Tim Bradstock-Smith from The London Smile Clinic shares his thoughts on the increasingly popular field of implant surgery and how dental referrals can help you and your practice...

Although traditional dentures still have a place, implant surgery is fast becoming an indispensible part of mainstream dentistry. Global forecasts suggest that Europe will continue to drive and dominate the area of dental implants and prosthetics until at least 2018.[1] What’s more, the current economic recovery is likely to see a further push and market expansion.

Successful restoration for an edentulous patient takes both functional and psychosocial adaptation, but their self-confidence is significantly enhanced[2]  by their resulting satisfaction with comfort, function, appearance and health. When compared to conventional complete dentures, data has provided scientific evidence of an improved quality of life after dental implant therapy.[3] Implants are much more convenient for patients and offer improved appearance, looking and feeling like natural teeth. Additionally, patients with positive self-esteem have been shown to experience significantly fewer physical health symptoms[4] and some researchers have gone so far as to suggest that the larger your smile, the longer you may live.[5] Whichever way you look at it, successful smile restoration has both physical and psychological benefits for patients.

The medical advantages of implants are that they help to prevent bone loss and actually stimulate growth to maintain the structure of the face. Also, well-maintained implants placed into adequate bone can be expected to last for many years.

Replacing or restoring missing or damaged teeth with virtually undetectable implants can be a complex procedure. However, it can be extremely rewarding for dentists who are able to not only produce a beautiful smile, but also raise patient self-esteem and confidence.

Successful implant surgery requires considerable attention to detail, outstanding accuracy and a comprehensive set of surgical skills acquired through on-going training and experience. Specialist technology and imaging is also needed to plan and execute implant treatment meticulously, ensuring optimal placement.

One clinician or indeed one practice may not have all the technology, space or the surgical skills required to provide the scope of treatment necessary for all implant surgery, particularly if a practice already provides specialist treatment in an alternative field of dentistry. Equally the patient demographics of the area may not make it financially worthwhile to support this provision. In addition, the training and education clinicians require to place implants successfully takes a significant amount of time as well as expense and often, if this knowledge is not used regularly, it is difficult for practitioners to maintain the skills required to achieve high quality work.

Even when a clinician is qualified to undertake implant surgery, there are still cases that require more specialist surgical skills with treatment sites that require advanced preparation or enhancement before implant surgery can take place. Some cases will require socket augmentation procedures, for example, or advanced regenerative procedures such as guided bone regeneration, bone condensation, ridge splitting, particulate grafting, autogenous block grafting, sinus augmentation, connective tissue grafting and further special methods such as inferior dental nerve lateralisation and distraction osteogenesis.

However, successful implant surgery can be still be delivered by suitably experienced clinicians or specialists in a team approach.

A centre of excellence such as London Smile Clinic provides a referral service to practitioners to undertake implant procedures on their behalf. Dr Zaki Kanaan is a highly trained implantologist, who will work closely with you to form a team, ensuring the best possible results for your patients. Whether you wish to refer more complex cases to Zaki or just refer out part of the overall treatment, the team at London Smile Clinic will keep you informed throughout the procedure. The patient will then return to you for continued treatment or on-going maintenance and care. London Smile Clinic prides itself on delivering a 5 star service and first class dentistry, and referring dentists can be confident that their patients will be in safe hands.

Keeping up in an ever-advancing industry can be both expensive and problematic. Equally, patient expectations are now much more forward thinking with an increase in people wishing to undertake corrective or cosmetic procedures.[6] It is not always possible to provide all services individually but by making use of the technology, facilities and skills offered by referral practices, it is possible to extend your areas of expertise and professionalism to enhance your treatment provision. In doing so, patient satisfaction and confidence is improved and as a result, these patients will return to your practice time and time again.

For more information, please contact 020 7255 2559 or
visit www.londonsmile.co.uk/refer

You’ve got CQC hindsight, but have you seen what’s coming?

The CQC have ‘Fresh Start’ plans for us in 2015        

It’s part of their strategy for 2013-2016, Raising standards, putting people first).

They are more focused than the previous ones and inspectors will be more

experienced in assessing dental practices.

The new standards are divided into eleven Fundamental parts. 

Fit and Proper Person (Directors) and Duty of Candour are 2 new standards.

The CQC have also beefed up their enforcement powers, meaning that they

may not give you a warning before they prosecute.

How do the old ‘Outcomes’ relate to the new Standards?

The simplest way to explain this is for you to complete my CQC survey: https://www.gdpuk.com/index.php?option=com_rsform&formId=57 and then I will send you an explanation of how to relate the old CQC to the new CQC and the new (ish) GDC principles. I will also send you an explanation of what the ‘Key Lines Of Enquiry’ (KLOE) is all about and how it will be applied in April 2015.

What effect have the CQC had so far?

Many of you kindly told me about your CQC thoughts in my survey, (see link above) which is still running.       By sending it back to me, you will now know what or who KLOE is. The CQC inspector will use these KLOE’s to guide the inspection process and make a judgement. The CQC still haven’t decided about publishing these.   

I have summarised what you have told me so far from my surveys and will be discussing them with the CQC. We may yet be able to have a sensible regulator looking at the right things in an intelligent way.

My prediction for 2015 is that FEES, Cosmetic dentistry and dermal fillers will also come under the spotlight.

Brief analysis (from 76 surveys)

I have used this as a pilot survey to determine whether there is a need to gather more information on how well the CQC registration and inspection process is received and what the beneficial effects may have been in driving improvement.

I think relatively few will have experienced re-registration and therefore a low %age answering YES to Q1 may be expected. However it is disappointing to see that 48% still felt that the process has not been made clearer. 

There continues to be much confusion over legal entities and I know (from personal experiences of clients that this is still a problem now, 76% of respondents agree.

81% felt that the inspection was not structured to reflect dental practices; even higher (87%) saying that the nuances were not understood and many said that a dental adviser is required.   

It seems that few felt that they understood what the CQC expectations are regarding safe, well-led and managed practices. I was particularly pleased that our own clients were in general more ‘upbeat’ about the potential benefits of CQC compliance and also felt more empowered and knowledgeable (judging from some open question comments).

The open questions were designed to test whether the process of declaring ‘compliant’ 48 times in the original application had sparked an interest in them to get things done before inspection, just in case. It seems that this was the case in as much as 72% said they had done some things, although I need to look more closely at this figure because some of what was said was fairly minor ‘window dressing’ was one comment.

The most significant results I feel were relating to the perceived benefit of CQC registration and inspection.

The positive improvements noted by patients and staff reached only 14% and the consequential improvements to the business reached 21%. Finally regarding your additional thoughts, there were many suggestions and yet only 6.5% of these were positive. I have concluded that an improved and much larger survey spread amongst a wider audience is required.

OK, so what?

From April 2015, CQC inspection reports will look quite different. Instead of considering just 4 or 5 Outcomes; the inspection will be constructed in a different way to test whether your practice clearly demonstrates that it is safe, caring, responsive, effective and well-led? A CQC inspector has described how the new process enables them to ‘get under the skin’ of the practice and see what is really happening.

Safety is now considered of paramount importance following on from the terrible instances of poor care graphically illustrated in the past few years. Although the CQC had considered that dentistry was relatively much lower risk; there was a severe jolt to this belief recently in Nottingham. The GDC are also convinced that there are also still much greater problems within the Profession. So it is my guess that safety will share top billing with being well-led.

It is hard to imagine that a well-led practice would be unsafe or that there would be many unresolved complaints or that there is a high staff turnover or patients don’t have fees explained properly.

RightPath4 can provide a system of governance mapped to 2015 CQC requirements which is simple to implement and does not cost £thousands or run to thousands of pages. It is easy to bespoke it to your practice and use as an important part of your practice meetings and induction. We have a unique template tool which helps you give confidence to the CQC that your practice is safe, caring, effective, responsive and well-led.

In the next blog article, I’m going to discuss how the CQC are going to assess and inspect in 2015.

Here’s wishing you a Happy, Healthy and Prosperous New Year,

Keith Hayes BDS

Clinical Director www.rightpath4.co.uk This email address is being protected from spambots. You need JavaScript enabled to view it.

Welcome back from the long weekend, now just a few weeks to run and you can all zip off to the sun again  

Monday  was perhaps the new Independence Day, as the Euro results poured in. I worry that this word 'Independence' is being politically hijacked

So:   Are you independent of mind and decision? Really?  Truly?

The EU elections this weekend have thrown three major GDPUK topics into a shaft of light.

Those of you who gaze from a distance at the sheer energy of some of our more vocal members will have notice three threads of great length. One touching on that supposedly untouchable subject, matters of belief and faith, while another has been exploring the issue of the Scottish vote on Independence due to take place later this year. 

Combined with the now famous histrionics of the orthodontic thread, you would be forgiven for having pressed the ‘snooze’ button.

So wake up at the back.   I want you to answer a question for yourself.  What does being independent mean to you?

Mr Farage is celebrating scoring some points in what is normally a three horse race, by arguing for the UK’s independence, and arguing against the £12Bn net spend to the EU every year.

As dentists, we pride ourselves on being independent – in practice, in thought and in action.

Ask 10 dentists a question to which the answer is Yes or No and you will get 20 different answers.

But are we independent? Really? Truly?  Where is the fine line between that and bloody mindedness?

If you practice under Government funding in any of the 4 parts of the UK, do you really feel independent? Or are you reluctantly beholden to how someone else wants you to help and practice dentistry for your patients against your better instinct??

If you are in private practice, are you one of those for whom the next big case is always the one to clear the overdraft?  Therefore you are always on the lookout for some poor soul to benefit from your great skills? Or perhaps you feel you cannot practice good dentistry because of a limited private capitation funding stream not of your making?

We even have this long abused concept of Independent Practice, as though “Private Practice” could be rude and insulting perhaps?  Will the BDA rinse that off for the next batch of unknown NHS England contract changes, I wonder?

Perhaps independence of thought and action is actually impossible without feeling pressurised or being selfish.

Cooperation over independence?

What dentists are masters at is cooperative action.  We run or work within highly efficient micro businesses and at a moments notice we can adapt and cooperate with whomsoever requires our skills and time.  The CQC roll into town – we change and adapt.  A patient arrives – we change and adapt.  New staff requirements develop - we change and adapt.

Long may this be the case because with EU and Scotland and a General Election, the next 18 months are going to be interesting.

That old French phrase has come to life.  Plus ça change, plus c'est la même chose.

Strangely while everything around you seems to be up in the air, it takes a very strong sense of independent spirit to simply wind the windows shut and focus on your patient needs with one hand while with the other you change and adapt

So that’s why four-handed dentists have developed !!

May your June be flaming. Ta-rah for now, fellow enamel warriors

I was surprised to see the advice we give our patients has not changed much in over 40 years! I am reading a book called “The Tooth Trip” that was written by dentist Thomas McGuire in 1972; he describes the same prevention based dentistry we practice today. This book was written for the public to understand oral diseases and their role in preventing it.

Some of the book is way off the mark with recipes for making homemade toothpaste with Sage, Myrrh and powdered roots. Making toothbrushes from twigs and sticks does not sound like the best use of an hour of your time. What resonated so strongly with me was the descriptions of self-examination of your mouth and emphasis on prevention and working together with your dentist. A whole chapter was on dental emergencies and what constitutes a real emergency- severe or recurrent bleeding or severe pain not relived by painkillers. Just getting your patients to read this chapter alone would save thousands of wasted dental appointments. There was sensible honest advice on how and why teeth can hurt and how you can prevent it and work together with your dental team to stop it recurring.

In our modern age, if we educate our patients in the causes of dental disease and how it is entirely preventable, they too could have healthy mouths and lower dental bills. Despite the fact that most of this information is freely available on the internet or in the leaflets that some dental practices give out, not much has changed. Why is that?

I feel that until the information is specifically tailored to our patents and they can see the benefit from following that specific advice, they will switch off. If you promote the fact that you fix teeth, they will just come and expect you to fix them. This is where modern dental teams come in. We need to genuinely listen to our patients, do not interrupt them, let them get their whole story out. Examine their mouth, show them the evidence of disease in a clear and non-judgemental way. Explain their options and how as a team, you can return their mouth to health. Make them understand that without them, all your treatment will fail. Spending extra time now will save hours of treatment in the future and help educate a generation that loves going to the dentist. All good dentists want their work to be appreciated and to last a life-time.

Four Dental sins from the 1970’s that Dentists still do to this day:

1. Leaflet avoidance. Handing your patients reading matter to explain your treatment and asking them to go home to go through it. Nothing beats a face to face discussion where you allow them time to discuss their personal fears and questions. Leaflets should be only a back-up once the conversation has taken place.

2. Technical jargon. Using dental terminology or complex words to explain your diagnosis and treatment. All professions have jargon. The skilled dentists explain it in a language that that specific patient will understand.

3. Carrying out treatment whilst discussing the patient’s options. No-one can fully concentrate when lying on their back with theirs mouth open or having treatment carried out. Stop, sit the patient up and have a face to face conversation.

4. Bulldozing. Talking it through you your patient until they are worn down and just say yes. Nothing is life or death that you need to decide there and then. Place a temporary filling and then explain the options; pros, cons and cost. Then let them go away and think about it.

How are you going to make the most of your patients next tooth trip?

Photo by Jenn Durfey, licence info

James Goolnik is a practising Dentist and his book “Brush” donates 100% of the profits to Dentaid. He recently led a team of 8 dental professionals to Malawi to install two dental chairs, equipment and deliver skills transfer workshops from these proceeds. He is a trustee of the charity “Heart your Smile”.

www.jamesgoolnik.com