Month: June 2020

Let’s get back to business

Part of getting back to business successfully will be about fully utilising the resources you already have available. For those practices with CS R4+ practice management software from Carestream Dental, this will be made easier with the support of a dedicated webinar series running throughout June.

Carestream Dental has partnered with Karen Turner of 22 Coaching and Consulting Ltd to present a 3-part webinar series. The sessions will focus on different areas of the business and explore the features of CS R4+ that will support a successful exit from lockdown and help future-proof the practice.

4th June 2pm

Webinar 1 – Communicating with your patients

The first webinar will concentrate on the diverse communication capabilities of the software. Karen will discuss the importance of keeping patients engaged and how you can utilise CS R4+ to provide the reassurance and information that they need before attending an appointment. She will also explore what the patient journey might look like and how this will differ from their experience pre-COVID. In addition, the importance of staying in touch with practice team members will be highlighted, with a wealth of advice provided to help principals support their teams.

11th June 2pm

Webinar 2 – Adjusting to the ‘new normal’

You will likely already be familiar with the phrase ‘new normal’ – but what exactly does it mean for dentistry and how will you need to adapt? Carestream Dental is here to support you in any changes or adjustments that you have to make. During this webinar, Karen will provide insight into both existing and new features of CS R4+ that you will find helpful in the weeks and months ahead. She will also discuss engaging with the team in more detail, exploring how they might be able to work from home effectively. Further still, Karen will cover what preparations you may consider for your re-opening and how you could maximise your infection control compliance.

18th June 2pm

Webinar 3 – Looking to the future

While it is crucial to focus on the here and now in order to re-open the practice doors safely and efficiently, a thought must also be given to how the business could be affected in the long-term. In the final webinar of this series, you can join Karen to postulate what that ‘new normal’ could mean for the future of your business. What role might digital technologies play? How will you manage patient expectations? How can you ensure the safety of your patients and staff moving forwards? All this will be discussed, as well as how the innovative CS R4+ software could be used to manage and optimise practice performance as business evolves.

Go back with confidence

It’s important that you, your team and your patients have the confidence to get back to dentistry in the coming weeks. Always committed to customer support, Carestream Dental is here to help and to give you the information and ideas you need to not only get the doors open, but keep them open.

 

For more information please contact Carestream Dental on 0800 169 9692 or visit www.carestreamdental.co.uk

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

FGDP reveals UK Guidelines for a safe return to dental practice during Covid-19

Ian Mills

At midday on Monday 1 June 2020, Ian Mills, Dean of the Faculty of General Dental Practice [UK] (FGDP), broadcast a brief statement via the organisation’s Facebook page to announce that FGDP and CGDent have published the UK Guidelines for a safe return to dental practice during Covid-19.

The 68-page document is available via the FGDP website – https://www.fgdp.org.uk/implications-covid-19-safe-management-general-dental-practice-practical-guide – and supports dental professionals to take a risk and evidence-based approach to providing safe general dental care in the current circumstances. It was developed jointly with the College of General Dentistry, and with the involvement of a wide range of other national dental organisations.

The document can be accessed here.

“Our guidelines are developed primarily by general dental practitioners, and are aimed at colleagues working in general dental practice,” explained Mills, along with CGDent Trustee Mick Horton and Covid-19 Task Group Chairman Onkar Dhanoya. “This has been particularly important at this critical time, but we could not have delivered this guidance without the support and expertise of many colleagues who work across all fields of healthcare. We have faced a huge challenge over the last few months, both as a profession and as a nation as we deal with the COVID-19 pandemic. Many colleagues have been touched by tragedy, and the dental profession has had to face significant hardship as dental practices across the country battle to support their patients, their colleagues and their businesses. The level of uncertainty during the pandemic has led to fear, anxiety and at times anger, as we struggled to cope with the unknown. It was clear that the profession needed specific guidance to support a safe return to practice in the knowledge that they would be able to continue to provide high quality care for their patients.”

https://www.facebook.com/fgdpuk/videos/282776126440679/

A practice differentiator

Straumann coDiagnostiX is more than just implant planning software. It’s a practice differentiator.

The state-of-the-art software offers numerous measurement and planning functionalities, while automatically detecting nerve canals for added peace of mind. It also enhances patient communication by providing enhanced visualisation for improved understanding and treatment acceptance. In addition, it directly integrates with the Straumann P10 – a capsule-based 3D printer designed to fabricate surgical guides in-practice.

The Straumann coDiagnostiX Easy offers a simplified software interface for the complete workflow, which is ideal for clinicians looking to  start their journey into guided surgery.

With more than 20 years development behind it, the Straumann coDiagnostiX offers superior treatment planning for minimal risk. For sophisticated but user-friendly diagnostics and supported implant planning that will help you stand out from the crowd, make coDiagnostiX your software of choice.

 

For more information, please visit at www.straumann-uk.co/cares-chairside

Dental Protection offers support to dentists deciding to re-open practices

Dental Protection has reassured all members working in England who choose to return to work that they will continue to be supported. While the situation with NHS practices reopening is clearer due to a general acceptance that the Chief Dental Officer (CDO)’s guidance will be followed, the position regarding private practice has been less clear and has left those dentists – many of whom are facing financial difficulties – concerned about when they can return to work and whether they would be protected if they choose to do so.

Dental Protection has said members operating in the private sector who decide to return to work can be reassured that the indemnity provided by Dental Protection will continue to meet their regulatory and legal obligations, as long as they are in active membership and paying the correct subscription for the work they will be undertaking.

It added that members will have access to support and advice if needed, and if a complaint or claim should arise from the decision to re-open, members can request assistance.

In an email to members, the organisation said that the decision to re-open rests with the individual practice owner and that while Dental Protection cannot make such decisions for dentists, it can advise members of what they should consider when making the decision, such as:

  • The GDC statement that ‘Practitioners providing NHS services will of course need to adhere to the directions given by  the CDO; other practitioners will want to take that into account in making decisions.’
  • The CQC’s stated position that it ‘cannot require providers of dental care services to close, unless we find clear evidence of a breach of our regulations that requires consideration of the use of our powers under the Health and Social Care Act 2008 and associated regulations. It has also said that ‘The decision to offer dental care services is one for the provider to take.’
  • The need to adhere closely to central Government guidance on social distancing and to the most recent dental guidance documents from various agencies including PHE and the prevailing CDO guidance.
  • If you operate in the private sector, you should review existing protocols and standard operating procedures (SOPs) and take these into account when developing your own protocols, individually or within groups, and ensure practice protocols/SOPs meet the standards set in the prevailing guidance. 
  • Undertaking a thorough clinical risk assessment of the operating environment and of the patient journey.

In the event of a complaint or claim regarding the decision to re-open or the care that was provided, Dental Protection also it would be important to be able to evidence the following:

  • Written SOPs consistent with the widely accepted evidence-base and at least as robust as those issued by the NHS
  • Evidence of understanding and adherence to the SOPs and protocols by all team members
  • Clinical records which, in additional to usual record keeping requirements, clearly show the process of care, the rationale of the clinical intervention(s), the PPE used together with details of the relevant guidance considered in clinical decision making.

Raj Rattan, Dental Director at Dental Protection said: “Our team at Dental Protection includes experienced clinicians, associates and practice owners, and we understand the myriad of challenges facing members during the current crisis, including the welfare of their staff, their patients and themselves. We also recognise the financial pressures they may be facing, which is why we have offered members the equivalent of two months’ subscription relief. As a profession, we may not know what the future looks like, but I can assure you that Dental Protection will be protecting members as the situation evolves.”

Further information is available at: https://www.dentalprotection.org/uk/articles/information-for-members-considering-re-opening-their-private-practice

12 million Brits move to electric toothbrushes

The number of British adults cleaning their teeth with an electric toothbrush has surpassed those using a manual one for the first time, according to the findings of a new nationwide study. The new data shows that nearly 12 million people in the UK have switched to an electric toothbrush over the last five years.

Around two-in-three (67%) adults now use an electric toothbrush – an estimated 34 million people – an increase of 52%. The research has been conducted by the Oral Health Foundation and Oral-B as part of National Smile Month – a charity campaign to raise awareness about the importance of having good oral health.

Dr Nigel Carter OBE, Chief Executive of the Oral Health Foundation, believes as the science behind the advantages of electric toothbrushes mounts, the decision whether to invest in one becomes much easier. “The strong and clear evidence is that electric toothbrushes are better for our oral health. Electric toothbrushes, especially those with heads that rotate in both directions, or ‘oscillating’ heads, are more effective at removing plaque than a manual brush.  This helps keep tooth decay and gum disease at bay.

“As technology has developed, the cost of having an electric toothbrush becomes even more affordable. Battery-powered toothbrushes are available for as little as £10 while electric brushes can be had for as little as £40. Whilst at the other end of the spectrum there are top end power brushes which have all the latest innovations such as artificial intelligence. Given the advantages of electric toothbrushes, having one is an excellent investment and could really benefit the health of your mouth.”

Recent data presented in the Journal of Clinical Periodontology, found that electric toothbrushes led to 22% less gum recession and 18% less tooth decay over the 11-year period.

The charity’s research shows that nearly half (45%) make the switch to electric brushes because they believe it cleans better than a manual brush.  More than one-in-four (27%) invest in an electric toothbrush on the advice of their dentist.

Technology also seems to be a growing trend for why people have moved to electric toothbrushes.  Around one-in-seven (18%) buy an electric toothbrush because of features like in-built timers or that they can be connected to apps which keep a track on how well you are brushing.  Others simply enjoy having it as a gadget. 

Eva Castro Perea, Professional & Academic Manager, Oral-B believes new technology has allowed more people to take a greater interest in the health of their mouth. “Over the last five years we have seen tremendous advances in oral healthcare technology.  There are now electric toothbrushes that alert you to areas in the mouth you have missed, or let you know if you are brushing too hard, or not hard enough.  By having new access to your brushing habits and behaviours allows you to be a more effective brusher, which will in turn give you a healthier mouth. Other features such as in-build timers, allow users to track two minutes in a more reliable way.  This is especially important for children and has been shown to be an excellent motivator for them.”

Despite the benefits of using an electric toothbrush, one-in-three (33%) adults in the UK still use a manual toothbrush. Findings from the Oral Health Foundation show that manual brushing is closely related to both age and household income.

The charity says whether you currently use an electric toothbrush or not, it is important that you are following a good oral health routine.

Dr Carter adds: “If you follow a good oral health routine then whether you use a manual or electric toothbrush, you’ll have a healthy mouth either way. That means brushing for two minutes, twice a day, with a fluoride toothpaste.  Brushing should be done last thing at night and at one other time during the day. A daily oral health routine would not be complete without cleaning in between your teeth with floss or interdental brushes and using mouthwash. Both can help to remove plaque bacteria from the mouth and keep your teeth and gums healthy.”

As part of National Smile Month, the Oral Health Foundation and Oral-B are hosting The Great British Brushathon on Wednesday 3 June. The event will ask people to post a video of themselves on social media brushing their teeth. The charity says the activity will help promote the value of tooth brushing and having a healthy smile.

To learn more about The Great British Brushathon and National Smile Month, visit www.smilemonth.org.

Tackling periodontitis in patients

Although it’s difficult to assess how many individuals currently have periodontitis in the UK, it’s generally assumed that at least 45% of individuals have some form of gum disease.[i] Of course, a large amount of this is likely to be gingivitis – but as this is the precursor to periodontitis is it any less important?

Claire Berry, dental hygienist and Ambassador for the British Society of Dental Hygiene and Therapy (BSDHT) explains how she treats patients with periodontitis, and why more professionals should be exploring different approaches to gum disease in order to get the best results.

Prevention first

“We all know that periodontitis is preceded by gingivitis, and yet I still think that some clinicians aren’t placing enough importance on prevention and the main thing that causes the issues – the biofilm. It’s common knowledge that once gingivitis has progressed into periodontitis the damage cannot be undone, so treatment from this point really needs to be about stabilising the condition so that it doesn’t worsen and cause more suffering and expense for the patient.

“Even a Basic Periodontal Examination (BPE) score of 1 should ring alarm bells – what we need to realise is that any bleeding, no matter how small, is evidence of an immune response in the patient. The immune response to bacteria is eventually what leads to bone loss and other irreversible changes, so we need to be able to stop this as soon as possible.”

Treatment for periodontitis

“I tend to take a unique approach to treating periodontitis and flip the usual appointment order around to facilitate better results. Basically, using methods I have learned from experienced and skilled clinicians, the first step after recording BPE and carrying out bleeding scores is to introduce Oral Hygiene Instruction (OHI) there and then with the help of disclosing the biofilm.

“This way, patients can easily visualise the current state of their mouth and see how the biofilm is leading to periodontitis and further problems in the oral cavity. I use disclosing solution as this perfectly highlights the biofilm and reveals all of the bacteria to patients. I often find this step gives them a jolt of realisation as it’s so visual – it’s easy to ignore what you can’t see, but once it’s visible the problem becomes more real.

“I then teach people how to remove this biofilm properly, so that they can perform excellent oral care at home twice a day. It allows me to tailor my advice to suit their current situation. I also remove all of the biofilm currently present both above and below the gingiva and tell them that this will begin to form again not long after I have removed it– this way I know we’re starting on a clean slate but demonstrates that they must continue with removing it daily and it encourages them to take an active part in stabilising their own periodontitis.

“I find this method really helps in the long run, as when patients return (six weeks later) there should be considerably less inflammation, swelling, bleeding etc. This means that I can take more accurate readings and assess the extent of the problem better as there will be no other factors impacting the readings. Following this, I ask patients to return every three months, routinely highlighting or disclosing the biofilm and ensuring that they are following the advice given to stabilise the condition properly.

“Stable and unstable periodontitis will need different treatment approaches. If a patient is already stable, routine check-ups are necessary to ensure that they remain so, and that their condition doesn’t deteriorate. On the other hand, those suffering from unstable periodontitis absolutely must have their conditions brought under control.”

The role of dental hygienists and dental therapists

“Dental hygienists and dental therapists are the best placed people in the practice to stabilise and prevent periodontitis. Despite this, I think we are still being overlooked in our profession by dentists and not enough awareness exists among patients as to what our roles actually involve.

“I’ve long believed that by implementing better skill mix and by championing the skills of dental hygienists and dental therapists to their full extent that practices will see better results for patients, less litigation and a more streamlined approach to care. We cannot properly help patients with periodontitis if we don’t have the correct amount of time and resources available, so this is something that needs to be understood in order for things to improve.

“I was excited to be chosen as a BSDHT Ambassador because it’s going to give me a chance to really show my passion for the profession and provide a good platform to speak about issues such as this. Many voices shout louder than a single voice alone, so I think it’s really important for people in the profession to join Societies which allow them to have this representation. The BSDHT is exceptional as it is always fighting our corner and always covers things which are of the utmost importance for us all.”

 

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

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

 

[i] BSP. Gum Health Resources for Patients. Link: https://www.bsperio.org.uk/patients/ [Last accessed January 2020].

New study finds water fluoridation reduces the number of children admitted to hospital for dental treatment under GA

Children living in greatest deprivation have most to gain from having a fluoridated drinking water supply, according to new research. Fluoride is added to water in order to prevent tooth decay and the new study demonstrates that community water fluoridation is particularly beneficial for the youngest children in the poorest communities.  

The research was carried out in New Zealand and published in the International Journal of Epidemiology. It adds to the body of research demonstrating that community water fluoridation (CWF) reduces dental health inequalities.  The key findings of the research are:

  • Children from the most deprived areas are more likely to be admitted to hospital for the treatment of pain or sepsis (abscesses) caused by dental decay
  • Fluoridation of the water supply reduces the number of children being admitted to hospital for dental extractions under a general anaesthetic
  • The youngest children in the 0-4 age category in the most deprived areas benefit most from water fluoridation

In New Zealand, around 60% of the population benefits from fluoridated water, mostly city-dwellers. The team from the University of Canterbury in Christchurch compared the number of hospital visits of children in 0-4 and 5-12 age categories from both fluoridated and non-fluoridated areas.

Professor Mike Lennon, a member of the British Fluoridation Society’s executive, said: “This paper shows the evidence supporting the benefits of fluoride in drinking water is getting stronger. It demonstrates that you can reduce the risk of negative dental experiences for children from poor homes. Without fluoride in the water, they are more likely to end up in hospital with toothache.”

The role of water fluoridation in reducing health inequalities was identified in the UK in the University of York Systematic Review of 2000.  Since then, the evidence base has continued to grow with more research undertaken in the UK as well as Israel, Korea and Australia.

Professor Lennon said the data collected by the team from the University of Canterbury had been rigorously analysed. Their focus was ambulatory sensitive hospitalisation (ASH) which are hospital outpatient admissions for preventable conditions, in this instance for tooth decay and infection.

Comparisons were carried out between different census areas and then adjusted for factors which could negatively influence the result, such as living miles away from a dental practice. The overall conclusion of the study is: “As deprived areas have the highest incidence of dental ASH, caries and poor oral health, those who live in the most deprived areas have the most to gain from CWF. In summary, our study supports evidence linking CWF to better health in children. Variation in CWF contributes to structural inequities in oral-health outcomes for children.”

Simon Hearnshaw, the Chair of the Local Dental Network for North Yorkshire and Humber and coordinator of the National Community Water Fluoridation Network, welcomed the research, saying: “This paper provides more support for the argument that fluoridation is effective and reduces the social-health gradient. The challenge now is to implement schemes to bring these important benefits to deprived communities.”

The latest research is entitled: Area-level deprivation, childhood dental ambulatory sensitive hospitalizations and community water fluoridation: evidence from New Zealand https://doi.org/10.1093/ije/dyaa043

Taking a conservative approach with elderly patients

At any age, caries will compromise dental and general health, due to its proven association with systemic diseases and conditions.[i],[ii],[iii] The modern approach to caries management is preventive, with practitioners supporting patients to adopt the behaviours that will help them avoid caries in the first place. Although prevention has long been talked about among the profession, what has changed, especially over the last decade, is patients’ understanding of its importance and what they must do at home if they want to visit the dentist less.

But what about older individuals who, alongside a lifetime of biting and chewing, will have received little in the way of preventive education in their younger years? The last Adult Dental Health Survey (ADHS) is still a useful resource, although an updated version is due soon. In 2011, when it was published, it talked of an older generation with a “better outlook” than their predecessors, although “the legacy of higher disease levels earlier in the life course and different patterns of dental care remain visible”.[iv]

Changing patterns of care

When we think about how “patterns of dental care” have changed, “drill and fill” used to be the common treatment for caries. Older patients will testify to this and statistically they present with more restorations and failed restorations.[v]

Caries in combination with the “physiological, psychological and functional” impact of aging are a significant problem.[vi] Elderly people are more prone to caries, because limited dexterity can make toothbrushing harder. Also, they may not be attending routine preventive appointments, because of decreased mobility, worries about needing treatment and confusion over costs.[vii] Other age-related risk factors for caries include dehydration, xerostomia caused by things like medication and cancer treatment, ­and a lower standard of nutrition.

Even if an older patient is receptive to learning new preventive behaviours, this may be too late to halt established oral disease. If caries treatment is required, the modern thinking is that a conservative, minimally invasive approach should be taken.

Minimally invasive dentistry encompasses the whole process, from “cavity preparation design, techniques to material selection” and it has a wealth of benefits for all patients.[viii] It’s about prioritising the preservation of the natural tooth and is not a new idea ­– the science has had to catch up. For example, this quote is from 1951: “loss of even a part of a human tooth should be regarded as a serious injury, never to be considered lightly”.[ix] Nearly 70 years on, dentists now have the cutting-edge techniques and innovative materials to deliver minimally invasive dental treatment as a matter of routine. Research has led to a deeper understanding about the caries process and practice has developed to match the learning.

A growing elderly population

Dentists will be treating more older patients as our elderly population continues to grow.[x] Every member of the dental team will need to know how to treat these vulnerable people with dignity and respect, but ensure they get the best dental care too. Conservative and ethical caries management and treatment, which does not damage the surrounding dental tissue, will be a comfortable, efficient experience and means less time in the chair for those who are elderly and infirm. Implant therapy is one area of dentistry that has advanced in leaps and bounds, but for a patient of any age, being able to keep their own tooth is always the preferred option.

For an elderly person who has found it difficult to eat or speak due to pain caused by dental decay, treatment that quickly restores them to good oral health can also restore them to better physical and psychological health. They will be able to eat better, communicate better. Toothache and/or oral pain can be debilitating and isolating for anyone; for an already vulnerable, older patient, the impact could be significant.

Minimally invasive dentistry is stable, functional and cost-effective. The latest materials mean that restorative treatment can be wrapped up in one appointment, with the restoration adjusted in the chair if necessary. Suitable for restoring carious defects, COLTENE’s BRILLIANT COMPONEER™ is a veneering system comprised of prefabricated shells, for aesthetic anterior restorations in a single visit, no laboratory required. This is great for dentists, who can offer a high-quality result despite minimal time in the chair and for patients, who will appreciate a great result that has preserved the dentition and supporting tissue. Older patients will benefit from knowing that the dentist prioritised conservative treatment, instead of simply selecting the easiest option.

Patterns of dental care have evolved, with modern practitioners wanting to avoid any unnecessary damage to healthy tooth structures. A minimally invasive approach benefits all patients, especially elderly patients. Dentists should use the techniques and select the right materials to allow them to deliver this kind of ethical, efficient treatment for caries and still see brilliant, stable results every time.

 

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

 

Author: Mark Allen, General Manager at COLTENE

 

[i] Glodny B, Nasseri P, Crismani A, Schoenherr E, Luger AK, Bertl K, Petersen J. The occurrence of dental caries is associated with atherosclerosis. Clinics. 2013 Jul; 68 (7): 946-53.

[ii] Latti BR, Kalburge JV, Birajdar SB, Latti RG. Evaluation of relationship between dental caries, diabetes mellitus and oral microbiota in diabetics. Journal of Oral and Maxillofacial Pathology: JOMFP. 2018 May;22(2) :282.

[iii] Kane SF. The effects of oral health on systemic health. Gen Dent. 2017 Nov;65 (6):30-4.

[iv] The Health and Social Care Information Centre. Executive Summary: Adult Dental Health Survey 2009, 24 March 2011. Found at: http://www.hscic.gov.uk/catalogue/PUB01086/adul-dent-heal-surv-summ-them-exec-2009-rep2.pdf (accessed January 2020).

[v] Adult Dental Health Survey 2009.

[vi] Chen X, Naorungroj S, Douglas CE, Beck JD. Self-reported oral health and oral health behaviors in older adults in the last year of life. Journals of Gerontology Series A: Biomedical Sciences and Medical Sciences. 2013 Oct 1; 68(10): 1310-5.

[vii] Chen X, Clark JJ, Preisser JS, Naorungroj S, Shuman SK. Dental caries in older adults in the last year of life. Journal of the American Geriatrics Society. 2013 Aug; 61(8): 1345-50.

[viii] Murdoch-Kinch CA, McLEAN ME. Minimally invasive dentistry. The Journal of the American Dental Association. 2003 Jan 1;134 (1): 87-95.

[ix] Markley MR. Restorations of silver amalgam. The Journal of the American Dental Association. 1951 Aug 1; 43(2): 133-46.

[x] Overview of the UK population: August 2019. Office for National Statistics, 23 August 2019. Link: https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/articles/overviewoftheukpopulation/august2019 (accessed January 2020).