DT UK 2610

Another Brown(e) causes potential money woes / News / News & Opinions / Putting things into perspective / World of Webinars / Maverick dentists making a difference / Elegant with a modern twist / The 10th dimension… the power of ten / CQC registration - an introduction / Making your pension work / Principles of trusts / The emergency patient / Telescope or double crowns / Protocol on how to use SDR / Industry News / Encouraging change is essential / Classified

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Table of contents

October 25-31, 2010

PUBLISHED IN LONDON
News in Brief
Help rebuild Haiti
The earthquakes which devastated Haiti destroyed a third
of the countries dental practices. Chantal Noël, National
Liaison Officer of the Association Dentaire Haïtienne plans
to help Haiti recover from the
earthquake and its aftermath.
Without help, most Haitian
dentists will not be able to rebuild their practices. Chantal
plans to enlist the support of
NDAs worldwide in the rebuilding and re-equipping
efforts. She will use VOX to
communicate with all FDI
members about the equipment that is needed by Haitian
dentists. Already engaged, the
American Dental Association is raising funds for Haiti
through a campaign called
“Adopt-a-Practice; Rebuilding
Dental Offices in Haiti” which
aims to raise $350,000 by the
end of 2010.
BDA Bookclub
BDA members will have access to a new scheme offering
discounts of up to one-fifth off
a wide range of key dentistry
titles following the launch of
BDA Bookclub at Showcase
(14 October). This new benefit arises from an exclusive
deal the BDA has negotiated
with leading publishers, such
as Elsevier, Oxford University Press, Informa and WileyBlackwell. A core range of
50 titles is available to BDA
members, and the Bookclub
also offers a facility for members to buy any other dentistry title from the participating
publishers at a discount. Further information about BDA’s
Bookclub, as well as secure
online ordering, can be accessed at www.bda.org/bookclub, or email enquiries to
bdashop@bda.org. The service is only available to BDA.
Truro Practice wins Award
The River Practice in Truro,
Cornwall, has won the British Dental Association Good
Practice Scheme “Practice
of the Year 2010”. Every year
the British Dental Association (BDA) hosts an annual
Honours and Awards Dinner where awards are given
in recognition of outstanding
and distinguished services
to the association and to the
dental profession. The Good
Practice Scheme Practice of
the Year is awarded to celebrate a practice that champions the Scheme recognising
the efforts of a whole dental
team. “The BDA Good Practice Scheme has helped us
develop a truly exceptional
service that strives to provide the best in patient care.”
For more information on the
Good Practice Scheme visit
www.bdasmile.org
www.dental-tribune.co.uk

News

Feature

DCP Research award
Colgate awards research by
dental care professionals

page 3

Mavericks in Morocco

Michael Oliver’s diary of charity
care in Morocco

VOL. 4 NO. 26
Clinical

Money Matters

Telescope

Pension dreams

Thomas Dickson discusses linking your pension with property

pages 10-11

A look at
prosthetics

and

crowns

precision

page 16

dental

pages 22-24

Another Brown(e) causes
potential money woes
Proposed university fee increase in independent review could
have serious implications for dental students

L

ord Browne of Madingley
in his Review of Higher
Education Funding and
Student Finance has recommended an increase in university
tuition fees. If the proposed plans
go ahead there could be serious
implications for students all over
the country.
It is currently unclear whether the government will consider
going ahead with Lord Browne’s
review; however, whatever decision the government decides to
make is likely to involve increasing university fees. Along with
the proposed changes to the system with regards to budget cuts,
universities across Britain will
lose a proportion of state-funding
in an effort to try and reduce the
country’s ever-increasing deficit.
The problem that arises with
the proposed changes will have
far greater implications for dental and medical students, as their
courses tend to be significantly
longer than the usual three years.
Recently, figures of £7,000 per
year are being discussed; however there is also talk of an unlimited annual fee to be determined
by individual universities. If these
changes are brought into action
then students are going to potentially leave university with a staggering debt of £100,000.
As it stands, many students
are struggling to find a job after
graduation due to the economic
climate, resulting in interest piling on top of their student loans
at an uncontrollable rate; this
undoubtedly will put off future
students.

The implications that this
could have on society has a recipe for disaster. A decrease in
the number of future dental and
medical university students could
result in a sudden shortage of
trained professionals in the future
and could ultimately affect economic growth. As Lord Browne
stated in his review: “Analysis
submitted to the Review suggests
that, in the UK between 2000 and
2007, the increase in employed
university graduates accounted
for six per cent of growth in the
private sector (measured by the
extra wages they earned as a result of being graduates) or £4.2bn
of extra output.”
According to the Independent Review of Higher Education
Funding and Student Finance the
current system puts a “limit on
the level of investment for higher
education” and it has been suggested that the country’s education standard is at risk of “falling
behind rival countries.” The proposals will introduce a greater
investment: students are going
to be persuaded that by paying
more in they will get more out.
Reported cuts throughout the
economic sector have further
made the proposed fee increase
an ever more pressing subject;
university budgets will be cut by
£1bn, affecting research funds
and student support, and it is
feared that worse may follow. Reports in the media suggest that
the coalition government aim to
cut £82m from university budgets next year and that the number
of student places available is to be
halved.

It is believed that if the proposed changes are adhered to,
selected universities, where students compete to get a place,
would end up charging higher
fees for the privilege.
However, through all the
speculation, those who are closest to the students have generally
said that ‘dental and medical stu-

dents are guaranteed a job that
is well paid and because of this
they leave university in a better
position to pay back their fees.’
Dental Tribune contacted
various dental schools who were
reluctant to comment before
the announcement of the Comprehensive
Spening
Review
(CSR). DT

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If you’re thinking about selling your
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a chat with us.
Call Max on 01737 221020 EXT 2042
or email DTacquisitions@adp-dental.com

[2] =>

2 News

United Kingdom Edition October 25-31, 2010

GDC launches revalidation consultation

T

he General Dental Council (GDC) has opened its
new 12 week consultation
into revalidation. The aim of the
revalidation is to provide a way of
checking that dentists continue to
meet GDC.

had in the past is that it is assumed dental professionals are
continuing to meet its standards,
unless the regulator receives information which suggests otherwise. The GDC have admitted
that this is not good enough.

The issue that the GDC’s Fitness to Practise proceedings has

The GDC plans to introduce
revalidation for dentists in 2014:

they have stated that the revalidation will simply build on the current requirements for continuing
professional development and
will provide an opportunity for
those in difficulty to identify and
tackle any problems before they
become serious.
A standards and evidence

framework will set out the standards dentists must meet under the
four domains of clinical, management and leadership, communication and professionalism. The
framework will also set out the
evidence which will be acceptable to demonstrate compliance
with each standard.

Dentists will gather this evidence over five years, and revalidate at the end of each cycle.
The GDC are proposing a
three-stage process at the end of
each cycle:
• Stage 1 – compliance check,
which will apply to all dentists;
• Stage 2 – remediation phase,
which will provide an opportunity to dentists who do not pass
Stage 1 to remedy deficiencies;
• Stage 3 – in-depth assessment,
which will apply to dentists who
fail to demonstrate compliance at
the end of the remediation phase.
The consultation can be found
on the GDC’s website www.gdcuk.org. The proposals aim to
avoid over-regulation by making
as much use of existing and developing quality systems.
The consultation takes into
account the findings of an earlier
consultation, research and pilots
carried out in 2009.
Chair of the GDC’s Revalidation Working Group and Council
Member, Denis Toppin said: “We
are keen to get feedback from a
range of stakeholders including
registrants, patients, organisations representing the interests of
patients and providers of quality
initiatives. We want to make sure
we get it right for the dentists we
regulate. As a practising GDP I
want the GDC to keep the extra
regulatory burden to a minimum
whilst maximising patient protection. We need you to get involved and have your say on our
proposals so that you can help
us to get them right and have the
confidence of the public and professionals alike.” DT

Published by Dental Tribune UK Ltd
© 2010, Dental Tribune UK Ltd.
All rights reserved.

Dental Tribune UK Ltd makes every
effort to report clinical information and
manufacturer’s product news accurately,
but cannot assume responsibility for
the validity of product claims, or for
typographical errors. The publishers also
do not assume responsibility for product
names or claims, or statements made by
advertisers. Opinions expressed by authors
are their own and may not reflect those of
Dental Tribune International.
Group Editor
Lisa Townshend
Tel: 020 7400 8979
Lisa@dentaltribuneuk.com
Managing Director
Mash Seriki
Mash@dentaltribuneuk.com
Director
Noam Tamir
Noam@dentaltribuneuk.com

Editorial Assistant
Laura Hatton
Laura..hatton@dentaltribuneuk.com

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Joe Aspis
Tel: 020 7400 8969
Joe@dentaltribuneuk.
com
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Tel: 020 7400 8964
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Design & Production
Ellen Sawle
Ellen@dentaltribuneuk.com

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

[3] =>

News 3

United Kingdom Edition October 25-31, 2010

Editorial comment

F

resh
after
another successful BDTA
Showcase I hope
readers
are
not
counting the cost of
gadgets and gizmos
on their credit cards
(although, one dentist said
to me ‘I don’t need the cards,
they all know me’). There was a
lot to see and hear at the event,

Colgate DCP
Research Awards

T

he Colgate DCP Research
Awards are in partnership with the Oral Dental Research Trust (ODRT) and
support research of clinical relevance, which has been carried
out by Dental Care Professionals.
There is a special emphasis on
preventive care and up to four
awards, each to a value of £2,500,
are presented annually.
The 2010 awardees were presented with their certificates by
Professor Angus Walls, Chair of
the Oral Dental Research Trust,
at a reception and luncheon held
at the British Dental Conference
in Liverpool earlier this year.
Professor Walls commented
that; “The Colgate DCP Research Awards is recognised as
an important forward looking
initiative encouraging DCPs to
embark on novel research of immediate clinical relevance and
help build and strengthen the
academic base of the entire dental team.”
The Colgate DCP Research
Awards is an important introduction to research methodology
for those who have never been
involved in research previously
and it offers all DCPs the opportunity to carry out research. A
research team can be made up of
all members of a general dental
practice, including dental nurses,
hygienists, technicians and therapists, and may also include a
dentist as a mentor or supervisor.
Look out for the call for 2011
applications which will be announced in the dental press before the end of this year. DT

L-R Kerry Stone (School of Dental Sciences, Newcastle), Prof Angus Walls (Chair,
ODRT), Susan Bissett (School of Dental
Sciences, Newcastle), Lisa Pope (Hafren
House Dental Practice, Alfreton), Hayley
Lawrence (The Dental Practice, St John’s
Wood), Dr Anousheh Alavi (Scientific Affairs, Colgate)

so look out in the next issue
for a comprehensive review of
the exhibition.
Of course, the majority of
the talk in the coffee shops was
CQC registration. One of the
main bugbears was the lack of
information about fees; even
those who have been on the
advisory boards had to admit

exasperatedly that they didn’t
have a clue what the potential fees might be! Conspiracy theorists amongst you are
convinced that the CQC were
waiting for the GDC’s fee
announcement
(for
your
thoughts on that go to page
six...) to see what they
could get away with. Not
something I’d necessarily agree

with, but it is easy to understand
the frustrations of knowing
you have to sort this CQC-thing
out but not being able to properly budget for all of the fees
being piled up on practices. We
all need clear guidance from
CQC about fees, regulation, expectation... a
lot of things really, and
with the start of registration date looming, this guidance
should be here. DT

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@dentaltribuneuk.com

[4] =>

4 News

United Kingdom Edition October 25-31, 2010

Dunmurry Dental Practice gets a makeover

fter an extension and refurbishment Dunmurry
Dental Practice has been
officially reopened and is now
one of Northern Ireland’s largest dental practices.
The practice was opened by
Donncha O’Carolan, Chief Dental Officer for Northern Ireland.
Over the years, Dunmurry
Dental Practice has won numerous industry awards including
Best Practice, Best Team and
Best Young Dentist in Northern
Ireland (at the UK Dentistry
Awards) for 2008 and 2009.
Over £400,000 was funded

by Ulster Bank to finance the
investment and the development is enabling the local
business to provide increased
dental services to the local
community, where it is already providing both NHS and
private dental care to over 6,000
patients.
The 100 year old property,
in which the Practice is situated, has been sympathetically
restored, and now offers a warm
and spacious reception area,
with bright and welcoming
surgeries, all of which are fully equipped with state-of-theart equipment.

Speaking at the official opening Chief Dental Officer Donncha O’Carolan said: “Around
90 per cent of health service
dentistry is delivered through
high street dental practices such
as this one. I acknowledge the
significant personal and financial investment that Philip has
made into Dunmurry Dental
Practice. This investment enables patients in and around the
Dunmurry area to access health
service dentistry, practised to
a high standard and in wellequipped modern facilities. You
provide an essential and valued
service and your commitment is
greatly appreciated”.

meet the demands of today’s requirements for patient care and
best practice. It is a pleasure to
see Dunmurry Dental Practice developing to meet the needs of patients both now and for the future.”

Speaking at the opening
owner and Principal Dentist
Philip McLorinan said “We are
delighted with the results of
the design and building works
which has developed the Practice to incorporate six surgeries. I am very proud of our team
who have worked very hard
through what has been an exciting but very busy year and we
look forward to providing dental
care to more people within the
local community.”

Since the development the
team has been newly expanded
and the practice now incorporates five dentists, a dental
hygienist, seven nurses, three
receptionists and a business
manager.

Claudette Christie, Director
BDA Northern Ireland said “The
dental practice as a workplace
and clinical environment has to

For
further
information
visit
www.dunmurry-dentalpractice.co.uk or follow us on
Facebook. DT

Smiles all round for Denplan Golf Champions

he Denplan Golf Challenge final went off to a
tee once again this September, as 26 golfers took part
on the Ailsa Championship
course at the Westin Turnberry
Golf Resort in Scotland.
Each player qualified from
regional heats around the country, which took place throughout the summer.
The ultimate 2010 Denplan Golf Challenge champions
were Glenn Robb and Roger
Armstrong, whilst Nick Dobbs
and Robert Bond took second
place and Paul White and Mark
Turner came in third. Whether
they won or not, everyone thoroughly enjoyed the day.
Gemma Mills, Events Executive at Denplan commented;
“The Denplan Golf Challenge is
one of the most long-running
and popular events on the Den-

plan calendar and this year’s
event certainly went with a
swing!
“All the golfers enjoyed some
great weather while they completed a nine-hole warm up
round and a full dayâ€™s play
on this most prestigious course.
This was all followed by a complimentary
dinner,
awards
presentation and over-night accommodation - all courtesy of
Denplan! It we another hugely
successful day and we’re already planning the Denplan Golf
Challenge 2011, so watch this
space!”
For more information about
the Denplan Golf Challenge or
any of the other Denplan events,
Please contact the Events team
on 0800 169 5697.
For more photos from the
event please visit Denplan’s
Flickr page. DT
2010 Denplan Golf Challenge champions were Glenn Robb and Roger Armstrong

Colgate Partners with European Dental School Deans

t the recent Association
for Dental Education in
Europe (ADEE) Congress held in Amsterdam, Colgate once again partnered with
the Forum of European Heads
and Deans of Dental Schools
(FEHDD). Established in 2007,
FEHDD facilitates the sharing
of expertise across the continent
and together with the ADEE
aims to form a powerful combined ‘lobby’ for dental education.
The daylong event included
a dynamic and interactive session on change management.
Jacques, whose motto is “what
will be the benefit for the audience, and what are they going to
change in their organisation?”
brought a wealth of experience

in increasing awareness about
this topic.
Professor Nairn Wilson, Secretary of FEHDD and Dean and
Head of School, Kings College
London, Dental Institute said
“This symposium was very well
received and provided very useful information to support European Deans and Heads of Dental
Schools”.
Dr Anousheh Alavi, Scientific Affairs, Colgate UK and Ireland, said “Colgate are delighted to once again partner with
the FEHDD. This year’s theme
highlighted the importance of
the key role of the deans in the
current climate as agents of
change”. DT

Light therapy research at UCL

he UCL multidisciplinary research team of
the UCL Eastman Dental Institute has been awarded a
grant to support their work into
the use of light-activated antimicrobial agents.
The grant, which was awarded by the Medical Research
Council, falls under the auspices
of the Developmental Pathway
Funding Scheme (DPFS), which
was set up to support the development of novel health therapies and interventions, includes
a contribution from commercial collaborator, Ondine Biopharma Inc. and totals £1.1m.
The UCL research team, which
includes Professor Michael
Wilson and Dr Jonathan Pratten, have successfully applied
the technology, known as
photodynamic therapy, to de-

velop a new system named the
PeriowaveTM
system.
The
system is used in the painless
treatment
of
periodontitis, and is planned to
be extended into potential
applications in the medical
field,
particularly
in
the
development of catheters.
The research is entitled “The
use of light-activated antimicrobials to prevent catheter-associated infections” and builds
on the group’s knowledge and
experience and it will be undertaken by a multidisciplinary project team that includes
Professor Ivan Parkin (UCL
Chemistry), Dr Chris Kay (UCL
Chemistry), Dr Sandy Mosse
(UCL Medical Physics and Bioengineering) and Dr Sandy
MacRobert (UCL National Medical Laser Centre). DT

Light Ray Technology

[5] =>

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For more information or to place an order please call 0800 169 9692
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© Carestream Dental Ltd., 2010.
The Kodak trademark and trade dress are used under license from Kodak.

[6] =>

6 News & Opinions

United Kingdom Edition

ARF - Your Views

We asked for your comments, and we got them...

I

find it despicable that we pay
for the running of this inept
organisation and have no say
as to how they are run or how
they spend my money. And in
addition they have no real teeth,
or are about to become edentulous, when the new CQC thing
takes over, which an issue that
is beyond imagination.
Brian Rubin, East Sussex

When the rise in ARF happened a few years ago, I was incensed and wrote to the GDC. I
explained that I work part-time
in Community Dental Services
- why should I pay the same
retention fee as a GDP working full-time in private practice
probably earning five or six
times my salary! I received a
standard letter from the GDC
saying that they had no facilities
to pro rata the fee for part-time
staff. As many women are parttime because of having families
etc, I feel this is discrimination
against women. I still feel very
angry about this stupid ruling.
Dr Cate Jarrold, Aldershot

wishes to practice, he or she
must register with this body,
the GDC, which represents
a monopoly in that regard.
Monopolies are insensitive and
uncompetitive, with a relaxed
attitude to their captive audiences’ plights.
The GDC gets a large
number of frivolous complaints,
but almost everything goes to
first stage of litigation. I recently endured a frivolous complaint, which was eventually
thrown out. Although the GDC
came to the correct conclusion;
the process was cumbersome
and resulted in hours of work
for my defence lawyers. I was
stressed for months. I would
have appreciated a call from
someone at the GDC to explain
the process, which was unfamiliar and disturbing to me.
Instead I received a threatening
letter accusing me of six major
breaches of my duty of care to
patients, based on the say so of
one individual.

What are we paying for?
It seems that bureaucracy
has gone mad. How can they
warrant a rise of 25 per cent
in times of recession when
dentists are finding a lower
footfall into their practices with
addition of CQC inspection at
a cost to the practice of around
£1,500 (what registered laser
practices have been paying)?
For many practices this will
have an effect on their ability
to continue with NHS contracts
as these rises were never in the
contract costs when they were
introduced. Surely this is the
time to get every dentist into
action against these excessive
increases. This on top of the
intention to remove the use of
the title “Doctor” makes one
wonder what the real role of the
GDC is.
Name and address supplied

The GDC is out of touch.
In my opinion, the increase in
GDC retention fees is a reflection of their lack of innovation in dealing with increased
complaints, and a failure to
budget correctly. The GDC
should be pursuing costs
against those people who make
frivolous complaints, and using
the monies acquired to balance
the budget. They’ve already
grabbed millions from dental
nurses and other DCPs, and
yet still claim it’s not enough.
Something is very wrong with
that. It feels to most dentists
that we are being forced to
pay for a body which likes to
punish us whenever it can. The
voice of the public drowns out
the voice of the profession, the
majority of who are caring and
conscientious and doesn’t need
a big stick to put patients’ interest first.

I find the trend across the
entire public sector of increasing fees well above the rate
of inflation to be disgraceful
and unsustainable. If a dentist

I suppose the extra money
will come in useful for their
misguided and malicious campaign to prevent dentists using
the courtesy title Dr!

Dr Martin K Edwards, Dental Surgeon
I think it is absolutely disgraceful that the GDC have put
the ARF up for DCPs. As we are
all aware, DCPs are made up
of dental hygienists, therapists,
technicians and dental nurses;
all of whom earn differing
amounts of money. Why should
dental nurses, most of whom
earn nothing compared to the
likes of dental hygienists and
therapists, have to pay the
same ARF?
The GDC will not even
consider, it seems, a pay
monthly scheme for the ARF,
even though this would greatly
reduce the burden of paying
the now £120 out of our measly
pay packets. Surely the GDC
should come to some sort of an
arrangement where the ARF
is based on the registrant’s
earnings or at least lowered for
dental nurses? The rising cost
of the ARF as well as indemnity
insurance, the cost of CPD and
the lack of decent wages for
dental nurses could very well
drive more dental nurses away
from the profession.
Flustered Practice Manager
This is nothing but extortion and we are paying for the
failings/incompetence within
the GDC as well as those DCPs
who did not re-register this
year. The GDC need to get their
act together and manage their
finances, as we have to do in
our businesses. Shame we cannot put up our prices by 35 per
cent! My anger cannot be put
into words.
Name and address supplied
We are paying for the
mismanagement of the GDC
over the past few years. Every
project they have undertaken
has become unnecessarily complex and expensive. Revalidation should be dumped before it
gets completely out of hand.
Jenny Pinder
On my wages I can barely
afford the current fee. As this is

coming into force 2011 I think
it would be a good idea if GDC
introduced the option paying
this in monthly instalments via
direct debit. You can pay pretty
much everything else (car
insurance, house insurance etc)
via instalments so I think this
option would be welcomed. I
know there are a lot of DCPs
on a lower wage than me who
would struggle and the new
fees could possibly makepeople
think twice about choosing dentistry as their chosen career.
Kate Powell
Why has the CQC not yet
decided what the registration
should be for their enforced
membership? They are waiting
to see what the GDC can get
away with. Today I have to take
time out to go to a compulsory
talk about child protection. No
fee for this, but no compensation for loss of UDA time either.
Retirement? Foreign climes?
Anything! I am a clinician, get
me out of here!
Peter F-Jones
Somebody please outline
the justification for this 31
per cent increase for the ARF
when there are fees payable for
another regulatory body on the
way. Is the wine cellar looking
empty at the GDC?
Name and address supplied
Is it reasonable? The industry is in a recession and we
are being asked to pay more. I
do think that as the GDC is a
monopoly the case for increase
of its ARF should be referred
to the trade’s commission, I
know that I personally have
not received any increase in
revenue this year and it will
be financially difficult for the
average dental technician to pay
these fees.
Name and address supplied
It’s a disgrace! The GDC
are helping themselves to a 31
per cent pay increase at a time
when every one else is tightening their belts.
The GDC already charge
morethan the General Medical
Council,who charge £420 per
annum (www.gmc-uk.org/doctors/fees.asp). It should be noted that the GMC also give a 50
per cent discount for registrants
who have a low income - such

October 25-31, 2010

as those on further studies.
Some minutes from a GDC
finance committee meeting
give a few clues as to where the
money goes: (www.gdc-uk.org/
NR/rdonlyres/F4666199-40644D74-8A33-E96C70764430/0/1
51209MinutesConfirmedwebsi
te.doc). The highlights point to
lax procedures for approving
expenses, lack of budget planning, and hiring consultants to
review their current Final Salary Pension Scheme which had
a deficit from last year. It also
mentions planning permissions
for developing Wimpole - the
lavish central London offices.
Are they really on the
same planet as us? 31 per cent
fees hike, final salary pension schemes? Have they been
somewhere else for the last few
years? It amazed me to find out
that they still have a final salary
pension scheme - even open to
new recruits. I’m not sure how
pleased most dentists would be
to realise this is how the ARF is
spent.
This isn’t professional
self-regulation - it’s difficult to
describe their behaviour using
civilised language! Maybe it’s
time to abandon “self-regulation” and allow the profession
to be regulated more sensibly
by the HPC. I for one can find
better ways to spend £500 per
annum than someone else’s
pension scheme, expenses, and
flashy offices.
Name and address supplied
A rise of 25 per cent in the
ARF is appalling for dental
nurses. Unlike hygienists and
technicians the salary scale of
qualified dental nurses is still
dreadful and an insult after
working for two years - attending a course and working in
their own time - before they
can qualify. As a hygienist with
FETC, I have in the past tutored
dental nurse students and
qualified dental nurses studying
for their Oral Health Education
Certificate, and I was surprised
at the syllabus content for both
of the qualifications. Perhaps
the dental nurses’ professional
body should try and educate
dentists and fight strongly for
better salaries.
Barbara Jones, RDH DT

[7] =>

United Kingdom Edition October 25-31, 2010

Tribune_feb10:Precision

Putting things into
perspective
Neel Kothari talks to Leo Cheng about the work
of Christian dental charity Mercy Ships and how
it’s providing many West African communities
with much-needed dental care

ver the past couple of
years, you will no doubt
have read numerous
articles outlining some of the
day-to-day failures seen within
the NHS (some even by myself,
perhaps). While the difficulties
have been much publicised,
many of the things we get right
are often forgotten and, dare I
say it, taken for granted.
The advantages of the NHS
are even more noticeable when
looking at developing countries,
where a lack of basic provisions
often results in the spread of
disease considered eradicated
in the west.
Reaching out
Let me turn your attention to
the work of Christian dental
charity Mercy Ships, who provide free medical and dental
care for countries who are not
fortunate enough to have a system like the NHS.
Mercy Ships comprises of
a fleet of hospital ships, which
have been visiting developing nations since 1978 and are
crewed by volunteers offering
healthcare and other professional services free of charge.
Many people in developing
countries have never had the
opportunity to see a dentist. Dental care is almost non-existent in
much of West Africa, as well as
many of the other areas Mercy
Ships visits. In common with
many industrialised countries
worldwide, the most frequently
seen oral diseases are dental
caries and periodontal disease.
However, unlike many coun-

hear of death as a result of untreated dental infections. Consultant oral and maxillofacial
surgeon Mr Leo Cheng, who
regularly volunteers onboard
Mercy Ships, informs us that in
third-world countries dental infection can and does kill.
For example, because of a
direct lack of healthcare, one
patient required life-saving
emergency treatment as a result
of a spreading dental infection.
Drains were inserted in all facial spaces in his neck and floor
of mouth and regular irrigation
through the drains with antiseptics (for example, betadine,
hydrogen peroxide, etc) was
necessary to wash out abscess
cavities within his chest. Thereafter, this patient was intubated
in ITU and was kept in ITU for
three days before extubation. He
continued to receive irrigation
of his mediastinal abscesses for
another two weeks before his infection was under control.
First-class dentistry for the
third world
Onboard, the volunteer dentists,
nurses and hygienists play an
important role in the prevention
of dental diseases and help educate patients by showing simple
oral hygiene tips, as well as by
introducing fluoride to the oral
cavity. While many patients
have to undergo procedures
such as the extraction of teeth
and roots, dentists are also able
to restore teeth with composite
fillings. Mr Cheng also informs
us that when at one point dental students had come on board
to observe Mercy Ships in action, in the short time they were

‘Thousands of people suffer from dental
pain for weeks, months, sometimes even
years, because of the lack of
available dental care’
tries, thousands of people suffer from dental pain for weeks,
months, sometimes even years,
because of the lack of available
dental care.
Although difficulties accessing NHS services can lead to
difficulties for some patients in
some areas, in the UK we rarely

there, they ended up extracting
more than 90 roots and teeth,
more than required for their entire dental training!
Deformities in developing
nations
For the poor in developing nations,
accessing
necessary
medical and surgical care is

extremely difficult, due to their
remote location, lack of medical facilities and financial constraints. Conditions that would
be treated in the early stages in
developed nations grow to the
point of being life threatening in
undeveloped nations; the consequence for many is a lifetime of
disability and rejection.
Cleft lip and/or palate is a
condition easily repaired in the
developed world; however, cleft
lip babies born in developing
countries are often malnourished because they cannot feed
properly. Children who do survive are often rejected because
of their deformity. The statistics
tell us that cleft lip and palate
is the number one facial birth
defect and the fourth most common birth defect overall, affecting 1 in 700-1,000 live births
(WHO).

In a recent report by the BBC,
Humphrey Hawksley reported
that, while billions of dollars of
aid have been invested in programmes to modernise Africa
à DT page 8

15:31

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In the UK, cleft lip and/or
palate is routinely treated at a
young age, however, in West Africa it can be left untreated. In
West Africa, superstition also
plays an important role in how
children with facial deformities
are treated. I am informed that
many children with this condition are kept hidden from view,
rejected by friends and family,
stoned if they appear in public
and in some cases have been
buried alive.
Superstitious practices
The lack of healthcare provision
and education has meant that
in many cases, witch doctors
or village chiefs are often the
first port of call for many local
villagers. Unfortunately, the advice given can have disastrous
consequences for those affected.
Rather than recognising these
conditions as defects, which may
be corrected through surgery,
often the cause is put down to
the devil or to evil spirits. Much
of the advice given is based on
local superstition and a real
lack of healthcare access means
that, for many, there is no option
other than to take this advice.

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[8] =>

8 Feature
ß DT page 7

and end poverty, traditions such
as secret societies and witchcraft are still deeply entrenched
and often pitted against what the
West is trying to achieve there.
If you are interested in learning more about the work provided by Mercy Ships, please visit
www.mercyships.org.uk, where
you will be able to find a plethora of information and some tru-

United Kingdom Edition

October 25-31, 2010

ly heartwarming stories about
some third world citizens not
lucky enough to have access to
proper health care, let alone a
national health service.
About Mercy Ships
Mercy Ships is an international Christian charity that
provides free medical care and
humanitarian aid to the poorest countries in Africa through
its ship – the Africa Mercy. The
Africa Mercy is the world’s larg-

Mercy Ships have provided dental care to third world countries for over 30 years

Patient safety rests in your hands

est charity hospital ship. It has
a 78-bed ward, six operating
theatres, x-ray facilities, a CT
scanner and laboratory facilities.
The surgeons on board per-

‘Mercy Ships has
worked in more
than 70 countries
providing services
valued at £530m’

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form operations on children
and adults such as cleft lip and
palate, cataract and crossed
eye corrections, facial reconstructions, club feet and dental
treatments. Entire communities
have been changed through the
provision of medical equipment
and medicines, as well as water
sanitation projects, and agriculture and construction training.
Over the last 30 years, Mercy
Ships has worked in more than
70 countries providing services
valued at £530million and impacting about 2.5million people.
The charity has treated more
than 485,000 people in village
medical and dental clinics, performed more than 47,000 surgeries and completed more than
1,000 community development
projects focusing on water and
sanitation, education, development and agriculture.
Who works on them?
The Africa Mercy is crewed by
more than 450 volunteers ranging from surgeons and nurses,
to engineers, cooks and agriculturlists, each paying crew fees
for the time they serve onboard.
Thus the highest proportion of
funds received by the charity
go directly to those in desperate need as all medical services
on board the ships are free of
charge. DT

About the author
Neel
Kothari
qualified as a dentist from Bristol
University Dental
School in 2005, and
currently works in
Cambridge as an
associate within the
NHS. He has completed a year-long
postgraduate certificate in implantology at UCL’s Eastman Dental Institute,
and regularly attends postgraduate
courses to keep up-to-date with current best practice.

[9] =>

Webinars 9

United Kingdom Edition October 25-31, 2010

what you
World of Webinars See
are missing...

Dental Tribune looks at the upcoming Dentsply
academy series webinar starring Trevor Bigg

T

he 2010 Dentsply Academy webinar series, in association with Smile-on,
is in full swing with broadcasts
from Baldeesh Chana and Sarah
Murray discussing root surface
debridement; and Carol Tait enlightening attendees with techniques for cleaning and shaping
the root canal system.
Next to take to the virtual
stage is Trevor Bigg looking at
Smart Dentine Replacement™
(SDR), the recently-released
composite base from Dentsply
designed for posterior restorations offering bulk filling (up to
four mm) combined with excellent flow-like cavity adaptation.
Trevor will be looking at
the various indications where
SDR might make a cost- and

Dentist Trevor Bigg appearing on a computer screen soon!

want to reduce tooth fracture
in later life. The only problem
with this is that a good compos-

‘Trevor’s easy presentation style and large
knowledge base has proven very popular
with past webinar attendees’

time-effective alternative to
more traditional methods, as
well as giving hints and tips on
how to use the material to best
effect, from the restoration of
deep cavities to children’s dentistry. Patients are requesting
‘white’ fillings and the latest research suggests that we dentists
should be supplying them if we

ite filling takes so long to insert.
SDR™ simplifies this process
and reduces the risk of sensitivity from composite contraction,
in the process saving time.
Trevor’s easy presentation
style and large knowledge base
has proven popular with past
webinar attendees and this event

is looking like no exception.
For those new to the webinar
concept, webinars are a type of
web conference with a difference, as it is live and interactive.
The direction of the presentation
is primarily led by the presenter/speaker however, audience
participation is integral and indeed necessary for a more useful and interesting experience.
A webinar is ‘live’ and interactive – with the ability to give,
receive and discuss information. There is a ‘chat’ facility
available for attendees to post
questions and comments, which
can then be answered live by
the presenter.
Trevor’s presentation, Smart
Dentine Replacement – No more
time-consuming layering!, will
be broadcast on October 26th
starting at 7.30pm. For more
information go to www.dentalwebinars.co.uk or call 020 7400
8989. DT

Upcoming Webinars

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Oburation of the cleaned and shaped
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Speaker: Bal Chana, Sarah Murray
Roof Surface Debridement - mechanical
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Date: 10th November 2010
Speaker: Dr Trevor Bigg
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Webinar attendees can post questions in the chat room whilst watching the presentation

[10] =>

10 Feature

United Kingdom Edition October 25-31 2010

Maverick dentists making a difference
Dentsist Michael Oliver details his experiences in North East Monocco

M

y name is Michael
Oliver,
from
Oliver’s Dental Studio,
Sunderland.
I had heard about the Moroccan people’s struggles through a
friend who went there for three
days and was stunned by the

sheer beauty of the unspoilt landscape and the friendly people.
But on further inspection; he noticed their teeth were in a state of
bad decay and they desperately
needed help.
So with this insight I was

duty-bound to finance my own
charitable journey and treat
the Berber people with a newly
formed charitable group; Dental
Mavericks.
On route we would meet the
following adventurers; Abdul

high up in the Rif mountains who
served up real bee’s honey combs
for breakfast, a Belgian counsel
who spoke like Rene from Alo
Alo, a female Moroccan Professor of dentistry, and a handsome
maverick Moroccan missionary
doctor… all of them had one pur-

pose - to make a dental difference
for 50 Berber children.
Never had this been undertaken by a UK dentist and so I
set off with seven dynamic dental
colleagues on a charity expedition I will never forget.
It was a hot sunny afternoon
in El Jebah, Morocco and I was
treating 50 Berber kids in a remote fishing village nestled in
the hard to reach Rif Mountains.
Make no mistake this was the
most overwhelming experience
of my dental career!
Duty Calling Day 1
Flying to Malaga we spent a night
in Alora, Spain, where we visited
Spain’s second oldest church. It
was locked, but our flamboyant
expedition guide Domien asked
a few local gypsies who held the
key and voila, we gained entry to
a magnificent church!
Duty Calling Day 2
We got up eager and early next
morning and headed onto Algeciras to jump aboard the fastest
ferry in the world to Tangier. According to history, the Moorish
people were kicked out of Spain
in 1609 as part of the Spanish Inquisition. Little did we know that
many settled in a town in North
East Morocco called Chechaouen
(pronounced Chef Chowan): It’s
nick named the ‘Blue City’ in the
hills.
En route we stopped at a very
traditional Moroccan restaurant
where we were treated to meat
balls; it was there that I avoided
the first hole in the ground toilet. On arriving in Chechaouen
we were treated to a guided tour
around the ancient city’s small
Medina; I was most surprised to
see that in this day and age Berber women still washed clothes
in the river. To finish off our second day we scoffed a traditional
Moroccan tagine of meat and
vegetables.
Duty Calling Day 3
Five times a day the Muslim lo-

Oral health instruction - Maverick style!

[11] =>

United Kingdom Edition October 25-31, 2010

cals are enticed to the Mosque
by a loud speaker. The first call
goes at five am (ish) and I eventually got use to it. We started
our day early and after six hours
of walking through the magnificent Rif Mountains we arrived at
Albergue De Azilane. It was the
home of Abdul Carear, one of the
most fascinating and happy characters I had ever met. We had
home-made bread, sweet mint
tea and cheese on arrival and
Fruit of the Land – a traditional
Moroccan Tagine consisting of a
tiny piece of grisly meat and fresh
stewed vegetables for dinner.
Berber Tribe Day 4
After a, traditional breakfast consisting of four different breads
and bees honeycomb, our charity expedition continued towards ‘God’s Bridge’; a natural
arch built upon the Farda River
through the dorsal limestone
grounds. We were laden with
honey and bread (well, actually
it was stored in our rucksacks
on the hardy Donkey we named
Josephine). We continued trekking through the Rif Mountains
and various Berber settlements
along easy shaded paths, which
wound their way between smallholdings, tiny farmhouses, and

the Mediterranean coast not yet
ruined by tourism.
A fish dinner bought from the
fishing boats was served by
Fwed, the guest house owner, on
the spectacular roof terrace overlooking the smelly fishing port. At
9pm we were exhausted and eager to start the next day: we were
ever closer to making a dental
difference for the Berber kids.
Dental Difference Day 6
At 9am sharp we were taken to a
school nestled in the Rif Mountains and met by Luc, the Belgian
counsel to Morocco, who had
been our go-between. He was a
real gentle caring man who resembled Rene from Alo Alo. We
were next introduced to an extreme humanitarian Dr Banani,
the founder of a group of international medics ‘Ranks of Honour,’ who travel to hard to reach
villages in Africa to set up camp
to treat all kinds of illnesses and
disease.
We were introduced to Dental Professor Tress from Morocco and her team of young
dentists, as supplies were unloaded courtesy of Henry Schein
and placed on an old wooden

found it difficult and often distressing with the language barrier even though we had transla-

‘It was very upsetting for all of us,
including the children, but we served
our purpose.’
tors. It was very upsetting for all
of us, including the children, but
we served our purpose.
At the end of the most humbling of days, I presented a Sunderland football shirt to Dr Banani and to Luc a signed book.
Dental Difference Day 7
We finally ended up in Marbella
in a nice hotel; we had a hot bath
and some serious memories to
linger on forever.
This delightful dental difference trip was the tip of the
iceberg. Overall, fifty Moroccan kids, some of them Berber,
were treated out of a school of
six hundred; we had made just
under a ten per cent difference.
Our next objective was to fund a
nurse who would visit the school
weekly, educating the children
on tooth decay prevention; for serious cases where children were
in pain, we aimed to bring in a
dentist from Chechaouen every
month.
I plan to go back next year to
make a further difference.
I got an awful lot from being able to help some beautiful, beautiful children with their
dental problems. To come to a
country that doesn’t have any
dental care at all and to do just
a little bit, which to these people,
probably felt a lot, means a lot to
me. Hopefully for those children
who’ve had the treatment, they
will feel better from our efforts.

The group gather outside for a group photo

numerous ancient mills that
were still working amongst green
crops and fields.

table. Around us small groups
of excited but scared children
assembled in the classroom.

As we got higher in the mountains, we glimpsed monkeys and
found ourselves walking along a
mountain path, which was one
foot wide and sometimes narrowed to only a few centimetres,
where it cascaded vertically hundreds of feet down to the village
of Akchour! Scary!

It was here where they were
educated on brushing and caring
for their teeth, which were mostly
rotten. After a diagnosis with urgent dental treatment they were
sent to get fillings or to have teeth
pulled to prevent further dental
damage. On further investigation
we discovered about 20 per cent
had a toothbrush at home; but
how many of them actually used
it was another question. The decay in some of the children was
so bad there were just roots left
which had to be extracted.

Dental Difference Day 5
Bab Beret is a small town that
trades in one of Morocco’s biggest exports, Hashish. We didn’t
stop here, we drove through a
cowboy town high up into the
mountains, where some of us
cycled 50km downhill into El
Jebah, a little fishing village on

I wanted to speak English to
reassure the scared and in pain
kids and put them at ease, but I

This privilege does carry a
responsibility, because once the
Morocco air had been absorbed
into my lungs, there was no cure.
Like me, I hope you have become
fascinated by the people more
commonly known as the Riffians, who have been displaced
for more than 700 years from as
far away as Egypt and the River
Nile - the possible meaning “free
people” or “free and noble men.”
Please note that Dental Mavericks is a non profit organisation
and all time, money and resources spent organising the Morocco
Expedition, has been done so, for
free, at our own expense. If you
would like to help us make a dental difference for 600 Rif Mountain children, you can do so here
www.castleparkdental.co.uk.
If you have any further questions please email me at mjoliver73@sky.com. DT

Feature 11

[12] =>

12 Event Review

United Kingdom Edition October 25-31, 2010

Elegant with a modern twist
Phil Wander details the launch of Seminars@38 in London’s West End

attended the launch of Seminars@thirtyeight which is
located at 38 Devonshire
Street, just off Harley Street in
the heart of London’s West End
Medical District. It is an elegant
Edwardian building steeped
in medical and dental history,
which has just been brought
bang up to date with the launch
of a dedicated conference suite
on the whole of the lower
ground floor.
38 Devonshire Street is
home to a successful, private
dental practice run by Gaynor
Barrett, which has a number
of large and beautifully appointed and equipped dental consulting rooms, which can also be
used for hands on courses, photography (of special interest to
me!) and filming.

The seminar suite and practice facilities offer an impressive
and flexible venue to entertain
and educate dental professionals
with first rate continuing professional development (CPD).
More than 70 guests visited
during the open event and we
were told that a roster of elite
lecturers drawn from Gaynor’s
worldwide contacts had been
drawn up and that the dedicated suite would allow guests
direct access to both speakers and sponsors in a way not
possible with hotel or conference venues, allowing them to
interact in an intimate and less
intimidating setting. In fact I
was told it was the only seminar
facility in the area which provides the delegate or the company hiring it with a whole dedicated suite to configure in the

way best suited to their needs.
According to the new website, a Diplomate of the American Board of Endodontics,
Pirooz Zia, was the first to
lecture in the new seminar
suite before its official launch
and he will be followed by
high profile lecturers, including Jason Smithson who is
running a hands on course
on direct resin artistry and is
supported by Nuview and Optident in October and November
and Professor Giovanni Zucchelli in 2011. Seminars@thirtyeight plans to offer courses at
various times during the working week and at weekends with
the aim of making high quality CPD more accessible to both
dentists and team members
alike.

I intend to run a hands-on
Dental Photography course at
the venue in 2011.
I am told that after I left the
atmosphere shifted and a pianist
sat at a baby grand piano in the
wood panelled reception room
and entertained the guests to a
jazz concert. At one point, one of
Gaynor’s Associates, Emilliano
Zanaboni, sang some operatic
Italian arias to the delight of the
crème de la crème of the medical district who sipped Champagne and toasted the success of
the new venture. DT
Further details from www.
seminars@thirtyeight.co.uk
The stunning staircase

Seminars@38 offers the best courses with world class speakers given Dr Gaynor
Barrett’s strong links with UK and International dental professionals. First class
lecturers from around the world will be invited to our intimate facility to mentor you.
The comfortable and private backdrop of 38 Devonshire Street will provide direct
access to these speakers to facilitate a unique learning process, encouraging a culture
of open dialogue and interaction between delegates and speakers.
30th October 2010 - (9am to 5pm)

Dr. Jason Smithson BDS (Lond), DipRestDent RCS (Eng)
Hands on seminars ‘Direct Resin Artistry: Simple, Predictable, Easy’
Anterior [6 hour verifiable CPD for each course]

3rd November 2010 / 10th November 2010 - (3pm to 6pm)

Fiona Stuart-Wilson & Tim Eldridge
CQC Registration and Compliance (Part 1) - Don’t Bury Your Head
[6 hour verifiable CPD]

13th November 2010 - (9am to 5pm)

Dr. Jason Smithson BDS (Lond), DipRestDent RCS (Eng)
Hands on seminars ‘Direct Resin Artistry: Simple, Predictable, Easy’
Posterior [6 hour verifiable CPD for each course]

15th November 2010 / 13th December 2010 / 17th January 2011 - (6pm to 9pm)

Dr. Emiliano Zanaboni DDS, PG Implant (NY),...
Three of the Best: Putting implants at the top of your treatment
options [5.25 hour verifiable CPD] Seminar 1: from diagnosis to the
final restoration

12th March 2011

Dr Pirooz Zia BDS, MScD & Dr Benjamin Watkins DDS
Endodontic course. Details to follow.

The facility is furnished with state of the art equipment
19th March 2011

Dr Massimiliano Di Giosia DDS Cert. Orofacial pain (USA)
Dental Management of Snoring and Obstructive Sleep Apnea.
Details to follow.

2nd April 2011

Dr. Jason Smithson BDS (Lond), DipRestDent RCS (Eng)
Hands on seminars ‘Direct Resin Artistry: Simple, Predictable, Easy’
[6 hour verifiable CPD for each course]

19th, 20th & 21st May 2011 (9am to 5pm)

Prof. Giovanni Zucchelli DDS PhD
Soft Tissue Plastic Surgery in the Aesthetic Areas: A three day course
[17 hours verifiable CPD] Day #2: May 20; Day #3: May 21 In-depth
knowledge and understanding of gingival plastic surgery procedures

Spring 2011

Dr Marc Cooper DDS
Mastery Programme. Details to follow.

www.seminarsthirtyeight.com
catherine@seminarsthirtyeight.com
Training can be undertaken in modern surroundings

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0208.9429751

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DENTEC SERVICES
01582.492749

GLASGOW
C.E.I. SERVICES
01236.875059

WEST MIDLANDS,
SOUTH WALES & SOUTH WEST
CADENT Ltd. 01527.576345

EAST MIDLANDS,
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JGM DENTAL 01949.869085

NORTHWEST & NORTHEAST
R.P.A. DENTAL 01942.245808
Free phone 08000933975

[14] =>

14 Practice Managment

United Kingdom Edition October 25-31, 2010

The 10th dimension… the power of ten
Ed Bonner and Adrianne Morris consider the considerable power of persuasion

y mere dint of the fact
that we have a professional
qualification,
it can (for the most part) be
assumed that we are competent in our sphere of endeavour. Why then are some of us
successful and others less so?
James Borg, an eminent work
psychologist, business consultant and development coach
believes that the crucial factor
may be an individual’s power
of persuasion.
We all know people who,
regardless of the issue under
consideration, seem able to get
us to see, accept and even vote
for their point of view. We also
know others whom we like
and respect, but do not have
the power to persuade us that
we should accept and buy into
their ideas. Compare Tony Blair
and Gordon Brown, or Margaret
Thatcher and John Major, for
example.
Now, you may not think
this is all that important, but if
you think about the number of
treatment plans that you have
suggested to patients and consider how many of those have
not been taken up, you might
come to the conclusion that
your inability to get others to
accept that it is to their overwhelming advantage to ride
with you is actually costing you
a huge amount of lost revenue.

Listen to your patients and act on what you have heard

So, what 10 factors increase
our powers of persuasion?
1.
Treating
people
as
individuals
The first big key; unlike socks,
there is no “one size fits all”
approach that will work for all
patients. Some need to be given dollops of TLC, while others want only efficiency, by the
same token. Some staff need an
authoritarian approach, others
thrive under the “I trust you,
get on with it” tactic. Successful
dentists find the key and then
use it to persuade both patients
and staff that the surgery is the
best place to have their dreams
fulfilled.

If you cannot move others, you may remain unmoved
yourself. As Borg says: ‘Every
day at work – and in your personal life – you come into contact with people who need to
2. Being a good listener
understand your point of view,
The second big key; really heareither for you to help them, or
ing what your patients and staff
for them to help you. Equally,
tell you about their problems,
you need to understand their
rather than simply imposing
point of view.’ We need to find
your solutions on them. Listenthat magic formula, that, ‘mesing to them tells them that you
sage that attempts to influence
really care, but having heard, it
people’s opinions, attitudes
necessary
or ad
actions’.
D6
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attention to detail – this tells
the person with whom you are
communicating that you have
heard, remembered and valued everything they have said.
Paraphrase what they have said,
so that they can hear that you
have heard them.
3. Avoiding too many options
We are obliged to discuss all
treatment options explaining
their benefits and downside,
and we should note that we have
done so. This said and done,
when you actually come down
to give them a choice between
the two or three best options
and emphasise the one you favour most.
4. Positive body language
Two people in discussion send
messages to each other, not only
verbally but by their dress, demeanor and posture. You are
more likely to trust someone
when the words they are speaking are in harmony with their
body language as expressed by

eye contact, position of arms, activity of fingers etc.

front, but perhaps we can split it
into 10 payments of £200.’

5. Having a good memory
Ever noticed how impressed
someone is when, at a party,
having only met them once and
that 30 minutes before, you remember their name? Magic!
Not as difficult as you think,
but it requires concentration
and focus – or writing it down.
Remembering people’s names,
birthdays, where they went on
holiday, family details, but most
of all what you discussed last
time is an essential key to being
able to get them to buy into your
ideas.

8. Using ‘open’ communi
cation
Instead of saying, ‘You have to
floss twice a day’, you could
say: ‘I think that it would really
be of benefit to you if you could
floss twice a day’. Other useful
‘open’ phrases include: ‘In my
opinion…’, ‘I feel that…’. Make
the words you use work for you
rather than antagonising the patient or employee.

6. Avoiding ‘attention breakdown’
An example of this might be the
scenario where you are discussing something with a patient,
the phone rings, you take the
call, and on completion you
say ‘Right, where were we?’ Remember, it’s difficult to control
attention when there isn’t any in
the first place!
7. Understand why ‘difficult’
individuals behave the way
they do
Difficult people use stratagems
to achieve certain objectives for
themselves, for example very
autocratic or authoritarian people try to persuade you that they
are stonger than you and bully
you into submission: I understand that you can only come
at night/weekends, but I cannot get staff of the quality I have
during the week to achieve your
perfect result.
Needy people try to persuade
you that their needs are more
important than yours and make
you feel sorry for them. See
where they are coming from,
get behind their attitudes, and
then adopt tactics that will help
you get them to see your point
of view: ‘I understand that you
cannot afford to pay £2,000 up

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9. Selling the benefits, not
the problems
The message that people take
away from a meeting is the one
that makes the biggest impact
on their minds. ‘By having the
treatment now, you will save
yourself a lot of money and
pain in the future and help keep
all your teeth and your lovely
smile’, is a better message than,
‘Because you have such serious
problems, your treatment will
be painful and it’s going to cost
you a lot of money, and I can’t
guarantee success’ Creating fear
will send them elsewhere.
10. Creating mutually beneficial outcomes
Stephen Covey was clear that
in order to be successful, we
need to create win/win results
where both parties benefit. It
will benefit you not at all when
the cost (to you and/or that person) of working with someone
exceeds the benefit you or they
experience. DT

About the author
Adrianne Morris is a highly trained
success coach whose aim is to get people from where they are now to where
they want to be, in clear measured
steps.
Ed Bonner has owned many practices,
and now consults with and coaches
dentists and their staff to achieve their
potential. For a free consultation, or a
complementary copy of The Power of
Ten e-zine, email Adrianne at alplifecoach@yahoo.com or Ed on bonner.
edwin@gmail.com, or visit www.thepoweroften.co.uk.

W
IN

Ze
rm 2 n
att ig
/ Sw ht
itz s
erl
an
d

[15] =>

United Kingdom Edition October 25-31, 2010

Practice Management 15

CQC registration - an introduction
Vinai Patel and Amar Flora discuss Care Quality Commission registration

CQC has introduced a new
system of registration for all providers of Health and Social Care.
This one-off process gives the
practice a licence to operate and
primary care dental services,
both NHS and private, all need
to be registered by April 1st 2011.
The new registration system requires NHS and private practices
to comply with the CQC Essential
Standards of quality and safety
(Table 1).
Outcomes
There are 28 ‘outcomes’ and associated regulations. Dentists
will need to comply with 16 of
these. Registration will either be
classed as ‘Individual’, ‘Partnership’ or ‘Organisation’ (Table 2).
Health care providers will need

Dental practices with a practice manager who is in charge
of the day-to-day running of the
service will also need to complete
the Registered Managers’ form.
They will also need to complete a
medical report, professional reference, enhanced CRB check and
a free text question.
Deadline
The deadline for completing
the forms varies depending on
whether you run an NHS or a private practice. NHS practices will
have a 28 day window to complete these application forms and
private practices have until the
31st December 2010.
The forms will be assessed by the CQC in early
2011 when they will judge
each application and make a
decision
about
registration.
Once registered the practice should expect visits from
CQC once every three to 24
months.
These
inspections
will be either planned or tar-

‘There are 28 ‘outcomes’ and associated
regulations. Dentists will need to comply
with 16 of these.’

should fail to comply with CQC’s
stringent demands. To reduce the
weighty administrative burden,
busy practitioners will benefit
from external assistance when
undergoing the registration process and completing the application form. Specialist companies
do exist to guide you through
the Registered Managers’ form,
the enhanced CRB check and all
the other relevant documents required by the CQC, even completing them on your behalf.
Whether you simply need
your hand to be held when filling
in the various application forms
or if you require assistance with
producing all the necessary polices and evidence required for
compliance, advice from the experts is worth its weight in gold.
Some companies will also offer
guidance on how to deal with
ongoing monitoring after registration and practical courses for
practice managers on how to successfully navigate the application
process. This will help to make
the entire process as streamlined,
efficient and painless as possible.
Help and Advice
Choose a course led an experienced provider such as CQC
Support who has plenty of experience in the dental field who will
help and advise dentists and their
managers depending on their individual needs. DT

to register for all their regulated
activities for each location. Once
registered, the service will be
regularly monitored to ensure
that it continues to meet the
Essential Standards.

geted. Planned visits will check
compliance to all 16 outcomes
(Table 3) and action will be
proportionate. Targeted inspections come in response to a specific area of concern or outcome.

The application process requires dental professionals to
complete various different documents, including the main application, a Statement of Purpose
and two main free text questions.
There are also various other details about the regulated activities, location and compliance that
will need to be submitted.

CQC will then produce a live
working document called a Quality Risk Profile (QRP) for each
provider which will demonstrate
the quality, safety, integrity and
capability of each service.

Please visit our website
at www.cqcsupport.co.uk for
course dates and more information on the range of packages we offer. Otherwise, call
Vinai Patel or Amar Flora on
07956 817 654, 07931 786 062
or at info@cqcsupport.co.uk.

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[16] =>

16 Money Matters

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United Kingdom Edition October 25-31, 2010

Making your
pension work
Thomas Dickson explains just what’s involved in
buying a freehold dental practice through your
Self-Invested Pension Plan (SIPP)

ensions are the future.
There is no doubt that a
wise saver will have considered their future financial
security and plan. This will
also involve making sure they
have sufficient assets in place to
maintain their lifestyle throughout retirement.
For those dentists with a
secure, guaranteed NHS pension
scheme, the assets cannot be
accessed until you reach the age
of 55. However, for those with
private pensions, although the
age to access the money stays the
same, there is a great deal that
you can do in the meantime.
Control your future
Pensions do not have to work
hard for you just when you’ve
retired. A well-implemented
pension scheme can also provide

lease the premises.
Buyers’ market?
Arguably, there has never been
a better time for practitioners to
enter into the acquisition of commercial property. The financial
sector is looking favourably on
the dental market, while the new
NHS contract is helping practitioners secure a more regular
monthly income stream.
Buying the freehold directly
is only one of the options. Many
practitioners are choosing to explore another option: purchasing
the property through a personal
pension scheme.
What are the advantages?
While not for everyone, there
are some definite advantages
to buying commercial property
through a Self-Invested Pension

‘While not for everyone, there are some
definite advantages to buying commercial
property through a Self-Invested Pension
Plan (SIPP):’
the opportunity for a dentist to
control their future now, managing a portfolio of investments or
even buying property.
Pensions are not the first
thought in many investor’s minds
when they think of purchasing
property. When it comes to taking the plunge and securing your
own practice, practitioners either buy the freehold or simply

Plan (SIPP):
• The purchaser avoids paying
Capital Gains Tax (CGT) on the
sale of the property. Although the
rate of CGT has been lowered
to 18 per cent, this is still a tax
worth saving and there’s every
possibility this will be raised at
some point in the future, to bring
it into line with the highest rate
of tax at 50 per cent.
• The pension fund can borrow

Sirona Dental Systems Ltd.,
7 Devonhurst Place,
Heathfield Terrace,
Chiswick, London W4 4JD

Dental

Potential downfalls
As well as the obvious benefits of
this opportunity, it is also wise to
point out the potential downfalls.
Most pension funds are implemented for good reason, and the
assets are usually invested with
a fair degree of diversification often combining a range of financial options, including stocks and
shares, bonds as well as cash.
Therefore, investing wholly in
just one asset class – commercial
property – is considered to be a
relatively high-risk strategy.
Another disadvantage is that
a SIPP containing a property is
usually considerably more expensive to run. It’s also worth
pointing out that technically the
investor does not own the property, it is owned by the pension
fund/trustees and any rental income or capital receipts from the
sale of the property cannot be removed from the fund until retirement age is reached – the minimum retirement age is now 55.
Before making a decision
on the most appropriate way to
purchase a property, it is advisable to seek professional advice.
There are many pitfalls that can
befall a practitioner when taking
this big step, and professional assistance from the start can save
thousands of pounds, as well as
hours of time. DT

About the author

Telephone: 0845 0715040
e-mail: info@sironadental.co.uk
www.sironadental.co.uk

The

against the security of the property. Many practitioners are able
to purchase a freehold property
with 100 per cent finance, as
lenders consider the profession
to be a reliable ‘safe lend’. However, if a traditional mortgage is
not available, for those who need
to find a deposit before being
able to access the capital, drawing from a pension fund can be
an ideal solution.
• VAT can be reclaimed if the
property is VAT registered.

Company
There are many pitfalls that can befall a practitioner when taking this big step

Thomas Dickson,
director of Essential Money Limited,
formerly a partner
of Money4Dentists.
For more information, and to receive
a free copy of its
Guide to Buying
a Dental Practice,
packed full of practical hints and tips,
contact
Essential
Money on 0121 685 5060, email thomas@essentialmoney.co.uk or visit
www.essentialmoney.co.uk.

[17] =>

CAD/CAM SYSTEMS | INSTRUMENTS | HYGIENE SYSTEMS | TREATMENT CENTERS | IMAGING SYSTEMS

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Ceramic Systems Ltd
Telephone: 0845 070 0137
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Henry Schein Minerva Dental Ltd
Telephone: 08700 102041
email: sales@henryschein.co.uk
www.henryschein.co.uk

Ceramic Systems Ltd
Telephone: 0845 070 0137
e-mail: sales@ceramicsystems.co.uk
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Henry Schein Minerva Dental Ltd
Telephone: 08700 102041
email: sales@henryschein.co.uk
www.henryschein.co.uk

Sirona Dental Systems Ltd
Telephone: 0845 071 5040
e-mail: info@sironadental.co.uk
www.sironacadcamsolutions.co.uk

Henry Schein Minerva Dental Ltd
Telephone: 08700 102041
email: sales@henryschein.co.uk
www.henryschein.co.uk

Sirona Dental Systems Ltd
Telephone: 0845 071 5040
e-mail: info@sironadental.co.uk
www.sironacadcamsolutions.co.uk

Sirona Dental Systems Ltd
Telephone: 0845 071 5040
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T h e

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C o m p a n y

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[18] =>

18 Money Matters

United Kingdom Edition

Principles of trusts
We’ve all heard of ‘trusts’ in relation to our finances, but what
are they and how can they be of benefit to us? Edward Stanley explains

ow attractive are the following concepts? Providing financial security for
your family and future generations? Securing pension arrange-

ments? Investing funds? Leaving
assets for worthy causes? Protecting your assets from third parties? These are just some of the
situations where a modern-day

trust is applied. All very appealing, no doubt, but what on earth
is a ‘trust’ and how can this apparently mysterious device be of
practical benefit?

Pearl Dental Software

So, what is a ‘trust’? A trust
best describes the situation where
one person (known as the ‘Trustee’) is given an asset by someone
else (the ‘Settlor’) for that per-

for PRIVATE Practices

October 25-31, 2010

son to hold ‘on trust’, that is for
the benefit of a third person (the
‘Beneficiary’), usually subject to
various terms. The relationship
between the Trustee and the Beneficiary is said to be a ‘Trust’ and
is governed by numerous rules
and obligations.
Trusts in the modern world
Trusts have a very broad range
of application in domestic life,
and in the world of commerce.
Some typical illustrations follow.
Wealth Preservation Tax, we
can be comforted, will remain a
constant in ever changing times.
The Trust can be used to plan
to reduce or even avoid taxes
charged on benefits received and
on formal ownership of property.
All of us would prefer to avoid
unnecessary income tax, capital gains tax and inheritance tax
both now and in the future. Higher-rate taxpayers can save subsequent tax by transferring assets
into a trust. Income tax earned by
the capital assets will disappear
because the asset will have been
given away. Capital taxes will be
avoided if the asset’s capital value
increases as the asset will belong
to the trust. Inheritance tax payable on death will be avoided as
the asset will not form part of the
taxpayer’s estate. Some examples:
Pay into a Trust an amount
up to the prevailing nil rate band
(currently £325,000) every seven
years without any lifetime inheritance tax becoming due on
that transfer. For married couples or civil partners the limit is
£650,000.
Create growth in asset value
outside your estate. For example, create a Trust with a modest amount of cash or take out
a large loan to acquire capital
assets. Over time the loan is repaid and the growth in value of
the assets remains in the Trust,
not in the Settlor’s estate. Transfer into a Trust assets having a
low value but potential for large
growth. The value transferred
from the Settlor’s estate is small
and all future growth occurs outside the estate.

See a demonstration at
www.bhasoftware.com/pearl
www.bhasoftware.com

tel. 0800 027 2406

Leaving business property on
death to a spouse wastes tax relief. A gift to a spouse or civil partner is exempt. Business property
qualifying for 100 per cent relief
should be given to the lower generations or to appropriate Trusts.
This overcomes the problem that
such property, if left to the surviving spouse, may become an investment rather than a trading asset, losing entitlement to business
property relief on the spouse’s
death. If the spouse may need
the business assets, place them
into a ‘wait-and-see’ discretionary Trust and, if needed, distribute to the surviving spouse after
the first spouse’s death. Leave a
legacy to one or more pilot Trusts
creating a nil rate band for inher-

[19] =>

United Kingdom Edition October 25-31, 2010

itance tax purposes for each Trust
and legacy, thereby reducing the
amount of incidental inheritance
tax charges.
Estate Planning Trusts can
provide security for the family
and future generations, for example, by giving away assets into a
Trust set up in your lifetime or by
making a gift into a Trust upon
your death. This has the effect of
ring-fencing the funds for specified and/or prospective Beneficiaries. Protective Trusts protect
family funds or property from a
financially vulnerable or spendthrift child. The child would receive some benefit but core funds
would not be at risk.
Asset Protection Trusts can be
particularly helpful if you anticipate that your assets may be exposed to risks including: Claims
(whether actual or prospective)
from your own creditors ’Forced
heirship’ laws, where you may be
subject to the laws of a country
which dictate that on your death
your property must be dealt with
in a certain way. However, simply
placing assets into a Trust to defeat creditors could be unlawful
and liable to be set aside. Again,
careful advice needs to be taken
when considering any such steps.
Trusts themselves incur tax!
Bear in mind that the trust is
not a magic wand and tax may
not vanish completely. Certain
types of Trusts attract tax charges. The basic rate of tax applicable to trusts for income tax is 50
per cent on rental and savings
income and 42.5 per cent on dividends. Advice is essential to see
whether there can be any reduction in the amount of tax suffered
by trusts.
Beware of the distinction,
which is not always clear, between tax avoidance and tax evasion. The former is legitimate
estate planning carried out to prevent a tax from falling due in the
first place. The latter is a criminal
scheme disposing of tax that has
already fallen due. It is wise to be
aware of this when considering
any attractive suggestions that
promise to make your current tax
liability disappear!
HMRC are razor sharp in
identifying any sham or artificial
arrangements entered into, ostensibly giving away property into
Trust but in fact reserving for the
Settlor a benefit and/or a degree
of control over that property; in
such an event tax will be charged
according to the transaction’s
true nature. The law will change
to deter such arrangements. It is
essential that you take proper legal advice before committing to
any such arrangement.
Who would you trust? As
someone creating the Trust by
giving away assets, you will need
to ensure that you make the right

Money Matters 19

option agreements need to be set
ticipation of all reasonably foreappointment of Trustees. Trusup; you wish to protect your asseeable developments.
tees are in a fiduciary position to
sets; you wish to make provision
the Beneficiaries. They must act
for your family and future generWhy dispose of your assets?
in good faith and with the utmost
ations. There are, however, many
There are many advantages to be
integrity, putting the interests of
pitfalls in this complex area of the
obtained from setting up a Trust.
the Beneficiaries first at all times.
law. Legal advice should be taken
Why would you be interested in so
As the Trust may exist for many
only from those with sufficient
doing? You have available funds
years, you need to be assured that
expertise and experience.
from the sale of your practice.
what was once your own capital is administered properly. You
This is not intended to be
Your practice may be about
need not only to make the right
9361
DBG of
ClinicalGov
probe
338x244.qxd:Layout
1 1/7/10 13:39
a 1detailed consideration of the
to undergo restructuring,
from Page
choice
Trustee butThe
also
to enlaw and advice should always
the introduction of new partners
sure that the Trust deed is drafted
be sought as to the options that
to the acquisition of land; crosswith the utmost care and in an-

Clinical Governance including
Patient Quality Measures Is your practice compliant?

might be suitable for your situation. DT

About the author
Edward Stanley is a partner in Cohen
Cramer Solicitors and heads up its private client department. His specialism
extends to contentious probate and
trusts. He is an affiliate member of the
Society of Trust and Estate Practitioners. Cohen Cramer provides a comprehensive range of legal services to
dentists. To contact them, call 0113 244
0597, email dental.team@cohencramer.co.uk or visit www.cohencramer.
co.uk.

Are you waiting to find out when
the Care Quality Commission*
inspect your practice?
Have you addressed all 28 CQC
outcomes?
Your compliance with Clinical Governance
and Patient Outcomes will be questioned
with the introduction of the Care Quality
Commission*, HTM 01-05 and the increase
in PCT practice inspections.
Would you like to know how you would fare when your
practice is inspected and have the opportunity to take
corrective action?
The DBG Clinical Governance Assessment is the all
important experience of a practice audit visit rather than
the reliance on a self audit which can lead to a false sense
of compliance. The assessment is designed to give you
reassurance that you have fulfilled your obligations and
highlight any potential problems. We will provide help
and advice on the latest guidance throughout the visit.

The areas the DBG assesses are:

premises including access, facilities, security, fire
• Your
precautions, third parties and business continuity plans.
governance including Freedom of Information Act,
• Information
manual and computerised records, Data Protection and security.
• Training, documentation and certificates.
• Radiography including IRR99 and IR(ME)R2000 compliance.
infection and decontamination including HTM 01-05
• Cross
compliance and surgery audits.
emergencies including resuscitation, drugs,
• Medical
equipments and protocols.
• Training, documentation and certificates.
• Waste disposal and documentation and storage.
• Practice policies and written procedures.
• Clinical audit and patient outcomes including quality measures.

The assessment will take approximately four hours of your Practice Manager’s time depending on the number of surgeries and we
will require access to all areas of your practice. A report will be despatched to you confirming the results of our assessment. If you have
an inspection imminent then we suggest that you arrange your DBG assessment at least one month before the inspection to allow you time
to carry out any recommendations if required. Following the assessment you may wish to have access to the DBG Clinical Governance
Package with on-line compliance manuals.

For more information and a quote contact the DBG on 0845 00 66 112

20
YEARS

www.thedbg.co.uk
Please Note: Errors and omissions excluded. Any prices quoted are subject to VAT. The DBG reserves the right to alter
or withdraw any of their services at any time without prior notice.

*England only.

[20] =>

20 Education

United Kingdom Edition October 25-31, 2010

The emergency patient
Dental Protection looks at dealing with emergencies

A

revealing measure of
a dentist’s level of care
and commitment to
patients’ needs can be found
in the way they deal with emergencies.
Many
complaints
and allegations of negligence

involve a patient’s feelings
of having been abandoned
or ignored, when finding
it was impossible to access
dental care in an emergency
situation.

Pain
If there is one particular treatment outcome, which has a
particular propensity to inflame
a patient’s sense of dissatisfaction, and to make a complaint or
claim more likely, it is the on-

set of pain. Whenever a patient
experiences pain or severe discomfort following treatment, it
may well be attributed to some
kind of failure on the part of the
clinician. The patient’s displeasure on these occasions is exac-

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erbated if the dentist is unavailable (or inaccessible) at the time
when they are in pain.
The situation can sometimes occur where a patient attends for routine dental treatment having experienced no
symptoms to date whatsoever,
but subsequently find themselves in acute pain shortly after
the treatment has been completed. Certain procedures carry
a particular risk of creating
postoperative pain or sensitivity, and in these cases it is
sensible to prepare patients for
any adverse outcome by giving
them both preoperative warnings
and
postoperative
instructions.
Pulp Proximity
Commonly this situation arises
when a deep filling is provided
in close proximity to the pulp.
This can often precipitate a

‘ Certain procedures
carry a particular
risk of creating
postoperative pain
or sensitivity, and
in these cases it is
sensible to prepare
patients for
any adverse outcome’

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transient acute pulpitis, which,
if the patient has been warned
about what to expect and how to
manage the symptoms, is generally overcome without too much
difficulty. But if such a procedure is carried out just before
a weekend or public holiday, or
a special event in the patient’s
life, and the patient has not been
forewarned, they may well assume that something has gone
wrong. The patient may subsequently hold the dentist responsible for the pain they have suffered.
Practical arrangements
Emergency patients without appointments can be difficult to
accommodate within normal
surgery hours unless time has
previously been set aside for
this purpose. Alternatively, time
can sometimes be found for
them, but only at the expense of
time which had originally been
reserved for other patients.

For more information contact your preferred dealer or
contact Septodont Head Office on 01622 695520

Good practice management
is an integral part of good risk
management, and the effective

[21] =>

United Kingdom Edition October 25-31, 2010

care of a patient in pain challenges many aspects of practice management. Having an
effective telephone system and
appropriate staff available to
answer the telephone promptly
and effectively during surgery
hours, with a caring and compassionate telephone voice is
certainly a good start. An appointment system that can accommodate emergency patients
at short notice is the next requirement, and will make it easier for a receptionist to respond
promptly and effectively to the
patient’s needs.
In this connection, it is important to recognise the crucial
role played by reception staff not
only in making an emergency
appointment, or offering appropriate advice, but also in the way
in which the patient is listened to
and spoken to. Patients requesting emergency treatment are, at
best, being inconvenienced and,
at worst, may be in severe pain
or distress. Not uncommonly,
the patient may not have slept
because of their dental problem,
and any response needs to take
these factors into account.
What is an emergency?
There is a wide spectrum
of opinion as to what constitutes an ‘emergency’. The obvious examples are a patient
in acute pain, or with an abscess, or swelling, or excessive postoperative bleeding. It
must also include the shocked
and distressed child who has
parted company not only with
a skateboard or bicycle, but also
with one or more teeth. All of
these are situations where few
would disagree that a dentist’s
duty of care extends to seeing
these patients without delay.
Views differ, however, on the
sore spot beneath the denture, or
the loose crown, or the lost filling which is symptomless. Some
practitioners may be perfectly

willing to see such patients with
such complaints at short notice during surgery hours, but
will be unimpressed if they are
called out at a weekend or late
in an evening in such situations.
Most practices will have certain
individual patients who tend
to abuse emergency arrangements, for reasons of personal
convenience rather than genuine need, and it is easy for these
patients to influence a practice’s
attitude to emergencies. It is
important not to allow experiences with such patients
to prejudice the response to other patients who genuinely need
emergency care, because it is
not always going to be possible
to provide this emergency care
personally.
Cover Arrangments
Dentists will normally put in
place some kind of emergency
cover arrangements for periods
of holiday, sickness or other absence. This may take the form
of a colleague within the same
practice, or perhaps someone
in another local practice where
cover is provided on a reciprocal basis. Emergency rotas are
common, whereby a number of
dentists in one area join forces
to provide out of hours cover on
a rota basis.
Other dentists – particularly
those in isolated or rural areas
– will sometimes prefer to make
their own arrangements wherever possible. In some areas, a
local hospital or other clinic can
provide a readily available additional level of cover for patients,
while in other areas there is no
such backup, within a reasonable distance of the surgery.
A sympathetic team
It may not always be possible (or
even, necessary) for the patient
to speak to the dentist immediately, and here the experience
and knowledge of the person
answering the telephone should

allow him/her to assess the severity and possible causes of the
patient’s pain. If it is necessary
for the dentist to ring the patient
back, make realistic and achievable promises of when this will
be possible – and ensure that
those promises are kept. Time
passes very slowly for patients in

Education 21
who is in pain or bleeding heavily, or a tearful child can lead
to an emotional response: similarly with a traumatic injury or
someone with an acute abscess
with a rapidly worsening swelling. The patient who is turned
away may feel they have been let
down and treated without care

‘Every effort should be made to convey a
supportive, caring, compassionate and
sympathetic response; transmitting the feeling that the team has understood the problem and are doing their best to resolve it as
quickly as possible for the patient.’
pain, while perceptions of abandonment and feelings of anger
develop surprisingly quickly.

and consideration. In such cases expressions of genuine anger
and resentment are not unusual.

Every effort should be made
to convey a supportive, caring,
compassionate and sympathetic
response thereby transmitting
the feeling that the practice team
has understood the problem and
are doing their very best to resolve it as quickly as possible for
the patient.

Sometimes, the patient’s request for emergency treatment
is not related to pain or swelling
at all; their emergency request
is based on some imminent
personal deadline. Having a
crown re-cemented before going on holiday the next day, or
a filling replaced before getting
married, or before an important business meeting, may not
be an ‘emergency’ in the eyes
of the dentist or members of
staff, but it is an emergency as
far as the patient is concerned.
Refusing such a patient will
provoke similar levels of resentment, anger and frustration.

Refusals cause complaints
A patient’s request for emergency treatment is a situation
that has a significant potential
to create dento-legal problems.
In most cases it is a perceived
lack of care or concern, perhaps compounded by a refusal
(by the dentist, or by a member of staff) to see the patient,
or the lack of emergency cover
arrangements, that causes the
complaint. Sometimes the problem arises from the treatment
actually provided; perhaps as a
direct result of the fact that time
has to be created at short notice,
when in reality no time is available, and any treatment is done
within tight time constraints.

Systems
The best approach to the problem is to establish a clearly defined system for dealing with
emergency patients. Like any
system, you and other front-line
members of the dental team will
need some ‘house rules’ about
what exactly constitutes an
emergency, leaving some flexibility to assess other situations
on their merits.

A refusal to see a patient
The next stage is to design
a structured system for accommodating emergency patients
both during surgery hours and
(where necessary) out of hours,
and then to communicate information about this system and
how it works to all patients. In
some practices, there is a pattern whereby more requests for
emergency attention tend to be
received at certain times of day,
or on certain days of the week.

Patients in pain need to be handled with compassion

Professional Commitment
Most dentists show an admirable professional commitment
to patients who have a reserved
(pre-booked) appointment on a
given day. But there will be occasions when, in order to accommodate a genuine emergency, these plans may need to
be altered. Explaining this to
a patient who will thereby be
inconvenienced, will, if handled correctly and with sensi-

tivity, be less problematic than
trying to explain to a patient in
severe pain why they must wait
several hours before they can
be seen.
Any request for emergency
treatment needs to be recorded
in the patient’s notes (preferably
indicating the time) together
with a note of the response, advice/treatment given, etc. If a
receptionist offers times for the
patient to attend, later that day,
but the patient declines because
they are too busy that afternoon
and would prefer to come in the
following morning, then all of
this should be recorded in the
patient’s notes. If the patient’s
condition should happen to
worsen overnight, then at least
it can be demonstrated that this
need not have happened, had
the patient accepted the earlier
appointments that had been offered to them.
It is worthwhile keeping a
‘log’ or similar record of all calls
taken when away from the practice, so key details can be copied
back onto the patient’s clinical
notes at the first opportunity.
Summary
It is often overlooked what a
positive impact upon practice
goodwill can have by making a real effort to accommodate emergency patients. Not
surprisingly, many patients
who are treated with care and
consideration, and are accommodated promptly when their
need is greatest, will often be
enduringly grateful; some will
demonstrate their appreciation by becoming the most vocal
and enthusiastic ambassadors
for the dentist concerned.
Predictably enough, the reverse is also true, and a failure
to offer or provide emergency
care can create, by association,
a reputation for being uncaring,
unprofessional or even arrogant
and dismissive of patients’ needs.
A complaint or claim that is
fuelled by a patient’s anger and
resentment, and often personal
animosity towards a healthcare
professional who was apparently prepared to leave them in
pain or otherwise suffering, is
not easily resolved. Patients who
make such allegations are often
prepared to pursue them with a
crusading zeal, demonstrating a
single-minded determination to
prevent the same situation arising from other patients. DT

About Dental Protection
We are the world’s largest specialist provider of dental professional indemnity and risk management for the whole dental team.
The articles in this series are based
upon Dental Protection’s 100 years
of experience, currently handling
more than 8,000 cases for over 48,000
members in 70 Countries. Email querydent@mps.org.uk or visit www.detalprotection.org

[22] =>

22 Clinical

United Kingdom Edition October 25-31, 2010

Telescope or double crowns
Part 1 of precision dental prosthetics with highly engineered connections. By Ulrich Heker, Master Dental Technician & Verena
Tunn- Salihoglu, dentist, Aberdeen, Scotland

n this first of two articles we
will discuss the technical
side of the telescopic dentures before presenting the clini-

cal side in the second part.
Telescope prosthesis or double crowns are a proven option

for the prosthetic treatment of
dramatically reduced dentition
(fewer teeth might serve in some
cases as an alternative to im-

plants). However, the production
of such a prosthesis demands
high technical skills on the side
of the dentist and the dental tech-

D E N T S P LY A C A D E M Y W E B I N A R P R O G R A M M E

nician. Of equal importance is a
good communication between
dentist and technician. These
are the main keys to a successful case.
The telescopic attachment
consists of two parts:
1. The primary (inner) crown,
or coping, which is permanently
fixed to the anchor teeth, and
is preferably made out of a precious metal, a high gold alloy.
2. The secondary (outer) crown
implemented in to the prosthesis, made out of the same alloy.
The usual type of double
crown system next to the conus
type is the parallel telescopic
crown. They are named due to
the fact that all surfaces from
the primary (inner) and the secondary (outer) telescopic are not
only parallel to each other but
also parallel to the axis of each
incorporated tooth. However in
the case of a conus telescopic
system a 4 degree angle of both
telescopes to the axis of the tooth
is aimed for, provided by the exact preparation of the dentist.
Indications
Double crowns can be used in
the following situations: where
there is a strongly depleted dentition uncertain prognosis of individual teeth in a periodontally
damaged jaw (existing bone depletion, increased loosening of
the anchor teeth) with a suboptimal distribution of the remaining teeth for the retention of removable bridges

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Smart Dentine Replacement

The almost universal applicability is characteristic for this
anchoring system. Telescopic
crowns can be applied as claspfree connecting elements with
purely periodontally and periodontally-gingivally supported
partial prostheses.
The pros and cons of double
crowns
Advantages of the telescopic system:
• a predominantly axial loading
of the pillars leading to a favourable distribution of force protection of the anchor teeth from
decay
• the option of primary splinting
for the securing and fixing of
loose teeth
• integrated tilt-avoidance
• a straightforward ability to extend the prosthesis even up to a
full denture the aesthetic advantage as no clasps are used the
beneficial and straightforward
treatment and control of the parodontium and the internal coping
•can be used as a cost effective
alternative to implants
Disadvantages of the telescopic
system:
• requires a high technical effort
• correspondingly higher costs
• over sizing of the secondary
crowns if the pile has not been
efficiently reduced

[23] =>

Clinical 23

United Kingdom Edition October 25-31, 2010

• in comparison to a PMF crown
higher tooth substance loss in
preparation can only be coated/
veneered with composites
How double crowns work
Physical principles
The patient expects the prosthesis to be easily inserted and
removed. At the same time, the
prosthesis has to be sufficiently
attached so that it cannot be
leveraged off by motion during speech and eating. In order
for these conditions to be met,
you need certain physical preconditions. These are explained
below.

higher levels the patient can often not remove the prosthesis.

be removable without difficulty whilst not loosening at the
wrong moment or due to sticky
foods. The criteria must remain
valid over a longer period of
wear.

Achieving the correct friction of the individual telescopic
components is only possible
with considerable experience
and skill by both parties technically involved; the dentist and
the dental technician, and their
interdisciplinary communication. The success also depends
on the precision of each step

Note: The force required for
removal of the prosthesis:
250–300 P is regarded as acceptable to patients. The maximal force required for removal
should not exceed 650 P, as with

Telescope during insertion

à DT page 24

In order to achieve a hold between the primary and secondary telescopic, these have to fit
in a particular manner. There
are three different types of fit:
1. a clearance fit, in which there
is still a small bit of give/play
2. the medium fit, in which there
is a large tolerance or oversizing before the joining of the
components (which gives totally
useless telescopic crowns)
3. the pressure fit, where the
components are tight and interact such that friction is created
during fitting

“I need a

composite
that behaves
like a tooth!”
Dr. Arne Kersting

On the principle that both
crown pieces have to join exactly and without obstruction,
parallel telescopic crowns are
always pressure fittings; this is
why telescopic crowns are preferably made from precious alloys, because of their high elasticity.
The importance of friction
The inner and outer telescopes
are joined together by friction.
Stated simply, the friction is due
to the interaction between the
surface layers of the inner and
outer telescope. The binding
forces of the telescopic crowns
are therefore a consequence of
this friction.
Friction in telescopic crowns
is a value that is difficult to measure. It is principally dependent
on the technical construction of
the crown, which is influenced
by the following factors:
• the number of the planned telescopic crowns
• the length of the friction surfaces of the individual tooth and
also the sum of all available telescopes
• the placement of the friction
surfaces relative to one another.
Only oppositely facing parallel surfaces can provide the required friction with the elasticity of the materials, which is why
gold alloys are generally used
• the quality of the work
A prosthesis has to be prepared in such a way that the
patient can insert it without difficulty. Additionally, it must provide the feeling of fitting firmly.
The

denture

should

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22.09.2010 9:44:51 Uhr

[24] =>

24 Clinical

United Kingdom Edition

ß DT page 23

on good communication and
technical skill on both the dentists and the technical laboratory’s part.

and each detail.
Conclusion to Part 1
We have given you an overview
of the technical aspects of telescopic prostheses or double
crowns and their almost universal applicability. The basic
priciples of how they work and
the importance of achieving the
right level of friction are described. Success is dependent

October 25-31, 2010

Copies upper jaw polishes for modelling
the outer crowns

In the next article of “Part 2
of precision dental prosthetics
with highly engineered connections” we will illustrate the
clinical side to the telescopes or
double crowns, i.e. the planning
and preparation required. DT

Single Telescope with retention, showing primary and secondary telescope

References

Ems-swissqualitY.com

savE cElls

NEw Ems swiss iNstrumENts surgErY –
saviNg tissuE with NEw iNNovatioNs iN implaNt
dENtistrY
The inventor of the Original Piezon
Method has won another battle
against the destruction of tissue when
dental implants are performed. The
m a g ic word is dual cooling –
instrument cooling from the inside
and outside together with simultaneous debris evacuation and efficient
surgical preparations in the maxilla.

> EMS Swiss Instrument
Surger y MB6 with unique spiral
design and internal instrument
irrigation for ultralow
temperature at the operative site

cooliNg hEals
A unique spiral design and internal
irrigation prevent the instrument’s
temperature from rising during the
surgical procedure. These features
combine effectively to promote excellent regeneration of the bone tissue.

1. Becker, H: Einflüsse des umgebenden
Mediums auf das Haftverhalten teleskopierender Kronen. Zahnärztl Welt 91, 54,
(1982). 2. Becker, H: Wirkungsmechanismus der Haftung teleskopierender Kronen.
Zahnärztl. Prax 34, 281 (1983). 3. Böttger,
H: Das Teleskopsystem in der zahnärztlichen Prothetik. JA Barth, Leipzig 1961. 4.
Diedrichs, G: Ist das Teleskopsystem noch
zeitgemäß? Zahnärztl. Welt 99, 78 (1990).
5. Goslee, H: Principles and Practice of
Crown and Bridge Work Dental Items
of Interest Publishing Co., New York
1923. 6. Hedegard, B: Die Mitarbeit des
Patienten – ein Planungsfaktor. Zahnärztl.
Welt, Ref.88, 680 (1979). 7. Jacoby, W,
Gasser, F: Nachträgliche Haltverbesserung
von Teleskopkronen. Quintessenz 24, 59
(1973). 8. Jüde, HD, Kühl, W, Roßbach, A:
Einführung in die zahnärztliche Prothetik.
5.Aufl. Deutscher Ärzte- Verlag, Köln 1996.
9. Kammertöns, H: Haftreibungsprüfung
an Teleskop- und Konuskronenarbeiten.
Quintessenz Zahntech 14, 11 (1988). 10.
Krämer, A, Weber, H: Präzisionselemente
in der Teilprothetik Teleskopierende Systeme. Zahnärztl Mitt 80, 2328 (1990). 11.
Mack, H: Die teleskopierende Verankerung
in der Teilprothetik. Quintessenz Zahntech
9, 17 (1983). 12. Peeso, FA: Crown and
Bridgework. Henry Kimpton, London
1924. 13. Schreiber, S: Die Verankerung
von Teilprothesen mit Teleskopkronen.
Dtsch Zahnärztl Z 14, 983-988 (1959). 14.
Schwanewede von, H, Anderseck, E: Proteza Teleskopowa – Die Teleskopprothese im
stark reduzierten Lückengebiß. Prot Stom
35, 166 (1985). 15. Stüttgen, U, Hupfauf,
L: Kombiniert festsitzend – abnehmbarer
Zahnersatz. In: Horch, H-H, Hupfauf,
L, Ketterl, W, Schmuth,G, (Hrsg): Praxis
der Zahnheilkunde 6 (Teilprothesen), 2.
Aufl. Urban & Schwarzenberg, München
Wien – Baltimore 1988, S.163. 16. Wupper, H: Zur Biomechanik verschiedener
Verankerungssysteme – Grundsätze zur
Indikation von Geschieben, Stegen und
Teleskopen. Zahnärztl Welt 95, 36 (1986).

About the author

EMS Swiss Instruments Surgery
MB4, MB5 and MB6 are diamondcoated cylindr ica l instr uments
for secondary surgical preparation
(MB4, MB5) and final osteotomy
(MB6). A spiral design combined
with innovative dual cooling makes
these instruments unique in implant
dentistry.

coNtrol savEs
Effective instrument control fosters
atraumatic implant preparation and
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the bone tissue.

(membranes, nerves, blood vessels, etc.).
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embraced by EMS.

For more information >
www.ems-swissquality.com

Ulrich Heker is the
owner-manager
of Ulrich Heker
Dental Laboratory
founded in 1996
with the strap line
TEETH ‘R’ US. As
a qualified master
craftsman
(German Master Dental
Technician) since
1991, he has over
26 years’ experience both at the bench
and in running a successful business.
Ulrich lives in Mülheim on the river
Ruhr and is an accomplished ‘westernstyle’ rider in his spare time. Ulrich
is fluent in English and can easily be
contacted at: http://www.germansmile.info, or you can email Ulrich@
Teethrus.de
Verena Tunn- Salihoglu,was born
close to Stuttgart, Germany. During
her training at the Albert-LudwigsUniversity in Freiburg, Germany, she
developed a keen interest in prosthodontics,, especially in partial dentures
and telescopes. Now her main interest
is the integration of holistic dentistry
on a high precision dental quality level.
Verena is fluent in English and can easily be contacted at: oldmachardental@
gmx.com

[25] =>

Clinical 25

United Kingdom Edition October 25-31, 2010

Protocol on how to use SDR
Prof Peet van der Vyver presents a pictorial essay on the use of Dentsply’s SDR

SDR is marketed as a low
stress flow-able base material
that can be placed in layers of up
to 4mm in thickness and each
bulk increment light-cured for
only 20 seconds, as long as you
leave at least 2mm on the occlusal surface for regular viscosity
composite resin. According to the
manufacturer, a polymerizable
modulator was chemically em-

60per cent compared to conventional flowable composite resins (Inside Dentistry, 2009). The
volumetric shrinkage is 3.6per
cent but more importantly, the
stress generated during the polymerization is 1.4 MPa, whereas
many other flowable composites

are above 4 MPa. The material
is available in only one universal shade and can be used with
any dentine bonding system.
Figs 1-19 outlines two clinical case reports that illustrate the
benefits and clinical application

of this new innovative flowable
base material for direct posterior
composite resin restorations.
Base materials are mainly indicated to reduce the volume of
filling material (Lutz, et al., 1986)
à DT page 26

“I need a

the 1st flowable
bulk-fill base

*Limited stock available. Please allow up to 28 days for delivery by your Sales Specialist. **Users worldwide

Cavity configuration and the
method of insertion of composite resin into the cavities can influence the gaps at the interface
between the dentine/enamel and
the restoration (Walshaw & McComb, 1998). According to Davidson and De Gee (1984), the parallel walls of a box shaped cavity
may restrict the flow of composite
during polymerization, causing
stresses at the resin dentine interface (Feilzer, De Gee & Davidson,
1987). The present generation
of chemically or light activated
flowable composites undergo free
volumetric shrinkage of 4-9 per
cent as compared to regular viscosity and packable composites
at 2-5 per cent, with an average of
3.5 per cent. According to Jensen
and Chan (1985), polymerization shrinkage stresses have the
potential to initiate failure of the
composite-tooth interface which
could cause deformation of the
tooth, which might result in postoperative sensitivity and could
even open pre-existing enamel
micro-cracks (Jensen & Chan,
1985).

bedded into the flowable resin
material that allows extended
polymerization without a sudden
increase in cross-link density.
This extended “curing-phase”
maximizes the overall degree
of conversion, minimizing the
polymerization stress by up to

UKP00265

R

ecent developments in
composite resin materials
and bonding technology
have made possible the routine
use of these materials in posterior
teeth (Van der Vyver & Bridges,
2002). Direct posterior composite
resin restorations are now predictable and durable, and in many
instances their superior aesthetic
and tooth-supporting properties
make them the optimal treatment option when restoring the
posterior dentition (Liebenberg,
1997). The main shortcomings of
composite resin materials are polymerisation shrinkage (Dietschi,
Magne & Holz, 1994) and polymerization stress. Polymerization
stress can result in contraction
forces on the cusps that can result in cuspal deformation (Pearson & Hegarty, 1989), enamel
cracks and ultimately decrease
the fracture resistance of the
cusps (Wieczkowski et al, 1988).
This article aims to provide clinicians with a protocol on how to
use SDR (Dentsply) as a flowable
base material for direct and indirect restorations, by means of
a pictorial essay illustrating the
benefit of this new innovative restorative material.

composite
that behaves
like a tooth!”
Dr. Arne Kersting

ContaCt
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saMPLE*

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Changing dentistry 4mm at a NEW
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The advantages you will gain are: durable, reliable restorations, and above
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BDTA Dental Showcase 2010 · london
information.
14.-16.10.2010 · Stand: l04

+44 (0)1932 837303
VOCO GmbH · P.O. Box 767 · 27457 Cuxhaven · Germany · Tel. +49 (0) 4721 719-0 · Fax +49 (0) 4721 719-140 · www.voco.com

VOCO_DTI-UK_2610_GrandioSO_210x297.indd 1

22.09.2010 9:44:51 Uhr

[26] =>

26 Clincal
ß DT page 26

or to create adequate geometry to
the cavity preparation for inlay
/ onlay preparation techniques
(Dietschi & Spreafico, 1997). The
shape of the cavity preparation
will depend on the extent of the
decay or the geometry of the restoration to be replaced. The removal of decay often creates unwanted undercuts which are not
compatible with the principles of
cavity preparation design for inlays/onlays. In order to preserve

United Kingdom Edition

undercuts in order to preserve
additional enamel for adhesion
and to improve cuspal strength
during ceramic inlay cavity preparations. Figures 20 -29 depicts a
clinical case report to illustrate
the clinical application of the SDR
flowable base material to allow
ideal cavity preparation design
for indirect posterior inlay /onlay
restorations.

sound enamel/dentine as much
as possible, the internal tapered
design should be obtained by the
application of a base material (Dietschi & Spreafico, 1997). Sherrer
et al., 1994 demonstrated that the
resistance to fracture for full ceramic crowns is significantly influenced by the elasticity of the
core material and luting cement.
Because of the favorable properties of the SDR material the author is of the opinion that it might
be the ideal material to block out

Conclusions
Providing the clinician with a

flowable base material for posterior direct and indirect restorations that can be placed and
cured in bulk must be one of the
most exciting technological advancements in dentistry towards
technique simplification for what
is generally regarded as a highly
technique sensitive procedures.
The fact that SDR exhibits excellent adaptation to the preparation walls due to its flowable
nature, reducing the potential for

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October 25-31, 2010

void formation on the margins
that could lead to post-operative
sensitivity or aesthetic failure of
the restoration. Another unique
characteristic of the SDR material is the self-leveling feature
which eliminates the need to manipulate or sculpt the material
before curing. This also creates
an ideal surface for the addition
of any regular viscosity composite resin to complete direct restorations, providing the desired
strength, aesthetics and wear
resistance for occlusal surfaces.
The reduced polymerization
stress of the SDR base material
on normal and compromised
cusps after conventional cavity preparation might provide the
clinician with an improved and
simplified operative technique to
provide patients with more durable posterior restorations.

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Fig 3: SonicFlex air-driven scaler (KAVO) and SonicSys
Prep Ceram Tips (KAVO) that were used to redefine the
margins of the proximal boxes.

Fig 5: Angulated view of final cavity
preparation. Note the extended depth of
the distal gingival margin from the occlusal surface.

[27] =>

Clincal 27

United Kingdom Edition October 25-31, 2010

Fig 4: Final cavity preparation after caries
removal and the enamel margins of the
proximal surfaces prepared with the SonicSys Prep Ceram Tips (KAVO) to ensure
removal of any unsupported enamel.

Fig 6: Hawe Contoured Tofflemire Bands
(KERR) were used in a Tofflemire holder
to ensure correct contour of the definitive
restoration. A circular matrix was selected
above a sectional matrix because of the
missing upper first molar.

Fig 8: Different sizes of the Wave Wedges
(Triodent) that were utilized to seal the
matrix band against the mesial gingival
cavity margin to gain a tight marginal seal,
reducing the chance for contamination to
ensure the establishment of an uncompromised bond strength.
Fig 7: V-Ring (Triodent) was utilized to
create separation between the canine and
premolar in order to ensure a tight interproximal contact point.

Fig 15: The Class II cavity was transformed
into a Class I cavity according to the Bichacho technique (Bichado, 1994): mesial and
distal marginal ridges were built up with a
regular viscosity composite resin, one at a
time and light-cured.

Fig 11: SDR- Smart Dentine Replacement
(Dentsply) compula tip, which incorporates a fine, needle like nose for precise dispensing of the material with the attached
macro dispensing tip.
Fig 16: Successive increments of composite
were applied in an oblique layering technique, sculpted with a pointed composite
instrument and lightcured for 40 seconds.
The inclination of the rmaining cavosurface slopes were used as indication to
reconstitute the occlusal morphology.

Fig 20: Pre-operative view of the upper
right maxillary sextant. Clinical and radiographic examination of the upper right
first molar revealed a previously placed
occluso-palatal amalgam restoration and
interproximal decay on the mesial aspect
of the tooth.

Fig 27: The cavity preparation was prepared for bonding using XP Bond mixed
with the Self-Cure Activator (Dentsply) according to the manufacturer’s instructions.
The translucent shade of Calibra Resin
Cement (Dentsply) was used as a luting
cement for cementation of the prefabricated
inlay.

Fig 21: Pre-operative view of the isolated
upper right maxillary molar. This magnified view revealed a fracture in the amalgam restoration (arrow) and extensive
creep of the restoration margins.
Case Report 2 - SDR as base material under posterior ceramic inlay restoration

Fig 23: Final cavity preparation after
removal of caries left undercuts on axial
wall preparations and an irregular pulpal
floor plane.

Fig 12: After the bonding protocol, the SDR
material was dispensed using slow, steady
pressure from the deepest portions of the
mesial and distal proximal box preparations. After a 4mm increment was dispensed
the material was left undisturbed for a few
seconds to self-level before it was light-cured
for 40 seconds from the occlusal aspect.

Fig 17: Completed restoration after finishing and polishing with an egg-shaped 30
fluted carbide finishing bur (Endenta) and
sequential finishing with OptiDiscs (Kerr).

Fig 22: Cavity outline after removal of the
defective amalgam restoration and decay
on the mesial marginal ridge. Caries Indicator (Ultradent) was ultilised to identify
some caries affected tooth structure.

Fig 24: After etching with phosphoric acid
and application of XP Bond (Dentsply)
(Fig. 10) according to the manufacturer’s
instructions, the SDR flowable base material (Fig. 11) was applied to the treated
tooth structure. The objective was to block
out undercuts on the axial wall preparations and to level the pulpal floor plane.
After light-curing, the ideal cavity preparation was achieved by using a medium
grit diamond bur.

References
Bichacho N. The centripetal build-up technique for composite resin posterior restorations. Prac Periodontics Aesthet Dent 1994; 6:17-23.
Davidson CL, DeGee AJ. Relaxation of polymerization contraction stresses by flow in dental composites. Jnl Dent Res 1984; 63:146148. Dietschi D, Magne P, Hollz J. Recent trends in aesthetic restorations for posterior teeth. Quintessence Int 1994; 25:659-676. Dietschi
D, Spreafico R (1997) Adhesive Metal - Free Restorations: Current concepts for the aesthetic treatment of posterior teeth. Quintessence
Publishing Co. Inc, Chicago. Feilzer AJ, DeGee AJ, Davidson CL. Setting stress in composite resin in relation to configuration of the
restoration. Jnl Dent Res 1987; 66:1636-1639. Inside Dentistry (2009). Surefil SDR flow Posterior Bulk Fill Flowable Base. October, p124.
Jensen ME, Chan DCN. Polymerization shrinkage and microleakage. In: Posterior composite dental restorative materials. Vanherle G,
Smith DC, editors. Utrecht. The Netherlands: Peter Szulc Publishing Co., pp. 243-262. Liebenberg WH. Posterior composite resin restorations: assuring restorative integrity. FDI world 1997;6: 12-17, 19-23. Lutz F, Krejci I, Luescher B, Oldenburg TR. Improved proximal
margin adaptation of class II composite resin restorations by use of light-reflecting wedges. Quintessence INt 1986; 17:659-664. Pearson
GJ, Hegarty SM. Cusp movement of molar teeth with composite filling materials in conventional and modified MOD cavities. Br Dent J
1989; 166:162-165. Sherrer S, de Rijk WG, Belser UC, Meyer JM. Effect of cement film thisckness on the fracture resistance of a machinable glass-ceramic. Dent Mater 1994; 10:172-177. Van der Vyver PJ, Bridges PN. Posterior composite resin restorations: Part 1. Isolation.
SADJ 2002;57:142-146. Walshaw WS, McComb D. Microscopic features of clinically successful dentine bonding. Dent Update 1998;
September:281-286. Wieczkowski F, Joynt RB, Klockowski R, Davies EL. Effects of incremenntal versus bulk fill technique on resistance to
cuspal fracture of teeth restored with posterior composites. J Prosthet Dent 1988; 60:283-287.

Fig 9: Matrix assemblage: Hawe Contoured Tofflemire Band in a Tofflemir
holder activated V-Ring and small Wave
Wedge (white). Note the inadequate adaptation of the matrix band to the gingival
mesial margin on the buccal aspect of the
cavity preparation. The small wedge was
replaced with a larger Wave Wedge (pink)
(Fig.12) to achieve improved adaptation
of the matrix band against the gingival
enamel margin.

Fig 10: Enamel and dentine surfaces were
etched for 15 seconds with 36per cent
phosphoric acid, rinsed with water and
lightly air-dried. Two coats of XP Bond
(Dentsply) was applied to the etched
enamel and dentine surfaces, agitated with
a micro-brush for 15 seconds, lightly airdried and light-cured for 20 seconds with
a Valo Light-curing unit (Ultradent).

Fig 13: Another 4mm increment of SDR
was dispensed on top of the previous layer
up to approximately 3mm from the cavosurface margin. The material was again left
undisturbed to allow for self leveling before
it was lightcured for 40 seconds.

Fig 18: Angulated view of the buccal cusp
demonstrating no signs of enamel cracking
that could have been caused by polymerization shrinkage of the bulk fill flowable SDR
base material.

Fig 26: At the cementation appointment
the upper right sextant was isolated with
rubber dam and the temporary inlay removed. A single floss ligature was utilized
around the upper first molar to guarantee
optimal isolation. The cavity preparation
line angles were cleaned with OptiClean
(Kerr) to ensure removal of any remnants
of the temporary cement. Plumbers Tape
was folded around the upper first premolar to act as an isolation medium during
cementation.

Fig 29: Immediate post-operative view after
removal of the rubber dam. The final restoration reflects optimal restoration of aesthetics, occlusal anatomy, marginal ridges and
interproximal integrity.

Fig 14: The remaining part of the cavity
prep was filled with Teric N Ceram (Vivadent), a regular viscosity composite resin.

Fig 19: Immediate post-operative occlusal view after polishing with diamond
polishing paste (Ultradent) illustrating the
optimal aesthetics, improved interproximal
contour and the shape of the composite
restoration. Note the optical integration of
the composite resin and SDR with the surrounding tooth structure.

Fig 25: After making an impression with
Aquasil soft-putty and Aquasil light body
(Dentsply) the tooth was temporized with
Integrity (Dentsply). A porcelain inlay
fabricated in the laboratory from pressed
Emax (Ivoclar, Vivadent) was etched with
9.5per cent Hydrofluoric acid (Ultradent)
for 20secs, rinsed with water and air-dried.
Silane Coupling Agent (Dentsply) was
applied and left to dry for 1min before the
treated porcelain surface was coated with a
thin layer of Prime & Bond NT mixed with
Self-cure Activator (Dentsply)

Fig 28: Occlusal view after cementation of
the porcelain inlay. Final light-curing of
the cement was done from the occlusal and
palatal direction for 30 secs respectively, using a Valo light-curing unit (Ultradent).

[28] =>

28 Oral Health
Interdental brushing key
to maintaining healthy
gums and heart
With
proof
mounting
about the link between
atherosclerosis
and
periodontal disease, interproximal cleaning as an
effective
prophylactic
against poor health has never been more important. However, encouraging
patients to floss may not be enough – a survey carried out by the British Dental
Health Foundation found that less than 1% of the British population actually
claim to floss. Equally effective, but easier to use are inter-dental brushes.
Designed to fit into each interdental space, these simple tools help patients
to effectively remove plaque without damaging gums. Curaprox Interdental
Brushes are the result of 30 years of research and refinement. Made of nickel
free CURAL, Curaprox Interdental Brushes are five times stronger than any
other brushes, providing durability and value for money. Curaprox interdental
brushes also boast several other defining features, including:
• Dense, soft filaments for thourough but gentle cleaning
• Thin access radius to get into even the smallest of spaces
• Totally interchangeable with a wide range of handles
Curaprox offers the most comprehensive range of brushes on the market
to help ensure maximum cleanliness for gums and teeth, and better overall
bodily health for patients.For more information please call 01480 862084,
email info@curaprox.co.uk or visit www.curaprox.co.uk

Decapinol® Mouthwash – The safe and
gentle alternative
Dental professionals can now enjoy a
completely new and effective solution
to the management of gingivitis and the
prevention of periodontitis, focussed
on a long term approach of this gum
inflammation condition.
Decapinol®
Mouthwash has an innovative antisepticfree formula that maintains a healthy
balanced oral micro flora, whilst inhibiting
the build- up of the plaque forming bacteria
associated with periodontal disease. This
maintenance provides a probiotic protection against pathogenic invaders.
To combat the build-up of plaque, Decapinol® Mouthwash creates an invisible
barrier between dental plaque bacteria and the surface of the tooth and
gingiva, making it a clinically effective solution.
Decapinol® Mouthwash is a safe and gentle choice to other mouthwashes
claiming to have anti-microbial properties, and avoids the unpleasant taste
and staining associated with these products. It is easy to incorporate into a
patient’s oral hygiene routine, as there is not interaction with Sodium Lauryl
Sulphate; a common component of toothpaste.
Clinically effective against plaque and gingivitis in both the short and long
term, Decapinol® Mouthwash is the intelligent solution for preventing
periodontitis.
For more information call: 01483 410622 www.decapinol.com

United Kingdom Edition October 25-31, 2010

Trust The Dental Directory for Oral
Hygiene
As the UK’s largest dental supplier, we offer
one of the most comprehensive ranges
of oral hygiene products available – all
ready for free next day delivery, and all at
fantastically low prices.
Through BigBite our new and enlarged
dedicated oral hygiene mini catalogue –
we bring together the very latest products
from all the leading manufacturers and
combine them into one comprehensive and
convenient guide.
Every issue is packed with special offers and promotions designed to offer you
the very best in choice and value for money.
To get your free copy of BigBite and to see how much we can save you on oral
hygiene products, call us today on 0800 585 586.

Guru Increases Treatment
Plan Acceptance
Guru is a new standalone
computer based interactive
education tool that uses
unique “stop, draw and
teach technology” to help
dentists and hygienists
explain why a particular
treatment is their preferred
recommendation.
More
than just a generic educational tool, Guru enables practitioners to customise
patient presentations by incorporating individual patient X-rays, intraoral and
extraoral images. In addition the patient explanation can be augmented by
pausing the animation and annotating directly onto the screen via a tablet and
stylus, or by recording an audio explanation that addresses the specific needs
of the individual case. Presentations can then be printed, emailed or burnt to
a DVD or memory stick for the patient to take away. With patients increasingly
familiar with the application of new technology, Guru provides a fantastic allround experience, whilst the extensive range of media available on a huge
variety of clinical topics allows the dentist to use Guru to explain the benefits
of undertaking various treatment options, improving patient communication
and increasing treatment plan acceptance. See Guru’s powerful animations
and educational potential for yourself by visiting Stand J14 at Dental Showcase
2010. For more information on Guru or an in-practice demonstration, please
call 01622 604695, or visit www.howdoyouguru.com

Equia from GC.
‘a complete new approach
in dentistry offering a
perfect balance’
The name EQUIA stands
for “Easy – Quick – Unique
– Intelligent – Aesthetic”
which defines a totally new
approach to filling therapy:
restorations based on glass ionomer technology have never been so aesthetic
and translucent, high-performing and economical!
Easy - Because the restorative is moisture tolerant, there’s no need for rubber
dam and the self-adhesive properties allow a chemical adhesion without need
to use bonding agents.
Quick - The restorative can be placed in bulk and only one application of the
coat is required. Only 3’15 are needed to complete the restoration so you will
win a lot of valuable surgery time.
Unique - The infiltration and dispersion of the nano fillers of the coating will
protect the restoration and the margin over a very long period of time.
Intelligent - The restoration is maturing over time reaching a hardness
comparable to that of a modern composite material.
The Equia-concept is available in a variety of combination packages, consisting
of GC Fuji IX GP EXTRA, delivered in capsules in following shades A1, A2, A3,
A3.5, B1, B2, B3, C4 together with a bottle of G-Coat PLUS.
For further information please contact GC UK on 01908 218 999.

NSK Varios 970 Ultrasonic Scaler
The Varios 970 offers me the scope of greater
control of power and greater flexibility of use. The
tips are excellent in shape and form and the tactile
feel from the handpiece is as good as I have used.”
Bob McLelland, St Ann’s Dental, Manchester.
The Varios 970 ultrasonic scaler from NSK,
provides a patient friendly and efficient way of
meeting the challenges of specialist dentistry and
can be used for perio, endo, hygiene and minimal
intervention techniques, simply by exchanging
the tip – and with a choice of over 70 tips, there is always one for the procedure
you are undertaking.
Each Varios 970 LUX is supplied, as standard, with a twin LED handpiece, 3
tips, 3 tip wrenches and an autoclavable storage container for handpiece, tips
and wrenches. The twin LEDs deliver shadow-free illumination to the entire
treatment field, allowing faster and more accurate treatment.
And now you can Rent* the Varios 970 LUX for only £74.24 + VAT per month,
for more information contact Jane White at NSK on 0800 634 1909 or visit
www.myvarios.co.uk
*Business use only, subject to status. Rental is arranged through our finance
partners Snowbird Finance Ltd.

Industry News
ORAL RELIEF GEL
(does NOT contain choline salicylate!)
Ortho-Care (UK) Ltd. Oral Relief Gel is a well
established, highly popular product and unlike
other products on the market does not contain
choline salicylate.
It has been specially formulated with analgesic
properties to relieve pain and help reduce inflammation. Its antiseptic
properties also fight infection in mouth ulcers caused by braces and other
fixed appliances. The Gel is pleasant tasting as well as being mild when applied
to the affected area.
Great news especially for the younger patient!
Oral Relief Gel is available in over the counter display units containing 12
handy sized tubes.
For information call Customer Services on 01274 392017
Email info@orthocare.co.uk or visit the website
www.orthocare.co.uk

CLARK NATHWICH Innovative
practice design brings the sky
inside
Always at the forefront of
innovation for dental practice
design, Clark Dental can now
bring the vastness of the sky into
the surgery.
Instead of torn posters tacked to the ceiling, give patients a soothing focal
point whilst receiving treatment. From a single pane to an entire ceiling,
Skyinside will provide an instant ‘wow’ factor for the practice.
‘Skyinside’ is a unique way to transform the interior with luminous, highresolution images creating the impression of looking up at a beautiful vista of
blue skies, clouds, even stars. The virtual skylight provides an engaging illusion
of nature that positively occupies patient’s attention during procedures.
When short on space, Skyinside can give the illusion of windows where not
possible before. The effects can be stunning, giving interior spaces the sense of
openness, adding to the practice’s ambience as well as the patient experience.
Clark Dental is the UK and Ireland Dental agent for Skyinside products.
For more information contact Clark Dental on 01270 613750
or email sales@clarkdentalsales.co.uk

Real Patients, Real
Practitioners, Real
Research
The P&G Healthy Smile
Trial Programme has been
running for three months in the UK. Participating professionals were asked
to select six patients to receive a free Oral-B oscillating-rotating toothbrush.
Participants had to be over 18 years of age, have at least 20 natural teeth and
have exhibited mild to moderate plaque build-up.
947 professionals participated in the scheme which involved 1,296 patients.
To date, results have shown that having once tried the technology the
overwhelming majority of patients don’t want to give it up. 83% of patients
believe the oscillating-rotating toothbrush helped them improve their brushing
technique. Dental professionals saw an improvement in the gingival health of
89% of their patients. Unsurprisingly, 92% of participating dental professionals
claimed that they would recommend the oscillating rotating toothbrush to
their patients. Clearly, having seen the improvements themselves in their own
patients, professionals are more inclined to recommend to others.
The value of this research is evident not only because the results are likely to
be shown to be consistent with other similar trials in reducing plaque and
gingivitis but also because the outcomes will be in real people engaging in
their ‘normal’ routines.

Dental Sky Will Impress You!
Dental Sky supply an impressive range
of leading brand impression materials.
R&S Turboflex from Dental Sky is
the perfect addition cured silicone
that provides exceptional detail
reproduction. This complete range
allows you to use your existing
technique, be it the wash technique or double mixing.
The light bodied materials within the range are easily injected and do not
slump even when placed in the upper arches. Having extremely high levels
of hydrocompatibility Turboflex impressions will always provide precise
impressions even when in contact with gingival fluid and blood.
With a very good dimensional stability and high elastic memory removal of
the set impression is made simple. The material is so stable that you can make
several models from a single impression without any risk of deformation.
So, whether you choose your existing brand of impression material or would
like to try Dental Sky’s cost effective Turboflex, call Dental Sky on 0800 294
4700.

Book now!
2011 British Academy of Cosmetic
Dentistry 2011 Conference
SOMETHING TO SMILE ABOUT
Dental professionals should clear their
diaries and make sure they attend
what is set to be the most exciting
cosmetic dental event of 2011 – the
British Academy of Cosmetic Dentistry’s
SOMETHING TO SMILE ABOUT conference.
The BACD’s eighth annual conference, the 2011 event will focus on minimally
invasive aesthetic dentistry. Believing that beautiful smiles can be created
while preserving and enhancing a patient’s natural dentition, and at the
same time respecting functional principles, the BACD is leading the way in
promoting an ethical approach to smile design and enhancement.
Due to take place in London at the Hilton London Metropole Hotel from the
10th-12th of November, the event promises to provide an array of fantastic
opportunities for the whole dental team to learn from the profession’s
foremost experts, improve their clinical skills and re-fire their enthusiasm for
one of the most rewarding areas of dentistry.
However attendance will be limited, so book early to reserve your place - 2011
could prove to be career changing!
For more information about membership entitlements, including access to
next year’s conference, please contact Suzy Rowlands on 0208 241 8526 Or
email suzy@bacd.com

Making Endodontic
referrals simple
Winner
of
the
2009
Private Dentistry award
for Best Referral Practice,
the EndoCare chain of
endodontic practices strives
to provide all patients with the very best care and attention. The friendly,
knowledgeable team genuinely enjoys providing an excellent service to
referring clinicians and patients, with each and every member continuously
improving their skills through relevant courses.
Led by clinical director Dr. Michael Sultan, EndoCare makes referring simple
with its online referral system. The referring dentist is kept in the loop
throughout their patient’s treatment and details of treatment plans and
procedures are clearly communicated. Six months after surgery, all patients
are schedules a follow up appointment free of charge to further support
successful ongoing dental care.
The team at EndoCare is particularly adept at treating anxious patients,
going out of its way to listen carefully to the patient and adapt the procedure
accordingly. Referrals can be complex, for dentist, patient and specialist but
the EndoCare team ensures that the process is as painless as possible for all
involved.
For more information about EndoCare or to receive your free referral
pack please call 0844 8932020, email info@endocare.co.uk or visit
www.endocare.co.uk

[29] =>

United Kingdom Edition October 25-31, 2010

Genus – Making dreams a
reality
By starting up you own squat
practice, you have an enviable
‘blank canvas’ opportunity: a
chance to leave your own unique
stamp.
It’s vital that the practice
you create clearly reflects the
exclusive services you provide, the
professional ethos that you work by and ultimately, the type of patients that
you want to attract. Genus has a team of specialists that have enabled dentists
far and wide to achieve the practice of their dreams. By transforming derelict
premises and dilapidated buildings into stylish, eye-catching ‘boutique’ style
surgeries, Genus has helped many a dentist to create practices that intrigue
and attract passers-by. With the ability to identify the potential in even the
smallest of premises, Genus can renovate a previously run-down building into
a chic, fully functioning practice. Intelligent design plays an integral role in
Genus’ approach.
Genus also offers advice on creating a practical yet comfortable surgery by
choosing cleverly designed equipment and furniture within a small space. By
not being tied to any specific manufacturer, practitioners working with Genus
have free sourcing access to the best-suited fixtures, furniture and fittings for
their practice.
For more information, please call Genus on 01582 840484 or email
chris.davies@genusgroup.co.uk www.genusinteriors.co.uk

Kemdent’s ChairSafe Disinfectant Range
Carries the CE Mark with Pride!
Kemdent is proud to announce that our range
of ChairSafe disinfectants comply with the
newly reclassified EC regulations regarding
the disinfection of medical devices, and carry
their CE mark with pride! This is good news
for all Kemdent customers who can continue
to use our ChairSafe products with safety and
confidence in their Dental Surgeries.
To celebrate this, when you buy a 200ml ChairSafe disinfectant spray with a
1L ChairSafe refill, we will give you the same absolutely FREE during October!
ChairSafe is an alcohol-free disinfectant foam cleaner which has been specially
formulated to safely clean sensitive materials such as leather, acrylic glass and
vinyl and also hard surfaces and equipment. It is economical and easy to use,
as the foam is non-drip and remains exactly where you apply it.
ChairSafe is highly effective against HBV/HIV/HCV/BVDV/vaccinia, bactericidal
and fungicidal micro-organisms within one minute of application. Also
effective against MRSA and influenza A (H1N1) viruses (pathogens of swineflu),
it is also available as a heavy duty or economy wipe.
To take advantage of this excellent special offer ring Jackie or Helen on 01793
770256 or visit our website www.kemdent.co.uk.

Industry News 29
Referring to the Kent Implant
Studio
All practitioners referring their
patients to the Kent Implant Studio
can be safe in the knowledge that
their patients will be treated by
a group of skilled experts using
cutting edge technology.
Dr
Shushil Dattani is the Clinical
Director and owner at the studio situated on Northumberland Road in
Maidstone. He has several qualifications in implant dentistry to his name: he
is a member of the Faculty of General Dental Practice and the Association
of Dental Implantologists; he has a Diploma in Implant Dentistry; and also
an Advanced Certificate in Implant Dentistry (Bone Grafting) from the Royal
College of Surgeons of England.
Dr Dattani and his team pride themselves on completing treatment quickly
and effectively, focusing on complex cases including:
• Ridge expansions
• Bone grafts
• Sinus grafts
Kent Implant Studio is able to undertake each case in its entirety or complete
only the surgery aspect of the procedure. Either way, the practitioner is
welcome to oversee any stage in the treatment process and the patient is
returned to their regular surgery for follow up procedures.
For further information on the Kent Implant Studio or to obtain a referral pack
please call 01622 671 265, or visit www.kentimplantstudio.com

West London’s First Velopex
Picasso Laser
West London is now well and
truly on the map! Their first
Velopex Picasso Laser has been
installed at the Dental Practice
in Blyth Road, which can now
offer all patients the availability
of laser treatments as well as the
high quality dentistry previously
offered. The Velopex Picasso Laser contains two lasers: a 10 Watt Gallium
Aluminium Arsenate (GaAlAs) diode laser and a small laser pointer. The GaAlAs
laser is ideal for soft tissue (gum) work – as it does not interact with teeth
or bone. It is particularly indicated for both periodontal work – where it can
sterilise the pocket killing the bacteria.The GaAlAs laser has a wavelength that
makes it an ideal way to do minor oral surgery. Using this laser, an area can be
cut with localised haemostasis. Not only does the laser cut but it also sterilises
the tissues as well making for good post-operative results. Patient feedback
continues to be very positive with many patients commenting positively on
the laser.
For more information or to ask any questions, please contact:
Mark Chapman
Medivance Instruments Ltd
Barretts Green Road
LONDON
NW10 7AP Tel 07734 044877 Fax 020 8963 1270

NobelProcera™
CADCAM technology for General Dental
Practitioners!
Setting a new standard for the development, design and
manufacturing of dental prosthetics, NobelProcera™
offers professionals the most comprehensive technology,
materials and products within CAD/CAM dentistry.
NobelProcera™ incorporates cutting edge 3D design
software and superior patented conoscopic holograpic
optical scanning or “next generation” technology and
offers GDP’s:
• Precise impression scanning capabilities, supported by delivery of the
restoration on an accurately milled model
• Full assortment of shaded zirconia products (from cement to screw retained
restorations)
• Launch of new materials for cost effective solutions - such as cobalt chrome
and acrylics for different indications
• Introduction of a wide range of overdenture and screw retained bar solutions
– on Nobel Biocare and continuously updated competitor implant platforms
• 15yrs of clinical experience and research, and ongoing commitment to
continue this legacy with extended material and prosthetic options.
Easy preparation, fully supported by readily available guidelines, NobelProcera™
offers dentists the capability to deliver the highest quality esthetics simply,
affordably and quickly ensuring an excellent fit and consistently reliable
products. For further information on any of the new Nobel Biocare products
please call: +44 01895 452 912, or visit www.nobelbiocare.com

Set rates for implant work set PDS
Labs apart
Dental practitioners keen to enhance
the quality of life of their patients
through reasonably-priced, naturallooking implants and high quality
cosmetic restorations should consider
PDS Dental Laboratory. With two fullservice laboratories in Leeds and
Newcastle, over 20 years of experience
and several awards to their name, PDS
Labs are able to offer clinicians the
very latest in implantology and restoration CAD-CAM technology, thanks to
their continual investment in the latest equipment, including the newest cad/
cam scanners. Offering a range of top quality bio-compatible implant systems,
including Ivoclar’s Biofunctional Prosthetic System (BPS), TBR implants and
screw-retained single prosthetic solutions such as Nobel Procera, PDS Dental
Laboratory helps to ensure that your patients benefit from the most durable
and aesthetically-pleasing prosthetics available on the market today. PDS also
offers clients a two-tier delivery system, ensuing that emergency work can be
fast-tracked when necessary. With all crown and bridgework perfomed under
magnification, dentists can be assured of high quality, precision restoration
work and implant creation every time.
For more information and a Laboratory Pack, call Newcastle on 0191 232
4844 or Leeds 0113 239 3675.or visit www.pdsdental.co.uk and www.
futureveneers.com

schülke: Leading the way in
infection control
In the current climate of
MRSA and C.Diff scares, it has
never been more important
for dental professionals to
strictly and systematically
clean and disinfect surface
areas.
Understanding the
pivotal role that disinfection
plays in today’s dental surgery,
schülke, industry leader in
infection control products, offers effective cleaning and disinfection solutions.
mikrozid® AF liquid cleaner and disinfectant is an aldehyde-free, alcohol-based
rapid solution that is microbiologically effective against: bacteria (including
Tb), fungi, Hepatitis B viruses, HIV, Hepatitis C, adenoviruses, rotaviruses,
papovaviruses and polioviruses in just one minute. mikrozid® AF liquid cleaner
and disinfectant can be used to effectively disinfect:• Glass • Corian • Ceramics
• Laminates It is important to carry out the cleaning and disinfection of all
surfaces after each clinical session. Zoning is the preliminary step to surface
disinfection and focuses on clearly defining areas prone to contamination.
Standing at the forefront of infection control for the dental industry in the UK,
schülke provides the training and equipment required to ensure that your
surgery maintains and promotes the highest standard in infection control
procedures.For more information call 0114 254 3500, or visit www.schulke.
co.uk/dental or www.comparethemikrozid.com

Straight Talk Inman Aligner e-courses –
“Ideal as a refresher.”
GDPs are finding out how the Inman
Aligner can revolutionize their dental
practice. Providing a truly conservative
way to achieve natural-looking smiles,
this innovative device is currently the
fastest way to align anterior malocclusions,
whilst offering the flexibility of combining
straightening with other minimallyinvasive treatments such as bonding,
whitening or minimal prep veneers.
Practitioners who have completed the Straight Talk hands-on accreditation
course, led by Dr Tif Qureshi, and who are looking for a way to refresh their
knowledge base may wish to sign up for the Straight Talk six week Inman
e-course.
Covering all aspects of the treatment process, including case type limitations,
Straight Talk’s online accredited Inman programme also provides everything
the busy practitioner needs to begin treating simple to moderate cases
immediately.

Clark Dental: Providing outstanding
surgery design
Everything about your new surgery says
something about you as a dental professional,
and the service that you provide your patients.
From the style, quality and equipment used, to
the right furnishings and décor; your patients
are given an immediate impression of your
professional expertise and standards.

Time to revamp your
website? Try THE FRESH
approach!
If you can’t remember
the last time you updated
your practice’s website,
it’s probably high time
you did. As the constantly
evolving world wide web
becomes
increasingly
saturated with new information, your practice’s website can quickly
appear outdated and stale, lost amid a raft of fresher, more modern sites.
Whether you decide to update your site’s colour scheme or improve search
engine optimisation, a professional web designer will be a valuable asset of
you are to successfully achieve your aims.
The FRESH is an enthusiastic team of designers with years of experience in
helping rebrand and refresh dental practices’ websites.
Specialising in driving patients to the practice through your website, the
young, vibrant team of professionals at THE FRESH knows how to create an
inviting image and focus marketing on the patients you want to bring in to
the practice!

Compothixo : Improved Quality
Restorations
Kerr is proud to announce the launch of a
new product inspired by you: Compothixo!
Compothixo represents a unique generation
in composite placement and modelling
instrument, suitable for all classes of restorations. New Compothixo technology
enhances the thixotropic properties of composites by only changing its
viscosity, without altering the chemical and mechanical characteristics of the
material. Compothixo unique benefits:
Better wettability
Superior adaptation of composite to cavity walls
Reduction of air bubbles
Precise application
Layer thickness control
Improved sculptability
Reduced stickiness
Compothixo is indicated for:
Modelling of composite
Occlusal modelling, fissures and removal of excess
Layer application technique
Bulk technique in small cavities
Direct veneering
Compothixo – Our Vibrations Never Felt so GOOD!
To see how you can benefit from using Kerr’s products please telephone 01733
892292 or visit www.kerrdental.co.uk.

Enabling you to transform your unique
vision into a stunning reality, Clark Dental’s surgery design services provide
essential assistance and support to dentists at this crucial time. Using the
very latest in computer-aided design (CAD), Clark Dental allows practitioners
to have the clearest vision possible of any proposed design changes, whilst
adjustments can be easily made to ensure that the final design meets your
every requirement.
With Clark Dental, you are guaranteed the complete package and total peace
of mind. From the initial discussions and planning, right through to project
completion, Clark Dental will assist you in every aspect of the work; including
conforming to the latest regulations, and installation and training for any new
equipment.
For further information, contact Clark Dental on: 01268 733 146 or email:
enquiries@clarkdental.co.uk

THE FRESH offers bespoke branding and marketing solutions for the dental
industry, including the design of dental websites. To talk to a dedicated team
member at THE FRESH and to discuss a bespoke plan to drive your business
forward, visit www.thefreshuk.com

NobelReplace™
For a more comfortable procedure
NobelBiocare’s unique NobelReplace implant
system enables practitioners to offer their
patients the very best treatment whilst at the
same time reducing pain and minimising chair
time.
Developed by Nobel Biocare, world leaders in the
manufacture of dental implants, NobelReplace
is a user-friendly system boasting numerous
prosthetic options. A favourite among surgeons
and clinicians alike, NobelReplace is able to fulfil
all both aesthetic and biological expectations.
Implantologists of every level will find
NobelReplace’s colour-coded system for fast identification simple and easy
to use. Clear instructions and a step-by-step drilling protocol help to make
procedures much more predictable and less time-consuming.
As well as ensuring that the patient spends as little time in the chair as possible,
the implants also feature their very own surface, TiUnite, which is scientifically
proven to aid the healing process and encourage implant stability for long
lasting results and improved patient comfort.
Nobel Biocare not only offers excellent implant solutions but also first class
customer service.
For more information on NobelReplace™ implants, contact Nobel Biocare on
0208 756 3300, or visit www.nobelbiocare.com

For more information, or to book your place, please contact Caroline
on 0207 2552559 (UK) or visit www.straight-talks.com

[30] =>

30 Oral Health Feature

United Kingdom Edition October 25-31, 2010

Encouraging change is essential
E

ncouraging patients to
change their behaviour
and improve their oral
hygiene is challenging but essential. ‘To understand how to motivate change in patients, the oral
healthcare practitioner needs to
be aware of the distinction between compliance and adherence,’ according to the American

education experts Joyce Turcotte
and Rebecca Lang.
In an article in the journal
Contemporary Oral Hygiene, they
explain that the word ‘compliance’ suggests patients obey the
clinician’s instructions. In contrast, the term ‘adherence’ characterises patients as autonomous,

independent and intelligent, taking more active and voluntary
roles in their dental treatment.
‘The distinction is who is directing the change. Compliance is
authority-driven and adherence
is patient-driven. When a patient
behaves in a compliant manner,
he or she is following the hygien-

ist’s rules. This may not be valued, understood or committed to
by the patients. However, adherence is a commitment made to
particular behaviours congruent
with a selected lifestyle,’ say Turcotte and Lang. That lifestyle will
probably include achieving the
freshest possible breath.

Since most people have a bad
breath problem at some time and
in nine out of 10 cases the cause
originates from within the mouth
presenting fresh breath as a desirable, and even necessary, element of a successful oral hygiene
programme can greatly influence
the demand to see the hygienist.
The Facts
• The BDA estimates that approximately 30 per cent of the population suffer from chronic bad
breath at any one time.
• A survey conducted by Periproducts Ltd indicated that nearly 70
per cent of those questioned had
experienced bad breath on someone else.
• Approximately 90 per cent of
physiological malodour originating from sites within the oral cavity can be attributed to Volatile
Sulphur Compounds (VSC).
• The gingival tissue is a principal
location of VSC.
• 80 per cent of bad breath emanates from the back of the tongue
• VSC present themselves as
odour-causing molecules made
up of small sulphur atoms.
• The aim of bad breath prevention is to eliminate the VSC as
much as possible.
• A healthy mouth constantly produces VSC at very low levels therefore it is important to maintain a
good standard of oral hygiene.
•Tongue cleansing is an important element of a successful oral
hygiene programme to achieve a
high level of oral freshness.
• Recommend oral care products
specifically designed to eliminate
odour-causing Volatile Sulphur
Compounds (VSC) associated
with oral malodour, such as the
RetarDEX™ Alcohol Free oral
health care range with fluoride
and the OOLITT™ excel tongue
cleanser.
Co-discovering with the patient the areas in the mouth that
have the potential to harbour bacteria associated with tooth decay,
gum disease and bad breath will
help patients to accept that they
need regular visits to the dentist
and hygienist.
Explaining this to patients
before starting their examinations places you in a position of
impartial observer and allows
the patient to participate in the
self-discovery process that is necessary for them to become an active contributor in their own care.
An equally successful way of encouraging co operation is to ask
a simple question; ‘Are you ever
concerned about the freshness of
your breath?’ The answer to this
question can create an excellent
dialogue opener and allows for
further investigation and a committed patient. Who wouldn’t
want Fresh Breath? DT

[31] =>

Classified 31

United Kingdom Edition October 25-31, 2010

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

Custom-fitting Mouthguards* – the best protection for teeth
against sporting oro-facial injuries and concussion.
OPROshield – a self-fit guard enabling patients
to play sport whilst awaiting their custom–fit guard.
NightGuards – the most comfortable and effective way
to protect teeth from bruxism.
Bleaching Trays – the simplest and best method for
whitening teeth.
Snoreguards – snugly fitting appliances to
reduce or eradicate snoring.
OPROrefresh – mouthguard and tray
cleaning tablets.

In 2007, OPRO was granted the UK's most prestigious business award,
the Queen's Award in recognition of outstanding innovation.

www.smileguard.co.uk
email info@smileguard.co.uk or call 01707 251252

part of the oprogroup

* SmileGuard - the first to provide independent certification relating to
EC Directive 89/686/EEC and CE marking for mouthguards.

7320_09_3

• Valuations purchase, sale, buying in, retirement
• Purchases practices available countrywide
mouthguard and tray
• Sales
totally confidentialcleaning
service
for vendors
tablets
Practice loans
arranged for any
purpose from 0.95%
above base rate.

team@ft-associates.com
www.ft-associates.com

T 08456 123 434
F 01707 643 276

1 Bradmore Building, Bradmore Green
Brookmans Park, Herts AL9 7QR

Nationwide
service

info@medicsfinancialservices.com
www.medicsfinancialservices.com
+44 (0) 1403 780 770
Very competitive fixed rates - House and Practice
Finance
Surgery Finance - Bank of England Base
(from) + 1.00%
100% Mortgage Finance - House and Practice
Extremely Enhanced Income Multiples

Enhanced income
multiples, market
leading rates & highly
competitive
mortgage solutions

for Dentists

+44 (0) 1403 780 770

Your home may be repossessed if you do not keep up repayments on your mortgage. Medics Professional Mortgage Services is a trading style of Global Mortgages Ltd.,
which is an Appointed Representative of Home of Choice Ltd., which is authorised and regulated by the Financial Services Authority.

MPMS 95x50 Dentists.indd 1

11/12/2006 21:56:19

[32] =>

Habits started at a young age
can last a lifetime
Habits, good or bad, started at a young age can last a
lifetime. As you know, many adults do not brush their teeth
for as long as they should – twice a day for 2 minutes.
At Aquafresh we understand good toothbrushing habits
can offer patients a lifetime of protection.

lky
i
M
0-3
years

That’s why we have developed a range of products to suit
children of all ages, from when milk teeth first appear
and to support your recommendations. With the help of
the “nurdle” characters we hope to make brushing a fun
activity and help children develop good oral hygiene habits.

Aquafresh milk teeth
toothpaste

toothbrush

• Gentle protection for
baby teeth and gums
• 1000 ppm fluoride
• Sugar free
• Mild mint flavour

• Soft & gentle bristles
• Rubber cushioning on
brush head to protect
gums

Aquafresh little teeth
toothpaste

toothbrush

• Protection boost for
maturing milk teeth
• 1400 ppm fluoride
• Sugar free
• Mild mint taste

• Soft & gentle
bristles
• Comfortable grip
for ease of use
• Fun character
designs

4-6
years

Aquafresh big teeth

6+ s
year

sh

toothpaste

toothbru

• All round
protection for
new big teeth
• 1400 ppm
• Sugar free
• Fresh mint taste

• Different length
• Alcohol and
bristles
sugar free
• Designed to clean • 225 ppm
between gaps
fluoride
and gums
• Antibacterial
• Mild mint flavour

mouthwash

To find out more about Aquafresh and the Nurdles, visit:

www.aquafresh.co.uk
AQUAFRESH, THE THREE STRIPED logo, BIG TEETH (stylised), LITTLE TEETH (stylised), MILK TEETH (stylised) and the NURDLE CHARACTERS are trade marks of the GlaxoSmithKline group of companies.

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[cover] => DT UK 2610

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