DT UK No. 1, 2015

Editorial / UK News / World News / Business / Show Tribune Dentistry Show 2015 / Trends and Applications / Advertorial: iTOP / Interview: “Bowie’s teeth were like everything else about him: different”

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DTUK0115_01-02_Title 09.04.15 16:55 Seite 1

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DENTAL TRIBUNE
The World’s Dental Newspaper · United Kingdom Edition

Vol. 9, No. 1

www.dental-tribune.co.uk

GOOGLE

A MIXED NATIONAL PICTURE

DAVID BOWIE

Dental Focus Operations Manager Naz
Haque, aka the Scientist, explains what
dentists can do to get on page 1 in 2015.

King’s College professor and EuroPerio 8 chairman Prof.
Francis Hughes about the
current state of periodontology in the UK and why
much needs to be done.

Inspired by his unique look, a German artist recently made
a reproduction of the singer’s
original teeth. DT spoke with
her about the sculpture and
the perception of beauty.

” Page 7

” Page 21

” Page 31

IMPRINT
PUBLISHER:
Torsten OEMUS
GROUP EDITOR/MANAGING EDITOR DT UNITED KINGDOM:
Daniel ZIMMERMANN
newsroom@dental-tribune.com
CLINICAL EDITOR:
Magda WOJTKIEWICZ
ONLINE EDITOR:
Claudia DUSCHEK
ASSISTANT EDITORS:
Anne FAULMANN, Kristin HÜBNER
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DESIGNER:
Alexander JAHN

Published by Dental Tribune International
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Internet: www.dental-tribune.co.uk
E-mail: info@dental-tribune.com

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© 2015, Dental Tribune International GmbH.

All rights reserved. Dental Tribune makes every effort
to report clinical information and manufacturer’s
product news accurately, but cannot assume responsibility for the validity of product claims, or for typographical errors. The publishers also do not assume
responsibility for product names or claims, or statements made by advertisers. Opinions expressed by
authors are their own and may not reflect those of
Dental Tribune International.

Editorial
Dear reader,
Winston Churchill once famously said,
“Difficulties mastered are opportunities
won.” These words from one of Britain’s most
famous statesman aptly describe the relaunch of the Dental Tribune UK edition. The
newspaper that you are holding in your
hands is the result of months of reorientation
and repositioning that will see the return of
an active participant in the British dental
publishing scene. At this opportunity, we
would like to thank our former partners for
their years of commitment and wish them
best of luck for their future endeavours.
Our publishing group has come a long way
since the first edition of Dental Tribune UK
was launched in 2007. From a few publishers
operating in key markets only, it has grown
into a large-scale global operation with offices and representatives in almost every corner of the globe; to borrow a famous historical phrase, the sun never sets on the Dental
Tribune International (DTI) network, as
somewhere in the world a Dental Tribune
publisher or partner is always working. And
our expansion is still far from over: coinciding with the relaunch of the UK edition here
in Birmingham, Dental Tribune is introducing its first-ever Nordic edition this month at
the SCANDEFA show in Copenhagen in Denmark to serve all markets in Scandinavia and
Finland.
While remaining a print publisher at heart,
DTI has been successfully venturing forward
in other areas, most notably continuing professional education and events. While the
Dental Tribune Study Club provides free online education at an international and local
level, the new Clinical Masters series offers
high-quality CPD in selected areas, including
implantology, endodontics and aesthetic
dentistry. Moreover, last year saw the successful première of the Digital Dentistry
Show, a show within a show expo format that
will see further geographical and topical expansion in 2015.
Dentistry is becoming increasingly international and, in addition to reporting reliable
news on UK dentistry, Dental Tribune UK will
provide perspectives on developments and
trends from a much broader angle. Owing to
its licence partner network in over 90 countries, our group has almost unprecedented
access to markets and opinion leaders in the
world. As one of the few, for example, we have
reported extensively on the Minamata Convention on Mercury, a key multilateral agreement on the phase-out of mercury-containing products, including dental amalgam.
With its speciality magazines, like CAD/CAM
and cone beam, DTI is also following the use
of digital technologies in dentistry and the

impact of these on the work of dental practices and laboratories currently and in the future.
Furthermore, we keep up to date with the
industry. For example, we were recently invited to visit the headquarters of MIS Implants Technologies in Israel (see page 10 of

among other subjects, you will learn how to
recognise and manage orofacial pain, identify and deal with patients suffering from eating disorders, and boost your practice or business on Google.
We wish you an enjoyable read and look
forward to hearing your opinions and com-

“Difficulties mastered are opportunities won.”
this edition). Considered the next major
competitor in implant dentistry worldwide,
the company gave DTI full insight into its production facilities and corporate philosophy.
Dental Tribune also offers high-quality
and relevant clinical content. In this edition,

ments. If you are visiting the Dentistry Show
in Birmingham, we would like to invite you to
meet us at Stand P80.
Sincerely,
The Dental Tribune UK editorial team

PRINT
L
DIGITA N
TIO
EDUCA
EVENTS

The DTI publishing group is composed of the world’s leading
dental trade publishers that reach more than 650,000 dentists
in more than 90 countries.

[2] =>

DTUK0115_01-02_Title 09.04.15 16:55 Seite 2

UK NEWS

Dental Tribune United Kingdom Edition | 1/2015

Dental care professionals suitable for performing
oral screenings
By Dental Tribune

MANCHESTER, UK: Researchers from the
University of Manchester have found that
oral hygiene therapists can perform
screening for common dental diseases as
well as general dentists. Their study compared the diagnostic test accuracy of hygiene therapists in screening for dental
caries and periodontal disease in regularly
attending asymptomatic adults.
The finding has important ramifications
for service design in public-funded health
systems as regularly attending adult patients in the UK are increasingly asymptomatic and often do not require treatment at
their routine dental examinations. Thus,
using GDPs to undertake the check-ups on
regular low-risk patients represents a potentially unnecessary cost for state-funded
systems.
Given recent regulatory changes in the
UK, it is now theoretically possible to delegate a range of tasks to dental care professionals. According to the researchers, role
substitution in primary dental care may be
a promising option for reducing costs, releasing the GDP’s time and increasing the
capacity to care for those who do not currently access services. Throughout the UK,

only about 50 per cent of the population attend the dentist. The other half is generally
socio-economically disadvantaged and experiences the majority of dental diseases.
Ten dental practices across North West
England took part in the study and 1,899
asymptomatic adult patients were
screened. Visual screening by hygiene therapists was taken as the index test and the
GDP acted as the reference standard. The
primary outcomes measured were the sensitivity and specificity values for dental
caries and periodontal disease.
The results of the study showed that the
hygiene therapists performed comparably
to the GDPs. Richard Macey, lead author of
the study and research assistant at the dental school, told medicalnewstoday.com: “In
particular, hygiene therapists were good at
identifying those patients the GDP had
confirmed were caries free and at identifying periodontal disease where the dentists
confirmed its presence.”
Fiona Sandom, President of the British
Association of Dental Therapists, welcomed the findings of the study: “Our association find the results of this study encouraging and we view it as further evi-

Hygiene therapists performed comparably to the GDPs in the study.

dence to support delegation within the
dental team. The research confirms that
dental hygienists and therapists have key
parts to play in the future delivery of dental
care within the UK.”

The study, titled “The efficacy of screening for common dental diseases by hygiene-therapists: A diagnostic test accuracy study”, was published online on 20 January in the Journal of Dental Research.

Billions to suffer from
untreated decay

Alarming increase in
oral cancer rates

By Dental Tribune

LONDON, UK: Despite worldwide efforts to
improve oral health, a global study has found
that 35 per cent of the world’s population currently suffer from untreated carious lesions in
their permanent teeth. It also established that
621 million children worldwide have tooth decay that goes without dental care.
To make things worse, hundreds of millions
of new cases are expected to add to the burden
of dental decay annually owing to neglected
treatment, according to the new paper by researchers from the UK, the US and Australia
published online in the Journal of Dental Research.
Even developed countries are affected, with
one in three people in the UK suffering the consequences of neglected treatment, along with
one in five in the US, for example.
The findings, which are part of the latest
Global Burden of Disease study, involved a systematic review of all data on untreated dental
decay, leading to a comprehensive report on
rates of tooth decay for all countries and age
groups and both sexes for 1990 and 2010. The
team analysed 192 studies of 1.5 million children aged 1 to 14 years old, across 74 countries,
and 186 studies of 3.2 million people aged
5 years or older, across 67 countries.
“We have seen a clear shift in the burden of
tooth decay from children to adults. The cur-

rent perception that low levels of decay in
childhood will continue throughout life
seems incorrect,”said lead author Prof. Wagner
Marcenes from the Queen Mary University of
London.
“It is alarming to see prevention and treatment of tooth decay has been neglected at this
level because if left untreated it can cause severe pain, mouth infection and it can negatively impact children’s growth.”
Marcenes explained that the study underscores the vital need to develop effective oral
health promotion strategies.
“The fact that a preventable oral disease like
tooth decay is the most prevalent of all diseases and injuries examined in our report is
quite disturbing and should serve as a wake-up
call to policymakers to increase their focus on
the importance of dental health,” he continued. “Extending oral health promotion activities to the work environment is necessary to
maintain good oral health to reduce the major
biological, social and financial burden on individuals and healthcare systems.”
Tooth decay is the fourth most expensive
chronic disease to treat, and studies have
shown that if left untreated it can lead to
poor productivity at work and absenteeism in
adults and poor school attendance and
performance in children.

RUGBY, UK: In marking World Cancer Day,
the British Dental Health Foundation (BDHF)
has highlighted the constantly increasing
rates of oral cancer in the country. Latest
statistics from Cancer Research UK showed
that nearly 6,800 people are diagnosed with
mouth cancer in the UK every year. This figure
has increased by 50 per cent within the last ten
years.
According to leading oral cancer campaigners, mouth cancer rates could be reduced by
improving the public’s knowledge of the associated risk factors and possible symptoms.
World Cancer Day, an initiative of the Union
for International Cancer Control, takes place
every year on 4 February and aims to raise
awareness about the disease and to promote
action by governments and individuals all
around the world. Under the tagline “Not beyond us”, this year’s World Cancer Day placed
emphasis on cancer prevention, including
following a healthy lifestyle and early detection. In order to educate people about these
risks, as well as the signs and symptoms of
mouth cancer, the BDHF initiated Mouth Cancer Action Month, a month-long campaign
that has been run every November since
2009.
“It is almost as though these messages were
created with mouth cancer in mind, given the

huge significance they can make to reducing
the risk of the disease and catching it early,”
stated Dr Nigel Carter, OBE, Chief Executive of
the BDHF.
Lifestyle factors, such as tobacco use, excessive alcohol consumption, poor diet and human papillomavirus infection, contribute to
an increased risk of developing mouth cancer.
According to Cancer Research UK, nine in ten
cases of oral cancer are associated with these
factors.
“We often find many cases are diagnosed at
stage 4―the most advanced stage where time
is of the essence in potentially saving a life.
Without early detection, the five-year survival
rate for mouth cancer is only 50 per cent. If it
is caught early, survival rates over five years
can dramatically improve to up to 90 per
cent,” explained Carter. According to BDHF,
more than 1,800 people in the UK lose their
life to mouth cancer every year.
The BDHF recommends visiting the dentist
and checking for possible mouth cancer
symptoms regularly.
Carter emphasised: “We are asking everybody to be mouthaware by looking out for
ulcers which do not heal within three weeks,
red and white patches in the mouth and unusual lumps or swellings in the mouth are
early warning signs of mouth cancer.”

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DTUK0115_04_UKNews 09.04.15 15:18 Seite 4

UK NEWS

Dental Tribune United Kingdom Edition | 1/2015

Study finds e-learning as good as traditional training for health professionals
By Dental Tribune
LONDON,UK: Electronic learning could
enable millions more students to train as
doctors and nurses worldwide, according to

the latest research. A review commissioned
by the World Health Organization (WHO)
and carried out by Imperial College London

researchers concluded that e-learning is
likely to be as effective as traditional methods for training health professionals. These

new findings support the approach to continuing education Dental Tribune International (DTI) has adopted with its free online
education platform for dental professionals.

(Photo Odua Images)

The Imperial team, led by Dr Josip Car, carried out a systematic review of the scientific
literature to evaluate the effectiveness of
e-learning for undergraduate health professional education. They conducted separate
analyses on online learning, which requires
an Internet connection, and offline learning, delivered via CD-ROMs or USB flash
drives, for example.
The findings, drawn from a total of 108
studies, showed that students acquire
knowledge and skills through online and
offline e-learning as well as or better than
they do through traditional teaching.
E-learning, the use of electronic media
and devices in education, is already used by
some universities to support traditional
campus-based teaching or to enable distance learning. Wider use of e-learning
might help to address the need to train
more health workers across the globe. According to a recent WHO report, the world is
short of 7.2 million health care professionals, and the figure is growing.
The authors suggest that combining
e-learning with traditional teaching might
be suitable for health care training, as practical skills must also be acquired.
According to Car, from the School of Public Health at Imperial, “E-learning programmes could potentially help address
the shortage of healthcare workers by enabling greater access to education; especially in the developing world the need for
more health professionals is greatest.”
While the study focused on the education of
students, DTI follows a similar approach to continuing education, offering webinars via its
Dental Tribune Study Club, which it launched
in 2009. The platform regularly offers free online courses and in several languages. The wide
range of topics includes general dentistry, digital dentistry, practice management, as well as
specialties, such as implantology and endodontology. The webinars are presented by
experienced speakers and participants are
awarded continuing education credits.

[5] =>

DTUK0115_05_ADDE 09.04.15 16:40 Seite 5

Dental Tribune United Kingdom Edition | 1/2015

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WORLD NEWS

5

European dental markets trend towards
group practices and consolidation
By Dental Tribune
COLOGNE, Germany: Latest market figures
released by the Federation of the European
Dental Industry (FIDE), in cooperation with the
Association of European Dental Dealers
(ADDE), last month at the International Dental
Show in Cologne, indicate rapid changes toward a digital dentistry manifesting in overall
trends to a more global approach with group
practices and consolidations throughout dental markets in Europe. The organisation’s 2015
market survey also revealed that the number
of European dentists has slightly increased to
a total of 276,090 in 2014 compared to 270,045
the year before.
A contrary trend showed in the number of
dental offices and dental laboratories. While
the numbers of the former remained flat on
average, the total figures of labs in Europe has
decreased in almost every surveyed country.
According to ADDE President Dominique Deschietere, given the growing numbers of practicing dentists this development either indicates a trend to group practices or consolidation.

1998 and represents the interests of more than
960 dental dealer organisations, covers the
most relevant topics and trends for the Euro-

pean Dental Industry, such as the number of
customers and end users, sales values for the
main product categories, the use of computer

and e-commerce, sales segments, distribution
channels as well as VAT charges and their impact on the market.

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Dominique Deschietere (Photo Kristine Hübner, DTI)

While the number of dental technicians has
remained steady or slightly decreased in all
countries except Hungary, the number of dental hygienists increased in all countries of the
survey. This development is especially prominent in the UK, with the number of dental hygienists growing distinctively compared to
2013. As Deschietere has put it, this seems to be
a result of the evermore “bending of the laws”
in this area.
On the supply channels side, the percentage
of direct sales from manufacturers remained
steady in most countries, and the share of
products purchased via e-mail or internet is
constantly, if only slightly, increasing compared to the previous year. Further, the figures
indicate that the sales volume of equipment
has dropped in 2014, while sales of sundries
and consumables remained stable on average.
“Dentists continue to treat patients,” Deschietere pointed out. “Consumables and sundries, not new equipment like CAD/CAM units
or intra-oral X-ray units, kept the figures up
during the last years."
To this date the gathering of information on
new technologies seems to be the weak point
of the survey. Although Germany shows a
jump in the numbers of intra-oral scanners installed, most countries are not collecting data
on the subject so far, explained Deschietere.
The annual ADDE/FIDE survey, which is conducted through its national associations since

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DTUK0115_06_Albrektsson 09.04.15 15:20 Seite 6

WORLD NEWS

Per-Ingvar Brånemark—
An innovative genius
Prof. Tomas Albrektsson, Sweden, remembers the man who changed
dentistry with the discovery of osseointegration of dental implants
Per-Ingvar Brånemark passed away on 20
December 2014 at the age of 85. Throughout
his career as a researcher, he overcame fierce
opposition to dental implants and revolutionised methods for treating edentulous patients.
An extremely gifted scientist, Brånemark
was also as witty and quick on his feet as they
come. Various language editions of Reader’s
Digest, hardly considered a medical journal
of note, published an article in the late 1960s
about his research on microcirculation. At
the end of his first lecture about dental implants in Landskrona in Sweden in 1969, a
member of the audience, who turned out to
be a senior academic of Swedish dentistry,
rose and commented, “This may prove to be a
popular article, but I simply do not trust people who publish themselves in Reader’s Digest.” As it happened, that senior academic
was well known to the Swedish public for havPer-Ingvar Brånemark
ing recommended a particular brand of
toothpick. Brånemark immediately rose and
rable strength as a researcher at that very moinserted optical devices encased in titanium
struck back, saying, “And I don’t trust people
ment, realising immediately that the discovthat enabled intravital microscopy of microwho advertise themselves on the back of
ery had clinical potential and determining to
circulation in male volunteers.
boxes of toothpicks.”
focus on the development of dental imBy the late 1960s, he was able to produce
Young and naive as I was, I thought they
plants, an enterprise that had hitherto been
the highest resolution images of human cirwere just poking fun at each other, but it
regarded as beyond the scope of medical sciculation in the history of medicine. Many
turned out to be the opening shot of an eightence.
people are familiar with Lennart Nilsson’s
year battle with the dental profession. When
Brånemark grasped the fundamental
photographs of circulation that were taken at
someone cast aspersions on dental implants
truth that edentulousness represents a sigBrånemark’s laboratories and developed at
several years later because Brånemark was
nificant disability,
not a practitioner, he
particularly for peolost no time in replyple who cannot toling, “Teaching them
erate dentures for
anatomy is good
some reason. He openough for me.”
erated on his first
Brånemark compatient in 1965, a
pleted his medical
mere three years
training at Lund Unilater. The academic
versity in 1959 with a
community
was
doctoral thesis on
largely distrustful
microcirculation in
and hostile to the
the fibula of rabbits.
new approach. The
Grinding the bone to a
debate was not put
state of transparency
to rest until 1977,
permitted the use of
when three profesintravital microscopy
sors at Umeå Unito analyse the blood
versity in Sweden
flow in both bone and
announced
that
marrow tissue. The
Brånemark’s techthesis, which found
nique was the recwide
recognition
ommended firstboth in Sweden and
line treatment. Opabroad, landed Bråneposition in other
mark an appointcountries eventument at the Departally waned as well
ment of Anatomy of
and dental imthe University of
Dental
Tribune
Group
Editor
Daniel
Zimmermann
talking
to
Per-Ingvar
Brånemark
at
a
conference
in
plants, originally
Gothenburg just a
Gothenburg in 2009. (Photo Archive)
manufactured by a
year later. He was apmechanic in the
pointed as Associate
basement of the Department of Anatomy,
the Department of Anatomy. Brånemark
Professor of Anatomy (later received a full
scored one international triumph after anused a hollow optical device surrounded by
professorship) in 1963, which qualified him
other.
titanium to study microcirculation in rabbit
for laboratories of his own and the opportuNowadays, an estimated 15–20 million osbone, permitting both bone and blood vesnity to surround himself with a team of
seointegrated dental implants are installed
sels to grow through a cleft where they could
researchers.
every year, and a number of different acadebe examined by means of light microscopy.
Brånemark continued to pursue his studmies in the field hold annual conferences atDuring such an experiment in 1962, he disies in microcirculation in animal models and
tended by as many as 5,000 participants
covered that the optical device had fused into
ultimately in humans. A plastic surgery techeach. The University of Gothenburg features
the bone, a process that he eventually dubbed
nique was used to prepare soft-tissue cylina permanent exhibit on osseointegration
osseointegration. He revealed his incompaders on the inside of the upper arm. He then

Dental Tribune United Kingdom Edition | 1/2015

technology and there is a museum in Brånemark’s honour at the Faculty of Stomatology
of Xi’an Jiaotong University in Xi’an in China.
The P-I Brånemark Institute has been also established in Bauru in Brazil.

Not only dentistry
Back in the 1970s, Brånemark began collaborating with ear specialists and technicians
at Chalmers University of Technology to explore the additional potential of osseointegrated implants for developing hearing aids
inserted behind the ear. Hundreds of thousands of patients around the world have had
operations based on the technology initially
developed in Gothenburg under his
direction. Those of us who were on the team
at the time will never forget a teenage girl
who suffered from the effects of thalidomide. The medicine had caused not only limb
deformities, but also hearing loss in many patients. Equipped with the new hearing device,
she learnt to speak flawlessly.
The team also targeted facial deformities
occasioned by congenital or acquired injuries. A number of implants installed in the
viscerocranium served as fasteners for
silicon prostheses, a much more attractive
option than attaching them to the patient’s
glasses. Since the first operation in 1977, the
use of the technology has become widespread internationally.
Titanium implants installed in the femur
were the next spin-off of Brånemark’s research. Patients with above-knee amputations cannot have socket prostheses around
soft tissue and may have to rely on a wheelchair to get around. Inserting titanium
screws in the femoral stumps permitted the
installation of a prosthesis and the ability to
walk again. I can still remember the first patient as if it were yesterday. Another teenage
girl had been run over by a streetcar in
Gothenburg and had above-knee amputations in both legs. She was consigned to
spending the rest of her life in a wheelchair.
The operation was highly successful and she
learnt to walk again.

Acclaimed around the
world
Brånemark was fuelled by a passion to help
difficult-to-treat patients, and many of his
clinical discoveries from the first dental implant on were made in response to cases that
had been regarded as hopeless. His innovative genius, fortified by a large research laboratory at the Department of Anatomy, also
skyrocketed Gothenburg-based pharmaceutical companies like Nobel Biocare and
Astra Tech into leading positions in the global
market. He was devoted to the academic
community’s social responsibility long before many of his colleagues were aware of,
much less accepted, the concept. Ultimately,
the world came around and he was awarded
honorary doctoral degrees by 29 universities
and honorary memberships by more than 50
scientific associations—not to mention the
Royal Swedish Academy of Engineering Sciences’s medal for technical innovation, the
Swedish Society of Medicine’s Söderberg
Prize, the European Inventor Award for Lifetime Achievement and many other distinctions around the world.

Prof. Tomas Albrektsson is
working as a professor at the
universities in Gothenburg
and Malmö in Sweden.
He can be contacted at
tomas.albrektsson@
biomaterials.gu.se.

[7] =>

DTUK0115_07_Haque 09.04.15 15:20 Seite 7

Dental Tribune United Kingdom Edition | 1/2015

BUSINESS

Google: How to get on to Page 1 in 2015
By Naz Haque, Dental Focus
The holy grail for any organisation’s online marketing is to appear on Page 1 of
Google search results. Imagine how many
patients you would gain. How would you
like to achieve this without spending thousands of pounds? This is possible if you
have time on your hands and reduce online
competition through local listing.
According to Google, there are over
40,000 search queries every second. This
roughly amounts to 3.5 billion searches per
day globally, with a significant portion of
this (increasing all the time) being searches
on mobile devices.
Google is always tweaking and improving the search factors to deliver search results based on the user’s intent. Therefore,
it is understandable that your website
should be focused on patients and easy for
Google to find and read.
Even without a state-of-the-art website,
it is possible to appear on Page 1. Organic
(natural non-paid) rankings are achieved
by being relevant and having authority in
the online world, and depend on online
competition.
On Page 1 of Google, aside from the organic listings, there are typically three to

seven map listings. The most feasible way
of achieving Page 1 rankings in your location is to register for a Google My Business
listing first. If it has already created a listing, you will have to claim and verify this.
Choose the tags relevant to the services
your provide (dental practice) and ensure
that your phone number (geographical
number) is displayed, as well as your address and post code. Do also brand the page
with your logos and personalise it with
photographs of your team and practice
(not necessary for rankings but highly advised). Finally, encourage your patients to
leave you a five-star review on this page.
This is a very important factor.
Once you have your page set up and optimised, the next step is to establish your online authority by inserting a link to your
Google Business Place on your website. Ensure that your website has your contact details displayed. Then list your address details in local and large directories (try not to
get carried away) and ask local businesses
to cite your details online. Ensure that the
details are always consistent and accurate,
as inconsistent address or telephone number details will confuse Google.

Citations are a key factor for ensuring
Google recognises your presence in your location. It may be that local hotels, bed and
breakfasts, or newspapers are recommending dentists in your town. Even if there is no
link to your website, having your address
will benefit your rankings.
Google reviews can only be submitted by
individuals with their own Google Account.
I do not recommend allowing patients to
provide reviews using your practice Internet connection, as Google may identify the
location and think the reviews may not be
authentic or independent. Once you have
received seven reviews, Google will place a
number of stars next to your practice name
on the map listings. The more five-star reviews you have, the higher your score will
be. It has been documented that having five
stars encourages a 23 per cent increase in
click through to your website.
These simple steps will set you in the
right direction to achieving Page 1 rankings. Remember the results will be specific
to your location and based on the user’s
search terms. Google is focused on the user,
so if there are seven other practices nearer
to the user’s post code they inevitably will

be higher up on the results list. Consider organic or pay-per-click campaigns if you
want to have a higher chance of success.
There are no guarantees with Google, but
you should always focus on building visibility where Google is looking, because
your patients will be directed there. The
recipe for success in any business is focus
on serving the client, and it seems the same
rule applies with your online marketing.
Focus on the patient in using the platform
is key to everything.

Naz Haque, aka the Scientist, is
Operations Manager at Dental
Focus. He has a background in
mobile and network computing, and has experience supporting a wide range of bluechip brands, from Apple to
Xerox. As an expert in search
engine optimisation, Naz is
passionate about helping
clients develop strategies to
enhance their brand and increase the return on investment from their dental
practice websites.
He can be contacted at
naz@dentalfocus.com.
AD

[8] =>

DTUK0115_08_Leaver 09.04.15 15:21 Seite 8

BUSINESS

Dental Tribune United Kingdom Edition | 1/2015

“Asia is completely new to us”
An interview with Neoss Chief Financial Officer Guy Leaver
As one of the few manufacturers of dental
implants, UK company Neoss has not operated in Asia before. With a recent financial
support package of £1.5 million from Yorkshire Bank, the company now intends to develop new business in countries like Japan,
China and Taiwan. Dental Tribune had the opportunity to speak with Chief Financial Officer Guy Leaver about the upcoming market

entry and what makes his company stand out
from its numerous competitors there.
Dental Tribune: Mr Leaver, how is this investment package helping you with your market
entry into Asia?
Guy Leaver: The investment package will
support our product launch in Asia initially.
Currently, we are going through regulatory

approval processes in Japan, China and Taiwan. It is difficult to say exactly when, but our
expectation is that this year, probably in the
second half, we will actually start to make initial sales. While we expect the growth to be significant, we need the facility for our cash flow
in the beginning, as there will a certain
amount of money going out before money actually comes in.

What are your initial expectations for the region?
Since we do not have any sales in these
countries at the moment, operating in Asia is
completely new to us. We obviously have projections and want to see this business grow
consistently over time into something substantial.
Initially, we will focus on our dental implant
system, as this is the product segment we are
expecting approval for this year. In the future,
we will expand to our full product range, including new products we are introducing that
could also potentially target these markets.
Will you sell directly in Asia or through distributors?
We have already signed up with business
partners in these markets. In Japan, for example, we have an experienced distributor who
has personal contact with a number of leading
clinicians in the country who we understand
are interested in using our implant system. It
always helps to have this kind of endorsement.
We are also working with a major distributor in China and will see how that evolves. Potentially, we will put a person in charge there,
but this will depend on how successful we are.
If we feel there are more opportunities, we can
always tweak the model.
There is also an experienced distributor we
will be partnering with in Taiwan who has previously distributed a competitor’s product.
Generally, we try to choose people who understand what our product is all about, are familiar with the market and know what works in
that marketplace.
For Western manufacturers, the market environment in Asia can be tough.Where do you see
the challenges for your company there?
As with many of these markets, business in
Asia is primarily relationship based, so you
need to become involved with the right people and institutions. This is particularly important in China, where there are a growing
number of small private dental practices offering dental care in addition to the large government-run hospitals. We aim to take advantage of this development by choosing the
right contacts for this marketplace.
Where do you want to position yourself in the
market?
We want to position ourselves in the same
way as we do in most markets by delivering a
product that is the best there is. We strongly
believe that we have a good package. Our company was founded by a clinician and an engineer, so our focus is on delivering exceptional
clinical performance and product quality.
There is no point in introducing a product
that is not as good as someone else’s. It has to be
that good or even better. We always want customers to understand that they are getting a
value product. We do not sell cheap or offer
massive discounts. It is a good quality product
at good picing.
In terms of customer service, we aim for exceptional logistics and support. Take Europe,
for example, it is pretty much next-day delivery, so if you buy something from us in Germany, it will probably be there at noon the following day. Few of our international competitors can achieve the same.
Thank you very much for the interview.

[9] =>

A4 .indd 1

09/05/2014 14:58

[10] =>

DTUK0115_10_Mis 09.04.15 15:23 Seite 10

BUSINESS

Dental Tribune United Kingdom Edition | 1/2015

“It is our mission to simplify dental
implantology”
DT visits the MIS headquarters and main production facility in Israel
MIS Implants Technologies is a global specialist in the development and production of
advanced dental implantology products and
solutions. The company, which started as a family-run business, was founded in 1995—a
time when not many people understood the
potential of dental implants, CEO Idan
Kleifeld told Dental Tribune (DT) at a meeting
at the beginning of 2015.
Since its beginnings, MIS has seen significant growth, especially within the past ten
years. “Today, the company has succeeded in
building a recognised global brand in the
market and is the only non-premium company operating on a global scale,” Kleifeld
said. Headquartered in Israel, MIS currently
has operations in 65 countries worldwide,
covering major dental markets, such as the
US, China and Germany, through a well-established network of local distributors.
In 2009, MIS moved operations to a large
purpose-built production complex located
in a new high-tech industrial park in northern Israel. “Our location adds to our uniqueness. Israel is a country of high innovation
and offers particularly favourable conditions
for manufacturing, because of the quality of
education and people’s high levels of motivation. Furthermore, salaries are much lower
than in competitor countries, making manufacturing especially profitable,” he stated.
The MIS building in the Bar-Lev Industrial
Park spans about 10,000 m² and has two production floors with 50 Swiss high-precision
machines running 24 hours a day from Sunday to Friday. “The facility was designed and
built for growth. In the near future, our automatic warehouse, which currently covers
only half of its potential total area, will double
in size,” Kleifeld explained.
DTI further learnt that MIS primarily produces for stock, as products must be shipped
to local distributors within two working days.
For increased efficiency, processes controlling quality, sterilisation, packaging and storage are largely automated. This allows MIS to
produce over 800,000 implants per year.
The production site in Israel has a dedicated training centre with a fully equipped
dental clinic for live surgeries. Kleifeld said,
“We see education as an important tool to acquire new customers, especially in developing markets. It is an important driver in this

MIS headquarters (Photos courtesy of MIS, Israel)

business, and we offer doctors both fundamental and advanced training courses on
MIS products and protocols.”
In 2015, MIS will be introducing some important innovations. Only recently, the
company officially opened its MCENTER Europe, the new MIS digital dentistry hub in
Berlin in Germany, in order to meet the needs
of its growing customer base in central Europe. The centre offers direct services provided by locals to local customers, bringing
all MIS digital dentistry products together in
one location. It is aimed at providing a comprehensive range of services to clinicians
through advanced digital dentistry and
CAD/CAM technologies that facilitate fast
and accurate surgical implant procedures
with reduced chairside time and greater predictability in outcomes.
“We are extremely excited about the opening of the new MCENTER Europe facility, and

Production.—Right: MIS Implants Technologies CEO Idan Kleifeld.

especially proud to be able to offer MIS quality and simplicity in providing our customers throughout the region with highly
accurate and efficient guided implant place-

high-quality implants that
are completely new in the
market and will fit within
the premium segment.
MIS plans to offer this new
implant system to its
global distributors at the
end the second quarter of
2015, for local distribution
worldwide.
The name MIS originally
stood for “Medical Implant
Systems”. However, it is
also an acronym that reflects the company’s main
maxim to “Make it Simple”. “It is our mission to
simplify dental implantology and, in order to become the preferred choice
of dentists worldwide, we
offer new and innovative
products based on simple,
creative solutions. Design
and handling are made
simpler, and all products
are engineered to allow efficient, time-saving surgical procedures,” Kleifeld
said. “With this simplified
approach, we are set to become the largest global
dental implant producer,” he added.
However, the “Make It Simple” motto appears to apply to more than the company’s
products. The MIS philosophy defines almost

“We are set to become the largest global
dental implant producer.”
ment procedures and CAD/CAM solutions,”
said Christian Hebbecker, MCENTER Europe
Manager.
In addition to the new MCENTER Europe,
the company will be entering the premium
segment for dental implants with the launch
of a new implant system later this year. It has
a truly innovative design and consists of

all areas of the business (from human resources to production), and the organisational structure is simple and characterised
by flat hierarchies. “Make it Simple” embodies the start-up mentality that remains vibrant in a company that has become one of
the largest in the global dental implant market.

[11] =>

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17.03.15 12:02

[12] =>

DTUK0115_12_Maskery 09.04.15 15:24 Seite 12

BUSINESS
?????????????

Dental Tribune United Kingdom Edition | 1/2015

Pathways for selling or purchasing
a dental practice
By Amanda Maskery, Newcastle

According to a recent survey by the National Association of Specialist Dental Accountants and Lawyers, private buyers and
small groups in the UK have recently gained
ground over large corporates in dental practice sales. Particularly for individuals looking
to buy or purchase a practice, however, the
process can sometimes be overwhelming.
A dental practice transaction can be done
through an asset purchase (this gives the
purchaser the opportunity to cherry-pick
the assets) or a share sale (where the purchaser buys warts and all) if the seller has incorporated his or her practice. This will depend on factors such as the tax advantages of
either structure.
Solicitors will provide assistance with negotiating terms of the deal, including confidentiality and exclusivity. This can be with
either the agents or the other party’s solicitors. It is beneficial to have them involved at
this stage so that all major terms can be
agreed on, for example restrictive
covenants. This also assists in the preparation and negotiation of the sale agreement.
The purchaser’s solicitor will make an information request in respect of the business
and make standard enquiries for commercial property. The seller’s solicitor will assist
in the preparation of the responses to this.
The replies will then be reviewed and any further enquiries will be raised by the purchaser’s solicitor as need be. This is an important exercise, as it can flush out any major is-

sues at an early stage and allows the purchaser’s solicitor to negotiate indemnities
and/or warranty protection to be inserted
into the agreement or a retention of the purchase price.
The sale agreement can be the most protracted stage of the negotiations. The seller
will want to ensure that his or her post-completion obligations and liability are minimal, while the purchaser will want to ensure
coverage for anything that might go wrong
with the practice post-completion. This will
need to cover claw-back by NHS England and
patient charges and provide indemnities for
contractual obligations and employees. The
sale agreement will also deal with the mechanisms for the transfer of the NHS contract
via the partnership route and will differ depending on whether the seller is selling the
assets or the shares.
It is common now that a separate solicitor
will also have to deal with the property elements of the transaction. In the case of the
purchaser, his or her solicitor will carry out
searches against the property, review enquiries raised and prepare the transfer document. He or she will also then deal with the
registration of title to the property at the
Land Registry post-completion.
A solicitor will also review the planning aspects of the property and, where necessary,
provide a statutory declaration that the
property has been used as a dental practice
for a specific amount of time, depending on

the covenants attached to the property. The
property aspects will depend very much on
whether the property is leasehold or freehold, and consents may need to be obtained
from third parties, such as a landlord, to the
transfer of the property to the purchaser.
In addition, there may be others in occupation of the practice premises, such as a hygienist, or part of the premises may be used
as residential. In such cases, the purchaser’s
solicitor will need to be satisfied that there
are proper arrangements in place to deal
with the occupation of third parties. The
seller’s solicitor will deal with the removal of
any existing mortgage or security over the
property.
Throughout the transaction process, the
purchaser’s solicitor will liaise with the funder of the transaction to ensure that its requirements are met. The funder will want to
see that the title to the assets is appropriately
transferred and that adequate security is
given. It is important that this dialogue be begun at an early stage to ensure the smooth release of funds at completion.
The solicitors will also liaise with their respective client’s accountants and tax advisers to ensure that agreement on proposed
apportionments is met and that there are no
impediments to the transaction in this regard.
The dental practice being sold will have a
number of employees and this will vary
based on the size of the practice. In relation to

asset purchases, the Transfer of Undertakings Regulations will apply. The purchaser’s
solicitor will want to carry out careful due
diligence to ensure that he or she knows the
terms on which the employees are contracted. The seller may wish to do a tidying
exercise to ensure that contracts have been
distributed to all employees and may require assistance in this and will require assistance in compliance with the Transfer of Undertakings Regulations and consultation
with employees.
Often, the solicitors will liaise with NHS
England to ensure that the contract is correctly transferred and to ensure that there
are no issues arising that would affect the
smooth transfer of the business from the
seller to the purchaser. Where the seller is a
limited company, the contract will need to be
checked for change of control provisions,
whereby the NHS will need to give consent to
any transfer to a third party. Furthermore,
the solicitors will ensure that effective notices are given to the NHS, especially if the
partnership route is required.
There are a number of post-completion
matters that will need be dealt with, such as
registration of the transfer of the title with
the Land Registry, payment of stamp duty
where applicable and ensuring that the funder’s requirements are satisfied. The purchaser may want to do consolidation of legal
matters, including employment policies
and procedures, and register with the Information Commissioner’s Office for data protection. Other fields in which a solicitor can
provide advice are intellectual property/information technology issues, branding,
website issues or regulation. From time to
time, disputes may arise post-completion,
such as in relation to warranty claims, the
NHS or other matters resulting from the
transaction.
A solicitor may also provide debt collection assistance or, in conjunction with the
purchaser’s accountant, guidance on the
best business structure, whether this is a limited company, a partnership or an expensesharing partnership. He or she will prepare
any documentation required to incorporate
into a limited company and will provide a
partnership agreement.
One of the most meaningful ways in which
a lawyer can help in a transaction such as this,
however, is by offering general commercial
sense and assistance. If a solicitor is experienced in this industry, he or she will be able to
provide a much better service owing to an
understanding of the nuances and needs of a
dental practitioner embarking on the very
daunting task of buying or selling a dental
practice.

Amanda Maskery
Amanda Maskery is one of the
UK’s leading dental lawyers.
She is Chair of the Association
of Specialist Providers to Dentists (ASPD) in the UK and a
Partner at Sintons law firm in
Newcastle. Amanada can be
contacted at manda.maskery@
sintons.co.uk

[13] =>

DTUK0115_13-16_Show-InfoDTS 09.04.15 15:25 Seite 13

Show TRIBUNE
The World’s Dental Newspaper · United Kingdom Edition
Vol. 9, No. 1

www.dental-tribune.co.uk

INNOVATIONS

INTERVIEW

WHAT’S ON

Over 400 companies, dealers and service providers have registered for the Dentistry Show
in Birmingham. A small overview about products and services that will be on display.

Dental Tribune recently had the opportunity to discuss everything Digital Dentistry with
Avi Cohen, Director of Global
Dental for 3-D printing manufacturer Stratasys.

Over one million people make Birmingham the secondmost populous city in the
UK after the capital. Here
are some tips how to enjoy
your time off in the Brum.

” Page 16

” Page 18

” Page 20

Plenty to see and
do at Dentistry
Show 2015
Birmingham welcomes dental professionals from all
over the country to two days of innovation, learning
and fun
Photo courtesy of CloserStill Media, UK

By Dental Tribune

BIRMINGHAM, UK: A few weeks ago, the
International Dental Show in Cologne in
Germany closed its doors with another
record outcome of 135,000 visitors. During
the five days of the show, manufacturers
from all over the globe launched their latest
dental products and solutions to markets in
Europe. At the 2015 Dentistry Show, to be
held from 17−18 April at the NEC in Birmingham, dental professionals in the UK will finally have the chance to get their hands on
the latest materials and tools in dentistry.
The Launchpad UK, however, is only one of
many novelties the organiser has promised
to present this year. For the first time, for example, visitors of the show will have access
to the EndoLounge, a new forum designed in
association with the British Endodontic Society that will provide an update on the latest
clinical techniques, materials and research
in the field. Reflecting the increasing demand for information on facial aesthetics,
the new Facial Aesthetics Theatre will explore the latest clinical techniques and products in this particular area to help you deliver safe and effective treatment for all your
patients, the organiser said. Hosted by experts at Apolline, the Compliance Clinic will
offer a vast array of practical hints and tips to
ensure regulation compliance for all practice.
Visitors will also find old favourites such
as the ever popular PerioLounge, delivered
in association with the British Society of Periodontology, and the Short-Term-Orthodontics Lounge, as well as the ADI Implant,
GDP and CORE CPD theatres at the show.
Business Skills Workshops held in conjunction with Practice Plan will also return.
But it will be not just all mouth, the organiser said. On Friday evening, the show will
host the prestigious Dental Awards with
Purple Media Solutions in order to celebrate
outstanding individuals and teams whose
commitment continues to raise the bar in

UK dentistry. Attendees will be able to enjoy
a four-course meal and great entertainment
at this glittering black-tie gala dinner. Presenting with a Willy Wonka ice-cream stand,
UK-based charity Bridge2Aid will also host a
‘Village Fete’ with traditional games such as
‘test your strength’ strongman and ‘hook a
duck’.
“Not only a dental event that the whole
team will enjoy but also the perfect opportunity to gain valuable education and experience, The Dentistry Show, taking place on
Friday 17th and Saturday 18th April, is the place
for all dental professionals to be,” a representative said.
According to latest figures, more than
7,500 delegates are expected for this year’s
show, another record for the event that
only started six years ago. For the trade
show, more than 400 dental companies,
dealers and service providers have registered this year including Dental Tribune,
which will present its revamped UK edition, among other things. Coinciding with
the launch of its flagship publication, the
publisher said it will cover one of Britain’s
most important dental events with additional daily e-mail newsletters. Visitors of
the Dentistry Show are invited to booth
P080 adjacent to the Aesthetic Dentistry
Theatre to receive their individual copy of
the newspaper. The new edition was produced under the wings of DT’s Group Editor
and a new editorial team. Published
monthly, it will boast a modern, more
reader-friendly layout.
Dental professionals who are interested to
attend Dentistry Show 2015 are still able to register for the free event. More information about
the show, its educational offering and exhibition can be found at www.
thedentistryshow.co.uk. For
daily news updates go to
www.dental-tribune.co.uk or
scan the QR Code.

American Express
teams up with
Dentistry Show,
Hosts VIP Lounge
By Dental Tribune

BIRMINGHAM, UK: Under a new partnership, American Express will be supporting
the VIP experience granted to attending
owners, practice managers and dentists at
the Dentistry Show to be held from 17 to 18
April in Birmingham. In addition to the
American Express hosted VIP lounge, the VIP
experience includes fast tracked entry, complimentary lunch and front row seats in the
Aesthetic Dentist Theatre.
VIP status is granted automatically to attendees who have qualified in the past, the
company said. New attendees are invited to
visit the show’s website to find out more.
With a dynamic educational programme
as well as a first-chance look at the latest innovations in the UK industry, The Dentistry
Show is the UK’s largest source of live Continuing Professional Development (CPD) and
the fastest growing dental trade exhibition.
Providing numerous learning and networking opportunities for all members of the dental team, The Dentistry Show 2015 will host a
two-day programme packed with inspira-

tional lectures, practical advice and hands-on
experiences, as well as attendance from over
400 UK and international exhibitors.
World-class speakers will present on a wide
variety of clinical and business topics, with
over 100 CPD sessions available and theatres
dedicated to each area of the profession.
Director, Small Business Services UK,
Stacey Sterbenz, said: “American Express is
delighted to be a part of such a significant
event in the dental calendar. We have many
established and long-standing relationships
within the dental industry and with the small
businesses in this sector. We are very much
looking forward to welcoming show attendees to the American Express VIP Lounge at
The Dentistry Show.”
For more information about the range of
services provided by American Express, visitors are invited to speak to one of the American Express ambassadors in the VIP Lounge
at the show or visit
americanexpress.co.uk/dental.

[14] =>

DTUK0115_13-16_Show-InfoDTS 09.04.15 15:25 Seite 14

NEWS

14

Show Tribune United Kingdom Edition | 1/2015

“We will see an increasingly corporateheavy market in the UK”
An interview with Amanda Maskery, Head of Dental at Sintons & Partners
As Chair of the Association of Specialist
Providers to Dentists (ASPD) and Head of
Dental at Newcastle-based law firm Sintons

& Partners, Amanda Maskery advises dentists on legal issues on a daily basis. Working
closely with the dental community in north-

ern England, she will be offering her expertise to visitors to this year’s Dentistry Show in
Birmingham (Booth E76). Dental Tribune

Dental Tribune: Ms Maskery, you have been
heading ASPD for over a year. What have been
the major challenges during that time?
Amanda Maskery: There are continually
challenges for the dental profession, which
we at ASPD have to address. During the past
year, we have seen a great deal of unrest
among dental professionals due to the potential introduction of the new NHS contract. As a result, there is much uncertainty
as to what lies ahead.

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had the opportunity to speak with her about
the new National Health Service (NHS) contract and its impact on dentists in the UK.

Ea r n M e m b e rs h i p Rewa rd s ® p o i n ts o n
v i r t u a l l y a l l of yo u r eve r yd ay b u s i n ess
ex p e n ses a n d u se t h ose p o i n ts to h e l p pay fo r

f u t u re p u rc h a ses — f ro m e q u i p m e n t to f l i g h ts. *

The new NHS dental contract has indeed
stirred up some debate in the UK dental community. Is this reflected in the number of
clients you see and the kind of requests that
you have received from dentists?
There has been a marked rise in the number of people wanting to sell their practice
and exit the profession perhaps earlier than
they would otherwise have done. This has resulted in corporates buying up practices in
increased numbers, but also offers the opportunity to young dentists to purchase a
practice from someone leaving the profession. My team and I work extensively
throughout the UK and saw a significant increase in sales and transactions last year.
At Sintons, we have a ten-strong specialist
dental team and are regarded as being
among the leading advisers in the UK. We are

Te r m s, ta xes, fe es a n d c h a rges a p p l y.

to w ar ds
a n ew

A m e r i ca n Ex p ress ® i s a cce p te d a t m ost
m a j o r d e n ta l s u p p l i e rs i n t h e U K .

“There is much
uncertainty as to
what lies ahead.”

To f i n d o u t m o re, v i s i t
a m e r i ca n ex p ress. co. u k /d e n ta l
o r yo u ca n ca l l u s o n 0 8 0 8 16 8 73 97.

receiving new instructions from clients
across the country as a result of the changing
nature of the industry and uncertainty
around the new contract.
What other issues are you confronted with on
a daily basis?
There is genuine difficulty in getting
things done according to a particular
timescale owing to the levels of red tape that
exist within the Care Quality Commission
and NHS England.

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is offered by American Express Services Europe Limited. Registered Office: Belgrave House, 76 Buckingham Palace Road, London SW1W 9AX,
United Kingdom. Registered in England and Wales with Company Number 1833139. American Express Services Europe Limited is authorised in the
United Kingdom by the Financial Conduct Authority under the Payment Services Regulations 2009 (reference number 415532) for the provision of
payment services.

When are dentists advised to seek legal advice
in general?
Key times are if the structure of the practice is changing, in which case legal advice
from an employment and governance point
of view will be very important. Obviously, it
is essential when buying or selling a practice.
It is also advisable to seek the advice of a
knowledgeable legal professional regarding
the new NHS dental contract, after discussions with local area teams.
 page 16

[15] =>

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TM

in Aesthetic and Restorative Dentistry
12 days of intensive live training with the Masters in Athens (GR) and Geneva (CH)

Three sessions with live patient treatment, hands-on practice, plus
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Collaborate
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you will receive
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Tribune Group GmbH is the ADA CERP provider. ADA CERP is a service
of the American Dental Association to assist dental professionals in
identifying quality providers of continuing dental education. ADA CERP
does not approve or endorse individual courses or instructors, nor does it
imply acceptance of credit hours by boards of dentistry.

100

C.E.

CREDITS

Tribune Group GmbH i is designated as an Approved PACE Program Provider by the
Academy of General Dentistry. The formal continuing dental education programs of this
program provider are accepted by AGD for Fellowship, Mastership, and membership
maintenance credit. Approval does not imply acceptance by a state or provincial board of
dentistry or AGD endorsement.

[16] =>

DTUK0115_13-16_Show-InfoDTS 09.04.15 15:25 Seite 16

BUSINESS

 page 14

of many connections who are able to update
me from a dentist’s point of view, ensuring I
have true insights into the profession.
In my native North East England, we are
heavily involved in the dental community
and work closely with Newcastle University’s
School of Dental Sciences to understand the
profession from its outset. Further, being
Chair of ASPD, as well as a member of the National Association of Specialist Dental Accountants and Lawyers, gives me access to a
wide professional network.

Providing advice to dentists requires an indepth understanding of the complexities facing dentists. How do you keep up to date with
the field?
I have a very strong network of influential
dentists, among them chairpersons of local
dental committees, representatives on national bodies, and entrepreneurial dentists
who know and understand the marketplace.
At the Dentistry Show, my firm is sharing a
stand with Anushika Brogan and Damira
Dental Studios, which has an extensive portfolio across the south of England. She is one

usability that has come to define Planmeca
products.
The innovative dashboard interface of the
new version utilises a flexible tile-based layout, helping users accelerate their workflow
through fewer clicks. The software also dedicates more room to patient images, while its
redesigned toolbars enhance usability.
In addition, the Planmeca Romexis 3D Implant Planning module has been upgraded
with several tools, including implant align-

greatest challenges and opportunities for
dentists in the UK currently and in the future?
We will see an increasingly corporateheavy market in the UK, but there will also be
opportunities for young dentists to buy into
practices, since dentists are exiting the profession owing to the new contract.
Banks and funders are also very much
open for business with deals in the health
care sector, and this offers another avenue
for dentists to acquire their own practice or
practices and be able to secure the finance to
do so.

As a lawyer, you encounter developments in
dentistry very early on. Where do you see the

Thank you very much for the interview.

ment, safety areas with alerts, as well as a custom abutment designer. Furthermore, a
number of essential functional enhancements have been added, such as the 3-D object browser—a feature that allows easy management of annotations and implant simulation elements.
“We have strived to build a complete
ecosystem of devices, software and services
that communicate with each other smoothly.
Planmeca Romexis has always been integral

to this process, as it is essentially the brains
behind all our products,” remarked Helianna
Puhlin-Nurminen, vice-president of the digital imaging and applications division at Planmeca . “The new software version is a great
step forward in providing users with an even
smoother workflow. With Planmeca Romexis
4.0, the future of digital dentistry has arrived.”
Planmeca is a worldwide forerunner in
developing a complete range of solutions
for dental professionals. The Planmeca
Romexis software platform supports the
most versatile range of 2-D and 3-D imaging
modalities and integrates the entire chairside CAD/CAM workflow, from intra-oral
scanning to prosthetic design and milling in
one system. The Planmeca Romexis Clinic
Management module further provides realtime information and monitoring of unit
usage and events.

Planmeca updates
Romexis software
The Planmeca Romexis software platform
offers a multitude of tools and features to
meet the demands of different specialists.
According to the manufacturer (Booth
F60), the new 4.0 version (available for Mac
OS and Windows) redefines the all-in-one experience, further improving user friendliness and presenting a wide selection of enhanced modules. Optimised for full high-definition screens, the revamped look and design of the software correspond with the fluid

Show Tribune United Kingdom Edition | 1/2015

VOCO innovates at Implants stand out
Dentistry Show
in comparative implant surface study
VOCO has developed the protective dental
cream Remin Pro forte especially for prophylaxis, adding ginger to the range of flavours
available in the Remin Pro product line. Also

Dental manufacturer VOCO (Booth L55)
aims to impress with several pioneering
products and devices at the Dentistry Show
2015. An example is Admira Fusion, the
world’s first restorative material to combine
ORMOCER with nano-hybrid technology. In
this product, both the fillers and the matrix
are based on silica—the company refers to
this as Pure Silicate Technology. Admira Fusion boasts excellent biocompatibility, extremely low shrinkage, optimal colour stability and a high filler content.
The new filling system is complemented
by Admira Fusion x-tra, which has the same
physical properties but allows increments of
up to 4 mm. Other new products include the
fast-setting glass ionomer material IonoStar
Plus and Clip Flow, a flowable restorative material for temporary restorations.

on display is Celalux 3, a new cordless highperformance LED light-curing device in a pen
design. It only weighs 70 g and is handled
much like other devices in the surgery.
In addition to these innovations and its
bestselling dental products and devices, the
company is exhibiting a whole host of offers
at reasonable prices at the event.

Israeli manufacturer MIS Implants Technologies has announced that its products
have achieved favourable results in an extensive qualitative and quantitative elemental analysis using scanning electron microscopy. The study was conducted on behalf of the Quality and Research Committee
of the European Association of Dental Implantologists. It included 65 systems of sterile-packaged implants from 37 manufacturers and ten countries.
According to the intermediate study report, the C1 implant and the SEVEN implant
manufactured by MIS achieved noteworthy
results. Although the SEVEN implant exhibited blasting material on up to 7 per cent of
the surface in earlier studies by the committee in 2011 and 2012, the researchers did not
find even isolated spots with residue on the
two MIS implant types of Grade 23 titanium
in the current study.
MIS Materials Discipline Manager Dr Tal
Reiner explained the surface treatment

processes applied by MIS that led to the results: “We monitor the surface roughness,
uniformity and purity of our implants on a
daily basis, taking samples from selected
batches, and using our own in-house scanning electron microscope. Because the
analysis is done in our own labs, on-site,
there’s no holding up production for repairs.”
“MIS adheres to strict procedures, adding
any steps necessary to ensure the lowest percentage of contaminants, including blasting
residue or remnants from various stages of
production,” Reiner added. “Because the
scanning electron microscope analysis is
done on samples only, a trained technician
also does a 100 per cent visual inspection on
each and every implant. Any flawed implants are unconditionally rejected.”
The intermediate report, titled “Surface
analysis of sterile-packaged implants”, was
published in the 01/2015 issue of the European Journal for Dental Implantologists.

[17] =>

The

of creating
smiles.

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At GC, we focus on individuality.
We understand that no two
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also understand no two dentists have
exactly the same preference when it
comes to placement technique or ideal
composite restorative.
To meet this need GC presents a range
of composites with handling options from
firm and packable through to flowing and
injectable. Each GC composite introduces
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create invisible restorations with simplicity
and efficiency. Each of these composites offers
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each product showcases the innovation and quality
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[18] =>

DTUK0115_18_Show-Interview 09.04.15 15:28 Seite 18

INTERVIEW

Show Tribune United Kingdom Edition | 1/2015

“The dental industry is moving closer
to a complete digital workflow”
An interview with Stratasys Director of Global Dental for 3-D printing, Avi Cohen
By Dental Tribune
Digital dentistry is an upcoming industry
that has undergone rapid development in
recent years. Intra-oral scanning, CAD/CAM
and 3-D printing have fundamentally
changed the workflow of dentists and dental
technicians and have improved many dental
procedures. Dental Tribune had the opportunity to discuss this topic with Avi Cohen,
Director of Global Dental for 3-D printing
manufacturer Stratasys recently at IDS.
Dental Tribune: Mr Cohen, what are the advantages of using 3-D printers and digital dentistry technologies in a dental practice or laboratory, and why is digital dentistry becoming
increasingly important for dental professionals?
Avi Cohen: The dental industry is by its
very nature fast paced and requires rapid
turnaround. When patient care is directly affected by a technology, technicians will always look for innovations that can reduce
time while improving quality and precision.

Avi Cohen talking about the recent developments
in the field of dental 3-D printing.

Dental technicians traditionally rely on
steady hands and expert eyes to prepare
crowns, bridges, frameworks, etc. The manual process is time-consuming and imprecise and requires materials that do not typically provide the best durability or aesthetic
appearance. With a 3-D printer doing the
hard work, dental laboratories eliminate the
bottleneck of manual modelling. By combining oral scanning, CAD/CAM and 3-D
printing, they can accurately and rapidly
produce crowns, bridges, stone models and a
range of orthodontic appliances.
Forward-thinking dental and orthodontic
laboratories are continually seeking to improve their processes, reduce lengthy
milling time and stay ahead of the competition. Using Stratasys’s PolyJet 3-D printing
technology, featured in our Dental Series 3-D
printers, laboratories can print in superfine
16 µ layers, dramatically increasing precision and reducing production time in comparison with traditional dental mould-making. This avoids the need for patients to return to dental laboratories for corrective
procedures, saving dentists both time and

money and having a direct and positive impact on patient care.
With the cost of laboratory work becoming a major factor in dental restoration planning and therapy, we are seeing an increase
in the adoption of digital dentistry by dental
laboratories. This enables them to improve
efficiency and provide a higher level of patient care.
For many dental professionals, this evolution has been a long-awaited and welcome
transition to a faster and labour-saving
process that improves quality and precision
while keeping businesses competitive.
How have dentists responded to the trend of
digital dentistry? Do you think that the majority of practices and laboratories are already
using or considering using digital technologies such as 3-D printing?
With any new technology, there is always
the need to educate and it is the same in dentistry. It could be argued that many dentists
hold traditional plaster moulds in high regard, but now there are alternatives. I believe
that an increasing number of dentists, as
well as newcomers entering the industry,
will adopt newly available technologies that
improve productivity, one of them being a
move to digital dentistry.
With an increased range of superior intraoral scanners and associated software now
available on the market, more and more dental laboratories of all sizes are exploring and
installing the level of 3-D printing technology that suits their company’s size and
budget.
Most notably this year, we have seen an explosion of devices dedicated to digital imaging, impression taking and CAD/CAM fabrication of restorations—both chairside and
in the laboratory. With the rollout of new 3-D
printing systems, materials and capabilities

over the coming year, many believe that
more dentists will begin to view the technology as a viable alternative for their practices.
We might look back at this year as the moment that dental laboratories passed the
point of no return from a traditional manual

workflow towards an all-digital design and
manufacturing process. In many respects,
digital dentistry is already here, with a growing number of laboratory owners incorporating it in some form into their strategic
business models.
What innovations in the field of digital dentistry is Stratasys presenting at this year’s IDS?
We are using IDS to exhibit new systems
and materials. At this event, we are presenting something the market has never seen before: a breakthrough and the future. For centuries, impressions formed the basis for
crowns and bridges. Everything was made by
hand. Then intra-oral scanners were invented, allowing for digital impressions and,

range of orthodontic models for various applications.
As the industry moves closer to a complete
digital workflow, dentists can now focus on
more strategic tasks, while their 3-D printer
accelerates the development of dental solutions, such as crowns, bridges, inlays, veneers and frameworks.
What in general makes your products stand
out from the rest?
With our Dental Series, dedicated to addressing the needs of dentists and orthodontic laboratories, we offer a full range of dental
solutions, making us a key participant in
digital dentistry. For example, our Objet
Eden260VS Dental Advantage 3-D printer is

Avi Cohen in conversation with DTI.

finally, the printing of models. With Stratasys’s new systems and materials, models can
be printed in full colour and in different textures, thus creating an exact copy of the patient’s mouth—the colour of the teeth and
the gingivae perfectly attuned to the original. There are 900 different colours and textures from which to select. This brings realism to the market. Now, there is no longer a
need for stone models. We are no longer in
the “Stone Age”; we have arrived in reality.
In addition, our 3-D-printed models have a
clear jaw to visualise the exact position of
nerves, and this helps dentists to prepare for
the placement of implants. Moreover, with
our 3-D printing solutions, it is possible for
the first time to print gingival masks to see
how and where to place an implant—this has
been done entirely by hand until now.
What kinds of dental solutions does Stratasys
offer for different indications and customers?
As a leading provider of digital dentistry,
we offer a wide range of 3-D-printed dental
solutions, including surgical guides produced in a clear biocompatible material—
the ideal solution for implant placement. We
also provide stone models for dental laboratories, thereby offering an extremely accurate replacement of plaster modelling and a

engineered to meet the demanding production needs of mid-sized dental laboratories
and medium to large orthodontic laboratories and provides new additional capabilities for improved productivity.
With labour costs as the main expense for
dental and orthodontic laboratories, the Objet Eden260VS Dental Advantage addresses
this through a greater level of automation.
Printing is done at the click of a button and,
owing to the water-soluble support mode,
cleaning of models is an automated process.
A single laboratory technician can design,
print and have all models cleaned automatically with no post-processing required. The
reduced cost per model has a knock-on effect
on the labour cost.
In addition to our Dental Series 3-D printers, we offer a range of advanced dental
materials, including the biocompatible
VeroGlaze. This material is ideal for applications requiring mucous membrane contact
for up to 24 hours, enabling dental laboratories to use VeroGlaze to create veneer try-ins
in precise A2 tooth shading. Soluble support
technology allows the easy cleaning of dental parts with fine features, such as small removable die inserts in dental models.
Thank you very much for this interview.

[19] =>

Centre for Advanced Professional Practices (CAPP) is an ADA CERP Recognized Provider.
ADA CERP is a service of the American Dental Association to assist dental professionals in
identifying quality providers of continuing dental education. ADA CERP does not approve
or endorse individual courses or instructors, nor does it imply acceptance of credit hours
by boards of dentistry.

CAD/CAM & DIGITAL DENTISTRY INTERNATIONAL CONFERENCE

10

06 - 10 MAY, 2015

MEET THE

th

JUMEIRAH BEACH HOTEL
DUBAI, UAE
14 CME HOURS

COURSES

www.cappmea.com/cadcam10

7 th DENTAL - FACIAL COSMETIC INTERNATIONAL CONFERENCE

Joint Meetings

11 - 16 NOVEMBER, 2015

Inman Aligner Symposium

JUMEIRAH BEACH HOTEL
DUBAI, UAE
14 CME HOURS

AAID 4th Global Conference

DENTAL HYGIENIST DAY 2015

14 NOVEMBER, 2015

Part of the
7th Dental - Facial Cosmetic International Conference

JUMEIRAH BEACH HOTEL
DUBAI, UAE

4 CME HOURS

3 RD A S I A - P A C I F I C E D I T I O N

CAD/CAM & DIGITAL DENTISTRY
INTERNATIONAL CONFERENCE

04 - 05 DECEMBER 2015
SUNTEC SINGAPORE
14 CME HOURS

www.capp-asia.com

DENTAL TECHNICIAN FORUM part of IDEM SINGAPORE 2016
in cooperation with Koelnmesse

09-10 APRIL 2016
SUNTEC
SINGAPORE

www.idem-singapore.com

HANDS-ON COURSES

VISIT: www.cappmea.com

PR / CORPORATE EVENTS & MEETINGS
CONTACT:

In 2012 CAPP joined a global family of 95 publishers by
becoming the proud owner of the Dental Tribune Middle
East & Africa edition, and since then we have been delivering 6 print publications to over 20, 000 Dental Professionals and in the MEA region, 24 e-newsletters are delivered
to more than 41, 000 active subscribers, and through an
international website the latest industry news reaches the
largest dental community worldwide wide an audience of
over 650, 000 Dental Tribune readers.

www.dental-tribune.me

DR. D. MOLLOVA
MANAGING DIRECTOR

T. DEYANOV
DIRECTOR

M: +971 50 4243072
E: dr.mollova@cappmea.com

M: +971 55 1128581
deyanov@cappmea.com

DUBAI OFFICE | CAPP FZ L.L.C
P.O. Box: 450355 | Dubai, UAE
T: +971 4 3616174 | Fax: +971 4 3686883
CAPP Lebanon:
Rodny Abdallah, Marketing Communications ME
T: +961 1 901022 | M: +961 3 704022 | : +961 76 704022
Beirut, LEBANON | Email: info@rodny.org

[20] =>

DTUK0115_20_Show-WhatsOn 09.04.15 16:57 Seite 20

TRAVEL

Show Tribune United Kingdom Edition | 1/2015

Birmingham “Back to Backs”:
Welcome to Brum
By Annemarie Fischer

“I grew up in Birmingham, where they
made useful things and made them well”,
says Birmingham native author Lee Child.
Birmingham has been titled the “Second
city”, and is also referred to as Brum, derived
from an ancient variation of “Brummagem”.
Over one million “Brummies” make it the second-most populous city in the UK after the
capital.
Birmingham epitomises the idea of Enlightenment in England, fostered the Midlands Enlightenment (also “Birmingham Enlightenment”) which sparked the scientific
revolution, became the pulse of the industrial revolution, and currently hosts five universities as the UK’s second-largest student
city.

Lots to see and do
For a true time travel experience, the Back
to Backs offers a restoration of the historic
back-to-back housing. Each interior repre-

sents a different era from the 1800s the preand postwar 20th century. Admission is via
guided tour only and can be booked via 0121
666 7671.
The Birmingham Science Museum Thinktank at the Millennium Point Building offers
a hands-on experience of Birmingham as the
historic “Workshop of the World” in the “City
of a Thousand Trades”. It also hosts the oldest
and working Smethwick Engine by Boulton
and Watt from 1779, along with a planetarium
and a Science Garden. Just opened in March,
the Spitfire Gallery explores the history of
the legendary aircraft, which was produced at
the Castle Bromwich factory.
The Museum of the Jewellery Quarter captures the craftsmanship in a time capsule
and preserves its iconic 19th century architecture. The museum serves as the starting
point to explore the largest European hub of
jewellery business, buzzing with local shops
and art galleries–with St. Paul’s Gallery as the
largest art gallery outside of London. Watch

out for the two trails, the “Findings Trail” and
the “Charm Bracelet Trail” made by Birmingham artists, as a guide for visitors throughout the quarter.
Located at Chamberlain Square, the Birmingham Museum and Art Gallery offers free
admission and hosts a collection of paintings
starting from the 14th century to present, as
well as fine art and historical industrial objects. Visitors should enter via the Big Brum
clock tower, greeting visitors with the slogan
“By the gains of Industry we promote Art”.
One may also hunt for gold in the brand
new Staffordshire Hoard collection of an Anglo-Saxon gold treasure. The guided tour
“Birmingham: its people, its history” offers a
Victorian Birmingham experience. Contemporary and upcoming artists from the West
Midlands are also continuously showcased.
The Bullring with the iconic Selfridges
building and the Mailbox provides large
shopping areas, with the Great Western Arcade offering a true Victorian shopping expe-

rience. For independent shops and entertainment visitors should definitely pay a visit to
the Custard Factory. A Birmingham souvenir
bag should definitely include Typhoo tea
along with Cadbury’s chocolate. The factory
premises Cadbury World in Bournville offer
chocoholics not only a taste of the treat and
the biggest Cadbury shop; the chocolate
aroma permeates the town specifically conceptualized according to the needs of the factory.
If you are in the mood for something
savoury instead, the pub scene around Broad
Streetindulges in a fusion cuisine that thanks
to Birmingham’s multicultural population is
unique in Britain. While the Michelinawarded Adam’s and Purnell’s have specialised in British contemporary cuisine, the
Golden Balti Indian Takeaway is the best
place to go for a Balti, a curry dish that has
originated in Birmingham.
www.visitbirmingham.com

What’s on in Birmingham, 17−19 April
Hamlet
(Theatre)

Andy Wickett
& World Service

Nadine Shah
+ The Black Site

George Clinton
& Parliament Funkadelic

Dates & time: 16– 18 April, 7.30 pm
Location: Crescent Theatre,
20 Sheepcote Street
www.crescent-theatre.co.uk

Date & time: 17 April, 8.30 pm
Location: Tower of Song Café Bar
107 Pershore Road S
www.towerofsong.co.uk

Date & time: 18 April, 6.30 pm
Location: The Rainbow Venues,
160 Digbeth High Street
www.therainbowvenues.co.uk

Date & time: 19 April, 8.00 pm
Location: O2 Academy Birmingham,
16−18 Horsefair
www.o2academybirmingham.co.uk

Probably the most famous play in the world
and interpreted in thousands of different ways
on stage and screen, Shakespeare’s Hamlet will
be staged at the Crescent Theatre for only four
nights in April. According to the theatre, Stage2
has a long established history of presenting
award-winning five star Shakespeares that are
clear and accessible to all ages and all levels of
experience. There will also be plenty of twists
and concepts to provoke discussion and debate.

A true Midlands artist, Andy Wickett started
his career back in the 1980s singing and playing in a number of bands, most famously New
Wave poster childs Duran Duran. In addition,
he has produced music videos and co-written
albums with world renowned Asian artists
Nusrat Ali Fateh Khan, Malkit Singh, Stereo Nation, Taz and DCS, among others. With his latest
band World Service, he is regularly performing
in large arenas and venues in the UK and
around the world.

Often compared to PJ Harvey, this 27 year-old
North England singer and songwriter with Pakistani and Norwegian roots just released her
second album. Her current tour will make a
stop on Saturday in Birmingham at the Rainbow Venues. The Guardian wrote about her distinctive voice “Think Marianne Faithfull, not
the prim young creature courted by Mick Jagger in the mid-60s but the ravaged, battle-worn
survivor who re-emerged with Broken English
in the late 70s.”

Seventy-four year old George Clinton needs
no introduction. Born in North Carolina, he almost single-handedly ruled black music in
the 1970s. His inspiration, dedication and determinationresulted in the elevation of
“funk” music to complete recognition and acceptance as a true genre in and of itself. As the
single most sampled artist in music history,
he inspired a whole line of artists including
Afrika Bambaataa, Prince or Rap legends Public Enemy.

[21] =>

DTUK0115_21-22_Hughes 09.04.15 15:36 Seite 21

TRENDS & APPLICATIONS

Dental Tribune United Kingdom Edition | 1/2015

A mixed national picture
The current state of periodontology in the UK and why there needs a lot to be done
By Prof. Francis Hughes, London

Periodontal disease has now been associated with risk of a number of other systemic
conditions, most notably cardiovascular
and cerebrovascular disease, among many
other conditions. It has been clearly shown
that periodontal disease causes a measurable systemic inflammatory response but it
is not at all clear that periodontal treatment
actually reduces the risk of these conditions, or whether the conditions are associated through common factors such as genetic predisposition. Nevertheless, given
the importance of these systemic conditions it is recommended that periodontal
health should be regarded as part of general
health.

Manpower

Access to specialist treatment services within the NHS remain very patchy.

The UK is gearing up to host the largest
conference in Periodontology and Implant
Dentistry ever held with EuroPerio8 taking
place on 3 -6 June at London ExCel. Over 100
speakers will contribute to the main scientific programme and there are many additional sponsor sessions. Over 1,500 abstracts have been accepted. Already over
7,000 periodontists, implantologists, general dentists and dental hygienists from 96
different countries have confirmed their attendance. We expect to have nearly 10,000
people at the conference in total, a new
record for a conference in this field, and it is
till not too late to register.
Given the huge popularity of this event, it
is perhaps a perfect time to reflect on the
state of periodontology in the UK. It is clear
that periodontal disease is not going to go
away any time soon. Although there is a lack
of detailed epidemiology of the disease in
the UK, the Adult Dental Health Survey provides a useful indicator of trends in the epidemiology of the disease, even if it probably
seriously underestimates true prevalence
rates, owing to the limited methodology
used in this survey.
The good news is that there has been significant reductions in the number of people
with visible plaque and calculus present,
(but this is still reported as 45 % of the population) and concomitant reductions in the
amount of mild periodontal disease, consisting of gingivitis and those with low levels of attachment loss. However, perhaps
unexpectedly, this has not been associated
with similar reductions in moderate and severe periodontitis. In fact, the number of
adults with severe periodontitis (pocketing
of 6mm+) has increased from 6 % in 1998 to
9 % in 2009. The reasons for this may be
complex but are likely to include the fact
that we have an increasingly aging population, and that dentists are (rightly) taking
out fewer teeth even when judged to have
poor long term prognoses.
This disconnection between trends in
plaque control to more severe destructive

periodontitis is a common finding in a
number of recent epidemiological surveys
in different populations and underlines the
complexity of aetiological factors which determine susceptibility to destructive periodontitis. Although plaque tends to correlate directly with gingival disease, in the majority of people this may not necessarily result in the progression to more severe
periodontitis. The major risk factors which
are implicated in this process including
smoking, genetic factors, and medical factors, particularly diabetes and medications
such as calcium channel blocker antihypertensive drugs.
The impact of the well documented rise in
the numbers of older people may be particularly important for future treatment
needs. The over 65-year olds are often fit and
well and have high expectations for their
continued health needs, even though they
may also suffer from common medical conditions such as type 2 diabetes and hypertension and may take multiple medications.

Impact of
periodontal disease
Periodontal disease has typically been
seen as a “silent disease” which might have
few consequences unless resulting in tooth
loss. However, there is now lots of evidence
to refute this concept. Patients with periodontitis consistently report significant
impacts of the condition on their quality of
life, particularly impacting on function,
aesthetics, comfort and self esteem. Furthermore, even mild disease resulting in
gingival bleeding and perhaps halitosis impact on social acceptability and remain
highly legitimate reasons for treatment
need. Prevention of more severe disease is
of course best achieved by primary prevention and early disease control by achievement of high levels of plaque control together with management of modifiable risk
factors, particularly smoking cessation.

Clearly there remains a major, often unmet, periodontal treatment need within the
UK population, which represent a significant challenge for dental health professionals. There are currently over 30,000 registered dentists and over 6,000 dental hygienists in the country. In addition, there

are approximately 300 periodontists on the
specialist list, who work mainly in private
specialist practices or in the hospital and
university services. Given that there are an
estimated five million cases of moderate to
severe periodontitis, and perhaps 20 to 30
million with some signs of periodontal disease, it would appear that these relative proportions of dental manpower are not currently ideally suited for the provision of primary and secondary periodontal care according to actual clinical needs. There are of
course a significant but unknown number
of general dentists who provide a degree of
periodontal treatments that might otherwise considered to be at secondary care
level.
The number of specialist periodontists in
training is small (certainly less than 20
every year), which is probably insufficient
to maintain the total number on the specialist list over time. There is considerable interest and some commitment to providing
a group of dentists with additional skills in
specific restorative specialties including
periodontology, who could potentially

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[22] =>

DTUK0115_21-22_Hughes 09.04.15 15:36 Seite 22

meet much of the treatment need for secondary care periodontal treatment, but this
group does not really exist at the present
time. It should also be commented that this
model of periodontal care provision does
remain essentially untested on a large scale
at present.
Overall the picture of periodontal care provision in the UK at present is mixed at best. In
most areas of the country, those choosing to
seek their periodontal care from the private
sector, are able to access specialist care from
highly trained periodontists and their teams,
who often provide a wide range of effective
and sophisticated treatment options. HowAD

TRENDS & APPLICATIONS

ever, outside the dental schools there is little
or very patchy access to specialist treatment
services within the NHS. Recognition of this
manpower deficit and a move to address it
through intermediate level training in periodontal therapy is an encouraging but still
unproven development.
Possibly the most important health professional for the implementation of primary
prevention are dental hygienists. Although
there is little evidence on deployment of hygienists within primary care, anecdote suggests that they may spend much of their time
removing supragingival calculus (as prescribed by their employing dentists) without

any routine attention to properly targeted attempts to provide adequate personalised oral
hygiene instruction. Indeed the whole issue of
the routine “scale and polish” as a therapeutic
intervention has been questioned and is the
subject of current research projects whose
findings are yet to be reported.

Implantology
Many aspects of implantology, including
surgical management, management of soft
and hard tissues, and management of periimplant health and disease, are squarely
within the realm of periodontal treatments,

Dental Tribune United Kingdom Edition | 1/2015

and implantology is indeed a substantial component of specialist training in periodontology. Whilst the growth in implant treatments
has been markedly slower than in many other
European countries, there is now a large and
ever growing use of dental implants in UK dental practice and a wider acceptance from significant numbers of patients of the value of implants and their potential cost/benefits. It is
quite clear that the potential for implant treatment could never be met within the National
Health Services as the costs could potentially
swallow much of the total NHS budget. However some recognition of the clinical needs and
cost/ benefits on a more individual basis even
within the NHS dental services would appear
to be inevitable in the future.
There are two major developing issues,
which are partly related to each other, which
may particularly affect the periodontist practicing implant dentistry. Firstly, there is the
growing problem of peri-implantitis. Reported prevalence rates of long standing implants do vary but are typically on the region of
30 %. This progressive destructive condition
creates particular problems as it appears to be
much more difficult to manage than its first
cousin, periodontitis. As many more implants
have been placed for a number of years there is
great concern about the growth of this condition.
Secondly, apparently oblivious to the above
problems and an understanding of long term
survival rates of teeth and implants, there is a
disturbing trend amongst some to advocate
early removal of diseased teeth and replacement by implants. There may be some short
term gains for the dentist and/or patient to be
had from this approach but it is a sure way to
store up major new problems for the future.
So there remains a lot to do tackle periodontal disease in the UK. One of the most encouraging developments in the near future is the
development of care pathways within the General Dental Services which place considerable
emphasis on prevention, risk factor management and tackling early periodontal disease, as
well as mapping out appropriate care pathways for those in need of more involved periodontal treatment. This will inevitably be
painful for some as it represents a new way of
service delivery based on evidence based outcomes. However it also carries with it the
prospects for better provision of higher level
periodontal care, particularly if the planned
development of dentists with some specialist
skills is successful.

Challenges remain
The challenge of managing periodontal disease in an increasingly aging population are
likely to become a major issue going forward,
and at time the profession will have to consider
how it interacts with general medical services,
for example in screening and detection of the
currently estimated 750,000 people in the UK
who may have undiagnosed diabetes.
The private sector looks set to increase its
provision of specialist periodontal care and
implant provision. The challenges of long
term implant survival and management of
peri-implant disease will present new challenges for many. There will undoubtedly be
novel treatments and developments which we
can only speculate on. Interesting times indeed but there is lots to do.

Francis Hughes is Professor of
Periodontology at Kings College London and Chair of the
Europerio8 conference in
London. He can be contacted at
francis.hughes@kcl.ac.uk.

[23] =>

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24

TRENDS & APPLICATIONS

Dental Tribune United Kingdom Edition | 1/2015

Knowledge can save lives
Understanding and treating patients with eating disorders
By Linda Douglas, Canada

© Kzenon

These include diabulimia,5 where individuals
intentionally take insufficient insulin in order to lose weight; anorexia athletica, which
is obsessive, excessive exercising to the point
of being detrimental to health; and bigorexia, or muscle dysmorphia, where the individual perceives his or her body to be
underdeveloped, despite having a large,
muscular physique. Orthorexia nervosa is an
obsession with the quantity and quality of
the food consumed. The compulsive, excessive intake of food during the hours normally
reserved for sleep—often getting up multiple times during the night to eat—is called
night eating syndrome. Finally, there is pica,
the persistent eating of non-food substances,
and various food-related phobias.

The UK has the highest rate of eating disorders in Europe. Recent figures suggest that
one in 100 British women have a clinically diagnosed eating disorder.6 In the US, anorexia
nervosa is the third most common chronic
illness among adolescents.7 Eating disorders
occur mostly in females aged 15–25, but also
occur in males, in children as young as 7 years
of age, and in people aged over 50.
As one of the most common eating disorders, bulimia nervosa is characterised by a
pattern of consumption of massive amounts
of food (binge eating) and recurrent inappropriate weight control behaviours. These include purging through self-induced vomiting, abuse of laxatives and other substances,
as well as behaviours such as fasting (not eat-

Heart and major organs
• Cardiac arrhythmias, and cardiac arrest related to electrolyte imbalance
(especially low potassium), dehydration, or starvation-induced atrophy of the
myocardium
• Slow pulse rate
• Low blood pressure
• Impaired capacity to think, due to starvation-related brain changes
• Kidney damage
• Liver damage due to starvation or substance abuse14
• Hypothyroidism
• Infertility related to amenorrhoea

Digestive system
• Abdominal pain
• Chronic constipation
• Poor muscle tone of the colon, and incontinence related to misuse of laxatives
• Ruptured oesophagus, or Mallory–Weiss lesions
(gastro-oesophageal laceration syndrome), due to vomiting
• Gastric bleeding
• Stomach might rupture during bingeing
• Swollen parotid glands and sore throat related to purging

General
• Dehydration, malnutrition
• Fatigue
• Electrolyte imbalance
• Hypoglycaemia
• Anaemia
• Low white blood cell count, and impaired immunity
• Slow metabolism
• Osteoporosis
• Loss of muscle mass, causing stick-like limbs

Skin (especially with anorexia)
According to the US National Institute of
Dental and Craniofacial Research, 28 per cent
of patients with bulimia are first diagnosed at
a dental appointment. Although dentists are
in an ideal position to detect the warning
signs of eating disorders, research has found
that knowledge of the oral and physical signs
of these conditions is often limited.1
Nevertheless, we have an ethical obligation
to increase our knowledge and participate in
secondary prevention of eating disorders, as
it could improve prognosis and even be a lifesaver for some patients. Research has shown
that such disorders have the highest mortality rate of all psychiatric illnesses.2 We need to
initiate timely interventions, to minimise
damage to the oral hard and soft tissue, and

instigate medical referral for access to specialists in treating eating disorders.

An overview of eating
disorders
Eating disorders are psychiatric illnesses
characterised by disordered eating and disturbed attitudes to eating and body image.
They are often accompanied by inappropriate, dangerous methods of weight control.
The three most common eating disorders are
bulimia nervosa (binge–purge), anorexia
nervosa (starvation) and binge-eating disorder (bingeing without purging).3 There are
variations of disordered eating, including
eating disorders not otherwise specified.4

• Extremely dry, scaly, itchy skin with a grey cast15
• Decreased scalp hair, which is short and brittle
• Increased lanugo hair—fine hair on the body and arms (the
body’s attempt to retain heat after excessive loss of body fat)
• Bloodshot eyes and broken capillaries (petechiae) of the skin around the eyes,
related to forced vomiting

Extremities
• Clubbed fingers16 related to cardiac complications or overuse of laxatives
• Cold hands and feet related to peripheral vasoconstriction
• Russell’s sign: calluses, scars or abrasions on the knuckles of the dominant hand,
related to inserting the fingers in the mouth to induce vomiting
• Carotenoderma, orange pigmentation of skin, especially on the palms of the hands,
related to excessive intake of foods containing carotene

Table 1: Medical complications of eating disorders.12, 13

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DTUK0115_24-27_Douglas 09.04.15 15:37 Seite 25

TRENDS & APPLICATIONS

Dental Tribune United Kingdom Edition | 1/2015

ing for at least 24 hours) or excessive exercise.
The weight of bulimic individuals tends to
fluctuate, but remains within normal limits.
About one-third of bulimics have a history of
anorexia nervosa, and some have a history of
obesity.
During bingeing, bulimic individuals usually consume between 1,500 and 3,000 calories within 1 or 2 hours, and have been known
to consume as much as 60,000 calories in
one bulimic binge. They typically eat sweet,
high-calorie foods, which are easy to consume quickly, like ice cream. This is followed
by depression, panic and guilt, and a compulsion to purge. These episodes occur at least
twice weekly over a period of several months.
Some bulimic individuals even vomit five or
six times per day. Most bulimics who die do
so in the act of purging.
Anorexia nervosa is characterised by a refusal to eat enough to maintain body weight
within 15 per cent of the minimal normal
weight for age and height (the anorexic individual is often 20 per cent to 40 per cent below a healthy body weight); they have an extreme fear of gaining weight; and a distorted
body image, which results in patients believing that they are fat, even when they are
emaciated; and amenorrhoea (absence of
menstruation).
A significant number of anorectic individuals also purge, and some have pica; they
may consume cotton balls soaked in orange
juice, for example, to control hunger. The
main difference between bulimia nervosa
and purging anorexia is that the individual
with anorexia is underweight.
Binge-eating disorder is characterised by
frequent consumption of abnormally large
amounts of food in one sitting, while feeling
a loss of control over eating. Individuals with
this disorder do not purge afterwards, but
feel depressed and guilty after overeating.
Most individuals with binge-eating disorder
are obese, with the related increased risks of
diabetes, heart disease, certain cancers, and
arthritis.

Aetiology
The aetiology of eating disorders is multifactorial and not completely understood.
Contributing factors, however, include living
in a culture where thinness is generally
admired. There are indeed unrealistic
depictions of beauty and thinness in most
media. At about 6 feet (1.82 m) tall and 117
pounds (53.07 kg), today’s fashion model
weighs 23 per cent less than the average
woman. Some overachieving perfectionists
who do not fit this questionable ideal develop
eating disorders. They have not only a low
self-esteem, but also a distorted perception
of body shape, as well as a poor body image.8
The risk of a female developing anorexia
nervosa increases ten to 20 times if she has a
sibling with the disorder. Eating disorders often occur in individuals who have suffered
physical or psychological trauma,9 and are
frequently accompanied by other psychiatric illnesses,10 such as depression, anxiety,11
self-harm (such as cutting), obsessive–compulsive disorder, and chemical dependency.

Oral findings
Traumatic lesions on the palate and
oropharynx are caused by insertion of objects to induce vomiting. Signs of nutritional
deficiencies occur, such as angular cheilitis,
candidiasis, glossitis, and oral mucosal ulceration. Individuals with eating disorders also
experience a dry mouth related to dehydration or xerogenic medications, such as antidepressants and anxiolytics.

Figs. 1 & 2: Severe dental erosion related to bulimic purging. (Produced with permission from Dr S. Weinstein)
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[26] =>

DTUK0115_24-27_Douglas 09.04.15 15:37 Seite 26

Vomit has a pH of about 3.8. During purging, the vomit hits the palatal aspects of the
maxillary anterior teeth. Dental erosion due
to purging by vomiting becomes apparent
about six months after onset.18 It eventually
undermines the palatal surfaces and leads to
incisal fractures and chipping, and overeruption of the mandibular anterior teeth.
Erosion also occurs in the posterior teeth,
causing perimolysis: tooth tissue surrounding restorations is eroded, leaving the
restorations with a raised, island-like appearance. Eroded occlusal contacts also lead to
loss of vertical dimension.

TRENDS & APPLICATIONS

Dental Tribune United Kingdom Edition | 1/2015

Bulimics tend to consume foods high in refined carbohydrates, and individuals with
eating disorders often consume acidic diet
beverages. Therefore, they have a high caries
risk and impaired salivary buffering capacity. Dental hypersensitivity is also common.
The loss of bone density increases the risk of
jaw fracture during extractions.

Dental management
of patients with
eating disorders19, 20
Medical treatment21 of eating disorders includes nutritional therapy to treat the medical complications and the starvation-related
brain changes that perpetuate the illness.
This is combined with psychotherapy and
medication, such as antidepressants.
Individuals with eating disorders also need
regular dental visits in a supportive environment, for continuing care. They must be regarded as medically compromised, owing to
the risk of grave medical complications, particularly cardiac arrest due to electrolyte imbalance.
Thorough clinical assessment includes
general appraisal, which begins the moment
we greet our patient. We should tactfully observe his or her general demeanour, gait, and
facial symmetry. The skin should also be observed for lesions and pallor, and the hands
for Russell’s sign or clubbed fingers. A comprehensive medical history is needed, as well
as monitoring of the vital signs. Extra-oral
and intra-oral examination, as well as exam-

• Depression, anxiety
• Perfectionist, overachiever
• Low self-esteem
• Mood swings
• Guilt, shame
• Alienation, loneliness
• Social isolation
• Eating alone
• Compulsive behaviours
• Misperception of hunger and satiation
• Obsessive thoughts about food,
calories and weight often weighing
themselves several times per day.
• Secrecy and denial of their illness:
individuals with anorexia nervosa
often dress to hide their body shape,
and they might put coins in their
pockets when being weighed.
• They often claim to have food allergies
in order to justify their restrictive diet.

Table 2: Psychological aspects of eating disorders.17

ination of the oral hard and soft tissue, is
needed, plus comprehensive documentation that includes detailed clinical notes, periodontal charts, radiographs, intra-oral photographs and study models to monitor damage.
When an eating disorder is suspected, this
sensitive topic needs to be approached in a
non-judgemental, non-threatening manner.
It is beyond our scope of practice to diagnose
eating disorders, but we can present the findings of our examination to the patient.22 For
example, if there is dental erosion, we could
mention some possible causes, like acidic
drinks, acid reflux or frequent vomiting. This
gives the patient an opportunity for disclosure. If he or she discloses his or her eating
disorder to us, he or she should be referred to
his or her physician. If he or she is not ready to
tell us, we can still be supportive and initiate

[27] =>

DTUK0115_24-27_Douglas 09.04.15 15:38 Seite 27

Dental Tribune United Kingdom Edition | 1/2015

a prevention protocol based on our clinical
findings.
Definitive dental restorations cannot be
completed while a patient is purging regularly, as acid erosion will compromise the
restorations. Only essential restorative work
should be done, to limit tooth damage and
keep the patient free of pain. Pending the patient’s recovery from his or her eating disorder, the dental hygienist can provide interventions to limit damage to the oral hard and
soft tissue, and relieve xerostomia and dental
hypersensitivity. During dental hygiene appointments, such patients should be polished with a non-abrasive fluoride paste.
A protocol to reduce caries risk should include in-office fluoride varnish applications,
plus self-applied neutral fluoride, and calcium and phosphate products, such as NovaMin, Recaldent and nano-hydroxyapatite,
to remineralise and desensitise.
Xylitol-containing products, such as toothpastes, gum and candies, are also beneficial.
When used for 5 minutes, five times per day,
they stimulate salivary flow, reduce the oral
population of cariogenic bacteria, and reduce
oral acidity. Patients should brush three
times per day with a soft brush and a toothpaste containing 5,000 ppm fluoride. They
should clean the interproximal embrasures
daily and clean their tongue too, to remove
biofilm and acid residue.

A mouth guard can be used to protect the
dentition during vomiting. Brushing directly
after vomiting causes more loss of tooth
structure, and rinsing with water reduces the
protective properties of the saliva. Instead,
the oral pH should be neutralised by rinsing
with one teaspoon of sodium bicarbonate in
250 ml water, or with a product containing
calcium and phosphate ions. For additional
support, we can share information on resources for those who struggle with eating
disorders.23 With increased knowledge and
vigilance, dental care professionals can enhance detection of warning signs of eating
disorders, for improved patient care and
favourable outcomes.
Editorial note: A complete list of references is
available from the publisher.

Linda Douglas is a British dental hygienist currently residing
in Ontario in Canada. She can
be contacted at
lindadouglas@sympatico.ca.

TRENDS & APPLICATIONS

The SCOFF questions*
• Do you make yourself Sick because you feel uncomfortably full?
• Do you worry you have lost Control over how much you eat?
• Have you recently lost more than One stone (6.35 kg) in a three-month period?
• Do you believe yourself to be Fat when others say you are too thin?
• Would you say that Food dominates your life?
* One point for every “yes”; a score of ≥ 2 indicates a likely case of anorexia
nervosa or bulimia.
Table 3:The SCOFF questionnaire utilises an acronym in a simple five-question test devised for use by
non-professionals to assess the possible presence of an eating disorder.24
AD

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DTUK0115_28-29_Orofacial 09.04.15 16:42 Seite 28

TRENDS & APPLICATIONS

Dental Tribune United Kingdom Edition | 1/2015

Avoiding irreversible dental treatment
Types of orofacial pain and understanding them correctly
By Prof. Joanna Zakrzewska, London

Pain is one of the most complex health
conditions encountered, as it affects not
only the sufferers, but also the community
in which they live. It is often associated
with other co-morbidities, especially anxiety, depression and chronic pain elsewhere.
In the orofacial region, the most commonly
reported pain is dental, and this inevitably
requires a visit to a dentist, who in most instances can provide a cure. However, there
are other pains encountered in the orofacial region that can become chronic, defined as pain that has been present for over
three months. These pains need to be diagnosed correctly, as their management is
different.
At present, we have no biomarkers for
chronic pain, and the only way we can make
a diagnosis is to listen carefully to the history the patient gives. We need to elicit the
key features of pain, for example onset, duration, location, severity, character, provoking and relieving factors, as well as the
impact on quality of life and activities of
daily living. It is essential to determine the

presence of other illnesses, especially other
chronic pain. Chronic orofacial pain has a
significant psychological impact, as the
face used to express pain from other parts
of the body is now in pain itself. Patients
with chronic orofacial pain are also confused as to whom they should consult, a
dentist or a doctor. Their choice of health
care provider will significantly affect both
first-line treatment and subsequent referral.
Pain is notoriously difficult to communicate and poor communication of pain is
cited as the main barrier to treatment and
management. This “unsharability” of pain
can be correlated with its resistance to language. This results in an intense burden of
suffering and isolation for the individual. It
is further compounded when patients do
not have the requisite language skills. Yet
we know that words may help a clinician in
the differential diagnosis; for example, patients with musculoskeletal pain will use
words such as “heavy”, “aching” and “nagging”, whereas those with neurological

causes will describe their pain as “burning”,
“pins and needles”, “shooting” and “stabbing”.
We also try to measure pain using a scale
of 1 to 10, but do these verbal measures really capture the experiences of those with
facial pain? This question recently led to a
project with a visual artist to create photographic images of pain. Thus images were
co-created by the artist Deborah Padfield
and facial pain sufferers, aiming to reflect
the individual experience of pain. A selection of these images were then made into
pain cards, which are now being used with
other pain patients to help improve mutual understanding and communication
between doctors and patients. They appear
to be helpful in describing the characteristics of the pain, as well as initiating discussions about its impact.
Once a dental or oral mucosal cause of
pain has been excluded, the commonest
cause of pain in the lower part of the face is
temporomandibular disorders (TMD).
TMD can present as clicking or locking of
the jaw and can come on suddenly. It can
present on only one side or both. Pain in the
muscles of mastication with or without
pain in the joint itself is the commonest
form of this group of disorders. It is very
common and up to 20 per cent of cases can
become chronic.
The pain is centred in the pre-auricular
area and can spread down the mandible

and neck, as well as up to the forehead. It
can be associated with clicks on opening or
closing and rarely with reduced opening.
The pain is described as dull, aching, sore
and occasionally sharp. When the main
muscles are palpated, the same character
pain is elicited.
A careful history is essential in order to
identify any potential red flags. It is important to check for possible temporal arteritis
in anyone over the age of 50 having his or
her first episode, as prompt treatment with
steroids is required to prevent blindness.
Any history of malignancy, neurological
deficits, weight loss or severe trismus will
require prompt investigation.
Traditional TMD has been managed by
dentists with the provision of a variety of
intra-oral appliances. They do provide pain
relief, but this may be due to the natural
history of the condition. Current data from
the world’s largest study on TMD in the US
has highlighted that the most common
provoking factors are psychosocial. There
is increasing evidence that patients with
TMD also experience pain in other parts of
the body and are more likely to be headache
and migraine sufferers. This data therefore
suggests that our approach to management of these conditions needs to be radically changed to include a more holistic approach as described below.
A condition with increasing incidence is
persistent dentoalveolar pain, also known

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Dental Tribune United Kingdom Edition | 1/2015

TRENDS & APPLICATIONS

tient or dentist realises that it is non-dental. In the early stages, the pain is highly responsive to anti-convulsants, either carbamazepine or oxcarbazepine, and all guidelines suggest this as the first-line drug type.
However, for trigeminal neuralgia, there is
a wide range of treatments, both medical
and surgical, and so patients need to be
seen not only by neurologists or oral physicians, but also by neurosurgeons. In correctly diagnosed patients, surgical outcomes can give the longest pain relief periods.
It is increasingly important that dentists
recognise that there are many non-dental

causes of orofacial pain. Time needs to be
spent in eliciting a careful history, and irreversible dental treatment must be avoided.
Chronic orofacial pain patients will have
better outcomes if managed by specialist
teams with multidisciplinary staff.

Prof. Joanna Zakrzewska leads
the largest UK multidisciplinary facial pain unit at University College London Hospitals
NHS Foundation Trust.
She can be contacted at
j.zakrzewska@ucl.ac.uk.

Orofacial pain can have many non-dental causes.
AD

as atypical facial pain. This is pain in the region of the teeth and/or tooth-bearing area
in which a dental cause cannot be identified. In some cases, the pain is related to
nerve injury. This can occur after extraction of teeth, especially third molars, as
well as after root canal work, implants or facial trauma.
This pain is often not identified and leads
to extensive irreversible, unnecessary dental treatment. It is probably a neuropathic
pain and so needs to be managed in the
same manner as other reported neuropathic pains according to guidelines. Drugs
such as anti-depressants and anti-convulsants are helpful; opioids are of no help in
these conditions. However, management
with medications alone is insufficient. Patients need to be given an explanation
about pain and how it is influenced by past
experiences, mood, attention, significant
life events, as well as genetic variability.
Evidence shows that chronic pain outcomes are improved when a biopsychosocial approach is used. Cognitive behaviour
therapy needs to be delivered by multidisciplinary teams that include clinical psychologists and physical therapists.
Pain that remains intra-oral and does not
radiate externally is burning mouth syndrome. This is defined as a burning pain or
discomfort often present continuously on
the tongue and other parts of the oral mucosa. There are no local or systematic factors to account for this pain, and often it is
associated with altered taste and changes
in salivary flow. Its highest incidence is in
perimenopausal women, and so it had for
many years been labelled as a psychological pain; however, recent research has now
shown that this is also a neuropathic pain
with abnormalities especially in perception of warmth and cold.
There have been a number of randomised controlled trials performed, but
the evidence of any efficacy is low. Cognitive behaviour therapy is effective, especially if it includes a careful explanation of
the potential causes of this condition and a
reassurance that it is not cancerous.
Another rare pain that dentists often see
is trigeminal neuralgia. It is defined as a
“sudden, usually unilateral, severe, brief,
stabbing, recurrent pain in the distribution
of one or more branches of the fifth cranial
nerve” that is provoked by light touch activities. It has a highly significant impact on
quality of life and if poorly managed leads
to depression. In some rare cases, it is
caused by multiple sclerosis or tumours,
but its cause is unknown in the majority of
patients. Many patients will have compression of the nerve inside the skull. The pain
often presents in the mouth, leading patients to believe that the cause is dental and
to ask dentists to investigate.
Again, many patients will undergo unnecessary irreversible treatment until pa-

www.DTStudyClub.com

Y education everywhere
and anytime
Y live and interactive webinars
Y more than 500 archived courses
Y a focused discussion forum
Y free membership
Y no travel costs
Y no time away from the practice
Y interaction with colleagues and
experts across the globe
Y a growing database of
scientific articles and case reports
Y ADA CERP-recognized
credit administration

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ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providersof continuing dental education.
ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry.

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DTUK0115_30_itop 09.04.15 15:40 Seite 30

ADVERTORIAL

Dental Tribune United Kingdom Edition | 1/2015

iTOP: It is like using a harp instead of a
rock guitar
In prophylaxis, the individual approach is
as important as the training aspect. Curaprox’s prophylaxis training iTOP, therefore, considers “prevention” to be more than
just using fluoride toothpaste. When Rolf Kufus, a Zurich dentist, talks about prevention,
he emphasises the demands that prevention
makes on dentists and patients alike. He compares it to music.
“In most cases, prophylaxis means that the
guitarist in a heavy metal band suddenly has
to learn to play the harp. This is not something you learn overnight—and especially
not without a teacher,” Kufus said.

Just like a delicate ripple on the 47 strings of
a harp, iTOP teeth cleaning means saying
goodbye to the coarse scrubbing by a rock
guitarist with his few chords. Right through
from cleaning interdental spaces to the
proper use of the single tuft and the efficient
method with a soft, densely-bristled toothbrush based on the modified Bass method:
iTOP is a three-step tutorial for dental professionals, beginners and advanced learners
alike.
With a toothbrush, a single tuft brush, as
well as interdental brushes and dental floss in
hand, participants learn over several days

What teeth need is prevention comparable to the gentle sound of a harp say dentist Rolf Kufus and iTOP
instructor Catherine Schubert. (Photo courtesy of Curaprox)

how prophylaxis is more than just fluoridation and that it means efficient and atraumatic brushing, individual training and even
tailored coaching.
Prophylaxis can also be a pleasure as well as
it can motivate. Yes, my teeth are clean, my
gums are healthy!

Train and train once again
iTOP is individually trained oral prophylaxis, that rejects the thinly-spread “watering-can” principle in favour of individually
tailored prevention. Every mouth is different. If one form of prophylaxis is ideal, another leads to sustainable success. And because the individual approach often means
“scrub less” that is also the training aspect
that iTOP alumni such as Rolf Kufus emphasise in particular. How else are we to compete
against the force of habit, which so often
causes us to brush our teeth incorrectly from
childhood on—with too much pressure from
too hard a toothbrush and dental floss where
only an interdental brush is of use?
“Patients with tooth-cleaning damage
such as exposed tooth necks are unaware of
being ill but instead they feel they’re doing
everything right,” said Kufus. “And nobody
wants to intentionally destroy their mouth.
These are all simply wrongly trained habits.”
Catherine Schubert, dental hygiene specialist and iTOP instructor, knows how detrimental these habits can be.“All too often, I see
patients who are still suffering from bleeding
gums even after ten years of treatment because they were not educated and trained.
This bleeding could so easily be stopped,” she
remarked.

Implants–the failures of
prophylaxis
Rolf Kufus realigned the prophylaxis concept for Personalised Dentistry in his practice
after his first iTOP course.
“People are living into their 90s nowadays.
It’s better without exposed tooth necks.”
He recalls that a tooth goes through about
six stages in the course of its existence from
emerging to falling out.
“If we succeed in delaying each of these
stages by a few years, then, except for special
cases such as accidents or agenesis, an implant may no longer be necessary.”
In this new interpretation, an implant can
be ultimately seen as a failure of prophylaxis.
It is no longer like it used to be, when prophylaxis was primarily understood to mean
brushing three times a day using fluoride
toothpaste and the brunt of the dental work
was placed on tooth repair. Today, there is an
ever-increasing number of dentists who view
prevention as an essential part of the Hippocratic oath—namely the obligation to dental
health as a whole. This also changes the role of
dental hygienists who are shedding their role
as “abrasive cleaners” and are turning into
partners and fitness trainers for the oral
health of patients.
Ultimately, iTOP also changes the role of a
dental practice, moving away from repair towards prevention—without losing sight of
profit orientation.
More information are available at
www.kufus.ch
www.curaprox.com
www.itop-dental.com

How dental care can be fun
The three most common mistakes.

The three most easily achievable improvements.

Cleaning in the wrong place: the toothbrush is not close
enough to the gums, with the result that its bristles cannot reach the sulcus.

Using an interdental brush: iTOP graduates learn with
surprising speed just how efficiently the spaces between
the teeth can be cleaned.

Brushing with too hard a toothbrush: if the toothbrush
bristles are too hard, the patient automatically moves
the brush away from the gums and simultaneously
causes brushing damage.

Feeling rather than intellect: DH professionals mainly instruct patients using a model. In iTOP courses, they learn
on each other how atraumatic tooth cleaning actually
feels.

Brushing with too much pressure: together with cuts by
flossing (and resulting recession of the gums), one the
most frequently corrected errors.

Brushing perceived as pleasure: bleeding disappears in
an instant thanks to a change in brushing technique and
a soft brush. Dental care and its results create happiness.

[31] =>

DTUK0115_31_Hein 09.04.15 15:40 Seite 31

OFF-TIME

Dental Tribune United Kingdom Edition | 1/2015

“Bowie’s teeth were like everything
else about him: different”
An interview with German tooth artist Jessine Hein
David Bowie was undoubtedly a major figure in popular music in the 1970s and 1980s.
He is also one of the many celebrities who
have undergone cosmetic dental treatment
and had his characteristically crooked teeth
replaced with a set of crowns in the early
1990s. Inspired by Bowie’s unique original
look, Jessine Hein, a German painter and
sculptor, made a reproduction of the singer’s
natural teeth. Dental Tribune had the opportunity to speak with Hein about her denture
sculpture and her perception of beautiful
teeth.

ture: Tooth Nuckles. With the knowledge acquired during those projects, I gained an idea
of how I could actually construct this replica.

to underline this, as well as pay homage to the
eras of the crooked-toothed miracle who fell
to earth once upon a time.

In your opinion, what drove David Bowie, who
was celebrated as a nerd, to have his crooked
teeth made into a “perfect” Hollywood smile?
I find it noteworthy that a pioneer of individualism, the archetype of “acting out oneself”, decided to “normalise” his mouth. It
seemed paradoxical. However, the dental
change was parallel to a change in his image
and music. It accompanied his development
and I assume that was not pure accident, owing to the Hollywood set of teeth that was
chosen rather than recreating a natural look
when medical intervention was needed.
I cannot imagine that a person like David
Bowie willingly left the interior design of his
mouth to someone else, so I interpret the
pearly whites he got as a bold statement that
signalled a new chapter in his career—maybe
a comment on the beauty obsession of our
society: “You want regulated perfection?
Here you have it!”. The transformation was
part of his development from alien hero of
the heart to world star. My sculpture intends

Could you believe that Bowie was not satisfied
with his teeth and underwent cosmetic dental
treatment for that reason? Perhaps, his
crooked teeth were a source of suffering, as is
the case with many other people.

“...the idea for the sculpture evolved
while I was nostalgically longing backto
Bowie’s old teeth.”
I do understand how orthodontics can
improve one’s self-confidence, as I went
through years of tooth alignment myself in
my teens. There are four teeth missing in my
maxillae. Besides having had trouble chew-

Hein’s hand-sculpted recreation of David Bowie's
natural teeth.

Dental Tribune: Ms Hein, how did you come up
with the idea of recreating David Bowie’s
teeth?
Jessine Hein: Bowie’s teeth were like everything else about him: different! Not the aesthetic norm, not perfect, but they were strikingly beautiful in the context of his whimsical and miraculous being. His smile revealed
an imperfection that made him seem more
real, more human, someone to identify with
even.
An imperfection worn confidentially inspires sympathy. Bowie was a role model for
many people and I think his teeth contributed to that. The vast variety of talents,
iconic style and incomparable physique that
make up Bowie, and the different universes
he created around himself, have always impressed and inspired me. I have been incredibly fascinated with teeth for a long time and
have paid close attention to the ivories of
those I admire. Therefore, I was very conscious about the loss of the Ziggy Stardust
choppers.
Teeth are an integral part of interhuman
communication. They are inevitably involved in laughing, talking, screaming and of
course singing. Bowie sang to us through his
crooked gaps and it was enchanting! So the
idea for the sculpture evolved while I was nostalgically longing back to Bowie’s old teeth.
Have you done any other artistic projects related to dentistry that inspired you to create a
denture sculpture?
In the past, I have done small projects at a
dental laboratory, such as a tooth pendant for
my necklace, which I have worn ever since
and never taken off, as well as another sculp-

ing properly, I looked like a freakish vampire.
It was not very helpful to have an odd-looking
set of teeth in this awkward phase of adolescence. Back then, I did not appreciate the
beauty in the difference because I was too
concerned with trying desperately to survive
as a shy teenager at school.
Today, however, I celebrate teeth that are
not the norm. I love the diversity and charac-

ter they bring to the human head. I find it
quite sad that these days almost every child
undergoes some kind of dental treatment
to align his or her differences solely for aesthetic reasons. Some of them might grow up
wishing they still had their characteristic natural look.
I have heard Bowie talk about his old teeth
in a confident way. He stated they looked fine
to him. So, no, I do not think he felt uncomfortable about them at the time, quite the
© Jessine Hein

The artist herself wearing a tooth mask.

opposite; he was famous for celebrating his
striking body in all its otherworldliness.
What do you intend to do with the sculpture?
Have you been approached by collectors and
fans of the singer who would like to purchase
it?
The sculpture is currently with me and will
be until an opportunity for exhibiting comes
up. I have various kinds of sculpture and
painting projects in the making that will need
some more time to develop. Once they are
completed, I envision the David Bowie dentures being presented in the context of the
new pieces.
I have been contacted by several potential
buyers, but the sculpture is not currently for
sale, as I would like to have the option of putting it on display.
A photo from 2007 showing Bowie with his new smile. (Photo Everett Collection)

Thank you very much for this interview.

[32] =>

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[cover] => DT UK No. 1, 2015

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