Dental Tribune UK No. 1, 2023

Taking stock and looking ahead / Evolving business systems into 2023 and beyond / UK NEWS

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The World‘s Dental Newspaper
Published in London

uk.dental-tribune.com

Vol. 13, No. 1

UK NEWS

A new study shows how early treatment of poor oral health may lead to
significant brain health benefits.

The launch of Aligner Dental
Academy and what it means for
you and your practice.

Page 06

INTERVIEW
For the fifth part of our series focusing on women in the dental field, we
interviewed Debra Worthington, a
dental nurse with more than 40 years
of experience.

Page 10

Page 12

Taking stock and looking ahead
The current and future dental implant landscape
By Dr Amit Patel, UK

The digital revolution continues
Like all areas of dentistry, implantology is going digital. A digital
workflow can be applied to various stages in the treatment journey, often improving outcomes, as
well as both the patient and professional experience.
We are seeing an uptake of intraoral scanners, which can acquire
highly accurate impressions while
improving
patient
comfort
compared
with
conventional

alginate methods. For the clinical
team, digital scans can be easily
integrated within the wider digital
workflow and facilitate prosthetic
design, as well as streamline
communication and collaboration
with colleagues. I would estimate
that around 20%-30% of clinicians
in the UK now own and utilise
these scanners, but I would expect
this to increase in the next couple
of years as the technology
improves and becomes even more
accessible.
CBCT is the other digital solution
supporting dental implantology
today. These scans have become

central to precise and confident
treatment planning, allowing clinicians to determine the ideal dental
implant position, angle, depth and
width in every single case. This,
combined with prosthetically
driven planning protocols, ensures
that any dental implant placed can
be restored correctly for good
function, aesthetics, maintenance
and longevity.

Attitudes to metal in
the mouth
Another trend we are seeing in the
UK is an increase in a patient-driven

“Effective new ways of cleaning
the products that we use would
be widely welcomed”
move away from metal. While certainly not yet the norm, my colleagues and I are receiving more
enquiries about and requests for
metal-free alternatives to conventional dental implants. This echoes
some of the changes already seen
across other disciplines of dentistry, such as restorative dentistry,

and creates an interesting dynamic for the future. Ceramic implants are available for clinicians to
utilise backed by science and
proved to deliver good clinical results and these are now being employed more regularly than they
were just a few years ago.
▶ Page 2

Evolving business systems into 2023 and beyond
An article series on five basic systems to improve practice management—Part 2: Marketing

In this article series, I address each
of the five basic systems that dentists and dental technicians need
to have in place and give advice on
how they can best prepare for the
future. In Part 1, I referenced the
seminal work The E-Myth Revisited
by Michael Geber and discussed
financial systems in dental practices. In this current article, I will
focus on Gerber's second business
system: lead generation systems
(how we attract new patients and
sell more to existing patients),
which is otherwise known as practice marketing.
Shortly, I will share with you a sixstep process for ensuring that your
marketing is contemporary and on
point, but before that, I want to
describe what I believe to be a
hugely important distinction, between advertising and marketing:
Advertising is the systems by
which you make strangers aware

of your practice and aware of the
products and services that you
offer.
Marketing is the systems by which
you encourage existing patients to
buy more and to recommend you
to their family, friends and colleagues.

By Chris Barrow, UK

The purpose of this article is to describe methods by which you can
do successful marketing, according to my definition, and it is not
within my scope of practice to talk
about advertising.
When my clients ask me about advertising, I direct them to experts
and agencies in this field, with the

warning that advertising can be
costly and necessitate a huge attrition rate (essentially advertising
is appealing to price shoppers and
potential time-wasters) and that
they need to carefully monitor
what the agencies do with their
money.
Can you detect a note of bias in my
language? I apologise, but I have
spent too many hours listening to
practice owners and managers
complaining about lack of results
and lack of information. Caveat
emptor!
My preference for marketing is
based upon the knowledge that it
can be a predominantly in-house
activity, under your control, relatively low-cost and easy to monitor. So, let us look at my marketing
systems, especially in this postCOVID digital world of ours.

Your recall system
It comes as a surprise to many clients when I suggest that a properly run patient recall system is the
first rung on the marketing ladder.
The COVID environment resulted
in many recall systems being
halted, and the demand for dentistry since has resulted in some
recall systems being left unattended while the waiting list is
dealt with.

▶ Page 4

[2] =>

UK NEWS

Dental Tribune United Kingdom Edition | 01/2023

▶ Page 1 - Taking stock and looking
ahead

Yet to come
There are some interesting technologies currently being introduced and in development that
could have a positive impact on
dental implantology in the future.
For example, there is navigation
software that allows the clinician
to prepare the dental implant site
using the CBCT scan in real time as
a kind of virtual guide. It offers an
alternative way to provide guided
surgery, allowing for a freehand
approach that makes use of digital
technology for more accurate and
confident dental implant placement. This kind of technology is
still quite new to the field, but it is
likely to become a more popular
technique as the software evolves.
The other area in which changes
are afoot is the management of
peri-implantitis. Prevalence is difficult to measure, but according to
current research, it occurs in 12.5%
and 19.5% of cases at implant level
and patient level, respectively.1 A
leading cause of dental implant
complications, it remains a disease

that is not fully understood by the
profession or by patients. Prof.
Niklaus Lang from Queen Mary
University of London once said at
a conference I attended: "Periodontitis was made by God;
peri-implantitis was made by
man." This illustrates the difference between the two diseases,
and we must develop management techniques that take this into
consideration. As a specialist periodontist, this is a topic I am passionate about, and the Association
of Dental Implantology has long
recognised it as an important area
for the progression of the field. We
have held events dedicated to discussing the challenges of peri-implantitis and exploring potential
solutions for this very reason.
For the future, how we clean dental implants will likely be further
scrutinised. There is already technology available for electrolytic
cleaning of the dental implant surface, which has been shown to inactivate bacterial biofilm far better
than using a powder-spray system. 2 Given the spotlight on prevention of bacterial infection in
the UK dental implant field, effective new ways of cleaning the

products that we use would be
widely welcomed.
Of course, this will be in addition
to, or perhaps even second to, prevention of the disease in the first
place. We know the risk factors for
peri-implantitis, but if we can hone
in on the exact mechanisms behind development, then we could
change the game entirely for many
patients. With more research, a
greater understanding of the disease and the next generation of
technology and materials, we will
be even better equipped to stop
peri-implantitis before it becomes
a problem.
Aside from these, there will no
doubt be a shift in some of the
other clinical techniques and
products employed as part of the
dental implant workflow in the
near future. For example, socket
shielding is being brought to the
fore at professional events, and
novel dental implant designs are
being worked on to help further
minimise potential complications.
It is an exciting time to be involved
in the dental implant field and to
utilise many new innovations as
they reach the market. Concen-

trating on science-backed and evidence-based solutions remains
crucial, but we can expect to deliver ever-better dental implant
treatment to patients in the
years
to
come.

References
1. Diaz P,
Gonzalo
E,
Villagra
LJ,
Miegimolle B, Suarez
MJ. What is the prevalence of
peri-implantitis? A systematic review and meta-analysis. BMC Oral
Health. 2022 Oct 19;22(1):449. doi:
10.1186/s12903-022-02493-8.
2. Ratka C, Weigl P, Henrich D,
Koch F, Schlee M, Zipprich H. The
effect of in vitro electrolytic cleaning on biofilm-contaminated implant surfaces. J Clin Med. 2019
Sep 6;8(9):1397. doi: 10.3390/
jcm8091397. Erratum in: J Clin
Med. 2022 Feb 8;11(3):882. doi:
10.3390/jcm11030882.

Dr Amit Patel
is a periodontist. He graduated in
dentistry from the University of
Liverpool in the UK in 1997 and
obtained his membership of
the Faculty of Dental
Surgery of the Royal
College of Surgeons of
Edinburgh in 2000. Dr
Patel also underwent a
four-year training
programme in periodontics and implantology at
what is now King’s College
London Faculty of
Dentistry, Oral and Craniofacial Sciences in the UK,
achieving a master’s degree in periodontics and clinical dentistry.
Passionate about providing
specialist dentistry to the highest
degree, Dr Patel also trains other
dental professionals. As associate
specialist in periodontics and
honorary clinical lecturer at the
University of Birmingham’s School
of Dentistry in the UK, he teaches
at undergraduate and postgraduate level. He also lectures both
nationally and internationally and is
the current president of the
Association of Dental Implantology,
the UK’s leading professional
organisation in the field. More
information can be found at www.
adi.org.uk.

High sugar levels in vegan ready meals, warns
campaign group

The sugar advisory group has
highlighted a butternut, almond
and pecan nut roast from the Plant
Kitchen range at Marks & Spencer,
which has 7.7 g of sugar per 100 g,
compared with M&S's roast beef
Yorkshire pudding meal, which
contains 1.1 g of sugar. Additionally, the Plant Kitchen version of
spaghetti Bolognese has 3.6 g of
sugar per 100 g compared with 2.3
g in the meat version.
High sugar levels in vegan food
isn't exclusive to ready meals. Action on Sugar also found that
vegan food at restaurant and fastfood chains can also be high in

IMPRINT
INTERNATIONAL
HEADQUARTERS
PUBLISHER AND CHIEF EXECUTIVE OFFICER: Torsten OEMUS
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sugar and salt, including pizzas,
chilli, burgers and pies.
Nutritionist Zoe Davies, of Action
on Sugar, said products labelled
'vegan' and 'plant based' are not
necessarily healthy, while there is
research to suggest that many
people wrongly believe they are.
Despite the decreasing levels of
tooth decay over the past decades, it still remains one of the
most common problems in the UK,
second only to the common cold.
It is estimated that one in three
adults suffers from dental caries
and close to one in four children
equally suffer from some form of
tooth decay.
World Health Organization research shows evidence that dental
caries incidence is lower when free
sugars intake is less than 10% of
energy intake.
Dental hygienist and nutritionist
Juliette Reeves comments: "Recent research suggests a link be-

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tween dental erosion and the
vegan diet. An increased consumption of acidic foods in the
diet seems to be the culprit. In ad-

B12 is found only in animal produce, and although the body
needs relatively small amounts,
gastro-intestinal conditions, pro-

Action on Sugar, a campaigning
group which informs and influences sugar reduction policies in
the UK, warns that vegan ready
meals can contain more than
seven times as much sugar as
meat-based alternatives. They
urge consumers to check food labels before purchasing these
seemingly healthy options.

High sugar levels in vegan ready meals, warns campaign group.

dition, high levels of hidden sugars
increase the risk of dental caries.
The vegan diet is particularly at
risk of vitamin B12 deficiency in
the long term.

longed antibiotic use, potassium
chloride supplementation and
some cholesterol lowering drugs
can adversely affect B12 synthesis
and absorption from the gut. Processed foods and the refining of
grains vastly reduces B vitamin

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responsibility for the validity of product claims or for
typographical errors. The publisher also does not
assume responsibility for product names, claims or
statements made by advertisers. Opinions expressed by authors are their own and may not reflect
those of Dental Tribune International GmbH.

All rights reserved. © 2023 Dental Tribune International GmbH. Reproduction in any manner in any language, in whole or in part, without the prior written
permission of Dental Tribune International GmbH is
expressly prohibited.

levels and inadequate protein intake can also affect B vitamin status. Avoiding processed foods and
ensuring the inclusion of a wide
range of fresh foods such as cereals, nuts and pulses provides adequate complete proteins, good vitamin B complex intake and lower
sugar, salt and saturated fats in the
diet.
So, whilst the adoption of a vegetarian or vegan diet has health
benefits such as a lower mean BMI,
cholesterol, and a lower mortality
from ischaemic heart disease, simply avoiding animal products or
relying on processed ready-made
meals can be detrimental. The reality is that plant-based diets require considerable nutritional
competence, determination and
perseverance with diet and supplementation regimens to avoid
both oral and systemic health consequences.

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Pioneer Designs

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UK NEWS

Dental Tribune United Kingdom Edition | 01/2023
▶ Page 1 - Evolving business systems in
2023 and beyond

Given the current economic landscape 'recession and inflation', I
am advising my clients to look
again at their recall systems and
reactivate regular reminders for
dental health reviews and hygiene
visits. You should consider the following:
1. Are your existing patients
being contacted on a regular
basis to remind them that their
appointments are due?
2. Are you able to triage dental
health reviews and visits by
zoning diaries to allow for
ample time to review and to deliver higher value treatment?
3. Do you have a virtual consultation platform in place so that
patients can talk to a treatment
coordinator or clinician before
visiting?
4. Do you offer an online booking system?
5. Do you offer an online chat
facility (chatbot)?
At a patient review or recall, you
will have the opportunity to upsell
higher value treatment (if appropriate and affordable) and ask for
word-of-mouth and digital referrals, as well as a Google review.

Social media
Complaining about social media is
as pointless as complaining about
the weather—it is here to stay. Irresponsible use of social media is
inappropriate in dentistry. Responsible use of social media,
however, allows our messages to
travel further and faster than at
any time in history.
I ask my clients to follow a simple
rule in all their marketing, the
80/15/5 rule for content:
· 80% stories about real patients
for whom you have made a positive difference;
· 15% stories about your team
members and how working with
you is enhancing their lives; and

Correctly used, social media can
be a godsend for your practice
marketing and your marketing
budget.
Many prospective patients, even
those referred by others, will visit
your website as part of their discovery process. Is your website
modern, freshly designed and engaging? Many years ago, and in
collaboration with a leading dental
web design company, we described the six essential components to make your website earn
its living.

Your website
Many prospective patients, even
those referred by others, will visit
your website as part of their discovery process. Is your website
modern, freshly designed and engaging? Many years ago, and in
collaboration with a leading dental
web design company, we described the six essential components to make your website earn
its living.
Profile
To begin with, address the profile
of your dental practice—this includes your name, brand and
unique selling points—and emphasise this throughout your website, especially on your home page
and landing page. This will help
build brand awareness so that you
become a familiar name throughout your community. You want
people to associate your profile
with good customer service and
quality dental care. Build up a collection of Google ratings and reviews from your existing patients
to help emphasise this further.
Make sure that your home page
and landing page are both unique,
interesting and engaging so that
they encourage prospective patients to explore the rest of your
website and leave their details or
contact you directly to either find
out more information or book an
appointment to visit you in person.

· 5% oral health education.
Far too many practices reverse
these proportions, and their social
media becomes me, me, me—me
on a course, showing off equipment, at team training or lecturing
on oral care. These may be important, but are largely boring to the
audience. Regarding social media
engagement, you should consider
the following:
1. Do you add three or four social media posts weekly?
2. Do they follow the 80/15/5
rule?
3. Do you engage and interact
daily with any followers who
engage with you?
4. Do you encourage Google
reviews from every patient with
a simple QR code on a card?
5. Do you regularly collect patient selfies and video testimonials (with the necessary consent)?

People and premises
Showcase the people on your
team and the premises of the dental practice. This is very important
in the marketing mix, as it helps
prospective patients to familiarise
themselves with you and your
team as well as find out more
about your surroundings to help
ease their nerves when they visit
you in person.
Price
The prices of your treatments are
very important. Most patients will
try to get the best deal possible. If
you can offer better prices than
the other dental practices in your
area, then this is beneficial for you.
If you have higher prices than your
competitors, then work to emphasise the quality of dental care that
you provide to justify your prices
and help patients recognise your
experience and expertise.
Promise and products

Promise your patients that you will
provide them with fantastic dental
care and excellent service and
prove this using the Google ratings and reviews as well as before
and after pictures of successful
treatments carried out at the practice. Inform patients of individually
tailored products in the form of
treatment plans or smile makeovers that they can undergo at
your dental practice.
Important considerations for your
website include:
1. Is your dental website refreshed every three years?
2. Is your bounce rate low so
that you know that visitors are
staying to research?
3. Have you incorporated the
six Ps?
4. Can you confidently say that
your website earns you a living?
5. Does your website include
videos of patient stories?
6. Is all your photography current and professional?
7. Do you have an online booking and chat facility?
8. Is all copy optimised for
search engine optimisation?

The digital patient
newsletter
Most of my clients publish a patient newsletter every month. The
objective is to upsell treatment
and to encourage patients to share
the newsletter with family, friends
and colleagues if they think an article will be of interest.
Although some may use a module
in their practice management
software, the majority will use a
modern newsletter platform like
Mailchimp. The content of the
newsletter follows the same
80/15/5 rules, but allows you to go
into more details, showcasing patients and team stories. The feedback is always that patients do
enjoy these publications, provided
they are not seen as sales documents.

The daily huddle
Given my focus on internal marketing, it will be no surprise that
the morning huddle is a focal
point, during which the list for the
day is reviewed to identify patients
visiting that day who could be approached for internal marketing. A
typical daily huddle list would be:
1. New patients: Count the
number of welcome packs sent
out at the end of the day.
2. New treatment plans: Add up
the total of the signed treatment plans at the end of the
day.
3. Production: Collect the completed average daily production sheets and insert the total
production into the sheet.
4. Facebook check-ins: Count
the number of check-ins on the
practice's Facebook administration page (practice manager
or treatment coordinator).

5. Problems: List any problems
reported throughout the day.
6. Follow-up calls: List any diarised follow-up calls. Also, note
any difficult treatments or concerns from the previous day
(clinicians).
7. Patients who failed to attend
or cancelled: List any patients
who failed to attend or cancelled on the previous day and
actions taken.
8. Achievement against production target: Compare reception-booked average daily
production sheets against the
targets for each clinician.
9. Emergencies: Make sure that
there are spaces in the appointment book for utilisation
for emergencies etc.
10. Laboratory work due: Check
the next working day for laboratory work and raise concerns
if laboratory work is missing
'dental nurses'.
11. Email addresses: Check in
the appointment book for an 'e'
icon next to the appointment. If
there is no 'e', then highlight for
collection the next day.
12. Smile checks: Identify patients who have not had a smile
check in the last 12 months and
highlight them on the list for a
smile check on arrival.
13. Handing out referral cards
to patients: These are normally
handed out to patients at the
end of treatment reviews.
14. Facebook engagement: Explain to patients that the practice is having a charity drive for
Facebook likes and reviews.
Ask!
15. Testimonials: Make sure
that at the end of treatment immediately after the final dentist
review, patients are booked
with the treatment coordinator
for a six-monthly healthy
mouth review booking and testimonial requests.
16. Membership:
Highlight any
patients not
on membership
(e.g. with
a different colour
in
the
appointment
book)
and
ask
whether
they are aware of
membership and its benefits.
17. Thank you: If a patient has
referred a new patient to us
(evident from a pop-up on the
patient's file), thank him or her
and ask whether he or she has
received his or her chocolates
yet? If not, find out why!
18. New patients: Make everyone aware of the time a new
patient is coming in. Be prepared!
19. Access issues for any patients: List the appointment
time and ensure surgery coordination.
20. Any known highly demanding patients: Find the time of
attendance and make sure you
are on time!

The end of treatment
review
When patients reach the end of a
course of cosmetic treatment,
they should be at an emotional
high point in their journey. That is
the best possible time to engage
them as an advocate for the practice—so be ready with your MRCREST approach:
Membership: Would you like to
join our dental plan?
Referral: May we give you three of
our business cards to pass on to
any family members, friends or
colleagues who would benefit
from visiting with us?
Check-in: If you have a Facebook
personal profile, could we ask you
to check in at the practice today?
Review: May we give you a Google
review card with a QR code and request a review?
Email: Do we have your email address and may we add you to the
subscriber list for our patient
newsletter?
Selfie: Can we take a selfie?
Testimonial: Do you have time
now to record a short video testimonial or can we invite you to one
of our VIP evenings to be filmed?

Conclusion
By adding all these steps together,
you create a full internal marketing system that will turn your patients into your unpaid sales force.
Internal marketing is a fun team
effort that strengthens and deepens your relationships—and it
works!

Chris Barrow
has more than 50 years of work
experience and has been active as
a consultant, trainer and coach to
the UK dental profession for over
25 years. His main professional
focus is through his Extreme
Business company,
providing coaching and
mentorship to
independent dentistry
around the world via
virtual consultancy,
practice visits, a
workshop programme and an online
learning platform. His
blog, Thinking
Business, enjoys a
strong following. During
the COVID-19 pandemic,
Barrow created the Regeneration Coaching Programme to help
practices to survive lockdowns and
to bounce back higher after their
return to work. More information
on his work can be found at
www.coachbarrow.com.

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UK NEWS

6

Dental Tribune United Kingdom Edition | 01/2023

The link between oral health and
systemic heath has been long understood by dental experts. Now
preliminary research, to be presented at the American Stroke Association's International Stroke
Conference 2023, suggests there
may be a link between oral health
and brain health. Adults with poor
oral health may be more likely to
show signs of declining brain
health than those with healthy
teeth and gums. Early treatment of
poor oral health may lead to significant brain health benefits.

ing (MRI)," said study author Dr
Cyprien Rivier, a postdoctoral fellow in neurology at the Yale School
of Medicine in New Haven, Connecticut. "Studying oral health is
especially important because poor
oral health happens frequently
and is an easily modifiable risk factor."

Periodontal disease, missing teeth
and other signs of poor oral health
and poor brushing habits and lack
of plaque removal can increase
stroke risk, according to studies.
Previous research has found that
gum disease and other oral health
concerns are linked to heart disease risk factors and other conditions like high blood pressure.

Between 2014 and 2021, researchers in this study analysed the potential link between oral health
and brain health among about
40,000 adults (46% men, with an
average age of 57 years) without a
history of stroke, enrolled in the
UK Biobank. Participants were
screened for 105 genetic variants
known to predispose persons to
have cavities, dentures and missing teeth later in life, and the relationship between the burden of
these genetic risk factors for poor
oral health and brain health was
evaluated.

"What hasn't been clear is whether
poor oral health affected brain
health, meaning the functional
status of a person's brain, which
we are now able to understand
better using neuroimaging tools
such as magnetic resonance imag-

Signs of poor brain health were
screened via MRI images of the
participants' brains, including
white matter hyperintensities, defined as accumulated damage in
the brain's white matter, which
may impair memory, balance and

© PopTika/Shutterstock.com

Poor oral health may contribute to a decline in
brain health, according to new research

Diabetes and toothlessness together worsen cognitive decline.

mobility and microstructural damage, which is the degree to which
the fine architecture of the brain
has changed in comparison to images for a normal brain scan of a
healthy adult of similar age.
The analysis found:
· People who were genetically
prone to cavities, missing teeth or
needing dentures had a higher
burden of silent cerebrovascular
disease, as represented by a 24%
increase in the amount of white

matter hyperintensities visible on
the MRI images.
· Those with overall genetically
poor oral health had increased
damage to the fine architecture of
the brain, as represented by a 43%
change in microstructural damage
scores visible on the MRI scans.
Microstructural damage scores
are whole-brain summaries of the
damage sustained by the fine architecture of each brain region.

"Poor oral health may cause declines in brain health, so we need
to be extra careful with our oral
hygiene because it has implications far beyond the mouth," Dr
Rivier said. "However, this study is
preliminary, and more evidence
needs to be gathered—ideally
through clinical trials—to confirm
improving oral health in the population will lead to brain health benefits."

Treating vulnerable patients in UK practice improves lives
and can be profitable for dental businesses
By Ben Atkins, UK

Dental care for homeless and vulnerable patients should not be left
to charities, but a priority for the
NHS, says Dr Ben Atkins, former
owner of Revive Dental Care in
Manchester and a Trustee of the
Oral Health Foundation.
He believes a UK-wide, standardised care system within the
scope of the NHS, and including
improved treatment signposting,
would hugely improve dental services for people who find it difficult to access services. And he
stresses: "It also has to be profitable for the practice because then
it becomes part of the normal and
the focus of the NHS."

Dr Atkins, former chair of the Salford Local Dental Committee and
a clinical expert to public health
leads such as NICE and NHS England, was instrumental in lobbying the Greater Manchester commissioning team to fund a service
for homeless people and those
with complex needs some 15 years
ago in his Ancoats Urban Village
Medical Centre practice. He says:
"One of the massive, personal reasons for me attending the LDC and
MCN-managed clinical network
meetings was to understand what
was going on, where the extra
funding is for dentistry, and get to
know the commissioners. There
are projects around currently, but
if you don't read about them, or
get involved, you will be the last to
know."
He explains his practice was already operating out-of-hours and
emergency services for Merseyside, Cheshire and a large area of
Greater Manchester, which was inundated with vulnerable patients
who'd found negotiating the NHS
system a nightmare or banned
from every other practice, who he
and his team would see. "So we
went back to our commissioner in

Greater Manchester and proposed
a proper access session just aimed
at hard-to-reach and homeless
people."
The commissioner awarded a contract
worth
approximately
£50,000, which Dr Atkins says enabled the practice to make a major
difference to the dental health and
wellbeing of vulnerable patients.
"It also took the pressure off our
actual out-of-hours service because we weren't having to field 10
or 15 patients a week who were
very complicated. The service
went from strength-to-strength
and it's possibly the highlight of
my career."
Since selling his practice to Rodericks Dental, Dr Atkins has continued to champion and consult on
contracts for hard-to-reach patients; there is now one piloting a
service in Leeds and another starting the journey in Cornwall, but he
stresses more are needed. "As a
profession, we're not really focused on where the actual needs
are in society. We focus very much
on the worried well and for me,
they are not the patients I qualified
to treat."

Dr Nigel Carter, chief executive of
the Oral Health Foundation agrees,
adding "The most challenging
needs often come from individuals with the highest rates of dental
decay. Frustratingly, access points
for this group are becoming
scarce—with a growing number of
dental deserts in the UK."
However, Dr Atkins says there is
now a drive towards getting a
standardised process in place not just for the homeless but also
other disenfranchised groups that
need prioritisation to access care.
He stresses that the "building
blocks are there" with dental practices operating to NICE guidelines
easily able to accommodate hardto-reach patients.
Aside from the issue of treatment
contracts for vulnerable groups,
Dr Atkins points to the hugely
negative impact of COVID-19 in
terms of the extra barriers now in
place to accessing treatment for all
patients, but particularly those
who are already hard to reach. He
explains: "There is already difficulty in the signposting journey
throughout the NHS and because
capacity has reduced across the

board, the people who will be the
hardest hit are the most vulnerable." In Manchester, Dr Atkins'
team worked with local shelters to
identify patients needing acute
care, which he says was a "real success".
He adds there are currently National Health Institute of Health
Research projects looking into
why some groups of people in society don't go to the dentist. "99%
of the time it's about signposting
- there are a lot of blockages we
need to unblock before it become
an easy journey."
In terms of how the UK's system of
treating
vulnerable
patients
benchmarks with other countries,
he points to Canada having a good
system of central referrals but
adds that similar issues exist
worldwide to those in the UK.
"We do it as well as any other
country and there some really
good signs that things are changing," he concludes.

[7] =>

UK NEWS

7

Dental Tribune United Kingdom Edition | 01/2023

Gum infection may be a risk factor for heart
arrhythmia, according to new research
Researchers found a significant
correlation between periodontitis
and fibrosis, scarring to an appendage of the heart's left atrium
that can lead to an irregular heart-

© Illus-Man/Shutterstock.com

Periodontitis can lead to a litany of
dental issues from bad breath to
bleeding and lost teeth. Now, researchers at Hiroshima University
have found that it could be con-

nected to even more severe problems elsewhere in the body - the
heart.

beat called atrial fibrillation, in a
sample of 76 patients with cardiac
disease.

The study, published in the January issue of JACC: Clinical Electrophysiology examined the relationship between periodontitis and
atrial fibrosis in atrial fibrillation.

"Periodontitis is associated with a
long-standing inflammation, and
inflammation plays a key role in
atrial fibrosis progression and
atrial fibrillation pathogenesis,"

said first author Shunsuke Miyauchi, assistant professor with the
Hiroshima University's Health Service Center. He is also affiliated
with the university's Graduate
School of Biomedical and Health
Sciences. "We hypothesized that
periodontitis exacerbates atrial fibrosis. This histological study of
left atrial appendages aimed to
clarify the relationship between
clinical periodontitis status and
degree of atrial fibrosis."
The left atrial appendages were
surgically removed from the patients, and the researchers analysed the tissue to establish the
correlation between the severity
of the patient's atrial fibrosis and
their gum disease. They found that
the more significant the periodontitis, the worse the fibrosis, suggesting that the inflammation of
gums may intensify inflammation
and disease in the heart.
"This study provides basic evidence that periodontitis can aggravate atrial fibrosis and can be a

novel modifiable risk factor for
atrial fibrillation," said corresponding author Yukiko Nakano,
professor of cardiovascular medicine in Hiroshima University's
Graduate School of Biomedical
and Health Sciences.
According to Nakano, in addition
to improving other risk factors
such as weight, activity levels, tobacco and alcohol use, periodontal care could aid in comprehensive atrial fibrillation management. However, she cautioned that
this study did not establish a
causal relationship, meaning that
while gum disease and atrial fibrosis degrees of severity appear connected, researchers have not
found that one definitively leads
to the other.

modifiable risk factor for atrial
fibrillation and to promote dental
specialists' participation in comprehensive atrial fibrillation management. Periodontitis is an easy
modifiable target with lower cost
among known atrial fibrillation
risk factors. Thus, the achievement
of this study series may bring benefits for many people worldwide."
Next, the researchers said they
hope to conduct future clinical trials to clarify if periodontal intervention reduces atrial fibrillation
occurrence and improves patient
outcomes.

"Further evidence is required for
establishing that periodontitis
contributes to the atrial fibrosis in
a causal manner and that periodontal care can alter fibrosis,"
Nakano said. "One of our goals is
to confirm that periodontitis is a

A study of nearly 3,000 school children has found that silver diamine
fluoride, as well as sealants, protected against cavities. The liquid
brushed onto the surface of teeth
was as effective against cavities as
dental sealants, the current standard of care. A single dose of either topical treatment given to primary school aged children was
found to prevent around 80% of
cavities, and kept 50% of cavities
from worsening when the children
were seen two years later.
Research conducted by experts at
New York University explored caries prevention in children between
the ages of four and nine. The
findings, published in JAMA Network Open, presents an efficient
and cost-effective approach to improving children's oral health.
Dental cavities are the most common chronic disease in children,
and children from low-income
families are at higher risk than
those from higher-income families. The randomised trial of 2,988
children in schools in New York
City compared the effectiveness
of two cavity prevention techniques: A 'simple' treatment using
silver diamine fluoride (SDF) and
fluoride varnish, and a (complex)
treatment using traditional glass
ionomer sealants and fluoride var-

nish. Both are non-invasive and applied to
the surface of teeth to
prevent and arrest cavities in children, but for
the same time and cost,
dental
professionals
can treat more children
with the simpler SDF
therapy.

© Yevhen Prozhyrko/Shutterstock.com

School dental program prevents 80% of cavities
with one-time, non-invasive treatment

Upon visiting each
school, the clinical research team, which included a supervising
dentist, dental hygienists, registered nurses,
and assistants, did
baseline exams to measure any tooth decay,
and then applied fluoride varnish and either
sealants or SDF, depending on whether
the school was assigned to receive the
complex or simple
treatment.
The researchers found
that both the simple School dental programme prevents 80% of cavities with one-time, non-invasive treatment.
and complex treatments were successful. Just one
progressing (56% for SDF and 46%
treatment was remarkably effeccavity prevention treatment prefor sealants).
tive over the following two-year
vented more than 80% of cavities
period," said Richard Niederman,
(81% for SDF and 82% for sealants)
"Without prevention, dental caviDMD, professor in the Department
and stopped half of cavities from
ties grow continuously if not
of Epidemiology & Health Promotreated. One cavity prevention
tion at NYU College of Dentistry,

co-principal investigator and the
study's senior author. "I know of
no other dental preventive intervention that had this great a beneficial impact across the pandemic."

[8] =>

UK NEWS

Dental Tribune United Kingdom Edition | 01/2023

Dental 3D-printing market is expected to grow an average
of 12% per year

3D printing is an attractive solution to challenges faced by the
dental industry, producing high
quality and more accurate products, from crowns to implants. The
process may save time and money
for both patient and dentist, while
the digitalised process could also
allow for highly customisable
products, offering a more precise
and accurate solutions for even
the most complex treatments.
The global growing incidence of
dental caries has led to experts
utilising the technology to prevent
tooth decay. Dental caries currently affects 92% of the adult
population, with global annual
management and treatment costing over US$300 billion, according
to the World Health Organization.

A new study carried out by researchers at the Institute of Phar-

such as the neutralisation of acid in
the oral cavity.

strated that urea can be incorpo-

The growth of dental diseases and
increased demand for dental
treatments is correlated with the
rise of the dental 3D-printing market, according to a new report. Between 2023 and 2035, 3D printing
in dentistry is expected to grow an
average of 12.6% per year over the
12-year period. The prosthodontics sector currently accounts for
the largest share in global dental
3D printing, with 55% of the market share.

Dental 3D printers can also produce highly accurate restorations,
from various materials including
resins, plastics and ceramics. A
new study conducted by the dual
Departments of Prosthodontics
and Orthodontics at Heidelberg
University Hospital observed the
fit of anterior zirconia veneers
made by either 3D printing or milling.

The dental 3D printing market is expected to grow an average of 12% per year, as studies show 3D printing can be used to prevent tooth
decay.

maceutical Sciences at ETH Zurich
examined the use of 3D printing of
a controlled urea delivery device
for the prevention of tooth decay.
Currently, caries prevention relies
on topical formulations containing
fluoride. Experts at the Institute of
Pharmaceutical Sciences suggest
these effective fluoride treatments
may not be sufficient in high-risk
individuals, leading to the explora-tion of alternative strategies—

carbohydrates in the presence of
urea-loaded 3D-printed tooth
caps.

The study, published in the International Journal of Pharmaceutics
fabricated 3D-printed personalised dental trays with a local and
prolonged release of urea. The
buffering capacity of urea in the
printed object was investigated in
vitro in the presence of Streptococcus salivarius, a common urease-producing bacteria from the
oral cavity. Researchers demon-

rated in a 3D-printed dental tray,
with the delivery controlled to certain parts of the dental tray. Importantly, the study suggests it is
possible to unidirectionally release urea towards the enamel,
with the ability to achieve high
local concentrations. This may potentially improve the efficacy of
the anti-cariogenic loaded agent.
What's more, the study showed a
reduced acidification of saliva by

The study, published in the March
2023 issue of the Journal of Dentistry, found that the fit of
3D-printed ceramic anterior restorations meets clinical standards. In
addition, 3D printing is associated
with a greater geometrical freedom than milling, and allows for
tighter adaption even after minimally invasive preparation.
Currently, North America captures
45% of the global 3D-printing
market, while a third of the industry is conducted in Europe. However, researchers are predicting
the Asia-Pacific region is likely to
grow at the fastest pace over the
next 12 years.

Researchers have discovered that
softer gums hinder the development of gingiva fibroblasts. A
group of scientists from Tohoku
University have discovered that
the gingiva stiffness influences the
properties of gingival fibroblasts,
which in turn affects whether inflammation is likely to occur and
make gingival fibers difficult to
form.
Their findings were published in
the journal Scientific Reports. "We
discovered that soft gingiva results in inflammation and hinders
the development of gingival fibres," says associate professor
Masahiro Yamada from Tohoku
University's Graduate School of
Dentistry.
It has long been known that individuals with thick or stiff gingiva
are less susceptible to gingival recessions. Many factors can lead to
gingival recession, such as gum
disease, over-brushing, and chewing tobacco. But this is the first
time that gingival stiffness has

been attributed to biological reactions.
Although fibroblasts play an important role in the maintenance,
repair and healing of the gingiva,
they also produce various inflammatory and tissue-degrading biomolecules which degrade the gingival fibres. In addition, fibroblasts
are associated with immune responses to pathogens.
Yamada, along with his colleague
Prof. Hiroshi Egusa, also from the
Tohoku University's Graduate
School of Dentistry, created an artificial culture environment that
simulated soft or hard gingiva and
cultured human gingival fibroblasts on them. They discovered
that hard gingiva-simulated stiffness activated an intracellular anti-inflammatory system in the gingival fibroblasts that prevented inflammation. Yet, soft gingiva-simulated stiffness suppressed the
fibroblastic
anti-inflammatory
system. This increased the likeli-

Gingival stiffness is biological and can lead to
more infections, according to new study

A new study from Japan has shown that gingival stiffness is biological, and can lead to more infections.

hood of inflammation and resulted in less collagen synthesis.
"Our research is the first to demonstrate the biological mechanisms

at play in regard to a patient's gingival properties," adds Yamada.
"The results are expected to accelerate the development of advanced biomaterials to control

local inflammation or microdevices that simulate the microenvironment of inflammatory conditions."

[9] =>

UK NEWS

Dental Tribune United Kingdom Edition | 01/2023

The global paediatric oral care
market is currently estimated to be
worth US$9 billion (GB£7.24 billion). A global Research and Markets report shares that the market
size is expected to reach US$15.5
billion in 10 years' time, a 6.9%
growth. Researchers attribute the
growth to the compounding issues of tooth decay, cavities and
dental diseases - leading to a
surge in demand for paediatric
oral care products.
With a growing global demand for
paediatric oral healthcare, there is
opportunity for dental professionals to engage, educate and care
for a younger population. There
has been an increase in demand
for new oral care products aimed
at children, such as flavoured
toothpastes and baby tongue
cleaners. These novel products,
which also include cavity protection
toothpastes
and
car-

toon-themed mouthwashes has
boosted the growth of the children's oral health market. The majority of these products are bought
in supermarkets - over 35% revenue share in 2021. Supermarket
dominance is attributed to easy
availability of products and the
large number of oral care products
in one place, which the consumer
can compare before purchasing.
However, online retail growth for
dental products is expected to
register the fastest growth by
2033.
The Asia Pacific region has
accounted for the largest market
share, of over 35%. Experts at
Research and Markets suggest this
is due to the increasing prevalence
of oral diseases in countries such
as India, China and Japan. Oral
diseases remain the most prevalent
disease group in India over the last
30 years, which may be associated

Global paediatric oral care industry is expected to
grow 7% by 2033

with a high population consuming
tobacco and tobacco products,
alongside unhealthy eating habits.
However, there is rising awareness
amongst the general population
in Asia Pacific countries regarding
using paediatric oral care products,
which may be attributed to the

market growth. Amongst a global
population, toothpaste is the most
widely purchased oral health
product, with a share of over 30%.
It may come as no surprise
therefore that key companies in
the global paediatric oral care
market include Colgate-Palmolive

Company, Johnson & Johnson,
Church & Dwight, Unilever, Procter
& Gamble, Pigeon Corporation,
Anchor Group and Amway.

Dentists who invest

How to leverage your value to your best advantage
When Dr James Martin badly injured his knee playing football, little did he know it would lead to a
new career and a Facebook group
with some 9,600 members and
counting.

He explains that the dental
profession
is
demanding—
particularly for those running their
own practice. This means that
dentists are left with very little
capacity or 'bandwidth' for

The accident, and subsequent surgery, happened in 2019, forcing
James to take a hiatus from dentistry, giving him time to focus on
what had until then been a
hobby—money and investments.
Then the pandemic struck, so with
time on his hands, James created

Today, James focuses on two key
ways of helping dentists: Mentoring them to leverage their time
spent in practice to make more
money—potentially in less time,
and helping them to create strategies for growing their wealth in
the longer term.

Dentists who Invest in recognition
that there was great scope to help
dentists improve their financial literacy, in turn empowering them to
make better financial choices.

anything else. "The 5% that's left
over is either spent in downtime—
with friends and family, or just
trying to recover," he says.

Earn more, don't
work more
James believes dentists generally
do want to understand how to
manage their time more effectively while maintaining, or even
increasing, their income but just
don't know how.
"The trick is to understand the
concept of leverage. The next step
is to understand how we can apply
this to our lives. This means we can
earn more and also have more
time to do the things that make us
happy," he says, adding: "If you ask
people (how can you earn more
money), most will say, 'maybe I
could work another day a week'.
That works, but there's only seven
days in a week and you can't ask
for eight days. So the trick is to get
more out of each day to increase
wealth without necessarily working more - the leverage in a system
is how much your input is multiplied by in order to obtain the output. Lots of dentists want to do
less dentistry but feel like they're
trapped because they don't necessarily have an understanding of
how to make the same or more
money but in less time."
James highlights the importance
of dentists properly gauging how
happy they are with their career
and work/life balance. "Unlike
most other jobs that you leave if
you don't enjoy, dentistry takes
you five years of studying to reach
that understanding, which is
pretty unique. Many dentists then
think that now they've come this
far, they have to keep going. Of

course, it's not that black and
white. I'm not saying just drop
dentistry but there has to be a
sweet spot." He asks his clients to
consider how happy they are on a
scale of one to 10. If they score 10,
then nothing needs to change; instead, he can help them with an investment strategy that will grow
their earnings for the future when
they retire.
However, if it's nine out of 10 or
less, James believes they're still
making compromises when it
comes to their life satisfaction and
that's when they should consider
how they can continue to earn the
same money but working fewer
days per week.

Leverage your value
He stresses that dentists are in the
perfect position to increase their
earnings from the services they already offer because dentistry is
value driven, rather than price
driven. "People will pay more
when they get a better service,
particularly when it comes to their
teeth. For instance, if you have a
procedure done on your teeth that
removes enamel, it is irreversible;
it needs to be done correctly the
first time. That means when someone is very good at their job, their
value is exponential. The more
value you give to someone, the
more you are within your rights to
ask for a greater amount of value
in return.
"That sounds like a really simple
theory, but the number of people
who actually practice that and are

ready to implement that mentality
is very small because dentists are
human too; they have the belief
that the best way to help someone
is to charge them the least amount
money, which makes no sense
whatsoever. If you went to a hairdresser and they shaved your head
for £5, would you feel they'd done
you a favour? No, you'd actually be
more grateful to the person who
charged five times that price, who
did a good job."
Instead, James advises his dentist
clients to let their decisions to be
guided by what they truly believe
to be the most suitable treatment
for the longevity and health of that
tooth. He believes this leads to
more profitable dentistry for two
reasons: The first is that patients
will be happier, more likely to return and to recommend the practice to friends and family; the other
is that the best treatment is likely
to be one at a slightly higher investment. "That's something dentists are scared of - pitching to
somebody that think might be offended that the investment is
more," he says.
James concludes that figuring out
how to get more out of each hour
of practice, to the point of earning
the same in four days compared to
five or even six days, will enhance
someone's life tenfold: "Because
now they have their optimum relationship with dentistry. Not in 30
years when they retire, but today."

[10] =>

UK NEWS

Dental Tribune United Kingdom Edition | 01/2023

Launch of Aligner Dental Academy announced
Next-level education and support for dentists striving to deliver gold standard

aligner therapy and accredit their work

Launch of Aligner Dental Academy. Pictured are Dr Raman Aulakh (front, six from left) and Dr Barry Buckley (front, seventh from left), co-founders of the Aligner Dental Academy, surrounded by ADA course delegates.

Aligner therapy has taken the dental sector by storm, revolutionising orthodontic and restorative
dental treatments. With new and
emerging digital technologies future-proofing high-level results,
patient demand continues to rise.
The rapid evolution and diversification in treatment delivery has
led to an increasing number of
general
dental
practitioners
(GDPs) seeking out ways to incorporate aligner therapy into their
everyday practice. But with this
comes an onus upon them to stay
abreast of innovation and best
practice protocols to ensure they
are well-equipped to provide
high-quality care, predictable results and meet patient expectations.
Now an exciting development has
created an opportunity for general dentists to excel in their delivery and unlock their professional
potential. The Aligner Dental
Academy launches on 3 April 2023.
This is the world's first independent and expert-led dental academy dedicated to clear aligner
therapy, which aims to become the
global go-to authority in education and support for GDPs.
The founders of the Academy—Dr
Barry Buckley, CEO and general
dentist and Dr Raman Aulakh, CEO
and specialist orthodontist—have
been delivering Invisalign certification courses in both the Go and
Comprehensive portfolios for
general dentists across EMEA for
the past seven years.
In 2021, they launched a new support and education platform

called the Aligner Global Community (AGC) as a separate brand
under the Aligner Consulting umbrella. Since then, the two brands
have been operating side by side
certifying, educating, and supporting Invisalign doctors on their
journey. Now, to take their offering to the next level, they have
merged to create the world's first

to building a strong ethos of professionalism, boosting clinical
confidence and helping practitioners deliver great results. The
Academy is simply the only place
to go to learn everything there is
to know about aligner therapy if
you are a general dentist."

can ignite change within the industry."
Focusing on top-level education,
peer-to-peer support, and mentorship, the Aligner Dental Academy provides the most all-encompassing programme available to
GDPs:

The Aligner Dental Academy is al·

·
·

Aligner Dental Academy.
Dr Buckley explains: "We are
bringing together motivated dentists who are focused on elevating
their clinical and non-clinical expertise and capabilities to give the
best patient experience. As the
leading authority in education,
support, and career development
for those dentists providing
aligner therapy, we offer a wealth
of opportunities for them to succeed.
From
niche
industry-specific
workshops to global virtual conferences, in-depth case reports to
essential troubleshooting tips, we
believe that connection and
knowledge sharing are essential

Unlimited access to more
than 70 hours of CPD-certified e-learning modules
Mentorship, with the option
to book one-to-one mentorship calls
Support with 48-hour Forum
response time
Access to a comprehensive library of clinical documents,
downloads, videos and articles
Monthly live and online
events with presentations
from industry experts.

ready the fastest-growing, industry-specific peer-to-peer community developed for dentists by
dentists and boasts an 10,000+
membership from 112 countries
around the globe.

Clinical topics include SAFE assessments, troubleshooting in Invisalign, mastery of ClinCheck, ortho-restorative and ortho-perio,
managing occlusion, case analysis
and predictability with aligners.

Dr Aulakh adds: "We are providing
everything GDPs need to be better clinicians. We believe the
Aligner Dental Academy offers
general dentists a badge of excellence and commitment to
best-practice clear aligner therapy
and minimally invasive comprehensive dentistry. By providing
gold-standard continued education, mentoring and career support—and a recognised accreditation pathway—we believe we

Non-clinical topics covered include litigation, virtual consultations, Invisalign promotion days,
career planning, marketing, remote aligner workflows, sales and
patient conversions, leadership,
practice management, consent
and finance.

Membership and accreditation
The Aligner Dental Academy offers three incremental tiers of
membership:
1. Academy member: This tier is
open to all qualified GDPs committed to best-practice GP aligner
therapy through gold-standard
continued education, mentoring,
and career support
2. Accredited Academy member:
This tier is the gold standard for
professionals leading initiatives
within the profession. Accredited
members must demonstrate a
high standard of knowledge, experience, and development. Dentists must apply to become a
member.
3. Academy Fellow: Becoming an
Academy Fellow is the ultimate indicator of significant professional
experience and expertise. Academy fellow members have shown
evidence of outstanding contributions and performance in dentistry. Application is also required
for this tier.
Membership of The Aligner Dental
Academy is £49 per month. To attend a launch event webinar on 4
April at 7.30 pm, to find out more
to ensure you are best-equipped
to catapult your career, visit and
register in advance:
https://alignerconsulting.zoom.
us/webinar/register/WN_0N8WcQ4HQiKXz0Np3bk-Fw

[11] =>

UK NEWS

Dental Tribune United Kingdom Edition | 01/2023

Exposing the immune system to
citrullinated bacterial proteins is
seen as a trigger for rheumatoid
arthritis. The anti-citrullinated
protein antibodies (ACPAs) seen
in many rheumatoid arthritis (RA)
patients, which serve as a diagnostic marker, may have their origin in periodontal disease, researchers said.
Traces of bacteria associated with
periodontal disease have been
found in samples collected from
rheumatoid arthritis patients.
"Our findings indicate that damage of the oral mucosal barrier
mediated by [periodontal disease] results in repeated, spontaneous translocation of citrulli-

nated oral bacteria to the blood,
which trigger innate and adaptive
immune responses in RA associated with systemic disease flares,"
the research group wrote in Science Translational Medicine.
This is not the first study to link
RA with periodontal disease. One
2008 study found that RA patients were at eightfold higher
risk of having periodontitis compared with non-RA individuals.
Similarly, in 2019, a Korean analysis showed that while RA was not
connected to periodontitis in survey data, it was more likely in
people experiencing early tooth
loss. However, this study may be
the first to suggest a clear caus-

ative pathway between dental infections and RA.
Researchers conducted a series of
studies in several patient cohorts.
Their findings confirmed that oral
bacterial components 'especially
from Streptococcus species' entered the circulation at higher
rates in the RA patients with periodontal disease compared with
those without. The researchers
also determined that during RA
clinical exacerbations, expression
spiked for genes associated with
inflammatory monocyte responses in synovial tissue, but
only in the patients with periodontal disease. Tracing the connection between the two condi-

Periodontal disease is more common in patients
with rheumatoid arthritis, according to new study

Periodontal disease is more common in patients with rheumatoid arthritis, according to new
study.

tions could help develop therapies for rheumatoid arthritis,
while the approach that led to the

study could prove fruitful in other
disease contexts, such as cancer.

Global dental composite market is expected
to grow by 9%

The growth of the dental composites market can be attributed to
factors such as rapid technological

advancement, increasing demand
for cosmetic dentistry and increasing awareness among the population globally about oral care issues
are some of the prominent factors
contributing to the growth of the
market. The higher demand for
tooth fillings that have identical
colour and structure to the tooth
for aesthetic purposes attributes
to the growth of the segment.
The growing use of tobacco and
smoking has also led to an increase in the prevalence of dental
problems, increasing the use of
dental composites. According to
the Centers for Disease Control

and Prevention, almost 40% of
adults globally aged 20 to 64 who
currently smoke cigarettes have
untreated tooth decay. Also, nearly
43% of adults aged 65 or older
who currently smoke cigarettes
have experienced tooth loss.
The composite market has been
categorised into bulk fill composite, universal composite, flowable
composite, and others. Among
them, the universal composite
segment, intended for use in the
anterior and posterior areas of the
tooth, is expected to have significant growth. This type of composite should produce long-lasting

restorations that have the mechanical properties and aesthetics
needed for the area. The dental
fillings segment is expected to
hold a higher compound annual
growth rate, which the researchers
suggest is due to a rising number
of dental procedures like cavities,
dental bridges and repair of damaged teeth. For instance, the prevalence of cracked teeth is around
80% in patients over 40 years of
age. The incidence of incomplete
tooth fracture with vital pulps is
9.7%.

the forecast period. The major factors such as the growing prevalence of oral diseases and the
well-established healthcare infrastructure in the region.
© Wavebreakmedia_micro/Freepik

The global dental composites
market is anticipated to grow, due
to changes in diet and lifestyle,
and a rapidly growing geriatric
population across the globe, leading to an increased incidence of
dental caries or tooth decay. According to a new report published
by UnivDatos Markets Insights, the
dental composite market was valued at US$25 million in 2020,
which is expected to grow at a
compound annual growth rate of
around 9% from 2022-2028.

North America is anticipated to
grow at a substantial rate during

The "Dentaverse" aims to reduce
the gap between physical and
virtual dental care for dental
professionals and dental students.
A new report conducted by
Cognitive
Market
Research
indicates
that
the
global
augmented and virtual reality
market in dentistry was around
US$550.1 million in 2022, and is
projected to reach US$3,554.5
million by 2030—a CAGR of 18.4%.
The dental industry is continuously evolving due to the constant
innovation of technologies. Computer-aided technology has significantly impacted dental industry, and wide usage of technological tools like augmented reality

(AR) and virtual reality (VR) proves
very beneficial for its growth. The
research report findings indicate
that augmented reality technology is widely preferred in dental
surgeries, especially for those performing dental implants, craniofacial surgery, and orthognathic surgery. During these surgeries AR
focuses on providing more visibility of the surgical field. Hence, it is
primarily used to display dynamic
navigation systems in dental implantology, while glasses and
headsets used in AR and VR simulate patient reactions.
The demand for AR and VR in
training and education has increased amid the COVID-19 pan-

demic, as restrictions to prevent
the pandemic spread have provided limited learning opportunities to students. Simulation technology is widely accepted for dental education and training, allowing trainers to demonstrate
various dental techniques to enhance the manual dexterity of the
students. The technology provides
high precision during the learning
period owing to the direct involvement of every student.
Furthermore, anxiety and fear of
pain is common amongst dental
patients. In such scenarios, VR
helps doctors to transport patients to an artificial environment
of pleasant views to divert their

minds. Furthermore,
if any equipment
fails, it is not advisable to wait for a
professional to repair it because this
might be dangerous
for patients. AR
technology allows
technicians to remotely guide dentists through their
headsets so that
they can easily fix
the dentistry equipment.

Virtual reality use in dentistry is increasing, with the
global market projected to grow by 18%

The report author
suggests "It is not inappropriate to
say that the future is here as AR

and VR are definitely changing the
way of life for dentists and patients."

[12] =>

UK NEWS

Dental Tribune United Kingdom Edition | 01/2023

Women in dentistry: Meet dental nurse and
BADN President Debra Worthington

Debra Worthington (left) has held various positions as a dental nurse, head dental nurse and unit manager.

By Franziska Beier,
Tribune International

Dental

For the fifth part of our series focusing on women in the dental
field, Dental Tribune International
(DTI) interviewed Debra Worthington, a dental nurse with more
than 40 years of experience who
was recently elected president of
the British Association of Dental
Nurses (BADN). She has held various positions as a dental nurse,
head dental nurse and unit manager and discovered her passion in
orthodontics. A founding member
of the Orthodontic National
Group, a specialist group for orthodontic dental nurses and therapists in the UK, she served as its
president for three years until
2021. In conversation with DTI, she
speaks about her contributions to
dentistry, current challenges for
dental nurses in the UK and her future aspirations for the BADN.
Ms Worthington, you have been
a dental nurse for over 40 years.
You must have such a wealth of
knowledge and experience.
How has dental nursing evolved
since you started?
When I started working, we were
still called dental surgery assistants and accordingly our association was called Association of British Dental Surgery Assistants. At
one of the association's Annual

General Meetings, it was agreed to
re-claim the title 'dental nurse' a
good change really. In 2008, statutory registration with the General
Dental Council was introduced for
all dental care professionals, including dental nurses.
Generally, I would say that nowadays dental nurses have a voice
and can work more independently.
They can run their own clinics, in
which they can apply fluoride varnish and take radiographs and impressions, providing that they are
adequately trained, competent
and indemnified. In that respect,
things have changed, but there is
still more to accomplish for the
profession.
What would you say are some of
the greatest challenges for today's dental nurses?
I think that there is still a bit of a
divide between the dentist and the
dental nurse. I am not saying that
dental nurses are not valued, but
it's just not the same. I think—and
that's something we have heard
from our members too—that the
skills of dental nurses within the
dental team are still not used to
their full potential.
Another problem is the salary. I
know that this is concerning a lot
of people at the moment what
with living costs constantly in-

creasing, but for dental nursing,
the pay just does not keep up with
what dental nurses deserve, if you
compare it with the responsibility
they have.
There is also the question of recognition by the National Health
Service (NHS). Dental nurses who
work in practices, even NHS practices, are not employees of the
NHS, and therefore, they have
none of the benefits of working for
the NHS. This is an issue, and we
have been campaigning for this to
change.
All of this was particularly highlighted during the last three years.
Although dental nurses helped
out hugely during the COVID crisis, many of them volunteering to
help out in hospitals and in ICUs,
wearing all this additional PPE for
the entire working day, their efforts have never been properly
recognised.*
You have been a member of the
Advancing Dental Care review
group, and you have worked on
reforming dental education and
training to provide more targeted care. Could you tell us
more about this group and its
aims?
This group consisted of people
working in different positions of
the dental team. We looked at the

dental workforce as a whole, including dentists, trainees, junior
dentists, dental hygienists, dental
therapists and dental nurses, and
explored how we could change
dental education and training to
produce a skilled multi-professional oral healthcare workforce
and to improve skills and make
better use of the skill mix in each
of the disciplines.
I have to say that I was a bit disappointed with the final report, as
there was not as much for dental
nurses as I had hoped. In my opinion, the scope of practice for dental nurses should be widened. I see
no reason why dental nurses could
not be part of the primary care
network and offer, for example,
smoking and alcohol cessation advice. This could have such an impact on the overall well-being of
patients, since oral health and
general health share so many
links. In addition to improving oral
hygiene, dental nurses could really
help prevent long-term systemic
disease.
Last year, we published an interview with past President Jacqui
Elsden about the BADN's menopause policy. Are there any new
developments that you would
like to share?
We keep promoting the menopause policy at various shows. I

will be speaking about it at the
BDIA Dental Showcase in London
and the North of England Dentistry Show in Manchester, both in
March. In May, I will be speaking at
the British Dental Conference and
Dentistry Show in Birmingham.
What are your aspirations as
president of the BADN for the
future?
If I achieve anything, it will be
more recognition for dental
nurses. I would like to initiate discussions about improving pay,
which won't be easy, but it will not
keep me from trying. Also, as mentioned earlier, I would like to expand the scope of practice for
dental nurses to give them more
recognition.
To ensure the next generation of
dental nurses, we are spearheading a project to produce an online
career leaflet, to be sent out to colleges and schools that talks about
careers in dentistry other than that
of dentist. Currently, the information going out mostly concentrates on the profession of dentist,
so we feel that there is a lack of information for school-leavers on
other career options within the
dental team.

*After this interview was conducted, following a meeting with Debra Worthington, Labour MP Cat Smith wrote to the Chancellor of the Exchequer and the Secretary of State for Health and Social Care. In her letter, she addresses the
issues of pay and lack of recognition by the NHS of dental nurses, leading to the current crisis in dental nurse recruitment and retention.

[13] =>

UK NEWS

Dental Tribune United Kingdom Edition | 01/2023

Stop talking, start scanning
The secret to working smarter
By Dr Marcos White
"Imagine finding out you can better care for patients, be more profitable, have better record keeping
and deliver more predictable results, all with skills you already
have and a tool you already own,"
challenged Dr Marcos White of the
Courtyard Clinical Academy in
Huddersfield, speaking during a
Working Smarter with Digital presentation.
The first event of 2023, staged by
Align Technology, heard Dr White
tell attendees how his practice
now takes a scan of every patient
to build trust and conversion, plus
to create better practice efficiency
and ultimately profits. His academy now how six iTero intraoral
scanners, but he says the first
made an immediate and significan't difference to his business.
"We saw 33% growth over 12
months with the first iTero we ever
bought. When we added a second
scanner we saw it leap up again.

The reason it worked was because
it prompted greater case acceptance—more people said yes to
larger treatment plans. Digital
tools impress patients, they create
stories. The sheer act of showing
patients their problems and the
solutions on-screen blows their
mind and builds their confidence
in you," he told delegates.
He stressed that scanning during a
consultation allows patients to see
their own problems, creating a
"massive change in revenue" because a scan allows patients to not
only visualise their dental problems, but also how those problems
can be fixed. And he added: "The
more we can use the software
within the iTero scanner to showcase an outcome, the easier it is for
a patient to buy into what we're
talking about." He adds that seeing their dental problems for
themselves, also leads patients to
ask questions, which creates an
engaging way for his team to
demonstrate their oral health to
them.

He used a recent example of a patient who'd arrived at his practice
wanting new veneers, but more
seriously, didn't have back teeth.
Their scan also revealed periodontal problems. The patient didn't
want false teeth, so Dr White and
his team were able to treat her
with dental implants.
"As in this case, what we've discovered time and again through this
process is that there's a co-discovery going on and that the best
idea in the world is always the patient's idea as they ask questions
and come up with the solutions,
they end up with something that
they wanted, not something we
told them they needed. And that is
massive," he said.
Using scanners has also enabled
Dr White to reengineer the
check-up process from a 10-minute appointment every six months,
to one 20-minute appointment he
calls a Dental Health Assessment.
This new way of working gives
every patient a scan and X-rays,

Dr Marcos White

plus time to discuss their oral
health and any treatment needed.
"Plus we handed the 500 hours of
check-ups to our hygiene therapy
team, which freed up unbelievable
amount of capacity for the dentists," Dr White told the webinar,
adding that the new way of working also has other benefits.

He said the digital scans not only
enable automated diagnostics and
build a bank of scans per patient,
but also build loyalty to the practice. "We've now got circa five
years of scans for some of our patients. It creates a bond with your
patient that they won't want to
lose."

Diabetes and toothlessness together worsen
cognitive decline
cognitive function than their counterparts without either condition.
Over time, older adults aged 65 to
74 with diabetes alone experienced accelerated cognitive de-

older, which may be explained by
this group having overall greater
cognitive impairment, potentially
being healthier (as unhealthy individuals may be less likely to sur-

For older adults with both poor
oral health and diabetes, the researchers stress the importance of
regular dental visits, adherence to
diabetes treatment and self-care

A growing connection among diabetes, oral health, and dementia
highlights the importance of dental care and diabetes management
as we age. Having both diabetes
and tooth loss contributes to
worse cognitive function and
faster cognitive decline in older
adults, according to a new study
published in a special issue of the
Journal of Dental Research.
While both diabetes and missing
teeth are risk factors for dementia,
little research has focused on the
effects of having both conditions
in the course of cognitive decline.
To address this gap, Bei Wu, the
study's lead author, and her colleagues turned to the University of
Michigan's Health and Retirement
Study, analysing 12 years of data
(2006-2018) from the longitudinal
study in order to observe cognitive changes over time.

to contribute to changes in the
brain.
A growing body of research has
revealed a similar connection
among poor oral health, particularly gum disease and tooth loss,
and cognitive impairment and dementia. Like diabetes, inflammation plays a key role, and these inflammatory processes may contribute to cognitive decline. In addition, painful gums and missing
teeth can make it difficult to chew,
leading to changes in diet that can
result in nutritional deficiency. Nutritional deficiency, which can also
be worsened by impaired glucose
tolerance and insulin sensitivity in
diabetes, is another risk factor for
cognitive impairment and dementia.
"Poor oral health, diabetes, and
cognitive decline are all connected, and we're beginning to
understand how they may influence and exacerbate one another,"
said Wu.

The researchers included 9,948
older adults who were grouped by
age in their analysis. The Health
and Retirement Study included
measures of memory and cognitive function, assessed every two
years, along with questions about
tooth loss, diabetes, and other
health and demographic factors.
In this analysis, the researchers
were particularly interested in
older adults who had lost all of
their teeth.

cline, and those aged 65 to 84
without any teeth also experienced accelerated cognitive decline, but older adults aged 65 to
74 with both diabetes and complete tooth loss had the fastest
rate of cognitive decline.

They found that older adults aged
65 to 84 with both diabetes and
complete tooth loss had worse

The relationship among diabetes,
tooth loss, and cognitive decline
was inconclusive for adults 85 and

vive into their late 80s), or perhaps
having more experience managing their diabetes.

to control blood sugar levels, and
cognitive screenings in primary
care settings.

"Access to dental care for older
adults—especially those with diabetes—is critical, and health care
providers should educate their patients about the connection between oral health and cognition,"
said Wu.

Diabetes is a known risk factor for
cognitive decline and dementia.
Several of the hallmarks of diabetes—high blood sugar, insulin resistance, inflammation, and related heart disease—are thought

"Our findings underscore the importance of dental care and diabetes management for older adults
in reducing the devastating personal and societal costs of Alzheimer's disease and other related
dementias," said Wu.

[14] =>

UK NEWS

14

Dental Tribune United Kingdom Edition | 01/2023

Dental practices are increasingly
turning to latest technology, not
only to manage bookings and
prompt repeat appointments and
create more positive patient journeys, but even to monitor their
dental wellbeing remotely.

© DentalMonitoring

Technology is powering more efficient dental
practices

Apps powered by artificial intelligence (AI) are able to take the
strain from practice receptionists,
automatically
communicating
with patients pre and post appointment, confirming details,
asking health screening questions
and even prompting online reviews.
Three of the latest new pieces of
technology to hit the market are
FollowApp.Care, RoboReception
and DentalMonitoring, all of which
claim to be capable of taking on
some of the more time-consuming aspects of a busy practice,
while enhancing patient care.

Boosting online reviews
tient management workflows and
motivates them to follow up effectively and efficiently.
Says Dr Holmes: "It doesn't matter
if there is a new staff member, if
you have had a busy day, or if a patient had a 'light' appointment.

able to initiate a two-way SMS dialogue with patients.
The technology uses population-level insights on behaviour
and communication patterns to
drive patient engagement, operational efficiency and revenue

Launched in 2021 by dentist
turned dental business mentor Dr
Grant McAree, RoboReception allows dental teams to track each
enquiry they receive, helping to
speed up lead follow-up times by
up to 50%, leading them to convert 25% more patients and

dural recommendations, invites
recalls for future treatment and
prompts feedback on their experience, including Google reviews.
Patients don't need to download
an app, which means easier accessibility and better response rates;
instead they receive an SMS message instantly post appointment
containing a link to a survey tailored to the appointment or procedure they have just undergone.
Because it is automated, no input
is needed from the clinician, giving
them time to focus on clinical care:
It is activated by front-of-house
staff, which helps to smooth pa-

reviews and negative online feedback."

A digital eye on progress
Meanwhile, DentalMonitoring is
an AI-powered platform using
patented technology that is able
to monitor patients remotely.
After a practice has seen a patient
in-person and considered a treatment plan, it can choose the information it wants to receive about
their treatment from more than
130+ oral observations detected
by the AI on the DentalMonitoring
platform.

© DentalMonitoring

FollowApp.Care, which delivers
automated notifications to patients post treatment, is the brainchild of dentist Dr David Holmes,
who developed the concept in response to the challenges he had
faced in his own dental clinic. The
pre-emptive technology, based on
each dental experience, checks in
on patients, provides post-proce-

Every patient receives a personalised automated SMS message to
ensure they have had an exemplary experience and to ensure
that if they need any further care
or information it can be provided.
There's no extra work to the clinic,
but it still gives a personalised experience."
Importantly, the system analyses
responses to flag any problems
early—from a patient in pain to
negative feedback and the system
is so intuitive, it can be programmed to offer tailored 'next
step' advice. The dentist is also

growth. It also gives access to
some key business analytics.

Keeping pace with
new leads
RoboReception is a dental chatbot
and lead-tracking system that can
help practices convert leads to
help boost turnover. It was borne
of out of an understanding that
taking too long to respond to new
enquiries can result in dental practices losing up to 60% of new patient leads.

achieve a 15% or higher increase in
revenue.
Says Dr Acree: "RoboReception
gives you a bird's eye view of your
business at the touch of a button.
How many leads are in the system,
where they came from, ROI, lead
nurturing, and so much more! As
practice owners in a competitive
market, we cannot afford to miss
60% of enquiries. One enquiry
could be thousands of pounds of
treatment. One lead not being
contacted could create bad feelings and result in thousands of
pounds of lost revenue with poor

Patients use DentalMonitoring's
proprietary ScanBoxpro device with
their smartphone to take intraoral
images and send them to you
through the patient app. The platform then analyses, sorts and
crops the images; when a prescribed observation is detected,
the practice's customised treatment protocol is enabled and instructions sent directly to the patient.
Orthodontic Specialist Dr Helen
Griffiths of Taunton-based Confident Orthodontics, says DentalMonitoring helps the practice
team to remotely monitor patients, while also maintaining
good communications with them:
"It helps us to monitor patient
treatment progression—to pick
things up that may not be going
well or congratulate them when
they're maintaining really good
tooth brushing."

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[cover] => Dental Tribune UK No. 1, 2023

[toc] => Array ( [0] => Array ( [title] => Taking stock and looking ahead [page] => 1 ) [1] => Array ( [title] => Evolving business systems into 2023 and beyond [page] => 1 ) [2] => Array ( [title] => UK NEWS [page] => 6 ) ) [toc_html] =>

Table of contents

[toc_titles] =>

Taking stock and looking ahead / Evolving business systems into 2023 and beyond / UK NEWS

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