I learned something earlier in the week that made me realise I know NOTHING! The ‘something’ was mouth related and I was made to feel that every dental professional on the planet knew about it, but they excluded me from the secret. I’ll tell you the secret a little later. You will be…AMAZED! Or maybe not.

Prolonging the agony? - My view on Slow Dentistry - By @DentistGoneBadd

When browsing the news I’m always astounded at how many articles there are about the lax approach to oral care among the general populace of the UK. Whilst some of these headlines are more than likely sensationalised by the media to draw in an audience, there is often a grain of truth hidden amongst the hyperbole, and one article in particular that caught my eye recently detailed some harrowing statistics that couldn’t be ignored.

A result of the recent National Dental Survey performed by BUPA Dental Care, the article revealed that over 2 million UK adults hadn’t been to the dentist in over a decade.[i] I personally find it almost unbelievable that in this day and age there are so many people out there who are willing to ignore their oral health and avoid seeking out the proper guidance necessary to ensure that their teeth remain healthy, especially for such a long period of time.

I think in many of these cases people believe in the adage “don’t fix what isn’t broken” and if they aren’t experiencing any pain or visible signs of decay they assume that their mouths are in good condition. As professionals, we know this isn’t necessarily the case. However, when delving further into the article it seems that more than a third of British people mask or ignore dental pain with the use of painkillers instead of curing it with a visit to the dentist. This is an astonishing statistic that suggests that what we really need to do is go back to education and make it clear to these people that prevention and treatment are always better options than pain.

The findings of the survey revealed that many British people skip brushing their teeth if they are in a rush and that a third of them never floss or visit the hygienist either. In a way these statistics are less surprising – how often have you told a patient they need to floss and they return with no change? It still indicates a widespread problem that we, as professionals, need to do our part in changing. Perhaps to combat these statistics we need to explore new methods of guidance to help guarantee that the message really sinks in.

One method that I think could make a big difference is a wider use of dental photography. Not only does this ensure patients will be able to visually see the damage that they are causing to their teeth, but it is also a useful way to track the progress of any treatments you offer. These photos are also useful marketing materials for the practice as long as you ensure that your patients give you the proper consent. This is especially great as with the ever-growing rise in platforms such as Facebook and Instagram, these visual aids can really help people discover what your team are capable of and even bring in new business.

Another method worth exploring is the introduction of technology with visual aids such as animations and diagrams. Not only do these help educate patients by detailing procedures in a way that they can understand, but they also prove to be invaluable resources when faced with patients who have been repeatedly given advice and don’t seem to take it on-board.

Whatever the reason behind this wide-scale neglect it’s from clear reports like these that there is more work to be done. Professionals need to be vigilant when encouraging good oral care habits in our patients, and if that means we should explore new methods to make them aware of the dangers, then it’s something worth considering.

Of course, patients too must take some responsibility, however, when making it clear that regular brushing and interdental cleaning are a necessary part of maintenance and giving the best service we possibly can, we can reassure those who have avoided the dentist for years that seeing us isn’t as scary as they may think. Hopefully these measures will help minimise these worrying statistics detailed by the report over time.

For further information please call EndoCare on 020 7224 0999

Or visit www.endocare.co.uk

EndoCare, led by Dr Michael Sultan, is one of the UK’s most trusted Specialist Endodontist practices. Through the use of the latest technologies and techniques, the highly-trained team can offer exceptional standards of care – always putting the patient first. What’s more, EndoCare is a dependable referral centre, to which dentists from across the country send their patients for the best in specialist endodontic treatment.

[i] Dentistry.co.uk. Over 2 Million Brits Haven’t Seen a Dentist in More Than a Decade. Link: http://www.dentistry.co.uk/2018/05/25/2-million-brits-havent-seen-dentist-decade/ [Last accessed june 18].

In endodontic therapy, the complete removal of microbes from the root canal system and prevention of reinfection is essential to the overall outcome.

The most effective means of eradicating infection is a combination of chemical and mechanical debridement, because when irrigation is introduced alongside instrumentation the chance of removing inflamed and necrotic pulp tissue, microbes and debris is significantly higher.

As it stands, there is little evidence to prove that certain irrigants are more effective than others, but research has shown that no single irrigant on its own holds all the required characteristics needed to effectively eradicate and prevent infection.[i] Only a combination of two or more solutions in the appropriate sequence can predictably obtain safe and effective irrigation.[ii]

Perhaps the most commonly used irrigant is sodium hypochlorite (NaOCI) in concentrations varying from 0.5 to 6.00%, as this can dissolve organic tissue and has a broad antimicrobial spectrum allowing it to effectively kill biofilms adherent to the root canal walls.[iii] For those who prefer to use sodium hypochlorite, it is worth bearing in mind that a high concentration NaOCI has demonstrated better results than 1% and 2% solutions. [iv] In cases where NaOCI has been used but has been ineffective, it may be that the strength of the formula – or lack of – has compromised the success of the outcome.

The downside of NaOCI is that it does not remove the smear layer. This can be overcome, however with subsequent irrigation with Ethylenediaminetetraacetic acid (EDTA), as it can dissolve inorganic material, including hydroxyapatite. Importantly, EDTA is also biocompatible, able to condition dentine and has shown positive effects on the root canal seal.[v] Nevertheless, it is important to remember that EDTA must be used as a final rinse, not as an alternating rinse with NaOCI.

Another possible irrigant is chlorhexidine digluconate (CHX), which has good antimicrobial activity and is biocompatible. As it is incapable of dissolving organic tissue it cannot replace sodium hypochlorite. One could also opt for hydrogen peroxide, but again, this lacks antibacterial activity when used alone and cannot dissolve tissue.

Whichever combination is used, it is important to choose quality irrigation products from a trustworthy manufacturer of endodontic solutions. At COLTENE, all products are designed and produced using the latest materials and technology to guarantee optimal results. The range of solutions includes CanalPro NaOCI in 3% and 6% formula, CanalPro EDTA 17% and CanalPro CHX 2%, providing all the characteristics needed for effective irrigation. For best results, use alongside HyFlex EDM NiTi root canal files, also available from COLTENE.

The role of irrigation and its impact on the overall success rates of root canal treatment is clear, so be sure to consider your choice of irrigants.

To find out more visit www.coltene.com, email This email address is being protected from spambots. You need JavaScript enabled to view it. or call 01444 235486

As dentists, we are aware that our patients are afraid of receiving anaesthetic injections. It’s the needle and the anticipation of the pain that does it – and it’s a big problem. For us, it can be a real issue. While we may be very skilled at administering anaesthetic, when faced with a nervous patient things become a little more complicated and, if the procedure goes poorly, we can be left doubting our own skills. In the case of extremely nervous patients, who we have had a great deal of difficulty injecting, we sometimes think it would just have been easy to sedate the patient from the outset. But sedation, of course, is just a short-term fix. It benefits us, as the clinician, more than the patient – it doesn’t remedy their fear.

As such, there has been a succession of different delivery systems for anaesthesia that have attempted to alleviate our patient’s fears. One of the most popular options is the anaesthetic wand. This device gives patients a much calmer and gentler injection due to its computerised delivery mechanism. It’s a great piece of kit and many dental practices have adopted it into every day procedures – mine included. I’ve actually found that my patients, who have historically been afraid of injections, have responded very positively to the wand – and have really appreciated the alternative option.

However, at the end of the day, the wand still uses a needle.

What dentists have been looking for, then, is the needleless anaesthetic – the Holy Grail of dentistry. This is why an article in the news piqued my interest recently. Apparently, a company in America has developed a completely needle-free option that consists of a simple nasal spray.

From the information we have available, this new nasal spray system looks quite promising. It induces minimal side effects (runny noses mostly) and is demonstrably effective. Unfortunately, it is only effective at numbing from one upper pre-molar to the other – and this, as we all know, is the area in which we are probably the most skilled at administering anaesthetic already.

What we need, therefore, is a system that will let us anaesthetise the lower mandibular molars – especially those with hot pulps. This is the hardest area to anaesthetise and unfortunately the nasal spray may be the wrong pharmaceutical to inhale for adequate relief.

As such, I can’t see this new system being revolutionary. I do believe that anything that helps our patients feel more at ease in the treatment room is of great value and I do not doubt that in very specific circumstances, this nasal spray will be an effective option. Patients in need of very simple restorative procedures, who are scared of the needle, will undoubtedly benefit – and this is not something to scoff at.

But for other procedures, we will simply have to rely on the tools we have available now and, for the time being, the quest for that Holy Grail must continue.

For further information please call EndoCare on 020 7224 0999

Or visit www.endocare.co.uk

EndoCare, led by Dr Michael Sultan, is one of the UK’s most trusted Specialist Endodontist practices. Through the use of the latest technologies and techniques, the highly-trained team can offer exceptional standards of care – always putting the patient first. What’s more, EndoCare is a dependable referral centre, to which dentists from across the country send their patients for the best in specialist endodontic treatment.

2D digital imaging has given the dentist greater opportunity to visualise the tooth than ever before, but with the revolution in 3D imaging and cone-beam computed tomography (CBCT), the practitioner can now visualise the full picture.

Due to its wide range of applications and its contribution to easier, quicker and more effective results, it has become embedded in the practice’s daily routine. It allows the tooth to be viewed in any direction or orientation, and negates the need for speculation, which is what has often happened with 2D views. Dentists can interpret this valuable new information to make better treatment plans and give more accurate diagnoses.

One of the more specialised areas of dentistry that 3D imaging is of particular use in is implantology. CBCT allows for bone evaluation in terms of thickness and density, identification of anatomical landmarks and provides multiple options for views. Most notably it also allows for ‘virtual’ implant placement. When the implant has been placed, historically, 2D images would have only shown a portion of the placed implant, but with 3D imaging, the whole picture can be seen meaning the greater likelihood of long term success.

Endodontics is another speciality finding this development in technology essential. Root morphology can be more accurately assessed and the ability to see different views of the canal, be it in cross section, long axis or oblique, allows the endodontist greater virtual visualisation of the form and structure of the root canal. More accurate measurements can be achieved resulting in more effective treatment success. It is also effective in the identification of post endodontic treatment infections, which often could not be identified with 2D radiographs.

Making it a Reality

Manufactured by the world class Sirona and supplied by the experienced Clark Dental, the ORTHOPHOS SL 3D is at the cutting-edge of technology. Clark Dental can help you make the leap to 3D imaging, and all the advantages that it brings with it, a reality.  The ORTHOPHOS SL 3D offers exceptionally sharp 2D panoramic images with its ‘Direct Conversion Sensor’ (DCS) and ‘Sharp Layer’ (SL) Technology, but also full 3D flexibility with its selectable fields of view. 

With just a single rotation, thousands of images can be taken and the SL technology can bring the entire jaw into sharp resolution.  Further still, the interactive element of SL allows you to manipulate the image and select a particular area that you want to focus on.  The ground-breaking DCS provides unrivalled character sharpness with unmatched clarity, ultimately resulting in greater success in all fields of application.  

For more information call Clark Dental on 01268 733 146, email This email address is being protected from spambots. You need JavaScript enabled to view it. or visit www.clarkdental.co.uk

I have to admit, I have never enjoyed our annual infection control lecture. Past experience has left concerned about the quality of the CPD on offer, worried that I will be subjected to another afternoon of scare-mongering and opportunistic commercialism. Far worse, though, is the yo-yo-like introduction and withdrawal of guidelines that happens year on year – usually without any scientific evidence to support the decisions.
 

Like any conscientious practitioner, I take these responsibilities very seriously and, ultimately, I think the changes that have been made have been positive.
 

But all I want is a little consistency. I’m sure we can all remember when we were required to keep our sterilised equipment in bags, to be re-sterilised after 30 days of non-use. That quickly changed to 60 days and now it’s gone up to one year. Why?
 

Who knows?
 

The science that dictates these guidelines is not made widely available to professionals – we are simply required to dogmatically follow them. What’s more worrying, however, is the fact that private practitioners are not consistently informed of these regularly changing guidelines. NHS practices and hospitals receive regular updates from the Department of Health – but we are too often left in the dark. Gone are the days when the BNF was sent to all practices: we now have to purchase it or subscribe online.
 

In fact, and I say this with a certain amount of trepidation, I regularly find out about new guidelines by reading through some of the GDC fitness to practise hearings. I often see cases where practitioners are being penalised for something of which I’m not even aware. In this, I think, there has been a fundamental failing in the profession – which is having serious ramifications for practitioners right across the country. 

 

I also couldn’t help tallying up just how much compliance could end up costing. With all the changes, with all the considerations, I was left wondering what strategies I would have to employ to make it feasible – and it all came back down to the question of consistency again. Should practices spend significant sums of money to replace their old sinks with ones that are compliant this year but potentially not the next? Should they have to budget for the government’s indecisiveness?

It’s a difficult situation and, ultimately, the patient will suffer. If practitioners are always having to buy new equipment, new cabinetry or new PPE the cost of treatment will inevitably go up to accommodate the additional costs. It’s not a case of ignoring these topics – the protection of our patients is, and always will be, our foremost consideration – but in order to best do that, we need a consistent direction and a better system for sharing the knowledge we need.

For further information please call EndoCare on 020 7224 0999

Or visit www.endocare.co.uk

Dr Michael Sultan BDS MSc DFO FICD is a Specialist in Endodontics and the Clinical Director of EndoCare. Michael qualified at Bristol University in 1986. He worked as a general dental practitioner for 5 years before commencing specialist studies at Guy’s hospital, London. He completed his MSc in Endodontics in 1993 and worked as an in-house Endodontist in various practices before setting up in Harley St, London in 2000. He was admitted onto the specialist register in Endodontics in 1999 and has lectured extensively to postgraduate dental groups as well as lecturing on Endodontic courses at Eastman CPD, University of London. He has been involved with numerous dental groups and has been chairman of the Alpha Omega dental fraternity. In 2008 he became clinical director of EndoCare, a group of specialist practices.

So: you have taken on a case, diagnosed the patient’s problem, discussed their options and gained their informed consent to proceed. The treatment has gone well and the patient leaves your clinic, a little numb admittedly, but in good spirits. You are satisfied you have done everything you can for them.

But there is just one thing missing: aftercare. Or proper aftercare, at least. An unfortunate majority of dental professionals seem to believe that aftercare consists simply of handing a patient an advice leaflet as they head out the door and booking them in for a follow-up appointment.
 

But there has to be more than this. 
 

When I first set up my practice, we made the effort to contact every patient after treatment, just to assess their recovery and assuage any concerns they might have had after returning home. For the most part, the patients appreciated this – they were happy we rang because it showed we cared about their progress. Some, however, were immediately suspicious and thought perhaps we were ringing to tell them about a problem with their treatment. The majority of people were simply surprised we had phoned at all, because no one had ever done it before.
 

This possibly stems from the fact that we have become so invested in the time-honoured maxim that ‘no news is good news.’ Surely, we think, our patients will contact us if there is something wrong.
 

But the fact is, they probably won’t. Whether it’s because they are embarrassed or they think we’re too busy to talk to them, most patients will suffer in silence.
 

This is, of course, a fundamental failing in our role as healthcare providers. We need to care for our patients until they are well again, not just until they walk out our door. Admittedly, trying to call each and every patient can be a time-consuming task, especially for larger practices. It can also be utterly superfluous, if only a handful of patients actually need additional attention.
 

What is needed, therefore, is an overhaul of current aftercare procedure. We need a way of targeting those patients who need our help and reassurance. With modern technology what it is, this surely cannot be difficult to achieve. I imagine apps that can track patients’ post-treatment pain in real time, helping us recognise trends and deliver precise assistance to those who need it most; I can see text services and instant messaging being integrated into dentistry to provide personalised aftercare for all patients.
 

This would surely improve our profession, not just in standards of care, but in reputation – just imagine the positive response your patients will offer when they know that you genuinely care about their progress and wellbeing?       
 

And if that isn’t incentive enough to improve our aftercare, I don’t know what is.

For further information please call EndoCare on 020 7224 0999

Or visit www.endocare.co.uk

Dr Michael Sultan BDS MSc DFO FICD is a Specialist in Endodontics and the Clinical Director of EndoCare. Michael qualified at Bristol University in 1986. He worked as a general dental practitioner for 5 years before commencing specialist studies at Guy’s hospital, London. He completed his MSc in Endodontics in 1993 and worked as an in-house Endodontist in various practices before setting up in Harley St, London in 2000. He was admitted onto the specialist register in Endodontics in 1999 and has lectured extensively to postgraduate dental groups as well as lecturing on Endodontic courses at Eastman CPD, University of London. He has been involved with numerous dental groups and has been chairman of the Alpha Omega dental fraternity. In 2008 he became clinical director of EndoCare, a group of specialist practices.

I always try to be as open-minded about the development of our profession – I try to read extensively on many different topics to ensure I know what new ways I can care for the patients who come to me asking for help.

But every so often I come across certain articles and opinions that truly test my resolve. The most recent was a piece that was written to promote the work of holistic dentists and, while I am fully supportive of any dental professional who strives to improve their patients’ general health through their work, I found the particular attitude on display in this piece both cynical and unwarranted.
 

Indeed, it is an attitude I am seeing more and more often in the alternative press – how holistic or homeopathic dentists are the only ones in the profession who truly treat their patients as a whole, not just a set of disembodied teeth.
 

Admittedly, when I’m working and the patient is dozing off in the chair and I’ve got my microscope on and all I can see is the canal, it’s easy to get a little bit lost in the treatment. Of course, I’ve never completely forgotten that there is a person attached to the tooth, but sometimes – and I am sure that many of you are exactly the same – I can become so absorbed in what I am doing that the tooth is all I see.
 

But beyond the treatment, this is by no means the case. Dentists in this country are part of a caring, protecting profession and we are all aware of the links between oral health and general health. We always discuss dietary habits with our patients, explain how stress and anxiety may manifest in dental conditions such as bruxism or TMJ disorders.
 

That holistic dentists would try to monopolise this aspect of the responsibility all dental practitioners have to their patients is simply a cynical marketing tactic – and it is fundamentally inaccurate.
 

What’s worse is the attitudes many alternative practitioners have to the materials and techniques the majority of modern professionals use on a daily basis. In particular, holistic dentistry attacks amalgams, portraying them as irredeemably toxic, or fluoridated water as an institutionalised evil.
 

This attitude is undermining the profession apart from the inside. As dentists, we already have to protect ourselves from the bad reputation external sources burden us with; to have to do the same from our own colleagues is a disaster. True, we should welcome diversity and forward thinking, but this can only happen without the need to scare the public or lambast each other.

For further information please call EndoCare on 020 7224 0999 or visit www.endocare.co.uk

Dr Michael Sultan BDS MSc DFO FICD is a Specialist in Endodontics and the Clinical Director of EndoCare. Michael qualified at Bristol University in 1986. He worked as a general dental practitioner for 5 years before commencing specialist studies at Guy’s hospital, London. He completed his MSc in Endodontics in 1993 and worked as an in-house Endodontist in various practices before setting up in Harley St, London in 2000. He was admitted onto the specialist register in Endodontics in 1999 and has lectured extensively to postgraduate dental groups as well as lecturing on Endodontic courses at Eastman CPD, University of London. He has been involved with numerous dental groups and has been chairman of the Alpha Omega dental fraternity. In 2008 he became clinical director of EndoCare, a group of specialist practices.

In dentistry what you can see greatly affects what you can treat. By embracing the latest magnification and visualisation technology, such as the Carl Zeiss OPMI Pico dental microscope, your practice will see countless benefits and be able to treat so much more.

Available in the UK from Nuview, the OPMI Pico incorporates the latest video and ‘live streaming’ technology, allowing you to record examinations and treatments in HD. The innovative camera options available facilitate excellent patient consultation and documentation and provide a fantastic tool for education and communication for the whole dental team.

The compact, high performing and easy-to-use OPMI Pico offers solid, ergonomic support for the most demanding of applications – whether in restorative dentistry, endodontics, implantology or periodontics. It is also available with a Varioskop objective lens that allows you to adjust the focal length to focus on virtually any image detail without leaving your preferred working position.

To find out more about the Carl Zeiss OPMI Pico contact Nuview today.      

For more information please call Nuview on 01453 872266,

email This email address is being protected from spambots. You need JavaScript enabled to view it. or visit www.nuview.co

When it comes to unveiling your new and exciting products, timing is key! As one of the first major dental shows of the year, The Dentistry Show 2016 will enable you to reveal your latest and greatest in style, while networking with the 8,000 plus delegates expected.

The Dentistry Show 2016 will be working alongside leading societies and associations to deliver you a high quality and high value experience, including names such as the British Academy of Cosmetic Dentistry (BACD), British Society of Periodontology (BSP), British Endodontic Society (BES), British Association of Dental Nurses (BADN) and many more.

With the support of The Product & Services and Launchpad UK Guides exhibitors receive extensive coverage leading up to the event through print and online media platforms, show guides and direct mail to delegates promoting your products and company logo.

80% of exhibitors from 2015 have already booked in for 2016 with a confirmed total of 196 stands. With a first come first serve choice on location avoid disappointment and book your place now!

Sign up now and guarantee your place at one of the biggest dental events of the year.

 

The Dentistry Show and DTS 2016 will be held on Friday 22^nd and Saturday 23^rd April, NEC in Birmingham. For further details visit www.thedentistryshow.co.uk call 020 7348 5270

or email This email address is being protected from spambots. You need JavaScript enabled to view it.

When we offer endodontic treatment to patients it helps if they are, at least, a little bit anxious. I don’t want them to be scared, but it is important for them to be concerned about, firstly, the condition of their teeth and, secondly, about the proposed treatment.

Similarly, in cosmetic dentistry, we need our patients to be a little bit vain, because if they weren’t, they wouldn’t want the treatment in the first place. Of course, in both of these cases, there has to be a balance. It would be incredibly unhelpful for us, as clinicians, to have an utterly terrified patient, or one that is so dysmorphic that their expectations have become unreasonable.

What we are looking for, therefore, is a sense of equilibrium. Not too much, but just enough. My family’s motto has always been même dans la modération être modérée – or, ‘even in moderation be moderate.’ I remember this idea being embodied by my aunt, who has not long ago turned 92. She always (somewhat ironically) insisted that she did not want to live for a long time – she just wanted to live healthily. She made grand pronouncements in the kitchen about what we should and should not eat and it turns out that she was probably right about a lot of things. She understood how to live in moderation and she knew the relationship between healthy eating and healthy living and that’s why she has just had a cookbook published.

Of course, food is an important consideration when we’re thinking about health. I recently read an article about how experts expect that by 2020 more liver transplants will be due to over-eating rather than alcoholism.[1] Indeed, by the same year, experts fear that at least a third of people in the UK will also be obese. As we all know, obesity can lead to any number of further health complications, including heart disease and diabetes.[2]

We are fortunate in our profession to be able to help with these concerns – we are all aware of the links between oral health and periodontal disease with both heart disease and diabetes and, as a result, we can be at the very forefront of necessary preventative treatments. And as we do so, we are in the perfect position to be able to help promote a moderate lifestyle and thus potentially extend lives healthily.     

We can apply this idea to all aspects of our lives – not just in health care and dietary considerations – and by doing so we can enjoy longer, happier and healthier lives. It can help us be better clinicians and, in turn, make us better patients.

For further information please call EndoCare on 020 7224 0999

Or visit www.endocare.co.uk

Dr Michael Sultan BDS MSc DFO FICD is a Specialist in Endodontics and the Clinical Director of EndoCare. Michael qualified at Bristol University in 1986. He worked as a general dental practitioner for 5 years before commencing specialist studies at Guy’s hospital, London. He completed his MSc in Endodontics in 1993 and worked as an in-house Endodontist in various practices before setting up in Harley St, London in 2000. He was admitted onto the specialist register in Endodontics in 1999 and has lectured extensively to postgraduate dental groups as well as lecturing on Endodontic courses at Eastman CPD, University of London. He has been involved with numerous dental groups and has been chairman of the Alpha Omega dental fraternity. In 2008 he became clinical director of EndoCare, a group of specialist practices.

The CS 8100 OPG unit from Carestream Dental offers a perfect blend of simplicity and sophistication. Designed to produce the highest quality images in the shortest amount of time, the CS 8100 delivers crystal clear, optimally exposed images in seconds.

Dr Robert Watson of Dollar Street Dental uses the CS8100 in his practice, he says:

“Our new CS81003D has really transformed the way we diagnose and treat our patients. 

“We are a general practice with a special interest in implants and endodontics. Both procedures are transformed by having the ability to view the proposed treatment in a 3D image. There is no steep learning curve when using the machine and the huge benefits are instantly available for both clinician and patients. Well done Carestream for bringing quality panoral and CT scanning to the general practitioner at a cost that makes sense.”

If you are looking to advance your treatment workflows with cutting-edge imaging technologies, contact Carestream Dental today.

For more information, contact Carestream Dental on 0800 169 9692 or visit www.carestreamdental.co.uk