DT UK No. 10, 2012

News / ‘Periodontal Disease and Overall Health: A Clinician’s Guide’ / Discussing dental nurses / The receptionist role in CQC compliance / In whose interests? / Lab Tribune / Cause for concern / Seeking release from the daily grind / Industry News / Editorial Board / Classified

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April 16-22, 2012

PUBLISHED IN LONDON
News in Brief
One ‘Smiley’ school!
With National Smile Month
only a matter of weeks away,
one school could barely contain
their smiles. St Marie’s Catholic Primary School and Nursery
are showing off their ‘Smileys’
on Friday 30 March as part of
the campaign, organised by the
British Dental Health Foundation. Taking place from 20 May
to 20 June 2012, it is the UK’s
largest and most successful
oral health campaign. With
the help of more organisations
raising the importance of oral
health, Chief Executive of the
Foundation, Dr Nigel Carter,
believes further advances can
be made. Dr Carter said: “Statistics show not enough children give consideration to their
oral health, and that’s where
National Smile Month comes
in.” Visit www.smilemonth.org
for information.
Survey finds mid-life crisis
Middle-aged women are most
likely to suffer from fear of the
dentist, a new study found.
Clinical observation of patients
taking part in a multi-year clinical trial conducted at the Dental Phobia Clinic in Westmead,
Sydney, has indicated that the
level of dental anxiety is highest among women in their forties. According to the researchers, this demographic was
also found to have perceived
a traumatic dental experience,
including orofacial trauma, in
the past and to be more prone
to stress or mental disorders
like depression. The results
are intended to help investigate the relationship between
dental anxiety and the perception of and coping with pain, as
well as to develop strategies for
managing the condition successfully.
Congenital heart disease risk
Several studies have shown
that poor dental hygiene behaviours in patients with congenital heart disease are increasing their risk of endocarditis.
For the first study participants
completed a questionnaire
that measured the use of alcohol, cigarettes and illicit drugs,
dental care and physical activity. The researchers calculated
risk scores for ‘substance use’
and ‘dental hygiene’. In adolescents with congenital heart disease, substance use increased
with age. The results reveal
that health risk behaviours are
prevalent in adolescents with
congenital heart disease and
they increase with age. The
findings were presented at the
12th Annual Spring Meeting on
Cardiovascular Nursing, 16-17
March, in Copenhagen. (www.
escardio.org/congresses/cardio-nursing-2012/Pages/welcome.aspx)
www.dental-tribune.co.uk

Lab Tribune

Practice Management

News

VOL. 6 NO. 10
Clinical

Direct
Direct.com
MyFaceMyBody

Awards celebrate the cosmetic
industry

page 4

Direct.com

The receptionist’s role

Glenys Bridges discusses team
work

Best of British

Richard Daniels promotes dental laboratories

page 9

The daily grind

Pav Khaira discusses bruxism

page 11

pages 26-27

Direct.com

End of the line for
tobacco displays
.com

New legislation came into effect
on 6 April to protect
Direct
children from being the target of tobacco promotion and to help
people quit smoking

rom April all large shops
and supermarkets in England had to cover up cigarettes and hide tobacco products
from public view.
Evidence shows that cigarette displays in shops can lure
young people to start smoking.
More than eight million people in
England still smoke – it is one of
biggest preventable killers causing more than 80,000 deaths each
year. Nearly two-thirds of current
and ex-smokers say they started
smoking before they were 18.
Up until now, every time parents do their weekly shop their
children are exposed to tobacco,
making it a normal part of everyday life. Statistics show:
• Five per cent of children aged
11-15 are regular smokers
• More than 300,000 children under 16 try smoking each year
• 39 per cent of smokers say that
they were smoking regularly before the age of 16
Covering tobacco displays will
protect children and young people from the promotion of tobacco
products in shops, helping them
to resist the temptation to start
smoking. It will also help and support adults who are trying to quit.

Direct.com

catching, cigarette displays. Most
adult smokers started smoking as
teenagers and we need to stop this
trend.

“Banning displays of cigarettes
and tobacco will help young people resist the pressure to start
smoking and help the thousands
of adults in England who are currently trying to quit.”

said: “National Children’s Bureau
welcomes the end of tobacco displays.
“Children and young people
tell us that outside influences
make it even more difficult for
them to choose healthier lifestyles. A yet to be released National Children’s Bureau health
survey has found that more than
one in four young people felt they
needed more information about
the health effects of drugs, alcohol or tobacco.

Direct.com

Jo Butcher, programme director of health and well-being at
the National Children’s Bureau,

Direct.com

“It’s essential that we create
a culture that promotes and protects public health and tobacco
legislation is a significant factor in
making this happen.”
Cigarettes and all tobacco
products will have to be out of
sight except when staff are serving customers or carrying out
other day-to-day tasks such as
restocking. Those responsible
in shops not complying with the
law could be fined up to £5,000 or
could face imprisonment. DT

Direct
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Health Minister Anne Milton
said: “We cannot ignore the fact
that young people are recruited
into smoking by colourful, eye-

Direct.com

[2] =>

2 News

United Kingdom Edition

April 16-22, 2012

Children call for smoke-free homes
A
new hard-hitting campaign, highlighting the
shocking truth behind
second-hand smoke recently hit
our TV screens.

The New TV and radio adverts will show that smoking by a window or the backdoor is not enough to protect
children
from
second-hand
smoke. More than 80 per cent
of second-hand smoke is invisible. This contains harmful
cancer-causing toxins and poisons that are unknowingly damaging children across the country every day.
Millions of children in the
UK are exposed to secondhand smoke that puts them at
increased risk of lung disease,
meningitis and cot death. It results in more than 300,000 GP

visits, 9,500 hospital visits in the
UK each year and costs the NHS
more than a staggering £23.6
million every year.

The only way to completely
protect people from secondhand smoke is to make homes
and cars entirely smoke free. As
the campaign launches, a new
survey reveals that children
want smoke free lives. The survey found:
• 98 per cent of children wish
their parents would stop smoking
• 82 per cent of children wish
their parents wouldn’t smoke in
front of them at home
• 78 per cent of the children
wished their parents wouldn’t
smoke in front of them in the car

• 41 per cent of children said cigarette smoke made them feel ill

shops. We will also be consulting
on plain packaging this spring.”

• 42 per cent of children said cigarette smoke made them cough

Chief Medical Officer Professor Dame Sally Davies said:
“Second-hand smoke can cause
a range of serious health problems for children and adults.
Smoking damages our lungs,
causes cancers and is now the
biggest risk for cot death. Parents
who smoke need to think about
the effect it has on their family.

Health
Secretary
Andrew
Lansley
said:
“We
all
know
smoking
kills but not enough people realise the serious effect that second-hand smoke can have on
the health of others, particularly
children.
“This campaign will raise
awareness of this danger and encourage people to take action to
protect others from second-hand
smoke.
“This is just one part of our
wider strategy on tobacco. We
need to do more. That is why we
will end tobacco displays in large

Consultant Paediatrician at
the Royal Surrey Hospital Dr
Charles Godden said: “I see
children every week with conditions which are made worse by
second-hand smoke. Most parents would be horrified to know
that even a short car journey
where an adult has been smoking would result in breakdown
products of nicotine in their
child’s urine.

“Giving up smoking or making sure you have a completely
smoke free home and car is the
only way to protect your family.

“This shows exactly why we
should all make our homes and
cars smoke free and that children
need protection from exposure to
second-hand smoke.”

“If people do want to quit
there is excellent support and advice available. Get in touch with
your local stop smoking service,
GP or pharmacist or visit nhs.uk/
smokefree.”

Smokers
can
order
a
new NHS Smokefree Kit by texting POISONS to 63818 or by visiting nhs.uk/smokefree for facts,
tips and tools to help them on the
way to a smoke free future. DT

Nominations open for Principal Executive Committee

he nominations process
for the new BDA Principal Executive Committee (PEC) has opened. The
new committee, which will
replace the current Representative Body and Executive
Board, will assume overall responsibility for BDA policy and
governance. PEC members
will also be the legally responsible directors of the Association.
The Committee will consist

of 15 members, 12 of whom will
represent geographical constituencies and three who will
be elected on a UK-wide basis.
All members will be elected in
spring 2012. Seats will then be
subject to a revolving cycle of
elections starting in December
2014, when a third will be subject to fresh elections.
Those interested in standing for election are invited to
submit a completed nomination form and personal sup-

porting statement by Friday
23 April 2012. Members will
have the opportunity to hear
from prospective candidates
at a series of ‘speed-dating’
style events at the British
Dental Conference and Exhibition which takes place in
Manchester between 26-28
April, and will receive ballot
papers, where required, at the
end of April.
Encouraging applications,
BDA Chief Executive Peter

Make an exhibition for
yourself in Manchester
the key appointments they need.

elegates at the forthcoming British Dental Conference and Exhibition
can plan their visit to the exhibition element of the event using an
innovative new online bookings
system that allows attendees to reserve time with exhibitors.
For the first time ever, visitors can book time with exhibitors
that they want to spend time with
in advance of the event, using a
simple online bookings system
hosted on a BDA-managed British
Dental Conference and Exhibition
microsite. The system also allows

delegates to plan the conference
sessions that they intend to attend,
thereby creating a personalised
schedule for the event that can be
downloaded to Outlook diaries.
The exhibition is expected to
feature more than 140 exhibitors,
including equipment suppliers,
product manufacturers, service
providers and trade associations.
The meeting reservation facility
has been introduced in response to
feedback from exhibitors and visitors and aims to help busy delegates
maximise the value of their visit
by allowing them to schedule all of

Linda Stranks, Director of
Marketing and Membership at the
BDA, said: “Some delegates are
happy to peruse the exhibition and
find inspiration as they explore,
but others visit the exhibition with
a very specific aim – researching
the purchase of a particular piece
of equipment, for instance.
“This new tool will help delegates to tailor their British Dental Conference and Exhibition
experience to create a bespoke
schedule that ensures they get the
time they want with exhibitors
when they want it, to fit around
the conference sessions they are
planning to attend.” The 2012
British Dental Conference and
Exhibition takes place at the
Manchester Central Convention
Complex from 26-28 April. For full
details visit: www.bda.org/conference. DT

Ward said: “The BDA occupies a unique position in UK
dentistry. Members of the new
Principal Executive Committee will be working in the interests of their professional
colleagues, taking on the governance and stewardship of
the Association and overseeing the next stage of its development. They will inherit
resources, reputation and research and will help shape the
future of the BDA and the dental profession.

“I encourage all members
who care passionately about
the future of the organisation
and UK dentistry to think seriously about standing for election to the PEC.”
Further information on
the Principal Executive Committee and the election timetable, is available at: http://
www.bda.org/pec
Nomination forms are also available
via the above link. DT

Action group
seeks DA evidence

group of dental hygienists have formed a campaign group in order to
influence the future of dental
access to patients.
Key DCPs are hoping to encourage fellow DH&Ts to help
influence the future of their
profession.
The Direct Access Action
Group is campaigning for direct access to patients for dental hygienists and plans to keep
colleagues in the loop as to
what this will mean for them,
the profession as well as for
patients.
The Office of Fair Trading (OFT) is currently re-examining whether the private
and NHS dentistry markets are
working well for patients Ð and
this includes an investigation
into how patients currently access dental care including ac-

cess to dental hygienists.
Elaine Tilling, Sarah Murray, Christina Chatfield, Margaret Ross, Bal Chana, Amanda
Gallie, Dave Bridges and Ann
Gilbert have together formed
the Direct Access Action Group
in time for the release of the
OFT’s report, due in May.
The group would like the
help of all DH/Ts in collating
evidence of their current perceptions of the Direct Access
issue.
To take part, visit www.facebook.com/DAActionGroup
or follow @DAActionGroup on
Twitter and take a few minutes to fill out a brief survey
hosted on Survey Monkey.
Go to www.surveymonkey.
com/s/HK8C56P or email the
group at directactiongroup1@
gmail.com. DT

[3] =>

United Kingdom Edition

Editorial comment

ig congratulations
to
those
who
found themselves
with a place in the
top 50 most influential people in
dentistry, as voted
for by members of
the profession.

running, a big achievement
and in recognition for the
Heart Your Smile campaign
which he founded last year;
aiming to bring positivity back
to the dental profession.
Congratulations also go to
Dean of the Peninsula Dental School and Dental Tribune
editorial board member Liz

News 3

April 16-22, 2012

Kay, number four in the list.
Other notable names familiar
to DT readers include Mhari
Coxon (5), Elaine Halley (11),
Nik Sisodia (23), Wyman Chan
(35), Julian Webber (38) and
Susie Sanderson (49).
Thoughts are now also
turning to the upcoming
events prominent in the dental

calendar: the Dental Awards
(April 20), BDA Conference
and Exhibition in Manchester (April 26-28) and the
Clinical Innovations Conference in London (May 18-19).
I will be attending
all three events – if
you see me come
over, say hi and
let me know your
thoughts on Dental
Tribune! DT

James Goolnik made the
top spot for the second year

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

New

Metformin may
lower risk for
oral cancer

lighter
tint

Duraphat

Dental Suspension Fluoride Varnish

Metaformin tablets

ccording to a new study,
Metformin Prevents the
Development of Oral
Squamous Cell Carcinomas
from Carcinogen-Induced Premalignant Lesions, published
in Cancer Prevention Research,
Metformin may protect against
oral cancer.
Metformin is the most
widely used treatment for patients with type 2 diabetes,
and according to the study authors, scientists have noticed
that “metformin reduces the
growth of HNSCC (Head and
neck squamous cell carcinoma) cells and diminishes their
mTORC1 activity by both AMPK-dependent and -independent mechanisms.”
According to a report, J Silvio Gutkind, PhD, chief of the
Oral and Pharyngeal Cancer
Branch of the National Institute of Dental and Craniofacial Research at the National
Institutes of Health, and colleagues induced premalignant
lesions in laboratory mice;
they then studied the effect of
metformin on progression of
these lesions to oral cancers.
The scientists found that
metformin reduced the size
and number of carcinogen-induced oral tumoral lesions in
mice and significantly reduced
the development of squamous
cell carcinomas by about 70
per cent to 90 per cent. DT

In surgery treatment for
caries prevention


Clinically proven caries efficacy1
– 33% reduction in dmfs
– 46% reduction in DMFT



Quick and easy application



Temporary light tint for
visual control

Applying fluoride varnish containing 22,600ppm F is a recommended intervention in
‘Delivering Better Oral Health – An evidence-based toolkit for prevention’2
Duraphat 50 mg/ml Dental Suspension. Active ingredients: 1ml of suspension contains 50mg Sodium Fluoride equivalent to 22.6mg of Fluoride (22,600ppm F)
Indications: Prevention of caries, desensitisation of hypersensitive teeth. Dosage and administration: Recommended dosage for single application: for milk teeth: up to
0.25ml (=5.65mg Fluoride), for mixed dentition: up to 0.40ml (=9.04 Fluoride), for permanent dentition: up to 0.75ml (=16.95 Fluoride). For caries prophylaxis the application is
usually repeated every 6 months but more frequent applications (every 3 months) may be made. For hypersensitivity, 2 or 3 applications should be made within a few days.
Contraindications: Hypersensitivity to colophony and/or any other constituents. Ulcerative gingivitis. Stomatits. Bronchial asthma. Special warnings and special
precautions for use: If the whole dentition is being treated the application should not be carried out on an empty stomach. On the day of application other high fluoride
preparations such a fluoride gel should be avoided. Fluoride supplements should be suspended for several days after applying Duraphat. Interactions with other medicines:
The presence of alcohol in the Duraphat formula should be considered. Undesirable effects: Oedematous swelling has been observed in subjects with tendency to allergic
reactions. The dental suspension layer can easily be removed from the mouth by brushing and rinsing. In rare cases, asthma attacks may occur in patients who have bronchial
asthma. Legal classification: POM. Product licence number: PL 00049/0042. Product licence holder: Colgate-Palmolive (U.K.) Ltd, Guildford Business Park,
Middleton Road, Guildford, Surrey GU2 8JZ. Price: £22.70 excl VAT (10ml tube) Date of revision of text: July 2008.
®

1 Marinho et al. (2002); Cochrane Database Syst. Rev. no3. 2 Delivering Better Oral Health - An evidence-based
toolkit for prevention, Second Edition, Department of Health, July 2009.

www.colgateprofessional.co.uk

[4] =>

4 News

United Kingdom Edition

April 16-22, 2012

MyFaceMyBody Awards
The MyFaceMyBody Awards has been
organised to celebrate and award those
who have made a difference in the cosmetic sphere

he aesthetic and dental
business is one of the
most forward-looking
industries in the world. It is
constantly pushing the boundaries of what is possible to
achieve and matches technological advances with human
endeavour to create stunning
solutions which change people’s lives for the better.
To recognise this the first
aesthetic and dental consumer

awards, The MyFaceMyBody
Awards, has been organised
to celebrate and award those
who have made a difference in
the cosmetic sphere. Celebrating in style, The MyFaceMyBody Awards will be delivered
in the form of a masquerade
ball and held at The Landmark
Hotel, London on the 3rd November 2012.
The prestigious awards,
which are sponsored by handi…MEDIA and will be televised, are the first awards
within the aesthetic and dental industry where consumers are involved in the voting process. Every treatment
and cutting-edge procedure
is aimed at helping consumers, so why not let them have
a say in the products and procedures which have changed
their lives? Let consumers tell

us which clinics they love…
For this reason the awards
aim to recognise and reward
brands for their product innovation and popularity. Clinics
will also be rewarded for providing exceptional experiences and outstanding customer
service.
What’s more, the awards
will be supporting Bridge2Aid,
a charity set up to help bring
dental pain relief to East Africa, an area where people
have no access to pain relief,
leaving millions in pain. The
charity helps to train local
health workers in basic extraction techniques. Focussing on sustainability, and
with the help of dentists and
nurses from the UK, they train
more than 48 health workers
each year with plans for expansion.

Aesthetic Awards list
• Best Injectable Anti-Ageing
Treatment
• Best Cosmeceutical Product
• Best Body Reshaping procedure including semi-invasive
as well as take home devises
• Best Skin Tightening Treatment ( take home or professional) includes Micro-needling, skincare, skin peels and
also Laser treatments
• Dental Awards

ing or smile transformations
-vitamin, meso and fillers)
Television Awards
• Best Documentary or Television Series
• Best Online Information Resource
• Best Beauty Ambassador

Best tooth whitening Product
• Best Dental Hygiene Product Floss, Electric, Mouthwash
• Most Innovative Treatment or
Service
• Clinic Awards

MyFaceMyBody is a television and online resource for
consumers
seeking
advice
on hundreds of beauty and
cosmetic treatments. It allows
people to access information,
learn about treatments, follow
the latest procedures and discuss them via our social media
channels.

Best Customer Experience
• Best Clinic
• Best Clinic Team
• Best Non-Surgical Makeover
(Facial Aesthetics, body reshap-

The MyFaceMyBody Awards
and the masquerade ball and
held at The Landmark Hotel,
London on the 3rd November
2012. DT

Dental plaque may trigger blood clots
This activates the platelets,
a blood particle involved in clotting.
The bacterium then use the
new blood clots to encase itself,
protecting it from the body’s immune system and antibiotics.

human proteins.

Platelet clumping can lead
to growths on the heart valves
(endocarditis), or inflammation
of blood vessels that can block
the blood supply to the heart or
brain.

Researchers from the Royal
College of Surgeons in Ireland
(RCSI) and the University of Bristol discovered that S. gordonii is
able to produce a molecule on its
surface that lets it mimic the human protein fibrinogen - a bloodclotting factor.

However, according to reports, scientists who presented
their work at the Society for General Microbiology’s Spring Conference in Dublin have suggested
that with further research new
drugs could be used to tackle infective heart disease.

Bacteria in the bloodstream can cause blood clots

esearch states that oral
bacteria that enter the
bloodstream can cause
life threatening endocarditis
and blood clots. According to research if Streptococcus gordonii,
which contributes to plaque that
forms on teeth, enters the bloodstream through bleeding gums, it
can cause chaos by acting as

Dr Helen Petersen who is presenting the work said that better
understanding of the relationship
between bacteria and platelets
could ultimately lead to new treatments for infective endocarditis.
She explained in a report how a
crucial step in the development of
infective endocarditis is the bacteria sticking to the heart valve,
which activates the platelets
to form a clot. This can be treated with surgery or by strong
antibiotics, however, because of
growing antibiotic resistance this
is becoming far more difficult to
achieve.
“About 30 per cent of people
with infective endocarditis die
and most will require surgery
for replacement of the infected
heart valve with a metal or animal
valve,” Dr Petersen explained.

“Our team has now identified
the critical components of the S.
gordonii molecule that mimics fibrinogen, so we are getting closer
to being able to design new compounds to inhibit it. This would
prevent the stimulation of unwanted blood clots,” said Dr Steve
Kerrigan from the RCSI in an online report.
The team are also looking more widely at other dental
plaque bacteria that may have
similar effects to S. gordonii: “We
are also trying to determine how
widespread this phenomenon is
by studying other bacteria related to S. gordonii. What our work
clearly shows is how important
it is to keep your mouth healthy
through regular brushing and
flossing, to keep these bacteria in
check,” stressed Dr Petersen. DT

Dental Protection in the Dock – it’s a sell-out

50 dentists and lawyers assembled at the Mermaid
Theatre Conference Centre
in Puddle Dock, to attend the first
ever Dento-legal Study Day organised by Dental Protection. The
delegates either had an interest in
working in this area of dentistry or
were already doing so and wanted to hear from the UK’s leading
provider of indemnity; 70 per cent
of UK dentists are already Dental
Protection members.
In addition to cases of clinical
negligence, the revelation that the
GDC has allocated 1200 hearing
days in multiple venues for 2012
confirmed that their interest was
well founded. Members of the fif-

ty-strong team of dento-legal advisers already supporting Dental
Protection were on hand to share
their experiences with delegates
on a one-to one basis.

scribed the law of negligence and
explained how a ‘breach of duty’ is
described and the process of analysing whether or not a breach has
caused any loss.

The Dento-legal Study Day included presentations from experienced dentists and lawyers including Raj Rattan, who discussed the
ethical dimension of dento-legal
cases and how professional conduct can complicate the management of complaints and claims.
Anne Green, a barrister from
Radcliffes Le Brasseur described
the crucial and central role of
the GDC’s Investigating Committee and Melanie Rowles, Head of
Claims Management for MPS, de-

Kevin Lewis, Director of Dental Protection said: “With the unprecedented case load currently
being experienced in all three
DPL offices, it is reassuring see
such a high level interest from
dental colleagues and other who
are interested in working in this
challenging area of dentistry.
Since its inception over a century
ago Dental Protection has always
taken pride in the quality of its
service to members. The same is
true today and events like help to

ensure that the same service will

be available in the future.” DT

Speakers Hilary Firestone and Melanie Rowles take questions from the audience

[5] =>

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[6] =>

6 News

United Kingdom Edition

April 16-22, 2012

New information to help improve patient outcomes

N

ew information that will
help put the NHS on the
side of patients and improve results for patients has recently been published.
As part of the Government’s
drive to improve results for patients, new detailed information
on 20 of the 30 NHS Outcomes
Framework indicators, which
measure the care patients receive, has been published by the
NHS Information Centre.
The figures provide a regional and local snapshot of
how the NHS is performing
against the Outcomes Frame-

work. Crucially, they illustrate
where there are variations
in
outcomes
–
highlighting the importance of the
Government’s approach of concentrating on results, not targets.
For example, liver disease
mortality rates have increased
nationally over the last decade,
but have decreased in the last few
years in London and the South
East, while rates were twice as
high in the North West compared
to the East of England in 2009.
The Government committed
to focus on outcomes not process
targets in 2010 and announced

last year that the NHS would be
held increasingly to account for
measurable results, including
whether a patient’s treatment
was successful, whether they
were looked after well by NHS
staff, and whether they recovered
quickly after treatment.
Health Secretary Andrew
Lansley said: “The information
published today is another step
towards shifting the health service towards the benefits for people who matter - patients.
“Crucially, we aren’t telling
doctors and nurses how to do
their job – the approached adopt-

ed by the previous Government.
We are now clear about what the
NHS should achieve, not telling
the NHS how to do its job. These
results will shine a light on results achieved and where performance needs to be improved.”
The publication of the figures
today means the NHS can be held
to account for all aspects of care
that patients receive, and is part
of a drive to make the health service more transparent. They provide a basis for driving improvements in the future through the
Secretary of State’s Mandate to
the NHS Commissioning Board,
expected in the next few months

and will allow the NHS to take action where patient outcomes are
not as good as they should be.
NHS Medical Director Bruce
Keogh said: “Patients rightly
expect the NHS to provide care
that is effective and safe. And
one of the things that makes
for a positive patient experience is when everything joins
up seamlessly as they move
from GP surgery to hospital
to community clinic or social
care provider. So through the
Outcomes Framework, and the
information released today, the
foundations are being laid to
achieve just that.” DT

MDDUS dental road show coming to town

D

entists can learn how
to stay out of trouble by
signing up for one of nine
dento-legal lectures being held
throughout the UK in May and
June this year.
UK-wide dental defence organisation MDDUS is co-hosting
a series of educational sessions
that will provide top tips on how
to avoid dento-legal pitfalls that
could lead to patient complaints,
claims of clinical negligence or
referral to the GDC.
MDDUS has teamed up with
dental
equipment
providers
Wright Cottrell to host the lectures
which kick off on Wednesday, May
23 in Newcastle with further dates
in Manchester, Leeds, Liverpool,
Inverness, Aberdeen, Glasgow
and Edinburgh, before concluding
in Dundee on Thursday, June 21.

The lecture will feature MDDUS Head of Dental Division and
adviser Aubrey Craig, who has
long experience helping MDDUS
members deal with professional
difficulties.
He says: “Being on the receiving end of a claim, complaint or
referral to the GDC is an expensive, time-consuming and stressful experience.
“Every year at MDDUS, we
assist members who find themselves in such situations and these
lectures will draw upon our considerable experience in this area
to provide delegates with practical
advice on how to avoid professional difficulties.”
Wright and W&H will also lead
a session unravelling the mysteries of the national decontamina-

tion guidelines. This will enlighten dentists to the realities of what
is expected and arm them with
the know-how to achieve a fully
compliant practice.
W&H Northern Territory Manager Claire Wilson will present the
sessions in England, with Scottish
Territory Manager Raymond Baxter hosting the Scottish ones.
In addition, the Scottish dates
will also feature George McDonagh, Clinical Adviser for the NHS
in Scotland, who will share his
unrivalled knowledge of decontamination procedures that he has
accrued from his 20 years’ experience in the industry.
Robert Donald, non-executive director of MDDUS and
well-known Scottish dentist and
magazine columnist, welcomed

the CPD-accredited evening roadshow initiative.
He says: “Staying out of trouble
with the GDC and decontamination compliance are hot topics for
all UK dentists. The collaboration
of MDDUS and Wrights in providing practical advice and support in
addressing these important issues
is a very positive step indeed and
I would encourage my colleagues
to attend.”
To book your place at one
of the lectures or for further information, contact Karen Walsh
at kwalsh@mddus.com. Tickets
costs £30 with a light buffet available from 6pm and the programming commencing at 6.30pm. DT
Dates and venues for lectures
(all dates 2012):
• Wednesday, May 23: St James’

Park, Newcastle
•Wednesday, May 30: Mandec,
Manchester Dental Hospital
• Thursday, May 31: Weetwood
Hall, Leeds
• Thursday, June 7: Liverpool
Crowne Plaza, Liverpool
• Tuesday, June 12: Drumossie
Hotel, Inverness
• Wednesday, June 13: The Marcliffe Hotel, Aberdeen
• Tuesday, June 19: MDDUS offices, Glasgow
• Wednesday, June 20: RCP of Edinburgh, Edinburgh
• Thursday, June 21: Wright Cottrell offices, Dundee

Wheelchair controlled by remote control in mouth

T

he Tongue Drive system,
which is a wireless device that enables people
with high-level spinal cord injuries to operate a computer and
maneuver an electrically powered wheelchair simply by moving their tongues, is getting less
conspicuous and more capable.
The newest prototype of the
system allows users to wear an
inconspicuous dental retainer
embedded with sensors to control
the system. The sensors track the
location of a tiny magnet attached
to the tongues of users. In earlier versions of the Tongue Drive
System, the sensors that track the
movement of the magnet on the
tongue were mounted on a headset worn by the user.
The new intraoral Tongue
Drive System was presented and
demonstrated on Feb. 20, 2012 at
the IEEE International Solid-State
Circuits Conference in San Fran-

cisco. Development of the system
is supported by the National Institutes of Health, National Science
Foundation, and Christopher and
Dana Reeve Foundation.
The new dental appliance
contains magnetic field sensors
mounted on its four corners that
detect movement of a tiny magnet
attached to the tongue. It also includes a rechargeable lithium-ion
battery and an induction coil to
charge the battery. The circuitry
fits in the space available on the
retainer, which sits against the
roof of the mouth and is covered
with an insulating, water-resistant
material and vacuum-molded inside standard dental acrylic.
When in use, the output signals from the sensors are wirelessly transmitted to an iPod or
iPhone. Software installed on the
iPod interprets the user’s tongue
commands by determining the
relative position of the magnet

with respect to the array of sensors
in real-time. This information is
used to control the movements of
a cursor on the computer screen
or to substitute for the joystick
function in a powered wheelchair.

additional commands to be programmed into the system. The
existing Tongue Drive System
that uses a headset interprets
commands from seven different
tongue movements.

Ghovanloo and his team have
also created a universal interface
for the intraoral Tongue Drive
System that attaches directly to
a standard electric wheelchair.
The interface boasts multiple
functions: it not only holds the
iPod, but also wirelessly receives
the sensor data and delivers it to
the iPod, connects the iPod to the
wheelchair, charges the iPod, and
includes a container where the
dental retainer can be placed at
night for charging.

The ability to train the system
with additional commands – as
many commands as an individual
can comfortably remember – and
having all commands available to
the user at the same time are significant advantages over the sipn-puff device that actsas a simple
switch controlled by sucking or
blowing through a straw.

In preliminary tests, the intraoral device exhibited an increased signal-to-noise ratio,
even when a smaller magnet
was placed on the tongue. That
improved sensitivity could allow

The researchers plan to begin testing the usability of the intraoral Tongue Drive System by
able-bodied individuals soon and
then move onto clinical trials to
test its usability by people with
high-level spinal cord injuries.
In recent months, Ghovanloo
and his team have recruited 11

individuals with high-level spinal
cord injuries to test the headset
version of the system at the Atlanta-based Shepherd Center and
the Rehabilitation Institute of Chicago. Trial participants received
a clinical tongue piercing and
tongue stud that contained a tiny
magnet embedded in the upper
ball. They repeated two test sessions per week during a six-week
period that assessed their ability
to use the Tongue Drive System to
operate a computer and navigate
an electric wheelchair through an
obstacle course.
“During the trials, users have
been able to learn to use the system, move the computer cursor
quicker and with more accuracy,
and maneuver through the obstacle course faster and with fewer
collisions,” said Ghovanloo. “We
expect even better results in the
future when trial participants begin to use the intraoral Tongue
Drive System on a daily basis.” DT

[7] =>

United Kingdom Edition

News 7

April 16-22, 2012

‘Periodontal Disease and Overall Health: A Clinician’s Guide’
systemic conditions.
The overall goal of this textbook is to present the emerging
and compelling evidence that

T

he UK launch of ‘Periodontal Disease and Overall Health: A Clinician’s
Guide’ a textbook, supported
by an educational grant from
Colgate, took place at Chandos
House, London. A host of attendees representing a wide range
of educators, periodontists and
those with a shared interest in
medicine came together to hear
about the most contemporary
thinking behind what the dental
and medical literature suggest is
an association between oral and
systemic diseases.
Dr Anousheh Alavi, Scientific
Affairs Manager, Colgate UK &
Ireland, opened the proceedings
introducing Dr Fotinos Panagakos, Colgate Director of Clinical
Research. Dr Panagakos, who
is based in the US, shared insight into the 18 chapters, which
delve into the sciences behind
diabetes mellitus, atherosclerosis, adverse pregnancy events,
respiratory diseases, osteoporosis, rheumatoid arthritis and
cancer, looking at risk factors
in common with periodontal
disease such as inflammatory
processes. The book then logically follows with a discussion
of the steps needed for comprehensive co-management of the
diseases by both dental and
medical caregivers.
The editors, Drs Robert J
Genco and Ray C Williams, assembled this textbook working
with a number of internationally
renowned authors. In their overview they set out clear goals for
this text book stating “Much research is focused on understanding how periodontal disease
increases the risk for systemic
diseases. It is not yet clear what
impact the biofilm in the oral
cavity might have on distant sites
and organs; likewise the role of
the inflammatory response is not
fully understood. Some of the
chapters in this textbook review
the biological plausibility for
periodontal disease as a risk for

periodontal disease is a risk for
several systemic conditions and
to look at the role of oral health
in contributing to overall health.
This book also seeks to provide

the reader with a guide to patient
management in which dentistry
and medicine work together.”
This textbook will be provid-

ed in hard copy to UK and Irish
dental libraries, and available to
all dental professionals to download as a PDF from www.colgateprofessional.co.uk DT

[8] =>

8 Interview

United Kingdom Edition

April 16-22, 2012

Discussing dental nurses

In the third part of this four-part interview, Neel Kothari talks to Susie Sanderson
about dental nurses
I think has been really good
for the profession, because it’s
challenged the dentists’ perception of paternalism.
So to sum up I suspect it
probably is value for money,
in terms of the empowerment of the profession of dental nurses – although it may
not be appreciated as such.
And just saying my last sentence highlights something
new: profession of dental
nurses? So it has established
professional behaviour and it
has established a voice and a
role politically, representationally and also parochially
as well.

Are nurses getting the best deal when it comes to cost?

K: I wanted to ask
about dental nurses.
Nurses are amongst
the lowest paid of the dental
team and they’ve suffered a
huge rise in costs – registration fees, compliance with
CPD and other rules and regulations. Have they seen good
value for money and are these
costs fair?
SS: This is one of those circular issues. We know from
our research that a significant
proportion of practices pay
their dental nurses’ regulation costs, and by that I mean
not just the GDC fees but also
the CPD fees. Now that’s
fine, but of course it just gets
recycled into the expenses
of the practice so the wages
bill looks bigger or the education bill looks bigger, profits are smaller and so their
wages are then suppressed for
longer. So it is a circular problem – without a doubt it is
a cost.
Pay freeze
The Department of Health
has been told by the Treasury and by the Secretary of
State that there’s a pay freeze
on public sector workers so
dentistry gets an amount of
money which the Department
of Health think that they can
contribute to the expenses of
running dental practices, plus
an efficiency saving, which
at the moment is currently
expressed by improving prevention through fluoride var-

nishing. So in real terms, in
order to achieve the efficiency saving, dentists are doing
more for the same money,
and their expenses are not
being fully met. In effect, a
pay cut.

nificant part of the whole
dental team.
Fifteen years ago, dentistry
was a very paternalistic profession: the dentist decided
what they were going to do,
issued instructions, people
ran round them, made them
coffee, put their metaphorical slippers on for them and
kept quiet in the surgery. I

around for longer), they actually quite like the requirement
to do CPD and they find it empowering.

‘And actually when you talk to dental
nurses (perhaps not the youngsters,
but certainly nurses who have been around
for longer), they actually quite like the
requirement to do CPD and they
find it empowering’

So while I suspect there’s
probably a compromise in
my own mind – and again it’s
not BDA policy, because BDA
policy is that the whole team
should be regulated as it stands
at the moment – but perhaps
there should be a mandatory
regulation for anyone who has
an extended duty qualification
and does anything to and with
patients directly, rather than
just standing and being under
instruction all the time, and
perhaps there should be a voluntary regulation for dental
nurses as well.

think we can take some credit
in the BDA for developing the
team role through BDA Good
Practice, which I think was
probably, along with Denplan,
one of the first programmes
which suggested that dental
nurses had a role in the success, the sustainability, the
morale, the improvement in
patient care in a practice and
had a significant part to play.
Now the minute that happened, the whole dental team
became worth something; it
had a value, self-worth, selfesteem, responsibility and the
enjoyment of that responsibility. And actually when you
talk to dental nurses (perhaps
not the youngsters, but certainly nurses who have been

Empowering
One
of
the
knock-ons
is that, when you look at the
GDC now, the majority of the
registrants with the GDC are
dental nurses. So that has
been hugely empowering, not
just on a practice basis, but
politically as well. You will
not find many central committees, either advisory committees or committees that
are influencing changes in
dentistry, regulation, all sorts
of other things, that don’t have
the full spread of DCPs on
it. So being regulated and being part of the GDC has immediately led to full representation of the dental team,
and it’s not just token representation, but this is really active representation. Now, that

Step too far?
So you’re absolutely right, it’s
potentially a real expense to
the dental nurses ultimate-

ly; however you badge it, it
could end up with them. So I
think that’s rather sad and in
my personal view - and it’s
not BDA policy at the moment
- I think it was a step too far
to require GDC regulation of
all dental nurses. That doesn’t
apply to the extended duty
dental nurses – the dental
nurses who have additional
qualifications so that they
can be more involved directly
in patient care. I think the
regulation in that situation is
justified – not only justified
from a patient safety point
of view, but I think justified
loosely from a career progression point of view as well and
for the ability to demonstrate
responsibility and be a sig-

NK: It seems that if you’re a
full time nurse, that’s great,
but it seems that there are
large numbers of people who
are concerned about the cost.
For instance, I can pick out
three nurses from my own experience who have come back
from maternity and have said,
can I afford to go back into the
profession?
SS: Yes, and it isn’t just dental nurses either who struggle with it. Part time dentists
still have to pay the full annual registration fee. They
also pay a significant proportion of the full BDA membership at the moment. When we
first starting having on call
rotas, and it was a 1990 contract that brought out of hours
responsibilities in, huge rows
erupted about ‘well I only do
one day a week, why should I
do the same amount of on call
cover on the rota as my friend
who works seven days a week
and works all night?’ It was a
similar problem. DT
• In the final part, Susie
Sanderson answers questions
on the amalgam issue and
her thoughts on the future of
dentistry.

About the author
Neel
Kothari
qualified as a dentist from Bristol
University Dental
School in 2005, and
currently
works
in Sawston, Cambridge as a principal dentist at High
Street Dental Practice. He has completed a year-long
postgraduate certificate in implantology and is currently undertaking the
Diploma in Implantology at UCL’s
Eastman Dental Institute.

[9] =>

United Kingdom Edition

April 16-22, 2012

The receptionist role
in CQC compliance
Glenys Bridges highlights the need for team work

IMAGING SYSTEMS | TREATMENT CENTRES |
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Service with a smile is a significant first step toward creating a welcoming environment

he Health and Social
Care (HSC) Act continues to dominate the
news during 2012. The regulatory basis of health care services in the UK have been under the microscope for some
time now with the Health and
Social Care Act of 2008 (Regulated Activities) Regulations
2010 creating a new range of
requirements for dental care
providers alongside those for
our colleagues in other health
care sectors.
Whilst there is nothing new
about
dental
professionals
working to a range of guidelines and standards that aim to
ensure high standards of quality and safety in patient care, the
way that the regulations introduced in 2011 seek to involve
each member of the dental
team is. As such each and every member of the dental team
needs to know and understand
the practices’ quality standards and Statement of Purpose.
They must also be trained and
supported to play their role in
delivering suitable quality care
services to patients.
The regulatory basis for
dental care is set out in the HSC
Act. The standards for each
constituent Country of the UK
have been stipulated by an appointed local regulatory body.
NHS and independent practices
in England will be governed by
the Care Quality Commission
(CQC), in Scotland this will
be the role of Healthcare Improvement Scotland (HIS), in
Wales the CQC will work in collaboration with the Healthcare
Inspectorate Wales and in
Northern Ireland the standards
have been set by the Regulation
and Quality Improvement Authority (RQIA).

Irrespective of where your
practice is located, the new
culture of healthcare is one
of the whole team working to
meet required care standards.
Inspectors will visit practices
to ensure that each member
of the team, irrespective of
whether or not they are a GDC

High quality and customer
care sits at the core of care quality standards. Service with a smile
is a significant first step toward
creating a welcoming environment. However, a smile alone is
not enough to create a perception of competence. Intelligent
reception services are developed

‘Inspectors will visit practices to ensure
that each member of the team, irrespective
of whether or not they are a GDC registrant have the training and resources
required to provide safe, high quality
dental care and services’
registrant have the training and
resources required to provide
safe, high quality dental care
and services.
When it comes to defining
the receptionists’ role to ensure
compliance with healthcare
regulations, there are several essential requirements. For each
of these the Provider and Registered Manager must develop
policies and procedures. To
name but a few, these include
procedures for: blending NHS
and private services, communicating about and collecting patient’s fees, data security, equality and diversity, patient safety,
consent, confidentiality, child
protection, risk assessment, the
Mental Capacity Act, Information Governance requirements
and many more. Irrespective
of whether it is delivered inhouse or by external trainers,
training and preparation for
each of these complex aspects
needs to be delivered to ensure
practice policy and procedures
shape the services delivered
to patients, rather than simply
filling-up a folder on a shelf in
an office.

with in-depth understanding of
patients’ needs for information
about all aspects of their treatment. Care quality standards
specify the need to collect information so that patient satisfaction
levels can be monitored. Then to
go on to use the information gathered, to evolve systems and procedures to meet the needs identified by patients, the practice team
and regulatory bodies.
Historically, the training and
development needs for reception staff have been side-lined.
In the current regulatory climate
it would be naive of practices to
overlook the need for their reception teams to be fully involved
in developing care standards.
Even although they are not GDC
registrants in their own right,
unless receptionists are fully involved in setting and meeting
the practice’s standards of quality
and care, the hard work of clinical teams will fail to reach their
full potential. DT

Digital imaging can be so simple: Ergonomically and
anatomically perfect placement of the sensor, imaging
with lowest dose, images with excellent image quality
available within seconds, intuitive diagnostics and
comfortable post-processing of the data in the practice
workflow. USB or Ethernet operation – the choice is
yours. Sirona offers the right solution for each use case:
The XIOSPLUS intraoral sensor system – as flexible and
individual as your dental practice.
Enjoy every day. With Sirona.
Sirona Dental Systems, Lakeside House,
1 Furzeground Way, Stockley Park,
Heathrow, London UB11 1BD
Telephone: 0845 0715040
e-mail: info@sironadental.co.uk
www.sironadental.co.uk

About the author
Glenys Bridges is an independent
dental team trainer. She can be contacted at glenys.bridges@gmail.com

The Dental Company

[10] =>

10 Money Matters

United Kingdom Edition

April 16-22, 2012

In whose interests?
Andy Acton warns about an offer that’s too good to be true
available to purchase it right
away. Furthermore, it wouldn’t
cost me a penny to sell my
house because the buyer was
going to pay this stranger.
Surely this is all too good to be
true?

A ‘direct approach’ is never the way to get best value for your business

ne fine, sunny afternoon, there I was relaxing on the sofa at
home when a complete stranger knocked on my door and
told me he had someone who
would love to buy my house

for £35,000 and assured me
this was an excellent price. He
then proceeded to tell me that
in the current market there is
almost no one out there with
any money and the buyer he
has, by chance, has the money

rankly

Of course this story isn’t
true because my Mum always
told me to never answer the
door to strangers! You may be
surprised to learn however,
that many, many principals
have sold dental practices on
this basis. It might be a cold
call from another dentist,
corporate player or a dental
broker but whatever way the
initial contact is made, it is a
recipe for disaster.
Whilst it is very flattering
to get a direct approach, this is

peaking

DO engage the services of an independent firm to liaise with the Banks
on your behalf – will ensure proposal is packaged for best chance of a
positive response and also to negotiate best terms.
DO ensure you provide an accurate summary of your current position
including all savings and existing borrowing.
DO ensure your CV is up to date with particular focus on any past
Managerial experience.
DO expect the Bank to want you to put down a contribution towards
the purchase.
DO undertake your own research of the local area and find out why the
current owner is selling.

1542COR FTA 140x100mm AD1.indd 1

A knock on the door could
well spark your interest, but
from here on in you need to be
looking after your own interest
and not be guided by someone
who may purport to be looking
after you, but is actually being
paid by another party. In this
scenario – who are they are really looking after? In business,
the person paying the bill will
get looked after first. Anyone
who claims to be acting for the
seller of a practice yet is being
paid by the buyer, has a clear
conflict of interest – and in my
opinion there is no doubt on
this. If you sign an Authority

‘A knock on the
door could well
spark your interest,
but from here on in
you need to be looking after your own
interest and not be
guided by someone
who may purport
to be looking after
you, but is actually
being paid by another party’

Raising Finance?

Tel: 08456 123 434
01707 653 260
www.ft-associates.com

never the way to get best value
for your business. How do you
know the ‘real market value’
other than what you have been
told? How many other good
quality buyers are really out
there? How much is the person
who made the approach being
paid by the buyer? Who else
could fund the purchase?

with a client to sell their practice you have a duty of care to
achieve the best deal you can
for that client and act with integrity.
You may be aware of the
mantra in online marketing
that “if you’re not paying for
an online service, you’re not
the customer; you’re the product.” This has recently been
in the news with the way that
Facebook and Google use your
data. The quote applies equally well to the sale of a dental
practice – if you aren’t paying
them then you can be sure that
someone else is!
The true market for the sale
of practices is far from the stories being spread by the ‘direct
approachers’. Last year FTA
Finance, the leading arranger
of finance for dentists in the
UK, arranged £109 million

05/01/2011 13:36

worth of finance for dentists –
this blows away the myth that
there is no one out there with
any money. Last year a practice
in Essex had 12 offers of which
some were above the asking
price – and no one is buying
dental practices? This particular practice was initially marketed to 975 dentists who were
actively looking for a practice
that matched the profile of this
one.
I would also strongly advise
that you pay for selling your
practice too. In this way there
is no doubt you are the client,
you are receiving the service
and if you work with a reputable firm you should also end up
with more in your pocket. If we
go back to my house which I
was offered £35,000 for, if I had
checked the true value I would
have found out it was worth
£65,000. A good agent would
also have found me a buyer at
that price, but charged me a
fee – say 2.5 per cent. End result is I get £63,375.
The only real loser from
selling as a result of a direct
approach is the seller. The
buyer pays you £35,000 - if
there is an agent of any sort
involved they may get between
£5,000 and £25,000 so the true
cost to buyer is £40,000 to
£60,000 (which is still below
the market value). The buyer
and agent are delighted and
you are left feeling hard done
by and slightly embarrassed;
but only if you know about it.
Whilst this may read like a
piece of fiction, in my experience so many dentists do sell
for tens of thousands of pounds
less than they could have.
A direct approach can sound
very convincing and to seek a
second opinion may well cost
you nothing – so why wouldn’t
you? You have worked hard
all your life to build value into
your business - you owe it to
yourself to sell it for what it is
worth. DT

About the author
Andy Acton is a director and coowner of Frank Taylor and Associates
– the leading independent valuers and
sales agent to the dental profession.
Its sister company, Loan Hunter, provides financial solutions to the dental
industry. Andy is a regular contributor
to the dental media and has also delivered many lectures across the UK.
Tel. 08456 123434
Email: andy.acton@ft-associates.com
Frank Taylor and Associates @franktaylorassc

[11] =>

Lab Tribune
Endo Tribune

Endo Tribune

Tripping over tripple trays

Ultra suction denture

David Hands and Neil Photay shed some light

Mony Paz and Ted Carson discuss suction
dentures

Endo Tribune

The material of multiple options
Lee Culp and Prof Edward Mclaren discuss Lithium disilicate

pages 14-17

pages 12-13

pages 18-22

Best of British
Dental Tribune speaks with DLA Chief Executive Richard Daniels about the
organisations latest campaign to promote British
dental laboratories

F

ollowing the launch of
the British Bite Mark
last month, the Dental
Laboratories Association have
had an incredible response
from UK dental laboratories
wanting to be part of the DLA’s
first ever campaign direct to
the public. To date there are
now 277 dental laboratories
that have signed the declaration of compliance to the British Bite Mark with several
hundred still waiting.
Speaking to Dental Tribune
Richard Daniels, Chief Executive of the Dental Laboratories Association made it clear
why he felt the campaign was
necessary and what he hoped
the outcome of the campaign
would be.
Outsourcing
“The launch of the British Bite
Mark was deliberately made in
March on the back of the announcements from some dental bodies corporate that they
were looking to review their
procurement processes in
2012. Whilst on the face of the
procurement changes there
was nothing to suggest a desire
to move towards outsourcing
work to dental laboratories
in the Far East, it was clear
from the pricing structures
that the DLA should be concerned that this is the ultimately where the path could
lead. Equally the subsequent
enthusiasm by some dental practices to use dental
lab outsourcing agents over
their usual dental laboratory, provided greater reasoning to start a campaign
that provides transparency to
the patient.”

It seemed appropriate to
ask Richard why he felt there
was a need for a campaign of
transparency that effectively
could by-pass the dentist in
terms of offering patient information.
“The British Bite Mark
campaign is like any other
‘Made in Britain campaign’,
its aim is to provide the patient with an informed choice
about their purchase, far from
by-passing the dental practice, the campaign is going to
actively embrace those dental practices that use registered British Bite Mark dental
laboratories, over the coming
months we will have information packs that dental practices can use free of charge
to promote the fact that they
use a British Bite Mark dental

Laboratories
Association
led by Richard Daniels
has proactively lobbied against custom
made dental appliances manufactured
outside of the UK, even though
there has never
been
a
case
identified
in
the UK against
an
appliance
manufactured
overseas, Dental
Tribune
asked
Richard if he felt
that there really
was sufficient danger to the patient that justified
the British Bite Mark as an essential tool for patients when
making decisions with their
dentists over their prescription. Richard replied: “This
campaign isn’t necessarily

‘In my opinion, dental laboratories
that carry the British Bite Mark should be
proud, dental practices that use British
Bite Mark dental laboratory’s should be
proud and we want to help them promote
the fact to their patients, frankly if the
DLA don’t promote British dental technology, who is?”’
laboratory to their patients,
they will also have the opportunity to be featured on a
website that is to be launched
later in the year called www.
britishsmiles.org which we
hope to be a major on-line facility for patients seeking information on all issues relating to dentistry.”
Since

2004,

the

Dental

about danger to the patient;
since 2004 when we worked
with our brother organisation in the US exposing lead
in crowns from China, substantial quality monitoring
has been encouraged in China
and the rest of the Far East,
however, encouraging quality management systems in a
dental laboratory is commendable, but it isn’t law and at the

moment only dental laboratories operating in the UK and
the EU have the possibility of
a competent authority visiting the manufacturing dental
laboratory to ensure appropriately trained professionals are
operating in the lab and that
CE marked materials are being used.
‘‘The truth of the matter is
that there are good and bad
labs everywhere in every country, the comforting thought for
patients here in the UK is that
there is a significantly higher
chance of them getting found
out here in the UK than anywhere else in the world and
the easiest way of getting
this message across is with an
easily identifiable logo, that
instantly offers patients peace
of mind.”
When discussing the British Bite Mark campaign and
it objectives, it is clear that
Richard thinks the DLA have
got it right, both for the patient
and for the DLA membership.
Dental Tribune asked Richard
if he had received any resist-

ance from the membership
following the launch of the
British Bite Mark, he said: “in
all honesty, I have received
three complaints, understandably all from members who
have a commercial interest in dental laboratory outsourcing, but as I have said to
them and anyone other party
that has enquired, my mission is not to say that British
dental laboratories are best
or that dental practices that
use overseas dental laboratories are bad but merely to
manage a campaign states
the facts, facts that the patient and for that matter many
dentists should be aware of
when choosing a manufacturer of custom made dental
appliances. In my opinion,
dental laboratories that carry
the British Bite Mark should
be proud, dental practices that
use British Bite Mark dental
laboratory’s should be proud
and we want to help them promote the fact to their patients,
frankly if the DLA don’t promote British dental technology, who is?” DT

[12] =>

12 Lab Tribune

United Kingdom Edition

April 16-22, 2012

Tripping over triple trays
David Hands and Neil Photay shed some light on the pitfalls of using triple trays
and how they could end up costing more than they are worth

T

he use of triple trays
are becoming more
common in the surgery to take an impression
of prepared teeth (as well as

opposing teeth) for the dental
laboratory to prepare a fixed
prosthesis such as a crown or
bridge. With a thin, pliable
mesh separating the impres-

sion material, the trays are
used to simultaneously register the upper and lower bite.
They tend to be seen by dentists as a cost-effective solu-

tion for taking impressions,
but your dental technician
may take a different view.
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Triple trays’ main downfall
is that an impression of only
four or five teeth is able to be
taken. This makes it almost
impossible for the technician
to get a clear idea of the arrangement of the patient’s
teeth, making it extremely difficult to create suitable restorations for them. Imagine being asked to cook a stranger
their perfect meal, without

‘There are so many
different techniques
and products that
a dentist can use to
ensure they are
taking impressions
as accurately as
possible, but in my
opinion using a
triple tray is not
one of them’

being told which ingredients
they don’t like! Essentially
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this is the challenge dental
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the highest quality and perfect fit, laboratories need to
accurately register the patient’s bite. There is a very
fine line between a perfectly
fitting crown and one that
causes the patient irritation
– the difference can be a matter of millimetres. There are
so many different techniques
and products that a dentist
can use to ensure they are
taking impressions as accurately as possible, but in my
opinion using a triple tray is
not one of them.

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Along with the correct
bite, technicians must also
be able to assess the size and
shape of the preparation margin and also of any adjacent
teeth. The only way to do
this effectively is to use stock
trays which enable the dentist
to take an impression of the
full upper and lower arches.
This really helps technicians
to visualise for themselves
how the patient’s bite, teeth
and margin are formed.

Illustrations & images courtesy of Amman Girrbach ©

Triple trays can also be

[13] =>

United Kingdom Edition

awkward to use. I frequently
have to ask dentists to retake
their impressions after receiving a model which shows that
the patient has bitten through
the tray into the mesh. Avoiding this can be tricky and a lot
depends on how much material needs to be used and how
deep the outside of the tray
is. Having said that, with the

‘With the right technique triple trays
can be successfully
used for small inlays but I would
avoid using them
for anything more
complex, such as
bridgework’

It can be very easy to become accustomed to using
the system that you have done
for years and it is understandable why at first clinicians might be loath to switch
their impression tray. Nevertheless, I do believe that by
using full arch stock trays,
practitioners
will
benefit
from more accurate restorations, a smoother service and
an easier relationship with
their laboratory. Likewise, the
patient will receive an excel-

April 16-22, 2012

Lab Tribune 13
lent restoration quickly and
hopefully without having to
return to the practice for a repeat impression. DT

About the author

By taking full arc impressions, dentists won’t have to extend patient chair time

David Hands and Neil Photay are
Elite Managers of CosTech Elite dental laboratory. For more information
on CosTech Elite Dental Laboratory
or for a free Elite pack call 01474 320
076 or visit www.costech.co.uk

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right technique triple trays
can be successfully used
for small inlays but I would
avoid using them for anything more complex, such as
bridgework.
Another word of warning:
triple trays may at first appear to be the cost effective
method of taking impressions
but my experience tells me
otherwise. With their lack of
consistency and inability to
take an impression of full
upper and lower arches, impressions frequently have
to be retaken. This involves
rescheduling
appointments
at great inconvenience to
both the patient and the dentist, costing time and, ultimately, money.
Dental Technology schools
heed a warning regarding triples trays as a source of inaccuracy and therefore a higher
rate of device failure. Some
even go as far as refusing to
work on triple tray impressions at all.
Most laboratories will refuse to fabricate any bridge
work on triple tray impressions, and rightly so, as the
functionality of the bridge
cannot be created or checked.
If working only on the quadrant, the excursions of the
full arch cannot be replicated
which is essential information
for the technician to have. Inevitably dentists may have to
grind bridgework chair-side
and create any guide planes
by sight and feedback from
the patient. Surely the cost of
extended chair time is more
than the cost of taking full
arch impressions.

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[14] =>

14 Lab Tribune

United Kingdom Edition

April 16-22, 2012

Ultra Suction Denture Stabilisation System
Mony Paz and Ted J Carson discuss suction dentures

Fig A

Fig B

Fig C

Fig D
ing forces (Fig B).

Fig E

Fig F

Fig G

Fig J
a retention chamber (Fig A).
As he wearer bites firmly, the air trapped between
the mucosa and the denture is expelled through the
valves. Under negative at-

The documented dental
literature teaches us that the
supporting soft tissue under
a well crafted maxillary complete denture is subjected to
-80mmHg of negative atmospheric pressure. This is the
suction level experienced by
upper denture wearers. Ultra
Suction valves have been developed to generate the same
negative force when applied
to the mandibular dentures or
palatless maxillary dentures.

‘Ultra Suction works on a simple mechanical principle: Suction’

Fig H
Fig I

U

ltra Suction system increases the retention
of mandibular complete dentures. There retentive capacity in comparison
to conventional dentures has
been positively demonstrated
via retention tests and clinical
observation.

A clinical study published
in the EDA Journal (Jan. 2010
Vol. 56) shows a significant
improvement in denture retention after the application
of the Ultra Suction system.
The aim of this article is to
familiarise the clinician with
the materials and methods
through a comprehensive in-

stallation process.

Fig 1

Fig 2

Fig 3

Fig 6

Fig 7

Fig 8

Ultra Suction works on a
simple mechanical principle:
Suction. Two tiny one-way
valves, embedded into the lingual or palatal aspect of the
denture bas, draw air from
beneath the denture via two
channels, collectively open to

mospheric pressure, the diaphragms seal off the valve
inlets. The pressure difference
ie, the lower pressure beneath
the denture exerts a pull and
draws the denture closer to the
borders. The result is a better
fit to the tissue and an improved resistance to dislodg-

The system is commercialised as a full kit with illustrated mounting instructions. The
components many be used
for upper or lower dentures,
on completely new dentures
or fitted on existing dentures
during the rebase/reline pro-

Fig 4

Fig 4

Fig 10
Fig 9

Fig 11

Fig 12

Fig 13

Fig 14

Fig 15

[15] =>

United Kingdom Edition

Lab Tribune 15

April 16-22, 2012

Fig 16

Fig 17

Fig 18

Fig 19

Fig 20

Fig 21

Fig 22

Fig 23

Fig 24

Fig 25
à DT page 16

cedure (Fig C).
System Components
The spacer bar is used to create a retention chamber. Made
of malleable metal, the bar
is designed to sit intimately
against the ridge. It can be
easily bent, burnished and
adapted to almost any alveolar
ridge. (Fig D).

18th and 19th May 2012

Millennium Gloucester Hotel & Conference
Centre, London Kensington

Valves
Two one way valves designed
to expel the air from beneath
the dentures. The central hole
in the valve body is described
as the inlet, and the valve cover as the exhaust (Fig F).

info@smile-on.com | www.clinicalinnovations.co.uk | 020 7400 8989

Switch
on to new
ideas

Processing Caps
As their name suggests the
caps are fitted onto the valve
bodies before the instillation
procedure. Their role is to

‘Two tiny one-way
valves, embedded
into the lingual or
palatal aspect of
the denture bas,
draw air from
beneath the denture
via two channels,
collectively open
to a retention
chamber’

Speakers:
Prof Nasser Barghi
Dr Richard Kahan
Prof Gianluca Gambarini
Dr Wyman Chan
Dr John Moore
Dr Ajay Kakar
Ms Jackie Coventry

protect the valves. They are
removed only after the polishing stage (Figs G and H).
Diaphragms
Two diaphragms and two
spares come with the kit.
These tiny plastic discs seal
the inlet under negative atmospheric
pressure
and
release the pressure under
resting conditions, at the rate
of 10mmHg per 15 seconds
(Fig I).
The service key has two
extremities. The upper part is
used to grip, close & open both
the valve covers and the processing caps. The lower part
is a slightly larger replica of
the valve and may be used as a
gauge for depth and diameter
(Fig J).

Dr Mona Kakar
Basil Mizrahi

EA
RL
Y

Fraser McCord
Mhari Coxon
Amit Patel
BO

Anthony Roberts

OK
I

NG

DI

SC

OU

NT

[16] =>

16 Endo Tribune

United Kingdom Edition

April 16-22, 2012

ß DT page 19

Fig 26

Fig 27

Fig 28

Fig 30

Fig 31

Fig 32

Fig 29a

Fig 29b

Fig 33

Fig 34

Fig 35

Fig 36

Fig 37

Fig 38

Fig 39

Fig 40

Fig 41

Fig 42

Fig 46

Fig 47

Fig 48

tween first and second premolar, with the centre of the valve
preferably 1-1.5mm above the
highest point of the retention
chamber (Figs 24-25).

chamber, drilling is done at an
obtuse angle.

Fig 44

It’s time for your check up!

Fig 43

UltraSuction Dentures

7” X 5”h

Service Pkg Postcard

Version 1

Fig 45

Fig 49
ing techniques are acceptable.
Each model was packed in
a two part flask (Figs 15-16).
The spacer bar remained on
the model and any under cuts
were blocked-out (Fig 17).
Cold cure acrylic poured in
(Fig 18).
Ultra Suction Technique
The following sequences of
images display us through the
instillation process starting
with two light body vinyl polysiloxane impressions loaded
on special trays. In Figs 1 and
2, the impressions were boxed
with particular attention to
preserving accurate borders
and to encompass the tuberosity protuberances.
Yellow stone was used to
pour the casts from the impressions and after setting,
the cast models were trimmed
(Figs 3-4).
On the ridge, the location
of the spacer bar was pencil
designed, making sure that

the bar stopped at least 1cm
short of the end of the denture
(Figs 5-6). The bar was stabilised using two or three small
drops of cyanoacrylate and
any under cuts were blockedout (Figs 7-8).
Hard base plates were prepared on top of the spacer
bars (Figs 9-10), followed by
bite blocks (Fig 11). After bite
registration, the casts were
mounted on an articulator
(Fig 12) and teeth set-up for
try-in was carried out (Figs
13-14).
In this case study the Agar
flasking technique and cold
cure acrylic was used. However, all other flasking and pack-

After polymerisation and
de-flasking, the bars were removed from the dentures by
digging prudently to prevent
damage to the walls of the retention chamber (Fig 19-22).
The dentures were then
trimmed and polished (Fig
23). It should be noted that if
the valves are mounted before polishing the dentures,
there is a high risk of ending
up with protruding valve covers, which is not a favourable
outcome in terms of patient
comfort.
At the chosen lingual site,
the location of the valves was
drawn with a felt marker be-

The cavities for the valves
were prepared with a round
bur (Fig 26) intermittently using the gauge side of the service key for guidance ie,depth
and diameter (Figs 27-28).
Processing caps were then
placed in the valves to protect
the core from being filled with
self cure acrylic and then tried
in (Figs 29a-30).
The valves were installed
with cold cure acrylic (Figs
31-32). Soft rubber cylinder
points were used to remove
excess material and to polish
around the valves (Fig 33).
The dentures were given a final sheen (Fig 34).
The processing caps were
removed and the valve body
inspected (Figs 35-36).
Using a 1mmØ fissure a
communication channel was
created between the valve and
the high point of the retention chamber (Figs 37-38). For
dentures with a significant
thickness of acrylic between
the valves and the retention

Each valve was rinsed and
dried thoroughly to ensure a
smooth placement of the diaphragm into its housing (Figs
39-40). The perforated cover
was fitted and tied up using
the service key (Figs 41-43).
Preventative maintenance
Practitioners were encouraged to recall their patients
every six months. This shows
that the clinician cares, thus
increasing patient loyalty and
also income stream.
A simple and efficient recall system developed by Fred
Carson consists of a computerised patient database and
a recall postcard printed on
both sides (Figs 44-45). The
patient’s last visit was entered into the records. Six
months later a pop up window displayed the names due
for check-up. A postcard was
sent. Most patients responded
positively to this follow up.
During the biannual visit,
dentures were checked for
their fit to the supporting tissue, followed by a general
examination of the oral cavity. On this occasion, calculus
deposits were removed from

[17] =>

United Kingdom Edition

Lab Tribune 17

April 16-22, 2012

around the retention chamber and the air channels were
thoroughly cleaned (Fig 46).
The valve covers were
opened over a receptacle
of water to avoid losing the
components. The valves were
cleaned and the diaphragms
replaced. Patients were instructed to clean their dentures and the valves on a
daily basis. Patients who had
manual dexterity were given
the service key, together with
spare diaphragms and were
instructed to perform routine
maintenance in between the
biannual visits (Figs 47-51).
Discussion
Ultra Suction system appears to
increase considerably the retention of complete dentures in
both clinical observations and
statistical findings. Their retentive capacity is superior to that
of conventional dentures. The
decrease in the rate of applied
negative force by 10mmHg per
15 seconds, attributed to the
design of the diaphragms, suggests that we may have a more
tissue friendly denture than we
first thought. It is well known
that the supporting tissue is
subject to -80mmHg under conventional maxillary dentures,
which caused an increase in
epithelial width in the palate
and attached gingival, and a decrease in the epithelial width in
the alveolar mucosa4 in most, if
not all, complete denture wearers. The response is directly related to the functional demands
of the tissue. In view of this
documented evidence, it would
be responsible to conclude that
Ultra Suction’s negative force
is less invasive that that of conventional dentures. DT

Fig 51

Fig 52

Treat small
spaces with

confidence
Human histology shows the apical
extent of the junctional epithelium
below which there is a supracrestal
connective tissue attachment to the
laser microchannel surface2.

Laser-Lok 3.0 placed in
aesthetic zone.

Radiograph shows proper
implant spacing in limited site.

Image courtesy of Michael Reddy, DDS

Image courtesy of Cary Shapoff, DDS

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

Fig 50

About the author

• Two-piece 3mm design offers restorative flexibility in narrow spaces
• Implant design is more than 20% stronger than competitor implant2
• 3mm threadform shown to be effective when immediately loaded3
• Laser-Lok microchannels create a physical connective tissue attachment (unlike Sharpey fibers) 4

For more information contact the UK
distributors:

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

Abacus Dental, 7 Oxford Place, Bradford, West Yorkshire, BD3 0EF
Email: chrisb@abacus-dental.com
References
1. Badra SH, Radi I, Aboulela Aet al.
The effect of Ultra Suction system on retentionof mandibular complete denture.
EDJ Vol.56 Jan 2010.
2. Rahn AO, Heartwell CM. Text book of
complete denture [5th ed.] BC Decker Inc.
Hamilton London.
3. Zarb GA, Bolender CL, Carlsson G.
Boucher’s Prosthodontic Treatment for
Edentulous Patients. [11th ed.] St. Louis
C.V. Mosby, 1997: 460-468.
4. Grossman ES, Forbes ME. Studies related to reaction of supporting soft tissue
to denture wear: the histological response
of vervet monkey oral epithelium to a
-80mmHg vacuum. J Oral Rehabbil. 1990
Nov;17(6): 587-97.
5. Yi – Cheong Jae. Ultra Suction
Denture, Journal of Korean Academy of
Dental Technology Vol.29 No2.

1. Radiographic Analysis of Crestal Bone Levels on Laser-Lok Collar Dental Implants. CA Shapoff, B Lahey, PA Wasserlauf, DM Kim, IJPRD, Vol 30, No 2, 2010.
2. Implant strength & fatigue testing done in accordance with ISO standard 14801.
3. Initial clinical efficacy of 3-mm implants immediately placed into function in conditions of limited spacing. Reddy MS, O’Neal SJ, Haigh S, Aponte-Wesson R, Geurs NC.
Int J Oral Maxillofac Implants. 2008 Mar-Apr;23(2):281-288.
4. Human Histologic Evidence of a Connective Tissue Attachment to a Dental Implant. M Nevins, ML Nevins, M Camelo, JL Boyesen, DM Kim.
SPMP10109 REV D SEP 2010
International Journal of Periodontics & Restorative Dentistry. Vol. 28, No. 2, 2008.

Bio Horizons_treat small.indd 1

01/03/2011 16:33

[18] =>

18 Lab Tribune

United Kingdom Edition

April 16-22, 2012

Lithium disilicate, the restorative
material of multiple options
Lee Culp and Prof Edward McLaren

Fig. 2 Mandibular molar restored with CAD/CAM-designed and -milled e.max restoration, using stain and glaze technique for aesthetics

Fig. 3 Pre-existing clinical condition of maxillary posterior quadrant to be restored

Fig. 1 Pre-existing clinical condition of mandibular molar to be restored

s dentistry continues
to evolve, new technologies and materials are continually being offered to the dental profession.
Throughout the years, restorative trends and techniques
have come and gone. Some
material developments have
transformed the face of aesthetic dentistry, while other
initial concepts have phased
out and died. Today all ceramic restorations continue
to grow in the area of restorative dentistry, from pressed
ceramic techniques and materials to the growing use of
zirconia, and new materials
that can be created from CAD/
CAM technology. This article
will explore new uses for the
all-ceramic material, known
as lithium disilicate, and the
use of a digital format to design and process this material
in new and exciting ways. An
overview of the material and
unique clinical procedures
will be presented.
Introduction
Embracing proven alternative solutions and transforming traditional methods can be
challenging to dental restorative teams facing increasing
patient demands while being
tasked with delivering highstrength restorative options
without compromising the
aesthetic outcomes. Traditionally, dental professionals have used a high-strength
core material made of either
a cast metal framework or an
oxide-based ceramic (such as

zirconia or alumina). This approach has two disadvantages.
Compared with glass-ceramic materials, the substructure material has high value
and increased opacity but may
not be aesthetically pleasing. 1
This is especially an issue in
conservative tooth prepara-

fracture toughness. 2, 3 The zirconia core (with a 900 to 1,000
MPa flexural strength) is less
than half of the cross-sectional width of a restoration;
it must be completed with
a veneering material with a
flexural strength in the range
of 80 to 110 MPa (depending
on delivery method). 4 The

vary substantially because of
cleanliness of the bond surface, furnace calibration, user
experience and other issues.
In today’s industry, monolithic glass-ceramic structures can provide exceptional
aesthetics without requiring
a veneering ceramic. Greater

Fig. 4 Maxillary posterior quadrant restored with CAD/CAM-designed and -milled e.max restorations, using a micro-layering technique for aesthetics. Clinical dentistry in Figure 3 & 4 was done by Dr Michael Sesseman

tion when the core material
will be close to the restoration’s exterior surface.
The other disadvantage
is that although the highstrength material has great
mechanical properties, the
layering ceramic with which
it is veneered exhibits a much
lower flexural strength and

veneering material tends to
chip or fracture during function. Also, such restorations
depend significantly on the
ability to create a strong bond
interface between the dissimilar materials of oxide-ceramic
and silica-based glass-ceramic, a bond that is not difficult
to create. 5 However, the quality of the bond interface can

structural integrity can be
achieved by eliminating the
veneered ceramic and its requisite bond interface.6 The
relative strength of the available glass-ceramic material
has traditionally been the disadvantage of these restorations. Owing to their flexural
strength of 130 to 160 MPa,
they are limited to single-

tooth restorations, and adhesive bonding techniques are
needed for load sharing with

‘Embracing proven
alternative solutions and transforming traditional
methods can be
challenging to
dental restorative teams facing
increasing patient
demands’

the underlying tooth.6 This
has been resolved through the
development of highly aesthetic lithium-disilicate glassceramic materials.
The 70 per cent crystal
phase of this unique glassceramic
material
refracts
light very naturally, while also
providing improved flexural
strength (360 to 400 MPa). 7
This gives more indications
for use and the ability to place
restorations using traditional cementation techniques,
while also having strength
and aesthetics.

[19] =>

United Kingdom Edition

With a monolithic technique (Figs 1 & 2), most restorations built from lithiumdisilicate materials can be
completely fabricated. This approach provides high strength
and aesthetics but requires
surface colourants for the final shade. When in-depth colour effects are needed, a partial layering technique may be
employed. Although no longer
a purely monolithic structure
(Figs 3 & 4) because the restoration maintains a large volume of the core material, the
resulting restoration should

option is used, the technician
will design the restoration
digitally rather than perform a
full wax-up and invest/press.
Preparation options
If LT or HT ingots will be
needed, then dentists can have
flexibility with their preparations because of the translucent margins. This is the
situation with partial preparations (for example inlays, onlays and veneers)—the margins can be placed wherever

April 16-22, 2012

clinically proper. IPS e.max’s
translucency enables dentists
to place the margins virtually
anywhere on the restoration,
blending seamlessly with the
natural dentition.
Dentists can use a traditional preparation of 1.0 to 1.5
mm reduction (for example
a full-crown preparation) if
they need more opaque materials (for example HO and
MO). Because the resulting
restoration will have a slight

Lab Tribune 19
opacity, the margins will be
equi-gingival or slightly subgingival. In either case, the
material will be fully layered
to create the final restoration.
IPS e.max provides the choice
of using traditional or creative
preparation designs.

e.max also provides options
for cementation. Conventional
self-etching primer cement is
ideal for full crowns. For partial and veneer preparations
for which adhesive protocol
will be used, full light-cure
bonding is preferred.

Cementation options
Because lithium disilicate can
be fully light-cure bonded or
cemented using a self-etching primer with conventional
resin-cement techniques, IPS

Case study
A 42-year-old female presented with discoloured teeth
that had been repaired with
à DT page 20

PERIODONTAL

‘In today’s industry,
monolithic glassceramic structures
can provide exceptional aesthetics
without requiring a
veneering ceramic’

STANDARD GRACEY
CURETTE
SG5/675
AFTER FIVE
GRACEY CURETTE
SRP11/1273

reasonably maintain its high
strength. However, no evidence supports this.
Aesthetic options
If covering or masking underlying tooth structure is
part of the treatment plan,
the restorative team can imagine doing so in an aesthetic
way. The ceramist can make
that vision a reality with IPS
e.max (Ivoclar Vivadent) by
using a very high opacity ingot. Ingot opacities available
for IPS e.max include high
opacity (HO), medium opacity
(MO), low translucency (LT)
and high translucency (HT). 7
The MO ingot can be used as
an anatomic framework material if restorations must be
fully layered. LT ingot can
be employed with stain and
glaze methods or hybrid layering techniques, which have
been used for years with IPS
Empress Aesthetic (Ivoclar
Vivadent). The HT ingot is
meant for stain and glaze
techniques.
Choosing one of these four
different aesthetic options depends on the preparation and
the technique to be used in
order to match the adjacent
dentition or restorations. In
addition, the laboratory can
select the processing choice
that is appropriate for the selected restoration. IPS e.max
includes press and CAD/CAM
options because lithium disilicate can be pressed from
ingot form or milled from a
block form. If the CAD/CAM

MINI FIVE
GRACEY CURETTE
SAS7/877

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AND EVEREDGE
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COMBINATION FOR
ALL YOUR HAND
SCALING NEEDS

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before in a scaler. We’ve applied stateof-the-art technology in metallurgy,
heat treatment and crynogenics to
create a superior stainless steel alloy
for scalers and curettes that stay
sharper longer than any instrument
you’ve used.
That means less frequent sharpening,
less hand fatigue, and greater comfort
throughout the day.
The improved sharpness of
EVEREDGE® TECHNOLOGY
instruments does not come from a
superficial coating –
the long-lasting wear is present
throughout the entire instrument tip.

HU-FRIEDY - THE ORIGINAL MANUFACTURER OF GRACEY CURETTES!
STANDARD GRACEY CURETTE — The Gracey curettes combine a unique offset blade with 9 different shank
designs to be used on specific tooth surfaces, thus improving adaptation and deposit removal. Also referred to as
Finishing Gracey Curettes.
AFTER FIVE GRACEY CURETTE — Designed for instrumentation in deeper periodontal pockets. Elongated
terminal shank (3mm) provides better clearance around crowns, and superior access to root contours and pockets
5 mm or more in depth. Thinner blade permits easier subgingival insertion.
MINI FIVE GRACEY CURETTE — Designed with the same elongated terminal shank (3 mm) and thinned blades
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For more information on our products please:
- call us on 0770 318 6612 or 0770 318 6474,
- visit our website www.hu-friedy.eu
- e-mail us on info@hufriedy.eu
- contact your regular Dental Dealer.

How the best perform

Gracey ad_GB_A4_2012.indd 1

16.02.12 14:38

[20] =>

20 Lab Tribune

United Kingdom Edition

April 16-22, 2012

ß DT page 19

various composite restorations placed throughout the
years (Fig 5). A lingual amalgam restoration in tooth #12
and composite restorations
in teeth #23, 21, 11 and 13
showed recurrent decay that
was diagnosed with digital Xrays. She possessed a negative
medical history and good oral
hygiene with resultant periodontal health and asymptomatic teeth. Treatment options
of zirconia or porcelain-fusedto-metal crowns or CAD/CAM
all-ceramic restorations were
discussed with the patient.

Fig. 5 Pre-existing clinical condition of maxillary anterior teeth to be restored

Fig. 6 Veneer preparations for the anterior restoration

Ultimately, CAD/CAM all-

laboratory, and the laboratory
receives all the materials from
the dentist.

Then, the impressions are
poured, models mounted, and
dies trimmed.

Appropriate restorations—
layered,
pressed,
milled,
cast, or combinations—are
made.

Fig.
7 E4D LabWorks system
used for the scan,
design, and milling of
the veneer restorations

ceramic restorations were
tested. When proper preparation and occlusal design
considerations are followed,
properly placed CAD/CAMdesigned and -milled restorations have been extremely
successful. The patient made
a preparation appointment,
during which the existing
restorations were removed,
and teeth #23 to 13 were prepared for all-ceramic veneer
restorations, following accepted CAD/CAM glass-ceramic preparation guidelines
(Fig 6): adequate clearance,
rounded internal aspects, and
equi-gingival butt-joint margins were ensured. Once the
preparations were completed, conventional impressions
were taken and poured in
high-quality, laser-reflective
dental stone.
Laboratory communication
The dentist is to the dental
technician what the architect
is to the builder. Each has a
primary role in indirect restorative dentistry, which is
to imitate natural function
and aesthetics perfectly and
translate that into a restorative solution. The communication between the clinician
and technician entails a thorough transfer of information,
including functional components, occlusal

Fig. 8 Computerised image of digital 3-D model

parameters, phonetics and
aesthetics,
and
continues
throughout the restorative
process, from the initial consultation through treatment
planning and provisionalisation to final placement.
The primary and conventional communication tools
between the dentist and technician are:
• Photography

However, as restorative
dentistry shifts further into
the digital era, clinicians
must change their perceptions
and definitions of the dental
laboratory. Traditionally, a
laboratory is the site that receives and processes patient
impressions and returns the
completed restorations to the
clinician, who adjusts and
delivers them to the patient.
Similar to how the Internet
has transformed the communication landscape, the possibility of using CAD/CAMrestoration files electronically
has spurred evolutions in the
way dental restorative teams
perceive and structure the
dentist–laboratory
relationship.

• written documentation
• impressions of the patient’s
existing dentition

Fig. 9 Computerised 3-D digital composite file, showing preparation, provisional models and digital restoration design

• clinical preparation
• opposing dentition
This information is used
to create models, which are
mounted on an articulator to
simulate the mandibular jaw
movements.
Traditional indirect restorative process
The indirect restorative process involves the following
steps:

The clinician prepares
the case according to the appropriate preparation guidelines, takes the impressions,
sends these and other critical
communication aspects to the

Fig. 10 Final digital restorations, with cut-back design for the micro-layering of enamel
ceramics

The digital process
When the E4D LabWorks system (D4D Technologies) was
introduced in 2008 (Fig 7), it
was the first computerisation
model to present a real 3-D
virtual model accurately and
account for the occlusal effect of the opposing and adjacent dentition automatically.
It enables the user to design
16 individual, full-contour,
anatomically correct teeth simultaneously. The device condenses the information from
a complex occlusal case and
displays it in a user-friendly
format that allows clinicians
with basic knowledge of dental anatomy and occlusion to
modify the design. Once this
has been completed, the information is sent to the automated milling unit.
The innovation of digitally
designed restorations meant
that some of the more me-

[21] =>

United Kingdom Edition

chanical and labour-intensive
procedures (for example waxing, investing, burn-out, casting and pressing) involved in
the conventional fabrication of
a restoration were essentially
automated. The dentist and
technician had a consistent,
precise method to construct
functional dental restorations.
A file is created within the
design software for each patient. The operator can input
the patient’s name or record
number and selects the appropriate tooth number(s) to be
treated. Each tooth’s planned
restoration is checked (for example full crown, veneer, inlay
and onlay). Lastly, additional
preferences include material
choices and preferred shade.
System defaults that can be
set ahead of time or changed
for each patient are preferred
contact tightness, occlusal
contact intensity and virtual

clinically ideal location. Instead, the operator relies on
his or her knowledge of form
and function and experience
to reposition and contour the
restoration. As the crown’s
position and rotation are finetuned, the software’s automatic occlusion application will
readjust each triangular ridge
and cusp tip—and the restoration’s contours, contacts and
marginal
ridges—employing the preferences and biteregistration information. The

April 16-22, 2012

virtual restoration adapts all
parameters in relation to the
new position. Instantaneously, the position and intensity
of each contact point is illustrated graphically and colour
mapped, where it can easily
be modified based on the operator’s and clinician’s preferences. Through a variety
of virtual carving and waxing
tools, customisation and artistry are also possible. These
tools can be used to adjust occlusal anatomy, preferences

Lab Tribune 21
and contours, reflecting actual
laboratory methods. Each step
in the process is updated on
the screen; therefore, the effect of any changes is immediately apparent. For this case,
three files were loaded into
the computer software for restoration design. Scans of the
preparations, provisional restorations and opposing dentition were joined to form a
composite file that represented the patient’s oral situation
accurately (Fig 9). Once the

final virtual restorations have
been completely designed
(Fig 10), the milling chamber
with the predetermined shade,
opacity and size of the IPS
e.max block is loaded, an onscreen button is pressed, and
an exact replica of the design is
produced in ceramic in a short
time.
Glass-ceramics are categorised according to their
à DT page 22

‘However, as restorative dentistry shifts
further into the
digital era, clinicians must change
their perceptions
and definitions
of the dental
laboratory’

die spacer, which determines
the internal fit of the final restoration to the die/preparation. All this information can
be entered prior to treatment
or changed at any time if the
actual treatment differs from
what was planned.
When the images of the
preparation, provisional restorations and opposing dentition are captured, the computer has all the required
information for preparing the
working models, preparation and opposing model. The
real 3-D virtual model is then
shown on the screen and can
be rotated and viewed from
any perspective (Fig 8). In
designing the restoration, the
first step must be to define the
final restoration’s parameters
digitally. This is achieved by
employing the opposing and
adjacent teeth for occlusal interproximal contact areas and,
finally, the gingival margins of
the preparation.
Using input and neighbouring anatomic detail as a
basis, the software will place
the restorations in an appropriate position—but not to the

Look
o
free s ut for our
ample
within
this is
sue of
Denta
l tribu
ne

[22] =>

22 Lab Tribune

United Kingdom Edition

April 16-22, 2012

ß DT page 20

chemical composition and/
or application. The IPS e.max
lithium disilicate is composed
of quartz, lithium dioxide,
phosphorus oxide, alumina,
potassium oxide, and other
components.7 These powders
are combined to produce a
glass melt, which is poured
into a steel mould, where it
cools until it reaches a specific temperature at which
no deformation occurs. This
method results in minimal
defects and improved quality
control (owing to the translucency of the glass). The blocks
or ingots are generated in one
batch, based on the shade and
size of the materials. Owing
to the low thermal expansion
that results during manufacture, a highly thermal, shockresistant glass-ceramic is produced.
Next, the glass ingots or
blocks are processed using
CAD/CAM-milling procedures
or lost-wax hot-pressing techniques (IPS e.max Press; Fig
11). The IPS e.max CAD blue
block is based on two-stage
crystallisation: a controlled
double nucleation process, in
which the first step includes
the precipitation of lithiummetasilicate crystals. Depending on the quantity of colourant added, the resulting
glass-ceramic demonstrates a
blue colour. This ceramic has
superior processing properties for milling. After the milling process, a second heattreating process is performed
in a porcelain furnace at approximately 850°C, at which
temperature the metasilicate
is dissolved and the lithium
disilicate crystallises. This
results in a fine-grain glassceramic with 70 per cent crystal volume incorporated into a
glass matrix.
With two crystal types and
two microstructures during
processing, the IPS e.max
CAD material demonstrates
distinctive properties during
each phase. The intermediate lithium-metasilicate crystal structure promotes easily milling, without excessive

Fig. 11 IPS e.max milling blocks, shown in blue stage

Fig. 12 Milled e.max full contour posterior restoration, shown in blue stage

Fig. 13 Milled e.max full contour posterior restoration, shown in final crystallised stain and glaze stage

Fig. 15 Milled e.max cut-back anterior
restoration, shown in final crystallised
micro-layered and glazed stage

bur wear, while maintaining
high tolerances and marginal
integrity. In the blue stage,
the glass-ceramic contains
approximately 40 per cent
volume lithium-metasilicate
crystals that are approximately 0.5μm. The final-stage
microstructure of lithium disilicate gives the restoration its
superior mechanical and aesthetic qualities. In this stage,
the glass-ceramic contains
approximately 70 per cent volume lithium-disilicate crystals
that are approximately 1.5 μm
(Figs 12–15).
The laboratory process
Once designed and milled,
the IPS e.max ceramic restorations are then prepared for
final aesthetic adjustments.
After the milling sprue has
been removed, the technician
defines surface texture and
occlusal anatomy using diamond and carbide burs, carefully avoiding any alteration
to the perfected occlusal and
interproximal contacts. Afterwards, restorations are rinsed
to remove surface debris and
dried. Then, the milled blue

Fig. 14 Milled e.max cut-back anterior
restoration, shown in blue stage

Fig. 17

Fig. 18

restorations are placed in a
conventional ceramic furnace
for the crystallisation process.
These restorations were digitally designed with an incisal
cut-back design that will allow a minimal application of
translucent ceramics to mimic
the incisal effects found in
nature. Contoured to final
anatomic shape, the restorations are further aesthetically
improved by subtle colouring
and glazing.

followed by a silane coupling
agent (Monobond-S, Ivoclar
Vivadent), which was also
placed for a minute onto the
internal surfaces, and then
air-dried. For the final cementation, Variolink Veneer
(Ivoclar Vivadent) was used.
After excess cement had been
removed, final light-curing
was done. The occlusal contacts were then reviewed and
excursive pathway freedom
was confirmed. Owing to the
correct capture and alignment
of the bite-registration information, few adjustments were
required.

Restoration placement
Next, five per cent hydrofluoric acid (IPS Ceramic Etching
Gel, Ivoclar Vivadent) was applied for 30 seconds onto the
internal surfaces of the glazed
restorations. Then they were
rinsed and dried. This was

Conclusion
IPS e.max is about restorative
options. Dentists and technicians now have a material

Figs. 16–18 Maxillary anterior section
restored with CAD/CAM-designed and
-milled e.max restorations, using a
micro-layering technique for aesthetics

with which they can do anterior or posterior restorations.
With four different opacities
or translucencies available,
a variety of creative aesthetic
options can be accomplished
in a restoration. Dentists and
their laboratory ceramists
now have the opportunity to
be more creative for their patients (Figs 16–18).
Editorial note: A complete list
of references is available from
the publisher.

About the author
Lee Culp is Chief Technology Officer,
Microdental Laboratory, Dublin, California
Prof Edward A. McLaren is Professor, Founder and Director, UCLA Post
Graduate Esthetics; Director, UCLA
Center for Esthetic Dentistry, Los Angeles, California

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[23] =>

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• More efficient procedure for the dentist

Developer of the Champions system / CEO

• Champions® implants: a wide range of innovative
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t
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Champions®-tulips
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[24] =>

24 Feature

United Kingdom Edition

April 16-22, 2012

Cause for concern
Mark Phillips discusses when, how, and to whom dental professionals should
raise concerns
dentist who was brought in to
cover. They also quickly established a good working relationship, but after a few weeks, the
nurse began to notice the dentist was starting to speak rather
abruptly to patients and had on
one occasion, lost his temper
with a patient who was needle
phobic but required a local anaesthetic to undergo a procedure. When the nurse attempted
to speak to the dentist about the
incident she was given shortshrift and told to mind her own
business.

Is a colleague’s behaviour causing you concern?

A large, successful dental
or many dental profespractice recruited two new staff
sionals, the enjoyment
members to help cope with an
of working in a pracincreasing
patient
register.
tice comes from the teamwork
13860_BDJ_Nobel
8/2/12
13:10
Page had
1 an excellent
The practice
involved in ensuring
patient
reputation for providing a high
satisfaction. But team working
standard of care and didn’t want
can bring its own challenges,
to this be affected by the inparticularly if a colleague’s
creasing demand for its servicbehaviour gives cause for cones so it engaged a new dentist
cern.

and nurse to work alongside
one another.
Within the first month the
dentist and nurse had formed an
excellent working relationship,
but soon after, the dentist had to
take an extended period of leave
due to illness and the nurse was
allocated to work with a new

The dentist’s behaviour continued to be of concern until one
day the receptionist witnessed
him pouring alcohol into his
tea in the kitchen. When questioned, the dentist’s response
was “everyone’s allowed a drink
once in a while”.
The dentist worked at the
practice for a total of seven
months and during this time,
a number of colleagues had

witnessed inappropriate behaviour. Although the staff had
discussed their concerns informally among themselves, these
weren’t taken any further. On
one occasion, another dentist at
the practice pulled his colleague

‘Although the staff
had discussed their
concerns informally
among themselves,
these weren’t taken
any further’

aside and attempted to discuss
his behaviour. The dentist put
his temper down to stress. Concerns about his behaviour were
subsequently taken to the practice manager, who in line with
the practice’s sickness policy
offered the dentist a course of

Limited places
available!

Enrol today! Call for details

TR213860

[25] =>

United Kingdom Edition

counselling and some time away
from work. Neither of these offers were acted upon and eventually, because of the potential
risk to patients, the practice
manager was forced to alert
the GDC to his concerns and
the dentist was asked to leave
the practice.

• the problem is so severe that
the GDC clearly need to be involved (for example, issues of
indecency, violence or dishonesty, serious crime, or illegal
practice)

A sensitive subject
The DDU recognises that it can
be difficult to raise concerns
about a colleague, particularly
those in a position of authority.
The fear of victimisation and
bullying may be all too real
but this is often not the case.
In instances where behaviour
may be putting patients at
risk, you have a legal and ethical duty to say something. The
GDC guidance on raising concerns states that: “The duty to
put patients’ interests first and

Will I be protected?
Under the Public Interest
Disclosure Act 1998 (PIDA) 3
those working in NHS or pri-

‘The GDC guidance
on raising concerns
states that: “The
duty to put patients’
interests first and
act to protect them
must override personal and professional loyalties’

act to protect them must override personal and professional
loyalties.”1 The GDC adds that
if you fail to raise a concern
that potentially puts patients at
risk, you could be risking your
registration.
When and how – the regulations
The action that you take will
depend on the type of concern
that is raised. If the concern is
about poor performance that
does not pose an immediate
risk to patients, this can be
raised at a local level through
Practitioners’ Advice and Support Schemes for dental professionals. You may also want
to raise a concern with your
manager or employer but this
may not always be appropriate, particular if they are the
subject of the concerns. In
such cases, concerns can be
raised with your local PCT or
NHS hospital trust.
There are however circumstances when you should contact the GDC. This is advisable
in instances when:
• taking action at a local level
would not be practical
• action at a local level has
failed

• there is a genuine fear of victimisation or a cover-up2

Feature 25

April 16-22, 2012

vate practice and those who
are self-employed and contracted to provide NHS services, will
be protected if they raise concerns about potentially illegal or
dangerous practices, as long as
you have acted in good faith and
in the first instance, followed local level procedures. In addition,
the GDC’s guidance in Principles
of Dental Team Working makes
clear that those who employ,
manage or lead a team must
support team members who

raise concerns (paragraph 5.5).
Finally, the DDU advises you to
remember that your duty to raise
a concern should override any apprehension you may have about
doing so, and that you should take
steps to resolve issues at a local
level, where appropriate, before
contacting the GDC. Dental professionals who are unsure whether to raise a concern in the workplace should contact their defence
organisation for advice. DT

References:
1. & 2. GDC Principles of raising concerns
at work, page 6, p.1.1; page 8, p.3.6
3. Public Interest Disclosure Act 1998
(PIDA) http://www.legislation.gov.uk/
ukpga/1998/23/contents

About the author
Mark Phillips has worked pedominantly in NHS dental practices as an
associate and principal for 25 years
prior to joining the DDU. He continues
to work one day a week as a clinical
demonstrator in the Prosthetic department and has recently been appointed
chairman of the Dental Undergraduate Admissions Panel at GKT.

[26] =>

26 Clinical

United Kingdom Edition

April 16-22, 2012

Seeking release from the daily grind
Pav Khaira discusses treatments for bruxism

Fig 1
NTI side

f ever there was an appropriate time for raising
awareness of bruxism, the
parafunctional grinding and
clenching of teeth, and the
problems it causes, this could
be it.
As a dentist with a special
interest in migraine and pain
management, Pav Khaira of
the Migraine Care Institute
says the condition is becoming increasingly common as
the economic crisis takes its
toll on the nation’s health.
“I think bruxism is definitely becoming more common,”
says Pav. “The symptoms and
fallout of bruxism that we see
are more common too, such as
frequent headaches and migraines, and increased facial
pains.” Dozens of new cases
arrive in his practice every
month and between 80 and
90 per cent of patients show
some signs of at least some
historic bruxism, he adds.
Many of the new patients
presenting with these issues
may have always suffered
from bruxism to some extent,
but found that their symptoms
are increasing as their stress
levels rise along with debt or

Fig 3
Effects of bruxism

job security worries.
“From my point of view
stress is a modifier to bruxism, not a driving force,” adds
Pav. “And it is a complex subject that highlights biodiversity. It’s like a threshold. For
some people, as their stress
drops below the threshold,
their symptoms will resolve.
But other people always
seem to be above their threshold, even if their stress levels
are low.”
For many patients, arrival
in a migraine and pain management practice might follow
months or years of shuttling
between different medical
practitioners in search of help.
A lack of knowledge about
bruxism throughout the medical education system is to
blame for that, suggests Pav.
“It’s not about a lack of empathy, it’s about a lack of knowledge,” he adds.
In general practice there
can be gaps in knowledge
about bruxism, or where to
send sufferers, according to
Pav. “If I see somebody who
has really crooked teeth, I
send them to my orthodontist.
If I’ve got somebody with rag-

Fig 2
NTI front

ing toothache and I can’t do
the root treatment I send them
to my endodontist. Where
do you send patients who’ve
got these types of problems?
There is no set speciality,”
he says. “I’m not one of those
people who say you can cure
bruxism. But you can manage
it; you can manage the signs
and the symptoms, and often
you can get the patient completely comfortable. There
are some patients who are absolute monster clenchers and
grinders, and somebody has
to help them. You can’t just
leave them.”
As well as substantially
improving quality of life for
patients, successful management of bruxism can also save
them from future dental problems that might necessitate
invasive and expensive treatment. “Bruxism can cause
extensive damage in the long
term,” says Pav.
To treat the condition effectively and efficiently, practitioners must take the time
to make the fullest diagnosis
possible, Pav believes: “We
do a very in-depth history, a
very in-depth analysis. I talk
to the patient about whether they have ever had jaw
popping and clicking, locking jaw joints, any sinus
pain, any ear pain, any joint
pains elsewhere. I also do a
full muscular examination, a
full ligament insertion examination.”
This process is used to
tease as much information
from the patient as possible.

“Quite often people say, ‘I’ve
had a clicking jaw joint for
several years, and it was really painful for four or five
months. But then it settled
down by itself.’ But of course
it didn’t settle down by itself.
Something happened and you
have to try to get to the bottom
of it.”
Sometimes,
asking
the
right questions can open the
floodgates of medical history.
If a patient feels they are finally being listened to after years
of migraines or jaw pain, they
may have a lot to say. “Sometimes it turns out that the
problems stem back to an old
whiplash injury from five, ten,
15 or even 20 years earlier,”
says Pav.
“You need to understand
that a problem won’t just

sidual problem. You need to
be very thorough if you are
going to give the patients the
treatment they deserve.”
To make sense of all the information gleaned without being overloaded, it is important
for practitioners to change
their mind set, says Pav: “You
have to take off your dental
shoes and put on your pain
management ones.”
This means assessing all
of the body’s systems independently of each other, and
accepting that patients can
appreciate, and benefit from,
alternative treatments.
Pav is licensed to practise
acupuncture, and often refers patients to a chiropractor. “People often say to me,
‘Isn’t that just placebo effect?’

‘If I see somebody who has really crooked
teeth, I send them to my orthodontist. If I’ve
got somebody with raging toothache and
I can’t do the root treatment I send them to
my endodontist. Where do you send patients who’ve got these types of problems?
There is no set speciality’
cause immediate pain in a
particular place, it can also
give referred pain in another area – perhaps causing a
headache. Often I see people
who have seen other dentists
and found it helped a bit. Other practitioners have done the
right thing, but part of the diagnosis has been missed and
that is why there is still a re-

Well, it might be. But if the patient gets pain free, does that
matter?”
It is vital to remember that
being pain free and having
an improved quality of life is
the ultimate goal for most patients. Pav relates a story of
two recent female patients,
both of whom had been suf-

[27] =>

United Kingdom Edition

fering from between 15 and
18 migraines a month. After
treatment both patients were
happy, even though the frequency at which they suffered
the migraines had remained
constant. The improvement
had been in the duration of
the migraines: instead of suffering for up to two days each
time, the migraines were lasting for an hour and could, literally, be slept off.
To treat bruxism effectively, practitioners must be openminded about issues such as
occlusion, says Pav. “The fact
is that occlusion is not the
driving factor in a lot of these
issues. It can sometimes be a
modifying factor but it is not
a driving factor. That is not to
say that doing something occlusally will not give pain relief, but it is still not the driving factor,” he insists.
“What a lot of dentists say
is that, if your teeth do not fit
perfectly where your jaw joints
and muscles harmoniously
want to contract, your muscles
will fight to find a comfortable
position. The theory is that if
you remove these interferences from your bite, you let
the patient close their mouth
correctly and their problems
go away. My take on this is
actually the other way around:
if you suffer from bruxism
you are going to clench and
grind your teeth, no matter
what. And there is strong,
scientific evidence to support
this. Sometimes your teeth
will get in the way, which will
exacerbate the pain. Sometimes by harmonising the
bite you can get resolution
of these symptoms, but that
doesn’t make it the driving
factor.”
Pav’s treatment model assumes that patients are suffering a neurological phenomenon, rather than an
anatomical one. He achieves
considerable success in treating patients with the NTI-tss
occlusal splint. This small device fits over the front teeth,
and reduces muscle tension
intensity by about 75 per cent
when patients try to clench
in their sleep. It prevents the
posterior teeth from occluding and reduces the amount of
pressure that can be applied
while clenching.
“The other thing is that
when your teeth touch you
get a neurological impulse to
your brain telling you they are
touching. Because with the
NTI-tss the teeth at the back
of the mouth are not touching, the amount of sensory
overload going back to the
brain significantly reduces,
and that is how it helps reduce

migraine, by reducing excessive nocioceptive input to the
sphenopalatine ganglion” he
says.
By preventing the posterior
teeth from occluding, the NTItss essentially achieves the
same function as removing
interferences at the back of
the mouth, which according to
conventional wisdom should
prevent clenching and grind-

Clinical 27

April 16-22, 2012

ing. “When you fit an NTI-tss
you have no interferences at
the back of the mouth, so if the
argument is correct the drive
for clenching and grinding
your teeth should have disappeared. So how do I explain
the scratches that appear on
almost 100 per cent of the
NTI-tss devices that I fit over
time? The bite is not the driving factor.”

“People need to realise that
NTI-tss is part of a philosophy.
The device itself is the easiest
way to deliver that philosophy,
but it is not the only way to do
it,” says Pav. While some dentists fear, incorrectly, that the
device can overload the jaw
joint, Pav says that a success
rate of over 90 per cent means
that patients like the NTI-tss a
great deal. DT

About the author
Dr Pav Kahira, the
founder and director of the Migraine
Care Institute, is
a dentist with a
special
interest
in migraine and
pain management.
Shortlisted twice
for the accolade
of Best Young Dentist, he trained at
Kings College London and the University of London. He has extensive
experience of treating migraine sufferers.

Taking diagnosis and treatment
of bruxism to a new level

GrindCare Measure is the ideal tool for dental professionals
who seek to
• present hard facts to patients denying to be bruxers
• sell a treatment plan based on clinical facts
• manage risk when planning reconstruction work or
• measure the effect of a chosen treatment
GrindCare Measure is the first ever tool for acurately measuring
whether and how often your patients grind their teeth. Within
just 3-5 nights of use, GrindCare Measure identifies and quantifies the patients’ grinding pattern.

Pain

Sleep
disturbances

Dental
damage

Teeth
grinding
Headaches

Tension

Waking
others

GrindCare Clinic is a breakthrough solution for reducing
grinding and clenching.
GrindCare records the activity in the temporalis muscle
via a small electrode that adheres to the temple. Each
time the patient grinds, the device transmits a mild electrical impulse that stimulates a conditioned reflex in the
jaw muscles, instantly interrupting the grinding.
Actually reduces teeth grinding
Clinical studies have shown that GrindCare can reduce
grinding by at least 50% in just 3 weeks. By reducing the
grinding activity, GrindCare helps reduce the accom
panying symptoms.

For more information,
please contact:
Prestige Dental
Tel: 01 274 721 567
email: info@prestige-dental.co.uk
www.grindcare.com

* F. Jadidi, E. Castrillon & P. Svensson: Effect of conditioning electrical
stimuli on temporalis electromyographic activity during sleep. Journal
of Oral Rehabilitation, 2008.

[28] =>

28 Industry News
Dental Unit Water System Decontamination

Dental Unit Water System
Decontamination ALKAZYME-W
“Clean Water in – Clean Water Out”

Alkazyme-W a combined cleaning
and disinfecting agent for the weekly
decontamination of the integral dental
chair-side water supply.
ALKAZYME-W
Simple to use:
A 15 minute weekly routine service clean
with Alkazyme-W is all that is required to
ensure the dental unit water supply unit
remains free of bactericidal contamination
thus ensuring ‘clean water in – clean water
out’.
Microbial Activity: Unique combined
enzyme based detergent/disinfectant
system rapidly removes bactericidal bio-film leaving all internal surface areas
thoroughly clean & disinfected.
Highly Economical: Each 500gm tub of Alkazyme-W allows for up to 100
service applications.
Safe to use: Non-toxic and fully biodegradable.
Alkazyme-W 500gm concentrate is available from all dental sundry suppliers.
“Clean Water in – Clean Water Out”

Alkazyme-W a combined cleaning and disinfecting agent for the weekly
decontamination of the integral dental chair-side water supply.

United Kingdom Edition

Ultrasonic Instrument cleaning

Alkazyme® enzymatic a combined cleansing and disinfecting agent for the
thorough cleaning-pre-disinfection of all reusable, immersible dental
instruments prior to autoclaving.

*Rapid cleaning action
When used in conjunction with a standard ultrasonic cleaner a maximum 5
minute immersion time is all that is required to render soiled instruments
thoroughly clean & shining bright.

Continual Disinfection

Simple to use:
A 15 minute weekly routine service clean with Alkazyme-W is all that is
required to ensure the dental unit water supply unit remains free of bactericidal
contamination thus ensuring ‘clean water in – clean water out’.

Alkazyme® continually disinfects the contaminated ‘wash water’ as created
within the ultrasonic cleaner

Microbial Activity:
Unique combined enzyme based detergent/disinfectant system rapidly
removes bactericidal bio-film leaving all internal surface areas thoroughly
clean & disinfected.

Just 5 grams of Alkazyme® with ordinary tap water makes 1 litre of enzymatic
cleaning/disinfecting solution

Highly Economical:
Each 500gm tub of Alkazyme-W allows for up to 100 service applications.

Safe to use:
Non toxic and fully biodegradable.

Alkazyme-W 500gm concentrate is available from all dental sundry suppliers.

For comprehensive product information on Alkazyme-W www.alkapharm.co.uk

For comprehensive product information on Alkazyme-W
www.alkapharm.co.uk

The Dental Directory – great
products at fantastic prices
The Dental Directory is one of the
leading names in dentistry, and has
built a strong reputation based on
providing quality goods at affordable
prices.

Economical

Choice of user format
Available from all dental sundry suppliers in both 750gm loose powder tub and
tubs of 100 easy dose water soluble sachets

Ultrasonic Instrument cleaning
Alkazyme® enzymatic a combined
cleansing and disinfecting agent for
the thorough cleaning-pre-disinfection
of all reusable, immersible dental
instruments prior to autoclaving.
*Rapid cleaning action
When used in conjunction with a
standard ultrasonic cleaner a maximum
five minute immersion time is all that is
required to render soiled instruments
thoroughly clean & shining bright.

For comprehensive product information visit www.alkazyme.com

Continual disinfection: Alkazyme® continually disinfects the contaminated ‘wash
water’ as created within the ultrasonic cleaner
Economical: Just five grams of Alkazyme® with ordinary tap water makes one
litre of enzymatic cleaning/disinfecting solution
Choice of user format: Available from all dental sundry suppliers in both 750gm
loose powder tub and tubs of 100 easy dose water soluble sachets
For comprehensive product information visit www.alkazyme.com

The Champions® Implants: new horizons in dental implantology
The philosophy of Champions-Implants GmbH is to provide dentists and
patients with optimal and efficient state-of-the-art solutions. About 2,800
dental offices and clinics successfully placed and restored more than 50,000
Champions® implants in Germany in 2010. The company won the Regio Effekt
award (Germany 2011).
The Champions® implant is not just another implant system. The Champions®
implant system stands out for its innovative, beneficial and easy handling
properties. Compared to the conventional dental implant and prosthodontic
treatment, the Champions® implant system itself, the treatment with it, and the
prosthodontic restorations are more cost-efficient and therefore affordable for
a higher number of patients. One-piece and two-piece Champions® implants
can be used for many indications. They can both be inserted using the MIMI®
method, the Minimally Invasive Method of Implantation, which is suitable for
80 per cent of the cases. The implants are manufactured in Germany of the
highest quality.
You can find clinical cases and articles on our website at: www.championsimplants.com. The Champions® concept sets new standards in Implantology
AND innovation is the key to progress!

Contact us at dentsply.co.uk or 0800 072 3313 Earn Rewards against purchases at
dentsplyrewards.co.uk Access webinars and product demonstrations and earn
CPD at dentsplyacademy.co.uk

DENTSPLY’S SDR™ – ideal when
time counts
SDR™ (Smart Dentine Replacement)
from the makers of Spectrum and
Ceram.X™ Duo offers a revolutionary
way to save precious time for
practitioners and patients.
Because of its ability to bulk-fill in
increments of up to 4mm without
the need for layering, SDR from
DENTSPLY makes posterior direct restorations less cumbersome for the clinician
and saves up to 40% of the time taken with conventional layering techniques.*
With a convenient dispensing mechanism for quick and easy placement, and
available in one universal shade, SDR is ideal for everyday practice use for Class
I and II restorations. Widely acclaimed by clinicians, SDR was voted flowable
resin of choice in the March 2010 Clinicians’ Report and positive feedback from
dentists regularly praises SDR’s adaptation, low incidence of mikroleakage and
reduced postoperative sensitivity, resulting in longevity of restorations.
SDR is compatible with the use of any methacrylate-based composite for
capping, meaning dentists do not have the expense of replacing their existing
material because DENTSPLY recognises that small things can make a big
difference.
Contact us at dentsply.co.uk or 0800 072 3313
Earn Rewards against purchases at dentsplyrewards.co.uk Access webinars
and product demonstrations and earn CPD at dentsplyacademy.co.uk
*Data on file

UK’s First elexxion Pico
Laser
The UK’s first elexxion Pico
Laser has been installed at
the Kalyani Dental Lounge
in Bath Street.
The elexxion Pico Laser
contains a five Watt Gallium
Aluminium
Arsenate
(GaAlAs) diode laser and
a small laser pointer. The
GaAlAs laser is ideal for soft
tissue work and both periodontal work (where it can sterilise the pocket killing
the bacteria) and endodontic work (where it can sterilise the root canal). The
laser energy is fibre delivered - the smallest available fibre being 200 microns.
The elexxion Pico Laser can also be used for Tooth Whitening (of both vital and
non-vital teeth). Dr Jayabalan, who is no stranger to lasers, said of the Elexxion
Pico Laser: “This is a super unit, neat compact and easy to use.”
Daniel Pinder, Sales Manager from Velpox, who supplied the Pico laser,
commented: “It’s great to see great customers and great products coming
together, thats what Velopex is all about.”
The elexxion Pico Laser is easy to operate and is battery powered. The Laser
fibre delivery system allows movement of the hand-piece and patient feedback
is positive. For more information contact Mark Chapman, Area Sales Manager,
Elexxion laser AG. Tel 07946 714039 Dr Jayabalan is based at Kalyani Dental
Lounge, 200 Bath Street, Glasgow, G2 4HG

Make a dramatic improvement in your
smile
The LR Appliance from Oralign Ltd is
the smallest and most discreet of tooth
appliances for straightening front teeth.
If you want to see results, you do not have
long to wait.
The appliance is easy to use, requiring
only 14-16 hours of wear a day. This
means the appliance can be fitted in
easily with a busy routine. It is ideal for use in both young and old.
For many years fixed appliances such as braces were the only option, but now
the LR appliance can straighten and improve in a matter of weeks. It can only be
used by certified dentists which means you can be sure of receiving the highest
standards of care.
“Compared to other systems the LR appliance is quicker and more cost effective,
with tremendous benefits to both patients and dentists. After the excellent
Oralign course I was very confident in offering this option for my patients.” - Dr
Hap Gill from Smile Studio.

The Waterpik® Water Flosser Cordless Plus
“I feel that my gums are pinker and healthier”
Dr Anoup Nandra, principal dentist at Edgbaston
Dental Centre, has been using the Waterpik®
Cordless Plus for three months now.
“I love it. The product has altered my oral
hygiene/brushing routine. I now “water floss”
once a day. I have noticed that immediately
after I use the “Water floss” I can feel that debris
has been removed from in between my teeth.
I feel that my gums are pinker and healthier. I
have fixed lingual retainers in my mouth post
orthodontic treatment, and interdental cleaning
was previously difficult. This makes it quick and easy.
“I have recommended it to many of my patients, particularly those with
orthodontic appliances, or dental implants in situ.”
The Waterpik® Water Flosser is lightweight, easy to use and makes it simple to
maintain a healthy mouth. Its four unique tips all rotate 360 degrees allowing
it to reach all areas of the mouth.

The new LR Appliance is a faster way to a straighter smile.
For clinical information contact Dr Ross Hobson on 07710 243690
or email: ross@oralign.co.uk

For more information on Waterpik® Water Flossers please speak to your
wholesaler or visit www.waterpik.co.uk. Waterpik® products are widely
available in Boots stores and selected Lloyds Pharmacies.

Open to Everyone – the
AOG
The AOG was formed 30
years ago by a group of
dental students at the
London
Hospital,
Mile
End, who all shared similar
backgrounds with financial
hardships. It began as a social network and every event that was organised led
to charitable contributions due to previous habits. Today, the AOG welcomes
everyone to join and support their work for ‘the greater good’. Dr Sangeeta
Lakhanpaul is the practice owner of Park Avenue Dental Care in London, with
her husband. Below, she outlines some of the advantages of being involved
with the AOG. “When I first became involved with the AOG, it was still very
much run by the founders as a social group. There is a huge charitable element,
and there are often chances to volunteer for educational tours and offer your
personal services to those who need them around the world.” “For those of us
who attend the events regularly, it is great to see old faces as well as constantly
meet new people. And tthere is always someone to offer fresh answers and
ideas!” Give something back to the dental industry, and gain access to a pool
of knowledge with the AOG.
The AOG – Do Dentistry: Do Good

Stay Ahead of the Competition
with ArmourBite®
Dr Garry McMahon is the
principal of McMahon Dental in
Blackrock, County Dublin, and
an authorised provider of Bite
Tech’s Under Armour Performance
MouthwearTM featuring ArmourBite® technology.
“Last year, a group of us, along with the Castleknock Dental practice, fitted the
entire Dublin Gaelic Football team with ArmourBite®”, says Dr McMahon. “The
feedback from the players and their fitness coaches was very positive. The team
went on to win the All-Ireland football final against Kerry in Croke Park in front
of 80,000 people.
“Around the same time we fitted top international rugby referees Alain Rolland
and Alan Lewis with non-contact mouthpieces. Alain Rolland, who also played
for Ireland, says that he routinely wears the mouthpiece when training and
during all his matches.
“We have also fitted Irish Rugby Internationals Felix Jones and Kevin McLoughlin,
along with a number of young golf professionals. Golfers are another target
group who can see the benefits of reducing stress and tension in the neck and
shoulder area.
“When it comes to Armourbite® in competition, the athletes who train at the top
say it’s the difference between first and second place.”

To showcase just some of its fantastic
new offers, The Dental Directory
has launched its latest Pricewatch
catalogue, which will run from April
until the end of June and features
a huge selection of infection control products at very special prices. These
include surface cleaners, disinfectants, wipes, gloves, autoclave equipment
and accessories to name but a few.
As you would expect from one of the UK’s leading dental suppliers, all of
the products listed in Pricewatch are designed to comply with the latest
decontamination guidelines provided by HTM 01-05 and the CQC.
To learn more about Pricewatch and The Dental Directory’s fantastic range of
infection control products, speak to your Dental Directory Representative, call
0800 585 586 or visit www.dental-directory.co.uk

Unique multiple rewards from unique
local anaesthetic
DENTSPLY has been committed to giving
the dental community innovative and
high quality dental products for more than
a century, providing the best tools and
materials for practitioners and patients
alike.
Citanest® offers a unique local anaesthetic
choice for dental patients who are sensitive to adrenaline. The adrenaline-free
product uses Felypressin as a vasoconstrictor to maintain local anaesthesia in
the required area.
Alongside other local anaesthetic products from DENTSPLY, Citanest can now be
ordered in the most cost effective way via the DENTSPLY Rewards website, with
significant extra rewards for practices placing bulk orders.
Xylocaine® 2 per cent with adrenaline is also available as part of the promotion.
Buying five boxes of either Xylocaine or Citanest can double the Rewards value
available. Ordering ten boxes can achieve triple Reward pounds.
By using the Rewards website, at dentsplyrewards.co.uk, dental practices can
benefit from significant Rewards pounds while still taking delivery from their
usual dental dealer. The Rewards pounds can be redeemed against future
purchases.

April 16-22, 2012

For information on administration contact Dr Lester Ellman on 07973 875 503 or
email: lester@oralign.co.uk Web: www.oralign.co.uk

For further details or to join visit www.aoguk.org.
For more information go to www.bitetech.com, call Nuview on 01453 872266 or
email armourbite@nuview-ltd.com

R4 Clinical+ Practice Management Software:
“supports clinical governance”
Dr Clive Schmulian is the principal dentist at
Clyde Dental Practice in Glasgow and has been
using R4 Practice Management Software (PMS)
from Carestream Dental for the last eight years.
“Our clinic is part of a group of dental practices,
all of which run R4 Clinical+,” says Dr Schmulian.
“The software supports clinical governance
in terms of record keeping. We perform both
sedation and implants and R4 is very good for
documenting all stages of sedation monitoring and implant treatment.
“R4 integrates well with KDIS and with Microsoft Word. It’s very adaptable.
“Having tried other PMS, I find that R4 is much easier to use and more powerful.
My staff certainly find it straightforward to operate.
“Our patients love the text messaging facility and we make good use of the
Communicator module for patient education. We’re able to email them
estimates and other information quickly and easily.”
For more information on R4 from Carestream Dental please call 0800 169 9692
or visit www.carestreamdental.co.uk

[29] =>

United Kingdom Edition

April 16-22, 2012

Dental Gateway: Join the
recruitment revolution
Post vacancies free of charge
Dental
Gateway
has
revolutionised
dental
recruitment in the UK with a
quick, convenient and cost-

RPA Dental – we heart dentists
In the competitive world of
dentistry, some companies stand
out on more than just price alone.
At RPA Dental we understand that
practices are often looking for a
little bit more from their equipment
provider – something extra that
makes them stand out from the
crowd.

effective service for dental professionals.
The UK’s only dedicated dental recruitment website, Dental Gateway allows
you to browse as many CVs as you like, free, until you find the person with the
right credentials and experience. You can also post any number of vacancies
at no charge. Once satisfied that you have found a suitable candidate, simply
purchase credit to access their contact details. Job seekers create a personal
profile, which includes qualifications, skills and availability, making it easy
for you to assess their suitability for the role. There is even a rating system
for temporary staff, to help you find the best candidates at short notice. With
an ever-growing database of available dentists, nurses, hygienists, practice
managers, receptionists and more, Dental Gateway has everything you need
in one place. Register with Dental Gateway and enjoy a user-friendly and
affordable service to help you find your ideal candidate, fast.
For more information visit www.dentalgateway.co.uk or call us on 0845 094
4031

That’s why we launched iheartdentists – www.iheartdentists.com – a campaign
that represents everything we stand for; a campaign designed to show our
clients just how much we care.
As a UK-based dedicated family business, we pride ourselves on knowing each
one of clients personally, knowing exactly what equipment they have, and
where they have it; knowing nurses on first name terms, and knowing exactly
who works where and when within the facility. It’s this level of care and customer
support that we feel makes us stand out head and shoulders above other
equipment providers as we really do heart dentists, and we think you’ll heart
us too!
To discuss your requirements or to arrange a cuddle, give us a call on 08000 933
975, or visit our equipment website, www.rpadental.net.

Industry News 29
Further your education with
Smile-on’s Key Skills 3
Smile-on is delighted to announce
the launch of their new Key Skills 3
on the 11th of April at FGDP. Smileon’s Key Skills 3: Record Keeping will
be a vital part of the MFGDP (UK)
examination and is a must needed
addition to dental education.
The Key Skills 3 qualification will
enable you to increase your understanding of the importance of keeping
full, precise and legible records. You will also be able to demonstrate your
understanding on the benefits of good record keeping and the potential
pitfalls and dangers of keeping poor records.
Smile-on’s Key Skills programme is a valuable and useful e-learning scheme
divided into 7 sections covering topics beneficial to you and your entire
team. Medical emergencies, infection control, radiography, team training, risk
management, legislation and practice guidelines are all covered in a straightforward format, which will help you fit your continuing education seamlessly
around your daily practice.
Smile-on wish to help you on your educational journey and all the information
you need for developing skills is at your fingertips online. The Key-Skills 3
launch will add to an existing successful scheme, continuing to help you
provide better treatment and care within practice.
For more information call 020 7400 8989, or email info@smile-on.com

Behind every successful Implantologist is
an Implantmed
The new Implantmed from W&H gives you the
most effective tools for oral surgical procedures
in the fields of implantology, microsurgery
and small-bone surgery with maximum
precision. The unit is easy to operate and
guarantees longer working without fatigue,
thanks to the lightweight, yet powerful motor
and the ergonomically-shaped contra-angle
handpiece. The easily operated foot control
allows for improved infection control whilst
freeing up both hands for treatment. The
automatic thread cutter function helps you
especially when inserting implants into hard bone. This function allows you for
thread tapping therefore minimizing compression of the bone and promoting
stress-free healing. The Implantmed is easy to use and its large display makes
values clearly legible. With a motor torque of 5.5Ncm and a motor speed range
of 300-40,000rpm, the Implantmed offers impressive power. The automatic
torque control can be set between five and 70Ncm, ensuring instrument
safety. In line with current decontamination guidelines, the motor and cable
are thermo washer disinfectable and can be sterilised. When used alongside
W&H’s range of surgical LED straight and contra-angle handpieces, the W&H
Implantmed is the first choice for professional dental Implantologists.
For further information regarding the full W&H Surgical Range contact W&H
(UK) on +44 (0)1727 874 990 or office.uk@wh.com. www.wh.com

BDA Conference Stand No C45
Bien-Air’s Reliability Guaranteed
Bien-Air regularly design and
release new products that are fully
backed by their Swiss guarantee.
The MX 2 brushless micromotor,
with adjustable LED light, is
Bien-Air’s newest micromotor.
Inspired by the MX, the MX2 offers
incomparable qualities including compact size, high power, and versatility;
perfect control of speed, torque and rotation and auto-reverse.
The latest additions are the Bien-Air Micro-Series contra-angles. They offer
you the very best in terms of grip and balance. They are ultra-precise, reliable
and as quiet as conventional models. With exceptional prices being offered at
Showcase, now is the time to invest in Bien-Air’s Micro-Series.
Also on show will be the latest addition to Bien-Air’s micromotor range, the MCX
Micromotor. When combined with Bien-Air’s Micro-Series Contra-angles, this is
one of the shortest brushless micromotors/handpiece combinations currently
available - comparable in length to a high speed turbine!
Come and talk to us about iChiropro, a new product for Implantology and claim
you free iPad 2. (Purchase of iChiropro required for free iPad 2)
Take advantage of the Bien-Air’s show only prices and we guarantee that you
won’t be disappointed!

CS 7600: intelligent X-ray
scanning
Simply ‘Scan & Go’ with the
new CS 7600, the ultimate
in digital intraoral imaging
plate technology from
Carestream Dental.
It couldn’t be easier to use.
Just take an image of the
patient’s teeth and swipe
the plate using the discreet
Scan & Go device attached
to your PC. Instantly, the plate is embedded with information such as patient
name, dentist name and tooth number.
Next, place the exclusive smart plate in the CS 7600 unit and high quality
images are automatically sent to the correct computer and patient file. In as
little as five seconds, you can view superior images for instant feedback.
Once the plate has been scanned, it is wiped of all data and ready for use on
the next patient.
Advanced Scan & Go technology ensures a faster and more efficient process.
Plates can be scanned in any order and the system does everything for you,
even notifying you if a plate has been inserted incorrectly.
The transition from film to digital imaging is simple and cost-effective with CS
7600, and provides a truly automated and secure workflow.
For more information, contact Carestream Dental on 0800 169 9692 or visit
www.carestreamdental.co.uk

dbg360 – the accreditation
package that works with you
dbg’s renowned accreditation
services are now even better
with dbg360, a flexible package

United Smile Centres – for
implant referrals you can
trust
At United Smile Centres
we use the latest dental
implant technology to
offer patients a real viable
alternative to dentures
and the prospect of failing
teeth. Our “Permanent
Teeth in a Day” treatment
can literally transform your patients’ lives, while opening up an additional
range of treatment options for you to offer your patients. We pride ourselves
on working together in synergy with referring dentists for the best possible
outcome. We even provide you with the final restoration ready for YOU to fit.
Jo, a busy professional from London, recently received treatment to replace
her failing teeth: “The United Smile Centres team were absolutely amazing.
The whole process was so smooth and efficient I went for the consultation on
the Wednesday and on the Monday I had the work done. “I’ve had a fabulous
experience with United Smile Centres – I really can’t recommend them highly
enough. From the nursing staff to the technicians and the dentists themselves,
they were all great. When you look at the credentials of the people treating you,
it’s hugely reassuring. You know you’re in the hands of a highly experienced
team.” For more information call United Smile Centres on 0800 8 49 49 59, email
info@unitedsmilecentres.co.uk, or visit www.unitedsmilecentres.co.uk

Visit Stand C45 or for further information please contact Bien-Air on 01306 711
303 or visit www.bienair.com

providing everything your practice needs.
With dbg360, practices can build a custom package to address their specific
needs, with options available in engineering, training and compliance. If you
feel your practice staff could benefit from on-site training in a particular area,
dbg360 offers a number of verifiable “Core” CPD and Health and Safety courses,
with CPD certificates available to download at any time upon completion. If your
equipment could use regular maintenance and service appointments, this can
be arranged.
The dbg360 package also includes the price of membership with dbg and all of
the exclusive services this entails. Additionally, all dbg360 customers will gain
access to the unique Virtual Compliance Office, an indispensible online tool
designed to offer even more compliance support and much more. With all of
these features included at a fixed price over 3 years, dbg360 is exceptionally cost
effective.
Stay compliant with “essential standards”, save time and save money by making
dbg360 an essential part of your practice routine.

BKH collaborates with The
Academy by Ash for Inaugural
Educational Programme
New dental corporate, the BKH
Group, has announced its first dental
education venture will take place
in collaboration with Dr Ashish B
Parmar (Ash) and his training academy, The Academy by Ash
(www.theacademybyash.co.uk).
“One of my goals personally is to always seek out and work with the best in
every field,” says Ash, “so I feel honoured I’ve been given this opportunity to
fulfil that goal.” Ash is a highly skilled cosmetic dentist and runs Smile Design by
Ash (www.smiledesignbyash.co.uk), a private dental practice in Essex. He has
taught both nationally and internationally, and was one of the leading dentists
on Extreme Makeover UK. “For me, the opportunity to work in synergy with
the likes of Chris Barrow and Laura Horton, and with the visionary leadership
of Dr Al Kwong Hing, is really very exciting,” Ash continues. “The BKH vision is
excellent, with the potential to make a big difference in UK dentistry.”
For more information about BKH please call 0161 820 5466 or email Al Kwong
Hing at al@bkh.co.uk, Chris Barrow at chris@bkh.co.uk or visit
www.bkh.co.uk
Want to stay in touch with the Barrow Kwong Hing Group: Connect with us
here Facebook: www.facebook.com/bkhgroupYouTube: www.youtube.com/
BarrowKwongHing
LinkedIn:
www.linkedin.com/company/barrow-kwong-hing-group:
Twitter: Chris Barrow @ChrisBKH, Dr Al Kwong Hingv@AlanBKH

Smile-on news for the 21st
century dentist
As a busy dental professional it
is important to keep up to date
with new knowledge and skills.
Nowadays, a hectic schedule makes
it easy to feel cut off from modern
developments and finding the time
to catch up on advancements in the
dental industry can be a challenge.
If you are constantly on the go with little time to access the information
you want, when you want, then the new Smile-on Application is for you. As
dedicated providers of further education to those in dentistry, Smile-on are
constantly finding new and innovative ways to ensure that you have the latest
dental news at your fingertips.
If you are a 21st century dentist, you will be able to access Smile-on News as an
App on your iPhone and iPad. This will mean that you can access up-to-date
articles, clinical case studies and all of the latest news relevant to you.
At any time of the day or night you will have a one-stop resource for all your
dental needs. Downloading the App could not be easier; simply visit the App
Store and download Smile-on News App and start learning dentistry your way,
in your own time.

For more information on how dbg could help your practice, call 0845 00 66 112,
or visit www.thedbg.co.uk

For more information please call 020 7400 8989 or email info@smile-on.com

Top five reasons why a Waterpik Water
Flosser should be part of your oral health
routine
With National Smile Month just around the
corner, here are just a few of the reasons why
a Waterpik Water Flosser makes a perfect
accompaniment to your patients’ regular oral
hygiene regime.
1. Patients get a fantastic clean feeling thanks
to the Waterpik Water Flosser’s pulsation and
pressure action, which dislodges bacteria and

Less is more
Philips
has
announced
the
introduction of the latest product to
add to its range of tooth whitening
innovations – Zoom DayWhite 6 per cent HP with ACP. This is an at-home
teeth whitening formula, designed to be dispensed by a dental professional,
in the form of custom fit trays into which whitening gel is applied. The trays
are worn twice a day for 15 to 30 minutes depending on the advice of the
dental professional, and will give patients a noticeably whiter smile within two
weeks. Zoom DayWhite 6 per cent contains Amorphous Calcium Phosphate
(ACP), which when combined with fluoride, spreads over the surface of teeth
and bonds with the enamel to provide enamel protection, improved luster and
shine, with reduced sensitivity. The product provides patients with a healthy
white smile and patients who have used it experienced less fadeback to their
original tooth colour after six months.

debris from teeth
2. It can clean between teeth, as well as deep below the gum line where other
products can’t reach, ensuring an all-over clean
3. Patients can say goodbye to bleeding or swollen gums and bad breath with
the Water Flosser’s proven ability to reduce gingivitis
4. Studies have shown the Water Flosser to be twice as effective as regular
dental floss for reducing bleeding1, making it an ideal additional treatment after
brushing
5. Featuring an adjustable pressure setting, patients using the Waterpik Water
Flosser can choose the most comfortable mode to suit them
Make the Waterpik Water Flosser part of your patients’ daily hygiene routine as
part of National Smile Month, and see the fantastic results for yourself!
For more information on Waterpik® Water Flossers please speak to your
wholesaler or visit www.waterpik.co.uk. Waterpik® products are widely available
in Boots stores and selected Lloyds Pharmacies. 1. Rosema study

An additional benefit for dental professionals is the product’s patented dualbarrel syringe technology, which provides guaranteed gel stability through its
shelf life without the need for refrigeration.
Philips Zoom DayWhite 6 per cent HP with ACP is compliant with the new
European Commission directive which prohibits the commercialisation of any
whitening products in the European Union (EU) containing more than six per
cent hydrogen peroxide.

[30] =>

United Kingdom Edition

De V is
n it
Sta tistry us!
nd S h
K 3 ow
1

FenderWedge
protects and separates

during tooth preparation

April 16-22, 2012

Dental Tribune UK
Editorial Board
Dr Neel Kothari
BDS Principal and General Dental Practitioner
Dr Stephen Hudson
BDS, MFGDP, DRDP
General Dental Practitioner
Mr Amit Patel
BDS MSc MClinDent MFDS RCEd MRD RCSEng
Specialist in Periodontics & Implant Dentist Associate Specialist Birmingham Dental Hospital
Professor Nick Grey
BDS, MDSc, PhD, DRDRCSEd, MRDRCSEd, FDSRCSEd, FHEA
Professor of Dental Education, National Teaching Fellow, Faculty Associate Dean for Teaching and Learning School
of Dentistry, Manchester
Professor Andrew Eder
BDS, MSc, MFGDP, MRD, FDS, FHEA
Director of Education and CPD, UCL Eastman Dental Institute
Mr Raj RajaRayan OBE
MA(Clin Ed), MSc, FDSRCS, FFGDP(UK), MRD, MGDS, DRD

FenderWedge protects the tissue and
separates the teeth, simplifying the following
application of a matrix.It can be applied
buccally or lingually for optimal access and
vision. Available in four color coded sizes.

Dramatically less traumatic
for you, your patients and
their dentition

Dr Trevor Bigg
BDS, MGDS RCS (Eng), FDS RCS (Ed), FFGDP (UK)
Practitioner in Private and Referral Practice
Baldeesh Chana
RDH, RDT, FETC, Dip DHE
President, BADT and Deputy Principal Hygiene and Therapy Tutor, Barts and The London School of Medicine and Dentistry
Dr Stuart Jacobs
BDS MSD (U Ind)
Full-time Private Practitioner
Shaun Howe
RDH
Dental Hygienist
Dr Richard Kahan
DS MSc (Lond) LDS RSC (ENG)
Endodontic Specialist
Mrs Helen Falcon
Postgraduate Dental Dean, Dental School, Oxford & Wessex Deaneries
Professor Liz Kay
Dean of the Peninsula Dental School, Plymouth
Pam Swain
MBA LCGI FIAM MCMI BADN® Chief Executive
Mr Raj Rattan
Associate Dean, London Deanery

Published by Dental Tribune UK Ltd
© 2012, Dental Tribune UK Ltd.
All rights reserved.

Dental Tribune UK Ltd makes every
effort to report clinical information and
manufacturer’s product news accurately,
but cannot assume responsibility for

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

Extraction Instruments

Luxator Periotomes are specially designed
periodontal ligament knives with fine tapering
blades that compress the alveolar bone, cut
the membrane and gently ease the tooth from
the socket. The whole operation is performed
with a minimum of tissue damage.

Group Editor
Lisa Townshend
Tel: 020 7400 8979
Lisa@dentaltribuneuk.com
Publisher
Joe Aspis
Tel: 020 7400 8969
Joe@dentaltribuneuk.com

Sales Executive
Joe Ackah
Tel: 020 7400 8964
Joe.ackah@
dentaltribuneuk.com

Design & Production
Ellen Sawle
Tel: 020 7400 8970
ellen@dentaltribuneuk.com

Editorial Assistant
Laura Hatton
Tel: 020 7400 8981
Laura.hatton@dentaltribuneuk.com

Design & Production
Rachel Harrison
Tel: 020 7400 8951

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

Follow us on Twitter

[31] =>

United Kingdom Edition

April 16-22, 2012

Classified 31

STAND OUT FROM THE CROWD

Choose a first class dental specialist
accountant, with unrivalled expertise
and over 30 years’ experience
dealing with:
• Tax savings – Chartered Tax Advisor
• Buying and selling a practice
• Incorporations
• NHS Superannuation
• HMRC Investigations

FREE
CONSULTATION
Book your free
initial meeting at
our Thame office.
WWW.DBS.ORG.UK
01844 260111

210x148.indd 1

29/03/2012 15:21

SPECIALIST DENTAL ACCOUNTANTS
- Assistance with Buying & Setting Up Practices
- NHS Contract Advice
- Tax Saving Advice for Associates and Principals
- National Coverage

Please contact:
Nick Ledingham BSc, FCA
Tel: 0151 348 8400
Email: mail@moco.co.uk
Website: www.moco.co.uk/dentists

- Incorporation Advice
- Particular Help for New Associates
- Help for Dentists from Overseas
- We act for more than 550 Dentists

Contact

To
advertise
call
Joe Ackah
on
0207
400 8964

[32] =>

Evolution in action
The original LED turbine just got even better!

Unbelievable Value:
Buy four W&H Synea Handpieces &
receive the least expensive FREE*

Synea offers an unbeatable range of handpieces to meet the needs of
our customers. This range includes W&H’s revolutionary range of LED
handpieces.
But not all LEDs are the same - and we want our customers to have the best.
So we are pleased to announce that W&H has raised the bar once again!
Improved positioning of the LED source at the head of the handpiece ensures
accurate bright illumination of your treatment site. The new LED+ also has an
unparalleled Colour Rendering Index (CRI) giving colours a supremely natural
feel. And Synea has a small head too, so your daylight quality light will not be
obscured by your handpiece.

ContacW&Htodayforadviceonhwtocmp

W&H(UK)Limted ParkSter,StAlbans t
6StroudWodBusine sCnter HertfodshireAL2 NJ,UnitedKingdom f
+

Contact W&H today to see things more clearly with Synea LED+.
W&H (UK) Limited
6 Stroud Wood Business Centre

* Conditions apply

Park Street, St Albans
Hertfordshire AL2 2NJ, United Kingdom

t +44 (0) 1727 874990
f +44 (0) 1727 874628

e office.uk@wh.com
wh.com

ISO2008
9001:
9001:
20002000
ISO ISO
9001:
Certificate
No.36436
FS 36436
Certificate
FS
Certificate
No.No.
FS 36436

Registered
Registered
Member
Member

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[cover] => DT UK No. 10, 2012

[toc] => Array ( [0] => Array ( [title] => News [page] => 01 ) [1] => Array ( [title] => ‘Periodontal Disease and Overall Health: A Clinician’s Guide’ [page] => 07 ) [2] => Array ( [title] => Discussing dental nurses [page] => 08 ) [3] => Array ( [title] => The receptionist role in CQC compliance [page] => 09 ) [4] => Array ( [title] => In whose interests? [page] => 10 ) [5] => Array ( [title] => Lab Tribune [page] => 11 ) [6] => Array ( [title] => Cause for concern [page] => 24 ) [7] => Array ( [title] => Seeking release from the daily grind [page] => 26 ) [8] => Array ( [title] => Industry News [page] => 28 ) [9] => Array ( [title] => Editorial Board [page] => 30 ) [10] => Array ( [title] => Classified [page] => 31 ) ) [toc_html] =>

Table of contents

[toc_titles] =>

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