DT UK 2009

Postcode lottery / News / News & Opinions / A smooth transaction / Don’t wait - act now / Saving for school / Tax-planning checklist / Perio Tribune / Leadership essentials for the ‘rookie’ / Setting yourself free / The 10th Dimension… the power of 10 / In this economy - customer service matters more than ever! / Help where it’s due? / Infection control guidance / Industry News / The children of Musoma / Classified

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Table of contents

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DTUK2009_01_Title

DENTAL TRIBUNE
The World’s Dental Newspaper · United Kingdom Edition
PUBLISHED IN LONDON
News in brief

AUGUST 7–13, 2009
News

VOL. 3 NO. 20

Money matters

Perio trib

Practice management

Agency death

Amalgam U-turn
The American drugs watchdog, the Food and Drug Administration has reversed its decision to warn against pregnant
women and children having
mercury fillings.
It now claims that following a
review of around 200 scientific
studies the levels released by
dental amalgam fillings ‘are
not high enough to cause harm
in patients’.

www.dental-tribune.co.uk

Perio disease

Anger management

Researchers in Bristol have invented a Chewing Robot to study
the wear and tear on dental fittings such as crowns.

Due diligence is a time-consuming subject, says Hewi Ma of Cohen Cramer solicitors, but what
does it mean exactly?

Effective periodontal treatment
in practice involves a series of
stages says Fiona Clarke in Perio
Tribune.

Anger wells up within us whenever we perceive that we have
been wronged, so how do we deal
with it?

page8

page9

page15

page27

Postcode lottery

look at the situation very carefully and try to improve it.’

further increases in both child
and adult dental registrations in
the last quarter, which indicate
that the measures we have
taken to improve access are
working.

cotland has seen a rise in the
number of NHS dental patients, but they are still very
much at the mercy of a postcode
lottery.
The percentage of patients
registered with an NHS dentist
ranges from 41.5 per cent in
Grampian to 78 per cent in
Greater Glasgow and Clyde.
Throughout Scotland, the number of registrations has increased.
By the end of March more
than 3.3m people in Scotland had
an NHS dentist, up from 2.9m a
year ago.
Health boards are also making improvements with the number of children on the books of
NHS dentists.
However six health boards
have still to meet a national tar-

get to register 80 per cent of three
to five-year-olds by 2010-11.
Below the target were Western Isles (51.4 per cent), Orkney
(62.1 per cent), Borders (68.4 per
cent), Grampian (69 per cent),
Fife (75.6 per cent) and Highland
(76.9 per cent).
This compares to 94.2 per
cent registered in NHS Greater
Glasgow and Clyde.
Dr Richard Simpson MSP,
Labour health spokesman,
said the figures showed that an
action plan set out by the previous Scottish Executive to increase the intake of dental students and improve NHS access
was beginning to have an effect.

Liberal Democrat health
spokesman Ross Finnie said it
showed the ‘embedded inequalities’ in NHS dental provision
throughout the country.
He said: ‘This postcode lottery must be addressed. The
Scottish government must work
harder to ensure that the increase in registration with NHS
dentists benefits the whole
country.’
Public Health Minister
Shona Robison said: ‘I am
pleased that there have been

DENTSPLY Procedures

While I recognise one of the
factors behind this increase will
be the extension of the registration period, there are other factors, such as the record number
of dentists in Scotland offering
NHS services.
Having said that, we know
there are still problems with access to an NHS dentist in certain
parts of Scotland and we are continuing to tackle this.’ DT

Indirect Restorations

Staff at a dentist's surgery in
Wigan returned to the 1970s
and donned afro wigs, platform boots and flowery shirts
to raise money for the health
charity Dentaid.
Dentists, dental nurses and a
hygienist at Pemberton Dental
Practice in Pemberton, raised
more than £250 for the charity,
which provides much needed
dental and oral health care in
the developing world.
Dr Phil Barton, from Pemberton Dental Practice, said: ‘It
was a great day. All the staff and
patients had a wonderful time.
The patients loved it too.’

Smooth transaction

S
Y
D
PL
TS CE N uk
N TI OU .co.
DE AC P tsply
n
E R
N P N .de
O E LIO ww
N
O IL a t w
M ore
E
N ut m
O nd o

Charity fundraiser

Chewing robot

Cross Infection Control
Rotary Endodontics
Anterior Restorations
Posterior Restorations
Periodontal Treatment

He said: ‘Things are improving. But the health boards that
are far below the targets need to

Forced resignation

dentist who had a nineyear affair with his dental
nurse, forced her to resign
from the practice when his wife
found out, an employment tribunal was told.
Tariq Drabu, 44, was said to
have lavished gifts, including a
diamond ring, on Paula Jackson
and rented a flat.
The 45-year-old was then
forced to resign from the practice in Middleton, Manchester,
when his wife Suraya found
out.
She said Dr Drabu had offered
her £100,000 if she left the practice and dumped her husband.
Mrs Jackson claimed that Dr
Drabu had told her she could
have anything she wanted and

eventually he would leave his
wife.
Mrs Jackson, who had started
at the practice as a trainee dental
nurse, had during the nine-year
affair, become practice manager
at Langley Dental Group.

Gain

verifiable

DENTSPLY Rotary Endodontic Team
Embrace Endodontic Success

She claimed she was ‘bullied’
into quitting her job and sued for
constructive dismissal, which Mr
Drabu admitted.

Due to her unique shape, she cuts quickly ensuring efficiency, whilst
maintaining flexibility whether you are heading straight or into a curve.
She doesn’t mind how experienced you are, whether you are a GDP who
hasn’t used her before or an endodontist, she’s high quality and easy to
work with, ensuring excellent and consistent results every time.

The amount of compensation
will be fixed later.
Dr Drabu has been suspended
by the General Dental Council
from working for four months.
It found his conduct was unprofessional, inappropriate and
not in the best interests of patients. DT

CPD

with our sales
specialists

Mrs ProTaper Universal lies at the centre of most successful
Endodontic procedures in the UK*.

She’s a true exception – let her be at the centre of your
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* ProTaper Universal is the market leader with 56.6% market share (Q1, 09 SDM data)

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+44 (0)800 072 3313
UKP00203

A dental insurance company is
searching for the family of a
dentist in Cheshire who died in
the arms of a call girl.
An insurance policy held by
David Hillary, from Alderley
Edge, has produced a payout of
about £5,000 for his next of kin.
However Dentists’ Provident
have been unable to find any of
his relatives - and the lump
sum remains unpaid.
Mr Hillary, 53, lived with his father, Jack, at a dental surgery
in Trafford Road, where he had
practised for nearly 20 years.
His father died from lung cancer just 10 days before Mr
Hillary was found dead.
An inquest into the dentist's
death found he had been out
drinking with a friend before
calling the Select escort
agency in Sale.
He then drank more alcohol
and took morphine with the escort until they fell asleep together on his sofa.
When the escort awoke in the
early hours of the next morning, she could not wake him up.
Cheshire coroner Nicholas
Rheinberg said that Mr Hillary
died from a combination of ‘alcohol and opiate toxicity’ - the
combined levels of alcohol and
drugs in his blood. He recorded
a verdict of accidental death.
Anyone who can help trace Mr
Hillary's next of kin is asked to
call Dentists' Provident on 020
7222 2511.

enquiry.uk@dentsply.com

w
y co.uk www
ww.dentsply.co
y m
www.dentsply.

[2] =>

DTUK2009_01_Title

DENTAL TRIBUNE United Kingdom Edition · August 7–13, 2009

News

Raising money for charity Cosmetic treatment

wo dentists played alongside ex-international rugby
player and Strictly Come
Dancing star Kenny Logan, in a
game which raised £25,000 for
charity. Dr Norman Bloom, who
has a private dental practice in the
West End of London, was joined by
his associate dentist, Shane
Roiser, who played professionally
for the London Wasps rugby team
for eight years.

The two dentists played in
the London Wasps Legends
team with Come Dancing star
Kenny Logan against Hartlepool
district where they raised
£25,000 for the Hartlepool and
District Hospice, which provides palliative care and bereavement support.
In another match, the London
Wasps Legends team won 41-7

against a combined channel island team in Guernsey.
Dr Bloom said: ‘We won 41-7
alongside ex-internationals Kenny
Logan, Andy Reed, Rob Lozowski,
Mark Denny and Jonny Ufton captained by ex-Wasps captain Mark
Rigby. We also raised over £5,000
for the Wooden Spoon society
which raises money for children’s
charities.’ DT

International Imprint
Executive Vice President
Marketing & Sales

The World’s Dental Newspaper · United Kingdom Edition

Published by Dental Tribune UK Ltd
© 2009, Dental Tribune UK Ltd. All rights reserved.
Dental Tribune UK Ltd makes every effort to report clinical
information and manufacturer’s product news accurately, but
cannot assume responsibility for the validity of product claims,
or for typographical errors. The publishers also do not assume
responsibility for product names or claims, or statements made
by advertisers. Opinions expressed by authors are their own and
may not reflect those of Dental Tribune International.

Chairman
Torsten Oemus
t.oemus@dental-tribune.com

Director
Noam Tamir
Noam@dentaltribuneuk.com

Managing Director
Mash Seriki
Mash@dentaltribuneuk.com

Advertising Director
Joe Aspis
Tel.: 020 7400 8969
Joe@dentaltribuneuk.com

Editor
Lisa Townshend
Tel.: 0207 4008979
Lisa@dentaltribuneuk.com
Clinical Editor
Prof Dr Liviu Steier
lsteier@gmail.com

Not just the
patient in
pain?

Mr Eubank has travelled to
Ireland to have the work carried
out by dentist Barry Buckley.
The work includes closing
the gap between his two front
teeth to improve the aesthetic nature of his smile.
Mr Eubank said: ‘I’m here to
see the best dentist in Ireland and
the UK. Before long nobody will

Peter Witteczek
p.witteczek@dental-tribune.com

DENTAL TRIBUNE

he former world champion boxer, Chris Eubank
is spending £30,000 on
cosmetic dental treatment - and
is hoping it will get rid of his
trademark lisp.

Marketing Manager
Laura McKenzie
Laura@dentaltribuneuk.com

Dental Tribune UK Ltd
4th Floor, Treasure House
19–21 Hatton Garden
London, EC1N 8BA

Verifiable
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Let’s face it, after a day in surgery,
who wants an aching back, neck
and shoulders. It doesn’t stop
there either. Pain can stop you
working. It is also the most
common cause of premature
retirement amongst practising
dental professionals.

4 Handed Dentistry
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• Taught by qualified medical
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Ease the pain of
dentistry in just
one day
Go to www.happybacks.co.uk
or call 01672 541 293 or email
richpilkington@hotmail.com

Back care courses for Dental Professionals

be able to accuse me of having a
lisp.’
Dr Buckley is carrying out the
work at Clane Hospital, Co Kildare, which will also see all his
other teeth slightly lengthened.
Dr Buckley said: ‘We’re getting rid of the gap between his
front teeth, adding length to the
teeth and widening his smile
slightly.
The main purpose of the work
is to make his teeth look better.
They are not a bad set of teeth but
they are a little bit worse for wear
because of his career.’ DT

Call for funding

HS dentists in England are
calling for extra funding to
help them implement the
decontamination guidance issued
by the Department of Health.
Dentists at the recent Local
Dental Committees’ (LDC) annual
conference voiced their concerns
over the extra time, extra staff and
extra equipment needed to implement HTM 01-05.
The Department of Health produced the guidance in response to
emerging evidence around the effectiveness of decontamination in
primary care dental practices and
the possibility of prion transmission through protein contamination of dental instruments.
The guidance for dentists in
England was published online in
April.
All NHS dentists have 12
months to implement HTM 01-05,
from when they receive the hard
copy of the guidance, which should
be with all dentists over the next
couple of months.
Dentists in Wales will also adopt
01-05 with a few modifications of
the terminology. But Scotland has
decided not to follow the guidance.
Lesley Derry, head of education
and standards at the British Dentists Association (BDA), who spoke
at the LDC conference said: ‘At the
moment, Scotland has just cleaning
protocols in place and this may be
less arduous but I don’t think Scotland is getting much of an easier
time.’
Under their guidance, all dentists in Scotland have to have a Local Decontamination Unit in place
by the end of the year. They are being given grants of around £20,000
to help them do this.
However a Scottish dentist at
the conference revealed that there
are currently 55 dental practices in
Glasgow facing closure as they are
unable to comply with this as they
do not have the space.
Jason Stokes from Norfolk LDC
called for the government to offer

dentists in England similar financial help.
‘The Department of Health
needs to offer funding to primary
care trusts (PCTs) to help dentists
implement 01-05. If it wants to see
more patient safety, we want to see
extra funding,’ he said.
While Vijay Sudra of Birmingham LDC claimed that the guidance will create ‘chaos’ and leave
dentists with a ‘logistical nightmare’.
Under the guidance, all dentists
will have to have an overarching infection control policy. So if a dentist
gets a new piece of equipment, he
or she will have to show how it will
be cleaned.
All practices will have to have a
rota in place detailing how all the
areas in the dental practices are
cleaned.
The guidance also stipulates
that single use instruments are
used wherever possible.
When cleaning instruments
and equipment, manual cleaning is
still acceptable according to the
guidelines but automated and validated processes need to be used
where possible.
Ms Derry said: ‘These are national guidelines but PCTs will be
able to adapt them as they see suitable.’
HTM 01-05 gives the Care
Quality Commission, the new regulatory organisation for healthcare, the right to inspect all practices and to see if they attain the two
standards of essential and best
practice.
By 2010, all dental practices in
the UK, both NHS and private, will
have to register with the Care Quality Commission and will be regulated by this body.
The full guidance can be accessed online at http://www.
dh.gov.uk/en/Publicationsandstatistics/Publications/P
ublicationsPolicyAndGuidance/DH_089245 DT

[3] =>

DTUK2009_01_Title

DENTAL TRIBUNE United Kingdom Edition · August 7–13, 2009

Underground
cinema

dentist is hoping to build
an underground cinema
under the garden of his
home in Lincolnshire.
Morne Gerber, who works as
a clinical director of Advanced
Dental in Market Rasen, also
wants to build an underground
tunnel that connects the current
patio outside his home to the
soundproof cinema.
The plans for his home in
Washingborough also includes
the construction of an open air
swimming pool.
Architect Mark Henderson
said in the plans: ‘Although it is
large the house is compartmentalised by small rooms which the
owner feels limits his aspirations
for a 21st century lifestyle.’
Other plans for the listed
building include the construction of a greenhouse and alterations to an outbuilding to create
a pool annex. DT

Dental
powder
mistake

olice have been left redfaced after they claimed to
find a stash of 13 kilos of cocaine with a street value of
£500,000 in Devon, only to discover after tests it was dental
powder.
Police said it was the largest
seizure of a class ‘A’ drug in Devon and Cornwall and arrested
five people on suspicion of possession with intent to supply.
However tests then revealed
the cocaine was actually benzocaine – a mild local anaesthetic
used by dentists to numb gums.
A police spokesman has revealed that no further action will
be taken following the raid on the
Prince Regent pub in Tiverton.
Police uncovered the stash of
white powder following a longrunning investigation into a
money-laundering operation in
Devon.
Around 13 kilos of white powder, which they believed to be cocaine, was found after officers
raided the Prince Regent pub, in
Lowman Green, Tiverton, and an
adjoining garage where they
found the powder in a holdall.
Police searched nine further
properties following the raid. DT

News

Rise in mouth cancer

upsetting to see a rising number of
younger women being affected.

Oral cancer has traditionally affected women over 70, but I am now
treating more women in their 40s.’

here has been a huge rise
in the number of young
women suffering with
mouth cancer in Merseyside,
according to doctors. In
Merseyside, there are now
twice as many people developing mouth cancer as the national average.

Professor Simon Rogers,
based at Fazakerley hospital, re-

vealed that he is now treating
women in their 40s rather than
the traditional over-70 age
range.
He is urging people to tell
their dentist or GP about any persistent soreness, lumps or ulcers.
He said: ‘I see the devastation
oral cancer causes people in our
communities and it is particularly

He blames the rise in cases on
the changing lifestyles and habits
of women who have been smoking and drinking more heavily
over recent years.
Researchers at the hospital
and Liverpool University are de-

veloping genetic techniques to
select better treatments, increase survival chances and reduce side effects.
He also believes that people
in Merseyside have a lack of
awareness of the symptoms of
oral cancer.
This delay in self-referral is
leading to around 40 per cent of
patients only going for help when
they have an advanced form of
cancer, he said. DT

[4] =>

DTUK2009_01_Title

DENTAL TRIBUNE United Kingdom Edition · August 7–13, 2009

News & Opinions

Xylitol sweetener prevents decay

he British Dental Health
Foundation has welcomed
research that shows the
non-artificial sweetener, Xylitol,
helps prevent decay in baby
teeth.
The non-artificial sweetener,
which acts as an anti-bacterial
agent against cavities is already
widely used as a ‘safe’ sweetener

in chewing gums and lozenges
for children with permanent
teeth.

vided into three doses and the final group given one single
smaller 2.67 gram dose.

Researchers at the University
of Washington, Seattle, split 94
babies aged nine to 15 months
into three groups – one receiving
eight grams of xylitol syrup divided into two daily doses, a second given the eight grams di-

After an average 10-month
wait until oral examinations, toddlers receiving higher syrup
doses showed significantly less
signs of early decay, according to
July’s Archives of Pediatrics and
Adolescent Medicine report.

Foundation chief executive Dr
Nigel Carter said: ‘These studies
could prove to be an invaluable
aid in preventing early years tooth
decay which is a key marker for
future oral health. The later children develop their first cavities,
the better their lifetime oral
health will be, so an easily-administered preventive regime would
be a fantastic development.

There is some evidence that
early-years caries is on the increase, particularly in less deprived
areas of the UK. Around half of UK
children under the age of five show
signs of decay even though caries is
easily preventable.’
He also called for parents to reduce their children’s intake of sugary snacks and drinks and to ensure
they brush their teeth twice daily
with fluoride toothpaste, at 1,000
parts-per-million up to age three,
and 1,350 ppm thereafter.
Lead researcher in the study,
Peter Milgrom, has concluded that
xylitol syrup could be a cost-effective anti-cavity measure in populations of high tooth decay and said:
‘Poor oral health affects diet and
nutrition and significantly diminishes quality of life. However, tooth
decay is a disease that is largely preventable. These results provide evidence for the first time (to our
knowledge) that xylitol is effective
for the prevention of decay in primary teeth of toddlers.’ DT

PracticeWorks

Practice Management Software
and Digital Imaging Systems
We have over 70,000 software installations worldwide to prove it. We also developed the ﬁrst
intraoral sensor, “RVG”, which started the digital radiography revolution.

Dental
surgery
reopens

And when you buy a PracticeWorks product you also buy great support. Our trainers,
engineers and help desk staff are always on hand to ensure you get the most from our
products and services

Our team at PracticeWorks are recognised for their expertise in dental technology, from
installation through to support and maintenance, whether it’s the most advanced practice
management software or the most innovative digital imaging systems.

dental surgery in Gloucestershire, which has lain
empty for nearly two
years, has opened its doors once
again to NHS patients.

So not only do you get the very best service at all times, you also get peace of mind from
knowing that your satisfaction is our top priority.

The Springbank dental practice in Springbank, shares facilities with a GP surgery, and is
staffed by one dentist and one hygienist.
NHS Gloucestershire is planning to open five more dental surgeries in the county at a cost of
£6m.

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The practice will be open for
two days a week and will offer
routine NHS dental care to between 800 and 1,200 patients.
Jan Stubbings, chief executive of NHS Gloucestershire,
said: ‘This is another important
development for primary care
services in the Springbank area
and for NHS dentistry in Gloucestershire.

The very best products, expertise, support and service
brought to you on a plate
For more information or to place an order please call 0800 169 9692
or visit www.practiceworks.co.uk

PracticeWorks

We know that access to NHS
dentistry is important and we will
continue to invest funds in expanding provision for patients.’
Councillor John Morris (LD,
Springbank called it ‘really positive news’ and said: ‘I'm delighted we are getting a dentist's
surgery.
It’s been a long time coming
but people who live in the area
will be very pleased.
We’ve now got a doctor’s surgery, a chemist and a dentist all in
the same building which is a terrific resource. We want to make
sure people make full use of it.’ DT

[5] =>

DTUK2009_01_Title

DENTAL TRIBUNE United Kingdom Edition · August 7–13, 2009

Swine flu guidance
D

ental Protection, the professional indemnity body,
has been receiving a
large volume of calls asking for
advice about what to do about the
spread of swine flu.
In response, it has issued a paper highlighting the indemnity
and risk management aspects of
pandemic influenza, including a
section on frequently asked
questions with some of the recurring questions that its dento-legal advisers are being asked.
A spokesman for the company
said: ‘Dental Protection has had
experience of advising and assisting its members in similar situations in other parts of the world,

such as members in Hong Kong
and Singapore who were badly affected by the SARS outbreak and
the C5N1 avian flu epidemic.
This experience heightens
our awareness of the kind of issues and risks that need to be
considered.’
Dental Protection warns that it
is up to dental professionals to act
responsibly and said it is in the
public interest that everyone
should play their part in limiting
the spread of pandemic influenza.
Guidance includes:
Taking every reasonable step
to maintain your own health and
that of those around you.
It is irresponsible to continue
treating patients when you have
reason to believe that you may be
infectious; this may apply to your
professional colleagues as well
as to yourself.
In such situations you should
monitor your own health (including your temperature), take
medical advice when necessary
and appropriate, and act upon
this advice.
It is equally irresponsible to
expect or require your employees to attend the workplace and
come into contact with colleagues and patients when you
have reason to believe that they
may be infectious.
The temptation may be greatest when you are already shortstaffed, but it must be resisted,
warns Dental Protection.
On the other hand, those
healthcare professionals that are
fit and well can make a valuable
contribution by covering for colleagues who are unwell and unable to work.

Those who are in positions of
responsibility and leadership –
including practice owners, and
those with management responsibilities in all branches of dentistry – should plan in advance for
a range of possible scenarios so
that they know how they would
deal with many of the likely contingencies.

This will make it easier to
make good decisions under pressure at a later stage. There are
also legal considerations for
practice owners and employers,
according to Dental Protection.
Employers have a duty,
amongst other things, to maintain a safe workplace, and to

News & Opinions
make adequate provision for the
health, safety and welfare of their
employees.
They also have a legal obligation to provide staff members
with appropriate Personal Protective Equipment (PPE).
Team members should wear
good quality, well fitting masks
and adequate surgery ventilation
and high volume suction will all
help to minimise the risks inherent in the dental environment.

The General Dental Council requires all registered dental health professionals to
maintain adequate and appropriate professional indemnity at all times, and Dental
Protection recommends all its
members to ensure that those
with whom they work (regularly or in exceptional circumstances) do have such indemnity.
For more information, go to
www.dentalprotection.org DT

[6] =>

DTUK2009_01_Title

DENTAL TRIBUNE United Kingdom Edition · August 7–13, 2009

News & Opinions

Tooth decay caused by multiple medicines

he British Dental Health
Foundation claims many
oral problems are being
caused by people taking multiple
medicines.
Scientists are blaming multiple medications for the growing problem of dry mouth syndrome which can lead to tooth
decay.

Foundation chief executive
Dr Nigel Carter said: ‘Dry
mouth affects our saliva levels
which can expose the teeth to
risks of tooth decay, since saliva
is a natural protection against
caries.
With advances in healthcare,
more and more medicines have
hit the market. As more people

take multiple medicines, the risk
of oral health problems such as
xerostomia has greatly increased, especially amongst
older people.

A good oral health routine
and regular trips to the dentist, as
often as the dentist recommends,
will help look after your mouth
and quality of life.’

Dry mouth increases exposure to the main causes of tooth
loss, decay, erosion and gum disease, yet these problems are entirely preventable.

Dry mouth can also be caused
by medical conditions such as diabetes and lupus, or natural factors such as ageing and
menopausal changes.

There are a wide range of
products designed for dry mouth
which can help prevent any problems preventing risks of decay
and minimising other attendant
issues, such as a lack of saliva affecting swallowing.
Products such as gels and
sprays can help moisture levels
in the mouth, while it is important to brush teeth twice a day
with a fluoride toothpaste to prevent decay.
Avoiding sugary foods and citrus acids will minimise risks of
dental decay and erosion.
Though sucking sweets and
chewing gum can help stimulate
the flow of saliva and counteract
dry mouth, it is vital to use sugarfree products.

The Clearstep System

Those with more severe cases
may even choose to sleep with a
de-humidifier in the room and
practice breathing through the
nose rather than the mouth.
Alcohol, caffeine and salty
foods are on the banned list in cases
of dry mouth, while sufferers
should drink plenty of water. DT

Comprehensive invisible orthodontics made easy
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orthodontic system, able to treat patients as young as 7.
It is based around 5 key elements, including
expansion,space closure/creation, alignment, final
detailing and extra treatment options such as functional
jaw correction.
GDP friendly, with our with our Diagnostic Faculty
providing full specialist diagnostic input and treatment
planning, no orthodontic experience is necessary. As
your complete orthodontic toolbox, Clearstep empowers
the General Practitioner to step into the world of
orthodontics and benefit not only their patients, but
their practice too.

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14th July
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1st - 3rd December
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info@clearstep.co.uk
www.clearstep.co.uk

Yorkshire
carries out
fluoride
study

orkshire and Humber
Strategic Health Authority
is to carry out a feasibility
study into whether fluoride
should be added to drinking water in a drive to improve oral
health in the region.
The health authority is carrying out the study on behalf of the
whole region but at the specific
request of primary care trusts in
Bradford and Airedale and
Kirklees.
NHS Bradford and Airedale
Trust believe it would bring benefits for the people, as it will optimise exposure to fluoride and reduce tooth decay.
The trust runs a fluoride varnish scheme for children, which
it wants to expand.
Chief executive of NHS
Bradford and Airedale, Simon
Morritt said discussions with
Yorkshire Water had revealed it
was not possible to contain water fluoridation to just West
Yorkshire.
Because of this, he has asked
the health authority to carry out a
feasibility study for the entire
Yorkshire region.
It is expected to be completed
by April 2010. DT

[7] =>

DTUK2009_01_Title

DENTAL TRIBUNE United Kingdom Edition · August 7–13, 2009

News & Opinions

GDC ‘an outward-looking regulator’

he General Dental Council
is an ‘outward-looking
regulator with a real focus
on customer service’, according
to the watchdog for healthcare
regulators.
The Council for Healthcare
Regulatory Excellence (CHRE),
in its review of the GDC, also
found the council had a clear
commitment to continuous improvement, and a willingness to
innovate.
Among other initiatives, the
GDC has demonstrated ‘excellence and good practice’ by encouraging dental patients to expect better standards through a
process of educating and empowering them, said the CHRE.
The report by the watchdog
said ‘we are impressed with the
GDC’s approach and would encourage others to consider
such a customer-focused strategy’.

Gold
medal
award
Anthony Power, who recently
completed his undergraduate
dental programme at King's College London Dental Institute, has
won the 2009 University of London
BDS Gold Medal. This is the eighth
year in succession that a graduate
of King's has been awarded this
highly prestigious prize.
The medal is awarded to the
candidate who most distinguishes
him or herself in the final Bachelor
of Dental Surgery exams. Both
London dental schools are invited
to nominate candidates for the gold
medal examination - an oral conducted by six external examiners.
Each school selects candidates
from students with the highest
number of merits and distinctions.
Anthony, who is undertaking
his vocational training in the
coastal resort of Minehead with the
South West Deanery, said: 'It was
both with pride and trepidation
that I attended the viva for the Gold
Medal on graduation morning. To
be told at the graduation ceremony
later that day that I had received the
award was an unexpected delight,
not to mention a great honour.
'I am very grateful to have
studied at King's for the past 5
years, since the teaching and facilities were wonderful on the
whole, and the memories I have
will always be cherished. I hope
that I can return one day, perhaps
as an SHO, to some familiar
friendly faces.'
He will receive the medal,
with a cheque for £500, at the Institute's annual prize giving in
November. DT

It also praised ‘excellent’ initiatives such as measures to inform
stakeholders, increasing public
involvement, and boosting customer service, by using mystery
shopping and customer surveys.
GDC chief executive and registrar Duncan Rudkin said: ‘We
welcome the rigour and scrutiny
of the review and the opportunity

for us to show that we’re accountable. But we’re not complacent.
We are keen to do all we can to
stay focused on continual improvement.’
The CHRE said it would follow
‘with interest’ the GDC’s progress
on revalidation, appraising and
assessing fitness to practise panellists, a new ‘risk-based’ ap-

proach to education and training,
and how it measures and manages its own performance.

process and the CHRE welcomed
the GDC’s stated intent to share
the learning from its pilot with
other regulators.

It commended the GDC’s new
continuous improvement team
and the new role of head of customer service.

The GDC is currently undertaking a major review of its
Fitness to Practise work, including a comprehensive and
challenging review of how the
function is managed and governed.

The GDC will be the first regulator to pilot its revalidation

A strategic review is also
planned. DT

[8] =>

DTUK2009_01_Title

News & Opinions

DENTAL TRIBUNE United Kingdom Edition · August 7–13, 2009

Chewing robot to test crowns and bridges

esearchers in Bristol have
invented a Chewing Robot
to study the wear and tear
on dental fittings such as crowns
and bridges.

Summer Science Exhibition, the
premier annual showcase for scientific excellence in the UK.

The UK spends around
£2.5bn each year on dental materials to replace or strengthen
teeth.

from well-known metals, polymers and ceramics but their dental wear properties are often
poorly understood. Clinical trials examining the
wear of human teeth are
expensive and timeconsuming and by the
time a new material has
been tested, it is often
obsolete.

Researchers at the University
of Bristol’s department of mechanical engineering in collaboration with the Department of
Oral and Dental Science have developed the Chewing Robot to
test dental materials.

This is why researchers came up with
the Chewing Robot
which replicates the
movements and forces
involved in chewing.

The inspired invention was
shown to the public for the first
time at this year's Royal Society

The robot is based on
a three-dimensional mechanism
with six linear actuators that re-

Dental fittings, such as
crowns and bridges, are made

produce the motion and forces
sustained by teeth within a human mouth.

Chewing Robot concept based on
just such a platform.

A human jaw is a powerful
and complex piece of natural machinery, allowing a person to
chew in many different ways.

The design and development
of the chewing robot was carried
out by Daniel Raabe, a PhD student
in the department of mechanical
engineering at Bristol University.

The lower jaw and the teeth
move with six degrees of freedom, translating and rotating
along each of the Cartesian axes.

The robot has the potential to
dramatically
improve
the
process of developing and testing
new dental materials.

Dr Kazem Alemzadeh, senior
lecturer in the department of mechanical engineering recognised that the Stewart-Gough
platforms have been used to provide and control the same six degrees of freedom in aircraft simulators, and so he proposed the

Daniel Raabe said: ‘By reproducing natural bite forces and
movements, the chewing robot
can help improve and accelerate
the process of developing new
dental restorative materials that
may someday be found in a person’s mouth.’ DT

Fill in your CPD hours online Good oral healthcare

ll dental professionals registered with the General
Dental Council will be able
to fill in their annual continuing
professional development hours
online from August.
Around 47,000 dental care
professionals need to provide an
annual declaration of continuing
professional development (CPD)
hours this summer – and a new
section of the eGDC website will
be able to help.

ter with instructions on how they
can log on to the eGDC website
and fill in their annual CPD hours
electronically.
A spokesman for the GDC said:
‘Although we’re encouraging professionals to submit their hours
online, alternatively they can submit a return form which will be
sent out with the letter this August.
A special telephone helpline
and email advice service will go

record CPD hours over their fiveyear cycle at the click of a mouse.
If they have previously submitted paper forms, they will be
able to edit and add hours from
their current five-year cycle online.
Once they’ve entered their
hours for this year, the site will
tell them how many hours they
have left to do.
Registrants need to keep
hold of their certificates as
proof of carrying out verifiable CPD.

This is important as the
GDC carries out audits at the
end of each five-year cycle.

The Journal of Dental Research found that bacteria in our
mouths could play a direct part in
causing obesity.

The deadline for professionals to submit their hours
is the end of September.

All dental care professionals
who registered with the General
Dental Council (GDC) before 30
July 2008 and paid the annual retention fee by 31 July this year
will receive - along with their Annual Practicing Certificate - a let-

live in August to help with any
questions registrants may have
in filling out their paper forms or
hours online.’
The new online facility will
allow professionals to track and

combats obesity

GDC registration development manager, Sarah
Arnold, said: ‘As well as submitting your CPD returns,
you can also check and update your contact details that
appear on the register, pay
your annual retention fee by
credit or debit card, set up a
direct debit and access your
annual practising certificate.’
Dental care professionals
who registered with the GDC on
or after 31 July won’t have to fill
in a return form until August
2010. DT

ood oral healthcare could
hold the key to combating
obesity, according to new
dental research.

The study was carried out on
five hundred women, three hundred of whom were clinically
obese.
This found that out of forty
kinds of bacteria tested, one
species - selenomonas noxia was present at levels of more than
one per cent of total bacteria in 98
per cent of the overweight group.
This bacteria has previously
been linked with the development of gum disease.
Further research will now explore the importance of these infectionary agents as indicators of
and potential causes of obesity.

Foundation chief executive
Dr Nigel Carter said: ‘Though
this information represents very
early stages of research, it is another fascinating example of the
potential overall health links related to our oral health.
It is uncertain whether people may become obese due to
changes in the bacteria in their
mouths or whether these
changes occur as a result of
obesity. What impact changing
the bacterial make up may have
on helping to reduce obesity is
certainly worth additional research.
There are hundreds of bacteria in our mouths at any one time,
contributing to the most common dental hygiene issue - gum
disease.
Alongside posing risks of
causing tooth loss if left
unchecked, gum disease has
been linked to heart disease, diabetes and premature births.’ DT

[9] =>

DTUK2009_01_Title

DENTAL TRIBUNE United Kingdom Edition · August 7–13, 2009

Money Matters

A smooth transaction
Due diligence is a time-consuming subject,
says Hewi Ma of Cohen Cramer solicitors,
who explains what it actually means and
how it affects you when you’re buying or
selling a practice

ue diligence is invariably
the most time-consuming stage of a dental practice sale or purchase and one of
the most crucial. “Due diligence”
means the raising by the buyer’s
solicitors of enquiries about the
practice and the premises. The

‘Due diligence
means the raising by the buyer’s
solicitors of enquiries about the
practice and
premises.’

buyer’s solicitors send out enquiries at the initial stages of a
transaction. The enquiries not
only ask for written replies, but
also the provision of substantial
amounts of documentation from
a seller. The replies and documents are scrutinised by the
Buyer’s solicitors, which then
lead to the raising of further enquiries and requests for further
documentation.

Don’t be fooled
The Credit Crunch has affected everyone including solicitors. When the bottom fell
out of the property market,
some commercial property solicitors attempted to move into
dental work, but do not be
fooled! A low quote for selling
your practice may seem like a
bargain, but if it sounds too
good to be true – it usually is. A
solicitor with no experience in
dealing with dental practices
may quickly find themselves
out of their depth, with fees spiralling out of control and a
deeply unsatisfied client.
A solicitor with a well-established background in dental
practice sales and acquisitions
should be familiar with how a
practice works and will know
the right questions to ask. They
should ask you if you are NHS,
private or a member of a capitation scheme. They will ask if
you have any associates, what
type of NHS contract you hold –
GDS or PDS. If they are asking
you the right questions, they
should also ask the right questions of a seller (if instructed by
a buyer) and will be able to understand and deal with questions raised by a buyer (if acting
for a seller).

I have acted for many a Seller
who tackles these enquiries with
great gusto and fervour providing prompt replies and a wellcompiled bundle of due diligence
documents, which expedites the
transaction to exchange and
completion.

When you receive the enquiries from your solicitor, my
top tip is to hand it to your practice manager. There will, in most
cases, be two parts to the enquiries; property and business.

At the opposite end of the
scale is the Seller who sends
through replies and supporting
documents in dribs and drabs
and whose replies are incomplete and inadequate. This can
mean delay, more work and more
expense for a Seller.

Commercial Property Standard Enquiries (or CPSEs) ask for
information about the property.
The vast majority of solicitors for
any commercial-property transaction use them. Replies should
be sent to you in draft for you to
approve and add to if you have

Enquiries for the seller

any further comments before
being sent to a
Buyer’s solicitors.

Dent
al Pr
actic
e

Business enquiries are a completely
different kettle of fish! At present,
there are no standard enquiries
relating to a Dental Practice’s
business. Our firm and a handful
of others (all members of the Association of Specialist Providers
to Dentists) have an agreed form
of enquiries. This is useful as we
know what to expect of one another and the enquiries can be
sent to you as soon as a transaction commences although “standard” enquiries are often supplemented by bespoke enquiries
relevant to that particular transaction.
Most business enquiries are
relatively straightforward although in many cases they are
numerous and do take time to
deal with properly.

Providing an inventory
One thing you are guaranteed
to be asked for is an inventory of
all items included and excluded
from the practice. The aim is to be
thorough but not pedantic. Generally, the main items of equipment are detailed, for example,
name, model and serial number,
then furniture, computers and
fixtures and fittings, a process
similar to when you are selling a
house. You will not be expected to
list things classed as stock or
such sundry items like a mop and
bucket as in one case I dealt with.
The inventory you prepare
will be appended to the Business
Transfer Agreement, so it is important that you are happy with it.
In addition, be sure to detail the
items at the practice, which are
not included in the sale, as you

wouldn’t
want to surrender
that rather expensive intraoral camera you have just purchased.

If your practice works under
an NHS contract, you will also be
expected to provide up to date
UDA figures and a whole copy of
the NHS contract itself – not just
the signature pages and schedules. NHS contracts do vary and it
is important that your solicitor
has sight of this. If your Practice
runs a capitation scheme you
may be asked to provide at least
six months’ written reports.

‘If you’re selling
your practice,
questions relating to staff form a
large part of any
due diligence
enquiries.’
Enquires relating to staff
form a large part of any due diligence enquires. Under TUPE
regulations, the transfer of the
staff goes hand in hand with the
transfer of the business. You may
be required to provide copies of
the signed contracts of employment, GDC registration certificates and vaccination records for
clinical staff and attendance
records.

the inventory you
must advise your solicitor. Replacement of missing equipment
will be a painfully costly lesson.
Asking a seller to disclose
their accounts for the last three
financial years is crucial and you
should always seek the advice of
your accountant. Due care
should also be taken when inspecting the number of UDAs
achieved as you wouldn’t want
the PCT demanding a clawback
as a result of the seller underperforming prior to completion.

Conclusion
Due diligence is one of the
most crucial and fundamental
parts of any sale or purchase of a
dental practice. For the seller, a
speedy and satisfactory response to the enquiries goes a
long way to expediting a sale. As
for the buyer – you should always
instruct a solicitor who knows
the right questions to ask and
who will persevere until appropriate replies and supporting
documentation have been provided. DT

About the author

An inability to provide full and
accurate replies to these enquiries may at most endanger a
sale and at the least, it will cause
a significant delay.

Enquiries for a buyer
Your part is easy. Instruct
“dentally aware” solicitors and
sit back, let them do the hard
work. Your solicitor should report back to you upon the seller’s
documentation.
You will be provided with an
inventory and you must ensure
that it gives a true representation
of what you believe is included in
the purchase. If you noted a nice,
new autoclave when you visited
and this doesn’t appear to be on

Hewi Ma joined
Cohen Cramer
in 1999 and is a key member of the
dental team working on dental
practice sale and acquisition
transactions. Her particular area
of expertise lies in dealing with enquiries before the exchange of
contracts, producing practice acquisition reports on purchases
and disclosure bundles for sales.
To contact Cohen Cramer Solicitors, call 0113 2440597, email
dental.team@cohencramer.co.uk
or visit www.cohencramer.co.uk.

[10] =>

DTUK2009_01_Title

DENTAL TRIBUNE United Kingdom Edition · August 7–13, 2009

10 Money Matters

Don’t wait, act now
Without financial planning, you might not end up with the retirement package you
had imagined, says Suzanne Allen who offers some advice

n the current climate many
dentists are wondering if they
will ever be able to retire from
dentistry. Like them, you may
have spent your working life
building your practice to provide
wealth for you and your family,

making good profits, yet they still
worry about their finances because they have little or no real
understanding of their true personal financial position. Their
fears are often not rational and
without foundation, but how are

Husband
£

Wife
£

Joint Income
£

26,500
18,000
1,500
4,953
8,000
58,593

2,600
1,500
4,953
8,000
17,053

26,500
18,000
2,600
3,000
9,906
16,000
75,646

9,000
4,000
13,000

18,000
8,000
26,000

Total Gross Income

71,593

30,053

101,646

Less Tax/NI

13,367

1,513

14,880

Taxable Income
NHS Pension
SIPP – Income Drawdown
Annuity
Bank Interest
State Pension (from age 65)
Practice Rent
Tax-free Income
Managed Portfolio (CGT)
ISA Income

Total Net Annual Income

58,226

Outgoings
Housekeeping Expenses
Personal Expenses (incl. holidays)
Children / Grandchildren
Motoring Expenses
Life Assurance / Insurance
Investments
Total Outflows
Net Annual Income Less Outgoings

but are you confident that a lifetime’s effort will be translated
into your desired post-practice
lifestyle? There is so much to
consider now: has the impact of
the global recession decimated
your private pensions and ISAs?
Is there still the same value in
practice goodwill? Are there any
potential buyers still around?
Some dentists may be in control of their practice and according to their accountants, may be

28,540

86,766

20,150
26,000
7,000
10,900
5,250
6,000
_____
75,300
11,466

they to know? It’s rather like being passenger in a fast car, you
are almost certainly safe, but
there’s still this degree of uncertainty and it’s only the driver who
feels totally in control.
The way to lose that financial
fear is to become the driver and
take control. When considering
your impending retirement,
bring in specialists who can
make the process easier and take
away the worry and pressure –

they become your financial sat
nav system; they won’t drive the
car for you, but they will guide
you to your destination. A practice valuer will provide an up-todate valuation of the practice and
help make it fit for sale. The accountant will advise on the tax
implications of selling and the
tax reliefs available. Financial
planners will pull together all the
assets and develop a cohesive
long-term retirement strategy.
This latter specialist ultimately
puts you back in control of your finances by taking you through a 3stage process.

1. Information gathering
and analysis
This is a fact-finding mission
whereby all your financial information is pulled together and
your vision for retirement is
identified. A net worth statement
of all your assets is drawn up. It is
quite surprising how much you
could be worth! The following
table illustrates the asset chart of
a 59-year old dentist who aims to
cease work by his sixtieth birthday.

2. Assimilating
the Information
Dentists have different retirement requirements. Some can’t
wait to sell up, some are happy to
sell their goodwill yet maintain
the property to provide an excellent rental stream, while others
cannot let go and still want to
keep their hand in. There is no
prescriptive formula, which is
why a financial adviser is vital to
show you the level of retirement
income you can expect from all
sources, and how it matches up
with your spending needs during
retirement.
The second stage therefore is
to pull all these income streams
together and illustrate where you
would be in retirement. It’s surprising how many sources can

make up your income: the NHS
pension, state pension, private
pensions, ISAs, cash accounts,
the practice’s sale proceeds, the
practice property rental, etc.

3. Creating the solution:
Having identified the assets
and income sources, the most
suitable and tax efficient means
of securing the income is determined. The following is illustrative of the planning adopted by
our 59-year old dentist.

vides a comfortable surplus for
any contingencies, and those extra little luxuries!
This dentist was delighted
that he could restructure his investments so that his income
would cover his anticipated ongoing expenditure and in future,
he and his wife will only be paying a composite rate of tax of less
than 15 per cent of their gross income!

Take control
Having chosen to sell his
goodwill but keep the property, a
strategy was prepared around his
retirement vision that gave him
flexibility, fitted in with his tolerance to investment risk, and took
advantage of available tax
breaks.
With the security of the NHS
Pension, he wanted to keep his
private pensions more actively
managed and not be tied into an
annuity, so he set up an Income
Withdrawal Plan, took the maximum tax-free cash and a flexible
income. Yet for his wife, an annuity was appropriate because of
the smaller pension fund. Having
sufficient cash put aside for
emergencies, he was happy to invest his practice goodwill into a
joint discretionary managed
portfolio with his wife, geared for
growth. From this they take income in the form of capital gains
each year, entirely tax-free!
This portfolio may also fund
their future ISA payments; moving money from a potentially taxable fund to a more tax-efficient
environment. They are also now
drawing a tax-free income from
their ISAs. By transferring 50 per
cent of the practice property into
his wife’s name, the tax on her
share of the rental income is only
taxed at the basic rate. The following table shows how their income comfortably covers their
regular expenditure and pro-

"We don't worry about
our NHS compliance
anymore".
Dental Air has one of the best customer service reputations in the
dental industry, and with our fast call out times, it is no surprise that
we are the leading supplier of oil-free compressed air packages.

You feel in control of your finances when you are in control of
them! Waiting until you retire
could be too late. If you are planning to retire in the next five
years, do so with confidence that
you and your family have a level
of regular income commensurate with the retirement lifestyle
you desire. DT

About the author

Suzanne Allen
is managing director of Heritage
Financial Advisers, a team of independent, fee-based financial planning specialists dedicated to the
dental sector. She has over 12 years
experience in the financial-planning industry, having spent half
this time working with dentist
clients. Suzanne holds a diploma
in financial planning and possesses specialist knowledge of
pensions, taxation and trusts. Visit
www.hfadvisers.co.uk for more
information.

[11] =>

DTUK2009_01_Title

DENTAL TRIBUNE United Kingdom Edition · August 7–13, 2009

Money Matters 11

Saving for school
If you still plan to send your child to a fee-paying school despite the recession, it’s a
good idea to start putting money aside as soon as you can. Mark Blakeman explains

s the recession continues
to bite, private schools are
being hit hard. Some reports suggest that over 30 schools
have already closed, merged or
been taken over. It’s a worrying
time for pupils and parents alike,
with one mother likening the closure of her daughter’s school to
“a bereavement”. Equally difficult would be the prospect of removing your child from school if
you could no longer afford to pay
the fees, which this year have
shown an average rise of 5.9 per
cent, according to the Independent Schools Census.
If you plan to send your children to a fee-paying school, the
key is to start putting money
aside as soon as you can. You
might be surprised to know that,
according to our research it can
cost almost half a million pounds
to educate two children privately
followed by a three-year degree
course at university. That’s a
massive financial investment,
but one most parents would
agree is worth making, seeing as
a good education can be key to
giving children the best start in
life.

Planning ahead
Before you decide how you
want to plan paying for school
fees, there are a number of factors that you should take into
consideration.
• It’s worth exploring whether
there are any bursaries, grants

or scholarships available to assist you in funding your child’s
education. More details should
be available from the school or
Local Education Authority.
• If you already have a portfolio of
assets and investments, you
should review these and consider if they will cover all the
costs. You may want to make additional contributions to increase their worth or even seek
new investment opportunities.
If you commit to new investments make sure you consider
their maturity date to ensure that
they release funding to coincide
with the times when you need to
pay the school fees.

Savings options
Once you’ve considered your
current position, you need to
think about the options available
to you. Some parents will find it a
strain to pay education fees continuously from regular, taxed income and prefer to spread a portion of the costs over a longer period.

Individual Savings Accounts
(ISAs)
A tax efficient savings option
is to use your ISA allowance,
which currently stands at £7,200.
ISAs allow your savings to grow
free of income tax. Investments
can either be made in lump sums
or as regular savings, starting at
around £20 per month.

Up to £3,600 of your ISA allowance can be invested in a Cash
ISA. This is an ideal home for
money that you will require in five
years or less. The remaining part
of the allowance could go into a
stocks and shares ISA, designed
for medium to long term saving.
Alternatively, you can invest
the whole of the allowance into a
stocks and shares ISA. There are
various types available depending on your attitude to risk. For
more cautious investors there are
with-profits ISAs which invest in a
mixture of shares, fixed-interest
securities and property. Regular
bonuses are added in order to
smooth out investment returns.

be covered from the returns. You
should speak to your financial
consultant to find a tax efficient
and flexible approach that suits
your needs.
For longer-term savings, direct investment in unit trusts is
another option. This can also be a
tax efficient option because investors can use their annual capital gains allowance of up to
£10,100 to make tax-free withdrawals. With capital gains tax
standing at 18 per cent, compared to income tax at 40 per
cent, generating income through
capital growth can be beneficial
but talk to your financial consultant as this is a complex area.

help, they can make tax-efficient
contributions to the education of
their grandchildren whilst minimising Inheritance Tax liability
on their estates. If this could be of
benefit to your family talk to your
financial consultant to get more
information.
Finally it’s worth thinking
about how you would continue to
pay fees if your personal circumstances change, for example if
you are sick, made redundant or
die. You might want to ensure
your payments are suitably protected to cover you in the event of
such unforeseen circumstances.

Take professional advice
A popular alternative is unit
trust ISAs. A choice of funds is
available which invest in the UK
or overseas shares, fixed interests or property. Your investment
in these funds will fluctuate in
value in-line with the underlying
investments.
It’s worth remembering that,
from April next year, the annual
ISA investment limit will be increased to £10,200, of which up to
£5,100 can be placed in a cash ISA.
Those 50 and over will be able to
benefit from these new allowances from 6 October this year.

It’s also worth considering a
regular savings plans that can be
put into discretionary trusts for
children. Managed funds can be
used which spread the investment risk across shares, fixed interests and property.
There are other investment
options available according to
your timescale and attitude to
risk. Your attitude to risk will be a
key factor in helping you to decide
what type of financial planning to
undertake. If you are a cautious
investor you might want to choose
funds with a safer, lower return.
More speculative investors might
consider higher-risk options.

Other investments
If you have the capital available you could invest a lump sum
of money. A wise investment
could ensure that future fees can

Trust planning
If you’re in the fortunate position of having parents who can

There are many ways in which
money can be put aside to help
pay the costs of your children’s education. Every family will have
different requirements so it
makes sense to take professional
advice from a financial consultant
who has a good understanding of
the subject and of your own
needs. The sooner you start saving the better prepared you will be
to cover these costs. DT

About the author
Mark Blakeman
is National Sales Manager for Wesleyan Medical Sickness, specialist
providers of financial services and
products for dentists. For information, call 0800 980 1885 or visit
www.wesleyan.co.uk/dtuk

Tailored financial advice for dentists
Wesleyan Medical Sickness specialises in providing tailored
financial advice to the dental profession. Our Financial
Consultants are trained to understand the specific needs of
dentists and are dedicated to helping you plan for a more
secure financial future.

What’s more, Wesleyan Assurance Society, our parent
company, is one of the financially strongest and longest
serving mutuals in the UK. Choose Wesleyan Medical
Sickness and you choose a Financial Consultant who is
dedicated to your profession.

To arrange a no-obligation financial review, please call 0800 980 1885
Wesleyan Medical Sickness is a trading name of Wesleyan Financial Services Ltd, which is authorised and regulated by the Financial Services Authority. Wesleyan Financial Services Limited is wholly owned by Wesleyan Assurance Society. Registered No. 1651212.
The Financial Services Authority does not regulate most commercial mortgages. Head Office: Colmore Circus, Birmingham, B4 6AR. Fax: 0121 200 2971. Telephone calls may be recorded for monitoring and training purposes.

DE-AD-10-05/09

[12] =>

DTUK2009_01_Title

DENTAL TRIBUNE United Kingdom Edition · August 7–13, 2009

12 Money Matters

Tax-planning checklist
Now that we’re well past the April 5 deadline, it is time to consider what tax-planning
ideas and opportunities are available for the 2009/2010 tax year. Thomas Dickson
explains in the second of this two-part feature

here’s quite often a rush
at the end of the tax year
to make sure you’ve
maximised on all the tax savings you can. As always we had
pension cheques arriving right
up to the end of the tax year and
we were submitting ISAs right
up till the last working day.
However, you’ve actually got 52
weeks before then to arrange
your finances and maximise
the tax reliefs available. Following on from the points I
raised in part one of this feature, here are further ideas that
could save you a considerable
amount of money.

Capital Gains Tax (CGT)
Capital Gains Tax is now set at a
flat rate of 18 per cent of any net
gain (gain after expenses), and entrepreneurs relief has also recently
been introduced which charges
tax at an effective rate of 10 per cent
on certain business gains up to a
cumulative lifetime limit of £1m.
Although it’s not good news for
landlords, as buy-to-let properties
however have specifically been excluded from this relief.
You can crystallise gains to
the extent of the annual allowance which is £10,100 for
2009/2010, but remember you
must not buy back the same
shares or assets within 30 days.
For any gains made in this tax
year the CGT will be payable on
31 January 2011, so if you can
wait until 6 April 2010 to sell your
investment the tax would not be
payable until 2012. Another often-used method to reduce CGT
is to transfer assets between
spouses before sale to utilise both
annual allowances. Reinvestment relief is also available,
where the chargeable gain is deferred when the gain is re-invested in a qualifying Enterprise
Investment Scheme (EIS).

Estate planning
It’s often said that Inheritance
Tax is a voluntary tax. If your estate is likely to be above the nil rate
band (£325,000 for 2009/2010)
you may need to take some simple
steps to reduce the tax bill.

Many people think that their
spouse is automatically entitled
to any assets that are not held
jointly even if they haven’t written a will. The reality is that under the laws of intestacy (dying
without a will), if you have children, your spouse is only entitled
to the first £250,000 and an interest in half the remainder. In addition, if you have married or divorced since having your will
drafted, your original will is no
longer valid. So the first step is to
avoid this is to review your will
and update if necessary. (If you
don’t have a will and want to
check who will benefit simply
check the decision tree available
at www.essentialmoney.co.uk
/laws-of-intestacy
Despite some financial costs
associated with implementing a
will, the benefits from a will or
some other estate planning technique far outweigh the initial
costs. Remember, solicitors typically make more from sorting out
intestate estates (no will) than
they do from setting up wills.
Another common mistake is
that people don’t realise their life
insurance is included in their estate when they die, so review

whether you can put them in trust
for your children or beneficiaries
and you might be able to save
thousands of pounds of tax. Who
would you rather have your
money – your beneficiaries or
HM Revenue & Customs?
One of the simplest
methods of inheritance tax
planning is to make full use
of each year’s annual exemptions, such as:
• Annual exemption – £3,000
(you can also use £3,000 for
2009/10 if not already used)
• Small gifts exemption –
max £250 per donee (person receiving the gift) per
tax year
• Gifts out of normal expenditure
– for example, premium payments to a life insurance policy
under trust will often be a simple economic and acceptable
way of providing cash on death
that is free of Inheritance Taxation (IHT) and using the annual
and normal expenditure out if
income exemptions
You could also consider a “deed
of variation” where an inheritance
has been received in the last two
years to make the distribution of the
inheritance more tax efficient.
If you’re living with your partner, but not legally married, your
estate could be left with a large
inheritance tax bill as a result.
This is because if you leave your
estate to your partner and the
value exceeds £325,000 then tax
will be due at 40 per cent. However, if you are married the entire
transfer is exempt.
The other benefit of being
married is that if your estate
passes to your spouse on death
(and the nil rate band is therefore
not used) your surviving spouse
will then have the benefit of both
nil rate bands, increasing the taxexempt element to £650,000.

Transferring assets may also
be beneficial for avoiding Inheritance Tax. Lifetime gifts to bare
trusts are Potentially Exempt
Transfers. No inheritance tax is
due on these ‘PETs’ if the donor
survives for seven years. If the asset is sold within seven years
there may be an IHT charge if the
donor dies within that time so
don’t spend all the money.
Another approach taken to
avoid IHT is to buy shares or securities in Alternative Investment Market (AIM) listed stock.
After two years the assets benefit
from 100 per cent Business Property Relief and are not liable to Inheritance Tax.
You can also use Business Property Relief (BPR) to your advantage
by setting up a family trust. This can
be useful if you’re planning to sell
your practice, you want to reduce
your IHT liability and you don’t
necessarily need all your assets to
provide an income. All you need to
do before you agree to sell your
practice is to set up a family trust
and gift your practice property into
it. The assets then immediately
qualify under BPR and remain outside your estate for IHT purposes.
The only downside to point out is
that the assets are now irrevocably
outside your estate and the only
people that can benefit will be the
beneficiaries – typically your children or grandchildren.

For every £1 donated, your
charity can receive 28 pence, so
the total value of the donation is
£1.28. A higher rate taxpayer can
then claim back the difference
between the higher rate of tax at
40 per cent and the basic rate of
tax at 20 per cent on the total
value of their gross donation.
This article simply provides
some general planning ideas &
touches on a number of areas that
may be of interest. However, consideration should always be given
to your overall financial position
before making any decisions. For
more in depth information on any
of the above areas, please contact
us on 0121 685 5060 or to download a free financial guide for dentists please visit www.essentialmoney.co.uk. DT

About the author

Thomas Dickson

Charity gifts
Charities can reclaim the basic
rate of tax of 20 per cent on Gift Aid
donations. This means that for
every £1 donated, the charity can
claim an extra 25 pence. In addition, HMRC will automatically pay
your charity a further three pence
for every pound donated. This
‘transitional relief’ – to adjust to the
fall in basic rate tax (from 22 per
cent to 20 per cent) – is available
from 6 April 2008 until 5 April 2011.

was brought up in Hong Kong and
studied at Aston University Birmingham and in Tokyo. Thomas started
working as a financial adviser in
1993, became an Independent Financial Adviser in 1996, and is now a
Director of Essential Money Limited. Essential Money provides independent financial advice to dentists
throughout the UK. Thomas has
been awarded the Advanced Financial Planning Certificate by the
Chartered Insurance Institute and is
a Certified Financial Planner.

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[13] =>

DTUK2009_01_Title

PERIO TRIBUNE
Protection

Treatment

Maintenance

Gingival recession

New series

Dental implants

Prof. Dr. Liviu Steier
outlines how best to
prevent gingival recession with a clinical
case study.

Effective periodontal
treatment in practice
involves a series of
stages explains Fiona
Clarke.

Hygienist Leah Beckman looks at the longterm compliance and
maintenance of dental
implants.

page 21

page 15

page 17

Antibiotics don’t trigger resistance Oral osteoporosis drugs

esearchers have developed
a new generation of antibiotic compounds that do not
provoke bacterial resistance.
Bacterial resistance to antibiotics is one of medicine's most
vexing challenges.
But a recent study in an edition of Nature Chemical Biology,
has revealed that researchers
from Albert Einstein College of
Medicine of Yeshiva University
have developed two compounds
that work against two notorious
microbes: Vibrio cholerae, which
causes cholera and E. coli
0157:H7, the food contaminant.

Most antibiotics initially work
extremely well, killing more
than 99.9 per cent of microbes
they target.
But through mutation and the
selection pressure exerted by the
antibiotic, a few bacterial cells
inevitably manage to survive, repopulate the bacterial community, and flourish as antibiotic-resistant strains.
Professor Vern L Schramm
and Ruth Merns, chair of Biochemistry at Einstein and senior
author of ‘Transition State
Analogs of 5 – Methylthioadenosine Nucleosidase Disrupt Quo-

rum Sensing’ tested three transition state analogs against the
quorum-sensing pathway.
All three compounds were
highly potent in disrupting quorum sensing in both V cholerae
and E. coli 0157:H7.
‘In our lab, we call these
agents everlasting antibiotics,’
said Dr Schramm.
This study involved three
compounds, but Dr Schramm said
that his team has now developed
more than 20 potent MTAN inhibitors, all of which are expected
to be safe for human use. PT

Researchers find new proteins

esearchers have found two
new proteins that may lead
to more effective treatment
of endocarditis and infections associated with implants.
Endocarditis is an inflammation of the heart valves that can
be life threatening and streptococcus gordonii, a bacterium
that exists in the mouth, is one of
the bacteria that cause the disease.
To survive in the oral cavity,
the bacteria must be able to attach to a surface such as the mucous membrane.
This is done with the help of
proteins.
In the mid-1990s, one of these
proteins from S. gordonii was
identified by a research team in
England.

Now associate professor Julia
Davies, and her research team at
the Faculty of Odontology at
Malmö University in Sweden
have found two more and
thereby taken a step towards understanding how these bacteria
attach to a surface, like heart
valves for instance.

Once the bacteria are encapsulated, it is extremely difficult to
get rid of them.

The two new proteins SGO
0707 and SGO 1487 are found in
the cell wall of the bacterium S.
gordonii.

‘If we can block this binding
with the help of drugs, treatment
will be more effective,’ said Professor Davies.

The proteins are produced by
the bacterium and without them
the bacterium cannot fasten to a
surface, which is a precondition
for its survival.

Previously, researchers knew
that bacteria that grow in
biofilms alter their properties
when they settle on a surface.

If bacteria get in the bloodstream, they can bind to the heart
valves, where they produce a
biofilm and encapsulate themselves.

But with enhanced knowledge of how bacteria fasten to
surfaces, it will be easier to find
effective strategies to treat
biofilm-induced diseases.

For example, they become
more resistant to antibiotics and
antibacterial
compounds.
These researchers are now investigating how this resistance
arises. PT

ven short-term use of
common oral osteoporosis drugs may
leave the jaw vulnerable to
devastating necrosis, claim
researchers.
Researchers at the University Of Southern California, School Of Dentistry
have released results of
clinical data that links oral
bisphosphonates to increased jaw necrosis.
The study is among the
first to acknowledge that
even short-term use of common oral osteoporosis
drugs may leave the jaw
vulnerable to devastating
necrosis, according to the
report in the Journal of the
American Dental Association (JADA).
‘Oral Bisphosphonate Use and
the Prevalence of Osteonecrosis
of the Jaw: An Institutional Inquiry’ is the first large institutional study in America to investigate the relationship between
oral bisphosphonate use and jaw
bone death, said principal investigator Parish Sedghizadeh, assistant professor of clinical dentistry
with the USC School of Dentistry.
After controlling for referral
bias, nine of 208 healthy School of
Dentistry patients who take or
have taken Fosamax, the most
widely prescribed oral bisphosphonate, for any length of time
were diagnosed with osteonecrosis of the jaw (ONJ).
The study's results are in contrast to drug makers’ prior assertions that bisphosphonate-related ONJ risk is only noticeable

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with intravenous use of the
drugs, not oral usage.
Professor Sedghizadeh said.
‘We've been told that the risk with
oral bisphosphonates is negligible, but four percent is not negligible.’
He hopes that other researchers will confirm his findings and thus encourage more
doctors and dentists to talk with
patients about the oral health
risks associated with the widely
used drugs.
The results confirm the suspicions of many in the oral health
field.
He said: ‘Here at the School of
Dentistry we’re getting two or
three new patients a week that
have bisphosphonate-related
ONJ and I know we're not the
only ones seeing it.’ PT

[14] =>

DTUK2009_01_Title

DENTAL TRIBUNE United Kingdom Edition · August 7–13, 2009

14 Perio Tribune

Thinking outside the box

ardiovascular disease represents one of the leading
causes of death in the
Western world. With this in mind,
it is interesting to note that the
American Academy of Periodontolgy has just informed its members of its new clinical recommendations developed in regards to arteriosclerotic cardiovascular diseases, which has

been published in the American
Journal of Cardiology.
The American periodontoligists presented scientific evidence which convinced the cardiologists that they needed to alert
their fellow colleagues that they
were able to help reduce the risk of
cardiovascular diseases in patients suffering from periodontitis.

An important relationship
Here I will make a few points on
the interrelation between periodontal and cardiovascular diseases.
Dental plaque may become
colonised by periodontal pathogens
such as:
• Porphromonas gingivalis;
• Camplyobacter rectus,

• Fusobacterium nucleatum,
• Bacteroides forsythus,
• Prevotella intermedia,
• Actinobacillus actinomycetemcomitans, for example.
Bacteria and its products
reaching the gingival tissue stimulate inflammatory response leading to infiltration of neutrophils,
lymphocytes, macrophages and
mast cells. Inflammation is a wellestablished determinant for cardiovascular and periodontal disease.

Beside the inflammatory response an immune response of
the body will be as well induced.
Interleukin-1gene polymorphisms has been identifed as a
‘candidate that influences inflammation’.
Genetics today describes
three IL-1 genes located on human chromosome 2q13. Polymorphism in these genes are described with variations in levels
of IL-1‚ and IL-1 ra.
Artherosclerosisisis is the
consequence of artheromateus
plaque formation. It has been
demonstrated that bacteria in
blood, during bacteraemia may induce platelet accumulation which
will enmesh in fibrin, leading to a
thrombus. An occlusive thrombus,
or clot, obstructs the heart muscle’s
blood supply. Formation of an occlusive thrombus represents a life
– threatening episode in coronary
artery disease.

How can you win a
ﬁght with an enemy
that increases in
number every day?

In their paper called, Elevation
of systemic Markers Related to Cardiovascular Diseases in the Peripheral Blood of Periodontitis Patients,
Loos et al. (JoP 2000) proved that:
‘Periodontitis results in higher systemic levels of CRP (C-Reactiv Protein), IL-6, and neutrophils.’
In his reappraisal on the topic
of inflammation and periodontal
diseases, Van Dyke draws the
public’s attention to the following:

When that enemy is periodontitis, with bacteria
reproducing at a frightening rate, you need a dependable
ally that you can call on at the ﬁrst sign of the disease.
An ally such as Dentomycin Periodontal Gel.
Where pockets are 5mm or more, Dentomycin
Periodontal Gel, used as an adjunctive treatment is
particularly effective in breaking down bioﬁlm and helping
reduce the vicious circle of periodontal destruction(1).
With its pre-ﬁlled applicator, Dentomycin is simply and
painlessly applied, helping you make a rapid start on
managing the condition and minimising its effect.
So you can, by taking early action, step up the ﬁght
against periodontal disease and signiﬁcantly improve the
effectiveness of the treatment.

For more information please call 020 7224 1457
Information about adverse event reporting can be found at
www.yellowcard.gov.uk
Adverse events should also be reported to Blackwell Supplies,
Medcare House, Centurion Close, Gillingham Business Park,
Gillingham, Kent ME8 0SB or by telephone: 01634 877525

Dentomycin
• Inhibits destructive collagenases(2)
• Exerts a positive anti-inﬂammatory action(3)
• Conditions the root surface(4)
• Promotes connective tissue attachment(5)
• Signiﬁcantly reduces key periodontal pathogens(1)
• Actively helps the healing process(4,5)
• Is well tolerated(1) and does not interact with alcohol

Dentomycin Periodontal Minocycline
Gel 2%
w/w
(as hydrochloride)
*

Dentomycin abridged prescribing information.
Please refer to the Summary of Product Characteristics before using Dentomycin
Periodontal Gel 2% w/w (minocycline hydrochloride).
Presentation: a light yellow coloured gel containing minocycline hydrochloride
equivalent to minocycline 2% w/w. Each disposable application contains minocycline HCI
equivalent to 10mg minocycline in each 0.5g of gel.
Uses: Moderate to severe chronic adult periodontitis as an adjunct to scaling and root
planing in pockets of 5mm depth or greater.
Dosage: Adults – Following scaling and root planing to pockets of at least 5mm depth.
Gel should ﬁll each pocket to overﬂow. Applications should be every 14 days for 3-4
applications (e.g. 0,2,4 and 6 weeks) This should not normally be repeated within 6
months of initial therapy. Use only one applicator per patient per visit which should be
wiped with 70% ethanol between applications to each tooth. Avoid tooth brushing,
ﬂossing, mouth washing, eating or drinking for 2 hours after treatment. Elderly – As
adults, caution in hepatic dysfunction or severe renal impairment. Children – contraindicated in children < 12 years. Not recommended in children > 12 years.
Contraindications: Hypersensitivity to tetracyclines, complete renal failure, children

under 12 years. Precautions: Closely observe treatment area. If swelling, papules,
rubefaction etc. occur, discontinue therapy. Safety in pregnancy and lactation not established.
Side-effects: Incidences are low and include local irritation and very rarely diarrhoea,
upset stomach, mild dysphoria and hypersensitivity reactions. Storage: 2°-8°C.
Legal category: POM. Presentation and cost: Disposable applicator in an aluminium
foil pouch. Each carton contains 5 pouches. Carton £90.00.
Licence No: PL 27880/0001 PA1321/1/1. Product Licence Holder: Henry Schein UK
Holdings Limited, Medcare House, Centurion Close, Gillingham Business Park,
Gillingham, Kent, ME8 0SB. Telephone 020 7224 1457 Fax 020 7224 1694
Distributed by: Blackwell Supplies a division of Henry Schein UK Holdings Ltd,
Medcare House, Gillingham Business Park, Gillingham, Kent ME8 0SB Tel 020 7224 1457
Fax 020 7224 1694 References: (1) Van Steenberghe D et al (1993),
J Periodontal 64 637-644. (2) Rifkin B et al (1993), J Periodontal 64, 819-827. (3)
Seymour RA, Heasman PA: Tetracyclines in the management of periodontal diseases. A
review. J Clin Periodontal 1995 22 22-35. (4) Rompen EH et al (1993), J Dent Res 72
(3) 607-612. (5) Somerman MJ et al (1998), J Periodontal Res 23 154-159.
Date of preparation: June 2009 *Registered Trademark
BLA/DEN 15

‘Inflammatory mechanisms appear to be critical factors in the development and progression of most
of the chronic diseases in ageing.
• Diet and genetic variations interact to control differences in inflammation among individuals.
Inflammation is actively resolved
by specific mechanisms that help
to restore homeostasis, and there
ways to augment these processes.
• Although our genes do not
change, the control of how certain genes are expressed in specific tissue can change substantially throughout our lives by
factors such as diet, stress, and
bacterial accumulation.
• Visceral fat accumulations
around one’s waist substantially increase the inflammatory burden on the body.
• Over expression of inflammation may be one of the key aspects of aging that influences
and links different diseases in
different individuals.”

Discussion
Patient education as well as
inter-professional communication (‘thinking outside the box’)
may help save our patients lives,
and if they came trustfully into
our dental practices it is our responsibility to help, advise and
protect their health and life!

Conclusion
Continuing professional education today should contain understanding for infection, inflammation and its consequences for the human body.
Dentistry can help and prevent dramatic cardiovascular
diseases. PT

[15] =>

DTUK2009_01_Title

DENTAL TRIBUNE United Kingdom Edition · August 7–13, 2009

Perio Tribune 15

Perio disease – risk factors
It’s more likely a combination of factors than one single one that makes a person
susceptible to periodontal disease. Fiona Clarke explains

ffective periodontal treatment in practice involves a
series of stages; firstly understanding the aetiology and
pathogenesis of the disease,
early and accurate diagnosis, followed by effective treatment
with due consideration of all the
associated risk factors. This
needs to be followed by timely reassessment and continued periodontal maintenance and monitoring.

So if poor oral hygiene alone
cannot account for severe destructive periodontal disease and
everyone is not equally prone to
the disease, the question then becomes what makes some individuals more susceptible than others. Risk factors which have been

oration of noxious products by the
entire plaque flora that resulted in
destructive disease. Clinical trials
have documented the importance
of controlling the microbial
plaque in the treatment of gingivitis and periodontitis. The association of specific bacterial species

generally harmful to the host, but
the host response to this attack
may be protective or destructive.
The varying balance between
harmful and beneficial interactions of the host accounts for the
wide variety of patterns of tissue
changes in patients. It is believed

When considering the aetiology of a complex disease like periodontitis, we need to consider
both the direct cause and factors
associated with cause. Within
this, we can define two components; risk factors and susceptibility factors. A risk factor is defined as any environmental or
behavioural characteristic of an
individual that increases the
probability of developing a disease. Risk factors such as smoking and poor oral hygiene are
modifiable. In contrast, susceptibility factors (often called risk determinants) such as age, gender
and genetic make-up cannot be
modified.
It is now accepted that bacteria are essential, but insufficient
for the development of periodontitis. A susceptible host is a prerequisite. Periodontitis is primarily driven by a bacterial challenge, but a complex interplay
exists between the oral bacteria
and host which is influenced by a
range of risk factors.
Periodontitis is thus described today as a complex disease having a multifactorial aetiology and although bacteria are
still believed to be the primary
aetiological agents in periodontitis, often the amount of plaque
present does not fully explain the
observed severity of the disease.
Some patients experience severe
periodontal breakdown despite
low levels of plaque and conversely other patients have little
destructive disease despite widespread build-up of plaque.

ies show that diabetic patients
are at increased risk of periodontitis, in particular those with poor
oral hygiene or poor diabetic
control.
Despite identification of
many of the genes responsible
for most of the syndromic forms
of periodontitis this has not shed
much light on improving understanding of the pathogenesis of
the more common types of periodontal disease. Although there
has been a great deal of interest
in the association between the
risk of periodontitis and systemic
diseases it still remains unclear
to what extent common systemic
disease may affect the severity
and progression of periodontitis.

Smoking

Fig. 1

with disease came about in the
early 1960s when microscopic examination of plaque revealed that
different bacterial species were
found in periodontally healthy
versus periodontally diseased
sites (specific plaque hypothesis).

that bacteria can however only
account for about 20 % of this
variance in disease and current
evidence indicates that most destruction of the periodontium is
host mediated.

Systemic disease

Much research has focused
around trying to better understand the microbial aetiology of
the disease. In the mid 20th century, it was believed that all bacterial species found in plaque
were equally capable of causing
disease and that periodontitis
was the result of cumulative exposure to dental plaque.

Periodontitis has been associated with specific pathogenic
bacteria which colonise the subgingival area including P. gingivalis and A. actinomycetemcomitans. However, evaluation of
these pathogens as risk factors
for identification of attachment
loss over time indicate that none
of them are useful in predicting
periodontal disease progression

This non-specific plaque hypothesis assumed it was the elab-

Bacterial products and bacterial invasion of the tissues are

reported to be associated with increased susceptibility to periodontitis include the specific
bacteria within the microflora,
smoking, systemic disease, behavioural and psychosocial factors such as negative life events
and stress (figure 1).

Systemic disease can adversely effect host defence systems and therefore act as a risk
factor for both gingivitis and periodontitis. Depressed neutrophil number and function (as
in neutropenia, Chédiak Higashi
syndrome, Down’s syndrome
and Papillon-Lefèvre syndrome)
are associated with severe periodontitis. Diabetes mellitus is
one of the strongest systemic risk
factors for periodontitis and stud-

A positive association between smoking and periodontal
disease has been reported in both
cross sectional and longitudinal
studies. In the past few years increased attention has been paid
to this relationship, and smoking
is believed to be a significant factor in the development and progression of the disease. In studies
in which plaque levels were adjusted between smokers and
non-smokers, greater probing
depths, clinical attachment loss
and bone loss have been reported
in smokers.
It has been found that there is
reduced gingival inflammation
and bleeding in patients who
smoke. This may be explained by
the fact that nicotine exerts local
vasoconstriction reducing blood
flow, oedema and clinical signs of
inflammation. Smokers are believed to be between two and six
times more likely to have severe
periodontitis than non-smokers.
Several studies have demonstrated that the severity of periodontal disease appears to be related to the duration of tobacco
use and amount of daily tobacco
PT page 16

[16] =>

DTUK2009_01_Title

DENTAL TRIBUNE United Kingdom Edition · August 7–13, 2009

16 Perio Tribune
PT page 15

intake. Of clinical significance is
the fact that although smokers
benefit from periodontal therapy, clinical improvements are
less than those for non smoking
patients.
It is encouraging to note that
clinical studies demonstrate periodontal disease progression
slows in patients who quit smoking and that these individuals

have a similar response to periodontal therapy as non-smokers.
Thus smoking cessation advice
and support should be as important in our management of patients as our improvement in the
patient oral hygiene and we
should acknowledge the important role we have in highlighting
this issue to our patients.

Psychosocial factors
There appears to be an association between periodontal

disease and stress. Socially determined behaviours and responses to life circumstances
are thought to affect the immune system and thereby
health and periodontal disease.
Psychosocial factors lead to
changes in oral habits and in behavioral responses, such as
poor oral hygiene and smoking,
and the host’s response to environmental determinants such
as stress. Studies suggest stress
is a significant risk indicator for
periodontal disease and that the

impact of negative life events,
number of negative life events
and being unemployed are all
significantly associated with
periodontitis and should not be
under estimated.

Genetics
The view that genetic factors
influence periodontal disease is
not a recent one. In 1930, after reviewing the periodontal status of
several families, Denny concluded that susceptibility to peri-

odontal disease is probably heritable. The present theory of disease susceptibility is that it depends upon the presence of a critical number of one or more pathogenic bacteria in a susceptible
host. Studies have shown that the
number and type of bacteria required to exceed an individual’s
critical disease threshold defines
host susceptibility, and that this
susceptibility is influenced by a
number of factors, including genetics.
Initial attempts to define risk
factors for periodontal disease
have focused primarily on bacteriological and immunological
parameters while significantly
less effort has been directed at
defining host genetic factors.
Studies on periodontal disease
incidence in humans have
shown that genetics do not explain population variance in the
incidence of P. gingivalis or of P.
intermedia, two oral Gram-negative bacteria associated with
periodontal disease. We also
know that P. gingivalis has been
demonstrated in many studies to
be correlated with periodontitis
yet not all individuals are
equally prone to bone resorption when they are infected with
this bacteria.

Thus, it has been suggested
that genetic factors may have
more influence on host response
to infection than on bacterial
colonisation. In order to better
understand, classify and ultimately manage the disease it
would be useful if we understood
how genetic variation in host response could explain the differences which can be observed in
disease progression.

Plastic coated – no big shock!

We are now beginning to understand that it is more likely a
combination of risk factors that
predispose a patient to periodontitis and not a single factor and so
consideration of all associated
risk factors involved in a particular patient’s condition should be
considered before treatment
commences.. PT

Contact Info

TePe Original and G2

TePe Extra Soft

Available in eight colour-coded sizes (0.4mm to 1.3mm)
and two textures, TePe make it easy to select the correct
size for the majority of interdental spaces.
With plastic-coated wires and a choice of extra soft or
medium filaments, these brushes are also suitable for
use on implants and around sensitive areas.

For more information, please contact Molar Ltd
on 01934 710022 or visit www.molarltd.co.uk

All TePe Interdental Brushes have
plastic-coated wires for comfort
and protection

Dr Fiona Clarke
graduated from WITS Dental
School, South Africa and completed an MSc and PhD at Barts and
The London School of Medicine
and Dentistry with a special interest in genetic risk factors for periodontal disease. She’s currently
working as a clinical perio tutor at
Guy’s Hospital and in private practice. Teaching interests include
periodontology, local anaesthesia
and the use of e-learning in dental
education.

[17] =>

DTUK2009_01_Title

DENTAL TRIBUNE United Kingdom Edition · August 7–13, 2009

Keeping up appearances
Hygienist Leah Beckman looks at the long-term
compliance and maintenance of dental implants

oday anyone can achieve
permanent tooth replacement. Dental implants are
the standard of care for patients
presenting with lost or missing
teeth. As dentistry moves forward
in leaps and bounds, the dental
care professional must provide
the patient as well as other colleagues with the knowledge to be
able to maintain these implants.
The most important factor is
the regularity and frequency of
homecare and the proper use of
the appropriate hygiene aids.
The patient must also be dedicated to excellent homecare and
to maintain regular recare appointments with the dental hygienist at decided intervals usually every three months. At these
recare visits, the dental hygienist
must provide motivation for the
long-term compliance and maintenance of the implants. Good
dental health begins with superior dental hygiene.

Regular maintenance
A dental hygienist has the role
of providing regular maintenance and professional care of
dental implants. The area most
prone to damage is the interdental papilla. This mainly results
from the fact that it is an area that
is difficult to access and keep
plaque free.
First, assess the area with a
periodontal screening. The interdental papilla around an implant should have the same characteristics as a papilla around a
natural tooth. The tissue should
be firm, pink in color and plaque
free. There should be no swelling
or bleeding. There should be no
evidence of vertical bone loss
upon radiographic examination
and no mobility.
The dental hygienist must
probe and scale the implant using
only titanium or carbon fiber instruments. Metal curettes and
probes can scratch the surface of
the implant causing increased
plaque retention. Today there are
also many options for using ultrasonic tips with a Teflon coating
such as the piezoelectric tip from
NSK. This tip is autoclavable and
fits into the piezo headpiece.

Patient education
The role the dental hygienist
plays in patient education is of
the utmost importance. Without
proper patient education, the
proper daily homecare cannot be

achieved. The dental hygienist
must provide the patient with
tangible results at each professional prophylaxis appointment
that will motivate the patient’s
compliance at home.

W
E
N

Homecare starts with the appropriate hygiene aids and the
instruction on how to use them
correctly. The use of a sonic
toothbrush is highly recommended.

Perio Tribune 17
Nothing replaces floss
An implant patient should always use special floss with a
thicker foam coating. Again, instructing the patient on how to
adapt the floss around the implant and under the gingiva main
priority.
Ask the patient if they have
ever been instructed on how to
properly adapt floss and especially teach them how to clean
the interproximal areas around
the implant.

Interdental brushes are a
wonderful aid as well. However, only those with a plastic
coating over the metal wire can
be used. PT

About the author
Leah Beckman
is a registered hygienist with 12
years’ experience in the dental field.

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0908DT

28.07.09 09:54

[18] =>

DTUK2009_01_Title

DENTAL TRIBUNE United Kingdom Edition · August 7–13, 2009

18 Perio Tribune

Classic periapical radiography before, during
and at completion of RCT on tooth 46.

CBCT scans of the RCT performed on tooth 46.
Very good opportunity to evaluate the cone fit
(www.ct-dent.co.uk).

CBCT scans of the RCT performed on tooth 46
(www.ct-dent.co.uk).

Classic periapical radiography before, during
and at completion of RCT on tooth 15.

Cone Beam CT the change of paradigm in modern dentistry
– clinical applications in endodontics and periodontology
By Prof. Dr. Liviu Steier

anoramic
radiography
changed the paradigm of
diagnosis when introduced
in the early 1960s. The limitations of two-dimensional radiography are:
1.Magnification,
2. Distortion,
3. Superimposition,
4. Misrepresentation of structures.

Due to this the use is and
was limited.
Cone beam technology
(CBCT) is a recent introduced
technology in dentistry which
succeeded to change and continues to change diagnosis,
treatment indication and treatment approach – having as such
a more comprehensive impact
than the introduction of

panoramic radiography. Of
course on of the most impressive topic is the availability of
software for 3D – reconstruction.
It is of great importance to
mentione that CBCT provides
data at lower cost and absorbed doses than conventional CT.

www.periproducts.co.uk

Bends over backwards to
make cleaning easier.

CBCT of the same case. Upper picture demonstrating the panoramic view while
the lower shows the cepahlometric view

Experience the Interproximal brush that bends but is hard to break, allowing access to all
areas of the mouth. Well-designed and comfortable to hold, the flexible head, neck and
body allow the user greater control making teeth and gums easier to clean. The surgical steel
grade wire head, cleans effectively and gently as the wire has a specially formulated coating
that prevents potential damage to teeth and gums. The twist flex wire head is made of medium

CBCT scans of the RCT performed on tooth 15. Good opportunity to evaluate
the successfully obturated lateral canal in the periapical third of the palatal
canal

Tynex blisters for maximum cleaning effect.
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Clinical picture of the patient showing a very thin periodontal biotype.

[19] =>

DTUK2009_01_Title

DENTAL TRIBUNE United Kingdom Edition · August 7–13, 2009

Panoramic image of the upper jaw produced by the CBCT

The author has resumed this
articlefor the purpose of demonstration how CBCT aided
tremendous value to routine
dental practice.

1. Use of CBCT in
endodontics
2. CBCT in periodontics
2.1 CBCT and soft tissue
In 2008 Januario et al published in the Journal of of Esthetic Restorative Dentistry (J
Esthet Restor Dent 20: 366-374,
2008) a paper called: ‘Soft Tissue
Cone Beam Computed Tomography: A Novel Method for the
Measurement of Gingival Tissue
and the Dimensions of the Dentogingival Unit’. In this paper,
the authors described a simple
method to diagnose the thickness of the gingiva specially in
the anterior aesthetic zone. The
scans were performed with an
iCAT (Imaging Science International, Inc., Hatfield, PA; USA).
The authors positioned the subject for the scan wearing a plastic lip retractor.
A 28-year-old female patient
was referred to our practice for
evaluation and treatment planning of the periodontal status. No
special remarks regarding medical or dental history. The patient
has undergone orthodontic over
a couple of years.
The patient was referred for
the completion of the diagnostic
to take a CBCT at CTdent (2
Devonshire Place, W1G 6HJ,
London, see also www.ct-dent.
co.uk).
The CBCT confirmed the preliminary diagnosis.
A treatment plan has been
elaborated.
2.2 CBCT and hard tissue
Vandenberghe and coworkers researched periodontal bone
architecture using 2D CCD and
3D full-volume CBCT-based imaging modalities.
Their investigation concluded that CBCT offered a significant benefit over conventional radiography.
The authors concluded that
CBCT can be used to diagnose
the bony support as well as surrounding soft tissue and may reveal valuable informations for
PT page 20

Perio Tribune 19

CBCT Image showing an almost completely resorbed buccal alveolar plate and a very thin periodontal biotype.

[20] =>

DTUK2009_01_Title

20 Perio Tribune

DENTAL TRIBUNE United Kingdom Edition · August 7–13, 2009
PT page 19

example regarding furcation involvement.

Panoramic view CBCT image showing the advanced
bone resorption at the level of the first upper molars.

The CBCT confirms the class III furcation involvement

A 53 old human patient was referred to our practice for evaluation, treatment planning and execution. Of major concern was the
first upper molars. After performing the routine diagnostic approaches such as BOP, periodontal probing, etc, the patient was referred to CTdent for a CBCT.

IDT launches its
NEW Low Cost Online service

SimPlant
Reformatting
From

£40

Upload an i-CAT Vision, DICOM CT or CBCT dataset to

www.ctscan.co.uk

Book and pay online and have the results returned to you
in SimPlant View format (or SimPlant Planner for £10 more)
electronically within 3 working days.
Enjoy all of the great services you have experienced from
IDT in the past but now at a more cost effective price.

NEW Easy to Use Online Booking
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NEW Radiologist Report Available

Summary
Information provided by this
modern technology represents an
invaluable milestone in diagnostic, treatment planning as well as
evaluation of treatment outcame
specially for periodontal applications, especially in the areas of intrabony defects, dehiscence and
fenestration defects, and periodontal cysts, and in the diagnosis
of furcation-involved molars.

Conclusion
1. For periodontology, CBCT
proves to be superior to 2D imaging for the visualisation of bone
topography and lesion architecture as well as for the covering
soft tissue.

The CBCT centre sent along as 3D
reconstruction of the left side

The CBCT centre sent along as 3D
reconstruction of the right side

2. For endodontics CBCT seems
to be the most promising applications for diagnosis, treatment planning and treatment
evaluation.
CBCT images and 3D reconstructions allow for visualisation
and exact measurement of dimensions.
Diagnosis built on the combination of clinics and CBCT are a
reliable aid in planning and execution of simple as well as advanced dental procedures. PT
References are available on request.

About the author

NEW Planning Service Available
To log in or register, go to www.ctscan.co.uk
Contact IDT today if you need any help with this online service
bookings@ctscan.co.uk or call +44 (0)20 8600 3540

Dr. med. dent. Liviu Steier

www.ctscan.co.uk

is a visiting professor at the School
of Dental Medicine in Florence;
visiting professor at Tufts School of
Dental Medicine on its endodontic
postgraduate programme; and an
honorary clinical associate professor at Warwick Medical School. He
is a registered specialist in endodontics (GDC) and Spezialist
fuer Prothetik (www.dgzpw.de).
He can be reached at
l.steier@msdentistry.co.uk

[21] =>

DTUK2009_01_Title

DENTAL TRIBUNE United Kingdom Edition · August 7–13, 2009

Perio Tribune 21

Protecting the root
Prof. Dr. Liviu Steier outlines how
best to prevent gingival recession
A clinical case of generalised gingival recession in a patient with thin gingiva biotype and high muscular insertion.

oot surface exposure as a
consequence of gingival recession is a challenge for the
dental practitioner. Over the past
decade, many procedures have
been introduced and presented to
prevent and/or treated this complex phenomenon. Most of the
treatment approaches consist of
mucoginigival graft techniques.
Variation in gingival thickness (GTH) has been related to
different periodontal ‘biotypes’
(Seibert & Lindhe 1989):

• Thick – flat biotype (quadratic
teeth with a broad zone of keratinised tissue)
• Thin – scalloped biotype (slender teeth with a narrow zone of
keratinised tissue)
Gingival thickness not only interferes with dental procedures
but can advance if left untreated.
Among the most common found
clinical manifestations are:
• Tooth sensitivity.
• Long tooth appearance

Gingival biotype
and natural teeth
As a consequence of this thin
biotype, gingiva can receed during
life. It is not often that clinical situations like the one below can be seen
in practice. Treatment which doesn’t address the primary disease was
performed using adhesive filling
material to reduce tooth sensitivity
and mask esthetics. With time,
restorations have to grow and an
unpleasant image occurs.
Gingival biotype
and prosthetics
Ericsson &. Lindhe demostrated
in an experimental study (1984)
performed on beagle dogs, that
once metallic strips were inserted
subgingivally, recession was more
likely to appear in areas with thin
gingiva architecture.

scalloped gingiva tends to recede
from source of irritation, for example, an artificial crown. Margin or microbial irritants (Seibert
& Lindhe 1989), and gingival recession often occurs following
traumatic, or surgical injury
(Claffey & Shanley 1986).
Gingival biotype and implant
therapy in the esthetic zone
(ITI Treatment Guide Vol I –
Implant Therapy in the Esthetic
Zone – Quintessence 2007)
Subgingival elements covered
by a thick – gingival biotype assure
a predictable esthetical outcome
lowering the treatment risks.
A medium – gingival thickness biotype is associated with
higher long-term esthetical risk.
The thin – gingival thickness
biotype is associated with the risk
of recession and may lead to esthetical insufficiency.

Müller et al. (2007) demonstrated that subjects with a thin
periodontal phenotype have
also relatively thin palatal mucosa not very suitable for harvesting connective tissue grafts.
As a consequence, the use of
‘acellular dermal matrix’ derived from donated human skin
(AlloDerm – BioHorizons) may
be the only treatment alternative in cases of thin gingival biotype.

Soft-tissue grafting
Soft-tissue grafting is performed for different reasons:
1. Changing of the natural gingival biotype by augmentation a preventive approach.
2. Root coverage a curative
approach in ready installed
disease.

Clinical picture showing a ‘dark margin’ of a PFM crown in a thin gingiva biotype patient having multiple recessions.

Gingival biotype and
surgical endodontics
It is a widely accepted clinical
impression that a thin, highly-

Clinical picture demonstrating gingival recession around an implant.

Picture demonstrating the ‘Treatment Algorithm for Gingival Recession’ (modification of the UCLA approach).

PT page 22

Alloderme package

Swann Morton surgical blade used for the cervical incision

… placed in sterile saline bath for rehydratation

Post-operative pictures

… rehydrated and cut in strip

Tunnel periotome used to raise the flap

[22] =>

DTUK2009_01_Title

DENTAL TRIBUNE United Kingdom Edition · August 7–13, 2009

22 Perio Tribune

Postoperative pictures
Placing the Alloderm under the raised tunnel flap

The Algorithm on page 21
should best exemplify diag-

PT page 21

foundation
for optimal
aesthetics

nosis and adequate treatment.
Alloderm
Alloderm is an acellular dermal matrix derived from donated
human skin. The donor material
is deprived of the epidermis and
immunogenic cells. It undergoes
a final freeze drying and an extensive panel of serology tests
and a sterilisation process.

Pre-operative pictures

Post-operative pictures
Gingival recession with
root surface restorations.

AlloDerm graft placed
in pouch and sutured.

Complete root
coverage at one year
postoperatively.

Case courtesy of Dr. Edward P. Allen

Biologic Solutions
BioHorizons comprehensive Biologic product portfolio offers a wide range of evidence-based regeneration options to
ensure ideal site development. Delivering optimal aesthetics and successful implant placement is the goal of our proven
hard and soft tissue products.

One can say that the Allogrfat
Tissue is transformed into a Regenerative Tissue Matrix consisting of a complex acellular
heterogenous scaffold, containing growth factors binding sites
and blood vessel architecture.
It has been demonstrated that
due to retained vascular channels
the patients blood infiltration is facilitated and accelerated – revascularisation can start as early as
one week after implantation.

Clinical case

• AlloDerm® – regenerative tissue matrix for use as an effective
alternative to palatal tissue for soft tissue augmentation*

™

• MinerOss

– blend of mineralized allograft cancellous and cortical
chips that provide an osteoconductive scaffold for bone regeneration

• Mem-Lok™ – resorbable collagen membrane that is cell occlusive

A 29-year-old male was refered for the management and
prevention of recession. The
medical history was uncomplicated with no special recording
in the dental history.
The clinical dental examination proved:
• Thin gingiva biotype
• Temperature sensitivity
• Gingival recessions with tendency to expansion
• There were no signs of inflammation or ulceration.

and slowly resorbing to promote clot maintenance and bone formation

For more information, contact BioHorizons
Customer Care: 01344 752560
Email: infouk@biohorizons.com
visit us online at www.biohorizons.com

*Histologic Evaluation of Autogenous Connective Tissue and Acellular Dermal
Matrix Grafts in Humans. Cummings LC, Kaldahl WB, Allen EP. J Periodontol
2005;76(2):178-186. MinerOss manufactured by Osteotech. Mem-Lok
manufactured by Collagen Matrix, Inc. AlloDerm manufactured by LifeCell.
SPMP09095 REV A APR 2009

The initial management was
conservative and consisted in
cleaning and hygiene instruction.
Follow-up a few weeks later
showed a clear improvement in
oral hygiene. The patient was explained treatment goals and different available treatment options.
The selected and agreed
treatment plan was two-fold:
• First to thicken the gingiva using graft technique (Alloderm)
• At a later stage for complete
root coverage a ‘coronally
repositoned flap’. Consent was
obtained.

[23] =>

DTUK2009_01_Title

DENTAL TRIBUNE United Kingdom Edition · August 7–13, 2009

Pre-op mirrow view of the left side

Post-op view of the same side

Pre-op mirrow view of the right side

Perio Tribune 23

Post-op mirrow view of the same side

Step-by-step treatment
Preparing Alloderm for use:
The package is opened and the
graft is dropped into a sterile saline
bath, where it is kept for 30 minutes. The paper back is removed
from the graft. It is important to
identify the two sides of the graft.
The basement of the membrane is
rough and does not absorb blood,
while the dermal side does.
Preparation of
the recipient side
Adequate anesthesia is administrated – usually infiltration
will suffice.

How can
one size
ﬁt all?

The surface of the root is
scaled and planed. Papillary incisions are made using a Swann
Morton blade to a depth of 3-4 mm
apically. The papilla is left intact
to prevent flap retraction and improve blood supply to the graft
during the healing phase.
To lift the tunnelled papillae, a
microsurgical papilla elevator is
used and a mucoperiosteal pouch
( past the mucogingival junction)
is created.
The Alloderm graft is cut to fit
from the distal of the canine to the
mesial of the molar. The graft is inserted into the pouch preparation
under the intact papilla using the
micro papilla elevator. The graft is
than positioned with the connective tissue side facing the bone.
The margins of the garft are
fixed to the tooth with Histoacryl
glue. No suture needed.
The patient was instructed
not to brush the area for six
weeks, to start rinsing the mouth
with saline solution for seven
days. After seven days, disinfection was performed with oral
rinse with CHX solution. The patient was seen for postsurgical
check up after two days, seven
days and six weeks.
After six weeks, a thorough
cleaning was perfromed and the
patient instructed to restart regular hygiene. Healing was re-evaluated after three months and the
next treatment step scheduled.

We have always believed that the digital imaging requirements of
dentists vary from practice to practice.
So we offer a range of options and systems to meet the needs of every
one, be it general or specialist. Be it large, medium or small.
Our competitors take a different approach, preferring the single
solution route.
Only you can decide who has it right. But a few facts may help you make
that decision.
Unlike others, we design, manufacture and develop our software entirely
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every aspect of manufacture and distribution, leaving nothing to chance.
We should also add that, because of the way we work, our prices are
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So there you have it. If you are thinking of investing in dental imaging
equipment do you want choice or no choice?
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For further details, advice on the most suitable solution for your
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or e-mail: info@e-wootech.co.uk

• Superb panoramic image
• Provides a variety of views:
adult/child, frontal,
left/right, TMJ, sinus

Conclusion
Early diagnosis and preventive
regenerative periodontal treatment can avoid long-term gingival
recession. Patients with a thin gingiva biotype will also lack adequate connective tissue in the
palate for transplant. The use of
donated human tissue represents
a viable alternative technique. PT
References are available on request.

E-WOO Technology UK Ltd, Axiom House, The Centre, Feltham, Middlesex TW13 4AU.

www.e-wootech.co.uk

[24] =>

DTUK2009_01_Title

DENTAL TRIBUNE United Kingdom Edition · August 7–13, 2009

24 Practice Management

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Leadership essentials for the ‘rookie’
By Sally McKenzie, CMC

pon entering your first
“real” dental practice either as an associate or as
an owner, with the dental degree
in hand and requisite experience
on your resume, it’s likely that
one thing became abundantly
clear very early on: The learning
process had only just begun.
There is a whole lot more to a career in dentistry than most young
dentists ever imagine.
Almost without warning,
many are tossed into leadership
roles seemingly overnight. And
it’s that part of the job requirement that often leaves new dentists shaking their heads in bewilderment. Certainly, there is a
lot to learn as a leader, but here
are a few essentials to follow
from day one as “The Boss.”

successful at scheduling and recall and would be better suited
for those duties. Don’t be afraid to
restructure responsibilities to
make the most of team strengths.
Invest in training early and often
to build loyalty and ensure excellence.

No. 3: Give feedback often
Along with clear expectations, direction and guidance,
employees crave feedback. Don’t
be stingy. Give praise often and
appraise performance regularly.
Employees want to know where
they stand and how they can improve. Verbal feedback can be
given at any time, but it is most effective the moment the employee
is engaging in the behavior that
you either want to praise or correct.

reviews offer critical information
that is essential in your efforts to
make major decisions regarding
patients, financial concerns,
management systems, productivity and staff in your new practice.

Know the numbers
Certainly, it doesn’t take long
for every new dentist to realize
that just as important as your role
as dentist is your role as CEO. It is
critical that you understand completely the business side of your
practice. There are 22 practice
systems, and you should be well
versed in each of them. If not,
seek out training for new dentists. The effectiveness of the
practice systems will directly and
profoundly impact your own success today and throughout your
entire career.

No. 1: Never assume
This is the most common pitfall in leading employees: assuming that your staff knows
what you want. Spell out your expectations and the employees’
responsibilities in black and
white for every member of your
team from the beginning. Do not
convince yourself that because
they’ve worked in this dental
practice for X number of years
that they know how you want
things done. They don’t, and they
will simply keep performing
their responsibilities according
to what they think you want unless they are directed otherwise.
For example, your scheduling coordinator may be very experienced in scheduling according to how other dentists want
their days structured, which may,
in fact, be very different from
how you want your days scheduled. Most good employees want
clear direction, and it’s tremendously frustrating for everyone
when staff are forced to guess at
what you want. So speak up.

No. 2: Staff success =
your success
Recognize the strengths and
weaknesses among your team
members because all employees
bring both to their positions. The
fact is that some people are much
better suited for certain responsibilities and not others. Just because Brittany has been handling
insurance and collections for the
practice doesn’t mean she’s effective in those areas. Look at results. Brittany may be much more

‘Your success is
dependent upon
your ability to
lead your team.’
If the assistant emphasizes to
Mrs. Patient just how much she is
going to absolutely love her new
veneers and steers the patient
clear of second guessing this investment she is about to make,
tell her! Express your sincere appreciation and emphasize the
value of the assistant’s contribution to the practice. Similarly, if
employees need constructive
feedback, don’t be shy with that
either. If the front desk helper is
talking about how gross she/he
thinks that whole implant thing
is, she/he needs education and
constructive direction.
Nip problems in the bud or
you’ll suffer numerous thorns in
your side. If an employee is not
fulfilling her/his responsibilities,
address the issue privately and directly. Be prepared to discuss the
key points of the problem as you
see it, as well as possible resolutions. Use performance reviews
to motivate and encourage your
team to thrive in their positions.
Base your performance measurements on individual jobs. Focus on specific job-related goals
and how those relate to improving the total practice.
Used effectively, employee
performance measurements and

Overhead. For starters, routinely monitor practice overhead. It should break down according to the following benchmarks to ensure that it is within
the industry standard of 55 percent of collections.
• Dental supplies 5%
• Office supplies 2%
• Rent 5%
• Laboratory 10%
• Payroll 20%
• Payroll taxes and benefits 3%
• Miscellaneous 10%
Salaries. Keep a particularly
close eye on staff salaries. These
can mushroom out of control and
send overhead into the 70–80
percent range in record time.
Payroll should be between 20–22
percent of gross income. Tack on
an additional 3–5 percent for payroll taxes and benefits. If your
payroll costs are higher than that,
here’s what may be happening:
• You have too many employees.
More staff does not guarantee
an improvement in efficiency
or production. It does, however,
guarantee an increase in overhead, unless you are hiring a
patient coordinator who is going to make sure the schedule is
full and production goals can be
met.
• You are giving raises based on
longevity rather than productivity/ performance. If production is going down and overhead is going up, payroll cannot
be increased. Establish a compensation policy stating that
raises will be given based upon
employee performance and

only if the practice is making a
profit.
• The hygiene department is not
meeting the industry standard
for production, which is 33 percent of total practice production. If the dentist steps back
and takes a closer look at what
is happening, he/she will find
that the hygienists have far
more down time than they
should, patient retention is seriously lacking and periodontal
treatment is minimal at best.
The recall system, if there
even is one, needs immediate attention to ensure that the hygiene schedule is full, the hygienist is scheduled to produce three
times his/her salary and cancellations are filled.
Production. Hand-in-hand
with practice overhead is production, and one area that directly affects your production is
your schedule. Oftentimes, new
dentists simply want to be busy.
Sure you want to be busy, but
more important than being busy
is being productive. Take the following measures to get your
schedule on the path to productivity. Start by using your schedule to meet production objectives. First, establish a goal. Let’s
say yours is to break the million
dollar mark. Taking 33 percent
out for hygiene leaves the dentist
with $670. This calculates to
about $13,958 per week (taking
four weeks out for vacation).
Working 32 hours per week
means the dentist will need to
produce about $436 per hour. A
crown charged out at $950,
which takes two appointments
for a total of two hours, exceeds
the per hour production goal by
$39.
This excess could be applied
to any shortfall caused by smaller
ticket procedures. Unfortunately, you are probably not doing crowns every hour on the
hour. Use the formula below to
determine the rate of hourly production and whether you’re
meeting your own personal production objectives.
1) The assistant logs the amount
of time it takes to perform specific procedures. If the procedure takes the dentist three appointments, she/he should
record the time needed for all
three appointments.
2) Record the total fee for the procedure.

3) Determine the procedure
value per hourly goal. Take the
cost of the procedure — for example $215 — and divide it by
the total time to perform the
procedure, 50 minutes. The
production per minute value is
$4.30. Multiply that by 60 minutes to arrive at $258/hour.
4) The amount must equal or exceed the identified goal. Now
you can identify tasks that can
be delegated and opportunities for training that will maximize the assistant’s functions.
You also should be able to see
more clearly how setup and
tasks can be made more efficient. Thus, you’ll be well on
your way to achieving your
own production goals, whatever those may be.
In your practice, every system
directly affects your success, as
does every member of your team.
Each is an extension of you. Your
systems and your team will affect
whether you have enough money
to pay your bills. They will keep
your schedule on track or off.
They will tell you what you don’t
want to hear when you don’t want
to hear it. They will be a source of
great joy and satisfaction, as well
as anger and frustration. But no
matter what, your success as a
dentist is dependent upon your
ability to lead your team effectively and manage your systems
efficiently. DT

About the author

Sally McKenzie
is CEO of McKenzie Management,
which provides success-proven
management solutions to dentistry nationwide. She is also editor
of The Dentist’s Network Newsletter, www.thedentistsnetwork. net;
e-Management Newsletter from
www.mckenziemgmt.com; and
The New Dentist™ magazine,
www.thenewdentist.net. She can
be reached at (877) 777.6151 or
sallymck@mckenziemgmt.com.

[25] =>

DTUK2009_01_Title

DENTAL TRIBUNE United Kingdom Edition · August 7–13, 2009

Practice Management 25

Setting yourself free

About the author
Dr Simon Hocken,

Simon Hocken shows how you can increase your
success with a personal and professional vision

verything that exists is created twice: once in the
mind, then again in the
outside world. In fact, nothing
can be created without being envisioned first. Just as a mountain
climber can hold in mind the image of standing on the peak,
hands on hips, or an Olympic
runner pictures himself crossing
the finish line, the vision begins
at the end of the adventure, when
your goal has been realised.

don’t see the captain of the ship
sitting with the crew, rowing; he’s
the one with the telescope, scanning the horizon, or studying the
treasure map, and giving orders.

founding partner of Breathe Business, has a wealth of
experience as a successful private dentist and business
coach, helping clients recognise developing trends, increase turnover and find the perfect balance between
their personal and professional lives. Breathe Business
is a unique leading coaching and consultancy company which specialises in working with dental principals and their teams in order to develop and grow their
practices. For more information, contact Dr Simon
Hocken and the Breathe team by calling 0845 299 7209
or emailing info@nowbreathe.co.uk.

This efficient use of time lets
dentists enjoy a happier home
life, with more holidays, more
dinner with friends, more visits
to the cinema… DT

Instant Gratiﬁcation
for Denture Patients

Understand your goal
Once you know what you want
to accomplish, you can then determine more effectively what
has to be done on the way. The
most innovative leading coaches
in dentistry use this strategy to
help principals and their teams
reverse-engineer their success,
because it facilitates the decisionmaking process; when you know
where you want to be, the decisions you make along the way become so much easier. You simply
ask yourself, whenever you reach
a fork in the road: which path will
take me closer to my goal? The difference a vision makes can be
equated to the difference between
meandering around a maze, or
cruising along the highway.
When it comes to helping a
client develop his or her own
unique vision, the coach might
well begin by asking the threeyear question:
‘If we met in three years’ time,
and looked back over the last 36
months, what would have to have
happened, both personally and
professionally, for you to be happy
with your progress?’

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Coaching is all about giving
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With the right marketing structure, and robust, efficient working systems, increased profitability can be reliably achieved
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Make time work
By having the right team
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up to focus on the treatments you
are passionate about. Your coach
will also help you make time
work for you, not against you, reducing your clinical hours without reducing your profit. With the
extra time available, you can
monitor your team more effectively, appraise the performance
of your business, and respond to
new opportunities quickly. You

This one-piece implant enables placement with
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[26] =>

DTUK2009_01_Title

[27] =>

DTUK2009_01_Title

Practice Management

The 10 Dimension…
the power of 10
th

Ed Bonner and Adrianne Morris discusses 10
ways to deal with anger

nger wells up within us
whenever we perceive
that we have been
wronged, but how we deal with
the situation will determine
whether the problem escalates
or is resolved. Here are 10 ways to
resolve a toxic situation:

1. Take a deep breath…
and wait
Breathing calms the body,
and by reducing the physical
signs of anger, calms the mind.
When something has angered
you, rather than erupting spontaneously, or sending off an angry letter or email, breathe
deeply and then exhale – and the
exhalation should be longer and
more complete than the inbreath (say, in for seven seconds
and out for 10). Repeat this several times. Wait until you are
physically calm. Only then
should you express yourself. If
you cannot reach a state of calm,
consider what benefit you are
trying to get out of the situation,
and take measured, considered
action which does not include
ranting or sending an invectivefilled or vitriolic email or letter
which can only inflame and
worsen the already fraught state
of affairs.

2. Don't deny your anger, but
consider the consequences

4. Recognise tiredness
and stress

Anger should not be suppressed. Doing so and storing it
only builds up to a more explosive eruption later. Rather use it
and lose it. Anger can be used
appropriately or inappropriately. It is appropriate when you
use it to achieve a desired outcome. It is inappropriate when
the anger uses you, takes over
and brings about an unconsidered and unwanted outcome.
Think about poor service on an
airline: don't explode at the
hostess – ranting and raving will
just annoy other passengers and
may just get you barred from using that airline in future – rather
call the senior purser and voice
your complaint in a measured
way and you are likely to be offered a better meal, an upgrade,
or air-miles.

One of the most common
places we recognise that we are
tired and/or stressed is in a car.
This is where most arguments
between spouses or companions
occur. The trigger may be not following the best route, heavy traffic or the poor control of another

3. Eat properly…
and drink sensibly
Healthy, but not excessive
eating, drinking lots of water,
enjoying tea, coffee and alcohol
but not in excess are all sensible
responses to irrational emotion
or tiredness. They may also prevent
and
control
stress
headaches.

‘One of the most
common places
we recognise
that we are
tired and/or
stressed is in
a car.’
driver. The consequences of losing your temper may be an insufferable journey or, worse, an accident. You might injure someone, kill or be killed. Rather
breathe deeply and wait. Above
all, do not drive when tired.
Tiredness and stress are equally
damaging at work and at home.
Rather than get embroiled in a
major argument, say you are upset and walk away.

5. Control your
environment
As anger specialist
Mike Fisher says, ‘Anger
thrives in a toxic environment, feeding on itself. If
you manage to stay calm
at work or in a car, other
people will be less
stressed and angry, which
will in turn help you to
control your own anger’.
The dental practice environment – working on a
tiny cavity on a small object in a small mouth in a
small room – is unfortunately not conducive to
relaxation, but can be
controlled by having good
equipment, lighting and
ventilation and improving
the local ambiance.

6. Anger as a justified
response to wrong-doing should be proportionate
There are times and
situations when it is completely appropriate to be
angry, but when for example, one goes into a rant
because one your employees has spilled a bottle of
varnish, this is disproportionate.

DT page 28

[28] =>

DTUK2009_01_Title

28 Practice Management

DENTAL TRIBUNE United Kingdom Edition · August 7–13, 2009
DT page 27

On the other hand, becoming
apoplectic at the spillage of a bottle of mercury is by no means unjustified!

7. Focus on the issue rather
than on the person
When we are angry it is easy
to use terms like ‘you always get
things wrong when you speak to
patients’, but this tends to bring

‘The exhalation
should be longer
and more complete than the
inbreath’
about a response like ‘no, I don't
always, just in this case, but you
always say always!’ Focusing on

the issue, like: ‘Mrs Jones was
upset – do you think you could
have handled her in a different
way?’ will produce a very different and less emotional response.

8. Get help
If one is in a persistently
stressed and angry state to the
detriment of one's health, wellbeing, and relationships with
others, it is eminently sensible
to seek help from a doctor, therapist or coach. Help may come
in the form of advice, medication or suggestion for life-style
change, but someone else is far
more likely to see the bigger
picture.

9. Join a support group
Examples would be The
British Association of Anger
Management or Alcoholics
Anonymous, or one's church,
mosque or synagogue. Joining
a yoga or tai chi group often provides a nurturing community
for dealing with lower-level
stress.

10. Take responsibility
A problem may be caused by
another person, but until you
recognise that the greater
problem of your excessive response to a negative situation
rests within you rather than
with others, you are unlikely to
improve the situation. As soon
as you start to blame others, focus on your own errors or misconceptions that have clouded
the picture, and accept responsibility.

‘As soon as you
start to blame
others, focus on
your own errors
that have
clouded the
picture.’
It 's in your mind and in your
hands!
Adrianne Morris is a highly
trained success coach whose
aim is to get people from where
they are now to where they
want to be, in clear measured
steps.
Ed Bonner has owned many
practices, and now consults
with and coaches dentists and
their staff to achieve their potential.
If you would like to discuss anything about this article, or a free
consultation, or to subscribe to
The Power of 10 e-zine, feel free
to contact Ed at bonner.edwin@gmail.com or phone 077 7
666 01 338 or e-mail Adrianne
(alplifecoach@yahoo.com) DT
1

Recommended reading: Beating
Anger by Mike Fisher, director of
The British Association of Anger
Management

[29] =>

DTUK2009_01_Title

DENTAL TRIBUNE United Kingdom Edition · August 7–13, 2009

Practice Management 29

In this economy, customer service matters more than ever!
By Roger P. Levin, DDS

hat constitutes superior customer service?
More than you might

think.

Truly excellent customer
service doesn’t happen by accident. It requires a system that
dictates how every patient every
hour of every day will be treated.
And that system is absolutely vital to your practice.

notepads are just a few of the
many mementos you can give
your patients to keep your
practice foremost in their
minds. Giveaways like this
don’t constitute great customer service — they merely
reinforce it.

6) Think carefully about the specialists to whom you refer. If
your patients have a bad customer service experience in a
specialist’s office, then it will
reflect poorly upon you. Make
sure the specialists you work
with have the same attitude

toward customer service as
you do.

Conclusion
Customer service goes far, far
beyond simply being nice. It’s
about making every interaction

with every patient a pleasant experience. By consistently providing
high levels of customer service,
you are helping protect your greatest investment — your practice.
Superior customer service isn’t a
luxury. In today’s economy, it’s a
necessity. DT

Superior customer service
requires a system
Your system for customer
service must be one that can be
repeated for every patient, every
day. You should outline the steps
that lead to exceptional customer
service so that all employees
know what you want to have happen for every patient, every single time.
So just how can you improve
the customer service in your office? Here are six of the many recommendations from Levin
Group’s Stage III Customer Service curriculum.

Introducing A-dec 300
stylish functional innovative

1) Give new patients clear instructions for getting to your office.
This is easy to overlook. Some
patients may become frustrated just getting to your office. Are you on a busy street or
an unmarked side road? Will
your patients have to pay for
parking? If so, does your office
validate? Give clear instructions and directions to patients
when they call to avoid a negative reaction.
2) Do not make patients wait.
When you fail to keep your appointment times with patients, you set the stage for
their impression of your customer service — no matter
what other positive experiences they had in your office.
You ask that they arrive on
time so make sure they can be
seen on time!
3) Provide your staff members
with clear job descriptions.
Knowing exactly what is required of staff members will
make them less stressed and
friendlier to patients. Develop
phone scripts so that your staff
members are prepared when
patients call. This will make
for clearer, easier interaction
with patients.
4) Be sure to greet patients
warmly in the treatment area.
Whether they are arriving for a
hygiene visit, an evaluation or
treatment, patients need to
feel welcome. Something as
simple as a smile or a handshake is a good beginning toward achieving this goal.
Team training is the key, as I
discuss in my GP Blog at
www.levingroupgp.com.
5) Give patients something to
help them remember your office. Pens, key chains, and

A healthy new choice for dentistry
Find out why the A-dec 300 is a great choice for your practice.
For details contact your local authorised A-dec dealer or A-dec on 0800 233 285 or visit www.a-dec300.com

[30] =>

DTUK2009_01_Title

Education

Help where it’s due?
Could the NHS do more for those who want the
best available, yet essential treatment, but are
unable to afford it? Neel Kothari finds out

L
MAKE THE MOST OF YOUR SURGERY

Architectural Services

Surgery Design

ast week, an 18-year-old
patient came in with sever
facial trama, an avulsed
central incisor, as well as multiple fractures affecting his alveolar bone and incisor teeth, after
falling of his bike at speed.
Thankfully his wounds have
healed well. W have also been
able to temporarily restore some
of his teeth with composites and
a small denture, which will hopefully buy us some much needed
time, especially as he is soon to sit
his A-level exams. His family
would like him to have the best
treatment possible, ideally
within the NHS, but are aware of
the limitations within the NHS
especially with dental implants.

Once again, we hear the
phrase ‘clinically appropriate’ as
brandished all over NHS literature, but we are still left with the
reality of clinical opinion clearly
opposing the reality of clinical
practice, and I’m left in the situation where my patient still cannot
get an implant under the NHS.
While the public may be led to believe that actual clinical decisions
are based on clinically appropriate reasons many PCTs nationwide regard the provision of dental implants as ‘a low priority treatment other than in the selected
groups due to the availability of
more cost-effective treatments.’

A wider argument
Scope for treatment

Dental Equipment

Building Contract

Surgery Design

Architectural Services
-Feasibility Studies
-New Build
-Interior Design

Refurbishment
-Interior Refurbishment
-Exterior Refurbishment
-Building Contract

Complete Dental Equipment
- Dental Chairs
- X-ray Machine
- Washer Disinfectors
- Dental Handpieces
- Dental Instruments

Dental Cabinetry
- Metal Cabinetry
- Italian Design

After discussing his case with
an oral surgeon and a specialist
prosthodontist, it is clear his
avulsed tooth is best replaced by
a dental implant, so I decided to
find out the scope for this treatment under the NHS. After
searching through a range of online articles and NHS sources, the
conditions under which implant
services are available within the
NHS are still unclear.
For patients with congenitally missing teeth, as well as
head and neck pathology such as
cancer, there does appear to be
good scope for having dental implants, but if a patient suffers
from trauma it is still very blurry
as to whether the patient is eligible to get dental implants on the
NHS. I decided to contact my local maxilla-facial department to
find out more.
In my opinion, this patient
would be an excellent candidate
for dental implants, so why
should he have to pay for this privately if he is eligible for treatment at no cost to him under the
NHS? Discussing the case with
various clinicians it was clear
that they were not the ones deciding on which cases they could
provide implants for. Each case
has to be approved from senior
administrators, which leads me
to question how they judge suitability. Of course money matters
and the NHS must provide a costeffective solution, but how exactly do senior managers decide
the benefits in terms of quality of
life for individual patients needing dental implants?

This single dilemma draws a
wider argument into how NHS
dentistry is funded. As technology and dentistry continues to
progress it is clear that more consideration will need to be given to
complicated treatment items
such as implants. Since 2006 all
the evidence has shown the provision of more complex treatments has gone down within the
NHS, but this is not the case with
the rest of the world where the
provision of implantology is on
the rise as patients demand more
predictable, fixed long term options. But all this comes at a cost
and the real debate is not
whether implants or other complex dentistry is clinically effective but more a case of whether it
is cost effective. If we cannot provide dental implants to patients
with tooth loss due to trauma,
could NHS dentists also deny
treatments such as root canal
therapy on the same grounds of
cost effectiveness or is this a
bridge too far? (Excuse the pun.)

Unreasonable expectations
Personally, I’m still not absolutely convinced that the NHS
should provide dental implants, as
I’m sure PCTs do have other areas
of high priority, but asking a
teenager to pay the full whack for
a private implant retained crown
(which is clearly the best option
for him) is far too much to expect
from an average 18-year-old.
Surely here the government cannot claim that this would be a private option for ‘cosmetic improvement’ and if the patient does proceed with dental implants, does
this not return us to a time where
healthcare renews its links with
affluence rather than available to
all free at the point of delivery?

How funding is distributed
www.parsdental.com
info@parsdental.com
02087 884400

In my recent interview with
Chief Dental Officer Barry Cockcroft, I asked him about how the
NHS funds dental implants. Dr
Cockcroft replied: ‘We fund it
where it’s clinically appropriate
in the secondary sector, but at the
moment it’s not part of primary
care.’

In my opinion, something at
some point needs to change, but
as yet the more I read into this the
more confusing things seem to
get. While in an ideal world I
would like to think I could get an
implant under the NHS if I needed
it, I guess the reality is that I would
prefer to know that if I had a seri-

ous life-threatening illness, the
NHS is there to provide treatment.
This however still leaves a big
void in the middle where far too
many patients are having to go
private for treatments they feel
they need, not just elective cosmetic procedures like tooth
whitening.
The rising cost of dentistry as
well as a greater demand from
patients for fixed permanent
tooth replacements seems to get
lost within the fixed target driven
UDA system of commissioning
primary dental care. Whilst the
core values of helping those most
in need still remain, unless NHS
dentistry changes with the times
it will by de facto become a more
basic service.

Coughing up
My patient’s mother will probably pay privately for her son. She
has enquired whether the NHS
could pay for part of her treatment and she could top up the
rest, but as I have explained to
her, the NHS does not have scope
for that at present. Whether patients will ever have scope under
the NHS to have complex treatments such as implants under the
NHS in a part-payment system is
yet to be known, but the precedent has been set with drugs used
in the treatment of cancer (March
2009). Although this has come
under public criticism for introducing a two-tier system within
the NHS, the NHS still lives on
with more people now able to access a wider range of cancer medication as opposed to what the
NHS chooses to fund. DT

About the author

Neel Kothari
qualified as a dentist from Bristol
University Dental School in 2005,
and currently works in Cambridge
as an associate within the NHS. He
has completed a year-long postgraduate certificate in implantology at UCL’s Eastman Dental Institute, and regularly attends postgraduate courses to keep up-to-date
with current best practice. Immediately post graduation, he was able to
work in the older NHS system and
see the changes brought about
through the introduction of the new
NHS system. Like many other dentists, he has concerns for what the
future holds within the NHS and as
an NHS dentist, appreciates some of
the difficulties in providing dental
healthcare within this widely criticised system.

[31] =>

DTUK2009_01_Title

DENTAL TRIBUNE United Kingdom Edition · August 7–13, 2009

Industry Report 31

Infection control guidance
HTM 01-05 guidance requires that every practice should be capable of meeting the
essential quality requirements. Dental Tribune rounds up some important points

ealth Technical Memorandum 01-05 is intended
to progressively raise the
quality of decontamination work
in primary care dental services
by covering the decontamination
of reusable instruments within
dental facilities.
Patients deserve to be treated
in a safe and clean environment
with consistent standards of care
every time they receive treatment. It is essential that the risk
of person-to-person transmission of infections be minimised
as much as possible.
Here are some ways this can
be done.

Essential quality requirements
• Regardless of the technology
used, the cleaned instru-

ments, prior to sterilisation,
should be free of visible contaminants when inspected.
Instruments should be reprocessed using a validated
decontamination cycle including: cleaning/washing; a
validated steam steriliser, and
at the end of the reprocessing
cycle they should be in a sterilised state.
• Reprocessed dental instruments should be stored in such
a way as to ensure restraint of
microbiological recolonisation. These measures should
be backed by careful controls
on the storage times to which
instruments that are less frequently used are subject.
• Practices should audit their
decontamination processes

quarterly using an audit tool
(the use of the Infection Prevention Society/DH audit tool
that accompanies this document is strongly recommended).
• Practices should have in place
a detailed plan on how the provision of decontamination
services will move towards
best practice.
Best practice
To demonstrate best practice,
further improvements are required in three main areas:
• A cleaning process that should
be carried out using a validated
automated washer-disinfector.
• The environment in which decontamination is carried out

Postgraduate
Dental Education
New Course

MSc in Endodontics
Endodontic treatment is one of the most technically demanding
procedures in general dental practice. Growing demand from
patients for teeth to be saved rather than extracted has presented
a need for further training in this area. The Postgraduate
Dental Education Unit (PGDEU) at Warwick Medical School has
developed a new MSc in Endodontics to deliver comprehensive
and ﬂexible endodontic education.

should be such as to minimise
the risk of recontamination of
instruments and the possibility
of generating aerosols, which
may reach patients or unprotected staff. For best practice,
the decontamination facilities
should be clearly separate from
the clinical treatment area.
This implies the use of a separate room or rooms for the accommodation of clean (output)
and dirty (input) work. In these
facilities, the room(s) should be
used for this purpose only and
access should be restricted to
those staff performing decontamination duties. However,
plant and equipment not necessarily used for decontamination may be located in these
rooms (but preferably in the
dirty room) provided it can reasonably be shown that the de-

vices do not conflict with the requirement for a clean environment.
• The storage of reprocessed
dental instruments in a simple but carefully designed facility clearly separate from
the clinical treatment area is
an important best practice
improvement. The facility
should take account of the
need to reduce recolonisation of sterilised instruments
and also make the identification/selection of instruments
easy. This storage facility will
ordinarily be part of the clean
area within the decontamination room(s).
For a full report on the guidance,
visit the Department of Health
website at www.dh.gov.uk. DT

The MSc in Endodontics has been designed to develop your knowledge
and conﬁdence in this complex discipline, enabling you to deliver a high
quality service. As a part-time course spread over 3-5 years, it offers you
the ﬂexibility to continue working in clinical practice while studying.
You will study a wide range of topics from sterilisation and disinfection
procedures to tissue regeneration and preventing cross infections.
The closing date for applications is 15th October 2009.
Applicants should be registered with the General Dental Council
and have full professional indemnity insurance.

Contact Anne Duhig-Reader for further information,
quoting reference code: C0908F3

+44 (0) 24 7657 4640
dentists@warwick.ac.uk
www.warwick.ac.uk/go/dentistry

The PGDEU also offers: MSc Orthodontics, MSc Lingual Orthodontics, MSc Implant Dentistry and a range of short courses.

[32] =>

DTUK2009_01_Title

DENTAL TRIBUNE United Kingdom Edition · August 7–13, 2009

32 Infection Control
For
further
information
please contact Bien-Air on
01306 711 303 or visit www.
bienair.com

Tough Infection
Control with
The Dental
Directory

Topdental
Topdental are a leading specialist provider of every day
dental sundries and disposable
dental products. The current
Summer-2009 offer sheet offers
a FREE Digital Photo Frame
with remote on all orders over
£190 exc vat.

Safer Handpieces from
Bien-Air
To help prevent the risk of
cross-infection the Bien-Air
Unifix quick-connect couplings
are supplied with a non-return
valve, designed to prevent infection through the exhaust
line. Bien-Air turbines already
have a non-return valve incorporated into the water line in
the handle of the instrument,
but this additional valve provides even more ‘security’.

With the release of the updated HTM 01-05 government
guidelines and the outbreak of
the Swine-Flu H1N1 Virus,
never before has eliminating
the risk of cross infection been
so at the forefront of your mind
and so paramount for your dental practice.

The Issue 2 catalogue is now
available to order, featuring
over 1,000 commonly used
items, it is packed full of money
saving products and special
bulk purchase offers. All products featured come with a full
100% money back guarantee.
Topdental also manufacture
a range of infection control
chemicals, which cover all requirements in a typical dental
surgery environment. Items
such as surface wipes through
to water line treatments are
available at competitive prices.

Following the announcement of the World Health Organisations move to pandemic
phase 6 and the number of confirmed cases within the UK rising to 7,447* from Swine-Flu,
the necessity to follow best
practice guidelines and use
tested products to prevent
spread of infection and decontamination is clearly evermore
paramount.

As well as being able to place
your order from the comprehensive catalogue, you can also
order online at www.topdental.org , you will receive a 3%
discount on all on-line orders.

The Bien-Air range of instruments are designed with
safety as a major requirement.
All instruments are autoclaveable and/or can be cleaned and
disinfected to the highest criteria.
SPRAYNET 500 is perfect for
cleaning and disinfecting all
surfaces and hoses. The surfaces and grip of the handpieces
are easily cleaned; screws are
concealed to avoid possible areas where debris and germs can
accumulate; cleanliness has always been a feature of Switzerland and this has become integral with the design of instruments all of which are manufactured to European Standards.
Bien-Air is confident that they
provide the highest standards of
safety.

BioSonic UC125

ChairSafe is an aerosol and
alcohol free foam that is suitable, not only for alcohol sensitive materials such as leather,
acrylic glass and vinyl but also
hard surfaces, inventory and
medical products. It is effective
against HBV/HIV/HCV/BVDV/
vaccinia, bactericidal and fungicidal microorganisms within
one minute of application.

Proven
Coltène/Whaledent quality
with additional
customized
operation!
Cross Contamination procedures are an extremely important aspect of the dental surgery
so Coltene Whaledent is

Kemdent customers require
high quality, value for money
products. This foam provides
all dental professionals and
pleased to launch the new
BioSonic Ultrasonic Cleaning
Unit 125 which delivers a variety of customized options. The
cleaning time cycle can be selected individually, a countdown timer is available to inform the user with the amount
of cleaning time remaining, and
indicate exactly when the instruments will be ready for sterilisation. The new unit is
equipped with a solution tracking function to inform the user
how long the solution has been
in use, so that mandatory
changing of the cleaning solution will not be forgotten. With
a simple touch of a button, degassing of the solution, i.e. air

*As of 6th July 2009, www.direct.gov.uk/swineflu

If you would like to receive a
FREE copy of the catalogue
and regular offer sheets please
telephone: 0800 132 373

For further information on
special offers or to place orders call Jackie or Helen on
01793 770256 or visit our website www.kemdent.co.uk.

ChairSafe is the new disinfectant foam cleaner from the
Kemdent range of cross infection control products. ChairSafe
foam is specially formulated to
clean sensitive surfaces and
equipment, including
the
leather and synthetic facings of
dental chairs. As soon as you try
it you will recognise the real
benefit of this product.

Some of The Dental Directory’s range of own label Classic products have been tested
as effective against H1N1 Human Influenza Virus EN14476
(ATCC-VR-1469), Swine-Flu.
Our Classic Hard Surface Disinfectant Spray is for rapid disinfection of hard surfaces and
is available in 500ml trigger
spray bottle (GSC 300) and 5
litre refill (GSC 305).

The catalogue also includes
over 100 new products including uniforms, Topdental are
now the dental distributors for
leading uniform manufacturer
Simon Jersey.

their patients with the highest
possible level of protection. Because its non-drip, it is also economical to use.

ChairSafeaerosol and
alcohol free
foam for quick
disinfection
and cleaning
of surfaces

For our latest prices, full cross
infection range and advice
please call 0800 585 586 or visit
www.dental-directory.co.uk

DT page 33

Easy to use

Website
Comprehensive
Prices you can smile about

Spend just

Catalogue

£190 in Aug or Sept 2009*
www.topdental.org
0800 132 373

t o Fr ame
D ig it a l 7” P h o ide o s
P lays P h o t o s, V
a n d Mus ic
Great Summer

Free Gift
Topdental (Products) Ltd
Tel: 0870 7667 866, Fax: 01535 652 751
email: sales@topdental.co.uk, www.topdental.org

ck page of offer sheet for
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Great Special Offers
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Infection Control
products

[33] =>

DTUK2009_01_Title

DENTAL TRIBUNE United Kingdom Edition · August 7–13, 2009
DT page 32

entrapments which hinder the
cleaning process, will disappear. A comprehensive range of
accessories and BioSonic cleaning solutions are available to efficiently clean and disinfect instruments, prostheses, and
other items throughout the dental practice.
If you would like further information or to arrange a demonstration call free phone 0500
295454 www.coltenewhaledent.com

Kerr’s
Solutions
for Infection
Control
Have you ever had to deal
with staff shortage and busy
days, high-risk patients or autoclave breakdown? The new
Sterile Oral Health Examination Kit from Kerr is here to
help. This pre-sterilised examination kit is also perfect for
domicilliary visits.
This small sterile package
contains a tray with disposable
instruments including a stainless steel explorer probe, tweezers and mirror. Also included
are a patient bib, a napkin, 2 cotton wool rolls and 2 latex-free
‘ear loop’ masks. The sterile examination kits stack neatly for
easy storage and are available in
compact boxes of 50.
The kit was developed in
1997 by a maxillofacial surgeon
who recognised the need for
dentists to offer every patient a
routine examination using a

trol within the surgery environment, and in view of the recent
well publicised reports regarding re-use of dental instruments, Prima Dental Group are
proud to offer you the Sterisafe
range.
At last a full range of burs
are available in pre-sterilised
packaging only from Prima.
Whether you are looking for diamonds, tungsten carbide or
steel rotary instruments Prima
are able to supply the full complement.

More information is available
from Prestige Medical direct by
calling 01254 844 103 or email
sales@prestigemedical.co.uk

Many hospitals are taking
advantage of the Sterisafe burs
to ensure complete infection
control, particularly oral surgery departments and those
clinics offering implant treatments. It has been shown that
oral surgery burs may carry a
risk, albeit low, similar to that
of endodontic instruments in
the possible transmission of
vCJD. For absolute peace of
mind Sterisafe burs are the
only option.

For
further
information
please contact Kerr on 01733
892292.

Pre-sterilised
Burs from
Prima Dental
Group
With increasing emphasis
being placed on infection con-

Decontamination and Debris
Removal for
Your Dental
Instruments
from Dental Sky

For
further
information
please contact Prima Dental
Group on (0044) 1452 307 171
or visit www.primadentalgroup.com.

Infection
control in
safe hands
with Prestige
Medical
As a leading manufacturer of
decontamination
equipment, Prestige Medical say that
they have made it their business
to understand the requirements
of HTM 01-05 and are now in a
position of being able to provide
dental practices with a ‘one stop
shop’ for Integrated Decontamination Solutions.

complete sterile kit. First introduced into dental practices in
China the sales have grown today in excess of 7 million kits
per year. Users of this product
already claim savings in autoclaving costs making it one of
the most cost-effective products
that you can buy today.

ent monitoring of the equipment
4. Decontamination
procedures should be separated
from clinical procedures by
using either a designated
room or a designated area
within the surgery with a
dirty to clean workflow
5. A log must be kept for each
cycle of the equipment used
in the decontamination
process
6. Practices are encouraged to
plan to introduce washer disinfectors which will also improve the cleaning and disinfection of hand pieces.

Briefly, the essential requirements (to be in place by
January 2010) state that:
1. Effective decontamination,
infection control and health
and safety policies and procedures should be in place
2. Decontamination equipment
should be fit for purpose and
validated
3. Chart loggers or printers are
required to enable independ-

Dento-viractis 55 is a versatile combined pre-sterilisation
detergent that disinfects whilst
cleaning instruments. Dentoviractis has been designed
specifically to remove debris
from hand instruments and
surgical equipment prior to
sterilisation. It is particularly
useful in the removal of blood
and pus. It quickly dissolves
proteins due to its enzymatic
action. This bacterial, fungicidal and virucidal product is
available exclusively from
Dental Sky in either a 2kg or
5kg bucket or 50 unidoses of
15g each. Dento-viractis 55
dissolves quickly and easily
saving time and effort.
Competitively priced Dentoviractis 59 is a highly efficient
concentrate solution for cleaning and pre-disinfecting dental
instruments that is ideal for use
in your ultrasonic bath. This
grapefruit smelling product
speeds up the process of debris
removal and is also bactericidal, fungicidal and virucidal.
Dental Sky exclusively supply a complete range of Dentoviractis disinfecting products
developed specifically to meet
the demands of modern day
practice.
For further information or to
request you FREE catalogue
please contact Dental Sky on
0800 294 4700.

Industry News 33
Industry News

The only direct
composite that
could be called
Empress
IPS Empress Direct provides
outstanding results
IPS Empress Direct offers
the aesthetics of a ceramic combined with the convenience of a
composite – due to a wide range
of shades, various levels of
translucency and good processing properties.
The light-curing nano-hybrid composite IPS Empress Direct is based on the latest composite technology and was developed in cooperation with researchers, dental professionals
and colour specialists. Due to
the lifelike shades and opacities, natural looking and aesthetic results can be achieved
for all indications.
Anterior aesthetics
The properties of IPS Empress Direct are shown to full
advantage in demanding anterior restorations in particular.
The wide range of 35 dentin and
enamel shades in five levels of
translucency allow teeth to be
faithfully reconstructed. Two
high-end shade guides ensure
that the quality of the shade selection, as the starting point of
every highly aesthetic restorative procedure, is consistent.
Convenient handling
IPS Empress Direct offers
high stability, shade fidelity and
excellent modelling and polishing properties. The material’s
handling is also exceptional: As
the natural dentin is simply replaced by Dentin material and
the enamel by Enamel material,
there is no need for a “recipe”.
Even the physical properties
meet the highest demands, such
as an optimum radiopacity and
a low sensitivity to light. As a result of the low light sensitivity,
enough time is available to design the restorations without
pressure.
Proven system with new options
For nearly 20 years, IPS Empress has been synonymous
with all-ceramics and high exceptional aesthetics for the reconstruction of dental defects.
With the introduction of IPS
Empress Direct, the aesthetics
of the ceramic are now combined with the convenience of a
composite.
IPS Empress Direct is available both in syringes and in Cavifils.

Ivoclar Vivadent Ltd
Ground Floor,
Compass Building
Feldspar Close
Enderby
LE19 4SD
TEL:0116 284 7880

NEW Velopex
Intra-x
The new x-ray processor for
all sizes of intra-oral x-ray film
will be arriving over the Summer.
Simple Technology delivering proven archival quality film.
The new Velopex Intra-x
combines all the best features of
its predecessors as well as incorporating the latest electronic control systems.
The new Velopex Intra-x is a
high quality intra oral x-ray film
processor that has been designed to make the processing
of film simple.
• Simple to use and operate in
daylight - making the darkroom a thing of the past.
• Simple to position – its compact design means that it can
be sighted almost anywhere in
the surgery, sterilisation room
or office.
• Simple to maintain - making it
very user friendly.
The unique film transport
system has been designed by
our engineers to make ‘lost’
films a thing of the past.
The new Intra-x has a ‘super
fast’ facility for rapid processing
of endodontic films. This means
that a ‘wet’ film is available for
viewing in just 2 minutess!

For more information please
call Mark Chapman on 07734
044877, or your normal
Dealer

Nobel Biocare

NobelGuide™
for Precision
Planning
and Time
Management
Pioneers in digital dentistry, Nobel Biocare have
transformed treatment planning with NobelGuide™, the
leading diagnosis, planning

DT page 34

[34] =>

DTUK2009_01_Title

34 Industry News
DT page 33

and guided surgery software.
In addition to NobelGuide™,
Nobel Biocare’s complete oral
rehabilitation digital platform
includes state-of-the-art scanners and unique CAD/CAM capabilities for ultimate precision.
Reflecting the demands of
today’s restoration market,
CAD/CAM driven dentistry is
one of the fastest growing market sectors. CAD/CAM dentistry replaces traditional
labour-intensive processes,
increasing practice and procedure efficacy, and offers higher
quality product precision for
improved aesthetic results.
NobelGuide™ enables professionals to deliver treatments safely and with ease, allowing placement of the implant, abutment and restorative
crown
or
bridge
simultaneously. Prosthetics
can be pre-fabricated in the
dental lab and delivered to clinicians on the day of surgery.

No-Rust Cleaning solution New Omnisan
Forte from
PANADENT
Ideal for cleaning and storing all dental equipment, the
new Omnisan Forte cleaning

selection between 3 settings:
Full, Mandibular view and
Maxillary view. These enhanced views will also result in
faster reporting times when
follow-ups do not necessitate
full volume images. Additionally the GALAXIS v1.7 upgrade
further increases image quality and panorama precision.

solution with benzethonium
kills 99.9% of micro organisms
with 30 seconds (undiluted)
and 5 minutes at 1:2 dilution
(British Standard tests). More
concentrated than most leading brands and with up to 10
days lasting action, Omnisan
Forte represents outstanding
value for money as an every
day cleaning solution in the
surgery. RRP: £19.50 plus VAT
and carriage
Special introductory offer: Buy 2
Get one Free
Call Panadent: 01689 88 17 88 or
Henry Schein: 08700 102043

Universal
primer suitable
for all
restorations

By computerising every
step of the entire planning
process, the NobelGuide™ system offers significant benefits
to both dental professionals
and their patients through
flexible planning steps for optimal treatment flow.

For further information about
NobelGuide™ or to discuss
training in your area, please
call: +44 01895 452 912, or visit
www.nobelbiocare.com

DENTAL TRIBUNE United Kingdom Edition · August 7–13, 2009

Calypso: Fighting bacteria
with a tropical
twist
Septodont’s fresh tasting Calypso mouthwash is specifically
designed to cleanse and freshen
the patient’s mouth before, during and after dental treatments.
Not only does Calypso
mouthwash cleanse, but contains chlorhexidine gluconate
which acts as an antiseptic
agent against bacteria, viruses,
bacterial spores and fungi infections.
Calypso is supplied in an assorted pack or as individual
flavours of Orange, Raspberry
and Mint. To use, simply squirt
a pump-measured dose of the
antibacterial wash into a cup
and add water, it couldn’t be
easier!

Monobond Plus – one primer
for all materials
With
Monobond
Plus,
Ivoclar Vivadent is pleased to
announce the launch of a universal primer that helps establish a reliable bond to all
restorative materials.
Monobond Plus meets a requirement that is essential for
dental professionals: ease of
use. The innovative combination of three different functional groups – silane methacrylate, phosphoric acid methacrylate and sulfide methacrylate enables a strong and durable
bond to be established to any
restorative material.

Calypso is formulated for use
in the dental practice and is
available now. For more information on Calypso and other
products offered by Septodont
please contact your preferred
dealer, call 0800 435 155 or log
onto www.septodont.co.uk

Sirona 3D
imaging now
even more user
and patient
friendly

Therefore, there is no need
to purchase and store different
primers for different materials.
Uniform reaction time, easy
storage
Not only is the easy conditioning of the restorative surfaces an attractive feature of
Monobond Plus. The primer
also simplifies the bonding procedure, because a uniform reaction time of 60 seconds is
needed on all the various material surfaces.
In addition, Monobond Plus
does not require cool storage.
The universal primer can be
stored at room temperature.

Ivoclar Vivadent Ltd
Ground Floor,
Compass Building
Feldspar Close
Enderby
LE19 4SD
TEL:0116 284 7880

For further information please
contact: Sirona Dental Systems 0845 071 5040, Info@
sironadental.co.uk

Endodontic
vCPD at the
‘Theatre of
Dreams’ & the
'Bridge'.
GOAL: How to score in Endodontics
Dr Rich Mounce will lecture
at Old Trafford, Manchester on
the 5th November & Stamford
Bridge, Chelsea on the 6th November 2009.
This full day vCPD lecture
costing £150 will include refreshments, lunch & a complimentary tour of the stadium &
museum. Book today so not to
miss this amazing learning experience...
Kindly
make
cheques
payable to Ormco BV (SybronEndo Division) & send to Keith
Morgan c/o Kavo Dental Ltd.,
Raans Road, Amersham HP6
6JL

Contact keith.morgan@sybrondental.com for full vCPD
overview & key learning objectives.

Join the
Corsodyl 21
Day Challenge
For a Healthy
Mouth
With 90% of people suffering from gum disease at some
point in their lives1, it’s important to maintain healthy gums
and teeth everyday. That’s why
GlaxoSmithKline (GSK) Consumer Healthcare has launched
new Corsodyl Daily Gum &
Tooth Paste.

The all new GALILEOS
Comfort and GALILEOS Compact systems offer noticeable
advancements in the sphere of
3D X-ray equipment. Using innovative collimation these
models will further reduce the
radiation dose by 15% in comparison to the already low
full volume dose of the original GALILEOS. The new
GALILEOS collimation allows

To coincide with the launch
GSK is inviting people wanting
to maintain healthy gums to take
the ‘Corsodyl 21-day challenge’.
Participants to the Corsodyl
21-day challenge will be encouraged to use new Corsodyl
Daily Gum & Tooth Paste in
place of their regular toothpaste
for 21 days. Corsodyl Daily Gum

& Tooth Paste contains a special
combination of plant extracts
and mineral salt which means
that it has a unique taste which
may take a couple of weeks to
get used to.
Interested participants can
sign up for the challenge at
www.gumsmart.co.uk. They
will then receive a £1 coupon
to redeem against a purchase
of the toothpaste. Participants
can view other people’s experiences of using the product
for 21 days on the website and
will also receive supportive
advice from a panel of experts
over the three weeks of the
challenge.

The Future
of Cosmetic
Dentistry

The British Academy of Cosmetic Dentistry is holding its 6th
annual conference at the EICC
in Edinburgh from the 19th to
21st of November. The leading
source of innovative education,
the BACD promotes a dynamic
attitude to developing techniques, materials and skills in
all areas of Cosmetic Dentistry.
Recognising a shift in preference from traditional orthodontic methods to less invasive dental treatment, the BACD presents ‘Simple Orthodontics For
You and Your Patients – Panel
Presentation’. Demonstrating
the latest techniques available
for GDP’s, each speaker is a pioneer in their field of alternative
orthodontic treatment.
Attendees will gain confidence from demonstrated implementation techniques and
explore a wide range of simple
orthodontic systems to address
both the patient’s aesthetic and
functional needs.
Cosmetic Dentistry is moving away from aggressive tooth
preparations and toward less
invasive pre-alignment and
alignment techniques. Ensure
you are at the forefront of Cosmetic Dentistry in the UK and
secure your place at the 2009
BACD!
For more information or a
booking form please contact
Suzy Rowlands on 02082418526
or email suzy@bacd.com.

[35] =>

DTUK2009_01_Title

Dental Webinars
Be Wherever You Want
Let the Seminar Come to You...
DENTSPLY & Smile-on, two for-

ward thinking companies come together for a
ground breaking, interactive learning experience.
Engage with a leading expert, ask questions,
get solutions.
Relax in the comfort of your own home and keep
up to date through interacting with the world's
leading thinkers.

To find out more go to
www.dentalwebinars.co.uk
or call
020 7400 8989
or email
info@smile-on.com

Webinar 1:
Speaker:
Date:

Impression Taking for Dentures
Justin Stewart
17th September 2009, 7:30 - 9pm

Webinar 2:
Speaker:
Date:

Whitening
Trevor Bigg
13th October 2009, 7:30 - 9pm

Webinar 3:
Speaker:
Date:

Endodontics
Julian Webber
24th November 2009, 7:30 - 9pm

Webinar 4:
Speaker:
Date:

Preventing Periodontal Disease
Baldeesh Chana and Sarah Murray
30th November 2009, 7:30 - 9pm

Webinar 5:
Speaker:
Date:

Advanced Endodontics
Julian Webber
1st December 2009, 7:30 - 9pm

[36] =>

DTUK2009_01_Title

DENTAL TRIBUNE United Kingdom Edition · August 7–13, 2009

36 Events

The children of Musoma
Keval Ashok Shah goes on a life-changing journey to help make a
difference in Musoma, Tanzania
‘What
struck me
immediately,
was the pace…
how laidback
everything
was, compared to London. No one
seemed to be
in a hurry, and
I put it down
to the blazing
midday sun.’

fter months of anticipation, Tanzania came into
view. What better way to
define this than with the snow
peak of Kilimanjaro, glistening
in the moonlight. It was enough
to wake us up after the exhausting 14-hour journey from London Heathrow, as we drove
along a pitch-black road to an
inn in Moshi, where we were going to spend the first night.
Nothing prepares you for its
beauty, and one can only gawk
in wonder at its immense size.
The team staring out of the windows were Dr Manny Vasant,
Mrs Meena Vasant, Dr Kishor
Vasant, Dr Auriel Gibson, Hudson Cook (a builder by trade),
Fleur (a dental practice manager) and myself.

On the road
The next day, we visited the
town of Moshi, which is situated 70km east of Arusha. What
struck me immediately, was the
pace… how laidback everything was, compared to London. No one seemed to be in a

hurry, and I put it down to the
blazing midday sun. After buying much-needed bananas,
chocolates and water, we visited Marangu Falls, in the
foothills of Kilimanjaro. We
stood for a while and took in the
sight of the 60-foot cascade
dropping into a plunge pool,
which led away as a rivulet
through a dense jungle that
seemed to stretch for miles.

Marangu Falls, in the foothills of Kilimanjaro

The next we made our way
back to the airport to fly to
Mwanza, the southern port of
Lake Victoria. Looking out of
the plane, it was easy to see the
devastating impact of human
activity on the environment.
Hundreds of hectares of forests
had been cleared to make way
for grazing and farming, evident by myriads of white lanes
in the barren land. But that was
what it was – barren. I don’t
know if it was due to lack of
rainfall, or overuse… it just
seemed like a huge waste, land
that could no longer be used by
people or animals.
Upon landing, we visited the
Hindu Union Hospital, where I
witnessed a small portion of the

enormous contribution Manny
had made to the healthcare in
Tanzania. The dental clinic he
donated was well up and running, except for a handpiece,
that he quickly made a note to
fix.
A few more bottles of water,
and we began on the threehour journey to Musoma, with
the Serengeti rushing past us

Dr Manny Vasant and Prem

Arriving at Musoma
Dreams aside, we reached
Musoma, to be warmly welcomed by Denis Mahina, Andy
Vanzandt, Lizzie Cameron and
her parents. Denis, a small man
with a big heart, started the Lake
Victoria
Disability
Centre
(LVDC), with nothing more than
his savings and determination, to
improve access to social, economic and educational opportunities for disabled youths in the
Mara region of Tanzania. Many
articles are constructed by the
trainees and assistants (for example, desks, bicycles for the disabled) and sold to help fund the
project. The project is otherwise
funded by donation and has charitable status. The absence of regular funding is a continual problem.
Andy Vandanzt, a 22-year-old
qualified carpenter/joiner from
Suffolk, is spending three
months in Musoma to teach his
skills at the LVDC, and help with
its renovation.

plains their deep love for the
place and its people. Sadly, ever
since the 1970s, the town has suffered economic decline. The isolated rural majority across Mara
continue to suffer from abject
poverty due to an absence of employment opportunities, ill
health caused by malnutrition,
and shortage of schools and affordable health centres.

Rodney and Lizzie

Back to school

on the right as we touched its
western tip. As darkness fell,
the clouds gathered over the
heart of the Serengeti, and
gave birth to lightning. I could
just imagine the horror in the
eyes of a wildebeest, as the bolt
illuminated a crouching lioness with only one thing on its
mind.

Lizzie, a 26-year old graphic
designer from Edinburgh, Scotland, found out about the project,
and joined him, to work with the
local disabled children and
teenagers. She has been living in
Musoma for a year now, except
for one month this summer,
when she returned home to get a
job to fund her work and living
expenses in Tanzania.
A vibrant and beautiful town,
Musoma is situated on the shores
of Lake Victoria. Manny and
Kishor grew up here, which ex-

We planned to work in Musoma for four days, and Lizzie organised our schedule to see and
treat the children from the
Mwisenge Blind School, the
Mwembeni Deaf and Intellectually-impaired School, and the
youth from the LVDC. One in ten
people in Tanzania are disabled –
3.5 million people suffer from a
physical, mental, hearing or visual impairment. This statistic is
high because of causes such as
catching malaria or meningitis
as a baby, unprofessional administration of herbal medicine, mis-

[37] =>

DTUK2009_01_Title

DENTAL TRIBUNE United Kingdom Edition · August 7–13, 2009
Inside the clinic

Treating children from the Mwisenge
Blind School

handling during delivery, trachoma etc.
Education in Tanzania is
free, but clothing, books and
equipment need to be purchased. In rural areas, classes
are large, holding more than 60
students each. Approximately
80 per cent of children attend to
the age of 11 but only 30 per cent
go on to secondary education.
Books, writing materials,
teachers and their assistants,
are all in short supply. Swahili is
the taught language of primary
school and English at secondary level.
The classrooms did not have
adequate light, so I decided to
do the check-ups outside.
Within seconds of suggesting
this, benches and chairs were
brought out and transformed
into a makeshift dental chair
and the largest waiting room I
had ever seen.
The blind kids had never
had their mouth checked and
treated. So, understandably, a
number of them were pretty apprehensive about what was to
be done. But after a few successful check-ups, word spread
among them, and everyone
happily consented to it. I
needed to revise my Swahili
quickly to enable reassuring
conversation. Thankfully, I was
in the company of very helpful
people, and everything ran
smoothly. Halfway through my
checkups, the children sang
songs to show their gratitude;
their voices were simply divine.
While Hudson and Fleur
helped out with the renovations
at the LVDC, Lizzie, Sandra,
Meena and I continued with the
dental check-ups, through the
morning. If it wasn’t for the cool
shade provided by the trees, we
would have baked under the
midday African sun. We took
the kids that needed further
treatment to the dental surgery
at the Musoma Regional Hospital, and helped them as much as
we could. The treatments included extractions of decayed
teeth and fillings, and referrals
to other departments if required. Thankfully, no one appeared obviously malnourished, and the kids were well
clothed and took pride in their
appearance.

The surgery itself needed a lot
of organisation. This was probably the first time that the challenges of health care in the developing world, hit home. Everything that I took for granted
working in my cosy clinic in
Northampton, had to be
arranged – the different types of
equipment, nursing staff, the administration, ensuring infection
control, and making sure we did
not get in each other’s way working in a small room. But Auriel’s
determination and Manny’s cool
exterior drove me on. At the end
of the day, we were exhausted,
but very happy that we could
slightly improve the lives of these
children.
While the first day’s challenge was verbally communicating reassurance to the kids who
could not see, the next day’s hurdle was to successfully gesture to
those who could not hear. The
teachers at the Mwembeni Deaf
School taught us basic sign language, but I realised that if you
looked into the child’s eyes with
an honest willingness to help
him/her, that child put all their
trust in you. A gentle reassuring
hand on the shoulder was
enough to put them at ease. The
most challenging were the mentally impaired kids, but the headmaster’s kind words and reassurance enabled their compliance.
Children that we thought had a
systemic illness or condition,
were referred onto Dr Kishor
Vasant to examine and facilitate
further treatment.
Whichever school we went to,
we were welcomed wholeheart-

Prevention better
than the cure

Prevention always being better than a cure, we returned to the
Mwisenge Blind School, the next
day, and gave a little talk on tooth
decay, and the diet responsible
for it. We then sat down with each
kid, and taught him/her how to
brush well. Thankfully, no one
found it boring because my broken Swahili proved to be thoroughly entertaining. At the end of
it, even I couldn’t keep a straight
face!

‘The unseen
killers in this
part of Africa
are malaria
and HIV.’

me!’ psychology to caring more
about others who need help.

The unseen killers in this part
of Africa are malaria and HIV.
The population of mosquitoes
grows, the nearer you get to the
lake. A number of Dennis’s family members, including himself
and little Rodney, have tasted the
wrath of this disease, and he is
now in the process of raising capital to build a house away from
the shores. But it has been challenging for him, as most of the
time, he is working voluntarily.

The way forward

This trip has strengthened my
purpose in life – reduce poverty
and conserve what is left of nature. The two cannot be separated; if one worsens, so does the
other, and vice versa. It has never
been enough to just sit back and
wait for governments and organisations to make a move. Mahatma Gandhi said: ‘We must become the change we want to see
in the world.’

Prevention is key to the reduction of the prevalence of
these diseases. Education and
healthcare are the weapons of
choice. Just at the entrance of one
of the schools, we discovered a
massive collection of stagnant
water – a breeding ground for
mosquitoes. Measures such as
eradication of these hotspots,
and the provision of mosquito
nets, would go a long way indeed.
Over the years, Manny has spent
significant time and energy, in

Denis is planning to arrange
an outreach programme to target people in the rural parts of
Africa, to get people aware of
AIDS and a range of other disabilities and how to prevent
them. To raise funds, he is
thinking of opening a pizza
takeaway service…the first in
Musoma. He continues to support his family, and provide a
home to other children who
need one. He is the driving force
behind the LVDC, and an inspiration to all who know him.

Overpopulation is a basic issue that needs to come first on
the agenda of every charity in
existence. It cannot be ignored.
All our efforts are cancelled out
if we cannot control the growth
of the human population. No
one likes a crowded train or
having to fight for jobs…at the
rate at which we are going, we
will soon have to fight for food
and water, a phenomenon already facing the millions living
in poverty.

The view over the Serengeti

raising awareness and funds to
improve healthcare in Musoma.
Despite contributions from a few
organisations, the majority of
these funds have originated from
his own hard-earned wealth. He
has facilitated the provision of

‘All the little kids rushed to
shake our hands or give us a
hug…and their smiles got imprinted in my head forever.’
edly…and treated with respect
and genuine affection. All the little kids rushed to shake our
hands or give us a hug…and their
smiles got imprinted in my head
forever.

Events 37

dental equipment, including
units and dental chairs, and medical necessities like oxygen cylinders, defibrillators and beds.
We spent the remaining days
in Tanzania, admiring nature in
the Serengeti and Ngorongoro.
Words cannot describe the feeling of being among some of the
most beautiful animals on Earth
– wildebeests migrating in their
hundreds, elephants drinking in
the river and watching their little
ones wading around in excitement, monkeys hiding their babies as we approach, lionesses
stalking their prey amongst the
savannah, zebras grazing in
pairs, giraffes walking in majestic strides, giant hippos enjoying
the sun, and a lazy leopard fast
asleep on an acacia tree. It is simply paradise. And if they don’t
move you, the Serengeti sunset
will.
Yet despite all that we have
been blessed with, we choose to
destroy it, and deny the goodness
of this world to the children of tomorrow.

Lizzie has become an angel
for the kids in Musoma, a constant provider of joy for them.
She continues her work with the
local disabled children and
teenagers, teaching and caring
for them, and always thinking of
ways to improve their lives. Sandra aids in her daughter’s work,
and manages health care for the
children. Gilbert, Lizzie’s dad, a
teacher by profession, is in the
process of helping in the renovation of LVDC, and building
Dennis’s new home.
Manny and Auriel have put
their efforts into creating a
medical and dental training
centre, adjacent to LVDC. This
would aim to train local persons
to become adept at recognising
disease, and act alongside a
trained and experienced dentist. The knowledge and expertise of dentists from the UK
would be greatly welcome, in
addition to final year dental students from the UK to visit and
carry out treatment, and other
research activities within an
‘elective’ framework. In addition to this, Manny is trying to
raise money to improve LVDC
itself. Donations will allow the
construction of dormitories for
disabled students from other
areas, employment of more
staff to teach the necessary
communication skills, construction of classrooms, and development of a health outreach
programme for the Lake Victoria region.
Upon returning to the UK,
Andy Vanzandt plans to continue being involved in projects
aimed at reducing world
poverty.

It will take all of us to make a
real and significant change in
this world. And how we live here,
affects everything and everyone
around us. The fundamental
problem is the ‘me, me, me’ psychology and the ‘I want more’
lifestyle.

Survival of the fittest can be
allowed in the Serengeti… not in
London, New York and Dubai!
We have evolved beyond searching for food and shelter in the
wild, to become intelligent beings that are capable of caring for
more than ourselves. As poorer
countries develop to give their
people basic healthcare, education and nutrition, more resources will be consumed and
the environment will have to pay
dearly for this. We must change
our lifestyle to accommodate
this.
It is time to give more, take
less and evolve further. It is time
to become the change. DT

About the author

A better place

Keval Ashok Shah

This has been a true example
of the power of the individual to
make the world a better place; an
illustration of a deeper approach
to the reduction of poverty
through improvement of health
care; a case of not following like
sheep, doing your own thinking,
and taking matters into your own
hands; a shift from the ‘me me

is a community dentist, working in
Northampton. He gives special
thanks to Iain Scott, and his books
What will it take? and Actions speak
louder than words. He believes that
time is of the essence and that we
need to act now to make a difference. You can email him on
keval.a.shah@hotmail.co.uk or
text/call him on 07828 972189.

[38] =>

DTUK2009_01_Title

DENTAL TRIBUNE United Kingdom Edition · August 7–13, 2009

38 Classified

Distinguish yourself

DENTAL INSTITUTE Distance Learning
A unique education experience with access to world-leading experts
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AYUB

ENDODONTICS

www.ayub-endo.com
WIMBLEDON

MClinDent Fixed & Removable Prosthodontics
MSc Advanced General Dental Practice
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www.kcl.ac.uk/distancedentistry

SPECIALIST DENTAL ACCOUNTANTS
- Assistance with Buying & Setting Up Practices
- New PDS/GDS Contract Advice
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- Incorporation Advice
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- Help for Dentists from Overseas
- We act for more than 550 Dentists

Please contact:
Nick Ledingham BSc, FCA
Tel: 01244 328301
Email: mail@moco.co.uk
Website: www.moco.co.uk/dentists

Dental Education Ltd

PRESENTS
ESSENTIAL KNOWLEDGE

Dr. Howard Stean
Clinician, author and tutor

Course in Aesthetic Restorative Dentistry
September 2009– 2010
5 months one Wednesday per month
s Suitable for newly qualified and experienced dentists
s Fully updated syllabus with state of the art illustrations
s Practical exercises and assisted study

The Course venue in Kew, West London is
conveniently located and timed to be accessible
from most parts of the UK

Your Specialist Legal Provider
We deliver a specialist legal service tailored
to the needs of the dental profession.
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SURIHVVLRQLWLVLPSRUWDQWWKDWZHHPSOR\WKHULJKWSHRSOH
WRHQVXUHZHFRPSOHWHWKHMRELQDprompt, supportive DQG
effectivePDQQHU½UVWWLPHHYHU\WLPH©WKDWµVZK\ZH
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WRXVDQGRXUFOLHQWV

The Course is eligible for 30 hours Verifiable CPD
& a Certificate will be issued
Fee of £2250 (plus vat) that includes Course material and buffet

CALL 0208 876 4542 or Email: howardstean@ukteeth.com
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For a FIXED FEE quotation please call

email dental.team@cohencramer.co.uk

FREEPHONE 0800 542 9408

or visit www.cohencramer.co.uk

[39] =>

DTUK2009_01_Title

DENTAL TRIBUNE United Kingdom Edition · August 7–13, 2009

Classified 39

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Something to
Smile about!...

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SmileGuard is part of the OPRO Group, internationally renowned for revolutionising the
world of custom-fitting mouthguards. Our task is to support the dental professional with
the very latest and best oral protection and thermoformed products available today.

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Custom-fitting Mouthguards* – the best protection for teeth
against sporting oro-facial injuries and concussion.

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OPROshield – a self-fit guard enabling patients
to play sport whilst awaiting their custom–fit guard.

[40] =>

DTUK2009_01_Title

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D;>C8G:6H>C<7GJH=>C<I>B:
To motivate behavioural change, it helps if patients understand the beneﬁts
of brushing for at least 2 minutes twice a day with ﬂuoride toothpaste,
compared to an average brushing time of around 46 seconds.1
New research results from Aquafresh show that increasing brushing time:
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26% more plaque removal
was observed with brushing
for 120 seconds compared
with 45 seconds*2

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Recommend a great
tasting ﬂuoride dentifrice
to encourage your
patients to brush for
longer, for increased
ﬂuoride protection and
plaque removal

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fashion over the period
30–180 seconds*3

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1. Beals D, Ngo T, Feng Y, et al. Development and laboratory evaluation of a new toothbrush with a novel brush head design. Am J Dent 2000; 13: SpIss 5A–13A.
2. Gallagher A, Sowinski J et al. The effect of brushing time and dentifrice on dental plaque removal in vivo. [Accepted for publication in J Dent Hyg]
3. Zero DT, Creeth JE et al. The effect of brushing time and dentifrice dose on ﬂuoride delivery in vivo and enamel surface microhardness in situ. [Manuscript submitted]
AQUAFRESH is a registered trade mark of the GlaxoSmithKline group of companies.

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[page] => 29
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[12] => Array
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Table of contents

Postcode lottery

01 - 01

view

News

02 - 03

view

News & Opinions

04 - 08

view

A smooth transaction

09 - 09

view

Don’t wait - act now

10 - 10

view

Saving for school

11 - 11

view

Tax-planning checklist

12 - 12

view

Perio Tribune

13 - 23

view

Leadership essentials for the ‘rookie’

24 - 24

view

Setting yourself free

25 - 25

view

The 10th Dimension… the power of 10

27 - 28

view

In this economy - customer service matters more than ever!

29 - 29

view

Help where it’s due?

30 - 30

view

Infection control guidance

31 - 32

view

Industry News

33 - 34

view

The children of Musoma

36 - 37

view

Classified

38 - 39

view

[toc_titles] => Postcode lottery
/ News
/ News & Opinions
/ A smooth transaction
/ Don’t wait - act now
/ Saving for school
/ Tax-planning checklist
/ Perio Tribune
/ Leadership essentials for the ‘rookie’
/ Setting yourself free
/ The 10th Dimension… the power of 10
/ In this economy - customer service matters more than ever!
/ Help where it’s due?
/ Infection control guidance
/ Industry News
/ The children of Musoma
/ Classified

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