DT UK No. 3, 2014

News / Buying a dental practice – everything you need to know / “Kennedy’s wound was clearly incompatible with life” / Perio Tribune: Management of plaque related periodontal conditions / Perio Tribune: Perio meets implant dentistry / Perio Tribune: Beauty and health in one simple - state of the art - system / Get your Endo right first time / Industry News

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March 2014

PUBLISHED IN LONDON
News in Brief

A look back at the assassination
of JFK by witness Dr Don Curtis

pages 8-10

page 2

Plaque related perio
A clinical audit

Perio meets implants
By Rainer Buchmann

pages 11-14

pages 15-16

New leader for the PEC to
take the reins at the BDA
The British Dental Association chooses new chair for Principal
Executive Committee after dramatic few months of upheaval
ference and Exhibition, which
takes place in Manchester
from 10–12 April. DT

“Dentistry in the UK is facing a complicated and evolving set of challenges. We are
increasingly underfunded, but
over-regulated. High standards are expected of the care
we provide to our patients, but
often the treatment we receive
from those that fund and oversee us leaves a great deal to be
desired. All too often the professionalism of dentists and
their ability to put patients
first is challenged, rather than
supported. We must assert our
professionalism as the guiding
force by which decisions about
dentistry should be made and
I will lead practitioners in doing exactly that.”
Dr Armstrong will give his

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Commenting on his appointment, Dr Armstrong said:
“I am honoured to be elected

first address as the leader of
the professional association at
the 2014 British Dental Con-

Dr Armstrong (pictured) is
a general dental practitioner
in a mostly-NHS practice in
Castleford, West Yorkshire.
He has been a member of the
PEC since its inception in July
2012, having been elected to
its membership by BDA members across Yorkshire and the
Humber. He graduated from
Newcastle Dental School in
1985. He has served on the
BDA’s Representative Body
and General Dental Practice
Committee, and was Chair of
the Conference of Local Dental Committees in 2011.

to serve the profession as
Chair of the BDA’s Principal
Executive Committee and look
forward to leading the profession as it attempts to navigate
the minefield of complexity it
is confronting.

M A

r
Mick
Armstrong
has been elected as
the new Chair of the
British Dental Association’s
(BDA’s) Principal Executive
Committee (PEC) following
the departure of previous incumbent, Martin Fallowfield.

www.dental-tribune.co.uk

Killing Kennedy

First lay GDC chair to
speak at BDA conference
The GDC’s first lay Chair,
William Moyes, will address
the issue of patient protection at this year’s BDA Conference. The event takes
place at Manchester Central Convention Complex
10-12 April 2014. Mr Moyes
will be speaking 11 April Charter Room 2 at 11:45am.
For more information visit
the GDC website. DT

Teeth found in baby’s brain

1,000-year-old plaque reveals diet and disease
Researchers have discovered disease-causing bacteria in 1,000-year-old teeth
similar to disease-causing
bacteria in humans today.
The research team extracted DNA from samples of
the dental calculus - which
preserves bacteria and microscopic particles of food
on the surfaces of teeth - of
a German Medieval population. They discovered the
ancient human oral cavity
carries numerous opportunistic pathogens and that
periodontal disease is caused by the same bacteria
today as in the past, despite
major changes in human
diet and hygiene.

Brain tumour

Perio
Tribune
Clinical

O T

Only 20 per cent of children eat vegetables
Only one in five children
eats vegetables every day,
and one in ten totally refuses to eat vegetables, according to a survey commissioned by Vouchercloud.
The Infant & Toddler Forum
(ITF) says these results are
not surprising because children prefer familiar foods
and parents tend to offer
those foods that they know
their children will eat. The
ITF says that children need
to be encouraged to try new
foods and it is best to begin
healthy eating habits early.

Perio Tribune

Feature

Could potatoes fight
disease?
A new project will investigate the potential of naturally occurring chemicals in
potatoes, tomatoes and saffron to combat human diseases such as cancer and arteriosclerosis and ease the
pain caused by various ailments. The DISCO project
also hopes to find sustainable ways of producing these
chemicals, known as bioactive compounds. The DISCO partners, which include
15 organisations from seven countries, aim to capitalise on their experience
in metabolic engineering,
hyper-production of highvalue plant substances, and
in bringing technology to
the market.

News

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2 News

United Kingdom Edition

March 2014

Water fluoridation could save NHS millions

he NHS could save at
least £4 million every
year on hospital admissions for the removal of rotten
teeth if water fluoridation were
extended to areas with high levels of tooth decay, according to
research published in the British Dental Journal.

25,000 people were admitted to hospital for tooth removal last year

Teeth found in
baby’s brain tumour

Analysis by the researchers of hospital statistics over a
three-year period suggests that
on average, 6,900 young people were admitted annually for
dental extractions in the largely

non-fluoridated North West.
In the same period, that figure
was just 1,100 in the West Midlands which is largely fluoridated.
Using data from 2008-9, the
cost of carrying out a dental extraction under general anaesthetic was £558 or £789 depending on the complexity of the
procedure, bringing the total
cost of the operations to around
£4 million in the North West.
Professor Damien Walmsley,

the British Dental Association’s
Scientific Adviser, said: “This
study is a powerful reminder
of how water fluoridation saves
the NHS money, and how whole
populations can benefit from a
huge improvement in their dental health.
“It’s a shocking fact that
over 25,000 young people in
England last year suffered such
poor dental health that they
had to have teeth removed under general anaesthetic in hospital.” DT

Gingival implant helps
reduce cluster headache
online in Cephalalgia shows that
the device demonstrated clinical
effectiveness in treating cluster headache, and provided significant improvement in patient
quality of life and headache disability.
“Cluster headaches cause so
much disability that patients are
often unable to function normally,” said Professor Dr Jean Schoenen from the University of Leige
in Belgium.

Teeth were found in the tumour mass

ultiple fully formed
teeth have been found
inside a tumour mass
that was growing in the brain of
a four-month-old child.
The boy was initially admitted to a clinic in Baltimore
after a routine paediatric visit
due to an increasing head circumference. The doctors also
found structures near the mass
similar to those of teeth in the
mandible.

Upon surgical removal
of the tumour, the surgeons
found a number of teeth inside the mass, which was
identified as an adamantinomatous craniopharyngioma.
Such tumours arise from
Rathke’s pouch, an embryonic precursor to the anterior
pituitary, and consist of stratified squamous epithelium
and wet keratin, and may be
cystic. DT

A remote control is used to begin the therapy

new mini-implant has
been developed to help
those affected by cluster
headaches.
Cluster headache is one of the
most severe forms of headache.
It is usually unilateral and occurs
mostly around the eye or in the
temple, and attacks can last up to
several hours.

The ATI Neurostimulation
System includes a novel, miniaturised device that is implanted
using oral surgery, leaving no externally visible scars. When the
patient feels a cluster attack beginning, they hold a remote controller up to their cheek to begin
the neurostimulation therapy.
A new clinical study published

“Current preventive treatments are often ineffective, and
in many patients acute and preventive treatments may not be
tolerated or are contraindicated.
This new and innovative therapy offers a way for a significant
number of patients to control the
debilitating pain of cluster headache.” DT

Call for smoking in films to be banned

hildren
should
be
banned from watching
films featuring actors
smoking, according to a new
survey carried out by the British Dental Health Foundation.

Published by Dental Tribune UK Ltd
© 2014, 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

More than two thirds (67
per cent) of those surveyed
thought films which involved
smoking should receive the
highest classification rating,
suitable only for adults. According to the British Board of Film

Classification, rated-18 films
currently allow scenes of drugtaking, provided ‘the work as a
whole must not promote or encourage drug misuse’.
The film board makes no
reference to smoking or alcohol misuse, two of theleading
risk factors for mouth cancer.

Chief Executive of the
British Dental Health Foundation, Dr Nigel Carter OBE,
said: “The risks of smoking
have been well documented
for many years, yet for many
young people the message still
isn’t getting through. Children
see movie stars as role models. If they are smoking, chil-

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 UK.

Editor
Lisa Townshend
Tel: 020 7400 8979
Lisa@healthcare-learning.
com

Sales Executive
Joe Ackah
Tel: 020 7400 8964
Joe.ackah@
healthcare-learning.com

Advertising Director
Joe Aspis
Tel: 020 7400 8969
Joe@healthcare-learning.
com

Editorial Assistant
Angharad Jones
Angharad.jones@healthcarelearning.com

Design & Production
Ellen Sawle
Tel: 020 7400 8970
ellen@healthcare-learning.
com

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

Smoking should butt out of films, say campaigners

dren are more likely to take
up the habit. The same applies
to sports stars, people we see
on every day TV and even parents. By re-classifying films
containing smoking scenes,
it could lead to a drop in the
number of young children taking up the habit.” DT

[3] =>

United Kingdom Edition

Study queries
sense of extracting teeth before
heart surgery

R

emoving an infected
tooth prior to cardiac
surgery may increase
the risk of major adverse outcomes, including risk of death
prior to surgery, according to
a study in the March 2014 issue of The Annals of Thoracic
Surgery.
Dental extraction of abscessed or infected teeth is
often performed to decrease
the risk of infection during
surgery and endocarditis (an
inflammation of the inner
layer of the heart) following
surgery.

Editorial comment
Welcome to this
month’s Dental Tribune UK edition.
As you will have
seen from the front cover
story, the British Dental Association has appointed a new
leader of the Principal Executive Committee.

Dr Mick Armstrong, a GDP
from Yorkshire, has been a
member of the PEC since July
2012 and is seen by many to be
the man who can steady the
ship of the BDA and make the
changes necessary to see the
Association back on track to
represent their members.

luck Dr Armstrong!
On the subject of the BDA,
next month sees the first BDA
Annual Conference and Exhibition since the membership
structure changes and the ensuing damage to finances etc.
it will be interesting to feel
the mood of both management
and members at the
event. It is being held in
Manchester 10-12 April;
I may see you there. DT

Congratulations and good

Do you have an opinion or something to say on any Dental Tribune
UK article? Or would you like to
write your own opinion for our
guest comment page?
If so don’t hesitate to write to:
The Editor,
Dental Tribune UK Ltd,
4th Floor, Treasure House,
19-21 Hatton Garden,
London, EC1 8BA
Or email:
lisa@healthcare-learning.com

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Cardiac surgeon Joseph
A. Dearani, MD, along with
anaesthesiologists Mark M.
Smith, MD and Kendra J.
Grim, MD, and colleagues
from the Mayo Clinic in Rochester, Minn., evaluated the
occurrence of major adverse
outcomes in 205 patients who
underwent at least one dental
extraction prior to planned
cardiac surgery from 2003 to
2013. The median time from
dental extraction to cardiac
surgery was seven days (average 35 days).

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“Guidelines
from
the
American College of Cardiology and American Heart Association label dental extraction
as a minor procedure, with
the risk of death or non-fatal
heart attack estimated to be
less than one per cent,” explained Dr. Smith. “Our results, however, documented a
higher rate of major adverse
outcomes, suggesting physicians should evaluate individualized risk of anaesthesia
and surgery in this patient
population.”

SIROINSPECT

In this study, patients
who underwent dental extraction prior to cardiac surgery experienced an eight
per cent incidence of major
adverse outcomes, including
new heart attack, stroke, kidney failure and death. Overall,
three per cent of patients died
after dental extraction and
before the planned cardiac
surgery could be performed.
Noting the limitations of
their retrospective review, Dr
Dearani said: “With the information from our study we
cannot make a definitive recommendation for or against
dental extraction prior to cardiac surgery. We recommend
an individualised analysis of
the expected benefit of dental extraction prior to surgery
weighed against the risk of
morbidity and mortality as observed in our study.” DT

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4 News

United Kingdom Edition

March 2014

Aggression towards NHS staff on the rise

he NHS has reported a
rise of verbal and physical aggression towards
health and social care staff – up
5.8 per cent to 63,199 or reported
assaults in 2012/13. Now a University of Huddersfield lecturer
has called for a programme of research to establish the best methods for dealing with the problem.
Various techniques known as
‘de-escalation’ have evolved in
order to calm threatening situations, but Dr Andrew Clifton says
there is a lack of solid evidence
to identify the most successful

approaches.
In a new article entitled Deescalation: the evidence, policy
and practice, Dr Clifton and his
co-author Dr Pamela Inglis call
for a ‘randomised controlled trial’ to be conducted. This would
involve the comparison of different de-escalation techniques
employed at a sample of different
hospitals and settings, such as
A&E departments or acute psychiatric hospital wards. Evidence
could then be compiled to show
which the most effective methods were.

De-escalation techniques can
be purely verbal, says Dr Clifton,
or they can involve a physical intervention. “It could be the physical environment or the human
environment that you change, or
it could be a case of having members of staff who are highly skilled
and trained in the latest de-escalation techniques which are supported by evidence,” he says.
Dr Clifton points out that
failure to deal effectively with
aggression is highly costly for
the NHS, in terms of time and
resources. DT

Acupuncture holds promise for
treating inflammatory disease
matory disorder they develop after the infection. So we hoped to
study how to control the inflammatory disorder.”

tudy suggests pathways to
alleviating inflammation in
disorders such as sepsis, arthritis.
When acupuncture first became popular in the Western Hemisphere it had its doubters. It still
does. But over time, through detailed observation, scientists have
produced real evidence that ancient Chinese practitioners of the
medical arts were onto something.
Now new research documents
a direct connection between the
use of acupuncture and physical

processes that could alleviate sepsis, a condition that often develops
in hospital intensive care units,
springs from infection and inflammation, and takes an estimated
250,000 lives in the United States
every year.
“Sepsis is the major cause of
death in the hospital,” says Luis
Ulloa, an immunologist at Rutgers
New Jersey Medical School who
led the study, which has been published by the journal Nature Medicine. “But in many cases patients
don’t die because of the infection.
They die because of the inflam-

The researchers already knew
that stimulation of one of the
body’s major nerves, the vagus
nerve, triggers processes in the
body that reduce inflammation, so
they set out to see whether a form
of acupuncture that sends a small
electric current through that and
other nerves could reduce inflammation and organ injury in septic
mice. Ulloa explains that increasing the current magnifies the effect of needle placement, and
notes that electrification is already
FDA-approved for treating pain in
human patients.
When electroacupuncture was
applied to mice with sepsis, molecules called cytokines that help
limit inflammation were stimulated as predicted, and half of those
mice survived for at least a week.
There was zero survival among
mice that did not receive acupuncture.
Ulloa and his team then probed
further, to figure out exactly why
the acupuncture treatments had

succeeded. And they made a
discovery that, on its face, was
very disappointing. They found
that when they removed adrenal glands – which produce hormones in the body – the electroacpuncture stopped working.
That discovery presented a big
potential roadblock to use of acupuncture for sepsis in humans,
because most human cases of
sepsis include sharply reduced
adrenal function. In theory, electroacupuncture might still help
a minority of patients whose adrenal glands work well, but not
many others.
So the researchers dug even
deeper – to find the specific anatomical changes that occurred
when electroacupuncture was
performed with functioning adrenal glands. Those changes included increased levels of dopamine,
a substance that has important
functions within the immune system. But they found that adding
dopamine by itself did not curb
the inflammation. They then substituted a drug called fenoldopam
that mimics some of dopamine’s
most positive effects, and even
without acupuncture they suc-

ceeded in reducing sepsis-related
deaths by 40 percent.
Ulloa considers the results a
double triumph.
On the one hand, he says, this
research shows physical evidence
of acupuncture’s value beyond
any that has been demonstrated
before. His results show potential benefits, he adds, not just for
sepsis, but treating other inflammatory diseases such as rheumatoid arthritis, osteoarthritis and
Crohn’s disease.
On the other hand, by also
establishing that a drug reduced
sepsis deaths in mice, he has provided an innovative road map toward developing potential drugs
for people. That road map may be
crucial, because no FDA-approved
drug to treat sepsis now exists.
“I don’t even know whether
in the future the best solution for
sepsis will be electroacupuncture
or some medicine that will mimic
electroacupuncture,” Ulloa concludes. The bottom line, he says,
is that this research has opened
the door to both. DT

Epigenetics could play role in dental care
according to researchers at
the University of Adelaide.

visit to the dentist
could one day require
a detailed look at how
genes in a patient’s body are
being switched on or off, as
well as examining their teeth,

“Our genetic code, or DNA,
is like an orchestra – it contains all of the elements we
need to function – but the
epigenetic code is essentially
the conductor, telling which
instruments to play or stay silent, or how to respond at any
given moment,” says Associate Professor Toby Hughes.
“This is important because,

in the case of oral health, epigenetic factors may help to
orchestrate healthy and unhealthy states in our mouths.
They respond to the current
local environment, such as
the type and level of our oral
microbes, regulating which
of our genes are active. This
means we could use them to
determine
an
individual’s
state of health, or even influence how their genes behave.
We can’t change the underlying genetic code, but we may

be able to change when genes
are switched on and off,”
he says.
Professor Hughes continues: “We know that our genome plays a key role in our
dental development, and in
a range of oral diseases; we
know that the oral microbiota
also play a key role in the state
of our health; we now have the
potential to develop an epigenetic profile of a patient, and
use all three of these factors to

provide a more personalised
level of care.
“Other
potential
oral
health targets for the study
of epigenetics include the inflammation and immune responses that lead to periodontitis, which can cause tooth
loss; and the development and
progression of oral cancers.”
The paper has been published in the Australian Dental
Journal. DT

[5] =>

United Kingdom Edition

March 2014

News 5

Sugar tax may be introduced, says chief medical officer

A

sugar tax may need to
be introduced to cut
down on obesity rates,
chief medical officer Dame
Sally Davies has said.
According to the BBC, she
told a committee of MPs that
the government needs to be
firm with food and drink manufacturers in order for them to
reformulate their products.
Dame Sally said: “We have
a generation of children who,
because they’re overweight
and their lack of activity, may
well not live as long as my
generation. They will be the
first generation that live less,
and that is of great concern.”

orie packed” some smoothies,
fruit juices and carbonated
drinks were.

Terry Jones of the Food
and Drink Federation said any
extra tax on sugar would “hit
the poorest families hardest
at a time when they can least
afford it,” adding that sugar
content was already clearly
labelled among products’ ingredients. DT

“People need to know one’s
fine, but not lots of them,” she
said. “We may need to move
towards some form of sugar
tax, but I hope we don’t have
to.”
msc_endo_advert_2014.pdf 1 18/03/2014 12:02:24

Master of Science in

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She added that she believed researchers will find
that sugars are addictive, and
the public needed to have “a
big education” over how “cal-

Dentist saves
patient’s life

A

woman was saved by
her dentist when she
suffered a heart attack
on her way to work.
According to the Ilford
Recorder, Catherine Forman
from Barkingside got a lift
from a stranger during the
London Tube strike. Once
in the car, Catherine experienced a pain in her chest,
breathlessness and loss of vision.
C

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The driver stopped at
The Valentine Dental Health
Centre in Ilford where Dr
Hitesh
Mody
(Catherine’s
dentist)
used
his
medical kit and knowledge from
a DVD on emergencies in
the surgery to provide first
aid. Dr Mody administered aspirin and a spray containing
glyceryl trinitrate which helps
the heart to pump more easily
while they waited for an ambulance to arrive. DT
CY

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[6] =>

6 Business & Finance

United Kingdom Edition

March 2014

Buying a dental practice – everything
you need to know
In the second of his series on buying a practice, Jon Drysdale considers the
critical issues of where to look and how to assess its value

uch like purchasing
a house, often the
hardest part of buy-

ing a practice is finding one
that is suitable. The mantra
‘location, location, location’

isn’t necessarily as important
as with house buying because
you’re not going to live there

and don’t need to consider
such things as where your
children will go to school.

Town or country?
Our experience of selling dental practices tells us that city
centre practices and those
close to large centres of population are in high demand.
There are a variety of reasons for this not least because
highly populated areas attract
large numbers of dentists and
competition for practices can
be fierce. Also, corporate bodies tend to favour having practices in close proximity for the
sake of efficiency (transfer of
staff, ease of visiting etc) and
this is usually only possible in
large conurbations.

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It doesn’t necessarily follow that city centre practices
are more profitable than rural ones. Dentists prepared
to look slightly further afield
than cities and large towns
may be rewarded by finding a
practice which is great value
for money and turns a good
profit. Where you live in relation to the practice is a consideration. A commute of up to an
hour each way is probably the
limit for most dentists – after
all dentistry is a demanding
job, physically and mentally.
How to search?
Wherever your desired practice location, it is worth registering with all the main dental practice agents to receive
details of practices coming
to market. Establishing your
financial position with these
agents is worthwhile in order that any offer you make
is taken seriously. Preparing
the groundwork for this is vital and part one of this series
provided details on this.

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I find most dentists know
the broad geographical area
they’re considering. Not all
regions offer the same availability of practices so the larger
the area you’ll consider, the
greater your likely choice.

Dental
practice
sales
agents will usually provide a
prospectus outlining the main
financial aspects of the practice as well as details of turnover, equipment and location.
An asking price for goodwill
(usually including equipment)
should be stated as should the
price of purchasing any freehold property, if applicable.
An asking price isn’t necessarily an accurate valuation, although it should be a realistic
estimate of the eventual sale
price. NHS practices in built

[7] =>

United Kingdom Edition

up areas often sell for more
than the asking price due to
competing buyers. In this situation the agent should set a
closing date for offers.
Many practices are sold by
word of mouth, so keep your
ear to the ground with colleagues and friends. Often
associates get first refusal on
buying the practice they work
at. This can be a good way to
buy, although negotiations on
price can be difficult between
a principal and an associate or
associates trying to maintain a
working relationship.

before making an offer. This
can be an important element
in the vendor’s decision making process. Turn up on time,
ask relevant questions and try
to build a rapport in a professional manner.
Practice owners are unlikely to be impressed with an offer significantly (probably 10
per cent or more) lower than
their stated asking price. For
practices in popular locations

Business & Finance 7

March 2014

this approach just won’t work.
If the practice is being sold
through an agent, remember
the agent is acting for the vendor and not you the purchaser.
Agents will take note of your
credentials as a buyer including your financial position and
discuss this with the practice
owner.

the table and the practice is
popular. Without stating the
obvious, put your best offer
forward, having first checked
this is financially viable. Don’t
be too disheartened if you
aren’t successful. The experience will be valuable and
most dentists don’t buy the
first practice they look at.

If ‘best and final offers’ are
requested this usually means
there are multiple offers on

In part three of this series
we will look at the different
ownership options including

partnerships and limited companies and the financial implications of each. DT

Author Bio
Jon Drysdale is an
Independent Financial Adviser for PFM
Dental,
specialising in arranging
finance for dentists
buying a practice.
For further information on the issues covered in this article please
contact PFM Dental on 0845 241 4480
or visit pfmdental.co.uk

How to value?
As mentioned, the asking
price may be determined by
the selling agent. Making your
own assessment of the value of
a practice can be difficult. The
key element to this is profitability and not, as is often
thought, the turnover. While
asking prices are commonly
expressed relative to the turnover (e.g. 100 per cent of turnover) this is not necessarily a

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‘Dentists prepared
to look slightly further afield than cities and large towns
may be rewarded
by finding a practice which is great
value for money
and turns a good
profit’
meaningful way to arrive at a
valuation. For example, two
practices in similar locations
with a similar turnover but
different levels of profit are
probably not worth the same.
A professional valuer (see
www.aspd.co.uk) will be able
to offer their assessment of
the practice having reviewed
the
financial
information
and equipment. For associates buying a practice where
they already work, a jointly
instructed valuation with the
principal can be a good idea.
However, the value here may
be hard to dispute for either
party, so this can work against
you in some situations. Factors that increase or decrease
the value of a practice tend not
to be cosmetic and are usually
financial. For example a practice with private fee income
from a capitation scheme is
likely to be valued higher than
one with fee per item private
income. Practices that are
deemed to be overstaffed or
those with a relatively high
cost lease will find it harder to
command the highest price.
What to offer?
You must view the practice

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VOCO_DentalTribune-UK_Mar14_Futurabond U_210x297.indd 1

06.02.2014 14:20:03

[8] =>

8 Feature

United Kingdom Edition

March 2014

“Kennedy’s wound was clearly
incompatible with life”
Few people are granted the opportunity to become an active part of historical
events. Seventy-six-year-old Dr Don T. Curtis, a former dentist and oral surgeon
from Amarillo in Texas, is one of them. As a resident in oral and maxillofacial surgery at Parkland Memorial Hospital in Dallas, he was one of the first doctors to
have performed emergency treatment on US President John F. Kennedy after he
was shot on 22 November 1963. DTI Group Editor Daniel Zimmermann had the
opportunity to speak with him about that day and the reason he thinks that there
was more to the assassination than a lone gunman

Dr Don T. Curtis as a dental student in 1962 (DTI/Photo courtesy of Baylor College
of Dentistry, USA)

TI: A feature film
about the events at
Parkland Memorial
Hospital, produced by Tom
Hanks and starring Billy Bob
Thornton, has just been released on the 50th anniversary of the Kennedy assassination. Have you seen it,
and does it stay true to the
events, in your opinion?
Dr Don T. Curtis: I have not
seen it but I have heard criticism that it paints rather a

sensationalised picture of the
events. I guess I would go see
it if it were shown here in Amarillo.
You began working at Parkland Memorial Hospital in
1963. What was your position back then?
At that time, I was half way
through my first year of residency in oral and maxillofacial surgery. Before I took a
residency there, I also com-

US Secret Service agents and local police examine the presidential limousine outside of Parkland Memorial Hospital in Dallas, as
President John F. Kennedy is treated inside (DTI/Photo courtesy of John F. Kennedy Presidential Library and Museum, USA)

pleted an internship. I became
interested in the field while
working as a surgical technician in a general hospital during my time in dental school
at the Texas A & M University
Baylor College of Dentistry in
Waco.
Were you aware of the president being in Dallas on 22
November 1963?
I was not aware of that and was
surprised when they brought

him to the hospital. I had a
surgery scheduled for later

lunch-room however required
me to leave the building and

‘When I got there, it was obvious that the
president was in extremis. He tried to
breathe but was unable to do so’

that day and was on my way
to have lunch. The way to the

walk across the receiving
area of the emergency room,

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[9] =>

United Kingdom Edition

where I noticed police cars and
the presidential limousine,
which had blood on it and
roses that were given to the
First Lady, Jacqueline Kennedy, when she arrived at the
airport. When a policeman
asked me whether I was a doctor,
I said yes. He then replied that
the president was hurt and escorted me to the trauma room
where President Kennedy was.
In what condition was Kennedy when you arrived?
When I got there, it was obvious that the president was in
extremis. He tried to breathe
but was unable to do so. Dr
Charles James Carrico, a Parkland resident surgeon, had
placed an endotracheal tube in
an attempt at ventilation. However, that did not work because
there was a blockage of the
president’s airway, so he decided to do a tracheostomy.

According to eyewitnesses,
discussions broke out about
who was authorised to do the
autopsy. Did you notice any of
that?
I did not because I left the
trauma room soon after the
president
had
been
pronounced dead and went back
to the clinic to see my patient
in the operating room. However, I found that all scheduled
surgeries for that day had
been cancelled and all patients
had been sent back to the ward.

Only a few surgeries were underway at that time, including
that of Governor John Bowden
Connally, who had also been
injured during the shooting.
I told my patient that her surgery had been postponed. She
understood that. Since there
was nothing else for me to do, I
then cleared my business in the
clinic and went home. There,
we spent the weekend watching television and listening to
the news on the radio. We were

Commission appointed by the
government to investigate the
circumstances of the assassination. Did you observe any
irregularities between this official version and the events
you witnessed?
The Warren Commission’s report reflected what the people
wanted to hear, which was that
Oswald acted alone and that
there was no conspiracy. The

relieved that President Lyndon
B. Johnson had made it safely
back to Washington and that
the government was uninterrupted. Finally on Sunday, we
learned that the suspect, Lee
Harvey Oswald, had been shot,
which indicated that there was
something going on in addition
to just a lone shooter.
The majority of Americans
do not believe that Oswald
acted alone, as concluded
by the report of the Warren

à DT page 10

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I helped the nurse to undo
the president’s tie and remove his shirt to prepare him
for the procedure. Then Dr
Malcolm Perry, a senior surgeon, came into the room and
it was decided that he should
do the tracheostomy. Dr Carrico assisted Dr Perry, and I
performed a cut-down on the
left leg to provide for intravenous replacement of blood.
When I looked up later, the
room was filled with the
senior chiefs of all surgical departments at Parkland. There
were also some people I did not
know.

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It became very quiet. Nobody
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Were you aware that the president had been the subject of
an assassination attempt?
I was unaware of the nature of
the injury to the president because his head was on a pillow
and I could not see a wound. I
remember the chief of neurosurgery, Dr Kemp Clark, rotating Kennedy’s head to the left,
revealing that the posterior
part of his skull had been radically fractured. He then said,
“Stop; this injury is incompatible with life.”

In your opinion, was there any
chance that the president’s
life could have been saved?
Nothing that we did made a difference. Kennedy’s wound was
clearly incompatible with life.

Feature 9

March 2014

[10] =>

10 Feature
ß DT page 9

United Kingdom Edition

been at least two bullets that
came through the front.

doctors of Parkland however
when wiping the blood from
Kennedy’s neck for the tracheostomy found a single bullet
hole that was apparently an
entrance wound, which meant
that must have been a projectile that entered the president
from the front. Because of its
nature, the wound on the back
of Kennedy’s head was an exit
wound, so there must have

While all the doctors’ testimonies, including mine, were
included in the report, their
knowledge of the wounds
did not have much influence
on the Commission’s overall conclusion. Why it was
interpreted that way has remained a mystery for the past
50 years.

What do you believe actually
happened that day?
My personal belief is that
there were of course multiple
shooters and that Oswald did
not do it alone. This would indicate however that there was
in fact a conspiracy.
After the events, you stayed
at Parkland Memorial Hospital for another two years.
Were the events discussed
by the staff in the aftermath?

March 2014

We actually never talked about
it. This was something we just
did not want to discuss. However, I left Parkland in 1965
for an exchange residency in
London and Zurich, where
I often discussed the events
with my colleagues abroad.
Particularly in England, there
was much interest in US politics and the assassination.
You recently went public
with your knowledge after

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Dr. Don T Curtis speaking at a recent
event on the occasion of the 50th anniversary of the Kennedy assassination.
(DTI/Photo Stephanie Price/PanhandlePlains Historical Museum, USA)

50 years. What were your
reasons for doing so?
Everything that I would say
is already in the literature
about the assassination but I
think there needs to be general knowledge of what people
who were actually involved
knew.

‘The Warren Commission’s report
reflected what the
people wanted to
hear, which was
that Oswald acted
alone and that
there was no conspiracy’

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More than six million pages
of classified evidence on the
Kennedy assassination are
going to be released by 2017.
Are you interested in this
knowledge, or do you consider that chapter of your
life closed?
There is a great deal of speculation of what information
these documents actually contain. I do not look forward to
it but would be interested to
know what could be learned
from them. DT

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BHA-A4-ad-Mince pie (Dentistry).indd 1

14/02/2014 16:52

President and Mrs Kennedy arrive at Love
Field in Dallas, TX, 22 November 1963.
(Image Cecil Stoughton, White House Photographs. John F. Kennedy Presidential
Library and Museum, Boston)

[11] =>

Perio Tribune
Perio Tribune

Perio Tribune

Plaque-related perio management

Beauty and health

Perio meets implant dentistry

A clinical audit of general dental practice

Rachel Kendrick looks at Acteon’s Air-n-Go system

Rainer Buchmann looks at integrated dentistry

pages 11-14

pages 17-18

pages 15-16

Management of plaque
related periodontal conditions
A clinical studying the assessment and management of plaque-related
periodontal conditions of patients by the practitioners at a general dental
practice in Hertfoldrshire in 2013

bstract:
Undiagnosed and unmanaged periodontal
conditions are fast becoming one of the biggest areas
of litigation and complaints
within the dental field. Thorough periodontal assessment
is vital for diagnosis, treatment planning and monitoring
the progression of periodontal
disease. This is a report of a
clinical audit that studied the
periodontal assessment carried out at a general dental
practice in Stevenage, Herts.
This audit was conducted over
a seven month period, analysing 50 patients for each audit
cycle. A new protocol for periodontal assessment using the
guidelines of the British Society of Periodontology was introduced. The results demonstrate a marked improvement
in assessing the periodontal
condition of patients in this
general dental practice.
Clinical relevance:
Regular periodontal assessment is required to aid diagnosis, treatment planning and
monitoring of disease. Without
such assessment, it is possible
to misdiagnose, develop incorrect treatment plans and prevent objective assessment of
disease progression. With the
periodontium being the scaffolding for all other restorative
techniques performed by dentists, this is an essential area
which must not be overlooked

or under managed.
Null Hypotheses:
The five dental practitioners
being audited would not exceed the expected percentage
of 50 per cent of patients being provided with Gold Standard treatment with regards to
periodontal monitoring and
management.
The five dental practitioners being audited would exceed the expected percentage of less than 10 per cent of
patients being provided with
Unacceptable treatment with
regards to periodontal monitoring and management.
Aim:
The aim of this audit is to assess periodontal screening and
subsequent non-surgical periodontal treatment for patients
with plaque-related periodontal conditions at the practice
compared to that suggested in
guidance documents.
The main objective for
the audit is to investigate the
standard of screening and
treatment patients are receiving with regards to their periodontal condition. This will
be achieved by ensuring that
the number of ‘Unacceptable’
treatments provided is minimal, meaning the majority of
patients seen at the practice
receive at least an ‘Acceptable’
level of treatment, if not the

‘Gold Standard’ level. In this
way, the audit aims to disprove
the first null hypothesis.
A secondary objective is
that, as long as the first objective is achieved, the majority of the patients receive the
‘Gold Standard’ of screening
and treatment with regard to

surgical periodontal therapy.
Specific risk factors for patients were not included, such
as smoking status and medical
conditions. Ten patients were
chosen at random from each
of the GDP’s day lists. These
patients had been seen within
four weeks of 17th December
2012; the start date for the au-

‘The aim of this audit is to assess periodontal screening and subsequent non-surgical
periodontal treatment for patients with
plaque-related periodontal conditions at
the practice compared to that suggested in
guidance documents’
their periodontal condition. In
this way, the audit aims to disprove the second null hypothesis.
Description:
This audit examined sets of
patient’s notes kept by the five
dental practitioners (GDP’s)
working at the practice with
regards to their periodontal
screening process and any
follow up treatment based on
this. The type of treatment
investigated was the initial
treatment phase of plaquerelated periodontal conditions
which concerned patient’s oral
hygiene habits, and any professional and patient-based
cleaning of their teeth i.e. non-

dit. This gave an overall sample size of 50 patients, which
was deemed a decent sample
size for the audit. A four week
period prior to the date of the
audit was chosen meaning
that any periodontal treatment

suggested for the patient at the
time of their exam was likely
to have been carried out or at
least started by the start date
of the audit. Notes before this
were not investigated as this
may not represent the most
current practice of the practitioners being audited.
Inclusion criteria for the patients were as follows:
• The patient must have been
seen for an exam within the
four weeks prior to the audit start date. This ruled out
the possibility that the patient
had attended for an emergency appointment in the last
four weeks, where a full exam
including
a
periodontal
screening may not have been
carried out.
• The patients must have been
over 18 at the time of their
most recent exam and any
edentulous patients were excluded. This meant that an
exam must
DT page 12

Ref 1.0 Flowchart constructed in order to grade patients notes
with regards to their periodontal screening and management

[12] =>

12 Perio Tribune

United Kingdom Edition

March 2014

ß DT page 11

include a full periodontal
screening, which may not have
been done for children and adolescents, or patients without
their natural teeth remaining.
A flow-chart was constructed which was followed during
the auditing process in order
to score each set of notes based
on whether sufficient periodontal screening had been
carried out and whether the
correct subsequent non-surgical management was recommended or carried out based
on the results of the screening.
Each of the sets of notes
were studied and the flowchart
followed in order to grade the
overall process of the monitoring and managing plaque-related periodontal disease. The
flowchart is shown in Ref 1.0.
By following the flowchart,
each patient’s screening and
management was given a
score according to the number
of correct steps completed. If
any step had not been correctly completed this was reflected
in the scoring system and lead
to a lower overall score for the
patient’s treatment.
A standard BPE was accepted as an appropriate screening
of periodontal health during a
patient’s exam.
If a patient had been offered
the correct treatment (i.e. it
was recommended) according
to the findings of their screening, but had refused to accept
or failed to attend for treatment suggested by the GDP,
the practitioner was scored according the steps taken up to
that point in the management
of the patient. This was considered acceptable treatment
delivered by the GDP as it was
the patient’s choice not to undergo suggested procedures.
Eight patients included in the
first cycle and one patient in
the second cycle of audit declined treatment which was
recommended to them. Two
patients in the first cycle were
found to be edentulous when
examining the notes and so
were re-selected; none were
found to be edentulous in the
second cycle.
Since the default recall
time for patients attending
this practice is six monthly,
this was accepted as the intended follow-up time for a
patient where no specific recall period was stated in the
notes. If the patient needed
to be seen before this time, it
should be written in the patients notes e.g. ‘Follow-up 3-4
months’, or modified on the
computer system, which was
also checked at time of audit.
This would be appropriate for

Table 1.0
Sources:
Clerehugh, V., Tugnait, A., and Genco, R. J., 2009. Periodontology at a Glance. West Sussex: Wiley-Blackwell
The Royal College of Surgeons of England, 2003. Faculty of Dental Surgery: Clinical guideline summaries - Second edition [Online] The
Royal College of Surgeons of England. Available at:
[Accessed 04.02.2013]
British Society Of Periodontology, 2012. Young Practitioners Guide to Periodontology [Online] British Society Of Periodontology. Available at: [Accessed 04.02.2013]
any patients with a BPE of 3, 4,
* or with pockets ≥ 4mm, who
had undergone plaque-related
periodontal treatment for this,
in order to monitor healing
and observe where further
treatment may be necessary.
Therefore if, for these patients,
a recall period was not stated
in their notes or modified on
the computer system following
treatment, this was seen as inappropriate follow-up.
The type of follow-up treatment was not included as part
of this audit. This was due to
the fact that not enough time
would have passed between
the start date of the audit and
the allocated four week period
prior to this, from which patients were chosen, in order
for the follow-up treatments to
have been carried out.
‘Appropriate’ management
of the periodontal condition
included further investigations and treatment based on
the BPE and was decided upon
by amalgamating information
from three different sources.
A chart was drawn up which
indicates the correct management for each particular
finding of the BPE screening.
This is shown in Table 1.0; the
sources are also quoted below
the table.
This audit included whether a diagnosis was made relating to the periodontal condition. The accuracy of diagnosis
in relation to the BPE findings
was not investigated as this is
outside the scope of the audit.
Each grading which was
given to a patients periodontal treatment according to the

Table 1.1

Table 1.1
(*Where Gold Standard and Unacceptable treatments are within the stated expected values)

Table 1.2

flowchart was then put into
one of three categories: Gold
Standard, Acceptable and Unacceptable.
This
reflected
the standard of treatment delivered to each patient. The
scores included in each category and explanations are as
follows:
Unacceptable= 0-2
Represents
patients
who
hadn’t received an appropriate screening at examination,
had had no diagnosis made
or treatment recommended
and hadn’t received correct
management for their plaquerelated periodontal condition
indicated by the screening
process. This was deemed an
unacceptable level of treatment.
Acceptable= 3-4
Represents patients who had
an appropriate screening carried out during their exam
and the correct treatment was
delivered according to this
screening. The ‘Gold Standard’
level was not given to these as
some steps along the flowchart
had not been followed e.g. diagnosis or follow-up wasn’t
included. However this was

not deemed as neglectful on
behalf of the GDP as screening and appropriate treatment
was still carried out for the patient, and the ultimate goal of
diagnosing and managing the
patient’s plaque-related periodontal condition was reached.
Gold Standard= 5
Represents the patients who

received completely correct
screening and management
from their GDP according to
the flowchart.
The percentage of the overall sample each category made
up was then calculated and
this was compared to the expected percentages set out at
the start of the audit.

Ref 1.1

Ref 1.1 Graph showing expected ranges of each category and actual percentages for first cycle

[13] =>

United Kingdom Edition

Ref 1.2

Perio Tribune 13

March 2014

this level of treatment, this
meant that the Gold Standard
level of treatment was delivered to less than 50 per cent of
patients.
The results from the first
cycle of audit prove both null
hypotheses correct, and thus
the aims of the audit to disprove these are not met during
this cycle. Therefore changes
must be implemented at the
practice in order to improve
the levels of treatments be-

ing provided to patients at the
practice with regards to their
periodontal condition and disprove the hypotheses.
In order to improve these
results, the Gold Standard level of treatment provided must
be increased and the Unacceptable level of treatment provided must be decreased.
When examining the raw
data collected during cycle one
of the audit, there are some

obvious areas which needed
to be improved in order to increase the level of Gold Standard treatment and decrease
the level of Unacceptable
treatment provided. Where
treatment was Unacceptable,
this was mainly because a BPE
had not been performed at any
examinations within the last
year. Another point to note was
that the majority of treatments
provided within the Acceptable
à DT page 14

Ref 1.2 Sticker implemented to improve
monitoring and management of periodontal disease at the practice

Results Cycle 1:
The expected and actual percentages of each category
found during the first cycle of
the audit are shown below.
It was expected that Gold
Standard screening and treatment for plaque-related periodontal conditions should make
up more than 50 per cent of
the results and that Unacceptable periodontal screening
and treatment should make up
less than 10 per cent. If both
of these criteria are satisfied,
Acceptable treatments would
represent anything from 0 per

‘It was found during the second cycle
of audit that where
the stickers were
used in the patient’s notes, Gold
Standard treatment
was delivered or
planned’

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cent to 50 per cent, which is
why the expected percentage
for Acceptable treatments is
stated as less than or equal to
50 per cent where Gold Standard and Unacceptable treatments are within the stated
expected values. Where Gold
Standard treatments do not
make up more than 50 per
cent, but Unacceptable treatments make up less than 10
per cent, the Acceptable treatment percentage will rise
above 50 per cent.
As shown by the graph
(Ref 1.1), the percentage of
all treatment standards found
in the first cycle of audit were
outside the expected values.
The Acceptable level of treatment was delivered to 56 per
cent of patients included in
the audit, which is above the
expected 50 per cent. Due to
the Unacceptable treatment
being above the expected 10
per cent of patients provided

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[14] =>

14 Perio Tribune

United Kingdom Edition

March 2014

ß DT page 13

category, were not deemed as
Gold Standard due to the fact
that either a diagnosis had been
omitted, a follow-up time period
had not been recommended, or
both. These are the areas which
must be looked at in order to improve results at the next cycle of
audit. There was no specific pattern of scores for each individual
practitioner.
Changes implemented to improve overall standard of treatment provided:
As there was no specific pattern
shown from the scores for the
different practitioners, it was not
deemed appropriate to speak
to each individually to improve
the results, but to implement a
method which would improve
the practice’s score as a whole
for
periodontal
diagnoses,
management and follow up.
With this in mind, a sticker
was designed and produced,
which was to be stuck in each
patients notes who was attending for a regular check-up, and
which outlined the key parts
of diagnosis, treatment and
follow-up for periodontal conditions. The sticker designed is
shown in Ref 1.2.
Using this, each practitioner
would be able to concisely and
quickly record information regarding a patient’s periodontal
condition at their exam, and
would be less likely to forget to
include aspects such as a diagnosis and suggested follow-up
period. The sticker is designed
to give the practitioner a ‘tick
system’ for the management of
the patient’s periodontal condition. The treatment recommended for the BPE scores
found are shown in the brackets
next to the treatment options,
making it easy for the GDP to
tick which treatment they recommend the patient should receive according to the BPE score
and diagnosis recorded above.
There is also an option to circle
whether the GDP will carry out
the treatment or whether it is to
be carried out by the hygienist
working at the practice.
These stickers were distributed between the four surgeries and some were also given
to the receptionists. Staff, including the GDP’s, nurses and
receptionists, were instructed
to put a sticker in a patients
notes if they were attending
for a check-up only so that this
could be completed at their
appointment.
Following
implementation of these stickers into the
patients’ notes, the five GDP’s
were re-audited four weeks
later by again choosing and examining 10 patient’s notes from
each GDPs list at random who
had attended for an exam and

Ref 1.3

Ref 1.4

Ref 1.3 Graph showing expected ranges of each category and actual percentages for second cycle Ref 1.4 Results from Cycle 1 and 2 represented in pie charts

recording the score.
As shown by the table (1.2)
and the graph below (Ref 1.3),
the results from the second
cycle of the audit were found
to be within the expected values set out at the beginning of
the audit, therefore disproving
both the null hypotheses. The
audit has therefore achieved
its aim by improving the overall standard of monitoring
and management of patient’s
periodontal conditions at the
practice. It was found during
the second cycle of audit that
where the stickers were used in
the patient’s notes, Gold Standard treatment was delivered or
planned, resulting in the significant improvement in the findings during the second cycle.

to make the results of the audit
more reliable.
The presence, or otherwise,
of risk factors for periodontal
disease was not accounted for
in this audit. The aim of the
audit was to determine whether the correct non-surgical
plaque-related treatment was
being carried out for each patient according to the screening
results, regardless of the risk
factors, e.g. medical conditions,
medications and smoking status. It was assumed that these
risk factors were observed by
the GDP and discussed or investigated accordingly. Also,
the precise diagnosis arrived at
for each patient was not investigated. The audit only looked
at the basic principles of man-

‘Periodontal disease is becoming increasingly prevalent amongst today’s population due to, amongst other factors, people
living for longer and maintaining their
natural teeth later into life’
The next step to improve the
results further would be to ensure that all dentists are using
the stickers during every adult
patient exam, as where this
wasn’t being done, some elements were still being omitted
resulting in treatment which
was less than Gold Standard. In
the future the monitoring and
management of periodontal
condition will need to be re-audited to ensure these standards
are maintained and improved
on where possible. The results
from both cycles can be seen
represented in the pie charts in
Ref 1.4.
Limitations and Improvements to the Audit:
There are many limitations
to this audit and possible improvements which could be
made to refine the results and
give a much broader and more
accurate representative of periodontal screening and treatment at the practice. Firstly,
a very small sample size was
considered. According to the
number of patients recorded on
the practice system, 50 patients
make up about 0.36 per cent
of the total patient population
of the practice. A much larger
sample size would be needed

agement of plaque-related periodontal condition according
to the findings of the BPE and
the diagnosis given, assuming
this diagnosis was correct. If a
patient suffered from any condition other than plaque-induced generalised gingivitis/
periodontitis, this was not accounted for.
Radiographs were not included in the ‘further investigations’ section as it was assumed
these were taken at the time
of examination and they were
appropriate to the periodontal
condition. This would be another area to expand the scope
of the audit.
To improve the audit and
make the results more valid,
the extent of treatment provided should be further scrutinised
to include whether the diagnosis made was correct according
to the findings of the screening,
and whether treatment took
into account associated risk
factors as well as oral hygiene
factors alone. The difficulty
with investigating a practitioner’s diagnoses is that these can
be very subjective and can vary
from dentist to dentist.

It would be hard to judge
whether a practitioner had
made the correct diagnosis
based on retrospective investigation of a patients notes alone
and without examining the patient. It is likely that more than
one investigator would need to
carry out the audit and interand intra-examiner calibration
would need to be done in order
for this to be reliable and valid.
This is another improvement which could be picked up
on with the current audit; only
one examiner carried out the
audit. This person may have
had different judgements on
whether the notes displayed
‘correct’ or ‘appropriate treatment’ according to the chart and
flowchart which were followed
when carrying out the audit.
Again, it would be improved by
having a second examiner present when auditing the patient’s
notes, giving the opportunity for
discussion and in order that a
more rounded decision is made
if there is any query over the
treatment provided.
For the patients who refused to accept or commence
appropriate treatment based
on their BPE score, it was assumed that the practitioner explained the risks of not having
the treatment suggested to the
patient, and that this was sufficient enough for the patient to
understand. For completeness,
this aspect should be checked
from the notes taken on the day
to ensure these patients were
able to make an informed decision on the treatment they had
chosen to opt out of.
It was noted by members
of staff at the practice that the
stickers used to improve the results were a costly way of doing
so, due to the expense of purchasing the stickers and then
printing the design onto them.
Following a successful trial period of the stickers use in patients’ notes at the practice, it
may be more cost-effective to
create a stamp which includes
the information on the sticker,
and use this to create the same
template in patients’ notes instead. With this method, staff
and GDP’s at the practice would
be able to use the stamp multiple times, with only the initial
expense of the stamp itself and

occasional cost of ink pads.
Conclusion:
Periodontal disease is becoming
increasingly prevalent amongst
today’s population due to,
amongst other factors, people
living for longer and maintaining their natural teeth later into
life. For this reason it is essential
to identify and manage any periodontal conditions as early as
possible in the disease process
in order to delay the deleterious effects of the condition and
prevent it progressing further.
In order to do this, we as dental
professionals must have simple
and effective methods of recording periodontal screenings
and diagnoses so that we may
recommend and deliver appropriate treatment to patients for
these periodontal conditions.
As demonstrated by the
implementation of a simple
pro-forma during a patient examination, in this case in the
form of a sticker, periodontal
screening and management
can be greatly improved. This
template quickly and effectively allows the practitioner to
cover all relevant areas of periodontal screening and management and means it is less likely
that any essential components
will be omitted from the process. With a reliable and reproducible procedure such as
this in place, the periodontal
condition of patients attending the practice is more likely
to remain healthier for longer.
This will subsequently improve
the prognosis of all other dental procedures delivered by the
GDP, giving the patients a better quality of care overall. DT

About the authors
Catherine Turner BChD (Leeds)
DF Trainee Bedford Scheme (Health
Education East of England)
Victor Gehani
BDS. MFDS RCS (Eng). MFGDP(UK).
DPDS (Bristol). PG Cert (Med and Den
Ed).
FHEA. FICOI. MSc Implant Dentistry
(Warwick). FIADFE. PG Cert Rest
Dent (UCL).
DF Trainer Bedford Scheme (Health
Education East of England)
Patch Associate Dental Dean (North
Central London)
Health Education England, London
Dental Education and Training.
Sabina Wadhwani
BDS (U.Lond). MFGDP(UK). PG Cert
(Med and Den Ed). FHEA. PG Cert
(Mentoring).
DF Trainer Bedford Scheme (Health
Education East of England)

[15] =>

United Kingdom Edition

Perio Tribune 15

March 2014

Perio meets implant dentistry
Author_Rainer Buchmann

he preservation of the natural dentition is the prerequisite in daily patient
care. In advanced periodontal
disease, the successful realisation of implant therapy requires
knowledge in patient expectations, clinical diagnostics, proper
surgical skills and delegation of
basic services to dental hygienists. Implant treatment in severe
periodontitis demands a two-step,
time-tested approach, evaluating
the outcomes of basic periodontal therapy before implant placement.

• Long-term missing bridgeworks
or prosthesis, edentulous mandible
• Advanced endodontic damage
• Trauma (tooth fracture)
• Oral cancer surgery
Periodontal diseases represent
can-indications. Treatment plan-

ning is running more complex.
The decision- making comprises
a time-tested therapeutic approach. In advanced periodontal
settings of more than 50 per cent
bone loss with furcation involvement level III, patients suffer
from oral discomfort. The tooth
prognosis becomes less positive,
the frequencies of follow-up visits increase (Fig 1). Periodontal

therapy ‘before’ implant planning
is aimed at saving doubtful (not
hopeless) teeth with a grace period of at least three to six months to
evaluate for periodontal treatment
outcomes. Thorough scaling and
root planing frequently results in
a mid-term improvement (two
years) up to a long-term stabilisation (five years) of preliminary affected teeth.

£3,300

The decision to maintain the
periodontally compromised dentition undergoes the following criteria (Fig 2):
• Patients with no preferences to
comfort, aesthetics and costs
• Patients willing to accept enhanced tooth mobility, occasional
à DT page 16

inc.

Integrated dentistry: Success
The successful positioning of
dental partnerships in the fastgrowing health market implicates
predictable treatment strategies
to save permanent teeth. According to orthopaedic, cardiac or
vascular medicine, an on-time
decision-making protocol for implant therapy is recommended to
counterbalance functional and
aesthetic discomfort in advanced
endodontic
and
periodontal
breakdown settings. Patient’s current and future expectations drive
our practices into the necessity to
provide synergistic periodontal
and implant treatment solutions.
The advantages are:
• Optimising implant success
by proceeding with periodontal
therapy
• Enhanced economic profit due
to by-effects from delegated scaling and root planing
• Promotion of oral and body
health of both dental patients and
staff members
The need to preserve healthy
teeth and gums, the ever-expanding influences of web, TV and
magazines and an increase in
low-cost implant treatment render implant dentistry internationally attractive. The transition of
dental practices into the implant
market is reasonable, especially
for growing dental partnerships.
The capital investment and running costs for a surgical implant
setting are redeemed by more
than 30 implants a year. Because
of the economic commitment, a
careful financial strategy is needed not to neglect challenges and
developing concepts preserving
and salvaging compromised teeth
from conservative and periodontal dentistry.

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Decision-making
Classical implant therapy protocols comprise must-indications
resulting in an immediate treatment plan. According to patient
preferences, clinical settings and
insurance plans, these must-indications with an ad-hoc implant
placement recommendation are,
in order of precedence:

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[16] =>

16 Perio Tribune

United Kingdom Edition

March 2014

ß DT page 15

food impaction and frequent professional tooth cleaning
• Individuals with chronic diseases and autoimmune disorders
The recommendation to replace affected teeth with implants is indicated in the following
clinical situations and should be
planned on-time after completion
of periodontal therapy (three to
six months):
• Patients running a demanding
business striving for fixed teeth
• Enhanced masticatory and
cleaning comfort
•Long-termrehabilitationwithlow
input in time, effort and expenses

Fig. 1 Treatment of advanced periodontal disease with implants replacing the natural
dentition is recommended “time-tested” 3-6 months following periodontal therapy (SRP).

Currently, the items above are
effective at implant placements
within the local bone, minor
lateral hard and soft tissue deficiencies, following sinus floor elevation, in settings with sufficient
implant abutment distances of
3mm and after periodontal therapy. Extended surgical protocols
enhance treatment time (Fig 3),
render the case prognosis uncertain and may aggravate long-term
success.
Implant therapy in advanced
periodontal disease
The survival rates of teeth with
severe periodontal damage published in evidence-based studies are rarely valid for patients
inquiring treatment in dental offices (Fig 4). Shortcomings in oral
hygiene, lack in supportive care,
oral dysfunctions, stress, smoking
and general disorders abbreviate
the function times of periodontally
compromised teeth sustainably.
The advice to replace affected
teeth with implants in advanced
periodontal settings within the
maxilla implicates on-time patient information of the second
and third molar removal: implant
placement and prosthetic bridgeworks are scheduled in the functional masticatory area until to the
first molar. In the mandible, the
second molars can be preserved
due to their beneficial root anatomy. They should be restored,
but not included in implant planning. Following the removal of
the first molar in the maxilla, implant therapy is often preceded (if
the supporting bone is less than
4mm) or accompanied by a simultaneous sinus lift. The implant
treatment plan in periodontally
compromised patients results in a
reduced dentition (Fig 5):
• Fixed bridgeworks in the maxilla
and mandible up to the first molar
• Maxilla: preservation of premolars and first molars, tooth removal and implant therapy with
sinus floor elevation at furcation involvement level III (Fig 6)
• Mandible: preservation of second molars, restoration, no inclusion into bridgeworks
• Volume thickening with free autogenous gingival grafts in initial
thin biotype settings (Fig 7)

Fig. 3 Implant therapy should be performed with minimal augmentation. Extended
surgical therapy prolongs treatment time, renders case prognosis unsafe and may aggravate long-term success.

Fig. 8 Short implants are advised in
critical anatomic situations when the
alveolar bone width is sufficient. Functionally, they represent no alternative to
classical augmentation protocols. (Photo:
Kochhan)

Fig. 2 Exclusion criteria for implants with continuation of saving natural teeth after
comprehensive periodontal therapy.

Fig. 4 Unexpected life-events half cut the
survival rates of teeth with advanced
periodontal bone loss in daily practice
down to 5–7 years.

Fig. 5 Guidelines to a safe implant treatment protocol in advanced periodontal
disease.

Fig. 6 The piezosurgical access to the lateral sinus is the best approach to promote
implant supported bone in the maxilla.
plants are not advocated, internal lifts
technique-sensitive.

Fig. 7 Volume thickening with a free gingival graft in an initial thin tissue with
buccal perforation.

Fig. 9 Insertion of short implants close to
the alveolar nerve in the mandible with
sufficient alveolar bone width. (Photo:
Kochhan)

Fig. 10 Implants require a comprehensive maintenance care. Peri-implant inflammations display foreign body infections that are more harmful for the body health than
periodontal diseases.

Fig. 11 Periodontal therapy lowers the inflammatory burden and promotes health while
optimizing body metabolism with stimulating effects onto the vascular system.

• Short implants in both aesthetically and functionally less demanding situations as an alternative
to surgical augmentation (Fig 8).
Low bone quality (D3/D4),
lateral hard-tissue deficiencies
and increased mechanical loading are contraindications for short
implants. According to conventional implant rehabilitation, the
horizontal width of the alveolar
bone crest is the fundament for
functional stabilisation, vascularisation and nutrition, thus for implant survival and clinical success
(Fig 9).
Inflammation and hygiene
Clinical healthy and stable implants are completely covered
within the alveolar bone by os-

seointegration. They also are attached to the peri-implant gingiva
and thereby become functionally
included into the body’s metabolism. This explains the high overall survival rates of oral implants
between eight and more than 15
years. The combination of
• A thin biotype gingiva with lack
of soft tissue protection
• Functional overload due to
stress, habits or a missing frontcanine equilibration
• Loss of biofilm protection by
periodontal diseases often causes
mid-term damages (two years
after functional loading) of the
implant-to-bone interface. Like
periodontally affected teeth with
lack of hygiene access and enhanced biofilm accumulation,

implants develop a potential risk
of inflammation when bacteria
enter the implant-to-bone interface (Fig 10). If the close hard
and soft tissue sealing disappears
irreversibly, foreign-body infections occur within the oral cavity,
which are more harmful for the
implant-supporting bone and the
body health than periodontal diseases. The best protection against
peri-implant inflammation is not
avoiding implants: a careful implant placement strategy with
concomitant thickening of the
surrounding tissues and relief
from functional overload preceded by comprehensive periodontal
therapy (hygiene) are the best
therapeutic helpers for implant
survival and oral health (Fig 11).

evaluate the affected dentition for
periodontal treatment outcomes.
If patients anticipate immediately
fixed and aesthetic restorations,
on-time implant therapy with
minimal augmentative solutions
is recommended. Preservation of
periodontally compromised natural teeth is advised when patients
display no preference for further
comfort and aesthetics. Periodontal therapy is continued, supplemented with surgery in advanced
intra-bony settings where oral hygiene is impaired. The long-term
success for the natural dentition
and implants similarly depends
on patient’s medical and local risk
factors that cannot be forecasted
with any genetic or susceptibility
test for sale. DT

Summary
In advanced periodontal diseases, the network between medical progress and ever-expanding
patient’s expectations requires a
time-tested schedule with a grace
period of three to six months to

About the author
Prof Dr Rainer Buchmann
Practice limited to Periodontics
Königsallee 12, 40212 Düsseldorf,
Germany
Tel.: +49 211 8629120
E-Mail: info@rainer-buchmann.de
www.rainer-buchmann.com

[17] =>

United Kingdom Edition

Perio Tribune 17

March 2014

Beauty and health in one simple,
state of the art, system
Rachel Kendrick looks at Acteon’s Air-n-Go
A system that’s going to
particularly appeal to hygienists is Acteon’s Air-n-Go.

This is the first dual purpose – supra and perio – air
polisher. No other polisher
better exemplifies the possi-

bilities of combining the beauty and health of your patients’
teeth. It speeds up treatment,
maximising your time, while

giving your patients the most
gentle, yet powerful cleaning
experience they’ve ever encountered.
à DT page 18

A

dvancements in dental
technology offer better solutions for traditional oral health problems
than ever before. Technology
makes dentistry as comfortable, durable, efficient and
natural-looking for the patient
as possible. Patient and dentist benefit from newer techniques that are less invasive
and more dependable than
ever before. Procedures that
formerly took multiple trips to
the dentist or required multiple health care providers can
now often be performed in the
comfort of one surgery by one
qualified provider.
Technology increases efficiency significantly. With
the latest generation of dental equipment, patients see

‘Technology
increases efficiency
significantly With
the latest generation of dental
equipment,
patients see exactly what you see’

exactly what you see. This
creates trust and empowers them to make decisions
about their own care, and not
rely purely on the first advice
they’re given.
Technology
also
helps
with patient education and
case acceptance. If someone
is missing a tooth, the team
can virtually place an implant
and crown with 3D scans and
show them exactly where the
tooth will go. Patients can see
digital X-rays and photos of
their teeth blown up on flat
screen monitors right in front
of or above their dental chair.
Showing patients what’s
going on in their mouth, versus just trying to explain it,
leads to quicker understanding and fewer questions, making both dental practitioner
and hygienist’s job easier.

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[18] =>

18 Perio Tribune

United Kingdom Edition

ß DT page 15

based ‘Perio’ powder, the Airn-Go is used for sub-gingival
pockets of between 4-10mm,
in addition to initial therapy.
It provides remarkable therapeutic results, with a considerable reduction of inflammation and pocket during the
phase of initial periodontal
treatment. And the nozzle
comes with 3-6-9mm depth
markings to allow rapid assessment of the health of a
patient during sub-gingival
treatments. The use of this device eliminates bacteria in the
pocket and prevents recurrence of the disease.

Air-n-Go is extremely versatile. The device is made up
of a convertible handpiece,
available in supra and perio
versions, that are compatible
with high performance powders, unique in that they are
made from all natural components and taste great. Treatments are very gentle, which
results in a significant reduction in bleeding and pain. A
winning combination for patient choice.
The reason for Air-n-Go’s
versatility is its convertible
handpiece. This increases
options for supra-gingival
and sub-gingival treatments.
In Supra mode, it helps you
achieve perfect cosmetic results with fast, effective, painless polishing that is gentle to
both the gingiva and teeth. In
Perio mode, it transforms into
a simple and efficient device
to treat periodontal disease
and
peri-implantitis
subgingivally. Just 20 seconds
of maintenance is enough to
treat periodontitis or peri-implantitis effectively.
The ergonomic handpiece
The handpiece has been
designed to create better
working conditions for whoever handles it. It is fine, lightweight, well balanced, easy to
manipulate and has 360º rotation, resulting in less stress
and less manual fatigue. It
enables smooth, fast move-

The 20º angle of the perio
nozzle means that all sides of
the tooth or implant may be
treated without changing instruments. It also means that
treating periodontitis or periimplantitis in just 20 seconds
is now possible.
And it’s worth noting here
that ‘Perio’ powder can also
be used in supra mode for the
prevention and control of periodontitis and peri-implantitis.
By pressing the ‘stop powder’ button, at the back of the
tank, you cut off the powder
flow, which transforms the air
polisher into an air and water syringe. This feature allows you not only to clean the
treated area, but also to rinse
out the interior of the device.
Switching
from
supra
mode to perio couldn’t be sim-

‘The flavours I was offered are amazing.
I wanted to try them all! In fact, I got
carried away and tried two: peppermint
and raspberry’

long and a short one, suit all
hand sizes
• Two tanks – supra and perio
– come with a ‘Clip-n’Go’ connector (bayonet type) and a
colour coding system for identification
• Specific powders for each
type of treatment: supra-gingival and sub-gingival applications
• Autoclavable (except for the
tank and its lid), all parts of
Air-n-Go can be cleaned, to
prevent the risk of clogging
and to ensure the best hygiene.
In Supra mode, the indications are:

ment, improved visibility and
excellent accessibility, even in
the difficult to reach posterior
areas. A non-slip silicone ring
on the front gives you a better
grip during treatment – even
with wet gloves. Manipulation
is precise to enable the practitioner to focus on the treatment area. Two exchangeable
heads – short and long to suit
all hand sizes – are autoclavable. The shorter ‘hygienist’
head is specially designed for
smaller hands and as it rests
perfectly in the hand, it ensures you exert less pressure
manipulating the handpiece
during treatment.

pler or quicker. You select the
nozzle, power and the tank –
depending on the treatment –
and then choose which mode
you want without any need to
change instrument.
This has the added benefit of needing only one direct
connection to the delivery system and other convenience
features include:
• Three nozzles cover a variety of applications, including
prophylaxis, periodontal and
implant maintenance
• Two exchangeable heads, a

• Polishing – to finish after scaling or to prepare for
bleaching
• Cleaning – interproximal
areas, fissures and troughs,
preparation of the tooth surface before etching and orthodontic brackets
• Removal – biofilm, plaque,
stains and remnants of temporary cementum
In Perio mode, the
indications are:
When combined with the action of ultra-fine glycine-

Powders
The well-being approach to
prophylaxis is a concept that
is perfectly matched to the
needs and wants of your patients. The Classic range of
Air-n-Go powders are indicated for maintenance, prevention of tooth decay and
improving the oral hygiene
of the patient. Their abrasive
properties cause no damage to
the enamel, the gingiva or the
root surface.
This range comes in a variety of flavours that each
patient chooses, according
to individual taste. There is
a choice of cola, raspberry,
neutral, peppermint or lemon.
The fine balance between flavour and sodium saccharin
concentration removes any
unpleasant taste and offers a
feeling of freshness.
In addition to Classic, there
is Pearl, a powder specifically
designed for supra mode and
Perio, exclusively for sub-gingival treatment.
Many patients think of a
polishing session as an unpleasant experience, so the
motivation to establish a maintenance plan fades quickly.
Most sodium bicarbone-based
powders are composed of layered particles, with angular
geometries which have an

March 2014

abrasive effect that is too aggressive on delicate tissues.
For this reason, Satalec’s
research and development
department studied these angles and grain size to come up
with a formula that is more
suitable. The new powder
formulation they developed
specifically reduces the sensation of pain and bleeding
caused by most of the others
on the market.
The
anti-clogging
and
controlled hydrophobic properties of these powders give
them a dual action effect:
• In contact with water, micro-particles shrink slightly:
the polishing effect is much
more efficient
• The powder dissolves gently,
which avoids trauma to the
delicate tissues and prevents
the risk of clogging.
So what do patients think? .
“I have a double problem: I’m
hooked on caffeine and cigarettes! So it’s not surprising my
smile was not very attractive,
with stained, dull teeth. The
results of this treatment are
really impressive and visible!
I no longer have the unsightly
stains on my teeth that used to
stop me from smiling normally.” Stephanie, 23.
“I love being able to choose
the flavor I want. For once, I
can have my say at the dentists!
I really liked the raspberry – it
was almost as if I was actually
eating some.” Maya, 31.
“Like many people, I’m
afraid of going to the dentist
and I hate having my teeth polished. You have to admit that it
hurts and isn’t pleasant at all.
But this time, it was quite the
opposite – completely different! During this session, I forgot my fear and felt no pain at
all, although I’m very sensitive
where my teeth are involved. It
made me want to come back to
my dentist.” Carlos, 31.
“The flavours I was offered
are amazing. I wanted to try
them all! In fact, I got carried away and tried two: peppermint and raspberry, and
I didn’t have to wait long because the tanks of powders had
already been prepared. I like
mint best, it’s so refreshing.”
Hugh, 34.
Air-n-Go is an ideal complement to Acteon’s Newtron
portfolio of piezo-ultrasonic
equipment too. DT

About the author
Rachel Kendrick
is
a
freelance
journalist with a
special interest in
the dental sector

[19] =>

PART OF THE

ADVANCED DEFENCE RANGE

[20] =>

20 Clinical

United Kingdom Edition

March 2014

Get your Endo right first time
Richard Kahan discusses why you should be getting your endo right, first time

I

ment profile. I wanted to find
out whether the type of cases I
was treating had changed over
time.
I was not really expecting
to improve anything within the

practice, as some audits do, but
I was seeking clarification as
to whether the nature of the
treatments I was carrying out
were becoming more complex
requiring greater time and effort as I had thought, or wheth-

er I was just becoming more
knackered and complaining
with age!
Treatment sessions were
categorised and I analysed four
random months of appoint-

EW

n about the middle of 2013
and in a fit of post-CQC
inspection guilt that I had
cast aside mundane management issues for more interesting pastimes, I decided to
carry out an audit on my treat-

ments three years apart.
The result of the null hypothesis was, I have to admit,
inconclusive, but as a pilot
study it gave me some food for
thought and what I would like
to share with you was a finding that might shock (or not,
depending on how much of a
sceptic you are).

N

Above some of the more
complex stratified layers of
categories was, Primary Treatment, Retreatment unrelated
to Primary Treatment, and Retreatment due to unsatisfactory
Primary Treatment.

E L E VAT I N G D E N T I S T RY

Shattering the status quo
541C

A staggering 43.4 per cent
of my treatment time in a random period of four months,
was spent treating the conse-

‘A staggering 43.4
per cent of my treatment time in a random period of four
months, was spent
treating the consequences of other
dentists’ substandard work.’

quences of other dentists’ substandard work. Whether due to
underfilling, under extension,
missed canals, poor coronal
seals, ledges, transportation,
or perforation, I was spending
almost half of my time sorting
out the legacy of poor primary
root canal treatment.

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Returning to the eye watering 43.4 per cent, this will not
come as a great surprise to the
hospital endodontists who are
sitting on a huge mountain of
never-to-be-managed ’GP Retreat’ referrals, as they were
categorised at the Eastman
Dental Institute.

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XV1_Shattering_UK_A4.indd 1

Being fair, not all retreatment work was done due to
poor treatment and 21.8 per
cent of my time was spent diagnosing and retreating issues
probably unrelated to the quality of the root treatment, such
as fracture, complex anatomy,
lateral canals, and extra radicular infection.

2/26/13 3:11 PM

For those of a more cynical
outlook this could be considered good news for specialist
endodontists such as myself,

[21] =>

United Kingdom Edition

and certainly the implantologists. The rather ignominious decline of the dentition
through iatrogenesis, starting
with overenthusiastic ‘drill and
fill’ in the younger and immature tooth, the placement of
cosmetic leaking restorations,
pulpal damage during crown
preparation, and then poor
‘quick-fix’ endodontics. This is
a pattern I am seeing all too often in my middle aged patients.
There are a number of consequences to this category of
retreatment.
1. Patient management. With
an increasingly litigious population, being informed that failure of treatment is due to inadequate or substandard work, is
likely to trigger off a complaint

more complex treatment is,
the higher the failure rate. Bypassing materials, ledges and
blockages created by a previous visitor, is not always possible, bringing in the possible
need for surgery to accomplish
treatment objectives. Even
if a technical masterpiece is
achieved, our success/failure
research clearly shows retreatment success lagging 10-15 per
cent behind primary treatment.
The reason for this is that the
contaminating bacteria are no

Clinical 21

March 2014
October
2013

longer primarily anaerobic as
in primary treatment, but more
hardy and resistant facultative
anaerobes.
The solution to this evergrowing mountain of iatrogenic
endodontic disease and patient
dissatisfaction, is education.
It may be a simplistic approach but I believe that if general dental practitioners were
taught how to carry out effective endodontic treatment first

time around, much future grief
could be avoided.
Indeed, there are political issues at the heart of this,
but if dedicated practitioners
truly understood the issues at
hand, maybe they would not let
themselves be pushed around
by government agencies only
interested in saving money.
Treatment carried out correctly at the primary stage is
easier, and more successful,

and should be done most of
the time by competent general
practitioners. There will be
complex primary treatments,
but these can be recognised
and the general practitioner
should have an understanding of their own capabilities.
If they don’t feel confident, the
patient should be referred to
your friendly local endodontist
or specialist hospital department. After all, 43.4 per cent of
their time could now be spent
twiddling their thumbs! DT

‘Treatment carried
out correctly at the
primary stage is
easier, and more
successful, and
should be done
most of the time by
competent general
practitioners’
or two. Could this be the next
big legal bonanza after injuries at work? Text messages
reading ‘Contact us if you have
had root canal treatment’? It is
of course how you tell it, and
most patients are very reasonable (many times too reasonable!), but the process leaves
a poor impression. A patient
loses confidence in the general
practitioner they have had faith
in for many years, and with the
dental profession as a whole.
2. Treatment management. Retreatments are more complex
and time-consuming than primary treatment. This makes
the process more expensive
and what with deconstruction,
retreatment and then a new
restoration if successful, the
expense will not be that far
away from an extraction and
implant placement.
3. Treatment prognosis. The

About the author
Richard Kahan is
a specialist endodontist
working
in Harley Street,
London and the
former
Director of Endodontic
Courses at UCL
Eastman CPD. He
has lectured widely on endodontics and technology
and has recently set up the Academy
of Advanced Endodontics to teach
the fundamentals of endodontics to
VTs and GDPs, more advanced techniques for GDPs and GDPwSI Endo,
and CBCT reporting for Specialists
and GDPwSI Endo, through practical
hands-on courses. The 4 day course
‘Get it Right – First Time!’ begins in
May 2014. For more information visit
www.endoacademy.co.uk

Early Bird oﬀer – 20% oﬀ if booked before May 15, 2014.
See website for details

[22] =>

22 Industry News
Impregum Penta impression material
– the only true polyether impression
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material is the latest in the line of 3M
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Impregum Penta Soft Quick impression material is also easy and convenient
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Discover the newest product of the biggest selling brand in impressioning in
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Penta Soft Quick impression material today.

United Kingdom Edition

7connections – Professional, Honest and
Down To Earth
Lorraine Wilson is the practice manager
of ‘Dentistry on the Square’, in Glasgow.
She and her team recently enlisted the
business expertise of Karl Taylor-Knight from
7connections, to help make sure the business
was ready for expansion. “We chose to seek
business support in order to grow the practice
and ensure it reached its full potential,” she says.
“We approached the team at 7connections
due to their high reputation and extensive experience within dental coaching.
“Karl has helped us focus on associate profitability and provided more in depth
training with regards to recording budgets P&L, this has been a fantastic help.
He also provided a list of areas to look at and improve, in order to enhance our
productivity and income. “Working with Karl has helped me enormously – it’s
great to have someone with experience to bounce ideas off, and he has provided
valuable support.

March 2014

“All in all, the 7connections team are very professional, honest and provide
great guidance. I would certainly recommend their business support to other
practices.”

An Impressive Display From Carestream
Dental
Renowned for providing a wealth of top
quality and user-friendly technologies
alongside first-class customer service,
Carestream Dental remains a leading
supplier of digital imaging systems and
practice management software worldwide. As the team demonstrated at this
year’s Dentistry Show, the full range of equipment and services available are
designed to ensure practices run as smoothly as possible. Amongst the cuttingedge equipment on display was the new RVG 6200 digital radiography, a
sensor offering superior quality images and designed with leading technology
that works the way you do. Carestream Dental Ltd were thrilled to showcase
the new CS 8100 3D imaging system, offering the power of 3D to aid diagnosis
together with the impressive 7 times award winning design of the CS 8100.
Proving the flexibility of their products, the experts also introduced delegates
to the innovative CS Solutions, which combines the ability to scan, design, mill
and place restorations chairside. In addition, delegates were impressed by
the new eSignatures module available and the easy accessibility created by
full integration of all technologies with the R4 Clinical+ practice management
software. If you missed the team at The Dentistry Show 2014, or would like
further details, contact Carestream Dental today.

For more information about 7connections business coaching
please call 01647 478145 or email phillippa.goodwin@7connections.com

For more information please contact Carestream Dental
on 0800 169 9692 or visit www.carestreamdental.co.uk

For more information, call 0845 602 5094 or visit www.3Mespe.co.uk

“Personal, Efficient,
Thorough and Informative”
Castellini and Tavom UK
Dr Nick Hall, orthodontist at
Bamford Dental Practice in
Greater Manchester, is one of many long-term customers of Castellini and
Tavom UK. “Having worked with Castellini / Tavom UK for many years, we have
first-hand experience of the excellent service and quality of equipment,” he
says. “My previous surgery had provided 14 years of first class reliable service
and I saw no reason not to continue with the companies. “The design phase of
my most recent project was personal, efficient, thorough and informative, with
plenty of choice of materials, designs and colours. The installation proceeded
absolutely as planned, on schedule and with support on hand when we first
used the new surgery. The instruction on the use of the Skema 6 Cart was
straightforward and hands on with help easily available if required. “Having
used the new equipment for six months I can say it has functioned perfectly,
keeping the surgery running smoothly and efficiently. Overall the level of
service has, as always, been excellent. Castellini / Tavom UK understand my
needs and requirements as a busy orthodontist and have provided a first class
surgery installed to the highest standard.”

For more information on how Castellini UK Ltd and Tavom UK could help you
transform your dental environment, please visit www.tavomuk.com or www.
castellini.com

IAS – Promoting Ethical Orthodontics at
The Dentistry Show
Demonstrating the latest developments
in the world of minimally invasive
orthodontics, the team behind Intelligent
Alignment Systems (IAS) were popular
exhibitors at The Dentistry Show 2014.
Comprising of three main components
– the Inman Aligner, ClearSmile and
Powerprox 6 Month Braces – IAS offers effective cosmetic orthodontic
solutions for a wide range of patients. The team were keen to highlight both
the advantages and limitations of each system to delegates, promoting an
ethical approach to all cases both basic and complex. Delegates were able to
source information about the 3D design technology used with each appliance,
as well as upcoming training courses delivered by industry leaders, including
world-renowned cosmetic orthodontic instructor Rick DePaul. Details were
also available about the on-going advice and support provided via online
forums, ensuring delegates’ success in practise. If you missed the team at
The Dentistry Show and want to find out how IAS could help expand your
treatment range and grow your practice, contact the experts today.
For more information on Intelligent Alignment Systems,
visit www.inmanalignertraining.com, www.6mbrace.com, and
www.clearsmilealigner.com or phone 0845 366 5477

SafeSeen Touch – Making a Complicated Job
Easier
Providing a complete compliance suit, SafeSeen
Touch is a compact tablet designed to help dental
professionals enhance their patient consent
acquisition, security and CQC compliance.
Paul Kaye, Director of QuiqSolutions, has been
working with SafeSeen Touch to ensure the CQC
module meets the demands of the industry.
“It seemed like a perfect marriage – our CQC understanding and IT skills
combined with the SafeSeen Touch team’s dental experience and expertise,”
he says.
“As a result the tablet contains a module that highlights the aspects of
CQC relevant to dental practices, helping them implement effective audits
and action plans to enhance and evidence their compliance. It’s making a
complicated job much easier.
“The module is also very scalable, so information is provided at group, regional
and national level and as a collaborative platform, it offers a very useful
management tool for dental co-operatives and networks.”
For more information, please visit www.safeseentouch.co.uk, call 0845 576
2833 or email cbooth@safeseentouch.co.uk

TRUST us . . . The Dental Directory is here
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T – Take it as proven that we have been independently verified as the best priced
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Speak to The Dental Directory today for all your equipment and imaging needs.
The UK’s largest independent dental dealer

EndoCare – “In 10 years we’ve saved
over 10,000 teeth”
At EndoCare we understand just how
valuable a tooth can be. In 10 years
we’ve saved over 10,000 teeth, avoiding
extraction, leaving our patients happy
and pain free.
If you need help or support with
Endodontics, contact our experienced
team today. Our team of warm and
friendly Endodontists are all experts in
their field, and are dedicated to treating
dental pain and infection in all its forms. To ensure your patients receive the
very best care possible, we work closely with all our referring colleagues and
will keep you updated through every stage of your patient’s time with us.
Indeed we welcome all contact, and we are more than happy to discuss cases,
and offer our help and support in any way we can.
To learn more about Endodontic referrals, and how we can become a crucial
extra member of your team, contact EndoCare today.
For further information please call EndoCare on 020 7224 0999
Or visit www.endocare.co.uk

The Independently Verified Best Priced Dealer! For more information, contact
The Dental Directory on 0800 585 585, or visit www.dental-directory.co.uk

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Nobel Biocare – the experts’ implant of choice
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As a Specialist in Prosthodontics, Paul Tipton knows
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A service you can trust
At Sparkle Dental Labs, we understand how
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Now working with more and more practices, we have recently welcomed two
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demand for our expert craftsmanship and quality service.
We keep you informed every step of the way so that you’ll know which technician
is looking after your order and when your product is ready for dispatch and free
delivery. We will also send all new restorations with patient statement certificates
both for your peace of mind and to ensure compliance with GDC regulations.
Serving as an extension to your professional team, we work hard to create the
products you need, when you need them
So if you are looking for a British dental laboratory that you can trust, contact
Sparkle dental Labs today.
For any additional information please call 0800 138 6255 or email
customerservice@sparkledentallabs.com or visit:
www.sparkledentallabs.com

Increase staff productivity and satisfaction
with Tavom UK
Tavom UK realises that designing a high quality
dental environment, which increases staff
productivity and reduces stress-levels, is of
paramount importance to any practice manager
or owner. Millions of working days are lost each
year in the UK, with employees taking sick days
due to stress and costing employers millions of
pounds. But by working with the expert planners
and engineers at Tavom UK you can create the dental practice of your dreams,
ensuring it is ergonomically designed and aesthetically pleasing. This will
enhance staff satisfaction and productivity, which in turn will increase profits for
the business.
Tavom UK specialises in supplying hygienic cabinetry for dental practices. All
products are made for maximum durability and are easily cleanable for full and
easy compliance with HTM 01-05 regulations.
Tavom UK cabinetry comes in a huge range of colours and styles, leaving no
detail to chance. Listening to their customers ensures the team provide the right
product and design for every solution.
So, whether you are looking to completely redesign your practice or give it a
facelift, contact the experts at Tavom UK today. For more information on Tavom
UK, please visit www.tavomuk.com

[23] =>

United Kingdom Edition

Vitrebond Powder & Liquid – back
by popular demand
Having listened to your feedback
and identified the need for a
handmix liner/base solution, 3M
ESPE has re-launched Vitrebond
Powder & Liquid Glass-Ionomer
Liner/Base. Indicated for lining
and basing applications under composites, amalgam, ceramic and metals,
Vitrebond powder & liquid offers several benefits to you and your patients. You
can control the mix ratio of powder/liquid to create your preferred consistency,
enabling you to dispense just the amount you need.
Vitrebond liner/base also provides extra protection for patients by preventing
microleakage under the restoration and releasing fluoride into the tooth for
caries reduction .
Providing the advantages of a liner/base and the flexibility to achieve your
preferred consistency, Vitrebond powder & liquid from 3M ESPE is back.
For more information, call 0845 602 5094 or visit www.3Mespe.co.uk

March 2014

Zesty celebrates London’s best
Dentists
Zesty announced the winners of its 2013
Awards, celebrating the best London
has to offer. From family clinics to
orthodontic specialists, Zesty recognised
London’s premier award winning
practices and expert Dentists.
Congratulations to all the winners:
• Best Practice – Progressive Dentistry,
Principal Dentist Nissit Patel. • Best
Family Practice – The Fulham Dentist,
Principal Dentist Dr Sarveen Mann. • Best Hygienist – Henriette at Open Dental
Care. • Best Dentist for Teeth Whitening – Dr Favero at Favero Wimpole Clinic.
• Best Practice for Nervous Patients – The Gentle Dentist, Principal Dentist Dr
Antonia Paolella. • Best for Restorative Dentistry – Dr Punit Shah of Dazzle
Dental Care. • Best for Orthodontics – Dr Neil Counihan of Victoria Dental Care.
• Best for Cosmetic Dentistry – Dr Thang Nghiem at Ultra Smile.
• Best Holistic Dental Practice – The Neem Tree, Principal Dentist Dr Smita
Merha.

3M ESPE and Vitrebond Powder & Liquid are trademarks of the 3M Company.

Zesty is a new marketing channel for healthcare professionals. Sign up to
register your practice and start receiving new patients straight away!
Simply email hello@zesty.co.uk or visit www.zesty.co.uk or call 0203 287
5416 for more details

BPE guidance at your fingertips - new gum
health app available now!
GlaxoSmithKline
Consumer
Healthcare,
manufacturer of Corsodyl mouthwash, has
launched a new mobile app to help support
dental professionals with the use of the Basic
Periodontal Examination (BPE). The app provides
information on:

Philips extends support programme for young dentists
Young dentists are the focus of the Philips exhibition presence at the BDA
Conference and Exhibition in Manchester this April, and trainee and FD dentists
are particularly encouraged to visit stand number B05.

• Background to the BPE codes
• Description and clinical image of each BPE code
• Summary of recommended treatment
Developed by the British Society of Periodontology, the BPE allows dental
professionals to consistently & accurately assess their patients’ gum health.1 The
assessment of gum health, together with the provision of support for patients to
help prevent periodontal disease, will be of even greater importance once the
Dental Quality & Outcomes Framework comes into force in the revised dental
contract. The Corsodyl brand is committed to supporting dental professionals
when educating patients on the importance of gum health and the early signs
of gum disease. This app forms part of a range of materials that also includes the
Corsodyl Gum Care Guidance Pack which can be requested for dental practices.
Compatible with iphones and ipads, the app can be downloaded from the app
store by searching “bpe app” and further information can be accessed from
www.gsk-dentalprofessionals.co.uk

To fuel their on-going thirst for knowledge both rookie and experienced dental
professionals are being offered free access to a newly expanded Phillips website,
giving them access to free CDP material, mentoring, tutorial podcasts and other
information to smooth their path into effective professionalism. A click on a
QR code on the show stand which give stand visitors a direct route to the new
website – www.philips-tsp.co.uk
For those hungry to learn about the latest innovations in tooth whitening,
members of the Philips team will be at the show to take them through the
intricacies of the Zoom range.
Also on show will be the upgraded Philips AirFloss – an award winning
interdental cleaning device with far-reaching implications. The hand held device
fires micro-droplets of air and water (or mouthwash) between the tooth giving
the whole mouth a thorough clean in 30 seconds.

To back up the campaign, Align Technology is developing a number of promotions
with the BDHF to educate the public and drive potential patients to enquire about
tooth straightening.

Dr Uns Moutiz, Dental Associate at All Saints Green Dental Practice says: “With
the loupes I can see minor details, which can otherwise be missed and helps in
diagnostics. I can add finesse to a greater degree, which was not achievable with
naked eye, especially when I am doing cosmetic work and a higher level of finesse is
expected. I don’t have to adjust the light if I want to see in odd corners of the mouth
as the light follows my direction of the head. I would absolutely recommend these
to every dentist.”

However, using a set of Carl Zeiss loupes doesn’t just
guarantee enhanced visualisation, it also ensures
comfort. Carl Zeiss loupes allow the user to sit in
an upright position, this improved posture makes
developing back and neck problems a lot less likely.

Available exclusively in the UK from Nuview, Carl Zeiss loupes offer comfort,
sophisticated technology and unparalleled visualisation.

For more information visit www.nationalsmilemonth.org or www.invisalign.co.uk
For more information please call Nuview on 01453 872266.

The Carl Zeiss OMPI Pico microscope is available exclusively from Nuview
in the UK. “John and his team at Nuview recognise this purchase as a large
investment,” continues Dr Vaghela. “I have dealt with the team for a few years
now and have no hesitation in recommending them. They offer good technical
support, advice and a prompt service.”
For more information please call Nuview on 01453 872266,
email info@nuview-ltd.com or visit www.nuview.co

An authorised member of the faculty of universities interested in adding
Invisalign® to its orthodontic training curriculum is requested to email:
eu-universities@aligntech for more information.

The University of Buckingham and LDTA agreement
The University of Buckingham and the Leicester Dental Teaching Academy
(LDTA) signed a joint venture agreement on April 27th 2012 to establish a Dental
School in Leicester which would initially provide a five year BDS degree course.
This was to complement a new Medical School which the University was also
pursuing at the time.
In October 2012 the University and the LDTA hosted a launch in Leicester to an
invited audience of 200 delegates drawn from Leicester’s dental professionals
and a small number of other interested parties. Both the University and the
LDTA pursued this venture with enthusiasm. However, delays in the anticipated
start date for the Medical School and the large amount of resource required for
this project alone has left the University with no choice but to delay the Dental
School until the Medical School is established. As the University is unable to
commit to a start date this has made it impossible for the LDTA to complete
contracts for the provision and construction of facilities as required in the joint
venture. Both parties therefore reached an amicable agreement to end the joint
venture in January 2014.
The University of Buckingham will support, as far as it is able, the efforts by the
LDTA to attract an alternative venture partner.

For more information please visit the new Philips website www.sonicare.com ;
email philipsoralhealthcare@philips.com or telephone 0800 0567 222.

Carl Zeiss Loupes from Nuview – “The field of
vision is brilliant.”
Many dentists are discovering the numerous
advantages that a set of loupes can bring to their
clinical work. The name Carl Zeiss is recognised for
creating visualisation systems of the very highest
standard and Carl Zeiss’range of loupes is no exception.

The Carl Zeiss OMPI Pico microscope – “I
remain as impressed now as I was when I
purchased it
“I’ve been using the OMPI Pico microscope
for about 18 months now and I remain as
impressed now as I was when purchased it,”
says Dr Devin Vaghela of The Morgan Clinic in
Maidenhead. “The unit is very well designed.
Its arms and Mora interface allow it to be
positioned at a wide range of angles over a
two-metre span. Its locking screws hold very
well even when gently tightened, allowing
minor degrees of movement, especially
important when under high magnification. A DSLR or Camcorder specific
adaptor can be mounted on the unit. It’s great for presentations to colleagues
and patients. Assistants like it too!”

Invisalign university programme for post graduate orthodontic training
expands
Align Technology has reached agreement with a further four dental schools
to join its orthodontic training programme, bringing the number at which it
teaches to seven. The Invisalign University Training Programme starts with
an introduction to the Invisalign Doctor Site; treatment options and treatment
selection; record submission; the use of the ClinCheck® software and aligner
delivery, through to monitoring and finishing. Each university is provided
with a University Kit which includes Invisalign materials and access to the
Clincheck software programme - everything the students need to get started.
The participating university is also issued with a username and password for
students to use to access the Invisalign Dr Site which is a website portal for
submitting cases. In addition to this, the site includes an educational sub-site
which is continuously updated with clinical tips, hints, clinical presentations
and publications. Other benefits include additional free Invisalign treatments
and discounts once the first student intake has submitted their first cases.
Every student who participates is also entitled to an Invisalign account which
is activated after their graduation, which allows them to care for patients using
the Invisalign system once they start in practice.

Show visitors will also be able to get a handle on the newest Sonicare - its Philips
Sonicare for Kids which targets young brushers aged 4-10.

Aligned with the British Dental
Health Foundation
Align Technology is supporting the
British Dental Health Foundation’s 2014
National Smile Month campaign.
Orthodontic treatment has the
potential to help some patients
overcome their dental phobia. The most
recent Adult Dental Health Survey1
showed that 12% of people surveyed in the UK experience extreme dental anxiety.
However orthodontic treatment is viewed as a positive aspect of dentistry – where
people are motivated to actually seek out treatment from their dental professional
to improve their smiles.

Invisalign providers are also being encouraged to hold open days to capitalise in the
interest being generated during National Smile Month and to support this initiative;
Align is offering them 50% discounts on their lab fees between 19 May and 19 June.
The company is also branding the famous National Smile Month ‘smile on a stick’
providing participating practices with something to promote Smile Month events.

Industry News 23

Enhance Your Patient Service With The
Experts At The London Smile Clinic
Regardless of your dedication to training and education, at some point you will
come across a patient that requires treatment outside of your skill set.
In those cases, offer patients the widest range of treatment options by referring
to the award-winning London Smile Clinic. The practice is open for referrals for
orthodontic treatment, implant work and complex multi-disciplinary cases.
The expert team includes implantologist Dr Zaki Kanaan and Specialist
Orthodontist Dr Preet Bhogal, two highly experienced and qualified professionals
dedicated to ensuring the success of your patient’s treatment.
As the referring dentist, you will be involved in the treatment planning, have
regular progress updates, and be required to approve each stage of the treatment.
Every case is documented with before and after photographs, while orthodontic
referrals receive treatment-planning models to send to their ceramist.
Offer your patients more – contact the London Smile Clinic and see how they can
work with you to provide optimum treatment and patient care.
For more information, please contact 020 7255 2559 or visit www.londonsmile.
co.uk/refer - your patients will be glad you did!

CB12® – effective relief from the
effects of halitosis
Patients who suffer from chronic
bad breath have to contend with
both the physical and psychological
effects of their condition.
In a seven-year Swiss study,
halitosis has been found to bring
about inhibition, insecurity, withdrawal and reduced social contact to chronic
sufferers.
The power of information from Christie + Co
Whatever questions you may have about selling of buying a practice, Christie +
Co can help provide you with the right answers.
From the best strategy to sell your practice to the best specialist dental finance
to suit your needs, Christie + Co can draw upon its years of experience and
expertise to provide you with the right information and the best guidance.
Whether you’re buying or selling a dental practice, Christie + Co knows how the
right information presented in the right way can lead to the most desirable result
– your business or retirement goals, met with ease.
To discuss how Christie + Co might help you achieve your future plans please
contact Simon Hughes on 0207 227 0749

You can greatly help by recommending CB12, which has been proven to
effectively neutralise all three odour-causing Volatile Sulphur Compounds
better than 18 other leading mouthwash brands.
For all-day freshness and confidence, patients can also use CB12 boost. This
new product is a scientifically formulated two-layer, sugar-free gum that
contains zinc, fluoride and xylitol – three ingredients that prevent bad breath,
strengthen teeth and prevent caries, and reduce plaque.
For effective relief from halitosis that can help set your patients’ minds at ease,
you can confidently recommend these two products from CB12.
For more information about CB12 and how it could benefit your patients,
please visit www.cb12.co.uk

[24] =>

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[cover] => DT UK No. 3, 2014

[toc] => Array ( [0] => Array ( [title] => News [page] => 01 ) [1] => Array ( [title] => Buying a dental practice – everything you need to know [page] => 06 ) [2] => Array ( [title] => “Kennedy’s wound was clearly incompatible with life” [page] => 08 ) [3] => Array ( [title] => Perio Tribune: Management of plaque related periodontal conditions [page] => 11 ) [4] => Array ( [title] => Perio Tribune: Perio meets implant dentistry [page] => 15 ) [5] => Array ( [title] => Perio Tribune: Beauty and health in one simple - state of the art - system [page] => 17 ) [6] => Array ( [title] => Get your Endo right first time [page] => 20 ) [7] => Array ( [title] => Industry News [page] => 22 ) ) [toc_html] =>

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