Sunday, 30 November 2014

Buying and Building Your Dental Practice - LCF Law Event

So this week I attended a seminar at the BDA's offices in London which was run by LCF Law on how to buy and build your Dental Practice



Whilst it may seem a bit premature and ambitious to be attending an event like this as a Foundation Dentist, it was great to learn more of the business side of Dentistry which is totally skipped at Undergraduate Level.

I also dragged my boyfriend along to the event, but it wasn't such a bore for him since he is studying to become a Lawyer!

Here is a summary of what I've taken away from the event: a brief introduction to those like myself, who before going to this event, would not have a clue about how to go about setting up a Dental Practice.


What do I need to take into consideration when buying a Dental Practice?


Well there is an endless list of general things you should think about. Like most big decisions in your life the usual questions like why do you want to do it, can you afford it, how will you finance it, will you have enough time etc should run through your mind. 
But in more specific terms for Dentistry some things to consider include:

What type of Practice is it?

Purely NHS, purely private or mixed.

In terms of NHS practices, you then need to ask if they have a GDS (general dental services) or PDS (personal dental services) contact. It is relatively easy to add or change people on a GDS contract, but for PDS contracts you will have to ask the NHS's permission or change the contract to a GDS one; however, the NHS can then renegotiate your contract value (more often than not, downwards). 

For private practices, or for the private work of a mixed practice, you can change owners through the limited (ltd) company quite easily.

How long will it take?

On average, buying an NHS Dental Practice takes 4-6 months but it can take longer if you need to register with the CQC (a legal requirement) or if there is a third party landlord to deal with. 

Due Diligence

This is an appraisal of the business of the practice which your lawyers should undertake prior to you buying a practice in order to establish the practice's assets, liabilities and evaluate the business i.e. making sure you are making a good investment. 

Due diligence for a dental practice will be looking at things like the profits, patient numbers, types of patients, equipment and furnishings of the practice. 
Your lawyers should also place warranties or policies in the contract to deal with faulty equipment, partially completed treatments, lab bills and guarantees on previous treatments. There should also be clause to prevent the seller from setting up a practice nearby and poaching your patients (usually they can't set up a practice within 5 miles for 1 year after selling).

Freehold or Leasehold?

Whilst it's attractive to have the Freehold (i.e. to own the bricks and mortar as well as the business), Leasehold may be the more appropriate option because it's cheaper so you can buy more businesses in the long run! Just make sure you check how much time there is left on the Lease!

Who wants to buy Dental Practices in the UK?


There are 4,182 dentists registered with Frank Taylor and Associates (just one of the Dental brokers) who are looking to buy a practice in the UK. 
This is a staggering figure that shows the huge competition you're up against if you're looking to buy a practice - especially in popular areas such as London!

Despite the belief that corporates such as IDH or Oasis are buying up everything, they actually only account for 8% of the dental market.
Whilst corporates are looking to buy, especially since they can now buy unlimited numbers of practices (read here to see why), Principals are not keen to sell to them. 

There has been a recent emergence of the Entrepreneurial Dentist during the past few years, with some individuals owning up to 12 practices! It has been estimated by FT&A Finance Services that these individuals make up about 12% of the marketplace today.  

That leaves around 80% of the competition left, who are individual or small partnership ownerships that are looking to buy. 

Who are the experts?


When buying a practice, especially if it's your first time, you will need to have a good team of experts surrounding you to help with the process. These will include:
  • Dental Specialist Solicitor such as LCF Law
  • Dental Specialist Accountants
  • Dental Specialist Banks (there are 14 dental banks in the UK)
  • Independent Financial Advisers 
  • Dental Sales Agents e.g. Frank Taylor and Associates
All of your experts need to be Dental Specialists, otherwise problems can arise!



So what makes a successful Practice?


1. VISION

Set out a business plan early. And don't be afraid to change it regularly. Set your goals so you know what your targets are.

2. PERFORMANCE

Throw yourself into your business, work with others who have the same vision as you. Work hard but don't forget there is a life outside of your practice!

3. CUSTOMERS

In the end, it matters less how many patients you get through your door, it's how many you come back. Customer service is key. 
The best way to advertise to new patients is by the personal recommendations by other patients so focus to delivering excellent care.


I'd also like to mention TempDent a Dental Recruitment Agency, who also attended the event and held a prize draw which I actually won! I don't think I've ever won a draw before so thanks every much, I'm sure the other staff members of my practice will be chuffed with some free CPD! See my post about the Safeguarding CPD afternoon we had here

First Prize courtesy of TempDent


The main message I took from the evening was that in order to have a vision and build an effective business plan, you need experience! You need to know what you love doing and where you'd like to be in 5 years! 
Having only worked in practice for 3 months, I've got a long while yet before I know where my career is heading! I'll keep you posted!


Has anyone got any other tips for people thinking of buying a Dental Practice? Please leave your comments in the section below! 



Wednesday, 26 November 2014

The Daily Grind



In early October I came across this article in the Evening Standard when my house mate brought it back to our flat one evening and pointed it out to me. 

The article speaks about Bruxism - a condition that some dentists think can affect as many as one in 10 people in Britain! Patients will often wear down their teeth and have aches and pains associated with their jaws as a result of grinding or clenching their teeth at night-time. 

Lucy Tobin reports on how teeth-grinding is an increasingly common problem amongst city workers with the stress of their daily lives taking its toll on their teeth.

As a frequent grinder myself, I can emphasise with the dull ache that patients can commonly experience on waking but the pain can rarely be much more severe than just an achey or clicky jaw. 

Whilst the most common treatment for bruxism is some form of mouthguard or splint to wear at night time, this isn't the only option. Wearing something at night time isn't always appealing to every patient or even possible. I find it very difficult to sleep with my mouthguard in - I always play around with it and my tongue can't find a comfortable position so it keeps me up longer. 

Other options include Botox injections, mandibular advancement devices (MAD) or hypnotherapy. 

Other options may be more suitable for daytime clenchers too. From my experience I often find myself clenching my teeth together when providing patients with more complex treatment - I can't exactly wear my mouthguard when treating patients!

I'm really glad I found this article and that the Evening Standard chose to feature it as I feel like bruxism is a condition that the general public aren't really that aware of despite its high prevalence. 


To see the original article please see the Evening Standard's website.

Ever been told by your spouse that you grind your teeth? Or do you wake up with headaches in the mornings? You might be a tooth-grinder! Please share your thoughts and experiences in the comment section below!



Monday, 24 November 2014

Mountains of Macaroons: BBC Good Food Show

So last week I did something a bit more cultured than usual - I attended the BBC Good Food Show at Olympia.

The main exhibition hall, a mountain of macaroons (yum) and an epic amount of cheese at the Cheese Awards

We decided to go on a Sunday, as we got buy one get one free tickets! It was pretty busy but not crazy and we arrived just before lunchtime so pretty much peak time.

The main exhibition was full of stands varying from Kenwood to Ovaltine to Amarula

We got give away bags on our way in, which had a fair amount of teabags in (I don't think I'll ever have to buy tea again) as well as coffee, rice and lots of vouchers.

Wandering about the stands I picked up mouthfuls of food and drink - noodles, fudge, Yakult, port. There was some really quaint stands: one had chocolate in many weird and wonderful shapes such as spanners and scissors!

And there was a chance to see celebrity chefs! 

We happened upon an interview with Michel Roux Jr. Apparently he won't be making a reappearance in Master Chef.

Interview with Michel Roux Jr. 

You could also watch the chefs cook! Unfortunately you had to pay again to see them, although it was only an extra £3. We also missed Mary Berry and Paul Hollywood who were there on the Friday and Saturday.

So we went to see Michel Roux Jr. cook. It was good to see him good live, even if I didn't really find the breakfast dish he cooked that appealing (choux buns stuffed with scrambled eggs and topped with port braised chicken).


Michel Roux Jr. at work


The next BBC Good Food show is in Birmingham this weekend and it's Winter food themed. 

Check out the BBC Good Food website to check out more shows coming up.



Did you go to the BBC Good Food show? What did you think of it? Meet any of the celebrity chefs? Let me know in the comments below!


Saturday, 22 November 2014

So... Where's the Evidence Base?

Mention Evidence Based Dentistry (EBD) to me during final year at Dental School and to be honest I would probably have rolled my eyes at you. 

Caught up in learning specific studies and statistics it was easy to forget the importance of an evidence base. 

However, a lot of what we do in dentistry has little or NO evidence base. The main problem is that here isn't much independent funding out there to produce unbiased evidence to draw conclusions from. 

My DF1 scheme requires me to produce a project implementing evidence based dentistry in practice, so I recently attended a study day with Dominic Hurst about EBD. Here I shall summarise what I learnt from the day.


What is Evidence Based Dentistry (EBD)


Using clinical experience, research and patient preferences and values in shared decision making and implementing them in practice.

So what is shared decision making? 
It is involving the patient is the decision making process so that they can make a more informed choice. A good way to do this would be using an option grid or decision aids e.g. why choose root canal treatment over an extraction.  

How to implement EBD in practice


1. Identify a clinical problem - what needs improving in your practice?

2. Find the best evidence available and adapt it to your practice 
    - ask a question
    - search for systematic reviews e.g. Cochrane 
    - appraise the evidence

3. Assess the barriers to using EBD in practice e.g. time constraints, patients, GDPs, practice environment etc

4. Assess how to overcome those barriers

5. Implement changes

6. Monitor implementation - evaluate outcomes

So what evidence is there?


There are lots of different types of evidence available out there.

The Hierarchy of Evidence shows the level of validity of each type of evidence; however, it is important to keep in mind that not all questions are best answered by the highest hierarchy of evidence i.e. systematic reviews.

The hierarchy follows below:


The Hierarchy of Evidence


Guidelines - although a lot of guidelines out there to follow but bare in mind that a lot are not evidence based but are based on expert opinion.

Some useful guidelines out here:


When searching for evidence you can break out searches into 4 different domains to find the evidence most suitable for your problem (i.e. PICO):

Population
   Intervention
   Comparison
Outcome

When assessing evidence validity, you should take into consideration:
  • Whether the trial was randomised, non-randomised, matching, statified etc.
  • Is the trial blinded? And to what extend: single, double, triple or quadruple? 
  • What statistical analysis is used to draw conclusions? Mean difference, relative risk, absolute relative risk, number needed to treat (NNT) etc

What is the difference between audit, research and evaluation?


Research is when you are 'creating' new knowledge. For NHS research, it must follow a set protocol. 

Audit is when you use predetermined standards set according to research in order to assess current practices and involves cycles of analysis. See my previous blog post about audit here

Evaluation is where you answer the question: 'What standards do we achieve?' 


I hope you have found this post useful. Please see one of my previous posts with evidence based survival rates of common dental restorations here. 


Is there anything else you would like to know about Evidence Based Dentistry? Please leave your comments in the section below!




Monday, 17 November 2014

The Underground Film Club: American Psycho

So last week, me and my flatmate spent the evening at the The Underground Film Club in the underground vaults in Waterloo. 



















Having seen the ads in Timeout, we were very excited and it didn't disappoint.

The event was sold out and the film we chose to see was American Psycho, although there are a lot of Christmas films coming up in December (I'm particularly tempted by Home Alone).

Drinks weren't too pricey (it was Happy Hour after the film too) and there was ample popcorn available to buy as well as other food and snacks!

The atmosphere was great - it really felt like you were in an wartime air raid shelter!
You wear headphones (it was a bit like being in a silent disco) which was good if you needed to pop out to the loo as you could still hear the movie!

Every so often there was a rumble overhead from the trains passing through Waterloo; it did feel very surreal and a bit like an escape from London life. 

I would recommend getting to the venue ahead of time as most screenings are fully booked so if you want to get a decent seat arrive early! Some people had to sit in the aisles if they arrived late!


The Big Screen and the entrance to the Underground Vaults





















To find out more about the Underground Film Club including listings see their website


Have you been to the Underground Film Club? What did you see? I love to hear your thoughts in the comments section below!

Saturday, 15 November 2014

#TubulesLive Event: Ridge Preservation with Professor Nikos Donos


This week's #TubulesLive Event was with Professor Nikos Donos about Ridge Preservation. 




It is important when assessing patients for implant work you inform them there may be a need for bone or soft tissue grafts so they can make a fully informed decision about treatment. 
This episode of #TubulesLive has taught me what options are out there in terms of grafting materials and which cases may require them.

Here I will summarise learning points from the event:

  • It is important to plan the loss of a tooth in depth by assessing the amount of bone and soft tissue present to support either an implant or a prosthesis. 
  • The ALVEOLAR PROCESS is the maxillary or mandibular bone that supports teeth, roots and unerupted tooth buds. 
  • The process of healing after tooth extraction typically follows:
                 0-3 days          Inflammation and formation of blood clot in the socket
                 4-7 days          Fibroplasia and the formation of granulation tissue
                 7-30 days        Mineralisation and the formation of woven bone
                 30 + days        Remodelling and formation of lamellar bone
  • The most abundant tissue present in bone healing is connective tissue
  • Studies show that there is significant resorption of buccal bone following extractions (since buccal bone is thinner than lingual/palatal bone), and two thirds of this resorption occurs in the 1st month following extraction
  • Alveolar atrophy can be caused by functional factors (e,g, loading of a prosthesis), inflammatory factors (e.g. traumatic extractions, periodontal problems) and systemic and anatomical factors (e.g. age, nutrition)
  • Options for implant placement:
             1. Extract and wait: 6-8 weeks (Type I), 12-16 weeks (Type II), more than 6 months (Type III)
             2. Extract and immediate placement of implant (Type IV)
             3. Extract and alveolar ridge preservation techniques (ARP)
  • ARP techniques include: grafting, guided tissue regeneration (GTR), sponges/plugs, soft tissue sealing, growth factors, systemic medications or a combination of any of these. 
  • Some studies have shown that there is a reduction in the loss of alveolar ridge width and height following extractions with ARP compared to unassisted healing.
  • 100% ARP is unpredictable and you cannot prevent resorption after extractions
  • There is currently no significant difference between ARP techniques in systematic reviews 
  • There are lots of different products on the market to use in grafting procedures e.g. BioOss (which is demineralised bovine bone mineral i.e. DBBM, and collagen) and synthetics (which are usually hydroxyapatite and tricalcium silicates or phosphates)
  • Implant placement can be done with a flap or flaplessly
  • Whilst flapless techniques have the advantage of having no periosteal disruption, raising a flap will allow for better access and assessment and primary closure of the guided bone regeneration
  • On animal studies, flaps have been shown to lead to less horizontal bone loss, whilst the flapless technique leads to more keratinised tissue and less discomfort for the patient.
  • Soft tissue sealing can be carried out with synthetic grafts or with free gingival grafts which are sutured on top of the socket
  • Whilst at the moment there is no clinical evidence supporting soft tissue sealing, it has been suggested that there may be an increase in the amount of keratinised tissue on the buccal side to support an implant

In summary, whilst alveolar ridge preservation may not be needed in all patients, for example where there is an active endodontic abscess associated with a tooth, ARP can be useful in a lot of cases to help preserve tissues in order to support an implant and give a good aesthetic result.

I hope you have found these notes useful. The next #TubulesLive event will be in the new year, on the 22nd January with Dr Alan Sidi: Sinus Augmentation for Dental Implants.


I hope to see you there! Please leave your thoughts about ridge preservation and dental implants in the section below!


To see my other posts about previous #TubulesLive events see here



Tuesday, 11 November 2014

A Guide to Endodontics



So recently, I had a study day on Endodontics, a procedure that can be source of nightmares for many dentists! 

Having limited experience at Dental School (I think I carried out 6 root fillings in total whilst studying!), once we graduate we are expected to be competent in this area of dentistry. 
Whilst a 20 year old patient who required root canal treatment (RCT) on their upper central incisor wouldn't really lead to a sleepness night of worry, endodontic treatment of a molar (which is a very common treatment in practice) would certainly lead to some trepidation!

This study day, led by Dr Rohan Rajasingham, a specialist endodontist, has taught me that there are no shortcuts when it comes to this sort of treatment and the more practice you get, the better and more efficient you will become when providing RCT for your patients. 

Here is a summary of what I took from the day.


What Leads to Successful Endodontic Treatment?


  1. Shaping i.e. the shaping of the root canal system to allow for a placement of a filling material
  2. Debridement: by mechanical and chemical means e.g. irrigants, intracanal medicaments
  3. Obturation i.e. good sealing of the root canal system coronally and apically which prevents recontamination of micro-organisms and their products

Why is there a need for chemical irrigation?

It is virtually impossible to instrument the entire root canal system via mechanical means alone therefore we must use an irrigant to access the complex root anatomy, especially the apical deltas which are most associated with pathogenic bacteria. 

Which irrigant should I use?

The irrigant which has been proved to be the most effective throughout the years is Sodium Hypochloride (3%).
There should be adequate enlargement of the root canal in order to allow the irrigant to reach the apical anatomy and there should be frequent turnover and sufficient volume of the irrigant which should be agitated in order to work most effectively (by means of a hand file or ultrasonic activation).
EDTA can also be used synergistically with sodium hypochloride, as it can dissolve inorganic tissue whilst sodium hypochloride can dissolve organic tissue. 

What is Patency Filing?

The passive movement of a small file (ISO 08-10 K File) <1mm through the apical foramen which is only carried out once the coronal preparation has been completed.
The theory behind doing this is that it may allow irrigants to reach the apical deltas, it helps prevent ledging and transportation and encourages drainage of exudate or pus. 

What is Recapitulation?

This ensures the irrigant is replaced apically. 
Instrumentation leads to dentine mud (saturated irrigant and dentine debris) which can block the canal apically. Therefore it is important to frequently replace the irrigant and place a small K file (08/10) to full length and agitating the fluid. 


Access Cavity Design


This is crucial and should not be rushed! 

The entire roof of the pulp chamber needs to be removed in order to get good vision and tactile access to the entrances of the root canals i.e. Straight Line Access

The access should preserve as much tooth tissue as possible whilst allowing for the above and there should be good resistance form for a temporary restoration.
It also may be prudent to reduce cusps or provide a cuspal-coverage restoration in order to protect the tooth from fracturing between visits. 

MAGNIFICATION is highly recommended, whether it be Loupes or a microscope. This will make your life much easier! 
Safe-end burs e.g. Endo Z, are essential to preventing damage to the pulp floor when removing the roof of the pulp. 
Endodontic ultrasonic tips can be useful when revealing canal entrances or removing calcifications - especially when revealing MB 2 in upper molars, 90% of upper 6s have MB 2 canals!


Determination of Working Length (WL)


WL - length at which each instrument is used in the root canal. This is not necessarily the same as canal length!

This is best determined by an apex locator, estimating from radiographs is not reliable although it is sensible to take a working length radiograph to confirm your reading. 

The WL should be set at 1mm short of the canal length (in more experienced operators this can be reduced to up to 0.25mm short) 


Canal Preparation Techniques


1. Handfiling - Step Back or Crown Down. Crown Down is preferred as this removes the more infected coronal tissue first and allows for deeper penetration of the irrigant. 

2. Protapers - Continuous clockwise rotation of the files. Use of S1, S2, F1 and F2 files (or Sx file to use for coronal flaring). Need to be used with a light brushing motion and needs a glide path. Avoid using in very curved canals as there is high risk of file separation. 
Use up to size 20 K File to scout the canal as the actual size of a S1 file is 0.18mm.
DO NOT use a brushing stroke with finishing files, immediately withdraw the file once it reaches WL in order to prevent over-instrumentation. 

3. Single File Preparation e.g. Recriproc, Wave One - Reciprocating movement of the file. It is not necessary to have a glide path. One file is used to prepare the entire canal.


Having practised with each technique (although at the moment the only technique I use on patients is handfiling), my favourite is the single file system (we tried with Reciproc).

Once you get used to the tactile sensation of the file which feels quite destructive, the procedure is very quick and easy. Whilst the Protaper system is efficient too, it was easy to get the file 'stuck' in the canal and I had to reverse it back out quite often!

A one file system is also advantageous as often I will use up to 10 different files on a patient, so there is a lot of waste! Despite the initial cost of the handpiece and the single files being more expensive than hand files, in the long term these systems could save money as well as time!


An endodontic training tooth which I prepared using the Protaper rotary system. 

Obturation Techniques


Remember you need to create an Apical Stop in order to prevent the root filling extruding out of the apex. Protapers, Reciproc and Wave One all have their corresponding sized Gutta Percha Points. 
All techniques should use a sealer in combination with the gutta percha e.g. Sealapex

1. Lateral Condensation - the most common technique in general practice. The use of a master cone with accessory gutta percha points condensed with finger spreaders. Once placed, a warm plugger should be used to encourage spread of the GP into lateral canals. 

2. System B - Packing of thermafil GP at the apex much like a GP pellet. To be used in combination with Obtura.

3. Obtura - Thermafil GP used more coronally. The GP should be backfilled against the GP placed with System B.


Please click to see more information about Reciproc, Wave One, Protaper, System B and Obtura


I hope you have found this guide useful! Have you used Reciproc, Wave One or the Protaper system? What were your thoughts them? I'd love to hear your views in the comments below!

Why not take a look at my other Clinical Guide posts?



Saturday, 8 November 2014

#Tubuleslive Event: Laser Periodontics - Where a Scaler and Blade Just Won't do.

This week's #Tubuleslive Event held at Henry Schein was led by Dr Rana al Falaki - Laser Periodontiics: Where a Scaler and Blade just won't do. 




The use of Lasers in Dentistry is rapidly expanding but is not something many undergraduates learn about when at Dental School. 

This event has opened by eyes to the many uses and evidence of the effectiveness of lasers in the field of periodontology and it is certainly something that I would be interested in learning more about, not only in this area of dentistry, but in other areas such as restorative dentistry and oral surgery. 

Here is a summary of the points I took from the event:
  • Periodontitis is being linked to more and more systemic conditions, from cardiovascular disease to rheumatoid arthritis to alzheimers
  • In treating periodontitis we aim mainly to save teeth but also to preserve function and improve aesthetics in order to improve a patient's quality of life
  • The most challenging aspect of managing periodontitis is reducing the risk of relapse.
  • We can manage periodontitis non-surgically, surgically, with perioplastic surgery and supportive periodontal therapy
  • Risk factors for periodontitis include: smoking, diabetes, nutritional deficiencies, stress and genetics. 
  • Lasers do not replace our traditional instruments but should be used as an adjunct to scalers and blades in the management of periodontitis
  • If a patient's gums are very sore, you should advise them to brush using Corsodyl gel
  • When looking at radiographs to assess periodontal disease you should examine root length and shape, furcations and type of bone loss e.g. horizontal, vertical, bony defects, angular defects
  • Moderate pockets are classed 4-5mm, above 6mm the pockets are classed as severe
  • When using an ER, CR:YSGG laser (Waterlase) to treat periodontitis, the water-cooled laser should be used after ultrasonic scaling (using full mouth local anaesthetic) using a 500 micron tip
  • Lasers have been shown to increase the stability of the periodontal condition as well as long term decrease in bleeding
  • The effects of lasers include: they kill bacteria, remove biofilm and smear layer (this promotes the adhesion of fibroblasts), remove calculus, endotoxin and infected cementum 
  • Although there isn't enough good evidence at the moment in support of Lasers as there aren't enough Randomised Controlled Trials (RCTs), there is a growing belief amongst periodontists that lasers are as effective, if not better than scaling alone when treating periodontitis, there is less recesssion, lasers produce a more stable result and perhaps there is new generation of bone and attachment
  • Whilst the regeneration of attachment (cementum, bone, ligament) is often unpredictable, using lasers could promote this attachment instead of the usual healing by Long Junctional Epithelium formation after treatment with scalers alone
  • Angular bone defects are difficult to treat by non-surgical means 
  • Diode lasers may help reduce post-operative pain 
  • Lasers are more patient friendly, less expensive, are faster, have better visibility and have the potential for regeneration.
  • Regeneration is most predictable in 3-walled defects and class II furcations. 
  • Other uses of lasers include gingivectomies, crown lengthening surgery, fraenectomies, grafting, non-surgical apiecectomies, vestibular deepening, restoration of biological width and management of peri-implantitis. 
  • There is a 30% incidence of peri-implant mucositis and peri-implantitis, although this varies according to which study you look at.

I think the most exciting thing I took away from the talk was the potential for tissue regeneration which I think could revolutionise the field of periodontology in future!


The next #Tubuleslive event will be next week the 13th of November: Ridge Preservation with Professor Nikos Donos.
Why not attend the live audience where you can get FREE CPD! Register online and I hope to see you there!


Have you had experience using Lasers in practice or would like to start using them on patients? Please comment in the section below!

To see my other posts about previous #TubulesLive events see here


Friday, 7 November 2014

The Guessing Game: When Will my Filling Fall Out?

So ever been asked by a patient how long will a filling or crown last? Do you pluck a figure out of thin air?


A conventional cantilever bridge I provided for a patient recently.


Although each mouth is individual it is important in order to obtain informed consent from a patient, to be honest and clear about the lifespan of dental restorations. This means that you need to use 'Evidence Based Dentistry' when educating patients. 
This shouldn't be interpreted by patients as a warranty, but as a guide. 


Here is a summary of the most common dental restorations based on current scientific literature:


Fillings


Amalgam - 90% still in place after 10 years. High copper based amalgams have better survivals

Composite - Mostly tested in cervical regions where failures are greater, better survival with enamel etching


Inlays


Tooth coloured - no difference between composite and porcelain survival rates, both more than 5 years

Gold - 99% present at 20 years, 75% at 25 years


Crowns


All ceramic - there isn't much long term data available at the moment, but Procera crowns have 94% still present after 5 years, Inceram have 94-98% after 3 years and Empress have 95% after 2 years.

Single crowns - mean survival is 9.5 years, but remember this is including all data. As I said in one of my previous posts here on extra-coronal restorations, the mean survival of NHS crowns is only 2 years!

Gold crowns - consistently good performance, around 16 years.

If teeth are root filled post-cementation, there are greater chances of failure.

Loss of vitality after crowning is around 15% after 5 years.


Porcelain Veneers


91% are still present after 10 years, with a greater failure rate if they are partially bonded to dentine.


Bridges


All Bridges - 85% are still present at 10 years which reduces to 65% at 15 years. There is no significant difference between cantilevers and fixed-fixed.

Adhesive Bridges - Average lifetime is 9.8 years but the greater the number of abutments, the greater the risk of failure.


Root Canal Treatment





Studies vary from 53-95% success rate and it depends heavily on tooth selection as well as operator experience.

The presence of a peri-apical area of infection lowers the success rate by 10-20%


Implants 


Figures vary from 82-99% success rate over a mulit-year analysis.

The most successful area for implants is the lower anterior region, whilst the worst are any areas that required grafting.



Are there any other restoration survival rates you would like to know? Please leave your questions and comments below! I shall be writing another post about Evidence Based Dentistry soon so keep a look out!




Monday, 3 November 2014

Leadership with Michael Vaughan - BPP Lecture Overview

So this evening I attended the BPP Vice Chancellor's Lecture which was delivered by the one and only Michael Vaughan


Michael Vaughan speaking this week at BPP


I heard about the event from my boyfriend, an LPC student at BPP university, as he knew that cricket is something that I loosely follow having been brought up in a family obsessed with the game!

Unsure of what he was actually going to talk about at the event, I was relieved that he mostly referred to cricket - specifically his captaincy in the 2005 Ashes.

Michael spoke of what it was like leading his team to a victory and how to succeed in communicating effectively with a team. 


His main points to help you succeed in leadership were:

1. Hard work

To succeed with most things in life you need to work hard, although sometimes luck may be on your side, when it comes down to it hard work always pays off. 

2. Careful planning

When Michael was planning for the Ashes series of 2005, he took over 2 years to plan out a strategy - drawing up statistics and targets for the team to aim for.

3. Managing all members of the team

This includes managing more disruptive members of the team effectively (maybe a reference to Kevin Pietersen perhaps), which would involve getting to know each member of the team so you know what makes them tick and how they manage pressure.

4. Getting all team members involved in decision making 

Michael used to ask new members of the team to contribute towards the field plan during matches to make them feel like they were integrating with the team. 
It also means asking members for feedback and advice; he used to get all players involved with team huddles at the beginning of the day.
If a team thinks as one, it is likely that they will work more effectively together. 

5. Positive attacking attitude

If you think you will fail in a task, then you probably will. 
The lesson is to look past your fear of failing and whilst sometimes an attacking attitude can be risky, sometimes this attitude can pay off. 


Sadly, we didn't win any of the raffle prizes (I had my eyes on the signed cricket bat) but Michael was a really good speaker - all those press conferences must have been great practice!

And finally to clarify, although Michael was born in Manchester, he is through and through a Yorkshire lad. 

Listening to Michael speak really enthused me to get back involved with cricket, especially since he spoke of how the women's game is really getting more and more popular.

Finding women's cricket clubs has been an issue for me in the past, but I hope with the wider publicity of the game such as with the 20/20 leagues, there will be more accessibility in the future so that generations to come can get involved in the sport!


Sorry I had to share this snap I took this summer at a day-night match between Notts Outlaws and Warwickshire Bears



I would love to hear your opinions about leadership skills or cricket in general! Please use the comment section below!


Sunday, 2 November 2014

Dental Student's Got Talent 2014




Earlier on this year, Dental Protection (DPL) held a Dental Student's Got Talent competition. Previous winners from other years have shown off the many different talents of Dental Students.

This year I decided to enter, not only because there were cash prizes up for grabs, but also to have a break from the challenges of final year!

I think it's really important to cultivate your interests and hobbies in order to have a good work-life balance. Before I entered my piece for the competition it had been a while since I had even picked up a paintbrush. 

After 4 hours of work I had produced my first proper art piece since my GCSE exam! 

There were so many fantastic entries this year, from sports to singers to musicians, so it was no surprise that I didn't win any prizes but it didn't really matter, I had gotten back into something that I had forgotten how much I enjoyed. 

To see the winning videos from this year's competition see the DPL website.


My Entry


See how I made my piece 'The Bird Lady'.








What did you think of this year's entries? Which was your favourite? Please leave your comments in the section below!



Related Posts Plugin for WordPress, Blogger...