Joining us at the ADI Team Congress 2023 is Dr Dirk Duddeck – renowned clinician and the founder of the CleanImplant Foundation.

He explains the organisation’s aims and the importance of truly clean dental implants:

“The CleanImplant Foundation has analysed over 300 different implants from 200 companies – 1 in 3 show significant organic contaminants, remnants, or impurities. As clinicians, we should not accept this.

“The CleanImplant Foundation is a non-profit organisation who guarantees total transparency and 100% unbiased analyses. In 2017, we developed the first consensus paper to establish a threshold of acceptable contamination, defining what makes a dental implant ‘clean’. The companies whose products meet our requirements understand the problem. They have invested money, time, effort, and extensive human resources on improving their production processes and corresponding quality management as a result.

“I hope delegates in my session will be encouraged to ask their sales representatives if they have unbiased proof that their dental implant is as clean as they say. If they are unknowingly using a product that is not as clean as they think, they could be looking in the wrong areas to determine why their patients experience peri-implantitis. “

Join us at the ADI Team Congress next year to hear more from Dr Dirk Duddeck.

The ADI Team Congress 2023 will be held on 4-6 May at the Birmingham ICC. Visit the website for details in due course. ADI members get significantly discounted rates for all ADI events.

www.adi.org.uk

Oral health practitioners aim to deliver quality care that satisfies clinical objectives and their patients’ expectations ­– this part can be trickier. Patients’ expectations are high, they differ and can sometimes be unrealistic. They are also a “key determinant in their satisfaction with treatment (encompassing) not only notions of the outcome (…) but also the process”. [i] So, not only the result, but the entire experience.

Patients desire a beautiful smile, and there are a range of solutions available to improve its appearance that also benefit function and health. Over the past decade, more adults are opting for orthodontic treatment, often self-referring, particularly since the introduction of near-invisible options for efficiently and ethically straightening teeth. People are doing their own research and finding out that, unlike treatment they may have had as a child, no one needs to know that they are wearing an appliance. They’re discovering that the cost of quality orthodontics is manageable and the risk of complications is small. Although it tends to be easier to move the teeth while the mouth and jaws are still growing, treatment for adults can be incredibly successful, and give lasting results – it’s not too late!

Broadly, the objectives of orthodontic treatment will be the same whatever your patient’s age. For cases involving adults, the difference is likely to be with their expectations. Someone in their 40s, who has spent years feeling unhappy, self-conscious and disliking their appearance in photographs, will be aware of how much their confidence and self-esteem has been affected. Their expectations might be primarily for a beautiful smile, plus for significant psychological, emotional and social benefits. You will also be able to tell them that, even if their concerns are nearly entirely aesthetic, aligned teeth are also easier to keep clean, and will optimise mechanical function and the distribution of force and stress. Long-term oral health and comfort can therefore be improved.

But delivering adult orthodontics can be challenging. If they expect perfection, this might not be achievable. Body dysmorphic disorder (BDD) is a “psychiatric disorder which an individual has a preoccupation with a ‘slight’ or ‘perceived’ defect in appearance”. [ii] Such individuals “sometimes seek inappropriate or unnecessary treatment from multiple health care providers including orthodontists (…) and are frequently dissatisfied with the results of treatment.”[iii]

In all cases, although modern methods are undeniably efficient, and retention protocols vastly better, an adult starting orthodontics must understand the level of commitment required during the planning stage, as well as for long-term maintenance. The internet and social media will show photos of smiles transformed by beautifully straightened teeth, but often not the journey that the dental team and the patient had to take to reach their final destination.

For successful orthodontics, and to establish a patient’s confidence, expectations will need to be identified and managed. Workflows are becoming increasingly digitised, with cutting-edge software available to enable virtual monitoring between practice visits, but there will also need to be plenty of good conversations too, and they must be willing to commit the time to having these discussions. The potential for age-related changes in the mouth must be understood, for example. If they have been neglecting their oral health, they will need to improve it. An adult patient is likely to have more restored teeth and exhibit signs of tooth wear. The dental team – including the dental hygienist and/or dental therapist as well as the dentist/orthodontist – will need to emphasise how to minimise the risk factors for caries, periodontal disease and gingivitis. Poor oral hygiene can compromise the success of orthodontics, so encourage them to get into good habits during the planning stage; also, they need to understand that even when their teeth are beautifully aligned, periodontal problems can still follow, if they are not cleaning properly. They may require regular visits to the dental hygienist, as well as practise elevated daily hygiene. This means they must be shown how to brush and clean interdentally, to remove debris lurking in small spaces and around their appliance. One range you could recommend is TANDEX, with different-sized brushes and interdental tools that can be used, safely and comfortably, to keep teeth and gums healthy before and during treatment, and beyond.

Successful adult orthodontics comes with more challenges for the clinical team. Expectations must be managed and, in some cases, the patient will need to understand that the ideal plan might need to be deviated from.^[iv]Modern treatments may be simpler, more ‘user-friendly’ and conservative than they were in the past, but this is also high-quality dentistry, being delivered by skilled, knowledgeable and talented professionals. To achieve the most satisfactory outcome for everyone involved, there needs to be cooperation, commitment, education and understanding.

For more information on Tandex’s range of products,
visit https://tandex.dk/ or visit the Facebook page: https://www.facebook.com/TandexUK

Products are also available from UK wholesalers CTS Dental Supplies https://www.cts-dental.com/ and DHB Oral Healthcare https://dhb.co.uk/

• Author Kimberley Lloyd- Rees on behalf of Tandex

Kimberley graduated from the University of Sheffield in 2010, where she now works as a clinical tutor in Dental Hygiene and Therapy as well as working in practice. She has spent her career working across a variety of specialist private and mixed dental practices, for the MOD and volunteering her time to a dental charity in Nepal.

[i] J T Newton & S J Cunningham (2013) Great expectations: What do patients expect and how can expectations be managed?, Journal of Orthodontics, 40:2, 112117, DOI: 10.1179/1465313312Y.0000000038 

^[ii] Anthony MT, Farella M. Body dysmorphic disorder and orthodontics ­­– an overview for clinicians. Aust Orthod J. 2014 Nov; 30(2):208-13. PMID: 25549524.

^[iii] Anthony MT, Farella M. Body dysmorphic disorder and orthodontics ­­– an overview for clinicians. Aust Orthod J. 2014 Nov; 30(2):208-13. PMID: 25549524.

^[iv] Christensen, L., Luther, F. Adults seeking orthodontic treatment: expectations, periodontal and TMD issues. Br Dent J 218, 111–117 (2015). https://doi.org/10.1038/sj.bdj.2015.46

Cloud-based practice management solutions are set to revolutionise how dental practices operate.

So, why not take the first step and embrace some cloud-based features today?

Patient Bridge from Carestream Dental has been specifically developed to introduce cloud-based userbility to existing R4+ practice management software users.

Simply by upgrading your existing set up, you can benefit from a wealth of exceptional new features, including automated marketing materials, patient surveys and more.

This way, you can enhance the patient experience instantly, helping to create a more convenient service and encouraging good reviews – the best marketing tool for any practice!

To find out more, please contact Carestream Dental today.

For more information, contact Carestream Dental on 0800 169 9692 or

visit www.carestreamdental.co.uk

For the latest news and updates, follow us on Facebook and Instagram @carestreamdental.uk

From the Straumann Group, Createch Medical provides a range of high-quality services to laboratories with or without a scanner.

Createch is at your lab’s service!

Outsourcing will save any initial outlay, if resources are limited, in order to offer your supplying dentists added value.

Services include Createch additive, allowing you to avoid other associated challenges, such as not having the in-house manufacturing services.

Createch offers fast production and predictability through this direct-to-lab milling service. There are a variety of dental framework options through the use of Selective Laser Melting (SLM) manufacturing, with a 10-year guarantee on prosthetics.

Let Createch help you do more, and achieve excellence.

Register for your account with Createch Medical at http://www.createchmedical.com/en/file-sending/login-registro/

For more information on the Createch Medical direct-to-lab milling service from the Straumann Group, visit https://www.straumann.com/gb/en/dental-professionals/products-and-solutions/implant-borne-prosthetics/products/createch-medical.html

For patients seeking discreet, aesthetic and long-lasting veneers, consider the PANAVIA^™ veneer LC resin cement as part of your dental restorative repertoire.

Now available through J&S Davis, this exceptional adhesive will revolutionise how you place your veneers. With innovative Nanocluster technology, the resin cement has the ideal consistency for a secure application, with the newly-developed spherical silica fillers preventing drifting or sagging.

The working time of 200 seconds (under ambient light and when using the Panavia^™ V5 Tooth Primer) allows you to place multiple veneers instantaneously, without having to race against time. This also offers fantastic bond strength.

If you’re looking for a restorative adhesive that offers you an array of outstanding benefits, and more, get in touch today to find out more.

For more information on the industry-leading products available from J&S Davis, visit www.js-davis.co.uk, call 01438 747 344 or email jsdsales@js-davis.co.uk

The EM-12 L stand-alone brushless electric motor, proudly delivered by W&H, provides clinicians with impressive functionality and comfort.

With an ideal balance of performance and ergonomics, the EM-12 L is small and light, yet offers consistently high power and with a varied spectrum of applications. When paired with the Synea speed increasing handpieces, for instance, the highest demands are satisfied. Clinicians can also avoid fatigue, even when working for extended periods of time.  

With integrated LED technology, the treatment site is illuminated for a more precise view. Plus, the EM-12 L is quiet with low vibration, for a smooth performance for the clinician and the patient.

For more information, get in touch with the W&H team or visit the website today.

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

As dental professionals, it’s important to ensure that patients are sufficiently educated on oral health maintenance for the prevention of diseases. But, more often than not many of you will encounter patients who lack the foundational knowledge on how to keep their oral cavity healthy.

As with most things, going back to basics is effective in making sure that patients know how to best care for their dental health. Brushing and flossing are accepted as the ideal methods for cleaning interdentally, keeping the mouth clean and free from complications, but as you well know there are areas that often get forgotten.

Out of sight, out of mind 

The posterior teeth are considered to be one of the most common areas to be missed during at-home dental care. It could be argued that this region requires more focus when brushing and flossing, as it is at a higher risk of certain complications, such as fractures and plaque formation. For instance, research has highlighted that posterior teeth have an increased susceptibility to caries, as a result of their pit and fissure occlusal landscape, arch position and eruption status.[i] It has also been suggested that the mandibular molars are the most commonly fractured teeth, due to torque forces when eating, for example.[ii] Further research has noted that posterior sites within the mouth are more prone to gingival inflammation when compared to anterior teeth,[iii]likewise noting that this is most likely due to patients’ anatomical and physiological features.

Tip of the tongue

If you ask a patient to consider where else they should focus on cleaning in the mouth, how many would say the tongue? The dorsum of the tongue has a large surface that accommodates masses of microorganisms,[iv]and the biofilm of the tongue consists of epithelial cell debris, blood cells and food debris.[v] Researchers have noted that cleaning the tongue can help to prevent oral issues such as halitosis,^iv as it aids in the removal of the bacteria that produces volatile compounds (VSCs), which are the cause of malodour.  

Studies have also noted that the tongue could host periodontal pathogens,^iv increasing the risk of the disease in patients.[vi] ‘White tongue’ is another condition whereby the papillae on the tongue become inflamed, partly due to poor oral hygiene and ineffective cleaning of the tongue.[vii]

The twilight zone

Keeping the gingiva clean is vital to prevent the development of pathologies, like periodontitis. The gingiva is highly susceptible to poor dietary and lifestyle habits, such as smoking and consuming high levels of sugary foods and drinks, which are prevalent habits among the population.[viii]^,[ix] Alongside brushing, patients should be flossing and/or interdentally brushing to remove food debris and bacteria along the gumline – according to the Oral Health Foundation, however, one in three adults have never flossed or cleaned interdentally.[x]

For dental professionals, this is a highly worrying figure, as not only can an unhealthy gingiva affect oral health, but it can also impact other areas of the body. Links have been found between periodontitis and hypertension,[xi] in addition to erectile dysfunction and certain types of cancer.[xii] [xiii]

Keeping things clean

For dental professionals, basic oral hygiene maintenance is second nature. But many patients may not have this knowledge, whether due to a lack of instruction in their earlier years, or if they have a busy lifestyle that means their dental hygiene is neglected from time to time. Ensuring patient compliance can be challenging, especially when some patients do not enjoy the sensation of interdental brushing and conventional flossing, for instance, which are two highly-important methods for removing debris and preventing disease. Many of you may hear that interdental brushing makes the patient’s gingiva bleed, or that they simply do not have the time to floss. Fortunately, there are solutions available on the market that are accessible for patients and deliver an outstanding performance, all from tried and trusted brands.

With 60 years of innovation, Waterpik^® is the world’s number 1 water flosser brand. They have developed the Waterpik^® Ultra Professional Water Flosser, which is ideal for patients who struggle with conventional interdental cleaning. This innovative model comes with seven flossing tips, ten pressure settings and a water on/off pause button in the handle. It also helps to remove up to 99% of plaque and is 50% more effective for improving gingiva health versus string floss.[xiv] [xv] With this solution, your patients can enjoy a thoroughly clean oral cavity, every day.

There are many reasons why a patient may lack the basic understanding of an effective oral health routine. This could include their background, their education level, language barriers or past experiences. Nonetheless, it’s never too late to equip them with the knowledge on how to better care for their dental health.

For more information on Waterpik^® Water Flosser products visit www.waterpik.co.uk. Waterpik^® products are available from Amazon, Costco UK, Argos, Boots, Superdrug and Tesco online and in stores across the UK and Ireland.

Join the 3,000+ dental teams who have already benefitted from a professional Waterpik^Ò Lunch & Learn. Book your free session for 1 hour of verifiable CPD and a free Waterpik^Ò Water Flosser – available either face to face or as a webinar – at www.waterpik.co.uk/professional/lunch-learn/ 

Margaret Black Bio

I have more than 40 years experience in dental practice starting as a dental nurse in an nhs practice in 1978 and qualified as a dental hygienist in 1992.

I worked for 21 years in nhs practice before becoming a clinical hygienist research assistant with the University of Dundee.

Presently I fill my time as a self employed locum hygienist  Even Brighter Hygienist  Services and presently cover 7 mainly private practices in Fife/Tayside/Perthshire and Angus.  My enthusiasm for perio has never waned, and my post as a Professional Educator for Waterpik has enabled me to share experience gained over the years with other professionals and I love meeting lovely teams in different practices and settings.

In my personal life I am married with a grown up daughter, and enjoy networking with other professionals, reading, walking our Cockapoo and ‘grandpup’ Goldendoodle and spending time with friends and family. 

[i] Dinis, M., Traynor, W., Agnello, M., Sim, M.-S., He, X., Shi, W., Lux, R. and Tran, N.C. (2022). Tooth-Specific Streptococcus mutans Distribution and Associated Microbiome. Microorganisms, [online] 10(6), p.1129. Available at: https://www.mdpi.com/2076-2607/10/6/1129/htm [Accessed 6 Jul. 2022].

[ii] Mamoun, J. and Napoletano, D. (2015). Cracked tooth diagnosis and treatment: An alternative paradigm. European Journal of Dentistry, [online] 9(2), p.293. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4439863/ [Accessed 6 Jul. 2022].

[iii] Sreenivasan, P.K. and Prasad, K.V.V. (2017). Distribution of dental plaque and gingivitis within the dental arches. Journal of International Medical Research, [online] 45(5), pp.1585–1596. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5718714/[Accessed 7 Jul. 2022].

[iv] Asakawa, M., Takeshita, T., Furuta, M., Kageyama, S., Takeuchi, K., Hata, J., Ninomiya, T. and Yamashita, Y. (2018). Tongue Microbiota and Oral Health Status in Community-Dwelling Elderly Adults. mSphere, [online] 3(4). Available at:https://journals.asm.org/doi/full/10.1128/mSphere.00332-18 [Accessed 6 Jul. 2022].

[v] Fukui, M., Asakuma, H., Horiuchi, H., Takii, H., Yoshioka, M. and Hinode, D. (2022). Oral care tablet containing kiwifruit powder affects tongue coating microbiome. Clinical and Experimental Dental Research, [online] 8(3), pp.721–728. Available at: https://onlinelibrary.wiley.com/doi/full/10.1002/cre2.591 [Accessed 6 Jul. 2022].

[vi] Faveri, M., Feres, M., Shibli, J.A., Hayacibara, R.F., Hayacibara, M.M. and de Figueiredo, L.C. (2006). Microbiota of the Dorsum of the Tongue After Plaque Accumulation: An Experimental Study in Humans. Journal of Periodontology, [online] 77(9), pp.1539–1546. Available at: https://pubmed.ncbi.nlm.nih.gov/16945032/ [Accessed 7 Jul. 2022].

[vii] www.medicalnewstoday.com. (2020). White tongue: Causes and how to get rid of it. [online] Available at: https://www.medicalnewstoday.com/articles/319814#causes [Accessed 7 Jul. 2022].

[viii] Jalayer Naderi, N., Semyari, H. and Elahinia, Z. (2015). The Impact of Smoking on Gingiva: a Histopathological Study. Iranian Journal of Pathology, [online] 10(3), pp.214–220. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4539769/ [Accessed 7 Jul. 2022].

[ix] Moreira, A.R.O., Batista, R.F.L., Ladeira, L.L.C., Thomaz, E.B.A.F., Alves, C.M.C., Saraiva, M.C., Silva, A.A.M., Brondani, M.A. and Ribeiro, C.C.C. (2020). Higher sugar intake is associated with periodontal disease in adolescents. Clinical Oral Investigations, [online] 25(3), pp.983–991. Available at: https://link.springer.com/article/10.1007/s00784-020-03387-1 [Accessed 7 Jul. 2022].

[x] Oral Health Foundation. (n.d.). Oral health statistics in the UK. [online] Available at: https://www.dentalhealth.org/oral-health-statistics[Accessed 7 Jul. 2022].

[xi] Muñoz Aguilera, E., Suvan, J., Buti, J., Czesnikiewicz-Guzik, M., Barbosa Ribeiro, A., Orlandi, M., Guzik, T.J., Hingorani, A.D., Nart, J. and D’Aiuto, F. (2019). Periodontitis is associated with hypertension: a systematic review and meta-analysis. Cardiovascular Research, 116(1), pp.28–39. doi:10.1093/cvr/cvz201.

[xii] Huang, N., Li, C., Sun, W., Yang, Y., Tang, Q. and Xiao, F. (2022). Association Between Chronic Periodontal Disease and Erectile Dysfunction: A Case–Control Study. American Journal of Men’s Health, [online] 16(2), p.155798832210847. Available at: https://journals.sagepub.com/doi/full/10.1177/15579883221084798 [Accessed 7 Jul. 2022].

[xiii] Sobocki, B.K., Basset, C.A., Bruhn-Olszewska, B., Olszewski, P., Szot, O., Kaźmierczak-Siedlecka, K., Guziak, M., Nibali, L. and Leone, A. (2022). Molecular Mechanisms Leading from Periodontal Disease to Cancer. International Journal of Molecular Sciences, [online] 23(2), p.970. Available at: https://www.mdpi.com/1422-0067/23/2/970/htm [Accessed 7 Jul. 2022].

[xiv] Waterpik UK. Waterpik Water Flosser removes 99.9% of plaque biofilm. Available online. https://www.waterpik.co.uk/professional/clinical-research/water-flosser-removes-plaque-gorur-2009/. [Accessed 11 May 2022 22]

[xv] Waterpik UK. Waterpik Water Flosser: Twice as effective as string floss. Available online. https://www.waterpik.co.uk/professional/clinical-research/dental-floss-vs-water-flossing-reduce-gingival-bleeding-rosema-2011/. Accessed 11 May 2022]