Dentists spend much of their time in close contact with their patients. This facilitates a positive professional-patient rapport, and helps dentists to gain a deeper understanding of each individual. As a result, every patient receives tailored dental care suited to their situation.

However, most dentists will encounter patient complaints throughout their career, and regardless of the complaint’s validity, it can be incredibly demoralising. The elusive nature of grievances means they can come at any time, for any reason, and so devising a preventative strategy can be challenging. Nonetheless, all dentists should continue to minimise the possibility of complaints arising and should a claim be made, be able to take steps to rectify the situation.

For dentists who are new to the industry, or those who have been in the field for years, patient complaints provide the opportunity to learn from errors and gain the skills necessary to handle complaints confidently and constructively.

Complaints and treatment

It’s vital for dentists to understand why patients complain and, instead of taking these criticisms personally, listen to them without putting on a defensive front. It can often be difficult to remain calm in the face of a grievance, especially when a patient becomes aggressive or rude, but staying composed will keep the situation manageable and resolvable.

According to the Dental Defence Union (DDU), the most common cause for a complaint was dissatisfaction about treatment.[i] Even when a dentist takes all the appropriate steps to ensure the treatment outcome is successful, a patient may still be dissatisfied. For protection from legal action, dentists should ensure they’ve covered all bases, by communicating effectively with their patients, engaging them during the treatment planning and keeping them consistently informed throughout the treatment process.

Developing a positive professional-patient relationship and delivering exceptional patient care throughout the duration of treatment may help dentists to mitigate a potential complaint. If, for instance, the patient has undergone dental implant therapy and was unhappy with the aesthetic outcome, instead of the grievance escalating, the dentist can remedy the situation through communicating with the patient directly and offering compensation. This can be in the form of a full or partial refund and rectifying the treatment promptly. By demonstrating a willingness to correct any problems, the patient will recognise that their complaint has been taken seriously.

The dental environment

There are various non-clinical factors that can influence a patient’s decision to log a complaint, ranging from administrative to environmental influences. If something were to go awry during treatment, a patient may be more inclined to complain if other aspects of the dental practice were also dissatisfactory. If the dental environment is inadequate in some way (perhaps the furniture in the waiting room is uncomfortable, or the bathroom facilities are sub-par) then this will further affect the patient’s opinion of the dental practice. Thus, ensuring that the dental practice is a pleasant and visually-welcoming place can make all the difference.

All members of the dental team, especially those who are largely patient-facing, such as receptionists and dental nurses, play a significant role in making the patient experience positive and affirming. When entering the dental practice, patients wish to be greeted by approachable, knowledgeable and courteous staff. This is especially true for patients who may be experiencing dental anxiety, or vulnerable patients who need extra consideration. A friendly, welcoming face will help relax patients and set the overall tone for their visit. The dental team will also be able to spot the early signs of patient dissatisfaction and make attempts to rectify the situation before it becomes a matter of complaint.

The quality of the facilities is another driving factor in patient satisfaction – the participants in one qualitative study[ii] noted that the quality of dental services, such as the technologies, equipment and facilities used, were factors in patient satisfaction. Dentistry has developed impressively over the years, producing new modalities that aid in maximising how dentists deliver care to their patients. Adopting new tools and equipment, such as those digital in nature, can come with a steep learning curve, but dentists should consider upgrading their dental repertoire to help streamline treatment and deliver more successful outcomes more efficiently than with conventional methods.

The support when you need it most

Rodericks Dental is committed to supporting dentists efficiently and competently, by providing them with access to a complaint handling team, as well providing high-grade materials, equipment and state-of-the-art facilities, helping dentists to deliver exceptional care to every patient. Because Rodericks Dental is clinically-led, they recognise the needs of not just patients, but of dentists too, so they provide ample benefits such as career development opportunities and mentoring for enhanced skills. A career with Rodericks Dental means providing optimal dentistry with support readily available whenever it’s needed.

Complaints are unpleasant, for the patient and the dentist both and can be triggered by many different reasons that cannot always be foreseen. Nonetheless, they also present an opportunity to grow as a professional, and gain the skills to handle them with confidence and assurance should they arise in the future.

For more information on the career opportunities available at Rodericks, please visit www.rodericksdentalcareers.co.uk, or contact Ashley Lillyman at recruitment@rodericksdental.co.uk or on 01604 970988 (option 1)

#wearerodericks

[i] Why do dental patients complain? (2013c). British Dental Journal, [online] Available at: https://www.nature.com/articles/sj.bdj.2013.1014 [Accessed 1 Mar. 2022].

[ii] Luo, J.Y.N., Liu, P.P. and Wong, M.C.M. (2018b). Patients’ satisfaction with dental care: a qualitative study to develop a satisfaction instrument. BMC Oral Health, [online] Available at: https://bmcoralhealth.biomedcentral.com/articles/10.1186/s12903-018-0477-7#Sec6 [Accessed 1 Mar. 2022].

The British Orthodontic Conference (BOC) is taking place this September, and will be the largest annual gathering of UK orthodontists! Alongside superb speakers and the chance to debate and discuss all the latest conversations in orthodontics, delegates will have the chance to see some brilliant brands and products, too.

ClearCorrect^®, a Straumann Group brand, will be on display at this year’s event. This solution has been engineered for precision, delivering remarkable outcomes in a wide variety of cases. With ClearQuartz^™ tri-layer material, the ClearCorrect^® aligners are tough and stain-resistant, and help to provide a consistent, continuous force to the teeth for predictable movement.

The ClearPilot^™ software is just one of the benefits of the latest tools available and includes an Individual Tooth Movement feature, allowing clinicians to make adjustments to the desired final position on the 3D model. The latest update allows you to incorporate bite ramps and aligner cut outs for buttons and elastics in your treatment set up, enabling you to treat more of your patients with ClearCorrect^®.

Be sure to book your place and visit ClearCorrect^® at the BOC – the event takes place at the ICC in Birmingham, 15-17^th September!

For more information, visit www.clearcorrect-uk.com 

TMD alone causes a patient much distress and discomfort, but it has also been linked with several comorbidities that have a much greater impact. The combination of more than one ailment can significantly reduce a patient’s quality of life, often making them feel despondent and antisocial. 

Tinnitus often presents comorbidly with TMD.[1] Given the proximity of the ear canal to the temporomandibular joint (TMJ) it is unsurprising that the latter can affect the former. Tinnitus is often described as a ringing sound, similar to the tones we sometimes hear as we lose another sound frequency to the aging process. However, tinnitus sufferers may experience other sounds that might be described as buzzing, hissing, whistling – just about any sound could be endured. The sound experienced may vary in volume or pitch, and can occur intermittently or be a constant.[2]

A potential symptom of TMD is ringing in the ears, in some instances treating TMD will also alleviate the patient’s tinnitus symptoms. However, in other instances while the two conditions are correlated, the TMD is not always the causative factor.

Tinnitus is by no means the only TMD comorbidity. TMD is more common in people experiencing chronic stress, bruxism, sleep complaints and insomnia, anxiety, and depression.[3]^{, [4], [5]} These conditions often overlap, for instance psychological disturbance can reduce sleep quality and increase the likelihood of bruxism.[6] The exact cause and effect relationship between these conditions is not yet fully understood or agreed upon, but they do appear to be associated.[7]

TMD is also associated with various pain conditions such as migraine, chronic fatigue syndrome, irritable bowel syndrome, and interstitial cystitis. Moreover, the severity and duration of TMD pain appears to be positively associated with the incidence of comorbidities. In other words, the more the patient is affected by their TMD, the more likely they are to have another condition present as well.[8] Pain conditions can have a marked impact on quality of life, they are another factor that can adversely influence sleep and mental wellbeing. Likewise, not getting sufficient quality sleep can reduce resilience to pain.[9] This bidirectional relationship between pain and sleep can thus create a vicious circle, with pain thwarting good sleep, and that lack of sleep increasing the patient’s perception of pain.

With all these overlapping conditions how can the dental team help patients? Well, the good news is that because these problems are linked, progress with one can have a positive impact on another. As dental practitioners, helping a patient with TMD probably will not eliminate another condition, but it can certainly improve the patient’s quality of life. Moreover, by giving the patient a concrete treatment plan, particularly where they feel like they are actively contributing to their own recovery, this can be very beneficial for how they feel about their illness. Chronic conditions can make a person feel helpless, which is very bad for their mental wellbeing. A plan of attack, and steps a patient can take, will help them regain some sense of control.

With TMD, some patients may benefit from physical tools to assist their jaw rehabilitation exercises, such as the OraStretch Press, [10] available through Total TMJ. This simple yet effective device helps the user to gradually open their mouth wider, and with more comfort over time. With continued use of the OraStretch Press, a typical patient can gain 1-2 mm per week in range of motion. These exercises enable patients to maximise their range of motion, reduce joint pain, and develop jaw muscle strength.

The experience of TMD comorbidities can be very disheartening for patients, as they may feel problems are stacking up, one after another. If there is a silver lining to be found, it is that by understanding where conditions are linked, and how, treating one can lead to progress with the other. For some patients, treating their TMJ issues will also resolve their tinnitus symptoms. For others, getting a better handle on daily stressors will help alleviate their symptoms. The body is an incredibly complex system, rarely does something effect only one part in isolation. By looking at dental patients more holistically, the dental team might better aid their general wellbeing.

For more details about Total TMJ and the products available, please email phil@totaltmj.co.uk or karen@totaltmj.co.uk

Author: Karen Harnott Operations Director Total TMJ

[1] Mottaghi A., Menéndez-Díaz I., Cobo J., González-Serrano J., Cobo T. Is there a higher prevalence of tinnitus in patients with temporomandibular disorders? A systematic review and meta-analysis. Journal of Oral Rehabilitation. 2019; 46(1): 76-86. https://doi.org/10.1111/joor.12706 April 11, 2022.

[2] British Tinnitus Association. All about tinnitus. British Tinnitus Association. https://www.tinnitus.org.uk/all-about-tinnitus April 11, 2022.

[3] Babiloni H., Martel A., Lavigne G. Sleep disturbances in temporomandibular disorders: a narrative review. Oral Surgery. 2020; 13(4): 335-348. https://doi.org/10.1111/ors.12451 April 11, 2022.

[4] Auerbach S., Laskin D., Frantsve L., Orr T. Depression, pain, exposure to stressful life events, and long-term outcomes in temporomandibular disorder patients. Journal of Oral and Maxillofacial Surgery. 2001; 59(6): 628-633. https://doi.org/10.1053/joms.2001.23371 April 11, 2022.

[5] Bertoli E., de Leeuw R. Prevalence of suicidal ideation, depression, and anxiety in chronic temporomandibular disorder patients. Journal of Oral Facial Pain and Headache. 2016; 30(4): 296-301. https://doi.org/10.11607/ofph.1675 April 11, 2022.

[6] Serra-Negra J., Scarpelli A., Tirsa-Costa D., Guimarães F., Pordeus I., Paiva S. Sleep bruxism, awake bruxism and sleep quality among Brazilian dental students: a cross-sectional study. Brazilian Dental Journal. 2014; 25(3): 241-247. https://doi.org/10.1590/0103-6440201302429 April 12, 2022.

[7] Fernandes G., Franco A., Siqueira J., Goncalves D., Camparis C. Sleep bruxism increases the risk for painful temporomandibular disorder, depression and non-specific physical symptoms. Journal of Oral Rehabilitation. 2012; 39(7): 538-544. https://doi.org/10.1111/j.1365-2842.2012.02308.x April 12, 2022.

[8] Dahan H., Shir Y., Velly A., Allison P. Specific and number of comorbidities are associated with increased levels of temporomandibular pain intensity and duration. The Journal of Headache and Pain. 2015; 16: 47. https://doi.org/10.1186/s10194-015-0528-2 April 11, 2022.

[9] Irwin M. Sleep and inflammation in resilient aging. Interface Focus. 2014; 4(5): 20140009. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4142016/ April 11, 2022.

[10] OraStretch Press System. https://www.craniorehab.com/orastretch [Accessed March 2022]

Dr Reema Aggarwal describes a case where she used products from 3M Oral Care to help refresh the smile of a patient who had advanced tooth surface loss.

A male patient presented with a high level of Tooth Surface Loss (TSL) and a number of missing teeth on both the upper and lower arch. The teeth with TSL had worn down considerably and were no longer visible during speech due to the reduction in height. Furthermore, a number of the patient’s remaining teeth were heavily restored, with multiple amalgam fillings, composite fillings and crowns (figures 1-6).

Assessment

Despite the significant TSL, the patient had a high standard of oral health and excellent gingival condition. Amalgam fillings were present on UL4, UL5, UL8, UR8 and LR5. The patient had composite fillings on UL3, LL7, LL4 and LR7. UR6 and UR3 had crowns, while UR7, UR5, UL6, UL7, LL6, LL5 and LR6 were missing.

Clinical photographs were taken. The wear pattern on the upper and lower anterior teeth suggested that a combination of factors was to blame. Parafunctional grinding due to the lack of posterior teeth had caused significant wear, while acid erosion caused by diet had weakened and damaged the teeth further. The patient was extremely dental phobic, and therefore had attended routine appointments sporadically in the last decade. 

Though some tooth structure remained in the majority of the TSL affected teeth, UR4 had almost no structure left at the palatal aspect. In addition, the crown on UR3 was failing.

A detailed occlusal examination was performed and a reduction in face height was noted due to the TSL and the patient’s habitual attempt to bring the upper and lower teeth together during closure. Interestingly, this case was more complex than first thought, as the lack of space between the remaining anterior teeth meant it was impossible to place restorations.

Treatment options

Treatment options were discussed with the patient. Restoring using multiple crowns would have been destructive and detrimental to preserving the remaining tooth structure. Therefore, using composites to restore the teeth with significant TSL was a more viable option. A conservative approach via the “Dahl Concept” was chosen, meaning that teeth from UL5 to UR4 and LL4 to LR5 would be restored in order to re-establish canine protected occlusion. It was also agreed that existing amalgam fillings would be replaced as a precautionary measure.

The patient was informed about the risk of his bite feeling uncomfortable while it adjusted, as well as the possibility of composite chipping in the short term and needing minor repairs.

Treatment

Before treatment, the patient underwent a month of tooth whitening to reach the desired shade for his new smile.

A detailed occlusal examination and use of Lucia jig to record centric relation was carried out. A semi adjustable articulator was used and a wax up of the desired vertical height of the teeth being restored was requested from the laboratory. A laboratory putty template was made of the wax ups and used as a guide to establish the occlusion and guidance, for placing the restorations. The labial aspects were sculpted freehand and anatomy changed where needed to achieve a better emergence profile.

Due to the patient’s dental phobia, he had to undergo cognitive therapy in order to prepare for treatment. He had found even basic dental work traumatic in the past, but we overcame this difficulty by letting him listen to music throughout the 6-hour procedure.

All teeth exhibiting TSL were built up using 3M Filtek Universal Restorative (including the Pink Opaquer shade). After applying 3M Astringent Retraction Paste, teeth were rebuilt freehand, sculpted to suit the desired smile aesthetics and composite was secured using 3M RelyX Unicem Self-Adhesive Universal Cement and 3M Scotchbond Universal Adhesive. A1 shade of 3M Filtek Universal Restorative was used along with A1D dentine shade of 3M Filtek Supreme XTE in most upper anteriors.

Once the anterior teeth had been restored to the predetermined vertical height, the failing UR3 crown was replaced with an aesthetic all-ceramic zirconia crown that matched the height and shade of the new smile. The patient also opted to have the gold UR6 crown replaced with a ceramic option three months after the composite build up to further enhance his smile aesthetics.

All failing silver amalgam restorations were replaced with 3M Filtek Bulk Fill Flowable Restorative and, in some cases, 3M Filtek P60 Posterior Restorative where additional strength was needed due to the size of the restoration (figures 7-8).

Final thoughts

This was a challenging but very rewarding case that offered a complete smile makeover for the patient. He was very pleased with his new smile and went on to have the missing teeth replaced by implants to complete the transformation.

I chose 3M products throughout this case because I like the reliability and versatility that they provide. The polish retention on 3M composites and ability to shade match so easily are far superior to many other composites on the market, meaning I could create an aesthetic and enduring result that the patient loved.

The retraction paste in compules is also excellent to control any blood from gingival margins. They are easy to use in the composite gun and don’t dissolve in saliva to stain the composite, which really impressed me. Since then, I have dispensed with use of other retraction pastes during composite bonding. I have found 3M composites extremely easy to manipulate and sculpt. They hold while sculpting and do not collapse as compared to other composites. In addition, along with the use of the dentine and enamel shades, one achieves colour, shade, translucency with great ease. Graded 3M Sof-Lex polishing discs to complete the finishing and polishing are all that is needed for gloss that is comparable to ceramics. Freehand sculpting of the teeth was easily achievable while respecting the wishes of the patient and the constraints caused by his dentition and his dental phobia.

Images

Author bio: Reema graduated in dentistry from Bangalore University in 1995. She has worked in private practice in Cheltenham, Somerset, Hereford and Bristol for the last twenty years in the UK, while devoting most of her time to postgraduate study, both in the UK and the USA.

She gained the MDJF from the Royal College of Surgeons in 2009 and her Diploma in Restorative Dentistry in 2013. She was awarded the Gold Medal by the Royal College of Surgeons for “Excellence in Restorative Dentistry”. Subsequently, she completed an MSc in Restorative Dentistry from Leeds University in 2016. Reema currently accepts referral cases for Periodontics, Endodontics and Restorative Dentistry for the My Dentist Group, Colosseum Group and other independent practices in Cheltenham, Somerset and Hereford.

With many issues affecting the longevity of natural dentition, such as disease, trauma or certain health conditions, dental implants have become a life-changing solution for patients of all ages.

In recent years, researchers and developers have made remarkable improvements to the techniques, technologies and products in the field. Despite this, many clinicians will still encounter challenging cases. As with all dental treatments, the safety of the patient overrides all else, and as such the clinician will need to make the right decision for the health and happiness of their patients. One such decision includes referring patients to a specialist, which gives them peace of mind that their patient is receiving the most appropriate care for their needs.

Failed implant cases

Dental implant failure is certainly frustrating for the patient and the clinician alike. There are many circumstances that can lead to implant failure. Researchⁱ has noted that early implant failures are mainly biological in nature, potentially caused by unsuccessful osseointegration, iatrogenic trauma or infection. Soft tissue complications can occur around dental implants, namely a lack of attached mucosa, deficient volume and peri-implant mucosal recession.[i] Mechanical causes of implant failure include implant fractures that occur due to fatigue and trauma, which require a complex, surgical extraction of the dental implant and its supporting bone.[ii] Damage to the abutment and abutment screw are also considered mechanical causes of dental implant failure.

One study found that the survival rate of dental implants, placed at sites where a previous implant had failed, is lower than generally reported.[iii] The clinician will need to balance the risk factors with the desires of the patient, as the issues that caused the original failure may also threaten the replacement restoration.[iv] If presented with a failed implant case, the clinician may consider referring if this is beyond their remit, to ensure the patient receives the highest standard of care.  

Nerve damage

As nerve damage during treatment can cause neuropathic pain and discomfort for the patient, this surgical complication is highly undesirable and stringent steps must be followed for its prevention. Nerve damage can be caused by several situations, including injury from drilling, compression by the dental implant fixture, an abnormal mandibular nerve canal or hematoma.[v]

The importance of early diagnosis, and treatment, cannot be understated.[vi] As you well know, preventative measures are paramount to ensuring that nerve damage does not occur. For some cases, nerve lateralisation and repositioning may be clinically necessary to allow the placement of longer implants in the mandible. Indeed, research has noted that these complex surgical techniques may be the only possible procedure for patients seeking restorative care, but present with an atrophic posterior mandible.[vii]

Elderly and medically-compromised dental implant patients

Patients from a range of age brackets can undergo dental implant therapy and enjoy an aesthetic, functional dentition. Of course, vulnerable patients, such as the elderly and those who are medically-compromised, may be at a higher risk than other patient groups for complications.

Older patients may present with multimorbidity, frailty and polypharmacy; thus, their approach to care must be tailored to their situation to ensure clinical safety. Additionally, medical treatments such as radiotherapy may have an influence on the dental implant’s survival, with associations to a higher risk of halitosis.[viii] General aging also puts patients at risk of developing issues such as inflammation and periodontitis.[ix]

Medically-compromised patients, such as those with systematic conditions like arthritis, cardiovascular diseases and neurologic disorders,[x] will likewise require individualised care. Clinical decisions and assessments must be made carefully with all patients, but especially those with increased health risks. Balancing the patient’s desires with considerations for their condition can be challenging; seeking guidance from a specialist can aid clinicians in delivering treatment that is tailored to the patient’s circumstances.

Put your patient first

If a patient case falls outside of a clinician’s skill or experience, referring the patient to a specialist will ensure that they received the most appropriate care.  

The Centre for Oral-Maxillofacial and Dental Implant Reconstruction ensures that all patients receive relevant and personalised care. Run by Dr Cemal Ucer, Specialist Oral Surgeon, the Centre provides a range of treatment options, all performed by highly-trained and competent professionals. These include day-care surgery for the elderly and medically compromised patients, the management of nerve damage/nerve lateralisation and the management and re-treatment of failing dental implants, among plenty more. With cutting-edge facilities and technologies, the Centre for Oral-Maxillofacial and Dental Implant Reconstruction provides the highest standards of patient care, with personal and individual attention.

By referring, clinicians are increasing the possibility for a successful treatment outcome, as well as prioritising the safety of their patients.

Please contact Professor Ucer at ucer@icedental.institute or Mel Hay at mel@mdic.co

01612 371842

www.ucer-clinic.dental

Author: Professor Cemal Ucer (BDS, MSc, PhD, Oral Surgeon, ITI Fellow)

[i] Thoma, D.S., Gil, A., Hämmerle, C.H.F. and Jung, R.E. (2022). Management and prevention of soft tissue complications in implant dentistry. Periodontology 2000, [online] 88(1), pp.116–129. Available at: https://onlinelibrary.wiley.com/doi/full/10.1111/prd.12415  [Accessed 19 May 2022].

[ii] Shemtov-Yona, K. and Rittel, D. (2015). An Overview of the Mechanical Integrity of Dental Implants. BioMed Research International, [online] 2015, pp.1–11. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4637045/ [Accessed 19 May 2022].

[iii] Oh, S.-L., Shiau, H.J. and Reynolds, M.A. (2020). Survival of dental implants at sites after implant failure: A systematic review. The Journal of Prosthetic Dentistry, [online] 123(1), pp.54–60. Available at: https://pubmed.ncbi.nlm.nih.gov/31027959/ [Accessed 19 May 2022].

[iv] Quaranta, A., Perrotti, V., Piattelli, A., Piemontese, M. and Procaccini, M. (2014). Implants Placed in Sites of Previously Failed Implants. Implant Dentistry, [online] 23(3), pp.311–318. Available at: https://journals.lww.com/implantdent/Fulltext/2014/06000/Implants_Placed_in_Sites_of_Previously_Failed.15.aspx [Accessed 19 May 2022].

[v] Fukuda, K., Ichinohe, T. and Kaneko, Y. (2012). Pain Management for Nerve Injury following Dental Implant Surgery at Tokyo Dental College Hospital. International Journal of Dentistry, [online] 2012, pp.1–9. Available at: https://www.hindawi.com/journals/ijd/2012/209474/ [Accessed 19 May 2022].

[vi] Shavit, I. and Juodzbalys, G. (2014). Inferior Alveolar Nerve Injuries Following Implant Placement – Importance of Early Diagnosis and Treatment: a Systematic Review. Journal of Oral and Maxillofacial Research, [online] 5(4). Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4306320/ [Accessed 19 May 2022].

[vii] Abayev, B. and Juodzbalys, G. (2015). Inferior alveolar nerve lateralization and transposition for dental implant placement. Part I: a systematic review of surgical techniques. Journal of oral & maxillofacial research, [online] 6(1), p.e2. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4414233/ [Accessed 19 May 2022].

[viii] Maluf, G.V., Caldas, R.J., Fregnani, E.R., Antunes, H.S., Tobias, M.A.S. and da Silva Santos, P.S. (2022). Evaluation of halitosis parameters in patients undergoing head and neck radiotherapy. Oral Diseases. [online] Available at: https://pubmed.ncbi.nlm.nih.gov/35485180/#:~:text=Higher%20doses%20of%20radiation%20to [Accessed 19 May 2022].

[ix] Woelber, J.P. and Fretwurst, T. (2022). Patient-related risk factors for peri-implantitis and pre-implant treatment – Online DZZ. 01, [online] 01(347), pp.36–36. Available at: https://www.online-dzz.com/archive/issue/article/dzzint-1-2022/5797-1053180-dzz-int20220005-patient-related-risk-factors-for-peri-implantitis-and-pre-implant-tr/ [Accessed 19 May 2022].

[x] Ghimire, P., Suwal, P. and Basnet, B.B. (2022). Management of Medically Compromised Prosthodontic Patients. International Journal of Dentistry, [online] 2022, p.7510578. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8767402/ [Accessed 19 May 2022].

When performing oral surgery or dental implant placement, it pays to utilise innovative technology that truly enhances your skills.

The Implantmed from W&H is a prime example of how a piece of technology not only works for you, but with you, to ensure optimal outcomes.

The system boasts an intuitive, user-friendly interface, and also offers additional functions such as a thread-cutting feature, automatic torque control and wireless foot control for ultimate convenience.

Furthermore, combined with the W&H Osstell Beacon, the Implantmed can accurately measure implant stability at a glance, encouraging long-lasting outcomes and helping to ensure that osseointegration occurs as predicted.

Take treatment to the next level by contacting W&H today.

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

Do you have patients struggling with trismus, temporomandibular joint (TMJ) dysfunction, or other issues affecting their jaw muscles? The OraStretch Press[i] from Total TMJ can safely and effectively aid patients’ jaw rehabilitation.

This simple yet effective device helps the user to gradually open their mouth wider, and with more comfort over time. Through continued use of the OraStretch Press, a typical patient can gain 1-2 mm per week in range of motion. These exercises enable patients to maximise their jaw mobility, reduce joint pain, and develop jaw muscle strength. A safety limit screw is incorporated into the design to prevent overstretching.

The OraStretch Press is light and compact, has ergonomic easy to grip handles, and a sliding scale that is designed for readability – all features that make it ideal for older or weaker patients.

The OraStretch Press comes with a lifetime limited warranty and free exchanges are offered if a different size is required. Contact Total TMJ for more details.

For more details about Total TMJ and the products available, please call

01202 313701 or email info@totaltmj.co.uk 

[i] OraStretch Press System. https://www.craniorehab.com/orastretch [Accessed March 2022]

The importance of a good night’s sleep cannot be understated. Sleep provides our body with time to regulate core biological functions. It also allows us to unwind and feel refreshed when we wake up, giving us much-needed energy to perform capably. Unfortunately, modern life provides plenty of pressures that can make sleeping, well, a challenge.

There is much literature on the topic of sleep and health, but what about its effects on oral health? Sleep behaviours and oral health are often closely entwined, but many patients may not consider how their sleep behaviours play a role in the condition of their dental hygiene. Raising awareness of the importance of sleep on oral health (and all aspects of health) could help patients take steps to establish better habits at night-time. Additionally, communicating the importance of regular dental appointments can help in the identification and resolving of many disruptive sleep disorders.

The stages of sleep

There are two primary categories of sleep: non-rapid eye movement (NREM), which is comprised of 4 stages, and rapid eye movement (REM).[i] Stage 1 is a light sleep; muscle activity slows and individuals can be easily awoken. At stage 2, our brain waves become slower and our eye movements cease. In stages 3 and 4, we are in the very deep phases of sleep, with no eye movement or muscle activity.[ii] When we move into REM sleep, our heart rate increases and breathing becomes more irregular; it is thought that this phase occupies 20-25% of night-time sleep in healthy human adults.[iii] A deep sleep provides ample benefits to our mind and body; it is important for cognitive function and memory,[iv] in addition to our mood and energy.[v] A lack of sleep can be detrimental to our health; even one night of total sleep deprivation can affect the way the brain functions.[vi]

The most common sleep disorders include insomnia, narcolepsy, restless leg syndrome and sleep apnoea.[vii] These conditions can cause significant disruption to a sleep routine, often resulting in poor sleep behaviours for those afflicted.

With around 67% of UK adults suffering from disrupted sleep and 23% managing no more than 5 hours a night,[viii] sleep deprivation is certainly a pressing issue for healthcare providers. Many people who notice their dental health deteriorating may not have considered that a sleep disorder is the cause. However, research^ix has noted the integral role that dental professionals play in the identification of sleep disorders in patients.

Sleep and oral health

Sleep bruxism is perhaps the most common sleep disorder that has drastic consequences for oral health. Not only do patients sustain wear to the structure of their teeth, but they are also at risk of muscle hypertrophy and/or pain, temporomandibular disorders and loss of periodontal support.[ix] With many individuals unaware that they are grinding their teeth whilst sleeping, the issue could continue undetected for some time, causing their dental hygiene to deteriorate substantially. Similarly, obstructive sleep apnoea has been associated with xerostomia, soft tissue irritation, gingivitis and periodontitis.[x]

Dental professionals play a unique role in the detection of these conditions. Patients who present with complaints such as bad breath, worn and/or sensitive teeth or jaw pain may have an underlying sleep disorder. Upon detection, dental professionals can offer all the relevant advice the patient may require, not only to sleep better but to improve their oral health, too.

Establish better habits

For patients whose oral health has declined due to certain sleep conditions, aiding them in establishing better oral care habits will improve the quality of their dental health, thus contributing to better health overall.

For a gentle yet effective dentifrice, dental professionals should consider recommending the Arm & Hammer^™ Sensitive Pro Baking Soda toothpaste to their patients. This low abrasion toothpaste uses patented Liquid Calcium^™ technology to form a shield over the teeth, protecting exposed nerves and 1100ppm fluoride to promote remineralisation. It also contains baking soda, which helps remove plaque, neutralises odour and cleans deep between the teeth and below the gumline. The Arm & Hammer^™ Sensitive Pro Baking Soda is an accessible, clinically-proven solution that will aid patients in getting their oral health back on track.

Sleep is an integral requirement for good health, but far too many of us struggle to establish healthy sleep habits. Consequently, other areas of our health begin to feel the effects. Dental professionals are vital figures for patients suffering from sleep conditions; with their expert guidance and recommendations, patients can be better-equipped when taking the steps to establish improved habits for all areas of their health.

For more information about the carefully formulated Arm & Hammer™ toothpaste range, please visit https://www.armandhammer.co.uk/ or email: ukenquiries@churchdwight.com

Arm & Hammer™ oral healthcare products are available at Boots, Superdrug, Sainsbury’s, Tesco, Asda and Morrisons throughout the UK.

Author:

Charleane McInally is a professional educator for Waterpik, and dental hygienist

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By becoming a member of the Association of Dental Implantology (ADI), you’ll have access to an ADI script for dental implant consultations on Kiroku. This digital note-taking solution is ideal for busy clinicians, saving them time and reducing stress.

To ensure completeness, Kiroku provides a comprehensive template for patient notes, prompting professionals to complete all the necessary fields. By automatically populating certain fields when selected, the whole note-taking process is sped up significantly – this helps to maintain in-depth notes after every appointment.

By keeping more accurate, organised records, Kiroku helps clinicians protect themselves from potential litigation.

In addition to Kiroku, an ADI membership offers plenty more benefits to members, so why not consider joining today?

Get in touch with the team, or visit the website, to find out more.

For more information about the ADI, or to join, please visit the website www.adi.org.uk