Month: March 2023

We’re part of the action!

For over 60 years, the British Association of Dental Therapists (BADT) has acted as a mouthpiece for professionals across the UK.

So, why not join in on the action?

If you’re a dental therapist or dental hygienist who is passionate about what you do, wants to have your voice heard and wants to connect with like-minded individuals, the BADT is the choice for you.

With an excellent array of membership benefits and a true, family feel, the BADT offers everyone the support, guidance and skills they need to succeed.

To find out more, please get in touch with the team today.

 

For more details, please visit www.badt.org.uk

Free patient leaflets with your ADI membership

There are many benefits to becoming a member of the Association of Dental Implantology (ADI). We want to ensure that our membership helps you not only in your career, but gives you the resources you need to support your patients.

Just one of our benefits is 50 free ADI patient information leaflets, ‘Considering Dental Implants?’. We’ve compiled commercially unbiased information to ensure patients receive the most up-to-date information regarding dental implants and potential treatment pathways.

This 12-page booklet contains information on each stage of the treatment, frequently asked questions, mythbusters, aftercare and alternative solutions. For patients who are unsure, or who would just like some additional information before they start their dental implant journey, this resource is great to have in your dental practice or to hand-out during appointments.

To find out more, get in touch with the team or visit the website today.

 

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

Discover the Straumann Group at DTS

Discover all that the Straumann Group has to offer at the Dental Technology Showcase (DTS) this May.

The Straumann Group provides a wide range of market-leading implant, digital, and orthodontic solutions which aim to transform the workflows of every dental team. Our portfolio includes innovative prosthetic solutions from Createch Medical and Medentika®, as well as intuitive digital software to improve your planning and designing workflows. 

 

Come along to DTS 2023 and see how we can improve your workflows on the 12th and 13th May at the NEC Birmingham.

For more information on the Straumann Group, visit https://www.straumann.co.uk

BSPD welcomes publication of ‘Oral Health Psychology’ textbook

The British Society of Paediatric Dentistry (BSPD) welcomes the insights and recommendations outlined in a new book called ‘Oral Health Psychology’. The book is an international collaboration between dentists and psychologists who draw on scientific research as well as their personal experiences in clinical practice. Published by Springer in November 2022, this academic and practical textbook has been written by a team from Norway and The Netherlands with contributions from Paediatric Dentists and Psychologists from the University of Sheffield.

‘Oral Health Psychology’ describes a patient-cantered approach to communication, preventive dentistry, dental anxiety and dental care in a range of patient groups. Chapters of particular interest to Paediatric Dentists include:

  • Positive Encounters for Children to Prevent Dental Anxiety – Theory and Practice written by Helen Rodd, Anne Rønneberg, Therese Varvin Fredriksen, Ingrid Berg Johnsen and Zoe Marshman
  • Family Violence and Child Maltreatment written by Anne Rønneberg, Jenny Harris, Therese Varvin Fredriksen and Tiril Willumsen
  • The Psychosocial Impacts of Orofacial Features: With Examples from Orthognathic Surgery written by Paula Frid, Sarah R. Baker and Jan-Are Kolset Johnsen

The book covers modern theories on a patient-centered approach to communication, preventive dentistry, dental anxiety and oro-facial disfigurement. It provides guidance on the implementation of a trauma-sensitive approach. There is attention given to the effective delivery of preventive care and dental treatment for fearful and abused children. Further chapters address topics as varied as managing blood-injury-injection phobia, dealing with a severe gag reflex, dental professionalism and practitioner burnout.

Sarah Baker, Professor of Psychology as Applied to Dentistry, University of Sheffield said “We look at the importance of psychology to the maintenance and promotion of good oral health – as well as the role oral health plays in overall health using a biopsychosocial approach. It has been inspiring to work with the teams from Oslo and Amsterdam who brought their multi-disciplinary approach to bear. There is consensus that a person-centred focus on oral health can impact positively on quality of life. Our research explored the psychosocial impacts of conditions affecting oro-facial appearance, and the role psychologists can play in patient care.”

Zoe Marshman, Professor in Dental Public Health, University of Sheffield said: “Together with our colleagues from Norway, Professor Helen Rodd, who provided clinical insights as a Consultant Paediatric Dentist, and I explored the significance of making a child’s visit to the dentist a positive experience. Anxiety is a key barrier to children attending the dentist. Dental anxiety (DA) is extremely common in children, with a 2020 systematic review reporting a global pooled prevalence of around 24%[1]. This is a phenomenon that many practicing Paediatric Dentists will recognise.  So, we are glad that our contribution can provide insights and tips to make dentist appointments for children a positive experience.”

Dr Jenny Harris, President, BSPD and Consultant Community Paediatric Dentist at Sheffield Teaching Hospitals NHS Trust, said: “Dental teams have a duty of care to provide a safe place for children to feel that they can ask questions and speak up when they need help or feel scared. Our chapter focuses on recognising and responding to maltreatment or family violence so we can give our patients, both children and adults, adequate help and support. We provide tools to support students of dentistry as well as experienced dental professionals.  BSPD believes that Oral Health Psychology is an excellent educational resource and will help readers to solve challenges in their own clinical settings.”

Reference:

[1] Grisolia BM, Dos Santos APP, Dhyppolito IM, et al. Prevalence of dental anxiety in children and adolescents globally: A system- atic review with meta-analyses. Int J Paediatr Dent. 2021;31:168– 83. https://doi.org/10.1111/ipd.12712.

 

Perio Master Clinics bring periodontal education to three continents in a year

Perio Master Clinic conferences are about to become a more global affair with three editions in three continents being organised in less than a year. Perio Master Clinic, the brand created by the EFP (European Federation of Periodontology) in 2014 for providing career-boosting training to dental clinicians on the best periodontal techniques, is about to take place in Europe, the Americas, and Asia.

Dental practitioners from all around the world can take part in Perio Master Clinic 2023 in Antwerp, Belgium in March, in International Perio Master Clinic 2023 in León, Mexico next May, and in International Perio Master Clinic 2024 in Singapore in January 2024. In principle, Perio Master Clinic is a triennial conference held in Europe with the global leading speakers, followed by a non-European updated edition the following year with some additional local experts. The coming series of three iterations in a row is due to calendar changes caused by the Covid-19 pandemic.
Bringing Perio Master Clinic conferences to three different continents in such a short period illustrates the global scope currently reached by the EFP, which brings together 37 national scientific societies of periodontology and implant dentistry not only from Europe but from six continents.

Monique Danser

The philosophy of Perio Master Clinic is based on a distinctive practical, hands-on approach to improve the skills and understanding of dental clinicians, be they experienced or relatively newly qualified. It aims to deliver teaching on the latest and most advanced techniques in key practical areas of gums-related dentistry. That is why, unlike EFP’s EuroPerio congresses, each Perio Master Clinic conference focuses on a specific topic.

‘Perio-ortho synergy’ is the topic chosen for Perio Master Clinic 2023 in Antwerp, Belgium on 3-4 March, which will be led by chair Peter Garmyn and scientific chair Virginie Monnet-Corti. The conference will focus on how patients with periodontitis can be treated to improve aesthetic and functional outcomes by taking a combined periodontal and orthodontic treatment approach. This is the first time that the common ground between periodontology and orthodontics is systematically addressed in an international major conference.

Led by conference chair Álex García and scientific chair Anton Sculean, International Perio Master Clinic 2023 will be held on 5-6 May in León, Mexico, marking the first time that this EFP conference has ventured to the Americas. The topic will be ‘Hard- and soft-tissue aesthetic reconstructions around teeth and dental implants – current and future challenges’, with an outstanding faculty including leading international speakers, including some from the US and Latin America. Registration is possible at the EFP’s website.

Finally, International Perio Master Clinic 2024 will take place in Singapore on 19-20 January, 2024 and will address the perio-ortho synergy just as Perio Master Clinic 2023. Featuring Philip Preshaw as conference chair, Jonathan Phua as co-chair, and Virginie Monnet-Corti as scientific chair, International Perio Master Clinic 2024 will bring the brand to Asia for the second time, following the success of International Perio Master Clinic 2019 in Hong Kong.

“We are particularly proud of the global impact that our Perio Master Clinic conference brand is making among the dental clinicians around the world, and we see the organisation of these major events in Europe, Latin America, and Asia as a natural consequence of the worldwide scope of EFP’s projects and publications,” sums up Monique Danser, member of the organising committee of all three conferences and EFP treasurer. “The interests, challenges, and knowledge of dental practitioners are quite similar everywhere, and so is our determination to upskill and improve their technique at the dental practice, so they can offer the best possible treatment to their patients and periodontal health can make everyone’s life better.”

Returning teeth to their former glory

Everyday life presents many opportunities for accidents to occur. From tripping over your children’s toys to banging your head on an open cupboard, many of us can attest to sustaining some form of personally-inflicted injury from time to time. You’ll likely have encountered many patients who have sustained a dental injury in a similar way. In light of this, it’s important to utilise products that offer the best performance to help restore patients’ teeth to their former glory.

Watch your step

Traumatic dental injuries (TDIs) are often associated with sports or car accidents, violence and occupational incidents. iv [i] TDIs are considered a serious issue in the dentition of children and young adolescents,[ii] who often sustain trauma through falls either at home or at school. Older individuals are also more likely to sustain a dental injury through falls.[iii]

Dental trauma encompasses injuries sustained to the soft and hard tissues of the mouth, such as the teeth and the periodontium.[iv] Such injuries can include luxation, categorised depending on the severity of displacement: concussion, subluxation, extrusive, lateral and intrusive.[v] Luxation injuries are thought to be more common in primary dentition, while crown fractures are often reported in permanent dentition.[vi]Fractures can likewise vary in severity, depending on whether the pulp has been exposed. [vii] Uncomplicated crown fractures include enamel fractures and enamel-dentine fractures, which don’t expose the pulp. More complicated versions include enamel-dentine fractures that do expose the pulp; however, research demonstrates that unless a luxation injury has also been sustained, pulp sensibility tests are usually positive.[viii] In certain situations where the pulp has been exposed, more extensive treatment may be indicated.

TDIs can be sudden and unexpected, and will likely affect the person’s quality of life. While aesthetic concerns may be the initial worry for patients, functional issues can cause complications with mastication and speech.[ix] For patients who delay treatment, whether due to time/financial constraints, a lack of knowledge or dental anxiety, there may be an increased risk of complications within the damaged dentition.[x] This can include pulp necrosis, crown discolouration, root and bone resorption and an infection of the root canal.[xi] In certain situations, seemingly uncomplicated crown fractures can also lead to difficulties, resulting from delayed treatment.ix

Treating the issue

Accidents that cause TDIs can happen at any time, to anyone. Even someone who initially presents with good oral hygiene can suddenly be burdened with additional dental work and care. It’s vital that individuals who sustain a TDI seek dental care as soon as possible. In cases where a non-complicated fracture has occurred, with no involvement of the pulp, treatment can be relatively straightforward with function and aesthetics swiftly restored. In many cases, the fractured piece of tooth can be reattached, which has been recommended by the International Association of Dental Traumatology as the best method for restoring uncomplicated crown fractures in permanent teeth. vii  This is, no doubt, preferred by clinicians and patients alike, as the natural tooth can be restored quickly. However, possible complications could include fragment debonding, colour disparity and incomplete fragment rehydration.[xii]

Alternatively, a composite resin restoration can be placed where reattaching the fragment is not viable. Modern dentistry provides ample restorative solutions that help clinicians achieve outstanding aesthetic and functional results that are natural and long-lasting. When delivering a direct restoration, factors such as colour, translucency, opalescence, shape and surface texture must be taken into account.xi Composite, for example, has become a popular material of choice, due to its longevity, relatively low cost and being easy to repair and replace over time.[xiii] As opposed to direct restorations, research highlights that direct composite restorations have few endodontic complications, and facilitate patient satisfaction/comfort as they can be placed in a single appointment.[xiv] Furthermore, a study found that restorative and biological failures were detected more frequently in teeth restored with a reattached fragment, compare to a direct composite restoration.[xv]

A trustworthy product

 For a simple, easy to use material for direct restorations, the Filtek Universal Restorative from 3M Oral Care should be your product of choice. This solution utilises nanotechnology and fluorescent pigments to deliver a beautifully aesthetic outcome,* with eight designer shades that cover 100% of VITA shades.* Unique features include its high strength, which is suitable for use in stress bearing areas,* and the proprietary low stress monomers help to reduce shrinkage stress.* Filtek Universal Restorative from 3M Oral Care was selected as a top award winner in the 2022 Dental Advisor awards, in the Composite: Universal category!

TDIs can be highly unpleasant experience for patients of all ages, but thankfully, treating them can be straightforward with the right tools, materials and techniques at hand.

For more information, call 0800 626 578 or visit www.3M.co.uk/Dental

3M and Filtek are trademarks of the 3M Company.

*3M Internal data

**Dental Advisor awards 2022: https://www.dentaladvisor.com/evaluations/3m-filtek-universal-restorative/

[i] Kallel, I., Douki, N., Amaidi, S. and Ben Amor, F. (2020). The Incidence of Complications of Dental Trauma and Associated Factors: A Retrospective Study. International Journal of Dentistry, [online] 2020, pp.1–8. Available at: https://www.hindawi.com/journals/ijd/2020/2968174/ [Accessed 17 Nov. 2022].

[ii] Sogi, S., Patidar, D., Patidar, D.C. and Malhotra, A. (2021). Traumatic Dental Injuries in Pediatric Patients: A Retrospective Analysis. International Journal of Clinical Pediatric Dentistry, [online] 14(4), pp.506–511. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8585915/#:~:text=Generally%2C%20children%20are%20likely%20to,to%2014%20years%20of%20age.&text=Accidental%20falls%2C%20road%20traffic%20accidents,dental%20injuries%20in%20children%20worldwide. [Accessed 18 Nov. 2022].

[iii] Patel, J., Wallace, J., Doshi, M., Gadanya, M., Ben Yahya, I., Roseman, J. and Srisilapanan, P. (2021). Oral health for healthy ageing. The Lancet Healthy Longevity, [online] 2(8), pp.e521–e527. Available at: https://www.sciencedirect.com/science/article/pii/S2666756821001422#bib13 [Accessed 17 Nov. 2022].

[iv] Antipovienė, A., Narbutaitė, J. and Virtanen, J.I. (2021). Traumatic Dental Injuries, Treatment and Complications in Children and Adolescents: A Register-Based Study. European Journal of Dentistry. [online] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8382465/#:~:text=Dental%20traumas%20are%20injuries%20to,bodily%20injuries%20among%20preschool%20children. [Accessed 16 Nov. 2022].

[v] Goswami, M., Rahman, B. and Singh, S. (2020). Outcomes of luxation injuries to primary teeth-a systematic review. Journal of Oral Biology and Craniofacial Research, [online] 10(2), pp.227–232. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7254462/#:~:text=Luxation%20injuries%20can%20be%20classified,%2C%20extrusion%2C%20intrusion%20and%20avulsion.&text=Avulsion%20or%20ex%2Darticulation%20of,knocked%20out%20of%20the%20socket. [Accessed 16 Nov. 2022].

[vi] Levin, L., Day, P.F., Hicks, L., O’Connell, A., Fouad, A.F., Bourguignon, C. and Abbott, P.V. (2020). International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: General introduction. Dental Traumatology. [online] Available at: https://onlinelibrary.wiley.com/doi/full/10.1111/edt.12574 [Accessed 16 Nov. 2022].

[vii] Mordini, L., Lee, P., Lazaro, R., Biagi, R. and Giannetti, L. (2021b). Sport and Dental Traumatology: Surgical Solutions and Prevention. Dentistry Journal, [online] 9(3), p.33. Available at: https://www.mdpi.com/2304-6767/9/3/33/htm [Accessed 17 Nov. 2022].

[viii] Bourguignon, C., Cohenca, N., Lauridsen, E., Therese Flores, M., O’Connell, A., Day, P., Tsilingaridis, G., Abbott, P.V., Fouad, A.F., Hicks, L., Ove Andreasen, J., Cehreli, Z.C., Harlamb, S., Kahler, B., Oginni, A., Semper, M. and Levin, L. (2020). International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 1. Fractures and luxations. Dental Traumatology. [online] Available at: https://onlinelibrary.wiley.com/doi/full/10.1111/edt.12578 [Accessed 17 Nov. 2022].

[ix] Mahmoodi, B., Rahimi-Nedjat, R., Weusmann, J., Azaripour, A., Walter, C. and Willershausen, B. (2015). Traumatic dental injuries in a university hospital: a four-year retrospective study. BMC Oral Health, [online] 15(1). Available at: https://bmcoralhealth.biomedcentral.com/articles/10.1186/s12903-015-0124-5 [Accessed 17 Nov. 2022].

[x] Chaudhary, S., Singh, H., Gharti, A. and Adhikari, B. (2021). Evaluation of Clinical and Radiographic Findings among Patients with Traumatic Dental Injuries Seeking Delayed Treatment. International Journal of Dentistry, [online] 2021, p.9549508. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8405333/ [Accessed 17 Nov. 2022].

[xi] Lam, R. (2016). Epidemiology and outcomes of traumatic dental injuries: a review of the literature. Australian Dental Journal, [online] 61, pp.4–20. Available at: https://onlinelibrary.wiley.com/doi/10.1111/adj.12395 [Accessed 17 Nov. 2022].

[xii] Lise, D., Vieira, L.C., Araújo, É. and Lopes, G. (2012). Tooth Fragment Reattachment: The Natural Restoration. Operative Dentistry, [online] 37(6), pp.584–590. Available at: https://meridian.allenpress.com/operative-dentistry/article/37/6/584/190603/Tooth-Fragment-Reattachment-The-Natural [Accessed 18 Nov. 2022].

[xiii] Vural, U.K., Kiremitçi, A. and Gökalp, S. (2017). Clinical Performance and Epidemiologic Aspects of Fractured Anterior Teeth Restored with a Composite Resin: A Two-Year Clinical Study. Journal of Prosthodontics, [online] 28(1), pp.e204–e209. Available at: https://onlinelibrary.wiley.com/doi/abs/10.1111/jopr.12645  [Accessed 18 Nov. 2022].

[xiv] Apponi, R., Murri dello Diago, A., Colombini, V. and Melis, G. (2021). Direct versus Indirect Techniques to Menage Uncomplicated Crown Fractures of Anterior Teeth Following Dentoalveolar Trauma. Dentistry Journal, [online] 9(2), p.13. Available at: https://www.mdpi.com/2304-6767/9/2/13/htm [Accessed 18 Nov. 2022].

[xv] Haupt, F., Meyerdiercks, C., Kanzow, P. and Wiegand, A. (2022). Survival analysis of fragment reattachments and direct composite restorations in permanent teeth after dental traumatic injuries. Dental Traumatology: Official Publication of International Association for Dental Traumatology. [online] Available at: https://pubmed.ncbi.nlm.nih.gov/36116107/  [Accessed 18 Nov. 2022].

 

The benefits of Reverse Osmosis (RO) water in your dental practice

Water is a vital component of various protocols within the dental practice. Practices use water during dental treatment, pre-sterilisation cleaning of instruments, and many sterilisation systems, such as autoclaves, also require water for operation. As such, having RO water is vital to keep your equipment in good condition, minimise unit breakdowns and reduce the risks of pathogens spreading.

Dental unit water lines and infection risk

Dental unit water lines (DUWLs) are a network of plastic tubing, valves and connectors that are prime environments for the formation of microbial biofilm. This sticky substance is an amalgamation of microorganisms such as bacteria, fungi and viruses,[i] which have adhered to interior surfaces of the DUWLs. This contamination could originate not only from the mains water, should it be piped into the dental unit, but also the draw-back of patients’ saliva – thus, more than water-borne microorganisms can present in DUWLs, including ones from the oral cavity, too.i

Biofilm formation can occur due to the type of tubing that’s used in DUWLs, namely long, small-diameter tubing that provides ample conditions for adhesion.[ii] Additionally, periods of stagnation and low water flow can also promote microbial growth.i Despite the adherence of biofilm to the interior surfaces of the DUWLs, microbes can still travel within the water flow – in fact, high microbial levels have been discovered in the water used in handpieces and air/water syringes.ii Aerosol and splatter are thus potential sources of infection during dental treatment.

The risk of Legionella pneumophila, a bacterium that can cause severe pneumonia, is also of concern. There have been numerous reports of patients succumbing to Legionnaires’ disease, and while research on the risks to dental staff is differential, one casualty has been reported as a result of this disease – Legionella was detected in the dental unit water system in their practice.[iii] According to HTM01-05 guidance, ‘at-risk systems, particularly those used with the patient, must be drained at least at the end of each working day’.[iv] Most dental chairs utilise reservoir bottled-water systems, which require regular disinfection in order to minimise the risks of infection. Purified water, such as distilled or reverse osmosis (RO) with ultra-violet (UV) treatment can be used to both fill and flush self-contained water bottles. HTM01-05 guidance states that with either of these options, the build-up of biofilm is likely to be low (as long as regular disinfection and maintenance are carried out).iii


Protecting systems from hard water

Water quality can also impact systems within the dental practice that utilise water, such as an autoclave. Hard water, which is thought to affect around 60% of the UK,[v] contains high levels of dissolved calcium and magnesium.[vi] Dental practices in hard water areas may experience calcium carbonate build-up (limescale) in their medical equipment, especially autoclaves. This can quickly lead to blocked/broken pipes and inefficient heating, compromising the sterilisation process and incurring potentially expensive repair costs. HTM01-05 guidelines advise that either distilled or RO water be used in an autoclave, as opposed to tap water, so which should you use?

During the use of distillation processes, impurities and minerals are removed from the water through boiling. The water is heated in a chamber until it evaporates into steam, which is then chilled and turned back into pure water droplets. Any contaminants are left behind in the chamber. In the RO process, water is filtered through a semi-permeable membrane that removes impurities, salt, bacteria, and organic materials. While both methods are able to produce pure water, distillers do require high levels of energy, heat and electricity, so they may not always be the most cost-effective option. In contrast, RO systems are much more economical and can produce a larger quantity of water compared to a conventional water distiller. Also, some RO systems utilise ultra-violet technology (UV) to provide further protection against pathogens.

Protect patients with pure water

The Reverse Osmosis (RO) System from Eschmann enables clinicians to have a reliable supply of RO water for use in practice. Suitable for connection to all mains cold water supplies and with WRAS complaint backflow protection, the RO system is ideal for use in autoclaves, DUWLs and for cleaning instruments. The compact size means it can fit discreetly and neatly into any available cupboard space. Plus, the RO system filters out minerals, totally dissolved solids (TDSs) and eliminates bacteria and microorganisms from the water supply, with the addition of UV technology for added protection. This way, it guarantees water that is safe for use throughout your whole practice.   

Purified water is an essential resource in dental practices, and a vital component of your infection control protocols. With safe, clean water, you’re guaranteed the peace of mind that your sterilisation systems remain in good condition and the risks of waterborne infections are reduced. 

For more information on the highly effective and affordable range of infection control products from Eschmann, please visit www.eschmann.co.uk or call 01903 875787

[i] Spagnolo, A.M., Sartini, M. and Cristina, M.L. (2020). Microbial Contamination of Dental Unit Waterlines and Potential Risk of Infection: A Narrative Review. Pathogens, [online] 9(8). Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7460066/ [Accessed 7 Nov. 2022].

[ii] Tuvo, B., Totaro, M., Cristina, M.L., Spagnolo, A.M., Di Cave, D., Profeti, S., Baggiani, A., Privitera, G. and Casini, B. (2020). Prevention and Control of Legionella and Pseudomonas spp. Colonization in Dental Units. Pathogens, [online] 9(4), p.305. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7238104/ [Accessed 8 Nov. 2022].

[iii] Petti, S. and Vitali, M. (2017). Occupational risk forLegionellainfection among dental healthcare workers: meta-analysis in occupational epidemiology. BMJ Open, [online] 7(7), p.e015374. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5734417/#R4 [Accessed 9 Nov. 2022].

[iv] www.england.nhs.uk. (n.d.). NHS England» (HTM 01-05) Decontamination in primary care dental practices. [online] Available at: https://www.england.nhs.uk/publication/decontamination-in-primary-care-dental-practices-htm-01-05/ [Accessed 8 Nov. 2022].

[v] www.scaleguard.co.uk. (n.d.). Water Hardness Areas in the UK. [online] Available at: https://www.scaleguard.co.uk/hard-water-areas.html#:~:text=Around%2060%25%20of%20the%20UK [Accessed 8 Nov. 2022].

[vi] Sengupta, P. (2013). Potential health impacts of hard water. International journal of preventive medicine, [online] 4(8), pp.866–75. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3775162/ [Accessed 8 Nov. 2022].