In modern dentistry, efficiency is key. Patient lists are getting larger, complex treatments are becoming more widely accessible and the demand for speedy treatment and rise in patient expectations means that without an efficient approach, practices will struggle.

To cope with this, it’s important for practices to examine their workflows and concentrate on areas where they can streamline their services, as well exploring other ways to boost productivity.

Practice management makes perfect

Like every business, a dental practice needs good management in place in order to thrive. An effective practice management system is essential, as these systems help to streamline the organisational aspects of the business in many ways.

Firstly, going paperless and incorporating a digital system is likely to make a number of daily management tasks a lot more convenient. Appointments can easily be booked in and moved if necessary, and it’s far easier to keep track of patients and estimate profit margins and other significant financial aspects of the business, especially as all of this information will be in once place.

A good practice management system will also allow staff to chase up no-shows and reorganise missed or cancelled appointments effectively – this helps to prevent times where dentists will have no scheduled patients to see, improving efficiency throughout the day.

Motivation and education

Of course, although patients are the lifeblood of a practice, your team is just as crucial to keep happy, motivated and ready to work. Efficiency in each role is essential for a well-run unit, and a lot of efficiency relies on factors such as motivation as well as innovation.

It’s no secret that dentistry is a fast-evolving industry where new treatments are introduced all the time. Are your staff trained in these new methods? Have they had the chance to explore these new techniques so that they can apply these skills in everyday practice? It’s likely that the majority of new treatments and techniques will aim to shorten treatment times or allow for shorter appointments, and this is something worth considering as this will soon boost your business in terms of speed. Furthermore, patients will be drawn to establishments that offer state-of-the-art treatments and this can help fill your patient lists with people who are willing to pay for more niche or trendy treatments.

It’s also important to consider the job satisfaction of the people who work with you and for you. It’s likely that if any member of the dental team is feeling stuck in a rut, their motivation, performance and therefore efficiency as an employee will be affected. Boredom is routinely cited as one of the core reasons for lower productivity, and can also result in talented staff members leaving your practice if they feel they are not being engaged enough.[i]

In order to combat this, it’s worth seeing if there are any training courses that you can send people on so that they can learn new skills. This will not only keep them invested as they feel that you are helping them to develop their career, but it will also come with further benefits such as them picking up bankable skills that can help your practice become more profitable.

Perfect your daily workflow

It’s all well and good to look at the wider picture, but it’s also necessary to examine your everyday workflows to see if these can be improved.

Are there any technologies that your practice could use which you invested in? As digital technology continues to make leaps and bounds, these systems make it easier than ever to streamline your workflows, especially in terms of treatments such as the taking of oral impressions.

Your instruments too can impact your efficiency as a professional. Precise, well-made instruments not only help you to perform more accurate surgeries, but also help to decrease patient discomfort. This means that you will inevitably achieve high-quality outcomes, faster, allowing you to improve your own efficiency levels.

Now practitioners can benefit from some truly high-quality precision instruments by choosing myplant. A sister company of Meisinger, myplant has recently been launched in the UK, allowing professionals to buy the world-famous Meisinger instruments in the UK for the first time. This includes the whole Meisinger portfolio of steel instruments, diamond instruments, ceramic abrasives, flexible polishers and more.

Focus on what’s best for your business

Improving efficiency doesn’t have to require drastic changes. By identifying areas where your practice can improve as well as investing in essentials that can help aid your performance, you can ensure that your practice is likely to become a more profitable and efficient in the future.

To find out more, visit www.myplant-dental.com, email order@myplant-dental.comor call 0049 21311 259465

[i]LinkedIn. How to Handle Boredom in the Workplace. Link: https://www.linkedin.com/pulse/how-handle-boredom-workplace-peter-stark-csp-1c/[Last accessed July 19].

Rodericks is proud to work with an array of skilled and enthusiastic individuals throughout the group. We strive to create the best possible working environments with the support and facilities professionals need to truly strive. As such, we are delighted that so many people stay with us for many years, developing their careers as they see fit.

This week, we sadly say goodbye to a highly valued member of our team at West Quay – Bernadette Jackson. She has worked as part of the reception team at the practice for more than three decades and will soon be leaving to embark on a new adventure.

Looking back over her time in dentistry, Bernadette said:

“I initially worked for Patrick Daly, before Rodericks bought the practice in 2017. We were so thrilled to work in a new build practice with cutting-edge technologies and carefully designed facilities. In fact, my fondest memory of the last 37 years is that of preparing the new practice with my colleagues. We had a lot of fun and it was very exciting to try something new.

“Since then, we have continued to see many of the same patients who return for their regular dental appointments. This has helped to build a rapport with patients and really get to know them.

“The biggest changes I experienced were related to my particular role. As the practice has developed with Rodericks, new protocols have been introduced. This brought with it the need to remember all the changes and new ways of doing things in order to perform my job to the best of my ability. However, many changes have been for the good of our patients so it was worth it. It was therefore very rewarding to help our patients adjust to the new practice – especially our older patients who initially found it difficult to adapt. Most have kept coming back so we definitely did something right!”

With so much experience, Bernadette goes on to share a pearl of wisdom for other professionals starting out a career in dentistry.

“My advice for any new receptionists at Rodericks would be to learn the rules and regulations in order to really become familiar and comfortable with them. There will always be more experienced individuals to turn to for information or support if you have any queries.

“For me, having been in the same job for so long, it is simply time for a new challenge. I have thoroughly enjoyed working in dentistry and I’m excited for what the future holds!”

From everyone at Rodericks, we would like to thank Bernadette for all her hard work and outstanding dedication to her patients. We wish you the very best for the future!

As we head into autumn, it’s time for thousands of individuals to begin higher education. In fact, in 2018 alone, over a quarter of all 18-year-olds from England, Wales, Scotland and Northern Ireland got accepted into universities – record breaking numbers that prove how popular higher education remains for those leaving secondary school.[i]

For many, this is the first chance they get to experience being self-sufficient and away from their parents, allowing them to exercise their freedom, make their own decisions and find their own way through life. Of course, with this big step comes big responsibilities, and it is little surprise that for many of these young adults the shock of having to do their own laundry, buy their own food, budget and pay bills can be a bit of a reality check.

With all of these aspects of life to consider, it’s little surprise that oral health may fall by the wayside, especially as the university lifestyle itself can promote bad habits. When people are given the freedom to eat what they like for the first time it’s inevitably going to lead to a spike in junk food and other treats that they would not have eaten so often at home. A study that recorded the average weight gain experienced by university students during their first year found that an increased intake of sugar and other poor dietary choices were to blame.[ii]Of course, this is bad news for teeth too, as sugar can quickly cause cavities.

What other behaviour do we instantly associate with students? If you answered heavy drinking, you wouldn’t be wrong. Binge drinking is often seen as part of the student experience, and with events such as Fresher’s Week, Carnage (effectively a bar crawl that often lives up to its name), club socials and other reasons to head to the bar, it’s little wonder that alcohol consumption among students is high. According to data gathered by the National Union of Students, as many as 20% of students say that they get drunk on purpose at least once a week. Among this figure 2% say they drink every day and 23% drink heavily 2-3 days a week.[iii]

As well as many alcoholic beverages containing high levels of sugar (a simple Jager Bomb usually contains as much as 21g of sugar!),[iv]excessive consumption has also been proven to alter the oral bacteria, leaving teeth more prone to decay.[v]

So, what can you do as a dental hygienist or dental therapist? It might be worth contacting any nearby universities to see if you can have a stall at Fresher’s Week to help remind students that their oral health is important. It is also a good idea to hold an open day or run promotions for new student patients if possible – by encouraging them to consider their oral health from the start, it’s likely they will form good habits during their time at university which they can continue into graduate life.

Some students may remain registered with their dentist back at home, but this doesn’t mean that you can’t help them through simple awareness. Can you contact medical centres on campus to put up posters? As long as these individuals are getting the care they need, they can enjoy their first breath of freedom away from home without having to worry about their dental health deteriorating.

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

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

References

[i]UCAS. A Record Percentage of Young People Are Off To University.  Link: https://www.ucas.com/corporate/news-and-key-documents/news/record-percentage-young-people-are-university[Last accessed June 19].

[ii]Wiles, N., Nakhooda, R. Consumption of Added Sugars Among Undergraduate Students at a South African University and its Association with BMI. South African Journal of Clinical Nutrition, DOI: 10.1080/16070658.2018.1553360

[iii]NUS. New Survey Shows Trends in Student Drinking. Link: https://www.nus.org.uk/en/news/press-releases/new-survey-shows-trends-in-student-drinking/[Last accessed June 19].

[iv]Spark People. Calories in Jager Bomb. Link: https://www.sparkpeople.com/calories-in.asp?food=jager+bomb[Last accessed June 19].

[v]Oral Health Foundation. How Your Favourite Tipple Could Be Changing The Bacteria In Your Mouth…And It’s Not Good News. Link: https://www.dentalhealth.org/news/how-your-favourite-tipple-could-be-changing-the-bacteria-in-your-mouth-and-its-not-good-news[Last accessed June 19].

Over time even mildly irritating sensations can drive a person to distraction. Particularly when stressed – and who isn’t faced with stressors today – little annoyances can mount up and cause far more aggravation than the sum of their parts. Rather than putting up with an issue and letting it gradually wear us down, doing what we can to minimise routine nuisances is a cornerstone of modern self-care.  

This becomes ever more important over time. As we age, our bodies accumulate more and more wear and tear, our muscles weaken, our skin thins, our mouths become drier – we become more sensitive to irritation. It is little coincidence that as we enter the later decades of life, the risk of losing our teeth goes up considerably. With tooth loss comes adverse aesthetic and functional changes, which is commonly treated with dentures.

Unfortunately, some older denture designs were and still are, imperfect. Many fit poorly, giving rise to a considerable number of issues – from gingival resorption, to affecting speech and the shape of the face, or the appliance coming loose, uncomfortable or even falling out and all the embarrassment that can cause. The mouth is one of the most sensitive areas of the body and is actively involved in several fundamental aspects of the human experience. From talking and conveying emotion such as smiling, to eating, the mouth is a critical anatomical area and any impediment can be significantly stressful and worrying. Our voices and faces are so closely tied to our identities, to who we are as people and how we express ourselves, so even relatively minor changes can be psychologically troubling and lead to a perceived reduction in quality of life.

To offer patients a modern alternative to traditional metal-based or flexible removable partial dentures (RPDs), Solvay Dental 360^®has custom-developed Ultaire^®AKP. Specifically designed to fit into the workflow for the fabrication of digital denture designs, this new generation polymer offers an accurate fit with tremendous retention and aesthetics. Ultaire^®AKP is lightweight yet it does not distort and is remarkably strong and resilient. It also has a bone-like feel and is highly compliant, which makes it pleasant and comfortable for patients to wear.

Traditional metal partial denture frames come with a host of potential drawbacks. They can damage remaining teeth, have unsightly visible clasps or cause discomfort due to their relative weight. They can leave a metallic taste that many patients find unpleasant or distracting, and for patients with metal sensitivity they can cause substantial, even painful, allergic effects.

Ultaire^®AKP is a metal-free, highly biocompatible alternative. It is therefore the ideal material for a comfortable and discrete partial denture. Aesthetically pleasing and with absolutely no metallic taste, your patients can benefit from partial dentures made from this advanced, long-life polymer for years to come.

Solvay Dental 360^® want you and your patients to get the very best out of the latest innovations and is passionate about education. It has gathered a team of experts that are ready to visit dental practices where, in the comfort of your clinic, you can attend a professional Lunch and Learn session. The experienced Solvay educators will explain the digital workflow and help you to understand the processes involved in the design and manufacture of removable partial dentures. They will also introduce you to Ultaire^®AKP, show you the benefits of polymer-based RPD frameworks and of course, supply a tasty lunch for you and your team.

With any prostheses, the ultimate goal should be to seamlessly replicate the form and function of the missing or damaged anatomy – prostheses should ideally not call attention to themselves and be so comfortable that the user forgets that they are not part of their body. By using non-irritating, comfortable and mechanically effective materials, we can better achieve this goal – which will help the patient feel confident and at ease. For many patients, a well-fitted partial denture made from Ultaire^® AKP is as close to their original teeth as they can possibly imagine.

With the opportunity to take any potential irritations away from your patient’s experience of removable partial dentures, an advanced, tailor-made Ultaire^®AKP solution is sure to leave them smiling.

Solvay Dental 360^® is confident that you will find Ultaire^®AKP a transformative step forward for RPDs. Contact our team today to find out more about this revolutionary new material or to arrange an informative professional Lunch and Learn session at your practice.

To book a Solvay Dental 360^®Professional Lunch and Learn or to find more information Ultaire^®AKP and Dentivera^®milling discs,
please visit www.solvaydental360.com

Obstructive Sleep Apnoea is a highly debilitating condition whereby the walls of the upper airway relax during sleep and obstruct breathing, leading to interrupted sleep. When the patient is assessed correctly an alternative to CPAP is the fabrication of a special dental appliance that prevents the airway closing, something which is considerably easier when using a digital intraoral scanner with high precision such as the CS 3600 from Carestream Dental.

The impact of sleep apnoea

Paul Reaney, a dentist from Dentistry @ Markethill, explains the dangers of sleep disorders and why the CS 3600 intraoral scanner from Carestream Dental is the ideal option for treating these patients due to its innovative features and versatile design:

“What many people don’t realise is that the impact of conditions such as sleep apnoea is huge. Acute sleep loss can quickly lead to problems such as anxiety, stress and even day-to-day injuries – it takes the fun away from people’s lives, damages relationships and this, in turn, affects their productivity. Long-term effects can even be life threatening, as diabetes and heart attacks are just some of the conditions associated with lack of sleep that professionals need to be aware of.

“Unlike cosmetic dentistry where patients experience satisfaction based on aesthetics alone, effective sleep dentistry can literally change patients’ lives, not only improving the quality but also the quantity of sleep. Research has found that those who experience interrupted sleep are likely to see their lifetimes reduced by as much as 12 years. Using the CS 3600 plays a valuable contribution to this patient care which is not only life changing but life extending.

“This is why I’m always looking to make a big difference for my patients, fast. By adopting a digital workflow and using an intraoral scanner instead of traditional impression techniques I can ensure that my patients get the care they need in a much shorter timescale and provide better outcomes.”

Portable and precise

The CS 3600 from Carestream Dental has a number of interchangeable tips, all of which have been especially designed to overcome challenges such as smaller oral cavities or to reach more difficult to scan sites such as buccal or posterior regions.

“For me, one of the biggest benefits of the CS 3600 is the selection of tips,” says Paul. “It has the smallest tip available on the market, and as I work with a lot of younger patients for orthodontic care, this really helps me to treat everybody properly.

“The live scanning warnings are also incredibly helpful – they point out any areas of the scan that may need to be redone or filled in, and as I can send the scan to my technician as soon as it has been taken, I can easily retake it if necessary without my patient having to book another appointment. As I travel between clinics, the portable nature of the scanner is another huge benefit.”

Achieving an accurate fit

The appliances used to treat sleep apnoea have to be custom made to the individual, protruding the mandible so that the airway no longer becomes obstructed. Paul comments:

“The completely digital workflow helps me achieve patient satisfaction and streamline treatment at the same time. Patients love that they have access to a state-of-the-art treatment option, and this helps to build patient-practitioner trust.”

“Due to the CS 3600’s accuracy, I can instantly assess a number of important details that are necessary for the fabrication of an effective appliance. Not only are the scans highly accurate, but I can also pick up details that are simply impossible to capture using traditional methods. Furthermore, as the CS 3600, in particular, has such a good level of trueness and I can use the scans to assess the depths of undercuts – a necessary measurement to ensure that appliances fit perfectly.”

“The Multiple Bite option is integral to providing Mandibular Advancement Appliances. This function allows me to take up to three different bite registrations that can be viewed in the software: for example, normal, open and protruded bites, without inaccuracies of recording the bite registration by traditional methods.”

Ongoing excellence

As Paul continues, care for patients with sleep apnoea continues beyond the initial treatment.

“One of the most important things to provide patients fitted with these appliances is continued support. Appliances can cause teeth to move over time, and with the CS 3600 I can take scans at review appointments and superimpose them to identify any tooth movement. This is also useful for patients with bruxism before receiving their appliance, as it is an effective way to gauge tooth wear when rescanned at reviews.

Always by your side

“For me, one of the main benefits of the CS 3600 is that it’s so easy to use. The software is intuitive and the wand itself is straightforward, helping the whole process to become stress-free. The support from Carestream Dental is also fantastic – they really provide that personal connection that you don’t often get in the digital age, and that makes all the difference.”

The CS 3600 is suited to a wide array of indications and can help enhance outcomes as well as turnaround times and patient comfort. To find out more, contact Carestream Dental.

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

Author Bio: Dr Paul Reaney BDS  MFGDP  DPDS Dip PCOrth RCS (Eng)

Dentistry@Markethill / Snoring SolutionsNI

Accredited Member of the European Academy of Dental Sleep Medicine

The incidence of Type 2 diabetes (T2D) in the UK has more than doubled since the turn of the millennium.[1]Today, more than 3.8 million people in Britain have been diagnosed with diabetes, with around another 1 million estimated to be unaware that they are living with the disease.[2]This equates to more than 5% of the entire population, and with that population aging and a quarter of adults now obese, this figure is likely to continue increasing in the near future.[3]^,[4]Of those living with diabetes, around 90% have Type 2.[5]

Diabetes incidence and glucose intolerance has also been associated with rising temperatures, which can alter insulin absorption and diffusion, as well as various counter-regulatory hormones that can significantly impact acute or even chronic glycaemic management.[6]Researchers have posited that on average, for every 1°C the temperature increases, age-adjusted diabetes increases by 0.3 per 1000 people.[7]With climate change well under way and temperatures likely to continue to rise, even a comparatively small effect could see millions more people develop the condition.

Inflammation complications

Inflammation is a natural reaction to infection and injury, playing an integral role in our body’s immune response and healing processes. However, when inflammation becomes chronic, it can become counterproductive to a patient’s well-being, resulting in a wide-variety of inflammatory conditions.[8]Both obesity and T2D cause chronic low-level inflammation in the patient.[9]

Diabetes is associated with a substantially increased susceptibility to infection of all kinds, compared to the general population. This is further compounded when patients have synergistic risk factors, such as smoking.[10]Infection can, of course, result in sustained inflammation.

Chronic inflammation plays a key role in gingivitis, periodontitis and peri-implantitis, resulting in tissue damage and destruction. This inflammation is primarily the effect of the immune system responding to an overgrowth of bacteria in the oral cavity.[11]It has long been theorised that systemic inflammatory diseases increase the risk of periodontal diseases. However, whether the presence of the former actually causes the latter, or if they simply share disease pathways, has been difficult to determine.[12]

While we may not know for sure if it is a causative factor, T2Dis significantly associated with periodontitis. Some research indicates that this is especially true among males, due to their lower levels of compliance with good oral hygiene practices (on average, men are more likely to fail to brush twice a day, etc.). All patients must be encouraged to maintain good oral hygiene, and extra vigilance should be paid to high risk demographics in order to minimise preventable complications.[13]

Controlling diabetes

Whether a patient’s diabetes is under control significantly modifies the risk it poses. Research indicates that patients with poorly controlled diabetes are around twice as likely to develop peri-implantitis as those where it is well managed. Likewise, implant patients with poorly controlled diabetes generally exhibit lower stability ratings in the first 2-6 weeks, indicating delayed osseointegration. Stability measurements do eventually reach parity with those without the condition and those where it is well managed, however, this takes twice as long.[14]

Diabetes has systemic repercussions, such as increasing the risk of cardiovascular disease (CVD) and microvascular complications over time. Quite simply, the longer a person has lived with the disease, the greater the risk of developing related complications like ischemic heart disease and neuropathy. While T2D has classically been associated with the elderly, early onset diabetes (regarded as beginning prior to the age of 40) is increasingly common in the UK. Consequently, these patients can expect to face this these types of complications sooner.[15]It is therefore advisable to, where possible, learn and consider how long a patient has been living with the condition – as their metabolic health could more resemble an older individual’s than their age would suggest.

Reducing the risk of infection is critical to minimising complications from dental implant therapy, and this is especially important for patients who already have systemic health issues. Selecting a high-quality implant solution helps minimise the chance of infection and is beneficial for all patients, particularly for those with compromised health. TBR’s Z1^®implant features an innovative zirconia collar that acts as an antibacterial shield to minimise the risk of infection. Indeed, zirconia surfaces demonstrate a lower affinity to bacteria compared to titanium.[16]This helps to protect the crestal bone and the gingiva from iatrogenic inflammation, encouraging the soft tissue to heal around the implant in a manner that closely resembles natural gingival growth.

Dental implants are safe for diabetic patients, and where good glycaemic control and oral hygiene is maintained, implant survival is in line with those without the condition.[17]However, because these patients are at increased risk of various complications, and in many cases will have comorbid conditions that can further influence their health, it is important that they are regularly checked for developing problems.

For more information on the Z1^®implant, visit tbr.dental, email support@denkauk.comor call 0800 707 6212

References

[1]Sharma M., Nazareth I., Petersen I. Trends in incidence, prevalence and prescribing in type 2 diabetes mellitus between 2000 and 2013 in primary care: a retrospective cohort study. BMJ Open. 2016; 6(1): e010210. https://bmjopen.bmj.com/content/6/1/e010210May 20, 2019.

[2]Diabetes UK. Diabetes Prevalence 2018. Diabetes UK.2018. https://www.diabetes.org.uk/professionals/position-statements-reports/statistics/diabetes-prevalence-2018May 20, 2019.

[3]ONS. Overview of the UK population: November 2018. Office for National Statistics.2018. https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/articles/overviewoftheukpopulation/november2018May 20, 2019.

[4]Baker C. Obesity statistics. House of Commons Library. 2018. https://researchbriefings.files.parliament.uk/documents/SN03336/SN03336.pdf

May 20, 2019.

[5]Diabetes UK. Facts & figures. Diabetes UK. 2019.https://www.diabetes.org.uk/professionals/position-statements-reports/statisticsMay 20, 2019.

[6]Kenny, G. P., Sigal, R. J., & McGinn, R. (2016) Body temperature regulation in diabetes. Temperature (Austin, Tex.). 3(1): 119–145. doi:10.1080/23328940.2015.1131506. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4861190/.May 20, 2019.

[7]Blauw L., Aziz N., Tannemaat M., Blauw C., Craen A., Pijil H., Rensen P. Diabetes incidence and glucose intolerance prevalence increase with higher outdoor temperature. BMJ Open Diabetes Research & Care. 2017; 5: e000317. https://drc.bmj.com/content/5/1/e000317May 17, 2019.

[8]Cekici A., Kantarci A., Hasturk H., Van Dyke T. Inflammatory and immune pathways in the pathogenesis of periodontal disease. Periodontology 2000. 2014; 64(1): 57-80. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4500791/May 20, 2019.

[9]Schaeffler A. Is diabetes and inflammatory disease and be treated like that. Annals of Rheumatic Diseases. 2017; 76(Suppl. 2): 39. https://ard.bmj.com/content/76/Suppl_2/39.1May 20, 2019.

[10]Carey I., Critchley J., DeWilde S., Harris T., Hosking F., Cook D. Risk of infection in type 1 and type 2 diabetes compared with the general population: a matched cohort study. Diabetes Care.2018; 41(3): 513-521. http://care.diabetesjournals.org/content/41/3/513May 20, 2019.

[11]Cekici A., Kantarci A., Hasturk H., Van Dyke T. Inflammatory and immune pathways in the pathogenesis of periodontal disease. Periodontology 2000. 2014; 64(1): 57-80. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4500791/May 20, 2019.

[12]Winning L., Linden G. Periodontitis and systemic disease. BDJ Team. 2015; 2: 15163. https://www.nature.com/articles/bdjteam2015163May 20, 2019.

[13]Liu Y., Yu Y., Nickel J., Iwasaki L., Duan P., Simmer-Beck M., Brown L. Gender differences in the association of periodontitis and type 2 diabetes. International Dental Journal. 2018; 68(6). https://onlinelibrary.wiley.com/doi/full/10.1111/idj.12399May 20, 2019.

[14]Naujokat H., Kunzendorf B., Wiltfang J. Dental implants and diabetes mellitus – a systematic review. International Journal of Implant Dentistry. 2016; 2(1): 5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5005734/May 20, 2019.

[15]Song S. Complication characteristics between young-onset type 2 versus type 1 diabetes in a UK population. BMJ Open Diabetes Research & Care. 2015; 3(1): e000044. https://drc.bmj.com/content/3/1/e000044May 20, 2019.

[16]Rimondini, L., Cerroni, L., Carrassi, A., Torricelli, P. Bacterial colonisation of zirconia ceramic surfaces: an in vitro and in vivo study. Int. J. Oral Maxillofac. Implants. 2002; 17(6): 793-798. Link: https://www.researchgate.net/publication/10969412_Bacterial_Colonization_of_Zirconia_Ceramic_Surfaces_An_in_Vitro_and_in_Vivo_Study. May 20, 2019.

[17]Naujokat H., Kunzendorf B., Wiltfang J. Dental implants and diabetes mellitus – a systematic review. International Journal of Implant Dentistry. 2016; 2(1): 5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5005734/May 20, 2019.

Luke Moore – Co-Founder of Dental Elite – presents the third instalment of his series of articles considering potential pitfalls of practice sales and acquisitions. Here we focus on problematic areas relating specifically to associates and dental hygienists.

As a major source of income for any dental practice, ensuring everything is in order with associates and dental hygienists in the business is crucial. Any complications or grey areas can be particularly problematic when it comes to selling or buying a practice, as these individuals can have a significant

impact on current and future profits and capacity. While there are many possible obstacles to overcome, the following are the most commonly faced in dentistry today…

Employed versus self-employed

There has recently been a lot of conversation over the potential discrepancies in contracts relating to associates. The same contentions exist for dental hygienists as they meet some of the criteria for both employed and self-employed status. However, you should bear in mind that if the status was ever in question, then HMRC would more likely find them to be an employee if they didn’t meet all the criteria for self-employment. By way of example, hygienists are often paid guaranteed hourly rates and remain in the practice for a prescribed number of hours each week, so although they may work for different practices, they most likely wouldn’t meet HMRC’s criteria for self-employment.

If dental hygienists or the powers that be decide they are employed by the practice, then the principal at the time would owe National Insurance Contributions (NICs) and tax for that individual for up to seven years. Similarly, staff would be entitled to all the rights that an employed status brings, including paid holiday and pension contributions. The situation would be the same for an associate without a contract who claimed they were employed, even if the principal believed they were not. The importance of ensuring every single member of staff in the practice has an up-to-date contract cannot be stressed enough when preparing to sell or buy.

Restrictive Covenants

Regarding contracts, it’s vital that all members of staff are subjected to carefully written restrictive covenants. These protect the business from an individual leaving and setting up shop right next door, but they are only effective when drafted correctly. The clauses have to be reasonable for both parties in order to be enforceable; otherwise they can quite easily be argued and thrown out by a good legal team. This includes the physical distance from the existing practice that a new business could be established or worked in, as well as the length of time after leaving that someone could work within this area. Collaborating with an expert in the field when drawing up staff contracts is therefore a good idea when completing due diligence in preparation for a practice sale or acquisition. Some principals mistakenly believe there is a ‘fairness test’ applied by the court whereby if the restriction is too wide – say 20 miles – then the court can re-write the contract to 5 miles. This is not the case; the clause either works in it’s entirety or doesn’t work at all, meaning that a dentist could setup next door if their restrictive covenant is deemed too wide.

UDA underperformance

Where a practice is underperforming on its NHS contract, a buyer could seek to postpone completion until they know if a breach notice will be issued. If it is, a buyer may request a reduction in price. As such, it is beneficial for vendors to take on locum professionals or open longer hours in order to pick up the slack if there is any risk of not meeting NHS contract targets. The objective is to avoid underperformance wherever possible in the lead up to and during a practice sale. Working with a company like Dental Elite provides the vendor with access to sales support, as well as quick and efficient recruitment of locums.

Associates

Most principals will keep the sale of their practice private until the final stages of the transaction. However, an existing associate may sometimes reveal that they would have wished to buy the practice, though it will usually be too late by this point. Whether this is a serious offer or not, a disgruntled associate leaving at a late stage in the transaction could jeopardise the sale – especially in a small, private practice. It is advisable to seek the support of appropriate experts in such situations in order to mitigate the potential problems. Usually, if a new associate can be recruited fairly quickly, the sale will still go through. It is crucial to replace them quickly, though, and not believe that because completion is only a month or two away, that it can be left for the buyer to deal with. Even at the very latest stages, a buyer can still pull out – the sale is not done until it is done.

The small print

Many of the above potential pitfalls can be avoided by simply ensuring that contracts with associates and dental hygienists are present and correct. Any other issues need to be dealt with swiftly to facilitate a smooth sale process.

For more information contact Dental Elite. Visit www.dentalelite.co.uk, email info@dentalelite.co.ukor call 01788 545 900