No.1 for dental professionalsprofessio in Scotland We talk to December 2011/January 2012 the National Clinical Lead for Quality, Jason Leitch Page 24

It’s show time! register now for your free place at the must attend dental event of 2012 Turn to page 6 for Dundee details dreams We speak to the dental school’s new dean of dentistry page 20

Bookmark this link today… www.irelandsdentalmag.iewww.scottishdentalmag.co.uk

ISSUE 6, VOL.2 Welcome Editor’s desk with Bruce Oxley Call to action Inside this issue of Scottish enough for putting their faith further hours in the show Dental magazine you should in this inaugural event. programme as well. have found a special poster We are also extremely Finally, we will soon be Contents for the Scottish Dental Show excited about the calibre launching a dedicated show December 2011/January 2012 on 24-25 May. of speakers that we have website where you will be I think that this is going to managed to secure. Once able to find all the latest News> be one of the most exciting word got out about the news and information. 05 Column: biting back events of its kind in many show, we were inundated However, in the meantime, with Arthur Dent years and we are keen to with requests from speakers you can still register your 06 Scottish Dental spread the word to as many and companies offering to FREE place at the show, and Show latest news dental professionals as host a talk or workshop. be entered into a prize draw 10 honours for former possible. So, please put this Unfortunately, we couldn’t to win an iPad 2, by visiting GDC presidents up on your staff noticeboard fit everyone in, but I think www.scottishdentalmag/ or in the lunch room and the line-up of specialists and show FEATURES> encourage your colleagues experts is second to none. You can also follow us on 20 New Dundee dean to register online – they may From aesthetic dentists Twitter – @ScottishDental – Prof Mark Hector even win an iPad 2 for their and implantologists, to and find us on Facebook at 24 Jason Leitch trouble. accountants, business www.Facebook.com/ 28 Kilimanjaro The trade exhibition at the coaches and dento-legal ScottishDental for up-to- challenge show amazingly sold out advisors, we have a date news, views and show 38 Who’s who in within six weeks and the facinating array of talks for information. Scottish Dentistry waiting list for companies the entire dental team. hoping to exhibit is getting There will be 12 hours Clinical> longer. The dental trade has of verifiable CPD available ® 46 Live case study – supported the magazine to delegates over the two Bruce Oxley is editor of part three Scottish Dental magazine. To 59 Decon update with gusto for many years days of the event and contact Bruce, email bruce@ 69 Thiel bodies and I can’t thank them we are hoping to include connectcommunications.co.uk

Scottish Dental magazine 3

Column Biting back with Arthur Dent The decon ‘con’ ention the Improvement Scotland (HIS) or the but have instead flowed from the word ‘decon- Scottish Health Department itself. ‘Precautionary Principle’ and the tamination’ in So, for example, in England there four health departments have been the company of are the mandatory Essential Quality at the mercy of whichever ‘experts’ dentists and the Requirements which do not require they have chosen to consult. Some Mresponse will most likely be a practices to have a local decon- of them have taken a sensible, cacophony of groans. Recent years tamination unit (LDU), whereas moderate and balanced view and have seen dentists bombarded in Scotland, all practices should given pragmatic practical advice, with various, frequently by now have an LDU in operation while others have been... let’s say changing recommendations or at least have submitted plans for somewhat over-zealous! and mandatory requirements possible extension or relocation to How ridiculous it is that in punctuated by numerous target enable installation of one. matters of such importance, dates for compliance. Scottish practices should have dentists in different parts of the UK One of the most irritating features washer/disinfectors installed in are judged by different standards. of the ‘decon debacle’ is the fact their LDU, despite the fact that If a dentist fails to comply with the that the four nations of the UK these are unreliable, with frequent relevant health department rules require different standards of their breakdowns and leakages. “How for their country, what sanctions dentists. A recent analysis by the In Wales, standards are more ridiculous might be used? Possibly referral to British Dental Association shows relaxed (as in England), whereas it is that the General Dental Council (GDC) that while the broad aims and prin- the Northern Ireland department because it currently has UK-wide ciples of decontamination are the is taking a stricter ‘Scottish-style’ in matters jurisdiction of all dentists and same, the details of what exactly approach with a November 20ı2 of such dental care professionals. What a is required by the four UK health deadline to meet the ‘Best Practice’ importance, dilemma for the GDC if a dentist fell departments varies considerably. requirements of HTM 0ı-05. dentists in short of the standards required by England, Wales and Northern The Chief Dental Officer in different one health department, but would Ireland follow their own variations Scotland now chairs a group which parts of not be found wanting if judged by of the dreaded HTM 0ı-05 (catchy oversees all Scotland’s decontami- the UK are the rules of another part of the UK. title), but in Scotland, we have to nation standards, so this has brought Surely it is time for all four health follow the advice, recommenda- some sort of sense to our situation judged by departments to get their act tions and requirements of various here. So, why these differing stand- different together and agree a common set bodies such as the Scottish Dental ards? The main problem seems to standards” of decontamination requirements Clinical Effectiveness Programme be that few of the standards are which are sensible, practical and (another catchy title), Health based on hard scientific evidence, evidence-based?

Details and contributors Scan this QR code with your smartphone Editor Design and Subscriptions to see all of our social Bruce Oxley production Ann Craib media offerings Tel: 0141 560 3050 Fiona Wilson Tel: 0141 560 3021 is published by bruce@connect Renny Hutchison ann@connect communications.co.uk Scott Richmond communications.co.uk

Senior sub-editor Advertising 1 year, 6 issue The copyright in all articles published in Scottish Wendy Fenemore sales manager subscriptions: UK £60; Dental magazine is reserved, and may not be Ann Craib overseas £75; reproduced without permission. Neither the Studio 2001, Mile End, Sub-editors: Tel: 0141 560 3021 students £30. publishers nor the editor necessarily agree with Paisley PA1 1JS Chris Fitzgerald ann@connect Back issues: £5, views expressed in the magazine. Tel: 0141 561 0300 Gary Atkinson communications.co.uk subject to availability. ISSN 2042-9762 Fax: 0141 561 0400 www.scottishdentalmag.co.uk

Scottish Dental magazine 5 Scottish Dental Show To register for your FRee place at the show, visit www.scottishdentalmag.co.uk/show

A unique event for the profession

With a packed trade show and a full list of outstanding speakers, the free to attend Scottish Dental Show will have something for all members of the team

s the only show of have given their support to the event. Speakers its kind north of the With product launches and The programme of speakers at the border, the Scottish demonstrations taking place Scottish Dental Show will be second Dental Show offers a throughout the day, there will be to none, with no less than 12 hours unique opportunity plenty to see and to do in the exhibi- of verifiable CPD available to all Afor dental professionals to top up tion areas. Everyone from equipment delegates. With concurrent streams their CPD and see the latest products manufacturers, implant companies, running throughout the two days, and services on offer, right on their indemnity providers, dental labs and there is an unparalleled level of doorstep. specialist referral clinics will be on choice for the entire dental team. Taking place at the home of Scot- hand to talk about their products and Chick Young Edinburgh GDP and former GDC tish football, Hampden Park, on 24 services, with many offering special president Hew Mathewson will be and 25 May, the new event is free deals and offers to delegates. giving the welcoming address and to everyone involved in the dental At the end of the first day there he will be followed by a selection of industry, with something on offer for will also be an opportunity to some of the finest dentists working the whole dental team. catch up with colleagues and make in Scotland today, including Brian Even in these difficult economic new acquaintances at the evening Miller, Stephen Jacobs, Philip Friel, times, the show’s 84 trade stands drinks reception. As the event is Kevin Lochhead, Abid Faqir, David amazingly sold out within six weeks. being hosted at Scotland’s national Offord, Elaine Halley and Carol Tait. And, with a waiting list starting to stadium, it seemed fitting to invite They will be joined by the selling grow, it is testament to the vibrancy everyone’s favourite BBC football Aubrey Craig coach Ashley Latter who will be of the Scottish dental industry that so reporter, Chick Young, to round off revealing his recession busting many of the major dental companies the first day in style. strategies on the first day and then

6 Scottish Dental magazine Scottish Dental Show

Hotel deals

Win an iPad 2 We have managed to secure a range If you register online at www. of special rates ScottishDentalmag.co.uk/ for delegates Show for your FREE place at the Scottish Dental Show, and exhibitors then you will automatically be during the show entered into a prize draw to win an iPad 2. So, if you didn’t get one for Christmas then this is your HHHHH chance to pick up one of the Glasgow Hilton Hotel most desired gadgets on the Approximately 2.5 miles from Hampden market today. All you have to Stadium. Special rates of £135 for single do is register your interest in room and £145 for double or twin room. attending the show and the Rate inclusive of breakfast, service and draw will be made at Hampden VAT. Please quote Scottish Dental Show in May. when booking your room. Everyone who registers All rates are subject to availability online is eligible to win the www.hilton.co.uk/glasgow prize, but remember, you have to be in it, to win it! HHHHI Glasgow Thistle Hotel Approximately 2.8 miles from Hampden Stadium. Special rates of £90 for single room and £100 for double or twin room. Rate inclusive of breakfast, service and VAT. Please quote Scottish Dental Show when booking your room. uncovering the secrets behind All rates are subject to availability perfect communication in your www.thistle.com/en/hotels/united_ practice on day two. kingdom/glasgow/thistle_glasgow/ But that’s not all, we also have indemnity specialists Hugh Harvie (Dental Protection) and Aubrey Craig HHHII (Medical and Dental Defence Union Kings Park Hotel of Scotland) sharing their wisdom Approximately 1.6 miles from Hampden and experiences, John Barry from the Stadium. Special rate of £85 for a single Brian Miller Dental Business Academy revealing and £95 for double or twin room. Rate his secrets to running a successful inclusive of breakfast, service and VAT. dental business and Neil Morrison Please quote Scottish Dental Show when and Roy Hogg from accountants booking your room. Campbell Dallas providing a topical All rates are subject to availability update on finance and taxation. www.kingsparkhotel.com Other confirmed speakers include John Meechan, Payman Langroudie, Alternatively there are a number of Premier Inn’s around the Louis Mackenzie, Bob McLelland, Glasgow area offering good rates. Visit www.premierinn.com and Richard Brookshaw and Farahbod search for Glasgow hotels. Elaine Halley Nakhaei. And finally, there is always www.lastminute.com to see an array of hotels, bed and breakfasts and guest houses in the Glasgow area. Continued »

Scottish Dental magazine 7 To register for your Free place at the show, visit Scottish Dental Show www.scottishdentalmag.co.uk/show

Continued »

Lifetime Achievement Award The event will also see the intro- duction of the Scottish Dental Lifetime Achievement Award. This prestigious honour is intended to pay tribute to an individual who has made a real difference to dentistry in Scotland during their career. Follow us on Twitter @Scottish- We will be accepting nomina- Dental for all the latest news and tions from everyone in the dental updates on the Scottish Dental community in Scotland and details Show. And don’t forget to use the of how to nominate will be revealed hashtag #ScottishDentalShow in the New Year. So keep an eye on when retweeting or posting a the website, in the magazine and on message about the show our social media sites for details. to your own followers.

Coming soon… We will be launching a dedicated Scottish Dental Show website where all the latest news and infor- mation will be easily accessible. To Our Facebook make sure you find out exactly when page (Facebook.com/ the site is launched, simply register ScottishDental) will also be at the Scottish Dental magazine updated regularly with pictures website (www.scottishdentalmag. and information, so ‘Like’ us and co.uk/show) and we will contact keep yourself up to date. you when it is up and running.

Scottish Dental Show – exhibitor list

Adair Dental Laboratory Dentsply NSK A-dec UK Ltd Dickie & Moore NV Design ARC Dental DMG Optident Astra Tech Dolby Medical Orascoptic AWB Textiles DTS – PLATINUM SPONSOR PDS Dental Laboratory Bambach Edinburgh Dental Specialists Pearl White Dental Laboratory Bank of Scotland Enlighten Planmeca Bien-Air UK Ltd Eschmann Equipment Practice Financial Management Biomet 3i Garrison Dental Practice Plan BioHorizons UK Geistlich Practitioner Services Blackhills Clinic Giffnock Orthodontic Practice Premier Dental Products Bond Chartered Accountants Glasgow Orthodontics QED Braemar Finance Henry Schein Renishaw CADE Heraeus Kulzer SAS Shopfitters Campbell Dallas I W Technology Services Septodont Carestream Dental IndepenDent Care Plans – Sirona – BRONZE SPONSOR Carestream Health SILVER SPONSOR Smiles Imaged4U Cattani Integrated Dental Holdings Software of Excellence Coatbridge College J & S Davis Southern Implants Coltene – GOLD SPONSOR KaVo Sybron Endo Condies Chartered Accountants Kerr UK Tavom Confidental Leca Dental Laboratory The Dental Business Academy Denplan Martin Aitken Vega Implants Dental A2Z MDDUS Voco Dental Defence Union Med Imaging W & H Dental Directory Medicert WhiteWash Laboratories Dental Protection Molar Ltd Wysdom

8 Scottish Dental magazine

News Nurses column p19 | Kilimanjaro climb p28 | Live case study p46

NHS sign-ups Honours for two former reach record level – report Scottish presidents Registrations Edinburgh dentist and former BDA Awards. Major in dentistry. He was appointed Nearly four million President of the General Dental CBE in 2004 for services to people are now Council Hew Mathewson was recognition at dentistry and healthcare registered with an NHS among the recipients at the prestigious London regulation. dentist, according to BDA Honours and Awards ceremony for pair BDA President Janet Clarke figures released by ISD Dinner held at Chancery Court MBE said: “We are delighted Scotland – the highest in London recently. service to the dental profession. to host these awards, which number ever recorded. Hew, who was awarded a The University of Edinburgh celebrate excellence across the As of 30 September, CBE in 20ı0, was presented graduate of ı973 was previously whole dental family. They are 70 per cent of adults (3.1 with the BDA Fellowship dean and Pro-Vice Chancellor our opportunity to say thank million) and 86 per cent by Stuart Johnston (chair of at Manchester Dental School you to all those who contribute of children (894,000) BDA representative body) in before becoming dean at KCL their time, expertise and good- were registered with an celebration of his outstanding in 200ı. will for the betterment of the NHS dentist. The new and distinguished service to Durng his distinguished dental profession.” figures represent an the BDA and the dental profes- career he has been editor of the increase of 1.36 million sion in general. Over the years, Journal of Dentistry, Chairman since March 2007, when his BDA roles have included of the Joint Committee for Stuart Johnston and Hew the SNP administration being chair of Branch Council, Specialist Training in Mathewson came to power. branch president, chair of Dentistry and Dean of the The ISD report also the Scottish Dental Practice Faculty of Dental Surgery highlights the fact Committee, as well as vice of the Royal College that 69.4 per cent of chair of the General Dental of Surgeons of Edinburgh. primary seven children Practice Committee. Nairn was a are showing no obvious There was also an award for member of the signs of tooth decay, another Scottish former GDC team which another record high and President and CBE recipient, developed light- the first time that all this time the outgoing Dean cured composite NHS boards have met of Dentistry at Kings College systems. Subse- the Scottish Govern- London, Nairn Wilson. Nairn quently, he has ment’s 60 per cent was presented with the John contributed target in this area. Tomes medal, which is awarded extensively to Public Health Minister in recognition of scientific the scientific Michael Matheson, eminence and outstanding and other literature whose party introduced continuous registration in April 2010, said: “It is fantastic that we now Johnstone Health Centre, the have an extra 1.3 million Russell Institute and one of the Scots registered with an two surgeries based at Foxbar. NHS dentist. Approximately 3,000 “Our latest figures patients who would have show there are record needed to travel into the numbers of dentists Glasgow Dental School for working in NHS Scotland treatment will now be able to be and this has resulted seen at the new Paisley centre. in more people being All the new surgeries in the able to access an NHS dental centre have been fully dentist. equipped to offer the full range “With increased of treatment, from oral surgery access we will expect to A new dental opened at the Royal Alexandra to orthodontics. Two of the see improvements in the Hospital (RAH) in Paisley. surgeries have been specially- oral health of the nation centre for RAH The new centre, which designed to treat special and these figures show also includes eight student care patients with additional that we are already New facilities outreach chairs, will amal- support needs: surgery 11 for seeing leaps forward in gamate five former stand-alone younger patients and surgery children’s dental health.” A state-of-the-art £3.4 million clinics into the RAH: Dykebar 16 for sedation/adult special dental centre has been officially Hospital, Glenburn Clinic, care patients.

10 Scottish Dental magazine

News Who’s who p38 | Decon update p59 | New products p82

Award. Glasgow dentist rubs shoulders with Lords and Baronesses at Downing Street Glasgow dentist goes to Number 10

How does a dentist from neurial endeavours that got her Glasgow end up having lunch an invitation to a celebratory with the Prime Minister at Eid lunch at Downing Street. Number ı0, surrounded by Rita, who owns three Lords and Baronesses? other dental practices in Well, in the case of Bath the Glasgow area under the Street Dental Practice’s prin- Peppermint Studios brand Rubbing shoulders: Rita cipal dentist Rita Ahmad, it was (Maryhill, Eglinton Toll and with the Prime Minister thanks to an award she picked Chapelhall Dental Practices), and Baroness Warsi up last year for her entrepre- was presented with the Entre- preneur of the Year award at And Rita explained that she impressed with his knowl- “It was a the 20ı2 Scottish Asian Business was more starstruck by meeting edge of Islam and his attitudes very positive Awards. the Baroness than she was towards the burgeoning Arab Rita said: “I think winning meeting the Prime Minister: democracies that have started experience the award meant that I “She’s amazing. She is one of the to find their feet in recent because he was probably ticked a few boxes – coolest Asian women in Britain months. very positive young, female, Asian, business in my eyes, and the things that She said: “It was a very posi- professional. she has done for Asian people tive experience because he was about the fact “It was actually Baroness is phenomenal. very positive about the fact that that democracy in Warsi, (co-chair of the Tory “I got to speak to her for a wee democracy in Muslim coun- Muslim countries Party) who had been given the while and I was just in awe of tries has happened and he was task of finding guests to come her to be honest.” very keen to demonstrate that has happened” down and celebrate this lunch, As for the Prime Minister, he understands Islam and he Rita Ahmad who invited me along.” Rita explained that she was understands Muslims.”

Jacobs resource – and is chairman Waiting room comes to life of its editorial board. hands over He is a specialist oral Art Joan Ashcroft, a budding young surgeon, the clinical painter, was contacted to ADI reigns lead of the diploma/MSc It’s not often that a dental display her works. An opening programme in implant waiting room is described as a night drinks reception at the to Ucer dentistry at the School of work of art, but for one practice end of October saw more than Health Care Professions of in Edinburgh a collaboration 100 people visit the practice, Appointment University of Salford and a with a local artist has turned with Joan selling 35 per cent of member of the Faculty of their waiting room into a her stock. Bearsden-based dentist Examiners for the Diploma contemporary gallery space. Stephen Jacobs has handed in Implant Dentistry of the Having previously hosted over the presidency of RCSEd. small exhibitions of a friend’s the Association of Dental work when they first moved Implantology to Professor into the premises at Ferryburn Cemal Ucer after his two- House, principal dentist Janet year term of office came to Clarke is no stranger to the an end. art world. But the exhibitions Prof Ucer has been an were short lived after the artist active member of the ADI had a change of career and Board since 2005 as its Janet busied herself running a North West representa- successful practice. tive and leader of the ADI’s However, when her patients mentor training course at started asking when the next Salford University. exhibition would be, Janet He has authored the decided that it was maybe foundation course for Ark – time to consider making the the ADI’s online education Taking over: Prof Cemal Ucer gallery a permanent addition Joint project: Joan Ashcroft (left) to the practice. So local artist and practice owner Janet Clarke

12 Scottish Dental magazine

News Jason Leitch p24 | Hypnosis p65 | Careers fair p74

Cash boost for dental schools BADN abolish chairman’s role Funding resources to share an admin- in recent times. This funding istrator who will help support from SFC provides an excel- appointment Glasgow and Dundee Dental their joint research activities lent opportunity to build a Schools are set to benefit from and work with stakeholders, strong and sustainable oral The council of the British a funding boost of £ı32,000 to including primary carers and health research portfolio. Association of Dental strengthen their collabora- the University of Aberdeen “It will ensure that there Nurses voted to abolish tion on dental and oral health Dental School. is synergy and a sharing of the position of chairman research. Professor Jeremy Bagg, expertise which will help both of council and expand the The money, from the Scot- Head of the Dental School institutions to deliver research role of president at their tish Funding Council and at the University of Glasgow, outputs relevant to the Scot- recent AGM. spread over three years, will who has been involved in tish population and enhance Glasgow dental nurse allow the schools to focus on developing the Scottish Oral their positions and research Nicola Docherty becomes inequalities in dental health, Health Research Strategy, reputations within the UK and the first president to take access to dental services, said: “Glasgow and Dundee internationally.” on the newly expanded oral cancer and craniofacial Dental Schools have been Professor Mark Hector, role after she was officially birth defects. The two univer- moving towards closer collab- Dean of Dentistry at the inducted at the BDTA sities will also pool their oration on a number of fronts University of Dundee, said: Showcase in October. “This SFC funding will facili- Speaking about the deci- “Glasgow and tate a greater level of effective sion, which was proposed Dundee Dental collaboration between by a BADN member and Schools have been experts at the Universities passed by a 96 per cent of Dundee and Glasgow to majority, Nicola said: “I moving towards accelerate progress towards would like to thank past closer collaboration finding solutions to problems chairman Angie McBain for on a number of fronts and implementing them with her sterling work on behalf in recent times” a beneficial impact on the of the association.” Professor Jeremy Bagg health of the population.”

14 Scottish Dental magazine

News New Dundee dean p20 | Thiel bodies p69 | Ad features p76

Legal. Westminister review may lead to change of rules Prizegiving season for Scottish HIV consultation dentists Awards is set in motion A Glasgow dentist has celebrated the first The Department of Health in recent review could be set to even further if the healthcare anniversary of his clinic’s Westminster has announced change that. worker is taking effective drug launch by picking up a there is to be a public consul- The review’s chairman, therapy for HIV and being clutch of awards within the tation into the relaxation of Professor Brian Gazzard, monitored by HIV and occu- space of a few weeks. restrictions placed on health- said: “Our careful review of pational health specialists.” Philip Friel Advanced care workers with HIV. the evidence suggests that Kevin Lewis, dental Dentistry, which first The consultation, which the current restrictions on director of indemnity opened its doors in launched on ı December healthcare workers with HIV providers Dental Protection, Hyndland in November and will run until 9 March are now out of step with who have long campaigned 2010, was named Scottish 20ı2, comes after a review by evidence about the minimal for a review of the regula- Practice of the Year and the Expert Advisory Group tions, welcomed the news: Most Attractive Practice on AIDS found no reported “The changes to “The introduction of effec- of the Year at the Private transmissions of HIV from the regulations tive antiretroviral therapy Dentistry Awards and then healthcare workers, despite proposed by the in the ı990s, combined with Most Attractive Practice investigations involving the absence of any proven and Best Private Practice ı0,000 patients who were Department of transmission in the dental at the Dentistry Scotland tested for HIV. They also Health are a setting, makes it totally unfair Awards a few weeks later. found that few other coun- logical step to continue to force members The practice was also tries around the world have that restores of the dental team to quit their highly commended in two such tight restrictions as the fairness” chosen profession. categories: Practice of the UK. Kevin Lewis, dental director, “Apart from the personal Year – West, and for Most As all elements of dentistry Dental Protection consequences, these skilled Outstanding Practitioner are currently considered clinicians are removed from for Phil’s dental implant ‘exposure prone’, any dental risk of transmission of infec- the workforce that currently nurse Kasia. professional who contracts tion to patients and policies struggles to provide sufficient The Best Specialist HIV is unable to work directly in most other countries. access to dental care for the Practice award at the with patients. However, the This risk can be reduced growing UK population.” Dentistry Scotland Awards was presented to Beam Orthodontics from Dundee, while Fergus and Glover from Aber- deen was named Best Restored faith Employer at the event held at Gleneagles. Appointments 1988 and later that year she Gongs: Phil Friel moved to The Royal London and wife A referral clinic in Edin- Hospital, where she discov- Stephanie burgh has recruited a new ered her interest in periodon- specialist to its team in the tics. Dr Murray was added to form of restorative dentist Dr the GDC’s specialist list as a Madeleine Murray. restorative dentist in 1998, Dr Madeleine Murray Dr Murray will be joining before returning to Scotland Vermilion, based on St John’s to help set up, and subse- Road in Corstorphine, with a quently teach on, the Masters worked as a specialist in a primary focus on periodontal in Dental Primary Care course China-US joint venture clinic, disease. An alumnus of the in Glasgow Dental School, as well as teaching Dental class of 1984 at Glasgow which she combined with English in the Dental School of Dental School, she has limited specialist private practice Jiaotong University. her practice to periodontics limited to periodontics while Dr Murray comments: “I am for the last 10 years. studying for her MPhil in delighted to return home and She obtained her Fellowship Medical Law and Ethics. become involved, once again, in Dental Surgery from the Dr Murray has just returned in the treatment and support Royal College of Physicians from a five-year stint in of patients with periodontal and Surgeons of Glasgow in Shanghai, China, where she disease.”

16 Scottish Dental magazine News Fight NHS pension reform, says BDA The chair of the British Dental Pensions. Dr Robert Kinloch insists public the pensions that hardworking Association’s Scottish Council NHS staff contribute to. has urged dentists north of sector strikes must be shown support “The BDA has not, at this the border to join with their stage, balloted on potential colleagues in other parts of pension scheme has been Sanderson, Chair of the strike action on this issue. It the UK in voicing opposition overhauled just a few years ago BDA’s Executive Board, said: is important that decision is to government changes to and remains in surplus. Further “Like other public sector not misinterpreted as a lack of NHS pensions. reform is untimely and unjusti- workers, dentists’ pensions are concern about the proposed Dr Robert Kinloch made the fied. The Scottish Government under threat. changes and we encouraged pronouncement ahead of the has indicated that it intends to “The BDA and other unions dentists to join with colleagues day of action on 30 November, follow the pension reform path have fought the Govern- across the public sector and which saw dentists working currently being trodden by its ment hard on these proposals show their support for the day in general practice, primary counterparts at Westminster. and some concessions have of action on 30 November.” salaried care and hospitals in That is disappointing. been won. Nonetheless, the Scotland and across the UK “Dentists in Scotland will proposals on the table still participate in a cross-public share the anger of colleagues represent a significant attack on sector campaign. While BDA south of the border at what members were not on strike, they see as unnecessary and “The NHS pension they were encouraged to show unjustified reform of the NHS support for the public sector pension scheme that hard- scheme has been workers’ strike by displaying working colleagues across overhauled just posters, signing petitions and the health service contribute a few years ago tweeting their opposition using to during their working lives. and remains in the hashtag #30nov. We urge them to make their surplus” Dr Kinloch said: “The NHS feelings known.” Dr Susie Dr Robert Kinloch

First Coatbridge CPD set to become annual

Conference Jennifer Lowe, Head of School for Dental Studies, More than 90 delegates said: “The conference was a attended the first continual fantastic day, as it provided a professional development platform for learning and an (CPD) conference for opportunity for delegates to the entire dental team at meet up with fellow dental Coatbridge College Dental practitioners. School recently. “The speakers provided Speakers from NHS Educa- insightful and enjoyable tion Scotland and Dental presentations. Protection were joined by “Due to the success of those from general practice the event, the dental school to provide an update on are now looking at making several core CPD subjects the CPD conference an required by the GDC. annual event.” Topics included: ‘Mini- During the conference the mising the risk of infection school announced that it was control’ presented by Irene in receipt of provisional GDC Black, ‘Medical Emergencies approval to offer a diploma in and the Dental Team’ by Carol orthodontic therapy, a qualifi- Anne Reid, ‘Dental Radiog- cation that would allow DCPs raphy’ by Iain Henderson and to deliver orthodontic treat- ‘Legal and Ethical Issues and ment to patients under the Complaints’ presented by supervision and prescription Helen Kaney. of a specialist orthodontist.

Scottish Dental magazine 17

Column

From the chairsidewith Alison McKenzie Don’t forget Madeline

or the first time in eight years the British Association of Dental Nurses (BADN) National Conference was to be Fhosted in Scotland. For the majority, this occasion would have been the first opportunity to attend and show support at the inauguration of a new Scottish president and provide an excellent platform to encourage new Scottish members. Also, for the first time, the BADN face outside competition, so the cancellation, due to the economic climate, of its most prominent event must have been a further disappointment to the association. The realisation of the financial commitments with registration has revealed an increase in independent trade unions, CPD providers, and alternative websites for dental nurses, also insurance companies offering support and advice. “Should when you consider the member- touting for our business. So, with the Its biggest achievement was a we take ship package on offer. After some choices on offer, which route should 40-year campaign for registration advantage research, I found that if I were Scottish dental nurses follow? and professional status. It also to purchase individual packages Should we take advantage of the developed indemnity insurance of the new with other providers – i.e. ı0 hours new alternatives available or the specifically for dental nursing based alternatives CPD at £20 (although free CPD is organisation formed for us by British on a sliding scale fee, giving dental available available, this rarely includes the dental nurse Madeline Winter? nurses with additional qualifica- or the or- recommended core units), journal Despite the restrictions of ı940s tions and responsibilities greater ganisation subscription at £82, indemnity insur- wartime Britain, Madeline travelled insurance protection. A recently formed for ance at £84 – it totals £ı86. That’s a the country recruiting members published salary survey highlighted us by British difference of £66! for the new group she founded low wages and a recommended pay Of course, the choice is up to the the BADN with her dentist Philip scale guideline is now available for dental nurse individual who they wish to Grundy. Realising the advantage employers. It fought on our behalf Madeline support, but, when making the deci- of a qualification, they formed the for tax relief on the ARF fee and Winter?” sion, we should all remember that National Examination Board of laundry costs, and a new campaign the BADN is the voice of our profes- Dental Nurses (NEBDN) in ı943 for tax relief for CPD costs is sion, there are 46,793 dental nurses (which became independent from currently under way. Along with the in the UK, including 6,6ı6 from the BADN in ı987). indemnity insurance, a quarterly Scotland, and regardless of whether The BADN is still the only recog- journal, CPD and various discounts you are a member or not, all dental nised professional association for and benefits are included in the nurses stand to benefit from the dental nurses, a non-profit making membership. BADN’s achievements as it group relying on the income of After I qualified I became a campaigns on our behalf, surely it membership fees and voluntary member of the BADN. I paid £ı20 is only right that we should support workers covering nine regions and this year; this is not expensive it while it does so.

Scottish Dental magazine 19 Interview By Bruce Oxley

Northern Exposure

aving made the move So, for the new dean, the contrast Professor Mark from his childhood home between his former life in London and Hector, new dean in Kenya back to one of his new one in the picturesque Tayside the worst winters in living countryside, should be less of a shock, of Dundee Dental memory, the new dean of even if the last two Scottish winters are Hdentistry at Dundee Dental School should anything to go by. School, tells of his have no problem acclimatising to his new After growing up in the West Country, position in Tayside. Prof Hector began his academic life as shock at the snow The son of a colonial police officer, a dental student in London. He enjoyed after emigrating from Professor Mark Hector was born in Nairobi the scientific side of his studies so much and emigrated back to the UK at the age that he took time out of his BDS studies Kenya aged six and of six when Kenya declared independence to do a two-year inter-collated degree in in the winter of ı962/63. The contrast physiology before returning to dentistry how he is adjusting to between the temperatures of East Africa and qualifying in ı98ı. the slower pace of life and a severe British winter were quite He then spent three years dividing his drastic, as Prof Hector remembers vividly. time between Bristol University and Kings in Tayside, compared He said: “The snow started on Boxing Day College London (KCL) while studying and didn’t go away until ı April. Even where for his PhD, completing his thesis on the with the hustle and we lived in the Bristol Channel it was lying reflexes around salivary glands, specifi- three-feet deep in the garden. So it was an cally the way that receptors in the mouth bustle of London incredible amount of snow.” control secretion around teeth. After

20 Scottish Dental magazine finishing his PhD studies he started work A touch in oral medicine and oral pathology at Guy’s Hospital in London, but in order of silver to pursue that any further he would have had to go back and train as a doctor, which In his spare time didn’t interest him at the time. He was then Professor Hector approached about a job at the London is a silversmith. Hospital Medical College (now the Queen He discovered Mary University of London). his passion for Prof Hector takes up the story: “The silver during a then dean Professor Alan Brook offered dental meeting me a post as a lecturer, which is what I was in Copenhagen. after, but in child dental health. At the time He visited the children’s dentistry was not on my radar famous Georg so to speak, but he explained that what he Jensen workshop wanted out of the job was not so much the with his mentor, clinical dentistry but the other skills to Prof Declan help support postgraduate teaching. Anderson, and “So I went along there in early ı987 and decided to try it was absolutely brilliant. I enjoyed the and replicate an clinical work, working with children was ornate butter fantastic. It has been very, very rewarding.” knife that was on He found that the main differences display. So, after between treating adults and children is surreptitiously mainly down to the ability to commu- tracing it’s outline nicate and manage behaviour. He said: and design on a “You have to spend so much more time piece of paper, he preparing children to accept dentistry. It returned home to takes a bit longer and there is a bit more try his hand. patience required to get them to under- Over the stand what we are trying to do and that last 25 years it is not going to be too difficult for them. he has made “So the behaviour management is more a number of difficult, it requires a little more time and retirement gifts patience. With an adult you can negotiate for colleagues much more easily than you would be and even pieces able to with a child, particularly younger of jewellery children.” for friends and Prof Hector explained that in his experi- family. ence in London many children’s first visit to the dentist was to tackle disease and to take out teeth. He said: “So it wasn’t the greatest start and there is a similar pattern up here. “But one of the joys of coming to Dundee “I enjoyed is the huge expertise in managing dental the clini- caries in a very conservative way. Taking a much more biological approach to it as cal work, opposed to a technical, reparative one. It’s working not all about fillings, it is about the other with chil- things that we can do, and the school has a really good reputation for that.” dren was After nearly 25 years at the Queen fantastic. Mary, where he moved up the ladder from It has been lecturer, gaining his readership in 200ı and then becoming a professor of oral health very, very of children in 2002, he was approached to rewarding” take on the role of dean at Dundee. Having Professor Mark Hector worked at Dundee as an external examiner previously he was aware of the school and its well-respected teaching and research reputation, as well as a few familiar faces who he had crossed paths with at Bristol and at KCL.

Continued »

Scottish Dental magazine 21 Interview

dentists will begin to take on the role of team leader,” he explained, “delegating more of the work down to other members of the team. It will make for a more efficient way of working but it is going to require a big sea change in attitudes.” But, while their jobs may be changing in terms of scope and structure, Prof Hector is optimistic for the futures of the gradu- ates the university is producing. He said: “I think, at the moment, job prospects are very good and the vast majority will get work. Last year every single graduate got a job, and although that is not guaranteed now, the likelihood is that they will all get jobs.” When asked what the main differences are between students back in his univer- sity days and today, he replied that the people are generally the same, although the academic standards are far higher now. “When I started off I got two Cs and a D at A-Level,” he said. “Whereas the expectation now at A-Level is three As, or Highers five As. “I actually got in on below offer, I was offered three Cs and got in with two Cs and a D. But these days very few students get offered a place if they don’t get all As.” However, while in the past dental students were expected to do as many fillings, extractions and make as many dentures as possible, nowadays the emphasis is on gaining competency. Prof Hector added: “It’s very much a competency-led approach and it is better in many ways because some people learn more quickly than others, some people are Continued » “I think what Bill has gifted with their hands and find the opera- tive work really easy but may struggle a bit But, on top of the many draws that achieved is a very stable with the academic side, while there will be Dundee Dental School held for Prof and very well regarded some who are the other way around. Hector, another driver was his desire to school by other UK “So this way everyone moves through get out of London. the course at a slightly different rate. They He said: “Not being a Londoner, I’ve dental schools” all have to pitch up at the same exams never really settled there, so the idea of Professor Mark Hector but if someone is really struggling with moving out of London was an appealing something they can take a bit more time one, and it has worked well for the family endodontics and applied dental mate- on it, and that happens rather more than as well.” rials. Prof Hector said: “I think what Bill it used to.” His two eldest sons are at university in has achieved is a very stable and very And, despite his new position, Prof Hull and Stirling, while his youngest is still well regarded school by other UK dental Hector still remains passionate about in further education and will move up to schools. Dundee has always been regarded teaching and hopes to carry on lecturing Tayside in the summer with Prof Hector’s as a very well-run school producing excel- and working with students when every- wife when they have found a house in the lent students. thing has settled down. He said: “Teaching area. And, as well as enjoying the easy “It also has quite a focused research is my fundamental reason for staying in a commute from his rented apartment at the agenda and it has a very good reputation. dental school. Whether it is lecturing or City Quays, which is in stark contrast to the Some schools you don’t hear very much working on the clinics, absolutely, that’s busy traffic and crowded public transport about, but Dundee is very much on the map what I want to do, that’s what I enjoy doing. of the UK’s biggest city, he is relishing the and that is very good.” “At the end of the day, it is all about the opportunity to carry on the good work of Among his main aims at the school, students. It is why we are here, it is why the his predecessor. Prof Hector is keen to expand the range of hospital is here. Professor William Saunders enjoyed a taught masters programmes offered and he “The dental hospital and all the NHS decade as dean of dentistry at Dundee, is currently undertaking a redesign of the staff who work within it wouldn’t be here having been appointed in 2000. After curriculum to try and reflect the growing if it wasn’t for the students. They essen- stepping down he has reverted back to emphasis on the dental team and where tially pay our salaries – so we have to work his research interests, which include each member fits into the team. “The for them.”

22 Scottish Dental magazine

Quality Strategy

As the National Clinical Lead for Quality, Jason Leitch is leading the drive to improve the standard of healthcare in Scotland. Here, he tells Tim Power why the dental industry needs to be proactive in achieving this aim

s the Scottish Government’s Quality Strategy starts to impact on the healthcare sector, Athe dental profession has the chance to take a lead in developing a quality strategy of its own. That’s the opinion of Jason Leitch, dentist and oral surgeon at Glasgow Dental School who is now on secondment as National Clinical Lead for Quality. Jason is part of the team spear- heading the implementation of the Quality Strategy which was launched in May 20ı0. This aims to deliver the highest quality of healthcare services to people in Scotland – and, through this, be recognised as among the best healthcare providers in the world. However, while his focus is on medical care now, he foresees the momentum of the quality agenda encompassing other healthcare sectors, such as dentistry too. That’s why he believes it’s the Quality ideal time for the dental profes- sion to take the initiative and take ownership for the development of its own standards in line with the Quality Strategy. Jason explained: “The Quality Strategy is intended to affect all assured aspects of NHSScotland, including the dental profession, so now is the perfect opportunity for the profession to take a proactive stance on the issue. Why not take the initia- tive to develop your own quality

24 Scottish Dental magazine Quality Strategy

Jason continues to use his dental surgery skills by volunteering for the Indian Rural Evangelical Fellowship, which supports young people

systems rather than have them nationally renowned and highly He was successful and in 2005, he foisted on you? influential Institute for Healthcare charity left Scotland with his wife for a year “In conversations with the Chief Improvement (IHI) in the US that work studying in Boston at the prestigious Dental Officer and her Deputy, I was offering Quality Improvement Harvard School of Public Health and have found that they are keen on Fellowships – and after reading working with the IHI. having this conversation too. It’s all more, he decided that this was a road Jason hasn’t The IHI has an international about defining what quality looks he wanted to travel. totally turned reputation for its focus on quality his back on like in the dental arena: is it about Before this happened, Jason was dentistry – he systems and Jason, like five other making fillings last longer and better enjoying a successful career as an still uses his Fellows from that year, came under dental and customer care? Are there other oral surgeon at Glasgow Dental oral surgery the thrall of its inspirational leader aspects that can be looked at, and School. He qualified as a graduate skills every few Dr Donald Berwick. then how do you measure quality in in ı99ı and, as dental practice “did years to help a Jason explained the philosophy: community in a dental context?” not float his boat”, he decided on a south-east India “In Dr Berwick’s world, everyone In fact, it’s already on Scotland’s career in surgery. He also completed which runs has two jobs: one that you do to Chief Dental Officer’s radar, as a doctorate on the care of dental orphanages, the best of your technical ability; schools and Margie Taylor told Scottish Dental patients suffering from anxiety other educa- and a second that means striving to tional work for find a better way of doing it – and about 2,000 children and that means embracing a culture of “Now is the perfect time for young people. continuous improvement. “It was a fascinating year and it the dental profession to take As trustee for the UK wing of opened my eyes to quality systems a proactive stance on quality” the Indian Rural in healthcare. In addition to stud- Evangelical ying, we also got to travel around Jason Leitch, National Clinical Lead for Quality Fellowship, he helps organise the US to see public healthcare a team of best practice in action, such as fellow health professionals the Intermountain Healthcare in magazine earlier this year: “The – specifically in the delivery of to visit the Salt Lake City, an association of 23 Quality Strategy has helped focus sedative drugs to patients under- remote state hospitals and medical services, and of Andhra our attention on what makes a going dental treatment. Pradesh to the Cincinnati Children’s Hospital ‘quality dental practice’ and we Jason said: “It was unique at provide Medical Center. are going to be engaging with the the time and we invented a new much-needed “We also compared healthcare healthcare. profession in 20ıı to ensure they drug delivery device that could be systems and I was pleased to see that get an opportunity to help define self-administered to the patient’s Since 2006, Scotland compared pretty well with he’s raised this clearly.” needs – it was a leap forward in nearly £30,000 other countries, particularly in the So how did an Honorary treating people with a phobia for the charity universal provision of healthcare, Consultant in Oral Surgery become about dentists!” and ran the but there were certainly pockets of Glasgow half an acolyte for the quality mantra? However, his work in this field marathon in excellence within the US and other His epiphany came about through was put on hold when he decided to September. countries such as Sweden that we a bit of serendipitous surfing on apply for the IHI Fellowship. could learn from. www.just- the web while he was looking for “I did not know it at the time, but giving.com/ “At the end of the year, I was PhD funding for the Dental School. this was a decision that would turn user/4662333 His online research led to the inter- my career upside down,” he said. Continued »

Scottish Dental magazine 25

Quality Strategy

The Institute for Healthcare Improvement

The Institute for Healthcare Improvement (IHI) was co-estab- lished by Dr Donald Berwick in 1989 in Cambridge, Massachu- setts, as a centre to promote safe and effective health care. Originally a paediatrician in Harvard, Dr Berwick developed an interest in quality systems, and after investigating quality control measures in other industries such as aeronautics and manu- facturing, he considered their application in healthcare settings Continued » improvements in quality can bring His vision for healthcare is: savings in costs. care that is safe, effective, really looking forward to putting my The key to a successful patient-centred, timely, efficient, new skills and training to use back programme is developing a quality and equitable. in Scotland.” framework that identifies, measures Today, IHI is a highly influential, Jason returned to the Glasgow and seeks to improve every aspect independent, not-for-profit organ- Dental School in 2006, but it wasn’t of healthcare provision from the isation focused on identifying and long before he got the chance to put technical expertise of practitioners, testing new models of healthcare his new knowledge to good use in the patient experience and right in partnership with both patients 2008 when he helped lead the Scot- through to staff development and and healthcare professionals; tish Patient Safety Programme. The job satisfaction. and ensuring the broadest main aim was to reduce hospital So far, dentists have not been possible adoption of best prac- mortality by ı5 per cent in five involved in this quality exercise, tices and effective innovations years… and three-and-a-half years but as a former practitioner, Jason around the world. later, hospital standard mortality believes that the dental profession In April 2010, President Obama rates are down seven per cent. would find much to gain by taking appointed Dr Berwick as Adminis- His next challenge came when a proactive role in developing their trator of the Centres for Medi- he was appointed National Clinical own quality systems. care and Medicaid to help push Lead for Quality following the “What we are doing in primary through his healthcare reforms. publication of the Scottish Govern- and acute healthcare provision ment’s Quality Strategy in May 20ı0. can easily be replicated in dentist This aims to put Scotland among practices. In fact, I think dental the best in the world in terms of practices have much to teach us, delivering high-quality healthcare particularly in the area of patient services by putting people at the experience. Dentists are small heart of the services, building on businesses who are very aware the values of the people working in of the need for good customer and with healthcare services, and relationships and, like GPs, are very making measurable improvements good at developing this trust with in the quality of care. whole families. Jason explained his involvement: “I think the challenge for imple- “My role is to help implement the menting quality systems in dentistry Quality Strategy across Scotland will be in assessing the technical to remove geographical variations quality of care, how we measure this in effective delivery, while at the and then improve on it in the context same time looking at costs and of providing value to money. If this productivity.” can be done, there will be real value He said the quality agenda will for dentists to show how continue to play a big part in accountable they are to shaping healthcare in the future public funding. The time and will expand its remit into other is ripe for the dental profession areas of healthcare provision and to start a conversation about what eventually link into the social care quality means to them so they can sector – driven by the ethos that drive their own quality agenda.”

Scottish Dental magazine 27 Kilimanjaro climb

When Alasdair Reid’s 24-year-old daughter was diagnosed with cancer, he knew he had to hit new heights in order to raise money for research into the disease, writes Bruce Oxley Rising to the challenge

lasdair Reid had for the appeal in recognition just one thought of the outstanding care she “That last day’s walk I in his mind as received from the dedicated his legs started staff there. So far, Morvern and was just thinking about to grow heavier her determined band of fund- Aand heavier on the final push raising friends and family have Morvern and the reasons to the summit of the moun- managed to raise just short of we were doing this” tain – his 24-year-old daughter £25,000 and donations are still Alasdair Reid Morvern. being gratefully accepted at As he ploughed onward and Justgiving.com/morvern4the- upward, the Bearsden GDP beatson party into a fundraising event started on the marathon course, took inspiration from his eldest She started off with a car boot by asking for donations to the without breaking stride. daughter, who was diagnosed sale in July that raised £ı56 and appeal instead of presents. She With all these events being with ovarian cancer in March, then 20 of her friends agreed to turned up at the Reid’s door planned or under way, Alas- and for whose chosen charity run the Paisley ı0k in August, with £850 in a poly bag. dair knew he would need to he was scaling the heights in with all sponsorship going to Then, one of Alasdair’s do something special to get aid of. her online Just Giving page. friends, Kenny Fairlie, managed people, especially his patients At the end of September, In early September, Morvern’s to raise £ı,000 in sponsorship in the practice, to dig deep and Alasdair, his friend and younger sister Susie and her by completing the Glasgow donate money to the cause. fellow dentist Stuart Craig sixth year classmates at Glen- ı0k, immediately followed by And so the idea of walking up from Auchinleck, and godson nifer High School in Paisley the half marathon. He simply Mount Kilimanjaro, the highest Graeme Reid from Johannes- held a bake sale and managed crossed the finish line after the point in Africa, came burg, took on the challenge to raise an amazing £5ı0. ı0k, trotted over the road and into being. of climbing ı9,000 feet to the Morvern’s mum Pamela, along summit of Mount Kilimanjaro with a group of friends, then in Tanzania to help raise money took part in a sponsored walk of for the Beatson Pebble Appeal. the 90 miles of the Great Glen The appeal is a £ı0 million Way from Inverness to Fort campaign to raise funds to William, which they completed build the Beatson Transla- in mid-October. tional Research Centre, the On top of all these planned final element in the crea- events, there were also a tion of the Glasgow Centre number of spontaneous for Cancer Research. After moments of generosity receiving chemotherapy at that surprised Morvern the Beatson West of Scotland and her family. One Pack mentality: Cancer Centre earlier this year, of her mum’s work Alasdair Reid (right) Morvern decided to try to raise colleagues turned and Stuart Craig as much money as she could her 60th birthday

28 Scottish Dental magazine Kilimanjaro climb

New horizons: a spectacular sunrise

Band of brothers: Graeme, Alasdair and Stuart

Peak practice: On the trail: group begin the top of Mount their long ascent Kilimanjaro

Alasdair convinced fellow You look around and everyone Just before they reached dentist and friend of the family Morvern is the same. Everyone is in their the summit, Alasdair decided Stuart to join him and, with own wee world and that last to leave a keepsake on the neither men having much hour just stretches on and on mountainside, in the form of an experience of hill climbing, let explained that the five days forever.” impromptu time capsule: “We alone mountain climbing, they prior to reaching the summit And Alasdair revealed that put a rock to one side and put a decided to get a bit of training were not particularly difficult, his daughter was always high in picture of Morvern with a wee in. In the weeks and months with the only surprise being his thoughts as he got closer to message on the back, a bit of leading up to the September the weather. He said: “It rained the top. He said: “That last day’s Scottish quartz as well as a few trip out to East Africa, Alasdair every single day. It was either walk I was just thinking about other bits and pieces and rolled and Stuart started a campaign rain or snow. On the third day Morvern and the reasons we the rock back over.” of hill walking in an attempt to it was like walking through were doing this. Stuart said the Just like her father and his get in shape for the challenge Glencoe in December. There same thing, there was a reason walking buddies as they neared that lay ahead. was two or three inches of we were there and we just had the summit, the family are However, despite their prep- snow lying on the ground, just to get to the top. But that was hoping there is light at the end aration, the actual climb itself like home! what kept us going. of the tunnel for Morvern and tested both men to the limit. “But none of the climbs in the “Your legs are saying you her treatment. Alasdair explained: “It was a first five days were that difficult. don’t have to do this, just turn She finished her last round of great experience. But that final Just long, slow, steady climbs.” around and go home. But we chemotherapy the week before day climb was the hardest thing However, on the sixth day did have to do it. For Morvern.” Alasdair left for Africa and I have ever done in my life. I had Alasdair, Stuart and Graeme As they went on, the sounds the latest round of scans have maybe underestimated it. We along with the rest of their of other groups reaching the been largely positive, although had done loads of preparation, group were woken at ııpm, fed top started to filter down. the family are determined to we had climbed a Scottish hill and set on their way to the peak, “Up ahead you can hear folk stay realistic and not get their every weekend for about three with the aim to get to the top cheering when they get to the hopes up. months before we went, so we and then start back down again top,” explained Alasdair. “So Alasdair explained: “She were both fit enough. in one day. you start to hear that as you recently went in for an MRI “It was just the height. The But, as they got closer and get closer. But you just say to scan and we will wait two base camp was at ı5,000 feet closer to the top, each climber yourself: ‘Just keep going, don’t weeks for the results. If that and it was that climb from to a man started to struggle look up, don’t look up’. comes back okay, then that’s the ı5,000 up to ı9,000 through the with the lack of oxygen – or “And then, at about 6am the end of her treatment and she night that was really tough.” more precisely the lack of sun came up over the horizon will be reviewed three-monthly The final day trek, which oxygen pressure. Alasdair said: just as we were approaching and scanned six-monthly for started at ııpm and saw the “The hardest thing is just not the summit and it was fabulous. the next three years.” men reach the summit at just having the puff. As we got near There is another volcano that after dawn, was the culmina- the top I found I was just trying sits adjacent to Kilimanjaro and ® tion of a six-day expedition up my hardest to get one foot to the sun just came up over the To donate, please visit the mountain and was followed go in front of the other. It was peak of that and it was just spec- www.justgiving.com/ by a two-day descent. Alasdair like an old man shuffling along. tacular, absolutely fantastic.” morvern4thebeatson

Scottish Dental magazine 29

Business development Becoming the perfect salesperson Changing your mindset and giving customers what they need can help boost business, says Ashley Latter

re you in sales? I recently asked this question at a presentation I was delivering Ato more than 300 people from the dental profession: “How many people here are in sales?” Only a few hands went up, maybe less than 20 per cent. So why is it only a few hands went up? And currently, how do you feel about selling? Well, maybe you don’t see yourself as a salesperson; after all you spent over seven years learning about dentistry, not communication, or busi- ness skills. However, every day you have to sell your ideas, whether it be to the patients/clients or to other Hard sell: staff members. If you are not Ashley Latter convincing and you are not speaking the language of the visits your practice or not, more business and giving the Many studies have been person who you are selling by the way they answer your patient what they want. After done about what makes a to, they probably will not buy telephone. all, if you are a private dentist person successful. In fact, into your ideas. This article is not going it could be that ı00 per cent here is a simple exercise to Everyone in your practice is to give you a ı80 per degree of your income will derive do. Think about a person you selling an idea every day. Your change in your way of from your ability to influ- know who is successful in reception team are the most thinking. However, only a ence patients. In the current dentistry and develop a list important people in your small change in your thinking economic climate these skills of all the skills, attitudes and team. They can often make can enable you to become may be paramount if your or break whether someone more successful in generating practice is going to survive. Continued »

Scottish Dental magazine 31 Business development

Continued » interested in the person and “It is hardly surprising that, make them feel like the most attributes that person has. important person in the Once you have done this, list when I ask the question, world. Put them at ease. them into ‘Skills’, ‘Attitudes’ 80 per cent never consider 3. Ask questions – after and ‘Product Knowledge’. building rapport you can I bet on the list there are themselves in sales” carry on asking questions, but many skills such as good this time about their clinical communication and listening So why is there sometimes with the assumption that health. What they like or skills, and the ability to build negative thinking with sales is about pushing some- don’t like about their appear- empathy with the patient. On regard to the word sales? thing on a customer when ance and what they would the attitudes side, are there Well, maybe our national they don’t really want it. It is like to change. Find out their things like positivity and media doesn’t help. It seems hardly surprising that, when I vision. enthusiasm? Have they also that whenever we see some- ask the question, 80 per cent 4. Provide a solution. Only got product knowledge? thing in the news about of the room never consider when you fully understand On occasions, when I have selling, often it is about themselves in sales. the patient’s goals do you a discussion with a dentist, unscrupulous tactics from provide a solution. Use the technical skills are often salespeople supposedly What is the benefits and do not talk too left out. Although important conning their vulnerable definition of sales? technical. Use evidence to and vital, technical skills for customers. I often think this A dictionary definition will back up what you are saying. doing the job only usually is unfair, as it is only a very tell you that it is to exchange 5. Test for commitment – account for about ı0-ı5 per small percentage that might goods and services for money once you have provided a cent of a person’s success and, give the many millions of or kind; to convince of value. solution, ask the patient if without good communica- good sales people out there a There is nothing in the they are happy and what their tion skills, and the ability to bad name. If you think about definition that states that it reaction is. build empathy and patient it, without the ability to sell, is about pushing people or 6. Ask for commitment – if commitment, you might the whole country would forcing people into decisions. the patient is very keen to never be able to put into come to a halt and nothing Let us look at another key move forward, then you can practice your technical would ever get made. word here – the word value. ask for commitment. ability. It may also be associated I think value is about finding So, think about how you out what true value is to the can change your mindset. other person in their context, Look inside yourself and ask or in other words, their situa- what is stopping you. If you tion. So what about changing think you provide significant your mindset from one of value to patients, then why selling, or pushing to: not give more patients the • finding out what the patient opportunity to have more thinks is value (wants and of the same services. You needs) are doing them and you an • showing how you can injustice if you don’t. satisfy the want/need Pay attention to what you • when he believes you can, are saying to yourself, such that person will probably buy. as can’t or won’t, and change It really isn’t about selling to can and will. Change your it is about being the provider mindset to the fact that: “I of significant value. To do this provide significant value effectively, you have to follow everyday to patients” and just a few simple common read some of the letters you sense steps. receive from happy patients. These include: Your team’s jobs exist ı. Preparing for your appoint- because of your ability to ment – here you can check influence people and, if you the previous notes from your think about it, without these patient’s records, have a team skills, the UK economy would meeting for the day and ensure come to a halt. that you are fully prepared Sales is something to be mentally and that you are posi- proud of. Without your ability tive about your day. You are to communicate well and serving the public, be excited listen emphatically, patients and positive. will not get what they need 2. Build rapport – spend just a and, in most cases, want and few minutes building rapport no one then benefits. It is and making the patient feel something to be proud of. important. Talk about work, When done right, both parties then, become genuinely benefit.

32 Scottish Dental magazine

Record keeping

Left: Figure 1, Extract from patient data sheet

Right, Figure 2, Audit results summary sheet (poor records falling below acceptable standards are highlighted in red). This results table shows with 87 per cent compliance that a target level would have been met for round one but not round two Keeping tabs on patient notes ime and time again we This incompleteness of clinical are told of the impor- Record keeping for dental records is very much supported tance of record keeping practitioners: a comprehensive in the evidence we have available and perhaps it is right from published audits. In 200ı, an firstly to consider why audit. By Dr Terry Simpson audit looking at the records from Twe need good records. The British 47 general dental practitioners Dental Association (BDA) sees have easy access to their record.” entering the quality assurance record keeping as fulfilling the In discussions with dentists programme of a private capitation following purposes: over the years, it is clear that many scheme (BUPA) in England and • patient safety will admit to deficiencies in the Wales found various deficienciesı. • monitoring past when recording some of the These records were examined • accounts information that we now accept by an independent assessor and • probity enquiries should help comprise a good clinical measured against seven different • evaluation of treatment. record. Very often time is cited as domains for which a standard was However, the General Dental the reason; sometimes dentists only identified (effectively one domain Council in its Standards for dental see positive findings as requiring split into two separate further areas professionals is more vague, stating any detail. Whatever the reason, it of interest giving eight domains). only: “Make and keep accurate and is clear that it is our responsibility The domains were medical history, complete patient records, including to maintain good contemporaneous examination of soft tissues, full tooth a medical history, at the time you and complete notes from clinical treat them. Make sure that patients encounters. Continued »

Scottish Dental magazine 35 Record keeping

Continued » data gathering tool were approved About References by LCQD for distribution to all the charting, periodontal screening, dentists in Lothian. The remit was author 1. Morgan RG. Quality evaluation of at-risk periodontally and pocket to produce an audit that: clinical records of a group of general depth chart (the separated domain), • was comprehensive covering all dental practitioners entering a quality diagnosis and treatment planning. aspects of record keeping Dr Terry assurance programme. Br Dent J. Simpson is a 2001;191:436-41 The results showed dentists • set out the data sheet as a set of general dental 2. Cole A, McMichael A. Audit of only to have achieved more than simple questions practitioner Dental Practice Record-Keeping: A and honorary PCT-Coordinated: Clinical Audit by 50 per cent of target frequency of • allowed the data gatherer to research Worcestershire Dentists. Primary recording in one domain – full tooth answer questions ‘yes’, ‘no’ or ‘not fellow at the Dental Care. 2009; 16:85-93 charting (70 per cent). Completed applicable’ University of 3. MacPherson D. A Job Worth Doing. Edinburgh. Summons. Summer 2010;18-19 medical histories were only avail- • resulted in one overall figure for Terry would like 4. MacPherson D. Making a SEA able in 45 per cent of clinical records compliance. to acknowledge Change. Summons. Autumn and, worst of all, nearly 80 per cent Having looked at several audits the contribution 2010;18-19 of the Clinical of patients had no periodontal and the data gathering tools that Governance screening at all. accompanied them, several points Support Team at NHS Lothian Another audit from 2009 showed became apparent. Record keeping and, in partic- of each column which are then used an improving picture but still with audits had concentrated on certain ular, Denise to calculate the total compliance. some deficiencies2. However, unlike domains such as periodontal treat- Needham in Totals for each patient record constructing the 200ı audit, the method employed ment and medical histories. While and promoting audited can then easily be trans- in this study was self-assessment, using a domain-focused audit can be this audit. He ferred to a results summary sheet which is largely dependent on very useful, it would appear to miss would also like (Fig 2). By completing the results to acknowl- how well-calibrated and rigorous the important first step of analysing edge NCAAG electronically, calculation can be the assessors were in applying all areas of record keeping which (National made for each data sheet based on Clinical Audit the criteria. If, indeed, the quality might be overlooked e.g. quality of Group in E & W) a compliance figure (Yes/Yes + No of clinical records is improving, referral letters, details of surgical which piloted x ı00 per cent). When all 25 patient we have the defence societies procedures, etc. This approach can the initial records are complete, an overall spreadsheet and professional bodies such as also be messy as there are different design. compliance figure for all patients the Faculty of General Dental results for different domains. can be attained. Practitioners (FGDP) to thank for Having a single compliance figure All audits suffer to some extent continually preaching the impor- overcomes some of these problems. from not weighting the data by tance and assisting us in achieving In developing the Lothian audit importance. For example, would a better standard. data gathering tool it was decided having a dog-eared written record to leave it simple with each ‘yes’, ‘no’ card equate in importance to not The Lothian Record or ‘not applicable’ answers carrying having a current medical history – Keeping Audit the same weight and total compli- probably not? Other articles have presented a ance expressed as a percentage. It However, further refinements of thoughtful case for incorporating should be stressed at this juncture the audit in future might allow clinical audit (and significant event that before embarking on any audit weighting to be applied to the analysis [SEA]) into everyday prac- an acceptable standard needs to be results and this would be a relatively tice3,4. These sentiments have been set by those involved in the project. simple tweak to incorporate into the similarly recognised by the Quality This is up to the individual prac- data collection tool. It would be Improvement Team for Dentistry titioner to decide, but in the pilot possible with this audit to adapt it in Lothian (Lothian Committee for studies the target for round one was further and weight each answer Quality in Dentistry – LCQD). set at 80 per cent and round two at according to a system of desirable or In April 2009, the committee 90 per cent. essential outcomes. We hope this commissioned an audit on clinical An example of the data gathered audit will continue to evolve and documentation standards that could is shown in figure one. This shows assist many dental practitioners for be used by all dental professionals. the information split into several years to come! This audit was to use the planned questions which require a ‘yes’, ‘no’ updated standards issued by the or ‘not applicable’ answer. Changing ® FGDP as the basis for the audit. any of the answers will automati- This article first appeared in the The following year the protocol and cally change the totals at the bottom Autumn 2011 issue of Summons

Obtaining a copy

Copies of the audit comprising instructions, protocol, data collection sheets (one per patient) and results summary sheets can be obtained, in electronic version only, by contacting Denise Needham at NHS Lothian ([email protected]). Printed sheets can be made from these if the data gatherer prefers but the data collections sheets fit best on A3 sheets or alternatively several landscape A4 sheets.

36 Scottish Dental magazine

Who’s who

Scotland has long punched above its weight in the dental field, producing and attracting some of the finest clinicians in the world. Here we celebrate the wealth of talent at our disposal

Who’s who in Scottish dentistry

elcome to the first Dr Philip Friel, BDS, BSc, MFDS Scottish Dr Friel is clinical director at Philip Friel Advanced Dentistry Dental in Glasgow’s West End, heading an ı8-strong team. magazine His clinic was recently named ‘Best Private Practice’ and WWho’s Who in Scottish ‘Most Attractive Practice’ in the prestigious Dentistry Scot- Dentistry. land Awards and also named ‘Practice of the Year – Scotland’ We are extremely fortunate in the Private Dentistry Awards 20ıı. to have such a wealth of talent, Glasgow University graduate Dr Friel concentrates on experience and innovation in restorative and cosmetic dentistry with particular focus on our dental community and this dental implants. As a referral clinic, Dr Friel and his team feature aims to highlight some work with and mentor a number of Scottish dentists. of the key players practising Named in Dentistry Magazine’s 20ı0 list of the UK’s Top 50 Most Influential Dentists, north of the border. Dr Friel was said to be “regarded as one of Scotland’s finest implants surgeons”. Many of these clinicians have He is currently President-Elect of the Association of Dental Implantology. reputations that are recognised around the world, holding leading positions in various associations, professional Arshad Ali, BDS, FDSRCS, FDSRCPS, DRD, MRD RCS bodies and committees. And, while not a definitive Arshad is clinical director of the Scottish Centre of Excellence for list by any means, we still have Dentistry (SCED). some of the finest minds and He qualified with commendation at the University of Glasgow most recognisable faces in the in ı978 and carried out ten years of postgraduate training in Scottish dental community on Glasgow, Cardiff, London and Sweden. He was the first NHS these pages. consultant in restorative dentistry in Wales and, until recently, Given the size of the dental was consultant in restorative dentistry in Glasgow Dental Hospital world in Scotland, chances are and School. you will know, have worked Arshad gives lectures and courses in crowns, bridges and with, or rubbed shoulders implants. He was also an examiner in Dental Surgery for The Royal College of Physicians with many of them and we’re and Surgeons of Glasgow. He has served on the Specialist Advisory Committee at the Royal sure you’ll agree that this is an College of Surgeons and has been a Council member of the Royal College of Physicians and impressive line-up. Surgeons of Glasgow.

38 Scottish Dental magazine Who’s who

Jacqueline Fergus, Stephen Jacobs, BDS BDS, MSc ImpDent Stephen qualified from The University of Birmingham in ı985 and entered general practice in London. In ı990 he moved with his future wife, Lucy, to Glasgow and Jacqueline has joined Lewis Geneen’s prestigious practice, where been in partner- he stayed, becoming a partner, until 2006. This phase ship at Fergus & was vital to him in developing the skills that are now Glover for ı5 years, growing the prac- required in today’s competitive market-place with tice to its current award-winning status increasingly demanding patients. from scratch; winning ‘Best Employer’ Stephen first started with implant dentistry in ı99ı. at the 2009 Private Dentistry Awards It became an increasingly bigger part of his day-to-day and 20ıı Dentistry Scotland Awards. practice and led him to set up Dental fx, the referral centre for implant and recon- Having served on the Council of the structive dentistry, where all treatments in the field of implantology are carried IAAFA for many years, facial aesthetics out, including the treatment of peri-implantitis. Two years ago saw the acquisition in dentistry is of special interest to of a cone beam CT scanner, and to date he has placed over 4,200 implants and Jacqueline, along with implantology, carried out in excess of 800 sinus grafts. and she was awarded with the prize He lectures throughout Europe on various aspects of implant dentistry, has for ‘Best Facial Aesthetic Smile’ at the published many articles and is on the editorial board of three journals. Smile Awards. Stephen is the Immediate Past President of The Association of Dental Jacqueline has lectured internation- Implantology (UK) and is actively involved with the Association of Osseointe- ally on the subject of dental implants gration (USA). and is currently a GIFT Tutor as He runs a variety of courses, ranging from simple introductory implant courses part of the Warwick University MSc to a comprehensive one-year modular course on implants, this latter one with programme in implant dentistry. Clive Schmulian. Jacqueline is also one of the UK He is currently researching a number of areas including insertion torques, clinical mentors for the Avinent peri-implantitis and sinus graft biomaterials. Implant System. Dr Kevin A. Lochhead, BDS, MFGDP Dr Rita Ahmad, BDS Dr Lochhead qualified from Kings Dr Ahmad is the owner of the College London in ı987. His special Peppermint Studios group of dental interests lie in complex reconstruc- practices in Glasgow. tion, dental implants and cosmetic The University of Glasgow graduate dentistry. In 2002, he was recognised (ı999) took over Bath Street Dental by the GDC as a specialist in prosthodontics. practice in 2003, a practice that has been Dr Lochhead is clinical director of Edinburgh Dental in operation for more than ı00 years. Since that first acqui- Specialists, a referral only, multidisciplinary practice sition she has gone on to purchase three other practices in comprising ı2 GDC or GMC-recognised specialists and the Glasgow area: Maryhill Dental Practice, Eglinton Toll a support team of over thirty staff. The practice also Dental Practice and Chapelhall Dental Practice. benefits from its own onsite laboratory, with six tech- In November, Dr Ahmad was a guest of the Prime nicians including a master ceramist, carrying out all Minister David Cameron for a celebratory Eid lunch at aspects of prosthetic and crown and bridgework. Downing Street and she is a regular spokesperson on the At various times in the past ı8 years, Dr Lochhead has BBC Asian Network on dental health and diabetes issues. represented the Association of Dental Implantology in The 20ı0 ‘Entrepreneur of the Year’ at the Scottish Asian Scotland, been diploma tutor for the east of Scotland Business Awards is also a member of the Glasgow Local Faculty of General Dental Practitioners and clinical Dental Committee and has recently been appointed to the tutor on the MSc in Primary Dental Care at Glasgow Scottish committee for Oxfam. Dental Hospital.

Mrs Gillian surgery unit. In 2003, she surgery under local anaesthetic Ainsworth, became one of the first two or sedation and teaching both BDS, FDS RCPS, MSc, surgeons to complete the new undergraduate dental students MSurgDent specialist training programme and newly qualified NHS staff. in surgical dentistry, also Gillian is a recognised oral After graduation from the obtaining a MSc research surgery specialist, a fellow of University of Sheffield in ı996, degree. the Royal College of Physicians Gillian worked in general prac- For the last eight years, and Surgeons of Glasgow and a tice, a district general hospital Gillian has worked at Glasgow member of the Royal College of and a busy city maxillo-facial Dental Hospital providing oral Surgeons of Edinburgh.

Scottish Dental magazine 39 Who’s who

Scot Muir, the University of Dr Judith Lello, BDS, MFGDP, RCS, MSc BDS , MDS Central Lancashire (UcLan) and for the Since graduating Since graduating from the University of online educational from Sheffield Glasgow in the mid-nineties, Scot has certificate course University in spent his time developing a career in provided through ı978, Judith has implantology and smile design. Smiletube. undertaken He has graduated from the Royal College Scot practices at extensive post- of Surgeons in England and completed Loveyoursmile Dental Care practice in graduate training. his masters degree in implantology at Prestwick and Hamilton, and at White- She spent three years at Zurich Warwick University. cross Dental Care in Edinburgh city centre. Dental Institute, undertaking He currently provides the clinical His practice centres around the provi- teaching, research and patient training in implant dentistry, from sion of dental implantology at all levels management: following which, she certificate to full masters level for including bone grafting and sinus lifts. received a masters degree from Sheffield University. She spent one year in Johan- Alastair MacDonald, BDS nesberg at the University of Witwatersand, before returning Alastair qualified from Glasgow University in June ı985. to the UK in ı988 to practice in After five years in general dental practice in Glasgow, he Manchester. Since moving to Edin- decided to specialise in endodontics. After a fact-finding burgh in ı990, she has maintained mission to the USA, where endodontics has been an ADA- a special interest in advanced accredited speciality since ı963, he entered a two-year restorative work and a commit- programme in ı990 at Indiana University and qualified ment to postgraduate and research with a certificate and masters degree in endodontics activities. She is a GDC certified in ı992. specialist in prosthodontics and On returning to Scotland, Alastair established the first specialist endodontic she continues to limit her practice referral practice. He is the only American-trained endodontist in Scotland. to complete reconstruction, dental Referrals are taken from general and specialist dentists from all over Scotland implants and aesthetic dentistry. and beyond for orthograde and surgical endodontics.

Ruaridh Dr David Clive Offord, Schmulian, McKelvey BDS MFDS RCPS DGDP, MGDS, BDS, FDSRCS, Dip.Con.Sed. FFGDP, RCS M.Orth

Dr Offord gradu- Clive graduated Ruaridh graduated in ı995 from the ated from the University of Edinburgh from the University of Glasgow in ı993 University of Glasgow and gained in ı994. and is a partner at Clyde Dental Prac- his fellowship in dental surgery with He spent six years in general dental prac- tice, Ivy Cottage Dental Practice and the Royal College of Surgeons in tice before moving to hospital-based Commonwealth Dental Practice. ı998. He then spent three years in oral and maxillofacial surgery positions. He also supervises undergraduates in specialist orthodontic training on In 2007, he was recognised by the GDC the restorative department at Glasgow the prestigious Bristol post-graduate as a specialist in oral surgery. Dental School, lecturing on CBCT in course, completing the orthodontic His extensive experience in implant dental practice. exam in Edinburgh in 2002. surgery has led to him being Scotland’s His practices welcome patient refer- After completing his orthodontic representative at the Association of rals for restorative and oral surgery specialist training he served as Dental Implantology. under conscious sedation. an army reservist in the UK Special Forces. In 2005, he and his wife Jane Dr Fran Veldhuizen, BDS, In 2007, she launched Beam Orthodontics MFDS RCS, M Clin Dent, MRD RCS gained her in Dundee. masters degree Beam was awarded ‘Best in fixed and Specialist Practice’ and was highly Dr Veldhuizen qualified from the removable pros- commended in the Best Dental University of Dundee in ı996. She thodontics and Team category at the recently-held spent several years in general prac- in 2009 she was Dentistry Scotland awards. tice and developed her interest in awarded her Ruaridh is also the creator and prosthodontics gaining her MFDS postgraduate specialist qualification, founding member of the national prior to taking up the position of from the Royal College of Surgeons Specialist Orthodontist Society. specialist registrar in Edinburgh. of Edinburgh.

40 Scottish Dental magazine Who’s who

Dr Crawford Bain, BDS, DDS, MSc, MBA Cert. Perio, Dr Penny Hodge, Cert. Fixed Pros BDS, PhD, FDS RCS(Ed). Specialist in periodontics

After spending nine years in general practice in Scotland and Dr Canada, Dr Bain completed speciality training in periodontics Hodge and prosthodontics at the University of Pennsylvania in ı98ı. is a Since then he has been at various times director of occlu- specialist sion, head of periodontics and director of implant dentistry at peri- Dalhousie University, Canada. odontist In ı990-ı99ı he was the Branemark surgical implant fellow at UCLA, USA, who, in where his research into implants and smoking resulted in the Osseointegration addition Foundation/Quintessence Publishing Company Award for the best scientific to practicing at Edinburgh article in the International Journal of Oral and Maxillo-Facial Implants in ı993. He Dental Specialists, is also a has maintained a specialist practice since ı98ı, returning to Scotland in ı995. part-time clinical lecturer Dr Bain is certified by the GDC as a specialist in periodontics, prosthodontics in periodontology at and restorative dentistry. Glasgow Dental School. Her main area of Dr Bruce research is risk factors in Dr Janet periodontitis, including Strickland, smoking, diabetes and Clarke, BDS, DipImpDent, genetics. Dr Hodge was BDS, FDS RCPS RCS awarded her PhD in ı999 and was admitted to the Dr Clarke qualified Dr Strickland has General Dental Council’s from Birmingham been placing dental specialist list in perio- with BDS in ı988 implants in general dontics in 2002. and initially worked in the hospital practice for the last ı3 years. He has service rotating through oral surgery pursued his interest in implants by and then restorative and orthodontic completing his Implant Diploma with and paediatric positions in Birmingham Advanced Certification in Bone Grafting Simon Miller, and London. She gained FDS RCPS with the Royal College of Surgeons. He is a BDS, MDO, RCPS, MSc, from Glasgow and in ı995 moved to lecturer and member of the International FDS RCPS Edinburgh and started working in the Team for Implantology. practice she became principal of in ı997. Over this period of time he has placed Dr Clarke relocated the practice in June more than 3,000 implants and worked Simon 2003 and renamed it Ferryburn Dental closely with his referring dentists from is the Care. It currently has a staff of three all over Scotland. principal dentists, two hygienists and six nurses His aim is to partner with other clini- ortho- in the four-surgery practice. cians as an extension of their team to dontist at She also work as an advisor for provide a referral service which enhances Glasgow Denplan implementing the Excel the treatment portfolio offered to their Ortho- Accreditation programme of which all patients. dontics specialist referral Ferryburn dentists are part of. As part of These partnerships are built around practice in Renfield Street her role with Denplan she has achieved a win/win relationship as Bruce aims to in the centre of Glasgow. the Certificate of Appraisal of Dental support those who wish to restore their Along with his experi- Practices and plans next year to enrol in own patients through his mentoring enced dental team, Simon the Certificate in Mentoring. programme and with the support of his has been producing on-site laboratory technicians. consistently excellent results since ı998. With no waiting list and Dr Stuart W McLaren, MBChB, BDS, MFDS, RCS an excellent working rela- Dr McLaren qualified in dentistry from Glasgow University in ı999 tionship with Practitioner and gained his Membership to the Faculty of Dental Surgeons at The Services, their cases are Royal College of Surgeons of Edinburgh in 200ı. At this time, he then currently being approved entered medical school at Dundee University, qualifying as a medical within two weeks. doctor in 2005. Simon is supported by Following this, he took up several positions encompassing many a large team of dedicated disciplines in medicine and surgery, latterly having a significant specialists and qualified interest in emergency medicine. therapists who strive to In September 20ıı, Dr McLaren opened Prestige Dental Clinic provide a high quality in Rutherglen, Glasgow, where they carry out general, cosmetic and implant dentistry, service to their patients, accepting referrals from colleagues in all aspects of implant dentistry. parents and referring He is a member of the British Medical Association, The Royal College of Surgeons of dentists. Edinburgh and the Association of Dental Implantology.

Scottish Dental magazine 41 Who’s who

Dr Pierluigi Coli, Dr Willie Jack, BDS, DGDP RCS, MGDS RCS, MMedSci DDS, PhD Dental Implantology Dr Coli gradu- ated Willie Jack qualified from Edinburgh in ı983 and after two from the years with Lothian Health Board he moved to Shropshire and Univer- mid Wales. He practised there for the next 25 years in his own sity of practice and in corporate dentistry. Genova, He was awarded two post-graduate diplomas from The Royal Colleges in Italy in ı990. He then Edinburgh and London before gaining a masters degree in Implantology from the trained as a specialist in University of Sheffield. periodontology, dental He returned to Edinburgh to join colleagues at Stafford Street Dental Care in implantology and pros- 20ı0, where he offers a surgical a restorative implantology referral service and an thodontics at Goteborg ongoing implant teaching programme. University where he also He is the clinical director for Euroteknika Implant Systems for which he teaches received his PhD in pros- and mentors dentists in UK and France. thetic dentistry and oral material sciences. Mr Martin He has been involved Paley, BDS, MB Zannar Ossi, in the training of BDS, MFDS RCS ChB, FFDRCSI, FRCS, undergraduate and post- EMClinDent Prosth graduate students at the FRCSEd faculty of odontology, Goteborg University, Martin is a consultant where he worked as a oral and maxillo- Zannar graduated specialist. facial surgeon for NHS Lothian based from Kharkov State He then moved to the in the Regional Maxillofacial Unit at St Medical University in Ukraine in UK to join the Edinburgh John’s Hospital. His main area of interest ı998, followed by intensive hospital Dental Specialists. is head and neck cancer and he performs residency training in general the complex reconstruction and oral dentistry with a special interest in rehabilitation using free tissue transfer prosthodontics. techniques and dental implantology. He then pursued his career in a Stuart Campbell, He has recently introduced the private clinic, concentrating on pros- BDS, MFDS, RCS newer minimally invasive techniques of thodontics, aesthetic dentistry and sialoendoscopy to manage salivary gland dental implants. disease to the unit. He has clinics at the As well as attending and presenting Stuart Western General Hospital Oncology at various implantology conferences, qualified Centre, Edinburgh Dental Institute Zannar also works as a lecturer at in 200ı and in both Fife and the Borders. He also the Edinburgh Postgraduate Dental from has a weekly clinic at the Spire Murray- Institute. Dundee, field Hospital. and is currently George Glover, Dr Carol Tait, a partner at Loanhead Dental Practice in BDS, MSc, ImpDent BDS Hons, MSc, MFDS Midlothian. RCS, MRD RCS He is an LDFT trainer George has been a in the South East of Scot- partner at Fergus & After qualifying from land and Chairman of Glover in Aberdeen the University of the Edinburgh branch of for ı5 years, one of Dundee in ı987, Dr Tait the British Academy of Scotland’s most widely recognised dental worked in general practice developing her Restorative Dentistry. practices. interest in endodontics before moving to He has two main With a special interest in dental implants Cape Town in ı998, where she worked clinical interests – adhe- and aesthetic dentistry, lifelong learning is as a lecturer in restorative dentistry sive dentistry and dental extremely important to George. He is an teaching endodontics and gained an MSc in implants. honorary clinical tutor at the University of endodontics. He has written several Warwick for the MSc in implant dentistry, After returning to the UK, she worked as clinical articles for Scot- ans a GIFT tutor and clinical mentor for the a clinical lecturer and specialist registrar in tish Dental magazine and Avinent Implant system. endodontics at the University of Dundee. has recently had a paper George’s leadership skills were acknowl- She gained her postgraduate specialist accepted for publication edged when the practice won Best qualification in 2004. in a future issue of the Employer at the 2009 Private Dentistry She is proficient in modern endodontic Dental Update. Awards and the 20ıı Dentistry Scotland techniques and carries out non-surgical and Awards at Gleneagles. surgical treatments.

42 Scottish Dental magazine Who’s who

Professor Glenn E. in association with seven Univer- and England. He has published Lello, BDS, FDS RCS, RCP, sities in a number of countries, many articles and served as editor MRCS, MBBCH, FRCS, PhD including South Africa, Switzer- of the British Journal of Oral and land, USA and the UK. Maxillofacial Surgery. For the past He has held many positions ı6 years he has held a consultant Professor Lello undertook dental, within training and professional NHS post in Edinburgh and medical, oral and cranio maxillo- associations including the Royal maintains a specialist practice facial surgery training and practice College of Surgeons of Edinburgh including dental implants.

Dr Elaine Halley, BDS, MFGDP Colin Burns, BDS, MFDS RCS Dr Halley is the principal dentist at the Cherrybank Dental Spas, private dental practices in Perth and, more recently, Edinburgh. Colin She was president of the British Academy of Cosmetic Dentistry Burns in 2009, and is the only dentist in Scotland to have achieved BACD gradu- accreditation. She was recently recognised as the winner of the ated from Outstanding Individual for her services to dentistry at the Scottish Glasgow Dental Awards in November 20ıı. in ı990 Her main interest is cosmetic and advanced restorative and dentistry. She is currently nearing the end of a masters degree in aesthetic and having fulfilled various restorative dentistry. hospital posts he settled She is also on the editorial board for Private Dentistry and Aesthetic Dentistry Today. down to general practice and now works entirely from his Crow Road prac- Dr Neil Heath, Jennifer Lowe tice, located in Jordanhill, Glasgow. DCR(R), BDS, MSc, As head of school for Colin’s specialist interest MFDS RCS, DDR RCR dental studies at Coat- is in surgical and implant bridge College, Jennifer dentistry with an emphasis Neil works as an is in charge of courses on cosmetic and aesthetic NHS consultant and which have been smile design and in order honorary clinical designed to up-skill the to further his expertise in senior lecturer in oral and maxillo-facial dental team. this area he is undertaking radiology at Glasgow Dental Hospital and The school offer Professional Develop- a masters degree in implant School. ment Awards in: Dental Management as dentistry at the University He qualified as a diagnostic radiographer well as Dental Administration and Facili- of Warwick. from Sheffield in ı987 then worked as a tating Learning, Training and Assessment Colin is a member general radiographer at the Royal Hallam- in the Workplace. of the Association of shire Hospital gaining experience in neuro, The success of their core CPD conference Dental Implantology, the orthopaedic and A&E radiography. resulted in the school developing a core CPD International Team for He qualified in Restorative dentistry from evening programm offering six hours of Implantology, Society Newcastle in ı995 and completed his VT in verifiable CPD. for the Advancement of Edinburgh in ı996. An MSc in restorative Specialist qualifications in orthodon- Anaesthesia in Dentistry dentistry followed and he became a member tics; radiography; oral health education; and is the Glasgow/Edin- of the dental faculty at the Royal College of implant dentistry; scope of practice; tooth burgh Study Club director. Surgeons in Edinburgh in 200ı. whitening; and customer care are available.

Professor Lars Sennerby, DDS, PhD Mark Skimming, BDS

Professor Sennerby graduated from the Mark opened his clinic Dentistry on Faculty of Dentistry at the University of the Square to establish a referral prac- Gothenburg in ı986. He trained in oral tice focusing on restorative dentistry surgery at the Branemark Clinic, Public and orthodontics. Health Service and Faculty of Dentistry in Mark gained a diploma from the Gothenburg. The Branemark Clinic served as an international Royal College of Surgeons, leading centre for clinical work, research and education regarding treat- to an MSc in advanced restorative dentistry from the ment of edentulous patients with dental implants. In ı993, he was University of Leeds. He leads a team of clinicians focused appointed associate professor and then professor in clinical and on minimally invasive and ‘pain-free’ dentistry. This is experimental oral implantology at the University of Gothenburg. achieved through techniques such as the ‘quick sleeper’ He is now a part-time professor at the Department of Oral pain-free injection system, IV sedation and the RA system. and Maxillo-facial Surgery, Institute of Odontology, Sahlgrenska The clinic has visiting specialists in maxillo-facial surgery Academy at Gothenburg University, and works with implant and orthodontics as well as highly skilled clinicians. surgery in private practice in Sweden, Italy and Scotland.

Scottish Dental magazine 43 44 Scottish Dental magazine

Live case study Setting the standard In the next part of our journey through a live course of implant treatment, Stephen Jacobs talks about placement and healing

n the last issue we had atrau- CBCT socket at the time of extraction. Also, matically extracted both Five weeks post-extraction, it was bearing in mind that it is only weeks upper central incisor tooth decided that a cone beam CT scan following extraction, the outline of roots, and having fitted the was justified in order to assess the the sockets can be clearly seen, and adhesive bridge, our patient bone volume for the proposed with adequate bone apico-palatal to INC, was delighted with the result. implants. I have been using cone the sockets, where the implants are The sockets were noted to be beam scanning technology for planned to be positioned. healing well over the following several years, culminating with the The placement of the implants was weeks (Figs ı, 2 and 3), however acquisition of a CBCT machine planned for a few weeks later, when the adhesive bridge did require (PaxDuo,Vatech-Ewoo) almost two sufficient soft tissue healing over re-bonding on a few occasions. years ago. Having an onsite CBCT the sockets had been obtained, and I find that when using an machine at Dental fx has been a NC was informed that guided bone adhesive bridge in this situ- resounding success, improving regeneration would be required, but ation, particularly where the the efficiency and service to the that the implants could be placed at lateral incisors are being used to patients, not to mention our referring the same visit. replace both centrals, the lack of colleagues. The images generated, surface area for the palatal wings together with the software function- Implant placement can predispose to de-bonding of ality, allow me to plan and assess On the day of placement, following the bridge. On reflection, using implant cases with a huge amount removal of the provisional bridge, metal wings in a classic ‘Rochette of detail and predictability. We have NC was given a chlorhexidine bridge’, may or may not have been found that we carry out far less bone (0.2 per cent) mouthwash for two less susceptible to de-bonding. grafting as a result. minutes, after which infiltration However, in any such case, when On looking at the cross-sectional local anaesthesia (articaine 4 per educating and informing the images of the two prospective cent, ı:ı00,000 adrenaline) was patient of this possibility at the implant sites, it can be seen that in administered. planning stages, they may be the ıı position, the coronal half of the A mucoperiosteal incision was prepared to accept this compro- buccal plate is absent (Fig 4), while made, palatal to the crest of the mise, rather than wear a partial the 2ı would appear to have the bony ridge, with vertical relieving inci- denture. Our patient, NC, was socket intact (Fig 5). These find- sions from just distal to the buccal very much a good case in point ings are consistent with the direct gingival zenith of the lateral incisors, in this regard. inspection and sounding of the extended beyond the muco-gingival

Fig 131 Fig 2 Fig 3

46 Scottish Dental magazine Live case study

Fig 4 Fig 5 Fig 6

junction. Reflection of the flap nique of placing into immediate to the cemento-enamel junction of revealed a mass of granulation extraction sockets. The 2mm twist the adjacent teeth. tissue in the ıı site, that once drill was used and prepared to a It may strike some that these curetted left a dehiscence defect of depth of ı3mm, with care taken to implants have been placed with approximately 5mm, the contralat- ensure that the long axis emerged remarkably low implant insertion eral site, at 2ı, having better bone between the cingulum and incisal torques. This subject is one of morphology, but nevertheless with edges of the two teeth to be replaced. the current hot topics in implant a smaller crestal defect (Fig 6). The osteotomies were enlarged dentistry. These findings were once again using the 3.2mm twist drill (Figs 8 However, some recent unpub- consistent with the cross sectional and 9) and finally the conical drill lished work has shown that low images seen on the CT scan. (Fig ı0), which is part of the implant insertion torque using a fluoride At this stage, in view of the system being used, completed the modified textured implant surface augmentation of the site that would site preparation (Fig ıı). produces a flatter implant stability be required, periosteal relieving inci- Two 4.5mm diameter, ı3mm time lineı, a study that I, with a sions were made (Fig 7). I carry this long implants (Fig ı2), were placed co-worker, have modified and are out at this stage, due to the vascu- (AstraTech, Dentsply) by hand (Fig currently working on. larity of the periosteum, allowing ı3), with the insertion torques then A personal view of mine is that any bleeding to have subsided by being measured at ı8Ncm using an many implants these days are being the time the biomaterials would be electronic torque controller (NSK, placed at very high insertion torques, required and handled. Japan). Implant stiffness was meas- sometimes in excess of 50Ncm, It was decided that, with all the ured using a resonance frequency something that I feel cannot be good information to hand and the fact that machine (Osstell ISQ , Goteborg, for osseous healing, and possibly the implants were to be positioned Sweden), the ISQ (implant stability slowing down the osseointegration where the original tooth roots were, quotient) values being 65 for the process, if one looks at the healing/ from the mesio-distal perspective, a ıı and 7ı for the 2ı implants. Cover integration graphs that are produced surgical guide was not required. screws were then attached to the when primary stability is investi- The osteotomies were prepared, implants. gated as a variable. starting with a small round bur Care was taken to ensure that the Further, in a study accepted for introduced towards the palatal wall depth of placement was optimal, the of the socket, similar to the tech- implant platform being 2-3mm apical Continued »

Fig 7 Fig 8 Fig 9

Fig 10 Fig 11 Fig 12 Fig 13

Scottish Dental magazine 47

Live case study

Fig 14 Fig 15 Fig 16

Continued » microthreads were exposed. result of the periosteal relieving inci- Some autogenous bone, that sions referred to earlier. Further, the publication, there has been shown was collected on the drill flutes surgical site was relatively dry with a 95.5 per cent implant survival during the osteotomy preparation, minimal bleeding, because these rate on 68 immediately placed and was placed directly on the implant scoring incisions were carried out provisionalised implants in extrac- surface, with a deproteinated bovine near the beginning of the procedure tion sockets over a follow-up period bone mineral xenograft (BioOss, (Fig ı9). up to nine years, where the insertion Geistlich Biomaterials) layered torque was ≤25Ncmı. on top of this. A collagen porcine Post-operative instructions membrane (BioGide, Geistlich Antibiotics and non-steroidal anti- Guided bone regeneration Biomaterials) was placed in two inflammatories were prescribed, As can be seen in Figures ı4 and ı5, layers, over the xenograft in order to together with 0.2 per cent chlo- a large defect revealed the micro- protect it and create a bony healing rhexidene mouthwashes. NC was threads on the conical shaped part compartment (Figs ı6, ı7 and ı8). advised to apply ice packs to the of the ıı implant being uncovered by Closure was obtained using 5-0 outside of the face, for the remainder bone, with a smaller defect on the Vicryl Rapide (Ethicon) sutures. 2ı implant, where several coronal This closure was tension free as a Continued »

Scottish Dental magazine 49 Live case study

Fig 17 Fig 18 Fig 19

Continued » reassurance, was given over the phone and the pain very quickly references of the day in order to reduce the settled completely, in fact by the swelling. following day NC was pain free. Initial healing was uneventful, This highlights the importance of Barewal R, Implant stability in except for the one occasion where giving patients your contact details relation to insertion torque, NC was experiencing some fairly in case of any problems, even if it EAO Congress 2010. significant pain, three days following is only advice and reassurance that surgery. Post-operative pain is they require, it is an essential part of Norton MR, The Influence very unusual – I would actually patient management. of Insertion Torque on Implant say it was rare – following implant NC was to be reviewed one week Survival in Immediately surgery, assuming that the correct after surgery followed by a period Placed and Restored Single- analgesia is provided. So, to receive of three to four months to allow Tooth Implants, Accepted for a telephone call on a Sunday after- osseo-integration and graft matura- publication, Int J Oral and noon, while I was at a wedding, came tion. During this time the profile of Maxillofacial Implants. somewhat as a surprise. the soft tissue was to be assessed in Advice, and more importantly, order to determine the next stages.

50 Scottish Dental magazine Live case study: the patient’s perspective As painless as possible Contrary to how it looks, Patient NC explains that he felt little post-0perative pain after his treatment

n my house, it is well known I added a large Lagavulin to the mix “Regard- swelling. The comprehensive post- that I have the pain threshold to ensure blessed sleep. less of operative guidance was exemplary of a sunburned three-year-old Now, let’s get some perspective how much and worked (my own outstanding whose useless parents forgot to into this. The truth is that I WAS contribution to medical science is bring the calamine lotion. Man in some “fairly significant pain” oral pain to have devised an ingenious new Ior mouse? Pass the cheese. for about ı8 hours, three days after you are in, cold pack to reduce swelling which My plight is compounded when the procedure. Bizarre and unex- never think I WILL patent, so don’t get any ideas: she who must be obeyed happens plained, I know. salvation simply roll frozen peas into cling to be a former nursing sister, Perhaps the reason it was so lies at the film, mold into a moustache shape, so reducing the prospects of a surprising was that I had been Southern freeze and apply to the upper lip, distress-easing cup of tea to below completely at ease during the actual General’s replacing each one as it melts – a zero. It has to be clinically proven procedure, thanks to the thorough hell of a lot easier than trying to confirmation of my mortal coil explanation of what was to be done emergency get an entire bag of frozen veg on departure before any form of and excellent anaesthetic manage- GP clinic” your face… which, being a bit thick, gentle ministration is forthcoming. ment. At no time was there any I tried!). Getting the picture? discomfort in the hour or so I was The “worst”, I am told, is over and But I merely set the scene. You in the chair, probably longer than we are now on the last lap to my new will have digested the science bit generally required because of the teeth. The trials of the flying bridge from the good Doctor Jacobs. So, number of images being taken for (see last issue) and the discomfort of when he describes a post-operative your benefit! While orally more post-op are now behind me. Surely day of excruciating agony (I’m a invasive than anything I have there is nothing more to come. journalist, I exaggerate profession- experienced, it was, in truth, not But wait: the editor has just shown ally) as “some fairly significant pain”, really arduous at all. Slightly nervy me pictures of what was done inside I immediately suspect he and my – then again I am – but simple and my mouth while I wasn’t looking. other half of a clandestine conversa- straightforward from the patient That’s it, back to the whisky bottle… tion before I set out on this journey! perspective. no wonder it bloody hurt! The sympathy clearly lying with Dr What was remarkable was that Jacobs, of course. there was no pain post-operatively At this point, I would also issue a from the site of the procedure and public health warning. Regardless of there was minimal bruising and how much oral pain you are in, never think salvation lies at the Southern General’s emergency GP clinic. Presenting dental pain to the hard- pressed team there elicits roughly the same response as asking the recently repossessed homeowner to discuss the merits of the banking profession! They really don’t want to know; a fact proven by the four and half hour wait before I finally gave up and fled into the night. Before I left, they did, however, give me – I suspect – a DFıı8 (or its modern equivalent) that certainly did for the pain… and nearly for me when

Scottish Dental magazine 51

Financial Brushing up on your financial systems

It is important to weigh the pull off reports each month or ments, items of service quarter as suits. Figures will provided and track these over benefits and pitfalls of any then be available to compare time. Is your practice manage- fee income, expenses and over- ment software also capable of investment, writes Jayne Clifford heads to previous periods and providing more detailed finan- ensure your practice is headed cial information on figures ll of my dental spending now to accumulate in the right direction and oper- such as income breakdown and clients are keen later. ating efficiently. details of overheads? to add value to This provides a timely Good accountants will Different sizes of practices their practice reminder that the Annual discuss such things with you will have different require- in one way or Investment Allowance for tax at your accounting year-end, ments, and to ensure clear, Aanother. This is especially true decreases from £ı00,000 to but imagine how much more accurate and useful manage- in today’s economic climate £25,000 from ı April 20ı2, so if useful these figures would be ment information is available where, although there is not you are planning renovations, to you if you could take correc- to you, your software package necessarily a ‘recession’ in time is starting to run out. tive action as and when issues has to be set up properly from terms of patient numbers, The vast majority of dentists, are identified, rather than day one. If you think comput- there is an element of people and indeed all my clients, are several months later down erising your financial records delaying having major dental ambitious for themselves, their the line? could benefit you, save you works carried out because of trainees, their patients and There are additional benefits time, give peace of mind and their own personal finances, their practices. But how do you too: if HMRC came knocking assist with adding further value and there is certainly a funding know how much of a financial on your door for a spot check to your practice, then get in squeeze as banks tighten up return you are achieving on this on your record keeping, are touch with your accountant their lending criteria. investment? you satisfied you could provide and see what they can recom- Many practitioners It is important in any size and them with all the answers mend. We offer practical are adding value to their type of organisation to monitor within a reasonable time training services to get you up practices by carrying out reno- performance and costs. Chari- period? Or would you have to and running in no time so you vations to plant and equipment, ties, small and medium sized take time out to get your bank can get back to focusing on improving the décor of their enterprises, right up to major statements, invoices and NHS what really matters – providing practice, increasing marketing PLCs do this. While I am loathe schedules together and spend patients with high quality care and providing additional to suggest a target-focused your leisure time writing up and service. services above and beyond culture to dental practices spreadsheets and cashbooks? traditional dentistry. It is about where medical need is the We work closely with many primary driver, key perfor- of the banks and financiers mance indicators are crucial operating within the health- About the to ensure all is going to plan in care sector, and where you author your practice. require finance such as a The installation of a comput- loan or overdraft facility, it is Jayne Clifford is a partner at erised accounting package helpful to be able to produce Martin Aitken & Co and has can assist with this. My firm, advised many dentist clients, good quality management including those both in the Martin Aitken & Co, is a accounts each quarter or half NHS and private sectors, for member of the Sage Account- year to furnish the bank with over twenty years. Jayne is contactable at [email protected] ants Club, meaning we can the required information they and by telephone on 0141 272 provide accountancy software are increasingly asking for to 0000. You can find out more solutions to organisations of all satisfy themselves. about Martin Aitken & Co by looking at their website www. sizes. The program is designed Many practice maco.co.uk to be used by non-finance management soft- This is our understanding of the personnel, and can provide law at this point in time, and we ware tools will would advise you to seek profes- you with timely and regular let you track sional advice prior to taking any financial information. appoint- actions based on the above. This article is not intended as The installation of a software professional advice – it is for package such as Sage (others Right: information purposes only. are available), will make it Jayne possible to quickly and simply Clifford

Scottish Dental magazine 53

Sedation

Inhalation sedation – friend or foe?

ain control is an Janet Pickles of RA Medical Surely this is over simplifica- invaluable part tion? The technique should not of the dentist’s gives an update on relative be dismissed purely on these toolbox. Often grounds – indeed, it smacks of the way this is analgesia in general dentistry ‘throwing the baby out with the Pperformed is down to indi- bathwater’ to ignore this well- vidual preference. Many this valuable tool on a daily regularly employ varying proven, safe and valuable asset. dentists’ only experience of basis. The use, as you travel methods of IV, mucosal, oral Of all the techniques of inhalation sedation will have around European countries, and RA sedation – often in conscious sedation, undoubt- come as part of their under- varies significantly, but it is combination and whichever edly, inhalation sedation, or graduate training and, as this reported that sales of inhala- seems most appropriate for the as more commonly called, varies appreciably according tion sedation equipment in individual. In order to utilise relative analgesia, is the one to which dental school they the Scandinavian countries this, dental practices will which has the greatest inbuilt attended, can result in a some- have almost reached ‘satura- have to equip and familiarise flexibility and by far the widest what ‘patchy’ approach to the tion’ level, suggesting that an themselves with the relevant application to all age groups. use of relative analgesia in extremely high percentage of equipment. Indeed, there is a The particular concept of dental practices. dentists use this facility. school of thought that states: relative analgesia dates from It is estimated that use of The recent NICE report “Sedation should be offered ı940 when Harry Langa and inhalation sedation in the UK actively seeks to encourage as a matter of course to avoid other enthusiasts began to use could be as low as ı5 per cent – more use of conscious seda- creating a generation of dental low concentrations of nitrous and in some geographical areas tion. Flexibility of method is phobics.” oxide allied to semi-hypnotic this drops to zero. Contrast this the watchword and all forms of Some members of the profes- suggestions for their dental with the US where the figure pain control are to be encour- sion have stated that they find patients. They discovered that rises to somewhere between aged and used wherever inhalation sedation “too much 50-58 per cent of dentists using possible. Already, practitioners of a bother” or “too expensive”. Continued »

Scottish Dental magazine 55

Sedation

Continued » when fear, anxiety and appre- hensions are eliminated and the patient is given a changed mental focus, a number of valuable effects follow. One of the most dramatic of these is a raising of the pain threshold, so that minor discomfort is no longer magnified and exagger- ated by fearı. Once it has been estab- lished that relative analgesia can be a great asset to the dental practice, then great care must be taken to ensure the equipment complies with all the latest specification and requirements. This does not necessarily have to be around the area of finding difficult or expensive. Great “The use of relative suitable places/mentors to leaps forward in provision practice. SAAD have declared of titrated flowmeters and analgesia in general that their selection process scavenging sundries have dental practice should will exclude any candidate who been made in recent years cannot prove that their place of and a comprehensive range of not be dismissed lightly” work will provide them with equipment is available to suit this facility. all requirements. This may have the result of If cost remains an issue, bility, which is limited at times. was launched at the Dental discouraging some interested re-conditioned equipment There are many indications Sedation Teacher Group parties and seems a great should be considered. We are that the use of inhalation seda- Meeting (DSTG) in May 20ıı shame. There does appear fortunate in the UK as the tion within dental practices and was well received by the to be quite a strong element Quantiflex range used to be – both high street and commu- large number of delegates. The of interest and articles on manufactured here in the ı960s nity are enjoying a period 22 October issue3 contained an the subject are already starting and 70s, including the MDM, of growth. Indeed, this equip- article written by David Craig to appear, aimed specifically Mark I and Mark II sedation ment, which has always of Kings College London. This at dental hygienists and flowmeters. These have proved traditionally been perceived as was an explanation of the work therapists. long lasting – some units solely for dental use, is starting of the new Independent Expert currently in daily use are over to move outside this, into Group on Training Stand- Conclusions 40 years old. other areas – being employed ards for Sedation in Dentistry Although financial consid- A recent article for Dental in hospital emergency depart- (IEGTSSD) – comprising erations cannot be ignored, Nursing, written by a trained ments – more specifically for many former members of the use of relative analgesia sedation nurse, mentions one paediatric use. the IACSD. as a valuable tool in general such unit in almost daily use The BDJ has recently Details of this group, and the dental practice should not be and comments: “Regularly published a number of articles work already carried out, were dismissed lightly. serviced it still looks as good around the subject of inhala- presented to delegates of this Expert advice should be as new. There are not many tion sedation. September2 saw year’s Society for Advancement sought on initial requirement pieces of dental equipment that a research summary published of Anaesthesia in Dentistry and purchasing of equipment will still be working every day on The Indicator of Sedation (SAAD) held in September. to avoid expensive ‘mistakes’ after this length of time.” This Need (IOSN) a new assess- This long-established group and the use of an efficient clearly illustrates the benefits ment tool written by a team of saw record numbers attending scavenging system is an abso- of taking re-conditioned equip- six dental professionals headed in 20ıı and is a further indica- lute necessity on grounds of ment into consideration when by Professor Paul Coulthard of tion of the increased interest COSHH (Control of Substances evaluating the costings for Manchester Dental School. in the whole field of conscious Hazardous to Health) and setting up of this facility, the This document, divided into sedation. health and safety. only drawback being availa- an estimated four or five parts, A further development is However, once the hurdle of the introduction of training establishing a sedation facility for hygienists in inhalation is passed, then the equipment References sedation techniques. The first should, if maintained correctly, course took place in 20ı0 and give many years of trouble free the second in November 20ıı. usage, adding an extra dimen- 1 Allen W. Relative Analgesia. Dental Practice Vol.14 no: 5 May 1976 2 BDJ Volume 211 No.5 September 10 2011 There appears to be consid- sion to the practice facilities on 3 BDJ Volume 211 No.8 October 22 2011 erable interest although a slight offer and further cementing the issue appears to have arisen dentist/patient bond.

Scottish Dental magazine 57

Decontamination Don’t mention the

econtamination of the necessity for these major is never far away A personal review of a contentious changes. Many have argued from the headlines problem by Irene Black about the lack of evidence of and controversy. harm caused by our infection Although I’m still control and decontamination Da practice owner with the view of the overall picture. idea of one standard across processes. The counterpoint same concerns as every GDP, Over the last ı0 years I’ve all sectors in both acute and is that the lack of evidence my other roles mean I often seen deadlines pass and lead primary care appears plausible. of harm is not evidence that need to step back from organisations and individuals With insight, however, this is no harm has occurred. The the ranting and take a balanced come and go. I’ve watched more than a little naïve. In my experts’ argument being that new participants, with some opinion, the requirement has no one has actually looked. vested interest, moving from to be appropriate standards Research is being carried committee to committee. for each sector based on the out in a variety of related Shuffling deck chairs on level of risk to patient safety. topics. Some of these studies the Titanic frequently The difficulty being that the are likely to look further at springs to mind. specifics of these risks have microbiological contamina- One constant never been clearly identified tion of dental instruments has been the or defined. following our potentially inad- mantra that there equate processing systems. can only be one Evidence I’m not entirely convinced standard and that Evidence, or rather the lack of it, that this will help. This type no risk can ever has been another fundamental of evidence is difficult to be acceptable. At problem. Dentists, understand- argue with. My confession first glance, the ably, have demanded evidence is that I struggle to under- stand at which point the specific microbiology, the “The counterpoint is level of contamination and the potential to cause harm that the lack of evidence becomes significant. Zero, or of harm is not evidence a number close, appears to be the only acceptable level. The that no harm has protestation as to the heavily contaminated field of opera- occured” tion, i.e. patient’s mouths, Irene Black appears to be irrelevant.

Continued »

Scottish Dental magazine 59 Decontamination

Continued » improved with a willingness organisations but, generally, The information in these to listen and some recogni- the buck stops with us. guidance documents filters Policy and implementation tion of the need for joined up down significantly slower Over the years, the organisa- working has been agreed. Guidance in our sector. As we eventu- tions charged with leading I do actually have some Adhering to all relevant ally became more aware of on decontamination have sympathy for those tasked guidance and regulation is the guidance, the barriers to appeared to have little under- with advising government on the mainstay of ensuring application become apparent. standing of independent decontamination policy. Their compliance. Guidance such as the Scottish contractor’s arrangements. corporate concerns are mainly In managed sectors this They have found our anom- focused on the legal implica- guidance would be made alous contractual situation tions when anything goes available on release. within the GDS difficult to deal wrong. This is exacerbated It would be read with. There has been confu- by the worry of the inevitable by the relevant line sion around the differences media repercussions. Hence managers, meetings between the directly managed the reason they rigidly apply held, improve- service and a misconception guidance and regulation as a ments planned, that the GDS was the ‘private’ non-negotiable stance. Even policies developed sector. if they were unconvinced as to and adopted. I believe this lack of under- the extent of risk in our sector, standing has improved although they are constrained by their they are still unsure how to deal circumstances and can never with dental practices as they actually deviate from that have no direct connection, policy position. influence or control. In reality, for those of us in Our current strong lead- a GDS setting, if something ership has enabled the does go horribly wrong, relationship with these the risk is entirely our own. organisations to mature signif- There would certainly be icantly over the last three some repercussions for our years. Communications have health board and external

60 Scottish Dental magazine Decontamination

Health Technical Memoranda Although HTM 0ı-05 has not (SHTMs) are extensive tech- exactly been welcomed with “Few would disagree nical documents. These were open arms by our colleagues produced many years ago in the south, it is at least a that these documents by technical experts and are single readable document. The are now in urgent need certainly not an easy read for general principles are virtually dentists and their teams. the same as our requirements. of review and revision” Few would disagree that There are differences in the these documents are now in details, some of which are even urgent need of review and more challenging than ours. revision in line with techno- Some details in HTM 0ı-05 logical changes and emerging have already been challenged evidence. The conundrum here in relation to emerging evidence is that until this guidance is in areas such as storage times, reviewed nothing can actually which were originally based change. The experts exhibit a on expert’s best guesstimates. limpet like adherence to the I believe there is a plan to letter of guidance despite the revise the whole structure of fact it may no longer be entirely HTM 0ı-05 and potentially appropriate. change it significantly in the Another source of confu- coming year. sion in relation to guidance is the fact that the rest of Manufacturers the UK adopted HTM 0ı-05 and suppliers in 2009. Scotland did not. Manufacturers and suppliers The reason for this was are inevitably involved with that our experts believe our the provision of decontamina- standards are higher than tion equipment. This presents those in HTM 0ı-05 and we were leading the pack. Continued »

Scottish Dental magazine 61 62 Scottish Dental magazine Decontamination

Continued » dentists with another dilemma; on one hand these companies are trying to convince us that they can solve all our problems simply and cost effectively if we purchase their product. On the other hand, the experts tell us some of these items don’t fulfil all the technical requirements. Who are we supposed to believe? This has left dentists, as usual, between a rock and a hard place. One example of this problem has to be washer disinfec- tors and the difficulties with eased, to some cleaning handpieces. These “Experts extent, by funding companies must shoulder during the good old some of the blame here. tell us some of days of practice improve- All manufacturers and ment grants. suppliers have had ı0 years these items don’t My concern has always been since the first Glennie technical the provision of support, both guidance demanded a move to fulfil all the technical financial and practical as the automated cleaning processes. requirements. Who are we missing components. That Some forward thinking and has been resolved to an extent joined up working might have supposed to believe?” through concerted efforts from served to obviate some of the dental practice advisers, NHS problems we have to work Education, some health boards through now. had prevailed for a short time my opinion, would be for and the Scottish Dental Clin- There appears to have been a at least. Predictably, these a new robust and efficient ical Effectiveness Programme. serious lack of communication positive changes are being practice inspection system There are certainly still on all sides which has resulted challenged by academics and to be introduced. This would barriers in relation to fully in a classic case of the cart the technical experts. We will cover infection control and embracing and implementing before horse. need to watch this space. the general requirements for the changes but most are decontamination compliance. moving in the right general Recent progress The future – compliance I would welcome a move direction. Despite this seemingly Compliance with guidance away from a tick box exercise I firmly believe the days despondent diatribe, there means more than having a proven to have little value of ranting about the general have been some glimmers of separate room for decon- in reality. principles of these changes are light at the end of a very dark tamination. It involves having This could still be under- done. However, there is still tunnel. validated equipment tested and taken through health boards plenty of scope for vociferous In these times of reces- maintained, robust processes, and retain peer input. If this haggling over the detail. sion I do sense a hint of documented training, manage- could be accepted by all parties Decontamination has a more pragmatic approach ment systems in place and lots we might manage to keep the certainly been a catalyst for from some quarters. I some- more besides. burden of further external change. Despite our intrinsic times even convince myself that As we hurtle headlong scrutiny and regulation at bay. resistance, in many situa- the precautionary principle towards the December 20ı2 tions there have been positive might have slithered off into the deadline and this mysterious The last word outcomes. long grass. concept, the answer to the It’s hard to argue that our Those who have seen The tangible effects have million dollar question of who practices did not need to this as an opportunity resulted in some significant will come and get us if we don’t, improve in response to public and not a threat have grasped concessions; one being an can’t or won’t fully comply, is and Government demands the potential to improve their acknowledgment that manu- still not certain. around the highly charged practices. Delivering patient facturers’ instructions are The potential for Health issue of healthcare associated care in pleasant surroundings the legal position in relation Improvement Scotland to infection. The status quo was with better working conditions to testing requirements. The assume the role of inspection not an option. for our hard-pressed teams other was the statement from and inspection regulation of Over the years I’ve seen the can only be a positive experi- Scottish Healthcare Tech- dental services in Scotland is general mood of the profession ence for both patients and nologies Group that there is still alive and well. move gradually from incredu- professionals. no evidence for improved The fact that the CQC has lous disbelief to a disgruntled Change is never comfortable. patient safety or cost benefit assumed this role in England acceptance that decontamina- It is usually an inevitability in having vacuum autoclaves has heightened my concerns. tion requirements are here and can occasionally have in the GDS. Commonsense The preferred option, in to stay. This transition was a happy ending.

Scottish Dental magazine 63

Clinical Waking up to hypnosis

Lindsay C Howden, consultant clinical hypnotherapist, explores the history of hypnotherapy as an aid to easing patients’ fear, and details the potential benefits in modern-day treatment

ne in three people fear the dentist. Fear of dental procedures is a very common Oand distressing condition and, according to the BDA, affects one adult in three. The problem also exists in many children. People may neglect their dental health so much that oral disease seri- ously affects their general health and quality of life. Some people are so afraid of the dentist that they seldom or never attend, with serious health consequences. Hypnotic techniques can help many anxious and seriously phobic patients. Patients who experience gagging, bruxism, temporomandibular joint prob- lems and excessive salivation can also benefit. Simple hypnotic techniques can be used in the chair while some patients may require a longer course of hypnosis, conducted either by a dentist trained in hypnosis or a consultant hypnotherapist. For people with a severe phobia, whose extreme anxiety makes it impossible for them to enter a dental surgery and talk to a dentist, the initial consultation is likely to be held away from the surgery and carried out by a hypnotherapist or the patient’s GP. In the longer term, the aim is to enable the patient to cope with dental treatment with greatly reduced anxiety.

Continued »

Scottish Dental magazine 65 Clinical

Continued » of the 20th century, doctors and 60 years ago to describe the applica- dentists were rediscovering the About tion of controlled suggestion and A brief history of benefits that hypnosis could offer the hypnosis to the practice of dentistry. modern hypnosis their patients. By the 2ıst century, author Much can be done to reduce anxiety General interest in science and such a general medical and scientific levels in patients from the moment things as gravity and magnetism consensus has been reached that Lindsay they arrive at the surgery. It has even Howden, PhD influenced the beliefs of Franz hypnotherapy can benefit patients CBiol GQHP been suggested that something as Anton Mesmer (ı734-ı8ı5) who suffering from a wide range of GHR Reg. is apparently minor as the doorbell an analytical undoubtedly became the most conditions and this is backed up hypnothera- volume and tone can have an impact famous, or perhaps infamous, of by thousands of scientific studies. pist who is on on anxiety. early hypnotists. After a French To take only one example, hypno- the General Many dentists and their staff are Hypnotherapy government commission largely therapy is now the treatment of Register. He is well aware of the importance of discredited Mesmer’s work, a choice for patients with irritable also a chartered creating a welcoming atmosphere number of pioneers toned down bowel syndrome as recommended biologist and and give careful attention to the practiced as a and refined Mesmer’s techniques. by NICE in England and Wales. pharmacist for layout and décor of the reception Notably, the Marquis de Puységur many years in area and the waiting room. It is both hospital and the Abbé Feria hypnotised large What is hypnotherapy – where he ran also very important to recognise numbers of people. They replaced and how does it work? a medicines the impact of the language used the theatrical mesmeric passing of Hypnosis is defined by the British information with the patient. In using hypnosis centre – and in hands or wand over the body with Psychological Society as: “...an the community. for weight loss, for example, many verbal suggestion. interaction between one person, the He first became experts recommend avoiding the The most interesting results came ‘hypnotist’, and another person or interested and use of the word ‘heavy’. involved in from India in the ı840s where Dr people, ‘the subjects’. In this inter- hypnotherapy During hypnotic induction and James Esdaile, a Scottish surgeon, action the hypnotist attempts to many years suggestion, the language used is ago. He has a used hypnosis as an anaesthetic in influence the subjects’ perceptions, private practice carefully selected to obtain the most hundreds of operations, including feelings, thinking and behaviour in the new town positive outcome. It is just as impor- amputations and the removal of by asking them to concentrate of Edinburgh. tant to be aware of the potential for scrotal tumours. This work was on appropriate ideas and images. invoking anxiety attached to certain further advanced by James Braid, The verbal communications that words, such as ‘pain’. Words like another Scottish doctor. As well as the hypnotist uses to achieve these ‘pressure’ or ‘discomfort’ may be popularising the term ‘hypnosis’, he effects are termed ‘suggestions.’ less worrying to the patient. When developed the modern eye-fixation Suggestions differ from everyday discussing a patient’s feelings about techniques. kinds of instructions in that they an imminent procedure the dentist His favoured method of inducing imply that a ‘successful’ response might talk about ‘concern’ rather the state was to hold a shiny scalpel experienced by the subject has a than ‘fear’. case in front of, and slightly above, his quality of involuntariness or effort- patients’ eyes, bringing about visual lessness. Subjects may learn to go Hypnotic treatment of fatigue, eye closure and then trance. through the hypnotic procedures the phobic patient All of this had come a long way from on their own, and this is termed Probably the most effective treat- the days of Mesmer. Hypnotism ‘self-hypnosis’.” ment for the phobic patient is was made even more popular when Hypnotherapy is simply the systematic desensitisation, as physicians with the eminence of application of hypnosis for the described by Joseph Wolpe. This is Jean-Martin Charcot in Paris took benefit of the patient. Almost a gradual process best carried out up its practice. The first reference everyone can be hypnotised and, away from the surgery and is likely to an extraction being performed in fact, several times each day we to require several sessions. under hypnosis was in ı836 when will all find ourselves in a natural Under hypnosis, the patient is a Parisian dentist by the name of hypnotic state, particularly first first taught how to quickly reach Oudet carried out the procedure. thing in the morning when neither a deep state of relaxation. The The discovery and develop- fully asleep nor fully awake, or when anxiety-provoking stimulus is then ment of inhalation anaesthetics in reading an engrossing book and broken down into a number of surgery, including dental surgery, losing track of time. steps or stages starting with the led to a decline in the popularity least frightening and graduating of hypnosis by the end of the ı9th Dental anxiety and phobia to the most frightening in around century. However, by the middle The term ‘hypnodontics’ was coined five steps. The response to each stimulus is rated by the patient “His favoured method of using the subjective feelings of distress scale (SUDS) with zero inducing hypnosis was to hold a representing no fear at all (perhaps sitting in a comfortable chair at shiny scalpel case in front of, and home) and five representing frank terror (perhaps hearing the sound slightly above, his patients’ eyes, of the drill). Clearly frightening bringing about visual fatigue, stimuli will vary for each individual, reflecting their personal history of eye closure and then trance” dental treatment.

66 Scottish Dental magazine Clinical

Under hypnosis, each stimulus, self-hypnotise and to suggest that, Hypnosis can be used along with starting with the least challenging, after practising this technique, it further traditional treatment and can help is rated by the patient both before should be used the night before reading improve pain control and relaxa- and after, triggering powerful going to the dentist and while sitting tion. relaxation images. This may need in the waiting room. It is essential Heartlands Medical and to be repeated several times until that the dentist is aware the patient Dental Hypnosis. Analgesia, bleeding control, the anxiety subsides significantly. will be using hypnosis and can allow Fourth Edition. gagging and excessive salivation Churchill Living- The next most challenging stimulus the patient time to prepare. stone 2002 Pharmacological analgesia and is then introduced and the process Weiner. The local anaesthesia can be enhanced is continued with desensitisa- Use of hypnosis for Fearful Dental by hypnosis and, in some patients, Patient: A guide tion being achieved at each stage specific conditions to under- the need for local anaesthetic can until the whole anxiety-provoking Hypnosis has been used to help standing and be lessened or eliminated. The scenario has been worked through. with the treatment of a number of managing. problems of excessive bleeding, Wiley-Blackwell The relaxing image and specific problems and conditions: 2011 gagging and copious salivation can sensations can also be ‘anchored’ Hammond. also be addressed using hypnosis Handbook to a covert gesture such as fist Bruxism of Hypnotic in suitable patients. clenching or pressing the thumb Many patients with clenching and Suggestions and index finger together. The tooth-grinding are very tense and and Metaphors. Conclusion patient can then use this when stressed individuals and the relaxa- Norton 1990 Weiner says that “unless dentists presented with the actual anxiety- tion obtained through hypnosis broaden their diagnostic skills and provoking stimulus in the waiting and particularly self-hypnosis has management abilities, dental fear room and then in the dentist’s chair. been found to be very successful will remain as prevalent in the A posthypnotic suggestion can also in treating this condition, often future as it has been in the past. All be given that each and every time bringing relief. the modern equipment and tech- the worrying situation is encoun- nical skills are useless, if the tered the patient will feel more Temperomandibular practitioner does not get and keep and more relaxed about facing the joint dysfunction the patient coming for regular scenario. Hypnosis has been found to be care.” Hypnotherapy has proven to It is also very useful to teach the an extremely useful adjunct in be a valuable adjunct to the exper- patient how to quickly and easily the treatment of this problem. tise of the dentist.

Scottish Dental magazine 67 RELEVANT DETAILS IF REQUIRED Heading | Diary dates p12 | New practices p18 | New products p24

68 Scottish Dental magazine

Clinical

Christine Hanson tells how new cadavers have helped students learn

Teaching extractions is no longer a pain xtracting teeth was that was, in essence, a continuation month and in the ’60s a dental historically taught by an of the old hands-on apprenticeship surgeon took out, from patients apprenticeship scheme to the present, where students are under general anaesthetic, 283 teeth and it wasn’t until the versed in the science behind their in one day. early ı700s that Paul actions and practise on models The number has fallen slowly EFauchard first published a book for before treating patients. Investiga- over the years and the reasons dentists, which included a descrip- tion into old Dundee Dental School are multiple. There is now better tion of the stance and position that student records, and interviews access to dental care in Tayside. the operator should adopt. Some- with retired dentists, produced an Education, fluoride in toothpaste, thing we still do today “plus ça amazing level of undergraduate and recent celebrities’ tooth-whitening change plus c’est la même chose”. postgraduate experience of tooth fads and the television programme Teaching students how to extract extraction. In the ’30s, one Dundee teeth has progressed from a system student took out 280 teeth in one Continued »

Scottish Dental magazine 69 Clinical

Fig 1 Fig 2 Fig 3 A Thiel body before the dental students’ A cadaver being prepared for a class Somewhat apprehensive students look on attention at a demonstration extraction

Continued » Later, it was the pig’s head. The bone and, indeed, if the teeth were event, with all the cultural and extracted from the mannequins, ‘Ten Years Younger’ have, it would aesthetic drawbacks, was memo- they wore out and were very expen- seem, all encouraged people in our rable if only for the pungent odour sive to replace. The models were catchment area to look after their of the heads on a warm day in the very basic in form and this limited teeth. laboratory. their use. To teach the skill of extrac- Frasaco produced replaceable In Dundee University there is the tion to students we have always metal teeth in a mannequin head, Centre for Human Identification, needed a practice model. Talking which was infinitely preferable. It under the direction of professor to retired dentists at the Lindsay was then easy to get the student Sue Black. They have bodies Society for the Study of the History and the forceps in the right place donated for use in medical science, of Dentistry, this model was the to do the deed. It gave a degree of including training and research. patient; with a lecturer literally realism but still did not have the Cadavers embalmed by the newly hands-on guiding the student’s. feel of withdrawing the tooth from introduced Thiel method leaves

70 Scottish Dental magazine Clinical

Fig 4 Fig 5 The oral tissues remain supple and can Fig 7 easily be retracted. It gives a good hands- The bodies may well have been used on feel to allow positioning of forceps by the medical school to teach surgery Literally hands-on during an extraction prior to a real extraction before we arrive

them soft and supple, unlike the process. There is a little degenera- manipulate and we still use silicon hard unyielding high formalin tion in the perio membrane, too, but models for this. But despite this, preserved ones that most will it’s not significant to our students’ the students could experience the remember. You only have to shut experience of their first extraction. hard tissue, bone cutting and tooth your eyes to recall the nose-searing It does not make it easier to extract cleaving aspects of dento-alveolar smell on entering the dissecting the teeth – as some of them found surgery. The centre plans to change room for the first time. out when they fractured the roots. their embalming technique so that Thiels have little smell. They However, another trial using all bodies will be prepared in this have all the attributes of a live Thiels for teaching minor oral way, but at present there were patient, the tissues are soft and surgery work found that the longer only sufficient numbers to allow a easily retracted as in life. They have they had been embalmed the pilot study to appraise the value of though, a strange appearance, remi- thinner and more tissue-paper Thiels as a teaching model for the niscent of an unfinished wax doll, like the mucosa became. It was in that all hair is lost during this not robust enough for students to Continued »

Scottish Dental magazine 71 Clinical

Fig 9 One Theil body had an OAC which could Fig 10 Fig 8 be demonstrated by inserting a quill to its maximum depth. Something most Students observing an extraction Student attempts an extraction certainly not advised in a live patient

Continued » practise?” was one comment. They tiring struggle to take mannequin wanted to ask more questions which About theory into the clinic, but I was staff and students. It was carried might have been difficult in front of the unprepared for just how good these out this summer for the students a patient and realised that the prob- author bodies are for teaching. The ability who were to make the transition lems could be easily demonstrated to freeze-frame, intervene and from books to clinic in the autumn. on the Thiels. All students in the Dr Christine correct with explanations, which The students seemed at ease with third BDS year, not only those that J. Hanson, is would be entirely inappropriate in a Lecturer/ the concept of working on the got this experience, seemed keen Associate the clinical setting, was liberating. bodies. Only one out of 32 students that it should be rolled out to all Specialist in Some with the Thiel experi- did not want to extract a tooth. students in following years. It is Oral Surgery at ence agreed that it bolstered their Dundee Dental Already, there is considerable possible that these bodies should School, Dundee confidence, which was just as well, experience in using these cadavers be used for other post graduate University. for those who made this comment for all the basic dental local procedures, for example implant rated their confidence to carry out anaesthetic techniques. The local placement. I have experienced their first extraction on the low side. dissipates and can be given repeat- implant courses that use isolated Would these have been the students edly. For the extractions, they were plastic mandibles but it is difficult who were so apprehensive that they given a scenario for each case and to find the words without seeming would have dragged their heels to be encouraged to explain and interact to over exaggerate to emphasise how among the last to extract teeth, and with the Thiel as if it were a patient. superior the bodies are. building up more of a psychological It gave them the opportunity to As a lecturer barrier to success as time went on? begin to build an interactive script I recognise They have also said that they would and develop their clinical manner, that it is diffi- love to have done more extractions albeit with an unresponsive patient. cult to find a and that the term should be a mix of They are usually so concerned with practise model live patients and Thiel bodies. the mechanics of their first live that has transla- Over the years I have tried extraction that conversation with tional validity and to produce realistic models for the patient stalls and explanations it has always been a teaching. With the exceptions that to patients that they may experi- the patient is not seated and there ence deep pressure etc, becomes is a lack of interaction, these are my forgotten. ideal bodies for teaching extraction Feedback showed that those who techniques. It is a teaching oppor- did not have this primary introduc- tunity not to be missed and I hope tion to extraction felt they were that we can extend this facility to disadvantaged. Some would have all the undergraduates in the next liked to return after they had academic year. carried out their first Professor Sue Black and her team, in vivo extraction – “The ability to who some of you will remember “Why wouldn’t from their television series, is you want to freeze-frame, running the somewhat unusual intervene and campaign ‘Million for a Morgue’ to correct with raise money for building a modern explanations, morgue where all the bodies will be preserved in this way. The Univer- which would sity of Dundee has earmarked be entirely £ı million to expand the centre for inappropriate Anatomy and Human Identification (CAHID) and the campaign target in the clinical is to match this. setting, was Details of it can be found at liberating” www.millionforamorgue.com

72 Scottish Dental magazine

Advertising feature Constant thirst for knowledge

Former Glasgow dental student and founder of the British Medical Dental Careers Fair at the University of Glasgow, Bilal Aslam, says students’ high motivation levels and ceaseless desire for new information is the reason behind the meteoric growth of the upcoming event

ollowing two ı,000 in 20ı0, within the region previous successful of 2,000 delegates expected events, March 20ı2 to attend next year’s fair at will see the return of Hunter Halls on Saturday, 3 the British Medical March 20ı2. FDental Careers Fair at the Bilal, who is also the organiser University of Glasgow. and president of the Careers The brainchild of former Fair Committee, explained Glasgow dental student, Bilal how the event started. He said: Aslam, the fair has grown “The concept for a careers fair from around 500 delegates at arose during my third year the inaugural event in 2008, to in dental school while trying to find information about a specialty I was interested in. to the thirst for knowledge of After looking around for advice, the students that attend. He decided to expand the event there were still a number of said: “I believe dental students to also include CPD lectures. queries I had. Having realised and dentists are extremely He said: “This year we are this gap in career informa- motivated individuals who lucky enough to work in tion for the dental profession, like to be well informed when collaboration with the Royal I approached the dean it comes to making decisions College of Physicians and of Glasgow Dental School, about their respective careers. Surgeons of Glasgow, and Professor Jeremy Bagg, It is only with their support therefore are able to offer with a proposition for the that the careers fair is still dentists the opportunity to British Dental Careers Fair.” running.” listen to world-renowned And he believes that the However, after two speakers and gain core verifi- event has been a success thanks successful events, Bilal able CPD at the event. We explained that they have have also opened up the event

Confirmed Speakers:

Mrs Laetitia Brocklebank, Consultant in Dental Radiology Dr Alexander Crighton, Consultant in Oral Medicine Ms Serpil Djemal, Consultant in Restorative Dentistry Mrs Laura Mitchell, Consultant in Orthodontics Mr David Mitchell, Consultant in Oral and Maxillofacial Surgery Professor Andrew Smith, Professor in Microbiology Professor Richard Welbury, Professor in Paediatric Dentistry

74 Scottish Dental magazine to ı,000 medical students ® from across Scotland in addi- For more information on the tion to dental students from British Medical Dental Careers Fair across the UK.” or to register for the event, visit Having completed his voca- www.mdcareersfair.com/register tional training with the Please note, early registration London Deanery, Bilal is is highly recommended as currently working at his six- delegate places are limited. month post at the oral surgery department at the Glasgow Date: Saturday 3 March 2012 Dental Hospital, followed by Time: 2pm-6pm a six-month post as a senior Venue: Hunter Halls, house officer in oral and University of Glasgow, max-fac surgery at the G12 8QQ Southern General Hospital.

Confirmed Exhibitors:

British Dental Association British Orthodontic Society British Society of Paediatric Dentistry Dental Defence Union Dental Protection General Dental Council HSBC Integrated Dental Holdings MeDen Medical Dental Defence Union of Scotland NHS Histopatholgy Training Optident Pastest Projects Abroad Royal College Physicians and Surgeons of Glasgow Royal College Surgeons of Edinburgh Royal Navy Scottish Dental magazine Wesleyan Medical Sickness

Scottish Dental magazine 75 Advertising feature CBCT versus traditional radiography

cientific evaluation Comparing the clinical is crucial to estab- lishing the potential benefits of focused- results of endo- field CBCT with X-ray dontic therapy, assessments in Sproviding practitioners with the means to accurately predict endodontics the likely outcome of a range of medical care options. In X-rays, however, are far from either of the severity of the this way, it greatly empowers foolproof. Even half a century problem or whether or not there patients when it comes to ago, researchers notedı that is even an endodontic problem deciding which endodontic radiography couldn’t accurately at all2. Thanks to imaging treatment to proceed with as and reliably identify periapical developments in recent years, they have sufficient knowledge lesions in spongy bone. Indeed, the solution to this is clear. greater method of accurately to make an informed choice. there are many published Investigations have shown3 diagnosing periapical lesions. Endodontic treatment cases recording the shortcom- that periapical lesions which A study looking at diseased evaluation has typically been ings of X-rays, particularly the were not identified on X-rays root canals in dogs5 involved associated with the use of inherent problems associated were subsequently discovered taking X-rays and CBCT scans X-ray radiography for almost a with reducing a complicated, using Cone Beam CT scans. of the periapical tissues post- century. This method of using involved, 3D image into a 2D This 3D imaging system avoids mortem, then checking these X-rays to determine the health radiograph. The resulting X-ray the problems, or restraints, images and subsequent find- of the tooth root, dental pulp can be difficult to read because commonly associated with 2D ings against the conclusions of and surrounding tissue, offers of blurring and malformation of intraoral radiographs. a histopathological assessment. a far more verifiable appraisal shapes within the image. Both in vivo and ex vivo The research concluded that than performing an examination Imperfections such as these analyses4 have come to the CBCT was the better system for and referring to medical history. can lead to incorrect diagnosis, conclusion that CBCT is a far predictable and precise identi-

76 Scottish Dental magazine Advertising feature fication of apical periodontitis, ically, research looking at offer genuine advice on endo- with a clarity of image that periapical lesion diagnosis dontic treatment options. References was significantly lacking in using CBCT scans9, showed Above all else it is impera- the X-rays. The inquiry also that halving the scanning arc tive to provide patients with 1 Bender & Seltzer (1961) confirmed that by using X-rays, from 360 to ı80 degrees had an understanding of the risks 2 Bender (1997), Lofthag- practitioners were more likely no negative repercussions on and the likelihood of a positive Hansen et al. (2007), Paula- to misjudge the extent of pathology identification, while outcome, in order for them Silva et al. (2009a) disease. greatly reducing patient risk. to make important decisions 3 Bornstein et al. (2011) However, the enhanced Technological advances offer relating to their health. It is 4 O¨zen et al. (2009), Patel precision of CBCT does come practitioners the opportunity not only the ethical thing to et al. (2009), Paula-Silva et at a cost: the procedure requires to reassess their methodology do, it is also a requirement of al. (2009b,c) the patient to take a larger dose for determining endodontic the CQC that we empower 5 Paula-Silva et al. (2009 b,c) of radiation. Having said that, treatment. CBCT offers a patients with the ability to give 6 Loubele et al. (2009) scans required for endodontic predictability with diagnosis informed consent to recom- 7 Holroyd & Gulson 2009, diagnosis require the smallest that has been demonstrated mended courses of treatment. Patel & Horner (2009) depth of field, so patients are as superior to radiography, Mounting evidence suggests 8 Durack et al. (2011) given the least possible dose for which is essential in certain that the accuracy of CBCT 9 Lennon et al. (2011). maximum effect6. circumstances. Such preci- scanning, in particular with Because CBCT is able sion imagery is apt to provide regard to potential apical to target the required area, clinical information that will periodontitis, along with dose- and simple selection of the only pertinent information clearly show which treat- control capability, is one of the field of view that best matches is captured and the volume ment approach is more likely most effective diagnostic tools clinical needs, optimises of superfluous scanning is to reap success. The limita- to have in the surgery. radiation dose and minimises minimal7. In addition to this, tions of X-rays can potentially One example of a powerful patient risk. findings are indicating that it’s be harmful to the patient, and easy-to-use Cone Beam 3D possible to have an effective increasing the possibility of system is the Kodak 9500 from ® lower dose by altering the misdiagnosis and unsuitable Carestream Dental. The tech- For more information, contact equipment’s default exposure or ineffective treatment. Only nology delivers anatomically Carestream Dental on 0800 settings, with no impact on when the way forward is clear correct images while an intel- 169 9692 or visit www. diagnostic capacity8. Specif- to the practitioner can they ligent design allows the swift carestreamdental.co.uk

Scottish Dental magazine 77 78 Scottish Dental magazine Advertising feature The ADI welcomes Dr Michael Pikos

he Association and soft-tissue grafting courses DCPs the opportunity to listen Professor Cemal Ucer, who of Dental Implan- with alumni that now number to highly acclaimed dental recently took over from Scot- tology is proud to more than 2,400 from around professionals. tish dentist Stephen Jacobs, is present the latest the world. After the lecture attendees particularly looking forward to in our Masterclass Dr Pikos is also a well- will be able to: the Masterclass. He said: “The Tseries: ‘Maxillary Alveolar Ridge published author, who has ı. Understand the importance combination of a high-quality Regenerative Strategies: From lectured extensively on dental of a sequential CBCT-based speaker, fascinating topic and Extraction Site Management implants in North and South digital diagnostic protocol peer interaction, all in a full-day to Full Arch Reconstruction’ America, Europe, Asia, and the for maxillary alveolar ridge masterclass format, should with Dr Michael A. Pikos, on Middle East. augmentation. make this event one not to Monday 26 March 20ı2. The ADI is delighted that Dr 2. Appreciate the indica- be missed.” Dr Pikos, originally from Pikos has accepted our invita- tions for maxillary extraction Campbell, Ohio, is one of tion to present this six-hour site management and ridge ® the world’s leading expo- in-depth lecture. It is a topic augmentation. The Masterclass will take nents on hard and soft-tissue that will appeal to both experts 3. Understand the application place at the Royal College of grafting procedures in implant and beginners in the dental and protocols of current hard Surgeons of England, London. dentistry. He is founder and implant field. and soft tissue grafting tech- You can register for the CEO of the Pikos Implant Insti- Masterclasses are an integral niques for maxillary alveolar event at www.adi.org.uk/ tute. Since ı990, Dr Pikos has part of the ADI calendar, giving ridge augmentation. masterclass2012 or call the been teaching advanced bone clinicians, technicians and The ADI’s new President, ADI office on 020 8487 5555.

Scottish Dental magazine 79 80 Scottish Dental magazine Advertising feature Get the knowledge – get the WYSdom

CONic Dental Prac- it gives the practice an oppor- learning curve for dentists and and printers ready to take tice Software developer tunity to get to grips with the nurses significantly and at the advantage of the latest tech- WYSdom Dental Tech- whole concept of computerisa- same time makes charting very nologies available. nologies, based in Milton tion for minimal outlay. There’s simple, accurate and fast. Not only do WYSdom Keynes, has launched also the bonus of £50 discount The system typically comes customers get a great hardware Ian all-inclusive hardware per month for the first ı0 with business-level professional service, the software support and software rental scheme customers of the scheme, with hardware, too, so reliability staff are ex-dental profes- for the Scottish and Northern systems starting at just £349 is high and running costs sionals. Ireland dental markets. plus vat. (consumables such as printer In a move that offers a three- The ICONic system is widely cartridges and appointment Key Features: year scheme with a fixed accepted to be the easiest cards remain the practice’s • Fixed all-inclusive monthly monthly price to cover instal- software to use currently on responsibility) are kept to a rental fee, guaranteed for up to lation of all hardware, software the market and, with its image- minimum. All equipment is six years. and maintenance – and guar- based charting, it reduces the covered under the mainte- • Easy to learn image-driven anteed to have no price nance element of the charting. increase for up to six support contract so no • Business-quality hardware. years – WYSdom partic- nasty surprises if some- • All new hardware every ularly hopes to tempt thing stops working for three years those practices which still some reason. • One-stop-shop, single point use paper-based patient Every three years all of contact hardware and soft- records. the hardware will be ware support. For practices that replaced with brand new currently don’t have a equipment ready for the ® computerised system next rental period so Go to www.wysdom.co.uk/ this option makes a very clients will always have rentals for more information, or attractive proposition as up-to-date computers call Marion on 01908 324045.

Scottish Dental magazine 81 Product news

Small things, UnoDent Nitrile New from UnoDent, big difference Gloves, soothe Nine Plus Capsules on the move A resin-free glass In these tough economic ionomer restorative times, Dentsply For examination gloves that are also kind that isn’t sticky and understand that small to the skin, The Dental Directory now stock handles with ease. things can make a big UnoDent Nitrile gloves with Aloe vera. Biocompatible and difference to dental Each ambidextrous glove is specially radiopaque, Nine Plus practices that want to coated with Aloe vera – a substance isn’t sensitive to moisture, with the advantage keep an eye on costs renowned for its soothing, anti- of being insoluble in water and acidic conditions without compromising on quality. That is inflammatory properties, and the cooling, after setting. In addition Nine Plus offers lower why the Dentsply Rewards website (www. moisturising effect it can have on the skin. opacity than many of its competitors, giving dentsplyrewards.co.uk), which offers rewards to UnoDent Nitrile Aloe vera gGloves come better translucency and aesthetics, with superior customers, is proving so popular. in boxes of 100 and in a range of sizes. fluoride release. Capsules available in shades Dentsply is the leading manufacturer of dental These gloves have been manufactured and A2, A3 and A3.5. Available as an assorted pack materials and equipment in the UK and Ireland, tested to standard EN 455 (Parts 1 and 2) of 30 (10 x A2, A3 and A3.5) or boxes of 50, with with a sound reputation for quality products. By for your peace of mind. optional Capsule Applicator. ordering via the easy-to-use Dentsply Rewards To accompany the capsules are Nine Plus LC website, practices accrue rewards that can then For more information Varnish – a nano-filled, light-cured coating to be redeemed on other Dentsply products. Get the on the UnoDent Nitrile protect the surface of restorations from exposure highest-quality dental products and save money! Aloe vera gloves and to moisture/saliva, as well as Conditioner – other types within the designed to clean the cavity and condition For more information, visit dentsply.co.uk or range, contact The dentine and enamel to enhance the bond phone 0800 072 3313. Earn rewards against Dental Directory on between the ionomer and the tooth structure. purchases at dentsplyrewards.co.uk Access 0800 585 586, or webinars and products demonstrations and visit www.dental- Contact The Dental Directory on 0800 585 earn CPD at dentsplyacademy.co.uk directory.co.uk 586, or visit www.dental-directory.co.uk

82 Scottish Dental magazine

Oral health/Financial

Number one on Five times more Finance 4 The Gadget Show The Oral-B Precision Clean brush head Patients The Oral-B Triumph 5000 toothbrush was has been proven to remove up to five recently ranked the number one power times more plaque along the gum line toothbrush by The Gadget Show. The products versus a regular manual brush. The bristle were tested under the supervision of Dr Uchenna head configuration of the Oral-B power Okoye, the dentist who does the teeth makeovers toothbrush works in harmony with the Finance 4 Patients provides a revolutionary, on the TV programme ‘10 Years Younger’. handle and gives the user an amazing interest-free finance product into the Dr Okoye praised the effectiveness clean sensation. The small, round brush dentistry market. of the Oral-B 5000 and made it her top head mimics the action used in dental Traditionally, when a dental practice offers recommendation. So what is it that makes prophlyaxis. It is designed to conform finance, it’s the practice staff that does all the it so good? Well, as well as being extremely gently to the contours of the teeth, thus work. Filling out the credit application forms, efficient at removing plaque, it also tackles the encouraging patients to clean each tooth printing copies for the customer and their issue of compliance. The key to compliance is individually. It also facilitates access to provider, waiting for documents to be returned. communication and that’s why this ingenious posterior teeth. Finance 4 Patient provides a simple and model has functions to help patients to brush for Whatever your affordable way for the costs of dental treatment, longer, without applying too much pressure. patients’ dentition, including private treatments, to be paid for with A pressure indicator lights up when too much you can be sure that a 12-month interest-free loan – with not a paper force is applied, and an override mechanism Oral-B has a suitable form in sight. Designed from the ground up automatically reduces speed and stops the solution. around a paperless e-signature process, Finance pulsating motion. Your patients plan 4 Patients redefines finance for the digital age. The unit also to keep their teeth Now dentists can offer credit without the staffing alerts users when for life. Your care, cost overhead. they’ve brushed combined with for two minutes, Oral-B’s expertise, For an e-brouchure, contact Brian even displaying will help them Thomson on 01294 318718 or email a ‘three-minute achieve this goal. [email protected] reward’. www.Finance4patients.com

Scottish Dental magazine 85

Product news

Special New Alkaspray-Ultra Free CPD at the Alkaspray-Ultra is specifically formulated Dentistry Show Year offer for use within the medical/dental This is an environment to both clean and disinfect all 2012 excellent time to non-pervious hard surfaces in one simple buy Kemdent’s operation. The Dentistry Show 2012 is firmly focused on the Diamond Micro Alkaspray-Ultra formulation contains future, and with over 55 hours of free, verifiable Luting Cement highly effective cleansing agents to CPD available, aims to help dental healthcare Capsules. Available thoroughly clean hard surface areas, while professionals meet the challenges ahead. in boxes of 20 x 0.25g capsules, if you buy 60 its unique disinfectant properties achieve The two-day event, at the NEC in Birmingham capsules you’ll receive a 38 per cent discount. That a high level of disinfection. on 2-3 March is very much geared to the whole works out at £59.40 for 60 capsules during January Sixty-second high-level disinfection for dental team and offers an exciting range of 2012 – less than £1 per capsule! bactericidal (incl MRSA) tuberculocidal; seminars, live-surgery demonstrations and Diamond Micro is a resin-reinforced, chemically- virucidal (HBV/HCV/HIV, SARS, vaccinia, workshops aimed at clinicians, managers, curing, glass ionomer cement for permanent herpes, influenza H1N1/H5N1. It is also nurses, hygienists, therapists and technicians. cementation of orthodontic appliances. With yeasticidal and fungicidal. Leading policy-makers, clinicians and experts will a working time of two to four minutes at room The spray has a universal alcohol-free air their views in a series of thought-provoking temperature and a sets-in-the-mouth time of solution – ready to use on panel debates that range from recession-proofing three to five minutes, these capsules are easy to virtually any non-porous businesses, to the changing role of hygienists handle, have a low solubility in the mouth and high surface. and therapists, to competition for UK dental labs adhesion. They also have an excellent potential for Available in both a and much, much more. luting zirconium oxide crowns. one-litre bottle with And, thanks to 4everlearning trigger and five-litre (www.4everlearning.com), everyone visiting the For information on Kemdent’s full range of economy drums. show will also be able to access free online CPD. Diamond products or to request your free sample, call Helen or Jackie on 01793 770090 Visit our website www. For more information, please visit or visit our website, www.kemdent.co.uk and alkapharm.co.uk www.thedentistryshow.co.uk, call 020 7348 follow us on twitter @Kemdent 5269 or email [email protected]

Scottish Dental magazine 87 Product news

Quality repairs Learn the key to Nitram Dental goes and servicing from implant success off like a ‘gazelle’ Handpiece Express With the DAC Universal The Implantology Year Course with Dr combination autoclave Handpiece David Guy, in association with Biohorizons, as the driving force, the Express is the comprises 10 lectures over 12 months, as Danish company Nitram brand name well as practical sessions, and commences Dental A/S has grown for The Dental in January . throughout the financial Directory’s handpiece repairs and servicing Offering 70 hours of verifiable CPD and crisis – partly as a result branch, offering service and repair packages requiring no experience of implantology, of dental clinics having a for all handpieces, motors, couplings and sonic this course provides a very high level of greater focus on hygiene. scalers. training, enabling clinicians to perform As a result, the company Every repair and service by Handpiece Express implant dentistry skilfully. has just been allocated ‘gazelle’ status – a is guaranteed, with each instrument tested to The lectures and practical sessions will Danish designation for high-growth companies. ensure its performance matches specifications. be held at Dr Guy’s practice in Cardiff. DAC Universal combination autoclaves clean, For absolute quality of service, all Handpiece Dr Guy achieved a distinction in his MSc lubricate and sterilise dental instruments. Express technicians are manufacturer-accredited, in Implant Dentistry and holds a Certificate They also provide a healthy business for the and will ensure the quality of every repair by in Restorative Dentistry. The Implantology manufacturer – Nitram Dental in Denmark. As individually testing all replacement parts. If your Year Course costs £4,000 per person and a result, the company has been able to turn its handpiece is not returned within 24 hours of a is limited to eight participants. back on the current financial crisis. telephone quote, you will not be charged. Nitram Dental has more than doubled its For further details, please visit www. turnover in the course of just four years, and has To find out more about handpiece service and courses.guysdentalclinic.co.uk, email returned a profit each year. The company has repair, contact Handpiece Express today on courses @guysdentalclinic.co.uk or call therefore just been designated an exceptional 01253 600 090 to receive impartial expert 02920 growth company by the most important Danish advice and fantastic value. Alternatively, 220 business newspaper, Børsen. Out of more than contact The Dental Directory on 0800 585 794. 560,000 registered companies in Denmark, only 586, or visit www.dental-directory.co.uk 827 have achieved the coveted gazelle status.

88 Scottish Dental magazine

Product news

Virtual and real-time Latest patient-specific efficiency with the CAD/CAM abutments Atlantis 3D Editor Astra Tech Dental is result. The abutment is pleased to announce available in five shades of Astra Tech Dental, leader and the introduction of biocompatible zirconia, provider of comprehensive solutions Atlantis crown abutment including the exclusive for implant dentistry, is pleased modifications, such as core, margin for single-tooth screw- translucent white zirconia. to announce the introduction of and shoulder adjustments to their retained restorations. A cost-effective solution, Atlantis 3D Editor, a service that Atlantis abutment designs. In The introduction of saving time and money. will further improve efficiency and addition, it offers the convenience of Atlantis crown abutment turnaround time. 24/7 access to their Atlantis cases. will be an important addition Contact Astra Tech product Atlantis 3D Editor is the latest to dentists preferring screw- manager Chris Orpin on 0845 service offered in the internet-based For further information, please retained prosthetic solutions. 450 0586, e-mail: implants. Atlantis WebOrder system, a natural contact Chris Orpin, product The Atlantis crown abutment is [email protected] or visit next step and an enhancement to manager, on 0845 450 0586, uniquely designed from the final www.astratechdental.co.uk or the Atlantis 3D Viewer software. email [email protected] tooth shape for a more natural www.atlantisabutment.com Atlantis 3D Editor provides the or visit www.astratechdental.co.uk possibility to make real-time or www.atlantisabutment.com “A very exciting ‘No-touch’ technology development” The all new compact, wall • Alsoft-E 1.2 litre mountable touch-less sensitive hand/skin Dr Eoin Fleetwood is based at Eyre with, as do our referring dentists. Saraya UD9000 infrared disinfectant (800 Square Dental Clinic, a state-of-the- “This platform shift will allow dispenser with its applications) art dental practice in Galway, West more predictability in maintaining ‘no-touch’ technology will • Saraya 1.2 litre mild Ireland. He has been working with the bone height close to the accurately dispense foaming hand soap (1500 the new NobelReplace Platform Shift restored platform of the fixture, Alsoft-E clinical/surgical applications). (Terms and implants from Nobel Biocare. which can only help to minimise hand disinfectant or conditions apply.) “The introduction the possibility of recession hand soap. Now available complete with a of a true platform- problems. The fact that we Features include: a new compact 1.2 litre refill pack for just £89. shift ability with the do not have to order a new design (152x100x290mm) and full NobelReplace is a very inventory of restorative clinical hand disinfection in just 15 Call Alkapharm customer exciting development,” components is also very seconds. We are also offering a service 01785 714919 or said Dr Fleetwood. “We desirable.” special introductory offer where for comprehensive product have worked with the each dispenser comes with a FREE Information, simply visit our NobelReplace Tri-Lobe Contact Nobel Biocare on choice of either: website www.alkapharm.co.uk for the last ten years and 0208 756 3300 or visit find it a very simple platform to work www.nobelbiocare.com Ease the cost of decontamination Enjoy many fantastic discounts with Value+ can be a real challenge. With this in mind, DPAS have teamed up with In these difficult catalogue prices with Campbell Montague International financial times, there are its special Value+ From 2012, a decontamination room (CMI), to offer their client practices a numerous challenges promotion that will run will be a legal requirement in all loan to cover expenditure associated facing the modern until the end of the year. dental practices and failure to comply specifically with the implementation dental practice. The A one-stop-shop could result in your practice being of HTM01-05 regulations. increasing cost of regulation and for all your everyday essentials, closed down. The unsecured loans are compliance is certainly one – as The Dental Directory also stocks For those who require significant underwritten by a major UK bank with too is the cost of overheads. While specialist materials from the likes of changes this work can cost many a strong track record working with the outgoings may be increasing, orthodontics and facial aesthetics. thousands of pounds and funding medical and dental professions. income is dropping, with fewer such finance from day-to-day patients attending. For more information, contact cashflow can be difficult when Practices should contact their In response, The Dental Directory The Dental Directory on 0800 appointment books are not DPAS practice consultant for more is offering savings of up to 54 per 585 586, or visit www.dental- necessarily full. Moreover, finding a information or telephone 01747 cent off its competitors’ published directory.co.uk suitable loan in the current climate, 870910 for an application form.

90 Scottish Dental magazine