Month: February 2018

The life-saving difference a dentist can make – Charlotte Gentry

Recently, the programme ‘Surgeons: at the edge of life’ was aired on the BBC. The first episode demonstrated the incredible procedures used to treat those with head and neck cancers – specifically the removal of a cancer in the maxilla with a facial reconstruction using a free flap from part of the hip. Shortly after the programme I had the privilege of spending a week with the maxillofacial team at the Queen Elizabeth Hospital in Birmingham. It was truly inspiring and it reminded me of our hugely important role as dentists for these patients.

In lectures we learn about oral squamous cell carcinomas, in practice we know to look out for it; however we may only ever discover one in our lifetime as a practising dentist. It is easy to underestimate the incidence of oral cancer in the population as we are not exposed to it relatively often. I was exceptionally surprised at how many patients were treated weekly at this one hospital alone, and it gave me the realisation that oral cancers are very real and aren’t as ‘rare’ as they may seem; it turned the issue from something conceptual to reality. I saw many patients receiving the diagnosis of oral squamous cell carcinoma, receiving the news the carcinoma had been successfully resected and receiving the news that their prognosis is very poor. These patients had to undergo radical, often life-changing, surgery with very limited prognosis over five years. It re-confirmed to me how important our role as general dental practitioners is to pick these carcinomas up early. In fact, our role is just as crucial, although in a different way, as the Maxillofacial surgeons that carry out the procedures.

I saw patients who had a localised malignant lesion, which could be resected with adequate margins; their cancer had ‘gone’ and their prognosis could be up to 95 per cent over five years. There were then the patients who had cancers that had been detected later and had spread to nodes whose prognosis is significantly guarded. Of course, with every cancer the later it is detected the poorer the prognosis. Head and neck cancer, though, is particularly difficult to treat with such important surrounding structures being present. We as dentists are in the exceptional position to see patients regularly –  every six months, maybe even more frequently. We are in the best position to detect these carcinomas at the earliest stage when the prognosis is greatest. People don’t see their doctors this regularly and often ignore symptoms of other cancers as they don’t want to face the possible truth, often leading to late diagnosis of malignancies. However, we should be the reason patients have a good prognosis! Although we spend our days drilling and filling, this is the one situation where our job really can determine life or death.

I was surprised to hear from my supervising consultant that the incidence of oral cancer is on the rise, though we are unsure why this is at the moment. Smoking, alcohol and the Human PapiIlomavirus remain the most highly associated risk factors. However, I thought about the possibility of an ageing population being a possible explanation for this rise in the incidence of oral cancer. With this in mind, it is also important to remember that cancer is a disease of all ages.

My placement at the QE Hospital not only inspired me, but reminded me that however busy we are, as much as we are squeezed by time constraints, we are often hugely important in ensuring patients have the best prognosis possible. With oral cancer on the rise, we have to be even more pro-active at spotting it. We all need to do that 30 second extra oral examination and soft tissue examination, no matter what the circumstance. That next patient who walks through our door may embody our one- of-a-lifetime diagnosis.

New study shows link between red wine and healthy gums

A new study from the Institute of Food Science Research in Madrid has suggested that red wine, previously thought to stain your teeth, has other beneficial effects for your mouth.

The tests, performed on model gum tissue, revealed that a chemical in red wine called polyphenols actually prevented bacteria – that causes plaque, cavities and periodontal disease – from sticking to the gum tissue.

Although the results are at a very early stage, researchers found that when combining polyphenols with Streptococcus dentisani, an oral probiotic, they were even better at keeping bacteria at bay.

Professor Naveed Sattar, Professor of Metabolic Medicine at the University of Glasgow, was involved in the study. He told the Mirror: “The findings do not support drinking more red wine to stop people getting infections.

“There is no good evidence that drinking wine per se is overall good for health – on the contrary, more and more evidence from other sources now suggest the less wine of alcoholic drinks, the lower the risks of range of disease and the lower the mortality risks.

“People should not be fooled into thinking wine is good or health giving, however much they would like to hear such a message”

Sudden wave of departure after Dental Protection changes

Five senior dentists, who have more than 90 years experience advising dental professionals between them, have left Dental Protection in recent months.

The departures were sudden and unannounced, which left colleagues and members in a state of concern.

Those that have left are as follows: Sue Boynton, head of dental services for Ireland, Stephen Henderson, senior dentolegal adviser and head of services in Hong Kong, David Croser, communications manager, Sue Willat, head of dental services and Lynn Rees, senior dentolegal adviser.

Dr Rattan spoke to Dentistry.co.uk about the lack of announcement regarding this: “It would not be appropriate to comment on the circumstances of individuals, but we wish those who have recently left us well in the future and thank them for their strong contribution to protecting dentists.”

Dental Protection, a subsidiary of the Medical Protection Society, is currently introducing a new case management system. The new ‘whole team’ approach is claimed to give members faster access to advice.

Previously, a member of the dental team facing a complaint would call Dental Protection and be put through to a dentist for colleague advice. Under this new proposal, a staff member that does not have a qualification in dentistry will handle requests for advice initially.

Dr Rattan, the Dental Director told Dentistry.co.uk: “Members place value in the increased efficiency, and in having a multidisciplinary team at their disposal to answer queries and handle their case.”

Don’t miss the ADI Masterclass 2018

 

Supporting an inspirational programme of education for professionals, the Association of Dental Implantology (ADI) is hosting a Masterclass at IET London: Savoy Place on 10 March 2018. “The Transition from Teeth to Implant Supported Teeth” will be presented by two world-renowned dental implantologists, Dr Marco Degidi and Professor Paulo Malo. As well as providing delegates with the chance to enhance and broaden their knowledge, the programme is sure to provide an arena for some stimulating debate.

                                                                                        

There are an increasingly large number of circumstances where immediate loading allows clinicians to offer patients a very favourable result. Each speaker will deliver both a morning and afternoon session on this topic and when asked to detail the key points of his presentations, Dr Marco Degidi explained:

“One of the most important areas I intend to cover is the growing realisation that the use of immediate loading for the treatment of edentulous patients and those with terminal dentition has significant benefits over all other options. Very frequently it is the only viable choice and I will discuss a number of different techniques and approaches that can be used.

“As every clinician knows, no two patients are exactly the same and excessive standardisation of approaches is not always in the best interests of the individual patient. Therefore, I will discuss how tailoring treatment plans for a specific patient sometimes requires open mindedness and superior technical skill, yet it allows us to a provide a made-to-measure product for that patient with all the advantages that this entails.

“At the afternoon session I will demonstrate The Degidi Protocol and discuss the current state of the art and future developments in placing and restoring dental implants. We will examine the introduction of intra-oral welding and the way it has impacted and increased the number of patients that can access one-day treatment with immediate loading. I will also cover The Conometric Concept, which has made it possible to create fixed prostheses that can be fitted without the use of cement or occlusal screws.”

During his sessions of this popular Masterclass, Professor Paulo Malo intends to discuss The MALO CLINIC Protocol – a graftless, painless and immediate loading aesthetic fixed solution that can significantly improve quality of life for edentulous patients. Professor Malo will also provide a retrospective view of the last 25 years and when asked what delegates would gain from his presentations he said:

“Delegates will have the opportunity to learn the basics and the evolution of The MALO CLINIC Protocol from past to present, with a scientific and clinical experience based overview of the entire treatment concept. They will gain an understanding of its wide application for treatment of complete edentulous and failing dentition cases and the indications, as well as the pros and cons of the modified technique will also be covered. I will discuss the incorporation of zygomatic implants to overcome the challenges of the severely resorbed maxillae and examine some of the new products that have been developed to expand treatment options and increase even more the versatility and predictability of this treatment concept. Delegates will also be shown how to clinically manage patients with this protocol and I will demonstrate the medical data gathering process, diagnosis, treatment planning, surgical protocols and fabrication of both provisional and definitive implant-supported prosthesis.”

With such a wealth of wisdom and expertise as well as a plethora of exchanged experiences, delegates will leave this ADI Masterclass excited, inspired and with an enhanced understanding of the various immediate loading protocols and quality implant supported restorations available. Book your place now.

 

Book soon to make sure you don’t miss out!

 

For more information or to book, please visit www.adi.org.uk/events/masterclass18

 

 

 

Tooth shows first natives have links to living Caribbeans

As reported in Express, the thousand-year-old tooth, discovered by researchers, can be traced back to the first natives that met Columbus in the New World. This amazing find also provides evidence that there are descendants of said naties living in the Caribbean.

Researches found the woman’s tooth in a cave on the island of Eleuthera in the Bahamas to sequence the first complete ancient human genome from the Caribbean.

The woman lived sometime in between the 8th and 10th Centuries, at least 500 years before Columbus made landfall in the Bahamas.

The Express notes that researchers have said the results provide “unprecedented” insights into the genetic makeup of the Taino – commonly used to describe the indigenous people of the region.

There had been much research based on modern DNA that suggested that there was a link of continuity between the indigenous people and the Caribbean contemporary communities today. The new finding – in the form of the tooth -prove this to be true, with indigenous ancestry surviving to the present day.

The researchers found that contemporary Puerto Ricans has the closest link to the ancient Taino than any other group but further research is likely to be prove that this isn’t exclusive to Puerto Ricans and spreads across other Caribbean communities.

The discovery of the tooth, documented in the journal ‘Proceedings of the National Academy of Sciences’ is to be of great significance to Caribbeans, who have claimed their heritage but historical narratives had branded Taino ‘extinct’.

Professor Eske Willerslev, of St John’s College, Cambridge University, and Copenhagen University, told Express: “It has always been clear that people in the Caribbean have Native American ancestry, but because the region has such a complex history of migration, it was difficult to prove whether this was specifically indigenous to the Caribbean, until now.”

Dragons Den shock as dental app inventors reject four offers

As reported in the Sun, London-based Paul Varga, Tolulope Ogunsina and Matthaus Ittner approached the Dragons with a new app called ‘Playbrush’. This involves using the toothbrush as a gaming controller by attaching a small device to the toothbrush that can then connect to a phone or tablet.

The aim is to encourage children to brush their teeth for the correct amount of time.

The business had a 2016 turnover of £1.2 million and had reached £2 million by the time of filming, they had also secured a deal with Unilever. The trio requested an £100,000 investment from the Dragons for just 1 per cent stake in their firm.

Four Dragons offered the inventors of Playbrush their asking price but for a slight increase of stake in the business, to which they were met with rejection.

The business trio were willing to part with 1.25 per cent of Playbrush but left empty-handed, with the Dragons saying they expected them to be more flexible with negotiations.

 

HPV – Not gender specific – Helen Minnery

The human papilloma virus (HVP) has been in the news a lot of late. It is the name given to a group of more than 200 viruses that affect the skin and moist membranes lining the body and can affect the cervix, anus, mouth and throat. It is thought to cause around 5% of all cancers worldwide,[i] including 70% of oropharyngeal cancers,[ii] as well as genital warts.

Despite the perceived higher risk of health conditions caused in women, it has become clear that men face a high risk as well. Attention has been brought, in particular, to the fact that boys and men are left relatively unprotected from the dangers of HPV.

In the UK, girls of school age have been offered a free vaccination for HPV since 2008, with women over the age of 25 provided access to free cervical cancer screenings. However, boys are excluded from the free vaccination by the NHS and adult men have virtually no form of screening for any HPV-related illnesses. Men who have sex with other men do qualify for a free vaccination at sexual health clinics, but this is only made available if they are attending for a different reason and therefore this is not provided across the board. The decision by the Joint Committee on Vaccination and Immunisation in the summer of 2017 to not regularly vaccinate boys against HPV was a disappointing one. Indeed, it may even be described as an act of discrimination – and HPV does not discriminate between male and female. It also presented a missed opportunity for prevention over cure, as the approximately £20-22m a year it would cost to vaccinate boys is a far less than the cost of treating HPV-related cancers and warts.

The need for education and awareness among the general population remains clear. Worryingly, a poll by HPV Action – a collaborative partnership of 48 patient and professional organisations striving to raise awareness of the risks of HPV – suggested that fewer than one in eight adults identified HPV as associated with diseases that affect men. In addition, more than one in three British men did not believe themselves to be at risk of HPV.

HPV Action is therefore working hard to educate the general public and to warn everyone of the dangers of the potentially life-threatening virus. The focus is very much on encouraging boys and men to understand more about the disease and its possible consequences, in an attempt to prevent infection and transmission.

The British Society of Dental Hygiene and Therapy (BSDHT) feels this is an important issue right now and is a member of HPV Action in order to help spread the word. Dental professionals are well placed to provide information and advice to a wide range of patients on the topic, and we would like to encourage you all to get involved, support the cause and make sure your patients are informed on such an important subject.

A dedicated campaign was launched by HPV Action in December 2017 to take this to the next level. Jabs for the Boys is an initiative designed specifically to provide all the useful information members of the public need and it is a great tool for dental practices to utilise when broaching the subject with patients. The website (www.jabsfortheboys.uk) includes details about the virus, who can get it, what it does and how it can be prevented – all vital information for everyone to have.

The BSHDT would encourage all dental professionals to make use of this website by offering it as a source of information. It will take a massive joint effort if we are to raise awareness of HPV and its risks and help more people avoid the potentially horrific consequences it can bring.

For more information about the BSDHT, please visit www.bsdht.uk,

call 01788 575050 or email enquiries@bsdht.org

 

 

Cyclist using his phone loses his teeth during crash

As reported in the Metro newspaper, a cyclist from Coventry was so engrossed in his mobile phone that he crashed into a gate in front of him.

Daz Rollins captured the incident on CCTV and posted it online with the caption ‘Dentist for you my son’.

He went outside later on and discovered several of the cyclist’s teeth along with an abundance of blood.

Daz told the Metro: “I think no matter what you’re driving or riding you shouldn’t go on your phone. It only takes a split second for something to happen and if you’re busy looking at your phone then obviously bad things can happen.

“As you can see from the footage, if he wasn’t looking at his phone he would have saw there was a big metal gate. Looking at his phone has just cost him about six teeth. Let that be a lesson to people.”

Director of Policy and Research at IAM Roadsmart said: “This footage shows that distraction from smartphones causes exactly the same problems for cyclists as it does for drivers. You simply can’t multitask if you are concentrating on a call.

“Cycling offences are a grey area, which are currently being renewed by the Westminster government. We may also soon see a re-education course being made available for careless cycling. Given the vulnerability of cyclists however using a phone is more likely to lead to a very painful reminder.”

Customised treatment for long-term periodontal health with Dr Martelli

It has become recognised that periodontal disease is closely connected to several systemic diseases, including osteoporosis, cardiovascular disease, diabetes and the risk of premature birth.[1] Dr Francesco Martelli has made the study of the effects of periodontal disease on general health his life work, and he now leads a network of clinics conducting customised, non-surgical periodontal treatment.

Dr Martelli originally trained as a general practitioner in the 1980s before re-qualifying as a periodontologist and implantologist. In Florence, Italy, he became an expert at treating aggressive periodontitis with surgical procedures. However, after around 15 years of performing first-class treatment, Dr Martelli found himself intrigued by patients who did not respond or became worse after surgery. He recognised that he was able to stabilise the teeth of many patients but despite his best efforts, for others there was only littlie or no improvement in their periodontal situation. In order to understand the challenge of periodontal disease more comprehensively, Dr Martelli decided to return to education and enhance his knowledge of microbiology, molecular cell biology, biochemistry, genetics and immunology.

“At the end of this updating process I had more knowledge in terms of microbiology, immunology and genetics and could now understand the reasons why some patients did not get any benefit from surgical periodontal treatment,” Dr Martelli said from his IMI Clinic in Leeds.

Around the year 2000, new chair side microbiological testing became available on the market, making it possible for Dr Martelli to both identify and quantify periodontal pathogens. This type of testing provided him with clear information about the oral environment, the composition of the microbes that colonise in periodontal pockets and a better understanding of the molecular biology and ecological system of each individual patient. Dr Martelli was able to precisely customise treatment according to the patient’s genetic and microbiological predisposition.

This new insight allowed Dr Martelli and his team to develop ground breaking strategies to manage and challenge periodontal disease. Gradually, he and his clinical teams were able to significantly reduce the number of surgical procedures they performed. By carefully tailoring treatment according to the patient’s microbiological, genetic and enzymatic assessments a customised treatment plan, adapted according to the diagnostics of each individual patient, can be delivered to a large number of patients, both consistently and effectively.

In order to have his treatment methods recognised, Dr Martelli and his associates conducted double-blinded randomised studies on 2,683 dental patients at a number of different dental centres. This allowed them to evaluate the efficacy of the new protocol and revealed that periodontal treatment using laser irradiation, guided by accurate microbiological patient characterisation, and was consistently effective in modifying oral microbiome and eradicating periodontal pathogens, thereby restoring long-term periodontal health.[2]

Describing the bio laser assisted therapy, Dr Martelli stated: “Operating microscopes are used to guide the laser light. This allows us to penetrate periodontal tissue and deliver selective and precise action to break down cell membranes and destroy periodontal pathogens. By using laser treatment, we do not damage any healthy tissue and we are able to root plane the teeth, eradicate pathogens and bio-modulate inflammation without detaching the gum or causing bleeding. Through this approach, we have achieved an up to 100% success rate and patients receive a solution that is non-invasive so there is less pain, sensitivity and swelling.

“Even the assessments that we carry out are painless. The microbiological test for example, is carried out by inserting a small cone of absorbent paper into the periodontal pocket. The periodontal disease risk or genetic test is simple; a swab taken from the mucosa inside the cheek.”

 

The process is carefully monitored, he added.

“After each session we check the status of the microflora ecosystem once again to ensure that we have either reached our final goal or if we need to supplement the treatment. This does not mean that we never do periodontal surgery but we have been able to reduce it right down to around 2-5% of patients, and only after we have tried the personalised, laser assisted PerioBlast™ protocol first.”

Dr Martelli’s passion for this revolutionary treatment is fuelled by the fact that as well as killing off periodontal pathogens, the PerioBlast™ protocol also triggers the immune system into action and bio-stimulates the bone marrow stem cells surrounding the teeth. Apart from genetic, microbiological and biomechanical assessments, Dr Martelli and his clinicians also make bone metabolism assessments to measure bone density. This gives them insight into the health of the maxilla and mandible, indicates where the patient presents in terms of osteopenia or osteoporosis and monitors osseous-regeneration of the periodontal bone and, ultimately, the stability of the teeth.

Dr Martelli believes that this customised approach to treatment has the potential to restore the long-term periodontal health and prevent relapse. In just three words, he summed up the key points of the PerioBlast™protocol: “Decontamination, bio-modulation and bio-stimulation.” This method modifies the bacterial communities of periodontal pockets, restores the oral ecosystem to health and offers enduring stability. He also claims that it has the potential to keep the teeth in function for the rest of a patient’s life, providing they are fully compliant following the procedure.

When asked about healing time, Dr Martelli explained that there are two facets to healing: “In terms of the infection and the microbiology of the situation, I can usually reach a solution within a few weeks. By eradicating the infection we can then help the periodontal tissues to heal, stimulate bone growth and improve bone density that will have benefits for many for years to come.

Dr Martelli concluded that periodontal therapy guided by the microbiological characteristics of the patient not only prevents pathogenic bacteria from thriving and destroying periodontal tissues, but also has the potential to prevent those pathogens from entering the bloodstream and causing or exacerbating other systemic diseases.

 

For further information about the PerioBlast™ protocol and IMI Clinics visit www.perioblast.com 

 

IMI team Leeds

 

 

[1] Kim J & Amar S. Periodontal disease and systemic conditions: a bidirectional relationship. Odontology. 2006 Sep; 94(1): 10–21. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2443711/ [Accessed 18th July 2017]

[2] Martelli FS et al. Long-term efficacy of microbiology-driven periodontal laser-assisted therapy. European Journal of Clinical Microbiology & Infectious Diseases March 2016. Vol. 35(3)423-431. https://link.springer.com/article/10.1007/s10096-015-2555-y [Accessed 18th July 2017].

Detecting demineralisation in the digital age – Bruce Vernon

The consequences of demineralisation on the enamel of the teeth can be disastrous if it is left untreated. We have seen the effects of this in young members of the population, between the ages of 16 to 34, who have been observed with the highest prevalence of primary dental caries – and it seems one in ten adults are guilty of forgetting to brush their teeth regularly, further exacerbating the demineralisation process that could irrevocably damage their teeth.[i] These figures present damning evidence that a lack of care for oral health is having a substantial effect on the young population in Britain.  

As dentists are now aware, the downward trend of childhood tooth decay continues to spiral out of control, and modern advances in dentistry are rising to challenge this issue in earnest.[ii] Despite this, it is interesting to observe that with all the ground-breaking technology of our digitally dominated age, the young adults of Britain still struggle to care about and maintain the health of their teeth. In fact, research has suggested that video gaming could be responsible for poor oral health among adolescents – with the study indicating a correlation between prolonged exposure to computer screens, and the consumption of highly sugary snacks and drinks, which, as we know, facilitates demineralisation.[iii] Hence, gamers are more than twice as likely to suffer the effects of dental demineralisation than those with more active lifestyles.[iv]

Additionally, it has been reported that a staggering 97% of the population under the age of 25 currently uses a smartphone device in their daily lives.[v] Healthcare professionals have already witnessed the detrimental physical and mental effects of technology overuse in patients as they struggle with obesity, complications with vision and muscular strain.[vi] The dental profession should equally acknowledge that the exaggerated use of technology may fuel a poor diet of extremely sugary and acidic food and drinks, which if left to demineralise the teeth, can eventually lead to dental caries. This is important to consider, particularly as young people often seek an intense sugar fix to boost their energy in front of the TV, while on their smartphone, or when playing on the games console.

We are already familiar with the knowledge that demineralisation, if diagnosed too late or left untreated, can lead to cavitation of the tooth and exposure of the sensitive inner structure. Other negative effects can occur as a result of this, including infections, tooth loss and the formation of abscesses.[vii] Until they start to experience toothache, patients often fail to appreciate the consequence of demineralisation, or are simply unaware of the causes and therefore prevention techniques. As such, dental professionals must do everything they can to educate patients on the importance of brushing twice a day and attending regular dental check-ups. This is no easy task for dentists who may find it difficult to engage with the youth of Britain, especially those who are too absorbed in digital technology to pay much heed to lectures in dental hygiene. It is, therefore, crucial that the profession finds original and creative ways to communicate information with patients in order to take effective preventive measures against the possible effects of demineralisation.

Some of the latest innovations in dental health technology include games that can be used to motivate children to maintain good oral health from an early age. There are, likewise, applications appealing to adults of all ages that can help them develop a better technique of brushing their teeth. Digital radiography is also helping dentists to explain complex and technical dental issues to their patients in a way that is more constructive than that of traditional methods. Most modern radiographic systems and sophisticated intraoral scanners are being utilised in practice as a way of giving patients a visual representation of the condition of their teeth – dental scans are digitised in real-time so that they are available to review immediately. This can be incredibly useful to indicate to patients what exactly is wrong with their teeth, so that practitioners can have a more informed discussion about appropriate treatments.

In the past, methods of detecting early mineral changes in the teeth have been subject to errors with less than perfect reliability and validity.[viii] It is often too late for anything but restorative treatment to be carried out by the time practitioners are able to identify signs of active demineralisation, indicative of early caries. However, advanced visual technologies are emerging on the dental market that will improve the precision and efficacy of diagnostics, and encourage enhanced preventive care. The state-of-the-art CALCIVIS® imaging system uses bioluminescence (light-emission) to detect demineralisation on the surface of the tooth. This system allows dentists to undertake and communicate simple preventive treatments to patients, including remineralisation therapy.

Technology can be both a blessing and a curse, particularly when we consider Britain’s youth in relation to the risks of heavy sugar consumption following bad habits, fuelled by the digital revolution of our time. However, visual and interactive elements of digital technology can be used to effectively engage with patients about the importance of good dental health – both patient and practitioner are better able to see more clearly the effects of demineralisation and react to it, thus, improving clinical care.

 

For more information visit www.CALCIVIS.com or call 0131 658 5152

 

 

[1] National Health Service. (2011) 2: Disease and related disorders – a report from the Adult Dental Health Survey 2009. Link: http://digital.nhs.uk/catalogue/PUB01086. [Last accessed: 17th November 2017].

[1] Public Health England. (2016) National Dental Epidemiology Programme for England: oral health survey of five-year-old children 2015: A report on the prevalence and severity of dental decay. Link: http://www.nwph.net/dentalhealth/survey-results%205(14_15).aspx. [Last accessed: 17th November 2017].

[1] Animated-Teeth.com. (2017) The chemistry of tooth decay (How and why cavities form). Link: https://www.animated-teeth.com/tooth_decay/t2_tooth_decay_caries.htm. [Last accessed: 23rd November 2017].

[1] Poss, J, Marshall T, and Qian F, Weber-Gasparoni K, Skotowski, C. (2010) Video Gaming Teenagers: An Examination of Diet and Caries. Conference Paper AADR Annual Meeting. Link: https://www.researchgate.net/publication/266778891_Video_Gaming_Teenagers_An_Examination_of_Diet_and_Caries. [Last accessed: 17th November.17].

[1] Google. (2017) Consumer Barometer: The Connected Consumer Survey – Percentage of people who use a smartphone. Link: https://www.consumerbarometer.com/en/trending/?countryCode=UK&category=TRN-AGE-UNDER-25. [Last accessed: 17th November 2017].

[1] Digital Responsibility. (2016) Digital Responsibility: Taking Control of Your Digital Life – Health and Technology. Link: http://www.digitalresponsibility.org/health-and-technology/. [Last accessed: 17th November 2017].

[1] The Happy Tooth. (2017) How an Abscessed Tooth can Damage Your Overall Health. Link: http://happytoothnc.com/abscessed-tooth-can-damage-health/. [Last accessed: 17.11.17].

[1] Baelum, V, Hintze H, Wenzel A, Danielsen B. and Nyvad B. (2012). Implications of caries diagnostic strategies for clinical management decisions. Community Dentistry and Oral Epidemiology. 40(3): 257-266. https://www.ncbi.nlm.nih.gov/pubmed/22103270 [Last Accessed 27th November 2017]