Professor No.1 for dental professionals in Scotland Mike Wise October-November 2013 hosts a study day on aesthetics Page 21
On the ball We talk to East Kilbride dentist and Clyde FC director David Macpherson page 22
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ISSUE 5 VOL. 4 Welcome Editor’s desk with Bruce Oxley Whose business is it?
The recent announcement If the individual was level (i.e negligable) then that the ban on HIV positive working outside the rules, the patients involved were dental professionals then he/she will probably no more at risk than they Contents undertaking ‘exposure face some sort of sanction, would be at any other dental October-November 2013 prone procedures’ was to regardless of the outdated practice. be lifted was, as expected, nature of the legislation. The question is this: with NEWS> received favourably by the However, the subsequent the new rules allowing 05 Biting back profession. coverage in the newspapers dentists with HIV to practise with Arthur Dent Dentists, like their medical – with the Daily Mail running again, do patients have a 08 BDA issues colleagues, recognise with the headline ‘More right to know that their budget warning that the advances in anti- than 3,000 patients may dentist is HIV positive, or is 11 A ‘victory for retroviral therapy, allied to have been exposed to it none of their business? human rights’ 15 How to avoid the strict infection control HIV after Scottish dentist My personal feeling is burnout and decontamination contracted infection’ – that, as long as all the protocols employed within raises an interesting, and precautions are being taken, FEATURES> every dental practice, worrying, question. there should be no need for 22 Interview with means that any risk to I appreciate that the these public panics to be David Macpherson patients is negligable and health boards involved issued through the press 26 A life-changing has been for some time. in this latest ‘scare’ have in future. experience However, a matter of a duty of care and saw I suppose only time will 29 Practice profile days after the Department it as their responsibility tell if public perception will –Fergus & Glover, of Health announcement, to contact all patients come round to the same Glasgow a story broke in Scotland involved. However, if the way of thinking. that thousands of dental dentist in question – and CLINICAL> patients in Dumfries and this is me hypothesising, I 40 Intra-oral scanners Paisley had been contacted have no insider knowledge ® 47 Crawford Bain - after a dentist had been of the case – was on Bruce Oxley is the editor of Implants in a year Scottish Dental magazine. and a half ‘outed’ as being HIV medication and his viral To contact Bruce, email bruce@ positive. load was at a manageable connectcommunications.co.uk 52 Periodontics
Scottish Dental magazine 3
Column Biting back with Arthur Dent Bullied and blackmailed
n my previous column I that it was PSD’s inefficiencies that with a serious discussed the paltry 2.5ı per created the problem and this has dilemma. cent uplift in NHS fees which been exacerbated by SG’s policy of It did not Scottish Government (SG) continuous registration of patients, wish to yield was proposing – the first fee dating back to 2006. to threats and Iuplift in over three years and one BDA Scotland sought legal bullying from which will not remotely address opinion on the matter and was Scottish Government, the spiralling increases in dental advised that there was a strong especially when BDA/ practice expenses. case to challenge at least part of SDPC had a sound legal I have also previously discussed the recovery – that relating to the case. However, it also SG’s proposal to reclaim alleged period 2006-08. This accounted for had an obligation to act in ‘overpayments’ to GDPs resulting around £2 million of the total £3.5m the best interests of GDPs from duplicate registrations, i.e. proposed clawback so would be a in Scotland. I have learned that the two dentists being simultaneously significant win on behalf of- Scot “The whole meeting lasted several hours while paid capitation or continuing care tish GDPs. episode the SDPC agonised over this diffi- payments for the same patient. In the light of this opinion, the leaves a cult decision. When a patient registers with a new BDA duly notified SG that it was In the end, pragmatism prevailed GDP the computer system at Prac- considering taking the matter to bitter taste and SDPC decided to withdraw the titioner Services Division (PSD) judicial review in order to prevent and has legal challenge; it reasoned that the should remove that patient from the the recovery of the £2m from the further majority of GDPs would benefit more list of the previous dentist and stop period 2006-08. SG responded with soured from receiving the fee uplift than they registration payments. the threat that if the BDA took such relations“ would lose from the clawback. However, it appears that the legal action then the offer of a 2.5ı per However, the whole episode system was inefficient in doing this cent fee uplift would be completely leaves a bitter taste and has further and that, for a number of years, some withdrawn and there would again be soured relations between Scottish duplicate payments were made out- NO FEE INCREASE. SG’s position Government and the dental profes- with the knowledge of the dentists. was that it needed the money from sion. For SG to threaten to renege The BDA’s Scottish Dental Prac- the recovery in order to finance the on a previous agreement does it no tice Committee (SDPC), which fee uplift, effectively giving with one credit and will further deepen the represents the interests of GDPs in hand and taking with the other! mistrust. Scotland, has vigorously challenged SDPC held an emergency The dental profession in Scotland SG’s attempts to reclaim these meeting to discuss the SG ulti- deserves better than bullying and monies from dentists. SDPC argues matum. The committee found itself blackmail.
DETAILS AND CONTRIBUTORS Scan this QR code with your smartphone Editor Design and Subscriptions to see all of our social Bruce Oxley production Ann Craib media offerings Tel: 0141 560 3050 Lindsay Neill Tel: 0141 560 3021 is published by bruce@connect ann@connect communications.co.uk Advertising communications.co.uk sales manager Senior sub-editor Ann Craib 1 year, 6 issue The copyright in all articles published in Scottish Wendy Fenemore Tel: 0141 560 3021 subscriptions: UK £60; Dental magazine is reserved, and may not be ann@connect overseas £75; reproduced without permission. Neither the Studio 2001, Mile End, Sub-editors: communications.co.uk students £30. publishers nor the editor necessarily agree with Paisley PA1 1JS Gary Atkinson Back issues: £5, views expressed in the magazine. Tel: 0141 561 0300 Chris Fitzgerald subject to availability. ISSN 2042-9762 Fax: 0141 561 0400 www.scottishdentalmag.co.uk
Scottish Dental magazine 5
Scottish Dental Show 2014 Scotland’s biggest dental show is back Braehead Arena is to play host to the 2014 Scottish Dental Show
ollowing the success of the 20ı3 event, plans for the 20ı4 Scottish Dental Show are already at an Fadvanced stage. The show will be moving from its home for the last two years, Hampden Park, to a brand new venue, Braehead Arena on Friday 9 and Saturday ı0 May 20ı4. The new venue provides the scope for more than ı30 exhibition stands in “There will be one hall, with the speaker sessions entering and exiting directly onto the trade show something of THE VENUE floor. At the time of writing, more than 40 interest for every BRAEHEAD: Featuring more than per cent of exhibition stands have been sold, one million square feet of retail, having been on sale only since the beginning member of the catering and leisure space, of September. Braehead is one of Scotland’s The lecture programme will again offer up team to take back largest shopping centres and to eight hours of verifiable CPD and, for 20ı4, retail parks. Situated on the we have expanded our scientific committee to their practice” south bank of the River Clyde in to include Blackhills Clinic’s clinical director Renfrewshire it is home to more Paul Stone and GDP Stuart Campbell who to take back to their practice. than 150 retailers and has an is a partner at Loanhead Dental Practice We are also hoping to include a series annual footfall of 17 million. in Midlothian. They will join our scientific of parallel workshops to run alongside the Braehead Arena was built in chairman Kevin Lochhead, clinical director main speaker programme. Details are yet 1999 and is located within the at Edinburgh Dental Specialists, who has to be confirmed but are likely to include Braehead complex. It was a agreed to help shape the programme for a hands-on sessions, product demonstrations venue for the 2000 World Curling second year. and small group seminars. Championships and is the home The talks will focus on four main streams: The website for the 20ı4 Scottish Dental rink of the Braehead Clan UK Elite Dentists, Dental Team, DCPs and Business/ Show is currently in development and will Ice Hockey League team and Financial. The final programme of speakers be ready to launch within the next few regularly plays host to concerts, will be announced in the near future but we weeks. We are also planning on opening events and ice shows. can guarantee there will be something of registration before Christmas with details of interest for every member of the dental team an exciting prize draw to be included.
6 Scottish Dental magazine Scottish Dental Awards 2014
Awards. Ceremony relocates to the Glasgow Science Centre and promises a host of new categories The science of dental awards
he 20ı4 Scottish Dental Show in the country, it offers interactive displays, is not the only event moving games and activities as well as a state-of- to a new venue as the Scottish the-art planetarium and IMAX cinema. Dental Awards finds a new The judging panel from the 20ı3 Scottish home. The Glasgow Science Dental Awards is meeting up in the near TCentre will play host to the 20ı4 awards future to discuss the new award categories, dinner allowing up to 450 guests to attend entry requirements and judging criteria. the ceremony. Unlike other awards, we have no plans Opened to the public in 200ı, the to start charging for nominations and we Science Centre is situated at Pacific Quay hope to be able to offer an awards that is opposite the SECC on the River Clyde. a true celebration – and reflection – of the It is an independent Scottish charity dental industry in Scotland. that was set up to present concepts of science and technology in unique and ® inspiring ways. Further details will be published in due course One of the most fascinating attractions online and in the next issue of the magazine.
Scottish Dental magazine 7 News | Interview p22 | Intra-oral scanners p40 | Product news p86
NHS funding. Association warns of a decline in patient care if a cash-limited BADN budget is introduced in Scotland criticises council
GDC
BDA issues The British Associa- tion of Dental Nurses (BADN) has claimed that the absence of a budget warning dental nurse on the new GDC council presents a “void of knowledge on he BDA has “We are battling through matters pertaining to warned that the a challenging period for dental nurses”. introduction of NHS dentistry in Scotland In a letter to the a cash-limited in which practitioners are GDC’s chair-elect budget for NHS striving to provide high- William Moyes, the Tdental care in Scotland quality care to patients. BADN welcomes the could restrict the number of The imposition of a cap on appointment of a lay patients that can be cared for funding, which effectively member as chair, and prevent dentists tells some patients that they saying that it hopes providing treatment to those won’t be cared for while this will lead the council who want it. others are, exacerbates the away from its current The warning, delivered in problems dentistry faces. “dentist focused culture the BDA’s 20ı3 submission Above: Dr Robert Donald “For many years the Scot- towards one which of evidence to the Doctors’ tish Government has worked more equably reflects and Dentists’ Review Body are inspected, and funding cooperatively with the profes- the diversity of GDC (DDRB), follows notification streams that have helped to sion and, as a result, access to registrants”. However, that such an arrangement is solve problems accessing care care has been improved and it expressed concerns being imposed for the 20ı3–ı4 have been scaled back or with- a targeted attack on oral health that of six dental financial year and that it has drawn completely. A 2.5ı per inequalities has been launched appointees, only one not been ruled out for 20ı4–ı5. cent funding uplift secured with the widely-heralded is a DCP – technician The BDA is concerned that this year, while a step in the Childsmile project. That David Smith. its imposition could result in right direction, fell short of progress must not be thrown The letter continues patients going without the care the DDRB’s recommendation away; it must be consolidated by saying: “The appoint- they need. and does not address the gap and built on. We’re asking ment of just one non- News of the change has come opened up by several years of for a fair deal for dentistry in dental nurse DCP to the after a challenging period for funding neglect, according to 20ı4 that starts to address GDC fails to reflect the general dental practice in Scot- the association. funding issues and recognises importance of DCPs land in which the burden of Dr Robert Donald, chair that patients’ needs, rather in general and dental bureaucracy has been increased of the BDA’s Scottish Dental than cash limitations, must nurses in particular.” by changes to the way practices Practice Committee, said: come first.”
First prosecution in Scotland for illegal dentistry
CONVICTION He admitted practising ille- The GDC confirmed that Mr career all over again. gally at the Bridge of Don Barogiannis had made “two or “I am sorry about what has An unregistered dentist from Dental Clinic and Research three” applications since June happened. I haven’t worked as Aberdeen has become the first Centre between 3 January and 20ıı but that they had been a dentist in more than two years in Scotland to be prosecuted for 5 March 20ı2. He claimed that incomplete. NHS Grampian but I made a mistake and it was practising illegally. he had applied to the General stated that he has never applied wrong. ” Ronnie Barogiannis, of Loch- Dental Council (GDC) for to be included on their dental list. The case marks the first time side Terrace, Bridge of Don, registration in advance of his Speaking to The Herald, Mr a prosecution for the illegal pled guilty at Aberdeen Sheriff relocation from Greece to Scot- Barogiannis said: “This whole practice of dentistry has been Court to a breach of Section land, and he only stepped in to thing has been terrible. I made launched in Scotland. It was 38(ı) of the Dentists Act ı984. He help out when the surgery had a stupid mistake and it has brought about by Police Scot- was fined £500 – £76 less than the just opened, despite not having been a very difficult experience land and the Procurator Fiscal, Annual Retention Fee. received his papers. for me. I will have to start my helped by the GDC.
8 Scottish Dental magazine
Charity expedition p26 | Crawford Bain p47 | News
Edinburgh college A ‘victory for launches clinical skills competition human rights’ The Royal College of Surgeons of Edinburgh (RCSEd)’s he ban on HIV positive dental the new rules, we must know how they will work Faculty of Dental professionals treating patients in practice, as well as ensuring that healthcare Surgery has launched has been lifted under new plans workers are given support and any additional a Dental Clinical Skills revealed by the UK Government. training to re-enter the profession in order to competition, to take Following years of campaigning, deliver the safest possible patient care.” place in the UK’s 14 Toutdated rules stopping dental professionals The regulations were brought in after the dental schools this with the virus performing ‘exposure prone’ publicity associated with the death of an autumn/winter. procedures have been scrapped, American dental patient in ı990, one The heats, which bringing the UK into line with coun- of six patients believed to have been will take place from tries such as Sweden, France, New infected with HIV in an unresolved October to December, Zealand and Canada. Florida case. Regulatory bodies will see final year Dental Protection’s dental in most countries responded dental students director Kevin Lewis (pictured), to the case differently – the showcase their whose organisation have led the UK banned all HIV-infected clinical skills, with the fight to lift the ban on HIV posi- healthcare professionals from best student from tive workers, said: “This is a huge undertaking exposure-prone each heat winning victory for human rights. After procedures. Since most dental a travel and accom- decades of living in fear and dealing procedures are classified as exposure modation package to with prejudice, dentists can finally prone, the ban had a devastating signifi- compete in the Grand return to their professional calling, although cance for dentists diagnosed with the disease. Final at RCSEd on regrettably it is too late for some to do so. Patient There have been two major developments 6 March 2014. safety should be at the forefront of healthcare, since the rules were put in; anti-retroviral The overall but the original rules were introduced as a reac- therapy, which is effective in lowering the viral winning prize is an tion to a mysterious and exceptional case, the level for patients with HIV, and improved infec- all-expenses-paid likes of which we have not seen before or since. tion control standards. Together these mean that trip to the Chicago “We have long pushed for the scientific basis it is safe for a dentist with the disease to return to Dental Society’s for limiting healthcare workers in their clinical work provided they comply with the conditions Midwinter Meeting in practise to be reassessed. Although we welcome of the new regulations. February 2015. The Grand Final of the competition will be followed by a Patients contacted after HIV scare dinner in the 500-year- old Edinburgh College Thousands of dental patients Public health. NHS boards write to dental at which presenta- in Dumfries and Paisley have tions will be made been contacted after it was patients in Paisley and Dumfries to the winner and discovered the dentist who two runners-up. All treated them has been diag- The former dentist also ‘exposure prone’ procedures. participants in the nosed with HIV. provided Sunday emergency Dr Syed Ahmed, NHSGGC competition will NHS Greater Glasgow and cover at Nithbank Hospital in consultant in public health receive a certificate Clyde has contacted approxi- Dumfries between April 2004 medicine, said: “It is very rare for of participation and a mately 3,000 NHS and private and 2007 and is thought to have HIV to be passed from a health year’s Affiliation with patients registered with treated nearly 250 patients. care practitioner to a patient the RCSEd. Kelburne Dental Surgery on NHS Dumfries and Galloway because all work follows strict Glasgow Road in Paisley, who said that it had contacted all ‘infection control’ measures. ® were treated by the dentist at but ı4 patients thought to be “These measures are For further information some point between January affected. designed to prevent infections about the Dental Clinical 2004 and March 20ı3. The The news came less than a like HIV being passed between Skills Competition health board revealed that it week after the Scottish and UK people and through our inves- please visit www. had written to the vast majority governments announced they tigations into this case we are rcsed.ac.uk/dental- but they have been unable to were to relax rules governing confident that all appropriate skills-comp or contact trace about 250 NHS patients healthcare workers, including infection control measures [email protected] and 230 private patients. dentists, with HIV performing were followed by the dentist.”
Scottish Dental magazine 11 News SDPC decision gives uplift green light
n agreed funding Legal challenge. BDA committee decides Dr Robert Donald, the chair uplift for general of SDPC, said: “This has been dental practice against pursuing judicial review a contentious issue which across Scot- has its genesis in the forced land is to be if such a challenge were made, both the Scottish Government’s implementation of continuous Aimplemented following a deci- the uplift agreed by SDPC in costs and its own. registration arrangements sion not to pursue a judicial good faith earlier this year The BDA’s legal challenge to to which the BDA objected review process that would would not be honoured. This the proposal had already forced strongly even before they have prevented the award would have led to practices the Government to re-examine were imposed. being made. across Scotland being deprived and delay implementation, “We have been presented In light of the potential conse- of the funding indefinitely. allowing practitioners more with a very stark choice that quences of pursuing a legal case It would also have caused time to understand the poten- has profound repercussions instead of accepting the award significant pension detriment tial impact on their own for dental care across Scotland uplift, the BDA’s Scottish Dental in the long term. The uplift practices and prepare for and this is not a time to allow Practice Committee (SDPC) will now be implemented appeals where appropriate. dogma to cloud our judgement. has decided not to pursue a from ı November 20ı3 and It has also seen the timescale “Practices and their patients judicial review of Scottish backdated to ı April. for the process extended and come first and we are making Government’s decision to A challenge could also have an appeals process for those the choice that best serves recover alleged overpayments created further financial jeop- who believe they are incor- their interests by providing of patient registration fees. ardy, because in the event of an rectly being subjected to it a much-needed and overdue It was made clear to SDPC by unsuccessful review the BDA established, following repre- injection of funding into the Scottish Government that would have been liable for sentations from SDPC. NHS dentistry.”
New salaried contract is finally agreed…
NEGOTIATIONS
Scotland’s salaried dentists have voted overwhelmingly to accept the new terms and conditions and pay scales that have been negotiated by the Scottish Salaried Dentists New surgery kitted out Committee. The changes, which will Corstorphine-based private exciting moment for us. also support the creation of referral clinic Vermilion has We have been delighted a new Scottish Dental Public dentists in Scotland recognised recently added a fourth with the Stern Weber Service, came after years of for the important work we dental chair to the practice. S220TR chairs that we negotiation by the Britis Dental do, and will help secure the The new chair will be installed when we opened Association (BDA). services we provide for our used by Dr David Jones, two years ago, and have Robert Hamilton (pictured), most vulnerable patients.” practice limited to endo- gone with the same again. the Chair of the BDA’s Scottish Further information about dontics, and Dr Zannar “Thanks to Martin Moor Salaried Dental Committee, the implementation of the Ossi, practice limited to and team at Clark Dental, said: “We are delighted by the arrangements will be published prosthodontics. Farahbod Nakhaei at NVDC overwhelming support for on the BDA website following Practice principal Dr and our indispensable IT these proposals. We believe further discussion with David Offord said: “It’s an contractor Ian Wilson.” this will finally see salaried Scottish Government.
12 Scottish Dental magazine
Practice profile p29 | Periodontics p52 | Oral cancer p69 | News
Seminar. Former Glasgow City Council leader Steven Purcell and Dr Bobby Broadfoot explored the stress journey at a recent seminar held at a Glasgow practice How to avoid burnout
n evening seminar dentists were more likely to exploring stress, suffer from stress, anxiety and anxiety and profes- depression, however he coun- Asional burnout was tered that by saying: “As a high held at Clyde Dental Centre in achiever, you have the powerful Glasgow recently. mind to cope with this.” Hosted by Clive Schmulian He spoke about the tools that and featuring former Glasgow we all have to manage depres- City Council leader Steven sion and how he managed to Purcell and Dr Bobby Broad- find emotional balance through (l-r) Dr Bobby Broadfoot, foot, the evening saw more than things like meditation and the Clive Schmulian and 20 dentists in attendance. importance of talking to people Steven Purcell A self-deprecating and in the same situation. He also engaging speaker, Steven mentioned the stigma attached who talked about the stress as stress is cumulative and opened by saying: “I stand to metal illness, stating: “I journey: from stress, through builds up over time. As well before you as a recovering found that it was easier for anxiety and onto burnout. as the science of the sympa- politician,” and went on to me to come out just before a He also described the thetic nervous system, he describe the circumstances by-election than it was to come American definition of stress also discussed the lack of of his “very public episode of out as having a mental illness.” – cumulative trauma disorder research into stress in dentistry, stress, anxiety and depression”. Steven was followed on to the – and remarked how it is a claiming that it “isn’t a sexy He said that as high achievers, podium by Dr Bobby Broadfoot particularly apt description, subject. Relevant, but not sexy”.
Scottish Dental magazine 15 News
BDA. Recent change to membership structure has hit association’s bottom line Budget shortfall could lead to redundancies taff at the British Dental Asso- Dr Martin Fallowfield (pictured), the are now in the process of re-shaping the ciation (BDA) are facing chair of the BDA’s Principal Executive association to deliver the services they widespread redun- Committee, said: “The dental have asked for. This is the same business dancies as a result profession has changed and our planning process any dental practice of the change structure needed to change would go through when changing its prac- Sin membership structure with it. We have asked tice balance. introduced in the summer. dentists what they need “Unfortunately, this may mean some The introduction from their professional BDA staff leaving the organisation and we of a three-tier system association and shaped the are consulting on proposed changes. We appears to have seen the BDA accordingly. Listening have already put in place a new financial vast majority of members to feedback from the profes- model that supports the changed business choose the cheapest option, sion we have created a range model to ensure a sustainable future. which has led to a budget of membership packages which “Members can be assured that services shortfall in the region of £3 million. allows members to choose, and pay will be sustained and that the future BDA staff have been sent a letter of for, the services they wish to receive. of the BDA is secure. This is a new era consultation as the first stage in making a “We have analysed the financial and for the BDA and we can face the future round of redundancies. resource impacts of their decisions and confidently.”
single Combined Practice Comply with Inspection process to be carried out over a three-year inspection rolling programme. “Practitioners must meet checklists all essential criteria, with all relevant documenta- ADVICE tion prepared for inspector review in the order set out Failure to comply with new in the checklist. Failure to practice inspection check- comply with the standards lists could jeopardise access in the practice inspection to NHS grants and allow- checklists could affect their ances, dental defence access to NHS grants and organisation MDDUS has allowances. warned. “Since the turn of the year, “There are some impor- MDDUS has had queries from tant changes practice members regarding the new owners should be aware inspection checklists, from of in both these docu- concerns about confidenti- ments and dentists should ality issues to who will carry start to prepare now for out the inspection.” inspections rather than Practices undertaking IV waiting until closer to any sedation must also ensure potential inspection date,” they comply with the guide- says MDDUS dental adviser lines on sedation. Rachael Bell. “While an Automated “NHS Boards and NES External Defibrillator (AED) is previously had their own recommended for non-seda- practice inspection check- tion practices, it is manda- lists. These have now been tory for any practice using brought together into a sedation,” continued Bell.
16 Scottish Dental magazine
18 Scottish Dental magazine Refurbishment profile p35 | Independence – financial implications p76 | News
Graham Gilmour speaking at the Wesleyan conference buys up Practice Plan and Medenta
ACQUISITION
Wesleyan Assur- ance Society has announced the acquisition of the Practice Plan Group, comprising Prac- Event. Glasgow welcomes the scientific conference tice Plan, a leading featuring an expanded speaker line-up and exhibition provider of practice- branded dental membership plans, and Medenta, one of the leading providers New venue for of patient finance to UK dental practices. Craig Errington, Wesleyan’s chief Scottish BDA event executive, said: “The acquisition of Practice early 400 delegates descended on The pain management room saw Samuel Plan is part of a larger Glasgow recently for the BDA’s Caddens present on ‘Facing down pains in the strategic growth Scottish Scientific Conference and mouth and face – mechanisms, presentations and programme that we Exhibition 20ı3. complications’. John Meechan then talked about are embarking upon After outgrowing its previous ‘Bespoke dental anaesthesia’ before Tara Renton over the coming Nvenue at the Dunblane Hydro, the expanded took to the stage to present on ‘Minimising and years. Until now we event saw four lecture streams and a larger exhi- managing trigeminal nerve injuries’. The final have largely focused bition area at the Crowne Plaza Hotel. The event speaker was John Gibson, who spoke on ‘The on providing personal was officially opened by Chief Dental Officer mouth – part of the face and part of the body’. financial services to Margie Taylor, who praised the event’s organi- The core CPD room featured Graeme Ramage, dentists. Practice sation and said that the conference showed “the who presented an overview of medical emergen- Plan is a strong and BDA at its best”. cies and David Conway and John Gibson, who successful business The clinical focus room featured Glasgow covered oral cancer prevention and detection. and will play an inte- graduates Graham Gilmour – who spoke on The final speaker room held a variety of talks gral role in helping us ‘Treatment planning and avoiding failure in fixed aimed at the dental team including Margaret to grow our commer- restorations’ – and Mike Cassidy, who gave an Ross’s talk on ‘Sharing the load: roles and respon- cial offering to dental ‘Update in ceramic materials for use in crown sibilities’ and Richard Welbury and Christine practices. and bridgework’. Harris on safeguarding vulnerable children. “Practice Plan offers a great synergy with the Wesleyan brand; it has an excellent New oral health guidance for care homes reputation within the dental profession and NEW RESOURCE Scotland’s national oral health providing daily oral care has built up strong improvement programme for specific to residents’ needs relationships with a New oral care guidance for dependent older people and and describing the associated large number of dental older people in care homes has been endorsed by the Care links between poor oral health practices nationwide. has been launched by NHS Inspectorate. and systemic disease. We can develop these Education for Scotland, in The guidance emphasises It will support the training links further to provide conjunction with NHS Health the importance of providing delivered by NHS teams a more comprehen- Scotland. person-centred, safe and and serve as a reference for sive financial service The new resource, Caring effective care by detailing oral health information and tailored specifically to for Smiles – A Guide for the importance of individual best practice relevant to this market.” Care Homes, will serve as oral health risk assessments, older people.
Scottish Dental magazine 19 20 Scottish Dental magazine Orthodontic special feature p56-67 | News
Study day. Prof Mike Wise provides a guiding light in aesthetic dentistry at Glasgow’s Lighthouse Wise words on aesthetics Glasgow ne of the UK’s leading names specialist in restorative dentistry was gives CT talk in Glasgow Orecently to host a study day PRESENTATION on aesthetics and implant- supported restorations. Glasgow-based specialist Professor Mike Wise hosted orthodontist Dr Imran Shafi the event at the Lighthouse in (pictured) was among the Mitchell Lane with an audi- keynote speakers at the recent ence of more than 40 dentists annual general meeting of the in attendance. His presenta- British Society for Oral and tion began with a look at Dental Research. diagnosis and the factors that The event, which marked the influence dental aesthetics. He society’s 60th annual meeting, then looked at factors influ- was held in Bath and saw Imran encing the choice of ceramic present on ‘Computer predic- for veneers, veneer prepa- tion systems for planning the ration considerations and Above: Prof Mike Wise with event organiser Ian Macmillan surgical correction of facial techniques, before covering deformities’. His presentation, the cementation of veneers The final session of the day School, University of London which previously won the TC on denine and enamel with looked at the aesthetic consid- and University College White Lecture Award, focused illustrating case studies. erations for some implant London, he has held courses on his research undertaken at The lunch break saw dele- situations as well as high and spoken throughout the the University of Glasgow. gates browsing the sponsors’ density polymers – what they UK and abroad for the last He received a certificate stands, including DTS, Opti- are, uses etc. He finished by 30 years. and the award during the Bath dent, Henry Schein, NSK and looking at a case presentation He is on the specialist meeting from BSODR president Taylor Defence Services. featuring porcelain onlays for lists for restorative dentistry Professor Tim Watson. After lunch, Prof Wise a wear case. and oral surgery and, until Imran said: “It was a looked at the factors influ- Prof Wise graduated from December 20ıı, was a visiting particular honour to be able encing the choice of ceramic the University of London professor at the Eastman to make a keynote speech for crowns as well as case in ı969 and established his Dental Institute. He has now during this special anniversary studies showing the considera- own private practice in ı973. retired from clinical practice meeting. From the feedback tions and techniques involved As well as lecturing posts at to concentrate on his teaching I’ve had, the lecture was well with crown preparation. the London Hospital Dental and mentoring commitments. received.”
NHS valuations stay higher than private
GOODWILL SURVEY the National Association of have also shown that NHS fetch more than expected and Specialist Dental Account- practices secure more than private practices go for less NHS dental practices across ants and Lawyers (NASDAL), 100 per cent of turnover, than expected. the UK continue to attract covered the period April to July with private practices at or The valuation average for higher prices than private and showed that, on average, below 100 per cent. When mixed practices was 100 per practices according to the an NHS practice commands the figures for valuations cent in the quarter ending July latest goodwill survey results. 105.2 per cent of turnover. are compared to the figures 2013 and the deals show an The survey, carried out by Previous NASDAL surveys for deals, NHS practices can average price of 95 per cent.
Scottish Dental magazine 21 Interview By Bruce Oxley
It’s a career of two halves From playing Marilyn Manson in his practice to helping football club Clyde FC, David Macpherson is not your average dentist
PHOTOS: MIKE WILKINSON
or most people, breaking a tooth in a Following his VT year, David worked in fall would be nothing more than an general practice in north Glasgow for a year unpleasant memory. However, for and then joined Whitemoss in ı994 as an asso- FDavid Macpherson, it inspired him ciate. At the time, the principal was making to set out on a successful career as a dentist. plans for his retirement and was grooming David, who is the principal dentist at David to become a partner in the practice. Whitemoss Dental Practice in East Kilbride, However, it dawned on David that it would describes the day in secondary school when make more sense if he took over the practice he and his friends were “messing about” in a and the principal became his associate. home economics class. He said: “I slipped on a He said: “I hadn’t heard of colleagues or piece of wet floor and hit the edge of a cooker peers changing roles before, but I asked with my face. I ended up at the dentist with him if it wouldn’t make more sense if my front tooth in half. he became my associate. That way, his “As I was lying there I had a eureka moment transition to retirement becomes a lot easier of: ‘This is what I should do’. I wanted to do and I take on all the hassle. So we did it and something with the public and I didn’t fancy it worked, we never had a bad word and it a desk job. I was looking for something that allowed me to immediately start to put my was engaging and I was always quite good with mark on the practice.” my hands, so I just thought: ‘Wait a minute, As soon as he took over, David put plans this is it’. in place to transform the rather dated two- “I’m working with people, I’m working with surgery practice into his vision of a modern my hands and I’m not sitting behind a desk clinic with patient care at its heart. “It was all doing paperwork... well, turns out I was wrong about trying to make the place as non-dental about the paperwork!” as possible,” he said. “At university, my elec- After graduating from Glasgow Dental tive was on phobic patients, because I had an School in ı99ı, David was part of the first interest in people that were nervous. cohort to take part in the new vocational “We looked at all the senses – people training scheme and he was fortunate enough don’t tend to like the smell of the dentists, to get a job just five minutes from his family they don’t like the sounds of the dentists home in Newton Mearns. and they don’t like seeing nasty pictures.
22 Scottish Dental magazine David with Clyde boss Jim Duffy (right) and assistant manager Chic Charnley
So we decided to get rid of all these upgrading. He has made sure that his staff are things. We introduced aromatherapy candles looked after and that they feel valued. David and music.” and the practice itself have picked up many Moving away from the stereotypical “gold- awards over the years – including Dentist of fish bowl in the corner and classical music”, the Year at the Scottish Dental Awards in May David regularly offers to play the patients’ – a testament to the high esteem he is held in choice of music during their treatment, by his staff. among other things, as an aid to relaxation. David’s nomination for the Scottish The Scotsman picked up on the story and Dental Award, and his recent nomination this, inadvertently, led to him being mentioned for the Best Boss in Britain Award run by on a French-Canadian Marilyn Manson fan Smooth Radio (he made the final 20), have website... both been surprises sprung on him by David explained: “I think the Scotsman used his staff. Marilyn Manson as it was the most unusual He said: “When I won the Scottish Dental music we had played. Award, I made a point of saying that this is “Someone from the fanzine must have been a team effort. One individual can’t achieve Googling and came across the story. So, there anything, it’s all about teamwork. I was in this fanzine. I had to translate it from “Both (nominations) were a complete French and there I was, the dentist who plays surprise. I must admit, my first impression was Marilyn Manson – which wasn’t quite true, but embarrassment, but then you think about it for it makes a good story, I guess!” a moment and you realise what it means and Since taking over, David has invested how nice it is just to be put up for these awards. heavily in the practice, adding three surgeries, “It’s humbling, you don’t do anything to get an LDU as well as a conservatory that is used awards, you do what you do because you are as the waiting room. But it is not just the bricks driven. When people ask me why I do certain and mortar that he has spent time and money things, I tell them it’s because I enjoy them.
Continued »
Scottish Dental magazine 23 24 Scottish Dental magazine Interview
Continued »
“I’ve been a vocational trainer for 12 years, because I love doing it. That doesn’t mean you don’t have hiccups or problems, but, in general, it keeps you young, it keeps you invigorated and it keeps you engaged.” As well as a VT trainer, David also works for NHS Education Scotland part time, supporting potentially under-performing dentists. He holds mentoring and coaching accreditation and has regularly given evidence and written reports for the GDC. He said: “It’s a job I find very rewarding, because things can happen to dentists for a whole bunch of reasons. Whether it is home life or developing bad habits – nobody goes to work with the intention for something to go wrong. “The diversity of problems I have been involved with are quite vast. Often, I am working with dentists that are anything from angry to suicidal, so it is incred- ibly rewarding when you get through the process with them. You are there as a mentor for them, as someone who is not judging them, just trying to share some of David explained that although many foot- As a result, David was invited down to the experience that you have and put in ballers are clearly conscious of health and Westminster for the launch of the Mouth place better processes.” fitness, they are often unaware of the impor- Cancer Action Month campaign. Whitemoss was also the pilot for the first tance of dental health to their general health So, who would have thought that a health promoting dental practice, a Lanark- and wellbeing. From the first team down chance slip on a classroom floor could shire initiative that involved, not just oral through the various age groups – under-ı9s, lead to a career in dentistry, a mention in health promotion, but general health under-ı7s and u-ı5s – David gives valuable an obscure shock rock fanzine and being promotion. Although not directly related, advice and support on oral health and diet, on the board of the football club he has this ties in quite nicely with David’s other including the hot topic of sports drinks. supported since childhood? passion outside dentistry: his involvement He has also registered a number of However, while the origins of his career with his beloved Clyde FC. players and staff as patients, including the and certain elements of his life have been A third generation supporter, David was well kent face of Chic Charnley, Clyde’s somewhat unusual, his professional desire, introduced to the Bully Wee as a small child ebullient assistant manager. He said: “I’ve ambition and drive certainly haven’t been. and has been following them through thick had a few characters in my chair over the He said: “I always had this deep ambition and thin ever since. years, including a few ex-Rangers and Celtic to do the best that I could in whatever I did. Originally from Rutherglen, the club players. It’s really nice and it’s fun for me. I And that’s what we did here. We decided has something of a nomadic reputation in now have some really good contacts through to change the rules and try to be a wee bit recent years since moving from Shawfield the Scottish football world, from people who different. And I think we have managed to Stadium – its home since ı898 – in ı986. It have been involved in the club at some stage.” do that quite well.” ground shared with Partick Thistle and In 20ıı, to coincide with Mouth Cancer Hamilton before moving to Broadwood Action Month, David contacted the British Stadium in Cumbernauld in ı994. Dental Health Foundation and arranged David, who has been the club dentist for for the club to sponsor the campaign and SPORT IS IN THE BLOOD many years, joined the board five years ago feature the Blue Ribbon Badge on the home and, as well as his official role as director shirt for the duration of the season. The David is married with two budding of fundraising, has been heavily involved in following season, the badge was sported teenage tennis star daughters, Hayley the ongoing negotiations to move the club on the away strip, due, in part, to the fact (17) and Tanya (15). His wife and chil- to East Kilbride. that they would be playing Rangers at dren are currently living out in Barce- He said: “What we realised at the club is Ibrox twice that season and it offered lona as they pursue their dreams of that there are three or four serious dental maximum publicity. careers as professional tennis players. injuries a year – players get knocks, bangs He said: “I said to the board that, as a David explained that his youngest has in the head or face etc. Even before I was dentist, I am involved in promoting dental even trained at Sánchez-Casal – the the club dentist I was getting asked to have health. I have an ethical drive to get the same academy that Andy Murray a look at a broken tooth and so on. message out there. The demographics trained earlier in his career. He said: “Then we realised that there are a few were changing and, for the most part, “When the girls were younger, on teams, like Chelsea, who actually have a mouth cancer was affecting young men. numerous occasions, Andy would be club dentist and there was an opportunity “My attitude was, if I can raise awareness on court either before, beside or after there to get the word out – we’ve always by doing something as simple as putting a them. So, from that period onwards been big on promoting and getting that blue ribbon on the back of a football shirt, they grew up watching Andy play.” message out as a practice.” then great.”
Scottish Dental magazine 25 Charity expedition A life-changing experience Hygienist/therapist Kirsty Sharp is part of a trio of Forth Valley dental professionals who embarked on an African adventure to take their vital skills and expertise to those suffering from serious oral conditions
n June, I headed off on a two- week expedition, along with dental nurses Gemma O’Malley and Hayley Robertson, to the Dodoma region of ITanzania with charity Bridge2aid, which specialises in helping those with no access to dental care of any description. Since 2002, Bridge2aid (B2A) – the UK’s fastest-growing dental charity working in developing nations – has trained over 220 local health workers in Tanzania in emergency dentistry, with their goal of more than 50 people a year learning essential dental skills having now been achieved. This training has not only directly treated tens of thou- Gemma, Kirsty and Hayley play with a sands of people, but has also patient’s daughter. Left: children who extended emergency dentistry came to see the makeshift clinic services to those living in rural areas. An estimated 2.2 million people now live within reach of someone who can help to events in the local area, including a alleviate their pain. race night and an 80s disco. We also More than 70 per cent of received generous donations from the world’s population have patients and workplaces and the no access to the simplest form businesses in the local community of dental pain relief. B2A was development programme with the donated raffle prizes. founded to address this problem disabled and people affected by As soon as we arrived, we began and is the UK’s fastest-growing leprosy at Bukumbi Care Centre. working with dentists to deliver UK dental charity working in Before we set off, we raised emergency dental procedures while developing nations. more than £4,683 by staging events also training local health workers, The charity’s Dental Volunteer throughout Clackmannanshire. leaving a lasting legacy of our Programme (DVP) allows quali- This helped to finance flights, efforts there. fied dental professionals to pass accommodation and living costs, Over 13 days, our team – consisting their skills on to clinical officers to with any additional proceeds being of six dentists and four dental safely extract teeth. The programme donated to further the charity’s nurses – worked in remote rural began in 2004 and works with work in the third world country. clinics, developing the skills of the Tanzanian government. B2A We had planned the trip for more clinical officers and delivering basic has also established a long-term than a year and hosted fund-raising dental services to the community.
26 Scottish Dental magazine Charity expedition
“One 17- year-old ABOUT THE walked 55 AUTHORS miles to get his tooth Dental hygienist/therapist Kirsty Sharp trained at Glasgow Dental out and was Hospital and School and currently Miswak sticks are used as so grateful” works at Tooth+ and Platt and toothbrushes in Africa Common in Stirling. Dental nurse Gemma O’Malley trained at Falkirk College and currently works We worked in two medical centres dental treatment to those who really at Macdonald and Morson in Alloa. Dental nurse Hayley Robertson also which were extremely basic with need it after we are gone. It may trained at Falkirk College and currently no electricity or running water, and be hard to imagine living with no works at Central Orthodontics in a basic wooden chair in place of a access to a dentist but, for almost Stirling. dental chair. two-thirds of the world’s population, We assisted the team by making that is a reality. sure the ‘clinics’ ran smoothly, It is not uncommon for people a difference. We would recommend including preparation of the anaes- to have to live with unbearable it to anyone remotely interested, it thesia, instruments and sterilisation toothache for many years, which, is such a well-run organisation and – which involved the use a pres- as dental workers, we find very the sense of teamwork is fantastic. sure cooker. We also assisted by disturbing. The patients we treated are so holding heads during extractions The trip was an incredible life- grateful and appreciative that you and sometimes holding babies, as changing experience. It gave us all a are there to help and never complain well as training the clinical officers great sense of achievement. after sometimes having toothache in sterilisation techniques and oral It not only helps people out of for years and walking for days to get health education. pain, but educates clinical officers to the makeshift clinics. One 17-year- Bridge2aid is a terrific charity as it who will be able to make a difference old walked 55 miles himself to get his not only treats dental pain but also in their community after we have tooth out and was so grateful just to teaches others the skills to deliver gone. The charity really does make be seen.
Scottish Dental magazine 27
Practice profile New horizons Aberdeen-based private clinic opens second practice in Scotland’s second city
acqueline Fergus and George After much deliberation, they decided Glover opened their practice that there was neither the room nor on Union Street in Aberdeen in the market to make the Aberdeen prac- ı995 and have seen it grow into a tice any bigger, so they started looking successful, multi award-winning further afield. And, having held a number Jprivate practice. of courses in Glasgow, they thought From their spacious lounge with comple- Scotland’s second city would be the ideal mentary refreshments to their use of the base for their sister practice. latest in digital imaging and X-ray tech- They started scouring the city, looking at nology, the team at Fergus and Glover pride the city centre, the Merchant City and the themselves on keeping patient care at the West End for the ideal ground floor, shop heart of everything they do. front-style premises. In 20ıı, they came However, determined not to rest on across a former retail unit on Hutcheson their laurels, Jacqueline and George had Street in the Merchant City. always planned to grow the business. The question was how and where. Continued »
Scottish Dental magazine 29
Practice profile
Continued » Situated next door to the high-end audio and video retailer Bang and Olufsen, the unit presented a modern all-glass frontage and plenty of potential. The lease was signed in April 20ı2 and, at the beginning of the summer, they put the construction work out to competitive tender, with the building work starting in September last year. The interior of the new practice was ripped out and essentially taken back to an empty shell. The floors were raised and ceilings lowered in order for the plumbing and electrical services to be installed. George oversaw the development and the overall concept of the design and build, with his practice manager Mikey Bateman room and a private consultation room for Morag Powell who is relocating to Glasgow running the project on the ground. patients to discuss their options with the from Aberdeen. The reception and waiting areas manage practice’s treatment co-ordinators. Practice manager Mikey said: “We are to appear comfortable and welcoming, The practice will offer all the same always looking to explore new ways of while still maintaining the contempo- treatments and services that the Aber- working and I think a big benefit to having rary design feel of the exterior. The two deen practice currently provides, with the two practices will be that we will be surgeries in Glasgow take many of their George planning to work two days a week able to take the best bits of both practices cues from the Aberdeen practice – clean in Glasgow when the practice is up and going forward and integrate what works lines, minimalism, high-gloss cabinetry and running. best into the other and so on. glass. The practice also features an LDU He will be joined by implant dentist Abid “It’s an exciting time for us. We can’t wait kitted out with all the latest equipment and Faqir who will also be working two days to open the doors in Glasgow and start stainless steel worktops, a dedicated OPT a week and full-time hygienist/therapist welcoming patients to the new practice.”
Scottish Dental magazine 31 Advertising feature Investing in its people Glasgow laboratory’s success leads to ambitious expansion plans
eca Dental is a family run full service laboratory, known for its dedication to quality, value, Lembracing new technologies and investment in youth opportunities. The company was founded eleven years ago by Tommy Leca and his son Martin who were, at the time, the only employees. However, since then the work force has increased from two to more than 50. Both Tommy and Martin have always believed that the key to a successful labo- ratory is ensuring you have the correct balance of employing experienced, highly gifted technicians while also developing young people. To that end, since 2005, Leca Dental has recruited a minimum of two apprentices every year, ensuring that four days a week are spent in the laboratory learning all the right habits, the Leca way.
32 Scottish Dental magazine Advertising feature
The company has enjoyed a ı00 per enable them and their clients to follow cent retention rate of all apprentices as the progress of every single piece of work they look to broaden their skill base and that comes into the lab. Each item of work opportunities with the lab. All of the quali- will be assigned a barcode and this will fied technicians are GDC registered, with be scanned at each stage of its journey various members of staff travelling around through the laboratory, ending with the the world to gain additional training and driver scanning and gaining a signature of qualifications in, for example: implan- receipt at the dental practice upon delivery. tology, E-Max and Valplast. This will not only ensure a robust audit Based in Hillington, Glasgow, Leca Dental trail, it will allow dentists to log in to their has six vans on the road offering a free daily own private portal to track where each pick-up and delivery service throughout piece of work is, and when it is expected Scotland’s Central Belt, as far south as to be ready. The system is undergoing its Dumfries and Galloway and as far north as final stages of testing before being rolled Aberdeen. Clients further afield enjoy the out to all customers in the coming months. benefits of a free UK postal service, many As Leca Dental’s range of products and of whom are repeat customers that have services has expanded and more staff have moved away and have been unable to secure been brought on board to fulfil the work, a laboratory in their local area to provide the it has become apparent that the business same high standards as Leca Dental. has outgrown the building it currently Originally better known as a denture occupies. Tommy and Martin hope to “Leca Dental laboratory, in recent years Leca Dental has stay within Hillington Park Industrial built a very reputable crown and bridge Estate and they are currently exploring has built a very department in addition to investing in a the options that the complex offers them. NobelProcera scanner to provide a range With scope to double the current size of reputable crown of implants, attachments and zirconia building, Leca Dental have big plans to frameworks. facilitate its continued growth while main- and bridge The company has recently invested taining an exceptionally high level department” in a barcode tracking system that will of service.
Scottish Dental magazine 33
Refurbishment profile Inspiring a community When Bert Hay took over the dental practice in Kingussie, he decided a change of brand was needed
n days gone by, the only One dentist who has tested marketing dentists had this theory is Bert Hay, from to do (or, in fact, were Inspire Dental in Kingussie. allowed to do) was put up Originally known as Kingussie their plaque and wait for Dental Practice, Bert and his Ithe patients to come in through then business partner took over the front door. the business and its sister prac- Things have moved on quite tice Aviemore Dental Practice a bit from those days, with in 2004 after the owner passed modern practices developing away. For the last five years, Bert their brands and undertaking worked solely out of Aviemore. more and more sophisticated However, this summer, the marketing and advertising opportunity arose for Bert to opportunity to work together Bert explained: “I think in techniques. join forces with his friend Chris was too good to pass up. the past there had been some However, when it comes to Barrowman and take over the Bert and Chris took over in reservations about changing changing the name of an estab- running of the one-surgery July and set about revamping the long-standing practice lished practice in a rural area, Kingussie practice. Chris, who the practice. Their biggest deci- name, with concerns that long- there is always going to be an owns Infinityblu Dental Care sion was what to do with the term existing customers might element of uncertainty – would in Pitlochry, has been friends practice name and, after lengthy become put off or confused. people be put off and see it as with Bert since their days at discussions, they decided to too big a change? Dundee Dental School and the change it to Inspire Dental. Continued »
Scottish Dental magazine 35 36 Scottish Dental magazine Refurbishment profile
Continued » complete with unique lighting features and branding. New “However, we felt we needed chairs were also brought in and something fresh to give the the dental chair was re-covered practice a brand new start, as in the vibrant Inspire pink. well as a unique identity. Bert and Chris invested in “We chose Inspire because a new IT system, including a we want to inspire the local digital X-ray system, as well as community and because we, new signage. They also added as dentists, are inspired by the innovative touches such as advances in modern dentistry. fresh flowers, cups and saucers We put a lot of work and a lot with the branding, SPF 20 lip of budget into getting the brand balm with their logo and golf have gone to six days a week, turn, helps keep the standard of right and getting the image out umbrellas and hessian shop- including three late nights. customer care high. there. We are delighted with ping bags, complete with the They will also have a dental “Finally, our commitment to the way it has turned out and practice livery. therapist, Gemma MacLennan, continual development as indi- how it has been received.” Bert said: “Considerable working one day a week to offer viduals, as a team and as a With the brand logo and time and investment was also a range of treatments for both practice means that we are vibrant pink colour scheme put into developing a website adult and child patients. constantly improving and agreed upon, the decision was to work alongside our initial Bert said: “We have three setting higher standards for our made to close the practice for a marketing campaign. An active main aims: the customer, the patients and staff.” week while the refurbishment social media set-up has proven team and our continual devel- was carried out. New floors to be a key additional factor to opment. We wanted to make ® were installed throughout the our initial growth and commu- the practice really customer For more information on Inspire practice and the walls were nity integration.” focused to make their experi- Dental, visit www.inspire- resurfaced and repainted. And, while it is still only a ence as positive as possible. dental.co.uk, follow them on The reception desk was one-surgery practice, instead “We also have a big focus on Twitter @inspire_dental or ripped out and a new contem- of four short days, Bert and teamwork – making sure we are ‘Like’ them at www.facebook. porary desk was installed, his associate Niall Neeson all pulling together and that, in com/InspireDentalPractice
We would like to wish Inspire Dental all the very best for the future
For more information or to advertise in Scottish Dental magazine, call Ann on 0141 560 3021 or email [email protected]
Scottish Dental magazine 37
Clinical Making a digital impression Duncan Black explores the history and the development of intra-oral scanners in modern dental practice
hen Dr been many entrants to the Gordon market, but the main players Christensen are: CEREC (Sirona), Itero Wcalled digital (Align Technology), True Defi- impressions part of the ‘Current nition (3M) and Trios (3Shape). paradigm shift in dentistry’ The majority of these machines (Christensen, 2007), as usual do not produce a crown at the he was ahead of the rest of the chairside – only the CEREC profession, certainly on this can do that. Even Sirona has side of the Atlantic. Up until realised that a limited number then, there had only been one of dentists are interested in the system of digital impression time investment and learning machines available to dentists: curve involved in milling your CEREC from Sirona. own restorations. The theory of digital impres- To my eye, hand-stacked sions in dentistry started with porcelain by a skilled dental the French dentist François technician has a superior Duret, who first envisioned appearance, important in the his theory in ı970 as a dental anterior segment, but that is student, and finally produced just my opinion. a single crown on a willing These machines, however, subject (his wife) for the ı983 do look good in the modern Academy of French Dentistry practice environment (Fig ı). meeting. His original idea was to send the scanned informa- Why change? Fig 1 tion to a dental laboratory. All this is very interesting Trios in a modern practice environment At the same time, the Swiss to anoraks like me, but why dentist Werner Mormann was change? A recent study found inventing what became the that 44.2 per cent of dental CEREC system, producing impressions of prepared teeth a chairside crown in ı985. submitted to three dental labs These two fundamental types in the UK were unsuitable for of workflow persist today: a making a dental restoration digital impression then a labo- (Storey, Coward, 20ı3). ratory produced restoration Dental impression materials and a digital impression then a are subject to distortion, tearing, chairside produced restoration. and inadequate adhesive use, In 2007, the Itero system came which pulls material away from to market, the second genera- trays. Trays that are too flexible tion of intra-oral scanner. This contribute to inaccuracy. Let’s system now has produced not even mention moisture Fig 2 over two million restorations control. Polyether impression in the USA alone. There have material is very popular with Printed models are very accurate
40 Scottish Dental magazine Clinical
Workflow In this article, I will describe the workflow that occurs when an intra-oral scanner is used in implant dentistry. I have been fortunate enough to have been the first UK dentist to use the 3M LCOS scanner (a second- Fig 3 Fig 6 generation scanner) and also Radiographs show accurate Fig 4 Patient after some inital fit of scanned implant veneer placement the 3Shape Trios more recently Scan flag in sterile packaging (a third-generation scanner), which I use in practice today. implant dentists. How many titanium or zirconia abutments can attest to this. There is an It is used in all situations of us can guarantee that our (Almeida, et al., 20ı3, and Güth, excellent fit (Fig 3). where conventional impres- impressions are cast within 24 et al., 20ı3). The added benefit for sions for restorative work hours, or are transported to the Furthermore, Lee and dentists working with the would be taken. lab in an environment which has Gallucci (20ı3) found that Trios is the flexibility of the The difference between the less than 50 per cent humidity, as operators preferred taking machine. If, for instance, you Trios (and the new Cerec per manufacturer’s instructions? digital implant impressions are concerned about clearance Omnicam), compared with Or are they in the same bag as a when in direct comparison of a preparation, it can give machines of a previous genera- wrapped wet alginate? with conventional impressions. you a digital guide on screen. tion, is that there is no need for This is without begin - So much implant dentistry is If more adjustment is required, ‘powdering’ the teeth before ning to list the things which now CAD/CAM designed. At you can ‘erase’ that small area scanning. Previous genera- could possibly go awry on the the moment our impressions and re-scan it. tions of machine would require laboratory side: incorrect are cast in stone, trimmed and You can examine the margins a layer of titanium dioxide stone mixtures, voids in stone, then digitalised for design of and shape of preparations powder to be sprayed over the dropped models, incorrect copings in titanium or zirconia. prior to emailing the impres- teeth prior to scanning, other- trimming of models, incorrect It makes perfect sense to avoid sion to the laboratory. The wise it was unable to record fitting of analogues to impres- the middle step of casting and machine has a scanner head those surfaces. This can make sion copings, etc. hand trimming and go straight with an autoclaveable/ remov- moisture control more tricky. The models produced with to digital design. Technicians able tip, which is easy to use After implant placement scanning show excellent detail also trim and design digital (it is remarkable how many and suitable time after second- and clear margins. There is models on a large computer intra oral-scanning devices stage surgery, an appointment also ample evidence in implant screen, which is much easier have non-autoclaveable tips!). is required for fixture head dentistry that it can be difficult for identification of margins The scanning process itself is impression. A digital lab to take implant fixture head and soft tissue contours. The very quick. sheet is prepared on the impressions, in patients with printed models handle well Also, a copy will be kept for Trios. Similar to a conven- limited opening for instance, and technicians like them. The all your models digitally. A tional lab sheet, this contains but inaccuracy of conventional preparations and margins are great reduction in the amount information such as patient impressions has been shown to very clear (Fig 2). of gypsum in your practice. details, delivery time and occur with increased implant The results for dentists are The results speak for them- type of restoration. It also depth and implant angle (Link- that restorations require less selves. Fitting times are much allows for all case informa- evicius, et al., 20ı2, Mpikos, et adjustment to fit, and there is reduced in implant and in tion needed, including pre-op al., 20ı2). a reduced number of remakes. conventional crown and This is without any refer- From personal experience, I bridge work. Continued » ence to how our patients feel about having an implant fixture head impression taken. Again, studies show that there is a positive patient reac- tion to digital impressions in comparison to conventional impressions (Wismeijer, et al., 20ı3). There is ample evidence already (Ender and Mehl, 20ıı, and Seelbach, Brueckel and Wöstmann, 20ı3) that digital impressions are very accurate and have potential to improve on the accuracy of conven- tional impressions. This is even more pertinent when conven- tional models would need to Fig 5 be digitalised for production of Scanned arches showing clearance guide
Scottish Dental magazine 41
Clinical
Fig 7 Fig 8 Soft tissue profiles from implant Scan flags secured to implant
Continued » scans if wanted, or the scan of a wax-up in a more cosmetic case. This allows for shade mapping and annotation for individual teeth, if required. The opposing arch is scanned, this usually takes ı.5 Fig 9 Fig 10 Fig 11 minutes. The operative arch is The soft tissue model on a Retracted lips showing hinge articulator completed restorations then scanned after removing Scan flag attached to implant the healing cap/caps. This gives a soft tissue impression full seating of the scan flag. The tions which check restorative In the first case, the patient as the machine is very good at area around the implant is then space and occlusal contacts had been wearing a partial picking up soft tissue contours. rescanned. There is a bite scan (Fig 5). After that all you do is acrylic denture for several A small scan flag is placed in which then occludes the digital press the ‘send’ button. years. She was very unhappy the implant and secured. models. This process usually This information is then sent with the appearance of her A ‘scan flag’ is a small plastic takes a total of 2-4 minutes to your dental laboratory. The teeth. We undertook some computer impression coping depending on the number of technicians will receive the preliminary veneer work on (Fig 4). There are currently implants to be scanned. information within ı0 minutes anterior teeth, which had some scan flags for all major brands There are several post- and be able to review your unsightly fillings (Fig 6). After of dental implants. This gives scanning features that are of impression and respond with implant placement and healing, the software not only the type use. You can review the scans a message back to you if there I scanned the mouth and then of implant being restored, and the scan information. If you are any issues with it. fitted milled temporary crowns but its 3D co-ordinates and suspect an area is inadequate, If you require a monolithic and bridges to increase the angulation. As usual, a check then you can erase it and rescan restoration, or a temporary vertical dimension a little, radiograph is taken to ensure the area. There are also func- restoration direct to an implant increasing restorative space. fixture head or on a titanium After further tissue matura- base, then the laboratory need tion, I scanned again to ensure no further information and can we incorporated the new emer- mill the restoration. However, gence profiles in the final depending on the case and what restorations. Figure 7 shows the you wish, they will usually print scan on the technicians’ screen a model. This can now be printed where you can see the soft with soft tissue if required. tissue shape. Figure 8 shows Any type of restoration can the same but with the scan then be constructed, whether a flags in place. A printed model gold-based crown, either screw with soft tissue was produced or cement retained, implant bar (Fig 9), showing the model restorations, zirconia or tita- with soft tissue on one side and nium abutments and crowns. soft tissue removed showing anologues on the other. The Example cases Fig 12 patient was very happy with I have included a couple of the result (Fig ı0). Scan of scan flag in position on Trios screen. cases to illustrate the workflow, Easy to inspect from any angle and results of the Trios. Continued »
Scottish Dental magazine 43
Clinical
Continued » lutionise dental practice, The second case is a simple both in patient acceptance single tooth replacement. The and clinical efficiency. patient attended with a failed Improved communication post crown in tooth 24. Unfor- with the dental laboratory will tunately, it had been left with a mean better restorations from root fracture for a considerable both the patient’s and the time. The tooth was removed clinician’s perspective. and, following healing, an It is time to change. It implant was placed (Fig ıı). will be a gradual change but A temporary Rochette bridge this is happening all over was constructed. After second Europe and around the world. stage surgery, a scan flag was The UK is slowly changing inserted (Fig ı2) and scanned as practitioners begin to see to construct a temporary, the benefits. As patients milled from Telio CAD (Ivoclar begin to hear about these tech- Vivadent). The scan appears nologies being available, they will very clearly and it is easy to also begin to demand their use. manipulate on the screen of I would like to thank Craig the Trios (Fig ı3). Smith of DTS for his excellent Fig 13 The scan was sent in seconds porcelain work. Designing the temporary crown on technician’s screen to the dental laboratory. The technician imports the scan into the 3Shape software and designs the temporary crown. Figure ı4 shows the manipula- tion of emergence angle. The temporary can be checked for excursive contacts on one of 5 ‘virtual’ articulators (Fig ı4). Fig 15 The occlusal carving of the Refining occlusal carving temporary can be finessed on on temporary crown screen (Fig ı5). The temporary was fitted and further tissue maturation ABOUT THE was allowed. If required, addi- AUTHOR tional material can be added to the Telio CAD temporary Dr Duncan Black BDS, MJDF RCS to build further tissue support. (Eng) is the principal dentist at Somerset Place Consulting. He Another scan was taken to is a member of the Association Fig 14 record the new emergence of Dental Implantology and the Designing occlusal surface of temporary crown, profile, and a final restora- Academy of Osseointegration. with the help of a virtual articulator tion was constructed: a screw retained zirconia crown. If the final restoration is a monolithic one, for example REFERENCES full contour zirconia or Lava Ultimate restoration, then no Almeida E Silva, JS, Erdelt, K, Edel- Lee, SJ, Gallucci, GO, 2013. Digital and conventional impression tech- model will need to be made. hoff, D, Araújo, E, Stimmelmayr, M, vs. conventional implant impres- niques and workflow. Clinical Oral Vieira, LC, Güth, JF, 2013. Marginal sions: efficiency outcomes. Clinical Investigations, Sep; 17(7): 1759-64. For a gold/porcelain or, as in and internal fit of four-unit zirconia Oral Implants Research, May;17(4): Storey, D, Coward, TJ, 2013. The this case zirconia porcelain, fixed dental prostheses based on 1201-8. quality of impressions for crowns then a model will be printed digital and conventional impression Linkevicius, T, Svediene, O, Vinda- and bridges: an assessment of the techniques. Clinical Oral Investiga- siute, E, Puisys, A, Linkeviciene, work received at three commercial and used in the construction of tions, May 29. [Epub ahead of print] L, 2012. The influence of implant dental laboratories, assessing the the final restoration (Fig ı6). The Christensen, GJ, 2007. Current placement depth and impres- quality of impressions of prepared paradigm shifts in dentistry. sion material on the stability of teeth. European Journal of Prostho- patient was delighted with the Dentistry Today, Feb;26(2):90, 92, an open tray impression coping. dontics and Restorative Dentistry, try in of the restoration (Fig ı7). 94. Journal of Prosthetic Dentistry, Jun;21(2):53-7. However we decided improve- Ender, A, Mehl, A, 2011. Full arch Oct;108(4):238-43. Wismeijer, D, Mans, R, van scans: conventional versus digital Mpikos, P, Tortopidis, D, Galanis, Genuchten, M, Reijers, HA, 2013. ments were needed and the impressions - an in-vitro study. C, Kaisarlis, G, Koidis, P, 2012. The Patients’ preferences when final restoration had improved International Journal of Computer- effect of impression technique comparing analogue implant colour and length (Fig ı8). ized Dentistry, 14(1):11-21. and impression angulation on the impressions using a polyether Güth, JF, Keul, C, Stimmelmayr, M, accuracy of external- and internal- impression material versus digital Beuer, F, Edelhoff, D, 2013. Accu- connection implants. International impressions (Intraoral Scan) of The future racy of digital models obtained by Journal of Oral and Maxillofacial dental implants. Clinical Oral direct and indirect data capturing. Implants, Nov-Dec;27(6):1422-8. Implants Research, Aug 14 doi:10. Digital dental impressions Clinical Oral Investigations, May; Seelbach, P, Brueckel, C, Wöst- 1111/clr. 12234. [Epub ahead of are a clinically available 17(4):1201-8. mann, B, 2013. Accuracy of digital print] technology that will revo-
Scottish Dental magazine 45
Restorative Tooth in a year and a half While immediate implant placement and other accelerated treatment protocols have a place in the implant dentists’ armamentarium, Crawford Bain presents a case that benefited from a little more time
he use of dental popular more accelerated implants has treatment approaches. become a main- stream treatment Case report method in tooth Patient RR was a healthy, Treplacement. In recent years, non-smoking 44-year-old much emphasis has been male, who presented with a placed on rapid restoration complaint of an unaesthetic of the lost dentition with upper right central incisor, extraction, implant placement, with extensive recession grafting and restoration on showing a large amount of occasion being combined in darkened labial root surface. one appointment to allow the The situation was wors - patient to minimise or elimi- ened by a high smile line Fig 2 nate time spent in a removable and a porcelain crown Initial clinical examination prosthesis. This has been vari- contrasting dramatically with ously described as ‘Teeth in an the root colour. hour’, ‘Teeth in a day’, ‘Diem’ The patient had experi- and ‘All-on-4’, as well as several enced periodic swelling other buzz phrases. at the apical part of the While shortened treatment recession over a long period. protocols offer clear benefits There was also a history of in simple tooth replacement trauma in his teens, leading cases where rapid restora- to root canal treatment and a tion of function is the crown, and subsequent apicec- primary objective and tomy in his 20s. all necessary hard and soft Clinical examination Fig 3 tissues are present (ITI revealed an otherwise peri- Bialteral pedicals using adjacent Classification “Straightfor- odontally healthy, well papilla to cover connective tissue Fig 2 ward”), they have potential looked-after mouth (Figs ı surfaces of the tuberosity graft One year on shortcomings in more complex and 2). and aesthetically demanding Diagnosis was of endodontic situations, which fall into failure and possible root frac- Rebuilding the lost epithelial graft from the tuber- the ITI ‘Advanced’ or ture, leading to loss of labial soft tissue osity – using a distal wedge ‘Complex’ classifications. bone and soft tissue. ı. Fabrication of a tooth-borne technique. This article presents a The treatment plan was immediate partial denture. 5. Bilateral pedicles using case where treatment over essentially divided into three 2. Extraction and the split root adjacent papilla to cover the a protracted period of time stages: confirmed. connective tissue surfaces of results in an outcome which • Rebuilding the lost soft tissue 3. De-epithelialise the socket the tuberosity graft (Fig 3). could not predictably be • Rebuilding the lost bone and ensure bone bleeding. achieved with the currently • Replacing the tooth 4. A connective tissue and Continued »
Scottish Dental magazine 47 Restorative
Fig 4 Fig 5 Fig 6 Fig 7 Underlying bone was curetted Endobon xenograft material was OsseoGuard xenograft mem- Flap sutured with 4-0 silk with a Rhodes chisel and a round placed after being moistened brane was trimmed and fitted to achieve primary closure burr to ensure bone bleeding with blood and saline once seated under the flap over the site
Fig 8 Fig 9 Fig 10 Fig 11 A 15mm Full Osseotite straight- As the implant was largely in Temporary cylinder and a This was torqued to 20N/cm sided hex implant is placed with regenerated bone, no additional clear crown form fabricated and cotton wool and Cavit an insertion torque of 45Ncm grafting material was required a temporary crown placed in the access hole
Continued » Rebuilding the lost bone 4. OsseoGuard xenograft bone, immediate restoration ı. Re-entry was carried out membrane (Biomet 3i) was was not attempted. No addi- 6. Fitting and adjusting as at four months using a full trimmed and fitted once it seated tional grafting material was necessary the tooth-borne thickness flap for access. passively under the flap (Fig 6). needed (Figs 8 and 9). immediate partial denture. 2. Underlying bone was 5. The flap was sutured with 3. After four months, exposure 7. Monitoring of soft tissue curetted with a Rhodes chisel 4-0 silk to achieve primary was carried out using a punch healing. Tissue from the tuber- and a round bur was used on the closure over the site (Fig 7). gingivectomy approach. osity and adjacent papillae labially-facing surface of bone 6. The partial denture was 4. A temporary cylinder was gives a better match than to ensure bone bleeding (Fig 4). adjusted and refitted after seated and a clear crown form palatal tissue. We are ready to 3. Endobon xenograft material ensuring there was no posi- was used with cold cure acrylic re-enter when incision lines are (Biomet 3i) was placed after tive pressure in the area of the to fabricate a temporary crown. fully closed. being moistened with blood grafted bone. This was Torqued to 20N/cm and saline (Fig 5). 7. Monitoring of healing. and cotton wool and Cavit Sutures were removed at two placed in the access hole (Figs weeks and periapical X-rays ı0 and ıı). “We enjoy fast food… but taken at two and four months 5. Four week’s healing was to check for good graft conden- allowed for gingival contour prefer slower fine dining ” sation and to ensure there were to be developed (a little longer no voids in the graft material. would have been preferred, The timing of implant place- however the patient was ment will also depend on bone moving away from the region) available beyond root apex (Fig ı2). position. 6. Pick-up coping impression was taken with Impregum Replacing the tooth injection into sulcus to ı. The graft was left to mature capture emergence profile for six months then a full thick- developed with the tempo- ness papillae preserving flap rary crown. Occlusal records was used to access the site, and shade were taken and revealing excellent regener- agreement was reached with ated bone. the patient on a midline dias- 2. A ı5mm Full Osseotite tema to improve symmetry straight-sided external hex (Fig ı3). implant (Biomet 3i) was placed 7. The porcelain fused to metal, with an insertion torque of screw retained crown was Fig 12 45Ncm. Because the implant tried in, and the fit and occlu- Four weeks’ healing was allowed for gingival contour to be developed was largely in regenerated sion were checked then, after
48 Scottish Dental magazine Restorative aesthetics had been approved Conclusions We may all enjoy fast food by the patient, a square Goldtite This case report illustrates occasionally, but generally ABOUT THE screw was torqued to 32 N/cm that not all tooth replacement slower, more relaxed fine and access sealed with cotton problems can be managed by dining is preferred. It is perhaps AUTHOR wool and composite. immediate or rapid implant appropriate to consider Dennis Crawford Bain BDS DDS MSc 8. A final X-ray was taken and restoration. While the concepts Tarnow’s maxim: “Do one MBA is professor of periodon- tics and programme director of oral hygiene instruction and of immediate replacement and miracle at a time.” graduate periodontics at Dubai recall advice were given. immediate loading of implant School of Dental Medicine. 9. The patient returned one prostheses certainly has a Acknowledgements year later for a recall examina- place in our armamentarium, • All laboratory work by DTS tion and X-ray and was still it is not applicable to all Laboratory delighted with the aesthetic situations and is certainly a • Annibale Coia referring improvement (Figs ı4 and ı5). long way from being a panacea. dentist
Fig 13 Pick up coping impression was taken with Impregum Fig 14 Fig 15 injection into sulcus One year on X-ray one year later
Scottish Dental magazine 49
Clinical Managing aggressive periodontitis Dr Jose Armas describes the management and treatment of a patient diagnosed with generalised aggressive periodontitis
he following case periodontal condition. Main day. No previous HPT for her The majority of the dentition report describes complaints for the last two periodontal disease. exhibited increased mobility the manage - previous years were: and furcation involvement was ment of a patient • Inadequate aesthetics Medical history evident in relation to the molar with generalised • Tooth mobility Fit and healthy 42-year-old teeth. These findings are shown Taggressive periodontitis, • Migration female. No reported allergies. in Figure ı. combining non-surgical/ • Bleeding on brushing Non smoker and moderate The dentition was heavily surgical periodontal • Sensitivity. alcohol consumption (ı6 restored, predominantly with therapy, regenerative proce- units/week). amalgam. Tooth 22 was restored dures, orthodontic and Dental history with an all-ceramic crown. restorative treatment to The patient had been an Examination Tooth ı2 appeared discoloured address inadequate aesthetics. irregular attendee to GDP Extra-oral at the disto-incisal area due in previous years. This has Competent lips with a medium- to the presence of a cingulum Presenting complaint improved in the last six months. high upper lipline showing amalgam restoration. Tooth 46 Female patient, 42 years of age, The current oral care regime full crown length of maxillary presented with fracture of the referred by her general dental consisted of tooth brushing central and lateral incisor teeth amalgam restoration. practitioner for the assess- and the use of interdental when smiling, without any ment and treatment of her brushes three to four times a gingival display. Occlusion Otherwise, nil of note. Class one incisal relationship in a skeletal class one. The Intra-oral maxillary incisor teeth were Soft tissues were moist and proclined with a presenting healthy. Oral hygiene was overjet of 4mm on tooth ı2 adequate with minimal isolated and 3.5 mm on tooth 2ı, they supragingival plaque deposits, also had a triangular shape and mainly located in the poste- were spaced out approximately rior interdental areas. There ımm to ı.5 mm between all was no evidence of suprag- anterior teeth. ingival calculus, but there were The maxillary tooth 2ı was generalised deposits of over erupted approximately subgingival calculus. ımm. Dental maxillary and Gingivae appeared gener- mandibular midlines were ally erythematous and there displaced by approximately was brisk bleeding on probing ı.5mm to the left side and Fig 2 (BoP). Probing depths ranged not coincident with the facial Periapical radiographs at time of initial presentation between 3mm and 9mm. midline.
Additional investigations • Full periodontal examination (Figure ı). • Full mouth periapical radiographs (Figure 2). The following findings were observed: – Generalised moderate hori- zontal bone loss, ≥ 50 per cent, of the root length in both maxillary and mandibular Fig 1 Periodontal pocket probing depths and tooth mobility recorded at initial presentation arches. More advanced hori-
52 Scottish Dental magazine Clinical
zontal bone loss, ≥ 75 per cent, in the maxillary left quadrant. – Vertical bone defects mesial aspect of teeth 37 and 42. – Evidence of furcation bone loss present on the maxillary molar teeth and tooth 46. – Evidence of endodontic treatment of tooth 22 with adequate apical obturation. This tooth was restored with a customised post-core of adequate width and length. There was no evidence of periapical pathology associated Fig 3 Six probing pocket chart with this tooth. – Tooth 46 showed evidence of endodontic treatment with inadequate root preparation and inadequate obturation. Both the mesial and distal roots had poorly condensed root fillings that were more than ı5mm short of the radiographic apex. Periapical pathology was evident on the mesial root. Fig 4 Six probing pocket chart taken at re-assessment post surgical phase therapy Diagnoses • Generalised aggressive periodontitis • Chronic periapical periodontitis due to failed endodontic treatment • Failed restoration of mandibular tooth 46 • Missing teeth • Inadequate aesthetics. Fig 5 Six probing pocket chart at review visit after supportive phase therapy
Treatment plan • General dental practitioner sodium fluoride and prescrip- been noticed since the high- Ten weeks after the surgical to assess tooth 46 for repeat tion of high content of sodium fluoride desensitising agent therapy was completed, root canal treatment and fluoride dentifrice for daily use. had been applied. the patient was reassessed. full coverage restoration At re-evaluation after The areas with persistent Complaints at this stage were: • Hygiene phase therapy non-surgical hygiene therapy, pockets were treated surgi- • Generalised cervical • Re-evaluation the main complaints were: cally. The grade two buccal gingival recession • Open root surface • Generalised cervical furcation of tooth ı6 also • Large interdental instrumentation sensitivity required regeneration with spaces present in the as indicated • Generalised gingval xenograft material (Bio-Oss, maxillary anterior sextant. • Re-evaluation recession. Geistlich) and a resorbable Intraorally, the oral hygiene • Orthodontic-restorative collagen membrane (Bio-Gide, and supragingival plaque Treatment for aesthetic Intraoral examination revealed Geistlich. The muco-periosteal control was excellent. Minimal improvement excellent oral hygiene, with no flap was coronally advanced supragingival calculus • Supportive periodontal supra gingival plaque deposits and sutured with polypro- deposits had reformed lingual therapy. detected. Gingivae appeared pylene monofilament suture. to the mandibular incisal pink and moist, with good tissue Four weeks after surgical teeth. The periodontal exami- Hygiene phase therapy tone and evidence of gener- instrumentation of the mandib- nation of the full dentition Hygiene phase therapy was alised gingival recession of ular right molar area, the revealed no pathological completed over eight visits. 2-3mm (Figure 3). Periodontal patient developed a lateral probing depths, no bleeding During this time, the patient examination demonstrated periodontal abscess. It was on probing and isolated developed generalised mild residual probing depths of drained under local anaes- increased mobility as shown dentine hypersensitivity 5-6mm with increased mobility thesia and a three-day course of on the pocket chart shown in that was treated with a of several teeth as seen in Metronidazole 400mg was Figure 4. combination of topical the pocket chart shown in prescribed in conjunction application of desensitising Figure 3. Slight improvement with analgesia as required and agent with high content of in the general sensitivity had chlorhexidine rinse twice a day. Continued »
Scottish Dental magazine 53 Clinical
Fig 6a Fig 6b Fig 6c Fig 6d
Fig 6e Fig 6f Fig 6g Fig 6h
Frontal and lateral intraoral views with the labial veneer in place on the left hand side and without on the right. Extraoral views with forced smile
Continued »
There was clinical evidence of a good response to surgical therapy with reduction in periodontal probing depths, mild gain of attachment, reduction of tooth mobility and improvement in the areas of furcation involvement. Fig 7 Six probing chart Supportive phase therapy The patient was placed on a supportive phase therapy patient’s main concern was oral hygiene with a stable appliances with additional programme with a dental the large interdental “gaps” periodontal condition as seen interproximal stripping to hygienist on a three-monthly present in the maxillary from the pocket chart dated reduce the interdental spaces basis, with instruction to anterior sextant. The perio- 20-ı0-09 (Figure 7). Tooth ı7 in both arches, retrocline the re-instrument deep pockets of dontal condition was good and showed isolated distal and maxillary anterior sextant ≥ 4mm that bled on probing. stable as seen from the pocket buccal pockets of 5-6mm to create contact points and This can be a sign of re- chart in Figure 5. It was felt that requiring additional non- intrude maxillary tooth 2ı to colonisation of pockets. In the patient would benefit at surgical re-instrumentation align the incisal edge with the addition, re-enforcement of this stage from a labial acrylic under LA. Teeth 24 and 25 contralateral incisor tooth. the importance of good suprag- gingival veneer in order to exhibited increased mobility of The patient was aware ingival plaque control with address her aesthetic concerns. grade ı requiring removal of the of the need of permanent daily use of interdental brushes. The result is acceptable occlusal interference adjusting retention in the form of palatal At the eight-month review, considering the lack of contact the occlusion in lateral excur- bonded wire. It was also points present between the sions. Taking into account made clear that, due to the lateral and central incisor teeth the excellent motivation of shape of her maxillary teeth “The result and thus the impossibility of the patient and medium-term and the gingival recession as filling the whole interdental periodontal stability, an ortho- a result of the periodontal is acceptable space with the acrylic material. dontic opinion was sought to treatment received to date, This was an interim measure assess suitability for treatment. orthodontic treatment alone considering prior to the orthodontic would not remove the “black the lack assessment and treatment Orthodontic- triangles”. For that reason, (Figure 6). restorative treatment restorative treatment in the of contact During a tailored periodontal Following an orthodontic form of composite additions maintenance programme, the assessment, the patient received mesial and distal to the central points” patient maintained excellent maxillary and mandibular fixed and lateral maxillary incisor
54 Scottish Dental magazine Clinical teeth, plus replacement of the ask appropriate questions that will guarantee the long-term suffering from aggressive all ceramic crown of maxil- concern them. stability of the periodontal periodontitis must be closely lary tooth 22, should follow to The patient must demon- disease for the molar teeth. monitored. If reinfection obtain an overall better result. strate good motivation, The provision of the labial occurs, disease tends to have Or, alternatively, continue and maintain excellent acrylic veneer involving six a more rapid progression with the labial gingival acrylic supragingival plaque control units, although not ideal than any other periodontal veneer (Figure 8a). Additional to achieve periodontal stability because of the proclined condition. hygiene support was provided overtime before the aesthetic position of the maxillary A tailored maintenance to avoid any relapse of the and mobility concerns could teeth and the lack of contact programme is of great impor- periodontal disease during be reviewed. points, has proved to be tance to arrest at early stages orthodontic treatment. The maxillary molar teeth successful in addressing and any occurring reactivation were treated differently. There improving the aesthetics of the that might take place. A three- Appraisal of the is good evidence to support maxillary anterior sextant as an monthly appointment seems treatment outcomes buccal furcation class two in interim measure. to be an adequate regime. One of the keys for success molar teeth responding well A more pleasing result in periodontal treatment is to regenerative techniques. to attempt infill of the to make sure that the patient This is not the case for molar interdental spaces has required a ABOUT THE understands the etiological proximal furcations class two. combined orthodontic-restora- AUTHOR cause and evolution of his/her In this case, the left maxillary tive approach. Full commitment disease and the role that he/ molar teeth did not receive of the patient understanding Dr Jose Armas MBBS, BDS, MFDS (Glas). MRD (Perio). she has in it. Spending time at additional treatment after the length of time that this Specialist periodontist the first visit with the patient the surgical instrumentation. type of approach involves and practicing at Somerset Place and giving them adequate time The proximal furcations were maintaining excellent oral Consulting and consultant in periodontics at Glasgow Dental to process the information left to heal by repair. A targeted hygiene during the orthodontic School and hospital. received will allow them to supportive therapy programme phase is paramount. Patients
Fig 8a Fig 8b
Fig 8c Fig 8d
Post orthadontic treatment frontal and lateral intraoral views with labial veneer in place
Scottish Dental magazine 55 Orthodontic practice feature Making their patients beam Dundee orthodontic practice is striving for perfection every single day
eam Specialist is the place to refer your own Orthodontic much-loved patients to. Quite Practice’s prin- simply, we’ll care for them as cipal orthodontist you would expect and wish Ruaridh McKelvey for your own kin. We’ve also B(known as Rhu) sums up created an amazing place to his craft quite simply. “As come to work and patients pick specialist orthodontists, we up on that as soon as they walk perfect smiles using braces. It’s through our doors.” all we do,” he says. However, The success and ethos of Beam do much more than that. Beam undoubtedly lies with The energetic team at the the Beam team. Launching Dundee clinic, who work with patients from throughout Fife, Stirlingshire, Perthshire and Aberdeenshire, as well as Tayside and Angus, don’t just correct imperfections. They strive for perfection and, every day, go above and beyond what’s expected – whether the ‘customer’ is an NHS dentist, NHS patient or a private patient. Beam was unveiled in 2007 when Rhu and his wife Jane, a dentist and talented interior designer, set about converting the warm, enthusiastic great lengths to ensure a seam- the former Evangelical Church and friendly environ- less relationship with our Hall in Dundee’s buzzing ment that greets patients, referring dentists. We more Cultural Quarter into the whether they’re private than understand the daily pres- state-of-the-art practice or NHS customers.” sures facing general dentists Beam is today. with one specialist orthodon- When it comes to NHS and work hard on perfecting A real ‘Grand Designs’ tist and two part-time nurses, orthodontic treatment, Beam our communication and feed- project, the result is simply the practice now employs a enjoy an excellent relation- back systems to ensure that stunning, with an open-plan, team of four fully-qualified and ship with dentists along the we not only handle refer- cutting-edge clinic enabling in-house trained orthodontic east of Scotland, with only rals professionally, but work orthodontic therapists to work therapists, six orthodontic orthodontists on the GDC’s successfully as a team, particu- closely with specialist ortho- nurses, two receptionists, a specialist list looking after their larly on multi-disciplinary dontists, complemented by practice business manager and patients’ treatment planning cases. more private treatment spaces. a treatment coordinator. and management. Beam under- “Our orthodontists are easily Speaking of the fantastic Rhu said: “We are exception- stands the potential difficulties available to discuss specific environment, Rhu said: “It’s ally proud of our team who faced when referring to an treatments and multidiscipli- our wish that patients enjoy are constantly working hard outside team and values each nary cases, working alongside the process as well as the result to reflect Beam’s ethos and patient referral. the dentists’ own treatment of our treatments and Beam brand. It’s instantly evident in Rhu explained: “We go to aims, to make the restorative
56 Scottish Dental magazine Orthodontic practice feature outcomes as successful as they Jane said: “In the very early are always happy to embrace can possibly be.” days of Beam, we were aware at Beam and expect our team Putting the clinical side of that the piles of paperwork to be able to follow suit. We do dentistry aside, Beam also were mounting and that the constantly try to be the best we prides itself on being a ‘hub’ business side of things could can be, and that is one fabulous for referring dentists, who can become suffocating. That’s advantage about being an inde- tend to feel isolated in their when we joined Breathe Dental pendent owner-run creature day-to-day working lives. Coaching, run by former dentist – if something isn’t working, Through ‘Beam Business Dr Simon Hocken. That saved then we try something new Rhu Basics’, Beam offers CPD veri- our lives and became the cata- until it does.” McKelvey fiable meetings and events, lyst for change and progress. And it’s not all work, Beam which cover everything from “We’re eager to pass on also hosts regular informal key performance indicators the lessons we have learnt to social gatherings which allow TESTIMONIAL and staff issues to patient other dentists who can easily for the much-needed and off- engagement processes. find themselves swallowed up the-record interactions, and “Thanks to a great team, your skill and competence are one Beam also offers in-house by the non-stop clinical and chances to discuss cases. thing, but it’s your warmth training for referring dentists’ hugely administrative job that and empathy that make you clinical support teams, be it is NHS dentistry. We certainly So what’s next for Beam? outstanding.” Patsy Whelehan, Beam patient. clinical photography, impres- haven’t got everything right but “Our vision is to open one or sion taking or help achieving it’s good to share even the diffi- two more Beams,” said Rhu. radiology exam practicals. cult experiences with others “The only sticking point is to “After much blood, sweat and The hub provides a platform and learn from each other”. pinpoint the people who ‘get tears – and a lot of investment! for informal sharing of ideas It seems that Beam never it’ and who will honour the – I’m extremely proud of our and experiences, with Beam stand still, and are not afraid of brand and do it justice which is Beam set-up and, underpinned sharing their own systems trying the new, be it clinical or why we’re currently seeking an by the passion which the entire and knowledge often gleaned management techniques. additional specialist orthodon- Beam team share, truly believe over years of involvement with Jane continued: “As with the tist to grow the team, and bring that we’ve got the structure in their mentors at ‘Breathe rest of life, the one certainty is a relentlessly positive attitude place to move onwards and Dental Coaching’. change – that’s something we to work every day. upwards.”
Scottish Scottish Dental Dental magazine magazine 57 Orthodontic practice feature Lucky number 13 for Edinburgh Orthodontics Anniversary celebrations for Gilmore Street-based specialist clinic
dinburgh Orthodontics has nologies, we have continued to focus on be faster and less costly than the quick-fix become a teenager! It is ı3 years using our specialist knowledge to provide branded products. this month (October) since we an optimal treatment plan for each Your patients should only undergo opened for business at Gilmore individual patient. orthodontic treatment once. We feel Place. Over the years, we have In an era when one is bombarded with that it is important that all options are Ebecome an established and respected the seductive promises of ‘quick fix’ discussed with your patient to ensure an member of the Scottish dental fraternity. branded orthodontic products, we believe appropriate and optimal treatment. We All our team are GDC-registered that there is no substitute for specialist are delighted to liaise closely with the specialist orthodontists, who provide knowledge and experience in delivering referring practitioner either by phone, continuity of care for your patients from quality orthodontic care. e-mail or meeting in person to optimise initial assessment to completion and As we can offer all systems, from interdisciplinary care. retention of their orthodontic treatment. conventional fixed appliances, through So, whether it is orthodontics for chil- We believe that this continuity provides aesthetic ceramic systems, to Invisalign dren and teens, quality aesthetic treatment optimal care and quality of outcomes. and hidden lingual braces, we can find for adults or complicated orthodontic/ While we have embraced new develop- an optimal solution that is appropriate to restorative cases, we have the knowledge ments in the specialty, such as miniscrew your patient’s clinical problem and needs. and experience to help you achieve the best implant anchors and the digital tech- Indeed, our specialist solutions can often for your patients.
58 Scottish Dental magazine
Orthodontic practice feature Ensuring great smiles Gavin Caves Orthodontics is thriving in the heart of East Lothian
avin Caves graduated from Having spent ı0 enjoyable years Edinburgh University with working in two of the largest specialist his BDS in ı993 – receiving practices in Edinburgh (Scottish Ortho- the class prize in ortho- dontics and Edinburgh Orthodontics), dontics – and gained his Gavin decided it would be great to start GFDS from the Royal College of Surgeons his own small, personal practice and of Edinburgh (RCSEd) in ı996. He then realised the perfect geographical need completed his three year orthodontic for an orthodontist was in the heart of specialist training in Glasgow, graduating East Lothian, Haddington. with an MSc from the University of From one day a week, Gavin’s practice Glasgow and his Membership in Ortho- has grown by word of mouth to become full dontics from RCSEd in 2000. time, with over ı,500 referrals received so Gavin has worked in specialist ortho- far. Every patient is seen from start to finish dontic practice in Edinburgh since 2000 by Gavin, whose meticulous attention to and was also involved for many years detail and friendly nature ensure that all with the clinical teaching of postgraduate of his patients have great smiles. students at the Edinburgh Dental Institute A comprehensive range of appliance ® until starting his new specialist practice types are available, from NHS fixed appli- Gavin lives with his wife Marian, in Haddington in 20ı0. He is an ances for all ages to ceramic fixed a part-time GP, and his three loud examiner for the Edinburgh Royal College appliances, Incognito Lingual appliances and amazing children – Hannah (8), of Surgeons in MOrth. and Invisalign. Cameron (6) and Rachel (3).
Scottish Dental magazine 61
Orthodontic practice feature Saying a big thank you! Glasgow Southside Orthodontics shows appreciation to its referring practitioners by expanding its team further to improve service
lasgow Southside Lindsey’s appointment will Orthodontics help spread the workload and (GSO) wish to allow us to cut down the time say a big thank between referral and initial you to all the assessment of the patients. Gdental practitioners who refer To make referrals as easy patients to us. as possible, we have recently GSO was established in updated our Dental Prac- 2009 by Nadia Hajjaj and Fern titioners’ Referral Form on Stewart and has steadily grown our practice website. Alterna- over the last four years. tively, we can be contacted by At Glasgow Southside Ortho- telephone, by e-mail or in dontics, our aim is to continually writing (for this last option review and strive to improve the we can supply you with services we offer and at this Referral Pads). stage in our development, we Again, thank you for your are delighted to announce the ongoing support and we look appointment of Lindsey Church forward to continuing to offer who has joined us as a third you our best attention at Above: Nadia Hajjaj and Fern Stewart specialist orthodontist. all times. (inset) Lindsey Church
Scottish Dental magazine 63 Orthodontic practice feature Park life Andrew McGregor, specialist orthodontist, outlines exciting changes at Park Orthodontics
he world has We’re proud of our new changed since ı972 waiting room which was when our clinic completed in summer 20ı3. A lingual and aligner cases. first opened on big effort was made to keep the This has been an exciting which require pre- the southern side Victorian features of the West challenge for us, allowing our restorative orthodontics. Tof Kelvingrove Park. It was End property, while introducing clinicians to develop new skills Working closely with those the only specialist orthodontic new features such as a Smart with new appliances: lingual providing the restorative work practice in Glasgow and, since TV, contemporary furniture and braces in particular are opening is something we enjoy and most then, has been passed down original art. up possibilities to a whole importantly it’s improving the to successive specialists, right We’ve been updating our group of patients who would final results for our mutual up to the current partnership service too. NHS orthodontics previously not have considered patients. which commenced in 20ı2. still makes up the majority of orthodontic treatment. Throughout the 40 years of The practice has changed our workload, but, as more We’re also witnessing an orthodontic provision, the with the times; never more so adults are looking for aesthetic increase in the number of focus has been on quality than in the last year as we have and discreet solutions to suit referrals undergoing multi- service to both patients and modernised and improved the their lifestyle, we’ve seen a disciplinary care, usually referring dentists. We keenly orthodontic experience. rise in the number of ceramic, involving implants and bridges, anticipate the next 40...
64 Scottish Dental magazine
Orthodontic practice feature Patient care is top priority Glasgow clinic boasts flexible appointment times and no waiting list
iffnock Orthodontic Centre suit patient’s needs and with free private is a specialist orthodontic consultations, any patient looking to find TESTIMONIAL practice situated on the out about which treatments best suit south side of Glasgow. Our their individual needs can do so without “I have been referring my orthodontic practice has been estab- financial obligation. patients to Giffnock Orthodontic Glished since ı986 and is conveniently The patient’s journey is important to us Centre for many years. The service located close to public transport routes and our aim is to ensure that each patient provided by Yas, George, and the to and from the city centre. We also have is given the time needed to understand team is first class. on-site parking for patients who wish to their treatment options. Our trained treat- “I always ask patients and parents travel by car. ment co-ordinators are a key part of our for feedback and it is invariably We offer NHS and private ortho - team who work alongside our two full-time extremely favourable. My own dontic treatments for adults and children orthodontists Yas Aljubouri (principal) son recently required orthodontic including Invisalign, lingual (Incognito) and George Kantopoulos. They are ably treatment and I had no hesitation and fixed appliances using metal and supported by our orthodontic therapist in sending him to see Yas, who has ceramic technology. From January we Amanda Macrae. worked magic with his mild but tricky will have an additional specialist ortho- malocclusion.” dontist joining our team, which helps to ® Dr Valerie Bleau, Bleau & Small ensure that we have no waiting lists. By For more information, contact our practice Dental Surgery offering flexible appointment times to manager Valerie Noble on 0141 638 4150
66 Scottish Dental magazine Orthodontic practice feature Going from strength to strength ifteen months after IOTN scores, the removal, opening its doors, without any compensation, of St Andrews Ortho- the fee for repairing fixed appli- dontics continues to ances, and the introduction grow from strength that no further NHS support Fto strength and provides an is given to patients after they essential and welcome ortho- have been wearing retainers for dontic service to the East Neuk a year are all examples of new of Fife and its surrounding area. rules that have challenged the With the number of referrals ability of St Andrews Ortho- increasing each week, the prac- dontics to continue to provide tice has increased its clinical orthodontics on the NHS. hours to cope with demand, “However, as part of the and there are plans to increase service to the local area, we staffing levels to maintain the continue to offer all categories excellent service on offer. of patients NHS treatment are seen at the soonest oppor- courses, the aim is to make it Practice partner Nimo where possible.” tunity. Referrals are received easier for referring practitioners Rostami said: “Given the chal- The practice aim is to provide by mail and telephone but are to meet patients’ demands. lenges that all colleagues have the best service to the patients also possible via the practice The practice remains to bear – in a climate of NHS and the referring dentists and website and email. committed to providing NHS cutbacks and spiralling costs thus continue to grow so more One goal is to work with refer- treatment, but also provides the to meet new regulations – we people can benefit from the ring colleagues to assist with latest array of options for those have to confess it hasn’t been service on offer. The staff work their multidisciplinary cases. who would like to explore the an easy ı5 months! The intro- hard to ensure no waiting lists Whether by arranging joint latest in orthodontics that the duction of rationing based on are in place and new patients clinics or individually tailored NHS does not or cannot offer.
Scottish Dental magazine 67
Clinical How do I ensure I don’t miss an oral cancer? Professor Graham Ogden talks about the aetiology and early detection of oral cancers
he early detection of • Failure to make an early diagnosis certain groups have had some oral cancer has now • Failure to refer to a specialist success (e.g. “Give it up for baby” become a recom - • Claiming damages for the conse- – a smoking cessation intervention mended topic by the quences of a failure to detect the for pregnant women in Scotland, General Dental Council cancer at an early stage organised by Paul Ballard and NHS Tfor Continuing Professional Devel- • A perception by the patient that Tayside) there is still a long way to opment. This is, in part, due to an the dentist had not taken their go. Clinicians should be actively increasing number of patients who concerns seriously. involved in raising awareness of are claiming (rightly or wrongly) the potential detrimental effects of that their dentist failed to diagnose Key questions to consider smoking on oral health and giving their mouth cancer and, as such, are when assessing the malignant smoking cessation advice. suing them for negligence. potential of an oral lesion A key question to ask the patient One recent example considered ı. What Risk Factors are present? with a clinically suspicious lesion is: in the High Court in England earlier “Do you smoke?” At least 75 per cent this year, cleared the dentist, but not a)Tobacco of oral cancers are associated with before his being accused of failing to While the number of cigarettes tobacco use. identify the cancer on her gum at an consumed within the UK has With the increase in cost, many early stage. dropped profoundly over the last 25 people are turning to hand-rolled years or so (from a staggering ı02 cigarettes because they are cheaper, What can we do to help billion in ı990), the reduction in the but they may lack an effective filter. minimise such an event? number of smokers has not been Key additional questions include In America, the top reasons why a as dramatic. Approximately 25 per recording type of tobacco use, patient pursues a case of negligence cent of the population in Scotland number of years they have smoked against a dentist in respect of oral still smoke. and daily quantity consumed. cancer are: Although novel approaches to b) Alcohol As with tobacco, it is worth asking about their use of alcohol, as this is an important risk factor for oral cancer, particularly when combined with tobacco use. The Government and indeed all the Royal Colleges, support the guidance as regard low risk drinking. For men this is considered as no more than four units in a day or 2ı units in a week (for women it is no more than three units in a day and ı4 units in a week) with at least two days free of alcohol. Obtaining a reliable alcohol history isn’t always easy, partly because many patients don’t know Fig 1 the alcohol unit content of what they drink, but also because we are often Typical textbook appearance of an advanced oral cancer Reproduced from Dental Update (ISSN 0305-5000), by permission of economical with the truth. Studies George Warman Publications (UK) Ltd. Continued »
Scottish Dental magazine 69
Clinical
“Obtaining manifestation of oral cancer. a reliable Yet leukoplakia is often alcohol considered the most frequent precancerous lesion. By focusing history on the white element, the issue of isn’t always any surrounding erythema may easy... we be lost. Although much is made are often of the white patch, its malignant economical transformation rate is probably less with the than 5 per cent, whereas that of the truth” erythroplakia is at least 80 per cent (far more significant). Having said that, the most significant leukoplakias are those that are large and non homogenous. Far more important and more frequently associated with asymp- tomatic early oral cancer are the so called speckled leukoplakias (eryth- Fig 2 roleukoplakia). Note atrophic red area of early cancer surrounded by satellites of white keratoses 3. What does the early oral cancer look like? The early asymptomatic cancer presents in a far more subtle way than many of the textbooks might suggest. The identification of an oral cancer that has raised, rolled hard edges surrounding an area of ulceration that is oozing blood is an advanced lesion that hopefully no one would miss. Unfortunately, by the time it has that appearance, such an advanced lesion has had plenty of opportu- nity to either invade surrounding tissues (such as bone) or metastasise to local, regional or distant lymph nodes. Our attention as clinicians should Fig 3 be to focus on raising our index of Early oral cancer affecting buccal sulcus. Note the areas of diffuse keratosis suspicion. High risk sites in the UK and atrophy surrounding the ‘whorl’ of slightly raised, reddened mucosa are the so-called non-keratinising sites such as ventral tongue and floor of mouth. However, the routine Continued » many students would appear to be screening and recording in the notes drinking at a level that would trigger of the entire oral mucosa should be have shown that in the UK there a brief alcohol intervention. mandatory. Not only to help detect is a 40 per cent underestimation of The development of an appro- an early lesion, but also to help what people claim they drink, when priate intervention for dental protect yourself from any claims of compared with actual alcohol sales. practice is currently being explored negligence that you failed to detect We have gathered data regarding (Shepherd S, et al Current prac- the cancer at an early stage. drinking habits and understanding tices and intention to provide Such a task that takes minimal of alcohol guidelines over several alcohol-related health advice in time, requires no fancy expensive years during our annual Mouth primary dental care, British Dental equipment, but yet could make Cancer Awareness Week campaigns Journal 2ıı:322-3 20ıı doi:ı0.ı038/ such a difference to the patient’s at the University of Dundee. There sj.bdj.20ıı.822). prognosis (if a cancer is there), is is a tendency for students to under- ignored at our peril. (The use of estimate the number of units of 2. What is the colour? dyes or techniques based upon alcohol in a pint of beer. When this (‘Red is a mean mean colour’) fluorescence or cytology are still is combined with the frequency While I’m sure Steve Harley didn’t being evaluated or have not proved that they admit to binge drinking have oral cancer in mind when he to have the sensitivity or specificity (defined as at least six units in wrote that song, it seems peculiarly to become adopted as routine tests). any one session for women, and apposite. Red is a far more signifi- at least eight units for men), then cant colour when it comes to early Continued »
Scottish Dental magazine 71
Clinical
Continued » • Is it painful? (Pain is a relatively late manifestation, hence a non The recent high profile case in painful ulcer should arouse which the patient attempted to suspicion). sue the dentist for negligence in Remember, the early lesion is failing to detect the oral cancer at often asymptomatic (no pain, no an early stage was exonerated. He ulceration, no bleeding). was greatly helped by the accuracy Remember too that a patient is of his record keeping and screening never too young to get oral cancer. of the mucosa. One in ı0 cases now arise in those below the age of 45 years. Conclusion (See the Ben Walton Trust The early detection of an oral www.benwaltontrust.org) cancer, can quite literally save that patient’s life. In helping to raise your ® index of suspicion when assessing For those who wish to get the malignant potential of an oral involved in raising awareness of ABOUT THE AUTHOR lesion you should consider: oral cancer, for example during • What risk factors are present? (NB Mouth Cancer Awareness Week Prof Ogden is professor of oral surgery at the University of Dundee. His main research themes are aetiology tobacco and alcohol) in November each year, then (in particular alcohol) and early detection of oral cancer. • What is its colour? (NB red) see the link to “You too can raise On the GDC’s specialist list for both oral surgery and • How long has it been present? oral medicine, he is currently president of the Associa- awareness of mouth cancer” tion of British Academic Oral & Maxillofacial Surgeons (It should have healed in two www.benwaltotrust.org/pdf/mouth_ (ABAOMS). to three weeks) cancer_awareness_booklet.pdf Prof Ogden is a former chair of the Special Advisory Committee for Oral Surgery, responsible for writing the curriculum for specialty training in oral surgery. He is also on the Medical Advisory Panel for Drinkaware and is “Remember... a patient is never now a vice dean (Dental Faculty) of the Royal College of too young to get oral cancer ” Physicians and Surgeons of Glasgow.
Scottish Dental magazine 73 Advertising feature Is your dental equipment costing you more than money? Testing company is ensuring the quality of your compressed air
OQ Services Ltd has and procedures. Although or costly procedures to fix. review is near to completion recently been working not novel, our services are Coincidentally, there has been and will give clearer instruc- with both NHS and relatively new to private a sharp increase in demand tions to private dental practices private dental prac - surgeries and, quite often, the on modern dental practices on maintenance and testing tices to ensure their benefits of such testing and to reduce potential risks to requirements with many local icompressed air is not adversely services are not well known. patients. The introduction of governing bodies looking to affecting patients, equipment Poorly maintained or old dental LDUs and water monitoring include testing as part of the compressors often produce as per SHTM 0ı-04 (Part A dental practice inspection. air that is contaminated with: and B documents are currently Sign up to our mailing list at under consultation) will go www.ioqservices.co.uk to make • Water some way to addressing the sure you receive our white • Oil growing concern but, without paper on the guidance docu- • Particulates legislation, dental air is still not ment and the implications it • Viable micro-organisms tested regularly enough and will have for practices like (see pic right). can expose practices to some yours. Do not delay; quality of the high risks outlined above. testing of dental compressed Together, these can lead to The NHS Guidance document air can you save time, money infection, dissatisfaction and/ (HTM 2022 Supplement ı) and patient satisfaction.
74 Scottish Dental magazine Scottish Dental magazine 75 Financial
As the clock ticks down to the Scottish independence referendum, Jayne Clifford of Martin Aitken & Co looks at the potential financial implications
Scottish independence… a real mouthful ith less is the conflicting research and Pensions for both yourselves, and your than a comments that are made. While there is no way to staff. However, as business year to But what does this really draw any conclusions, or owners, and with the upcoming go until mean for you and your dental even predict how this will be auto-enrolment regulations, the 20ı4 practice? Without claiming to affected, it is a widely accepted the ongoing cost of all of this Wreferendum on Scottish inde- have a crystal ball, or coming key issue. Everyone wishes to will also be a significant factor. pendence, you can barely go down on one side of the fence be in the position that they feel With no firm outcome as to a day without hearing another or the other, there are two comfortable and secure when who will be responsible for the story from one side of the fundamental areas that need to they retire. government-based pensions debate or the other. The main be further examined if Scotland You, as practitioners, will be that are already in place, there issue behind all of the stories votes ‘Yes’ on ı8 September. no different in what you wish is potential that this will have
76 Scottish Dental magazine a massive impact on the And if you are an owner in money available to the Scot- an incorporated business you tish Government, should the are also subject to Corpora- referendum go in favour of tion Tax over and above that. the independence. Confused already? This itself may be an indi- Unfortunately there are no rect cost to you and your definitive answers to what practice. If the government will happen post referendum has less funds available to if changes are required. The distribute, then there may ‘Yes’ campaign has predicted be a rethink of what grants that there will be no signifi- and payments are available cant tax changes given the to NHS dentists. There will proposed ‘Oil Fund’ approach also be the potential that that has been muted recently. the criteria for these will be Although, helpfully enough, re-evaluated as a result. the current government in In addition, there may also Westminster has also said be the direct costs related that this approach, similar to to the actual contributions Norway, will not only result that are required to be made. in higher rates of tax being Again, if this is a cost that needed to be paid, but also rises, this will have a direct inflation. impact on you, your staff Clearly there are some key and the ability to grow your questions which need to be business. Recent quotes answered by both parties. At have suggested that National Martin Aitken & Co we are in Insurance will continue to be regular communication with paid in line with current regu- business-owners about their lations, but unfortunately concerns. I feel there are with pensions, it isn’t always many issues which still need as straightforward. to be debated further and I’m sure the press coverage over Tax the coming months will aim If pensions is a complex area, to do this. However, until then then tax has had even less these are areas of considera- said about it in the press, or tion and concern with no by either campaigns. If you definitive answers, yet. are working in partnerships or as a sole trader you are ® already subject to Income Jayne Clifford, partner at Martin Tax at an ever changing rate, Aitken & Co, leads the specialist as well as VAT on most of the dentistry team. Jayne can be purchases for your business. contacted on 0141 272 0000.
Scottish Dental magazine 77
Business and financial New standards Michael Royden explains the GDC’s latest advice on the use of social media in your practice
he GDC have consent. Even where informa- corresponding with individual maintain appropriate personal issued Dental tion is anonymised, a patient patients via social media. and professional behaviour. Team Standards could identify themselves and Social media policy. All This applies to both personal which became raise a complaint. dental professionals should and business use. The impact effective at the end Maintaining appropriate comply with the internet and on a person’s professional Tof September. The guidance boundaries. Social media social media policies of their standing should be considered covers a range of issues, and allows communication barriers practice. Every practice should when using social media, for time will tell as to how they will to be removed. However, if have a policy that is adequate any reason. be interpreted and enforced. you use social media, you are to protect the practice and Many of the GDC Standards The standards are supple- opening your own comments patients. This should be distrib- are in line with expectations mented by some additional up to public consumption. One uted to all team members with prior to issue, but it is essential notes, one of which relates to key question is should friend a clear message that compli- that all team members famil- social media, with three key requests from patients be ance is essential. iarise themselves with them. areas covered: accepted. My answer would be Aside from these guidelines, Protecting patient infor- no. Accepting requests could we would also recommend that ® mation. No information which impact on your professional standard nine is considered Michael Royden is the partner could identify a patient should relationship with a patient. I when using social media. This who heads up the dental team be published without explicit would also recommend not states that all the dental team within Thorntons Law LLP.
82 Scottish Dental magazine Business and financial National recognition Edinburgh-based accountants shortlisted for UK-wide awards
tark Main & Co achieve absolute compliance, Dental has been grow their practices and reduce AWARD shortlisted as Scot- their tax bills significantly. WINNERS tish Accountant As part of its genuinely of the Year in the proactive approach, it saved SBritish Accountancy Awards, its dental clients an average of British Accountancy and waits with bated breath to £25,000 last year and £86,000 Awards 2012 – Scottish see if its scoops the award at for practice acquisitions. Accountant of the Year the ceremony in the Tower of As a ‘taster’ of its tax planning Practice Excellence London in late November. services and to celebrate its awards shortlisting, the firm is Awards – UK Small As the reigning award winner, offering the first 20 Scottish Firm of the Year 2012 its team is justifiably proud of dental practices to respond a SBB Excellence Awards – this sustained recognition. copy of its free tax busting Employer of the Year 2011 Among the many reasons its guide and a free tax health Accountants Club – UK specialist dental sector team check. Why not see if you Firm of the Year 2011-2012 continues to be recognised could reduce your practice Featured in the book The nationally in this way is the tax bills? Simply email UK’s Best Accountancy difference it makes with its [email protected] Practices (2011) dental clients in helping them to take advantage.
Scottish Dental magazine 83
Finance Pension deadline draws closer Important changes regarding NHS pensions and HMRC protection are imminent. Financial adviser Jon Drysdale lays out the options
entists with NHS pension This isn’t a significant enough saving to This strategy involves crystallising your pots valued close to the Life appeal to most, unless you have a real need personal pension and drawing out suffi- Time (pension) Allowance for additional tax-free cash. cient income annually to freeze the value. (LTA) may need to act now This needs to be well managed and through to avoid a tax charge from Action 3: Apply for HMRC protection a SIPP (self invested personal pension). DApril 20ı4. The current pension limit of Not as simple as it sounds. There are five Independent advice is needed to ensure £ı.5 million allows a dentist to take NHS forms of HMRC protection, some of which investment risk meets your objectives. pension benefits of up to £65,000pa without are no longer available or don’t apply in I strongly recommend dentists seek liability. However, with the limit set to certain situations. Fixed protection 20ı4 independent advice on their proximity to reduce to £ı.25m next year, those taking and Individual protection are the ones to the LTA. A good starting point is obtaining pension benefits in excess of £54,000pa will focus on. a forecast of NHS pension benefits. Advice be affected. Personal pension values also Firstly, you can’t have these if you already will need to be tailored to individual need to be considered in these calculations. have an existing protection certificate in circumstances. The comments in this There are options available for those place. The outcome is to fix your LTA at article are based on current legislation seeking to avoid the reduction to the HMRC £ı.5m beyond 20ı4. Rules apply preventing and pension rules, which are subject to lifetime limit. Here’s our opinion on these: those with fixed protection from further change. The article is not intended as pension accrual. In effect, you lose the individual advice. Action one: Take your NHS protection if you continue to actively Pension before April 20ı4 accrue pension benefits (NHS or personal). Effective, but drastic. This will crystallise This may be appropriate for some indi- the value of your NHS pension and trigger viduals and Fixed Protection will need JARGON BUSTER an immediate assessment against the to be applied for and accepted before Life Time Allowance (LTA): HMRC’s limit on current pension allowance of £ı.5m. This April 20ı4. the value of your combined pensions. action is likely to be of use to dentists with HMRC protection: A way of locking into the NHS pension benefits forecasted to be Action 4: Accept a LTA charge current LTA. Crystallisation events: Taking pension between £54,000 and £65,000pa. Worth considering. The LTA charge benefits from the NHS or personal pensions. Personal pensions must also be consid- may not be as punitive as you think. For Annuity: An annual income purchased with your personal pension fund. ered here. For example, a dentist with example, if you breach the allowance by Drawdown: A means of extracting income lower NHS pension benefits of £45,000pa £ı00,000, an annual deduction of £ı,250 will from your personal pension without but personal pension values of £ı65,000 be applied to your NHS Pension. purchasing an annuity. Open market option: Shopping around for will reach the limit at April 20ı4. Taking The key here is to assess whether taking the best annuity rate. NHS pension benefits before the standard your pension benefits early and/or applying Tax free cash: A lump sum provided at NHS retirement date of 60 will incur a penalty, for protection puts you in a better finan- Pension age and/or 25 per cent of the value of your personal pension. so a careful assessment should be made cial position than paying the charge. This before doing this. Applying for your NHS requires some detailed analysis and calcula- pension can take up to four months, so tions involving your NHS Pension, personal don’t leave it until the last minute. pensions and existing annuity income. A competent adviser with specialist NHS ABOUT THE AUTHOR Action two: Increase your knowledge will be able to do this for you. Jon Drysdale is an independent financial NHS tax free lump sum adviser and director of PFM Not effective enough. Swapping NHS Action 5: Cap the growth of Dental (Financial Advice). PFM Dental offers wealth pension income for a larger tax-free lump personal pension funds management services can reduce your liability to the LTA. For Effective damage limitation. This is most exclusively for dentists. Please contact the author every £60,000 of additional lump sum, you likely to be suitable for those close to the to discuss your individual will lose £5,000pa of pension income and LTA limit and with personal pension funds situation. Jon can be reduce the deemed total pension value by in excess of £ı00,000. Pension drawdown contacted at www.pfmdental.co.uk £55,000. In effect, you avoid a tax charge can be used to avoid a ‘second test’ of the or on 0845 241 4480. amounting to only £700pa. LTA in future years.
Scottish Dental magazine 85 Product news
Locator Over Stay ‘Up To Date’ Denture Implant Rinse with system with Oral-B confidence Oral-B have released the dates for its next Following the introduction of Pro-Expert General Medical ‘Up To Date’ scientific exchange seminars toothpaste, Oral-B is now launching a introduce the LODI and is inviting clinical dental professionals complementary mouthrinse, Oral-B Pro-Expert (Locator Over Denture to attend a complimentary CPD-accredited Clinic Line Rinse. This alcohol-free rinse contains Implant) System from evening event at Edinburgh’s Heriot Watt cetylpyridinium chloride (CPC) making it effective Zest, manufacturer of University on 22 May 2014. against a broad range of bacteria commonly the world’s leading This year, Professor Iain Chapple will associated with plaque and implant-retained overdenture attachments, for critically appraise the ‘Brave New World’ gingivitis. just £112.12 plus VAT each. of 21st century dentistry and Prof Avijit Moreover, the CPC in The LODI system can be used to securely retain Banerjee will discuss technologies used Oral-B Pro-Expert Clinic Line both maxillary and mandibular overdentures and in the dental surgery that complement Rinse has a high level of is ideal for cases with narrow ridges, where there the minimally invasive, tooth preserving bioavailability which are financial considerations or when the operator approach to caries management. increases both its wants minimal invasive flapless surgery. efficacy and its Ready for immediate placement, self-tapping Spaces are limited and allocated on a durability. Oral-B’s LODI implants are available in two diameters first come, first served basis. To attend, rinse is effective for up (2.4mm and 2.9mm) and three lengths (10mm, contact Julia Fish on 07585-508550 or to 12 hours offering all 12mm and 14mm) and are supplied together e-mail [email protected] or day protection against with Zest Locator Abutments with a choice of two register online at www.dentalcare.com plaque and gum soft tissue cuff heights ( 2.5mm and 4.0mm ), 12 problems. This makes options in total. it appealing to a broad range of your patients, Contact General Medical on 01380 734990, including children (over visit www.generalmedical.co.uk or email six years), and those [email protected] with sensitivity issues.
86 Scottish Dental magazine Product news
Safeguarding and Child Protection Pro CPD bundle Following the GDC’s recently updated bundles on core CPD topics, Standards Guidance on dental Radiography and Radiation teams’ responsibilities towards Protection, and Disinfection and child protection, ProDentalCPD has Decontamination, with more created a Safeguarding and Child to follow. Protection Pro CPD bundle. Pro CPD bundles are available Available to subscribers online and all you need and non-subscribers, to access them is this premium an account with bundle gathers ProDentalCPD. together expertly To protect your produced material young patients while allowing you to contribute meeting your CPD towards your verifiable CPD. requirements, contact the experts at Successful completion of the ProDentalCPD today. bundle will mean your ProDental CPD certificate certifies you in Level To learn more about Pro CPD 2 Child Protection, which is valid bundles, contact ProDentalCPD for two years. on 0114 282 3509, or visit The company also offers other www.prodentalcpd.com/bundles Obesity matters Currently there are 15 million spittoon or over-the-patient unit people in the UK classified as is attached to the chair. obese and this figure is set to For standalone chairs, rise. It is reported that half of UK including the Clesta I and II, 037 males could be obese by 2030 if Pro II and Clair chairs the limit current trends continue. has increased to 31 stone. Planning for the future has Takara Belmont chairs are always been at the forefront therefore extremely strong and of Takara Belmont’s R&D stable, so will meet the needs programme and the of certain bariatric company is pleased patients. to report that the weight-lifting For further capacity of Takara information or Belmont’s chairs clarification, call 020 has increased to 7515 0333 or e-mail 22 stones when a [email protected] Make your practice thrive Practice Management in Dentistry Management; and Marketing. – The Definitive Guide is a unique For more information on Practice eLearning programme which has Management in Dentistry – The been carefully structured to provide Definitive Guide, speak with your its students with all that there is local Business Consultant from The to know about running a dental Dental Directory. practice that thrives. The course has been produced Contact The Dental Directory by Healthcare Learning: Smile-on on 0800 585 586, or visit and is being sponsored by The www.dental-directory.co.uk Dental Directory, which is offering its customers an exclusive reduced price on attending the course. The course is split into five areas: Money Matters; The Patient Journey; Team Leadership; Premises
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The complete package
Providing an array of solutions to patient communication to organise and simplify daily and automatic reminders, the tasks, Carestream Dental really software keeps everything in one can help your practice enhance place for convenience and clarity. productivity and long-term For quick and efficient success. diagnosis, all impression The CS R4 Clinical+ Practice images and scans can also be Management Software is the integrated into the software, complete package, combining aiding treatment explanations to every aspect needed for a thriving patients and optimising access business. From the appointment to patient data for all authorised schedule, to patient records, professionals.
Contact Carestream Dental on 0800 169 9692 or visit www.carestreamdental.co.uk
As one CPD cycle comes to an end, another begins. Why not get the new Begin as cycle off on the right foot by joining the DENTSPLY Academy? you mean DENTSPLY Academy offers an extensive range of live webinars to go on throughout the year and has more than 50 hours of archived webinars gaining verifiable CPD without available to view online for free. having to travel to lectures and Joining the DENTSPLY Academy seminars. Instead, students can offers dental professionals a way of gain their CPD when it suits them. Upcoming webinars include ‘Light Curing in Dentistry – A Brief History and Update with Dr Robin Mills’ on 31 October and ‘Local Anaesthetics – An Update For the Dental Hygienist with Dr Nigel Robb’ on 14 November.
Contact www.dentsply.co.uk or 0800 072 3313
Tasty tooth protection GC UK’s extended Minimal following bleaching, after Intervention range of products ultrasonic, hand scaling or includes GC Tooth Mousse. root planing, after removal GC Tooth Mousse is a water- of orthodontic brackets and based sugar-free topical cream following professional cleaning. that contains Recaldent. This topical paste will provide extra Contact GC UK on 01908 protection for the patients’ teeth. 218 999 or e-mail info@ It has been shown that the twice uk.gceurope.com daily use of 1 per cent solution produced a 19 per cent reduction in enamel demineralisation (Reynolds, 1988). There is a wide range of benefits for GC Tooth Mousse. It can be used immediately
88 Scottish Dental magazine Product news
Septalkan single use wipes Scientifically developed for medical Septalkan Wipes allow cleaning and devices, Septalkan wipes are disinfection in one simple operation. themselves a class 11b medical device Use and discard no rinsing required. and allow for the thorough cleaning Septalkan wipes are now and disinfection of both invasive and available through medical and dental non-invasive medical devices and wholesalers in a soft flow dispense equipment. pack containing 100 x Developed for use in (200mm x 180mm) higher risk areas, spun-lace wipes Septalkan are for saturated in use within the solution medical/dental surgical environment. For comprehensive product They are active from information, ask your dealer or contact, eliminating up to 99.9999 per call Alkapharm customer service cent of micro organisms that may be on 01785 714 919. Product present on the device – and also the information can be viewed and/ wipe itself – ensuring low risk from or downloaded from the website, cross contamination. simply visit www.alkapharm.co.uk Denplan hits £1 million milestone With an established history of offering member practices practical and financial support, Denplan is celebrating lending more than £1 million through its Evolve loan scheme in the last 12 patients, as well as attract new months. ones. These loans have proved With increased competition especially popular in difficult from state-of-the-art practices, economic conditions with Evolve loans are designed to competitive interest rates and no enable Denplan Key Client arrangement fees. members to update, refurbish and refresh their practices to For more information about offer a best in class patient Denplan Evolve loans, please experience, retain existing call 0800 169 9962.
The surgical contra-angle handpiece with 45° head The NEW WS-91 and WS-91 LG the drive speed, the ratio of 1:2.7 high-speed surgical contra-angle ensures the optimal bur rotation handpieces feature a 45° head speed. The WS-91 LG offers and 1:2.7 ratio. The 45° head perfect LED+ daylight quality offers an ideal angle for surgical illumination. The 3-port spray applications giving improved guarantees cooling of the bur, access to hard-to-reach tooth and bone. The new WS-91 operating areas and also benefits from an improved guaranteeing excellent scratch-resistant surface coating visibility for treatment and can be fully dismantled for indications such as cleaning and sterilisation purposes. wisdom tooth extraction, precise tooth separation For further information, and apical resections. call 01727 874 990 or Dependent upon email [email protected]
Scottish Dental magazine 89 Product news
New self-etching and adhesive flowable composite When restoring teeth as part of and saves valuable time too. a minimally-invasive procedure Post-operative sensitivity is also wouldn’t it be great to save markedly reduced. additional time too? This new three-in-one flowable DMG’s new Constic self- composite combines etching etching and adhesive flowable gel, bonding agent and flowable composite eliminates both composite in one single product. the etching and bonding steps Consequently, it eliminates both the etching and bonding steps and the associated time expenditure.
Contact DMG on 01656 789401 or email [email protected]
Minimally invasive, maximally effective
Piezomed is the new force in surgeon’s working environment. bone surgery. This device from With high precision, only the bone W&H puts all the advantages substance is removed and the of innovative ultrasound surrounding soft tissue is left technology at the surgeon’s undamaged. fingertips: high-frequency With automatic instrument microvibrations allow cutting detection, as soon as an with incredible precision and instrument is inserted, the cavitation effect ensures an Piezomed automatically almost blood-free surgical site. detects the instrument and Thanks to assigns it to the correct innovative power class. ultrasound technology, Contact W&H (UK) on Piezomed 01727 874 990 or email transforms the [email protected]
The latest in innovation W&H launched a number of new contra-angle handpiece with a 45 and innovative products at the degree head and 1:2.7 ratio. recent BDTA Dental Showcase Also on show was the in Birmingham, including: the latest decontamination new Assistina 3X3, the most equipment range, including the thorough handpiece cleaning ThermoKlenz washer disinfector and lubrication system dryer and Lisa steriliser as well currently available; as the Implantmed surgical the Piezomed, system and the full range of the minimally oral hygiene products. invasive, maximally effective surgical unit; For more information, and the new range of call 01727 874990 surgical handpieces or contact your including the WS-91, preferred W&H the first high-speed supplier.
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