If there’s one thing that causes our patients more pain than anything else, it’s toothache. As dentists, we have front-row seats to the effects of this problem – and we know how debilitating it can be. Not only does toothache cause excruciating physical pain, it also causes incredible emotional turmoil, usually because it can stop us eating or sleeping properly. Of course, we all know the various reasons behind toothache – and, in most cases, we can treat it effectively. But it has always been a mystery exactly why toothache is so bad and causes so much physical and emotional suffering, especially when compared to other injuries or ailments. Indeed, many people would rate toothache as a far greater pain than a broken bone or sprain, and they regularly admit it is far more emotionally draining too.

Scientists in America may have recently discovered why this may be the case. A team from Duke University in North Carolina has found that sensory neurons from the teeth and face are wired directly to one of the brain’s principal emotional signaling hubs, while sensory neurons from the body are connected only indirectly. Pain signals from the head versus those from the body are carried to the brain through two different groups of sensory neurons, and it is thus possible that neurons from the head are simply more sensitive to pain than neurons from the body are.[1]

Their research also suggested that these pain groups which were directly connected to the facial area activated the brain’s emotional centres more dramatically than elsewhere. This would mean that the strong emotional reaction to toothache and similar ailments have a biological root cause that is, in the majority of cases, inescapable.

In practice, this means that we, as dentists, should not simply be focusing on the treatment of our patients’ pain, but responding to the emotional aspects of that pain as well. Of course, the majority of patients will only be concerned with the removal of the pain – that’s what they primarily come into the practice to have solved. And while we should adhere to our patients’ wishes and do everything we can to safely and efficiently provide a solution, we should also be mindful of their emotional response – not only to the pain, but to the solution too.

After all, the teeth are crucial to our self-esteem and self-image – and if the treatment we have proposed to remove their pain comes at the cost of extracting a tooth, then we have to help patients deal with this decision. Similarly, as we all know, dental treatment can cause incredible anxiety in patients – exacerbated by pain – and we must use all of our skill and expertise (not to mention our professional empathy) to help patients deal with these insecurities.

Another important aspect of dealing with the emotional response to dental pain and palliative treatment is aftercare. It is crucial that we do not simply ‘fix’ our patients and cut them off to fend for themselves. Even with relatively routine treatments, it is important to communicate with patients throughout the healing stage – even if it is to reassure them that everything is OK. Sometimes it is easy to forget, especially after hundreds of cases, that the patient might not realise that something we would recognise as normal is such. They might not realise that the ache or pain they are experiencing is part of the typical healing process and is nothing to worry about.

These emotional markers are crucial for not only effective healing, but also for building a strong relationship with the patient and assuage any fears they might have about future visits to the practice.

The research done by the team at Duke University, while certainly an enlightening look into the neurological repsonses to dental and facial pain, is more useful to us as a reminder to consider all aspects of our patient’s reaction to toothache – and can be used to direct our attitudes to dealing with both pre- and post-operative situations that might cause our patients emotional suffering. Indeed, it is the remit of any healthcare provider to care for the patient in the most wholesome and holistic manner, and by looking at toothache as more than just a physical pain to soothe, we can provide our patients with a better, more empathetic service in the future.

For further information please call EndoCare on 020 7224 0999

Or visit www.endocare.co.uk

[1] Dental Tribune: Toothaches: Why head and facial pain cause particular suffering. Link: http://www.dental-tribune.com/articles/news/americas/37211_toothaches_why_head_and_facial_pain_cause_particular_suffering.html

Every general dental practitioner has an understanding of the fundamental principles of root canal treatment. You clean out the canals to eradicate infection then fill and seal the space inside the root where the tissue had been – simple. Or at least it is on paper and when you’re practicing on phantom heads in a classroom. When you’re new to the game and your experience of providing endodontic treatment in the dental practice is limited, achieving successful results can be anything but simple.

Indeed, according to the British Endodontic Society the success rate of root canal treatment is 90% if carried out to good standard, yet problems can occur if the tooth develops decay or the restoration fails.[i] With the additional prospect of human error, dentists can never be too careful when providing endodontic therapy. If you’re a general dental practitioner (GDP) looking to branch out into endodontics, here are some points to consider.

First things first, you need to be confident in your diagnosis before proceeding with root canal treatment. There are a number of tell-tale signs to look out for, including lasting or severe hot and/or cold sensitivity, periapical lesions of endodontic origin (which can present with and without biting sensitivity), localised gingival swelling and tenderness, and foul odour. To diagnose correctly, a full history and full examination (both intraoral and extraoral) are always required. Particular attention should be paid to palpation, percussion and mobility. Radiography of the root and periapical region is also essential, while pulp testing, the use of an electric pulp tester, thermal pulp testing and sensibility testing are useful techniques, especially in complex cases.

The more information you have the better, as it will enable you to determine whether or not you are able to treat the patient yourself. Generally, the rule of thumb is that if all the canals of the tooth are clearly visible in the radiograph, then a GDP can attempt the root canal treatment. However, there are a number of exceptions where a GDP would not be qualified to carry out the treatment, in which case the patient would need to be referred to a specialist endodontist. Any instance where the canals are not visible is regarded as a complex case, as is any patient where the canal appears to start mid-way down the root. Other exceptions can include teeth that have had previous root canal therapy, long roots, severe root curvature and posterior teeth with difficult access.

With the cases that you are able to treat there are a few top tips you can follow to help achieve a successful outcome. When cleaning the canal to provide a canal shape that can be fully obturated, for instance, be sure to remove as little tooth structure as possible to ensure maximum strength during the procedure. The file that you use is also important because some rotary files can fracture in the canal if they aren’t strong enough to withstand the rotation. As such, you must take care when putting together your ‘toolbox’ to select tools with a proven track record of performance. The HyFlex EDM NiTi files by COLTENE, for example, which offer up to 700% higher fracture resistance, are well known for their flexibility and strength. This unique combination also makes it possible to reduce the number of files required for cleaning and shaping without having to compromise preservation of the root canal anatomy for maximum efficiency.

Once debridement and disinfection has taken place, care must be taken to get obturation just right – in other words ensuring that the canals are not under filled or over filled. Radiographs are helpful to a certain extent, but as they can only show you where the radiographic apex is and not the anatomic apex, it is always best to use this method alongside other tools and techniques. The use of an apex locator is one such solution that is renowned for achieving accurate results, as it determines the working length and calculates where to end the instrumentation and obturation. It can take a bit of getting used to so the more practice you can get in the better. Courses are a great way to learn and improve techniques, so it might be worth signing up to a one or two-day hands-on training course if you have the time.

Undoubtedly, endodontics can sometimes be challenging for new comers. However, if you take the time to research recommended practices, become more proficient through training and source the best materials and tools from leading manufacturers like COLTENE, then you can rest assured that you can provide safe and effective endodontic treatment to your patients.

To find out more visit www.coltene.com, email info.uk@coltene.com or call 01444 235486

[i] British Endodontic Society: Further Information. Accessed online 1^st December 2017 at https://www.britishendodonticsociety.org.uk/patients/further-information.html

It was reported recently that common oral health problems are costing the economy more than £105 million each year in sick days, with around one in 20 UK employees thought to have taken time off in the last year alone.[i]

The growing sugar consumption is one such problem that continues to plague the profession. Indeed, despite widespread efforts from the government, avid campaigning from a number of high profile dental bodies and attempts from global food companies to reduce sugar content in popular food products, intake remains well above the recommended sugar allowance. It doesn’t help that every which way we turn there’s some sort of sweet treat there waiting to tempt us, from cakes and biscuits being passed under our noses in the workplace to chocolate and fizzy drinks on display in our local supermarket. Even those with high self-control are likely to crack from the pressure of temptation.

The same goes for alcohol. Despite a notable decline in consumption, there is still a booze culture in the UK that threatens to reverse all the hard work that has been going on behind the scenes. Dental caries and periodontal disease are two of the main culprits for toothache and oral discomfort, and it’s no coincidence that excessive drinking has been linked to both these conditions. Throw in the effects of tobacco on oral health (the prevalence of smoking in adults aged 18 and above is 15.5 per cent)[ii] and it’s almost no wonder that employees are taking time off to deal with or rectify oral illness.

Of course attendance remains one of the largest issues, with data suggesting that just 61 per cent of adults go for a check up on a regular basis and more than a quarter of adults only visit their dentist when they have a problem.[iii] Accessibility has had a lot to do with this, as has affordability.

So what can be done to help? As well as encouraging regular dental checks, raising awareness and urging patients to adopt a thorough oral hygiene routine will be essential moving forward. You’ll also need to recommend products that are affordable yet effective, such as Curaprox CS toothbrushes and CPS interdental brushes, informing patients of the benefits that using specially designed adjuncts can have on their oral health.

The needless pain of patients that are resorting to going off sick simply cannot be allowed to continue any longer, and with your ongoing support and hard work the profession can put an end to this suffering.

For more information please call 01480 862084, email info@curaprox.co.uk or visit www.curaprox.co.uk

[i] The Oral Health Foundation: ‘Charity urges workplaces to tackle poor oral health as sick days cost UK economy £105m’. Published 15 May 2017. Accessed online 17 August 2017 at https://www.dentalhealth.org/news/details/961

[ii] NHS Digital: ‘Statistics on Smoking, England – 2017. Published 15 June 2017. Accessed online 21 August 2017 at http://www.content.digital.nhs.uk/catalogue/PUB24228

[iii] National Smile Month: ‘Facts and Figures’. Accessed online 21 August 2017 at http://www.nationalsmilemonth.org/facts-figures/

Your dental surgery is the workspace where you will treat and interact with your patients for many years. It must be right for you, your staff and your patients in serving your needs today, and also changing with the times. Be sure to take your time and plan it carefully, with a clear vision and the right help, it will be well worth the effort and any headaches incurred along the way.

Here are some important principles for you to consider that might make the process easier:

Work towards set objectives

The very first step to designing a dental surgery is to decide precisely what you want from the space you have. This includes deciding what demographic you will be targeting, what type of dentistry you will be offering and where you want to be in the future. Only after you have these things ordered in your head should you begin the project, with your goals set firmly at the finish line. By doing so, the result of all your hard work and investment will be what you always wanted.

Plan for the future

Designing a dental surgery with nothing but the present in mind will undoubtedly lead to issues further down the line. Dentistry in the UK is advancing at an unprecedented rate and new technology is appearing on the market every year, making it necessary for dental professionals to adapt to emerging trends and patient expectations. Keeping an eye on what is just around the corner whilst planning the layout of your dental surgery will help you prepare for any changes that might come your way – and will ultimately help you ‘future proof’ your business.

Use your space wisely

You must consider the best ways to utilise the space you have available in the surgery. A dental surgery must allow for comfortable access and efficient treatment, but not waste unnecessary space. Every inch of your surgery should be used to its full extent, so it’s worth taking the time to plan out exactly where you think things should go – and whether it is the best place for them.

Cabinetry position

Cabinetry is a crucial element of any dental surgery – and its placement will directly impact your workflow. As such, it’s important to consider how you and your team like to work and design your space around your preferences. For example if you utilise the four-handed technique, your cabinetry will need to be arranged to facilitate a better workflow. All cabinetry must contribute to everyday efficiency, whilst also conforming to both ergonomic and regulatory requirements.

Aesthetic appeal

With so much else to take into account, it can be easy to forget that your surgery also needs to look great, not only your reception area or the waiting room. Today’s patients expect an ‘experience’ when they visit the dentist, and your surgery should reflect who you are as a practice, whether it is in the colour scheme or the choice of music to put your patients at ease as they undergo treatment. This does not need to break the bank – little touches can, after all, make all the difference – but it is important to put the effort in.

Invest in quality technology

Dentistry in the UK is experiencing a definite evolution in terms of equipment and technology. It is important, therefore, to stay up with the latest trends – in order to stay current and at the cutting edge. But choosing new dental equipment can be a monumental task. With every manufacturer maintaining that their products are best, it can be difficult to be sure that what you’re spending your hard-earned money on is worth what you are paying for it. Quality is, by far, the most important consideration when buying new equipment – and the best way of ensuring quality is to buy from a trusted dealer.

Get help from the experts

Considering all the big and small necessities for your all-important surgery is no mean feat – and you may find yourself out of your depth. As such, it can be beneficial to get help from a company that is experienced with dental surgery design. This way, you can rest assured that the decisions you are making are backed by the experts. Clark Dental, for example, have over 40 years’ experience of helping dental professionals design their dental surgeries and know precisely what is needed to turn an initial idea into reality. They also have expert knowledge of the latest dental technology, meaning they can be trusted to provide you with the very best products.

Designing a dental surgery that will serve the needs of you, your staff and, of course, your patients is always a challenge – but with the right help, you will be able to create something you will be proud of!

For more information call Clark Dental on 01268 733 146, email info@clarkdental.co.uk or visit www.clarkdental.co.uk

It’s a huge leap from associate to practice principal. The planning process alone can be daunting, especially if you’re beginning from a standing start. However, with a bit of time and effort it doesn’t take long to set the wheels in motion, you just need to know where to begin so that when the time comes, you’ll be ready.

As silly as it might sound, it’s always good to start with your CV. By thinking about the sort of practice you might like to buy, you can build up a stable work history in that area. Any future lender will need to feel confident that you have the experience and ability to run your own practice, and your CV will be a key document in proving your suitability as a principal. It’s never too early to start organising your finances either. Your financial affairs will come under scrutiny by the bank sooner or later so you might as well get everything in order and start saving for a deposit as soon as possible – even if buying isn’t on the cards for several years.

Alongside this, look at what’s out there well in advance of when you actually intend to buy. Because although it may be a while before you’re in a position to be able to buy, it’s certainly never too soon to scope out the marketplace – what’s popular, what’s not, and what’s predicted to be – as it will allow you to get a feel of the market. That way when the time is right you’ll be well placed to make a competitive offer and feel confident in your decision-making. As you know, trends can change and the average sale price across regions and practice types will fluctuate depending on the state of the economy, so by recognising shifts you’ll be able to stay well ahead of the game.

Equally, keep your options open. With demand still very high across the sector, you may need to look at a wide variety of practices in different locations before you find an ideal fit. That means keeping a watchful eye on all the big players, because much like homeowners will often sell through one estate agent, vendors tend to stick to one agency for the sale of their practice. If you were to only target one company in particular your options would be limited and you would run the risk of missing out on your perfect practice.

Just be prepared that when you do find a suitable practice you’re interested in, you’ll likely need to have an independent valuation carried out on behalf of your lender to confirm your offer. It is well known that lending banks value conservatively and as they can only rely on comparable data from completed practices they are usually nine months behind the market. This could affect the amount of cash input that would be required from you to make the transaction work. This is especially true if you are competing against corporates and micro-consolidators that have bigger pockets and don’t have the bank valuation hurdle to overcome. Even if you later decide against that particular practice or you miss out, you’ll have a better understanding of the process ready for when the right practice comes along.

If, however, it’s the case that you plan on buying into the practice where you are an associate, your strategy will be a little different. For starters, you’re already one step ahead in that you’ve found your ‘ideal practice’, but you will still need to determine the value by having an independent valuation. The other decision that you’ll need to make is whether you want to buy outright or purchase in instalments over time.

Alongside this, be sure to find out the principal’s exit strategy in advance to optimise your chances of achieving a smooth changeover with minimal impact on the practice and finances. Again, it can help to do your homework on the work involved, and acquire the appropriate knowledge so that you know what you’re letting yourself in for. If you are caught unawares a partnership agreement could force a sale of the whole practice if you can’t finance the remaining share.

When it comes to the legal and technical side of things seeking advice from a specialist sales and acquisitions agency can go a long way in ensuring a successful outcome. Dental Elite, for instance, will arrange the sale structure and finance, as well as guide you through the acquisition process from start to finish.

Altogether, there’s a lot to take in when planning to buy, but as long as you start preparations early and have the right support the transition from associate to principal should be successful.

For more information on Dental Elite visit www.dentalelite.co.uk, email info@dentalelite.co.uk or call 01788 545 900