DT UK No. 9, 2014

UK News / Dental materials: Are we all deviants? / Dentist health scare–shocking - but rare / New US government regulation eyes mercury disposal by dental offices / Business / “It is unacceptable to neglect severe oral diseases” / Online reviews: Does Google really forget? / Advantages of HEMOSTASYL for thixotropic wound dressing confirmed / “Patients must be at the top of our agenda” / Trends & Applications / A working opportunity for dental professionals in Europe

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DENTAL TRIBUNE
The World’s Dental Newspaper · United Kingdom Edition
Vol. 8, No. 9

www.dental-tribune.co.uk

PERIODONTITIS

ONLINE REVIEWS

SANDBLASTERS

An interview with Prof. Marcenes from
Barts and The London School of Medicine
and Dentistry about the findings of a
new study and why they are a cause for
concern.

With right to be forgotten legislation, relief from careerdamaging reviews now seems to be at hand, but does
Google really forget? Musing from Naz Haque of
Dental Focus.

Dentist Dr Hans H. Sellmann talks about Hager & Werken’s
Airsonic Mini Sandblaster in
dental practice and why it has
to be considered a “blast” for
patients.

” Page 8

” Page 10

” Page 14

IMPRINT
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Massive patient recall after breach
by dentist in Nottinghamshire
By Dental Tribune International
Thousands of patients treated by a dentist at
Daybrook Dental Surgery in Gedling near Nottingham have been recalled by NHS England
in Nottinghamshire to be tested for bloodborne viruses. Dr Desmond Jude D’Mello was
recently suspended for 18 months by the Gen-

eral Dental Council for violation of cross-infection control standards in multiple cases.
Police are also investigating the death of a
woman believed to have been treated by the
dentist and who died of viral acute myocarditis last year.

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© 2014, Dental Tribune International GmbH. All
rights reserved.
Dental Tribune makes every effort to report clinical information and manufacturer’s product news
accurately, but cannot assume responsibility for
the validity of product claims, or for typographical
errors. The publishers also do not assume responsibility for product names or claims, or statements
made by advertisers. Opinions expressed by authors are their own and may not reflect those of
Dental Tribune International.

Over 20,000 patients have been placed at low risk of being exposed to hepatitis B or C and HIV.
(Photograph Minerva Studio)

Charges against D’Mello arose after a whistle-blower sent secretly filmed footage to the
NHS.
Overall, he is believed to have treated more
than 20,000 patients since he started practising at the clinic in the early 1980s.
While NHS investigations found that he
did not carry blood-borne viruses himself,
the patients he saw could have been placed at
low risk of being exposed to hepatitis B or C
and HIV, Medical Director for NHS England in
Nottinghamshire Dr Doug Black said.
He said that his organisation is currently
working with Public Health England and the
General Dental Council to resolve the issue.
Support is also being provided by Southern
Dental, which has been running D’Mello’s
former practice since August, according to
Black.
Patients believed to have been treated by
the dentist are advised to contact the authorities for further advice. NHS has set up a community clinic at the health centre in Arnold,
as well as a telephone line, to support patients
treated by the dentist.
“Effective treatments are available for all
blood-borne viruses,” Dr Vanessa MacGregor,
Consultant in Communicable Disease Control for Public Health England in the East Midlands, said.

Millions lost to front-line health
care abuse in Northern Ireland
By Dental Tribune International
Health and dental care worth
£ 44 million were lost to crosscountry fraud last year, Health
and Social Care in Northern Ireland has reported. It said that, of
over 30,000 dental and ophthalmic treatments claimed for
exemption in the region in 2013,
over 8,000 have been under investigation owing to charges of
abuse.
More than 400 people have
been removed from general practitioner lists
in the last 18 months owing to fraudulent activities and more than 200 are facing legal action.
In most of these cases, exemption from
health care charges was claimed under false
pretences or fraud was committed by staff

submitting false time or travel
sheets.
In one case, for example,
£ 25,000 was claimed by a nurse
forging her manager’s signature.
The total loss is estimated at
3–5 % of the region’s health care
budget, which is £4 billion.
Northern Ireland’s Health Minister Jim
Wells (Photo www.dhsspsni.gov.uk)

“Fraud affects us all. All organisations suffer as a result and the health service is no exception. Every penny lost to fraud means less
to spend on front line services, meaning that
the range of treatment and care we may receive is severely reduced,” commented

Northern Ireland’s Health Minister Jim Wells
on the figures.
He said that the government is doing
everything possible to investigate fraud and
recover money lost, but support is also
needed from the public to tackle the problem.
“No one is above the law. I would encourage
everyone within the Health and Social Care
system to familiarise themselves with how to
report it and ask the public to ensure that
they are aware of what they are entitled,”
Wells said.
Since 2013, the service has been working
with Counter Fraud Services to detect and
prevent cases of fraud. This collaboration has
resulted in a conviction rate of 96 per cent, according to Health and Social Care.

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UK NEWS

Dental Tribune United Kingdom Edition | 9/2014

Barts study on severe periodontitis reveals
looming crisis
By Dental Tribune International
Figures by the National Health Service
indicate that at least one in 15 adults in the
UK currently suffers from the most severe
form of periodontal disease. Worldwide,
the situation looks even more devastating
with the condition to be found in roughly 11
per cent of the earth’s population. An international review published by researchers
from Barts and The London School of Medicine and Dentistry and dental institutions
in Australia and US in the Journal for Dental
Research has recently provided the first insights into the global dynamics of the disease and where it is most prevelant.
According to the paper, prevalence as
well as incidence of severe periodontitis
was reportedly highest in East Sub-Saharan
Africa and most parts of South America.
Several countries including Australia, Indonesia or Greece, among others, also
ranked below the global average.
Regions with low occurrence were North
America, followed by developed countries
in the Asia Pacific region, as well as Oceania
and Western Europe.
While no statistically relevant difference
could be found between genders, the researchers said the condition seemed to in-

crease with age throughout all surveyed
countries. Hence, people at age 38 and beyond are most at risk for developing severe
periodontitis.
Overall, the study found that more than
700 million new cases of severe periodontitis worldwide add to the already large burden every year, which makes the condition
rank among the six most prevalent diseases worldwide. If untreated, it can lead
not only to physical pain and psychological
discomfort, but also to functional limitation, as well as physical and psychological
disabilities, according to the author, Director of Research at Barts Health NHS Trust
Prof. Wagner Marcenes, who headed the
study.
“The number of severe periodontitis
cases has increased dramatically between
1990 and 2010. Since we did not include
other types of periodontitis such as its mild
and moderate forms, we are facing an even
more serious problem in the population’s
oral health,” he commented on the results.
He said that the data are currently being
evaluated further to find out what might
cause this high prevalence including socioeconomic indicators and other risk factors.

Periodontitis is most severe in South America and East Sub-Saharan Africa, according to the report.
(DTI/Photo eteimaging)

One of the largest assessment ever conducted on the disease, the review was looking at epidemiological data from more
than 70 studies involving 300,000 patients from 37 countries. While it provides
insight into the realities of the disease, according to the researchers, the results will
have to be treated with caution owing to the
problem on how to actually measure periodontal disease. A new standard intro-

duced by the American Academy of Periodontology and the US Centres for Disease
Control and Prevention in 2007, for example, made it difficult to compare any data
collected prior.
In the report, the researchers indicated
any site with Community Periodontal Index of Treatment Needs = 4, clinical attachment of larger than 6mm and pocket depth
of 5 as periodontitis.

GDC suspends dentist in rare case of malpractice
By Dental Tribune International
The General Dental Council (GDC) has reported that it is suspending the registration
of a dentist from Northern Ireland, after a
public hearing held by the disciplinary panel
in London found him guilty of over 100
charges of malpractice. According to the
council, he will be banned from practising
dentistry for five years unless he exercises his

right of appeal against being struck off the
register within 28 days.
The suspension is a rare case of a member
of the dental profession in the UK facing such
a high number of malpractice charges. In addition to allegations of having misdiagnosed
oral lesions and other conditions that led to
the development of oral cancer, the council

said that he had failed to carry out biopsies
when necessary and misinformed patients
about their condition.
Other charges against him involved poor
patient management and record keeping.
The council said that he had mistreated 27
of the patients he saw while working as consultant at the Royal Victoria Hospital’s School

of Dentistry in Belfast between 2006 and
2010. He was removed from the post when
patients he had treated presented with
symptoms of oral cancer.
Until August, he had worked as a dental educator at Queen’s University Belfast, but lost
in an unfair dismissal case.

Rise in endocarditis despite antibiotics
guidelines for dentists
By Dental Tribune International
Scientists at the University of Sheffield
have identified a significant rise in the number of people diagnosed with a serious heart
infection alongside a large fall in the prescription of antibiotic prophylaxis to dental
patients owing to respective guidelines introduced several years ago. The researchers
suggest that their results will provide the information the guideline committees need to
re-evaluate the benefits of administering antibiotics as a preventative measure.
The pioneering study is the largest and
most comprehensive to be conducted with
regard to the National Institute for Health
and Care Excellence (NICE) guidelines, which
recommend that dentists no longer give antibiotics before invasive treatments to patients considered at risk of the life-threatening heart infection infective endocarditis,
which in 40 per cent of cases is caused by bacteria from the mouth.

The team of international researchers, led
by Prof. Martin Thornhill at the University of
Sheffield’s School of Clinical Dentistry, discovered that since the NICE guidelines were
introduced in March 2008, there has been an
increase in cases of infective endocarditis
above the expected trend. By March 2013, this
accounted for an extra 35 cases per month.
They also identified that the prescription
of prophylactic antibiotics fell by 89 per cent
from 10,900 prescriptions a month before
the 2008 guidelines to 1,235 prescriptions a
month by March 2013.
Thornhill, Professor of Oral Medicine, said:
“Infective Endocarditis is a rare but serious
infection of the heart lining. We hope that our
data will provide the information that guideline committees need to re-evaluate the benefits, or not, of giving antibiotic prophylaxis.”
Thornhill stressed that health care professionals and patients should wait for the

guideline committees to evaluate the evidence and give their advice before changing
their current practice.
He added: “In the meantime, healthcare
professionals and patients should focus on
maintaining high standards of oral hygiene.
This will reduce the number of bacteria in the
mouth which have the potential to cause Infective Endocarditis and reduce the need for
invasive dental procedures to be performed.”
Barbara Harpham, National Director of
Heart Research UK, said: “The findings play
an important part in the ongoing exploration of the link between dental and heart
health. Projects such as this one are vital to
the ongoing collation of evidence to support
our understanding of how oral health can impact upon the heart and other conditions
within the body. We are committed to furthering medical research in the UK and welcome these new findings.”

The data was analysed by an international
group of experts from the University of
Sheffield, Oxford University Hospitals NHS
Trust, Taunton and Somerset NHS Foundation Trust, and the University of Surrey in
the UK, as well as from Mayo Clinic and the
Carolinas HealthCare System’s Carolinas
Medical Center in the US. The study was published in The Lancet journal online on 18 November under the title “Incidence of infective endocarditis in England, 2000–13: A secular trend, interrupted time-series analysis”
and presented last week to more than 19,000
international attendees at the American
Heart Association annual meeting in
Chicago.
The research was funded by a grant from
national heart charity Heart Research UK,
health care provider Simplyhealth and the
National Institute of Dental and Craniofacial
Research.

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OPINION

Dental Tribune United Kingdom Edition | 9/2014

Dental materials: Are we all deviants?
Dr Thomas O’Connor, London
When I was training at university,
every stage of a procedure was supervised,
step by tedious step. The
“idiot sheets” (as
our restorative
dentistry professor called them)
for each material
were available to
be referred to and followed religiously. Deviating from those instructions was not an
option.
A few years into practice, it begins to be
difficult recalling what was said about
which particular materials. You know that
you were told what was compatible with
what, and what was not. When a sales representative turns up with something wonderful and new and better, a little alarm
rings in your head, cautioning you that
what the representative is telling you is
contrary to what you were taught. But no,
the representative quite confidently assures you that the research says, the studies show and the in vitro trials prove. And
most importantly, the new product is
faster. Yes, faster, much faster. You can save
a whole 30 seconds per procedure. You do
not have to wait for the next step: this does
two steps in one or even three, if you want
to be really good. And faster is better.
At this point, you begin to regret your
failing recall of material science. How am I
supposed to evaluate which material is
best, when each of the glossy brochures
shows that they are all better than each
other?

lost in the day-to-day stresses of the workload: that little step being skipped just this
once, then once again, and then another
step gone the next time. It is the normalisation of deviance: people becoming so accustomed to deviating a little from procedure that “they don’t consider it as deviant,
despite the fact that they far exceed their

own rules for elementary safety”. Just skipping that little step this time, not performing the process exactly to the manufacturer’s instructions, finding a way that is
convenient, and assuming no responsibility for the results of the deviance. When
something goes wrong, when a restoration
fails, when a patient is in pain, it is the fault

of the material, or the patient, or the laboratory or the nurse.
The next time you are placing or cementing or layering, stop and ask yourself:
am I being a deviant? Refer to your idiot
sheet and take the time to recall the correct
process step by step. And deviate back to
normality.

The end to bleeding

“Maybe we all
have a bit of
that in us.”
The truth of the matter is, of course, that
virtually all of the mainstream products
out there are fit for purpose. What makes
any material good, bad or indifferent is
how the clinician uses it, including skill,
time, effort and the amount of care. Even
the best of products is going to be rubbish
in the hands of someone who uses it badly.
“Lithium disilicate crowns are useless,”
I was told by a dentist recently. “Every one
I have placed has fractured.” With twice as
many years of clinical experience as me,
this dentist was preparing for this material
exactly as he would for a porcelain-fusedto-metal (PFM) crown, using a coarse diamond fissure bur. The same internal angles, same margins, same lack of surface
finish, same flat occlusal surface on the
preparation that he had always had, and
cementing the final product with glass
ionomer. This had served him well for PFM
crowns, but this new material was letting
him down.
What was his conclusion? The material
was to blame. Progress was a bad thing. He
was going to stick with what he knew
worked, full coverage PFM crowns for
everyone, and disregard progress.
Maybe we all have a bit of that in us. All of
the exact details of every process can be

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Practical

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by mechanical action

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UK NEWS

Dental Tribune United Kingdom Edition | 9/2014

Dentist health scare–shocking, but rare
Amanda Maskery, Newcastle
The recent news that 22,000 patients of
a Nottinghamshire dentist are being contacted and offered testing for blood-borne
diseases, suchas HIV and Hepatitis B and C, is
truly shocking.
Every patient treated by Mr Desmond
D’Mello over the last 3 decades is being urged
to contact NHS England for testing, because

of concerns about the standards of clinical
care at his Nottingham surgery, primarily in
relation to infection-control procedures.
It is reported that NHS England were contacted by a whistle-blower in June 2014 and
as a result Mr D’Mello has been suspended.
Covert filming at his surgery apparently
shows, among other things, failure to prop-

erly sanitise equipment and the re-use of
dirty gloves.
NHS England has assessed the risk of infection as low, but the concern that his patients
are experiencing is completely understandable.
Dentists are subject to regulations that
cover all aspects of clinical practice, includ-

ing cleanliness and infection control. It is the
responsibility of the Care Quality Commission (CQC) to inspect dentists, such as Mr
D’Mello, and to ensure that fundamental
standards are being met.
According to the CQC, an inspection of his
practice last year raised no cause for concern.
However, in light of the information received by NHS England, a re-inspection identified failings in cleanliness and infection
control standards, safety and suitability of
equipment and monitoring of the quality of
service.
No doubt questions will be asked in due
course as to whether these failings could or
should have been identified sooner. It is
however, worth placing this undoubtedly
troubling case into context.
Earlier this year, my law firm Sintons
made a Freedom of Information Act request
to the CQC in order to determine the level of
enforcement action undertaken by the CQC
in the dental sector. The response clearly
demonstrated that the overwhelming majority of dental practices are compliant with
the regulations and that the breaches that
have come to light in this case are an exception to the rule.
By April 2014, there were over 10,000 locations where dental services were provided in
England. The CQC undertook 5,720 inspections, which resulted in 34 warning notices
being issued based on breaches of regulations. The warning notices stipulated a time
period for the provider to take the necessary
steps to remedy the breach.
The most common breach that was identified during the inspections were eight instances relating to cleanliness and infection
control (down from 20 cases in the previous
year). A failure to assess and monitor the
quality of service provision accounted for a
further seven warning notices.
In every case where a warning notice was
issued, the provider responded appropriately and addressed the breaches to ensure
future compliance. Consequentially, the
CQC took no further action.
The CQC have recently published their
planning for the way primary care dental
services should be regulated and inspected
in the future. One of their priorities is to develop an approach to inspection that protects the public from unsafe care. While such
an approach is welcomed, hopefully this
troubling case in Nottinghamshire will not
detract from the fact that the majority of
dental services are
safe and that the
quality of care is
good.

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

[5] => Musterseite_DTG

WORLD NEWS

Dental Tribune United Kingdom Edition | 9/2014

5

New US government regulation eyes
mercury disposal by dental offices
By Dental Tribune International
WASHINGTON, DC, USA: Despite its known
negative effects on the environment, tons of
mercury derived from removed amalgam
dental fillings end up in public wastewater
systems in the US each year. New rules proposed by the Environmental Protection
Agency (EPA) last week aim to reduce the
threats posed by improper waste disposal by
making it mandatory for dentists nationwide
to employ amalgam separators, among other
measures.
With the new regulations, which are part of
the Clean Water Act, the agency hopes to decrease toxic metal discharges, including mercury, by at least 8.8 tons a year. In order to reduce the financial burden for states and localities, which would have to implement and
oversee the new rules, EPA also announced
initiatives to streamline oversight require-

ganisation to ensure that it will not place undue burden on the dental profession. Dental
clinics that fully comply with the regulations
will incur a cost of US$700 a year, according to
EPA.

While relatively harmless when used in
dental fillings, mercury can become highly
toxic when it reacts with specific aquatic
microorganisms. This variant, known as
methylmercury, accumulates in fish and

fish-eating animals, posing serious health
risks to humans when consumed. Among
other conditions, research has linked it to cardiovascular disease and developmental
deficits in children.

© DmitriMaruta/Shutterstock.com

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effective in September next year.
EPA estimates that up to 3.7 tons of mercury are released annually from dental offices in the US, which equals 50 per cent of the
total mercury released by dentistry and
other industries into the public wastewater
system, according to the Zero Mercury Working Group in Vermont. While amalgam separators have been shown to be effective in the
collection of the toxic metal before it is released, so far only 12 states, including New
York and Massachusetts, have mandated
their use in dental clinics. Under the new
rules, dentists nationwide would be required
to install and use these systems permanently
for the very first time.
“This is a common sense rule that calls for
capturing mercury at a relatively low cost before it is dispersed into the publicly owned
treatment works. It would strengthen human
health protection by requiring removals
based on the technology and practices that
approximately 40 per cent of dentists across
the country already employ thanks to the
American Dental Association [ADA] and our
state and local partners,” commented Kenneth J. Kopocis, deputy assistant administrator for EPA’s Office of Water, in a press release.
The ADA has been recommending the use
of separators for disposing dental amalgam
through its best management practices
guidelines since 2007. Reports show, however, that in states without mandatory use of
the devices proper disposal of amalgam
waste is still seriously lacking. Asked by
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the proposal, ADA officials would only say
that it is currently being reviewed by their or-

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[6] => Musterseite_DTG

BUSINESS

6

Dental Tribune United Kingdom Edition | 9/2014

Henry Schein opens new UK headquarters
By Dental Tribune International
Almost a year after construction started,
Henry Schein opened its new headquarters
in the Gillingham Business Park in October.
The new state-of-the-art and energy-efficient
facility, which includes two floors of office
space and a warehouse, will serve as the main
office and distribution centre for the company’s dental and medical customers in
the UK.

The new facility was built adjacent to the
existing Henry Schein UK facility at the site,
which was established in 1991. Its new warehouse includes an education centre with a
showroom for product demonstrations featuring a wide range of innovative high-tech
digital technology. The company is also planning to develop additional warehouse space
if more storage capacity is needed.

“This new, outstanding facility is a source of
great pride for our company, underscoring
our commitment to environmental sustainability, as the project’s planning and construction has taken into account the impact on the
surrounding environment,” said Stanley M.
Bergman, Chairman of the Board and CEO of
Henry Schein, at the opening on 8 October,
which was attended by over 500 people.

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The company stated that its new facility
was built with sensitivity to the surrounding
natural habitat and local animal species.
Over the course of the project, measures were
taken to clear vegetation in an environmentally sensitive manner and to protect and relocate protected wildlife inhabiting the development site, and a trained ecologist made
periodic visits to the site. Henry Schein also
worked with Medway Council, the government authority charged with providing local
services to Gillingham and other nearby
towns, to create an acoustic and visual barrier
between the new facility and nearby homes
by planting trees.

Influx of
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targeted
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According to figures from the Medicines
and Healthcare Products Regulatory Agency
(MHRA) in London, over 12,000 individual
pieces of counterfeit and unapproved dental
products were seized in the UK up to April this
year. At the recent BDIA Dental Showcase, the
British Dental Industry Association (BDIA) announced that it will partner with major dental
and general media outlets, including the BBC,
to heighten awareness among dental professionals and the general public of the dangers
these products can potentially pose.
In addition to a widespread advertising
campaign to be run in the British dental press
in 2015, an upcoming episode of Fake Britain,
a consumer rights show airing on BBC One, is
going to address the situation, which, according to the BDIA, increasingly poses health
risks to both patients and users of the products.
While they still represent a small market
share, the number of substandard devices
purchased by dental professionals has
steadily grown in recent years across all segments.
“We are now seeing copies and substandard
versions of more complex devices, such as
dental X-ray machines and handpieces, being
increasingly purchased through the Internet
and other sources,” Bruce Petrie from the
MHRA told Dental Tribune.
In order to address the situation, the agency
in partnership with the BDIA launched the
Counterfeit and substandard Instruments
and Devices Initiative earlier this year, which
aims to make more dentists aware of the problem and to report questionable products to
the relevant authorities.
BDIA Executive Director Tony Reed commented, “We are pleased with the very positive reception that our initiative has received
and the next step in growing awareness
amongst the dental team is the launch of our
advertising campaign.”
According to the BDIA, dentists and members of the dental team should be vigilant regarding products of unknown origin and report suspect devices immediately through its
website. Products manufactured by reputable
suppliers such as BDIA members generally
pose no concerns, the association said.

[7] => Musterseite_DTG

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

[8] => Musterseite_DTG

WORLD NEWS

Dental Tribune United Kingdom Edition | 9/2014

“It is unacceptable to neglect
severe oral diseases”
An interview with Barts and The London School of Medicine and Dentistry Professor Wagner Marcenes, London.
In a report, researchers of the Global Burden of Diseases, Injuries, and Risk Factors
Study have recently shed light on the global
dimensions of severe periodontitis, which
now affects over 700 million people worldwide. This study is a major effort involving
more than 1,000 scientists to systematically
produce comparable estimates of the burden
of 291 diseases and injuries and their associated 1,160 sequelae in 1990, 1995, 2005 and

velop during adulthood, showing a steep increase between the third and fourth decades
of life. With more people living longer and retaining their teeth for life, the risk of developing severe oral health-related problems, particularly periodontitis, will be high. The
world’s population is expected to almost
double by end of this century, implying that
the number of people with severe periodontitis may at least double.

we see at the moment is a growing number of
people smoking in developing regions contrary to the trend in most developed countries. Nearly 80 per cent of the more than one
billion smokers worldwide live in low- and
middle-income countries. With 1,500 new
cases every year, Argentina for example has
the highest incidence of severe periodontitis,
which is almost double the global average,
and high tobacco consumption. We cannot

Prof. Wagner Marcenes

The choice of including only severe periodontitis and not less severe forms of periodontal disease, such as mild or moderate periodontitis and gingivitis, was because of
their low impact (disability weight) on quality of life. Since periodontitis tends to
progress from mild to severe if untreated, our
numbers reflect only the tip of the iceberg, indicating the seriousness of the challenge to
health professionals.

Aerial view of Buenos Aires, the capital of Argentina. The South American country has the highest incidence of severe periodontitis in the world.
(Photo Celso Diniz)

“With more people living longer and retaining their teeth
for life, the risk of developing severe oral health-related
problems, particularly periodontitis, will be high.”
2010. Dental Tribune UK had the opportunity to speak with lead author Prof. Wagner
Marcenes from Barts and The London School
of Medicine and Dentistry in London about
the findings and why they are a cause for concern.
Dental Tribune: Prof. Marcenes, the prevalence
of severe periodontitis on a global scale has not
increased significantly in the last two decades,
according to your report. Why are the numbers
worrying nevertheless?
Prof. Wagner Marcenes: Having more
than 700 million people suffering from severe periodontitis is really worrying. Although the proportion remained the same in
1990 and 2010, the number of people needing periodontal treatment has increased dramatically. This is because worldwide more
than one in ten people suffer from severe periodontitis and the world population grew
from 5.3 billion in 1990 to 6.9 billion in 2010.
Moreover, severe periodontitis tends to de-

How do the results compare to the situation
prior to the surveyed period?
We have updated the data from the first
Global Burden of Disease (GBD) study and
generated comparable figures in 1990 and
2010. Therefore, we were able to compare the
current and the previous situation to our survey in 2010. Since the study is unique, we do
not have global data before the first GBD
study. However, we know that oral diseases
have decreased significantly in most industrialised countries, such as the UK and the US,
in the last five decades.
Severe periodontitis appears to be most prevalent in South America and east sub-Saharan
Africa. What could be the reasons for that?
Our study was not actually designed to test
risk factors of periodontal disease, but based
on pure reasoning, I would say that, in addition to demographic changes, smoking and
poor oral hygiene may be the main factors associated with it. This is speculation, but what

establish a cause and effect relationship, but
I believe that the high incidence of periodontitis in these areas is most likely related to the
habit of smoking.
In you report, you mention how difficult it is to
determine disease prevalence owing to different classification systems. Is your representation of the situation therefore a realistic one?
I am confident our report provides a realistic, comprehensive assessment of the global
burden of severe periodontitis. After much
consideration, we used a Community Periodontal Index of Treatment Needs score of 4,
a clinical attachment loss of greater than
6 millimetres or a pocket depth of more than
5 millimetres as indicators of periodontitis.
We used the measurements adopted by the
World Health Organization, which are considered by most as the most reliable indicators of severe periodontitis. We endeavoured
to reflect the measures adopted by the larger
community of public health dentistry.

Why is the situation so little addressed by the
dental community, and how could it be better
addressed?
The fact that a preventable oral disease is
the sixth most prevalent of all 291 diseases
and injuries examined in the 2010 GBD is
quite disturbing and should cause all of us to
redouble our efforts to raise awareness of the
importance of oral health among policymakers. It is reasonable to prioritise life-threatening diseases that have a greater impact on
quality of life; however, it is unacceptable to
neglect severe oral diseases. Untreated caries
in the permanent dentition is the most
prevalent of all oral diseases and periodontitis the sixth, and untreated caries in the primary dentition is the tenth most prevalent
disease in the world.
It is possible that the prevention and treatment of periodontitis are neglected because
most health strategies target children at
school and severe periodontitis is uncommon before the age of 20. I believe we need to
seriously consider a change in strategy and
target the adult population. Also, we should
focus on determinants of health rather than
the disease itself.
We call this the common risk factor approach. For example, many dental practices
in the UK run smoking cessation programmes. This will not only reduce the number of cases of periodontitis but also help prevent life-threatening diseases, such as cancer
and cardiovascular disease. Adopting the
common risk factor approach would lead to
the inclusion of oral health in the top five
most relevant diseases. This is because oral
diseases and serious life-threatening diseases share the same determinants, for example smoking, hygiene and diet.
Thank you very much for the interview.

[9] => Musterseite_DTG

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Tribune Group GmbH is the ADA CERP provider. ADA CERP is a service
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33

C.E.

CREDITS

Tribune Group GmbH i is designated as an Approved PACE Program Provider by the
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[10] => Musterseite_DTG

TRENDS??????????
& APPLICATIONS

Dental Tribune United Kingdom Edition | 9/2014

Online reviews:
Does Google really forget?
Naz Haque, Dental Focus
How is your relationship with
Google; do you love or hate it? Does
it display negative information
about your dental practice? With
right to be forgotten legislation, relief from career-damaging reviews
now seems to be at hand, but does
Google really forget?
In May, the EU Court of Justice
found in favour of a Spanish citizen who sued Google for listing information about him that he asserted was no longer relevant. He
alleged that this information was
prejudicial to his selling a property. Fortunately for him, the court
approved his appeal, contributing
substantially to the right to be for-

gotten being drafted into European law.
For Google, this ruling opened
the floodgate for requests for thousands of links to be removed from its
search engine results page from residents in the EU. By July, it was estimated that the company had already received at least 70,000 such
requests. Many applicants have
made use of lawyers or search engine optimisation professionals,
creating a niche for companies,
which are charging the price of an
implant per month to manage their
clients’online reputation on Google.
The company’s hands are tied in
this matter. Regardless of its algo-

rithms’ preference in ranking news
and media sites, they have to follow
this ruling. Recent threats of financial penalties in various European
countries have softened Google’s
resolve further, and there is a similar ongoing case in Japan. Is it possibly the end of the line?
For some dentists, this could be
the long-awaited answer to their
prayers. In an era in which online
competition is omnipresent, to the
patient’s critical eyes, negative reviews can be very damaging to a
business. In the past, a lifelong career could be destroyed by unsubstantiated hearsay online. A seasoned professional’s one error

would previously always have been
visible on Google, possibly damaging that person’s confidence, career
and standing. I have numerous
conversations about negative Facebook/Yell/Google reviews on a
weekly basis here at Dental Focus
and receive a large volume of
phone calls about how to be removed from Google for bad press.
What about data on dentists who
have been investigated by the General Dental Council and cleared? Is
not making this data available fair
to them or do patients deserve to
know the full story regardless of
how much the dentist has invested
in developing or redeeming himself or herself? If you were a
prospective patient, would you
perform a search and be put off by
any negative findings?
No doubt, there is a minority
who deserve to be highlighted on
Google for all their wrong-doings.
What is the position regarding having their names omitted?

ual request and attempt to balance
the privacy rights of the individual
with the public’s right to know and
distribute information. When evaluating your request, we will look at
whether the results include outdated information about you, as
well as whether there’s a public interest in the information—for example, information about financial
scams, professional malpractice,
criminal convictions, or public conduct of government officials.”
Will you be safe once a link has
been removed from Google? There
are sites such as hiddenfromgoogle.com that openly display all
hidden results. Even if a result has
been hidden, the bottom of the results page on Google states that
some results have been removed.
At times, it even provides a link to
hiddenfromgoogle.com.
It appears that, even if something
has been deleted, Google still knows
everything about you. Everything
on the Internet is recorded forever

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Naz Haque, Dental Focus

www.hagerwerken.de
Tel. +49 (203) 99269-0  Fax +49 (203) 299283

Video

In the first week of Google making available a means for search removal requests, 22 per cent (the
greatest number by nation) of all applications came from the UK. When
requesting removal from Google’s
search engine results page, the user
must not only list all links he or she
wants to be removed, but also provide the reason that he or she wants
to have such links removed. Invasion of privacy appears to be a popular reason.
Unfortunately, the company has
also had numerous cases of fraudulent removal requests from impersonators trying to harm the competition. It seems that there is always
good and bad practice, whatever the
medium.
In order to manage this, Google
states: “We will assess each individ-

(your party antics, hangovers and
selfies), and where one stops tracking, another will take over. If a patient really wanted to dig up some
dirt, with a limited bit of knowledge,
he or she still could do so.

CONTACT INFO
Naz Haque, aka the Scientist, is Operations Manager at Dental Focus.
He has a background in mobile
and network computing, and has
experience supporting a wide
range of blue-chip brands, from
Apple to Xerox. As an expert in
search engine optimisation, Naz is
passionate about helping clients
develop strategies to enhance
their brand and increase the return
on investment from their dental
practice websites.

[11] => Musterseite_DTG

TRENDS & APPLICATIONS

Dental Tribune United Kingdom Edition | 9/2014

Advantages of HEMOSTASYL for
thixotropic wound dressing confirmed
Results from an empirical comparative study
Dr Sven Schomaker, Germany
Haemostasis has proved fundamental
for the prevention of excessive blood loss
and for wound healing after injury, or
wound setting. It is a basic prerequisite for
flawless work in restorative dentistry.
There are numerous tissue management
systems for haemostasis and retraction on
the dental market, including mechanical
techniques and locally acting chemical
agents, which can be applied alone or in
combination with retraction sutures.
In a survey in which German dentists
tested the practicality of various haemostatic agents and compared them, the
thixotropic HEMOSTASYL (Pierre Rolland,
Acteon Group) achieved the best results.
Among other things, the gel was found
superior in terms of astringent and haemostatic effects, as well as handling properties.

Rolland introduced a new type of gel in
Germany in 2007. HEMOSTASYL is a
thixotropic product for light to moderately heavy bleeding and contains
aluminium chloride. Its angled syringe applicator facilitates direct and precise application. The gel achieves its haemostatic
effect through a combination of
aluminium chloride and kaolin. This is
mechanically augmented by the thixotropic properties of the material.
Haemostasis should begin to take effect
in less than 2 minutes, after which the
treated area should be free of bleeding. The
gel is applied with the application cannula,
with no pressure exerted on the gingiva. After haemostasis has been achieved, the
turquoise-blue substance is removed with
a light air and water spray and simultaneous suction (Figs. 1–4).

The best means of avoiding possible
bleeding complications is a conservative
procedure that causes little trauma to the
tissues and vessels. In many cases, a sufficient local therapy can also help prevent
bleeding complications during and after
surgical procedures or reconstruction. In
addition to the body’s own haemostatic
mechanisms, there are a number of measures and substances in dentistry that support haemostasis. They can be mechanical,
chemical, thermal or surgical, or any combination of these. The choice of product or
technique depends on the clinical situation (localisation, and the extent or risk of
bleeding), as well as on the clinician’s preferences.
Adopting a different approach to the
products available on the market, Pierre

In order to determine whether this product offers advantages over other products
used for haemostasis, some 1,000 sample
packs were distributed to dentists, orthodontists and oral surgeons throughout Germany, along with instructions for use and a
questionnaire. Over 500 participants
agreed to take part in the test. The questionnaire was developed in collaboration with
the Department of Medical Biometry and
Epidemiology at the University Medical
Center Hamburg-Eppendorf. It consisted of
two sections: the first part dealt with general
information about other products used for
haemostasis and their indications, and the
second part asked participants to evaluate
HEMOSTASYL and compare it with the other
products with respect to haemostatic properties, handling and time to haemostasis.

Over the course of the study, HEMOSTASYL was tested 2,542 times. The majority
(69.4 %) of the participants applied it four
to ten times. The properties of the product
were compared with those of more than
13 other haemostatic products, including
ViscoStat, Ultradent; Astringedent, Ultradent; and Racestyptine, Septodont, which
were used by over 50 per cent of the participants. Just under half of the participants
said impression taking was the most frequent indication, followed by composite
fillings. Only one in ten reported using it in
tooth preparation. Other indications included cementation, temporary crowns,
bracket bonding, retainer bonding, and
amalgam and CEREC restorations.
Using the Mann–Whitney test, it was determined that the participants rated
haemostasis with HEMOSTASYL statisti-

cally significantly better than with the
other products for the listed indications. Almost 87 % (443) of the participants gave
haemostasis with the thixotropic gel a
score of 1 or 2. Only 69.4 % (354) of the
participants gave any of the reference products such a high rating.
A result of no bleeding after application
of HEMOSTASYL was reported by 32.2 %
(164) of the participants. With the reference
products, only 20 % achieved this effect.
Moderate bleeding with HEMOSTASYL was
reported by only 10.4 % (53) of the participants. By contrast, moderate bleeding after
application of one of the reference products was relatively frequent (26.3 %).
The gel from Pierre Rolland also achieved
a statistically significantly better result
with regard to handling: over 90% rated the

handling of HEMOSTASYL as very good or
good. This rating was given to the other
haemostatic products in only half of the
cases. These received a score of 1 from only
13.9 % (71) and a score of 2 from 40.6 % (207)
of the participants.
Using the chi-squared test, it was determined that the rating for HEMOSTASYL regarding time to haemostasis was also statistically significantly better than for the
reference products. More than three-quarters (386) of the participants reported that
haemostasis using the gel was achieved
rapidly. Only 34.7 % (177) of the participants
rated the other products just as highly.
Considering all properties together
(haemostasis, handling/application and
time to haemostasis), HEMOSTASYL was
rated better overall than any other reference product.
The aluminium chloride in the gel
appears to offer additional enhancement
of haemostasis. As it can be applied directly
and precisely in the mouth with the angled
syringe applicator, it also fared better with
the testers with regard to its handling and
application. Other advantages are that it
can be removed easily with an air and water
spray and it is easy to detect owing to its
high-contrast turquoise colour. In addition, HEMOSTASYL was given a higher rating by most of the participants with respect
to the time factor, as treatment (for example, taking an impression or bonding inlays) can be continued immediately after
haemostasis with the haemostatic wound
dressing under optimal conditions.
Participants also reported other benefits
of the product, including painless treatment, particularly when the wound dressing is applied to a healthy periodontium,
and high tolerability without undesirable
systemic side-effects, as can be the case
with haemostatic agents containing epinephrine for example.
Overall, HEMOSTASYL distinguishes
itself with its thixotropic properties and
consequent ease of application and very
good adhesion to the tissue without exerting pressure, as well as the associated
mechanical effect. The results proved that
HEMOSTASYL is indicated for efficient
haemostasis in cases of light to moderate
bleeding. With clear indications for use and
easy application with reduced risk to the patient, it can be considered another step forward in quality assurance in the dental
practice.
Editorial note: A list of references is available
from the publisher.

DR SVEN SCHOMAKER
maintains a private practice in Hamburg in Germany. His contact details
can be found at www.zahnarzt-hamburg.biz.

[12] => Musterseite_DTG

TRENDS & APPLICATIONS

Dental Tribune United Kingdom Edition | 9/2014

“Patients must be at the top
of our agenda”
An interview with the Chair of the BDA Health and Science Committee Dr Graham Stokes, London.
In November, experts and researchers
from around the UK met in London for a summit organised by the British Dental Association (BDA) to discuss what dentistry can do to
address the problem of antimicrobial resistance. Dental Tribune UK had the opportunity
to speak with Dr Graham Stokes, Chair of the
BDA Health and Science Committee and one
of the initiators of the summit, about its outcomes and implications for the profession.
Dental Tribune UK: Dr Stokes, antimicrobial resistance has been identified as a serious threat
to public health worldwide in a report issued
by the World Health Organization this year.
Deputy Chief Medical Officer for England Prof.
John Watson recently said that the rise of multidrug-resistant bacteria is creating the perfect storm. Is the summit to be understood as a
response to these warnings?
Dr Graham Stokes: The summit was actually held in conjunction with the upcoming
European Antibiotic Awareness Day on 18

cases, patients could be treated in alternative
ways that may be better suited to their pain.
What we need to do is to determine how we
can improve that situation by looking at the
factors that influence the reason that antibiotics are given in dentistry, both in primary
and secondary care. It is also important to
work together to ensure that the appropriate
treatment is given at the appropriate time to
patients. They must be at the top of our
agenda.
In a letter published in the recent edition of the
British Dental Journal, your colleague Dr Susie
Sanderson wrote that the encouragement for
antibiotic stewardship in dentistry in the UK is
lacking. Would you agree with this statement,
and who is to blame for the situation in your
opinion?
What we learnt at the summit was that dentists overall feel that they prescribe antibiotics to a minimal extent compared with
other fields. They also perceive that pressure

annual congress in Manchester. How far have
you come with this endeavour, and what were
the main points agreed on by most participants?
Obviously, there was a wide-ranging discussion on all of the topics and information
presented to us. One of the recommendations was that dentists should have properly
funded protected emergency slots in their
daily work. We also need systems in place to
protect dentists when complaints arise after
they have performed a treatment that they
believed was the appropriate one. Furthermore, it would be beneficial for dentists to
monitor their own prescribing patterns so
they can ensure the best care for their patients.
It is also important that we inform the public and our patients about antimicrobial resistance and encourage dentists to discuss
their antibiotic-prescribing policy with their
patients as early as possible. In order to do
this, we need to ensure that graduates receive

Dr Graham Stokes

“…dentists overall feel that they prescribe antibiotics
to a minimal extent compared with other fields.“

November. We at the BDA felt the need to convene experts and researchers working in the
field of antimicrobial resistance in order to
consider the role of dentistry in addressing
this difficult problem, in particular working
towards improving awareness in the profession and among the general public.
Dentists are responsible for approximately ten
per cent of all antibiotic prescriptions in the
UK. How much do we know about how many of
these are prescribed inappropriately?
Evidence suggests that of all antibiotics
prescribed through dentistry, some are indeed inappropriately given. In many of these

from patients sometimes influences
whether and how antibiotics are provided,
even when other treatments seem to be more
appropriate. That is why we need a co-ordinated approach to ensure that there is
enough time for dentists to treat patients
properly, particularly those who come in unscheduled with an emergency. Such care
needs to be appropriately funded as well.
There needs to be greater awareness among
dentists in general of the problem of antimicrobial resistance, however.
One of the aims of the summit was to compile
a consensus report to present at the BDA’s next

good knowledge of antibiotic prescription
through their training and that they know
how to translate this knowledge into practice.
Leadership from the Department of
Health is needed in co-ordinating all of these
efforts to avoid repetition in different areas.
What will be the next steps to translate these
recommendations into practice?
The overriding approach should one of education for the profession, our patients and
the public with regard to antimicrobial resistance and working together with the commissioning bodies to ensure that patient care
is put first.

What is the role of the dental profession in the
fight against antimicrobial resistance in the
future?
In dentistry, we need to ensure that we always provide our patients with the appropriate treatment. As we have regular contact
with the public, we also have to educate them
about the wider issues of antimicrobial resistance. By working together with our colleagues in medicine, dentists could play a key
role in combating this significant problem,
which we must all be aware of and take responsibility for.
Thank you very much for the interview.

[13] => Musterseite_DTG

[14] => Musterseite_DTG

TRENDS & APPLICATIONS

Dental Tribune United Kingdom Edition | 9/2014

Roughening, cleaning and preparing
Sandblasters in dental practice are a ‘blast’ for patients
Dr Hans H. Sellmann, Germany
Put in the hands of a knowledgeable expert, sandblasting is the method of choice for
cleaning and roughening dental surfaces.
Long known by dental technicians, there is
probably no laboratory in the world right
now without a sandblaster—which is used
for the removal of investment material
residues or the upper, porous, inhomogeneous layer.
However, dentists used to work with subtler methods and on finer objects. Although
sandblasting has no effect on soft tissue,
there are harder substances which we as clinicians have to work on. For those, mini sandblasters offer a suitable treatment option in
dental practice.
I have been looking for means and methods to make the cementing process of reconstruction much safer. In other words, I simply
wanted to avoid de-cementing. Every dentist
is aware of the complicated situation in
which a crown or a post becomes loose. Replacing it can be a nuisance not only due to
the treatment fee but also patient dissatisfaction. And what affects singular crowns is even
more severe in bridges and abutments. In
these cases, Airsonic is clearly showing its
strength.

Placing provisional crowns
While every practitioner has his or own
method, I set my crowns, bridges and telescope attachments ‘soft remaining’. I think
I am in good company, since I recently read

that immediate cementation without letting
the crown setting in can possibly lead to complaints and claims for compensation.
I became aware of the Airsonic Mini Sandblaster through a handout by Hager &
Werken, a dental company from Duisburg,
Germany. Although similar devices are available from other manufacturers, the
favourable price of the Airsonic was unbeatable. There is a fitting adapter for all units.
Therefore, only two steps were necessary for
my KaVo turbine coupling. After one click
and filling in some streaming powder, the device was ready to go. The results proved convincing from the first attempt. In mere seconds, the inner part of the crown, which was
to be cemented, was thoroughly cleaned.
The question remains why sandblasting
with the Airsonic by Hager & Werken enhances the adhesion of dental cements. Well,
the roughening of the surface during sandblasting results in an overall surface enlargement. These ‘mountains and valleys’ are what
we need for the mechanical interlocking
which is basically what happens during cementation. There is no chemical process
here.
By now, I have optimally prepared numerous crowns, bridges and dental posts for cementation with help of the Airsonic. Moreover, we found another type of application
during the treatment of a child patient
named David who needed to have his primary molars, that were slightly carious, restored. In the pictures you can clearly see that

Fig. 1: Components like the connecting hose, blasting powder container and optional adapter couplings are included with delivery.

with the use of the Airsonic, and within a
short amount of time, we were able to condition them optimally for the placement of occlusal composite fillings. No disruptive
bleeding was observed at the surrounding
gingiva tissue occurred, which is a common
phenomenon during treatment with a powder jet. Of course, the sand has to go somewhere at the end which is why a good suction
technique is required. But this is something
we already need when working with a turbine. The Airsonic Mini Sandblaster is delivered with an optional adapter for coupling it
quickly to the compressed air supply in dental practices and laboratories. There, it has its

Fig. 2: For every turbine connection (and for the air connection in dental laboratories),
there is a fitting adapter coupling.

uses as well. Hager & Werken also offers the
mobile Airsonic Absorbo Box which ensures
a clean and fast working environment with
abraded material remains and no extra suction system needed. The changeable filter absorbs the abraded material remains reliably.
Meanwhile, the sand blaster has shown to
be an almost indispensable tool for our practice. It is not only cost-effective but is also
very reliable. The integrated valve is what differentiates the Airsonic from all its competitors that need the pressure to be controlled
through the hose. With help of a pneumatic
valve, the hose can be conserved and has a
longer life time.

DR HANS H. SELLMANN
DDS, MSc, PhD

Fig. 3: The sandblaster lies comfortably in the hand.
Fig. 4: Prior to cementing a dental post, the surface is roughened with the Airsonic®.
Fig. 5: The “loose” crown is thoroughly cleaned before re-cementation.
Fig. 6: Initial caries in the distopalatinal fissure of tooth 55 (mirror image).
Fig. 7: After the cleaning with Airsonic (with dental dam), a small defect was also detected in the central occlusal fissure.
Fig. 8: Filling with tooth-coloured composite material after bonding. Owing to the
roughening of the enamel, etching was not necessary.

maintains a private practice in Nortrup in Germany.
He can be contacted at
info@der-zahnmann.de.

[15] => Musterseite_DTG

Dental Tribune United Kingdom Edition | 9/2014

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professionals in Europe
One of Europe’s largest and most modern
private centres for general dentistry and implantology is looking for talented professionals interested to join its team of leading dentistry professionals that provide domestic
and international patients with the highest
standards of care by offering a wide-range of
treatment options. They have created the 21st
century dental clinic in order to offer patients
a welcoming environment and the very best
experience in high-end dental treatments.
The Lausanne Dental & Implant Clinic provides high end implantology (including immediate loading procedures), as well as aesthetic and cosmetic dentistry, dental crowns,
dental veneers, CEREC, teeth whitening, root
canal treatment, gum treatment, hygienist
services and wisdom tooth removal. Every
member of the team has many years of focused training and ongoing personal development in the area of dentistry and implantology, in particular.
Located in the Olympic city of Lausanne in
Switzerland, the centre consists of 18 large
dental private practices and four high-tech
surgery rooms dedicated to implantology

and oral graft procedures. Inside the complex, a conference theatre hosts a state-ofthe-art dental laboratory as well as continuing education courses on a regular basis.

In addition to the Lausanne facility, the
group runs two other clinics in the region of
Montreux. A new clinic is planned to open in
early 2015 in Sion, the capital city of canton

Valais. This will be the second largest in
Switzerland after their clinic in Lausanne.
For more information and how to apply
visit www.swiss-dentalclinic.com.

[16] => Musterseite_DTG

Dental Tribune International
The World’s Largest News and
Educational Network in Dentistry
www.dental-tribune.com

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[cover] => DT UK No. 9, 2014

[toc] => Array ( [0] => Array ( [title] => UK News [page] => 01 ) [1] => Array ( [title] => Dental materials: Are we all deviants? [page] => 03 ) [2] => Array ( [title] => Dentist health scare–shocking - but rare [page] => 04 ) [3] => Array ( [title] => New US government regulation eyes mercury disposal by dental offices [page] => 05 ) [4] => Array ( [title] => Business [page] => 06 ) [5] => Array ( [title] => “It is unacceptable to neglect severe oral diseases” [page] => 08 ) [6] => Array ( [title] => Online reviews: Does Google really forget? [page] => 10 ) [7] => Array ( [title] => Advantages of HEMOSTASYL for thixotropic wound dressing confirmed [page] => 11 ) [8] => Array ( [title] => “Patients must be at the top of our agenda” [page] => 12 ) [9] => Array ( [title] => Trends & Applications [page] => 14 ) [10] => Array ( [title] => A working opportunity for dental professionals in Europe [page] => 15 ) ) [toc_html] =>

Table of contents

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