The risks from dental X-rays are extremely low and offer a valuable benefit for human health in the detection of disease and the prevention of real illness and injuries.

Despite the low risk, radiation – like other forms of medicine and treatment – must be used responsibly and only in the amounts required to do the job in order to adhere to best practices. Often this means trying to use the least amount of radiation and most advanced methods to offer the best balance of risk versus benefit.

Digital X-rays offer the lowest dose. On average, a direct digital sensor can decrease the radiation dosage by more than 80% over its film counterparts. It’s important to note that digital X-rays nonetheless must still be used responsibly.

We encounter radiation every day just by being alive on this earth. This is known as background radiation, is caused by terrestrial radiation and cosmic rays and is applicable indoors or outdoors.

The average US resident receives approximately 300 millirem (3,000 µSv) of this background radiation a year. This equates to a little less than approximately 1 millirem per day.

The amount of ionising radiation used in dentistry is considered a very low dose. It is so low that it is difficult to estimate cancer risks from exposures due to statistical limitations; therefore, mathematical risk models are used. The most conservative mathematical risk model used today is the linear no-threshold  (LNT) dose-response model, which implies that there is no threshold and the risk is proportional to the dose.

This conservative LNT model can be explained by a model analogy of snowflakes and avalanche. In an avalanche, snow can cause injury or death. The LNT model assumes every snowflake bears some increase of death or injury.  While that isn’t likely, it’s a conservative safety model to always make sure one minimises the potential risks.

The current LNT model for X-rays suggests that the radiation dose may accumulate risks over time. It is not clear what triggers cancer to occur or when it may be triggered.  Cancer is present even without the introduction of radiation, where there is a weak carcinogen. However, we want to be careful with any amount of radiation and will use the principles of ALARA (as low as reasonably achievable), as well as patient selection criteria when deciding what dental images should be taken for each case.

The interval for receiving radiographs is now dependent on the patient’s oral health risk assessment (performed by the dentist) and the task that the images will be used for. Ultimately, each dentist must assure justification and benefit for taking each image –even if the risk is very low.

The table below compares common dental exams and relative risk.

The effective dose in µSv (or in millrem) considers the sensitivity of the tissues and regions of the body to ionising radiation. Once expressed in these terms, we can compare this to LNT fatal cancer risk per million exams and equate it to the amount of radiation that a person is exposed to on a daily basis to try to help one understand the relative effect on a person.

^*Based on a naturally occurring U.S. background radiation of 3,000 µSv per year Source: National Council on Radiation Protection and Measurements.^4 
+Wall BF, Hart D. Revised radiation doses for typical x-ray examinations. The British Journal of Radiology 70:437–439; 1997.  

As can be seen in the table, the risks of a dental X-ray are fairly minimal and would only really cause a problem where repeated images were required.As the effects of radiation are latent, often requiring many years to express a clinical effect, the inherent wisdom is to minimise exposure to young patients that will have more lifetime ahead to express any possible long-term effect. As the body ages, it becomes less sensitive to the effects of radiation and particular attention must be given to minimize dose and re-examinations  to younger audiences (under the age of 18 years).

Regardless, reducing the risk wherever possible remains a priority in all healthcare sectors, including dentistry. The CS 8100 3D family of imaging systems from Carestream Dental offers a particularly versatile choice as not only do the units use the smallest possible dosage of radiation during the image taking process, but they also provide professionals with the option to take detailed 3D images. Furthermore, they have inbuilt diagnostic tools which help professionals to assess the image properly, adding further diagnostic value.

Care should be taken whenever X-rays are indicated as part of a patient’s treatment. They pose a fairly low risk but they should still be requested and conducted responsibly to in order to maximise the safety of the patient.

For more information, contact Carestream Dental on 0800 169 9692 or

visit www.carestreamdental.co.uk

For the latest news and updates, follow us on Twitter @CarestreamDentl

and Facebook

 ¹Wall BF, Hart D. Revised radiation doses for typical x-ray examinations. The British Journal of Radiology 70:437–439; 1997. (5,000 patient dose measurements from 375 hospitals). Available at http://bjr.birjournals.org/content/70/833/437.full.pdf. 
²Available at http://www.hpa.org.uk/Topics/Radiation/UnderstandingRadiation/UnderstandingRadiationTopics/MedicalRadiation/medic_TedEquivalent/.
³Ludlow JB, Davies-Ludlow LE, White SC. Patient risk related to common dental radiographic examinations. J Am Dent Assoc 139:1237–1243; 2008. 
⁴National Council on Radiation Protection and Measurements. Radiation protection in dentistry: Recommendations of the National Council on Radiation Protection and Measurements. Bethesda: NCRP; NCRP Report No. 145; 2003.

The idea of being able to see into the future has fascinated people for centuries. This special power has been claimed by fortune tellers, soothsayers, oracles, prophets, witches, astrologists and clairvoyants since time began and most individuals at sometime during their life, have admitted that it would be useful if we could see what is ahead of us. Certainly, most people would love to know what the lottery numbers will be on Saturday but also, a peep into the future would enable us to prevent dangerand to reduce the anxiety and fear that is associated with the unknown.

For obvious reasons, if we were able to see into the future and to predict occurrences, there would be no surprises or events to look forward to. Things would happen exactly as we would expect. As it is, there are an infinite number of different futures and possibilities ahead of every individual person and only when measureable dimensions such as scientific information, probabilities and mathematics are applied can one attempt to present a possible prediction or forecast.

Fortunately, knowledge, technology and progress have all helped us to learn and create inventions that make our lives easier, more comfortable, less dangerous and some ways a little more predictable. For example, most drivers have a sat nav device in their car to find the most suitable route, keep them on course and even beat the traffic. And in the future, it is likely that our cars may be able to interact with other vehicles to prevent accidents, communicate with traffic lights to improve flow, handle fuel payments and even collect data and supply footage of incidents.

Already technology can plunge people into different surroundings and ‘realities’ and in industry, augmented reality with interactive virtual objects or digital content enables businesses to run with greater efficiency and lower costs. For example the logistics giant DHL recently discovered that they could increase the efficiency of their order pickers by 25 per cent by equipping them with smart glasses containing software to assist them to navigate the warehouse, locate and select items.[i]

This type of technology literally helps people to see what is around the corner, but it cannot predict what could happen next. Nevertheless, computer scientists from the University of Bonn have developed self-learning software that is able to look a few minutes ahead in time. During their studies, a computer‘watched’ hours of video showing people preparing breakfast meals and salads in order to ‘teach’ it to anticipate the next steps needed to prepare various meals. Algorithms were developed to identify which actions followed each other and how long they last, before it was able to anticipate what happens next with surprising accuracy in short forecast periods.[ii]This type of activity prediction is still in its infancy but there is tremendous potential for machines that can be taught tasks and anticipate what humans might typically do or need in a few minutes time.

Health care professionals cannot foresee what diseases or problems that patients might encounter in the future. However, extensive research, scientific evidence and modern technology enable them to determine the expected course of certain ailments or diseases and offer some relatively accurate forecasts. As well as this, medicine and technology continues to advance rapidly and recently there have been some remarkable innovations. Already implantable medical devices such as pacemakers have been developed to sense and measure a patient’s cardiac activity and provide remedial therapy when required.[iii]Now researchers have found that applying artificial intelligence to data retrieved from wearable technology may enable them to assess changes in aerobic responses, which one day, may be able to predict the onset of cardiovascular or respiratory disease.[iv]Furthermore, it has been suggested that instead of using biomarkers measured in the blood or by analysing genomic markers, there is the potential to use vocal intonations as a diagnostic and preventive tool for a range of different illnesses.[v]

In the dental sector, the CALCIVIS^®imaging system is revolutionising preventive dentistry by helping practitioners to detect caries and dental erosion at its earliest, most reversible stages. Using a bioluminescent photoprotein, it produces light in the presence of free calcium ions released by actively demineralising tooth surfaces. An integral sensor then detects the bioluminescent signal and in just one second, displays a visual map of active demineralisation at the chair-side. The CALCIVIS imaging system is a valuable communication tool as it enables patients to see potential ‘hot spots’ and understand their oral health more easily. Then, with the expertise of their dental practitioner, effective preventive measures or treatment can be implemented to avoid more invasive or complex intervention further down the line.

Although it is impossible to see precisely what the future holds, advanced technology allows us to reduce uncertainty and obtain more insight, which in turn, helps us to make more accurate predictions and achieve better outcomes.

For more information visit www.CALCIVIS.com

or call 0131 658 5152

[i]Matt Looker. Seeing into the future – Virtual, Augmented and Mixed Realities. 26 Dec 2017. New Anglia Advanced Manufacturing and Engineering. http://www.naame.net/news/seeing-into-the-future-virtual-augmented-and-mixed-realities/[Accessed 16^thJuly 2018]

[ii]Phys.org News. June 13 2018. University of Bonn. Computer program looks five minutes into the future. https://phys.org/news/2018-06-minutes-future.html[Accessed 16th July 2018]

[iii]Dell’Orto S. et al. Sensors for rate responsive pacing. Indian Pacing Electrophysiol J. 2004 Jul-Sep; 4(3): 137–145. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1501080/[Accessed 16^thJuly 2018]

[iv]Science Daily. Science News 16^thMay 2018. Wearable technology and A1 to predict the onset of health problems. Source: University of Waterloo. https://www.sciencedaily.com/releases/2018/05/180516123701.htm[Accessed 16th July 2018]

[v]Shaheed G. Vocal biomarkers: The future of diagnostic medicine. Wccftech. 2016. https://wccftech.com/vocal-biomarkers-future-of-diagnostic-medicine/[Accessed 16^thJuly 2018]

The business of dentistry has become a complex, time-consuming and stressful affair. The role of the principal is diverse and comprises of many different daily, monthly and annual tasks, which must all be completed in addition to delivering patient care. These often require a good understanding of legal regulations, which in themselves can cause a lasting headache for those trying to ensure compliance while running a busy dental practice.

It’s all about delegation…

Depending on the size of your practice, the number of staff working with you and the type of dentistry you deliver, there will be different opportunities available to you to delegate certain tasks. Your practice manager, for example, could take on the responsibility of CQC compliance and ensure that all contracts, CPD records and other documentation relevant to staff are in order. Your dental nurse may be happy to manage stock or contribute towards your marketing activities by taking control of your social media platforms and building relationships with local media. If you provide a high volume of dental implants, it may be worth creating the role of treatment coordinator so they can manage the patient journey and maintain an efficient diary for all clinicians.

No matter what you delegate or who takes on which tasks, allocating some of your work to others can free up your time, allowing you to focus on your patients and do what you do best – providing your patients with high quality dentistry. As long as everyone understands their duties and how to fulfil them, your practice will likely enjoy an increased level of efficiency when several people share responsibility for running the business.

…And automation…

In some instances, tasks can be optimised by technology. With regards to practice management, dental software systems on the market make it easier to organise appointments, contact patients for recalls at the right time and monitor business performance through digital data collection and analysis. These save you and your staff time while also helping to make sure your patients receive the very best service.

Other areas that can be automated include inventory management and product ordering, and several modern autoclaves offer data logging for automated recording of sterilisation procedures and easy compliance with infection control regulations. Both these features encourage smooth workflows throughout the working day, improving practice performance and reducing the risk of mistakes.

…And outsourcing

While patients always have been and always will be the priority, dental practices are fundamentally businesses and therefore there will be aspects that principals and other members of staff may not be comfortable doing. For example, there can be much confusion over topics such as payroll, pensions and HMRC filing, which dental professionals have to learn for themselves – these subjects are certainly not covered in dental school.

This can be problematic as an error in calculating pension contributions, a delay in paying wages or the submission of an incorrect P11D to HMRC (required if you provide benefits or expenses to employees or directors) can result in far-reaching consequences. Whether completely accidental or through a simple slip of the fingers on the keyboard, a mistake during these processes could lead to additional tax bills, disgruntled staff or even totally unnecessary and avoidable fines from HMRC.

To eliminate the risk of error throughout these processes, outsourcing the whole task can bring with it peace of mind for both you and your staff. It also makes sense to utilise the expertise of professionals with extensive experience in payroll and HMRC dealings, offering your business protection and support.

Working with a company such as Wagemate would be ideal for dental practices of all sizes looking to streamline processes while saving up to 66% on payslip costs. The team offer an automated payroll service with a risk-free guarantee that covers everything from payroll to pensions, HMRC documents and BACS payments. They also provide an innovative and totally secure online ePayslips portal that enables you and your staff to monitor finances in a convenient and easy way.

Headache free business management

There are many different aspects involved in running a successful dental practice, and a lot of skills and knowledge are required to ensure compliance. By appropriately delegating certain tasks and outsourcing areas that can be completed more efficiently by experts in their fields, you can make business management easier, more reliable and more cost-effective.

For more information on Wagemate,

call us on 03330 102102 or email info@wagemate.com

We all know how intrinsically systemic and oral health are linked. There is even sometimes a two-way relationship between poor dental hygiene and severity of general health conditions, meaning that neither can be optimised without the other. This can be challenging as some systemic diseases, or the medications used to manage them, can cause various side effects that influence the oral cavity, dental health standards and the sufferer’s confidence. One of these side effects is halitosis.

Origins of halitosis

While not a life-threatening complication, halitosis can have a huge impact on a patient’s quality of life. In fact, it has a negative effect on nearly every aspect of a sufferer’s life, including their friendships, dating experience, marriage, schooling and employment.[1] 

In nearly 85% of cases, the origin of halitosis is in the oral cavity[2]and one of the most common causes is the accumulation of food debris and plaque in the mouth.[3]Another major cause is xerostomia.

Patients with dry mouth have been shown to exhibit higher amounts of plaque on their teeth and tongue.[4]This is because saliva plays an important role in the remineralisation of the teeth, pH balance of the oral cavity, regulation of the microflora and primary digestion, among various other functions. Hypofunction of the salivary glands therefore has an inhibitory effect on all these areas[5]and dry mouth is associated with poorer dental health for this reason.

There are a number of systemic health conditions that can trigger decreased saliva secretion, or hyposialy. These include diabetes, depression and Sjogren’s syndrome.[6]

In diabetes, oral malodour can also be caused by diabetic ketoacidosis (DKA). This is the process by which the body burns fatty acids because there is insufficient insulin to allow enough glucose into the cells. It produces acidic ketone bodies that can be expelled through the mouth and result in an unusual smell on the breath.[7]

The support patients need

Regardless of what medical conditions a patient may be living with, they absolutely deserve to be relieved of the everyday symptoms wherever possible, enabling them to experience a better quality of life. The range of CB12 products provides one such solution for those suffering from halitosis.

Developed by dentists, the CB12 mouthwash has been formulated specifically to neutralise oral malodour and go on working all day. Unlike other mouthwashes that simply attempt to mask the unpleasant smell, CB12 targets the problem at the source.[8]Its patented formula contains low levels of zinc acetate and chlorhexidine diacetate. This combination has been clinically proven to be the most effective for converting the sulphur content of the volatile sulphur compounds (VSCs) known to cause oral malodour in the mouth into insoluble sulphides,[9]eliminating the smell completely. 

But the advantages don’t stop there. CB12 mouthwash is not only the ideal adjunct to daily tooth brushing and interdental cleaning, but it is also a long-lasting solution that will give your patients total confidence for up to 12 hours.[10]This is once again thanks to the product’s innovative formula that binds the liquid to the surfaces of the teeth for enduring protection. 

Giving you complete peace of mind that you are recommending the best product for your patients, CB12 mouthwash has been proven to work more effectively than 18 other leading European mouthwash brands.[11]The solutionalso contains 0.05 per cent sodium fluoride to help prevent decay and strengthen tooth enamel, and it’s available in mint/menthol and mild mint/menthol flavours to suit everyone’s taste buds.

Ensuring added convenience for busy patients, or those who appreciate the reassurance of an on-the-go solution, CB12 is available as a useful mouth spray. CB12 boost offers even more choice – it’s a sugar-free chewing gum that contains zinc acetate to target VSCs and oral malodour, as well as the popular sugar substitute xylitol, which has been shown to reduce cavities.[12]  

Added benefits

For any patients who come to you with halitosis, but especially for those who are simultaneously dealing with systemic health complications, anything you can do to alleviate their symptoms will be greatly appreciated by them. Exceeding their expectations by going the extra mile is likely to increase their satisfaction even further. So why not keep them smiling with CB12 White?

The latest product in the brand’s portfolio, CB12 White combines the power of unpleasant breath neutralisation with stain reduction, giving patients a beautiful, healthy and bright smile. Patients need only use it twice a day for two weeks to help remove even tough stains and protect their teeth from future discolouration. The alcohol-free mouthwash is available in soft mint/menthol flavour and, like the rest of the CB12 products, it can be used daily by anyone over 12-years-old.

Making the link

Patients are not always aware that their health conditions could affect their oral health, so it’s important to give them all the relevant information and guidance necessary. Halitosis can be a source of great anguish for some people, and whether it originates from a systemic disease, plaque accumulation, periodontitis,[13]or dentures,[14]there are proven solutions available to give patients back their confidence and their quality of life.

For more information about CB12 and how it could benefit your patients, please visit www.cb12.co.uk

[1]Azodo CC, Osazuwa-Peters N, Omili M. Psychological and social impacts of halitosis: a review. Journal of Social and Psychological Sciences. 2010 Jan;3(1) 74-91

[2]Bollen CML, Beikler T. Halitosis: the multidisciplinary approach. Int J Oral Sci. 2012 Jun; 4(2): 55–63. Published online 2012 Jun 22. doi: 10.1038/ijos.2012.39

[3]Porter SR, Scully C. Oral Malodour (halitosis). BMJ. 2006 Sep 23; 333(7569): 632–635. doi:  10.1136/bmj.38954.631968.AE

[4]Albuquerque DF, Tolentino EdS, Amado FM, Arakwa C, Chinellato LEM. Evaluation of halitosis and sialometry in patients submitted to head and neck radiotherapy. Oral Medicine Pathology, Oral Cir Bucal. 2010 Nov 1;15 (6):e850-4.doi:10.4317/medoral.15.e850

[5]Guobis Z, Kareiviene V, Baseciciene N, Paipaliene P, Niedzelskiene I, Sabalys G, Kubilius R, Gervickas A. Microflora of the oral cavity in patients with xerostomia. Medicina (Kaunas) 2011;47(12):646-51

[6]About halitosis. Dry mouth halitosis (xerostomia). http://abouthalitosis.net/tag/what-is-dry-mouth-xerostomia/[Accessed May 2018]

[7]Diabetes.co.uk Short term complications. Diabetic Ketoacidosis (DKA). https://www.diabetes.co.uk/diabetes-complications/diabetic-ketoacidosis.html[Accessed June 2018]

[8]Thrane et al (2009) A new mouthrinse combining zinc and chlorhexidine in low concentrations provides superior efficacy against halitosis compared to existing formulations: A double-blind clinical study’, The Journal of Clinical Dentistry, 18(3): 82-86. http://www.ncbi.nlm.nih.gov/pubmed/17913002 [Accessed May 2018]

[9]Erovic Ademovski Set al. The effect of different mouth rinse products on intra-oral halitosis. Int J Dent Hyg. 2016 May; 14(2):117-23. DOI https://www.ncbi.nlm.nih.gov/pubmed/26031397

[10]Thane et al. Zn and CHX mouthwash effective against VSC responsible for halitosis for up to 12 hours. Journal of the British Society of Dental Hygiene and Therapy, Dental Health Vol 48 2009 No 3 of 6. http://www.cb12.fr/fileadmin/user_upload/cb12_fr_new/pdf/studie_090929_2.pdf [Accessed May 2018]

[11]Saad S et. al. Oral Diseases, Comparative effects of various commercially available mouth rinse formulations on oral malodour, (2011), 17:180-186 http://oralchroma.es/informacion-cientifica/Saad-2011.pdf

^[12]Burt BA, The use of sorbitol- and xylitol-sweetened chewing gum in caries control. J Am Dent Assoc. 2006 Feb;137(2):190-6. http://www.ncbi.nlm.nih.gov/pubmed/16521385

[13]Morita M, Wanf HL. Association between oral malodor and adult periodontitis: a review. J Clin Periodontol 2001; 28: 813–819

[14]Bosinceanu D, Forna DA, Bosinceanu DN, Forna N. Prevalence and clinical signs of xerostomia in denture wearers. Romanian Journal of Oral Rehabilitation

Vol. 7, Issue 4, October – December 2015

How the role of dental hygienists and dental therapists might continue to affect change within dentistry for years to come.

To say that dentistry has changed over the years would be an understatement. The role of the dental hygienist and dental therapist, in particular, has evolved with the times in order for us to deliver the best possible patient care. 

Skill mix utilisation

Now able to work to their full scope of practice, even without the prescription of a dentist thanks to direct access, dental hygienists and dental therapists have the opportunity to deliver a wide range of services.

As their roles have changed, so too has the potential for them to effect the patient care delivered, as well as the profitability of the business. For example, with dental hygienists and dental therapists able to provide certain treatments directly to patients, this enables practices to maximise on skill mix within the team. This in turn facilitates more efficient workflows as it frees up precious time for the dentists and allows them to focus on more complex treatment.

Patients therefore benefit from easier access to quality care, practitioners benefit from higher job satisfaction and the practice can take advantage of the higher earning potential afforded by this improved skill mix utilisation. This is particularly topical for dental care providers right now with the uncertainty surrounding the associate recruitment shortage in some areas of the UK, which may only worsen with Brexit. If we can better delegate responsibilities within the practice, we may be able to alleviate some of the pressures faced in the future.

Patient engagement

What with oral health statistics being what they are in the UK right now, it has never been so important to engage with the population and raise awareness of the importance of dental health. The role dental hygienists and dental therapists play with regards to patient education is crucial now and will continue to be so in the future, as they can have a major impact on prevention.

We are ideally placed to discuss topics such as home care routines, diet and lifestyle choices with patients in order to encourage healthier habits. Not only does our scope of practice incorporate preventive procedures – such as fluoride varnish applications and temporary fillings – but we also often have the time and experience needed to offer advice and recommendations on everything from oral health products to brushing technique.

Further still, we are widely considered to be highly approachable by patients, so they may be more likely to voice their concerns or ask questions of us than perhaps our dentist colleagues. We can then address these queries and really motivate patients to engage with their oral health by taking some of the responsibility for maintaining high standards of hygiene. In addition, we all know how closely oral health is associated with general health. If we can continue to promote the need for good dental hygiene routines and help patients understand the link with decreased risk of various systemic health conditions, we can influence their long-term quality of life as well.

All this serves to not only improve the dental health of patients and therefore enhance overall statistics for the UK, but also to encourage patient loyalty to the practice. Taking a personal approach can make patients feel more relaxed and once strong relationships are built with their dental practitioners, they are far more likely to remain loyal to the practice for increased revenue in the long-term.

Looking in the crystal ball

As dentistry is such a fluid profession, we expect to see many more changes in the years to come.

Importantly for us, the British Society of Dental Hygiene and Therapy (BSDHT) is currently working alongside the British Association of Dental Therapists (BADT) on a joint project aiming for exemptions to the Medicines Act. We are hoping to establish a list of prescription-only medications that can be administered by dental hygienists and dental therapists without the prescription of the dentist. Based on our own experiences in practice and having listened to the stories of others, we believe this will help us deliver much more efficient care to our patients in the future. It will also enable practices to further maximise chair time of all their practitioners, including dental hygienists, dental therapists and dentists. By removing the risk of delays in treatment – currently caused when a patient’s situation changes and a new prescription from the dentist is required to ensure appropriate care – the patient service is improved, workflows are streamlined and patients are less likely to go elsewhere.

We also hope to see the increased use of skill mix in practices across the UK, as this will further enable the profession to deliver excellent patient care. As the scope of practice for dental hygienists and dental therapists expands, so too will our ability to share treatment and prevention responsibilities with our colleagues – both dental and medical – making everyone’s lives easier. 

As such, we would encourage all dental hygienists and dental therapists to keep up the great work! Be confident in your capabilities and seek the right training to enable you to extend your skills and fulfil your career aspirations. It’s also important to make your voice heard – by getting involved with professional societies and associations, you can help us have a greater impact on changes that will affect our profession for years to come.

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

call 01788 575050 or email enquiries@bsdht.org.uk

There is high demand for an aesthetic smile among today’s population. Whether due to societal pressures, personal preferences or self-confidence, more and more people are looking to improve the appearance of their teeth in some way. Tooth whitening, orthodontics, crowns and bridges are just some of the popular procedures being sought across the UK, but sometimes these are not enough to treat existing problems and deliver the results a patient desires. Another condition that can affect smile aesthetics is gingival recession.

The prevalence of gingival recession is believed to be high among the UK population, with one paper finding recession on at least one tooth in 100% of the young adult participants.[1]While this focused on a small sample size, it is indicative of the widespread occurrence of the condition.

Causes and impact

There are many possible causes of gingival recession, including build up of calculus leading to disease and inflammation,[2]history of and current ‘hard’ tooth brushing,[3]and misaligned teeth.[4]Lifestyle habits like smoking[5]and features such as lip piercings[6]have also been shown to promote the development of gingival recession.

When attempting to predict potential recession in patients, key characteristics such as thickness of the keratinized tissue, presence of periodontal disease and poor marginal fit of restorations have been associated with increased risk.[7] 

A major impact of gingival recession is what it does to the smile aesthetics – this is often the main complaint from the patient. It can also lead to plaque retention, gingival bleeding and inflammation, loose teeth and pain or discomfort.[8]Further still, recession can cause dentine hypersensitivity[9]and lead to continued discomfort for the patient that could affect their quality of life.

The old mantra that ‘prevention is better than cure’ applies here, as it does in most areas of dentistry. Patient education is key and they should be encouraged to appreciate the importance of good tooth brushing technique and products, effective interdental cleaning and regular dental check-ups with their dentist and / or dental hygienist in order to maintain oral health and avoid development and progression of receding gums.

Treatment of gingival recession

Where minor recession has occurred and it is detected early, there are some fairly simple treatment options available. Revision of home care routines and a review of any existing restorations or tooth alignment can help stop the condition from progressing any further. Where infection is identified, the appropriate topical antibiotics, antiseptics or antimicrobials can be applied. Alternatively, orthodontic treatment may be considered.

In cases where the recession is quite advanced, more complex intervention may be required, including periodontal plastic surgery. This encompasses a wide range of surgical procedures that involve improving the soft tissue aesthetics by restoring the position of the gingiva.

The main surgical procedures employed for root coverage can generally be placed into one of two categories:[10]

1. Pedicle soft tissue graft procedures

These grafts allow soft tissue to be repositioned over the defect, but as they remain attached they retain their own blood supply. This type of graft includes coronally advanced flaps and laterally positioned flaps.

2. Free soft tissue graft procedures

Where there is insufficient soft tissue close to the defect or tissue thickness needs to be increased, these procedures involve placing a grafted material from elsewhere – usually the palate. These include free gingival grafts and connective tissue grafts.

A connective tissue graft covered with an overlying flap is widely considered to be the gold standard treatment for gingival recession defects in the profession. It is believed that the two blood supplies afforded by this technique provide an optimal aesthetic outcome.[11]

Appropriate treatment

It is logical that a practitioner’s clinical experience could affect case selection and effectiveness of surgical skill when addressing gingival recession, so ensuring that you deliver treatment within your remit is essential to success. Treatment should begin with less invasive procedures when possible, but where greater gingival recession is identified, advanced intervention may be required. Referral to a colleague with the appropriate skills and experience may be in the best interests of your patient and working with the specialist team from BPI Dental could offer a solution. Accepting referrals for an array of periodontal plastic surgery procedures – including connective tissue grafts, as well as crown lengthening and ridge augmentation – the team can offer an extension to your services and ensure your patients receive the highest quality care with outstanding aesthetic outcomes.

For more information on the referral services available from Birmingham Periodontal & Implant (BPI) Dental, visit www.bpidental.co.uk,

call 0121 427 3210 or email info@bpidental.co.uk

[1]Seong J, Bartlett D, Newcombe RG, Claydon NCA, Hellin N, West NX. Prevalence of gingival recession and study of associated related factors in young UK adults. Journal of Dentistry. September 2018;76; 58-67

[2]Van Palenstein Helderman WH, Lembariti BS, Van Der Weijden GA, Van’t Hof MA. Gingival recession and its association with calculus in subjects deprived of prophylactic dental care. Journal of Clinical Periodontology. 1998;25(2); 106–111.

[3]Khocht A, Simon G, Person P, Denepitiya JL. Gingival recession in relation to history of hard toothbrush use. Journal of Periodontology. 1993;64(9); 900–905.

[4]Gorman W J. Prevalence and etiology of gingival recession. J Periodontol 1967; 38; 316–322.

[5]Banihashemrad SA, Fatemi K, Najafi MH. Effect of smoking on gingival recession. Dent Res J. 2018;5(1): 1-4

[6]Er N, Ozkavaf A, Berberoglu A, Yamalik N. An unusual cause of gingival recession: oral piercing. J Periodontol 2000; 71; 1767–1769.

[7]Patel M, Nixon PJ, Chan MFWY. Gingival recession: part 1. Aetiology and non-surgical management. British Dental Journal. 2011; 211(6): 251-254

[8]Healthline. Receding gums. Symptoms of receding gums. https://www.healthline.com/health/dental-oral-health-receding-gums#causes[Accessed September 2018]

[9]Strasslet HE, Drisko CL, Alexander DC. Dentin hypersensitivity: Its inter-relationship to gingival recession and acid erosion. Aegis Dental Network. June 2008; 29(5) https://www.aegisdentalnetwork.com/special-issues/2008/06/dentin-hypersensitivity-relationship-to-gingival-recession[Accessed September 2018]

[10]Alghamdi H, Babay N, Sukumaran A. Surgical management of gingival recession: A clinical update. The Saudi Dental Journal. 2009;21(2); 83-94. doi:10.1016/j.sdentj.2009.07.006.

[11]Wilcko M.T., Wilcko W.M., Murphy K.G., Carroll W.J., Ferguson D.J., Miley D.D. Full-thickness flap/subepithelial connective tissue grafting with intramarrow penetrations: three case reports of lingual root coverage. Int. J. Periodont. Rest. Dent. 2005;25(6): 561–569.

As we draw closer to the end of 2018, Dr Donald Sloss is preparing to step down as this year’s President of the British Academy of Cosmetic Dentistry (BACD). Dr Sloss is one of the most respected members of the dental profession, was one of the first dentists in the country to be made a Fellow in General Dental Practice of the Royal College of Surgeons of England, and has also passed the prestigious BACD Accreditation Programme. 

“I’m very privileged to have been elected as BACD President for the last year and it’s been an honour to serve the Academy in this way,” says Dr Sloss. “I’ve been lucky to be able to work with a great Board of Directors, who have been very supportive throughout my time as President. Their hard work has enabled the Academy to continue investing in higher quality education that delivers a great return on investment for our members.

“As a result of Board involvement, we have been able to offer even more Recommended Meetings, which have garnered great feedback from delegates. The BACD has also been able to provide other educational opportunities such as the incredibly popular Young Dentists Day and Ladies Who Do Dentistry event. We are now looking forward to holding another great Annual Conference in November, with many leaders in the profession – from both the UK and abroad – eager to share their knowledge. The Academy is particularly excited to be welcoming Dr John Kois to the stage. He is a master in occlusion, which is a key element of both advanced dentistry and everyday practice, so it’ll be exciting to hear what he has to say.”

Reflecting on his year as BACD President, Dr Sloss says: “I was proud to represent the BACD at the Annual General Meeting of the International Federation of Esthetic Dentistry (IFED) in Chicago this year. It was great to be able to share the stage with various other cosmetic dental academies from around the world. Many BACD members are now going on to lecture internationally and have become recognised as leaders in cosmetic and aesthetic dentistry, which is a true testament to how much the Academy has supported its members as they’ve grown within their careers.

“Throughout my time as a member of the BACD, I have been motivated by many people who have invested their time into helping me progress as a professional, and I have benefitted immensely from their guidance. Therefore, when I was elected President, I was more than happy to give up my free time to help the next generation of dentists, as a way of paying forward the goodwill that has been gifted to me in the past. I hope that by doing this, I’m helping to foster a culture whereby future generations of dentists give back what they have gained from being a BACD member.

“This is something that I am truly passionate about because I believe the social aspect and extreme inclusivity of the Academy cannot be beaten. Everyone within the BACD strives to help one another and it’s wonderful that you can approach anybody. As President, I’ve been delighted to be able to engage with people from all walks of life, from some of the youngest dental students in the profession, to established leaders from other organisations. The BACD enables you to network with various different people from diverse backgrounds, which I think is brilliant.

“My year as BACD President has been one of the most influential and enjoyable roles I have undertaken, and one with many rewards. Since I joined the BACD many years ago, I have been able to develop a fantastic career in dentistry and I now have a practice that has become recognised as one of the best in the country. I have only been able to do this through the networking and continuing educational programmes the BACD provides. Because I have gained so much from being a member of the Academy, I’m keen to remain active and will continue contributing to the BACD in as many ways as I can. I highly recommend dentists at any stage of their career to join the Academy and explore the ways that they can progress through its membership and Accreditation Programme.

“With regard to the future, I’m very much looking forward to the Sixteenth Annual Conference in 2019, which is guaranteed to be an excellent educational and social event held at Celtic Manor. Beyond this, however, it’ll be great to enjoy some well-earned downtime and get back into the hobbies I gave up in order to fully embrace my role as BACD President. In fact, I’m eager to reduce my golf handicap and to see more of my wife, who I hope will be happy to see more of me as well!”

For further enquiries about the British Academy of Cosmetic Dentistry, visit www.bacd.com

Career progression is essential for every dental professional. It ensures the advancement of skills, broadening of experience and achievement of personal aspirations.

When it comes to finding the best-fit job role, there are various aspects that require consideration. What does the position involve on a day-to-day basis? What opportunities are there to progress? Will it be challenging without leaving you out of your depth? Is there an established support network? What training and CPD are available that will be relevant to my role?

There are some in our profession who are apprehensive about working with a dental group. For reasons based on past experience, assumptions or hearsay, some dental hygienists and dental therapists prefer to work for smaller, single-handed establishments and avoid anything else completely. It is perfectly understandable that for some, these environments are a good fit – but for others, dental groups can offer an array of benefits that could truly propel your career forward.

All members of the Association of Dental Groups (ADG) have worked hard to understand and therefore effectively utilise the skill and scope of dental hygienists and dental therapists. Efficient use of skill mix is a particularly important area for us all, as our various members look to continually improve the patient care they offer.

As part of their commitment to their clinical teams, many groups also offer comprehensive training programmes for dental hygienists and dental therapists, which contribute to annual CPD requirements. Additional educational opportunities such as courses for extended duties are readily available for those interested and the structure of the companies affords various different positions within each group to encourage career progression and promotion.

But you don’t have to take our word for it. Here are some comments from dental hygienists and dental therapists working within ADG member groups about their experiences:

Jan Proudler, dental therapist from mydentist Bingley Road, Saltaire, said:

“I’ve had an amazing journey since joining mydentist in 2014. With the support of my practice team and our area development manager, my role has grown and developed over the years, increasing my working days at the practice from one to four per week.

“With the support of my colleagues, I’m able to utilise my full scope of practice as a dental therapist. I’m lucky to work alongside a very pro-therapist group of dentists – together we manage complex treatment plans and I’m continuously learning and improving my skills through the process of peer review. I’ve had the opportunity to speak with dentists and practice managers within our area, helping to promote the role of dental hygienists and therapists, encouraging the use of our role, and the benefits it can bring not only to other clinicians, but also to our patients. I’m currently working on a number of projects and events with the mydentist Resourcing and Employer Brand team to promote the opportunities the group can offer to dental hygienists and therapists throughout the UK.”

Laura Walker, dental hygiene therapist from Centre for Dentistry, commented:

“I have been with Centre for Dentistry nearly 5 years. There is a great sense of community, especially with the patients, which gives me a real sense of satisfaction in my work. I always feel supported clinically, by the other staff and dentists at the practice, as well as by management.

“I absolutely feel that the group cares about me as an individual. As a hygiene therapist, my clinical judgment is respected, and this matters hugely. We are very fortunate to have access to up-to-date equipment and materials which helps us deliver the best care to our patients. There is also ample time to complete treatments and a generous bonus scheme.” 

Amy Hambly-Symons, dental therapist at Smile Together, commented:

“I believe there are several benefits to working within the group sector as a dental therapist. Firstly, you have sufficient time to treat and educate patients, and while there are still time pressures in community dental services such as those offered by Smile Together, the knowledge that we can book patients in for longer or additional appointments to finish work to a high standard is extremely comforting. Secondly, I work in multi-surgery environments, so there are always dentists next door should I have any questions and there is also a network of people to contact for advice. In addition, you get to work with highly trained dental nurses; you have the support of an effective management team orchestrating all the compliance paperwork; and you have the opportunity to complete CPD and further training to advance your skills, which is funded as part of your employment package and helps you feel very invested in the group. Plus, community dentistry offers the chance to make a real difference locally and it is extremely rewarding to gain experience with ‘special care’ patients who have more complex needs.”

Becky Pollard, dental therapist at 543 Dental Care, added:

“Working in a large practice means I get to do a wide range of treatments and have lots of dentists that refer patients to me. The concept of dental therapy is well understood by our associates and I get to use my full  ‘scope of practice’, including impression taking, extractions and tooth whitening.”

We all know that dental hygienists and dental therapists are key members of the dental team within modern practices. The clinical skill set, patient relationships and passion for oral health promotion among those in the field are just some of the attributes that make them such proactive and valuable members of the profession. Finding an environment whereby your skills can be fully utilised is important for both your job satisfaction and career development. A dental group might be more beneficial than you have previously thought, so make sure you don’t limit your options and opportunities in the future.

For more information about the ADG visit www.dentalgroups.co.uk

Istvan Urban will be among the outstanding speaker line-up at the ADI Team Congress 2019, bringing a wealth of experience and expertise from Hungary to help delegates develop their knowledge and understanding of all aspects of the treatment involved with augmentation procedures.

Istvan qualified from Semmelweis University School of Medicine and Dentistry in Budapest, Hungary, before completing a programme in Oral Surgery at St Istvan Hospital and a PhD in Periodontology at the University of Szeged. He currently teaches implant dentistry on the graduate programme at Loma Linda University, California, is a board member of the Osteology Foundation and a Clinical Associate Professor in the Department of Periodontology and Oral Medicine at the University of Michigan. About his lecture for the ADI Team Congress 2019, Istvan comments:

“There is a growing number of patients with bone defects among both the older and younger generations. This is due to the rising incidence of tooth loss and the increasing number of dental implants consequently being placed, as well as accidents and even small tumours. Compared to traditional concepts, the simplified and less invasive techniques available today can be learned and successfully provided by a wide range of skilled dental professionals.

“As with many aspects of dentistry, the devil hides in the details when it comes to successful bone augmentation processes. The actual procedures are not that complicated, but they are not forgiving and if any details are missed, this can quickly lead to problems. For example, thorough patient preparation is of the utmost importance. Other considerations are how we manage the soft tissues for passive graft coverage and also how we can reconstruct both the bone and soft tissues for a natural-looking and long-lasting outcome.”

Istvan’s lecture, entitled “Perspectives on Vertical and Horizontal Augmentation”, will be presented on the plenary programme on Thursday 2 May. Istvan continues:

“Treatment of vertical and horizontal defects has to be comprehensive. During my lecture, I will discuss all aspects of the treatment involved with various different case examples. I will spend a great deal of time focusing on the mandible, but I will also explore major defects in the anterior maxilla. The Sausage Technique^TMdesigned for horizontal defects will also be explained.

“I hope delegates will gain a very good idea of how they can plan and execute ridge augmentation successfully.”

The ADI Team Congress 2019 will be the dental implantology event of the year, and Istvan’s talk is set to be a particular highlight.

“I think the ADI is a highly professional organisation and the programme at the ADI Team Congress 2019 will be perfect for modern dental professionals,” concludes Istvan. “That is why I would recommend that dentists and their teams participate! I am looking forward to speaking at the event and also being able to drive around and look at the beautiful surroundings of Edinburgh. Honestly, I have never driven on the other side of the road, so we will see how far I get!”

 ADI Team Congress 2019

Shaping the Future of Dental Implantology: Techniques – Technology – Teamwork

2 – 4 May 2019, EICC, Edinburgh

For more information or to book please visit www.adi.org.uk/congress19

ADI members can attend at significantly reduced rates, join online today.

In light of the European Parliament’s vote to phase down amalgam, has it become more important than ever for dentists to find trustworthy alternatives. This means you need new restorative materials you can trust to deliver the same easy handling, durability and effectiveness, without any of the negative side effects. 3M Oral Care offers several products that are more than capable of rising to this challenge.

Among these is the Filtek One bulk fill restorative (Figure 1), which enables clinicians to create excellent restorations[i]with speed and simplicity ii]It allows for easy sculpting and shaping,[iii]with good adaptability to the cavity and margins,[iv]low shrinkage when cured[v]and slump resistance for simple placement.[vi]Improving the professional workflow, one-step placement of the bulk fill material saves precious time[vii]compared to traditional composite procedures.

In terms of aesthetics, the Filtek One material is available in shades that match the demands for posterior restorations,[viii]enabling the fabrication of natural-looking outcomes.[ix]What’s more, Filtek One bulk fill restorative features higher wear resistance,[x]compressive[xi]and flexural strength,[xii]polish retention[xiii]and fracture toughness[xiv]than other leading brands.

Sharon Caro, Principal of St Annes Private Dental Centre in Lancashire, said:

“Filtek One’s handling properties are excellent; it doesn’t stick and it’s very easy to manipulate. The aesthetics are absolutely fantastic; the colours are very good and the translucency is very similar to the tooth tissue, providing highly natural-looking restorations, as can be seen in the photographs.

“The material also doesn’t require layering for beautiful aesthetics, therefore there is no need to use clear or enamel coloured surface product and it is incredibly easy to finish – polishing is quick and easy with the Sof Lex discs. This saves a huge amount of time.

“I would definitely recommend Filtek One to other practitioners.”

 Ketac Universal glass ionomer restorative is another effective alternative to amalgam (Figure 2). With an ideal viscosity[xv]and a less sticky consistency in comparison to other glass ionomer solutions,[xvi]it allows for easy application. In fact, 78% of dentists who trialled the product reported excellent overall handling (n=51).[xvii]To complement this and further encourage a simple treatment procedure,[xviii]Ketac Universal requires no layering,[xix]conditioner or coating.[xx]The fewer steps afford a smoother workflow and reduced chair time[xxi]for increased patient comfort.

Compared to other glass ionomer materials on the market, Ketac Universal delivers higher compressive strength[xxii]and surface hardness.[xxiii]It also features high wear resistance[xxiv]for both stress bearing and non-stress bearing restorations,[xxv]giving you and your patients confidence that long-lasting results will be achieved.[xxvi]

An additional benefit of Ketac Universal glass ionomer restorative is that it continuously releases more fluoride than competitive products[xxvii]for at least 12 months post placement.[xxviii]As fluoride has been shown to aid in caries prevention,[xxix]^,[xxx]this is a great advantage for any patients who experience recurrent caries.

Kunal Shah, Principal of LeoDental in London, commented:

“I think Ketac Universal is a fantastic product – it does everything I need it to do. It doesn’t stick and is one of the easiest products on the market to place. It’s strong, quick and easy to use, with a simple workflow that promotes patient comfort. The steady release of fluoride is also a benefit for maintaining patients’ general oral health. 

“Although I would rarely give a product 10 out of 10, I think Ketac Universal deserves it! I love it – it’s my go-to product for core build ups.”

If you’re looking for materials to replace amalgam, you need look no further than the clinically proven portfolio from 3M Oral Care.

For more information, call 0800 626 578 or visit www.3M.co.uk/Dental

REFERENCES

[i]3M Oral Care Data. Filtek One. Excellent restorations. Claim 6783, 2016.

[ii]3M Oral Care Data. Filtek One. Speed and simplicity. Claim 6065, 2014.

[iii]3M Oral Care Data. Filtek One. Sculpting and shaping. Claim 6761, 2016.

[iv]3M Oral Care Data. Filtek One. Adaptability. Claim 6763, 2016.

[v]3M Oral Care Data. Filtek One. Low shrinkage. Claim 6823, 2016.

[vi]3M Oral Care Data. Filtek One. Slump resistance. Claim 6771, 2016.

[vii]3M Oral Care Data. Filtek One. Time saving. Claim 6781, 2016.

[viii]3M Oral Care Data. Filtek One. Shade matching. Claim 6065, 2016.

[ix]3M Oral Care Data. Filtek One. Natural looking. Claim 6786, 2016.

[x]3M Oral Care Data. Filtek One. Wear resistance. Claim 6863, 2016.

[xi]3M Oral Care Data. Filtek One. Compressive strength. Claim 6841, 2016.

[xii]3M Oral Care Data. Filtek One. Flexural strength. Claim 6842, 2016.

[xiii]3M Oral Care Data. Filtek One. Polish retention. Claim 6839, 2016.

[xiv]3M Oral Care Data. Filtek One. Fracture toughness. Claim 6840, 2016.

[xv]3M Oral Care Data. Ketac Universal. Ideal viscosity. Claim 6227, 2014.

[xvi]3M Oral Care Data. Ketac Universal. Less sticky. Claim 6357, 2014.

[xvii]3M Oral Care Data. Ketac Universal. Excellent overall handling. Claim 6243, 2014.

[xviii]3M Oral Care Data. Ketac Universal. Fewer steps = simpler. Claim 6333, 2014.

[xix]3M Oral Care Data. Ketac Universal. Bulk fill. Claim 6175, 2014.

[xx]3M Oral Care Data. Ketac Universal. No conditioner or coating needed. Claim 6331, 2014.

[xxi]3M Oral care data. Ketac Universal. Reduced chair time. Claim 6332, 2014.

[xxii]3M Oral Care Data. Ketac Universal. Compressive strength. Claim 6178, 2014.

[xxiii]3M Oral Care Data. Ketac Universal. Higher surface hardness. Claim 6251, 2014.

[xxiv]3M Oral Care Data. Ketac Universal.Wear resistance. Claim 6180, 2014.

[xxv]3M Oral Care Data. Ketac Universal. Reliable choice in non- stress bearing and stress bearing restorations. Claim 6185, 2014.

[xxvi]3M Oral Care Data. In an application test where 3500 fillings were placed, 61% of the dentists were confident to use Ketac Universal for long-term restorations (more than two years). Claim 6237, 2014.

[xxvii]3M Oral Care Data. Ketac Universal. Higher fluoride release. Claim 6253, 2014.

[xxviii]3M Oral Care Data. Ketac Universal. Continuous fluoride release. Claim 6177, 2014.

[xxix]Marcia Ditmyer, Georgia Dounis, Connie Mobley, Eli Schwarz. A case-control study of determinants for high and low dental caries prevalence in Nevada youth. DOI: 10.1186/1472-6831-10-24

[xxx]Griffin SO, Regnier E, Griffin PM, Huntley V. Effectiveness of fluoride in preventing caries in adults. J Dent Res. 2007 May;86(5):410-5.