There’s lots to look forward to at this year’s British Dental Conference and Dentistry Show. Specialist Periodontist, Dr Paul Renton-Harper, will be in the Next Generation Conference discussing emerging concepts for the treatment of periodontal diseases and related conditions.

“I would encourage dental professionals to attend the British Dental Conference and Dentistry Show because it’s always interesting,” he says. “There are CPD opportunities to benefit from and it’s good to keep up-to-date with the latest developments in dentistry. I’m looking forward to seeing any new and exciting innovations that might help with the treatment of patients.”

Don’t miss out – register for free online!

The British Dental Conference and Dentistry Show 2020 – Friday 21^st  and Saturday 22^nd MAY 2021, Birmingham NEC, co-located with DTS.

 For all the latest information or to register for free, please visit www.thedentistryshow.co.uk, call 020 7348 5270 or email dentistry@closerstillmedia.com

A dental practice is very much a local business and a successful practice will be fully focussed on meeting the specific needs of its community. In this new era of dentistry, although we will see changes, what won’t change is the importance of providing an exceptional patient service for improved health outcomes. When oral health is good, general health and wellbeing is good. Your practice will have to adapt and find new ways of doing things, but this is a real opportunity to be more responsive to your patients than ever before.

The quality of every dental visit will be fundamental to ensuring patients return for appointments, are motivated to keep attending and are receptive to any advice you give. For some years now, how to build patient loyalty and maintain your numbers has been a hot topic. Although every practice has many long-term, even life-long patients on its books, a growing number of people will happily switch to a different practice that is cheaper/has more convenient appointment times/has a better reputation/was recommended by a friend, etc.

What does patient loyalty look like in 2020, with many practices only just now reopening after months of closure? The long-term impact of Coronavirus on the dental industry is unknown. How every practice manages a return to “normality” will be down to factors unique to them and is unlikely to be a linear process. With none of us having faced these circumstances before, we’re all on a learning curve. There will also be patients fearful about going to the dentist at all because they are worried about infection control, or who have less money to spend on treatment.

When you are a true centre of dental excellence, you actually want your patients to be coming in less often, because you have enabled them to value and to take control of their own oral health. When a dentist has motivated an individual to practise daily, preventive behaviours and understand that by intercepting problems early, they will avoid frequent (and expensive) appointments, patient and practice will reap the benefits. The patient will reduce their risk of dental and oral-health related complications and keep more of their natural teeth intact. This means they’ll save time and money too. For the practice, you will be improving the standard of oral health and therefore general health of your local community.

Essentially, when your patients come to your practice, they are empowering themselves. They’re taking the first step towards needing fewer oral interventions. An example of this is the early interception of tooth wear because action now will improve the oral and general health of future generations. Tooth wear is a clinically significant issue because it is affecting more and more younger adults, as well as children.[i] Early detection and interception will prevent younger patients in your community facing functional and aesthetic problems in later life – severe tooth wear in adulthood has also been negatively associated with psychological impacts.[ii]

When tooth wear is detected in the permanent teeth of a child, even if they can’t see or feel it, responding now will avoid any serious compromise to their dentition in the future, which could necessitate “extensive restorative procedures” to restore the function, form and look of the teeth – a beautiful smile has become a hugely important and desirable asset in recent years.[iii] Preventive measures for children will include recommending they change certain behaviours, for example, dietary habits (consuming acidic fruits/fruit juice is associated with tooth wear) and reviewing brushing technique (they should be shown how to gently brush, not scrub). For young adults, the dentist will consider factors like acid reflux (often the consequence of disordered eating), and bruxism. The practitioner will want to investigate what is causing the patient to exhibit these habits, or make a referral to other healthcare providers if an eating problem is suspected or confirmed by the patient.[iv]

A responsive dentist who intercepts tooth wear at its early stage is supporting their patient to slow down the rate of dental decline. When restorative treatment is required for an older patient, because tooth wear wasn’t intercepted early enough, a conservative, minimally invasive approach that preserves healthy dentition must be favoured.[v] The clinician should use materials that strengthen, rather than take away from the tooth structure. COLTENE has a range of restorative materials, including BRILLIANT™ EverGlow, Crios and Fill-Up™ that clinicians can use in various situations, including as a solution for tooth wear. The materials will restore function as well as aesthetics and will provide a strong, long-lasting result that will prevent the patient getting into a restorative cycle.

This is the time to focus on offering a local centre of dental excellence, responding to patients’ needs so they can return to and stay in good oral health for years to come. This means they will enjoy improved quality of life in the present with fewer interventions in the future and you will become a central part of a healthier community.

For more on COLTENE, visit www.coltene.com,
email info.uk@coltene.com or call 0800 254 5115.

Author: Nicolas Coomber COLTENE  National Account & Marketing Manager

^[i] Bartlett DW, Lussi A, West NX, Bouchard P, Sanz M, Bourgeois D. Prevalence of tooth wear on buccal and lingual surfaces and possible risk factors in young European adults. J Dent 2013; 41: 1007-1013.

[ii] Li MH, Bernabé E. Tooth wear and quality of life among adults in the United Kingdom. J Dent 2016 Dec 1;55: 48-53.

^[iii] Carvalho TS, Lussi A, Jaeggi T, Gambon DL. Erosive tooth wear in children. Monogr Oral Sci 2014; 25: 262-278.

[iv] J Dent 2013; 41: 1007-1013.

[v] Loomans B, Opdam N, Attin T, Bartlett D, Edelhoff D, Frankenberger R, Benic G, Ramseyer S, Wetselaar P, Sterenborg B, Hickel R. Severe tooth wear: European consensus statement on management guidelines. J Adhes Dent. 2017 Mar 1;19 (2): 111-9.

Available from Clark Dental, the NOMAD^® Pro 2 handheld x-ray device provides the freedom for you to work flexibly – whether in a single practice or across multiple surgeries.

The portability of the NOMAD^® Pro 2 eliminates the need for wall-mounted x-ray units. This enables you to save on the cost and time of specialist installations, so you can benefit from a lightweight device that is ready to use right out of the box.

Moreover, the NOMAD^® Pro 2 offers the latest in radiographic technology to consistently produce accurate, high-resolution images. It also features unique shielding to prevent radiation leakage and protect against unnecessary exposure.  

For more information contact Clark Dental on 01270 613750, email info@clarkdental.co.uk or visit www.clarkdentalsales.co.uk

Kenny Valentine, Commercial Director M&A Colosseum Dental UK, discusses why it’s so important for principals to be prepared for selling their practice well ahead of their retirement.

When you sell a business, you are often ending your association with that business, as well as selling the organisation itself. In the retail sector, once deals are completed, the vendor will generally walk away and have nothing further to do with the company. However, it is not the same in dentistry.

Many dental practice principals view the sale of their business and their retirement as a significant joint life event – which is not the same as other sectors. It’s not yet common knowledge among the profession that most buyers want principals to remain in practice for a number of years after the transaction. This is because a substantial proportion of the practice’s value is directly associated with the vendor.

Continuity is the greatest commodity

This is not just in terms of monetary value – although there are implications for the asking price if the principal intends to leave immediately after a sale, as they are commonly responsible for a large proportion of the revenue.

The greatest value is in the continuity provided for both patients and practice team members when the principal stays on. For many dental practices, the vendor is the focal point for everyone else. If the principal has run the practice for 10, 20, even 30 years, they will have built strong relationships with their patients, who will trust them and be accustomed to the care they provide. The uncertainty caused by the principal leaving can lead some patients to try a new practice perhaps closer to home. There is a similar risk of associates leaving should a principal suddenly announce their exit, if they are not confident in the security of their job and the environment they will be working in post-sale.

For the business to remain strong beyond a sale, protecting its legacy and patient services, much forward planning is needed to replace the principal.

A phase, not forever

Of course, when a principal sells the practice with retirement in mind, they may want to discuss a potential exit plan with the buyer. In my experience, staying for a minimum of three years post-sale is ideal. This gives time to work out the handover plan with the buyer. It provides reassurance for patients, who appreciate receiving the continuity of care and time to identify, recruit and introduce their successor.

It is worth pointing out that agreeing to stay for three years doesn’t always mean that the vendor leaves the business at this time. We actively want our vendors to stay with the business as long as possible. I have come across many an ex-principal who enjoys dentistry so much after eliminating the pressures of running the business, that they postpone retirement for many years.

Start early

It’s never too early to start thinking about your exit plan and begin the conversation. Even if you’re still 10 years away or more from your target retirement or exit date, it is beneficial to start to build relationships with potential suitors. I often speak to principals who have no intention of selling for many years – it’s about knowledge building. These conversations enable individuals to learn about the common challenges and highlight the importance of finding an acquirer who is the right fit for their practice, in turn increasing the likelihood of a successful transaction when the time does come. Furthermore, this research might help you set a goal for your business in terms of growth, revenue and structure – which can take years to implement and develop – helping you get the very most from the sale for a stress-free retirement.

You will likely know colleagues who have sold practices, so why not speak to them about their experience? Find out who they worked with, what the sale process was like and how they chose their buyers. It will also help you understand general buyer expectations so you can ensure that your practice has the appropriate paperwork and protocols in place to meet them. This research doesn’t cost you anything but a little personal time.

A new chapter

Whether you’re considering the next chapter in your life in the near or long-term future, there’s no harm in being prepared. Running a dental practice is a stressful business – especially in such unpresented circumstances that the profession has faced this year. Regardless of how many years away you are from retirement, if you’re thinking of selling a practice with more than three surgeries, find out how Colosseum Dental UK could support you. Just visit the website and complete the form if you would like to know more at www.colosseumdental.co.uk/sell-your-practice.

For more information about Colosseum Dental, please visit www.colosseumdental.co.uk

This is a challenging time for many dental practices. To help you through the recovery period, 3M Oral care is offering  a variety of limited time promotions to make purchasing top-quality products even more cost-effective.

A BUY 3 GET 1 FREE promotion is available for a limited time on a wide array of leading restorative and prosthodontic solutions, including:

• 3M™ Filtek™ Universal Restorative
• 3M™ Filtek™ One Bulk Fill Restorative
• 3M™ Ketac™ Universal Glass Ionomer Restorative
• 3M™ Ketac™ Molar Aplicap Glass Ionomer Restorative
• 3M™ Scotchbond™ Universal Adhesive
• 3M™ Protemp™ 4 Temporisation Material
• 3M™ Protemp™ Crowns
• 3M™ Astringent Retraction Paste Capsules
• 3M™ Imprint™ 4 VPS Impression Material
• And many more!

For more details and the full list of promotions from 3M designed to help your practice through its recovery, visit  www.3M.co.uk/dental or contact your local 3M sales representative today.

For more information, call 08705 360 036 or visit www.3M.co.uk/Dental

3M, Filtek, Ketac, Scotchbond, Protemp and Imprint are all trademarks of the 3M Company.

Dr Nishan Dixit presents a case study with a 6-year follow-up where he took a minimally invasive approach to restore the function and aesthetic of his patient’s upper anterior teeth to an exceptionally high standard.  

A 33-year-old female patient in good general health attended the practice complaining about the appearance of her upper anterior teeth. She was unhappy with the colour of the teeth and the fact that they were becoming thinner. She also reported that she did not smile as much due to the way that the upper central and lateral incisors protruded outwards. The patient had undergone two unsuccessful courses of orthodontic treatment in the past, so her goal was to have an improved smile with teeth that were aligned and all of a similar colour.

Assessment and diagnosis

A comprehensive dental health examination was completed and the patient’s oral hygiene found to be of a fair standard. The patient’s soft tissues, temporomandibular joints and masticatory muscles were also assessed, but this did not reveal anything abnormal. As there was nothing untoward with the patient’s existing occlusal scheme, it was decided that a conformative approach would be taken, utilising the existing maximum intercuspal position.

The loss of tooth substance was present on the palatal surfaces of the upper central and lateral incisors. The patient advised that she did not consume acidic beverages and had a limited intake of acidic fruits. She did not drink alcohol or smoke, but she did report having a funny, sour-like taste in her mouth upon waking up in the morning and even during the day sometimes. Therefore, it was diagnosed that the loss of tooth substance was due to regurgitated acid from gastro-oesophageal reflux.  

Figure 1 Initial presentation

Figure 2 Retracted view of initial smile

Figure 3 Right side retracted view

Figure 4 Left side retracted view

Figure 5 Occlusal view of upper anterior teeth

Figure 6 Close up of upper central and lateral incisors

Treatment planning

The patient was instructed to see her general practitioner (GP) for advice and treatment regarding her gastro-oesophageal reflux diagnosis. The treatment plan was for the patient to undergo oral hygiene therapy with oral care and dietary advice provided. Professional tooth whitening treatment would then be performed with Philips Zoom! system, which would also involve the patient using the Philips NiteWhite tooth whitening kit at home for 3 to 4 days.

Following this, the patient’s carious teeth would then be restored with composite restorations. In addition, full coverage e.max dental crowns would be fitted to the upper central and lateral incisors once the patient had seen and approved a diagnostic wax-up. Upper and lower Essix retainers would also be worn by the patient during the night to maintain the arch form.

Restoration

The patient’s GP prescribed her some antacid medications to take on a daily basis. After a period of stability with her condition was achieved, we were able to proceed with dental treatment.

Initially, the patient’s bite was recorded using Futar D registration material from Optident Ltd. Study models and a facebow transfer were also recorded, enabling the case to be articulated onto a Denar articulator. Using this information, Ivan Knezevic – a dental technician from Woodlands Dental Laboratory – was able to create a wax diagnostic mock-up of the four proposed crowns for the upper central and lateral incisors. Alginate impressions were taken so that bleaching trays for the upper and lower arch could be made.

The first stage of treatment involved completing oral hygiene therapy on the patient. She then underwent professional tooth whitening treatment with the Philips Zoom! in-office kit, followed by 3 to 4 days of NiteWhite tooth whitening gel at home for one hour every day on the upper and lower arch. Once the new colour of the teeth had stabilised, the carious lesions on the patient’s posterior teeth were restored with composite enamel and dentine shades of Empress from Ivoclar Vivadent.

Once the patient had seen and approved of her diagnostic wax-up, treatment began with the e.max crowns. The upper central and lateral incisors were prepared with local anaesthetic. Preparation guides were used to ensure tooth reduction was minimal on the buccal and incisal aspects of the teeth. Very little preparation was required on the palatal aspect due to previous acid erosion, so the margins were simply redefined. 

At this point, additional bite records were taken. An occlusal stick bite was also recorded to ensure that the horizontal plane of the new e.max crowns was level with the interpupillary line. The final impression was taken using Provil Novo putty and a medium bodied wash from Kulzer. Temporary gingival retraction was achieved by using KaVo’s Expasyl for approximately 2 to 3 minutes.

Following this, custom temporary crowns were made using DMG Luxatemp. These were produced from an initial pre-operative impression and modified with the DMG Luxaflow flowable composite. Once we were happy with the size and shape of the temporary crowns, they were glazed with DMG Luxatemp Blaze & Bond. The crowns were then cemented into place temporarily using Temp Bond Clear.

The patient was left to trial the temporary crowns – the height of the central incisor crowns was 11.5mm and the width 9mm. At the review stage of treatment, minor adjustments were made to the mesial line angles of both the UL1 and the UR1, and the incisal edges of these teeth also levelled.

Once the patient was happy with the length and shape of her proposed new teeth, another alginate impression of the upper arch was taken so that the dental technician would be able to replicate the dimensions of the temporary restorations when making the final e.max crowns. A shade was chosen with the aid of the Optident Ltd Trushade device and a Vita shade guide, following Vanini’s shade mapping technique. This involves using a chromatic chart and colour card to determine the colour of the restoration.[i]

After administering local anaesthetic to the area, the new e.max crowns were fitted using 3M RelyX cement. The crowns were etched and silanated prior to seating. The patient’s occlusion was checked in all excursions using Hanel occlusion foil 12mm and Shimshock. She returned to the practice 10 days later and did not report any complications or discomfort following treatment. She was very happy with the final result and could now smile with confidence. At this stage, Essix retainers for the upper and lower arch were produced and provided to the patient to wear on a nightly basis. She was advised that retention is for a lifetime.

Figure 7 Shade matching

Figure 8 Posterior teeth restored with composite

Figure 9 Patient’s smile with temporary crowns

Figure 10 Right side view of smile with temporary crowns

Figure 11 Left side view of smile with temporary crowns

Figure 12 Retracted view of temporary crowns

Figure 13 Occlusal view of temporary crowns

Figure 14 Full view of patient’s face with final e.max crowns

Figure 15 Patient’s smile with final crowns

Figure 16 Right side of smile with final crowns

Figure 17 Left side of smile with final crowns

Figure 18 Retracted view of final crowns

Figure 19 Occlusal view of restored upper anterior teeth

Figure 20 Close up of upper central and lateral incisors

Figure 21 Right side view of restored teeth

Figure 22 Left side view of restored teeth

Review and reflection

Figures 23, 24 and 25 demonstrate the stability of colour, gingival health and integrity of the e.max crowns after a 6-year follow-up of the patient. She remains highly motivated and continues to attend the practice every 3 to 4 months for oral hygiene appointments. She also wears her retainers on a nightly basis.

In this case, the patient’s aesthetic concerns were effectively addressed and the appearance of her smile improved with minimal tooth reduction. With the popularity of cosmetic dentistry continuing to rise, the need for conservative approaches to treatment is becoming much more apparent. This can be beneficial for both patients and practitioners, making treatment more comfortable and maximising the result to achieve optimal patient satisfaction.

Figure 23 Patient’s smile after a 6-year follow-up

Figure 24 Retracted view of smile after 6 years

Figure 25 Close-up of restored teeth after 6 years

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

Author bio:

Dr Nishan Dixit qualified from Guy’s Dental Hospital in 1994. After qualifying, he worked as an associate in a couple of practices in northwest London for 5 years. In 2000, he established Blue Court Dental in Harrow, Middlesex. Being in a general practice environment, he covers all aspects of dentistry. However, he has a particular interest in minimally invasive aesthetic dentistry.

Dr Dixit is currently the President of the British Academy of Cosmetic Dentistry (BACD) and previously was the Scientific Director. Prior to this, he served on the Anglo-Asian Odontological Group (AOG) Committee for 10 years in various capacities. Following his passion has led him to be trained by leading clinicians both nationally and internationally.

[i] Vanini, L. and Mangani, F. M. (2001) Determination and Communication of Color Using the Five Color Dimensions of Teeth. Pract Proced Aesthet Dent. 13(1): 19-26.

Dr Sami Butt, Principal of S3 Dental in Haywards Heath, shares his initial experience of the innovative, AI-supported DenToGo™ Virtual Check software from the Straumann Group.

“The ability to provide virtual assessments meant we were able to continue responding to patient queries about potential treatment and keep some momentum going despite having closed the practice.

“The AI-generated report has been very useful in identifying areas that need my attention when patients upload their images. This has helped to both educate the patient and help me prepare for far more productive follow-up consultations.

“DenToGo™ was also really easy to integrate into the website – so simple that I did it myself. That said, the support available from the Straumann Group continues to be fantastic – they were among the few representatives that continued to reach out and offer support when many other companies shut down, which was greatly appreciated. My on-going relationship with the Straumann Group was integral to my decision to introduce DenToGo™ Virtual Check – I like being part of the bigger family and operating within the well-established and strong ecosystem.”

For more information, please visit www.straumanngroup-uk.co/dentogo

As dental hygienists and dental therapists, we are known in the profession for building strong relationships with our patients. This is often the result of our passion for patient care and our focus on oral health promotion and education. As a result of services and therapies we provide, many patients will see us more regularly than their dentists, which means we need to be ready to identify and report anything that might be a cause for concern.

Aside from screening for potential oral health problems, it is also important that we are aware of the symptoms of sepsis. As such a dangerous yet difficult to diagnose condition, sounding the alarm as early as possible can make a huge difference to the success of treatment and recovery for the patient.

Signs and symptoms

Sepsis – sometimes referred to as blood poisoning – occurs when the immune system reacts to an infection too aggressively and starts to attack the body’s own cells. This can happen in response to infection with bacteria, viruses or fungi. Unfortunately, it can be very difficult to identify because its symptoms are diverse and common.[i] For adults, the most important include:

• Confusion, slurred speech or not making sense
• Blue, pale or blotchy skin, lips or tongue
• A rash that does not fade when a glass is pressed onto it
• Difficulty breathing, breathlessness or breathing very fast

For babies or young children, the symptoms are even more vague:

• Blue, pale or blotchy skin, lips or tongue
• A rash that does not fade when a glass is pressed onto it
• Difficulty breathing (grunting noises or a stomach sucking sound under the ribcage), breathlessness or breathing very fast
• A weak, high-pitched cry that is unlike their normal cry
• Responding differently to normal, or simply not interested in feeding or other regular activities
• Sleepier than normal or difficult to wake up

Minimising the risks

If detected early – before any vital organs have been affected – sepsis can be managed simply and effectively with antibiotics. The majority of people therefore recover fully. Severe sepsis or septic shock require immediate admittance to hospital as medical emergencies. Sadly, approximately 29% of people who develop sepsis die in the UK.[ii] The risk of developing sepsis is highest for those most vulnerable to infection, including babies and young children, women after childbirth, those with compromised immune systems, anyone aged over 60 and people recovering from surgery. [iii]^{, [iv]}

This only goes to emphasise the importance of early detection. With World Sepsis Day held in September, this is a good opportunity to refresh your knowledge in the area. Though rare in the dental practice, being able to provide the right information to patients when appropriate and to confidently identify (or rule-out) suspicious signs or symptoms, could literally mean the difference between life or death for someone.

Another arrow to your bow

Dental hygienists and dental therapists today can support patients in many different ways. The rapport we build often means that patients feel comfortable with us and therefore share more personal details than they might with other healthcare professionals. It’s our job to be as prepared as we can and that includes being confident with the signs and symptoms of sepsis.

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

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

[i] NHS. Health A to Z. Sepsis. Symptoms. https://www.nhs.uk/conditions/sepsis/ [Accessed May 2020]

[ii] Bray A., Kampouraki E., Winter A., Jesuthasan A., Messer B., Graziadio S. High variability in sepsis guidelines in UK: why does it matter? International Journal of Environmental Research and Public Health. 2020; 17(6): 2026. https://doi.org/10.3390/ijerph17062026 April 7, 2020.

[iii] NICE. Resource impact report: sepsis: the recognition, diagnosis and early management (NG51). National Institute for Health and Care Excellence. 2016. https://www.nice.org.uk/guidance/ng51/resources/resource-impact-report-pdf-2549846269 April 7, 2020.

[iv] Lin G., McGinley J., Drysdale S., Pollard A. Epidemiology and immune pathogenesis of viral sepsis. Frontiers in Immunology. 2018; 9: 2147. https://doi.org/10.3389/fimmu.2018.02147 April 7, 2020.