A female patient in her early 40s presented to the practice. She was unhappy about the appearance of her prominent anterior teeth – especially the laterals, which were tucked behind the centrals – and she had quite a lot of crowding in the lower arch. The patient was seeking options for aligning the anterior teeth without fixed appliances, as she wasn’t keen to have wires and brackets given her age and lifestyle.

A full dental history was taken, with no issues or abnormalities detected. The comprehensive oral health assessment also demonstrated no concerns, with no active disease or existing restorations.

Treatment planning

To begin the treatment planning phase, clinical photographs and intraoral scans were taken with the 3Shape Trios scanner. These were quickly and easily uploaded to the ClearCorrect^Ò Doctor Portal (Straumann Group), where an initial treatment simulation was produced. This is used to ensure the suitability of the case for treatment in this manner and to give the patient a visualisation of what the final result could look like for informed consent. The technology also integrates very well to ensure a smooth and efficient digital workflow from start to finish.  

At this point, the entire treatment sequence was explained to the patient in detail, describing all the potential benefits, limitations and risks. There were two main concerns that needed to be communicated. The first was that the central incisors were quite triangular in shape, which increased the chance that black triangles would form as the teeth moved. The second potential issue was some existing gingival recession that could become worse during alignment. Both these issues were explained to the patient, who was happy to take the risk. She had the opportunity to ask any questions and once completely happy, provided consent to proceed.

Treatment provision

The ClearCorrect^® aligners were fabricated and returned by the laboratory, and the first was fitted on the patient. She was shown how to safely place and remove the aligners and instructed to wear them for at least 22 hours per day. The Unlimited treatment option was selected and we ended up using a total of 26 aligners throughout the course of treatment.

The patient returned to the practice every few weeks for review and for interproximal reduction (IPR) to be performed to create space for tooth movement. Overall, 2.5mm of IPR was completed progressively. Engagers were placed on the UR3, UR1, UL1 and LR3 at 6 weeks into treatment to encourage the desired movement/rotation.

The patient’s compliance both with wearing the aligners was excellent and treatment proceeded as planned. Alignment was very nearly finished when the UK went into its first national lockdown, but the patient was able to continue wearing her final aligner to prevent the teeth from relapsing. I was in contact with her and explained that we would need to wait until she could visit the practice to remove the engagers and take a final impression for the retainers, which she understood. Providing an extra level of security, we would have been able to make and send out a new aligner if hers had broken at all during lockdown, though this wasn’t necessary.

Though the patient’s oral hygiene remained good throughout treatment, her love of tea and coffee did cause some staining on the teeth. Once the world has settled down slightly and some more normality returns, she hopes to come back to the practice for some aerosol removal of the surface stains and possibly also some tooth whitening. However, even without these finishing touches, the patient is extremely happy with what was achieved with alignment only.

Case review

In hindsight, when reflecting on the post-treatment images, I would have liked to tweak the lateral incisors a little more. However, the patient didn’t see this as an imperfection and as it was her decision to stop treatment, I had to respect that. As I have said before, patients are often happy to conclude alignment before the clinician, but this is only because we scrutinise the smallest clinical details that sometimes don’t matter to the patient.

I was also pleased to find that the two initial concerns I had about this case didn’t not turn out to be a problem. Black triangles did not form, although the central incisors are still a little prominent. This patient would be a good candidate for block bonding and contouring if she is interested in the future as an effective follow-up treatment. In addition, the gingiva remained stable during alignment and no further recession occurred.

Images

For more information on ClearCorrect^®, visit: https://www.straumann.com/clearcorrect/en/home.html

Author: Dr Sami Butt is the Principal of S3 Dental in Haywards Heath

The London Dentistry Show 2021 will be held on Friday 17^th and Saturday 18^th September at Olympia London, offering a vibrant lecture programme with sessions catering to the clinical and business needs of both NHS and private dental providers.

Dr Sami Butt will share his experience with clear aligners to show colleagues how they could expand their treatment range and deliver treatment that their patients desire. About his session, he comments:

“I will provide an introduction to ClearCorrect^® from the Straumann Group, discussing how the system works, how you submit cases for 3D treatment set-ups and what makes the ClearQuartz material so beneficial. I will also cover the different treatment options available and the advantages of the fully digital workflow when using the Trios^® intraoral scanner from 3Shape.

“Finally, I will be sharing some of my cases and offering practical advice for colleagues interested in getting involved or developing their current skills.”

To hear from Sami and the many other speakers at the London Dentistry Show 2021, register online for free today!

London Dentistry Show 2021

Friday 17^th and Saturday 18^th September

Olympia London

Register for free at https://london.dentistryshow.co.uk/ 

The complexity of payroll is often a surprise. As workers, we take it for granted that we’ll be paid the correct amount and on time, so once we see how layered the process is, we find a new appreciation for the people who make it happen.

If you’re a dental practice owner, an efficient payroll is a priority. Over the past year the payroll industry has faced a number of challenges due to the pandemic. If you were, or still are, covering any employee wages through the Coronavirus Job Retention Scheme (CJRS), or furlough, that will spring to mind first.

But there have been other recent changes that could affect your payroll too. The delayed legislation for off-payroll working, known as IR35, finally hitting the private sector for one. Also, at the beginning of April, rules on how long companies have to keep National Minimum Wage (NMW) records changed.

From April, employers now have to keep the records that establish they are renumerating at a rate at least equal to NMW for six years, rather than three years as had previously been the case. If they don’t stick to the rules, they face a fine or even being “named and shamed” – this was happening before April though, with some big, household names exposed as failing to pay the NMW to some of its workers. Also, employers are now required to keep all records of furlough claim calculations for six years too. Retaining all of this data is for lawful purpose, so there is no breach of GDPR.

Related were increases to the NMW for workers age 16 and over. The apprentice rate of NMW, for any apprentice aged under 19 or, if they are aged 19 or over, for the first year of their apprenticeship, has also increased to £4.30 per hour. The National Living Wage (NLW) rose in April as well, from £8.72 to £8.91 per hour, and this now applies to anyone aged 23 or over (it had applied to anyone 25 or over). All the new rates are the result of the government accepting the findings of the Low Pay Commission’s 2020 report.

Protecting all workers

The first point to make here is the pandemic has made it plain how lower-paid workers often perform the kinds of critical roles that keep the economy going during the toughest of times. The second is that HMRC is clearly committed to ensuring that these workers’ living standards are protected.

Taking care of everyone in your practice, no matter how many there are and how much they earn, means that you can not only grow your reputation for being a great place to work, but you will also retain a motivated, talented team to support you on this journey. Your patients will benefit from an efficiently-run, productive practice too. This is why outsourcing your payroll to a specialist provider is often a great idea. They can take care of all the functions of payroll, cutting though any complexity, to ensure it is smooth and accurate, and keep you compliant with any change to the law – and help you prepare for any more changes to come. This saves stress as well as time, eliminating the risk of errors, leaving you free to get on with the day to day of providing an exceptional level of care. Wagemate is one specialist provider that manages payroll for many happy clients. Combining expertise and experience with the best use of the latest technology, you will get other features that simplify certain processes, such as its ePayslips portal, which is user-friendly as well as highly secure.

Relevant record keeping is a key protocol of efficient payroll. Knowing that you have the correct information to hand, if and when required, means peace of mind for you, and that you won’t get into hot water with HMRC. Payroll is a hard-working process that keeps all businesses functioning properly, as well as keeping all those who work for them happy. It has had changes forced upon it by the pandemic, but some new rules have been long planned, and there are likely to be more in the not-so-distant future. To stay on top, outsource to a provider that will make the job easy, effortless and correct, every time.

To better manage your payroll, contact payroll specialists Wagemate today,
tel: 03330 102102 or email info@wagemate.com

Author:

Daniel Hull – Director – Wagemate Limited

“Money isn’t everything, but its right up there with oxygen”.

Staff are a business’s most important asset and peoples pay matters! Making sure employees are paid correctly, on time and have access to their pay information is one of the fundamentals to keeping staff happy. That is what we do and much more.

My goal is to take away the stress of payroll away from as many people as possible, making sure staff are paid accurately and on time and by adding value, providing excellent service and plenty of convenience to our clients.

“The BACD is distinguished by how supportive it is of young dentists, from holding events that are tailored to this audience, to maintaining a community of members that – regardless of their experience or accomplishments – are all approachable,” says foundation dentist, Dr Roshni Ruparelia.

“By welcoming dental professionals from a range of backgrounds, the BACD provides its pool of members with the unique opportunity to learn from each other. It’s inspiring to engage in discussion with such incredible dentists – some of whom are only a few years beyond me – and learn from their successes.”

Explore your membership options via the BACD website today.

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

The recent Supreme Court decision concerning thousands of Uber drivers is likely to hold the employment status of individuals up to the light in a number of sectors in the coming months, not just in the gig economy but also in the dental industry.

This is something which I have written about on previous occasions but this judgment now clearly poses potential issues surrounding the employment status of associate dentists. For a variety of reasons in the past, the consensus and presumption has been that “all dentists are self-employed” regardless of the reality of the relationship from day to day or the documentation which sits alongside it.

The Supreme Court dismissed Uber’s appeal on Friday 19 February, meaning that Uber drivers are to be considered as “workers” and not self-employed contractors.

This falls short of making Uber drivers employees with full employment protection rights but it does provide them with the basic rights of paid holiday, rest breaks, and the national minimum wage. In addition, there are potential pension right issues which can arise or at least will arise for Uber which can be a huge headache due to the fluctuations in earnings from month to month or even day to day. The same could prove to be an issue in the future for dental practices.

The status quo for associate dentists has long been that they do not have holidays; they have ‘time away from the practice’, ‘non-clinical days’ or ‘agreed absence’ for which they are not paid. Whilst the risk of a claim of this nature might appear low, the potential financial exposure is considerable and associate dentists could make such claims whilst remaining engaged under their associate agreements.

In the current economic climate, the potential back-pay of holiday for associate dentists with considerable daily rates of pay in a private practice for example could well thrust huge financial stress on a practice.

If you look at some of the reasons for the Supreme Court coming to their judgment last week, one can start to see the parallels with your associate dentist:

1. Uber determined the terms and conditions it has for using the service(s);
2. Uber controlled the fares for each ride their driver attends to and Uber drivers are not permitted to set their own pricing. A key component of being self-employed is the ability to set your own prices (and therefore the possibility of sustaining a loss);
3. Uber had policies and procedures in place whereby drivers could face penalties for not accepting a requested ride;
4. Uber ensured that their driver and passenger were all but prohibited from having an agreement outside of the application which Uber proved.

As you work through the above, you can start to see the parallels in how practice owners (and arguably even more so in the case of larger corporates), control the pricing within their practices with associates bound to charge those prices or face financial clawback or penalty, control patient appointment times, the materials used and the approach to the treatment of patients. In addition, it would be difficult to find an associate dentist armed with the right to set their own set of terms and conditions with a patient. In practice, it is often the case that an associate dentist has no real option but to accept the patients assigned to them for appointments unless such planned treatment is outside of their requisite specialism.

It is the case that associate dentists are often bound to use specified equipment and, or materials as well as particular laboratories (and where they have the right to choose that can mean effectively a financial penalty with the practice owner only sharing the lab costs for specified laboratories).

It is of particular note that one of the key components of being a worker compared to a self-employed contractor is the requirement to provide personal service. In reality, despite the wording of the majority of associate agreements, associate dentists are required to provide personal service and the supposed right to appoint a locum is seldom a reality save in relation to extended periods of illness or absence due to maternity. This important point was highlighted in the Employment Tribunal case of Marshall V Jussab (t/a Cheadle Village Dental Practice) (2414676/2012) where the associate dentist was not only found to be a worker but also an employee.

The way in which practice owners adapt to this is crucial whether that be to cede some control to its associate dentists who are engaged to treat the patients and assist with building up the goodwill or whether it wants to maintain or even increase the level of control over its associates but accepting the worker status likely to come with it. This judgment is clear and confirms previous cases in that labelling someone as self-employed is insufficient and the need for contractual documentation to reflect the reality has never been greater.

The discussion as to whether there are some associate dentists working in practices who are effectively employees is perhaps for another test case. There will be some junior associate dentists working with stringent targets and designated appointment times with all equipment and resource provided to them with a great degree of control exerted over them by practice owners, who have an arguable case that they are employees.

It is arguable that associate dentists are self-employed contractors until they walk through the practice and start to utilise the facilities of a practice, during which they are workers with their materials, patients and support all provided by the practice owner. An associate dentist could be a self-employed contractor under one engagement where they are a visiting specialist once a month at practice A but a worker under his regular associate agreement at Practice B. Each case will turn on its facts.

There are other factors which mean the question over the employment status of dentists remains largely untested in the courts, including settlements being reached and the historic tax advantages and special dispensation from HMRC.

As we come out the other end of the pandemic and with IR35 regimes upon us, it is not difficult to imagine why associate dentists with their earnings squeezed over the pandemic might want to assert additional employment rights and equally why practice owners should heed the call and ensure their documentation reflects the working practices and constantly re-evaluate their business model and the risks that may pose.

If you have any questions or would like to speak to a lawyer about a situation, get in touch today: enquiries@lindermyers.co.uk

Authors:

Ben Williams is an employment solicitor at Linder Myers and has advised employers, associate dentists, contractors and employees in the dental industry since 2013 and qualified as a solicitor in 2017 which gives him considerable experience of this sector and the variety of challenges faced by dental practice owners, clinicians and employees alike. 

Ben’s experience includes advising on varying employment terms and conditions following or in relation to business restructures, advice on TUPE business transfers and service provision changes, employment tribunal representation and redundancy processes as well as advising on, negotiating and drafting settlement agreements on behalf of employers and employees.

Ben can also provide advisory services to dental practice owners including via the firm’s Employ-Line service to his clients such as drafting contracts of employment, service agreements, dental / orthodontic associate agreements, staff handbooks and policies and procedures.

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Alan is Principal Lawyer, Head of Commercial Division and Employment Department and  has considerable experience of representing both employers and senior employees in a wide range of Employment Tribunal and High Court disputes

Alan is one of only a handful of Solicitors in the North West who has received special recognition by the internationally acclaimed directory ‘The Legal 500’. The Legal 500 ranks lawyers across each country based on their feedback, work and by recommendation of their peers, for which Alan received an additional accolade for his work