Putting a smile on the faces December 2010 / January 2011 of anxious young patients Page 33

LET HIV DENTISTS WORK BRIDGING THE GAP FOR WHOM THE SAYS INDEMNITY GROUP WITH PAUL STONE BELL TOLLS Dental Protection leads a The new EAO president talks David Conway addresses campaign to overturn about implantology at home politicians at Westminster ‘draconican rules’ Page 9 and abroad Page 28 on mouth cancer Page 54

In sync National project hailed as a beacon of teamwork and co-operation Page 20

BOOKMARK THIS DID YOU KNOW? Your Scottish Dental magazine is now available LINK TODAY… online with new and exclusive content PLUS regular news updates www.scottishdentalmag.co.uk

ISSUE 6, VOL.1 Welcome Editor’sdesk with Bruce Oxley Contents Singing from the Dec 2010 / January 2011 NEWS> 06 Funding boost for dental charity same day sheet 09 Let HIV dentists work says DPL While I was speaking to all Now after spending a fair health boards, students and 10 Supervision the people involved with amount of time talking to patients all benefit. for Dundee dental outreach for the Andrew Forgie, David In these times of all- graduate article featured on page 20 Watson and Andrew Hall, consuming bureaucracy FEATURES> of this issue, I kept asking plus the people on the and news of bail outs and 20 Dental the same question. ground in Kilmarnock, it double-dip recessions, it is outreach I asked them whether became clear that this refreshing to get a genuine 28 Interview: Paul Stone they were surprised, given wasn’t arrogance, just a good news story. 33 Special Smiles all the different bodies and reflection of how proud this Speaking of good news I’d play project organisations involved, that group of people were with like to take this opportunity dental outreach has been what they had achieved. to welcome our newest CLINICAL> so successful? It was also a reflection of columnist, Spencer Wells, 44 Water fluoridation by I was half-hoping at least years of hard work and to the Scottish Dental Colwyn Jones one of them would look cooperation in bringing family. Claire Walsh left 46 Neil Heath over their shoulder and together ten NHS boards, some pretty big shoes to fill looks at dental whisper: “Well, off the two (soon to be three) (metaphorically-speaking imaging 50 Why refer: the record, it was a nightmare dental schools and NHS of course), but I have every benefits of dealing with so and so,” or Education for Scotland. faith that Spencer is more working with “This group seem to have And, what became clear than up to the task. specialist practice got the better deal”. But no, from very early on is that ® to a man they all said they this has worked because 54 Mouth cancer: Bruce Oxley is editor of Scottish Dental a political weren’t surprised in the everyone is gaining from magazine. To contact Bruce, email issue? slightest. the project. Universities, [email protected]

Scottish Dental magazine 3 4 Scottish Dental magazine CONTACT SPENCER AT: [email protected] Column Biting back with Spencer Wells No names – just fun and games

s this is my first ity, mainly NHS with the odd bit be back home with the missus Man (love that programme, I column for of private here and there – and and the teenager who mooches am definitely turning into my Scottish Dental by odd, I mean the patients. around like the world owes him father). These days, it seems magazine, I I attend the occasional course a living. I’d been hoping he we are all being strangled Athought I’d give or meeting to keep up to date would follow in my footsteps, in by bureaucracy and, for that you a wee bit of background on and shoot the breeze with old other words take over the prac- reason, I have decided to be myself. I’ve never written in a friends, and I am up to here with tice so I can talk to my plants all anonymous, because I don’t magazine before, I post the odd writing policies on health and day long, but he isn’t showing want to go above any radars just thing on GDPUK.com every because I have had a moan and now and then but there isn’t a whinge. much to interest us Scots there “I’ve owned a practice for I know it’s a cop out, but Big at the moment. What with all longer than is good for my Daddy is always watching – the HTM whatever it is, and well, Big Brother is finished, so CQC ranting and raving…I sanity, mainly NHS with the my nurse reliably informs me, swing between thinking ‘ha ha’ so who else can watch over us and ‘who cares?’ odd bit of private here and now, lying in wait with the To put it bluntly, I am a late proverbial banana skin so we 40s, greying-round-the-edges, there – and by odd, I mean can get the legs pulled from bog-standard dentist. I’ve got a the patients” under us? standard bog as well, but it has Never mind, maybe someday been adapted for disabled use, I will reveal myself, like that so that should suit my nurse safety and all that rubbish we much interest in pulling his fin- guy with the motorbike helmet who has a physical incapacity to have to spend time on these ger out any time soon. on the popular BBC motoring go an hour without sloping out days. I have a long-term associ- So, in other words, I reckon I show. If that day ever comes for a fag. ate who gets on my nerves, and am just like quite a lot of you: I hope to God you have your I’ve owned a practice for a younger one that thinks he Grief at work, grief at home, dark glasses on, as I’m not a longer than is good for my san- knows it all, so I might as well and turning into a Grumpy Old pretty sight!

DETAILS AND CONTRIBUTORS

Editor Design and production Subscriptions The copyright in all Bruce Oxley Renny Hutchison, Ann Craib articles published in is published by Tel: 0141 560 3050 Paul McGinnity, Tel: 0141 560 3021 Scottish Dental magazine bruce@connect Fiona Wilson ann@connect is reserved, and as such articles may not be communications.co.uk communications.co.uk publications Advertising reproduced without Senior sub-editor sales manager 1 year, 6 issue permission. Neither the Studio 2001, Mile End, Wendy Fenemore Ann Craib subscriptions: UK £48; publishers nor the editor Paisley PA1 1JS Sub-editors: Tel: 0141 560 3021 overseas £65; students necessarily agree with Tel: 0141 561 0300 Gary Atkinson, ann@connect £25. Back issues: £5, views expressed in the Fax: 0141 561 0400 Jim Byers, Penny Murray communications.co.uk subject to availability. magazine. ISSN 2042-9762 www.scottishdentalmag.co.uk

Scottish Dental magazine 5 News | Dental outreach p20 | Public health p44 | Practice news p18

GDC withdraws entry qualification

INSPECTION after an inspection into the first develop an action plan that this still leaves a cohort of part that was sat in June, the addresses the issues raised in dentists who sat the first part An independent inspection, GDC found “serious issues with the report, before running any in limbo as they wait to hear commissioned by The General the award” and withdrew the further sittings. whether they will have to resit Dental Council (GDC) into the second sitting that was due to “The GDC is working with the the exam and when they will be Royal College of Surgeons be sat in September. college to bring the LDS up to allowed to complete the (RCS) of England’s Licence in A statement from the council the required standard. The second part. Dental Surgery (LDS), has led read: “The council endorsed report of the inspectors will be The GDC said: “We are to the withdrawal of the the recommendation of the published on the GDC website sympathetic to candidates of qualification. inspectors that the LDS was at a later date.” the LDS and appreciate that The LDS, which is sat in two ‘insufficient’ for registration as The RCS have indicated that they are in a difficult position. parts, serves as an alternative a dentist in the UK. The report the second part is provisionally However, we must be assured route towards GDC registration was shared with the college, scheduled to sit in April, that dental professionals are to the council’s Overseas who agreed to withdraw the pending the outcome of the safe to practise on patients Registration Exam. However, first sitting of part two and to inspector’s report. However, when they join the registers.”

Accreditation award for Perth clinician Funding boost A Perthshire dentist has become the first clinician in set to create a Scotland to achieve Accreditation for the British Academy of Cosmetic Dentistry (BACD). Special Smile Dr Elaine Halley, of Cherrybank Dental Spa, completed the rigorous two-stage process that is Education. Charity workers express their joy only awarded to clinicians after securing the future of a vital project who have achieved a level of excellence with regard to their cosmetic dental skills. A dental project that promotes developing and refining the funding that would allow them The BACD accreditation oral healthcare through play idea of the Dental Playboxes. I to run for another two years. pathway has been in place has received a funding boost think it is a wonderful project The grants they have since 2005 and candidates that will enable them to and I would hate to see it die a received so far will go towards must demonstrate their continue in the Glasgow area death through lack of funding. covering the project’s staff, ability to diagnose, plan and for a further 18 months. “This project represents so resources and running costs, execute cosmetic treat- The Special Smiles project, much of what our charity including: Special Smiles ment to the highest run by the charity Action for stands for in helping vulnera- Playboxes and Playpacks for standards, showing that it Sick Children (Scotland), has ble children and young people every school, training for staff can be performed safely, secured funding to the tune of meet their healthcare needs. and parents, a part-time ethically and competently. £30,000 from the Hugh Fraser Special Smiles provides this project co-ordinator (15 hours and Pfizer foundations. often forgotten group of young a week) to produce and Catherine Nelson, Dental people with information and distribute resources and Playbox Co-ordinator for the preparation for treatment in a deliver the training, as well as charity, explained that if the fun way, appropriate to their a range of back-up support. funding hadn’t been found the age and understanding.” project would not have been Thanks to the funding boost, ® able to continue. the Special Smiles project will For more information and to She said: “I am absolutely be offered to 12 schools over download a copy of Action for Sick delighted that we have the next 18 months, and this Children (Scotland)’s publication managed to secure sufficient could increase to around 16 if Preparing your child for dental funding to ensure the additional funding is secured. treatment, please visit Left: Dr continuation of the project. I Catherine explained that they www.ascscotland.org.uk Elaine have been working on this are still waiting to hear back on Turn to page 33 for an in-depth look Halley project for seven years now, a further £8,500 worth of at the Special Smiles project.

6 Scottish Dental magazine Scottish Dental magazine 7 News

Domestic violence Government delays initiative launched PVG scheme The Scottish Government has announced a TRAINING delay to the introduction of its Protecting Vulnerable Groups (PVG) scheme, which will A new initiative aimed at training replace the current disclosure arrangements. dentists to encourage patients to The scheme had been due to go live in 30 report domestic abuse has been November but has been postponed until launched in Ayrshire. February 2011 following advice from the PVG Health Minister Nicola Sturgeon scheme programme board. was on hand to meet Medics Against Children’s Minister Adam Ingram explained Violence (MAV) founder Dr Christine the reasons behind the move: “We all remember Goodall at the North West Kilmarnock Dr Goodall explained that dentists the problems that arose when Disclosure Area Centre at the official launch. are perfectly placed to offer advice, Scotland was established with a massive back- Ms Sturgeon saw examples of the she said: “Victims of domestic abuse log of checks. I believe that appalling situation training that will be given to dentists often suffer injuries to their teeth, face came about because quality was sacrificed to on how to spot signs of abuse and and neck, so dentists are often the meet arbitrary timescales. We will not make the encourage victims to report it to the first health professionals they see. same mistake.” police or support services. About 90 “We felt it was time to take advan- The General Dental Council has revealed that it dentists are expected to attend the tage of this ‘golden moment’ to has a legal obligation to share information with first training session, which will intervene and help. On average it takes the PVG scheme but that it is unclear as to the comprise a short film and a series of around 35 incidents of abuse before a nature of the information. The council have short inputs from MAV and the victim feels able to tell the police or a confirmed, however, that any information Violence Reduction Unit. support service. This is about helping, received from the PVG scheme will not result in NHS Ayrshire and Arran are piloting encouraging and supporting victims automatic erasure, but it will be dealt with as an the initiative but a number of other to be able to make that call whenever allegation of impaired fitness to practise. health boards are expressing interest. they are ready.”

8 Scottish Dental magazine Interview p27 | Revalidation p40 | Product news p75 | News

Let HIV dentists work, says IN BRIEF CHRISTMAS APPEAL indemnity organisation The British Dental Association has launched a special Christmas EXCLUSION was thought to have infected six health professionals for more Appeal to raise money for patients with the AIDS virus. No than a decade in several parts of dental professionals who A leading indemnity provider is other transmissions of the dis- the world and will continue to find themselves in need challenging the Department of ease have ever been recorded in take action against this kind of this festive season. Health to withdraw the rule that a dental setting since. unfair and discriminatory treat- A spokesman for the stops HIV positive dentists from Kevin Lewis, director of Dental ment of its members. BDA said: “As a UK regis- treating patients. Protection, called on the “The international evidence tered charity, the Dental Protection argues that Department of Heath to show base is overwhelming and the Benevolent Fund offers it is 20 years since the ‘draconian Beijing Declaration unequivocal support to dentists and rules’ were introduced and cur- “HIV infected dentists in confirming that HIV infected their families in times of rent evidence suggests that can continue to prac- dentists can continue to practise need, and can make a vital there is no risk of transmission tise safely with no risk safely with no risk to patients, difference to their lives.” from dentist to patients. to patients, subject subject only to some very The Fund provides sup- It claims that many UK den- only to some very clear and manageable criteria port through grants and tists, hygienists and therapists clear and manageable being met. interest-free loans.” have lost their livelihoods criteria being met” “In every other area of profes- because they have been forced Kevin Lewis, Dental Protection sional activity, dental health ® to stop working. professionals are directed to fol- If you or anyone you know The rules banning HIV positive greater fairness and a more con- low the evidence base, but HIV requires the fund’s help , call dental professionals from treat- sistent application of the has for too long remained a sin- Sally Atkinson on 020 7486 ing patients were introduced as a evidence. He said: “Dental gular exception – during which 4994 or email dentistshelp precautionary measure after the Protection has championed the time careers have been @btconnect.com case of Dr Acer in the US who cause of HIV-infected dental destroyed.”

Scottish Dental magazine 9 News | Hew Mathewson p30 | Dental imaging p46 | Financial p58 IN BRIEF Supervision for DENPLAN LOSES EUROPEAN COURT RULING OVER VAT One of the leading dental Dundee graduate plan providers in the UK has expressed its disappointment after Fitness to Practise. Treatment fell way October 2008 after Hampshire the European Court of below standard expected says PCC Primary Care Trust removed Justice (ECJ) ruled it him from its performers list must pay VAT on and following a decision by the administration fees. A Dundee Dental School testimony to this committee. Family Health Service Appeals Denplan, which has graduate has been ordered to Your failures were repeated, Authority (FHSAA) in June more than 6,500 work under conditions by the wide-ranging and serious. You 2009, he was disqualified from member dentists and General Dental Council exposed a number of your carrying out NHS work. about 1.8 million patients, (GDC), after his treatment was patients to significant risk The committee noted that had previously won a described as “deplorable”. of harm. prior to this period and since decision in the High Jonathan Gregor qualifying in 1986 his record Court that stated VAT Drummond, who qualified in “Your failures were was unblemished. They also was not payable on 1986 and now lives in repeated, wide- recognised that during the administration fees Hampshire, was charged with ranging and serious. period in question he had a the company charges failing to properly treat five You exposed a heavy workload, was profes- to dentists. patients between June 2004 number of your sionally isolated and his work The UK tax authorities, and September 2008. The patients to significant conditions were difficult. HMRC, appealed the failings described by the risk of harm” While none of these matters decision to the Court of Professional Conduct were deemed to excuse the Appeal which then asked Committee (PCC) included poor standard of treatment, the ECJ for a ruling. the diagnosis and management “In respect of ten patients the PCC ruled that a Stephen Gates, of caries, root canal treatment, your record keeping was poor suspension would be a dispro- Managing Director of radiography, communication and well below the standard of portionate punishment. Denplan (pictured with patients and the prescrip- a reasonable dentist.” The committee ordered that below), said: “The tion of antibiotics. However, the committee he must work under a series of decision will make no Addressing Drummond at noted that while the deficien- conditions for 18 months, difference whatsoever the hearing, the chairman of cies are capable of being including working under to our future business the PCC said: “The standard of remedied, so far they had not supervision and formulating a or charges. your treatment was deplorable, been. It also pointed to the fact personal development plan to “Denplan has paid VAT as you recognised in your that he had not worked since address his deficiencies. on these fees for the past 25 years and will continue to do so. This judgement is retrospec- tive and will in no way Essex GDP reprimanded by the affect our pricing or activities.” GDC for poor quality of care The ECJ ruled that the payment processing GDC HEARING chronic adult periodontitis, with The Professional Conduct provided by Denplan was Gandecha proceeding to Committee reported that: “No akin to a ‘debt collection A Glasgow dentist has been provide advanced restorations attempt was made to analyse or service’ and hence reprimanded by the General on the patients anterior teeth – remedy what other dental excluded from the Dental Council (GDC) after namely veneers and a new witnesses described as an exemption failing to provide a proper crown – without treating the obvious problem.” for pay- standard of care to a patient gum disease first. Significant deficiencies with ments or over a period of 18 months. It was also found that the regards to his record-keeping transfers Atul Gandecha, who graduat- dentist, while practising at the for the same patient were also and ed from Glasgow Dental School Hainault Dental Practice in Ilford, noted. However, while the subject in 1990 but who currently lives also failed to take adequate committee decided that to VAT. in Essex, admitted carrying out account of the patient’s occlu- Gandecha’s fitness to practise is treatment that was not in the sion when fitting the veneers. impaired, it decided that: “…a patient’s best interests in When the veneers fell off, in one reprimand was a sufficient and September 2006 and in the case on several occasions, he proportionate sanction in this following months. failed to analyse why and also case having regard to its duty to The charges centred around a failed to take remedial action in protect the public and uphold failure to adequately diagnose relation to the veneers. proper standards.”

10 Scottish Dental magazine Scottish Dental magazine 11 News | Practice profile p36 | Mouth cancer p54 | Domiciliary care p67 |

New oral cancer HPV status ‘predicts’ cancer guide for GDPs survival chances

ADVICE taking and record keeping. Researchers from Australia have discovered that can- Professor Damien Walmsley, the cer patients with the Human Papilloma Virus (HPV) The British Dental Association BDA’s Scientific Adviser, said: have a greater chance of survival from mouth cancer (BDA) has published a new guide “General dental practitioners and than those whose cancer is HPV negative. aimed at helping dental profession- their teams are ideally placed to The study, carried out by scientists at the University als combat the growing lead the fight back, but of Sydney, monitored 198 patients suffering from problem of oral cancer. they face many practi- mouth cancer after they had surgery or radiotherapy Early detection and cal difficulties, including for two years. It was found that those with HPV posi- prevention of oral cancer: patient resistance to tive cancer were four times less likely to die than those a management strategy practitioners’ advice on who were HPV negative. for dental practice co- lifestyle factors. They also found that cancer was three times less written by Saman This publication pro- likely to reoccur at the primary site in patients with Warnakulasuriya (pic- vides in-depth guidance HPV positive cancer. tured) offers practical on overcoming those Dr Angela Hong, who led the research, said: “Our advice on preventing, problems and involving study, which focused on a group of patients with detecting and managing the whole dental team advanced oropharyngeal cancer, found that those with oral cancer, addressing in the effective preven- cancer caused by HPV had a significantly better chance both the clinical aspects of the con- tion, detection and treatment of of survival than cancer which was not caused by HPV. dition, and the management of the disease.” “HPV status is now the strongest predictor of relationships whether a patient will survive oropharyngeal cancer or with patients. ® whether the disease will return. Various clinical trials It explains risk factors, provides BDA members can access are now in development to tailor treatment according guidance on talking to patients and the guide free of charge at: to HPV status of tumours.” offers tips on medical history www.bda.org/cancerdetection GDC under fire for increase

ANNUAL RETENTION FEE do all we can to continue to use our resources efficiently and effectively.” The General Dental Council’s (GDC) However, a spokesman for the decision to increase the Annual Dental Professionals Association was Retention Fee (ARF) has come under outspoken in his criticism, he said: fire from leading dental unions. “The General Dental Council seems to As of 31 December, dentists will have finally lost the plot, with their have to pay £576, while the DCP fee daring daylight smash and grab on the has increased to £120 – however, this dental profession’s income. is not due until 31 July. The dentist “Instead of tackling endemic increase amounts to an extra £11.50 a inefficiency and bloated expense month and the DCP increase £2. allowances, it has decided help The GDC claims that the increase itself to a larger share of has been set due to a number of ‘sig- registrants’ earnings.” nificant challenges’ that will ‘place The British Dental Association additional pressure on its resources’ in spokesman was, however, a little 2011. They point to a 40 per cent rise in more circumspect in his view: “This is fitness to practise cases, legal costs “More significantly, fitness to prac- Above: GDC a challenging time for dentists with standing at more then £8 million and tise caseloads continue to grow and headquarters growing financial pressure from the additional costs of revalidation as these costs are largely driven by alle- regulation across the board and this is its main reasons for the increase. gations against dentists. Dental care yet another burden. GDC chair Alison Lockyer said: “We professionals are now beginning to “Practitioners will clearly want to have looked very carefully at what it feature in fitness to practise work too. understand the reasons for the costs us to regulate dentistry. Costs “Our strategy commits us to application of a substantial rise in the include keeping our two registers, one protecting the public, regulating the GDC’s annual retention fees both for for dentists and one for DCPs, up-to- dental team. It also commits us to themselves and the dental care date with people joining and leaving. ensuring value for money and we will professionals they work with.”

12 Scottish Dental magazine Scottish Dental magazine 13 14 Scottish Dental magazine News Scotland leads the way

Speakers at a national conference say Scotland enough. We have put an enor- point of use or not, Prof Smith gets it right on decontamination guidance mous amount of time, money insisted he felt it was just a mat- and effort into trying to address ter of time before a consensus these challenges. I think that we was reached. “I think most peo- When it comes to decontamina- topics from Dr Riina are probably about the best in ple will tend to admit that it is tion and infection control Richardson’s look at infectious Europe, and I don’t think that not a revolution,” he said. “We’re Scotland is leading the way in diseases in the oral cavity to message gets out to dental prac- going to have an evolution and Europe according to a leading Mark McCutcheon’s experi- titioners, patients and other we will move eventually to ster- Glasgow University academic. ences advising more than 80 ile at point of use. Basically, the Professor Andrew Smith was practices on installing LDUs. same standards that apply to all speaking at the university’s Guidance and the variations other surgical professions. I fourth National Conference on in guidance were themes that think we will get there, it is just Decontamination of Dental ran through the day, but there a matter of time. And money, of Instruments, held at the Royal were constant nods towards course.” Armouries museum in Leeds Scotland, as David Hurrell, Prof Smith has also been in November. microbiologist with Healthcare recently appointed as the chair- The aim of the event was to Science Ltd, remarked: man of a new Europe-wide present the theory and practice “England and Wales tend to Above: Royal Armouries museum infection control organisation, of local decontamination, giving march together, Northern the Association for European practical advice alongside Ireland take a slightly divergent people in central government Safety and Infection Control in sound scientific evidence. view. And Scotland gets it right.” enough.” Dentistry. He said: “It will be a With speakers from all over And Dr Smith agrees, he said: When asked about the con- very useful forum for commu- the UK and Ireland, the confer- “Certainly in Scotland perhaps stant debate about whether nication as well as, I hope, a lead ence covered a wide range of we don’t fly the flag often instruments need to be sterile at for research and innovation.”

Scottish Dental magazine 15 News | Why refer? p50 | Dental plans p60 | Infection control p72 Aberdeen research highlights the triggers for oral cancer

STUDY study looked at 350 patients smoking tobacco, alcohol con- to increased alcohol consump- under the age of 50 with upper sumption and/or a lack of fruit tion and future studies will New research from Aberdeen aerodigestive tract (UADT) and vegetables in a person’s determine whether ‘binge’ University has found that cancers and 400 patients diet. UADT cancers kill more drinking carries a particularly young people who smoke, free of these diseases in an than 100,000 people across high risk.” drink and eat low levels of attempt to discover what Europe and 10,000 in the UK The results of the study – fruit and vegetables are at a factors influenced their each year. which was funded by a higher risk of developing development. Professor of Epidemiology at European Union grant – indicate cancers of the mouth, larynx The findings confirmed that the University of Aberdeen, that the public health message and oesophagus. 88 per cent of UADT cancers in Gary Macfarlane (pictured), in preventing cancers of the The five-year pan-European this age group were caused by who led the study said: “Our UADT should remain the same findings confirmed that for young and old alike. The message we need to smoking tobacco, heavy Professor Macfarlane contin- be communicating to the alcohol consumption and a ued: “The results of our study public remains the same – lack of fruit and vegetables in a further emphasise that the person’s diet remained the message we need to be that smoking, drinking most important causes of communicating to the public and diet are the major cancers of the UADT. remains the same – that triggers of these “The increase in the occur- smoking, drinking and diet diseases at all ages rence of UADT cancers in this are the major triggers of these Gary Macfarlane (pictured right) age group is likely to be linked diseases at all ages.”

16 Scottish Dental magazine Scottish Dental magazine 17 Practice news Practices of the year

AWARDS and The Scottish Centre for Excellence in Dentistry (SCED) Two Glasgow practices picked in Govan was named Best Physiotherapist Anne Lyall, centre, shows Neena Mahal and up major accolades at a national Specialist Referral Practice Ken Corsar some of the new facilities in the centre awards ceremony held in at the 2010 UK Private London’s Intercontinental Dentistry Awards. Hotel recently. Spring Grove won the prize for Ribbon cut at David Cunningham’s Spring Best Patient Care and was run- Grove Clinic in Garrowhill was ner-up in the Best Community or Hamilton clinic named Practice of the Year 2010 Charity Project category.

A new £4.6 million community Corsar, chairman of NHS SCED was named health clinic in Hamilton has Lanarkshire, cut the ribbon at Best Specialist been officially opened in a the Douglas Street Community Referral Practice special ceremony. Health Clinic, which will offer Mrs Neena Mahal, community dentistry and chairwoman of the NHS orthodontic treatments as Lanarkshire South Community well as a range of other Health Partnership, and Ken primary care services.

Three cheers for

NEW SURGERY “Our staff are looking forward to welcoming new Health Secretary Nicola patients and we hope the Sturgeon has officially community will take full opened a £450,000 NHS advantage of the facility.” dental surgery in the Ayrshire The practice has more than town of Stevenston. 2,000 NHS registrations avail- Three Towns Dental Care able and, so far they have also opened its doors in the sum- enrolled over 200 children on mer but recently held a special the Childsmile programme. opening ceremony where The new facility – which took Ms Sturgeon cut the ribbon two and a half years to plan, together with the practice prin- but only seven months to cipal’s mother. Owner Simon build – houses a dedicated Morrow said: “The official Childsmile oral health opening of the practice education room. cements our progress to date Simon explained that the and I would like to give particu- practice benefited from a lar thanks to Nicola Sturgeon Scottish Dental Access and my mother Sheila Morrow Initiative grant for relocation for opening the building. and, as well as having full

18 Scottish Dental magazine Practice news

Spring Grove staff celebrate their win New Fife dental centres given the green light Speaking after the win, David And Arshad Ali, SCED’s clinical Cunningham said: “I’m absolute- director, said: “When we set up Two new six-surgery dental centres in Fife have been given ly delighted to have won the blue SCED last year we had the oppor- the go-ahead by Fife Council. Work at the £1.5 million riband award in the UK for the tunity to make something really Glenwood Dental Centre in Glenrothes will begin shortly best dental practice. To have special. We put together the and is expected to be open to patients in summer 2011. won that in combination with country’s best team and provid- The new dental centre will sit alongside the redeveloped winning the award for ed them with the most advanced Glenwood Health Centre on Napier Road, providing NHS Best Patient Care is the equipment and resources to give services to the local population. ultimate combination. patients the finest treatment to Dawn Adams, clinical director of NHS Fife’s salaried den- It’s been a long road for me be had anywhere. To be awarded tal service, said: “We are delighted to be securing NHS to go from an NHS practitioner Best Specialist Referral Practice dental services within the Glenrothes area with such an who was very disillusioned to at the Private Dentistry Awards is impressive new facility. The unit will provide NHS dental somebody who has managed to proof that we are firmly achiev- care with additional facilities to extend current services for create a fully private practice in ing what we set out to do.” special needs patients and specialist dental services.” the East End of Glasgow. Also on the night, The Berkeley Fife Council also gave the green light in October for work “I just want to thank every- Clinic’s Jamie Newlands just to begin on the Kirkland Dental Centre in Methil. It is also body that has helped us over the missed out on the title of Private espected to be finished in time to see patients in the years, my patients, my staff and Dentist of the Year as he finished summer of next year. the group of advisors who I have second to the winner Shameek had around me.” Popat from Hertfordshire. Three Towns...

access for people with disabili- times and cutting down on ties, it features a fully missed visits. computerised system that As well as Stevenston, Three enables close tracking and Towns Dental Care has a sister monitoring of patients, practice in Saltcoats. Together, providing reminders for the organisation employs more appointments, reducing waiting than 30 members of staff. International recognition for Edinburgh laboratory

An implant laboratory in tion of groups across Germany Edinburgh has become the who meet to discuss ceramic first international member of a aesthetics and CAD CAM. specialist association. Recently, members flew to The Edinburgh Dental Edinburgh for a course hosted Implant Laboratory at by the laboratory’s master Edinburgh Dental Specialists ceramist Bianca Mueller. has become the first non- German member of the Vita ® Health Secretary Nicola Sturgeon opens the new dental practice In-Ceram Professionals. The For more information, visit association is a conglomera- www.edinburghdentist.com

Scottish Dental magazine 19 Dental outreach Everyone’s a winner

A project that brings together two universities, ten health boards and a major NHS funding body could be a headache in the making. But, as Bruce Oxley discovers, positive collaboration is a powerful thing

here is no compe- fold: to give students experience outwith Glasgow and Dundee students (and tition, there is no the dental schools, to provide service in eventually Aberdeen when their first final point scoring, it is areas that have either a lack of NHS year comes through) spend roughly half just a very positive, provision or where there is a high treat- their final year on outreach placements in “T collaborative ment need, and finally, to promote various locations, seeing a diverse range framework that we’ve got.” recruitment into areas that are having of patients. These are the words of Andrew Hall, David Watson, Senior Clinical final year coordinator at Dundee Dental University Teacher and course coordina- School, but they could have been spoken tor for BDS5 at Glasgow Dental School, is by any one of a number of people involved the teaching lead for outreach at Glasgow in one of the most successful, and far- and was involved with the original pilot at reaching, dental projects of recent times. Greenock Health Centre. He was a Both Dundee and Glasgow dental salaried dentist working in the centre schools have collaborated with ten out of when outreach was trialled and he had no the 14 health boards in Scotland, as well doubt it was a positive development. He as NHS Education for Scotland, to said: “I always did think it would work. I produce a comprehensive dental outreach didn’t think it would be easy, and it has programme that is garnering overwhelm- been a lot of hard work on all sides. It has ingly positive reviews from all involved. involved a lot of travelling around and Dental outreach is not especially new, monitoring, but I think that the feedback Glasgow has been running a paediatric that we have had has confirmed that it is outreach programme for a number of working.” years and it also piloted student And, although the outreach outreach back in 1997. What is different programmes at Glasgow and Dundee about the current system, introduced differ in the specifics, the two schools have nationwide in 2006, is the fact that it “I think it has been successful worked closely together over the past few brings together so many different years, sharing knowledge and experience. elements and provides so many solutions because nobody is trying to The fact that Andrew worked with David to common problems. get more out of it than anyone in Greenock when the original outreach Andrew Forgie, (pictured) Associate else. If everyone is gaining and was being set-up, further strengthens the Dean for Postgraduate Dental Education nobody is taking advantage alliance. Andrew said: “It’s a great at NHS Education for Scotland, who you are more likely to get working relationship and I know that if I supplies all the revenue funding for out- better collaboration” have a problem in Dundee, I can phone up reach, explained: “I think that it has been David and ask them what they did in successful because nobody is trying to get difficulty recruiting dentists or students.” Glasgow, how they got round a particular more out of it than anyone else. If every- There are currently 12 dental outreach problem and vice versa.” one is gaining and nobody is trying to take centres across the country, providing David and Andrew are supported by advantage of anyone else then I think you more than 70 chairs. And, with a further full-time outreach administrators Frank are more likely to get better collaboration. five centres in development, the number “The ethos behind outreach was three- of outreach chairs will be over 100 by 2012. Continued »

20 Scottish Dental magazine Feature header

CAREER FILE

JAMES MCCALL qualified from Glasgow in 1997 and was in general practice for ten years, both NHS and private, before moving to Kilmarnock when the centre opened three years ago. While in general practice he worked one day a week at Glasgow Dental Hhospital teaching students, which paved the way for his career in dental outreach.

CAREER FILE:

DONALD MACFARLANE qualified in 1999 from Glasgow and initially worked as a community dental trainee for two years before going into general practice in Beith and then Portobello. After two years he moved into the salaried service where he worked with David Watson in Greenock before joining the outreach team in Kilmarnock three years ago.

(l-r) Glasgow final year students Viraj Patel, Nial Balloch and Jamie Kinnell with tutors James McCall and Donald Macfarlane (seated)

Scottish Dental magazine 21 Dental outreach

Continued »

Bonner and Bruce Watt, who deal with timetabling and placement issues, logistics and expenses as well as helping the teaching leads evaluate the programme, amongst many other things. The Scottish Government has invested over £100 million into dentistry since 2005 and a significant amount of that has been used to build and refurbish community dental centres, some of which now include a proportion of outreach chairs. Patients visiting the outreach centre don’t pay for their treatment, providing a much- needed service to people on low incomes or those who have been unable to register with another NHS practice. The students work under close supervision with a tutor on hand to advise them at all times and with nurses available to provide a level of assistance that just isn’t possible in the dental school. Donald Macfarlane, one of the tutors at the Kilmarnock outreach clinic, explained that having better nursing support is often David Watson (seated) and Frank Bonner from cited in student feedback, but the Glasgow Dental School

Continued »

22 Scottish Dental magazine Scottish Dental magazine 23 24 Scottish Dental magazine Dental outreach

Continued » experience gives them a better under- standing of what lies ahead. He said: “They get much more of a taste as to what it is like working in general practice. They get to experience the whole range of treatment that a general practitioner would be expected to provide and in the safe environment of a supervised clinic. They are free to carry out their treatment but they know that if they have to ask questions, or things go wrong then they have a safety net.” His fellow tutor at the North West Kilmarnock Area Centre, James McCall, added: “I think they get a more realistic picture of what things are like when they are out in practice. They get to bring all the individual elements that they learn in the hospital together, in order to treat patients in a more holistic manner. I think it is quite good preparation for them going into VT.” “These guys are young, enthusiastic, keen to learn and they are also learning the latest techniques and devel- opments in materials from the dental hospital, which we are then required to know about in order to teach them. So it keeps us on our toes”

Donald and James currently have four Glasgow students on placement at the centre, each seeing up to five patients a day. Final year student Viraj Patel, 23, explained how he was enjoying his time in outreach: “It’s absolutely brilliant. You The ratio of tutors to students is much higher in outreach than in the dental schools just get to do so much more, seeing patients one after the other and it’s good preparation for what it is going to be like to the students, as Donald explained: “It’s goals. Everyone benefits, from the NHS in practice. You just get such a variety of a very stimulating environment to work boards and their patients, to the students things and I’m really enjoying it. in. These guys are young, enthusiastic, and the universities. “The supervision from the tutors is keen to learn and they are also learning Andrew Forgie concluded by saying: “I great. Even if you don’t have a patient, or the latest techniques and developments in think it has been a win-win situation for someone cancels, they can give you materials from the dental hospital, which all those involved. Hopefully it will pro- tutorials and talk to you about anything we are then required to know about in duce students who are much more aware else you might need help with.” order to teach them. So we ourselves have of the real world situation and we are Fellow outreach student Jamie Kinnell, to continue learning and it keeps us on getting patients treated who may other- 26, paid tribute to the staff. He said: “The our toes.” wise have struggled to get care. So I think facilities are excellent; the staff and His sentiments were echoed by James: that is about as good as you can really get.” nurses are great. At the dental hospital we “If you are teaching somebody you need And the view from the universities is don’t have as many nurses but here we to be really sure about what you are also very positive David said: “The have staff on hand to assist us, and help talking about. I think it encourages you to success of outreach to date has been the us. We can also see more patients, and keep up-to-date and to develop yourself. result of teamwork. Considering the there is a greater integration with the It is quite inspiring seeing some of these close working relationships which have dental team. students, they are so keen and that fires developed among all of the stakeholders: “It is just thoroughly enjoyable, we see your own enthusiasm.” NES, the universities and the host NHS more patients, we get to do more dentistry Dental outreach in Scotland seems to be boards, outreach is probably one of the and it lets us feel more like dentists.” a unique example of multiple organisa- best examples of partnership working you But the benefits are not just restricted tions working together to achieve multiple can find in the present time.”

Scottish Dental magazine 25

Osseointegration

Sporting a Bridging the gap between science kilt was just one way Paul and clinical practice was the aim Stone was championing of the European Association for Scotland Osseointegration’s recent congress and of its scientific chairman Paul Stone, writes Bruce Oxley Key Stone

t’s not every day a European that the event had finally arrived. congress filled with world-class He said: “I guess I am relieved that speakers arrives on your door people seem to be enjoying the event. step, and for oral surgeon Paul Delegates have to spend a lot of money IStone the four-day event marked getting here, taking time out of their the culmination of three year’s hard practices, travelling long distances and work. staying in hotels. So I do worry about As the scientific chairman and letting people down, as there is a great president-elect, the Perthshire deal of trust that the EAO will provide specialist had plenty on his plate but he a world-class congress, but I am pleased still found time during the European to say that everyone I have spoken to Association for Osseointegration’s seems to be very positive.” (EAO) 19th Annual Scientific Congress The congress saw the EAO take over to speak to Scottish Dental magazine. three halls in the SECC, accommodat- The EAO Congress, at Glasgow’s ing the trade exhibition and meeting SECC, saw more than 3,000 rooms as well as the Clyde Auditorium, clinicians from around the world come which was the venue for the plenary together to see presentations from an sessions. educational faculty of more than 40 After welcoming delegates to the world-class speakers and session congress, Paul co-chaired the first chairmen. After so many years of session, entitled ‘Aesthetics: Clinical preparation and collaboration with guidelines’, with Professor Daniel Buser other members of the scientific from Switzerland. Paul said: “Daniel committee, Paul admitted that his over- riding emotion was one of relief now Continued »

Scottish Dental magazine 27 Osseointegration

“What we don’t want is large numbers of dentists entering the discipline without adequate training, as this will only damage the good reputation that has been created”

Continued » “It was my hope that by Scotland and with a Scottish therefore they often practice in promoting Scotland to such a father-in-law and two equally isolation relying heavily on the Buser is probably one of the large audience, I would be able patriotic Scottish sons, it is easy information they are given by most respected implant to stimulate interest in the del- to see why I should be so loyal dental companies.” surgeons in the world and I egates to return and explore to a country that has looked Paul continued: “The EAO’s found it quite intimidating this country more than they after me so well.” philosophy is one of ‘bridging sharing a platform with some- might otherwise have done.” And Paul’s belief in Scotland the gap between science and one who is this well-known, but Paul, who qualified from is not just restricted to its clinical practice’ and this is I have to say he was a delight to Liverpool Dental School in 1985, history and traditions; he particularly relevant to today’s work with.” explained that he also had a believes that Scottish implant clinicians. The idea of this And, the following day Paul, personal reason for promoting clinicians are doing the country congress is that world-respect- wearing his wife’s family tartan, his adopted country to the proud. He said: “Scotland is a ed clinicians and researchers addressed the whole delegate small country with a small present on a specific topic, each audience at the ‘Congress number of cities but we have a being asked to review the Ceremony’. He introduced really high standard of care. At relevant scientific literature and delegates to their host country, the moment though, we don’t relate this to every day clinical speaking about the geography, seem to have enough of these practice. My aim as scientific culture and history of Scotland, high calibre clinicians to meet chairman was that every with special mention of the the demand that we see on a delegate would return home medical and scientific break- day-to-day basis. with practical, evidence-based throughs and developments “However, what we don’t information that they could that made Scotland famous. want is large numbers of apply to their clinical practise. “I really wanted people to dentists entering the discipline “I have no intention of patro- come to this congress and have without adequate training, nising any dentist who attends no doubt that they were in as this will only damage the such a meeting but many of us Scotland,” he said. “This is very good reputation that has been find that some of the complex important to me as I am only created.” research papers published in too aware that many clinicians The theme of the Glasgow the implant journals are quite travel the world attending attending delegates. He said: “I congress was ‘Clinical difficult to fully understand and different conferences and moved up to Scotland over 22 Controversies in Implant often even harder to relate to meetings. However, most see years ago for a six-month job Dentistry’ and, as Paul every day practise. It’s the little more of the host country and I have never left. Although explained: “The problem is that responsibility of the presenter than the airport, taxi cab, hotel I’m English, anybody will tell many clinicians don’t know to attempt to demystify some of and conference centre. you how patriotic I am of what they don’t know and the controversies we have in

28 Scottish Dental magazine Osseointegration

“It was clear from some of the presentations that the science does not always support what some of the companies are telling clinicians to do” implant dentistry and to present was conveyed in an appropriate the evidence for or against the way.” various options available. Paul, who took over the “It is my strong impression presidency of the EAO at the from the presentations I have end of the conference from seen that many of the faculty of Professor Christoph Hämmerle speakers are concerned with from Switzerland, finished by how quickly many clinicians try saying: “Not that long ago, it to carry out the various stages would be common to see differ- of an implant-based treatment ent meetings attended by either plan. The message seems to the scientists or the dental very clearly suggest that more practitioners and we would see predictable results could be one group presenting ‘evidence’ more often obtained if a little while the other presented more time was taken to ensure ‘opinion’. that each stage was carried out “This is not the situation with correctly. EAO congresses and I hope that “There seemed genuine during my two years as concern that where this was not president, I will ensure that this the case, patients could end philosophy continues. For me up significantly worse off it is very important that than when they had started wherever possible, all clinical treatment. It was clear from practise is based on sound some of the presentations that scientific evidence. the science does not always “It is all about taking the support what some of the science and making it clinically companies are telling clinicians relevant and trying to give to do. colleagues real perspective as to “The EAO board is very how they might treat their aware of this situation and patients.” certainly I was very keen to gather together a group of ® speakers and moderators, who For more information on the EAO, would ensure that this message visit www.eao.org

Scottish Dental magazine 29 Mental health Dangers of stress Anxiety and addiction to alcohol or drugs can be an issue in the profession due to the stressful nature of the job. It is important to seek help from organisations such as The Dentists’ Health Support Programme, writes Hew Mathewson

entistry is a stressful tance of mine even took up profession. Indeed, weightlifting in his late middle age. Professor Cary But many of us reach for a glass of Cooper’s famous study wine when we get home. Of course, Dof stress in the work- this is not in itself a problem. That place found that, of 104 jobs, it is one comes much further down the road of the 10 most stressful in the UK, when a patient complains they can alongside fire fighting, police work, smell alcohol on your breath in the social work, mining and medicine. morning or you’re caught driving It’s easy see why: here is public-fac- over the limit on the way in to the ing job that requires you to remain practice. calm and in control despite carrying In most cases of substance abuse out what can be extremely difficult reported to the GDC, the members and intimate procedures. Even the of the Fitness to Practise Committee, routine things, such as giving an operating in private session in their injection, cause a surge of adrenaline ‘health’ mode, will ask for blood tests every time you do it. and a report from an expert psychi- And it would take a clairvoyant to atrist, all in strict confidence. The arrange for every difficult patient to dentist is likely to be suspended as arrive when you are at your peak. they decide what to do. While pro- Many dentists will have had that dif- in cases of neurological disease such tection of patients is paramount, let ficult molar endo that comes in at as Parkinson’s or multiple sclerosis, me emphasise here that the commit- 5.20pm: you’re tired, your blood sugar or blood-borne diseases such as hep- tee’s role is also to help dentists is low, your partner’s out of town, atitis B and HIV – mental health recover and get back to work. you’re meant to be picking the kids problems and addiction are by far the To this end, committee members up from the childminder at 6.15pm – main ones. will be looking for evidence that an and you can’t find the third canal. In the past, the abused substance alcoholic or a dependent drug user It’s hardly surprising, then, to find was almost always alcohol, but can get their life in order. They might that as a profession we experience increasingly drugs are involved too, well revoke their fitness to practise, higher than average levels of anxiety, and it is currently estimated that one but they might just as well allow a addiction and both attempted and in seven practitioners will have a dentist to work under certain provi- successful suicide. So, while there are problem with one and/or the other sos – such as having to work a number of reasons why a dentist at some point in their career. alongside a colleague or being limit- might come before the General Everybody has their own way of ed to three days a week. After a time, Dental Council with health prob- managing stress. Some knock seven even this condition might be lifted. lems – they could, for example, be bells out of a squash ball, others take Each case is treated on its own mer- seeking a ruling on fitness to practise up yoga or meditation; an acquain- its. The point is to help dentists in

30 Scottish Dental magazine Mental health

trouble stage a recovery, by setting better to intervene than to stand by conditions that are helpful and help- THE STRESS FACTOR while a colleague implodes. ing them get back to work. In one tragic case, a dentist became It would, of course, be better all As if the stresses of den- up to date with the GDC so stressed that he left the surgery round if someone with a growing tistry weren’t enough, at and consequently not after a day’s work, filled a couple of drink or drug problem sought help this time of year there is, receiving the renewal forged prescriptions at two chemists, before the GDC got involved. The unfortunately, one more notice (or the reminder) checked into a hotel and downed the local GP and Occupational Health are to contend with: paying is one of the most com- lot. He woke up in his own vomit a obvious ports of call. The Dentists’ the Annual Retention Fee. mon reasons. It is day and a half later, realised his fam- Health Support Programme (DHSP, Next to addiction it is a particularly prevalent ily would be worried sick, and formerly known as the Sick Dentist minor matter, but I want among young dentists decided to drive home – and ended Scheme) also has a crucial role. to mention it because the who have changed jobs up crashing into a police car as he left Independent of the GDC, it is run by consequences of non- and location. the hotel. He was charged with dentists in recovery themselves and payment can be Other reasons for driving under the influence, and then, is strictly confidential. That it exists considerable – the non-payment include when the police found out where he at all is partly an acknowledgement worst of which is being changing bank accounts had got the drugs, he was charged that dentists, particularly in small removed from the and being too near the with that too. How different things towns, are unlikely to go to a support register and told to limit on your account. might have been had he felt able group like Alcoholics Anonymous stop working. Nobody wants to be to seek help or had a colleague where they may run into their own While occasionally den- told in early February to intervened. patients. With regular meetings all tists in financial straits stop work this instant over the country, the DHSP aims to will deliberately not pay when they’ve got a full ® overcome that obstacle. the fee and carry on waiting room and The Dentists’ Health Support Programme To see ourselves as others see us working anyway – which Christmas bills to pay, so I can be contacted confidentially on is a rare quality, so it may well be a is a serious offence – the urge you to ensure you’re 020 7224 4671. colleague who has to persuade a reason for lack of pay- up-to-date. The stresses troubled dentist to seek help or qui- ment is almost always of dentistry are great Hew Mathewson is a general practitioner etly contact the DHSP to seek help administrative. Not keep- enough without incurring in Edinburgh, a special adviser to the for them. It will be difficult, but I urge ing your address details them needlessly. MDDUS and a former President of the all of you to be vigilant – it is far General Dental Council

Scottish Dental magazine 31

Child education

A project using toys, as well as other resources, is helping improve the dental health of children, writes Catherine Nelson

Above: play resources help children better understand dental treatment Playschool

pecial Smiles is an innovative Dental Playbox Project, which ASC(S) The need for a co-ordinated approach play-based dental health project launched in 2003 as their response to the with key agencies and professionals work- which the charity, Action for Scottish Executive’s paper – Towards Better ing in partnership to tackle dental decay Sick Children (Scotland), Oral Health in Children 1, a document which was also highlighted, giving rise to the idea S(ASC(S)), has been running for highlighted the poor record of children’s of Dental Playboxes, based on the highly the last two years in special schools oral health in Scotland, namely: successful Hospital Playbox scheme run by throughout Tayside. The purpose of the • 55 per cent of all five-year-olds had ASC(S) for many years. Special Smiles Dental Project (SSDP) is to dental disease Play is a child’s language, but more than improve the dental health and therefore • by age 14, 68 per cent of children had that, research shows that play reduces anx- overall quality of life of children and young dental disease in adult teeth iety, facilitates communication and speeds people with a range of severe and complex • more than a quarter of a million teeth recovery and rehabilitation2. ASC(S) additional support needs, by promoting were extracted from children each year believes in the importance of adequate learning through play using dental • tooth extraction was the largest single preparation for any form of treatment and play resources. reason for children receiving general Special Smiles is a development of the anaesthesia in hospital. Continued »

Scottish Dental magazine 33 Child education

Continued » • many children with additional and com- treatment. It is with these issues in mind plex support needs experiencing dental that the SSDP was designed and received in the role of play in this regard and has long anxiety which makes dental care difficult funding from Boots Plc for ASC(S) to refine promoted the concept of hospital play as a to carry out. the Dental Playboxes into a specialised way of helping children cope with the trau- Children with additional and complex resource for use with children with addi- ma of procedures, treatment and pain and needs are therefore at a higher risk of need- tional support needs. ASC(S) consulted and to understand what is happening to them. ing specialist dental services than the researched a wide range of individuals, So, following discussions with staff at the general population and at the highest risk organisations and publications during the Glasgow Dental Hospital and with funding of having to undergo general anaesthesia course of this period and, in addition to the from Boots Plc through their Community for dental procedures. Despite the growing Dental Playboxes, developed a portable Investment Fund, ASC(S) developed number of oral health initiatives for chil- Dental Playpack for use at home by parents. 30 Dental Playboxes with the aims of dren in Scotland, it was found that none of The basis of the SSDP was to test out encouraging children to attend the dentist, them adequately addressed the needs of these specially developed play resources, dispelling the anxieties associated with by piloting them in schools for children and dental treatment, and promoting good oral young people with additional and complex health habits. The Playboxes contained support needs in one Scottish Health Board books and toys about teeth and dentists, area over a two-year period (2007-2009). safe dental equipment, mini uniforms, Funding was secured from the Scottish worksheets, certificates and stickers. Government and resources were placed in These Dental Playboxes were available 29 schools throughout Tayside. These on loan to nurseries, primary schools, included specialist nursery, primary and school nurses and hospitals throughout secondary schools, a sensory service and Scotland and 18,500 children had access to also units in mainstream schools with spe- the Playboxes over the two-year period. cialist provision for pupils with additional The feedback received from schools, par- and complex support needs which covered ents, children and dental professionals was a range of conditions, such as Autistic overwhelmingly positive and an evaluation Spectrum Disorders, as well as those with by an independent consultant indicated sensory and physical impairment. The proj- that the aims had been successfully realised. ect complemented the work of NHS A need was identified for a resource specif- Tayside as it implemented its Childsmile ically geared for children with physical programme in mainstream schools. disability, sensory or learning impairment. Each school received a Special Smiles At the same time, the Scottish Executive Dental Playbox and a portable Playpack for was setting out a commitment to improv- home use and training was provided for ing children’s oral health in the Action Plan teaching staff and carers in the use of the for Improving Oral Health and Above: Dental Playbox and portable Playpack various resources in school, nursery and Modernising NHS Dental Services in home settings. The Special Smiles Scotland.3 A key principle of the Action Plan “Despite the grow- resources included books, DVDs, puppets, was that: “Services for children and young games and toys about teeth and dentists, people should be focused on prevention ing number of oral safe dental equipment and mini-uniforms, and meet the oral health needs of those in worksheets and stickers, together with tem- the most disadvantaged circumstances.” health initiatives, plates for social and multi-sensory stories it was found that which could be adapted to the individual The Action Plan also set oral needs of a child. Books, charts and work- health targets that: none of them sheets with Makaton and Boardmaker • 60 per cent of five-year-olds to show no addressed the symbols were also included. Additional signs of obvious dental disease by 2010 resources such as inflatable dentist chairs • 60 per cent of 11-12-year-olds to show no needs of children were made available and replacement dis- signs of obvious dental disease in their posable materials were also supplied as permanent teeth by 2010. with physical required. Two-minute timers were sup- Research evidence suggests that children disability, sensory plied for every child. Throughout the with additional and complex support needs project, back-up support was provided by have poorer oral health and receive less or learning the project staff in the form of workshops preventive care and restorative treatment with children, meetings with parents, activ- than children in the general population. impairment” ity sessions and competitions and exchange Reasons put forward to explain this include: of ideas through regular newsletters. • children being unable to take care of children with physical disability, sensory or The aims of the project were to improve their teeth learning impairment. the oral hygiene understanding and prac- • children refusing to co-operate with Thus, it was acknowledged that children tices of these children and young people carers with tasks such as tooth brushing and adolescents with additional and com- and reduce the anxiety associated with den- • children experiencing communication plex support needs required a specialised tal treatment by promoting learning difficulties oral health intervention which would raise through play using the dental play • lack of experience among dentists in their awareness and improve oral health resources. It was also hoped that the proj- treating children with additional and practices, and that using a therapeutic play ect would heighten the awareness of the complex support needs strategy would prepare them for dental dental health needs of these children and

34 Scottish Dental magazine Child education

young people among parents, carers and relevant professionals, and assist them in FEEDBACK: Teachers and parents are all smiles providing for their oral healthcare needs. Guidelines for use of the play resources “The children loved dress- before, but with Special still slightly apprehensive, were inserted in each box and pack and a ing up and taking part in Smiles, it became a group but will now have treat- training programme was offered to staff and the role-play activities and activity. I noted quite a big ment. The resources, parents. This included information on how at the end of the project all change. Even the most combined with an under- to make best use of the resources, guidance but one were able to indi- sensory defensive child standing dentist, have on play, anxiety reduction, oral health and cate that they weren’t held a toothbrush.” made a big difference.” children with additional support needs and worried about going to the Heather Miller, Nursery Parent, Tulloch Primary School, links to other organisations and websites. dentist.” Teacher, Fairview School, Perth Perth The schools used the resources in differ- Isla MacDonald, Grange “Heather now brushes her “My child treats teeth ent ways. There were opportunities for Primary School, Monifieth teeth two to four times a cleaning more as a game medical play, using a mixture of real and toy “The children had been day and visits the dentist now, so it is much easier to equipment to assess and encourage infor- brushing teeth individually every three months. She is help her.” mation sharing – what the child will Parent, Fairview School experience and how procedures will occur; opportunities for projective play, using toys such as Play-Doh or teddy patients to help before and after questionnaires, and on non-compliant, but successfully complet- children play out their experiences; oppor- other means such as photographs, drawings ed a course of dental treatment after using tunities also for role-play, using the mini and observation. The greatest amount of the Dental Playpack. uniforms, masks, gloves and goggles, allow- feedback came from the teaching staff who It is hoped that by using the Special ing them the chance to try on adult roles, were universally in favour of the project Smiles resources with the support of pro- giving them a sense of control which can with very positive feedback. fessionals, parents and carers, children will help identify any hidden misunderstand- The success of the Special Smiles Dental require less dental treatment and when ings, fears or feelings. Project is in no doubt, having been received they do, will have strategies in place reduc- Some schools ran sessions purely on oral enthusiastically by children, parents, car- ing the need for general anaesthesia for health promotion, and used the resources ers and professionals. The Evaluation treatment, a costly and risky procedure. to refer to healthy teeth and diet. Others set Report4 can be accessed on the ASC(S) ASC(S) believes that Special Smiles could up a dental surgery with chair and held role- website. It concludes that the project met greatly enhance the Scottish Government’s play sessions in class using all the resources, its main aims and that oral health under- ability to achieve their oral health targets while other schools used the resources for standing and practices improved among for children in Scotland. short-term projects on related themes. staff, parents and children, and child den- More than 700 hundred children in 29 tal anxiety was reduced. ® schools had access to the resources over the Research shows that dental anxiety can Catherine Nelson is a Dental Playbox period of the project. Because of the very prevent children from accessing dental Co-ordinator. Further information about the complex needs of some of the children, it treatment5 and highlights children with project can be obtained from: Action for Sick was difficult to measure any change in the additional and complex needs to be among Children (Scotland), 22 Laurie Street, Edinburgh children’s understanding using traditional the most vulnerable. Special Smiles staff EH6 7AB, tel 0131 553 6553, methods, so there was a reliance on parents received several reports of extremely anx- [email protected] and carers to answer on their behalf using ious children who were initially totally www.ascscotland.org.uk

References 1. Scottish Executive (2002) Towards Better Oral Health in Children. Edinburgh HMSO, 2002.

2. Russ, S. (2004) Play in child development and psychotherapy: Towards empirically supported practiced. Mahwah, NJ.: Lawrence Erlbaum Ass.

3. Scottish Executive (2005) An Action Plan for Improving Oral Health and Modernising NHS Dental Services in Scotland. Edinburgh HMSO, 2005.

4. Chambers, S., Turner, S. & Freeman, R. (2009) Special Smiles Dental Project Evaluation Report Dental Health Services Research Unit, University of Dundee, 2009

5. Howard, K.E. & Freeman, R. (2009) An evaluation of the passivity to activity through live symbol after treatment modelling intervention to reduce dental anxiety in child dental patients. International Journal of Paediatric Dentistry 2009. Above: Special Smiles books help to reduce children’s anxiety over dental treatment

Scottish Dental magazine 35 Practice profile - Giffnock Orthodontic Centre

stretched to two-and-a-half years, some- thing Yas was determined to reduce, The ‘wow’ factor with the help of his associate George Kantopoulos. He said: “The waiting list was unacceptable. It’s not in the best interests For Yas Aljubouri, patient satisfaction of the patients to be waiting that long for is the most important part of the job treatment, especially when you are young. “It took us the best part of six months to do it but we managed to get the waiting list almost down to nothing. We increased our hen Yas Aljubouri working week from 35 hours to 40, worked describes the look on through lunches in shifts and even opened his patients’ faces when on some Saturdays. But we got there.” he removes their fixed Since taking over, Yas has managed to Wappliances – after what increase the referral rate by two-and-a-half is often a long treatment period – his to three times, month on month. “A high passion for the job really shines through. referral rate shows that our referring “You get that ‘wow’ smile and it makes it dentists are happy with the service we are all worthwhile. For me this is the reward, providing. It is so important to have a this is the job satisfaction and it makes my stable, long-term relationship with day every time.” referring dentists, and it’s a huge big thanks Yas graduated in 1991 and obtained his Yas was determined to reduce the waiting list to them that we are where we are now.” Specialist Orthodontic Certificate (M Orth) While this was going on Yas was also from The Royal College of Surgeons of an opportunity arose for him to buy his own completing a series of renovations to the Edinburgh in 2003 following his three-year practice. practice, which he felt needed freshening Specialist Orthodontic training in Glasgow Yas took over Giffnock Orthodontic up. A rolling programme of refurbishments Dental Hospital & School, where he also Centre in October 2008, one of the oldest was introduced with new floors, furnish- completed his Orthodontic MSc in 2002. He orthodontic practices in Glasgow with an ings, cabinetry, window blinds and a new worked as a specialist orthodontist in established referral base. computer system – with digital X-ray Glasgow and Dundee for five years, before However, the waiting list at the practice system – as well as an LDU, all installed.

36 Scottish Dental magazine Scottish Dental magazine 37 38 Scottish Dental magazine Revalidation

Skills check-up The General Dental Council has launched a consultation on a new system of checks that will ensure dentists are meeting the minimum standards, writes Denis Toppin

he term revalidation has been As a dentist working in Scotland, I am surprised to find this doesn’t happen. floating around the medical well aware of the demands regulation is Revalidation will bring reality into line profession for some years now. putting on the profession. The second part with their expectations. Plans to introduce it for doctors of the Scottish Government’s consultation Now is the time to have your say on what Tin the UK have been under on the regulation of independent health- we’re planning through our consultation, discussion for quite some time. care has recently closed, the Protecting which is open on our website www.gdc- The current proposals for the introduc- Vulnerable Groups scheme started at the uk.org now and runs until January next year. tion of revalidation were triggered by The end of November and already in place are The consultation document sets out the Shipman Inquiry, chaired by Dame Janet the health board inspections, vocational GDC’s proposals for revalidating dentists. Smith, which concluded that the NHS and training practice inspections and, of course, We don’t plan to consider in-depth whether General Medical Council did not have the registration with the GDC. revalidation is necessary for dental care systems or culture in place that would have But our plans for revalidation are about professionals (DCPs) until the random allowed the conduct of someone like individuals. It’s about protecting patients by audit of their first cycle of continuing pro- Harold Shipman to be detected. ensuring you’re giving them the best pos- fessional development (CPD) is complete Following publication of the report, Sir sible care. You may well be at the top of your in late 2013. However, their views on this Liam Donaldson, Chief Medical Officer for game as far as technology and practices go consultation would be very welcome. England, was asked to undertake a broad when you first register with us, but we want Put simply, the philosophy behind the review of medical regulation which led in to ensure it stays that way throughout your proposals is to avoid over-regulation by 2007 to the publication of the White Paper: entire career. The scheme, for the first time, making as much use of existing systems Trust, Assurance and Safety – The will provide a proactive way of checking within dentistry as possible. It should be Regulation of Health Professionals in the 21st that dental professionals carry on meeting seen as a very useful extension of what den- century. This led to the passing of our standards after they join our registers. tal professionals are already doing with legislation in 2008 granting the powers to The GDC’s fitness to practise proce- CPD – which is an earnest attempt to keep establish revalidation. dures are reactive rather than proactive; themselves up to date. It’s far from a In spite of delays, the General Medical they assume that dental professionals meet panacea, nothing can remove all risk, but Council recently confirmed its plans to its standards unless information to suggest what we need is a scheme that isn’t too bur- introduce medical revalidation in 2012. The otherwise is received. That is not good densome and that will give that additional General Dental Council (GDC) is also mov- enough. Patients believe and expect that reassurance to patients and the public. ing ahead with developing its own scheme dental professionals’ compliance with stan- and is currently consulting on the issue. dards is checked on a regular basis and are Continued »

Scottish Dental magazine 39 Revalidation

Continued » • Stage 3 – in-depth assessment, which will restoration to the register. However, there apply to dentists who fail to demonstrate will be an appeals process. Revalidation will make clear the mini- their compliance at the end of the We are keen to get feedback from a full mum standards that all dentists must meet. remediation phase. range of stakeholders including patients It is expected that the majority of dentists Dentists who refuse to engage with the and organisations representing the inter- will already be meeting these standards and process, or who do but who fail to revali- ests of patients. In order to secure a wide should have no difficulty revalidating. date, will ultimately be removed from the range of views we are also carrying out However, the system will provide an register, with additional requirements for other activities alongside the formal con- opportunity for those in difficulty to iden- sultation. These activities include research tify and tackle any problems before they into patient and public views, dedicated become serious. About the author focus groups, meetings, and piloting activ- A standards and evidence framework Dentist Denis Toppin is on the council of the GDC ities as the project progresses. Once the and is also chairman of the Revalidation Working will set out the standards dentists must Group. A returning registrant member to the council consultation has closed we will collate all meet under the four domains of clinical, of the GDC, Denis was born in Glasgow where he the responses we have received and GDC management and leadership, communica- returned to study and work. staff will carry out a consultation analysis tion and professionalism. The framework He qualified as a dentist in 1977 from the and produce a report for the Revalidation will also set out the evidence that will be University of Glasgow and has been working in Working Group to consider. This report general dental practice ever since. acceptable to demonstrate compliance with Denis developed an interest in dental education will be published on the GDC website each standard. through his involvement in dental vocational and will influence the proposals the Dentists will gather this evidence over training as a vocational training trainer, adviser and working group makes to council for five years, and revalidate at the end of each regional adviser as well as through teaching revalidating dentists. undergraduate dental students clinical practice in cycle. We are proposing a three-stage restorative dentistry. He also teaches on numerous process at the end of each cycle: postgraduate courses. He holds a masters degree ® • Stage 1 – compliance check, which will in education. Readers of Scottish Dental magazine can apply to all dentists He was a member of the Scottish Dental Practice respond to the consultation by email on • Stage 2 – remediation phase, which Board for the maximum six year period and he [email protected] or by filling in the form currently holds a part-time post of Assistant will provide an opportunity to dentists Director of Postgraduate General Dental Practice at www.gdc-uk.org or by writing to: who do not pass Stage 1 to remedy Education with NHS Education for Scotland. Revalidation Consultation, General Dental deficiencies Council, 37 Wimpole Street, London W1G 8DQ.

40 Scottish Dental magazine

Advertising feature Fit to practise?

Event looks at the GDC inquiry process that to the Investigating Committee GDC viewpoint, highlighting for consideration. the challenges and pitfalls examines a registrant’s fitness to practise The work of this committee encountered in preparing a case was outlined by Andrew for a Fitness to Practise hearing. Keetley, a former member of the Jason Leitch, chair of the Health n the first event of its kind, the concept ‘Fit to Practise’. committee, who explained the and Conduct Committees, dis- Dental Protection in con- Kevin Lewis, dental director important features of a com- cussed the many health issues junction with the British of Dental Protection, reviewed plaint that would influence the that could potentially impair a Dental Association (BDA) the nature, number and pattern committee’s decision to refer a registrant’s fitness to practice, Iheld a joint meeting in of complaints received by the case for further investigation, and outlined how the GDC Edinburgh on 19 November, GDC in the wake of the changes and the weight given to the var- deals with ill health in the which took a unique ‘behind the in the Fitness to Practice Rules, ious documents appertaining to Health Committee. scenes’ look at the processes which occurred in July 2006. the case. Delegates were provid- Undoubtedly, the highlight of involved in a General Dental ed with a bundle of documents the day was the live dramatisa- Council (GDC) inquiry into a The delegates were similar to one that would be tion of part of a Fitness to registrant’s fitness to practise. able to put them- provided to the legal teams Practise hearing involving This proved to be an interac- representing the parties actors and barristers. This tive, informative and engaging selves in the shoes involved in a real enquiry. An demonstrated how stressful and event aimed at raising aware- of the Investigating assessment of the bundle con- challenging a hearing can be, ness of the fitness to practise Committee; review tents was covered by Chris and proved to be both informa- process, from the initial patient case notes, hear from Morris, head of Dental Team, tive and entertaining. This was complaint, through to a poten- the complainant, Hempsons Solicitors, who followed by an enlightening tial fitness to practise hearing, caseworkers, prosecu- advised the delegates about the presentation by John Gibson, which was brought to life in a tion, expert witnesses gathering of information on the who is a member of the Fitness powerful re-enactment. and members of the case by the solicitor, and what to Practise panel, discussing The delegates were able to Investigating and factors influence the content of how decisions are reached, and put themselves in the shoes of Fitness to Practise the letter of observations factors which influence the the Investigating Committee – Committees returned to the GDC. panel when considering review case notes, hear from the After lunch, the attendees whether to take action on reg- complainant, caseworkers, voted by SMS text on which istration. A final vote was cast prosecution, expert witnesses Stephen Henderson, a dento- cases merited further investiga- on the hearing, and a discussion and members of the legal adviser with Dental tion. This was followed by a on the lessons learned. Investigating and Fitness to Protection, proceeded to intro- presentation from barrister The day was deemed a great Practise Committees. This duce a number of fictionalised Philip Blakebrough, head of success by the large number of allowed them to make their own complaints and invited the audi- Fitness to Practise at the GDC, delegates present, who ranged judgements on the allegations of ence to review these and vote on who described the process of from students and graduates to impaired fitness to practise and which case should be referred case investigation from the experienced practitioners. consider the sanctions available. The likely impacts of being involved in such an inquiry were explored with a high level LEARN ABOUT RISK MANAGEMENT... of realism that drew upon the experience of council members The Premier Symposium ‘Mastering Your Risk’ work- tions that often act as a trigger of the GDC together with organised in conjunction with shops offer an evidence-based point or catalyst to a complaint employees and advisers from Schülke is now celebrating its overview of the important role or claim. Dental Protection and the BDA. 10th anniversary. The risk man- communication, behaviour and Each workshop is led by a The attendees were wel- agement event was held on performance play in providing trained facilitator with comed by BDA Scotland Saturday 4 December 2010 at quality care and reducing the experience in delivering com- Director Andrew Lamb, which Kings College London. risk relating to patient dissatis- munication-based training. was followed by an informative Speakers included Professor faction. The format is designed These workshops take place presentation by Alison Lockyer, Tara Renton, who discussed for no more than 25 delegates at various locations throughout chair of the council, GDC, who the cause of nerve injuries and and offers an opportunity for the UK, are approved for three brought the delegates up to their management, and each participant to develop hours’ verified CPD and are free speed on the new GDC, its roles Professor Richard Palmer who skills to meet the increasing to DPL members, so book now and responsibilities, and provid- spoke about implant risks. number of challenging situa- as numbers are limited. ed an explanation of its view of

42 Scottish Dental magazine Scottish Dental magazine 43 Public health

The experience of other countries over several decades tells us that water fluoridation is safe and effective, explains Colwyn Jones Glass half empty?

he USA Centers for supply water to more than 1,000 and effectiveness of water Disease Control people, to add fluoride to the fluoridation. and Prevention public water supply under their In Canada, 45 per cent of the recently released control or management. population receive fluoridated Tthe latest water The Queensland legislature water, in Eire 67 per cent or two fluoridation statistics for 2008, also committed AUS$35 million million people, in Spain about 10 which showed that 58 per cent to improve the infrastructure of million, in Singapore and Hong of people living in California water treatment plants over this Kong the proportion is 100 per receive fluoridated water, more six-year period and implement cent. In New York, with a pop- than double the 27 per cent who fluoridation. The new water bill ulation of eight million, the benefited in 2002.1 Across the followed a petition from the water was fluoridated 45 years Thanks to efforts led by a USA 72 per Australian Dental Association ago in 1965. Virtually all of the charitable trust established cent of the of Queensland signed by more major cities in the United States by the California Dental population than 25,000 Queenslanders sup- of America are fluoridated. Association (CDA) Foundation, on mains porting water fluoridation.2 In the UK, water fluoridation, it has steadily expanded access water In 2008, 65 per cent or 11.5 mil- either natural or adjusted, is to water fluoridation. California receives lion Australians benefited from available to only about 10 per now has the largest total num- water drinking fluoridated water and cent of the English population. ber of residents of any fluoridation this proportion is increasing. The only area in Scotland which American state receiving fluor- Like the USA and the UK, fluor- did have naturally fluoridated idated water; 21.5 million people idation of water supplies has water at 1ppm was on the Moray or four times the Scottish been practised for more than coast.3 However, the water came population. 50 years without credible from a borehole supply which Before the CDA Foundation- evidence of any harmful effects is no longer used. Most of the led efforts to expand fluorida- water collected for domestic tion in the late 1990s, only 17 per use in Scotland has a moorland cent of California’s population Current water fluoridation catchment, which means it will received the benefit of fluoridat- (selected countries, various years) be low in fluoride. So, in ed water. Progress was achieved Population receiving Scotland, despite having a pub- Country Percentage water fluoridation largely by legislation approved Scotland 0% none lic water supplier, there is in 1995. USA 64.3% 195 million essentially no water fluorida- The CDA fulfils the same role Canada 45% 31 million tion, either natural or artificial. in the state of California as the England 10% 6 million Across Europe only England, British Dental Association does Eire 67% 2 million Ireland and Spain practise arti- Australia 65% 11.5 million in Scotland, including being an New Zealand 61% 2.3 million ficial water fluoridation and advocate for water fluoridation. Israel 75% 4.2 million while many other European Since then, the CDA Singapore & Hong Kong 100% 10 million countries do have natural water Foundation and its partners, fluoridation, they prefer to rely often working with private fun- on professionally applied fluo- ders, have provided grants to tion; the state of Maryland has on general health. For genera- rides for the preventive benefits; help communities initiate 99.8 per cent benefiting from tions, millions of people have those countries within the fluoridation projects. water fluoridation. lived in areas where fluoride is European Union are governed The USA federal govern- Across the Pacific in 2008, the found naturally in the drinking by water quality directives ment’s Healthy People 2010 state of Queensland in Australia water in concentrations as high which allows for natural fluo- objective for fluoridation is also adopted legislation to pro- as or higher than those recom- ride levels of up to 1.5ppm. 75 per cent, which is a target mote water fluoridation with mended to prevent tooth decay. (Council Directive 98/83/EC. 3 that the CDA foundation the aim of 90 per cent of Research conducted among November 1998. The quality of reports it plans to achieve in the Queensland residents having these groups confirms the water intended for human con- near future. access to fluoridated water by safety of fluoride in the water sumption). The target level for Across the USA, 72 per cent 2012. Under this legislation, a supply. While we welcome artificial water fluoridation in of the population on mains statutory duty was placed on more research, there are no temperate climates is lower at water receives water fluorida- public water suppliers who concerns about the safety 1mg/L and unlike school-based

44 Scottish Dental magazine Public health

programmes, it should be noted children are admitted to hospi- use of fluoridated toothpaste that people of all ages do bene- tal for treatment under a general and caries-preventive programs References fit from water fluoridation. anaesthetic. Dental treatment implemented by the municipal 1: www.cdc.gov/ fluoridation/statistics/ Dental fluorosis is present in creates additional problems for dental services in Denmark.” 2008stats.htm areas both with and without some (e.g. diabetics, haemophil- They reported that at a level 2: http://statements.cabinet. water fluoridation and in a iacs, transplant patients, of fluoride of about 1ppm, a qld.gov.au/MMS/ European context the mild den- the immune compromised) reduction in tooth decay of StatementDisplay 4 Single.aspx?id=56475 tal fluorosis found is a minor for whom a healthy mouth around 50 per cent was found. 3: Stephen KW, Macpherson cosmetic issue. is essential. So even in countries with LMD, Gilmore WH, Stuart RAM, The suggestion that water Some evidence shows that widespread use of fluoridated Merrett MCW. A blind caries fluoridation is mass medication fluoridation is particularly ben- toothpaste and caries-preven- and fluorosis prevalence is false. All water supplies, even eficial in preventing tooth decay tive programmes, such as in study of schoolchildren in naturally fluoridated and in Scotland, have some natural in deprived groups of children Scotland, the evidence shows nonfluoridated townships fluoride and the water fluorida- who may have difficulty with that water fluoridation would of Morayshire, Scotland. tion process just involves their own preventive care. provide major, additional Community Dent Oral adding fluoride (or removing However, it benefits all improvements in child Epidemiology 2002; 30: 70-9. 4: Kirkeskov et al 2010. The fluoride in some areas of the children, and reduces dental dental health. association between fluoride world) to the level that protects health inequalities. The recent lesson from in drinking water and dental dental health. It does not involve A recent paper reporting on California and Queensland, and caries in Danish children. adding anything to the water natural fluoridation and the historically elsewhere, is that Linking data from health that is not already present. effect on the dental health of local dentists need to engage registers, environmental registers and administrative There is no difference between children across Denmark con- politicians in promoting a statu- registers. Community Dent fluoride present naturally and cluded that: “The study tory duty on public water Oral Epidemiol 2010; 38: that which is added to water. confirmed previous findings of suppliers to fluoridate. 206–212. Water fluoridation both an inverse relation between ® Disclaimer reduces tooth decay and also fluoride concentration in the The views expressed in the need for dental treatment. In drinking water and dental caries Colwyn Jones is a Consultant this article are solely those Scotland extraction of teeth is in children. This correlation was in Dental Public Health for of the author. still the main reason that young found in spite of the extensive NHS Health Scotland

Scottish Dental magazine 45 Dental imaging A real head turner

Introduction In recent times, technology has taken a huge leap forward, not least in the field of dental imaging. The following article is a light-hearted look at some issues around cross-sectional dental imaging with a few serious comments and warnings for the uninformed. General dental practitioners are becoming increasingly involved in implant planning, placement and in the restorative phase of this newer treatment modality.

right eyed and bushy before the exams and allowed ographic appearance I noted This offers the opportunity tailed, we headed off osmosis to take effect. Spotting today?” This is the ongoing chal- for some skilled and daring to university. For caries was not rocket science if lenge. The spectre of missing a souls in our profession to move some this is a fond, you could sort out the pesky sinister lesion can sometimes out of their long-established Bbut distant memory. “cervical burnout” lesion! weigh heavily. Should I refer on comfort zone of routine Remember struggling with the Wade through the black and for an opinion or will I look silly? dentistry into a brand new vagaries of anatomy? Then later, white/gray stuff for exam pur- The steep learning curve tails world of surgical “Meccano”. trying to apply it when looking poses and get stuck into real off and the bump and grind of Remembering dad’s advice, at X-rays, oops... meant radi- dentistry – this perhaps sums up daily practice can begin to lull implantology represents a good ographs – “X-rays being most people’s experience of invisible”, I was reminded often. radiology at undergraduate Driven by the promise of What memories of the X-ray level, unless like this author you department? Didn’t the staff were a bit of an imaging geek. restored function and have strange job titles such as But what if all of that radiol- radiographer, radiologist and ogy speak actually had a eternal youth, implantology dark room technician? The practical use? I soon became makes its entrance latter was the poor soul aware, after graduation in den- condemned to darkness for tistry, that many clinical one into a state of professional “ology” to get involved in. much of their working day – decisions centre on a sound stupor. Then along comes a new Besides, there are some flashy what was all that about? understanding of radiological “ology”. Driven by the endless new shiny toys which fit easily Dad said to study an “ology”, anatomy and the ability to makeover programmes and with the dental profession as we so maybe that made radiology recognise the “abnormal”. the promise of restored are so used to working in con- a useful topic – so we got those How to ward off that nagging function and eternal youth, fined spaces and have excellent radiology tomes out, laid them thought that occurs just as you implantology makes its manual dexterity. on our chests in the park on a place your head on the pillow: entrance on to the dental In order to avoid that nasty sunny afternoon in May just “what exactly was that radi- high street. letter from a lawyer should the

46 Scottish Dental magazine Dental imaging

expensive implant work fail and and avoid operator hyperten- are losing me, you might say… to avoid the “welling up” of red sion. A bit larger than an OPG Put simply, this is essentially stuff in the floor of mouth due machine, obtaining its images good news for the patient as it to pranging a neurovascular by circling the head in anything cuts down the rays. canal or misaligning the implant between 10 and 40 seconds, the Having spent a serious completely, perhaps a timely bit CBCT produces cross-section- amount of cash acquiring the of imaging is required. al images that can be viewed impressive looking “Daddy of So we dust off that radiology from three plains: axial, coronal all dental imagers”, the question book and apply the knowledge. and sagittal. Variable thickness- arises as to who is going to take Conventional views have es in section can be shown, the scan? In the opinion of this served for a number of years down to 0.25mm. author, it should be a medical/ with well-placed per-apicals In addition, using a software dental professional with appro- (paralleling technique) and the package, the data can be made priate training. This may trusty panoramic, but the illu- so that the acquired volume include a radiographer, or a den- sive third dimension is missing. (field of view) can be viewed tist. One should appreciate that There are those at confer- like the trusty old friend “the the use of dental nurses or ences who will sell the line that dental panoramic”. 3D recon- hygienists even with a dental they can eyeball an implant into structed images of the jaw are radiography qualification is the mandible from a thousand possible and can be manipulat- contentious in the acquisition of yards, using skills honed over a ed at the chairside, sending the CBCT images at this time. thousand cases. The realities patient into raptures of delight may be quite different to as they see their inner-self IRMER issues the novice operator on the revealed. In order to comply with the implant scene. radiation regulations, a great Alas, 3D imaging systems can So, CBCT imaging – can’t be deal of effort has to go into informing the Health and Safety Executive that you have the Fig 1: Mass in the left piriform Having spent a serious CBCT scanner and into docu- fossa (see axial section) menting your IRMER 2000 and amount of cash acquiring the IRR1999 protocols. CBCT room design will have impressive looking “Daddy to allow for radiation protection of all dental imagers”, the features to cope with a 120KV beam energy. This 120KV beam question arises as to who has increased penetrating power, compared to dental sets is going to take the scan? at approximately 65KV to 70KV. A radiation protection advisor (a medical physicist) will have offer some peace of mind. that difficult, can it? to verify this has been carried Visualisation of the bucco-lin- Perhaps I should get one for the out correctly in compliance gual dimension is now possible practice?1 CBCT comes in vari- with IRR1999. – seen in the coronal plane, ous shapes and sizes and are All the IRMER documents remember. Sagittal, coronal and classified as large (field of view) must be in place, which entitle axial, the orthogonal planes FOV and small FOV. The small- the various staff members to used by anatomists and radiol- er field size can offer dose carry out their roles under ogists to describe sections. reduction and limited viewing IRMER in regard to the CBCT The fog of the undergraduate of teeth and immediate sur- machine. For example, who is memory clears. rounding structures. acting as employer, referrer, Super-crisp images in the operator and practitioner. The cone beam CT scanner brochures tempt one with res- Protocols must be in place Since units have become avail- olution “to die for”. Was the itemising all possible CBCT able on the high street, dentistry picture produced on a patient imaging situations, detailing has been quick to appreciate the though, I hear you say? who can refer for them and benefits of an office-based (how What is not immediately under what kind of situations – American), low-dose (com- apparent is that there are that is, what “justification” is Fig 2. Lateral lingual canal situated in pared to medical CT), 3D nuances to the CBCT systems. required. All must be docu- canine region of mandible (sagittal imaging device, the cone beam For example, the 0.4mm voxel mented and be robust enough to section) CT scanner. CBCT can address setting gives better pictures withstand an IRMER inspec- many of the problem solving than the 0.2 mm voxel setting on tion. This gets a little aspects of diagnosis in dentistry. iCat. This comes down to the complicated, but is distillable With regard to implants, maths involved in the imaging with some effort. Also, in terms knowing where those pesky algorithm. The system utilises a of image interpretation, IRMER nerves are is all-important in the limited tube current in order to quest to give a predictable result keep dose down. No more, you Continued »

Scottish Dental magazine 47

Dental imaging

Continued » Some anatomy to know where significant medical radi- about on a CBCT sectional ological presentations are 2000 demands that all of the image missed, there will be medico- radiographic image should be Recently, small “neurovascular legal ramifications. assessed and an appropriate canals” have come into view on It is also good practice to report documented. CBCT that were not appreciat- warn the patient prior to the ed before2. The “lateral lingual CBCT scan that non-dental fea- So how do I report on the canal” in the body of mandible tures/lesions may become CBCT images? is a good example. These neu- apparent on the scan, which Much of the software available rovascular canals usually lie may involve ongoing referral, will make dental diagnosis near but separate from the men- and potentially give rise to a very user-friendly and allow tal foramen. In the patient with period of uncertainty until a planning for implant placement an atrophic mandible, they can definitive diagnosis or treat- straightforward, for example, offer a potential surgical hazard ment can be realised. ICat vision software (Imaging for implant placement. They With respect to Ionising Sciences). can contain nerve fibres from Radiation Regulations, if they There is, however, a sizeable the nerve to myelohoid and so are not properly implemented amount of tissue data that may if impinged upon by an implant, into practices with CBCTs, then be missed in the FOV. This can pain can present post op. (Fig 2) the Scottish Executive may have be seen on the MPR screen on the right under IRMER2000 to iCat vision or with better reso- Some examples of lesions take action which could close lution on the Xoran software not to be missed from the imaging service down. used with iCat. This author CBCT images In my opinion, the “Daddy”, reports direct from the Xoran A keen rugby player and diver in colloquial parlance, is the software, which is presented in presented for a 4cm FOV pre- wise practitioner who puts the the orthogonal planes. implant assessment of his patient’s best interests first. The Fig 3. Haemangioma in lateral Currently there are few if any upper centrals. Assessment of “Daddy” is also someone who mass of CV1 (atlas) noted in all courses being run on how to the full field of view revealed a plays to their strengths. three planes report CBCT. Problem-solving haemangioma of CV1. (Fig 3) It may be that image acquisi- begins when appearances are tion is more easily carried out at unusual. Is the appearance Assessment of the base of another site where all the above benign or does it represent an skull is imperative – ear issues have been addressed. It aggressive process? If so, is it structures should be may be that image interpretation malignant? Having knowledge reported on is best carried out by a suitably of “normal” on an image section The appearance of chronic qualified other. will help, but pattern recogni- inflammatory lesions in the The fear of losing a patient to tion may be a bit scary at first. middle ear – an early another operator who has “the New anatomical territory is cholesteatoma (Fig 4). big daddy” of dental imagers now visualised: inner ear, base will be less if the CBCT is of skull, cervical spine, peri-oral Conclusion and opinion sited in a secondary referral soft tissues to name a few. A Having a knowledge of the centre/practice. sound knowledge of what soft appropriate “ology” is the key Discussions with the owning tissue outlines are supposed to here, for peace of mind and practitioner/specialist should resemble will give peace of ongoing success in implant ensure that we act as a family mind that no tumours have been planning. It is for the person within the profession, with missed, for example, in the functioning in the IRMER oper- respect for each other’s role in laryngo-pharynx (Fig 1). ator role to produce the image the treatment team. The old imaging maxim: “Just report. Confusingly, this may compare left with right sides” not be the person pressing the ® has merit, assuming lesions button to obtain the scan (see Dr Neil D C Heath, DCR, BDS, MSc, are not bilateral in their IRMER2000 regulations). MFDS RCS, DDR RCR, Consultant presentation. Appreciation of The IRMER operator and Specialist in Oral Maxillofacial the anatomical site, the relative (reporter) must report the Radiology, Edinburgh Dental density, outline of a lesion and CBCT scan and any other rele- Specialists access to any previous vant images, unless that role is imaging will all help in reaching delegated to a suitably trained References Fig 4. Soft tissue mass in right a differential diagnosis. other, such as a radiologist. This 1. Heath N and Macleod R I, Dental Prussac’s space (medial to the Getting the dissection/ author would argue that the Update 2008 (35) 353 tympanic membrane-possible early Cone beam CT in Dental Practice cholesteatoma). Coronal section radiology books out from times best-placed radiologist to showing the middle and inner ear past may be a good way to start. undertake this role should have 2.Trikeriotis et al structures. Cerumen also noted in However, not much cross-sec- a dental background. 2008,Dentomaxillofac Radiol (37) the right external auditory 125-129. tional anatomy was taught at This obviously has cost impli- Anterior mandible canal dental school. cations that must be passed on communications: a potential portal of The following examples are to the patient. However, in the entry for tumour spread. in no way comprehensive: long term, if cases come to light

Scottish Dental magazine 49 Specialist services Why refer?

Arshad Ali of the Scottish Centre for Excellence in Dentistry discusses the benefits of referral to a multi-disciplinary centre

s a general dental requirements for our patients. patients can be seen within a practitioner In the Maintaining Standards relatively short period of time. (GDP), it has document published by the Some referral centres have a become increas- General Dental Council, small number of specialists Aingly difficult to November 1997, paragraph 3.3 providing their services; others carry out every aspect of treat- states: “When accepting a have more specialists in differ- ment that patients require. patient, a dentist assumes a When a GDP wishes to refer ent specialities. In the latter More patients are wishing to duty of care which includes the to a specialist, he or she can case, the centre will be able to avoid removable partial den- obligation to refer the patient refer to a general or dental hos- provide comprehensive multi- tures, resulting in the need for for further professional advice pital where dental services are disciplinary care in one site. more extensive crown and or treatment if it transpires that provided. In most cases there This will often result in bridge and implant treatment. the task in hand is beyond the are waiting lists for a consulta- better co-operation and com- We also have an increase in dentist’s own skills. tion and also to have treatment munication between the the elderly population who “A patient is entitled to a refer- carried out. specialists, which would be of are retaining their teeth into ral for a second opinion at any The other option is to refer benefit to the patient. Specialist old age. This is resulting in time and the dentist is under an to a specialist or dentist with centres also should have spe- more complex treatment obligation to accede to the special interest in the high planning and treatment request and to do so promptly”. street where, in most cases, Continued »

50 Scottish Dental magazine CASE STUDIES

Fig 1a

Fig 1b

Fig 2a

Fig 2b

Fig 2c Fig 2d

Scottish Dental magazine 51 Specialist services

Fig 3a Fig 3b Fig 4a

Legend endodontically treated with a with problems related to upper bridgework from 13 to 23. further bone loss around the large periradicular area. The posi- anterior bridge. Bridgework Figs 3a & 3b: Patient had implants. Figs 1a &1b: Patient referred for tion of 48 was not ideal and extended from 13 to 23 with implants placed in USA in 1993 Figs 4a & 4b: advice regarding continuing pain prognosis of 47 was poor. The post-crown retainers; there was with no maintenance following Patient referred for a fixed in the lower right quadrant. GDP, who had experience in oral peri-radicular infection related to treatment, which has resulted in restoration in the upper arch. Recent restoration on 48. This surgery, was advised to extract 12 and 13 and extensive caries in considerable bone loss around CT scan assessment carried tooth was TTP and there was also 47 and 48 and carry out 23. The GDP will carry out some of the implants. He will out for implant-retained periradicular infection related to curettage of the 47 socket. general care with the specialist have treatment to stabilise the restorations showed that bone- 47. 47 had previously been Figs 2a to 2d: Patient referred carrying out implant-retained peri-implant tissues and reduce grafting will be required.

Continued » know and trust to carry out crown-lengthening surgery, first-class treatment for their endodontic treatment prior cialised equipment such as patients. The specialist should to restoration or orthodontic operating microscopes and be considered as part of the treatment prior to restora- cone beam CT scanners to help team and should be able to tive treatment. them carry out assessment and support the GDP in a number • Provide specialist treatment treatment of complicated cases. of ways: in cases where all of the treat- When considering where to • To provide diagnostic and ment is beyond the scope of refer a patient for specialist treatment planning advice. the GDP. Examples may be advice or treatment, it is vital There will be cases where the the provision of extensive that the dentist has the confi- GDP is happy to undertake crown and bridgework, dence in the specialist and treatment, but requires implant treatment or multi- knows they are referring their advice on treatment plan- disciplinary treatment. patients to someone who they ning. In such cases, it is often • Provide opportunities for the referring GDP to visit and discuss cases personally. The referral centre should Most specialists will be provide the GDP with a very happy for the GDP to visit the centre to discuss comprehensive referral planning of cases. • Communicate regularly and pack. This should provide the keep the GDP updated with GDP with all the information treatment progress. It is important that any GDP who they require in relation to sends a patient to a referral centre is kept fully updated referral of patients, details with the progress of their of the services provided patient’s treatment. At the end of treatment, the patient and also a fee guide will be referred back to the GDP for continuing care or useful for the GDP to attend there may be situations with their patient on the where shared care may be consultation appointment. best for the patient. • Assist with part of the treat- • Provide training and teach- ment. There will be other ing opportunities for the cases where the GDP is GDP and their team. Many happy to carry out most of referral centres will provide the treatment but requires seminars, hands-on courses assistance with part of the and year courses which will treatment plan, for example help develop their knowl-

52 Scottish Dental magazine Fig 4b

About the author Arshad Ali is the Clinical Director and Managing Director of the Scottish Centre for Excellence in Dentistry. He is also a part time Consultant in Restorative Dentistry at Glasgow Dental Hospital and School and an Honorary Clinical Senior Lecturer at the University of Glasgow.

SCED has recently been awarded Best Specialist Referral Practice UK at the Private Dentistry Awards in London

edge and skills, help master best way to build a relation- new techniques and allow ship is to meet with the them to treat more specialist, visit the centre complex cases. and discuss ways they can In order to make the refer- work together. ral process easier, the referral It is best to visit the prem- centre should provide the ises as it will give the GDP a GDP with a comprehensive feel of how they work and the referral pack. This should GDP can see for themselves provide the GDP with all the where their patients will be information they require in going to for their treatment. relation to referral of patients, Many referral practices also details of the services provid- have open days and it would ed and also a fee guide. be very useful for the GDP The referral centre should and their team to attend one also provide the GDP with of these open days. This is also information leaflets on treat- an opportunity for you to ment procedures. Many GDPs meet the specialists. prefer to refer online and this Referral of patients to a mode of referral will no doubt referral centre should be com- increase in the months and plementary to a GDP’s years to come. existing services. By working The referral centre should effectively together, everyone provide the patient with a wel- will benefit. come pack explaining the By referring cases that are consultation process and beyond the scope of the GDP, what can be expected on the it will also reduce the risk of first visit. legal claims in negligence and Some referral centres have difficulties with the General agreed contracts with med- Dental Council. ical insurance providers and patients need to be made ® aware of this before they are For further details about the referred. Some medical insur- services provided at the Scottish ance companies do provide Centre for Excellence in Dentistry, cover for specialist consulta- visit www.scottishdentistry.com tions and investigations and If you would like to request a also some surgical procedures. referral pack or visit the centre, Many GDPs will already please contact Heather have a relationship with a spe- McCaffery on 0141 427 4530 or cialist or referral centre. The email [email protected]

Scottish Dental magazine 53 Mouth cancer For whom the bell tolls Hatton Senior Clinical Research Prize winner David Conway was invited to speak at the Houses of Parliament on the launch of Mouth Cancer Action Month 2010. Here’s what he said to the politicians…

hank you for this The research which I am and described. There is plenty histories of patients recently opportunity to going to talk about today is a of evidence that smoking and diagnosed with cancer and the speak at the launch European collaborative with 14 alcohol increase risk. And there control group were recruited to of Mouth Cancer centres across 11 countries – is moderate level evidence that the study matched on age and TAction Month 2010. including our own in Glasgow; diets low in fresh fruit and sex only – in that they were On my way here I was thinking, Manchester and Newcastle vegetables, and human broadly identical, but didn’t as I heard Big Ben’s bell ringing, were the other UK centres. The papilloma virus (HPV) infec- have cancer. that my research chimes with research was well funded by the tion, also increase risk. Data collected included the location here in the Houses EU framework grant. Our systematic review of the demographics, full-time occu- of Parliament. It also chimes We studied mouth cancer world literature has also shown pation history, very detailed with the current economic and alongside pharynx/throat, lar- definitively that low socioeco- information on smoking, alco- social climate that we live in. ynx and oesophagus/gullet – nomic status by income, hol and diet behaviours. My research on mouth cancer grouped together as upper education and occupational Socioeconomic status was inequalities is a subject that is aerodigestive tract cancers. social class increases risk for measured in several ways: edu- inherently political. Our Collectively, they are among the mouth cancer significantly. cation, occupational social class research at the University of most common in the world, However, the components and and unemployment experience. Glasgow Dental School is especially in developing coun- nature of this socioeconomic We managed to recruit large focused on understanding and tries, but increasingly in Europe risk are not well understood – numbers due to the multi-cen- ultimately tackling socioeco- and North America. with lifestyle risk factors (smok- tre collaboration and the good nomic inequalities in oral health. Globally there are about ing, and alcohol) being the funding arrangements. Some Mouth cancer is a horrible, 550,000 cases a year, in Europe, accepted explanation. 2,200 people with cancer and a insidious disease. Horrible, as about 180,000 cases every year So, in our European study, we similar number of controls par- John Diamond – the respected and in the UK, we observe more aimed to assess socioeconomic ticipated – making this the journalist who so vividly docu- than 10,000 cases, 1,000 in factors associated with upper largest study of its kind in the mented his suffering and death Scotland. aerodigestive tract cancer risk, world. More than half the cases from oral cancer – described it Socioeconomic inequalities – both independently and were those with mouth cancer. as “like being on death row”. with the poorest bearing the through their influence on What were our findings? Insidious, because it hides greatest burden – are increas- known lifestyle behaviours. • low occupational social class under the radar of public and ingly being recognised. In We employed a case-control – manual workers – had a research attention, casting a Scotland there is a two-fold study design with robust meth- 50 per cent increase risk rel- dark shadow of devastating and greater incidence in the most ods. This involved hour-long ative to non-manual workers. often fatal consequences for deprived compared to the least face-to-face interviews by • unemployed experience individuals, families, and com- deprived areas. trained research nurses follow- conferred a 60 per cent munities, while also stretching Traditional risk factors for ing a detailed standardised increase risk limited healthcare resources. mouth cancer are well known script. We investigated full life • low educational attainment

54 Scottish Dental magazine Mouth cancer

gave a near two-fold • affects access to healthcare • further investigation into need to further shift from a increase risk. services, health information underlying biological treatment to a preventive However, when we took into and uptake processes is required, includ- focus. account how much of these dif- • determines values, attitudes, ing the role of psychosocial In these regards, there ferences were explained by cognitive decision-making, stress. remains some uncertainty about alcohol, smoking and diet, sig- and risky behaviours. Finally, if I may, and given our which direction policy is going nificance was diminished in all We must also reflect that location at the heart of political with the coalition government. but education, with education smoking and alcohol are social- decision making, I would Health inequalities were con- conferring a 30 per cent ly patterned and have been like to extend our research spicuous by their absence from increase risk independent of described as social justice issues. findings into some potential the initial coalition agreement. lifestyle. This finding was con- While one could argue that implications for policy and Health and wellbeing sistent for all cancer subsites – smokers in a sense choose to practice : inequalities seem to be lost from including mouth cancer. It was smoke, we know that this choice 1 We need upstream action – by the discourse around the gov- more prominent in UK and is effected by the unequal social that I mean efforts to address ernment’s spending review – northern and eastern European circumstances in which they the underlying socioeconom- where I would argue that the centres compared to central and are made. Analysis of the liter- ic determinants are required impact of the cuts should be southern European centres. ature reveals important factors if we are to really tackle health viewed through this lens and We also found, from the life such as: inequalities. The ongoing health inequalities’ impact course of occupational histo- debate about the fairness (or assessed. Moreover, health ries, that downward social otherwise) of the public inequalities seem sidelined in mobility or being consistently in sector cuts in the recent com- the NHS White Paper. lower socioeconomic group, prehensive spending review We need to follow the Dental relative to a life-time in a high- highlights some acknowledg- Health Foundation’s lead with er socioeconomic group gave an ment of this. The Marmot shifting from Mouth Cancer increased risk. Review into tackling health Awareness to Mouth Cancer So, the explanation for our inequalities needs to be Action Month – we need findings boil down to two path- implemented, but it looks like more action. ways: the ‘cause of the cause’ Above: David (right) with Ralph it may be ignored just as the And for all the politicians explanation – with low socio- Goodson of Heads2gether Patient Black Report was nearly 30 here, I leave you with a quote economic circumstances influ- Support Group years ago. from George Orwell’s The Road encing behaviour – and we have 2 Maintaining education – as a, to Wigan Pier, which I believe seen this; and the more ‘direct/ • advertising targeted to more if not the, top governmental encapsulates the will required fundamental’ effects of socio- deprived areas and groups priority – is essential, partic- to tackle inequalities in health, economic status, and we have • unequal dissemination of ularly in these times. including those we observe for observed this also. smoking information and 3 Public health and preventive mouth cancer : What was interesting was availability of smoking cessa- programmes or behavioural “Economic injustice will that low educational attainment tion services risk factors need to more stop the moment we want it to was the strongest socioeconom- • social stresses, cultural differ- explicitly acknowledge and stop and no sooner, and if we ic risk factor. The explanations ences and norms. be designed to take into genuinely want it to stop, for this have yet to be fully In conclusion, our study found: account socioeconomic cir- the method adopted hardly unbundled, but education • socioeconomic inequalities cumstances. matters.” potentially: in mouth cancer risk are not 4 Rather than target interven- • reflects childhood socioeco- totally explained by lifestyle tions to deprived communities, ® nomic circumstances risk activities and services should David Conway is a Clinical Senior • influences position in • education is the most power- be developed with communi- Lecturer in Dental Public Health society, social networks ful of the socioeconomic ties as full partners. at the University of Glasgow and income factors 5 And finally, health services Dental School

Scottish Dental magazine 55 56 Scottish Dental magazine Refurbishment feature First impressions count for Blackhills

Upgrade. It doesn’t have to take a complete overhaul to change the feel of an The waiting and reception area important space,as this project shows

little over three years after opening their doors in Aberuthven, Perthshire, the team at ABlackhills Clinic decid- ed the time was right to revamp the waiting and reception areas. Clinic Manager, Trudie Imrie said: “When we moved in the areas gave a feeling of open space and comfort and we bought in the furniture ourselves to reflect this. comes through the big two-storey single unit which houses all these “However, the waiting area, as well window and shines on the waiting disparate elements into a single piece as being for our customers, was now area and the reception desk. They of fixed furniture. This has freed up being used for educational meetings. wanted to make the most of that. space and created a more coordinat- The furniture we purchased original- “So, we came up with the idea of ed arrangement within the seating ly, while being functional and using the wall next to reception as a area, reinforcing and better reflecting comfortable, was not easy to move feature wall and take advantage of the the Blackhill’s passion for creating around and after three years it had light coming from the sun.” a quality environment for their become a little ‘tired’ looking.” Farahbod designed a green glass patients.” After seeing previous examples of feature wall next to the reception And the effect of the changes their work in Scottish Dental desk incorporating the practice logo hasn’t gone unnoticed, as Trudie said: magazine Trudie, along with the and opposite the reception desk they “It is just excellent, we are so pleased practice’s clinical directors Paul installed a glass partition to separate with it. We’ve had positive comments Stone and Ken Watkins, decided to the two areas, but keep the sense of from both patients and other dentists. contact Farahbod Nakhaei and space and light. The new partition “First impressions are very Homan Varghaei of NV Design and also has the added benefit of provid- important; it is a top priority for us. Construction. They were tasked with ing patients with an extra level of You only get one chance to put across reinvigorating a bright open space privacy when they are discussing that first look at the image and the and incorporating the practice colour treatments at the desk. style of the practice.” scheme and identity into the design. As the waiting area also The waiting and reception desk accommodated the practice’s area was already spacious with a education evenings for dentists the double-height window facing the furniture needed to be modern, front of the building but, as Trudie comfortable and practical, to replace explained: “Previously, it was neutral the older more cumbersome and comfortable but not very furniture they had previously. contemporary and we wanted to Farahbod continued: “Quite often freshen it up and bring to the it is the small details that can make forefront our brand image.” all the difference and this attention Farahbod takes up the story: “We to detail is important in waiting and were tasked with coming up with the reception areas. So, rather than ideas for reinvigorating the space having numerous pieces of furniture and make it a more interesting space and fittings serving different to move through. They mentioned functions, such as bins, fridges, that at certain times of the day the sun display cabinets, etc, we designed a

Scottish Dental magazine 57 Advertising feature How the new dentistry regulations affect you

Update. The impact long-term sickness payments two sets of financial statements inflation, also from April 2011. and maternity leave payments. (one for the unincorporated A positive provision in the on practices of The new guidance does, how- practice and another for the emergency budget for new recent amendments ever, clarify the issue of multiple company). practices is the regional list registrations where practi- employer NI contribution holi- Regulations update tioners serve different patients Tax update day. The revenue will waive the On 24 September 2010, the in different practices – it is pos- More than four months have employer’s NI contributions for Scottish Government released a sible to be registered on the passed since the new chancel- the first ten employees in a new memo notifying NHS boards of first list and the second list if one lor delivered the emergency business, to a maximum of further amendments to the new treats patients via a DBC and budget. Among the measures £5,000 per employee. This NHS dentistry regulations. also as a sole-practitioner. announced were some key applies to new businesses for These revisions were made We do not believe there is a revisions to the tax system, both the period from 22 June 2010 to after our comments in the cost-effective way in which this positive and negative. 5 September 2013. August/September 2010 issue could be taken advantage of to The personal tax-free Employer’s NI is an addition- of this magazine, which covered retain full entitlement to grants allowance for income tax will be al cost that each business must the impact of these new regula- and allowances while trading as increased by £1,000 up to £7,475 bear. Therefore, the above con- tions on NHS practitioners a Dental Body Corporate and from 6 April next year, with a cession represents a reasonable operating their practice as a benefiting from the favourable target of £10,000 by the end of saving for a new business. Dental Body Corporate. tax rates companies pay in com- 2015. However, there will be no This saving is only available We have reviewed the new parison to individuals via benefit for higher-rate taxpay- for new practices, however, and guidance and our opinion income tax. ers because the starting point of the practice must be based in an remains the same as previously Patients must be registered the higher-rate tax band will be eligible area. The whole of set out: due to changes in the with one practice only and reduced accordingly. Scotland is eligible. If you com- way NHS practitioners register the choice must be made The bad news for higher-rate mence trading as a practitioner on the NHS dental list, practi- whether this is the practitioner taxpayers continues: the rate of for the first time during the eli- tioners registered as a Dental as an individual, or via his capital gains tax increased from gible period of 22 June 2010 to Body Corporate (DBC) lose or her company. 18 per cent to 28 per cent com- 5 September 2013, you are clas- entitlement to income under A possibility may be to split mencing midnight on the day sified as a new business for the several determinations as set your patient book by registering the emergency budget was purpose of these rules. out in the Statement of Dental some with your DBC, and the delivered. The positive, howev- Opening a new practice as Remuneration. These include remainder with you as an er, is the first £5 million of gains, part of an existing chain is mere- vocational training allowances, individual. The patients would if applicable for entrepreneurs ly an extension of an existing grants, seniority payments, appear on one practice list only, relief, is only taxed at 10 per cent. business and this would be inel- but entitlement to grants and The lifetime limit was previous- igible for relief. There are also a allowances is reopened. ly £2 million, so this is good news number of anti-avoidance rules However, this would also for people in business who to stop claims, which the rev- mean more complex may have capital gains over enue considers to be against the administration work their lifetime at this level. spirit of the new concession. and the preparation of The employers’ rate of ® “A possibility may be to split your Stephen Neville is a Partner at patient book by registering some with Martin Aitken & Co and has advised your Dental Body Corporate and the many dentist clients, including in remainder with you as an individual” the NHS and private sectors, for Stephen Neville more than 20 years. Stephen can be contacted at [email protected] national insurance (NI) has and on 0141 272 0000. Visit been increased by 1 per cent, www.maco.co.uk bringing the rate to a total of This is our understanding of the law 13.8 per cent from April 2011. To at this time and we advise you to Right: Stephen compensate employers for the seek professional advice prior to Neville, Partner, effects of this increase, the taking any actions based on the Martin Aitken threshold at which employees’ above. This article is not intended & Co earnings start to be taxed will be as professional advice – it is for increased by £21 per week above information purposes only.

58 Scottish Dental magazine Advertising feature Act quickly to beat the VAT increase

The seemingly never ending stream of that they will take a dim view on any terms of cash flow, this can cause tem- bad news regarding the economy and sharp practice as they see it where porary difficulties for many practices. gloomy predictions are undoubtedly invoices have been provided at the There may also be a reluctance to causing businesses to look closely at 17.5 per cent rate for deliveries which approach your bank to extend facilities. any capital expenditure. will knowingly take place at some Braemar Finance can provide tax A natural reaction, and with the unspecified date in the future. loans over a short term – usually six to year-end fast approaching, is that If you are considering a purchase, 12 months – to assist with practice some may be postponing any pur- there is also some good news on the cash flow. They are quick and simple chases until a clearer picture emerges. tax front. Up to £100,000 of capital to arrange and may well prevent any This will, however, mean that a pur- expenditure may qualify for 100 per penalties that HMRC will levy for late chase made next year will attract the cent tax relief in the year of purchase. payments of your tax liability. Above: David new increased standard rate of 20 per This is the annual investment Foster, Managing Paying tax is unavoidable, but by cent for VAT, from 4 January 2011. allowance and will substantially Director, Braemar maximising available tax relief, and On a £10,000 purchase, this reduce your tax liability for your cur- Finance taking advantage of the current rate of equates to an additional cost of £250 – rent tax year. This annual investment VAT, you can take comfort in the fact not huge, but better in your pocket allowance incidentally reduces to that you are minimising your personal than that of HM Revenue & Customs. £25,000 from April 2012 so this contribution to the Government Making a purchase simply to save should be factored into next year’s budget deficit. tax is never good practice, but if the spending plans as well. purchase is planned and required, it Speaking of tax, 31 January 2011 is a ® would make sense to bring this for- date viewed by many businesses with For more information on Braemar ward to 2010. But hurry, as suppliers a degree of trepidation as it is the Finance, phone 01563 852100, fax will be low on stock at this time of the deadline for income tax to be paid. 01563 852111 or email info@braemar year and HMRC have made it clear With December often a poor month in finance.co.uk

Scottish Dental magazine 59

Advertising feature Practice Plan boost for Bridge2Aid

CHARITY SUPPORT by leprosy was invaluable, as decide that Practice Plan is the well as their sponsorship of right choice for them, and men- With charity incomes under some of our community tion Bridge2Aid in the process.” increasing pressure in the midst development staff. Practice Plan Managing of the current economic “This new commercial part- Director Nick Dilworth said: climate, new sources of income nership offers great benefits to “We are constantly looking at are becoming more important. Bridge2Aid at a time when all innovative ways of making a Many charities are receiving a charities are looking for new difference with the various welcome funding injection funding streams. At Bridge2Aid charities that we support. from commercial partnerships we are grateful for how our sup- “Over the past four years we where companies donate a per- for a patient membership plan. porters’ continuing donations have been fortunate to share a centage of what they receive The donation is based on the have helped us to keep growing number of experiences in from new business to charity. number of patients that convert our services at a time when support of Bridge2Aid. To this end, dental plan to a private patient membership finances are under extreme “We are really pleased to be provider Practice Plan has plan and is offered to pressure. I am delighted that we associated with Bridge2Aid in decided to build on its support Bridge2Aid at no additional cost can look forward to funding this new arrangement which of Bridge2Aid over the past four to the patient or the dentist. from this partnership if people will make another small years by offering just such a Bridge2Aid Chief Executive difference to the plight funding stream to the charity. Mark Topley said: “Practice of those less fortunate For dentists that may require Plan’s support over the past four in Tanzania.” the services of Practice Plan, years has made a huge differ- Bridge2Aid is delighted to ence to what we have been able ® announce that it will receive a to achieve in Tanzania. Its For information on Bridge2Aid visit donation for any dental prac- team’s work at Bukumbi Care www.bridge2aid.org, to find out tices that mention Bridge2Aid Centre with the disabled more about Practice Plan head to when contacting Practice Plan community and people affected www.practiceplan.co.uk

Scottish Dental magazine 61

Advertising feature A 21st-century private practice

Denplan’s Michael records not only eliminates the need already, so what else is out there that About the for hundreds of patient folders, it could make your dental practice Author Rudman looks at the also opens up a world of marketing stand out from the crowd? Social Michael Rudman is Dental Strategy benefits of investing opportunities and time-saving meas- networking sites such as blogs, Manager at Denplan. ures. A couple of clicks is all it takes Facebook and Twitter can not only With more than 11 in the latest systems to make, cancel or amend appoint- allow you to share all your latest years’ experience and technology ments and, with patient information news and information with col- providing marketing advice and solutions to at your fingertips, you can develop leagues and patients, but also the small businesses, even better relationships by noting real-time nature of online updates Michael has been There’s more to running a success- birthdays, applauding special mile- can cause a real buzz and interest in focusing on Denplan ful practice than flashy gadgets – in stones for children or recognising what you have to say. products for four fact, up to 30 per cent of dental nervous patients. You can set most up in minutes years to not only develop its offering practices in the UK still have no and it’s a great way of updating your for practices, but computerisation at all. However, Speculate to accumulate patients and colleagues on your also expand its online keeping up to date with 21st-centu- All these ideas are all very well and latest practice news, events, servic- communications ry technology can not only help you good, but in the current financial es and products. And the best thing strategy. attract new patients, but also help climate, you may be wary of making is most social networking sites are your business thrive. The following expensive changes to your practice. completely free! tips are designed to give you an idea However, Practiceworks (sole sup- So, if it’s time for an injection of of where to start. pliers of the Kodak R4 system) technology, my advice would be to indicate that a two-surgery practice consult the experts and take that Websites could have a basic networking leap to bring your practice into the Having a website is one of today’s system installed from under £10,000, 21st century. most important yet inexpensive while with digital imaging and other advertising tools. The best websites innovations, you could be looking are visually appealing, informative, at closer to £25,000. With a little inviting and regularly updated, so effort to make the best use of the invest in a good basic design and the new technology, Practiceworks rest can be done in-house. Most den- estimates that most practices will tal practice websites are outsourced cover the cost of such an investment to a specialist provider for design within 12 months. and support and this can be an easy Installation and training can usu- and efficient way to achieve an inter- ally be done in three days, with the net presence. practice being closed for a maximum of just one day. Additional training Mobile phones can be delivered at any time and More than 40 million people in the some payment plan providers offer UK own a mobile phone and for the a range of verifiable CPD courses to forward-thinking dental practice, its help integrate your team into new simplest application can be its great- systems or ways of working. est asset. By reminding patients of Some also offer a wealth of serv- their forthcoming appointments via ices, including the ability to share text message, you can save thou- patient information to ensure your sands of pounds in lost revenue. records are always up to date and a These can even be sent automatical- wide range of professional and per- ly on a daily basis, as part of a practice sonal discounts. management software system. Social media Computerised records If your practice already has the Michael Rudman Storing computerised patient basics, you’re probably a convert

Scottish Dental magazine 63 Advertising feature Plans managed better

Isoplan is one step ahead besides. We like to keep one step Our new and guidance and provide you with in developing perfect ahead and help our practices obtain improved step-by-step procedures, forms and best practice standards at all times. templates. It allows you to edit the plans for practice needs PMS has This is why we offer our Practice recently existing content to tailor it to your Management System (PMS). Many been practice needs, including adding t Isoplan, we offer a of Isoplan’s practices in England are revamped your own documents. wide variety of plans, currently taking advantage of our Your completed records such as including maintenance, PMS to assist with upcoming Care and made employment contracts, job capitation and chil- Quality Commission guidelines. more acces- descriptions, training records etc are dren’s plans. While this is not imminent in sible... The simply printed off and put into your A PMS is avail- Your local Business Development Scotland, it would be a worthwhile folder. With regular updates and IT Consultant will be on hand at every exercise to ensure that your practice able for a support included, it is a must for stage of the process and will help you is compliant with these guidelines nominal fee forward thinking practices wishing to to choose the best type of plan to suit for the future. to Isoplan be at the forefront of managing your needs. Our new and improved PMS has practices their practice. We don’t charge a set-up fee and recently been revamped and made will help you calculate the correct more accessible through a flash drive ® cost for your plan as well as assisting and loose-leaf folder for ease of use. Call our head office on 0845 123 5228 for you with all aspects of marketing the The PMS is available for a nominal more details. plan from brochure and posters to a fee to Isoplan practices. website for your practice. We have also included an in-depth At Isoplan, we don’t only offer to health and safety section along with construct the perfect practice plan a helpline for enquiries. The manage- for your practice, but much more ment system will give you clear

64 Scottish Dental magazine

66 Scottish Dental magazine News

Siggi goes Report aims to boost forth with domiciliary care visits dental unit

A report that highlights the After 25 years decline in domiciliary care visits working with by GDPs has been launched by DentalMan the Scottish Dental Needs and Lysta Assessment Programme promoting their (SDNAP). mobile dental The number of domiciliary units in the UK, dental care visits among GDPs Siggi Jokumsen has halved in the last ten years, (above with down from 30,712 in 2000 to good friend Boris Johnson) has 13,771 in 2008. The SDNAP set out on his own. Above: (l-r) Working group members Tracey Welbury, Euan Thomson, working group looked at the Derek Richards, Maura Edwards, Petrina Sweeney and Karen Gordon Through his new company, provision of domiciliary dental Newcodent, Siggi has developed care in Scotland, identified gaps financial remuneration and lack a complete portable dental unit in the service and made recom- of adequate equipment. Report was produced along- that is lightweight and includes a mendations for the future. “A proposal in this report is to side Caring for Smiles – a wide range of instrumentation. Euan Thomson, the GDP on pay GDPs a sessional rate for guide for trainers to deliver oral the working group, said: “There visits and make grants available care in care homes. ® are a number of reasons for the for specialised equipment.” For more information, please call fall in visits from GDPs with two The Domiciliary Dental ® Newcodent Ltd on 01844 213399 of the main ones being level of Care Needs Assessment For more information on SDNAP or visit www.newcodent.com and its reports, visit

Scottish Dental magazine 67

Advertising feature

Keith McFarlane looks back at how one course instantly. Consequently, I achieved better results more consistently and proved to be the best investment he ever made had happier patients. The helpful structure of the course was instrumental in guiding my learning. The mix of theory and prac- Meeting the tical allowed me to strike a perfect balance between understanding and performing. The practicals were a great way to see the theory come to demands of a life and really challenged me to con- sider why I was performing each step, what the most appropriate choice was, and why a certain treatment plan mixed dental might be more suitable for a case. All the information given to us was backed up by theory and scientific studies, which gave me the confi- practice dence when discussing treatment with patients and colleagues. Having this extra confidence enabled me to s I stepped into Dr Paul knowledge... and this was just the “I realised demonstrate my knowledge and Tipton’s lecture room first day! the impor- capabilities more effectively in the for the first time I As the course progressed I could tance of workplace and allowed me to take on didn’t really know what see the positive impact it was having communica- more complex work. I was able to to expect. I’d heard a lot on the way I worked, by improving start charging more for my work, A tion and about Paul’s courses through friends my standards. Even minor changes which really opened my eyes to who either knew somebody who had were having an impact. For instance, impression what was possible. It was gradually benefited from the course or who by making small changes in my quality for becoming the most profitable had read his articles in the dental restorative techniques I found I was improving and successful investment I had press. So, I felt at ease knowing that able to reduce post-op sensitivity. the results ever made! both he and the course came That meant I could reduce the from my The change to a new practice with highly recommended. chance of problems for patients and technician. more private work was a slow pro- I was about six years qualified me occurring after treatment. It was then I gression, but the course really helped when I joined the Tipton Training I started to feel much more confi- began to speed things along and ease my tran- Restorative Course. I was a relative- dent and began implementing the realise my sition. I am really pleased I did the ly new VDP trainer at the time and new skills into my work. I became potential” course when I was younger had just moved to a new dental prac- accustomed with new impression as it definitely changed the tice. After just a few months at this and temporisation techniques. These way I looked at dentistry. As new practice, I could see that there allowed me to strive for better results. a VDP trainer, even was demand to deliver more I realised the importance of commu- now, I refer to the complex cases than I had been used nication and impression quality for same studies and to. Slightly overwhelmed, I decided improving the results from my tech- literature that Dr it was time to further my skills and nician. It was then I began to realise Tipton intro- knowledge. So, I signed myself up for my potential. duced me to. a place on Tipton Training’s One One of the best elements of the Year Restorative course. My friend course was Paul’s personal input. By ® had been on the same course the pre- the end of the course I had built up Keith McFarlane vious year and said it had been really a bank of knowledge from all the completed Tipton helpful in bridging the gap between tips and techniques that he had Training’s VT training and working full-time in described and demonstrated Restorative Level 1 a mixed practice, building practical- throughout the course. What was and Level 2 ly on what we had already learnt in great is that all of these could easily (Phantom Head) dental school, but with a real fit into my working practice, so I Courses in 2004 commercial edge. didn’t need to alter the way I did and 2008. After a brief introduction and things or learn new skills to see meet and greet, Paul and his positive results. faculty quickly got the course off to By picking and choosing a great start. We got stuck straight the elements that worked into exploring the topic of occlu- best for me I could sion. Even though it was a topic I see that I was able felt familiar with, I remember being to make my surprised to leave that day feeling patients even I had just been presented with a just that little mound full of new insights and bit better

Scottish Dental magazine 69 Advertising feature

• Facial analysis (hands-on) • Tooth set up and diagnostics Just inspired dentistry wax-ups/provisionals • Simple ortho for the GDP (hands-on) Inspired Dental hands-on aesthet- Clinical Director and Course • Endodontics for the GDP ic-restorative Lecturer David Winkler said: (hands-on) Courses provides course – promising “We are giving people access to • Basic perio surgery for the ‘must attend’ top quality educa- a education at a price point that’s GDP (hands-on with pigs’ aesthetic- Ation at affordable not prohibitive. We want to bring heads) prices – is being hailed as a ‘must- in quality people who have a pas- • Impressions restoration attend’ for dentists in 2011. sion for fields of interest and are • Failure festival and many more. sessions Inspired Dental Courses has enthusiastic about imparting this The 12-day course – supported brought together some of the top knowledge to their colleagues. by Discus Dental – takes place clinical lecturers and teachers “We feel general dentists are across six months throughout from around the globe, including tired of show-and-tell lectures 2011 (from April until October) David Winkler (pictured), and, since we’re all wet-fingered and takes place at the London Raymond Bertolotti, Gary clinicians, we aim to provide a Dental Education Centre Unterbrink, Phil Wander, whole host of excellent hands-on near Waterloo mainline station David Bloom, Michael sessions connected to a myriad in London. Miyasaki, Zaki Kanaan, of topics.” It offers 84 hours of verifiable Amarjit Gill and Laura CPD and costs only £315 per day Frost. Topics covered include: – or £280 per day if the course is And this course • Treatment planning/ paid for in advance. promises to teach diagnostics every GDP attend- • Setting goals/informed con- ® ing key practical sent and dento-legal matters Venue is LonDEC King’s College, skills, which can be imple- • Smile design and digital pho- London, SE1. To reserve a place or mented in practice the very tography (hands-on) speak to one of the clinical team, next day. • The business of dentistry call 01923 851 574.

70 Scottish Dental magazine

Decontamination Eschmann delivers nationwide state-of- the-art decon room facilities

Dr Harj Basra, from Station House Dental Practice in Telford, discusses how he planned and implemented the very latest, state-of-the-art decontamination room from Eschmann, in order to meet with HTM 01-05 guidelines and become compliant with ‘best practice’ standards n March 2009, Harj new facilities. I remember now contacted five different that Eschmann still hadn’t decon specialists in the charged any deposit for their marketplace to discuss his expertise to date and that Iplans for extending his Martin was due a return visit to practice to incorporate a new me with his own plans for my decon room. Having carried out practice, based on the archi- some investigative work into tect’s drawings. their credentials, quality of Prior to delivering plans for a service, customer support and decon room, Harj had already product specs, he decided to spoken to his head dental have a second meeting with nurses to identify usage levels Martin Loftus from Eschmann. and exactly which types of According to Harj, his equipment would fulfil their meeting with Martin gave criteria. Both Sara Dixon and him an astonishing insight Sophie Davies were consulted into Eschmann’s immense throughout the entire process knowledge within this area of and they also provided vital dentistry. Harj said: “Unlike information on the cleanliness other specialist consultant of the handpieces, together with companies, Martin really the benefits and features of understood what we were other types of products that trying to achieve and knew how would support their everyday to implement the entire process roles within the new ‘clean’ so that my team and I did environment. not have to concern ourselves Once the surveyor had with any issues regarding the visited Station House Dental planning and construction of practice, Martin returned to our proposed project. provide the costs and options “Martin and I arranged for required to fulfil Harj’s plans, Eschmann’s surveyors to visit together with the information my architects and practice to provided by the head dental inspect the internal supplies and nurses and Practice Manager services required to create the Aisling Perkins. perfect environment for our Following his second meeting

72 Scottish Dental magazine Decontamination Scottish dentist makes the grade

The BACD would like to Currently, there are congratulate Dr Elaine only a handful of Halley for becoming the clinicians country-wide firstScottish dentist to who have managed to achieve BACD attain this prestigious Accreditation. award, making Dr Open to full Halley’s achievement all members, BACD the more exceptional. Above: (l-r) Aisling, Martin, Harj been freed up by the autoclaves Accreditation is a To acknowledge her and nurses Sara and Sophie and washer/ disinfectors. Every rigorous two-stage achievement, Elaine will Left: The decon room in action Decon360 room solution is process that illustrates receive a BACD supported by Eschmann who to peers and patients Accredited Member’s with Martin, Harj decided to ensures that staff are provided alike that a technician or practitioner plaque to hang on her wall, specify Eschmann’s unique with tailored training to suit the has achieved a level of excellence confirming that the quality of her Decon360 solution in order to practice requirements. This with regard to their cosmeticdental clinical skills has been independently meet the highest possible includes practical advice and skills. Anyone attempting to obtain verified. standards attainable. During user training on all the latest BACDAccreditation must this visit, Harj selected DuPont regulations to ensure that every demonstrate their ability to diagnose, For more information on the Corian worksurfaces through- practice is complying with plan and execute cosmetictreatment accreditation process or BACD out; non-splashback sinks, an HTM 01-05. to the highest standards, and show membership, contact Suzy illuminated magnifier to survey that this can be performed safely, Rowlands on 0207 612 4166 or cleanliness, an air tight pouch The overall experience ethically and competently. email [email protected] sealer, two washer/disinfectors, In Harj Basra’s experience, three new autoclaves coupled Eschmann has created a with ‘brilliant white’ cabinets business model with the and ‘clean’ white cupboards Decon360 solution that harvests with the wording ‘clean’ written the personal touch. During his in relief and contoured into the experience of the Decon surface area of the units. installation, he was keen to With every area under point out that the whole process extreme scrutiny, no detail was was “stress-free”. He continued: left unplanned and every “I thoroughly enjoyed the additional item that the confidence I experienced Decon360 range has to offer through working with was equally specified. Eschmann.” Since gaining compliance Benefits of an Eschmann with his contemporary decont- Decon360 room amination room, the practice Creating a system of cross- has been able to standardise all infection control provides an instruments, consulting with all overall standardised process for associates and hygienists to the dental team to work with. make sure that they have the The benefits this provides appropriate instruments within for the principal is markedly their own personal packs. noticeable. Because there is no Harj is now enjoying a autoclave in every surgery, smoother balance between the handpieces are easier to locate clinical running of his practice for all members of the practice and the compliant issues that he as they are now stored in only faced prior to gaining his own one area. Decon360 solution. Each handpiece or dental tool is also easier to locate by size as ® each draw or airtight pouch is Contact Eschmann today on marked with the contents. 01903 875 787 or email Furthermore, each surgery can [email protected] be equipped with more treat- Alternatively visit our website at ment zones where space has www.eschmann.co.uk/decon360

Scottish Dental magazine 73

Restorative

NobelReplace – for a more NobelActive: for a secure fit comfortable procedure Increasing numbers of practices The NobelBiocare’s unique As well as ensuring that are offering implant treatments implant has NobelReplace implant the patient spends as little meaning that implantologists undergone system enables time in the chair as possible, have to go the extra mile. stringent practitioners to offer their the implants also feature Nobel Biocare, world leader in clinical patients the very best treatment their very own surface, evidence-based dental solutions, testing and while reducing pain and TiUnite, which is scientifically offers the more experienced user results from minimising chair time. proven to aid the healing excellent results with NobelActive. the one-year, Developed by Nobel Biocare, process and encourage Providing accurate placements cumulative world leaders in the manufacture implant stability for long with minimal pain and invasion, survival rate for a NobelActive of dental implants, NobelReplace lasting results and improved the NobelActive implant system is implant show that 96.5 per cent of is a user-friendly system boasting patient comfort. built around a unique design that implants placed survived. numerous prostheticoptions. helps it provide speed, simplicity A favourite among surgeons and For more information on and ease of use. Instead of For more details, contact Nobel clinicians alike, NobelReplace is able NobelReplace implants, contact cutting, the implant gently Biocare on 0 208 756 3300, or to fulfil all aestheticand biological Nobel Biocare on 0208 756 3300, compresses into the bone. visit www.nobelbiocare.com expectations. or visit www.nobelbiocare.com

Guiding practitioners Perfect restorations towards implant success with NobelProcera

The NobelGuide state-of- techniques, orCT NobelProcera is an easy- overdenture on both the-art computer-based scanning and 3D to-use, practical system natural teeth and implants. implant rehabilitation CAD/CAM software. The by Nobel Biocare, The system has been system assists dentists system allows you to plan designed to save designed for intuitive with pre-planned, the exact positions and practitioners time navigation, impressions are predictable guided depths of implants before when creating dental scanned with accuracy and implant surgery to surgery and to plan for prosthetics. models are milled precisely. accomplish both provisional and prosthetics well in advance. Nobel Using the best NobelProcera offers an final prostheticresults. Biocare will then produce a CAD/CAM technology, NobelProcera assortment of shaded zirconia, In four simple steps, detailed surgical template, enables the dental practitioner to acrylic, alumina, titanium and cobalt NobelGuide will assist in quick, incorporating the exact data from produce perfect restorations. Unique chromium products, including effective dental treatment, your own scanning and planning. scanning technology allows for highly cement and screw retained options. reducing the time the patient precise data acquisition. spends in the chair. For more details, contact Nobel NobelProcera solutions include For more details, call Nobel Biocare NobelGuide can be used with Biocare on 0208 756 3300 or abutments, crowns, bridges, implant on 0208 756 3300 or visit conventional model-based visit www.nobelbiocare.com bridges and implant bars www.nobelbiocare.com

Accept no imitations The perfect answer to General Medical is the swelling and pain than using sinus lift GBR UKdistributor of the any other system including Mectron Piezosurgery 3. surgical burs and General Medical is the UK Like its predecessors it microsaws. distributor for the complete range features Mectron’s The only unit with 10 of OsteoBiol bone graft materials time of five months, MP3 is unique dual wave years of research and and membranes, including MP3, extremely competitively priced modulated frequency publications behind the perfect answer to sinus and fully resorbable within a technology, which ensures it, Mectron’s liftGBR. clinically defined timescale. Total optimised cutting efficiency at a third Piezosurgery 3 is Ideally suited to lateral access conversion to natural bone of the power setting of the imitations still the best, can be sterilised up to sinus lift procedures, MP3 guaranteed. which are piezosurgery units in 135°Cand has a two-year warranty. consists of prehydrated OsteoBiol name only. granules in a sterile syringe. Using For more details, call General The benefit of this unique feature For further information, telephone MP3 facilitates easier and more Medical on 01380 734990, visit is that bone cut using the Mectron General Medical on 01380 734990, convenient handling. www.generalmedical.co.uk or Piezosurgery 3 heals quicker and visit www.generalmedical.co.uk or With a recommended re-entry email info@general medical.co.uk with dramatically less post operative email [email protected]

Scottish Dental magazine 75 Restorative

A little bit easier... Unique Atlantis abutment warranty

The European Association for Astra Tech introduces a unique Osseointegration Congress in warranty forAtlantis patient- Glasgow saw the launch of Astra specificabutments. With this Tech’s new colour-coded products, comprehensive abutment expanding Atlantis patient- extra components for OsseoSpeed horizontal space. With the addition of warrantyAstra Tech will cover both specificabutment assortment. TX, and an extended range of single a temporary abutment and a taller the abutment and the implant if Atlantis abutments are available patient drills. These products were healing abutmentyou can achieve another implant supplier does not for major implant systems such as well received by all delegates who even greater results in your work. honour their warranty due to the Astra Tech, Straumann, Nobel visited the Astra Tech booths. Optimal sharpness, easy handling use of an Atlantis abutment. Biocare, Biomet 3i, Zimmer Dental Yellow, aqua and lilac– it is easy to and no cleaning or sterilisation. The Find out more aboutAtlantis and BioHorizons. select the right implant pick-ups, benefits of single patient drills are patient-specificabutments transfers, guide pins, replicas and now available for all drilling and the unique warranty For more information , drivers. With the colour-coding protocols. terms and conditions at contact Astra Tech on system, each component is marked www.atlantisabutment.co.uk 0845 450 0586, email with the same colour as the chosen For more information, contact Astra Dentsply Friadent is the latest [email protected] or implant connection. Tech on 0845 450 0586, manufacturer to be added to the www.astratechdental.co.uk The OsseoSpeed TX 3.0 S implant [email protected] or is designed for cases with limited visit www.astratechdentaluk.com Predictable treatment Key opinion leaders results and affordability support Biodentine Rehabilitating the mandible or patients with edentulous maxilla inevitably faster, less Some of the UK’s leading biocompatible and presents a challenge for dental traumatic dental experts have bioactive material that professionals, but with the All-on-4 procedures; put their names can be used wherever system from Nobel Biocare, you can as well as behind a new product dentine is damaged, enjoy predictable results for even the a rapid described as “the both in the crown and most challenging clinical cases. recovery. ultimate dentine the root. The All-on-4 is a revolutionary Ideally substitute”. procedure based on placing two suited to be a Septodont launched its For more information , straight anterior implants and two practice’s second system, it provides new product, Biodentine, to rave contact your dental dealer , angulated posterior implants to a wider range of patients an excellent reviews from some of the leading or contact Septodont on avoid the sinus nerve, while reducing solution to traditional implant lights in dentistry. What makes 01622 695 520, cantilever. Unlike traditional treatment at a highly affordable price. Biodentine so unique is the fact [email protected] or procedures that may necessitate the that it is the first all-in-one, visit www.septodont.co.uk complete rehabilitation of the upper For further information, call Nobel and lower jaw, the All-on-4 system Biocare on 020 875 633 00, or enables practitioners to provide their isit www.nobelbiocare.com Keep your patients happy and satisfied with NobelProcera BioHorizons announces

Due to developments in material dates for the 2011 calendar options, the days when restorations were seen by patients as a financial BioHorizons is pleased to ball and chain are now long gone. announce the 2011 dates for the Offering a range of material options advanced production facilities. The Global Symposium and Ultimate including titanium, zirconia and NobelProcera system uses cutting- ImplantYearCourse. alumina, Nobel Biocare enables edge CAD software, enabling Held in Phoenix, Arizona on 28 Ultimate ImplantYearCourse practitioners to provide increased clinicians to deliver aesthetically April – 1 May, 2011 BioHorizons (NIDIC), the second edition will flexibility in pricing, which in turn pleasing yet robust restorations. Global Symposium will be held at run from February 2011. helps them to attract new patients. Providing bespoke restorations by the prestigious Arizona Biltmore NobelProcera from Nobel using NobelProcera, clinicians can Hotel with topics that include For more information or to Biocare offers an integrated set of enjoy increased patient numbers immediate loading, aesthetics, arrange a meeting with your technologies, along with a seamless, with greater financial rewards. tissue regeneration and implant local product support specialist automated industrialised complications. ,contact 01344 752560, email: manufacturing process; from For further information, call Nobel Following a highly acclaimed [email protected] or visit conoscopicholography and the latest Biocare on 020 875 633 00 or and sell out first edition of the www.biohorizons.com 3D prostheticsoftware, to highly visit www.nobelbiocare.com

76 Scottish Dental magazine

News

Healthy discounts Clean up and beat The Perfect Dental at the BACD’s Dam Solution meeting the VAT increase Wash, bag and Using dental dam within sterilize for just endodontictreatments help £9,995 + VAT, with protect the patient from a great offer from inhaling or swallowing Provider of the Healthy Discounts Dental Plan, W&H (UK). The instruments, isolates the Munroe Sutton was on hand at the British ‘Beat the VAT treatment area, protects soft Academy ofCosmeticDentistry’sConference and increase’ package tissue and the riskof cross Exhibition thisSeptember to tell delegates about is available until infection is greatly reduced. its innovative new scheme. the end of Fiesta colour coded clamps Attendees at the event learned how they could December, and provide easy identification and selection during the improve the affordability and accessibility of the contains a DS50 dental dam procedure, and feature a non-reflective quality dental treatment they provide, while DRS Washer Disinfector Dryer plus a DS50 DRS matt finish for bettervisibility during clinical use. remaining in control of their business. LOG data logger, a Lisa 517 FullyAutomatic Nine popular clamps are available supplied on a Dentists of all specialities are invited to sign up Vacuum B Sterilizer, and a Seal2 bag sealer for stainless steel organiser, which provides easy to the Healthy Discounts Dental Plan, providing pouching items prior to sterilization and storage and cleaning. their services at a reduced cost and, in return, gain storage. Allied to this Flexi Dam non latex is easier to access to a large database of potential patients. The washer disinfector dryer has a compact apply, saving chair time. The excellent retraction The plan reduces out-of-pocket costs making it exterioryet a spacious interior, for cost effective properties ensure close contact around the tooth for easier for patients to afford necessary treatments cleaning in the minimum time – a full load effective isolation and best possible moisture and for dentists to increase their treatment plan cycle wash including thermal disinfection & control. It is more tear resistant than latex dental acceptance rates. What’s more, there are no drying cycle takes less than 60 minutes. dam with no latex reaction, powder free and a long-term contracts and no joining fees. pleasant smell. To order, call 01727 874990 or e-mail For more information, please call 0808 234 [email protected], quoting reference Call free phone 0500 295454 exts 223/224 or 3558 or visit www.munroesutton.co.uk SD2010, before 31st December 2010. visit our website www.coltenewhaledent.com

78 Scottish Dental magazine Oral

Backed by science Real patients, real practitioners, real research The British Dental Health by dental professionals. It’s Foundation only not surprising then that The P&G HealthySmile give it up, with 83 per cent accredits consumer they are the only adult Trial Programme has been believing that the products once it power brushes running for three months oscillating-rotating has checked the accredited by the in the UK. Participating toothbrush helped them manufacturers British Dental professionals were asked improve their brushing claims are clinically Health Foundation. to selectsixpatients to technique. sound and are not Dr Nigel Carter, receive a free Oral-B Dental professionals saw exaggerated in any way. Chief Executive of the oscillating-rotating toothbrush. an improvement in the gingival A panel of independent, British Dental Health There were 947 professionals health of 89 per cent of their international experts Foundation commented: participating in the scheme, patients. Unsurprisingly, 92 per undertakes the accreditation. “The range of powerbrushes from involving 1,296 patients. cent of participating dental Oral-B are delighted that all its Oral B have been shown to effectively To date, results have shown professionals claimed that oscillating-rotating power toothbrush and efficiently reduce plaque. Their that having once tried the they would recommend the packaging carries the Foundation’s claims are 100 per cent accurate technology, the overwhelming oscillating rotating toothbrush seal of approval. and that is why we have added majority of patients don’t want to to their patients. Oral-B power toothbrushes are the them to our elite list of accredited most used and recommended brand dental products.” Get smart this Christmas Full benefits of Chlorhexidine With Christmas coming, patients may communicates usage information without the disadvantages be looking for inspiration on gift to the user. ideas, or maybe they just want to The cleverfreestanding Clinically proven to effectively system and low alcohol content, use the start of a new year as an SmartGuide provides continuous control the bacterial pathogens patients can enjoy an effective opportunity to review their oral feedbackto the patient to ensure their responsible for gingivitis and oral hygiene regime without health as part of a general resolution brushing effort is maximised. And the periodontal disease, the Curasept experiencing irritation of the oral to be healthier. Whatever the reason, oscillating-rotating toothbrush head ADS system from mucosa, brown now’s a great time to getyour means that it removes more plaque Curaprox offers the discolouration of the teeth patients motivated by investing in the than a manual toothbrush full benefits of a or impairment of taste Oral-B Triumph with SmartGuide. and facilitates greater access chlorhexidine- sensation. Oral-B power toothbrushes are to difficult to reach areas of based oral universally acclaimed. Upheld as the the mouth. treatment while For free samples or more leading power toothbrush, they’re keeping side effects information call 01480 used by more UKdentists For more information, to a minimum. 862084, email themselves than any other brand. contact your local Thanks to its [email protected] or The flagship product, the Oral-B representative or anti-discolouration visit www.curaprox.co.uk Triumph with SmartGuide, is an dental dealer. ingenious brush that contains a microchip in the handle that Protecting against acid erosion and bacteria Philips unveils new Sonicare branding to BDTA delegates Listerine Total Care level, which can be Enamel Guard is achieved by use of Philips has reported a record- so as well. To uniquely formulated to Listerine Total Care breaking BDTAShowcase. For the encourage defend tooth enamel Enamel Guard, first time the company sold the switch, against acid erosion maximises fluoride Sonicare brushes from its stand, Philips and the plaque uptake and mineral achieving more than 2,000 sales. welcomed bacteria, which cause exchange. The The uptake was partly as a 1,105 caries. It does this in mouthwash contains 225 result of an new brand direction delegates to three ways; its high fluoride content ppm fluoride which has been proven which was unveiled at the show. brush their remineralises and hardens enamel, to increase fluoride levels above The new campaign has been teeth in one of the stand’s its essential oils are highly active those for brushing with a fluoridated designed to encourage those who brushing booths. against pathogens that attack toothpaste alone. haven’t already done so to make enamel, and as a mouthwash it can the ‘switch’ from a manual or low- If you would like more details reach all enamel surfaces more easily For more information and a free end power toothbrush to a about switching to Sonicare, than a toothpaste. sample of Listerine Total Care Sonicare toothbrush, and to visit www.sonicare.co.uk/dp or Several studies have shown that Enamel Guard, contact Johnson & recommend that their patients do call 0800 0567 222. an optimum short-term salivary pH Johnson on 0800 328 0750.

Scottish Dental magazine 79

BDTA

Subscriptions Hogies eyewear success skyrocket at Blackwell Supplies was pleased because of their ergonomic, BDTA with the response from delegates lightweight design. to its showcase of Created with precision The Dental Nursing Journal and Hogies specialist dental and comfort in mind, Dental Nursing Online were eyewear range during Hogies MaximEyes delighted with the number of this year’s BDTA Dental eyewear not only reduces delegates renewing and taking up Both Dental Nursing Online and Showcase at London’s the weight of loupes on the new subscriptions at the British the Dental Nursing Journal also ExCel in October. nose by 70 per cent, Dental Trade Association Showcase feature articles on professional Delegates visiting resulting in less neckstrain in October. issues, the latest news from the Blackwell at the and fatigue Attendees were impressed by the profession and advice on career KentExpress stand were journal’s focus on professional development to ensure dental impressed with the ergonomic For more information, call John advancement and core CPD subjects. nurses are making the most of their design and superb quality of Jesshop of Blackwell Supplies Both the website and the magazine abilities. Hogies MaximEyes loupes, not on 020 7224 1457 or are full of informative clinical case only because of their excellent email john.jesshop studies and multiple choice For more informaton, call magnification capability but also @blackwellsupplies.co.uk questionnaires to make learning 0800 137 201 or visit relevant and easy to digest. www.dental-nursing.co.uk schülke entertains Innovative technology schülke’s stand at the British Dental from Carestream Dental Trade Association Showcase 2010 was a hive of activity with delegates Carestream Dental flocking to join in the fun and show (formerly PracticeWorks) off their moves alongside a enjoyed an excellent professional dance troupe to the response from delegates sounds of MCHammer. attending this year’s To celebrate the success of the BDTA Dental Showcase, company’s popular line of touch-free the UK’s premier dental oral hygiene education, decontamination systems with the their recently launched comparison exhibition, held at ExCel in Carestream Dental truly strap line, ‘You can’t touch this’, website comparethemikrozid.com London during October. epitomised this year’s showcase dancers entertained visitors with the where their mascot Mike explained to Showcasing the latest theme of ‘Innovation, Integration famous dance routine, as well as delegates whether or not their advances in dental software and and Education’. giving the lucky few a chance to learn practice’s surface cleaner and technology, including the cutting the flamboyant dance techniques disinfectant was suitable. edge 3D OralInsights system, Call 0800 169 9692 or visit with prizes for the best performer. currently revolutionising youth www.carestreamdental.co.uk The team at schülke also used the For more info, call 0114 254 3500 or opportunity to raise awareness of visit www.s4dental.com IndepenDent value DENTSPLY tailors its stand With over fifteen years experience, IndepenDent understands the value to reflect delegates’ needs that dentists place on maintaining their own independence. Visitors to DENTSPLY’s Delegates at this year’s event stand at the British Dental learnt that every IndepenDent client Trade Association retains complete control over their Showcase 2010 explored own plan, and after paying a once- the company’s innovative only joining fee, staff receive new endodonticand comprehensive training. Additionally, via direct debit and payments to the restorative products, practices are supplied with the practice via electronictransfer. including the revolutionarySDR could be found at discounted promotional materials and software Delegates also heard about their (Smart Dentine Replacement). rates. The new DENTSPLY required to support their plan. Group Purchasing Scheme, They also tookadvantage of an Academy also proved to be a Clients are designated an subsidised training and marketing area dedicated to product talking point. IndepenDent consultant who support that is available. promotions, where products such manages things like patient as ProTaper, Cavitron units and Call 0800 072 331, or visit registration, payment schedules/ For more information, call 01463 inserts, and Ash instruments www.dentsply.co.uk insurance, and payment collection 222999 or visit www.ident.co.uk

Scottish Dental magazine 81 Equipment

BackOffice simplifies Innovative practice design time-consuming tasks brings the sky inside

CareStream Dental Directory product codes and At the forefront of innovation for (formerly known as allows every drug and stock dental practice design, Clark PracticeWorks) believes item to be electronically Dental can now bring the vastness that sound practice recorded with a list of of the sky into the surgery. management depends preferred suppliers. It will Give patients a soothing focal on the instant then notifyyou when a base point while receiving treatment. availability and efficient level has been reached and From a single pane to an entire Skyinside can give the illusion of manipulation of then automatically enter ceiling, Skyinside will provide an windows. The effects can give administrative data, as that item onto the next instant ‘wow’ factor. spaces a sense of openness, well as simplifying time- supply order. It transforms interiors with adding to the patient experience. consuming tasks. luminous, high-resolution images Now, thanks to KodakBackOffice, For more information, contact creating the impression of blue For details, contact Clark Dental the business management software CareStream Dental (formally skies, clouds, even stars. on 01270 613 750 or email from CareStream Dental, stock known as PracticeWorks) on When short on space, [email protected] control is more efficient. BackOffice 0800 169 9692 or visit now comes scanned with Dental www.practiceworks.co.uk

NOMAD Pro: ‘Significantly Increase your lowers staff doses’ handpiece life The leading technology of NOMAD To ensure longevity of grade stainless steels such Pro has recently joined the family your handpiece it is as those found inside of award-winning Aribex NOMAD imperative to lookafter it Bien-Air handpieces. handheld dental X-ray systems. properly, maintaining its Aquacare is easy to use. In a recent study, the hand- results, high performance. Attach your handpiece to held, battery-powered dental use of the Aquacare from Bien- the Aquacare spray nozzle intraoral x-ray system (NOMAD), NOMAD Air is a special pre-cleaner used to and spray through the handpiece was compared in terms of image “results in significantly lower staff remove physiological fluids such as and any external irrigation tube for a quality, and patient/staff doses compared to wall-mounted saline. Saline is often used as an period of 2 seconds. This effectively radiation doses, to a wall- systems.” irrigant and unless your handpiece is removes any residue and any mounted intraoral x-ray system cleaned thoroughly after use, this remaining physiological liquid that (GendexGX-770). For more information, contact physiological salt water can sit in the may be sitting in your handpiece. The study said: ‘‘The resolution Clark Dental Nantwich on 01270 handpiece ducts wreaking havoc. and contrast for the NOMAD are 613 750 or email Saline will crystallise if left For further information, contact superior”, and based on the [email protected] unchecked in as little as two hours Bien-Air on 01306 711 303 or visit and will attackall metals, even high- www.bienair.com Steritrak: easy auditing New safety regulations mean that Dentalk walks the talk dental practices need to do more to demonstrate that they keep dental at BDTA Showcase instruments free of contaminants. Creating auditable protocols for Dentalk, the new (pictured left with re-usable instrument sterilisation telecoms provider Dentalkfounder Barry can be a minefield. However, with for the dental world, Sanders), a dentist from R4’s new module, Steritrak, the officially launched its St John’s Wood, whose innovative new software add-on from services at the BDTA practice is set to save 50 Carestream Dental, rigourous safety exhibition at Excel in per cent in the coming procedures and simplicity need not October with a year on its telecoms be opposed. R4 Steritrakis a quickly and easily, cutting keyboard guarantee that it will costs, thanks to Dentalk. barcode-based auditing system that entry down to a minimum. save any dental Dr Roland said the tracks the surgical instrument cycle. practice or business switchover to Dentalk Steritrakallows staff to keep tabs For more information, contact at least 20 per cent on their had been smooth, with the on criteria such as where trays are Carestream Dental (formally telecoms costs. Dentalk team ensuring that all located and when they were known as PracticeWorks) Among the visitors to the the arrangements were last autoclaved. on 0800 169 9692 or visit Dentalkstand wasSimon Roland straightforward and transparent. In-depth reports can be generated www.practiceworks.co.uk

82 Scottish Dental magazine Restorative

Stuart’s a winner BioHorizons dates for 2011

At the 2010 EAO Congress, part of. The prize was an the hands-on workshops in all-inclusive international Following a busy and exciting immediate loading, aesthetics the Astra Tech Inspirational course of choice. 2010 for BioHorizons and on the and implant complications. Center was once again a We are happy to backof their highly successful And the second edition of the success, and most announce the winner was congresses in Colombia and Ultimate ImplantYearCourse sessions were sold out. DrColin Gardner from Turkey, BioHorizons is pleased to (NIDIC) hosted by Dr Ken More than 55 delegates Botanics Dental Care in announce the 2011 dates for the Nicholson will run from February. from 16 countries had the Glasgow. DrGardner was presented Global Symposium and Ultimate opportunity to place the new his certificate by Jenny Williams, ImplantYearCourse. Calll 01344 752560 or visit OsseoSpeed TX implant in a model. SalesSpecialist, Scotland. The BioHorizons Global www.biohorizons.com The lecturer in the workshops was Symposium will be held at the StuartConway, Astra Tech’sTraining For more information on Astra Tech prestigious Arizona Biltmore Hotel and Education manager in the UK. products and services, please call in Phoenix, Arizona on 28 April to New for this year was a lottery that 0845 450 0586 or e-mail 1 May with topics that include all participants were automatically [email protected] BACD/AACD Conference an all-out success

The British Academy ofCosmetic in the field of cosmeticdentistry, latest clinical trends in the field. Dentistry enjoyed a high turnout enabling delegates to rub shoulders to its Esthetics Meets Aesthetics with some of the best, as well as gain For more information about conference, the first of its kind, held invaluable knowledge and skills from membership entitlements, in London thisSeptember. the world-class professionals. including access to next year’s The conference brought The week-long meeting featured conference, please contact Suzy together some of the world’s most talks on cutting edge subjects such Rowlands on 0208 241 8526, or pre-eminent and progressive experts as dental branding, together with the email [email protected]

Scottish Dental magazine 83 BDTA/Product news

Set rates for implant GC announces G-aenial work set PDS Labs apart composite courses

Dental practitioners keen to GCis launching a new series of For more enhance the quality of life of their courses for 2011 that will take place advanced users patients through reasonably at the company’s European there is an priced, natural-looking implants headquarters in Leuven, Belgium. additional and high-quality cosmetic GChas recently launched an course that restorations should consider PDS improved composite system with G- adopts a Dental Laboratory. PDS takes pride in getting your aenial. The hands-on training theoretical and With two full-service lab workjust right. courses have been designed for practical laboratories in Leeds and dentists to learn how to place the approach. Newcastle, and more than 20 For more information, call very best composite using a years of experience, PDS is able to Newcastle on 0191 232 4844 or combination of materials. After Spaces on these two-day courses offer clinicians the very latest in Leeds 0113 239 3675.Or visit analysing the structure of the are limited for maximum implantology and restoration www.pdsdental.co.uk or surrounding teeth, simple steps are personalisation. To register your CAD-CAM technology. www.futureveneers.com used to create the perfect restoration interest please contact GC UK Ltd using G-aenial. on 01908 218999. Places limited! Join the Admor Buying Club and save time and money PDS Dental Laboratory: Thanks to the new Admor Buying trusted by clinicians Club, dental office supply management just got easier With more than 20 years of and more cost effective. experience and several awards to Dentists who join the club not only its name, PDS Dental Laboratories gain admission to the best deals prides itself on providing high- around, including an array of special quality restorations at set rates in offers and exclusive discounts, but a friendly, efficient manner. also benefit from the convenience of Mr Daryl Castanha of Guys and online access to a one-stop resource StThomas’ NHS Foundation Trust then taken for PDS to support the for all their practice essentials. (pictured), said: “We appointed Hospital with some of our fixed It has a comprehensive range of solution that makes complete PDS Dental laboratory three years prosthodonticwork.” office, janitorial and furniture business sense. ago to carry out laboratory products available to order online for support services. Its appointment For more information, call next-day delivery, together with credit For more information or to register was to carry out removable Newcastle on 0191 232 4844 or facilities and friendly, helpful service. for your account, call 01903 prosthodontics and as time Leeds 0113 239 3675, or visit Admor offers dentists a practical 858910 or visit www.admor.co.uk proceeded the quality of cases www.pdsdental.co.uk and received was high. A decision was www.futureveneers.com A reason to smile at the BDTA Dental Showcase Dentists cluster to Attendees with an interest in helps to halt demineralisation and try The Wand preventative dentistry and good strengthens tooth enamel as well oral health made sure theyvisited as effectively fighting bacteria. During Dental Showcase dozens TANDEX’s stand at the BDTA Dental Clinical trials available from of dentists accepted an invitation Showcase and Exhibition 2010. TANDEX show the effectiveness of from Dental Practice Systems TANDEXGELproved to be a TANDEXGEL. (DPS) to undergo a local particular talking point among anaestheticinjection using The dental professionals at the For more information on TANDEX Wand computer controlled local exhibition, with its effective GEL or any other of TANDEX’s anaesthesia system. combination of sodium fluoride products visit www.tandex.dk The single tooth anaesthesia need one in each of my surgeries” and chlorhexidine digluconate. procedures were carried out and “Can I take one with me”. Making it ideal for use by patients throughout the three-day event on with a predisposition towards the DPS stand. For more information on plaque and caries. The typical reactions were: The Wand, please visit TANDEXGELcan simply be “Amazing”, “I didn’t feel a thing”, www.d-p-s.uk.com or call applied using an interdental brush, “The Wand really is magic”, “I DPS on 01438 820550.

84 Scottish Dental magazine Product news schülke has number Everything your practice one disinfectant needs under one roof Don’t miss the brand new Admor In a world of MRSA and it prevents cracking and catalogue, available now, C.Diff scares, disinfection smearing. containing information on how must be paramount in Available in liquid form your practice can join the new the minds of all dental and wipes, mikrozid Admor Buying Club, providing professionals, and industry sensitive cleaner and massive savings on more than leader schülke can provide disinfectant can be used 20,000 office essentials. the most effective solutions on artificial and natural Admor supplies a wide range of available on the market. leather, perspex/ office products at the best prices. mikrozid sensitive is an alcohol- plexiglas and soft PVC. Thousands of Admor is also able to produce collection of stylish furniture, free surface cleaner and disinfectant dental professionals already trust the even small quantities of including reception desks and that is kind on surfaces made of mikrozid brand, making it the UK’s customised colour print work, practice signage. delicate materials but no less number one surface disinfectant. even in small quantities. The effective in the control of infection. Admor catalogue also features an Order from www.admor.co.uk or It is ideal for sensitive materials, For more details, call 0114 254 3500 interiors section, which boasts a call 01903 858910. alcohol-free, a disinfectant, or visit www.schulke.co.uk/dental bactericidal, fungicidal, virucidal and or www.comparethemikrozid.com New studies show SDR praised by panel benefits for oral health

A group of researchers from the A set of new clinical studies has The third study, conducted among Product Research and Evaluation reinforced the efficacy of using a dental professionals in the UK, by Practitioners panel has PhilipsSonicare power toothbrush to Netherlands and Denmarkshowed responded with words of praise clean teeth and reduce gingivitis. that more than 75 per cent of dental for DENTSPLY’sSDR (Smart consider replacing their current The first study from the University professionals are highly satisfied Dentine Replacement). SDR was material with SDR. of North Carolina, USA, showed that with the cleaning performance and the second highest evaluated It also found that 86 per cent Sonicare FlexCare+ improved gum manoeuvrability of the compact product ever by the panel. who used a flowable as a liner tissue condition and maintained the ProResults brush head. SDR is a bulk-fill, flowable would consider switching to SDR longevity of teeth and gums in composite base for posterior and 83 per cent were satisfied patients with periodontitis. For more information about these Class I and II restorations. After with SDR and 75 per cent said they A study from the University of and other clinical studies, please evaluation in clinical practice, the would buy the product and Zurich evaluated the cleaning efficacy visit www.sonicare.co.uk/dp panel found that all evaluators recommend it to their colleagues. of brush heads on orthodontic who used a bulk-fill posterior attachments, showing thatSonicare composite technique and a For more details, call 0800 072 power toothbrushes with a compact flowable as a bulk-fill base would 3313 or visit www.dentsply.co.uk of standard ProResults brush head provided superior results. A third of parents let their children skip brushing PDS dental laboratory

Worrying new research shows that brush their teeth causes anxiety. A PDS Dental Laboratories is the many parents are ignoring the further six per cent let their children ideal technical partner for dental warnings of dental professionals, off because they don’t want to cause practitioners striving to provide as it finds that millions of British an argument. high-quality smile design and parents are letting their children off restoration treatment to patients. brushing their teeth simply because For more information about PDS has grown to become a they’re too rushed or stressed. Sonicare For Kids and the ways in laboratory that is highly respected The study found that nearly a third which it encourages compliance by for its quality workmanship and of parents let their children skip children aged 4 -10 years innovative approach to dental Laboratory recently opened its brushing if they’re in too much of a can be obtained on technology. PDS performs all its second full service dental rush, while one in five says they let www.sonicare.co.uk/dp or by laboratory workin-house within laboratory in Newcastle. their kids off part of their morning calling 0800 0567 222. its purpose-built, state-of-the-art brushing routine, simply to avoid the facilities in Pudsey, Leeds. For more information, call hassle. In addition, a quarter of those Due to its ongoing success, and 0191 232 4844 or visit polled in the survey by Philips as part of its 20th anniversary www.pdsdental.co.uk and Sonicare claim theiryoungsters’ celebrations, PDS Dental www.futureveneers.com constant arguing about having to

Scottish Dental magazine 85 Product news

Become a high flier Christmas

As part of its continuing commitment DENTSPLYwill fly the winner to Las is coming to investing in better dentistry, Vegas for the American Dental DENTSPLYis proud to once again Association’s annual conference in It’s fast approaching that time sponsor the 2011 BDA/DENTSPLY October as part of an all-expenses again, and Kemdent is delighted StudentClinician Research Awards. paid trip, during which he or she will to announce their popular Held annually, this prestigious be introduced to a wide range of Christmas hamper promotion. awards programme serves as a way leading figures, peers and potential To qualify for a free Christmas more you spend on Kemdent to identify new talent from within employers from within the dental hamper, Kemdent’s customers products in November, the larger undergraduate dental students as profession – a truly unique career need to spend £225 or more your hamper will be. well as supporting any promising opportunity. during November; a taskwhich research with the potential to The runner-up will receive a cash should present few problems For further details on the improve the way that future dentistry prize of £500. given the wide range of offers on Christmas hamper and special is practised. surgery products currently offers, contact Helen or Jackie on For more information, and entrance available. 01793 770256, or visit requirements, contact your local Three sizes ofChristmas www.kemdent.co.uk Follow us BDA/DENTSPLY Student Clinician hamper are available, and the on twitter: twitter.com/kemdent Research Awards representative or visit www.bda.org/students/ awards-competitions An efficient service New generation in With more than 20 years of composite experience in the dental profession, placement PDS Dental Laboratories prides itself on providing a high quality of service, Kerr has launched a new layer thickness control, improved retaining the personal touch in all product: Compothixo! sculptability and reduced their dealings with clients. Compothixo is a composite stickiness. It is indicated for the In addition to providing high placement and modelling modelling of composite, occlusal quality workmanship, PDS also instrument, suitable for all classes modelling, fissures and removal strives to build close working of restorations. of excess, layer application relationships with all its clients. Its New Compothixo technology technique, bulktechnique in two-tier delivery service also helps to enhances the thixotropic small cavities and direct ensure that all lab workis delivered properties of composites. veneering. on time and to specification. Compothixo’s unique benefits Dr Muhammed Iqbal Kathrada of For more information, call include better wettability, superior To see how to benefit from Kerr’s My Dental Health Club in Hull said: Newcastle on 0191 232 4844 or adaptation of composite to cavity products call 01733 892292 or “After using PDS for some time now I Leeds 0113 239 3675 or visit walls, reduction of air bubbles, visit www.kerrdental.co.uk am finding the service they provide to www.pdsdental.co.uk and be of a very high standard. www.futureveneers.com Simple system for everyday endodontics Precise scaling with Dental Sky’s Tri-Scaler The latest addition to the Dental Sky endodonticrange is the new CMA The new high quality R&STri- nickel-titanium rotary file system. The ScalerCompact from Dental Sky is CMASystem was designed to economically priced. simplify endodontictreatments by With a detachable, minimising the number of autoclaveable handpiece, the instruments necessary and providing Tri-ScalerCompact features three one uncomplicated sequence for options – scaling, periodontal allowing you to add other clinical both treatment and re-treatment. including a shorter handle to improve and endodonticfunctions. It is solutions. With eight scaler tips CMA stands forCoronal, Median ease of access to molars and a helical verysimple to operate and included, the Tri-ScalerAqua and Apical and provides a simple shape to aid removal of debris from includes five tips. represents excellentvalue. sequence with onlyfour instruments the canal. The largerTri-ScalerAqua in the range. benefits from the same features For further details or to place CMA provides safe, secure and For further information, as the Compact with the added your order, contact Dental Sky reliable rotary instruments with please contact Dental Sky benefit of a built-in water reservoir on 0800 294 4700. several unique design features on 0800 294 4700.

86 Scottish Dental magazine