOOD LUCK!

Using a sheet of pink wax, create angled shuttering and attach to the lower model. The posterior angle of the wax should be

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p30

does open doors and can allow our voices to be heard by those we target” Larry was a driving forces behind the exciting connection between Dental Technicians Great Britain and the magazine. “Both platforms started because technicians wanted to exchange knowledge

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DENTAL TECHNICIANS GREAT BRITAIN

BILL SHARPLING

The awards scheme is running until December this year and we want as many of you to participate! It couldn't be simpler to submit your entry. If you are a dental technician in the UK, Join Dental Technicians Great Britain Facebook Group and post pictures, a video or anything that showcases your work or talents to be considered by our judging panel. Alternatively you can send to awards@dentaltechnician.org.uk

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Best Chrome Technician Judged by Dave Smith (Phoenix Dental Castings) Sponsored by Blueprint Dental

There will also be two other awards that will be voted for at the end of the year rather than on a quarterly basis:

DENTAL TECHNICIANS GREAT BRITAIN

By Larry Browne I Editor

Best Orthodontics Technician Judged by Andrea Johnson (OTA and Den-Tech) Sponsored by WHW Plastics

HERE ARE SOME EXAMPLES:

FIRST ROUND NOMINATIONS

assessments to UK and Ireland. I do think there will be scope for overseas entries sometime in the near future, but I am anxious to show the excellence we produce here in these Islands. With the curse of the NHS pricing formulae it is often difficult for commercial technicians to break free from the daily pressures from those who don’t really understand the nuances of true quality Laboratory work. I know that even under great daily pressure there are technicians out there who just want the chance to be recognised as able and Talented. The Merit Award is a great platform to take a little time to wave the flag for technical dentistry within our Islands. Inspire the next generation and commit to making Teeth both beautiful and as the patients need them. Let us see the remarkable restorations taking place in the Maxillo-Facial department of our hospitals and the amazing quality all the hospital Technicians are committed

Best Prosthetics Technician Judged by Chris Wibberley (CW Dentures) Sponsored by Bredent

A website page will also be created on The Dental Technician Magazine website with key information regarding the scheme along with the rules and regulations.

TECHNICIAN MERIT AWARDS

Best Ceramics/Crown and Bridge Technician Judged by Andrew Wheeler (Precision Ceramics) Sponsored by Ivoclar Vivadent

We want to see what you have to offer. A nomination for each category will be chosen every three months to be shortlisted for the winner in December!

All dental technicians can submit their entries to Dental Technicians Great Britain Facebook Group (if you are not a member join now!) or by post to The Dental Technician Magazine.

DENTAL TECHNICIANS GREAT BRITAIN

We have had a good response to the merit awards, especially in the Prosthetics and Ceramic Crown and Bridge. It would be nice to get a few more examples for Maxillo-Facial and Orthodontics but I do believe that as we show the wonderful work and ability of the UK and Ireland technicians it should stir those who are a bit reticent to shine a light on their own talent. I think you will all be very impressed with the standard of the first entries, selected by the technician judges and I am sure some of you will believe you can do as well if not better. But we won’t know that unless you send your examples to us as entries for the Awards. The sponsors who are sharing in the project are indeed well known to all of you and we cannot thank them enough for recognising that this really is a technician based, competition judged by technicians for technicians. I know we have had a few overseas entries but at this stage we are limiting our

An awards scheme like no other to allow dental technicians to showcase their talents by submitting entries be it a picture, video, case study or even articles of interest. We selected a judging panel for six different categories made up of some of the most respected technicians around:

The awards scheme is running until December 2020 and we want as many of you to participate! It couldn't be simpler. If you are a dental technician in the UK, Join Dental Technicians Great Britain Facebook Group and post pictures, a video or anything that showcases your work or talents to be considered by our judging panel. Alternatively you can send to: awards@dentaltechnician.org.uk

This is a very exciting time and we look forward to seeing all of what you have to offer!

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THE MERIT AWARDS ARE LOOKING GOOD

THE DENTAL TECHNICIAN MAGAZINE AND DENTAL TECHNICIANS GREAT BRITAIN

FOCUS

We at The Dental Technician Magazine respect the integrity of the group and have made it our mission to work closely with DTGB to maintain that. So far, we have helped with bringing new innovative ideas and products to the group that are integral to all Dental Technicians development. Whilst we work with some of the biggest suppliers in the industry we have been careful with what promotional material is shared.

CW Dentures, and in recognition of the work he has done at his clinic, became the recipient of the BACDTs highest award, Member of the Year - 2018. Chris has lectured on some of the largest stages in Dental Technology, including the International Dental Show (IDS) in Cologne and at the Dental Technology Showcase (DTS), in Birmingham. He has gained a reputation for achieving extremely natural looking Denture Aesthetics for his patients and regularly runs training courses on how to achieve these results. In his spare time Chris has numerous interests away from dentistry, which include road cycling and Brazilian Jiu-Jitsu. He’s a keen spectator of Rugby Union (because he’s now too old and injury prone to play) and loves to spend time walking with his Labrador, Ralph and young family in the Saddleworth Countryside (especially when it involves a pit-stop at the pub).

Now we understand the important landmarks of natural gingiva, we have an idea of where to start and with what colours when layering composite onto the denture base. First, we must prep the denture base after it has been processed. As you can see in figure 2.1 the wax up has been cut back prior to processing, thus exposing the necks of the teeth. This gives us enough room for our stains and pastes. The dentures are deflated and trimmed. They are then sandblasted, with pink wax covering the majority of the tooth surfaces.

lll CASE STUDY

FOCUS

It is testament to the excellent work of Alan and his team that a handful of publications were interested in joining forces; The Dental Technician Magazine is proud to have been given the chance. It was clear from the initial conversations that we both share the same vision to provide all Dental Technicians their voice.

n Chris is a Clinical Dental Technician based in Saddleworth, Oldham. He qualified as a Dental Technician from Manchester Metropolitan University in 2009. In 2011, he was part of the first cohort of students to enrol onto the Clinical Dental Technology Course at The University of Central Lancashire (UCLAN), and graduated in 2013 as one of the youngest CDTs in the UK. His passion for working as a CDT saw him working for an NHS Domiciliary Service in the Huddersfield area along with running a clinic twice a week at a private Dental practice in Saddleworth. Chris now runs a bespoke Denture clinic called

THE BUILD UP

Well the first nominations were announced in the various skill sets and some fantastic work on show from all those nominated. Thank you to our judges who take the time to go through the various cases that members profile in the group and please keep sharing that’s what it’s all

about, we all learn from each other, ask questions, there are never any stupid questions, if you don’t know ask, we are fortunate to have some world renowned techs as members of our group, but I am sure they will all empathise with the fact that they didn’t get to where they are with their skills without watching others, asking questions, and trying things time and time again to improve what they are able to produce.

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Best Orthodontics Technician Nomination

David Baldry - Atomic Dental Laboratory for the Clarke Twin Block Appliance

We all start somewhere, so show your work off, take pride in the knowledge that in this Country we have some of the best Dental technologists in the world, strive to be the next one passing on your skills. Bang the Drum of British Dental Technicians. Stay safe all. Alan Wright

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and opinions and learn from each other. Our aims are the same and it makes very logical sense to continue combining our efforts and by so doing increase all our knowledge and understanding of the craft and the world in which we need to live”

DENTAL TECHNICIANS GREAT BRITAIN

We launched “The Technicians Merit Award Scheme” which was designed to shine the light on the fantastic work of all Dental Technicians by submitting entries via the Facebook group or the magazine by means of a picture or video of their work. A very knowledgeable panel of judges, made up of Dental Technicians, was assigned to choose nominations for six different categories on a quarterly basis. These nominations are then put back to the audiences of The Dental Technician Magazine and DTGB to choose the overall winners. The uptake with submissions has been inspiring and wonderful to see. Of course, there has been a pause of late but we are in the process of re-launching the scheme for the second round of nomination soon. This awards scheme would not have been possible without the interaction from skilled dental technicians on the Facebook group. We can’t wait to see more! The Dental Technician Magazine also offered its FREE ECPD scheme to all Dental Technicians Great Britain Facebook group members. One of the main reasons for the joining of forces was to assist with continual development, making it

easily accessible, and free for all members! We are happy to say a new online learning section of The Dental Technician Magazine website will be launching soon and will play a vital part in ECPD points for all technicians. Dental Technicians Great Britain Facebook group proudly supports charity Den-Tech and its project Veterans Bite Back both founded by Andrea Johnson who is a Dental Technician Magazine editorial board member and Technicians Merit Award Scheme judge. The charity was set up to provide the much needed support to those less fortunate in the UK and enlisted a board of trustees who are equally passionate about using their skills and experience to help. Vets Bite Back is an initiative to offer free dental care for homeless veterans and used the Southampton Veterans Drop in Centre to form the first Vets Bite Back surgery. The clinical equipment has been supplied and fitted by Blueprint Dental with continued and highly valued support from Alan Wright. The Dental Technician Magazine is proud to make quarterly donations to these excellent causes and we want to continue highlighting the fantastic work from all involved.

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Our vision for the magazine is to encourage more of the Dental Technicians Great Britain Facebook group members come forward with contributions and suggestions for the magazine. The most recent months have seen some fantastic new features that have received very positive feedback from our readers. We want to expand on this. If you have any budding young Technicians that would like to write about their career pathway, or you are a retiring Technician who would like to share your exiting stories with us, we would really encourage you to submit your stories, technical walk-throughs and ideas with the new editorial team. This magazine and forum is yours, together we are better, together we are stronger and together we can continue to grow. If you are not a member of Dental Technicians Great Britain you can join for free today! Simply find the group on Facebook, apply to join, and answer the screening questions to become a member of the closed group and join 1700 authentic Dental Technicians to help each grow. Best wishes to you from all of The Dental Technician Magazine Team.

MARKETPLACE ZIRKONZAHN NEW M2 MILLING UNIT COMFORT LINE – FULLY AUTOMATIC, FLEXIBLE, OPEN w The new M2 milling unit comfort line stands for modern operating comfort and flexibility. With the M2 Wet Heavy Metal, the M2 Teleskoper, the M2 Dual Wet Heavy Metal, the M2 Dual Teleskoper and the M2 Dual Double Teleskoper, the comfort line comprises five milling units with fully automatic 5+1 axis simultaneous milling technology. The highlight in terms of flexibility is the extra-large Teleskoper Orbit (Ø 125 mm) that, in combination with special holders, permits to process all common soft and hard material blanks of Ø 95 mm, Ø 98 mm, Ø 106 mm or even Ø 125 mm. With the Teleskoper Orbit blanks can be removed and reinserted back into the orbit at exactly the same position with a precision in μm range. This is particularly helpful for adjusting the friction of telescopic jobs or for the twostage fabrication of immediate restorations in case of implant-supported prostheses (with the double milling technique). All M2 milling units are stand-alone solutions: it is possible to start milling and calibration processes or load elaboration tools directly from the machine via the integrated PC with touchscreen. The optical tool detection ensures greater safety during milling. The two separate large milling chambers are the trademark of the M2 Dual milling units. However, also the M2 and the M2 Telescoper milling units are characterised by spaciously designed,

ABOVE: Extra-large Teleskoper Orbit: for the elaboration of material blanks with Ø 95 mm, 98 mm, 106 mm or even 125 mm, as well as glass-ceramic and Raw-Abutments® blanks. Discs can be removed and reinserted back into the orbit at exactly the same position with high precision in the μm range – particularly useful for the two-stage fabrication of immediate restorations in case of implantsupported prostheses (Double Milling technique).

optimally illuminated and easily accessible milling chambers as well as with a separated, contamination-protected tool chamber with 21-compartment automatic tool changer (optional up to 3 x 21 for the M2 Dual versions). The automatic selfcleaning function, the integrated Cleaning Kit for an easy cleaning of the milling chambers and the Ioniser (optional) ensure a particularly clean elaboration of the materials. The performance range of the machines can be extended by integrating different accessories available, e.g. the Glass Ceramic/Raw-Abutment® Holder and the JawPositioner Support. With the M2/M2 Dual Upgrade Kit, the M2 Wet Heavy Metal and the M2 Dual Wet Heavy Metal milling units can be upgraded to the Teleskoper version.

FOR MORE INFORMATION VISIT: www.zirkonzahn.com Know more about the M2 line and the Double Milling technique! Scan the code.

STAY UP TO SPEED WITH THE BRAND-NEW 20% FASTER GENERATION RED E SCANNERS FROM 3SHAPE w 3Shape announces the launch of its brandnew Generation Red E scanners for labs.

available at the same price points as their corresponding E models.

GENERATION RED E SCANNER SPEEDS AND ACCURACY

The Generation Red E scanners are upgrades of the 3Shape E1, E2 and E3 dental lab scanners to the same next generation platform as the award-winning E4 lab scanner. The next generation platform enables the three Generation Red E scanners to scan 20% faster for optimized productivity.

“With the 20% increase in speed, coupled with the already lightning fast E4, the Generation Red line of lab scanners make it easier than ever for labs to do more of what they love, faster. Productivity is paramount for labs. The speed and accuracy of Generation Red E scanners combined with our easy to use software ensure that lab professionals can work quickly, predictably, and at a great price!” says Rune Fisker, 3Shape Senior Vice President, Product Strategy.

DISCOVER MORE ABOUT THE GENERATION RED E LAB SCANNERS: https://www.3shape.com/en/ scanners/lab

20% FASTER AT NO EXTRA COST!

Despite the significant boost in scanning speed, all Generation Red E scanners are

Generation Red E scanners include from two to four 5MP cameras (depending on the model) and auto start scanning. ISO-documented accuracy in the E4 and E3 models is suitable for implant bars. The E line of lab scanners are Red Dot international product design winners.

Generation Red E4

Generation Red E3 Generation Red E2

Generation Red E1

Full arch scan speed

9 sec.

18 sec.

24 sec.

32 sec.

Full arch impression scan speed

45 sec.

64 sec.

72 sec.

104 sec.

Accuracy (ISO 12836)

4 μm

7 μm

10 μm

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ADVERTORIAL

KEMDENT

Health & Safety - Pumice slurry and brushes l A major source of crossÂ-contamination in the dental lab comes from pumice slurry and brushes used to polish a denture before returning it to the dentist for fitting in the patient's mouth. One study found that slurry samples were heavily contaminated with pathogenic micro-organisms, and that adding a cleaner lowered the bacterial count.

Pumice made up with an appropriate cleaner reduces the risk of bacteria and fungi in the slurry, thereby limiting the risk of cross infection, as well as reducing bad smells

This means that slurry, polishing instruments and the dental appliances being polished are all potential sources of crossÂ-contamination. The technician doing the polishing is at risk, as well as the dentist who will handle the appliance and above all the patient who will wear it. Another study associated contaminated slurry with the high level of eye infections amongst dental technicians observed, due to spatter. There are several preventive measures, which are very efficient at reducing the risks of crossÂ contamination; these include disinfecting the pumice pan and changing pumice slurry regularly, making up the slurry using an appropriate cleaner, soaking

brushes and rag wheels after each use in cleaner to ensure they are not contaminated and wearing the appropriate protective clothing (such as eye protection and a dust mask to protect from spatter).

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Brushes should be soaked in a cleaner

DENTAL TECHNOLOGY

TESTING THE VITA AKZENT PLUS STAINS AND GLAZE MATERIALS: VERSATILE AND EFFECTIVE

Urszula Młynarska, Master Dental Technician (Warsaw, Poland), shows how she uses the VITA AKZENT PLUS stains and glaze materials effectively in her laboratory and demonstrates how versatile these materials are in practical application.

hroughout their professional lives, dental technicians continue to learn and perfect their skills in using ceramic to recreate typical features of dentition such as the internal structure, the surface, and transparent and translucent areas that are as natural in appearance as possible. In order to replicate these effects and characteristics, a wide variety of stains is required in addition to conventional ceramic materials. In addition to conventional tasks such as surface shade characterization and the application of cracks to the enamel or areas of abrasion, Ursula Młynarska also uses the complete range of VITA AZKENT PLUS products in her laboratory in Warsaw in order to increase or reduce the level of brightness with BODY STAINS or in order to replicate depth effects and translucency using EFFECT STAINS.

In this article, you can find out how Urszula Młynarska uses the new stains and glaze materials effectively in her laboratory as well as how versatile these materials are in practical application.

more silk-matte in appearance; however, it too facilitates reliably compacted surfaces. This material is especially recommended for the base area of bridge pontics and in the tooth-neck area where the gingiva is particularly sensitive.

More than just surface shine: glaze material Anyone with experience in biscuit bake firing of ceramically veneered crowns and bridges will agree that at this stage of the process, we cannot really evaluate either the tooth shade or the depth effects in a ceramic restoration. This is because the surface shine is not yet evident. In other words, without a glaze we cannot evaluate either the deep shade effects from within or the effects (usually varied) that we intended to achieve with our layering.

l We use VITA AKZENT PLUS Glaze LT for ceramics that are fired at temperatures below 800 °C (LT stands for Low Temperature). This low-melting glaze material is also available as a powder, paste or spray.

The VITA AKZENT PLUS glaze materials support the three-dimensional effect of the tooth shade, seal microporosities and improve the biocompatibility of the veneer, particularly in the tooth-neck area. You can choose from three glaze materials, each of which creates a different surface shine. The conventional VITA AKZENT PLUS Glaze is available as a powder, paste or spray. This glaze creates a natural-looking surface shine and retains all veneer detail as well as the surface texture.

l VITA

AKZENT PLUS Finishing Agent available as a powder or a spray - the shine is

The surface structure can also be influenced through the type of application: VITA AKZENT PLUS GLAZE SPRAY, for example, tends to result in a more homogenous surface, and when a brush is used to apply it, the scope for versatile effects can be controlled individually. Spray application is particularly suited to chairside restorations fabricated with CAD/ CAM technology, using VITABLOCS. Glaze and natural surface shine in comparison Once the glaze has been applied and fired, most dental technicians have completed their work – or so it would seem. There is one more small thing, which, however, can only be seen when magnified using a camera lens. This is the only way to reliably verify the quality of a glaze and compare it with the shine of natural adjacent dentition. As part of the final step following glaze firing, the surface is matted using a silicone polisher. The result is a natural-looking shine (Case study 1: Fig. 1 to 3).

CASE STUDY 1 FIG. 1: Initial situation: the prepared stump (21). FIG. 2: Verification using the lens of a digital camera: the excessive amount of shine of the glaze after firing is clearly visible. FIG. 3: Level of shine of crown 21 following correction: the surface was matted manually using the silicone polisher.

DENTAL TECHNOLOGY Using stains to create nuances In order to adapt the shade of the restoration to that of the natural adjacent dentition, I use VITA AKZENT PLUS stains. They should be applied in thin layers so that the shade can be controlled and nuanced during adaptation. If they are applied too thickly, they prevent the transmission of light. We use the stains for internal coloring during layering as well as for the application of surface effects. They can be used with any kind of ceramic dental material within a CTE range of 6.9 – 15.7.

Classically simple: mixing the shades Mixing using the two processing forms (powder and liquid) is very simple: VITA AKZENT PLUS POWDER is mixed with the appropriate POWDER FLUID. The ready-touse paste comes pre-prepared for application. In order to achieve a consistency that can be easily applied, the material is mixed 12 hours prior to use. Thanks to its creamy consistency, the individual shades can be easily and precisely applied without the formation of streaks. For glaze firing, the same furnace programs are used as for VITA AKZENT shades; the effects that have been applied do not lose any of their effectiveness or intensity after firing. Rich selection of shades with BODY STAINS The options in terms of shade selection are more than satisfactory. Adapted in order to match the basic shades, VITA AKZENT PLUS BODY STAINS (BS) offer five shades, from yellow to grey-brown. We usually use these shades to emphasize the shade intensity in the area around the tooth neck, at contact points and on occlusal surfaces. We have also found additional use for BODY STAINS in our work with our patients. Generally these materials allow the degree of light transmission at the incisal edge to be reduced – a solution that can also be used in “emergency situations”. Moreover, the BS03 BODY STAINS (orange) also allow warmer shading to be very discretely applied to the incisal edge (Case study 2: Fig. 4 to 7). The BODY STAINS can also be applied even in broader strokes without any hesitation. The overall result is a smoother, unobtrusive effect that is more pastel in appearance and emphasizes the shades rather than modifying them. The yellow hue BS01 has proven itself an excellent choice for outlining the incisal edge. When applied to the end of the highly transparent incisal edge, the lower transparency of the BODY STAINS creates a contrast that facilitates a greater dynamic in this area. They subtly emphasize the internal delineation as well as the EFFECT ENAMEL and MAMELON materials that this contains.

CASE STUDY 2 FIG. 4: Initial situation: prepared stumps (12 to 22). FIG. 5: All-ceramic cut-back crowns after firing. As a result of extension using ENAMEL, the incisal edges are too long and transparent. FIG. 6: Crowns 12, 11: the incisal edge that has been extended using ENAMEL can be clearly recognized. FIG. 7: Crowns 21, 22 (modification of the shade): reduction of the chroma in the central area using ES12 (grey-blue). The ENAMEL was only lightly colored using BS01 (yellow) and BS03 (orange), the incisal edge emphasized using BS01.

The materials should not be too watery on application. In order to prevent inadvertent shifting of the ceramic material during insertion, the restoration is pre-dried. Local characterization and shade adaptation using EFFECT STAINS The extremely fine-grained masking stains (EFFECT STAINS) offer excellent coverage thanks to the intensive appearance of each shade. They are recommended for applying natural surface effects. In our laboratory, these materials are applied in the area around the tooth neck, on occlusal surfaces and at contact points. Cream (ES02), sunshine yellow (ES04) and orange (ES05) are particularly suited in this case. By adding a little ES03 to ES05, for example, we can create a lovely hue. ES05 (orange) can be used together with ES08 (pink) to shade the incisal edge. In practice, we simply use a small brush for gentle application along the incisal edge.

Regulating transparency in the incisal edge area A standard task that we are continually faced with in our daily routine is controlling the degree of translucence along the incisal edge. Thanks to VITA AKZENT PLUS, performing this task is no longer an issue, but a lot more enjoyable now. There are many options that can be used to modify shades, one of which is ES13 (grey). Where the shade effect must be intensified or refracted, ES13 (grey) or ES14 (black) can be added. Mixing the shades ES08 (pink) + ES12 (grey-blue) + ES13 (grey) is also a good solution in this case. In order to strengthen the delineation of the incisal edge, and to emphasize the deep mamelon effects from within, I recommend using the pure hue ES12 (grey-blue). Opalescence at the marginal ridges, for example in the case of the central incisors, can be emphasized using ES10 (lilac).

The broad spectrum of shades from ES09 to ES14 (from dark red, lilac, blue, and grey to black) is only applied to the surface where they act as a shade filter.

However, these are just some examples and suggestions for initial testing. The more work you carry out using VITA AKZENT PLUS shades, the more possibilities you will discover by yourself.

Although we initially had doubts with regard to certain shades, in terms of where they should be used, every one of these hues later proved to be necessary and justified in practice.

Clever replication of white effects VITA AKZENT PLUS offers a slightly transparent white shade. It is ideally suited to the creation of “misty” effects.

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DENTAL TECHNOLOGY However, what should be done in situations where a calcification effect or merely a white stroke of color is required? With VITA AKZENT PLUS, ES01 (white) and ES02 (cream) powders are provided. ES01 is a slightly translucent white, which does, however, also include an additional hue as well as a different translucence to the comparable “white” shade provided with VITA AKZENT. It is an excellent solution for cusp tips, as well as for the reproduction of staining and more subtle lines. In order to emphasize the incisal edge, mixing ES01 (white) with just a hint of ES05 is recommended as this creates a lovely effect at the incisal edge. The ES02 (cream) material, on the other hand, unlocks entirely new possibilities. This shade offers a maximum level of opaqueness and is chalky in appearance. It allows calcification, spotting, and cracks to be very easily replicated. The powerful white effect is retained, even when firing has been performed several times (Case study 3: Fig. 8 to 10). Brightening shades in a completed restoration While we're on the subject of “bright shades”, we should look at an issue that crops up on a regular basis: what can be done in order to brighten the color of a restoration that has already been completed? The trick is to mix ES01 (white) and ES02 (cream); this enables the degree of shade brightness to be modified (Case study 4: Fig. 11 to 13). This can therefore be considered a kind of “lifebelt” for the ceramic technician. This

CASE STUDY 3 FIG. 8: Initial situation (11): incisal pressceramic veneer fabricated from VITA PM 9. FIG. 9: The dark preparation surfaces were coated using VITA PM 9 in the shade VITA 2M2. FIG. 10: The veneer was stained using VITA AKZENT PLUS, the incisal edge lightly shaded using ES12 (grey-blue) and enamel cracks applied using ES02 (cream).

mixture increases the level of brightness of the entire restoration, while still retaining the purity and depth of the veneer. Increasing brightness in this way is ideal for the central area of crowns. What if the final veneer is too bright? The complete opposite to brightening the restoration is the situation where the brightness of the shade must be reduced. This is where particular attention should be paid to the ES13 EFFECT STAINS (grey) as they can be used to reduce the level of brightness.

Limited space, thin layers, opaque material that shows through, but also flaws in the shade depth: These issues can all be resolved with outstanding results using ES13. This material clearly reduces all of these shade defects while at the same time supporting the threedimensional effect of the restoration. For this purpose, it can simply be applied in its pure form in the central area of the crown. Summary As there are a variety of glazing techniques and procedures, there is an approach to suit everyone. However, essential in this respect is that VITA AKZENT PLUS shades can be ideally integrated in the ceramic thanks to the lightness and transparence of the material. As they do not interfere with the play of light within the veneer, they help us break away from established patterns of thought that we may still have in regards to how to stain our restorations. Thanks to VITA AKZENT PLUS, crowns that have been fabricated using the simplest of methods can be transformed into vivid restorations with a unique, incredibly dynamic appearance. Could VITA AKZENT PLUS shades replace the AKZENT shades? They certainly provide us with many new options as well as allowing greater freedom in our work. They are also the answer when it comes to our ongoing search for new ways to express ourselves. Their essence and unique properties offer benefits that everyone must discover for themselves as part of their daily work.

CASE STUDY 4 FIG. 11: Initial situation: prepared stumps (13 to 23) fitted with post abutments. FIG. 12: All-ceramic crowns veneered using VITA VM 9: basic shade is VITA 1M2. The shade was brightened at the request of the patient. The degree of brightness of crowns 21 and 22 was increased with a mixture of ES01/ES02 (white/cream). FIG. 13: Result: The brightened crowns are clearly visible here.

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Source: Dental Labor Poland 3/2013, Verlag Neuer Merkur GmbH, Germany. VITA® and other VITA products mentioned are registered trademarks of VITA Zahnfabrik H. Rauter GmbH & Co. KG, Bad Säckingen, Germany.

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