Endodontic procedures are risky and a miscalculation can prove costly in terms of a poor outcome for the patient and the potential for a claim or complaint. But by working alongside a specialist endodontist, cases can be treated quickly and effectively, benefiting everyone involved.

Endodontists become specialists by completing two or more years of advanced training following dental school. They perform routine as well as difficult and very complex endodontic procedures, including root canal treatment, endodontic surgery and special procedures to save teeth after traumatic dental injuries. By focusing on specific areas such as root canal treatment, surgery and trauma, endodontists are experts at managing a wide array of complex endodontic problems efficiently. They also have advanced technologies at their disposal, and along with specialised techniques, they can gain a very accurate view of the inside of the tooth, which allows them to treat cases quickly and comfortably.[1]

Endodontists are also experienced at finding the cause of oral and facial pain that has been difficult to diagnose and can work with referring dentists to ensure patients get the correct care. By saving the tooth, a specialist can help to maintain the patient’s natural smile, so they can remain functional and maintain their overall health.¹

But referring is not always simple, as many patients are often unprepared to pay more for specialist endodontic work. This puts pressure on GDPs to undertake the procedures themselves which can often lead to inadequate results. Mid-treatment referrals, particularly aborted attempts, should be avoided wherever foreseeable following preoperative assessment. This is because they are frequently associated with complications, often making the procedure much more difficult and unpredictable for the endodontist. Furthermore, a patient who experiences problems after not having been referred in time may also lose his or her confidence in the GDP. To avoid mid-treatment referrals, the GDP should carefully select between cases that they can undertake and those they should refer to an endodontist. Immediate referral also benefits the patient, as it helps to reduce additional costs in the long run.[2]

It is important for the referring GDP to assure the patient of their upmost confidence in the endodontist. Developing a strong relationship with an endodontist will help to ensure the process is seamless and allow the GDP to work in partnership with the specialist to deliver quality dental care. Certain aspects need to be taken into account when deciding where to refer cases, including location, patient management, waiting time and ultimately the quality of care. The London Smile Clinic is an award winning referral dental centre that offers outstanding endodontic treatment. The latest technology and techniques are employed by the team of expert specialists, allowing them to deal effectively with the most difficult cases. What’s more, you can be confident that you will be kept informed during every stage of the process until your patient is safely returned for continuing care.

Endodontic treatment can have a success rate of up to 90%.[3] By referring out complicated endodontic work, both the GDP and specialist can work together to provide patients with exceptional care and fantastic outcomes.

For more information, please contact 020 7255 2559 or
visit www.londonsmile.co.uk/refer

[1] Sigurdsson, A. (2010). Trauma & nerve damage to teeth. Dear Doctor. Available online: http://www.deardoctor.com/articles/trauma-and-nerve-damage-to-teeth/index.php [Accessed 9^th February 2016].

[2] Broome, J. L. (2016). Main non-clinical factors influencing endodontic referral. Primary Dental Journal, 5 (3), 64-68.

[3] British Endodontic Society. Further information. Available online: https://www.britishendodonticsociety.org.uk/patients/further-information.html [Accessed 8th February 2017].

As a particularly nasty strain of flu threatens the UK, make sure you’re prepared!

‘Tis the season for flu right now and you will likely be encountering the nuisances of no-shows and last minute cancellations. While these reduce efficiency of the dental surgery, the annual bout of nationwide influenza is completely out of our control.

However, this year’s influenza warning comes with extra caution following the worst flu outbreak for 50 years in Australia. Many in the healthcare sector are concerned that the deadly strain is currently on its way to the UK.

Why the alarm?

Every year, winter brings with it the cold and flu viruses, with thousands of people being affected throughout the UK. Under normal circumstances, influenza is not life-threatening and most people can treat themselves at home by getting plenty of sleep, staying warm, drinking lots of water and taking mild over-the-counter painkillers to lower their temperature and ease the aches and pains.

There are different strains of influenza that can circulate and they are split into three categories – A, B and C. Influenzas A and B are responsible for the annual flu season, while type C symptoms are far less severe.

There are very serious fears right now that an outbreak of the Influenza H3N2 strain is about to hit the UK, which is a category A. The strain has reportedly been responsible for the worst outbreak of flu in Australia in a long time, where more than 195,300 cases were confirmed by the beginning of September (the end of their winter season) – almost two-and-a-half times more than in 2016.[1] At time of writing, 417 influenza-related deaths had been reported to the National Notifiable Diseases Surveillance System, 87% of which, were the result of influenza A. Notification rates were also highest in adults aged 80 years or older, with the second most common age group being children of 5 to 9 years.

This particular strain is believed to be similar to that which circulated the UK in the winter of 2014/15, which caused chaos among the population and led to a significant number of fatalities. Experts are warning that the H3N2 strain could pose the same threat to humanity as the Hong Kong flu pandemic of 1968, which killed a devastating one million people worldwide.

Some scientists have also raised concerns that this year’s vaccine might not be effective against the H3N2 strain. Made by World Health Organisation in March, based on the influenza strains their scientists expected to circulate this year, the vaccine given out from September may not match the H3N2 strain and could therefore leave the population vulnerable to the virus. The consequence of this could spell trouble for the already stretched NHS, with the possibility of elective treatments being postponed as Trusts attempt to deal with the huge scale flu outbreak currently expected.

What can we do?

Educate patients

Most adults can pass on the virus from one day before symptoms develop (which is typically one to four days after the virus enters the body) until 5-7 days after becoming sick, but children may be contagious for longer. As such, seemingly healthy patients may unwittingly visit the dental practice while infected, increasing the risk of virus transmission to both staff and other patients. It’s therefore important that you highlight the risks associated with flu season so that people are aware of the dangers. They should be reminded and encouraged to wash their hands regularly and stay at home if they suspect that they have the virus, or if they have recently been in contact with someone who developed flu. Patient information leaflets, emails and a section on the website are all good communication techniques.

Stop the virus in its tracks

Flu is transmitted via droplets propelled into the air when a contaminated person coughs or sneezes and the resulting droplets land in someone’s mouth or nose, or are inhaled into the lungs. It is also possible to contract the virus by touching a surface or object that is contaminated with similar droplets and then touch the mouth or nose. You should therefore make tissues and hand santiser available in the waiting room to help prevent virus paticles from spreading. It’s also essential to use disinfectants and cleaners you can trust to eliminate viruses from inanimate surfaces and objects. The Steri-7 Xtra range of products from Initial Medical deactivate 99.9999% of pathogens, including influenza A and various other viruses, infections, fungi, spores and yeasts. Non-toxic and non-irritant, the high level surface disinfectants feature ‘Reactive Barrier Technology’ that offers protection for up to 72 hours after application.

By taking these two simple steps, you can do your bit to help prevent the widespread transmission of the so-called ‘Aussie-flu’ this winter. Influenza is nothing new and we should be on guard every winter season to help protect vulnerable people from the impact of the virus. As it seems that the threat could be greater than normal this year, continued diligence and patient education are more vital than ever.

For further information please visit www.initial.co.uk/medical or Tel: 0870 850 4045

[1] Australian Government Department of Health. Australian Influenza Surveillance Report. No. 10, 2017. 16-29 September 2017. http://www.health.gov.au/internet/main/publishing.nsf/Content/cda-surveil-ozflu-flucurr.htm/$File/ozflu-surveil-no10-2017.pdf [Accessed October 2017]

Today’s Generation Z can count their blessings when it comes to their health, even if they choose to do it with one of their new fangled gadgets. They have been born into a world where medical advances have brought the reduction of many major diseases in human societies, including poliomyelitis, measles and tuberculosis, and the eradication of one – smallpox. Previously, if these diseases did not kill their sufferers, they certainly did not make them stronger, and often left them with permanent disabilities or disfigurement.

In their wake, medical practitioners today face new challenges that were unknown or rare hundreds of years ago. Instead of the infectious diseases of the past, many of these conditions are lifestyle related – morbid obesity, metabolic syndrome, atherosclerosis, heart disease, type 2 diabetes, lung cancer and other respiratory illnesses caused by tobacco use.

Unfortunately, there is also one ancient disease that while known to our ancestors, has soared to become a global pandemic in the past 300 years – dental caries.[i] It is an equal opportunity abuser; it is not merely an affliction of developing nations, where dental care and oral hygiene education are low, but also of wealthy countries, where the disparity between dental care for the affluent and economically disadvantaged is pronounced.

Wherever they come from, its victims experience its detrimental effects on their lives, from the pain they endure, to difficulty in eating and speaking from decay of the teeth. Children in particular confront other problems, from the impact on their education from absenteeism from school, to embarrassment and bullying, which have been reported in studies of caries among youth around the world.[ii]

In the UK, dental decay persists as a complex problem linked to lifestyle habits, education and poverty. Although online viewing has overtaken TV viewing in recent years, British children still watch on average more than two hours of television daily.[iii] As they sit in front of their TVs, they are assaulted by a barrage of food advertisements, many for products that are cariogenic. A 2012 study of TV advertisements found that almost 70 per cent of food commercials during children’s peak viewing hours were for products that were potentially harmful to their dental health.[iv] The advertisements appear to hit home, with UK youngsters consuming more sugary drinks than anywhere else in Europe.

The effect of excessive refined sugar consumption is clear in the surge in dental decay incidence among children in the UK, particularly in economically deprived areas. In 2014-15, 33,781 children under the age of 10 underwent tooth extractions in England, an increase of nearly 10 per cent from 30,761 four years earlier; almost 129,000 kids had teeth extracted during that four-year period.[v] Alarmingly, it is the number one cause of admittance to hospital among UK children. There are warnings that the situation may get even worse; in August, a leading daily newspaper ran a front-page story describing the “sugar tsunami” of cheap imports that were predicted to cause a spike in obesity rates in the long term, and dental decay in the short. [vi]

Dental professionals are on the front line of the mission to safeguard the nation’s dental health, and they are determined to use preventive dentistry to keep children’s teeth healthy instead of accepting caries as an inevitable part of life. In 2017, there have been several initiatives to overcome the problem. The British Association of Paediatric Dentistry is campaigning for the “Dental Check by One” for all UK infants to prevent caries.[vii] The Irish Dental Association is urging its government to pay for children’s first dental check-up[viii], while the British Medical Association wants the distribution of free toothbrushes to all under-fives and graphic warnings on sugar-laden products focused on child consumers[ix].

Dental professionals have also called upon parents to take responsibility for educating their children about dental health and hygiene. It is here that technology can play a part in showing patients when dental decay is developing. The revolutionary CALCIVIS® imaging system, which can be used on patients as young as six years of age, reveals active demineralisation on tooth surfaces, allowing dentists and their patients to treat the problem of caries before it progresses to cavitation.

It’s time to take the battle of dental caries in hand. Consistent and concerted preventive dental hygiene education and technological advancements will be the essential weapons in winning the war.

For more information visit www.CALCIVIS.com

or call 0131 658 5152

[i] Caries through history: http://cdn.intechopen.com/pdfs/32161/InTech–

[ii] Impact of dental caries on pre-school children’s quality of life: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1806-83242012000700015

[iii] UK children & time spent online vs TV viewing: http://www.bbc.co.uk/news/education-35399658

[iv] Food ads on UK TV popular with children http://www.nature.com/bdj/journal/v222/n3/full/sj.bdj.2017.120.html?foxtrotcallback=true

[v] Rise in tooth decay among UK children: http://www.bbc.co.uk/news/health-35672775

[vi] Implications of EU lifting of curb on sugar quota in October 2017: http://www.express.co.uk/life-style/health/836756/Brexit-EU-imports-obesity-crisis-UK-European-Union-cheap-sugar-farming-policy

[vii] Dental check-ups for under-ones: http://www.nature.com/bdj/journal/v223/n1/full/sj.bdj.2017.566.html

[viii] Irish Dental Association recommendations: http://www.thejournal.ie/children-dentist-check-ups-cutbacks-operations-3249274-Feb2017/

[ix] BMA recommendations for children’s dental health: http://www.telegraph.co.uk/news/2017/06/29/free-toothbrushes-toddlers-doctors-demand/

More than 2.5 million cases of healthcare-associated infections occur each year in the EU/EEA resulting in high numbers of morbidity and mortality.[1] The risk of infection associated with contamination in dentistry is still unknown. However, cross-transmission of viruses and bacteria is believed to be significant and often under-reported among dental practices.[2] Prevention and control of infection through effective decontamination is essential for the safety of both personnel and patients.

The dental setting provides a unique environment that exposes staff and patients to a number of major risks of cross-contamination. The oral cavity alone offers a natural habitat for a large number of microorganisms, such as fungi, bacteria and viruses, as well as saliva and blood that are known vectors of infection. The ecological niche provides a reservoir for opportunistic and pathogenic microorganisms that have the potential to cause infection. This is particularly important in cases of routine dental practice, where procedures are open and invasive.²

There are a number of possible means by which transmission of viral and bacterial pathogens can occur. Pathways of contamination can be bidirectional from a patient to a member of the dental team, or vice versa. Moreover, pathogens can be transferred from patient to patient through a surface located in the dental practice, or a device or instrument used during treatment. This can apply in the case of inadequate sterilisation of the dental instruments or disinfection of the dental unit.²

Saliva, blood and plasma are all major vectors of cross-transmission. Blood-borne pathogens can expose staff to dangerous and potentially lethal infectious diseases such as Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV). Contamination can arise by exposure to the infectious material through non-intact skin and mucosal lesions. However, the highest risk of this type of infection is associated with accidental punctures by contaminated needles or injuries by sharp instruments. Various studies have shown that the proportion of injuries from sharp instruments is 53%[3] to as high as 72%.[4] The other possible device-borne means of pathogen transmission can occur through insufficient cross-contamination control, such as improper decontamination of dental instruments.[5]

Stringent standards are required in order to meet legislations and provide a safe environment for staff and patients. When it comes to decontamination of instruments, the dental team must follow a strict cross-infection regime in accordance with HTM 01-05. Instruments must be cleaned, lubricated and then correctly sterilised. It is worth regularly reviewing the most effective methods of improving these in order to meet current guidance and improve the work-flow. For example, the use of thermo-washer disinfector dryers, such as the ThermoKlenz from W&H is considered to be ‘best practice’, for a number of reasons.

Accredited thermo-washer disinfectors are manufactured for purpose and are sophisticated medical devices: thorough cleaning is achieved by very high water flow rates at high pressure, these machines use formulated and validated solutions for the particular machine cycles, developed to take into account cleaning efficacy balanced with the necessity to minimise damage to instruments. They ensure a reproducible, valid and medically effective washing process is achieved every time, reducing the risk of cross infection amongst patients and team members.

Following effective cleaning, dental handpieces require lubricating with manufacturer recommended service oil prior to sterilisation. The majority of dental handpieces do not require disassembly prior to decontamination, although some specialist instruments are able to be disassembled. The manufacturer’s instructions should always be adhered to, whether lubricating manually or using an automatic system such as the Assistina from W&H. Bagging and sterilisation then follows in accordance with manufacturer instructions, HTM 01-05 and/or other appropriate guidelines. The autoclave is a key piece of equipment in any dental practice and clean saturated steam under pressure is by far the most reliable medium for the sterilisation of medical devices. For unrivalled sterilisation, W&H offers dental practices the new Lisa steriliser with Class B automatic cycles and a fast cycle. The user-friendly touch screen and menu structure supports easy navigation, while performance is second to none with advanced Eco Dry technology, saving practices time and power consumption.

Dental instruments, including handpieces should be sterile when used in order to prevent cross-contamination. Decontamination equipment provides fast and effective sterilisation to ensure dental practices meet the current legislations. It is also worth remembering that in accordance with HTM 01-05 recommendations, decontamination equipment should be validated at the point of installation and then revalidated annually thereafter.

Decontamination is an important concern for all dental professionals, as procedures are carried out in an environment that exposes staff and patients to significant risk. Correct sterilisation, hygiene and maintenance are essential if patients and staff are to remain safe from cross-contamination.

To find out more visit www.wh.com/en_uk, call 01727 874990 or email office.uk@wh.com

[1] Cassini A, Plachouras D, Eckmanns T, et al. Burden of six healthcare-associated infections on European population health: estimating incidence-based disability-adjusted life years through a population prevalence-based modelling study. PLoS Med 2016;13(10):1-16.

[2] Laheij AM, et al. Healthcare-associated viral and bacterial infections in dentistry. Journal of Oral Microbiology 2012;4:1-10.

[3] Porter K, Scully C, Theyer Y, Porter S. Occupational injuries to dental personnel. J Dent 1990;18(5):258-262.

[4] Shimoji S, Ishihama K, Yamada H, et al. Safety among dental health-care workers. Adv Med Educ Pract 2010;1:41-47.

[5] Ramich T, Eickholz P, Wicker S. Work-related infections in dentistry: risk perception and preventative measures. Clin Oral Invest 2017;21:2473-2479.

At an airport in Europe, the first stream of early morning departures is ready to take to the skies. Under pressure to depart on time, one flight crew does a rushed run-through of the Preflight Checklist. They know its points off by heart, tick all the boxes as required and are quickly cleared for takeoff.

Unfortunately, their cursory attention to detail is to prove their downfall. In their haste, the crew overlooked the fact that the depressurisation switch was still on manual, instead of auto, and the gradual loss of oxygen in the cockpit causes the crew to fall unconscious. [i]

This may read like the scenario for one of the melodrama-filled “Airport” films of the early 1970s, but the sad reality is there was no brave flight attendant to save the day. It parallels an actual fatal crash when safety regulations were flouted in the name of meeting deadlines – with disastrous consequences.

The same rules governing the importance of adherence to protocols apply to many other fields, including dentistry, and the risks we run if we do not follow them. The procedures apply to specific aspects of the practice to ensure its success, from meeting GDC standards in patient treatment, ensuring that all administrative and legal concerns are properly covered to the accepted conduct of members of staff outlined by the Employee Handbook, among others. Each contributes in its own way to the ultimate goal of a satisfactory patient experience.

Of course, infection control figures prominently, and there can be no shirking from maintaining the highest standards for the safety of patients and your staff. After all, in its Standards for the Dental Team, the GDC states that patients must be treated “in a hygienic and safe environment …”[ii]. We all know that if we do not follow those procedures, the dental practice can be a breeding ground for hazardous viral and bacterial agents, from the hepatitis viruses, candida, e. coli, seasonal flu, Varicella-zoster virus, Streptococcus pneumoniae, Haemophilus influenza, Neisseria meningitis, Corynebacterium diphtheria, Bordetella pertussis and many more.

Some less familiar but even more potent pathogens are joining this dangerous crowd, including Methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections, MCR-1, a new strain of superbug, the coronavirus MERS CoV, bird flu, Ebola and Zika virus. Several of these, such as MERs CoV and bird flu, are viral infections of the respiratory tract, which are easily transmitted from person to person, especially through germs expelled from the oral cavity.[iii] For dental professionals, the standard use of masks and gloves, pre-procedure rinses, rubber dam and high volume suction reduces the risk of contracting many infective agents when treating a sick patient, whether they are afflicted by the common cold or a potentially deadly disease.[iv]

It is essential that all parts of the practice are sterilised to the required standards. Without stringent infection control protocols, stipulated by the Health and Social Care Act 2008, practices are at risk of transmission of infection from medical devices to service users and staff. on the prevention and control of infections and related guidance states,.[v]                        

We have probably come a long way since the findings of a survey of nearly 200 practices a year in 2009, when instrument decontamination training was limited to demonstrations in 97 per cent of cases, and 74 per cent of dental nurses and 57 per cent of dentists were unable to recognise the symbol used for a single-use device.[vi] There are still 300,000 healthcare-associated infections in patients treated in the NHS system annually but, alarmingly, a third of infection prevention experts recently reported reductions in their community infection control services.[vii]

There is no room for complacency in the ever-changing landscape of infection control, and no dentist worth his license would consider putting patients or his staff at risk. They invest in the best decontamination products available; the choice of many are those from EschmannDirect, from its range of autoclaves to surface sanitising wipes.

There is no excuse for cutting corners in hygiene maintenance and standards. For those who do will have no valid excuse for the potential ramifications and the damage to their professional reputation.

For more information on the highly effective and affordable range of decontamination equipment and products from Eschmann, please visit www.eschmann.co.uk or call 01903 753322

[i] Air Accident Investigation & Aviation Safety Board (AAIASB), Ministry of Transport & Communications, Hellenic Republic. Aircraft Accident Report: Helios Airways Flight HCY522. November 2006. Link: http://www.aaiasb.gr/imagies/stories/documents/11_2006_EN.pdf

[ii] General Dental Council (undated). Standards for the Dental Team. Link: file:///Users/officeekc/Downloads/NEW%20Standards%20for%20the%20Dental%20Team.pdf

[iii] Monaghan, N.P. British Dental Journal, Vol. 221. “Emerging Infections – Implications for Dental Care.” Online publication date July 8, 2016.

[iv] Department of Health. “Decontamination Health Technical Memorandum 01-05. Decontamination in primary care dental practices”. (2013). Link:

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/170689/HTM_01-05_2013.pdf

[v] The Health and Social Care Act (2008). Link: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/449049/Code_of_practice_280715_acc.pdf

[vi] Smith, A., Creanor, S, Hurrell, D, Bagg, J., McCowan, M. The Journal of Hospital Infection. Management of Infection Control in Dental Practice. Vol. 71, April 2009. Link: ww.journalofhospitalinfection.com/article/S0195-6701%2808%2900493-3/abstract

[vii] Infection Prevention Society. “Cuts in Investment in Infection Prevention Threatens Patient Safety.” Media release. June 2, 2017.