A 74-year-old retired lady was referred to The Park Dental Practice for the restoration of her missing and failing maxillary dentition with dental implants.

The patient had been suffering from dental phobia for most of her life and had avoided seeing a dentist for regular examination. She only attended when in acute pain and discomfort. This resulted in the loss of all her upper posterior teeth and all her lower molars except the 36 and 46.

Due to a slightly exaggerated gag reflex, the patient could not tolerate a full palate prosthesis. She, however, presented with a ‘horse-shoe’ shaped removable upper acrylic denture, which she reluctantly used for aesthetic reasons only, as it was unstable during chewing.

Her medical history was clear and she was fit and healthy.

The patient’s initial priority was to have her upper jaw restored, with a prosthesis which would be completely stable during function. She also requested the prosthesis to be ‘fixed’ in her mouth on the same day as the remaining failing anterior teeth were extracted. She wanted a low maintenance prosthesis, which would allow for ease of oral hygiene measures.

We discussed the possibility of fixed implant retained bridgework and a removable implant retained denture using Locator attachments. Due to financial constraints, she opted for the latter option. The patient was also aware that if she wanted to ‘upgrade’ to a fixed prosthesis in the future, then that would be possible with Anthogyr Multi-unit abutments.

Assessment

A thorough extra-oral examination, including the patient’s profile and lip support, was carried out (Figure 1).

An intra-oral clinical examination was undertaken, which showed the remaining teeth had drifted and were mobile. The upper alveolar ridges had ample keratinised mucosa with adequate bone width and good bone height (Figure 2).

The lower 46 was compromised and the patient was very reluctant to lose it as it had never caused her any problems. We decided to carry out some root planing of this tooth and keep it under review. The remaining dentition was sound with a healthy periodontal status.

The OPG radiograph confirmed the absence of any pathology in both jaws and the presence of large maxillary sinuses, with inadequate bone volume below them for the placement of dental implants in these regions, without sinus grafts (Figure 3). The patient was very reluctant to undergo any sinus grafting procedures.

A CBCT scan of the upper jaw was taken to accurately assess the anatomy of the maxilla, the trajectory of the alveolar ridges and to ascertain if immediate implant placement was going to be possible (Figures 4).  The scan confirmed adequate bone volume in the anterior maxilla, with good bone height beyond the apices of the failing teeth and intact labial alveolar plates, the density of the trabecular bone was adequate to allow for very good initial primary stability for the immediate placement and loading of the implants.

The CBCT scan also confirmed inadequate bone volume beneath the maxillary sinuses (Figures 5).

A well-fitting immediate partial ‘horse-shoe’ shaped upper acrylic denture was constructed prior to the planned implant surgery. The patient’s consent was obtained during the construction of the denture to ensure that she was happy with the final aesthetic outcome.

The technician had relieved the denture in the anterior alveolar region to allow room for the locator attachments and the metal housings, which would be picked up in the denture, chairside, immediately after implant placement for immediate loading.

implant placement

The CBCT scan was used to plan the immediate placement of implants in the 13 and 24 regions following the extraction of these teeth (Figure 6) and placement in the 14,12 and 22 regions.

Anthogyr Axiom^® PX BL (Bone Level) implants – a Straumann Group brand – were placed under intravenous sedation.

One 4 mm diameter/10 mm length implant was placed in the 14 region.

Four 4mm diameter/12mm length implants were placed in the 13, 12, 22 and 24 regions.

All implants were placed in healthy bone using the simple drilling sequence of the Anthogyr implant system. The primary stability achieved was excellent. Locator abutments size 4mm diameter and 3.4mm gingival height were tightened into the implants at a torque of 25Ncm. Platelet rich growth factor (PRGF) was placed into the remaining extraction sockets and the soft tissue sutured (Figure 7).

The locator metal housings were then attached to the Locator abutments (Figure 8) and picked up, in the denture, directly in the mouth with cold-cure acrylic.

Once the acrylic had fully set, securing the metal housings within the removable denture, the denture was removed from the mouth and adjusted (Figure 9).

It was then immediately fitted and secured back onto the Locator attachments (Figure 10). The patient left the surgery with new implant supported teeth.

The locator abutments allow for up to 40-degree angle correction between implants.

Axiom^® PX Bone Level^® is a very user-friendly implant. The implant surgical kit, and the steps involved during the surgery are straightforward, resulting in minimum trauma to the bone and osteotomy site. The implants afford excellent primary stability, due to the thread design, even in soft bone. The prosthetic kit is also easy to use and sterilise.

Maintenance of the final Prosthesis and Locator abutments

Immediately following surgery, the patient is advised to adhere to a soft diet and not to remove the denture for two weeks, but keep it very clean by brushing and using a Waterpik.

The patient was then reviewed at appropriate intervals to assess healing and an OPG radiograph taken as a baseline record (Figures 11,12,13).

The patient was very pleased with the final aesthetic result, which improved her confidence when talking to people. She was once again able to enjoy chewing food without discomfort  (Figures 14,15).

Images

1. pre-op

2. pre-op

3. pre-op OPG

4. extraction

5. immediate loading

6. immediate placement – locators

7. 3 weeks healing

8. 12 weeks healing

9. final 1

10. final 2

11. locator attachment in overdenture

12. post-op OPG

Author bio

Dr Waseem Noordin MSc ImpDent (Lond), BDS, DipImpDent RCS (Eng) (Adv cert), LDS RCS (Eng), MFGDP (UK).

Dr Waseem Noordin is a faculty member of Practical Implant Dentistry Academy, with over 33 years of experience in all aspects of surgical and restorative implant dentistry.  He regularly lectures and runs courses in this field.  Waseem provides assistance to colleagues in planning cases and one-to-one mentoring in all aspects of implant treatment.

Dr Noordin is a Fellow of the International College of Dentists.  He was a tutor, lecturer, cohort director and examiner of the FGDP Diploma in Implant Dentistry at the Royal College of Surgeons of England for ten years.  He was a board member of the FGDP (UK) for nine years and director of the Central London Division. 

The Park Dental Practice
166 Whitchurch Lane
Edgware
Middlesex  HA8 6QL
Tel: 020 8905 6324
Email:  theparkdentalpractice@gmail.com

Charlotte Rogers has worked at Charlton Dental Clinic as a dental nurse for many years. She shares her experience of what it was like when her clinic joined Colosseum Dental UK:

“Not a lot changed in the clinic initially when we joined Colosseum. After a few weeks, the new leadership team started to visit clinic to see what it was like. They listened to what we had to say, which was something we were not used to!

“In fact, the Colosseum leadership are constantly asking for our opinions. This can be via the annual ‘Great Place to Work’ survey, regular visits to the clinics, making themselves available for calls or emails at any time and, pre-COVID, our annual showcase event.

“More than anything, recent Year of the Dental Nurse re-enforced that Colosseum Dental sees us all, not just as dental nurses or mere employees, but as valuable colleagues. We have a voice that will be listened to.”

The Year of the Dental Nurse was all about improving the working environment and the opportunities available to individuals in this role. It sought the opinions and experiences of dental nurses throughout Colosseum Dental UK and used these to develop new benefits specifically for them. Among some of the enhancements made were hundreds of pay rises, the chance to learn new skills with training costs covered and the opportunity to earn more as a result of the advanced capabilities obtained. Longer holiday entitlement was also made available to long-standing dental nurses as a thank you for their continued hard work and dedication to their patients.  

This has not been the only way in which Colosseum Dental UK has invested in its people, its clinics and its patients. Even at a time when most dental providers were pulling back, we carried on strengthening and improving all aspects of our organisation over recent times. Charlotte says:

“In the last few years, Colosseum Dental has made massive investments in both our people and buildings. We had a huge refurbishment project, investing in lots of state-of-the-art equipment. 

“There is also always training and education available. Right now, I am just waiting for my place on an implant course for dental nurses. When you reach a certain age, you tend to think you are ‘over the hill’. I’ve been really impressed at how the company appreciates the experience we oldies bring! I feel quite excited to be learning new skills. I may not have had the confidence to take on something like this in the past, but my practice manager, Monalisa, has been gently nudging me out of my comfort zone since she started just over a year ago. She’s amazing too!” 

The happiness, professional accomplishment and wellbeing of our people matter greatly to us. We will continue to support our people and show that we care more in all that we do. Charlotte concludes:

“I think it was Richard Branson who said ‘Customers are not the most important part of your organisation, your staff are. If you look after your workforce properly, they will give your customers exceptional service.’ Colosseum are obviously aware of this. They understand that if we, as a team, feel cared for, we will always go that extra mile for our patients. The company cares about all of us, from the cleaners to the specialist dentists and everyone in between. 

“Having worked at Charlton Dental Clinic for coming up to 24 years, I have seen 5 changes of ownership in that time. I have to say that Colosseum are the only ones to really listen to us and actually take on board and act on the information we are giving them. As long as they stick with me, I’ll be sticking with them.”

For more information on what opportunities are available for dental nurses with Colosseum Dental UK, visit the website and get in touch today!

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

#WeCareMore

“The biggest benefit of joining the BACD is the camaraderie and support likeminded colleagues give you, especially in the bar after lectures!” says BACD Accredited dentist, Dr Julian Caplan.

“Dental education involves a number of building blocks. Passing your dental degree is just the start of the adventure. We are lucky to have the BACD to help us add further building blocks to our education in a very supportive environment that is clinically relevant to the day-to-day skills we need and are actively sought after by today’s patients.

“Seize the opportunity with both hands and you will not regret it.” 

Visit the BACD website to find out more about becoming a member today.

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

The supplier you choose to source your dental magnification equipment from can make a significant difference to ensuring maximum return on your investment.  

“I always back and promote Nuview because when you have a great relationship with a business – especially one that supports you and provides an excellent service – you have no reason to look elsewhere,” says Dr Daniel Caga. “I highly recommend Nuview and the dental loupes and microscopes they offer, particularly the EXTARO^® 300. In my opinion, this is the best dental microscope available on the market.

“I’d like to thank Nuview for supplying me with an EXTARO^® 300. It is quite simply a fantastic piece of equipment that I’m very privileged to have in my armamentarium.”

For more information please call Nuview on 01453 872266, email info@nuview-ltd.com, visit www.nuview.co.uk or ‘like’ Nuview on Facebook.

It’s been a year of challenges, new experiences and innovation across the dental industry. The pandemic wrought havoc on UK dental practices in early 2020 and disrupted the entire population much until spring of 2021. If you’d have asked me this time last year whether a dental practice sold in February 2020 would have held its value, I would probably have answered in the negative – especially as, at this point, dental practices were re-opening with significant fallow times and no real concept of how long this would go on for, or even if this would become an annual event. As social restrictions continue to ease according to the Government’s roadmap, at time of writing, life looks set to resume some real normality in just a few days. In dentistry, business has already recovered, with many practitioners reporting an increased appetite for services – especially cosmetic solutions – among patients, which will help greatly in their financial recovery.

With regards to the practice sales and acquisitions market, similar trends have occurred over the past 12 months. A significant dip in activity was an unsurprising consequence of the first full lockdown, as well as the very gradual return to normal that followed with no real completion activity until September 2020. Growing public confidence in general has been mirrored by the return of practice acquisitions, arguably a year with proportionally greater consolidator activity than the norm, as they were able to return to the market quickly in the Autumn. Many individuals had to wait for management accounts demonstrating a solid recovery to satisfy their lenders before being able to transact, meaning that in reality, there was little significant activity amongst those borrowing from high street lenders until early 2021.

A buyer’s market to borrow

In fact, the market right now is especially acquisitive, with some fantastic deals available for finance from various lenders. These include cheap debt options with 20% contribution levels, as well as still fairly cheap debt at 10% contribution levels. Similarly, the current dental market landscape is attractive for private equity, attracting new investment and fuelling consolidation amongst the dental groups that they fund. 

The data

While Dental Elite’s Annual Goodwill Report for the end of financial year 2021 offers some useful insights into the market, it is important to remember that a smaller number of sales were completed than in a typical year. However, notwithstanding my earlier comments, just over 55% of sales were still to those buying their 1^st, 2^nd or 3^rd practice, with the next largest group being tier 2 consolidators (groups with 10+ sites but not the Big 5).

When looking at the data according to region, those in London and the South-East continue to attract the highest multiple of EBITDA for a mixed practice; 13.18x EBITDA, 10.76x Adjusted EBITDA. Nationally, the average multiple of EBITDA paid is up to 8.36x from 7.21x in the 2019 report, a trend we are seeing continue in newly agreed sales with multiple of adjusted net profit. This is the valuation metric typically used for smaller practices, which has broadly remained flat with a slight fall from 3.53x to 3.42x. In contrast, the average percentage of gross fees fell 10 percentiles – a likely indication that the average dental practice has become less profitable in the last two years, even after modification for the COVID-19 pandemic. 

There are various potential reasons for this. As is it especially true of NHS practices, these have faced significant upward pressure on associate remuneration whilst revenue remained broadly flat. It could also be a key driving force in the consolidation we have seen in the market for mixed and private practices.

To focus on average sale values, these were above £1 million for the first time since the inception of this report.

Emerging trends

Interestingly, there was little activity amongst those owning between 4-10 practices. Why is this? It may be that owners in this range were finding it more difficult to secure competitive lending, or they might be looking to consolidate their estates after the pandemic, rather than expand.

The data also indicates that in a number of cases, smaller groups seem to be offering more competitive terms than the largest corporates. The average EBITDA multiple paid by tier 1 buyers – the big 5 groups – was 7.14x (averaged at 7.10x), while tier 2 buyers – 10+ practices – offered 7.70x for practices in the most popular locations (averaged at 6.53x). This could be due to a difference in strategy – smaller groups tend to be more open to paying slightly above the original multiple where they are confident that organic growth can be readily achieved. Larger groups don’t commonly take this approach.

Finally, current evidence suggests that location continues to be an ever-more important factor in business value. The price gap between practices sold in the North, North-West, Midlands, London and the South-East, compared to those sold in Scotland, the South-West and Wales, is growing. With the continued resourcing challenges in the latter regions, this is unlikely to change drastically any time soon.

Takeaways

The latest Annual Goodwill Report provides evidence that the dental practice sales market is bouncing back after the disruption caused by COVID-19, despite the smaller pool size from which to obtain data. To access the full report, please visit the Dental Elite website https://www.dentalelite.co.uk/goodwill-guide/ to request your free copy. 

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

Luke Moore is one of the Founders and Directors of Dental Elite and has overseen well in excess of 750 practice sales and valuations. With over 11 years working in the dental industry, Luke has extensive knowledge in both dental practice transfers and recruitment and understands the complexities of NHS and Private practices.

In the first of a two-part series of case studies, Dr Kunal Shah demonstrates how the Osstell Beacon from W&H supports the delivery of predictable dental implant treatment.

A female patient in her 40s was referred to the practice. She had been a long-standing attendee that was fit and well with no medical issues and she was also periodontally and restoratively stable. The main concern was that her LR7 had a vertical root fracture. As the LR7 had a hopeless prognosis, extraction was indicated and treatment options to restore the space were provided to the patient, including a denture, bridge or dental implant. The option of leaving the gap was also given.

With regards to implant treatment, the patient was offered either immediate or delayed implant placement. She decided on delayed implant placement, as we were keen to allow the bone to heal properly post-extraction and regain its strength and density. In addition, her dental function was normal up to her first molar, which meant there was no rush to restore the LR7. Once treatment was explained to the patient and consent obtained to proceed, extraction of the LR7 was carried out atraumatically.

Treatment planning

Following six to eight weeks of healing post-extraction, the patient returned to the practice for a CBCT scan so that the inferior dental nerve (IDN) in the lower jaw could be evaluated. We also wanted to assess any concavities, the buccal-lingual width of the bone, and the distance from the crest of the alveolar ridge to the IDN in order to ensure that treatment planning and placement of the dental implant would be correct.

In cases like this, it is important to ensure that the implant is placed in occlusion with the opposing teeth. This revolves around following a prosthetically driven approach, in which the placement of the final restoration is determined first so that the implant is positioned correctly. For this case, it was essential that the implant be placed on the lingual aspect to ensure we cleared the IDN and obtained a desirable result. Treatment was planned with a NobelReplace Conical Connection PMC 4.3x10mm dental implant.

Implant surgery

Once we obtained consent from the patient, surgery began with an injection of local anaesthetic to numb the area, before an incision was made to raise a surgical flap. We used the WS-75 L surgical handpiece and the Implantmed Plus surgical unit from W&H, which was pre-set to an implant programme. The unit’s wireless foot control was really useful in this case, making it easy to manoeuvre as required without cables getting in the way.

After assessment of the bone, a step-by-step drill sequence was followed – the bone was very dense so we used a dense bone drill at the surgical site to the same length as where we wanted to finish. The reason for this was that it enabled the implant threads to better engage with the bone during placement.

Once the surgical site was prepared, the implant was then placed. At this point, we wanted to make sure we had achieved good primary stability of the implant, which is when the W&H Osstell Beacon proved really useful. We placed an Osstell ISQ SmartPeg specific to the implant and used the Osstell Beacon to measure the Resonance Frequency Analysis (RFA), which enabled us to evaluate the primary stability of the implant.

In this case, we found that we had achieved excellent primary stability of the implant, which was indicated by the Osstell Beacon flashing green and providing a mesio-distal and buccal-lingual Implant Stability Quotient (ISQ) reading of 74 and 72. The data obtained with this device provided a safety net from a litigation point of view, as it demonstrated that we achieved good primary stability at the time of placement. The Osstell Beacon itself is really straightforward to use and easy to set up in combination with the Implantmed Plus – you just have to make sure that the treatment site is dry when you employ the device and that you order the correct Osstell SmartPegs for the case.

The Osstell SmartPeg was removed and as we knew the primary stability of the implant was good, a healing abutment was placed and the surgical site sutured without tension in the soft tissue. The patient was then sent away with routine post-surgery aftercare instructions. At this point, we typically request that the patient returns in two weeks’ time for a review, before the implant is allowed to fully osseointegrate over at least 3 to 4 months.

Images

Figure 1 – CBCT Scan 3D Render showing LR7 region

Figure 2 – Sectional Slice showing LR7 region and IDN

Figure 3 – Sectional Slice showing LR6 and IDN for comparison with Figure 2

Figure 4 – IO Image showing LR7 edentulous region

Figure 5 – IO Image showing incision and Flap Elevation

Figure 6 – IO Image showing NP 3.6x10mm Drill Fully Seated Lingual View

Figure 7 – IO Image showing NP 3.6x10mm Drill Fully Seated Buccal View

Figure 8 – IO Image showing RP 4.3x10mm Drill Fully Seated Lingual View

Figure 9 – IO Image showing RP 4.3x10mm Replace CC PMC Implant Seated Occlusal View

Figure 10 – IO Image showing RP 4.3x10mm Replace CC PMC Implant Seated Buccal View

Figure 11 – IO Image showing SmartPeg for RP 4.3x10mm Replace CC PMC Implant Seated Lingual View

Figure 12 – IO Image showing SmartPeg and OStell Beacon for RP 4.3x10mm Replace CC PMC Implant Seated and measuring Torque Strength Lingual View

Figure 13 – IO Image showing Healing Abutment on Implant and Lingual Wall Intact

Figure 14 – IO Image showing LR7 sutures

To find out more visit www.wh.com/en_uk, call 01727 874990 or email office.uk@wh.com

Modern dentistry is all about finding innovative ways of solving new clinical challenges. The Association of Dental Implantology (ADI) provides the opportunity for clinicians and their teams to discuss new ideas and assess emerging treatments with the ADI Team Congress 2022.

The event will feature a unique mixture of lectures and workshops, with sessions tailored to each member of the dental team. Entitled “The Great Debate: Current Dilemmas in Dental Implantology”, the educational programme will see industry-leading and internationally renowned speakers share their insights and opinions on key topics.

Join the debate – don’t miss the ADI Team Congress 2022

ADI Team Congress 2022

“The Great Debate”

26-28 May 2022, Manchester Central

ADI members will be able to attend the ADI Team Congress for discounted rates. Join today.

www.adi.org.uk/congress22

In the past few years, there has been a big focus on dentistry becoming a more sustainable industry. In fact, before the pandemic, green dentistry was likely top of the list for many professionals as it was receiving considerable media coverage.

However, the arrival of Covid-19 has meant that eco-friendly dentistry has taken rather a backseat of late, especially when you consider the necessity for increased levels of single-use PPE, more regular use of cleaning products and other measures that have become part of everyday infection control.

But with hope on the horizon, is it time to explore ways to implement more responsible dentistry once again?

The benefits of going green

Unlike before the pandemic, when we look at greener dentistry now we have to consider that certain regulations and protocols – such as enhanced used of PPE – could remain in place in the future. At the time of writing, there is no clear timeline of when any regulations will cease, and this means that to head towards more eco-friendly dentistry now, we need to think outside the box and examine ways to cut down waste, reduce power and be more efficient, without impacting infection control measures.

But what are the benefits? Of course, the greatest benefit is the knowledge that you are doing your part to help preserve our planet, protect wildlife and help safeguard our future. On the other hand, there are more immediate benefits too.

For example, according to research, people are far more likely to want to use eco-friendly services or use their money to support greener businesses.[i] A related survey found that the majority of people would be willing to pay more for a greener product/service than save money and choose a less sustainable  option.

For dental practices, this means that going green could be a wonderful marketing opportunity. By making changes and ensuring green credentials are highly visible on your website, social media and other marketing materials, you can help to draw in new patients who prioritise an environmental approach when looking for services.

There’s a further financial benefit – depending on how you take a greener approach you could soon begin to have lower energy bills, less product wastage and be able to streamline your armamentarium, all of which quickly result in less expenditure.

Look at your energy consumption

One source that looked at energy consumption in NHS dental practices found that electricity, gas and other supplies attributed to 15.3% of their total carbon footprint.[ii] That may not sound like much, but if you consider that the total carbon footprint of NHS dentistry is 675 kilotonnes of carbon dioxide equivalents, it’s still a significant amount.[iii]

As such, it’s a good idea to see where you can cut energy consumption. The best way to do this is to look at greener energy sources such as solar panels – these may not be an option for every practice, but they are an excellent way to boost your green credentials quickly. If the shift to sustainable energy sources isn’t attainable, you should look at reducing energy use where possible. Energy saving lightbulbs, screensavers on computers, turning off lights when not in use – these small changes can all make a big difference over time.

Are there greener alternatives for your products?

Your armamentarium is likely to have a number of products that could have greener alternatives available. Look for items that have recyclable packaging or which have been designed to create less waste – these products will last longer, giving you better value for money and reducing the amount of waste generated at the same time. You should also look at products that can streamline your armamentarium – a single product that can replace four or five others is always going to result in less waste, especially as you won’t have to throw away expired adhesives and cements.

The new RelyX Universal Resin Cement from 3M Oral Care features a unique automix syringe that results in up to 80% less cement wastage per use and 50% less plastic wastage as well.[iv] Furthermore, due to its versatility it can replace a number of items in your armamentarium, streamlining your restorative process and helping the planet by avoiding the need to constantly replenish expired products. 

Remember that small changes make a difference

At this point in time we need to think of the more subtle ways we can become greener and head towards sustainable dentistry. By examining your armamentarium and your energy costs, you can make savings that benefit your practice, your patients and the planet.

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

3M representatives continue to be available via video calling technologies for your convenience.

3M and RelyX are trademarks of the 3M Company. – NB to editors: this line must be included at end of editorial when published

Author: John Rafelt

After finishing his PhD in Chemistry in 1999 at York University, John worked as a food analyst at the Government research laboratories and an advisor on research funding working closely with the European Commission. John joined 3M Oral Care in 2002 and is currently Scientific Affairs Manager for the 3M Oral Care UK and Ireland region. John lectures widely on advancements in dental materials and regularly writes articles on the same topic for the dental press.

[i] Carbon and More. Do Consumers Prefer Eco-Friendly Companies? Link: https://www.carbonandmore.com/do-consumers-prefer-eco-friendly-companies/ [Last accessed March 21].

[ii] Duane, B. et al. Environmentally Sustainable Dentistry: Energy Use Within The Dental Practice. British Dental Journal. 2019: 226(5); 367-373.

[iii] Duane, B. et al. An Estimated Carbon Footprint of NHS Primary Dental Care Within England. How Can Dentistry Be More Environmentally Sustainable. British Dental Journal. 2017: 223(8):589-593

[iv] Per application when compared to currently available standard automix systems – 3M internal data.

Looking after the oral health of our children is incredibly important. Not only does good oral health encourage proper development of the adult dentition, but by ensuring children are looking after their teeth from a young age, we can also help ingrain good habits for their lifetime.

In the U,K we are currently living in what many people have labelled a child tooth decay crisis. Latest figures have suggested that childhood tooth decay costs the NHS over £40 million per year, and that nearly a quarter (23%) of children aged five years and younger have experienced dental decay across the country.[i]

Worryingly, the pandemic may have even exacerbated this problem, with many children unable to see dental professionals during the lockdown period. In some deprived areas, the rate of childhood tooth decay has doubled during the pandemic, showing that more needs to be done to keep on top of this problem.[ii]

As such, when dental nurse Jo Dawson, visited local pre-schools and schools to offer oral health education to children, she was shocked to see that these establishments were still offering children raisins and sultanas as snacks as part of the government-funded School Fruit and Vegetable Scheme (SFVS). What concerned her further was that thousands of children are also allowed to bring dried fruit and other high-sugar snacks in every day.

Though there are health benefits to dried fruit, the foods have been classified as cariogenic. Not only do raisins and sultanas have high levels of sugar, but they are also sticky, meaning that when being consumed they adhere to the teeth and can easily get caught in hard to reach places, promoting decay.

Although Jo reached out to the Department of Health and Social Care and the SFVS, she was informed that it was not viable to supply children with fresh fruit with this level of regularity, and that as the dried fruit was only supplied six times per year, this was unlikely to have an impact on children’s oral health.

As dental professionals we know that even occasional eating of dried fruit may promote bad snacking habits and have an impact on oral health. So, in response, Jo Dawson has launched a new campaign called “Raisin Awareness” which aims to end the supply of dried and processed fruit snacks in primary schools. She hopes to improve the oral health of children in primary schools through better education and by linking dental practices with schools so that they can work together to achieve this goal.

This is an important initiative and taking these steps could significantly help to diminish the childhood tooth decay crisis across the UK. With more education and healthier snacking comes a better understanding of oral health at all ages, and this is something that will help protect children from avoidable tooth decay moving forwards.

So, why not get involved? If you’re interested and your practice is family friendly and interested in promoting a culture of prevention, please contact the BSDHT today to learn more!

 For more information about the BSDHT, please visit www.bsdht.org.uk, call 01788 575050 or email enquiries@bsdht.org.uk

[i] The Guardian. Children’s Tooth Decay Costs the NHS More Than £40 Million a Year in England. Link: https://www.theguardian.com/society/2020/aug/22/childrens-tooth-decay-costs-nhs-more-than-40m-a-year-in-england [Last accessed April 21].

[ii] BMJ Paediatrics Open. COVID-19 and the Impact on Child Dental Services in the UK. Link: https://bmjpaedsopen.bmj.com/content/5/1/e000853 [Last accessed April 21].