Saturday, 27 December 2014

Top 10 Things To Do in Tanzania

So it's the Christmas period - let's have a bit of a break from dentistry!

A Pride of lions and their cubs in the Serengeti. We were so lucky to chance upon these lionesses just after a kill and they were taking their cubs to the carcass to have a bite to eat!

Some of you fourth year dentists may be trying to decide where to go on your electives in the summer. There are a lot of places to choose from but those of you who have read my previous post about volunteering as a dentist (see here) will know how I travelled to Tanzania last summer to treat patients in a rural hospital in Zanzibar. 

As the cold wintery months kick in I find myself reminiscing about my previous adventures to hotter climates so here I will list my top 10 things to do in Tanzania to help you plan your visit to Africa!


1. Safari

This is definitely the number one thing to do in Africa in my opinion. Whilst safaris can be quite expensive, I'd recommend shopping around tour companies, go for camping safaris or limit the number of days you go.

We opted for a 3 night 4 day safari as we wanted to go to the Serengeti, the Ngorogoro crater and Tarengire national parks. 
The Serengeti is HUGE so most of the options that included it were the longer Safaris.

You can book the Safari before you arrive in the country but we were lucky as we got a pretty safe recommendation from people we were staying and were able to barter down the price too which you shouldn't be afraid to do! 

I think that 3 nights in a tent was definitely the maximum I could've handled and it's surprisingly cold at night time so bring something to wrap up warm!

A baby elephant we saw in Tarengire National Park


2. Zanzibar beaches


When you picture blue waters and white sands, the beaches in Zanzibar surpass your expectations!

Pretty much wherever you go in Zanzibar there are great beaches. I'd recommend Nungwi, Kendwa, Jambiani and Paje.
Be prepared to bombarded with locals trying to sell you anything, from snorkelling trips to coconuts to sunglasses.

Wind surfers at Paje Beach

3. Kilimanjaro


The highest lone standing mountain in the world - you don't have to fully commit to climbing Kili if that's not your cup of tea!

It takes around 6-7 days to climb the mountain and come back down again and it's not as challenging as some other mountain ranges. The cost however was pretty similar to safari so we decided not to climb all the way to the top, instead we explored the foothills around the mountain with a guide who was from one of the villages at the foot of the mountain, Marangu.

Even if you're passing through Moshi, the nearest big town to the mountain, or flying into Kilimanjaro airport you can get pretty nice views on a clear day.

One of the numerous waterfalls around the bottom slopes of Kilimanjaro

4. Kijamboni


A small village a short distance from Dar es Salaam, it can be a nice escape to the hustle and bustle of the city.

Whilst the beaches aren't as lovely as the beaches on Zanzibar, they are still very pretty and were much quieter and peaceful as they're weren't really that many touts about. It's also cheaper as there's more of a local vibe as there aren't as many tourists about.

Apparently it does it a bit busier at weekends when people come down from the city, but if you're looking for more a local experience I'd recommend Kijamboni. Getting there is pretty easy from Dar as there's lots of Bajajis (or Tuk Tuks) eager to take you!


5. Snorkelling


There are so many opportunities in Tanzania to snorkel: we snorkelled on 3 different occasions, at Mnemba in Zanzibar, just off Prison Island and at Pangani.

Out of the three, Pangani was definitely the most enjoyable as the gear we were given was the best and we were the only group in the sea and the coral reef was full of life, whereas Mnemba was full of other snorkel groups and Prison Island was scarily quiet!

Equipment really does make a lot of difference when snorkelling, so either bring your own or make sure the equipment offered is of decent quality.

And don't worry if you haven't snorkelled before, I had never snorkelled before and it's not too difficult even if you're not a great swimmer as you can wear a life jacket!

Aboard a dhow enroute to Mnemba Island Atoll

6. Prison Island


A small island just a short dhow trip from Stone Town in Zanzibar, the island has an old ruined prison but more famously,  sanctuary of tortoises, some reaching so big you could ride them (but as the signs frequently remind you, you must no sit on the tortoises).

There is also a great beach and an opportunity to snorkel whilst you're there.

Feeding the tortoises at Prison Island

















7. Dolphin/whale watching


Whilst there are a lot of companies and individuals offered dophin watching trips be careful as it can turn into a hunting session where one boat spots a dolphin and every boat in the vicinity chases after it.

We saw a humpback whale on one of these trips, but this was all we saw and be warned if you have a delicate tummy - the sea can get very choppy and rough.

We actually happened across a pod of dolphins accidentally when we were getting a local boat across from Pangani to Nungwi which was much more rewarding that chasing after them.

Either way be prepared for a very early start in the morning!


8. Stone Town and Forodhani night market


The capital of Zanzibar, Stone Town is a maze of alleys filled with stalls and shops.

There area great places to eat along the seafront, but my highlight by far is when the sun goes down is the food market that pops up every night in Forodhani Gardens. Everything from the famous Zanzibar pizzas to shwarma wraps to lobster skewers.

So after a spot of souvenir shopping (remember to bargain hard!) gorge on the best food from the locals!

The famous Zanzibar pizzas - yum yum!


9. Full moon party, Kendwa


Whilst the full moon parties of Thailand are infamous, the monthly full moon party at Kendwa Rocks on the north tip of Zanzibar should not be missed!

Make sure you book accommodation in Kendwa in advance as places (especially Kendwa Rocks itself) book up pretty quickly.

There is also half moon parties so don't panic if there's not a full moon for when you're planning to be there.


10. Masai Village


We visited a Masai village called Malanga on our way back from Safari in Ngorogoro national park.

It was really interesting to learn about how these Masai people lived and we were shown around their homes in their village as well as looking at their little school (which was reserved just for the boys) and they told us stories of how they lived for example the risk of lion attacking their cattle or even villagers themselves!

You can also arrange village visits from Arusha and there is a 'donation' that the village leader charges to let you into their homes.

A Masai welcoming dance we were given at the village in Ngorogoro national park


This was my first trip to Africa and it really did open my eyes to what life is like in poorer countries as well as learning about their culture and religion. We arrived into Zanzibar during the fasting period of Ramadam so we had to learn how to dress and behave respectfully in this Islamic region. We had a great time and the more touristic areas were there in case we were hungry during the day!

I hope that those of you who are planning to travel to Africa have a few more ideas of what to do when you're out there! 
And if you're thinking about going out to South East Asia why not check out my post with my top activities when you're out there!


I'd love to hear any other recommendations for what to do in Tanzania from others who have been there! Please leave your comments in the section below!


Tuesday, 16 December 2014

A Guide to Periodontology


Periodontitis is becoming ever more evident in the media recently, with lots of press linking a poor periodontal condition to cardiovascular disease, diabetes and even erectile dysfunction!

As patients are living longer, they expect their teeth to last a lifetime and there is greater awareness which both contribute to the rise in litigation against dentists who fail to diagnose periodontal disease. 

Here I will discuss the importance of spotting gum disease and how to manage the condition. 

How is Periodontitis classified?


Since the British Society of Periodontology (BSP) changed it classification of this disease in 1999, periodontitis is classified into 8 different types:
  1. Gingivitis
  2. Necrotising Ulcerative Gingivitis/Periodontitis
  3. Chronic Periodontitis
  4. Aggressive Periodontitis
  5. Periodontal abscesses
  6. Perio-endo lesions
  7. Gingival hyperplasia
  8. Periodontitis as a manifestation of systemic disease
Periodontitis can also be Localised (less than 30% of sites are affected) or Generalised and also mild, moderate or severe. 
Mild: 1-2mm clinical attachment loss
Moderate: 3-5mm clinical attachment loss
Severe:  more than 5mm clinical attachment loss (CAL)

See more about the classification of periodontal disease here 


What cases can I treat in practice? 


The BSP released some guidelines to help GDPs decide which cases can be treated in general practice and which cases they may consider a referral appropriate. They follow in terms of complexity:

1. BPE scores between 1 and 3 - Treat in General Practice

2. BPE scores of 4 - Treat in General Practice or consider a referral for periodontal surgery

3. Surgical cases which involve implants, cases which require tissue augmentation or crown lengthening, patients younger than 35, patients who smoke more than 10 cigarettes a day, complex medical histories, complicated root morphologies or more than 2mm of CAL in 1 year - Refer to specialist



A BPE score of 4 - this could warrant a referral to Specialist services


Risk Factors


The 2 main risk factors for periodontitis are PLAQUE and SMOKING.

Whilst in some forms of periodontitis (e.g. aggressive), plaque control doesn't correlate with the severity of the periodontal disease, poor oral hygiene is the major factor for the breakdown of the periodontal tissues.

Smokers are 2.8 more times at risk to periodontal disease than non-smokers. This is because:
  • There is decreased blood flow to the tissues
  • Smoking impairs white blood cell function
  • There is impaired wound healing
  • There is an increased production of inflammatory mediators which leads to periodontal breakdown
Studies have shown that there is 1mm less probing depth reduction in smokers following non-surgical management of periodontal disease compared to non-smokers. 

Whilst poorly controlled diabetes can aggravate the periodontium, if a patient's diabetes is well controlled then there is no increased risk of periodontal destruction than non-diabetics. 


When should I start performing a Basic Periodontal Examination (BPE)?

Look at a child's incisors and 1st molars, as these are the teeth that can be affected earlier on if life if a patient suffers from aggressive periodontitis.
Examine one tooth in each quadrant.
Aged 7-11: Use codes 0-2
Aged 12+: Use codes 0, 1, 2, 3, 4, *


How much reduction in pocket depths can I expect following successful treatment?


Whilst the main reduction in pocket depths is due to the resolution in inflammation i.e. recession, there is some reattachment of long junctional epithelium at the base of the pocket. 

In pockets 1-3mm, there is on average 0.03mm reduction in probing depths.

In pockets 4-6mm, there is an average of 1.29mm reduction.

And in pockets greater than 6mm, there is an average 2.16mm reduction.

Studies have also shown that you can measure up to a 0.8mm reduction in probing depths from improvement in oral hygiene ALONE.

Options for non-responsive cases.


  1. Another round of non-surgical management (NSM), if there is a potential to heal further and residual subgingival calculus is felt or seen.
  2. Accept and maintain
  3. Extraction of teeth of poor prognosis and assess restorative and aesthetic solutions
  4. Referral for specialist treatment, either privately or to a hospital.
Cases which have furcation involvement may be difficult to treat in practice and there are several options to manage these areas:
  • Scaling and root instrumentation alone
  • Furcation plasty
  • Root resection
  • Tunnel preparation
  • Guided Tissue Regeneration (GTR) - only suitable in some cases
  • Extraction

Should I use Antibiotics?


In general practice, it's not very often that antibiotics are prescribed in the management of periodontitis (unless a patient has a periodontal abscess).
The disadvantages such as the spread of resistance, the disturbance of ecological equilibrium and general side effects of antibiotics often outweigh any beneficial effects.

Systemic antibiotics are widely distributed throughout the mouth, but also throughout the whole body so their effects can be diluted.
Studies have shown that there was a significant difference in the improvement of CAL when using metronidazole in combination with NSM and there was better results in aggressive and refractory types and in deep pockets.
There is no guidance on what dosage to use or for how long, but in these severe cases, the action of metronidazole is on Actinobacillus actinomycetemcomitans.

Localised antibiotics such as doxycycline polymer, minocycline gel or tetracycline fibres act on the sites you place them at, but they need to be able to reach the base of the pocket and be maintained there which can be a problem due to the constant flushing effect of Gingival Crevicular Fluid (GCF).

Periostat can also be prescribed. This is 20mg of doxycycline taken twice a day for 3-9 months. This sub-microbial dose of antibiotics suppresses collagenases and matrix metalloproteinases (MMPs) so there is less periodontal breakdown. 


Guided Tissue Regeneration (GTR)


The basis behind this treatment is to prevent the downgrowth and reattachment of the long junctional epithelium as only periodontal cells e.g. fibroblasts, cementoblasts are able to regenerate the periodontium and these cells are much slower than long junctional epithlial cells to colonise the base of the pocket.

GTR is not effective in treating all cases. It works best in angular 3-walled defects or class II furcations and the narrower the defect, the more predictable the outcome. 

Bone grafts are used e.g. BioOss as well as barrier membranes which cover the graft material e.g. BioGuide. There is some evidence to support just placing the barrier membrane without the bone graft eliminates the recolonisation of long junctional epithelial cells - but it's prudent to place bond grafts in large defects as it preserves the space so you can place the membrane.


This was yet another informative study day - and two weeks on the trot we got to practice surgical procedures on pig's heads! (mind the pun) Thanks to Neesha Patel and her team for a great study day.

To see the effect of an aging population has on the treatment of periodontal disease, please see my post about a talk by the renowned Prof Francis Hughes here.


Please leave any questions or thoughts in the comments below! I'd love to hear other people's views about when they decide to refer periodontal patients to secondary care!

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



Sunday, 14 December 2014

All I Want For Christmas Are My Two Front Teeth

It's approaching Christmas time! Woohoo! 

First term has gone so quickly! Only 11 more sleeps and Santa will be here. But what do you want for Christmas? Here's what's on my Christmas List this year. 


One of our practice's Buddas feeling festive!


1. ARF fee

The BDA have been leading the fight against the ARF hike. 


There's been a surge of dentists cancelling their direct debits to the GDC, me being one of them. 
There was no way I would've been able to live this month if the increased annual retention fee of £890 was taken out on the 1st. Hopefully Santa will be generous this year! 

Thanks to the BDA for all their efforts in voicing the profession's discontent!

See my recent article about how this increase will affect young dentists. 


2. Loupes




Everyone keeps going on about buying Loupes and I believe you; it improves your posture, makes life easier for yourself and increases the quality of the dentistry you deliver! Unfortunately I don't have the funds to buy some at the moment.

I know the best type of Loupes need to have a light source too, and I wear glasses so I need to bear that in mind when deciding which type to buy. If anyone has any suggestions, please let me know in the comments section below!


3. Camera




I do love my bridge personal camera, but a dedicated clinical SLR with a 100mm macro lens and a Ringflash would be great. It would also save me carting my camera to and from work as I never know when I need it!

I also think an intra-oral camera would be a great tool to help demonstrate and educate patients about their oral health - it's surprising how many patients don't really know what's going on in their mouths!

See one of my articles about what sort of camera to buy for good quality clinical photographs here

MERRY CHRISTMAS EVERYONE!

Remember this tune?



So what's on your Christmas list? Does it look similar to mine? Let me know in the comments section below!




Thursday, 11 December 2014

DF1s Facing the ARF Increase: The Young Dentist FMC Article



Christmas is coming and the purse strings are tightening. But they are even more stretched for young dentists like me! 

All the debts from my student years are looming over me, but even more scary is the prospect of having to finance the massive annual retention fee (ARF) due by the end of December by the General Dental Council.

In my latest article I talk about the financial worries of young dentists and the consequences of this 55% increase in ARF!

See the full article

I'd love to hear your thoughts and opinions about the ARF increase and the current financial climate in dentistry in the comments section below!

Wednesday, 10 December 2014

The Art of Direct Composites

Another study day post; this one is based on a Study Day held by the iCAD Academy.



So already in my first 3 months in practice I've been asked numerous times how much a white filling is.
Despite having some experience with composite at dental school, I still feel a bit guilty telling a patient who wants a white filling in their back tooth, according to my practice policy it will come under private treatment and therefore they will have to pay more.

I really enjoy working with amalgam and I think it's a great material to work with, but I do empathise with patients who are concerned with it's appearance - I used to have a large MOD amalgam in an upper six that was replaced a year ago with a nice white Emax onlay.

I see a lot of really natural and attractive composites online by some really skilled dentists so I have felt some disappointment when looking at my posterior composites; especially where I can clearly see the transition between composite and tooth or a very disappointing attempt at a fissure pattern. My composites were functional, but not pretty.

This study day with Neel and Anup really taught me a lot and I have already put the tips into practice to deliver more aesthetic solutions for my patients.


What makes up composite?


1. Polymer resin matrix, mostly based of bis-GMA
2. Filler e.g. silica, strontium, zirconia silica

Other components include initiators, pigments and stabilisers 

So do composites or amalgam (or silver) fillings last longer?

According to studies, amalgams last between 6.6-14 years.
Compare this to 3.3-4.7 years for composite fillings.

BUT a lot of this data is skewed by short studies, testing areas of high failure e.g. cervical cavities, or they do not take into account factors such as operator technique. 

So can I restore this cavity with composite?


There are a few factors you need to take into consideration:

1. Occlusal Assessment - check the patient's ICP and RCP, excursions, centric stops. If the composite would be where the centric stop is, or the patient is a bruxist, a composite restoration may not be strong enough to withstand these heavy forces

2. Contact area Assessment - using floss and radiographic assessment. Can you recreate a good contact point?

3. Is there a ring of enamel? This is essential to get a good bond. 

4. Is there good moisture control? Contamination with blood or saliva weakens composite and doesn't allow for a good bond to the tooth structure. 


Some useful tips:

  • It may be beneficial to soak the finished cavity with chlorhexidine as this can reduce post-operative sensitivity
  • Do not use flowable composite to line cavities as it has increased shrinkage and higher concentrations of the monomer which can lead to post-operative sensitivity 
  • Customise your wedge to create a good contact point. Trim with a scalpel or a bur so it is the correct size for the interproximal space 
  • You can also pre-wedge the cavity so that you can visualise the contact point prior to placing the restoration
  • Use a mico-brush to smooth the composite before curing and be careful not to incorporate dust or hairs!
  • Shape as much before curing. You want to polish as little as possible as this exposes the flaws in the composite which you will see as white specks. 
  • Bevel incisal fractures buccally to ensure there is no unsupported enamel and to improve the transition between the tooth and the composite or use a Starburst bevel
  • DO NOT use bond on instruments or cured over the top of composite to improve appearance as this will lead to staining. Use a specific wetting agent instead - each brand of composite will have their corresponding brand of wetting agent. 



Anterior Composites

Here is a step by step technique:

1. Always use a putty matrix made from a diagnostic wax up

2. Place the palatal wall in enamel shade

3. Recreate the contact point either with a customised wedge, a matrix seated in the index (metal or clear), using a clear matrix and wedge or using the Mylar Pull method.

4. Use a small amount of opaque shade composite

5. Use a dentine shade to build up a layer of a few millimetres thick, leaving enough for an enamel layer and small deficiencies to mimic the mammelons in the adjacent tooth

6. Use a SMALL amount of tint to exaggerate these mammelons - usually blue, grey or halo.

7. Finally use a enamel translucent shade to recreate the natural contour of the buccal surface.


The palatal view of the restored upper left central incisor. The labial view is seen in the title photo,


Posterior Composites

Here is a step by step technique:

1. Using a custom or pre-wedging technique, adapt your matrix (circumferential or sectional) to recreate the contact point

2. Turn the class II cavity into a class I i.e. recreate the marginal ridge

3. You can now remove the matrix

4. Use a dentine layer on the cavity floor

5. Using the P K Thomas incremental technique, build up each cusp one by one, creating small triangles to recreate the cusps and cure each separately. This is difficult to explain so please see this video

6. Add tints to the fissure pattern

7. Add a final layer of enamel shade.


My posterior class II composite. Can you guess if it was a DO or an MO?


Whilst it's great having all these different shades to build up the composite, shade comes with shape!

If you shape the composite properly and finish it smoothly, you can build up perfectly good looking composite restorations in one shade.


One shade composite repair of the upper right central incisor which had an mesial-incisal fracture

For more information please see this article on contouring composites or see the iCAD's website, facebook page or follow them on twitter. Thanks to the iCAD team for holding a great study day!


At the beginning of our study day we were asked which brand of composite we use in practice. It was surprising how many of us didn't actually know! Do you? And more importantly, what type of bonding agent? Please leave your comments below!




Information posted with the kind permission of the iCAD academy

Sunday, 7 December 2014

A Guide to Oral Surgery

A couple of weeks ago I attended a study day led by Dr Parimal Patel about oral surgery, where we got to practice minor oral surgery and suture techniques on pig's heads (gross I know). Here I will summarise the main learning points from the day.



When encountering extractions in practice, general practitioners should be able to deal with most situations, but assessment is key!

Things that may ring some alarm bells when it comes to difficulty include:
  • Close proximity to vital structures e.g. antrum, ID canal
  • Long, curved or unusual root morphology
  • Buried roots which are root treated
  • Severely impacted teeth
  • Difficult to manage patient e.g. anxious, trismus, complex medical history
  • Decoronated molars

When it comes to lower wisdom tooth impactions, mesio-angular impactions tend to look more difficult radiographically (on DPTs), and disto-angular impactions look easier than they turn out to be!

There are some assessment scales out there to help categorise difficulty of the impaction for example Pell and Gregory.

Principles of Flap Design


1. Good Access
2. Broad base in order to allow for a good blood supply
3. On sound bone
4. Avoids vital structures e.g. mental foramen



There may be an increased risk of oro-antral communication (OAC) if there is a:
  1. Large antrum
  2. Lone standing tooth in an atrophic maxilla
  3. Molar tooth with large, splayed roots close to antral floor
There is thought to be a 10% incidence of OAC in upper molars, with 0.5% of oro-antral fistulas (OAF). 

OAFs are epithelialised OACs and are more difficult to treat than OACs.


The floor of the Antrum highlighted with the arrows


Sometimes, it may be acceptable to leave a root fragment in place when a fracture occurs mid-extraction. Criteria for leaving root fragments in place include:
  • No periapical infection around the root
  • Fragment is less than an apical third
  • The root is not mobile
  • The root is close to vital structure e.g. antrum
If you think you have perforated the antrum, if you see is a dark grey lining evident that moves in a out as the patient breathes, you haven't, you can just see the lining!

Management of an OAC:

  1. 3 sided broad based flap with periosteal relief (90% success rate)
  2. OR Partial thickness palatal rotational flap
  3. Record fully and explain what has happpened to patient
  4. Advise the patient to avoid blowing their nose for 10-14 days
  5. 7 day course of broad spectrum antibiotics
  6. Nasal spray/drops (ephedrine 0.5%)
  7. CHX mouthwash
  8. Review after 1 week

Complicated Medical Histories


Bisphosphonates

Patients may be taking these to manage disorders such as rheumatoid arthritis, but these will mostly be oral preparations. 
Evidence shows that IV bisphosphonates pose the most risk for osteonecrosis

Some patients who present with a history or are currently on courses of chemotherapy for some cancers are often being or have been treated with IV bisphosphonates. Guidelines recommend that these patients be referred to a secondary setting for extractions and may need antibiotic cover e.g. metronidazole for 3 days prior to the extraction.

Warfarin

An anticoagulant taken for many conditions to help thing a patient's blood. The measure of its effect on a patient is measured with the International Normalised Ratio (INR).

The target INR should be between 2 and 4, anything above 4 you would not attempt an extraction in primary care without liaising with their GMP.

INR should be taken at most 3 days before the extraction and if it fluctuates a lot, the INR should be taken on the day. 

You should also treat these patients as early on in the day as possible so that you don't disturb their medication regime (similar to how you would manage diabetics). 

Complications of Extractions


Intra-operative:
  • Failure of anaesthetic
  • Decoronation
  • Damage to adjacent teeth/restorations
  • Displacement of root or tooth
  • Oral-antral communication (OAC)
  • Tuberosity fracture
  • Soft tissue damage/tears
  • Alveolar fracture
  • Bleeding
  • Dislocation
Post-operative:
  • Dry Socket
  • Infection
  • Pain
  • Inflammation
  • Secondary Bleeding
  • Paraesthesia/anaesthesia/disthesthesia
  • Trismus
  • Haematoma

There is a recent school of thought when extracting teeth, it is really important to help preserve as much tissue as possible in order to support implants. Some tips to help do this include:
  1. Do not raise a flap
  2. No bone removal
  3. Minimal trauma during extraction
  4. Preserve soft tissue architecture 
  5. Forced orthodontic extrusion in order to create soft tissue/bone?

A lot of patients I see in practice ask about implants and consider having them to replace teeth, so minimising trauma and loss of the bone or soft tissue structure during extractions is something I try my best at, even though I've been experiencing some really difficult cases at the moment such as fractured roots which are root filled which had a previously were post crowned.

My heart used to sink whenever this type of patient presented to me, as I knew getting that tooth out would be difficult. But the tips I learnt from this day have helped to build up my confidence and in the end, it is ok to refer these sort of cases if you cannot do them yourself and you have properly assessed them.  

And nowadays with the increasing threat of litigation, it is important, as the GDC would say, to work within your remit skill set.

Please see a previous post about ridge preservation for implants here.


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


Have you had some difficult extraction cases? Please leave your experiences and any other tips for young dentists in the comment section below!



Friday, 5 December 2014

Paediatric Dentistry Conference


So a few weeks ago one of my study days was a Paediatric Dentistry and Orthodontic conference which covered the main challenges when managing children in practice.



There has been a lot of publicity recently about the high caries rate in under 3 year olds and in London, the most common reason for children being admitted to hospital is to have teeth taken out under general anaesthetic!

For a preventable disease, this is quite shocking!

So why is caries a public health problem?

The impact that caries has on oral health can be significant - it can lead to pain, it affects a patient' s quality of life and can have high financial implications in terms of the cost of managing the disease and loss of earnings in order to visit the dentist. 

Although caries prevalence has gone down in the past 40 years (mainly due to fluoridated toothpastes), untreated caries is the globally the highest prevalent disease in adults (35%), whilst this figure is around 9% in children and only two thirds to children in the UK see a dentist regularly. 

More and more people are retaining their teeth for longer so caries is going to become more and more prevalent. 

Caries has also been associated with poor child growth, low weight, higher risk of hospitalisation, higher school absence and compromised academic performance. 

Oral disease has also been shown to be the 4th most expensive to treat in the UK and dental health education is not very effective in preventing disease. 

Dental health professionals are at an ideal position to screen for other general health problems as well as for oral health as most people see dentists more regularly than they see any other health professional. For example, dentists could be used in the future to screen for diabetes, obesity and provide smoking cessation services. 

Whilst programmes like Childsmile in Scotland helped to reduce caries in children and improve oral health, other means need to be taken throughout the country to help prevent oral disease in children. 


During the conference there was also a presentation about Orthodontics (to see some of my previous posts about orthodontics see here), and also trauma in children which you can see an overview of here.

I hope you've found this post useful! Please leave your thoughts in the comments section below!


Wednesday, 3 December 2014

A Foundation Year in London: The Young Dentist FMC Article



I've been asked countless times why I decided to move down to the capital for my Foundation Year and what is my experience of living in the Big Smoke so far?

Those of you who have read some of previous blog posts about some of the things I've been up to since September will know the variety of opportunities and experiences there are in London. 

In this new post on The Young Dentist FMC, I explain why I decided to chose London and why this is was one of the best decisions I've ever made!

View the full article

I'd love to hear your experiences of living in London in the comments below!







Tuesday, 2 December 2014

A Week of Gigs: Dying Fetus, The Pretty Reckless and New Found Glory



This past week has a been a whirlwind of sound checks and encores.

Having not attended a gig for a few months (in fact, the last music event I went to was T in the Park this summer), I was really looking forward to this week, although I knew I would be knackered by the end of it!

Needless to say Sunday was spent in recovery on the sofa but it was totally worth it!

I also got to explore the different music venues in London. Having previous lived in Kent I have been to a few different venues when travelling up to London to see my favourite bands - but a couple of the places I visited this week I'd never been to before. 

Gig number 1: Dying Fetus, Goatwhore and Malevolence


Apologies to those who have never heard these bands before - their names are more on the controversial end of the spectrum.

This gig was actually a spur of the moment thing, with friends from home deciding to come up to London and since it wasn't sold out, I'd decided to tag along.

The venue was The Garage in Highbury, just up the road from me, so it wasn't even that much effort to go. I was also keen to try taking some decent photos as I had been on a photography course in the morning and I was itching to try out some of the stuff I had learnt.

I have heard of the two main acts before, but haven't really listened to their music that much. I particularly enjoyed Malevolence (see a clip of them at the gig here), but the atmosphere in the place was really great and the venue was really quite intimate so you could get really close to the acts.

The title picture above is of the front man of Goatwhore.

The Headline Act - Dying Fetus


Gig number 2: The Pretty Reckless



Being a big fan of Gossip Girl, I was very excited to see Taylor Momsen (who plays Jenny) on stage and to compare her persona to that of her character in the series.

This time it was more of a trek for us as the venue was the O2 Academy in Brixton, which I had been before a few years back.

The whole performance was very atmospheric, making the most of the sound system and lights although a few times the strobe lighting was a bit blinding.

I was also a big fan of her outfit: sparkly jacket, union jack dress and very shiny boots that looked like she borrowed them from Noel Fielding!


A snapshot of a video I've taken. To see the full clip click here



Gig number 3: New Found Glory, The Story So Far and State Champs


Last but far from least was the Pop Punk's Not Dead Tour!

I had seen both New Found Glory and The Story So Far at the Vans Warped Tour in 2012 so I was looking forward to seeing them again in a smaller venue. The gig was at The Forum in Kentish Town, which had reasonably priced drinks considering it was at an event.

I must say that The Story So Far didn't beat the last time I had seen them, but that was at a very intimate venue in Newcastle a year ago (at Trillians which is a pub/bar) but I still had a great time shouting along with Parker (the frontman).

State Champs were also good although I don't really know any of their stuff, I'll be sure to look it up.

And I did spend the majority of New Found Glory in the pit - which was great fun although I have the bruises to show for it!

The main act - New Found Glory

So my sudden binge of gigs is over for now and I don't think I'll be going to another one until January at least (Funeral For a Friend are playing, my favourite band!).


Did you go to any of these gigs? Or seen any of these bands before? Let me know your thoughts in the comments section below!


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