Thursday, 31 December 2015

Bratwursts in Berlin: Top Tips at Christmas

This Christmas, I spent my first ever holiday season away from home in Berlin, Germany.

'Berlin Christmas Market' - market at Alexanderplatz with the TV tower 'Fernsehturm' in the background

Together with my boyfriend and his siblings, we decided to venture abroad to celebrate Christmas amongst the famous markets in Berlin. But let's get some basic facts first.

What language is spoken there?
German; however, English is widely spoken, signs and menus are usually in both and most locals speak really good English.

What is the currency?
Euros. At the moment it's around 1.3 Euros to the pound. 

How do I get around?
Getting around is really easy with the U-Bahn (underground), S-Bahn (local trains), buses and trams. Taxis are pretty cheap in comparison to London prices and you can get them even cheaper when booking with Uber which operates in the city.

Local culture
German culture is pretty much the same as most of Europe. Local food you should try will of course be the famous German sausages - wursts. Excellent in a bun from the market (Bratwurst) or smothered in sweet tomato sauce (Currywurst). Wash down with half a litre of good beer (I recommend the Berliner Pilsner), or a Gluhwein in the winter (mulled wine).

Where did we stay?
We chose to stay at Adina Apartments - a chain of Australian hotel apartments who have several branches through Berlin. This proved to be a really good choice as the apartments had small kitchen facilities (hob, microwave, kettle), which allowed us to cook for ourselves when it was more difficult to find places to eat (like on Christmas Eve). The rooms were very spacious and there was a jacuzzi and sauna available for us to use. The only downside is that we would've had to pay to use WiFi in our rooms although on the whole, the hotel was very good value for money in a really central location.


When planning our trip what concerned me the most was how much there would be to do around Christmas Eve, Christmas Day and Boxing Day. I read on several forums, as well as from many locals, that Germans celebrate Christmas more on the 24th rather than 25th like us. 
Generally however, the holidays didn't affect our activities too much. On Christmas Eve, a lot of shops, attractions and restaurants did shut, but mostly after 2pm and there was still plenty of restaurants open after then and plenty of pubs and clubs open later on into the night. From the 25th onwards, most things were back open again!

So what did we get up to?


Christmas Markets


There are countless markets to visit in Berlin including: Alexanderplatz, Potsdamer Platz, Gendarmenmarkt, Charlottenburg Castle (there are over 50 to explore!)

Our hotel being right by Alexanderplatz, we visited that one many times for a Gluhwein, beers, bratwursts and crepes.

Not only was there plenty of delicious food to try, lots of cool trinkets, gifts and souvenirs to buy - my favourite was the brightly coloured German lanterns and fairy lights. And if you're up for a bit of ice skating or a carousel before settling down for a bier the market at Alexanderplatz has everything for you; it really got us in the Christmas spirit. 

The Gendarmenmarkt is set in a beautiful square in the historic centre of Berlin - Mitte. We explored the square on Christmas eve when most things were shut, but on any other day it is bustling, although you do have to cough up one Euro to explore the market itself. 


Christmas Market at Alexanderplatz


The Berlin Wall


The most famous attraction to Berlin - the wall that split Berlin in half which stood from 1961-1989, dividing West Germany from the German Democratic Republic (GDR) in order to stop the mass exodus from the soviet east to western Europe.  

The majority of the wall has been demolished since 1989 but you can still visit areas where the sections of the wall still stands or where it is commemorated. 

The place where a substantial part of the wall remains is at the East Side Gallery - where you can explore either side of the wall and admire your favourite mural or section of graffiti. It is minutes from Ostbaunhauf  or Warschauer stations.


There were actually 2 walls that ran parallel to each other, with a 'death strip' between which was filled with barbed wire, trenches, bunkers, dogs and watch towers with guards who would shoot to kill if you were caught trying to cross the border. An area that was famously inside the death strip (a no-man's land) was the Brandenburg gate. This historical gate was inaccessible to each side of Germany and when the border was opened, there is a famous picture of the people of Berlin standing a top the wall at this site. There isn't any remainder of the wall around the gate, but the gate itself is well worth a visit. 

There are small segments of the wall displayed at Potsdamer Platz - an area that was also inside the death strip. The area is therefore full of new high-rise buildings and office blocks as well as the Sony Centre, housing restaurants and a cinema. 

Checkpoint Charlie

The crossing between either sides of the wall - this checkpoint became a symbol of the 'iron curtain' that separating east and west Europe during the Cold War. 

Where the wall used to stand there is a line of cobblestones and a copy of the original guardhouse and checkpoint sign is in place (as well as the addition of a MacDonalds!).

There is a museum Haus am Checkpoint Charlie, which is surprisingly bigger on the inside than what you expect from the outside. It's a very informative museum with lots of read and it was open until 10pm on Christmas Eve when we went!




Fernsehturm


The tallest building in Berlin, the TV tower looms over Alexanderplatz and you can see the tower from pretty much any point in the city. 

We went up the tower on Christmas Day for our festive meal. The restaurant was pretty similar to when I went up the BT tower in London. The service was pretty slow, but the food was amazing!

When you book at the restaurant, you still need to pay the 13 Euros (for adults) to get up to the top of the tower, but you get to skip the queue for tickets (which can be over an hour at peak times!). The restaurant rotates around at the top so you get a 360 degree view of the city. We went up around 3.30pm so we could view the city in the daylight as well as at night-time. 

To see more, see their website

Museumsinsel


Museum Island in Mitte has 5 internationally renowned museums and is a UNESCO World Heritage Site. You can buy a combined ticket for all 5 museums, or if you only want to go to want you can buy a single ticket (although there's only around 6 Euros difference). The museums are:
  1. Altes (Old) Museum
  2. Neues (New) Museum
  3. Alte Nationalgalerie (Old National Gallery)
  4. Bode Museum
  5. Pergamon Museum
We only visited the Neues Museum and saw the famous bust of the Egyptian Queen Nefertiti. Avoid the queues especially at the Pergamon Museum by getting there early - you could definitely spend an entire day there!


The National Gallery and Neues Museum at sunset

There was so much to see and do in Berlin; as well as the above we visited the Berlin Dungeon (although the London version is still the best), the Reichstag (the Berlin parliament building) as well as the haunting memorial to the Jews killed in the Holocaust.

Holocaust Memorial

Overall we spent just over 4 days in Berlin and although when reading through this post it looks like we crammed in a lot in those days, we still had plenty of chill out time (and recovering from a few nights out as well). What struck me is how London-like the city is, but just on a bigger and more spread out scale. I would definitely recommend it for a short break away in Europe, even if it's not Christmas time!



Have you been to Berlin? Been to any of the attractions I went to? Let me know in the comments below!





Wednesday, 16 December 2015

A 'Wee'kend with the Irish: Rathlin Island and Titanic Belfast

At the beginning of summer, my boyfriend and I went to go visit some of our friends who lived in Northern Ireland. Here's a brief reminiscence of the trip.

Hundreds of birds nesting on the cliffs at Rathlin Island

This was my first ever visit to Ireland and despite it being July, the temperature difference between Belfast and London was still rather significant for me!

Most visitors would hit up the Giant's Causeway for their visit, but our friends had made different plans!


Rathlin Island


This L shaped island just off the coast is the only inhabited island around Northern Ireland with 135 people inhabiting the small 6 mile island. 

A rough ferry ride across from Ballycastle and a few queasy tummies later we caught the Puffin across the island to the RSPB West Light Seabird Centre

The charismatic bus driver entertained us with tales of the myths surrounding the strategically located island including the tale of Robert Bruce, the Scottish King who took refuge on Rathlin when he was driven out by Edward I of England. 

The main village centre on Rathlin

At the West Light House nesting among the cliffs were hundreds of puffins, guillemots, razorbills and kittiwakes (if you can handle the smell!). You can also see Scotland in the distance and we even caught a glimpse of a couple of seals along the bay.

If you're looking for places to eat there isn't that much choice; the single pub on the island or the local chippy. Still the island is cool place to explore and if the weather is sunny I imagine cycling across the Rathlin would be rather pleasant!

A couple of cheeky seals popping up to say hi!

To find out more about Rathlin to check out the ferry timetable, see here


Titanic Belfast


If you didn't know, the infamous 'unsinkable' ship was manufactured in Belfast and the shipyard were this took place now houses a quirky looking exhibition centre with a Titanic museum. 

Being a bit of Titanic fanatic when I was younger (me and my brother know pretty much all the lines of the film), I was very excited about going. I think you could spend a good few hours wandering around the museum which transverses the entire history of the ship; from the life of the people who built it (there's a cool ride at this point), to a simulation of what a cabin looked like, to how they discovered the wreck on the floor of the Atlantic. 

Did you know there were 8,000 cigars on the Titanic?

This fact seemed to be repeated several times throughout the exhibit. 

The centre also houses guest exhibitions - at the time this was about Robots in films. Plenty of photo opportunities with R2D2 and Robocop!

Great photo opportunity!


To see what else is going on, see the Titanic Belfast website

Also, if you're in Belfast city centre and looking for a good place to have dinner, check out the Ivory restaurant at the top of House of Fraser for some yummy cocktails and filling food! 


It was great weekend, almost like going abroad for a break (even the Sterling notes are different), despite a few hiccups with delayed flights! 


Have you been to Rathlin Island or Titanic Belfast? Let me know in the comments below!

Tuesday, 8 December 2015

European Society of Aesthetic Orthodontics: Foundation Course

Sorry for the silence loyal readers! Back with a bang with a recap of a day with the ESAO and their foundation course in London - talks from Prof Derrick Willmot and Dr Yvonne Shaw.



Despite a fun-filled Christmas party the evening before, I made it bright and early for the ESAO foundation course. The European Society of Aesthetic Orthodontics (ESAO) was set up to provide resources and support GDPs who practice orthodontics as well as offering information to patients. 

ESAO aims to educate GDPs and improve their general core orthodontic knowledge, no matter what 'system' they choose to use. 

The day was a good recap of our basic orthodontic knowledge without the bias of a particular brand. Here are just a few main points from the day:

Orthodontic Assessment and Treatment Planning


The crucial steps in assessing whether a patient may be suitable for orthodontic treatment. Some key points Prof Willmot explained to us were:

43% of missing or peg-shaped laterals are associated with palatally impacted canines. 

What is a compensating extraction?
Relating to molars, if there is a 6 that needs to be extracted due to caries/poor prognosis/peri-apical disease, then you may consider extracting the opposing tooth to prevent it over-erupting. If you extract a lower molar, then consider the extraction of the opposing upper tooth; however,  if an upper molar needs extracting you do not usually need to take out the lower molar as these do not tend to over-erupt. 

How can I analyse space? 

There are many ways to analyse space to help you assess how much space you may need to create, just a few examples include:
  • Qualitatively
  • Quantitatively i.e. mm
  • Royal London analysis
  • Ashley Howe analysis
  • Arch Perimeter analysis
  • Bolton analysis

Why do I need space?

There may be multiple reasons why you need to create space:
  • To relieve crowding
  • To decrease overjet
  • Levelling the Curve of Spee
  • To make incisor tip/tongue changes
  • To contract the arches

Ways to create space:

  • Extractions
  • Distal movement of molars
  • Expansion of the arch (1mm of expansion will create 0.5mm of space)
  • Enamel stripping i.e. IPR (interproximal reduction) - there is no evidence this creates any long term sequelae
Or a combination of the above


Once you've assessed the patient and made a diagnosis, you then need to make a problem list which you will address with your treatment plan. The list can be broken down into 4 components:
  1. Oral health
  2. Aesthetics e.g. lip competence
  3. Occlusion
  4. Future stability e.g. if changing intercanine width is this stable?


Dento-legal aspects of GDP orthodontics


Orthodontics is the 5th highest reason for claims against dentists and out of these claims 63% are against GDPs providing aesthetic orthodontics.

15% of patients with fixed appliances will get white spot demineralisation.

What do patients complain about with orthodontics?

  • Dissatisfied with outcome
  • Relapse
  • Collateral damage
  • Failure to refer
  • Unhappy with progress

More than 50% of claims are as a result of mistakes at diagnosis and treatment planning! This isn't surprising - as GDPs we are not specialists and therefore can be thrown by things not going to plan or failing to identify if a case is suitable for aesthetic orthodontics. 

It is important that we realise which cases are suitable for our treatments and which should be seen by a specialist. Always offering a referral to a specialist is advised although many patients will opt for your treatment as they may not want 2 years of fixed appliances etc. 

Obtaining valid consent is never as simple as getting the patient to sign one of the orthodontic system's proformas - you must explain risks of treatment especially things like root resorption, relapse, caries, pain etc. 


Thanks to ESAO for this informative day! If you want more information about GDP orthodontics, see the ESAO website.


Do you provide orthodontics as a GDP? Or attended the course on Saturday? Let me know your thoughts in the comments below!




Thursday, 26 November 2015

Academia to Workplace: An Interview with The 3 Day Practice

If you've read any of my posts about Click Convert Sell you'll be familiar with the founder, Aalok Shukla, who has also launched a site The 3 Day Practice to help dentists work less and live more. 


The transition from university to practice has been a tricky one as I'm sure most young dentists will agree. In today's environment of litigation, increased regulation and increasing patient expectations settling into a practising career can be a bit of a challenge!

After 5 years of studying there is so much more to learn that patients will ask you about: tooth whitening, smile make-overs, short term orthodontics. It can be tempting to jump in feet first and go on course after course - I certainly felt that that a few months ago. 

Aalok kindly asked to interview me on my views on this transition and how to navigate the minefield!

Thanks Aalok for the opportunity and please feel free to comment and share your experiences as young dentists!

To read to full article, see The 3 Day Practice website here


Monday, 23 November 2015

Fun in Frome or Should I say 'Froom'?

A few weekends ago together with some of my girlfriends headed to Frome in Somerset for a long weekend of relaxation. 

The pretty streets of Frome

Despite our age, none of us can drive or are confident drivers, so when we looking for a place to visit we needed to be able to access it easily by public transport. Frome is a short train journey from Bath Spa so really easy to get to from London and the South of England. 

Where did we stay?
Once again limited by accessibility by public transport we used Air BnB to find a little cottage to stay and found a fantastic place with a hot tub (and pool in the summer seasons), see here to have a sneaky look of the place. I'd never used Air BnB before but I would definitely recommend it if you are travelling in a bigger party of people and the hosts were very welcoming and helpful, eager to answer any questions we had about the area. 


Frome

We discovered as we arrived on the trundling train from Bath, that actually Frome is pronounced 'Froom' like a broom, rather than Frome like a home. We found this hilarious and I realised then why my mother throught I was heading to Italy (she thought I said Rome when I spoke to her...). 

Frome is a quiet and charming town which is perfect for those looking to get away from the busy city with quirky shops, pubs and restaurants. Just make sure you plan your train journey there and back as although there are plenty of trains during the day, the times can be irregular. 

Despite the weather being pretty poor the weekend we were there, we explored the winding cobbled streets of the Artisan area of the town and had the yummiest Sunday lunch at the 'Old Bath Arms' - a restaurant/pub/BnB which was the winner of Channel 4's Three in a Bed!

To read more about Frome, see here


Bath

Being so close to the UNESCO World Heritage site of Bath, we had to find an excuse to explore the city. 

As it was Bonfire Night weekend, we found that the biggest display in the area was being held at Bath Rugby Club so we braved the cold to watch a really good display of fireworks. 

The city itself is beautiful, full of grand yellow-stone Victorian style buildings including the Abbey, the famous Crescent and Circus. Bath is the only place in the UK where you can bathe in naturally hot spa water and original Roman style baths. Unfortunately, we didn't have the chance to check these out but they are definitely on my list of things to do when I manage to explore the city again. 

We ate out at an Italian 'The Real Italian Pizza Co.' which was reasonably priced and had a vast menu to choose from (it also accepts all the major chains vouchers if you have any!). 

The grand Bath Abbey

Overall we had a fantastic weekend drinking Prosecco in our hot tub, exploring the quaint streets of rural Somerset and being wowed by brilliant fireworks. Having a long weekend to get away from things is something that we all need every now and then to refuel you until the next break away!



Monday, 16 November 2015

10km Mouth Cancer Walk

So back on the 19th of September the annual FREE Mouth Cancer 10km walk took place and our very own Bobby (chairman of the India Association) made an appearance in preparation for the main event in India.



It was a lovely sunny day in Hyde Park in London and there was a huge turnout of people arriving from 11am. 

The 10th annual walk saw a variety of people taking part including the families of those who have suffered from mouth cancer as well the victims, health professionals and others supporting the cause. 

The day was supported and ran by the Mouth Cancer Foundation and as it was the 10th anniversary, there were some really motivating introductory speeches, including one from Bobby about his 2800 mile walk from one tip of India to another in aid of Great Ormond Street, HRH Prince of Wales Trust and the India Association.  

There was lots of support for Bobby, the crowd cheered and applauded - the 10km was certainly 'a walk in the park'

All the people who completed the walk earned their medals and goody bags at the end and along the walk there was lots of tips for both the general public and health professionals on how to examine oral cancer and what the signs and symptoms are. 

Fellow members of Sterling Dental Foundation walked alongside Bobby and Rajan Bhanot (of the India Association). Nisha K Narwal, committee member of the foundation says ''Overall it was a great fun day organised by bubbly enthusiastic people''

Read more about the walk here



Want to show your support for Bobby? There's still a limited number of tickets available for the annual Sterling Foundation Ball on the 28th November where we are raising funds for Bobby's cause and contributing to his target of £1.5million! Make sure you snap yours up soon!


Thursday, 12 November 2015

Bones and Bisphosphonates

Confused about when you can treat patients who are taking bisphosphonates? Here's some things I've learnt during my time at hospital about how to manage these patients.

Bisphosphonate-induced osteonecrosis of the jaw. Photo credit: Borgioli et al. Ther Clin Risk Manag. 2009; 5: 217–227.


 Why are bisphosphonates prescribed?

  1. Osteoporosis
  2. Metastatic bone cancer
  3. Paget's disease/Fibrous dysplasia/Osteogenesis Imperfecta
  4. Multiple myeloma

How do they work?


Bisphosphonates decrease hypercalcaemia and reduce bone resorption by inhibiting osteoclasts. They tend to accumulate in areas of high bone turnover such as in the jaw - reducing bone turnover and bone blood supply. 

Your skeleton is completely remodelled around every 2 years in order to adapt to mechanical stress, remove micro-fractures in bone and as a result of calcium homeostasis.  Alveolar bone is perforated by teeth which are loaded when in function which can lead to micro-fractures, this fact on top of the high turnover of bone makes the jaw a highly susceptible site for osteonecrosis. 

Which ones are the problems?


Amino bisphosphonates are the ones which mean there is an increased risk e.g. zoledronic acid  

Risk of MRONJ for IV bisphosphonates is around 2% compared to oral which is 0.1% (and that is after 5 years of use).

Co-risk factors:
  • Steroids
  • Poorly controlled diabetes
  • Smoking
  • Increased age

Osteoporosis


2 million women in the UK suffer from osteoporosis. This condition leads to a loss in density of bone which makes bone fractures much more likely. 

There is little evidence to support the long-term use of bisphosphonates i.e. for more than 5 years and the type of oral bisphosphonate tends to be ones that are less likely to cause problems e.g. alendronic acid.

Metastatic bone cancer


Most likely primary tumours that metastasise to bone: 
  • Prostate
  • Lung
  • Breast
They are used to help increase chances of survival by decreasing hypercalcaemia. This decreases pain and delays other skeletal effects of the cancer. 

Bisphosphonates that are prescribed for bone metastases are:
  • High dose treatments
  • IV
  • Duration is often for life
  • 100% bio-availability 
  • Often weekly infusions

Osteonecrosis


Previously known as BRONJ/BONJ, the more accepted term more often used is MRONJ (medically related osteonecrosis of the jaw).

Other causes of osteonecrosis include:
  • Trauma
  • Steroids
  • Radiation
  • Excess alcohol
  • Herpes
  • Cocaine
  • Bonjella
  • Lupus
The diagnosis can only be made if there is exposed bone in the jaw for more than 8 weeks which fails to heal. 




50% of MRONJ is precipitated by extractions but it can also be triggered by periodontal treatment, lingual tori, implant placement or it can even be spontaneous. 

Staging


0 - no exposed bone but painful or numb

1 - exposed bone but no infection

2 - exposed bone and infection

3 - fracture or fistula formation

Management


ORAL
  1. Chlorohexidine mouthwash
  2. Doxycycline 100/200mg OD if there is infection
  3. Remove sequestra if they are loose or traumatic
IV
  1. Minimise risk of MRONJ i.e. excellent OH, restore teeth rather than XLA if possible, adjust flanges of dentures so they are not traumatic
  2. XLA non-restorable teeth before being placed on meds if possible
  3. Stopping the meds is not useful, if MRONJ develops maintain oral comfort as much as possible i.e. CHX, antibiotics if become infected

In stage 3 disease (commonly caused more by radiation), you should consider resection and reconstruction of the diseased area. 

Some useful guidelines to follow when dealing with these patients and when you may want to refer to secondary care are the SDCEP guidelines (click here).


Do you feel confident treating these patients in practice? Let me know in the comments below!


Wednesday, 4 November 2015

Bobby's Black Tie Event

As some you may have noticed, I'm supporting a fantastic cause at the moment: Bobby's Walk. There have been a few great events leading up to the Sterling Charity Ball later on this month, one of which was Bobby's Black Tie

The yummy menu from the evening

The evening was a great event with lots of people from all across London across many different businesses. There were lots of inspirational speeches throughout the night including from Bobby himself and plenty of opportunities to raise funds in aid of Great Ormond Street, HRH Princes Trust and the India Association.

In case you didn't know, Bobby, the 81 year year old Chair of the India Association is planning to walk 2600 miles from one tip of India to another in 5 months in aid of these charities. His inspirational story led many people to donate generously towards Bobby's target of £1.5 million!

After an evening of fantastic food at the Jumeriah Charlton Hotel in London, we were entertained by the resident band and amazed by the skills of a magician. The raffle and silent auction were very popular which raised lots of money towards Bobby's target and throughout the night, there were touching personal stories about each cause through speeches from different Professors as well an emotional speech by a father whose child was treated at GOSH 


Lots of fantastic items for the silent auction

The Sterling Dental Foundation is hoping to raise even more money for Bobby with our annual charity ball. The Charity Ball is sure to be another wonderful evening of dancing and dining as well as a fantastic opportunity to see old colleagues, meet new friends and relax – all while helping those who need it the most.

With special guests and renowned entertainment, plus the chance to learn more about Bobby’s good works and help make a real difference yourself, this is one event that simply cannot be missed.


The Annual Sterling Dental Charity Ball 2015, in support of Bobby’s Walk Full Circle:

Saturday 28th November 2015 at the Hilton London Metropole, 225 Edgware Road, London W2 1JU.



For information about the Sterling Dental Group and to book your tickets, visit www.sterlingdentalgroup.co.uk

#GoBobbyGo

Sunday, 1 November 2015

Temple Trekking in Java

Following my previous post with my Top 10 things to do in South East Asia, I decided that I would write about some of the time I spent exploring the temples around Yogyakarta in Java, Indonesia. 

Looking out from the top of Borobundur


Yogyakarta is a convenient stop on the way from Jakarta to Bali and is a really good base to visit some of the top attractions in Java from the temples of Prambanan and Borobudur to the Merapi volcano. Here are some basic facts about the area. 

What language is spoken there?
Indonesian but it is very easy to get around as most people speak English and signs and menus are in both languages.

What is the currency?
Indonesian Rupiah. At the moment, it's around 20,000 Rupiah to the pound

How do I get around?
The best way to get around and possibly the easiest is local taxis which are relatively cheap. You can also get Tuk-Tuks and horse-drawn carts to take you around the city. 

Local culture
Java like most of Indonesia is an Islamic area, so women need to be aware of what they wear - be respectful, cover shoulders and knees.

Where did we stay?
Tulips Guest House - the room was average but comfortable for the price but the highlight of the place was definitely the private pool and the small enclosed restaurant.


We organised a tour with one of the travel companies around the town to see both of the temples in one day as we were only there for 2 days. It was easy to organise and there are plenty of different packages you can opt for or you could take a taxi to take you directly to the temples. 

Borobudur


We chose the sunrise tour of Borobudur which meant getting up around 5am which I admit was a bit of a struggle and I question whether it was worth it. 

You have to pay to go up to the viewing point over the temple with the silhouette of the volcano Merapi looming in the background. Before we chose to go, I had heard that the experience of hit or miss depending on the weather. 

It was pretty misty when we went and you could just about see the top of the temple emerging from the morning fog. 

Sunrise over Borobundur

The good thing about getting up so early to see the sunrise meant that we got to Borobudur before the crowds! We also happened to be there during Ramadam so it was even quieter than normal!

I'd recommend getting one of the staff to take you round and explain the significance of the depictions around the walls and the tiers. The temple is a UNESCO world heritage site which has undergone much restoration work, especially as a result of earthquakes in the area and eruptions from the nearby active volcano Merapi. The temple is a Buddhist stupa despite being in a primarily Islamic area. 

As part of our package we had breakfast included after exploring the temple - this was just toast and fruit so if you've worked up more of an appetite when climbing the steps of the temple, you may need to get something else from the little food stalls at the bottom of the temple. 


Having too much fun!


Prambanan


Next stop the Hindu temple of Prambanan. Similar to Borobudur, the temple was seriously damaged by earthquake but has been restored really well. 

By the time we got to the temple it was approaching mid-day and the temperature was getting pretty uncomfortable so perhaps it would've been better to go a bit earlier in the day. There lots of steep steps like Borobudur so make sure you wear comfortable shoes - you also get a discount if you buy a combo ticket for both temples. 

In retrospect I would probably have wanted to visit this temple at sunset as I've heard the views are spectacular. 


Prambanan Temple


Have you been to Yogyakarta? Been to either of the temples or to Merapi? Please leave your comments in the section below!



Sunday, 25 October 2015

Could YOU walk a Marathon a Day for 5 Months?

Following last year’s tremendous success, the Sterling Dental Foundation is delighted to invite you to the Annual Sterling Dental Charity Ball 2015.

Bobby setting off on his way to India


Once again supporting Bobby, the Chairman of the India Association, as he undertakes his monumental five-month, 2,600 mile charity walk across India, the Sterling Dental Foundation is hoping to raise money for underprivileged children across the globe.


Bobby’s Walk Full Circle is an exceptional event, that showcases one man’s passion for bringing smiles to the faces of those less fortunate. Starting in Kanyakumari in the south of country, Bobby will be walking along the vast east coast, through seven Indian states, to New Delhi – raising awareness of oral hygiene and dental health every step of the way.


The Sterling Dental Foundation is proud to be able to support Bobby in this spectacular feat and, this year, is inviting UK and Indian dental practitioners to join Bobby on various legs of the journey – helping to spread happiness and good oral health to some of India’s poorest areas.


In line with their own initiatives to raise awareness of oral health and dental education across all 29 states of the country, the Indian Government is also fully supporting the event. With their help, special pop-up clinics will be opening along the way – which will be perfect for sharing crucial information and treatments throughout the five-month journey.


The Charity Ball is a fantastic event, where you can learn more about Bobby’s amazing undertaking and show your support for a worthy cause. Promising to be a sensational evening of top-quality entertainment and award-winning cuisine, the Charity Ball will undoubtedly show how generous and supportive the UK dental profession truly is.


And it is hoped that, through this unparalleled generosity, over £1.5 million will be raised. Donated to the Great Ormond Street Hospital Charity, HRH the Prince of Wales charity, the British Asian Trust and many other admirable causes that seek to provide high quality care and innovative new treatments for children all across the world, this money will help ensure all children can receive the dental care they need.


The Sterling Dental Foundation humbly asks for your support in this astounding endeavour. The Charity Ball is sure to be a wonderful evening of dancing and dining as well as a fantastic opportunity to see old colleagues, meet new friends and relax – all while helping those who need it the most.


With special guests and renowned entertainment, plus the chance to learn more about Bobby’s good works and help make a real difference yourself, this is one event that simply cannot be missed.


The Annual Sterling Dental Charity Ball 2015, in support of Bobby’s Walk Full Circle:

Saturday 28th November 2015 at the Hilton London Metropole, 225 Edgware Road, London W2 1JU.



For information about the Sterling Dental Group and to book your tickets, visit www.sterlingdentalgroup.co.uk

#GoBobbyGo

Thursday, 22 October 2015

Peri-implantitis with Dr Ope Sodeinde

Last week, I attended the first ever Perio-Implant Study Club hosted by Ope Sodeinde



Ope is a specialist periodontitist working in Wimpole Street in a specialist periodontal referral practice. Ope offers some fantastic support for GDPs who refer patients to him including being able to attend study clubs. 

Last week, the topic Ope discussed was peri-implantitis - a growing concern in modern dentistry. 
Here's a brief summary of his talk. 

What diseases can affect implants?


1. Peri-mucositis - appears as redness/swelling of gingivae, bleeding on probing, sometimes suppuration but no bone loss

2. Peri-implantitis - this will have the same clinical appearance as above BUT with bone loss


Commonly, peri-implant disease presents with no complaints from the patient until the situation becomes very advanced. Inflammatory lesions appear deeper and much quicker around implants than teeth as there is no connective tissue present, so if a patient presents with a mobile implant, the implant itself is probably about to fall out.

There could be the added issue in a patient with a thick gingival biotype, the inflammed tissues are masked and are less likely to recede so detection can be delayed. Pockets around implants are also physiologically deeper than around teeth, so a 4mm pocket may indicate disease around a tooth but not around an implant. The pockets themselves may be difficult to measure around an implant due to subgingival threads or bulbous crowns making access parallel to the long axis impossible. 

So how can we detect Peri-Implant disease?


Regular maintenance and imaging is paramount to the early detection of disease. 
CBCTs are not useful as the implants create scatter, but bitewings are very good to show bone levels around implants. 


Risk factors for Peri-Implant disease


Patient factors:
  • History of periodontal disease 
  • Smoking
  • Poor oral hygiene
  • Lack of maintenance
Implant factors:
  • Implant surface roughness 
  • Soft tissue cuff height
  • Presence of keratinised tissue
  • Implant-abutment junction - if there is biofilm at this junction, there is increased risk of failure

How do I treat Peri-Implant disease?


Non-surgical management:
  1. Scaling (hand instruments/ultrasonic). - whatever you may use for the treatment of periodontal disease
  2. Local/systemic antibiotics
  3. Lasers
You can also manage this disease surgically, but some things you need to consider are:
  • Is there enough keratinised tissue present?
  • Is the thread pitch of the implant (the distance between the threads) enough for Guided Bone Regeneration (GBR)?
  • Can the implant be adequately decontaminated?
  • How much recession is acceptable? (especially in anterior teeth)

Thanks so much to Ope, Jo and the team for organising a really informative evening. Can't wait for the next one!

To see more information see Ope's practice website here


Do you feel confident diagnosed peri-implant disease? Let me know in the comments below!



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