DT UK 2209
‘Filthy’ dental laboratory put workers’ health at risk
/ News
/ News & Opinions
/ Reflection from Northern Ireland
/ News & Opinions
/ The 10th Dimension… the power of 10
/ Exercising caution
/ Prevention is better than the cure
/ Survival of the fittest
/ What’s mine is yours?
/ Company Promotion
/ Choosing an adviser
/ Keeping up appearances
/ Do you want a challenge?
/ The future of dental training
/ Home alone
/ The importance of groundwork
/ Clinical
/ Industry News
/ Dental care for everyone
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DTUK2209_01_Title.qxd
DENTAL TRIBUNE
The World’s Dental Newspaper · United Kingdom Edition
PUBLISHED IN LONDON
News in brief
SEPTEMBER 14–20, 2009
News
Feature
VOL. 3 NO. 22
Money Matters
Education
Retention fee
Just over 4,000 dental care professionals (DCPs) have been removed from the General Dental
Council register for failing to pay
the annual retention fee (ARF);
and 651 other DCPs have specifically asked to be removed for
reasons including taking a career break or retiring.
Letters informing registrants
who have not paid their ARF that
they are being removed from the
register were sent out on 18 August. Primary Care Trusts,
Health Boards, Deaneries and
indemnity providers have also
been informed.
CERK updated
The book Clinical Examination
and Record Keeping: Good Practice Guidelines has been updated in line with the latest guidance from the General Dental
Council (GDC), the British Dental Association, the National Institute for Health and Clinical
Excellence (NICE) and the Faculty of General Dental Practice
(UK) FGDP(UK).
Where possible, the book includes parallel guidance on
Scottish standards regulations.
The updated edition, which advises and informs the clinician
on the practical and legal aspects of record-keeping, whilst
complying with clinical governance is available now.
Birmingham bonus
Survive and thrive
Endless search
Challenge Nepal
New NHS dental practice for
Birmingham’s Selley Oak area;
plus dentists urged to look out for
child abuse when treating kids.
Mark Garner looks at ways to acknowledge and change the loss
in patient numbers in an increasingly competitive market.
Is it possible to find a financial adviser that will work on your behalf, without being influenced by
commission payments from
product providers?
Trekking Encounters looks at the
benefits of volunteering your
skills in one of the highest countries on earth.
page4
page11
page16
page19
‘Filthy’ dental laboratory put workers’ health at risk
A
‘filthy’ dental laboratory
that put workers’ health at
risk, has been ordered to
pay £4,000 in fines and court costs.
Rossford Dental Laboratory in
Swinton, Greater Manchester,
which specialises in manufacturing dentures, gum shields and
other dental products, was fined
£2,500 and ordered to pay costs of
£1,500 at Trafford Magistrates’
Court.
The laboratory was served
with an Improvement Notice after
a Health and Safety Executive
(HSE) inspector visited the site
and found it to be ‘extremely unclean’, putting the health of workers at risk.
It was given two months to comply with the Improvement Notice
however it failed to clean up its act.
HSE Inspector Matt Greenly
said the laboratory was in a ‘filthy
state’ and ‘there were layers of debris everywhere, the sinks were
blocked and waste materials had
been allowed to build up throughout the premises’.
He added: “Improvement Notices should act as a wake-up call
for companies to improve their
health and safety procedures, for
their own and their employees’
benefit. Unfortunately, in this
case, Rossford appears to have ignored the warning and carried on
as normal.”
without making any improvements.”
“HSE realises that many companies are under a lot of pressure
at the moment, but that’s not an excuse for ignoring health and
safety.”
There are two types of
notices - improvement and prohibition.
“We will try to be understanding if people have genuine reasons
for not meeting deadlines, but they
can’t just hope they’ll get away
HSE issues enforcement notices when it finds serious
breaches of health and safety regulations.
Improvement Notices require
any changes to be made within at
least 21 days, and Prohibition Notices stop work from taking place
until the specific improvements
have been made. DT
Dentistry website
The UK website, the Cosmetic
Dentistry Guide, is now the
world’s most visited cosmetic
dentistry website, according to
Alexa, the web information
company. Viewed by more than
140,000 visitors a month and
climbing, the website has now
overtaken the American website www.mynewsmile.com
The site includes easy to understand information about cosmetic dental procedures, the latest news and innovations in cosmetic dentistry and ‘Find a local
cosmetic dentist’ directory.
Scottish children
The number of Scottish children
registered with an NHS dentist
has risen to its highest level ever.
Statistics show that the number
of children aged between three
and five registered with a dentist
has gone up by nearly 15 per cent
in the last two years, to 80 per
cent.
Lothian has one of the best registration rates in the country,
with 91.5 per cent registered
with a dentist.
Public health minister Shona
Robison claimed it shows that
strategies to encourage parents
to register their children are
working.
www.dental-tribune.co.uk
Dentist suspended after failing
to reveal £25,000 theft
A
dentist has been suspended for a year after he
applied for a job with a
primary care trust, despite being investigated by the police
over a £25,000 theft.
Samit Ashok Shah, was convicted of stealing £25,000 from
his employer, John Lewis Plc, on
4 August at Southwark Crown
Court in London
The General Dental Council’s (GDC) Professional Conduct Committee heard that Mr
Shah failed to disclose he was
under investigation by the police when he applied to the GDC
for registration on the Dentists
Register and to the London
Deanery for the position of specialist registrar in Dental Public
Health. He also failed to disclose
the criminal proceedings which
led to his conviction on his applications for employment to the
Hillingdon Primary Care Trust
(PCT) and the St. Mary’s NHS
Trust.
Mr Shah admitted all of the
heads of charge and his fitness to
®
practise was found to be impaired by reason of his misconduct.
A spokeswoman for the GDC
said: ‘The Committee was clear
that this misconduct was not
only dishonest, but also has a
profound, adverse impact on
the reputation of, and public
confidence in, the profession.
However the Committee was
told that Mr Shah is an exceptionally bright and valued dentist
who is involved in volunteer and
charity work. It also heard that at
the time of the offence he was under intense personal pressure.’
She added that the Committee
‘was satisfied that he has shown
insight and remorse at having
been convicted of dishonesty.
The Committee was also very impressed with the current level of
professional support from senior
colleagues.’
The Committee considered
the matter to be very serious.
However in the light of everything it heard, it decided to suspend him for a year. DT
Plastic coated – no big shock!
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With plastic-coated wires and a choice of
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All TePe Interdental Brushes have
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For more information, please contact Molar Ltd
on 01934 710022 or visit www.molarltd.co.uk
[2] =>
DTUK2209_01_Title.qxd
2
DENTAL TRIBUNE United Kingdom Edition · September 14–20, 2009
News
Dentist escapes Parents pay more than £1K
being struck off for Britain’s first tooth bank
A
dentist who failed to properly treat a woman's
chronic gum disease and
had to repeatedly fix his own
work, has escaped being struck
off the dental register.
Glaswegian dentist, Stephen
Reid, formerly of The Station
Clinic, Shotts in Lanarkshire saw
the patient 90 times in seven
years between November 1999
and 2006.
However the General Dental
Council (GDC) heard that even
after all this work, the woman
still needed dentures.
Dr Reid did not give the
woman advice on oral hygiene
and had to cut some of the
woman’s gum after crowns he
had fitted caused an infection.
However the GDC heard that
Dr Reid was under a lot of pressure during this time and was seeing more than 40 patients a day.
The chairman of the panel, told
Dr Reid that the committee was
‘satisfied that these circumstances’
played a part in failing to treat and
properly manage the patient.
Dr Reid had acknowledged that
he had been under too much pressure by selling the practice in 2006.
He had also expressed ‘regret
and remorse’ and recently been
accepted onto an MSc course.
In light of this, the GDC decided that his continued practise
did not present a risk to the public and that his fitness to practise
was not impaired. DT
‘Hard sell’ dentist allowed
to practise again
A
dentist accused of adopting a ‘hard sell’ approach
in getting a patient to pay
for unnecessary orthodontic
treatment, has been allowed to
practise again.
The General Dental Council
found that Davinder Singh Jamus, had made it a requirement
for a patient to view a promotional DVD of cosmetic treatments available at his clinic, and
had adopted a ‘hard sell’ approach towards the provision of
unnecessary orthodontic treatment, both of which are contrary
to best professional practice.
The Committee met to review
the four-month suspension of Mr
Jamus following the earlier hearing, in which his fitness to practise was found to be impaired.
At the hearing, the chairman
said: “This Committee has been
encouraged by your demonstration of improved insight as well
as your recognition that a change
of attitude was necessary. You
have satisfied us that you fully
understand that your rehabilitation has started, but is an on-going process.”
T
The information gathered
from the survey (no personal
details such as name and email
address) will be used in discussions with the General Dental
Council (GDC) regarding the
need to lower the Annual Retention Fee (ARF).
A spokeswoman for the
BADN said: ‘In order to prove
that the £96 ARF is too high for
dental nurses, we need to gather
BioEden is Britain’s first tooth
bank and parents pay £950 for the
privilege, plus an annual £90
service charge.
When their child’s tooth falls
out, they pack it up into a special
container, which is then couriered
to the company’s lab in Cheshire.
The company has been helped
on its way by UK Trade and Investment (UKTI), the joint department run by the FCO (Foreign and
Before the event, Romsey
dentist, Richard Hurrell, said: “I
am really looking forward to the
National 3-peaks Challenge, especially after all the preparation
and practice we have been doing.
I think the real test will be the
lack of sleep as we travel to the
next location, but although I
know it will be tough, I also know
information on salary levels and
other working conditions.’
The BADN is also upset that
the GDC did not consult with
the association before the registration fees were set.
To take part in the survey, go to
www.badn.org.uk DT
Dr James said: “We’ve had
teeth arriving from Kuwait, In-
Stem cell research is still in its
infancy, but by the time this generation of BioEden children are
grown up, scientists believe it
could be possible to use their cells
to treat diseases they might develop, ranging from Alzheimer’s
to Multiple Sclerosis to Parkinson’s. DT
The climb, which took place
on the 12-13 September, involved
scaling the three highest peaks in
Britain over a 24-hour period.
All the money raised will go
toward helping oral health charity Dentaid supply countries in
the developing world with access
to dentistry.
The BADN believes that as
dental nurses earn less than
hygienists and therapists, the
ARF should reflect this.
With the help of a dozen investors, he set up BioEden, which
complies with strict European
regulations from the Human Tissue Authority.
BioEden extracts the stem
cells from the teeth and then
freezes them. One set of cells is
stored in Cheshire, the other in a
secret lab in case of an accident
such as a fire at the main site.
M
“The Committee also is satisfied that the progress you have
made, and your commitment to
continue with your professional
development, are sufficient for it
not to impose conditions on your
registration.”
The £96 fee has been set at
the same rate as hygienists and
therapists.
BioEden was founded in 2007
by dentist David James, after he
found research on the internet by
Dr Songtai Shi, a cellular biologist at the National Institute of
Health in America, who had discovered stem cells in his young
daughter's milk teeth.
dia and Italy. As long as we get
the tooth within the 48 hours and
it’s healthy, we can harvest the
cells.”
embers of the Denplan
dental payment plan
team took part in the National 3-Peaks challenge to raise
vital funds for the oral health
charity Dentaid.
The Denplan team climbed
Snowdon (1085m/3560ft), Scafell
Pike (978m/3209ft) and Ben
Nevis (1344m/4408ft) and covered approximately 27 miles during the 24-hour period.
The Committee stopped the
suspension and decided he could
resume unrestricted practice. DT
Commonwealth Office) and the
Department for Business, Enterprise and Regulatory Reform.
Denplan takes on climbing
challenge for oral health charity
“In the light of evidence put
before us today the Committee
feels that to order a further period
of suspension would be disproportionate, punitive and would
not be in the public interest.”
Call for dental nurses to
take part in salary survey
he British Association of
Dental Nurses (BADN) is
calling for all dental
nurses to take part in its confidential salary survey.
P
arents are paying more
than £1,000 to freeze stem
cells from their children’s
milk teeth as an insurance policy
against diseases they might develop when they grow up.
all the good our sponsorship will
do for Dentaid...can’t wait!”
Members of the Denplan team
in Winchester recently took part in
the Yorkshire 3-Peaks challenge
also raising money for Dentaid.
This event consisted of a hiking route climbing the three highest peaks in Yorkshire - Pen-yghent (691m), Whernside (728m),
and Ingleborough (723m).”
One of the volunteers, Guillaume Hermile, said: “The Yorkshire 3-peak challenge was fantastic fun and we raised hundreds of pounds for Dentaid.
“We had great weather and all
enjoyed the day very much. It
nearly killed us, but we are all
still alive and breathing and
helping this worthy cause really
spurred us on to complete the 25mile route.” DT
International Imprint
Executive Vice President
Marketing & Sales
Peter Witteczek
p.witteczek@dental-tribune.com
DENTAL TRIBUNE
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
Managing Director
Mash Seriki
Mash@dentaltribuneuk.com
Editor
Lisa Townshend
Tel.: 020 7400 8979
Lisa@dentaltribuneuk.com
Director
Noam Tamir
Noam@dentaltribuneuk.com
Advertising Director
Joe Aspis
Tel.: 020 7400 8969
Joe@dentaltribuneuk.com
Marketing Manager
Laura McKenzie
Laura@dentaltribuneuk.com
Dental Tribune UK Ltd
4th Floor, Treasure House
19–21 Hatton Garden
London, EC1N 8BA
[3] =>
DTUK2209_01_Title.qxd
DENTAL TRIBUNE United Kingdom Edition · September 14–20, 2009
Editorial comment
Conference calling
This week has seen the
great migration of school
children and commuters
back to their usual routine. The trains are
busier, the roads are
busier and the cool kids are see-
‘
Smile-on at
this year’s
FDI Annual
World Dental
Congress
D
ental professionals visiting this year’s FDI Annual
World Dental Congress in
Singapore were able to explore
the latest innovations in dental
technologies and education at
the Smile-on stand.
The FDI Annual World Dental
Congress plays an important role
in the advancement of dentistry.
At the Congress, Smile-on in
association with Dental Protection Ltd (DPL) launched the next
three modules of Communication
in Dentistry, an outstanding flexible approach to dental training.
The Modules 4 to 6 of Communication in Dentistry consist of:
Module 4: Complaint handling
and dealing with difficult patients
Module 5: Consent and communicating choices
Module 6: Recording communications
A spokeswoman for Smile-on
said: ‘With a focus on key areas in
which effective and reliable lines of
communication are absolutely vital, these modules will help the
practice to develop working systems that will ensure patients receive the best possible standard of
service, and that all relevant information is recorded to protect the
practice medico-legally.’
Kevin Lewis, dental director for
DPL and John Tiernan, DPL’s assistant dental director, introduced the
cutting edge technology and visitors enjoyed the many screenings of
the exciting new footage from Communication in Dentistry 2 and a
glass of champagne with the team.’
Professor Raman Bedi, former
chief dental officer for England, was
also on hand to discuss his exciting
new online community Dentalghar, (www.dentalghar.com) offering professionals an invaluable opportunity to join a global network
and explore the latest news, case
studies, interviews, special offers
and charitable events.
For more information on any
of Smile-on’s educational resources please call 020 7400 8989
or email info@smile-on.com DT
ing exactly how far removed from
the regimented school uniform
they can get away with whilst still
wearing a tie and blazer.
This time of year signals for
me a shift in the mindset as the
trade and profession alike look to
the busy period between now
and the C-word (that’s Christmas for those who thought I was
referring to something else!).
The next three months sees a
flurry of conferences and exhibi-
News
tions across a variety of dental
disciplines and organisations,
including:
• European Society of Endodontology Biennial Congress – 2426 September , Edinburgh
• British Society of Dental Hygienists & Therapists Annual
Conference – 16-17 October,
Bournemouth
• British Association of Dental
Nurses Annual Meeting – 23-24
October, Cheltenham
• British Dental Trade Association Dental Showcase Exhibi-
3
tion – 12-14 November, Birmingham
• British Academy of Cosmetic
Dentistry – 19-21 November,
Edinburgh
I am looking forward to attending as many as I can over the coming months to keep readers up to
date with the current thinking in
these areas of dentistry.
Got something to say?
E-mail me at lisa@
dentaltribuneuk.com DT
’
[4] =>
DTUK2209_01_Title.qxd
News & Opinions
4
DENTAL TRIBUNE United Kingdom Edition · September 14–20, 2009
New endodontics clinic opens
The opening was attended by more than 50 of
Dr Bhanderi’s referring
general dentists plus the
business coach Chris Barrow.
Dr Bhanderi’s referred patients come
from a wide catchment
area from as far as North
Wales, Lancashire, as
well as locally from Manchester and Cheshire.
He has established Endo
61 for easy accessibility
close to the major motorways around South Manchester.
new clinic specialising in
endodontics has opened
in the north west of Eng-
Dr Bhanderi said:
“The dental surgery is
usually the last place
where referred patients
want to be, so I wanted to
create an environment that would
make their experience with me as
comfortable as possible.”
Dr Sanjeev Bhanderi, a registered specialist in endodontics,
has opened a new state-of-theart specialist endodontic practice called Endo 61 in Gatley in
South Manchester.
He has an ongoing commitment to the teaching of postgraduate endodontics with the
University of Manchester and
Endo 61 is already used for
teaching their visiting postgraduate students.
A
land.
The patient lounge and consultation rooms on the ground
floor are equipped to double-up
as teaching rooms with LCD displays that can stream live procedures performed by Dr Bhanderi
under his operating microscope
in his operatory upstairs. Two
further surgeries on the ground
floor have been fitted with operating microscopes and digital
cameras, which have the same
AV capability for one-to-one endodontic/microscope training.
“Teaching the art of endodontics has been a passion since I completed my own training in 1997
and I am extremely delighted to
have the opportunity to design a
practice where I can enjoyably
‘spread the word’ to my colleagues
and patients,” said Dr Bhanderi.
He is course leader for the
MSc/PGDip. in Endodontology at
the University of Central Lancashire, and honorary clinical
teacher for the University of
Manchester Endodontics programme, and lectures all over
the North West and internationally. He is on the Council of the
British Endodontic Society and
Chairman of the North West Endodontic Study group. DT
New NHS practice
opens in Birmingham
A
new NHS dental practice
has opened in Selly Oak in
Birmingham.
Midlands Smile Centre in Selly
Oak is part of a chain of several
dental practices owned by Dr Greg
Fickert.
About 70 per cent of the dental work carried out by the
chain is NHS work and the rest
is private, mainly made up
white fillings and white
crowns, tooth whitening, hy-
giene, implants and orthodontic work.
Dr Fickert commented: “The
team here at Midlands Smile Centre could not be more delighted
with the new look of the practice.
It was designed to provide an environment where patients can be
confident they are receiving the
highest standards of treatment.”
The Lord Mayor and the Lady
Mayoress of Birmingham officially opened the practice. DT
Dentists treating children urged to look out for child abuse
D
entists treating children
should check for tell
tale signs of neglect as
they could be warning signs of
wider neglect and child abuse,
according to child protection
experts.
A new policy urging dentists
to look for signs of neglect, when
treating children with severe
oral disease, has been published
in the International Journal of
Paediatric Dentistry.
Dental neglect is defined as
the persistent failure to meet a
child’s basic oral health needs.
Oral disease can have a significant impact on the health of a
child and can cause severe pain,
loss of sleep and even reductions
in body weight and growth.
Europe, is the result of a collaboration between the University of Warwick, the University of Sheffield
and Leeds Dental Institute.
He calls for dentists to refer
cases to child protection services
if they have any concerns.
Dr Sidebotham said: ‘There is
evidence which indicates that
abused children have higher levels of untreated dental disease
than their non-abused peers.
Many dentists have taken part in
child protection training, but still
find it difficult to put into practice
what they have learned when
they suspect abuse.’
The document, which is
thought to be the first of its kind in
The policy details the numerous factors that need to be
Dr Peter Sidebotham from the
University of Warwick co-authored
the policy document on dental neglect in children for the British Society of Paediatric Dentistry.
taken into account when
assessing a child with suspected dental neglect and gives
guidance on how the dental
team should respond.
Dr Sidebotham added: “I am
impressed by how much dentists
already do to educate and support parents. But when concerned that a child is suffering,
perhaps as a result of missed appointments, I would always encourage them to seek advice
from other health professionals
experience in child protection
and, if necessary, to make a child
protection referral.”
"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.
The report calls for all dental
staff to have regular child protection training.
For clinical staff, this must include recognition of signs of
abuse and neglect, and how to respond when concerned about a
child. This should be a mandatory component of dental training at every level: undergraduate, foundation training, special
interest and specialist training,
said the report.
To see the full report go to
www.bspd.co.uk/publication27.pdf DT
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DENTAL TRIBUNE United Kingdom Edition · September 14–20, 2009
News & Opinions
5
Interim guidance on CBCT scanners
T
he Health Protection
Agency has come up with
interim guidance for dentists using or planning to install
dental cone beam computed tomography (CBCT) scanners.
These CBCT scanners are
now being installed and used in a
growing number of dental practices within the UK.
many circumstances not be adequate for CBCT.”
The HPA’s Radiation Protection Division has set up a working party to look into the
issues associated with the use
of CBCT equipment and the
British Dental Association is
represented on the working
party.
Formal guidance for the UK is
expected later this year, following a consultation exercise.
Mr Holroyd said: “However,
due to the increasing popularity
of CBCT equipment and the current vacuum of official guidance,
the HPA felt it was vital to make
dentists using or planning to install CBCT equipment aware of
the most important issues as
soon as possible.”
gramme to ensure regular testing
of the equipment is carried out.
The interim guide, which can
be downloaded from the BDA website, looks at how to select appropriate equipment, including the selection of a suitable field of view (FOV),
exposure parameters and resolution settings and the establishment
of a suitable quality assurance pro-
It also discusses training requirements for all persons involved in the use of CBCT, including operators and those performing clinical evaluation of images
and the legislative compliance
when dealing with referrals from
other dental practices. DT
There is currently little guidance available for dentists on the
different radiation protection requirements needed for this type
of radiography equipment.
In a report by the Health Protection Agency (HPA), John Holroyd of the Radiation Protection
Division said: “Suitable guidance
is urgently needed to ensure that
appropriate radiation safety
measures are in place for the protection of staff and patients, and
to advise practices using CBCT
scanners with respect to radiation safety legislation.”
“Working procedures and
precautions that are well-established for conventional dental xradiography equipment will in
Distinguished
service award
for ortho
technician
T
he chief orthodontic technician at the Royal London
Hospital has been given
the Orthodontic Technician
Award for Distinguished Service.
Kieran McLaughlin became
the first orthodontic technician
to gain an MSc, graduating from
the Queen Mary University of
London Faculty of Medicine in
1994. Since 1995 he has worked
with Dr Ama Johal and Dr Joanna
Battagel designing appliances
for the treatment of obstructive
sleep apnoea; and he has also
worked with Dr Neville Bass on
developing the Dynamax appliance.
David Bearn, chair of the
Scholarships and Grants Committee of the BOS commented:
“The Committee conferred the
2009 Award on Kieran McLaughlin in recognition of the huge and
on-going contribution he has
made to the profession and we
salute his achievements over an
incredible thirty years of service.”
Mr McLaughlin has taught all
aspects of orthodontic appliance
design and construction to undergraduate and postgraduate
dental students as well as student
dental technicians at Barts and
The London School of Medicine
and Dentistry for more than
twenty years, and has almost
thirty years of experience in orthodontic technology. DT
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[6] =>
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6
DENTAL TRIBUNE United Kingdom Edition · September 14–20, 2009
Feature
Reflection from Northern Ireland
A new primary dental care contract in Northern Ireland has been implemented
which follows the same direction as proposals outlined in the Steele Review.
Simon Reid reports on the latest developments...
imately one third of dentists’
earnings was from non-item of
service), but he recommended
that we should develop the blend
to improve efficiency and equity
of care. We also recognised the
earlier recommendations from
Sir Kenneth Bloomfield’s report,
a long-standing and respected
public servant here in Northern
Ireland, which also advocated a
blended approach.
Extensive work on the format
and components of the Patient
Care Pathway has led to the following proposed blended system
of remuneration.
The system we have developed is not target-based as with
the UDA system, and has been
developed in an attempt to reduce the ‘treadmill effect’ and facilitate regular payments for improved practice cashflow. Importantly, quality of care will also be
recognised and rewarded.
A core range of treatments
T
here’s an old joke often recounted here about a lost
traveller stopping to ask
for directions from an old farmer
somewhere in rural Ireland. The
farmer listens carefully to where
the traveller wants to go, pauses
to think and then says, “Well, if
you’re heading there, you wouldn’t want to be starting from here!”
Having been heavily involved
in the development and negotiation of a new Primary Dental
Care Contract (PDCC) in Northern Ireland since late 2006, our
work and proposals in the Steele
Review are heading in the same
direction.
Up until the 2006, the new
dental contract was introduced
in England and Wales, while
Northern Ireland and Scotland
had taken the existing GDS
model and then made regional
adjustments to bring it within
their legislation. Most of the
framework and regulations were
carried across and there were obvious resource advantages for
Northern Ireland and Scotland in
‘piggy-backing’ in this way.
Other components were added to
or modified in the GDS contract
to suit both countries’ individual
needs. Both these parts of the UK
have continued to use their regionally adjusted GDS systems.
Need for reform
From Northern Ireland’s perspective, the work in England on
the modernisation of dentistry
with the Options for Change
Agenda, led to the realisation that
our current GDS system needed
reform. The drive for change be-
gan with our Oral Health Strategy
in 2004 and Primary Dental Care
Strategy in 2006, which have led
to the development of a bespoke
contract to meet our specific public dental health needs. In November 2006, negotiations began
between the Department of
Health, Social Services & Public
Safety (NI) and the Dental Practice Committee of the Northern
Ireland Branch of the British
Dental Association.
By developing our new contract, having reflected on the
original GDS, the PDS model and
the 2006 contract, it could be said
that our work parallels the Steele
Review process. I accept that we
have had the benefit, as have
those in Scotland, of watching
how the 2006 contract was rolled
out in England and Wales and the
challenging times as it bedded in.
We do not derive pleasure from
this, but rather have reflected on
your experiences and used these
considerations whilst planning
and developing our own contract
model.
A blended approach
One of the earliest steps we
took in 2007 was to commission
Professor Ciaran O’Neill, a
health economist formerly of
Queen’s University Belfast, to
carry out a global review of primary dental care remuneration
systems and the current GDS
model. Ciaran subsequently reported that the best approach
was a blended model that would
maximise the advantages of the
different remuneration methods. We were already operating a
de facto blended system (approx-
A key process has been to consider the core range of treatments, what we call “Essential
Services” that should be available under the new contract.
These are the treatments that we
consider are the most cost effective and are evidence-based using a hierarchy of evidence.
We have defined and listed
this range, but also have a
process to allow opportunity for
equality of access to care in exceptional cases where clinical
necessity is proven, the “Exceptional Treatments”. The Steele
• Staged pathway
• Registration for continuing care
• Urgent care option
• Preventive care
• Evidence-based guidelines
• Blend of registration/quality/activity
payments
• Proposed development of quality measures
• Defined data set
• Proposed range of restorative treatments
• Weighted capitation formula
make the contract attractive to
GDPs. Our aim is to increase
practitioner commitment by
recognising that a mixed economy exists and by clearly defining the range of clinically and
cost-effective treatments, as “Essential Services”, to be available
under the new system. As such,
the expectations and responsibilities within the system would
be clearly communicated to patient and practitioner alike. We
aim to allow access to “Occasional Services” for those requiring urgent care but to encourage
long-term patient care and preventive measures by using a Patient Care Pathway and with associated registration.
Registration simplified
We propose an enhanced capitation payment for registration
via the Patient Care Payment to
cover the patient journey
through the Patient Care Pathway. As such, it is more representative of patient-care needs than
the original concept and banding
of capitation and continuingcare payments under GDS
arrangements. DHSSPSNI is currently developing a weighted
capitation formula to calculate a
patient-specific payment dependent on patient need and
truly reflecting expected workload.
We now note that the Steele
review recommends registration
and payment for the continuing
care of patients.
Effective communication
We propose to have clear and
open communication between
patients, practitioners and commissioners. The aim is to ensure
that all understand their own responsibilities while being fully
aware of what to expect from the
other parties in this relationship.
The aim is to correct past market
failures of what Professor Steele
calls the, ‘Imbalance of knowledge’ and what Professor O’Neill
describes as, ‘Asymmetric information’.
Review, while not defining a list
of treatments, suggests a similar
approach for routine care and
“advanced/high-skill
treatments” though proposes that not
all practitioners may provide
these.
In our model there will be a
key duty for the commissioners
to produce a, “simple and transparent” system that is, “easily accessible and understandable” for
patients. Such a system could be
achieved by primarily using
web-based information. Equally
we must communicate effectively with practitioners and facilitate them to adjust their practise to the new and different ‘philosophy’ of our new contract.
Improving access
Data and administration
We believe that local commissioning is the key to improving
access, but it is also important to
Our proposals are to have a
simplified system of administration and reporting with practice-
Key items of common ground between the Steele Review recommendations and the draft N. Ireland
PDCC model
held data sets and minimum data
sets for reporting, to reduce the
administrative burden. There
has been some criticism of the
2006 contract resulting in reduced data capabilities for the
BSA and the Steele Review proposes the development of a common set of indicators. An effective data capability can inform
weighted capitation systems. We
also concur that data reporting
should be carried out electronically and we hope to develop an
‘IT-lite’ system for simplified reporting, which could also be
linked into existing integrated
practice management systems
for those practices that are fully
computerised.
From a Northern Ireland perspective we are pleased with the
independently-led Steele review
which appears to support many
of our current proposals. We
hope that our colleagues in the
rest of the UK can now reflect on
our work and are reassured by
the tremendous similarities with
the findings and recommendations of the Steele Review.
Currently we are undergoing
great structural changes here
following a review of public administration in health and social
care, but are continuing to develop our new contract and are
actively working towards piloting.
Local
commissioning
groups have been set up and with
the establishment of a single
health and social care board (regional equivalent of PCT), there
is a huge opportunity to develop
effective local commissioning
arrangements. We await with interest the results of the work that
will follow on from the Steele Review and we in turn, will be able
to reflect on those findings. DT
About the author
Simon Reid
BDS MFGDP MMedSc
has 20 year’s experience in general
practice. He is currently a dental
officer with the Business Services
Organisation in Belfast and has
been seconded part-time to the
Department of Health, Social Services & Public Safety Northern Ireland, working on the development
and negotiation of a new dental
contract.
[7] =>
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DENTAL TRIBUNE United Kingdom Edition · September 14–20, 2009
News & Opinions
7
Dental services in West Sussex and Leeds get huge cash boost
W
est Sussex Primary
Care Trust has invested £1.5m into
dental services in the county.
The cash investment means
that 20,000 extra patients
will now be able to see an NHS
dentist.
Due to the cash boost,
nearly one third of all dental
practices in West Sussex – 152
out of 160 – are taking on new
patients.
They will also offer extended opening hours.
David Grant, dental contracts manager at West Sussex
BOS Student
Technician
of the Year
A
student technician from
the University of Bristol
Dental Hospital has won
this year’s British Orthodontic
Society’s Student Technician
Award.
Chetan Geisel received his
award at the Orthodontic Technicians Association’s annual conference in Milton Keynes.
Entrants for the award were
required to prepare two removable appliances to a given prescription along with a written
commentary on the rationale for
the designs.
David Bearn, one of the
judges and chairman of the
British Orthodontic Society’s
(BOS) Scholarship & Grants
Committee said: “Chetan’s entries were outstanding pieces of
work showing that the skill of the
orthodontic technician is alive
and well.”
A spokesman for the University of Bristol Dental Hospital
called it a ‘keenly contested
award with entrants from around
the country taking part’ and said:
“It is the first time that a student
technician from Bristol has won
the award. This reflects the hard
work and commitment that
Chetan has put into achieving the
standard that is required to win
this important award.”
After completing his Dental
Technology studies at the University of Wales Institute in
Cardiff (UWIC), Mr Geisel
gained experience in a private
crown and bridge laboratory in
Cardiff, after which he secured a
position in Bristol Dental Hospital in 2007.
Through his employment at
the hospital, he has been able to
return to UWIC and study for an
MSc in Dental Technology. DT
Primary Care Trust, said: “We
know that access to NHS dentistry has been a problem but
the situation has improved recently.”
“Even before this new investment, access in West
Sussex was steadily improving
and so it is important that people know there are NHS dentists out there if they want one.”
In a similar move, NHS
Leeds is offering an additional
33,000 NHS dental places
throughout the city, due to a
£2.3m three-year investment.
NHS Leeds is encouraging local people to contact the Leeds
Dental Advice Line and register with a NHS dentist.
“We want to dispel the myth
that there aren’t enough dental
places in the city. We are committed to securing high-quality
NHS dental care for people in
Leeds and want to make sure
that those people who want access to a NHS dentist are able to
do so.
Steve Laville, head of dental
contracts for NHS Leeds said:
“Last year we made a large
investment in dentistry which
meant that there were an additional 36,500 NHS dentist
places available in Leeds.”
“NHS Leeds is continuing to
make significant improvements in access to NHS Dental
Care. A lengthy procurement
process has recently been
completed securing an additional 33,000 NHS dental
places throughout the city.” DT
[8] =>
DTUK2209_01_Title.qxd
Practice Management
The 10 Dimension…
the power of 10
th
Ed Bonner and Adrianne Morris discuss the
10 most common problems they encounter
in their consultancy work
Perceived insufficiency
of patients
We use the word perceived
because it is quite likely that if all
the patients who have attended
your practice in the last five
years could be converted from
“occasionals” to “regulars”, your
practice would be in hominid
overflow. However, if your practice is really short of patients,
there are two solutions to the
problem: improved recall system, and marketing.
Breakdown of equipment
If one starts from the assumption that it is possible to manufacture good-quality equipment
that won’t break down as soon as
the guarantee expires, the most
cynical among us might think
that planned obsolescence could
be a culprit in this scenario. However, even if this was not the case,
the longevity of your equipment
will be dependent on the quality
of maintenance, whether inhouse or by contract, and by care
with usage.
Discontinuity of staff
Although the usual reason for
staff leaving one job to move to
another is given as inadequate
remuneration or enforced relocation, the reasons are usually
far more complex and relate to issues such as lack of personal
growth and low motivation. But
paying a reasonable salary helps!
Erratic attendance
Lack of enjoyment of work
and low motivation are probably
the biggest reasons that certain
members of staff do not attend
work when they are not genuinely ill. The solution here is to
have a policy of no show, no pay,
but better still is to find out why
your employee is not happy.
Difficult patients
If one starts from the position
that all patients are difficult, it offers an opportunity to deal with
every patient on an even playing
field and with a pre-considered
strategy. The only trick is to identify which type of ‘difficult’ they
are and act accordingly. For example, some patients are inherently preachers and always need
to show ‘a better way’. Others are
born whingers. A few are malignant spirits. But you might also
start from the premise that there
are no difficult patients, only difficult dentists, and the most difficult of all is the one who believes
that he/she is never wrong. If you
can overcome that hurdle and
ask yourself the questions: ‘Why
is there a problem here?’ and
‘What do I have to do to overcome
this problem?’, you are more than
halfway to its solution.
Poor-quality
laboratory work
We get the lab work we deserve, and if we choose on price
rather than quality, if we don’t
set out our stall from the word
go on what will be acceptable
standards to ourselves, and finally if we do not provide the
quality of work sufficient to allow the technician to do their
job adequately, we have only
ourselves to blame.
Lack of financial control
Ascribe this primarily to poor
record keeping and poor communication with your bookkeeper and/or accountant. It is
perfectly possible in this computerised age to know exactly
what is happening in your personal financial world at the press
of a button – indeed we insist on
this as a starting point when we
advise on financial planning of
any nature. How can you possibly know how to get somewhere
if you don’t know where you are
starting from? Once you have
this information available to you,
it is not difficult (with a little
guidance if necessary) to do simple budgeting and cash-flow
forecasting and analyses that
will enable you to have your finger on the day-by-day pulse of
your business.
Poor communication
The biggest and most difficult problem to overcome, but
unless you are able to communicate in a clear, positive and decisive manner with all on whom
you impact, you are always going to struggle. Solution? Read
books or attend courses such as
NLP on improving communications skills, or seek assistance
from a coach.
Inadequate records
This again requires a mighty
leap into the computer age by
going digital, but if you insist on
storing atoms instead of bytes,
you will always have a problem
filing, storing and retrieving
paper.
Failed appointments
Again, not an issue of difficult
patients, rather one of inadequate communication and fear of
enforcement. If you let your pa-
One common problem is the perceived
lack of patients coming to the surgery
tients know in a non-threatening
manner that there are rules and
that it will cost them to break
those rules, then you are well on
the way to make this a nonexistent problem.
These problems are common
to virtually every practice we
work with and each of them has
a solution. Finding solutions are
actually quite easy, but finding
the will to seek them is not. All it
takes on the part of the dentist is
to accept that you don’t have to
put up with those problems day
in and day out. It’s not a case of
‘can’t cook’, much more of ‘won’t
cook’ – sometimes it helps to call
in a new hand to stir the batter,
and that is what coaches and
consultants do. DT
About the authors
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,
have a free consultation, or subscribe to The Power of 10 e-zine,
feel free to contact Ed at
bonner.edwin@gmail.com, call
07776 660 1338 or email Adrianne
at alplifecoach@yahoo.com.
[9] =>
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Practice Management
Exercising caution
It pays to manage risk so that you avoid ever
being served with a breach/remedial notice by
the PCT. Tim Lee explains
F
or a GDS/PDS contractor,
it’s serious to be served
with a breach/remedial
notice by the PCT. They are increasingly using these powers
and the risks to contractors need
careful management.
The PCT’s powers to serve
such notices are set out at clauses
329 to 336 of the standard GDS
Contract, (309 – 315 of the standard PDS Agreement – this article
will refer to GDS Contract only
for simplicity, but the provisions
are similar for both GDS Contracts and PDS Agreements).
Once a notice has been
served, if the contractor either
repeats the breach; otherwise
breaches the contract resulting
in either a (further) remedial
notice or further breach notice,
the PCT can serve a termination
notice.
There is some protection for
contractors. The PCT must not
serve a notice to terminate the
contract unless satisfied that the
“cumulative effect of the
breaches” is such that the PCT
“considers that to allow the contract to continue” would be prejudicial to the efficiency of the
services to be provided under the
contract.
A complex situation
The sharp-eyed will notice
that these limitations are not
clear-cut. But what does “the PCT
considers” mean? An alternative
less serious than termination is
for the PCT to “withhold or
deduct” monies payable under
the contract “in respect of the obligation which is the subject of
the breach”.
The sharp-eyed will also notice that these provisions are unclear. Do they mean that the PCT
has the power to “fine” the contractor? Does there have to be a
monetary loss or can the PCT
withhold / deduct money even if
there is no monetary loss?
My view is that the PCT’s powers to withhold/deduct monies
can only be exercised if there is
actual financial loss, and only to
the extent to reflect that loss,
pound for pound. However, the
point is unclear.
Remedial notices
The PCT can serve a remedial
notice if the contractor has
breached the contract and the
breach is “capable of remedy”. A
remedial notice must contain:
a) Details of the breach
b) The steps the contractor must
take to satisfy the PCT in order
to remedy the breach
c) The period during which such
steps must be taken (no less
than 28 days unless necessary
for patient safety / avoidance
of material financial loss).
negotiate a withdrawal of the
notice. But bear in mind that
the PCT served the notice in
the first place and will probably be reluctant to negotiate!
If the contractor fails to remedy the breach, the PCT may
serve a termination notice. But
you must take into consideration
the importance of the remedial
notice containing the prescribed
information. I have in the past
been successful in challenging
remedial notices, which failed to
contain sufficient information.
b) An application to the National
Health Service Litigation Authority. Even though the contract does not provide a specific provision for challenge, it
is likely that a dispute about a
remedial / breach notice could
be taken to the NHSLA under
the general contractual dispute provisions.
‘Once a notice
has been served,
if the contractor
either repeats
the breach; otherwise breaches
the contract resulting in either
a (further) remedial notice or
further breach
notice, the PCT
can serve a
termination
notice.’
a)– b) are available if you have
opted for NHS Contract Status
(see Part 3 of your contract
agreement.)
c) An application in the civil
courts. This route might be
available if you had not opted
for NHS Contract Status. The
application might seek an order to have the notice declared
invalid and/or restraining the
PCT from relying upon the notice and/or other remedies.
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Of course, (but caution is
strongly counselled) you have
the option not to challenge the
notice unless and until the PCT
take further action. Be careful
though - it could be argued that
by taking no action, you have accepted the validity of the notice.
Please also remember that
even a successful challenge on
technical grounds could still
leave the PCT the option of serving a second and valid notice.
What’s the difference?
Time limits
Some feel that remedial notices are less “serious” than
breach notices but this is not necessarily so. If the breach is not
“capable of remedy” then the
PCT may serve a breach notice.
Consider speedy action and
do not delay as time may be
against you. Time limits may apply, and if you are in any doubt,
seek immediate advice. DT
In practice, less serious
breaches may be capable of remedy, so sometimes less serious
breaches attract remedial notices and more serious breaches
may attract breach notices, but
this does not necessarily follow.
MAKE THE MOST OF YOUR SURGERY
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-Building Contract
x
Complete Dental Equipment
- Dental Chairs
- X-ray Machine
- Washer Disinfectors
- Dental Handpieces
- Dental Instruments
Challenging a notice
Contractors often wish to dispute the validity and/or fairness
of remedial/breach notices. The
contract contains nothing specific to enable a challenge. Compare this to a termination notice
where the contract provides for a
challenge to the NHSLA.
x
- Metal Cabinetry
- Italian Design
Tim Lee
The options available to a
contractor to challenge a remedial/breach notice are:
a) Local Dispute Resolution with
the PCT. It may be possible to
Dental Cabinetry
is commercial law director and solicitor at Young and Lee Solicitors
Limited in Birmingham. For more
information, visit www.younglee.
co.uk or call 0121 633 3233.
www.parsdental.com
info@parsdental.com
02087 884400
[10] =>
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10 Practice Management DENTAL TRIBUNE United Kingdom Edition · September 14–20, 2009
Prevention is better than the cure
Dr Martin Rinker discusses making preventive care affordable in these tough times
W
e all know that people
are facing hard choices
when it comes to finances, and that the recession is
hitting many sectors, from people taking fewer holidays abroad,
to the decline in sales of luxury
items.
In a country used to healthcare
through the NHS, people are still
making regular appointments
with the doctor, yet dentistry is reportedly feeling the crunch, with
the uptake of treatment or even attendance at dental appointments
reportedly affected.
Routine dental appointments
cost money, and if people feel that
their teeth are not presenting immediate problems, a check up
will not be considered ‘essential’.
However, oral health is anything but non-essential and is
something that has been identified as vital from almost all sectors, including the recent Steele
review, where it was flagged as
needing to become the focus of
dentistry in a move away from the
‘drill and fill’ mindset, prevalent
over so many years.
Prevention is always better than
cure and if patients are only seeing
their dentist for interventive work,
and sacrificing the oral health maintenance side, this will have a longterm impact, including being a move
in the wrong direction to what has
just been identified as the right road.
Making it affordable
However, you cannot force
people to go for regular dental
check ups, so how do we encourage them in the door? By making it
affordable. And accessible.
This is the beauty of Patient Referral Plans. They are highly effective, yet elegantly simple:
1. A dentist joins the scheme – free
2. His name goes on the participating practitioner database, with
access to a large pool of patients –
free
3. The patient joins for a nominal
subscription for access to treatment at ANY participating dentist’s practice
4. The patient gets treatment at 20
per cent off savings on a broad
range of treatments and pays at
the time of service
5. Dentists get free marketing via
the scheme and access to discounted lab fees.
So the up sides are that the
dentist gets a whole lot for free by
signing up to the scheme. The patient gets a significant 20 per cent
reduction on treatment, making
the vital maintenance visits far
more affordable, including the
occasional unexpected trip to the
dentist for emergency care.
Fancy boutique-style practices
are becoming all the rage and are
raising the standard of ambience
and care available to the patient, yet
what are the criteria on which patients choose their provider? Consider a theoretical case of two practices, each with equally, skilled
dentists offering the same range of
treatment, and both charging similar rates for the area. One practice
participates in the Patient Referral
Plan scheme, offering 20 per cent
discounts on treatments; the other
does not. Who is the patient going to
choose? It’s not rocket science!
Long-term benefits
Oral health is of paramount importance in the long term. And the
economy won’t be the only thing in
recession if gum health and overall
oral care is not attended to on a regular basis. Patients should not feel
forced to sacrifice dental care in difficult economic times. We need to
make care affordable to avoid a step
backwards from the all-important
preventive imperative. DT
About the author
Dr Martin Rinker
is Chairman of the Board of
Munroe Sutton. For more information on patient referral plans, call
020 7887 6084 or visit www.
munroesutton.co.uk/dentist.
[11] =>
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DENTAL TRIBUNE United Kingdom Edition · September 14–20, 2009
Feature 11
Survival of the fittest
Struggling in the recession? Mark Garner discusses how to ensure your practice is
able to evolve during these tough times, even in the face of reducing patient numbers.
B
oth long standing and
newly established private practices can experience patient loss at any time,
but in this period of economic
uncertainty this can be a significant issue. Patient loss is often
caused by a range of factors
and will have a considerable
impact on your business and its
revenue.
It is therefore important to
understand the reasons for this
loss and to treat the cause before it has a negative effect on
your practice. This could be
anything from the levels of care
you provide, to patient services
and value for money offered by
your practice - but it is essential
you get the full picture of where
you are now and how to get to
where you want to be. Below are
some tips to help you assess why
patients are leaving your practice and how you can avoid this.
Undertake a full review
The first step is to review your
practice’s finances in detail, to
work out where you may be able
to make cut-backs without having a detrimental effect on care or
service levels. This will guard
against any initial drop in income, while you develop a strategy to combat it in the future. The
next step it to understand why
your patients are leaving you,
why new patients are not joining
and how to prevent this.
One way of doing this is to undertake a Patient Performance
Report. This is a quantitative and
qualitative look at exactly how
many patients are leaving, why
they are leaving, where they are
going and the financial impact
this will have on your practice income. This should give you a
more comprehensive picture on
where your weaknesses may lie
and where you can make improvements. You don’t have to
deal with them all but you can select those you feel best equipped
to do something about.
‘Research clearly
suggests that
environmental
factors are
crucial in retaining existing patients and attracting new ones and
you only have
one chance to
make a first
impression.’
Mystery shoppers not only give a chance to evaluate your practice team, but also the local competitions'!
Environmental
and patient audits
Another step is to invite an
honest outsider into your practice to cast a critical eye over
your environment and décor.
This is called an Environmental
Audit and is designed to look at
every area of your practice from
its outside appearance and reception, to toilets and disabled
facilities. Research clearly suggests that environmental factors are crucial in retaining existing patients and attracting
new ones and you only have one
chance to make a first impression.
Patient audits use specific
questions to ascertain the current level of customer service
offered by your practice. Based
upon the answers given you can
produce meaningful data to
shape the future direction of
your patient services and care.
Some payment plan providers
can help you with this and undertake patient and environmental audits on your behalf to
provide you with straightforward results and advice.
Mystery shopping
Mystery shopping is one of the
most helpful tools for monitoring
your levels of service, as it gathers the highest quality and level
of information. A mystery shopper will use a carefully constructed script to telephone your
reception team and those of other
practices in the area and will
pose as a potential new patient.
They can then score each practice according to the level of help
and service they receive. This not
only gives you the opportunity to
benchmark your team, but you
also get a valuable insight into
the telephone service standards
of your competitors.
It is important however, that
mystery shopping be undertaken
without your team’s knowledge,
to ensure that you gather meaningful results. Some payment plan
specialists can provide a mystery
shopping service in order to help
you gather and interpret your results and help you move forward.
They can also look at your competitors’ patient literature in comparison to your own to see if any
improvements could be made.
Top Tips
• Review your practice’s finances in detail to see where you can make cut-backs in
the short term
• Undertake a Patient Performance Report to find out why patients are leaving/not
joining
• Undertake an Environmental Audit to see where you can make improvements to
your practice’s appearance
• Invest in a mystery shopper to review your teams customer service
• Develop an action plan to map out your future improvements
• Undertake training to help you achieve your goals.
Action plans and training
Once collated, the information from all your research can
then be used to develop an action plan to fine tune your patient offering and to address the
issues of attracting new patients and retaining existing
ones. This plan will also help
you decide what changes you
need to make and whether they
can be achieved immediately,
in the medium term or as a future objective, as well as providing a focus so that your practice team remain motivated and
focused.
Some providers can also put
together bespoke training sessions that focuses on the areas
you feel impact on your patient
experience, practice services
and financial goals and help you
to resolve any issues. These can
also count towards verifiable
Continuing Professional Development (CPD) when undertaken
in accordance with GDC requirements.
It can be very easy to assume
that it is the recession that is negatively affecting your practice
and that everyone will be in the
same position. This is certainly
not the case and there is no reason why dental practices shouldn’t look upon these difficult times
as an opportunity to make themselves indispensable to their patients. By undertaking a thorough audit of your services and
environment you can not only
guard against economic uncertainty, but you can come out the
other side more successful than
ever. DT
About the author
Mark Garner
is an Area Manager at Denplan. He
joined Denplan in 1996 and, after
working as a Consultant for five
years, became Area Manager for the
Midlands and East Anglia. He leads a
team of Consultants who provide
support for dentists, pre and post conversion.
To find our more information about
the Denplan Evolve Programme,
please call 0800 328 3223.
Asking existing patients for feedback is a great way to see your practice from your patients' point of view
[12] =>
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DENTAL TRIBUNE United Kingdom Edition · September 14–20, 2009
12 Money Matters
What’s mine is yours?
Elizabeth Hoddler suggests that seeking the advice of a specialist solicitor
is paramount when starting separation or divorce proceedings
H
ow to protect your financial assets after separating
from
your
spouse is a question solicitors
are often asked, with concerns
about splitting pensions and
mortgages
causing
great
stress. Divorce and separation
is considered one of the most
stressful life events, along with
family bereavement and job
loss.
Worry and uncertainty that
comes from separating all aspects of a life shared, emotionally, physically and financially
Both parties will have questions, concerning their wishes to
protect their hard-earned finances and investments, so naturally black and white answers will
often be sought. It is important to
note that a solicitor will have to advise on likely outcomes based
upon the client’s case and a judge’s
criteria therefore concrete answers may not be available, especially in an initial meeting.
PracticeWorks
Practice Management Software
Judging a case
The criteria a judge will apply
to each case are set out in section
25 of the Matrimonial Causes Act
1973:
and Digital Imaging Systems
(a) The income, earning capacity, property and other financial resources which each
party has or is likely to have in
the foreseeable future including, in the case of earning capacity, any increase in that capacity which it would be, in
the opinion of the court, reasonable to expect a person to
take steps to acquire.
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.
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.
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
So not only do you get the very best service at all times, you also get peace of mind from
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can be assuaged by seeking expert advice from a solicitor, who
specialises in this area of law.
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‘Divorce and
separation is
considered one
of the most
stressful life
events, along
with family
bereavement
and job loss.’
(b) The financial needs, obligations and responsibilities
each party has or is likely to
have in the foreseeable future.
(c) The standard of living enjoyed by the family before the
breakdown of the marriage.
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(d) The ages of each party and the
duration of the marriage.
(e) Any physical or mental disability.
(f) The contributions each party
has made or is likely to make
in the foreseeable future to the
welfare of the family, including any contribution by looking after the home or caring
for the family.
(g) The conduct of each party, if
that conduct is such that it
would in the opinion of the
[13] =>
DTUK2209_01_Title.qxd
DENTAL TRIBUNE United Kingdom Edition · September 14–20, 2009
Court be inequitable to disregard.
(h) The value to each party of any
benefit one party because of
the divorce will lose the
chance of acquiring (most
usually pension provision)
Exchanging information
When seeking legal advice,
both parties will be asked to provide the same financial information to their individual solicitors
enabling a ‘level playing field’.
Each solicitor will exchange information, and each side can
then ask for further details to fill
any gaps or to clarify issues that
may have arisen.
• Get surrender values for any
endowment policies/bonds
• Take in your P60
• Make a summary (as far as you
can) of your spouses’ assets
• Make a list of your debts and
those of your spouse (if any)
• Get a statement showing the
balance on your mortgage account/s.
This information will aid
your solicitor in understanding
where you stand financially,
and enable them to provide you
with initial advice on how the
court may treat different assets
within your case.
Seeking the advice of a specialist solicitor is paramount when
starting separation or divorce proceedings and as such it is wise to be
wary of well meaning friends and
colleagues who have been through
a separation. As the Section 25
checklist is applied to individual
circumstances, the right outcome
for them may not necessarily be the
correct option for you. DT
Money Matters 13
About the author
Elizabeth Hoddler
is partner and head of the family law department at Gross & Co Solicitors, Bury St Edmunds, Suffolk. The first woman Partner in
Gross & Co’s 161-year history, Elizabeth was
admitted in 1984 and is a resolution-trained
collaborative lawyer. Practising purely in family law and specialising in family-owned business or high-value asset divorce cases, Elizabeth represents clients across the UK. For more
information please visit Gross & Co Solicitors at
www.gross.co.uk or call 01284 763333.
To provide solicitors with
an indication of how to split a
family’s finances, clients will
be asked to provide valuable
financial information about
them.
Solicitors will request:
• Details of earnings both past
and present
• Values of pension/s
• Non-financial contributions to
the family unit (such as looking
after the children/home)
• Contributions to the family ‘pot’
of money which were not
earned by either party (inheritances under a family member’s estate)
• Future expectations (pay increases/new jobs with fringe
benefits such as company car or
private healthcare).
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On reviewing this information, a solicitor will take into account Section 25 criteria a) – h) for
both parties and assess an equitable outcome for their own client.
A fair outcome
In order to achieve an overall
fair outcome for both parties, a
claim to assets may be required.
Assessing how a court will divide up a family’s assets such as
a dental practice or pension
fund is not a precise science, as
Judges ultimately only have discretion over the facts placed before them.
Only when all relevant case
facts are known can a solicitor
offer advice on the likely outcome based on the statutory
checklist Section 25 and current law.
Meeting with a solicitor for
an initial interview to discuss financial implications of divorce
is the first step towards achieving a fair outcome. If both parties provide the solicitor with a
frank and exhaustive account
of their financial positions, it
will enable the solicitor to be in
the same position as the Judge
who will judicially determine a
case.
Tips for the initial meeting
with your solicitor:
• Take three local estate
agents’/brokers marketing appraisals with you giving an idea
of the value of your home and
any other property such as your
dental practice or laboratory
• Get a current transfer value for
your pension/s
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[14] =>
DTUK2209_01_Title.qxd
14 Company Promotion
DENTAL TRIBUNE United Kingdom Edition · September 14–20, 2009
From concept
to commission
The complete equipment solution from The Dental Directory.
T
he Dental
Directory is a
national, full
service dental dealer,
providing, today’s dentists
with everything, from a
paper cup to a full surgery
refit, all, at the most
competitive price and with
the, best service possible.
So whether your
equipment, requirement
concerns a small
handpiece, a large
equipment unit or a
complete, surgery
refurbishment, The
Dental, Directory can help
you. You may need, your
equipment repaired,
serviced, or a, new
alternative sourced,
whatever the, issue no
matter how large or small
the, equipment team are
here to assist you.
The equipment division
forms a major, part of The
Dental Directory
operation, spanning across
the headquarters in,
Witham and two office
facilities with, showrooms
in Perth and Liverpool. A,
national team of
experienced engineers,
equipment specialists,
surgery design, consultants
and customer service,
members ensure every
dentist receives, the very
best service from start to
finish.
Mark Wheatstone,
Technical Sales, Director
at The Dental Directory,
comments, “When
purchasing, equipment,
Dentists are making a,
considerable investment in
the practice, and they need
to know that the
supplying, company
supports this commitment.,
We firmly believe that it’s
about a long, term
partnership and in turn
we invest, in our people,
products and services to,
ensure that we are always
there when, needed and
with the right solution. We,
completely tailor our
equipment service, to the
client and their needs,
providing a, professional
product that’s, on time
and within budget”.
Quality Guaranteed
The Dental Directory
works, with the worlds
leading, equipment
suppliers and, although all
products meet, todays
regulations and, their own
strict quality, programmes,
The Dental, Directory still
performs, its own quality
control, checks. Every
piece of, equipment
installed is tested, and
demonstrated by our, own
manufacturer-trained,
engineers to ensure
correct, performance.
Equipment new to the
market is, reviewed by a
new product board and,
selected for supply based
on suitability,
functionality, reliability,
quality and, innovation.
Beginning to End
We support you through
the complete, buying
process from guidance on,
design, equipment
selection, supply, and
installation, right through
to, aftercare. The Dental
Directory offers, you
complete piece-of-mind
that you, are making the
right decisions for your,
practice.
Our national team of
The Dental Directory supplies bespoke dental cabinets from Modwood.
Oakmor Dental Centre, Braintree, Essex. A quality Surgery
refit by The Dental Directory.
engineers, provide an
excellent aftercare service
for, repair and
maintenance.
Manufacturer, acredited,
our engineers are on hand
so, you can continue your
work confidently, knowing
that assistance is only ever
a, phone call away.
Bespoke Surgery
Planning
Every Dentist has their
own way of, working and
that’s why The Dental,
Directory offers a bespoke
surgery, planning and
design service. Your,
surgery created just the
way you, want it. Our
design experts will visit,
your practice for a full
free of charge,
consultation, where full
measurements, are taken
and then a detailed,
specification produced. A
schedule, of work can then
be agreed, planning,
works and contractors
around your, timetable to
minimise distruption and,
surgery downtime.
The Dental Directory
provides, the full turnkey
[15] =>
DTUK2209_01_Title.qxd
DENTAL TRIBUNE United Kingdom Edition · September 14–20, 2009
We are, so confident of this
that if the work is, not
completed within 24 hours
of your, approval of the
quotation then you will,
not be charged.*
Not only is Handpiece
Express fast, but the
quality of work is
exemplary, as, only
experienced,
manufacturer-trained, and
accredited engineers will
work on, your equipment.
Company Promotion 15
which, leads ultimately to
improved, treatment
standards and comfort, for
patients.
including treatment
centre, x-ray, and bespoke
cabinetry,
Manufacturer Support
All of this great service
would be, meaningless if
we did not have the,
support of leading
manufacturers. The Dental
Directory has a, range of
products from the, most
renowned and respected,
5 Reasons to choose,
Th
h e Dental Directory
2
. The Widest possible
choice –, We offer a
range of products
from, leading
manufacturers ensuring
you, can find the right
equipment for you.
The newest addition to our equipment portfolio, KaVo Dental.
ESTETICA E80T/C is the ultimate KaVo system.
solution to surgery,
refurbishment. We
understand it, is not
simply about the supply of,
equipment products. We
have the, expertise to help
you through the, whole
process with informed
advice, on current
reguations and guidelines,
including the recent
HTM01-05,
decontamination
memorandum, and,
project management to
develop a long, term
partnership.
Digital Imaging
Our range of digital
imaging products, includes
Panoramic, Cephalometric,
and CT digital imaging
systems., We supply
products from Soredex,
Dürr, Schick, Gendex
and more, recently, Vatech
(E-WOO), so, ensuring
that we can provide the,
most up-to-date digital
diagnostic, solution. The
Dental Directory is, able to
provide expert advice in
all, areas; from single user,
stand alone, systems to
fully networked solutions;,
from intra-oral cameras to
3D CT, and from direct
sensor systems, (wired or
wireless) to phosphor
plate, technology.
3
. Unbiased,
impartial advice –,
As we are not tied to
any particular,
manufacturer, we can give
you, completely impartial
advice.
4
. A complete service
– We, don’t just sell
you a box and walk,
away. The Dental
Directory will, plan,
deliver and install your
new, equipment with the
minimum, disruption to
your surgery.
Handpiece Express
Handpiece Express is the,
dedicated handpiece
servicing, and repair
service from The, Dental
Directory. Suggested, in
the name, you can be,
assured of a fast
turnaround repair of, your
handpieces and motors.
5
PaX-Reve 3D sets a new benchmark as the world’s most
advanced dental Cone Beam CT machine.
We have the expertise to help you choose the right equipment to
comply with the recent HTM01-05 decontamination memorandum.
1
. A dedicated team of
in-house, specialists
– We have a team, of
specilaists in digital
imaging, equipment and
surgery refit and, design to
explain what is available,
and which will suit your
needs best.
Regularly servicing
handpieces, motors,
couplings and scalers will,
prolong the life of your
equipment., Inevitably
handpieces will always fail,
at the most inconvenient
times, causing maximum
disruption., Planned
maintenance and,
scheduled servicing can
prevent, this. Servicing
also ensures, reduced
running costs, smoother,
operation and efficiency
manufacturers within,
Dentistry. These, include
Belmont, Anthos, Kavo,
Stern, Webber, Modwood,
W&H, Satelec, Tridac,
Schick, E-woo, Dürr,
Cattani, and Murray to
name, but a few.
Our equipment, range is
vast, enabling us to,
provide everything, from a
replacement, bulb or
handpiece, through to a
complete, surgery
. Attractive finance
packages, – In
partnership with
leading, financial
institutions, we can offer,
very competitive finance
packages, including lease,
lease purchase and,
payment holiday options.
Expert advice on your
equipment, needs is
only a phone call
away, call us on 0800
585 585 or visii t
www.dentaldirectory.co.uk
*Terms and conditions apply.
[16] =>
DTUK2209_01_Title.qxd
DENTAL TRIBUNE United Kingdom Edition · September 14–20, 2009
16 Money Matters
Choosing an adviser
Is it possible to find a financial adviser that will
work on your behalf, without being influenced by
commission payments from product providers?
Ray Prince analyses the different types and their
service propositions
I
f you’re looking for help with
your financial-planning decisions, there are a number of
resources you can turn to:
• The internet/media
• Friends and family
• Your own knowledge.
Ideally, it’s likely that you’ll
want impartial information upon
which you can make objective
decisions. Whilst these three resources can be utilised, they may
not ’do the job’ as you’ll be hard
pressed to get an objective view
with no emotion (which often
runs high when making financial
decisions) attached.
The alternative is to seek advice from a financial professional.
The advantage of this route is that,
ideally, they will be able to take an
objective stance. The downside
however, is that there are so many
different types of financial adviser/planners to choose from.
How will you know if you are
dealing with someone that is 100
per cent impartial, or a slick
salesperson whose focus is to sell
you what they have?
Let’s look at the options available and also the steps you can
take to find the right type of adviser/planner (from the 45,000 or
Not just the
patient in
pain?
so registered individuals authorised to provide advice) for your
circumstances.
The first step is to determine
what type of service you require. Do
you simply need someone to help
you choose the right income protection plan, or do you need someone to help you create a ‘financial
roadmap’ for the rest of your life, so
that you’ll be able to see how your
future will look until you’re 90?
The financial
product retailer
If you have an idea of the type
of product you need, this may be
6
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there either. Pain can stop you
working. It is also the most
common cause of premature
retirement amongst practising
dental professionals.
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• Taught by qualified medical
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• Based on up-to-date research
• Help self manage and prevent
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• Over 2,000 attended
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Can you find your way through the thousands of financial advisers to find the
right one?
for you. The ‘service proposition’
from an adviser that offers this
service will probably be to uncover exactly what you need and
then to match the need with a financial product.
can be used to help individuals
purchase certain financial products. However, commission has
been blamed for some of the past
mis-selling scandals so one cannot ignore the scepticism.
It’s possible that the advice
provided will focus only on the
areas that you wish to discuss.
For example, if you want some
form of life assurance to cover a
mortgage/debt, your retirement
income requirements may not be
discussed at all.
After all, how can you guarantee that the product being recommended is the most suitable for
you, and has not been selected
based on how much commission
is being paid to the adviser?
Whether you end up with the
best product available on the
market will probably depend
upon the type of adviser that you
are dealing with.
A tied adviser is one that only
offers the products from one financial institution. They represent the institution, not you (this
point is crucial).
A multi-tied adviser offers the
products from a few providers.
Obviously, as they have more
choice to offer you, this is a better
option that dealing with a tied adviser. The downside is that you
can never be certain that the
product being recommended is
the most suitable, as they don’t
have access to all the providers in
the marketplace. Like the tied
adviser, they represent the institution, not you.
An independent adviser (also
referred to as whole of market) is
able to choose from the majority
of providers in the marketplace.
So if all you require is income
protection, they’ll be able to select the plan that is most suitable
for you. Although, bear in mind
here that certain providers, such
as banks, don’t offer their products through whole-of-market
advisers. Crucially, an independent adviser is the agent of the
client, not any institution.
Paying for advice
It’s important to understand
that the majority of the financial
services industry operates on
commission. So, when you purchase a product, the institution
will make a payment to the advising firm (not normally to the individual adviser).
There’s nothing inherently
wrong with the commission system as such, especially when it
If you want to increase your
chances of being recommended
the right product, I believe you
should only deal with an independent, whole-of-market adviser. Why would you take any
chances by dealing with a tied or
multi-tied adviser? It has nothing
to do with how competent the adviser may be. It’s really about the
range of products that they can
choose from to help you purchase the most suitable one.
‘Whether
you end up with
the best product
available on the
market will
probably depend
upon the type of
adviser that you
are dealing
with.’
A good independent adviser
should be open enough with you
to show you the actual research
that they’ve done so you can see
why they are recommending certain providers.
Regarding commission, the
majority of providers pay a similar amount of commission within
each product category. Doubts
have arisen where an adviser
recommends one product category over another. For example,
an investment bond may pay up
to eight per cent commission on
the original investment, whereas
a unit trust would usually pay a
maximum of three per cent initial commission.
DT page 17
[17] =>
DTUK2209_01_Title.qxd
DENTAL TRIBUNE United Kingdom Edition · September 14–20, 2009
‘I would suggest
that you choose
to work with
someone who is
willing to work
with you to
create your own
financial plan.
You will have
a great deal of
involvement in
creating your
plan, so be prepared to engage
in the process
throughout. ’
DT page 16
I believe the solution is very
straightforward (and fair). When
a client invests new money, the
same commission should be
charged regardless of product
category. This should remove
any question of bias.
Don’t be fooled
Whichever type of adviser
you deal with, don’t allow them
to fool you that they are paid a
salary and don’t earn their
money via commission. If they
do earn a salary, they will have
sales targets to meet. In fact, I
recently met with a friend that
works for a bank and he told me
that he had to sell enough products to validate his salary sevenfold. Not an environment I’d like
to work in…
You should also ask the adviser whether you could pay for
the arrangement of the financial product by paying them a
fee. If they agree to this, and
subsequently don’t take a commission from the provider, you
will benefit for several reasons:
• For investments, more of your
money should be invested
• For protection, the monthly
cost of the plan may reduce.
Of course, it will make
sense to calculate which route
is the most cost-effective. Now,
let’s look at the other type of
service.
Money Matters 17
lent, but who then are tested
specifically on their Financial
Planning skills to become CFP
professionals. In the UK, the Institute of Financial Planning is
responsible for the assessing
and the certification of CFP professionals.
Impartiality is the key to getting the
right financial planning service
It’s important to be aware
that the type of qualification the
adviser has is separate to their
service proposition and whether
they are tied, multi-tied or whole
of market. For example, it’s perfectly possible for a tied adviser
to be qualified to chartered level.
Choosing an adviser
The comprehensive financial planner
An adviser that offers this service will normally (but not always,
so beware) operate a financial
planning process that is aimed at
helping the client achieve their
most important goals in life. The
process may include:
will be remunerated regardless
of the outcome. As a consequence, they should have no
vested interest in the solutions
they devise for you. Of course,
there’s no way of guaranteeing
this, but I’m sure it will increase
• What goals are important to you
that you want to achieve?
• What action are you taking to
achieve these?
• Are you on track?
• If yes, can you reduce the
amount of risk you are taking?
• If yes, can you spend more
money without affecting your
• current or future lifestyle?
• If no, can you invest more
money/increase the amount of
risk that you’re willing to take?
‘Personally,
I prefer fixed
fees. That way,
all parties know
where they stand
right at the start
of the process.’
Their service proposition is
not about retailing financial
products, although they will
usually help clients buy the right
ones if required. Often, additional financial products are not
required.
the chances of receiving a 100 per
cent impartial service.
I would suggest that you
choose to work with someone
who is willing to work with you
to create your own financial
plan. You will have a great deal
of involvement in creating your
plan, so be prepared to engage in
the process throughout.
Paying for services
So, how should you pay for
such a service? I am of the opinion that you should pay a fee. By
doing so, the financial planner
And remember, impartiality
is the key. How much you pay will
depend upon the adviser and
their firm. I’ve come across a
whole range of figures and ways
of charging. Personally, I prefer
fixed fees. That way, all parties
know where they stand right at
the start of the process.
Qualifications to look for
There really is an ‘alphabet
soup’ of qualifications that any
type of adviser could possess. Let
me cover the ones that I feel are
the most important:
• The Certificate in Financial
Planning. This is the basic
qualification required to work
as a regulated financial adviser, accredited by the Chartered Insurance Institute.
There’s also the Certificate for
Financial Advisers (CeFA).
These are the absolute minimum qualifications required
and advisers qualified to this
level may use the designation
CertPFS or CeFA after their
name.
• The Diploma in Financial
Planning develops advanced
technical knowledge and understanding across a broad
range of key advisory areas
(the regulator, the Financial
Services Authority, has proposed that all advisers must
achieve this qualification, or
its equivalent, by the end of
2012). Advisers qualified to
this level may use the designation DipPFS after their
name.
• The Advanced Diploma in Financial Planning enables professional advisers to develop
their specialist planning capabilities, providing clear differentiation from the main body of
advisers. Once achieved, individuals may use the title ‘Chartered Financial Planner’.
• The Certified Financial Planner licence, an advanced qualification, being an internationally recognised certification
awarded to individuals who
have already proven their technical competency by passing
appropriate examinations to
the level of DipPFS or equiva-
To find an adviser, here are
some resources:
• Ask a colleague/friend for a
personal recommendation
• Search online
• Visit IFA Promotion’s ‘Find an
Adviser’ online search tool at
www.unbiased.co.uk
• Search for a certified financial
planner at www.financialplanning.org.uk.
Free audio CD
To learn more about your retirement planning options, you can
request a free copy of one of Rutherford Wilkinson’s Audio CDs: ‘How
To Avoid The 3 Most Common Retirement Planning Mistakes’. Just
call Catherine Lowes on 0191 217
3340 and a copy will be posted to
you (please quote ref: DT). DT
About the author
Ray Prince
is a fee-based certified financial
planner with Rutherford Wilkinson
Ltd and helps dentists plan towards
their ideal retirement, as well as
getting the best deals on mortgages,
protection and investments. You
can contact him on 0191 217 3340
and ray.prince@rwpfg.co.uk. To
register for the free, twice monthly
e-newsletter containing financial
advice and tips, visit www.
medicaldentalfs.com.
[18] =>
DTUK2209_01_Title.qxd
DENTAL TRIBUNE United Kingdom Edition · September 14–20, 2009
18 DCPs
Keeping up appearances
Days of inadequate cold sterilisation using harmful chemicals are over,
says Mhari Coxon who encourages all forward-thinking practices to make
changes before a deadline is issued.
A
lthough the holidays will
be well and truly over by
the time you read this, I am
writing this piece on the countdown to spending six weeks with
the kids. Both my children’s
schools have had swine flu outbreaks, but there no longer
seems to be the value of closure
as new cases are increasing rapidly beyond the singular outbreak.
I sound like a broken record
reminding each child to wash
their hands before eating, avoid
touching their eyes or mouth in
class, and use a tissue if you need
to sneeze or cough. These basic
measures can reduce their risk of
contracting H1 N1. I notice a lot
more people wearing masks (to
questionable benefit unless the
wearer is infected and trying to
reduce transmission) on the
train and Tube and most people
are carrying tissues in case they
do need to cough or sneeze, and
those people that don’t feel the
icy stares from fellow commuters.
I have also re-evaluated my
cross-infection protocol in practice, but thankfully we are following best practice with regards
to transmission of viruses within
our limits.
Our cleaning routine
In my practice, I work with a
floating nurse/oral health educator, so I’m often doing all my
own instrument cleaning. Yes,
this can be time consuming, but
it’s one of the things I refuse
to rush.
What we are working on is
our move to improve our disinfection and decontamination
procedures in our centre. We are,
at present, using ultrasonic baths
to decontaminate, then hand
rinsing and visually checking,
and autoclaving in non-vacuum
unit, before bagging instruments
and dating them. Our “dirty area”
is clearly marked, but is still in
one of the surgeries. We quality
check our ultrasonic baths with
foil tests monthly and have our
autoclave serviced regularly,
while all ultrasonic baths are
emptied at least daily. But we
ALCOHOL FREE
ANTI-MICROBIAL
DISINFECTANTS
In her article, Mhari Coxon refers to the end of sterilisation using “harmful chemicals” yet we still see
Dental Care Practitioners using alcohol based gels that can irritate skin to the extent that the HTM
01-05 hand hygiene policy recommends using “a hand cream following hand washing to counteract
dryness.” Why not simply use alcohol free anti microbial hand care products that prevent dryness and
have a conditioning effect?
Alcohol based products are also still used to clean or disinfect surfaces but can lead to micro-cracking which
provide the ideal habitat for harmful micro-organisms and reduce the useful working life of equipment.
Continu alcohol free disinfectants are ideal for all cleaning procedures and are available as spray,
wipes, liquid soap or hand cleansing foam. Respected Harley Street Endodontist, Catherine Thomas,
states that “Nuview have come up with an excellent range of products. The hand wash and foam
have proved very kind to skin and cross infection hand procedures are much easier”.
Nuview has also recently launched its new products – the Anti Microbial Dental Impression Mix and
a combined surface cleaner/disinfectant. The surface cleaner offers a 2 in 1 solution that removes dirt
or grease whilst disinfecting the treated area to ensure surfaces are clean as well as decontaminated.
The Dental Impression Mix saves time by disinfecting impressions at source using Continu to mix the
alginate, rather than water. Continu effectively inhibits fungal growth for up to 3 weeks.
Continu has been proven in tests to British Standards EN1276 and EN1650 to deliver many
advantages over traditional solutions:
t2VJDL &GGFDUJWF – A kill rate of 99.9998% within 30 seconds
t*OGFDUJPO $POUSPM – Does not cause micro cracking for bacteria to inhabit
t-POH -BTUJOH – Keeps working for several
days after application
t&DPOPNJDBM – Prolongs useful working life of
surfaces and equipment
t4BGF – With “hazard” rating of water it is
harmless to patients and staff
t%FSNBUPMPHJDBMMZ CFOFmDJBM – Does not dry
or damage skin
t&OWJSPONFOUBMMZ 'SJFOEMZ – No alcohol,
acids or solvents to dispose of
t7FSTBUJMF – Use on all surfaces including
computers and equipment
t0EPVS 'SFF – Attacks unpleasant odours,
creating a fresh environment
If you would like to find out more about how Continu can improve your
infection control results, please visit us on Stand L05 at the BDTA Dental
Showcase in Birmingham from 12th – 14th November or contact us today:
Nuview Ltd, Vine House, Selsley Road, North Woodchester,
Gloucestershire, GL5 5NN UK.
Tel: +44 (0) 1453 872266
Fax: +44 (0) 1453 872288
Email: continu@nuview-ltd.com Web: www.voroscopes.co.uk
know we need to switch to using
a washer system to reduce our
contamination risk significantly.
The Department of Health
has issued best practice guidance, available to download at
http://www.dh.gov.uk/en/Pub
licationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_089245.
This is what all dental health professionals should be working towards achieving in any dental
environment.
The aim of the guidance is to
improve the quality of disinfection and decontamination of
reusable dental equipment. Over
the next few years, every dental
centre, both private and NHS,
will have to be registered to show
they offer a safe, clean environment for dental treatment, especially that they are using appropriate decontamination of dental
equipment.
Most dental professionals
registered with the GDC will
have to improve their current
practice to achieve this standard.
Newly refurbished, and purposebuilt practices will have installed
these protocols as they developed.
A clean space
Our biggest hurdle is creating
a separate area for this purpose.
Our practice is small and there is
little room for expansion. This
means having a designated room
for this purpose, which is going to
be a challenge. One possible solution is to have a section of my
large surgery partitioned off to
create a room. We also want to
purchase equipment that will
work best with our practice and
reduce the risk of downtime if
there were any repairs required.
If I am honest, it is proving to
be a headache. Forget the obvious expense – this is secondary. It
is the number of clinical hours
that will be lost in the process that
is the problem. But after much
deliberation, we have decided to
invest in professional help, and
as it happens, there are many
well-read and versed individuals
out there who can offer solutions
to almost all situation; even the
autoclave in the staff kitchen scenario (although I hope there are
not too many of those left).
For instance, Martin Fulford
is an expert in this field and is
very in demand. He will be speaking at the London BSDHT meeting on 26 September as well as
providing a workshop opportunity to problem solve and offer
solutions. He will also be speaking at the BSDHT Annual meeting in Bournemouth in October
and at Independent Seminars
core subject day in December.
Many companies, for example Prestige Medical, offer an
evaluation service to practices. I
feel it would be prudent for all the
team to discuss the protocols followed in their practice and to familiarise themselves with the
document.
Doing your groundwork
The Dental Showcase exhibition in Birmingham in November
would be an ideal opportunity to
gather information and ask
knowledgeable representatives
of companies related to cross infection and disinfection and decontamination any questions you
have. I know that several, for instance Continu, are planning to
offer verifiable CPD to help us
gain a better understanding of
the standards we are striving towards. There will also be CPD
lectures running on a first come,
first served basis on all three
days. Considering this is a free
event, I cannot see why we would
miss this opportunity.
I believe that it is good for our
profession to be registered and
will offer reassurance to the public in this time for transparency
and clarity. I also believe that the
days of inadequate cold sterilisation with harmful chemicals
have had its day. All forwardthinking practices should be
looking to make these changes
before a deadline is issued. Remember, you have a duty to uphold these standards even if your
employer does not feel the need.
Perhaps it’s time to have that
talk… DT
About the author
Mhari Coxon
is a dental hygienist practising in
Central London. She is chairman of
the London British Society of Dental Hygiene and Therapy (BSDHT)
regional group and is on the publications committee of its journal,
Dental Health. She is also clinical
director of CPDforDCP, which provides CPD courses for all DCPs. To
contact her, email mhari.coxon@
cpdfordcp.co.uk.
[19] =>
DTUK2209_01_Title.qxd
DENTAL TRIBUNE United Kingdom Edition · September 14–20, 2009
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Do you want a challenge?
C
ould you live without the
basic comforts of electricity, hot water and modern
plumbing, etc? Could you accept
a culture that is very different
from your own? Could you cope
with being in a very unfamiliar
place which made you feel isolated? If you would be prepared to
meet these challenges, then you
could be opening the door to a
personally enriching and lifechanging experience by becoming involved in a unique and diverse group of activities in Nepal.
For example, you could undertake voluntary work in dentistry
by training and assisting qualified local people to undertake
simple dental procedures, and
also by teaching basic dental care
in the local schools. There could
also be a fantastic opportunity for
you to provide back-up emergency dental care to some major
expeditions that are happening
over the next 12 months, including an Everest Summit Bid.
There would also be the opportunity to take time out for an adventure trek in the spectacular regions of Everest, Annapurna and
Langtang or challenge yourself
further and climb a magnificent
Trekking Peak.
Although ‘Gap Year’ is normally associated with students
who are taking a break from their
studies, it can also apply to anyone of any age who wants to take
time out to broaden his or her
outlook on life, by experiencing a
different culture and by helping
to improve education and the
quality of community life.
You can bring much needed
hands-on skills – teaching dentistry and dental hygiene, nursing, joinery, bricklaying, plastering, plumbing, agriculture, etc,
or just the basic helping out of
everyday chores, these all greatly
benefit the local villages which
have a very simple day – day way
of life. It is also an opportunity to
have an adventure of a lifetime,
make new friends from all walks
of life and a great chance to travel
in this remarkable and much
undiscovered part of the world.
Nepal is regarded as one of the
most under-developed countries
in the world; it is ranked the 12
poorest on earth with 45 per cent
of people living in dire poverty.
This is due to is difficult geographical location, limited access
to development aid, inadequate
resources and investment and an
overall lack of awareness and education amongst the people. So
whether you are taking a “Gap
Year”, taking a career break or
just time out, the people of Nepal
would appreciate your help to
enable them to develop much
needed community projects
within their own areas. Of paramount importance to the success
of these projects are employment
skills, dental health education,
primary health care,
child welfare, economic wellbeing, basic human rights and
the promotion of
equality for women
and children.
There are no fixed
guidelines on how to
volunteer. You can
decide on your own
aims and goals and on
how best to achieve them. The
choice is yours and there is no
time limit. Trekking Encounters
are the UK representatives for
KEEP (Kathmandu Environment
Education Project) and we work
very closely with them in organising community projects. The
school projects that are taking
place at the moment includes the
Community Development Programme and Volunteer Teaching
in Government Schools. There is
a programme packaged for people who choose to work as a volunteer for a longer period, three
months to up to five months. During this programme, the volunteer stays with a family (Homestay) while engaging in activites
such as teaching in a school or
helping in social organisation and
community development activities. Through this integration students can gain a broader understanding of the outside world. In
addition to “Homestay” KEEP can
organise a number of other types
of volunteering to tie in with your
particular agenda eg assisting in
orphanage homes. This is a great
opportunity to change not only
your own life, but that of others.
The list is unrestrictive and open
to options.
It is not always easy to take
that first step and that is why with
Trekking Encounters’ experienced team we can help you take
that first step and be with you
through the journey. If you need
reassurance, encouragement or
just ideas contact us let Trekking
Encounters help you make that
dream a reality.
If you wish to volunteer, contact Trekking Encounters at
info@trekkingencounters.com
or visit our website www.
trekkingencounters.com
Don’t just change your life,
change the life of others.
It is in our experience that
once you are in Nepal and visiting
the villages you will relish the opportunity to see more of this fantastically diverse country.
The Himalayan region of
Nepal is the ultimate destination
with its unique landscape natural beauty and vibrant cultures.
• The highest mountain in the
world - Mt Everest and eight of
the fourteen highest mountains
in the world all upwards of
8,000m (ranked 1,3,4,5,6,7,8
and 10)
• Only 800km by 140km (0.1 per
cent of the world’s landmass)
ranging from 70m above sea
level to 8,848m
• Home to two per cent of the
world’s flowering plants
• Home to eight per cent of the
word’s birds and
• Home to four per cent of the
world’s mammal species
Lying between the two giant
countries of India to the south
and the Peoples Republic of
China to the North, no other
country can offer such variety as
Nepal, with 103 ethnic groups
and 93 spoken languages. Birthplace to Lord Buddha – Lumbini
and with two of the oldest religions, this country lives in harmony embracing both Buddhism
and Hinduism. With eight of the
highest mountains in the world,
Nepal has been the focus of some
of the most outstanding achievements in the world of mountaineering. There are some 326
peaks opened for mountaineering today.
Trek to Everest Base Camp
in the region also known as the
Khumbu region, which has
drawn walkers, trekkers and
mountaineers for many years
now. It is justifiably regarded as
the most famous trekking and
mountaineering region in the
world. Mt Everest is situated in
the Sagarmatha National Park,
a Natural World Heritage Site.
The region is also renowned for
its Sherpa people and villages,
Namche Bazaar being the capital
of the Sherpa people the area also
has stunning Buddhist monasteries.
Trek to the
Annapurna Region
located in central
Nepal the most geographically and culturally diverse region for trekking.
The region stretches
over 2,600sq km and
is the region where
the famous Gurkha
soldiers are from.
The area is rich with
sub-tropical lowlands, valleys, bamboo, oak and rhododendron forests,
alpine meadows,
windswept desert
plateaus, glaciers
and of course the impressive Annapurna
Mountain range.
Trek to the
Langtang Region
this is a protected
area in the Langtang
National Park covering an area of
1710 sq km. Known as ‘The Valley
of the Glaciers’, it is a narrow valley running parallel with the Tibetan border and north of Kathmandu. Enclosed to its north by
the main Himalayan range and to
its south by a slightly lower series
of snowy peaks this is a high and
isolated area. The park has a variety of climatic zones ranging from
subtropical to alpine and around
25 per cent of the park is forested
with trees such as oak, maple,
pine and rhododendron. Animals
include red panda, Himalayan
black bear and monkey.
Cultural Nepal
Kathmandu is both the capital and largest city of Nepal with a
population of about 700,000. The
three main historic cities are
Kathmandu, Patan and Bhaktapur. The Kathmandu valley has
seven World Heritage Sites
within a radius of 20km designated by UNESCO in 1979.
Lumbini - Lord Buddha's
birthplace site, is the sacred
birthplace of Siddhartha Gautam, the Shakya Prince, the eventual Shakyamunu and the ultimate Buddha - the Enlightened
One. It is the holiest pilgrimage
site for Buddhists.
Chitwan National Park:
stretches across an area of 932 sq
km and lies in the inner Terai belt
of Chitwan. The park offers nature at its best with a jungle safari, a canoe on the river where
you can see crocodiles and visit
an elephant nursery. DT
This country will give you a
challenge, are you ready for it?
Contact us on
info@trekkingencounters.com
Telephone: + 44 (0) 1738 620725
Visit our website –
www.trekkingencounters.com
[20] =>
DTUK2209_01_Title.qxd
20 Education
DENTAL TRIBUNE United Kingdom Edition · September 14–20, 2009
The future of dental training
The University of Manchester and Smile-On have joined forces to offer the first
online postgraduate degree in restorative and aesthetic dentistry in the UK
W
hen considering the
finest training and top
education facilities for
future dentists, one often thinks of
the many fine institutions that the
UK can proudly boast. However
the thought of obtaining a world
class MSc in Restorative and Aesthetic dentistry at any time, anywhere in the world is sure to raise
eyebrows until the reality of this is
thoroughly explored.
Education has changed. That
is the simple fact of the matter.
The keywords in building CPD,
developing skills and keeping up
to date with the ever-changing
world of dentistry more than ever
revolve around “flexibility”.
Offering both students and
professionals access to a flexible
training curriculum promotes
options as well as opportunities.
Looking to the future
As more and more dental professionals and students turn to
flexible learning options, it is important to find a programme that
is of the highest quality. Explore
the objectives of the course and
make sure it aims to deliver:
Don’t read this...
• An innovative programme
which enhances current knowledge and clinical skills
• Present sound academic theory
and high-quality practical training by qualified and recognised
mentors
• The confidence and ability to
enhance current clinical practice through the latest advances
in technology and research
• Access to the course regardless
of place or time zone whilst
maintaining employment or
dental practice.
Many reputable universities
such as the University of Manchester have recognised the importance of flexible learning and are
already offering outstanding
courses such as the MSc in Restorative and Aesthetic dentistry.
Joining forces with Smile-on,
the market leader for flexible
learning and education in healthcare, this innovative, technology
driven MSc course brings together
a high-class international faculty
for a modern global classroom.
Predicated on self-directed
learning, this course is divided
into seven parts:
...unless you are interested in:
앫 Lower professional indemnity subscriptions
앫 Free personal indemnity for every dental nurse and/or
dental technician you employ for both clinical negligence
and professional matters
앫 Free annual subscriptions to a comprehensive online
information resource including a wide range of business
and healthcare legislation and regulatory requirements
앫 CPD for the whole dental team
앫 Free Indemnity for practice managers and receptionists
앫 Employment law helpline
앫 Dispute resolution assistance for disputes between
professional colleagues
앫 Practice management and clinical audit tools to make your
practice safer, more easily managed and more successful
An Xtraordinary Indemnity Programme for the Whole Practice
For more information go to www.dentalprotection.org/uk/dplxtra or call our Membership Helpline on 0845 718 7187
• Foundations of 21st Century
Practice (150 hours – 15 credits)
• Aesthetic Considerations (150
hours – 15 credits)
• Anterior Aesthetics (300 hours
– 30 credits)
• Posterior Aesthetics (150 hours
– 15 credits)
• Complex Treatments (300
hours – 30 credits)
• Research Methodology (150
hours – 15 credits)
• Research Project/Dissertation
(600 hours – 60 credits)
(Total time and credits 1800
hours – 180 credits)
This is the first online postgraduate degree in restorative
and aesthetic dentistry in the UK.
With the progression of flexible
training and education, dental
professionals are offered many
more exciting opportunities to
easily and most importantly
credibly work toward better
skills within dentistry.
For more information about
the MSc in restorative and aesthetic dentistry, visit www.
smile-on.com/msc. DT
[21] =>
DTUK2209_01_Title.qxd
DENTAL TRIBUNE United Kingdom Edition · September 14–20, 2009
Education 21
Home alone
Surviving the first weeks at university can be daunting, but you’ll manage if you keep
healthy, active and organised. Recent graduate Sarah Armstrong offers some advice
S
tarting dental school is a
daunting time and it’s all too
easy to overdo things during
the early stages – the academic
workload being only a small proportion of university life. The first
few weeks will be spent finding
your feet, settling in with new
friends and getting to grips with
your course.
Keeping healthy and active is
essential. The onset of the dreaded
‘fresher’s flu’ during your first few
months is inevitable with so many
students congregating in one
place, and immune systems being
dented with too many late nights
and too much alcohol. The obvious solution being to keep both to
sensible levels! Come autumn,
‘fresher’s flu’ may not be the only
flu you need to be vigilant against,
with the increasing incidence of
Novel H1N1 flu (‘Swine flu’) it’s important to be on the look out for flulike symptoms from yourself and
others around you to prevent
spread and make sure you register
with a doctor on arrival.
In these difficult financial
times it’s worth remembering
that loans/credit cards are a lot
harder to come by, which in some
ways can be viewed as a good
thing, preventing unwanted debt
amassing early on.
Although university life is a
lot of fun, it can be easy to get
overwhelmed, tired and homesick. It’s worth remembering that
you’re never alone, there are
plenty of people you can turn to
for advice including flatmates,
family, dental school tutors etc.
Don’t keep things bottled up,
you’ll be surprised at how much
they can help and identify with
your situation. DT
How can one size fit all?
A minute on the lips
Eating is an important consideration, even if you’re staying in
catered halls! Often halls of residence will only provide breakfasts
and dinner on weekdays so you’ll
need to provide lunches, all meals
throughout the weekend, and depending on your timetable demands you may miss the odd
catered meal during the week due
to timetable clashes. It’s all to easy
to slip into the habit of ordering
takeaway and making sneaky visits to the kebab shop on these occasions; but not only is it expensive,
it’s no good for the waistline!
Unless you’re already a culinary genius, your best bet is either
to befriend one on arrival or to buy
an idiot-proof basic cookbook to
get you started. If you’re in selfcatered halls then you’re going to
be thrown in right at the deep end
fending for yourself, and the above
will be more important than any
‘essential’ text on your reading list.
Watching the pennies
Budgeting is another important
(though frustrating) consideration.
It’s essential to keep a tight rein on
your finances, especially during
the early stages of your degree.
Every year students go on spending
sprees after receiving their student
loan, seeing it as ‘free money’ leaving precious little to survive on once
the term comes to a close and this
can lead to an ongoing cycle of debt.
We have always believed that the digital imaging requirements of
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About the author
Sarah Armstrong
qualified from Newcastle University in 2008 and is currently working as a vocational dental practitioner in Brampton, Cumbria.
E-WOO Technology UK Ltd, Axiom House, The Centre, Feltham, Middlesex TW13 4AU. Tel: 0208 831 1660. www.e-wootech.co.uk
[22] =>
DTUK2209_01_Title.qxd
DENTAL TRIBUNE United Kingdom Edition · September 14–20, 2009
22 Education
The importance of groundwork
The key to any successful implant treatment lies in its planning
and execution. Dr Riz Syed explains
T
he implant surgeon may
feel a case is successful
based on the criteria, but it
can be seen as a failure if all of the
patient’s desires are not fulfilled.
It is therefore important dur-
ing the initial consultation to listen to the patient and understand
what he or she is hoping to
achieve. Following careful clinical and radiographic evaluation,
the range of options should be
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presented and a treatment decided upon that best suits both
clinician and patient. Risks and
complications can be listed and
explained in a comprehensive
consent form tailor-made for that
patient.
Periodontal status must be
measured and treated if necessary before beginning any sort of
implant therapy. A clear interaction with either the hygienist or
the periodontist is crucial for
long-term success.
Any active decay should be
noted and treated. Also check for
occlusal disharmonies and decide whether to use a conformative or a re-organised approach.
The type of soft tissue around
the proposed site should be
noted, as this will have a significant effect on the restorative and
long-term success. Smile lines,
current position and colour of the
teeth are all noted to determine
the final desired result.
‘It is therefore
important during
the initial consultation to listen
to the patient
and understand
what he or she is
hoping to
achieve.’
The medical history
A detailed medical history
will enable assessment of any
risk involved during or after the
surgery. Interaction with the patient’s physician will help deal
with patients with complicated
medical histories, including
those who are taking anticoagulants, have had major surgery or
cancer treatment. These patients
are suitable for surgery providing that set protocols are followed.
Current medication, such as
bisphosphonates, can also affect
the outcome of surgery. This is
not a contraindication provided
set guidelines are followed.
Periapical radiographs
www.ctscan.co.uk
Simple periapical images
help to assess bone level, periapical pathology, caries and current
restorative situation of teeth.
This assists in deciding on prognosis and treatment for each
tooth.
Calibrated ball bearings are
useful to measure the height of
[23] =>
DTUK2209_01_Title.qxd
DENTAL TRIBUNE United Kingdom Edition · September 14–20, 2009
‘Pan-oral radiographs are very
useful to view
overall condition
of current dentition and bone
level, vital structures or the level
and size of maxillary sinuses. ’
CT scans are also very useful
in exploring the sinus before
augmentation procedures. In a
significant number of cases,
maxillary sinuses have a septum
that can lead to complications.
Knowledge of this can help surgeons modify the design of the
window needed to lift the floor of
the sinus.
Education 23
About the author
Dr Riz Syed
qualified at the Royal London Hospital in 1999 and runs a referral clinic in
Islington and Walton-on-Thames, and was one of the first surgeons in the
country to use NobelGuide. He is a mentor for Nobel Biocare, helping to
train UK implant surgeons. Regularly consulted for complex treatment
planning cases, Dr Syed lectures on guided implant surgery. He is a member of the Association of Dental Implantology, the International Congress
of Oral Implantologists and Fellow of the Royal Society of Medicine. His
practice includes sinus grafting, surgical crown lengthening and hard and
soft tissue grafting, and has been awarded the Clinic of Excellence in Implant Dentistry. To contact Dr Syed, email rizsyed@hotmail.co.uk, call
01923 223479 (Mulberry Dental Care) or 020 7226 9797 (AG Dentistry).
For further information, call
01895 430 650, email info.uk@
nobelbiocare.com or visit
www.nobelbiocare.com. DT
available bone and can be used in
conjunction with periapicals or
pan-oral radiographs. Ball bearings are usually five mm in diameter and help to calibrate the
X-ray. Distance between adjacent teeth, from the crestal ridge
to the inferior dental nerve, mental nerve and sinus can be measured using this approach.
Veraviewepocs 2D/3D
Pan-oral radiographs
Pan-oral radiographs are very
useful to view overall condition of
current dentition and bone level,
vital structures or the level and
size of maxillary sinuses.
Ridge mapping
Often, ridge width will appear
sufficient for implant placements, but once a flap is raised,
the true width of the bone is very
narrow. This is due to the thick
soft tissue above the bone ridge.
The surgeon is therefore left
with the issue of grafting the narrow ridge and delaying implant
placement as well as explaining
extra cost and time to the patient.
During a full consultation, the
patient can be anaesthetised and
bone callipers used to give an accurate ridge measurement. Or, study
models can be taken and a plastic
suck-down guide with multiple
holes across the ridge produced by
the lab. The patient is anaesthetised and a probe used to measure the depth of each hole from the
soft tissue to the bone. These measurements are returned to the lab
where a model is produced showing the exact dimensions of bone
on that selected area. A guide can
be produced from this model to
help with implant placement.
CT scan
CT scans are becoming increasingly popular in helping with
bone diagnosis and placement of
single and multiple implants. The
dicom files received from a scanning centre give the most accurate
measurement. File conversion
software is available, allowing
users to reconstruct the image as a
3D model of the desired ridge.
With Nobel Biocare’s successful NobelProcera software the
surgeon can plan and place implants with outstanding accuracy
and create a surgical stent. Prosthesis can be fabricated based on
where the implants will be placed.
The stent is placed into the mouth
and implants can then be placed
and loaded during the same visit.
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From the first step, upgradable 2D devices, to the basic version Veraviewepocs 3De and the high-quality X-Ray CT unit 3D Accuitomo 170, one thing
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[24] =>
DTUK2209_01_Title.qxd
DENTAL TRIBUNE United Kingdom Edition · September 14–20, 2009
24 Clinical
Global Ceram • X Case Contest 2008/2009
I
n the Dentsply Global Ceram•
X Case Contest three UK students came out on top and
were put forward to the global final. In this issue we take a look at
Barts and The London, Queen
Mary’s School of Medicine and
Dentistry (UK) student Reena
Wadia’s presentation.
Before
After
Fractured maxillary central
incisors.
A highly aesthetically-pleasing result, with the restorations showing natural and
harmonious integration into
the surrounding dentition.
Introduction to the case
A 59-year-old female patient
presented with large fractures
of her maxillary right (UR1) and
left (UL1) central incisors.
These were a result of a traumatic fall and necessitated
restorations for aesthetic and
functional reasons.
The UL1 responded normally
to sensibility testing and therefore considered to be vital ; the
UR1 had been treated endodontically, satisfactorily. This case was
restored using Ceram•XTM duo;
advanced nano-ceramic technology.
Step 1- Study models & wax-up
Alginate impressions were taken
and an intercuspal position registration was recorded. Thereafter,
study models were mounted on a
semi-adjustable articulator. A diagnostic wax-up was completed to
aid fabrication of a silicone putty
matrix.
Step 2- Shade selection & isolation
The teeth were cleaned with
Nupro® prophylaxis paste. Shades
were chosen prior to isolation, to
avoid possible interference in
chroma and opacity evaluation
due to tissue dehydration. Using the
Ceram•XTM shade guide in natural
light, E3 (enamel) and D2 (dentine)
were selected and agreed by the patient. A rubber dam was then placed
to isolate the working field.
Step 3- Etch & adhesive Step 4Silicone putty matrix
Each tooth was etched with 36 per
cent phosphoric acid, which was applied selectively along the enamel
margins for 15 seconds before extending the etching gel onto the dentinal
cavity surfaces for another 15 seconds.The etchant was rinsed off thoroughly and the preparation dried, but
not desiccated. Prime&Bond®NT was
applied in an even layer, the solvent
blown dry for 20 seconds and the
adhesive cured.
Step 4- Silicone putty matrix
The palatal silicone putty matrix
was tested in position, which
showed the space that was created
following the diagnostic waxup.
The matrix was used to fix the
palatal profile and the incisal edge
position.
Step 5- First enamel layer
The ‘enamel’ composite was applied directly onto the silicone matrix, which was then placed up
against the teeth. This allowed the
palatal build-up to be performed
easily and precisely. Enamel shades
were applied in 2mm increments
and cured for 10 seconds (light output 500mW/cm2).
Step 6- Dentine core
The dentine core of the restorations
was created by applying and shaping several layers of the ‘dentine’
composite. Dentine shades were applied in 2mm increments and cured
for 30 seconds (light output
800mW/cm2).
Step 7- Final enamel layer
A transparent matrix band was
then fixed to either side of the tooth
and used to help shape the final
layer of ‘enamel’ composite. This
completed the proximal and labial
profiles of the restoration and provided the desired translucency and
brightness.
Step 8- Shaping & polishing
Excess material was removed and the
restoration shaped using a flameshaped fine-grit diamond bur.Abrasive discs were used on the palatal
and labial surfaces, and abrasive
strips used approximally.The final
polishing of the restoration was obtained using disc-shaped Enhance
and PoGo finishing instruments.After
removal of the rubber dam, the occlusion was marked and adjusted.
A layer of unfilled resin was then applied as a final thin coat to reduce the
chance of microleakage.
ties and is understood to have
good longevity. This is thus an at-
tractive option especially for anterior restorations. Ceram•XTM
Material and method
Ceram•XTM duo (Shade E3
and D2), Nupro® prophylaxis
paste (Dentsply DeTrey), 36%
phosphoric acid (DeTrey® Conditioner 36, Dentsply DeTrey),
Prime&Bond®NT (Dentsply DeTrey), Enhance and PoGoTM
(Dentsply DeTrey), unfilled
resin.
Direct adhesive bonding followed by natural layering technique. Ceram•XTM duo shade E3
used to give enamel-like translucency and shade D2 used to replace the lost dentine giving the
correct opacity and chroma. Final polishing for superior surface
gloss and smoothness.
Discussion and conclusion
A very aesthetically-pleasing,
‘life-like’ result was achieved.
This material also has excellent
handling and placement proper-
duo certainly brings a smile to
both the patient and dentist. DT
Under-treatment & Supervised Neglect
ment” allegations described as
“under-treatment”. The background to these cases is often more
complex than it might seem at first
sight.
The emotive phrase “supervised neglect” is often used to describe a situation where a patient’s
oral health has been allowed to deteriorate over a period of time, despite regularly attending the dentist who is responsible for the patient’s care and treatment.
Fig. 1
A
n interesting contrast between cases that involve
dental practitioners and
those that involve medical practitioners is that the former tend to involve criticisms of treatment that
has been provided, while the latter
include a significant number of
“failure to treat” or “delayed treat-
• Whether or not the dentist had
identified the relevant problems
that existed in the patient’s
mouth (for example, defective or
fractured restorations, periodontal disease, uncontrolled caries,
tooth tissue loss through erosion,
abrasion, attrition or fracture,
hard or soft tissue pathology, etc).
• Whether or not the dentist has
been monitoring the patient’s
condition, and/or carrying out
appropriate
investigations
that would provide the information necessary to reach a
proper diagnosis and treatment plan.
• Whether or not the dentist had
identified any relevant risk factors that might be contributing to
the patient’s deteriorating oral
health (for example, oral hygiene,
It is sometimes confused with a
situation in which the patient’s oral
health has been deteriorating despite the dentist’s best efforts,
rather than because of any lack of
effort or attention on the part of the
dentist concerned.
The key to this pivotal difference is often to be found in the clinical records, from which it will be
clear:
diet, smoking, bruxism or parafunction).
• Whether or not the dentist had informed the patient about his or
her oral condition, and communicated effectively with the patient
about what was being done and
why, or what the patient could do
to help, control or improve the situation.
• Whether or not the dentist had explained the available treatment
options to the patient, which in
some circumstances might include the possibility of a referral
for specialist advice or treatment.
The Patient’s Response
Fig. 2
Fig. 3
The record should describe the condition of the dental tissues at the time of the initial examination. In cases where things remain less than perfect or continue to
deteriorate, the reasons for this should also be clearly documented.
On the one hand, there will be
cases where the patient has repeatedly declined the dentist’s recommendations for certain treatment,
or perhaps a referral. This may be
on grounds of cost, inconvenience,
disinterest/apathy or for a variety of
other reasons. Whatever the cir-
[25] =>
DTUK2209_01_Title.qxd
DENTAL TRIBUNE United Kingdom Edition · September 14–20, 2009
• Other dentists are unwell physically or mentally, and may not always realise this at the time; in
one instance the explanation
was no more complex than that
the practitioner in question had
not realised the extent to which
his eyesight had deteriorated.
• Sometimes dentists are simply
too busy, perhaps having been
unable to replace a departed colleague, and “supervised neglect” becomes a response to having to see too many patients in too
little time.
Fig. 5
Fig. 4
Fig. 6
cumstances, it is important to
record the recommendations that
were made (and the patient’s response) very clearly in the notes at
the time.
uled review appointments, that one
course of treatment seems to
merge seamlessly into the next.
There is a danger that the patient’s
treatment might be approached on
these occasions in a reactive “patch
and mend” fashion, rather than a
more proactive “what’s happening
here, and why?” fashion.
Similarly, it is important to
record each and every appointment that the patient fails to attend
or cancels at the last minute. Reception and administrative staff should
be encouraged to amplify clinical
notes to reflect what has been
agreed with the patient. For example, “Patient rang to cancel appointment. Offered to rebook, but patient
prefers to contact us when more
convenient.”
With most (although not all)
computerised records and appointment systems, it is relatively easy to
record the fact that a patient cancels an appointment scheduled
several days or weeks after the
booking has been made. This helps
to establish a more complete record
of the patient’s attendance pattern,
and this can become very important if allegations of supervised
neglect or excessive treatment delays are made at a later date.
Where manual (paper) records
are being used, however, it would be
much more unusual for a receptionist to retrieve the patient’s notes,
specifically in order to record the
fact that the next appointment, a
week or two later, had been cancelled by the patient. In the absence
of this record, the appointment book
itself can sometimes become a valuable additional record—although
many receptionists prefer to erase
cancelled appointments completely, in order to indicate availability and to legibly insert a new name.
At some stage in their career,
most practitioners will have had
patients who seem to stagger from
one crisis to another, and whose
treatment never really feels to be
under the practitioner’s control.
These patients often present with
so many unexpected emergency
problems in between their sched-
Fig. 8
Assessing the Situation
In such cases it is important to
stand back from time to time and
to make the effort to take a more
detailed overview of the patient’s
oral health, approaching this in
the same logical fashion as one
might approach a patient who you
were treating for the first time. If
the records can demonstrate that
this was done, then it becomes
much easier to defend subsequent
allegations of under-treatment or
“supervised neglect”.
The records sometimes tell the
story of a patient who was at one
stage being treated very diligently
and attentively by a practitioner,
but gradually this picture changes
to one in which medical histories
are not being updated, periodontal
health is not being monitored, xrays are not being taken, and so on.
A periodontal problem or a sinus over a root apex is “treated”
with a prescription for antibiotics,
but with no other details recorded
in the notes, and no arrangements
made for follow-up. Worse still,
the records simply mention that a
prescription was given, with no
explanation of why this was being
done.
Many factors can contribute to
a greater or lesser extent in the
“supervised neglect” of a patient:
• A dentist who is under stress for
reasons unrelated to dentistry
(perhaps financial worries, or
domestic/personal problems)
may be distracted by these outside pressures and become less
attentive in the treatment of patients.
Fig. 9
A significant number of the
“multiple” cases of “supervised
neglect”, tend to involve practitioners who are nearing retirement,
which is a particular concern, since
a large number of the practitioner’s
patients will shortly be seen by a
second dentist. This is often the
means by which “supervised neglect” comes to light. And where supervised neglect has been occurring on a wide scale, over an extended period of time, there have
been many instances where this
has created a nightmare situation
(financially and logistically) for any
dentist(s) who takes over the care of
the patients within the same practice. The worst scenario arises
when such a dentist has taken over
a “rolling” list of capitation patients,
and finds a significant number of
them needing extensive treatment
in return for minimal capitation
payments.
When a dentist is treating the
patient within a capitation payment
system, “supervised neglect” can
arise for slightly different reasons.
Very occasionally, a dentist appears
to be practicing planned inactivity
on capitation patients, while carrying out a normal range of treatment
for patients who are paying fees on
an item of service basis. Clearly, it is
difficult to justify and defend the
ethics of such an approach; it is a deliberate abuse of the capitation remuneration system and it is important to appreciate that it is the individual dentist, not the payment system, who is responsible for abuse of
this kind.
Assumptions
When a patient actively declines treatment that has been recommended, the situation becomes quite clear-cut. A feature of
“supervised neglect” cases, however, is sometimes an assumption
on the part of the treating clinician
that the patient “wasn’t interested” in a certain treatment option, or that some old and discoloured restorations “didn’t
worry them”. When there is no
confirmation of this in the records,
it is easy for a patient to respond
along the lines of how did you
know—you never asked me?’
Fig. 10
Clinical 25
Fig. 7: Patients’ inability to attend for treatment can sometimes explain why their
dentition is in a state of poor repair.
To avoid this situation it is sensible either to make, or not make, a
specific treatment recommendation, to discuss the options with the
patient and to record the outcome
of these conversations clearly in the
clinical notes. This becomes particularly important when treating patients with whom you have a less
formal relationship—perhaps professional colleagues, staff, friends
or family members. These are precisely the situations where conversations that should take place,
might not occur.
Comfort Zone
Various studies have shown
that dentists are likely to look
more critically at restorations
placed by others, than they are in
situations where they placed the
restorations in question themselves—particularly in a regularly-attending patient that they
have been treating over many
years. One will often observe an
old restoration with less-thanoptimal margins, surface defects
or discolouration. A clinician,
who has observed these same
restorations over several years
with little or no deterioration,
and no other signs or symptoms,
is well placed to appreciate that
the situation is stable.
A clinician seeing this patient
for the first time might take the
decision to replace the restorations immediately. Whether or
not this is seen by the patient as
indicative of any fault on the part
of the previous dentist, will often
depend heavily upon the way in
which the second dentist describes the situation.
The above situation can look
somewhat different when this is
not an isolated restoration, but
one of many such restorations in
the same mouth, and when this is
just one patient out of hundreds
where the same situation is encountered. Seen through one
pair of eyes this is supervised
neglect; seen through another
pair of eyes, this is prudent, cautious, minimum-intervention
dentistry.
Summary
All dentists have a duty of care to
exercise a reasonable level of skill
and competence when treating
each patient under their care. Failing to provide necessary treatment
is one way in which this duty of care
can be breached; recommending or
providing unnecessary treatment
falls at the other extreme, but is still
a breach of a clinician’s duty of care.
Regular and effective communication with patients about their
oral condition, and about what
treatment is (and isn’t) being proposed, and why, is a valuable protection against an allegation of under-treatment. Full and meticulous
records based upon appropriate investigations are equally invaluable. These two strategies, coupled
with an up-to-date awareness of
current thinking in diagnosis and
treatment planning, will avoid the
majority of problems in this area.
Editorial Note: This text
should ideally be read in conjunction with the article on history taking to be published in the next edition of Dental Tribune. DT
About the author
We are the world’s largest specialist provider of dental professional
indemnity and risk management
for the whole dental team. The articles in this series are based upon
Dental Protection’s 100 years of experience, currently handling more
than 8,000 cases for over 48,000
members in 70 Countries.
33 Cavendish Square
London W1G 0PS, UK
E-mail: General enquiries
querydent@mps.org.uk
The complete set of 36 risk management
modules can be ordered from
lynne.moorcroft@mps.org.uk
www.dentalprotection.org
Fig. 11
Existing restorations can look very different when viewed by the dentist who placed them some years earlier, as opposed to a second dentist who is examining them for the first time.
[26] =>
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26 Industry News
DENTAL TRIBUNE United Kingdom Edition · September 14–20, 2009
sors, Eschmann can offer Decon360 cabinetry solutions that
can be tailored to meet the
needs of every type and size of
practice, from single chair surgeries to multiple chair clinics.
SmartLiteTM PS
Daily essential
in dentistry
Six out of ten dental procedures require a curing light. Today’s daily essential in dentistry
is a curing light which is small,
silent, lightweight and completely cordless with a high performance. In other words, today’s daily essential in dentistry
is a SmartLiteTM PS.
More than 25,000 customers
across Europe are using the
SmartLite pen-style, high
power LED curing lights; and 9
of 10 dentists surveyed said this
purchase was “good or very
good”. At two international centres, 99% of 344 restorations
cured with the SmartLite PS
demonstrated no post-operative problems.
Decon360 offers high quality cabinetry using the very best
materials, including fully fabricated Corian surfaces. Decon360 solutions incorporate a
number of unique design features that address many of the
challenges that can be encountered in practices where space
is at a premium.
• Time sensitive (soon to expire) supplies
• Returned equipment and supplies
• Used equipment
• Refurbished equipment
• End of line supplies
Hundreds of dentists have already registered (for FREE) on
the site since it launched at the
start of July.
Are you fully
compliant?
For more information on the latest Decon360 decontamination
room solutions, contact Eschmann on 01903 875787 or email
ic.sales@eschmann.co.uk,
www.eschmann. co.uk
What is the beating heart of a
dental practice? Often unintentionally neglected, the air compressor system is relied upon to
provide safe, dry and infection
free compressed air to numerous instruments and handpieces on a daily basis.
Chairs need
cleaning after
every patient
To regulate dental air compressors for risk of contaminants, all systems must now be
compliant with NHS HTM
2022/1 guidelines and conform
to the following quality conditions:
Offering high performance
with short curing times, an investigation that tested the curing of 145 dental materials with
the SmartLite PS showed that
87% of materials cured in 20
seconds or faster!
• Dryer System – Should be capable of producing air with an
atmospheric dew-point not
less than -20°C
• Filter System – Should provide
dust filtration down to 1 µm
with a DOP (aerosol) efficiency of not less than 99.97%
and bacteria filtration down to
0.01 µm with a DOP (aerosol)
efficiency of not less than
99.9999%
For more information, please
call DENTSPLY on +44(0)800
072 3313 or visit www.
dentsply.co.uk
Call Dental Air on FREEPHONE
0800 542 7575 and ask for a FREE
Practice Manager’s Guide, or
visit www.dentalair.co.uk
‘Decon360’,
the new, allinclusive decontamination
room solution
from Eschmann
Eschmann is delighted to announce the launch of ‘Decon360’
Decontamination Room Cabinetry, developed specifically to
help dentists meet the Best Practice requirements of HTM 01-05.
Eschmann are the first company in the UK to provide an allencompassing, one-stop solution, allowing dentists to work
directly with the UK’s leading
decontamination specialists at
all stages of the process, from
initial enquiry and site survey,
through to the production and
installation of the finished decontamination room.
By working directly with
their dedicated team of advi-
ChairSafe is the new disinfectant foam cleaner from the
Kemdent range of Cross Infection Control products. It is available in 200ml bottles and 1L refill containers and with the new
Kemdent range of durable and
economy wipes. These extra
large ChairSafe wipes mean
that you can clean a chair for
just a few pence after each patient, protecting you and your
staff.
HTM 01-05 is a guidance
published by the DOH. It recommends that Dental Chairs
need to be cleaned between
every patient to minimise the
dispersal of microorganisms.
ChairSafe foam and ChairSafe
wipes are specially formulated
to clean sensitive surfaces and
equipment, including
the
leather and synthetic facings of
dental chairs.
ChairSafe foam and wipes are
alcohol free. They are effective
against HBV/HIV/HCV/BVDV/
vaccinia, bactericidal and fungicidal microorganisms within
one minute of application.
Dental professionals can be
assured that ChairSafe foam
and wipes will help them decontaminate their Dental Chair
economically and effectively.
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.
You’ve Got
Mail!
Nothing
Compares To
Genus Design
and Build
Nothing compares to seeing
your dreams realised. Genus
takes great pride in helping
dentists achieve their ambition
of providing cutting edge treatment in a stylish and fully compliant environment, with its celebrated Design and Build service.
When you work with Genus,
your expectations are exceeded. At the design stage, the
Genus experts use the latest
software and technology to set
out your vision, taking into account all new and existing industry requirements. Then you
see your vision take shape during the construction phase, with
a dedicated specialist ensuring
that everything runs smoothly
and that time and budget limits
are respected.
For more information please
call Genus on 01582 840484 or
email info@genusgroup.co.uk,
www.genusinteriors.co.uk
10 Years
Younger
Exhibition
Looking to buy second-hand
equipment?
Can’t find what you are looking for?
When you are in the market for
second-hand equipment it can
be time consuming and often
lead to many hours spent looking, only to find out it wasn’t
quite what you were looking for.
Wouldn’t it be easier if the
equipment came to you?
Well now it can! If you visit www.
inventorycircle.com then you
can set up an Email Alert for the
relevant item that you are looking for. Simply fill in the form and
create the email alert.
www.inventorycircle.com has
been designed to connect dentists across the globe who want
to buy and sell:
The 10 years younger exhibition held at Earls Court earlier this year introduced the
general public to latest youth
and beauty promoting products.
Delegates were keen to discuss and explore all the new advancements in modern cosmetic dentistry to help them
achieve a beautiful smile and
the BACD team members
walked them through options
available including finding an
appropriately skilled cosmetic
dentist and the find-a-cosmetic
dentist service.
Delegates also commented
on the lecture from the BACD
held on Saturday 4th calling it
“informative” and “easy to understand”. The lecture consisted of images and an uncomplicated tutorial on procedures
such as veneers, crowns and
bridges, whitening and Orthodontic treatments.
For more information on the
BACD or to talk to an advisor
on becoming a member call
+44 20 7612 4166, email:
info@bacd.com or visit www.
bacd.com
Saniject –
Award
Winning Pain
Free Injection
System
Introducing the first 100%
single use, self-dosing injection
system from SaniSwiss. This innovative design offers effortless
application of a precise unit
dose of anaesthetic from a 1.8ml
cartridge as well as reducing
the risk of cross infection. The
patented SPI-system provides
gentle and pain-free diffusion
into the tissue by preventing
painful or harmful pressure, especially for intra-ligamental
anaesthesia. The feather- light
and compact design enables
easier oral access and quick assembly of the syringe. Injections have never been made
easier! For our introductory offer and further information
about this unique product contact Swallow Dental on 01535
656312.
Tel: 01535 656312
Fax: 01535 656437
Email: rebecca.jacques@
swallowdental.co.uk
www.swallowdental.co.uk
NEW
Hate paper
printouts? – Go
Wireless!
A market leader in infection
control solutions, YoYo Dental is
proud to launch the NEW SpectruM Wireless Data Logger.
Connected to your current
washer disinfector or autoclave, SpectruM Wireless Data
Logger will convert all equipment to produce HTM 01-05
compliant validated data readings.
DT page 27
[27] =>
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DENTAL TRIBUNE United Kingdom Edition · September 14–20, 2009
DT page 26
• No more Paper – All validated
data is transmitted to your PC,
removing need to file and organise printouts
• Fast – Broadband WiFi Connectivity transmits constant
data stream to PC
• Cost Effective – Is compatible
with all YoYo equipment
• Safe – All data stored on PC
memory is protected, and will
not be lost if PC crashes
Lightweight and cordless,
the Waterpik® dental water jet
offers many advantages. It is
convenient when travelling and
its slender shape enables easy
storage. The many health benefits of Waterpik® dental water
jets include a hygienic mouth,
strong and healthy teeth and
gingivae, fresh breath confidence and excellent protection
against plaque, bacteria, bleeding and a range of periodontal
diseases.
For more information visit
www.waterpik.co.uk
Sitting Pretty
After 15 Years!
Scientifically proven to offer
great advantages in a daily
healthcare regime, the Waterpik® Dental Water Jet can dramatically improve overall oral
health.
Dental professionals can
also order Waterpik® dental water jets through their dental
wholesaler and make the most
of their professional courtesy
discount.
anterior and posterior and the
instrument’s sharp and fine tips
make them invaluable.”
DENTSPLY’s Artio colourcoded instruments are available in an array of tip sizes and
shapes for periodontal scaling
and restorative procedures.
Each Artio instrument has an
Ash Cryosteel tip, cryogenically
treated stainless steel for the ultimate in durability.
For more information on the
latest solutions to sterilisation, contact Eschmann on
01903 875787 or email ic.
sales@eschmann.co.uk, www.
eschmann.co.uk
Brushing’s
Back on the
Box
For more information please
free-phone +44 (0) 800 072 3313
or visit www.dentsply.co.uk
For more information, or for
a FREE compliance survey,
please call Yoyo on 0845 241 5776
or email info@yoyodental.com,
www.yoyodental.com
The benefits of Waterpik®
Dental Water Jet have been documented in numerous clinical
studies. Water Pik is delighted
to announce that this groundbreaking equipment is now
available in over 800 Boots
stores across the UK.
• Proven broad spectrum Hydrogen Peroxide/Silver Nitrate disinfectant
• Silver Nitrate technology enhances the level and longevity
of protection
• Portable and compact, one
unit can treat several rooms/
zones
• SeptPeroxide Test Sticks can
be used to validate the
process.
“The colour coding system is
brilliant for ease of distinction
when instruments are laid out
on the tray. I would highly recommend Artio, as they are so effective.”
Replacing your current USB
and printer, YoYo Dental’s costeffective Wireless Data Logger
is compact and discreet, optimising on space whilst ensuring best practice to HTM 01-05
guidelines.
Waterpik®
Dental Water
Jets Now Available Across All
Boots Stores!
Industry News 27
The Bambach Saddle Seat
has successfully been in production for 15 years. This market leading seat is the only one
of its kind to be endorsed by the
Australian Physiotherapy Association and for a very good reason. There are many cheap
copies on the market that do not
necessarily have the clinical papers or experience to back their
claims.
Introducing
SeptProtector
for complete
surgery
disinfection
The correct seating position
using the Bambach Saddle Seat
can alleviate many of the problems associated with muscle fatigue by encouraging an improved sitting posture. This
Seat helps to maintain the natural s-shape of the spine, preventing the discs from being put
under pressure.
The company are so convinced of the benefits that they
are offering you a free 30-day
trial in your own practice.
For
further
information
please contact Bambach directly on 0800 581 108
“I would highly
recommend
Artio”
Hygienist, Margaret Gretton
from The Smile Centre, Canterbury, enjoys working with the
DENTSPLY Artio range. “I have
been using Artio for more than a
year now and as they are light
and well-designed, they are
easy to manipulate when working in confined, difficult areas. I
use Artio for deep scaling. They
are excellent for working on the
Eschmann, the first name in
infection control, is proud to introduce the powerful SeptProtector, the complete surgery
disinfection
solution.
Microparticles and bacteria, particularly those distributed by
dental turbines can contaminate exposed surfaces and remain active for many hours
within the surgery.
The SeptProtector is specifically designed to safeguard
against cross-infection risks.
• Reliable, automated, handsfree disinfection of all patient
areas
• Protects against microbial, viral and sporicidal contagions
• Disinfects all exposed surfaces more effectively than
manual methods
P&G Oral Health are striving
to build consumer interest in,
and awareness of, the importance of looking after your
teeth. Their latest TV commercial encourages patients that
they can, with the help of an
Oral-B power toothbrush,
match the wonderful ‘dentist
clean’ feeling experienced after
prophylaxis. The ‘tongue in
cheek’ ad (no pun intended!)
depicts a young woman leaving
a dental practice with the prophy handpiece in tow, which
she manages to stretch all the
way to her bathroom in her desire to recreate that wonderful
sensation. P&G know that to improve the health of the nation
they need to reach the whole of
the population, not just those
who regularly visit a dentist.
This latest TV campaign is just
one means by which they plan to
help get Britain brushing and
ensure that oral care gets its
share of airplay alongside the
plethora of ads promoting other
aspects of healthcare.
Excellence,
built in
Tavom’s striking contemporary furniture designs and unparalleled functionality make
them the market leaders in dental cabinetry. Each outstanding
range includes wall units,
stand-alone units, cabinets,
storage, shelving and sinks –
boasting a variety of colours.
Ideal for a demanding environment, each unit is robust yet
stylish, and Tavom’s durable
worktops are impervious to
wear and easy to clean – perfect
for infection control.
Sandra King, Nurse Manager at Scottish Centre for Excellence in Dentistry was impressed with Tavom’s quality
and customer care
She continued to say, “The
aftercare team have been very
thorough and provided all the
support we needed. We’ve chosen an attractive light shade for
our cabinetry, and we have
found every unit is functional
and easy to keep clean. We can’t
praise them highly enough!”
Enjoy the benefits of smooth
data equipment management, custom made for your
practice with Tavom. For further information call Tavom
UK on 0870 752 1121
Dentomycin
for Effective
Periodontal
Management
Containing 2% minocycline,
an antibiotic well known for its
ability to eliminate key periodontal pathogens, Dentomycin’s gel formulation binds to
the root surface and is slowly released over time. In patients
with pocket depths of 5mm or
more, Dentomycin can be used
in conjunction with mechanical
debridement to reduce pocket
depths.
Dentomycin’s anti-bacterial
action helps to maintain the reduction in bacteria levels
achieved through scaling and
root planning, preventing levels returning to baseline within
the typical period of 8 weeks.
Dentomycin is easy to use as it is
supplied in pre-filled applicators, which allows the gel to be
introduced in controlled quantities directly into the periodontal pocket.
Blackwell Supplies is committed to providing high quality,
high performance products like
Dentomycin to the dental profession and has additionally
produced a patient information
leaflet ‘How healthy are my
gums? – Help and advice on your
DT page 28
[28] =>
DTUK2209_01_Title.qxd
28 Industry News
long relied on DENTSPLY’s
well-respected Hi-Di Diamond
burs. ‘’I have used Hi-Di® Diamond burs since I qualified in
1994. I have always found them
very efficient so have never
needed to change to an alternative. After trying other burs, I
soon went back to Hi-Di.’’
DT page 27
oral care’. This important publication is available free to practices and patients and is designed to help promote better
oral health and combat periodontitis.
For more information please call
John Jesshop of Blackwell Supplies on 020 7224 1457, fax 020 7224
1694 or email john.jesshop@
blackwellsupplies.co.uk
Expert Support
From The
Royal Bank Of
Scotland And
The ASPD
With its dedicated Healthcare teams and Healthcare Relationship Managers, the Royal
Bank of Scotland has proven
time and again that its services
are of great benefit to dentists.
This has enabled it to join the
Association
of
Specialist
Providers to Dentists, the first
port of call for dentists in need of
a little help. With in-depth sector knowledge, tailor-made financial packages to meet the
needs of even the most unique
practice, specialist insurance
and up to 100% finance and
funding for goodwill, the Royal
Bank of Scotland provides reliable support for dentists.
ASPD members also include
Solicitors, Accountants, Independent Financial Advisers,
Valuers & Sales Agents, Insurance Brokers and more, who
can all work together to create
effective solutions. Call now
and request the ASPD Directory,
or visit the website to view helpful articles and profiles on
members.
For more information on the
ASPD please call 0800 458 6773
or visit www.aspd.co.uk
Dentanurse
Sterile Post
Extraction
Care
As a Dental Surgeon of many
years clinical experience I have
realised that good post tooth extraction aftercare:
DENTAL TRIBUNE United Kingdom Edition · September 14–20, 2009
1. Minimises post operative
bleeding.
2. Prevents premature loss of
blood clot.
3. Encourages post operative
healing.
4. Diminshes the occurrence of
“dry socket” which is post operative local inflammation of
the bony socket.
5. Promotes early healing without too much pain.
Until now there has not been
a commercial extraction after
care product. Dental Surgeons
are in the habit of cutting up non
sterile gamgee tissue which
they give to their patients after
extraction, sometimes with
photo copied notes on what to
do and what not to do. I think the
time of non sterile mouth
wound pads must be over.
After tooth extraction use
Dentanurse STERILE haemostatic pressure packs. For
around 3p per patient Dentanurse packs provide the patient
with DO’s and DON’T’s for the
very vital 24 hours after tooth
extraction. These STERILE
packs will diminish the chances
of post extraction bleeding and
the loss of the blood clot which
can lead to dry socket.
Tony Lees BDS
Free sample with this issue of
Dental Tribune.
Available from CTS Dental
or direct from
Dentanurse Ltd.
The Mill,
Preston on Wye,
Hereford,
HR2 9JU
Tel: 01981 500 135
Fax: 01981 500115
Email:
sales@dentanurse.com
“After trying
other Burs, I
soon went back
to Hi-Di®’’
Dr Dipak Patel of Edgware
Dental Practice, Middlesex has
A name synonymous with
quality, DENTSPLY Hi-Di Diamond burs can be relied upon
for their longevity and cost-effectiveness. Unlike alternative
burs, DENTSPLY Hi-Di Diamond burs are precision engineered, with multi-layering of
natural diamonds, ideal for a
variety of treatment preparations and procedures.
Dr Patel commented, “the
shapes of the burs are great.
The 556 and 557 crown cutters
are excellent for crown preparation, and the 554 is perfect
when you have a problem with
access, as it is thinner and more
comfortable to use. The taper of
the burs is excellent for this procedure, and I have found that
the margins are more refined
than with other burs I have
used. I would highly recommend Hi-Di Diamond burs to all
my colleagues.’’
For more information please
call +44 01932 853 422 or visit
www.dentsply.co.uk
Digital Dental
Jaw-x
Help eliminate
Osteoporosis
from your
Practice
Jaw-x software provides a
quick and easy way to measure
bone quality and enables Dentists to identify previously
unidentified patients at risk of
osteoporosis before it becomes
a problem. It can help avoid literally hundreds of thousands of
unnecessary bone fractures per
year!
The new Jaw-x software,
based on results from the Osteodent Study (carried out by the
University of Manchester and
other European Universities),
helps Dentists perform a bone
quality test in just 3 minutes using a conventional digital dental x-ray.
It can help put Dentists at the
forefront in the diagnosis and
treatment of this serious medical condition because most
people visit their Dentist regularly and receive dental X-rays
as a matter of routine. Quick
and easy to perform it can be a
real Practice Builder.
Jaw-x will be exhibited on the
Digital Dental Stand K01 at
the BDTA Showcase or visit
www.jaw-x.com for more information and demonstration
video.
Invest In Your
Career
The UCL Eastman Dental
Institute has supported dental
professionals for 60 years by offering a variety of training pathways supporting career development. Whether it is studying
towards specialty training or
just to expand your knowledge,
the Eastman provides a vast selection of courses.
A wide range of part-time
modular UCL programmes
start at various stages throughout the year (eg Restorative,
Aesthetic, Implant) and support
committed dental professionals
wishing to update their clinical
skills and work towards Certificate, Diploma and MSc degrees.
Applications to study for
other MSc and MClinDent subject areas will be taken until
early January 2010 for October
2010 entry and will offer graduates the opportunity to acquire
advanced clinical skills.
Research degrees are available for graduates wishing to
undertake independent research leading to a PhD, MPhil
or MD(Res) degree.
For further information please
contact 020 7915 1092 or email
academic@eastman.ucl.ac.
uk
HTM 01-05
solutions - the
‘one stop shop’
approach from
Prestige
Medical
Prestige Medical say that, as
a manufacturer of decontamination equipment, it is their
business to understand the requirements of the new legislation. They are now in a position
to offer practices guidance on
all stages in the process - cleaning, decontamination, inspection and sterilization of equipment.
They say that they can
arrange a free practice survey
and organize the design and installation of a decontamination
room that, whilst fully compliant, will be tailor-made to suit
the needs of the individual practice business. This includes
special cabinetry, sinks, work
tops, taps etc.
They can then supply the
equipment: their UltraClean II
washer disinfector dryer is fully
compliant, has an RO connection as standard and has been
specifically designed to help
protect dental hand pieces. The
C3 Advance vacuum autoclave
has a vacuum cycle (for porous,
pouched or hollow instruments) and a non-vacuum cycle
(for loose, solid instruments). It
features a fast vacuum cycle
and 6 full tray capacity, claimed
to be more than twice that of
most other machines on the
market.
Prestige Medical will also
arrange for their own engineer
to commission the equipment,
ensuring that practice staff are
fully conversant with the correct operation of the machine.
For more information, contact
Prestige Medical direct on
01254 844 103 or email sales@
prestigemedical.co.uk
First
Orthodontic
Commissioning
Education Day
has bite
The British Orthodontic Society has now confirmed the final line up of the first ‘Orthodontic Commissioning Education Day’ which is to be held in
parallel with this year’s British
Orthodontic Conference in Edinburgh on 14 September 2009.
The day is aimed at individuals
and organisations who are involved in commissioning NHS
orthodontic services and 100
PCT representatives have already registered to attend.
Along with the Department
of Health and the Chief Dental
Officer, the British Orthodontic
Society firmly believes in the
value of shared learning about
local commissioning and contracting between different areas of the country. Whilst the
new contractual arrangements
of 2006 in England and Wales
brought about a number of positive changes, there are still
many issues that would benefit
from further clarification and
guidance. The main purpose of
this day is to help facilitate the
process of sharing knowledge
and best practice.
DT page 29
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DENTAL TRIBUNE United Kingdom Edition · September 14–20, 2009
DT page 28
The topics for discussion
will include “The Justification
for Orthodontic Treatment”
which will be presented by
David Morris and will be followed by a talk about “The PDS
Contract: Fact and Fiction” by
Richard Jones. Brian Kelly and
Darren Boelema from NHS
Dental Services will then present “Monitoring Orthodontic
Contracts: The Role of NHS
Dental Services” and they will
be followed by The Deputy
Chief Dental Officer Sue Gregory taking about” Orthodontics: Everybody’s Business?”
In the afternoon Jackie
Sowerbutts from Surrey PCT
will be talking about “Transferring orthodontic contracts:
competition, tendering and
continuity of care for the patient. A delicate balancing act”.
She will be followed by Jo Clark
who will illustrate “The Pleasures and Pitfalls of developing
an Orthodontic Managed Clinical Network”. After which Andrew Dibiase will discuss”
Managing Orthodontic Referrals”
support or strategies to enhance
profitability
and
practice
growth.
“A firm I
can rely and
depend on”
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.
For more information please
visit www.lansdellrose.co.uk
call Lansdell & Rose on 020
7376 9333
Based on the ever popular
Tooth Mousse, MI Paste Plus
provides 900ppm of this unique,
patented form of fluoride. As MI
Paste Plus stimulates saliva
flow, in short it neutralises bacteria acids, at the same time it
reduces sensitivity by occluding
the exposed dentinal tubules. It
has proved to be very useful for
orthodontic patients as it prevents white spots around the
brackets and after debonding.
A full report of the event will
be published by the British Orthodontic Society after the
event.
For more information please
visit www.bos.org
IPS Empress Direct provides
outstanding results
Whatever your practice
needs, Lansdell & Rose can
help, offering reliable service
packages relevant to your situation.
Help Your
Patients to
Prevent Caries
With MI Paste
Plus from GC
UK
MI Paste Plus helps to prevent caries by strengthening
enamel in patients who are
prone to caries or those that
take medication that reduces
saliva flow. Many find it to be
particularly beneficial in helping to maintain good oral
health.
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.
that it affects such a large proportion of the population.” The BSP
will be distributing the leaflet as
widely as possible. Samples are
going to be included in the registration packs at the Autumn BSP
meeting, and supplies will also be
available for registrants to take
away with them to use in their
practices. All BSP members will
also receive samples in the autumn. Alternatively, you may
contact your Oral-B representative who will also have stocks
available for any practices.
Denti-Brush™
Wire-Free
Interdental
Brushes
Denti-Brush
interdental
brushes are uniquely designed
for a more effective approach to
cleaning between the teeth. They
are wire-free helping to eliminate gingival trauma and galvanic shock. The rubber-like tips
are coated with Sodium Fluoride
with obvious oral health benefits.
The brush adapt to different interdental spaces up to 0.3mm.
Join the Minimal Intervention Programme today with
GC’s MI Paste Plus!
For further information please
contact GC on 01908 218999 or
visit www.gceurope.com
Lansdell & Rose understand
what it takes to make a dental
practice successful. Offering a
variety of bespoke accountancy,
financial planning and tax consultancy services, with expertise in ‘Incorporation’ (the transition from Sole Trader to Limited Company) they deliver
comprehensive advice without
the usual complexity associated
with financial guidance.
Dr Stephen Tarr, Dentist
from Wiltshire, is a client of
Lansdell & Rose, and comments
“By first understanding my
own unique circumstances,
Lansdell & Rose were able to
offer solutions specific to me –
not a ‘one size fits all’ approach.” By assessing a practitioner’s unique business goals
and aspirations, Lansdell &
Rose can deliver tailor-made
Patient Communications
The public are largely unaware of the risks associated with
periodontal disease let alone the
means of preventing or controlling it. The British Society of Periodontology (BSP) have produced
a patient leaflet that explains in
clear language and with simple
illustrations what the disease is,
who can get it and how it can be
treated. The leaflet has been produced in conjunction with P&G
Oral Health whose spokesperson
commented, “Consumer press
coverage on dental matters is
starting to increase but most of
this seems to relate to cosmetic
dentistry. Clearly periodontal
disease is not such an attractive
topic, which is ironic considering
Industry News 29
For further information please
contact Periproducts Ltd
Tel 020 8868 1500
E mail: denti-brush@
periproducts.co.uk
The only direct
composite that
could be called
Empress
improvement can be made.
However, even with great
beauty there is room for enhancement. This was the sentiment of Takara Belmont who
are launching their unique Cleo
II treatment centre. Like all
good makeovers, there are
many subtle improvements,
which collectively result in an
exquisite transformation. The
Cleo already boasts a design of
distinction; its’ folding leg rest
giving it a less intimidating appearance than other conventional designs, whilst offering
obvious ergonomic benefits to
the practitioner. As a society we
are obsessed with aesthetics,
however, this can be at the expense of functionality, reliability and cost. Takara Belmont is
confident that their new model
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
Top Model
Booked In For
Makeover
When you have what is arguably the most ergonomic
treatment centre on the market
it’s often difficult to see where
will not disappoint on any of
these accounts and looks forward to unveiling it at Dental
Showcase.
The key to
increased
profitability
In times of recession, all
businesses need to keep a sharp
eye on their finances and ensure that they stay afloat and
ride out the turbulent times.
This is particularly relevant to
the dental market where competition is fierce and the attraction and retention of patients is
key to maintaining a profitable
practice.
Pioneered in the United
States and boasting over 7 million members, the Munroe Sutton Patient Referral Plan assures increased profitability for
dentists, yet simultaneously delivers savings for patients. It
also includes free marketing
and promotion of the practice,
with free enrolment in the
scheme for all dentists who
meet the required professional
criteria. This ensures that patients are also guaranteed an
excellent level of care through
the scheme. Patients additionally enjoy discounted rates and
pay at the time of service.
For more information please call
020 7887 6084 or visit www.
munroesutton.co.uk/dentist
[30] =>
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DENTAL TRIBUNE United Kingdom Edition · September 14–20, 2009
30 Events
Dental care for everyone
Can you help Dentaid support two dentists in their efforts to improve the
service they offer those less fortunate and to utilise their skills to the full?
D
r Frank Mugisha is the only
dental surgeon at Ruhooko
Hospital in south-western
Uganda, and during the three years
he has been there, extractions are
the only treatment he has been able
to offer (apart from scaling) as a
few forceps are the only other instruments he has.
Although the hospital is government-funded, repeated ef-
forts to obtain a fully equipped
dental surgery have been fruitless. Oral health is not given any
priority in Uganda and has been
largely neglected in national programmes, possibly because the
majority of dental disease is not
seen as life-threatening.
Records show that Ruhooko
Hospital Dental Department receives around 1,000 patients
each month; only those requiring
simple extractions can be treated
while others have to be referred
to Mbara Hospital, which is
200km away.
Dentaid offers help
Dr Mugisha has approached
Dentaid for help in providing
equipment and instruments to
enable him to offer a full range of
services to the local people. He
particularly wishes to be able to
conserve carious teeth rather
that extract them; to be able to
provide surgical treatment and
fracture management; and to offer scaling, endodontics and orthodontic procedures. All treatment is free of charge, and if a
Dentaid surgery is received, Dr
Mugisha estimates that 300 patients could be treated each week.
Suction by turkey baster!
Silvia Morales is a Mexican
dentist, who, for the past five
years, has been providing free
treatment to poor children and
their families in Nicaragua
through local charity, Pro-Dental
Mission Service.
She says: ‘Our objective in creating the dental mission is to
reach people who are too poor to
afford dental care. Many live on
the rural outskirts of the city and
cannot pay the added expense for
transportation. So we go to them.
‘For this reason, we would
value portable equipment as
well, so that we can move it easily
from the established clinic to
more remote areas and back
again. We use rudimentary dental equipment and improvise in
many ways. For example, the
light that we use burns very hot
which means we can only use it
for a short while. While it cools,
my assistant uses a battery operated flashlight as well as headlight.
‘Since we do not have adequate suction equipment, we use
a turkey baster which we sterilise
between patients. This, as you
may imagine, considerably slows
the process and we are not able to
work on as many patients’ teeth.
‘Our industrial air compressor, which is exceptionally loud,
requires our technician to remain nearby because the hoses
leak and provide inconsistent
power – at this moment it needs
new parts.
Can you help?
Each of these projects requires funding of around £4,500 to
cover equipment, crating and airfreight. If you, your practice, company or local group would like to
help towards these worthwhile
projects, please contact Dentaid,
Giles Lane, Landford, Salisbury,
Wilts SP5 2BG; call 01794 324249
or email info@dentaid.org.
If you have redundant equipment or instruments that could
be given a second lease of life in
a developing country, please
contact Richard Grapes on
01794 625148 or email projects@
dentaid.org. DT
[31] =>
DTUK2209_01_Title.qxd
DENTAL TRIBUNE United Kingdom Edition · September 14–20, 2009
Classified 31
Postgraduate DCP Tutors
Salary commencing at £38,666 pa (pro rata) including London Weighting
Up to six positions based across London
The London Deanery is currently recruiting for Postgraduate Dental
Care Professionals (DCP) Tutors.
The post is for either one or two sessions per week. If you are in hospital
employment you may be appointed by secondment to the post.
You will be responsible and accountable to the Postgraduate
Dental Dean for the delivery, monitoring and assessment of
postgraduate education and the continuing training for the dental
team at a local level, as well as needs assessment, mentoring
and appraisal of the dental workforce when required. You will be
based at one of the postgraduate centres funded by the Deanery
and will work in collaboration with other Deanery tutors.
Informal enquiries should be made to Raj Raja Rayan OBE
(07739303490)/raj.rayan@londondeanery.ac.uk)
or Corinne Tapsell (020 7866 3218 or 020 7866 3177/
corinne.tapsell@londondeanery.ac.uk)
A tutorial background is not an essential requirement for this post,
you must however, be fully registered as a DCP with the General
Dental Council. You will be enthusiastic with a commitment
to continuing professional development, both of yourself and
the Dental Team of Nurses, Hygienists, Therapists and Dental
Technicians. In return, we offer a bespoke training programme to
enhance your personal development in this role.
Alternatively for general enquiries email ldnrecruit@
londondeanery.ac.uk or call 020 7866 3176
during business hours (09.00 - 17.00).
To apply online, visit our website
http://www.londondeanery.ac.uk/var/recruitment/
internal-recruitment
Closing date for receipt of applications and detailed
curriculum vitae: 14th September 2009.
Interviews will be held week commencing
21st September 2009.
www.londondeanery.ac.uk
THE ROYAL COLLEGE OF SURGEONS
- agents for Eurodent, Metasys, Tridac, Ewoo,Loran & more
- wide range of SECOND-HAND Equipment
- Cabinetry & Sterilisation units
- HPA registered
- 3D Image surgery design & re-fit service
- full diagnostic & repair service
- On site staff training
- NHS suppliers
EDINBURGH
FACULTY OF DENTAL SURGERY
NEED TO REPLACE EQUIPMENT BUT CAN’T AFFORD TO?
Contact us now to make an appointment at our showrooms – 0844 873 1262
sales@hatchardmedical.co.uk
SYMPOSIUM
SPECIALIST DENTAL ACCOUNTANTS
- Assistance with Buying & Setting Up Practices
- New PDS/GDS Contract Advice
- Tax Saving Advice for Associates and Principals
- National Coverage
- Incorporation Advice
- Particular Help for New Associates
- 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
AYUB
ENDODONTICS
www.ayub-endo.com
WIMBLEDON
PREDICTABLE
EXCELLENCE IN
AESTHETIC FIXED
PROSTHODONTICS
Dr John Sorensen,
&OUNDER$IRECTOROF0ACIlC
Dental Institute, Portland, Oregon
Saturday 7 November 2009,
9.30am–4pm
The Royal College of Surgeons of
Edinburgh, Quincentenary Hall,
Nicolson Street, Edinburgh EH8 9DW
Approved for 4.5 CPD points
Full registration fee: £120
Early registration fee: £95 (to be
received by Friday 2 October 2009)
For further information contact:
dental@rcsed.ac.uk / 0131 5271621
Apply online at:
[32] =>
DTUK2209_01_Title.qxd
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NEW
Now introducing new Sensodyne Pronamel
Gentle Whitening toothpaste
* ]XX]QYJ\]N ]QJ] Y[X_RMN\ ]QN JLRM N[X\RXW KNWNOR]\ XO
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/ Survival of the fittest
/ What’s mine is yours?
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/ Choosing an adviser
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/ Home alone
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