Tuesday, 31 March 2015

My Brownie Promise

Me teaching some of the Brownies about tooth anatomy

As many of you who follow my Facebook page may know, a few weeks ago I spoke at a Brownie's group in East London. 
When I was at university I was part of an organisation called 'Brush Up' which similarly ran after school events from Brownies to Scouts to Rainbows. We spoke about oral health and ran lots of activities to get kids interested in what's in their mouths!

Having a friend who was a Brownie Leader, I was eager to get involved in this sort of activity again, especially since I don't get to see that many children in my practice. 

What did I do?


I split the evening into 2 sections: one where we chatted in a circle about general oral health, and the other where I split the kids into 3 stations where they had an activity at each table. 

It's always interesting to see how much children know about oral health and sometimes they do come out with some surprising stuff; I once had one 7 year old ask me what was ameleogenesis imperfecta!

These brownies knew quite a bit! When I asked them to brush their teeth with imaginary toothbrushes and stop when they were done, there were 3 kids still frantically brushing away after 2 and a half minutes! Whether they do this at home or not is another question, but they definitely deserved stickers after that!


I had also filled an orange juice and a fizzy drink bottle with the amount of sugar in each and played a 'good food, bad food' game to help them learn what kind of foods can be harmful for your teeth.

At the stations, the girls dressed up as dentists and counted each others' teeth (there was a girl with some stainless steel crowns that got a lot of attention), played with my dentist playdough set (best christmas present ever) and at the third station I taught the girls about tooth anatomy and what happens when you get tooth decay. 

One of the girls dressing up as a dentist

I really had a lot of fun with the Brownies who seemed to have lots of fun too; there were quite a few girls who said they wanted to be dentists by the end of the evening! If you ever get the opportunity to get involved with something like this I would highly recommend it - it's really fulfilling as you get to improve your skills with children as well as it looking good on your CV.

My promise


The Brownie Promise has changed a bit from back in my day, but as it says,

I promise that I will do my best: To be true to myself and develop my beliefs, To serve the Queen and my community, To help other people and To keep the Brownie Law.

Getting involved in the community is something I would encourage all dentists to get involved with and non-dentists as well! Helping others to understand the importance of oral health is something we should be responsible for as a profession. Whilst awareness of oral health is increasing with some of the TV documentaries  that have aired recently, there is still a lot of work to do when the most common reason for childhood admissions to hospital is to have teeth taken out. 

So whilst it's easy to turn off your dentistry brain when you leave your surgery, we need to seize these sort of opportunities to help all people, not just children, improve their health. So I promise to do my best to improve the oral health of the general population, not just the patients who visit my practice.


Do you speak at events like this or been to a school to treat patients? Let me know in the comments below!




Photos taken with the permission of the Brownie Leader - Bethnal Green

Sunday, 29 March 2015

Litigation in Dentistry: Do you see what I see?

This post is based on a talk by James Foster at the Young Dentist Conference 2015. 



I've posted quite a bit recently about litigation - there's been lots of talks by Dental Protection that I've been to!

There are lots of challenges for dentists in today's environment, not just dento-legal challenges of course. Some of these challenges include:
  • Complaints (see a previous post about why people complain here)
  • Negligence claims
  • Regulatory investigations (GDC, CQC)
  • Disciplinary procedures
  • Criminal investigations e.g. fraud

Top litigation claims against dentists

  1. Crown/Bridgework
  2. Endodontics
  3. Nerve damage
  4. Oral surgery
  5. Restorative work
  6. Periodontal claims
With the increase in quick-fix orthodontics, implant surgery and facial aesthetics (botox/dermal fillers), these will surely enter the list soon!

In a dentists career, there are around 250,000 interactions with patients (on average). During your career, you will have around 1-2 GDC cases, and 3-4 negligence claims. 

To reduce your risk of a complaint you must learn how to communicate effectively with patients. See my previous post about this here. Also be aware of what you post online on social media - closed groups and forums are not as safe as you may think!

How to respond to a complaint effectively

  1. Acknowledge the complaint
  2. Express meaningful regret
  3. Tell the patient that you are sorry - this is not an admission of fault
  4. Discuss possible solutions
  5. Do not abandon the patient

James showed us some rather terrifying pictures of negligent dentists or claims that patients had made which included hypochlorite accidents and surgical emphysemas! It certainly shocked a lot of us. 
The important message wasn't to scare us off practising dentistry, but to prepare us for when things go wrong and how to explain risks and adverse situations to patients.

To see my summary of Raj Rattan's talk at the conference see here.

Do you have any thoughts about the increase in litigation in dentistry in the past few years? Please leave your comments in the section below!



Wednesday, 25 March 2015

Mishaps of Oral Surgery: Are you referring to me?

This blog post is based on a talk by Julie Cross at the Young Dentist Conference


Like endodontics, oral surgery can be a source of anxiety for young dentists. As mentioned in my previous post about oral surgery (see here), it can be difficult to assess what treatments you are competent to perform in practice, and those which should be referred to secondary care. 


Common pitfalls in oral surgery in practice

1. Fractured teeth
2. Soft tissue damage
3. Root in the antrum/oroantral communication
4. Haemorrhage
5. Fractured tuberosity

So what does a simple extraction look like?


  • Periodontally involved teeth
  • Orthodontic extractions
  • Intact teeth

What may be a difficult extraction?


  • Broken down teeth
  • Subgingival caries
  • Bulbous roots
  • Divergent roots
  • Root treated teeth
  • Cervical caries
  • Dense bone
So when should I refer? 
Where most likely, a surgical approach is required and you do not feel confident doing this

Surgical removal of teeth

Flap design:


  • Think about the anatomy e.g. mental nerve in lower premolar region, lingual nerve in wisdom tooth extractions
  • Either envelope, 2 or 3 sided
  • Always cut perpendicular to tissues
  • Cut down to bone i.e. through periosteum
  • Lift flap with periosteal elevator, Howarth/Mitchell's trimmer or curved Warwick-James elevator

Bone removal


  • May not be required if can apply elevators/forceps once flap is raised 
  • Use a tungsten carbide fissure or rosehead bur with saline irrigation
  • Make sure you protect the soft tissues from burns
  • Remove a gutter of bone buccally to gain application point - try to be as minimal as possible whilst going through the cortex
  • If no movement on bone removal, you should consider sectioning the tooth

Luxators


  • Often used incorrectly as elevators
  • Used to create space between bone and root for application of elevators or forceps
  • Take care when using in posterior maxillary region

Complications of oral surgery

Root in antrum/OAC

  1. Assess radiographically
  2. Explain to patient and reassure
  3. Remove root surgically (this would probably require a referral)
  4. Close OAC with buccal advancement flap
  5. Post-operative instructions e.g. avoid blowing nose, decongestant sprays, antibiotics

Haemorrhage


  1. Check the patient's medical history (this needs to be done prior to treatment anyway)
  2. Is there an underlying medical reason for bleeding? 
  3. Maintain pressure with gauze
  4. Use LA with adrenaline
  5. Haemostatic agent e.g. Surgicel, and horizontal mattress suture
  6. Bone wax
  7. Refer onto A and E

Fractured Tuberosity


  1. Usually occurs with upper wisdom teeth or lone-standing molar - if tooth and tuberosity are minimally displaced, take an impression for vacuum formed splint and support and allow for healing
  2. Surgically remove tooth at least 6 weeks later
  3. If tooth and tuberosity are mobile, they need to be removed
  4. Carefully dissect out - do not just pull as risk of damaging blood vessel and causing haemorrhage
  5. Once you've removed the tuberosity, check for OAC
  6. Primary closure with sutures

Ultimately, you shouldn't take on treatments that you don't feel confident with! Always refer for a second opinion if you are unsure as complications with oral surgery can be serious!

To see my recent post about a litigation talk by James Foster that was held at the conference, see here.

Do you find knowing when to refer for oral surgery difficult? Please leave your comments in the section below. 


Sunday, 22 March 2015

Dentistry isn't all about Teeth: CCS Entrepreneur Mixer

You may have seen one of my previous posts summarising a Click Convert Sell Webinar about marketing STO in practice. I was lucky enough to be invited to their first Entrepreneur Mixer this weekend.



What is CCS?


Click Convert Sell's (CCS) mission is to help grow small businesses so that they not only are more profitable, but also so that they gain more freedom by implementing lifecycle marketing, virtual teams globally and automation. 

Their products:


  • 'Marketing As You Go' - a service to create videos, blogs and landing pages to improve your SEO ranking.
  • 'Elite Virtual Team' - creating a global team in places such as the Phillipines to help you with your work load
  • 'The Automation Experts' - implementing lifecycle marketing for your business
  • 'Attract Sell Wow' - mastering the three stages of the customer lifecycle
  • 'The Straight Teeth Engine Academy' - increase the number of STO you do in practice 
  • 'Convert your Calls' - training in handling the front of desk of your business
  • 'CCS Live' - live talks by the founders, Aalok and Lucie on marketing and business
  • 'CCS Content Factory' - hands on course teaching to help you with attracting clients


Is CCS just for dentists?

Of course not! 

The mixer event was held for entrepreneurs and whilst there were a few dentists there, there was also a range of other professions; from TV producers to photographers to personal trainers. 

It was great to meet and network with people other than just dentists for a change and there were really inspiring and charismatic individuals who helped open my mind to life outside of the world of NHS dentistry.

Dentistry is unique as a profession as it blurs the boundary between a health service and a consumer service. Patients are usually paying for the treatment you provide for them, so their expectations can be much higher than in other health professions, especially in private dental care.

The environment young dentists are qualifying into has changed dramatically compared to that of older generations of the profession so in order to succeed we need to get out of our 'drill and fill' attitude. We should have an entrepreneurial approach to our careers whilst still providing excellent care for our patients. 

Being only 6 months into what is looking to be a 40 year career, it's hard to imagine feeling bored or fed up of practice life at the moment; nevertheless, I have been warned that after a few years of churning out the UDAs, life can become tiresome. Instead of being isolated in the box that is your dental surgery,  you can get involved in other aspects of dentistry, other businesses or look abroad to develop your career. 

Some Entrepreneurial Tips I learnt from the evening:

  • See dentistry as a business as well as a health service - value each of your patients by acting in their best interests
  • Develop your online presence - the use of social media as well as learning the tricks of Search Engine Optimisation are key. 
  • Build a good team around you - consider the use of overseas teams to delegate tasks to 
  • Network with other professionals, not just those of your own profession
  • Consider professional photography for your social media (especially Linked In) and your websites
  • Don't get stuck in a job you're not enjoying, it's never too late to switch careers
  • Don't get caught up in the 'typical' career paths of your profession - think outside the box and make your own career path
  • Personal development is the key to career success. 

Thanks to Aalok, Lucie and the whole CCS team for holding such a great evening and if anyone is looking for an exclusive venue in central London, check out the Eight Member's Club in Bank - their mojitos  are fantastic! 


See the CCS website for more details about their services.


Wednesday, 18 March 2015

How to Build your CV

This can be something people overlook the importance of in Dentistry since some posts like DF1 and DCT are application form based and do not require a CV. So here are a few tips to get you going for when you may need one!

This article can also be found on DentSpace



It's is always useful to have an up-to-date CV to pull out of the bag even if you're not actively looking for a job. 
CV writing is something you need to take seriously, it's not something you can knock together in 30 minutes! It can take time to get it right so that when you are job hunting, it gives you the best chances of getting the job you want!

It's also important when applying for positions that you send in a cover letter or email together with your CV which is tailored to the job you are applying for - look at the personal specification that most jobs include when they are advertised and use this to your advantage.

When writing your CV, remember to be concise; ideally it should not be more than 2 pages long. Use tables to summarise information and display it in a clear manner. If you are applying to hospital jobs, you may want to have a separate CV from the one you use to apply to be an associate in practice.

Essential things to include in your CV include:

  • Personal details e.g. name, address, e-mail, telephone, website etc. (I wouldn't include a photograph in your CV and employer's should not request one at the interview stage)
  • Education (this is probably best displayed in a table)
  • Personal specification
  • Work experience
  • Publications
  • Audits
  • Courses that you've been on (you don't have to list every single one you've gone to, just ones that you've found particularly useful or interesting)
  • Any presentations or lectures you have done
  • Volunteer work
  • Interests outside of work
  • Contact information for your references (at least two)

Need some help?

Linked In

Make use of this professional social media network! It can help you out a lot with what information you can fill in and getting personal recommendations or endorsements from your colleagues and mentors is something that employers may value. 
There's even a printable PDF format of your profile you can print off which can act like a quick-fix CV if you're desperate - although I would definitely recommend writing a separate CV rather than rely on this feature of the social network.
If you're wondering what my Linked In looks like, see here and feel free to connect with me. 

Portfolio websites

There are quite a few sites out there where you can create your own professional portfolio of your work. Whether you choose to build your portfolio on one of these sites or use your own platform, this is something that can help you out when applying for jobs. Some of these sites include Dentinal Tubules, Dental Circle and Denteez

Where can I post my CV?

A really good site to post your CV is the Dental Job Board which even has a dedicated section for DF1s and DCTs to enter their CVs.
The site allows you to upload your own CV as well as enter profile information so employers can see a brief overview of yourself. Plus there are opportunities to have CV makeovers if you are struggling to put yours together! You can browse through posts on this site too, not only throughout the UK, but internationally too.
It's quite a nice format which is simple to use and I think it is much clearer than the BDJ jobs site, although there aren't as many posts advertised. 


Remember to review your CV monthly to make changes and get another person to read through it for errors before you send it off to perspective employers. Try to avoid folding your CV as this looks unprofessional and if you can, hand in your CV in person to the employer so that they remember you (you can check out the place you're applying to work in at the same time).

To find out more about careers in dentistry, please see one of my previous posts here.


I hope you have found this post useful. If you have any more tips for CV writing or have used the Dental Jobs Board website please leave your comments in the section below. 



Sunday, 15 March 2015

#Tubuleslive Event: A Novel Approach in the use of Maryland Bridgework as Provisionals

This post is based on the latest #Tubuleslive Event by Dr Ken Hemmings

This Maryland bridge that I provided for a patient recently was a definitive restoration

Dr Hemmings raised the issue of ways to temporise spaces following tooth extractions in the interim period where the tissues are able to heal enough for a definitive restoration. 
Usually, I offer patients a removable partial denture in this interim period but Dr Hemmings pointed out that if it was your mouth, would you prefer a RPD or a fixed bridge? You may worry that decementing a Maryland bridge can be difficult, but Dr Hemmings gave us a few tips to help us plan for this use of the restoration.
  • Maryland bridges or even conventional bridgework can be used in interim periods, especially when providing implant work
  • The material used can be heat-cured acrylic for short term replacements, or longer term composite bonded to metal work could be used
  • There is also the option of using the extracted tooth for the pontic as long as the tooth is intact enough (usually more useful for periodontally involved teeth)
  • If using the patient's own tooth, you can have the metal work made in the lab and then bond it to the tooth using Panavia after you have performed a rudimentary root canal treatment in the coronal portion to prevent discolouration
  • To make decementation easier, you should use a smaller bonding area on the tooth and create a bevel coronally on the metal wing so that you have an application point for the chisel on removal
  • Cement with permanent cement e.g. Panavia and due to the bevel you will have a greater cement lute than normal which you may need to remove with an ultrasonic prior to applying the chisel
  • Remember to sharpen the chisel every time you use it as the autoclave will blunt the surface
  • There is no need to cement the Maryland under Rubber Dam as this is it a provisional restoration
  • Other options for adhesive bridge provisionals include Rochette bridges or using GIC as the cement 
  • Always use a floss tie when attempting decementation as a safety measure
  • Top tip to remove excess cement on the abutments is to use a fluted Tungsten Carbide bur carefully. Do not press hard as this will remove enamel
  • Another way to remove excess cement is with an ultrasonic which can be safer but takes longer
  • If removing cement from the bridge over the sink, remember to put the plug in the sink!
  • To remove residue and get a cleaner impression, use a cotton wool pledget soaked in chlorhexidine 
  • For a more stable bite record use Beauty Wax reinforced with metal foil which prevents distortion n transit to the lab
  • When removing conventional cantilever bridges, try to remove with a Towel Clip and if that doesn't work use a Bridge remover with smaller and then bigger taps to break the cement
  • When designing the occlusion for the bridgework, try to create a static single contact on the abutment and none on the pontic
  • Bond failures with Marylands can either be due to poor treatment planning or poor execution in cementation
  • If the debond occurs and there is no cement on the bridge, that means that the metal wing was not prepared enough i.e. sandblasted prior to cementation
  • If the debond occurs and there in no cement on the tooth, that means that there was a moisture contamination on cementation
  • For a good aesthetic result, ask the lab for an ovate pontic and for 0.5mm gingival relief on the cast itself
This week's #Tubuleslive was a bit different, with videos of the cases shown to us with Dr Hemmings commentating over the top which was really helpful in demonstrating some of the cases he treats. 


The next #Tubuleslive event will be next week the 26th of March: Principles of bone augmentation for implant dentistry with Dr Koray Feran.

Why not attend the live audience where you can get FREE CPD! 

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

Have you ever used a Maryland Bridge as a provisional restoration? What do you think about applying this technique in practice? Please leave your comments in the section below!



Saturday, 14 March 2015

Top 10 Travelling Tips

Going travelling this summer? Or going on elective? Check out my Top 10 Tips for travelling!

Maya Beach in Thailand

1. Plan!


This is pretty obvious but it's something that a lot of people fail to do. You may book flights and maybe look at a few places to stay beforehand but if you're out travelling for more than a couple of weeks you may feel like you have the time to not have planned certain aspects.
There are some things you can get away with not planning so much, but in my opinion some of the essentials that you should plan before you leave include:
  • Flights 
  • How long you plan to stay in each location
  • A couple of ideas of places to stay, perhaps book some of the early on accommodation
  • A few ideas of what activities you want to do in each place
  • If you're planning anything big during your trip, get that sorted; safari, scuba diving, Machu Picchu trek, climbing Kilimanjaro etc.
  • Budget - how much you can spend a day so you don't run out of money mid-trip!

2. Pack light


You may feel like you need to pack for every instance, especially if you're going on a long trip; however, in the end you will pick up lots of items during your trip and if you're moving around a lot too, it will become tedious dragging a massive backpack or suitcase around. 
As mentioned during my post about my trip to South East Asia, I stuck to a small CabinMax backpack which if required can be taken on as hand luggage which I found much more preferable to the 80L backpack I heaved around Tanzania with me!

3. Travel insurance


This is a bit boring but it's important to give you peace of mind just in case something happens. Unfortunately things do sometimes go wrong, whether it be a stolen wallet or an accident with a scooter.
A good site to check out travel insurance is Money Supermarket where you can compare the different providers.
If you're going on elective or volunteering you need to make sure you have appropriate insurance too - check out organisations such as Dental Protection who can provide this for you. 

4. Get personal recommendations


Rather than just Google the places you want to visit, ask around the people you know. A lot of people travel nowadays so just putting out a Facebook status asking for recommendations around that area of the world will get you plenty of responses. 
I've also been lucky to know people who have either lived or are currently living in other areas of the world which is great as you'll get the inside information from the people who know these areas best. 

5. Haggle


When you're elsewhere in the world, don't be afraid to haggle when you're out and about but know where it is appropriate.
Whilst generally it's ok to haggle in market places, you can also get better deals with things such as safari trips, excursions and even hostel rates in the down season. 
Some people love this, but some people really hate the idea of being hassled or haggling with locals. It's up to you but as long as you have an idea in your head of what you are willing to pay and remain friendly with the seller then you'll get on great!

Sunset over the River, Kuala Selangor, Malaysia

6. Lonely planet


The bible of travellers' guides. Take caution with some versions as they may be a couple of years out of date and there were a few instances where the places in the Lonely planet were no longer open and the prices are usually not always right. 
They do come into handy on the move with their maps of the areas and give you a great overview of the areas you're visiting. 


7. Don't always get your currency in the UK


You may feel like you need to get all your currency all at once before you head over where you want to go, but look up the best way of getting your required currency as this isn't always the best way.
When I went to Tanzania I took American Dollars with me as a lot of places accepted this currency and it also got a decent exchange rate over there into Tanzanian Shillings.
We also took Sterling over to South East Asia and changed it up out there to avoid having to order in the currency which some Forex's charge for.

8. Take a good camera


To capture all those great moments! This is also a good reason why you should have insurance. 
We bought our camera out when we were in Hong Kong and it was definitely worth it, we got some really memorable pictures from our trip.

9. Skyscanner


Skyscanner is a great site to help you book your flights. It compares different flight carriers and it's easy to visualise what is the cheapest option with the flexible month bar chart which shows the prices nicely. 
I've booked all my flights via Skyscanner and not had any problems. 


10. Make the use of stop overs


So on Skyscanner or whichever site you're using it says you have a significant stop over time. Whilst long stopovers overnight can be wearisome you can actually turn them into something positive.
Some airlines let you extend your stop over to a few days, even for free! On the way back from Tanzania, we extended our stopover in Dubai for a week! And when we had a 26 hour stop over in Beijing, we were able to get a 72 hour visa and explore the sites of the Chinese capital.

Desert Safari in Dubai

I hope you've found this post useful when you're planning your trips abroad! Do you have any other tips? Or planning a particularly special exploration? Please leave your comments in the section below!


Tuesday, 10 March 2015

Are you referring to me? Endodontic Calamities.

This blog post is based on a talk by Dr Simon Stone at the Young Dentist Conference.


As I have discussed in one of my previous posts (see here), root canal treatment is often strikes fear into the hearts of young dentists like myself. Knowing which cases are suitable for treatment, as well as which ones should be referred onto a specialist is a skill which we all need to know so that patients are able to have realistic expectations in terms of whether their tooth can be saved or not. 

Predictability of root canal treatment is determined by the following:
  1. Pre-treatment assessment
  2. Preparation of pulp space
  3. Irrigation, disinfection and instrumentation
  4. Sealing of pulp space
  5. Coronal restoration
Difficulties which are often encountered before or during root canal include:

Decision making - is this tooth restorable? Don't be forced into treatments by patients

Managing patient's expectations - do not promise anything. How long will the root canal last depends on so many factors including your experience at endodontics and the case itself. 

Clinical Examination

  • The general state of the dentition - caries and periodontal status? Is root canal really the right option?
  • Quality and quantity of the remaining tooth tissue?
  • Do you have a solid foundation for a definitive restoration?
  • What to do if the tooth has an existing crown?
If in doubt about restorability, strip down the restorations and caries to make a decision.


Radiographic Examination

A radiograph is essential in order to come to the correct diagnosis and treatment plan. A periapical is usally sufficient, but sometimes parallax or CBCT can be helpful.

Things to assess on a radiograph:
  • Coronal quality - restorations, remaining tooth
  • Visible pulp chambers and radicular pulp - shape and size
  • Has this tooth been previously root treated?
  • Apical status e.g. apical periodontitis, abscess, cyst, granuloma?
Remember to report on your films fully!

Diagnosis and Treatment Planning

Beware if a patient presents with an odd history e.g. changing nature of pain, abnormal radiation, exacerbating factors, crosses the midline of the face etc. 
In these cases you should consider other possible diagnoses e.g. TMD, phantom tooth pain, trigeminal neuralgia, cracked tooth syndrome. 

If in doubt, other clinical tests you could employ include:
  • Hot/cold/TTP/EPT testing
  • Comparative testing to other teeth
State clearly your diagnosis e.g. symptomatic apical periodontitis 16 due to caries, then your treatment plan e.g.
  1. Assess restorability 16
  2. RCT 16
  3. Composite core 16
  4. Emax onlay 16

Instrumentation

The key message in instrumentation is know your system! There are lots of systems out there including Wave One, Reciproc, Sendoline, Protaper. 
Make sure you have a glide path and irrigate regularly with copious sodium hypochlorite which means you need to work under rubber dam!

If you are using a rotary system, follow the instructions for each system, but make sure you never force the instrument and a 'three peck rule' may be useful to minimise the risk of file separation. 

And remember to maintain patency throughout to prevent accumulation of dentine sludge. 

To read about obturation, see my previous endodontic post here

When should I refer?

Sometimes, things do go wrong. If you have trouble providing effective treatment, or even if you'd like a second opinion then referral is a sensible option. 
Questions you should ask yourself if you are considering referring a case include:
  • Does the tooth have a strong prognosis for (re)RCT?
  • Is it going to be a predictable treatment?
  • If not why not?
  • Can I (or anyone else) do a better job?
  • Do the alternatives have a strong prognosis?
There are 4 options for these teeth:
  1. Do nothing, observe/monitor
  2. Extract
  3. Orthograde treatment or retreatment
  4. Surgery 

So what sort of things are commonly referred?

  • Patients with a medical risk for XLA e.g. bisphosphonates, post radiotherapy
  • Anterior/premolar teeth are prioritised (often 7s are not accepted)
  • Important teeth with strong long term prognosis (>2mm ferrule, prognosis of endodontics better than prosthetic replacement)
  • Trauma and its sequelae including root resorption 
  • Atypical pain
  • Suspicious pathology
  • Surgical endodontics
Remember to always send a good quality radiograph when referring a case - either an original film, a copy printed on photography paper, or a CD ROM copy. 


Having seen a few cases in practice that I have struggled to treat, this talk has helped to clarify what cases are usually accepted for referrals. It was great to be lectured by one of my old tutors from Newcastle too - made me miss the old days of student life a bit!

See my latest post from the Young Dentist Conference - Are you referring to me? Mishaps of oral surgery. 

Do you find it difficult to decide when to refer endodontic cases to secondary care? Please leave your comments in the section below!


Saturday, 7 March 2015

How to Survive as a Young Dentist

This post is based on a talk by Reena Wadia at the Young Dentist Conference.  



What environment are young dentists graduating into?

After 5 years of hard studying and training, newly qualified dentists are spat back out into the real world where there are uncertain job prospects, there is increased litigation and less NHS funding available due to the austerity cuts.

On top of this, we are now graduating with much less experience than our more senior counterparts did - I could count the number of root canals I did in dental school on one hand! With so much competition how are we supposed to get good jobs? 

Reena shared her top tips with us to thrive as young dentists.


Reena's Top Tips 

1. Be confident

Believe in yourself and the treatments you provide. If you believe in yourself, your patients will too!

2. Maintain your record keeping skills and get good at communicating

Make sure your notes are contemporaneous i.e. whilst the patient is still in the chair. Make use of your nurse and those down-times in appointments where you usually chat to your patient e.g. when waiting for LA to take effect, when the patient is rinsing out. 

3. Invest in Loupes with illumination

Start around 2.5 X magnification as wearing Loupes is a learning curve, the more the magnification, the steeper the learning curve.
As well as illumination and magnification, you need to look at the resolution (the definition), chromatic aberration (any colour change) and spherical aberration (any shape change).  

A useful tip Reena gave us was to use the Loupes to look at a ruler to check the definition, colour, shape etc. Also check what type of battery comes with your Loupes light and how often they need to be charged.

4. Save up for a camera

Clinical photos are not only good for patient records, but you can reflect on the quality of your work as well as building up a portfolio of work which you can attach to your CV! See one of my previous posts about clinical photography in dentistry.

Always remember to take appropriate consent.

5. Get the job you want

The job market is really competitive at the moment, especially in big cities like London. There are plenty of ways to put yourself out there.

Contact practices that interest you directly and meet them face to face as this personal approach is much more appealing that a generic cover letter or CV and you also get the opportunity to speak to associates that work there.
Update your CV regularly, around once a month is ideal. If you are applying to hospital and associate jobs, it may be useful to have 2 separate CVs.

6. Network and find a mentor

Go to educational events and conferences, talk to as many dentists as possible. This is a great way to get to socialise with other dentists, but you can also learn lots from others and increases the chances of you hearing of any jobs going before they go onto job sites.

Having a mentor will also help you both professionally and personally.

7. Get published

This doesn't have to be in journals, there are lots of dental forum and education sites you can publish articles on, or why not start a blog (you'll get addicted to it like me!).

If you're looking into getting published into a journal, pair up with a mentor or a dentist who has been published before so you get the hang on how to structure your article.

8. Enjoy yourself!

The thing that gets you up in the morning should be something you enjoy doing! Yes we have our ups and downs, but if your career in dentistry is going to last a good 30 or 40 years, you've got to enjoy what you're doing!

Patients will notice it too! Dentistry may seem a bit doomy and gloomy at the moment with litigation, the GDC and NHS cuts, but there is so many opportunities out there for young dentists with some exciting developments coming up in the next few years!


And Reena's final non-dental tip I found particularly useful: Book your holidays! Make sure you have something to work towards, whether it be skiing in the Alps or surfing in Bali!

See my next post from the Young Dentist Conference: Endodontic Calamities.


Do you have any tips for young dentists? Please leave them in the comments section below!


Wednesday, 4 March 2015

What are Fizzy Drinks doing to your Teeth?

If you follow my Facebook page you may be familiar with this picture.


We all lecture our patients about the dangers of high sugar and acidic diets, not only for our teeth but for our general health!

But sometimes I feel like patients tune us out - they are fed up with the lecturing and being told off. They need something more concrete to discourage bad health habits; that's why some of these health documentaries on TV really do work!

On one of my non-clinical days at work, I set up a little experiment: What is the effect of popular drinks on our teeth?

I set up 3 cups with equal amounts of Coca Cola, Milkshake and Orange Juice. The experiment was mostly looking at the effects of the acid in these drinks, as it is hard to simulate the effects of the sugars in these drinks without the presence of the oral micro-flora (i.e. the bacteria that cause decay).

The sugar content in each of these drinks is pretty shocking - per 100ml of each drink there is:

10.6g in Coca Cola

9.8g in the Milkshake

8g in Orange Juice


Watch this video to see a visual representation of how much sugar that actually is!



I left each tooth is the drink over a weekend - there wasn't too much change in the appearance in the milkshake tooth or the juice tooth, but check out the one that was left in the Coca Cola. 

Before picture of the tooth

The effect of a weekend submerged in Coca Cola
This damage by the Coca Cola is due it's very low pH of 2.5. So not only does Coca Cola expose your teeth to high sugar levels and cause tooth decay, but the low pH of the phosphoric acid wears away your teeth!

There's a big push with the government to reduce the rates of tooth decay in children. As I've said in a previous post, the biggest admission to hospitals for children is to have teeth taken out under general anaesthetic which is shocking!

Top Tips to Protect your Teeth

  • Reduce intake of fizzy drinks and other high sugar foods or drinks. You shouldn't be having more than 3 intakes of high sugar foods and drink a day
  • If you find it hard to cut down, have the high sugary foods or drinks with a meal because you've already stimulated your saliva to be produced which can buffer the high acids and protect your teeth
  • Drink high sugar drinks through a straw to minimise contact with your teeth
  • Avoid brushing your teeth for half an hour after an acidic drink to avoid brushing the acid into your teeth
  • Avoid taking any drink apart from water to bed with you and avoid late night consumption of acidic or sugary drinks
  • Drink milk or water between meals
  • Chew sugar free chewing gum after sugary intakes to stimulate saliva production

Are you a coke addict? Or conducted an experiment like this before? Please leave your comments in the section below!





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