DT UK 2910

The future’s bright... the future’s dental / News / Charity fright bite at dental practice / News / Halloween on Canal St / Fantastic plastic? / Perio Tribune / The value of a treatment coordinator / Advertorial / Company Profile / Industry News / Classified

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November 29-December 5, 2010

PUBLISHED IN LONDON
News in Brief
Fewer smokers quit since
recession
The number of people giving up smoking has dropped
since the start of the recession, new figures show. According to a study by Professor Robert West, director of
tobacco studies at the Cancer
Research UK Health Behaviour Research Centre, the
proportion of smokers trying to quit has fallen from
32 per cent in 2007 to just 17
per cent in 2010. Fewer than
five per cent use the NHS
quit smoking services, despite research showing that
they are four times more effective than other methods.
Invasive dentistry
Recent research undertaken by researchers from the
UCL Eastman Dental Institute (UCL EDI), UCL Epidemiology and Public Health
Department and the London
School of Hygiene and Tropical Medicine and funded by
the Wellcome Trust and the
British Heart Foundation,
suggests that invasive dental treatment such as extractions, carries a small, but statistically significant increase
in the risk of stroke and heart
attack over the short term.
In a study published in
Annals of Internal Medicine,
researchers examined data
from the claims database of
a US Medicaid programme to
investigate whether impairment to blood flow resulting
from invasive dental treatment created a higher risk
for cardiovascular events.
The records suggested that
in the month following invasive
dental
treatment,
the risk of a heart attack or
stroke is increased by 50 per
cent. However, the risk then
returned to normal in the
weeks. The researchers are
keen to stress that any risk
increase is likely to be outweighed by the long-term
benefits of dental treatment.
An evolutionary edge
A sophisticated new examination of teeth from 11 Neanderthal and early human
fossils shows that modern humans are slower than our ancestors to reach full maturity.
The research, led by scientists at Harvard University,
the Max Planck Institute for
Evolutionary Biology (MPIEVA), and the European
Synchrotron Radiation Facility (ESRF), is detailed in the
Proceedings of the National
Academy of Sciences. The
current study involves some
of the most famous Neanderthal children ever discovered,
including the first hominin
fossil, discovered in Belgium
in the winter of 1829-30.

News

Money Matters

Competition

Radioactive dentists
Guidance on radiation is
introduced in the practice

Festive fun

Dental Tribune joins forces with
the BDA in our Competition

page 4

VOL. 4 NO. 29

page 6

Perio Tribune

Fantastic Plastic?

Application of PAD

Richard Lishman provides options to manage your money

Liviu Steier takes a closer look at photo
activated disinfection

page 9

pages 15-18

The future’s bright...
the future’s dental

Key figures look to the future as issues surrounding piloting and
patient care are discussed by the profession and politicians

T

he future of dentistry
took centre stage at an
event in London where
the necessity of piloting and the
burden of bureaucracy was discussed.
Key figures from the dental profession and the Department of Health, such as Prof
Jimmy Steele, Dr Sue Gregory,
Dr Nigel Carter, Dr Susie Sanderson and Dr Mike Warburton,
debated the issues of piloting,
reforming the dental contract,
overburdening of the profession
with red tape and legislation
and the implementation of successful practices within a pilot
framework.
The main message was one
of positivity, with many of the
speakers looking to a bright future for NHS dentistry. In par-

ticular, much was made of the
potential benefits of the National
Commissioning Board, due to
take over the reins from PCTs in
the next few years.
Another issue discussed was
the piloting schedule and the
commitment made by the Coalition government to piloting
prior to any reform of the current NHS dental contract.
Dr John Milne, chair of the
BDA’s General Dental Practice
Committee, looked at the current situation with pilots and
said: “I fully support an honest attempt to create meaningful pilots. Dentists are looking
to be recognised as responsible
clinicians, with the opportunity
to run successful businesses.
“Dental professionals need

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the chance to do what they
are trained to do; and be engaged with, not dictated to,
with imposed contracts and red
tape. We are all working for
the same thing: to make things
better, not worse.”
Justin Ash, Chief Executive
of Oasis Healthcare, discussed
the pilots being run at five of the
company’s practices in Cumbria. He said: “There are many
positive elements being found
in the pilots, but they will only
make a positive future if we turn
them into real action.
“In the pilots we have
been running in Cumbria, we
have highlighted a fundamental need to use the wider skills
mix of the whole dental team
to provide the health check-type
approach which can deliver

patient-focused care.”
Dr Sue Gregory, Deputy
CDO for England, reiterated the
Government’s publicised stance
on dentistry that it is not an alsoran to the more frontline healthcare services and brought the
top-line view of the current
situation to the fore. She said:
“The Government have four key
priorities for dental services:
Improvement of access, prevention, oral health of children and
reform of the dental contract.
“Within the framework of
the pilots, capitation variables
and the use of oral health pathways need to be tested. We must
assure quality, underpinning
practice with guidelines and
support. We have to change the
culture within dentistry so we
will need to do a lot of work’’. DT

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www.dental-tribune.co.uk
Dental Tribune_Dec2010.indd 1

23/11/10 13:45:38

[2] =>

2 News

United Kingdom Edition November 29-December 5, 2010

Study secures SGH funding
A

study that will investigate the effect of social deprivation on oral
health in outer north-east London has won a grant of more
than £88,000.
The study, which will investigate whether people living
in deprived communities define
oral health differently from their
peers living in less deprived
areas, beat off competition
from eleven other proposals
to secure funding from the
Shirley
Glasstone
Hughes
Trust Fund.
The study, which will consider the populations of Redbridge,
Waltham Forest and Barking

and Dagenham, will assess
whether individuals’ concepts of
oral health affects the way they
care for themselves and what
barriers exist to individuals
accessing care and adopting
healthy behaviours.
Patient concepts of oral
health will be used to find out
whether deprivation can explain
why some individuals engage in
behaviours such as smoking,
excessive alcohol consumption
and irregular visits to a dentist, which increase their risk of
oral diseases.
The study aims to assess
the strengths and shortcomings
of the way oral health serv-

ices are provided, providing
evidence on how to adapt
existing structures and develop
new services and interventions
that overcome barriers to care.
It will also provide evidence to
underpin models of commissioningcare.
Prof Liz Kay, Chair of the
Trustees of the Fund, said:
“Despite an overall improvement in the oral health of
the UK over the past four decades, a persistent and unacceptable chasm between those
with the best and worst oral
health persists.
Understanding why we have
this gap is crucial to addressing

this situation. The trustees hope
that this piece of work can make
a significant contribution to
expanding that understanding
and helping to develop practical
tools to address it.”

The FGDP(UK) will work in
collaboration with the host
institution, Barts and The
London SMD, Queen Mary
University of London, which
has a tradition of research in
health inequalities.

The project will be led by
Dr Russ Ladwa, Dean of the
Faculty of General Dental Practice at the Royal College of Surgeons of England in London. It
will be hosted by the Institute of
Dentistry at Barts and The
London School of Medicine
and Dentistry.

Both the Institutions are
delighted to be given the opportunity to carry out research
that will provide evidence to
develop cost effective models of delivering prevention
and treatment in primary
dental care.”

Thanking the trustees, Dr
Ladwa said: “The award of this
grant represents a great boost
to research in primary care.

For
further
information
about the Shirley Glasstone
Hughes Trust Fund visit www.
dentistryresearch.org DT

Survey: Experience
of decay at age 12
A
survey carried out by the
North West Public Health
Observatory (NWPHO)
and The Dental Observatory
(TDO) working with the Department of Health (DH) and the
British Association for the Study
of Community Dentistry (BASCD) has provided information
on the caries prevalence and severity of 12 year olds attending
state schools.

Additional reports provided
information about the demand
and need for orthodontic intervention in this age group, experience of oral discomfort and
the impact it has on quality of
life, self-perception of enamel
opacities1 of front teeth and
brushing habits.
The data was collected by
trained and calibrated examiners employed by PCTs. The
data collection involved visually
detecting
missing
teeth,
filled teeth and teeth with

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
Editor
Lisa Townshend
Tel: 020 7400 8979
Lisa@dentaltribuneuk.com
Advertising Director
Joe Aspis
Tel: 020 7400 8969
Joe@dentaltribuneuk.com

obvious dentinal decay.

In addition the need and
demand
for
orthodontic
intervention were measured
along with self-perception of
enamel opacities, self-reporting of oral symptoms and the
impact they had on quality of
life, brushing frequency and
the presence and absence
of plaque.

The Results
At a national level, the study
revealed that 33.4 per cent of
pupils had experience of caries, having one or more teeth
which were decayed to dentinal
level, extracted or filled because
of caries.
The remaining 66.6 per
cent were free from visually
obvious dental decay. Overall, the study revealed that on
average, 12 year old children
in England have 0.32 teeth
decayed into dentine.

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.

Sales Executive
Sam Volk
Tel: 020 7400 8964
Sam.volk@
dentaltribuneuk.com
Editorial Assistant
Laura Hatton
Laura.hatton@dentaltribuneuk.com

Design & Production
Ellen Sawle
ellen@dentaltribuneuk.com
Clinical Editor
Liviu Steier

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

At a national level, the average number of filled teeth is
0.35 and the average number of
missing teeth is 0.07.
The results also showed that
reducing levels of disease are in
alignment with those found in
previous years. The geographic
distribution of disease levels
is also consistent with previous surveys. The northern
SHAs, Yorkshire and The Humber, North West and North East
show higher prevalence and
severity of disease than SHAs

Average number of dentinally Decayed, Missing (due to decay) and Filled Teeth (D3MFT) in
12 year old children including 95% confidence limits.Strategic Health Authorities, 2008/09

in the Midlands and the South
West. The more southern
and easterly SHAs, South
Central, South East Coast and
London, along with East of
England, have the lowest levels

Fear of red tape

arlier last week, the British Dental Association
(BDA) warned that growing bureaucracy is destroying the
morale of high street dentists in
England and could be driving experienced practitioners to retire
early or leave the NHS. According
to their research, excessive administration is the primary factor
behind a downturn in dentists’
confidence and this could be driving many experienced practitioners to consider early retirement.
Nearly half of all high street
dentists are reporting that their
morale has fallen during the
past twelve months. More than
60 per cent of those said that
growing administration was to
blame for the decline in morale. Rising expenses and continuing problems with the
2006 dental contract, including
a lack of time to provide preventive care to patients, were also cited as major factors in the declining confidence of the profession.

Worryingly, more than ten per
cent of dentists aged 55 and over are
already leaving the NHS each year.
The BDA is concerned
that the registration of dental
practices with the Care Quality Commission in 2011 could
exacerbate the problems that
are already being seen, and
drive many dentists into early
retirement. This would be a serious concern both because
it could affect patients’ ability
to access dental care and
because it would deprive dentistry of a generation of highly experienced dentists.
John
Milne,
Chair
of
the BDA’s General Dental
Practice Committee, said: “Morale amongst family dentists
in England is becoming a real
problem. My fear is that many
of our most experienced practitioners, the dentists that families
have relied on for generations,
could feel so wrapped up in red

of disease.
The full tables of results at
PCT, LA and regional level are
available at www.nwph.net/
dentalhealth. DT
tape that they simply choose
to walk away. That would be
a disaster.
“The Government is taking
steps to address the problematic contract that was introduced
in 2006 and we are looking
forward to an announcement
of how new arrangements
will be developed. But it’s also
clear that red tape is becoming
a major issue, with CQC registration a real concern for dentists. If the new contract is to be a
success the Government must
look at this carefully, untangle
the red tape and free dentists to
do what they are trained for: care
for patients.” DT

Dentists face a mountain of paperwork

[3] =>

United Kingdom Edition November 29-December 5, 2010

Editorial comment

Award for
excellence

E

dward Lynch, Head of
Warwick Dentistry, part
of
Warwick
Medical
School, has been honoured with
accredited membership of the
prestigious American Society for
Dental Aesthetics (ASDA).
Fewer than 200 educators, innovators and practitioners worldwide have received
this distinguished accredited
membership since ASDA was
established in 1976, when it became the first aesthetic dental association in the world.

attendees was that everything will
be alright for NHS dentistry.
This would be fantastic news,
except for the fact that to me it
seemed that many of the speakers, with their various levels of interest in the success of a new contract and piloting, were almost
trying to convince themselves
that the future was indeed rosy.

I can see the need for and encourage a positive attitude
when it comes to the future
of NHS dentistry. Stakeholders from all side of the spectrum need to come together and
take the best bits from the pilot
schemes to improve the experiences for patients and the working conditions for practitioners.
However, there are too many cyn-

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

The AOG and Smile-on in association with The Dental Directory bring you

Clinical Innovations
CONFERENCE 2011

THE

A

s you will
have
seen
from the front
page story of this issue, I recently attended the Westminster Health Forum’s
meeting looking at
the future of dentistry. The event
was interesting and informative
with the overriding message for

ics (myself definitely included in
that) in dentistry who would feel
most disquieted by a united show
of optimism from both the profession and politicians. I reserve
judgement until we have more
clarity about CQC and
how the Commissioning Board will function before donning
my shades and basking in the glow of the
bright new NHS. DT

News 3

Throughout its 34-year history, the association has sought
to raise awareness of this specialised area of dentistry by showcasing those experts who are able to
share the best and most innovative techniques.
Edward explained: “I’m delighted to receive the honour of
this prestigious accreditation...We
are building a team of world class
academics in Warwick Dentistry
and we aim to be a world-leading
postgraduate unit, internationally
renowned for our high quality and
relevance of our education programmes and for the excellence
and significance of our research.’’
To mark his membership,
Edward was asked to give the
prestigious keynote address at
the annual ASDA congress in San
Antonio, Texas. ASDA introduced
his keynote address by recognising his efforts in the development of Education and Research
in Dentistry and for his many
achievements and contributions
to the profession, appearance related dentistry, dental education
and research. He was also voted
by his peers in April 2010 as this
year’s most influential person in
UK dentistry. DT

Friday 6th and Saturday 7th May 2011
The Royal College of Physicians,
Regent’s Park, London
Contact us on 020 7400 8967 quoting DTUK10 to get your early booking discount

Already confirmed to speak are:
Tif Qureshi, James Russell, Nasser Barghi, Wyman Chan, Raj Rayan, Trevor Burke,
Raj Rattan, Julian Satterthwaite, Wolfgang Richter

Edward Lynch

[4] =>

4 News

United Kingdom Edition November 29-December 5, 2010

The Arts and Crafts of charity
T

he
Northern
Ireland
Branch of the BDA is
holding an art and craft
exhibition and auction in aid of
the Ben Fund.
All the pieces have been created and donated by branch
members their families and their
friends. The pieces range from
pictures in oil, acrylic and watercolour to bronzes, wood carvings, walking sticks and patchwork quilts.
You can view the pieces and
bid for them online at www.
bda.org/nibenfundauction. The

online auction continues until
7.00pm on Monday 6th December. There will be an exhibition
and sealed bid auction of the
pieces on Tuesday 7th December
at Malone Lodge Hotel, Belfast
starting at 7.00pm. The presidential address will follow at 8.00pm.
The highest bid online or on
the night will take the piece.
Henry Schein have kindly
agreed to sponsor the evening
and have agreed to deliver the
items to the winning bidder. To
view and bid visit www.bda.org/
nibenfundauction DT

Some of the lots waiting to be bid on by one of the contributors, Tamara Timofejeva

Prison dentist gets prison sentence Radioactive dentists

dentist who treated jail
inmates has been given a
2.5-year prison sentence
for defrauding the NHS.
According to news reports,
John
Hudson
was
jailed for claiming more than
£300,000 from the health service by billing twice for the same
treatment.
Hudson, 58, provided dental care for inmates at HMP
Altcourse, a privately run facility at Fazakerley near Liverpool.
Dental services at Altcourse
were also contracted out and the
dentist took advantage of

a change in NHS accounting
and billing systems in 2006.
The court heard that a
good part of the illegally gotten
payments went on fees for
the education of his three children and holidays, but he now
owes £40,000 and is being
sued by the NHS for £500,000.
Hudson admitted to two
charges of dishonesty and
illegally obtaining credit from
the health service. Judge
Graham Morrow QC, who
sentenced Hudson yesterday
at Liverpool Crown Court,
said that Hudson had held a

respected position in the community at the nearby town of
Whitworth, but had committed acts of blatant dishonesty
that deprived patients of money
that should have gone towards
their care.
It was revealed that Hudson
was paid by HMP Altcourse
but also claimed £307,000 over
two years.
It was also reported that
Hudson
approached
Liverpool Primary Care Trust about
a contract at the jail demanding £247,000 a year; he went
on to accept half that figure. DT

Vegetables are good for you: Fact

esults from a recent study
have shown that women
who consume high volumes of folic acid found in Vitamin B from vegetables and some
fruits are less likely to suffer
from mouth cancer.

more likely to develop mouth
cancer than those who drank
high volumes of alcohol but had
high volumes of folic acid in
their diet.

Starting in 1976, 87,000 nurses were followed by researchers from the Columbia University Medical Centre and Harvard
School of Public Health
for 30

As recent studies have
shown, alcohol is one of the major risk factors for mouth cancer
and those who drink to excess
are four times more likely to be
diagnosed. However, this is the
first time that folic acid intake
has been shown to affect
the risk of the disease.

years.
The
research revealed that
women who drank a high volume of alcohol and had low folic
acid intake were three times

Chief Executive of
the British Dental Health
Foundation, Dr Nigel
Carter, said: “Rates
of mouth cancer in women
have
been
increasing
for many
years
as
a result of
changed social habits
with
more
women smoking and drinking.
This new research
could offer a method to
reduce this by looking at the

folic acid intake and increasing fruit and vegetables ontaining folic acid in the diet.
“In the past studies have tended
to focus on males, as they are
twice as likely to suffer from
the disease. Whilst this study
focuses on women we know that
men also benefit from the protective value of increased fruit
and vegetables”.
Folic acid or vitamin B9 is essential to an individual’s health
by helping to make and maintain
new cells. Alcohol leads to a reduction in folic acid metabolism
by creating acetaldehyde which
leads to a reduction of folic acid
in the body. Folic acid is found in
vegetables such as spinach, asparagus, beans, peas and lentils
and is added to bread. Fruit juices, broccoli and brussel sprouts
contain smaller amounts.
Having an unhealthy diet
has been linked with around
a third of mouth cancer cases.
Recent research has also shown
that an increase in food such as
eggs and fish that contain Omega 3, and nuts, seeds and brown
rice, which are high in fibre, can
help decrease the risks. DT

he Health Protection
Agency has been introducing guidance on radiation protection for dentists
using certain new types of scanners in dental surgeries.
In the past few years, specialist dental surgeries all over the
UK have been introducing Cone
Beam Computed Tomography
(CBCT) technology to aid treatment. These scanners are similar to those used in hospitals for
medical examinations; however
they only scan the jaw and skull.

adequately protected and making sure rooms where the equipment will go are specifically designed for the technology.
• How existing regulations apply
to the use of CBCT.
• Standards that dental CBCT
scanners should be tested
against to make sure they work

The scanners are used for
specialist examinations and can
deliver higher doses of radiation, unlike other X-ray equipment that dentists use.
Because of the rapid uptake
of this new technology and the
lack of specific safety guidance
on its use, the Health Protection Agency’s dental radiation
specialists assembled a group
of experts to formulate guidance
for dentists.

New guidance on radiation protection has
been released for dental professionals

correctly and are capable of
keeping patient doses as low as
practicable.

Dr John Cooper, Director of
the Health Protection Agency’s
Centre for Radiation, Chemicals
and Environmental Hazards,
said: “Cone Beam Computed Tomography is a new and useful
tool for dentists. However, like
any X-ray equipment this technology utilises radiation and
therefore there are risks.

• The training that dentists and
other users, will need to enable
them to use the new technology
properly.

“I am sure that the detailed
and thorough work undertaken,,
will play an important role in ensuring that doses to patients are
effectively controlled and that all
others involved in the use of this
technology, dentists and their
staff, are well protected.”

Dr Cooper added: “This guidance will play an important role
in protecting all those involved
in the use of CBCT and I want to
thank the group which developed
it for its hard work. The fact that
those on the group come from
such diverse backgrounds illustrates how this advice has been
developed by all those with a
professional interest in this field.

The new guidelines sets out:
• What dentists should do before acquiring a CBCT scanner,
including choosing suitable
equipment, ensuring staff are

The expert group included
HPA dental and medical radiation protection staff, dentists,
regulators, medical physicists
and academics.

“I hope that dental professionals
will
find
this
guidance useful.” DT

[5] =>

40% of denture patients are
1
concerned about denture odour
Yet many denture wearers fail to keep their
dentures clean2.
That’s because brushing dentures with ordinary toothpaste can scratch
denture surfaces3. And scratched surfaces can lead to bacterial growth4
leading to denture odour.

Scanning electron microscope (SEM)
images at 240 minutes confirm a significantly
higher build up of Streptococcus oralis on
denture materials previously cleaned with
ordinary toothpaste vs. a non abrasive solution5

Poligrip denture cleansing tablets effectively
remove plaque and tough stains6 without
scratching3, to leave dentures clean and fresh.
Poligrip Total Care denture cleansing tablets
also kill 99.9% of odour causing bacteria.

Recommend Poligrip denture
cleansing tablets to help your
patients control denture odour
References: 1. GlaxoSmithKline data on file, 2010. 2. Dikbas I et al, Int J Prosthodont 2006; 19: 294-8.
3. GlaxoSmithKline data on file Study L2630368 2006. 4. Charman KM et al. Lett Appl Microbiol. 2009;
48(4):472-477. 5. GlaxoSmithKline data on file Study NPD/EU/062/07 2008. 6. GlaxoSmithKline data on
file Study USNPD 016 and CS5244.

POLIGRIP is a registered trade mark of the GlaxoSmithKline group of companies.

SPEAK, EAT AN D SMILE
WITH CONFIDENCE

[6] =>

6 Competition

United Kingdom Edition November 29-December 5, 2010

Charity fright bite at Queen’s awarded for
communication
dental practice
Q
G
oing
to
the
dentist is already a scary
prospect for many, but
one Hampshire surgery made
sure patients were in for
an extra fright this Halloween.
Spooky goings on at the Boyatt
Wood Dental Centre, Eastleigh,
saw Count Dracula and his team
of Mummies, Witches Fairies and
Cat Woman pacing up and down
the corridors. Peter Saund and his
bewitching dental team ensured
a trick and treat for their patients
as they donned their scariest outfits to end a month of fundraising
for Cancer Research UK.
Dr Saund, who lost his
wife Veena to ovarian cancer
in September 2007 at the tender age of 43, said that this was
the second year their campaign

raised over £1400. Last year the
theme was Christmas and they
raised £906. They have already
started planning next year’s

campaign,
Hawaian
fancy
dress, in the summer. ‘It would
be great if we could hit £2000
next year’, said Peter. DT

ueen’s University and
RNID Northern Ireland
have won a national
award for their work in ensuring future doctors are better
equipped to communicate with
deaf patients.

Queen’s School of Medicine, Dentistry and Life Sciences received the Organisational
Achievement accolade at the
annual Signature Awards for its
Specialist Module on Deafness.
Hosted by leading deaf charity
Signature, recognise those who
have made a significant contribution towards achieving a society
in which deaf and deafblind people have full access to society.

Peter Saund and his spooky team

Second year medical students
are offered the specialist mod-

ule, delivered by the RNID in
British Sign Language (BSL). It
ensures that future doctors are better equipped to communicate with
deaf patients, and includes
information on deaf awareness, deaf culture and healthcare issues for people who
are deaf or hard of hearing.
Following the success of the
module, both Queen’s and the
RNID now intend to make the
module available to all healthcare-related undergraduates at
the University, through the development of a website funded by
the Higher Education Academy.
For information on the School
of Medicine, Dentistry and Life
Sciences at Queen’s visit at www.
qub.ac.uk/schools/mdbs/ DT

Christmas Competition
With Christmas just around the corner you can’t help but feeling
Christmassy! So what’s better than a festive Competition?
This Christmas, Dental Tribune has teamed up with the British Dental Association (BDA) to give you a chance to
win some unique Christmas gifts and for those who want to buy a Christmas gift with a difference look no further!
The BDA have come up with a unique range of charity gifts in assocation with Dentaid, who have supported 210
oral health projects in 58 countries around the world.
The range of charitable gifts include a dentist’s toolkit and training manual to help a dentist in the developing
world; a chance to pay for 250 education leaflets to help stop the practice of infant oral mutilation, the second
most common cause of infant mortaility in Uganda; there is also a gift which supplies a Cambodian orphanage with
dental care for a year.
Alongside these charitable gifts are also some rather unique ideas, such as tooth-shaped golf tees, which come with
uniquely-shaped ball markers. There are also tooth and brush cufflinks and tooth charm earrings, a tooth floor lamp and
framed cartoons with a dental theme.
For a chance to win one of three goodie bags worth more than £50, simply answer this question:

In what year was the BDA founded? Was it
a) 1792
b) 1850
c) 1880
Email your answers to lisa@dentaltribuneuk.com with the subject ‘Christmas competition’.
The closing date for the competition is 15th December 2010.

Good Luck!
To have a look at all the gifts available visit the BDA website

[7] =>

United Kingdom Edition November 29-December 5, 2010

Denplan Awarded ‘Best
Large Stand’ at BDTA

s part of the 2010 BDTA
Dental Showcase, Denplan was recognised as the
winner of Exhibiting Magazine’s
‘Best Large Stand’ category!
Exhibiting is the UK’s leading exhibition and events magazine, which conducted an independent review of all the stands
at this year’s showcase.
Editor, James Barrett, com-

mented that: “The Denplan
brand was very well represented
by its stand and staff. Staff were
bright and attentive and the
stand design, promotional giveaways and staff attire all linked in
to its brand values and image.”
The Denplan stand asked
“Do you do Denplan?” and
demonstrated that it is the only
dental payment plan brand that
consumers can ask for by name.

Denplan’s Managing Director,
Steve Gates added: “Our stand
this year was designed to highlight the unique benefit that our
brand offers members.
“The BDTA has been a great
success for us this year and
this award is the icing on the
cake, recognising the team
spirit and hard work of our
Events team and all the staff on
the stand.” DT

Free screening for oral cancer

dental practice in Surrey is offering free
screenings for oral cancer to support Mouth Cancer
Action Month.
Throughout November, the
Montrose Smile Studio in Montrose Avenue, Whitton, is offering patients a free screening
test, as part of Mouth Cancer
Action Month.
As has been stressed throughout Mouth Cancer Action Month,
oral cancer is fast becoming common in the UK, however, many
people are unaware of the symptoms and signs to look out for;
consequently many are failing to
see a doctor or dentist until their
condition is at an advanced stage.
Therefore, the aim of the
campaign is to promote regular

appointments in order to ensure
early detection and treatment.
The Montrose Smile Studio is
raising awareness by using the
slogan which accompanies the
campaign ‘If in doubt, get checked
out’; in addition to the screening
programme, the surgery is also
providing patients with leaflets
and information about symptoms
and causes of oral cancer.
Dr Nigel Carter, from the
British Dental Health Foundation, is urging members of
the
public
to
see
their
dentist for a check-up every
six to twelve months. It is being asked that people keep an
eye out for symptoms of
oral cancer and make positive
changes to their lifestyle habits, in order to reduce the risk of
developing oral cancer.

Drinking regularly and smoking have been identified as the
major risk factors of oral cancer
and a poor diet, lacking in fruit
and vegetables, can also increase
the risk.
Symptoms and signs to look
out for include red or white
patches in the mouth, unusual
swelling or lumps in the throat
or mouth and sores which do not
heal for a long time. DT

New BSDHT President

t the recent BDTA Showcase Sally Simpson, (pictured), was installed as
the new President of the British Society of Dental Hygiene
& Therapy, BSDHT. Sally takes
over from Marina Harris. who
has completed her two-year term.

Sally has been a member of
the BSDHT from when she was a
student at King’s College in London in 1995 where she was studying to be a dental hygienist. She
subsequently joined her BSDHT
regional committee and held the
positions of Honorary Treasurer
and Regional Representative on
the National Council. Since then
Sally has acted as a consultant to
the dental trade industry, working closely in the development
of equipment aimed at the DCP
markets and has been a member of the Executive Committee
for the last four years. Sally became President Elect two years
ago and will serve a two-year
term as President.
Speaking at the Annual General Assembly of Members Sally

said: “ It is an honour and a privilege to become BSDHT President,
I am committed to representing
the views of our membership,
promoting our profession and
organisation, and continuing the
work of past presidents and ex-

ecutives in further developing
relationships with other major
organisations in Dentistry and
Healthcare.”
The President of the BSDHT,
leads an Executive Committee of
10 that is responsible for the dayto-day management of the Society. The President also heads the
BSDHT Council, which ratifies
recommendations made by the
Executive, sets budgets and ensures that the aims of the Society
are being met.
The British Society of Den-

tal Hygiene & Therapy, BSDHT
(formerly British Dental Hygienists’ Association, BDHA) was set
up in 1949 by a group of 12 dental hygienists who felt the time
was right to organise a professional association to represent the
interests of their profession. More
than 60 years later, the BSDHT
is a nationally recognised body
that represents more than
4,000 members across the UK
and beyond.
The Society’s aims are to:
• Represent members at national
level, particularly in the political
arena.
• Provide services to members.
• Support members on issues
which affect their working lives.
• Produce a publication that educates, updates and inspires.
• Provide CPD opportunities, both
locally and nationally.
• Help members to find employment and provide guidance on
contractual matters, as well as
salaries, and access to a 24/7 legal helpline.
• Listen to members and respond
accordingly. DT

News 7

[8] =>

8 MSc Blog

United Kingdom Edition

Halloween on Canal St

Elaine Halley gets residential and looks at critical reading

ollowing on from a few
more webinars, the course
module on critical reading
has begun. This is hosted on Manchester University’s own platform
called Blackboard, which allows
us to follow the course on-line

week by week. We were introduced to the system by AnneMarie Glenny, who is the course
leader and tutor and advised
us that if we keep up week by
week she will be facilitating the
discussion board and we will

get feedback week by week.
This has been a good discipline as otherwise it has
been tempting
to let the
lectures build up and then find
you have nine hours of webinar to
catch up on in a short space of time.

The blackboard system utilises
interactive learning with videos
and tutorials on searching for
documents on Medline and other
databases – I had no idea there
were so many different ways to
search! There are also links to

November 29-December 5, 2010

further learning including some
very useful checklists on how to
critically appraise different types
of studies – dusting down my
memory banks to remember the
difference between an RCT (not
the endo type!) and a cohort study
etc. And I am thrilled, in a kind of
sad way that I should probably not
admit, to see that this week there is
a section on Endnote – I may finally understand how to keep
track of all my references! Hooray!
We faced considerable stress
and late nights to complete the
submission of our next five clinical cases – which was reduced
to three at the last minute, but I
managed to submit five as that
means I’ve only got six instead
of eight to get together before the
end of January. The clinical case
submissions are very specific
which makes case selection quite
difficult – and we are learning
how to include more evidence in
the case write-ups. The specific
feedback is yet to be received so
we’ll see! I was fortunate to have
documented many cases over the
years which I could use in some
instances (although there always
seems to me a photo missing!)
but if you have just started with
photography at the start of this
course, the workload to get all the
cases in must be even harder.
This deadline was closely
followed by our second residential course held in Manchester
with teaching at the MANDEC
institute. We had three days
with Prof Nasser Barghi, who
has unbelievable energy and
passion for teaching – and provided a detailed update on materials, repairs in porcelain
and handling Zirconia. The
hands-on session was well supported by Optident who had order forms for everything that
was mentioned in the lectures.
The Sunday was a hands-on critical
appraisal session (not easy
afterHalloween on Canal Street
– you’d think I’d learn!) followed by a hands-on session on
muscle
exam
and
facebow registration.
Again, I have the greatest respect for the students who have
travelled literally from all over
the world. Never again can I complain about the flight from Edinburgh. The diversity within our
student group truly adds to the
learning experience.
Meanwhile – I have two deadlines looming in the next few
weeks – a critical reading assignment and two essays. Help –
Medline here I come!! DT

About the author
Elaine Halley BDS DGDP (UK) is the
BACD Immediate Past President and
the principal of Cherrybank Dental
Spa, a private practice in Perth. She
is an active member of the AACD and
her main interest is cosmetic and advanced restorative dentistry and she
has studied extensively in the United
States, Europe and the UK.

[9] =>

United Kingdom Edition November 29-December 5, 2010

Money Matters 9

Fantastic plastic?

See what you
are missing...

Richard Lishman discusses some of the options
available to manage your credit cards

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scar Wilde once famously remarked, when
a colossal fee for an
operation was mentioned, that
he would have to die beyond his
means.
Even before the recession, the
statistical evidence that many of
us were sustaining our lifestyles
on the back of our credit cards
was overwhelming. As hard
times continue, and with inflation returning, if you find you
cannot clear the balance on your
plastic friend at the end of every
month, it’s time to take a long,
hard look at the deals on offer
across the credit card market.
In spite of a Bank Base Rate
of only 0.5 per cent, credit card
interest rates are averaging an
astonishing 18 per cent, the
highest level since 1998. Dr. Alt-

those for existing card holders.
For the cost of a phone call, you
may be able to switch to this
lower rate – typically about half
of what you may be paying now.
It’s well worth the effort; the difference between 18 per cent and
nine per cent on an outstanding balance of £5,000 is £450, or
roughly £9 a week!

in after the 0 per cent period,
which will be higher the longer
the interest free period lasts.

If this direct approach is unsuccessful (the company may
feel you are a high risk customer, depending on your payment
record or pattern of card usage,
or it may simply not be company
policy), then you need to vote
with your feet.

Naturally not everyone is in
this happy position, but there
are alternatives on offer.

A by no means exhaustive
check of the market quickly revealed no fewer than 85 zero per
cent balance transfer offers with
a wide disparity in terms and

‘Although as individuals we cannot control
macro economics, we are able to take
responsibility for own circumstances.

man, a former Downing Street
pension’s adviser, is calling for
an investigation into the industry and has suggested appointing
a regulator to protect the public
from exploitation. Recent Government proposals do suggest it
is considering taking action, but
the companies themselves justify the figures by referring to the
increasing number of customers
defaulting on their liabilities, itself a reflection of the recessioninduced rise in unemployment.
Although as individuals we
cannot control macro economics, we are able to take responsibility for own circumstances.
The first step is to attempt to reduce the rate being charged by
your current card provider. The
market is awash with card issuers, and in the competitive pursuit of new business introductory
rates are often much more favourable than

conditions. You need to decide
which offer dovetails best with
your own finances.
Whatever the banks may say
about supporting society, their
first obligation is to make a profit and 0 per cent loans are clearly untenable in the longer term.
But this does not mean you cannot exploit the situation to your
own maximum benefit.
Of the 85 offers I found, only
two did not charge a transfer
fee, while the 0 per cent interest ‘honeymoon’ period varied between one an 15 months,
with some stating a definite end
date. In most cases the fee was
between two and four per cent
of the balance transferred, with
the longer interest free periods
attracting the higher fees. Of
course, if the transfer fee is taken into account and spread over
the relevant period, 0 per cent effectively ceases to be 0 per cent,
whatever the advertisements
may say! You
should
also
take note of the
rate which
kicks

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However, if you are confident you can clear the outstanding balance within the 0 per cent
period, and especially if there is
no transfer fee, this is the ideal
deal for you.

Some companies are offering specific transfer rates for the
life of the balance, and these are
worth considering if you know
it is likely to be years before you
will be back in credit. Comparable with an orthodox personal
loan, balances can be repaid
at any time without penalty if
your circumstances change.
Again, terms and conditions
vary widely, (with rates from 0
to a massive 35 per cent!), and
in some cases fees are applied.
Flexibility is a key advantage of
these arrangements, and over
the longer term they may well
prove competitive for some types
of borrowers.
Zero per cent on purchases
for the first few months is always
tempting, and makes sense if
you can clear the balance at the
end of that time, but the eventual
rate on such a deal is likely to be
significantly higher than average.
The credit card ‘tart’ who
changes provider every ninemonths in pursuit of 0 per cent
deals often finds it’s more expensive when fees are taken into account, and whenever you switch
check on the ultimate rate before you decide. Sticking with
one company with a lower rate
for the life of the balance is often
the best policy.
Most vital of all, (apart from
reading the small print!), is to
make at least the minimum
monthly payment, and do talk to
the card provider if you’re struggling. Defaults are not in anybody’s best ‘interests!’ DT

About the author
Richard T Lishman of money4dentists,
which
are a specialist firm
of Independent Financial
Advisers
who help dentists
across the UK manage their money
and achieve their
financial and lifestyle goals. For more information call
0845 345 5060 or email info@money4dentists.com

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[11] =>

Perio Tribune
Perio Tribune

Application of PAD
Liviu Steier takes a closer look at photo activated disinfection

Perio Tribune

Washed away

The next generation
Helmut Nissen
cleaning

discusses

page 15-18

Perio Tribune

interdental

Howard Thomas discusses the effectiveness of mouthwash

page 19-20

pages 21-22

Appraising the true value of Decision – Making
Process for Tooth
Retention or Extraction
by Prof Dr med dent Liviu Steier

vila et al. state that the
decision
tree
introduced “…was developed
upon available scientific literature”. This last phrase may be
misleading to the general dental
practitioner.
The author of the current paper has written this paper to avoid
confusion among the profession.
Scientific papers published in
peer reviewed journals should
have a similar framework:
• Introduction – to emphasise
the topic / question / hypothesis
raised by the paper.
• Methods – to explain the approach, topic / question that

should be highlighted.
• Conclusions – to conclude
if results / findings / answer
of the question introduced are
applicable to.
Accumulation of knowledge
today is based on what information is supplied. Textbooks represent an excellent resource of
information. They will mostly
update you on different concepts,
techniques, and approaches. Appraisal of procedures, techniques
and concepts can be performed
based on scientific papers published in peer reviewed journals.
Correct, comprehensive and
adequate appraisal of the literature is decisive for the outcome

‘Correct, comprehensive and adequate appraisal of the literature is decisive for the
outcome of contemporaneous papers’

has been approached / studied /
researched by the paper by answering the classic questions:
who, what, why, when, and
where.
• Results – to describe the findings / results / answer and
present them.
• Discussion – to explain the
importance / significance
of
the findings / answer and put
in context with the evidence by
analysing own methodology and
compare with available data and
knowledge; if need of further
work has been identified this

of contemporaneous papers.
The paper published by Avila et al. in 2009: “A novel decision – making process for tooth
retention or extraction” in the
JOP is intended as “…a reference
guide for dentists when making
the decision to save or extract a
compromised tooth.”
Who wrote this paper?
The paper has been written by
multiple authors with different
backgrounds:
1. Periodontists: Gustavo Avila,
Thiago Morelli, Stephen Soehren, Hom – Lay Wong.

2. Oral Surgeon: Pablo Galindo –
Moreno.
3. Prosthodontist: Carl Misch.
What is the goal?
The authors’ intention was to offer “…a reference guide for dentists when making the decision
to save or extract a compromised
tooth”.
Why has this paper been
published?
Fast on-going research has expended multiple fold treatments
options in modern Dentistry: Biotissue - and Biofilm engineering, three dimensional diagnosis
(radiology), CAD CAM technique
as well as dental materials ensure more support for diseased
hard and soft tissue. Reviewing
treatability in the context of disease stadium was the major goal
of the paper.
When was the paper
published?
The paper was published in Volume 80 of The Journal of Periodontology in 2009. It is of major
importance for the general practitioner with limited time availabilities and a restrained access
to the literature to be offered
updated complex decision taking
instruments.
Where was the paper
published?
The paper has been published in
the official organ of the American Academy of Periodontology.
The review methodology of this
journal guarantees the highest
professional confidence.
130 papers have been referenced by the authors. The refà DT page 12

[12] =>

12 Perio Tribune
erenced papers have been published in the following journals:
• International Journal of Prosthodontics - 1
• Journal of Prosthetic
Dentistry - 4
• Clinical Oral Implants
Research - 4
• Journal of Periodontology - 37
• Journal of Clinical Periodontology - 24
• Periodontology 2000 - 5
• International Journal of
Periodontics and Restorative
Dentistry - 1
• Annals of Peridodontology - 1
• Journal of Endodontics - 4
• Australian Endodontic
Journal - 1
• International Journal of Oral
Maxillofacial Surgery - 1
• Oral Surgery, Oral Medicine,
Oral Pathology, Oral
Radiology - 2
• Acta Odontologica
Scandinavia - 2
• Dental Clinics of North
America - 1
• Journal of Dental
Research - 1

Dentofacial Orthopaedics - 1
• International Journal of Maxillofacial Implants - 3
• Journal of Dentistry - 1
• Operative Dentistry - 1
• Quitessence International - 1
• Journal Contemporary Dental
Practice - 1
• Scandinavian Journal of Dental Research - 2
• Journal Bone Miner. Res. - 3
• Endocrinology - 1
• Journal of Dental
Education - 1
• Cochrane Database - 1
• Clinical Oral Investigation - 1
• Journal of Oral
Investigation -2
• Journal of Orofacial
Orthopaedics- 1
• European Journal of Orthodontics - 1
• Journal of American Dental
Association - 1
• Clinical Anatomy - 1
• Current Opinions in
Dentistry - 1
• Journal of Evidence Based Dental Practice - 1
• International Endodontic
Journal - 1

‘The authors successfully managed to build
a first decision tree for the general practitioner when appraising the question: to
save or to extract?’
• Compendium of Continuing
Education Dentistry - 3
• Current Opinion in
Dentistry - 1
• Amercian Journal Orthodontics

• Drugs - 1
• Science - 1
• Journal of Clinical
Investigation - 1
• General Dentistry - 1

United Kingdom Edition November 29-December 5, 2010

to save or to extract? The decision making chart will benefit
by revision and introduction of
additional levels. The American
Association of Endodontics published in 2006 a “case difficulty
assessment”. Similar cases of
difficulty assessments would be
beneficial for the different specialties. Placing case difficulty
assessments at the forefront of
any specialist decision tree will
help differentiate between treatment offered by the general
practitioner and the one granted
by specialists.
The reduced number of referenced endodontic, prosthetic
and orthodontic papers when
compared to the number of
periodontic papers, prove the
high specialty bias of the current
paper.
Correct, comprehensive and adequate appraisal of the literature is decisive for the outcome of contemporaneous papers

• Pharmacotherapy - 1
• Journal of Oral
Implantology - 1
Results
Avila et al. have built a “colorbased decision-making chart
with six different levels…” which
they present to their readership.
Conclusion
The task to decide on the save
ability of tooth is a multidisciplinary decision. The authors have
taken the profession a great step
forward by analysing decision
criteria from different specialties. Out of 130 referenced papers, 67 were written by perio-

dontists, five by prosthodontists,
six by endodontists and one by
an orthodontist, etc. This is an
uneven distribution.
As an example: Endodontics has come a long way in
the past decade to offer a wide
variety of treatment options
for compromised teeth. The
panel of authors should have
been expended by the expertise and the knowledge of an
endodontist.
The authors successfully
managed to build a first decision
tree for the general practitioner
when appraising the question:

Correct and comprehensive
appraisal of literature published
and used by the profession is
mandatory. It should be taken
as highly recommended advice
to never relay on non-critically
appraised papers no matter from
which source of publication. DT

About the author

This is more than a cassette.
It is a business solution.

Dr med den Liviu Steier, FICOI,
FRSM, FIAG, FIADF Liviu Steier
received his Dr
med dent (PhD)
in 1982. He is Spezialist fuer Prothetik
(www.dgpro.
de) and Specialist
in
Endodontics
(GDC-UK). He is
Honorary Clinical
Associate Professor
at Warwick Dentistry, Warwick Medical School – University of Warwick, and course director
of the MSc in Endodontics. He holds a
Visiting Professorship at Tufts School of
Dental Medicine - Boston (US) in the
Department of Postgraduate Endodontics, as well as a Visiting Professorship
at Florence School of Dental Medicine
(Italy) - Restorative Department. He
is a member of the Scientific Board of
the Journal of Endodontics, Editor-inChief of REALITY ENDO (www.realityesthetics.com), and Clinical Editor
of Dental Tribune UK and maintains
private practices in 20 Wimpole Street,
London (www.msdentistry.co.uk) and
Mayen, Germany (www.drsteier.de).

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The discussed paper can
be considered a helpful but not
exclusive tool for general practitioners when evaluating treatment options for diseased teeth.
Multidisciplinary decision making enhancements should be offered to the profession to guarantee highest level of evidence.
Addition of case difficulty assessments to differentiate between
treatments options performed
by general practitioners and specialists will compliment the presented reference guide.

1. Avila G, Galindo-Moreno P, Soehren S,
Misch CE, Morelli T, Wang HL., A novel
decision-making process for tooth retention or extraction., J Periodontol. 2009
Mar;80 (3):476-91.
2. http://www.aae.org/uploadedFiles/
Publications_and_Research/Endodontics_Colleagues_for_Excellence_Newsl
etter/2006CaseDifficultyAssessmentFor
mB_Edited2010.pdf

11/19/10 4:28 PM

[13] =>

Perio Tribune 13

United Kingdom Edition November 29-December 5, 2010

A prevention-based approach
Mhari Coxon looks at moving your practice to
prevention based dentistry as best practice

arning – this is not an
evidence based clinical abstract. This is
an article based on 15+ years of
experience in practice growing
and developing, providing a preventative regime that empowers
both your team and the client in
a profitable manner. Those who
have the perfect preventative
based practice can thankfully
stop reading now (that doesn’t
include me you know, there is
always room to improve).

dentist. Our patient’s feedback
to us is that they feel happier
knowing
that
they
have
someone who knows how they
feel to support them.
How many times have you
been to see a consultant or spe-

cialist and forgotten all the things
you wanted to ask. “White coat
syndrome” can happen to the
best of us so why should our patients be immune? Using staff to
provide a supportive and informative role can make the patient

happier and your day as a dentist
more rewarding.

you have any worries about your
mouth or treatment?

Examples of questionnaire
questions: When was that last
time you had any dental treatment? What was your main reason for your visit today? Do you
feel you have good dental health?
Do your gums bleed? Are you
sensitive to hot/cold/sweet? Do

Big up your team
It is difficult to appreciate the
role of preventative treatment as
a patient and it is vital that you
convey that importance and the
skills of your team if you want
to have a success with that cli-

Treat small

Changing attitudes
Dentistry has been a ‘see the
problem - name the problem fix the problem’ profession for a
very long time. We were conditioned that way while in our safe
institutions and find it hard to
move to a preventative approach
to our health care when we transition to general practice and the
time constraints and attitudes
that come with it.

spaces with

confidence

With growing evidence showing common sense links with our
systemic health (if you had an
inflamed, suppurating, bacteria
covered area on your arm the
size of an egg you would expect
to feel ill so why would it not be
the same for the same size lesion in the mouth?!) and our oral
health we as a profession need to
improve our prevention led practice. This is clearly best practice.
“But we do it already” I hear
us all cry. “You are reinventing
the wheel Mhari!” If this was the
case then the incidence of periodontal disease and caries in the
population would be decreasing,
as would the incidence of litigation against dental professionals
in relation to periodontal issues
and undiagnosed caries. It is not
easy to look at what we are not
doing and seek to improve but it
is the only way we, as clinicians
and as practices can develop
and progress.
The right foundations
The first time your patient spends
in your practice will affect how
they feel about treatment and
how happy they will be at the
end of treatment. How much information you glean from them
can determine the level of success with each client. In my
opinion, supported by its success
in our practice, a short interview
in a non-dental environment can
be very useful before the patient
even sets eyes on the dentist. Our
receptionist, oral health advisor,
hygienist and nurse can all carry
out this interview and are trained
to listen and repeat to show that
the patients wants, needs and
concerns are being understood
and will be presented to the

à DT page 14

Laser-Lok 3.0 placed in
aesthetic zone.

Radiograph shows proper
implant spacing in limited site.

Image courtesy of Michael Reddy, DDS

Image courtesy of Cary Shapoff, DDS

Introducing the Laser-Lok® 3.0 implant
Laser-Lok 3.0 is the first 3mm implant that incorporates Laser-Lok technology to create a biologic seal and maintain crestal bone
on the implant collar1. Designed specifically for limited spaces in the aesthetic zone, the Laser-Lok 3.0 comes with a broad array
of prosthetic options making it the perfect choice for high profile cases.

• Two-piece 3mm design offers restorative flexibility in narrow spaces.
• 3mm threadform shown to be effective when immediately loaded.2
• Laser-Lok microchannels create a physical connective tissue attachment (unlike Sharpey fibers).3

For more information, contact BioHorizons
Customer Care: +44 (0)1344 752560 or
visit us online at www.biohorizons.com

1. Radiographic Analysis of Crestal Bone Levels on Laser-Lok Collar Dental Implants.
CA Shapoff, B Lahey, PA Wasserlauf, DM Kim, IJPRD, Vol 30, No 2, 2010.
2. Initial clinical efficacy of 3-mm implants immediately placed into function in conditions of
limited spacing. Reddy MS, O’Neal SJ, Haigh S, Aponte-Wesson R, Geurs NC.
Int J Oral Maxillofac Implants. 2008 Mar-Apr;23(2):281-288.
3. Human Histologic Evidence of a Connective Tissue Attachment to a Dental Implant.
M Nevins, ML Nevins, M Camelo, JL Boyesen, DM Kim.
International Journal of Periodontics & Restorative Dentistry. Vol. 28, No. 2, 2008.
SPMP10109 REV B MAY 2010

[14] =>

14 Perio Tribune
ß DT page 13

ent’s behavioural change and
treatment acceptance. Do you
think saying “you have some
gum problems and the hygienist will see you for a scale and
polish” conveys a preventative
message? Does that show that
the patient has to make a commitment to their treatment by
supporting with their home routine? Or does it make it sound as
though the patient has a “problem” that you have “named” that

the hygienist will “fix” and so the
cycle continues. Our principal
talks about the gums and bone
as the foundation to any dental
work and without solid foundations he can’t work. He also explains how the biggest health
benefit we can give patients is
their oral health assessment and
advice programme, which always follows an examination and
is precursor to any further treatment. If you as “The Dentist”
are telling them they need this
then they will feel it has some

United Kingdom Edition November 29-December 5, 2010

value and are more likely to be
open to advice from your team.
Communication prevention
So, how do we change our patient’s behaviour? By changing
our own behaviour of course. If
what we were saying RIGHT now
in practice worked, then almost
all our patients would be regular
maintenance patients with a good
level of understanding of their
health and stability in their oral
health for the majority. If this is
not the case then what have you

got to lose by trying something
new? Communication at that initial examination can make all the
difference. It doesn’t need to be a
long session, you just have to fine
tune how you talk and listen to
patients. Some good rules are:
• If you ask a question, REALLY listen to the answer....and
don’t interrupt!! (harder than it
sounds, I know)
• Ask about the patient’s knowledge about the topic you wish
to discuss. This can open up the
discussion in a non-confronta-

“I need a

composite
that behaves
like a tooth!“
A. Kersting

tional manner
• Be positive...but realistic about
their treatment needs
• Ask the patient if what you have
said makes sense to them. Are
you sure they understand the
message you are trying to convey?
• Praise the talents of your team.
“Sell” their care to your patient and
watch as your treatment acceptance increases with little effort
A picture speaks 1000 words
Every working environment is
different and has restrictions, but
preventative dental care is very
cost-effective and time-friendly
so we do not have an excuse as
a profession. For those with good
budget to change the practice dynamics, you will save time and
increase compliance with the
addition of a microscope. This
should be linked to a live screen
so the patient can see what you
see. Taking a sample of your patient’s plaque and showing them
what is growing there is very
powerful and motivating. Backing this up with a few photos
of inflamed gum or early decay
with an explanation can be all it
takes to get that oral health advice appointment booked.
Be positive
We all respond better to positive
suggestion as a rule and so how
we discuss this with the patients
can affect their attitude towards
their health and your team’s part
in it. I do not like to be lectured
or scolded by anyone - an automatic wall comes up; so why
would I use this method with
my patients. Yes there are “problems” in their mouths. Yes you
can “name” those problems. But
you and your team cannot “fix”
their problems. You can help the
patient to find solutions and attain and maintain health. This is
ultimately more beneficial than
fixing the problem then trying
to modify the behaviour. That is
like feeding the donkey the carrot and then asking it to carry the
load.

SO TOOTH-like
in the sum of its physical properties, Grandio®SO is the filling material
that on a world-wide scale is most similar to natural teeth.*
The advantages you will gain are: durable, reliable restorations, and above
all satisfied patients.

NeW

• Meeting highest demands, universally usable in the anterior and posterior areas
• Natural opacity for tooth-like results using only one shade

So to summarise:
Use your team to glean information and discuss patient needs,
fears and expectations; Question
the patient gently to develop conversation about their health; Emphasise the importance of prevention in dental health and the
benefits of this; Show your patients what is happening; Be positive, explain that they can make a
difference with their home routine; “Sell” your team and their
part in preventative care in
the practice.

• Intelligent colour system with new shades that make good sense: VCA3.25 and VCA5
Obviously, if the patient is
immediate pain or risk then this
should be dealt with. Otherwise
resist carrying out treatment until the preventative routine has
been introduced.

• Smooth consistency, high light stability, simple high-gloss polishing

* Please feel free to request
our scientific product information.

For more information please contact
Tim McCarthy
Mobile: 07500 769 613

For any questions please
email me at mhari.coxon@cpdfordcp.co.uk DT

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_2810_GrandioSO_GB_210x297.indd 1

14.10.2010 11:36:15 Uhr

[15] =>

United Kingdom Edition November 29-December 5, 2010

Perio Tribune 15

Application of PAD in clinical dentistry and the literature evidence

Liviu Steier takes a closer look at Photo Activated Disinfection and its
uses in differing areas of clinical dentistry

pread of antibiotic resistance among pathogenic
bacteria
is
alarming
the medical science. Inappropriate prescription of antibiotics in
the dental profession could add
to this. Oral bacterial infection can commonly be considered of local origin. Several
attempts
have
been
undertaken
in
dentistry
to try and maintain antimicro
bial treatment regimens restricted locally.
The combination of dyes
and visible light has proven to
kill microorganisms about 100
years ago. Harmless dyes sensitive to light are delivered locally
(soft and hard tissue) and exposed to light at certain predetermined wavelength are highly
successful in disinfection. Key
is presence of oxygen to excited
state of the Photosensitiser enhancing transfer of electrons
to the ground state of molecular oxygen resulting in reactive
oxygen like singlet oxygen and
hydroxyl radicals. The latest two
have lethal effect on pathogenic
microorganisms. The process described is called photo
activated disinfection when
related to dentistry. Resistance
to Photo Activated Disinfection (PAD) has been researched
in periodontology but could not
be induced artificially (Lauro et
al. 2002).

the photobiological principles of
light involved in the process:
• The Grotthus-Draper law: dis-

cusses the wavelength of light
requested
• The Stark – Einstein law: discuss-

Photo Activated Disinfection

W
Photo-activated disinfection
provides proven high level disinfection

tak

e a ch nce?
a

for the treatment of root canals,
periodontal disease, peri-implantitis and
caries, eliminating 99.99% of all species
of oral bacteria, on demand, in a matter
of seconds.
Offering a genuine advance in minimal
invasive dental treatment,
Little Sister PAD signiﬁcantly
increases the level of treatment success.

• Photosensitisers and their interaction with different bacterial strains.
• Photodynamic therapy at different tissue structures.

Eschmann infection control advisor or

Cohen et al. (1995) cited by
Meisel et al. (2005) summarised

à DT page 16

LittleSister

Dai et al. (2009) reviewed literature on Photodynamic therapy (PDT) in regards to localised infections.
Key points of interest were:

As a result one can state
that bactericidal action was
achieved by neutral or cationic
PS molecules on Gram positive
flora when compared to cationic
in combination with non cationic ones on Gram negative (Nitzan et al. 1992, Merchat et al.
1996,). Santamaria et al. (1972)
listed more than 400 compounds
demonstrating
photosensitising properties. Usacheva et al.
has proven in 2001 that:
“TB exhibits a greater bactericidal activity than MB against
most bacteria in dark and
light conditions.”

light applied

es the amount of absorbed light
• The Bunsen – Roscoe law: discusses intensity and duration of

To enjoy the beneﬁts of PAD for
yourself and your patients, contact your
visit the Little Sister PAD website.

To download the Little Sister PAD
Scientiﬁc Evidence guide, visit:

Only £1995.00 with FREE
starter kit worth over £500*

www.eschmann.co.uk/pad

*List Price £2495. Starter kit includes: Little Sister PAD unit, Caries Pack (25pcs),
Endo Pack (25pcs), Perio Pack (25pcs), LED Light Guide (1pcs), Anti-glare paddle
(1pcs), Anti-glare glasses (1pcs), Mains Power adaptor (1pcs).

For further information and to order your PAD
call EschmannDirect on: 01903 875787
ic.sales@eschmann.co.uk | www.eschmann.co.uk

LittleSister from

Direct

Retail value of treatment packs can be worth in excess of £800 (when the price of
PAD is included within cost of treatment)
Offer valid to 31st Dec 2010 Price excl. carriage and VAT

[16] =>

16 Perio Tribune
ß DT page 15

Meisel and Kocher identified
in their review 2005 the “prerequisites and further demands”
in regards to PAD in Periodontology: suitability of the photosensitising dyes, optimisation of
efficacy, determination of irradiation device as well as exposure
time, etc.
Today PAD can be regarded as a helpful adjutant in
biofilm management. Its indication in clinical dentistry
varies from Cariology to Periimplantitis
covering
Endodontics and Periodontology.
Application in Perio
Use of PAD in Periodontology is
multifaceted as an adjutant after non-surgical or in conjunction with surgical approaches.
Interestingly, Azarpazhooh
et al (2010) performed a systematic review and meta analysis
for the use of PAD in Periodontology and concluded: “PDT
as an independent treatment or
as an adjunct to SRP was not
superior to control treatment
of SRP. Therefore, the routine
use of PDT for clinical management of periodontitis cannot be
recommended.”
Once
one
understands
mechanisms of action of PAD,
as briefly discussed above, and
starts to critically appraise the
systematic review performed
by the group of Azarpazhooh
et al. a major shortcoming becomes eminent – there was no
appraisal of the studies included, in regards of suitable selection of photosensitiser, adequate
light source and timing. Correct conclusion would have referred to the kind of PS used and
the question if photobiological
principles of light have been
disregarded.
It is sad to admit that even
applying the highest criteria for appraisal according
to the Cochrane library one
may generate confusing conclusions if authors are not familiar with the review topic.
In 2009, Ramos de Oliviera
et al. managed to demonstrate
a statistically significant reduction in TNF -a level 30 days following treatment when PAD
used without SRP. Similar results were achieved by Braham

et al.(2009).
An in vivo study by Sigusch et al. (2010) showed
“that the adjuvant application
of the described PDT method
is appropriate to reduce periodontal inflammatory symptoms and to successfully treat
infection with F. nucleatum.”
The results of Allan et al.
(2007) using Toluidine blue “indicate that PDT may be an effective alternative to conventional
modalities in the treatment of
periodontal disease.”
Andersen et al. (2007) compared the use of Pad to SRP and
concluded that “Within the limits of the present study, it can be
concluded that SRP combined
with photodisinfection leads to
significant improvements of the
investigated parameters over
the use of SRP alone.”
Milanezi de Almeida et al.
(2008) induced periodontal
bone loss in rats by ligature
and treated with PAD. Their
conclusion: “PDT may be an
effective alternative for control
of bone loss in furcation areas
in periodontitis.” Kömerik et
al. (2003) researched the lethal
action of Toluidine blue as PS
on Porphyromonas Gingivalis
and concluded “The results of
this study show that Toluidine
blue-mediated lethal photosensitisation of P. gingivalis is possible in vivo and that this results
in decreased bone loss. These
findings suggest that photodynamic therapy may be useful
as an alternative approach for
the antimicrobial treatment of
periodontitis.”
Application for treatment of
Peri-implantitis
Hayek et al (2005) published a
study comparing conventional
therapy versus PAD for treatment of ligature induced periimplantitis in dogs. They concluded that the non invasive
PAD technique could be used
to reduce pathological microorganism in peri-implantitis.
Shibli et al. (2003) examined
the efficacy of PAD application alone in ligature induced
peri-implantitis in dogs and concluded that complete elimination of pathogens was achieved
in some cases.
Dörtbudak et al. (2001) re-

United Kingdom Edition November 29-December 5, 2010

searched microbial decontamination on peri-implantitis affected IMZ implants in vivo and
identified a significant reduction

Fig1 - SRP - Pocket debridement using US

Fig2 - Instillation of the PS (Toluidine
blue) into the pocket

Fig3 - Tip of light source (Aseptim Plus,
Denfotex) in situ

Fig4 - Application of light (120 sec)

Fig5 - Clinical picture showing advanced
bone loss. Teeth involved demonstrated no
mobility. Tooth 24 received a RCT

Fig6 - PAD disinfection once mechanical
debridement completed and prior to GBR

Fig7 - Clinical picture showing localised
peri-implantitis. Similar to the case above
once mechanical debridement completed
PAD disinfection applied prior to GTR

after PAD application.
Baron et al (2000) reviewed
29 papers on regenerative methods in regards to regeneration of peri-implantitis affected
sites and concluded: “Of all
tested treatment methods, the
combination of guided bone
regeneration and augmentation with demineralised freezedried bone resulted in the most
favorable
results
regarding
bone gain and reosseointe
gration.”
Application in Cariology
Williams et al (2002) researched
the bactericidal efficacy of Toluidine blue and variable energy
on Streptococcus mutans. The
results were extremely encouraging: “The system was highly
effective in killing TBO-treated
Streptococcus mutans NCTC
10449 in stirred planktonic
suspension, killing at least 109
cfu/ml. Antibacterial action increased as the delivered energy
dose increased.”
The study of Lima et al.
(2009) “evaluated the effect of
PACT (Photodynamic antimicrobial therapy) on dentine caries produced in situ.” They came
to the following conclusions:
“PACT was effective in killing
oral microorganisms present in
dentine caries produced in situ
and may be a useful technique
for eliminating bacteria from
dentine carious lesions before
restoration.”
Steier et al. researched the
efficacy of PAD bovine root canal dentine previously infected
with Enterococcus Faecalis monoculture Biofilm.
Especially
with
today’s
trends of minimalistic intervention and using adhesive
dentistry the use of PAD may
prevent excessive hard tissue removal and help maintain great
amounts of dentin. Major benefit of course is the conservation
on tooth vitality.
Application in Endodontics
An in vivo study performed by
Bonsor et al. (2006) concluded
that “Results indicate that the
use of a chelating agent acting
as a cleaner and disrupter of
the biofilm and photo-activated
disinfection to kill bacteria is an
effective alternative to the use
of hypochlorite as a root canal
cleaning system.”

Another in vivo study published as well in 2006 by the
group of Bonsor researched the
ability of PAD to compliment
conventional RCT disinfection
and concluded that “The PAD
system offers a means of destroying bacteria remaining after using conventional irrigants
in endodontic therapy.”
Williams et al. (2006) tested
the efficacy of PAD on Fusobacterium nucleatum, Peptostreptococcus micros, Prevotella
intermedia and Streptococcus
intermedius and concluded that
“PAD killed endodontic bacteria
at statistically significant levels
compared to controls.”
Garcez et al (2008), in an
in vivo study, researched the
“Antimicrobial Effects of Photodynamic Therapy on Patients
with Necrotic Pulps and Periapical Lesion” and their results
suggested “that the use of PDT
added to endodontic treatment
leads to an enhanced decrease
of bacterial load and may be an
appropriate approach for the
treatment of oral infections.”
The research hypothesis of
Bergmans et al. (2007) was: “To
test the hypothesis that photoactivated disinfection (PAD) has
a bactericidal effect on pathogens inoculated in root canals,
with emphasis on biofilm formation/destruction.” Their conclusions were: Photo-activated
disinfection is not an alternative
but a possible supplement to the
existing protocols for root canal
disinfection as the interaction
between light (diode laser) and
associated dye (TBO) provides a
broad-spectrum effect.”
The research goal of Garcez
et al. (2006) was “To compare
the effectiveness of antimicrobial photodynamic therapy (PDT),
standard endodontic treatment
and the combined treatment
to eliminate bacterial biofilms
present in infected root canals.”
Their results: “Endodontic
therapy alone reduced bacterial
bioluminescence by 90 per cent
while PDT alone reduced bioluminescence by 95 per cent. The
combination reduced bioluminescence by >98 per cent, and
importantly the bacterial regrowth observed 24 hours after
treatment was much less for the
combination (P<0.0005) than
for either single treatment.”

[17] =>

United Kingdom Edition November 29-December 5, 2010

The in vitro study of Soukos
et al. (2006) ended with the conclusion that “PDT may be developed as an adjunctive procedure
to kill residual bacteria in the
root canal system after standard
endodontic treatment.”
Pinheiro et al. (2007) study
was to “evaluate photodynamic
therapy in deciduous teeth with
necrotic pulp by means of fully
quantifying viable bacteria, before and after instrumentation
and after the use of photodynamic therapy”. They concluded
that “Photodynamic therapy is
recommended as adjunct therapy for microbial reduction in
deciduous teeth with necrotic
pulp.”
When using Methylen blue
as PS, Fimple et al. (2008) concluded “that PDT can be an
effective adjunct to standard
endodontic antimicrobial treatment when the PDT parameters
are optimised.“
The research group around
Lim (2009), calling the PAD
process “Light Activated Disinfection” (LAD) used “biofilms
of Enterococcus faecalis at two
different stages of maturation”
and extracted teeth. The results
of the study showed “Sodium
hypochlorite and improved
LAD showed the ability to significantly inactivate bacteria
in four-day-old biofilms when
compared to the control and
LAD (p < 0.05). Inactivation of
bacteria from deeper dentine
was higher in improved LAD
than sodium hypochlorite. In
four-week-old biofilms, a com-

‘Confirming treatment efficacy is a
demanding and
highly time-, resource-and financeconsuming process.’
bination of chemomechanical
disinfection and improved LAD
produced significant bacterial
killing compared to either chemomechanical disinfection or
improved LAD alone.”
Souza et al (2010) compared
the efficacy of Methylen blue
and Toluidine blue as an adjuvant in root canal disinfection.
Their conclusions were “These
in vitro results suggest that PDT
with either MB or TB may not
exert a significant supplemental effect to instrumentation/
irrigation procedures with regard to intracanal disinfection.
Further adjustments in the PDT
protocol may be required to enhance predictability in bacterial elimination before clinical
use is recommended.” It may be
noted that the culture media for
E. faecalis may play a role in the
different outcomes.

edge and evidence the author
suggests the implementation
of PAD in root canal disinfection once conventional protocol
completed.

into the identification process of
correlating adequate PS to specific bacterial infection, enhancing dye penetration, adjusting
light exposure time, etc.

Conclusion
PAD is not at all a new concept. It has proven it s efficacy
in action over almost the last
hundred years. New microbiologic knowledge is continuously
compensated with advanced research in light emitting sources.
Intensive work is committed

On the other side numerous
new applications arise. Confirming treatment efficacy is a
demanding and highly time-, resource-and finance-consuming
process. Rewards are amazing
taking under consideration the
huge added benefits in regards
of antibiotic resistance. DT

Perio Tribune 17

Fig8 – Application of light source

à DT page 18

PHOTO ACTIVATED
DISINFECTION

P R OV E N
A STEP FORWARD IN
DENTAL DISINFECTION FROM DEXCEL DENTAL
LED technology makes
PAD affordable for all dental professionals
PAD Plus Photo Activated Disinfection system eliminates bacterial and fungal infections
in the majority of dental procedures. This breakthrough in LED technology allows you
to e ectively and e ciently eradicate 99.9% of all oral bacteria in one patient visit giving
you increased pro tability and providing a less stressful patient experience.

TREATMENT AREAS
?

Endodontics
Caries
Periodontics
Implants
Trauma
Dry socket

Simply visit our website or call our freephone number
below to order PAD Plus or to book a demonstration
with one of our representatives

www.dexceldental.co.uk

0800 013 2333
* excluding VAT & delivery

Based on current knowlA4 Indesign.indd 1

13/5/10 11:17:18

[18] =>

18 Perio Tribune

United Kingdom Edition November 29-December 5, 2010

ß DT page 17

Fig9 – Pre-operative and post-operative
(six-month recall) radiographs of a periimplantitis affected and treated implant.
The treatment involved implantplastic

Fig10 – (a&b) A cross-sectional view of the dentinal tubules a - before PAD activation (control group) b - after PAD activation – SEM 10000x

Fig11 – (a&b) The roots were split in halves, then SEM/BSE observations were made along
the dentinal tubules starting from the canal wall through the tubules. The length of action
of PAD was assessed (Mm) – this image shows the overall look of the control group, with e
faecalis invading the whole length of the tubules. SEM 2000x; a – control, b - PAD

Figs13-18 Example of PAD used in endodontic therapy

Fig 14

Fig12 - Assessment of the length of action of PAD was assessed (Mm) – Backscattering (BSE) SEM 20000x; a – control - e faecalis invading
the whole length of the tubules; b - PAD activation – small number of e faecalis invading the tubules, with dentinal tubules free of the
bacteria to a length of 20 Mm; c - PAD activation – dentinal tubules free of the bacteria to its whole length

Fig 15

References
1. Steier L; Rossi-Fedele G; Figueiredo MAZ ; Figueiredo JAP.,Effect of Photo-Activated Disinfection on Enterococcus Faecalis Monoculture Biofilm using a bovine root canal dentine
model and SEM/BSE observations (in process of publication) 2. Marina N. Usacheva, Matthew C. Teichert , Merrill A. Biel. Comparison of the methylene blue and toluidine blue
photobactericidal efficacy against gram-positive and gram-negative microorganisms, Lasers in Surgery and Medicine, Volume 29, Issue 2, pages 165–173, August 2001 3. Juliana P. M.
Lima, Mary A. Sampaio de Melo, Fátima M. C. Borges, Alrieta H. Teixeira, Carolina Steiner-Oliveira, Marinês Nobre dos Santos, Lidiany K. A. Rodrigues, Iriana C. J. Zanin Evaluation of the antimicrobial effect of photodynamic antimicrobial therapy in an in situ model of dentine caries,. European Journal of Oral Sciences, Volume 117, Issue 5, pages 568–574,
October 2009 4. Castanoa AP, Demidovaa TN, Hamblin MR. Mechanisms in photodynamic therapy: part one—–photosensitizers, photochemistry and cellular localization. Photodiagnosis and Photodynamic Therapy (2004) 1, 279—293 5. Castanoa AP, Demidovaa TN, Hamblin MR. Mechanisms in photodynamic therapy: part two—–cellular signaling, cell metabolism
and modes of cell death, Photodiagnosis and Photodynamic Therapy (2005) 2, 1—23 6. Castanoa AP, Demidovaa TN, Hamblin MR. Mechanisms in photodynamic therapy: Part three—–
Photosensitizer pharmacokinetics, biodistribution, tumor localization and modes of tumor destruction, Photodiagnosis and Photodynamic Therapy (2005) 2, 91—106 7. Tardivoa JP, Del
Giglio A, de Oliveira CS, Gabrielli DS, Junqueira HC, Tada DB, Severino D, Turchiello R de FT, Baptista MS. Methylene blue in photodynamic therapy: From basic mechanisms to
clinical applications, Photodiagnosis and Photodynamic Therapy (2005) 2, 175—191 8. Daia T, Huanga YY, Hamblin MR. Photodynamic therapy for localized infections—–State of the art,
Photodiagnosis and Photodynamic Therapy (2009) 6, 170—188 9. Allison RR, Downie GH, Cuenca R, Hu XH, Childs CJH, Sibata CH. Photosensitizers in clinical PDT, Photodiagnosis
and Photodynamic Therapy (2004) 1, 27—42 10. O’Riordan K, Akilov OE, Hasan T. The potential for photodynamic therapy in the treatment of localized infections, Photodiagnosis and
Photodynamic Therapy (2005) 2, 247—262 11. Lima JPM, de Melo S, Borges FMC, Teixeira AH, Steiner-Oliveira C, dos Santos NM, Rodrigues LKA, Zanin ICJ. Evaluation of the
antimicrobial effect of photodynamic antimicrobial therapy in an in-situ model of dentine caries. Eur J Oral Sci 2009; 117: 568–574. 12. Williams JA, Pearson GJ, Colles MJ, M.Wilson. The
Effect of Variable Energy Input from a Novel Light Source on the Photoactivated Bactericidal Action of Toluidine Blue O on Streptococcus mutans, Caries Res 2003;37:190–193 13. Williams
JA, Pearson GJ, Colle MJ, Wilson M, The Photo-Activated AntibacterialAction of Toluidine Blue O in a Collagen Matrix and in Carious Dentine, Caries Res 2004;38:530–536 14. Bonsor SJ,
Nichol R, Reid TMS, Pearson GJ, An alternative regimen for root canal Disinfection, British Dental Journal 2005; 201: 101-105 15. Williams JA, Pearson GJ, Colles MJ. Antibacterial action
of photoactivated disinfection {PAD} used on endodontic bacteria in planktonic suspension and in artificial and human root canals, Journal of Dentistry (2006) 34, 363–371 16. Garcez AS,
Nuñez SC, Hamblin MR, Ribeiro MS. Antimicrobial Effects of Photodynamic Therapy on Patients with Necrotic Pulps and Periapical Lesion, JOE—Volume 34, Number 2, February 2008
17. Bergmans L, Moisiadis P, Huybrechts B, Van Meerbeek B, Quirynen M, Lambrechts P. Effect of photo-activated disinfection on endodontic pathogens ex vivo, International
Endodontic Journal, 41, 227–239, 2008 18. Garcez AS, Ribeiro MS, Tegos GP, Nunez SC, Jorge AOC, Hamblin MR. Antimicrobial Photodynamic Therapy Combined With Conventional
Endodontic Treatment to Eliminate Root Canal Biofilm Infection, Lasers in Surgery and Medicine 39:59–66 (2007) 19. Garcez AS, Nuñez SC, Hamblim MR, Suzuki H, Ribeiro MS,
Photodynamic therapy associated with conventional endodontic treatment in patients with antibiotic-resistant microflora: a preliminary report. J Endod. 2010 Sep;36(9):1463-6. 20.
Fimple JL, Carla Raquel Fontana CR, Foschi F, Ruggiero K, Xiaoqing Song X, Pagonis TC, Tanner ACR, Kent R, Apostolos G. Doukas AG, Stashenko PP, Soukos NS. Photodynamic
Treatment of Endodontic Polymicrobial Infection In Vitro, JOE—Volume 34, Number 6, June 2008 21. Lim Z, Cheng JL, Lim TW, Teo EG, Wong J, George S, Kishen A. Light activated
disinfection: an alternative endodontic disinfection strategy, Australian Dental Journal 2009; 54: 108–114 22. Bonsor SJ, Nichol R, Reid TMS, Pearson GJ. Microbiological evaluation of
photo-activated disinfection in endodontics (An in vivo study), BRITISH DENTAL JOURNAL VOLUME 200 NO. 6 MAR 25 2006 23. Souza LC, Brito PRR, de Oliveira JCM, Alves FRF,
Moreira EJL, Sampaio-Filho HR, Rocas IN, Siqueira JF Jr. Photodynamic Therapy with Two Different Photosensitizers as a Supplement to Instrumentation/Irrigation Procedures in
Promoting Intracanal Reduction of Enterococcus faecalis, JOE — Volume 36, Number 2, February 2010 24. Pagonis TC, Chen J, Fontana CR, Devalapally H, Ruggiero K, Song X, Foschi
F, Dunham J, Skobe Z, Yamazaki H, Kent R, Tanner AC, Amiji MM, Soukos NS., Nanoparticle-based endodontic antimicrobial photodynamic therapy. J Endod. 2010 Feb;36(2):322-8. 25.
Fonseca MB, Júnior PO, Pallota RC, Filho HF, Denardin OV, Rapoport A, Dedivitis RA, Veronezi JF, Genovese WJ, Ricardo AL, Photodynamic therapy for root canals infected with
Enterococcus faecalis. Photomed Laser Surg. 2008 Jun;26(3):209-13. 26. Pinheiro SL., Ada Almeida Schenka AA, Neto AA., de Souza CP, Rodriguez HMH, Ribeiro MC,. Photodynamic
therapy in endodontic treatment of deciduous teeth, Lasers Med Sci 27. Nikolaos S. Soukos, Peter Shih-Yao Chen, DMD, MS,‡ Jason T. Morris, DMD, MS,‡ Karriann Ruggiero, BS,*
Abraham D. Abernethy, BS,* Sovanda Som, BS, MS,* Federico Foschi, DDS,* Stephanie Doucette, BS,* Lili Luschke Bammann, DMD, PhD,† Carla Raquel Fontana, DDS,* Apostolos G.
Doukas, PhD,§ and Philip P. Stashenko, Photodynamic Therapy for Endodontic Disinfection, JOE — Volume 32, Number 10, October 2006 28. Hayek RR, Araújo NS, Gioso MA, Ferreira
J, Baptista-Sobrinho CA, Yamada AM, Ribeiro MS., Comparative study between the effects of photodynamic therapy and conventional therapy on microbial reduction in ligatureinduced peri-implantitis in dogs. J Periodontol. 2005 Aug;76(8):1275-81. 29. Shibli JA, Martins MC, Theodoro LH, Lotufo RF, Garcia VG, Marcantonio EJ. Lethal photosensitization in
microbiological treatment of ligature-induced peri-implantitis: a preliminary study in dogs. J Oral Sci. 2003 Mar;45(1):17-23. 30. Lui J, Corbet EF, Jin L. Combined photodynamic and
low-level laser therapies as an adjunct to nonsurgical treatment of chronic periodontitis. J Periodontal Res. 2010 Sep 22. 31. Malik R, Manocha A, Suresh DK. Photodynamic therapy--a
strategic review. Indian J Dent Res. 2010 Apr-Jun;21(2):285-91. 32. Sigusch BW, Engelbrecht M, Völpel A, Holletschke A, Pfister W, Schütze J. Full-mouth antimicrobial photodynamic
therapy in Fusobacterium nucleatum-infected periodontitis patients. J Periodontol. 2010 Jul;81(7):975-81. 33. Azarpazhooh A, Shah PS, Tenenbaum HC, Goldberg MB. The effect of
photodynamic therapy for periodontitis: a systematic review and meta-analysis. J Periodontol. 2010 Jan;81(1):4-14. Review. 34. Rühling A, Fanghänel J, Houshmand M, Kuhr A, Meisel P,
Schwahn C, Kocher T. Photodynamic therapy of persistent pockets in maintenance patients-a clinical study. Clin Oral Investig. 2009 Oct 13 35. Braham P, Herron C, Street C, Darveau R.
Antimicrobial photodynamic therapy may promote periodontal healing through multiple mechanisms. J Periodontol. 2009 Nov;80(11):1790-8. 36. Lulic M, Leiggener Görög I, Salvi GE,
Ramseier CA, Mattheos N, Lang NP. One-year outcomes of repeated adjunctive photodynamic therapy during periodontal maintenance: a proof-of-principle randomized-controlled
clinical trial. J Clin Periodontol. 2009 Aug;36(8):661-6. 37. Polansky R, Haas M, Heschl A, Wimmer G. Clinical effectiveness of photodynamic therapy in the treatment of periodontitis. J
Clin Periodontol. 2009 Jul;36(7):575-80. 38. de Oliveira RR, Schwartz-Filho HO, Novaes AB, Garlet GP, de Souza RF, Taba M, Scombatti de Souza SL, Ribeiro FJ. Antimicrobial
photodynamic therapy in the non-surgical treatment of aggressive periodontitis: cytokine profile in gingival crevicular fluid, preliminary results. J Periodontol. 2009 Jan;80(1):98-105. 39.
de Almeida JM, Theodoro LH, Bosco AF, Nagata MJ, Oshiiwa M, Garcia VG. In vivo effect of photodynamic therapy on periodontal bone loss in dental furcations. J Periodontol. 2008
Jun;79(6):1081-8. 40. Kömerik N, Nakanishi H, MacRobert AJ, Henderson B, Speight P, Wilson M. In vivo killing of Porphyromonas gingivalis by toluidine blue-mediated photosensitization in an animal model. Antimicrob Agents Chemother. 2003 Mar;47(3):932-40. 41. Pfitzner A, Sigusch BW, Albrecht V, Glockmann E. Killing of periodontopathogenic bacteria by
photodynamic therapy. J Periodontol. 2004 Oct;75(10):1343-9. 42. Meisel P, Kocher T. Photodynamic therapy for periodontal diseases: State of the art, Journal of Photochemistry and
Photobiology B: Biology 79 (2005) 159–170 43. Andersen R, Loebel N, Hammond D, Wilson M. Treatment of periodontal disease by photodisinfection compared to scaling and root
planing. J Clin Dent. 2007;18(2):34-8.

Fig 16

Fig 17

Fig 18

About the author
Dr med den Liviu Steier, FICOI,
FRSM, FIAG, FIADF Liviu Steier
received his Dr
med dent (PhD) in
1982. He is Honorary Clinical Associate Professor at
Warwick Dentistry, Warwick Medical
School – University of Warwick, and
course director of the MSc in Endodontics. He holds a Visiting Professorship at Tufts School of Dental Medicine - Boston (US) in the Department
of Postgraduate Endodontics, as well
as a Visiting Professorship at Florence
School of Dental Medicine (Italy). He
is a member of the Scientific Board of
the Journal of Endodontics, Editor-inChief of REALITY ENDO, and Clinical
Editor of Dental Tribune UK and maintains private practices.

[19] =>

United Kingdom Edition November 29-December 5, 2010

Perio Tribune 19

Interdental Cleaning: the path to
better oral hygiene for patients
Helmut Nissen discusses the next generation of cleaning products

ne of the most important parts of the job of
any dental practitioner
is the education of their patients
with regards to maintaining a
good oral care regime. Some of
the most important parts of the
mouth in this respect are the interdental areas, which experts
agree are an ideal breeding
ground for pathogenic bacteria
and a high-risk area for the development of caries. The self-care
regimens taught by practitioners are crucial in the prevention
of gum disease, but patients can
struggle to maintain their good
work outside of the dentist’s office and often slip back into bad
habits. Worryingly, the British
Dental Health Foundation now
estimates that a mere 21 per
cent of the British public use
dental floss.
In recent years, researchers have amassed a body of
evidence to substantiate claims

‘Some of the most
important parts of
the mouth in this
respect are the interdental areas, which
experts agree are
an ideal breeding
ground for pathogenic bacteria and
a high-risk area for
the development
of caries’
about the links between oral and
other diseases, including, but
not limited to, diabetes, cardiovascular disease, dementia and
strokes. In trials conducted by
the Northern Manhattan Stroke
Study (NOMAS) links between
oral infection and the onset of a
stroke have been examined. Seventy eight people of mixed ethnicity (Caucasian, Hispanic and
Afro-American) who resided in
the same community and had
never suffered strokes, received
detailed oral examinations.
These included measurement of
probing depth and attachment
loss at six sites per tooth as well
as an ultrasound measurement
of the carotid arteries. It was
duly noted that those with the
most severe periodontal disease
also showed the greatest thickening of the arteries. These results remained consistent, even

when known cardiovascular
risk factors were accounted for,
Estetica A4 SELECTED:Layout 1
including hypertension, diabe-

tes, and cholesterol levels. It has
been noted that many patients
25/2/09 13:42 Page 1
contract some kind of infection

shortly before suffering a stroke,
and this provides a link between
periodontal disease and cardio-

vascular disease. The results
suggest that infections such
à DT page 19

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[20] =>

20 Perio Tribune
ß DT page 20

as these can cause chronic inflammation and activation of TLymphocytes, leading to plaque
formation and lesions in the
carotid arteries. Further thickening of the arterial walls can
severely increase the possibility
of stroke or heart disease.
Interproximal Cleaning
With evidence for the connection between oral health and
general health mounting and
data suggesting a strong link

between periodontal disease
and cardiovascular disorders,
interproximal cleaning is at the
top of many dental researchers’ priority lists. In light of up
to date research, recent studies
have attempted to assess the
oral health benefits of regular
interproximal cleaning both
alone and with the addition of
specially formulated gels. These
studies focussed on the effects
of daily use of a fluoride-based
gel with chlorhexidine (0.2 per
cent sodium fluoride (900ppm)

United Kingdom Edition November 29-December 5, 2010

and 0.2 per cent chlorhexidine
digluconate), applied with an
interdental brush.
The University College of
Health Sciences, Kristianstad,
with the Department of Cariology, Goteburg University in
Sweden, carried out a doubleblind crossover design trial,
which used an active gel as
well as a placebo. In this trial
15 healthy patients with at least
four open approximal spaces
in the pre-molar/molar re-

gion were chosen from the
Department
of
Peridontology in Kristianstad and clinical parameters were registered at eight approximal tooth
surfaces: Plaque index after
using a disclosing solution,
pocket depth, sulcus bleeding index and gingival fluid flow using
a periotron.
Participants were asked to
use the gel after brushing, applying it with an interdental brush
twice a day, ensuring that each

Those patients predisposed
to plaque and caries are known
to benefit from a dual action
formula created to strengthen
and desensitise tooth surfaces
and help maintain oral hygiene.
For these patients a product that
lists fluoride as an active ingredient and posts the anti-bacterial properties of chlorhexidine
(CHX) can help prevent the
build up of bacteria.

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instrument cooling from the inside
and outside together with simultaneous debris evacuation and efficient
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EMS Swiss Instruments Surgery
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An optimum view of the operative
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The new EMS Swiss Instruments
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interproximal space was cleaned
twice. Results were assessed
as mean values at three points
within the trial – on days 0, 7,
and 21. From the very beginning
of the trial a noticeable improvement was shown in all four parameters. The study concluded
that three weeks of interdental
brushing combined with an interdental gel could significantly
improve oral health as well as
helping to prevent the build up
of plaque.

benefit of dental practitioners and
patients alike – the very philosophy
embraced by EMS.

Using interdental gels and
brushes can also be beneficial
as these will help the patient access those ‘hard to reach’ areas.
Using a product containing bacteria fighting CHX will allow the
fluoride to work to better effect,
but patients would be well advised to use a non-abrasive formula to protect the tooth enamel from demineralisation.
A dual acting gel can be an
ideal accompaniment to interdental brushes for oral hygiene
issues of varying types and
severity. It may be appropriate
for practitioners to recommend
an interdental cleaning product
based on fluoride and supported
by the antibacterial properties
of CHX. Interdental gels are excellent products for the effective
support of your patients’ interdental care regime and specially formulated, dual-action gels
can provide patients with a
convenient and effective ‘takehome’ method of cleaning interdental spaces.
That traditional interdental
cleaning is no longer a priority for patients is obvious from
the statistics cited by the British
Dental Health Foundation, but
many practitioners have high
hopes that the next generation
of cleaning products now available will encourage the British
public to improve their dental
hygiene. If these products can
successfully motivate the masses, we may see a dramatic improvement in dental health into
the coming decade. DT

About the author

For more information >
www.ems-swissquality.com

Helmut Nissen
International Marketing
&
Sales
Manager
Helmut
has been working
for over 20 years in
the health and oral
care market and is
dedicated to establishing strong brands based on
real
user benefits
Email www.tandex.dk for more information

[21] =>

United Kingdom Edition November 29-December 5, 2010

Perio Tribune 21

A look at the effectiveness of
chlorhexidine-based mouthwashes

Howard Thomas discusses the advantages of mouthwashes in the treatment of periodontal disease, with a specific look at chlorhexidine-based products

T

he use of antiseptic
mouthwashes as a secondary line of defence
against the onset of periodontal
disease has been in existence
for approximately 40 years.
In addition to conventional
brushing, mouthwashes offer a
number of significant advantages for patients, helping to control the oral pathogens that lead
to problems like halitosis, dental caries and of course, dental
plaque biofilm formation.
However, for patients with
manual dexterity issues who
may find brushing difficult, as
well as those recovering from
implant or endodontic surgery,
an antiseptic mouthrinse may
be vital in maintaining good
oral health and/or preventing
the onset of infection.
Numerous clinical studies have sought to establish the
effectiveness of the active ingredients commonly found in
mouthwashes, including chlorhexidine (CHX), cetyl pyridinium chloride and plant extracts
such as essential oils and chlorophyll in controlling the spread
of supragingival plaque and
gingivitis. Overall, it has been
shown that mouthwashes containing chlorhexidine are by far
the most proficient in controlling sub-gingival plaque, eradicating oral fungi and reducing
the bleeding and inflammation
associated with gingivitis when
compared to other antimicrobial agents, including hydrogen
peroxide. 1, 2, 3, 4, 5
Chlorhexidine is a highly effective bactericide, thanks to its
capacity to set up chemical links
with the anionic groups such as
phosphates and sulphates found
in the cell wall of bacteria,
leading to an increase in cellular permeability and thereby
destabilising the bacterial cell,
ultimately leading to its destruction or eradication during
brushing. 6
Although considered to be
the ‘gold standard’ of chemical
antiseptic agents,7 there are a
few limitations and drawbacks
that go along with using this
otherwise highly effective ingredient.
One of the main disadvantages of using chlorhexidine
is its tendency to cause staining on the teeth, especially in
the inter-proximal areas and

the mucous membranes on
the back of the tongue, as well
as the lead to discolouration of

dental restorations and prostheses. This is caused by the chemical interaction of tooth-bound

chlorhexidine
and
leftover
chromogens from food or beverages and is known as the

Maillard reaction.
à DT page 22

[22] =>

22 Perio Tribune
ß DT page 21

This issue of chlorhexidine
and dental discolouration is
more difficult to resolve, making
most CHX mouthwashes inappropriate for long-term use.
However, this major issue
looks to have been resolved
thanks to the inclusion of an anti-discolouration system, known
for short as ADS, which is
thought to significantly reduce
the likelihood of discolouration
and taste interference without in any way diminishing the
plaque-fighting effects of CHX.
Recent studies undertaken
in 2004,8 20059 and 200810 to
assess this claim have shown
that not only did a chlorhexidine ADS formulation perform
better in terms of the stain index14, but that CHX ADS was
just as effective at controlling
plaque formation and reducing
gingival inflammation in postoperative patients as more traditional forms of 0.2 per cent CHX
mouthwashes.15, 16
The efficacy of chlorhexi-

dine is also significantly diminished by its interaction with
several anionic compounds
found in detergents such as sodium lauryl sulfate (SLS) that
are commonly added to toothpaste.11 This means that in
general, patients need to wait
for a full 30 minutes after brushing before rinsing in order to get
the full benefits out of their chlorhexidine mouthwash. However,
the use of SLS-free toothpaste
can help patients get around this
issue, even getting a double dose
of CHX when using an SLS-free
paste containing Chlorhexidine.
Many chlorhexidine-based
mouthrinses also contain alcohol, which has been known to
cause irritation of the oral mucosa, leading to a stinging or
burning sensation in the mouth.
Currently,
over-the-counter
brands of mouthwash can contain anything between 18- and
26 per cent alcohol. Whilst there
have been suggestions of a link
between the alcohol content and
oral cancer, a critical analysis
of literature12 has failed to find
evidence of a direct casual link

United Kingdom Edition November 29-December 5, 2010

and so far, the studies have been
inconclusive.
However, the same study
also concluded that there is no
evidence that alcohol improves
the effectiveness of anti-plaque
agents.13 As demand for nonalcoholic mouthwashes has
increased, the need to develop
effective
chlorhexidine-based
mouthwash products with reduced negative side effects has
become ever greater. Addressing
this demand, several manufacturers have risen to the challenge to develop an alcohol-free
chlorhexidine mouthwash.
In an effort to rectify the problems associated with chlorhexidine, several studies have looked
at alternatives such as combining agents (ie sodium fluoride
and cetyl pyridinium chloride)
with CHX.
There is evidence to suggest that, when used together in
low concentrations, the combination of CHX and fluoride
provide added benefits to patients, including the prevention

the prep course

of caries and the remineralisation of teeth, and whilst also acting as an efficient prophylactic
against oral diseases.14 There
is also evidence to suggest
that this combination is effective in tackling oral pathogens
such as streptococcusmutans.15
Another
long-term16
study
sought to examine the antibacterial capacity and side effects of an ethanol-free lower
concentration of chlorhexidine
(0.05 per cent), combined with
0.05 per cent cetyl pyridinium chloride, and found that
it had an anti-plaque effect
comparable with that of a 0.2
per cent chlorhexidine + alcohol
solution, but with reduced subjective side effects: slightly less
staining and better taste. However, such combinations, whilst
effective, do not completely remove the problem of alcohol
and the clear trend away from
its inclusion in mouth rinses for
a number of reasons, including
stinging and burning.
Another chemical plaquecontrol agent that has been
studied is essential oils. In a sixmonth randomised controlled
clinical trial,17 a commercially
available mouth rinse containing essential oils was compared
with an experimental mouth
rinse containing 0.07 per cent
cetylpyridinium chloride and
found both to be effective in reducing gingivitis and the proportions of periodontal pathogens.
Furthermore, a meta-analysis
of six-month studies18 found six
studies that showed essential
oils to be effective as both an
anti-plaque and anti-gingivitis
agent, comparable with the results achieved by 0.12 per cent
chlorhexidine. However, essential oils have the disadvantage of
poor substantivity and, in some

cases, an unpleasant bitter taste
and burning sensation.
Conclusion:
Although chlorhexidine is the
‘gold standard’ in antimicrobial
rinses, in general it is not considered suitable for long-term
use due to a number of factors,
including discolouration and
altered taste sensations, which
are likely to make patient compliance problematic. DT

About the author
Following his degree in biochemistry, Howard Thomas’s early career
was in the pharmaceutical industry,
where he worked
for a number of the
large multinationals before becoming was CEO of Merck for 11 years.
After leaving Merck, Howard set up
his own company Britannia Health
Products. Britannia Health Products
developed and launched the world’s
first Evening Primrose Oil product
(Efamol), which became market leader and really established the market
for health supplements. Subsequently,
Howard introduced Imedeen, a natural product for preventing wrinkles
and damage to the skin caused by free
radicals and ultra violet light which
received tremendous press coverage as a breakthrough in the prevention of premature skin ageing when it
was launched. Since1980, Howard has
worked with many research groups
developing “natural remedies” and has
been involved with many health-related organizations. He set up his own
nutritional supplement companies for
the human and veterinary markets and
also has been director of a number of
biotechnology start-up companies in
the Cambridge area. Until recently, his
principle activity was as Chairman of
Life Plus Europe, a successful multilevel marketing company supplying
nutritional products on a personal import basis throughout Europe. In January 2001, he sold that business to the
US affiliate and is now taking a much
more active role in the management
and product development of Oraldent
Ltd. Howard is focusing on developing
a range of natural products for the dental market. The dental market in terms
of product development has been neglected by companies, yet over 90% of
the population has some form of gum
disease and suffer form minor to severe discomfort.

References

contact: 0845 6046448

website: www.advanceddentaleducation.com

the restorative course

1. Siegrist AE, Gusberti FA, Brecx ML, Weber HP, Lang NP. Efficacy of supervised rinsing
with chlorhexidine digluconate in comparison to phenolic and plant alkoloid compounds. J Periodont Res Suppl 60, 1986 2. Gusberti FA, Sampathkumar P, Siegrist BE,
Lang NP. Microbiological and clinical effects of chlorhexidine gluconate and hydrogen
peroxide mouthrinses on developing plaque and gingivitis. J Periodontol 15: 60, 1988 3.
Svantun B, Gjermo P, Eriksen HM, Rolla G. A comparison of the plaque-inhibiting effect
of stannous fluoride and chlorhexidine. Acta Odont Scand: 35:247, 1977. 4. Hefti AG, Huber
B. The effect on early plaque formation, gingivitis and salivary bacterial counts of mouthwashes containing hexitidine/zinc, aminfluoride/tin or chlorhexidine. J Clin Periodontol
1987; 14:515 5. Fazi MI. Photographic assessment of the antiplaque properties of sanguinarine and chlorhexidine. J Clin Periodontal 1988; 15:106 6. BASSO ET AL. A modified
mouthwash, to reduce the discoloration caused by Chlorhexidine. Dental Cadmos, set 76
(7), 2008. 7. Jones CG. Chlorhexidine: is it still the gold standard? Periodontal 2000 1997:
15: 55-62 8. Bernardi F, Pincelli MR, Carloni S, Gatto MR, Montebugnoli L. Chlorhexidine
with an anti discoloration system. A comparative study. Int J Dent Hyg. 2004; 2: 122-6.
9. Addy M, Sharif N, Moran J. A Non-saining Chlorhexidine mouthwash? Probably
not: A Study in vitro. Int J Dent Hyg. 2005;3:2:59-63 10. Cortellini P, Labriola A, Zambelli
R, Pini Prato G, Nieri M, Tonetti M. Chlorhexidine with an Anti Discoloration System
after periodontal flap surgery: a cross-over, randomized, triple-blind clinical trial. J Clin
Periodontol 2008; 35: 614-620. 11. Barkvoll P, Rölla G, Svendsen AK. Interaction between
chlorhexidine digluconate and sodium lauryl sulphate in vivo. J Clin Periodontol 1989;
16:593-595 12. Carretero Pelaez MA, Esparza Gomez GC, Figuero Ruiz E, Cerero Lapiedra R. Alcohol-containing mouthwashes and oral cancer. Critical analysis of literature.
Med Oral 2004: 9: 120-123, 116-120. 13. Carretero Pelaez MA, Esparza Gomez GC, Figuero
Ruiz E, Cerero Lapiedra R. Alcohol-containing mouthwashes and oral cancer. Critical
analysis of literature. Med Oral 2004: 9: 120-123, 116-120. 14. Jenkins S, Addy M, Newcombe
R: Evaluation of a mouthrinse containing chlorhexidine and fluoride as an adjunct to
oral hygiene. J Clin Periodontol 1993; 20: 20-25. 15. Ostela I, Karhuvaara L, Tenovuo J:
Comparative antibacterial effects of chlorhexidine and stannous fluoride-amine fluoride
containing dental gels against salivary Streptococci mutans. Scand J Dent Res 1991; 99:
378-383.; Meurman JH: Ultrastructure, growth, and adherence of Streptococcus mutans
after treatment with chlorhexidine and fluoride. Caries Res 1988; 22: 283-287. 16. Quirynen
M, Soers C, Desnyder M, Dekeyser C, Pauwels M, van Steenberghe D. A 0.05% cetyl pyridinium chloride/0.05% chlorhexidine mouth rinse during maintenance phase after initial
periodontal therapy. J Clin Periodontol 2005; 32: 390-400. 17. Albert-Kiszely A, Pjetursson
BE, Salvi GE, Witt J, Hamilton A, Persson GR, Lang NP. Comparison of the effects of
cetylpyridinium chloride with an essential oil mouth rinse on dental plaque and gingivitis
– a six-month randomized controlled clinical trial. J Clin Periodontol 2007; 34: 658-667.
18. Gunsolley, JC. A meta-analysis of six-month studies of anti-plaque and anti-gingivitis
agents. JADA 2006, 137: 1649-1657.

[23] =>

It wasn’t the champagne that gave him
the confidence to make his speech,
it was his dentist.

The biggest problem
for some new denture
wearers isn’t their
dentures, it’s the
emotional impact of
losing their teeth. This
can affect people’s
confidence in social

situations, so even
dentures that fit perfectly
can’t always overcome
that feeling of selfconsciousness. This is
where recommending
a denture fixative like
Poligrip can help.

POLIGRIP is a registered trade mark of the GlaxoSmithKline group of companies.

Because it gives people
the confidence to feel
comfortable about
themselves and so at
ease with others. Even
if they are telling bad
jokes in front of a
hundred people.

SPEAK, EAT & SMI LE
WITH CONFIDENCE

[24] =>

24 Practice Management

United Kingdom Edition November 29-December 5, 2010

The value of a treatment coordinator
Glenys Bridges looks at the role of a treatment coordinator in practice

I

magine how beneficial it
would be to have a treatment
coordinator
in
you practice? Particularly now
when practices are fine tuning qualityaspects for their
application for Care Quality Commission registration,

and really need to generate
a strong income stream despite the current economic
environment.
Many practices have already
realised the potential benefits
of developing the treatment

coordinator role. They recognise the win-win outcome of
this new team role that can
sustainably increase profitably, whilst enhancing the job
satisfaction of senior DCPs,
in whom over a number of
years the business has made

investment.

gain a recognised qualification.

In many cases the main reason practices have not yet taken
this idea forward is because
they are not in a position to
invest £1,000 in a training
course for their chosen DCP to

This being the case, there
is excellent news for practices in this position; until
December
2010
there
is a £1,000 training grant available to reimburse practices
willing to pay out for practice
management or care coordination training.

a

substantial

Over the past 10 years the
treatment coordinator role has
been introduced to numerous
practices, allowing them to hold
on to valued staff who feel they
have reached a dead-end in
their dental nursing career. In
some cases this is because after many years they need more
challenging work, or because
occupational health issues, such
as back pain, make it difficult
from them to continue to work
chair side.
In the treatment coordinator
role these staff can continue to
offer excellent benefits for the
business, the patients and the
dental team.
Observing practices across
the UK, there is notable divide
opening-up between proactive
practices, with a customer care
philosophy; and those who are
at full stretch on reactive treadmill and are not able to devote
time to the development of coordinated care procedures to
enable patients to make fully
informed treatment choices,
based on their understanding
of the potential health gains,
rather than purely on the financial concerns.
To optimise the full benefits
of treatment coordination, it is
advisable to train your treatment coordinator in aspects of
project management, the GDC
Standards, health promotion,
psychology and sociology.
Working toward a level 3 Diploma in dental care ordination
enables dental professionals to
build skills and confidence to
research, develop and review
procedures designed especially
for your practice, patients and
team.
To find out how you can get
your training costs fully reimbursed for care coordination
training please see the Dental
Resource Company website
www.dental-resource.com DT

About the author
Glenys Bridges is managing director
of the Dental Resource Company, and
has provided training for dental teams
since 1992. For more information, visit
www.dental-resource.com or call 0121
241 6693

[25] =>

NEW & IMPROVED

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IST

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[26] =>

26 Advertorial

United Kingdom Edition November 29-December 5, 2010

Nobel Biocare offers the Nobel FAST
One Year Implantology course

or
the
fourth
year
running, implant giant Nobel Biocare will be offering
a limited number of clinicians
in Northern Ireland the chance
to study practical dental implantology on its yearlong

course, NobelFAST. Dr Raj Patel
and Dr Damian McNally will
lead
2011’s
fascinating
programme, beginning on January 15.
Over the course of 12 months,

dental graduates will gain plenty
of hands-on training to equip
them with the skills and knowledge necessary for independent
practice in dental implantology,
along with six hours of CPD for
each day of the course.

The programme is divided
into a series of modules. Section 1
covers assessment and treatment
planning and will include surgical practice on pigs heads, suturing and flap design, membranes,
and equipment training (surgical

and prosthetic). This part of the
course spans four days.
Section 2 of the course concentrates on implant surgery,
looking at both first and second
stage implant surgery using local anaesthetic and intravenous
sedation. Delegates will also
learn how to use surgical stents
and surgical indexing. More advanced subjects such as bone
grafting and the management of
surgical complications will also
be covered in this section, which
lasts for six full days.
The third section of the course
gives clinicians a solid grounding in implant prosthetics and
includes modules in taking impressions, jaw registration, articulation, maintenance, problem
solving and the management of
failures, and how to satisfy patients’ aesthetic demands. Dentists will be required to attend this
section for five full days.

For a
free sample

Delegates will benefit from a
wide range of teaching methods,
including seminars that provide
all the essential background and
theoretical information on the
subject. This knowledge is reinforced in consultant-led clinics
to illustrate the individual facets
of implantology and encourage
reflective learning. Each student
will have the opportunity to devise their own treatment plans
and will undertake the surgical placement and restoration
of several patients to practise
practical techniques. Students
on the course will be required
to undertake a suitable amount
of independent study, including
preparation for clinical sessions
and research into topics that are
relevant to oral implantology
but not formally covered in the
course material.

UKP00246

*Chemically compatible with methacrylate based adhesives and composites. **Limited samples available

please contact us using
the details below

The revolutionary way to save time
Increments up to 4mm without layering
Flowable for excellent cavity adaptation
Compatible with your current adhesive*

+44 (0)1932 837303

(quoting free SDR sample)

On completion of the course,
dental professionals will be able
to recognise the clinical rationale behind the placement of
dental implants and be aware
of the principles of appropriate
patient selection. They will also
have an in-depth knowledge of
the practical surgical and prosthodontic aspects of the subject
using the NobelReplace™ and
Brånemark systems. Clinicians
will also understand how the
provision of general clinical dentistry and dental implantology
is affected by both medical and
social factors and will be able
to appreciate the role of clinical, technical and ancillary personnel in patient management.
Dentists who are looking to
introduce this exiting area of dentistry into their practices and gain
plenty of practical experience
are encouraged to contact Nobel
Biocare quickly to reserve their
place on this popular course. For
further information contact Nobel
Biocare on: 0208 756 3300 or visit
www.nobelbiocare.com DT

[27] =>

United Kingdom Edition November 29-December 5, 2010

Company Profile 27

Easier, Faster, Safer, Stronger
T

he late Stuart Filhol
founded Filhol Dental,
which for more than 30
years has been recognised as a
leader in pin and post technology. Stuart was credited with
being first to identify the benefits of using pure titanium in the
production of FILPIN retention
pins and FILPOST customised
root canal posts. He was also
instrumental as an innovator
in the manufacture of fine
turned parts for the dental industry. Since Stuart’s unexpected passing last year his wife,
Sarah, filled his position as
managing director and with her
team continues to build on the
excellent reputation created by
her husband.

Filhol Dental is a company
prized by its customers for its
ability to work with difficult or
challenging materials and finishes. The finer manufacturing work was moved in 1970
to Southern Ireland, from Warwick, to focus on the production of its patented parapulpal
dentine pins originally made
from stainless steel. Following
Stuart’s research into finding
the best materials he became
the first manufacturer of dentine pins to use pure titanium.
Pure titanium is recommended
as the most biocompatible grade
for the body implants, therefore,
it was the best decision for use
in the production of the Filhol
products. This focus on dental
solutions enabled Filhol to move
from a manufacturer of components for other companies to a
manufacturer of pin and post
products in its own right and it
is recognised as being one of the
leaders in its field.
FILPIN has been in production since the 1980’s. The
FILPIN dentine retention pin
is design engineered to make
placement easier, faster, safe
and stronger. The shaft is 99.8
per cent pure titanium, biocompatible and compatible with all
dental materials so will not corrode. The self-threading, selfaligning pin speeds and eases
placement for self-shearing first
time, every time once optimum
depth has been reached. After
insertion FILPIN can be easily bent to suit the restoration
without breaking it or the tooth.
A unique thread design maximises retention strength without
causing internal stresses that
may lead to cracking or crazing.
This patented pin has been used
in the UK market for more than
30 years.
FILPIN enhances the retention of all types of restorations
to dentine. If the tooth’s dentine is too soft or its depth inadequate, the company has de-

vised the Filratch pin inserter to
give greater tactile control and
ease of placement. The Filratch
is for use by hand and ideal for
reaching difficult positions. The
pin is inserted by a continuous forward and back turning
of the plastic finger grip on the
Filratch. This has a ratchet action and so threads the pin
into the pre-drilled hole. When
the pin reaches the bottom of
the hole the pin shears at the
break-off point, leaving half the
thread anchored in the dentine
and half the thread above the
surface for restoration.

compatible 99.8 per cent pure
titanium FILPOST, the post
may be customised to suit the
canal without risking fracture
thus providing easy insertion of
multiple posts into converging
canals and providing mechanical retention whilst minimising stress to the tooth structure.
The retention is provided by
a unique multi-cement interlock between the dentine and
the post. The retention grooves
in the canal are prepared with
the FILPOST Universal Groover which has proportionally
sized grooving edges, smaller
and closer at the tip that become larger and wider as the
diameter increases.
A further product marketed
by Filhol Dental is the FILPOST
Customizer, which is purposedesigned stainless steel pliers
to make customising the pupal post faster, easier and
more exacting to the re-

quirements
of
the
root
canal. Additionally, the Customizer makes fast work in the
placement of two FILPOSTs
into a molar to ensure greater
stability and anti-rotational se-

curity of crowns.

Filhol Dental, Better by
Design restoration retention
system. DT

Filpin Pin Bender with two Filpins in one restoration

new ideal accessory,
the FILPIN Pin Bender, has
been developed to enhance the
FILPIN restoration retention
system. After inserting a pin it
may be necessary to bend the
protruding pin(s) to suit the
restoration. It is engineered for
precision and accuracy to protect against damage to the pin
and tooth structure and creates uniform bends each time
whilst minimising uneven pressures upon the pin and dentine.
The Filhol Dental slogan is
“Easier, Faster, Safer, Stronger”.
A classic example of this ethic of
restoration retention systems is
the FILPOST. It is provided in
two sizes, and can be more easily bent and adjusted to fit the
specific length and shape of the
patient’s root canal and provides
little, if any, dentine removal to
place, in a word, Customised.
The patented passive FILPOST, manufactured by Filhol
Dental, is the perfect choice
for all post requirements. It is
also design engineered to be
easier, faster and safer to place
and provides maximum advantages without compromising safety, dentine integrity
or retention. By using the bio-

Old Police Station, Chipping Campden, Gloucestershire GL55 6HB UK
Tel: +44 (0)1386 841 864 Fax: +44 (0)870 116 9790
email: info@filhol.com www.filhol.com
Patented Worldwide
Untitled-2 1

Available from your Dental Dealer
4/1/08 10:40:05

[28] =>

The Dental Directory:
Experts on Digital
Imaging Equipment
D

igital Imaging is an
extremely fast
growing area
within today’s dentistry
field, and one that may
require a dentist to make a
substantial investment in
terms of equipment. Due
to the complex nature of
Digital Imaging, the
necessary equipment
currently available is often
highly advanced and
relatively new to the

market. With this in mind,
it is vital that suppliers
keep up to speed with
industry developments;
and one that has is The
Dental Directory.

Dr Boota S Ubhi is the
Specialist Periodontist and
Implant Surgeon at the
Birmingham Periodontal
and Implant Centre. He
works alongside Dr Tuss
Tambra who is an
American trained Specialist
Prosthodontist. The
practice is a large specialist
centre based in Harborne,
Birmingham and has a
wide referral base covering
most of the Midlands. He
has been a client of The

Dental Directory for the
last thirteen years,

‘ I have been using the
services of The Dental
Directory since 1997 and
have had only positive
experiences in all of my
dealings with them.
Initially The Dental
Directory offered me a
very good deal on a
particular product, the

service was excellent, and
as a result I’ve been a
client ever since. I decided
that I would seek the
assistance of The Dental
Directory when it came to
choosing and installing new
Digital Imaging equipment
in my practice, and it
paid off.’

Dr Ubhi’s multidisciplinary
practice specialises in
treating patients with
advanced periodontal
problems, fixed and
removable prosthodontics
and Implant therapy. Dr
Ubhi was entered onto the
General Dental Council’s
Specialist Register in
Periodontics in 2000 and

has been accepting
referrals for advanced
dental care since 1996. Dr
Tambra is a registered
specialist Prosthodontist in
Canada, UK and USA.

In addition to this, the
practice facilities which
include a large lecture
room and dedicated
surgical suite allow them to
provide training to

and after treatment.
Five years ago, Dr Ubhi
changed to using both the
intra-oral and extra-oral
digital imaging supplied by
The Dental Directory. He
was extremely pleased with
how this worked out and
investigated the CT
scanner options.

Having read research
produced by the University

‘The equipment arrived
promptly and was exactly
to spec; I was delighted.
The whole experience was
thoroughly well-planned,
low stress and professional;
qualities that I’ve come to
expect from The Dental
Directory.’
referring dentists and their
staff to enable them to gain
the understanding and
confidence to deal with
advanced dental care. The
Surgical and Prosthodontic
10 day modular implant
course is now in its 5th
year. This course covers
surgical implant therapy,
sinus and bone grafting,
bone augmentation and the
Prosthodontic aspect of
Implant therapy. Nurse’s
courses are also run and
cover a range of topics
including basic implant
techniques, care of
instruments, sterile
techniques, implant kits
and care of patients before

of Manchester, Dr Ubhi
learned that the i-CAT
scanner provided the best
quality images, and most
importantly, the lowest
dose of radiation available
on the current market.
After intensive
consultation, The Dental
Directory supplied Dr
Ubhi with a Gendex
GXCB-500 CBCT System.

‘After considering the
necessary specifications, I
approached several
different suppliers, one of
which was The Dental
Directory. I discussed my
requirements with them

and they were extremely
knowledgeable. They have
a dedicated Digital Imaging
Manager, Mohammed Latif
who is on hand to offer
advice and explanation.
Their expertise was
invaluable and made me
feel confident that my
choice of equipment and
supplier was the right one.’

The Gendex GXCB-500
provides powerful,
instantaneous diagnostic
and treatment planning
tools; giving distortion-free
images to reveal critical
anatomical details. This
scanner is one of many
pieces of Digital Imaging
equipment available from
The Dental Directory, and
Dr Ubhi is extremely
happy with his purchase.
He feels that the addition
of 3D imaging to his
practice means that he is
providing a much higher
standard of care for his
Implant cases. The
planning and execution of
his treatment is much
quicker and safer due to
the on site CT scanner.
He explains,

‘The i-CAT scanner is
fantastic. The installation
was arranged efficiently by
The Dental Directory and
needed very little input
from me. The engineers
arrived at 8am to set up the
i-CAT, and by late
afternoon I had taken my
first scan! The equipment
arrived promptly and was
exactly to spec; I was
delighted. The whole
experience was thoroughly

[29] =>

[30] =>

30 Industry News
BioHorizons announces
dates for the 2011
calendar
Following
a
busy
and exciting 2010 for
BioHorizons and on the back of their highly successful congresses in Colombia
and Turkey, BioHorizons is pleased to announce the 2011 dates for the Global
Symposium and Ultimate Implant Year Course.
Held in Phoenix, Arizona on April 28 - May 1, 2011 BioHorizons Global
Symposium will be held at the prestigious Arizona Biltmore Hotel with topics
that include immediate loading, aesthetics, tissue regeneration and implant
complications. Addressing a wide range of implant dentistry challenges, it’s
the perfect opportunity to stay abreast of the latest treatment options while
enjoying time with colleagues in the unique landscape of the Sonoran desert.
2010 was an exciting year for BioHorizons with the launch of Laser-Lok 3.0mm,
(the first 3mm implant to incorporate Laser-Lok technology to create a biologic
seal and maintain crestal bone on the implant collar) followed by an impressive
600 delegate attendance at their Symposium in Turkey in September.
For more information on BioHorizons implants, Biologic range, courses and
Symposium or to arrange a meeting with your local product support specialist
contact the UK office now on 01344 752560, email: infouk@biohorizons.com
or visit the website at www.biohorizons.com.

The Dental Directory:
Massive discounts on
DENTSPLY products
From
now
until
the
24th December, dental
professionals can enjoy
exclusive and unbeatable
offers on a range of
DENTSPLY products when they buy from The Dental Directory!
Many of The Dental Directory’s DENTSPLY promotional prices are an
unbelievable 65% lower than Henry Schein Minerva’s*, and with such a huge
variety of DENTSPLY products to choose from, why purchase your dental
sundries from anywhere else?
Excellent discounts are available on products including:
• Ash® Forceps • Thymozin Instrument • Ash® Polytrays • SaniTip®
• Dispersalloy® • And much more!
As the UK’s key distributor of DENTSPLY’s leading anaesthetic products,
Citanest® and Xylocaine®, The Dental Directory is also able to offer dentists the
very best knockout prices on these products too.
With The Dental Directory placing your order couldn’t be simpler. Leading
brands are dispatched from under one roof and next-day delivery is
guaranteed.
To order, simply contact your local Dental Directory Representative, call 0800
585 586, or alternatively visit: www.dental-directory.co.uk.

‘EyeMag Pro Loupes have
literally been an eyeopener!’
For dental practitioners
looking for an affordable
magnification
solution
that won’t compromise on
quality and reliability, look
no further than the EyeMag Pro Loupes and Illumination unit.
Designed by world-renowned Carl Zeiss, the EyeMag Pro range offers 3.2x –
5.0x magnification, along with five working distances from 500mm to 300mm;
promoting perfect posture.
Dr Ash Quraishi of the West Mount Dental Surgery, is delighted with the many
benefits he is experiencing with his new EyeMag Pro Loupes,
‘The EyeMag Pro Loupes and Illumination unit has been a complete blessing
with regards to my clinical work. I can appreciate the margins so much better
than before and the standard of my clinical work has vastly improved. From
simple procedures such as examinations, to complex crown preparations, the
EyeMag Pro Loupes have quite literally be eye-openers
Nuview offers a comprehensive service including a survey of the client’s needs,
full installation, training and prompt aftercare.
For more information call: 01453 872 266 or email: info@nuview-ltd.com
www.voroscopes.co.uk

91% of clinicians trialling SDR™ plan to use the
product in their practices
A survey of dentists using the new bulk-fill,
flowable composite base, SDR™ (Smart Dentine
Replacement), has revealed that 91% of respondents
plan to use the material on a daily basis in their
practice.
SDR is the revolutionary new way for clinicians
to save time, making posterior direct restorations
simpler and quicker to place. Over 1200 new users in
the UK and thousands of users worldwide agree that
the first flowable, bulk-fill composite base material
significantly reduces the time and effort spent in the
placement of Class I and II restorations.
Excellent internal cavity adaptation and reduced air bubbles mean that with
SDR, post-operative sensitivity is significantly reduced. The material also
boasts a very low incidence of microleakage and can be capped with any
methacrylate-based composite, making it easy for dentists to switch from their
currently used composite.
Clinicians wishing to try SDR for themselves are invited to contact DENTSPLY
to receive a free sample.
For more information, or to book an appointment with your local DENTSPLY
Product Specialist, call 0800 072 3313 or visit www.dentsply.co.uk

United Kingdom Edition

November 29-December 5, 2010

Christmas is coming!
It’s fast approaching that time again, and
Kemdent are delighted to announce their
popular Christmas Hamper Promotion for
2010!
To qualify for a Free Christmas Hamper,
Kemdent’s customers need to spend £225
or more during November; a task which
should present few problems given the wide
range of offers on surgery products currently
available!
Kemdent’s Diamond Restoratives and Cross-infection Control Products are
among the items on special offer in the run-up to Christmas, which include
Diamond Capsules, Diamond Core and ChairSafe and PracticeSafe Economy
Wipes.
Three sizes of Christmas hamper are available, and the more you spend on
Kemdent products in November, the larger your hamper will be! For further
details and to take full advantage of the Kemdent special offers, contact Helen
or Jackie on 01793 770256.
For further information on the Christmas hamper promotion or to place orders
call Helen on 01793 770256 or visit our website www.kemdent.co.uk. Follow
us on twitter: twitter.com/kemdent

Up ‘Forum’
discussion…
Practice
plan,
leading provider of
practice branded
dental membership
plans recently held their first ever Dental Forum.
Ten dentists from across the UK ranging from Cardiff, London, Worcester and
Derby, ventured to Nottingham, where they were joined by President of the
BDTA, Ed Attenborough, Nigel Jones and Nick Dilworth from Practice Plan and
BDA President, Amarjit Gill who chaired the forum.
The forum was organised to provide an invaluable opportunity for a range of
dentists to exchange views on the current challenges facing dentistry. Topics
that were discussed ranged from the future of the NHS and the new regulatory
regime (CQC/HTM0 105), to marketing dentistry, with particular focus on the
use of online methods such as websites and social media, as well as new dental
technology, where consideration was given to the use of the forum as a future
testing ground for such developments.
Following the success of this initial gathering, Practice Plan is now intending to
hold at least two forums a year henceforth.
If you would like any further information on Practice Plan, please visit
www.practiceplan.co.uk or call 01691 684135.

SMARTSEAL WINS FDA
APPROVAL
Smartseal
has
gained
approval for its innovative
endodontic root filling
systems from the United
States regulatory body, the

For peace of mind choose Citanest® 3%
with Octapressin
from DENTSPLY
DENTSPLY’s Citanest® 3% with Octapressin
Dental Injection (prilocaine hydrochloride
and octapressin corresponding to felypressin)
can now be purchased in 2.2ml standard and
self-aspirating cartridges.

The FDA, which is part of the US Department of Health and Human Services,
is responsible for protecting public health by assuring the safety, efficacy and
security of drugs, biological products and medical devices.
Jerry Watson, the chief executive of smartseal, said he was delighted to hear
from the FDA approving smartseal’s obturation system. “This is the news that
we’ve been waiting for,” he said. “Approval from the FDA is hugely important
and proves to dental professionals across the world that our product’s safety
is completely assured.”

Suitable for use in combination with
medications where plain and adrenaline
solutions are not appropriate, Citanest® 3%
does not produce the cardiovascular effects of
adrenaline . Citanest® is also 40% less toxic than similar products as it contains
prilocaine rather than lidocaine .

Food and Drugs Administration (FDA).

Smartseal is a simple two part endodontic root filling system using radiopaque
hydrophilic polymers. The propoint obturation points expand with the natural
water present in the tooth (in the lateral direction only) and when coupled
with our smartpaste dental sealer, which also expands to fit the canal and fill
those lateral canals, dentists get an excellent 3D seal.
The smartseal family also includes biocompatible root canal sealer,
smartpaste bio, smartpaste and smartpointPT. For more information please
visit www.smart-seal.co.uk

The BACD 2011 Conference Something to Smile About
Dental professionals should book
now for the 2011 British Academy
of Cosmetic Dentistry’s SOMETHING
TO SMILE ABOUT conference, which
will focus on ‘Maximum Beauty from
Minimal Intervention’ - a growing
trend within UK aesthetic dentistry.
Far from being poles apart, the
BACD believes that successful smile design and conservative dentistry can be
combined to preserve and enhance a patient’s natural dentition in an ethical
manner, whilst simultaneously respecting key dental principles.
Bringing together dental professionals with some of the world’s foremost
speakers and experts, the eighth annual BACD conference will take place
between the 11th - 12th of November at the Hilton London Metropole Hotel,
London.
Attendance is limited, so be sure to book now for this unmissable event. Early
birds also stand to benefit from preferential booking rates, as well as the
chance to win an all-expenses paid trip to the DMG in Hamburg.
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

DENTSPLY PathFile™
Your Path To Success
DENTSPLY has launched
the new PathFile™ range of
rotary instruments for the
mechanical creation of the
glide path and for preflaring
root canals.

Practitioners using Citanest® 3% can be sure that the product will always
achieve the depth and duration required during routine dental procedures .
Patient safety is paramount for DENTSPLY, so Citanest® contains no latex –
allowing dental professionals to deliver the product with confidence.
Supply is readily available through the dealers Henry Schein, Wright Cottrell,
Dental Sky and The Dental Directory. For further details and prescribing
information please contact DENTSPLY on +44 (0) 800 072 3313 and ask for your
local Product Specialist.
www.dentsply.co.uk

CQC Registration Made Easy
The Care Quality Commission (CQC) has introduced
compulsory registration for all practice owners.
Although it seems daunting, registration can be
a breeze with the help of CODE’s Pre-registration
Compliance Check.
CODE can provide members and non-members with
a specialist consultant who will offer help with:
• Any missing policies, procedures, audits and risk
assessments
• Sources of appropriate solutions
• Analysis of your practice’s strengths and weaknesses
• Staff training
• CQC recommended remedial action
After the on-site visit, the CODE consultant will also offer you an additional
half day of support by telephone, fax and email to help you complete the
registration documentation.
Should they wish, CODE members can also benefit from a complete hand
holding service. In addition to everything in the Pre-registration Compliance
Check, your CODE consultant will spend three days in the practice to help
set up the procedures, risk assessments, policies and action plans needed to
achieve compliance.
Feel free to contact us for more details on prices and special offers.
Please visit www.CODEuk.com, email info@CODEuk.com or call 01409
254 354 for more information about CODE Assure and the benefits of CODE
membership. Follow CODE on Twitter at twitter.com/paulcode

Flexible and resistant to cyclic fatigue, NiTi alloy PathFile™ rotary instruments
offer the clinician numerous advantages over their manual counterparts.

Clinical confidence with Smart
Dentine Replacement™
97% of clinicians using the 1st ever bulkfill, flowable composite base material,
SDR™ (Smart Dentine Replacement),
stated they had already used the product
in a clinical context and most of them
rated it as ‘excellent’ or ‘good’.
The survey, conducted throughout
August-September 2010 highlights dentists’ confidence in the material’s
outstanding properties after having used SDR.

PathFile™ rotary instruments have been designed to create the glide path
rapidly and safely, reducing instrumentation time and offering the patient a
more comfortable experience.

Only recently launched in the UK, SDR by DENTSPLY is already being used by
more than 1000 clinicians throughout the country and by several thousands
worldwide.

A gradual increase in the diameter facilitates the progression of the file without
the need for strong axial pressure. This helps to better maintain the original
cavity anatomy.

With a significantly reduced risk of post-operative sensitivity thanks to its
excellent internal cavity adaptation and lack of air bubbles, SDR boasts a very
low incidence of microleakage and can be capped with any methacrylatebased composite.

Available in three ISO sizes (013, 016 and 019), practitioners are able to order
PathFile™ with immediate effect.
For more information, or to book an appointment with your local DENTSPLY
Product Specialist call 0800 072 3313 or visit www.dentsply.co.uk

To save both time and effort when placing Class I and II posterior restorations,
contact DENTSPLY today to receive your free sample of SDR.
For more information, or to book an appointment with your local DENTSPLY
Product Specialist, call 0800 072 3313 or visit www.dentsply.co.uk

[31] =>

Midi Pro

Simple and reliable unit
with generous specification.
only 7% VAT - buy directly
from the manufacturer
• reliable, pneumatic unit
based on DCI parts (USA)
• piezo scaler and fibre optic
handpiece outlet as standard
• services hidden in chair’s base
• wide range of optional equipment
• continental, international
and cart systems available

£7,990

mobile
07981075157
27 Woodcock Close
voicemail 08450044388
Birmingham, B31 5EH
fax
08719442257
e-mail office@profi-dental.co.uk

To advertise here please contact Sam Volk
on 0207 400 8964

Classified 31

United Kingdom Edition November 29-December 5, 2010

WWW.PROFI-DENTAL.CO.UK

A ONE YEAR MODULAR COURSE IN

RestoRative DentistRy 2011

Now in its fourth successful year, this course has revolutionized the teaching of restorative
dentistry. The combination of an increase in knowledge and practical skills will bring high
quality dentistry into your ‘comfort zone’. There is one single feature that all delegates
who have completed this one-year course have acquired – confidence!

Fri 7th Jan
Sat 29th Jan
Sat 26th Feb
Sat 12th March
Sat 9th April
Sat 14th May
Sat 25th June
Sat 9th July
Sat 19th August
Sat 17th Sept
Sat 8th Oct
Sat 12th Nov
Fri 9th Dec

Intro: Occlusion 1
Occlusion 2
Anterior Direct Composite Restorations
Posterior Composites and Bonded Amalgams
Dentures; Full and Partial
Endodontics
Crown Preparations 1
Crown Preparations 2
Implants
Smile Design and Veneer Preparations
Bridgework
Periodontology
Posts, Treatment Planning and Practice Marketing

Set in central Leeds, the course utilizes the high spec phantom head room in The Leeds
Dental Institute for all its practical sessions.

0791 458 9692

claire@thenorthofenglanddentalacademy.com

one year modular course

£450

per course day,
inc VAT

To view the full dates for all available courses, please visit:

84.5

www.thenorthofenglanddentalacademy.com

hrs
CPD

[32] =>

3D Head and Neck for Dentistry DVD-ROM
An innovative new resource for dentists in practice, training and teaching.
An invaluable addition to your image and reference library, this DVD-ROM includes clear,
accurate and interactive 3D anatomy, clinical images, text and 3D cross sections with MRI
correlation.
Choose from over 100 3D views of head, neck, face, oral and nasal cavities, dentition,
individual teeth in 3D and cross section, larynx and pharynx, sinuses, eye, brain and more.
Specialised clinical content includes 3D views of progressive dental conditions such as
caries and gingivitis and detailed and interactive 3D nerve views of intraoral injections.
Each 3D view can be rotated and layers of anatomy can be added or removed. Point
at any visible structure to label it, then access text with one click of a mouse.
• Quickly review, explain and teach complex anatomy of the head and neck using
3D models that focus on the most relevant anatomy for dentists.
• Get a new perspective on anatomy by viewing the floor of an oral cavity in 3D cross
section, for example, rotate to get a patient view, then add or remove anatomy.
• Save valuable time finding images for patient education, presentations and posters
by simply exporting or printing any image direct from the software, royalty free.
• Explain conditions and procedures more quickly and effectively using
images and clinical illustrations during consultations.

SPECIAL OFFER - SAVE 20%
3D Head and Neck Anatomy for Dentistry DVD-ROM
for only £165.60
Please quote offer DTRB3 when ordering.
(Regular price £207.00) Prices include VAT.
Please add £3.50 for postage and packaging.

PLACE YOUR ORDER TODAY
Call 020 7637 1010
Order securely online at www.primalpictures.com
Use order code DTRB3 at the checkout to apply discount.

Email sam@primalpictures.com
Fax 0207 636 7776

Technical requirements:
DVD-ROM drive
512MB RAM
1.5GHz Processor
200MB free disk space
Windows XP, Vista and Windows 7.
Mac 0SX 10.3, 10.4, 10.5 and 10.6.

DVD-ROMs are sold for a single license intended for use by one individual only (not licensed for sharing of installing on a server).
For details on multi user licenses please contact sam@primalpictures.com.

www.anatomy.tv

www.primalpictures.com

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