The Probe - Proudly serving the dental profession for over 60 years

BDNJ Spring 2021 – Mental health GDC Learning Outcome: A

Course Dates: 24th May 2021 - 24th May 2023
Enrollment Dates: Enroll Anytime
Who can Enroll: Anyone
Course Language: English
Price: FREE

About the Course

To appreciate why we should all be talking about mental health.

To know the oral health problems that can manifest as a result of poor mental health and related behaviours.

To understand what dental nurses can do to help patients and how.

Course Structure

Instructors

The Probe



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Facing rising fears

Course Dates: Open-ended
Enrollment Dates: Enroll Anytime
Who can Enroll:
Price: FREE

About the Course

Fear of the dentist is not a new phenomenon. In fact, some sources state that almost 20% of the UK population suffer from dental phobia – a fear that is occasionally so strong that it prevents people from visiting the dentist and receiving the care they need.[i]

However, concerning new reports have suggested that this fear is on the rise. A recent article in The Telegraph revealed that searches for questions such as “Why am I scared of the dentist?” have risen by almost 250% in the last year alone, indicating that more and more people are starting to feel anxious about visiting dental practices and what this could involve.[ii]

Why is this bad news?

Of course, this is a worrying statistic for dental professionals everywhere for a number of reasons. Firstly, it’s essential for people to seek the expert care of dental professionals in order to keep on top of their oral health, and these rising fears may put a number of people off visiting the dentist altogether, leaving them open to higher risks of tooth decay and similar oral health issues.

Secondly, we also need to think about the impact that this may have on dental practices. Fewer patients means less revenue, and after a year that has already caused considerable financial difficulty for a number of practices across the country, this could have some pretty dire consequences.

What’s causing these fears?

In order to dissect dental fear we have to look at it from a patient perspective. Arguably one of the main causes of dental phobia is the idea that a visit to the dentist will cause pain or will involve a loss of control. This often stems from a past visit that has indeed caused a person pain, or can simply be encouraged by ideas associated with the dentist and imagining that certain dental treatments will be painful.

If a patient suffers from anxiety or depression, these conditions can significantly impact their perception of visiting the dentist and exacerbate any worries they may have about receiving treatment and care. People with anxiety or depression are prone to overthinking things such as visiting the dentist, and this can quickly cause a downward spiral of possible scenarios in their minds, which results in them cancelling their appointment due to fear of the unknown.

But why are these fears increasing so much? Although there is no way to tell for certain, it is likely the prevalence of stress and mental anguish that people have suffered over the course of the pandemic is to blame. So many people have been experiencing higher levels of stress than usual, and this stress may be directly feeding into existing anxieties and worries and even creating new ones.

We also need to consider that the pandemic has made a number of people highly aware of disease transmission and the associated risks of going to public spaces such as dental practices. Although there are measures in place in practices to keep them as safe as possible, people may still be concerned about venturing outside of their homes and putting themselves at risk when travelling on public transport or heading into crowded areas.

Most fears are completely individual to the person, which can make overcoming these barriers difficult for professionals. However, what we can do is implement a number of measures that will make a visit to the dental hygienist or dental therapist as approachable as possible.

Making your services as approachable as possible

First of all, communication is vital, especially during this pandemic where people may be unsure of what safety measures are necessary for them to receive care. A smart way to keep patients informed is to email them or call them before their appointment, letting them know what they will need (face mask, etc.) and what measures are in place for their safety. This will hopefully allow them to prepare for what is in store, meaning they won’t have the fear of the unknown that so often leads to people thinking of the worst case scenarios.

Another effective measure you may want to consider is telling patients to only arrive at the practice at the time of their appointment so that they are able to receive treatment right away. For many people, the waiting time leading up to the appointment is what causes anxiety, so this option cuts the chance of fears building over time.

What about playing relaxing music in your treatment room? A number of dental fears are associated with the noises dental instruments can make, so you can overcome this by playing music for anxious patients to enjoy during treatment. In fact, Harvard Medical School has recommended that music or visual stimuli be placed in treatment rooms to help people with fears, so you can always look into these options if possible.[iii]

Hopefully, with these approaches and measures in place you can do your bit to help people overcome their concerns and receive the treatment they need. If you have any questions or concerns, you can always turn to an organisation like the British Society of Dental Hygiene and Therapy (BSDHT) who will be more than happy to help you find a solution.

 

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

 

Author:

DIANE ROCHFORD – President BSDHT –  CEB DIP DENT HYGIENE 1996, BSC (HONS) 2016 – DENTAL HYGIENIST

 

[i] Dentalphobia.co.uk. Are You Afraid Of The Dentist? Link: https://www.dentalphobia.co.uk/ [Last accessed April 21].

[ii] The Telegraph. Fear Of The Dentist is on the Rise – So Here’s How To Deal With It. Link: https://www.telegraph.co.uk/health-fitness/mind/fear-dentist-rise-deal/ [Last accessed April 21].

[iii] Harvard Medical School. Dental Fear? Our readers Suggest Coping Techniques. Link: https://www.health.harvard.edu/blog/dental-fear-our-readers-suggest-coping-techniques-20100825327 [Last accessed April 21].

Navigating litigious times

Course Dates: Open-ended
Enrollment Dates: Enroll Anytime
Who can Enroll:
Price: FREE

About the Course

Dentistry, much like other healthcare professions, comes with a certain level of risk for professionals. As society continues to become more litigious, dental professionals need to be more meticulous than ever, especially as even a minor mistake can lead to considerable trouble.

So how can professionals navigate running a successful practice during these tricky times?

Litigation in the modern day

It’s safe to say that claims against dentists are becoming more common. Just a quick Google search will reveal many legal firms that specialise in dental negligence claims, and this number is only increasing due to growing demand.

Research suggests that 90% of dentists now fear being sued, and as dental negligence claims have more than doubled in the last decade, this is understandable.[i]

The increase might be fuelled by the advent of more intensive procedures such as more dental implants being placed or simply a wider knowledge of dental negligence and people being more willing to take action. For dental professionals, it means that they have to be incredibly cautious if they want to ensure that their practice continues to operate successfully.

The dangers of legal action

Legal action against your practice comes with a number of unpleasant effects. Not only is there the chance that you will lose the case and potentially have your license revoked or, at the very least pay a large amount of financial compensation, but there is a stigma attached to legal proceedings as well. Patients are unlikely to want to keep visiting a practice that has been subject to legal action from an angry patient, and this is highly damaging for your reputation.

Litigation and the Covid-19 pandemic

Interestingly, the pandemic has been estimated to have far reaching effects. Dentists, much like other healthcare workers in the UK, offered a pillar of support for communities by continuing care throughout the majority of the pandemic thus far. Following temporary closures during the first national lockdown and re-opening with new regulations in place, the demand for dentistry was impressive. Practices faced the challenges that come with balancing increased patient demand with extra safety measures, such as fallow time between appointments.

Despite this, there are fears that dentists could be hit by a new wave of litigation, even once the pandemic has eased. As cases against dentists tend to be filed months, if not years after the treatment in question, this has inspired some locations – including certain states of the US – to provide immunity for healthcare workers against litigation regarding treatment provided in good faith during the pandemic.

In the UK, there are calls for the same protection to apply to dentists and other healthcare workers. However, at the time of writing, this has not yet become the case.[ii]

But how has the pandemic impacted litigation in general?

A study that looked at medical negligence claims provides small insight into what dentists could potentially expect in the future and why a larger number of claims could occur.

In this study, it points out that the delay or inability for patients to get access to treatment is likely to form a number of claims in the future. It also suggests that the number of claims during the pandemic has become much smaller. Whether this is because people realise the strains the healthcare industry is under or they are simply unaware of the legitimacy of making a claim during these times is unclear, but this lull in claims does suggest that there may be a peak once again when things settle down.[iii] Although we cannot know if a similar pattern will emerge in dentistry, it is possible given past trends.

As such, it’s important for professionals to evaluate all of their workflows and ensure they are protecting themselves as much as possible.

Protect yourself from litigation

To go back to basics, the best defence against legal action is to be incredibly precise with records. These are solid evidence of what treatments have been performed with patient consent – even in difficult, busy times it’s so vital to keep these up to date and ensure that everything is in order.

It’s also a good idea to address patient dissatisfaction as soon as possible – if a patient makes a complaint, find out the root of the problem and work through it together. The majority of problems can be worked out without any legal action if you are willing to take the time to put patients’ concerns to rest.

If things do escalate or you simply need legal advice, the team at lawyers4dentists are able to help. Offering award-winning advice, the team only work with dental professionals so are always up to date on all of the latest guidance and regulations that could apply to your particular case, giving you the best guidance possible.

Better safe than sorry

The pandemic has brought significant change to the dental industry, so it’s important to be prepared for all eventualities. Good record keeping is essential, but if you’re ever unsure or are facing legal action, seeking advice from experts who understand the industry is an excellent decision.

 

For more information please call 0845 345 5060 or 0754 DENTIST. Email info@4dentistsgroup.com or visit www.4dentistsgroup.com

 

Author: Richard T Lishman

Managing Director of the 4dentists Group of companies

 

[i] All Med Pro. ()% of Dentists Now feared Getting Sued. Link: https://allmedpro.co.uk/90-of-dentists-now-fear-being-sued-are-you-sufficiently-protected/ [Last accessed March 21].

[ii] Medical Solicitors. Medical Negligence Claims and the Coronavirus Pandemic. Link: https://www.medical-solicitors.com/medical-negligence-claims-and-the-coronavirus-pandemic [Last accessed March 21].

[iii] Poole,N. Coronavirus and Clinical Negligence. Sage Journal. 2020: 25 (3); 97-98.

Zygomatic Implants

Course Dates: Open-ended
Enrollment Dates: Enroll Anytime
Who can Enroll:
Price: FREE

About the Course

Dental implants are widely regarded as the gold standard for edentulous rehabilitation. However, there are anatomical factors that can prevent implant placement. Most notably, for patients who have severely resorbed, insufficient or poor-quality bone available for conventional implants in the maxilla, additional procedures such as grafts are typically required to facilitate implant anchorage.

While often highly successful, grafting procedures can be costly, time consuming and carry their own risks of complications. Major grafts inherently require at least one additional surgery, with the attendant pain, discomfort, morbidity and inconvenience that entails. The time factor can also be significant – it typically takes around six months for a graft to heal and become ready for implant placement. Typically, implant treatment with staged grafting takes 8 – 12 months to complete. During these months, wearing provisional dentures can be quite uncomfortable for patients, particularly for extended periods of time. Many patients might even avoid using their dentures temporarily during this period.

Zygomatic implants (ZI) side-step the challenges and difficulties of grafting procedures, potentially offering a more efficient treatment path with a reduced risk of morbidity.[1] Unlike many procedures requiring grafts, it is entirely possible for a prosthesis to be loaded onto the implants immediately, using the so called “same day teeth” treatment approach.

Zygomatic implants are strongly indicated for rehabilitation of the severely atrophic maxilla or replacement of failing full arch implants or grafts. These implants can also help those who have had ablative tumour surgery in the maxilla, which can leave a patient with substantial anatomical defects. Zygomatic implants have been successfully used to support an obturator and removable dentures in patients who have undergone a maxillectomy, which otherwise can be difficult to adequately secure in instances where few teeth remain.[2]

While once a comparatively under-used procedure, in recent years, zygomatic implants have become significantly more accessible, in part thanks to the development of the Zygoma Anatomy-Guided Approach (ZAGA), a technique pioneered by Carlos Aparicio.

ZAGA is a patient-centric and anatomically-guided approach. This method allows maximum fixation of a ZI strategically in three key anatomical points; the alveolar ridge, anterior wall of the maxilla and the dense zygomatic bone. Depending on the resorption pattern of the maxilla and concavity of the anterior wall of the sinus cavity, ZI can follow an intra-sinus or extra-sinus trajectory (ZAGA classification 0-4). Where possible ZI are placed using a “channel” through the lateral sinus wall to increase the bone implant contact as much as possible. The ZAGA technique advocates the use of the new Straumann ZAGA implants with reduced profiles. This preserves available bone and helps to maximise the sealing of the underlying sinus cavity.

Under this protocol, the relationship between the zygomatic buttress and the intra-oral starting point, based upon the specific anatomy of the patient, determines the trajectory of the implant through the sinus wall. For some patients, this means the implant will be in a completely intra-sinus position (ZAGA tunnel technique), but for the vast majority it is placed either extra-sinus or in the wall of the maxilla (ZAGA channel technique). Anatomically-guided, ZAGA classifications (0-4) help oral surgeons in selecting the ideal entrance points for drilling. This helps to maximise bone anchorage and enhances sinus cavity “sealing” which has seen a reduction in long-term complications compared to earlier approaches.[3], [4]

As with other advanced surgical procedures, training and experience make a substantial difference to patient outcomes. Zygomatic implants present some unique challenges compared to conventional implants. There is considerable anatomical variation in zygoma bone between patients.1 Due to this variation, the angled approach required, the proximity to sensitive structures and other challenges, 3D scanning and treatment planning are particularly advantageous for zygomatic procedures. 3D treatment planning and computer guided implant surgery have a huge role to play in further increasing the safety and efficiency with which these procedures can be caried out by oral surgeons or dentists of all experience levels. For example, 3D models can now be printed, giving surgeons an opportunity to practice on a replica of their patient’s precise anatomy prior to surgery. International ZAGA Centres provide a network of highly qualified oral surgeons who share their experience and collaborate with each other in research and advancement of ZI techniques for the rehabilitation of fully edentulous patients with advanced bone atrophy.

If you are dealing with a complex or urgent case, such as a patient with a severely atrophic maxilla, consider referring your patient to the Centre for Oral-Maxillofacial and Dental Implant Reconstruction, a ZAGA centre based in Manchester. Led by Professor Cemal Ucer – Specialist Oral Surgeon – the clinic offers the latest patient-centric treatments and technologies. Putting the patient first is at the heart of everything we do. The team are well-versed in complex procedures, including block grafting, vertical GBR, 3D  customised allografts and, of course, zygomatic dental implants, allowing us to find the right solution for your patient’s specific needs. The experienced and friendly team will put your patient at ease, while keeping them safe with strict adherence to hygiene and safety protocols.

While zygomatic implants have numerous advantages, they can be an intimidating treatment modality, as by definition they require deeper penetration into the patient’s bone tissue than conventional dental implant procedures. However, with astute diagnosis, case selection and planning, zygomatic implants can actually be a more reliable and expedient oral rehabilitation path in certain instances. Dental implants are very much not a one-size fits all proposition. Ultimately, the best possible results and highest satisfaction can be achieved by drawing on clinical experience to provide tailored, patient-centric treatment to suit each individual patients different anatomical, functional and aesthetic needs.

 

Please contact Professor Ucer at ice@ucer.uk or Mel Hay at mel@mdic.co

01612 371842

 

 

[1] Ramezanzade S., Yates J., Tuminelli F., Keyhan S., Yousefi P., Lopez-Lopez J. Zygomatic implants placed in atrophic maxilla: an overview of current systematic reviews and meta-analysis. Maxillofacial Plastic and Reconstructive Surgery. 2021; 43(1): 1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7788139/ March 31, 2021.

[2] Sender B., Lacroix T., Jaby P., Chaux-Bodard A. Are zygomatic implants a simple and reliable technique for the stabilization of obturator prostheses? Case report and review of the literature. Journal of Oral Medicine and Oral Surgery. 2020; 26(2): 12. https://doi.org/10.1051/mbcb/2020002 April 1, 2021.

[3] Aparicio C. The zygoma anatomy-guided approach: ZAGA—a patient-specific therapy concept for the rehabilitation of the atrophic maxilla. In: Chow J. (eds) Zygomatic Implants. Springer, Cham. 2020. https://doi.org/10.1007/978-3-030-29264-5_5 April 1, 2021.

[4] Davó R., Bankauskas S., Laurincikas R., Koçyigit I., de Val J. Clinical performance of zygomatic implants—retrospective multicenter study. Journal of Clinical Medicine. 2020; 9(2): 480. https://doi.org/10.3390/jcm9020480 April 1, 2021.